HOSPITAL STANDARD CHARGES: ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
 HOSPITAL:  ASPIRUS EAGLE RIVER HOSPITAL ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
 Locations: All Aspirus Eagle River  Hospital locations ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
" UPDATED:  January 1, 2024 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"The list of Aspirus’ standard charges include a comprehensive list of GROSS CHARGES for each inpatient and outpatient service or item provided by a hospital – each test, exam, surgical procedure, room charge, etc. Given the many services provided by hospitals 24 hours a day, seven days a week, the listing contains thousands of services and related charges. ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
 Description of Item or Service ,CPT/HCPCS/ DRG Code,Revenue Code,NDC Code,ERx Charge Quantity, Gross Charge , Discounted Cash Price ," Anthem Blue Cross Blue Shield Blue Preferred - HMO/POS;
Blue Access - PPO
Indemnity/Traditional/Standard ", Anthem Blue Cross Blue Shield Medicare Advantage HMO/PPO , Anthem Blue Cross Blue Shield Medicaid ," jogo do cruzeiro ao vivo
 Plan, Inc. Commercial HMO/POS "," Bone & Joint Clinic, SC Bone & Joint Health Plan ", Cigna PPO and Open Access Plus Benefit Plans , First Health Group Corp National rental PPO Network-Facility , First Health Group Corp National rental PPO Network-Provider , Forest County Potowatomi Forest County Potowatomi Plans , Group Health Cooperative of Eau Claire Commercial HMO , Group Health Cooperative of Eau Claire Medicaid HMO-BadgerCare Plus/SSI , Health Partners Commercial PPO , HealthSmart (f/k/a Interplan Health Group (IHG)) National rental PPO Network , Humana Commercial HMO/PPO/POS/EPO and Traditional Indemnity Plans ," MultiPlan, Inc. Health EOS PPO Networks "," MultiPlan, Inc. PHCS PPO Networks "," MultiPlan, Inc. MultiPlan and Other Brand Affiliated PPO Networks "," MultiPlan, Inc. Aetna Health Plan PPO Networks "," Security Health Plan of Wisconsin, Inc. Commercial/SAS Plans "," Security Health Plan of Wisconsin, Inc. Tiered Plan ", The Alliance (f/k/a Employer Health Care Alliance Cooperative) Multiple Commercial Plans ," United Healthcare of Wisconsin, Inc. Commercial HMO/PPO/POS/EPO (ACA On/Off Exchange Plans) "," United Healthcare of Wisconsin, Inc./Optum Commercial - United Behavioral Health ", WPS Health Plan Commercial HMO/POS , WPS Insurance FOCUS (exclusively offers jogo do cruzeiro ao vivo
) , WPS Insurance Traditional (Indemnity) , WPS Insurance PPO/POS/EPO (ACA on/off exchange Plans) , De-identified Minimum Third-Party Payer Charges , De-identified Maximum Third-Party Payer Charges 
Angio Extremity Unilat,CPT® 75710,N/A,N/A,N/A," $2,036.00 "," $1,323.40 ", $845.18 , $145.51 , $243.51 , $767.82 , $943.10 ," $1,893.48 "," $1,832.40 "," $1,832.40 "," $1,628.80 "," $1,628.80 ", $243.51 ," $1,879.84 "," $1,934.20 "," $1,832.40 "," $1,832.40 "," $1,832.40 "," $1,893.48 "," $1,954.56 ", $864.54 ," $1,730.60 "," $1,032.36 ", $861.00 , N/A , $782.81 , $782.81 ," $1,934.20 ", $906.12 , $145.51 ," $1,954.56 "
Valvuloplas Tricus W Ring Insert,CPT® 33464,N/A,N/A,N/A," $19,214.00 "," $12,489.10 "," $14,233.05 "," $2,197.21 "," $2,378.00 "," $10,434.64 "," $10,372.15 "," $17,869.02 "," $17,292.60 "," $17,292.60 "," $15,371.20 "," $15,371.20 "," $2,378.00 "," $17,740.29 "," $18,253.30 "," $17,292.60 "," $17,292.60 "," $17,292.60 "," $17,869.02 "," $18,445.44 "," $13,186.43 "," $16,331.90 "," $13,141.42 "," $11,714.67 ", N/A ," $10,638.24 "," $10,638.24 "," $18,253.30 "," $12,085.04 "," $2,197.21 "," $18,445.44 "
Replacement Gastro-Jejunostomy Tube Percutaneous,CPT® 49452,N/A,N/A,N/A," $6,137.00 "," $3,989.05 ", $840.06 , $129.92 , $765.20 , $686.38 , $683.32 ," $5,707.41 "," $5,523.30 "," $5,523.30 "," $4,909.60 "," $4,909.60 ", $765.20 ," $5,666.29 "," $5,830.15 "," $5,523.30 "," $5,523.30 "," $5,523.30 "," $5,707.41 "," $5,891.52 ", $607.46 ," $5,216.45 ", $736.82 , $811.52 , N/A , $699.76 , $699.76 ," $5,830.15 ", $731.90 , $129.92 ," $5,891.52 "
 Fac Prq Trluml Coronary Angio/Atherec Addl Art/Brnch ,CPT® 92925,0481 - CARDIAC CATH LAB,N/A,N/A," $5,905.00 "," $3,838.25 "," $4,960.20 ", N/A , $177.48 ," $4,771.24 "," $5,314.50 "," $4,999.17 "," $5,314.50 "," $5,314.50 "," $5,314.50 "," $5,019.25 ", $174.00 ," $5,452.09 "," $5,609.75 "," $5,019.25 "," $5,491.65 "," $5,491.65 "," $5,609.75 "," $5,668.80 "," $4,831.47 "," $5,314.50 "," $5,019.25 "," $4,664.95 ", N/A ," $4,778.92 "," $4,778.92 "," $5,609.75 "," $5,067.08 ", $174.00 ," $5,668.80 "
Removal of Skin Tags,11200,N/A,N/A,N/A, $337.00 , $219.05 , $244.80 , $74.08 , $40.50 , $199.18 , $197.46 , $313.41 , $303.30 , $303.30 , $269.60 , $269.60 , $40.50 , $311.15 , $320.15 , $303.30 , $303.30 , $303.30 , $313.41 , $323.52 , $265.13 , $286.45 , $390.71 , $259.40 , N/A , $203.07 , $203.07 , $320.15 , $235.48 , $40.50 , $390.71 
"Sigmoidoscopy,Diagnostic",45330,N/A,N/A,N/A," $1,000.00 ", $650.00 , $342.49 , $53.33 , $68.55 , $303.35 , $313.33 , $930.00 , $900.00 , $900.00 , $800.00 , $800.00 , $68.55 , $923.30 , $950.00 , $900.00 , $900.00 , $900.00 , $930.00 , $960.00 , $243.98 , $850.00 , $342.54 , $325.47 , N/A , $309.28 , $309.28 , $950.00 , $323.46 , $53.33 , $960.00 
 HEPARIN (PORCINE) 100 UNIT/ML IV SOLN (INPT) ,HCPCS J1644,0636 - DRUGS REQUIRING DETAILED CODIN,00409-7650-62,250 mL, $79.63 , $51.76 , $66.89 , $0.27 , $0.27 , $64.34 , $71.67 , $67.41 , $71.67 , $71.67 , $71.67 , $67.69 , $0.26 , $73.52 , $75.65 , $67.69 , $74.06 , $74.06 , $75.65 , $76.44 , $65.15 , $71.67 , $67.69 , $62.91 , N/A , $64.44 , $64.44 , $75.65 , $68.33 , $0.26 , $76.44 
 IOHEXOL 300 MG/ML IJ SOLN ,HCPCS Q9967,0255 - DRUGS/RADIOLOGY,00407-1413-61,50 mL, $285.61 , $185.65 , $239.91 , $0.13 , $0.17 , $230.77 , $257.05 , $241.80 , $257.05 , $257.05 , $257.05 , $242.77 , $0.17 , $263.70 , $271.33 , $242.77 , $265.62 , $265.62 , $271.33 , $274.19 , $233.69 , $257.05 , $242.77 , $225.63 , N/A , $231.14 , $231.14 , $271.33 , $245.08 , $0.13 , $274.19 
 Pro Removal of Shoulder Lesion ,CPT® 23075,0982 - PRO FEE/OUTPT,N/A,N/A," $3,149.00 "," $2,046.85 "," $2,002.85 ", $312.68 , $122.79 ," $1,565.39 "," $1,579.30 "," $2,928.57 "," $2,834.10 "," $2,834.10 "," $2,519.20 "," $2,519.20 ", $122.79 ," $2,907.47 "," $2,991.55 "," $2,834.10 "," $2,834.10 "," $2,834.10 "," $2,928.57 "," $3,023.04 "," $1,849.84 "," $2,676.65 "," $1,744.81 "," $1,856.79 ", N/A ," $1,595.93 "," $1,595.93 "," $2,991.55 "," $1,875.78 ", $122.79 ," $3,023.04 "
" Fac Culture Anaerobe Ident, Each ",CPT® 87076,0306 - LAB/BACT-MICRO,N/A,N/A, $115.00 , $74.75 , $96.60 , $8.24 , $8.24 , $92.92 , $103.50 , $97.36 , $103.50 , $103.50 , $103.50 , $97.75 , $8.08 , $106.18 , $109.25 , $97.75 , $106.95 , $106.95 , $109.25 , $110.40 , $94.09 , $103.50 , $97.75 , $90.85 , N/A , $93.07 , $93.07 , $109.25 , $98.68 , $8.08 , $110.40 
 DESFLURANE INH SOLN ,HCPCS RXA250,0250 - PHARMACY,10019-0641-34,15 each," $1,583.34 "," $1,029.17 "," $1,330.01 ", N/A , N/A ," $1,279.34 "," $1,425.01 "," $1,340.46 "," $1,425.01 "," $1,425.01 "," $1,425.01 "," $1,345.84 ", N/A ," $1,461.90 "," $1,504.17 "," $1,345.84 "," $1,472.51 "," $1,472.51 "," $1,504.17 "," $1,520.01 "," $1,295.49 "," $1,425.01 "," $1,345.84 "," $1,250.84 ", N/A ," $1,281.40 "," $1,281.40 "," $1,504.17 "," $1,358.66 "," $1,250.84 "," $1,520.01 "
 MEPERIDINE HCL 25 MG/ML IJ SOLN ,HCPCS J2175,0636 - DRUGS REQUIRING DETAILED CODIN,00641-6052-25,1 mL, $28.52 , $18.54 , $23.96 , $7.46 , $9.78 , $23.04 , $25.67 , $24.15 , $25.67 , $25.67 , $25.67 , $24.24 , $9.59 , $26.33 , $27.09 , $24.24 , $26.52 , $26.52 , $27.09 , $27.38 , $23.34 , $25.67 , $24.24 , $22.53 , N/A , $23.08 , $23.08 , $27.09 , $24.47 , $7.46 , $27.38 
"Removal Arm/Elbow F.B.,Superficial",24200,N/A,N/A,N/A," $1,355.00 ", $880.75 , $867.10 , $133.90 , $65.65 , $676.19 , $678.21 ," $1,260.15 "," $1,219.50 "," $1,219.50 "," $1,084.00 "," $1,084.00 ", $65.65 ," $1,251.07 "," $1,287.25 "," $1,219.50 "," $1,219.50 "," $1,219.50 "," $1,260.15 "," $1,300.80 ", $803.92 ," $1,151.75 ", $743.95 , $802.46 , N/A , $689.38 , $689.38 ," $1,287.25 ", $810.26 , $65.65 ," $1,300.80 "
" Pro Anoscopy, Remove for Body ",CPT® 46608,0981 - PRO FEE/ER,N/A,N/A, $622.00 , $404.30 , $498.75 , $77.52 , $60.48 , $396.14 , $392.69 , $578.46 , $559.80 , $559.80 , $497.60 , $497.60 , $60.48 , $574.29 , $590.90 , $559.80 , $559.80 , $559.80 , $578.46 , $597.12 , $356.23 , $528.70 , $433.53 , $465.58 , N/A , $403.86 , $403.86 , $590.90 , $422.41 , $60.48 , $597.12 
Wedging of Cast,CPT® 29740,N/A,N/A,N/A, $602.00 , $391.30 , $413.47 , $64.41 , $15.36 , $339.04 , $316.55 , $559.86 , $541.80 , $541.80 , $481.60 , $481.60 , $15.36 , $555.83 , $571.90 , $541.80 , $541.80 , $541.80 , $559.86 , $577.92 , $385.84 , $511.70 , $347.89 , $398.97 , N/A , $345.65 , $345.65 , $571.90 , $406.28 , $15.36 , $577.92 
 Fac or Room Chg Lvl4 Base ,Custom OPTORBASELVL4,0360 - OR SERVICES,N/A,N/A," $12,924.00 "," $8,400.60 "," $10,856.16 ", N/A , N/A ," $10,442.59 "," $11,631.60 "," $10,941.46 "," $11,631.60 "," $11,631.60 "," $11,631.60 "," $10,985.40 ", N/A ," $11,932.73 "," $12,277.80 "," $10,985.40 "," $12,019.32 "," $12,019.32 "," $12,277.80 "," $12,407.04 "," $10,574.42 "," $11,631.60 "," $10,985.40 "," $10,209.96 ", N/A ," $10,459.39 "," $10,459.39 "," $12,277.80 "," $11,090.08 "," $10,209.96 "," $12,407.04 "
 CEFAZOLIN SODIUM-DEXTROSE 2-4 GM/100ML-% IV SOLN ,HCPCS J0689,0636 - DRUGS REQUIRING DETAILED CODIN,00338-3508-41,100 mL, $57.02 , $37.06 , $47.90 , $1.24 , $1.21 , $46.07 , $51.32 , $48.27 , $51.32 , $51.32 , $51.32 , $48.47 , $1.19 , $52.65 , $54.17 , $48.47 , $53.03 , $53.03 , $54.17 , $54.74 , $46.65 , $51.32 , $48.47 , $45.05 , N/A , $46.15 , $46.15 , $54.17 , $48.93 , $1.19 , $54.74 
" Pro Preventive Visit, New, Age 40-64 ",CPT® 99386,0982 - PRO FEE/OUTPT,N/A,N/A, $478.00 , $310.70 , N/A , $145.76 , $62.71 , $254.52 , $256.24 , $444.54 , $430.20 , $430.20 , $382.40 , $382.40 , $62.71 , $441.34 , $454.10 , $430.20 , $430.20 , $430.20 , $444.54 , $458.88 , $314.18 , $406.30 , $256.54 , $253.45 , $183.25 , $259.48 , $259.48 , $454.10 , $311.66 , $62.71 , $458.88 
 Pro Colonoscopy Stoma W/Biopsy Single/Multiple ,CPT® 44389,0982 - PRO FEE/OUTPT,N/A,N/A," $3,109.00 "," $2,020.85 "," $1,048.58 ", $162.03 , $362.74 , $877.22 , $900.47 ," $2,891.37 "," $2,798.10 "," $2,798.10 "," $2,487.20 "," $2,487.20 ", $362.74 ," $2,870.54 "," $2,953.55 "," $2,798.10 "," $2,798.10 "," $2,798.10 "," $2,891.37 "," $2,984.64 ", $754.30 ," $2,642.65 ", $988.37 , $999.00 , N/A , $894.34 , $894.34 ," $2,953.55 ", $935.39 , $162.03 ," $2,984.64 "
Transurethral Incision of Prostate,CPT® 52450,N/A,N/A,N/A," $3,276.00 "," $2,129.40 "," $2,572.55 ", $454.14 , $613.65 ," $2,295.67 "," $2,149.97 "," $3,046.68 "," $2,948.40 "," $2,948.40 "," $2,620.80 "," $2,620.80 ", $613.65 ," $3,024.73 "," $3,112.20 "," $2,948.40 "," $2,948.40 "," $2,948.40 "," $3,046.68 "," $3,144.96 "," $2,572.85 "," $2,784.60 "," $2,431.68 "," $2,893.50 ", N/A ," $2,340.46 "," $2,340.46 "," $3,112.20 "," $2,750.88 ", $454.14 ," $3,144.96 "
"Remv Prostate,Retropub,Radical",CPT® 55840,N/A,N/A,N/A," $6,715.00 "," $4,364.75 "," $5,163.28 "," $1,110.12 "," $1,536.80 "," $3,765.42 "," $4,320.65 "," $6,244.95 "," $6,043.50 "," $6,043.50 "," $5,372.00 "," $5,372.00 "," $1,536.80 "," $6,199.96 "," $6,379.25 "," $6,043.50 "," $6,043.50 "," $6,043.50 "," $6,244.95 "," $6,446.40 "," $4,854.69 "," $5,707.75 "," $6,886.49 "," $5,674.65 ", N/A ," $3,838.89 "," $3,838.89 "," $6,379.25 "," $4,601.13 "," $1,110.12 "," $6,886.49 "
Anal Sphincterotomy,46080,N/A,N/A,N/A," $2,676.00 "," $1,739.40 ", $954.01 , $149.01 , $76.84 , $752.34 , $765.98 ," $2,488.68 "," $2,408.40 "," $2,408.40 "," $2,140.80 "," $2,140.80 ", $76.84 ," $2,470.75 "," $2,542.20 "," $2,408.40 "," $2,408.40 "," $2,408.40 "," $2,488.68 "," $2,568.96 ", $684.09 ," $2,274.60 ", $847.43 , $892.58 , N/A , $767.02 , $767.02 ," $2,542.20 ", $802.20 , $76.84 ," $2,568.96 "
 Fac Fibrinolytic Plasminogen ,CPT® 85420,0305 - LAB/HEMATOLOGY,N/A,N/A, $119.00 , $77.35 , $99.96 , $6.66 , $6.66 , $96.15 , $107.10 , $100.75 , $107.10 , $107.10 , $107.10 , $101.15 , $6.53 , $109.87 , $113.05 , $101.15 , $110.67 , $110.67 , $113.05 , $114.24 , $97.37 , $107.10 , $101.15 , $94.01 , N/A , $96.31 , $96.31 , $113.05 , $102.11 , $6.53 , $114.24 
" Pro Hemorrhoidectomy,External ",CPT® 46250,0982 - PRO FEE/OUTPT,N/A,N/A," $2,999.00 "," $1,949.35 "," $1,965.02 ", $304.55 , $307.34 ," $1,492.61 "," $1,526.34 "," $2,789.07 "," $2,699.10 "," $2,699.10 "," $2,399.20 "," $2,399.20 ", $307.34 ," $2,768.98 "," $2,849.05 "," $2,699.10 "," $2,699.10 "," $2,699.10 "," $2,789.07 "," $2,879.04 "," $1,405.70 "," $2,549.15 "," $1,682.37 "," $1,780.26 ", N/A ," $1,521.74 "," $1,521.74 "," $2,849.05 "," $1,591.57 ", $304.55 ," $2,879.04 "
1st Hospital IP/Obs Care Sf/Low Mdm 40 Minutes,99221,N/A,N/A,N/A, $324.00 , $210.60 , $197.44 , $79.64 , $82.46 , $174.68 , $174.13 , $301.32 , $291.60 , $291.60 , $259.20 , $259.20 , $82.46 , $299.15 , $307.80 , $291.60 , $291.60 , $291.60 , $301.32 , $311.04 , $251.10 , $275.40 , $219.03 , $219.35 , $40.00 , $178.09 , $178.09 , $307.80 , $205.40 , $40.00 , $311.04 
 Pro Myocardial Spect Single Study at Rest or Stress ,CPT® 78451,0974 - PRO FEE/NUC MED,N/A,N/A," $1,093.00 ", $710.45 ," $1,823.87 ", $310.94 , $190.06 ," $1,680.22 "," $1,863.35 "," $1,016.49 ", $983.70 , $983.70 , $874.40 , $874.40 , $190.06 ," $1,009.17 "," $1,038.35 ", $983.70 , $983.70 , $983.70 ," $1,016.49 "," $1,049.28 "," $1,888.50 ", $929.05 ," $2,039.68 "," $2,293.53 ", N/A ," $1,713.00 "," $1,713.00 "," $1,038.35 "," $1,982.84 ", $190.06 ," $2,293.53 "
Replace Eye Fluid,CPT® 67025,N/A,N/A,N/A," $6,665.00 "," $4,332.25 "," $3,878.55 ", $609.73 , $768.38 ," $3,581.58 "," $3,376.62 "," $6,198.45 "," $5,998.50 "," $5,998.50 "," $5,332.00 "," $5,332.00 ", $768.38 ," $6,153.79 "," $6,331.75 "," $5,998.50 "," $5,998.50 "," $5,998.50 "," $6,198.45 "," $6,398.40 "," $5,333.96 "," $5,665.25 "," $3,493.20 "," $4,551.62 ", N/A ," $3,651.47 "," $3,651.47 "," $6,331.75 "," $4,030.75 ", $609.73 ," $6,398.40 "
Assay Metanephrines,CPT® 83835,N/A,N/A,N/A, $238.00 , $154.70 , N/A , $17.28 , $17.28 , $95.83 , $114.66 , $221.34 , $214.20 , $214.20 , $190.40 , $190.40 , $17.28 , $219.75 , $226.10 , $214.20 , $214.20 , $214.20 , $221.34 , $228.48 , $113.11 , $202.30 , $110.29 , $61.44 , N/A , $89.43 , $89.43 , $226.10 , $97.73 , $17.28 , $228.48 
 Fac Trauma 3 Activation W/Pre-ED Notiification Lvl 1 -W/O Critical Care ,Custom 6830000003,0683 - TRAUMA LEVEL III,N/A,N/A," $5,894.00 "," $3,831.10 "," $4,950.96 ", N/A , N/A ," $4,762.35 "," $5,304.60 "," $4,989.86 "," $5,304.60 "," $5,304.60 "," $5,304.60 "," $5,009.90 ", N/A ," $5,441.93 "," $5,599.30 "," $5,009.90 "," $5,481.42 "," $5,481.42 "," $5,599.30 "," $5,658.24 "," $4,822.47 "," $5,304.60 "," $5,009.90 "," $4,656.26 ", N/A ," $4,770.01 "," $4,770.01 "," $5,599.30 "," $5,057.64 "," $4,656.26 "," $5,658.24 "
" Mra W/O Contrast, Chest ",HCPCS C8910,0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA-OTHER,N/A,N/A," $3,009.00 "," $1,955.85 "," $2,527.56 ", N/A , N/A ," $2,431.27 "," $2,708.10 "," $2,547.42 "," $2,708.10 "," $2,708.10 "," $2,708.10 "," $2,557.65 ", N/A ," $2,778.21 "," $2,858.55 "," $2,557.65 "," $2,798.37 "," $2,798.37 "," $2,858.55 "," $2,888.64 "," $2,461.96 "," $2,708.10 "," $2,557.65 "," $2,377.11 ", N/A ," $2,435.18 "," $2,435.18 "," $2,858.55 "," $2,582.02 "," $2,377.11 "," $2,888.64 "
 TIMOLOL MALEATE 0.5 % OP SOLN ,HCPCS RXC637,0250 - PHARMACY,61314-0227-05,5 mL, $87.33 , $56.76 , $73.36 , N/A , N/A , $70.56 , $78.60 , $73.93 , $78.60 , $78.60 , $78.60 , $74.23 , N/A , $80.63 , $82.96 , $74.23 , $81.22 , $81.22 , $82.96 , $83.84 , $71.45 , $78.60 , $74.23 , $68.99 , N/A , $70.68 , $70.68 , $82.96 , $74.94 , $68.99 , $83.84 
1st Hospital IP/Obs Care Moderate Mdm 55 Minutes,CPT® 99222,N/A,N/A,N/A, $441.00 , $286.65 , $268.34 , $126.08 , $90.83 , $236.74 , $237.02 , $410.13 , $396.90 , $396.90 , $352.80 , $352.80 , $90.83 , $407.18 , $418.95 , $396.90 , $396.90 , $396.90 , $410.13 , $423.36 , $341.36 , $374.85 , $297.04 , $298.13 , $126.75 , $241.36 , $241.36 , $418.95 , $278.36 , $90.83 , $423.36 
Computerized Corneal Topography Uni/Bi,92025,N/A,N/A,N/A, $118.00 , $76.70 , $78.32 , $35.63 , $24.40 , $66.64 , $67.92 , $109.74 , $106.20 , $106.20 , $94.40 , $94.40 , $24.40 , $108.95 , $112.10 , $106.20 , $106.20 , $106.20 , $109.74 , $113.28 , $111.99 , $100.30 , $114.55 , $80.10 , N/A , $67.93 , $67.93 , $112.10 , $80.82 , $24.40 , $114.55 
Needle Emg Ea Extremty W/Paraspinl Area Complete,CPT® 95886,N/A,N/A,N/A, $524.00 , $340.60 , $372.32 , $96.17 , $68.64 , $291.21 , $289.36 , $487.32 , $471.60 , $471.60 , $419.20 , $419.20 , $68.64 , $483.81 , $497.80 , $471.60 , $471.60 , $471.60 , $487.32 , $503.04 , $442.83 , $445.40 , $252.42 , $348.25 , N/A , $296.90 , $296.90 , $497.80 , $364.99 , $68.64 , $503.04 
 Pro Cltx Rdl H/N Fx W/O Mnpj ,CPT® 24650,0981 - PRO FEE/ER,N/A,N/A, $957.00 , $622.05 ," $1,529.32 ", $243.22 , $194.38 ," $1,155.93 "," $1,180.19 ", $890.01 , $861.30 , $861.30 , $765.60 , $765.60 , $194.38 , $883.60 , $909.15 , $861.30 , $861.30 , $861.30 , $890.01 , $918.72 ," $1,410.37 ", $813.45 ," $1,291.66 "," $1,377.14 ", N/A ," $1,178.49 "," $1,178.49 ", $909.15 ," $1,385.17 ", $194.38 ," $1,529.32 "
 Myocardial Perf Spect Mult ,CPT® 78452,0341 - NUC MED/DX PROCEDURES,N/A,N/A," $4,271.00 "," $2,776.15 "," $3,587.64 ", $430.43 , $323.37 ," $3,450.97 "," $3,843.90 "," $3,615.83 "," $3,843.90 "," $3,843.90 "," $3,843.90 "," $3,630.35 ", $317.03 ," $3,943.41 "," $4,057.45 "," $3,630.35 "," $3,972.03 "," $3,972.03 "," $4,057.45 "," $4,100.16 "," $3,494.53 "," $3,843.90 "," $3,630.35 "," $3,374.09 ", N/A ," $3,456.52 "," $3,456.52 "," $4,057.45 "," $3,664.95 ", $317.03 ," $4,100.16 "
"Closed Rx Med Malleolus Fx,Manip",CPT® 27762,N/A,N/A,N/A," $1,416.00 ", $920.40 ," $2,693.02 ", $424.52 , $423.69 ," $2,081.98 "," $2,113.34 "," $1,316.88 "," $1,274.40 "," $1,274.40 "," $1,132.80 "," $1,132.80 ", $423.69 ," $1,307.39 "," $1,345.20 "," $1,274.40 "," $1,274.40 "," $1,274.40 "," $1,316.88 "," $1,359.36 "," $2,468.04 "," $1,203.60 "," $2,322.85 "," $2,446.54 ", N/A ," $2,122.61 "," $2,122.61 "," $1,345.20 "," $2,494.81 ", $423.69 ," $2,693.02 "
"Removal Foreign Body,Musc",20525,N/A,N/A,N/A," $1,639.00 "," $1,065.35 "," $1,500.01 ", $234.49 , $305.27 ," $1,200.67 "," $1,201.07 "," $1,524.27 "," $1,475.10 "," $1,475.10 "," $1,311.20 "," $1,311.20 ", $305.27 ," $1,513.29 "," $1,557.05 "," $1,475.10 "," $1,475.10 "," $1,475.10 "," $1,524.27 "," $1,573.44 "," $1,395.55 "," $1,393.15 "," $1,323.78 "," $1,413.07 ", N/A ," $1,224.10 "," $1,224.10 "," $1,557.05 "," $1,438.75 ", $234.49 ," $1,573.44 "
Collect Blood From Implant Venous Access Device,CPT® 36591,N/A,N/A,N/A, $161.00 , $104.65 , $255.30 , $26.05 , $15.87 , $99.35 , $101.83 , $149.73 , $144.90 , $144.90 , $128.80 , $128.80 , $15.87 , $148.65 , $152.95 , $144.90 , $144.90 , $144.90 , $149.73 , $154.56 , $149.99 , $136.85 , $124.88 , $118.90 , N/A , $101.29 , $101.29 , $152.95 , $115.07 , $15.87 , $255.30 
 AMIODARONE HCL 150 MG/3ML IV SOLN ,HCPCS J0282,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0616-03,6 mL, $21.58 , $14.03 , $18.13 , N/A , $0.23 , $17.44 , $19.42 , $18.27 , $19.42 , $19.42 , $19.42 , $18.34 , $0.23 , $19.92 , $20.50 , $18.34 , $20.07 , $20.07 , $20.50 , $20.72 , $17.66 , $19.42 , $18.34 , $17.05 , N/A , $17.46 , $17.46 , $20.50 , $18.52 , $0.23 , $20.72 
 POLYETHYLENE GLYCOL 3350 17 G PO PACK ,HCPCS RXC637,0250 - PHARMACY,00904-6931-81,1 packet, $9.61 , $6.25 , $8.07 , N/A , N/A , $7.76 , $8.65 , $8.14 , $8.65 , $8.65 , $8.65 , $8.17 , N/A , $8.87 , $9.13 , $8.17 , $8.94 , $8.94 , $9.13 , $9.23 , $7.86 , $8.65 , $8.17 , $7.59 , N/A , $7.78 , $7.78 , $9.13 , $8.25 , $7.59 , $9.23 
 Fac Assay of Urine Creatinine ,CPT® 82570,0301 - LAB/CHEMISTRY,N/A,N/A, $63.00 , $40.95 , $52.92 , $5.28 , $5.28 , $50.90 , $56.70 , $53.34 , $56.70 , $56.70 , $56.70 , $53.55 , $5.18 , $58.17 , $59.85 , $53.55 , $58.59 , $58.59 , $59.85 , $60.48 , $51.55 , $56.70 , $53.55 , $49.77 , N/A , $50.99 , $50.99 , $59.85 , $54.06 , $5.18 , $60.48 
 Fac Amb Ift 911 Base Als Non-Emergent ,HCPCS A0426,0540 - AMBULANCE,N/A,N/A," $2,300.00 "," $1,495.00 "," $1,932.00 ", N/A , $258.38 ," $1,858.40 "," $2,070.00 "," $1,947.18 "," $2,070.00 "," $2,070.00 "," $2,070.00 "," $1,955.00 ", $253.31 ," $2,123.59 "," $2,185.00 "," $1,955.00 "," $2,139.00 "," $2,139.00 "," $2,185.00 "," $2,208.00 "," $1,881.86 "," $2,070.00 "," $1,955.00 "," $1,817.00 ", N/A ," $1,861.39 "," $1,861.39 "," $2,185.00 "," $1,973.63 ", $253.31 ," $2,208.00 "
" Fac Assay of Troponin, Quant ",CPT® 84484,0301 - LAB/CHEMISTRY,N/A,N/A, $148.00 , $96.20 , $124.32 , $12.72 , $12.72 , $119.58 , $133.20 , $125.30 , $133.20 , $133.20 , $133.20 , $125.80 , $12.47 , $136.65 , $140.60 , $125.80 , $137.64 , $137.64 , $140.60 , $142.08 , $121.09 , $133.20 , $125.80 , $116.92 , N/A , $119.78 , $119.78 , $140.60 , $127.00 , $12.47 , $142.08 
Cont Gluc Mntr Physician/Qhp Provided Equiptment,CPT® 95250,N/A,N/A,N/A, $926.00 , $601.90 , $340.54 , $141.63 , $50.79 , $346.25 , $372.69 , $861.18 , $833.40 , $833.40 , $740.80 , $740.80 , $50.79 , $854.98 , $879.70 , $833.40 , $833.40 , $833.40 , $861.18 , $888.96 , $465.73 , $787.10 , $495.71 , $576.31 , N/A , $353.01 , $353.01 , $879.70 , $411.55 , $50.79 , $888.96 
 GUANFACINE HCL ER 1 MG PO TB24 ,HCPCS RXC637,0250 - PHARMACY,24979-0533-01,1 tablet, $53.90 , $35.04 , $45.28 , N/A , N/A , $43.55 , $48.51 , $45.63 , $48.51 , $48.51 , $48.51 , $45.82 , N/A , $49.77 , $51.21 , $45.82 , $50.13 , $50.13 , $51.21 , $51.74 , $44.10 , $48.51 , $45.82 , $42.58 , N/A , $43.62 , $43.62 , $51.21 , $46.25 , $42.58 , $51.74 
 Fac Blood Viscosity Examination ,CPT® 85810,0305 - LAB/HEMATOLOGY,N/A,N/A, $128.00 , $83.20 , $107.52 , $11.90 , $11.90 , $103.42 , $115.20 , $108.36 , $115.20 , $115.20 , $115.20 , $108.80 , $11.67 , $118.18 , $121.60 , $108.80 , $119.04 , $119.04 , $121.60 , $122.88 , $104.73 , $115.20 , $108.80 , $101.12 , N/A , $103.59 , $103.59 , $121.60 , $109.84 , $11.67 , $122.88 
 AMOXICILLIN 250 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00781-2020-01,1 capsule, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Pro I & D Abscess of Labia-Lh ,CPT® 56405,0982 - PRO FEE/OUTPT,N/A,N/A, $741.00 , $481.65 , $606.40 , $122.85 , $122.21 , $442.68 , $446.19 , $689.13 , $666.90 , $666.90 , $592.80 , $592.80 , $122.21 , $684.17 , $703.95 , $666.90 , $666.90 , $666.90 , $689.13 , $711.36 , $616.66 , $629.85 , $585.17 , $446.08 , N/A , $451.32 , $451.32 , $703.95 , $541.33 , $122.21 , $711.36 
Apply Finger Splint,29130,N/A,N/A,N/A, $268.00 , $174.20 , $175.70 , $27.56 , $10.31 , $137.91 , $137.01 , $249.24 , $241.20 , $241.20 , $214.40 , $214.40 , $10.31 , $247.44 , $254.60 , $241.20 , $241.20 , $241.20 , $249.24 , $257.28 , $162.22 , $227.80 , $149.86 , $165.82 , N/A , $140.61 , $140.61 , $254.60 , $165.26 , $10.31 , $257.28 
 Fac Assay of Vitamin B-6 ,CPT® 84207,0301 - LAB/CHEMISTRY,N/A,N/A, $265.00 , $172.25 , $222.60 , $28.66 , $28.66 , $214.12 , $238.50 , $224.35 , $238.50 , $238.50 , $238.50 , $225.25 , $28.10 , $244.67 , $251.75 , $225.25 , $246.45 , $246.45 , $251.75 , $254.40 , $216.82 , $238.50 , $225.25 , $209.35 , N/A , $214.46 , $214.46 , $251.75 , $227.40 , $28.10 , $254.40 
 NM Bone Scan Limited Area ,CPT® 78300,0340 - NUCLEAR MEDICINE,N/A,N/A," $2,043.00 "," $1,327.95 "," $1,716.12 ", $207.83 , $132.28 ," $1,650.74 "," $1,838.70 "," $1,729.60 "," $1,838.70 "," $1,838.70 "," $1,838.70 "," $1,736.55 ", $129.69 ," $1,886.30 "," $1,940.85 "," $1,736.55 "," $1,899.99 "," $1,899.99 "," $1,940.85 "," $1,961.28 "," $1,671.58 "," $1,838.70 "," $1,736.55 "," $1,613.97 ", N/A ," $1,653.40 "," $1,653.40 "," $1,940.85 "," $1,753.10 ", $129.69 ," $1,961.28 "
 Other Disorders Of Nervous System With McC ,MS DRG V40 (FY2023) 091,N/A,N/A,N/A," $31,839.20 "," $20,695.48 "," $26,744.93 ", N/A , N/A ," $25,726.07 "," $28,655.28 "," $26,955.07 "," $28,655.28 "," $28,655.28 "," $28,655.28 "," $27,063.32 ", N/A ," $29,397.13 "," $30,247.24 "," $27,063.32 "," $29,610.46 "," $29,610.46 "," $30,247.24 "," $30,565.63 "," $26,050.83 "," $28,655.28 "," $27,063.32 "," $25,152.97 ", N/A ," $25,767.46 "," $25,767.46 "," $30,247.24 "," $27,321.22 "," $25,152.97 "," $30,565.63 "
 NITROGLYCERIN 0.4 MG SL SUBL ,HCPCS RXC637,0250 - PHARMACY,59762-3304-03,1 tablet, $131.89 , $85.73 , $110.79 , N/A , N/A , $106.57 , $118.70 , $111.66 , $118.70 , $118.70 , $118.70 , $112.11 , N/A , $121.77 , $125.30 , $112.11 , $122.66 , $122.66 , $125.30 , $126.61 , $107.91 , $118.70 , $112.11 , $104.19 , N/A , $106.74 , $106.74 , $125.30 , $113.17 , $104.19 , $126.61 
Exc Skin Benig 0.6-1cm Remaindr Body,11421,N/A,N/A,N/A, $608.00 , $395.20 , $351.80 , $105.96 , $93.30 , $301.07 , $297.24 , $565.44 , $547.20 , $547.20 , $486.40 , $486.40 , $93.30 , $561.37 , $577.60 , $547.20 , $547.20 , $547.20 , $565.44 , $583.68 , $385.15 , $516.80 , $590.53 , $385.78 , N/A , $306.95 , $306.95 , $577.60 , $355.95 , $93.30 , $590.53 
 PEMETREXED DISODIUM 100 MG IV SOLR ,HCPCS J9305,0636 - DRUGS REQUIRING DETAILED CODIN,00002-7640-01,4 mL," $2,377.54 "," $1,545.40 "," $1,997.13 ", $8.09 , $28.23 ," $1,921.05 "," $2,139.79 "," $2,012.83 "," $2,139.79 "," $2,139.79 "," $2,139.79 "," $2,020.91 ", $27.68 ," $2,195.18 "," $2,258.66 "," $2,020.91 "," $2,211.11 "," $2,211.11 "," $2,258.66 "," $2,282.44 "," $1,945.30 "," $2,139.79 "," $2,020.91 "," $1,878.26 ", N/A ," $1,924.14 "," $1,924.14 "," $2,258.66 "," $2,040.17 ", $8.09 ," $2,282.44 "
 Lt Lower Ext MRI With Contrast ,CPT® 73719,0610 - MRI,N/A,N/A," $5,973.00 "," $3,882.45 "," $5,017.32 ", $270.51 , $497.69 ," $4,826.18 "," $5,375.70 "," $5,056.74 "," $5,375.70 "," $5,375.70 "," $5,375.70 "," $5,077.05 ", $487.93 ," $5,514.87 "," $5,674.35 "," $5,077.05 "," $5,554.89 "," $5,554.89 "," $5,674.35 "," $5,734.08 "," $4,887.11 "," $5,375.70 "," $5,077.05 "," $4,718.67 ", N/A ," $4,833.95 "," $4,833.95 "," $5,674.35 "," $5,125.43 ", $270.51 ," $5,734.08 "
 Fac So Cap Design W/O Jnts Cf ,HCPCS L3671,0274 - PROSTHETIC DEV,N/A,N/A," $1,009.00 ", $655.85 , $847.56 , $959.23 , $664.39 , $815.27 , $908.10 , $854.22 , $908.10 , $908.10 , $908.10 , $857.65 , $651.36 , $931.61 , $958.55 , $857.65 , $938.37 , $938.37 , $958.55 , $968.64 , $825.56 , $908.10 , $857.65 , $797.11 , N/A , $816.58 , $816.58 , $958.55 , $865.82 , $651.36 , $968.64 
 DIAZEPAM 5 MG/ML IJ SOLN ,HCPCS J3360,0636 - DRUGS REQUIRING DETAILED CODIN,00409-1273-32,1 mL, $189.22 , $122.99 , $158.94 , $5.36 , $8.72 , $152.89 , $170.30 , $160.19 , $170.30 , $170.30 , $170.30 , $160.84 , $8.55 , $174.71 , $179.76 , $160.84 , $175.97 , $175.97 , $179.76 , $181.65 , $154.82 , $170.30 , $160.84 , $149.48 , N/A , $153.14 , $153.14 , $179.76 , $162.37 , $5.36 , $181.65 
 Facial Bones Min 3 Vw- Mh ,CPT® 70150,0972 - PRO FEE/RAD/DX,N/A,N/A, $171.00 , $111.15 , $268.95 , $46.31 , $40.44 , $195.31 , $228.20 , $159.03 , $153.90 , $153.90 , $136.80 , $136.80 , $40.44 , $157.88 , $162.45 , $153.90 , $153.90 , $153.90 , $159.03 , $164.16 , $260.39 , $145.35 , $248.46 , $209.30 , N/A , $199.13 , $199.13 , $162.45 , $230.50 , $40.44 , $268.95 
Sgmdsc Flx With Endoscopic Mucosal Resection,CPT® 45349,N/A,N/A,N/A," $2,493.00 "," $1,620.45 "," $1,216.80 ", $187.96 , $133.80 , N/A , N/A ," $2,318.49 "," $2,243.70 "," $2,243.70 "," $1,994.40 "," $1,994.40 ", $133.80 ," $2,301.79 "," $2,368.35 "," $2,243.70 "," $2,243.70 "," $2,243.70 "," $2,318.49 "," $2,393.28 ", $874.13 ," $2,119.05 "," $1,034.18 "," $1,160.23 ", N/A , $888.60 , $888.60 ," $2,368.35 ", $930.05 , $133.80 ," $2,393.28 "
Xcapsl Ctrc Rmvl Insj Io Lens Prosth Insj 1+,66991,N/A,N/A,N/A," $7,064.00 "," $4,591.60 "," $4,206.54 ", $659.93 , $430.89 , N/A , N/A ," $6,569.52 "," $6,357.60 "," $6,357.60 "," $5,651.20 "," $5,651.20 ", $430.89 ," $6,522.19 "," $6,710.80 "," $6,357.60 "," $6,357.60 "," $6,357.60 "," $6,569.52 "," $6,781.44 ", N/A ," $6,004.40 "," $3,564.55 "," $4,978.77 ", N/A ," $3,590.35 "," $3,590.35 "," $6,710.80 "," $3,964.34 ", $430.89 ," $6,781.44 "
 TRAZODONE HCL 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6868-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Excise Deminal Vesicle,CPT® 55650,N/A,N/A,N/A," $3,935.00 "," $2,557.75 "," $3,185.85 ", $685.25 , $922.06 ," $2,303.20 "," $2,327.04 "," $3,659.55 "," $3,541.50 "," $3,541.50 "," $3,148.00 "," $3,148.00 ", $922.06 ," $3,633.19 "," $3,738.25 "," $3,541.50 "," $3,541.50 "," $3,541.50 "," $3,659.55 "," $3,777.60 "," $2,990.12 "," $3,344.75 "," $3,707.29 "," $3,475.16 ", N/A ," $2,348.13 "," $2,348.13 "," $3,738.25 "," $2,814.38 ", $685.25 ," $3,777.60 "
"Exc Soft Tiss Tumor Shldr,Subq",CPT® 23075,N/A,N/A,N/A," $3,149.00 "," $2,046.85 "," $2,002.85 ", $312.68 , $122.79 ," $1,565.39 "," $1,579.30 "," $2,928.57 "," $2,834.10 "," $2,834.10 "," $2,519.20 "," $2,519.20 ", $122.79 ," $2,907.47 "," $2,991.55 "," $2,834.10 "," $2,834.10 "," $2,834.10 "," $2,928.57 "," $3,023.04 "," $1,849.84 "," $2,676.65 "," $1,744.81 "," $1,856.79 ", N/A ," $1,595.93 "," $1,595.93 "," $2,991.55 "," $1,875.78 ", $122.79 ," $3,023.04 "
 Fac Culture Type Immunofluoresc ,CPT® 87140,0306 - LAB/BACT-MICRO,N/A,N/A, $130.00 , $84.50 , $109.20 , $5.68 , $5.68 , $105.04 , $117.00 , $110.06 , $117.00 , $117.00 , $117.00 , $110.50 , $5.57 , $120.03 , $123.50 , $110.50 , $120.90 , $120.90 , $123.50 , $124.80 , $106.37 , $117.00 , $110.50 , $102.70 , N/A , $105.21 , $105.21 , $123.50 , $111.55 , $5.57 , $124.80 
Ketorolac Tromethamine Inj,HCPCS J1885,N/A,N/A,N/A, $20.00 , $13.00 , N/A , $0.56 , $0.60 , N/A , N/A , $18.60 , $18.00 , $18.00 , $16.00 , $16.00 , $0.60 , $18.47 , $19.00 , $18.00 , $18.00 , $18.00 , $18.60 , $19.20 , $0.52 , $17.00 , $0.65 , $0.83 , N/A , N/A , N/A , $19.00 , N/A , $0.52 , $19.20 
Chemodenervation of Trunk 6 or More Muscles,CPT® 64647,N/A,N/A,N/A," $1,110.00 ", $721.50 , $627.02 , $121.37 , $99.05 , $744.03 , $723.64 ," $1,032.30 ", $999.00 , $999.00 , $888.00 , $888.00 , $99.05 ," $1,024.86 "," $1,054.50 ", $999.00 , $999.00 , $999.00 ," $1,032.30 "," $1,065.60 ", $677.01 , $943.50 , $707.22 , $784.07 , N/A , $758.56 , $758.56 ," $1,054.50 ", $813.77 , $99.05 ," $1,065.60 "
 Removal FB External Auditory Canal W/O Anes - Mh ,CPT® 69200,0761 - TREATMENT ROOM,N/A,N/A, $217.00 , $141.05 , $182.28 , $45.22 , $46.62 , $175.34 , $195.30 , $183.71 , $195.30 , $195.30 , $195.30 , $184.45 , $45.71 , $200.36 , $206.15 , $184.45 , $201.81 , $201.81 , $206.15 , $208.32 , $177.55 , $195.30 , $184.45 , $171.43 , N/A , $175.62 , $175.62 , $206.15 , $186.21 , $45.22 , $208.32 
 Fac Slctv Cath 1stord W/WO Art Punct/Fluor/S&I Bil ,CPT® 36252,0360 - OR SERVICES,N/A,N/A," $8,182.00 "," $5,318.30 "," $6,872.88 ", $321.27 ," $1,252.47 "," $6,611.06 "," $7,363.80 "," $6,926.88 "," $7,363.80 "," $7,363.80 "," $7,363.80 "," $6,954.70 "," $1,227.91 "," $7,554.44 "," $7,772.90 "," $6,954.70 "," $7,609.26 "," $7,609.26 "," $7,772.90 "," $7,854.72 "," $6,694.51 "," $7,363.80 "," $6,954.70 "," $6,463.78 ", N/A ," $6,621.69 "," $6,621.69 "," $7,772.90 "," $7,020.97 ", $321.27 ," $7,854.72 "
 HYDROCORTISONE 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00115-1697-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 CARBOPLATIN 450 MG/45ML IV SOLN ,HCPCS J9045,0636 - DRUGS REQUIRING DETAILED CODIN,00703-4248-01,450 mg, $191.09 , $124.21 , $160.52 , $2.46 , $2.53 , $154.40 , $171.98 , $161.78 , $171.98 , $171.98 , $171.98 , $162.43 , $2.48 , $176.43 , $181.54 , $162.43 , $177.71 , $177.71 , $181.54 , $183.45 , $156.35 , $171.98 , $162.43 , $150.96 , N/A , $154.65 , $154.65 , $181.54 , $163.97 , $2.46 , $183.45 
 Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC ,MS DRG V40 (FY2023) 060,N/A,N/A,N/A," $35,419.74 "," $23,022.83 "," $29,752.58 ", N/A , N/A ," $28,619.15 "," $31,877.77 "," $29,986.35 "," $31,877.77 "," $31,877.77 "," $31,877.77 "," $30,106.78 ", N/A ," $32,703.05 "," $33,648.75 "," $30,106.78 "," $32,940.36 "," $32,940.36 "," $33,648.75 "," $34,002.95 "," $28,980.43 "," $31,877.77 "," $30,106.78 "," $27,981.59 ", N/A ," $28,665.20 "," $28,665.20 "," $33,648.75 "," $30,393.68 "," $27,981.59 "," $34,002.95 "
Fx Cl Humeral W/O Manipul,24576,N/A,N/A,N/A," $1,464.00 ", $951.60 ," $1,950.91 ", $309.19 , $184.42 ," $1,473.39 "," $1,496.54 "," $1,361.52 "," $1,317.60 "," $1,317.60 "," $1,171.20 "," $1,171.20 ", $184.42 ," $1,351.71 "," $1,390.80 "," $1,317.60 "," $1,317.60 "," $1,317.60 "," $1,361.52 "," $1,405.44 "," $1,793.26 "," $1,244.40 "," $1,643.12 "," $1,749.60 ", N/A ," $1,502.13 "," $1,502.13 "," $1,390.80 "," $1,765.55 ", $184.42 ," $1,950.91 "
"Repair Conjunc Lac,Rearrang,in Hosp",CPT® 65273,N/A,N/A,N/A," $3,484.00 "," $2,264.60 "," $2,344.29 ", $367.24 , $278.93 ," $2,155.80 "," $1,975.98 "," $3,240.12 "," $3,135.60 "," $3,135.60 "," $2,787.20 "," $2,787.20 ", $278.93 ," $3,216.78 "," $3,309.80 "," $3,135.60 "," $3,135.60 "," $3,135.60 "," $3,240.12 "," $3,344.64 "," $3,218.99 "," $2,961.40 "," $2,005.29 "," $2,736.76 ", N/A ," $2,197.86 "," $2,197.86 "," $3,309.80 "," $2,426.16 ", $278.93 ," $3,344.64 "
"Assay Progesterone,17-D",CPT® 83498,N/A,N/A,N/A, $250.00 , $162.50 , N/A , $27.71 , $27.71 , $153.70 , $183.89 , $232.50 , $225.00 , $225.00 , $200.00 , $200.00 , $27.71 , $230.83 , $237.50 , $225.00 , $225.00 , $225.00 , $232.50 , $240.00 , $181.42 , $212.50 , $178.40 , $98.51 , N/A , $143.44 , $143.44 , $237.50 , $156.75 , $27.71 , $240.00 
 AMOXICILLIN-POT CLAVULANATE 400-57 MG PO CHEW ,HCPCS RXC637,0250 - PHARMACY,00093-2272-34,1 tablet, $30.19 , $19.62 , $25.36 , N/A , N/A , $24.39 , $27.17 , $25.56 , $27.17 , $27.17 , $27.17 , $25.66 , N/A , $27.87 , $28.68 , $25.66 , $28.08 , $28.08 , $28.68 , $28.98 , $24.70 , $27.17 , $25.66 , $23.85 , N/A , $24.43 , $24.43 , $28.68 , $25.91 , $23.85 , $28.98 
 Fac Upp Ext Fx Orthosis Humeral ,HCPCS L3980,0274 - PROSTHETIC DEV,N/A,N/A, $540.00 , $351.00 , $453.60 , $411.85 , $204.36 , $436.32 , $486.00 , $457.16 , $486.00 , $486.00 , $486.00 , $459.00 , $200.35 , $498.58 , $513.00 , $459.00 , $502.20 , $502.20 , $513.00 , $518.40 , $441.83 , $486.00 , $459.00 , $426.60 , N/A , $437.02 , $437.02 , $513.00 , $463.37 , $200.35 , $518.40 
 TRASTUZUMAB-ANNS 150 MG IV SOLR ,HCPCS Q5117,0636 - DRUGS REQUIRING DETAILED CODIN,55513-0141-01,7.2 mL," $4,021.88 "," $2,614.22 "," $3,378.38 ", $24.44 , $34.04 ," $3,249.68 "," $3,619.69 "," $3,404.92 "," $3,619.69 "," $3,619.69 "," $3,619.69 "," $3,418.60 ", $33.37 ," $3,713.40 "," $3,820.79 "," $3,418.60 "," $3,740.35 "," $3,740.35 "," $3,820.79 "," $3,861.00 "," $3,290.70 "," $3,619.69 "," $3,418.60 "," $3,177.29 ", N/A ," $3,254.91 "," $3,254.91 "," $3,820.79 "," $3,451.18 ", $24.44 ," $3,861.00 "
 LANSOPRAZOLE 15 MG PO TBDD ,HCPCS RXC637,0250 - PHARMACY,64764-0543-11,1 tablet, $85.30 , $55.45 , $71.65 , N/A , N/A , $68.92 , $76.77 , $72.21 , $76.77 , $76.77 , $76.77 , $72.51 , N/A , $78.76 , $81.04 , $72.51 , $79.33 , $79.33 , $81.04 , $81.89 , $69.79 , $76.77 , $72.51 , $67.39 , N/A , $69.03 , $69.03 , $81.04 , $73.20 , $67.39 , $81.89 
Stim/Pacing Heart Post IV Drug Infu,CPT® 93623,N/A,N/A,N/A," $1,979.00 "," $1,286.35 "," $1,701.12 ", $247.05 , $380.96 ," $1,148.34 "," $1,127.28 "," $1,840.47 "," $1,781.10 "," $1,781.10 "," $1,583.20 "," $1,583.20 ", $380.96 ," $1,827.21 "," $1,880.05 "," $1,781.10 "," $1,781.10 "," $1,781.10 "," $1,840.47 "," $1,899.84 "," $1,824.87 "," $1,682.15 "," $1,093.63 "," $1,899.54 ", N/A ," $1,170.74 "," $1,170.74 "," $1,880.05 "," $1,297.78 ", $247.05 ," $1,899.84 "
 POLIDOCANOL 1 % IV SOLN ,HCPCS RXA250,0250 - PHARMACY,67850-0141-05,0.1 mL, $16.68 , $10.84 , $14.01 , N/A , N/A , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , N/A , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $13.18 , $16.01 
 Excision External Thrombotic Hemorrhoid ,CPT® 46320,0361 - OR/MINOR,N/A,N/A, $845.00 , $549.25 , $709.80 , $107.89 , $165.14 , $682.76 , $760.50 , $715.38 , $760.50 , $760.50 , $760.50 , $718.25 , $161.90 , $780.19 , $802.75 , $718.25 , $785.85 , $785.85 , $802.75 , $811.20 , $691.38 , $760.50 , $718.25 , $667.55 , N/A , $683.86 , $683.86 , $802.75 , $725.09 , $107.89 , $811.20 
"Ileostomy/Jejunostomy,Nontube",CPT® 44310,N/A,N/A,N/A," $6,847.00 "," $4,450.55 "," $6,222.19 ", $964.92 ," $1,152.57 "," $4,928.99 "," $4,976.75 "," $6,367.71 "," $6,162.30 "," $6,162.30 "," $5,477.60 "," $5,477.60 "," $1,152.57 "," $6,321.84 "," $6,504.65 "," $6,162.30 "," $6,162.30 "," $6,162.30 "," $6,367.71 "," $6,573.12 "," $4,457.87 "," $5,819.95 "," $5,521.68 "," $5,830.14 ", N/A ," $5,025.17 "," $5,025.17 "," $6,504.65 "," $5,255.81 ", $964.92 ," $6,573.12 "
 Fac Iaad Ia Hepatitis Be Antigen ,CPT® 87350,0306 - LAB/BACT-MICRO,N/A,N/A, $108.00 , $70.20 , $90.72 , $11.76 , $11.76 , $87.26 , $97.20 , $91.43 , $97.20 , $97.20 , $97.20 , $91.80 , $11.53 , $99.72 , $102.60 , $91.80 , $100.44 , $100.44 , $102.60 , $103.68 , $88.37 , $97.20 , $91.80 , $85.32 , N/A , $87.40 , $87.40 , $102.60 , $92.67 , $11.53 , $103.68 
 Pro Closed Tx Bimalleolar Ankle Fracture W/O Mnpj ,CPT® 27808,0981 - PRO FEE/ER,N/A,N/A," $1,446.00 ", $939.90 ," $1,908.27 ", $301.59 , $190.55 ," $1,449.98 "," $1,478.68 "," $1,344.78 "," $1,301.40 "," $1,301.40 "," $1,156.80 "," $1,156.80 ", $190.55 ," $1,335.09 "," $1,373.70 "," $1,301.40 "," $1,301.40 "," $1,301.40 "," $1,344.78 "," $1,388.16 "," $1,757.34 "," $1,229.10 "," $1,621.71 "," $1,717.78 ", N/A ," $1,478.27 "," $1,478.27 "," $1,373.70 "," $1,737.49 ", $190.55 ," $1,908.27 "
 DEXTROSE IN LACTATED RINGERS 5 % IV SOLN ,HCPCS RXA258,0258 - IV SOLUTIONS,00990-7929-09,"1,000 mL", $79.82 , $51.88 , $67.05 , N/A , N/A , $64.49 , $71.84 , $67.58 , $71.84 , $71.84 , $71.84 , $67.85 , N/A , $73.70 , $75.83 , $67.85 , $74.23 , $74.23 , $75.83 , $76.63 , $65.31 , $71.84 , $67.85 , $63.06 , N/A , $64.60 , $64.60 , $75.83 , $68.49 , $63.06 , $76.63 
 Pro Lyr Clsr S/a/T/E 2.6 Cm-7.5 Cm ,CPT® 12032,0982 - PRO FEE/OUTPT,N/A,N/A," $1,160.00 ", $754.00 , $608.50 , $183.18 , $82.48 , $532.01 , $524.46 ," $1,078.80 "," $1,044.00 "," $1,044.00 ", $928.00 , $928.00 , $82.48 ," $1,071.03 "," $1,102.00 "," $1,044.00 "," $1,044.00 "," $1,044.00 "," $1,078.80 "," $1,113.60 ", $668.28 , $986.00 ," $1,043.68 ", $685.38 , N/A , $542.39 , $542.39 ," $1,102.00 ", $628.99 , $82.48 ," $1,113.60 "
 Fac Trlml Balo Angiop Open/Perq W/Img S&I Addl Vein ,CPT® 37249,0360 - OR SERVICES,N/A,N/A," $5,851.00 "," $3,803.15 "," $4,914.84 ", $132.82 , $750.06 ," $4,727.61 "," $5,265.90 "," $4,953.46 "," $5,265.90 "," $5,265.90 "," $5,265.90 "," $4,973.35 ", $735.35 ," $5,402.23 "," $5,558.45 "," $4,973.35 "," $5,441.43 "," $5,441.43 "," $5,558.45 "," $5,616.96 "," $4,787.29 "," $5,265.90 "," $4,973.35 "," $4,622.29 ", N/A ," $4,735.21 "," $4,735.21 "," $5,558.45 "," $5,020.74 ", $132.82 ," $5,616.96 "
Open Rx Fingr Articular Fx,CPT® 26746,N/A,N/A,N/A," $2,374.00 "," $1,543.10 "," $4,544.15 ", $713.02 , $381.08 ," $3,573.09 "," $3,558.02 "," $2,207.82 "," $2,136.60 "," $2,136.60 "," $1,899.20 "," $1,899.20 ", $381.08 ," $2,191.91 "," $2,255.30 "," $2,136.60 "," $2,136.60 "," $2,136.60 "," $2,207.82 "," $2,279.04 "," $4,226.05 "," $2,017.90 "," $3,916.02 "," $4,238.02 ", N/A ," $3,642.81 "," $3,642.81 "," $2,255.30 "," $4,281.58 ", $381.08 ," $4,544.15 "
 ER MD Closed Tx Carpometacarpal-Lh ,CPT® 26670,0981 - PRO FEE/ER,N/A,N/A," $1,780.00 "," $1,157.00 "," $1,932.00 ", $304.70 , $101.43 ," $1,473.39 "," $1,459.87 "," $1,655.40 "," $1,602.00 "," $1,602.00 "," $1,424.00 "," $1,424.00 ", $101.43 ," $1,643.47 "," $1,691.00 "," $1,602.00 "," $1,602.00 "," $1,602.00 "," $1,655.40 "," $1,708.80 "," $1,780.30 "," $1,513.00 "," $1,602.09 "," $1,770.69 ", N/A ," $1,502.13 "," $1,502.13 "," $1,691.00 "," $1,765.55 ", $101.43 ," $1,932.00 "
"Preventive Visit,Est,Age5-11",CPT® 99393,N/A,N/A,N/A, $313.00 , $203.45 , N/A , $101.86 , $62.20 , $163.06 , $164.73 , $291.09 , $281.70 , $281.70 , $250.40 , $250.40 , $62.20 , $288.99 , $297.35 , $281.70 , $281.70 , $281.70 , $291.09 , $300.48 , $202.54 , $266.05 , $165.77 , $163.22 , N/A , $166.24 , $166.24 , $297.35 , $199.66 , $62.20 , $300.48 
 Pro Cltx Iphal Jt Dislc 1 W/Mnpj W/O Anes ,CPT® 26770,0981 - PRO FEE/ER,N/A,N/A," $1,507.00 ", $979.55 ," $1,609.47 ", $257.24 , $74.85 ," $1,227.08 "," $1,253.31 "," $1,401.51 "," $1,356.30 "," $1,356.30 "," $1,205.60 "," $1,205.60 ", $74.85 ," $1,391.41 "," $1,431.65 "," $1,356.30 "," $1,356.30 "," $1,356.30 "," $1,401.51 "," $1,446.72 "," $1,478.71 "," $1,280.95 "," $1,373.73 "," $1,463.84 ", N/A ," $1,251.03 "," $1,251.03 "," $1,431.65 "," $1,470.39 ", $74.85 ," $1,609.47 "
 Tixagev and Cilgav Covid Inj ,HCPCS M0220,0771 - VACCINE ADMINISTRATION,N/A,N/A," $1,335.00 ", $867.75 ," $1,121.40 ", N/A , $153.51 ," $1,078.68 "," $1,201.50 "," $1,130.21 "," $1,201.50 "," $1,201.50 "," $1,201.50 "," $1,134.75 ", $150.50 ," $1,232.61 "," $1,268.25 "," $1,134.75 "," $1,241.55 "," $1,241.55 "," $1,268.25 "," $1,281.60 "," $1,092.30 "," $1,201.50 "," $1,134.75 "," $1,054.65 ", N/A ," $1,080.42 "," $1,080.42 "," $1,268.25 "," $1,145.56 ", $150.50 ," $1,281.60 "
Brnchsc W/Brncl Alveolar Lavage,CPT® 31624,N/A,N/A,N/A," $2,066.00 "," $1,342.90 ", $733.70 , $127.44 , $308.45 , $575.79 , $562.18 ," $1,921.38 "," $1,859.40 "," $1,859.40 "," $1,652.80 "," $1,652.80 ", $308.45 ," $1,907.54 "," $1,962.70 "," $1,859.40 "," $1,859.40 "," $1,859.40 "," $1,921.38 "," $1,983.36 ", $709.54 ," $1,756.10 ", $784.99 , $709.66 , N/A , $587.02 , $587.02 ," $1,962.70 ", $691.34 , $127.44 ," $1,983.36 "
 Neck MR Angiography W/O Contrast ,CPT® 70547,0615 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA-HEAD AND NECK,N/A,N/A," $5,079.00 "," $3,301.35 "," $4,266.36 ", $221.31 , $403.88 ," $4,103.83 "," $4,571.10 "," $4,299.88 "," $4,571.10 "," $4,571.10 "," $4,571.10 "," $4,317.15 ", $395.96 ," $4,689.44 "," $4,825.05 "," $4,317.15 "," $4,723.47 "," $4,723.47 "," $4,825.05 "," $4,875.84 "," $4,155.64 "," $4,571.10 "," $4,317.15 "," $4,012.41 ", N/A ," $4,110.43 "," $4,110.43 "," $4,825.05 "," $4,358.29 ", $221.31 ," $4,875.84 "
"Closed Rx Ulna Shaft Fx,Manipulatn",25535,N/A,N/A,N/A," $2,575.00 "," $1,673.75 "," $2,828.09 ", $446.23 , $307.34 ," $2,178.51 "," $2,197.64 "," $2,394.75 "," $2,317.50 "," $2,317.50 "," $2,060.00 "," $2,060.00 ", $307.34 ," $2,377.50 "," $2,446.25 "," $2,317.50 "," $2,317.50 "," $2,317.50 "," $2,394.75 "," $2,472.00 "," $2,617.19 "," $2,188.75 "," $2,417.41 "," $2,567.19 ", N/A ," $2,221.01 "," $2,221.01 "," $2,446.25 "," $2,610.49 ", $307.34 ," $2,828.09 "
 METHYLPHENIDATE HCL 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,16729-0478-01,1 tablet, $3.66 , $2.38 , $3.07 , N/A , N/A , $2.96 , $3.29 , $3.10 , $3.29 , $3.29 , $3.29 , $3.11 , N/A , $3.38 , $3.48 , $3.11 , $3.40 , $3.40 , $3.48 , $3.51 , $2.99 , $3.29 , $3.11 , $2.89 , N/A , $2.96 , $2.96 , $3.48 , $3.14 , $2.89 , $3.51 
 Pro Egd Injection Sclerosis Esophgl/Gastric Varices ,CPT® 43243,0982 - PRO FEE/OUTPT,N/A,N/A," $2,660.00 "," $1,729.00 "," $1,451.45 ", $224.05 , $249.97 ," $1,200.18 "," $1,294.30 "," $2,473.80 "," $2,394.00 "," $2,394.00 "," $2,128.00 "," $2,128.00 ", $249.97 ," $2,455.98 "," $2,527.00 "," $2,394.00 "," $2,394.00 "," $2,394.00 "," $2,473.80 "," $2,553.60 "," $1,042.92 "," $2,261.00 "," $1,420.11 "," $1,383.06 ", N/A ," $1,223.59 "," $1,223.59 "," $2,527.00 "," $1,279.76 ", $224.05 ," $2,553.60 "
Contour of Face Bone Lesion,CPT® 21029,N/A,N/A,N/A," $5,174.00 "," $3,363.10 "," $3,807.44 ", $598.98 , $474.20 ," $3,100.09 "," $3,150.18 "," $4,811.82 "," $4,656.60 "," $4,656.60 "," $4,139.20 "," $4,139.20 ", $474.20 ," $4,777.15 "," $4,915.30 "," $4,656.60 "," $4,656.60 "," $4,656.60 "," $4,811.82 "," $4,967.04 "," $3,562.66 "," $4,397.90 "," $3,475.36 "," $3,681.51 ", N/A ," $3,160.58 "," $3,160.58 "," $4,915.30 "," $3,714.81 ", $474.20 ," $4,967.04 "
"Venipuncture,Over Age 3",36410,N/A,N/A,N/A, $82.00 , $53.30 , $56.68 , $8.74 , $16.64 , $40.95 , $40.19 , $76.26 , $73.80 , $73.80 , $65.60 , $65.60 , $16.64 , $75.71 , $77.90 , $73.80 , $73.80 , $73.80 , $76.26 , $78.72 , $52.57 , $69.70 , $49.95 , $46.82 , N/A , $41.76 , $41.76 , $77.90 , $47.42 , $8.74 , $78.72 
 Fac Exc 1st&/Crv Rib ,CPT® 21615,0360 - OR SERVICES,N/A,N/A," $7,612.00 "," $4,947.80 "," $6,394.08 ", $571.35 , $922.06 ," $6,150.50 "," $6,850.80 "," $6,444.32 "," $6,850.80 "," $6,850.80 "," $6,850.80 "," $6,470.20 ", $903.98 ," $7,028.16 "," $7,231.40 "," $6,470.20 "," $7,079.16 "," $7,079.16 "," $7,231.40 "," $7,307.52 "," $6,228.14 "," $6,850.80 "," $6,470.20 "," $6,013.48 ", N/A ," $6,160.39 "," $6,160.39 "," $7,231.40 "," $6,531.86 ", $571.35 ," $7,307.52 "
 Adm Sarscov2 100mcg/0.5ml3rd ,CPT® 0013A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
 ALTEPLASE 100 MG IV SOLR ,HCPCS J2997,0636 - DRUGS REQUIRING DETAILED CODIN,50242-0085-27,13 mL," $3,363.86 "," $2,186.51 "," $2,825.64 ", $90.93 , $89.79 ," $2,718.00 "," $3,027.47 "," $2,847.84 "," $3,027.47 "," $3,027.47 "," $3,027.47 "," $2,859.28 ", $88.03 ," $3,105.85 "," $3,195.67 "," $2,859.28 "," $3,128.39 "," $3,128.39 "," $3,195.67 "," $3,229.31 "," $2,752.31 "," $3,027.47 "," $2,859.28 "," $2,657.45 ", N/A ," $2,722.37 "," $2,722.37 "," $3,195.67 "," $2,886.53 ", $88.03 ," $3,229.31 "
 Pro MRI Orbt/Fac/Nck W/O & W/Dye ,CPT® 70543,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,176.00 ", $764.40 ," $2,450.00 ", $349.15 , $633.95 ," $2,342.63 "," $2,974.48 "," $1,093.68 "," $1,058.40 "," $1,058.40 ", $940.80 , $940.80 , $633.95 ," $1,085.80 "," $1,117.20 "," $1,058.40 "," $1,058.40 "," $1,058.40 "," $1,093.68 "," $1,128.96 "," $2,109.58 ", $999.60 ," $3,241.53 "," $3,729.85 ", N/A ," $2,388.34 "," $2,388.34 "," $1,117.20 "," $2,764.54 ", $349.15 ," $3,729.85 "
 Fac Opn Brachial Artery Expos Dlvr Evasc Prosth Uni ,CPT® 34834,0360 - OR SERVICES,N/A,N/A," $13,009.00 "," $8,455.85 "," $10,927.56 ", $114.09 , $279.55 ," $10,511.27 "," $11,708.10 "," $11,013.42 "," $11,708.10 "," $11,708.10 "," $11,708.10 "," $11,057.65 ", $274.07 ," $12,011.21 "," $12,358.55 "," $11,057.65 "," $12,098.37 "," $12,098.37 "," $12,358.55 "," $12,488.64 "," $10,643.96 "," $11,708.10 "," $11,057.65 "," $10,277.11 ", N/A ," $10,528.18 "," $10,528.18 "," $12,358.55 "," $11,163.02 ", $114.09 ," $12,488.64 "
 Pro Treatment of Tibia Fracture ,CPT® 27752,0982 - PRO FEE/OUTPT,N/A,N/A," $2,050.00 "," $1,332.50 "," $3,010.67 ", $474.05 , $502.11 ," $2,384.99 "," $2,399.89 "," $1,906.50 "," $1,845.00 "," $1,845.00 "," $1,640.00 "," $1,640.00 ", $502.11 ," $1,892.77 "," $1,947.50 "," $1,845.00 "," $1,845.00 "," $1,845.00 "," $1,906.50 "," $1,968.00 "," $2,794.53 "," $1,742.50 "," $2,643.98 "," $2,805.41 ", N/A ," $2,431.52 "," $2,431.52 "," $1,947.50 "," $2,857.92 ", $474.05 ," $3,010.67 "
 Inj of Sinus Tract/Fistula ,CPT® 20501,0761 - TREATMENT ROOM,N/A,N/A, $407.00 , $264.55 , $341.88 , $35.24 , $43.94 , $328.86 , $366.30 , $344.57 , $366.30 , $366.30 , $366.30 , $345.95 , $43.08 , $375.78 , $386.65 , $345.95 , $378.51 , $378.51 , $386.65 , $390.72 , $333.01 , $366.30 , $345.95 , $321.53 , N/A , $329.39 , $329.39 , $386.65 , $349.25 , $35.24 , $390.72 
Cath Plmt L Hrt/Arts/Grfts Wnjx & Angio Img S&I,CPT® 93459,N/A,N/A,N/A," $11,648.00 "," $7,571.20 "," $7,217.08 "," $1,084.73 ", $850.21 ," $6,339.97 "," $6,775.60 "," $10,832.64 "," $10,483.20 "," $10,483.20 "," $9,318.40 "," $9,318.40 ", $850.21 ," $10,754.60 "," $11,065.60 "," $10,483.20 "," $10,483.20 "," $10,483.20 "," $10,832.64 "," $11,182.08 "," $6,832.85 "," $9,900.80 "," $6,435.12 "," $6,597.45 ", N/A ," $6,463.67 "," $6,463.67 "," $11,065.60 "," $7,165.05 ", $850.21 ," $11,182.08 "
Esophagoscopy Flex Balloon Dilat <30 Mm Diam,CPT® 43220,N/A,N/A,N/A," $5,420.00 "," $3,523.00 ", $720.79 , $111.47 , $996.11 , $607.44 , $619.19 ," $5,040.60 "," $4,878.00 "," $4,878.00 "," $4,336.00 "," $4,336.00 ", $996.11 ," $5,004.29 "," $5,149.00 "," $4,878.00 "," $4,878.00 "," $4,878.00 "," $5,040.60 "," $5,203.20 ", $517.34 ," $4,607.00 ", $677.94 , $681.91 , N/A , $619.29 , $619.29 ," $5,149.00 ", $647.72 , $111.47 ," $5,203.20 "
 Seizures Without McC ,MS DRG V40 (FY2023) 101,N/A,N/A,N/A," $27,705.95 "," $18,008.87 "," $23,273.00 ", N/A , N/A ," $22,386.41 "," $24,935.36 "," $23,455.86 "," $24,935.36 "," $24,935.36 "," $24,935.36 "," $23,550.06 ", N/A ," $25,580.90 "," $26,320.65 "," $23,550.06 "," $25,766.53 "," $25,766.53 "," $26,320.65 "," $26,597.71 "," $22,669.01 "," $24,935.36 "," $23,550.06 "," $21,887.70 ", N/A ," $22,422.43 "," $22,422.43 "," $26,320.65 "," $23,774.48 "," $21,887.70 "," $26,597.71 "
 LINEZOLID 600 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6553-04,1 tablet, $448.40 , $291.46 , $376.66 , N/A , N/A , $362.31 , $403.56 , $379.62 , $403.56 , $403.56 , $403.56 , $381.14 , N/A , $414.01 , $425.98 , $381.14 , $417.01 , $417.01 , $425.98 , $430.46 , $366.88 , $403.56 , $381.14 , $354.24 , N/A , $362.89 , $362.89 , $425.98 , $384.77 , $354.24 , $430.46 
 Fac Genomic Seq Analys Dna&Rna Analys 5-50 Gene ,CPT® 81450,0300 - LABORATORY,N/A,N/A," $3,414.00 "," $2,219.10 "," $2,867.76 ", $774.72 , $774.72 ," $2,758.51 "," $3,072.60 "," $2,890.29 "," $3,072.60 "," $3,072.60 "," $3,072.60 "," $2,901.90 ", $759.53 ," $3,152.15 "," $3,243.30 "," $2,901.90 "," $3,175.02 "," $3,175.02 "," $3,243.30 "," $3,277.44 "," $2,793.33 "," $3,072.60 "," $2,901.90 "," $2,697.06 ", N/A ," $2,762.95 "," $2,762.95 "," $3,243.30 "," $2,929.55 ", $759.53 ," $3,277.44 "
 MIDAZOLAM 1 MG/ML (ANES) ,HCPCS J2250,0636 - DRUGS REQUIRING DETAILED CODIN,23155-0600-41,1 mL, $16.68 , $10.84 , $14.01 , $0.14 , $0.17 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.17 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.14 , $16.01 
Open Rx Humeral Supracondylar Fx,24545,N/A,N/A,N/A," $6,138.00 "," $3,989.70 "," $5,629.07 ", $881.28 , $768.38 ," $4,483.29 "," $4,452.62 "," $5,708.34 "," $5,524.20 "," $5,524.20 "," $4,910.40 "," $4,910.40 ", $768.38 ," $5,667.22 "," $5,831.10 "," $5,524.20 "," $5,524.20 "," $5,524.20 "," $5,708.34 "," $5,892.48 "," $5,241.06 "," $5,217.30 "," $4,920.45 "," $5,284.83 ", N/A ," $4,570.77 "," $4,570.77 "," $5,831.10 "," $5,372.28 ", $768.38 ," $5,892.48 "
" Fac X-Ray Aorta, Leg Arteries ",CPT® 75630,0320 - DX X-RAY,N/A,N/A," $2,022.00 "," $1,314.30 "," $1,698.48 ", $152.85 , $266.62 ," $1,633.78 "," $1,819.80 "," $1,711.83 "," $1,819.80 "," $1,819.80 "," $1,819.80 "," $1,718.70 ", $261.39 ," $1,866.91 "," $1,920.90 "," $1,718.70 "," $1,880.46 "," $1,880.46 "," $1,920.90 "," $1,941.12 "," $1,654.40 "," $1,819.80 "," $1,718.70 "," $1,597.38 ", N/A ," $1,636.40 "," $1,636.40 "," $1,920.90 "," $1,735.08 ", $152.85 ," $1,941.12 "
"Incise Tendon/Muscle,Shldr,Single",23405,N/A,N/A,N/A," $3,234.00 "," $2,102.10 "," $3,790.61 ", $591.33 , $461.04 ," $3,012.60 "," $3,015.25 "," $3,007.62 "," $2,910.60 "," $2,910.60 "," $2,587.20 "," $2,587.20 ", $461.04 ," $2,985.95 "," $3,072.30 "," $2,910.60 "," $2,910.60 "," $2,910.60 "," $3,007.62 "," $3,104.64 "," $3,522.94 "," $2,748.90 "," $3,327.28 "," $3,526.66 ", N/A ," $3,071.38 "," $3,071.38 "," $3,072.30 "," $3,609.96 ", $461.04 ," $3,790.61 "
Reconstr Total Shoulder Implant,23472,N/A,N/A,N/A," $5,844.00 "," $3,798.60 "," $8,726.19 "," $1,362.37 "," $1,327.39 "," $7,041.56 "," $6,985.49 "," $5,434.92 "," $5,259.60 "," $5,259.60 "," $4,675.20 "," $4,675.20 "," $1,327.39 "," $5,395.77 "," $5,551.80 "," $5,259.60 "," $5,259.60 "," $5,259.60 "," $5,434.92 "," $5,610.24 "," $8,144.18 "," $4,967.40 "," $7,732.13 "," $8,275.48 ", N/A ," $7,178.95 "," $7,178.95 "," $5,551.80 "," $8,437.82 "," $1,327.39 "," $8,726.19 "
" Pro Rerepair Ing Hernia, Blocked ",CPT® 49521,0982 - PRO FEE/OUTPT,N/A,N/A," $4,746.00 "," $3,084.90 "," $4,277.98 ", $663.84 , $769.85 ," $3,357.69 "," $3,399.52 "," $4,413.78 "," $4,271.40 "," $4,271.40 "," $3,796.80 "," $3,796.80 ", $769.85 ," $4,381.98 "," $4,508.70 "," $4,271.40 "," $4,271.40 "," $4,271.40 "," $4,413.78 "," $4,556.16 "," $3,064.08 "," $4,034.10 "," $3,778.65 "," $3,968.11 ", N/A ," $3,423.20 "," $3,423.20 "," $4,508.70 "," $3,580.31 ", $663.84 ," $4,556.16 "
Treat Ankle Fracture,27808,N/A,N/A,N/A," $1,446.00 ", $939.90 ," $1,908.27 ", $301.59 , $190.55 ," $1,449.98 "," $1,478.68 "," $1,344.78 "," $1,301.40 "," $1,301.40 "," $1,156.80 "," $1,156.80 ", $190.55 ," $1,335.09 "," $1,373.70 "," $1,301.40 "," $1,301.40 "," $1,301.40 "," $1,344.78 "," $1,388.16 "," $1,757.34 "," $1,229.10 "," $1,621.71 "," $1,717.78 ", N/A ," $1,478.27 "," $1,478.27 "," $1,373.70 "," $1,737.49 ", $190.55 ," $1,908.27 "
"Assay of Vit D,Calcifediol",CPT® 82306,N/A,N/A,N/A, $266.00 , $172.90 , N/A , $30.19 , $30.19 , $167.51 , $200.39 , $247.38 , $239.40 , $239.40 , $212.80 , $212.80 , $30.19 , $245.60 , $252.70 , $239.40 , $239.40 , $239.40 , $247.38 , $255.36 , $197.65 , $226.10 , $194.62 , $107.35 , N/A , $156.33 , $156.33 , $252.70 , $170.83 , $30.19 , $255.36 
 Pro Initial Treatment of Burn(S) ,CPT® 16000,0982 - PRO FEE/OUTPT,N/A,N/A, $161.00 , $104.65 , $143.24 , $43.12 , $29.25 , $126.05 , $122.05 , $149.73 , $144.90 , $144.90 , $128.80 , $128.80 , $29.25 , $148.65 , $152.95 , $144.90 , $144.90 , $144.90 , $149.73 , $154.56 , $157.17 , $136.85 , $242.63 , $162.35 , N/A , $128.51 , $128.51 , $152.95 , $149.03 , $29.25 , $242.63 
Post OP Wound Infct Drain,CPT® 10180,N/A,N/A,N/A," $1,179.00 ", $766.35 , $560.69 , $168.12 , $111.13 , $482.45 , $474.37 ," $1,096.47 "," $1,061.10 "," $1,061.10 ", $943.20 , $943.20 , $111.13 ," $1,088.57 "," $1,120.05 "," $1,061.10 "," $1,061.10 "," $1,061.10 "," $1,096.47 "," $1,131.84 ", $615.17 ," $1,002.15 ", $954.47 , $613.85 , N/A , $491.86 , $491.86 ," $1,120.05 ", $570.41 , $111.13 ," $1,131.84 "
"Biopsy of Vagina,Simple",CPT® 57100,N/A,N/A,N/A, $653.00 , $424.45 , $305.90 , $61.60 , $46.08 , $273.07 , $267.14 , $607.29 , $587.70 , $587.70 , $522.40 , $522.40 , $46.08 , $602.91 , $620.35 , $587.70 , $587.70 , $587.70 , $607.29 , $626.88 , $321.79 , $555.05 , $351.46 , $273.12 , N/A , $278.40 , $278.40 , $620.35 , $333.93 , $46.08 , $626.88 
Mumps,CPT® 86735,N/A,N/A,N/A, $128.00 , $83.20 , N/A , $13.31 , $13.31 , $73.84 , $88.32 , $119.04 , $115.20 , $115.20 , $102.40 , $102.40 , $13.31 , $118.18 , $121.60 , $115.20 , $115.20 , $115.20 , $119.04 , $122.88 , $87.14 , $108.80 , $85.96 , $47.32 , N/A , $68.91 , $68.91 , $121.60 , $75.30 , $13.31 , $122.88 
 LEVOCARNITINE 200 MG/ML IV SOLN ,HCPCS J1955,0636 - DRUGS REQUIRING DETAILED CODIN,54482-0147-01,5 mL, $226.67 , $147.34 , $190.40 , $36.13 , $34.85 , $183.15 , $204.00 , $191.90 , $204.00 , $204.00 , $204.00 , $192.67 , $34.17 , $209.28 , $215.34 , $192.67 , $210.80 , $210.80 , $215.34 , $217.60 , $185.46 , $204.00 , $192.67 , $179.07 , N/A , $183.44 , $183.44 , $215.34 , $194.51 , $34.17 , $217.60 
 Fac Rp Loclzj Tum Plnr Whole Body Single Day Imaging ,CPT® 78802,0340 - NUCLEAR MEDICINE,N/A,N/A," $2,413.00 "," $1,568.45 "," $2,026.92 ", $283.34 , $262.76 ," $1,949.70 "," $2,171.70 "," $2,042.85 "," $2,171.70 "," $2,171.70 "," $2,171.70 "," $2,051.05 ", $257.61 ," $2,227.92 "," $2,292.35 "," $2,051.05 "," $2,244.09 "," $2,244.09 "," $2,292.35 "," $2,316.48 "," $1,974.32 "," $2,171.70 "," $2,051.05 "," $1,906.27 ", N/A ," $1,952.84 "," $1,952.84 "," $2,292.35 "," $2,070.60 ", $257.61 ," $2,316.48 "
 Fac Thromboendarterectomy; Axillary-Brachial ,CPT® 35321,0360 - OR SERVICES,N/A,N/A," $3,737.00 "," $2,429.05 "," $3,139.08 ", $801.06 ," $1,072.19 "," $3,019.50 "," $3,363.30 "," $3,163.74 "," $3,363.30 "," $3,363.30 "," $3,363.30 "," $3,176.45 "," $1,051.17 "," $3,450.37 "," $3,550.15 "," $3,176.45 "," $3,475.41 "," $3,475.41 "," $3,550.15 "," $3,587.52 "," $3,057.61 "," $3,363.30 "," $3,176.45 "," $2,952.23 ", N/A ," $3,024.35 "," $3,024.35 "," $3,550.15 "," $3,206.72 ", $801.06 ," $3,587.52 "
"Apply Finger Splint,Dynamic",29131,N/A,N/A,N/A, $348.00 , $226.20 , $208.13 , $32.91 , $23.04 , $161.49 , $163.04 , $323.64 , $313.20 , $313.20 , $278.40 , $278.40 , $23.04 , $321.31 , $330.60 , $313.20 , $313.20 , $313.20 , $323.64 , $334.08 , $192.53 , $295.80 , $178.41 , $195.79 , N/A , $164.64 , $164.64 , $330.60 , $193.50 , $23.04 , $334.08 
Revise Median N/Carpal Tunnel Surg,CPT® 64721,N/A,N/A,N/A," $2,658.00 "," $1,727.70 "," $2,135.38 ", $420.71 , $355.74 ," $2,342.38 "," $2,296.44 "," $2,471.94 "," $2,392.20 "," $2,392.20 "," $2,126.40 "," $2,126.40 ", $355.74 ," $2,454.13 "," $2,525.10 "," $2,392.20 "," $2,392.20 "," $2,392.20 "," $2,471.94 "," $2,551.68 "," $2,295.69 "," $2,259.30 "," $2,272.90 "," $2,518.27 ", N/A ," $2,388.09 "," $2,388.09 "," $2,525.10 "," $2,561.83 ", $355.74 ," $2,561.83 "
 Pro Exc Tr-Ext Mlg+Marg > 4 Cm ,CPT® 11606,0982 - PRO FEE/OUTPT,N/A,N/A," $1,933.00 "," $1,256.45 "," $1,003.41 ", $298.77 , $439.58 , $869.82 , $842.77 ," $1,797.69 "," $1,739.70 "," $1,739.70 "," $1,546.40 "," $1,546.40 ", $439.58 ," $1,784.74 "," $1,836.35 "," $1,739.70 "," $1,739.70 "," $1,739.70 "," $1,797.69 "," $1,855.68 "," $1,100.70 "," $1,643.05 "," $1,689.51 "," $1,111.40 ", N/A , $886.79 , $886.79 ," $1,836.35 "," $1,028.36 ", $298.77 ," $1,855.68 "
 Fac Mod Sed Other Phys/Qhp Initial 15 Mins 5/> Yrs ,CPT® 99156,0370 - ANESTHESIA,N/A,N/A, $135.00 , $87.75 , $113.40 , $72.45 , $60.13 , $109.08 , $121.50 , $114.29 , $121.50 , $121.50 , $121.50 , $114.75 , $58.95 , $124.65 , $128.25 , $114.75 , $125.55 , $125.55 , $128.25 , $129.60 , $110.46 , $121.50 , $114.75 , $106.65 , N/A , $109.26 , $109.26 , $128.25 , $115.84 , $58.95 , $129.60 
Advance Care Planning Ea Addl 30 Mins,CPT® 99498,N/A,N/A,N/A, $188.00 , $122.20 , $139.82 , $69.50 , $64.54 , N/A , N/A , $174.84 , $169.20 , $169.20 , $150.40 , $150.40 , $64.54 , $173.58 , $178.60 , $169.20 , $169.20 , $169.20 , $174.84 , $180.48 , $134.02 , $159.80 , $157.64 , $162.90 , N/A , $120.69 , $120.69 , $178.60 , $139.20 , $64.54 , $180.48 
 FUROSEMIDE 20 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,51079-0072-20,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Perq Vert Agmntj Cavity Crtj Uni/Bi Cannulj Lmbr,22514,N/A,N/A,N/A," $6,109.00 "," $3,970.85 "," $2,858.05 ", $445.26 ," $5,745.46 "," $2,336.16 "," $2,468.46 "," $5,681.37 "," $5,498.10 "," $5,498.10 "," $4,887.20 "," $4,887.20 "," $5,745.46 "," $5,640.44 "," $5,803.55 "," $5,498.10 "," $5,498.10 "," $5,498.10 "," $5,681.37 "," $5,864.64 "," $2,674.79 "," $5,192.65 "," $2,510.82 "," $2,752.56 ", N/A ," $2,381.74 "," $2,381.74 "," $5,803.55 "," $2,799.39 ", $445.26 ," $5,864.64 "
Lens Spher Bifoc Plano 4.00d,HCPCS V2200,N/A,N/A,N/A, $85.00 , $55.25 , N/A , $61.01 , N/A , N/A , N/A , $79.05 , $76.50 , $76.50 , $68.00 , $68.00 , N/A , $78.48 , $80.75 , $76.50 , $76.50 , $76.50 , $79.05 , $81.60 , N/A , $72.25 , $85.00 , $55.43 , N/A , N/A , N/A , $80.75 , N/A , $55.43 , $85.00 
Ventilation Assist & Mgmt Inpatient 1st Day,CPT® 94002,N/A,N/A,N/A," $1,352.00 ", $878.80 , $211.70 , $88.36 , $71.72 , $207.24 , $205.51 ," $1,257.36 "," $1,216.80 "," $1,216.80 "," $1,081.60 "," $1,081.60 ", $71.72 ," $1,248.30 "," $1,284.40 "," $1,216.80 "," $1,216.80 "," $1,216.80 "," $1,257.36 "," $1,297.92 ", $278.41 ," $1,149.20 ", $272.69 , $348.79 , N/A , $211.29 , $211.29 ," $1,284.40 ", $246.32 , $71.72 ," $1,297.92 "
Antibody Hla Class I & Class II Antigens Qual,CPT® 86828,N/A,N/A,N/A, $454.00 , $295.10 , N/A , $65.47 , $44.30 , $223.92 , $267.83 , $422.22 , $408.60 , $408.60 , $363.20 , $363.20 , $44.30 , $419.18 , $431.30 , $408.60 , $408.60 , $408.60 , $422.22 , $435.84 , $428.61 , $385.90 , $259.49 , $188.53 , N/A , $208.98 , $208.98 , $431.30 , $228.37 , $44.30 , $435.84 
Therapeutic Activities,CPT® 97530,N/A,N/A,N/A, $126.00 , $81.90 , $72.58 , $36.99 , $33.60 , $78.91 , $71.03 , $117.18 , $113.40 , $113.40 , $100.80 , $100.80 , $33.60 , $116.34 , $119.70 , $113.40 , $113.40 , $113.40 , $117.18 , $120.96 , $97.11 , $107.10 , $104.41 , $91.40 , N/A , $80.44 , $80.44 , $119.70 , $89.47 , $33.60 , $120.96 
 SODIUM CHLORIDE (HYPERTONIC) 5 % OP SOLN ,HCPCS RXC637,0250 - PHARMACY,00536-1254-94,15 mL, $25.20 , $16.38 , $21.17 , N/A , N/A , $20.36 , $22.68 , $21.33 , $22.68 , $22.68 , $22.68 , $21.42 , N/A , $23.27 , $23.94 , $21.42 , $23.44 , $23.44 , $23.94 , $24.19 , $20.62 , $22.68 , $21.42 , $19.91 , N/A , $20.39 , $20.39 , $23.94 , $21.62 , $19.91 , $24.19 
 Pro Treat Thigh Fracture ,CPT® 27248,0975 - PRO FEE/OR,N/A,N/A," $4,898.00 "," $3,183.70 "," $4,524.98 ", $706.58 , $824.74 ," $3,586.32 "," $3,555.48 "," $4,555.14 "," $4,408.20 "," $4,408.20 "," $3,918.40 "," $3,918.40 ", $824.74 ," $4,522.32 "," $4,653.10 "," $4,408.20 "," $4,408.20 "," $4,408.20 "," $4,555.14 "," $4,702.08 "," $4,204.96 "," $4,163.30 "," $3,932.08 "," $4,219.55 ", N/A ," $3,656.30 "," $3,656.30 "," $4,653.10 "," $4,297.46 ", $706.58 ," $4,702.08 "
 Ins Tunneled Cvad W Port 5 Yrs or Older ,CPT® 36561,0761 - TREATMENT ROOM,N/A,N/A," $5,901.00 "," $3,835.65 "," $4,956.84 ", $311.47 ," $1,557.13 "," $4,768.01 "," $5,310.90 "," $4,995.79 "," $5,310.90 "," $5,310.90 "," $5,310.90 "," $5,015.85 "," $1,526.60 "," $5,448.39 "," $5,605.95 "," $5,015.85 "," $5,487.93 "," $5,487.93 "," $5,605.95 "," $5,664.96 "," $4,828.20 "," $5,310.90 "," $5,015.85 "," $4,661.79 ", N/A ," $4,775.68 "," $4,775.68 "," $5,605.95 "," $5,063.65 ", $311.47 ," $5,664.96 "
 Pro Treatment of Penis Lesion ,CPT® 54220,0981 - PRO FEE/ER,N/A,N/A," $1,126.00 ", $731.90 , $581.48 , $125.43 , $341.89 , $430.28 , $436.29 ," $1,047.18 "," $1,013.40 "," $1,013.40 ", $900.80 , $900.80 , $341.89 ," $1,039.64 "," $1,069.70 "," $1,013.40 "," $1,013.40 "," $1,013.40 "," $1,047.18 "," $1,080.96 ", $546.67 , $957.10 , $697.57 , $645.59 , N/A , $438.67 , $438.67 ," $1,069.70 ", $525.78 , $125.43 ," $1,080.96 "
Remove Abdominal Wall Lesion,CPT® 22900,N/A,N/A,N/A," $3,603.00 "," $2,341.95 "," $3,404.96 ", $530.29 , $444.61 ," $2,698.99 "," $2,691.87 "," $3,350.79 "," $3,242.70 "," $3,242.70 "," $2,882.40 "," $2,882.40 ", $444.61 ," $3,326.65 "," $3,422.85 "," $3,242.70 "," $3,242.70 "," $3,242.70 "," $3,350.79 "," $3,458.88 "," $3,150.48 "," $3,062.55 "," $2,982.96 "," $3,176.55 ", N/A ," $2,751.65 "," $2,751.65 "," $3,422.85 "," $3,234.17 ", $444.61 ," $3,458.88 "
"Preventive Visit,New,65 & Over",CPT® 99387,N/A,N/A,N/A, $513.00 , $333.45 , N/A , $158.20 , $59.72 , $273.38 , $275.44 , $477.09 , $461.70 , $461.70 , $410.40 , $410.40 , $59.72 , $473.65 , $487.35 , $461.70 , $461.70 , $461.70 , $477.09 , $492.48 , $337.65 , $436.05 , $276.04 , $271.53 , N/A , $278.72 , $278.72 , $487.35 , $334.77 , $59.72 , $492.48 
 Fac Strpg Unna Boot ,CPT® 29580,0761 - TREATMENT ROOM,N/A,N/A, $341.00 , $221.65 , $286.44 , $25.02 , $20.61 , $275.53 , $306.90 , $288.69 , $306.90 , $306.90 , $306.90 , $289.85 , $20.21 , $314.85 , $323.95 , $289.85 , $317.13 , $317.13 , $323.95 , $327.36 , $279.01 , $306.90 , $289.85 , $269.39 , N/A , $275.97 , $275.97 , $323.95 , $292.61 , $20.21 , $327.36 
"Cortisol, Free",CPT® 82530,N/A,N/A,N/A, $197.00 , $128.05 , N/A , $17.04 , $17.04 , $94.54 , $113.10 , $183.21 , $177.30 , $177.30 , $157.60 , $157.60 , $17.04 , $181.89 , $187.15 , $177.30 , $177.30 , $177.30 , $183.21 , $189.12 , $111.58 , $167.45 , $110.29 , $60.59 , N/A , $88.23 , $88.23 , $187.15 , $96.42 , $17.04 , $189.12 
" Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC ",MS DRG V40 (FY2023) 561,N/A,N/A,N/A," $48,481.19 "," $31,512.77 "," $40,724.20 ", N/A , N/A ," $39,172.80 "," $43,633.07 "," $41,044.18 "," $43,633.07 "," $43,633.07 "," $43,633.07 "," $41,209.01 ", N/A ," $44,762.68 "," $46,057.13 "," $41,209.01 "," $45,087.51 "," $45,087.51 "," $46,057.13 "," $46,541.94 "," $39,667.31 "," $43,633.07 "," $41,209.01 "," $38,300.14 ", N/A ," $39,235.83 "," $39,235.83 "," $46,057.13 "," $41,601.71 "," $38,300.14 "," $46,541.94 "
 PRAMIPEXOLE DIHYDROCHLORIDE 0.125 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,13668-0091-90,1 tablet, $15.16 , $9.85 , $12.73 , N/A , N/A , $12.25 , $13.64 , $12.83 , $13.64 , $13.64 , $13.64 , $12.89 , N/A , $14.00 , $14.40 , $12.89 , $14.10 , $14.10 , $14.40 , $14.55 , $12.40 , $13.64 , $12.89 , $11.98 , N/A , $12.27 , $12.27 , $14.40 , $13.01 , $11.98 , $14.55 
 AMPHETAMINE-DEXTROAMPHET ER 10 MG PO CP24 ,HCPCS RXC637,0250 - PHARMACY,57664-0337-88,1 capsule, $31.52 , $20.49 , $26.48 , N/A , N/A , $25.47 , $28.37 , $26.68 , $28.37 , $28.37 , $28.37 , $26.79 , N/A , $29.10 , $29.94 , $26.79 , $29.31 , $29.31 , $29.94 , $30.26 , $25.79 , $28.37 , $26.79 , $24.90 , N/A , $25.51 , $25.51 , $29.94 , $27.05 , $24.90 , $30.26 
 Pro DXA Bone Density Study 1+ Sits Axial Skel ,CPT® 77080,0972 - PRO FEE/RAD/DX,N/A,N/A, $941.00 , $611.65 , $207.70 , $37.34 , $90.07 , $191.46 , $259.32 , $875.13 , $846.90 , $846.90 , $752.80 , $752.80 , $90.07 , $868.83 , $893.95 , $846.90 , $846.90 , $846.90 , $875.13 , $903.36 , $341.81 , $799.85 , $285.05 , $313.78 , N/A , $195.20 , $195.20 , $893.95 , $225.93 , $37.34 , $903.36 
 Pro Mod Sed Other Phys/Qhp Initial 15 Mins <5 Yrs ,CPT® 99155,0981 - PRO FEE/ER,N/A,N/A, $882.00 , $573.30 , $187.99 , $79.01 , $73.59 , $198.64 , $212.70 , $820.26 , $793.80 , $793.80 , $705.60 , $705.60 , $73.59 , $814.35 , $837.90 , $793.80 , $793.80 , $793.80 , $820.26 , $846.72 , $250.02 , $749.70 , $246.36 , $364.61 , N/A , $202.51 , $202.51 , $837.90 , $236.11 , $73.59 , $846.72 
"Knee Scope,Remv Loose Body",CPT® 29874,N/A,N/A,N/A," $3,550.00 "," $2,307.50 "," $3,269.31 ", $512.95 , $464.24 ," $2,594.34 "," $2,595.60 "," $3,301.50 "," $3,195.00 "," $3,195.00 "," $2,840.00 "," $2,840.00 ", $464.24 ," $3,277.72 "," $3,372.50 "," $3,195.00 "," $3,195.00 "," $3,195.00 "," $3,301.50 "," $3,408.00 "," $3,045.45 "," $3,017.50 "," $2,863.42 "," $3,055.89 ", N/A ," $2,644.96 "," $2,644.96 "," $3,372.50 "," $3,108.77 ", $464.24 ," $3,408.00 "
 Fac Islet Cell Antibody ,CPT® 86341,0300 - LABORATORY,N/A,N/A, $172.00 , $111.80 , $144.48 , $24.04 , $19.62 , $138.98 , $154.80 , $145.62 , $154.80 , $154.80 , $154.80 , $146.20 , $19.24 , $158.81 , $163.40 , $146.20 , $159.96 , $159.96 , $163.40 , $165.12 , $140.73 , $154.80 , $146.20 , $135.88 , N/A , $139.20 , $139.20 , $163.40 , $147.59 , $19.24 , $165.12 
" Fac Locm 100-199mg/Ml Iodine,1ml ",HCPCS Q9965,0636 - DRUGS REQUIRING DETAILED CODIN,N/A,N/A, $3.00 , $1.95 , $2.52 , $1.34 , $1.58 , $2.42 , $2.70 , $2.54 , $2.70 , $2.70 , $2.70 , $2.55 , $1.55 , $2.77 , $2.85 , $2.55 , $2.79 , $2.79 , $2.85 , $2.88 , $2.45 , $2.70 , $2.55 , $2.37 , N/A , $2.43 , $2.43 , $2.85 , $2.57 , $1.34 , $2.88 
Remv Pilonidal Lesion Complic,11772,N/A,N/A,N/A," $3,963.00 "," $2,575.95 "," $1,846.64 ", $548.02 , $432.26 ," $1,557.59 "," $1,531.58 "," $3,685.59 "," $3,566.70 "," $3,566.70 "," $3,170.40 "," $3,170.40 ", $432.26 ," $3,659.04 "," $3,764.85 "," $3,566.70 "," $3,566.70 "," $3,566.70 "," $3,685.59 "," $3,804.48 "," $2,033.11 "," $3,368.55 "," $3,070.37 "," $1,979.40 ", N/A ," $1,587.98 "," $1,587.98 "," $3,764.85 "," $1,841.52 ", $432.26 ," $3,804.48 "
 Fac Heterophile Antibodies ,CPT® 86308,0302 - LAB/IMMUNOLOGY,N/A,N/A, $83.00 , $53.95 , $69.72 , $5.28 , $5.28 , $67.06 , $74.70 , $70.27 , $74.70 , $74.70 , $74.70 , $70.55 , $5.18 , $76.63 , $78.85 , $70.55 , $77.19 , $77.19 , $78.85 , $79.68 , $67.91 , $74.70 , $70.55 , $65.57 , N/A , $67.17 , $67.17 , $78.85 , $71.22 , $5.18 , $79.68 
Simple Repair 2.5cm or Le,12011,N/A,N/A,N/A, $685.00 , $445.25 , $172.01 , $51.31 , $66.00 , $150.86 , $147.21 , $637.05 , $616.50 , $616.50 , $548.00 , $548.00 , $66.00 , $632.46 , $650.75 , $616.50 , $616.50 , $616.50 , $637.05 , $657.60 , $189.71 , $582.25 , $296.15 , $192.22 , N/A , $153.81 , $153.81 , $650.75 , $178.36 , $51.31 , $657.60 
 ATEZOLIZUMAB 840 MG/14ML IV SOLN ,HCPCS J9022,0636 - DRUGS REQUIRING DETAILED CODIN,50242-0918-01,14 mL," $21,296.87 "," $13,842.97 "," $17,889.37 ", $84.33 , $82.68 ," $17,207.87 "," $19,167.18 "," $18,029.93 "," $19,167.18 "," $19,167.18 "," $19,167.18 "," $18,102.34 ", $81.06 ," $19,663.40 "," $20,232.03 "," $18,102.34 "," $19,806.09 "," $19,806.09 "," $20,232.03 "," $20,445.00 "," $17,425.10 "," $19,167.18 "," $18,102.34 "," $16,824.53 ", N/A ," $17,235.56 "," $17,235.56 "," $20,232.03 "," $18,274.84 ", $81.06 ," $20,445.00 "
Diagnostic Computed Tomography Thorax W/O Cntrst,CPT® 71250,N/A,N/A,N/A," $2,468.00 "," $1,604.20 ", $943.67 , $135.95 , $250.57 , $858.63 ," $1,106.95 "," $2,295.24 "," $2,221.20 "," $2,221.20 "," $1,974.40 "," $1,974.40 ", $250.57 ," $2,278.70 "," $2,344.60 "," $2,221.20 "," $2,221.20 "," $2,221.20 "," $2,295.24 "," $2,369.28 ", $792.11 ," $2,097.80 "," $1,205.70 "," $1,056.69 ", N/A , $875.39 , $875.39 ," $2,344.60 "," $1,013.28 ", $135.95 ," $2,369.28 "
Fit/Insert Intravag Support Device,CPT® 57160,N/A,N/A,N/A, $460.00 , $299.00 , $213.95 , $43.44 , $15.36 , $191.41 , $190.18 , $427.80 , $414.00 , $414.00 , $368.00 , $368.00 , $15.36 , $424.72 , $437.00 , $414.00 , $414.00 , $414.00 , $427.80 , $441.60 , $228.25 , $391.00 , $249.77 , $192.55 , N/A , $195.15 , $195.15 , $437.00 , $234.06 , $15.36 , $441.60 
Tissue Expander Placement Breast Reconstruction,CPT® 19357,N/A,N/A,N/A," $7,848.00 "," $5,101.20 "," $3,690.84 "," $1,105.07 "," $1,330.88 "," $4,102.19 "," $4,052.47 "," $7,298.64 "," $7,063.20 "," $7,063.20 "," $6,278.40 "," $6,278.40 "," $1,330.88 "," $7,246.06 "," $7,455.60 "," $7,063.20 "," $7,063.20 "," $7,063.20 "," $7,298.64 "," $7,534.08 "," $4,066.93 "," $6,670.80 "," $8,115.71 "," $5,259.11 ", N/A ," $4,182.22 "," $4,182.22 "," $7,455.60 "," $4,849.97 "," $1,105.07 "," $8,115.71 "
 Skull Less Than 4 Views ,CPT® 70250,0320 - DX X-RAY,N/A,N/A, $365.00 , $237.25 , $306.60 , $35.33 , $34.64 , $294.92 , $328.50 , $309.01 , $328.50 , $328.50 , $328.50 , $310.25 , $33.96 , $337.00 , $346.75 , $310.25 , $339.45 , $339.45 , $346.75 , $350.40 , $298.64 , $328.50 , $310.25 , $288.35 , N/A , $295.39 , $295.39 , $346.75 , $313.21 , $33.96 , $350.40 
 BACITRACIN EX OINTMENT PACKET (INPT) ,HCPCS RXC637,0250 - PHARMACY,45802-0060-70,1 each, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Closed Rx Post Hip Fix Disloc,Anesth",CPT® 27266,N/A,N/A,N/A," $2,568.00 "," $1,669.20 "," $3,570.13 ", $559.59 , $549.47 ," $2,800.32 "," $2,792.35 "," $2,388.24 "," $2,311.20 "," $2,311.20 "," $2,054.40 "," $2,054.40 ", $549.47 ," $2,371.03 "," $2,439.60 "," $2,311.20 "," $2,311.20 "," $2,311.20 "," $2,388.24 "," $2,465.28 "," $3,311.68 "," $2,182.80 "," $3,082.86 "," $3,299.05 ", N/A ," $2,854.97 "," $2,854.97 "," $2,439.60 "," $3,355.60 ", $549.47 ," $3,570.13 "
 Fac Dop Echo P-W&/or Cont W/Spectral F-Up/Lmtd Std ,CPT® 93321,0483 - CARDIOLOGY – ECHOCARDIOLOGY,N/A,N/A, $398.00 , $258.70 , $334.32 , $24.66 , $47.42 , $321.58 , $358.20 , $336.95 , $358.20 , $358.20 , $358.20 , $338.30 , $46.49 , $367.47 , $378.10 , $338.30 , $370.14 , $370.14 , $378.10 , $382.08 , $325.64 , $358.20 , $338.30 , $314.42 , N/A , $322.10 , $322.10 , $378.10 , $341.52 , $24.66 , $382.08 
 Fac Ewhfo W/Joint(S) Cf ,HCPCS L3766,0274 - PROSTHETIC DEV,N/A,N/A," $1,519.00 ", $987.35 ," $1,275.96 "," $1,445.49 "," $1,001.19 "," $1,227.35 "," $1,367.10 "," $1,285.99 "," $1,367.10 "," $1,367.10 "," $1,367.10 "," $1,291.15 ", $981.56 ," $1,402.49 "," $1,443.05 "," $1,291.15 "," $1,412.67 "," $1,412.67 "," $1,443.05 "," $1,458.24 "," $1,242.85 "," $1,367.10 "," $1,291.15 "," $1,200.01 ", N/A ," $1,229.33 "," $1,229.33 "," $1,443.05 "," $1,303.45 ", $981.56 ," $1,458.24 "
 Fac Revsc Opn/Prq Tib/Pero W/Stnt/Angiop Uni Ea Vsl ,CPT® 37234,0360 - OR SERVICES,N/A,N/A," $16,200.00 "," $10,530.00 "," $13,608.00 ", $252.61 , $204.75 ," $13,089.60 "," $14,580.00 "," $13,714.92 "," $14,580.00 "," $14,580.00 "," $14,580.00 "," $13,770.00 ", $200.74 ," $14,957.46 "," $15,390.00 "," $13,770.00 "," $15,066.00 "," $15,066.00 "," $15,390.00 "," $15,552.00 "," $13,254.84 "," $14,580.00 "," $13,770.00 "," $12,798.00 ", N/A ," $13,110.66 "," $13,110.66 "," $15,390.00 "," $13,901.22 ", $200.74 ," $15,552.00 "
Deep Incis Shldr Bone Cortex,CPT® 23040,N/A,N/A,N/A," $4,732.00 "," $3,075.80 "," $4,380.35 ", $685.55 , $768.38 ," $3,463.41 "," $3,454.45 "," $4,400.76 "," $4,258.80 "," $4,258.80 "," $3,785.60 "," $3,785.60 ", $768.38 ," $4,369.06 "," $4,495.40 "," $4,258.80 "," $4,258.80 "," $4,258.80 "," $4,400.76 "," $4,542.72 "," $4,061.84 "," $4,022.20 "," $3,814.33 "," $4,076.13 ", N/A ," $3,530.99 "," $3,530.99 "," $4,495.40 "," $4,150.15 ", $685.55 ," $4,542.72 "
 Fac Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes ,CPT® 97130,0430 - OCCUPATION THER,N/A,N/A, $266.00 , $172.90 , $223.44 , $21.62 , $18.37 , $214.93 , $239.40 , $225.20 , $239.40 , $239.40 , $239.40 , $226.10 , $18.01 , $245.60 , $252.70 , $226.10 , $247.38 , $247.38 , $252.70 , $255.36 , $217.64 , $239.40 , $226.10 , $210.14 , N/A , $215.27 , $215.27 , $252.70 , $228.25 , $18.01 , $255.36 
"Renal Endoscopy,Cath Ureter",CPT® 50553,N/A,N/A,N/A," $2,694.00 "," $1,751.10 "," $1,684.06 ", $296.28 , $153.67 ," $1,538.31 "," $1,430.47 "," $2,505.42 "," $2,424.60 "," $2,424.60 "," $2,155.20 "," $2,155.20 ", $153.67 ," $2,487.37 "," $2,559.30 "," $2,424.60 "," $2,424.60 "," $2,424.60 "," $2,505.42 "," $2,586.24 "," $1,695.40 "," $2,289.90 "," $1,627.07 "," $1,937.70 ", N/A ," $1,568.33 "," $1,568.33 "," $2,559.30 "," $1,843.35 ", $153.67 ," $2,586.24 "
Open Rx Femur Fx+Plate/Screw,27507,N/A,N/A,N/A," $4,468.00 "," $2,904.20 "," $5,842.92 ", $913.43 , $865.46 ," $4,694.10 "," $4,649.94 "," $4,155.24 "," $4,021.20 "," $4,021.20 "," $3,574.40 "," $3,574.40 ", $865.46 ," $4,125.30 "," $4,244.60 "," $4,021.20 "," $4,021.20 "," $4,021.20 "," $4,155.24 "," $4,289.28 "," $5,449.56 "," $3,797.80 "," $5,147.02 "," $5,519.11 ", N/A ," $4,785.68 "," $4,785.68 "," $4,244.60 "," $5,624.88 ", $865.46 ," $5,842.92 "
 Fac Htlv/Hiv Confirmatory Test ,CPT® 86689,0300 - LABORATORY,N/A,N/A, $260.00 , $169.00 , $218.40 , $19.74 , $19.74 , $210.08 , $234.00 , $220.12 , $234.00 , $234.00 , $234.00 , $221.00 , $19.35 , $240.06 , $247.00 , $221.00 , $241.80 , $241.80 , $247.00 , $249.60 , $212.73 , $234.00 , $221.00 , $205.40 , N/A , $210.42 , $210.42 , $247.00 , $223.11 , $19.35 , $249.60 
 IOPAMIDOL 76 % IV SOLN ,HCPCS Q9967,0255 - DRUGS/RADIOLOGY,00270-1316-30,50 mL, $308.22 , $200.34 , $258.90 , $0.13 , $0.17 , $249.04 , $277.40 , $260.94 , $277.40 , $277.40 , $277.40 , $261.99 , $0.17 , $284.58 , $292.81 , $261.99 , $286.64 , $286.64 , $292.81 , $295.89 , $252.19 , $277.40 , $261.99 , $243.49 , N/A , $249.44 , $249.44 , $292.81 , $264.48 , $0.13 , $295.89 
 Fac Tx Prq Achll Tdn Spx Local Anes ,CPT® 27605,0360 - OR SERVICES,N/A,N/A," $1,686.00 "," $1,095.90 "," $1,416.24 ", $178.40 , $76.84 ," $1,362.29 "," $1,517.40 "," $1,427.37 "," $1,517.40 "," $1,517.40 "," $1,517.40 "," $1,433.10 ", $75.33 ," $1,556.68 "," $1,601.70 "," $1,433.10 "," $1,567.98 "," $1,567.98 "," $1,601.70 "," $1,618.56 "," $1,379.49 "," $1,517.40 "," $1,433.10 "," $1,331.94 ", N/A ," $1,364.48 "," $1,364.48 "," $1,601.70 "," $1,446.76 ", $75.33 ," $1,618.56 "
 Fac Chemodenervation Muscle Neck Unilat for Dystonia ,CPT® 64616,0360 - OR SERVICES,N/A,N/A, $803.00 , $521.95 , $674.52 , $98.15 , $78.09 , $648.82 , $722.70 , $679.82 , $722.70 , $722.70 , $722.70 , $682.55 , $76.56 , $741.41 , $762.85 , $682.55 , $746.79 , $746.79 , $762.85 , $770.88 , $657.01 , $722.70 , $682.55 , $634.37 , N/A , $649.87 , $649.87 , $762.85 , $689.05 , $76.56 , $770.88 
" Mra W/O Contrast, Abdominal ",HCPCS C8901,0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA-OTHER,N/A,N/A," $2,943.00 "," $1,912.95 "," $2,472.12 ", N/A , N/A ," $2,377.94 "," $2,648.70 "," $2,491.54 "," $2,648.70 "," $2,648.70 "," $2,648.70 "," $2,501.55 ", N/A ," $2,717.27 "," $2,795.85 "," $2,501.55 "," $2,736.99 "," $2,736.99 "," $2,795.85 "," $2,825.28 "," $2,407.96 "," $2,648.70 "," $2,501.55 "," $2,324.97 ", N/A ," $2,381.77 "," $2,381.77 "," $2,795.85 "," $2,525.39 "," $2,324.97 "," $2,825.28 "
" Fac Compatibility Test, Electric ",CPT® 86923,0300 - LABORATORY,N/A,N/A, $136.00 , $88.40 , $114.24 , N/A , $34.63 , $109.89 , $122.40 , $115.14 , $122.40 , $122.40 , $122.40 , $115.60 , $33.95 , $125.57 , $129.20 , $115.60 , $126.48 , $126.48 , $129.20 , $130.56 , $111.28 , $122.40 , $115.60 , $107.44 , N/A , $110.06 , $110.06 , $129.20 , $116.70 , $33.95 , $130.56 
" Fac Russell Viper Venom, Diluted ",CPT® 85613,0305 - LAB/HEMATOLOGY,N/A,N/A, $141.00 , $91.65 , $118.44 , $9.77 , $9.77 , $113.93 , $126.90 , $119.37 , $126.90 , $126.90 , $126.90 , $119.85 , $9.58 , $130.19 , $133.95 , $119.85 , $131.13 , $131.13 , $133.95 , $135.36 , $115.37 , $126.90 , $119.85 , $111.39 , N/A , $114.11 , $114.11 , $133.95 , $120.99 , $9.58 , $135.36 
 Fac Endoscopy Upper Small Intestine ,CPT® 44360,0360 - OR SERVICES,N/A,N/A," $2,066.00 "," $1,342.90 "," $1,735.44 ", $136.17 , $494.85 ," $1,669.33 "," $1,859.40 "," $1,749.08 "," $1,859.40 "," $1,859.40 "," $1,859.40 "," $1,756.10 ", $485.15 ," $1,907.54 "," $1,962.70 "," $1,756.10 "," $1,921.38 "," $1,921.38 "," $1,962.70 "," $1,983.36 "," $1,690.40 "," $1,859.40 "," $1,756.10 "," $1,632.14 ", N/A ," $1,672.01 "," $1,672.01 "," $1,962.70 "," $1,772.83 ", $136.17 ," $1,983.36 "
 Fac Implantable Tissue Marker ,HCPCS A4648,0278 - SUPPLY/IMPLANTS,N/A,N/A, $356.00 , $231.40 , $299.04 , N/A , N/A , $287.65 , $320.40 , $301.39 , $320.40 , $320.40 , $320.40 , $302.60 , N/A , $328.69 , $338.20 , $302.60 , $331.08 , $331.08 , $338.20 , $341.76 , $291.28 , $320.40 , $302.60 , $281.24 , N/A , $288.11 , $288.11 , $338.20 , $305.48 , $281.24 , $341.76 
 Fac Semi-Private Room ,Custom 1210000001,0121 - MED-SUR-GYN/2BED,N/A,N/A," $1,848.00 "," $1,201.20 "," $1,552.32 ", N/A , N/A ," $1,493.18 "," $1,663.20 "," $1,564.52 "," $1,663.20 "," $1,663.20 "," $1,663.20 "," $1,570.80 ", N/A ," $1,706.26 "," $1,755.60 "," $1,570.80 "," $1,718.64 "," $1,718.64 "," $1,755.60 "," $1,774.08 "," $1,512.03 "," $1,663.20 "," $1,570.80 "," $1,459.92 ", N/A ," $1,495.59 "," $1,495.59 "," $1,755.60 "," $1,585.77 "," $1,459.92 "," $1,774.08 "
"MRI, Face, Neck, Combo",CPT® 70543,N/A,N/A,N/A," $10,646.00 "," $6,919.90 "," $2,450.00 ", $349.15 , $633.95 ," $2,342.63 "," $2,974.48 "," $9,900.78 "," $9,581.40 "," $9,581.40 "," $8,516.80 "," $8,516.80 ", $633.95 ," $9,829.45 "," $10,113.70 "," $9,581.40 "," $9,581.40 "," $9,581.40 "," $9,900.78 "," $10,220.16 "," $2,109.58 "," $9,049.10 "," $3,241.53 "," $3,729.85 ", N/A ," $2,388.34 "," $2,388.34 "," $10,113.70 "," $2,764.54 ", $349.15 ," $10,220.16 "
 Pro Cltx Carp/Mtcrpl Dislc Thmb W/Mnpj ,CPT® 26641,0981 - PRO FEE/ER,N/A,N/A," $1,822.00 "," $1,184.30 "," $2,367.82 ", $373.63 , $58.71 ," $1,653.94 "," $1,633.22 "," $1,694.46 "," $1,639.80 "," $1,639.80 "," $1,457.60 "," $1,457.60 ", $58.71 ," $1,682.25 "," $1,730.90 "," $1,639.80 "," $1,639.80 "," $1,639.80 "," $1,694.46 "," $1,749.12 "," $2,180.49 "," $1,548.70 "," $1,791.20 "," $1,971.42 ", N/A ," $1,686.21 "," $1,686.21 "," $1,730.90 "," $1,981.90 ", $58.71 ," $2,367.82 "
"Cardiac Stress Tst,Tracing Only",CPT® 93017,N/A,N/A,N/A, $471.00 , $306.15 , $217.49 , $34.70 , $64.05 , $209.94 , $243.87 , $438.03 , $423.90 , $423.90 , $376.80 , $376.80 , $64.05 , $434.87 , $447.45 , $423.90 , $423.90 , $423.90 , $438.03 , $452.16 , $208.80 , $400.35 , $230.14 , $202.84 , N/A , $214.03 , $214.03 , $447.45 , $237.27 , $34.70 , $452.16 
Left Heart Cath by Transeptal Puncture,CPT® 93462,N/A,N/A,N/A," $4,590.00 "," $2,983.50 "," $1,229.61 ", $189.06 , $143.07 ," $1,110.51 "," $1,102.24 "," $4,268.70 "," $4,131.00 "," $4,131.00 "," $3,672.00 "," $3,672.00 ", $143.07 ," $4,237.95 "," $4,360.50 "," $4,131.00 "," $4,131.00 "," $4,131.00 "," $4,268.70 "," $4,406.40 "," $1,143.49 "," $3,901.50 "," $1,070.44 "," $1,205.97 ", N/A ," $1,132.18 "," $1,132.18 "," $4,360.50 "," $1,255.03 ", $143.07 ," $4,406.40 "
 Pro Psychotherapy W/Patient 60 Minutes ,CPT® 90837,0961 - PRO FEE/PSYCH,N/A,N/A, $495.00 , $321.75 , $174.64 , $129.40 , $115.70 , $282.88 , $254.06 , $460.35 , $445.50 , $445.50 , $396.00 , $396.00 , $115.70 , $457.03 , $470.25 , $445.50 , $445.50 , $445.50 , $460.35 , $475.20 , $334.66 , $420.75 , $330.47 , $481.69 , $175.00 , $288.40 , $288.40 , $470.25 , $336.21 , $115.70 , $481.69 
 Fac Endoven Abltj Incmptnt Vein Xtr Rf 2nd+ Veins ,CPT® 36476,0360 - OR SERVICES,N/A,N/A, $616.00 , $400.40 , $517.44 , $120.99 , $230.12 , $497.73 , $554.40 , $521.51 , $554.40 , $554.40 , $554.40 , $523.60 , $225.61 , $568.75 , $585.20 , $523.60 , $572.88 , $572.88 , $585.20 , $591.36 , $504.01 , $554.40 , $523.60 , $486.64 , N/A , $498.53 , $498.53 , $585.20 , $528.59 , $120.99 , $591.36 
 Fac Chg Hbb Full Gene Sequence ,CPT® 81364,0310 - PATHOLOGY LAB,N/A,N/A," $1,881.00 "," $1,222.65 "," $1,580.04 ", $331.07 , $264.85 ," $1,519.85 "," $1,692.90 "," $1,592.45 "," $1,692.90 "," $1,692.90 "," $1,692.90 "," $1,598.85 ", $259.66 ," $1,736.73 "," $1,786.95 "," $1,598.85 "," $1,749.33 "," $1,749.33 "," $1,786.95 "," $1,805.76 "," $1,539.03 "," $1,692.90 "," $1,598.85 "," $1,485.99 ", N/A ," $1,522.29 "," $1,522.29 "," $1,786.95 "," $1,614.09 ", $259.66 ," $1,805.76 "
Cath/Inject Sis/Hysterosalpingogram,CPT® 58340,N/A,N/A,N/A, $904.00 , $587.60 , $266.00 , $54.59 , $114.71 , $238.79 , $236.90 , $840.72 , $813.60 , $813.60 , $723.20 , $723.20 , $114.71 , $834.66 , $858.80 , $813.60 , $813.60 , $813.60 , $840.72 , $867.84 , $280.82 , $768.40 , $308.64 , $241.16 , N/A , $243.44 , $243.44 , $858.80 , $292.00 , $54.59 , $867.84 
 Fac Biopsy Soft Tissue Neck/Chest ,CPT® 21550,0360 - OR SERVICES,N/A,N/A," $2,225.00 "," $1,446.25 "," $1,869.00 ", $150.40 , $50.81 ," $1,797.80 "," $2,002.50 "," $1,883.69 "," $2,002.50 "," $2,002.50 "," $2,002.50 "," $1,891.25 ", $49.81 ," $2,054.34 "," $2,113.75 "," $1,891.25 "," $2,069.25 "," $2,069.25 "," $2,113.75 "," $2,136.00 "," $1,820.50 "," $2,002.50 "," $1,891.25 "," $1,757.75 ", N/A ," $1,800.69 "," $1,800.69 "," $2,113.75 "," $1,909.27 ", $49.81 ," $2,136.00 "
" Pro Strapping,Ankle ",CPT® 29540,0981 - PRO FEE/ER,N/A,N/A, $186.00 , $120.90 , $109.46 , $16.87 , $27.51 , $89.69 , $127.55 , $172.98 , $167.40 , $167.40 , $148.80 , $148.80 , $27.51 , $171.73 , $176.70 , $167.40 , $167.40 , $167.40 , $172.98 , $178.56 , $102.32 , $158.10 , $137.37 , $106.42 , N/A , $91.44 , $91.44 , $176.70 , $107.47 , $16.87 , $178.56 
 Fac Indium111 Oxyquinoline Wbc Diag per Study-C ,HCPCS A9570,0343 - DIAGNOSTIC RADIOPHARMACEUTICALS,N/A,N/A," $3,230.00 "," $2,099.50 "," $2,713.20 ", N/A , N/A ," $2,609.84 "," $2,907.00 "," $2,734.52 "," $2,907.00 "," $2,907.00 "," $2,907.00 "," $2,745.50 ", N/A ," $2,982.26 "," $3,068.50 "," $2,745.50 "," $3,003.90 "," $3,003.90 "," $3,068.50 "," $3,100.80 "," $2,642.79 "," $2,907.00 "," $2,745.50 "," $2,551.70 ", N/A ," $2,614.04 "," $2,614.04 "," $3,068.50 "," $2,771.66 "," $2,551.70 "," $3,100.80 "
Close Enterostomy,CPT® 44620,N/A,N/A,N/A," $5,681.00 "," $3,692.65 "," $5,180.11 ", $804.20 , $922.06 ," $4,101.89 "," $4,140.44 "," $5,283.33 "," $5,112.90 "," $5,112.90 "," $4,544.80 "," $4,544.80 ", $922.06 ," $5,245.27 "," $5,396.95 "," $5,112.90 "," $5,112.90 "," $5,112.90 "," $5,283.33 "," $5,453.76 "," $3,713.20 "," $4,828.85 "," $4,592.18 "," $4,848.78 ", N/A ," $4,181.92 "," $4,181.92 "," $5,396.95 "," $4,373.84 ", $804.20 ," $5,453.76 "
"Open Rx Carpomet Disl,Non-Thumb,W/WO Fix",CPT® 26685,N/A,N/A,N/A," $3,800.00 "," $2,470.00 "," $3,537.89 ", $555.77 , $307.34 ," $2,777.20 "," $2,791.76 "," $3,534.00 "," $3,420.00 "," $3,420.00 "," $3,040.00 "," $3,040.00 ", $307.34 ," $3,508.54 "," $3,610.00 "," $3,420.00 "," $3,420.00 "," $3,420.00 "," $3,534.00 "," $3,648.00 "," $3,287.45 "," $3,230.00 "," $3,077.51 "," $3,293.15 ", N/A ," $2,831.39 "," $2,831.39 "," $3,610.00 "," $3,327.89 ", $307.34 ," $3,648.00 "
 Pro Treat Clavicle Dislocation ,CPT® 23552,0982 - PRO FEE/OUTPT,N/A,N/A," $4,508.00 "," $2,930.20 "," $3,995.62 ", $621.15 , $768.38 ," $3,146.73 "," $3,159.48 "," $4,192.44 "," $4,057.20 "," $4,057.20 "," $3,606.40 "," $3,606.40 ", $768.38 ," $4,162.24 "," $4,282.60 "," $4,057.20 "," $4,057.20 "," $4,057.20 "," $4,192.44 "," $4,327.68 "," $3,712.64 "," $3,831.80 "," $3,486.06 "," $3,721.44 ", N/A ," $3,208.13 "," $3,208.13 "," $4,282.60 "," $3,770.70 ", $621.15 ," $4,327.68 "
Glucose Tolerance Test (Gtt),CPT® 82951,N/A,N/A,N/A, $128.00 , $83.20 , N/A , $13.13 , $13.13 , $72.84 , $87.10 , $119.04 , $115.20 , $115.20 , $102.40 , $102.40 , $13.13 , $118.18 , $121.60 , $115.20 , $115.20 , $115.20 , $119.04 , $122.88 , $85.94 , $108.80 , $84.34 , $46.57 , N/A , $67.98 , $67.98 , $121.60 , $74.28 , $13.13 , $122.88 
 Os Calcis or Heel Min 2 Views ,CPT® 73650,0320 - DX X-RAY,N/A,N/A, $257.00 , $167.05 , $215.88 , $28.08 , $25.85 , $207.66 , $231.30 , $217.58 , $231.30 , $231.30 , $231.30 , $218.45 , $25.34 , $237.29 , $244.15 , $218.45 , $239.01 , $239.01 , $244.15 , $246.72 , $210.28 , $231.30 , $218.45 , $203.03 , N/A , $207.99 , $207.99 , $244.15 , $220.53 , $25.34 , $246.72 
" Debrid, Skin, Sub-Q Tissue,Each Add 20 Sq Cm ",CPT® 11045,0761 - TREATMENT ROOM,N/A,N/A," $1,125.00 ", $731.25 , $945.00 , $23.74 , $12.63 , $909.00 ," $1,012.50 ", $952.43 ," $1,012.50 "," $1,012.50 "," $1,012.50 ", $956.25 , $12.38 ," $1,038.71 "," $1,068.75 ", $956.25 ," $1,046.25 "," $1,046.25 "," $1,068.75 "," $1,080.00 ", $920.48 ," $1,012.50 ", $956.25 , $888.75 , N/A , $910.46 , $910.46 ," $1,068.75 ", $965.36 , $12.38 ," $1,080.00 "
" Fac Immunoassay, Nonantibody ",CPT® 83519,0302 - LAB/IMMUNOLOGY,N/A,N/A, $217.00 , $141.05 , $182.28 , $18.77 , $18.76 , $175.34 , $195.30 , $183.71 , $195.30 , $195.30 , $195.30 , $184.45 , $18.39 , $200.36 , $206.15 , $184.45 , $201.81 , $201.81 , $206.15 , $208.32 , $177.55 , $195.30 , $184.45 , $171.43 , N/A , $175.62 , $175.62 , $206.15 , $186.21 , $18.39 , $208.32 
Special Casting Material,HCPCS A4590,N/A,N/A,N/A, $116.00 , $75.40 , N/A , N/A , N/A , N/A , N/A , $107.88 , $104.40 , $104.40 , $92.80 , $92.80 , N/A , $107.10 , $110.20 , $104.40 , $104.40 , $104.40 , $107.88 , $111.36 , N/A , $98.60 , $50.60 , $29.42 , N/A , N/A , N/A , $110.20 , N/A , $29.42 , $111.36 
Thyroid Stim Immunoglobulins (Tsi),CPT® 84445,N/A,N/A,N/A, $383.00 , $248.95 , N/A , $51.88 , $32.28 , $131.58 , $157.40 , $356.19 , $344.70 , $344.70 , $306.40 , $306.40 , $32.28 , $353.62 , $363.85 , $344.70 , $344.70 , $344.70 , $356.19 , $367.68 , $339.60 , $325.55 , $332.48 , $184.38 , N/A , $122.80 , $122.80 , $363.85 , $134.20 , $32.28 , $367.68 
 Pro Control Nasal Hemorrhage ,CPT® 30905,0982 - PRO FEE/OUTPT,N/A,N/A," $1,138.00 ", $739.70 , $562.01 , $99.47 , $223.20 , $380.68 , $372.34 ," $1,058.34 "," $1,024.20 "," $1,024.20 ", $910.40 , $910.40 , $223.20 ," $1,050.72 "," $1,081.10 "," $1,024.20 "," $1,024.20 "," $1,024.20 "," $1,058.34 "," $1,092.48 ", $541.66 , $967.30 , $529.87 , $535.02 , N/A , $388.11 , $388.11 ," $1,081.10 ", $457.08 , $99.47 ," $1,092.48 "
 Hip Arthrography ,CPT® 73525,0320 - DX X-RAY,N/A,N/A," $1,156.00 ", $751.40 , $971.04 , $128.89 , $92.85 , $934.05 ," $1,040.40 ", $978.67 ," $1,040.40 "," $1,040.40 "," $1,040.40 ", $982.60 , $91.03 ," $1,067.33 "," $1,098.20 ", $982.60 ," $1,075.08 "," $1,075.08 "," $1,098.20 "," $1,109.76 ", $945.84 ," $1,040.40 ", $982.60 , $913.24 , N/A , $935.55 , $935.55 ," $1,098.20 ", $991.96 , $91.03 ," $1,109.76 "
 DEXAMETHASONE 2 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00054-8176-25,1 tablet, $3.82 , $2.48 , $3.21 , N/A , N/A , $3.09 , $3.44 , $3.23 , $3.44 , $3.44 , $3.44 , $3.25 , N/A , $3.53 , $3.63 , $3.25 , $3.55 , $3.55 , $3.63 , $3.67 , $3.13 , $3.44 , $3.25 , $3.02 , N/A , $3.09 , $3.09 , $3.63 , $3.28 , $3.02 , $3.67 
Open Rx Rad/Ulna Shaft Fx+Fix 1,CPT® 25574,N/A,N/A,N/A," $4,277.00 "," $2,780.05 "," $4,119.57 ", $648.80 , $485.34 ," $3,245.38 "," $3,243.45 "," $3,977.61 "," $3,849.30 "," $3,849.30 "," $3,421.60 "," $3,421.60 ", $485.34 ," $3,948.95 "," $4,063.15 "," $3,849.30 "," $3,849.30 "," $3,849.30 "," $3,977.61 "," $4,105.92 "," $3,831.23 "," $3,635.45 "," $3,575.26 "," $3,831.48 ", N/A ," $3,308.70 "," $3,308.70 "," $4,063.15 "," $3,888.89 ", $485.34 ," $4,119.57 "
 DILTIAZEM HCL 100 MG IV SOLR ,HCPCS RXA250,0250 - PHARMACY,00409-4350-03,1 each, $70.34 , $45.72 , $59.09 , N/A , N/A , $56.83 , $63.31 , $59.55 , $63.31 , $63.31 , $63.31 , $59.79 , N/A , $64.94 , $66.82 , $59.79 , $65.42 , $65.42 , $66.82 , $67.53 , $57.55 , $63.31 , $59.79 , $55.57 , N/A , $56.93 , $56.93 , $66.82 , $60.36 , $55.57 , $67.53 
Mast Smpl Compl,19303,N/A,N/A,N/A," $4,281.00 "," $2,782.65 "," $2,989.89 ", $887.00 , $664.14 ," $2,713.01 "," $2,632.15 "," $3,981.33 "," $3,852.90 "," $3,852.90 "," $3,424.80 "," $3,424.80 ", $664.14 ," $3,952.65 "," $4,066.95 "," $3,852.90 "," $3,852.90 "," $3,852.90 "," $3,981.33 "," $4,109.76 "," $3,274.28 "," $3,638.85 "," $5,320.08 "," $3,254.96 ", N/A ," $2,765.94 "," $2,765.94 "," $4,066.95 "," $3,207.58 ", $664.14 ," $5,320.08 "
 Fac Brnchsc Brushing/Protected Brushings ,CPT® 31623,0360 - OR SERVICES,N/A,N/A," $2,809.00 "," $1,825.85 "," $2,359.56 ", $125.81 , $210.86 ," $2,269.67 "," $2,528.10 "," $2,378.10 "," $2,528.10 "," $2,528.10 "," $2,528.10 "," $2,387.65 ", $206.73 ," $2,593.55 "," $2,668.55 "," $2,387.65 "," $2,612.37 "," $2,612.37 "," $2,668.55 "," $2,696.64 "," $2,298.32 "," $2,528.10 "," $2,387.65 "," $2,219.11 ", N/A ," $2,273.32 "," $2,273.32 "," $2,668.55 "," $2,410.40 ", $125.81 ," $2,696.64 "
Ntrprof Phone/Ntrnet/Ehr Assmt&Mgmt 5/> Min,CPT® 99451,N/A,N/A,N/A, $140.00 , $91.00 , $69.04 , $34.81 , $29.19 , $76.22 , N/A , $130.20 , $126.00 , $126.00 , $112.00 , $112.00 , $29.19 , $129.26 , $133.00 , $126.00 , $126.00 , $126.00 , $130.20 , $134.40 , $65.53 , $119.00 , $78.45 , $80.44 , N/A , $77.70 , $77.70 , $133.00 , $90.58 , $29.19 , $134.40 
Exc Tumor Soft Tissue Neck/Ant Thorax Subfascial 5+Cm,21554,N/A,N/A,N/A," $5,013.00 "," $3,258.45 "," $4,408.04 ", $688.01 , $607.30 ," $3,515.65 "," $3,494.74 "," $4,662.09 "," $4,511.70 "," $4,511.70 "," $4,010.40 "," $4,010.40 ", $607.30 ," $4,628.50 "," $4,762.35 "," $4,511.70 "," $4,511.70 "," $4,511.70 "," $4,662.09 "," $4,812.48 "," $4,080.46 "," $4,261.05 "," $3,860.71 "," $4,118.79 ", N/A ," $3,584.25 "," $3,584.25 "," $4,762.35 "," $4,212.78 ", $607.30 ," $4,812.48 "
Ureteroplasty,CPT® 50700,N/A,N/A,N/A," $6,447.00 "," $4,190.55 "," $5,009.06 ", $880.56 ," $1,229.45 "," $4,530.03 "," $4,213.05 "," $5,995.71 "," $5,802.30 "," $5,802.30 "," $5,157.60 "," $5,157.60 "," $1,229.45 "," $5,952.52 "," $6,124.65 "," $5,802.30 "," $5,802.30 "," $5,802.30 "," $5,995.71 "," $6,189.12 "," $5,027.16 "," $5,479.95 "," $4,768.80 "," $5,693.63 ", N/A ," $4,618.42 "," $4,618.42 "," $6,124.65 "," $5,428.27 ", $880.56 ," $6,189.12 "
" Fac Fibrin Degradation, Quant ",CPT® 85379,0305 - LAB/HEMATOLOGY,N/A,N/A, $202.00 , $131.30 , $169.68 , $10.38 , $10.38 , $163.22 , $181.80 , $171.01 , $181.80 , $181.80 , $181.80 , $171.70 , $10.18 , $186.51 , $191.90 , $171.70 , $187.86 , $187.86 , $191.90 , $193.92 , $165.28 , $181.80 , $171.70 , $159.58 , N/A , $163.48 , $163.48 , $191.90 , $173.34 , $10.18 , $193.92 
 Sestamibi per Study Dose ,HCPCS A9500,0343 - DIAGNOSTIC RADIOPHARMACEUTICALS,N/A,N/A, $534.00 , $347.10 , $448.56 , $118.61 , $118.22 , $431.47 , $480.60 , $452.08 , $480.60 , $480.60 , $480.60 , $453.90 , $115.90 , $493.04 , $507.30 , $453.90 , $496.62 , $496.62 , $507.30 , $512.64 , $436.92 , $480.60 , $453.90 , $421.86 , N/A , $432.17 , $432.17 , $507.30 , $458.23 , $115.90 , $512.64 
Partial Removal of Fibula,CPT® 27641,N/A,N/A,N/A," $4,156.00 "," $2,701.40 "," $3,996.01 ", $625.43 , $768.38 ," $3,240.15 "," $3,201.61 "," $3,865.08 "," $3,740.40 "," $3,740.40 "," $3,324.80 "," $3,324.80 ", $768.38 ," $3,837.23 "," $3,948.20 "," $3,740.40 "," $3,740.40 "," $3,740.40 "," $3,865.08 "," $3,989.76 "," $3,734.70 "," $3,532.60 "," $3,521.74 "," $3,816.47 ", N/A ," $3,303.37 "," $3,303.37 "," $3,948.20 "," $3,882.63 ", $625.43 ," $3,996.01 "
Rhophylac Injection,HCPCS J2791,N/A,N/A,N/A, $39.00 , $25.35 , N/A , $5.00 , $5.08 , N/A , N/A , $36.27 , $35.10 , $35.10 , $31.20 , $31.20 , $5.08 , $36.01 , $37.05 , $35.10 , $35.10 , $35.10 , $36.27 , $37.44 , $6.11 , $33.15 , $9.73 , $6.14 , N/A , N/A , N/A , $37.05 , N/A , $5.00 , $37.44 
 Fac Teaec +-Patch Grf Abdl Aorta ,CPT® 35331,0360 - OR SERVICES,N/A,N/A," $5,489.00 "," $3,567.85 "," $4,610.76 "," $1,301.43 "," $1,340.24 "," $4,435.11 "," $4,940.10 "," $4,646.99 "," $4,940.10 "," $4,940.10 "," $4,940.10 "," $4,665.65 "," $1,313.96 "," $5,067.99 "," $5,214.55 "," $4,665.65 "," $5,104.77 "," $5,104.77 "," $5,214.55 "," $5,269.44 "," $4,491.10 "," $4,940.10 "," $4,665.65 "," $4,336.31 ", N/A ," $4,442.25 "," $4,442.25 "," $5,214.55 "," $4,710.11 "," $1,301.43 "," $5,269.44 "
 Respiratory Infections And Inflammations With McC ,MS DRG V40 (FY2023) 177,N/A,N/A,N/A," $24,402.78 "," $15,861.81 "," $20,498.34 ", N/A , N/A ," $19,717.45 "," $21,962.50 "," $20,659.39 "," $21,962.50 "," $21,962.50 "," $21,962.50 "," $20,742.36 ", N/A ," $22,531.09 "," $23,182.64 "," $20,742.36 "," $22,694.59 "," $22,694.59 "," $23,182.64 "," $23,426.67 "," $19,966.35 "," $21,962.50 "," $20,742.36 "," $19,278.20 ", N/A ," $19,749.17 "," $19,749.17 "," $23,182.64 "," $20,940.03 "," $19,278.20 "," $23,426.67 "
 Sc Bx Pancreas Perc Ndl ,CPT® 48102,0761 - TREATMENT ROOM,N/A,N/A," $1,447.00 ", $940.55 ," $1,215.48 ", $225.24 , $490.80 ," $1,169.18 "," $1,302.30 "," $1,225.03 "," $1,302.30 "," $1,302.30 "," $1,302.30 "," $1,229.95 ", $481.18 ," $1,336.02 "," $1,374.65 "," $1,229.95 "," $1,345.71 "," $1,345.71 "," $1,374.65 "," $1,389.12 "," $1,183.94 "," $1,302.30 "," $1,229.95 "," $1,143.13 ", N/A ," $1,171.06 "," $1,171.06 "," $1,374.65 "," $1,241.67 ", $225.24 ," $1,389.12 "
 ADO-TRASTUZUMAB EMTANSINE 100 MG IV SOLR ,HCPCS J9354,0636 - DRUGS REQUIRING DETAILED CODIN,50242-0088-01,5 mL," $11,002.85 "," $7,151.85 "," $9,242.39 ", $39.10 , $37.00 ," $8,890.30 "," $9,902.57 "," $9,315.01 "," $9,902.57 "," $9,902.57 "," $9,902.57 "," $9,352.42 ", $36.27 ," $10,158.93 "," $10,452.71 "," $9,352.42 "," $10,232.65 "," $10,232.65 "," $10,452.71 "," $10,562.74 "," $9,002.53 "," $9,902.57 "," $9,352.42 "," $8,692.25 ", N/A ," $8,904.61 "," $8,904.61 "," $10,452.71 "," $9,441.55 ", $36.27 ," $10,562.74 "
 Fac Comprehensive Review of Data ,CPT® 88325,0312 - PATHOL/HISTOL,N/A,N/A," $1,131.00 ", $735.15 , $950.04 , $131.01 , $120.81 , $913.85 ," $1,017.90 ", $957.50 ," $1,017.90 "," $1,017.90 "," $1,017.90 ", $961.35 , $118.44 ," $1,044.25 "," $1,074.45 ", $961.35 ," $1,051.83 "," $1,051.83 "," $1,074.45 "," $1,085.76 ", $925.38 ," $1,017.90 ", $961.35 , $893.49 , N/A , $915.32 , $915.32 ," $1,074.45 ", $970.51 , $118.44 ," $1,085.76 "
Duplex Lo Extrem Art Unilat/Ltd,CPT® 93926,N/A,N/A,N/A," $1,339.00 ", $870.35 , $822.71 , $125.31 , $148.70 , $824.08 , $823.32 ," $1,245.27 "," $1,205.10 "," $1,205.10 "," $1,071.20 "," $1,071.20 ", $148.70 ," $1,236.30 "," $1,272.05 "," $1,205.10 "," $1,205.10 "," $1,205.10 "," $1,245.27 "," $1,285.44 ", $642.13 ," $1,138.15 ", $439.95 , $578.09 , N/A , $840.15 , $840.15 ," $1,272.05 ", $931.31 , $125.31 ," $1,285.44 "
 Fac Bx Breast W Device Addl Lesion Magnet Res Guide ,CPT® 19086,0361 - OR/MINOR,N/A,N/A," $4,621.00 "," $3,003.65 "," $3,881.64 ", $86.42 , $68.60 ," $3,733.77 "," $4,158.90 "," $3,912.14 "," $4,158.90 "," $4,158.90 "," $4,158.90 "," $3,927.85 ", $67.25 ," $4,266.57 "," $4,389.95 "," $3,927.85 "," $4,297.53 "," $4,297.53 "," $4,389.95 "," $4,436.16 "," $3,780.90 "," $4,158.90 "," $3,927.85 "," $3,650.59 ", N/A ," $3,739.78 "," $3,739.78 "," $4,389.95 "," $3,965.28 ", $67.25 ," $4,436.16 "
"Chylmd Trach, Dna, Amp Probe",CPT® 87491,N/A,N/A,N/A, $317.00 , $206.05 , N/A , $35.79 , $35.79 , $198.56 , $237.51 , $294.81 , $285.30 , $285.30 , $253.60 , $253.60 , $35.79 , $292.69 , $301.15 , $285.30 , $285.30 , $285.30 , $294.81 , $304.32 , $234.30 , $269.45 , $230.30 , $127.26 , N/A , $185.31 , $185.31 , $301.15 , $202.50 , $35.79 , $304.32 
"Amputation Foot,Midtarsal-Chopart",CPT® 28800,N/A,N/A,N/A," $4,244.00 "," $2,758.60 "," $3,268.33 ", $509.18 , $537.90 ," $2,669.86 "," $2,674.01 "," $3,946.92 "," $3,819.60 "," $3,819.60 "," $3,395.20 "," $3,395.20 ", $537.90 ," $3,918.49 "," $4,031.80 "," $3,819.60 "," $3,819.60 "," $3,819.60 "," $3,946.92 "," $4,074.24 "," $3,035.75 "," $3,607.40 "," $2,929.43 "," $3,108.62 ", N/A ," $2,721.95 "," $2,721.95 "," $4,031.80 "," $3,199.27 ", $509.18 ," $4,074.24 "
Gerd Tst W/ Nasal Impedence Electrod,CPT® 91037,N/A,N/A,N/A, $794.00 , $516.10 , $404.14 , $166.18 , $132.55 , $358.37 , $387.96 , $738.42 , $714.60 , $714.60 , $635.20 , $635.20 , $132.55 , $733.10 , $754.30 , $714.60 , $714.60 , $714.60 , $738.42 , $762.24 , $755.60 , $674.90 , $513.95 , $612.40 , N/A , $365.36 , $365.36 , $754.30 , $425.94 , $132.55 , $762.24 
 Fac Chg Hba1/Hba2 Gene Analysis Full Gene Sequence ,CPT® 81259,0300 - LABORATORY,N/A,N/A," $3,851.00 "," $2,503.15 "," $3,234.84 ", $612.00 , $489.60 ," $3,111.61 "," $3,465.90 "," $3,260.26 "," $3,465.90 "," $3,465.90 "," $3,465.90 "," $3,273.35 ", $480.00 ," $3,555.63 "," $3,658.45 "," $3,273.35 "," $3,581.43 "," $3,581.43 "," $3,658.45 "," $3,696.96 "," $3,150.89 "," $3,465.90 "," $3,273.35 "," $3,042.29 ", N/A ," $3,116.61 "," $3,116.61 "," $3,658.45 "," $3,304.54 ", $480.00 ," $3,696.96 "
Blood Viscosity Examination,CPT® 85810,N/A,N/A,N/A, $128.00 , $83.20 , N/A , $11.90 , $11.90 , $66.06 , $78.97 , $119.04 , $115.20 , $115.20 , $102.40 , $102.40 , $11.90 , $118.18 , $121.60 , $115.20 , $115.20 , $115.20 , $119.04 , $122.88 , $77.92 , $108.80 , $76.23 , $42.32 , N/A , $61.65 , $61.65 , $121.60 , $67.37 , $11.90 , $122.88 
Open Rx Kneecap Dislocatn,CPT® 27566,N/A,N/A,N/A," $5,973.00 "," $3,882.45 "," $5,408.78 ", $846.59 , $768.38 ," $4,307.54 "," $4,272.42 "," $5,554.89 "," $5,375.70 "," $5,375.70 "," $4,778.40 "," $4,778.40 ", $768.38 ," $5,514.87 "," $5,674.35 "," $5,375.70 "," $5,375.70 "," $5,375.70 "," $5,554.89 "," $5,734.08 "," $5,034.43 "," $5,077.05 "," $4,724.20 "," $5,074.39 ", N/A ," $4,391.59 "," $4,391.59 "," $5,674.35 "," $5,161.69 ", $768.38 ," $5,734.08 "
Iaad Ia Hepatitis Be Antigen,CPT® 87350,N/A,N/A,N/A, $108.00 , $70.20 , N/A , $11.76 , $11.76 , $65.23 , $77.98 , $100.44 , $97.20 , $97.20 , $86.40 , $86.40 , $11.76 , $99.72 , $102.60 , $97.20 , $97.20 , $97.20 , $100.44 , $103.68 , $76.99 , $91.80 , $76.23 , $41.79 , N/A , $60.88 , $60.88 , $102.60 , $66.53 , $11.76 , $103.68 
Remv Tissue for Graft Othr,CPT® 20926,N/A,N/A,N/A," $2,450.00 "," $1,592.50 ", N/A , N/A , N/A , N/A ," $2,125.65 "," $2,278.50 "," $2,205.00 "," $2,205.00 "," $1,960.00 "," $1,960.00 ", N/A ," $2,262.09 "," $2,327.50 "," $2,205.00 "," $2,205.00 "," $2,205.00 "," $2,278.50 "," $2,352.00 ", N/A ," $2,082.50 ", N/A , N/A , N/A , N/A , N/A ," $2,327.50 ", N/A ," $1,960.00 "," $2,352.00 "
 Fac Ambulatory Bp Mntr W/Sw 24 Hr+ Recording Only ,CPT® 93786,0480 - CARDIOLOGY,N/A,N/A, $88.00 , $57.20 , $73.92 , $21.78 , $32.85 , $71.10 , $79.20 , $74.50 , $79.20 , $79.20 , $79.20 , $74.80 , $32.21 , $81.25 , $83.60 , $74.80 , $81.84 , $81.84 , $83.60 , $84.48 , $72.00 , $79.20 , $74.80 , $69.52 , N/A , $71.22 , $71.22 , $83.60 , $75.51 , $21.78 , $84.48 
 Bld Transfus > Hrs ,CPT® 36430,0391 - BLOOD/ADMIN,N/A,N/A, $847.00 , $550.55 , $711.48 , $37.97 , $21.99 , $684.38 , $762.30 , $717.07 , $762.30 , $762.30 , $762.30 , $719.95 , $21.56 , $782.04 , $804.65 , $719.95 , $787.71 , $787.71 , $804.65 , $813.12 , $693.02 , $762.30 , $719.95 , $669.13 , N/A , $685.48 , $685.48 , $804.65 , $726.81 , $21.56 , $813.12 
Triiodothyronine Free Assay (Ft-3),CPT® 84481,N/A,N/A,N/A, $219.00 , $142.35 , N/A , $17.28 , $16.40 , $66.85 , $79.96 , $203.67 , $197.10 , $197.10 , $175.20 , $175.20 , $16.40 , $202.20 , $208.05 , $197.10 , $197.10 , $197.10 , $203.67 , $210.24 , $113.11 , $186.15 , $110.29 , $61.44 , N/A , $62.39 , $62.39 , $208.05 , $68.18 , $16.40 , $210.24 
 Pro I&D Absc Smpl/1 ,CPT® 10060,0982 - PRO FEE/OUTPT,N/A,N/A, $464.00 , $301.60 , $340.58 , $102.58 , $41.23 , $265.18 , $259.37 , $431.52 , $417.60 , $417.60 , $371.20 , $371.20 , $41.23 , $428.41 , $440.80 , $417.60 , $417.60 , $417.60 , $431.52 , $445.44 , $366.26 , $394.40 , $512.03 , $344.96 , N/A , $270.35 , $270.35 , $440.80 , $313.53 , $41.23 , $512.03 
Open/Perq Placement Intravascular Stent Same 1st,CPT® 37238,N/A,N/A,N/A," $24,722.00 "," $16,069.30 "," $1,799.53 ", $277.62 , $364.83 ," $1,387.15 "," $1,420.00 "," $22,991.46 "," $22,249.80 "," $22,249.80 "," $19,777.60 "," $19,777.60 ", $364.83 ," $22,825.82 "," $23,485.90 "," $22,249.80 "," $22,249.80 "," $22,249.80 "," $22,991.46 "," $23,733.12 "," $1,670.72 "," $21,013.70 "," $1,581.48 "," $1,488.53 ", N/A ," $1,414.22 "," $1,414.22 "," $23,485.90 "," $1,606.55 ", $277.62 ," $23,733.12 "
"Hypospad Repair,1 Stage,Dist,Plasty",CPT® 54326,N/A,N/A,N/A," $5,188.00 "," $3,372.20 "," $4,168.90 ", $896.56 , $925.30 ," $3,038.76 "," $3,059.26 "," $4,824.84 "," $4,669.20 "," $4,669.20 "," $4,150.40 "," $4,150.40 ", $925.30 ," $4,790.08 "," $4,928.60 "," $4,669.20 "," $4,669.20 "," $4,669.20 "," $4,824.84 "," $4,980.48 "," $3,920.91 "," $4,409.80 "," $4,874.06 "," $4,581.66 ", N/A ," $3,098.05 "," $3,098.05 "," $4,928.60 "," $3,713.20 ", $896.56 ," $4,980.48 "
 CILOSTAZOL 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,50268-0176-15,1 tablet, $11.48 , $7.46 , $9.64 , N/A , N/A , $9.28 , $10.33 , $9.72 , $10.33 , $10.33 , $10.33 , $9.76 , N/A , $10.60 , $10.91 , $9.76 , $10.68 , $10.68 , $10.91 , $11.02 , $9.39 , $10.33 , $9.76 , $9.07 , N/A , $9.29 , $9.29 , $10.91 , $9.85 , $9.07 , $11.02 
 Fac Tap Block Unilateral by Injection(S) ,CPT® 64486,0490 - AMBUL SURG,N/A,N/A," $1,036.00 ", $673.40 , $870.24 , $53.31 , $97.79 , $837.09 , $932.40 , $877.08 , $932.40 , $932.40 , $932.40 , $880.60 , $95.87 , $956.54 , $984.20 , $880.60 , $963.48 , $963.48 , $984.20 , $994.56 , $847.66 , $932.40 , $880.60 , $818.44 , N/A , $838.43 , $838.43 , $984.20 , $888.99 , $53.31 , $994.56 
"Silicone Gel Sheet, Each",HCPCS A6025,N/A,N/A,N/A, $58.00 , $37.70 , N/A , N/A , N/A , N/A , N/A , $53.94 , $52.20 , $52.20 , $46.40 , $46.40 , N/A , $53.55 , $55.10 , $52.20 , $52.20 , $52.20 , $53.94 , $55.68 , N/A , $49.30 , $31.79 , $18.48 , N/A , N/A , N/A , $55.10 , N/A , $18.48 , $55.68 
 Fac Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn ,CPT® 62323,0761 - TREATMENT ROOM,N/A,N/A," $1,802.00 "," $1,171.30 "," $1,513.68 ", $95.03 , $290.12 ," $1,456.02 "," $1,621.80 "," $1,525.57 "," $1,621.80 "," $1,621.80 "," $1,621.80 "," $1,531.70 ", $284.43 ," $1,663.79 "," $1,711.90 "," $1,531.70 "," $1,675.86 "," $1,675.86 "," $1,711.90 "," $1,729.92 "," $1,474.40 "," $1,621.80 "," $1,531.70 "," $1,423.58 ", N/A ," $1,458.36 "," $1,458.36 "," $1,711.90 "," $1,546.30 ", $95.03 ," $1,729.92 "
 Dry Needling 15 Min ,CPT® 97799,0430 - OCCUPATION THER,N/A,N/A, $50.00 , $32.50 , $42.00 , N/A , $94.49 , $40.40 , $45.00 , $42.33 , $45.00 , $45.00 , $45.00 , $42.50 , $92.64 , $46.17 , $47.50 , $42.50 , $46.50 , $46.50 , $47.50 , $48.00 , $40.91 , $45.00 , $42.50 , $39.50 , N/A , $40.47 , $40.47 , $47.50 , $42.91 , $39.50 , $94.49 
 OSM - OXIDIZED CELLULOSE (NU-KNIT EX PADS) ,HCPCS RXA250,0250 - PHARMACY,56091-0043-50,1 package, $461.81 , $300.18 , $387.92 , N/A , N/A , $373.14 , $415.63 , $390.97 , $415.63 , $415.63 , $415.63 , $392.54 , N/A , $426.39 , $438.72 , $392.54 , $429.48 , $429.48 , $438.72 , $443.34 , $377.85 , $415.63 , $392.54 , $364.83 , N/A , $373.74 , $373.74 , $438.72 , $396.28 , $364.83 , $443.34 
 I 131 Therapy Capsules per Mci ,HCPCS A9517,0344 - THERAPEUTIC RADIOPHARMACEUTICALS,N/A,N/A, $49.00 , $31.85 , $41.16 , N/A , $169.63 , $39.59 , $44.10 , $41.48 , $44.10 , $44.10 , $44.10 , $41.65 , $166.30 , $45.24 , $46.55 , $41.65 , $45.57 , $45.57 , $46.55 , $47.04 , $40.09 , $44.10 , $41.65 , $38.71 , N/A , $39.66 , $39.66 , $46.55 , $42.05 , $38.71 , $169.63 
 ZINC SULFATE 220 (50 ZN) MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,20555-0040-00,1 capsule, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Hemodialysis, Repeated Eval.",CPT® 90937,N/A,N/A,N/A, $801.00 , $520.65 , $240.00 , $99.52 , $107.14 , $232.66 , $231.18 , $744.93 , $720.90 , $720.90 , $640.80 , $640.80 , $107.14 , $739.56 , $760.95 , $720.90 , $720.90 , $720.90 , $744.93 , $768.96 , $318.02 , $680.85 , $303.10 , $394.24 , N/A , $237.19 , $237.19 , $760.95 , $276.53 , $99.52 , $768.96 
 Lower Ext. Art.- Multi Level ,CPT® 93923,0921 - PERI VASCUL LAB,N/A,N/A, $616.00 , $400.40 , $517.44 , $125.11 , $133.50 , $497.73 , $554.40 , $521.51 , $554.40 , $554.40 , $554.40 , $523.60 , $130.88 , $568.75 , $585.20 , $523.60 , $572.88 , $572.88 , $585.20 , $591.36 , $504.01 , $554.40 , $523.60 , $486.64 , N/A , $498.53 , $498.53 , $585.20 , $528.59 , $125.11 , $591.36 
Foot Arch Supp Longitud/Meta,HCPCS L3060,N/A,N/A,N/A, $124.00 , $80.60 , N/A , $86.28 , $60.29 , N/A , N/A , $115.32 , $111.60 , $111.60 , $99.20 , $99.20 , $60.29 , $114.49 , $117.80 , $111.60 , $111.60 , $111.60 , $115.32 , $119.04 , N/A , $105.40 , $71.36 , $72.58 , N/A , N/A , N/A , $117.80 , N/A , $60.29 , $119.04 
Esophageal Motility Study,91010,N/A,N/A,N/A, $838.00 , $544.70 , $531.00 , $218.16 , $175.19 , $533.47 , $422.52 , $779.34 , $754.20 , $754.20 , $670.40 , $670.40 , $175.19 , $773.73 , $796.10 , $754.20 , $754.20 , $754.20 , $779.34 , $804.48 , $961.96 , $712.30 , $559.57 , $670.34 , N/A , $543.88 , $543.88 , $796.10 , $639.86 , $175.19 , $961.96 
 Fac Compre Ep Eval Abltj 3d Mapg Tx Vt ,CPT® 93654,0481 - CARDIAC CATH LAB,N/A,N/A," $20,931.00 "," $13,605.15 "," $17,582.04 ", $920.46 ," $1,236.93 "," $16,912.25 "," $18,837.90 "," $17,720.18 "," $18,837.90 "," $18,837.90 "," $18,837.90 "," $17,791.35 "," $1,212.68 "," $19,325.59 "," $19,884.45 "," $17,791.35 "," $19,465.83 "," $19,465.83 "," $19,884.45 "," $20,093.76 "," $17,125.74 "," $18,837.90 "," $17,791.35 "," $16,535.49 ", N/A ," $16,939.46 "," $16,939.46 "," $19,884.45 "," $17,960.89 ", $920.46 ," $20,093.76 "
 Fac Assay of Free Thyroxine ,CPT® 84439,0301 - LAB/CHEMISTRY,N/A,N/A, $106.00 , $68.90 , $89.04 , $9.20 , $9.20 , $85.65 , $95.40 , $89.74 , $95.40 , $95.40 , $95.40 , $90.10 , $9.02 , $97.87 , $100.70 , $90.10 , $98.58 , $98.58 , $100.70 , $101.76 , $86.73 , $95.40 , $90.10 , $83.74 , N/A , $85.79 , $85.79 , $100.70 , $90.96 , $9.02 , $101.76 
 Fac Cftr Gene Analysis Duplication/Deletion Variants ,CPT® 81222,0310 - PATHOLOGY LAB,N/A,N/A, $11.00 , $7.15 , $9.24 , $443.77 , $105.71 , $8.89 , $9.90 , $9.31 , $9.90 , $9.90 , $9.90 , $9.35 , $103.64 , $10.16 , $10.45 , $9.35 , $10.23 , $10.23 , $10.45 , $10.56 , $9.00 , $9.90 , $9.35 , $8.69 , N/A , $8.90 , $8.90 , $10.45 , $9.44 , $8.69 , $443.77 
 Fac Teaec W/Patch Grf Crtd Vrt Subcla Nck Inc ,CPT® 35301,0360 - OR SERVICES,N/A,N/A," $4,710.00 "," $3,061.50 "," $3,956.40 "," $1,005.98 "," $1,009.51 "," $3,805.68 "," $4,239.00 "," $3,987.49 "," $4,239.00 "," $4,239.00 "," $4,239.00 "," $4,003.50 ", $989.72 ," $4,348.74 "," $4,474.50 "," $4,003.50 "," $4,380.30 "," $4,380.30 "," $4,474.50 "," $4,521.60 "," $3,853.72 "," $4,239.00 "," $4,003.50 "," $3,720.90 ", N/A ," $3,811.80 "," $3,811.80 "," $4,474.50 "," $4,041.65 ", $989.72 ," $4,521.60 "
 Pro US Scrotum Color Flow Only- Mh ,CPT® 93976,0972 - PRO FEE/RAD/DX,N/A,N/A, $390.00 , $253.50 , $921.31 , $140.61 , $182.49 , $879.56 ," $1,204.75 ", $362.70 , $351.00 , $351.00 , $312.00 , $312.00 , $182.49 , $360.09 , $370.50 , $351.00 , $351.00 , $351.00 , $362.70 , $374.40 , $707.53 , $331.50 , $638.64 , $626.01 , N/A , $896.72 , $896.72 , $370.50 , $994.02 , $140.61 ," $1,204.75 "
 Fac Bld Typing RBC Ags Oth/Thn Abo/Rh D Ea ,CPT® 86905,0300 - LABORATORY,N/A,N/A, $110.00 , $71.50 , $92.40 , $3.91 , $3.91 , $88.88 , $99.00 , $93.13 , $99.00 , $99.00 , $99.00 , $93.50 , $3.83 , $101.56 , $104.50 , $93.50 , $102.30 , $102.30 , $104.50 , $105.60 , $90.00 , $99.00 , $93.50 , $86.90 , N/A , $89.02 , $89.02 , $104.50 , $94.39 , $3.83 , $105.60 
 Fac Ileoscopy Stoma W/Bx Single/Multiple ,CPT® 44382,0360 - OR SERVICES,N/A,N/A," $1,204.00 ", $782.60 ," $1,011.36 ", $70.20 , $76.65 , $972.83 ," $1,083.60 "," $1,019.31 "," $1,083.60 "," $1,083.60 "," $1,083.60 "," $1,023.40 ", $75.15 ," $1,111.65 "," $1,143.80 "," $1,023.40 "," $1,119.72 "," $1,119.72 "," $1,143.80 "," $1,155.84 ", $985.11 ," $1,083.60 "," $1,023.40 ", $951.16 , N/A , $974.40 , $974.40 ," $1,143.80 "," $1,033.15 ", $70.20 ," $1,155.84 "
 Pro Oph Bmtry Prtl Coher Intrfrmtry Io Lens Pwr Cal ,CPT® 92136,0962 - PRO FEE/EYE,N/A,N/A, $282.00 , $183.30 , $108.52 , $46.46 , $75.68 , $157.42 , $164.65 , $262.26 , $253.80 , $253.80 , $225.60 , $225.60 , $75.68 , $260.37 , $267.90 , $253.80 , $253.80 , $253.80 , $262.26 , $270.72 , $167.21 , $239.70 , $277.76 , $165.78 , N/A , $160.48 , $160.48 , $267.90 , $190.91 , $46.46 , $277.76 
Normal Saline Solution Infus,HCPCS J7050,N/A,N/A,N/A, $23.00 , $14.95 , N/A , $0.65 , $0.67 , N/A , N/A , $21.39 , $20.70 , $20.70 , $18.40 , $18.40 , $0.67 , $21.24 , $21.85 , $20.70 , $20.70 , $20.70 , $21.39 , $22.08 , $0.94 , $19.55 , $0.65 , $0.88 , N/A , N/A , N/A , $21.85 , N/A , $0.65 , $22.08 
 CHERRY PO SYRP ,HCPCS RXC637,0250 - PHARMACY,00395-2662-16,473 mL, $85.05 , $55.28 , $71.44 , N/A , N/A , $68.72 , $76.55 , $72.00 , $76.55 , $76.55 , $76.55 , $72.29 , N/A , $78.53 , $80.80 , $72.29 , $79.10 , $79.10 , $80.80 , $81.65 , $69.59 , $76.55 , $72.29 , $67.19 , N/A , $68.83 , $68.83 , $80.80 , $72.98 , $67.19 , $81.65 
" Fac Assay of Phenytoin, Free ",CPT® 80186,0301 - LAB/CHEMISTRY,N/A,N/A, $109.00 , $70.85 , $91.56 , $14.04 , $14.04 , $88.07 , $98.10 , $92.28 , $98.10 , $98.10 , $98.10 , $92.65 , $13.76 , $100.64 , $103.55 , $92.65 , $101.37 , $101.37 , $103.55 , $104.64 , $89.18 , $98.10 , $92.65 , $86.11 , N/A , $88.21 , $88.21 , $103.55 , $93.53 , $13.76 , $104.64 
 Pro Treat Dislocation/Fracture ,CPT® 23680,0982 - PRO FEE/OUTPT,N/A,N/A," $6,093.00 "," $3,960.45 "," $5,622.70 ", $882.70 , $922.06 ," $4,483.23 "," $4,453.56 "," $5,666.49 "," $5,483.70 "," $5,483.70 "," $4,874.40 "," $4,874.40 ", $922.06 ," $5,625.67 "," $5,788.35 "," $5,483.70 "," $5,483.70 "," $5,483.70 "," $5,666.49 "," $5,849.28 "," $5,236.48 "," $5,179.05 "," $4,920.45 "," $5,279.41 ", N/A ," $4,570.71 "," $4,570.71 "," $5,788.35 "," $5,372.20 ", $882.70 ," $5,849.28 "
 Fac Assay Alkaline Phosphatase ,CPT® 84075,0301 - LAB/CHEMISTRY,N/A,N/A, $73.00 , $47.45 , $61.32 , $5.28 , $5.28 , $58.98 , $65.70 , $61.80 , $65.70 , $65.70 , $65.70 , $62.05 , $5.18 , $67.40 , $69.35 , $62.05 , $67.89 , $67.89 , $69.35 , $70.08 , $59.73 , $65.70 , $62.05 , $57.67 , N/A , $59.08 , $59.08 , $69.35 , $62.64 , $5.18 , $70.08 
 Pro Repair Achilles Tendon ,CPT® 27650,0975 - PRO FEE/OR,N/A,N/A," $4,457.00 "," $2,897.05 "," $4,053.47 ", $634.54 , $588.80 ," $3,200.62 "," $3,230.07 "," $4,145.01 "," $4,011.30 "," $4,011.30 "," $3,565.60 "," $3,565.60 ", $588.80 ," $4,115.15 "," $4,234.15 "," $4,011.30 "," $4,011.30 "," $4,011.30 "," $4,145.01 "," $4,278.72 "," $3,765.19 "," $3,788.45 "," $3,543.15 "," $3,785.55 ", N/A ," $3,263.07 "," $3,263.07 "," $4,234.15 "," $3,835.26 ", $588.80 ," $4,278.72 "
"Lap,Pyeloplasty",CPT® 50544,N/A,N/A,N/A," $8,674.00 "," $5,638.10 "," $6,700.19 "," $1,176.39 "," $1,215.80 "," $6,097.38 "," $5,662.64 "," $8,066.82 "," $7,806.60 "," $7,806.60 "," $6,939.20 "," $6,939.20 "," $1,215.80 "," $8,008.70 "," $8,240.30 "," $7,806.60 "," $7,806.60 "," $7,806.60 "," $8,066.82 "," $8,327.04 "," $6,734.14 "," $7,372.90 "," $6,415.49 "," $7,660.24 ", N/A ," $6,216.35 "," $6,216.35 "," $8,240.30 "," $7,306.42 "," $1,176.39 "," $8,327.04 "
"Full Thick Grft Head,Fac,Hand <20sqc",CPT® 15240,N/A,N/A,N/A," $4,264.00 "," $2,771.60 "," $2,542.01 ", $764.25 , $851.98 ," $2,189.94 "," $2,158.28 "," $3,965.52 "," $3,837.60 "," $3,837.60 "," $3,411.20 "," $3,411.20 ", $851.98 ," $3,936.95 "," $4,050.80 "," $3,837.60 "," $3,837.60 "," $3,837.60 "," $3,965.52 "," $4,093.44 "," $2,784.10 "," $3,624.40 "," $4,303.16 "," $2,805.59 ", N/A ," $2,232.67 "," $2,232.67 "," $4,050.80 "," $2,589.15 ", $764.25 ," $4,303.16 "
 ROFLUMILAST 500 MCG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00310-0095-30,1 tablet, $88.54 , $57.55 , $74.37 , N/A , N/A , $71.54 , $79.69 , $74.96 , $79.69 , $79.69 , $79.69 , $75.26 , N/A , $81.75 , $84.11 , $75.26 , $82.34 , $82.34 , $84.11 , $85.00 , $72.44 , $79.69 , $75.26 , $69.95 , N/A , $71.66 , $71.66 , $84.11 , $75.98 , $69.95 , $85.00 
 METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP ,HCPCS J1030,0636 - DRUGS REQUIRING DETAILED CODIN,00009-3073-01,1 mL, $70.02 , $45.51 , $58.82 , $7.76 , $8.24 , $56.58 , $63.02 , $59.28 , $63.02 , $63.02 , $63.02 , $59.52 , $8.08 , $64.65 , $66.52 , $59.52 , $65.12 , $65.12 , $66.52 , $67.22 , $57.29 , $63.02 , $59.52 , $55.32 , N/A , $56.67 , $56.67 , $66.52 , $60.08 , $7.76 , $67.22 
"Removal Adenoids,Primary,<12 Y/O",CPT® 42830,N/A,N/A,N/A," $1,445.00 ", $939.25 ," $1,308.58 ", $206.60 , $228.19 , $998.97 ," $1,038.12 "," $1,343.85 "," $1,300.50 "," $1,300.50 "," $1,156.00 "," $1,156.00 ", $228.19 ," $1,334.17 "," $1,372.75 "," $1,300.50 "," $1,300.50 "," $1,300.50 "," $1,343.85 "," $1,387.20 ", $919.98 ," $1,228.25 "," $1,132.88 "," $1,173.39 ", N/A ," $1,018.46 "," $1,018.46 "," $1,372.75 "," $1,065.20 ", $206.60 ," $1,387.20 "
 Pro Needle Insertion W/O Injection 1 or 2 Muscles ,CPT® 20560,0981 - PRO FEE/ER,N/A,N/A, $146.00 , $94.90 , $94.51 , $14.78 , N/A , $78.65 , N/A , $135.78 , $131.40 , $131.40 , $116.80 , $116.80 , N/A , $134.80 , $138.70 , $131.40 , $131.40 , $131.40 , $135.78 , $140.16 , $90.69 , $124.10 , $78.19 , $95.51 , N/A , $80.18 , $80.18 , $138.70 , $94.26 , $14.78 , $140.16 
Sub Grft F/S/N/H/F/G/M/D /<100scm Ea Adl 25scm,CPT® 15276,N/A,N/A,N/A, $196.00 , $127.40 , $80.44 , $23.62 , $26.04 , $68.56 , $68.48 , $182.28 , $176.40 , $176.40 , $156.80 , $156.80 , $26.04 , $180.97 , $186.20 , $176.40 , $176.40 , $176.40 , $182.28 , $188.16 , $87.96 , $166.60 , $135.59 , $89.22 , N/A , $69.89 , $69.89 , $186.20 , $81.06 , $23.62 , $188.16 
Complete Replacement Picc Rs&I,CPT® 36584,N/A,N/A,N/A," $1,347.00 ", $875.55 , $361.99 , $55.92 , $374.09 , $291.69 , $287.29 ," $1,252.71 "," $1,212.30 "," $1,212.30 "," $1,077.60 "," $1,077.60 ", $374.09 ," $1,243.69 "," $1,279.65 "," $1,212.30 "," $1,212.30 "," $1,212.30 "," $1,252.71 "," $1,293.12 ", $339.02 ," $1,144.95 ", $347.89 , $334.21 , N/A , $297.38 , $297.38 ," $1,279.65 ", $337.83 , $55.92 ," $1,293.12 "
 Fac Iadna Human Papillomavirus High-Risk Types ,CPT® 87624,0306 - LAB/BACT-MICRO,N/A,N/A, $317.00 , $206.05 , $266.28 , $35.79 , $35.79 , $256.14 , $285.30 , $268.37 , $285.30 , $285.30 , $285.30 , $269.45 , $35.09 , $292.69 , $301.15 , $269.45 , $294.81 , $294.81 , $301.15 , $304.32 , $259.37 , $285.30 , $269.45 , $250.43 , N/A , $256.55 , $256.55 , $301.15 , $272.02 , $35.09 , $304.32 
Layer Closure 7.6-12.5cm,12054,N/A,N/A,N/A," $1,652.00 "," $1,073.80 ", $691.80 , $208.93 , $210.26 , $622.08 , $609.78 ," $1,536.36 "," $1,486.80 "," $1,486.80 "," $1,321.60 "," $1,321.60 ", $210.26 ," $1,525.29 "," $1,569.40 "," $1,486.80 "," $1,486.80 "," $1,486.80 "," $1,536.36 "," $1,585.92 ", $758.54 ," $1,404.20 "," $1,218.52 ", $778.84 , N/A , $634.21 , $634.21 ," $1,569.40 ", $735.47 , $208.93 ," $1,585.92 "
Dexamethasone Sodium Phos,HCPCS J1100,N/A,N/A,N/A, $7.00 , $4.55 , N/A , $0.12 , $0.13 , N/A , N/A , $6.51 , $6.30 , $6.30 , $5.60 , $5.60 , $0.13 , $6.46 , $6.65 , $6.30 , $6.30 , $6.30 , $6.51 , $6.72 , $0.22 , $5.95 , $0.65 , $0.17 , N/A , N/A , N/A , $6.65 , N/A , $0.12 , $6.72 
Cast Sup Lng Arm Splint Plst,HCPCS Q4017,N/A,N/A,N/A, $37.00 , $24.05 , N/A , $11.04 , $6.74 , N/A , N/A , $34.41 , $33.30 , $33.30 , $29.60 , $29.60 , $6.74 , $34.16 , $35.15 , $33.30 , $33.30 , $33.30 , $34.41 , $35.52 , N/A , $31.45 , $33.74 , $10.03 , N/A , N/A , N/A , $35.15 , N/A , $6.74 , $35.52 
Drug Assay Voriconazole,CPT® 80285,N/A,N/A,N/A, $170.00 , $110.50 , N/A , $27.65 , $22.12 , $115.33 , N/A , $158.10 , $153.00 , $153.00 , $136.00 , $136.00 , $22.12 , $156.96 , $161.50 , $153.00 , $153.00 , $153.00 , $158.10 , $163.20 , $181.02 , $144.50 , $129.23 , $79.62 , N/A , $107.63 , $107.63 , $161.50 , $117.39 , $22.12 , $181.02 
"Cysto/Uretero/Pyeloscopy, Calculus Tx",52352,N/A,N/A,N/A," $3,336.00 "," $2,168.40 "," $1,897.67 ", $333.29 , $375.30 ," $1,738.68 "," $2,378.40 "," $3,102.48 "," $3,002.40 "," $3,002.40 "," $2,668.80 "," $2,668.80 ", $375.30 ," $3,080.13 "," $3,169.20 "," $3,002.40 "," $3,002.40 "," $3,002.40 "," $3,102.48 "," $3,202.56 "," $1,908.24 "," $2,835.60 "," $1,869.70 "," $2,182.87 ", N/A ," $1,772.61 "," $1,772.61 "," $3,169.20 "," $2,083.44 ", $333.29 ," $3,202.56 "
" Wound Exc Skin Malig 2.1-3cm Trunk,Arm,Leg ",CPT® 11603,0761 - TREATMENT ROOM,N/A,N/A," $1,425.00 ", $926.25 ," $1,197.00 ", $185.66 , $250.91 ," $1,151.40 "," $1,282.50 "," $1,206.41 "," $1,282.50 "," $1,282.50 "," $1,282.50 "," $1,211.25 ", $245.99 ," $1,315.70 "," $1,353.75 "," $1,211.25 "," $1,325.25 "," $1,325.25 "," $1,353.75 "," $1,368.00 "," $1,165.94 "," $1,282.50 "," $1,211.25 "," $1,125.75 ", N/A ," $1,153.25 "," $1,153.25 "," $1,353.75 "," $1,222.79 ", $185.66 ," $1,368.00 "
 Pro Incision of Heel Bone ,CPT® 28300,0982 - PRO FEE/OUTPT,N/A,N/A," $5,177.00 "," $3,365.05 "," $3,976.44 ", $623.61 , $614.70 ," $3,179.79 "," $3,182.01 "," $4,814.61 "," $4,659.30 "," $4,659.30 "," $4,141.60 "," $4,141.60 ", $614.70 ," $4,779.92 "," $4,918.15 "," $4,659.30 "," $4,659.30 "," $4,659.30 "," $4,814.61 "," $4,969.92 "," $3,700.65 "," $4,400.45 "," $3,496.77 "," $3,740.86 ", N/A ," $3,241.84 "," $3,241.84 "," $4,918.15 "," $3,810.30 ", $614.70 ," $4,969.92 "
 Pro Revision of Eyelid ,CPT® 67966,0982 - PRO FEE/OUTPT,N/A,N/A," $7,010.00 "," $4,556.50 "," $4,017.85 ", $630.25 , $618.40 ," $3,722.71 "," $3,506.99 "," $6,519.30 "," $6,309.00 "," $6,309.00 "," $5,608.00 "," $5,608.00 ", $618.40 ," $6,472.33 "," $6,659.50 "," $6,309.00 "," $6,309.00 "," $6,309.00 "," $6,519.30 "," $6,729.60 "," $5,520.86 "," $5,958.50 "," $3,639.49 "," $4,720.30 ", N/A ," $3,795.34 "," $3,795.34 "," $6,659.50 "," $4,189.59 ", $618.40 ," $6,729.60 "
Fetal Non-Stress Test,CPT® 59025,N/A,N/A,N/A, $295.00 , $191.75 , $134.01 , $46.00 , $50.89 , $111.46 , $119.70 , $274.35 , $265.50 , $265.50 , $236.00 , $236.00 , $50.89 , $272.37 , $280.25 , $265.50 , $265.50 , $265.50 , $274.35 , $283.20 , $137.25 , $250.75 , $258.69 , $211.43 , N/A , $113.63 , $113.63 , $280.25 , $131.36 , $46.00 , $283.20 
 Pro CT Neck Spine W/O Dye ,CPT® 72125,0972 - PRO FEE/RAD/DX,N/A,N/A, $615.00 , $399.75 , $924.28 , $132.63 , $250.57 , $880.34 ," $1,131.84 ", $571.95 , $553.50 , $553.50 , $492.00 , $492.00 , $250.57 , $567.83 , $584.25 , $553.50 , $553.50 , $553.50 , $571.95 , $590.40 , $776.12 , $522.75 ," $1,232.67 "," $1,197.04 ", N/A , $897.52 , $897.52 , $584.25 ," $1,038.91 ", $132.63 ," $1,232.67 "
 Set Radn Therapy Field Simple ,CPT® 77280,0982 - PRO FEE/OUTPT,N/A,N/A, $317.00 , $206.05 ," $1,506.72 ", $265.10 , $174.36 ," $1,287.32 ", $934.37 , $294.81 , $285.30 , $285.30 , $253.60 , $253.60 , $174.36 , $292.69 , $301.15 , $285.30 , $285.30 , $285.30 , $294.81 , $304.32 ," $1,586.30 ", $269.45 ," $1,024.65 "," $1,556.33 ", N/A ," $1,312.44 "," $1,312.44 ", $301.15 ," $1,519.17 ", $174.36 ," $1,586.30 "
Iaadiadoo Streptococcus Group A,CPT® 87880,N/A,N/A,N/A, $99.00 , $64.35 , N/A , $16.86 , $16.65 , $67.85 , $81.18 , $92.07 , $89.10 , $89.10 , $79.20 , $79.20 , $16.65 , $91.41 , $94.05 , $89.10 , $89.10 , $89.10 , $92.07 , $95.04 , $110.37 , $84.15 , $77.85 , $48.45 , N/A , $63.32 , $63.32 , $94.05 , $69.20 , $16.65 , $110.37 
 CEFAZOLIN SODIUM 1 G IJ SOLR ,HCPCS J0690,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9924-90,10 mL, $16.68 , $10.84 , $14.01 , $0.89 , $0.79 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.77 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.77 , $16.01 
 Fac Optime Anes General Tech ,Custom OPTANESGENERAL,0370 - ANESTHESIA,N/A,N/A, $239.00 , $155.35 , $200.76 , N/A , N/A , $193.11 , $215.10 , $202.34 , $215.10 , $215.10 , $215.10 , $203.15 , N/A , $220.67 , $227.05 , $203.15 , $222.27 , $222.27 , $227.05 , $229.44 , $195.55 , $215.10 , $203.15 , $188.81 , N/A , $193.42 , $193.42 , $227.05 , $205.09 , $188.81 , $229.44 
Thromboplas Time Part Plasma Frac,CPT® 85732,N/A,N/A,N/A, $118.00 , $76.70 , N/A , $6.60 , $6.60 , $36.62 , $43.78 , $109.74 , $106.20 , $106.20 , $94.40 , $94.40 , $6.60 , $108.95 , $112.10 , $106.20 , $106.20 , $106.20 , $109.74 , $113.28 , $43.20 , $100.30 , $42.17 , $23.44 , N/A , $34.18 , $34.18 , $112.10 , $37.35 , $6.60 , $113.28 
Prq Trluml Coronary Stent/Ath/Angio Addl Branch,CPT® 92934,N/A,N/A,N/A," $2,049.00 "," $1,331.85 ", N/A , N/A , N/A , N/A , N/A ," $1,905.57 "," $1,844.10 "," $1,844.10 "," $1,639.20 "," $1,639.20 ", N/A ," $1,891.84 "," $1,946.55 "," $1,844.10 "," $1,844.10 "," $1,844.10 "," $1,905.57 "," $1,967.04 ", N/A ," $1,741.65 ", N/A , N/A , N/A , N/A , N/A ," $1,946.55 ", N/A ," $1,639.20 "," $1,967.04 "
Afo Ankle Gauntlet,HCPCS L1902,N/A,N/A,N/A, $137.00 , $89.05 , N/A , $87.31 , $52.02 , N/A , N/A , $127.41 , $123.30 , $123.30 , $109.60 , $109.60 , $52.02 , $126.49 , $130.15 , $123.30 , $123.30 , $123.30 , $127.41 , $131.52 , N/A , $116.45 , $80.45 , $73.46 , N/A , N/A , N/A , $130.15 , N/A , $52.02 , $131.52 
 Fac Perq Sft Tiss Loc Device Plmt 1st Les W/Gdnce ,CPT® 10035,0361 - OR/MINOR,N/A,N/A," $1,523.00 ", $989.95 ," $1,279.32 ", $81.07 , $424.13 ," $1,230.58 "," $1,370.70 "," $1,289.37 "," $1,370.70 "," $1,370.70 "," $1,370.70 "," $1,294.55 ", $415.81 ," $1,406.19 "," $1,446.85 "," $1,294.55 "," $1,416.39 "," $1,416.39 "," $1,446.85 "," $1,462.08 "," $1,246.12 "," $1,370.70 "," $1,294.55 "," $1,203.17 ", N/A ," $1,232.56 "," $1,232.56 "," $1,446.85 "," $1,306.89 ", $81.07 ," $1,462.08 "
 Outpt Infant Hearing Screening -Mh ,CPT® 92587,0471 - AUDIOLOGY/DX,N/A,N/A, $365.00 , $237.25 , $306.60 , $21.51 , $57.95 , $294.92 , $328.50 , $309.01 , $328.50 , $328.50 , $328.50 , $310.25 , $56.81 , $337.00 , $346.75 , $310.25 , $339.45 , $339.45 , $346.75 , $350.40 , $298.64 , $328.50 , $310.25 , $288.35 , N/A , $295.39 , $295.39 , $346.75 , $313.21 , $21.51 , $350.40 
Tangential Biopsy Skin Single Lesion,CPT® 11102,N/A,N/A,N/A, $244.00 , $158.60 , $121.11 , $36.38 , $78.04 , $101.29 , N/A , $226.92 , $219.60 , $219.60 , $195.20 , $195.20 , $78.04 , $225.29 , $231.80 , $219.60 , $219.60 , $219.60 , $226.92 , $234.24 , $134.04 , $207.40 , $199.02 , $138.93 , N/A , $103.26 , $103.26 , $231.80 , $119.75 , $36.38 , $234.24 
"Chemistry-Protein,Electro",CPT® 84165,N/A,N/A,N/A, $132.00 , $85.80 , N/A , $10.95 , $10.95 , $60.74 , $72.67 , $122.76 , $118.80 , $118.80 , $105.60 , $105.60 , $10.95 , $121.88 , $125.40 , $118.80 , $118.80 , $118.80 , $122.76 , $126.72 , $71.71 , $112.20 , $165.43 , $38.94 , N/A , $56.69 , $56.69 , $125.40 , $61.95 , $10.95 , $165.43 
Psycl/Nrpsycl Tst Elec Platform Auto Result,CPT® 96146,N/A,N/A,N/A, $11.00 , $7.15 , $4.15 , $2.08 , $2.17 , $4.05 , N/A , $10.23 , $9.90 , $9.90 , $8.80 , $8.80 , $2.17 , $10.16 , $10.45 , $9.90 , $9.90 , $9.90 , $10.23 , $10.56 , $7.82 , $9.35 , $7.07 , $7.16 , $2.97 , $4.13 , $4.13 , $10.45 , $4.82 , $2.08 , $10.56 
"X-Ray Leg, Infant",CPT® 73592,N/A,N/A,N/A, $247.00 , $160.55 , $178.87 , $31.03 , $27.65 , $128.52 , $148.62 , $229.71 , $222.30 , $222.30 , $197.60 , $197.60 , $27.65 , $228.06 , $234.65 , $222.30 , $222.30 , $222.30 , $229.71 , $237.12 , $172.54 , $209.95 , $163.71 , $136.90 , N/A , $131.02 , $131.02 , $234.65 , $151.65 , $27.65 , $237.12 
Lens Sphcy Bifocal 4.25-7d/.,HCPCS V2207,N/A,N/A,N/A, $85.00 , $55.25 , N/A , $71.11 , N/A , N/A , N/A , $79.05 , $76.50 , $76.50 , $68.00 , $68.00 , N/A , $78.48 , $80.75 , $76.50 , $76.50 , $76.50 , $79.05 , $81.60 , N/A , $72.25 , $85.00 , $64.62 , N/A , N/A , N/A , $80.75 , N/A , $64.62 , $85.00 
Treat Tibial Shaft Fractr,CPT® 27750,N/A,N/A,N/A," $2,288.00 "," $1,487.20 "," $2,003.43 ", $317.27 , $156.40 ," $1,532.38 "," $1,554.50 "," $2,127.84 "," $2,059.20 "," $2,059.20 "," $1,830.40 "," $1,830.40 ", $156.40 ," $2,112.51 "," $2,173.60 "," $2,059.20 "," $2,059.20 "," $2,059.20 "," $2,127.84 "," $2,196.48 "," $1,847.67 "," $1,944.80 "," $1,707.35 "," $1,815.91 ", N/A ," $1,562.28 "," $1,562.28 "," $2,173.60 "," $1,836.23 ", $156.40 ," $2,196.48 "
Ondansetron Hcl Injection,HCPCS J2405,N/A,N/A,N/A, $20.00 , $13.00 , N/A , $0.11 , $0.09 , N/A , N/A , $18.60 , $18.00 , $18.00 , $16.00 , $16.00 , $0.09 , $18.47 , $19.00 , $18.00 , $18.00 , $18.00 , $18.60 , $19.20 , $0.12 , $17.00 , $0.65 , $0.13 , N/A , N/A , N/A , $19.00 , N/A , $0.09 , $19.20 
 Fac Gonadotropin (Lh) ,CPT® 83002,0301 - LAB/CHEMISTRY,N/A,N/A, $172.00 , $111.80 , $144.48 , $18.89 , $18.89 , $138.98 , $154.80 , $145.62 , $154.80 , $154.80 , $154.80 , $146.20 , $18.52 , $158.81 , $163.40 , $146.20 , $159.96 , $159.96 , $163.40 , $165.12 , $140.73 , $154.80 , $146.20 , $135.88 , N/A , $139.20 , $139.20 , $163.40 , $147.59 , $18.52 , $165.12 
"MRI, Dorsal Spine",CPT® 72146,N/A,N/A,N/A," $5,671.00 "," $3,686.15 "," $1,369.76 ", $195.41 , $423.92 ," $1,065.70 "," $2,013.41 "," $5,274.03 "," $5,103.90 "," $5,103.90 "," $4,536.80 "," $4,536.80 ", $423.92 ," $5,236.03 "," $5,387.45 "," $5,103.90 "," $5,103.90 "," $5,103.90 "," $5,274.03 "," $5,444.16 "," $1,172.15 "," $4,820.35 "," $2,195.69 "," $2,079.70 ", N/A ," $1,086.50 "," $1,086.50 "," $5,387.45 "," $1,257.63 ", $195.41 ," $5,444.16 "
Instill Anticancer Agent in Bladder,51720,N/A,N/A,N/A, $748.00 , $486.20 , $235.23 , $41.44 , $34.30 , $393.98 , $363.86 , $695.64 , $673.20 , $673.20 , $598.40 , $598.40 , $34.30 , $690.63 , $710.60 , $673.20 , $673.20 , $673.20 , $695.64 , $718.08 , $236.46 , $635.80 , $412.12 , $321.58 , N/A , $401.67 , $401.67 , $710.60 , $472.10 , $34.30 , $718.08 
"Remov Sesamoid Bone,1st Toe",CPT® 28315,N/A,N/A,N/A," $3,212.00 "," $2,087.80 "," $2,025.21 ", $317.59 , $206.19 ," $1,607.33 "," $1,594.49 "," $2,987.16 "," $2,890.80 "," $2,890.80 "," $2,569.60 "," $2,569.60 ", $206.19 ," $2,965.64 "," $3,051.40 "," $2,890.80 "," $2,890.80 "," $2,890.80 "," $2,987.16 "," $3,083.52 "," $1,883.23 "," $2,730.20 "," $1,726.97 "," $1,912.14 ", N/A ," $1,638.69 "," $1,638.69 "," $3,051.40 "," $1,926.04 ", $206.19 ," $3,083.52 "
 MAGNESIUM OXIDE 400 MG (APPROX) PO TABS (INPT) ,HCPCS RXC637,0250 - PHARMACY,10006-0700-28,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 CYPROHEPTADINE HCL 4 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,52817-0210-10,1 tablet, $5.49 , $3.57 , $4.61 , N/A , N/A , $4.44 , $4.94 , $4.65 , $4.94 , $4.94 , $4.94 , $4.67 , N/A , $5.07 , $5.22 , $4.67 , $5.11 , $5.11 , $5.22 , $5.27 , $4.49 , $4.94 , $4.67 , $4.34 , N/A , $4.44 , $4.44 , $5.22 , $4.71 , $4.34 , $5.27 
 Fac Anticoagulant Mgmt for Pt Taking Warfarin ,CPT® 93793,0761 - TREATMENT ROOM,N/A,N/A, $15.00 , $9.75 , $12.60 , $11.26 , $9.52 , $12.12 , $13.50 , $12.70 , $13.50 , $13.50 , $13.50 , $12.75 , $9.33 , $13.85 , $14.25 , $12.75 , $13.95 , $13.95 , $14.25 , $14.40 , $12.27 , $13.50 , $12.75 , $11.85 , N/A , $12.14 , $12.14 , $14.25 , $12.87 , $9.33 , $14.40 
Antidepressants Tricyclic Other Cyclicals 1 or 2,CPT® 80335,N/A,N/A,N/A, $156.00 , $101.40 , N/A , N/A , N/A , N/A , N/A , $145.08 , $140.40 , $140.40 , $124.80 , $124.80 , N/A , $144.03 , $148.20 , $140.40 , $140.40 , $140.40 , $145.08 , $149.76 , N/A , $132.60 , $114.69 , $67.79 , N/A , $90.04 , $90.04 , $148.20 , $98.20 , $67.79 , $149.76 
" Fac Amino Acids, Quan, 6 or More ",CPT® 82139,0301 - LAB/CHEMISTRY,N/A,N/A, $478.00 , $310.70 , $401.52 , $17.21 , $17.21 , $386.22 , $430.20 , $404.67 , $430.20 , $430.20 , $430.20 , $406.30 , $16.87 , $441.34 , $454.10 , $406.30 , $444.54 , $444.54 , $454.10 , $458.88 , $391.10 , $430.20 , $406.30 , $377.62 , N/A , $386.85 , $386.85 , $454.10 , $410.17 , $16.87 , $458.88 
Repair Recto-Vag Fistula,CPT® 57300,N/A,N/A,N/A," $3,369.00 "," $2,189.85 "," $2,908.45 ", $586.39 , $842.54 ," $2,299.21 "," $2,269.35 "," $3,133.17 "," $3,032.10 "," $3,032.10 "," $2,695.20 "," $2,695.20 ", $842.54 ," $3,110.60 "," $3,200.55 "," $3,032.10 "," $3,032.10 "," $3,032.10 "," $3,133.17 "," $3,234.24 "," $2,987.21 "," $2,863.65 "," $2,982.96 "," $2,293.23 ", N/A ," $2,344.08 "," $2,344.08 "," $3,200.55 "," $2,811.58 ", $586.39 ," $3,234.24 "
" Amputation, Leg, Open ",CPT® 27882,0360 - OR SERVICES,N/A,N/A," $9,318.00 "," $6,056.70 "," $7,827.12 ", $543.52 , $614.70 ," $7,528.94 "," $8,386.20 "," $7,888.62 "," $8,386.20 "," $8,386.20 "," $8,386.20 "," $7,920.30 ", $602.65 ," $8,603.31 "," $8,852.10 "," $7,920.30 "," $8,665.74 "," $8,665.74 "," $8,852.10 "," $8,945.28 "," $7,623.99 "," $8,386.20 "," $7,920.30 "," $7,361.22 ", N/A ," $7,541.06 "," $7,541.06 "," $8,852.10 "," $7,995.78 ", $543.52 ," $8,945.28 "
 Sinus Less Than 3 Views ,CPT® 70210,0320 - DX X-RAY,N/A,N/A, $331.00 , $215.15 , $278.04 , $31.70 , $28.75 , $267.45 , $297.90 , $280.22 , $297.90 , $297.90 , $297.90 , $281.35 , $28.19 , $305.61 , $314.45 , $281.35 , $307.83 , $307.83 , $314.45 , $317.76 , $270.82 , $297.90 , $281.35 , $261.49 , N/A , $267.88 , $267.88 , $314.45 , $284.03 , $28.19 , $317.76 
Fac Rpr Blvsl Dir Lxtr,35226,N/A,N/A,N/A," $7,110.00 "," $4,621.50 "," $4,840.55 ", $746.44 , $479.52 ," $3,599.96 "," $3,617.45 "," $6,612.30 "," $6,399.00 "," $6,399.00 "," $5,688.00 "," $5,688.00 ", $479.52 ," $6,564.66 "," $6,754.50 "," $6,399.00 "," $6,399.00 "," $6,399.00 "," $6,612.30 "," $6,825.60 "," $4,468.66 "," $6,043.50 "," $4,567.20 "," $4,012.59 ", N/A ," $3,670.20 "," $3,670.20 "," $6,754.50 "," $4,169.35 ", $479.52 ," $6,825.60 "
 Pro Extremity Study ,CPT® 93923,0982 - PRO FEE/OUTPT,N/A,N/A, $591.00 , $384.15 , $806.46 , $125.11 , $133.50 , $744.31 , $816.97 , $549.63 , $531.90 , $531.90 , $472.80 , $472.80 , $133.50 , $545.67 , $561.45 , $531.90 , $531.90 , $531.90 , $549.63 , $567.36 , $565.33 , $502.35 , $435.90 , $515.15 , N/A , $758.84 , $758.84 , $561.45 , $841.18 , $125.11 , $841.18 
Egd Deliver Thermal Energy Sphnctr/Cardia Gerd,43257,N/A,N/A,N/A," $1,168.00 ", $759.20 ," $1,422.14 ", $218.70 , $274.68 ," $1,136.95 "," $1,570.98 "," $1,086.24 "," $1,051.20 "," $1,051.20 ", $934.40 , $934.40 , $274.68 ," $1,078.41 "," $1,109.60 "," $1,051.20 "," $1,051.20 "," $1,051.20 "," $1,086.24 "," $1,121.28 "," $1,019.34 ", $992.80 ," $1,719.84 "," $1,350.90 ", N/A ," $1,159.13 "," $1,159.13 "," $1,109.60 "," $1,212.32 ", $218.70 ," $1,719.84 "
 ETOPOSIDE 500 MG/25ML IV SOLN ,HCPCS J9181,0636 - DRUGS REQUIRING DETAILED CODIN,16729-0114-08,25 mL, $292.04 , $189.83 , $245.31 , $0.71 , $0.91 , $235.97 , $262.84 , $247.24 , $262.84 , $262.84 , $262.84 , $248.23 , $0.89 , $269.64 , $277.44 , $248.23 , $271.60 , $271.60 , $277.44 , $280.36 , $238.95 , $262.84 , $248.23 , $230.71 , N/A , $236.35 , $236.35 , $277.44 , $250.60 , $0.71 , $280.36 
 LIDOCAINE-EPINEPHRINE 0.5 %-1:200000 IJ SOLN ,HCPCS RXA250,0250 - PHARMACY,00409-3177-01,50 mL, $23.89 , $15.53 , $20.07 , N/A , N/A , $19.30 , $21.50 , $20.23 , $21.50 , $21.50 , $21.50 , $20.31 , N/A , $22.06 , $22.70 , $20.31 , $22.22 , $22.22 , $22.70 , $22.93 , $19.55 , $21.50 , $20.31 , $18.87 , N/A , $19.33 , $19.33 , $22.70 , $20.50 , $18.87 , $22.93 
" Pro Mast, Mod Rad ",CPT® 19307,0982 - PRO FEE/OUTPT,N/A,N/A," $6,301.00 "," $4,095.65 "," $3,694.44 "," $1,094.48 ", $842.85 ," $3,213.09 "," $3,125.50 "," $5,859.93 "," $5,670.90 "," $5,670.90 "," $5,040.80 "," $5,040.80 ", $842.85 ," $5,817.71 "," $5,985.95 "," $5,670.90 "," $5,670.90 "," $5,670.90 "," $5,859.93 "," $6,048.96 "," $4,052.16 "," $5,355.85 "," $6,310.23 "," $4,063.28 ", N/A ," $3,275.78 "," $3,275.78 "," $5,985.95 "," $3,798.81 ", $842.85 ," $6,310.23 "
"Shav Skin Les 11-20mm Face,Facial",CPT® 11312,N/A,N/A,N/A, $605.00 , $393.25 , $238.03 , $71.74 , $86.30 , $213.59 , $207.56 , $562.65 , $544.50 , $544.50 , $484.00 , $484.00 , $86.30 , $558.60 , $574.75 , $544.50 , $544.50 , $544.50 , $562.65 , $580.80 , $263.31 , $514.25 , $413.90 , $273.21 , N/A , $217.77 , $217.77 , $574.75 , $252.54 , $71.74 , $580.80 
Moderna Administration First Dose,CPT® 0011A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $76.25 , $128.02 , N/A , $79.82 , $79.82 , $66.50 , $92.91 , $38.92 , $128.02 
Therapeutic Spinal Puncture Drainage CSF,CPT® 62272,N/A,N/A,N/A, $620.00 , $403.00 , $416.99 , $81.94 , $89.21 , $458.77 , $444.83 , $576.60 , $558.00 , $558.00 , $496.00 , $496.00 , $89.21 , $572.45 , $589.00 , $558.00 , $558.00 , $558.00 , $576.60 , $595.20 , $447.85 , $527.00 , $447.80 , $485.27 , N/A , $467.72 , $467.72 , $589.00 , $501.75 , $81.94 , $595.20 
 Pro Physician Telephone Evaluation 21-30 Min ,CPT® 99443,0982 - PRO FEE/OUTPT,N/A,N/A, $171.00 , $111.15 , $198.24 , $94.59 , $31.65 , $66.94 , $66.34 , $159.03 , $153.90 , $153.90 , $136.80 , $136.80 , $31.65 , $157.88 , $162.45 , $153.90 , $153.90 , $153.90 , $159.03 , $164.16 , $181.57 , $145.35 , $82.51 , $84.19 , $44.00 , $68.24 , $68.24 , $162.45 , $78.72 , $31.65 , $198.24 
 Fac Rubella Antibody ,CPT® 86762,0302 - LAB/IMMUNOLOGY,N/A,N/A, $133.00 , $86.45 , $111.72 , $14.68 , $14.68 , $107.46 , $119.70 , $112.60 , $119.70 , $119.70 , $119.70 , $113.05 , $14.39 , $122.80 , $126.35 , $113.05 , $123.69 , $123.69 , $126.35 , $127.68 , $108.82 , $119.70 , $113.05 , $105.07 , N/A , $107.64 , $107.64 , $126.35 , $114.13 , $14.39 , $127.68 
Incision Exten Foot/Toe Tendon,28234,N/A,N/A,N/A," $2,762.00 "," $1,795.30 "," $1,658.02 ", $261.45 , $61.48 ," $1,302.61 "," $1,309.07 "," $2,568.66 "," $2,485.80 "," $2,485.80 "," $2,209.60 "," $2,209.60 ", $61.48 ," $2,550.15 "," $2,623.90 "," $2,485.80 "," $2,485.80 "," $2,485.80 "," $2,568.66 "," $2,651.52 "," $1,535.95 "," $2,347.70 "," $1,418.33 "," $1,541.89 ", N/A ," $1,328.03 "," $1,328.03 "," $2,623.90 "," $1,560.92 ", $61.48 ," $2,651.52 "
 LEVOFLOXACIN 500 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6352-61,1 tablet, $86.41 , $56.17 , $72.58 , N/A , N/A , $69.82 , $77.77 , $73.15 , $77.77 , $77.77 , $77.77 , $73.45 , N/A , $79.78 , $82.09 , $73.45 , $80.36 , $80.36 , $82.09 , $82.95 , $70.70 , $77.77 , $73.45 , $68.26 , N/A , $69.93 , $69.93 , $82.09 , $74.15 , $68.26 , $82.95 
 Fac Virus Antibody Nos ,CPT® 86790,0302 - LAB/IMMUNOLOGY,N/A,N/A, $189.00 , $122.85 , $158.76 , $13.14 , N/A , $152.71 , $170.10 , $160.01 , $170.10 , $170.10 , $170.10 , $160.65 , N/A , $174.50 , $179.55 , $160.65 , $175.77 , $175.77 , $179.55 , $181.44 , $154.64 , $170.10 , $160.65 , $149.31 , N/A , $152.96 , $152.96 , $179.55 , $162.18 , $13.14 , $181.44 
 Pro Oph Medical Xm&Eval Intrm Est Pt ,CPT® 92012,0962 - PRO FEE/EYE,N/A,N/A, $264.00 , $171.60 , $110.70 , $49.63 , $30.59 , $93.38 , $93.76 , $245.52 , $237.60 , $237.60 , $211.20 , $211.20 , $30.59 , $243.75 , $250.80 , $237.60 , $237.60 , $237.60 , $245.52 , $253.44 , $144.13 , $224.40 , $158.14 , $112.11 , N/A , $95.20 , $95.20 , $250.80 , $113.26 , $30.59 , $253.44 
 OXYCODONE HCL ER 15 MG PO T12A ,HCPCS RXC637,0250 - PHARMACY,59011-0415-20,1 tablet, $45.55 , $29.61 , $38.26 , N/A , N/A , $36.80 , $41.00 , $38.56 , $41.00 , $41.00 , $41.00 , $38.72 , N/A , $42.06 , $43.27 , $38.72 , $42.36 , $42.36 , $43.27 , $43.73 , $37.27 , $41.00 , $38.72 , $35.98 , N/A , $36.86 , $36.86 , $43.27 , $39.09 , $35.98 , $43.73 
R& L Hrt Cath W/Injec Hrt Art/Grft& L Vent I,CPT® 93461,N/A,N/A,N/A," $9,420.00 "," $6,123.00 "," $8,838.05 "," $1,328.32 "," $1,042.25 "," $7,778.96 "," $8,314.21 "," $8,760.60 "," $8,478.00 "," $8,478.00 "," $7,536.00 "," $7,536.00 "," $1,042.25 "," $8,697.49 "," $8,949.00 "," $8,478.00 "," $8,478.00 "," $8,478.00 "," $8,760.60 "," $9,043.20 "," $8,408.77 "," $8,007.00 "," $7,899.84 "," $8,140.06 ", N/A ," $7,930.74 "," $7,930.74 "," $8,949.00 "," $8,791.33 "," $1,042.25 "," $9,043.20 "
 Ng Og Tube Placement ,CPT® 43752,0361 - OR/MINOR,N/A,N/A, $417.00 , $271.05 , $350.28 , $38.28 , $41.38 , $336.94 , $375.30 , $353.03 , $375.30 , $375.30 , $375.30 , $354.45 , $40.57 , $385.02 , $396.15 , $354.45 , $387.81 , $387.81 , $396.15 , $400.32 , $341.19 , $375.30 , $354.45 , $329.43 , N/A , $337.48 , $337.48 , $396.15 , $357.83 , $38.28 , $400.32 
 Cardiopulmonary Resuscitation -Mh ,CPT® 92950,0920 - OTHER DX SVS,N/A,N/A, $833.00 , $541.45 , $699.72 , $175.23 , $189.13 , $673.06 , $749.70 , $705.22 , $749.70 , $749.70 , $749.70 , $708.05 , $185.42 , $769.11 , $791.35 , $708.05 , $774.69 , $774.69 , $791.35 , $799.68 , $681.56 , $749.70 , $708.05 , $658.07 , N/A , $674.15 , $674.15 , $791.35 , $714.80 , $175.23 , $799.68 
Duplex Up Extrem Art Unilat/Ltd,CPT® 93931,N/A,N/A,N/A," $1,089.00 ", $707.85 , $788.84 , $121.04 , $121.35 , $696.53 , $917.20 ," $1,012.77 ", $980.10 , $980.10 , $871.20 , $871.20 , $121.35 ," $1,005.47 "," $1,034.55 ", $980.10 , $980.10 , $980.10 ," $1,012.77 "," $1,045.44 ", $552.55 , $925.65 , $489.62 , $492.29 , N/A , $710.12 , $710.12 ," $1,034.55 ", $787.17 , $121.04 ," $1,045.44 "
Herpes Simplex Test,CPT® 86694,N/A,N/A,N/A, $150.00 , $97.50 , N/A , $14.68 , $14.68 , $81.40 , $97.43 , $139.50 , $135.00 , $135.00 , $120.00 , $120.00 , $14.68 , $138.50 , $142.50 , $135.00 , $135.00 , $135.00 , $139.50 , $144.00 , $96.09 , $127.50 , $94.07 , $52.19 , N/A , $75.97 , $75.97 , $142.50 , $83.02 , $14.68 , $144.00 
 Fac Antidepressants Not Otherwise Specified ,CPT® 80338,0301 - LAB/CHEMISTRY,N/A,N/A, $69.00 , $44.85 , $57.96 , N/A , N/A , $55.75 , $62.10 , $58.42 , $62.10 , $62.10 , $62.10 , $58.65 , N/A , $63.71 , $65.55 , $58.65 , $64.17 , $64.17 , $65.55 , $66.24 , $56.46 , $62.10 , $58.65 , $54.51 , N/A , $55.84 , $55.84 , $65.55 , $59.21 , $54.51 , $66.24 
Urine Pregnancy Test,CPT® 81025,N/A,N/A,N/A, $66.00 , $42.90 , N/A , $8.78 , $8.78 , $35.80 , $42.83 , $61.38 , $59.40 , $59.40 , $52.80 , $52.80 , $8.78 , $60.94 , $62.70 , $59.40 , $59.40 , $59.40 , $61.38 , $63.36 , $57.49 , $56.10 , $42.17 , $25.24 , N/A , $33.41 , $33.41 , $62.70 , $36.51 , $8.78 , $63.36 
"Fx Radial Head or Neck,Cl",24640,N/A,N/A,N/A, $893.00 , $580.45 , $507.52 , $78.44 , $62.26 , $453.97 , $465.63 , $830.49 , $803.70 , $803.70 , $714.40 , $714.40 , $62.26 , $824.51 , $848.35 , $803.70 , $803.70 , $803.70 , $830.49 , $857.28 , $464.54 , $759.05 , $512.03 , $456.76 , N/A , $462.82 , $462.82 , $848.35 , $543.97 , $62.26 , $857.28 
" Ptt, Partial Thromboplastin Beaker1 ",CPT® 85730,0305 - LAB/HEMATOLOGY,N/A,N/A, $97.00 , $63.05 , $81.48 , $6.13 , $6.13 , $78.38 , $87.30 , $82.12 , $87.30 , $87.30 , $87.30 , $82.45 , $6.01 , $89.56 , $92.15 , $82.45 , $90.21 , $90.21 , $92.15 , $93.12 , $79.37 , $87.30 , $82.45 , $76.63 , N/A , $78.50 , $78.50 , $92.15 , $83.24 , $6.01 , $93.12 
 Fac Determinative Hchem/Cchem ID Nzm Ea ,CPT® 88319,0312 - PATHOL/HISTOL,N/A,N/A, $296.00 , $192.40 , $248.64 , $132.92 , $37.95 , $239.17 , $266.40 , $250.59 , $266.40 , $266.40 , $266.40 , $251.60 , $37.21 , $273.30 , $281.20 , $251.60 , $275.28 , $275.28 , $281.20 , $284.16 , $242.19 , $266.40 , $251.60 , $233.84 , N/A , $239.55 , $239.55 , $281.20 , $254.00 , $37.21 , $284.16 
 Pro Rmvl Tun Ctr Vad W/Subq Port/Pmp Ctr/Prph Insj ,CPT® 36590,0982 - PRO FEE/OUTPT,N/A,N/A," $1,813.00 "," $1,178.45 "," $1,149.27 ", $178.03 , $375.08 , $885.08 , $883.91 ," $1,686.09 "," $1,631.70 "," $1,631.70 "," $1,450.40 "," $1,450.40 ", $375.08 ," $1,673.94 "," $1,722.35 "," $1,631.70 "," $1,631.70 "," $1,631.70 "," $1,686.09 "," $1,740.48 "," $1,057.02 "," $1,541.05 "," $1,100.77 ", $935.17 , N/A , $902.35 , $902.35 ," $1,722.35 "," $1,025.04 ", $178.03 ," $1,740.48 "
 Fac Cellular Function Assay Stimul&Detect Biomarker ,CPT® 86352,0302 - LAB/IMMUNOLOGY,N/A,N/A, $209.00 , $135.85 , $175.56 , $138.58 , $99.25 , $168.87 , $188.10 , $176.94 , $188.10 , $188.10 , $188.10 , $177.65 , $97.30 , $192.97 , $198.55 , $177.65 , $194.37 , $194.37 , $198.55 , $200.64 , $171.00 , $188.10 , $177.65 , $165.11 , N/A , $169.14 , $169.14 , $198.55 , $179.34 , $97.30 , $200.64 
"Med Nutr Ther, Subsq, Indiv, Ea 15 Min",97803,N/A,N/A,N/A, $113.00 , $73.45 , $64.46 , $27.15 , N/A , $61.35 , $62.99 , $105.09 , $101.70 , $101.70 , $90.40 , $90.40 , N/A , $104.33 , $107.35 , $101.70 , $101.70 , $101.70 , $105.09 , $108.48 , $85.60 , $96.05 , $83.12 , $104.94 , N/A , $62.56 , $62.56 , $107.35 , $72.92 , $27.15 , $108.48 
"Assay Vitamin, Unspecified",CPT® 84591,N/A,N/A,N/A, $174.00 , $113.10 , N/A , $17.40 , $16.11 , $65.65 , $78.53 , $161.82 , $156.60 , $156.60 , $139.20 , $139.20 , $16.11 , $160.65 , $165.30 , $156.60 , $156.60 , $156.60 , $161.82 , $167.04 , $113.91 , $147.90 , $76.23 , $50.11 , N/A , $61.27 , $61.27 , $165.30 , $66.95 , $16.11 , $167.04 
 METOPROLOL SUCCINATE ER 50 MG PO TB24 ,HCPCS RXC637,0250 - PHARMACY,00904-6323-61,1 tablet, $6.37 , $4.14 , $5.35 , N/A , N/A , $5.15 , $5.73 , $5.39 , $5.73 , $5.73 , $5.73 , $5.41 , N/A , $5.88 , $6.05 , $5.41 , $5.92 , $5.92 , $6.05 , $6.12 , $5.21 , $5.73 , $5.41 , $5.03 , N/A , $5.16 , $5.16 , $6.05 , $5.47 , $5.03 , $6.12 
Total Abdom Hysterectomy,CPT® 58150,N/A,N/A,N/A," $5,971.00 "," $3,881.15 "," $4,754.80 ", $963.96 , $887.97 ," $4,111.31 "," $4,050.89 "," $5,553.03 "," $5,373.90 "," $5,373.90 "," $4,776.80 "," $4,776.80 ", $887.97 ," $5,513.02 "," $5,672.45 "," $5,373.90 "," $5,373.90 "," $5,373.90 "," $5,553.03 "," $5,732.16 "," $4,972.38 "," $5,075.35 "," $5,332.57 "," $4,130.51 ", N/A ," $4,191.52 "," $4,191.52 "," $5,672.45 "," $5,027.46 ", $887.97 ," $5,732.16 "
 Fac Assay of Vip ,CPT® 84586,0301 - LAB/CHEMISTRY,N/A,N/A, $313.00 , $203.45 , $262.92 , $36.04 , $17.70 , $252.90 , $281.70 , $264.99 , $281.70 , $281.70 , $281.70 , $266.05 , $17.35 , $288.99 , $297.35 , $266.05 , $291.09 , $291.09 , $297.35 , $300.48 , $256.10 , $281.70 , $266.05 , $247.27 , N/A , $253.31 , $253.31 , $297.35 , $268.59 , $17.35 , $300.48 
 Pro Exc Trchntric Bursa/Calcification ,CPT® 27062,0975 - PRO FEE/OR,N/A,N/A," $3,630.00 "," $2,359.50 "," $2,786.10 ", $437.25 , $329.90 ," $2,199.19 "," $2,199.13 "," $3,375.90 "," $3,267.00 "," $3,267.00 "," $2,904.00 "," $2,904.00 ", $329.90 ," $3,351.58 "," $3,448.50 "," $3,267.00 "," $3,267.00 "," $3,267.00 "," $3,375.90 "," $3,484.80 "," $2,586.57 "," $3,085.50 "," $2,426.33 "," $2,590.31 ", N/A ," $2,242.09 "," $2,242.09 "," $3,448.50 "," $2,635.27 ", $329.90 ," $3,484.80 "
 Pro Exc Tr-Ext B9+Marg 0.5 < Cm ,CPT® 11400,0982 - PRO FEE/OUTPT,N/A,N/A, $486.00 , $315.90 , $269.31 , $81.33 , $48.12 , $218.95 , $215.53 , $451.98 , $437.40 , $437.40 , $388.80 , $388.80 , $48.12 , $448.72 , $461.70 , $437.40 , $437.40 , $437.40 , $451.98 , $466.56 , $293.40 , $413.10 , $426.39 , $284.49 , N/A , $223.23 , $223.23 , $461.70 , $258.85 , $48.12 , $466.56 
Psychiatric Diagnostic Eval W/Medical Services,CPT® 90792,N/A,N/A,N/A, $589.00 , $382.85 , $229.70 , $170.04 , $177.53 , $316.53 , $276.60 , $547.77 , $530.10 , $530.10 , $471.20 , $471.20 , $177.53 , $543.82 , $559.55 , $530.10 , $530.10 , $530.10 , $547.77 , $565.44 , $438.98 , $500.65 , $359.87 , $541.11 , $210.00 , $322.71 , $322.71 , $559.55 , $376.22 , $170.04 , $565.44 
 Fac Bldr Instlj Anticarcinogenic Agt ,CPT® 51720,0761 - TREATMENT ROOM,N/A,N/A, $962.00 , $625.30 , $808.08 , $41.44 , $34.30 , $777.30 , $865.80 , $814.43 , $865.80 , $865.80 , $865.80 , $817.70 , $33.63 , $888.21 , $913.90 , $817.70 , $894.66 , $894.66 , $913.90 , $923.52 , $787.11 , $865.80 , $817.70 , $759.98 , N/A , $778.55 , $778.55 , $913.90 , $825.49 , $33.63 , $923.52 
" Fac Immunoassay, Nonantibody ",CPT® 83519,0302 - LAB/IMMUNOLOGY,N/A,N/A, $217.00 , $141.05 , $182.28 , $18.77 , $18.76 , $175.34 , $195.30 , $183.71 , $195.30 , $195.30 , $195.30 , $184.45 , $18.39 , $200.36 , $206.15 , $184.45 , $201.81 , $201.81 , $206.15 , $208.32 , $177.55 , $195.30 , $184.45 , $171.43 , N/A , $175.62 , $175.62 , $206.15 , $186.21 , $18.39 , $208.32 
 Fac Rmvl Non-Biodegradable Drug Dlvr Implt ,CPT® 11982,0361 - OR/MINOR,N/A,N/A, $375.00 , $243.75 , $315.00 , $69.06 , $93.57 , $303.00 , $337.50 , $317.48 , $337.50 , $337.50 , $337.50 , $318.75 , $91.74 , $346.24 , $356.25 , $318.75 , $348.75 , $348.75 , $356.25 , $360.00 , $306.83 , $337.50 , $318.75 , $296.25 , N/A , $303.49 , $303.49 , $356.25 , $321.79 , $69.06 , $360.00 
" Fac Macro Exam/Dissect/Prep for Non-Micro Study, Ea ",CPT® 88387,0310 - PATHOLOGY LAB,N/A,N/A, $668.00 , $434.20 , $561.12 , $33.79 , $34.27 , $539.74 , $601.20 , $565.53 , $601.20 , $601.20 , $601.20 , $567.80 , $33.60 , $616.76 , $634.60 , $567.80 , $621.24 , $621.24 , $634.60 , $641.28 , $546.56 , $601.20 , $567.80 , $527.72 , N/A , $540.61 , $540.61 , $634.60 , $573.21 , $33.60 , $641.28 
"Needle Biopsy,Muscle",20206,N/A,N/A,N/A, $918.00 , $596.70 , $353.73 , $55.01 , $134.06 , $292.48 , $286.69 , $853.74 , $826.20 , $826.20 , $734.40 , $734.40 , $134.06 , $847.59 , $872.10 , $826.20 , $826.20 , $826.20 , $853.74 , $881.28 , $328.65 , $780.30 , $308.64 , $344.99 , N/A , $298.19 , $298.19 , $872.10 , $350.47 , $55.01 , $881.28 
 Fac Smpl Rpr Supfc S/N/Ax/G/T 2.5cm/< ,CPT® 12001,0761 - TREATMENT ROOM,N/A,N/A, $583.00 , $378.95 , $489.72 , $41.72 , $52.39 , $471.06 , $524.70 , $493.57 , $524.70 , $524.70 , $524.70 , $495.55 , $51.36 , $538.28 , $553.85 , $495.55 , $542.19 , $542.19 , $553.85 , $559.68 , $477.01 , $524.70 , $495.55 , $460.57 , N/A , $471.82 , $471.82 , $553.85 , $500.27 , $41.72 , $559.68 
 Fac Assay of Metanephrines ,CPT® 83835,0301 - LAB/CHEMISTRY,N/A,N/A, $238.00 , $154.70 , $199.92 , $17.28 , $17.28 , $192.30 , $214.20 , $201.49 , $214.20 , $214.20 , $214.20 , $202.30 , $16.94 , $219.75 , $226.10 , $202.30 , $221.34 , $221.34 , $226.10 , $228.48 , $194.73 , $214.20 , $202.30 , $188.02 , N/A , $192.61 , $192.61 , $226.10 , $204.23 , $16.94 , $228.48 
 Fac Appl Short Leg Cst Belw Kne-Toe Walking/Ambl Typ ,CPT® 29425,0761 - TREATMENT ROOM,N/A,N/A, $606.00 , $393.90 , $509.04 , $52.05 , $72.09 , $489.65 , $545.40 , $513.04 , $545.40 , $545.40 , $545.40 , $515.10 , $70.68 , $559.52 , $575.70 , $515.10 , $563.58 , $563.58 , $575.70 , $581.76 , $495.83 , $545.40 , $515.10 , $478.74 , N/A , $490.44 , $490.44 , $575.70 , $520.01 , $52.05 , $581.76 
 Fac Chorionic Gonadotropin Assay ,CPT® 84703,0301 - LAB/CHEMISTRY,N/A,N/A, $120.00 , $78.00 , $100.80 , $7.67 , $7.67 , $96.96 , $108.00 , $101.59 , $108.00 , $108.00 , $108.00 , $102.00 , $7.52 , $110.80 , $114.00 , $102.00 , $111.60 , $111.60 , $114.00 , $115.20 , $98.18 , $108.00 , $102.00 , $94.80 , N/A , $97.12 , $97.12 , $114.00 , $102.97 , $7.52 , $115.20 
Treat Hip Dislocation,CPT® 27250,N/A,N/A,N/A," $1,278.00 ", $830.70 ," $1,065.87 ", $165.79 , $208.13 , $875.35 , $864.39 ," $1,188.54 "," $1,150.20 "," $1,150.20 "," $1,022.40 "," $1,022.40 ", $208.13 ," $1,179.98 "," $1,214.10 "," $1,150.20 "," $1,150.20 "," $1,150.20 "," $1,188.54 "," $1,226.88 ", $994.46 ," $1,086.30 ", $958.04 ," $1,022.68 ", N/A , $892.42 , $892.42 ," $1,214.10 "," $1,048.91 ", $165.79 ," $1,226.88 "
 PHENOL 1.4 % MT LIQD ,HCPCS RXC637,0250 - PHARMACY,78112-0012-55,177 mL, $37.28 , $24.23 , $31.32 , N/A , N/A , $30.12 , $33.55 , $31.56 , $33.55 , $33.55 , $33.55 , $31.69 , N/A , $34.42 , $35.42 , $31.69 , $34.67 , $34.67 , $35.42 , $35.79 , $30.50 , $33.55 , $31.69 , $29.45 , N/A , $30.17 , $30.17 , $35.42 , $31.99 , $29.45 , $35.79 
Closed Rx Tib Plat Fx+Manip,27532,N/A,N/A,N/A," $4,361.00 "," $2,834.65 "," $3,542.63 ", $556.13 , $384.19 ," $2,787.61 "," $2,778.76 "," $4,055.73 "," $3,924.90 "," $3,924.90 "," $3,488.80 "," $3,488.80 ", $384.19 ," $4,026.51 "," $4,142.95 "," $3,924.90 "," $3,924.90 "," $3,924.90 "," $4,055.73 "," $4,186.56 "," $3,272.69 "," $3,706.85 "," $3,065.02 "," $3,276.05 ", N/A ," $2,842.00 "," $2,842.00 "," $4,142.95 "," $3,340.38 ", $384.19 ," $4,186.56 "
Layer Closure 7.6-12.5cm,CPT® 12054,N/A,N/A,N/A," $1,652.00 "," $1,073.80 ", $691.80 , $208.93 , $210.26 , $622.08 , $609.78 ," $1,536.36 "," $1,486.80 "," $1,486.80 "," $1,321.60 "," $1,321.60 ", $210.26 ," $1,525.29 "," $1,569.40 "," $1,486.80 "," $1,486.80 "," $1,486.80 "," $1,536.36 "," $1,585.92 ", $758.54 ," $1,404.20 "," $1,218.52 ", $778.84 , N/A , $634.21 , $634.21 ," $1,569.40 ", $735.47 , $208.93 ," $1,585.92 "
"Remove Tonsils/Adenoids,12+ Y/O",CPT® 42821,N/A,N/A,N/A," $2,056.00 "," $1,336.40 "," $1,873.17 ", $294.90 , $273.54 ," $1,450.93 "," $1,492.77 "," $1,912.08 "," $1,850.40 "," $1,850.40 "," $1,644.80 "," $1,644.80 ", $273.54 ," $1,898.30 "," $1,953.20 "," $1,850.40 "," $1,850.40 "," $1,850.40 "," $1,912.08 "," $1,973.76 "," $1,325.12 "," $1,747.60 "," $1,628.85 "," $1,699.26 ", N/A ," $1,479.24 "," $1,479.24 "," $1,953.20 "," $1,547.11 ", $273.54 ," $1,973.76 "
 Pro Repair of Abdominal Wall ,CPT® 49900,0982 - PRO FEE/OUTPT,N/A,N/A," $5,308.00 "," $3,450.20 "," $4,930.45 ", $765.38 , $307.34 ," $3,835.46 "," $3,903.96 "," $4,936.44 "," $4,777.20 "," $4,777.20 "," $4,246.40 "," $4,246.40 ", $307.34 ," $4,900.88 "," $5,042.60 "," $4,777.20 "," $4,777.20 "," $4,777.20 "," $4,936.44 "," $5,095.68 "," $3,512.83 "," $4,511.80 "," $4,328.14 "," $4,546.25 ", N/A ," $3,910.30 "," $3,910.30 "," $5,042.60 "," $4,089.75 ", $307.34 ," $5,095.68 "
 DUTASTERIDE 0.5 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,31722-0131-30,1 capsule, $31.09 , $20.21 , $26.12 , N/A , N/A , $25.12 , $27.98 , $26.32 , $27.98 , $27.98 , $27.98 , $26.43 , N/A , $28.71 , $29.54 , $26.43 , $28.91 , $28.91 , $29.54 , $29.85 , $25.44 , $27.98 , $26.43 , $24.56 , N/A , $25.16 , $25.16 , $29.54 , $26.68 , $24.56 , $29.85 
Pcv20 Vaccine for Intramuscular Use,CPT® 90677,N/A,N/A,N/A, $376.00 , $244.40 , N/A , $294.43 , $246.26 , N/A , N/A , $349.68 , $338.40 , $338.40 , $300.80 , $300.80 , $246.26 , $347.16 , $357.20 , $338.40 , $338.40 , $338.40 , $349.68 , $360.96 , N/A , $319.60 , $845.09 , $409.11 , N/A , $544.76 , $544.76 , $357.20 , $634.12 , $246.26 , $845.09 
Open Rx Prox/Mid Fing Shft Fx,26735,N/A,N/A,N/A," $2,395.00 "," $1,556.75 "," $3,648.13 ", $573.87 , $307.34 ," $2,873.69 "," $2,876.39 "," $2,227.35 "," $2,155.50 "," $2,155.50 "," $1,916.00 "," $1,916.00 ", $307.34 ," $2,211.30 "," $2,275.25 "," $2,155.50 "," $2,155.50 "," $2,155.50 "," $2,227.35 "," $2,299.20 "," $3,390.43 "," $2,035.75 "," $3,164.93 "," $3,404.22 ", N/A ," $2,929.76 "," $2,929.76 "," $2,275.25 "," $3,443.51 ", $307.34 ," $3,648.13 "
Drug Screening Stimulants Synthetic,CPT® 80371,N/A,N/A,N/A, $75.00 , $48.75 , N/A , N/A , N/A , N/A , N/A , $69.75 , $67.50 , $67.50 , $60.00 , $60.00 , N/A , $69.25 , $71.25 , $67.50 , $67.50 , $67.50 , $69.75 , $72.00 , N/A , $63.75 , $114.69 , $67.79 , N/A , $90.04 , $90.04 , $71.25 , $98.20 , $60.00 , $114.69 
"Mediastinoscopy, Chst Approach",CPT® 39010,N/A,N/A,N/A," $8,771.00 "," $5,701.15 "," $3,147.50 ", $720.52 ," $1,844.17 "," $2,765.48 "," $2,839.28 "," $8,157.03 "," $7,893.90 "," $7,893.90 "," $7,016.80 "," $7,016.80 "," $1,844.17 "," $8,098.26 "," $8,332.45 "," $7,893.90 "," $7,893.90 "," $7,893.90 "," $8,157.03 "," $8,420.16 "," $4,292.78 "," $7,455.35 "," $4,238.94 "," $3,592.07 ", N/A ," $2,819.44 "," $2,819.44 "," $8,332.45 "," $3,267.98 ", $720.52 ," $8,420.16 "
Lactic Acid Assay,CPT® 83605,N/A,N/A,N/A, $140.00 , $91.00 , N/A , $11.80 , $11.80 , $60.41 , $72.27 , $130.20 , $126.00 , $126.00 , $112.00 , $112.00 , $11.80 , $129.26 , $133.00 , $126.00 , $126.00 , $126.00 , $130.20 , $134.40 , $77.26 , $119.00 , $69.74 , $38.74 , N/A , $56.38 , $56.38 , $133.00 , $61.61 , $11.80 , $134.40 
Incision of Eyelid Fold,CPT® 67715,N/A,N/A,N/A," $2,451.00 "," $1,593.15 ", $657.22 , $103.64 , $151.20 , $611.81 , $583.74 ," $2,279.43 "," $2,205.90 "," $2,205.90 "," $1,960.80 "," $1,960.80 ", $151.20 ," $2,263.01 "," $2,328.45 "," $2,205.90 "," $2,205.90 "," $2,205.90 "," $2,279.43 "," $2,352.96 ", $902.48 ," $2,083.35 ", $604.80 , $773.22 , N/A , $623.75 , $623.75 ," $2,328.45 ", $688.52 , $103.64 ," $2,352.96 "
Hyperbaric Oxygen Therapy,CPT® 99183,N/A,N/A,N/A, $802.00 , $521.30 , $242.42 , $101.04 , $159.79 , $243.80 , $267.41 , $745.86 , $721.80 , $721.80 , $641.60 , $641.60 , $159.79 , $740.49 , $761.90 , $721.80 , $721.80 , $721.80 , $745.86 , $769.92 , $322.25 , $681.70 , $356.83 , $408.97 , N/A , $248.56 , $248.56 , $761.90 , $289.78 , $101.04 , $769.92 
 Pro Anes Comp Emer Conditions Spec ,CPT® 99140,0964 - PRO FEE/ANES CRNA,N/A,N/A, $292.00 , $189.80 , N/A , N/A , $27.15 , N/A , N/A , $271.56 , $262.80 , $262.80 , $233.60 , $233.60 , $27.15 , $269.60 , $277.40 , $262.80 , $262.80 , $262.80 , $271.56 , $280.32 , N/A , $248.20 , N/A , N/A , N/A , N/A , N/A , $277.40 , N/A , $27.15 , $280.32 
 Fac Drug Assay Vedolizumab ,CPT® 80280,0301 - LAB/CHEMISTRY,N/A,N/A, $309.00 , $200.85 , $259.56 , $39.34 , $31.47 , $249.67 , $278.10 , $261.60 , $278.10 , $278.10 , $278.10 , $262.65 , $30.85 , $285.30 , $293.55 , $262.65 , $287.37 , $287.37 , $293.55 , $296.64 , $252.82 , $278.10 , $262.65 , $244.11 , N/A , $250.07 , $250.07 , $293.55 , $265.15 , $30.85 , $296.64 
 Fac CSF Shunt Evaluation ,CPT® 78645,0340 - NUCLEAR MEDICINE,N/A,N/A," $3,331.00 "," $2,165.15 "," $2,798.04 ", $294.87 , $165.19 ," $2,691.45 "," $2,997.90 "," $2,820.02 "," $2,997.90 "," $2,997.90 "," $2,997.90 "," $2,831.35 ", $161.95 ," $3,075.51 "," $3,164.45 "," $2,831.35 "," $3,097.83 "," $3,097.83 "," $3,164.45 "," $3,197.76 "," $2,725.42 "," $2,997.90 "," $2,831.35 "," $2,631.49 ", N/A ," $2,695.78 "," $2,695.78 "," $3,164.45 "," $2,858.33 ", $161.95 ," $3,197.76 "
Treatment Toe Fracture,28510,N/A,N/A,N/A, $817.00 , $531.05 , $743.67 , $118.80 , $61.48 , $587.40 , $600.10 , $759.81 , $735.30 , $735.30 , $653.60 , $653.60 , $61.48 , $754.34 , $776.15 , $735.30 , $735.30 , $735.30 , $759.81 , $784.32 , $688.46 , $694.45 , $651.18 , $699.92 , N/A , $598.86 , $598.86 , $776.15 , $703.87 , $61.48 , $784.32 
 Fac Drug Screening Methadone ,CPT® 80358,0301 - LAB/CHEMISTRY,N/A,N/A, $166.00 , $107.90 , $139.44 , N/A , N/A , $134.13 , $149.40 , $140.54 , $149.40 , $149.40 , $149.40 , $141.10 , N/A , $153.27 , $157.70 , $141.10 , $154.38 , $154.38 , $157.70 , $159.36 , $135.82 , $149.40 , $141.10 , $131.14 , N/A , $134.34 , $134.34 , $157.70 , $142.44 , $131.14 , $159.36 
"Visual Field Exam,Extended",92083,N/A,N/A,N/A, $232.00 , $150.80 , $136.22 , $61.50 , $30.53 , $112.81 , $112.62 , $215.76 , $208.80 , $208.80 , $185.60 , $185.60 , $30.53 , $214.21 , $220.40 , $208.80 , $208.80 , $208.80 , $215.76 , $222.72 , $192.94 , $197.20 , $198.69 , $135.34 , N/A , $115.01 , $115.01 , $220.40 , $136.81 , $30.53 , $222.72 
 BUPROPION HCL ER (SR) 100 MG PO TB12 ,HCPCS RXC637,0250 - PHARMACY,68084-0697-01,1 tablet, $8.55 , $5.56 , $7.18 , N/A , N/A , $6.91 , $7.70 , $7.24 , $7.70 , $7.70 , $7.70 , $7.27 , N/A , $7.89 , $8.12 , $7.27 , $7.95 , $7.95 , $8.12 , $8.21 , $7.00 , $7.70 , $7.27 , $6.75 , N/A , $6.92 , $6.92 , $8.12 , $7.34 , $6.75 , $8.21 
Emergency Department Visit Straightforward Mdm,99282,N/A,N/A,N/A, $248.00 , $161.20 , $148.19 , $40.13 , $25.96 , $116.08 , $119.87 , $230.64 , $223.20 , $223.20 , $198.40 , $198.40 , $25.96 , $228.98 , $235.60 , $223.20 , $223.20 , $223.20 , $230.64 , $238.08 , $125.96 , $210.80 , $88.51 , $89.62 , $21.00 , $118.34 , $118.34 , $235.60 , $142.01 , $21.00 , $238.08 
 Fac Mnpj Ch Facilitate Lng Funcj Sbsq ,CPT® 94668,0412 - INHALATION SVC,N/A,N/A, $158.00 , $102.70 , $132.72 , $35.35 , $11.09 , $127.66 , $142.20 , $133.76 , $142.20 , $142.20 , $142.20 , $134.30 , $10.87 , $145.88 , $150.10 , $134.30 , $146.94 , $146.94 , $150.10 , $151.68 , $129.28 , $142.20 , $134.30 , $124.82 , N/A , $127.87 , $127.87 , $150.10 , $135.58 , $10.87 , $151.68 
 Fac Amb 911 Base Als Non-Emergent ,HCPCS A0426,0540 - AMBULANCE,N/A,N/A," $1,409.00 ", $915.85 ," $1,183.56 ", N/A , $258.38 ," $1,138.47 "," $1,268.10 "," $1,192.86 "," $1,268.10 "," $1,268.10 "," $1,268.10 "," $1,197.65 ", $253.31 ," $1,300.93 "," $1,338.55 "," $1,197.65 "," $1,310.37 "," $1,310.37 "," $1,338.55 "," $1,352.64 "," $1,152.84 "," $1,268.10 "," $1,197.65 "," $1,113.11 ", N/A ," $1,140.30 "," $1,140.30 "," $1,338.55 "," $1,209.06 ", $253.31 ," $1,352.64 "
Egd Percutaneous Placement Gastrostomy Tube,43246,N/A,N/A,N/A," $3,393.00 "," $2,205.45 "," $1,214.72 ", $187.69 , $744.68 ," $1,008.36 "," $1,217.72 "," $3,155.49 "," $3,053.70 "," $3,053.70 "," $2,714.40 "," $2,714.40 ", $744.68 ," $3,132.76 "," $3,223.35 "," $3,053.70 "," $3,053.70 "," $3,053.70 "," $3,155.49 "," $3,257.28 ", $873.20 ," $2,884.05 "," $1,338.05 "," $1,156.34 ", N/A ," $1,028.04 "," $1,028.04 "," $3,223.35 "," $1,075.22 ", $187.69 ," $3,257.28 "
Rpr Aa Hernia 1st < 3 Cm Ncrc8/Strangulated,CPT® 49592,N/A,N/A,N/A," $4,256.00 "," $2,766.40 ", N/A , $434.85 , $339.39 , N/A , N/A ," $3,958.08 "," $3,830.40 "," $3,830.40 "," $3,404.80 "," $3,404.80 ", $339.39 ," $3,929.56 "," $4,043.20 "," $3,830.40 "," $3,830.40 "," $3,830.40 "," $3,958.08 "," $4,085.76 ", N/A ," $3,617.60 "," $2,521.48 ", N/A , N/A ," $1,872.04 "," $1,872.04 "," $4,043.20 "," $1,959.87 ", $339.39 ," $4,085.76 "
Psycl/Nrpsycl Tst Phys/Qhp 2+ Tst Ea Addl 30 Min,CPT® 96137,N/A,N/A,N/A, $186.00 , $120.90 , $43.39 , $17.98 , $50.09 , $40.80 , N/A , $172.98 , $167.40 , $167.40 , $148.80 , $148.80 , $50.09 , $171.73 , $176.70 , $167.40 , $167.40 , $167.40 , $172.98 , $178.56 , $81.44 , $158.10 , $53.51 , $74.34 , $60.97 , $41.60 , $41.60 , $176.70 , $48.50 , $17.98 , $178.56 
 Other Circulatory System Diagnoses With McC ,MS DRG V40 (FY2023) 314,N/A,N/A,N/A," $21,551.94 "," $14,008.76 "," $18,103.63 ", N/A , N/A ," $17,413.97 "," $19,396.75 "," $18,245.87 "," $19,396.75 "," $19,396.75 "," $19,396.75 "," $18,319.15 ", N/A ," $19,898.91 "," $20,474.34 "," $18,319.15 "," $20,043.30 "," $20,043.30 "," $20,474.34 "," $20,689.86 "," $17,633.80 "," $19,396.75 "," $18,319.15 "," $17,026.03 ", N/A ," $17,441.99 "," $17,441.99 "," $20,474.34 "," $18,493.72 "," $17,026.03 "," $20,689.86 "
" CT Angio Aorta, Iliofemoral Leg Run ",CPT® 75635,0350 - CT SCAN,N/A,N/A," $5,929.00 "," $3,853.85 "," $4,980.36 ", $285.11 , $432.47 ," $4,790.63 "," $5,336.10 "," $5,019.49 "," $5,336.10 "," $5,336.10 "," $5,336.10 "," $5,039.65 ", $423.99 ," $5,474.25 "," $5,632.55 "," $5,039.65 "," $5,513.97 "," $5,513.97 "," $5,632.55 "," $5,691.84 "," $4,851.11 "," $5,336.10 "," $5,039.65 "," $4,683.91 ", N/A ," $4,798.34 "," $4,798.34 "," $5,632.55 "," $5,087.67 ", $285.11 ," $5,691.84 "
 Thyroid/Parathyroid US ,CPT® 76536,0402 - ULTRASOUND,N/A,N/A, $620.00 , $403.00 , $520.80 , $109.87 , $87.55 , $500.96 , $558.00 , $524.89 , $558.00 , $558.00 , $558.00 , $527.00 , $85.83 , $572.45 , $589.00 , $527.00 , $576.60 , $576.60 , $589.00 , $595.20 , $507.28 , $558.00 , $527.00 , $489.80 , N/A , $501.77 , $501.77 , $589.00 , $532.02 , $85.83 , $595.20 
Moderna Administration Third Dose,CPT® 0013A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $76.25 , $128.02 , N/A , $79.82 , $79.82 , $66.50 , $92.91 , $38.92 , $128.02 
 Pro Arthrs Elbw Surg W/Rmvl Loose Bdy/FB ,CPT® 29834,0982 - PRO FEE/OUTPT,N/A,N/A," $3,971.00 "," $2,581.15 "," $3,009.96 ", $473.11 , $500.35 ," $2,352.67 "," $2,367.22 "," $3,693.03 "," $3,573.90 "," $3,573.90 "," $3,176.80 "," $3,176.80 ", $500.35 ," $3,666.42 "," $3,772.45 "," $3,573.90 "," $3,573.90 "," $3,573.90 "," $3,693.03 "," $3,812.16 "," $2,803.63 "," $3,375.35 "," $2,610.09 "," $2,791.70 ", N/A ," $2,398.57 "," $2,398.57 "," $3,772.45 "," $2,819.18 ", $473.11 ," $3,812.16 "
"Anoscopy,Diagnostic",46600,N/A,N/A,N/A, $264.00 , $171.60 , $248.37 , $39.14 , $31.62 , $195.21 , $200.98 , $245.52 , $237.60 , $237.60 , $211.20 , $211.20 , $31.62 , $243.75 , $250.80 , $237.60 , $237.60 , $237.60 , $245.52 , $253.44 , $176.09 , $224.40 , $219.44 , $235.21 , N/A , $199.01 , $199.01 , $250.80 , $208.15 , $31.62 , $253.44 
 Pro Exploratory Shoulder Surgery ,CPT® 23040,0982 - PRO FEE/OUTPT,N/A,N/A," $4,732.00 "," $3,075.80 "," $4,380.35 ", $685.55 , $768.38 ," $3,463.41 "," $3,454.45 "," $4,400.76 "," $4,258.80 "," $4,258.80 "," $3,785.60 "," $3,785.60 ", $768.38 ," $4,369.06 "," $4,495.40 "," $4,258.80 "," $4,258.80 "," $4,258.80 "," $4,400.76 "," $4,542.72 "," $4,061.84 "," $4,022.20 "," $3,814.33 "," $4,076.13 ", N/A ," $3,530.99 "," $3,530.99 "," $4,495.40 "," $4,150.15 ", $685.55 ," $4,542.72 "
 DILTIAZEM HCL 30 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00093-0318-01,1 tablet, $5.14 , $3.34 , $4.32 , N/A , N/A , $4.15 , $4.63 , $4.35 , $4.63 , $4.63 , $4.63 , $4.37 , N/A , $4.75 , $4.88 , $4.37 , $4.78 , $4.78 , $4.88 , $4.93 , $4.21 , $4.63 , $4.37 , $4.06 , N/A , $4.16 , $4.16 , $4.88 , $4.41 , $4.06 , $4.93 
"Remove Foreign Body,Foot",28193,N/A,N/A,N/A," $2,814.00 "," $1,829.10 "," $2,279.29 ", $356.58 , $214.44 ," $1,826.54 "," $1,823.32 "," $2,617.02 "," $2,532.60 "," $2,532.60 "," $2,251.20 "," $2,251.20 ", $214.44 ," $2,598.17 "," $2,673.30 "," $2,532.60 "," $2,532.60 "," $2,532.60 "," $2,617.02 "," $2,701.44 "," $2,124.63 "," $2,391.90 "," $1,971.39 "," $2,164.89 ", N/A ," $1,862.17 "," $1,862.17 "," $2,673.30 "," $2,188.72 ", $214.44 ," $2,701.44 "
 Pro Control of Nosebleed ,CPT® 30901,0982 - PRO FEE/OUTPT,N/A,N/A, $781.00 , $507.65 , $301.30 , $53.21 , $34.36 , $216.79 , $209.25 , $726.33 , $702.90 , $702.90 , $624.80 , $624.80 , $34.36 , $721.10 , $741.95 , $702.90 , $702.90 , $702.90 , $726.33 , $749.76 , $289.39 , $663.85 , $296.15 , $286.56 , N/A , $221.02 , $221.02 , $741.95 , $260.29 , $34.36 , $749.76 
 Pro Drainage of Pilonidal Cyst ,CPT® 10080,0982 - PRO FEE/OUTPT,N/A,N/A, $795.00 , $516.75 , $335.61 , $100.38 , $61.55 , $282.06 , $278.01 , $739.35 , $715.50 , $715.50 , $636.00 , $636.00 , $61.55 , $734.02 , $755.25 , $715.50 , $715.50 , $715.50 , $739.35 , $763.20 , $367.33 , $675.75 , $553.06 , $359.71 , N/A , $287.57 , $287.57 , $755.25 , $333.47 , $61.55 , $763.20 
"Hypospad Repr,1 Stage,Dist,Extensv",CPT® 54328,N/A,N/A,N/A," $5,153.00 "," $3,349.45 "," $4,143.19 ", $890.64 , $938.90 ," $3,018.40 "," $3,038.47 "," $4,792.29 "," $4,637.70 "," $4,637.70 "," $4,122.40 "," $4,122.40 ", $938.90 ," $4,757.76 "," $4,895.35 "," $4,637.70 "," $4,637.70 "," $4,637.70 "," $4,792.29 "," $4,946.88 "," $3,896.26 "," $4,380.05 "," $4,840.17 "," $4,551.21 ", N/A ," $3,077.29 "," $3,077.29 "," $4,895.35 "," $3,688.30 ", $890.64 ," $4,946.88 "
Assay for Prolactin,CPT® 84146,N/A,N/A,N/A, $181.00 , $117.65 , N/A , $19.77 , $19.77 , $109.64 , $131.15 , $168.33 , $162.90 , $162.90 , $144.80 , $144.80 , $19.77 , $167.12 , $171.95 , $162.90 , $162.90 , $162.90 , $168.33 , $173.76 , $129.40 , $153.85 , $126.50 , $70.25 , N/A , $102.32 , $102.32 , $171.95 , $111.81 , $19.77 , $173.76 
 RHO D IMMUNE GLOBULIN 1500 UNITS IM SOSY ,HCPCS J2790,0636 - DRUGS REQUIRING DETAILED CODIN,00562-7805-01,300 mcg, $647.97 , $421.18 , $544.29 , $83.47 , $83.41 , $523.56 , $583.17 , $548.57 , $583.17 , $583.17 , $583.17 , $550.77 , $81.77 , $598.27 , $615.57 , $550.77 , $602.61 , $602.61 , $615.57 , $622.05 , $530.17 , $583.17 , $550.77 , $511.90 , N/A , $524.40 , $524.40 , $615.57 , $556.02 , $81.77 , $622.05 
"Assay Quantitative, Glucose",CPT® 82947,N/A,N/A,N/A, $42.00 , $27.30 , N/A , $4.01 , $4.01 , $22.20 , $26.53 , $39.06 , $37.80 , $37.80 , $33.60 , $33.60 , $4.01 , $38.78 , $39.90 , $37.80 , $37.80 , $37.80 , $39.06 , $40.32 , $26.24 , $35.70 , $25.95 , $14.22 , N/A , $20.72 , $20.72 , $39.90 , $22.64 , $4.01 , $40.32 
"Removal of Urethra,Female",CPT® 53210,N/A,N/A,N/A," $5,381.00 "," $3,497.65 "," $4,203.02 ", $739.17 , $845.22 ," $3,777.40 "," $3,540.14 "," $5,004.33 "," $4,842.90 "," $4,842.90 "," $4,304.80 "," $4,304.80 ", $845.22 ," $4,968.28 "," $5,111.95 "," $4,842.90 "," $4,842.90 "," $4,842.90 "," $5,004.33 "," $5,165.76 "," $4,185.59 "," $4,573.85 "," $4,008.79 "," $4,737.33 ", N/A ," $3,851.11 "," $3,851.11 "," $5,111.95 "," $4,526.41 ", $739.17 ," $5,165.76 "
 MICONAZOLE NITRATE 2 % EX OINT ,HCPCS RXC637,0250 - PHARMACY,68455-0108-52,141 gram, $55.05 , $35.78 , $46.24 , N/A , N/A , $44.48 , $49.55 , $46.61 , $49.55 , $49.55 , $49.55 , $46.79 , N/A , $50.83 , $52.30 , $46.79 , $51.20 , $51.20 , $52.30 , $52.85 , $45.04 , $49.55 , $46.79 , $43.49 , N/A , $44.55 , $44.55 , $52.30 , $47.24 , $43.49 , $52.85 
"Anoscopy,Diagnostic",46600,N/A,N/A,N/A, $586.00 , $380.90 , $248.37 , $39.14 , $31.62 , $195.21 , $200.98 , $544.98 , $527.40 , $527.40 , $468.80 , $468.80 , $31.62 , $541.05 , $556.70 , $527.40 , $527.40 , $527.40 , $544.98 , $562.56 , $176.09 , $498.10 , $219.44 , $235.21 , N/A , $199.01 , $199.01 , $556.70 , $208.15 , $31.62 , $562.56 
Replac Aort Valv W Annulu Enlrg,CPT® 33411,N/A,N/A,N/A," $29,418.00 "," $19,121.70 "," $19,528.02 "," $3,013.86 "," $2,378.00 "," $14,324.49 "," $14,210.82 "," $27,358.74 "," $26,476.20 "," $26,476.20 "," $23,534.40 "," $23,534.40 "," $2,378.00 "," $27,161.64 "," $27,947.10 "," $26,476.20 "," $26,476.20 "," $26,476.20 "," $27,358.74 "," $28,241.28 "," $18,097.63 "," $25,005.30 "," $18,013.70 "," $16,060.95 ", N/A ," $14,603.98 "," $14,603.98 "," $27,947.10 "," $16,590.14 "," $2,378.00 "," $28,241.28 "
" Fac Ca Screen,Flexi Sigmoidscope ",HCPCS G0104,0360 - OR SERVICES,N/A,N/A, $795.00 , $516.75 , $667.80 , $53.21 , $103.39 , $642.36 , $715.50 , $673.05 , $715.50 , $715.50 , $715.50 , $675.75 , $101.36 , $734.02 , $755.25 , $675.75 , $739.35 , $739.35 , $755.25 , $763.20 , $650.47 , $715.50 , $675.75 , $628.05 , N/A , $643.39 , $643.39 , $755.25 , $682.19 , $53.21 , $763.20 
"Cystoscopy,Dil Bladder,Gen Anesth",CPT® 52260,N/A,N/A,N/A," $2,079.00 "," $1,351.35 "," $1,128.04 ", $198.37 , $230.52 ," $1,033.76 ", $958.16 ," $1,933.47 "," $1,871.10 "," $1,871.10 "," $1,663.20 "," $1,663.20 ", $230.52 ," $1,919.54 "," $1,975.05 "," $1,871.10 "," $1,871.10 "," $1,871.10 "," $1,933.47 "," $1,995.84 "," $1,133.97 "," $1,767.15 "," $1,086.49 "," $1,294.66 ", N/A ," $1,053.93 "," $1,053.93 "," $1,975.05 "," $1,238.74 ", $198.37 ," $1,995.84 "
Closed Rx Tib Plat Fx+Manip,CPT® 27532,N/A,N/A,N/A," $4,044.00 "," $2,628.60 "," $3,542.63 ", $556.13 , $384.19 ," $2,787.61 "," $2,778.76 "," $3,760.92 "," $3,639.60 "," $3,639.60 "," $3,235.20 "," $3,235.20 ", $384.19 ," $3,733.83 "," $3,841.80 "," $3,639.60 "," $3,639.60 "," $3,639.60 "," $3,760.92 "," $3,882.24 "," $3,272.69 "," $3,437.40 "," $3,065.02 "," $3,276.05 ", N/A ," $2,842.00 "," $2,842.00 "," $3,841.80 "," $3,340.38 ", $384.19 ," $3,882.24 "
 Fac Ftl Lng Matrt Assmt Lamellar Bdy Dns ,CPT® 83664,0301 - LAB/CHEMISTRY,N/A,N/A, $145.00 , $94.25 , $121.80 , $19.71 , $6.73 , $117.16 , $130.50 , $122.76 , $130.50 , $130.50 , $130.50 , $123.25 , $6.60 , $133.88 , $137.75 , $123.25 , $134.85 , $134.85 , $137.75 , $139.20 , $118.64 , $130.50 , $123.25 , $114.55 , N/A , $117.35 , $117.35 , $137.75 , $124.42 , $6.60 , $139.20 
 Pro Drainage of Scrotum Abscess ,CPT® 55100,0982 - PRO FEE/OUTPT,N/A,N/A," $1,088.00 ", $707.20 , $740.16 , $160.07 , $30.71 , $530.69 , $546.97 ," $1,011.84 ", $979.20 , $979.20 , $870.40 , $870.40 , $30.71 ," $1,004.55 "," $1,033.60 ", $979.20 , $979.20 , $979.20 ," $1,011.84 "," $1,044.48 ", $691.67 , $924.80 , $875.98 , $802.59 , N/A , $541.04 , $541.04 ," $1,033.60 ", $648.45 , $30.71 ," $1,044.48 "
" Fac Assay, Three Catecholamines ",CPT® 82384,0301 - LAB/CHEMISTRY,N/A,N/A, $264.00 , $171.60 , $221.76 , $25.76 , $25.76 , $213.31 , $237.60 , $223.50 , $237.60 , $237.60 , $237.60 , $224.40 , $25.25 , $243.75 , $250.80 , $224.40 , $245.52 , $245.52 , $250.80 , $253.44 , $216.00 , $237.60 , $224.40 , $208.56 , N/A , $213.66 , $213.66 , $250.80 , $226.54 , $25.25 , $253.44 
Reposition Transvenous Electrode,CPT® 33215,N/A,N/A,N/A," $3,358.00 "," $2,182.70 "," $1,844.51 ", $285.54 , $280.43 ," $1,318.02 "," $1,276.47 "," $3,122.94 "," $3,022.20 "," $3,022.20 "," $2,686.40 "," $2,686.40 ", $280.43 ," $3,100.44 "," $3,190.10 "," $3,022.20 "," $3,022.20 "," $3,022.20 "," $3,122.94 "," $3,223.68 "," $1,701.99 "," $2,854.30 "," $1,602.09 "," $1,503.85 ", N/A ," $1,343.74 "," $1,343.74 "," $3,190.10 "," $1,526.48 ", $280.43 ," $3,223.68 "
Remv Ext Canal Soft Tissue Lesn,CPT® 69145,N/A,N/A,N/A," $2,320.00 "," $1,508.00 "," $1,233.70 ", $251.79 , $154.82 ," $1,200.10 "," $1,252.15 "," $2,157.60 "," $2,088.00 "," $2,088.00 "," $1,856.00 "," $1,856.00 ", $154.82 ," $2,142.06 "," $2,204.00 "," $2,088.00 "," $2,088.00 "," $2,088.00 "," $2,157.60 "," $2,227.20 "," $1,330.46 "," $1,972.00 "," $1,364.81 "," $1,204.90 ", N/A ," $1,223.52 "," $1,223.52 "," $2,204.00 "," $1,397.04 ", $154.82 ," $2,227.20 "
 VENLAFAXINE HCL ER 150 MG PO CP24 ,HCPCS RXC637,0250 - PHARMACY,68084-0713-01,1 capsule, $23.49 , $15.27 , $19.73 , N/A , N/A , $18.98 , $21.14 , $19.89 , $21.14 , $21.14 , $21.14 , $19.97 , N/A , $21.69 , $22.32 , $19.97 , $21.85 , $21.85 , $22.32 , $22.55 , $19.22 , $21.14 , $19.97 , $18.56 , N/A , $19.01 , $19.01 , $22.32 , $20.16 , $18.56 , $22.55 
 CEFOXITIN SODIUM 1 G IV SOLR ,HCPCS J0694,0636 - DRUGS REQUIRING DETAILED CODIN,25021-0109-10,10 mL, $36.99 , $24.04 , $31.07 , $5.10 , $5.26 , $29.89 , $33.29 , $31.32 , $33.29 , $33.29 , $33.29 , $31.44 , $5.16 , $34.15 , $35.14 , $31.44 , $34.40 , $34.40 , $35.14 , $35.51 , $30.27 , $33.29 , $31.44 , $29.22 , N/A , $29.94 , $29.94 , $35.14 , $31.74 , $5.10 , $35.51 
 CT Diskography Lumbar Spine ,CPT® 72295,0350 - CT SCAN,N/A,N/A," $1,187.00 ", $771.55 , $997.08 , $109.68 , $133.75 , $959.10 ," $1,068.30 "," $1,004.91 "," $1,068.30 "," $1,068.30 "," $1,068.30 "," $1,008.95 ", $131.13 ," $1,095.96 "," $1,127.65 "," $1,008.95 "," $1,103.91 "," $1,103.91 "," $1,127.65 "," $1,139.52 ", $971.20 ," $1,068.30 "," $1,008.95 ", $937.73 , N/A , $960.64 , $960.64 ," $1,127.65 "," $1,018.56 ", $109.68 ," $1,139.52 "
 Fac Ftl Biophysical Profile Non-Strs Tstg ,CPT® 76818,0402 - ULTRASOUND,N/A,N/A, $716.00 , $465.40 , $601.44 , $115.42 , $106.98 , $578.53 , $644.40 , $606.17 , $644.40 , $644.40 , $644.40 , $608.60 , $104.88 , $661.08 , $680.20 , $608.60 , $665.88 , $665.88 , $680.20 , $687.36 , $585.83 , $644.40 , $608.60 , $565.64 , N/A , $579.46 , $579.46 , $680.20 , $614.40 , $104.88 , $687.36 
 CT Virtual Colon Diag W/Contrast ,CPT® 74262,0350 - CT SCAN,N/A,N/A," $7,939.00 "," $5,160.35 "," $6,668.76 ", $291.85 , $577.87 ," $6,414.71 "," $7,145.10 "," $6,721.16 "," $7,145.10 "," $7,145.10 "," $7,145.10 "," $6,748.15 ", $566.54 ," $7,330.08 "," $7,542.05 "," $6,748.15 "," $7,383.27 "," $7,383.27 "," $7,542.05 "," $7,621.44 "," $6,495.69 "," $7,145.10 "," $6,748.15 "," $6,271.81 ", N/A ," $6,425.03 "," $6,425.03 "," $7,542.05 "," $6,812.46 ", $291.85 ," $7,621.44 "
 Fac Contrast X-Ray Exam of Aorta ,CPT® 75605,0320 - DX X-RAY,N/A,N/A," $1,114.00 ", $724.10 , $935.76 , $117.66 , $229.58 , $900.11 ," $1,002.60 ", $943.11 ," $1,002.60 "," $1,002.60 "," $1,002.60 ", $946.90 , $225.08 ," $1,028.56 "," $1,058.30 ", $946.90 ," $1,036.02 "," $1,036.02 "," $1,058.30 "," $1,069.44 ", $911.47 ," $1,002.60 ", $946.90 , $880.06 , N/A , $901.56 , $901.56 ," $1,058.30 ", $955.92 , $117.66 ," $1,069.44 "
Fit Contact Lens Tx Ocular Surface Disease,92071,N/A,N/A,N/A, $104.00 , $67.60 , $70.70 , $31.81 , $30.64 , $59.97 , $53.95 , $96.72 , $93.60 , $93.60 , $83.20 , $83.20 , $30.64 , $96.02 , $98.80 , $93.60 , $93.60 , $93.60 , $96.72 , $99.84 , $100.14 , $88.40 , $90.22 , $72.09 , N/A , $61.14 , $61.14 , $98.80 , $72.73 , $30.64 , $100.14 
Critical Care E&M L2,99292,N/A,N/A,N/A, $616.00 , $400.40 , $217.33 , $103.14 , $121.38 , $192.94 , $193.49 , $572.88 , $554.40 , $554.40 , $492.80 , $492.80 , $121.38 , $568.75 , $585.20 , $554.40 , $554.40 , $554.40 , $572.88 , $591.36 , $276.66 , $523.60 , $241.53 , $242.43 , N/A , $196.71 , $196.71 , $585.20 , $226.88 , $103.14 , $591.36 
 Fac Physical Therapy Treatment ,CPT® 97039,0430 - OCCUPATION THER,N/A,N/A, $124.00 , $80.60 , $104.16 , N/A , $33.59 , $100.19 , $111.60 , $104.98 , $111.60 , $111.60 , $111.60 , $105.40 , $32.93 , $114.49 , $117.80 , $105.40 , $115.32 , $115.32 , $117.80 , $119.04 , $101.46 , $111.60 , $105.40 , $97.96 , N/A , $100.35 , $100.35 , $117.80 , $106.40 , $32.93 , $119.04 
Sbsq Nursing Facility Care Sf Mdm 10 Minutes,CPT® 99307,N/A,N/A,N/A, $117.00 , $76.05 , $87.11 , $38.75 , $29.23 , $76.90 , $77.39 , $108.81 , $105.30 , $105.30 , $93.60 , $93.60 , $29.23 , $108.03 , $111.15 , $105.30 , $105.30 , $105.30 , $108.81 , $112.32 , $110.91 , $99.45 , $96.01 , $94.60 , N/A , $78.41 , $78.41 , $111.15 , $90.44 , $29.23 , $112.32 
Physician Telephone Evaluation 11-20 Min,99442,N/A,N/A,N/A, $114.00 , $74.10 , $134.06 , $64.08 , $21.48 , $44.31 , $44.11 , $106.02 , $102.60 , $102.60 , $91.20 , $91.20 , $21.48 , $105.26 , $108.30 , $102.60 , $102.60 , $102.60 , $106.02 , $109.44 , $122.78 , $96.90 , $54.76 , $55.96 , $29.00 , $45.17 , $45.17 , $108.30 , $52.10 , $21.48 , $134.06 
 TYPHOID VI POLYSACCHARIDE VACC 25 MCG/0.5ML IM SOSY ,HCPCS 90691,0636 - DRUGS REQUIRING DETAILED CODIN,49281-0790-51,0.5 mL, $751.79 , $488.66 , $631.50 , N/A , $84.53 , $607.45 , $676.61 , $636.47 , $676.61 , $676.61 , $676.61 , $639.02 , $82.87 , $694.13 , $714.20 , $639.02 , $699.16 , $699.16 , $714.20 , $721.72 , $615.11 , $676.61 , $639.02 , $593.91 , N/A , $608.42 , $608.42 , $714.20 , $645.11 , $82.87 , $721.72 
" Fac Creatine, Mb Fraction ",CPT® 82553,0301 - LAB/CHEMISTRY,N/A,N/A, $132.00 , $85.80 , $110.88 , $11.78 , $8.55 , $106.66 , $118.80 , $111.75 , $118.80 , $118.80 , $118.80 , $112.20 , $8.38 , $121.88 , $125.40 , $112.20 , $122.76 , $122.76 , $125.40 , $126.72 , $108.00 , $118.80 , $112.20 , $104.28 , N/A , $106.83 , $106.83 , $125.40 , $113.27 , $8.38 , $126.72 
Prolonged Outpatient E/M Service Each 15 Minutes,99417,N/A,N/A,N/A, $140.00 , $91.00 , N/A , $30.39 , N/A , N/A , N/A , $130.20 , $126.00 , $126.00 , $112.00 , $112.00 , N/A , $129.26 , $133.00 , $126.00 , $126.00 , $126.00 , $130.20 , $134.40 , $58.33 , $119.00 , $66.49 , $71.61 , N/A , $53.82 , $53.82 , $133.00 , $60.59 , $30.39 , $134.40 
 CT Acoustic/Sella W/Contrast ,CPT® 70481,0350 - CT SCAN,N/A,N/A," $3,956.00 "," $2,571.40 "," $3,323.04 ", $184.73 , $297.22 ," $3,196.45 "," $3,560.40 "," $3,349.15 "," $3,560.40 "," $3,560.40 "," $3,560.40 "," $3,362.60 ", $291.39 ," $3,652.57 "," $3,758.20 "," $3,362.60 "," $3,679.08 "," $3,679.08 "," $3,758.20 "," $3,797.76 "," $3,236.80 "," $3,560.40 "," $3,362.60 "," $3,125.24 ", N/A ," $3,201.59 "," $3,201.59 "," $3,758.20 "," $3,394.64 ", $184.73 ," $3,797.76 "
 WARFARIN SODIUM 7.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00832-1218-01,1 tablet, $4.74 , $3.08 , $3.98 , N/A , N/A , $3.83 , $4.27 , $4.01 , $4.27 , $4.27 , $4.27 , $4.03 , N/A , $4.38 , $4.50 , $4.03 , $4.41 , $4.41 , $4.50 , $4.55 , $3.88 , $4.27 , $4.03 , $3.74 , N/A , $3.84 , $3.84 , $4.50 , $4.07 , $3.74 , $4.55 
 CARBOPLATIN 600 MG/60ML IV SOLN ,HCPCS J9045,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0172-60,60 mL, $317.56 , $206.41 , $266.75 , $2.46 , $2.53 , $256.59 , $285.80 , $268.85 , $285.80 , $285.80 , $285.80 , $269.93 , $2.48 , $293.20 , $301.68 , $269.93 , $295.33 , $295.33 , $301.68 , $304.86 , $259.83 , $285.80 , $269.93 , $250.87 , N/A , $257.00 , $257.00 , $301.68 , $272.50 , $2.46 , $304.86 
 Fac Assay of Urine Potassium ,CPT® 84133,0301 - LAB/CHEMISTRY,N/A,N/A, $55.00 , $35.75 , $46.20 , $4.82 , $4.82 , $44.44 , $49.50 , $46.56 , $49.50 , $49.50 , $49.50 , $46.75 , $4.73 , $50.78 , $52.25 , $46.75 , $51.15 , $51.15 , $52.25 , $52.80 , $45.00 , $49.50 , $46.75 , $43.45 , N/A , $44.51 , $44.51 , $52.25 , $47.20 , $4.73 , $52.80 
 Fac Radiofrequency Abltj Nrv Nrvtg Si Jt W/Img Gdn ,CPT® 64625,0360 - OR SERVICES,N/A,N/A," $2,893.00 "," $1,880.45 "," $2,430.12 ", $188.08 , $393.42 ," $2,337.54 "," $2,603.70 "," $2,449.21 "," $2,603.70 "," $2,603.70 "," $2,603.70 "," $2,459.05 ", $385.71 ," $2,671.11 "," $2,748.35 "," $2,459.05 "," $2,690.49 "," $2,690.49 "," $2,748.35 "," $2,777.28 "," $2,367.05 "," $2,603.70 "," $2,459.05 "," $2,285.47 ", N/A ," $2,341.30 "," $2,341.30 "," $2,748.35 "," $2,482.48 ", $188.08 ," $2,777.28 "
Proph Retinal Dtchmnt W/O Drg Crtx Diathermy,CPT® 67141,N/A,N/A,N/A," $4,720.00 "," $3,068.00 "," $1,332.50 ", $209.37 , $614.70 ," $2,760.68 "," $2,603.61 "," $4,389.60 "," $4,248.00 "," $4,248.00 "," $3,776.00 "," $3,776.00 ", $614.70 ," $4,357.98 "," $4,484.00 "," $4,248.00 "," $4,248.00 "," $4,248.00 "," $4,389.60 "," $4,531.20 "," $4,105.23 "," $4,012.00 "," $2,692.15 "," $3,509.76 ", N/A ," $2,814.54 "," $2,814.54 "," $4,484.00 "," $3,106.89 ", $209.37 ," $4,531.20 "
 Fac Trauma 3 Activation W/ Pre-ED Notification- Level I W/Critical Care ,HCPCS G0390,0683 - TRAUMA LEVEL III,N/A,N/A," $5,894.00 "," $3,831.10 "," $4,950.96 ", N/A , N/A ," $4,762.35 "," $5,304.60 "," $4,989.86 "," $5,304.60 "," $5,304.60 "," $5,304.60 "," $5,009.90 ", N/A ," $5,441.93 "," $5,599.30 "," $5,009.90 "," $5,481.42 "," $5,481.42 "," $5,599.30 "," $5,658.24 "," $4,822.47 "," $5,304.60 "," $5,009.90 "," $4,656.26 ", N/A ," $4,770.01 "," $4,770.01 "," $5,599.30 "," $5,057.64 "," $4,656.26 "," $5,658.24 "
 Fac Pharmacy Culture ,Custom 331578,0306 - LAB/BACT-MICRO,N/A,N/A, $39.00 , $25.35 , $32.76 , N/A , N/A , $31.51 , $35.10 , $33.02 , $35.10 , $35.10 , $35.10 , $33.15 , N/A , $36.01 , $37.05 , $33.15 , $36.27 , $36.27 , $37.05 , $37.44 , $31.91 , $35.10 , $33.15 , $30.81 , N/A , $31.56 , $31.56 , $37.05 , $33.47 , $30.81 , $37.44 
 MINERAL OIL RE ENEM ,HCPCS RXC637,0250 - PHARMACY,00132-0301-40,1 enema, $16.40 , $10.66 , $13.78 , N/A , N/A , $13.25 , $14.76 , $13.88 , $14.76 , $14.76 , $14.76 , $13.94 , N/A , $15.14 , $15.58 , $13.94 , $15.25 , $15.25 , $15.58 , $15.74 , $13.42 , $14.76 , $13.94 , $12.96 , N/A , $13.27 , $13.27 , $15.58 , $14.07 , $12.96 , $15.74 
 GLIPIZIDE 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6637-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Pro Drain Blood From Under Nail ,CPT® 11740,0982 - PRO FEE/OUTPT,N/A,N/A, $187.00 , $121.55 , $101.46 , $30.96 , $37.00 , $89.90 , $88.22 , $173.91 , $168.30 , $168.30 , $149.60 , $149.60 , $37.00 , $172.66 , $177.65 , $168.30 , $168.30 , $168.30 , $173.91 , $179.52 , $110.68 , $158.95 , $173.05 , $117.10 , N/A , $91.66 , $91.66 , $177.65 , $106.30 , $30.96 , $179.52 
 PROPYLENE GLYCOL LIQD ,HCPCS RXA250,0250 - PHARMACY,00574-0072-16,473 mL, $55.89 , $36.33 , $46.95 , N/A , N/A , $45.16 , $50.30 , $47.32 , $50.30 , $50.30 , $50.30 , $47.51 , N/A , $51.60 , $53.10 , $47.51 , $51.98 , $51.98 , $53.10 , $53.65 , $45.73 , $50.30 , $47.51 , $44.15 , N/A , $45.23 , $45.23 , $53.10 , $47.96 , $44.15 , $53.65 
Obstetric Panel,CPT® 80055,N/A,N/A,N/A, $473.00 , $307.45 , N/A , $48.77 , $19.41 , $267.23 , $281.43 , $439.89 , $425.70 , $425.70 , $378.40 , $378.40 , $19.41 , $436.72 , $449.35 , $425.70 , $425.70 , $425.70 , $439.89 , $454.08 , $319.24 , $402.05 , $283.82 , $173.34 , N/A , $249.40 , $249.40 , $449.35 , $272.54 , $19.41 , $454.08 
 Fac Insj/Rplcmt Temp Transvns 1chmbr Eltrd/Pm Cath ,CPT® 33210,0360 - OR SERVICES,N/A,N/A," $2,677.00 "," $1,740.05 "," $2,248.68 ", $146.85 , $177.64 ," $2,163.02 "," $2,409.30 "," $2,266.35 "," $2,409.30 "," $2,409.30 "," $2,409.30 "," $2,275.45 ", $174.16 ," $2,471.67 "," $2,543.15 "," $2,275.45 "," $2,489.61 "," $2,489.61 "," $2,543.15 "," $2,569.92 "," $2,190.32 "," $2,409.30 "," $2,275.45 "," $2,114.83 ", N/A ," $2,166.50 "," $2,166.50 "," $2,543.15 "," $2,297.13 ", $146.85 ," $2,569.92 "
X-Ray Knee 1 or 2 View,CPT® 73560,N/A,N/A,N/A, $235.00 , $152.75 , $192.15 , $33.66 , $27.82 , $138.06 , $164.70 , $218.55 , $211.50 , $211.50 , $188.00 , $188.00 , $27.82 , $216.98 , $223.25 , $211.50 , $211.50 , $211.50 , $218.55 , $225.60 , $187.61 , $199.75 , $182.97 , $156.60 , N/A , $140.75 , $140.75 , $223.25 , $162.93 , $27.82 , $225.60 
 Fac Appl Short Leg Cst Belw Kne-Toe ,CPT® 29405,0761 - TREATMENT ROOM,N/A,N/A, $575.00 , $373.75 , $483.00 , $55.88 , $70.65 , $464.60 , $517.50 , $486.80 , $517.50 , $517.50 , $517.50 , $488.75 , $69.26 , $530.90 , $546.25 , $488.75 , $534.75 , $534.75 , $546.25 , $552.00 , $470.47 , $517.50 , $488.75 , $454.25 , N/A , $465.35 , $465.35 , $546.25 , $493.41 , $55.88 , $552.00 
Diagnostic Bone Marrow Biopsies,CPT® 38221,N/A,N/A,N/A," $1,202.00 ", $781.30 , $340.20 , $67.98 , $234.23 , $269.17 , $270.00 ," $1,117.86 "," $1,081.80 "," $1,081.80 ", $961.60 , $961.60 , $234.23 ," $1,109.81 "," $1,141.90 "," $1,081.80 "," $1,081.80 "," $1,081.80 "," $1,117.86 "," $1,153.92 ", $359.38 ," $1,021.70 ", $387.14 , $355.09 , N/A , $274.42 , $274.42 ," $1,141.90 ", $318.38 , $67.98 ," $1,153.92 "
Optx Dstl Radl I-Artic Fx/Epiphysl Sep 2 Frag,CPT® 25608,N/A,N/A,N/A," $3,236.00 "," $2,103.40 "," $5,041.66 ", $792.24 , $611.22 ," $3,971.14 "," $3,955.20 "," $3,009.48 "," $2,912.40 "," $2,912.40 "," $2,588.80 "," $2,588.80 ", $611.22 ," $2,987.80 "," $3,074.20 "," $2,912.40 "," $2,912.40 "," $2,912.40 "," $3,009.48 "," $3,106.56 "," $4,682.64 "," $2,750.60 "," $4,358.47 "," $4,694.37 ", N/A ," $4,048.63 "," $4,048.63 "," $3,074.20 "," $4,758.57 ", $611.22 ," $5,041.66 "
 Fac Pulmonary Rehab W Exer ,HCPCS G0424,0948 - PULMONARY REHABILITATION,N/A,N/A, $280.00 , $182.00 , $235.20 , N/A , N/A , $226.24 , $252.00 , $237.05 , $252.00 , $252.00 , $252.00 , $238.00 , N/A , $258.52 , $266.00 , $238.00 , $260.40 , $260.40 , $266.00 , $268.80 , $229.10 , $252.00 , $238.00 , $221.20 , N/A , $226.60 , $226.60 , $266.00 , $240.27 , $221.20 , $268.80 
Revsc Opn/Prq Tib/Pero W/Angioplasty Uni,CPT® 37228,N/A,N/A,N/A," $25,827.00 "," $16,787.55 "," $3,145.22 ", $484.20 , $412.40 ," $2,416.73 "," $2,383.92 "," $24,019.11 "," $23,244.30 "," $23,244.30 "," $20,661.60 "," $20,661.60 ", $412.40 ," $23,846.07 "," $24,535.65 "," $23,244.30 "," $23,244.30 "," $23,244.30 "," $24,019.11 "," $24,793.92 "," $2,671.28 "," $21,952.95 "," $2,997.23 "," $2,635.89 ", N/A ," $2,463.88 "," $2,463.88 "," $24,535.65 "," $2,798.98 ", $412.40 ," $24,793.92 "
 Pro Radiologic Exam Esophagus Double Contrast Study ,CPT® 74221,0972 - PRO FEE/RAD/DX,N/A,N/A, $433.00 , $281.45 , $642.64 , $110.45 , $85.64 , $508.35 , N/A , $402.69 , $389.70 , $389.70 , $346.40 , $346.40 , $85.64 , $399.79 , $411.35 , $389.70 , $389.70 , $389.70 , $402.69 , $415.68 , $627.02 , $368.05 , $644.57 , $549.00 , N/A , $518.26 , $518.26 , $411.35 , $600.62 , $85.64 , $644.57 
Bowel Imaging,CPT® 78290,N/A,N/A,N/A," $3,174.00 "," $2,063.10 "," $1,760.30 ", $301.84 , $156.54 ," $1,634.73 "," $1,794.16 "," $2,951.82 "," $2,856.60 "," $2,856.60 "," $2,539.20 "," $2,539.20 ", $156.54 ," $2,930.55 "," $3,015.30 "," $2,856.60 "," $2,856.60 "," $2,856.60 "," $2,951.82 "," $3,047.04 "," $1,827.07 "," $2,697.90 "," $1,954.93 "," $2,227.15 ", N/A ," $1,666.62 "," $1,666.62 "," $3,015.30 "," $1,929.14 ", $156.54 ," $3,047.04 "
"Inj., Benralizumab, 1 Mg",HCPCS J0517,N/A,N/A,N/A, $258.00 , $167.70 , N/A , $174.35 , $171.62 , N/A , N/A , $239.94 , $232.20 , $232.20 , $206.40 , $206.40 , $171.62 , $238.21 , $245.10 , $232.20 , $232.20 , $232.20 , $239.94 , $247.68 , $224.39 , $219.30 , $320.50 , $220.99 , N/A , N/A , N/A , $245.10 , N/A , $171.62 , $320.50 
Fetal Monitor/Interpret Only,CPT® 59051,N/A,N/A,N/A, $197.00 , $128.05 , $110.67 , $37.49 , $59.47 , $97.50 , $102.80 , $183.21 , $177.30 , $177.30 , $157.60 , $157.60 , $59.47 , $181.89 , $187.15 , $177.30 , $177.30 , $177.30 , $183.21 , $189.12 , $112.80 , $167.45 , $228.36 , $181.18 , N/A , $99.40 , $99.40 , $187.15 , $114.92 , $37.49 , $228.36 
Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm,CPT® 97607,N/A,N/A,N/A, $422.00 , $274.30 , $49.32 , $20.51 , $31.76 , $99.25 , N/A , $392.46 , $379.80 , $379.80 , $337.60 , $337.60 , $31.76 , $389.63 , $400.90 , $379.80 , $379.80 , $379.80 , $392.46 , $405.12 , $65.81 , $358.70 , $65.63 , $95.09 , N/A , $101.19 , $101.19 , $400.90 , $112.54 , $20.51 , $405.12 
 Ceretec/Tc Exametazime per Dose ,HCPCS A9521,0343 - DIAGNOSTIC RADIOPHARMACEUTICALS,N/A,N/A," $1,077.00 ", $700.05 , $904.68 , N/A , $463.17 , $870.22 , $969.30 , $911.79 , $969.30 , $969.30 , $969.30 , $915.45 , $454.09 , $994.39 ," $1,023.15 ", $915.45 ," $1,001.61 "," $1,001.61 "," $1,023.15 "," $1,033.92 ", $881.20 , $969.30 , $915.45 , $850.83 , N/A , $871.62 , $871.62 ," $1,023.15 ", $924.17 , $454.09 ," $1,033.92 "
"Releas Vitreous,Subret/Choroid Fluid",CPT® 67015,N/A,N/A,N/A," $5,432.00 "," $3,530.80 "," $3,749.59 ", $587.04 , $515.48 ," $3,280.69 "," $3,070.50 "," $5,051.76 "," $4,888.80 "," $4,888.80 "," $4,345.60 "," $4,345.60 ", $515.48 ," $5,015.37 "," $5,160.40 "," $4,888.80 "," $4,888.80 "," $4,888.80 "," $5,051.76 "," $5,214.72 "," $5,098.36 "," $4,617.20 "," $3,154.23 "," $4,172.45 ", N/A ," $3,344.70 "," $3,344.70 "," $5,160.40 "," $3,692.12 ", $515.48 ," $5,214.72 "
 Pro Physician Telephone Evaluation 5-10 Min ,CPT® 99441,0982 - PRO FEE/OUTPT,N/A,N/A, $60.00 , $39.00 , $71.80 , $34.15 , $11.11 , $22.64 , $21.88 , $55.80 , $54.00 , $54.00 , $48.00 , $48.00 , $11.11 , $55.40 , $57.00 , $54.00 , $54.00 , $54.00 , $55.80 , $57.60 , $65.53 , $51.00 , $27.00 , $28.23 , $15.00 , $23.08 , $23.08 , $57.00 , $26.61 , $11.11 , $71.80 
"Culture Typing, Added Method",CPT® 87158,N/A,N/A,N/A, $114.00 , $74.10 , N/A , $7.89 , $7.26 , $29.61 , $35.41 , $106.02 , $102.60 , $102.60 , $91.20 , $91.20 , $7.26 , $105.26 , $108.30 , $102.60 , $102.60 , $102.60 , $106.02 , $109.44 , $51.68 , $96.90 , $34.06 , $22.73 , N/A , $27.63 , $27.63 , $108.30 , $30.19 , $7.26 , $109.44 
 Pro Drainage Skin Abscess ,CPT® 10060,0982 - PRO FEE/OUTPT,N/A,N/A, $464.00 , $301.60 , $340.58 , $102.58 , $41.23 , $265.18 , $259.37 , $431.52 , $417.60 , $417.60 , $371.20 , $371.20 , $41.23 , $428.41 , $440.80 , $417.60 , $417.60 , $417.60 , $431.52 , $445.44 , $366.26 , $394.40 , $512.03 , $344.96 , N/A , $270.35 , $270.35 , $440.80 , $313.53 , $41.23 , $512.03 
"Closed Rx Metacarpal Fx,Percut",26608,N/A,N/A,N/A," $3,152.00 "," $2,048.80 "," $2,975.31 ", $468.01 , $412.82 ," $2,289.81 "," $2,307.09 "," $2,931.36 "," $2,836.80 "," $2,836.80 "," $2,521.60 "," $2,521.60 ", $412.82 ," $2,910.24 "," $2,994.40 "," $2,836.80 "," $2,836.80 "," $2,836.80 "," $2,931.36 "," $3,025.92 "," $2,760.18 "," $2,679.20 "," $2,535.16 "," $2,718.95 ", N/A ," $2,334.49 "," $2,334.49 "," $2,994.40 "," $2,743.86 ", $412.82 ," $3,025.92 "
"Destr Penis Lesn,Simpl,Surg Excis",CPT® 54060,N/A,N/A,N/A," $1,209.00 ", $785.85 , $581.81 , $126.10 , $76.84 , $417.28 , $425.04 ," $1,124.37 "," $1,088.10 "," $1,088.10 ", $967.20 , $967.20 , $76.84 ," $1,116.27 "," $1,148.55 "," $1,088.10 "," $1,088.10 "," $1,088.10 "," $1,124.37 "," $1,160.64 ", $542.68 ," $1,027.65 ", $679.73 , $630.66 , N/A , $425.42 , $425.42 ," $1,148.55 ", $509.88 , $76.84 ," $1,160.64 "
Perq Transcath Cls Paravalvr Leak Each Occls Dev,CPT® 93592,N/A,N/A,N/A," $2,686.00 "," $1,745.90 "," $2,429.77 ", $373.22 , $338.26 ," $2,246.12 "," $2,194.38 "," $2,497.98 "," $2,417.40 "," $2,417.40 "," $2,148.80 "," $2,148.80 ", $338.26 ," $2,479.98 "," $2,551.70 "," $2,417.40 "," $2,417.40 "," $2,417.40 "," $2,497.98 "," $2,578.56 "," $2,253.49 "," $2,283.10 "," $2,022.16 "," $2,389.53 ", N/A ," $2,289.94 "," $2,289.94 "," $2,551.70 "," $2,538.43 ", $338.26 ," $2,578.56 "
 Fac Assay of Blood Osmolality ,CPT® 83930,0301 - LAB/CHEMISTRY,N/A,N/A, $102.00 , $66.30 , $85.68 , $6.74 , $6.74 , $82.42 , $91.80 , $86.35 , $91.80 , $91.80 , $91.80 , $86.70 , $6.61 , $94.18 , $96.90 , $86.70 , $94.86 , $94.86 , $96.90 , $97.92 , $83.46 , $91.80 , $86.70 , $80.58 , N/A , $82.55 , $82.55 , $96.90 , $87.53 , $6.61 , $97.92 
 Fac Galactose ,CPT® 82760,0301 - LAB/CHEMISTRY,N/A,N/A, $100.00 , $65.00 , $84.00 , $11.42 , $11.42 , $80.80 , $90.00 , $84.66 , $90.00 , $90.00 , $90.00 , $85.00 , $11.20 , $92.33 , $95.00 , $85.00 , $93.00 , $93.00 , $95.00 , $96.00 , $81.82 , $90.00 , $85.00 , $79.00 , N/A , $80.93 , $80.93 , $95.00 , $85.81 , $11.20 , $96.00 
 Fac Fmr1 Analysis Eval to Detect Abnormal Alleles ,CPT® 81243,0300 - LABORATORY,N/A,N/A, $687.00 , $446.55 , $577.08 , $58.18 , $55.55 , $555.10 , $618.30 , $581.61 , $618.30 , $618.30 , $618.30 , $583.95 , $54.46 , $634.31 , $652.65 , $583.95 , $638.91 , $638.91 , $652.65 , $659.52 , $562.10 , $618.30 , $583.95 , $542.73 , N/A , $555.99 , $555.99 , $652.65 , $589.51 , $54.46 , $659.52 
Iadna S. Aureus Amp Prb Tq,CPT® 87640,N/A,N/A,N/A, $139.00 , $90.35 , N/A , $35.79 , $35.79 , $198.56 , $237.51 , $129.27 , $125.10 , $125.10 , $111.20 , $111.20 , $35.79 , $128.34 , $132.05 , $125.10 , $125.10 , $125.10 , $129.27 , $133.44 , $234.30 , $118.15 , $230.30 , $127.26 , N/A , $185.31 , $185.31 , $132.05 , $202.50 , $35.79 , $237.51 
"Vag Hyst,Uterus >250 Gms,Rem Tube/Ovary",CPT® 58291,N/A,N/A,N/A," $7,206.00 "," $4,683.90 "," $5,855.20 "," $1,183.03 "," $1,118.76 "," $5,062.84 "," $5,053.46 "," $6,701.58 "," $6,485.40 "," $6,485.40 "," $5,764.80 "," $5,764.80 "," $1,118.76 "," $6,653.30 "," $6,845.70 "," $6,485.40 "," $6,485.40 "," $6,485.40 "," $6,701.58 "," $6,917.76 "," $6,140.59 "," $6,125.10 "," $6,652.77 "," $5,086.67 ", N/A ," $5,161.62 "," $5,161.62 "," $6,845.70 "," $6,191.04 "," $1,118.76 "," $6,917.76 "
Xcapsl Ctrc Rmvl Insj Io Lens Prosth W/O Ecp,CPT® 66984,N/A,N/A,N/A," $5,873.00 "," $3,817.45 "," $3,349.71 ", $525.67 , $430.89 ," $5,195.80 "," $5,432.88 "," $5,461.89 "," $5,285.70 "," $5,285.70 "," $4,698.40 "," $4,698.40 ", $430.89 ," $5,422.54 "," $5,579.35 "," $5,285.70 "," $5,285.70 "," $5,285.70 "," $5,461.89 "," $5,638.08 "," $6,836.31 "," $4,992.05 "," $3,502.12 "," $4,600.11 ", N/A ," $5,297.18 "," $5,297.18 "," $5,579.35 "," $6,231.98 ", $430.89 ," $6,836.31 "
 Elbow Ap Lateral Bil- Mh ,CPT® 73070,0972 - PRO FEE/RAD/DX,N/A,N/A, $79.00 , $51.35 , $163.79 , $28.73 , $26.19 , $129.44 , $152.06 , $73.47 , $71.10 , $71.10 , $63.20 , $63.20 , $26.19 , $72.94 , $75.05 , $71.10 , $71.10 , $71.10 , $73.47 , $75.84 , $159.36 , $67.15 , $167.57 , $136.80 , N/A , $131.97 , $131.97 , $75.05 , $152.74 , $26.19 , $167.57 
 BUPROPION HCL ER (XL) 150 MG PO TB24 ,HCPCS RXC637,0250 - PHARMACY,68180-0319-06,1 tablet, $24.52 , $15.94 , $20.60 , N/A , N/A , $19.81 , $22.07 , $20.76 , $22.07 , $22.07 , $22.07 , $20.84 , N/A , $22.64 , $23.29 , $20.84 , $22.80 , $22.80 , $23.29 , $23.54 , $20.06 , $22.07 , $20.84 , $19.37 , N/A , $19.84 , $19.84 , $23.29 , $21.04 , $19.37 , $23.54 
 Fac Drug Screening Cannabinoids Natural ,CPT® 80349,0301 - LAB/CHEMISTRY,N/A,N/A, $156.00 , $101.40 , $131.04 , N/A , N/A , $126.05 , $140.40 , $132.07 , $140.40 , $140.40 , $140.40 , $132.60 , N/A , $144.03 , $148.20 , $132.60 , $145.08 , $145.08 , $148.20 , $149.76 , $127.64 , $140.40 , $132.60 , $123.24 , N/A , $126.25 , $126.25 , $148.20 , $133.86 , $123.24 , $149.76 
Repair Nonunion Radius or Ulna,25400,N/A,N/A,N/A," $3,142.00 "," $2,042.30 "," $4,887.61 ", $766.88 , $603.45 ," $3,871.95 "," $3,842.85 "," $2,922.06 "," $2,827.80 "," $2,827.80 "," $2,513.60 "," $2,513.60 ", $603.45 ," $2,901.01 "," $2,984.90 "," $2,827.80 "," $2,827.80 "," $2,827.80 "," $2,922.06 "," $3,016.32 "," $4,550.49 "," $2,670.70 "," $4,237.15 "," $4,578.54 ", N/A ," $3,947.50 "," $3,947.50 "," $2,984.90 "," $4,639.72 ", $603.45 ," $4,887.61 "
Excis Supratent Meningioma,CPT® 61512,N/A,N/A,N/A," $17,173.00 "," $11,162.45 "," $11,593.04 "," $2,264.07 "," $2,060.27 "," $13,730.44 "," $13,109.15 "," $15,970.89 "," $15,455.70 "," $15,455.70 "," $13,738.40 "," $13,738.40 "," $2,060.27 "," $15,855.83 "," $16,314.35 "," $15,455.70 "," $15,455.70 "," $15,455.70 "," $15,970.89 "," $16,486.08 "," $12,527.81 "," $14,597.05 "," $13,500.01 "," $14,180.47 ", N/A ," $13,998.35 "," $13,998.35 "," $16,314.35 "," $15,016.92 "," $2,060.27 "," $16,486.08 "
 Transfor Epidural Inj C-T Single Lvl-CT ,CPT® 64479,0761 - TREATMENT ROOM,N/A,N/A," $2,308.00 "," $1,500.20 "," $1,938.72 ", $125.54 , $223.29 ," $1,864.86 "," $2,077.20 "," $1,953.95 "," $2,077.20 "," $2,077.20 "," $2,077.20 "," $1,961.80 ", $218.91 ," $2,130.98 "," $2,192.60 "," $1,961.80 "," $2,146.44 "," $2,146.44 "," $2,192.60 "," $2,215.68 "," $1,888.41 "," $2,077.20 "," $1,961.80 "," $1,823.32 ", N/A ," $1,867.86 "," $1,867.86 "," $2,192.60 "," $1,980.49 ", $125.54 ," $2,215.68 "
 Hospice House Room & Board ,Custom 500162,0990 - PT CONVENIENCE,N/A,N/A, $282.00 , $183.30 , $236.88 , N/A , N/A , $227.86 , $253.80 , $238.74 , $253.80 , $253.80 , $253.80 , $239.70 , N/A , $260.37 , $267.90 , $239.70 , $262.26 , $262.26 , $267.90 , $270.72 , $230.73 , $253.80 , $239.70 , $222.78 , N/A , $228.22 , $228.22 , $267.90 , $241.98 , $222.78 , $270.72 
 ESMOLOL HCL 100 MG/10ML IV SOLN ,HCPCS J1805,0636 - DRUGS REQUIRING DETAILED CODIN,67457-0182-10,10 mL, $44.95 , $29.22 , $37.76 , N/A , N/A , $36.32 , $40.46 , $38.05 , $40.46 , $40.46 , $40.46 , $38.21 , N/A , $41.50 , $42.70 , $38.21 , $41.80 , $41.80 , $42.70 , $43.15 , $36.78 , $40.46 , $38.21 , $35.51 , N/A , $36.38 , $36.38 , $42.70 , $38.57 , $35.51 , $43.15 
Laryngoplasty Medialization Unliateral,CPT® 31591,N/A,N/A,N/A," $6,404.00 "," $4,162.60 "," $6,060.90 "," $1,070.63 ", $826.14 ," $3,834.02 "," $3,771.04 "," $5,955.72 "," $5,763.60 "," $5,763.60 "," $5,123.20 "," $5,123.20 ", $826.14 ," $5,912.81 "," $6,083.80 "," $5,763.60 "," $5,763.60 "," $5,763.60 "," $5,955.72 "," $6,147.84 "," $5,753.81 "," $5,443.40 "," $5,897.67 "," $5,292.42 ", N/A ," $3,908.83 "," $3,908.83 "," $6,083.80 "," $4,603.49 ", $826.14 ," $6,147.84 "
Emergency Department Visit Moderate Mdm,99284,N/A,N/A,N/A, $633.00 , $411.45 , $426.57 , $116.35 , $31.98 , $331.78 , $340.64 , $588.69 , $569.70 , $569.70 , $506.40 , $506.40 , $31.98 , $584.45 , $601.35 , $569.70 , $569.70 , $569.70 , $588.69 , $607.68 , $362.22 , $538.05 , $252.79 , $254.40 , $117.00 , $338.26 , $338.26 , $601.35 , $405.90 , $31.98 , $607.68 
 Foot Min 3vw - Mh ,CPT® 73630,0972 - PRO FEE/RAD/DX,N/A,N/A, $105.00 , $68.25 , $194.13 , $33.68 , $29.84 , $137.07 , $167.96 , $97.65 , $94.50 , $94.50 , $84.00 , $84.00 , $29.84 , $96.95 , $99.75 , $94.50 , $94.50 , $94.50 , $97.65 , $100.80 , $187.73 , $89.25 , $184.90 , $147.71 , N/A , $139.74 , $139.74 , $99.75 , $161.74 , $29.84 , $194.13 
" Pro US Guide, Vascular Access ",CPT® 76937,0972 - PRO FEE/RAD/DX,N/A,N/A, $180.00 , $117.00 , $222.14 , $38.38 , $33.32 , $151.94 , $188.43 , $167.40 , $162.00 , $162.00 , $144.00 , $144.00 , $33.32 , $166.19 , $171.00 , $162.00 , $162.00 , $162.00 , $167.40 , $172.80 , $211.85 , $153.00 , $206.09 , $176.02 , N/A , $154.91 , $154.91 , $171.00 , $179.33 , $33.32 , $222.14 
 Fac Assay of Magnesium ,CPT® 83735,0301 - LAB/CHEMISTRY,N/A,N/A, $80.00 , $52.00 , $67.20 , $6.83 , $6.83 , $64.64 , $72.00 , $67.73 , $72.00 , $72.00 , $72.00 , $68.00 , $6.70 , $73.86 , $76.00 , $68.00 , $74.40 , $74.40 , $76.00 , $76.80 , $65.46 , $72.00 , $68.00 , $63.20 , N/A , $64.74 , $64.74 , $76.00 , $68.65 , $6.70 , $76.80 
 NEOMYCIN-POLYMYXIN-GRAMICIDIN 1.75-10000-.025 OP SOLN ,HCPCS RXC637,0250 - PHARMACY,24208-0790-62,10 mL, $314.69 , $204.55 , $264.34 , N/A , N/A , $254.27 , $283.22 , $266.42 , $283.22 , $283.22 , $283.22 , $267.49 , N/A , $290.55 , $298.96 , $267.49 , $292.66 , $292.66 , $298.96 , $302.10 , $257.48 , $283.22 , $267.49 , $248.61 , N/A , $254.68 , $254.68 , $298.96 , $270.04 , $248.61 , $302.10 
"Stereotactic Radiosurgery, Cranial,Simple,Single",CPT® 61796,N/A,N/A,N/A," $13,095.00 "," $8,511.75 "," $4,665.60 ", $913.33 , $535.00 ," $5,482.32 "," $5,219.96 "," $12,178.35 "," $11,785.50 "," $11,785.50 "," $10,476.00 "," $10,476.00 ", $535.00 ," $12,090.61 "," $12,440.25 "," $11,785.50 "," $11,785.50 "," $11,785.50 "," $12,178.35 "," $12,571.20 "," $5,030.67 "," $11,130.75 "," $5,330.78 "," $5,675.42 ", N/A ," $5,589.29 "," $5,589.29 "," $12,440.25 "," $5,995.98 ", $535.00 ," $12,571.20 "
 Rep;Thoracoabdominal Aneur W/Grft; W/WO Cp Bypass;Open ,CPT® 33877,0360 - OR SERVICES,N/A,N/A," $9,319.00 "," $6,057.35 "," $7,827.96 "," $3,216.80 "," $2,106.32 "," $7,529.75 "," $8,387.10 "," $7,889.47 "," $8,387.10 "," $8,387.10 "," $8,387.10 "," $7,921.15 "," $2,065.02 "," $8,604.23 "," $8,853.05 "," $7,921.15 "," $8,666.67 "," $8,666.67 "," $8,853.05 "," $8,946.24 "," $7,624.81 "," $8,387.10 "," $7,921.15 "," $7,362.01 ", N/A ," $7,541.87 "," $7,541.87 "," $8,853.05 "," $7,996.63 "," $2,065.02 "," $8,946.24 "
"MRI, Upper Extrem",CPT® 73218,N/A,N/A,N/A," $6,670.00 "," $4,335.50 "," $1,992.48 ", $289.54 , $410.97 ," $1,731.44 "," $2,203.10 "," $6,203.10 "," $6,003.00 "," $6,003.00 "," $5,336.00 "," $5,336.00 ", $410.97 ," $6,158.41 "," $6,336.50 "," $6,003.00 "," $6,003.00 "," $6,003.00 "," $6,203.10 "," $6,403.20 "," $1,916.52 "," $5,669.50 "," $2,405.63 "," $3,384.37 ", N/A ," $1,765.22 "," $1,765.22 "," $6,336.50 "," $2,043.30 ", $289.54 ," $6,403.20 "
 Pro IP/Obs Consltj New/Est Pt Low Mdm 45 Minutes ,CPT® 99253,0987 - PRO FEE/HOS VIS,N/A,N/A, $496.00 , $322.40 , N/A , $98.01 , $86.25 , $251.90 , $250.97 , $461.28 , $446.40 , $446.40 , $396.80 , $396.80 , $86.25 , $457.96 , $471.20 , $446.40 , $446.40 , $446.40 , $461.28 , $476.16 , $319.65 , $421.60 , $244.53 , $252.43 , $120.25 , $256.82 , $256.82 , $471.20 , $305.75 , $86.25 , $476.16 
 Pro Exc Tumor Soft Tissue Thigh/Knee Subfasc 5+Cm ,CPT® 27339,0975 - PRO FEE/OR,N/A,N/A," $5,818.00 "," $3,781.70 "," $4,545.32 ", $707.82 , $618.82 ," $3,616.46 "," $3,590.82 "," $5,410.74 "," $5,236.20 "," $5,236.20 "," $4,654.40 "," $4,654.40 ", $618.82 ," $5,371.76 "," $5,527.10 "," $5,236.20 "," $5,236.20 "," $5,236.20 "," $5,410.74 "," $5,585.28 "," $4,210.08 "," $4,945.30 "," $3,978.46 "," $4,247.73 ", N/A ," $3,687.03 "," $3,687.03 "," $5,527.10 "," $4,333.59 ", $618.82 ," $5,585.28 "
 GABAPENTIN 400 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-6667-61,1 capsule, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Place Cath in Vein,Select",CPT® 36011,N/A,N/A,N/A," $5,524.00 "," $3,590.60 ", $935.87 , $143.95 , $828.27 , $688.02 , $675.03 ," $5,137.32 "," $4,971.60 "," $4,971.60 "," $4,419.20 "," $4,419.20 ", $828.27 ," $5,100.31 "," $5,247.80 "," $4,971.60 "," $4,971.60 "," $4,971.60 "," $5,137.32 "," $5,303.04 ", $871.51 ," $4,695.40 ", $831.37 , $776.82 , N/A , $701.44 , $701.44 ," $5,247.80 ", $796.84 , $143.95 ," $5,303.04 "
Pro Cltx Talotarsal Jt Dislc W/O Anes,28570,N/A,N/A,N/A, $801.00 , $520.65 ," $1,213.81 ", $193.02 , $153.67 , $710.83 , $689.70 , $744.93 , $720.90 , $720.90 , $640.80 , $640.80 , $153.67 , $739.56 , $760.95 , $720.90 , $720.90 , $720.90 , $744.93 , $768.96 ," $1,116.18 ", $680.85 , $743.95 ," $1,099.43 ", N/A , $724.69 , $724.69 , $760.95 , $851.77 , $153.67 ," $1,213.81 "
Cysto/Uretero/Pyeloscopy W/Lithotripsy,CPT® 52353,N/A,N/A,N/A," $3,899.00 "," $2,534.35 "," $2,100.25 ", $368.50 , $431.86 ," $1,924.93 "," $2,675.07 "," $3,626.07 "," $3,509.10 "," $3,509.10 "," $3,119.20 "," $3,119.20 ", $431.86 ," $3,599.95 "," $3,704.05 "," $3,509.10 "," $3,509.10 "," $3,509.10 "," $3,626.07 "," $3,743.04 "," $2,112.54 "," $3,314.15 "," $2,060.59 "," $2,413.34 ", N/A ," $1,962.49 "," $1,962.49 "," $3,704.05 "," $2,306.64 ", $368.50 ," $3,743.04 "
 Inj Proc Ankle Arthro ,CPT® 27648,0761 - TREATMENT ROOM,N/A,N/A, $677.00 , $440.05 , $568.68 , $48.60 , $46.08 , $547.02 , $609.30 , $573.15 , $609.30 , $609.30 , $609.30 , $575.45 , $45.18 , $625.07 , $643.15 , $575.45 , $629.61 , $629.61 , $643.15 , $649.92 , $553.92 , $609.30 , $575.45 , $534.83 , N/A , $547.90 , $547.90 , $643.15 , $580.93 , $45.18 , $649.92 
Laser Enucleation Prostate W Morcellation,CPT® 52649,N/A,N/A,N/A," $5,798.00 "," $3,768.70 "," $4,473.73 ", $786.71 , $763.05 ," $4,025.05 "," $3,711.91 "," $5,392.14 "," $5,218.20 "," $5,218.20 "," $4,638.40 "," $4,638.40 ", $763.05 ," $5,353.29 "," $5,508.10 "," $5,218.20 "," $5,218.20 "," $5,218.20 "," $5,392.14 "," $5,566.08 "," $4,490.27 "," $4,928.30 "," $4,203.25 "," $5,065.11 ", N/A ," $4,103.58 "," $4,103.58 "," $5,508.10 "," $4,823.19 ", $763.05 ," $5,566.08 "
Chmsrg Mohs Mg Tq T/a/L Ea Addl Stag,CPT® 17314,N/A,N/A,N/A," $1,850.00 "," $1,202.50 ", $563.01 , $168.46 , $290.50 , $510.17 , $493.19 ," $1,720.50 "," $1,665.00 "," $1,665.00 "," $1,480.00 "," $1,480.00 ", $290.50 ," $1,708.11 "," $1,757.50 "," $1,665.00 "," $1,665.00 "," $1,665.00 "," $1,720.50 "," $1,776.00 ", $622.98 ," $1,572.50 ", $981.24 , $654.20 , N/A , $520.12 , $520.12 ," $1,757.50 ", $603.18 , $168.46 ," $1,776.00 "
"CT Scan,Upper Extremity,W/O Contrast",CPT® 73200,N/A,N/A,N/A," $2,963.00 "," $1,925.95 "," $1,058.89 ", $150.37 , $242.16 , $853.40 ," $1,101.78 "," $2,755.59 "," $2,666.70 "," $2,666.70 "," $2,370.40 "," $2,370.40 ", $242.16 ," $2,735.74 "," $2,814.85 "," $2,666.70 "," $2,666.70 "," $2,666.70 "," $2,755.59 "," $2,844.48 ", $983.27 ," $2,518.55 "," $1,199.92 "," $1,164.25 ", N/A , $870.05 , $870.05 ," $2,814.85 "," $1,007.10 ", $150.37 ," $2,844.48 "
Rpr Hypospadias Complctjs Moblj Flaps & Urtp,CPT® 54344,N/A,N/A,N/A," $5,199.00 "," $3,379.35 "," $4,179.48 ", $898.26 ," $1,799.58 "," $3,044.55 "," $3,066.13 "," $4,835.07 "," $4,679.10 "," $4,679.10 "," $4,159.20 "," $4,159.20 "," $1,799.58 "," $4,800.24 "," $4,939.05 "," $4,679.10 "," $4,679.10 "," $4,679.10 "," $4,835.07 "," $4,991.04 "," $3,928.50 "," $4,419.15 "," $4,884.77 "," $4,591.07 ", N/A ," $3,103.96 "," $3,103.96 "," $4,939.05 "," $3,720.29 ", $898.26 ," $4,991.04 "
Abscess or Hematoma Ear,69000,N/A,N/A,N/A," $1,057.00 ", $687.05 , $587.55 , $120.89 , $30.71 , $571.83 , $595.04 , $983.01 , $951.30 , $951.30 , $845.60 , $845.60 , $30.71 , $975.93 ," $1,004.15 ", $951.30 , $951.30 , $951.30 , $983.01 ," $1,014.72 ", $631.71 , $898.45 , $649.40 , $582.65 , N/A , $582.99 , $582.99 ," $1,004.15 ", $665.66 , $30.71 ," $1,014.72 "
 LEVETIRACETAM 250 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,68084-0859-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Dehydroepiandrosterone-Sulfate,CPT® 82627,N/A,N/A,N/A, $222.00 , $144.30 , N/A , $22.67 , $22.67 , $125.81 , $150.47 , $206.46 , $199.80 , $199.80 , $177.60 , $177.60 , $22.67 , $204.97 , $210.90 , $199.80 , $199.80 , $199.80 , $206.46 , $213.12 , $148.43 , $188.70 , $145.97 , $80.62 , N/A , $117.41 , $117.41 , $210.90 , $128.30 , $22.67 , $213.12 
 ZOLEDRONIC ACID 5 MG/100ML IV SOLN ,HCPCS J3489,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0966-00,100 mL, $882.10 , $573.37 , $740.96 , $9.27 , $11.36 , $712.74 , $793.89 , $746.79 , $793.89 , $793.89 , $793.89 , $749.79 , $11.14 , $814.44 , $838.00 , $749.79 , $820.35 , $820.35 , $838.00 , $846.82 , $721.73 , $793.89 , $749.79 , $696.86 , N/A , $713.88 , $713.88 , $838.00 , $756.93 , $9.27 , $846.82 
 CLINIMIX E/DEXTROSE (4.25/5) 4.25 % IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00338-1113-04,"2,000 mL", $493.14 , $320.54 , $414.24 , N/A , N/A , $398.46 , $443.83 , $417.49 , $443.83 , $443.83 , $443.83 , $419.17 , N/A , $455.32 , $468.48 , $419.17 , $458.62 , $458.62 , $468.48 , $473.41 , $403.49 , $443.83 , $419.17 , $389.58 , N/A , $399.10 , $399.10 , $468.48 , $423.16 , $389.58 , $473.41 
 Pro US Breast Unilateral Complete ,CPT® 76641,0972 - PRO FEE/RAD/DX,N/A,N/A, $466.00 , $302.90 , $588.12 , $102.29 , $84.87 , $514.85 , $562.42 , $433.38 , $419.40 , $419.40 , $372.80 , $372.80 , $84.87 , $430.26 , $442.70 , $419.40 , $419.40 , $419.40 , $433.38 , $447.36 , $589.65 , $396.10 , $596.61 , $604.81 , N/A , $524.90 , $524.90 , $442.70 , $607.58 , $84.87 , $607.58 
 Fac Colonoscopy Flx With Endoscopic Stent Placement ,CPT® 45389,0360 - OR SERVICES,N/A,N/A," $3,777.00 "," $2,455.05 "," $3,172.68 ", $274.21 , $265.41 ," $3,051.82 "," $3,399.30 "," $3,197.61 "," $3,399.30 "," $3,399.30 "," $3,399.30 "," $3,210.45 ", $260.21 ," $3,487.30 "," $3,588.15 "," $3,210.45 "," $3,512.61 "," $3,512.61 "," $3,588.15 "," $3,625.92 "," $3,090.34 "," $3,399.30 "," $3,210.45 "," $2,983.83 ", N/A ," $3,056.73 "," $3,056.73 "," $3,588.15 "," $3,241.04 ", $260.21 ," $3,625.92 "
 PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ INJ ,HCPCS 90732,0636 - DRUGS REQUIRING DETAILED CODIN,00006-4943-00,0.5 mL, $344.26 , $223.77 , $289.18 , $136.14 , $107.94 , $278.16 , $309.83 , $291.45 , $309.83 , $309.83 , $309.83 , $292.62 , $105.82 , $317.86 , $327.05 , $292.62 , $320.16 , $320.16 , $327.05 , $330.49 , $281.67 , $309.83 , $292.62 , $271.97 , N/A , $278.61 , $278.61 , $327.05 , $295.41 , $105.82 , $330.49 
Nitric Oxide Expired Gas Determination,CPT® 95012,N/A,N/A,N/A, $186.00 , $120.90 , $46.88 , $18.17 , $14.99 , $35.07 , $36.21 , $172.98 , $167.40 , $167.40 , $148.80 , $148.80 , $14.99 , $171.73 , $176.70 , $167.40 , $167.40 , $167.40 , $172.98 , $178.56 , $60.99 , $158.10 , $61.84 , $61.98 , N/A , $35.76 , $35.76 , $176.70 , $42.27 , $14.99 , $178.56 
"Lap, Repair Paraesophageal Hernia, Incl Fundoplasty W/O Mesh",43281,N/A,N/A,N/A," $10,192.00 "," $6,624.80 "," $9,099.87 "," $1,405.68 "," $1,292.22 "," $7,254.46 "," $7,295.52 "," $9,478.56 "," $9,172.80 "," $9,172.80 "," $8,153.60 "," $8,153.60 "," $1,292.22 "," $9,410.27 "," $9,682.40 "," $9,172.80 "," $9,172.80 "," $9,172.80 "," $9,478.56 "," $9,784.32 "," $6,537.25 "," $8,663.20 "," $8,131.76 "," $8,532.66 ", N/A ," $7,396.00 "," $7,396.00 "," $9,682.40 "," $7,735.44 "," $1,292.22 "," $9,784.32 "
 Fac Chg Allergen Spec Ige Recombinant/Purified Compnt Ea ,CPT® 86008,0302 - LAB/IMMUNOLOGY,N/A,N/A, $359.00 , $233.35 , $301.56 , $18.29 , $18.06 , $290.07 , $323.10 , $303.93 , $323.10 , $323.10 , $323.10 , $305.15 , $17.71 , $331.46 , $341.05 , $305.15 , $333.87 , $333.87 , $341.05 , $344.64 , $293.73 , $323.10 , $305.15 , $283.61 , N/A , $290.54 , $290.54 , $341.05 , $308.06 , $17.71 , $344.64 
Allg Test Perq & Ic Drug/Biol Immed React W/ I&R,CPT® 95018,N/A,N/A,N/A, $73.00 , $47.45 , $17.94 , $6.92 , $7.41 , $13.01 , $12.65 , $67.89 , $65.70 , $65.70 , $58.40 , $58.40 , $7.41 , $67.40 , $69.35 , $65.70 , $65.70 , $65.70 , $67.89 , $70.08 , $22.53 , $62.05 , $21.29 , $21.99 , N/A , $13.26 , $13.26 , $69.35 , $15.68 , $6.92 , $70.08 
X-Ray Clavicle,CPT® 73000,N/A,N/A,N/A, $276.00 , $179.40 , $180.79 , $31.69 , $26.56 , $131.21 , $155.62 , $256.68 , $248.40 , $248.40 , $220.80 , $220.80 , $26.56 , $254.83 , $262.20 , $248.40 , $248.40 , $248.40 , $256.68 , $264.96 , $176.32 , $234.60 , $169.49 , $140.49 , N/A , $133.76 , $133.76 , $262.20 , $154.84 , $26.56 , $264.96 
 Pro CT Pelvis W/O Dye ,CPT® 72192,0972 - PRO FEE/RAD/DX,N/A,N/A, $615.00 , $399.75 , $946.05 , $135.96 , $239.47 , $697.73 , $918.19 , $571.95 , $553.50 , $553.50 , $492.00 , $492.00 , $239.47 , $567.83 , $584.25 , $553.50 , $553.50 , $553.50 , $571.95 , $590.40 , $794.11 , $522.75 , $997.69 , $947.47 , N/A , $711.35 , $711.35 , $584.25 , $823.40 , $135.96 , $997.69 
Simple Cystometrogram,CPT® 51725,N/A,N/A,N/A," $2,066.00 "," $1,342.90 "," $1,288.35 ", $223.70 , $211.78 , $903.06 , $881.67 ," $1,921.38 "," $1,859.40 "," $1,859.40 "," $1,652.80 "," $1,652.80 ", $211.78 ," $1,907.54 "," $1,962.70 "," $1,859.40 "," $1,859.40 "," $1,859.40 "," $1,921.38 "," $1,983.36 "," $1,259.86 "," $1,756.10 ", $997.29 ," $1,153.11 ", N/A , $920.68 , $920.68 ," $1,962.70 "," $1,082.13 ", $211.78 ," $1,983.36 "
MRI Breast Without&With Contrast W/Cad Bilateral,CPT® 77049,N/A,N/A,N/A," $2,480.00 "," $1,612.00 "," $2,059.46 ", $353.78 , $320.77 ," $1,797.77 ", N/A ," $2,306.40 "," $2,232.00 "," $2,232.00 "," $1,984.00 "," $1,984.00 ", $320.77 ," $2,289.78 "," $2,356.00 "," $2,232.00 "," $2,232.00 "," $2,232.00 "," $2,306.40 "," $2,380.80 "," $2,145.79 "," $2,108.00 "," $2,064.15 "," $5,151.59 ", N/A ," $1,832.84 "," $1,832.84 "," $2,356.00 "," $2,121.56 ", $320.77 ," $5,151.59 "
"I&D, Post Spine, Lumb/Sacr/Lumbosac",CPT® 22015,N/A,N/A,N/A," $6,040.00 "," $3,926.00 "," $5,647.33 ", $883.81 , $684.78 ," $4,332.87 "," $4,291.82 "," $5,617.20 "," $5,436.00 "," $5,436.00 "," $4,832.00 "," $4,832.00 ", $684.78 ," $5,576.73 "," $5,738.00 "," $5,436.00 "," $5,436.00 "," $5,436.00 "," $5,617.20 "," $5,798.40 "," $5,245.04 "," $5,134.00 "," $4,788.43 "," $5,269.28 ", N/A ," $4,417.41 "," $4,417.41 "," $5,738.00 "," $5,192.02 ", $684.78 ," $5,798.40 "
"Open Rx Weightbear Tib,Fix Tib Only",CPT® 27827,N/A,N/A,N/A," $4,215.00 "," $2,739.75 "," $6,846.58 "," $1,069.94 ", $946.73 ," $5,224.91 "," $5,223.20 "," $3,919.95 "," $3,793.50 "," $3,793.50 "," $3,372.00 "," $3,372.00 ", $946.73 ," $3,891.71 "," $4,004.25 "," $3,793.50 "," $3,793.50 "," $3,793.50 "," $3,919.95 "," $4,046.40 "," $6,349.41 "," $3,582.75 "," $5,767.88 "," $6,258.90 ", N/A ," $5,326.86 "," $5,326.86 "," $4,004.25 "," $6,260.96 ", $946.73 ," $6,846.58 "
 Fac Office/Outpatient Established High Mdm 40-54 Min ,CPT® 99215,0510 - CLINIC,N/A,N/A, $564.00 , $366.60 , $473.76 , $139.34 , $94.97 , $455.71 , $507.60 , N/A , $507.60 , $507.60 , $507.60 , $479.40 , $93.11 , $520.74 , $535.80 , $479.40 , $524.52 , $524.52 , $535.80 , $541.44 , $461.46 , $507.60 , $479.40 , $445.56 , N/A , $456.45 , $456.45 , $535.80 , $483.97 , $93.11 , $541.44 
 GOLIMUMAB 50 MG/4ML IV SOLN ,HCPCS J1602,0636 - DRUGS REQUIRING DETAILED CODIN,57894-0350-01,4 mL," $5,878.26 "," $3,820.87 "," $4,937.74 ", $13.56 , $14.13 ," $4,749.63 "," $5,290.43 "," $4,976.53 "," $5,290.43 "," $5,290.43 "," $5,290.43 "," $4,996.52 ", $13.85 ," $5,427.40 "," $5,584.35 "," $4,996.52 "," $5,466.78 "," $5,466.78 "," $5,584.35 "," $5,643.13 "," $4,809.59 "," $5,290.43 "," $4,996.52 "," $4,643.83 ", N/A ," $4,757.28 "," $4,757.28 "," $5,584.35 "," $5,044.13 ", $13.56 ," $5,643.13 "
" Pro Shoulder Arthroscopy, Dx ",CPT® 29805,0982 - PRO FEE/OUTPT,N/A,N/A," $3,101.00 "," $2,015.65 "," $2,865.27 ", $450.43 , $220.85 ," $2,279.09 "," $2,278.31 "," $2,883.93 "," $2,790.90 "," $2,790.90 "," $2,480.80 "," $2,480.80 ", $220.85 ," $2,863.15 "," $2,945.95 "," $2,790.90 "," $2,790.90 "," $2,790.90 "," $2,883.93 "," $2,976.96 "," $2,675.10 "," $2,635.85 "," $2,513.75 "," $2,686.95 ", N/A ," $2,323.56 "," $2,323.56 "," $2,945.95 "," $2,731.01 ", $220.85 ," $2,976.96 "
" Pro Inject Trigger Points, =/> 3 ",CPT® 20553,0982 - PRO FEE/OUTPT,N/A,N/A, $461.00 , $299.65 , $108.92 , $40.47 , $26.41 , $210.81 , $207.99 , $428.73 , $414.90 , $414.90 , $368.80 , $368.80 , $26.41 , $425.64 , $437.95 , $414.90 , $414.90 , $414.90 , $428.73 , $442.56 , $244.53 , $391.85 , $224.79 , $250.96 , N/A , $214.93 , $214.93 , $437.95 , $252.63 , $26.41 , $442.56 
 Fac Drug Test Def 1-7 Classes ,HCPCS G0480,0301 - LAB/CHEMISTRY,N/A,N/A, $172.00 , $111.80 , $144.48 , $116.72 , $65.23 , $138.98 , $154.80 , $145.62 , $154.80 , $154.80 , $154.80 , $146.20 , $63.95 , $158.81 , $163.40 , $146.20 , $159.96 , $159.96 , $163.40 , $165.12 , $140.73 , $154.80 , $146.20 , $135.88 , N/A , $139.20 , $139.20 , $163.40 , $147.59 , $63.95 , $165.12 
 PALIPERIDONE PALMITATE ER 156 MG/ML IM SUSY ,HCPCS J2426,0636 - DRUGS REQUIRING DETAILED CODIN,50458-0563-01,1 mL," $6,563.20 "," $4,266.08 "," $5,513.09 ", $14.50 , $13.92 ," $5,303.07 "," $5,906.88 "," $5,556.41 "," $5,906.88 "," $5,906.88 "," $5,906.88 "," $5,578.72 ", $13.65 ," $6,059.80 "," $6,235.04 "," $5,578.72 "," $6,103.78 "," $6,103.78 "," $6,235.04 "," $6,300.67 "," $5,370.01 "," $5,906.88 "," $5,578.72 "," $5,184.93 ", N/A ," $5,311.60 "," $5,311.60 "," $6,235.04 "," $5,631.88 ", $13.65 ," $6,300.67 "
Evac. Subungual Hematoma,11740,N/A,N/A,N/A, $187.00 , $121.55 , $101.46 , $30.96 , $37.00 , $89.90 , $88.22 , $173.91 , $168.30 , $168.30 , $149.60 , $149.60 , $37.00 , $172.66 , $177.65 , $168.30 , $168.30 , $168.30 , $173.91 , $179.52 , $110.68 , $158.95 , $173.05 , $117.10 , N/A , $91.66 , $91.66 , $177.65 , $106.30 , $30.96 , $179.52 
 Pro Bx/Exc Lymph Node Opn Dp Ax Node ,CPT® 38525,0982 - PRO FEE/OUTPT,N/A,N/A," $5,210.00 "," $3,386.50 "," $2,030.20 ", $410.70 , $363.55 ," $1,513.82 "," $1,566.39 "," $4,845.30 "," $4,689.00 "," $4,689.00 "," $4,168.00 "," $4,168.00 ", $363.55 ," $4,810.39 "," $4,949.50 "," $4,689.00 "," $4,689.00 "," $4,689.00 "," $4,845.30 "," $5,001.60 "," $2,165.66 "," $4,428.50 "," $2,317.50 "," $2,097.50 ", N/A ," $1,543.35 "," $1,543.35 "," $4,949.50 "," $1,790.50 ", $363.55 ," $5,001.60 "
 Pro New Patient Visit Level 2 ,CPT® 99202,0982 - PRO FEE/OUTPT,N/A,N/A, $191.00 , $124.15 , $97.59 , $46.48 , $50.34 , $86.35 , $86.61 , $177.63 , $171.90 , $171.90 , $152.80 , $152.80 , $50.34 , $176.35 , $181.45 , $171.90 , $171.90 , $171.90 , $177.63 , $183.36 , $89.09 , $162.35 , $108.02 , $109.92 , $42.00 , $88.04 , $88.04 , $181.45 , $101.55 , $42.00 , $183.36 
 Fac Cltx Medial Malls Fx W/O Mnpj ,CPT® 27760,0761 - TREATMENT ROOM,N/A,N/A," $3,315.00 "," $2,154.75 "," $2,784.60 ", $302.45 , $184.42 ," $2,678.52 "," $2,983.50 "," $2,806.48 "," $2,983.50 "," $2,983.50 "," $2,983.50 "," $2,817.75 ", $180.80 ," $3,060.74 "," $3,149.25 "," $2,817.75 "," $3,082.95 "," $3,082.95 "," $3,149.25 "," $3,182.40 "," $2,712.33 "," $2,983.50 "," $2,817.75 "," $2,618.85 ", N/A ," $2,682.83 "," $2,682.83 "," $3,149.25 "," $2,844.60 ", $180.80 ," $3,182.40 "
" Fac Vent Mgmt Inpat, Init Day ",CPT® 94002,0410 - RESPIRATORY SVC,N/A,N/A," $1,600.00 "," $1,040.00 "," $1,344.00 ", $88.36 , $71.72 ," $1,292.80 "," $1,440.00 "," $1,354.56 "," $1,440.00 "," $1,440.00 "," $1,440.00 "," $1,360.00 ", $70.31 ," $1,477.28 "," $1,520.00 "," $1,360.00 "," $1,488.00 "," $1,488.00 "," $1,520.00 "," $1,536.00 "," $1,309.12 "," $1,440.00 "," $1,360.00 "," $1,264.00 ", N/A ," $1,294.88 "," $1,294.88 "," $1,520.00 "," $1,372.96 ", $70.31 ," $1,536.00 "
 CT Guidance for Needle Placement ,CPT® 77012,0350 - CT SCAN,N/A,N/A," $1,545.00 "," $1,004.25 "," $1,297.80 ", $139.40 , $171.11 ," $1,248.36 "," $1,390.50 "," $1,308.00 "," $1,390.50 "," $1,390.50 "," $1,390.50 "," $1,313.25 ", $167.75 ," $1,426.50 "," $1,467.75 "," $1,313.25 "," $1,436.85 "," $1,436.85 "," $1,467.75 "," $1,483.20 "," $1,264.12 "," $1,390.50 "," $1,313.25 "," $1,220.55 ", N/A ," $1,250.37 "," $1,250.37 "," $1,467.75 "," $1,325.76 ", $139.40 ," $1,483.20 "
"Full Rout Obste Care,Vaginal Deliv",CPT® 59400,N/A,N/A,N/A," $6,957.00 "," $4,522.05 "," $5,662.38 "," $2,207.65 "," $1,172.31 "," $4,855.33 "," $5,128.77 "," $6,470.01 "," $6,261.30 "," $6,261.30 "," $5,565.60 "," $5,565.60 "," $1,172.31 "," $6,423.40 "," $6,609.15 "," $6,261.30 "," $6,261.30 "," $6,261.30 "," $6,470.01 "," $6,678.72 "," $6,594.77 "," $5,913.45 "," $11,277.07 "," $4,856.66 ", N/A ," $4,950.07 "," $4,950.07 "," $6,609.15 "," $5,722.77 "," $1,172.31 "," $11,277.07 "
 Fac Transferase (Ast) (Sgot) ,CPT® 84450,0301 - LAB/CHEMISTRY,N/A,N/A, $71.00 , $46.15 , $59.64 , $5.28 , $5.28 , $57.37 , $63.90 , $60.11 , $63.90 , $63.90 , $63.90 , $60.35 , $5.18 , $65.55 , $67.45 , $60.35 , $66.03 , $66.03 , $67.45 , $68.16 , $58.09 , $63.90 , $60.35 , $56.09 , N/A , $57.46 , $57.46 , $67.45 , $60.93 , $5.18 , $68.16 
"Complement, Antigen",CPT® 86160,N/A,N/A,N/A, $165.00 , $107.25 , N/A , $12.24 , $12.24 , $67.89 , $81.23 , $153.45 , $148.50 , $148.50 , $132.00 , $132.00 , $12.24 , $152.34 , $156.75 , $148.50 , $148.50 , $148.50 , $153.45 , $158.40 , $80.13 , $140.25 , $77.85 , $43.50 , N/A , $63.36 , $63.36 , $156.75 , $69.24 , $12.24 , $158.40 
"US,Infant Hips,Dynamic",CPT® 76885,N/A,N/A,N/A," $1,296.00 ", $842.40 , $651.22 , $118.83 , $86.75 , $694.32 , $791.98 ," $1,205.28 "," $1,166.40 "," $1,166.40 "," $1,036.80 "," $1,036.80 ", $86.75 ," $1,196.60 "," $1,231.20 "," $1,166.40 "," $1,166.40 "," $1,166.40 "," $1,205.28 "," $1,244.16 ", $793.20 ," $1,101.60 ", $860.94 , $814.38 , N/A , $707.87 , $707.87 ," $1,231.20 ", $819.35 , $86.75 ," $1,244.16 "
"Inj, Tezepelumab-Ekko, 1 Mg",HCPCS J2356,N/A,N/A,N/A, $54.00 , $35.10 , N/A , $19.10 , $18.24 , N/A , N/A , $50.22 , $48.60 , $48.60 , $43.20 , $43.20 , $18.24 , $49.86 , $51.30 , $48.60 , $48.60 , $48.60 , $50.22 , $51.84 , N/A , $45.90 , $34.25 , $23.49 , N/A , N/A , N/A , $51.30 , N/A , $18.24 , $51.84 
 Pro Pnxr Aspir Absc Hmtma Bulla/Cst ,CPT® 10160,0982 - PRO FEE/OUTPT,N/A,N/A, $490.00 , $318.50 , $307.12 , $92.99 , $30.77 , $262.79 , $257.92 , $455.70 , $441.00 , $441.00 , $392.00 , $392.00 , $30.77 , $452.42 , $465.50 , $441.00 , $441.00 , $441.00 , $455.70 , $470.40 , $335.46 , $416.50 , $510.24 , $335.24 , N/A , $267.91 , $267.91 , $465.50 , $310.70 , $30.77 , $510.24 
 Fac Semen Anal Vol/Count/Mot ,CPT® 89320,0300 - LABORATORY,N/A,N/A, $262.00 , $170.30 , $220.08 , $12.56 , $12.56 , $211.70 , $235.80 , $221.81 , $235.80 , $235.80 , $235.80 , $222.70 , $12.31 , $241.90 , $248.90 , $222.70 , $243.66 , $243.66 , $248.90 , $251.52 , $214.37 , $235.80 , $222.70 , $206.98 , N/A , $212.04 , $212.04 , $248.90 , $224.82 , $12.31 , $251.52 
 Fac Assay of Nos Vitamin ,CPT® 84591,0301 - LAB/CHEMISTRY,N/A,N/A, $174.00 , $113.10 , $146.16 , $17.40 , $16.11 , $140.59 , $156.60 , $147.31 , $156.60 , $156.60 , $156.60 , $147.90 , $15.79 , $160.65 , $165.30 , $147.90 , $161.82 , $161.82 , $165.30 , $167.04 , $142.37 , $156.60 , $147.90 , $137.46 , N/A , $140.82 , $140.82 , $165.30 , $149.31 , $15.79 , $167.04 
 Fac Private Room W/Telemetry ,Custom 1110000002,0111 - MED-SUR-GY/PVT,N/A,N/A," $2,117.00 "," $1,376.05 "," $1,778.28 ", N/A , N/A ," $1,710.54 "," $1,905.30 "," $1,792.25 "," $1,905.30 "," $1,905.30 "," $1,905.30 "," $1,799.45 ", N/A ," $1,954.63 "," $2,011.15 "," $1,799.45 "," $1,968.81 "," $1,968.81 "," $2,011.15 "," $2,032.32 "," $1,732.13 "," $1,905.30 "," $1,799.45 "," $1,672.43 ", N/A ," $1,713.29 "," $1,713.29 "," $2,011.15 "," $1,816.60 "," $1,672.43 "," $2,032.32 "
Gerd Tst W/ Mucos Ph Electrod,91035,N/A,N/A,N/A," $2,092.00 "," $1,359.80 "," $1,124.71 ", $455.01 , $409.86 ," $1,451.02 "," $1,181.73 "," $1,945.56 "," $1,882.80 "," $1,882.80 "," $1,673.60 "," $1,673.60 ", $409.86 ," $1,931.54 "," $1,987.40 "," $1,882.80 "," $1,882.80 "," $1,882.80 "," $1,945.56 "," $2,008.32 "," $2,177.10 "," $1,778.20 "," $1,566.19 "," $1,825.51 ", N/A ," $1,479.33 "," $1,479.33 "," $1,987.40 "," $1,740.40 ", $409.86 ," $2,177.10 "
Rmvl Tun Ctr Vad W/Subq Port/Pmp Ctr/Prph Insj,36590,N/A,N/A,N/A," $1,813.00 "," $1,178.45 "," $1,149.27 ", $178.03 , $375.08 , $885.08 , $883.91 ," $1,686.09 "," $1,631.70 "," $1,631.70 "," $1,450.40 "," $1,450.40 ", $375.08 ," $1,673.94 "," $1,722.35 "," $1,631.70 "," $1,631.70 "," $1,631.70 "," $1,686.09 "," $1,740.48 "," $1,057.02 "," $1,541.05 "," $1,100.77 ", $935.17 , N/A , $902.35 , $902.35 ," $1,722.35 "," $1,025.04 ", $178.03 ," $1,740.48 "
 Pro Cardioversion Elective Arrhythmia External ,CPT® 92960,0981 - PRO FEE/ER,N/A,N/A, $956.00 , $621.40 , $675.35 , $104.47 , $244.76 , $670.27 , $674.00 , $889.08 , $860.40 , $860.40 , $764.80 , $764.80 , $244.76 , $882.67 , $908.20 , $860.40 , $860.40 , $860.40 , $889.08 , $917.76 , $666.44 , $812.60 , $627.99 , $661.06 , N/A , $683.35 , $683.35 , $908.20 , $757.50 , $104.47 , $917.76 
"Rad Guided,Percut Drainage,W/Cath Place",CPT® 75989,N/A,N/A,N/A," $1,416.00 ", $920.40 , $648.85 , $111.07 , $134.80 , $578.69 , $657.81 ," $1,316.88 "," $1,274.40 "," $1,274.40 "," $1,132.80 "," $1,132.80 ", $134.80 ," $1,307.39 "," $1,345.20 "," $1,274.40 "," $1,274.40 "," $1,274.40 "," $1,316.88 "," $1,359.36 ", $468.53 ," $1,203.60 ", $716.49 , $615.27 , N/A , $589.98 , $589.98 ," $1,345.20 ", $682.91 , $111.07 ," $1,359.36 "
Exc Skin Benig 2.1-3cm Remaindr Body,11423,N/A,N/A,N/A," $1,032.00 ", $670.80 , $498.95 , $150.64 , $167.14 , $428.81 , $422.17 , $959.76 , $928.80 , $928.80 , $825.60 , $825.60 , $167.14 , $952.85 , $980.40 , $928.80 , $928.80 , $928.80 , $959.76 , $990.72 , $545.40 , $877.20 , $840.29 , $546.89 , N/A , $437.17 , $437.17 , $980.40 , $506.99 , $150.64 , $990.72 
 Shoulder Arthrogram ,CPT® 73040,0320 - DX X-RAY,N/A,N/A," $1,150.00 ", $747.50 , $966.00 , $129.87 , $101.89 , $929.20 ," $1,035.00 ", $973.59 ," $1,035.00 "," $1,035.00 "," $1,035.00 ", $977.50 , $99.89 ," $1,061.80 "," $1,092.50 ", $977.50 ," $1,069.50 "," $1,069.50 "," $1,092.50 "," $1,104.00 ", $940.93 ," $1,035.00 ", $977.50 , $908.50 , N/A , $930.70 , $930.70 ," $1,092.50 ", $986.82 , $99.89 ," $1,104.00 "
"Incis Colon for Explor,Bx,FB Rem",CPT® 44025,N/A,N/A,N/A," $7,228.00 "," $4,698.20 "," $5,874.31 ", $905.59 ," $1,498.38 "," $4,643.28 "," $4,697.66 "," $6,722.04 "," $6,505.20 "," $6,505.20 "," $5,782.40 "," $5,782.40 "," $1,498.38 "," $6,673.61 "," $6,866.60 "," $6,505.20 "," $6,505.20 "," $6,505.20 "," $6,722.04 "," $6,938.88 "," $4,192.46 "," $6,143.80 "," $5,223.74 "," $5,467.98 ", N/A ," $4,733.87 "," $4,733.87 "," $6,866.60 "," $4,951.14 ", $905.59 ," $6,938.88 "
 Fac Esophagoscopy Transoral Stent Placement ,CPT® 43212,0360 - OR SERVICES,N/A,N/A," $2,246.00 "," $1,459.90 "," $1,886.64 ", $176.36 , $144.71 ," $1,814.77 "," $2,021.40 "," $1,901.46 "," $2,021.40 "," $2,021.40 "," $2,021.40 "," $1,909.10 ", $141.87 ," $2,073.73 "," $2,133.70 "," $1,909.10 "," $2,088.78 "," $2,088.78 "," $2,133.70 "," $2,156.16 "," $1,837.68 "," $2,021.40 "," $1,909.10 "," $1,774.34 ", N/A ," $1,817.69 "," $1,817.69 "," $2,133.70 "," $1,927.29 ", $141.87 ," $2,156.16 "
"Biopsy of Testis,Incisional",CPT® 54505,N/A,N/A,N/A," $1,152.00 ", $748.80 , $929.14 , $200.74 , $153.67 , $672.88 , $681.28 ," $1,071.36 "," $1,036.80 "," $1,036.80 ", $921.60 , $921.60 , $153.67 ," $1,063.64 "," $1,094.40 "," $1,036.80 "," $1,036.80 "," $1,036.80 "," $1,071.36 "," $1,105.92 ", $874.70 , $979.20 ," $1,086.49 "," $1,017.48 ", N/A , $686.00 , $686.00 ," $1,094.40 ", $822.22 , $153.67 ," $1,105.92 "
Treat Articular Fracture,26742,N/A,N/A,N/A," $2,132.00 "," $1,385.80 "," $2,083.84 ", $329.17 , $168.45 ," $1,595.87 "," $1,612.46 "," $1,982.76 "," $1,918.80 "," $1,918.80 "," $1,705.60 "," $1,705.60 ", $168.45 ," $1,968.48 "," $2,025.40 "," $1,918.80 "," $1,918.80 "," $1,918.80 "," $1,982.76 "," $2,046.72 "," $1,930.83 "," $1,812.20 "," $1,771.58 "," $1,911.72 ", N/A ," $1,627.01 "," $1,627.01 "," $2,025.40 "," $1,912.32 ", $168.45 ," $2,083.84 "
Iadna Respiratry Probe & Rev Trnscr 3-5 Targets,CPT® 87631,N/A,N/A,N/A, $468.00 , $304.20 , N/A , $145.48 , $143.60 , $725.81 , $868.20 , $435.24 , $421.20 , $421.20 , $374.40 , $374.40 , $143.60 , $432.10 , $444.60 , $421.20 , $421.20 , $421.20 , $435.24 , $449.28 , $952.37 , $397.80 , $840.11 , $465.16 , N/A , $677.37 , $677.37 , $444.60 , $740.22 , $143.60 , $952.37 
Levalbuterol Concentrated,HCPCS J7612,N/A,N/A,N/A, $11.00 , $7.15 , N/A , $0.26 , $0.28 , N/A , N/A , $10.23 , $9.90 , $9.90 , $8.80 , $8.80 , $0.28 , $10.16 , $10.45 , $9.90 , $9.90 , $9.90 , $10.23 , $10.56 , $0.38 , $9.35 , $0.65 , $0.39 , N/A , N/A , N/A , $10.45 , N/A , $0.26 , $10.56 
 Antibody John Cunningham Virus Pbb ,CPT® 86711,0302 - LAB/IMMUNOLOGY,N/A,N/A, $131.00 , $85.15 , $110.04 , $17.23 , $16.11 , $105.85 , $117.90 , $110.90 , $117.90 , $117.90 , $117.90 , $111.35 , $15.79 , $120.95 , $124.45 , $111.35 , $121.83 , $121.83 , $124.45 , $125.76 , $107.18 , $117.90 , $111.35 , $103.49 , N/A , $106.02 , $106.02 , $124.45 , $112.41 , $15.79 , $125.76 
X-Ray Scapula,CPT® 73010,N/A,N/A,N/A, $323.00 , $209.95 , $133.63 , $23.16 , $27.82 , $141.45 , $169.96 , $300.39 , $290.70 , $290.70 , $258.40 , $258.40 , $27.82 , $298.23 , $306.85 , $290.70 , $290.70 , $290.70 , $300.39 , $310.08 , $129.33 , $274.55 , $188.75 , $153.06 , N/A , $144.21 , $144.21 , $306.85 , $166.92 , $23.16 , $310.08 
Assay Serum Sodium,CPT® 84295,N/A,N/A,N/A, $63.00 , $40.95 , N/A , $4.91 , $4.91 , $27.23 , $32.60 , $58.59 , $56.70 , $56.70 , $50.40 , $50.40 , $4.91 , $58.17 , $59.85 , $56.70 , $56.70 , $56.70 , $58.59 , $60.48 , $32.12 , $53.55 , $30.82 , $17.45 , N/A , $25.41 , $25.41 , $59.85 , $27.77 , $4.91 , $60.48 
 Venous Duplex Scan/Dvt-Unilateral ,CPT® 93971,0921 - PERI VASCUL LAB,N/A,N/A, $777.00 , $505.05 , $652.68 , $117.01 , $110.85 , $627.82 , $699.30 , $657.81 , $699.30 , $699.30 , $699.30 , $660.45 , $108.68 , $717.40 , $738.15 , $660.45 , $722.61 , $722.61 , $738.15 , $745.92 , $635.74 , $699.30 , $660.45 , $613.83 , N/A , $628.83 , $628.83 , $738.15 , $666.74 , $108.68 , $745.92 
TREAT HUMERUS FRACTURE,24565,N/A,N/A,N/A," $2,608.00 "," $1,695.20 "," $3,046.36 ", $480.76 , $307.34 ," $2,350.44 "," $2,360.26 "," $2,425.44 "," $2,347.20 "," $2,347.20 "," $2,086.40 "," $2,086.40 ", $307.34 ," $2,407.97 "," $2,477.60 "," $2,347.20 "," $2,347.20 "," $2,347.20 "," $2,425.44 "," $2,503.68 "," $2,815.98 "," $2,216.80 "," $2,599.38 "," $2,780.98 ", N/A ," $2,396.31 "," $2,396.31 "," $2,477.60 "," $2,816.51 ", $307.34 ," $3,046.36 "
Trg@ Gene Rearrangement Analysis,CPT® 81342,N/A,N/A,N/A," $1,753.00 "," $1,139.45 ", N/A , $205.53 , $205.53 ," $1,140.01 "," $1,350.04 "," $1,630.29 "," $1,577.70 "," $1,577.70 "," $1,402.40 "," $1,402.40 ", $205.53 ," $1,618.54 "," $1,665.35 "," $1,577.70 "," $1,577.70 "," $1,577.70 "," $1,630.29 "," $1,682.88 "," $1,345.46 "," $1,490.05 ", $961.14 , $730.61 , N/A ," $1,063.93 "," $1,063.93 "," $1,665.35 "," $1,162.65 ", $205.53 ," $1,682.88 "
Cmv Antibody,CPT® 86644,N/A,N/A,N/A, $155.00 , $100.75 , N/A , $14.68 , $14.68 , $81.40 , $97.43 , $144.15 , $139.50 , $139.50 , $124.00 , $124.00 , $14.68 , $143.11 , $147.25 , $139.50 , $139.50 , $139.50 , $144.15 , $148.80 , $96.09 , $131.75 , $94.07 , $52.19 , N/A , $75.97 , $75.97 , $147.25 , $83.02 , $14.68 , $148.80 
 DIPYRIDAMOLE 5 MG/ML IV SOLN ,HCPCS J1245,0636 - DRUGS REQUIRING DETAILED CODIN,00641-2569-44,10 mL, $122.06 , $79.34 , $102.53 , $3.86 , $3.88 , $98.62 , $109.85 , $103.34 , $109.85 , $109.85 , $109.85 , $103.75 , $3.80 , $112.70 , $115.96 , $103.75 , $113.52 , $113.52 , $115.96 , $117.18 , $99.87 , $109.85 , $103.75 , $96.43 , N/A , $98.78 , $98.78 , $115.96 , $104.74 , $3.80 , $117.18 
"Rep Tendon, Central Slip",CPT® 26426,N/A,N/A,N/A," $3,649.00 "," $2,371.85 "," $3,093.61 ", $487.06 , $480.44 ," $2,409.70 "," $2,410.15 "," $3,393.57 "," $3,284.10 "," $3,284.10 "," $2,919.20 "," $2,919.20 ", $480.44 ," $3,369.12 "," $3,466.55 "," $3,284.10 "," $3,284.10 "," $3,284.10 "," $3,393.57 "," $3,503.04 "," $2,870.76 "," $3,101.65 "," $2,651.12 "," $2,859.63 ", N/A ," $2,456.71 "," $2,456.71 "," $3,466.55 "," $2,887.52 ", $480.44 ," $3,503.04 "
 SPIRONOLACTONE 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,63739-0545-10,1 tablet, $4.48 , $2.91 , $3.76 , N/A , N/A , $3.62 , $4.03 , $3.79 , $4.03 , $4.03 , $4.03 , $3.81 , N/A , $4.14 , $4.26 , $3.81 , $4.17 , $4.17 , $4.26 , $4.30 , $3.67 , $4.03 , $3.81 , $3.54 , N/A , $3.63 , $3.63 , $4.26 , $3.84 , $3.54 , $4.30 
Layer Closure 7.6-12.5cm,12034,N/A,N/A,N/A," $1,268.00 ", $824.20 , $654.87 , $196.65 , $122.93 , $564.34 , $550.50 ," $1,179.24 "," $1,141.20 "," $1,141.20 "," $1,014.40 "," $1,014.40 ", $122.93 ," $1,170.74 "," $1,204.60 "," $1,141.20 "," $1,141.20 "," $1,141.20 "," $1,179.24 "," $1,217.28 ", $719.01 ," $1,077.80 "," $1,100.77 ", $726.60 , N/A , $575.35 , $575.35 ," $1,204.60 ", $667.22 , $122.93 ," $1,217.28 "
 Fac Smpl Rpr Supfc F/E/E/N/L/M 2.6cm-5.0cm ,CPT® 12013,0761 - TREATMENT ROOM,N/A,N/A, $116.00 , $75.40 , $97.44 , $53.74 , $76.93 , $93.73 , $104.40 , $98.21 , $104.40 , $104.40 , $104.40 , $98.60 , $75.42 , $107.10 , $110.20 , $98.60 , $107.88 , $107.88 , $110.20 , $111.36 , $94.91 , $104.40 , $98.60 , $91.64 , N/A , $93.88 , $93.88 , $110.20 , $99.54 , $53.74 , $111.36 
 Pro Cltx Tmprmand Dislc 1st/Sbsq ,CPT® 21480,0981 - PRO FEE/ER,N/A,N/A, $284.00 , $184.60 , $184.80 , $28.96 , $50.81 , $155.45 , $153.79 , $264.12 , $255.60 , $255.60 , $227.20 , $227.20 , $50.81 , $262.22 , $269.80 , $255.60 , $255.60 , $255.60 , $264.12 , $272.64 , $173.97 , $241.40 , $169.49 , $182.68 , N/A , $158.49 , $158.49 , $269.80 , $186.28 , $28.96 , $272.64 
Treat Metatarsal Fracture,28475,N/A,N/A,N/A," $1,739.00 "," $1,130.35 "," $1,407.45 ", $223.42 , $153.67 ," $1,112.20 "," $1,108.67 "," $1,617.27 "," $1,565.10 "," $1,565.10 "," $1,391.20 "," $1,391.20 ", $153.67 ," $1,605.62 "," $1,652.05 "," $1,565.10 "," $1,565.10 "," $1,565.10 "," $1,617.27 "," $1,669.44 "," $1,307.69 "," $1,478.15 "," $1,207.81 "," $1,312.14 ", N/A ," $1,133.90 "," $1,133.90 "," $1,652.05 "," $1,332.74 ", $153.67 ," $1,669.44 "
Repair Diaphr Hernia Trauma Acute,CPT® 39540,N/A,N/A,N/A," $4,992.00 "," $3,244.80 "," $3,461.66 ", $793.57 ," $1,383.11 "," $3,035.24 "," $3,088.14 "," $4,642.56 "," $4,492.80 "," $4,492.80 "," $3,993.60 "," $3,993.60 "," $1,383.11 "," $4,609.11 "," $4,742.40 "," $4,492.80 "," $4,492.80 "," $4,492.80 "," $4,642.56 "," $4,792.32 "," $4,728.86 "," $4,243.20 "," $4,586.83 "," $3,965.45 ", N/A ," $3,094.47 "," $3,094.47 "," $4,742.40 "," $3,586.76 ", $793.57 ," $4,792.32 "
"Cystoscopy,Remv Ureteral Stone",CPT® 52320,N/A,N/A,N/A," $1,721.00 "," $1,118.65 "," $1,320.49 ", $231.78 , $461.04 ," $1,210.73 "," $1,120.59 "," $1,600.53 "," $1,548.90 "," $1,548.90 "," $1,376.80 "," $1,376.80 ", $461.04 ," $1,589.00 "," $1,634.95 "," $1,548.90 "," $1,548.90 "," $1,548.90 "," $1,600.53 "," $1,652.16 "," $1,328.07 "," $1,462.85 "," $1,268.47 "," $1,519.75 ", N/A ," $1,234.36 "," $1,234.36 "," $1,634.95 "," $1,450.80 ", $231.78 ," $1,652.16 "
Close Urethrovaginal Fistula,CPT® 57310,N/A,N/A,N/A," $2,833.00 "," $1,841.45 "," $2,354.25 ", $475.59 , $928.06 ," $1,897.50 "," $1,854.37 "," $2,634.69 "," $2,549.70 "," $2,549.70 "," $2,266.40 "," $2,266.40 ", $928.06 ," $2,615.71 "," $2,691.35 "," $2,549.70 "," $2,549.70 "," $2,549.70 "," $2,634.69 "," $2,719.68 "," $2,439.73 "," $2,408.05 "," $2,379.94 "," $1,940.27 ", N/A ," $1,934.52 "," $1,934.52 "," $2,691.35 "," $2,320.35 ", $475.59 ," $2,719.68 "
CT Scan of Arm Combo,CPT® 73202,N/A,N/A,N/A," $1,892.00 "," $1,229.80 "," $1,598.10 ", $231.52 , $355.39 ," $1,321.56 "," $1,720.24 "," $1,759.56 "," $1,702.80 "," $1,702.80 "," $1,513.60 "," $1,513.60 ", $355.39 ," $1,746.88 "," $1,797.40 "," $1,702.80 "," $1,702.80 "," $1,702.80 "," $1,759.56 "," $1,816.32 "," $1,528.86 "," $1,608.20 "," $1,875.96 "," $1,802.08 ", N/A ," $1,347.34 "," $1,347.34 "," $1,797.40 "," $1,559.57 ", $231.52 ," $1,875.96 "
Rplcmt Compl Tun Ctr Vad W/Subq Port,36582,N/A,N/A,N/A," $7,018.00 "," $4,561.70 "," $1,734.85 ", $268.28 ," $1,170.87 "," $1,325.35 "," $1,318.83 "," $6,526.74 "," $6,316.20 "," $6,316.20 "," $5,614.40 "," $5,614.40 "," $1,170.87 "," $6,479.72 "," $6,667.10 "," $6,316.20 "," $6,316.20 "," $6,316.20 "," $6,526.74 "," $6,737.28 "," $1,606.31 "," $5,965.30 "," $1,634.20 "," $1,429.21 ", N/A ," $1,351.21 "," $1,351.21 "," $6,667.10 "," $1,534.97 ", $268.28 ," $6,737.28 "
 Fac Cc E/M Critically Ill/Injured 1st 30-74 Min ,CPT® 99291,0510 - CLINIC,N/A,N/A," $2,589.00 "," $1,682.85 "," $2,174.76 ", $205.74 , $270.56 ," $2,091.91 "," $2,330.10 ", N/A ," $2,330.10 "," $2,330.10 "," $2,330.10 "," $2,200.65 ", $265.25 ," $2,390.42 "," $2,459.55 "," $2,200.65 "," $2,407.77 "," $2,407.77 "," $2,459.55 "," $2,485.44 "," $2,118.32 "," $2,330.10 "," $2,200.65 "," $2,045.31 ", N/A ," $2,095.28 "," $2,095.28 "," $2,459.55 "," $2,221.62 ", $205.74 ," $2,485.44 "
 Fac Insertion Picc W/Rs&I 5 Yr/> ,CPT® 36573,0361 - OR/MINOR,N/A,N/A," $1,948.00 "," $1,266.20 "," $1,636.32 ", $80.09 , $314.22 ," $1,573.98 "," $1,753.20 "," $1,649.18 "," $1,753.20 "," $1,753.20 "," $1,753.20 "," $1,655.80 ", $308.06 ," $1,798.59 "," $1,850.60 "," $1,655.80 "," $1,811.64 "," $1,811.64 "," $1,850.60 "," $1,870.08 "," $1,593.85 "," $1,753.20 "," $1,655.80 "," $1,538.92 ", N/A ," $1,576.52 "," $1,576.52 "," $1,850.60 "," $1,671.58 ", $80.09 ," $1,870.08 "
Bcr/Abl1 Minor Breakpnt Qualitative/Quantitative,CPT® 81207,N/A,N/A,N/A, $157.00 , $102.05 , N/A , $147.74 , $147.74 , $819.44 , $970.40 , $146.01 , $141.30 , $141.30 , $125.60 , $125.60 , $147.74 , $144.96 , $149.15 , $141.30 , $141.30 , $141.30 , $146.01 , $150.72 , $967.13 , $133.45 , $689.76 , $525.16 , N/A , $764.75 , $764.75 , $149.15 , $835.70 , $125.60 , $970.40 
Biopsy Bone Open Superficial,20240,N/A,N/A,N/A," $1,469.00 ", $954.85 , $868.34 , $134.08 , $153.67 ," $1,050.49 "," $1,072.56 "," $1,366.17 "," $1,322.10 "," $1,322.10 "," $1,175.20 "," $1,175.20 ", $153.67 ," $1,356.33 "," $1,395.55 "," $1,322.10 "," $1,322.10 "," $1,322.10 "," $1,366.17 "," $1,410.24 ", $815.67 ," $1,248.65 "," $1,177.48 ", $876.05 , N/A ," $1,070.98 "," $1,070.98 "," $1,395.55 "," $1,258.77 ", $134.08 ," $1,410.24 "
Chmsrg Mohs Mg Tq T/a/L 1st Stag 5 Blocks,CPT® 17313,N/A,N/A,N/A," $2,996.00 "," $1,947.40 "," $1,025.81 ", $306.18 , $475.79 , $927.13 , $896.79 ," $2,786.28 "," $2,696.40 "," $2,696.40 "," $2,396.80 "," $2,396.80 ", $475.79 ," $2,766.21 "," $2,846.20 "," $2,696.40 "," $2,696.40 "," $2,696.40 "," $2,786.28 "," $2,876.16 "," $1,132.68 "," $2,546.60 "," $1,785.85 "," $1,186.67 ", N/A , $945.22 , $945.22 ," $2,846.20 "," $1,096.14 ", $306.18 ," $2,876.16 "
"Discission,2nd Cataract,Laser",66821,N/A,N/A,N/A," $1,563.00 "," $1,015.95 "," $1,923.81 ", $302.19 , $262.06 ," $1,757.76 "," $1,658.57 "," $1,453.59 "," $1,406.70 "," $1,406.70 "," $1,250.40 "," $1,250.40 ", $262.06 ," $1,443.12 "," $1,484.85 "," $1,406.70 "," $1,406.70 "," $1,406.70 "," $1,453.59 "," $1,500.48 "," $2,644.27 "," $1,328.55 "," $1,705.57 "," $2,236.74 ", N/A ," $1,792.06 "," $1,792.06 "," $1,484.85 "," $1,978.18 ", $262.06 ," $2,644.27 "
 Fac Emblc/Thrmbc +-Cath Rdl/UR Art Arm Inc ,CPT® 34111,0360 - OR SERVICES,N/A,N/A," $1,589.00 "," $1,032.85 "," $1,334.76 ", $537.36 ," $1,229.45 "," $1,283.91 "," $1,430.10 "," $1,345.25 "," $1,430.10 "," $1,430.10 "," $1,430.10 "," $1,350.65 "," $1,205.34 "," $1,467.12 "," $1,509.55 "," $1,350.65 "," $1,477.77 "," $1,477.77 "," $1,509.55 "," $1,525.44 "," $1,300.12 "," $1,430.10 "," $1,350.65 "," $1,255.31 ", N/A ," $1,285.98 "," $1,285.98 "," $1,509.55 "," $1,363.52 ", $537.36 ," $1,525.44 "
Perq Breast Loc Device Placemt 1st Lesio US Imag,CPT® 19285,N/A,N/A,N/A," $2,038.00 "," $1,324.70 ", $273.56 , $81.07 , $66.33 , $242.33 , $239.96 ," $1,895.34 "," $1,834.20 "," $1,834.20 "," $1,630.40 "," $1,630.40 ", $66.33 ," $1,881.69 "," $1,936.10 "," $1,834.20 "," $1,834.20 "," $1,834.20 "," $1,895.34 "," $1,956.48 ", $302.18 ," $1,732.30 ", $444.24 , $308.27 , N/A , $247.06 , $247.06 ," $1,936.10 ", $286.51 , $66.33 ," $1,956.48 "
 PROPRANOLOL HCL 1 MG/ML IV SOLN ,HCPCS J1800,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0604-01,1 mL, $62.08 , $40.35 , $52.15 , N/A , $3.39 , $50.16 , $55.87 , $52.56 , $55.87 , $55.87 , $55.87 , $52.77 , $3.32 , $57.32 , $58.98 , $52.77 , $57.73 , $57.73 , $58.98 , $59.60 , $50.79 , $55.87 , $52.77 , $49.04 , N/A , $50.24 , $50.24 , $58.98 , $53.27 , $3.32 , $59.60 
 Admin Sanofi-Gsk Booster 5mcg/0.5ml ,CPT® 0104A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , N/A , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , N/A , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $55.30 , $67.20 
Pro Arthrotomy Knee W/Jnt-Lh,27331,N/A,N/A,N/A," $2,576.00 "," $1,674.40 "," $2,915.84 ", $458.85 , $768.38 ," $2,293.03 "," $2,296.39 "," $2,395.68 "," $2,318.40 "," $2,318.40 "," $2,060.80 "," $2,060.80 ", $768.38 ," $2,378.42 "," $2,447.20 "," $2,318.40 "," $2,318.40 "," $2,318.40 "," $2,395.68 "," $2,472.96 "," $2,706.55 "," $2,189.60 "," $2,533.37 "," $2,698.28 ", N/A ," $2,337.77 "," $2,337.77 "," $2,447.20 "," $2,747.70 ", $458.85 ," $2,915.84 "
Simple Repair 2.6-5cm,12013,N/A,N/A,N/A, $582.00 , $378.30 , $180.71 , $53.74 , $76.93 , $169.97 , $163.73 , $541.26 , $523.80 , $523.80 , $465.60 , $465.60 , $76.93 , $537.36 , $552.90 , $523.80 , $523.80 , $523.80 , $541.26 , $558.72 , $198.93 , $494.70 , $328.27 , $200.67 , N/A , $173.28 , $173.28 , $552.90 , $200.96 , $53.74 , $558.72 
 Xr Cervical Spine 4 or 5 Views ,CPT® 72050,0320 - DX X-RAY,N/A,N/A, $474.00 , $308.10 , $398.16 , $52.56 , $50.07 , $382.99 , $426.60 , $401.29 , $426.60 , $426.60 , $426.60 , $402.90 , $49.09 , $437.64 , $450.30 , $402.90 , $440.82 , $440.82 , $450.30 , $455.04 , $387.83 , $426.60 , $402.90 , $374.46 , N/A , $383.61 , $383.61 , $450.30 , $406.74 , $49.09 , $455.04 
 Pt Active Wound Mgmt 1st 20 Sq Cm -Mh ,CPT® 97597,0761 - TREATMENT ROOM,N/A,N/A, $230.00 , $149.50 , $193.20 , $34.49 , $43.20 , $185.84 , $207.00 , $194.72 , $207.00 , $207.00 , $207.00 , $195.50 , $42.35 , $212.36 , $218.50 , $195.50 , $213.90 , $213.90 , $218.50 , $220.80 , $188.19 , $207.00 , $195.50 , $181.70 , N/A , $186.14 , $186.14 , $218.50 , $197.36 , $34.49 , $220.80 
"Lap,Rmv Adnexal Structure",CPT® 58661,N/A,N/A,N/A," $4,820.00 "," $3,133.00 "," $3,064.85 ", $620.13 , $493.32 ," $2,634.66 "," $2,605.51 "," $4,482.60 "," $4,338.00 "," $4,338.00 "," $3,856.00 "," $3,856.00 ", $493.32 ," $4,450.31 "," $4,579.00 "," $4,338.00 "," $4,338.00 "," $4,338.00 "," $4,482.60 "," $4,627.20 "," $3,205.11 "," $4,097.00 "," $3,430.76 "," $2,642.78 ", N/A ," $2,686.07 "," $2,686.07 "," $4,579.00 "," $3,221.77 ", $493.32 ," $4,627.20 "
"Thromboendartectmy Neck,Neck Incis",CPT® 35301,N/A,N/A,N/A," $6,452.00 "," $4,193.80 "," $6,531.66 "," $1,005.98 "," $1,009.51 "," $4,903.50 "," $4,547.27 "," $6,000.36 "," $5,806.80 "," $5,806.80 "," $5,161.60 "," $5,161.60 "," $1,009.51 "," $5,957.13 "," $6,129.40 "," $5,806.80 "," $5,806.80 "," $5,806.80 "," $6,000.36 "," $6,193.92 "," $6,047.39 "," $5,484.20 "," $5,748.25 "," $5,436.52 ", N/A ," $4,999.18 "," $4,999.18 "," $6,129.40 "," $5,679.06 "," $1,005.98 "," $6,531.66 "
" Fac Peri-Proc Prog Eval Implant Device,Cardvert/Defib ",CPT® 93287,0480 - CARDIOLOGY,N/A,N/A, $310.00 , $201.50 , $260.40 , $52.88 , $34.25 , $250.48 , $279.00 , $262.45 , $279.00 , $279.00 , $279.00 , $263.50 , $33.58 , $286.22 , $294.50 , $263.50 , $288.30 , $288.30 , $294.50 , $297.60 , $253.64 , $279.00 , $263.50 , $244.90 , N/A , $250.88 , $250.88 , $294.50 , $266.01 , $33.58 , $297.60 
Normal Saline Solution Infus,HCPCS J7040,N/A,N/A,N/A, $26.00 , $16.90 , N/A , $1.30 , $1.35 , N/A , N/A , $24.18 , $23.40 , $23.40 , $20.80 , $20.80 , $1.35 , $24.01 , $24.70 , $23.40 , $23.40 , $23.40 , $24.18 , $24.96 , $1.89 , $22.10 , $1.30 , $1.78 , N/A , N/A , N/A , $24.70 , N/A , $1.30 , $24.96 
 Fac Assay of Urine Phosphorus ,CPT® 84105,0301 - LAB/CHEMISTRY,N/A,N/A, $61.00 , $39.65 , $51.24 , $5.90 , $5.90 , $49.29 , $54.90 , $51.64 , $54.90 , $54.90 , $54.90 , $51.85 , $5.78 , $56.32 , $57.95 , $51.85 , $56.73 , $56.73 , $57.95 , $58.56 , $49.91 , $54.90 , $51.85 , $48.19 , N/A , $49.37 , $49.37 , $57.95 , $52.34 , $5.78 , $58.56 
 Fac Infant Transfer ,Custom 2310000001,0231 - NUR INCR/NURSERY,N/A,N/A, $851.00 , $553.15 , $714.84 , N/A , N/A , $687.61 , $765.90 , $720.46 , $765.90 , $765.90 , $765.90 , $723.35 , N/A , $785.73 , $808.45 , $723.35 , $791.43 , $791.43 , $808.45 , $816.96 , $696.29 , $765.90 , $723.35 , $672.29 , N/A , $688.71 , $688.71 , $808.45 , $730.24 , $672.29 , $816.96 
Office/Outpatient Est Pt May Not Req Phys/Qhp,99211,N/A,N/A,N/A, $92.00 , $59.80 , $18.08 , $8.63 , $16.58 , $16.02 , $15.74 , $85.56 , $82.80 , $82.80 , $73.60 , $73.60 , $16.58 , $84.94 , $87.40 , $82.80 , $82.80 , $82.80 , $85.56 , $88.32 , $16.50 , $78.20 , $19.50 , $20.26 , N/A , $16.33 , $16.33 , $87.40 , $18.83 , $8.63 , $88.32 
 Fac Myelography via Lumbar Inject Rs&I Lumbosacral ,CPT® 62304,0361 - OR/MINOR,N/A,N/A," $1,869.00 "," $1,214.85 "," $1,569.96 ", $113.00 , $189.79 ," $1,510.15 "," $1,682.10 "," $1,582.30 "," $1,682.10 "," $1,682.10 "," $1,682.10 "," $1,588.65 ", $186.07 ," $1,725.65 "," $1,775.55 "," $1,588.65 "," $1,738.17 "," $1,738.17 "," $1,775.55 "," $1,794.24 "," $1,529.22 "," $1,682.10 "," $1,588.65 "," $1,476.51 ", N/A ," $1,512.58 "," $1,512.58 "," $1,775.55 "," $1,603.79 ", $113.00 ," $1,794.24 "
"I&D Mouth/Tong Intra,Lingual",CPT® 41000,N/A,N/A,N/A," $1,086.00 ", $705.90 , $658.26 , $102.14 , $30.71 , $547.16 , $558.92 ," $1,009.98 ", $977.40 , $977.40 , $868.80 , $868.80 , $30.71 ," $1,002.70 "," $1,031.70 ", $977.40 , $977.40 , $977.40 ," $1,009.98 "," $1,042.56 ", $480.42 , $923.10 , $608.37 , $645.69 , N/A , $557.84 , $557.84 ," $1,031.70 ", $583.42 , $30.71 ," $1,042.56 "
" Rubidium Rb-82, Diagnostic per Study Dose Up to 60 Millicuries ",HCPCS A9555,0636 - DRUGS REQUIRING DETAILED CODIN,N/A,N/A," $1,726.00 "," $1,121.90 "," $1,449.84 ", $543.30 , N/A ," $1,394.61 "," $1,553.40 "," $1,461.23 "," $1,553.40 "," $1,553.40 "," $1,553.40 "," $1,467.10 ", N/A ," $1,593.62 "," $1,639.70 "," $1,467.10 "," $1,605.18 "," $1,605.18 "," $1,639.70 "," $1,656.96 "," $1,412.21 "," $1,553.40 "," $1,467.10 "," $1,363.54 ", N/A ," $1,396.85 "," $1,396.85 "," $1,639.70 "," $1,481.08 ", $543.30 ," $1,656.96 "
Neurobehavioral Status Xm Phys/Qhp 1st Hour,CPT® 96116,N/A,N/A,N/A, $638.00 , $414.70 , $191.11 , $79.27 , $110.32 , $194.18 , $188.75 , $593.34 , $574.20 , $574.20 , $510.40 , $510.40 , $110.32 , $589.07 , $606.10 , $574.20 , $574.20 , $574.20 , $593.34 , $612.48 , $360.18 , $542.30 , $247.35 , $326.00 , $140.00 , $197.96 , $197.96 , $606.10 , $230.79 , $79.27 , $612.48 
Occupational Therapy Eval Mod Complex 45 Mins,CPT® 97166,N/A,N/A,N/A, $366.00 , $237.90 , $197.34 , $100.30 , $63.91 , $169.43 , $179.72 , $340.38 , $329.40 , $329.40 , $292.80 , $292.80 , $63.91 , $337.93 , $347.70 , $329.40 , $329.40 , $329.40 , $340.38 , $351.36 , $245.52 , $311.10 , $302.90 , $204.76 , N/A , $172.73 , $172.73 , $347.70 , $192.12 , $63.91 , $351.36 
"Removal Foreign Body,Musc",20520,N/A,N/A,N/A," $1,338.00 ", $869.70 , $907.27 , $141.83 , $63.53 , $711.39 , $712.53 ," $1,244.34 "," $1,204.20 "," $1,204.20 "," $1,070.40 "," $1,070.40 ", $63.53 ," $1,235.38 "," $1,271.10 "," $1,204.20 "," $1,204.20 "," $1,204.20 "," $1,244.34 "," $1,284.48 ", $842.13 ," $1,137.30 ", $779.64 , $849.77 , N/A , $725.26 , $725.26 ," $1,271.10 ", $852.44 , $63.53 ," $1,284.48 "
Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn,62323,N/A,N/A,N/A, $821.00 , $533.65 , $490.00 , $95.03 , $290.12 , $540.47 , $529.00 , $763.53 , $738.90 , $738.90 , $656.80 , $656.80 , $290.12 , $758.03 , $779.95 , $738.90 , $738.90 , $738.90 , $763.53 , $788.16 , $530.64 , $697.85 , $518.87 , $600.56 , N/A , $551.01 , $551.01 , $779.95 , $591.10 , $95.03 , $788.16 
Enteroscopy > 2nd Prtn Abltj Lesion,CPT® 44369,N/A,N/A,N/A," $1,803.00 "," $1,171.95 "," $1,508.52 ", $232.72 , $720.30 ," $1,248.10 "," $1,287.83 "," $1,676.79 "," $1,622.70 "," $1,622.70 "," $1,442.40 "," $1,442.40 ", $720.30 ," $1,664.71 "," $1,712.85 "," $1,622.70 "," $1,622.70 "," $1,622.70 "," $1,676.79 "," $1,730.88 "," $1,084.53 "," $1,532.55 "," $1,409.41 "," $1,436.44 ", N/A ," $1,272.46 "," $1,272.46 "," $1,712.85 "," $1,330.86 ", $232.72 ," $1,730.88 "
Pro Drain Lower Leg Bursa,27604,N/A,N/A,N/A," $2,705.00 "," $1,758.25 "," $1,980.55 ", $310.29 , $46.08 ," $1,666.41 "," $1,646.97 "," $2,515.65 "," $2,434.50 "," $2,434.50 "," $2,164.00 "," $2,164.00 ", $46.08 ," $2,497.53 "," $2,569.75 "," $2,434.50 "," $2,434.50 "," $2,434.50 "," $2,515.65 "," $2,596.80 "," $1,882.87 "," $2,299.25 "," $1,809.04 "," $1,935.02 ", N/A ," $1,698.92 "," $1,698.92 "," $2,569.75 "," $1,996.84 ", $46.08 ," $2,596.80 "
 CEFAZOLIN SODIUM 10 G IJ SOLR ,HCPCS J0690,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9983-03,100 mL, $68.12 , $44.28 , $57.22 , $0.89 , $0.79 , $55.04 , $61.31 , $57.67 , $61.31 , $61.31 , $61.31 , $57.90 , $0.77 , $62.90 , $64.71 , $57.90 , $63.35 , $63.35 , $64.71 , $65.40 , $55.74 , $61.31 , $57.90 , $53.81 , N/A , $55.13 , $55.13 , $64.71 , $58.45 , $0.77 , $65.40 
 Fac Perq Breast Loc Device Placemt 1st Lesio US Imag ,CPT® 19285,0361 - OR/MINOR,N/A,N/A," $1,595.00 "," $1,036.75 "," $1,339.80 ", $81.07 , $66.33 ," $1,288.76 "," $1,435.50 "," $1,350.33 "," $1,435.50 "," $1,435.50 "," $1,435.50 "," $1,355.75 ", $65.03 ," $1,472.66 "," $1,515.25 "," $1,355.75 "," $1,483.35 "," $1,483.35 "," $1,515.25 "," $1,531.20 "," $1,305.03 "," $1,435.50 "," $1,355.75 "," $1,260.05 ", N/A ," $1,290.83 "," $1,290.83 "," $1,515.25 "," $1,368.67 ", $65.03 ," $1,531.20 "
 Fac Plmt Nephrostomy Cath Prq New Access Rs&I ,CPT® 50432,0761 - TREATMENT ROOM,N/A,N/A," $6,889.00 "," $4,477.85 "," $5,786.76 ", $194.48 , $670.07 ," $5,566.31 "," $6,200.10 "," $5,832.23 "," $6,200.10 "," $6,200.10 "," $6,200.10 "," $5,855.65 ", $656.93 ," $6,360.61 "," $6,544.55 "," $5,855.65 "," $6,406.77 "," $6,406.77 "," $6,544.55 "," $6,613.44 "," $5,636.58 "," $6,200.10 "," $5,855.65 "," $5,442.31 ", N/A ," $5,575.27 "," $5,575.27 "," $6,544.55 "," $5,911.45 ", $194.48 ," $6,613.44 "
 Fac Punch Biopsy Skin Single Lesion ,CPT® 11104,0761 - TREATMENT ROOM,N/A,N/A, $235.00 , $152.75 , $197.40 , $44.88 , $98.18 , $189.88 , $211.50 , $198.95 , $211.50 , $211.50 , $211.50 , $199.75 , $96.25 , $216.98 , $223.25 , $199.75 , $218.55 , $218.55 , $223.25 , $225.60 , $192.28 , $211.50 , $199.75 , $185.65 , N/A , $190.19 , $190.19 , $223.25 , $201.65 , $44.88 , $225.60 
 Fac Insj/Rplcmt Perm Dfb W/Trnsvns Lds 1/Dual Chmbr ,CPT® 33249,0360 - OR SERVICES,N/A,N/A," $7,409.00 "," $4,815.85 "," $6,223.56 ", $839.61 , $892.11 ," $5,986.47 "," $6,668.10 "," $6,272.46 "," $6,668.10 "," $6,668.10 "," $6,668.10 "," $6,297.65 ", $874.62 ," $6,840.73 "," $7,038.55 "," $6,297.65 "," $6,890.37 "," $6,890.37 "," $7,038.55 "," $7,112.64 "," $6,062.04 "," $6,668.10 "," $6,297.65 "," $5,853.11 ", N/A ," $5,996.10 "," $5,996.10 "," $7,038.55 "," $6,357.66 ", $839.61 ," $7,112.64 "
 PROPYLTHIOURACIL 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,68084-0964-25,1 tablet, $17.26 , $11.22 , $14.50 , N/A , N/A , $13.95 , $15.53 , $14.61 , $15.53 , $15.53 , $15.53 , $14.67 , N/A , $15.94 , $16.40 , $14.67 , $16.05 , $16.05 , $16.40 , $16.57 , $14.12 , $15.53 , $14.67 , $13.64 , N/A , $13.97 , $13.97 , $16.40 , $14.81 , $13.64 , $16.57 
 Fac Prq Transluminal Coronary Mechanicl Thrombectomy ,CPT® 92973,0481 - CARDIAC CATH LAB,N/A,N/A," $9,200.00 "," $5,980.00 "," $7,728.00 ", $157.97 , $176.92 ," $7,433.60 "," $8,280.00 "," $7,788.72 "," $8,280.00 "," $8,280.00 "," $8,280.00 "," $7,820.00 ", $173.45 ," $8,494.36 "," $8,740.00 "," $7,820.00 "," $8,556.00 "," $8,556.00 "," $8,740.00 "," $8,832.00 "," $7,527.44 "," $8,280.00 "," $7,820.00 "," $7,268.00 ", N/A ," $7,445.56 "," $7,445.56 "," $8,740.00 "," $7,894.52 ", $157.97 ," $8,832.00 "
Janssen Booster Covid-19 Vaccine,CPT® 0034A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $76.25 , $128.02 , N/A , $82.60 , $82.60 , $66.50 , $96.14 , $38.92 , $128.02 
Abdom Paracentesis Dx/Ther W Imaging Guidance,49083,N/A,N/A,N/A," $2,090.00 "," $1,358.50 ", $655.33 , $101.73 , $362.06 , $531.21 , $543.60 ," $1,943.70 "," $1,881.00 "," $1,881.00 "," $1,672.00 "," $1,672.00 ", $362.06 ," $1,929.70 "," $1,985.50 "," $1,881.00 "," $1,881.00 "," $1,881.00 "," $1,943.70 "," $2,006.40 ", $471.73 ," $1,776.50 ", $586.96 , $631.12 , N/A , $541.58 , $541.58 ," $1,985.50 ", $566.43 , $101.73 ," $2,006.40 "
Rplcmt Compl Tun Cvc W/O Subq Port/Pmp,36581,N/A,N/A,N/A," $5,106.00 "," $3,318.90 "," $1,119.76 ", $173.23 , $938.62 , $861.03 , $855.68 ," $4,748.58 "," $4,595.40 "," $4,595.40 "," $4,084.80 "," $4,084.80 ", $938.62 ," $4,714.37 "," $4,850.70 "," $4,595.40 "," $4,595.40 "," $4,595.40 "," $4,748.58 "," $4,901.76 "," $1,036.21 "," $4,340.10 "," $1,049.03 ", $917.13 , N/A , $877.83 , $877.83 ," $4,850.70 ", $997.21 , $173.23 ," $4,901.76 "
Repair Nail Bed,11760,N/A,N/A,N/A, $840.00 , $546.00 , $358.36 , $106.67 , $42.71 , $359.65 , $359.77 , $781.20 , $756.00 , $756.00 , $672.00 , $672.00 , $42.71 , $775.57 , $798.00 , $756.00 , $756.00 , $756.00 , $781.20 , $806.40 , $400.51 , $714.00 , $715.41 , $401.98 , N/A , $366.67 , $366.67 , $798.00 , $425.20 , $42.71 , $806.40 
"Phospholipid Neutralization,Hexagonal Phospholipid",CPT® 85598,N/A,N/A,N/A, $177.00 , $115.05 , N/A , $18.34 , $18.34 , $101.69 , $121.66 , $164.61 , $159.30 , $159.30 , $141.60 , $141.60 , $18.34 , $163.42 , $168.15 , $159.30 , $159.30 , $159.30 , $164.61 , $169.92 , $120.06 , $150.45 , $118.39 , $65.17 , N/A , $94.90 , $94.90 , $168.15 , $103.71 , $18.34 , $169.92 
Fine Needle Aspiration Bx W/US Gdn 1st Lesion,CPT® 10005,N/A,N/A,N/A, $341.00 , $221.65 , $237.56 , $70.37 , $100.23 , $188.19 , N/A , $317.13 , $306.90 , $306.90 , $272.80 , $272.80 , $100.23 , $314.85 , $323.95 , $306.90 , $306.90 , $306.90 , $317.13 , $327.36 , $244.10 , $289.85 , $387.37 , $258.53 , N/A , $191.86 , $191.86 , $323.95 , $222.49 , $70.37 , $387.37 
"Fusion Foot Bone,Midtarsal,1 Jt",CPT® 28740,N/A,N/A,N/A," $5,694.00 "," $3,701.10 "," $3,797.24 ", $594.52 , $307.34 ," $3,046.33 "," $3,041.70 "," $5,295.42 "," $5,124.60 "," $5,124.60 "," $4,555.20 "," $4,555.20 ", $307.34 ," $5,257.27 "," $5,409.30 "," $5,124.60 "," $5,124.60 "," $5,124.60 "," $5,295.42 "," $5,466.24 "," $3,532.53 "," $4,839.90 "," $3,327.28 "," $3,605.31 ", N/A ," $3,105.77 "," $3,105.77 "," $5,409.30 "," $3,650.39 ", $307.34 ," $5,466.24 "
Online Digital E/M Svc Est Pt <7 D 5-10 Minutes,99421,N/A,N/A,N/A, $49.00 , $31.85 , $26.12 , $12.47 , $11.93 , $22.17 , N/A , $45.57 , $44.10 , $44.10 , $39.20 , $39.20 , $11.93 , $45.24 , $46.55 , $44.10 , $44.10 , $44.10 , $45.57 , $47.04 , $23.23 , $41.65 , $28.39 , $28.50 , N/A , $22.60 , $22.60 , $46.55 , $25.96 , $11.93 , $47.04 
 IOPAMIDOL 41 % IJ SOLN ,HCPCS Q9966,0255 - DRUGS/RADIOLOGY,00270-1411-11,10 mL, $398.37 , $258.94 , $334.63 , $0.38 , $0.52 , $321.88 , $358.53 , $337.26 , $358.53 , $358.53 , $358.53 , $338.61 , $0.51 , $367.82 , $378.45 , $338.61 , $370.48 , $370.48 , $378.45 , $382.44 , $325.95 , $358.53 , $338.61 , $314.71 , N/A , $322.40 , $322.40 , $378.45 , $341.84 , $0.38 , $382.44 
"Shldr Arthroscop,Surg,W/Rotat Cuff Repr",CPT® 29827,N/A,N/A,N/A," $5,840.00 "," $3,796.00 "," $6,477.90 "," $1,013.19 ", $952.41 ," $5,119.72 "," $5,149.96 "," $5,431.20 "," $5,256.00 "," $5,256.00 "," $4,672.00 "," $4,672.00 ", $952.41 ," $5,392.07 "," $5,548.00 "," $5,256.00 "," $5,256.00 "," $5,256.00 "," $5,431.20 "," $5,606.40 "," $6,032.45 "," $4,964.00 "," $5,696.52 "," $6,048.21 ", N/A ," $5,219.61 "," $5,219.61 "," $5,548.00 "," $6,134.91 ", $952.41 ," $6,477.90 "
Open Rx Tar-Metatarsal Dislocation,CPT® 28615,N/A,N/A,N/A," $5,326.00 "," $3,461.90 "," $5,082.94 ", $796.23 , $384.19 ," $3,830.56 "," $3,833.76 "," $4,953.18 "," $4,793.40 "," $4,793.40 "," $4,260.80 "," $4,260.80 ", $384.19 ," $4,917.50 "," $5,059.70 "," $4,793.40 "," $4,793.40 "," $4,793.40 "," $4,953.18 "," $5,112.96 "," $4,698.67 "," $4,527.10 "," $4,206.82 "," $4,625.90 ", N/A ," $3,905.30 "," $3,905.30 "," $5,059.70 "," $4,590.11 ", $384.19 ," $5,112.96 "
 Fac Aspir&/Njx Rnl Cst/Pelvis Ndl Prq ,CPT® 50390,0360 - OR SERVICES,N/A,N/A," $2,576.00 "," $1,674.40 "," $2,163.84 ", $90.17 , $76.84 ," $2,081.41 "," $2,318.40 "," $2,180.84 "," $2,318.40 "," $2,318.40 "," $2,318.40 "," $2,189.60 ", $75.33 ," $2,378.42 "," $2,447.20 "," $2,189.60 "," $2,395.68 "," $2,395.68 "," $2,447.20 "," $2,472.96 "," $2,107.68 "," $2,318.40 "," $2,189.60 "," $2,035.04 ", N/A ," $2,084.76 "," $2,084.76 "," $2,447.20 "," $2,210.47 ", $75.33 ," $2,472.96 "
"Chemistry-Hemoglobin,Elec",CPT® 83020,N/A,N/A,N/A, $126.00 , $81.90 , N/A , $13.13 , $6.32 , $25.78 , $30.88 , $117.18 , $113.40 , $113.40 , $100.80 , $100.80 , $6.32 , $116.34 , $119.70 , $113.40 , $113.40 , $113.40 , $117.18 , $120.96 , $85.94 , $107.10 , $180.02 , $46.67 , N/A , $24.06 , $24.06 , $119.70 , $26.29 , $6.32 , $180.02 
 METHYLNALTREXONE BROMIDE 12 MG/0.6ML SC SOLN ,HCPCS J2212,0636 - DRUGS REQUIRING DETAILED CODIN,65649-0551-02,0.4 mL, $632.25 , $410.96 , $531.09 , N/A , N/A , $510.86 , $569.03 , $535.26 , $569.03 , $569.03 , $569.03 , $537.41 , N/A , $583.76 , $600.64 , $537.41 , $587.99 , $587.99 , $600.64 , $606.96 , $517.31 , $569.03 , $537.41 , $499.48 , N/A , $511.68 , $511.68 , $600.64 , $542.53 , $499.48 , $606.96 
 Xr Destruction of L S Facet Nerve Jts ,CPT® 64635,0360 - OR SERVICES,N/A,N/A," $3,446.00 "," $2,239.90 "," $2,894.64 ", $185.00 , $346.77 ," $2,784.37 "," $3,101.40 "," $2,917.38 "," $3,101.40 "," $3,101.40 "," $3,101.40 "," $2,929.10 ", $339.97 ," $3,181.69 "," $3,273.70 "," $2,929.10 "," $3,204.78 "," $3,204.78 "," $3,273.70 "," $3,308.16 "," $2,819.52 "," $3,101.40 "," $2,929.10 "," $2,722.34 ", N/A ," $2,788.85 "," $2,788.85 "," $3,273.70 "," $2,957.01 ", $185.00 ," $3,308.16 "
Pfizer Administration Third Dose,CPT® 0003A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $76.25 , $128.02 , N/A , $163.02 , $163.02 , $66.50 , $178.15 , $38.92 , $178.15 
 Pro Radiation Therapy Planning ,CPT® 77263,0982 - PRO FEE/OUTPT,N/A,N/A," $1,070.00 ", $695.50 , $936.99 , $164.77 , $189.11 , $793.74 , $821.69 , $995.10 , $963.00 , $963.00 , $856.00 , $856.00 , $189.11 , $987.93 ," $1,016.50 ", $963.00 , $963.00 , $963.00 , $995.10 ," $1,027.20 ", $937.90 , $909.50 , $899.46 , $922.66 , N/A , $809.22 , $809.22 ," $1,016.50 ", $936.71 , $164.77 ," $1,027.20 "
 Immunofixj Electrophoresis Oth Flu Pro ,CPT® 86335,0971 - PRO FEE/LAB,N/A,N/A, $131.00 , $85.15 , N/A , $29.94 , $29.94 , $166.05 , $198.62 , $121.83 , $117.90 , $117.90 , $104.80 , $104.80 , $29.94 , $120.95 , $124.45 , $117.90 , $117.90 , $117.90 , $121.83 , $125.76 , $195.98 , $111.35 , $288.69 , $106.41 , N/A , $154.97 , $154.97 , $124.45 , $169.35 , $29.94 , $288.69 
Rplcmt Cath Ctr Vad Subq Port/Pmp,CPT® 36578,N/A,N/A,N/A," $3,141.00 "," $2,041.65 "," $1,221.42 ", $189.08 , $795.77 , $945.27 , $939.68 ," $2,921.13 "," $2,826.90 "," $2,826.90 "," $2,512.80 "," $2,512.80 ", $795.77 ," $2,900.09 "," $2,983.95 "," $2,826.90 "," $2,826.90 "," $2,826.90 "," $2,921.13 "," $3,015.36 "," $1,124.00 "," $2,669.85 "," $1,157.86 "," $1,002.48 ", N/A , $963.72 , $963.72 ," $2,983.95 "," $1,094.79 ", $189.08 ," $3,015.36 "
Inj for Sacroiliac Jt Anesth,G0260,N/A,N/A,N/A, $332.00 , $215.80 , N/A , N/A , N/A , N/A , N/A , $308.76 , $298.80 , $298.80 , $265.60 , $265.60 , N/A , $306.54 , $315.40 , $298.80 , $298.80 , $298.80 , $308.76 , $318.72 , N/A , $282.20 , $265.60 , N/A , N/A , N/A , N/A , $315.40 , N/A , $265.60 , $318.72 
Hepatobiliary Syst Imaging Including Gallbladder,CPT® 78226,N/A,N/A,N/A," $3,404.00 "," $2,212.60 "," $1,738.32 ", $297.35 , $256.59 ," $1,630.13 "," $2,004.88 "," $3,165.72 "," $3,063.60 "," $3,063.60 "," $2,723.20 "," $2,723.20 ", $256.59 ," $3,142.91 "," $3,233.80 "," $3,063.60 "," $3,063.60 "," $3,063.60 "," $3,165.72 "," $3,267.84 "," $1,810.79 "," $2,893.40 "," $2,205.32 "," $2,227.75 ", N/A ," $1,661.94 "," $1,661.94 "," $3,233.80 "," $1,923.71 ", $256.59 ," $3,267.84 "
 DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00409-1660-10,100 mL, $308.22 , $200.34 , $258.90 , N/A , N/A , $249.04 , $277.40 , $260.94 , $277.40 , $277.40 , $277.40 , $261.99 , N/A , $284.58 , $292.81 , $261.99 , $286.64 , $286.64 , $292.81 , $295.89 , $252.19 , $277.40 , $261.99 , $243.49 , N/A , $249.44 , $249.44 , $292.81 , $264.48 , $243.49 , $295.89 
 EMPAGLIFLOZIN 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00597-0153-30,1 tablet, $121.91 , $79.24 , $102.40 , N/A , N/A , $98.50 , $109.72 , $103.21 , $109.72 , $109.72 , $109.72 , $103.62 , N/A , $112.56 , $115.81 , $103.62 , $113.38 , $113.38 , $115.81 , $117.03 , $99.75 , $109.72 , $103.62 , $96.31 , N/A , $98.66 , $98.66 , $115.81 , $104.61 , $96.31 , $117.03 
Telethx Isodose Pln Cplx W/Basic Dosimetry,CPT® 77307,N/A,N/A,N/A," $2,703.00 "," $1,756.95 "," $1,587.40 ", $281.92 , $222.42 ," $1,349.17 "," $1,472.49 "," $2,513.79 "," $2,432.70 "," $2,432.70 "," $2,162.40 "," $2,162.40 ", $222.42 ," $2,495.68 "," $2,567.85 "," $2,432.70 "," $2,432.70 "," $2,432.70 "," $2,513.79 "," $2,594.88 "," $1,614.36 "," $2,297.55 "," $1,638.27 "," $1,626.24 ", N/A ," $1,375.49 "," $1,375.49 "," $2,567.85 "," $1,592.17 ", $222.42 ," $2,594.88 "
 Incision of Eyelid Fold ,CPT® 67715,0981 - PRO FEE/ER,N/A,N/A, $560.00 , $364.00 , $657.22 , $103.64 , $151.20 , $611.81 , $583.74 , $520.80 , $504.00 , $504.00 , $448.00 , $448.00 , $151.20 , $517.05 , $532.00 , $504.00 , $504.00 , $504.00 , $520.80 , $537.60 , $902.48 , $476.00 , $604.80 , $773.22 , N/A , $623.75 , $623.75 , $532.00 , $688.52 , $103.64 , $902.48 
Insj/Rplcmt Perm Dfb W/Trnsvns Lds 1/Dual Chmbr,CPT® 33249,N/A,N/A,N/A," $9,777.00 "," $6,355.05 "," $5,442.65 ", $839.61 , $892.11 ," $3,950.83 "," $3,793.21 "," $9,092.61 "," $8,799.30 "," $8,799.30 "," $7,821.60 "," $7,821.60 ", $892.11 ," $9,027.10 "," $9,288.15 "," $8,799.30 "," $8,799.30 "," $8,799.30 "," $9,092.61 "," $9,385.92 "," $5,035.71 "," $8,310.45 "," $4,767.02 "," $4,433.48 ", N/A ," $4,027.91 "," $4,027.91 "," $9,288.15 "," $4,575.70 ", $839.61 ," $9,385.92 "
 Fac Flt3 Gene Anlys Tyrosine Kinase Domain Variants ,CPT® 81246,0300 - LABORATORY,N/A,N/A, $626.00 , $406.90 , $525.84 , $84.66 , $84.66 , $505.81 , $563.40 , $529.97 , $563.40 , $563.40 , $563.40 , $532.10 , $83.00 , $577.99 , $594.70 , $532.10 , $582.18 , $582.18 , $594.70 , $600.96 , $512.19 , $563.40 , $532.10 , $494.54 , N/A , $506.62 , $506.62 , $594.70 , $537.17 , $83.00 , $600.96 
 Fac Ova and Parasites Smears ,CPT® 87177,0306 - LAB/BACT-MICRO,N/A,N/A, $161.00 , $104.65 , $135.24 , $9.08 , $9.08 , $130.09 , $144.90 , $136.30 , $144.90 , $144.90 , $144.90 , $136.85 , $8.90 , $148.65 , $152.95 , $136.85 , $149.73 , $149.73 , $152.95 , $154.56 , $131.73 , $144.90 , $136.85 , $127.19 , N/A , $130.30 , $130.30 , $152.95 , $138.15 , $8.90 , $154.56 
 Fac Teaec +-Patch Grf Iliac ,CPT® 35351,0360 - OR SERVICES,N/A,N/A," $2,608.00 "," $1,695.20 "," $2,190.72 "," $1,143.11 "," $1,340.24 "," $2,107.26 "," $2,347.20 "," $2,207.93 "," $2,347.20 "," $2,347.20 "," $2,347.20 "," $2,216.80 "," $1,313.96 "," $2,407.97 "," $2,477.60 "," $2,216.80 "," $2,425.44 "," $2,425.44 "," $2,477.60 "," $2,503.68 "," $2,133.87 "," $2,347.20 "," $2,216.80 "," $2,060.32 ", N/A ," $2,110.65 "," $2,110.65 "," $2,477.60 "," $2,237.92 "," $1,143.11 "," $2,503.68 "
"Incis/Drain Scrotum/Testis,Epididym",CPT® 54700,N/A,N/A,N/A," $1,125.00 ", $731.25 , $943.06 , $203.19 , $46.08 , $685.19 , $696.57 ," $1,046.25 "," $1,012.50 "," $1,012.50 ", $900.00 , $900.00 , $46.08 ," $1,038.71 "," $1,068.75 "," $1,012.50 "," $1,012.50 "," $1,012.50 "," $1,046.25 "," $1,080.00 ", $885.89 , $956.25 ," $1,115.04 "," $1,029.40 ", N/A , $698.56 , $698.56 ," $1,068.75 ", $837.26 , $46.08 ," $1,115.04 "
"Closed Rx Tibia Shaft Fx,Manipulatn",27752,N/A,N/A,N/A," $2,050.00 "," $1,332.50 "," $3,010.67 ", $474.05 , $502.11 ," $2,384.99 "," $2,399.89 "," $1,906.50 "," $1,845.00 "," $1,845.00 "," $1,640.00 "," $1,640.00 ", $502.11 ," $1,892.77 "," $1,947.50 "," $1,845.00 "," $1,845.00 "," $1,845.00 "," $1,906.50 "," $1,968.00 "," $2,794.53 "," $1,742.50 "," $2,643.98 "," $2,805.41 ", N/A ," $2,431.52 "," $2,431.52 "," $1,947.50 "," $2,857.92 ", $474.05 ," $3,010.67 "
 PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN ,HCPCS J2371,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0751-01,1 mL, $19.73 , $12.82 , $16.57 , N/A , N/A , $15.94 , $17.76 , $16.70 , $17.76 , $17.76 , $17.76 , $16.77 , N/A , $18.22 , $18.74 , $16.77 , $18.35 , $18.35 , $18.74 , $18.94 , $16.14 , $17.76 , $16.77 , $15.59 , N/A , $15.97 , $15.97 , $18.74 , $16.93 , $15.59 , $18.94 
Treat Phalangeal Shft Frc,26725,N/A,N/A,N/A," $1,012.00 ", $657.80 ," $1,888.97 ", $298.96 , $132.15 ," $1,457.95 "," $1,481.04 ", $941.16 , $910.80 , $910.80 , $809.60 , $809.60 , $132.15 , $934.38 , $961.40 , $910.80 , $910.80 , $910.80 , $941.16 , $971.52 ," $1,742.10 ", $860.20 ," $1,625.28 "," $1,732.55 ", N/A ," $1,486.40 "," $1,486.40 ", $961.40 ," $1,747.03 ", $132.15 ," $1,888.97 "
" Pro Laparoscopy, Fundoplasty ",CPT® 43280,0982 - PRO FEE/OUTPT,N/A,N/A," $7,050.00 "," $4,582.50 "," $6,400.42 ", $989.92 , $935.01 ," $5,079.56 "," $5,125.75 "," $6,556.50 "," $6,345.00 "," $6,345.00 "," $5,640.00 "," $5,640.00 ", $935.01 ," $6,509.27 "," $6,697.50 "," $6,345.00 "," $6,345.00 "," $6,345.00 "," $6,556.50 "," $6,768.00 "," $4,590.49 "," $5,992.50 "," $5,707.22 "," $5,982.17 ", N/A ," $5,178.67 "," $5,178.67 "," $6,697.50 "," $5,416.34 ", $935.01 ," $6,768.00 "
Insj Tunneled Cvc W/O Subq Port/Pmp Age 5 Yr/>,CPT® 36558,N/A,N/A,N/A," $6,181.00 "," $4,017.65 "," $1,579.50 ", $244.84 ," $1,026.74 "," $1,210.08 "," $1,203.51 "," $5,748.33 "," $5,562.90 "," $5,562.90 "," $4,944.80 "," $4,944.80 "," $1,026.74 "," $5,706.92 "," $5,871.95 "," $5,562.90 "," $5,562.90 "," $5,562.90 "," $5,748.33 "," $5,933.76 "," $1,461.34 "," $5,253.85 "," $1,484.34 "," $1,306.67 ", N/A ," $1,233.69 "," $1,233.69 "," $5,871.95 "," $1,401.46 ", $244.84 ," $5,933.76 "
 Spinal Canal and Contents US ,CPT® 76800,0402 - ULTRASOUND,N/A,N/A, $632.00 , $410.80 , $530.88 , $152.11 , $120.18 , $510.66 , $568.80 , $535.05 , $568.80 , $568.80 , $568.80 , $537.20 , $117.82 , $583.53 , $600.40 , $537.20 , $587.76 , $587.76 , $600.40 , $606.72 , $517.10 , $568.80 , $537.20 , $499.28 , N/A , $511.48 , $511.48 , $600.40 , $542.32 , $117.82 , $606.72 
Excise Lip or Cheek Fold,CPT® 40819,N/A,N/A,N/A," $1,625.00 "," $1,056.25 "," $1,238.25 ", $194.00 , $137.47 ," $1,165.71 "," $1,184.65 "," $1,511.25 "," $1,462.50 "," $1,462.50 "," $1,300.00 "," $1,300.00 ", $137.47 ," $1,500.36 "," $1,543.75 "," $1,462.50 "," $1,462.50 "," $1,462.50 "," $1,511.25 "," $1,560.00 ", $904.86 ," $1,381.25 "," $1,288.09 "," $1,384.41 ", N/A ," $1,188.45 "," $1,188.45 "," $1,543.75 "," $1,242.99 ", $137.47 ," $1,560.00 "
 Fac Assay of CK (Cpk) ,CPT® 82550,0301 - LAB/CHEMISTRY,N/A,N/A, $95.00 , $61.75 , $79.80 , $6.64 , $6.64 , $76.76 , $85.50 , $80.43 , $85.50 , $85.50 , $85.50 , $80.75 , $6.51 , $87.71 , $90.25 , $80.75 , $88.35 , $88.35 , $90.25 , $91.20 , $77.73 , $85.50 , $80.75 , $75.05 , N/A , $76.88 , $76.88 , $90.25 , $81.52 , $6.51 , $91.20 
Fungus Isolation Culture,CPT® 87102,N/A,N/A,N/A, $121.00 , $78.65 , N/A , $8.58 , $8.58 , $47.52 , $56.86 , $112.53 , $108.90 , $108.90 , $96.80 , $96.80 , $8.58 , $111.72 , $114.95 , $108.90 , $108.90 , $108.90 , $112.53 , $116.16 , $56.16 , $102.85 , $55.14 , $30.49 , N/A , $44.35 , $44.35 , $114.95 , $48.46 , $8.58 , $116.16 
 Pro Dop Velocimetry Ftl Umbilical Art ,CPT® 76820,0972 - PRO FEE/RAD/DX,N/A,N/A, $204.00 , $132.60 , $257.17 , $44.42 , $48.03 , $227.31 , $212.43 , $189.72 , $183.60 , $183.60 , $163.20 , $163.20 , $48.03 , $188.35 , $193.80 , $183.60 , $183.60 , $183.60 , $189.72 , $195.84 , $258.10 , $173.40 , $231.13 , $268.82 , N/A , $231.74 , $231.74 , $193.80 , $268.25 , $44.42 , $268.82 
Assay Haloperidol,CPT® 80173,N/A,N/A,N/A, $117.00 , $76.05 , N/A , $16.10 , $16.10 , $82.40 , $98.56 , $108.81 , $105.30 , $105.30 , $93.60 , $93.60 , $16.10 , $108.03 , $111.15 , $105.30 , $105.30 , $105.30 , $108.81 , $112.32 , $105.37 , $99.45 , $95.69 , $52.81 , N/A , $76.90 , $76.90 , $111.15 , $84.04 , $16.10 , $112.32 
Hepatitis C Antibody,CPT® 86803,N/A,N/A,N/A, $173.00 , $112.45 , N/A , $14.56 , $14.56 , $80.74 , $96.60 , $160.89 , $155.70 , $155.70 , $138.40 , $138.40 , $14.56 , $159.73 , $164.35 , $155.70 , $155.70 , $155.70 , $160.89 , $166.08 , $95.28 , $147.05 , $94.07 , $51.72 , N/A , $75.35 , $75.35 , $164.35 , $82.34 , $14.56 , $166.08 
"Replacement/Revision,CSF Shunt",CPT® 62230,N/A,N/A,N/A," $5,878.00 "," $3,820.70 "," $3,892.20 ", $760.48 ," $1,472.37 "," $4,555.87 "," $4,399.72 "," $5,466.54 "," $5,290.20 "," $5,290.20 "," $4,702.40 "," $4,702.40 "," $1,472.37 "," $5,427.16 "," $5,584.10 "," $5,290.20 "," $5,290.20 "," $5,290.20 "," $5,466.54 "," $5,642.88 "," $4,199.84 "," $4,996.30 "," $4,501.19 "," $4,721.03 ", N/A ," $4,644.76 "," $4,644.76 "," $5,584.10 "," $4,982.74 ", $760.48 ," $5,642.88 "
 Disorders Of The Biliary Tract With Cc ,MS DRG V40 (FY2023) 445,N/A,N/A,N/A," $10,574.85 "," $6,873.65 "," $8,882.87 ", N/A , N/A ," $8,544.48 "," $9,517.37 "," $8,952.67 "," $9,517.37 "," $9,517.37 "," $9,517.37 "," $8,988.62 ", N/A ," $9,763.76 "," $10,046.11 "," $8,988.62 "," $9,834.61 "," $9,834.61 "," $10,046.11 "," $10,151.86 "," $8,652.34 "," $9,517.37 "," $8,988.62 "," $8,354.13 ", N/A ," $8,558.23 "," $8,558.23 "," $10,046.11 "," $9,074.28 "," $8,354.13 "," $10,151.86 "
" Pro Electrocardiogram,Report ",CPT® 93010,0976 - PRO FEE/RESPIR,N/A,N/A, $102.00 , $66.30 , $51.61 , $7.96 , $9.02 , $46.31 , $46.05 , $94.86 , $91.80 , $91.80 , $81.60 , $81.60 , $9.02 , $94.18 , $96.90 , $91.80 , $91.80 , $91.80 , $94.86 , $97.92 , $86.42 , $86.70 , $42.82 , $32.14 , N/A , $47.22 , $47.22 , $96.90 , $52.33 , $7.96 , $97.92 
 Pro Tap Block Unilateral by Injection(S) ,CPT® 64486,0982 - PRO FEE/OUTPT,N/A,N/A, $814.00 , $529.10 , $276.80 , $53.31 , $97.79 , $356.51 , $350.87 , $757.02 , $732.60 , $732.60 , $651.20 , $651.20 , $97.79 , $751.57 , $773.30 , $732.60 , $732.60 , $732.60 , $757.02 , $781.44 , $300.42 , $691.90 , $289.64 , $361.04 , N/A , $363.47 , $363.47 , $773.30 , $389.92 , $53.31 , $781.44 
 Major Chest Trauma Without Cc/McC ,MS DRG V40 (FY2023) 185,N/A,N/A,N/A," $32,809.35 "," $21,326.08 "," $27,559.85 ", N/A , N/A ," $26,509.95 "," $29,528.42 "," $27,776.40 "," $29,528.42 "," $29,528.42 "," $29,528.42 "," $27,887.95 ", N/A ," $30,292.87 "," $31,168.88 "," $27,887.95 "," $30,512.70 "," $30,512.70 "," $31,168.88 "," $31,496.98 "," $26,844.61 "," $29,528.42 "," $27,887.95 "," $25,919.39 ", N/A ," $26,552.61 "," $26,552.61 "," $31,168.88 "," $28,153.70 "," $25,919.39 "," $31,496.98 "
 Fac Rmvl Impltbl Dfb Plse Gen W/Repl Plse Gen 1 Lead ,CPT® 33262,0360 - OR SERVICES,N/A,N/A," $9,134.00 "," $5,937.10 "," $7,672.56 ", $344.20 , $279.46 ," $7,380.27 "," $8,220.60 "," $7,732.84 "," $8,220.60 "," $8,220.60 "," $8,220.60 "," $7,763.90 ", $273.98 ," $8,433.42 "," $8,677.30 "," $7,763.90 "," $8,494.62 "," $8,494.62 "," $8,677.30 "," $8,768.64 "," $7,473.44 "," $8,220.60 "," $7,763.90 "," $7,215.86 ", N/A ," $7,392.15 "," $7,392.15 "," $8,677.30 "," $7,837.89 ", $273.98 ," $8,768.64 "
Ecmo/Ecls Initiation Veno-Venous,CPT® 33946,N/A,N/A,N/A," $1,855.00 "," $1,205.75 "," $1,820.65 ", $280.29 , $372.76 ," $1,349.13 "," $1,348.57 "," $1,725.15 "," $1,669.50 "," $1,669.50 "," $1,484.00 "," $1,484.00 ", $372.76 ," $1,712.72 "," $1,762.25 "," $1,669.50 "," $1,669.50 "," $1,669.50 "," $1,725.15 "," $1,780.80 "," $1,684.53 "," $1,576.75 "," $1,608.13 "," $1,493.91 ", N/A ," $1,375.45 "," $1,375.45 "," $1,762.25 "," $1,562.51 ", $280.29 ," $1,820.65 "
Esophagoscopy Flexible Transoral W Submucous Inj,CPT® 43201,N/A,N/A,N/A, $867.00 , $563.55 , $628.16 , $97.62 , $228.21 , $527.54 , $621.47 , $806.31 , $780.30 , $780.30 , $693.60 , $693.60 , $228.21 , $800.50 , $823.65 , $780.30 , $780.30 , $780.30 , $806.31 , $832.32 , $449.08 , $736.95 , $681.51 , $593.77 , N/A , $537.83 , $537.83 , $823.65 , $562.53 , $97.62 , $832.32 
IP/Obs Consltj New/Est Pt Low Mdm 45 Minutes,99253,N/A,N/A,N/A, $496.00 , $322.40 , N/A , $98.01 , $86.25 , $251.90 , $250.97 , $461.28 , $446.40 , $446.40 , $396.80 , $396.80 , $86.25 , $457.96 , $471.20 , $446.40 , $446.40 , $446.40 , $461.28 , $476.16 , $319.65 , $421.60 , $244.53 , $252.43 , $120.25 , $256.82 , $256.82 , $471.20 , $305.75 , $86.25 , $476.16 
Esophagogastroduodenoscopy Transoral Diagnostic,CPT® 43235,N/A,N/A,N/A," $2,046.00 "," $1,329.90 ", $751.66 , $116.11 , $398.41 , $626.38 , $707.63 ," $1,902.78 "," $1,841.40 "," $1,841.40 "," $1,636.80 "," $1,636.80 ", $398.41 ," $1,889.07 "," $1,943.70 "," $1,841.40 "," $1,841.40 "," $1,841.40 "," $1,902.78 "," $1,964.16 ", $539.11 ," $1,739.10 ", $776.07 , $715.24 , N/A , $638.60 , $638.60 ," $1,943.70 ", $667.92 , $116.11 ," $1,964.16 "
Ewhfo W/Joint(S) Cf,HCPCS L3766,N/A,N/A,N/A," $1,556.00 "," $1,011.40 ", N/A ," $1,445.49 "," $1,001.19 ", N/A , N/A ," $1,447.08 "," $1,400.40 "," $1,400.40 "," $1,244.80 "," $1,244.80 "," $1,001.19 "," $1,436.65 "," $1,478.20 "," $1,400.40 "," $1,400.40 "," $1,400.40 "," $1,447.08 "," $1,493.76 ", N/A ," $1,322.60 "," $1,193.05 "," $1,216.15 ", N/A , N/A , N/A ," $1,478.20 ", N/A ," $1,001.19 "," $1,493.76 "
Sigmoidoscopy Flx W/Rmvl Tumor by Hot Bx Forceps,45333,N/A,N/A,N/A," $2,388.00 "," $1,552.20 ", $570.96 , $88.25 , $108.73 , $522.44 , $537.65 ," $2,220.84 "," $2,149.20 "," $2,149.20 "," $1,910.40 "," $1,910.40 ", $108.73 ," $2,204.84 "," $2,268.60 "," $2,149.20 "," $2,149.20 "," $2,149.20 "," $2,220.84 "," $2,292.48 ", $409.84 ," $2,029.80 ", $590.53 , $541.98 , N/A , $532.63 , $532.63 ," $2,268.60 ", $557.08 , $88.25 ," $2,292.48 "
Endoscopic Injection/Implant,CPT® 51715,N/A,N/A,N/A," $2,122.00 "," $1,379.30 "," $1,069.73 ", $188.31 , $278.93 , $980.86 , $909.98 ," $1,973.46 "," $1,909.80 "," $1,909.80 "," $1,697.60 "," $1,697.60 ", $278.93 ," $1,959.24 "," $2,015.90 "," $1,909.80 "," $1,909.80 "," $1,909.80 "," $1,973.46 "," $2,037.12 "," $1,077.85 "," $1,803.70 "," $1,034.76 "," $1,227.45 ", N/A ," $1,000.00 "," $1,000.00 "," $2,015.90 "," $1,175.37 ", $188.31 ," $2,037.12 "
Bx Synovium Metatarso-Phal Jt,CPT® 28052,N/A,N/A,N/A," $2,924.00 "," $1,900.60 "," $1,592.11 ", $249.33 , $276.59 ," $1,378.44 "," $1,386.82 "," $2,719.32 "," $2,631.60 "," $2,631.60 "," $2,339.20 "," $2,339.20 ", $276.59 ," $2,699.73 "," $2,777.80 "," $2,631.60 "," $2,631.60 "," $2,631.60 "," $2,719.32 "," $2,807.04 "," $1,628.99 "," $2,485.40 "," $1,507.53 "," $1,675.77 ", N/A ," $1,405.34 "," $1,405.34 "," $2,777.80 "," $1,651.78 ", $249.33 ," $2,807.04 "
 METHENAMINE HIPPURATE 1 G PO TABS ,HCPCS RXC637,0250 - PHARMACY,65862-0782-01,1 tablet, $10.75 , $6.99 , $9.03 , N/A , N/A , $8.69 , $9.68 , $9.10 , $9.68 , $9.68 , $9.68 , $9.14 , N/A , $9.93 , $10.21 , $9.14 , $10.00 , $10.00 , $10.21 , $10.32 , $8.80 , $9.68 , $9.14 , $8.49 , N/A , $8.70 , $8.70 , $10.21 , $9.22 , $8.49 , $10.32 
Layer Closure 20.0-30cm,12056,N/A,N/A,N/A," $2,535.00 "," $1,647.75 "," $1,217.88 ", $364.92 , $448.13 , $952.97 ," $1,010.78 "," $2,357.55 "," $2,281.50 "," $2,281.50 "," $2,028.00 "," $2,028.00 ", $448.13 ," $2,340.57 "," $2,408.25 "," $2,281.50 "," $2,281.50 "," $2,281.50 "," $2,357.55 "," $2,433.60 "," $1,338.76 "," $2,154.75 "," $2,001.72 "," $1,341.54 ", N/A , $971.56 , $971.56 ," $2,408.25 "," $1,126.68 ", $364.92 ," $2,433.60 "
 ED Temp External Pacing ,CPT® 92953,0480 - CARDIOLOGY,N/A,N/A, $6.00 , $3.90 , $5.04 , $0.79 , $17.40 , $4.85 , $5.40 , $5.08 , $5.40 , $5.40 , $5.40 , $5.10 , $17.06 , $5.54 , $5.70 , $5.10 , $5.58 , $5.58 , $5.70 , $5.76 , $4.91 , $5.40 , $5.10 , $4.74 , N/A , $4.86 , $4.86 , $5.70 , $5.15 , $0.79 , $17.40 
Introduction Catheter Aorta,CPT® 36200,N/A,N/A,N/A, $928.00 , $603.20 , $811.33 , $124.81 , $616.57 , $658.84 , $646.65 , $863.04 , $835.20 , $835.20 , $742.40 , $742.40 , $616.57 , $856.82 , $881.60 , $835.20 , $835.20 , $835.20 , $863.04 , $890.88 , $750.11 , $788.80 , $811.75 , $672.16 , N/A , $671.69 , $671.69 , $881.60 , $763.03 , $124.81 , $890.88 
 Pro Sbsq Hospital IP/Obs Care High Mdm 50 Minutes ,CPT® 99233,0987 - PRO FEE/HOS VIS,N/A,N/A, $344.00 , $223.60 , $204.50 , $115.78 , $54.97 , $180.73 , $179.46 , $319.92 , $309.60 , $309.60 , $275.20 , $275.20 , $54.97 , $317.62 , $326.80 , $309.60 , $309.60 , $309.60 , $319.92 , $330.24 , $260.33 , $292.40 , $222.78 , $228.27 , $107.50 , $184.26 , $184.26 , $326.80 , $212.51 , $54.97 , $330.24 
 PRIMIDONE 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,53746-0544-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Pro Anes Prtl Rib Rescj Nos ,CPT® 00470,0964 - PRO FEE/ANES CRNA,N/A,N/A, $22.00 , $14.30 , N/A , N/A , $18.11 , N/A , N/A , $20.46 , $19.80 , $19.80 , $17.60 , $17.60 , $18.11 , $20.31 , $20.90 , $19.80 , $19.80 , $19.80 , $20.46 , $21.12 , N/A , $18.70 , N/A , N/A , N/A , N/A , N/A , $20.90 , N/A , $17.60 , $21.12 
 Pro Smpl Rpr Supfc F/E/E/N/L/M 12.6cm-20.0cm ,CPT® 12016,0981 - PRO FEE/ER,N/A,N/A," $1,205.00 ", $783.25 , $401.06 , $118.20 , $180.97 , $362.55 , $349.59 ," $1,120.65 "," $1,084.50 "," $1,084.50 ", $964.00 , $964.00 , $180.97 ," $1,112.58 "," $1,144.75 "," $1,084.50 "," $1,084.50 "," $1,084.50 "," $1,120.65 "," $1,156.80 ", $439.48 ," $1,024.25 ", $702.92 , $442.73 , N/A , $369.62 , $369.62 ," $1,144.75 ", $428.65 , $118.20 ," $1,156.80 "
 SALINE 0.65 % NA SOLN ,HCPCS RXC637,0250 - PHARMACY,00225-0382-80,50 mL, $12.85 , $8.35 , $10.79 , N/A , N/A , $10.38 , $11.57 , $10.88 , $11.57 , $11.57 , $11.57 , $10.92 , N/A , $11.86 , $12.21 , $10.92 , $11.95 , $11.95 , $12.21 , $12.34 , $10.51 , $11.57 , $10.92 , $10.15 , N/A , $10.40 , $10.40 , $12.21 , $11.03 , $10.15 , $12.34 
"Assay of Insulin,Total",CPT® 83525,N/A,N/A,N/A, $172.00 , $111.80 , N/A , $11.66 , $11.66 , $64.64 , $77.34 , $159.96 , $154.80 , $154.80 , $137.60 , $137.60 , $11.66 , $158.81 , $163.40 , $154.80 , $154.80 , $154.80 , $159.96 , $165.12 , $76.32 , $146.20 , $74.60 , $41.44 , N/A , $60.33 , $60.33 , $163.40 , $65.93 , $11.66 , $165.12 
 Fac Culture Bacteri Aerobic Othr ,CPT® 87071,0306 - LAB/BACT-MICRO,N/A,N/A, $132.00 , $85.80 , $110.88 , $10.09 , $6.72 , $106.66 , $118.80 , $111.75 , $118.80 , $118.80 , $118.80 , $112.20 , $6.59 , $121.88 , $125.40 , $112.20 , $122.76 , $122.76 , $125.40 , $126.72 , $108.00 , $118.80 , $112.20 , $104.28 , N/A , $106.83 , $106.83 , $125.40 , $113.27 , $6.59 , $126.72 
 Fac Immunodiffusion Ouchterlony ,CPT® 86331,0302 - LAB/IMMUNOLOGY,N/A,N/A, $139.00 , $90.35 , $116.76 , $12.22 , $12.22 , $112.31 , $125.10 , $117.68 , $125.10 , $125.10 , $125.10 , $118.15 , $11.98 , $128.34 , $132.05 , $118.15 , $129.27 , $129.27 , $132.05 , $133.44 , $113.73 , $125.10 , $118.15 , $109.81 , N/A , $112.49 , $112.49 , $132.05 , $119.28 , $11.98 , $133.44 
Suture Abd Wall-Dehis/Eviscer,CPT® 49900,N/A,N/A,N/A," $5,308.00 "," $3,450.20 "," $4,930.45 ", $765.38 , $307.34 ," $3,835.46 "," $3,903.96 "," $4,936.44 "," $4,777.20 "," $4,777.20 "," $4,246.40 "," $4,246.40 ", $307.34 ," $4,900.88 "," $5,042.60 "," $4,777.20 "," $4,777.20 "," $4,777.20 "," $4,936.44 "," $5,095.68 "," $3,512.83 "," $4,511.80 "," $4,328.14 "," $4,546.25 ", N/A ," $3,910.30 "," $3,910.30 "," $5,042.60 "," $4,089.75 ", $307.34 ," $5,095.68 "
 FOLIC ACID 400 MCG PO TABS ,HCPCS RXC637,0250 - PHARMACY,50268-0346-15,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 DIGOXIN 125 MCG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-5921-61,1 tablet, $8.66 , $5.63 , $7.27 , N/A , N/A , $7.00 , $7.79 , $7.33 , $7.79 , $7.79 , $7.79 , $7.36 , N/A , $8.00 , $8.23 , $7.36 , $8.05 , $8.05 , $8.23 , $8.31 , $7.09 , $7.79 , $7.36 , $6.84 , N/A , $7.01 , $7.01 , $8.23 , $7.43 , $6.84 , $8.31 
 St Speech Therapy 16-30 Minutes -Mh ,CPT® 92507,0440 - SPEECH PATHOL,N/A,N/A, $371.00 , $241.15 , $311.64 , $76.23 , $100.15 , $299.77 , $333.90 , $314.09 , $333.90 , $333.90 , $333.90 , $315.35 , $98.19 , $342.54 , $352.45 , $315.35 , $345.03 , $345.03 , $352.45 , $356.16 , $303.55 , $333.90 , $315.35 , $293.09 , N/A , $300.25 , $300.25 , $352.45 , $318.36 , $76.23 , $356.16 
 Fac Blood Smear Interpretation ,CPT® 85060,0305 - LAB/HEMATOLOGY,N/A,N/A, $135.00 , $87.75 , $113.40 , $23.22 , $21.94 , $109.08 , $121.50 , $114.29 , $121.50 , $121.50 , $121.50 , $114.75 , $21.51 , $124.65 , $128.25 , $114.75 , $125.55 , $125.55 , $128.25 , $129.60 , $110.46 , $121.50 , $114.75 , $106.65 , N/A , $109.26 , $109.26 , $128.25 , $115.84 , $21.51 , $129.60 
 Pro Exc Tr-Ext Mlg+Marg 1.1-2 Cm ,CPT® 11602,0982 - PRO FEE/OUTPT,N/A,N/A," $1,048.00 ", $681.20 , $518.53 , $155.71 , $188.41 , $446.50 , $437.08 , $974.64 , $943.20 , $943.20 , $838.40 , $838.40 , $188.41 , $967.62 , $995.60 , $943.20 , $943.20 , $943.20 , $974.64 ," $1,006.08 ", $568.24 , $890.80 , $870.62 , $574.73 , N/A , $455.21 , $455.21 , $995.60 , $527.89 , $155.71 ," $1,006.08 "
 IR Insertion of Colonic Tube Perc W Guidance -C ,CPT® 49442,0750 - GASTR-INST SVS,N/A,N/A," $2,953.00 "," $1,919.45 "," $2,480.52 ", $198.33 , $825.14 ," $2,386.02 "," $2,657.70 "," $2,500.01 "," $2,657.70 "," $2,657.70 "," $2,657.70 "," $2,510.05 ", $808.96 ," $2,726.50 "," $2,805.35 "," $2,510.05 "," $2,746.29 "," $2,746.29 "," $2,805.35 "," $2,834.88 "," $2,416.14 "," $2,657.70 "," $2,510.05 "," $2,332.87 ", N/A ," $2,389.86 "," $2,389.86 "," $2,805.35 "," $2,533.97 ", $198.33 ," $2,834.88 "
 Pro Telhealth Inpt Consult 15min ,HCPCS G0406,0987 - PRO FEE/HOS VIS,N/A,N/A, $114.00 , $74.10 , $72.94 , $39.50 , N/A , $72.09 , N/A , $106.02 , $102.60 , $102.60 , $91.20 , $91.20 , N/A , $105.26 , $108.30 , $102.60 , $102.60 , $102.60 , $106.02 , $109.44 , $107.46 , $96.90 , $72.66 , $146.41 , N/A , $73.50 , $73.50 , $108.30 , $91.85 , $39.50 , $146.41 
 Fac Assay of Total Testosterone ,CPT® 84403,0301 - LAB/CHEMISTRY,N/A,N/A, $232.00 , $150.80 , $194.88 , $26.33 , $26.33 , $187.46 , $208.80 , $196.41 , $208.80 , $208.80 , $208.80 , $197.20 , $25.81 , $214.21 , $220.40 , $197.20 , $215.76 , $215.76 , $220.40 , $222.72 , $189.82 , $208.80 , $197.20 , $183.28 , N/A , $187.76 , $187.76 , $220.40 , $199.08 , $25.81 , $222.72 
 Fac Njx Px Prq Tx Xtr Pseudoarysm ,CPT® 36002,0361 - OR/MINOR,N/A,N/A, $960.00 , $624.00 , $806.40 , $97.28 , $106.54 , $775.68 , $864.00 , $812.74 , $864.00 , $864.00 , $864.00 , $816.00 , $104.45 , $886.37 , $912.00 , $816.00 , $892.80 , $892.80 , $912.00 , $921.60 , $785.47 , $864.00 , $816.00 , $758.40 , N/A , $776.93 , $776.93 , $912.00 , $823.78 , $97.28 , $921.60 
"Form Skin Pedicle Flap Lid,Ear,Nose",CPT® 15576,N/A,N/A,N/A," $5,100.00 "," $3,315.00 "," $2,095.45 ", $625.32 , $613.65 ," $1,837.04 "," $1,810.44 "," $4,743.00 "," $4,590.00 "," $4,590.00 "," $4,080.00 "," $4,080.00 ", $613.65 ," $4,708.83 "," $4,845.00 "," $4,590.00 "," $4,590.00 "," $4,590.00 "," $4,743.00 "," $4,896.00 "," $2,311.85 "," $4,335.00 "," $3,612.73 "," $2,349.44 ", N/A ," $1,872.88 "," $1,872.88 "," $4,845.00 "," $2,171.92 ", $613.65 ," $4,896.00 "
MRI Brain Contrast,CPT® 70552,N/A,N/A,N/A," $8,189.00 "," $5,322.85 "," $1,942.85 ", $277.80 , $506.39 ," $1,522.96 "," $2,537.94 "," $7,615.77 "," $7,370.10 "," $7,370.10 "," $6,551.20 "," $6,551.20 ", $506.39 ," $7,560.90 "," $7,779.55 "," $7,370.10 "," $7,370.10 "," $7,370.10 "," $7,615.77 "," $7,861.44 "," $1,663.93 "," $6,960.65 "," $2,763.87 "," $2,959.63 ", N/A ," $1,552.67 "," $1,552.67 "," $7,779.55 "," $1,797.26 ", $277.80 ," $7,861.44 "
Radiologic Exam Chest Single View,CPT® 71045,N/A,N/A,N/A, $344.00 , $223.60 , $145.12 , $25.48 , $15.52 , $88.96 , $99.17 , $319.92 , $309.60 , $309.60 , $275.20 , $275.20 , $15.52 , $317.62 , $326.80 , $309.60 , $309.60 , $309.60 , $319.92 , $330.24 , $140.79 , $292.40 , $149.63 , $110.18 , N/A , $90.69 , $90.69 , $326.80 , $104.98 , $15.52 , $330.24 
 PHENYLEPHRINE HCL 0.5 % NA SOLN ,HCPCS RXC637,0250 - PHARMACY,00225-0805-47,15 mL, $20.12 , $13.08 , $16.90 , N/A , N/A , $16.26 , $18.11 , $17.03 , $18.11 , $18.11 , $18.11 , $17.10 , N/A , $18.58 , $19.11 , $17.10 , $18.71 , $18.71 , $19.11 , $19.32 , $16.46 , $18.11 , $17.10 , $15.89 , N/A , $16.28 , $16.28 , $19.11 , $17.26 , $15.89 , $19.32 
"CT Scan, Face/Jaw Contrast",CPT® 70487,N/A,N/A,N/A," $2,981.00 "," $1,937.65 "," $1,083.53 ", $155.41 , $292.65 , $802.98 ," $1,449.20 "," $2,772.33 "," $2,682.90 "," $2,682.90 "," $2,384.80 "," $2,384.80 ", $292.65 ," $2,752.36 "," $2,831.95 "," $2,682.90 "," $2,682.90 "," $2,682.90 "," $2,772.33 "," $2,861.76 ", $911.36 ," $2,533.85 "," $1,577.43 "," $1,087.62 ", N/A , $818.65 , $818.65 ," $2,831.95 ", $947.60 , $155.41 ," $2,861.76 "
 Fac Glucose Test ,CPT® 82950,0301 - LAB/CHEMISTRY,N/A,N/A, $70.00 , $45.50 , $58.80 , $4.85 , $4.85 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $4.75 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $4.75 , $67.20 
 Fac Dilat Anal Sphnctr Spx Under Anes Oth/Thn Local ,CPT® 45905,0360 - OR SERVICES,N/A,N/A," $3,062.00 "," $1,990.30 "," $2,572.08 ", $162.29 , $133.31 ," $2,474.10 "," $2,755.80 "," $2,592.29 "," $2,755.80 "," $2,755.80 "," $2,755.80 "," $2,602.70 ", $130.70 ," $2,827.14 "," $2,908.90 "," $2,602.70 "," $2,847.66 "," $2,847.66 "," $2,908.90 "," $2,939.52 "," $2,505.33 "," $2,755.80 "," $2,602.70 "," $2,418.98 ", N/A ," $2,478.08 "," $2,478.08 "," $2,908.90 "," $2,627.50 ", $130.70 ," $2,939.52 "
Egd Transoral Control Bleeding Any Method,43255,N/A,N/A,N/A," $2,873.00 "," $1,867.45 "," $1,232.14 ", $189.89 , $252.38 ," $1,024.15 "," $1,368.12 "," $2,671.89 "," $2,585.70 "," $2,585.70 "," $2,298.40 "," $2,298.40 ", $252.38 ," $2,652.64 "," $2,729.35 "," $2,585.70 "," $2,585.70 "," $2,585.70 "," $2,671.89 "," $2,758.08 ", $883.66 ," $2,442.05 "," $1,498.61 "," $1,174.10 ", N/A ," $1,044.13 "," $1,044.13 "," $2,729.35 "," $1,092.06 ", $189.89 ," $2,758.08 "
Explore & Treat Carpometacarp Jt,CPT® 26070,N/A,N/A,N/A," $2,083.00 "," $1,353.95 "," $1,983.74 ", $314.53 , $230.52 ," $1,523.29 "," $1,495.80 "," $1,937.19 "," $1,874.70 "," $1,874.70 "," $1,666.40 "," $1,666.40 ", $230.52 ," $1,923.23 "," $1,978.85 "," $1,874.70 "," $1,874.70 "," $1,874.70 "," $1,937.19 "," $1,999.68 "," $1,853.70 "," $1,770.55 "," $1,641.34 "," $1,829.08 ", N/A ," $1,553.01 "," $1,553.01 "," $1,978.85 "," $1,825.34 ", $230.52 ," $1,999.68 "
 Pro Nerve Repair W/Allograft ,CPT® 64910,0982 - PRO FEE/OUTPT,N/A,N/A," $6,508.00 "," $4,230.20 "," $3,768.91 ", $727.52 , $537.05 ," $4,553.10 "," $4,408.67 "," $6,052.44 "," $5,857.20 "," $5,857.20 "," $5,206.40 "," $5,206.40 ", $537.05 ," $6,008.84 "," $6,182.60 "," $5,857.20 "," $5,857.20 "," $5,857.20 "," $6,052.44 "," $6,247.68 "," $4,133.12 "," $5,531.80 "," $4,356.68 "," $4,758.68 ", N/A ," $4,641.94 "," $4,641.94 "," $6,182.60 "," $4,979.72 ", $537.05 ," $6,247.68 "
 Fac Tcat Insj/Rpl Perm Leadless Pacemaker Rv W/Img ,CPT® 33274,0360 - OR SERVICES,N/A,N/A," $4,697.00 "," $3,053.05 "," $3,945.48 ", $441.08 , N/A ," $3,795.18 "," $4,227.30 "," $3,976.48 "," $4,227.30 "," $4,227.30 "," $4,227.30 "," $3,992.45 ", N/A ," $4,336.74 "," $4,462.15 "," $3,992.45 "," $4,368.21 "," $4,368.21 "," $4,462.15 "," $4,509.12 "," $3,843.09 "," $4,227.30 "," $3,992.45 "," $3,710.63 ", N/A ," $3,801.28 "," $3,801.28 "," $4,462.15 "," $4,030.50 ", $441.08 ," $4,509.12 "
 Fac Set Radiation Therapy Field ,CPT® 77295,0333 - RADIATION RX,N/A,N/A," $3,962.00 "," $2,575.30 "," $3,328.08 ", $471.16 , $596.89 ," $3,201.30 "," $3,565.80 "," $3,354.23 "," $3,565.80 "," $3,565.80 "," $3,565.80 "," $3,367.70 ", $585.19 ," $3,658.11 "," $3,763.90 "," $3,367.70 "," $3,684.66 "," $3,684.66 "," $3,763.90 "," $3,803.52 "," $3,241.71 "," $3,565.80 "," $3,367.70 "," $3,129.98 ", N/A ," $3,206.45 "," $3,206.45 "," $3,763.90 "," $3,399.79 ", $471.16 ," $3,803.52 "
Sono Guide Needle Biopsy,76942,N/A,N/A,N/A, $394.00 , $256.10 , $326.54 , $57.19 , $98.27 , $290.60 ," $1,078.86 ", $366.42 , $354.60 , $354.60 , $315.20 , $315.20 , $98.27 , $363.78 , $374.30 , $354.60 , $354.60 , $354.60 , $366.42 , $378.24 , $319.64 , $334.90 ," $1,180.66 ", $336.85 , N/A , $296.28 , $296.28 , $374.30 , $342.94 , $57.19 ," $1,180.66 "
 Pro Treat Wrist Bone Fracture ,CPT® 25645,0975 - PRO FEE/OR,N/A,N/A," $3,729.00 "," $2,423.85 "," $3,495.05 ", $548.91 , $481.11 ," $2,743.96 "," $2,730.76 "," $3,467.97 "," $3,356.10 "," $3,356.10 "," $2,983.20 "," $2,983.20 ", $481.11 ," $3,442.99 "," $3,542.55 "," $3,356.10 "," $3,356.10 "," $3,356.10 "," $3,467.97 "," $3,579.84 "," $3,244.12 "," $3,169.65 "," $3,015.07 "," $3,231.19 ", N/A ," $2,797.51 "," $2,797.51 "," $3,542.55 "," $3,288.05 ", $481.11 ," $3,579.84 "
" MEASLES, MUMPS & RUBELLA VAC IJ SOLR ",HCPCS 90707,0636 - DRUGS REQUIRING DETAILED CODIN,00006-4681-00,0.5 mL, $567.85 , $369.10 , $476.99 , N/A , $79.35 , $458.82 , $511.07 , $480.74 , $511.07 , $511.07 , $511.07 , $482.67 , $77.79 , $524.30 , $539.46 , $482.67 , $528.10 , $528.10 , $539.46 , $545.14 , $464.61 , $511.07 , $482.67 , $448.60 , N/A , $459.56 , $459.56 , $539.46 , $487.27 , $77.79 , $545.14 
"Preventive Visit,New,40-64",CPT® 99386,N/A,N/A,N/A, $478.00 , $310.70 , N/A , $145.76 , $62.71 , $254.52 , $256.24 , $444.54 , $430.20 , $430.20 , $382.40 , $382.40 , $62.71 , $441.34 , $454.10 , $430.20 , $430.20 , $430.20 , $444.54 , $458.88 , $314.18 , $406.30 , $256.54 , $253.45 , $183.25 , $259.48 , $259.48 , $454.10 , $311.66 , $62.71 , $458.88 
Pfizer-Biotech Admin Peds 6m - 4y Second Dose,CPT® 0082A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $56.00 , $128.02 , N/A , N/A , N/A , $66.50 , N/A , $38.92 , $128.02 
 Pro Low Back Disk Surgery ,CPT® 63030,0982 - PRO FEE/OUTPT,N/A,N/A," $7,044.00 "," $4,578.60 "," $4,581.51 ", $841.63 , $819.07 ," $6,157.37 "," $5,077.89 "," $6,550.92 "," $6,339.60 "," $6,339.60 "," $5,635.20 "," $5,635.20 ", $819.07 ," $6,503.73 "," $6,691.80 "," $6,339.60 "," $6,339.60 "," $6,339.60 "," $6,550.92 "," $6,762.24 "," $7,853.05 "," $5,987.40 "," $5,141.67 "," $5,560.93 ", N/A ," $6,277.51 "," $6,277.51 "," $6,691.80 "," $7,385.31 ", $819.07 ," $7,853.05 "
 Fac Assay of Mercury ,CPT® 83825,0301 - LAB/CHEMISTRY,N/A,N/A, $348.00 , $226.20 , $292.32 , $16.59 , $16.59 , $281.18 , $313.20 , $294.62 , $313.20 , $313.20 , $313.20 , $295.80 , $16.26 , $321.31 , $330.60 , $295.80 , $323.64 , $323.64 , $330.60 , $334.08 , $284.73 , $313.20 , $295.80 , $274.92 , N/A , $281.64 , $281.64 , $330.60 , $298.62 , $16.26 , $334.08 
"Reduce Volvulus,Intuss,Intern Hernia",CPT® 44050,N/A,N/A,N/A," $6,096.00 "," $3,962.40 "," $5,573.62 ", $862.94 ," $1,200.96 "," $4,391.77 "," $4,437.15 "," $5,669.28 "," $5,486.40 "," $5,486.40 "," $4,876.80 "," $4,876.80 "," $1,200.96 "," $5,628.44 "," $5,791.20 "," $5,486.40 "," $5,486.40 "," $5,486.40 "," $5,669.28 "," $5,852.16 "," $3,991.54 "," $5,181.60 "," $4,934.72 "," $5,179.56 ", N/A ," $4,477.46 "," $4,477.46 "," $5,791.20 "," $4,682.95 ", $862.94 ," $5,852.16 "
 THROMBIN 5000 UNITS EX SOLR ,HCPCS RXA250,0250 - PHARMACY,60793-0215-05,1 each, $444.65 , $289.02 , $373.51 , N/A , N/A , $359.28 , $400.19 , $376.44 , $400.19 , $400.19 , $400.19 , $377.95 , N/A , $410.55 , $422.42 , $377.95 , $413.52 , $413.52 , $422.42 , $426.86 , $363.81 , $400.19 , $377.95 , $351.27 , N/A , $359.86 , $359.86 , $422.42 , $381.55 , $351.27 , $426.86 
Lactate (Ld) (Ldh) Enzyme,CPT® 83615,N/A,N/A,N/A, $51.00 , $33.15 , N/A , $6.16 , $6.16 , $34.13 , $40.87 , $47.43 , $45.90 , $45.90 , $40.80 , $40.80 , $6.16 , $47.09 , $48.45 , $45.90 , $45.90 , $45.90 , $47.43 , $48.96 , $40.33 , $43.35 , $38.92 , $21.88 , N/A , $31.85 , $31.85 , $48.45 , $34.81 , $6.16 , $48.96 
" Pro Removal of Hydrocele,Tunica,Bilat ",CPT® 55041,0982 - PRO FEE/OUTPT,N/A,N/A," $2,687.00 "," $1,746.55 "," $2,274.10 ", $489.92 , $617.01 ," $1,637.18 "," $1,658.66 "," $2,498.91 "," $2,418.30 "," $2,418.30 "," $2,149.60 "," $2,149.60 ", $617.01 ," $2,480.91 "," $2,552.65 "," $2,418.30 "," $2,418.30 "," $2,418.30 "," $2,498.91 "," $2,579.52 "," $2,131.69 "," $2,283.95 "," $2,647.55 "," $2,467.53 ", N/A ," $1,669.13 "," $1,669.13 "," $2,552.65 "," $2,000.54 ", $489.92 ," $2,647.55 "
 MORPHINE SULFATE 10 MG/ML INJECTION (INPT) ,HCPCS J2270,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0451-01,1 mL, $34.29 , $22.29 , $28.80 , $4.69 , $3.41 , $27.71 , $30.86 , $29.03 , $30.86 , $30.86 , $30.86 , $29.15 , $3.34 , $31.66 , $32.58 , $29.15 , $31.89 , $31.89 , $32.58 , $32.92 , $28.06 , $30.86 , $29.15 , $27.09 , N/A , $27.75 , $27.75 , $32.58 , $29.42 , $3.34 , $32.92 
Estriol,CPT® 82677,N/A,N/A,N/A, $210.00 , $136.50 , N/A , $24.66 , $24.66 , $136.82 , $163.70 , $195.30 , $189.00 , $189.00 , $168.00 , $168.00 , $24.66 , $193.89 , $199.50 , $189.00 , $189.00 , $189.00 , $195.30 , $201.60 , $161.46 , $178.50 , $158.94 , $87.67 , N/A , $127.69 , $127.69 , $199.50 , $139.54 , $24.66 , $201.60 
 ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY ,HCPCS J1650,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0584-99,0.8 mL, $45.62 , $29.65 , $38.32 , $0.69 , $0.83 , $36.86 , $41.06 , $38.62 , $41.06 , $41.06 , $41.06 , $38.78 , $0.81 , $42.12 , $43.34 , $38.78 , $42.43 , $42.43 , $43.34 , $43.80 , $37.33 , $41.06 , $38.78 , $36.04 , N/A , $36.92 , $36.92 , $43.34 , $39.15 , $0.69 , $43.80 
Removal Drug Implant Device,CPT® 11982,N/A,N/A,N/A, $576.00 , $374.40 , $232.87 , $69.06 , $93.57 , $272.59 , $254.08 , $535.68 , $518.40 , $518.40 , $460.80 , $460.80 , $93.57 , $531.82 , $547.20 , $518.40 , $518.40 , $518.40 , $535.68 , $552.96 , $258.07 , $489.60 , $504.89 , $345.36 , N/A , $277.91 , $277.91 , $547.20 , $322.29 , $69.06 , $552.96 
 Fac Revsc Opn/Prq Fem/Pop W/Stnt/Athrc/Angiop Sm Vsl ,CPT® 37227,0360 - OR SERVICES,N/A,N/A," $44,811.00 "," $29,127.15 "," $37,641.24 ", $642.89 , $548.41 ," $36,207.29 "," $40,329.90 "," $37,936.99 "," $40,329.90 "," $40,329.90 "," $40,329.90 "," $38,089.35 ", $537.66 ," $41,374.00 "," $42,570.45 "," $38,089.35 "," $41,674.23 "," $41,674.23 "," $42,570.45 "," $43,018.56 "," $36,664.36 "," $40,329.90 "," $38,089.35 "," $35,400.69 ", N/A ," $36,265.54 "," $36,265.54 "," $42,570.45 "," $38,452.32 ", $537.66 ," $43,018.56 "
" Layer Closure Neck, Genitalia, Hands,Feet 12.6-20cm ",CPT® 12045,0981 - PRO FEE/ER,N/A,N/A," $1,528.00 ", $993.20 , $860.68 , $260.68 , $184.42 , $744.08 , $725.79 ," $1,421.04 "," $1,375.20 "," $1,375.20 "," $1,222.40 "," $1,222.40 ", $184.42 ," $1,410.80 "," $1,451.60 "," $1,375.20 "," $1,375.20 "," $1,375.20 "," $1,421.04 "," $1,466.88 ", $936.61 ," $1,298.80 "," $1,448.66 ", $942.06 , N/A , $758.60 , $758.60 ," $1,451.60 ", $879.73 , $184.42 ," $1,466.88 "
Home/Res Visit Est Patient High Mdm 60 Minutes,99350,N/A,N/A,N/A, $452.00 , $293.80 , $354.21 , $181.33 , $148.39 , $305.54 , $307.42 , $420.36 , $406.80 , $406.80 , $361.60 , $361.60 , $148.39 , $417.33 , $429.40 , $406.80 , $406.80 , $406.80 , $420.36 , $433.92 , $323.15 , $384.20 , $382.55 , $391.52 , N/A , $311.50 , $311.50 , $429.40 , $359.26 , $148.39 , $433.92 
Removal Impacted Cerumen Irrigation/Lvg Unilat,69209,N/A,N/A,N/A, $58.00 , $37.70 , $72.25 , $14.88 , $9.93 , $59.81 , $59.38 , $53.94 , $52.20 , $52.20 , $46.40 , $46.40 , $9.93 , $53.55 , $55.10 , $52.20 , $52.20 , $52.20 , $53.94 , $55.68 , $77.94 , $49.30 , $81.74 , $68.74 , N/A , $60.98 , $60.98 , $55.10 , $69.62 , $9.93 , $81.74 
 Fac Flo Cytometry Interpj 9-15 Markers ,CPT® 88188,0311 - PATHOL/CYTOLOGY,N/A,N/A, $563.00 , $365.95 , $472.92 , $60.52 , $86.85 , $454.90 , $506.70 , $476.64 , $506.70 , $506.70 , $506.70 , $478.55 , $85.15 , $519.82 , $534.85 , $478.55 , $523.59 , $523.59 , $534.85 , $540.48 , $460.65 , $506.70 , $478.55 , $444.77 , N/A , $455.64 , $455.64 , $534.85 , $483.11 , $60.52 , $540.48 
 DOBUTAMINE IN D5W 2 MG/ML IV SOLN ,HCPCS J1250,0636 - DRUGS REQUIRING DETAILED CODIN,00338-1075-02,250 mL, $246.57 , $160.27 , $207.12 , $9.01 , $7.11 , $199.23 , $221.91 , $208.75 , $221.91 , $221.91 , $221.91 , $209.58 , $6.97 , $227.66 , $234.24 , $209.58 , $229.31 , $229.31 , $234.24 , $236.71 , $201.74 , $221.91 , $209.58 , $194.79 , N/A , $199.55 , $199.55 , $234.24 , $211.58 , $6.97 , $236.71 
 Fac Reposit Prev Implanted Cardiac Electrode ,CPT® 33226,0360 - OR SERVICES,N/A,N/A," $5,799.00 "," $3,769.35 "," $4,871.16 ", $444.99 , $445.95 ," $4,685.59 "," $5,219.10 "," $4,909.43 "," $5,219.10 "," $5,219.10 "," $5,219.10 "," $4,929.15 ", $437.21 ," $5,354.22 "," $5,509.05 "," $4,929.15 "," $5,393.07 "," $5,393.07 "," $5,509.05 "," $5,567.04 "," $4,744.74 "," $5,219.10 "," $4,929.15 "," $4,581.21 ", N/A ," $4,693.13 "," $4,693.13 "," $5,509.05 "," $4,976.12 ", $437.21 ," $5,567.04 "
 Fac Revj Lxtr Artl Byp Opn Vein Patch Angiop ,CPT® 35879,0360 - OR SERVICES,N/A,N/A," $5,226.00 "," $3,396.90 "," $4,389.84 ", $821.61 , $982.67 ," $4,222.61 "," $4,703.40 "," $4,424.33 "," $4,703.40 "," $4,703.40 "," $4,703.40 "," $4,442.10 ", $963.40 ," $4,825.17 "," $4,964.70 "," $4,442.10 "," $4,860.18 "," $4,860.18 "," $4,964.70 "," $5,016.96 "," $4,275.91 "," $4,703.40 "," $4,442.10 "," $4,128.54 ", N/A ," $4,229.40 "," $4,229.40 "," $4,964.70 "," $4,484.43 ", $821.61 ," $5,016.96 "
Rsv Vaccine Pref Subunit Bivalent for Im Use,CPT® 90678,N/A,N/A,N/A, $872.00 , $566.80 , N/A , N/A , N/A , N/A , N/A , $810.96 , $784.80 , $784.80 , $697.60 , $697.60 , N/A , $805.12 , $828.40 , $784.80 , $784.80 , $784.80 , $810.96 , $837.12 , N/A , $741.20 , $697.60 , N/A , N/A , N/A , N/A , $828.40 , N/A , $697.60 , $837.12 
" Pro Critical Care, First Hour ",CPT® 99291,0982 - PRO FEE/OUTPT,N/A,N/A," $1,220.00 ", $793.00 , $433.06 , $205.74 , $270.56 , $385.76 , $385.10 ," $1,134.60 "," $1,098.00 "," $1,098.00 ", $976.00 , $976.00 , $270.56 ," $1,126.43 "," $1,159.00 "," $1,098.00 "," $1,098.00 "," $1,098.00 "," $1,134.60 "," $1,171.20 ", $551.34 ," $1,037.00 ", $480.07 , $484.31 , N/A , $393.30 , $393.30 ," $1,159.00 ", $453.59 , $205.74 ," $1,171.20 "
Replace Duodenostomy/Jejunostomy Tube Perq,CPT® 49451,N/A,N/A,N/A," $3,783.00 "," $2,458.95 ", $545.22 , $84.05 , $625.38 , $445.67 , $443.78 ," $3,518.19 "," $3,404.70 "," $3,404.70 "," $3,026.40 "," $3,026.40 ", $625.38 ," $3,492.84 "," $3,593.85 "," $3,404.70 "," $3,404.70 "," $3,404.70 "," $3,518.19 "," $3,631.68 ", $392.31 ," $3,215.55 ", $479.91 , $525.99 , N/A , $454.37 , $454.37 ," $3,593.85 ", $475.22 , $84.05 ," $3,631.68 "
" Bypass Graft, W/Other Than Vein; Axillary-Femoral ",CPT® 35621,0360 - OR SERVICES,N/A,N/A," $12,584.00 "," $8,179.60 "," $10,570.56 ", $976.21 ," $1,340.24 "," $10,167.87 "," $11,325.60 "," $10,653.61 "," $11,325.60 "," $11,325.60 "," $11,325.60 "," $10,696.40 "," $1,313.96 "," $11,618.81 "," $11,954.80 "," $10,696.40 "," $11,703.12 "," $11,703.12 "," $11,954.80 "," $12,080.64 "," $10,296.23 "," $11,325.60 "," $10,696.40 "," $9,941.36 ", N/A ," $10,184.23 "," $10,184.23 "," $11,954.80 "," $10,798.33 ", $976.21 ," $12,080.64 "
US Abdominal Aorta Real Time Screen Study Aaa,CPT® 76706,N/A,N/A,N/A, $521.00 , $338.65 , $606.85 , $105.25 , $74.59 , $434.43 , $479.15 , $484.53 , $468.90 , $468.90 , $416.80 , $416.80 , $74.59 , $481.04 , $494.95 , $468.90 , $468.90 , $468.90 , $484.53 , $500.16 , $606.44 , $442.85 , $615.79 , $530.13 , N/A , $442.90 , $442.90 , $494.95 , $512.69 , $74.59 , $615.79 
 Fac Emblc/Thrmbc Pop-Tibio-Proneal Art Leg Inc ,CPT® 34203,0360 - OR SERVICES,N/A,N/A," $7,836.00 "," $5,093.40 "," $6,582.24 ", $845.15 ," $1,070.40 "," $6,331.49 "," $7,052.40 "," $6,633.96 "," $7,052.40 "," $7,052.40 "," $7,052.40 "," $6,660.60 "," $1,049.41 "," $7,234.98 "," $7,444.20 "," $6,660.60 "," $7,287.48 "," $7,287.48 "," $7,444.20 "," $7,522.56 "," $6,411.42 "," $7,052.40 "," $6,660.60 "," $6,190.44 ", N/A ," $6,341.67 "," $6,341.67 "," $7,444.20 "," $6,724.07 ", $845.15 ," $7,522.56 "
 Pro Fluoroscopy Up to 1 Hour Physician/Qhp Time ,CPT® 76000,0972 - PRO FEE/RAD/DX,N/A,N/A, $185.00 , $120.25 , $239.02 , $42.11 , $59.59 , $222.68 , $273.12 , $172.05 , $166.50 , $166.50 , $148.00 , $148.00 , $59.59 , $170.81 , $175.75 , $166.50 , $166.50 , $166.50 , $172.05 , $177.60 , $232.48 , $157.25 , $300.46 , $239.65 , N/A , $227.02 , $227.02 , $175.75 , $262.79 , $42.11 , $300.46 
 Fac CT Abdomen W/Dye ,CPT® 74160,0350 - CT SCAN,N/A,N/A," $3,420.00 "," $2,223.00 "," $2,872.80 ", $234.02 , $324.11 ," $2,763.36 "," $3,078.00 "," $2,895.37 "," $3,078.00 "," $3,078.00 "," $3,078.00 "," $2,907.00 ", $317.75 ," $3,157.69 "," $3,249.00 "," $2,907.00 "," $3,180.60 "," $3,180.60 "," $3,249.00 "," $3,283.20 "," $2,798.24 "," $3,078.00 "," $2,907.00 "," $2,701.80 ", N/A ," $2,767.81 "," $2,767.81 "," $3,249.00 "," $2,934.70 ", $234.02 ," $3,283.20 "
 Fac Thyroid Met Uptake ,CPT® 78020,0340 - NUCLEAR MEDICINE,N/A,N/A, $706.00 , $458.90 , $593.04 , $77.33 , $74.88 , $570.45 , $635.40 , $597.70 , $635.40 , $635.40 , $635.40 , $600.10 , $73.41 , $651.85 , $670.70 , $600.10 , $656.58 , $656.58 , $670.70 , $677.76 , $577.65 , $635.40 , $600.10 , $557.74 , N/A , $571.37 , $571.37 , $670.70 , $605.82 , $73.41 , $677.76 
 DEGARELIX ACETATE(240 MG DOSE) 120 MG/VIAL SC SOLR ,HCPCS J9155,0636 - DRUGS REQUIRING DETAILED CODIN,55566-8403-01,6 mL," $9,395.44 "," $6,107.04 "," $7,892.17 ", $4.27 , $4.20 ," $7,591.52 "," $8,455.90 "," $7,954.18 "," $8,455.90 "," $8,455.90 "," $8,455.90 "," $7,986.12 ", $4.12 ," $8,674.81 "," $8,925.67 "," $7,986.12 "," $8,737.76 "," $8,737.76 "," $8,925.67 "," $9,019.62 "," $7,687.35 "," $8,455.90 "," $7,986.12 "," $7,422.40 ", N/A ," $7,603.73 "," $7,603.73 "," $8,925.67 "," $8,062.23 ", $4.12 ," $9,019.62 "
 PROPOFOL 500 MG/50ML IV EMUL ,HCPCS J2704,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0269-50,50 mL, $92.47 , $60.11 , $77.67 , $0.10 , $0.14 , $74.72 , $83.22 , $78.29 , $83.22 , $83.22 , $83.22 , $78.60 , $0.14 , $85.38 , $87.85 , $78.60 , $86.00 , $86.00 , $87.85 , $88.77 , $75.66 , $83.22 , $78.60 , $73.05 , N/A , $74.84 , $74.84 , $87.85 , $79.35 , $0.10 , $88.77 
"Fasciectomy,Partial Palma",CPT® 26123,N/A,N/A,N/A," $7,206.00 "," $4,683.90 "," $5,117.58 ", $805.06 , $768.40 ," $4,012.43 "," $4,004.12 "," $6,701.58 "," $6,485.40 "," $6,485.40 "," $5,764.80 "," $5,764.80 ", $768.40 ," $6,653.30 "," $6,845.70 "," $6,485.40 "," $6,485.40 "," $6,485.40 "," $6,701.58 "," $6,917.76 "," $4,752.90 "," $6,125.10 "," $4,401.29 "," $4,765.81 ", N/A ," $4,090.72 "," $4,090.72 "," $6,845.70 "," $4,808.04 ", $768.40 ," $6,917.76 "
 OLANZAPINE 2.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6283-61,1 tablet, $57.52 , $37.39 , $48.32 , N/A , N/A , $46.48 , $51.77 , $48.70 , $51.77 , $51.77 , $51.77 , $48.89 , N/A , $53.11 , $54.64 , $48.89 , $53.49 , $53.49 , $54.64 , $55.22 , $47.06 , $51.77 , $48.89 , $45.44 , N/A , $46.55 , $46.55 , $54.64 , $49.36 , $45.44 , $55.22 
 Other Disorders Of The Eye Without McC ,MS DRG V40 (FY2023) 125,N/A,N/A,N/A," $19,107.69 "," $12,420.00 "," $16,050.46 ", N/A , N/A ," $15,439.01 "," $17,196.92 "," $16,176.57 "," $17,196.92 "," $17,196.92 "," $17,196.92 "," $16,241.54 ", N/A ," $17,642.13 "," $18,152.31 "," $16,241.54 "," $17,770.15 "," $17,770.15 "," $18,152.31 "," $18,343.38 "," $15,633.91 "," $17,196.92 "," $16,241.54 "," $15,095.08 ", N/A ," $15,463.85 "," $15,463.85 "," $18,152.31 "," $16,396.31 "," $15,095.08 "," $18,343.38 "
Colonoscopy Stoma W/Biopsy Single/Multiple,44389,N/A,N/A,N/A," $3,109.00 "," $2,020.85 "," $1,048.58 ", $162.03 , $362.74 , $877.22 , $900.47 ," $2,891.37 "," $2,798.10 "," $2,798.10 "," $2,487.20 "," $2,487.20 ", $362.74 ," $2,870.54 "," $2,953.55 "," $2,798.10 "," $2,798.10 "," $2,798.10 "," $2,891.37 "," $2,984.64 ", $754.30 ," $2,642.65 ", $988.37 , $999.00 , N/A , $894.34 , $894.34 ," $2,953.55 ", $935.39 , $162.03 ," $2,984.64 "
 NAFCILLIN SODIUM 1 G IJ SOLR ,HCPCS RXA250,0250 - PHARMACY,44567-0221-10,4 mL, $67.81 , $44.08 , $56.96 , N/A , N/A , $54.79 , $61.03 , $57.41 , $61.03 , $61.03 , $61.03 , $57.64 , N/A , $62.61 , $64.42 , $57.64 , $63.06 , $63.06 , $64.42 , $65.10 , $55.48 , $61.03 , $57.64 , $53.57 , N/A , $54.88 , $54.88 , $64.42 , $58.19 , $53.57 , $65.10 
Histoplasma,CPT® 86698,N/A,N/A,N/A, $140.00 , $91.00 , N/A , $14.07 , $14.07 , $63.49 , $75.97 , $130.20 , $126.00 , $126.00 , $112.00 , $112.00 , $14.07 , $129.26 , $133.00 , $126.00 , $126.00 , $126.00 , $130.20 , $134.40 , $92.08 , $119.00 , $81.09 , $45.32 , N/A , $59.25 , $59.25 , $133.00 , $64.74 , $14.07 , $134.40 
"Insert,Inflatable Sphincter",CPT® 53445,N/A,N/A,N/A," $5,319.00 "," $3,457.35 "," $4,102.11 ", $722.62 ," $1,229.45 "," $3,680.02 "," $3,434.72 "," $4,946.67 "," $4,787.10 "," $4,787.10 "," $4,255.20 "," $4,255.20 "," $1,229.45 "," $4,911.03 "," $5,053.05 "," $4,787.10 "," $4,787.10 "," $4,787.10 "," $4,946.67 "," $5,106.24 "," $4,111.65 "," $4,521.15 "," $3,889.26 "," $4,635.14 ", N/A ," $3,751.83 "," $3,751.83 "," $5,053.05 "," $4,409.74 ", $722.62 ," $5,106.24 "
 GEMFIBROZIL 600 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60687-0224-01,1 tablet, $11.90 , $7.74 , $10.00 , N/A , N/A , $9.62 , $10.71 , $10.07 , $10.71 , $10.71 , $10.71 , $10.12 , N/A , $10.99 , $11.31 , $10.12 , $11.07 , $11.07 , $11.31 , $11.42 , $9.74 , $10.71 , $10.12 , $9.40 , N/A , $9.63 , $9.63 , $11.31 , $10.21 , $9.40 , $11.42 
"Anoscopy,Ablate Lesion",46615,N/A,N/A,N/A, $621.00 , $403.65 , $560.50 , $86.09 , $211.99 , $441.56 , $448.25 , $577.53 , $558.90 , $558.90 , $496.80 , $496.80 , $211.99 , $573.37 , $589.95 , $558.90 , $558.90 , $558.90 , $577.53 , $596.16 , $400.77 , $527.85 , $495.97 , $522.69 , N/A , $450.17 , $450.17 , $589.95 , $470.84 , $86.09 , $596.16 
 Immunoglobulin Beaker1 ,CPT® 82784,0301 - LAB/CHEMISTRY,N/A,N/A, $114.00 , $74.10 , $95.76 , $9.49 , $9.49 , $92.11 , $102.60 , $96.51 , $102.60 , $102.60 , $102.60 , $96.90 , $9.30 , $105.26 , $108.30 , $96.90 , $106.02 , $106.02 , $108.30 , $109.44 , $93.27 , $102.60 , $96.90 , $90.06 , N/A , $92.26 , $92.26 , $108.30 , $97.82 , $9.30 , $109.44 
 Fac Psa Screening ,HCPCS G0103,0300 - LABORATORY,N/A,N/A, $172.00 , $111.80 , $144.48 , $19.70 , $19.70 , $138.98 , $154.80 , $145.62 , $154.80 , $154.80 , $154.80 , $146.20 , $19.31 , $158.81 , $163.40 , $146.20 , $159.96 , $159.96 , $163.40 , $165.12 , $140.73 , $154.80 , $146.20 , $135.88 , N/A , $139.20 , $139.20 , $163.40 , $147.59 , $19.31 , $165.12 
Balloon Dilat Biliary Duct/Ampulla Prq Each Duct,CPT® 47542,N/A,N/A,N/A," $3,320.00 "," $2,158.00 ", $829.34 , $128.58 , $405.60 , $626.64 , $664.65 ," $3,087.60 "," $2,988.00 "," $2,988.00 "," $2,656.00 "," $2,656.00 ", $405.60 ," $3,065.36 "," $3,154.00 "," $2,988.00 "," $2,988.00 "," $2,988.00 "," $3,087.60 "," $3,187.20 ", $599.74 ," $2,822.00 ", $703.67 , $796.48 , N/A , $638.86 , $638.86 ," $3,154.00 ", $668.19 , $128.58 ," $3,187.20 "
 Pro Exc Tumor Soft Tissue Abdominal Wall Subq 3+Cm ,CPT® 22903,0982 - PRO FEE/OUTPT,N/A,N/A," $2,894.00 "," $1,881.10 "," $2,648.88 ", $412.17 , $361.86 ," $2,100.05 "," $2,088.99 "," $2,691.42 "," $2,604.60 "," $2,604.60 "," $2,315.20 "," $2,315.20 ", $361.86 ," $2,672.03 "," $2,749.30 "," $2,604.60 "," $2,604.60 "," $2,604.60 "," $2,691.42 "," $2,778.24 "," $2,454.49 "," $2,459.90 "," $2,306.79 "," $2,466.08 ", N/A ," $2,141.03 "," $2,141.03 "," $2,749.30 "," $2,516.46 ", $361.86 ," $2,778.24 "
 Cystourethroscopy; Temp Stent Placement ,CPT® 52000,0360 - OR SERVICES,N/A,N/A," $1,372.00 ", $891.80 ," $1,152.48 ", $75.96 , $144.34 ," $1,108.58 "," $1,234.80 "," $1,161.54 "," $1,234.80 "," $1,234.80 "," $1,234.80 "," $1,166.20 ", $141.51 ," $1,266.77 "," $1,303.40 "," $1,166.20 "," $1,275.96 "," $1,275.96 "," $1,303.40 "," $1,317.12 "," $1,122.57 "," $1,234.80 "," $1,166.20 "," $1,083.88 ", N/A ," $1,110.36 "," $1,110.36 "," $1,303.40 "," $1,177.31 ", $75.96 ," $1,317.12 "
"Exc Skin Malig 0.6-1cm Trunk,Arm,Leg",11601,N/A,N/A,N/A, $967.00 , $628.55 , $476.17 , $142.89 , $122.93 , $406.96 , $398.48 , $899.31 , $870.30 , $870.30 , $773.60 , $773.60 , $122.93 , $892.83 , $918.65 , $870.30 , $870.30 , $870.30 , $899.31 , $928.32 , $521.49 , $821.95 , $792.12 , $522.31 , N/A , $414.90 , $414.90 , $918.65 , $481.15 , $122.93 , $928.32 
 Pro MRI Pelvis W/O & W/Dye ,CPT® 72197,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,276.00 ", $829.40 ," $2,446.08 ", $347.59 , $639.90 ," $2,408.12 "," $3,045.38 "," $1,186.68 "," $1,148.40 "," $1,148.40 "," $1,020.80 "," $1,020.80 ", $639.90 ," $1,178.13 "," $1,212.20 "," $1,148.40 "," $1,148.40 "," $1,148.40 "," $1,186.68 "," $1,224.96 "," $2,110.15 "," $1,084.60 "," $3,316.64 "," $3,933.75 ", N/A ," $2,455.11 "," $2,455.11 "," $1,212.20 "," $2,841.83 ", $347.59 ," $3,933.75 "
 Pro Sub Grft F/S/N/H/F/G/M/D />100scm 1st 100scm ,CPT® 15277,0982 - PRO FEE/OUTPT,N/A,N/A," $2,293.00 "," $1,490.45 ", $706.66 , $209.45 , $229.39 , $615.40 , $572.66 ," $2,132.49 "," $2,063.70 "," $2,063.70 "," $1,834.40 "," $1,834.40 ", $229.39 ," $2,117.13 "," $2,178.35 "," $2,063.70 "," $2,063.70 "," $2,063.70 "," $2,132.49 "," $2,201.28 ", $777.03 ," $1,949.05 "," $1,141.80 ", $794.80 , N/A , $627.41 , $627.41 ," $2,178.35 ", $727.58 , $209.45 ," $2,201.28 "
 DOUBLE ANTIBIOTIC 500-10000 UNIT/GM EX OINT ,HCPCS RXC637,0250 - PHARMACY,70000-0070-01,28 gram, $48.76 , $31.69 , $40.96 , N/A , N/A , $39.40 , $43.88 , $41.28 , $43.88 , $43.88 , $43.88 , $41.45 , N/A , $45.02 , $46.32 , $41.45 , $45.35 , $45.35 , $46.32 , $46.81 , $39.90 , $43.88 , $41.45 , $38.52 , N/A , $39.46 , $39.46 , $46.32 , $41.84 , $38.52 , $46.81 
 Fac Antithrombin III Test ,CPT® 85300,0305 - LAB/HEMATOLOGY,N/A,N/A, $231.00 , $150.15 , $194.04 , $12.09 , $12.09 , $186.65 , $207.90 , $195.56 , $207.90 , $207.90 , $207.90 , $196.35 , $11.85 , $213.28 , $219.45 , $196.35 , $214.83 , $214.83 , $219.45 , $221.76 , $189.00 , $207.90 , $196.35 , $182.49 , N/A , $186.95 , $186.95 , $219.45 , $198.22 , $11.85 , $221.76 
Antepartum Head Manipulation,59412,N/A,N/A,N/A," $1,252.00 ", $813.80 , $273.09 , $92.55 , $92.65 , $240.23 , $251.94 ," $1,164.36 "," $1,126.80 "," $1,126.80 "," $1,001.60 "," $1,001.60 ", $92.65 ," $1,155.97 "," $1,189.40 "," $1,126.80 "," $1,126.80 "," $1,126.80 "," $1,164.36 "," $1,201.92 ", $278.44 ," $1,064.20 ", $556.63 , $444.36 , N/A , $244.92 , $244.92 ," $1,189.40 ", $283.17 , $92.55 ," $1,201.92 "
"Lap, Surg Proctectomy W Colostomy",CPT® 45395,N/A,N/A,N/A," $13,139.00 "," $8,540.35 "," $11,810.44 "," $1,834.39 "," $1,541.13 "," $9,433.79 "," $9,549.29 "," $12,219.27 "," $11,825.10 "," $11,825.10 "," $10,511.20 "," $10,511.20 "," $1,541.13 "," $12,131.24 "," $12,482.05 "," $11,825.10 "," $11,825.10 "," $11,825.10 "," $12,219.27 "," $12,613.44 "," $8,504.42 "," $11,168.15 "," $10,550.96 "," $11,171.22 ", N/A ," $9,617.86 "," $9,617.86 "," $12,482.05 "," $10,059.25 "," $1,541.13 "," $12,613.44 "
 Sacrum Coccyx Min 2vw- Mh ,CPT® 72220,0972 - PRO FEE/RAD/DX,N/A,N/A, $96.00 , $62.40 , $182.82 , $32.04 , $27.66 , $131.98 , $153.94 , $89.28 , $86.40 , $86.40 , $76.80 , $76.80 , $27.66 , $88.64 , $91.20 , $86.40 , $86.40 , $86.40 , $89.28 , $92.16 , $176.44 , $81.60 , $169.49 , $142.36 , N/A , $134.56 , $134.56 , $91.20 , $155.74 , $27.66 , $182.82 
" Ivl W/Stent + Atherectomy + Pta; Iliac, Fem Pop ",HCPCS C9767,0360 - OR SERVICES,N/A,N/A," $45,939.00 "," $29,860.35 "," $38,588.76 ", N/A , N/A ," $37,118.71 "," $41,345.10 "," $38,891.96 "," $41,345.10 "," $41,345.10 "," $41,345.10 "," $39,048.15 ", N/A ," $42,415.48 "," $43,642.05 "," $39,048.15 "," $42,723.27 "," $42,723.27 "," $43,642.05 "," $44,101.44 "," $37,587.29 "," $41,345.10 "," $39,048.15 "," $36,291.81 ", N/A ," $37,178.43 "," $37,178.43 "," $43,642.05 "," $39,420.26 "," $36,291.81 "," $44,101.44 "
Physician Telephone Evaluation 21-30 Min,CPT® 99443,N/A,N/A,N/A, $171.00 , $111.15 , $198.24 , $94.59 , $31.65 , $66.94 , $66.34 , $159.03 , $153.90 , $153.90 , $136.80 , $136.80 , $31.65 , $157.88 , $162.45 , $153.90 , $153.90 , $153.90 , $159.03 , $164.16 , $181.57 , $145.35 , $82.51 , $84.19 , $44.00 , $68.24 , $68.24 , $162.45 , $78.72 , $31.65 , $198.24 
Assay Calcium,CPT® 82310,N/A,N/A,N/A, $80.00 , $52.00 , N/A , $5.26 , $5.26 , $29.19 , $34.90 , $74.40 , $72.00 , $72.00 , $64.00 , $64.00 , $5.26 , $73.86 , $76.00 , $72.00 , $72.00 , $72.00 , $74.40 , $76.80 , $34.45 , $68.00 , $34.06 , $18.71 , N/A , $27.24 , $27.24 , $76.00 , $29.76 , $5.26 , $76.80 
" Pro Laparoscopy, Gastrostomy ",CPT® 43653,0982 - PRO FEE/OUTPT,N/A,N/A," $3,740.00 "," $2,431.00 "," $3,474.84 ", $538.65 , $781.95 ," $2,690.76 "," $2,750.20 "," $3,478.20 "," $3,366.00 "," $3,366.00 "," $2,992.00 "," $2,992.00 ", $781.95 ," $3,453.14 "," $3,553.00 "," $3,366.00 "," $3,366.00 "," $3,366.00 "," $3,478.20 "," $3,590.40 "," $2,485.12 "," $3,179.00 "," $3,052.53 "," $3,189.39 ", N/A ," $2,743.26 "," $2,743.26 "," $3,553.00 "," $2,869.17 ", $538.65 ," $3,590.40 "
 Pro Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Std ,CPT® 93926,0972 - PRO FEE/RAD/DX,N/A,N/A, $167.00 , $108.55 , $822.71 , $125.31 , $148.70 , $824.08 , $823.32 , $155.31 , $150.30 , $150.30 , $133.60 , $133.60 , $148.70 , $154.19 , $158.65 , $150.30 , $150.30 , $150.30 , $155.31 , $160.32 , $642.13 , $141.95 , $439.95 , $578.09 , N/A , $840.15 , $840.15 , $158.65 , $931.31 , $125.31 , $931.31 
 Fac Bilateral Thoracentesis/Paracentesis ,Custom 3610000003,0361 - OR/MINOR,N/A,N/A," $1,461.00 ", $949.65 ," $1,227.24 ", N/A , N/A ," $1,180.49 "," $1,314.90 "," $1,236.88 "," $1,314.90 "," $1,314.90 "," $1,314.90 "," $1,241.85 ", N/A ," $1,348.94 "," $1,387.95 "," $1,241.85 "," $1,358.73 "," $1,358.73 "," $1,387.95 "," $1,402.56 "," $1,195.39 "," $1,314.90 "," $1,241.85 "," $1,154.19 ", N/A ," $1,182.39 "," $1,182.39 "," $1,387.95 "," $1,253.68 "," $1,154.19 "," $1,402.56 "
Sling Oper Stres Incontinence,CPT® 57288,N/A,N/A,N/A," $5,271.00 "," $3,426.15 "," $3,521.70 ", $712.23 , $675.48 ," $2,923.16 "," $2,884.37 "," $4,902.03 "," $4,743.90 "," $4,743.90 "," $4,216.80 "," $4,216.80 ", $675.48 ," $4,866.71 "," $5,007.45 "," $4,743.90 "," $4,743.90 "," $4,743.90 "," $4,902.03 "," $5,060.16 "," $3,667.10 "," $4,480.35 "," $3,746.53 "," $2,957.02 ", N/A ," $2,980.20 "," $2,980.20 "," $5,007.45 "," $3,574.56 ", $675.48 ," $5,060.16 "
Simple Repair 20.1-30cm,12006,N/A,N/A,N/A," $1,108.00 ", $720.20 , $362.98 , $107.63 , $188.65 , $328.19 , $317.78 ," $1,030.44 ", $997.20 , $997.20 , $886.40 , $886.40 , $188.65 ," $1,023.02 "," $1,052.60 ", $997.20 , $997.20 , $997.20 ," $1,030.44 "," $1,063.68 ", $399.58 , $941.80 , $638.69 , $403.51 , N/A , $334.60 , $334.60 ," $1,052.60 ", $388.01 , $107.63 ," $1,063.68 "
 Fac Byp Oth/Thn Vein Aortoiliac ,CPT® 35637,0360 - OR SERVICES,N/A,N/A," $3,219.00 "," $2,092.35 "," $2,703.96 "," $1,468.36 "," $1,425.32 "," $2,600.95 "," $2,897.10 "," $2,725.21 "," $2,897.10 "," $2,897.10 "," $2,897.10 "," $2,736.15 "," $1,397.37 "," $2,972.10 "," $3,058.05 "," $2,736.15 "," $2,993.67 "," $2,993.67 "," $3,058.05 "," $3,090.24 "," $2,633.79 "," $2,897.10 "," $2,736.15 "," $2,543.01 ", N/A ," $2,605.14 "," $2,605.14 "," $3,058.05 "," $2,762.22 "," $1,397.37 "," $3,090.24 "
 ERYTHROMYCIN 5 MG/GM OP OINT ,HCPCS RXC637,0250 - PHARMACY,00574-4024-50,1 gram, $44.68 , $29.04 , $37.53 , N/A , N/A , $36.10 , $40.21 , $37.83 , $40.21 , $40.21 , $40.21 , $37.98 , N/A , $41.25 , $42.45 , $37.98 , $41.55 , $41.55 , $42.45 , $42.89 , $36.56 , $40.21 , $37.98 , $35.30 , N/A , $36.16 , $36.16 , $42.45 , $38.34 , $35.30 , $42.89 
Diazepam Injection,HCPCS J3360,N/A,N/A,N/A, $13.00 , $8.45 , N/A , $5.36 , $8.72 , N/A , N/A , $12.09 , $11.70 , $11.70 , $10.40 , $10.40 , $8.72 , $12.00 , $12.35 , $11.70 , $11.70 , $11.70 , $12.09 , $12.48 , $8.76 , $11.05 , $6.49 , $8.58 , N/A , N/A , N/A , $12.35 , N/A , $5.36 , $12.48 
 Fac Musc Myoq/Fascq Flap Lxtr ,CPT® 15738,0360 - OR SERVICES,N/A,N/A," $3,365.00 "," $2,187.25 "," $2,826.60 "," $1,197.74 "," $1,244.28 "," $2,718.92 "," $3,028.50 "," $2,848.81 "," $3,028.50 "," $3,028.50 "," $3,028.50 "," $2,860.25 "," $1,219.88 "," $3,106.90 "," $3,196.75 "," $2,860.25 "," $3,129.45 "," $3,129.45 "," $3,196.75 "," $3,230.40 "," $2,753.24 "," $3,028.50 "," $2,860.25 "," $2,658.35 ", N/A ," $2,723.29 "," $2,723.29 "," $3,196.75 "," $2,887.51 "," $1,197.74 "," $3,230.40 "
 GLYCOPYRROLATE 0.4 MG/2ML IJ SOLN ,HCPCS RXA250,0250 - PHARMACY,00143-9681-25,1 mL, $16.68 , $10.84 , $14.01 , N/A , N/A , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , N/A , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $13.18 , $16.01 
"Electrodessicatn,Anal Lesn(S)",CPT® 46910,N/A,N/A,N/A," $1,676.00 "," $1,089.40 ", $827.45 , $128.71 , $46.08 , $636.04 , $656.99 ," $1,558.68 "," $1,508.40 "," $1,508.40 "," $1,340.80 "," $1,340.80 ", $46.08 ," $1,547.45 "," $1,592.20 "," $1,508.40 "," $1,508.40 "," $1,508.40 "," $1,558.68 "," $1,608.96 ", $590.25 ," $1,424.60 ", $722.55 , $765.15 , N/A , $648.45 , $648.45 ," $1,592.20 ", $678.20 , $46.08 ," $1,608.96 "
 Fac Bleeding Tm ,CPT® 85002,0305 - LAB/HEMATOLOGY,N/A,N/A, $98.00 , $63.70 , $82.32 , $4.92 , $4.71 , $79.18 , $88.20 , $82.97 , $88.20 , $88.20 , $88.20 , $83.30 , $4.62 , $90.48 , $93.10 , $83.30 , $91.14 , $91.14 , $93.10 , $94.08 , $80.18 , $88.20 , $83.30 , $77.42 , N/A , $79.31 , $79.31 , $93.10 , $84.09 , $4.62 , $94.08 
" Fac Assay of Troponin, Qual ",CPT® 84512,0301 - LAB/CHEMISTRY,N/A,N/A, $140.00 , $91.00 , $117.60 , $10.29 , $10.29 , $113.12 , $126.00 , $118.52 , $126.00 , $126.00 , $126.00 , $119.00 , $10.09 , $129.26 , $133.00 , $119.00 , $130.20 , $130.20 , $133.00 , $134.40 , $114.55 , $126.00 , $119.00 , $110.60 , N/A , $113.30 , $113.30 , $133.00 , $120.13 , $10.09 , $134.40 
 Fac Replace Aortic Valve Openfemoral Artery Approach ,CPT® 33362,0360 - OR SERVICES,N/A,N/A," $29,463.00 "," $19,150.95 "," $24,748.92 "," $1,184.18 "," $1,109.01 "," $23,806.10 "," $26,516.70 "," $24,943.38 "," $26,516.70 "," $26,516.70 "," $26,516.70 "," $25,043.55 "," $1,087.26 "," $27,203.19 "," $27,989.85 "," $25,043.55 "," $27,400.59 "," $27,400.59 "," $27,989.85 "," $28,284.48 "," $24,106.63 "," $26,516.70 "," $25,043.55 "," $23,275.77 ", N/A ," $23,844.41 "," $23,844.41 "," $27,989.85 "," $25,282.20 "," $1,087.26 "," $28,284.48 "
Treat Femoral Shaft Frctr,CPT® 27501,N/A,N/A,N/A," $3,309.00 "," $2,150.85 "," $3,045.32 ", $478.84 , $451.87 ," $2,402.73 "," $2,405.11 "," $3,077.37 "," $2,978.10 "," $2,978.10 "," $2,647.20 "," $2,647.20 ", $451.87 ," $3,055.20 "," $3,143.55 "," $2,978.10 "," $2,978.10 "," $2,978.10 "," $3,077.37 "," $3,176.64 "," $2,825.08 "," $2,812.65 "," $2,654.69 "," $2,834.30 ", N/A ," $2,449.62 "," $2,449.62 "," $3,143.55 "," $2,879.15 ", $451.87 ," $3,176.64 "
Drain Vulva Abscess,CPT® 56405,N/A,N/A,N/A, $741.00 , $481.65 , $606.40 , $122.85 , $122.21 , $442.68 , $446.19 , $689.13 , $666.90 , $666.90 , $592.80 , $592.80 , $122.21 , $684.17 , $703.95 , $666.90 , $666.90 , $666.90 , $689.13 , $711.36 , $616.66 , $629.85 , $585.17 , $446.08 , N/A , $451.32 , $451.32 , $703.95 , $541.33 , $122.21 , $711.36 
Straighten Penis,CPT® 54300,N/A,N/A,N/A," $3,523.00 "," $2,289.95 "," $2,867.71 ", $615.76 ," $1,064.99 "," $2,059.83 "," $2,077.16 "," $3,276.39 "," $3,170.70 "," $3,170.70 "," $2,818.40 "," $2,818.40 "," $1,064.99 "," $3,252.79 "," $3,346.85 "," $3,170.70 "," $3,170.70 "," $3,170.70 "," $3,276.39 "," $3,382.08 "," $2,685.90 "," $2,994.55 "," $3,309.44 "," $3,111.45 ", N/A ," $2,100.02 "," $2,100.02 "," $3,346.85 "," $2,516.98 ", $615.76 ," $3,382.08 "
 BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP ,HCPCS J0702,0636 - DRUGS REQUIRING DETAILED CODIN,00517-0720-01,1 mL, $67.85 , $44.10 , $56.99 , $7.10 , $7.08 , $54.82 , $61.07 , $57.44 , $61.07 , $61.07 , $61.07 , $57.67 , $6.94 , $62.65 , $64.46 , $57.67 , $63.10 , $63.10 , $64.46 , $65.14 , $55.51 , $61.07 , $57.67 , $53.60 , N/A , $54.91 , $54.91 , $64.46 , $58.22 , $6.94 , $65.14 
"Burn Dressing,MD,W/O Anes",CPT® 16025,N/A,N/A,N/A, $580.00 , $377.00 , $353.80 , $104.77 , $43.96 , $304.75 , $296.43 , $539.40 , $522.00 , $522.00 , $464.00 , $464.00 , $43.96 , $535.51 , $551.00 , $522.00 , $522.00 , $522.00 , $539.40 , $556.80 , $384.92 , $493.00 , $592.31 , $389.98 , N/A , $310.69 , $310.69 , $551.00 , $360.30 , $43.96 , $592.31 
Incise/Drain Bladder,CPT® 51040,N/A,N/A,N/A," $2,019.00 "," $1,312.35 "," $1,583.78 ", $279.60 , $287.92 ," $1,411.64 "," $1,328.35 "," $1,877.67 "," $1,817.10 "," $1,817.10 "," $1,615.20 "," $1,615.20 ", $287.92 ," $1,864.14 "," $1,918.05 "," $1,817.10 "," $1,817.10 "," $1,817.10 "," $1,877.67 "," $1,938.24 "," $1,584.59 "," $1,716.15 "," $1,502.18 "," $1,783.57 ", N/A ," $1,439.18 "," $1,439.18 "," $1,918.05 "," $1,691.54 ", $279.60 ," $1,938.24 "
 Fac MRI Procedure ,CPT® 76498,0619 - MRI - OTHER,N/A,N/A," $6,968.00 "," $4,529.20 "," $5,853.12 ", N/A , N/A ," $5,630.14 "," $6,271.20 "," $5,899.11 "," $6,271.20 "," $6,271.20 "," $6,271.20 "," $5,922.80 ", N/A ," $6,433.55 "," $6,619.60 "," $5,922.80 "," $6,480.24 "," $6,480.24 "," $6,619.60 "," $6,689.28 "," $5,701.22 "," $6,271.20 "," $5,922.80 "," $5,504.72 ", N/A ," $5,639.20 "," $5,639.20 "," $6,619.60 "," $5,979.24 "," $5,504.72 "," $6,689.28 "
Set Radn Therapy Field Interme,CPT® 77285,N/A,N/A,N/A," $2,807.00 "," $1,824.55 "," $2,492.67 ", $434.27 , $274.62 ," $2,028.98 "," $1,653.91 "," $2,610.51 "," $2,526.30 "," $2,526.30 "," $2,245.60 "," $2,245.60 ", $274.62 ," $2,591.70 "," $2,666.65 "," $2,526.30 "," $2,526.30 "," $2,526.30 "," $2,610.51 "," $2,694.72 "," $2,629.68 "," $2,385.95 "," $1,812.41 "," $2,541.05 ", N/A ," $2,068.57 "," $2,068.57 "," $2,666.65 "," $2,394.40 ", $274.62 ," $2,694.72 "
Fecal Blood Scrn Immunoassay,HCPCS G0328,N/A,N/A,N/A, $128.00 , $83.20 , N/A , $18.41 , N/A , $40.93 , N/A , $119.04 , $115.20 , $115.20 , $102.40 , $102.40 , N/A , $118.18 , $121.60 , $115.20 , $115.20 , $115.20 , $119.04 , $122.88 , $120.52 , $108.80 , $41.52 , $57.68 , N/A , $41.74 , $41.74 , $121.60 , $52.16 , $18.41 , $122.88 
 Pro Cltx Phlngl Fx Prox/Middle Px/F/T W/Mnpj Ea ,CPT® 26725,0981 - PRO FEE/ER,N/A,N/A," $1,012.00 ", $657.80 ," $1,888.97 ", $298.96 , $132.15 ," $1,457.95 "," $1,481.04 ", $941.16 , $910.80 , $910.80 , $809.60 , $809.60 , $132.15 , $934.38 , $961.40 , $910.80 , $910.80 , $910.80 , $941.16 , $971.52 ," $1,742.10 ", $860.20 ," $1,625.28 "," $1,732.55 ", N/A ," $1,486.40 "," $1,486.40 ", $961.40 ," $1,747.03 ", $132.15 ," $1,888.97 "
 Pro Insj Biomchn Dev Intervertebral Dsc Spc W/Arthrd ,CPT® 22853,0982 - PRO FEE/OUTPT,N/A,N/A," $1,794.00 "," $1,166.10 "," $1,481.94 ", $230.73 , $199.49 ," $1,194.16 "," $1,149.23 "," $1,668.42 "," $1,614.60 "," $1,614.60 "," $1,435.20 "," $1,435.20 ", $199.49 ," $1,656.40 "," $1,704.30 "," $1,614.60 "," $1,614.60 "," $1,614.60 "," $1,668.42 "," $1,722.24 "," $1,387.35 "," $1,524.90 "," $1,364.69 "," $1,403.48 ", N/A ," $1,217.47 "," $1,217.47 "," $1,704.30 "," $1,430.96 ", $199.49 ," $1,722.24 "
 ESTROGENS CONJUGATED 0.625 MG/GM VA CREA ,HCPCS RXC637,0250 - PHARMACY,00046-0872-21,30 gram," $2,693.47 "," $1,750.76 "," $2,262.51 ", N/A , N/A ," $2,176.32 "," $2,424.12 "," $2,280.29 "," $2,424.12 "," $2,424.12 "," $2,424.12 "," $2,289.45 ", N/A ," $2,486.88 "," $2,558.80 "," $2,289.45 "," $2,504.93 "," $2,504.93 "," $2,558.80 "," $2,585.73 "," $2,203.80 "," $2,424.12 "," $2,289.45 "," $2,127.84 ", N/A ," $2,179.83 "," $2,179.83 "," $2,558.80 "," $2,311.27 "," $2,127.84 "," $2,585.73 "
"Herpes Simplex I Ag, Fluor",CPT® 87274,N/A,N/A,N/A, $113.00 , $73.45 , N/A , $12.22 , $12.22 , $67.85 , $81.18 , $105.09 , $101.70 , $101.70 , $90.40 , $90.40 , $12.22 , $104.33 , $107.35 , $101.70 , $101.70 , $101.70 , $105.09 , $108.48 , $79.99 , $96.05 , $77.85 , $43.47 , N/A , $63.32 , $63.32 , $107.35 , $69.20 , $12.22 , $108.48 
 NICARDIPINE 0.1 MG/ML INFUSION PREMIX (INPT) ,HCPCS RXA250,0250 - PHARMACY,43066-0009-10,200 mL, $626.70 , $407.36 , $526.43 , N/A , N/A , $506.37 , $564.03 , $530.56 , $564.03 , $564.03 , $564.03 , $532.70 , N/A , $578.63 , $595.37 , $532.70 , $582.83 , $582.83 , $595.37 , $601.63 , $512.77 , $564.03 , $532.70 , $495.09 , N/A , $507.19 , $507.19 , $595.37 , $537.77 , $495.09 , $601.63 
"Explor Postop Bleed,Infec,Clot-Chst",CPT® 35820,N/A,N/A,N/A," $13,519.00 "," $8,787.35 "," $11,736.01 "," $1,813.27 "," $1,990.17 "," $8,597.28 "," $8,520.41 "," $12,572.67 "," $12,167.10 "," $12,167.10 "," $10,815.20 "," $10,815.20 "," $1,990.17 "," $12,482.09 "," $12,843.05 "," $12,167.10 "," $12,167.10 "," $12,167.10 "," $12,572.67 "," $12,978.24 "," $10,860.04 "," $11,491.15 "," $10,793.59 "," $9,656.79 ", N/A ," $8,765.04 "," $8,765.04 "," $12,843.05 "," $9,957.08 "," $1,813.27 "," $12,978.24 "
 Pro Lyr Clsr F/E/E/N/L/M&/Muc 12.6 Cm-20.0 Cm ,CPT® 12055,0981 - PRO FEE/ER,N/A,N/A," $1,307.00 ", $849.55 , $942.68 , $283.32 , $288.68 , $824.87 , $801.32 ," $1,215.51 "," $1,176.30 "," $1,176.30 "," $1,045.60 "," $1,045.60 ", $288.68 ," $1,206.75 "," $1,241.65 "," $1,176.30 "," $1,176.30 "," $1,176.30 "," $1,215.51 "," $1,254.72 "," $1,033.61 "," $1,110.95 "," $1,598.52 "," $1,063.66 ", N/A , $840.96 , $840.96 ," $1,241.65 ", $975.24 , $283.32 ," $1,598.52 "
Cast Sup Long Leg Fiberglass,HCPCS Q4030,N/A,N/A,N/A, $135.00 , $87.75 , N/A , $92.25 , $59.67 , N/A , N/A , $125.55 , $121.50 , $121.50 , $108.00 , $108.00 , $59.67 , $124.65 , $128.25 , $121.50 , $121.50 , $121.50 , $125.55 , $129.60 , N/A , $114.75 , $157.65 , $83.81 , N/A , N/A , N/A , $128.25 , N/A , $59.67 , $157.65 
Egd Band Ligation Esophgeal/Gastric Varices,CPT® 43244,N/A,N/A,N/A," $2,061.00 "," $1,339.65 "," $1,506.25 ", $232.38 , $277.04 ," $1,246.36 "," $1,429.29 "," $1,916.73 "," $1,854.90 "," $1,854.90 "," $1,648.80 "," $1,648.80 ", $277.04 ," $1,902.92 "," $1,957.95 "," $1,854.90 "," $1,854.90 "," $1,854.90 "," $1,916.73 "," $1,978.56 "," $1,081.42 "," $1,751.85 "," $1,564.62 "," $1,434.32 ", N/A ," $1,270.67 "," $1,270.67 "," $1,957.95 "," $1,328.97 ", $232.38 ," $1,978.56 "
 Fac Smr Prim Src Wet Mount Nfct Agt ,CPT® 87210,0306 - LAB/BACT-MICRO,N/A,N/A, $66.00 , $42.90 , $55.44 , $5.94 , $5.93 , $53.33 , $59.40 , $55.88 , $59.40 , $59.40 , $59.40 , $56.10 , $5.81 , $60.94 , $62.70 , $56.10 , $61.38 , $61.38 , $62.70 , $63.36 , $54.00 , $59.40 , $56.10 , $52.14 , N/A , $53.41 , $53.41 , $62.70 , $56.63 , $5.81 , $63.36 
" Pro Strapping,Shoulder ",CPT® 29240,0981 - PRO FEE/ER,N/A,N/A, $181.00 , $117.65 , $116.61 , $17.96 , $16.01 , $92.07 , $215.74 , $168.33 , $162.90 , $162.90 , $144.80 , $144.80 , $16.01 , $167.12 , $171.95 , $162.90 , $162.90 , $162.90 , $168.33 , $173.76 , $109.01 , $153.85 , $231.93 , $111.84 , N/A , $93.87 , $93.87 , $171.95 , $110.34 , $16.01 , $231.93 
Intermittent Urinary Cath,HCPCS A4353,N/A,N/A,N/A, $15.00 , $9.75 , N/A , $9.51 , $4.72 , N/A , N/A , $13.95 , $13.50 , $13.50 , $12.00 , $12.00 , $4.72 , $13.85 , $14.25 , $13.50 , $13.50 , $13.50 , $13.95 , $14.40 , N/A , $12.75 , $8.43 , $8.63 , N/A , N/A , N/A , $14.25 , N/A , $4.72 , $14.40 
Triiodothyronine T3 Reverse,CPT® 84482,N/A,N/A,N/A, $210.00 , $136.50 , N/A , $16.08 , $10.68 , $43.52 , $52.09 , $195.30 , $189.00 , $189.00 , $168.00 , $168.00 , $10.68 , $193.89 , $199.50 , $189.00 , $189.00 , $189.00 , $195.30 , $201.60 , $105.23 , $178.50 , $103.80 , $57.15 , N/A , $40.62 , $40.62 , $199.50 , $44.39 , $10.68 , $201.60 
 OLANZAPINE 20 MG PO TBDP ,HCPCS RXA250,0250 - PHARMACY,55111-0265-81,1 tablet, $30.54 , $19.85 , $25.65 , N/A , N/A , $24.68 , $27.49 , $25.86 , $27.49 , $27.49 , $27.49 , $25.96 , N/A , $28.20 , $29.01 , $25.96 , $28.40 , $28.40 , $29.01 , $29.32 , $24.99 , $27.49 , $25.96 , $24.13 , N/A , $24.72 , $24.72 , $29.01 , $26.21 , $24.13 , $29.32 
CT Scan Skull Contrast,CPT® 70481,N/A,N/A,N/A," $2,390.00 "," $1,553.50 "," $1,288.91 ", $184.73 , $297.22 ," $1,313.67 "," $1,692.62 "," $2,222.70 "," $2,151.00 "," $2,151.00 "," $1,912.00 "," $1,912.00 ", $297.22 ," $2,206.69 "," $2,270.50 "," $2,151.00 "," $2,151.00 "," $2,151.00 "," $2,222.70 "," $2,294.40 "," $1,088.37 "," $2,031.50 "," $1,845.15 "," $1,788.51 ", N/A ," $1,339.30 "," $1,339.30 "," $2,270.50 "," $1,550.27 ", $184.73 ," $2,294.40 "
Remove Hemorrhoids & Fissure,CPT® 46257,N/A,N/A,N/A," $2,738.00 "," $1,779.70 "," $2,587.98 ", $403.59 , $568.00 ," $1,997.16 "," $2,047.70 "," $2,546.34 "," $2,464.20 "," $2,464.20 "," $2,190.40 "," $2,190.40 ", $568.00 ," $2,528.00 "," $2,601.10 "," $2,464.20 "," $2,464.20 "," $2,464.20 "," $2,546.34 "," $2,628.48 "," $1,881.20 "," $2,327.30 "," $2,255.06 "," $2,397.40 ", N/A ," $2,036.13 "," $2,036.13 "," $2,601.10 "," $2,129.59 ", $403.59 ," $2,628.48 "
 BEVACIZUMAB-BVZR 400 MG/16ML IV SOLN ,HCPCS Q5118,0636 - DRUGS REQUIRING DETAILED CODIN,00069-0342-01,16 mL," $7,214.35 "," $4,689.33 "," $6,060.05 ", $28.75 , $34.36 ," $5,829.19 "," $6,492.92 "," $6,107.67 "," $6,492.92 "," $6,492.92 "," $6,492.92 "," $6,132.20 ", $33.69 ," $6,661.01 "," $6,853.63 "," $6,132.20 "," $6,709.35 "," $6,709.35 "," $6,853.63 "," $6,925.78 "," $5,902.78 "," $6,492.92 "," $6,132.20 "," $5,699.34 ", N/A ," $5,838.57 "," $5,838.57 "," $6,853.63 "," $6,190.63 ", $28.75 ," $6,925.78 "
Hand-Held Pefr Meter,HCPCS A4614,N/A,N/A,N/A, $49.00 , $31.85 , N/A , $32.26 , $18.15 , N/A , N/A , $45.57 , $44.10 , $44.10 , $39.20 , $39.20 , $18.15 , $45.24 , $46.55 , $44.10 , $44.10 , $44.10 , $45.57 , $47.04 , N/A , $41.65 , $27.90 , $29.30 , N/A , N/A , N/A , $46.55 , N/A , $18.15 , $47.04 
 Fac Collagen Crosslinks ,CPT® 82523,0301 - LAB/CHEMISTRY,N/A,N/A, $254.00 , $165.10 , $213.36 , $19.05 , $14.46 , $205.23 , $228.60 , $215.04 , $228.60 , $228.60 , $228.60 , $215.90 , $14.18 , $234.52 , $241.30 , $215.90 , $236.22 , $236.22 , $241.30 , $243.84 , $207.82 , $228.60 , $215.90 , $200.66 , N/A , $205.56 , $205.56 , $241.30 , $217.96 , $14.18 , $243.84 
 Pro Cltx Carp/Mtcrpl Dislc Thmb W/Mnpj ,CPT® 26641,0982 - PRO FEE/OUTPT,N/A,N/A," $2,457.00 "," $1,597.05 "," $2,367.82 ", $373.63 , $58.71 ," $1,653.94 "," $1,633.22 "," $2,285.01 "," $2,211.30 "," $2,211.30 "," $1,965.60 "," $1,965.60 ", $58.71 ," $2,268.55 "," $2,334.15 "," $2,211.30 "," $2,211.30 "," $2,211.30 "," $2,285.01 "," $2,358.72 "," $2,180.49 "," $2,088.45 "," $1,791.20 "," $1,971.42 ", N/A ," $1,686.21 "," $1,686.21 "," $2,334.15 "," $1,981.90 ", $58.71 ," $2,367.82 "
 DIVALPROEX SODIUM 125 MG PO TBEC ,HCPCS RXC637,0250 - PHARMACY,60687-0211-21,1 tablet, $4.58 , $2.98 , $3.85 , N/A , N/A , $3.70 , $4.12 , $3.88 , $4.12 , $4.12 , $4.12 , $3.89 , N/A , $4.23 , $4.35 , $3.89 , $4.26 , $4.26 , $4.35 , $4.40 , $3.75 , $4.12 , $3.89 , $3.62 , N/A , $3.71 , $3.71 , $4.35 , $3.93 , $3.62 , $4.40 
Repair of Vagina,CPT® 57200,N/A,N/A,N/A," $1,916.00 "," $1,245.40 "," $1,584.55 ", $319.53 , $217.80 ," $1,226.76 "," $1,222.28 "," $1,781.88 "," $1,724.40 "," $1,724.40 "," $1,532.80 "," $1,532.80 ", $217.80 ," $1,769.04 "," $1,820.20 "," $1,724.40 "," $1,724.40 "," $1,724.40 "," $1,781.88 "," $1,839.36 "," $1,625.18 "," $1,628.60 "," $1,600.31 "," $1,235.45 ", N/A ," $1,250.69 "," $1,250.69 "," $1,820.20 "," $1,500.13 ", $217.80 ," $1,839.36 "
" Pro Dress/Debrid P-Thick Burn, S ",CPT® 16020,0981 - PRO FEE/ER,N/A,N/A, $364.00 , $236.60 , $173.81 , $52.76 , $30.25 , $148.68 , $145.73 , $338.52 , $327.60 , $327.60 , $291.20 , $291.20 , $30.25 , $336.08 , $345.80 , $327.60 , $327.60 , $327.60 , $338.52 , $349.44 , $191.27 , $309.40 , $289.02 , $192.11 , N/A , $151.58 , $151.58 , $345.80 , $175.80 , $30.25 , $349.44 
" Drainage External Ear Abscess, Simple - Mh ",CPT® 69000,0761 - TREATMENT ROOM,N/A,N/A," $1,119.00 ", $727.35 , $939.96 , $120.89 , $30.71 , $904.15 ," $1,007.10 ", $947.35 ," $1,007.10 "," $1,007.10 "," $1,007.10 ", $951.15 , $30.11 ," $1,033.17 "," $1,063.05 ", $951.15 ," $1,040.67 "," $1,040.67 "," $1,063.05 "," $1,074.24 ", $915.57 ," $1,007.10 ", $951.15 , $884.01 , N/A , $905.61 , $905.61 ," $1,063.05 ", $960.21 , $30.11 ," $1,074.24 "
 Renal With Vascular Flow ,CPT® 78701,0340 - NUCLEAR MEDICINE,N/A,N/A," $2,067.00 "," $1,343.55 "," $1,736.28 ", $207.06 , $164.69 ," $1,670.14 "," $1,860.30 "," $1,749.92 "," $1,860.30 "," $1,860.30 "," $1,860.30 "," $1,756.95 ", $161.46 ," $1,908.46 "," $1,963.65 "," $1,756.95 "," $1,922.31 "," $1,922.31 "," $1,963.65 "," $1,984.32 "," $1,691.22 "," $1,860.30 "," $1,756.95 "," $1,632.93 ", N/A ," $1,672.82 "," $1,672.82 "," $1,963.65 "," $1,773.69 ", $161.46 ," $1,984.32 "
"Repair Rotator Cuff,Chronic",23412,N/A,N/A,N/A," $5,635.00 "," $3,662.75 "," $5,174.20 ", $810.67 , $754.88 ," $4,110.06 "," $4,090.88 "," $5,240.55 "," $5,071.50 "," $5,071.50 "," $4,508.00 "," $4,508.00 ", $754.88 ," $5,202.80 "," $5,353.25 "," $5,071.50 "," $5,071.50 "," $5,071.50 "," $5,240.55 "," $5,409.60 "," $4,813.76 "," $4,789.75 "," $4,519.03 "," $4,843.14 ", N/A ," $4,190.25 "," $4,190.25 "," $5,353.25 "," $4,925.04 ", $754.88 ," $5,409.60 "
" Fac Immunoassay, Ria ",CPT® 83520,0302 - LAB/IMMUNOLOGY,N/A,N/A, $227.00 , $147.55 , $190.68 , $17.62 , $17.62 , $183.42 , $204.30 , $192.18 , $204.30 , $204.30 , $204.30 , $192.95 , $17.27 , $209.59 , $215.65 , $192.95 , $211.11 , $211.11 , $215.65 , $217.92 , $185.73 , $204.30 , $192.95 , $179.33 , N/A , $183.71 , $183.71 , $215.65 , $194.79 , $17.27 , $217.92 
 AMPHETAMINE-DEXTROAMPHETAMINE 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00555-0972-02,1 tablet, $8.81 , $5.73 , $7.40 , N/A , N/A , $7.12 , $7.93 , $7.46 , $7.93 , $7.93 , $7.93 , $7.49 , N/A , $8.13 , $8.37 , $7.49 , $8.19 , $8.19 , $8.37 , $8.46 , $7.21 , $7.93 , $7.49 , $6.96 , N/A , $7.13 , $7.13 , $8.37 , $7.56 , $6.96 , $8.46 
" Pro OB US, Detailed, Addl Fetus ",CPT® 76812,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,462.00 ", $950.30 ," $1,101.88 ", $190.57 , $131.67 , $991.81 ," $1,124.76 "," $1,359.66 "," $1,315.80 "," $1,315.80 "," $1,169.60 "," $1,169.60 ", $131.67 ," $1,349.86 "," $1,388.90 "," $1,315.80 "," $1,315.80 "," $1,315.80 "," $1,359.66 "," $1,403.52 "," $1,107.79 "," $1,242.70 "," $1,224.96 "," $1,147.62 ", N/A ," $1,011.16 "," $1,011.16 "," $1,388.90 "," $1,170.44 ", $131.67 ," $1,403.52 "
 ENFORTUMAB VEDOTIN-EJFV 20 MG IV SOLR ,HCPCS J9177,0636 - DRUGS REQUIRING DETAILED CODIN,51144-0020-01,2 mL," $8,097.62 "," $5,263.45 "," $6,802.00 ", $34.50 , $34.49 ," $6,542.88 "," $7,287.86 "," $6,855.45 "," $7,287.86 "," $7,287.86 "," $7,287.86 "," $6,882.98 ", $33.81 ," $7,476.53 "," $7,692.74 "," $6,882.98 "," $7,530.79 "," $7,530.79 "," $7,692.74 "," $7,773.72 "," $6,625.47 "," $7,287.86 "," $6,882.98 "," $6,397.12 ", N/A ," $6,553.40 "," $6,553.40 "," $7,692.74 "," $6,948.57 ", $33.81 ," $7,773.72 "
 Pro Repair/Revise Wrist Joint ,CPT® 25320,0975 - PRO FEE/OR,N/A,N/A," $5,876.00 "," $3,819.40 "," $6,011.40 ", $947.70 , $643.30 ," $4,758.23 "," $4,754.85 "," $5,464.68 "," $5,288.40 "," $5,288.40 "," $4,700.80 "," $4,700.80 ", $643.30 ," $5,425.31 "," $5,582.20 "," $5,288.40 "," $5,288.40 "," $5,288.40 "," $5,464.68 "," $5,640.96 "," $5,588.40 "," $4,994.60 "," $5,227.31 "," $5,645.67 ", N/A ," $4,851.07 "," $4,851.07 "," $5,582.20 "," $5,701.72 ", $643.30 ," $6,011.40 "
Trimethobenzamide Hcl Inj,HCPCS J3250,N/A,N/A,N/A, $35.00 , $22.75 , N/A , $45.94 , $45.84 , N/A , N/A , $32.55 , $31.50 , $31.50 , $28.00 , $28.00 , $45.84 , $32.32 , $33.25 , $31.50 , $31.50 , $31.50 , $32.55 , $33.60 , $52.92 , $29.75 , $20.11 , $55.92 , N/A , N/A , N/A , $33.25 , N/A , $20.11 , $55.92 
 CT Percutaneous Drainage W Plcmt of Cath- Mh ,CPT® 75989,0972 - PRO FEE/RAD/DX,N/A,N/A, $972.00 , $631.80 , $648.85 , $111.07 , $134.80 , $578.69 , $657.81 , $903.96 , $874.80 , $874.80 , $777.60 , $777.60 , $134.80 , $897.45 , $923.40 , $874.80 , $874.80 , $874.80 , $903.96 , $933.12 , $468.53 , $826.20 , $716.49 , $615.27 , N/A , $589.98 , $589.98 , $923.40 , $682.91 , $111.07 , $933.12 
Radex Hips Bilateral With Pelvis 2 Views,CPT® 73521,N/A,N/A,N/A, $293.00 , $190.45 , $280.63 , $40.66 , $31.33 , $189.91 , $199.17 , $272.49 , $263.70 , $263.70 , $234.40 , $234.40 , $31.33 , $270.53 , $278.35 , $263.70 , $263.70 , $263.70 , $272.49 , $281.28 , $226.01 , $249.05 , $237.88 , $189.29 , N/A , $193.62 , $193.62 , $278.35 , $224.12 , $31.33 , $281.28 
Excise Major Peripheral Neuroma,CPT® 64784,N/A,N/A,N/A," $4,838.00 "," $3,144.70 "," $3,535.32 ", $688.69 , $384.19 ," $4,018.68 "," $3,941.70 "," $4,499.34 "," $4,354.20 "," $4,354.20 "," $3,870.40 "," $3,870.40 ", $384.19 ," $4,466.93 "," $4,596.10 "," $4,354.20 "," $4,354.20 "," $4,354.20 "," $4,499.34 "," $4,644.48 "," $3,832.48 "," $4,112.30 "," $3,910.67 "," $4,286.73 ", N/A ," $4,097.09 "," $4,097.09 "," $4,596.10 "," $4,395.23 ", $384.19 ," $4,644.48 "
 Direct Immunofluorescence Additional Antibody Bill ,CPT® 88350,0301 - LAB/CHEMISTRY,N/A,N/A, $292.00 , $189.80 , $245.28 , $114.53 , $57.02 , $235.94 , $262.80 , $247.21 , $262.80 , $262.80 , $262.80 , $248.20 , $55.90 , $269.60 , $277.40 , $248.20 , $271.56 , $271.56 , $277.40 , $280.32 , $238.91 , $262.80 , $248.20 , $230.68 , N/A , $236.32 , $236.32 , $277.40 , $250.57 , $55.90 , $280.32 
 Fac Fungus Isolation Culture ,CPT® 87102,0306 - LAB/BACT-MICRO,N/A,N/A, $121.00 , $78.65 , $101.64 , $8.58 , $8.58 , $97.77 , $108.90 , $102.44 , $108.90 , $108.90 , $108.90 , $102.85 , $8.41 , $111.72 , $114.95 , $102.85 , $112.53 , $112.53 , $114.95 , $116.16 , $99.00 , $108.90 , $102.85 , $95.59 , N/A , $97.93 , $97.93 , $114.95 , $103.83 , $8.41 , $116.16 
Explor Sphenoid Sinus+Rmv Polyps,CPT® 31051,N/A,N/A,N/A," $3,893.00 "," $2,530.45 "," $3,881.42 ", $681.76 , $802.63 ," $2,455.57 "," $2,473.45 "," $3,620.49 "," $3,503.70 "," $3,503.70 "," $3,114.40 "," $3,114.40 ", $802.63 ," $3,594.41 "," $3,698.35 "," $3,503.70 "," $3,503.70 "," $3,503.70 "," $3,620.49 "," $3,737.28 "," $3,672.22 "," $3,309.05 "," $3,475.36 "," $3,234.01 ", N/A ," $2,503.48 "," $2,503.48 "," $3,698.35 "," $2,948.39 ", $681.76 ," $3,881.42 "
"Inj,Lumb Epidur,Blood/Clot Patch",CPT® 62273,N/A,N/A,N/A," $1,208.00 ", $785.20 , $559.10 , $108.56 , $122.93 , $643.03 , $619.00 ," $1,123.44 "," $1,087.20 "," $1,087.20 ", $966.40 , $966.40 , $122.93 ," $1,115.35 "," $1,147.60 "," $1,087.20 "," $1,087.20 "," $1,087.20 "," $1,123.44 "," $1,159.68 ", $604.41 ," $1,026.80 ", $603.01 , $686.89 , N/A , $655.58 , $655.58 ," $1,147.60 ", $703.28 , $108.56 ," $1,159.68 "
"Revision of Eyelid,> 1/4 Lid Margin",CPT® 67966,N/A,N/A,N/A," $7,010.00 "," $4,556.50 "," $4,017.85 ", $630.25 , $618.40 ," $3,722.71 "," $3,506.99 "," $6,519.30 "," $6,309.00 "," $6,309.00 "," $5,608.00 "," $5,608.00 ", $618.40 ," $6,472.33 "," $6,659.50 "," $6,309.00 "," $6,309.00 "," $6,309.00 "," $6,519.30 "," $6,729.60 "," $5,520.86 "," $5,958.50 "," $3,639.49 "," $4,720.30 ", N/A ," $3,795.34 "," $3,795.34 "," $6,659.50 "," $4,189.59 ", $618.40 ," $6,729.60 "
Telethx Isodose Pln Smpl W/Dosimetry Calculation,CPT® 77306,N/A,N/A,N/A," $1,547.00 "," $1,005.55 ", $816.47 , $145.47 , $113.93 , $691.12 , $752.51 ," $1,438.71 "," $1,392.30 "," $1,392.30 "," $1,237.60 "," $1,237.60 ", $113.93 ," $1,428.35 "," $1,469.65 "," $1,392.30 "," $1,392.30 "," $1,392.30 "," $1,438.71 "," $1,485.12 ", $830.15 ," $1,314.95 ", $845.99 , $842.28 , N/A , $704.61 , $704.61 ," $1,469.65 ", $815.58 , $113.93 ," $1,485.12 "
Tenotomy Elbow Lateral/Medial Debride Open,CPT® 24358,N/A,N/A,N/A," $3,464.00 "," $2,251.60 "," $3,246.69 ", $510.18 , $366.18 ," $2,520.37 "," $2,521.78 "," $3,221.52 "," $3,117.60 "," $3,117.60 "," $2,771.20 "," $2,771.20 ", $366.18 ," $3,198.31 "," $3,290.80 "," $3,117.60 "," $3,117.60 "," $3,117.60 "," $3,221.52 "," $3,325.44 "," $3,005.26 "," $2,944.40 "," $2,777.79 "," $2,984.45 ", N/A ," $2,569.55 "," $2,569.55 "," $3,290.80 "," $3,020.14 ", $366.18 ," $3,325.44 "
US Venous Duplex Upp/Low Ext Complete Bilateral Study,93970,N/A,N/A,N/A, $324.00 , $210.60 ," $1,195.35 ", $184.54 , $172.43 ," $1,061.24 "," $1,070.66 ", $301.32 , $291.60 , $291.60 , $259.20 , $259.20 , $172.43 , $299.15 , $307.80 , $291.60 , $291.60 , $291.60 , $301.32 , $311.04 , $842.19 , $275.40 , $576.80 , $745.00 , N/A ," $1,081.95 "," $1,081.95 ", $307.80 ," $1,199.37 ", $172.43 ," $1,199.37 "
 Pro Knee Arthroscopy/Surgery ,CPT® 29875,0975 - PRO FEE/OR,N/A,N/A," $1,922.00 "," $1,249.30 "," $3,028.48 ", $475.67 , $427.24 ," $2,393.20 "," $2,393.57 "," $1,787.46 "," $1,729.80 "," $1,729.80 "," $1,537.60 "," $1,537.60 ", $427.24 ," $1,774.58 "," $1,825.90 "," $1,729.80 "," $1,729.80 "," $1,729.80 "," $1,787.46 "," $1,845.12 "," $2,817.13 "," $1,633.70 "," $2,640.41 "," $2,823.34 ", N/A ," $2,439.90 "," $2,439.90 "," $1,825.90 "," $2,867.74 ", $427.24 ," $3,028.48 "
 Fac Incisional Biopsy Skin Single Lesion ,CPT® 11106,0761 - TREATMENT ROOM,N/A,N/A, $286.00 , $185.90 , $240.24 , $53.95 , $118.70 , $231.09 , $257.40 , $242.13 , $257.40 , $257.40 , $257.40 , $243.10 , $116.37 , $264.06 , $271.70 , $243.10 , $265.98 , $265.98 , $271.70 , $274.56 , $234.01 , $257.40 , $243.10 , $225.94 , N/A , $231.46 , $231.46 , $271.70 , $245.42 , $53.95 , $274.56 
Sono Guide Needle Biopsy,CPT® 76942,N/A,N/A,N/A," $1,427.00 ", $927.55 , $326.54 , $57.19 , $98.27 , $290.60 ," $1,078.86 "," $1,327.11 "," $1,284.30 "," $1,284.30 "," $1,141.60 "," $1,141.60 ", $98.27 ," $1,317.55 "," $1,355.65 "," $1,284.30 "," $1,284.30 "," $1,284.30 "," $1,327.11 "," $1,369.92 ", $319.64 ," $1,212.95 "," $1,180.66 ", $336.85 , N/A , $296.28 , $296.28 ," $1,355.65 ", $342.94 , $57.19 ," $1,369.92 "
 Toe(S) Min 2 Views ,CPT® 73660,0320 - DX X-RAY,N/A,N/A, $301.00 , $195.65 , $252.84 , $28.68 , $23.98 , $243.21 , $270.90 , $254.83 , $270.90 , $270.90 , $270.90 , $255.85 , $23.51 , $277.91 , $285.95 , $255.85 , $279.93 , $279.93 , $285.95 , $288.96 , $246.28 , $270.90 , $255.85 , $237.79 , N/A , $243.60 , $243.60 , $285.95 , $258.29 , $23.51 , $288.96 
Deep Muscle Biopsy,CPT® 20205,N/A,N/A,N/A," $1,139.00 ", $740.35 , $904.67 , $141.15 , $153.67 , $740.12 , $731.81 ," $1,059.27 "," $1,025.10 "," $1,025.10 ", $911.20 , $911.20 , $153.67 ," $1,051.64 "," $1,082.05 "," $1,025.10 "," $1,025.10 "," $1,025.10 "," $1,059.27 "," $1,093.44 ", $843.69 , $968.15 , $817.10 , $863.72 , N/A , $754.56 , $754.56 ," $1,082.05 ", $886.88 , $141.15 ," $1,093.44 "
"Trichomonas Vaginalis,Dir Probe",CPT® 87660,N/A,N/A,N/A, $118.00 , $76.70 , N/A , $20.45 , $20.45 , $113.46 , $135.73 , $109.74 , $106.20 , $106.20 , $94.40 , $94.40 , $20.45 , $108.95 , $112.10 , $106.20 , $106.20 , $106.20 , $109.74 , $113.28 , $133.88 , $100.30 , $131.37 , $72.72 , N/A , $105.89 , $105.89 , $112.10 , $115.71 , $20.45 , $135.73 
Identify Sentinel Node,CPT® 38792,N/A,N/A,N/A, $763.00 , $495.95 , $154.55 , $30.89 , $36.29 , $140.90 , $148.11 , $709.59 , $686.70 , $686.70 , $610.40 , $610.40 , $36.29 , $704.48 , $724.85 , $686.70 , $686.70 , $686.70 , $709.59 , $732.48 , $166.47 , $648.55 , $215.87 , $197.75 , N/A , $143.66 , $143.66 , $724.85 , $166.67 , $30.89 , $732.48 
 Pro Drainage of Pilonidal Cyst ,CPT® 10080,0981 - PRO FEE/ER,N/A,N/A, $582.00 , $378.30 , $335.61 , $100.38 , $61.55 , $282.06 , $278.01 , $541.26 , $523.80 , $523.80 , $465.60 , $465.60 , $61.55 , $537.36 , $552.90 , $523.80 , $523.80 , $523.80 , $541.26 , $558.72 , $367.33 , $494.70 , $553.06 , $359.71 , N/A , $287.57 , $287.57 , $552.90 , $333.47 , $61.55 , $558.72 
 VANCOMYCIN ORAL SOLN 50 MG/1 ML (COMPOUNDED WITH IV FORMULATION) ,HCPCS RXA250,0250 - PHARMACY,00001-0130-01,5 mL, $24.72 , $16.07 , $20.76 , N/A , N/A , $19.97 , $22.25 , $20.93 , $22.25 , $22.25 , $22.25 , $21.01 , N/A , $22.82 , $23.48 , $21.01 , $22.99 , $22.99 , $23.48 , $23.73 , $20.23 , $22.25 , $21.01 , $19.53 , N/A , $20.01 , $20.01 , $23.48 , $21.21 , $19.53 , $23.73 
Iadna Babesia Microti Amplified Probe Technique,CPT® 87469,N/A,N/A,N/A, $53.00 , $34.45 , N/A , $35.79 , $35.79 , N/A , N/A , $49.29 , $47.70 , $47.70 , $42.40 , $42.40 , $35.79 , $48.93 , $50.35 , $47.70 , $47.70 , $47.70 , $49.29 , $50.88 , N/A , $45.05 , $168.00 , N/A , N/A , $137.55 , $137.55 , $50.35 , $151.24 , $35.79 , $168.00 
 Carotid Duplex Scan ,CPT® 93880,0921 - PERI VASCUL LAB,N/A,N/A," $1,364.00 ", $886.60 ," $1,145.76 ", $187.12 , $169.41 ," $1,102.11 "," $1,227.60 "," $1,154.76 "," $1,227.60 "," $1,227.60 "," $1,227.60 "," $1,159.40 ", $166.09 ," $1,259.38 "," $1,295.80 "," $1,159.40 "," $1,268.52 "," $1,268.52 "," $1,295.80 "," $1,309.44 "," $1,116.02 "," $1,227.60 "," $1,159.40 "," $1,077.56 ", N/A ," $1,103.89 "," $1,103.89 "," $1,295.80 "," $1,170.45 ", $166.09 ," $1,309.44 "
Image-Guide Fluid Collxn Drainage Cath Visc Perq,CPT® 49405,N/A,N/A,N/A," $2,280.00 "," $1,482.00 "," $1,200.62 ", $185.07 , $162.82 ," $1,040.25 "," $1,071.22 "," $2,120.40 "," $2,052.00 "," $2,052.00 "," $1,824.00 "," $1,824.00 ", $162.82 ," $2,105.12 "," $2,166.00 "," $2,052.00 "," $2,052.00 "," $2,052.00 "," $2,120.40 "," $2,188.80 ", $867.06 ," $1,938.00 "," $1,009.30 "," $1,155.04 ", N/A ," $1,060.55 "," $1,060.55 "," $2,166.00 "," $1,109.23 ", $162.82 ," $2,188.80 "
"Fix Ectropion,Thermocaut",CPT® 67915,N/A,N/A,N/A," $2,920.00 "," $1,898.00 "," $1,220.18 ", $192.85 , $142.01 ," $1,117.41 "," $1,367.27 "," $2,715.60 "," $2,628.00 "," $2,628.00 "," $2,336.00 "," $2,336.00 ", $142.01 ," $2,696.04 "," $2,774.00 "," $2,628.00 "," $2,628.00 "," $2,628.00 "," $2,715.60 "," $2,803.20 "," $1,674.20 "," $2,482.00 "," $1,404.06 "," $1,427.05 ", N/A ," $1,139.22 "," $1,139.22 "," $2,774.00 "," $1,257.56 ", $142.01 ," $2,803.20 "
 Pro CT Maxillofacial W/Dye ,CPT® 70487,0972 - PRO FEE/RAD/DX,N/A,N/A, $700.00 , $455.00 ," $1,083.53 ", $155.41 , $292.65 , $802.98 ," $1,449.20 ", $651.00 , $630.00 , $630.00 , $560.00 , $560.00 , $292.65 , $646.31 , $665.00 , $630.00 , $630.00 , $630.00 , $651.00 , $672.00 , $911.36 , $595.00 ," $1,577.43 "," $1,087.62 ", N/A , $818.65 , $818.65 , $665.00 , $947.60 , $155.41 ," $1,577.43 "
 Fac Imfluor Std Ea Antb Dir Meth ,CPT® 88346,0312 - PATHOL/HISTOL,N/A,N/A, $418.00 , $271.70 , $351.12 , $149.59 , $52.81 , $337.74 , $376.20 , $353.88 , $376.20 , $376.20 , $376.20 , $355.30 , $51.77 , $385.94 , $397.10 , $355.30 , $388.74 , $388.74 , $397.10 , $401.28 , $342.01 , $376.20 , $355.30 , $330.22 , N/A , $338.29 , $338.29 , $397.10 , $358.69 , $51.77 , $401.28 
 Sarscov2-Inf a/B-Rsv Amp Prb Pbb ,CPT® 87637,0306 - LAB/BACT-MICRO,N/A,N/A, $553.00 , $359.45 , $464.52 , $145.48 , $145.48 , $446.82 , $497.70 , $468.17 , $497.70 , $497.70 , $497.70 , $470.05 , $142.63 , $510.58 , $525.35 , $470.05 , $514.29 , $514.29 , $525.35 , $530.88 , $452.46 , $497.70 , $470.05 , $436.87 , N/A , $447.54 , $447.54 , $525.35 , $474.53 , $142.63 , $530.88 
MR Angio Abdomen (Mra),CPT® 74185,N/A,N/A,N/A," $5,758.00 "," $3,742.70 "," $2,426.06 ", $346.46 , $464.63 ," $1,917.43 "," $2,466.98 "," $5,354.94 "," $5,182.20 "," $5,182.20 "," $4,606.40 "," $4,606.40 ", $464.63 ," $5,316.36 "," $5,470.10 "," $5,182.20 "," $5,182.20 "," $5,182.20 "," $5,354.94 "," $5,527.68 "," $2,092.90 "," $4,894.30 "," $2,686.83 "," $2,697.08 ", N/A ," $1,954.85 "," $1,954.85 "," $5,470.10 "," $2,262.77 ", $346.46 ," $5,527.68 "
 Aac Device Eval - 1 Hour ,CPT® 92607,0444 - SPEECH PATH/EVAL,N/A,N/A, $442.00 , $287.30 , $371.28 , $123.48 , $98.55 , $357.14 , $397.80 , $374.20 , $397.80 , $397.80 , $397.80 , $375.70 , $96.62 , $408.10 , $419.90 , $375.70 , $411.06 , $411.06 , $419.90 , $424.32 , $361.64 , $397.80 , $375.70 , $349.18 , N/A , $357.71 , $357.71 , $419.90 , $379.28 , $96.62 , $424.32 
 Pro Lyr Clsr/Wound-Lh ,CPT® 12032,0982 - PRO FEE/OUTPT,N/A,N/A," $1,160.00 ", $754.00 , $608.50 , $183.18 , $82.48 , $532.01 , $524.46 ," $1,078.80 "," $1,044.00 "," $1,044.00 ", $928.00 , $928.00 , $82.48 ," $1,071.03 "," $1,102.00 "," $1,044.00 "," $1,044.00 "," $1,044.00 "," $1,078.80 "," $1,113.60 ", $668.28 , $986.00 ," $1,043.68 ", $685.38 , N/A , $542.39 , $542.39 ," $1,102.00 ", $628.99 , $82.48 ," $1,113.60 "
 Pro Closed Tx Nasal Bone Fx W/Mnpj W/O Stabilization ,CPT® 21315,0982 - PRO FEE/OUTPT,N/A,N/A, $528.00 , $343.20 , $360.88 , $57.03 , $144.17 , $740.80 , $753.99 , $491.04 , $475.20 , $475.20 , $422.40 , $422.40 , $144.17 , $487.50 , $501.60 , $475.20 , $475.20 , $475.20 , $491.04 , $506.88 , $876.95 , $448.80 , $826.02 , $865.56 , N/A , $755.25 , $755.25 , $501.60 , $887.70 , $57.03 , $887.70 
 Pro Radex Hips Bilateral With Pelvis 2 Views ,CPT® 73521,0972 - PRO FEE/RAD/DX,N/A,N/A, $136.00 , $88.40 , $280.63 , $40.66 , $31.33 , $189.91 , $199.17 , $126.48 , $122.40 , $122.40 , $108.80 , $108.80 , $31.33 , $125.57 , $129.20 , $122.40 , $122.40 , $122.40 , $126.48 , $130.56 , $226.01 , $115.60 , $237.88 , $189.29 , N/A , $193.62 , $193.62 , $129.20 , $224.12 , $31.33 , $280.63 
 L/S Spine Nerve Block Add Level ,CPT® 64484,0761 - TREATMENT ROOM,N/A,N/A," $1,085.00 ", $705.25 , $911.40 , $49.44 , $119.93 , $876.68 , $976.50 , $918.56 , $976.50 , $976.50 , $976.50 , $922.25 , $117.58 ," $1,001.78 "," $1,030.75 ", $922.25 ," $1,009.05 "," $1,009.05 "," $1,030.75 "," $1,041.60 ", $887.75 , $976.50 , $922.25 , $857.15 , N/A , $878.09 , $878.09 ," $1,030.75 ", $931.04 , $49.44 ," $1,041.60 "
Antistreptolysin O Screen,CPT® 86063,N/A,N/A,N/A, $98.00 , $63.70 , N/A , $5.89 , $5.89 , $32.64 , $39.04 , $91.14 , $88.20 , $88.20 , $78.40 , $78.40 , $5.89 , $90.48 , $93.10 , $88.20 , $88.20 , $88.20 , $91.14 , $94.08 , $38.53 , $83.30 , $37.30 , $20.91 , N/A , $30.46 , $30.46 , $93.10 , $33.28 , $5.89 , $94.08 
 Fac Cpap Vntj Cpap Initiation&Mgmt ,CPT® 94660,0410 - RESPIRATORY SVC,N/A,N/A, $775.00 , $503.75 , $651.00 , $35.78 , $73.39 , $626.20 , $697.50 , $656.12 , $697.50 , $697.50 , $697.50 , $658.75 , $71.95 , $715.56 , $736.25 , $658.75 , $720.75 , $720.75 , $736.25 , $744.00 , $634.11 , $697.50 , $658.75 , $612.25 , N/A , $627.21 , $627.21 , $736.25 , $665.03 , $35.78 , $744.00 
 Pro MRI Chest Spine W/O Dye ,CPT® 72146,0972 - PRO FEE/RAD/DX,N/A,N/A, $773.00 , $502.45 ," $1,369.76 ", $195.41 , $423.92 ," $1,065.70 "," $2,013.41 ", $718.89 , $695.70 , $695.70 , $618.40 , $618.40 , $423.92 , $713.71 , $734.35 , $695.70 , $695.70 , $695.70 , $718.89 , $742.08 ," $1,172.15 ", $657.05 ," $2,195.69 "," $2,079.70 ", N/A ," $1,086.50 "," $1,086.50 ", $734.35 ," $1,257.63 ", $195.41 ," $2,195.69 "
Exc Skin Benig <5mm Remaindr Body,11420,N/A,N/A,N/A, $554.00 , $360.10 , $266.56 , $79.82 , $70.33 , $222.80 , $220.55 , $515.22 , $498.60 , $498.60 , $443.20 , $443.20 , $70.33 , $511.51 , $526.30 , $498.60 , $498.60 , $498.60 , $515.22 , $531.84 , $290.68 , $470.90 , $435.31 , $287.24 , N/A , $227.15 , $227.15 , $526.30 , $263.42 , $70.33 , $531.84 
 Pro Treatment of Heel Fracture ,CPT® 28400,0982 - PRO FEE/OUTPT,N/A,N/A," $1,673.00 "," $1,087.45 "," $1,427.86 ", $226.27 , $230.52 ," $1,105.57 "," $1,134.26 "," $1,555.89 "," $1,505.70 "," $1,505.70 "," $1,338.40 "," $1,338.40 ", $230.52 ," $1,544.68 "," $1,589.35 "," $1,505.70 "," $1,505.70 "," $1,505.70 "," $1,555.89 "," $1,606.08 "," $1,314.98 "," $1,422.05 "," $1,238.14 "," $1,313.86 ", N/A ," $1,127.14 "," $1,127.14 "," $1,589.35 "," $1,324.78 ", $226.27 ," $1,606.08 "
Removal of Talus,CPT® 28130,N/A,N/A,N/A," $4,350.00 "," $2,827.50 "," $3,783.39 ", $586.58 , $845.22 ," $3,022.13 "," $3,507.41 "," $4,045.50 "," $3,915.00 "," $3,915.00 "," $3,480.00 "," $3,480.00 ", $845.22 ," $4,016.36 "," $4,132.50 "," $3,915.00 "," $3,915.00 "," $3,915.00 "," $4,045.50 "," $4,176.00 "," $3,548.92 "," $3,697.50 "," $3,869.64 "," $4,149.18 ", N/A ," $3,081.09 "," $3,081.09 "," $4,132.50 "," $3,621.39 ", $586.58 ," $4,176.00 "
 Pro Colonoscopy Flx Dx W/Collj Spec When Pfrmd ,CPT® 45378,0982 - PRO FEE/OUTPT,N/A,N/A," $2,697.00 "," $1,753.05 "," $2,171.13 ", $174.38 , $351.69 ," $1,042.81 "," $1,052.25 "," $2,508.21 "," $2,427.30 "," $2,427.30 "," $2,157.60 "," $2,157.60 ", $351.69 ," $2,490.14 "," $2,562.15 "," $2,427.30 "," $2,427.30 "," $2,427.30 "," $2,508.21 "," $2,589.12 "," $1,335.02 "," $2,292.45 "," $1,156.07 "," $1,074.52 ", N/A ," $1,063.16 "," $1,063.16 "," $2,562.15 "," $1,276.23 ", $174.38 ," $2,589.12 "
"Exc Sweat Gland Lesn Perineal,Complx",CPT® 11471,N/A,N/A,N/A," $2,722.00 "," $1,769.30 "," $1,113.40 ", $332.57 , $345.88 , $939.58 , $928.20 ," $2,531.46 "," $2,449.80 "," $2,449.80 "," $2,177.60 "," $2,177.60 ", $345.88 ," $2,513.22 "," $2,585.90 "," $2,449.80 "," $2,449.80 "," $2,449.80 "," $2,531.46 "," $2,613.12 "," $1,211.01 "," $2,313.70 "," $1,858.99 "," $1,212.73 ", N/A , $957.91 , $957.91 ," $2,585.90 "," $1,110.87 ", $332.57 ," $2,613.12 "
Iiv3 Vaccine Split Virus 0.5 Ml Dosage Im Use,CPT® 90658,N/A,N/A,N/A, $42.00 , $27.30 , N/A , N/A , $31.00 , $34.30 , $35.86 , $39.06 , $37.80 , $37.80 , $33.60 , $33.60 , $31.00 , $38.78 , $39.90 , $37.80 , $37.80 , $37.80 , $39.06 , $40.32 , N/A , $35.70 , $47.64 , $29.97 , N/A , $34.96 , $34.96 , $39.90 , $40.76 , $29.97 , $47.64 
Hospital IP/Obs Care Same Date High Mdm 85 Min,CPT® 99236,N/A,N/A,N/A, $675.00 , $438.75 , $422.12 , $203.44 , $233.79 , $376.83 , $376.09 , $627.75 , $607.50 , $607.50 , $540.00 , $540.00 , $233.79 , $623.23 , $641.25 , $607.50 , $607.50 , $607.50 , $627.75 , $648.00 , $635.81 , $573.75 , $468.07 , $478.40 , $285.00 , $384.18 , $384.18 , $641.25 , $443.09 , $203.44 , $648.00 
 Pro Home/Res Visit Est Patient Mod Mdm 40 Minutes ,CPT® 99349,0987 - PRO FEE/HOS VIS,N/A,N/A, $328.00 , $213.20 , $256.54 , $124.28 , $100.42 , $221.05 , $221.63 , $305.04 , $295.20 , $295.20 , $262.40 , $262.40 , $100.42 , $302.84 , $311.60 , $295.20 , $295.20 , $295.20 , $305.04 , $314.88 , $233.75 , $278.80 , $275.29 , $281.82 , $192.00 , $225.37 , $225.37 , $311.60 , $259.93 , $100.42 , $314.88 
 LIDOCAINE 5 % EX OINT ,HCPCS RXA250,0250 - PHARMACY,68462-0418-20,35.44 gram," $1,626.63 "," $1,057.31 "," $1,366.37 ", N/A , N/A ," $1,314.32 "," $1,463.97 "," $1,377.10 "," $1,463.97 "," $1,463.97 "," $1,463.97 "," $1,382.64 ", N/A ," $1,501.87 "," $1,545.30 "," $1,382.64 "," $1,512.77 "," $1,512.77 "," $1,545.30 "," $1,561.56 "," $1,330.91 "," $1,463.97 "," $1,382.64 "," $1,285.04 ", N/A ," $1,316.43 "," $1,316.43 "," $1,545.30 "," $1,395.81 "," $1,285.04 "," $1,561.56 "
Deep Muscle Biopsy,20205,N/A,N/A,N/A," $1,139.00 ", $740.35 , $904.67 , $141.15 , $153.67 , $740.12 , $731.81 ," $1,059.27 "," $1,025.10 "," $1,025.10 ", $911.20 , $911.20 , $153.67 ," $1,051.64 "," $1,082.05 "," $1,025.10 "," $1,025.10 "," $1,025.10 "," $1,059.27 "," $1,093.44 ", $843.69 , $968.15 , $817.10 , $863.72 , N/A , $754.56 , $754.56 ," $1,082.05 ", $886.88 , $141.15 ," $1,093.44 "
TREAT HIP DISLOCATION,27257,N/A,N/A,N/A," $2,500.00 "," $1,625.00 "," $2,175.49 ", $340.85 , $307.34 ," $1,651.36 "," $1,600.28 "," $2,325.00 "," $2,250.00 "," $2,250.00 "," $2,000.00 "," $2,000.00 ", $307.34 ," $2,308.25 "," $2,375.00 "," $2,250.00 "," $2,250.00 "," $2,250.00 "," $2,325.00 "," $2,400.00 "," $2,030.92 "," $2,125.00 "," $1,766.22 "," $2,061.04 ", N/A ," $1,683.57 "," $1,683.57 "," $2,375.00 "," $1,978.80 ", $307.34 ," $2,400.00 "
 GLUCOSE 40 % PO GEL ,HCPCS RXC637,0250 - PHARMACY,00574-0069-15,3 each, $40.46 , $26.30 , $33.99 , N/A , N/A , $32.69 , $36.41 , $34.25 , $36.41 , $36.41 , $36.41 , $34.39 , N/A , $37.36 , $38.44 , $34.39 , $37.63 , $37.63 , $38.44 , $38.84 , $33.10 , $36.41 , $34.39 , $31.96 , N/A , $32.74 , $32.74 , $38.44 , $34.72 , $31.96 , $38.84 
Treat Hip Dislocation,CPT® 27265,N/A,N/A,N/A," $2,643.00 "," $1,717.95 "," $2,514.92 ", $401.80 , $336.07 ," $1,923.46 "," $1,959.11 "," $2,457.99 "," $2,378.70 "," $2,378.70 "," $2,114.40 "," $2,114.40 ", $336.07 ," $2,440.28 "," $2,510.85 "," $2,378.70 "," $2,378.70 "," $2,378.70 "," $2,457.99 "," $2,537.28 "," $2,304.80 "," $2,246.55 "," $2,151.58 "," $2,290.13 ", N/A ," $1,960.98 "," $1,960.98 "," $2,510.85 "," $2,304.84 ", $336.07 ," $2,537.28 "
 Fac Colonoscopy Stoma W/Endoscopic Mucosal Rescj ,CPT® 44403,0360 - OR SERVICES,N/A,N/A," $3,909.00 "," $2,540.85 "," $3,283.56 ", $288.12 , $210.78 ," $3,158.47 "," $3,518.10 "," $3,309.36 "," $3,518.10 "," $3,518.10 "," $3,518.10 "," $3,322.65 ", $206.65 ," $3,609.18 "," $3,713.55 "," $3,322.65 "," $3,635.37 "," $3,635.37 "," $3,713.55 "," $3,752.64 "," $3,198.34 "," $3,518.10 "," $3,322.65 "," $3,088.11 ", N/A ," $3,163.55 "," $3,163.55 "," $3,713.55 "," $3,354.31 ", $206.65 ," $3,752.64 "
"Open Rx Carpal Bone Fx,Each Bone",CPT® 25645,N/A,N/A,N/A," $3,729.00 "," $2,423.85 "," $3,495.05 ", $548.91 , $481.11 ," $2,743.96 "," $2,730.76 "," $3,467.97 "," $3,356.10 "," $3,356.10 "," $2,983.20 "," $2,983.20 ", $481.11 ," $3,442.99 "," $3,542.55 "," $3,356.10 "," $3,356.10 "," $3,356.10 "," $3,467.97 "," $3,579.84 "," $3,244.12 "," $3,169.65 "," $3,015.07 "," $3,231.19 ", N/A ," $2,797.51 "," $2,797.51 "," $3,542.55 "," $3,288.05 ", $481.11 ," $3,579.84 "
 MELATONIN 1 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,80681-0041-00,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Thoracoscopy With Biopsyies of Pleura,CPT® 32609,N/A,N/A,N/A," $2,104.00 "," $1,367.60 "," $1,335.27 ", $233.19 , $200.72 , $983.01 ," $1,000.00 "," $1,956.72 "," $1,893.60 "," $1,893.60 "," $1,683.20 "," $1,683.20 ", $200.72 ," $1,942.62 "," $1,998.80 "," $1,893.60 "," $1,893.60 "," $1,893.60 "," $1,956.72 "," $2,019.84 "," $1,295.08 "," $1,788.40 "," $1,448.66 "," $1,290.27 ", N/A ," $1,002.20 "," $1,002.20 "," $1,998.80 "," $1,180.31 ", $200.72 ," $2,019.84 "
" Pro Lap, Repair Paraesophageal Hernia, Incl Fundoplasty W/ Mesh ",CPT® 43282,0975 - PRO FEE/OR,N/A,N/A," $11,471.00 "," $7,456.15 "," $10,226.26 "," $1,580.54 "," $1,453.36 "," $8,156.96 "," $8,197.06 "," $10,668.03 "," $10,323.90 "," $10,323.90 "," $9,176.80 "," $9,176.80 "," $1,453.36 "," $10,591.17 "," $10,897.45 "," $10,323.90 "," $10,323.90 "," $10,323.90 "," $10,668.03 "," $11,012.16 "," $7,344.18 "," $9,750.35 "," $9,137.98 "," $9,590.48 ", N/A ," $8,316.11 "," $8,316.11 "," $10,897.45 "," $8,697.77 "," $1,453.36 "," $11,012.16 "
 Pro Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Std ,CPT® 93925,0972 - PRO FEE/RAD/DX,N/A,N/A, $304.00 , $197.60 ," $1,539.14 ", $235.61 , $209.65 ," $1,405.73 "," $1,423.41 ", $282.72 , $273.60 , $273.60 , $243.20 , $243.20 , $209.65 , $280.68 , $288.80 , $273.60 , $273.60 , $273.60 , $282.72 , $291.84 ," $1,092.19 ", $258.40 , $765.36 , $989.11 , N/A ," $1,433.16 "," $1,433.16 ", $288.80 ," $1,588.67 ", $209.65 ," $1,588.67 "
" Fac Vein X-Ray, Liver Without Hemodynamic Eval ",CPT® 75889,0320 - DX X-RAY,N/A,N/A," $1,206.00 ", $783.90 ," $1,013.04 ", $121.59 , $221.98 , $974.45 ," $1,085.40 "," $1,021.00 "," $1,085.40 "," $1,085.40 "," $1,085.40 "," $1,025.10 ", $217.63 ," $1,113.50 "," $1,145.70 "," $1,025.10 "," $1,121.58 "," $1,121.58 "," $1,145.70 "," $1,157.76 ", $986.75 ," $1,085.40 "," $1,025.10 ", $952.74 , N/A , $976.02 , $976.02 ," $1,145.70 "," $1,034.87 ", $121.59 ," $1,157.76 "
 Pro Smpl Rpr Supfc S/N/Ax/G/T 2.5cm/< ,CPT® 12001,0981 - PRO FEE/ER,N/A,N/A, $505.00 , $328.25 , $140.22 , $41.72 , $52.39 , $121.02 , $117.45 , $469.65 , $454.50 , $454.50 , $404.00 , $404.00 , $52.39 , $466.27 , $479.75 , $454.50 , $454.50 , $454.50 , $469.65 , $484.80 , $152.67 , $429.25 , $235.50 , $154.59 , N/A , $123.38 , $123.38 , $479.75 , $143.07 , $41.72 , $484.80 
 PENTAMIDINE ISETHIONATE 300 MG INH SOLR ,HCPCS RXC637,0250 - PHARMACY,63323-0877-15,6 mL," $1,028.77 ", $668.70 , $864.17 , N/A , N/A , $831.25 , $925.89 , $870.96 , $925.89 , $925.89 , $925.89 , $874.45 , N/A , $949.86 , $977.33 , $874.45 , $956.76 , $956.76 , $977.33 , $987.62 , $841.74 , $925.89 , $874.45 , $812.73 , N/A , $832.58 , $832.58 , $977.33 , $882.79 , $812.73 , $987.62 
 MINERAL OIL PO OIL ,HCPCS RXC637,0250 - PHARMACY,17856-0832-01,30 mL, $10.18 , $6.62 , $8.55 , N/A , N/A , $8.23 , $9.16 , $8.62 , $9.16 , $9.16 , $9.16 , $8.65 , N/A , $9.40 , $9.67 , $8.65 , $9.47 , $9.47 , $9.67 , $9.77 , $8.33 , $9.16 , $8.65 , $8.04 , N/A , $8.24 , $8.24 , $9.67 , $8.74 , $8.04 , $9.77 
" Fac Rhythm Ecg, Tracing ",CPT® 93041,0730 - EKG/ECG,N/A,N/A, $224.00 , $145.60 , $188.16 , $5.69 , $5.70 , $180.99 , $201.60 , $189.64 , $201.60 , $201.60 , $201.60 , $190.40 , $5.59 , $206.82 , $212.80 , $190.40 , $208.32 , $208.32 , $212.80 , $215.04 , $183.28 , $201.60 , $190.40 , $176.96 , N/A , $181.28 , $181.28 , $212.80 , $192.21 , $5.59 , $215.04 
 CYTARABINE (PF) 100 MG/ML IJ SOLN ,HCPCS J9100,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0120-20,20 mL, $128.84 , $83.75 , $108.23 , $0.94 , $1.04 , $104.10 , $115.96 , $109.08 , $115.96 , $115.96 , $115.96 , $109.51 , $1.02 , $118.96 , $122.40 , $109.51 , $119.82 , $119.82 , $122.40 , $123.69 , $105.42 , $115.96 , $109.51 , $101.78 , N/A , $104.27 , $104.27 , $122.40 , $110.56 , $0.94 , $123.69 
 Pro Cltx Dstl Phlngl Fx Fngr/Thmb W/Mnpj Ea ,CPT® 26755,0981 - PRO FEE/ER,N/A,N/A," $1,497.00 ", $973.05 ," $1,701.51 ", $269.64 , $63.53 ," $1,312.50 "," $1,334.43 "," $1,392.21 "," $1,347.30 "," $1,347.30 "," $1,197.60 "," $1,197.60 ", $63.53 ," $1,382.18 "," $1,422.15 "," $1,347.30 "," $1,347.30 "," $1,347.30 "," $1,392.21 "," $1,437.12 "," $1,574.04 "," $1,272.45 "," $1,464.72 "," $1,562.15 ", N/A ," $1,338.12 "," $1,338.12 "," $1,422.15 "," $1,572.76 ", $63.53 ," $1,701.51 "
"Control Throat Bleed,Compl in Hosp",CPT® 42961,N/A,N/A,N/A," $2,670.00 "," $1,735.50 "," $2,588.50 ", $406.67 , $279.04 ," $2,041.34 "," $2,103.95 "," $2,483.10 "," $2,403.00 "," $2,403.00 "," $2,136.00 "," $2,136.00 ", $279.04 ," $2,465.21 "," $2,536.50 "," $2,403.00 "," $2,403.00 "," $2,403.00 "," $2,483.10 "," $2,563.20 "," $1,840.23 "," $2,269.50 "," $2,294.31 "," $2,383.36 ", N/A ," $2,081.18 "," $2,081.18 "," $2,536.50 "," $2,176.69 ", $279.04 ," $2,588.50 "
Psychotherapy W/Patient 60 Minutes,90837,N/A,N/A,N/A, $211.00 , $137.15 , $174.64 , $129.40 , $115.70 , $282.88 , $254.06 , $196.23 , $189.90 , $189.90 , $168.80 , $168.80 , $115.70 , $194.82 , $200.45 , $189.90 , $189.90 , $189.90 , $196.23 , $202.56 , $334.66 , $179.35 , $330.47 , $481.69 , $175.00 , $288.40 , $288.40 , $200.45 , $336.21 , $115.70 , $481.69 
 TROSPIUM CHLORIDE 20 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,23155-0530-06,1 tablet, $14.58 , $9.48 , $12.25 , N/A , N/A , $11.78 , $13.12 , $12.34 , $13.12 , $13.12 , $13.12 , $12.39 , N/A , $13.46 , $13.85 , $12.39 , $13.56 , $13.56 , $13.85 , $14.00 , $11.93 , $13.12 , $12.39 , $11.52 , N/A , $11.80 , $11.80 , $13.85 , $12.51 , $11.52 , $14.00 
 Tcat Rmvl/Debulk Icar Mass Suction Dvc Perq ,CPT® 0644T,0360 - OR SERVICES,N/A,N/A," $3,073.00 "," $1,997.45 "," $2,581.32 ", $280.65 , N/A ," $2,482.98 "," $2,765.70 "," $2,601.60 "," $2,765.70 "," $2,765.70 "," $2,765.70 "," $2,612.05 ", N/A ," $2,837.30 "," $2,919.35 "," $2,612.05 "," $2,857.89 "," $2,857.89 "," $2,919.35 "," $2,950.08 "," $2,514.33 "," $2,765.70 "," $2,612.05 "," $2,427.67 ", N/A ," $2,486.98 "," $2,486.98 "," $2,919.35 "," $2,636.94 ", $280.65 ," $2,950.08 "
 Fac Sensory Integration ,CPT® 97533,0430 - OCCUPATION THER,N/A,N/A, $146.00 , $94.90 , $122.64 , $63.00 , $20.40 , $117.97 , $131.40 , $123.60 , $131.40 , $131.40 , $131.40 , $124.10 , $20.00 , $134.80 , $138.70 , $124.10 , $135.78 , $135.78 , $138.70 , $140.16 , $119.46 , $131.40 , $124.10 , $115.34 , N/A , $118.16 , $118.16 , $138.70 , $125.28 , $20.00 , $140.16 
Vitamin B12,CPT® 82607,N/A,N/A,N/A, $165.00 , $107.25 , N/A , $15.38 , $15.38 , $85.27 , $102.01 , $153.45 , $148.50 , $148.50 , $132.00 , $132.00 , $15.38 , $152.34 , $156.75 , $148.50 , $148.50 , $148.50 , $153.45 , $158.40 , $100.69 , $140.25 , $98.93 , $54.66 , N/A , $79.58 , $79.58 , $156.75 , $86.96 , $15.38 , $158.40 
"Remove Spinal Neurostim Electrode Perc Array, Incl Fluoro",63661,N/A,N/A,N/A," $2,715.00 "," $1,764.75 "," $1,585.17 ", $309.25 , $463.01 ," $1,789.69 "," $1,740.60 "," $2,524.95 "," $2,443.50 "," $2,443.50 "," $2,172.00 "," $2,172.00 ", $463.01 ," $2,506.76 "," $2,579.25 "," $2,443.50 "," $2,443.50 "," $2,443.50 "," $2,524.95 "," $2,606.40 "," $1,708.40 "," $2,307.75 "," $1,714.49 "," $1,919.56 ", N/A ," $1,824.61 "," $1,824.61 "," $2,579.25 "," $1,957.35 ", $309.25 ," $2,606.40 "
Apolipoprotein,CPT® 82172,N/A,N/A,N/A, $150.00 , $97.50 , N/A , $21.51 , $21.51 , $87.68 , $104.87 , $139.50 , $135.00 , $135.00 , $120.00 , $120.00 , $21.51 , $138.50 , $142.50 , $135.00 , $135.00 , $135.00 , $139.50 , $144.00 , $140.82 , $127.50 , $102.18 , $61.94 , N/A , $81.83 , $81.83 , $142.50 , $89.42 , $21.51 , $144.00 
"Muscle-Skin Flap,Arm",CPT® 15736,N/A,N/A,N/A," $9,450.00 "," $6,142.50 "," $3,852.30 "," $1,150.52 "," $1,516.95 "," $3,097.97 "," $3,042.93 "," $8,788.50 "," $8,505.00 "," $8,505.00 "," $7,560.00 "," $7,560.00 "," $1,516.95 "," $8,725.19 "," $8,977.50 "," $8,505.00 "," $8,505.00 "," $8,505.00 "," $8,788.50 "," $9,072.00 "," $4,233.88 "," $8,032.50 "," $6,121.12 "," $4,272.03 ", N/A ," $3,158.42 "," $3,158.42 "," $8,977.50 "," $3,662.69 "," $1,150.52 "," $9,072.00 "
Open Rx Periartic Fx/Disloc Elbow,24586,N/A,N/A,N/A," $4,283.00 "," $2,783.95 "," $6,584.63 "," $1,029.82 ", $934.20 ," $5,225.54 "," $5,173.18 "," $3,983.19 "," $3,854.70 "," $3,854.70 "," $3,426.40 "," $3,426.40 ", $934.20 ," $3,954.49 "," $4,068.85 "," $3,854.70 "," $3,854.70 "," $3,854.70 "," $3,983.19 "," $4,111.68 "," $6,134.89 "," $3,640.55 "," $5,717.93 "," $6,164.46 ", N/A ," $5,327.49 "," $5,327.49 "," $4,068.85 "," $6,261.69 ", $934.20 ," $6,584.63 "
 Fac Plmt Access Thru Biliary Tree Into Small Bwl New ,CPT® 47541,0361 - OR/MINOR,N/A,N/A," $5,982.00 "," $3,888.30 "," $5,024.88 ", $317.31 , $935.54 ," $4,833.46 "," $5,383.80 "," $5,064.36 "," $5,383.80 "," $5,383.80 "," $5,383.80 "," $5,084.70 ", $917.20 ," $5,523.18 "," $5,682.90 "," $5,084.70 "," $5,563.26 "," $5,563.26 "," $5,682.90 "," $5,742.72 "," $4,894.47 "," $5,383.80 "," $5,084.70 "," $4,725.78 ", N/A ," $4,841.23 "," $4,841.23 "," $5,682.90 "," $5,133.15 ", $317.31 ," $5,742.72 "
1st/Sbsq Psych Collab Care Mgmt Ea Addl 30 Mins,CPT® 99494,N/A,N/A,N/A, $207.00 , $134.55 , $80.60 , $39.50 , $61.72 , $69.81 , $74.04 , $192.51 , $186.30 , $186.30 , $165.60 , $165.60 , $61.72 , $191.12 , $196.65 , $186.30 , $186.30 , $186.30 , $192.51 , $198.72 , $74.13 , $175.95 , $89.65 , $94.00 , N/A , $71.17 , $71.17 , $196.65 , $82.09 , $39.50 , $198.72 
Somatomedin,CPT® 84305,N/A,N/A,N/A, $281.00 , $182.65 , N/A , $21.69 , $21.69 , $120.28 , $143.86 , $261.33 , $252.90 , $252.90 , $224.80 , $224.80 , $21.69 , $259.45 , $266.95 , $252.90 , $252.90 , $252.90 , $261.33 , $269.76 , $141.96 , $238.85 , $139.48 , $77.10 , N/A , $112.25 , $112.25 , $266.95 , $122.66 , $21.69 , $269.76 
Debridement Prmlg Hyperkeratotic Les W/Pdt,CPT® 96574,N/A,N/A,N/A, $970.00 , $630.50 , $668.52 , $277.67 , N/A , $508.02 , $539.02 , $902.10 , $873.00 , $873.00 , $776.00 , $776.00 , N/A , $895.60 , $921.50 , $873.00 , $873.00 , $873.00 , $902.10 , $931.20 , $885.68 , $824.50 , $851.15 , $923.97 , N/A , $517.94 , $517.94 , $921.50 , $603.81 , $277.67 , $931.20 
Initial Hosp Neonate 28 D/< Not Critically Ill,CPT® 99477,N/A,N/A,N/A," $2,232.00 "," $1,450.80 ", $926.69 , $330.68 , $310.69 , $951.61 , $944.28 ," $2,075.76 "," $2,008.80 "," $2,008.80 "," $1,785.60 "," $1,785.60 ", $310.69 ," $2,060.81 "," $2,120.40 "," $2,008.80 "," $2,008.80 "," $2,008.80 "," $2,075.76 "," $2,142.72 ", $876.98 ," $1,897.20 ", $754.61 ," $1,157.14 ", N/A , $970.17 , $970.17 ," $2,120.40 "," $1,160.82 ", $310.69 ," $2,142.72 "
 Fac Revsc Opn/Prg Fem/Pop W/Angioplasty Uni ,CPT® 37224,0360 - OR SERVICES,N/A,N/A," $14,525.00 "," $9,441.25 "," $12,201.00 ", $396.94 , $337.90 ," $11,736.20 "," $13,072.50 "," $12,296.87 "," $13,072.50 "," $13,072.50 "," $13,072.50 "," $12,346.25 ", $331.27 ," $13,410.93 "," $13,798.75 "," $12,346.25 "," $13,508.25 "," $13,508.25 "," $13,798.75 "," $13,944.00 "," $11,884.36 "," $13,072.50 "," $12,346.25 "," $11,474.75 ", N/A ," $11,755.08 "," $11,755.08 "," $13,798.75 "," $12,463.90 ", $331.27 ," $13,944.00 "
 Fac Emergency Level IV ,CPT® 99284,0450 - EMERGENCY SERVICES,N/A,N/A," $1,446.00 ", $939.90 ," $1,214.64 ", $116.35 , $31.98 ," $1,168.37 "," $1,301.40 "," $1,224.18 "," $1,301.40 "," $1,301.40 "," $1,301.40 "," $1,229.10 ", $31.35 ," $1,335.09 "," $1,373.70 "," $1,229.10 "," $1,344.78 "," $1,344.78 "," $1,373.70 "," $1,388.16 "," $1,183.12 "," $1,301.40 "," $1,229.10 "," $1,142.34 ", N/A ," $1,170.25 "," $1,170.25 "," $1,373.70 "," $1,240.81 ", $31.35 ," $1,388.16 "
Office/Outpatient Established Low Mdm 20-29 Min,CPT® 99213,N/A,N/A,N/A, $197.00 , $128.05 , $134.27 , $64.08 , $41.21 , $87.92 , $87.90 , $183.21 , $177.30 , $177.30 , $157.60 , $157.60 , $41.21 , $181.89 , $187.15 , $177.30 , $177.30 , $177.30 , $183.21 , $189.12 , $122.57 , $167.45 , $109.52 , $112.10 , $64.00 , $89.64 , $89.64 , $187.15 , $103.40 , $41.21 , $189.12 
 EPINEPHRINE 0.15 MG/0.3ML IJ SOAJ ,HCPCS RXC637,0250 - PHARMACY,49502-0101-02,0.3 mL, $963.17 , $626.06 , $809.06 , N/A , N/A , $778.24 , $866.85 , $815.42 , $866.85 , $866.85 , $866.85 , $818.69 , N/A , $889.29 , $915.01 , $818.69 , $895.75 , $895.75 , $915.01 , $924.64 , $788.07 , $866.85 , $818.69 , $760.90 , N/A , $779.49 , $779.49 , $915.01 , $826.50 , $760.90 , $924.64 
"Fx Radial & Ulnar,Closed",CPT® 25560,N/A,N/A,N/A," $1,798.00 "," $1,168.70 "," $1,610.31 ", $255.85 , $202.15 ," $1,207.93 "," $1,232.28 "," $1,672.14 "," $1,618.20 "," $1,618.20 "," $1,438.40 "," $1,438.40 ", $202.15 ," $1,660.09 "," $1,708.10 "," $1,618.20 "," $1,618.20 "," $1,618.20 "," $1,672.14 "," $1,726.08 "," $1,481.60 "," $1,528.30 "," $1,352.32 "," $1,443.52 ", N/A ," $1,231.51 "," $1,231.51 "," $1,708.10 "," $1,447.45 ", $202.15 ," $1,726.08 "
 Pro Open Bone Biopsy ,CPT® 20250,0982 - PRO FEE/OUTPT,N/A,N/A," $2,624.00 "," $1,705.60 "," $2,304.90 ", $362.39 , $284.25 ," $1,872.62 "," $1,855.73 "," $2,440.32 "," $2,361.60 "," $2,361.60 "," $2,099.20 "," $2,099.20 ", $284.25 ," $2,422.74 "," $2,492.80 "," $2,361.60 "," $2,361.60 "," $2,361.60 "," $2,440.32 "," $2,519.04 "," $2,168.98 "," $2,230.40 "," $2,062.38 "," $2,166.38 ", N/A ," $1,909.16 "," $1,909.16 "," $2,492.80 "," $2,243.92 ", $284.25 ," $2,519.04 "
Influenza Vaccine Splt Prsrv Free Inc Antigen Im,CPT® 90662,N/A,N/A,N/A, $95.00 , $61.75 , N/A , $71.34 , $86.64 , $72.50 , $94.59 , $88.35 , $85.50 , $85.50 , $76.00 , $76.00 , $86.64 , $87.71 , $90.25 , $85.50 , $85.50 , $85.50 , $88.35 , $91.20 , $79.27 , $80.75 , $92.25 , $114.91 , N/A , $73.91 , $73.91 , $90.25 , $86.15 , $71.34 , $114.91 
 Pro Arthrocnts Aspir&/Njx Intrm Jt/Bursa ,CPT® 20605,0981 - PRO FEE/ER,N/A,N/A, $327.00 , $212.55 , $226.79 , $35.10 , $50.55 , $181.29 , $253.86 , $304.11 , $294.30 , $294.30 , $261.60 , $261.60 , $50.55 , $301.92 , $310.65 , $294.30 , $294.30 , $294.30 , $304.11 , $313.92 , $211.99 , $277.95 , $276.53 , $217.48 , N/A , $184.83 , $184.83 , $310.65 , $217.21 , $35.10 , $313.92 
" Acute Myocardial Infarction, Discharged Alive With Cc ",MS DRG V40 (FY2023) 281,N/A,N/A,N/A," $39,942.46 "," $25,962.60 "," $33,551.67 ", N/A , N/A ," $32,273.51 "," $35,948.21 "," $33,815.29 "," $35,948.21 "," $35,948.21 "," $35,948.21 "," $33,951.09 ", N/A ," $36,878.87 "," $37,945.34 "," $33,951.09 "," $37,146.49 "," $37,146.49 "," $37,945.34 "," $38,344.76 "," $32,680.92 "," $35,948.21 "," $33,951.09 "," $31,554.54 ", N/A ," $32,325.43 "," $32,325.43 "," $37,945.34 "," $34,274.62 "," $31,554.54 "," $38,344.76 "
Bronchospasm Evaluation,CPT® 94060,N/A,N/A,N/A, $389.00 , $252.85 , $89.95 , $37.70 , $53.79 , $134.43 , $144.38 , $361.77 , $350.10 , $350.10 , $311.20 , $311.20 , $53.79 , $359.16 , $369.55 , $350.10 , $350.10 , $350.10 , $361.77 , $373.44 , $140.25 , $330.65 , $191.59 , $229.15 , N/A , $137.05 , $137.05 , $369.55 , $159.78 , $37.70 , $373.44 
 Manual Differential ,CPT® 85007,0305 - LAB/HEMATOLOGY,N/A,N/A, $31.00 , $20.15 , $26.04 , $3.88 , $3.88 , $25.05 , $27.90 , $26.24 , $27.90 , $27.90 , $27.90 , $26.35 , $3.80 , $28.62 , $29.45 , $26.35 , $28.83 , $28.83 , $29.45 , $29.76 , $25.36 , $27.90 , $26.35 , $24.49 , N/A , $25.09 , $25.09 , $29.45 , $26.60 , $3.80 , $29.76 
 Pro Incision of Tendon Sheath ,CPT® 25000,0975 - PRO FEE/OR,N/A,N/A," $2,059.00 "," $1,338.35 "," $2,132.91 ", $337.40 , $307.34 ," $1,618.68 "," $1,636.56 "," $1,914.87 "," $1,853.10 "," $1,853.10 "," $1,647.20 "," $1,647.20 ", $307.34 ," $1,901.07 "," $1,956.05 "," $1,853.10 "," $1,853.10 "," $1,853.10 "," $1,914.87 "," $1,976.64 "," $1,968.73 "," $1,750.15 "," $1,792.98 "," $1,930.07 ", N/A ," $1,650.26 "," $1,650.26 "," $1,956.05 "," $1,939.63 ", $307.34 ," $2,132.91 "
"Remove Foreign Body,Foot",28190,N/A,N/A,N/A, $961.00 , $624.65 , $821.41 , $128.35 , $42.71 , $660.87 , $659.35 , $893.73 , $864.90 , $864.90 , $768.80 , $768.80 , $42.71 , $887.29 , $912.95 , $864.90 , $864.90 , $864.90 , $893.73 , $922.56 , $767.83 , $816.85 , $713.63 , $787.33 , N/A , $673.77 , $673.77 , $912.95 , $791.93 , $42.71 , $922.56 
Revise/Repair Arm/Leg Nerve,CPT® 64708,N/A,N/A,N/A," $3,287.00 "," $2,136.55 "," $2,462.41 ", $482.54 , $614.70 ," $2,746.89 "," $2,681.85 "," $3,056.91 "," $2,958.30 "," $2,958.30 "," $2,629.60 "," $2,629.60 ", $614.70 ," $3,034.89 "," $3,122.65 "," $2,958.30 "," $2,958.30 "," $2,958.30 "," $3,056.91 "," $3,155.52 "," $2,681.02 "," $2,793.95 "," $2,652.90 "," $2,944.68 ", N/A ," $2,800.48 "," $2,800.48 "," $3,122.65 "," $3,004.26 ", $482.54 ," $3,155.52 "
 ISOSORBIDE MONONITRATE ER 15 MG TAB (COMES FROM 30 MG TABLET) ,HCPCS RXC637,0250 - PHARMACY,00001-0920-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Injection Aa&/Strd Genicular Nrv Branches W/Img ,CPT® 64454,0360 - OR SERVICES,N/A,N/A," $1,951.00 "," $1,268.15 "," $1,638.84 ", $79.01 , $168.18 ," $1,576.41 "," $1,755.90 "," $1,651.72 "," $1,755.90 "," $1,755.90 "," $1,755.90 "," $1,658.35 ", $164.88 ," $1,801.36 "," $1,853.45 "," $1,658.35 "," $1,814.43 "," $1,814.43 "," $1,853.45 "," $1,872.96 "," $1,596.31 "," $1,755.90 "," $1,658.35 "," $1,541.29 ", N/A ," $1,578.94 "," $1,578.94 "," $1,853.45 "," $1,674.15 ", $79.01 ," $1,872.96 "
Drug Test Def 15-21 Classes,HCPCS G0482,N/A,N/A,N/A, $298.00 , $193.70 , N/A , $202.71 , $135.46 , $313.81 , N/A , $277.14 , $268.20 , $268.20 , $238.40 , $238.40 , $135.46 , $275.14 , $283.10 , $268.20 , $268.20 , $268.20 , $277.14 , $286.08 ," $1,327.03 ", $253.30 , $378.65 , $583.70 , N/A , $319.94 , $319.94 , $283.10 , $399.93 , $135.46 ," $1,327.03 "
 PERMETHRIN 5 % EX CREA ,HCPCS RXC637,0250 - PHARMACY,21922-0021-07,60 gram, $606.26 , $394.07 , $509.26 , N/A , N/A , $489.86 , $545.63 , $513.26 , $545.63 , $545.63 , $545.63 , $515.32 , N/A , $559.76 , $575.95 , $515.32 , $563.82 , $563.82 , $575.95 , $582.01 , $496.04 , $545.63 , $515.32 , $478.95 , N/A , $490.65 , $490.65 , $575.95 , $520.23 , $478.95 , $582.01 
Sono Fetal Hrt Doppl F/U,CPT® 76828,N/A,N/A,N/A, $522.00 , $339.30 , $282.46 , $48.80 , $49.20 , $258.26 , $233.89 , $485.46 , $469.80 , $469.80 , $417.60 , $417.60 , $49.20 , $481.96 , $495.90 , $469.80 , $469.80 , $469.80 , $485.46 , $501.12 , $287.03 , $443.70 , $254.24 , $299.05 , N/A , $263.30 , $263.30 , $495.90 , $304.77 , $48.80 , $501.12 
Complex Repair 1.1-2.5cm,13131,N/A,N/A,N/A," $1,487.00 ", $966.55 , $776.05 , $231.89 , $176.33 , $684.64 , $667.66 ," $1,382.91 "," $1,338.30 "," $1,338.30 "," $1,189.60 "," $1,189.60 ", $176.33 ," $1,372.95 "," $1,412.65 "," $1,338.30 "," $1,338.30 "," $1,338.30 "," $1,382.91 "," $1,427.52 ", $855.05 ," $1,263.95 "," $1,330.91 ", $878.14 , N/A , $698.00 , $698.00 ," $1,412.65 ", $809.44 , $176.33 ," $1,427.52 "
 Fac Fibrinogen ,CPT® 85384,0305 - LAB/HEMATOLOGY,N/A,N/A, $118.00 , $76.70 , $99.12 , $9.91 , $9.91 , $95.34 , $106.20 , $99.90 , $106.20 , $106.20 , $106.20 , $100.30 , $9.72 , $108.95 , $112.10 , $100.30 , $109.74 , $109.74 , $112.10 , $113.28 , $96.55 , $106.20 , $100.30 , $93.22 , N/A , $95.50 , $95.50 , $112.10 , $101.26 , $9.72 , $113.28 
Cast Sup Sht Leg Splnt Ped F,HCPCS Q4048,N/A,N/A,N/A, $23.00 , $14.95 , N/A , $11.33 , $6.92 , N/A , N/A , $21.39 , $20.70 , $20.70 , $18.40 , $18.40 , $6.92 , $21.24 , $21.85 , $20.70 , $20.70 , $20.70 , $21.39 , $22.08 , N/A , $19.55 , $33.74 , $10.28 , N/A , N/A , N/A , $21.85 , N/A , $6.92 , $33.74 
Drain Lower Leg Deep Absc/Hematoma,CPT® 27603,N/A,N/A,N/A," $3,458.00 "," $2,247.70 "," $2,394.93 ", $374.21 , $200.19 ," $1,872.04 "," $1,898.94 "," $3,215.94 "," $3,112.20 "," $3,112.20 "," $2,766.40 "," $2,766.40 ", $200.19 ," $3,192.77 "," $3,285.10 "," $3,112.20 "," $3,112.20 "," $3,112.20 "," $3,215.94 "," $3,319.68 "," $2,217.61 "," $2,939.30 "," $2,094.49 "," $2,206.18 ", N/A ," $1,908.57 "," $1,908.57 "," $3,285.10 "," $2,243.27 ", $200.19 ," $3,319.68 "
Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq,45385,N/A,N/A,N/A," $3,621.00 "," $2,353.65 "," $1,559.74 ", $240.44 , $476.76 ," $1,453.13 "," $1,492.10 "," $3,367.53 "," $3,258.90 "," $3,258.90 "," $2,896.80 "," $2,896.80 ", $476.76 ," $3,343.27 "," $3,439.95 "," $3,258.90 "," $3,258.90 "," $3,258.90 "," $3,367.53 "," $3,476.16 "," $2,094.15 "," $3,077.85 "," $1,635.99 "," $1,482.99 ", N/A ," $1,481.48 "," $1,481.48 "," $3,439.95 "," $1,549.48 ", $240.44 ," $3,476.16 "
 BUSPIRONE HCL 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,51079-0985-20,1 tablet, $3.97 , $2.58 , $3.33 , N/A , N/A , $3.21 , $3.57 , $3.36 , $3.57 , $3.57 , $3.57 , $3.37 , N/A , $3.67 , $3.77 , $3.37 , $3.69 , $3.69 , $3.77 , $3.81 , $3.25 , $3.57 , $3.37 , $3.14 , N/A , $3.21 , $3.21 , $3.77 , $3.41 , $3.14 , $3.81 
 Fac Ewhfo Rigid W/O Jnts Cf ,HCPCS L3765,0274 - PROSTHETIC DEV,N/A,N/A," $1,436.00 ", $933.40 ," $1,206.24 "," $1,365.05 ", $183.66 ," $1,160.29 "," $1,292.40 "," $1,215.72 "," $1,292.40 "," $1,292.40 "," $1,292.40 "," $1,220.60 ", $180.06 ," $1,325.86 "," $1,364.20 "," $1,220.60 "," $1,335.48 "," $1,335.48 "," $1,364.20 "," $1,378.56 "," $1,174.94 "," $1,292.40 "," $1,220.60 "," $1,134.44 ", N/A ," $1,162.15 "," $1,162.15 "," $1,364.20 "," $1,232.23 ", $180.06 ," $1,378.56 "
 MIRABEGRON ER 25 MG PO TB24 ,HCPCS RXC637,0250 - PHARMACY,00469-2601-30,1 tablet, $91.83 , $59.69 , $77.14 , N/A , N/A , $74.20 , $82.65 , $77.74 , $82.65 , $82.65 , $82.65 , $78.06 , N/A , $84.79 , $87.24 , $78.06 , $85.40 , $85.40 , $87.24 , $88.16 , $75.14 , $82.65 , $78.06 , $72.55 , N/A , $74.32 , $74.32 , $87.24 , $78.80 , $72.55 , $88.16 
Pro Rmvl/Bivalv Full Arm/Full Leg Cst,29705,N/A,N/A,N/A, $364.00 , $236.60 , $271.51 , $42.35 , $25.41 , $227.88 , $224.32 , $338.52 , $327.60 , $327.60 , $291.20 , $291.20 , $25.41 , $336.08 , $345.80 , $327.60 , $327.60 , $327.60 , $338.52 , $349.44 , $257.01 , $309.40 , $246.20 , $267.11 , N/A , $232.33 , $232.33 , $345.80 , $273.07 , $25.41 , $349.44 
Change Gastrostomy Tube,CPT® 43760,N/A,N/A,N/A," $1,037.00 ", $674.05 , N/A , N/A , N/A , $226.32 , $232.10 , $964.41 , $933.30 , $933.30 , $829.60 , $829.60 , N/A , $957.46 , $985.15 , $933.30 , $933.30 , $933.30 , $964.41 , $995.52 , N/A , $881.45 , N/A , N/A , N/A , N/A , N/A , $985.15 , N/A , $226.32 , $995.52 
"Culture, Chlamydia",CPT® 87110,N/A,N/A,N/A, $180.00 , $117.00 , N/A , $19.99 , $19.99 , $110.84 , $132.59 , $167.40 , $162.00 , $162.00 , $144.00 , $144.00 , $19.99 , $166.19 , $171.00 , $162.00 , $162.00 , $162.00 , $167.40 , $172.80 , $130.87 , $153.00 , $128.13 , $71.05 , N/A , $103.44 , $103.44 , $171.00 , $113.04 , $19.99 , $172.80 
Insert Tissue Expander(S),CPT® 11960,N/A,N/A,N/A," $3,792.00 "," $2,464.80 "," $3,250.67 ", $973.80 , $606.55 ," $2,568.17 "," $2,489.81 "," $3,526.56 "," $3,412.80 "," $3,412.80 "," $3,033.60 "," $3,033.60 ", $606.55 ," $3,501.15 "," $3,602.40 "," $3,412.80 "," $3,412.80 "," $3,412.80 "," $3,526.56 "," $3,640.32 "," $3,576.68 "," $3,223.20 "," $4,956.13 "," $3,322.10 ", N/A ," $2,618.28 "," $2,618.28 "," $3,602.40 "," $3,036.33 ", $606.55 ," $4,956.13 "
Shav Skin Les >21mm Remaindr Body,CPT® 11308,N/A,N/A,N/A, $584.00 , $379.60 , $230.28 , $67.86 , $133.89 , $202.83 , $197.81 , $543.12 , $525.60 , $525.60 , $467.20 , $467.20 , $133.89 , $539.21 , $554.80 , $525.60 , $525.60 , $525.60 , $543.12 , $560.64 , $256.80 , $496.40 , $388.93 , $263.10 , N/A , $206.78 , $206.78 , $554.80 , $239.78 , $67.86 , $560.64 
" Fac Immunoassay, Nonantibody ",CPT® 83519,0301 - LAB/CHEMISTRY,N/A,N/A, $217.00 , $141.05 , $182.28 , $18.77 , $18.76 , $175.34 , $195.30 , $183.71 , $195.30 , $195.30 , $195.30 , $184.45 , $18.39 , $200.36 , $206.15 , $184.45 , $201.81 , $201.81 , $206.15 , $208.32 , $177.55 , $195.30 , $184.45 , $171.43 , N/A , $175.62 , $175.62 , $206.15 , $186.21 , $18.39 , $208.32 
 Fac Assay of Calcium in Urine ,CPT® 82340,0301 - LAB/CHEMISTRY,N/A,N/A, $68.00 , $44.20 , $57.12 , $6.15 , $6.15 , $54.94 , $61.20 , $57.57 , $61.20 , $61.20 , $61.20 , $57.80 , $6.03 , $62.78 , $64.60 , $57.80 , $63.24 , $63.24 , $64.60 , $65.28 , $55.64 , $61.20 , $57.80 , $53.72 , N/A , $55.03 , $55.03 , $64.60 , $58.35 , $6.03 , $65.28 
Incis Achilles Tendon+Local Anesth,CPT® 27605,N/A,N/A,N/A," $1,727.00 "," $1,122.55 "," $1,138.87 ", $178.40 , $76.84 , $903.28 , $904.73 ," $1,606.11 "," $1,554.30 "," $1,554.30 "," $1,381.60 "," $1,381.60 ", $76.84 ," $1,594.54 "," $1,640.65 "," $1,554.30 "," $1,554.30 "," $1,554.30 "," $1,606.11 "," $1,657.92 "," $1,066.53 "," $1,467.95 ", $984.80 ," $1,085.90 ", N/A , $920.91 , $920.91 ," $1,640.65 "," $1,082.38 ", $76.84 ," $1,657.92 "
 Pro Treat Elbow Dislocation ,CPT® 24640,0982 - PRO FEE/OUTPT,N/A,N/A, $893.00 , $580.45 , $507.52 , $78.44 , $62.26 , $453.97 , $465.63 , $830.49 , $803.70 , $803.70 , $714.40 , $714.40 , $62.26 , $824.51 , $848.35 , $803.70 , $803.70 , $803.70 , $830.49 , $857.28 , $464.54 , $759.05 , $512.03 , $456.76 , N/A , $462.82 , $462.82 , $848.35 , $543.97 , $62.26 , $857.28 
Exc Skin Benig 0.6-1cm Remaindr Body,11421,N/A,N/A,N/A, $596.00 , $387.40 , $351.80 , $105.96 , $93.30 , $301.07 , $297.24 , $554.28 , $536.40 , $536.40 , $476.80 , $476.80 , $93.30 , $550.29 , $566.20 , $536.40 , $536.40 , $536.40 , $554.28 , $572.16 , $385.15 , $506.60 , $590.53 , $385.78 , N/A , $306.95 , $306.95 , $566.20 , $355.95 , $93.30 , $590.53 
"Exc Skin Benig 2.1-3cm Trunk,Arm,Leg",CPT® 11403,N/A,N/A,N/A, $846.00 , $549.90 , $475.69 , $143.37 , $154.53 , $399.76 , $393.99 , $786.78 , $761.40 , $761.40 , $676.80 , $676.80 , $154.53 , $781.11 , $803.70 , $761.40 , $761.40 , $761.40 , $786.78 , $812.16 , $518.92 , $719.10 , $784.99 , $515.24 , N/A , $407.56 , $407.56 , $803.70 , $472.63 , $143.37 , $812.16 
 Fac Ercp Biliary/Panc Duct Stent Exchange W/Dil&Wire ,CPT® 43276,0360 - OR SERVICES,N/A,N/A," $6,185.00 "," $4,020.25 "," $5,195.40 ", $455.52 , $378.08 ," $4,997.48 "," $5,566.50 "," $5,236.22 "," $5,566.50 "," $5,566.50 "," $5,566.50 "," $5,257.25 ", $370.67 ," $5,710.61 "," $5,875.75 "," $5,257.25 "," $5,752.05 "," $5,752.05 "," $5,875.75 "," $5,937.60 "," $5,060.57 "," $5,566.50 "," $5,257.25 "," $4,886.15 ", N/A ," $5,005.52 "," $5,005.52 "," $5,875.75 "," $5,307.35 ", $370.67 ," $5,937.60 "
 Fac Assay of Vitamin A ,CPT® 84590,0301 - LAB/CHEMISTRY,N/A,N/A, $186.00 , $120.90 , $156.24 , $11.84 , $11.84 , $150.29 , $167.40 , $157.47 , $167.40 , $167.40 , $167.40 , $158.10 , $11.61 , $171.73 , $176.70 , $158.10 , $172.98 , $172.98 , $176.70 , $178.56 , $152.19 , $167.40 , $158.10 , $146.94 , N/A , $150.53 , $150.53 , $176.70 , $159.61 , $11.61 , $178.56 
 PROMETHAZINE HCL 25 MG/ML IJ SOLN ,HCPCS J2550,0636 - DRUGS REQUIRING DETAILED CODIN,00641-0928-25,1 mL, $16.68 , $10.84 , $14.01 , $3.21 , $3.28 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $3.22 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $3.21 , $16.01 
 Pro Endoven Abltj Incmptnt Vein Xtr Rf 1st Vein ,CPT® 36475,0982 - PRO FEE/OUTPT,N/A,N/A," $11,345.00 "," $7,374.25 "," $1,630.53 ", $251.72 ," $1,608.39 "," $1,210.78 "," $1,503.17 "," $10,550.85 "," $10,210.50 "," $10,210.50 "," $9,076.00 "," $9,076.00 "," $1,608.39 "," $10,474.84 "," $10,777.75 "," $10,210.50 "," $10,210.50 "," $10,210.50 "," $10,550.85 "," $10,891.20 "," $1,513.97 "," $9,643.25 "," $1,892.89 "," $1,357.13 ", N/A ," $1,234.41 "," $1,234.41 "," $10,777.75 "," $1,402.29 ", $251.72 ," $10,891.20 "
 Pfizer Covid Vaccine Admin Booster ,CPT® 0004A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , N/A , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , N/A , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $55.30 , $67.20 
 METHACHOLINE CHLORIDE 100 MG INH SOLR ,HCPCS J7674,0636 - DRUGS REQUIRING DETAILED CODIN,64281-0100-06,1 each, $511.64 , $332.57 , $429.78 , $0.88 , $0.85 , $413.41 , $460.48 , $433.15 , $460.48 , $460.48 , $460.48 , $434.89 , $0.83 , $472.40 , $486.06 , $434.89 , $475.83 , $475.83 , $486.06 , $491.17 , $418.62 , $460.48 , $434.89 , $404.20 , N/A , $414.07 , $414.07 , $486.06 , $439.04 , $0.83 , $491.17 
Slctv Cathj Ea 2nd+ Ord Abdl Pel/Lxtr Art Brnch,CPT® 36248,N/A,N/A,N/A, $911.00 , $592.15 , $293.87 , $45.41 , $110.48 , $217.02 , $217.12 , $847.23 , $819.90 , $819.90 , $728.80 , $728.80 , $110.48 , $841.13 , $865.45 , $819.90 , $819.90 , $819.90 , $847.23 , $874.56 , $239.97 , $774.35 , $269.39 , $246.25 , N/A , $221.26 , $221.26 , $865.45 , $251.33 , $45.41 , $874.56 
 Fac Smpl Rpr Supfc S/N/Ax/G/T 2.6cm-7.5cm ,CPT® 12002,0761 - TREATMENT ROOM,N/A,N/A, $498.00 , $323.70 , $418.32 , $54.60 , $67.36 , $402.38 , $448.20 , $421.61 , $448.20 , $448.20 , $448.20 , $423.30 , $66.04 , $459.80 , $473.10 , $423.30 , $463.14 , $463.14 , $473.10 , $478.08 , $407.46 , $448.20 , $423.30 , $393.42 , N/A , $403.03 , $403.03 , $473.10 , $427.33 , $54.60 , $478.08 
 LITHIUM CARBONATE 300 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00054-8528-25,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Introduction of Long GI Tube ,CPT® 44500,0750 - GASTR-INST SVS,N/A,N/A," $1,844.00 "," $1,198.60 "," $1,548.96 ", $18.51 , $24.57 ," $1,489.95 "," $1,659.60 "," $1,561.13 "," $1,659.60 "," $1,659.60 "," $1,659.60 "," $1,567.40 ", $24.09 ," $1,702.57 "," $1,751.80 "," $1,567.40 "," $1,714.92 "," $1,714.92 "," $1,751.80 "," $1,770.24 "," $1,508.76 "," $1,659.60 "," $1,567.40 "," $1,456.76 ", N/A ," $1,492.35 "," $1,492.35 "," $1,751.80 "," $1,582.34 ", $18.51 ," $1,770.24 "
Crutch Underarm Pair No Wood,HCPCS E0114,N/A,N/A,N/A, $71.00 , $46.15 , N/A , $64.02 , $41.82 , N/A , N/A , $66.03 , $63.90 , $63.90 , $56.80 , $56.80 , $41.82 , $65.55 , $67.45 , $63.90 , $63.90 , $63.90 , $66.03 , $68.16 , N/A , $60.35 , N/A , $58.17 , N/A , N/A , N/A , $67.45 , N/A , $41.82 , $68.16 
"Blastomyces, Antibody",CPT® 86612,N/A,N/A,N/A, $141.00 , $91.65 , N/A , $13.16 , $8.07 , $32.88 , $39.34 , $131.13 , $126.90 , $126.90 , $112.80 , $112.80 , $8.07 , $130.19 , $133.95 , $126.90 , $126.90 , $126.90 , $131.13 , $135.36 , $86.14 , $119.85 , $84.34 , $46.79 , N/A , $30.69 , $30.69 , $133.95 , $33.54 , $8.07 , $135.36 
Pro Removl of Knee Cartilage,27332,N/A,N/A,N/A," $5,233.00 "," $3,401.45 "," $3,937.96 ", $618.11 , $844.00 ," $3,093.66 "," $3,081.39 "," $4,866.69 "," $4,709.70 "," $4,709.70 "," $4,186.40 "," $4,186.40 ", $844.00 ," $4,831.63 "," $4,971.35 "," $4,709.70 "," $4,709.70 "," $4,709.70 "," $4,866.69 "," $5,023.68 "," $3,656.72 "," $4,448.05 "," $3,400.43 "," $3,654.64 ", N/A ," $3,154.02 "," $3,154.02 "," $4,971.35 "," $3,707.08 ", $618.11 ," $5,023.68 "
"Pro Strapping,Shoulder",29240,N/A,N/A,N/A, $181.00 , $117.65 , $116.61 , $17.96 , $16.01 , $92.07 , $215.74 , $168.33 , $162.90 , $162.90 , $144.80 , $144.80 , $16.01 , $167.12 , $171.95 , $162.90 , $162.90 , $162.90 , $168.33 , $173.76 , $109.01 , $153.85 , $231.93 , $111.84 , N/A , $93.87 , $93.87 , $171.95 , $110.34 , $16.01 , $231.93 
 Fac Chg Radiologic Exam Chest 4+ Views ,CPT® 71048,0324 - DX X-RAY/CHEST,N/A,N/A, $269.00 , $174.85 , $225.96 , $45.74 , $33.05 , $217.35 , $242.10 , $227.74 , $242.10 , $242.10 , $242.10 , $228.65 , $32.40 , $248.37 , $255.55 , $228.65 , $250.17 , $250.17 , $255.55 , $258.24 , $220.10 , $242.10 , $228.65 , $212.51 , N/A , $217.70 , $217.70 , $255.55 , $230.83 , $32.40 , $258.24 
 K-Y LUBRICATING EX GEL ,HCPCS RXC637,0250 - PHARMACY,67981-0089-12,113 gram, $24.38 , $15.85 , $20.48 , N/A , N/A , $19.70 , $21.94 , $20.64 , $21.94 , $21.94 , $21.94 , $20.72 , N/A , $22.51 , $23.16 , $20.72 , $22.67 , $22.67 , $23.16 , $23.40 , $19.95 , $21.94 , $20.72 , $19.26 , N/A , $19.73 , $19.73 , $23.16 , $20.92 , $19.26 , $23.40 
Dstrj All Prmlg 2-14 Ea,17003,N/A,N/A,N/A, $74.00 , $48.10 , $5.10 , $2.04 , $6.46 , $6.51 , $11.67 , $68.82 , $66.60 , $66.60 , $59.20 , $59.20 , $6.46 , $68.32 , $70.30 , $66.60 , $66.60 , $66.60 , $68.82 , $71.04 , $7.62 , $62.90 , $23.19 , $8.16 , N/A , $6.65 , $6.65 , $70.30 , $7.71 , $2.04 , $71.04 
Vascular Biopsy,CPT® 75970,N/A,N/A,N/A," $2,937.00 "," $1,909.05 "," $2,910.85 ", $511.34 , $490.27 ," $2,142.57 "," $2,272.22 "," $2,731.41 "," $2,643.30 "," $2,643.30 "," $2,349.60 "," $2,349.60 ", $490.27 ," $2,711.73 "," $2,790.15 "," $2,643.30 "," $2,643.30 "," $2,643.30 "," $2,731.41 "," $2,819.52 "," $2,043.97 "," $2,496.45 "," $2,525.04 "," $2,529.99 ", N/A ," $2,184.37 "," $2,184.37 "," $2,790.15 "," $2,528.45 ", $490.27 ," $2,910.85 "
 Fac Assay of Calcium ,CPT® 82310,0301 - LAB/CHEMISTRY,N/A,N/A, $80.00 , $52.00 , $67.20 , $5.26 , $5.26 , $64.64 , $72.00 , $67.73 , $72.00 , $72.00 , $72.00 , $68.00 , $5.16 , $73.86 , $76.00 , $68.00 , $74.40 , $74.40 , $76.00 , $76.80 , $65.46 , $72.00 , $68.00 , $63.20 , N/A , $64.74 , $64.74 , $76.00 , $68.65 , $5.16 , $76.80 
 Fac Colsc Flx With Directed Submucosal Njx Any Sbst ,CPT® 45381,0360 - OR SERVICES,N/A,N/A," $2,735.00 "," $1,777.75 "," $2,297.40 ", $189.78 , $386.96 ," $2,209.88 "," $2,461.50 "," $2,315.45 "," $2,461.50 "," $2,461.50 "," $2,461.50 "," $2,324.75 ", $379.37 ," $2,525.23 "," $2,598.25 "," $2,324.75 "," $2,543.55 "," $2,543.55 "," $2,598.25 "," $2,625.60 "," $2,237.78 "," $2,461.50 "," $2,324.75 "," $2,160.65 ", N/A ," $2,213.44 "," $2,213.44 "," $2,598.25 "," $2,346.90 ", $189.78 ," $2,625.60 "
Brnchsc Brushing/Protected Brushings,CPT® 31623,N/A,N/A,N/A," $2,046.00 "," $1,329.90 ", $727.49 , $125.81 , $210.86 , $569.64 , $558.35 ," $1,902.78 "," $1,841.40 "," $1,841.40 "," $1,636.80 "," $1,636.80 ", $210.86 ," $1,889.07 "," $1,943.70 "," $1,841.40 "," $1,841.40 "," $1,841.40 "," $1,902.78 "," $1,964.16 ", $703.51 ," $1,739.10 ", $779.64 , $701.65 , N/A , $580.75 , $580.75 ," $1,943.70 ", $683.94 , $125.81 ," $1,964.16 "
Repair Nail Bed,11760,N/A,N/A,N/A, $840.00 , $546.00 , $358.36 , $106.67 , $42.71 , $359.65 , $359.77 , $781.20 , $756.00 , $756.00 , $672.00 , $672.00 , $42.71 , $775.57 , $798.00 , $756.00 , $756.00 , $756.00 , $781.20 , $806.40 , $400.51 , $714.00 , $715.41 , $401.98 , N/A , $366.67 , $366.67 , $798.00 , $425.20 , $42.71 , $806.40 
Lens Sphcy Bifocal 4.25-7/2.,HCPCS V2208,N/A,N/A,N/A, $85.00 , $55.25 , N/A , $69.88 , N/A , N/A , N/A , $79.05 , $76.50 , $76.50 , $68.00 , $68.00 , N/A , $78.48 , $80.75 , $76.50 , $76.50 , $76.50 , $79.05 , $81.60 , N/A , $72.25 , $85.00 , $63.49 , N/A , N/A , N/A , $80.75 , N/A , $63.49 , $85.00 
 DICLOFENAC SODIUM 1 % EX GEL ,HCPCS RXC637,0250 - PHARMACY,45802-0953-01,100 gram, $75.52 , $49.09 , $63.44 , N/A , N/A , $61.02 , $67.97 , $63.94 , $67.97 , $67.97 , $67.97 , $64.19 , N/A , $69.73 , $71.74 , $64.19 , $70.23 , $70.23 , $71.74 , $72.50 , $61.79 , $67.97 , $64.19 , $59.66 , N/A , $61.12 , $61.12 , $71.74 , $64.80 , $59.66 , $72.50 
 Fac Colonoscopy W/Biopsy Single/Multiple ,CPT® 45380,0360 - OR SERVICES,N/A,N/A," $2,735.00 "," $1,777.75 "," $2,297.40 ", $189.88 , $603.31 ," $2,209.88 "," $2,461.50 "," $2,315.45 "," $2,461.50 "," $2,461.50 "," $2,461.50 "," $2,324.75 ", $591.48 ," $2,525.23 "," $2,598.25 "," $2,324.75 "," $2,543.55 "," $2,543.55 "," $2,598.25 "," $2,625.60 "," $2,237.78 "," $2,461.50 "," $2,324.75 "," $2,160.65 ", N/A ," $2,213.44 "," $2,213.44 "," $2,598.25 "," $2,346.90 ", $189.88 ," $2,625.60 "
 GEMCITABINE HCL 200 MG/5.26ML IV SOLN ,HCPCS J9201,0636 - DRUGS REQUIRING DETAILED CODIN,00409-0183-01,5.26 mL, $35.00 , $22.75 , $29.40 , $3.78 , $3.57 , $28.28 , $31.50 , $29.63 , $31.50 , $31.50 , $31.50 , $29.75 , $3.50 , $32.32 , $33.25 , $29.75 , $32.55 , $32.55 , $33.25 , $33.60 , $28.64 , $31.50 , $29.75 , $27.65 , N/A , $28.33 , $28.33 , $33.25 , $30.03 , $3.50 , $33.60 
" NM Plasma Volume, Multiple ",CPT® 78111,0340 - NUCLEAR MEDICINE,N/A,N/A," $1,022.00 ", $664.30 , $858.48 , $71.20 , $86.80 , $825.78 , $919.80 , $865.23 , $919.80 , $919.80 , $919.80 , $868.70 , $85.10 , $943.61 , $970.90 , $868.70 , $950.46 , $950.46 , $970.90 , $981.12 , $836.20 , $919.80 , $868.70 , $807.38 , N/A , $827.10 , $827.10 , $970.90 , $876.98 , $71.20 , $981.12 
" ANTIHEM FACT (BDD-RFVIII,SIM) 250 UNITS IV KIT ",HCPCS J7209,0636 - DRUGS REQUIRING DETAILED CODIN,68982-0139-01,1 int'l unit, $35.00 , $22.75 , $29.40 , $1.39 , $1.38 , $28.28 , $31.50 , $29.63 , $31.50 , $31.50 , $31.50 , $29.75 , $1.35 , $32.32 , $33.25 , $29.75 , $32.55 , $32.55 , $33.25 , $33.60 , $28.64 , $31.50 , $29.75 , $27.65 , N/A , $28.33 , $28.33 , $33.25 , $30.03 , $1.35 , $33.60 
"Ecg Monitor/24 Hrs,Dr Interp",CPT® 93227,N/A,N/A,N/A, $365.00 , $237.25 , $118.04 , $18.19 , $27.82 , $145.48 , $147.44 , $339.45 , $328.50 , $328.50 , $292.00 , $292.00 , $27.82 , $337.00 , $346.75 , $328.50 , $328.50 , $328.50 , $339.45 , $350.40 , $116.74 , $310.25 , $135.59 , $162.21 , N/A , $148.31 , $148.31 , $346.75 , $164.42 , $18.19 , $350.40 
Carbamazepine Total,CPT® 80156,N/A,N/A,N/A, $135.00 , $87.75 , N/A , $14.86 , $14.86 , $82.40 , $98.56 , $125.55 , $121.50 , $121.50 , $108.00 , $108.00 , $14.86 , $124.65 , $128.25 , $121.50 , $121.50 , $121.50 , $125.55 , $129.60 , $97.29 , $114.75 , $95.69 , $52.81 , N/A , $76.90 , $76.90 , $128.25 , $84.04 , $14.86 , $129.60 
"Immuniz Admin, Thru Age 18, Any Rte W Cnsel Ea Add Vax/Td",CPT® 90461,N/A,N/A,N/A, $188.00 , $122.20 , $30.35 , $9.95 , N/A , $28.51 , $29.13 , $174.84 , $169.20 , $169.20 , $150.40 , $150.40 , N/A , $173.58 , $178.60 , $169.20 , $169.20 , $169.20 , $174.84 , $180.48 , $44.86 , $159.80 , $37.51 , $39.95 , N/A , $29.07 , $29.07 , $178.60 , $34.44 , $9.95 , $180.48 
Standardized Cognitive Performance Testing,CPT® 96125,N/A,N/A,N/A, $464.00 , $301.60 , $242.76 , $101.78 , $71.88 , $260.17 , $244.92 , $431.52 , $417.60 , $417.60 , $371.20 , $371.20 , $71.88 , $428.41 , $440.80 , $417.60 , $417.60 , $417.60 , $431.52 , $445.44 , $457.12 , $394.40 , $321.35 , $451.99 , N/A , $265.25 , $265.25 , $440.80 , $309.21 , $71.88 , $457.12 
 Fac AR Gene Analysis Full Gene Sequence ,CPT® 81173,0310 - PATHOLOGY LAB,N/A,N/A, $7.00 , $4.55 , $5.88 , $307.38 , $245.90 , $5.66 , $6.30 , $5.93 , $6.30 , $6.30 , $6.30 , $5.95 , $241.08 , $6.46 , $6.65 , $5.95 , $6.51 , $6.51 , $6.65 , $6.72 , $5.73 , $6.30 , $5.95 , $5.53 , N/A , $5.67 , $5.67 , $6.65 , $6.01 , $5.53 , $307.38 
Chronic Care Mgmt Svc Phys 1st 30 Min Cal Month,CPT® 99491,N/A,N/A,N/A, $202.00 , $131.30 , $147.60 , $73.62 , N/A , $170.99 , N/A , $187.86 , $181.80 , $181.80 , $161.60 , $161.60 , N/A , $186.51 , $191.90 , $181.80 , $181.80 , $181.80 , $187.86 , $193.92 , $149.21 , $171.70 , $166.61 , $180.86 , N/A , $174.32 , $174.32 , $191.90 , $203.23 , $73.62 , $203.23 
Corrj Hallux Valgus W/Sesmdc W/1metar Medial Cnf,28297,N/A,N/A,N/A," $6,280.00 "," $4,082.00 "," $3,724.37 ", $582.05 , $693.20 ," $2,853.72 "," $2,850.91 "," $5,840.40 "," $5,652.00 "," $5,652.00 "," $5,024.00 "," $5,024.00 ", $693.20 ," $5,798.32 "," $5,966.00 "," $5,652.00 "," $5,652.00 "," $5,652.00 "," $5,840.40 "," $6,028.80 "," $3,455.82 "," $5,338.00 "," $3,107.84 "," $3,500.08 ", N/A ," $2,909.40 "," $2,909.40 "," $5,966.00 "," $3,419.59 ", $582.05 ," $6,028.80 "
Surgical Cleansing of Skin,CPT® 11000,N/A,N/A,N/A, $287.00 , $186.55 , $90.07 , $26.43 , $32.99 , $79.59 , $75.61 , $266.91 , $258.30 , $258.30 , $229.60 , $229.60 , $32.99 , $264.99 , $272.65 , $258.30 , $258.30 , $258.30 , $266.91 , $275.52 , $99.34 , $243.95 , $148.08 , $101.80 , N/A , $81.14 , $81.14 , $272.65 , $94.10 , $26.43 , $275.52 
 Vas Upper Ext Art-Single Level Bilateral ,CPT® 93922,0921 - PERI VASCUL LAB,N/A,N/A, $420.00 , $273.00 , $352.80 , $79.89 , $83.57 , $339.36 , $378.00 , $355.57 , $378.00 , $378.00 , $378.00 , $357.00 , $81.93 , $387.79 , $399.00 , $357.00 , $390.60 , $390.60 , $399.00 , $403.20 , $343.64 , $378.00 , $357.00 , $331.80 , N/A , $339.91 , $339.91 , $399.00 , $360.40 , $79.89 , $403.20 
"Colorectal Scrn, Hi Risk Ind",HCPCS G0105,N/A,N/A,N/A," $2,426.00 "," $1,576.90 "," $2,171.13 ", $174.38 , $351.69 , $373.81 , N/A ," $2,256.18 "," $2,183.40 "," $2,183.40 "," $1,940.80 "," $1,940.80 ", $351.69 ," $2,239.93 "," $2,304.70 "," $2,183.40 "," $2,183.40 "," $2,183.40 "," $2,256.18 "," $2,328.96 ", $813.03 ," $2,062.10 ", $420.39 ," $1,073.81 ", N/A , $381.10 , $381.10 ," $2,304.70 ", $476.38 , $174.38 ," $2,328.96 "
Open Rx Med Malleolus Fx,CPT® 27766,N/A,N/A,N/A," $4,074.00 "," $2,648.10 "," $3,702.66 ", $582.66 , $614.70 ," $2,952.59 "," $2,947.21 "," $3,788.82 "," $3,666.60 "," $3,666.60 "," $3,259.20 "," $3,259.20 ", $614.70 ," $3,761.52 "," $3,870.30 "," $3,666.60 "," $3,666.60 "," $3,666.60 "," $3,788.82 "," $3,911.04 "," $3,443.34 "," $3,462.90 "," $3,248.78 "," $3,462.61 ", N/A ," $3,010.20 "," $3,010.20 "," $3,870.30 "," $3,538.06 ", $582.66 ," $3,911.04 "
Open Rx Trimalleolar Fx,27822,N/A,N/A,N/A," $3,239.00 "," $2,105.35 "," $5,376.22 ", $838.56 , $738.92 ," $4,063.25 "," $4,063.58 "," $3,012.27 "," $2,915.10 "," $2,915.10 "," $2,591.20 "," $2,591.20 ", $738.92 ," $2,990.57 "," $3,077.05 "," $2,915.10 "," $2,915.10 "," $2,915.10 "," $3,012.27 "," $3,109.44 "," $4,979.47 "," $2,753.15 "," $4,481.57 "," $4,894.21 ", N/A ," $4,142.53 "," $4,142.53 "," $3,077.05 "," $4,868.93 ", $738.92 ," $5,376.22 "
Emergency Department Visit Straightforward Mdm,CPT® 99282,N/A,N/A,N/A, $248.00 , $161.20 , $148.19 , $40.13 , $25.96 , $116.08 , $119.87 , $230.64 , $223.20 , $223.20 , $198.40 , $198.40 , $25.96 , $228.98 , $235.60 , $223.20 , $223.20 , $223.20 , $230.64 , $238.08 , $125.96 , $210.80 , $88.51 , $89.62 , $21.00 , $118.34 , $118.34 , $235.60 , $142.01 , $21.00 , $238.08 
" Fac Echo Heart Xthoracic,Complete W Doppler ",CPT® 93306,0483 - CARDIOLOGY – ECHOCARDIOLOGY,N/A,N/A," $2,336.00 "," $1,518.40 "," $1,962.24 ", $193.19 , $335.09 ," $1,887.49 "," $2,102.40 "," $1,977.66 "," $2,102.40 "," $2,102.40 "," $2,102.40 "," $1,985.60 ", $328.52 ," $2,156.83 "," $2,219.20 "," $1,985.60 "," $2,172.48 "," $2,172.48 "," $2,219.20 "," $2,242.56 "," $1,911.32 "," $2,102.40 "," $1,985.60 "," $1,845.44 ", N/A ," $1,890.52 "," $1,890.52 "," $2,219.20 "," $2,004.52 ", $193.19 ," $2,242.56 "
 Fac Plmt Bile Duct Stent Prq Existing Access ,CPT® 47538,0360 - OR SERVICES,N/A,N/A," $15,594.00 "," $10,136.10 "," $13,098.96 ", $221.82 ," $3,563.55 "," $12,599.95 "," $14,034.60 "," $13,201.88 "," $14,034.60 "," $14,034.60 "," $14,034.60 "," $13,254.90 "," $3,493.68 "," $14,397.94 "," $14,814.30 "," $13,254.90 "," $14,502.42 "," $14,502.42 "," $14,814.30 "," $14,970.24 "," $12,759.01 "," $14,034.60 "," $13,254.90 "," $12,319.26 ", N/A ," $12,620.22 "," $12,620.22 "," $14,814.30 "," $13,381.21 ", $221.82 ," $14,970.24 "
 MEDROXYPROGESTERONE ACETATE 2.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00555-0872-02,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Chemodenervation 1 Extremity Ea Addl 1-4 Muscle ,CPT® 64643,0360 - OR SERVICES,N/A,N/A, $913.00 , $593.45 , $766.92 , $65.24 , $53.05 , $737.70 , $821.70 , $772.95 , $821.70 , $821.70 , $821.70 , $776.05 , $52.01 , $842.97 , $867.35 , $776.05 , $849.09 , $849.09 , $867.35 , $876.48 , $747.02 , $821.70 , $776.05 , $721.27 , N/A , $738.89 , $738.89 , $867.35 , $783.45 , $52.01 , $876.48 
 CYTARABINE (PF) 20 MG/ML IJ SOLN ,HCPCS J9100,0636 - DRUGS REQUIRING DETAILED CODIN,61703-0305-38,5 mL, $39.10 , $25.42 , $32.84 , $0.94 , $1.04 , $31.59 , $35.19 , $33.10 , $35.19 , $35.19 , $35.19 , $33.24 , $1.02 , $36.10 , $37.15 , $33.24 , $36.36 , $36.36 , $37.15 , $37.54 , $31.99 , $35.19 , $33.24 , $30.89 , N/A , $31.64 , $31.64 , $37.15 , $33.55 , $0.94 , $37.54 
"Scr C/V Cyto, Automated Sys",HCPCS G0147,N/A,N/A,N/A, $108.00 , $70.20 , N/A , $17.66 , $14.67 , $27.18 , N/A , $100.44 , $97.20 , $97.20 , $86.40 , $86.40 , $14.67 , $99.72 , $102.60 , $97.20 , $97.20 , $97.20 , $100.44 , $103.68 , $101.16 , $91.80 , $29.84 , $43.03 , N/A , $27.72 , $27.72 , $102.60 , $34.64 , $14.67 , $103.68 
Perq Drainage Pleura Insert Cath W/O Imaging,32556,N/A,N/A,N/A," $1,050.00 ", $682.50 , $668.15 , $116.48 , $529.94 , $478.43 , $463.57 , $976.50 , $945.00 , $945.00 , $840.00 , $840.00 , $529.94 , $969.47 , $997.50 , $945.00 , $945.00 , $945.00 , $976.50 ," $1,008.00 ", $645.36 , $892.50 , $645.83 , $636.27 , N/A , $487.76 , $487.76 , $997.50 , $574.43 , $116.48 ," $1,008.00 "
 Pro Exc Tr-Ext B9+Marg 0.6-1 Cm ,CPT® 11401,0982 - PRO FEE/OUTPT,N/A,N/A, $590.00 , $383.50 , $339.42 , $102.35 , $82.94 , $283.30 , $279.16 , $548.70 , $531.00 , $531.00 , $472.00 , $472.00 , $82.94 , $544.75 , $560.50 , $531.00 , $531.00 , $531.00 , $548.70 , $566.40 , $369.90 , $501.50 , $554.84 , $364.24 , N/A , $288.83 , $288.83 , $560.50 , $334.93 , $82.94 , $566.40 
" Fac Xray, Endovasc Thor Ao Repr ",CPT® 75956,0320 - DX X-RAY,N/A,N/A," $2,164.00 "," $1,406.60 "," $1,817.76 ", N/A , N/A ," $1,748.51 "," $1,947.60 "," $1,832.04 "," $1,947.60 "," $1,947.60 "," $1,947.60 "," $1,839.40 ", N/A ," $1,998.02 "," $2,055.80 "," $1,839.40 "," $2,012.52 "," $2,012.52 "," $2,055.80 "," $2,077.44 "," $1,770.58 "," $1,947.60 "," $1,839.40 "," $1,709.56 ", N/A ," $1,751.33 "," $1,751.33 "," $2,055.80 "," $1,856.93 "," $1,709.56 "," $2,077.44 "
"Shldr Arthroscop,Diagnostic",29805,N/A,N/A,N/A," $3,101.00 "," $2,015.65 "," $2,865.27 ", $450.43 , $220.85 ," $2,279.09 "," $2,278.31 "," $2,883.93 "," $2,790.90 "," $2,790.90 "," $2,480.80 "," $2,480.80 ", $220.85 ," $2,863.15 "," $2,945.95 "," $2,790.90 "," $2,790.90 "," $2,790.90 "," $2,883.93 "," $2,976.96 "," $2,675.10 "," $2,635.85 "," $2,513.75 "," $2,686.95 ", N/A ," $2,323.56 "," $2,323.56 "," $2,945.95 "," $2,731.01 ", $220.85 ," $2,976.96 "
 Fac Endoluminal Bx Biliary Tree Prq Any Meth 1/Mlt ,CPT® 47543,0361 - OR/MINOR,N/A,N/A," $2,373.00 "," $1,542.45 "," $1,993.32 ", $135.84 ," $1,047.93 "," $1,917.38 "," $2,135.70 "," $2,008.98 "," $2,135.70 "," $2,135.70 "," $2,135.70 "," $2,017.05 "," $1,027.38 "," $2,190.99 "," $2,254.35 "," $2,017.05 "," $2,206.89 "," $2,206.89 "," $2,254.35 "," $2,278.08 "," $1,941.59 "," $2,135.70 "," $2,017.05 "," $1,874.67 ", N/A ," $1,920.47 "," $1,920.47 "," $2,254.35 "," $2,036.27 ", $135.84 ," $2,278.08 "
"Nasal Endoscopy,Dx",CPT® 31231,N/A,N/A,N/A," $1,131.00 ", $735.15 , $300.20 , $61.54 , $207.30 , $250.32 , $243.40 ," $1,051.83 "," $1,017.90 "," $1,017.90 ", $904.80 , $904.80 , $207.30 ," $1,044.25 "," $1,074.45 "," $1,017.90 "," $1,017.90 "," $1,017.90 "," $1,051.83 "," $1,085.76 ", $331.89 , $961.35 , $340.76 , $328.59 , N/A , $255.20 , $255.20 ," $1,074.45 ", $300.54 , $61.54 ," $1,085.76 "
 CEFTRIAXONE SODIUM 500 MG IJ SOLR ,HCPCS J0696,0636 - DRUGS REQUIRING DETAILED CODIN,00409-7338-01,5 mL, $16.68 , $10.84 , $14.01 , $0.58 , $0.54 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.53 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.53 , $16.01 
 Ribs Bilateral (No Pa Cxr) ,CPT® 71110,0320 - DX X-RAY,N/A,N/A, $361.00 , $234.65 , $303.24 , $43.40 , $38.66 , $291.69 , $324.90 , $305.62 , $324.90 , $324.90 , $324.90 , $306.85 , $37.90 , $333.31 , $342.95 , $306.85 , $335.73 , $335.73 , $342.95 , $346.56 , $295.37 , $324.90 , $306.85 , $285.19 , N/A , $292.16 , $292.16 , $342.95 , $309.77 , $37.90 , $346.56 
Cecalcification Procedure,CPT® 88311,N/A,N/A,N/A, $198.00 , $128.70 , $73.70 , $20.00 , $16.43 , $83.45 , $92.98 , $184.14 , $178.20 , $178.20 , $158.40 , $158.40 , $16.43 , $182.81 , $188.10 , $178.20 , $178.20 , $178.20 , $184.14 , $190.08 , $134.15 , $168.30 , $97.31 , $76.61 , N/A , $77.88 , $77.88 , $188.10 , $85.58 , $16.43 , $190.08 
Radiation Therapy Plan Complex,CPT® 77263,N/A,N/A,N/A," $1,746.00 "," $1,134.90 ", $936.99 , $164.77 , $189.11 , $793.74 , $821.69 ," $1,623.78 "," $1,571.40 "," $1,571.40 "," $1,396.80 "," $1,396.80 ", $189.11 ," $1,612.08 "," $1,658.70 "," $1,571.40 "," $1,571.40 "," $1,571.40 "," $1,623.78 "," $1,676.16 ", $937.90 ," $1,484.10 ", $899.46 , $922.66 , N/A , $809.22 , $809.22 ," $1,658.70 ", $936.71 , $164.77 ," $1,676.16 "
Pelvic Exenteration,CPT® 51597,N/A,N/A,N/A," $15,945.00 "," $10,364.25 "," $12,361.06 "," $2,170.31 "," $2,378.00 "," $11,220.51 "," $10,403.48 "," $14,828.85 "," $14,350.50 "," $14,350.50 "," $12,756.00 "," $12,756.00 "," $2,378.00 "," $14,722.02 "," $15,147.75 "," $14,350.50 "," $14,350.50 "," $14,350.50 "," $14,828.85 "," $15,307.20 "," $12,394.84 "," $13,553.25 "," $11,814.07 "," $14,082.14 ", N/A ," $11,439.44 "," $11,439.44 "," $15,147.75 "," $13,445.40 "," $2,170.31 "," $15,307.20 "
"Preventive Visit,Est,Age 1-4",CPT® 99392,N/A,N/A,N/A, $313.00 , $203.45 , N/A , $102.18 , $62.20 , $163.06 , $164.73 , $291.09 , $281.70 , $281.70 , $250.40 , $250.40 , $62.20 , $288.99 , $297.35 , $281.70 , $281.70 , $281.70 , $291.09 , $300.48 , $202.15 , $266.05 , $165.77 , $163.22 , N/A , $166.24 , $166.24 , $297.35 , $199.66 , $62.20 , $300.48 
Neuropsych Testing by Psych/Phys,CPT® 96118,N/A,N/A,N/A, $646.00 , $419.90 , N/A , N/A , N/A , $177.21 , $169.91 , $600.78 , $581.40 , $581.40 , $516.80 , $516.80 , N/A , $596.45 , $613.70 , $581.40 , $581.40 , $581.40 , $600.78 , $620.16 , N/A , $549.10 , N/A , N/A , $179.00 , N/A , N/A , $613.70 , N/A , $169.91 , $620.16 
Fluorescein Angrph W/Multiframe I&R Uni/Bi,92235,N/A,N/A,N/A, $505.00 , $328.25 , $273.04 , $135.16 , $110.62 , $192.81 , $226.40 , $469.65 , $454.50 , $454.50 , $404.00 , $404.00 , $110.62 , $466.27 , $479.75 , $454.50 , $454.50 , $454.50 , $469.65 , $484.80 , $358.70 , $429.25 , $337.57 , $182.01 , N/A , $196.57 , $196.57 , $479.75 , $233.83 , $110.62 , $484.80 
 Cardiac Arrhythmia And Conduction Disorders With McC ,MS DRG V40 (FY2023) 308,N/A,N/A,N/A," $13,269.84 "," $8,625.40 "," $11,146.67 ", N/A , N/A ," $10,722.03 "," $11,942.86 "," $11,234.25 "," $11,942.86 "," $11,942.86 "," $11,942.86 "," $11,279.36 ", N/A ," $12,252.04 "," $12,606.35 "," $11,279.36 "," $12,340.95 "," $12,340.95 "," $12,606.35 "," $12,739.05 "," $10,857.38 "," $11,942.86 "," $11,279.36 "," $10,483.17 ", N/A ," $10,739.28 "," $10,739.28 "," $12,606.35 "," $11,386.85 "," $10,483.17 "," $12,739.05 "
Complex Repair 1.1-2.5cm,CPT® 13131,N/A,N/A,N/A," $1,487.00 ", $966.55 , $776.05 , $231.89 , $176.33 , $684.64 , $667.66 ," $1,382.91 "," $1,338.30 "," $1,338.30 "," $1,189.60 "," $1,189.60 ", $176.33 ," $1,372.95 "," $1,412.65 "," $1,338.30 "," $1,338.30 "," $1,338.30 "," $1,382.91 "," $1,427.52 ", $855.05 ," $1,263.95 "," $1,330.91 ", $878.14 , N/A , $698.00 , $698.00 ," $1,412.65 ", $809.44 , $176.33 ," $1,427.52 "
" Debride Skin, Subcut Tissue/Muscle ",CPT® 11043,0761 - TREATMENT ROOM,N/A,N/A," $1,976.00 "," $1,284.40 "," $1,659.84 ", $145.28 , $233.20 ," $1,596.61 "," $1,778.40 "," $1,672.88 "," $1,778.40 "," $1,778.40 "," $1,778.40 "," $1,679.60 ", $228.63 ," $1,824.44 "," $1,877.20 "," $1,679.60 "," $1,837.68 "," $1,837.68 "," $1,877.20 "," $1,896.96 "," $1,616.76 "," $1,778.40 "," $1,679.60 "," $1,561.04 ", N/A ," $1,599.18 "," $1,599.18 "," $1,877.20 "," $1,695.61 ", $145.28 ," $1,896.96 "
 Fac Exam & Select Archive Tissue Molecular Analysis ,CPT® 88363,0310 - PATHOLOGY LAB,N/A,N/A, $160.00 , $104.00 , $134.40 , $18.92 , $12.40 , $129.28 , $144.00 , $135.46 , $144.00 , $144.00 , $144.00 , $136.00 , $12.16 , $147.73 , $152.00 , $136.00 , $148.80 , $148.80 , $152.00 , $153.60 , $130.91 , $144.00 , $136.00 , $126.40 , N/A , $129.49 , $129.49 , $152.00 , $137.30 , $12.16 , $153.60 
 FENTANYL CIT-ROPIVACAINE-NACL 0.2-0.2-0.9 MG/100ML-% EP SOLN ,HCPCS RXA250,0250 - PHARMACY,70092-7108-36,100 mL, $510.60 , $331.89 , $428.90 , N/A , N/A , $412.56 , $459.54 , $432.27 , $459.54 , $459.54 , $459.54 , $434.01 , N/A , $471.44 , $485.07 , $434.01 , $474.86 , $474.86 , $485.07 , $490.18 , $417.77 , $459.54 , $434.01 , $403.37 , N/A , $413.23 , $413.23 , $485.07 , $438.15 , $403.37 , $490.18 
 Fac Urine Albumin Semiquantitative ,CPT® 82044,0301 - LAB/CHEMISTRY,N/A,N/A, $102.00 , $66.30 , $85.68 , $6.35 , $4.21 , $82.42 , $91.80 , $86.35 , $91.80 , $91.80 , $91.80 , $86.70 , $4.13 , $94.18 , $96.90 , $86.70 , $94.86 , $94.86 , $96.90 , $97.92 , $83.46 , $91.80 , $86.70 , $80.58 , N/A , $82.55 , $82.55 , $96.90 , $87.53 , $4.13 , $97.92 
 METHOHEXITAL SODIUM 0.5 G IJ SOLR ,HCPCS RXA250,0250 - PHARMACY,42023-0105-01,50 mL, $569.32 , $370.06 , $478.23 , N/A , N/A , $460.01 , $512.39 , $481.99 , $512.39 , $512.39 , $512.39 , $483.92 , N/A , $525.65 , $540.85 , $483.92 , $529.47 , $529.47 , $540.85 , $546.55 , $465.82 , $512.39 , $483.92 , $449.76 , N/A , $460.75 , $460.75 , $540.85 , $488.53 , $449.76 , $546.55 
"Cardiac Stress Tst,Interp/Rept Only",CPT® 93018,N/A,N/A,N/A, $237.00 , $154.05 , $91.46 , $13.76 , $16.17 , $79.74 , $81.22 , $220.41 , $213.30 , $213.30 , $189.60 , $189.60 , $16.17 , $218.82 , $225.15 , $213.30 , $213.30 , $213.30 , $220.41 , $227.52 , $90.47 , $201.45 , $74.93 , $89.87 , N/A , $81.30 , $81.30 , $225.15 , $90.12 , $13.76 , $227.52 
Surg Nasopharyngoscopy Dilat Eustachian Tube Bi,CPT® 69706,N/A,N/A,N/A," $19,532.00 "," $12,695.80 "," $1,139.55 ", $231.60 , N/A , N/A , N/A ," $18,164.76 "," $17,578.80 "," $17,578.80 "," $15,625.60 "," $15,625.60 ", N/A ," $18,033.90 "," $18,555.40 "," $17,578.80 "," $17,578.80 "," $17,578.80 "," $18,164.76 "," $18,750.72 "," $1,240.98 "," $16,602.20 "," $1,284.73 "," $1,220.16 ", N/A ," $1,076.51 "," $1,076.51 "," $18,555.40 "," $1,231.33 ", $231.60 ," $18,750.72 "
Egd Flexible Foreign Body Removal,CPT® 43247,N/A,N/A,N/A," $2,315.00 "," $1,504.75 "," $1,081.54 ", $167.00 , $186.68 , $894.33 , $972.62 ," $2,152.95 "," $2,083.50 "," $2,083.50 "," $1,852.00 "," $1,852.00 ", $186.68 ," $2,137.44 "," $2,199.25 "," $2,083.50 "," $2,083.50 "," $2,083.50 "," $2,152.95 "," $2,222.40 ", $777.60 ," $1,967.75 "," $1,066.87 "," $1,032.34 ", N/A , $911.79 , $911.79 ," $2,199.25 ", $953.64 , $167.00 ," $2,222.40 "
 METHOCARBAMOL 750 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-7058-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Icar Catheter Ablation Arrhythmia Add On,CPT® 93655,N/A,N/A,N/A," $3,536.00 "," $2,298.40 "," $1,824.62 ", $280.41 , $309.02 ," $2,256.26 "," $2,217.52 "," $3,288.48 "," $3,182.40 "," $3,182.40 "," $2,828.80 "," $2,828.80 ", $309.02 ," $3,264.79 "," $3,359.20 "," $3,182.40 "," $3,182.40 "," $3,182.40 "," $3,288.48 "," $3,394.56 "," $2,463.70 "," $3,005.60 "," $2,156.93 "," $2,053.32 ", N/A ," $2,300.28 "," $2,300.28 "," $3,359.20 "," $2,549.89 ", $280.41 ," $3,394.56 "
 No Imaging Thora W Tube Placement ,CPT® 32556,0761 - TREATMENT ROOM,N/A,N/A," $2,332.00 "," $1,515.80 "," $1,958.88 ", $116.48 , $529.94 ," $1,884.26 "," $2,098.80 "," $1,974.27 "," $2,098.80 "," $2,098.80 "," $2,098.80 "," $1,982.20 ", $519.55 ," $2,153.14 "," $2,215.40 "," $1,982.20 "," $2,168.76 "," $2,168.76 "," $2,215.40 "," $2,238.72 "," $1,908.04 "," $2,098.80 "," $1,982.20 "," $1,842.28 ", N/A ," $1,887.29 "," $1,887.29 "," $2,215.40 "," $2,001.09 ", $116.48 ," $2,238.72 "
" Fac Fluorescent Antibody, Titer ",CPT® 86256,0302 - LAB/IMMUNOLOGY,N/A,N/A, $152.00 , $98.80 , $127.68 , $12.29 , $12.29 , $122.82 , $136.80 , $128.68 , $136.80 , $136.80 , $136.80 , $129.20 , $12.05 , $140.34 , $144.40 , $129.20 , $141.36 , $141.36 , $144.40 , $145.92 , $124.37 , $136.80 , $129.20 , $120.08 , N/A , $123.01 , $123.01 , $144.40 , $130.43 , $12.05 , $145.92 
Prq Trluml Coronary Angioplasty One Art/Branch,CPT® 92920,N/A,N/A,N/A," $4,483.00 "," $2,913.95 "," $3,092.25 ", $474.89 , $605.17 ," $2,911.66 "," $2,932.08 "," $4,169.19 "," $4,034.70 "," $4,034.70 "," $3,586.40 "," $3,586.40 ", $605.17 ," $4,139.15 "," $4,258.85 "," $4,034.70 "," $4,034.70 "," $4,034.70 "," $4,169.19 "," $4,303.68 "," $2,863.66 "," $3,810.55 "," $1,620.93 "," $3,050.16 ", N/A ," $2,968.47 "," $2,968.47 "," $4,258.85 "," $3,290.59 ", $474.89 ," $4,303.68 "
Treat Articular Fracture,CPT® 26740,N/A,N/A,N/A," $1,456.00 ", $946.40 ," $1,375.21 ", $218.73 , $126.34 ," $1,034.45 "," $1,051.56 "," $1,354.08 "," $1,310.40 "," $1,310.40 "," $1,164.80 "," $1,164.80 ", $126.34 ," $1,344.32 "," $1,383.20 "," $1,310.40 "," $1,310.40 "," $1,310.40 "," $1,354.08 "," $1,397.76 "," $1,266.41 "," $1,237.60 "," $1,150.72 "," $1,238.55 ", N/A ," $1,054.63 "," $1,054.63 "," $1,383.20 "," $1,239.57 ", $126.34 ," $1,397.76 "
 Fac Eo W/O Joints Cf ,HCPCS L3702,0274 - PROSTHETIC DEV,N/A,N/A, $434.00 , $282.10 , $364.56 , $307.41 , $132.15 , $350.67 , $390.60 , $367.42 , $390.60 , $390.60 , $390.60 , $368.90 , $129.56 , $400.71 , $412.30 , $368.90 , $403.62 , $403.62 , $412.30 , $416.64 , $355.10 , $390.60 , $368.90 , $342.86 , N/A , $351.24 , $351.24 , $412.30 , $372.42 , $129.56 , $416.64 
 Fac Echo Transthoracic ,CPT® 93303,0480 - CARDIOLOGY,N/A,N/A," $2,646.00 "," $1,719.90 "," $2,222.64 ", $216.88 , $305.51 ," $2,137.97 "," $2,381.40 "," $2,240.10 "," $2,381.40 "," $2,381.40 "," $2,381.40 "," $2,249.10 ", $299.52 ," $2,443.05 "," $2,513.70 "," $2,249.10 "," $2,460.78 "," $2,460.78 "," $2,513.70 "," $2,540.16 "," $2,164.96 "," $2,381.40 "," $2,249.10 "," $2,090.34 ", N/A ," $2,141.41 "," $2,141.41 "," $2,513.70 "," $2,270.53 ", $216.88 ," $2,540.16 "
"Removal of Single Toe,Each",CPT® 28150,N/A,N/A,N/A," $2,859.00 "," $1,858.35 "," $1,724.00 ", $271.07 , $153.67 ," $1,386.13 "," $1,383.05 "," $2,658.87 "," $2,573.10 "," $2,573.10 "," $2,287.20 "," $2,287.20 ", $153.67 ," $2,639.71 "," $2,716.05 "," $2,573.10 "," $2,573.10 "," $2,573.10 "," $2,658.87 "," $2,744.64 "," $1,604.83 "," $2,430.15 "," $1,498.61 "," $1,639.66 ", N/A ," $1,413.17 "," $1,413.17 "," $2,716.05 "," $1,660.98 ", $153.67 ," $2,744.64 "
" Pro Rerepair Ing Hernia, Reduce ",CPT® 49520,0982 - PRO FEE/OUTPT,N/A,N/A," $4,096.00 "," $2,662.40 "," $3,788.14 ", $587.08 , $536.30 ," $2,964.45 "," $3,003.90 "," $3,809.28 "," $3,686.40 "," $3,686.40 "," $3,276.80 "," $3,276.80 ", $536.30 ," $3,781.84 "," $3,891.20 "," $3,686.40 "," $3,686.40 "," $3,686.40 "," $3,809.28 "," $3,932.16 "," $2,706.64 "," $3,481.60 "," $3,337.98 "," $3,500.59 ", N/A ," $3,022.29 "," $3,022.29 "," $3,891.20 "," $3,161.00 ", $536.30 ," $3,932.16 "
"Bx/Remv,Lymph Node,Deep Cerv",CPT® 38510,N/A,N/A,N/A," $5,210.00 "," $3,386.50 "," $1,947.85 ", $395.28 , $512.47 ," $1,473.28 "," $1,516.59 "," $4,845.30 "," $4,689.00 "," $4,689.00 "," $4,168.00 "," $4,168.00 ", $512.47 ," $4,810.39 "," $4,949.50 "," $4,689.00 "," $4,689.00 "," $4,689.00 "," $4,845.30 "," $5,001.60 "," $2,076.31 "," $4,428.50 "," $2,231.86 "," $2,025.57 ", N/A ," $1,502.03 "," $1,502.03 "," $4,949.50 "," $1,742.55 ", $395.28 ," $5,001.60 "
Pml/Raralpha Common Breakpoints Qual/Quant,CPT® 81315,N/A,N/A,N/A," $1,951.00 "," $1,268.15 ", N/A , $211.46 , $211.46 ," $1,172.91 "," $1,388.98 "," $1,814.43 "," $1,755.90 "," $1,755.90 "," $1,560.80 "," $1,560.80 ", $211.46 ," $1,801.36 "," $1,853.45 "," $1,755.90 "," $1,755.90 "," $1,755.90 "," $1,814.43 "," $1,872.96 "," $1,384.25 "," $1,658.35 ", $988.61 , $751.70 , N/A ," $1,094.63 "," $1,094.63 "," $1,853.45 "," $1,196.19 ", $211.46 ," $1,872.96 "
Musc/Tendon Repair Each; Arm/Elbow,24341,N/A,N/A,N/A," $5,145.00 "," $3,344.25 "," $4,549.87 ", $717.73 , $725.22 ," $3,598.81 "," $3,610.29 "," $4,784.85 "," $4,630.50 "," $4,630.50 "," $4,116.00 "," $4,116.00 ", $725.22 ," $4,750.38 "," $4,887.75 "," $4,630.50 "," $4,630.50 "," $4,630.50 "," $4,784.85 "," $4,939.20 "," $4,232.68 "," $4,373.25 "," $3,980.25 "," $4,247.67 ", N/A ," $3,669.04 "," $3,669.04 "," $4,887.75 "," $4,312.40 ", $717.73 ," $4,939.20 "
"Kyleena, 19.5 Mg",HCPCS J7296,N/A,N/A,N/A," $1,120.00 ", $728.00 , N/A , N/A ," $1,123.73 ", N/A , N/A ," $1,041.60 "," $1,008.00 "," $1,008.00 ", $896.00 , $896.00 ," $1,123.73 "," $1,034.10 "," $1,064.00 "," $1,008.00 "," $1,008.00 "," $1,008.00 "," $1,041.60 "," $1,075.20 ", N/A , $952.00 , $896.00 ," $1,409.26 ", N/A , N/A , N/A ," $1,064.00 ", N/A , $896.00 ," $1,409.26 "
Perq Replacement Gtube Not Req Revj Gstrst Trc,43762,N/A,N/A,N/A, $357.00 , $232.05 , $223.34 , $34.45 , $176.61 , $167.82 , N/A , $332.01 , $321.30 , $321.30 , $285.60 , $285.60 , $176.61 , $329.62 , $339.15 , $321.30 , $321.30 , $321.30 , $332.01 , $342.72 , $163.07 , $303.45 , $193.69 , $214.15 , N/A , $171.09 , $171.09 , $339.15 , $178.94 , $34.45 , $342.72 
 Pro Lyr Clsr F/E/E/N/L/M&/Muc 2.6 Cm-5.0 Cm ,CPT® 12052,0981 - PRO FEE/ER,N/A,N/A," $1,245.00 ", $809.25 , $637.70 , $191.98 , $151.59 , $557.59 , $545.09 ," $1,157.85 "," $1,120.50 "," $1,120.50 ", $996.00 , $996.00 , $151.59 ," $1,149.51 "," $1,182.75 "," $1,120.50 "," $1,120.50 "," $1,120.50 "," $1,157.85 "," $1,195.20 ", $700.90 ," $1,058.25 "," $1,084.71 ", $716.31 , N/A , $568.47 , $568.47 ," $1,182.75 ", $659.24 , $151.59 ," $1,195.20 "
Open Rod Fixatn Humeral Shaft Fx,CPT® 24516,N/A,N/A,N/A," $5,912.00 "," $3,842.80 "," $5,212.55 ", $816.69 , $881.43 ," $4,145.80 "," $4,120.69 "," $5,498.16 "," $5,320.80 "," $5,320.80 "," $4,729.60 "," $4,729.60 ", $881.43 ," $5,458.55 "," $5,616.40 "," $5,320.80 "," $5,320.80 "," $5,320.80 "," $5,498.16 "," $5,675.52 "," $4,853.59 "," $5,025.20 "," $4,552.93 "," $4,881.52 ", N/A ," $4,226.68 "," $4,226.68 "," $5,616.40 "," $4,967.85 ", $816.69 ," $5,675.52 "
 TALC 3 G PL POWD ,HCPCS RXA250,0250 - PHARMACY,62327-0333-43,3 gram, $940.05 , $611.03 , $789.64 , N/A , N/A , $759.56 , $846.05 , $795.85 , $846.05 , $846.05 , $846.05 , $799.04 , N/A , $867.95 , $893.05 , $799.04 , $874.25 , $874.25 , $893.05 , $902.45 , $769.15 , $846.05 , $799.04 , $742.64 , N/A , $760.78 , $760.78 , $893.05 , $806.66 , $742.64 , $902.45 
 Fac Injection Aa&/Strd Sciatic Nerve ,CPT® 64445,0360 - OR SERVICES,N/A,N/A," $2,656.00 "," $1,726.40 "," $2,231.04 ", $69.92 , $46.08 ," $2,146.05 "," $2,390.40 "," $2,248.57 "," $2,390.40 "," $2,390.40 "," $2,390.40 "," $2,257.60 ", $45.18 ," $2,452.28 "," $2,523.20 "," $2,257.60 "," $2,470.08 "," $2,470.08 "," $2,523.20 "," $2,549.76 "," $2,173.14 "," $2,390.40 "," $2,257.60 "," $2,098.24 ", N/A ," $2,149.50 "," $2,149.50 "," $2,523.20 "," $2,279.11 ", $45.18 ," $2,549.76 "
 Fac Iadna Anaplasma Phagocytophilum Amplifed Prb Tq ,CPT® 87468,0306 - LAB/BACT-MICRO,N/A,N/A, $53.00 , $34.45 , $44.52 , $35.79 , $35.79 , $42.82 , $47.70 , $44.87 , $47.70 , $47.70 , $47.70 , $45.05 , $35.09 , $48.93 , $50.35 , $45.05 , $49.29 , $49.29 , $50.35 , $50.88 , $43.36 , $47.70 , $45.05 , $41.87 , N/A , $42.89 , $42.89 , $50.35 , $45.48 , $35.09 , $50.88 
"Preventive Visit,Est,18-39",99395,N/A,N/A,N/A, $356.00 , $231.40 , N/A , $113.89 , $62.20 , $190.81 , $192.22 , $331.08 , $320.40 , $320.40 , $284.80 , $284.80 , $62.20 , $328.69 , $338.20 , $320.40 , $320.40 , $320.40 , $331.08 , $341.76 , $236.26 , $302.60 , $192.03 , $190.54 , N/A , $194.54 , $194.54 , $338.20 , $233.67 , $62.20 , $341.76 
 Fac Cltx Talus Fx W/O Mnpj ,CPT® 28430,0761 - TREATMENT ROOM,N/A,N/A," $2,235.00 "," $1,452.75 "," $1,877.40 ", $207.28 , $230.52 ," $1,805.88 "," $2,011.50 "," $1,892.15 "," $2,011.50 "," $2,011.50 "," $2,011.50 "," $1,899.75 ", $226.00 ," $2,063.58 "," $2,123.25 "," $1,899.75 "," $2,078.55 "," $2,078.55 "," $2,123.25 "," $2,145.60 "," $1,828.68 "," $2,011.50 "," $1,899.75 "," $1,765.65 ", N/A ," $1,808.79 "," $1,808.79 "," $2,123.25 "," $1,917.85 ", $207.28 ," $2,145.60 "
 Percutaneous Cystostomy Supra ,CPT® 51102,0361 - OR/MINOR,N/A,N/A," $4,961.00 "," $3,224.65 "," $4,167.24 ", $136.64 , $260.59 ," $4,008.49 "," $4,464.90 "," $4,199.98 "," $4,464.90 "," $4,464.90 "," $4,464.90 "," $4,216.85 ", $255.48 ," $4,580.49 "," $4,712.95 "," $4,216.85 "," $4,613.73 "," $4,613.73 "," $4,712.95 "," $4,762.56 "," $4,059.09 "," $4,464.90 "," $4,216.85 "," $3,919.19 ", N/A ," $4,014.94 "," $4,014.94 "," $4,712.95 "," $4,257.03 ", $136.64 ," $4,762.56 "
"Cytopathology-Prep,Scrn,I",CPT® 88161,N/A,N/A,N/A, $224.00 , $145.60 , $262.59 , $75.40 , $32.88 , $241.33 , $277.12 , $208.32 , $201.60 , $201.60 , $179.20 , $179.20 , $32.88 , $206.82 , $212.80 , $201.60 , $201.60 , $201.60 , $208.32 , $215.04 , $455.85 , $190.40 , $288.69 , $229.25 , N/A , $225.22 , $225.22 , $212.80 , $247.50 , $32.88 , $455.85 
X-Ray Orbits,CPT® 70200,N/A,N/A,N/A, $316.00 , $205.40 , $274.80 , $47.33 , $41.92 , $198.85 , $233.61 , $293.88 , $284.40 , $284.40 , $252.80 , $252.80 , $41.92 , $291.76 , $300.20 , $284.40 , $284.40 , $284.40 , $293.88 , $303.36 , $266.23 , $268.60 , $254.24 , $214.86 , N/A , $202.73 , $202.73 , $300.20 , $234.67 , $41.92 , $303.36 
Remv/Revs Sling for Stres Incontinence,CPT® 57287,N/A,N/A,N/A," $4,064.00 "," $2,641.60 "," $3,539.55 ", $714.38 , $642.75 ," $2,781.47 "," $2,753.25 "," $3,779.52 "," $3,657.60 "," $3,657.60 "," $3,251.20 "," $3,251.20 ", $642.75 ," $3,752.29 "," $3,860.80 "," $3,657.60 "," $3,657.60 "," $3,657.60 "," $3,779.52 "," $3,901.44 "," $3,651.00 "," $3,454.40 "," $3,575.26 "," $2,817.87 ", N/A ," $2,835.74 "," $2,835.74 "," $3,860.80 "," $3,401.28 ", $642.75 ," $3,901.44 "
 Pro Prp I/Hern Init Block >5 Yr ,CPT® 49507,0982 - PRO FEE/OUTPT,N/A,N/A," $3,844.00 "," $2,498.60 "," $3,519.62 ", $546.36 , $540.39 ," $2,746.91 "," $2,791.12 "," $3,574.92 "," $3,459.60 "," $3,459.60 "," $3,075.20 "," $3,075.20 ", $540.39 ," $3,549.17 "," $3,651.80 "," $3,459.60 "," $3,459.60 "," $3,459.60 "," $3,574.92 "," $3,690.24 "," $2,513.95 "," $3,267.40 "," $3,098.92 "," $3,250.04 ", N/A ," $2,800.50 "," $2,800.50 "," $3,651.80 "," $2,929.02 ", $540.39 ," $3,690.24 "
 Fac Microslide Consultation ,CPT® 88321,0310 - PATHOLOGY LAB,N/A,N/A, $670.00 , $435.50 , $562.80 , $81.51 , $77.65 , $541.36 , $603.00 , $567.22 , $603.00 , $603.00 , $603.00 , $569.50 , $76.13 , $618.61 , $636.50 , $569.50 , $623.10 , $623.10 , $636.50 , $643.20 , $548.19 , $603.00 , $569.50 , $529.30 , N/A , $542.23 , $542.23 , $636.50 , $574.93 , $76.13 , $643.20 
Insj Biomchn Dev Vrt Corpectomy Defect W/Arthrd,CPT® 22854,N/A,N/A,N/A," $2,100.00 "," $1,365.00 "," $1,918.22 ", $298.64 , $258.25 ," $1,545.86 "," $1,486.26 "," $1,953.00 "," $1,890.00 "," $1,890.00 "," $1,680.00 "," $1,680.00 ", $258.25 ," $1,938.93 "," $1,995.00 "," $1,890.00 "," $1,890.00 "," $1,890.00 "," $1,953.00 "," $2,016.00 "," $1,794.65 "," $1,785.00 "," $1,775.17 "," $1,815.08 ", N/A ," $1,576.02 "," $1,576.02 "," $1,995.00 "," $1,852.40 ", $258.25 ," $2,016.00 "
 Fac Bis Extracellular Fluid Alys Lymphedema Assmnt ,CPT® 93702,0420 - PHYSICAL THERAPY,N/A,N/A, $225.00 , $146.25 , $189.00 , $125.65 , N/A , $181.80 , $202.50 , $190.49 , $202.50 , $202.50 , $202.50 , $191.25 , N/A , $207.74 , $213.75 , $191.25 , $209.25 , $209.25 , $213.75 , $216.00 , $184.10 , $202.50 , $191.25 , $177.75 , N/A , $182.09 , $182.09 , $213.75 , $193.07 , $125.65 , $216.00 
Tissue Exam by Koh,CPT® 87220,N/A,N/A,N/A, $68.00 , $44.20 , N/A , $4.36 , $4.36 , $24.15 , $28.90 , $63.24 , $61.20 , $61.20 , $54.40 , $54.40 , $4.36 , $62.78 , $64.60 , $61.20 , $61.20 , $61.20 , $63.24 , $65.28 , $28.51 , $57.80 , $27.57 , $15.45 , N/A , $22.54 , $22.54 , $64.60 , $24.63 , $4.36 , $65.28 
 Fac Immune Complex Assay ,CPT® 86332,0302 - LAB/IMMUNOLOGY,N/A,N/A, $242.00 , $157.30 , $203.28 , $24.86 , $24.86 , $195.54 , $217.80 , $204.88 , $217.80 , $217.80 , $217.80 , $205.70 , $24.37 , $223.44 , $229.90 , $205.70 , $225.06 , $225.06 , $229.90 , $232.32 , $198.00 , $217.80 , $205.70 , $191.18 , N/A , $195.85 , $195.85 , $229.90 , $207.66 , $24.37 , $232.32 
 Fac Whfo W/Joint(S) Custom Fab ,HCPCS L3806,0274 - PROSTHETIC DEV,N/A,N/A, $510.00 , $331.50 , $428.40 , $483.55 , $231.34 , $412.08 , $459.00 , $431.77 , $459.00 , $459.00 , $459.00 , $433.50 , $226.80 , $470.88 , $484.50 , $433.50 , $474.30 , $474.30 , $484.50 , $489.60 , $417.28 , $459.00 , $433.50 , $402.90 , N/A , $412.74 , $412.74 , $484.50 , $437.63 , $226.80 , $489.60 
Revise Ulnar Nerve at Wrist,64719,N/A,N/A,N/A," $1,266.00 ", $822.90 ," $1,995.97 ", $392.48 , $549.85 ," $2,198.67 "," $2,142.58 "," $1,177.38 "," $1,139.40 "," $1,139.40 "," $1,012.80 "," $1,012.80 ", $549.85 ," $1,168.90 "," $1,202.70 "," $1,139.40 "," $1,139.40 "," $1,139.40 "," $1,177.38 "," $1,215.36 "," $2,144.33 "," $1,076.10 "," $2,119.47 "," $2,362.36 ", N/A ," $2,241.57 "," $2,241.57 "," $1,202.70 "," $2,404.68 ", $392.48 ," $2,404.68 "
 ESTROGENS CONJUGATED 0.625 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00046-1102-81,1 tablet, $41.33 , $26.86 , $34.72 , N/A , N/A , $33.39 , $37.20 , $34.99 , $37.20 , $37.20 , $37.20 , $35.13 , N/A , $38.16 , $39.26 , $35.13 , $38.44 , $38.44 , $39.26 , $39.68 , $33.82 , $37.20 , $35.13 , $32.65 , N/A , $33.45 , $33.45 , $39.26 , $35.47 , $32.65 , $39.68 
Total Disc Arthrp Ant Single Interspace Lumbar,22857,N/A,N/A,N/A," $10,895.00 "," $7,081.75 "," $10,617.36 "," $1,658.34 "," $1,160.02 "," $8,602.51 "," $6,752.99 "," $10,132.35 "," $9,805.50 "," $9,805.50 "," $8,716.00 "," $8,716.00 "," $1,160.02 "," $10,059.35 "," $10,350.25 "," $9,805.50 "," $9,805.50 "," $9,805.50 "," $10,132.35 "," $10,459.20 "," $9,913.39 "," $9,260.75 "," $7,548.38 "," $9,463.69 ", N/A ," $8,770.36 "," $8,770.36 "," $10,350.25 "," $10,308.28 "," $1,160.02 "," $10,617.36 "
 Veeg 12-26 Hours; With Intermittent Monitoring and Maintenance ,CPT® 95715,0740 - EEG,N/A,N/A," $2,698.00 "," $1,753.70 "," $2,266.32 ", $641.72 , $396.25 ," $2,179.98 "," $2,428.20 "," $2,284.13 "," $2,428.20 "," $2,428.20 "," $2,428.20 "," $2,293.30 ", $388.48 ," $2,491.06 "," $2,563.10 "," $2,293.30 "," $2,509.14 "," $2,509.14 "," $2,563.10 "," $2,590.08 "," $2,207.50 "," $2,428.20 "," $2,293.30 "," $2,131.42 ", N/A ," $2,183.49 "," $2,183.49 "," $2,563.10 "," $2,315.15 ", $388.48 ," $2,590.08 "
 Pro Arthrs Sho Surg Capsulorrhaphy ,CPT® 29806,0982 - PRO FEE/OUTPT,N/A,N/A," $6,522.00 "," $4,239.30 "," $6,420.64 "," $1,003.45 ", $938.38 ," $5,120.46 "," $5,089.63 "," $6,065.46 "," $5,869.80 "," $5,869.80 "," $5,217.60 "," $5,217.60 ", $938.38 ," $6,021.76 "," $6,195.90 "," $5,869.80 "," $5,869.80 "," $5,869.80 "," $6,065.46 "," $6,261.12 "," $5,969.11 "," $5,543.70 "," $5,626.94 "," $6,023.78 ", N/A ," $5,220.37 "," $5,220.37 "," $6,195.90 "," $6,135.79 ", $938.38 ," $6,420.64 "
 CLONIDINE 0.2 MG/24HR TD PTWK ,HCPCS RXC637,0250 - PHARMACY,00378-0872-99,1 patch, $286.46 , $186.20 , $240.63 , N/A , N/A , $231.46 , $257.81 , $242.52 , $257.81 , $257.81 , $257.81 , $243.49 , N/A , $264.49 , $272.14 , $243.49 , $266.41 , $266.41 , $272.14 , $275.00 , $234.38 , $257.81 , $243.49 , $226.30 , N/A , $231.83 , $231.83 , $272.14 , $245.81 , $226.30 , $275.00 
" Fac Chemotherapy, Into Cns ",CPT® 96450,0335 - CHEMOTHERP-IV,N/A,N/A, $872.00 , $566.80 , $732.48 , $74.10 , $201.46 , $704.58 , $784.80 , $738.24 , $784.80 , $784.80 , $784.80 , $741.20 , $197.51 , $805.12 , $828.40 , $741.20 , $810.96 , $810.96 , $828.40 , $837.12 , $713.47 , $784.80 , $741.20 , $688.88 , N/A , $705.71 , $705.71 , $828.40 , $748.26 , $74.10 , $837.12 
Molecular Cyto Inter 100-,CPT® 88275,N/A,N/A,N/A, $456.00 , $296.40 , N/A , $52.21 , $52.21 , $224.87 , $341.72 , $424.08 , $410.40 , $410.40 , $364.80 , $364.80 , $52.21 , $421.02 , $433.20 , $410.40 , $410.40 , $410.40 , $424.08 , $437.76 , $341.81 , $387.60 , $262.74 , $181.21 , N/A , $209.86 , $209.86 , $433.20 , $230.62 , $52.21 , $437.76 
IP/Obs Consltj New/Est Pt Low Mdm 45 Minutes,CPT® 99253,N/A,N/A,N/A, $496.00 , $322.40 , N/A , $98.01 , $86.25 , $251.90 , $250.97 , $461.28 , $446.40 , $446.40 , $396.80 , $396.80 , $86.25 , $457.96 , $471.20 , $446.40 , $446.40 , $446.40 , $461.28 , $476.16 , $319.65 , $421.60 , $244.53 , $252.43 , $120.25 , $256.82 , $256.82 , $471.20 , $305.75 , $86.25 , $476.16 
"Dialysis, Not Hemo, 1 Eval",CPT® 90945,N/A,N/A,N/A, $422.00 , $274.30 , $198.53 , $83.24 , $156.60 , $191.05 , $192.27 , $392.46 , $379.80 , $379.80 , $337.60 , $337.60 , $156.60 , $389.63 , $400.90 , $379.80 , $379.80 , $379.80 , $392.46 , $405.12 , $261.56 , $358.70 , $252.42 , $324.19 , N/A , $194.78 , $194.78 , $400.90 , $227.07 , $83.24 , $405.12 
"Hepb Ig, Im",CPT® 90371,N/A,N/A,N/A, $247.00 , $160.55 , N/A , $139.47 , $140.35 , $254.13 , $319.62 , $229.71 , $222.30 , $222.30 , $197.60 , $197.60 , $140.35 , $228.06 , $234.65 , $222.30 , $222.30 , $222.30 , $229.71 , $237.12 , $171.42 , $209.95 , $312.22 , $223.25 , N/A , $259.08 , $259.08 , $234.65 , $302.05 , $139.47 , $319.62 
 Tibia/Fibula (Lower Leg) 2 Views ,CPT® 73590,0320 - DX X-RAY,N/A,N/A, $292.00 , $189.80 , $245.28 , $31.03 , $26.21 , $235.94 , $262.80 , $247.21 , $262.80 , $262.80 , $262.80 , $248.20 , $25.70 , $269.60 , $277.40 , $248.20 , $271.56 , $271.56 , $277.40 , $280.32 , $238.91 , $262.80 , $248.20 , $230.68 , N/A , $236.32 , $236.32 , $277.40 , $250.57 , $25.70 , $280.32 
 Fac Molecular Pathology Procedure Level 5 ,CPT® 81404,0310 - PATHOLOGY LAB,N/A,N/A, $75.00 , $48.75 , $63.00 , $280.33 , $280.33 , $60.60 , $67.50 , $63.50 , $67.50 , $67.50 , $67.50 , $63.75 , $274.83 , $69.25 , $71.25 , $63.75 , $69.75 , $69.75 , $71.25 , $72.00 , $61.37 , $67.50 , $63.75 , $59.25 , N/A , $60.70 , $60.70 , $71.25 , $64.36 , $59.25 , $280.33 
 Fac Surfactant Admin Thru Tube ,CPT® 94610,0410 - RESPIRATORY SVC,N/A,N/A, $174.00 , $113.10 , $146.16 , $54.75 , $51.84 , $140.59 , $156.60 , $147.31 , $156.60 , $156.60 , $156.60 , $147.90 , $50.82 , $160.65 , $165.30 , $147.90 , $161.82 , $161.82 , $165.30 , $167.04 , $142.37 , $156.60 , $147.90 , $137.46 , N/A , $140.82 , $140.82 , $165.30 , $149.31 , $50.82 , $167.04 
 Fac Aep Scr Auditory Potential W/Stimuli Auto Alys ,CPT® 92650,0470 - AUDIOLOGY,N/A,N/A, $306.00 , $198.90 , $257.04 , $27.24 , $22.16 , $247.25 , $275.40 , $259.06 , $275.40 , $275.40 , $275.40 , $260.10 , $21.73 , $282.53 , $290.70 , $260.10 , $284.58 , $284.58 , $290.70 , $293.76 , $250.37 , $275.40 , $260.10 , $241.74 , N/A , $247.65 , $247.65 , $290.70 , $262.58 , $21.73 , $293.76 
Regadenoson injection,HCPCS J2785,N/A,N/A,N/A, $127.00 , $82.55 , N/A , $63.53 , $63.23 , N/A , N/A , $118.11 , $114.30 , $114.30 , $101.60 , $101.60 , $63.23 , $117.26 , $120.65 , $114.30 , $114.30 , $114.30 , $118.11 , $121.92 , $77.42 , $107.95 , $102.50 , $80.00 , N/A , N/A , N/A , $120.65 , N/A , $63.23 , $121.92 
Remov Heart Sac No Cp Bypass,CPT® 33030,N/A,N/A,N/A," $12,114.00 "," $7,874.10 "," $11,683.30 "," $1,802.12 "," $1,876.32 "," $8,547.68 "," $8,450.65 "," $11,266.02 "," $10,902.60 "," $10,902.60 "," $9,691.20 "," $9,691.20 "," $1,876.32 "," $11,184.86 "," $11,508.30 "," $10,902.60 "," $10,902.60 "," $10,902.60 "," $11,266.02 "," $11,629.44 "," $10,816.44 "," $10,296.90 "," $10,693.68 "," $9,578.82 ", N/A ," $8,714.46 "," $8,714.46 "," $11,508.30 "," $9,899.64 "," $1,802.12 "," $11,683.30 "
"Nasal Scopy,Rmv Tiss Maxill Sinus",CPT® 31267,N/A,N/A,N/A," $2,036.00 "," $1,323.40 "," $1,429.39 ", $252.66 , $443.76 ," $1,215.33 "," $1,188.79 "," $1,893.48 "," $1,832.40 "," $1,832.40 "," $1,628.80 "," $1,628.80 ", $443.76 ," $1,879.84 "," $1,934.20 "," $1,832.40 "," $1,832.40 "," $1,832.40 "," $1,893.48 "," $1,954.56 "," $1,369.40 "," $1,730.60 "," $1,675.24 "," $1,353.47 ", N/A ," $1,239.04 "," $1,239.04 "," $1,934.20 "," $1,459.23 ", $252.66 ," $1,954.56 "
 Fac Pinworm Exam ,CPT® 87172,0306 - LAB/BACT-MICRO,N/A,N/A, $62.00 , $40.30 , $52.08 , $4.36 , $4.36 , $50.10 , $55.80 , $52.49 , $55.80 , $55.80 , $55.80 , $52.70 , $4.27 , $57.24 , $58.90 , $52.70 , $57.66 , $57.66 , $58.90 , $59.52 , $50.73 , $55.80 , $52.70 , $48.98 , N/A , $50.18 , $50.18 , $58.90 , $53.20 , $4.27 , $59.52 
Repair Complex Addt,13153,N/A,N/A,N/A," $1,136.00 ", $738.40 , $433.74 , $129.18 , $143.36 , $387.36 , $372.44 ," $1,056.48 "," $1,022.40 "," $1,022.40 ", $908.80 , $908.80 , $143.36 ," $1,048.87 "," $1,079.20 "," $1,022.40 "," $1,022.40 "," $1,022.40 "," $1,056.48 "," $1,090.56 ", $478.39 , $965.60 , $745.74 , $493.49 , N/A , $394.92 , $394.92 ," $1,079.20 ", $457.97 , $129.18 ," $1,090.56 "
 Dysequilibrium ,MS DRG V40 (FY2023) 149,N/A,N/A,N/A," $20,095.37 "," $13,061.99 "," $16,880.11 ", N/A , N/A ," $16,237.06 "," $18,085.83 "," $17,012.74 "," $18,085.83 "," $18,085.83 "," $18,085.83 "," $17,081.06 ", N/A ," $18,554.06 "," $19,090.60 "," $17,081.06 "," $18,688.69 "," $18,688.69 "," $19,090.60 "," $19,291.56 "," $16,442.03 "," $18,085.83 "," $17,081.06 "," $15,875.34 ", N/A ," $16,263.18 "," $16,263.18 "," $19,090.60 "," $17,243.84 "," $15,875.34 "," $19,291.56 "
" CT Angio,Upper Extremity ",CPT® 73206,0350 - CT SCAN,N/A,N/A," $4,770.00 "," $3,100.50 "," $4,006.80 ", $258.04 , $354.97 ," $3,854.16 "," $4,293.00 "," $4,038.28 "," $4,293.00 "," $4,293.00 "," $4,293.00 "," $4,054.50 ", $348.01 ," $4,404.14 "," $4,531.50 "," $4,054.50 "," $4,436.10 "," $4,436.10 "," $4,531.50 "," $4,579.20 "," $3,902.81 "," $4,293.00 "," $4,054.50 "," $3,768.30 ", N/A ," $3,860.36 "," $3,860.36 "," $4,531.50 "," $4,093.14 ", $258.04 ," $4,579.20 "
Excision/Destruction Open Abdominal Tumors 5 Cm,CPT® 49203,N/A,N/A,N/A," $7,787.00 "," $5,061.55 "," $7,147.47 "," $1,109.35 ", $814.42 ," $5,646.55 "," $5,663.46 "," $7,241.91 "," $7,008.30 "," $7,008.30 "," $6,229.60 "," $6,229.60 ", $814.42 ," $7,189.74 "," $7,397.65 "," $7,008.30 "," $7,008.30 "," $7,008.30 "," $7,241.91 "," $7,475.52 "," $5,120.90 "," $6,618.95 "," $6,278.12 "," $6,673.81 ", N/A ," $5,756.72 "," $5,756.72 "," $7,397.65 "," $6,020.92 ", $814.42 ," $7,475.52 "
 Fac Removal of Indwelling Tunneled Pleural Catheter With Cuff ,CPT® 32552,0761 - TREATMENT ROOM,N/A,N/A, $869.00 , $564.85 , $729.96 , $148.82 , $151.27 , $702.15 , $782.10 , $735.70 , $782.10 , $782.10 , $782.10 , $738.65 , $148.30 , $802.35 , $825.55 , $738.65 , $808.17 , $808.17 , $825.55 , $834.24 , $711.02 , $782.10 , $738.65 , $686.51 , N/A , $703.28 , $703.28 , $825.55 , $745.69 , $148.30 , $834.24 
 Elbow 2 Views ,CPT® 73070,0320 - DX X-RAY,N/A,N/A, $257.00 , $167.05 , $215.88 , $28.73 , $26.19 , $207.66 , $231.30 , $217.58 , $231.30 , $231.30 , $231.30 , $218.45 , $25.68 , $237.29 , $244.15 , $218.45 , $239.01 , $239.01 , $244.15 , $246.72 , $210.28 , $231.30 , $218.45 , $203.03 , N/A , $207.99 , $207.99 , $244.15 , $220.53 , $25.68 , $246.72 
"Destr Penis Lesn,Simpl,Laser Surg",CPT® 54057,N/A,N/A,N/A, $761.00 , $494.65 , $431.04 , $94.37 , $46.08 , $302.05 , $310.86 , $707.73 , $684.90 , $684.90 , $608.80 , $608.80 , $46.08 , $702.63 , $722.95 , $684.90 , $684.90 , $684.90 , $707.73 , $730.56 , $400.27 , $646.85 , $494.19 , $465.44 , N/A , $307.94 , $307.94 , $722.95 , $369.08 , $46.08 , $730.56 
 LURASIDONE HCL 40 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,63402-0304-30,1 tablet, $291.51 , $189.48 , $244.87 , N/A , N/A , $235.54 , $262.36 , $246.79 , $262.36 , $262.36 , $262.36 , $247.78 , N/A , $269.15 , $276.93 , $247.78 , $271.10 , $271.10 , $276.93 , $279.85 , $238.51 , $262.36 , $247.78 , $230.29 , N/A , $235.92 , $235.92 , $276.93 , $250.14 , $230.29 , $279.85 
Injection Aa&/Strd Genicular Nrv Branches W/Img,CPT® 64454,N/A,N/A,N/A," $1,869.00 "," $1,214.85 ", $408.04 , $79.01 , $168.18 , $449.85 , N/A ," $1,738.17 "," $1,682.10 "," $1,682.10 "," $1,495.20 "," $1,495.20 ", $168.18 ," $1,725.65 "," $1,775.55 "," $1,682.10 "," $1,682.10 "," $1,682.10 "," $1,738.17 "," $1,794.24 ", $436.15 ," $1,588.65 ", $430.02 , $495.19 , N/A , $458.63 , $458.63 ," $1,775.55 ", $491.98 , $79.01 ," $1,794.24 "
 CALCIUM CITRATE 950 (200 CA) MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,80681-0140-00,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Removal of Hip Prosthesis,CPT® 27090,N/A,N/A,N/A," $5,707.00 "," $3,709.55 "," $5,040.43 ", $790.34 , $669.43 ," $3,987.17 "," $3,978.50 "," $5,307.51 "," $5,136.30 "," $5,136.30 "," $4,565.60 "," $4,565.60 ", $669.43 ," $5,269.27 "," $5,421.65 "," $5,136.30 "," $5,136.30 "," $5,136.30 "," $5,307.51 "," $5,478.72 "," $4,678.84 "," $4,850.95 "," $4,397.72 "," $4,712.18 ", N/A ," $4,064.96 "," $4,064.96 "," $5,421.65 "," $4,777.79 ", $669.43 ," $5,478.72 "
Crutch Forearm Pair,HCPCS E0110,N/A,N/A,N/A, $36.00 , $23.40 , N/A , $105.25 , $73.14 , N/A , N/A , $33.48 , $32.40 , $32.40 , $28.80 , $28.80 , $73.14 , $33.24 , $34.20 , $32.40 , $32.40 , $32.40 , $33.48 , $34.56 , N/A , $30.60 , N/A , $95.63 , N/A , N/A , N/A , $34.20 , N/A , $28.80 , $105.25 
 Fac M/Phmtrc Alys Ish Quant/Semiq Mnl Each Multiprb ,CPT® 88377,0310 - PATHOLOGY LAB,N/A,N/A," $1,385.00 ", $900.25 ," $1,163.40 ", $389.56 , $168.73 ," $1,119.08 "," $1,246.50 "," $1,172.54 "," $1,246.50 "," $1,246.50 "," $1,246.50 "," $1,177.25 ", $165.42 ," $1,278.77 "," $1,315.75 "," $1,177.25 "," $1,288.05 "," $1,288.05 "," $1,315.75 "," $1,329.60 "," $1,133.21 "," $1,246.50 "," $1,177.25 "," $1,094.15 ", N/A ," $1,120.88 "," $1,120.88 "," $1,315.75 "," $1,188.47 ", $165.42 ," $1,329.60 "
Excis/Curet Benign Elbow Lesn,CPT® 24120,N/A,N/A,N/A," $1,722.00 "," $1,119.30 "," $3,266.97 ", $513.19 , $491.78 ," $2,542.74 "," $2,548.08 "," $1,601.46 "," $1,549.80 "," $1,549.80 "," $1,377.60 "," $1,377.60 ", $491.78 ," $1,589.92 "," $1,635.90 "," $1,549.80 "," $1,549.80 "," $1,549.80 "," $1,601.46 "," $1,653.12 "," $3,028.76 "," $1,463.70 "," $2,808.12 "," $3,022.47 ", N/A ," $2,592.36 "," $2,592.36 "," $1,635.90 "," $3,046.95 ", $491.78 ," $3,266.97 "
Exclusion Laa Open Tm Strnt/Thrcm Any Method,CPT® 33268,N/A,N/A,N/A," $1,692.00 "," $1,099.80 ", $763.49 , $117.44 , $648.33 , N/A , N/A ," $1,573.56 "," $1,522.80 "," $1,522.80 "," $1,353.60 "," $1,353.60 ", $648.33 ," $1,562.22 "," $1,607.40 "," $1,522.80 "," $1,522.80 "," $1,522.80 "," $1,573.56 "," $1,624.32 ", N/A ," $1,438.20 ", $678.79 , $633.43 , N/A , $498.24 , $498.24 ," $1,607.40 ", $566.12 , $117.44 ," $1,624.32 "
Pro Rep Finger Tendon,26432,N/A,N/A,N/A," $2,574.00 "," $1,673.10 "," $3,451.37 ", $536.34 , $414.43 ," $2,376.11 "," $2,426.04 "," $2,393.82 "," $2,316.60 "," $2,316.60 "," $2,059.20 "," $2,059.20 ", $414.43 ," $2,376.57 "," $2,445.30 "," $2,316.60 "," $2,316.60 "," $2,316.60 "," $2,393.82 "," $2,471.04 "," $3,147.05 "," $2,187.90 "," $2,651.12 "," $2,837.40 ", N/A ," $2,422.47 "," $2,422.47 "," $2,445.30 "," $2,847.28 ", $414.43 ," $3,451.37 "
"Fusion Big Toe,Mt-P Jt",CPT® 28750,N/A,N/A,N/A," $5,538.00 "," $3,599.70 "," $3,563.76 ", $556.74 , $273.33 ," $2,894.41 "," $2,906.69 "," $5,150.34 "," $4,984.20 "," $4,984.20 "," $4,430.40 "," $4,430.40 ", $273.33 ," $5,113.24 "," $5,261.10 "," $4,984.20 "," $4,984.20 "," $4,984.20 "," $5,150.34 "," $5,316.48 "," $3,324.03 "," $4,707.30 "," $3,184.55 "," $3,400.28 ", N/A ," $2,950.89 "," $2,950.89 "," $5,261.10 "," $3,468.35 ", $273.33 ," $5,316.48 "
 Fac Complement/Function Activity ,CPT® 86161,0302 - LAB/IMMUNOLOGY,N/A,N/A, $190.00 , $123.50 , $159.60 , $12.24 , $12.24 , $153.52 , $171.00 , $160.85 , $171.00 , $171.00 , $171.00 , $161.50 , $12.00 , $175.43 , $180.50 , $161.50 , $176.70 , $176.70 , $180.50 , $182.40 , $155.46 , $171.00 , $161.50 , $150.10 , N/A , $153.77 , $153.77 , $180.50 , $163.04 , $12.00 , $182.40 
"Injection-Tendon,Ligament",CPT® 20550,N/A,N/A,N/A, $384.00 , $249.60 , $99.25 , $37.19 , $27.51 , $203.30 , $199.04 , $357.12 , $345.60 , $345.60 , $307.20 , $307.20 , $27.51 , $354.55 , $364.80 , $345.60 , $345.60 , $345.60 , $357.12 , $368.64 , $222.72 , $326.40 , $215.87 , $227.07 , N/A , $207.26 , $207.26 , $364.80 , $243.62 , $27.51 , $368.64 
 Pro Open Tx Distal Tibiofibular Joint Disruption ,CPT® 27829,0982 - PRO FEE/OUTPT,N/A,N/A," $3,591.00 "," $2,334.15 "," $4,358.71 ", $680.77 , $390.51 ," $3,306.79 "," $3,316.74 "," $3,339.63 "," $3,231.90 "," $3,231.90 "," $2,872.80 "," $2,872.80 ", $390.51 ," $3,315.57 "," $3,411.45 "," $3,231.90 "," $3,231.90 "," $3,231.90 "," $3,339.63 "," $3,447.36 "," $4,042.74 "," $3,052.35 "," $3,655.55 "," $3,972.04 ", N/A ," $3,371.32 "," $3,371.32 "," $3,411.45 "," $3,962.48 ", $390.51 ," $4,358.71 "
 Fac Mycobacteric Identification ,CPT® 87118,0306 - LAB/BACT-MICRO,N/A,N/A, $152.00 , $98.80 , $127.68 , $14.90 , $14.90 , $122.82 , $136.80 , $128.68 , $136.80 , $136.80 , $136.80 , $129.20 , $14.61 , $140.34 , $144.40 , $129.20 , $141.36 , $141.36 , $144.40 , $145.92 , $124.37 , $136.80 , $129.20 , $120.08 , N/A , $123.01 , $123.01 , $144.40 , $130.43 , $14.61 , $145.92 
"Smear-Special Stain,Paras",CPT® 87207,N/A,N/A,N/A, $111.00 , $72.15 , N/A , $6.11 , $6.11 , $33.88 , $40.57 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $6.11 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $40.00 , $94.35 , $134.61 , $21.73 , N/A , $31.62 , $31.62 , $105.45 , $34.56 , $6.11 , $134.61 
" Pro Scope Bladder, Removal of Tumors, Small ",CPT® 52234,0982 - PRO FEE/OUTPT,N/A,N/A," $1,651.00 "," $1,073.15 "," $1,317.84 ", $231.66 , $250.82 ," $1,207.45 "," $1,117.67 "," $1,535.43 "," $1,485.90 "," $1,485.90 "," $1,320.80 "," $1,320.80 ", $250.82 ," $1,524.37 "," $1,568.45 "," $1,485.90 "," $1,485.90 "," $1,485.90 "," $1,535.43 "," $1,584.96 "," $1,324.75 "," $1,403.35 "," $1,264.90 "," $1,516.12 ", N/A ," $1,231.01 "," $1,231.01 "," $1,568.45 "," $1,446.87 ", $231.66 ," $1,584.96 "
 Pro Colonoscopy Flx W/Endoscopic Mucosal Resection ,CPT® 45390,0982 - PRO FEE/OUTPT,N/A,N/A," $2,139.00 "," $1,390.35 "," $2,040.42 ", $314.66 , $265.41 , N/A , N/A ," $1,989.27 "," $1,925.10 "," $1,925.10 "," $1,711.20 "," $1,711.20 ", $265.41 ," $1,974.94 "," $2,032.05 "," $1,925.10 "," $1,925.10 "," $1,925.10 "," $1,989.27 "," $2,053.44 "," $1,466.15 "," $1,818.15 "," $1,730.74 "," $1,945.15 ", N/A ," $1,490.41 "," $1,490.41 "," $2,032.05 "," $1,559.96 ", $265.41 ," $2,053.44 "
"Fx Closed, Humeral",24530,N/A,N/A,N/A," $1,765.00 "," $1,147.25 "," $2,179.65 ", $345.51 , $245.89 ," $1,654.51 "," $1,676.86 "," $1,641.45 "," $1,588.50 "," $1,588.50 "," $1,412.00 "," $1,412.00 ", $245.89 ," $1,629.62 "," $1,676.75 "," $1,588.50 "," $1,588.50 "," $1,588.50 "," $1,641.45 "," $1,694.40 "," $2,006.52 "," $1,500.25 "," $1,841.15 "," $1,967.73 ", N/A ," $1,686.79 "," $1,686.79 "," $1,676.75 "," $1,982.57 ", $245.89 ," $2,179.65 "
App Skn Sub Grft T/a/L Area/>100scm Adl 100scm,CPT® 15274,N/A,N/A,N/A, $447.00 , $290.55 , $140.28 , $41.10 , $54.02 , $124.25 , $109.80 , $415.71 , $402.30 , $402.30 , $357.60 , $357.60 , $54.02 , $412.72 , $424.65 , $402.30 , $402.30 , $402.30 , $415.71 , $429.12 , $153.97 , $379.95 , $217.66 , $157.09 , N/A , $126.67 , $126.67 , $424.65 , $146.90 , $41.10 , $429.12 
 Pro X-Ray Exam of Trunk Spine ,CPT® 72080,0972 - PRO FEE/RAD/DX,N/A,N/A, $121.00 , $78.65 , $196.50 , $34.08 , $34.04 , $158.08 , $193.11 , $112.53 , $108.90 , $108.90 , $96.80 , $96.80 , $34.04 , $111.72 , $114.95 , $108.90 , $108.90 , $108.90 , $112.53 , $116.16 , $190.08 , $102.85 , $213.79 , $169.59 , N/A , $161.17 , $161.17 , $114.95 , $186.54 , $34.04 , $213.79 
 LIDOCAINE-EPINEPHRINE 2 %-1:200000 IJ SOLN ,HCPCS RXA250,0250 - PHARMACY,63323-0489-27,1 mL, $16.68 , $10.84 , $14.01 , N/A , N/A , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , N/A , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $13.18 , $16.01 
 Pro Thoracentesis Needle/Cath Pleura W/Imaging ,CPT® 32555,0975 - PRO FEE/OR,N/A,N/A," $3,674.00 "," $2,388.10 ", $602.20 , $104.93 , $293.25 , $441.35 , $422.54 ," $3,416.82 "," $3,306.60 "," $3,306.60 "," $2,939.20 "," $2,939.20 ", $293.25 ," $3,392.20 "," $3,490.30 "," $3,306.60 "," $3,306.60 "," $3,306.60 "," $3,416.82 "," $3,527.04 ", $586.09 ," $3,122.90 ", $588.74 , $585.22 , N/A , $449.97 , $449.97 ," $3,490.30 ", $529.94 , $104.93 ," $3,527.04 "
 Nse Componet Code Beaker1 ,CPT® 86316,0300 - LABORATORY,N/A,N/A, $238.00 , $154.70 , $199.92 , $21.23 , $21.23 , $192.30 , $214.20 , $201.49 , $214.20 , $214.20 , $214.20 , $202.30 , $20.81 , $219.75 , $226.10 , $202.30 , $221.34 , $221.34 , $226.10 , $228.48 , $194.73 , $214.20 , $202.30 , $188.02 , N/A , $192.61 , $192.61 , $226.10 , $204.23 , $20.81 , $228.48 
"Inject Trigger Points, > 3",CPT® 20553,N/A,N/A,N/A, $465.00 , $302.25 , $108.92 , $40.47 , $26.41 , $210.81 , $207.99 , $432.45 , $418.50 , $418.50 , $372.00 , $372.00 , $26.41 , $429.33 , $441.75 , $418.50 , $418.50 , $418.50 , $432.45 , $446.40 , $244.53 , $395.25 , $224.79 , $250.96 , N/A , $214.93 , $214.93 , $441.75 , $252.63 , $26.41 , $446.40 
Drug Test Def 1-7 Classes,HCPCS G0480,N/A,N/A,N/A, $270.00 , $175.50 , N/A , $116.72 , $65.23 , $151.10 , N/A , $251.10 , $243.00 , $243.00 , $216.00 , $216.00 , $65.23 , $249.29 , $256.50 , $243.00 , $243.00 , $243.00 , $251.10 , $259.20 , $764.07 , $229.50 , $218.40 , $336.08 , N/A , $154.06 , $154.06 , $256.50 , $192.55 , $65.23 , $764.07 
"Lens, 1.54-1.65 P/1.60-1.79g",HCPCS V2782,N/A,N/A,N/A, $50.00 , $32.50 , N/A , $75.45 , N/A , N/A , N/A , $46.50 , $45.00 , $45.00 , $40.00 , $40.00 , N/A , $46.17 , $47.50 , $45.00 , $45.00 , $45.00 , $46.50 , $48.00 , N/A , $42.50 , $50.00 , $68.55 , N/A , N/A , N/A , $47.50 , N/A , $40.00 , $75.45 
"Deep Dissec Foot Infec,Multiple",CPT® 28003,N/A,N/A,N/A," $4,722.00 "," $3,069.30 "," $1,611.68 ", $249.43 , $496.45 ," $2,779.28 "," $2,842.04 "," $4,391.46 "," $4,249.80 "," $4,249.80 "," $3,777.60 "," $3,777.60 ", $496.45 ," $4,359.82 "," $4,485.90 "," $4,249.80 "," $4,249.80 "," $4,249.80 "," $4,391.46 "," $4,533.12 "," $3,222.25 "," $4,013.70 "," $3,090.00 "," $3,269.80 ", N/A ," $2,833.51 "," $2,833.51 "," $4,485.90 "," $3,330.39 ", $249.43 ," $4,533.12 "
Inject Anesthetic Agent,CPT® 64402,N/A,N/A,N/A, $359.00 , $233.35 , N/A , N/A , N/A , N/A , $408.19 , $333.87 , $323.10 , $323.10 , $287.20 , $287.20 , N/A , $331.46 , $341.05 , $323.10 , $323.10 , $323.10 , $333.87 , $344.64 , N/A , $305.15 , N/A , N/A , N/A , N/A , N/A , $341.05 , N/A , $287.20 , $408.19 
 Fac Emergency Level I ,CPT® 99281,0450 - EMERGENCY SERVICES,N/A,N/A, $294.00 , $191.10 , $246.96 , $11.05 , $22.89 , $237.55 , $264.60 , $248.90 , $264.60 , $264.60 , $264.60 , $249.90 , $22.44 , $271.45 , $279.30 , $249.90 , $273.42 , $273.42 , $279.30 , $282.24 , $240.55 , $264.60 , $249.90 , $232.26 , N/A , $237.93 , $237.93 , $279.30 , $252.28 , $11.05 , $282.24 
 Fac Special Radiation Treatment ,CPT® 77470,0333 - RADIATION RX,N/A,N/A," $3,472.00 "," $2,256.80 "," $2,916.48 ", $137.14 , $219.71 ," $2,805.38 "," $3,124.80 "," $2,939.40 "," $3,124.80 "," $3,124.80 "," $3,124.80 "," $2,951.20 ", $215.40 ," $3,205.70 "," $3,298.40 "," $2,951.20 "," $3,228.96 "," $3,228.96 "," $3,298.40 "," $3,333.12 "," $2,840.79 "," $3,124.80 "," $2,951.20 "," $2,742.88 ", N/A ," $2,809.89 "," $2,809.89 "," $3,298.40 "," $2,979.32 ", $137.14 ," $3,333.12 "
 Pro Excise Hand/Foot Neuroma ,CPT® 64782,0982 - PRO FEE/OUTPT,N/A,N/A," $4,541.00 "," $2,951.65 "," $2,246.76 ", $439.08 , $230.52 ," $2,502.07 "," $2,432.00 "," $4,223.13 "," $4,086.90 "," $4,086.90 "," $3,632.80 "," $3,632.80 ", $230.52 ," $4,192.71 "," $4,313.95 "," $4,086.90 "," $4,086.90 "," $4,086.90 "," $4,223.13 "," $4,359.36 "," $2,433.72 "," $3,859.85 "," $2,385.29 "," $2,725.50 ", N/A ," $2,550.89 "," $2,550.89 "," $4,313.95 "," $2,736.50 ", $230.52 ," $4,359.36 "
" Pro OB US Nuchal Meas, Add-On ",CPT® 76814,0972 - PRO FEE/RAD/DX,N/A,N/A, $343.00 , $222.95 , $432.33 , $74.60 , $68.31 , $390.93 , $419.53 , $318.99 , $308.70 , $308.70 , $274.40 , $274.40 , $68.31 , $316.69 , $325.85 , $308.70 , $308.70 , $308.70 , $318.99 , $329.28 , $436.37 , $291.55 , $456.47 , $452.65 , N/A , $398.56 , $398.56 , $325.85 , $461.33 , $68.31 , $461.33 
Excis Dentoalveolar Lesion,CPT® 41825,N/A,N/A,N/A," $1,383.00 ", $898.95 , $743.93 , $117.90 , $176.06 , $597.42 , $612.35 ," $1,286.19 "," $1,244.70 "," $1,244.70 "," $1,106.40 "," $1,106.40 ", $176.06 ," $1,276.92 "," $1,313.85 "," $1,244.70 "," $1,244.70 "," $1,244.70 "," $1,286.19 "," $1,327.68 ", $530.97 ," $1,175.55 ", $667.24 , $704.62 , N/A , $609.08 , $609.08 ," $1,313.85 ", $637.03 , $117.90 ," $1,327.68 "
 Fac Psychotherapy W/Patient W/E&M Srvcs 60 Min ,CPT® 90838,0914 - PSYCH/INDIV RX,N/A,N/A, $237.00 , $154.05 , $199.08 , $103.04 , $133.44 , $191.50 , $213.30 , $200.64 , $213.30 , $213.30 , $213.30 , $201.45 , $130.82 , $218.82 , $225.15 , $201.45 , $220.41 , $220.41 , $225.15 , $227.52 , $193.91 , $213.30 , $201.45 , $187.23 , N/A , $191.80 , $191.80 , $225.15 , $203.37 , $103.04 , $227.52 
Incision of Urethra,CPT® 53000,N/A,N/A,N/A," $1,035.00 ", $672.75 , $805.69 , $142.25 , $153.67 , $722.35 , $680.62 , $962.55 , $931.50 , $931.50 , $828.00 , $828.00 , $153.67 , $955.62 , $983.25 , $931.50 , $931.50 , $931.50 , $962.55 , $993.60 , $809.29 , $879.75 , $770.72 , $913.87 , N/A , $736.44 , $736.44 , $983.25 , $865.57 , $142.25 , $993.60 
Esoph Balloon Distension Tst,CPT® 91040,N/A,N/A,N/A," $2,252.00 "," $1,463.80 "," $1,284.26 ", $518.74 , $398.78 , $974.83 , $689.06 ," $2,094.36 "," $2,026.80 "," $2,026.80 "," $1,801.60 "," $1,801.60 ", $398.78 ," $2,079.27 "," $2,139.40 "," $2,026.80 "," $2,026.80 "," $2,026.80 "," $2,094.36 "," $2,161.92 "," $2,368.45 "," $1,914.20 ", $913.36 ," $1,699.33 ", N/A , $993.84 , $993.84 ," $2,139.40 "," $1,158.63 ", $398.78 ," $2,368.45 "
 Pro Cltx Dstl Phlngl Fx Fngr/Thmb W/Mnpj Ea ,CPT® 26755,0982 - PRO FEE/OUTPT,N/A,N/A," $1,167.00 ", $758.55 ," $1,701.51 ", $269.64 , $63.53 ," $1,312.50 "," $1,334.43 "," $1,085.31 "," $1,050.30 "," $1,050.30 ", $933.60 , $933.60 , $63.53 ," $1,077.49 "," $1,108.65 "," $1,050.30 "," $1,050.30 "," $1,050.30 "," $1,085.31 "," $1,120.32 "," $1,574.04 ", $991.95 ," $1,464.72 "," $1,562.15 ", N/A ," $1,338.12 "," $1,338.12 "," $1,108.65 "," $1,572.76 ", $63.53 ," $1,701.51 "
 Fac Intracranial Study ,CPT® 93886,0920 - OTHER DX SVS,N/A,N/A," $1,559.00 "," $1,013.35 "," $1,309.56 ", $265.47 , $210.86 ," $1,259.67 "," $1,403.10 "," $1,319.85 "," $1,403.10 "," $1,403.10 "," $1,403.10 "," $1,325.15 ", $206.73 ," $1,439.42 "," $1,481.05 "," $1,325.15 "," $1,449.87 "," $1,449.87 "," $1,481.05 "," $1,496.64 "," $1,275.57 "," $1,403.10 "," $1,325.15 "," $1,231.61 ", N/A ," $1,261.70 "," $1,261.70 "," $1,481.05 "," $1,337.78 ", $206.73 ," $1,496.64 "
"Varicella Ag, Dfa",CPT® 87290,N/A,N/A,N/A, $113.00 , $73.45 , N/A , $13.69 , $13.69 , $67.85 , $81.18 , $105.09 , $101.70 , $101.70 , $90.40 , $90.40 , $13.69 , $104.33 , $107.35 , $101.70 , $101.70 , $101.70 , $105.09 , $108.48 , $89.61 , $96.05 , $77.85 , $43.47 , N/A , $63.32 , $63.32 , $107.35 , $69.20 , $13.69 , $108.48 
 Pro Treatment of Ankle Fracture ,CPT® 27808,0982 - PRO FEE/OUTPT,N/A,N/A," $2,205.00 "," $1,433.25 "," $1,908.27 ", $301.59 , $190.55 ," $1,449.98 "," $1,478.68 "," $2,050.65 "," $1,984.50 "," $1,984.50 "," $1,764.00 "," $1,764.00 ", $190.55 ," $2,035.88 "," $2,094.75 "," $1,984.50 "," $1,984.50 "," $1,984.50 "," $2,050.65 "," $2,116.80 "," $1,757.34 "," $1,874.25 "," $1,621.71 "," $1,717.78 ", N/A ," $1,478.27 "," $1,478.27 "," $2,094.75 "," $1,737.49 ", $190.55 ," $2,116.80 "
" Fac Fungi Identification, Yeast ",CPT® 87106,0306 - LAB/BACT-MICRO,N/A,N/A, $114.00 , $74.10 , $95.76 , $10.53 , $10.53 , $92.11 , $102.60 , $96.51 , $102.60 , $102.60 , $102.60 , $96.90 , $10.32 , $105.26 , $108.30 , $96.90 , $106.02 , $106.02 , $108.30 , $109.44 , $93.27 , $102.60 , $96.90 , $90.06 , N/A , $92.26 , $92.26 , $108.30 , $97.82 , $10.32 , $109.44 
 Fac Agglutinins Febrile Ea Ag ,CPT® 86000,0300 - LABORATORY,N/A,N/A, $55.00 , $35.75 , $46.20 , $7.12 , $7.12 , $44.44 , $49.50 , $46.56 , $49.50 , $49.50 , $49.50 , $46.75 , $6.98 , $50.78 , $52.25 , $46.75 , $51.15 , $51.15 , $52.25 , $52.80 , $45.00 , $49.50 , $46.75 , $43.45 , N/A , $44.51 , $44.51 , $52.25 , $47.20 , $6.98 , $52.80 
 Fac Hepatitis C Ab Test ,CPT® 86803,0302 - LAB/IMMUNOLOGY,N/A,N/A, $173.00 , $112.45 , $145.32 , $14.56 , $14.56 , $139.78 , $155.70 , $146.46 , $155.70 , $155.70 , $155.70 , $147.05 , $14.27 , $159.73 , $164.35 , $147.05 , $160.89 , $160.89 , $164.35 , $166.08 , $141.55 , $155.70 , $147.05 , $136.67 , N/A , $140.01 , $140.01 , $164.35 , $148.45 , $14.27 , $166.08 
 Pro Prolonged Outpatient E/M Service Each 15 Minutes ,CPT® 99417,0982 - PRO FEE/OUTPT,N/A,N/A, $140.00 , $91.00 , N/A , $30.39 , N/A , N/A , N/A , $130.20 , $126.00 , $126.00 , $112.00 , $112.00 , N/A , $129.26 , $133.00 , $126.00 , $126.00 , $126.00 , $130.20 , $134.40 , $58.33 , $119.00 , $66.49 , $71.61 , N/A , $53.82 , $53.82 , $133.00 , $60.59 , $30.39 , $134.40 
 TETANUS-DIPHTHERIA TOXOIDS TD 2-2 LF/0.5ML IM SUSP ,HCPCS 90714,0636 - DRUGS REQUIRING DETAILED CODIN,13533-0131-00,0.5 mL, $172.55 , $112.16 , $144.94 , $31.67 , $36.78 , $139.42 , $155.30 , $146.08 , $155.30 , $155.30 , $155.30 , $146.67 , $36.06 , $159.32 , $163.92 , $146.67 , $160.47 , $160.47 , $163.92 , $165.65 , $141.18 , $155.30 , $146.67 , $136.31 , N/A , $139.64 , $139.64 , $163.92 , $148.07 , $31.67 , $165.65 
Arthrodesis Posterior/Pstlat Tq 1ntrspc Thoracic,CPT® 22610,N/A,N/A,N/A," $8,190.00 "," $5,323.50 "," $7,480.79 "," $1,173.70 "," $1,061.94 "," $6,032.79 "," $5,967.13 "," $7,616.70 "," $7,371.00 "," $7,371.00 "," $6,552.00 "," $6,552.00 "," $1,061.94 "," $7,561.83 "," $7,780.50 "," $7,371.00 "," $7,371.00 "," $7,371.00 "," $7,616.70 "," $7,862.40 "," $6,955.74 "," $6,961.50 "," $6,704.51 "," $7,001.48 ", N/A ," $6,150.50 "," $6,150.50 "," $7,780.50 "," $7,229.01 "," $1,061.94 "," $7,862.40 "
"Destruct Internal Hemorrhoid, Thermal",CPT® 46930,N/A,N/A,N/A," $1,384.00 ", $899.60 , $953.16 , $147.02 , $143.79 , $710.05 , $733.17 ," $1,287.12 "," $1,245.60 "," $1,245.60 "," $1,107.20 "," $1,107.20 ", $143.79 ," $1,277.85 "," $1,314.80 "," $1,245.60 "," $1,245.60 "," $1,245.60 "," $1,287.12 "," $1,328.64 ", $682.46 ," $1,176.40 ", $801.04 , $850.75 , N/A , $723.90 , $723.90 ," $1,314.80 ", $757.11 , $143.79 ," $1,328.64 "
 Fac Cytopatholgy-Concentr Tec ,CPT® 88108,0310 - PATHOLOGY LAB,N/A,N/A, $260.00 , $169.00 , $218.40 , $65.00 , $38.28 , $210.08 , $234.00 , $220.12 , $234.00 , $234.00 , $234.00 , $221.00 , $37.53 , $240.06 , $247.00 , $221.00 , $241.80 , $241.80 , $247.00 , $249.60 , $212.73 , $234.00 , $221.00 , $205.40 , N/A , $210.42 , $210.42 , $247.00 , $223.11 , $37.53 , $249.60 
Excision Tumor Soft Tiss Face/Scalp Subq 2+Cm,21012,N/A,N/A,N/A," $2,275.00 "," $1,478.75 "," $2,061.02 ", $322.84 , $278.25 ," $1,628.35 "," $1,630.47 "," $2,115.75 "," $2,047.50 "," $2,047.50 "," $1,820.00 "," $1,820.00 ", $278.25 ," $2,100.51 "," $2,161.25 "," $2,047.50 "," $2,047.50 "," $2,047.50 "," $2,115.75 "," $2,184.00 "," $1,904.92 "," $1,933.75 "," $1,787.63 "," $1,929.36 ", N/A ," $1,660.12 "," $1,660.12 "," $2,161.25 "," $1,951.25 ", $278.25 ," $2,184.00 "
 PENTAFLUOROPROP-TETRAFLUOROETH EX AERO ,HCPCS RXC637,0250 - PHARMACY,00386-0008-03,116 mL, $178.17 , $115.81 , $149.66 , N/A , N/A , $143.96 , $160.35 , $150.84 , $160.35 , $160.35 , $160.35 , $151.44 , N/A , $164.50 , $169.26 , $151.44 , $165.70 , $165.70 , $169.26 , $171.04 , $145.78 , $160.35 , $151.44 , $140.75 , N/A , $144.19 , $144.19 , $169.26 , $152.89 , $140.75 , $171.04 
 Fac Radium Ra223 Dichloride Ther ,HCPCS A9606,0636 - DRUGS REQUIRING DETAILED CODIN,N/A,N/A, $287.00 , $186.55 , $241.08 , N/A , N/A , $231.90 , $258.30 , $242.97 , $258.30 , $258.30 , $258.30 , $243.95 , N/A , $264.99 , $272.65 , $243.95 , $266.91 , $266.91 , $272.65 , $275.52 , $234.82 , $258.30 , $243.95 , $226.73 , N/A , $232.27 , $232.27 , $272.65 , $246.27 , $226.73 , $275.52 
 FIDAXOMICIN 200 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,52015-0080-01,1 tablet," $1,448.23 ", $941.35 ," $1,216.51 ", N/A , N/A ," $1,170.17 "," $1,303.41 "," $1,226.07 "," $1,303.41 "," $1,303.41 "," $1,303.41 "," $1,231.00 ", N/A ," $1,337.15 "," $1,375.82 "," $1,231.00 "," $1,346.85 "," $1,346.85 "," $1,375.82 "," $1,390.30 "," $1,184.94 "," $1,303.41 "," $1,231.00 "," $1,144.10 ", N/A ," $1,172.05 "," $1,172.05 "," $1,375.82 "," $1,242.73 "," $1,144.10 "," $1,390.30 "
 Fetal Biophys Profile-Non Stress ,CPT® 76819,0402 - ULTRASOUND,N/A,N/A, $572.00 , $371.80 , $480.48 , $83.42 , $89.42 , $462.18 , $514.80 , $484.26 , $514.80 , $514.80 , $514.80 , $486.20 , $87.67 , $528.13 , $543.40 , $486.20 , $531.96 , $531.96 , $543.40 , $549.12 , $468.01 , $514.80 , $486.20 , $451.88 , N/A , $462.92 , $462.92 , $543.40 , $490.83 , $83.42 , $549.12 
Metacarpohalangeal Disloc,26700,N/A,N/A,N/A, $912.00 , $592.80 ," $1,924.98 ", $306.67 , $96.29 ," $1,453.63 "," $1,482.73 ", $848.16 , $820.80 , $820.80 , $729.60 , $729.60 , $96.29 , $842.05 , $866.40 , $820.80 , $820.80 , $820.80 , $848.16 , $875.52 ," $1,764.46 ", $775.20 ," $1,627.07 "," $1,738.39 ", N/A ," $1,481.99 "," $1,481.99 ", $866.40 ," $1,741.85 ", $96.29 ," $1,924.98 "
"Removal,Blood Clot,Ant Segment,Eye",CPT® 65930,N/A,N/A,N/A," $5,729.00 "," $3,723.85 "," $3,966.82 ", $621.81 , $557.87 ," $3,606.38 "," $3,398.44 "," $5,327.97 "," $5,156.10 "," $5,156.10 "," $4,583.20 "," $4,583.20 ", $557.87 ," $5,289.59 "," $5,442.55 "," $5,156.10 "," $5,156.10 "," $5,156.10 "," $5,327.97 "," $5,499.84 "," $5,431.18 "," $4,869.65 "," $3,516.39 "," $4,579.31 ", N/A ," $3,676.74 "," $3,676.74 "," $5,442.55 "," $4,058.65 ", $557.87 ," $5,499.84 "
Intrapulmonary Surfactant Administration,CPT® 94610,N/A,N/A,N/A, $448.00 , $291.20 , $127.51 , $54.75 , $51.84 , $125.67 , $135.64 , $416.64 , $403.20 , $403.20 , $358.40 , $358.40 , $51.84 , $413.64 , $425.60 , $403.20 , $403.20 , $403.20 , $416.64 , $430.08 , $167.24 , $380.80 , $178.41 , $211.20 , N/A , $128.12 , $128.12 , $425.60 , $149.35 , $51.84 , $430.08 
 Fac Rubeola Antibody ,CPT® 86765,0300 - LABORATORY,N/A,N/A, $134.00 , $87.10 , $112.56 , $13.14 , $13.14 , $108.27 , $120.60 , $113.44 , $120.60 , $120.60 , $120.60 , $113.90 , $12.88 , $123.72 , $127.30 , $113.90 , $124.62 , $124.62 , $127.30 , $128.64 , $109.64 , $120.60 , $113.90 , $105.86 , N/A , $108.45 , $108.45 , $127.30 , $114.99 , $12.88 , $128.64 
 Pro Fee Co Diffusing Cap ,CPT® 94729,0976 - PRO FEE/RESPIR,N/A,N/A, $456.00 , $296.40 , $135.19 , $55.39 , $41.69 , $120.11 , $140.31 , $424.08 , $410.40 , $410.40 , $364.80 , $364.80 , $41.69 , $421.02 , $433.20 , $410.40 , $410.40 , $410.40 , $424.08 , $437.76 , $179.54 , $387.60 , $186.52 , $205.98 , N/A , $122.45 , $122.45 , $433.20 , $142.75 , $41.69 , $437.76 
 Fac Phys Svcs F/O/P Car Rhab W/O Cont Ecg Mntr ,CPT® 93797,0943 - CARDIAC REHAB,N/A,N/A, $186.00 , $120.90 , $156.24 , $8.63 , $29.99 , $150.29 , $167.40 , $157.47 , $167.40 , $167.40 , $167.40 , $158.10 , $29.40 , $171.73 , $176.70 , $158.10 , $172.98 , $172.98 , $176.70 , $178.56 , $152.19 , $167.40 , $158.10 , $146.94 , N/A , $150.53 , $150.53 , $176.70 , $159.61 , $8.63 , $178.56 
 AMINOCAPROIC ACID 250 MG/ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00517-9120-25,20 mL, $55.48 , $36.06 , $46.60 , N/A , N/A , $44.83 , $49.93 , $46.97 , $49.93 , $49.93 , $49.93 , $47.16 , N/A , $51.22 , $52.71 , $47.16 , $51.60 , $51.60 , $52.71 , $53.26 , $45.39 , $49.93 , $47.16 , $43.83 , N/A , $44.90 , $44.90 , $52.71 , $47.61 , $43.83 , $53.26 
Radiologic Examination Osseous Survey Infant,CPT® 77076,N/A,N/A,N/A, $865.00 , $562.25 , $606.68 , $105.96 , $59.64 , $454.00 , $563.86 , $804.45 , $778.50 , $778.50 , $692.00 , $692.00 , $59.64 , $798.65 , $821.75 , $778.50 , $778.50 , $778.50 , $804.45 , $830.40 , $587.42 , $735.25 , $612.48 , $485.18 , N/A , $462.85 , $462.85 , $821.75 , $535.76 , $59.64 , $830.40 
 Pro Removal of Hemorrhoid Clot ,CPT® 46320,0981 - PRO FEE/ER,N/A,N/A, $748.00 , $486.20 , $692.64 , $107.89 , $165.14 , $525.60 , $539.21 , $695.64 , $673.20 , $673.20 , $598.40 , $598.40 , $165.14 , $690.63 , $710.60 , $673.20 , $673.20 , $673.20 , $695.64 , $718.08 , $493.49 , $635.80 , $594.09 , $627.81 , N/A , $535.85 , $535.85 , $710.60 , $560.45 , $107.89 , $718.08 
 Fac Physical Therapy Re-Eval Est Plan Care ,CPT® 97164,0424 - PHYS THERP/EVAL,N/A,N/A, $208.00 , $135.20 , $174.72 , $69.08 , $67.74 , $168.06 , $187.20 , $176.09 , $187.20 , $187.20 , $187.20 , $176.80 , $66.41 , $192.05 , $197.60 , $176.80 , $193.44 , $193.44 , $197.60 , $199.68 , $170.19 , $187.20 , $176.80 , $164.32 , N/A , $168.33 , $168.33 , $197.60 , $178.48 , $66.41 , $199.68 
 KETAMINE 50 MG/ML INJECTION (ANES&INPT) ,HCPCS RXA250,0250 - PHARMACY,70092-9120-43,1 mL, $97.91 , $63.64 , $82.24 , N/A , N/A , $79.11 , $88.12 , $82.89 , $88.12 , $88.12 , $88.12 , $83.22 , N/A , $90.40 , $93.01 , $83.22 , $91.06 , $91.06 , $93.01 , $93.99 , $80.11 , $88.12 , $83.22 , $77.35 , N/A , $79.24 , $79.24 , $93.01 , $84.02 , $77.35 , $93.99 
"Rhythm Ecg,1-3 Lead,Reprt",CPT® 93040,N/A,N/A,N/A, $88.00 , $57.20 , $77.48 , $12.30 , $13.97 , $68.13 , $73.52 , $81.84 , $79.20 , $79.20 , $70.40 , $70.40 , $13.97 , $81.25 , $83.60 , $79.20 , $79.20 , $79.20 , $81.84 , $84.48 , $76.57 , $74.80 , $69.58 , $74.54 , N/A , $69.45 , $69.45 , $83.60 , $76.99 , $12.30 , $84.48 
"Cystoscopy,Manipulatn",CPT® 52330,N/A,N/A,N/A," $3,997.00 "," $2,598.05 "," $1,411.11 ", $247.91 , $307.34 ," $1,294.89 "," $1,198.45 "," $3,717.21 "," $3,597.30 "," $3,597.30 "," $3,197.60 "," $3,197.60 ", $307.34 ," $3,690.43 "," $3,797.15 "," $3,597.30 "," $3,597.30 "," $3,597.30 "," $3,717.21 "," $3,837.12 "," $1,419.73 "," $3,397.45 "," $1,357.67 "," $1,625.31 ", N/A ," $1,320.16 "," $1,320.16 "," $3,797.15 "," $1,551.66 ", $247.91 ," $3,837.12 "
"Lap,Surg,Enterectomy,Resect & Anast",CPT® 44202,N/A,N/A,N/A," $9,185.00 "," $5,970.25 "," $8,246.55 "," $1,278.19 ", $293.67 ," $6,520.29 "," $6,577.19 "," $8,542.05 "," $8,266.50 "," $8,266.50 "," $7,348.00 "," $7,348.00 ", $293.67 ," $8,480.51 "," $8,725.75 "," $8,266.50 "," $8,266.50 "," $8,266.50 "," $8,542.05 "," $8,817.60 "," $5,909.56 "," $7,807.25 "," $7,316.45 "," $7,691.52 ", N/A ," $6,647.51 "," $6,647.51 "," $8,725.75 "," $6,952.60 ", $293.67 ," $8,817.60 "
 Fac Exc Nail Matrix Prm Rmvl ,CPT® 11750,0761 - TREATMENT ROOM,N/A,N/A, $431.00 , $280.15 , $362.04 , $98.28 , $111.46 , $348.25 , $387.90 , $364.88 , $387.90 , $387.90 , $387.90 , $366.35 , $109.27 , $397.94 , $409.45 , $366.35 , $400.83 , $400.83 , $409.45 , $413.76 , $352.64 , $387.90 , $366.35 , $340.49 , N/A , $348.81 , $348.81 , $409.45 , $369.84 , $98.28 , $413.76 
"Rad Excis Wrist Synov/Tendon,Flexor",CPT® 25115,N/A,N/A,N/A," $6,303.00 "," $4,096.95 "," $4,619.16 ", $726.54 , $691.53 ," $3,655.14 "," $3,641.07 "," $5,861.79 "," $5,672.70 "," $5,672.70 "," $5,042.40 "," $5,042.40 ", $691.53 ," $5,819.56 "," $5,987.85 "," $5,672.70 "," $5,672.70 "," $5,672.70 "," $5,861.79 "," $6,050.88 "," $4,299.45 "," $5,357.55 "," $4,005.22 "," $4,338.12 ", N/A ," $3,726.46 "," $3,726.46 "," $5,987.85 "," $4,379.93 ", $691.53 ," $6,050.88 "
 Fac Assay of Topiramate ,CPT® 80201,0301 - LAB/CHEMISTRY,N/A,N/A, $140.00 , $91.00 , $117.60 , $12.16 , $12.16 , $113.12 , $126.00 , $118.52 , $126.00 , $126.00 , $126.00 , $119.00 , $11.92 , $129.26 , $133.00 , $119.00 , $130.20 , $130.20 , $133.00 , $134.40 , $114.55 , $126.00 , $119.00 , $110.60 , N/A , $113.30 , $113.30 , $133.00 , $120.13 , $11.92 , $134.40 
Tobacco Use Cessation Intensive >10 Minutes,CPT® 99407,N/A,N/A,N/A, $108.00 , $70.20 , $60.58 , $24.29 , N/A , $54.36 , $54.78 , $100.44 , $97.20 , $97.20 , $86.40 , $86.40 , N/A , $99.72 , $102.60 , $97.20 , $97.20 , $97.20 , $100.44 , $103.68 , $77.22 , $91.80 , $54.76 , $54.44 , N/A , $55.42 , $55.42 , $102.60 , $66.56 , $24.29 , $103.68 
 Fac Punch Biopsy Skin Ea Sep/Additional Lesion ,CPT® 11105,0761 - TREATMENT ROOM,N/A,N/A, $130.00 , $84.50 , $109.20 , $24.42 , $48.20 , $105.04 , $117.00 , $110.06 , $117.00 , $117.00 , $117.00 , $110.50 , $47.25 , $120.03 , $123.50 , $110.50 , $120.90 , $120.90 , $123.50 , $124.80 , $106.37 , $117.00 , $110.50 , $102.70 , N/A , $105.21 , $105.21 , $123.50 , $111.55 , $24.42 , $124.80 
 Fac Hepatitis C Ab Test ,CPT® 86803,0302 - LAB/IMMUNOLOGY,N/A,N/A, $173.00 , $112.45 , $145.32 , $14.56 , $14.56 , $139.78 , $155.70 , $146.46 , $155.70 , $155.70 , $155.70 , $147.05 , $14.27 , $159.73 , $164.35 , $147.05 , $160.89 , $160.89 , $164.35 , $166.08 , $141.55 , $155.70 , $147.05 , $136.67 , N/A , $140.01 , $140.01 , $164.35 , $148.45 , $14.27 , $166.08 
 Fac Revsc Opn/Prq Tib/Pero W/Stnt/Athr/Angiop Sm Vsl ,CPT® 37231,0360 - OR SERVICES,N/A,N/A," $41,539.00 "," $27,000.35 "," $34,892.76 ", $668.19 , $561.06 ," $33,563.51 "," $37,385.10 "," $35,166.92 "," $37,385.10 "," $37,385.10 "," $37,385.10 "," $35,308.15 ", $550.06 ," $38,352.96 "," $39,462.05 "," $35,308.15 "," $38,631.27 "," $38,631.27 "," $39,462.05 "," $39,877.44 "," $33,987.21 "," $37,385.10 "," $35,308.15 "," $32,815.81 ", N/A ," $33,617.51 "," $33,617.51 "," $39,462.05 "," $35,644.62 ", $550.06 ," $39,877.44 "
 Fac Pvb Thoracic Single Injection Site W/Img Gid ,CPT® 64461,0361 - OR/MINOR,N/A,N/A," $1,713.00 "," $1,113.45 "," $1,438.92 ", $75.14 , $119.15 ," $1,384.10 "," $1,541.70 "," $1,450.23 "," $1,541.70 "," $1,541.70 "," $1,541.70 "," $1,456.05 ", $116.81 ," $1,581.61 "," $1,627.35 "," $1,456.05 "," $1,593.09 "," $1,593.09 "," $1,627.35 "," $1,644.48 "," $1,401.58 "," $1,541.70 "," $1,456.05 "," $1,353.27 ", N/A ," $1,386.33 "," $1,386.33 "," $1,627.35 "," $1,469.93 ", $75.14 ," $1,644.48 "
"Corneal Transplant,Penetrating",CPT® 65730,N/A,N/A,N/A," $11,139.00 "," $7,240.35 "," $7,745.27 "," $1,212.23 ", $992.13 ," $6,946.24 "," $6,473.73 "," $10,359.27 "," $10,025.10 "," $10,025.10 "," $8,911.20 "," $8,911.20 ", $992.13 ," $10,284.64 "," $10,582.05 "," $10,025.10 "," $10,025.10 "," $10,025.10 "," $10,359.27 "," $10,693.44 "," $10,603.17 "," $9,468.15 "," $6,650.99 "," $8,819.58 ", N/A ," $7,081.78 "," $7,081.78 "," $10,582.05 "," $7,817.35 ", $992.13 ," $10,693.44 "
 Chest MRI Without Contrast ,CPT® 71550,0610 - MRI,N/A,N/A," $8,147.00 "," $5,295.55 "," $6,843.48 ", $294.32 , $417.06 ," $6,582.78 "," $7,332.30 "," $6,897.25 "," $7,332.30 "," $7,332.30 "," $7,332.30 "," $6,924.95 ", $408.88 ," $7,522.13 "," $7,739.65 "," $6,924.95 "," $7,576.71 "," $7,576.71 "," $7,739.65 "," $7,821.12 "," $6,665.88 "," $7,332.30 "," $6,924.95 "," $6,436.13 ", N/A ," $6,593.37 "," $6,593.37 "," $7,739.65 "," $6,990.94 ", $294.32 ," $7,821.12 "
" Pro CT Scan,Abdomen and Pelvis,W/O Contrast ",CPT® 74176,0972 - PRO FEE/RAD/DX,N/A,N/A, $980.00 , $637.00 ," $1,300.39 ", $186.88 , $160.28 , $956.40 ," $1,210.07 ", $911.40 , $882.00 , $882.00 , $784.00 , $784.00 , $160.28 , $904.83 , $931.00 , $882.00 , $882.00 , $882.00 , $911.40 , $940.80 ," $1,090.32 ", $833.00 ," $1,315.49 "," $1,303.47 ", N/A , $975.06 , $975.06 , $931.00 ," $1,128.64 ", $160.28 ," $1,315.49 "
 Fac Tenotomy Elbow Lateral/Medial Percutaneous ,CPT® 24357,0360 - OR SERVICES,N/A,N/A," $2,201.00 "," $1,430.65 "," $1,848.84 ", $409.40 , $311.91 ," $1,778.41 "," $1,980.90 "," $1,863.37 "," $1,980.90 "," $1,980.90 "," $1,980.90 "," $1,870.85 ", $305.79 ," $2,032.18 "," $2,090.95 "," $1,870.85 "," $2,046.93 "," $2,046.93 "," $2,090.95 "," $2,112.96 "," $1,800.86 "," $1,980.90 "," $1,870.85 "," $1,738.79 ", N/A ," $1,781.27 "," $1,781.27 "," $2,090.95 "," $1,888.68 ", $305.79 ," $2,112.96 "
" Colon Air Contrast, Adult, Sa ",CPT® 74280,0320 - DX X-RAY,N/A,N/A," $2,537.00 "," $1,649.05 "," $2,131.08 ", $221.19 , $143.92 ," $2,049.90 "," $2,283.30 "," $2,147.82 "," $2,283.30 "," $2,283.30 "," $2,283.30 "," $2,156.45 ", $141.10 ," $2,342.41 "," $2,410.15 "," $2,156.45 "," $2,359.41 "," $2,359.41 "," $2,410.15 "," $2,435.52 "," $2,075.77 "," $2,283.30 "," $2,156.45 "," $2,004.23 ", N/A ," $2,053.19 "," $2,053.19 "," $2,410.15 "," $2,177.00 ", $141.10 ," $2,435.52 "
Ndsc Ablation & Rcnstj Atria X10sv W/O Bypass,CPT® 33266,N/A,N/A,N/A," $15,730.00 "," $10,224.50 "," $10,752.76 "," $1,662.00 "," $1,492.06 "," $7,895.29 "," $7,852.24 "," $14,628.90 "," $14,157.00 "," $14,157.00 "," $12,584.00 "," $12,584.00 "," $1,492.06 "," $14,523.51 "," $14,943.50 "," $14,157.00 "," $14,157.00 "," $14,157.00 "," $14,628.90 "," $15,100.80 "," $9,977.88 "," $13,370.50 "," $9,942.59 "," $8,848.92 ", N/A ," $8,049.34 "," $8,049.34 "," $14,943.50 "," $9,144.04 "," $1,492.06 "," $15,100.80 "
 Trauma 4 Activation W/Pre-ED Notiification Lvl 1 -W/O Critical Care ,Custom 1000887,0684 - TRAUMA LEVEL IV,N/A,N/A," $2,947.00 "," $1,915.55 "," $2,475.48 ", N/A , N/A ," $2,381.18 "," $2,652.30 "," $2,494.93 "," $2,652.30 "," $2,652.30 "," $2,652.30 "," $2,504.95 ", N/A ," $2,720.97 "," $2,799.65 "," $2,504.95 "," $2,740.71 "," $2,740.71 "," $2,799.65 "," $2,829.12 "," $2,411.24 "," $2,652.30 "," $2,504.95 "," $2,328.13 ", N/A ," $2,385.01 "," $2,385.01 "," $2,799.65 "," $2,528.82 "," $2,328.13 "," $2,829.12 "
"Lap,Cholecystectomy",47562,N/A,N/A,N/A," $6,054.00 "," $3,935.10 "," $3,944.33 ", $610.67 , $630.06 ," $3,936.84 "," $3,928.65 "," $5,630.22 "," $5,448.60 "," $5,448.60 "," $4,843.20 "," $4,843.20 ", $630.06 ," $5,589.66 "," $5,751.30 "," $5,448.60 "," $5,448.60 "," $5,448.60 "," $5,630.22 "," $5,811.84 "," $4,842.72 "," $5,145.90 "," $3,477.14 "," $3,647.95 ", N/A ," $4,013.66 "," $4,013.66 "," $5,751.30 "," $4,629.35 ", $610.67 ," $5,811.84 "
 Pro Repair Finger/Hand Tendon ,CPT® 26356,0975 - PRO FEE/OR,N/A,N/A," $2,987.00 "," $1,941.55 "," $4,885.86 ", $768.43 , $738.54 ," $5,216.15 "," $5,292.11 "," $2,777.91 "," $2,688.30 "," $2,688.30 "," $2,389.60 "," $2,389.60 ", $738.54 ," $2,757.90 "," $2,837.65 "," $2,688.30 "," $2,688.30 "," $2,688.30 "," $2,777.91 "," $2,867.52 "," $4,550.07 "," $2,538.95 "," $5,798.21 "," $4,542.61 ", N/A ," $5,317.93 "," $5,317.93 "," $2,837.65 "," $6,250.45 ", $738.54 ," $6,250.45 "
 Lyme Western Blot - Igm Beaker1 ,CPT® 86617,0302 - LAB/IMMUNOLOGY,N/A,N/A, $186.00 , $120.90 , $156.24 , $15.80 , $15.80 , $150.29 , $167.40 , $157.47 , $167.40 , $167.40 , $167.40 , $158.10 , $15.49 , $171.73 , $176.70 , $158.10 , $172.98 , $172.98 , $176.70 , $178.56 , $152.19 , $167.40 , $158.10 , $146.94 , N/A , $150.53 , $150.53 , $176.70 , $159.61 , $15.49 , $178.56 
 Fac Slctv Cathj 1st 2nd Ord Thrc/Brch/Cphlc Brnch ,CPT® 36216,0360 - OR SERVICES,N/A,N/A," $2,032.00 "," $1,320.80 "," $1,706.88 ", $246.31 ," $1,230.01 "," $1,641.86 "," $1,828.80 "," $1,720.29 "," $1,828.80 "," $1,828.80 "," $1,828.80 "," $1,727.20 "," $1,205.89 "," $1,876.15 "," $1,930.40 "," $1,727.20 "," $1,889.76 "," $1,889.76 "," $1,930.40 "," $1,950.72 "," $1,662.58 "," $1,828.80 "," $1,727.20 "," $1,605.28 ", N/A ," $1,644.50 "," $1,644.50 "," $1,930.40 "," $1,743.66 ", $246.31 ," $1,950.72 "
 Fac Esophagus Motility Study ,CPT® 91010,0750 - GASTR-INST SVS,N/A,N/A," $1,848.00 "," $1,201.20 "," $1,552.32 ", $218.16 , $175.19 ," $1,493.18 "," $1,663.20 "," $1,564.52 "," $1,663.20 "," $1,663.20 "," $1,663.20 "," $1,570.80 ", $171.75 ," $1,706.26 "," $1,755.60 "," $1,570.80 "," $1,718.64 "," $1,718.64 "," $1,755.60 "," $1,774.08 "," $1,512.03 "," $1,663.20 "," $1,570.80 "," $1,459.92 ", N/A ," $1,495.59 "," $1,495.59 "," $1,755.60 "," $1,585.77 ", $171.75 ," $1,774.08 "
 Pro Laryngoscopy Flexible Diagnostic ,CPT® 31575,0982 - PRO FEE/OUTPT,N/A,N/A, $713.00 , $463.45 , $364.67 , $65.21 , $98.45 , $294.56 , $382.52 , $663.09 , $641.70 , $641.70 , $570.40 , $570.40 , $98.45 , $658.31 , $677.35 , $641.70 , $641.70 , $641.70 , $663.09 , $684.48 , $347.16 , $606.05 , $406.77 , $341.75 , N/A , $300.30 , $300.30 , $677.35 , $353.68 , $65.21 , $684.48 
" Fac Lipopro Bld, Electrophoretic ",CPT® 83700,0301 - LAB/CHEMISTRY,N/A,N/A, $97.00 , $63.05 , $81.48 , $11.49 , $11.49 , $78.38 , $87.30 , $82.12 , $87.30 , $87.30 , $87.30 , $82.45 , $11.26 , $89.56 , $92.15 , $82.45 , $90.21 , $90.21 , $92.15 , $93.12 , $79.37 , $87.30 , $82.45 , $76.63 , N/A , $78.50 , $78.50 , $92.15 , $83.24 , $11.26 , $93.12 
I&D Rectal Wall Abscess W Anesth,CPT® 46045,N/A,N/A,N/A," $2,717.00 "," $1,766.05 "," $2,696.53 ", $418.09 , $153.67 ," $2,055.77 "," $2,104.74 "," $2,526.81 "," $2,445.30 "," $2,445.30 "," $2,173.60 "," $2,173.60 ", $153.67 ," $2,508.61 "," $2,581.15 "," $2,445.30 "," $2,445.30 "," $2,445.30 "," $2,526.81 "," $2,608.32 "," $1,929.23 "," $2,309.45 "," $2,322.85 "," $2,440.70 ", N/A ," $2,095.88 "," $2,095.88 "," $2,581.15 "," $2,192.06 ", $153.67 ," $2,696.53 "
 LEVOTHYROXINE SODIUM 88 MCG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6952-61,1 tablet, $3.60 , $2.34 , $3.02 , N/A , N/A , $2.91 , $3.24 , $3.05 , $3.24 , $3.24 , $3.24 , $3.06 , N/A , $3.32 , $3.42 , $3.06 , $3.35 , $3.35 , $3.42 , $3.46 , $2.95 , $3.24 , $3.06 , $2.84 , N/A , $2.91 , $2.91 , $3.42 , $3.09 , $2.84 , $3.46 
Bld Typing RBC Ags Oth/Thn Abo/Rh D Ea,CPT® 86905,N/A,N/A,N/A, $110.00 , $71.50 , N/A , $3.91 , $3.91 , $21.62 , $25.85 , $102.30 , $99.00 , $99.00 , $88.00 , $88.00 , $3.91 , $101.56 , $104.50 , $99.00 , $99.00 , $99.00 , $102.30 , $105.60 , $25.57 , $93.50 , $24.33 , $13.89 , N/A , $20.18 , $20.18 , $104.50 , $22.05 , $3.91 , $105.60 
Insertion Indwelling Tunneled Pleural Catheter,CPT® 32550,N/A,N/A,N/A," $4,961.00 "," $3,224.65 "," $1,098.60 ", $191.92 , $945.07 , $853.38 , $831.73 ," $4,613.73 "," $4,464.90 "," $4,464.90 "," $3,968.80 "," $3,968.80 ", $945.07 ," $4,580.49 "," $4,712.95 "," $4,464.90 "," $4,464.90 "," $4,464.90 "," $4,613.73 "," $4,762.56 "," $1,067.22 "," $4,216.85 "," $1,182.83 "," $1,065.69 ", N/A , $870.03 , $870.03 ," $4,712.95 "," $1,024.64 ", $191.92 ," $4,762.56 "
 DEXAMETHASONE 1 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00054-8174-25,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Ascend Aorta Grft W Root Replacmt,CPT® 33863,N/A,N/A,N/A," $22,707.00 "," $14,759.55 "," $18,294.64 "," $2,820.86 "," $2,378.00 "," $13,452.72 "," $13,311.09 "," $21,117.51 "," $20,436.30 "," $20,436.30 "," $18,165.60 "," $18,165.60 "," $2,378.00 "," $20,965.37 "," $21,571.65 "," $20,436.30 "," $20,436.30 "," $20,436.30 "," $21,117.51 "," $21,798.72 "," $16,971.78 "," $19,300.95 "," $16,875.46 "," $15,080.24 ", N/A ," $13,715.21 "," $13,715.21 "," $21,571.65 "," $15,580.47 "," $2,378.00 "," $21,798.72 "
Peritoneal Lavage W/WO Imaging Guidance,CPT® 49084,N/A,N/A,N/A, $852.00 , $553.80 , $634.66 , $98.21 , $76.36 , $512.20 , $494.13 , $792.36 , $766.80 , $766.80 , $681.60 , $681.60 , $76.36 , $786.65 , $809.40 , $766.80 , $766.80 , $766.80 , $792.36 , $817.92 , $459.31 , $724.20 , $533.44 , $601.50 , N/A , $522.19 , $522.19 , $809.40 , $546.17 , $76.36 , $817.92 
 Laceration Repair Trk Ext Intermediate </= 2.5 Cm - Mh ,CPT® 12031,0761 - TREATMENT ROOM,N/A,N/A, $839.00 , $545.35 , $704.76 , $146.05 , $60.48 , $677.91 , $755.10 , $710.30 , $755.10 , $755.10 , $755.10 , $713.15 , $59.29 , $774.65 , $797.05 , $713.15 , $780.27 , $780.27 , $797.05 , $805.44 , $686.47 , $755.10 , $713.15 , $662.81 , N/A , $679.00 , $679.00 , $797.05 , $719.95 , $59.29 , $805.44 
Insj/Rplcmt Temp Transvns 2chmbr Pacg Eltrds Spx,CPT® 33211,N/A,N/A,N/A," $2,054.00 "," $1,335.10 ", $998.86 , $152.81 , $168.03 , $777.36 , $755.10 ," $1,910.22 "," $1,848.60 "," $1,848.60 "," $1,643.20 "," $1,643.20 ", $168.03 ," $1,896.46 "," $1,951.30 "," $1,848.60 "," $1,848.60 "," $1,848.60 "," $1,910.22 "," $1,971.84 ", $921.92 ," $1,745.90 ", $952.69 , $818.47 , N/A , $792.52 , $792.52 ," $1,951.30 ", $900.33 , $152.81 ," $1,971.84 "
Insertion Central Vencath,36556,N/A,N/A,N/A," $1,860.00 "," $1,209.00 ", $514.22 , $79.62 , $322.67 , $528.55 , $516.83 ," $1,729.80 "," $1,674.00 "," $1,674.00 "," $1,488.00 "," $1,488.00 ", $322.67 ," $1,717.34 "," $1,767.00 "," $1,674.00 "," $1,674.00 "," $1,674.00 "," $1,729.80 "," $1,785.60 ", $476.45 ," $1,581.00 ", $636.91 , $489.07 , N/A , $538.87 , $538.87 ," $1,767.00 ", $612.15 , $79.62 ," $1,785.60 "
Indwelling Catheter Special,HCPCS A4340,N/A,N/A,N/A, $45.00 , $29.25 , N/A , $43.06 , $6.78 , N/A , N/A , $41.85 , $40.50 , $40.50 , $36.00 , $36.00 , $6.78 , $41.55 , $42.75 , $40.50 , $40.50 , $40.50 , $41.85 , $43.20 , N/A , $38.25 , $37.63 , $39.14 , N/A , N/A , N/A , $42.75 , N/A , $6.78 , $43.20 
"Laminec/Facetect/Foramin,Lumbar",CPT® 63047,N/A,N/A,N/A," $8,215.00 "," $5,339.75 "," $5,185.60 "," $1,014.94 ", $936.64 ," $6,157.37 "," $5,800.63 "," $7,639.95 "," $7,393.50 "," $7,393.50 "," $6,572.00 "," $6,572.00 ", $936.64 ," $7,584.91 "," $7,804.25 "," $7,393.50 "," $7,393.50 "," $7,393.50 "," $7,639.95 "," $7,886.40 "," $9,161.89 "," $6,982.75 "," $5,869.57 "," $6,309.44 ", N/A ," $6,277.51 "," $6,277.51 "," $7,804.25 "," $7,385.31 ", $936.64 ," $9,161.89 "
 Pro Sigmoidoscopy and Biopsy ,CPT® 45331,0982 - PRO FEE/OUTPT,N/A,N/A," $1,411.00 ", $917.15 , $440.31 , $68.50 , $109.66 , $358.68 , $372.82 ," $1,312.23 "," $1,269.90 "," $1,269.90 "," $1,128.80 "," $1,128.80 ", $109.66 ," $1,302.78 "," $1,340.45 "," $1,269.90 "," $1,269.90 "," $1,269.90 "," $1,312.23 "," $1,354.56 ", $315.49 ," $1,199.35 ", $408.55 , $417.80 , N/A , $365.67 , $365.67 ," $1,340.45 ", $382.45 , $68.50 ," $1,354.56 "
 CARBAMIDE PEROXIDE 6.5 % OT SOLN ,HCPCS RXC637,0250 - PHARMACY,00904-6627-35,15 mL, $11.64 , $7.57 , $9.78 , N/A , N/A , $9.41 , $10.48 , $9.85 , $10.48 , $10.48 , $10.48 , $9.89 , N/A , $10.75 , $11.06 , $9.89 , $10.83 , $10.83 , $11.06 , $11.17 , $9.52 , $10.48 , $9.89 , $9.20 , N/A , $9.42 , $9.42 , $11.06 , $9.99 , $9.20 , $11.17 
 CLINDAMYCIN PALMITATE HCL 75 MG/5ML PO SOLR ,HCPCS RXC637,0250 - PHARMACY,59762-0016-01,100 mL, $318.49 , $207.02 , $267.53 , N/A , N/A , $257.34 , $286.64 , $269.63 , $286.64 , $286.64 , $286.64 , $270.72 , N/A , $294.06 , $302.57 , $270.72 , $296.20 , $296.20 , $302.57 , $305.75 , $260.59 , $286.64 , $270.72 , $251.61 , N/A , $257.75 , $257.75 , $302.57 , $273.30 , $251.61 , $305.75 
"CT Angio, Chest, Combo, Incl Image Proc",CPT® 71275,N/A,N/A,N/A," $4,015.00 "," $2,609.75 "," $1,793.54 ", $259.37 , $407.84 ," $1,452.31 "," $2,130.66 "," $3,733.95 "," $3,613.50 "," $3,613.50 "," $3,212.00 "," $3,212.00 ", $407.84 ," $3,707.05 "," $3,814.25 "," $3,613.50 "," $3,613.50 "," $3,613.50 "," $3,733.95 "," $3,854.40 "," $1,671.95 "," $3,412.75 "," $2,318.95 "," $1,946.82 ", N/A ," $1,480.65 "," $1,480.65 "," $3,814.25 "," $1,713.88 ", $259.37 ," $3,854.40 "
" Fac Repair Flexor Tendon,Sing ",CPT® 26350,0361 - OR/MINOR,N/A,N/A," $8,410.00 "," $5,466.50 "," $7,064.40 ", $732.16 , $601.86 ," $6,795.28 "," $7,569.00 "," $7,119.91 "," $7,569.00 "," $7,569.00 "," $7,569.00 "," $7,148.50 ", $590.06 ," $7,764.95 "," $7,989.50 "," $7,148.50 "," $7,821.30 "," $7,821.30 "," $7,989.50 "," $8,073.60 "," $6,881.06 "," $7,569.00 "," $7,148.50 "," $6,643.90 ", N/A ," $6,806.21 "," $6,806.21 "," $7,989.50 "," $7,216.62 ", $590.06 ," $8,073.60 "
Crit Care Telehea Consult 50,HCPCS G0509,N/A,N/A,N/A, $665.00 , $432.25 , $366.34 , $183.63 , N/A , $340.90 , N/A , $618.45 , $598.50 , $598.50 , $532.00 , $532.00 , N/A , $613.99 , $631.75 , $598.50 , $598.50 , $598.50 , $618.45 , $638.40 , $529.78 , $565.25 , $361.20 , $731.30 , N/A , $347.55 , $347.55 , $631.75 , $434.44 , $183.63 , $731.30 
 Pro Exc H-F-Nk-Sp Mlg+Mar > 4 Cm ,CPT® 11626,0982 - PRO FEE/OUTPT,N/A,N/A," $2,096.00 "," $1,362.40 ", $925.79 , $275.85 , $457.12 , $801.49 , $778.13 ," $1,949.28 "," $1,886.40 "," $1,886.40 "," $1,676.80 "," $1,676.80 ", $457.12 ," $1,935.24 "," $1,991.20 "," $1,886.40 "," $1,886.40 "," $1,886.40 "," $1,949.28 "," $2,012.16 "," $1,014.19 "," $1,781.60 "," $1,559.27 "," $1,020.08 ", N/A , $817.13 , $817.13 ," $1,991.20 ", $947.60 , $275.85 ," $2,012.16 "
 Pro Nsl Ndsc Dx Uni/Bi Spx ,CPT® 31231,0982 - PRO FEE/OUTPT,N/A,N/A," $1,131.00 ", $735.15 , $300.20 , $61.54 , $207.30 , $250.32 , $243.40 ," $1,051.83 "," $1,017.90 "," $1,017.90 ", $904.80 , $904.80 , $207.30 ," $1,044.25 "," $1,074.45 "," $1,017.90 "," $1,017.90 "," $1,017.90 "," $1,051.83 "," $1,085.76 ", $331.89 , $961.35 , $340.76 , $328.59 , N/A , $255.20 , $255.20 ," $1,074.45 ", $300.54 , $61.54 ," $1,085.76 "
"Drain Mouth Absc/Cyst/Hematoma,Simpl",40800,N/A,N/A,N/A," $1,448.00 ", $941.20 , $740.22 , $115.73 , $30.71 , $643.19 , $665.31 ," $1,346.64 "," $1,303.20 "," $1,303.20 "," $1,158.40 "," $1,158.40 ", $30.71 ," $1,336.94 "," $1,375.60 "," $1,303.20 "," $1,303.20 "," $1,303.20 "," $1,346.64 "," $1,390.08 ", $540.50 ," $1,230.80 ", $726.11 , $759.67 , N/A , $655.74 , $655.74 ," $1,375.60 ", $685.83 , $30.71 ," $1,390.08 "
 Pro Treat Humerus Fracture ,CPT® 23600,0981 - PRO FEE/ER,N/A,N/A," $1,196.00 ", $777.40 ," $1,967.03 ", $311.94 , $245.89 ," $1,478.02 "," $1,510.03 "," $1,112.28 "," $1,076.40 "," $1,076.40 ", $956.80 , $956.80 , $245.89 ," $1,104.27 "," $1,136.20 "," $1,076.40 "," $1,076.40 "," $1,076.40 "," $1,112.28 "," $1,148.16 "," $1,808.38 "," $1,016.60 "," $1,657.40 "," $1,760.08 ", N/A ," $1,506.86 "," $1,506.86 "," $1,136.20 "," $1,771.09 ", $245.89 ," $1,967.03 "
 Pro Splt Agrft F/S/N/H/F/G/M/D Gt 1st 100 Cm<1 % ,CPT® 15120,0975 - PRO FEE/OR,N/A,N/A," $4,803.00 "," $3,121.95 "," $2,194.60 ", $656.83 , $799.78 ," $1,903.99 "," $1,858.32 "," $4,466.79 "," $4,322.70 "," $4,322.70 "," $3,842.40 "," $3,842.40 ", $799.78 ," $4,434.61 "," $4,562.85 "," $4,322.70 "," $4,322.70 "," $4,322.70 "," $4,466.79 "," $4,610.88 "," $2,407.55 "," $4,082.55 "," $3,717.99 "," $2,420.90 ", N/A ," $1,941.14 "," $1,941.14 "," $4,562.85 "," $2,251.05 ", $656.83 ," $4,610.88 "
 Fac Amb Ift 911 Base Specialty Care Transfer Sct ,HCPCS A0434,0540 - AMBULANCE,N/A,N/A," $4,300.00 "," $2,795.00 "," $3,612.00 ", N/A , $699.74 ," $3,474.40 "," $3,870.00 "," $3,640.38 "," $3,870.00 "," $3,870.00 "," $3,870.00 "," $3,655.00 ", $686.02 ," $3,970.19 "," $4,085.00 "," $3,655.00 "," $3,999.00 "," $3,999.00 "," $4,085.00 "," $4,128.00 "," $3,518.26 "," $3,870.00 "," $3,655.00 "," $3,397.00 ", N/A ," $3,479.99 "," $3,479.99 "," $4,085.00 "," $3,689.83 ", $686.02 ," $4,128.00 "
Critical Care E&M L1,99291,N/A,N/A,N/A," $1,220.00 ", $793.00 , $433.06 , $205.74 , $270.56 , $385.76 , $385.10 ," $1,134.60 "," $1,098.00 "," $1,098.00 ", $976.00 , $976.00 , $270.56 ," $1,126.43 "," $1,159.00 "," $1,098.00 "," $1,098.00 "," $1,098.00 "," $1,134.60 "," $1,171.20 ", $551.34 ," $1,037.00 ", $480.07 , $484.31 , N/A , $393.30 , $393.30 ," $1,159.00 ", $453.59 , $205.74 ," $1,171.20 "
Radiofrequency Abltj Nrv Nrvtg Si Jt W/Img Gdn,64625,N/A,N/A,N/A," $4,849.00 "," $3,151.85 ", $966.63 , $188.08 , $393.42 ," $1,066.40 ", N/A ," $4,509.57 "," $4,364.10 "," $4,364.10 "," $3,879.20 "," $3,879.20 ", $393.42 ," $4,477.08 "," $4,606.55 "," $4,364.10 "," $4,364.10 "," $4,364.10 "," $4,509.57 "," $4,655.04 "," $1,037.55 "," $4,121.65 "," $1,021.74 "," $1,175.79 ", N/A ," $1,087.21 "," $1,087.21 "," $4,606.55 "," $1,166.27 ", $188.08 ," $4,655.04 "
"Fx Closed, Humeral",CPT® 24530,N/A,N/A,N/A," $2,510.00 "," $1,631.50 "," $2,179.65 ", $345.51 , $245.89 ," $1,654.51 "," $1,676.86 "," $2,334.30 "," $2,259.00 "," $2,259.00 "," $2,008.00 "," $2,008.00 ", $245.89 ," $2,317.48 "," $2,384.50 "," $2,259.00 "," $2,259.00 "," $2,259.00 "," $2,334.30 "," $2,409.60 "," $2,006.52 "," $2,133.50 "," $1,841.15 "," $1,967.73 ", N/A ," $1,686.79 "," $1,686.79 "," $2,384.50 "," $1,982.57 ", $245.89 ," $2,409.60 "
Cessation Thrombolytic Ther W/Catheter Removal,CPT® 37214,N/A,N/A,N/A, $899.00 , $584.35 , $723.00 , $111.75 , $168.01 , $596.47 , $620.30 , $836.07 , $809.10 , $809.10 , $719.20 , $719.20 , $168.01 , $830.05 , $854.05 , $809.10 , $809.10 , $809.10 , $836.07 , $863.04 , $674.64 , $764.15 , $772.50 , $606.44 , N/A , $608.11 , $608.11 , $854.05 , $690.80 , $111.75 , $863.04 
Online Digital E/M Svc Est Pt <7 D 11-20 Minutes,99422,N/A,N/A,N/A, $77.00 , $50.05 , $51.58 , $24.61 , $23.72 , $45.29 , N/A , $71.61 , $69.30 , $69.30 , $61.60 , $61.60 , $23.72 , $71.09 , $73.15 , $69.30 , $69.30 , $69.30 , $71.61 , $73.92 , $47.07 , $65.45 , $56.03 , $58.07 , N/A , $46.18 , $46.18 , $73.15 , $53.00 , $23.72 , $73.92 
 Fac Cathj Umbilical Vein Dx/Ther Nb ,CPT® 36510,0361 - OR/MINOR,N/A,N/A, $607.00 , $394.55 , $509.88 , $51.68 , $150.54 , $490.46 , $546.30 , $513.89 , $546.30 , $546.30 , $546.30 , $515.95 , $147.59 , $560.44 , $576.65 , $515.95 , $564.51 , $564.51 , $576.65 , $582.72 , $496.65 , $546.30 , $515.95 , $479.53 , N/A , $491.25 , $491.25 , $576.65 , $520.87 , $51.68 , $582.72 
 MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP ,HCPCS RXC637,0250 - PHARMACY,66689-0053-99,15 mL, $6.79 , $4.41 , $5.70 , N/A , N/A , $5.49 , $6.11 , $5.75 , $6.11 , $6.11 , $6.11 , $5.77 , N/A , $6.27 , $6.45 , $5.77 , $6.31 , $6.31 , $6.45 , $6.52 , $5.56 , $6.11 , $5.77 , $5.36 , N/A , $5.50 , $5.50 , $6.45 , $5.83 , $5.36 , $6.52 
"Place Cath in Vein,Subselect",CPT® 36012,N/A,N/A,N/A," $5,777.00 "," $3,755.05 "," $1,035.13 ", $159.48 , $857.08 , $763.63 , $757.15 ," $5,372.61 "," $5,199.30 "," $5,199.30 "," $4,621.60 "," $4,621.60 ", $857.08 ," $5,333.90 "," $5,488.15 "," $5,199.30 "," $5,199.30 "," $5,199.30 "," $5,372.61 "," $5,545.92 ", $957.68 ," $4,910.45 ", $934.85 , $857.71 , N/A , $778.53 , $778.53 ," $5,488.15 ", $884.43 , $159.48 ," $5,545.92 "
Revision of Upper Eyelid,15822,N/A,N/A,N/A," $2,085.00 "," $1,355.25 "," $1,293.94 ", $387.20 , $614.70 ," $1,069.17 "," $1,072.20 "," $1,939.05 "," $1,876.50 "," $1,876.50 "," $1,668.00 "," $1,668.00 ", $614.70 ," $1,925.08 "," $1,980.75 "," $1,876.50 "," $1,876.50 "," $1,876.50 "," $1,939.05 "," $2,001.60 "," $1,408.82 "," $1,772.25 "," $2,139.09 "," $1,378.78 ", N/A ," $1,090.03 "," $1,090.03 "," $1,980.75 "," $1,264.07 ", $387.20 ," $2,139.09 "
 Pro Partical Mastectomy ,CPT® 19301,0982 - PRO FEE/OUTPT,N/A,N/A," $2,533.00 "," $1,646.45 "," $2,067.03 ", $612.83 , $305.59 ," $1,752.29 "," $1,701.51 "," $2,355.69 "," $2,279.70 "," $2,279.70 "," $2,026.40 "," $2,026.40 ", $305.59 ," $2,338.72 "," $2,406.35 "," $2,279.70 "," $2,279.70 "," $2,279.70 "," $2,355.69 "," $2,431.68 "," $2,255.88 "," $2,153.05 "," $3,436.11 "," $2,213.34 ", N/A ," $1,786.48 "," $1,786.48 "," $2,406.35 "," $2,071.72 ", $305.59 ," $3,436.11 "
"Lap,Inguinal Hernia Repr,Initial",49650,N/A,N/A,N/A," $3,308.00 "," $2,150.20 "," $2,598.83 ", $403.57 , $359.94 ," $2,009.15 "," $2,048.92 "," $3,076.44 "," $2,977.20 "," $2,977.20 "," $2,646.40 "," $2,646.40 ", $359.94 ," $3,054.28 "," $3,142.60 "," $2,977.20 "," $2,977.20 "," $2,977.20 "," $3,076.44 "," $3,175.68 "," $1,855.34 "," $2,811.80 "," $2,272.90 "," $2,383.24 ", N/A ," $2,048.35 "," $2,048.35 "," $3,142.60 "," $2,142.36 ", $359.94 ," $3,175.68 "
"Clot Inhib Protein C,Antigen",CPT® 85302,N/A,N/A,N/A, $239.00 , $155.35 , N/A , $12.25 , $12.25 , $67.98 , $81.33 , $222.27 , $215.10 , $215.10 , $191.20 , $191.20 , $12.25 , $220.67 , $227.05 , $215.10 , $215.10 , $215.10 , $222.27 , $229.44 , $80.19 , $203.15 , $79.47 , $43.56 , N/A , $63.44 , $63.44 , $227.05 , $69.32 , $12.25 , $229.44 
"Biopsy Tongue,Poster 1/3",CPT® 41105,N/A,N/A,N/A," $1,188.00 ", $772.20 , $678.08 , $106.72 , $76.84 , $541.72 , $556.68 ," $1,104.84 "," $1,069.20 "," $1,069.20 ", $950.40 , $950.40 , $76.84 ," $1,096.88 "," $1,128.60 "," $1,069.20 "," $1,069.20 "," $1,069.20 "," $1,104.84 "," $1,140.48 ", $486.61 ," $1,009.80 ", $606.58 , $638.08 , N/A , $552.29 , $552.29 ," $1,128.60 ", $577.63 , $76.84 ," $1,140.48 "
Assay Vitamin E,CPT® 84446,N/A,N/A,N/A, $129.00 , $83.85 , N/A , $14.46 , $14.46 , $80.20 , $95.96 , $119.97 , $116.10 , $116.10 , $103.20 , $103.20 , $14.46 , $119.11 , $122.55 , $116.10 , $116.10 , $116.10 , $119.97 , $123.84 , $94.68 , $109.65 , $92.45 , $51.43 , N/A , $74.85 , $74.85 , $122.55 , $81.79 , $14.46 , $123.84 
 Pro Place Needle in Vein ,CPT® 36000,0960 - PRO FEE,N/A,N/A, $359.00 , $233.35 , N/A , $29.75 , $34.55 , $40.05 , $40.19 , $333.87 , $323.10 , $323.10 , $287.20 , $287.20 , $34.55 , $331.46 , $341.05 , $323.10 , $323.10 , $323.10 , $333.87 , $344.64 , $51.91 , $305.15 , N/A , $46.82 , N/A , $40.83 , $40.83 , $341.05 , $46.38 , $29.75 , $344.64 
 LOSARTAN POTASSIUM 100 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-7049-61,1 tablet, $4.63 , $3.01 , $3.89 , N/A , N/A , $3.74 , $4.17 , $3.92 , $4.17 , $4.17 , $4.17 , $3.94 , N/A , $4.27 , $4.40 , $3.94 , $4.31 , $4.31 , $4.40 , $4.44 , $3.79 , $4.17 , $3.94 , $3.66 , N/A , $3.75 , $3.75 , $4.40 , $3.97 , $3.66 , $4.44 
"Trim Hyperkeratotic Skin Lesion, One",CPT® 11055,N/A,N/A,N/A, $206.00 , $133.90 , $51.44 , $15.16 , $26.33 , $45.02 , $42.27 , $191.58 , $185.40 , $185.40 , $164.80 , $164.80 , $26.33 , $190.20 , $195.70 , $185.40 , $185.40 , $185.40 , $191.58 , $197.76 , $56.75 , $175.10 , $82.07 , $57.83 , N/A , $45.91 , $45.91 , $195.70 , $53.23 , $15.16 , $197.76 
Treat Femoral Fracture,27508,N/A,N/A,N/A," $3,462.00 "," $2,250.30 "," $3,062.80 ", $481.59 , $614.44 ," $2,378.36 "," $2,393.52 "," $3,219.66 "," $3,115.80 "," $3,115.80 "," $2,769.60 "," $2,769.60 ", $614.44 ," $3,196.46 "," $3,288.90 "," $3,115.80 "," $3,115.80 "," $3,115.80 "," $3,219.66 "," $3,323.52 "," $2,834.72 "," $2,942.70 "," $2,636.85 "," $2,811.30 ", N/A ," $2,424.77 "," $2,424.77 "," $3,288.90 "," $2,849.98 ", $481.59 ," $3,323.52 "
Arthrocentesis-Int. Joint,20605,N/A,N/A,N/A, $382.00 , $248.30 , $226.79 , $35.10 , $50.55 , $181.29 , $253.86 , $355.26 , $343.80 , $343.80 , $305.60 , $305.60 , $50.55 , $352.70 , $362.90 , $343.80 , $343.80 , $343.80 , $355.26 , $366.72 , $211.99 , $324.70 , $276.53 , $217.48 , N/A , $184.83 , $184.83 , $362.90 , $217.21 , $35.10 , $366.72 
Treat Metacarpal Fracture,26600,N/A,N/A,N/A," $1,917.00 "," $1,246.05 "," $1,787.76 ", $284.00 , $155.34 ," $1,331.76 "," $1,361.00 "," $1,782.81 "," $1,725.30 "," $1,725.30 "," $1,533.60 "," $1,533.60 ", $155.34 ," $1,769.97 "," $1,821.15 "," $1,725.30 "," $1,725.30 "," $1,725.30 "," $1,782.81 "," $1,840.32 "," $1,640.20 "," $1,629.45 "," $1,491.48 "," $1,590.09 ", N/A ," $1,357.74 "," $1,357.74 "," $1,821.15 "," $1,595.82 ", $155.34 ," $1,840.32 "
 Pro Cysto/Uretero W/Lithotripsy &Indwell Stent Insrt ,CPT® 52356,0982 - PRO FEE/OUTPT,N/A,N/A," $2,817.00 "," $1,831.05 "," $2,227.03 ", $390.60 , $312.75 ," $2,036.34 "," $1,954.34 "," $2,619.81 "," $2,535.30 "," $2,535.30 "," $2,253.60 "," $2,253.60 ", $312.75 ," $2,600.94 "," $2,676.15 "," $2,535.30 "," $2,535.30 "," $2,535.30 "," $2,619.81 "," $2,704.32 "," $2,241.18 "," $2,394.45 "," $2,151.88 "," $2,560.84 ", N/A ," $2,076.07 "," $2,076.07 "," $2,676.15 "," $2,440.12 ", $312.75 ," $2,704.32 "
" Fac PR Program Eval Implant Device,Cardvert/Defib,Mult Lead ",CPT® 93284,0480 - CARDIOLOGY,N/A,N/A, $501.00 , $325.65 , $420.84 , $105.48 , $55.43 , $404.81 , $450.90 , $424.15 , $450.90 , $450.90 , $450.90 , $425.85 , $54.34 , $462.57 , $475.95 , $425.85 , $465.93 , $465.93 , $475.95 , $480.96 , $409.92 , $450.90 , $425.85 , $395.79 , N/A , $405.46 , $405.46 , $475.95 , $429.91 , $54.34 , $480.96 
" Fac PR Tte W or WO Fol Wcon,Doppler ",HCPCS C8929,0483 - CARDIOLOGY – ECHOCARDIOLOGY,N/A,N/A," $2,789.00 "," $1,812.85 "," $2,342.76 ", N/A , N/A ," $2,253.51 "," $2,510.10 "," $2,361.17 "," $2,510.10 "," $2,510.10 "," $2,510.10 "," $2,370.65 ", N/A ," $2,575.08 "," $2,649.55 "," $2,370.65 "," $2,593.77 "," $2,593.77 "," $2,649.55 "," $2,677.44 "," $2,281.96 "," $2,510.10 "," $2,370.65 "," $2,203.31 ", N/A ," $2,257.14 "," $2,257.14 "," $2,649.55 "," $2,393.24 "," $2,203.31 "," $2,677.44 "
Psychotherapy W/Patient 60 Minutes,CPT® 90837,N/A,N/A,N/A, $495.00 , $321.75 , $174.64 , $129.40 , $115.70 , $282.88 , $254.06 , $460.35 , $445.50 , $445.50 , $396.00 , $396.00 , $115.70 , $457.03 , $470.25 , $445.50 , $445.50 , $445.50 , $460.35 , $475.20 , $334.66 , $420.75 , $330.47 , $481.69 , $175.00 , $288.40 , $288.40 , $470.25 , $336.21 , $115.70 , $481.69 
Pmp22 Gene Analysis Full Sequence Analysis,CPT® 81325,N/A,N/A,N/A," $3,434.00 "," $2,232.10 ", N/A , $784.97 , $272.87 , N/A , N/A ," $3,193.62 "," $3,090.60 "," $3,090.60 "," $2,747.20 "," $2,747.20 ", $272.87 ," $3,170.61 "," $3,262.30 "," $3,090.60 "," $3,090.60 "," $3,090.60 "," $3,193.62 "," $3,296.64 "," $5,138.66 "," $2,918.90 "," $3,668.50 "," $2,260.26 ", N/A ," $3,055.23 "," $3,055.23 "," $3,262.30 "," $3,332.28 ", $272.87 ," $5,138.66 "
Aspiration Bladder Insert Suprapubic Catheter,CPT® 51102,N/A,N/A,N/A, $988.00 , $642.20 , $783.04 , $136.64 , $260.59 , $710.60 , $662.44 , $918.84 , $889.20 , $889.20 , $790.40 , $790.40 , $260.59 , $912.22 , $938.60 , $889.20 , $889.20 , $889.20 , $918.84 , $948.48 , $788.37 , $839.80 , $752.88 , $887.47 , N/A , $724.46 , $724.46 , $938.60 , $851.52 , $136.64 , $948.48 
 Fac Egd Intrmural Needle Aspir/Biop Altered Anatomy ,CPT® 43242,0360 - OR SERVICES,N/A,N/A," $3,523.00 "," $2,289.95 "," $2,959.32 ", $249.26 , $396.81 ," $2,846.58 "," $3,170.70 "," $2,982.57 "," $3,170.70 "," $3,170.70 "," $3,170.70 "," $2,994.55 ", $389.03 ," $3,252.79 "," $3,346.85 "," $2,994.55 "," $3,276.39 "," $3,276.39 "," $3,346.85 "," $3,382.08 "," $2,882.52 "," $3,170.70 "," $2,994.55 "," $2,783.17 ", N/A ," $2,851.16 "," $2,851.16 "," $3,346.85 "," $3,023.09 ", $249.26 ," $3,382.08 "
Urinalysis Nonauto W/O Scope,CPT® 81002,N/A,N/A,N/A, $46.00 , $29.90 , N/A , $3.55 , $3.55 , $14.47 , $17.33 , $42.78 , $41.40 , $41.40 , $36.80 , $36.80 , $3.55 , $42.47 , $43.70 , $41.40 , $41.40 , $41.40 , $42.78 , $44.16 , $23.24 , $39.10 , $16.22 , $10.20 , N/A , $13.50 , $13.50 , $43.70 , $14.76 , $3.55 , $44.16 
 NIVOLUMAB 40 MG/4ML IV SOLN ,HCPCS J9299,0636 - DRUGS REQUIRING DETAILED CODIN,00003-3772-11,4 mL," $3,596.10 "," $2,337.47 "," $3,020.72 ", $31.07 , $30.60 ," $2,905.65 "," $3,236.49 "," $3,044.46 "," $3,236.49 "," $3,236.49 "," $3,236.49 "," $3,056.69 ", $30.00 ," $3,320.28 "," $3,416.30 "," $3,056.69 "," $3,344.37 "," $3,344.37 "," $3,416.30 "," $3,452.26 "," $2,942.33 "," $3,236.49 "," $3,056.69 "," $2,840.92 ", N/A ," $2,910.32 "," $2,910.32 "," $3,416.30 "," $3,085.81 ", $30.00 ," $3,452.26 "
Insj Biomchn Dev Intervertebral Dsc Spc W/Arthrd,22853,N/A,N/A,N/A," $1,794.00 "," $1,166.10 "," $1,481.94 ", $230.73 , $199.49 ," $1,194.16 "," $1,149.23 "," $1,668.42 "," $1,614.60 "," $1,614.60 "," $1,435.20 "," $1,435.20 ", $199.49 ," $1,656.40 "," $1,704.30 "," $1,614.60 "," $1,614.60 "," $1,614.60 "," $1,668.42 "," $1,722.24 "," $1,387.35 "," $1,524.90 "," $1,364.69 "," $1,403.48 ", N/A ," $1,217.47 "," $1,217.47 "," $1,704.30 "," $1,430.96 ", $199.49 ," $1,722.24 "
" Pro Treat Finger Fracture, Each ",CPT® 26750,0982 - PRO FEE/OUTPT,N/A,N/A," $1,206.00 ", $783.90 ," $1,175.53 ", $187.84 , $59.10 , $887.15 , $909.28 ," $1,121.58 "," $1,085.40 "," $1,085.40 ", $964.80 , $964.80 , $59.10 ," $1,113.50 "," $1,145.70 "," $1,085.40 "," $1,085.40 "," $1,085.40 "," $1,121.58 "," $1,157.76 "," $1,079.00 "," $1,025.10 ", $995.51 ," $1,062.31 ", N/A , $904.46 , $904.46 ," $1,145.70 "," $1,063.07 ", $59.10 ," $1,175.53 "
 Fac Macroscopic Exam Parasite ,CPT® 87169,0306 - LAB/BACT-MICRO,N/A,N/A, $62.00 , $40.30 , $52.08 , $4.40 , $4.40 , $50.10 , $55.80 , $52.49 , $55.80 , $55.80 , $55.80 , $52.70 , $4.31 , $57.24 , $58.90 , $52.70 , $57.66 , $57.66 , $58.90 , $59.52 , $50.73 , $55.80 , $52.70 , $48.98 , N/A , $50.18 , $50.18 , $58.90 , $53.20 , $4.31 , $59.52 
Speech/Hearing Therapy,CPT® 92507,N/A,N/A,N/A, $371.00 , $241.15 , $180.41 , $76.23 , $100.15 , $176.55 , $161.26 , $345.03 , $333.90 , $333.90 , $296.80 , $296.80 , $100.15 , $342.54 , $352.45 , $333.90 , $333.90 , $333.90 , $345.03 , $356.16 , $194.15 , $315.35 , $211.87 , $299.39 , N/A , $179.99 , $179.99 , $352.45 , $209.85 , $76.23 , $356.16 
 Fac Drug Assay Rufinamide ,CPT® 80210,0301 - LAB/CHEMISTRY,N/A,N/A, $261.00 , $169.65 , $219.24 , $27.65 , $22.12 , $210.89 , $234.90 , $220.96 , $234.90 , $234.90 , $234.90 , $221.85 , $21.69 , $240.98 , $247.95 , $221.85 , $242.73 , $242.73 , $247.95 , $250.56 , $213.55 , $234.90 , $221.85 , $206.19 , N/A , $211.23 , $211.23 , $247.95 , $223.96 , $21.69 , $250.56 
 Pro X-Ray Exam of Lower Spine ,CPT® 72114,0972 - PRO FEE/RAD/DX,N/A,N/A, $198.00 , $128.70 , $350.67 , $60.93 , $66.50 , $294.27 , $340.30 , $184.14 , $178.20 , $178.20 , $158.40 , $158.40 , $66.50 , $182.81 , $188.10 , $178.20 , $178.20 , $178.20 , $184.14 , $190.08 , $341.82 , $168.30 , $373.65 , $310.70 , N/A , $300.01 , $300.01 , $188.10 , $347.27 , $60.93 , $373.65 
 Pro Debride Tissue/Muscle ,CPT® 11043,0975 - PRO FEE/OR,N/A,N/A," $1,073.00 ", $697.45 , $487.15 , $145.28 , $233.20 , $424.55 , $413.55 , $997.89 , $965.70 , $965.70 , $858.40 , $858.40 , $233.20 , $990.70 ," $1,019.35 ", $965.70 , $965.70 , $965.70 , $997.89 ," $1,030.08 ", $537.67 , $912.05 , $827.81 , $543.19 , N/A , $432.84 , $432.84 ," $1,019.35 ", $501.95 , $145.28 ," $1,030.08 "
"Partial Excis Lip,Wedge Prim Clos",CPT® 40510,N/A,N/A,N/A," $3,185.00 "," $2,070.25 "," $2,155.21 ", $337.51 , $448.41 ," $1,713.24 "," $1,752.48 "," $2,962.05 "," $2,866.50 "," $2,866.50 "," $2,548.00 "," $2,548.00 ", $448.41 ," $2,940.71 "," $3,025.75 "," $2,866.50 "," $2,866.50 "," $2,866.50 "," $2,962.05 "," $3,057.60 "," $1,537.25 "," $2,707.25 "," $1,916.08 "," $2,018.66 ", N/A ," $1,746.66 "," $1,746.66 "," $3,025.75 "," $1,826.82 ", $337.51 ," $3,057.60 "
 Rt Joint Low Ext MRI W/O &W/Contrast ,CPT® 73723,0610 - MRI,N/A,N/A," $7,942.00 "," $5,162.30 "," $6,671.28 ", $398.73 , $634.32 ," $6,417.14 "," $7,147.80 "," $6,723.70 "," $7,147.80 "," $7,147.80 "," $7,147.80 "," $6,750.70 ", $621.88 ," $7,332.85 "," $7,544.90 "," $6,750.70 "," $7,386.06 "," $7,386.06 "," $7,544.90 "," $7,624.32 "," $6,498.14 "," $7,147.80 "," $6,750.70 "," $6,274.18 ", N/A ," $6,427.46 "," $6,427.46 "," $7,544.90 "," $6,815.03 ", $398.73 ," $7,624.32 "
 ABATACEPT 250 MG IV SOLR ,HCPCS J0129,0636 - DRUGS REQUIRING DETAILED CODIN,00003-2187-13,10 mL," $8,506.05 "," $5,528.93 "," $7,145.08 ", $44.14 , $44.37 ," $6,872.89 "," $7,655.45 "," $7,201.22 "," $7,655.45 "," $7,655.45 "," $7,655.45 "," $7,230.14 ", $43.50 ," $7,853.64 "," $8,080.75 "," $7,230.14 "," $7,910.63 "," $7,910.63 "," $8,080.75 "," $8,165.81 "," $6,959.65 "," $7,655.45 "," $7,230.14 "," $6,719.78 ", N/A ," $6,883.95 "," $6,883.95 "," $8,080.75 "," $7,299.04 ", $43.50 ," $8,165.81 "
 St Video Swallow Study -Mh ,CPT® 92611,0444 - SPEECH PATH/EVAL,N/A,N/A, $391.00 , $254.15 , $328.44 , $90.20 , $125.23 , $315.93 , $351.90 , $331.02 , $351.90 , $351.90 , $351.90 , $332.35 , $122.77 , $361.01 , $371.45 , $332.35 , $363.63 , $363.63 , $371.45 , $375.36 , $319.92 , $351.90 , $332.35 , $308.89 , N/A , $316.44 , $316.44 , $371.45 , $335.52 , $90.20 , $375.36 
 POLIOVIRUS VACCINE INACTIVATED IJ INJ ,HCPCS 90713,0636 - DRUGS REQUIRING DETAILED CODIN,49281-0860-10,0.5 mL, $249.77 , $162.35 , $209.81 , N/A , $40.63 , $201.81 , $224.79 , $211.46 , $224.79 , $224.79 , $224.79 , $212.30 , $39.83 , $230.61 , $237.28 , $212.30 , $232.29 , $232.29 , $237.28 , $239.78 , $204.36 , $224.79 , $212.30 , $197.32 , N/A , $202.14 , $202.14 , $237.28 , $214.33 , $39.83 , $239.78 
 Fac Contrast X-Ray Exam of Aorta ,CPT® 75625,0320 - DX X-RAY,N/A,N/A," $1,109.00 ", $720.85 , $931.56 , $122.22 , $227.72 , $896.07 , $998.10 , $938.88 , $998.10 , $998.10 , $998.10 , $942.65 , $223.25 ," $1,023.94 "," $1,053.55 ", $942.65 ," $1,031.37 "," $1,031.37 "," $1,053.55 "," $1,064.64 ", $907.38 , $998.10 , $942.65 , $876.11 , N/A , $897.51 , $897.51 ," $1,053.55 ", $951.63 , $122.22 ," $1,064.64 "
 Godobenate Dimeglumine(Multihance) per Ml ,HCPCS A9577,0255 - DRUGS/RADIOLOGY,N/A,N/A, $8.00 , $5.20 , $6.72 , $1.85 , $2.77 , $6.46 , $7.20 , $6.77 , $7.20 , $7.20 , $7.20 , $6.80 , $2.72 , $7.39 , $7.60 , $6.80 , $7.44 , $7.44 , $7.60 , $7.68 , $6.55 , $7.20 , $6.80 , $6.32 , N/A , $6.47 , $6.47 , $7.60 , $6.86 , $1.85 , $7.68 
"Deoxyribonuclease, Antibody",CPT® 86215,N/A,N/A,N/A, $169.00 , $109.85 , N/A , $13.52 , $13.52 , $71.09 , $85.03 , $157.17 , $152.10 , $152.10 , $135.20 , $135.20 , $13.52 , $156.04 , $160.55 , $152.10 , $152.10 , $152.10 , $157.17 , $162.24 , $88.47 , $143.65 , $87.58 , $48.02 , N/A , $66.35 , $66.35 , $160.55 , $72.50 , $13.52 , $162.24 
 Mandible Less Than 4 Views ,CPT® 70100,0320 - DX X-RAY,N/A,N/A, $365.00 , $237.25 , $306.60 , $37.96 , $29.85 , $294.92 , $328.50 , $309.01 , $328.50 , $328.50 , $328.50 , $310.25 , $29.26 , $337.00 , $346.75 , $310.25 , $339.45 , $339.45 , $346.75 , $350.40 , $298.64 , $328.50 , $310.25 , $288.35 , N/A , $295.39 , $295.39 , $346.75 , $313.21 , $29.26 , $350.40 
"Laminotomy,Lumbar Disk,1 Intrsp",CPT® 63030,N/A,N/A,N/A," $7,044.00 "," $4,578.60 "," $4,581.51 ", $841.63 , $819.07 ," $6,157.37 "," $5,077.89 "," $6,550.92 "," $6,339.60 "," $6,339.60 "," $5,635.20 "," $5,635.20 ", $819.07 ," $6,503.73 "," $6,691.80 "," $6,339.60 "," $6,339.60 "," $6,339.60 "," $6,550.92 "," $6,762.24 "," $7,853.05 "," $5,987.40 "," $5,141.67 "," $5,560.93 ", N/A ," $6,277.51 "," $6,277.51 "," $6,691.80 "," $7,385.31 ", $819.07 ," $7,853.05 "
 Fac Physical Therapy Evaluation High Complex ,CPT® 97163,0424 - PHYS THERP/EVAL,N/A,N/A, $402.00 , $261.30 , $337.68 , $100.30 , $67.74 , $324.82 , $361.80 , $340.33 , $361.80 , $361.80 , $361.80 , $341.70 , $66.41 , $371.17 , $381.90 , $341.70 , $373.86 , $373.86 , $381.90 , $385.92 , $328.92 , $361.80 , $341.70 , $317.58 , N/A , $325.34 , $325.34 , $381.90 , $344.96 , $66.41 , $385.92 
 Pro Exc Face-Mm B9+Marg 3.1-4 Cm ,CPT® 11444,0982 - PRO FEE/OUTPT,N/A,N/A," $1,358.00 ", $882.70 , $723.93 , $216.51 , $338.07 , $620.10 , $603.18 ," $1,262.94 "," $1,222.20 "," $1,222.20 "," $1,086.40 "," $1,086.40 ", $338.07 ," $1,253.84 "," $1,290.10 "," $1,222.20 "," $1,222.20 "," $1,222.20 "," $1,262.94 "," $1,303.68 ", $790.64 ," $1,154.30 "," $1,204.24 ", $791.21 , N/A , $632.21 , $632.21 ," $1,290.10 ", $733.14 , $216.51 ," $1,303.68 "
Intraut Copper Contraceptive,HCPCS J7300,N/A,N/A,N/A," $1,044.00 ", $678.60 , N/A , N/A ," $1,045.50 ", N/A , N/A , $970.92 , $939.60 , $939.60 , $835.20 , $835.20 ," $1,045.50 ", $963.93 , $991.80 , $939.60 , $939.60 , $939.60 , $970.92 ," $1,002.24 ", N/A , $887.40 , $724.01 ," $1,258.50 ", N/A , N/A , N/A , $991.80 , N/A , $724.01 ," $1,258.50 "
 Fac Ercp Tumor/Polyp/Lesion Ablation W/Dilation&Wire ,CPT® 43278,0360 - OR SERVICES,N/A,N/A," $5,482.00 "," $3,563.30 "," $4,604.88 ", $409.07 , $342.73 ," $4,429.46 "," $4,933.80 "," $4,641.06 "," $4,933.80 "," $4,933.80 "," $4,933.80 "," $4,659.70 ", $336.01 ," $5,061.53 "," $5,207.90 "," $4,659.70 "," $5,098.26 "," $5,098.26 "," $5,207.90 "," $5,262.72 "," $4,485.37 "," $4,933.80 "," $4,659.70 "," $4,330.78 ", N/A ," $4,436.58 "," $4,436.58 "," $5,207.90 "," $4,704.10 ", $336.01 ," $5,262.72 "
Layer Closure 2.5cm or Le,12051,N/A,N/A,N/A," $1,095.00 ", $711.75 , $541.38 , $162.92 , $106.23 , $469.05 , $460.11 ," $1,018.35 ", $985.50 , $985.50 , $876.00 , $876.00 , $106.23 ," $1,011.01 "," $1,040.25 ", $985.50 , $985.50 , $985.50 ," $1,018.35 "," $1,051.20 ", $593.04 , $930.75 , $917.01 , $602.22 , N/A , $478.20 , $478.20 ," $1,040.25 ", $554.57 , $106.23 ," $1,051.20 "
Remv Bone for Graft Major,CPT® 20902,N/A,N/A,N/A," $3,276.00 "," $2,129.40 "," $1,664.52 ", $258.93 , $419.78 ," $1,384.97 "," $1,467.33 "," $3,046.68 "," $2,948.40 "," $2,948.40 "," $2,620.80 "," $2,620.80 ", $419.78 ," $3,024.73 "," $3,112.20 "," $2,948.40 "," $2,948.40 "," $2,948.40 "," $3,046.68 "," $3,144.96 "," $1,562.59 "," $2,784.60 "," $1,621.71 "," $1,619.88 ", N/A ," $1,411.99 "," $1,411.99 "," $3,112.20 "," $1,659.60 ", $258.93 ," $3,144.96 "
"Antithrombin III Test,Activ",CPT® 85300,N/A,N/A,N/A, $231.00 , $150.15 , N/A , $12.09 , $12.09 , $67.06 , $80.20 , $214.83 , $207.90 , $207.90 , $184.80 , $184.80 , $12.09 , $213.28 , $219.45 , $207.90 , $207.90 , $207.90 , $214.83 , $221.76 , $79.13 , $196.35 , $77.85 , $42.97 , N/A , $62.58 , $62.58 , $219.45 , $68.39 , $12.09 , $221.76 
 Fac Njx/Nfs Nulyt Sbst Edrl Crv/Thrc ,CPT® 62281,0360 - OR SERVICES,N/A,N/A," $2,736.00 "," $1,778.40 "," $2,298.24 ", $153.77 , $712.46 ," $2,210.69 "," $2,462.40 "," $2,316.30 "," $2,462.40 "," $2,462.40 "," $2,462.40 "," $2,325.60 ", $698.49 ," $2,526.15 "," $2,599.20 "," $2,325.60 "," $2,544.48 "," $2,544.48 "," $2,599.20 "," $2,626.56 "," $2,238.60 "," $2,462.40 "," $2,325.60 "," $2,161.44 ", N/A ," $2,214.24 "," $2,214.24 "," $2,599.20 "," $2,347.76 ", $153.77 ," $2,626.56 "
Immunodiffusion Ouchterlony,CPT® 86331,N/A,N/A,N/A, $139.00 , $90.35 , N/A , $12.22 , $12.22 , $67.76 , $81.09 , $129.27 , $125.10 , $125.10 , $111.20 , $111.20 , $12.22 , $128.34 , $132.05 , $125.10 , $125.10 , $125.10 , $129.27 , $133.44 , $79.99 , $118.15 , $77.85 , $43.44 , N/A , $63.24 , $63.24 , $132.05 , $69.11 , $12.22 , $133.44 
" Fac T Cells, Total Count ",CPT® 86359,0302 - LAB/IMMUNOLOGY,N/A,N/A, $348.00 , $226.20 , $292.32 , $38.48 , $38.48 , $281.18 , $313.20 , $294.62 , $313.20 , $313.20 , $313.20 , $295.80 , $37.73 , $321.31 , $330.60 , $295.80 , $323.64 , $323.64 , $330.60 , $334.08 , $284.73 , $313.20 , $295.80 , $274.92 , N/A , $281.64 , $281.64 , $330.60 , $298.62 , $37.73 , $334.08 
 Pro Cv Strs Tst Xers&/or Rx Cont Ecg I&R Only ,CPT® 93018,0982 - PRO FEE/OUTPT,N/A,N/A, $239.00 , $155.35 , $91.46 , $13.76 , $16.17 , $79.74 , $81.22 , $222.27 , $215.10 , $215.10 , $191.20 , $191.20 , $16.17 , $220.67 , $227.05 , $215.10 , $215.10 , $215.10 , $222.27 , $229.44 , $90.47 , $203.15 , $74.93 , $89.87 , N/A , $81.30 , $81.30 , $227.05 , $90.12 , $13.76 , $229.44 
 Orbits Min 4 Views ,CPT® 70200,0320 - DX X-RAY,N/A,N/A, $435.00 , $282.75 , $365.40 , $47.33 , $41.92 , $351.48 , $391.50 , $368.27 , $391.50 , $391.50 , $391.50 , $369.75 , $41.10 , $401.64 , $413.25 , $369.75 , $404.55 , $404.55 , $413.25 , $417.60 , $355.92 , $391.50 , $369.75 , $343.65 , N/A , $352.05 , $352.05 , $413.25 , $373.27 , $41.10 , $417.60 
 Fac Cltx Tibl Fx Prox W/O Mnpj ,CPT® 27530,0761 - TREATMENT ROOM,N/A,N/A, $660.00 , $429.00 , $554.40 , $285.61 , $164.92 , $533.28 , $594.00 , $558.76 , $594.00 , $594.00 , $594.00 , $561.00 , $161.69 , $609.38 , $627.00 , $561.00 , $613.80 , $613.80 , $627.00 , $633.60 , $540.01 , $594.00 , $561.00 , $521.40 , N/A , $534.14 , $534.14 , $627.00 , $566.35 , $161.69 , $633.60 
 Fac CCP Antibody ,CPT® 86200,0302 - LAB/IMMUNOLOGY,N/A,N/A, $209.00 , $135.85 , $175.56 , $13.21 , $13.21 , $168.87 , $188.10 , $176.94 , $188.10 , $188.10 , $188.10 , $177.65 , $12.95 , $192.97 , $198.55 , $177.65 , $194.37 , $194.37 , $198.55 , $200.64 , $171.00 , $188.10 , $177.65 , $165.11 , N/A , $169.14 , $169.14 , $198.55 , $179.34 , $12.95 , $200.64 
Pfizer Admin Biv Addtl Dose 6 Months to 4yrs,CPT® 0174A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , N/A , N/A , N/A , N/A , N/A , $66.50 , N/A , $38.92 , $67.20 
Amikacin Sulfate Injection 100 Mg,HCPCS J0278,N/A,N/A,N/A, $3.00 , $1.95 , N/A , $0.96 , $0.98 , N/A , N/A , $2.79 , $2.70 , $2.70 , $2.40 , $2.40 , $0.98 , $2.77 , $2.85 , $2.70 , $2.70 , $2.70 , $2.79 , $2.88 , $1.56 , $2.55 , $1.95 , $1.19 , N/A , N/A , N/A , $2.85 , N/A , $0.96 , $2.88 
 NA CHONDROIT SULF-NA HYALURON 20-15 MG/0.5ML IO SOSY ,HCPCS RXA250,0250 - PHARMACY,08065-1839-05,0.5 mL," $1,108.64 ", $720.62 , $931.26 , N/A , N/A , $895.78 , $997.78 , $938.57 , $997.78 , $997.78 , $997.78 , $942.34 , N/A ," $1,023.61 "," $1,053.21 ", $942.34 ," $1,031.04 "," $1,031.04 "," $1,053.21 "," $1,064.29 ", $907.09 , $997.78 , $942.34 , $875.83 , N/A , $897.22 , $897.22 ," $1,053.21 ", $951.32 , $875.83 ," $1,064.29 "
 Pro Punch Biopsy Skin Ea Sep/Additional Lesion ,CPT® 11105,0982 - PRO FEE/OUTPT,N/A,N/A, $229.00 , $148.85 , $82.38 , $24.42 , $48.20 , $69.36 , N/A , $212.97 , $206.10 , $206.10 , $183.20 , $183.20 , $48.20 , $211.44 , $217.55 , $206.10 , $206.10 , $206.10 , $212.97 , $219.84 , $90.89 , $194.65 , $135.05 , $95.17 , N/A , $70.71 , $70.71 , $217.55 , $81.99 , $24.42 , $219.84 
 Pro Arthroscop Rotator Cuff Repr ,CPT® 29827,0982 - PRO FEE/OUTPT,N/A,N/A," $5,840.00 "," $3,796.00 "," $6,477.90 "," $1,013.19 ", $952.41 ," $5,119.72 "," $5,149.96 "," $5,431.20 "," $5,256.00 "," $5,256.00 "," $4,672.00 "," $4,672.00 ", $952.41 ," $5,392.07 "," $5,548.00 "," $5,256.00 "," $5,256.00 "," $5,256.00 "," $5,431.20 "," $5,606.40 "," $6,032.45 "," $4,964.00 "," $5,696.52 "," $6,048.21 ", N/A ," $5,219.61 "," $5,219.61 "," $5,548.00 "," $6,134.91 ", $952.41 ," $6,477.90 "
 LAYER CLOSURE Trunk 12.6-20CM ,CPT® 12035,0981 - PRO FEE/ER,N/A,N/A," $1,518.00 ", $986.70 , $761.06 , $227.75 , $200.71 , $653.93 , $643.73 ," $1,411.74 "," $1,366.20 "," $1,366.20 "," $1,214.40 "," $1,214.40 ", $200.71 ," $1,401.57 "," $1,442.10 "," $1,366.20 "," $1,366.20 "," $1,366.20 "," $1,411.74 "," $1,457.28 ", $835.71 ," $1,290.30 "," $1,291.66 ", $837.00 , N/A , $666.69 , $666.69 ," $1,442.10 ", $773.15 , $200.71 ," $1,457.28 "
Plmt Urtrl Stent Prq New Access W/Sep Nfros Cath,CPT® 50695,N/A,N/A,N/A," $2,322.00 "," $1,509.30 "," $1,853.28 ", $324.19 ," $1,127.40 "," $1,777.70 "," $1,590.23 "," $2,159.46 "," $2,089.80 "," $2,089.80 "," $1,857.60 "," $1,857.60 "," $1,127.40 "," $2,143.90 "," $2,205.90 "," $2,089.80 "," $2,089.80 "," $2,089.80 "," $2,159.46 "," $2,229.12 "," $1,869.89 "," $1,973.70 "," $1,768.06 "," $2,132.06 ", N/A ," $1,812.39 "," $1,812.39 "," $2,205.90 "," $2,130.19 ", $324.19 ," $2,229.12 "
 Fac Drug Screen Quant Alcohols Biomarkers 1 or 2 ,CPT® 80321,0301 - LAB/CHEMISTRY,N/A,N/A, $270.00 , $175.50 , $226.80 , N/A , N/A , $218.16 , $243.00 , $228.58 , $243.00 , $243.00 , $243.00 , $229.50 , N/A , $249.29 , $256.50 , $229.50 , $251.10 , $251.10 , $256.50 , $259.20 , $220.91 , $243.00 , $229.50 , $213.30 , N/A , $218.51 , $218.51 , $256.50 , $231.69 , $213.30 , $259.20 
 Pet Brain Imaging Metabolic Eval ,CPT® 78608,0404 - PET POSITIVE EMISSION TOMOGRAP,N/A,N/A," $8,592.00 "," $5,584.80 "," $7,217.28 "," $1,511.21 "," $1,005.83 "," $6,942.34 "," $7,732.80 "," $7,273.99 "," $7,732.80 "," $7,732.80 "," $7,732.80 "," $7,303.20 ", $986.11 ," $7,932.99 "," $8,162.40 "," $7,303.20 "," $7,990.56 "," $7,990.56 "," $8,162.40 "," $8,248.32 "," $7,029.97 "," $7,732.80 "," $7,303.20 "," $6,787.68 ", N/A ," $6,953.51 "," $6,953.51 "," $8,162.40 "," $7,372.80 ", $986.11 ," $8,248.32 "
 Pro Tx Prq Achll Tdn Spx Local Anes ,CPT® 27605,0982 - PRO FEE/OUTPT,N/A,N/A," $1,727.00 "," $1,122.55 "," $1,138.87 ", $178.40 , $76.84 , $903.28 , $904.73 ," $1,606.11 "," $1,554.30 "," $1,554.30 "," $1,381.60 "," $1,381.60 ", $76.84 ," $1,594.54 "," $1,640.65 "," $1,554.30 "," $1,554.30 "," $1,554.30 "," $1,606.11 "," $1,657.92 "," $1,066.53 "," $1,467.95 ", $984.80 ," $1,085.90 ", N/A , $920.91 , $920.91 ," $1,640.65 "," $1,082.38 ", $76.84 ," $1,657.92 "
 Esophagram ,CPT® 74220,0320 - DX X-RAY,N/A,N/A, $843.00 , $547.95 , $708.12 , $98.12 , $72.27 , $681.14 , $758.70 , $713.68 , $758.70 , $758.70 , $758.70 , $716.55 , $70.85 , $778.34 , $800.85 , $716.55 , $783.99 , $783.99 , $800.85 , $809.28 , $689.74 , $758.70 , $716.55 , $665.97 , N/A , $682.24 , $682.24 , $800.85 , $723.38 , $70.85 , $809.28 
"Cystourethroscopy,Fulgur >5cm Lesn",CPT® 52240,N/A,N/A,N/A," $3,316.00 "," $2,155.40 "," $2,100.25 ", $368.50 , $514.64 ," $1,924.93 "," $1,781.28 "," $3,083.88 "," $2,984.40 "," $2,984.40 "," $2,652.80 "," $2,652.80 ", $514.64 ," $3,061.66 "," $3,150.20 "," $2,984.40 "," $2,984.40 "," $2,984.40 "," $3,083.88 "," $3,183.36 "," $2,112.54 "," $2,818.60 "," $2,017.78 "," $2,413.34 ", N/A ," $1,962.49 "," $1,962.49 "," $3,150.20 "," $2,306.64 ", $368.50 ," $3,183.36 "
 OB Greater or Equal to 14wks US ,CPT® 76805,0402 - ULTRASOUND,N/A,N/A, $670.00 , $435.50 , $562.80 , $134.36 , $138.63 , $541.36 , $603.00 , $567.22 , $603.00 , $603.00 , $603.00 , $569.50 , $135.91 , $618.61 , $636.50 , $569.50 , $623.10 , $623.10 , $636.50 , $643.20 , $548.19 , $603.00 , $569.50 , $529.30 , N/A , $542.23 , $542.23 , $636.50 , $574.93 , $134.36 , $643.20 
 MUSCLE RUB 10-15 % EX CREA ,HCPCS RXC637,0250 - PHARMACY,45802-0174-53,85 gram, $17.91 , $11.64 , $15.04 , N/A , N/A , $14.47 , $16.12 , $15.16 , $16.12 , $16.12 , $16.12 , $15.22 , N/A , $16.54 , $17.01 , $15.22 , $16.66 , $16.66 , $17.01 , $17.19 , $14.65 , $16.12 , $15.22 , $14.15 , N/A , $14.49 , $14.49 , $17.01 , $15.37 , $14.15 , $17.19 
 NITROGLYCERIN 0.4 MG/HR TD PT24 ,HCPCS RXC637,0250 - PHARMACY,00378-9112-93,1 patch, $11.17 , $7.26 , $9.38 , N/A , N/A , $9.03 , $10.05 , $9.46 , $10.05 , $10.05 , $10.05 , $9.49 , N/A , $10.31 , $10.61 , $9.49 , $10.39 , $10.39 , $10.61 , $10.72 , $9.14 , $10.05 , $9.49 , $8.82 , N/A , $9.04 , $9.04 , $10.61 , $9.58 , $8.82 , $10.72 
 LEUPROLIDE ACETATE (4 MONTH) 30 MG SC KIT ,HCPCS J9217,0636 - DRUGS REQUIRING DETAILED CODIN,62935-0303-30,1 each," $5,312.44 "," $3,453.09 "," $4,462.45 ", $169.18 , $192.10 ," $4,292.45 "," $4,781.20 "," $4,497.51 "," $4,781.20 "," $4,781.20 "," $4,781.20 "," $4,515.57 ", $188.33 ," $4,904.98 "," $5,046.82 "," $4,515.57 "," $4,940.57 "," $4,940.57 "," $5,046.82 "," $5,099.94 "," $4,346.64 "," $4,781.20 "," $4,515.57 "," $4,196.83 ", N/A ," $4,299.36 "," $4,299.36 "," $5,046.82 "," $4,558.60 ", $169.18 ," $5,099.94 "
Esophageal Motility Study,CPT® 91010,N/A,N/A,N/A, $838.00 , $544.70 , $531.00 , $218.16 , $175.19 , $533.47 , $422.52 , $779.34 , $754.20 , $754.20 , $670.40 , $670.40 , $175.19 , $773.73 , $796.10 , $754.20 , $754.20 , $754.20 , $779.34 , $804.48 , $961.96 , $712.30 , $559.57 , $670.34 , N/A , $543.88 , $543.88 , $796.10 , $639.86 , $175.19 , $961.96 
Radex Hip Unilateral With Pelvis Minimum 4 Views,CPT® 73503,N/A,N/A,N/A, $690.00 , $448.50 , $402.29 , $58.48 , $40.49 , $245.48 , $259.09 , $641.70 , $621.00 , $621.00 , $552.00 , $552.00 , $40.49 , $637.08 , $655.50 , $621.00 , $621.00 , $621.00 , $641.70 , $662.40 , $322.62 , $586.50 , $341.47 , $260.18 , N/A , $250.28 , $250.28 , $655.50 , $289.69 , $40.49 , $662.40 
 Fac Who W/Nontorsion Jnt(S) Cf ,HCPCS L3905,0274 - PROSTHETIC DEV,N/A,N/A," $1,475.00 ", $958.75 ," $1,239.00 "," $1,055.71 ", $463.28 ," $1,191.80 "," $1,327.50 "," $1,248.74 "," $1,327.50 "," $1,327.50 "," $1,327.50 "," $1,253.75 ", $454.20 ," $1,361.87 "," $1,401.25 "," $1,253.75 "," $1,371.75 "," $1,371.75 "," $1,401.25 "," $1,416.00 "," $1,206.85 "," $1,327.50 "," $1,253.75 "," $1,165.25 ", N/A ," $1,193.72 "," $1,193.72 "," $1,401.25 "," $1,265.70 ", $454.20 ," $1,416.00 "
 Bone Density Spine/Hips ,CPT® 77080,0320 - DX X-RAY,N/A,N/A, $578.00 , $375.70 , $485.52 , $37.34 , $90.07 , $467.02 , $520.20 , $489.33 , $520.20 , $520.20 , $520.20 , $491.30 , $88.30 , $533.67 , $549.10 , $491.30 , $537.54 , $537.54 , $549.10 , $554.88 , $472.92 , $520.20 , $491.30 , $456.62 , N/A , $467.78 , $467.78 , $549.10 , $495.98 , $37.34 , $554.88 
Part Remv Femur/Prox Tib/Fib,CPT® 27360,N/A,N/A,N/A," $5,623.00 "," $3,654.95 "," $5,541.19 ", $864.48 , $768.38 ," $4,104.64 "," $4,101.09 "," $5,229.39 "," $5,060.70 "," $5,060.70 "," $4,498.40 "," $4,498.40 ", $768.38 ," $5,191.72 "," $5,341.85 "," $5,060.70 "," $5,060.70 "," $5,060.70 "," $5,229.39 "," $5,398.08 "," $5,089.51 "," $4,779.55 "," $4,529.74 "," $4,843.08 ", N/A ," $4,184.73 "," $4,184.73 "," $5,341.85 "," $4,918.56 ", $768.38 ," $5,541.19 "
Remove Foreign Body Complic,10121,N/A,N/A,N/A," $1,048.00 ", $681.20 , $588.68 , $176.00 , $77.74 , $505.10 , $497.82 , $974.64 , $943.20 , $943.20 , $838.40 , $838.40 , $77.74 , $967.62 , $995.60 , $943.20 , $943.20 , $943.20 , $974.64 ," $1,006.08 ", $648.05 , $890.80 , $990.16 , $647.57 , N/A , $514.96 , $514.96 , $995.60 , $597.18 , $77.74 ," $1,006.08 "
Fitting of Diaphragm/Cap,CPT® 57170,N/A,N/A,N/A, $396.00 , $257.40 , $221.70 , $44.79 , $31.68 , $197.31 , $195.83 , $368.28 , $356.40 , $356.40 , $316.80 , $316.80 , $31.68 , $365.63 , $376.20 , $356.40 , $356.40 , $356.40 , $368.28 , $380.16 , $234.15 , $336.60 , $256.91 , $197.64 , N/A , $201.16 , $201.16 , $376.20 , $241.27 , $31.68 , $380.16 
"Knee Scope,Clean/Drain",29871,N/A,N/A,N/A," $3,549.00 "," $2,306.85 "," $3,138.79 ", $493.81 , $604.11 ," $2,483.32 "," $2,481.44 "," $3,300.57 "," $3,194.10 "," $3,194.10 "," $2,839.20 "," $2,839.20 ", $604.11 ," $3,276.79 "," $3,371.55 "," $3,194.10 "," $3,194.10 "," $3,194.10 "," $3,300.57 "," $3,407.04 "," $2,916.25 "," $3,016.65 "," $2,736.75 "," $2,931.30 ", N/A ," $2,531.78 "," $2,531.78 "," $3,371.55 "," $2,975.72 ", $493.81 ," $3,407.04 "
 Pro Cltx Rdl Head Sublxtj Chld Nursemaid Elbw W/Mnpj ,CPT® 24640,0981 - PRO FEE/ER,N/A,N/A, $599.00 , $389.35 , $507.52 , $78.44 , $62.26 , $453.97 , $465.63 , $557.07 , $539.10 , $539.10 , $479.20 , $479.20 , $62.26 , $553.06 , $569.05 , $539.10 , $539.10 , $539.10 , $557.07 , $575.04 , $464.54 , $509.15 , $512.03 , $456.76 , N/A , $462.82 , $462.82 , $569.05 , $543.97 , $62.26 , $575.04 
 Fac Njx Diskograpy Ea Lvl Crv/Thrc ,CPT® 62291,0361 - OR/MINOR,N/A,N/A," $1,821.00 "," $1,183.65 "," $1,529.64 ", $141.06 , $153.67 ," $1,471.37 "," $1,638.90 "," $1,541.66 "," $1,638.90 "," $1,638.90 "," $1,638.90 "," $1,547.85 ", $150.66 ," $1,681.33 "," $1,729.95 "," $1,547.85 "," $1,693.53 "," $1,693.53 "," $1,729.95 "," $1,748.16 "," $1,489.94 "," $1,638.90 "," $1,547.85 "," $1,438.59 ", N/A ," $1,473.74 "," $1,473.74 "," $1,729.95 "," $1,562.60 ", $141.06 ," $1,748.16 "
 Pro Cltx Phlngl Fx Prox/Middle Px/F/T W/O Mnpj Ea ,CPT® 26720,0981 - PRO FEE/ER,N/A,N/A, $841.00 , $546.65 ," $1,172.86 ", $187.01 , $74.22 , $886.14 , $907.35 , $782.13 , $756.90 , $756.90 , $672.80 , $672.80 , $74.22 , $776.50 , $798.95 , $756.90 , $756.90 , $756.90 , $782.13 , $807.36 ," $1,075.93 ", $714.85 , $995.51 ," $1,060.64 ", N/A , $903.43 , $903.43 , $798.95 ," $1,061.84 ", $74.22 ," $1,172.86 "
Foam Drg >16<=48 Sq in W/Bdr,HCPCS A6213,N/A,N/A,N/A, $20.00 , $13.00 , N/A , N/A , $10.69 , N/A , N/A , $18.60 , $18.00 , $18.00 , $16.00 , $16.00 , $10.69 , $18.47 , $19.00 , $18.00 , $18.00 , $18.00 , $18.60 , $19.20 , N/A , $17.00 , $27.90 , $16.22 , N/A , N/A , N/A , $19.00 , N/A , $10.69 , $27.90 
X-Ray Lumbar Spine 4 Vw,CPT® 72110,N/A,N/A,N/A, $462.00 , $300.30 , $289.71 , $50.58 , $51.88 , $231.57 , $260.36 , $429.66 , $415.80 , $415.80 , $369.60 , $369.60 , $51.88 , $426.56 , $438.90 , $415.80 , $415.80 , $415.80 , $429.66 , $443.52 , $279.18 , $392.70 , $285.05 , $246.15 , N/A , $236.09 , $236.09 , $438.90 , $273.27 , $50.58 , $443.52 
Reinforce Tibia,CPT® 27745,N/A,N/A,N/A," $4,976.00 "," $3,234.40 "," $4,601.29 ", $719.66 , $845.22 ," $3,660.75 "," $3,641.63 "," $4,627.68 "," $4,478.40 "," $4,478.40 "," $3,980.80 "," $3,980.80 ", $845.22 ," $4,594.34 "," $4,727.20 "," $4,478.40 "," $4,478.40 "," $4,478.40 "," $4,627.68 "," $4,776.96 "," $4,300.59 "," $4,229.60 "," $4,021.28 "," $4,299.21 ", N/A ," $3,732.18 "," $3,732.18 "," $4,727.20 "," $4,386.64 ", $719.66 ," $4,776.96 "
1st Hospital IP/Obs Care Moderate Mdm 55 Minutes,99222,N/A,N/A,N/A, $441.00 , $286.65 , $268.34 , $126.08 , $90.83 , $236.74 , $237.02 , $410.13 , $396.90 , $396.90 , $352.80 , $352.80 , $90.83 , $407.18 , $418.95 , $396.90 , $396.90 , $396.90 , $410.13 , $423.36 , $341.36 , $374.85 , $297.04 , $298.13 , $126.75 , $241.36 , $241.36 , $418.95 , $278.36 , $90.83 , $423.36 
 Fac Assay of Magnesium ,CPT® 83735,0301 - LAB/CHEMISTRY,N/A,N/A, $80.00 , $52.00 , $67.20 , $6.83 , $6.83 , $64.64 , $72.00 , $67.73 , $72.00 , $72.00 , $72.00 , $68.00 , $6.70 , $73.86 , $76.00 , $68.00 , $74.40 , $74.40 , $76.00 , $76.80 , $65.46 , $72.00 , $68.00 , $63.20 , N/A , $64.74 , $64.74 , $76.00 , $68.65 , $6.70 , $76.80 
"Excis Tendn/Capsule Lesn,Toes",CPT® 28092,N/A,N/A,N/A," $2,822.00 "," $1,834.30 "," $1,668.75 ", $264.05 , $153.67 ," $1,321.91 "," $1,334.27 "," $2,624.46 "," $2,539.80 "," $2,539.80 "," $2,257.60 "," $2,257.60 ", $153.67 ," $2,605.55 "," $2,680.90 "," $2,539.80 "," $2,539.80 "," $2,539.80 "," $2,624.46 "," $2,709.12 "," $1,548.06 "," $2,398.70 "," $1,445.09 "," $1,577.88 ", N/A ," $1,347.70 "," $1,347.70 "," $2,680.90 "," $1,584.02 ", $153.67 ," $2,709.12 "
 Fac Occupational Therapy Eval Mod Complex ,CPT® 97166,0434 - OCCUP THERP/EVAL,N/A,N/A, $366.00 , $237.90 , $307.44 , $100.30 , $63.91 , $295.73 , $329.40 , $309.86 , $329.40 , $329.40 , $329.40 , $311.10 , $62.66 , $337.93 , $347.70 , $311.10 , $340.38 , $340.38 , $347.70 , $351.36 , $299.46 , $329.40 , $311.10 , $289.14 , N/A , $296.20 , $296.20 , $347.70 , $314.06 , $62.66 , $351.36 
"Debridement, Skin, Sub-Q Tissue,Muscle,Bone,Each Add 20 Sq Cm",CPT® 11047,N/A,N/A,N/A, $693.00 , $450.45 , $302.33 , $89.66 , $47.16 , $268.63 , $258.80 , $644.49 , $623.70 , $623.70 , $554.40 , $554.40 , $47.16 , $639.85 , $658.35 , $623.70 , $623.70 , $623.70 , $644.49 , $665.28 , $333.45 , $589.05 , $520.95 , $341.04 , N/A , $273.87 , $273.87 , $658.35 , $317.58 , $47.16 , $665.28 
Alkaloids Not Otherwise Specified,CPT® 80323,N/A,N/A,N/A, $180.00 , $117.00 , N/A , N/A , N/A , N/A , N/A , $167.40 , $162.00 , $162.00 , $144.00 , $144.00 , N/A , $166.19 , $171.00 , $162.00 , $162.00 , $162.00 , $167.40 , $172.80 , N/A , $153.00 , $114.69 , $67.79 , N/A , $90.04 , $90.04 , $171.00 , $98.20 , $67.79 , $172.80 
Esophagoscopy Flex Transoral Lesion Ablation,CPT® 43229,N/A,N/A,N/A," $1,313.00 ", $853.45 ," $1,204.32 ", $186.05 , $156.39 , $990.75 ," $1,027.50 "," $1,221.09 "," $1,181.70 "," $1,181.70 "," $1,050.40 "," $1,050.40 ", $156.39 ," $1,212.29 "," $1,247.35 "," $1,181.70 "," $1,181.70 "," $1,181.70 "," $1,221.09 "," $1,260.48 ", $866.13 ," $1,116.05 "," $1,025.30 "," $1,148.50 ", N/A ," $1,010.08 "," $1,010.08 "," $1,247.35 "," $1,056.44 ", $156.39 ," $1,260.48 "
 HYDROCORTISONE 20 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00115-1700-01,1 tablet, $5.59 , $3.63 , $4.70 , N/A , N/A , $4.52 , $5.03 , $4.73 , $5.03 , $5.03 , $5.03 , $4.75 , N/A , $5.16 , $5.31 , $4.75 , $5.20 , $5.20 , $5.31 , $5.37 , $4.57 , $5.03 , $4.75 , $4.42 , N/A , $4.52 , $4.52 , $5.31 , $4.80 , $4.42 , $5.37 
 ULIPRISTAL ACETATE 30 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,73302-0456-01,1 tablet, $238.87 , $155.27 , $200.65 , N/A , N/A , $193.01 , $214.98 , $202.23 , $214.98 , $214.98 , $214.98 , $203.04 , N/A , $220.55 , $226.93 , $203.04 , $222.15 , $222.15 , $226.93 , $229.32 , $195.44 , $214.98 , $203.04 , $188.71 , N/A , $193.32 , $193.32 , $226.93 , $204.97 , $188.71 , $229.32 
 CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN ,HCPCS RXC637,0250 - PHARMACY,00904-7035-87,15 mL, $10.64 , $6.92 , $8.94 , N/A , N/A , $8.60 , $9.58 , $9.01 , $9.58 , $9.58 , $9.58 , $9.04 , N/A , $9.82 , $10.11 , $9.04 , $9.90 , $9.90 , $10.11 , $10.21 , $8.71 , $9.58 , $9.04 , $8.41 , N/A , $8.61 , $8.61 , $10.11 , $9.13 , $8.41 , $10.21 
Repair Nonunion Radius or Ulnaw/Graft,25405,N/A,N/A,N/A," $7,185.00 "," $4,670.25 "," $6,304.35 ", $985.61 , $998.92 ," $4,987.85 "," $4,950.73 "," $6,682.05 "," $6,466.50 "," $6,466.50 "," $5,748.00 "," $5,748.00 ", $998.92 ," $6,633.91 "," $6,825.75 "," $6,466.50 "," $6,466.50 "," $6,466.50 "," $6,682.05 "," $6,897.60 "," $5,866.43 "," $6,107.25 "," $5,459.24 "," $5,902.65 ", N/A ," $5,085.17 "," $5,085.17 "," $6,825.75 "," $5,976.89 ", $985.61 ," $6,897.60 "
Diagnostic Lumbar Spinal Puncture W/Fluor or CT,CPT® 62328,N/A,N/A,N/A," $1,159.00 ", $753.35 , $428.12 , $82.55 , $204.50 , $488.43 , N/A ," $1,077.87 "," $1,043.10 "," $1,043.10 ", $927.20 , $927.20 , $204.50 ," $1,070.10 "," $1,101.05 "," $1,043.10 "," $1,043.10 "," $1,043.10 "," $1,077.87 "," $1,112.64 ", $465.26 , $985.15 , $453.12 , $533.88 , N/A , $497.95 , $497.95 ," $1,101.05 ", $534.18 , $82.55 ," $1,112.64 "
Home/Res Visit Est Patient Sf Mdm 20 Minutes,99347,N/A,N/A,N/A, $146.00 , $94.90 , $110.04 , $44.02 , $40.81 , $95.28 , $96.34 , $135.78 , $131.40 , $131.40 , $116.80 , $116.80 , $40.81 , $134.80 , $138.70 , $131.40 , $131.40 , $131.40 , $135.78 , $140.16 , $99.81 , $124.10 , $120.02 , $120.72 , $58.00 , $97.14 , $97.14 , $138.70 , $112.03 , $40.81 , $140.16 
"Open Bladder,Remv Calculus",CPT® 51050,N/A,N/A,N/A," $3,295.00 "," $2,141.75 "," $2,560.36 ", $451.29 , $768.38 ," $2,308.74 "," $2,158.59 "," $3,064.35 "," $2,965.50 "," $2,965.50 "," $2,636.00 "," $2,636.00 ", $768.38 ," $3,042.27 "," $3,130.25 "," $2,965.50 "," $2,965.50 "," $2,965.50 "," $3,064.35 "," $3,163.20 "," $2,570.56 "," $2,800.75 "," $2,442.38 "," $2,909.83 ", N/A ," $2,353.78 "," $2,353.78 "," $3,130.25 "," $2,766.56 ", $451.29 ," $3,163.20 "
 Fac Compre Electrophysiologic Arrhythmia Induction ,CPT® 93620,0480 - CARDIOLOGY,N/A,N/A," $8,590.00 "," $5,583.50 "," $7,215.60 ", $921.07 , N/A ," $6,940.72 "," $7,731.00 "," $7,272.29 "," $7,731.00 "," $7,731.00 "," $7,731.00 "," $7,301.50 ", N/A ," $7,931.15 "," $8,160.50 "," $7,301.50 "," $7,988.70 "," $7,988.70 "," $8,160.50 "," $8,246.40 "," $7,028.34 "," $7,731.00 "," $7,301.50 "," $6,786.10 ", N/A ," $6,951.89 "," $6,951.89 "," $8,160.50 "," $7,371.08 ", $921.07 ," $8,246.40 "
 Reconstruct Vena Cava; Any Method ,CPT® 34502,0360 - OR SERVICES,N/A,N/A," $14,530.00 "," $9,444.50 "," $12,205.20 "," $1,391.40 "," $2,378.00 "," $11,740.24 "," $13,077.00 "," $12,301.10 "," $13,077.00 "," $13,077.00 "," $13,077.00 "," $12,350.50 "," $2,331.37 "," $13,415.55 "," $13,803.50 "," $12,350.50 "," $13,512.90 "," $13,512.90 "," $13,803.50 "," $13,948.80 "," $11,888.45 "," $13,077.00 "," $12,350.50 "," $11,478.70 ", N/A ," $11,759.13 "," $11,759.13 "," $13,803.50 "," $12,468.19 "," $1,391.40 "," $13,948.80 "
" Fac Fats/Lipids, Feces, Quant ",CPT® 82710,0301 - LAB/CHEMISTRY,N/A,N/A, $186.00 , $120.90 , $156.24 , $17.14 , $17.14 , $150.29 , $167.40 , $157.47 , $167.40 , $167.40 , $167.40 , $158.10 , $16.80 , $171.73 , $176.70 , $158.10 , $172.98 , $172.98 , $176.70 , $178.56 , $152.19 , $167.40 , $158.10 , $146.94 , N/A , $150.53 , $150.53 , $176.70 , $159.61 , $16.80 , $178.56 
Massage Therapy,CPT® 97124,N/A,N/A,N/A, $79.00 , $51.35 , $70.01 , $29.94 , $25.07 , $60.03 , $53.09 , $73.47 , $71.10 , $71.10 , $63.20 , $63.20 , $25.07 , $72.94 , $75.05 , $71.10 , $71.10 , $71.10 , $73.47 , $75.84 , $73.44 , $67.15 , $78.06 , $69.48 , N/A , $61.19 , $61.19 , $75.05 , $68.07 , $25.07 , $78.06 
 MICROFIBRILLAR COLL HEMOSTAT EX POWD ,HCPCS RXA250,0250 - PHARMACY,53276-1010-02,1 gram," $1,489.70 ", $968.31 ," $1,251.35 ", N/A , N/A ," $1,203.68 "," $1,340.73 "," $1,261.18 "," $1,340.73 "," $1,340.73 "," $1,340.73 "," $1,266.25 ", N/A ," $1,375.44 "," $1,415.22 "," $1,266.25 "," $1,385.42 "," $1,385.42 "," $1,415.22 "," $1,430.11 "," $1,218.87 "," $1,340.73 "," $1,266.25 "," $1,176.86 ", N/A ," $1,205.61 "," $1,205.61 "," $1,415.22 "," $1,278.31 "," $1,176.86 "," $1,430.11 "
 Fac Njx Px Hip Arthg Anes ,CPT® 27095,0360 - OR SERVICES,N/A,N/A, $947.00 , $615.55 , $795.48 , $77.55 , $127.02 , $765.18 , $852.30 , $801.73 , $852.30 , $852.30 , $852.30 , $804.95 , $124.53 , $874.37 , $899.65 , $804.95 , $880.71 , $880.71 , $899.65 , $909.12 , $774.84 , $852.30 , $804.95 , $748.13 , N/A , $766.41 , $766.41 , $899.65 , $812.62 , $77.55 , $909.12 
Cont Gluc Mntr Physician/Qhp Provided Equiptment,95250,N/A,N/A,N/A, $926.00 , $601.90 , $340.54 , $141.63 , $50.79 , $346.25 , $372.69 , $861.18 , $833.40 , $833.40 , $740.80 , $740.80 , $50.79 , $854.98 , $879.70 , $833.40 , $833.40 , $833.40 , $861.18 , $888.96 , $465.73 , $787.10 , $495.71 , $576.31 , N/A , $353.01 , $353.01 , $879.70 , $411.55 , $50.79 , $888.96 
"Percut Biopsy, Abdominal Mass",CPT® 49180,N/A,N/A,N/A," $1,092.00 ", $709.80 , $512.92 , $79.48 , $155.61 , $420.10 , $414.52 ," $1,015.56 ", $982.80 , $982.80 , $873.60 , $873.60 , $155.61 ," $1,008.24 "," $1,037.40 ", $982.80 , $982.80 , $982.80 ," $1,015.56 "," $1,048.32 ", $371.94 , $928.20 , $446.02 , $498.38 , N/A , $428.29 , $428.29 ," $1,037.40 ", $447.93 , $79.48 ," $1,048.32 "
Apply Long Leg Splint,29505,N/A,N/A,N/A, $570.00 , $370.50 , $310.83 , $49.45 , $46.08 , $241.34 , $244.33 , $530.10 , $513.00 , $513.00 , $456.00 , $456.00 , $46.08 , $526.28 , $541.50 , $513.00 , $513.00 , $513.00 , $530.10 , $547.20 , $289.85 , $484.50 , $267.61 , $292.25 , N/A , $246.04 , $246.04 , $541.50 , $289.17 , $46.08 , $547.20 
"Semen Analysis,Presence or Motil",CPT® 89300,N/A,N/A,N/A, $65.00 , $42.25 , N/A , $10.04 , $10.04 , $49.95 , $60.36 , $60.45 , $58.50 , $58.50 , $52.00 , $52.00 , $10.04 , $60.01 , $61.75 , $58.50 , $58.50 , $58.50 , $60.45 , $62.40 , $57.50 , $55.25 , $58.39 , $32.33 , N/A , $46.62 , $46.62 , $61.75 , $51.23 , $10.04 , $62.40 
Fo Pip/Dip W/O Joint/Spring,HCPCS L3927,N/A,N/A,N/A, $62.00 , $40.30 , N/A , $37.26 , $30.35 , N/A , N/A , $57.66 , $55.80 , $55.80 , $49.60 , $49.60 , $30.35 , $57.24 , $58.90 , $55.80 , $55.80 , $55.80 , $57.66 , $59.52 , N/A , $52.70 , $30.49 , $31.36 , N/A , N/A , N/A , $58.90 , N/A , $30.35 , $59.52 
" Pro Preventive Visit, Est, Age 18-39 ",CPT® 99395,0982 - PRO FEE/OUTPT,N/A,N/A, $356.00 , $231.40 , N/A , $113.89 , $62.20 , $190.81 , $192.22 , $331.08 , $320.40 , $320.40 , $284.80 , $284.80 , $62.20 , $328.69 , $338.20 , $320.40 , $320.40 , $320.40 , $331.08 , $341.76 , $236.26 , $302.60 , $192.03 , $190.54 , N/A , $194.54 , $194.54 , $338.20 , $233.67 , $62.20 , $341.76 
"Closed Rx Post Hip Fix Disloc,Anesth",27266,N/A,N/A,N/A," $2,568.00 "," $1,669.20 "," $3,570.13 ", $559.59 , $549.47 ," $2,800.32 "," $2,792.35 "," $2,388.24 "," $2,311.20 "," $2,311.20 "," $2,054.40 "," $2,054.40 ", $549.47 ," $2,371.03 "," $2,439.60 "," $2,311.20 "," $2,311.20 "," $2,311.20 "," $2,388.24 "," $2,465.28 "," $3,311.68 "," $2,182.80 "," $3,082.86 "," $3,299.05 ", N/A ," $2,854.97 "," $2,854.97 "," $2,439.60 "," $3,355.60 ", $549.47 ," $3,570.13 "
Nasal/Sinus Ndsc Surg W/Dilation Sphenoid Sinus,CPT® 31297,N/A,N/A,N/A," $11,696.00 "," $7,602.40 ", $773.61 , $137.07 , $124.42 , $626.73 , $620.42 ," $10,877.28 "," $10,526.40 "," $10,526.40 "," $9,356.80 "," $9,356.80 ", $124.42 ," $10,798.92 "," $11,111.20 "," $10,526.40 "," $10,526.40 "," $10,526.40 "," $10,877.28 "," $11,228.16 ", $741.53 ," $9,941.60 ", $874.19 , $731.85 , N/A , $638.96 , $638.96 ," $11,111.20 ", $752.48 , $124.42 ," $11,228.16 "
"Enterostomy/Cecostomy,Tube",CPT® 44300,N/A,N/A,N/A," $5,485.00 "," $3,565.25 "," $5,013.26 ", $776.52 , $820.82 ," $3,951.24 "," $4,006.38 "," $5,101.05 "," $4,936.50 "," $4,936.50 "," $4,388.00 "," $4,388.00 ", $820.82 ," $5,064.30 "," $5,210.75 "," $4,936.50 "," $4,936.50 "," $4,936.50 "," $5,101.05 "," $5,265.60 "," $3,592.39 "," $4,662.25 "," $4,458.38 "," $4,668.84 ", N/A ," $4,028.34 "," $4,028.34 "," $5,210.75 "," $4,213.21 ", $776.52 ," $5,265.60 "
"Amputate Thigh,Open Circular",CPT® 27592,N/A,N/A,N/A," $4,963.00 "," $3,225.95 "," $3,981.32 ", $618.45 ," $1,010.33 "," $3,302.59 "," $3,333.43 "," $4,615.59 "," $4,466.70 "," $4,466.70 "," $3,970.40 "," $3,970.40 "," $1,010.33 "," $4,582.34 "," $4,714.85 "," $4,466.70 "," $4,466.70 "," $4,466.70 "," $4,615.59 "," $4,764.48 "," $3,700.11 "," $4,218.55 "," $3,707.29 "," $3,818.26 ", N/A ," $3,367.03 "," $3,367.03 "," $4,714.85 "," $3,957.47 ", $618.45 ," $4,764.48 "
Other Source Albumin Quantitative Each Specimen,CPT® 82042,N/A,N/A,N/A, $81.00 , $52.65 , N/A , $7.94 , $7.18 , $29.27 , $35.00 , $75.33 , $72.90 , $72.90 , $64.80 , $64.80 , $7.18 , $74.79 , $76.95 , $72.90 , $72.90 , $72.90 , $75.33 , $77.76 , $51.95 , $68.85 , $34.06 , $22.85 , N/A , $27.32 , $27.32 , $76.95 , $29.85 , $7.18 , $77.76 
" Pro Echo Heart Xthoracic,Complete W Doppler ",CPT® 93306,0982 - PRO FEE/OUTPT,N/A,N/A," $1,205.00 ", $783.25 ," $1,263.28 ", $193.19 , $335.09 ," $1,223.05 "," $1,062.67 "," $1,120.65 "," $1,084.50 "," $1,084.50 ", $964.00 , $964.00 , $335.09 ," $1,112.58 "," $1,144.75 "," $1,084.50 "," $1,084.50 "," $1,084.50 "," $1,120.65 "," $1,156.80 "," $1,257.77 "," $1,024.25 ", $993.72 ," $1,255.10 ", N/A ," $1,246.92 "," $1,246.92 "," $1,144.75 "," $1,382.22 ", $193.19 ," $1,382.22 "
 METHYLERGONOVINE MALEATE 0.2 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60687-0410-94,1 tablet, $339.04 , $220.38 , $284.79 , N/A , N/A , $273.94 , $305.14 , $287.03 , $305.14 , $305.14 , $305.14 , $288.18 , N/A , $313.04 , $322.09 , $288.18 , $315.31 , $315.31 , $322.09 , $325.48 , $277.40 , $305.14 , $288.18 , $267.84 , N/A , $274.39 , $274.39 , $322.09 , $290.93 , $267.84 , $325.48 
"Sequestrectomy, Clavicle",CPT® 23170,N/A,N/A,N/A," $3,523.00 "," $2,289.95 "," $3,449.42 ", $541.76 , $334.72 ," $2,698.02 "," $2,693.27 "," $3,276.39 "," $3,170.70 "," $3,170.70 "," $2,818.40 "," $2,818.40 ", $334.72 ," $3,252.79 "," $3,346.85 "," $3,170.70 "," $3,170.70 "," $3,170.70 "," $3,276.39 "," $3,382.08 "," $3,200.68 "," $2,994.55 "," $2,972.25 "," $3,185.96 ", N/A ," $2,750.66 "," $2,750.66 "," $3,346.85 "," $3,233.02 ", $334.72 ," $3,449.42 "
 Fac Methylprednisolone 80 Mg Inj ,HCPCS J1040,0250 - PHARMACY,N/A,N/A, $32.00 , $20.80 , $26.88 , $12.15 , $13.01 , $25.86 , $28.80 , $27.09 , $28.80 , $28.80 , $28.80 , $27.20 , $12.75 , $29.55 , $30.40 , $27.20 , $29.76 , $29.76 , $30.40 , $30.72 , $26.18 , $28.80 , $27.20 , $25.28 , N/A , $25.90 , $25.90 , $30.40 , $27.46 , $12.15 , $30.72 
"Lap,Appendectomy",44970,N/A,N/A,N/A," $5,469.00 "," $3,554.85 "," $3,603.80 ", $559.02 , $505.80 ," $2,823.58 "," $2,862.61 "," $5,086.17 "," $4,922.10 "," $4,922.10 "," $4,375.20 "," $4,375.20 ", $505.80 ," $5,049.53 "," $5,195.55 "," $4,922.10 "," $4,922.10 "," $4,922.10 "," $5,086.17 "," $5,250.24 "," $2,577.70 "," $4,648.65 "," $3,179.20 "," $3,336.46 ", N/A ," $2,878.67 "," $2,878.67 "," $5,195.55 "," $3,010.78 ", $505.80 ," $5,250.24 "
Drug Screen Quantitative Levetiracetam,CPT® 80177,N/A,N/A,N/A, $181.00 , $117.65 , N/A , $13.52 , $13.52 , $75.01 , $89.06 , $168.33 , $162.90 , $162.90 , $144.80 , $144.80 , $13.52 , $167.12 , $171.95 , $162.90 , $162.90 , $162.90 , $168.33 , $173.76 , $88.47 , $153.85 , $63.00 , $48.05 , N/A , $70.00 , $70.00 , $171.95 , $76.49 , $13.52 , $173.76 
Non-Pneum Walk Boot Pre Ots,HCPCS L4387,N/A,N/A,N/A, $216.00 , $140.40 , N/A , $185.47 , $95.04 , N/A , N/A , $200.88 , $194.40 , $194.40 , $172.80 , $172.80 , $95.04 , $199.43 , $205.20 , $194.40 , $194.40 , $194.40 , $200.88 , $207.36 , N/A , $183.60 , $309.51 , $156.03 , N/A , N/A , N/A , $205.20 , N/A , $95.04 , $309.51 
"Closed Rx Mt-Phal Toe Disloc,Anesth",CPT® 28635,N/A,N/A,N/A," $1,208.00 ", $785.20 , $820.63 , $130.34 , $107.56 , $634.91 , $639.44 ," $1,123.44 "," $1,087.20 "," $1,087.20 ", $966.40 , $966.40 , $107.56 ," $1,115.35 "," $1,147.60 "," $1,087.20 "," $1,087.20 "," $1,087.20 "," $1,123.44 "," $1,159.68 ", $773.07 ," $1,026.80 ", $694.00 , $773.45 , N/A , $647.30 , $647.30 ," $1,147.60 ", $760.79 , $107.56 ," $1,159.68 "
 ESTROGENS CONJUGATED 0.3 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00046-1100-81,1 tablet, $41.33 , $26.86 , $34.72 , N/A , N/A , $33.39 , $37.20 , $34.99 , $37.20 , $37.20 , $37.20 , $35.13 , N/A , $38.16 , $39.26 , $35.13 , $38.44 , $38.44 , $39.26 , $39.68 , $33.82 , $37.20 , $35.13 , $32.65 , N/A , $33.45 , $33.45 , $39.26 , $35.47 , $32.65 , $39.68 
Drain Rectal Abscess,CPT® 46040,N/A,N/A,N/A," $3,478.00 "," $2,260.70 "," $2,598.90 ", $404.09 , $192.43 ," $1,960.97 "," $2,012.51 "," $3,234.54 "," $3,130.20 "," $3,130.20 "," $2,782.40 "," $2,782.40 ", $192.43 ," $3,211.24 "," $3,304.10 "," $3,130.20 "," $3,130.20 "," $3,130.20 "," $3,234.54 "," $3,338.88 "," $1,851.25 "," $2,956.30 "," $2,217.59 "," $2,340.82 ", N/A ," $1,999.23 "," $1,999.23 "," $3,304.10 "," $2,090.98 ", $192.43 ," $3,338.88 "
 Fac Cltx Acromclav Dislc W/O Mnpj ,CPT® 23540,0361 - OR/MINOR,N/A,N/A," $2,456.00 "," $1,596.40 "," $2,063.04 ", $233.67 , $133.38 ," $1,984.45 "," $2,210.40 "," $2,079.25 "," $2,210.40 "," $2,210.40 "," $2,210.40 "," $2,087.60 ", $130.76 ," $2,267.62 "," $2,333.20 "," $2,087.60 "," $2,284.08 "," $2,284.08 "," $2,333.20 "," $2,357.76 "," $2,009.50 "," $2,210.40 "," $2,087.60 "," $1,940.24 ", N/A ," $1,987.64 "," $1,987.64 "," $2,333.20 "," $2,107.49 ", $130.76 ," $2,357.76 "
Rsv Monoclonal Antb Seasonal Dose 0.5ml Im Use,CPT® 90380,N/A,N/A,N/A," $1,575.00 "," $1,023.75 ", N/A , N/A , N/A , N/A , N/A ," $1,464.75 "," $1,417.50 "," $1,417.50 "," $1,260.00 "," $1,260.00 ", N/A ," $1,454.20 "," $1,496.25 "," $1,417.50 "," $1,417.50 "," $1,417.50 "," $1,464.75 "," $1,512.00 ", N/A ," $1,338.75 ", N/A , N/A , N/A , N/A , N/A ," $1,496.25 ", N/A ," $1,260.00 "," $1,512.00 "
Hfe Hemochromatosis Gene Anal Common Variants,CPT® 81256,N/A,N/A,N/A, $463.00 , $300.95 , N/A , $66.67 , $66.67 , $369.81 , $437.93 , $430.59 , $416.70 , $416.70 , $370.40 , $370.40 , $66.67 , $427.49 , $439.85 , $416.70 , $416.70 , $416.70 , $430.59 , $444.48 , $436.42 , $393.55 , $311.77 , $236.99 , N/A , $345.13 , $345.13 , $439.85 , $377.15 , $66.67 , $444.48 
 ZINC OXIDE 40 % EX PSTE ,HCPCS RXC637,0250 - PHARMACY,74300-0000-71,113 gram, $35.99 , $23.39 , $30.23 , N/A , N/A , $29.08 , $32.39 , $30.47 , $32.39 , $32.39 , $32.39 , $30.59 , N/A , $33.23 , $34.19 , $30.59 , $33.47 , $33.47 , $34.19 , $34.55 , $29.45 , $32.39 , $30.59 , $28.43 , N/A , $29.13 , $29.13 , $34.19 , $30.88 , $28.43 , $34.55 
 Fac Iaad Ia Not Otherwise Specified Each Organism ,CPT® 87449,0306 - LAB/BACT-MICRO,N/A,N/A, $169.00 , $109.85 , $141.96 , $12.22 , $12.22 , $136.55 , $152.10 , $143.08 , $152.10 , $152.10 , $152.10 , $143.65 , $11.98 , $156.04 , $160.55 , $143.65 , $157.17 , $157.17 , $160.55 , $162.24 , $138.28 , $152.10 , $143.65 , $133.51 , N/A , $136.77 , $136.77 , $160.55 , $145.02 , $11.98 , $162.24 
 Pro 1st Hospital IP/Obs Care Moderate Mdm 55 Minutes ,CPT® 99222,0987 - PRO FEE/HOS VIS,N/A,N/A, $441.00 , $286.65 , $268.34 , $126.08 , $90.83 , $236.74 , $237.02 , $410.13 , $396.90 , $396.90 , $352.80 , $352.80 , $90.83 , $407.18 , $418.95 , $396.90 , $396.90 , $396.90 , $410.13 , $423.36 , $341.36 , $374.85 , $297.04 , $298.13 , $126.75 , $241.36 , $241.36 , $418.95 , $278.36 , $90.83 , $423.36 
 CEFUROXIME AXETIL 250 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,68180-0302-20,1 tablet, $22.60 , $14.69 , $18.98 , N/A , N/A , $18.26 , $20.34 , $19.13 , $20.34 , $20.34 , $20.34 , $19.21 , N/A , $20.87 , $21.47 , $19.21 , $21.02 , $21.02 , $21.47 , $21.70 , $18.49 , $20.34 , $19.21 , $17.85 , N/A , $18.29 , $18.29 , $21.47 , $19.39 , $17.85 , $21.70 
 Incision & Drainage Perianal Abscess Superficial - Mh ,CPT® 46050,0361 - OR/MINOR,N/A,N/A, $906.00 , $588.90 , $761.04 , $96.47 , $68.62 , $732.05 , $815.40 , $767.02 , $815.40 , $815.40 , $815.40 , $770.10 , $67.27 , $836.51 , $860.70 , $770.10 , $842.58 , $842.58 , $860.70 , $869.76 , $741.29 , $815.40 , $770.10 , $715.74 , N/A , $733.23 , $733.23 , $860.70 , $777.44 , $67.27 , $869.76 
"Closed Rx Metacarpal Fx,Open",26615,N/A,N/A,N/A," $2,386.00 "," $1,550.90 "," $3,532.95 ", $555.54 , $461.04 ," $2,775.50 "," $2,780.71 "," $2,218.98 "," $2,147.40 "," $2,147.40 "," $1,908.80 "," $1,908.80 ", $461.04 ," $2,202.99 "," $2,266.70 "," $2,147.40 "," $2,147.40 "," $2,147.40 "," $2,218.98 "," $2,290.56 "," $3,283.35 "," $2,028.10 "," $3,056.10 "," $3,289.76 ", N/A ," $2,829.65 "," $2,829.65 "," $2,266.70 "," $3,325.85 ", $461.04 ," $3,532.95 "
 Pro Tot Thyr Lobec Uni +-Isthmusectomy ,CPT® 60220,0975 - PRO FEE/OR,N/A,N/A," $5,736.00 "," $3,728.40 "," $4,289.16 ", $669.53 , $674.26 ," $3,649.89 "," $3,798.50 "," $5,334.48 "," $5,162.40 "," $5,162.40 "," $4,588.80 "," $4,588.80 ", $674.26 ," $5,296.05 "," $5,449.20 "," $5,162.40 "," $5,162.40 "," $5,162.40 "," $5,334.48 "," $5,506.56 "," $4,138.84 "," $4,875.60 "," $3,764.38 "," $3,510.37 ", N/A ," $3,721.11 "," $3,721.11 "," $5,449.20 "," $4,150.13 ", $669.53 ," $5,506.56 "
Foam Drg <=16 Sq in W/Border,HCPCS A6212,N/A,N/A,N/A, $17.00 , $11.05 , N/A , $13.17 , $6.81 , N/A , N/A , $15.81 , $15.30 , $15.30 , $13.60 , $13.60 , $6.81 , $15.70 , $16.15 , $15.30 , $15.30 , $15.30 , $15.81 , $16.32 , N/A , $14.45 , $11.68 , $11.97 , N/A , N/A , N/A , $16.15 , N/A , $6.81 , $16.32 
 MANNITOL 25 % IV SOLN ,HCPCS J2150,0636 - DRUGS REQUIRING DETAILED CODIN,00409-4031-01,50 mL, $17.21 , $11.19 , $14.46 , $5.03 , $5.08 , $13.91 , $15.49 , $14.57 , $15.49 , $15.49 , $15.49 , $14.63 , $4.98 , $15.89 , $16.35 , $14.63 , $16.01 , $16.01 , $16.35 , $16.52 , $14.08 , $15.49 , $14.63 , $13.60 , N/A , $13.93 , $13.93 , $16.35 , $14.77 , $4.98 , $16.52 
"Bx/Excis Spin Tum,Indur,Xmed,Lumb",CPT® 63282,N/A,N/A,N/A," $12,723.00 "," $8,269.95 "," $9,041.55 "," $1,768.37 "," $2,378.00 "," $10,635.71 "," $10,176.66 "," $11,832.39 "," $11,450.70 "," $11,450.70 "," $10,178.40 "," $10,178.40 "," $2,378.00 "," $11,747.15 "," $12,086.85 "," $11,450.70 "," $11,450.70 "," $11,450.70 "," $11,832.39 "," $12,214.08 "," $9,770.94 "," $10,814.55 "," $10,456.40 "," $11,013.27 ", N/A ," $10,843.24 "," $10,843.24 "," $12,086.85 "," $11,632.25 "," $1,768.37 "," $12,214.08 "
 Fac Iaad Ia Cryptococcus Neoformans ,CPT® 87327,0306 - LAB/BACT-MICRO,N/A,N/A, $103.00 , $66.95 , $86.52 , $13.69 , $13.69 , $83.22 , $92.70 , $87.20 , $92.70 , $92.70 , $92.70 , $87.55 , $13.42 , $95.10 , $97.85 , $87.55 , $95.79 , $95.79 , $97.85 , $98.88 , $84.27 , $92.70 , $87.55 , $81.37 , N/A , $83.36 , $83.36 , $97.85 , $88.38 , $13.42 , $98.88 
 Pelvis 1 or 2 Views- Mh ,CPT® 72170,0972 - PRO FEE/RAD/DX,N/A,N/A, $100.00 , $65.00 , $156.31 , $27.44 , $25.29 , $129.60 , $152.44 , $93.00 , $90.00 , $90.00 , $80.00 , $80.00 , $25.29 , $92.33 , $95.00 , $90.00 , $90.00 , $90.00 , $93.00 , $96.00 , $151.97 , $85.00 , $169.49 , $160.24 , N/A , $132.13 , $132.13 , $95.00 , $152.94 , $25.29 , $169.49 
Iadna Gardnerella Vagis Quan,CPT® 87512,N/A,N/A,N/A, $312.00 , $202.80 , N/A , $42.60 , $42.60 , $236.22 , $282.56 , $290.16 , $280.80 , $280.80 , $249.60 , $249.60 , $42.60 , $288.07 , $296.40 , $280.80 , $280.80 , $280.80 , $290.16 , $299.52 , $278.84 , $265.20 , $274.09 , $151.40 , N/A , $220.46 , $220.46 , $296.40 , $240.92 , $42.60 , $299.52 
"Metabolic Panel,Comprehensive",CPT® 80053,N/A,N/A,N/A, $170.00 , $110.50 , N/A , $10.77 , $10.77 , $59.75 , $71.54 , $158.10 , $153.00 , $153.00 , $136.00 , $136.00 , $10.77 , $156.96 , $161.50 , $153.00 , $153.00 , $153.00 , $158.10 , $163.20 , $70.51 , $144.50 , $69.74 , $38.30 , N/A , $55.76 , $55.76 , $161.50 , $60.93 , $10.77 , $163.20 
 DICYCLOMINE HCL 20 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6988-61,1 tablet, $3.44 , $2.24 , $2.89 , N/A , N/A , $2.78 , $3.10 , $2.91 , $3.10 , $3.10 , $3.10 , $2.92 , N/A , $3.18 , $3.27 , $2.92 , $3.20 , $3.20 , $3.27 , $3.30 , $2.81 , $3.10 , $2.92 , $2.72 , N/A , $2.78 , $2.78 , $3.27 , $2.95 , $2.72 , $3.30 
Upper Ext Fx Orthosis Rad/Ul,HCPCS L3982,N/A,N/A,N/A," $1,359.00 ", $883.35 , N/A , $418.18 , $145.21 , N/A , N/A ," $1,263.87 "," $1,223.10 "," $1,223.10 "," $1,087.20 "," $1,087.20 ", $145.21 ," $1,254.76 "," $1,291.05 "," $1,223.10 "," $1,223.10 "," $1,223.10 "," $1,263.87 "," $1,304.64 ", N/A ," $1,155.15 ", $369.14 , $351.84 , N/A , N/A , N/A ," $1,291.05 ", N/A , $145.21 ," $1,304.64 "
 Fac Rm Chg Nicu Level 4 ,Custom 1740000002,0174 - NURSERY LEVEL IV,N/A,N/A," $7,098.00 "," $4,613.70 "," $5,962.32 ", N/A , N/A ," $5,735.18 "," $6,388.20 "," $6,009.17 "," $6,388.20 "," $6,388.20 "," $6,388.20 "," $6,033.30 ", N/A ," $6,553.58 "," $6,743.10 "," $6,033.30 "," $6,601.14 "," $6,601.14 "," $6,743.10 "," $6,814.08 "," $5,807.58 "," $6,388.20 "," $6,033.30 "," $5,607.42 ", N/A ," $5,744.41 "," $5,744.41 "," $6,743.10 "," $6,090.79 "," $5,607.42 "," $6,814.08 "
Afo Plastic,HCPCS L1930,N/A,N/A,N/A, $318.00 , $206.70 , N/A , $294.69 , $172.96 , N/A , N/A , $295.74 , $286.20 , $286.20 , $254.40 , $254.40 , $172.96 , $293.61 , $302.10 , $286.20 , $286.20 , $286.20 , $295.74 , $305.28 , N/A , $270.30 , $239.39 , $247.94 , N/A , N/A , N/A , $302.10 , N/A , $172.96 , $305.28 
"Preventive Visit,Est,65 & Over",99397,N/A,N/A,N/A, $405.00 , $263.25 , N/A , $130.52 , $37.32 , $217.41 , $220.24 , $376.65 , $364.50 , $364.50 , $324.00 , $324.00 , $37.32 , $373.94 , $384.75 , $364.50 , $364.50 , $364.50 , $376.65 , $388.80 , $269.36 , $344.25 , $220.53 , $217.38 , N/A , $221.66 , $221.66 , $384.75 , $266.22 , $37.32 , $388.80 
 Pro US Venous Duplex Upp/Low Ext Complete Bilateral Study ,CPT® 93970,0972 - PRO FEE/RAD/DX,N/A,N/A, $367.00 , $238.55 ," $1,195.35 ", $184.54 , $172.43 ," $1,061.24 "," $1,070.66 ", $341.31 , $330.30 , $330.30 , $293.60 , $293.60 , $172.43 , $338.85 , $348.65 , $330.30 , $330.30 , $330.30 , $341.31 , $352.32 , $842.19 , $311.95 , $576.80 , $745.00 , N/A ," $1,081.95 "," $1,081.95 ", $348.65 ," $1,199.37 ", $172.43 ," $1,199.37 "
Thoracoscopy W/Thera Wedge Resexn Addl Ipsilatrl,CPT® 32667,N/A,N/A,N/A," $1,026.00 ", $666.90 , $804.31 , $139.75 , $119.74 , $594.63 , $605.83 , $954.18 , $923.40 , $923.40 , $820.80 , $820.80 , $119.74 , $947.31 , $974.70 , $923.40 , $923.40 , $923.40 , $954.18 , $984.96 , $778.71 , $872.10 , $879.54 , $774.25 , N/A , $606.24 , $606.24 , $974.70 , $713.97 , $119.74 , $984.96 
 Anes Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/O Img Gdn ,CPT® 62326,0960 - PRO FEE,N/A,N/A," $1,598.00 "," $1,038.70 ", $425.98 , $82.74 , $121.29 , $490.97 , $479.55 ," $1,486.14 "," $1,438.20 "," $1,438.20 "," $1,278.40 "," $1,278.40 ", $121.29 ," $1,475.43 "," $1,518.10 "," $1,438.20 "," $1,438.20 "," $1,438.20 "," $1,486.14 "," $1,534.08 ", $463.02 ," $1,358.30 ", $451.34 , $544.42 , N/A , $500.54 , $500.54 ," $1,518.10 ", $536.96 , $82.74 ," $1,534.08 "
 Fac Office/Outpatient Established Low Mdm 20-29 Min ,CPT® 99213,0510 - CLINIC,N/A,N/A, $248.00 , $161.20 , $208.32 , $64.08 , $41.21 , $200.38 , $223.20 , N/A , $223.20 , $223.20 , $223.20 , $210.80 , $40.40 , $228.98 , $235.60 , $210.80 , $230.64 , $230.64 , $235.60 , $238.08 , $202.91 , $223.20 , $210.80 , $195.92 , N/A , $200.71 , $200.71 , $235.60 , $212.81 , $40.40 , $238.08 
 Fac Drug Assay Amiodarone ,CPT® 80151,0301 - LAB/CHEMISTRY,N/A,N/A, $152.00 , $98.80 , $127.68 , $19.01 , $15.21 , $122.82 , $136.80 , $128.68 , $136.80 , $136.80 , $136.80 , $129.20 , $14.91 , $140.34 , $144.40 , $129.20 , $141.36 , $141.36 , $144.40 , $145.92 , $124.37 , $136.80 , $129.20 , $120.08 , N/A , $123.01 , $123.01 , $144.40 , $130.43 , $14.91 , $145.92 
 Fac Blood Clot Factor IX Test ,CPT® 85250,0305 - LAB/HEMATOLOGY,N/A,N/A, $325.00 , $211.25 , $273.00 , $19.42 , $19.42 , $262.60 , $292.50 , $275.15 , $292.50 , $292.50 , $292.50 , $276.25 , $19.04 , $300.07 , $308.75 , $276.25 , $302.25 , $302.25 , $308.75 , $312.00 , $265.92 , $292.50 , $276.25 , $256.75 , N/A , $263.02 , $263.02 , $308.75 , $278.88 , $19.04 , $312.00 
Hemorrhoidopexy by Stapling,CPT® 46947,N/A,N/A,N/A," $2,497.00 "," $1,623.05 "," $2,356.25 ", $366.67 , $291.53 ," $1,800.96 "," $1,849.41 "," $2,322.21 "," $2,247.30 "," $2,247.30 "," $1,997.60 "," $1,997.60 ", $291.53 ," $2,305.48 "," $2,372.15 "," $2,247.30 "," $2,247.30 "," $2,247.30 "," $2,322.21 "," $2,397.12 "," $1,676.23 "," $2,122.45 "," $2,042.75 "," $2,142.54 ", N/A ," $1,836.10 "," $1,836.10 "," $2,372.15 "," $1,920.37 ", $291.53 ," $2,397.12 "
Assay of Ascorbic Acid,CPT® 82180,N/A,N/A,N/A, $134.00 , $87.10 , N/A , $10.09 , $10.09 , $55.92 , $66.90 , $124.62 , $120.60 , $120.60 , $107.20 , $107.20 , $10.09 , $123.72 , $127.30 , $120.60 , $120.60 , $120.60 , $124.62 , $128.64 , $66.04 , $113.90 , $64.87 , $35.83 , N/A , $52.19 , $52.19 , $127.30 , $57.03 , $10.09 , $128.64 
" Incision/Drainage Abscess, Complicated ",CPT® 10061,0761 - TREATMENT ROOM,N/A,N/A," $1,523.00 ", $989.95 ," $1,279.32 ", $177.26 , $93.30 ," $1,230.58 "," $1,370.70 "," $1,289.37 "," $1,370.70 "," $1,370.70 "," $1,370.70 "," $1,294.55 ", $91.47 ," $1,406.19 "," $1,446.85 "," $1,294.55 "," $1,416.39 "," $1,416.39 "," $1,446.85 "," $1,462.08 "," $1,246.12 "," $1,370.70 "," $1,294.55 "," $1,203.17 ", N/A ," $1,232.56 "," $1,232.56 "," $1,446.85 "," $1,306.89 ", $91.47 ," $1,462.08 "
Office/Outpatient New Moderate Mdm 45-59 Minutes,CPT® 99204,N/A,N/A,N/A, $499.00 , $324.35 , $270.10 , $128.82 , $107.66 , $223.51 , $224.94 , $464.07 , $449.10 , $449.10 , $399.20 , $399.20 , $107.66 , $460.73 , $474.05 , $449.10 , $449.10 , $449.10 , $464.07 , $479.04 , $246.36 , $424.15 , $282.79 , $280.74 , $94.75 , $227.86 , $227.86 , $474.05 , $262.80 , $94.75 , $479.04 
 Fac X-Ray Stress View ,CPT® 77071,0320 - DX X-RAY,N/A,N/A, $201.00 , $130.65 , $168.84 , $53.02 , $24.76 , $162.41 , $180.90 , $170.17 , $180.90 , $180.90 , $180.90 , $170.85 , $24.27 , $185.58 , $190.95 , $170.85 , $186.93 , $186.93 , $190.95 , $192.96 , $164.46 , $180.90 , $170.85 , $158.79 , N/A , $162.67 , $162.67 , $190.95 , $172.48 , $24.27 , $192.96 
 CALCIUM CHLORIDE 10 % IV SOLN ,HCPCS RXA250,0250 - PHARMACY,76329-3304-01,10 mL, $64.73 , $42.07 , $54.37 , N/A , N/A , $52.30 , $58.26 , $54.80 , $58.26 , $58.26 , $58.26 , $55.02 , N/A , $59.77 , $61.49 , $55.02 , $60.20 , $60.20 , $61.49 , $62.14 , $52.96 , $58.26 , $55.02 , $51.14 , N/A , $52.39 , $52.39 , $61.49 , $55.54 , $51.14 , $62.14 
Mod Sedat Endo Service >5yrs,HCPCS G0500,N/A,N/A,N/A, $155.00 , $100.75 , $11.93 , $4.99 , N/A , $9.73 , N/A , $144.15 , $139.50 , $139.50 , $124.00 , $124.00 , N/A , $143.11 , $147.25 , $139.50 , $139.50 , $139.50 , $144.15 , $148.80 , $15.86 , $131.75 , $10.34 , $20.23 , N/A , $9.92 , $9.92 , $147.25 , $12.40 , $4.99 , $148.80 
" Pro Remove Spinal Neurostim Electrode Perc Array, Incl Fluoro ",CPT® 63661,0982 - PRO FEE/OUTPT,N/A,N/A," $2,715.00 "," $1,764.75 "," $1,585.17 ", $309.25 , $463.01 ," $1,789.69 "," $1,740.60 "," $2,524.95 "," $2,443.50 "," $2,443.50 "," $2,172.00 "," $2,172.00 ", $463.01 ," $2,506.76 "," $2,579.25 "," $2,443.50 "," $2,443.50 "," $2,443.50 "," $2,524.95 "," $2,606.40 "," $1,708.40 "," $2,307.75 "," $1,714.49 "," $1,919.56 ", N/A ," $1,824.61 "," $1,824.61 "," $2,579.25 "," $1,957.35 ", $309.25 ," $2,606.40 "
 PROTHROMBIN COMPLEX CONC HUMAN 500 UNITS IV KIT ,HCPCS J7168,0636 - DRUGS REQUIRING DETAILED CODIN,63833-0386-02,"1,500 unit"," $13,157.90 "," $8,552.64 "," $11,052.64 ", N/A , $0.01 ," $10,631.58 "," $11,842.11 "," $11,139.48 "," $11,842.11 "," $11,842.11 "," $11,842.11 "," $11,184.22 ", $0.01 ," $12,148.69 "," $12,500.01 "," $11,184.22 "," $12,236.85 "," $12,236.85 "," $12,500.01 "," $12,631.58 "," $10,765.79 "," $11,842.11 "," $11,184.22 "," $10,394.74 ", N/A ," $10,648.69 "," $10,648.69 "," $12,500.01 "," $11,290.79 ", $0.01 ," $12,631.58 "
Anal/Urinary Muscle Study,CPT® 51784,N/A,N/A,N/A," $1,383.00 ", $898.95 , $353.22 , $62.25 , $194.55 , $927.09 , $903.74 ," $1,286.19 "," $1,244.70 "," $1,244.70 "," $1,106.40 "," $1,106.40 ", $194.55 ," $1,276.92 "," $1,313.85 "," $1,244.70 "," $1,244.70 "," $1,244.70 "," $1,286.19 "," $1,327.68 ", $363.32 ," $1,175.55 "," $1,020.48 ", $424.52 , N/A , $945.18 , $945.18 ," $1,313.85 "," $1,110.92 ", $62.25 ," $1,327.68 "
 Myocardial Perf Spect Sgl ,CPT® 78451,0341 - NUC MED/DX PROCEDURES,N/A,N/A," $2,788.00 "," $1,812.20 "," $2,341.92 ", $310.94 , $190.06 ," $2,252.70 "," $2,509.20 "," $2,360.32 "," $2,509.20 "," $2,509.20 "," $2,509.20 "," $2,369.80 ", $186.33 ," $2,574.16 "," $2,648.60 "," $2,369.80 "," $2,592.84 "," $2,592.84 "," $2,648.60 "," $2,676.48 "," $2,281.14 "," $2,509.20 "," $2,369.80 "," $2,202.52 ", N/A ," $2,256.33 "," $2,256.33 "," $2,648.60 "," $2,392.38 ", $186.33 ," $2,676.48 "
Spherocylinder 4.25d/2.12-4d,HCPCS V2108,N/A,N/A,N/A, $55.00 , $35.75 , N/A , $55.30 , N/A , N/A , N/A , $51.15 , $49.50 , $49.50 , $44.00 , $44.00 , N/A , $50.78 , $52.25 , $49.50 , $49.50 , $49.50 , $51.15 , $52.80 , N/A , $46.75 , $55.00 , $50.25 , N/A , N/A , N/A , $52.25 , N/A , $44.00 , $55.30 
 Inj Procedure Wrist Arthro ,CPT® 25246,0361 - OR/MINOR,N/A,N/A, $482.00 , $313.30 , $404.88 , $70.02 , $61.84 , $389.46 , $433.80 , $408.06 , $433.80 , $433.80 , $433.80 , $409.70 , $60.63 , $445.03 , $457.90 , $409.70 , $448.26 , $448.26 , $457.90 , $462.72 , $394.37 , $433.80 , $409.70 , $380.78 , N/A , $390.08 , $390.08 , $457.90 , $413.60 , $60.63 , $462.72 
Repr Asd W Bypass,CPT® 33641,N/A,N/A,N/A," $13,974.00 "," $9,083.10 "," $9,549.48 "," $1,473.28 "," $2,378.00 "," $6,979.80 "," $6,941.14 "," $12,995.82 "," $12,576.60 "," $12,576.60 "," $11,179.20 "," $11,179.20 "," $2,378.00 "," $12,902.19 "," $13,275.30 "," $12,576.60 "," $12,576.60 "," $12,576.60 "," $12,995.82 "," $13,415.04 "," $8,856.34 "," $11,877.90 "," $8,790.08 "," $7,858.22 ", N/A ," $7,115.99 "," $7,115.99 "," $13,275.30 "," $8,083.78 "," $1,473.28 "," $13,415.04 "
"Remv Prostate,Retropub,Rad,Tot Nodes",CPT® 55845,N/A,N/A,N/A," $8,208.00 "," $5,335.20 "," $6,004.39 "," $1,290.60 "," $1,997.84 "," $4,383.13 "," $5,275.92 "," $7,633.44 "," $7,387.20 "," $7,387.20 "," $6,566.40 "," $6,566.40 "," $1,997.84 "," $7,578.45 "," $7,797.60 "," $7,387.20 "," $7,387.20 "," $7,387.20 "," $7,633.44 "," $7,879.68 "," $5,647.64 "," $6,976.80 "," $8,413.65 "," $6,604.15 ", N/A ," $4,468.65 "," $4,468.65 "," $7,797.60 "," $5,355.93 "," $1,290.60 "," $8,413.65 "
"Cath, Umbilical Artery",CPT® 36660,N/A,N/A,N/A, $864.00 , $561.60 , $431.08 , $66.22 , $96.18 , $267.36 , $306.23 , $803.52 , $777.60 , $777.60 , $691.20 , $691.20 , $96.18 , $797.73 , $820.80 , $777.60 , $777.60 , $777.60 , $803.52 , $829.44 , $395.96 , $734.40 , $388.93 , $350.45 , N/A , $272.58 , $272.58 , $820.80 , $309.66 , $66.22 , $829.44 
"Incision of Urethral Meatus,Infant",CPT® 53025,N/A,N/A,N/A, $479.00 , $311.35 , $366.91 , $65.21 , $46.08 , $333.81 , $342.68 , $445.47 , $431.10 , $431.10 , $383.20 , $383.20 , $46.08 , $442.26 , $455.05 , $431.10 , $431.10 , $431.10 , $445.47 , $459.84 , $367.50 , $407.15 , $387.14 , $422.08 , N/A , $340.32 , $340.32 , $455.05 , $400.00 , $46.08 , $459.84 
 Pro Att/Reargmt S/a/L Dfct 10.1 Cm-30.0 Cm ,CPT® 14021,0982 - PRO FEE/OUTPT,N/A,N/A," $4,360.00 "," $2,834.00 "," $2,261.44 ", $679.65 , $640.60 ," $1,962.55 "," $1,932.02 "," $4,054.80 "," $3,924.00 "," $3,924.00 "," $3,488.00 "," $3,488.00 ", $640.60 ," $4,025.59 "," $4,142.00 "," $3,924.00 "," $3,924.00 "," $3,924.00 "," $4,054.80 "," $4,185.60 "," $2,475.57 "," $3,706.00 "," $3,850.01 "," $2,514.00 ", N/A ," $2,000.85 "," $2,000.85 "," $4,142.00 "," $2,320.31 ", $640.60 ," $4,185.60 "
 NEOMYCIN-POLYMYXIN-HC 1 % OT SOLN ,HCPCS RXC637,0250 - PHARMACY,24208-0631-10,10 mL, $517.19 , $336.17 , $434.44 , N/A , N/A , $417.89 , $465.47 , $437.85 , $465.47 , $465.47 , $465.47 , $439.61 , N/A , $477.52 , $491.33 , $439.61 , $480.99 , $480.99 , $491.33 , $496.50 , $423.16 , $465.47 , $439.61 , $408.58 , N/A , $418.56 , $418.56 , $491.33 , $443.80 , $408.58 , $496.50 
" Fac Chg Clotting Function Activity Nos, Ea Analyt ",CPT® 85397,0305 - LAB/HEMATOLOGY,N/A,N/A, $218.00 , $141.70 , $183.12 , $31.48 , $31.48 , $176.14 , $196.20 , $184.56 , $196.20 , $196.20 , $196.20 , $185.30 , $30.86 , $201.28 , $207.10 , $185.30 , $202.74 , $202.74 , $207.10 , $209.28 , $178.37 , $196.20 , $185.30 , $172.22 , N/A , $176.43 , $176.43 , $207.10 , $187.07 , $30.86 , $209.28 
 Casirivi and Imdevi IV Infusion ,HCPCS M0243,0771 - VACCINE ADMINISTRATION,N/A,N/A," $1,335.00 ", $867.75 ," $1,121.40 ", N/A , $459.00 ," $1,078.68 "," $1,201.50 "," $1,130.21 "," $1,201.50 "," $1,201.50 "," $1,201.50 "," $1,134.75 ", $450.00 ," $1,232.61 "," $1,268.25 "," $1,134.75 "," $1,241.55 "," $1,241.55 "," $1,268.25 "," $1,281.60 "," $1,092.30 "," $1,201.50 "," $1,134.75 "," $1,054.65 ", N/A ," $1,080.42 "," $1,080.42 "," $1,268.25 "," $1,145.56 ", $450.00 ," $1,281.60 "
Aortic Dysfunction/Dilation Genomic Seq Analysis,CPT® 81410,N/A,N/A,N/A," $3,585.00 "," $2,330.25 ", N/A , $514.08 , $514.08 , N/A , N/A ," $3,334.05 "," $3,226.50 "," $3,226.50 "," $2,868.00 "," $2,868.00 ", $514.08 ," $3,310.03 "," $3,405.75 "," $3,226.50 "," $3,226.50 "," $3,226.50 "," $3,334.05 "," $3,441.60 "," $3,365.32 "," $3,047.25 "," $2,402.05 "," $1,480.25 ", N/A ," $2,000.88 "," $2,000.88 "," $3,405.75 "," $2,182.32 ", $514.08 ," $3,441.60 "
Ampicillin Sulbactam 1.5 Gm,HCPCS J0295,N/A,N/A,N/A, $20.00 , $13.00 , N/A , $1.93 , $2.33 , N/A , N/A , $18.60 , $18.00 , $18.00 , $16.00 , $16.00 , $2.33 , $18.47 , $19.00 , $18.00 , $18.00 , $18.00 , $18.60 , $19.20 , $3.63 , $17.00 , $4.54 , $3.43 , N/A , N/A , N/A , $19.00 , N/A , $1.93 , $19.20 
 LOSARTAN POTASSIUM 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-7048-61,1 tablet, $4.17 , $2.71 , $3.50 , N/A , N/A , $3.37 , $3.75 , $3.53 , $3.75 , $3.75 , $3.75 , $3.54 , N/A , $3.85 , $3.96 , $3.54 , $3.88 , $3.88 , $3.96 , $4.00 , $3.41 , $3.75 , $3.54 , $3.29 , N/A , $3.37 , $3.37 , $3.96 , $3.58 , $3.29 , $4.00 
" Pro Drain Abscess,Peritonsill ",CPT® 42700,0981 - PRO FEE/ER,N/A,N/A, $799.00 , $519.35 , $833.04 , $131.69 , $124.27 , $655.65 , $682.92 , $743.07 , $719.10 , $719.10 , $639.20 , $639.20 , $124.27 , $737.72 , $759.05 , $719.10 , $719.10 , $719.10 , $743.07 , $767.04 , $591.70 , $679.15 , $745.74 , $772.76 , N/A , $668.44 , $668.44 , $759.05 , $699.12 , $124.27 , $833.04 
" Fac Amb 911 Als Treatment, No Transport ",HCPCS A0988,0540 - AMBULANCE,N/A,N/A, $420.00 , $273.00 , $352.80 , N/A , N/A , $339.36 , $378.00 , $355.57 , $378.00 , $378.00 , $378.00 , $357.00 , N/A , $387.79 , $399.00 , $357.00 , $390.60 , $390.60 , $399.00 , $403.20 , $343.64 , $378.00 , $357.00 , $331.80 , N/A , $339.91 , $339.91 , $399.00 , $360.40 , $331.80 , $403.20 
"Percut Fix Carpometacar Disloc,Non-Thumb",CPT® 26676,N/A,N/A,N/A," $3,469.00 "," $2,254.85 "," $3,146.52 ", $496.58 , $152.92 ," $2,407.18 "," $2,425.03 "," $3,226.17 "," $3,122.10 "," $3,122.10 "," $2,775.20 "," $2,775.20 ", $152.92 ," $3,202.93 "," $3,295.55 "," $3,122.10 "," $3,122.10 "," $3,122.10 "," $3,226.17 "," $3,330.24 "," $2,920.95 "," $2,948.65 "," $2,663.61 "," $2,864.04 ", N/A ," $2,454.15 "," $2,454.15 "," $3,295.55 "," $2,884.50 ", $152.92 ," $3,330.24 "
" Fac US Exam Infant Hips, Static ",CPT® 76886,0402 - ULTRASOUND,N/A,N/A, $551.00 , $358.15 , $462.84 , $99.80 , $77.44 , $445.21 , $495.90 , $466.48 , $495.90 , $495.90 , $495.90 , $468.35 , $75.92 , $508.74 , $523.45 , $468.35 , $512.43 , $512.43 , $523.45 , $528.96 , $450.83 , $495.90 , $468.35 , $435.29 , N/A , $445.92 , $445.92 , $523.45 , $472.81 , $75.92 , $528.96 
"MRI, Chest",CPT® 71550,N/A,N/A,N/A," $4,055.00 "," $2,635.75 "," $2,022.79 ", $294.32 , $417.06 ," $1,970.26 "," $2,480.04 "," $3,771.15 "," $3,649.50 "," $3,649.50 "," $3,244.00 "," $3,244.00 ", $417.06 ," $3,743.98 "," $3,852.25 "," $3,649.50 "," $3,649.50 "," $3,649.50 "," $3,771.15 "," $3,892.80 "," $2,140.63 "," $3,446.75 "," $2,704.16 "," $3,832.37 ", N/A ," $2,008.70 "," $2,008.70 "," $3,852.25 "," $2,325.12 ", $294.32 ," $3,892.80 "
Apply- Long Arm Splint,29105,N/A,N/A,N/A, $580.00 , $377.00 , $248.63 , $39.02 , $45.35 , $288.42 , $289.62 , $539.40 , $522.00 , $522.00 , $464.00 , $464.00 , $45.35 , $535.51 , $551.00 , $522.00 , $522.00 , $522.00 , $539.40 , $556.80 , $235.01 , $493.00 , $317.56 , $339.98 , N/A , $294.05 , $294.05 , $551.00 , $345.59 , $39.02 , $556.80 
"Bone Biopsy,Trocar/Needle Superf",CPT® 20220,N/A,N/A,N/A," $1,120.00 ", $728.00 , $539.37 , $84.16 , $94.28 , $357.09 , $350.58 ," $1,041.60 "," $1,008.00 "," $1,008.00 ", $896.00 , $896.00 , $94.28 ," $1,034.10 "," $1,064.00 "," $1,008.00 "," $1,008.00 "," $1,008.00 "," $1,041.60 "," $1,075.20 ", $504.79 , $952.00 , $378.22 , $422.26 , N/A , $364.06 , $364.06 ," $1,064.00 ", $427.90 , $84.16 ," $1,075.20 "
" Esr ,Sedimentation ",CPT® 85651,0305 - LAB/HEMATOLOGY,N/A,N/A, $62.00 , $40.30 , $52.08 , $4.36 , $4.12 , $50.10 , $55.80 , $52.49 , $55.80 , $55.80 , $55.80 , $52.70 , $4.04 , $57.24 , $58.90 , $52.70 , $57.66 , $57.66 , $58.90 , $59.52 , $50.73 , $55.80 , $52.70 , $48.98 , N/A , $50.18 , $50.18 , $58.90 , $53.20 , $4.04 , $59.52 
"Remv Kidney,Complicated",CPT® 50225,N/A,N/A,N/A," $8,306.00 "," $5,398.90 "," $6,455.35 "," $1,134.71 "," $1,229.45 "," $5,860.61 "," $5,444.49 "," $7,724.58 "," $7,475.40 "," $7,475.40 "," $6,644.80 "," $6,644.80 "," $1,229.45 "," $7,668.93 "," $7,890.70 "," $7,475.40 "," $7,475.40 "," $7,475.40 "," $7,724.58 "," $7,973.76 "," $6,469.99 "," $7,060.10 "," $6,188.92 "," $7,335.15 ", N/A ," $5,974.96 "," $5,974.96 "," $7,890.70 "," $7,022.70 "," $1,134.71 "," $7,973.76 "
 Fac Who W/O Joints Cf ,HCPCS L3906,0274 - PROSTHETIC DEV,N/A,N/A, $765.00 , $497.25 , $642.60 , $539.49 , $242.01 , $618.12 , $688.50 , $647.65 , $688.50 , $688.50 , $688.50 , $650.25 , $237.26 , $706.32 , $726.75 , $650.25 , $711.45 , $711.45 , $726.75 , $734.40 , $625.92 , $688.50 , $650.25 , $604.35 , N/A , $619.11 , $619.11 , $726.75 , $656.45 , $237.26 , $734.40 
" Fac Hospice, Respite ",CPT® Q5005,0655 - HOSPICE/IP RESPITE,N/A,N/A, $508.00 , $330.20 , $426.72 , N/A , N/A , $410.46 , $457.20 , $430.07 , $457.20 , $457.20 , $457.20 , $431.80 , N/A , $469.04 , $482.60 , $431.80 , $472.44 , $472.44 , $482.60 , $487.68 , $415.65 , $457.20 , $431.80 , $401.32 , N/A , $411.12 , $411.12 , $482.60 , $435.91 , $401.32 , $487.68 
 Pro CT Angio Abdominal Arteries ,CPT® 75635,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,351.00 ", $878.15 ," $1,973.58 ", $285.11 , $432.47 ," $1,807.76 "," $2,366.72 "," $1,256.43 "," $1,215.90 "," $1,215.90 "," $1,080.80 "," $1,080.80 ", $432.47 ," $1,247.38 "," $1,283.45 "," $1,215.90 "," $1,215.90 "," $1,215.90 "," $1,256.43 "," $1,296.96 "," $2,452.59 "," $1,148.35 "," $2,578.97 "," $2,859.83 ", N/A ," $1,843.04 "," $1,843.04 "," $1,283.45 "," $2,133.34 ", $285.11 ," $2,859.83 "
"Fusion Finger Joint,Each Addnl",CPT® 26861,N/A,N/A,N/A, $712.00 , $462.80 , $611.91 , $94.71 , $186.84 , $499.38 , $488.06 , $662.16 , $640.80 , $640.80 , $569.60 , $569.60 , $186.84 , $657.39 , $676.40 , $640.80 , $640.80 , $640.80 , $662.16 , $683.52 , $573.91 , $605.20 , $540.57 , $587.19 , N/A , $509.12 , $509.12 , $676.40 , $598.41 , $94.71 , $683.52 
Rmvl Transvns Pm Eltrd 1 Lead Sys Atr/Ventr,CPT® 33234,N/A,N/A,N/A," $5,234.00 "," $3,402.10 "," $2,890.55 ", $446.64 ," $1,280.30 "," $2,121.99 "," $2,042.12 "," $4,867.62 "," $4,710.60 "," $4,710.60 "," $4,187.20 "," $4,187.20 "," $1,280.30 "," $4,832.55 "," $4,972.30 "," $4,710.60 "," $4,710.60 "," $4,710.60 "," $4,867.62 "," $5,024.64 "," $2,675.70 "," $4,448.90 "," $2,565.48 "," $2,347.73 ", N/A ," $2,163.40 "," $2,163.40 "," $4,972.30 "," $2,457.61 ", $446.64 ," $5,024.64 "
" Fac Doppler Echo Exam, Heart ",CPT® 93320,0483 - CARDIOLOGY – ECHOCARDIOLOGY,N/A,N/A, $613.00 , $398.45 , $514.92 , $49.80 , $128.64 , $495.30 , $551.70 , $518.97 , $551.70 , $551.70 , $551.70 , $521.05 , $126.12 , $565.98 , $582.35 , $521.05 , $570.09 , $570.09 , $582.35 , $588.48 , $501.56 , $551.70 , $521.05 , $484.27 , N/A , $496.10 , $496.10 , $582.35 , $526.02 , $49.80 , $588.48 
 Fac Tx Supfc Dehsn Smpl Clsr ,CPT® 12020,0761 - TREATMENT ROOM,N/A,N/A," $1,255.00 ", $815.75 ," $1,054.20 ", $179.70 , $32.39 ," $1,014.04 "," $1,129.50 "," $1,062.48 "," $1,129.50 "," $1,129.50 "," $1,129.50 "," $1,066.75 ", $31.75 ," $1,158.74 "," $1,192.25 "," $1,066.75 "," $1,167.15 "," $1,167.15 "," $1,192.25 "," $1,204.80 "," $1,026.84 "," $1,129.50 "," $1,066.75 ", $991.45 , N/A ," $1,015.67 "," $1,015.67 "," $1,192.25 "," $1,076.92 ", $31.75 ," $1,204.80 "
"Cholecystostomy,Explor/Remv Calc",CPT® 47480,N/A,N/A,N/A," $5,774.00 "," $3,753.10 "," $5,260.52 ", $816.28 , $768.38 ," $4,118.29 "," $4,194.07 "," $5,369.82 "," $5,196.60 "," $5,196.60 "," $4,619.20 "," $4,619.20 ", $768.38 ," $5,331.13 "," $5,485.30 "," $5,196.60 "," $5,196.60 "," $5,196.60 "," $5,369.82 "," $5,543.04 "," $3,788.85 "," $4,907.90 "," $4,651.06 "," $4,880.16 ", N/A ," $4,198.65 "," $4,198.65 "," $5,485.30 "," $4,391.35 ", $768.38 ," $5,543.04 "
 Pro Exc Tr-Ext Mlg+Marg 3.1-4 Cm ,CPT® 11604,0982 - PRO FEE/OUTPT,N/A,N/A," $1,490.00 ", $968.50 , $679.52 , $203.78 , $369.39 , $587.14 , $572.25 ," $1,385.70 "," $1,341.00 "," $1,341.00 "," $1,192.00 "," $1,192.00 ", $369.39 ," $1,375.72 "," $1,415.50 "," $1,341.00 "," $1,341.00 "," $1,341.00 "," $1,385.70 "," $1,430.40 ", $745.34 ," $1,266.50 "," $1,141.80 ", $752.81 , N/A , $598.60 , $598.60 ," $1,415.50 ", $694.18 , $203.78 ," $1,430.40 "
 Pro Treat Humerus Fracture ,CPT® 23615,0975 - PRO FEE/OR,N/A,N/A," $4,807.00 "," $3,124.55 "," $5,362.96 ", $840.53 , $768.38 ," $4,266.68 "," $4,250.31 "," $4,470.51 "," $4,326.30 "," $4,326.30 "," $3,845.60 "," $3,845.60 ", $768.38 ," $4,438.30 "," $4,566.65 "," $4,326.30 "," $4,326.30 "," $4,326.30 "," $4,470.51 "," $4,614.72 "," $4,992.25 "," $4,085.95 "," $4,695.66 "," $5,029.04 ", N/A ," $4,349.94 "," $4,349.94 "," $4,566.65 "," $5,112.71 ", $768.38 ," $5,362.96 "
Layer Clousre 2.6-7.5cm,CPT® 12042,N/A,N/A,N/A," $1,172.00 ", $761.80 , $627.61 , $188.46 , $103.08 , $547.43 , $537.01 ," $1,089.96 "," $1,054.80 "," $1,054.80 ", $937.60 , $937.60 , $103.08 ," $1,082.11 "," $1,113.40 "," $1,054.80 "," $1,054.80 "," $1,054.80 "," $1,089.96 "," $1,125.12 ", $689.37 , $996.20 ," $1,066.87 ", $703.69 , N/A , $558.12 , $558.12 ," $1,113.40 ", $647.23 , $103.08 ," $1,125.12 "
"Closed Rx Scapula Fx,Manipulatn",CPT® 23575,N/A,N/A,N/A," $2,802.00 "," $1,821.30 "," $2,345.66 ", $370.40 , $184.42 ," $1,805.56 "," $1,817.42 "," $2,605.86 "," $2,521.80 "," $2,521.80 "," $2,241.60 "," $2,241.60 ", $184.42 ," $2,587.09 "," $2,661.90 "," $2,521.80 "," $2,521.80 "," $2,521.80 "," $2,605.86 "," $2,689.92 "," $2,163.79 "," $2,381.70 "," $1,999.94 "," $2,138.02 ", N/A ," $1,840.79 "," $1,840.79 "," $2,661.90 "," $2,163.58 ", $184.42 ," $2,689.92 "
Fix Nonunion Metacarpal/Phalanx,CPT® 26546,N/A,N/A,N/A," $6,567.00 "," $4,268.55 "," $6,453.92 "," $1,008.56 ", $580.18 ," $4,738.19 "," $4,780.64 "," $6,107.31 "," $5,910.30 "," $5,910.30 "," $5,253.60 "," $5,253.60 ", $580.18 ," $6,063.31 "," $6,238.65 "," $5,910.30 "," $5,910.30 "," $5,910.30 "," $6,107.31 "," $6,304.32 "," $5,928.86 "," $5,581.95 "," $5,238.01 "," $5,636.08 ", N/A ," $4,830.64 "," $4,830.64 "," $6,238.65 "," $5,677.70 ", $580.18 ," $6,453.92 "
Emergency Department Visit High Mdm,99285,N/A,N/A,N/A, $894.00 , $581.10 , $618.57 , $168.76 , $44.31 , $489.08 , $501.00 , $831.42 , $804.60 , $804.60 , $715.20 , $715.20 , $44.31 , $825.43 , $849.30 , $804.60 , $804.60 , $804.60 , $831.42 , $858.24 , $526.01 , $759.90 , $369.80 , $374.75 , $182.00 , $498.62 , $498.62 , $849.30 , $598.36 , $44.31 , $858.24 
Amputation Finger/Thumb+Flaps,26952,N/A,N/A,N/A," $4,286.00 "," $2,785.90 "," $4,299.17 ", $669.14 , $336.65 ," $3,062.08 "," $3,105.60 "," $3,985.98 "," $3,857.40 "," $3,857.40 "," $3,428.80 "," $3,428.80 ", $336.65 ," $3,957.26 "," $4,071.70 "," $3,857.40 "," $3,857.40 "," $3,857.40 "," $3,985.98 "," $4,114.56 "," $3,934.94 "," $3,643.10 "," $3,405.78 "," $3,654.94 ", N/A ," $3,121.83 "," $3,121.83 "," $4,071.70 "," $3,669.26 ", $336.65 ," $4,299.17 "
Spherocylinder 4.25d/12-2d,HCPCS V2107,N/A,N/A,N/A, $55.00 , $35.75 , N/A , $55.15 , N/A , N/A , N/A , $51.15 , $49.50 , $49.50 , $44.00 , $44.00 , N/A , $50.78 , $52.25 , $49.50 , $49.50 , $49.50 , $51.15 , $52.80 , N/A , $46.75 , $55.00 , $50.12 , N/A , N/A , N/A , $52.25 , N/A , $44.00 , $55.15 
"Remv Prostate,Retropubic,Subtotal",CPT® 55831,N/A,N/A,N/A," $5,183.00 "," $3,368.95 "," $4,179.52 ", $819.03 ," $1,229.45 "," $3,036.51 "," $3,055.13 "," $4,820.19 "," $4,664.70 "," $4,664.70 "," $4,146.40 "," $4,146.40 "," $1,229.45 "," $4,785.46 "," $4,923.85 "," $4,664.70 "," $4,664.70 "," $4,664.70 "," $4,820.19 "," $4,975.68 "," $3,928.59 "," $4,405.55 "," $4,868.71 "," $4,577.37 ", N/A ," $3,095.76 "," $3,095.76 "," $4,923.85 "," $3,710.43 ", $819.03 ," $4,975.68 "
Wrist Gauntlet Molded to Pt,HCPCS L3906,N/A,N/A,N/A, $772.00 , $501.80 , N/A , $539.49 , $242.01 , N/A , N/A , $717.96 , $694.80 , $694.80 , $617.60 , $617.60 , $242.01 , $712.79 , $733.40 , $694.80 , $694.80 , $694.80 , $717.96 , $741.12 , N/A , $656.20 , $390.55 , $453.90 , N/A , N/A , N/A , $733.40 , N/A , $242.01 , $741.12 
"Cryosurgery, Anal Lesion(S)",CPT® 46916,N/A,N/A,N/A," $1,557.00 "," $1,012.05 ", $875.23 , $137.48 , $44.47 , $684.29 , $704.83 ," $1,448.01 "," $1,401.30 "," $1,401.30 "," $1,245.60 "," $1,245.60 ", $44.47 ," $1,437.58 "," $1,479.15 "," $1,401.30 "," $1,401.30 "," $1,401.30 "," $1,448.01 "," $1,494.72 ", $626.24 ," $1,323.45 ", $770.72 , $827.21 , N/A , $697.64 , $697.64 ," $1,479.15 ", $729.66 , $44.47 ," $1,494.72 "
Slings,HCPCS A4565,N/A,N/A,N/A, $27.00 , $17.55 , N/A , $10.44 , N/A , N/A , N/A , $25.11 , $24.30 , $24.30 , $21.60 , $21.60 , N/A , $24.93 , $25.65 , $24.30 , $24.30 , $24.30 , $25.11 , $25.92 , N/A , $22.95 , $9.08 , $9.48 , N/A , N/A , N/A , $25.65 , N/A , $9.08 , $25.92 
 ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY ,HCPCS J1650,0636 - DRUGS REQUIRING DETAILED CODIN,00548-5602-00,0.4 mL, $36.99 , $24.04 , $31.07 , $0.69 , $0.83 , $29.89 , $33.29 , $31.32 , $33.29 , $33.29 , $33.29 , $31.44 , $0.81 , $34.15 , $35.14 , $31.44 , $34.40 , $34.40 , $35.14 , $35.51 , $30.27 , $33.29 , $31.44 , $29.22 , N/A , $29.94 , $29.94 , $35.14 , $31.74 , $0.69 , $35.51 
Shav Skin Les <5mm Remaindr Body,11305,N/A,N/A,N/A, $411.00 , $267.15 , $123.52 , $36.29 , $46.39 , $107.98 , $103.20 , $382.23 , $369.90 , $369.90 , $328.80 , $328.80 , $46.39 , $379.48 , $390.45 , $369.90 , $369.90 , $369.90 , $382.23 , $394.56 , $135.45 , $349.35 , $201.60 , $138.82 , N/A , $110.08 , $110.08 , $390.45 , $127.66 , $36.29 , $394.56 
 Fac Diab Manage Trn per Indiv ,HCPCS G0108,0942 - EDUC/TRAINING,N/A,N/A, $103.00 , $66.95 , $86.52 , $53.88 , N/A , $83.22 , $92.70 , $87.20 , $92.70 , $92.70 , $92.70 , $87.55 , N/A , $95.10 , $97.85 , $87.55 , $95.79 , $95.79 , $97.85 , $98.88 , $84.27 , $92.70 , $87.55 , $81.37 , N/A , $83.36 , $83.36 , $97.85 , $88.38 , $53.88 , $98.88 
"Dil Uret Stric,Male,Subseq,Filiform",CPT® 53621,N/A,N/A,N/A, $911.00 , $592.15 , $387.38 , $67.88 , $38.38 , $353.26 , $326.63 , $847.23 , $819.90 , $819.90 , $728.80 , $728.80 , $38.38 , $841.13 , $865.45 , $819.90 , $819.90 , $819.90 , $847.23 , $874.56 , $388.20 , $774.35 , $369.30 , $445.17 , N/A , $360.15 , $360.15 , $865.45 , $423.30 , $38.38 , $874.56 
 Fac Assay for Phencyclidine ,CPT® 83992,0301 - LAB/CHEMISTRY,N/A,N/A, $155.00 , $100.75 , $130.20 , N/A , $20.40 , $125.24 , $139.50 , $131.22 , $139.50 , $139.50 , $139.50 , $131.75 , $20.00 , $143.11 , $147.25 , $131.75 , $144.15 , $144.15 , $147.25 , $148.80 , $126.82 , $139.50 , $131.75 , $122.45 , N/A , $125.44 , $125.44 , $147.25 , $133.01 , $20.00 , $148.80 
 Pro Incision of Foot Tendon ,CPT® 28234,0982 - PRO FEE/OUTPT,N/A,N/A," $2,762.00 "," $1,795.30 "," $1,658.02 ", $261.45 , $61.48 ," $1,302.61 "," $1,309.07 "," $2,568.66 "," $2,485.80 "," $2,485.80 "," $2,209.60 "," $2,209.60 ", $61.48 ," $2,550.15 "," $2,623.90 "," $2,485.80 "," $2,485.80 "," $2,485.80 "," $2,568.66 "," $2,651.52 "," $1,535.95 "," $2,347.70 "," $1,418.33 "," $1,541.89 ", N/A ," $1,328.03 "," $1,328.03 "," $2,623.90 "," $1,560.92 ", $61.48 ," $2,651.52 "
 Pro Repair of Thigh Muscle ,CPT® 27385,0982 - PRO FEE/OUTPT,N/A,N/A," $4,171.00 "," $2,711.15 "," $3,746.99 ", $586.39 , $691.53 ," $2,772.28 "," $2,791.27 "," $3,879.03 "," $3,753.90 "," $3,753.90 "," $3,336.80 "," $3,336.80 ", $691.53 ," $3,851.08 "," $3,962.45 "," $3,753.90 "," $3,753.90 "," $3,753.90 "," $3,879.03 "," $4,004.16 "," $3,442.62 "," $3,545.35 "," $3,073.94 "," $3,274.26 ", N/A ," $2,826.38 "," $2,826.38 "," $3,962.45 "," $3,322.00 ", $586.39 ," $4,004.16 "
 Fac Psychotherapy W/Patient 45 Minutes ,CPT® 90834,0914 - PSYCH/INDIV RX,N/A,N/A, $141.00 , $91.65 , $118.44 , $87.92 , $77.18 , $113.93 , $126.90 , $119.37 , $126.90 , $126.90 , $126.90 , $119.85 , $75.67 , $130.19 , $133.95 , $119.85 , $131.13 , $131.13 , $133.95 , $135.36 , $115.37 , $126.90 , $119.85 , $111.39 , N/A , $114.11 , $114.11 , $133.95 , $120.99 , $75.67 , $135.36 
Assay Body Fluid Acidity,CPT® 83986,N/A,N/A,N/A, $61.00 , $39.65 , N/A , $3.65 , $3.65 , $20.25 , $24.23 , $56.73 , $54.90 , $54.90 , $48.80 , $48.80 , $3.65 , $56.32 , $57.95 , $54.90 , $54.90 , $54.90 , $56.73 , $58.56 , $23.90 , $51.85 , $22.71 , $12.96 , N/A , $18.90 , $18.90 , $57.95 , $20.65 , $3.65 , $58.56 
 OXYCODONE HCL ER 40 MG PO T12A ,HCPCS RXC637,0250 - PHARMACY,59011-0440-20,1 tablet, $98.75 , $64.19 , $82.95 , N/A , N/A , $79.79 , $88.88 , $83.60 , $88.88 , $88.88 , $88.88 , $83.94 , N/A , $91.18 , $93.81 , $83.94 , $91.84 , $91.84 , $93.81 , $94.80 , $80.80 , $88.88 , $83.94 , $78.01 , N/A , $79.92 , $79.92 , $93.81 , $84.74 , $78.01 , $94.80 
"Cystourethroscopy,Ureter Catheter",CPT® 52005,N/A,N/A,N/A, $924.00 , $600.60 , $713.00 , $125.24 , $199.19 , $652.08 , $607.23 , $859.32 , $831.60 , $831.60 , $739.20 , $739.20 , $199.19 , $853.13 , $877.80 , $831.60 , $831.60 , $831.60 , $859.32 , $887.04 , $716.14 , $785.40 , $688.65 , $819.38 , N/A , $664.80 , $664.80 , $877.80 , $781.39 , $125.24 , $887.04 
 Fac Ercp Balloon Dilate Biliary/Panc Duct/Ampulla Ea ,CPT® 43277,0360 - OR SERVICES,N/A,N/A," $4,935.00 "," $3,207.75 "," $4,145.40 ", $358.06 , $301.47 ," $3,987.48 "," $4,441.50 "," $4,177.97 "," $4,441.50 "," $4,441.50 "," $4,441.50 "," $4,194.75 ", $295.56 ," $4,556.49 "," $4,688.25 "," $4,194.75 "," $4,589.55 "," $4,589.55 "," $4,688.25 "," $4,737.60 "," $4,037.82 "," $4,441.50 "," $4,194.75 "," $3,898.65 ", N/A ," $3,993.90 "," $3,993.90 "," $4,688.25 "," $4,234.72 ", $295.56 ," $4,737.60 "
 Pro Tissue Exam by Pathologist ,CPT® 88305,0971 - PRO FEE/LAB,N/A,N/A, $298.00 , $193.70 , $254.78 , $70.47 , $66.83 , $290.81 , $323.57 , $277.14 , $268.20 , $268.20 , $238.40 , $238.40 , $66.83 , $275.14 , $283.10 , $268.20 , $268.20 , $268.20 , $277.14 , $286.08 , $457.06 , $253.30 , $334.10 , $239.59 , N/A , $271.40 , $271.40 , $283.10 , $298.26 , $66.83 , $457.06 
" Fac Assay of Haptoglobin, Quant ",CPT® 83010,0301 - LAB/CHEMISTRY,N/A,N/A, $145.00 , $94.25 , $121.80 , $12.83 , $12.83 , $117.16 , $130.50 , $122.76 , $130.50 , $130.50 , $130.50 , $123.25 , $12.58 , $133.88 , $137.75 , $123.25 , $134.85 , $134.85 , $137.75 , $139.20 , $118.64 , $130.50 , $123.25 , $114.55 , N/A , $117.35 , $117.35 , $137.75 , $124.42 , $12.58 , $139.20 
Dx Dark Adaptation Exam Interpretation & Report,CPT® 92284,N/A,N/A,N/A, $187.00 , $121.55 , $124.27 , $45.09 , $106.75 , $108.95 , $112.48 , $173.91 , $168.30 , $168.30 , $149.60 , $149.60 , $106.75 , $172.66 , $177.65 , $168.30 , $168.30 , $168.30 , $173.91 , $179.52 , $178.08 , $158.95 , $190.58 , $131.52 , N/A , $111.07 , $111.07 , $177.65 , $132.15 , $45.09 , $190.58 
 TIOTROPIUM BROMIDE MONOHYDRATE 2.5 MCG/ACT INH AERS ,HCPCS RXC637,0250 - PHARMACY,00597-0100-51,4 gram, $220.53 , $143.34 , $185.25 , N/A , N/A , $178.19 , $198.48 , $186.70 , $198.48 , $198.48 , $198.48 , $187.45 , N/A , $203.62 , $209.50 , $187.45 , $205.09 , $205.09 , $209.50 , $211.71 , $180.44 , $198.48 , $187.45 , $174.22 , N/A , $178.47 , $178.47 , $209.50 , $189.24 , $174.22 , $211.71 
 FLUPHENAZINE HCL 5 MG PO TABS ,HCPCS RXA250,0250 - PHARMACY,00527-1790-01,1 tablet, $47.26 , $30.72 , $39.70 , N/A , N/A , $38.19 , $42.53 , $40.01 , $42.53 , $42.53 , $42.53 , $40.17 , N/A , $43.64 , $44.90 , $40.17 , $43.95 , $43.95 , $44.90 , $45.37 , $38.67 , $42.53 , $40.17 , $37.34 , N/A , $38.25 , $38.25 , $44.90 , $40.55 , $37.34 , $45.37 
 Temporomandibular Joints-Bil ,CPT® 70330,0320 - DX X-RAY,N/A,N/A, $540.00 , $351.00 , $453.60 , $52.18 , $45.11 , $436.32 , $486.00 , $457.16 , $486.00 , $486.00 , $486.00 , $459.00 , $44.23 , $498.58 , $513.00 , $459.00 , $502.20 , $502.20 , $513.00 , $518.40 , $441.83 , $486.00 , $459.00 , $426.60 , N/A , $437.02 , $437.02 , $513.00 , $463.37 , $44.23 , $518.40 
 OXYCODONE HCL 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6966-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Pro Smpl Rpr Supfc F/E/E/N/L/M 2.6cm-5.0cm ,CPT® 12013,0981 - PRO FEE/ER,N/A,N/A, $582.00 , $378.30 , $180.71 , $53.74 , $76.93 , $169.97 , $163.73 , $541.26 , $523.80 , $523.80 , $465.60 , $465.60 , $76.93 , $537.36 , $552.90 , $523.80 , $523.80 , $523.80 , $541.26 , $558.72 , $198.93 , $494.70 , $328.27 , $200.67 , N/A , $173.28 , $173.28 , $552.90 , $200.96 , $53.74 , $558.72 
"Insrt Pacing Elect,at Insert New Device",CPT® 33225,N/A,N/A,N/A," $4,836.00 "," $3,143.40 "," $2,746.64 ", $422.06 , $411.53 ," $1,991.31 "," $1,897.66 "," $4,497.48 "," $4,352.40 "," $4,352.40 "," $3,868.80 "," $3,868.80 ", $411.53 ," $4,465.08 "," $4,594.20 "," $4,352.40 "," $4,352.40 "," $4,352.40 "," $4,497.48 "," $4,642.56 "," $2,548.32 "," $4,110.60 "," $2,392.43 "," $2,264.89 ", N/A ," $2,030.16 "," $2,030.16 "," $4,594.20 "," $2,306.26 ", $411.53 ," $4,642.56 "
" Fac Microbe Susceptible, Mic ",CPT® 87186,0306 - LAB/BACT-MICRO,N/A,N/A, $102.00 , $66.30 , $85.68 , $8.82 , $8.82 , $82.42 , $91.80 , $86.35 , $91.80 , $91.80 , $91.80 , $86.70 , $8.65 , $94.18 , $96.90 , $86.70 , $94.86 , $94.86 , $96.90 , $97.92 , $83.46 , $91.80 , $86.70 , $80.58 , N/A , $82.55 , $82.55 , $96.90 , $87.53 , $8.65 , $97.92 
Calr Gene Analysis Common Variants in Exon 9,CPT® 81219,N/A,N/A,N/A, $679.00 , $441.35 , N/A , $124.06 , $100.04 , $509.71 , N/A , $631.47 , $611.10 , $611.10 , $543.20 , $543.20 , $100.04 , $626.92 , $645.05 , $611.10 , $611.10 , $611.10 , $631.47 , $651.84 , $812.15 , $577.15 , $579.92 , $441.02 , N/A , $475.69 , $475.69 , $645.05 , $519.82 , $100.04 , $812.15 
 POTASSIUM ACETATE 2 MEQ/ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00409-8183-01,20 mL, $21.27 , $13.83 , $17.87 , N/A , N/A , $17.19 , $19.14 , $18.01 , $19.14 , $19.14 , $19.14 , $18.08 , N/A , $19.64 , $20.21 , $18.08 , $19.78 , $19.78 , $20.21 , $20.42 , $17.40 , $19.14 , $18.08 , $16.80 , N/A , $17.21 , $17.21 , $20.21 , $18.25 , $16.80 , $20.42 
" Hepatitis C, Pcr Quant ",CPT® 87521,0306 - LAB/BACT-MICRO,N/A,N/A, $348.00 , $226.20 , $292.32 , $35.79 , $35.79 , $281.18 , $313.20 , $294.62 , $313.20 , $313.20 , $313.20 , $295.80 , $35.09 , $321.31 , $330.60 , $295.80 , $323.64 , $323.64 , $330.60 , $334.08 , $284.73 , $313.20 , $295.80 , $274.92 , N/A , $281.64 , $281.64 , $330.60 , $298.62 , $35.09 , $334.08 
 Pro Mod Sed Same Phys/Qhp Initial 15 Mins 5/> Yrs ,CPT® 99152,0981 - PRO FEE/ER,N/A,N/A, $119.00 , $77.35 , $28.01 , $11.70 , $40.63 , $26.51 , $27.37 , $110.67 , $107.10 , $107.10 , $95.20 , $95.20 , $40.63 , $109.87 , $113.05 , $107.10 , $107.10 , $107.10 , $110.67 , $114.24 , $37.64 , $101.15 , $37.36 , $46.92 , N/A , $27.03 , $27.03 , $113.05 , $31.50 , $11.70 , $114.24 
 Pro Respiratory Motion Management Simulation ,CPT® 77293,0982 - PRO FEE/OUTPT,N/A,N/A," $1,073.00 ", $697.45 ," $2,345.29 ", $406.68 , $371.36 ," $2,205.04 "," $2,230.07 ", $997.89 , $965.70 , $965.70 , $858.40 , $858.40 , $371.36 , $990.70 ," $1,019.35 ", $965.70 , $965.70 , $965.70 , $997.89 ," $1,030.08 "," $2,496.09 ", $912.05 ," $2,371.09 "," $2,628.89 ", N/A ," $2,248.06 "," $2,248.06 "," $1,019.35 "," $2,602.16 ", $371.36 ," $2,628.89 "
Riv4 Vacc Recombinant Dna Prsrv Antibio Free Im,CPT® 90682,N/A,N/A,N/A, $95.00 , $61.75 , N/A , $71.34 , $86.64 , N/A , N/A , $88.35 , $85.50 , $85.50 , $76.00 , $76.00 , $86.64 , $87.71 , $90.25 , $85.50 , $85.50 , $85.50 , $88.35 , $91.20 , $79.27 , $80.75 , $207.99 , $114.91 , N/A , $126.88 , $126.88 , $90.25 , $147.42 , $71.34 , $207.99 
 Pt Elect Stimu Manual 15 Min Ea ,CPT® 97032,0420 - PHYSICAL THERAPY,N/A,N/A, $110.00 , $71.50 , $92.40 , $14.33 , $23.97 , $88.88 , $99.00 , $93.13 , $99.00 , $99.00 , $99.00 , $93.50 , $23.50 , $101.56 , $104.50 , $93.50 , $102.30 , $102.30 , $104.50 , $105.60 , $90.00 , $99.00 , $93.50 , $86.90 , N/A , $89.02 , $89.02 , $104.50 , $94.39 , $14.33 , $105.60 
 SODIUM CHLORIDE 0.9 % IV SOLN (PVC-FREE) ,HCPCS RXA250,0250 - PHARMACY,00264-7800-10,500 mL, $53.21 , $34.59 , $44.70 , N/A , N/A , $42.99 , $47.89 , $45.05 , $47.89 , $47.89 , $47.89 , $45.23 , N/A , $49.13 , $50.55 , $45.23 , $49.49 , $49.49 , $50.55 , $51.08 , $43.54 , $47.89 , $45.23 , $42.04 , N/A , $43.06 , $43.06 , $50.55 , $45.66 , $42.04 , $51.08 
 Pro Radiologic Exam Small Int Single Contrast Study ,CPT® 74250,0972 - PRO FEE/RAD/DX,N/A,N/A, $290.00 , $188.50 , $713.86 , $122.45 , $77.22 , $491.78 , $578.71 , $269.70 , $261.00 , $261.00 , $232.00 , $232.00 , $77.22 , $267.76 , $275.50 , $261.00 , $261.00 , $261.00 , $269.70 , $278.40 , $696.07 , $246.50 , $631.74 , $522.08 , N/A , $501.37 , $501.37 , $275.50 , $580.35 , $77.22 , $713.86 
 ACETAMINOPHEN 80 MG PO CHEW ,HCPCS RXC637,0250 - PHARMACY,00904-5791-46,1 tablet, $0.42 , $0.27 , $0.35 , N/A , N/A , $0.34 , $0.38 , $0.36 , $0.38 , $0.38 , $0.38 , $0.36 , N/A , $0.39 , $0.40 , $0.36 , $0.39 , $0.39 , $0.40 , $0.40 , $0.34 , $0.38 , $0.36 , $0.33 , N/A , $0.34 , $0.34 , $0.40 , $0.36 , $0.33 , $0.40 
Radiation Therapy Plan Simple,CPT® 77261,N/A,N/A,N/A, $772.00 , $501.80 , $396.72 , $69.44 , $84.20 , $362.65 , $370.61 , $717.96 , $694.80 , $694.80 , $617.60 , $617.60 , $84.20 , $712.79 , $733.40 , $694.80 , $694.80 , $694.80 , $717.96 , $741.12 , $396.78 , $656.20 , $404.47 , $395.80 , N/A , $369.73 , $369.73 , $733.40 , $427.97 , $69.44 , $741.12 
Pro Placemnt Ndl Intraoss,36680,N/A,N/A,N/A, $557.00 , $362.05 , $352.37 , $55.03 , $56.64 , $254.33 , $251.09 , $518.01 , $501.30 , $501.30 , $445.60 , $445.60 , $56.64 , $514.28 , $529.15 , $501.30 , $501.30 , $501.30 , $518.01 , $534.72 , $324.91 , $473.45 , $314.00 , $287.54 , N/A , $259.29 , $259.29 , $529.15 , $294.56 , $55.03 , $534.72 
 Pro Lyr Clsr F/E/E/N/L/M&/Muc 2.5 Cm/< ,CPT® 12051,0982 - PRO FEE/OUTPT,N/A,N/A," $1,095.00 ", $711.75 , $541.38 , $162.92 , $106.23 , $469.05 , $460.11 ," $1,018.35 ", $985.50 , $985.50 , $876.00 , $876.00 , $106.23 ," $1,011.01 "," $1,040.25 ", $985.50 , $985.50 , $985.50 ," $1,018.35 "," $1,051.20 ", $593.04 , $930.75 , $917.01 , $602.22 , N/A , $478.20 , $478.20 ," $1,040.25 ", $554.57 , $106.23 ," $1,051.20 "
 Fac Assay of Theophylline ,CPT® 80198,0301 - LAB/CHEMISTRY,N/A,N/A, $130.00 , $84.50 , $109.20 , $14.42 , $14.42 , $105.04 , $117.00 , $110.06 , $117.00 , $117.00 , $117.00 , $110.50 , $14.14 , $120.03 , $123.50 , $110.50 , $120.90 , $120.90 , $123.50 , $124.80 , $106.37 , $117.00 , $110.50 , $102.70 , N/A , $105.21 , $105.21 , $123.50 , $111.55 , $14.14 , $124.80 
 Fac Platelet Antibodies ,CPT® 86022,0302 - LAB/IMMUNOLOGY,N/A,N/A, $325.00 , $211.25 , $273.00 , $18.74 , $18.74 , $262.60 , $292.50 , $275.15 , $292.50 , $292.50 , $292.50 , $276.25 , $18.37 , $300.07 , $308.75 , $276.25 , $302.25 , $302.25 , $308.75 , $312.00 , $265.92 , $292.50 , $276.25 , $256.75 , N/A , $263.02 , $263.02 , $308.75 , $278.88 , $18.37 , $312.00 
Gastroduodenostomy,CPT® 43810,N/A,N/A,N/A," $6,577.00 "," $4,275.05 "," $6,042.08 ", $934.31 , $922.06 ," $4,778.49 "," $4,814.21 "," $6,116.61 "," $5,919.30 "," $5,919.30 "," $5,261.60 "," $5,261.60 ", $922.06 ," $6,072.54 "," $6,248.15 "," $5,919.30 "," $5,919.30 "," $5,919.30 "," $6,116.61 "," $6,313.92 "," $4,330.00 "," $5,590.45 "," $5,359.33 "," $5,625.90 ", N/A ," $4,871.72 "," $4,871.72 "," $6,248.15 "," $5,095.31 ", $922.06 ," $6,313.92 "
Fluoroscopic Guidance Needle Placement Add On,CPT® 77002,N/A,N/A,N/A, $960.00 , $624.00 , $659.69 , $114.76 , $61.30 , $439.87 , $414.49 , $892.80 , $864.00 , $864.00 , $768.00 , $768.00 , $61.30 , $886.37 , $912.00 , $864.00 , $864.00 , $864.00 , $892.80 , $921.60 , $642.09 , $816.00 , $452.62 , $476.71 , N/A , $448.45 , $448.45 , $912.00 , $519.08 , $61.30 , $921.60 
Prq Transluminal Mechanical Thrombectomy Vein,CPT® 37187,N/A,N/A,N/A," $14,268.00 "," $9,274.20 "," $2,349.10 ", $362.17 ," $2,378.00 "," $1,778.90 "," $1,751.92 "," $13,269.24 "," $12,841.20 "," $12,841.20 "," $11,414.40 "," $11,414.40 "," $2,378.00 "," $13,173.64 "," $13,554.60 "," $12,841.20 "," $12,841.20 "," $12,841.20 "," $13,269.24 "," $13,697.28 "," $2,176.71 "," $12,127.80 "," $2,158.72 "," $1,941.08 ", N/A ," $1,813.60 "," $1,813.60 "," $13,554.60 "," $2,060.26 ", $362.17 ," $13,697.28 "
 Fac Telehealth Facility Fee ,HCPCS Q3014,0780 - TELEMEDICINE - GENERAL,N/A,N/A, $78.00 , $50.70 , $65.52 , N/A , $23.14 , $63.02 , $70.20 , $66.03 , $70.20 , $70.20 , $70.20 , $66.30 , $22.69 , $72.02 , $74.10 , $66.30 , $72.54 , $72.54 , $74.10 , $74.88 , $63.82 , $70.20 , $66.30 , $61.62 , N/A , $63.13 , $63.13 , $74.10 , $66.93 , $22.69 , $74.88 
 Pro Debride Infected Skin ,CPT® 11000,0982 - PRO FEE/OUTPT,N/A,N/A, $287.00 , $186.55 , $90.07 , $26.43 , $32.99 , $79.59 , $75.61 , $266.91 , $258.30 , $258.30 , $229.60 , $229.60 , $32.99 , $264.99 , $272.65 , $258.30 , $258.30 , $258.30 , $266.91 , $275.52 , $99.34 , $243.95 , $148.08 , $101.80 , N/A , $81.14 , $81.14 , $272.65 , $94.10 , $26.43 , $275.52 
 Fac Fluorescent Noninfectious Agent Antibody: Screen: Each Antibody ,CPT® 86255,0300 - LABORATORY,N/A,N/A, $146.00 , $94.90 , $122.64 , $12.29 , $12.29 , $117.97 , $131.40 , $123.60 , $131.40 , $131.40 , $131.40 , $124.10 , $12.05 , $134.80 , $138.70 , $124.10 , $135.78 , $135.78 , $138.70 , $140.16 , $119.46 , $131.40 , $124.10 , $115.34 , N/A , $118.16 , $118.16 , $138.70 , $125.28 , $12.05 , $140.16 
CT Scan of Leg Contrast,CPT® 73701,N/A,N/A,N/A," $3,699.00 "," $2,404.35 "," $1,188.95 ", $170.34 , $292.14 ," $1,075.69 "," $1,372.82 "," $3,440.07 "," $3,329.10 "," $3,329.10 "," $2,959.20 "," $2,959.20 ", $292.14 ," $3,415.29 "," $3,514.05 "," $3,329.10 "," $3,329.10 "," $3,329.10 "," $3,440.07 "," $3,551.04 "," $1,000.23 "," $3,144.15 "," $1,494.61 "," $1,464.57 ", N/A ," $1,096.68 "," $1,096.68 "," $3,514.05 "," $1,269.43 ", $170.34 ," $3,551.04 "
Cmbnd Anterpost Colporraphy W/Cysto,57260,N/A,N/A,N/A," $4,964.00 "," $3,226.60 "," $3,680.35 ", $744.02 , $768.38 ," $3,395.95 "," $3,378.00 "," $4,616.52 "," $4,467.60 "," $4,467.60 "," $3,971.20 "," $3,971.20 ", $768.38 ," $4,583.26 "," $4,715.80 "," $4,467.60 "," $4,467.60 "," $4,467.60 "," $4,616.52 "," $4,765.44 "," $3,841.26 "," $4,219.40 "," $4,435.18 "," $3,123.34 ", N/A ," $3,462.21 "," $3,462.21 "," $4,715.80 "," $4,152.72 ", $744.02 ," $4,765.44 "
 Pro MR Angiography Head W/O Dye ,CPT® 70544,0972 - PRO FEE/RAD/DX,N/A,N/A, $657.00 , $427.05 ," $1,543.08 ", $220.97 , $403.88 ," $1,863.94 "," $2,422.82 ", $611.01 , $591.30 , $591.30 , $525.60 , $525.60 , $403.88 , $606.61 , $624.15 , $591.30 , $591.30 , $591.30 , $611.01 , $630.72 ," $1,319.59 ", $558.45 ," $2,640.60 "," $2,189.99 ", N/A ," $1,900.31 "," $1,900.31 ", $624.15 ," $2,199.64 ", $220.97 ," $2,640.60 "
"N.Gonorrhoeae, Dna, Amp Prob",CPT® 87591,N/A,N/A,N/A, $317.00 , $206.05 , N/A , $35.79 , $35.79 , $198.56 , $237.51 , $294.81 , $285.30 , $285.30 , $253.60 , $253.60 , $35.79 , $292.69 , $301.15 , $285.30 , $285.30 , $285.30 , $294.81 , $304.32 , $234.30 , $269.45 , $230.30 , $127.26 , N/A , $185.31 , $185.31 , $301.15 , $202.50 , $35.79 , $304.32 
Treat Thumb Dislocation,26641,N/A,N/A,N/A," $2,457.00 "," $1,597.05 "," $2,367.82 ", $373.63 , $58.71 ," $1,653.94 "," $1,633.22 "," $2,285.01 "," $2,211.30 "," $2,211.30 "," $1,965.60 "," $1,965.60 ", $58.71 ," $2,268.55 "," $2,334.15 "," $2,211.30 "," $2,211.30 "," $2,211.30 "," $2,285.01 "," $2,358.72 "," $2,180.49 "," $2,088.45 "," $1,791.20 "," $1,971.42 ", N/A ," $1,686.21 "," $1,686.21 "," $2,334.15 "," $1,981.90 ", $58.71 ," $2,367.82 "
 Pro Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level ,CPT® 64483,0982 - PRO FEE/OUTPT,N/A,N/A," $1,016.00 ", $660.40 , $550.37 , $106.70 , $205.84 , $636.12 , $622.08 , $944.88 , $914.40 , $914.40 , $812.80 , $812.80 , $205.84 , $938.07 , $965.20 , $914.40 , $914.40 , $914.40 , $944.88 , $975.36 , $598.03 , $863.60 , $604.80 , $680.05 , N/A , $648.53 , $648.53 , $965.20 , $695.74 , $106.70 , $975.36 
 Pro Exc Tr-Ext B9+Marg > 4.0 Cm ,CPT® 11406,0982 - PRO FEE/OUTPT,N/A,N/A," $1,487.00 ", $966.55 , $784.82 , $234.46 , $381.08 , $667.03 , $648.45 ," $1,382.91 "," $1,338.30 "," $1,338.30 "," $1,189.60 "," $1,189.60 ", $381.08 ," $1,372.95 "," $1,412.65 "," $1,338.30 "," $1,338.30 "," $1,338.30 "," $1,382.91 "," $1,427.52 ", $857.06 ," $1,263.95 "," $1,302.37 ", $852.08 , N/A , $680.04 , $680.04 ," $1,412.65 ", $788.62 , $234.46 ," $1,427.52 "
 MISOPROSTOL 25 MCG DOSE ,HCPCS RXC637,0250 - PHARMACY,00001-0313-01,1 tablet, $5.04 , $3.28 , $4.23 , N/A , N/A , $4.07 , $4.54 , $4.27 , $4.54 , $4.54 , $4.54 , $4.28 , N/A , $4.65 , $4.79 , $4.28 , $4.69 , $4.69 , $4.79 , $4.84 , $4.12 , $4.54 , $4.28 , $3.98 , N/A , $4.08 , $4.08 , $4.79 , $4.32 , $3.98 , $4.84 
Antibody West Nile Virus Igm,CPT® 86788,N/A,N/A,N/A, $137.00 , $89.05 , N/A , $17.19 , $8.07 , $32.88 , $39.34 , $127.41 , $123.30 , $123.30 , $109.60 , $109.60 , $8.07 , $126.49 , $130.15 , $123.30 , $123.30 , $123.30 , $127.41 , $131.52 , $112.51 , $116.45 , $110.29 , $61.09 , N/A , $30.69 , $30.69 , $130.15 , $33.54 , $8.07 , $131.52 
 Pro Xcapsl Ctrc Rmvl Insj Io Lens Prsth Cplx Insj 1+ ,CPT® 66989,0975 - PRO FEE/OR,N/A,N/A," $8,476.00 "," $5,509.40 "," $5,267.47 ", $825.16 , $590.85 , N/A , N/A ," $7,882.68 "," $7,628.40 "," $7,628.40 "," $6,780.80 "," $6,780.80 ", $590.85 ," $7,825.89 "," $8,052.20 "," $7,628.40 "," $7,628.40 "," $7,628.40 "," $7,882.68 "," $8,136.96 ", N/A ," $7,204.60 "," $4,460.13 "," $6,233.11 ", N/A ," $4,495.88 "," $4,495.88 "," $8,052.20 "," $4,964.19 ", $590.85 ," $8,136.96 "
"Aminolevulinic Acid, 10% Gel",HCPCS J7345,N/A,N/A,N/A, $3.00 , $1.95 , N/A , $1.68 , N/A , N/A , N/A , $2.79 , $2.70 , $2.70 , $2.40 , $2.40 , N/A , $2.77 , $2.85 , $2.70 , $2.70 , $2.70 , $2.79 , $2.88 , $2.09 , $2.55 , $3.23 , $2.11 , N/A , N/A , N/A , $2.85 , N/A , $1.68 , $3.23 
 DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP ,HCPCS 90700,0636 - DRUGS REQUIRING DETAILED CODIN,58160-0810-52,0.5 mL, $170.43 , $110.78 , $143.16 , N/A , $15.30 , $137.71 , $153.39 , $144.29 , $153.39 , $153.39 , $153.39 , $144.87 , $15.00 , $157.36 , $161.91 , $144.87 , $158.50 , $158.50 , $161.91 , $163.61 , $139.45 , $153.39 , $144.87 , $134.64 , N/A , $137.93 , $137.93 , $161.91 , $146.25 , $15.00 , $163.61 
"Incis Iliopsoas,Open",CPT® 27005,N/A,N/A,N/A," $4,803.00 "," $3,121.95 "," $4,399.27 ", $682.72 , $461.04 ," $3,493.56 "," $3,482.07 "," $4,466.79 "," $4,322.70 "," $4,322.70 "," $3,842.40 "," $3,842.40 ", $461.04 ," $4,434.61 "," $4,562.85 "," $4,322.70 "," $4,322.70 "," $4,322.70 "," $4,466.79 "," $4,610.88 "," $4,068.35 "," $4,082.55 "," $3,846.44 "," $4,119.21 ", N/A ," $3,561.72 "," $3,561.72 "," $4,562.85 "," $4,186.30 ", $461.04 ," $4,610.88 "
 Pro Cltx Rdl&UR Shft Fxs W/O Mnpj ,CPT® 25560,0981 - PRO FEE/ER,N/A,N/A," $1,239.00 ", $805.35 ," $1,610.31 ", $255.85 , $202.15 ," $1,207.93 "," $1,232.28 "," $1,152.27 "," $1,115.10 "," $1,115.10 ", $991.20 , $991.20 , $202.15 ," $1,143.97 "," $1,177.05 "," $1,115.10 "," $1,115.10 "," $1,115.10 "," $1,152.27 "," $1,189.44 "," $1,481.60 "," $1,053.15 "," $1,352.32 "," $1,443.52 ", N/A ," $1,231.51 "," $1,231.51 "," $1,177.05 "," $1,447.45 ", $202.15 ," $1,610.31 "
" Fac Immunoassay, Tumor, Ca 19-9 ",CPT® 86301,0302 - LAB/IMMUNOLOGY,N/A,N/A, $222.00 , $144.30 , $186.48 , $21.23 , $21.23 , $179.38 , $199.80 , $187.95 , $199.80 , $199.80 , $199.80 , $188.70 , $20.81 , $204.97 , $210.90 , $188.70 , $206.46 , $206.46 , $210.90 , $213.12 , $181.64 , $199.80 , $188.70 , $175.38 , N/A , $179.66 , $179.66 , $210.90 , $190.50 , $20.81 , $213.12 
Removal Prepatella Bursa,CPT® 27340,N/A,N/A,N/A," $1,563.00 "," $1,015.95 "," $2,302.37 ", $362.46 , $307.34 ," $1,790.25 "," $1,800.84 "," $1,453.59 "," $1,406.70 "," $1,406.70 "," $1,250.40 "," $1,250.40 ", $307.34 ," $1,443.12 "," $1,484.85 "," $1,406.70 "," $1,406.70 "," $1,406.70 "," $1,453.59 "," $1,500.48 "," $2,129.87 "," $1,328.55 "," $1,982.10 "," $2,116.27 ", N/A ," $1,825.18 "," $1,825.18 "," $1,484.85 "," $2,145.24 ", $307.34 ," $2,302.37 "
 FLUOROURACIL 2.5 GM/50ML IV SOLN ,HCPCS J9190,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0117-51,50 mL, $79.11 , $51.42 , $66.45 , $1.87 , $2.57 , $63.92 , $71.20 , $66.97 , $71.20 , $71.20 , $71.20 , $67.24 , $2.52 , $73.04 , $75.15 , $67.24 , $73.57 , $73.57 , $75.15 , $75.95 , $64.73 , $71.20 , $67.24 , $62.50 , N/A , $64.02 , $64.02 , $75.15 , $67.88 , $1.87 , $75.95 
Clsd Tx Pelvic Ring Fx W/O Manipulation,CPT® 27197,N/A,N/A,N/A, $789.00 , $512.85 , $820.37 , $128.05 , $92.69 , $546.83 , $560.39 , $733.77 , $710.10 , $710.10 , $631.20 , $631.20 , $92.69 , $728.48 , $749.55 , $710.10 , $710.10 , $710.10 , $733.77 , $757.44 , $750.35 , $670.65 , $714.33 , $684.37 , N/A , $557.50 , $557.50 , $749.55 , $655.27 , $92.69 , $820.37 
 Pro Treat Knee Fracture ,CPT® 27530,0982 - PRO FEE/OUTPT,N/A,N/A," $1,636.00 "," $1,063.40 "," $1,803.82 ", $285.61 , $164.92 ," $1,350.84 "," $1,377.36 "," $1,521.48 "," $1,472.40 "," $1,472.40 "," $1,308.80 "," $1,308.80 ", $164.92 ," $1,510.52 "," $1,554.20 "," $1,472.40 "," $1,472.40 "," $1,472.40 "," $1,521.48 "," $1,570.56 "," $1,654.54 "," $1,390.60 "," $1,511.10 "," $1,607.37 ", N/A ," $1,377.20 "," $1,377.20 "," $1,554.20 "," $1,618.70 ", $164.92 ," $1,803.82 "
 Pro Microslide Consultation ,CPT® 88323,0971 - PRO FEE/LAB,N/A,N/A, $611.00 , $397.15 , $409.15 , $113.71 , $112.79 , $609.70 , $653.24 , $568.23 , $549.90 , $549.90 , $488.80 , $488.80 , $112.79 , $564.14 , $580.45 , $549.90 , $549.90 , $549.90 , $568.23 , $586.56 , $742.31 , $519.35 , $674.69 , $430.11 , N/A , $569.01 , $569.01 , $580.45 , $625.32 , $112.79 , $742.31 
 Fac Ko Elas W/ Condyle Pads & Jo ,HCPCS L1820,0274 - PROSTHETIC DEV,N/A,N/A, $220.00 , $143.00 , $184.80 , $166.24 , $75.59 , $177.76 , $198.00 , $186.25 , $198.00 , $198.00 , $198.00 , $187.00 , $74.11 , $203.13 , $209.00 , $187.00 , $204.60 , $204.60 , $209.00 , $211.20 , $180.00 , $198.00 , $187.00 , $173.80 , N/A , $178.05 , $178.05 , $209.00 , $188.78 , $74.11 , $211.20 
 Pro Emergency Department Visit Low Mdm ,CPT® 99283,0981 - PRO FEE/ER,N/A,N/A, $376.00 , $244.40 , $251.49 , $68.75 , $26.96 , $174.00 , $179.09 , $349.68 , $338.40 , $338.40 , $300.80 , $300.80 , $26.96 , $347.16 , $357.20 , $338.40 , $338.40 , $338.40 , $349.68 , $360.96 , $213.09 , $319.60 , $132.02 , $134.13 , $74.50 , $177.39 , $177.39 , $357.20 , $212.87 , $26.96 , $360.96 
 Pfizer Vac Admin 6 Mo-5 Yrs 1st Dose ,CPT® 0081A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
 Fac Remove Cva Device Obstruct ,CPT® 75901,0320 - DX X-RAY,N/A,N/A," $2,512.00 "," $1,632.80 "," $2,110.08 ", $227.42 , $88.54 ," $2,029.70 "," $2,260.80 "," $2,126.66 "," $2,260.80 "," $2,260.80 "," $2,260.80 "," $2,135.20 ", $86.80 ," $2,319.33 "," $2,386.40 "," $2,135.20 "," $2,336.16 "," $2,336.16 "," $2,386.40 "," $2,411.52 "," $2,055.32 "," $2,260.80 "," $2,135.20 "," $1,984.48 ", N/A ," $2,032.96 "," $2,032.96 "," $2,386.40 "," $2,155.55 ", $86.80 ," $2,411.52 "
"Cystoscopy,Remv Calculus,Simple",CPT® 52310,N/A,N/A,N/A," $1,809.00 "," $1,175.85 ", $811.61 , $142.63 , $249.02 , $741.48 , $689.79 ," $1,682.37 "," $1,628.10 "," $1,628.10 "," $1,447.20 "," $1,447.20 ", $249.02 ," $1,670.25 "," $1,718.55 "," $1,628.10 "," $1,628.10 "," $1,628.10 "," $1,682.37 "," $1,736.64 ", $815.26 ," $1,537.65 ", $783.20 , $931.02 , N/A , $755.96 , $755.96 ," $1,718.55 ", $888.49 , $142.63 ," $1,736.64 "
Arthrodesis Posterior/Pstlat Tq 1ntrspc Lumbar,CPT® 22612,N/A,N/A,N/A," $10,402.00 "," $6,761.30 "," $9,332.70 "," $1,456.19 "," $1,378.66 "," $7,612.21 "," $7,522.61 "," $9,673.86 "," $9,361.80 "," $9,361.80 "," $8,321.60 "," $8,321.60 "," $1,378.66 "," $9,604.17 "," $9,881.90 "," $9,361.80 "," $9,361.80 "," $9,361.80 "," $9,673.86 "," $9,985.92 "," $8,703.45 "," $8,841.70 "," $8,449.33 "," $8,845.33 ", N/A ," $7,760.74 "," $7,760.74 "," $9,881.90 "," $9,121.63 "," $1,378.66 "," $9,985.92 "
 Fac Radiologic Exam Upr GI Trc Single Contrast Study ,CPT® 74240,0320 - DX X-RAY,N/A,N/A," $1,945.00 "," $1,264.25 "," $1,633.80 ", $123.09 , $96.74 ," $1,571.56 "," $1,750.50 "," $1,646.64 "," $1,750.50 "," $1,750.50 "," $1,750.50 "," $1,653.25 ", $94.84 ," $1,795.82 "," $1,847.75 "," $1,653.25 "," $1,808.85 "," $1,808.85 "," $1,847.75 "," $1,867.20 "," $1,591.40 "," $1,750.50 "," $1,653.25 "," $1,536.55 ", N/A ," $1,574.09 "," $1,574.09 "," $1,847.75 "," $1,669.00 ", $94.84 ," $1,867.20 "
X-Ray Urethrocystogram+Voiding,CPT® 74455,N/A,N/A,N/A," $1,259.00 ", $818.35 , $602.50 , $103.57 , $79.78 , $385.42 , $451.26 ," $1,170.87 "," $1,133.10 "," $1,133.10 "," $1,007.20 "," $1,007.20 ", $79.78 ," $1,162.43 "," $1,196.05 "," $1,133.10 "," $1,133.10 "," $1,133.10 "," $1,170.87 "," $1,208.64 ", $583.24 ," $1,070.15 ", $491.14 , $416.42 , N/A , $392.94 , $392.94 ," $1,196.05 ", $454.83 , $79.78 ," $1,208.64 "
 Fac or Minor Procedure Rm Base ,Custom OPTORMPRBASE,0360 - OR SERVICES,N/A,N/A, $743.00 , $482.95 , $624.12 , N/A , N/A , $600.34 , $668.70 , $629.02 , $668.70 , $668.70 , $668.70 , $631.55 , N/A , $686.01 , $705.85 , $631.55 , $690.99 , $690.99 , $705.85 , $713.28 , $607.92 , $668.70 , $631.55 , $586.97 , N/A , $601.31 , $601.31 , $705.85 , $637.57 , $586.97 , $713.28 
 Pro Home/Res Visit Est Patient Sf Mdm 20 Minutes ,CPT® 99347,0987 - PRO FEE/HOS VIS,N/A,N/A, $146.00 , $94.90 , $110.04 , $44.02 , $40.81 , $95.28 , $96.34 , $135.78 , $131.40 , $131.40 , $116.80 , $116.80 , $40.81 , $134.80 , $138.70 , $131.40 , $131.40 , $131.40 , $135.78 , $140.16 , $99.81 , $124.10 , $120.02 , $120.72 , $58.00 , $97.14 , $97.14 , $138.70 , $112.03 , $40.81 , $140.16 
 HYDROXYZINE HCL 50 MG/ML IM SOLN ,HCPCS J3410,0636 - DRUGS REQUIRING DETAILED CODIN,00517-5601-25,1.2 mL, $208.09 , $135.26 , $174.80 , $13.89 , $13.37 , $168.14 , $187.28 , $176.17 , $187.28 , $187.28 , $187.28 , $176.88 , $13.11 , $192.13 , $197.69 , $176.88 , $193.52 , $193.52 , $197.69 , $199.77 , $170.26 , $187.28 , $176.88 , $164.39 , N/A , $168.41 , $168.41 , $197.69 , $178.56 , $13.11 , $199.77 
 Fac Fasct Foot&/Toe ,CPT® 28008,0360 - OR SERVICES,N/A,N/A," $1,339.00 ", $870.35 ," $1,124.76 ", $287.22 , $153.67 ," $1,081.91 "," $1,205.10 "," $1,133.60 "," $1,205.10 "," $1,205.10 "," $1,205.10 "," $1,138.15 ", $150.66 ," $1,236.30 "," $1,272.05 "," $1,138.15 "," $1,245.27 "," $1,245.27 "," $1,272.05 "," $1,285.44 "," $1,095.57 "," $1,205.10 "," $1,138.15 "," $1,057.81 ", N/A ," $1,083.65 "," $1,083.65 "," $1,272.05 "," $1,149.00 ", $150.66 ," $1,285.44 "
"Delay/Sectn Flap Lid,Nos,Ear,Lip",CPT® 15630,N/A,N/A,N/A," $2,843.00 "," $1,847.95 "," $1,100.31 ", $331.87 , $319.63 , $948.02 , $940.72 ," $2,643.99 "," $2,558.70 "," $2,558.70 "," $2,274.40 "," $2,274.40 ", $319.63 ," $2,624.94 "," $2,700.85 "," $2,558.70 "," $2,558.70 "," $2,558.70 "," $2,643.99 "," $2,729.28 "," $1,201.37 "," $2,416.55 "," $1,871.48 "," $1,210.52 ", N/A , $966.51 , $966.51 ," $2,700.85 "," $1,120.83 ", $319.63 ," $2,729.28 "
 Neuromuscular Junction Testing ,CPT® 95937,0922 - EMG,N/A,N/A, $386.00 , $250.90 , $324.24 , $103.46 , $61.92 , $311.89 , $347.40 , $326.79 , $347.40 , $347.40 , $347.40 , $328.10 , $60.71 , $356.39 , $366.70 , $328.10 , $358.98 , $358.98 , $366.70 , $370.56 , $315.83 , $347.40 , $328.10 , $304.94 , N/A , $312.39 , $312.39 , $366.70 , $331.23 , $60.71 , $370.56 
Hep C Screen High Risk/Other,HCPCS G0472,N/A,N/A,N/A, $181.00 , $117.65 , N/A , $47.28 , N/A , N/A , N/A , $168.33 , $162.90 , $162.90 , $144.80 , $144.80 , N/A , $167.12 , $171.95 , $162.90 , $162.90 , $162.90 , $168.33 , $173.76 , $309.49 , $153.85 , $88.52 , $136.13 , N/A , $85.70 , $85.70 , $171.95 , $107.11 , $47.28 , $309.49 
 Fac Doppler Color Flow Add-On ,CPT® 93325,0483 - CARDIOLOGY – ECHOCARDIOLOGY,N/A,N/A, $350.00 , $227.50 , $294.00 , $23.10 , $70.32 , $282.80 , $315.00 , $296.31 , $315.00 , $315.00 , $315.00 , $297.50 , $68.94 , $323.16 , $332.50 , $297.50 , $325.50 , $325.50 , $332.50 , $336.00 , $286.37 , $315.00 , $297.50 , $276.50 , N/A , $283.26 , $283.26 , $332.50 , $300.34 , $23.10 , $336.00 
 Fac Creatinine Clearance Test ,CPT® 82575,0301 - LAB/CHEMISTRY,N/A,N/A, $135.00 , $87.75 , $113.40 , $9.65 , $9.65 , $109.08 , $121.50 , $114.29 , $121.50 , $121.50 , $121.50 , $114.75 , $9.46 , $124.65 , $128.25 , $114.75 , $125.55 , $125.55 , $128.25 , $129.60 , $110.46 , $121.50 , $114.75 , $106.65 , N/A , $109.26 , $109.26 , $128.25 , $115.84 , $9.46 , $129.60 
Ablation & Rcnstj Atria X10sv W/O Bypass,CPT® 33255,N/A,N/A,N/A," $10,225.00 "," $6,646.25 "," $9,512.95 "," $1,470.43 "," $1,313.54 "," $6,986.68 "," $6,967.72 "," $9,509.25 "," $9,202.50 "," $9,202.50 "," $8,180.00 "," $8,180.00 "," $1,313.54 "," $9,440.74 "," $9,713.75 "," $9,202.50 "," $9,202.50 "," $9,202.50 "," $9,509.25 "," $9,816.00 "," $8,805.39 "," $8,691.25 "," $8,838.25 "," $7,842.44 ", N/A ," $7,123.00 "," $7,123.00 "," $9,713.75 "," $8,091.72 "," $1,313.54 "," $9,816.00 "
Treat Femoral Shft Fractr,27500,N/A,N/A,N/A," $3,015.00 "," $1,959.75 "," $2,938.33 ", $463.26 , $614.70 ," $2,318.06 "," $2,302.07 "," $2,803.95 "," $2,713.50 "," $2,713.50 "," $2,412.00 "," $2,412.00 ", $614.70 ," $2,783.75 "," $2,864.25 "," $2,713.50 "," $2,713.50 "," $2,713.50 "," $2,803.95 "," $2,894.40 "," $2,729.51 "," $2,562.75 "," $2,538.72 "," $2,731.05 ", N/A ," $2,363.29 "," $2,363.29 "," $2,864.25 "," $2,777.72 ", $463.26 ," $2,938.33 "
 Fac Perc D-E Cor Stent Ather S ,HCPCS C9602,0481 - CARDIAC CATH LAB,N/A,N/A," $15,529.00 "," $10,093.85 "," $13,044.36 ", N/A , N/A ," $12,547.43 "," $13,976.10 "," $13,146.85 "," $13,976.10 "," $13,976.10 "," $13,976.10 "," $13,199.65 ", N/A ," $14,337.93 "," $14,752.55 "," $13,199.65 "," $14,441.97 "," $14,441.97 "," $14,752.55 "," $14,907.84 "," $12,705.83 "," $13,976.10 "," $13,199.65 "," $12,267.91 ", N/A ," $12,567.62 "," $12,567.62 "," $14,752.55 "," $13,325.43 "," $12,267.91 "," $14,907.84 "
 Fac Hemorrhoidectomy Smpl Ligature ,CPT® 46221,0360 - OR SERVICES,N/A,N/A," $3,950.00 "," $2,567.50 "," $3,318.00 ", $185.85 , $46.08 ," $3,191.60 "," $3,555.00 "," $3,344.07 "," $3,555.00 "," $3,555.00 "," $3,555.00 "," $3,357.50 ", $45.18 ," $3,647.04 "," $3,752.50 "," $3,357.50 "," $3,673.50 "," $3,673.50 "," $3,752.50 "," $3,792.00 "," $3,231.89 "," $3,555.00 "," $3,357.50 "," $3,120.50 ", N/A ," $3,196.74 "," $3,196.74 "," $3,752.50 "," $3,389.50 ", $45.18 ," $3,792.00 "
 Fac Rapid 10 Pnl Urine Drg Scrn Occ Hlth ,Custom 3000000004,0300 - LABORATORY,N/A,N/A, $64.00 , $41.60 , $53.76 , N/A , N/A , $51.71 , $57.60 , $54.18 , $57.60 , $57.60 , $57.60 , $54.40 , N/A , $59.09 , $60.80 , $54.40 , $59.52 , $59.52 , $60.80 , $61.44 , $52.36 , $57.60 , $54.40 , $50.56 , N/A , $51.80 , $51.80 , $60.80 , $54.92 , $50.56 , $61.44 
Brnchsc Ebus Guided Sampl 3/> Node Station/Strux,CPT® 31653,N/A,N/A,N/A," $7,283.00 "," $4,733.95 "," $1,341.48 ", $232.37 , $763.89 ," $1,005.72 ", $920.88 ," $6,773.19 "," $6,554.70 "," $6,554.70 "," $5,826.40 "," $5,826.40 ", $763.89 ," $6,724.39 "," $6,918.85 "," $6,554.70 "," $6,554.70 "," $6,554.70 "," $6,773.19 "," $6,991.68 "," $1,299.84 "," $6,190.55 "," $1,266.96 "," $1,286.34 ", N/A ," $1,025.35 "," $1,025.35 "," $6,918.85 "," $1,207.56 ", $232.37 ," $6,991.68 "
Inject Second Level Cervical/Thoracic,CPT® 64491,N/A,N/A,N/A, $622.00 , $404.30 , $294.27 , $56.83 , $69.04 , $339.59 , $330.47 , $578.46 , $559.80 , $559.80 , $497.60 , $497.60 , $69.04 , $574.29 , $590.90 , $559.80 , $559.80 , $559.80 , $578.46 , $597.12 , $320.57 , $528.70 , $322.92 , $364.80 , N/A , $346.22 , $346.22 , $590.90 , $371.43 , $56.83 , $597.12 
 Fac Destruction Benign Lesions Up to 14 ,CPT® 17110,0761 - TREATMENT ROOM,N/A,N/A, $374.00 , $243.10 , $314.16 , $65.34 , $26.07 , $302.19 , $336.60 , $316.63 , $336.60 , $336.60 , $336.60 , $317.90 , $25.56 , $345.31 , $355.30 , $317.90 , $347.82 , $347.82 , $355.30 , $359.04 , $306.01 , $336.60 , $317.90 , $295.46 , N/A , $302.68 , $302.68 , $355.30 , $320.93 , $25.56 , $359.04 
Insertion Picc W/O Img Gdn < 5 Yr,CPT® 36568,N/A,N/A,N/A," $2,789.00 "," $1,812.85 ", $562.77 , $87.14 , $92.52 , $436.68 , $417.56 ," $2,593.77 "," $2,510.10 "," $2,510.10 "," $2,231.20 "," $2,231.20 ", $92.52 ," $2,575.08 "," $2,649.55 "," $2,510.10 "," $2,510.10 "," $2,510.10 "," $2,593.77 "," $2,677.44 ", $520.11 ," $2,370.65 ", $506.67 , $372.27 , N/A , $445.20 , $445.20 ," $2,649.55 ", $505.75 , $87.14 ," $2,677.44 "
Treat Femoral Shaft Frctr,27501,N/A,N/A,N/A," $2,930.00 "," $1,904.50 "," $3,045.32 ", $478.84 , $451.87 ," $2,402.73 "," $2,405.11 "," $2,724.90 "," $2,637.00 "," $2,637.00 "," $2,344.00 "," $2,344.00 ", $451.87 ," $2,705.27 "," $2,783.50 "," $2,637.00 "," $2,637.00 "," $2,637.00 "," $2,724.90 "," $2,812.80 "," $2,825.08 "," $2,490.50 "," $2,654.69 "," $2,834.30 ", N/A ," $2,449.62 "," $2,449.62 "," $2,783.50 "," $2,879.15 ", $451.87 ," $3,045.32 "
 ONDANSETRON 4 MG PO TBDP ,HCPCS RXA250,0250 - PHARMACY,68462-0157-13,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Imp Spinal Canal Cath ,CPT® 62350,0360 - OR SERVICES,N/A,N/A," $8,542.00 "," $5,552.30 "," $7,175.28 ", $375.49 , $340.77 ," $6,901.94 "," $7,687.80 "," $7,231.66 "," $7,687.80 "," $7,687.80 "," $7,687.80 "," $7,260.70 ", $334.09 ," $7,886.83 "," $8,114.90 "," $7,260.70 "," $7,944.06 "," $7,944.06 "," $8,114.90 "," $8,200.32 "," $6,989.06 "," $7,687.80 "," $7,260.70 "," $6,748.18 ", N/A ," $6,913.04 "," $6,913.04 "," $8,114.90 "," $7,329.89 ", $334.09 ," $8,200.32 "
 DANTROLENE SODIUM 20 MG IV SOLR ,HCPCS RXA250,0250 - PHARMACY,42023-0123-06,60 mL, $546.40 , $355.16 , $458.98 , N/A , N/A , $441.49 , $491.76 , $462.58 , $491.76 , $491.76 , $491.76 , $464.44 , N/A , $504.49 , $519.08 , $464.44 , $508.15 , $508.15 , $519.08 , $524.54 , $447.06 , $491.76 , $464.44 , $431.66 , N/A , $442.20 , $442.20 , $519.08 , $468.87 , $431.66 , $524.54 
 Pro Cltx Talotarsal Jt Dislc W/O Anes ,CPT® 28570,0981 - PRO FEE/ER,N/A,N/A, $801.00 , $520.65 ," $1,213.81 ", $193.02 , $153.67 , $710.83 , $689.70 , $744.93 , $720.90 , $720.90 , $640.80 , $640.80 , $153.67 , $739.56 , $760.95 , $720.90 , $720.90 , $720.90 , $744.93 , $768.96 ," $1,116.18 ", $680.85 , $743.95 ," $1,099.43 ", N/A , $724.69 , $724.69 , $760.95 , $851.77 , $153.67 ," $1,213.81 "
 Fac Slctv Cathj Ea 1st Ord Abdl Pel/Lxtr Art Brnch ,CPT® 36245,0761 - TREATMENT ROOM,N/A,N/A," $4,196.00 "," $2,727.40 "," $3,524.64 ", $216.04 ," $1,347.70 "," $3,390.37 "," $3,776.40 "," $3,552.33 "," $3,776.40 "," $3,776.40 "," $3,776.40 "," $3,566.60 "," $1,321.27 "," $3,874.17 "," $3,986.20 "," $3,566.60 "," $3,902.28 "," $3,902.28 "," $3,986.20 "," $4,028.16 "," $3,433.17 "," $3,776.40 "," $3,566.60 "," $3,314.84 ", N/A ," $3,395.82 "," $3,395.82 "," $3,986.20 "," $3,600.59 ", $216.04 ," $4,028.16 "
 Fac Dial Trainj Compld Course ,CPT® 90989,0851 - CCPD/COMPOSITE,N/A,N/A," $1,327.00 ", $862.55 ," $1,114.68 ", N/A , $419.04 ," $1,072.22 "," $1,194.30 "," $1,123.44 "," $1,194.30 "," $1,194.30 "," $1,194.30 "," $1,127.95 ", $410.82 ," $1,225.22 "," $1,260.65 "," $1,127.95 "," $1,234.11 "," $1,234.11 "," $1,260.65 "," $1,273.92 "," $1,085.75 "," $1,194.30 "," $1,127.95 "," $1,048.33 ", N/A ," $1,073.94 "," $1,073.94 "," $1,260.65 "," $1,138.70 ", $410.82 ," $1,273.92 "
 Fac Mod Sed Same Phys/Qhp Initial 15 Mins 5/> Yrs ,CPT® 99152,0371 - ANESTHES/RADIOLOGY,N/A,N/A, $227.00 , $147.55 , $190.68 , $11.70 , $40.63 , $183.42 , $204.30 , $192.18 , $204.30 , $204.30 , $204.30 , $192.95 , $39.83 , $209.59 , $215.65 , $192.95 , $211.11 , $211.11 , $215.65 , $217.92 , $185.73 , $204.30 , $192.95 , $179.33 , N/A , $183.71 , $183.71 , $215.65 , $194.79 , $11.70 , $217.92 
 VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML SC INJ ,HCPCS RXA250,0250 - PHARMACY,00006-4827-00,0.5 mL," $1,073.81 ", $697.98 , $902.00 , N/A , N/A , $867.64 , $966.43 , $909.09 , $966.43 , $966.43 , $966.43 , $912.74 , N/A , $991.45 ," $1,020.12 ", $912.74 , $998.64 , $998.64 ," $1,020.12 "," $1,030.86 ", $878.59 , $966.43 , $912.74 , $848.31 , N/A , $869.03 , $869.03 ," $1,020.12 ", $921.44 , $848.31 ," $1,030.86 "
 NIACIN ER (ANTIHYPERLIPIDEMIC) 500 MG PO TBCR ,HCPCS RXC637,0250 - PHARMACY,59651-0018-90,1 tablet, $21.77 , $14.15 , $18.29 , N/A , N/A , $17.59 , $19.59 , $18.43 , $19.59 , $19.59 , $19.59 , $18.50 , N/A , $20.10 , $20.68 , $18.50 , $20.25 , $20.25 , $20.68 , $20.90 , $17.81 , $19.59 , $18.50 , $17.20 , N/A , $17.62 , $17.62 , $20.68 , $18.68 , $17.20 , $20.90 
 Pro Perq Vert Agmntj Cavity Crtj Uni/Bi Cannulj Lmbr ,CPT® 22514,0975 - PRO FEE/OR,N/A,N/A," $6,109.00 "," $3,970.85 "," $2,858.05 ", $445.26 ," $5,745.46 "," $2,336.16 "," $2,468.46 "," $5,681.37 "," $5,498.10 "," $5,498.10 "," $4,887.20 "," $4,887.20 "," $5,745.46 "," $5,640.44 "," $5,803.55 "," $5,498.10 "," $5,498.10 "," $5,498.10 "," $5,681.37 "," $5,864.64 "," $2,674.79 "," $5,192.65 "," $2,510.82 "," $2,752.56 ", N/A ," $2,381.74 "," $2,381.74 "," $5,803.55 "," $2,799.39 ", $445.26 ," $5,864.64 "
"Releas Vitreous,Subret/Choroid Fluid",67015,N/A,N/A,N/A," $5,432.00 "," $3,530.80 "," $3,749.59 ", $587.04 , $515.48 ," $3,280.69 "," $3,070.50 "," $5,051.76 "," $4,888.80 "," $4,888.80 "," $4,345.60 "," $4,345.60 ", $515.48 ," $5,015.37 "," $5,160.40 "," $4,888.80 "," $4,888.80 "," $4,888.80 "," $5,051.76 "," $5,214.72 "," $5,098.36 "," $4,617.20 "," $3,154.23 "," $4,172.45 ", N/A ," $3,344.70 "," $3,344.70 "," $5,160.40 "," $3,692.12 ", $515.48 ," $5,214.72 "
 Pro Excision Tumor Soft Tissue Shoulder Subq 3+Cm ,CPT® 23071,0982 - PRO FEE/OUTPT,N/A,N/A," $3,297.00 "," $2,143.05 "," $2,536.63 ", $395.70 , $342.80 ," $2,010.77 "," $2,011.47 "," $3,066.21 "," $2,967.30 "," $2,967.30 "," $2,637.60 "," $2,637.60 ", $342.80 ," $3,044.12 "," $3,132.15 "," $2,967.30 "," $2,967.30 "," $2,967.30 "," $3,066.21 "," $3,165.12 "," $2,350.06 "," $2,802.45 "," $2,226.51 "," $2,366.34 ", N/A ," $2,050.01 "," $2,050.01 "," $3,132.15 "," $2,409.50 ", $342.80 ," $3,165.12 "
Spacer Bag/Reservoir,HCPCS A4627,N/A,N/A,N/A, $43.00 , $27.95 , N/A , N/A , $16.07 , N/A , N/A , $39.99 , $38.70 , $38.70 , $34.40 , $34.40 , $16.07 , $39.70 , $40.85 , $38.70 , $38.70 , $38.70 , $39.99 , $41.28 , N/A , $36.55 , $22.06 , $12.82 , N/A , N/A , N/A , $40.85 , N/A , $12.82 , $41.28 
 Pro Optx Post Ankle Fx ,CPT® 27769,0982 - PRO FEE/OUTPT,N/A,N/A," $6,273.00 "," $4,077.45 "," $4,436.97 ", $693.56 , $478.61 ," $3,494.63 "," $3,524.02 "," $5,833.89 "," $5,645.70 "," $5,645.70 "," $5,018.40 "," $5,018.40 ", $478.61 ," $5,791.86 "," $5,959.35 "," $5,645.70 "," $5,645.70 "," $5,645.70 "," $5,833.89 "," $6,022.08 "," $4,137.71 "," $5,332.05 "," $3,892.83 "," $4,153.59 ", N/A ," $3,562.82 "," $3,562.82 "," $5,959.35 "," $4,187.57 ", $478.61 ," $6,022.08 "
"Cystoscopy,Fragmt Ureteral Stone",CPT® 52325,N/A,N/A,N/A," $2,237.00 "," $1,454.05 "," $1,714.77 ", $301.28 ," $1,173.74 "," $1,573.39 "," $1,458.46 "," $2,080.41 "," $2,013.30 "," $2,013.30 "," $1,789.60 "," $1,789.60 "," $1,173.74 "," $2,065.42 "," $2,125.15 "," $2,013.30 "," $2,013.30 "," $2,013.30 "," $2,080.41 "," $2,147.52 "," $1,726.24 "," $1,901.45 "," $1,652.04 "," $1,975.43 ", N/A ," $1,604.10 "," $1,604.10 "," $2,125.15 "," $1,885.38 ", $301.28 ," $2,147.52 "
 ZOLPIDEM TARTRATE 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6082-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Aquatic Therapy/Exercises,CPT® 97113,N/A,N/A,N/A, $146.00 , $94.90 , $86.52 , $36.73 , $39.59 , $97.11 , $88.03 , $135.78 , $131.40 , $131.40 , $116.80 , $116.80 , $39.59 , $134.80 , $138.70 , $131.40 , $131.40 , $131.40 , $135.78 , $140.16 , $94.79 , $124.10 , $129.76 , $88.40 , N/A , $99.01 , $99.01 , $138.70 , $110.10 , $36.73 , $140.16 
 Pro Drain External Ear Lesion ,CPT® 69000,0981 - PRO FEE/ER,N/A,N/A, $718.00 , $466.70 , $587.55 , $120.89 , $30.71 , $571.83 , $595.04 , $667.74 , $646.20 , $646.20 , $574.40 , $574.40 , $30.71 , $662.93 , $682.10 , $646.20 , $646.20 , $646.20 , $667.74 , $689.28 , $631.71 , $610.30 , $649.40 , $582.65 , N/A , $582.99 , $582.99 , $682.10 , $665.66 , $30.71 , $689.28 
Cast Sup Shrt Leg Ped Fbrgls,HCPCS Q4040,N/A,N/A,N/A, $40.00 , $26.00 , N/A , $24.97 , $16.17 , N/A , N/A , $37.20 , $36.00 , $36.00 , $32.00 , $32.00 , $16.17 , $36.93 , $38.00 , $36.00 , $36.00 , $36.00 , $37.20 , $38.40 , N/A , $34.00 , $90.83 , $22.69 , N/A , N/A , N/A , $38.00 , N/A , $16.17 , $90.83 
Fit Contact Lens Tx Ocular Surface Disease,CPT® 92071,N/A,N/A,N/A, $104.00 , $67.60 , $70.70 , $31.81 , $30.64 , $59.97 , $53.95 , $96.72 , $93.60 , $93.60 , $83.20 , $83.20 , $30.64 , $96.02 , $98.80 , $93.60 , $93.60 , $93.60 , $96.72 , $99.84 , $100.14 , $88.40 , $90.22 , $72.09 , N/A , $61.14 , $61.14 , $98.80 , $72.73 , $30.64 , $100.14 
 Fac Screening Mammography Bi 2-View Breast Inc Cad ,CPT® 77067,0403 - MAMMOGRAPHY SCREENING,N/A,N/A, $488.00 , $317.20 , $409.92 , $126.63 , $108.04 , $394.30 , $439.20 , $413.14 , $439.20 , $439.20 , $439.20 , $414.80 , $105.92 , $450.57 , $463.60 , $414.80 , $453.84 , $453.84 , $463.60 , $468.48 , $399.28 , $439.20 , $414.80 , $385.52 , N/A , $394.94 , $394.94 , $463.60 , $418.75 , $105.92 , $468.48 
 Fac Insj 2 Transvns Eltrd Perm Pacemaker/Impltbl Dfb ,CPT® 33217,0360 - OR SERVICES,N/A,N/A," $3,863.00 "," $2,510.95 "," $3,244.92 ", $340.98 , $794.95 ," $3,121.30 "," $3,476.70 "," $3,270.42 "," $3,476.70 "," $3,476.70 "," $3,476.70 "," $3,283.55 ", $779.36 ," $3,566.71 "," $3,669.85 "," $3,283.55 "," $3,592.59 "," $3,592.59 "," $3,669.85 "," $3,708.48 "," $3,160.71 "," $3,476.70 "," $3,283.55 "," $3,051.77 ", N/A ," $3,126.33 "," $3,126.33 "," $3,669.85 "," $3,314.84 ", $340.98 ," $3,708.48 "
 CAPTOPRIL 12.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60687-0304-21,1 tablet, $8.73 , $5.67 , $7.33 , N/A , N/A , $7.05 , $7.86 , $7.39 , $7.86 , $7.86 , $7.86 , $7.42 , N/A , $8.06 , $8.29 , $7.42 , $8.12 , $8.12 , $8.29 , $8.38 , $7.14 , $7.86 , $7.42 , $6.90 , N/A , $7.07 , $7.07 , $8.29 , $7.49 , $6.90 , $8.38 
Pericardiocentesis Initial,CPT® 33010,N/A,N/A,N/A," $1,456.00 ", $946.40 , N/A , N/A , N/A , N/A , $496.18 ," $1,354.08 "," $1,310.40 "," $1,310.40 "," $1,164.80 "," $1,164.80 ", N/A ," $1,344.32 "," $1,383.20 "," $1,310.40 "," $1,310.40 "," $1,310.40 "," $1,354.08 "," $1,397.76 ", N/A ," $1,237.60 ", N/A , N/A , N/A , N/A , N/A ," $1,383.20 ", N/A , $496.18 ," $1,397.76 "
Foam Drg >16<=48 Sq in W/O B,HCPCS A6210,N/A,N/A,N/A, $38.00 , $24.70 , N/A , $27.03 , $10.67 , N/A , N/A , $35.34 , $34.20 , $34.20 , $30.40 , $30.40 , $10.67 , $35.09 , $36.10 , $34.20 , $34.20 , $34.20 , $35.34 , $36.48 , N/A , $32.30 , $23.36 , $24.55 , N/A , N/A , N/A , $36.10 , N/A , $10.67 , $36.48 
 PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR ,HCPCS J2543,0636 - DRUGS REQUIRING DETAILED CODIN,00781-3110-95,10 mL, $63.23 , $41.10 , $53.11 , $1.39 , $1.55 , $51.09 , $56.91 , $53.53 , $56.91 , $56.91 , $56.91 , $53.75 , $1.52 , $58.38 , $60.07 , $53.75 , $58.80 , $58.80 , $60.07 , $60.70 , $51.73 , $56.91 , $53.75 , $49.95 , N/A , $51.17 , $51.17 , $60.07 , $54.26 , $1.39 , $60.70 
Reconstruct Radial Head W Implant,24366,N/A,N/A,N/A," $4,544.00 "," $2,953.60 "," $4,159.09 ", $651.40 , $926.05 ," $3,280.79 "," $3,258.84 "," $4,225.92 "," $4,089.60 "," $4,089.60 "," $3,635.20 "," $3,635.20 ", $926.05 ," $4,195.48 "," $4,316.80 "," $4,089.60 "," $4,089.60 "," $4,089.60 "," $4,225.92 "," $4,362.24 "," $3,864.80 "," $3,862.40 "," $3,594.89 "," $3,871.17 ", N/A ," $3,344.81 "," $3,344.81 "," $4,316.80 "," $3,931.36 ", $651.40 ," $4,362.24 "
 Fac Htlv/Hiv Confirmatory Test ,CPT® 86689,0302 - LAB/IMMUNOLOGY,N/A,N/A, $169.00 , $109.85 , $141.96 , $19.74 , $19.74 , $136.55 , $152.10 , $143.08 , $152.10 , $152.10 , $152.10 , $143.65 , $19.35 , $156.04 , $160.55 , $143.65 , $157.17 , $157.17 , $160.55 , $162.24 , $138.28 , $152.10 , $143.65 , $133.51 , N/A , $136.77 , $136.77 , $160.55 , $145.02 , $19.35 , $162.24 
 Thoracic/Lumbar Junction 2 Views ,CPT® 72080,0320 - DX X-RAY,N/A,N/A, $306.00 , $198.90 , $257.04 , $34.08 , $34.04 , $247.25 , $275.40 , $259.06 , $275.40 , $275.40 , $275.40 , $260.10 , $33.37 , $282.53 , $290.70 , $260.10 , $284.58 , $284.58 , $290.70 , $293.76 , $250.37 , $275.40 , $260.10 , $241.74 , N/A , $247.65 , $247.65 , $290.70 , $262.58 , $33.37 , $293.76 
"Preventive Visit,Est, Infant < 1 Yr",CPT® 99391,N/A,N/A,N/A, $291.00 , $189.15 , N/A , $95.84 , $62.20 , $148.78 , $150.55 , $270.63 , $261.90 , $261.90 , $232.80 , $232.80 , $62.20 , $268.68 , $276.45 , $261.90 , $261.90 , $261.90 , $270.63 , $279.36 , $184.39 , $247.35 , $150.77 , $149.03 , N/A , $151.68 , $151.68 , $276.45 , $182.18 , $62.20 , $279.36 
"Reimplant Ureter,Extensive Tailoring",CPT® 50783,N/A,N/A,N/A," $7,855.00 "," $5,105.75 "," $6,086.43 "," $1,069.57 "," $1,104.00 "," $5,517.24 "," $5,125.53 "," $7,305.15 "," $7,069.50 "," $7,069.50 "," $6,284.00 "," $6,284.00 "," $1,104.00 "," $7,252.52 "," $7,462.25 "," $7,069.50 "," $7,069.50 "," $7,069.50 "," $7,305.15 "," $7,540.80 "," $6,112.75 "," $6,676.75 "," $5,803.56 "," $6,936.91 ", N/A ," $5,624.89 "," $5,624.89 "," $7,462.25 "," $6,611.25 "," $1,069.57 "," $7,540.80 "
"Suture Eyelid Wound,Partial Thick",CPT® 67930,N/A,N/A,N/A," $3,402.00 "," $2,211.30 "," $1,452.69 ", $227.28 , $329.68 ," $1,360.85 "," $1,283.92 "," $3,163.86 "," $3,061.80 "," $3,061.80 "," $2,721.60 "," $2,721.60 ", $329.68 ," $3,141.07 "," $3,231.90 "," $3,061.80 "," $3,061.80 "," $3,061.80 "," $3,163.86 "," $3,265.92 "," $2,003.83 "," $2,891.70 "," $1,336.26 "," $1,725.73 ", N/A ," $1,387.40 "," $1,387.40 "," $3,231.90 "," $1,531.51 ", $227.28 ," $3,265.92 "
Biopsy Soft Tissue Neck/Chest,CPT® 21550,N/A,N/A,N/A," $1,697.00 "," $1,103.05 ", $960.12 , $150.40 , $50.81 , $767.55 , $770.05 ," $1,578.21 "," $1,527.30 "," $1,527.30 "," $1,357.60 "," $1,357.60 ", $50.81 ," $1,566.84 "," $1,612.15 "," $1,527.30 "," $1,527.30 "," $1,527.30 "," $1,578.21 "," $1,629.12 ", $890.27 ," $1,442.45 ", $840.29 , $906.73 , N/A , $782.53 , $782.53 ," $1,612.15 ", $919.74 , $50.81 ," $1,629.12 "
Dehydroepiandrosterone,CPT® 82626,N/A,N/A,N/A, $245.00 , $159.25 , N/A , $25.78 , $25.78 , $142.97 , $171.04 , $227.85 , $220.50 , $220.50 , $196.00 , $196.00 , $25.78 , $226.21 , $232.75 , $220.50 , $220.50 , $220.50 , $227.85 , $235.20 , $168.73 , $208.25 , $165.43 , $91.63 , N/A , $133.43 , $133.43 , $232.75 , $145.81 , $25.78 , $235.20 
 Fac Mumps Antibody ,CPT® 86735,0302 - LAB/IMMUNOLOGY,N/A,N/A, $128.00 , $83.20 , $107.52 , $13.31 , $13.31 , $103.42 , $115.20 , $108.36 , $115.20 , $115.20 , $115.20 , $108.80 , $13.05 , $118.18 , $121.60 , $108.80 , $119.04 , $119.04 , $121.60 , $122.88 , $104.73 , $115.20 , $108.80 , $101.12 , N/A , $103.59 , $103.59 , $121.60 , $109.84 , $13.05 , $122.88 
Gonadotropin (Fsh),CPT® 83001,N/A,N/A,N/A, $173.00 , $112.45 , N/A , $18.95 , $18.95 , $105.15 , $125.74 , $160.89 , $155.70 , $155.70 , $138.40 , $138.40 , $18.95 , $159.73 , $164.35 , $155.70 , $155.70 , $155.70 , $160.89 , $166.08 , $124.06 , $147.05 , $121.64 , $67.37 , N/A , $98.13 , $98.13 , $164.35 , $107.23 , $18.95 , $166.08 
Immunofluorescence per Spec Add Singl Antb Stain,CPT® 88350,N/A,N/A,N/A, $292.00 , $189.80 , $421.28 , $114.53 , $57.02 , $287.31 , $328.28 , $271.56 , $262.80 , $262.80 , $233.60 , $233.60 , $57.02 , $269.60 , $277.40 , $262.80 , $262.80 , $262.80 , $271.56 , $280.32 , $700.71 , $248.20 , $560.53 , $252.47 , N/A , $268.14 , $268.14 , $277.40 , $294.67 , $57.02 , $700.71 
" LAYER CLOSURE Face,EYELIDS,NOSE,EARS,LIPS 7.6-12.5CM ",CPT® 12054,0981 - PRO FEE/ER,N/A,N/A," $1,652.00 "," $1,073.80 ", $691.80 , $208.93 , $210.26 , $622.08 , $609.78 ," $1,536.36 "," $1,486.80 "," $1,486.80 "," $1,321.60 "," $1,321.60 ", $210.26 ," $1,525.29 "," $1,569.40 "," $1,486.80 "," $1,486.80 "," $1,486.80 "," $1,536.36 "," $1,585.92 ", $758.54 ," $1,404.20 "," $1,218.52 ", $778.84 , N/A , $634.21 , $634.21 ," $1,569.40 ", $735.47 , $208.93 ," $1,585.92 "
Manipulatn Shldr Jt W Anesthesia,23700,N/A,N/A,N/A," $1,288.00 ", $837.20 ," $1,194.77 ", $187.52 , $142.01 , $946.55 , $942.80 ," $1,197.84 "," $1,159.20 "," $1,159.20 "," $1,030.40 "," $1,030.40 ", $142.01 ," $1,189.21 "," $1,223.60 "," $1,159.20 "," $1,159.20 "," $1,159.20 "," $1,197.84 "," $1,236.48 "," $1,107.03 "," $1,094.80 "," $1,038.33 "," $1,116.76 ", N/A , $965.02 , $965.02 ," $1,223.60 "," $1,134.26 ", $142.01 ," $1,236.48 "
 Fac Endoscopy Upper Small Intestine W/Biopsy ,CPT® 44361,0360 - OR SERVICES,N/A,N/A," $2,260.00 "," $1,469.00 "," $1,898.40 ", $150.34 , $371.14 ," $1,826.08 "," $2,034.00 "," $1,913.32 "," $2,034.00 "," $2,034.00 "," $2,034.00 "," $1,921.00 ", $363.86 ," $2,086.66 "," $2,147.00 "," $1,921.00 "," $2,101.80 "," $2,101.80 "," $2,147.00 "," $2,169.60 "," $1,849.13 "," $2,034.00 "," $1,921.00 "," $1,785.40 ", N/A ," $1,829.02 "," $1,829.02 "," $2,147.00 "," $1,939.31 ", $150.34 ," $2,169.60 "
 Pro Pulmonary Ventilation & Perfusion Imaging ,CPT® 78582,0972 - PRO FEE/RAD/DX,N/A,N/A," $2,236.00 "," $1,453.40 "," $1,779.96 ", $304.15 , $251.40 ," $1,647.98 "," $2,020.55 "," $2,079.48 "," $2,012.40 "," $2,012.40 "," $1,788.80 "," $1,788.80 ", $251.40 ," $2,064.50 "," $2,124.20 "," $2,012.40 "," $2,012.40 "," $2,012.40 "," $2,079.48 "," $2,146.56 "," $1,844.78 "," $1,900.60 "," $2,218.80 "," $2,248.96 ", N/A ," $1,680.14 "," $1,680.14 "," $2,124.20 "," $1,944.78 ", $251.40 ," $2,248.96 "
"Shav Skin Les 6-10mm Trunk,Arm,Leg",11301,N/A,N/A,N/A, $468.00 , $304.20 , $164.46 , $49.27 , $62.13 , $146.28 , $142.05 , $435.24 , $421.20 , $421.20 , $374.40 , $374.40 , $62.13 , $432.10 , $444.60 , $421.20 , $421.20 , $421.20 , $435.24 , $449.28 , $181.38 , $397.80 , $281.88 , $187.83 , N/A , $149.14 , $149.14 , $444.60 , $172.94 , $49.27 , $449.28 
"Cabg, Arterial, Two",CPT® 33534,N/A,N/A,N/A," $18,632.00 "," $12,110.80 "," $12,820.86 "," $1,981.14 "," $2,086.38 "," $9,390.72 "," $9,331.63 "," $17,327.76 "," $16,768.80 "," $16,768.80 "," $14,905.60 "," $14,905.60 "," $2,086.38 "," $17,202.93 "," $17,700.40 "," $16,768.80 "," $16,768.80 "," $16,768.80 "," $17,327.76 "," $17,886.72 "," $11,877.70 "," $15,837.20 "," $11,817.64 "," $10,535.24 ", N/A ," $9,573.95 "," $9,573.95 "," $17,700.40 "," $10,875.99 "," $1,981.14 "," $17,886.72 "
Fx Cl Shouder Disl W Mani,23650,N/A,N/A,N/A," $2,030.00 "," $1,319.50 "," $1,823.71 ", $292.70 , $192.43 ," $1,386.81 "," $1,412.59 "," $1,887.90 "," $1,827.00 "," $1,827.00 "," $1,624.00 "," $1,624.00 ", $192.43 ," $1,874.30 "," $1,928.50 "," $1,827.00 "," $1,827.00 "," $1,827.00 "," $1,887.90 "," $1,948.80 "," $1,671.17 "," $1,725.50 "," $1,548.57 "," $1,654.68 ", N/A ," $1,413.87 "," $1,413.87 "," $1,928.50 "," $1,661.81 ", $192.43 ," $1,948.80 "
 Fac Prq Impltj Nstim Eltrds Prph Nrv ,CPT® 64555,0360 - OR SERVICES,N/A,N/A," $19,023.00 "," $12,364.95 "," $15,979.32 ", $312.76 , $156.20 ," $15,370.58 "," $17,120.70 "," $16,104.87 "," $17,120.70 "," $17,120.70 "," $17,120.70 "," $16,169.55 ", $153.14 ," $17,563.94 "," $18,071.85 "," $16,169.55 "," $17,691.39 "," $17,691.39 "," $18,071.85 "," $18,262.08 "," $15,564.62 "," $17,120.70 "," $16,169.55 "," $15,028.17 ", N/A ," $15,395.31 "," $15,395.31 "," $18,071.85 "," $16,323.64 ", $153.14 ," $18,262.08 "
" Pro Laparoscopy, Aspiration ",CPT® 49322,0982 - PRO FEE/OUTPT,N/A,N/A," $2,444.00 "," $1,588.60 "," $2,248.29 ", $349.25 , $324.81 ," $1,740.58 "," $1,774.90 "," $2,272.92 "," $2,199.60 "," $2,199.60 "," $1,955.20 "," $1,955.20 ", $324.81 ," $2,256.55 "," $2,321.80 "," $2,199.60 "," $2,199.60 "," $2,199.60 "," $2,272.92 "," $2,346.24 "," $1,609.55 "," $2,077.40 "," $1,964.25 "," $2,074.70 ", N/A ," $1,774.54 "," $1,774.54 "," $2,321.80 "," $1,855.98 ", $324.81 ," $2,346.24 "
 FLUCONAZOLE 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,68462-0101-30,1 tablet, $28.78 , $18.71 , $24.18 , N/A , N/A , $23.25 , $25.90 , $24.37 , $25.90 , $25.90 , $25.90 , $24.46 , N/A , $26.57 , $27.34 , $24.46 , $26.77 , $26.77 , $27.34 , $27.63 , $23.55 , $25.90 , $24.46 , $22.74 , N/A , $23.29 , $23.29 , $27.34 , $24.70 , $22.74 , $27.63 
Insj Stablj Dev W/Dcmprn Lumbar Single Level,CPT® 22867,N/A,N/A,N/A," $9,765.00 "," $6,347.25 "," $6,293.95 ", $984.97 , N/A ," $4,498.27 "," $4,315.19 "," $9,081.45 "," $8,788.50 "," $8,788.50 "," $7,812.00 "," $7,812.00 ", N/A ," $9,016.02 "," $9,276.75 "," $8,788.50 "," $8,788.50 "," $8,788.50 "," $9,081.45 "," $9,374.40 "," $5,374.48 "," $8,300.25 "," $5,753.74 "," $5,269.88 ", N/A ," $4,586.04 "," $4,586.04 "," $9,276.75 "," $5,390.25 ", $984.97 ," $9,374.40 "
Osteotomy Tibia,CPT® 27705,N/A,N/A,N/A," $5,076.00 "," $3,299.40 "," $4,620.53 ", $719.54 , $672.05 ," $3,633.55 "," $3,652.90 "," $4,720.68 "," $4,568.40 "," $4,568.40 "," $4,060.80 "," $4,060.80 ", $672.05 ," $4,686.67 "," $4,822.20 "," $4,568.40 "," $4,568.40 "," $4,568.40 "," $4,720.68 "," $4,872.96 "," $4,283.00 "," $4,314.60 "," $4,028.42 "," $4,349.80 ", N/A ," $3,704.45 "," $3,704.45 "," $4,822.20 "," $4,354.04 ", $672.05 ," $4,872.96 "
 MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN ,HCPCS J2260,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9719-10,100 mL, $93.50 , $60.78 , $78.54 , $1.91 , $2.16 , $75.55 , $84.15 , $79.16 , $84.15 , $84.15 , $84.15 , $79.48 , $2.12 , $86.33 , $88.83 , $79.48 , $86.96 , $86.96 , $88.83 , $89.76 , $76.50 , $84.15 , $79.48 , $73.87 , N/A , $75.67 , $75.67 , $88.83 , $80.23 , $1.91 , $89.76 
 FENOFIBRATE 145 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,69097-0458-05,1 tablet, $29.43 , $19.13 , $24.72 , N/A , N/A , $23.78 , $26.49 , $24.92 , $26.49 , $26.49 , $26.49 , $25.02 , N/A , $27.17 , $27.96 , $25.02 , $27.37 , $27.37 , $27.96 , $28.25 , $24.08 , $26.49 , $25.02 , $23.25 , N/A , $23.82 , $23.82 , $27.96 , $25.25 , $23.25 , $28.25 
 HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6824-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Tracheostomy, Planned",CPT® 31600,N/A,N/A,N/A," $2,372.00 "," $1,541.80 "," $1,619.95 ", $283.80 , $546.87 ," $1,507.81 "," $1,467.71 "," $2,205.96 "," $2,134.80 "," $2,134.80 "," $1,897.60 "," $1,897.60 ", $546.87 ," $2,190.07 "," $2,253.40 "," $2,134.80 "," $2,134.80 "," $2,134.80 "," $2,205.96 "," $2,277.12 "," $1,565.22 "," $2,016.20 "," $2,096.28 "," $1,621.09 ", N/A ," $1,537.22 "," $1,537.22 "," $2,253.40 "," $1,810.40 ", $283.80 ," $2,277.12 "
" Fac Genotype, Dna, Hiv Reverse T ",CPT® 87901,0306 - LAB/BACT-MICRO,N/A,N/A," $2,376.00 "," $1,544.40 "," $1,995.84 ", $262.60 , $262.60 ," $1,919.81 "," $2,138.40 "," $2,011.52 "," $2,138.40 "," $2,138.40 "," $2,138.40 "," $2,019.60 ", $257.45 ," $2,193.76 "," $2,257.20 "," $2,019.60 "," $2,209.68 "," $2,209.68 "," $2,257.20 "," $2,280.96 "," $1,944.04 "," $2,138.40 "," $2,019.60 "," $1,877.04 ", N/A ," $1,922.90 "," $1,922.90 "," $2,257.20 "," $2,038.85 ", $257.45 ," $2,280.96 "
 CLARITHROMYCIN 500 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6872-04,1 tablet, $20.03 , $13.02 , $16.83 , N/A , N/A , $16.18 , $18.03 , $16.96 , $18.03 , $18.03 , $18.03 , $17.03 , N/A , $18.49 , $19.03 , $17.03 , $18.63 , $18.63 , $19.03 , $19.23 , $16.39 , $18.03 , $17.03 , $15.82 , N/A , $16.21 , $16.21 , $19.03 , $17.19 , $15.82 , $19.23 
Destruction Neurolytic Agt Genicular Nerve W/Img,CPT® 64624,N/A,N/A,N/A," $2,731.00 "," $1,775.15 ", $725.40 , $140.79 , $321.99 , $806.54 , N/A ," $2,539.83 "," $2,457.90 "," $2,457.90 "," $2,184.80 "," $2,184.80 ", $321.99 ," $2,521.53 "," $2,594.45 "," $2,457.90 "," $2,457.90 "," $2,457.90 "," $2,539.83 "," $2,621.76 ", $786.05 ," $2,321.35 ", $765.86 , $889.38 , N/A , $822.28 , $822.28 ," $2,594.45 ", $882.08 , $140.79 ," $2,621.76 "
Colonoscopy Flexible With Decompression,45393,N/A,N/A,N/A," $2,263.00 "," $1,470.95 "," $1,541.87 ", $237.46 , $265.41 , N/A , N/A ," $2,104.59 "," $2,036.70 "," $2,036.70 "," $1,810.40 "," $1,810.40 ", $265.41 ," $2,089.43 "," $2,149.85 "," $2,036.70 "," $2,036.70 "," $2,036.70 "," $2,104.59 "," $2,172.48 "," $1,108.62 "," $1,923.55 "," $1,311.38 "," $1,467.36 ", N/A ," $1,126.96 "," $1,126.96 "," $2,149.85 "," $1,179.56 ", $237.46 ," $2,172.48 "
 Pro Removal of Hydrocele ,CPT® 55500,0982 - PRO FEE/OUTPT,N/A,N/A," $2,919.00 "," $1,897.35 "," $1,738.25 ", $374.28 , $401.40 ," $1,261.41 "," $1,292.60 "," $2,714.67 "," $2,627.10 "," $2,627.10 "," $2,335.20 "," $2,335.20 ", $401.40 ," $2,695.11 "," $2,773.05 "," $2,627.10 "," $2,627.10 "," $2,627.10 "," $2,714.67 "," $2,802.24 "," $1,626.46 "," $2,481.15 "," $2,083.79 "," $1,891.21 ", N/A ," $1,286.02 "," $1,286.02 "," $2,773.05 "," $1,541.37 ", $374.28 ," $2,802.24 "
 PROCHLORPERAZINE 25 MG RE SUPP ,HCPCS RXC637,0250 - PHARMACY,00713-0135-12,1 suppository, $62.97 , $40.93 , $52.89 , N/A , N/A , $50.88 , $56.67 , $53.31 , $56.67 , $56.67 , $56.67 , $53.52 , N/A , $58.14 , $59.82 , $53.52 , $58.56 , $58.56 , $59.82 , $60.45 , $51.52 , $56.67 , $53.52 , $49.75 , N/A , $50.96 , $50.96 , $59.82 , $54.03 , $49.75 , $60.45 
" Pro Removal of FB,Pharynx ",CPT® 42809,0981 - PRO FEE/ER,N/A,N/A, $891.00 , $579.15 , $774.61 , $121.29 , $46.62 , $640.06 , $659.95 , $828.63 , $801.90 , $801.90 , $712.80 , $712.80 , $46.62 , $822.66 , $846.45 , $801.90 , $801.90 , $801.90 , $828.63 , $855.36 , $548.59 , $757.35 , $722.55 , $692.65 , N/A , $652.55 , $652.55 , $846.45 , $682.48 , $46.62 , $855.36 
 Pro Perm Rmv Nail Bed ,CPT® 11750,0982 - PRO FEE/OUTPT,N/A,N/A, $813.00 , $528.45 , $330.85 , $98.28 , $111.46 , $478.76 , $468.04 , $756.09 , $731.70 , $731.70 , $650.40 , $650.40 , $111.46 , $750.64 , $772.35 , $731.70 , $731.70 , $731.70 , $756.09 , $780.48 , $362.83 , $691.05 , $918.79 , $362.76 , N/A , $488.10 , $488.10 , $772.35 , $566.03 , $98.28 , $918.79 
Layer Closure 2.6-5cm,CPT® 12052,N/A,N/A,N/A," $1,245.00 ", $809.25 , $637.70 , $191.98 , $151.59 , $557.59 , $545.09 ," $1,157.85 "," $1,120.50 "," $1,120.50 ", $996.00 , $996.00 , $151.59 ," $1,149.51 "," $1,182.75 "," $1,120.50 "," $1,120.50 "," $1,120.50 "," $1,157.85 "," $1,195.20 ", $700.90 ," $1,058.25 "," $1,084.71 ", $716.31 , N/A , $568.47 , $568.47 ," $1,182.75 ", $659.24 , $151.59 ," $1,195.20 "
" Pro Arthro, Loose Body + Chondro ",HCPCS G0289,0975 - PRO FEE/OR,N/A,N/A, $111.00 , $72.15 , $187.94 , $79.26 , $84.92 , $159.72 , N/A , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $84.92 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $477.19 , $94.35 , $166.08 , $490.96 , N/A , $162.83 , $162.83 , $105.45 , $203.55 , $79.26 , $490.96 
 Si Joints Min 3vw- Mh ,CPT® 72202,0972 - PRO FEE/RAD/DX,N/A,N/A, $108.00 , $70.20 , $221.33 , $38.71 , $33.12 , $154.14 , $183.89 , $100.44 , $97.20 , $97.20 , $86.40 , $86.40 , $33.12 , $99.72 , $102.60 , $97.20 , $97.20 , $97.20 , $100.44 , $103.68 , $214.83 , $91.80 , $202.23 , $165.75 , N/A , $157.14 , $157.14 , $102.60 , $181.90 , $33.12 , $221.33 
Influenza Vacc Iiv4 Split Virus Prsrv Free ID,CPT® 90630,N/A,N/A,N/A, $40.00 , $26.00 , N/A , N/A , N/A , N/A , N/A , $37.20 , $36.00 , $36.00 , $32.00 , $32.00 , N/A , $36.93 , $38.00 , $36.00 , $36.00 , $36.00 , $37.20 , $38.40 , N/A , $34.00 , $32.00 , $35.18 , N/A , N/A , N/A , $38.00 , N/A , $32.00 , $38.40 
"Closed Rx Rad/Ulna Shaft Fx,Manip",CPT® 25565,N/A,N/A,N/A," $2,412.00 "," $1,567.80 "," $2,866.37 ", $452.75 , $396.91 ," $2,261.48 "," $2,289.35 "," $2,243.16 "," $2,170.80 "," $2,170.80 "," $1,929.60 "," $1,929.60 ", $396.91 ," $2,227.00 "," $2,291.40 "," $2,170.80 "," $2,170.80 "," $2,170.80 "," $2,243.16 "," $2,315.52 "," $2,644.54 "," $2,050.20 "," $2,519.10 "," $2,656.81 ", N/A ," $2,305.61 "," $2,305.61 "," $2,291.40 "," $2,709.92 ", $396.91 ," $2,866.37 "
 PETROLATUM 42 % EX OINT ,HCPCS RXA250,0250 - PHARMACY,00536-1143-98,454 gram, $74.63 , $48.51 , $62.69 , N/A , N/A , $60.30 , $67.17 , $63.18 , $67.17 , $67.17 , $67.17 , $63.44 , N/A , $68.91 , $70.90 , $63.44 , $69.41 , $69.41 , $70.90 , $71.64 , $61.06 , $67.17 , $63.44 , $58.96 , N/A , $60.40 , $60.40 , $70.90 , $64.04 , $58.96 , $71.64 
Hopd covid-19 spec collect,HCPCS C9803,N/A,N/A,N/A, $32.00 , $20.80 , N/A , N/A , $23.29 , N/A , N/A , $29.76 , $28.80 , $28.80 , $25.60 , $25.60 , $23.29 , $29.55 , $30.40 , $28.80 , $28.80 , $28.80 , $29.76 , $30.72 , N/A , $27.20 , $43.94 , N/A , N/A , N/A , N/A , $30.40 , N/A , $23.29 , $43.94 
 LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN ,HCPCS J1956,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9721-24,100 mL, $37.50 , $24.38 , $31.50 , $0.94 , $0.99 , $30.30 , $33.75 , $31.75 , $33.75 , $33.75 , $33.75 , $31.88 , $0.97 , $34.62 , $35.63 , $31.88 , $34.88 , $34.88 , $35.63 , $36.00 , $30.68 , $33.75 , $31.88 , $29.63 , N/A , $30.35 , $30.35 , $35.63 , $32.18 , $0.94 , $36.00 
 AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5ML PO SUSR ,HCPCS RXC637,0250 - PHARMACY,65862-0535-13,125 mL, $426.37 , $277.14 , $358.15 , N/A , N/A , $344.51 , $383.73 , $360.96 , $383.73 , $383.73 , $383.73 , $362.41 , N/A , $393.67 , $405.05 , $362.41 , $396.52 , $396.52 , $405.05 , $409.32 , $348.86 , $383.73 , $362.41 , $336.83 , N/A , $345.06 , $345.06 , $405.05 , $365.87 , $336.83 , $409.32 
 Pro Mod Sed Same Phys/Qhp Each Addl 15 Mins ,CPT® 99153,0982 - PRO FEE/OUTPT,N/A,N/A, $83.00 , $53.95 , $23.95 , $10.39 , $8.53 , $22.93 , $23.60 , $77.19 , $74.70 , $74.70 , $66.40 , $66.40 , $8.53 , $76.63 , $78.85 , $74.70 , $74.70 , $74.70 , $77.19 , $79.68 , $31.53 , $70.55 , $33.32 , $40.46 , N/A , $23.38 , $23.38 , $78.85 , $27.25 , $8.53 , $79.68 
 Pt Iontophoresis 15 Min Ea ,CPT® 97033,0430 - OCCUPATION THER,N/A,N/A, $152.00 , $98.80 , $127.68 , $19.60 , $23.98 , $122.82 , $136.80 , $128.68 , $136.80 , $136.80 , $136.80 , $129.20 , $23.51 , $140.34 , $144.40 , $129.20 , $141.36 , $141.36 , $144.40 , $145.92 , $124.37 , $136.80 , $129.20 , $120.08 , N/A , $123.01 , $123.01 , $144.40 , $130.43 , $19.60 , $145.92 
Nasal/Sinus Ndsc W/Rmvl Tiss From Frontal Sinus,CPT® 31276,N/A,N/A,N/A," $2,988.00 "," $1,942.20 "," $2,036.42 ", $359.32 , $708.30 ," $1,934.11 "," $1,887.67 "," $2,778.84 "," $2,689.20 "," $2,689.20 "," $2,390.40 "," $2,390.40 ", $708.30 ," $2,758.82 "," $2,838.60 "," $2,689.20 "," $2,689.20 "," $2,689.20 "," $2,778.84 "," $2,868.48 "," $1,951.17 "," $2,539.80 "," $2,661.82 "," $1,927.23 ", N/A ," $1,971.84 "," $1,971.84 "," $2,838.60 "," $2,322.25 ", $359.32 ," $2,868.48 "
 CEFTRIAXONE SODIUM 1 G IJ SOLR ,HCPCS J0696,0636 - DRUGS REQUIRING DETAILED CODIN,60505-6148-04,10 mL, $236.04 , $153.43 , $198.27 , $0.58 , $0.54 , $190.72 , $212.44 , $199.83 , $212.44 , $212.44 , $212.44 , $200.63 , $0.53 , $217.94 , $224.24 , $200.63 , $219.52 , $219.52 , $224.24 , $226.60 , $193.13 , $212.44 , $200.63 , $186.47 , N/A , $191.03 , $191.03 , $224.24 , $202.55 , $0.53 , $226.60 
Noninvasv Lo Extrem Art Stress/Rest,CPT® 93924,N/A,N/A,N/A," $1,301.00 ", $845.65 , $994.89 , $153.65 , $163.90 , $930.02 ," $1,024.10 "," $1,209.93 "," $1,170.90 "," $1,170.90 "," $1,040.80 "," $1,040.80 ", $163.90 ," $1,201.21 "," $1,235.95 "," $1,170.90 "," $1,170.90 "," $1,170.90 "," $1,209.93 "," $1,248.96 ", $702.35 ," $1,105.85 ", $546.39 , $642.03 , N/A , $948.16 , $948.16 ," $1,235.95 "," $1,051.06 ", $153.65 ," $1,248.96 "
"Closed Rx Prox/Shaft Fib Fx,Manip",27781,N/A,N/A,N/A," $1,168.00 ", $759.20 ," $2,480.21 ", $393.47 , $307.34 ," $1,890.96 "," $1,884.68 "," $1,086.24 "," $1,051.20 "," $1,051.20 ", $934.40 , $934.40 , $307.34 ," $1,078.41 "," $1,109.60 "," $1,051.20 "," $1,051.20 "," $1,051.20 "," $1,086.24 "," $1,121.28 "," $2,284.92 ", $992.80 ," $2,071.30 "," $2,258.37 ", N/A ," $1,927.85 "," $1,927.85 "," $1,109.60 "," $2,265.91 ", $307.34 ," $2,480.21 "
 Fac Assay RBC Protoporphyrin ,CPT® 84202,0301 - LAB/CHEMISTRY,N/A,N/A, $129.00 , $83.85 , $108.36 , $14.64 , $14.64 , $104.23 , $116.10 , $109.21 , $116.10 , $116.10 , $116.10 , $109.65 , $14.35 , $119.11 , $122.55 , $109.65 , $119.97 , $119.97 , $122.55 , $123.84 , $105.55 , $116.10 , $109.65 , $101.91 , N/A , $104.40 , $104.40 , $122.55 , $110.69 , $14.35 , $123.84 
Njx Noncmpnd Sclerosant Single Incmptnt Vein,CPT® 36465,N/A,N/A,N/A," $9,487.00 "," $6,166.55 ", $701.35 , $108.66 , N/A , $479.58 , $486.28 ," $8,822.91 "," $8,538.30 "," $8,538.30 "," $7,589.60 "," $7,589.60 ", N/A ," $8,759.35 "," $9,012.65 "," $8,538.30 "," $8,538.30 "," $8,538.30 "," $8,822.91 "," $9,107.52 ", $649.88 ," $8,063.95 ", $618.38 , $575.29 , N/A , $488.94 , $488.94 ," $9,012.65 ", $555.43 , $108.66 ," $9,107.52 "
" RABIES VACCINE, PCEC IM SUSR ",HCPCS 90675,0636 - DRUGS REQUIRING DETAILED CODIN,58160-0964-12,1 mL," $1,114.51 ", $724.43 , $936.19 , $336.59 , $280.73 , $900.52 ," $1,003.06 ", $943.54 ," $1,003.06 "," $1,003.06 "," $1,003.06 ", $947.33 , $275.23 ," $1,029.03 "," $1,058.78 ", $947.33 ," $1,036.49 "," $1,036.49 "," $1,058.78 "," $1,069.93 ", $911.89 ," $1,003.06 ", $947.33 , $880.46 , N/A , $901.97 , $901.97 ," $1,058.78 ", $956.36 , $275.23 ," $1,069.93 "
 Fac Drug Test Def 22+ Classes ,CPT® G0483,0301 - LAB/CHEMISTRY,N/A,N/A, $711.00 , $462.15 , $597.24 , $251.86 , $175.62 , $574.49 , $639.90 , $601.93 , $639.90 , $639.90 , $639.90 , $604.35 , $172.18 , $656.47 , $675.45 , $604.35 , $661.23 , $661.23 , $675.45 , $682.56 , $581.74 , $639.90 , $604.35 , $561.69 , N/A , $575.41 , $575.41 , $675.45 , $610.11 , $172.18 , $682.56 
Percut Rx Metatarsal Fx,CPT® 28476,N/A,N/A,N/A," $2,332.00 "," $1,515.80 "," $2,426.32 ", $380.95 , $229.93 ," $1,706.74 "," $1,705.73 "," $2,168.76 "," $2,098.80 "," $2,098.80 "," $1,865.60 "," $1,865.60 ", $229.93 ," $2,153.14 "," $2,215.40 "," $2,098.80 "," $2,098.80 "," $2,098.80 "," $2,168.76 "," $2,238.72 "," $2,211.22 "," $1,982.20 "," $1,860.78 "," $2,025.70 ", N/A ," $1,740.04 "," $1,740.04 "," $2,215.40 "," $2,045.18 ", $229.93 ," $2,426.32 "
 MRI Breast Cad ,HCPCS C8937,0614 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI-OTHER,N/A,N/A," $2,509.00 "," $1,630.85 "," $2,107.56 ", N/A , N/A ," $2,027.27 "," $2,258.10 "," $2,124.12 "," $2,258.10 "," $2,258.10 "," $2,258.10 "," $2,132.65 ", N/A ," $2,316.56 "," $2,383.55 "," $2,132.65 "," $2,333.37 "," $2,333.37 "," $2,383.55 "," $2,408.64 "," $2,052.86 "," $2,258.10 "," $2,132.65 "," $1,982.11 ", N/A ," $2,030.53 "," $2,030.53 "," $2,383.55 "," $2,152.97 "," $1,982.11 "," $2,408.64 "
Hematocrit,CPT® 85014,N/A,N/A,N/A, $39.00 , $25.35 , N/A , $2.42 , $2.42 , $13.43 , $16.05 , $36.27 , $35.10 , $35.10 , $31.20 , $31.20 , $2.42 , $36.01 , $37.05 , $35.10 , $35.10 , $35.10 , $36.27 , $37.44 , $15.83 , $33.15 , $16.22 , $8.59 , N/A , $12.53 , $12.53 , $37.05 , $13.70 , $2.42 , $37.44 
Nerve Repair W/Conduit Ea Nerve,64910,N/A,N/A,N/A," $6,508.00 "," $4,230.20 "," $3,768.91 ", $727.52 , $537.05 ," $4,553.10 "," $4,408.67 "," $6,052.44 "," $5,857.20 "," $5,857.20 "," $5,206.40 "," $5,206.40 ", $537.05 ," $6,008.84 "," $6,182.60 "," $5,857.20 "," $5,857.20 "," $5,857.20 "," $6,052.44 "," $6,247.68 "," $4,133.12 "," $5,531.80 "," $4,356.68 "," $4,758.68 ", N/A ," $4,641.94 "," $4,641.94 "," $6,182.60 "," $4,979.72 ", $537.05 ," $6,247.68 "
Ligation of Hemorrhoid(S),46221,N/A,N/A,N/A," $1,138.00 ", $739.70 ," $1,206.14 ", $185.85 , $46.08 , $914.44 , $947.04 ," $1,058.34 "," $1,024.20 "," $1,024.20 ", $910.40 , $910.40 , $46.08 ," $1,050.72 "," $1,081.10 "," $1,024.20 "," $1,024.20 "," $1,024.20 "," $1,058.34 "," $1,092.48 ", $861.85 , $967.30 ," $1,038.33 "," $1,090.74 ", N/A , $932.28 , $932.28 ," $1,081.10 ", $975.06 , $46.08 ," $1,206.14 "
 Pelvis MRI Without Contrast ,CPT® 72195,0614 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI-OTHER,N/A,N/A," $4,550.00 "," $2,957.50 "," $3,822.00 ", $235.76 , $417.22 ," $3,676.40 "," $4,095.00 "," $3,852.03 "," $4,095.00 "," $4,095.00 "," $4,095.00 "," $3,867.50 ", $409.04 ," $4,201.02 "," $4,322.50 "," $3,867.50 "," $4,231.50 "," $4,231.50 "," $4,322.50 "," $4,368.00 "," $3,722.81 "," $4,095.00 "," $3,867.50 "," $3,594.50 ", N/A ," $3,682.32 "," $3,682.32 "," $4,322.50 "," $3,904.36 ", $235.76 ," $4,368.00 "
Close Tear Duct Opening,CPT® 68760,N/A,N/A,N/A," $2,009.00 "," $1,305.85 ", $893.62 , $140.87 , $61.48 , $825.98 , $782.95 ," $1,868.37 "," $1,808.10 "," $1,808.10 "," $1,607.20 "," $1,607.20 ", $61.48 ," $1,854.91 "," $1,908.55 "," $1,808.10 "," $1,808.10 "," $1,808.10 "," $1,868.37 "," $1,928.64 "," $1,228.55 "," $1,707.65 ", $811.75 ," $1,051.46 ", N/A , $842.10 , $842.10 ," $1,908.55 ", $929.57 , $61.48 ," $1,928.64 "
 Pro Incis/Remv FB Sq Tissue Simple ,CPT® 10120,0982 - PRO FEE/OUTPT,N/A,N/A, $579.00 , $376.35 , $336.16 , $101.48 , $42.46 , $283.24 , $279.57 , $538.47 , $521.10 , $521.10 , $463.20 , $463.20 , $42.46 , $534.59 , $550.05 , $521.10 , $521.10 , $521.10 , $538.47 , $555.84 , $369.08 , $492.15 , $553.06 , $366.67 , N/A , $288.77 , $288.77 , $550.05 , $334.86 , $42.46 , $555.84 
Cast Supplies (Plaster),HCPCS A4580,N/A,N/A,N/A, $81.00 , $52.65 , N/A , N/A , N/A , N/A , N/A , $75.33 , $72.90 , $72.90 , $64.80 , $64.80 , N/A , $74.79 , $76.95 , $72.90 , $72.90 , $72.90 , $75.33 , $77.76 , N/A , $68.85 , $64.80 , N/A , N/A , N/A , N/A , $76.95 , N/A , $64.80 , $77.76 
 Anti Nuclear Antibody Titer - Ana. Beaker1 ,CPT® 86039,0300 - LABORATORY,N/A,N/A, $120.00 , $78.00 , $100.80 , $11.38 , $11.38 , $96.96 , $108.00 , $101.59 , $108.00 , $108.00 , $108.00 , $102.00 , $11.16 , $110.80 , $114.00 , $102.00 , $111.60 , $111.60 , $114.00 , $115.20 , $98.18 , $108.00 , $102.00 , $94.80 , N/A , $97.12 , $97.12 , $114.00 , $102.97 , $11.16 , $115.20 
 Path Immunoperoxidase Stain -Mh ,CPT® 88342,0310 - PATHOLOGY LAB,N/A,N/A, $430.00 , $279.50 , $361.20 , $98.62 , $54.62 , $347.44 , $387.00 , $364.04 , $387.00 , $387.00 , $387.00 , $365.50 , $53.55 , $397.02 , $408.50 , $365.50 , $399.90 , $399.90 , $408.50 , $412.80 , $351.83 , $387.00 , $365.50 , $339.70 , N/A , $348.00 , $348.00 , $408.50 , $368.98 , $53.55 , $412.80 
 ARIPIPRAZOLE LAUROXIL ER 675 MG/2.4ML IM PRSY ,HCPCS J1943,0636 - DRUGS REQUIRING DETAILED CODIN,65757-0500-03,2.4 mL," $6,749.24 "," $4,387.01 "," $5,669.36 ", $3.12 , $3.03 ," $5,453.39 "," $6,074.32 "," $5,713.91 "," $6,074.32 "," $6,074.32 "," $6,074.32 "," $5,736.85 ", $2.97 ," $6,231.57 "," $6,411.78 "," $5,736.85 "," $6,276.79 "," $6,276.79 "," $6,411.78 "," $6,479.27 "," $5,522.23 "," $6,074.32 "," $5,736.85 "," $5,331.90 ", N/A ," $5,462.16 "," $5,462.16 "," $6,411.78 "," $5,791.52 ", $2.97 ," $6,479.27 "
 WARFARIN SODIUM 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00832-1219-01,1 tablet, $4.89 , $3.18 , $4.11 , N/A , N/A , $3.95 , $4.40 , $4.14 , $4.40 , $4.40 , $4.40 , $4.16 , N/A , $4.51 , $4.65 , $4.16 , $4.55 , $4.55 , $4.65 , $4.69 , $4.00 , $4.40 , $4.16 , $3.86 , N/A , $3.96 , $3.96 , $4.65 , $4.20 , $3.86 , $4.69 
Prq Trluml Coronary Byp Grft Revasc Addl Vessel,CPT® 92938,N/A,N/A,N/A," $1,806.00 "," $1,173.90 ", N/A , N/A , N/A , N/A , N/A ," $1,679.58 "," $1,625.40 "," $1,625.40 "," $1,444.80 "," $1,444.80 ", N/A ," $1,667.48 "," $1,715.70 "," $1,625.40 "," $1,625.40 "," $1,625.40 "," $1,679.58 "," $1,733.76 ", N/A ," $1,535.10 ", N/A , N/A , N/A , N/A , N/A ," $1,715.70 ", N/A ," $1,444.80 "," $1,733.76 "
"Reticulocyte Count, Auto",CPT® 85045,N/A,N/A,N/A, $85.00 , $55.25 , N/A , $4.07 , $4.07 , $22.62 , $27.08 , $79.05 , $76.50 , $76.50 , $68.00 , $68.00 , $4.07 , $78.48 , $80.75 , $76.50 , $76.50 , $76.50 , $79.05 , $81.60 , $26.64 , $72.25 , $25.95 , $14.48 , N/A , $21.11 , $21.11 , $80.75 , $23.07 , $4.07 , $81.60 
"Excis Chalazion,Single",CPT® 67800,N/A,N/A,N/A, $968.00 , $629.20 , $629.59 , $98.86 , $67.40 , $584.99 , $551.22 , $900.24 , $871.20 , $871.20 , $774.40 , $774.40 , $67.40 , $893.75 , $919.60 , $871.20 , $871.20 , $871.20 , $900.24 , $929.28 , $869.30 , $822.80 , $569.12 , $744.29 , N/A , $596.41 , $596.41 , $919.60 , $658.35 , $67.40 , $929.28 
 ISATUXIMAB-IRFC 100 MG/5ML IV SOLN ,HCPCS J9227,0636 - DRUGS REQUIRING DETAILED CODIN,00024-0654-01,5 mL," $2,215.11 "," $1,439.82 "," $1,860.69 ", $75.84 , $73.39 ," $1,789.81 "," $1,993.60 "," $1,875.31 "," $1,993.60 "," $1,993.60 "," $1,993.60 "," $1,882.84 ", $71.95 ," $2,045.21 "," $2,104.35 "," $1,882.84 "," $2,060.05 "," $2,060.05 "," $2,104.35 "," $2,126.51 "," $1,812.40 "," $1,993.60 "," $1,882.84 "," $1,749.94 ", N/A ," $1,792.69 "," $1,792.69 "," $2,104.35 "," $1,900.79 ", $71.95 ," $2,126.51 "
Treat Metacarpal Fracture,26600,N/A,N/A,N/A," $1,243.00 ", $807.95 ," $1,787.76 ", $284.00 , $155.34 ," $1,331.76 "," $1,361.00 "," $1,155.99 "," $1,118.70 "," $1,118.70 ", $994.40 , $994.40 , $155.34 ," $1,147.66 "," $1,180.85 "," $1,118.70 "," $1,118.70 "," $1,118.70 "," $1,155.99 "," $1,193.28 "," $1,640.20 "," $1,056.55 "," $1,491.48 "," $1,590.09 ", N/A ," $1,357.74 "," $1,357.74 "," $1,180.85 "," $1,595.82 ", $155.34 ," $1,787.76 "
" Fac Phenotype, Dna Hiv W/Culture ",CPT® 87903,0306 - LAB/BACT-MICRO,N/A,N/A," $4,508.00 "," $2,930.20 "," $3,786.72 ", $498.43 , $498.43 ," $3,642.46 "," $4,057.20 "," $3,816.47 "," $4,057.20 "," $4,057.20 "," $4,057.20 "," $3,831.80 ", $488.66 ," $4,162.24 "," $4,282.60 "," $3,831.80 "," $4,192.44 "," $4,192.44 "," $4,282.60 "," $4,327.68 "," $3,688.45 "," $4,057.20 "," $3,831.80 "," $3,561.32 ", N/A ," $3,648.32 "," $3,648.32 "," $4,282.60 "," $3,868.31 ", $488.66 ," $4,327.68 "
 Seizures With McC ,MS DRG V40 (FY2023) 100,N/A,N/A,N/A," $64,441.44 "," $41,886.94 "," $54,130.81 ", N/A , N/A ," $52,068.68 "," $57,997.30 "," $54,556.12 "," $57,997.30 "," $57,997.30 "," $57,997.30 "," $54,775.22 ", N/A ," $59,498.78 "," $61,219.37 "," $54,775.22 "," $59,930.54 "," $59,930.54 "," $61,219.37 "," $61,863.78 "," $52,725.99 "," $57,997.30 "," $54,775.22 "," $50,908.74 ", N/A ," $52,152.46 "," $52,152.46 "," $61,219.37 "," $55,297.20 "," $50,908.74 "," $61,863.78 "
 PAMIDRONATE DISODIUM 90 MG/10ML IV SOLN ,HCPCS J2430,0636 - DRUGS REQUIRING DETAILED CODIN,61703-0326-18,10 mL, $107.01 , $69.56 , $89.89 , $10.53 , $10.78 , $86.46 , $96.31 , $90.59 , $96.31 , $96.31 , $96.31 , $90.96 , $10.57 , $98.80 , $101.66 , $90.96 , $99.52 , $99.52 , $101.66 , $102.73 , $87.56 , $96.31 , $90.96 , $84.54 , N/A , $86.60 , $86.60 , $101.66 , $91.83 , $10.53 , $102.73 
 Fac Cul Fngi Mold/Yeast Isol Prsmptv ID Isol Bld ,CPT® 87103,0306 - LAB/BACT-MICRO,N/A,N/A, $118.00 , $76.70 , $99.12 , $20.87 , $12.52 , $95.34 , $106.20 , $99.90 , $106.20 , $106.20 , $106.20 , $100.30 , $12.27 , $108.95 , $112.10 , $100.30 , $109.74 , $109.74 , $112.10 , $113.28 , $96.55 , $106.20 , $100.30 , $93.22 , N/A , $95.50 , $95.50 , $112.10 , $101.26 , $12.27 , $113.28 
Assay Cryoglobulin,CPT® 82595,N/A,N/A,N/A, $95.00 , $61.75 , N/A , $6.60 , $6.60 , $36.62 , $43.78 , $88.35 , $85.50 , $85.50 , $76.00 , $76.00 , $6.60 , $87.71 , $90.25 , $85.50 , $85.50 , $85.50 , $88.35 , $91.20 , $43.20 , $80.75 , $42.17 , $23.44 , N/A , $34.18 , $34.18 , $90.25 , $37.35 , $6.60 , $91.20 
 Pro Application Lower Leg Splint ,CPT® 29515,0982 - PRO FEE/OUTPT,N/A,N/A, $473.00 , $307.45 , $298.68 , $47.11 , $31.03 , $240.63 , $243.68 , $439.89 , $425.70 , $425.70 , $378.40 , $378.40 , $31.03 , $436.72 , $449.35 , $425.70 , $425.70 , $425.70 , $439.89 , $454.08 , $277.19 , $402.05 , $265.83 , $288.50 , N/A , $245.33 , $245.33 , $449.35 , $288.36 , $31.03 , $454.08 
Assay Cpk in Blood,CPT® 82552,N/A,N/A,N/A, $204.00 , $132.60 , N/A , $13.66 , $13.66 , $75.79 , $90.69 , $189.72 , $183.60 , $183.60 , $163.20 , $163.20 , $13.66 , $188.35 , $193.80 , $183.60 , $183.60 , $183.60 , $189.72 , $195.84 , $89.41 , $173.40 , $87.58 , $48.55 , N/A , $70.73 , $70.73 , $193.80 , $77.30 , $13.66 , $195.84 
 Fac Chemotx Admn Ia Nfs Tq Up 1 Hr ,CPT® 96422,0335 - CHEMOTHERP-IV,N/A,N/A," $1,065.00 ", $692.25 , $894.60 , $153.08 , $28.96 , $860.52 , $958.50 , $901.63 , $958.50 , $958.50 , $958.50 , $905.25 , $28.39 , $983.31 ," $1,011.75 ", $905.25 , $990.45 , $990.45 ," $1,011.75 "," $1,022.40 ", $871.38 , $958.50 , $905.25 , $841.35 , N/A , $861.90 , $861.90 ," $1,011.75 ", $913.88 , $28.39 ," $1,022.40 "
"Excise Excess Skin Tissue,Other",CPT® 15839,N/A,N/A,N/A," $3,402.00 "," $2,211.30 "," $2,347.84 ", $703.27 , $648.35 ," $2,004.69 "," $1,942.81 "," $3,163.86 "," $3,061.80 "," $3,061.80 "," $2,721.60 "," $2,721.60 ", $648.35 ," $3,141.07 "," $3,231.90 "," $3,061.80 "," $3,061.80 "," $3,061.80 "," $3,163.86 "," $3,265.92 "," $2,570.44 "," $2,891.70 "," $3,892.83 "," $2,554.78 ", N/A ," $2,043.80 "," $2,043.80 "," $3,231.90 "," $2,370.12 ", $648.35 ," $3,892.83 "
Gait Training Therapy,CPT® 97116,N/A,N/A,N/A, $146.00 , $94.90 , $69.17 , $29.46 , $31.19 , $64.49 , $57.31 , $135.78 , $131.40 , $131.40 , $116.80 , $116.80 , $31.19 , $134.80 , $138.70 , $131.40 , $131.40 , $131.40 , $135.78 , $140.16 , $75.10 , $124.10 , $84.14 , $68.54 , N/A , $65.75 , $65.75 , $138.70 , $73.15 , $29.46 , $140.16 
Assay Urine Phosphorus,CPT® 84105,N/A,N/A,N/A, $61.00 , $39.65 , N/A , $5.90 , $5.90 , $29.27 , $35.00 , $56.73 , $54.90 , $54.90 , $48.80 , $48.80 , $5.90 , $56.32 , $57.95 , $54.90 , $54.90 , $54.90 , $56.73 , $58.56 , $38.59 , $51.85 , $34.06 , $18.77 , N/A , $27.32 , $27.32 , $57.95 , $29.85 , $5.90 , $58.56 
 Fac Hgb F Qual ,CPT® 83033,0301 - LAB/CHEMISTRY,N/A,N/A, $55.00 , $35.75 , $46.20 , $8.16 , $8.16 , $44.44 , $49.50 , $46.56 , $49.50 , $49.50 , $49.50 , $46.75 , $8.00 , $50.78 , $52.25 , $46.75 , $51.15 , $51.15 , $52.25 , $52.80 , $45.00 , $49.50 , $46.75 , $43.45 , N/A , $44.51 , $44.51 , $52.25 , $47.20 , $8.00 , $52.80 
Urine Albumin Semiquantitative,CPT® 82044,N/A,N/A,N/A, $102.00 , $66.30 , N/A , $6.35 , $4.21 , $17.17 , $20.53 , $94.86 , $91.80 , $91.80 , $81.60 , $81.60 , $4.21 , $94.18 , $96.90 , $91.80 , $91.80 , $91.80 , $94.86 , $97.92 , $41.60 , $86.70 , $29.19 , $18.26 , N/A , $16.02 , $16.02 , $96.90 , $17.51 , $4.21 , $97.92 
 Pro Office/OP Consltj New/Est Pt Mod Mdm 40 Minutes ,CPT® 99244,0988 - PRO FEE/CONSULT,N/A,N/A, $735.00 , $477.75 , N/A , $159.18 , $107.79 , $337.93 , $336.49 , $683.55 , $661.50 , $661.50 , $588.00 , $588.00 , $107.79 , $678.63 , $698.25 , $661.50 , $661.50 , $661.50 , $683.55 , $705.60 , $427.34 , $624.75 , $328.55 , $337.38 , $233.00 , $344.53 , $344.53 , $698.25 , $410.14 , $107.79 , $705.60 
 ESTRADIOL 0.05 MG/24HR TD PTWK ,HCPCS RXC637,0250 - PHARMACY,00781-7133-54,1 patch, $119.22 , $77.49 , $100.14 , N/A , N/A , $96.33 , $107.30 , $100.93 , $107.30 , $107.30 , $107.30 , $101.34 , N/A , $110.08 , $113.26 , $101.34 , $110.87 , $110.87 , $113.26 , $114.45 , $97.55 , $107.30 , $101.34 , $94.18 , N/A , $96.48 , $96.48 , $113.26 , $102.30 , $94.18 , $114.45 
Suture Abd Wall-Dehis/Eviscer,49900,N/A,N/A,N/A," $5,308.00 "," $3,450.20 "," $4,930.45 ", $765.38 , $307.34 ," $3,835.46 "," $3,903.96 "," $4,936.44 "," $4,777.20 "," $4,777.20 "," $4,246.40 "," $4,246.40 ", $307.34 ," $4,900.88 "," $5,042.60 "," $4,777.20 "," $4,777.20 "," $4,777.20 "," $4,936.44 "," $5,095.68 "," $3,512.83 "," $4,511.80 "," $4,328.14 "," $4,546.25 ", N/A ," $3,910.30 "," $3,910.30 "," $5,042.60 "," $4,089.75 ", $307.34 ," $5,095.68 "
 Heart Failure And Shock With Cc ,MS DRG V40 (FY2023) 292,N/A,N/A,N/A," $21,281.43 "," $13,832.93 "," $17,876.40 ", N/A , N/A ," $17,195.40 "," $19,153.29 "," $18,016.86 "," $19,153.29 "," $19,153.29 "," $19,153.29 "," $18,089.22 ", N/A ," $19,649.14 "," $20,217.36 "," $18,089.22 "," $19,791.73 "," $19,791.73 "," $20,217.36 "," $20,430.17 "," $17,412.47 "," $19,153.29 "," $18,089.22 "," $16,812.33 ", N/A ," $17,223.06 "," $17,223.06 "," $20,217.36 "," $18,261.60 "," $16,812.33 "," $20,430.17 "
 Pro Arthrs Kne Surg W/Lss Ads +-Mnpj Spx ,CPT® 29884,0975 - PRO FEE/OR,N/A,N/A," $4,089.00 "," $2,657.85 "," $3,765.00 ", $591.75 , $888.33 ," $2,972.96 "," $2,994.86 "," $3,802.77 "," $3,680.10 "," $3,680.10 "," $3,271.20 "," $3,271.20 ", $888.33 ," $3,775.37 "," $3,884.55 "," $3,680.10 "," $3,680.10 "," $3,680.10 "," $3,802.77 "," $3,925.44 "," $3,506.92 "," $3,475.65 "," $3,305.87 "," $3,515.87 ", N/A ," $3,030.97 "," $3,030.97 "," $3,884.55 "," $3,562.46 ", $591.75 ," $3,925.44 "
 Traumatic Stupor And Coma >1 Hour With Cc ,MS DRG V40 (FY2023) 083,N/A,N/A,N/A," $19,384.87 "," $12,600.17 "," $16,283.29 ", N/A , N/A ," $15,662.97 "," $17,446.38 "," $16,411.23 "," $17,446.38 "," $17,446.38 "," $17,446.38 "," $16,477.14 ", N/A ," $17,898.05 "," $18,415.63 "," $16,477.14 "," $18,027.93 "," $18,027.93 "," $18,415.63 "," $18,609.48 "," $15,860.70 "," $17,446.38 "," $16,477.14 "," $15,314.05 ", N/A ," $15,688.18 "," $15,688.18 "," $18,415.63 "," $16,634.16 "," $15,314.05 "," $18,609.48 "
"Prevent Counsel,Indiv,60 Min",CPT® 99404,N/A,N/A,N/A, $533.00 , $346.45 , N/A , $107.78 , $38.71 , $212.77 , $214.46 , $495.69 , $479.70 , $479.70 , $426.40 , $426.40 , $38.71 , $492.12 , $506.35 , $479.70 , $479.70 , $479.70 , $495.69 , $511.68 , $263.29 , $453.05 , $214.53 , $211.96 , N/A , $216.92 , $216.92 , $506.35 , $260.55 , $38.71 , $511.68 
Orphenadrine Injection,HCPCS J2360,N/A,N/A,N/A, $34.00 , $22.10 , N/A , $16.87 , $5.49 , N/A , N/A , $31.62 , $30.60 , $30.60 , $27.20 , $27.20 , $5.49 , $31.39 , $32.30 , $30.60 , $30.60 , $30.60 , $31.62 , $32.64 , $7.45 , $28.90 , $12.33 , $5.31 , N/A , N/A , N/A , $32.30 , N/A , $5.31 , $32.64 
Evoked Otoacoustic Emissions Screen Auto Analys,CPT® 92558,N/A,N/A,N/A, $153.00 , $99.45 , N/A , $9.27 , $7.04 , $20.73 , $21.79 , $142.29 , $137.70 , $137.70 , $122.40 , $122.40 , $7.04 , $141.26 , $145.35 , $137.70 , $137.70 , $137.70 , $142.29 , $146.88 , $25.52 , $130.05 , $29.40 , $33.50 , N/A , $21.14 , $21.14 , $145.35 , $24.64 , $7.04 , $146.88 
 Pro Drg Fngr Absc Smpl ,CPT® 26010,0981 - PRO FEE/ER,N/A,N/A, $817.00 , $531.05 , $867.23 , $136.36 , $30.71 , $664.95 , $677.89 , $759.81 , $735.30 , $735.30 , $653.60 , $653.60 , $30.71 , $754.34 , $776.15 , $735.30 , $735.30 , $735.30 , $759.81 , $784.32 , $800.12 , $694.45 , $742.17 , $793.35 , N/A , $677.92 , $677.92 , $776.15 , $796.82 , $30.71 , $867.23 
"Closed Rx Ulna Shaft Fx,Manipulatn",CPT® 25535,N/A,N/A,N/A," $2,575.00 "," $1,673.75 "," $2,828.09 ", $446.23 , $307.34 ," $2,178.51 "," $2,197.64 "," $2,394.75 "," $2,317.50 "," $2,317.50 "," $2,060.00 "," $2,060.00 ", $307.34 ," $2,377.50 "," $2,446.25 "," $2,317.50 "," $2,317.50 "," $2,317.50 "," $2,394.75 "," $2,472.00 "," $2,617.19 "," $2,188.75 "," $2,417.41 "," $2,567.19 ", N/A ," $2,221.01 "," $2,221.01 "," $2,446.25 "," $2,610.49 ", $307.34 ," $2,828.09 "
Drug Screen Quantitative Tiagabine,CPT® 80199,N/A,N/A,N/A, $195.00 , $126.75 , N/A , $27.65 , $20.09 , $102.19 , $121.26 , $181.35 , $175.50 , $175.50 , $156.00 , $156.00 , $20.09 , $180.04 , $185.25 , $175.50 , $175.50 , $175.50 , $181.35 , $187.20 , $181.02 , $165.75 , $129.23 , $79.62 , N/A , $95.37 , $95.37 , $185.25 , $104.22 , $20.09 , $187.20 
Apply Finger Splint,29130,N/A,N/A,N/A, $268.00 , $174.20 , $175.70 , $27.56 , $10.31 , $137.91 , $137.01 , $249.24 , $241.20 , $241.20 , $214.40 , $214.40 , $10.31 , $247.44 , $254.60 , $241.20 , $241.20 , $241.20 , $249.24 , $257.28 , $162.22 , $227.80 , $149.86 , $165.82 , N/A , $140.61 , $140.61 , $254.60 , $165.26 , $10.31 , $257.28 
 Prolact Rtf 28 per Ml ,Custom 2200000008,0220 - SPECIAL CHARGES,N/A,N/A, $10.00 , $6.50 , $8.40 , N/A , N/A , $8.08 , $9.00 , $8.47 , $9.00 , $9.00 , $9.00 , $8.50 , N/A , $9.23 , $9.50 , $8.50 , $9.30 , $9.30 , $9.50 , $9.60 , $8.18 , $9.00 , $8.50 , $7.90 , N/A , $8.09 , $8.09 , $9.50 , $8.58 , $7.90 , $9.60 
 Fac Assay of Lipoprotein ,CPT® 83718,0301 - LAB/CHEMISTRY,N/A,N/A, $87.00 , $56.55 , $73.08 , $8.35 , $8.35 , $70.30 , $78.30 , $73.65 , $78.30 , $78.30 , $78.30 , $73.95 , $8.19 , $80.33 , $82.65 , $73.95 , $80.91 , $80.91 , $82.65 , $83.52 , $71.18 , $78.30 , $73.95 , $68.73 , N/A , $70.41 , $70.41 , $82.65 , $74.65 , $8.19 , $83.52 
"Lap,Inguinal Hernia Repr,Recur",49651,N/A,N/A,N/A," $3,627.00 "," $2,357.55 "," $3,390.21 ", $526.32 , $526.20 ," $2,612.42 "," $2,664.23 "," $3,373.11 "," $3,264.30 "," $3,264.30 "," $2,901.60 "," $2,901.60 ", $526.20 ," $3,348.81 "," $3,445.65 "," $3,264.30 "," $3,264.30 "," $3,264.30 "," $3,373.11 "," $3,481.92 "," $2,415.05 "," $3,082.95 "," $2,957.98 "," $3,089.28 ", N/A ," $2,663.40 "," $2,663.40 "," $3,445.65 "," $2,785.65 ", $526.20 ," $3,481.92 "
"Remv Thigh/Knee Tumor,Subcutaneous",27327,N/A,N/A,N/A," $4,268.00 "," $2,774.20 "," $1,912.82 ", $300.22 , $32.04 ," $1,507.88 "," $1,515.87 "," $3,969.24 "," $3,841.20 "," $3,841.20 "," $3,414.40 "," $3,414.40 ", $32.04 ," $3,940.64 "," $4,054.60 "," $3,841.20 "," $3,841.20 "," $3,841.20 "," $3,969.24 "," $4,097.28 "," $1,763.13 "," $3,627.80 "," $1,671.67 "," $1,778.91 ", N/A ," $1,537.31 "," $1,537.31 "," $4,054.60 "," $1,806.88 ", $32.04 ," $4,097.28 "
"Exc Skin Malig 0.6-1cm Trunk,Arm,Leg",CPT® 11601,N/A,N/A,N/A, $967.00 , $628.55 , $476.17 , $142.89 , $122.93 , $406.96 , $398.48 , $899.31 , $870.30 , $870.30 , $773.60 , $773.60 , $122.93 , $892.83 , $918.65 , $870.30 , $870.30 , $870.30 , $899.31 , $928.32 , $521.49 , $821.95 , $792.12 , $522.31 , N/A , $414.90 , $414.90 , $918.65 , $481.15 , $122.93 , $928.32 
 EPTIFIBATIDE 75 MG/100ML IV SOLN ,HCPCS J1327,0636 - DRUGS REQUIRING DETAILED CODIN,67457-0631-10,100 mL, $294.04 , $191.13 , $246.99 , N/A , $28.13 , $237.58 , $264.64 , $248.93 , $264.64 , $264.64 , $264.64 , $249.93 , $27.58 , $271.49 , $279.34 , $249.93 , $273.46 , $273.46 , $279.34 , $282.28 , $240.58 , $264.64 , $249.93 , $232.29 , N/A , $237.97 , $237.97 , $279.34 , $252.32 , $27.58 , $282.28 
 Fac Assay of Fetal Fibronectin ,CPT® 82731,0301 - LAB/CHEMISTRY,N/A,N/A, $594.00 , $386.10 , $498.96 , $65.70 , $65.70 , $479.95 , $534.60 , $502.88 , $534.60 , $534.60 , $534.60 , $504.90 , $64.41 , $548.44 , $564.30 , $504.90 , $552.42 , $552.42 , $564.30 , $570.24 , $486.01 , $534.60 , $504.90 , $469.26 , N/A , $480.72 , $480.72 , $564.30 , $509.71 , $64.41 , $570.24 
 Room Rate ,Custom 1170000001,0117 - ONCOLOGY/PVT,N/A,N/A," $1,848.00 "," $1,201.20 "," $1,552.32 ", N/A , N/A ," $1,493.18 "," $1,663.20 "," $1,564.52 "," $1,663.20 "," $1,663.20 "," $1,663.20 "," $1,570.80 ", N/A ," $1,706.26 "," $1,755.60 "," $1,570.80 "," $1,718.64 "," $1,718.64 "," $1,755.60 "," $1,774.08 "," $1,512.03 "," $1,663.20 "," $1,570.80 "," $1,459.92 ", N/A ," $1,495.59 "," $1,495.59 "," $1,755.60 "," $1,585.77 "," $1,459.92 "," $1,774.08 "
 Fac Iadna Respiratry Probe & Rev Trnscr 3-5 Targets ,CPT® 87631,0306 - LAB/BACT-MICRO,N/A,N/A, $468.00 , $304.20 , $393.12 , $145.48 , $143.60 , $378.14 , $421.20 , $396.21 , $421.20 , $421.20 , $421.20 , $397.80 , $140.78 , $432.10 , $444.60 , $397.80 , $435.24 , $435.24 , $444.60 , $449.28 , $382.92 , $421.20 , $397.80 , $369.72 , N/A , $378.75 , $378.75 , $444.60 , $401.59 , $140.78 , $449.28 
 Fac Assay of Arsenic ,CPT® 82175,0301 - LAB/CHEMISTRY,N/A,N/A, $205.00 , $133.25 , $172.20 , $19.35 , $19.35 , $165.64 , $184.50 , $173.55 , $184.50 , $184.50 , $184.50 , $174.25 , $18.97 , $189.28 , $194.75 , $174.25 , $190.65 , $190.65 , $194.75 , $196.80 , $167.73 , $184.50 , $174.25 , $161.95 , N/A , $165.91 , $165.91 , $194.75 , $175.91 , $18.97 , $196.80 
"Rabies Ig, Im/Sc",CPT® 90375,N/A,N/A,N/A, $641.00 , $416.65 , N/A , $290.37 , $150.22 , $530.08 , $630.08 , $596.13 , $576.90 , $576.90 , $512.80 , $512.80 , $150.22 , $591.84 , $608.95 , $576.90 , $576.90 , $576.90 , $596.13 , $615.36 , $387.14 , $544.85 , $615.33 , $350.35 , N/A , $540.42 , $540.42 , $608.95 , $630.04 , $150.22 , $630.08 
Closed Tx Interphalanx Jt Disloc W/ Manip W/ Anes -Mh,26775,N/A,N/A,N/A," $1,806.00 "," $1,173.90 "," $2,190.89 ", $348.94 , $96.07 ," $1,665.79 "," $1,696.44 "," $1,679.58 "," $1,625.40 "," $1,625.40 "," $1,444.80 "," $1,444.80 ", $96.07 ," $1,667.48 "," $1,715.70 "," $1,625.40 "," $1,625.40 "," $1,625.40 "," $1,679.58 "," $1,733.76 "," $2,017.00 "," $1,535.10 "," $1,860.78 "," $1,975.65 ", N/A ," $1,698.29 "," $1,698.29 "," $1,715.70 "," $1,996.10 ", $96.07 ," $2,190.89 "
 Pro Temporal Artery Procedure ,CPT® 37609,0982 - PRO FEE/OUTPT,N/A,N/A," $1,952.00 "," $1,268.80 "," $1,228.76 ", $191.29 , $190.55 , $893.52 , $904.87 ," $1,815.36 "," $1,756.80 "," $1,756.80 "," $1,561.60 "," $1,561.60 ", $190.55 ," $1,802.28 "," $1,854.40 "," $1,756.80 "," $1,756.80 "," $1,756.80 "," $1,815.36 "," $1,873.92 "," $1,133.39 "," $1,659.20 "," $1,131.10 "," $1,009.19 ", N/A , $910.96 , $910.96 ," $1,854.40 "," $1,034.85 ", $190.55 ," $1,873.92 "
" Layer Closure Face, Eyelids,Nose,Ears,Lips 2.5cm or Le ",CPT® 12051,0981 - PRO FEE/ER,N/A,N/A," $1,095.00 ", $711.75 , $541.38 , $162.92 , $106.23 , $469.05 , $460.11 ," $1,018.35 ", $985.50 , $985.50 , $876.00 , $876.00 , $106.23 ," $1,011.01 "," $1,040.25 ", $985.50 , $985.50 , $985.50 ," $1,018.35 "," $1,051.20 ", $593.04 , $930.75 , $917.01 , $602.22 , N/A , $478.20 , $478.20 ," $1,040.25 ", $554.57 , $106.23 ," $1,051.20 "
"Excis Urethral Tic,Female",CPT® 53230,N/A,N/A,N/A," $4,228.00 "," $2,748.20 "," $3,305.39 ", $580.85 , $768.38 ," $2,963.67 "," $2,778.32 "," $3,932.04 "," $3,805.20 "," $3,805.20 "," $3,382.40 "," $3,382.40 ", $768.38 ," $3,903.71 "," $4,016.60 "," $3,805.20 "," $3,805.20 "," $3,805.20 "," $3,932.04 "," $4,058.88 "," $3,307.57 "," $3,593.80 "," $3,159.58 "," $3,720.95 ", N/A ," $3,021.49 "," $3,021.49 "," $4,016.60 "," $3,551.32 ", $580.85 ," $4,058.88 "
 Fac Assay of Zinc ,CPT® 84630,0301 - LAB/CHEMISTRY,N/A,N/A, $155.00 , $100.75 , $130.20 , $11.62 , $11.62 , $125.24 , $139.50 , $131.22 , $139.50 , $139.50 , $139.50 , $131.75 , $11.39 , $143.11 , $147.25 , $131.75 , $144.15 , $144.15 , $147.25 , $148.80 , $126.82 , $139.50 , $131.75 , $122.45 , N/A , $125.44 , $125.44 , $147.25 , $133.01 , $11.39 , $148.80 
Exc Tumor Soft Tissue Upper Arm/Elbow Subq 3+Cm,CPT® 24071,N/A,N/A,N/A," $3,058.00 "," $1,987.70 "," $2,452.97 ", $382.32 , $332.95 ," $1,943.39 "," $1,947.61 "," $2,843.94 "," $2,752.20 "," $2,752.20 "," $2,446.40 "," $2,446.40 ", $332.95 ," $2,823.45 "," $2,905.10 "," $2,752.20 "," $2,752.20 "," $2,752.20 "," $2,843.94 "," $2,935.68 "," $2,274.55 "," $2,599.30 "," $2,155.15 "," $2,292.22 ", N/A ," $1,981.30 "," $1,981.30 "," $2,905.10 "," $2,328.72 ", $332.95 ," $2,935.68 "
"Hemorrhoidectomy,Int/Ext,Complx",46260,N/A,N/A,N/A," $3,579.00 "," $2,326.35 "," $2,955.75 ", $458.53 , $387.88 ," $2,254.34 "," $2,301.47 "," $3,328.47 "," $3,221.10 "," $3,221.10 "," $2,863.20 "," $2,863.20 ", $387.88 ," $3,304.49 "," $3,400.05 "," $3,221.10 "," $3,221.10 "," $3,221.10 "," $3,328.47 "," $3,435.84 "," $2,108.62 "," $3,042.15 "," $2,536.94 "," $2,681.16 ", N/A ," $2,298.33 "," $2,298.33 "," $3,400.05 "," $2,403.80 ", $387.88 ," $3,435.84 "
Transperineal Plmt Biodegradable Matrl 1/Mlt Njx,CPT® 55874,N/A,N/A,N/A," $20,049.00 "," $13,031.85 ", $732.03 , $157.24 , N/A , $503.15 , $532.99 ," $18,645.57 "," $18,044.10 "," $18,044.10 "," $16,039.20 "," $16,039.20 ", N/A ," $18,511.24 "," $19,046.55 "," $18,044.10 "," $18,044.10 "," $18,044.10 "," $18,645.57 "," $19,247.04 ", $687.86 ," $17,041.65 ", $858.26 , $797.27 , N/A , $512.97 , $512.97 ," $19,046.55 ", $614.81 , $157.24 ," $19,247.04 "
 Fac 1st Hosp Care PR D 30 Min ,CPT® 99221,0761 - TREATMENT ROOM,N/A,N/A, $293.00 , $190.45 , $246.12 , $79.64 , $82.46 , $236.74 , $263.70 , $248.05 , $263.70 , $263.70 , $263.70 , $249.05 , $80.84 , $270.53 , $278.35 , $249.05 , $272.49 , $272.49 , $278.35 , $281.28 , $239.73 , $263.70 , $249.05 , $231.47 , N/A , $237.12 , $237.12 , $278.35 , $251.42 , $79.64 , $281.28 
Open Rx Toe Fx,CPT® 28525,N/A,N/A,N/A," $3,823.00 "," $2,484.95 "," $2,505.88 ", $393.62 , $192.09 ," $1,931.23 "," $1,962.49 "," $3,555.39 "," $3,440.70 "," $3,440.70 "," $3,058.40 "," $3,058.40 ", $192.09 ," $3,529.78 "," $3,631.85 "," $3,440.70 "," $3,440.70 "," $3,440.70 "," $3,555.39 "," $3,670.08 "," $2,319.32 "," $3,249.55 "," $2,137.31 "," $2,326.66 ", N/A ," $1,968.92 "," $1,968.92 "," $3,631.85 "," $2,314.18 ", $192.09 ," $3,670.08 "
"Rad Excis Jt Lining,Flexor,Each",CPT® 26145,N/A,N/A,N/A," $3,441.00 "," $2,236.65 "," $3,167.78 ", $498.73 , $537.90 ," $2,463.83 "," $2,459.60 "," $3,200.13 "," $3,096.90 "," $3,096.90 "," $2,752.80 "," $2,752.80 ", $537.90 ," $3,177.08 "," $3,268.95 "," $3,096.90 "," $3,096.90 "," $3,096.90 "," $3,200.13 "," $3,303.36 "," $2,938.79 "," $2,924.85 "," $2,706.43 "," $2,924.45 ", N/A ," $2,511.90 "," $2,511.90 "," $3,268.95 "," $2,952.38 ", $498.73 ," $3,303.36 "
"Twist Hole Skull,Implant Cath/Device",CPT® 61107,N/A,N/A,N/A," $2,143.00 "," $1,392.95 "," $1,398.80 ", $272.34 ," $1,934.72 "," $1,691.16 "," $1,602.24 "," $1,992.99 "," $1,928.70 "," $1,928.70 "," $1,714.40 "," $1,714.40 "," $1,934.72 "," $1,978.63 "," $2,035.85 "," $1,928.70 "," $1,928.70 "," $1,928.70 "," $1,992.99 "," $2,057.28 "," $1,517.70 "," $1,821.55 "," $1,657.40 "," $1,741.66 ", N/A ," $1,724.16 "," $1,724.16 "," $2,035.85 "," $1,849.62 ", $272.34 ," $2,057.28 "
 DIPHENHYDRAMINE-ZINC ACETATE 2-0.1 % EX CREA ,HCPCS RXC637,0250 - PHARMACY,00904-5354-31,28 gram, $22.30 , $14.50 , $18.73 , N/A , N/A , $18.02 , $20.07 , $18.88 , $20.07 , $20.07 , $20.07 , $18.96 , N/A , $20.59 , $21.19 , $18.96 , $20.74 , $20.74 , $21.19 , $21.41 , $18.25 , $20.07 , $18.96 , $17.62 , N/A , $18.05 , $18.05 , $21.19 , $19.14 , $17.62 , $21.41 
 Pro Revj/Rmvl Implted Spi Npgr ,CPT® 63688,0982 - PRO FEE/OUTPT,N/A,N/A," $2,457.00 "," $1,597.05 "," $1,790.20 ", $351.09 , $400.51 ," $2,042.54 "," $1,979.16 "," $2,285.01 "," $2,211.30 "," $2,211.30 "," $1,965.60 "," $1,965.60 ", $400.51 ," $2,268.55 "," $2,334.15 "," $2,211.30 "," $2,211.30 "," $2,211.30 "," $2,285.01 "," $2,358.72 "," $1,935.77 "," $2,088.45 "," $1,967.82 "," $2,176.52 ", N/A ," $2,082.39 "," $2,082.39 "," $2,334.15 "," $2,233.92 ", $351.09 ," $2,358.72 "
 Fac Virus Antibody Nos ,CPT® 86790,0302 - LAB/IMMUNOLOGY,N/A,N/A, $189.00 , $122.85 , $158.76 , $13.14 , N/A , $152.71 , $170.10 , $160.01 , $170.10 , $170.10 , $170.10 , $160.65 , N/A , $174.50 , $179.55 , $160.65 , $175.77 , $175.77 , $179.55 , $181.44 , $154.64 , $170.10 , $160.65 , $149.31 , N/A , $152.96 , $152.96 , $179.55 , $162.18 , $13.14 , $181.44 
" Pro Laparoscopy, Biopsy ",CPT® 49321,0982 - PRO FEE/OUTPT,N/A,N/A," $3,508.00 "," $2,280.20 "," $2,070.64 ", $321.57 , $373.69 ," $1,625.05 "," $1,656.01 "," $3,262.44 "," $3,157.20 "," $3,157.20 "," $2,806.40 "," $2,806.40 ", $373.69 ," $3,238.94 "," $3,332.60 "," $3,157.20 "," $3,157.20 "," $3,157.20 "," $3,262.44 "," $3,367.68 "," $1,484.93 "," $2,981.80 "," $1,839.37 "," $1,929.04 ", N/A ," $1,656.76 "," $1,656.76 "," $3,332.60 "," $1,732.81 ", $321.57 ," $3,367.68 "
"Knee Scope,Abrasn Arthroplasty",CPT® 29879,N/A,N/A,N/A," $4,236.00 "," $2,753.40 "," $4,020.77 ", $630.74 , $570.08 ," $3,200.50 "," $3,196.91 "," $3,939.48 "," $3,812.40 "," $3,812.40 "," $3,388.80 "," $3,388.80 ", $570.08 ," $3,911.10 "," $4,024.20 "," $3,812.40 "," $3,812.40 "," $3,812.40 "," $3,939.48 "," $4,066.56 "," $3,742.83 "," $3,600.60 "," $3,530.66 "," $3,772.62 ", N/A ," $3,262.95 "," $3,262.95 "," $4,024.20 "," $3,835.11 ", $570.08 ," $4,066.56 "
"Repair of Hammertoe,One",28285,N/A,N/A,N/A," $3,525.00 "," $2,291.25 "," $2,376.27 ", $373.93 , $280.42 ," $1,861.09 "," $1,848.26 "," $3,278.25 "," $3,172.50 "," $3,172.50 "," $2,820.00 "," $2,820.00 ", $280.42 ," $3,254.63 "," $3,348.75 "," $3,172.50 "," $3,172.50 "," $3,172.50 "," $3,278.25 "," $3,384.00 "," $2,197.00 "," $2,996.25 "," $1,999.94 "," $2,217.14 ", N/A ," $1,897.41 "," $1,897.41 "," $3,348.75 "," $2,230.13 ", $280.42 ," $3,384.00 "
 Fac Roprtj > 1 Mo After Original Opration ,CPT® 35700,0360 - OR SERVICES,N/A,N/A, $202.00 , $131.30 , $169.68 , $133.86 , $362.61 , $163.22 , $181.80 , $171.01 , $181.80 , $181.80 , $181.80 , $171.70 , $355.50 , $186.51 , $191.90 , $171.70 , $187.86 , $187.86 , $191.90 , $193.92 , $165.28 , $181.80 , $171.70 , $159.58 , N/A , $163.48 , $163.48 , $191.90 , $173.34 , $133.86 , $362.61 
Fx Radial Shaft Closed,CPT® 25500,N/A,N/A,N/A," $1,781.00 "," $1,157.65 "," $1,601.34 ", $254.45 , $170.42 ," $1,203.90 "," $1,222.94 "," $1,656.33 "," $1,602.90 "," $1,602.90 "," $1,424.80 "," $1,424.80 ", $170.42 ," $1,644.40 "," $1,691.95 "," $1,602.90 "," $1,602.90 "," $1,602.90 "," $1,656.33 "," $1,709.76 "," $1,473.82 "," $1,513.85 "," $1,338.05 "," $1,436.19 ", N/A ," $1,227.40 "," $1,227.40 "," $1,691.95 "," $1,442.63 ", $170.42 ," $1,709.76 "
" Fac Genotype, Dna, Hepatitis C ",CPT® 87902,0306 - LAB/BACT-MICRO,N/A,N/A," $2,376.00 "," $1,544.40 "," $1,995.84 ", $262.60 , $262.60 ," $1,919.81 "," $2,138.40 "," $2,011.52 "," $2,138.40 "," $2,138.40 "," $2,138.40 "," $2,019.60 ", $257.45 ," $2,193.76 "," $2,257.20 "," $2,019.60 "," $2,209.68 "," $2,209.68 "," $2,257.20 "," $2,280.96 "," $1,944.04 "," $2,138.40 "," $2,019.60 "," $1,877.04 ", N/A ," $1,922.90 "," $1,922.90 "," $2,257.20 "," $2,038.85 ", $257.45 ," $2,280.96 "
Sono Abd Retroperitnl Ltd,76775,N/A,N/A,N/A, $348.00 , $226.20 , $327.35 , $58.03 , $88.69 , $276.72 , $576.01 , $323.64 , $313.20 , $313.20 , $278.40 , $278.40 , $88.69 , $321.31 , $330.60 , $313.20 , $313.20 , $313.20 , $323.64 , $334.08 , $324.22 , $295.80 , $627.89 , $326.12 , N/A , $282.12 , $282.12 , $330.60 , $326.56 , $58.03 , $627.89 
 Fac Molecular Pathology Interpr ,CPT® G0452,0310 - PATHOLOGY LAB,N/A,N/A, $77.00 , $50.05 , $64.68 , $49.22 , N/A , $62.22 , $69.30 , $65.19 , $69.30 , $69.30 , $69.30 , $65.45 , N/A , $71.09 , $73.15 , $65.45 , $71.61 , $71.61 , $73.15 , $73.92 , $63.00 , $69.30 , $65.45 , $60.83 , N/A , $62.32 , $62.32 , $73.15 , $66.07 , $49.22 , $73.92 
 Pro Image-Guide Fluid Collxn Drainage Cath Visc Perq ,CPT® 49405,0972 - PRO FEE/RAD/DX,N/A,N/A," $2,280.00 "," $1,482.00 "," $1,200.62 ", $185.07 , $162.82 ," $1,040.25 "," $1,071.22 "," $2,120.40 "," $2,052.00 "," $2,052.00 "," $1,824.00 "," $1,824.00 ", $162.82 ," $2,105.12 "," $2,166.00 "," $2,052.00 "," $2,052.00 "," $2,052.00 "," $2,120.40 "," $2,188.80 ", $867.06 ," $1,938.00 "," $1,009.30 "," $1,155.04 ", N/A ," $1,060.55 "," $1,060.55 "," $2,166.00 "," $1,109.23 ", $162.82 ," $2,188.80 "
Excis Recurrent Ganglion Wrist,25112,N/A,N/A,N/A," $1,166.00 ", $757.90 ," $2,400.19 ", $378.50 , $384.35 ," $1,856.12 "," $1,867.08 "," $1,084.38 "," $1,049.40 "," $1,049.40 ", $932.80 , $932.80 , $384.35 ," $1,076.57 "," $1,107.70 "," $1,049.40 "," $1,049.40 "," $1,049.40 "," $1,084.38 "," $1,119.36 "," $2,219.90 ", $991.10 ," $2,053.46 "," $2,208.50 ", N/A ," $1,892.34 "," $1,892.34 "," $1,107.70 "," $2,224.18 ", $378.50 ," $2,400.19 "
"Corneal Relax Incis,Correc Astig",CPT® 65772,N/A,N/A,N/A," $4,114.00 "," $2,674.10 "," $2,488.92 ", $391.53 , $360.74 ," $2,299.93 "," $2,147.13 "," $3,826.02 "," $3,702.60 "," $3,702.60 "," $3,291.20 "," $3,291.20 ", $360.74 ," $3,798.46 "," $3,908.30 "," $3,702.60 "," $3,702.60 "," $3,702.60 "," $3,826.02 "," $3,949.44 "," $3,415.02 "," $3,496.90 "," $2,201.53 "," $2,924.33 ", N/A ," $2,344.80 "," $2,344.80 "," $3,908.30 "," $2,588.36 ", $360.74 ," $3,949.44 "
 Fac Ko W/ Adj Flex/Ext Rotat Cus ,HCPCS L1845,0274 - PROSTHETIC DEV,N/A,N/A," $1,326.00 ", $861.90 ," $1,113.84 ", $979.86 , $633.70 ," $1,071.41 "," $1,193.40 "," $1,122.59 "," $1,193.40 "," $1,193.40 "," $1,193.40 "," $1,127.10 ", $621.27 ," $1,224.30 "," $1,259.70 "," $1,127.10 "," $1,233.18 "," $1,233.18 "," $1,259.70 "," $1,272.96 "," $1,084.93 "," $1,193.40 "," $1,127.10 "," $1,047.54 ", N/A ," $1,073.13 "," $1,073.13 "," $1,259.70 "," $1,137.84 ", $621.27 ," $1,272.96 "
 FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN ,HCPCS Q2009,0636 - DRUGS REQUIRING DETAILED CODIN,00069-5471-02,2 mL, $168.35 , $109.43 , $141.41 , N/A , $1.44 , $136.03 , $151.52 , $142.53 , $151.52 , $151.52 , $151.52 , $143.10 , $1.41 , $155.44 , $159.93 , $143.10 , $156.57 , $156.57 , $159.93 , $161.62 , $137.74 , $151.52 , $143.10 , $133.00 , N/A , $136.25 , $136.25 , $159.93 , $144.46 , $1.41 , $161.62 
Thorcoscpy W/Mediastinl &Regionl Lymphadenectomy,CPT® 32674,N/A,N/A,N/A," $1,940.00 "," $1,261.00 "," $1,102.45 ", $191.46 , $164.29 , $813.88 , $789.78 ," $1,804.20 "," $1,746.00 "," $1,746.00 "," $1,552.00 "," $1,552.00 ", $164.29 ," $1,791.20 "," $1,843.00 "," $1,746.00 "," $1,746.00 "," $1,746.00 "," $1,804.20 "," $1,862.40 "," $1,071.65 "," $1,649.00 "," $1,145.37 "," $1,063.30 ", N/A , $829.75 , $829.75 ," $1,843.00 ", $977.22 , $164.29 ," $1,862.40 "
 Fac Perc D-E Cor Stent Ather Br ,HCPCS C9603,0481 - CARDIAC CATH LAB,N/A,N/A," $15,529.00 "," $10,093.85 "," $13,044.36 ", N/A , N/A ," $12,547.43 "," $13,976.10 "," $13,146.85 "," $13,976.10 "," $13,976.10 "," $13,976.10 "," $13,199.65 ", N/A ," $14,337.93 "," $14,752.55 "," $13,199.65 "," $14,441.97 "," $14,441.97 "," $14,752.55 "," $14,907.84 "," $12,705.83 "," $13,976.10 "," $13,199.65 "," $12,267.91 ", N/A ," $12,567.62 "," $12,567.62 "," $14,752.55 "," $13,325.43 "," $12,267.91 "," $14,907.84 "
 Aspir and/or Inj of Thyroid Cyst ,CPT® 60300,0761 - TREATMENT ROOM,N/A,N/A," $1,645.00 "," $1,069.25 "," $1,381.80 ", $46.43 , $76.36 ," $1,329.16 "," $1,480.50 "," $1,392.66 "," $1,480.50 "," $1,480.50 "," $1,480.50 "," $1,398.25 ", $74.86 ," $1,518.83 "," $1,562.75 "," $1,398.25 "," $1,529.85 "," $1,529.85 "," $1,562.75 "," $1,579.20 "," $1,345.94 "," $1,480.50 "," $1,398.25 "," $1,299.55 ", N/A ," $1,331.30 "," $1,331.30 "," $1,562.75 "," $1,411.57 ", $46.43 ," $1,579.20 "
Cysto/Uretero W/Lithotripsy &Indwell Stent Insrt,CPT® 52356,N/A,N/A,N/A," $2,817.00 "," $1,831.05 "," $2,227.03 ", $390.60 , $312.75 ," $2,036.34 "," $1,954.34 "," $2,619.81 "," $2,535.30 "," $2,535.30 "," $2,253.60 "," $2,253.60 ", $312.75 ," $2,600.94 "," $2,676.15 "," $2,535.30 "," $2,535.30 "," $2,535.30 "," $2,619.81 "," $2,704.32 "," $2,241.18 "," $2,394.45 "," $2,151.88 "," $2,560.84 ", N/A ," $2,076.07 "," $2,076.07 "," $2,676.15 "," $2,440.12 ", $312.75 ," $2,704.32 "
"Lap,Lymph Node Bx",CPT® 38570,N/A,N/A,N/A," $7,494.00 "," $4,871.10 "," $2,404.95 ", $486.84 , $588.17 ," $1,889.37 "," $1,908.66 "," $6,969.42 "," $6,744.60 "," $6,744.60 "," $5,995.20 "," $5,995.20 ", $588.17 ," $6,919.21 "," $7,119.30 "," $6,744.60 "," $6,744.60 "," $6,744.60 "," $6,969.42 "," $7,194.24 "," $2,570.92 "," $6,369.90 "," $2,781.36 "," $2,483.56 ", N/A ," $1,926.24 "," $1,926.24 "," $7,119.30 "," $2,234.68 ", $486.84 ," $7,194.24 "
 Fac Chng Cstost Tube Smpl ,CPT® 51705,0361 - OR/MINOR,N/A,N/A, $537.00 , $349.05 , $451.08 , $49.05 , $89.32 , $433.90 , $483.30 , $454.62 , $483.30 , $483.30 , $483.30 , $456.45 , $87.57 , $495.81 , $510.15 , $456.45 , $499.41 , $499.41 , $510.15 , $515.52 , $439.37 , $483.30 , $456.45 , $424.23 , N/A , $434.59 , $434.59 , $510.15 , $460.80 , $49.05 , $515.52 
Psychotherapy for Crisis Initial 60 Minutes,CPT® 90839,N/A,N/A,N/A, $546.00 , $354.90 , $167.25 , $124.38 , $120.96 , $295.51 , $302.78 , $507.78 , $491.40 , $491.40 , $436.80 , $436.80 , $120.96 , $504.12 , $518.70 , $491.40 , $491.40 , $491.40 , $507.78 , $524.16 , $317.73 , $464.10 , $372.57 , $502.47 , $112.25 , $301.28 , $301.28 , $518.70 , $351.23 , $112.25 , $524.16 
Excise Breast Les W Xray Marker,CPT® 19125,N/A,N/A,N/A," $3,858.00 "," $2,507.70 "," $1,447.92 ", $430.51 , $347.51 ," $1,232.96 "," $1,203.57 "," $3,587.94 "," $3,472.20 "," $3,472.20 "," $3,086.40 "," $3,086.40 ", $347.51 ," $3,562.09 "," $3,665.10 "," $3,472.20 "," $3,472.20 "," $3,472.20 "," $3,587.94 "," $3,703.68 "," $1,579.49 "," $3,279.30 "," $2,426.33 "," $1,559.65 ", N/A ," $1,257.02 "," $1,257.02 "," $3,665.10 "," $1,457.72 ", $347.51 ," $3,703.68 "
 Fac Dihydrotestosterone (Dht) ,CPT® 82642,0301 - LAB/CHEMISTRY,N/A,N/A, $296.00 , $192.40 , $248.64 , $29.87 , $29.87 , $239.17 , $266.40 , $250.59 , $266.40 , $266.40 , $266.40 , $251.60 , $29.28 , $273.30 , $281.20 , $251.60 , $275.28 , $275.28 , $281.20 , $284.16 , $242.19 , $266.40 , $251.60 , $233.84 , N/A , $239.55 , $239.55 , $281.20 , $254.00 , $29.28 , $284.16 
" Fac Placental Alpha Microglobulin,Cervicovaginal Qualitative ",CPT® 84112,0301 - LAB/CHEMISTRY,N/A,N/A, $594.00 , $386.10 , $498.96 , $100.07 , $89.40 , $479.95 , $534.60 , $502.88 , $534.60 , $534.60 , $534.60 , $504.90 , $87.65 , $548.44 , $564.30 , $504.90 , $552.42 , $552.42 , $564.30 , $570.24 , $486.01 , $534.60 , $504.90 , $469.26 , N/A , $480.72 , $480.72 , $564.30 , $509.71 , $87.65 , $570.24 
 FINASTERIDE 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6830-61,1 tablet, $6.36 , $4.13 , $5.34 , N/A , N/A , $5.14 , $5.72 , $5.38 , $5.72 , $5.72 , $5.72 , $5.41 , N/A , $5.87 , $6.04 , $5.41 , $5.91 , $5.91 , $6.04 , $6.11 , $5.20 , $5.72 , $5.41 , $5.02 , N/A , $5.15 , $5.15 , $6.04 , $5.46 , $5.02 , $6.11 
 Fac Microscopic Exam of Urine ,CPT® 81015,0307 - LAB/UROLOGY,N/A,N/A, $33.00 , $21.45 , $27.72 , $3.11 , $3.11 , $26.66 , $29.70 , $27.94 , $29.70 , $29.70 , $29.70 , $28.05 , $3.05 , $30.47 , $31.35 , $28.05 , $30.69 , $30.69 , $31.35 , $31.68 , $27.00 , $29.70 , $28.05 , $26.07 , N/A , $26.71 , $26.71 , $31.35 , $28.32 , $3.05 , $31.68 
 Pro Appl Mlt-Layer Venous Wound Compress Below Knee ,CPT® 29581,0982 - PRO FEE/OUTPT,N/A,N/A, $552.00 , $358.80 , $174.46 , $26.75 , $73.50 , $64.70 , $62.04 , $513.36 , $496.80 , $496.80 , $441.60 , $441.60 , $73.50 , $509.66 , $524.40 , $496.80 , $496.80 , $496.80 , $513.36 , $529.92 , $163.06 , $469.20 , $66.01 , $167.13 , N/A , $65.96 , $65.96 , $524.40 , $77.53 , $26.75 , $529.92 
Family Psychotherapy W/Patient Present 50 Mins,CPT® 90847,N/A,N/A,N/A, $431.00 , $280.15 , $133.00 , $98.99 , $96.92 , $237.38 , $211.12 , $400.83 , $387.90 , $387.90 , $344.80 , $344.80 , $96.92 , $397.94 , $409.45 , $387.90 , $387.90 , $387.90 , $400.83 , $413.76 , $253.64 , $366.35 , $274.72 , $404.45 , $160.00 , $242.02 , $242.02 , $409.45 , $282.14 , $96.92 , $413.76 
Creatinine Clearance Test,CPT® 82575,N/A,N/A,N/A, $135.00 , $87.75 , N/A , $9.65 , $9.65 , $53.47 , $63.95 , $125.55 , $121.50 , $121.50 , $108.00 , $108.00 , $9.65 , $124.65 , $128.25 , $121.50 , $121.50 , $121.50 , $125.55 , $129.60 , $63.17 , $114.75 , $61.63 , $34.27 , N/A , $49.90 , $49.90 , $128.25 , $54.53 , $9.65 , $129.60 
Remove Eye Foreign Body,65205,N/A,N/A,N/A, $235.00 , $152.75 , $180.70 , $28.20 , $35.23 , $251.30 , $232.46 , $218.55 , $211.50 , $211.50 , $188.00 , $188.00 , $35.23 , $216.98 , $223.25 , $211.50 , $211.50 , $211.50 , $218.55 , $225.60 , $248.64 , $199.75 , $239.06 , $319.55 , N/A , $256.20 , $256.20 , $223.25 , $282.82 , $28.20 , $319.55 
 Fac Physician Blood Bank Service ,CPT® 86078,0305 - LAB/HEMATOLOGY,N/A,N/A, $195.00 , $126.75 , $163.80 , $48.03 , $45.87 , $157.56 , $175.50 , $165.09 , $175.50 , $175.50 , $175.50 , $165.75 , $44.97 , $180.04 , $185.25 , $165.75 , $181.35 , $181.35 , $185.25 , $187.20 , $159.55 , $175.50 , $165.75 , $154.05 , N/A , $157.81 , $157.81 , $185.25 , $167.33 , $44.97 , $187.20 
Esophagoscopy Flexible Removal Foreign Body,CPT® 43215,N/A,N/A,N/A," $2,231.00 "," $1,450.15 ", $857.42 , $132.36 , $142.67 , $710.20 , $749.12 ," $2,074.83 "," $2,007.90 "," $2,007.90 "," $1,784.80 "," $1,784.80 ", $142.67 ," $2,059.88 "," $2,119.45 "," $2,007.90 "," $2,007.90 "," $2,007.90 "," $2,074.83 "," $2,141.76 ", $615.50 ," $1,896.35 ", $822.45 , $813.17 , N/A , $724.06 , $724.06 ," $2,119.45 ", $757.29 , $132.36 ," $2,141.76 "
Assay Vitamin B-2,CPT® 84252,N/A,N/A,N/A, $282.00 , $183.30 , N/A , $20.64 , $20.64 , $114.50 , $136.98 , $262.26 , $253.80 , $253.80 , $225.60 , $225.60 , $20.64 , $260.37 , $267.90 , $253.80 , $253.80 , $253.80 , $262.26 , $270.72 , $135.15 , $239.70 , $132.99 , $73.37 , N/A , $106.86 , $106.86 , $267.90 , $116.77 , $20.64 , $270.72 
 Pro Amputate Metacarpal Bone ,CPT® 26910,0975 - PRO FEE/OR,N/A,N/A," $3,619.00 "," $2,352.35 "," $4,771.39 ", $742.52 , $461.04 ," $3,401.19 "," $3,432.13 "," $3,365.67 "," $3,257.10 "," $3,257.10 "," $2,895.20 "," $2,895.20 ", $461.04 ," $3,341.42 "," $3,438.05 "," $3,257.10 "," $3,257.10 "," $3,257.10 "," $3,365.67 "," $3,474.24 "," $4,375.01 "," $3,076.15 "," $3,773.30 "," $4,090.43 ", N/A ," $3,467.56 "," $3,467.56 "," $3,438.05 "," $4,075.60 ", $461.04 ," $4,771.39 "
Removal of Implant From Hand/Fingr,CPT® 26320,N/A,N/A,N/A," $1,785.00 "," $1,160.25 "," $2,159.50 ", $339.65 , $157.48 ," $1,668.66 "," $1,671.65 "," $1,660.05 "," $1,606.50 "," $1,606.50 "," $1,428.00 "," $1,428.00 ", $157.48 ," $1,648.09 "," $1,695.75 "," $1,606.50 "," $1,606.50 "," $1,606.50 "," $1,660.05 "," $1,713.60 "," $1,999.47 "," $1,517.25 "," $1,834.02 "," $1,983.46 ", N/A ," $1,701.22 "," $1,701.22 "," $1,695.75 "," $1,999.55 ", $157.48 ," $2,159.50 "
"Antibiotic Sens,Enzyme Detection,Each",CPT® 87185,N/A,N/A,N/A, $72.00 , $46.80 , N/A , $4.85 , $4.85 , $26.85 , $32.15 , $66.96 , $64.80 , $64.80 , $57.60 , $57.60 , $4.85 , $66.48 , $68.40 , $64.80 , $64.80 , $64.80 , $66.96 , $69.12 , $31.72 , $61.20 , $30.82 , $17.21 , N/A , $25.06 , $25.06 , $68.40 , $27.39 , $4.85 , $69.12 
Drug Screen Quantitative Mycophenolate,CPT® 80180,N/A,N/A,N/A, $196.00 , $127.40 , N/A , $18.41 , $18.41 , $102.15 , $121.26 , $182.28 , $176.40 , $176.40 , $156.80 , $156.80 , $18.41 , $180.97 , $186.20 , $176.40 , $176.40 , $176.40 , $182.28 , $188.16 , $120.52 , $166.60 , $85.61 , $65.44 , N/A , $95.33 , $95.33 , $186.20 , $104.18 , $18.41 , $188.16 
" Fac Gastrostomy,Open,W/O Tube Cnstr ",CPT® 43830,0360 - OR SERVICES,N/A,N/A," $5,317.00 "," $3,456.05 "," $4,466.28 ", $653.35 , $876.31 ," $4,296.14 "," $4,785.30 "," $4,501.37 "," $4,785.30 "," $4,785.30 "," $4,785.30 "," $4,519.45 ", $859.13 ," $4,909.19 "," $5,051.15 "," $4,519.45 "," $4,944.81 "," $4,944.81 "," $5,051.15 "," $5,104.32 "," $4,350.37 "," $4,785.30 "," $4,519.45 "," $4,200.43 ", N/A ," $4,303.05 "," $4,303.05 "," $5,051.15 "," $4,562.52 ", $653.35 ," $5,104.32 "
 Fac Chemotx Admn Tq Init Prolng Chemotx Nfus Pmp ,CPT® 96416,0335 - CHEMOTHERP-IV,N/A,N/A, $861.00 , $559.65 , $723.24 , $124.59 , $151.11 , $695.69 , $774.90 , $728.92 , $774.90 , $774.90 , $774.90 , $731.85 , $148.15 , $794.96 , $817.95 , $731.85 , $800.73 , $800.73 , $817.95 , $826.56 , $704.47 , $774.90 , $731.85 , $680.19 , N/A , $696.81 , $696.81 , $817.95 , $738.82 , $124.59 , $826.56 
 LOPERAMIDE HCL 2 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,60687-0229-01,1 capsule, $5.24 , $3.41 , $4.40 , N/A , N/A , $4.23 , $4.72 , $4.44 , $4.72 , $4.72 , $4.72 , $4.45 , N/A , $4.84 , $4.98 , $4.45 , $4.87 , $4.87 , $4.98 , $5.03 , $4.29 , $4.72 , $4.45 , $4.14 , N/A , $4.24 , $4.24 , $4.98 , $4.50 , $4.14 , $5.03 
"Hib Vaccine, Prp-Omp, Im",CPT® 90647,N/A,N/A,N/A, $84.00 , $54.60 , N/A , N/A , $42.80 , $63.14 , $65.60 , $78.12 , $75.60 , $75.60 , $67.20 , $67.20 , $42.80 , $77.56 , $79.80 , $75.60 , $75.60 , $75.60 , $78.12 , $80.64 , N/A , $71.40 , $87.18 , $47.43 , N/A , $64.38 , $64.38 , $79.80 , $75.04 , $42.80 , $87.18 
"Program Eval Implant Device,Cardvert/Defib,1 Lead",93282,N/A,N/A,N/A, $834.00 , $542.10 , $522.99 , $79.84 , $54.59 , $344.32 , $346.75 , $775.62 , $750.60 , $750.60 , $667.20 , $667.20 , $54.59 , $770.03 , $792.30 , $750.60 , $750.60 , $750.60 , $775.62 , $800.64 , $489.96 , $708.90 , $324.70 , $232.24 , N/A , $351.04 , $351.04 , $792.30 , $389.12 , $54.59 , $800.64 
 Pro Arthrocnts Aspir&/Njx Sm Jt/Bursa ,CPT® 20600,0981 - PRO FEE/ER,N/A,N/A, $291.00 , $189.15 , $218.01 , $33.86 , $39.50 , $174.29 , $169.45 , $270.63 , $261.90 , $261.90 , $232.80 , $232.80 , $39.50 , $268.68 , $276.45 , $261.90 , $261.90 , $261.90 , $270.63 , $279.36 , $203.80 , $247.35 , $183.76 , $206.34 , N/A , $177.69 , $177.69 , $276.45 , $208.86 , $33.86 , $279.36 
"Immunotherapy, 2+ Injections",95117,N/A,N/A,N/A, $62.00 , $40.30 , $28.24 , $11.27 , $5.05 , $18.37 , $18.87 , $57.66 , $55.80 , $55.80 , $49.60 , $49.60 , $5.05 , $57.24 , $58.90 , $55.80 , $55.80 , $55.80 , $57.66 , $59.52 , $24.53 , $52.70 , $32.44 , $31.18 , N/A , $18.72 , $18.72 , $58.90 , $22.13 , $5.05 , $59.52 
 SUGAMMADEX SODIUM 500 MG/5ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00006-5425-15,5 mL," $1,394.36 ", $906.33 ," $1,171.26 ", N/A , N/A ," $1,126.64 "," $1,254.92 "," $1,180.47 "," $1,254.92 "," $1,254.92 "," $1,254.92 "," $1,185.21 ", N/A ," $1,287.41 "," $1,324.64 "," $1,185.21 "," $1,296.75 "," $1,296.75 "," $1,324.64 "," $1,338.59 "," $1,140.87 "," $1,254.92 "," $1,185.21 "," $1,101.54 ", N/A ," $1,128.46 "," $1,128.46 "," $1,324.64 "," $1,196.50 "," $1,101.54 "," $1,338.59 "
 Pro Injection Into Skin Lesions ,CPT® 11900,0982 - PRO FEE/OUTPT,N/A,N/A, $234.00 , $152.10 , $95.06 , $28.80 , $24.16 , $85.56 , $82.69 , $217.62 , $210.60 , $210.60 , $187.20 , $187.20 , $24.16 , $216.05 , $222.30 , $210.60 , $210.60 , $210.60 , $217.62 , $224.64 , $106.07 , $198.90 , $165.92 , $109.74 , N/A , $87.22 , $87.22 , $222.30 , $101.15 , $24.16 , $224.64 
 Intracranial Hemorrhage Or Cerebral Infarction With McC ,MS DRG V40 (FY2023) 064,N/A,N/A,N/A," $16,350.41 "," $10,627.77 "," $13,734.34 ", N/A , N/A ," $13,211.13 "," $14,715.37 "," $13,842.26 "," $14,715.37 "," $14,715.37 "," $14,715.37 "," $13,897.85 ", N/A ," $15,096.33 "," $15,532.89 "," $13,897.85 "," $15,205.88 "," $15,205.88 "," $15,532.89 "," $15,696.39 "," $13,377.91 "," $14,715.37 "," $13,897.85 "," $12,916.82 ", N/A ," $13,232.39 "," $13,232.39 "," $15,532.89 "," $14,030.29 "," $12,916.82 "," $15,696.39 "
 FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN ,HCPCS J2680,0636 - DRUGS REQUIRING DETAILED CODIN,67457-0359-59,1 mL, $191.06 , $124.19 , $160.49 , $11.17 , $9.79 , $154.38 , $171.95 , $161.75 , $171.95 , $171.95 , $171.95 , $162.40 , $9.60 , $176.41 , $181.51 , $162.40 , $177.69 , $177.69 , $181.51 , $183.42 , $156.33 , $171.95 , $162.40 , $150.94 , N/A , $154.62 , $154.62 , $181.51 , $163.95 , $9.60 , $183.42 
Open Rx Ulnar Styloid Fx,25652,N/A,N/A,N/A," $4,143.00 "," $2,692.95 "," $3,814.79 ", $599.48 , $442.86 ," $3,000.99 "," $2,990.79 "," $3,852.99 "," $3,728.70 "," $3,728.70 "," $3,314.40 "," $3,314.40 ", $442.86 ," $3,825.23 "," $3,935.85 "," $3,728.70 "," $3,728.70 "," $3,728.70 "," $3,852.99 "," $3,977.28 "," $3,539.64 "," $3,521.55 "," $3,291.60 "," $3,549.30 ", N/A ," $3,059.54 "," $3,059.54 "," $3,935.85 "," $3,596.05 ", $442.86 ," $3,977.28 "
" Pro Flow Cytometry,Interp, 2-8 Markers ",CPT® 88187,0971 - PRO FEE/LAB,N/A,N/A, $182.00 , $118.30 , $127.61 , $34.55 , $69.65 , $289.75 , $315.78 , $169.26 , $163.80 , $163.80 , $145.60 , $145.60 , $69.65 , $168.04 , $172.90 , $163.80 , $163.80 , $163.80 , $169.26 , $174.72 , $234.44 , $154.70 , $327.61 , $164.36 , N/A , $270.41 , $270.41 , $172.90 , $297.17 , $34.55 , $327.61 
 Pro MRI Chest Spine W/O & W/Dye ,CPT® 72157,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,187.00 ", $771.55 ," $2,312.03 ", $329.80 , $655.99 ," $1,810.96 "," $2,764.24 "," $1,103.91 "," $1,068.30 "," $1,068.30 ", $949.60 , $949.60 , $655.99 ," $1,095.96 "," $1,127.65 "," $1,068.30 "," $1,068.30 "," $1,068.30 "," $1,103.91 "," $1,139.52 "," $1,989.35 "," $1,008.95 "," $3,010.40 "," $3,518.00 ", N/A ," $1,846.29 "," $1,846.29 "," $1,127.65 "," $2,137.13 ", $329.80 ," $3,518.00 "
 Fac Therapeutic Spinal Puncture Drainage CSF ,CPT® 62272,0761 - TREATMENT ROOM,N/A,N/A," $1,116.00 ", $725.40 , $937.44 , $81.94 , $89.21 , $901.73 ," $1,004.40 ", $944.81 ," $1,004.40 "," $1,004.40 "," $1,004.40 ", $948.60 , $87.46 ," $1,030.40 "," $1,060.20 ", $948.60 ," $1,037.88 "," $1,037.88 "," $1,060.20 "," $1,071.36 ", $913.11 ," $1,004.40 ", $948.60 , $881.64 , N/A , $903.18 , $903.18 ," $1,060.20 ", $957.64 , $81.94 ," $1,071.36 "
 Fac Platelet Antibodies ,CPT® 86022,0302 - LAB/IMMUNOLOGY,N/A,N/A, $325.00 , $211.25 , $273.00 , $18.74 , $18.74 , $262.60 , $292.50 , $275.15 , $292.50 , $292.50 , $292.50 , $276.25 , $18.37 , $300.07 , $308.75 , $276.25 , $302.25 , $302.25 , $308.75 , $312.00 , $265.92 , $292.50 , $276.25 , $256.75 , N/A , $263.02 , $263.02 , $308.75 , $278.88 , $18.37 , $312.00 
" Pro Arthrodesis Ant Interbody Inc Discectomy, Cervical Below C2 ",CPT® 22551,0982 - PRO FEE/OUTPT,N/A,N/A," $11,469.00 "," $7,454.85 "," $9,883.19 "," $1,543.42 "," $1,205.54 "," $8,156.71 "," $8,031.40 "," $10,666.17 "," $10,322.10 "," $10,322.10 "," $9,175.20 "," $9,175.20 "," $1,205.54 "," $10,589.33 "," $10,895.55 "," $10,322.10 "," $10,322.10 "," $10,322.10 "," $10,666.17 "," $11,010.24 "," $9,216.13 "," $9,748.65 "," $9,089.81 "," $9,390.58 ", N/A ," $8,315.86 "," $8,315.86 "," $10,895.55 "," $9,774.11 "," $1,205.54 "," $11,010.24 "
"Interrog Eval, Remote, Up to 90 Days,Cardvert/Defib",CPT® 93295,N/A,N/A,N/A, $495.00 , $321.75 , $233.35 , $35.86 , $51.99 , $366.04 , $362.15 , $460.35 , $445.50 , $445.50 , $396.00 , $396.00 , $51.99 , $457.03 , $470.25 , $445.50 , $445.50 , $445.50 , $460.35 , $475.20 , $230.79 , $420.75 , $337.19 , $208.07 , N/A , $373.18 , $373.18 , $470.25 , $413.68 , $35.86 , $475.20 
Trb@ Rearrangement Anal Amplification Method,CPT® 81340,N/A,N/A,N/A," $1,485.00 ", $965.25 , N/A , $213.10 , $213.10 ," $1,182.00 "," $1,399.77 "," $1,381.05 "," $1,336.50 "," $1,336.50 "," $1,188.00 "," $1,188.00 ", $213.10 ," $1,371.10 "," $1,410.75 "," $1,336.50 "," $1,336.50 "," $1,336.50 "," $1,381.05 "," $1,425.60 "," $1,395.01 "," $1,262.25 ", $996.68 , $757.51 , N/A ," $1,103.12 "," $1,103.12 "," $1,410.75 "," $1,205.47 ", $213.10 ," $1,425.60 "
 IR Asp/Ing Small Jt W/ US Guidance Inc-C ,CPT® 20604,0361 - OR/MINOR,N/A,N/A," $1,635.00 "," $1,062.75 "," $1,373.40 ", $44.00 , $56.73 ," $1,321.08 "," $1,471.50 "," $1,384.19 "," $1,471.50 "," $1,471.50 "," $1,471.50 "," $1,389.75 ", $55.62 ," $1,509.60 "," $1,553.25 "," $1,389.75 "," $1,520.55 "," $1,520.55 "," $1,553.25 "," $1,569.60 "," $1,337.76 "," $1,471.50 "," $1,389.75 "," $1,291.65 ", N/A ," $1,323.21 "," $1,323.21 "," $1,553.25 "," $1,402.99 ", $44.00 ," $1,569.60 "
 Bili Chek -Mh ,CPT® 88720,0301 - LAB/CHEMISTRY,N/A,N/A, $119.00 , $77.35 , $99.96 , $5.12 , $3.57 , $96.15 , $107.10 , $100.75 , $107.10 , $107.10 , $107.10 , $101.15 , $3.50 , $109.87 , $113.05 , $101.15 , $110.67 , $110.67 , $113.05 , $114.24 , $97.37 , $107.10 , $101.15 , $94.01 , N/A , $96.31 , $96.31 , $113.05 , $102.11 , $3.50 , $114.24 
 MYCOPHENOLATE MOFETIL 250 MG PO CAPS ,HCPCS J7517,0636 - DRUGS REQUIRING DETAILED CODIN,51079-0721-20,1 capsule, $20.36 , $13.23 , $17.10 , $0.21 , $0.22 , $16.45 , $18.32 , $17.24 , $18.32 , $18.32 , $18.32 , $17.31 , $0.22 , $18.80 , $19.34 , $17.31 , $18.93 , $18.93 , $19.34 , $19.55 , $16.66 , $18.32 , $17.31 , $16.08 , N/A , $16.48 , $16.48 , $19.34 , $17.47 , $0.21 , $19.55 
Diab Shoe for Density Insert,HCPCS A5500,N/A,N/A,N/A, $135.00 , $87.75 , N/A , $86.26 , $57.59 , N/A , N/A , $125.55 , $121.50 , $121.50 , $108.00 , $108.00 , $57.59 , $124.65 , $128.25 , $121.50 , $121.50 , $121.50 , $125.55 , $129.60 , N/A , $114.75 , $79.15 , $78.36 , N/A , N/A , N/A , $128.25 , N/A , $57.59 , $129.60 
Telhealth Inpt Consult 35min,HCPCS G0408,N/A,N/A,N/A, $308.00 , $200.20 , $194.76 , $101.95 , N/A , $192.79 , N/A , $286.44 , $277.20 , $277.20 , $246.40 , $246.40 , N/A , $284.38 , $292.60 , $277.20 , $277.20 , $277.20 , $286.44 , $295.68 , $288.50 , $261.80 , $192.68 , $392.23 , N/A , $196.55 , $196.55 , $292.60 , $245.68 , $101.95 , $392.23 
Open Implantation Nea Sacral Nerve,CPT® 64581,N/A,N/A,N/A," $4,564.00 "," $2,966.60 "," $3,212.87 ", $623.92 , $747.75 ," $3,695.69 "," $3,553.90 "," $4,244.52 "," $4,107.60 "," $4,107.60 "," $3,651.20 "," $3,651.20 ", $747.75 ," $4,213.94 "," $4,335.80 "," $4,107.60 "," $4,107.60 "," $4,107.60 "," $4,244.52 "," $4,381.44 "," $3,488.51 "," $3,879.40 "," $3,473.57 "," $3,993.35 ", N/A ," $3,767.80 "," $3,767.80 "," $4,335.80 "," $4,041.96 ", $623.92 ," $4,381.44 "
Occupational Therapy Eval High Complex 60 Mins,CPT® 97167,N/A,N/A,N/A, $417.00 , $271.05 , $197.34 , $100.30 , $63.91 , $169.43 , $179.72 , $387.81 , $375.30 , $375.30 , $333.60 , $333.60 , $63.91 , $385.02 , $396.15 , $375.30 , $375.30 , $375.30 , $387.81 , $400.32 , $245.52 , $354.45 , $302.90 , $204.76 , N/A , $172.73 , $172.73 , $396.15 , $192.12 , $63.91 , $400.32 
"Virus ID,Inoc Test,Addnl",CPT® 87253,N/A,N/A,N/A, $192.00 , $124.80 , N/A , $20.60 , $19.36 , $78.91 , $94.38 , $178.56 , $172.80 , $172.80 , $153.60 , $153.60 , $19.36 , $177.27 , $182.40 , $172.80 , $172.80 , $172.80 , $178.56 , $184.32 , $134.88 , $163.20 , $132.99 , $73.25 , N/A , $73.64 , $73.64 , $182.40 , $80.48 , $19.36 , $184.32 
Explor Ankle Joint,CPT® 27620,N/A,N/A,N/A," $3,031.00 "," $1,970.15 "," $2,772.97 ", $429.32 , $500.71 ," $2,226.46 "," $2,194.36 "," $2,818.83 "," $2,727.90 "," $2,727.90 "," $2,424.80 "," $2,424.80 ", $500.71 ," $2,798.52 "," $2,879.45 "," $2,727.90 "," $2,727.90 "," $2,727.90 "," $2,818.83 "," $2,909.76 "," $2,577.66 "," $2,576.35 "," $2,412.05 "," $2,581.02 ", N/A ," $2,269.89 "," $2,269.89 "," $2,879.45 "," $2,667.93 ", $429.32 ," $2,909.76 "
"Phospholipid Neutralization,Platelet",CPT® 85597,N/A,N/A,N/A, $180.00 , $117.00 , N/A , $18.34 , $18.34 , $101.69 , $121.66 , $167.40 , $162.00 , $162.00 , $144.00 , $144.00 , $18.34 , $166.19 , $171.00 , $162.00 , $162.00 , $162.00 , $167.40 , $172.80 , $120.06 , $153.00 , $118.39 , $65.17 , N/A , $94.90 , $94.90 , $171.00 , $103.71 , $18.34 , $172.80 
Myelography via Lumbar Inject Rs&I Lumbosacral,CPT® 62304,N/A,N/A,N/A," $1,746.00 "," $1,134.90 ", $583.39 , $113.00 , $189.79 , $678.54 , $680.21 ," $1,623.78 "," $1,571.40 "," $1,571.40 "," $1,396.80 "," $1,396.80 ", $189.79 ," $1,612.08 "," $1,658.70 "," $1,571.40 "," $1,571.40 "," $1,571.40 "," $1,623.78 "," $1,676.16 ", $633.19 ," $1,484.10 ", $616.60 , $728.91 , N/A , $691.79 , $691.79 ," $1,658.70 ", $742.13 , $113.00 ," $1,676.16 "
 NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,67457-0852-04,4 mL, $112.11 , $72.87 , $94.17 , N/A , N/A , $90.58 , $100.90 , $94.91 , $100.90 , $100.90 , $100.90 , $95.29 , N/A , $103.51 , $106.50 , $95.29 , $104.26 , $104.26 , $106.50 , $107.63 , $91.73 , $100.90 , $95.29 , $88.57 , N/A , $90.73 , $90.73 , $106.50 , $96.20 , $88.57 , $107.63 
" Fac Thrombin Time, Plasma ",CPT® 85670,0305 - LAB/HEMATOLOGY,N/A,N/A, $115.00 , $74.75 , $96.60 , $5.89 , N/A , $92.92 , $103.50 , $97.36 , $103.50 , $103.50 , $103.50 , $97.75 , N/A , $106.18 , $109.25 , $97.75 , $106.95 , $106.95 , $109.25 , $110.40 , $94.09 , $103.50 , $97.75 , $90.85 , N/A , $93.07 , $93.07 , $109.25 , $98.68 , $5.89 , $110.40 
 HYDRALAZINE HCL 20 MG/ML IJ SOLN ,HCPCS J0360,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0614-01,1 mL, $88.28 , $57.38 , $74.16 , $5.82 , $6.90 , $71.33 , $79.45 , $74.74 , $79.45 , $79.45 , $79.45 , $75.04 , $6.76 , $81.51 , $83.87 , $75.04 , $82.10 , $82.10 , $83.87 , $84.75 , $72.23 , $79.45 , $75.04 , $69.74 , N/A , $71.45 , $71.45 , $83.87 , $75.75 , $5.82 , $84.75 
 NALOXONE 0.4 MG/ML INJECTION (INPT) ,HCPCS J2310,0636 - DRUGS REQUIRING DETAILED CODIN,00409-1215-01,1 mL, $97.58 , $63.43 , $81.97 , $9.64 , $10.51 , $78.84 , $87.82 , $82.61 , $87.82 , $87.82 , $87.82 , $82.94 , $10.30 , $90.10 , $92.70 , $82.94 , $90.75 , $90.75 , $92.70 , $93.68 , $79.84 , $87.82 , $82.94 , $77.09 , N/A , $78.97 , $78.97 , $92.70 , $83.73 , $9.64 , $93.68 
 Fac Brnchsc Incl Fluor Gdnce Dx W/Cell Washg Spx ,CPT® 31622,0761 - TREATMENT ROOM,N/A,N/A," $3,149.00 "," $2,046.85 "," $2,645.16 ", $124.42 , $514.19 ," $2,544.39 "," $2,834.10 "," $2,665.94 "," $2,834.10 "," $2,834.10 "," $2,834.10 "," $2,676.65 ", $504.11 ," $2,907.47 "," $2,991.55 "," $2,676.65 "," $2,928.57 "," $2,928.57 "," $2,991.55 "," $3,023.04 "," $2,576.51 "," $2,834.10 "," $2,676.65 "," $2,487.71 ", N/A ," $2,548.49 "," $2,548.49 "," $2,991.55 "," $2,702.16 ", $124.42 ," $3,023.04 "
 Pro Active Wound Care/20 Cm or < ,CPT® 97597,0982 - PRO FEE/OUTPT,N/A,N/A, $242.00 , $157.30 , $82.90 , $34.49 , $43.20 , $54.44 , $46.92 , $225.06 , $217.80 , $217.80 , $193.60 , $193.60 , $43.20 , $223.44 , $229.90 , $217.80 , $217.80 , $217.80 , $225.06 , $232.32 , $109.43 , $205.70 , $69.95 , $54.53 , N/A , $55.50 , $55.50 , $229.90 , $61.73 , $34.49 , $232.32 
Revascularization Iliac Artery Angiop 1st Vsl,CPT® 37220,N/A,N/A,N/A," $11,102.00 "," $7,216.30 "," $2,323.56 ", $358.06 , $306.51 ," $1,795.41 "," $1,769.88 "," $10,324.86 "," $9,991.80 "," $9,991.80 "," $8,881.60 "," $8,881.60 ", $306.51 ," $10,250.48 "," $10,546.90 "," $9,991.80 "," $9,991.80 "," $9,991.80 "," $10,324.86 "," $10,657.92 "," $1,985.09 "," $9,436.70 "," $2,224.73 "," $1,940.98 ", N/A ," $1,830.44 "," $1,830.44 "," $10,546.90 "," $2,079.39 ", $306.51 ," $10,657.92 "
"Repair Paraesophageal Hiatal Hernia,Thoracotomy, W Mesh",CPT® 43335,N/A,N/A,N/A," $9,063.00 "," $5,890.95 "," $7,809.10 "," $1,204.30 ", $985.62 ," $6,337.33 "," $6,315.82 "," $8,428.59 "," $8,156.70 "," $8,156.70 "," $7,250.40 "," $7,250.40 ", $985.62 ," $8,367.87 "," $8,609.85 "," $8,156.70 "," $8,156.70 "," $8,156.70 "," $8,428.59 "," $8,700.48 "," $5,631.64 "," $7,703.55 "," $7,045.27 "," $7,381.51 ", N/A ," $6,460.99 "," $6,460.99 "," $8,609.85 "," $6,757.49 ", $985.62 ," $8,700.48 "
Change of Cystostomy Tube,51705,N/A,N/A,N/A, $598.00 , $388.70 , $277.44 , $49.05 , $89.32 , $253.25 , $237.97 , $556.14 , $538.20 , $538.20 , $478.40 , $478.40 , $89.32 , $552.13 , $568.10 , $538.20 , $538.20 , $538.20 , $556.14 , $574.08 , $278.88 , $508.30 , $269.39 , $320.52 , N/A , $258.19 , $258.19 , $568.10 , $303.46 , $49.05 , $574.08 
"Release Palm Contract,Percutaneous",CPT® 26040,N/A,N/A,N/A," $2,208.00 "," $1,435.20 "," $1,953.19 ", $308.46 , $153.67 ," $1,498.69 "," $1,506.37 "," $2,053.44 "," $1,987.20 "," $1,987.20 "," $1,766.40 "," $1,766.40 ", $153.67 ," $2,038.65 "," $2,097.60 "," $1,987.20 "," $1,987.20 "," $1,987.20 "," $2,053.44 "," $2,119.68 "," $1,809.89 "," $1,876.80 "," $1,646.69 "," $1,789.28 ", N/A ," $1,527.93 "," $1,527.93 "," $2,097.60 "," $1,795.87 ", $153.67 ," $2,119.68 "
"Dtap-Ipv, Im, Age 4-6 Year",CPT® 90696,N/A,N/A,N/A, $93.00 , $60.45 , N/A , N/A , $15.30 , N/A , N/A , $86.49 , $83.70 , $83.70 , $74.40 , $74.40 , $15.30 , $85.87 , $88.35 , $83.70 , $83.70 , $83.70 , $86.49 , $89.28 , N/A , $79.05 , $74.40 , $95.26 , N/A , N/A , N/A , $88.35 , N/A , $15.30 , $95.26 
 Allergen Spec Ige Recomb or Pur Component Beaker1 ,CPT® 86008,0302 - LAB/IMMUNOLOGY,N/A,N/A, $359.00 , $233.35 , $301.56 , $18.29 , $18.06 , $290.07 , $323.10 , $303.93 , $323.10 , $323.10 , $323.10 , $305.15 , $17.71 , $331.46 , $341.05 , $305.15 , $333.87 , $333.87 , $341.05 , $344.64 , $293.73 , $323.10 , $305.15 , $283.61 , N/A , $290.54 , $290.54 , $341.05 , $308.06 , $17.71 , $344.64 
 Fac Herpes Simplex Test ,CPT® 86694,0302 - LAB/IMMUNOLOGY,N/A,N/A, $150.00 , $97.50 , $126.00 , $14.68 , $14.68 , $121.20 , $135.00 , $126.99 , $135.00 , $135.00 , $135.00 , $127.50 , $14.39 , $138.50 , $142.50 , $127.50 , $139.50 , $139.50 , $142.50 , $144.00 , $122.73 , $135.00 , $127.50 , $118.50 , N/A , $121.40 , $121.40 , $142.50 , $128.72 , $14.39 , $144.00 
Needle Biopsy Pleura,CPT® 32400,N/A,N/A,N/A, $926.00 , $601.90 , $463.34 , $80.52 , $153.67 , $341.90 , $326.70 , $861.18 , $833.40 , $833.40 , $740.80 , $740.80 , $153.67 , $854.98 , $879.70 , $833.40 , $833.40 , $833.40 , $861.18 , $888.96 , $448.42 , $787.10 , $454.94 , $454.68 , N/A , $348.57 , $348.57 , $879.70 , $410.51 , $80.52 , $888.96 
" Fac Complement, Total (Ch50) ",CPT® 86162,0301 - LAB/CHEMISTRY,N/A,N/A, $256.00 , $166.40 , $215.04 , $20.73 , $20.73 , $206.85 , $230.40 , $216.73 , $230.40 , $230.40 , $230.40 , $217.60 , $20.32 , $236.36 , $243.20 , $217.60 , $238.08 , $238.08 , $243.20 , $245.76 , $209.46 , $230.40 , $217.60 , $202.24 , N/A , $207.18 , $207.18 , $243.20 , $219.67 , $20.32 , $245.76 
" Pro Contrast X-Ray, Bladder ",CPT® 74430,0972 - PRO FEE/RAD/DX,N/A,N/A, $198.00 , $128.70 , $229.91 , $40.61 , $59.34 , $177.18 , $218.13 , $184.14 , $178.20 , $178.20 , $158.40 , $158.40 , $59.34 , $182.81 , $188.10 , $178.20 , $178.20 , $178.20 , $184.14 , $190.08 , $225.26 , $168.30 , $234.98 , $192.51 , N/A , $180.64 , $180.64 , $188.10 , $209.09 , $40.61 , $234.98 
"CT Scan,Maxillofacial Area,W/O Contrast",CPT® 70486,N/A,N/A,N/A," $2,488.00 "," $1,617.20 ", $907.76 , $131.06 , $247.43 , $665.04 ," $1,202.45 "," $2,313.84 "," $2,239.20 "," $2,239.20 "," $1,990.40 "," $1,990.40 ", $247.43 ," $2,297.17 "," $2,363.60 "," $2,239.20 "," $2,239.20 "," $2,239.20 "," $2,313.84 "," $2,388.48 "," $1,375.32 "," $2,114.80 "," $1,309.71 ", $902.90 , N/A , $678.02 , $678.02 ," $2,363.60 ", $784.83 , $131.06 ," $2,388.48 "
Bedside Drainage Bag,HCPCS A4357,N/A,N/A,N/A, $17.00 , $11.05 , N/A , $13.17 , N/A , N/A , N/A , $15.81 , $15.30 , $15.30 , $13.60 , $13.60 , N/A , $15.70 , $16.15 , $15.30 , $15.30 , $15.30 , $15.81 , $16.32 , N/A , $14.45 , $11.68 , $11.97 , N/A , N/A , N/A , $16.15 , N/A , $11.68 , $16.32 
"Drainage of Hydrocele,Tunica",CPT® 55000,N/A,N/A,N/A, $769.00 , $499.85 , $371.96 , $80.27 , $30.71 , $272.78 , $276.02 , $715.17 , $692.10 , $692.10 , $615.20 , $615.20 , $30.71 , $710.02 , $730.55 , $692.10 , $692.10 , $692.10 , $715.17 , $738.24 , $349.08 , $653.65 , $440.66 , $410.02 , N/A , $278.11 , $278.11 , $730.55 , $333.31 , $30.71 , $738.24 
 Pro Oph Bmtry US Echograpy a-Scan Io Lens Pwr Cal ,CPT® 76519,0982 - PRO FEE/OUTPT,N/A,N/A, $225.00 , $146.25 , $378.04 , $66.49 , $72.09 , $404.02 , $453.06 , $209.25 , $202.50 , $202.50 , $180.00 , $180.00 , $72.09 , $207.74 , $213.75 , $202.50 , $202.50 , $202.50 , $209.25 , $216.00 , $372.87 , $191.25 , $496.92 , $419.21 , N/A , $411.90 , $411.90 , $213.75 , $476.79 , $66.49 , $496.92 
 Pro Change of Bladder Tube ,CPT® 51710,0981 - PRO FEE/ER,N/A,N/A, $895.00 , $581.75 , $428.61 , $75.87 , $125.78 , $392.45 , $365.81 , $832.35 , $805.50 , $805.50 , $716.00 , $716.00 , $125.78 , $826.35 , $850.25 , $805.50 , $805.50 , $805.50 , $832.35 , $859.20 , $429.64 , $760.75 , $413.90 , $492.61 , N/A , $400.11 , $400.11 , $850.25 , $470.28 , $75.87 , $859.20 
Forehead Flap W/ Prsrv Vasc Pedicle,CPT® 15731,N/A,N/A,N/A," $7,106.00 "," $4,618.90 "," $3,188.49 ", $955.58 , $823.72 ," $2,759.85 "," $2,708.91 "," $6,608.58 "," $6,395.40 "," $6,395.40 "," $5,684.80 "," $5,684.80 ", $823.72 ," $6,560.97 "," $6,750.70 "," $6,395.40 "," $6,395.40 "," $6,395.40 "," $6,608.58 "," $6,821.76 "," $3,486.19 "," $6,040.10 "," $5,412.85 "," $3,498.15 ", N/A ," $2,813.70 "," $2,813.70 "," $6,750.70 "," $3,262.96 ", $823.72 ," $6,821.76 "
Hepatic Function Panel,CPT® 80076,N/A,N/A,N/A, $117.00 , $76.05 , N/A , $8.33 , $8.33 , $46.19 , $55.29 , $108.81 , $105.30 , $105.30 , $93.60 , $93.60 , $8.33 , $108.03 , $111.15 , $105.30 , $105.30 , $105.30 , $108.81 , $112.32 , $54.55 , $99.45 , $53.52 , $29.63 , N/A , $43.11 , $43.11 , $111.15 , $47.11 , $8.33 , $112.32 
 Fac Eeg Cont Rec W/Video by Tech Min 8 Channels ,CPT® 95700,0740 - EEG,N/A,N/A, $901.00 , $585.65 , $756.84 , $165.57 , $206.53 , $728.01 , $810.90 , $762.79 , $810.90 , $810.90 , $810.90 , $765.85 , $202.48 , $831.89 , $855.95 , $765.85 , $837.93 , $837.93 , $855.95 , $864.96 , $737.20 , $810.90 , $765.85 , $711.79 , N/A , $729.18 , $729.18 , $855.95 , $773.15 , $165.57 , $864.96 
 Fac Plmt Urtrl Stnt Prq New Acess W/O Sep Nfros Cath ,CPT® 50694,0761 - TREATMENT ROOM,N/A,N/A," $10,574.00 "," $6,873.10 "," $8,882.16 ", $253.00 , $924.42 ," $8,543.79 "," $9,516.60 "," $8,951.95 "," $9,516.60 "," $9,516.60 "," $9,516.60 "," $8,987.90 ", $906.29 ," $9,762.97 "," $10,045.30 "," $8,987.90 "," $9,833.82 "," $9,833.82 "," $10,045.30 "," $10,151.04 "," $8,651.65 "," $9,516.60 "," $8,987.90 "," $8,353.46 ", N/A ," $8,557.54 "," $8,557.54 "," $10,045.30 "," $9,073.55 ", $253.00 ," $10,151.04 "
 Fac IV Dop Vel&/or Press C/Flo Rsrv Meas 1st Vsl ,CPT® 93571,0481 - CARDIAC CATH LAB,N/A,N/A, $746.00 , $484.90 , $626.64 , $253.68 , $269.51 , $602.77 , $671.40 , $631.56 , $671.40 , $671.40 , $671.40 , $634.10 , $264.23 , $688.78 , $708.70 , $634.10 , $693.78 , $693.78 , $708.70 , $716.16 , $610.38 , $671.40 , $634.10 , $589.34 , N/A , $603.74 , $603.74 , $708.70 , $640.14 , $253.68 , $716.16 
 Pro Exc Face-Mm Malig+Marg 0.6-1 ,CPT® 11641,0982 - PRO FEE/OUTPT,N/A,N/A," $1,253.00 ", $814.45 , $497.90 , $149.52 , $258.41 , $426.82 , $418.95 ," $1,165.29 "," $1,127.70 "," $1,127.70 "," $1,002.40 "," $1,002.40 ", $258.41 ," $1,156.89 "," $1,190.35 "," $1,127.70 "," $1,127.70 "," $1,127.70 "," $1,165.29 "," $1,202.88 ", $544.62 ," $1,065.05 ", $833.16 , $547.51 , N/A , $435.16 , $435.16 ," $1,190.35 ", $504.63 , $149.52 ," $1,202.88 "
" Pro Laryngoscopy,Indirect ",CPT® 31505,0981 - PRO FEE/ER,N/A,N/A, $278.00 , $180.70 , $265.36 , $47.56 , $48.28 , $188.55 , $189.85 , $258.54 , $250.20 , $250.20 , $222.40 , $222.40 , $48.28 , $256.68 , $264.10 , $250.20 , $250.20 , $250.20 , $258.54 , $266.88 , $252.04 , $236.30 , $265.83 , $249.84 , N/A , $192.23 , $192.23 , $264.10 , $226.41 , $47.56 , $266.88 
Inject Abdominal-Venous Shunt,CPT® 49427,N/A,N/A,N/A, $309.00 , $200.85 , $237.97 , $36.88 , $145.05 , $218.95 , $218.39 , $287.37 , $278.10 , $278.10 , $247.20 , $247.20 , $145.05 , $285.30 , $293.55 , $278.10 , $278.10 , $278.10 , $287.37 , $296.64 , $170.14 , $262.65 , $235.50 , $261.58 , N/A , $223.23 , $223.23 , $293.55 , $233.46 , $36.88 , $296.64 
 Fac Enzyme Cell Activity ,CPT® 82657,0301 - LAB/CHEMISTRY,N/A,N/A, $447.00 , $290.55 , $375.48 , $22.61 , $22.61 , $361.18 , $402.30 , $378.43 , $402.30 , $402.30 , $402.30 , $379.95 , $22.17 , $412.72 , $424.65 , $379.95 , $415.71 , $415.71 , $424.65 , $429.12 , $365.74 , $402.30 , $379.95 , $353.13 , N/A , $361.76 , $361.76 , $424.65 , $383.57 , $22.17 , $429.12 
 Fac Amb Ift 911 Loaded Mileage Bls ,HCPCS A0425,0540 - AMBULANCE,N/A,N/A, $41.00 , $26.65 , $34.44 , N/A , $7.08 , $33.13 , $36.90 , $34.71 , $36.90 , $36.90 , $36.90 , $34.85 , $6.94 , $37.86 , $38.95 , $34.85 , $38.13 , $38.13 , $38.95 , $39.36 , $33.55 , $36.90 , $34.85 , $32.39 , N/A , $33.18 , $33.18 , $38.95 , $35.18 , $6.94 , $39.36 
Right Heart Cath O2 Saturation & Cardiac Output,CPT® 93451,N/A,N/A,N/A," $5,764.00 "," $3,746.60 "," $5,685.03 ", $847.69 , $840.89 ," $4,199.92 "," $4,534.43 "," $5,360.52 "," $5,187.60 "," $5,187.60 "," $4,611.20 "," $4,611.20 ", $840.89 ," $5,321.90 "," $5,475.80 "," $5,187.60 "," $5,187.60 "," $5,187.60 "," $5,360.52 "," $5,533.44 "," $5,227.32 "," $4,899.40 "," $4,292.46 "," $4,311.24 ", N/A ," $4,281.87 "," $4,281.87 "," $5,475.80 "," $4,746.49 ", $840.89 ," $5,685.03 "
Chemodenervation Muscle Neck Unilat for Dystonia,64616,N/A,N/A,N/A," $1,842.00 "," $1,197.30 ", $505.39 , $98.15 , $78.09 , $578.28 , $570.10 ," $1,713.06 "," $1,657.80 "," $1,657.80 "," $1,473.60 "," $1,473.60 ", $78.09 ," $1,700.72 "," $1,749.90 "," $1,657.80 "," $1,657.80 "," $1,657.80 "," $1,713.06 "," $1,768.32 ", $544.97 ," $1,565.70 ", $577.51 , $621.45 , N/A , $589.57 , $589.57 ," $1,749.90 ", $632.47 , $78.09 ," $1,768.32 "
 Rt Upper Extremity Without Contrast ,CPT® 73218,0610 - MRI,N/A,N/A," $6,560.00 "," $4,264.00 "," $5,510.40 ", $289.54 , $410.97 ," $5,300.48 "," $5,904.00 "," $5,553.70 "," $5,904.00 "," $5,904.00 "," $5,904.00 "," $5,576.00 ", $402.91 ," $6,056.85 "," $6,232.00 "," $5,576.00 "," $6,100.80 "," $6,100.80 "," $6,232.00 "," $6,297.60 "," $5,367.39 "," $5,904.00 "," $5,576.00 "," $5,182.40 ", N/A ," $5,309.01 "," $5,309.01 "," $6,232.00 "," $5,629.14 ", $289.54 ," $6,297.60 "
 Pro Drain Lower Leg Lesion ,CPT® 27603,0982 - PRO FEE/OUTPT,N/A,N/A," $3,458.00 "," $2,247.70 "," $2,394.93 ", $374.21 , $200.19 ," $1,872.04 "," $1,898.94 "," $3,215.94 "," $3,112.20 "," $3,112.20 "," $2,766.40 "," $2,766.40 ", $200.19 ," $3,192.77 "," $3,285.10 "," $3,112.20 "," $3,112.20 "," $3,112.20 "," $3,215.94 "," $3,319.68 "," $2,217.61 "," $2,939.30 "," $2,094.49 "," $2,206.18 ", N/A ," $1,908.57 "," $1,908.57 "," $3,285.10 "," $2,243.27 ", $200.19 ," $3,319.68 "
Relieve Inner Eye Pressure,CPT® 65820,N/A,N/A,N/A," $5,655.00 "," $3,675.75 "," $5,149.50 ", $802.21 , $768.38 ," $4,228.38 "," $3,909.67 "," $5,259.15 "," $5,089.50 "," $5,089.50 "," $4,524.00 "," $4,524.00 ", $768.38 ," $5,221.26 "," $5,372.25 "," $5,089.50 "," $5,089.50 "," $5,089.50 "," $5,259.15 "," $5,428.80 "," $6,920.62 "," $4,806.75 "," $3,967.76 "," $5,385.34 ", N/A ," $4,310.88 "," $4,310.88 "," $5,372.25 "," $4,758.64 ", $768.38 ," $6,920.62 "
"Arthrotomy,Open Repair Meniscus",CPT® 27403,N/A,N/A,N/A," $4,130.00 "," $2,684.50 "," $3,932.89 ", $616.64 , $922.06 ," $3,084.39 "," $3,077.77 "," $3,840.90 "," $3,717.00 "," $3,717.00 "," $3,304.00 "," $3,304.00 ", $922.06 ," $3,813.23 "," $3,923.50 "," $3,717.00 "," $3,717.00 "," $3,717.00 "," $3,840.90 "," $3,964.80 "," $3,652.02 "," $3,510.50 "," $3,396.86 "," $3,629.26 ", N/A ," $3,144.58 "," $3,144.58 "," $3,923.50 "," $3,695.99 ", $616.64 ," $3,964.80 "
"Incis Tendon Sheath,Radial Styloid",CPT® 25000,N/A,N/A,N/A," $2,059.00 "," $1,338.35 "," $2,132.91 ", $337.40 , $307.34 ," $1,618.68 "," $1,636.56 "," $1,914.87 "," $1,853.10 "," $1,853.10 "," $1,647.20 "," $1,647.20 ", $307.34 ," $1,901.07 "," $1,956.05 "," $1,853.10 "," $1,853.10 "," $1,853.10 "," $1,914.87 "," $1,976.64 "," $1,968.73 "," $1,750.15 "," $1,792.98 "," $1,930.07 ", N/A ," $1,650.26 "," $1,650.26 "," $1,956.05 "," $1,939.63 ", $307.34 ," $2,132.91 "
Iadna Mycoplasma Genitalium Amplified Probe Tech,CPT® 87563,N/A,N/A,N/A, $314.00 , $204.10 , N/A , $35.79 , $28.63 , $149.27 , N/A , $292.02 , $282.60 , $282.60 , $251.20 , $251.20 , $28.63 , $289.92 , $298.30 , $282.60 , $282.60 , $282.60 , $292.02 , $301.44 , $234.30 , $266.90 , $168.00 , $103.06 , N/A , $139.31 , $139.31 , $298.30 , $151.94 , $28.63 , $301.44 
 Poisoning And Toxic Effects Of Drugs With McC ,MS DRG V40 (FY2023) 917,N/A,N/A,N/A," $21,094.91 "," $13,711.69 "," $17,719.72 ", N/A , N/A ," $17,044.69 "," $18,985.42 "," $17,858.95 "," $18,985.42 "," $18,985.42 "," $18,985.42 "," $17,930.67 ", N/A ," $19,476.93 "," $20,040.16 "," $17,930.67 "," $19,618.27 "," $19,618.27 "," $20,040.16 "," $20,251.11 "," $17,259.86 "," $18,985.42 "," $17,930.67 "," $16,664.98 ", N/A ," $17,072.11 "," $17,072.11 "," $20,040.16 "," $18,101.54 "," $16,664.98 "," $20,251.11 "
"Xray Upper GI Tract,W/Small Intest,F/T",CPT® 74245,N/A,N/A,N/A, $645.00 , $419.25 , N/A , N/A , N/A , N/A , $950.18 , $599.85 , $580.50 , $580.50 , $516.00 , $516.00 , N/A , $595.53 , $612.75 , $580.50 , $580.50 , $580.50 , $599.85 , $619.20 , N/A , $548.25 , N/A , N/A , N/A , N/A , N/A , $612.75 , N/A , $516.00 , $950.18 
"Home Visit,Hemodialysis",CPT® 99512,N/A,N/A,N/A," $1,672.00 "," $1,086.80 ", N/A , N/A , N/A , N/A , N/A ," $1,554.96 "," $1,504.80 "," $1,504.80 "," $1,337.60 "," $1,337.60 ", N/A ," $1,543.76 "," $1,588.40 "," $1,504.80 "," $1,504.80 "," $1,504.80 "," $1,554.96 "," $1,605.12 ", N/A ," $1,421.20 "," $1,337.60 ", N/A , N/A , N/A , N/A ," $1,588.40 ", N/A ," $1,337.60 "," $1,605.12 "
 NAPROXEN 250 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,50268-0594-15,1 tablet, $4.00 , $2.60 , $3.36 , N/A , N/A , $3.23 , $3.60 , $3.39 , $3.60 , $3.60 , $3.60 , $3.40 , N/A , $3.69 , $3.80 , $3.40 , $3.72 , $3.72 , $3.80 , $3.84 , $3.27 , $3.60 , $3.40 , $3.16 , N/A , $3.24 , $3.24 , $3.80 , $3.43 , $3.16 , $3.84 
 Fac Motor &/Sens 1-2 Nrv Cndj Preconf Eltrode Limb ,CPT® 95907,0922 - EMG,N/A,N/A, $426.00 , $276.90 , $357.84 , $88.30 , $74.18 , $344.21 , $383.40 , $360.65 , $383.40 , $383.40 , $383.40 , $362.10 , $72.73 , $393.33 , $404.70 , $362.10 , $396.18 , $396.18 , $404.70 , $408.96 , $348.55 , $383.40 , $362.10 , $336.54 , N/A , $344.76 , $344.76 , $404.70 , $365.55 , $72.73 , $408.96 
 Fac Iadna Mycobacteria Avium-Intraclre Amp Prb ,CPT® 87561,0306 - LAB/BACT-MICRO,N/A,N/A, $785.00 , $510.25 , $659.40 , $35.79 , $35.79 , $634.28 , $706.50 , $664.58 , $706.50 , $706.50 , $706.50 , $667.25 , $35.09 , $724.79 , $745.75 , $667.25 , $730.05 , $730.05 , $745.75 , $753.60 , $642.29 , $706.50 , $667.25 , $620.15 , N/A , $635.30 , $635.30 , $745.75 , $673.61 , $35.09 , $753.60 
 ACETAMINOPHEN 80 MG RE SUPP ,HCPCS RXC637,0250 - PHARMACY,51672-2114-02,1 suppository, $4.12 , $2.68 , $3.46 , N/A , N/A , $3.33 , $3.71 , $3.49 , $3.71 , $3.71 , $3.71 , $3.50 , N/A , $3.80 , $3.91 , $3.50 , $3.83 , $3.83 , $3.91 , $3.96 , $3.37 , $3.71 , $3.50 , $3.25 , N/A , $3.33 , $3.33 , $3.91 , $3.54 , $3.25 , $3.96 
 Fac Mycoplasma Antibody ,CPT® 86738,0302 - LAB/IMMUNOLOGY,N/A,N/A, $128.00 , $83.20 , $107.52 , $13.50 , $13.50 , $103.42 , $115.20 , $108.36 , $115.20 , $115.20 , $115.20 , $108.80 , $13.24 , $118.18 , $121.60 , $108.80 , $119.04 , $119.04 , $121.60 , $122.88 , $104.73 , $115.20 , $108.80 , $101.12 , N/A , $103.59 , $103.59 , $121.60 , $109.84 , $13.24 , $122.88 
 Fac Cltx Metatarsophlngl Jt Dislc W/O Anes ,CPT® 28630,0761 - TREATMENT ROOM,N/A,N/A, $768.00 , $499.20 , $645.12 , $106.32 , $134.96 , $620.54 , $691.20 , $650.19 , $691.20 , $691.20 , $691.20 , $652.80 , $132.31 , $709.09 , $729.60 , $652.80 , $714.24 , $714.24 , $729.60 , $737.28 , $628.38 , $691.20 , $652.80 , $606.72 , N/A , $621.54 , $621.54 , $729.60 , $659.02 , $106.32 , $737.28 
" Ligation, Division Short Saphenous Veins ",CPT® 37780,0360 - OR SERVICES,N/A,N/A," $3,724.00 "," $2,420.60 "," $3,128.16 ", $213.79 , $192.09 ," $3,008.99 "," $3,351.60 "," $3,152.74 "," $3,351.60 "," $3,351.60 "," $3,351.60 "," $3,165.40 ", $188.32 ," $3,438.37 "," $3,537.80 "," $3,165.40 "," $3,463.32 "," $3,463.32 "," $3,537.80 "," $3,575.04 "," $3,046.98 "," $3,351.60 "," $3,165.40 "," $2,941.96 ", N/A ," $3,013.83 "," $3,013.83 "," $3,537.80 "," $3,195.56 ", $188.32 ," $3,575.04 "
 MORPHINE SULFATE (CONCENTRATE) 10 MG/0.5ML PO SOLN ,HCPCS RXC637,0250 - PHARMACY,68094-0045-58,0.5 mL, $9.13 , $5.93 , $7.67 , N/A , N/A , $7.38 , $8.22 , $7.73 , $8.22 , $8.22 , $8.22 , $7.76 , N/A , $8.43 , $8.67 , $7.76 , $8.49 , $8.49 , $8.67 , $8.76 , $7.47 , $8.22 , $7.76 , $7.21 , N/A , $7.39 , $7.39 , $8.67 , $7.83 , $7.21 , $8.76 
Excision Tumor Soft Tissue Foot/Toe Subq 1.5+Cm,CPT® 28039,N/A,N/A,N/A," $3,578.00 "," $2,325.70 "," $2,127.19 ", $329.68 , $397.09 ," $1,713.47 "," $1,737.33 "," $3,327.54 "," $3,220.20 "," $3,220.20 "," $2,862.40 "," $2,862.40 ", $397.09 ," $3,303.57 "," $3,399.10 "," $3,220.20 "," $3,220.20 "," $3,220.20 "," $3,327.54 "," $3,434.88 "," $1,977.95 "," $3,041.30 "," $1,882.19 "," $2,022.19 ", N/A ," $1,746.91 "," $1,746.91 "," $3,399.10 "," $2,053.23 ", $329.68 ," $3,434.88 "
Hip Core Decompression,HCPCS S2325,N/A,N/A,N/A," $3,169.00 "," $2,059.85 ", N/A , N/A , N/A , N/A , N/A ," $2,947.17 "," $2,852.10 "," $2,852.10 "," $2,535.20 "," $2,535.20 ", N/A ," $2,925.94 "," $3,010.55 "," $2,852.10 "," $2,852.10 "," $2,852.10 "," $2,947.17 "," $3,042.24 ", N/A ," $2,693.65 "," $2,535.20 ", N/A , N/A , N/A , N/A ," $3,010.55 ", N/A ," $2,535.20 "," $3,042.24 "
Open Bone Biop Vert Lumb/Cerv,CPT® 20251,N/A,N/A,N/A," $2,706.00 "," $1,758.90 "," $2,509.46 ", $391.53 , $284.25 ," $2,005.60 "," $1,999.06 "," $2,516.58 "," $2,435.40 "," $2,435.40 "," $2,164.80 "," $2,164.80 ", $284.25 ," $2,498.45 "," $2,570.70 "," $2,435.40 "," $2,435.40 "," $2,435.40 "," $2,516.58 "," $2,597.76 "," $2,358.97 "," $2,300.10 "," $2,222.94 "," $2,366.04 ", N/A ," $2,044.73 "," $2,044.73 "," $2,570.70 "," $2,403.27 ", $284.25 ," $2,597.76 "
Incis of Hip/Thigh Fascia,CPT® 27025,N/A,N/A,N/A," $5,859.00 "," $3,808.35 "," $5,591.76 ", $874.92 , $691.53 ," $4,400.96 "," $4,415.50 "," $5,448.87 "," $5,273.10 "," $5,273.10 "," $4,687.20 "," $4,687.20 ", $691.53 ," $5,409.61 "," $5,566.05 "," $5,273.10 "," $5,273.10 "," $5,273.10 "," $5,448.87 "," $5,624.64 "," $5,186.83 "," $4,980.15 "," $4,881.20 "," $5,232.64 ", N/A ," $4,486.83 "," $4,486.83 "," $5,566.05 "," $5,273.63 ", $691.53 ," $5,624.64 "
 Pro Rmvl/Bivalv Gauntlet Boot/Bdy Cst ,CPT® 29700,0982 - PRO FEE/OUTPT,N/A,N/A, $443.00 , $287.95 , $198.45 , $30.97 , $22.66 , $160.94 , $161.75 , $411.99 , $398.70 , $398.70 , $354.40 , $354.40 , $22.66 , $409.02 , $420.85 , $398.70 , $398.70 , $398.70 , $411.99 , $425.28 , $185.48 , $376.55 , $178.41 , $193.88 , N/A , $164.08 , $164.08 , $420.85 , $192.87 , $22.66 , $425.28 
 PERFLUTREN LIPID MICROSPHERE 6.52 MG/ML IV SUSP ,HCPCS Q9957,0255 - DRUGS/RADIOLOGY,11994-0011-04,2 mL," $2,024.48 "," $1,315.91 "," $1,700.56 ", $43.57 , $50.04 ," $1,635.78 "," $1,822.03 "," $1,713.92 "," $1,822.03 "," $1,822.03 "," $1,822.03 "," $1,720.81 ", $49.06 ," $1,869.20 "," $1,923.26 "," $1,720.81 "," $1,882.77 "," $1,882.77 "," $1,923.26 "," $1,943.50 "," $1,656.43 "," $1,822.03 "," $1,720.81 "," $1,599.34 ", N/A ," $1,638.41 "," $1,638.41 "," $1,923.26 "," $1,737.21 ", $43.57 ," $1,943.50 "
 Fac Microdissection Prep Identified Target Manual ,CPT® 88381,0310 - PATHOLOGY LAB,N/A,N/A, $668.00 , $434.20 , $561.12 , $197.49 , $163.84 , $539.74 , $601.20 , $565.53 , $601.20 , $601.20 , $601.20 , $567.80 , $160.63 , $616.76 , $634.60 , $567.80 , $621.24 , $621.24 , $634.60 , $641.28 , $546.56 , $601.20 , $567.80 , $527.72 , N/A , $540.61 , $540.61 , $634.60 , $573.21 , $160.63 , $641.28 
Explore Elbow Joint,CPT® 24101,N/A,N/A,N/A," $2,816.00 "," $1,830.40 "," $3,093.94 ", $486.69 , $528.51 ," $2,410.49 "," $2,409.98 "," $2,618.88 "," $2,534.40 "," $2,534.40 "," $2,252.80 "," $2,252.80 ", $528.51 ," $2,600.01 "," $2,675.20 "," $2,534.40 "," $2,534.40 "," $2,534.40 "," $2,618.88 "," $2,703.36 "," $2,868.41 "," $2,393.60 "," $2,654.69 "," $2,844.73 ", N/A ," $2,457.52 "," $2,457.52 "," $2,675.20 "," $2,888.45 ", $486.69 ," $3,093.94 "
"Special Stains-Group 2,Al",CPT® 88313,N/A,N/A,N/A, $438.00 , $284.70 , $287.19 , $80.10 , $16.43 , $267.74 , $307.91 , $407.34 , $394.20 , $394.20 , $350.40 , $350.40 , $16.43 , $404.41 , $416.10 , $394.20 , $394.20 , $394.20 , $407.34 , $420.48 , $513.81 , $372.30 , $322.75 , $243.69 , N/A , $249.87 , $249.87 , $416.10 , $274.59 , $16.43 , $513.81 
Home/Res Visit New Patient Sf Mdm 15 Minutes,CPT® 99341,N/A,N/A,N/A, $185.00 , $120.25 , $108.70 , $48.13 , $24.03 , $95.06 , $95.77 , $172.05 , $166.50 , $166.50 , $148.00 , $148.00 , $24.03 , $170.81 , $175.75 , $166.50 , $166.50 , $166.50 , $172.05 , $177.60 , $99.22 , $157.25 , $119.27 , $119.98 , $74.00 , $96.92 , $96.92 , $175.75 , $111.78 , $24.03 , $177.60 
 Pro MRI Lumbar Spine W/Dye ,CPT® 72149,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,013.00 ", $658.45 ," $1,952.02 ", $278.24 , $506.39 ," $1,521.95 "," $2,499.38 ", $942.09 , $911.70 , $911.70 , $810.40 , $810.40 , $506.39 , $935.30 , $962.35 , $911.70 , $911.70 , $911.70 , $942.09 , $972.48 ," $1,677.11 ", $861.05 ," $2,725.35 "," $2,973.82 ", N/A ," $1,551.65 "," $1,551.65 ", $962.35 ," $1,796.06 ", $278.24 ," $2,973.82 "
 PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR ,HCPCS J2543,0636 - DRUGS REQUIRING DETAILED CODIN,00781-3113-95,15 mL, $94.85 , $61.65 , $79.67 , $1.39 , $1.55 , $76.64 , $85.37 , $80.30 , $85.37 , $85.37 , $85.37 , $80.62 , $1.52 , $87.58 , $90.11 , $80.62 , $88.21 , $88.21 , $90.11 , $91.06 , $77.61 , $85.37 , $80.62 , $74.93 , N/A , $76.76 , $76.76 , $90.11 , $81.39 , $1.39 , $91.06 
Pro Cltx Tarsal B1 Dislc Oth/Thn Talotarsal W/O Anes,28540,N/A,N/A,N/A," $1,049.00 ", $681.85 ," $1,098.57 ", $173.53 , $153.67 , $857.01 , $866.99 , $975.57 , $944.10 , $944.10 , $839.20 , $839.20 , $153.67 , $968.54 , $996.55 , $944.10 , $944.10 , $944.10 , $975.57 ," $1,007.04 "," $1,011.76 ", $891.65 , $938.42 ," $1,024.89 ", N/A , $873.74 , $873.74 , $996.55 ," $1,026.95 ", $153.67 ," $1,098.57 "
 TOPIRAMATE 100 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,68084-0344-01,1 tablet, $31.85 , $20.70 , $26.75 , N/A , N/A , $25.73 , $28.67 , $26.96 , $28.67 , $28.67 , $28.67 , $27.07 , N/A , $29.41 , $30.26 , $27.07 , $29.62 , $29.62 , $30.26 , $30.58 , $26.06 , $28.67 , $27.07 , $25.16 , N/A , $25.78 , $25.78 , $30.26 , $27.33 , $25.16 , $30.58 
I&D Deep Absc/Hematoma Neck/Chest,21501,N/A,N/A,N/A," $3,031.00 "," $1,970.15 "," $2,034.89 ", $320.83 , $177.51 ," $1,549.02 "," $1,575.62 "," $2,818.83 "," $2,727.90 "," $2,727.90 "," $2,424.80 "," $2,424.80 ", $177.51 ," $2,798.52 "," $2,879.45 "," $2,727.90 "," $2,727.90 "," $2,727.90 "," $2,818.83 "," $2,909.76 "," $1,860.63 "," $2,576.35 "," $1,734.11 "," $1,827.29 ", N/A ," $1,579.24 "," $1,579.24 "," $2,879.45 "," $1,856.17 ", $177.51 ," $2,909.76 "
"Strapping,Toes",CPT® 29550,N/A,N/A,N/A, $130.00 , $84.50 , $70.27 , $10.83 , $30.11 , $56.85 , $96.67 , $120.90 , $117.00 , $117.00 , $104.00 , $104.00 , $30.11 , $120.03 , $123.50 , $117.00 , $117.00 , $117.00 , $120.90 , $124.80 , $65.68 , $110.50 , $103.48 , $67.45 , N/A , $57.96 , $57.96 , $123.50 , $68.13 , $10.83 , $124.80 
Egd Ablate Tumor Polyp/Lesion W/Dilation& Wire,CPT® 43270,N/A,N/A,N/A," $4,359.00 "," $2,833.35 "," $1,377.74 ", $212.56 , $184.45 ," $1,168.51 "," $1,211.94 "," $4,053.87 "," $3,923.10 "," $3,923.10 "," $3,487.20 "," $3,487.20 ", $184.45 ," $4,024.66 "," $4,141.05 "," $3,923.10 "," $3,923.10 "," $3,923.10 "," $4,053.87 "," $4,184.64 ", $989.63 ," $3,705.15 "," $1,167.45 "," $1,311.97 ", N/A ," $1,191.31 "," $1,191.31 "," $4,141.05 "," $1,245.98 ", $184.45 ," $4,184.64 "
Developmental Tst Admin Phys/Qhp 1st Hour,CPT® 96112,N/A,N/A,N/A, $568.00 , $369.20 , $294.60 , $122.84 , $155.99 , $265.98 , N/A , $528.24 , $511.20 , $511.20 , $454.40 , $454.40 , $155.99 , $524.43 , $539.60 , $511.20 , $511.20 , $511.20 , $528.24 , $545.28 , $553.85 , $482.80 , $373.58 , $484.52 , N/A , $271.17 , $271.17 , $539.60 , $316.13 , $122.84 , $553.85 
"Removal of FB,Pharynx",42809,N/A,N/A,N/A, $891.00 , $579.15 , $774.61 , $121.29 , $46.62 , $640.06 , $659.95 , $828.63 , $801.90 , $801.90 , $712.80 , $712.80 , $46.62 , $822.66 , $846.45 , $801.90 , $801.90 , $801.90 , $828.63 , $855.36 , $548.59 , $757.35 , $722.55 , $692.65 , N/A , $652.55 , $652.55 , $846.45 , $682.48 , $46.62 , $855.36 
 Fac Revsc Opn/Prq Tib/Pero W/Athrc/Angiop Sm Vsl ,CPT® 37229,0360 - OR SERVICES,N/A,N/A," $20,828.00 "," $13,538.20 "," $17,495.52 ", $625.49 , $531.44 ," $16,829.02 "," $18,745.20 "," $17,632.98 "," $18,745.20 "," $18,745.20 "," $18,745.20 "," $17,703.80 ", $521.02 ," $19,230.49 "," $19,786.60 "," $17,703.80 "," $19,370.04 "," $19,370.04 "," $19,786.60 "," $19,994.88 "," $17,041.47 "," $18,745.20 "," $17,703.80 "," $16,454.12 ", N/A ," $16,856.10 "," $16,856.10 "," $19,786.60 "," $17,872.51 ", $521.02 ," $19,994.88 "
 Pro Destruction Benign Lesions Up to 14 ,CPT® 17110,0982 - PRO FEE/OUTPT,N/A,N/A, $342.00 , $222.30 , $157.95 , $65.34 , $26.07 , $189.80 , $190.02 , $318.06 , $307.80 , $307.80 , $273.60 , $273.60 , $26.07 , $315.77 , $324.90 , $307.80 , $307.80 , $307.80 , $318.06 , $328.32 , $233.71 , $290.70 , $374.65 , $246.56 , N/A , $193.50 , $193.50 , $324.90 , $224.41 , $26.07 , $374.65 
 Pro Rplcmt Compl Tun Ctr Vad W/Subq Port ,CPT® 36582,0982 - PRO FEE/OUTPT,N/A,N/A," $7,018.00 "," $4,561.70 "," $1,734.85 ", $268.28 ," $1,170.87 "," $1,325.35 "," $1,318.83 "," $6,526.74 "," $6,316.20 "," $6,316.20 "," $5,614.40 "," $5,614.40 "," $1,170.87 "," $6,479.72 "," $6,667.10 "," $6,316.20 "," $6,316.20 "," $6,316.20 "," $6,526.74 "," $6,737.28 "," $1,606.31 "," $5,965.30 "," $1,634.20 "," $1,429.21 ", N/A ," $1,351.21 "," $1,351.21 "," $6,667.10 "," $1,534.97 ", $268.28 ," $6,737.28 "
 CLADRIBINE 10 MG/10ML IV SOLN ,HCPCS J9065,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0140-10,10 mL," $2,681.45 "," $1,742.94 "," $2,252.42 ", $18.67 , $23.50 ," $2,166.61 "," $2,413.31 "," $2,270.12 "," $2,413.31 "," $2,413.31 "," $2,413.31 "," $2,279.23 ", $23.04 ," $2,475.78 "," $2,547.38 "," $2,279.23 "," $2,493.75 "," $2,493.75 "," $2,547.38 "," $2,574.19 "," $2,193.96 "," $2,413.31 "," $2,279.23 "," $2,118.35 ", N/A ," $2,170.10 "," $2,170.10 "," $2,547.38 "," $2,300.95 ", $18.67 ," $2,574.19 "
 FILGRASTIM 480 MCG/0.8ML IJ SOSY ,HCPCS J1442,0636 - DRUGS REQUIRING DETAILED CODIN,55513-0209-91,0.8 mL," $1,562.58 "," $1,015.68 "," $1,312.57 ", $1.01 , $1.00 ," $1,262.56 "," $1,406.32 "," $1,322.88 "," $1,406.32 "," $1,406.32 "," $1,406.32 "," $1,328.19 ", $0.98 ," $1,442.73 "," $1,484.45 "," $1,328.19 "," $1,453.20 "," $1,453.20 "," $1,484.45 "," $1,500.08 "," $1,278.50 "," $1,406.32 "," $1,328.19 "," $1,234.44 ", N/A ," $1,264.60 "," $1,264.60 "," $1,484.45 "," $1,340.85 ", $0.98 ," $1,500.08 "
 Fac Iaadiadoo Influenza ,CPT® 87804,0306 - LAB/BACT-MICRO,N/A,N/A, $114.00 , $74.10 , $95.76 , $16.88 , $16.65 , $92.11 , $102.60 , $96.51 , $102.60 , $102.60 , $102.60 , $96.90 , $16.32 , $105.26 , $108.30 , $96.90 , $106.02 , $106.02 , $108.30 , $109.44 , $93.27 , $102.60 , $96.90 , $90.06 , N/A , $92.26 , $92.26 , $108.30 , $97.82 , $16.32 , $109.44 
"Remove Eye Lesion,Sclera",CPT® 66130,N/A,N/A,N/A," $6,391.00 "," $4,154.15 "," $3,477.31 ", $545.32 , $50.17 ," $3,223.61 "," $3,056.57 "," $5,943.63 "," $5,751.90 "," $5,751.90 "," $5,112.80 "," $5,112.80 ", $50.17 ," $5,900.81 "," $6,071.45 "," $5,751.90 "," $5,751.90 "," $5,751.90 "," $5,943.63 "," $6,135.36 "," $4,775.13 "," $5,432.35 "," $3,186.34 "," $4,088.95 ", N/A ," $3,286.51 "," $3,286.51 "," $6,071.45 "," $3,627.88 ", $50.17 ," $6,135.36 "
" Pro Polysomnography, 4 or More ",CPT® 95810,0982 - PRO FEE/OUTPT,N/A,N/A," $5,862.00 "," $3,810.30 "," $2,228.13 ", $595.03 ," $1,061.47 "," $1,978.65 "," $2,194.06 "," $5,451.66 "," $5,275.80 "," $5,275.80 "," $4,689.60 "," $4,689.60 "," $1,061.47 "," $5,412.38 "," $5,568.90 "," $5,275.80 "," $5,275.80 "," $5,275.80 "," $5,451.66 "," $5,627.52 "," $2,646.65 "," $4,982.70 "," $1,924.03 "," $2,362.52 ", N/A ," $2,017.26 "," $2,017.26 "," $5,568.90 "," $2,480.00 ", $595.03 ," $5,627.52 "
Insert Intrauterine Device,58300,N/A,N/A,N/A, $588.00 , $382.20 , N/A , $108.57 , $89.76 , $213.25 , $207.47 , $546.84 , $529.20 , $529.20 , $470.40 , $470.40 , $89.76 , $542.90 , $558.60 , $529.20 , $529.20 , $529.20 , $546.84 , $564.48 , $256.00 , $499.80 , $265.83 , $220.53 , N/A , $217.41 , $217.41 , $558.60 , $260.79 , $89.76 , $564.48 
" Leukocyte Assessment, Fecal ",CPT® 89055,0300 - LABORATORY,N/A,N/A, $70.00 , $45.50 , $58.80 , $4.36 , $4.36 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $4.27 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $4.27 , $67.20 
"Preventive Visit,New,18-39",CPT® 99385,N/A,N/A,N/A, $394.00 , $256.10 , N/A , $126.45 , $62.20 , $208.95 , $211.09 , $366.42 , $354.60 , $354.60 , $315.20 , $315.20 , $62.20 , $363.78 , $374.30 , $354.60 , $354.60 , $354.60 , $366.42 , $378.24 , $258.56 , $334.90 , $212.28 , $208.60 , $155.50 , $213.03 , $213.03 , $374.30 , $255.87 , $62.20 , $378.24 
 BUPIVACAINE HCL (PF) 0.75 % IJ SOLN ,HCPCS J0665,0636 - DRUGS REQUIRING DETAILED CODIN,55150-0172-30,30 mL, $32.52 , $21.14 , $27.32 , N/A , N/A , $26.28 , $29.27 , $27.53 , $29.27 , $29.27 , $29.27 , $27.64 , N/A , $30.03 , $30.89 , $27.64 , $30.24 , $30.24 , $30.89 , $31.22 , $26.61 , $29.27 , $27.64 , $25.69 , N/A , $26.32 , $26.32 , $30.89 , $27.91 , $25.69 , $31.22 
Voltage-Gated Calcium Channel Antibody Each,CPT® 86596,N/A,N/A,N/A, $83.00 , $53.95 , N/A , $12.29 , $12.29 , N/A , N/A , $77.19 , $74.70 , $74.70 , $66.40 , $66.40 , $12.29 , $76.63 , $78.85 , $74.70 , $74.70 , $74.70 , $77.19 , $79.68 , N/A , $70.55 , $58.15 , $54.04 , N/A , $72.13 , $72.13 , $78.85 , $79.30 , $12.29 , $79.68 
Intestinal Stricturoplasty,CPT® 44615,N/A,N/A,N/A," $7,767.00 "," $5,048.55 "," $6,406.47 ", $989.09 , $987.41 ," $5,048.88 "," $5,105.00 "," $7,223.31 "," $6,990.30 "," $6,990.30 "," $6,213.60 "," $6,213.60 ", $987.41 ," $7,171.27 "," $7,378.65 "," $6,990.30 "," $6,990.30 "," $6,990.30 "," $7,223.31 "," $7,456.32 "," $4,577.79 "," $6,601.95 "," $5,676.89 "," $5,976.09 ", N/A ," $5,147.39 "," $5,147.39 "," $7,378.65 "," $5,383.61 ", $987.41 ," $7,456.32 "
Arthrd Pst/Pstlat Tq 1ntrspc Crv Belw C2 Segment,CPT® 22600,N/A,N/A,N/A," $8,321.00 "," $5,408.65 "," $7,579.26 "," $1,188.54 "," $1,074.45 "," $6,143.59 "," $6,075.52 "," $7,738.53 "," $7,488.90 "," $7,488.90 "," $6,656.80 "," $6,656.80 "," $1,074.45 "," $7,682.78 "," $7,904.95 "," $7,488.90 "," $7,488.90 "," $7,488.90 "," $7,738.53 "," $7,988.16 "," $7,041.85 "," $7,072.85 "," $6,857.94 "," $7,098.24 ", N/A ," $6,263.46 "," $6,263.46 "," $7,904.95 "," $7,361.81 "," $1,074.45 "," $7,988.16 "
 LEVOTHYROXINE SODIUM 25 MCG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6949-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
" Cytomegalovirus Antibody, Igg Beaker1 ",CPT® 86644,0302 - LAB/IMMUNOLOGY,N/A,N/A, $155.00 , $100.75 , $130.20 , $14.68 , $14.68 , $125.24 , $139.50 , $131.22 , $139.50 , $139.50 , $139.50 , $131.75 , $14.39 , $143.11 , $147.25 , $131.75 , $144.15 , $144.15 , $147.25 , $148.80 , $126.82 , $139.50 , $131.75 , $122.45 , N/A , $125.44 , $125.44 , $147.25 , $133.01 , $14.39 , $148.80 
Assay for Digoxin,CPT® 80162,N/A,N/A,N/A, $124.00 , $80.60 , N/A , $13.55 , $13.55 , $75.12 , $89.85 , $115.32 , $111.60 , $111.60 , $99.20 , $99.20 , $13.55 , $114.49 , $117.80 , $111.60 , $111.60 , $111.60 , $115.32 , $119.04 , $88.67 , $105.40 , $87.58 , $48.14 , N/A , $70.11 , $70.11 , $117.80 , $76.62 , $13.55 , $119.04 
"Knee Scope,Shave Articular Cart",29877,N/A,N/A,N/A," $3,578.00 "," $2,325.70 "," $3,782.09 ", $593.21 , $532.53 ," $3,003.86 "," $3,004.89 "," $3,327.54 "," $3,220.20 "," $3,220.20 "," $2,862.40 "," $2,862.40 ", $532.53 ," $3,303.57 "," $3,399.10 "," $3,220.20 "," $3,220.20 "," $3,220.20 "," $3,327.54 "," $3,434.88 "," $3,519.69 "," $3,041.30 "," $3,316.57 "," $3,540.30 ", N/A ," $3,062.47 "," $3,062.47 "," $3,399.10 "," $3,599.50 ", $532.53 ," $3,782.09 "
 Fac Revj Transvns Intrahepatic Portosystemic Shunt ,CPT® 37183,0761 - TREATMENT ROOM,N/A,N/A," $5,105.00 "," $3,318.25 "," $4,288.20 ", $354.26 , $391.79 ," $4,124.84 "," $4,594.50 "," $4,321.89 "," $4,594.50 "," $4,594.50 "," $4,594.50 "," $4,339.25 ", $384.11 ," $4,713.45 "," $4,849.75 "," $4,339.25 "," $4,747.65 "," $4,747.65 "," $4,849.75 "," $4,900.80 "," $4,176.91 "," $4,594.50 "," $4,339.25 "," $4,032.95 ", N/A ," $4,131.48 "," $4,131.48 "," $4,849.75 "," $4,380.60 ", $354.26 ," $4,900.80 "
Removal of Cervix,CPT® 57530,N/A,N/A,N/A," $1,997.00 "," $1,298.05 "," $1,777.40 ", $360.16 , $307.34 ," $1,414.70 "," $1,406.91 "," $1,857.21 "," $1,797.30 "," $1,797.30 "," $1,597.60 "," $1,597.60 ", $307.34 ," $1,843.83 "," $1,897.15 "," $1,797.30 "," $1,797.30 "," $1,797.30 "," $1,857.21 "," $1,917.12 "," $1,833.05 "," $1,697.45 "," $1,844.72 "," $1,415.80 ", N/A ," $1,442.30 "," $1,442.30 "," $1,897.15 "," $1,729.96 ", $307.34 ," $1,917.12 "
Revise/Repair Hand/Foot Nerve,CPT® 64704,N/A,N/A,N/A," $2,710.00 "," $1,761.50 "," $1,607.79 ", $315.08 , $444.61 ," $1,768.98 "," $1,719.84 "," $2,520.30 "," $2,439.00 "," $2,439.00 "," $2,168.00 "," $2,168.00 ", $444.61 ," $2,502.14 "," $2,574.50 "," $2,439.00 "," $2,439.00 "," $2,439.00 "," $2,520.30 "," $2,601.60 "," $1,732.86 "," $2,303.50 "," $1,680.59 "," $1,923.81 ", N/A ," $1,803.50 "," $1,803.50 "," $2,574.50 "," $1,934.73 ", $315.08 ," $2,601.60 "
REMOVE NASAL FOREIGN BODY,30320,N/A,N/A,N/A," $2,046.00 "," $1,329.90 "," $2,731.08 ", $480.81 , $439.86 ," $1,721.76 "," $1,741.61 "," $1,902.78 "," $1,841.40 "," $1,841.40 "," $1,636.80 "," $1,636.80 ", $439.86 ," $1,889.07 "," $1,943.70 "," $1,841.40 "," $1,841.40 "," $1,841.40 "," $1,902.78 "," $1,964.16 "," $2,578.44 "," $1,739.10 "," $2,447.74 "," $2,270.26 ", N/A ," $1,755.36 "," $1,755.36 "," $1,943.70 "," $2,067.30 ", $439.86 ," $2,731.08 "
Exc Mediastinal Tumor,CPT® 39220,N/A,N/A,N/A," $12,683.00 "," $8,243.95 "," $4,538.12 "," $1,040.17 "," $1,430.67 "," $4,000.81 "," $4,087.58 "," $11,795.19 "," $11,414.70 "," $11,414.70 "," $10,146.40 "," $10,146.40 "," $1,430.67 "," $11,710.21 "," $12,048.85 "," $11,414.70 "," $11,414.70 "," $11,414.70 "," $11,795.19 "," $12,175.68 "," $6,179.44 "," $10,780.55 "," $6,094.36 "," $5,198.78 ", N/A ," $4,078.87 "," $4,078.87 "," $12,048.85 "," $4,727.80 "," $1,040.17 "," $12,175.68 "
 Fac Community/Work Reintegration ,CPT® 97537,0430 - OCCUPATION THER,N/A,N/A, $90.00 , $58.50 , $75.60 , $31.80 , $18.09 , $72.72 , $81.00 , $76.19 , $81.00 , $81.00 , $81.00 , $76.50 , $17.74 , $83.10 , $85.50 , $76.50 , $83.70 , $83.70 , $85.50 , $86.40 , $73.64 , $81.00 , $76.50 , $71.10 , N/A , $72.84 , $72.84 , $85.50 , $77.23 , $17.74 , $86.40 
"Lap,Abdomen,Aspirate Cyst",49322,N/A,N/A,N/A," $2,444.00 "," $1,588.60 "," $2,248.29 ", $349.25 , $324.81 ," $1,740.58 "," $1,774.90 "," $2,272.92 "," $2,199.60 "," $2,199.60 "," $1,955.20 "," $1,955.20 ", $324.81 ," $2,256.55 "," $2,321.80 "," $2,199.60 "," $2,199.60 "," $2,199.60 "," $2,272.92 "," $2,346.24 "," $1,609.55 "," $2,077.40 "," $1,964.25 "," $2,074.70 ", N/A ," $1,774.54 "," $1,774.54 "," $2,321.80 "," $1,855.98 ", $324.81 ," $2,346.24 "
Remove Eye Foreign Body,65205,N/A,N/A,N/A, $421.00 , $273.65 , $180.70 , $28.20 , $35.23 , $251.30 , $232.46 , $391.53 , $378.90 , $378.90 , $336.80 , $336.80 , $35.23 , $388.71 , $399.95 , $378.90 , $378.90 , $378.90 , $391.53 , $404.16 , $248.64 , $357.85 , $239.06 , $319.55 , N/A , $256.20 , $256.20 , $399.95 , $282.82 , $28.20 , $404.16 
 Pro Polysomnography W/Cpap ,CPT® 95811,0982 - PRO FEE/OUTPT,N/A,N/A," $6,369.00 "," $4,139.85 "," $2,325.90 ", $622.13 ," $1,159.73 "," $2,077.89 "," $2,300.90 "," $5,923.17 "," $5,732.10 "," $5,732.10 "," $5,095.20 "," $5,095.20 "," $1,159.73 "," $5,880.50 "," $6,050.55 "," $5,732.10 "," $5,732.10 "," $5,732.10 "," $5,923.17 "," $6,114.24 "," $2,763.52 "," $5,413.65 "," $2,018.31 "," $2,480.88 ", N/A ," $2,118.44 "," $2,118.44 "," $6,050.55 "," $2,604.38 ", $622.13 ," $6,114.24 "
Ringers Lactate Infusion,HCPCS J7120,N/A,N/A,N/A, $34.00 , $22.10 , N/A , $2.44 , $2.61 , N/A , N/A , $31.62 , $30.60 , $30.60 , $27.20 , $27.20 , $2.61 , $31.39 , $32.30 , $30.60 , $30.60 , $30.60 , $31.62 , $32.64 , $3.09 , $28.90 , $1.95 , $3.29 , N/A , N/A , N/A , $32.30 , N/A , $1.95 , $32.64 
Excise Ext. Hemorrhoid,CPT® 46320,N/A,N/A,N/A, $870.00 , $565.50 , $692.64 , $107.89 , $165.14 , $525.60 , $539.21 , $809.10 , $783.00 , $783.00 , $696.00 , $696.00 , $165.14 , $803.27 , $826.50 , $783.00 , $783.00 , $783.00 , $809.10 , $835.20 , $493.49 , $739.50 , $594.09 , $627.81 , N/A , $535.85 , $535.85 , $826.50 , $560.45 , $107.89 , $835.20 
Treat Tibial Shaft Fractr,27750,N/A,N/A,N/A," $1,613.00 "," $1,048.45 "," $2,003.43 ", $317.27 , $156.40 ," $1,532.38 "," $1,554.50 "," $1,500.09 "," $1,451.70 "," $1,451.70 "," $1,290.40 "," $1,290.40 ", $156.40 ," $1,489.28 "," $1,532.35 "," $1,451.70 "," $1,451.70 "," $1,451.70 "," $1,500.09 "," $1,548.48 "," $1,847.67 "," $1,371.05 "," $1,707.35 "," $1,815.91 ", N/A ," $1,562.28 "," $1,562.28 "," $1,532.35 "," $1,836.23 ", $156.40 ," $2,003.43 "
 Fac N-Invas Ear/Pls Oximtry F/O2 Sat Mlt Deters ,CPT® 94761,0460 - PULMONARY FUNC,N/A,N/A, $281.00 , $182.65 , $236.04 , $3.40 , N/A , $227.05 , $252.90 , $237.89 , $252.90 , $252.90 , $252.90 , $238.85 , N/A , $259.45 , $266.95 , $238.85 , $261.33 , $261.33 , $266.95 , $269.76 , $229.91 , $252.90 , $238.85 , $221.99 , N/A , $227.41 , $227.41 , $266.95 , $241.13 , $3.40 , $269.76 
" Fac Tissue Homogenization, Cultr ",CPT® 87176,0306 - LAB/BACT-MICRO,N/A,N/A, $100.00 , $65.00 , $84.00 , $6.00 , $6.00 , $80.80 , $90.00 , $84.66 , $90.00 , $90.00 , $90.00 , $85.00 , $5.88 , $92.33 , $95.00 , $85.00 , $93.00 , $93.00 , $95.00 , $96.00 , $81.82 , $90.00 , $85.00 , $79.00 , N/A , $80.93 , $80.93 , $95.00 , $85.81 , $5.88 , $96.00 
 CLOBETASOL PROPIONATE 0.05 % EX CREA ,HCPCS RXC637,0250 - PHARMACY,51672-1258-01,15 gram, $658.73 , $428.17 , $553.33 , N/A , N/A , $532.25 , $592.86 , $557.68 , $592.86 , $592.86 , $592.86 , $559.92 , N/A , $608.21 , $625.79 , $559.92 , $612.62 , $612.62 , $625.79 , $632.38 , $538.97 , $592.86 , $559.92 , $520.40 , N/A , $533.11 , $533.11 , $625.79 , $565.26 , $520.40 , $632.38 
"Dest,Nerve,Facial",CPT® 64612,N/A,N/A,N/A, $731.00 , $475.15 , $572.10 , $112.30 , $185.45 , $639.64 , $644.20 , $679.83 , $657.90 , $657.90 , $584.80 , $584.80 , $185.45 , $674.93 , $694.45 , $657.90 , $657.90 , $657.90 , $679.83 , $701.76 , $614.83 , $621.35 , $654.75 , $689.66 , N/A , $652.12 , $652.12 , $694.45 , $699.57 , $112.30 , $701.76 
Assay for Phenobarbital,CPT® 80184,N/A,N/A,N/A, $107.00 , $69.55 , N/A , $15.61 , $15.61 , $64.77 , $77.50 , $99.51 , $96.30 , $96.30 , $85.60 , $85.60 , $15.61 , $98.79 , $101.65 , $96.30 , $96.30 , $96.30 , $99.51 , $102.72 , $102.16 , $90.95 , $74.60 , $44.94 , N/A , $60.45 , $60.45 , $101.65 , $66.06 , $15.61 , $102.72 
 Fac Immunofluorescence per Spec Add Singl Antb Stain ,CPT® 88350,0302 - LAB/IMMUNOLOGY,N/A,N/A, $292.00 , $189.80 , $245.28 , $114.53 , $57.02 , $235.94 , $262.80 , $247.21 , $262.80 , $262.80 , $262.80 , $248.20 , $55.90 , $269.60 , $277.40 , $248.20 , $271.56 , $271.56 , $277.40 , $280.32 , $238.91 , $262.80 , $248.20 , $230.68 , N/A , $236.32 , $236.32 , $277.40 , $250.57 , $55.90 , $280.32 
Treat Tibia Fracture,27824,N/A,N/A,N/A," $1,511.00 ", $982.15 ," $1,893.39 ", $300.54 , $217.57 ," $1,463.07 "," $1,483.65 "," $1,405.23 "," $1,359.90 "," $1,359.90 "," $1,208.80 "," $1,208.80 ", $217.57 ," $1,395.11 "," $1,435.45 "," $1,359.90 "," $1,359.90 "," $1,359.90 "," $1,405.23 "," $1,450.56 "," $1,754.63 "," $1,284.35 "," $1,628.85 "," $1,745.36 ", N/A ," $1,491.62 "," $1,491.62 "," $1,435.45 "," $1,753.18 ", $217.57 ," $1,893.39 "
 BUPIVACAINE HCL (PF) 0.25 % IJ SOLN ,HCPCS J0665,0636 - DRUGS REQUIRING DETAILED CODIN,00409-1159-02,30 mL, $16.68 , $10.84 , $14.01 , N/A , N/A , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , N/A , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $13.18 , $16.01 
 Lumbar Spine 2 or 3 Views ,CPT® 72100,0320 - DX X-RAY,N/A,N/A, $345.00 , $224.25 , $289.80 , $39.34 , $37.65 , $278.76 , $310.50 , $292.08 , $310.50 , $310.50 , $310.50 , $293.25 , $36.91 , $318.54 , $327.75 , $293.25 , $320.85 , $320.85 , $327.75 , $331.20 , $282.28 , $310.50 , $293.25 , $272.55 , N/A , $279.21 , $279.21 , $327.75 , $296.04 , $36.91 , $331.20 
Drug Test Def 22+ Classes,HCPCS G0483,N/A,N/A,N/A, $711.00 , $462.15 , N/A , $251.86 , $175.62 , $406.82 , N/A , $661.23 , $639.90 , $639.90 , $568.80 , $568.80 , $175.62 , $656.47 , $675.45 , $639.90 , $639.90 , $639.90 , $661.23 , $682.56 ," $1,648.74 ", $604.35 , $471.05 , $725.20 , N/A , $414.76 , $414.76 , $675.45 , $518.44 , $175.62 ," $1,648.74 "
Reconstruct Elbow Lat Ligmnt W/Graft,CPT® 24344,N/A,N/A,N/A," $5,023.00 "," $3,264.95 "," $6,649.83 "," $1,041.11 ", $442.83 ," $5,298.55 "," $5,254.56 "," $4,671.39 "," $4,520.70 "," $4,520.70 "," $4,018.40 "," $4,018.40 ", $442.83 ," $4,637.74 "," $4,771.85 "," $4,520.70 "," $4,520.70 "," $4,520.70 "," $4,671.39 "," $4,822.08 "," $6,185.33 "," $4,269.55 "," $5,807.13 "," $6,245.91 ", N/A ," $5,401.93 "," $5,401.93 "," $4,771.85 "," $6,349.19 ", $442.83 ," $6,649.83 "
 Fac Slctv Cathj Ea 1st Ord Abdl Pel/Lxtr Art Brnch ,CPT® 36245,0360 - OR SERVICES,N/A,N/A," $4,196.00 "," $2,727.40 "," $3,524.64 ", $216.04 ," $1,347.70 "," $3,390.37 "," $3,776.40 "," $3,552.33 "," $3,776.40 "," $3,776.40 "," $3,776.40 "," $3,566.60 "," $1,321.27 "," $3,874.17 "," $3,986.20 "," $3,566.60 "," $3,902.28 "," $3,902.28 "," $3,986.20 "," $4,028.16 "," $3,433.17 "," $3,776.40 "," $3,566.60 "," $3,314.84 ", N/A ," $3,395.82 "," $3,395.82 "," $3,986.20 "," $3,600.59 ", $216.04 ," $4,028.16 "
 NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SUSP ,HCPCS RXC637,0250 - PHARMACY,24208-0635-62,10 mL, $517.19 , $336.17 , $434.44 , N/A , N/A , $417.89 , $465.47 , $437.85 , $465.47 , $465.47 , $465.47 , $439.61 , N/A , $477.52 , $491.33 , $439.61 , $480.99 , $480.99 , $491.33 , $496.50 , $423.16 , $465.47 , $439.61 , $408.58 , N/A , $418.56 , $418.56 , $491.33 , $443.80 , $408.58 , $496.50 
 Fac Intra-Ventric&/Atrial Mapg Tachycard W/Cath MA ,CPT® 93609,0480 - CARDIOLOGY,N/A,N/A," $1,729.00 "," $1,123.85 "," $1,452.36 ", $365.22 , $385.44 ," $1,397.03 "," $1,556.10 "," $1,463.77 "," $1,556.10 "," $1,556.10 "," $1,556.10 "," $1,469.65 ", $377.88 ," $1,596.39 "," $1,642.55 "," $1,469.65 "," $1,607.97 "," $1,607.97 "," $1,642.55 "," $1,659.84 "," $1,414.67 "," $1,556.10 "," $1,469.65 "," $1,365.91 ", N/A ," $1,399.28 "," $1,399.28 "," $1,642.55 "," $1,483.65 ", $365.22 ," $1,659.84 "
 Fac Bfb Traing W/Emg&/Manometry Ea Addl 15 Min Cntct ,CPT® 90913,0917 - PSYCH/BIOFEED,N/A,N/A, $152.00 , $98.80 , $127.68 , $23.62 , $25.77 , $122.82 , $136.80 , $128.68 , $136.80 , $136.80 , $136.80 , $129.20 , $25.26 , $140.34 , $144.40 , $129.20 , $141.36 , $141.36 , $144.40 , $145.92 , $124.37 , $136.80 , $129.20 , $120.08 , N/A , $123.01 , $123.01 , $144.40 , $130.43 , $23.62 , $145.92 
 Fac DXA Bone Density Study Axial Skeleton ,CPT® 77085,0320 - DX X-RAY,N/A,N/A, $428.00 , $278.20 , $359.52 , $50.98 , $44.25 , $345.82 , $385.20 , $362.34 , $385.20 , $385.20 , $385.20 , $363.80 , $43.38 , $395.17 , $406.60 , $363.80 , $398.04 , $398.04 , $406.60 , $410.88 , $350.19 , $385.20 , $363.80 , $338.12 , N/A , $346.38 , $346.38 , $406.60 , $367.27 , $43.38 , $410.88 
Remove Foreign Body Complic,CPT® 10121,N/A,N/A,N/A," $1,048.00 ", $681.20 , $588.68 , $176.00 , $77.74 , $505.10 , $497.82 , $974.64 , $943.20 , $943.20 , $838.40 , $838.40 , $77.74 , $967.62 , $995.60 , $943.20 , $943.20 , $943.20 , $974.64 ," $1,006.08 ", $648.05 , $890.80 , $990.16 , $647.57 , N/A , $514.96 , $514.96 , $995.60 , $597.18 , $77.74 ," $1,006.08 "
Molecular Pathology Procedure Level 6,CPT® 81405,N/A,N/A,N/A," $1,338.00 ", $869.70 , N/A , $307.38 , $307.38 , N/A , N/A ," $1,244.34 "," $1,204.20 "," $1,204.20 "," $1,070.40 "," $1,070.40 ", $307.38 ," $1,235.38 "," $1,271.10 "," $1,204.20 "," $1,204.20 "," $1,204.20 "," $1,244.34 "," $1,284.48 "," $2,012.18 "," $1,137.30 "," $1,436.06 ", $885.06 , N/A ," $1,196.36 "," $1,196.36 "," $1,271.10 "," $1,304.85 ", $307.38 ," $2,012.18 "
 RIVASTIGMINE 13.3 MG/24HR TD PT24 ,HCPCS RXC637,0250 - PHARMACY,47781-0405-03,1 patch, $83.24 , $54.11 , $69.92 , N/A , N/A , $67.26 , $74.92 , $70.47 , $74.92 , $74.92 , $74.92 , $70.75 , N/A , $76.86 , $79.08 , $70.75 , $77.41 , $77.41 , $79.08 , $79.91 , $68.11 , $74.92 , $70.75 , $65.76 , N/A , $67.37 , $67.37 , $79.08 , $71.43 , $65.76 , $79.91 
 Pro Treat Ulnar Fracture ,CPT® 24685,0975 - PRO FEE/OR,N/A,N/A," $3,825.00 "," $2,486.25 "," $3,995.68 ", $627.48 , $614.70 ," $3,150.32 "," $3,155.45 "," $3,557.25 "," $3,442.50 "," $3,442.50 "," $3,060.00 "," $3,060.00 ", $614.70 ," $3,531.62 "," $3,633.75 "," $3,442.50 "," $3,442.50 "," $3,442.50 "," $3,557.25 "," $3,672.00 "," $3,718.00 "," $3,251.25 "," $3,478.92 "," $3,726.44 ", N/A ," $3,211.79 "," $3,211.79 "," $3,633.75 "," $3,774.99 ", $614.70 ," $3,995.68 "
 Pro MRI Abd C-Matrl ,CPT® 74181,0972 - PRO FEE/RAD/DX,N/A,N/A, $760.00 , $494.00 ," $1,409.80 ", $201.61 , $416.70 ," $1,583.40 "," $1,987.60 ", $706.80 , $684.00 , $684.00 , $608.00 , $608.00 , $416.70 , $701.71 , $722.00 , $684.00 , $684.00 , $684.00 , $706.80 , $729.60 ," $1,211.46 ", $646.00 ," $2,164.87 "," $2,609.32 ", N/A ," $1,614.30 "," $1,614.30 ", $722.00 ," $1,868.58 ", $201.61 ," $2,609.32 "
 Fac Anes Regional Technical ,Custom 1000698,0370 - ANESTHESIA,N/A,N/A, $639.00 , $415.35 , $536.76 , N/A , N/A , $516.31 , $575.10 , $540.98 , $575.10 , $575.10 , $575.10 , $543.15 , N/A , $589.99 , $607.05 , $543.15 , $594.27 , $594.27 , $607.05 , $613.44 , $522.83 , $575.10 , $543.15 , $504.81 , N/A , $517.14 , $517.14 , $607.05 , $548.33 , $504.81 , $613.44 
"Shav Skin Les 11-20mm Face,Facial",11312,N/A,N/A,N/A, $605.00 , $393.25 , $238.03 , $71.74 , $86.30 , $213.59 , $207.56 , $562.65 , $544.50 , $544.50 , $484.00 , $484.00 , $86.30 , $558.60 , $574.75 , $544.50 , $544.50 , $544.50 , $562.65 , $580.80 , $263.31 , $514.25 , $413.90 , $273.21 , N/A , $217.77 , $217.77 , $574.75 , $252.54 , $71.74 , $580.80 
 Pro Cltx Tibl Shft Fx W/O Mnpj ,CPT® 27750,0981 - PRO FEE/ER,N/A,N/A," $1,613.00 "," $1,048.45 "," $2,003.43 ", $317.27 , $156.40 ," $1,532.38 "," $1,554.50 "," $1,500.09 "," $1,451.70 "," $1,451.70 "," $1,290.40 "," $1,290.40 ", $156.40 ," $1,489.28 "," $1,532.35 "," $1,451.70 "," $1,451.70 "," $1,451.70 "," $1,500.09 "," $1,548.48 "," $1,847.67 "," $1,371.05 "," $1,707.35 "," $1,815.91 ", N/A ," $1,562.28 "," $1,562.28 "," $1,532.35 "," $1,836.23 ", $156.40 ," $2,003.43 "
 Fac Emblc/Thrmbc Fempop a-Iliac Art ,CPT® 34201,0360 - OR SERVICES,N/A,N/A," $7,836.00 "," $5,093.40 "," $6,582.24 ", $909.65 , $926.46 ," $6,331.49 "," $7,052.40 "," $6,633.96 "," $7,052.40 "," $7,052.40 "," $7,052.40 "," $6,660.60 ", $908.29 ," $7,234.98 "," $7,444.20 "," $6,660.60 "," $7,287.48 "," $7,287.48 "," $7,444.20 "," $7,522.56 "," $6,411.42 "," $7,052.40 "," $6,660.60 "," $6,190.44 ", N/A ," $6,341.67 "," $6,341.67 "," $7,444.20 "," $6,724.07 ", $908.29 ," $7,522.56 "
 Fac Antb ID Pltlt Associated Ig Assay ,CPT® 86023,0302 - LAB/IMMUNOLOGY,N/A,N/A, $109.00 , $70.85 , $91.56 , $12.71 , $12.71 , $88.07 , $98.10 , $92.28 , $98.10 , $98.10 , $98.10 , $92.65 , $12.46 , $100.64 , $103.55 , $92.65 , $101.37 , $101.37 , $103.55 , $104.64 , $89.18 , $98.10 , $92.65 , $86.11 , N/A , $88.21 , $88.21 , $103.55 , $93.53 , $12.46 , $104.64 
Psychotherapy W/Patient W/E&M Srvcs 45 Min,90836,N/A,N/A,N/A, $177.00 , $115.05 , $104.83 , $77.70 , $101.25 , $186.07 , $154.16 , $164.61 , $159.30 , $159.30 , $141.60 , $141.60 , $101.25 , $163.42 , $168.15 , $159.30 , $159.30 , $159.30 , $164.61 , $169.92 , $200.04 , $150.45 , $200.72 , $315.10 , $102.25 , $189.70 , $189.70 , $168.15 , $221.16 , $77.70 , $315.10 
"Injection,Therap/Proph/Diagnost, Im or Subcut",96372,N/A,N/A,N/A, $90.00 , $58.50 , $33.14 , $13.86 , $3.38 , $55.65 , $58.19 , $83.70 , $81.00 , $81.00 , $72.00 , $72.00 , $3.38 , $83.10 , $85.50 , $81.00 , $81.00 , $81.00 , $83.70 , $86.40 , $51.48 , $76.50 , $77.04 , $77.48 , N/A , $56.74 , $56.74 , $85.50 , $66.15 , $3.38 , $86.40 
"Clot Inhib Protein C,Activ",CPT® 85303,N/A,N/A,N/A, $272.00 , $176.80 , N/A , $14.12 , $14.12 , $78.24 , $93.59 , $252.96 , $244.80 , $244.80 , $217.60 , $217.60 , $14.12 , $251.14 , $258.40 , $244.80 , $244.80 , $244.80 , $252.96 , $261.12 , $92.41 , $231.20 , $90.82 , $50.16 , N/A , $73.02 , $73.02 , $258.40 , $79.80 , $14.12 , $261.12 
Assay RBC Cholinesterase,CPT® 82482,N/A,N/A,N/A, $119.00 , $77.35 , N/A , $10.01 , $10.01 , $43.45 , $51.99 , $110.67 , $107.10 , $107.10 , $95.20 , $95.20 , $10.01 , $109.87 , $113.05 , $107.10 , $107.10 , $107.10 , $110.67 , $114.24 , $65.50 , $101.15 , $50.28 , $28.81 , N/A , $40.55 , $40.55 , $113.05 , $44.31 , $10.01 , $114.24 
" Pro Rep Smpl Wnd Neck, Genitalia, Hands,Feet 2.6-7.5 Cm ",CPT® 12002,0982 - PRO FEE/OUTPT,N/A,N/A, $685.00 , $445.25 , $183.91 , $54.60 , $67.36 , $160.40 , $155.64 , $637.05 , $616.50 , $616.50 , $548.00 , $548.00 , $67.36 , $632.46 , $650.75 , $616.50 , $616.50 , $616.50 , $637.05 , $657.60 , $201.24 , $582.25 , $312.21 , $204.29 , N/A , $163.53 , $163.53 , $650.75 , $189.63 , $54.60 , $657.60 
 OSM - OXIDIZED CELLULOSE (FIBRILLAR EX PADS) ,HCPCS RXA250,0250 - PHARMACY,56091-0043-50,1 package, $461.81 , $300.18 , $387.92 , N/A , N/A , $373.14 , $415.63 , $390.97 , $415.63 , $415.63 , $415.63 , $392.54 , N/A , $426.39 , $438.72 , $392.54 , $429.48 , $429.48 , $438.72 , $443.34 , $377.85 , $415.63 , $392.54 , $364.83 , N/A , $373.74 , $373.74 , $438.72 , $396.28 , $364.83 , $443.34 
Shlder Fig 8 Abduct Restrain,HCPCS L3650,N/A,N/A,N/A, $96.00 , $62.40 , N/A , $76.71 , $49.96 , N/A , N/A , $89.28 , $86.40 , $86.40 , $76.80 , $76.80 , $49.96 , $88.64 , $91.20 , $86.40 , $86.40 , $86.40 , $89.28 , $92.16 , N/A , $81.60 , $58.39 , $64.54 , N/A , N/A , N/A , $91.20 , N/A , $49.96 , $92.16 
Exc Tumor Soft Tissue Shoulder Subfascial 5+Cm,CPT® 23073,N/A,N/A,N/A," $5,457.00 "," $3,547.05 "," $4,200.56 ", $655.86 , $568.22 ," $3,326.76 "," $3,305.98 "," $5,075.01 "," $4,911.30 "," $4,911.30 "," $4,365.60 "," $4,365.60 ", $568.22 ," $5,038.45 "," $5,184.15 "," $4,911.30 "," $4,911.30 "," $4,911.30 "," $5,075.01 "," $5,238.72 "," $3,901.55 "," $4,638.45 "," $3,660.90 "," $3,917.76 ", N/A ," $3,391.67 "," $3,391.67 "," $5,184.15 "," $3,986.41 ", $568.22 ," $5,238.72 "
 LORAZEPAM 2 MG/ML IJ SOLN ,HCPCS J2060,0636 - DRUGS REQUIRING DETAILED CODIN,00409-1985-30,1 mL, $40.35 , $26.23 , $33.89 , $0.87 , $1.20 , $32.60 , $36.32 , $34.16 , $36.32 , $36.32 , $36.32 , $34.30 , $1.18 , $37.26 , $38.33 , $34.30 , $37.53 , $37.53 , $38.33 , $38.74 , $33.01 , $36.32 , $34.30 , $31.88 , N/A , $32.66 , $32.66 , $38.33 , $34.62 , $0.87 , $38.74 
 Fac Special Radiation Dosimetry ,CPT® 77331,0333 - RADIATION RX,N/A,N/A, $422.00 , $274.30 , $354.48 , $63.78 , $62.97 , $340.98 , $379.80 , $357.27 , $379.80 , $379.80 , $379.80 , $358.70 , $61.74 , $389.63 , $400.90 , $358.70 , $392.46 , $392.46 , $400.90 , $405.12 , $345.28 , $379.80 , $358.70 , $333.38 , N/A , $341.52 , $341.52 , $400.90 , $362.12 , $61.74 , $405.12 
 Fdg per Dose ,HCPCS A9552,0343 - DIAGNOSTIC RADIOPHARMACEUTICALS,N/A,N/A, $414.00 , $269.10 , $347.76 , $538.22 , $367.20 , $334.51 , $372.60 , $350.49 , $372.60 , $372.60 , $372.60 , $351.90 , $360.00 , $382.25 , $393.30 , $351.90 , $385.02 , $385.02 , $393.30 , $397.44 , $338.73 , $372.60 , $351.90 , $327.06 , N/A , $335.05 , $335.05 , $393.30 , $355.25 , $327.06 , $538.22 
Cesarean Delivery+Postpartum Care,CPT® 59515,N/A,N/A,N/A," $4,518.00 "," $2,936.70 "," $3,024.87 "," $1,178.07 ", $674.01 ," $2,921.21 "," $3,065.37 "," $4,201.74 "," $4,066.20 "," $4,066.20 "," $3,614.40 "," $3,614.40 ", $674.01 ," $4,171.47 "," $4,292.10 "," $4,066.20 "," $4,066.20 "," $4,066.20 "," $4,201.74 "," $4,337.28 "," $3,548.82 "," $3,840.30 "," $6,781.23 "," $2,911.31 ", N/A ," $2,978.21 "," $2,978.21 "," $4,292.10 "," $3,443.09 ", $674.01 ," $6,781.23 "
Treat Femoral Fracture,CPT® 27508,N/A,N/A,N/A," $3,462.00 "," $2,250.30 "," $3,062.80 ", $481.59 , $614.44 ," $2,378.36 "," $2,393.52 "," $3,219.66 "," $3,115.80 "," $3,115.80 "," $2,769.60 "," $2,769.60 ", $614.44 ," $3,196.46 "," $3,288.90 "," $3,115.80 "," $3,115.80 "," $3,115.80 "," $3,219.66 "," $3,323.52 "," $2,834.72 "," $2,942.70 "," $2,636.85 "," $2,811.30 ", N/A ," $2,424.77 "," $2,424.77 "," $3,288.90 "," $2,849.98 ", $481.59 ," $3,323.52 "
Spherocylinder 4.25d/Over 6d,HCPCS V2110,N/A,N/A,N/A, $55.00 , $35.75 , N/A , $62.21 , N/A , N/A , N/A , $51.15 , $49.50 , $49.50 , $44.00 , $44.00 , N/A , $50.78 , $52.25 , $49.50 , $49.50 , $49.50 , $51.15 , $52.80 , N/A , $46.75 , $55.00 , $56.51 , N/A , N/A , N/A , $52.25 , N/A , $44.00 , $62.21 
"Repr Forearm Tend/Musc,Flex,Prim,Ea",25260,N/A,N/A,N/A," $4,316.00 "," $2,805.40 "," $3,892.40 ", $612.04 , $546.22 ," $3,033.01 "," $3,036.14 "," $4,013.88 "," $3,884.40 "," $3,884.40 "," $3,452.80 "," $3,452.80 ", $546.22 ," $3,984.96 "," $4,100.20 "," $3,884.40 "," $3,884.40 "," $3,884.40 "," $4,013.88 "," $4,143.36 "," $3,605.62 "," $3,668.60 "," $3,341.55 "," $3,595.95 ", N/A ," $3,092.19 "," $3,092.19 "," $4,100.20 "," $3,634.44 ", $546.22 ," $4,143.36 "
Layer Closure 7.6-12.5cm,12054,N/A,N/A,N/A," $1,652.00 "," $1,073.80 ", $691.80 , $208.93 , $210.26 , $622.08 , $609.78 ," $1,536.36 "," $1,486.80 "," $1,486.80 "," $1,321.60 "," $1,321.60 ", $210.26 ," $1,525.29 "," $1,569.40 "," $1,486.80 "," $1,486.80 "," $1,486.80 "," $1,536.36 "," $1,585.92 ", $758.54 ," $1,404.20 "," $1,218.52 ", $778.84 , N/A , $634.21 , $634.21 ," $1,569.40 ", $735.47 , $208.93 ," $1,585.92 "
CT Scan Cerv Spine Contrast,CPT® 72126,N/A,N/A,N/A, $687.00 , $446.55 ," $1,202.67 ", $172.41 , $303.06 ," $1,092.39 "," $1,383.77 ", $638.91 , $618.30 , $618.30 , $549.60 , $549.60 , $303.06 , $634.31 , $652.65 , $618.30 , $618.30 , $618.30 , $638.91 , $659.52 ," $1,012.21 ", $583.95 ," $1,506.16 "," $1,478.94 ", N/A ," $1,113.70 "," $1,113.70 ", $652.65 ," $1,289.13 ", $172.41 ," $1,506.16 "
 Fac Enteroscopy > 2nd Prtn W/Control Bleeding ,CPT® 44366,0360 - OR SERVICES,N/A,N/A," $3,241.00 "," $2,106.65 "," $2,722.44 ", $227.50 , $615.81 ," $2,618.73 "," $2,916.90 "," $2,743.83 "," $2,916.90 "," $2,916.90 "," $2,916.90 "," $2,754.85 ", $603.74 ," $2,992.42 "," $3,078.95 "," $2,754.85 "," $3,014.13 "," $3,014.13 "," $3,078.95 "," $3,111.36 "," $2,651.79 "," $2,916.90 "," $2,754.85 "," $2,560.39 ", N/A ," $2,622.94 "," $2,622.94 "," $3,078.95 "," $2,781.10 ", $227.50 ," $3,111.36 "
Reptilase Test,CPT® 85635,N/A,N/A,N/A, $134.00 , $87.10 , N/A , $10.05 , $10.05 , $55.66 , $66.62 , $124.62 , $120.60 , $120.60 , $107.20 , $107.20 , $10.05 , $123.72 , $127.30 , $120.60 , $120.60 , $120.60 , $124.62 , $128.64 , $65.77 , $113.90 , $64.87 , $35.71 , N/A , $51.95 , $51.95 , $127.30 , $56.77 , $10.05 , $128.64 
 Fac 2d Lim Transtho Echo W/Contr ,HCPCS C8924,0483 - CARDIOLOGY – ECHOCARDIOLOGY,N/A,N/A," $1,335.00 ", $867.75 ," $1,121.40 ", N/A , N/A ," $1,078.68 "," $1,201.50 "," $1,130.21 "," $1,201.50 "," $1,201.50 "," $1,201.50 "," $1,134.75 ", N/A ," $1,232.61 "," $1,268.25 "," $1,134.75 "," $1,241.55 "," $1,241.55 "," $1,268.25 "," $1,281.60 "," $1,092.30 "," $1,201.50 "," $1,134.75 "," $1,054.65 ", N/A ," $1,080.42 "," $1,080.42 "," $1,268.25 "," $1,145.56 "," $1,054.65 "," $1,281.60 "
 Fac Drug Screen Quantitative Lamotrigine ,CPT® 80175,0301 - LAB/CHEMISTRY,N/A,N/A, $156.00 , $101.40 , $131.04 , $13.52 , $13.52 , $126.05 , $140.40 , $132.07 , $140.40 , $140.40 , $140.40 , $132.60 , $13.25 , $144.03 , $148.20 , $132.60 , $145.08 , $145.08 , $148.20 , $149.76 , $127.64 , $140.40 , $132.60 , $123.24 , N/A , $126.25 , $126.25 , $148.20 , $133.86 , $13.25 , $149.76 
"Stereotactic Radiosurgery, Cranial,Complex,Single",CPT® 61798,N/A,N/A,N/A," $14,174.00 "," $9,213.10 "," $6,299.18 "," $1,231.03 ", $668.75 ," $7,474.49 "," $7,096.88 "," $13,181.82 "," $12,756.60 "," $12,756.60 "," $11,339.20 "," $11,339.20 ", $668.75 ," $13,086.85 "," $13,465.30 "," $12,756.60 "," $12,756.60 "," $12,756.60 "," $13,181.82 "," $13,607.04 "," $6,799.75 "," $12,047.90 "," $7,266.49 "," $7,714.39 ", N/A ," $7,620.33 "," $7,620.33 "," $13,465.30 "," $8,174.84 ", $668.75 ," $13,607.04 "
 Fac Anes General Technical per 15 Mini ,Custom 1000082,0370 - ANESTHESIA,N/A,N/A, $239.00 , $155.35 , $200.76 , N/A , N/A , $193.11 , $215.10 , $202.34 , $215.10 , $215.10 , $215.10 , $203.15 , N/A , $220.67 , $227.05 , $203.15 , $222.27 , $222.27 , $227.05 , $229.44 , $195.55 , $215.10 , $203.15 , $188.81 , N/A , $193.42 , $193.42 , $227.05 , $205.09 , $188.81 , $229.44 
 Pro Treat Clavicle Fracture ,CPT® 23515,0982 - PRO FEE/OUTPT,N/A,N/A," $4,739.00 "," $3,080.35 "," $4,385.42 ", $688.96 , $614.70 ," $3,469.11 "," $3,468.64 "," $4,407.27 "," $4,265.10 "," $4,265.10 "," $3,791.20 "," $3,791.20 ", $614.70 ," $4,375.52 "," $4,502.05 "," $4,265.10 "," $4,265.10 "," $4,265.10 "," $4,407.27 "," $4,549.44 "," $4,077.69 "," $4,028.15 "," $3,828.60 "," $4,093.83 ", N/A ," $3,536.79 "," $3,536.79 "," $4,502.05 "," $4,156.99 ", $614.70 ," $4,549.44 "
 Fac Parathyroid Imaging W/Tomographic Spect & CT ,CPT® 78072,0341 - NUC MED/DX PROCEDURES,N/A,N/A," $3,202.00 "," $2,081.30 "," $2,689.68 ", $400.85 , $284.63 ," $2,587.22 "," $2,881.80 "," $2,710.81 "," $2,881.80 "," $2,881.80 "," $2,881.80 "," $2,721.70 ", $279.05 ," $2,956.41 "," $3,041.90 "," $2,721.70 "," $2,977.86 "," $2,977.86 "," $3,041.90 "," $3,073.92 "," $2,619.88 "," $2,881.80 "," $2,721.70 "," $2,529.58 ", N/A ," $2,591.38 "," $2,591.38 "," $3,041.90 "," $2,747.64 ", $279.05 ," $3,073.92 "
Radiologic Examination Femur 1 View,CPT® 73551,N/A,N/A,N/A, $359.00 , $233.35 , $197.68 , $28.73 , $21.76 , $131.90 , $139.97 , $333.87 , $323.10 , $323.10 , $287.20 , $287.20 , $21.76 , $331.46 , $341.05 , $323.10 , $323.10 , $323.10 , $333.87 , $344.64 , $161.25 , $305.15 , $168.82 , $140.49 , N/A , $134.47 , $134.47 , $341.05 , $155.66 , $21.76 , $344.64 
"Hemorrhoidectomy,Int/Ext,Complx",CPT® 46260,N/A,N/A,N/A," $3,579.00 "," $2,326.35 "," $2,955.75 ", $458.53 , $387.88 ," $2,254.34 "," $2,301.47 "," $3,328.47 "," $3,221.10 "," $3,221.10 "," $2,863.20 "," $2,863.20 ", $387.88 ," $3,304.49 "," $3,400.05 "," $3,221.10 "," $3,221.10 "," $3,221.10 "," $3,328.47 "," $3,435.84 "," $2,108.62 "," $3,042.15 "," $2,536.94 "," $2,681.16 ", N/A ," $2,298.33 "," $2,298.33 "," $3,400.05 "," $2,403.80 ", $387.88 ," $3,435.84 "
"Orchiopexy,Abd Apprch,Abd Testis",CPT® 54650,N/A,N/A,N/A," $3,906.00 "," $2,538.90 "," $3,156.99 ", $680.10 ," $1,059.91 "," $2,284.84 "," $2,306.27 "," $3,632.58 "," $3,515.40 "," $3,515.40 "," $3,124.80 "," $3,124.80 "," $1,059.91 "," $3,606.41 "," $3,710.70 "," $3,515.40 "," $3,515.40 "," $3,515.40 "," $3,632.58 "," $3,749.76 "," $2,964.81 "," $3,320.10 "," $3,675.17 "," $3,449.30 ", N/A ," $2,329.42 "," $2,329.42 "," $3,710.70 "," $2,791.94 ", $680.10 ," $3,749.76 "
Manipulatn Knee Jt+Anesthesia,CPT® 27570,N/A,N/A,N/A, $479.00 , $311.35 , $931.58 , $147.22 , $151.20 , $726.41 , $730.37 , $445.47 , $431.10 , $431.10 , $383.20 , $383.20 , $151.20 , $442.26 , $455.05 , $431.10 , $431.10 , $431.10 , $445.47 , $459.84 , $859.06 , $407.15 , $802.83 , $858.23 , N/A , $740.58 , $740.58 , $455.05 , $870.45 , $147.22 , $931.58 
 In111 Dtpa/Pentetate per .5 Mci ,HCPCS A9548,0343 - DIAGNOSTIC RADIOPHARMACEUTICALS,N/A,N/A," $1,690.00 "," $1,098.50 "," $1,419.60 ", N/A , $222.13 ," $1,365.52 "," $1,521.00 "," $1,430.75 "," $1,521.00 "," $1,521.00 "," $1,521.00 "," $1,436.50 ", $217.77 ," $1,560.38 "," $1,605.50 "," $1,436.50 "," $1,571.70 "," $1,571.70 "," $1,605.50 "," $1,622.40 "," $1,382.76 "," $1,521.00 "," $1,436.50 "," $1,335.10 ", N/A ," $1,367.72 "," $1,367.72 "," $1,605.50 "," $1,450.19 ", $217.77 ," $1,622.40 "
Excise Varicocele,CPT® 55530,N/A,N/A,N/A," $1,929.00 "," $1,253.85 "," $1,567.92 ", $337.48 , $401.40 ," $1,130.23 "," $1,147.65 "," $1,793.97 "," $1,736.10 "," $1,736.10 "," $1,543.20 "," $1,543.20 ", $401.40 ," $1,781.05 "," $1,832.55 "," $1,736.10 "," $1,736.10 "," $1,736.10 "," $1,793.97 "," $1,851.84 "," $1,468.70 "," $1,639.65 "," $1,834.02 "," $1,703.56 ", N/A ," $1,152.28 "," $1,152.28 "," $1,832.55 "," $1,381.08 ", $337.48 ," $1,851.84 "
 Pro Rpr Nail Bed ,CPT® 11760,0981 - PRO FEE/ER,N/A,N/A, $840.00 , $546.00 , $358.36 , $106.67 , $42.71 , $359.65 , $359.77 , $781.20 , $756.00 , $756.00 , $672.00 , $672.00 , $42.71 , $775.57 , $798.00 , $756.00 , $756.00 , $756.00 , $781.20 , $806.40 , $400.51 , $714.00 , $715.41 , $401.98 , N/A , $366.67 , $366.67 , $798.00 , $425.20 , $42.71 , $806.40 
 Pro DXA Bone Density Study 1+ Sits Axial Skel ,CPT® 77080,0972 - PRO FEE/RAD/DX,N/A,N/A, $363.00 , $235.95 , $207.70 , $37.34 , $90.07 , $191.46 , $259.32 , $337.59 , $326.70 , $326.70 , $290.40 , $290.40 , $90.07 , $335.16 , $344.85 , $326.70 , $326.70 , $326.70 , $337.59 , $348.48 , $341.81 , $308.55 , $285.05 , $313.78 , N/A , $195.20 , $195.20 , $344.85 , $225.93 , $37.34 , $348.48 
 METHYLPREDNISOLONE SODIUM SUCC 1000 MG INJECTION (INPT) ,HCPCS J2930,0636 - DRUGS REQUIRING DETAILED CODIN,00009-0698-01,16 mL, $271.13 , $176.23 , $227.75 , $5.84 , $6.07 , $219.07 , $244.02 , $229.54 , $244.02 , $244.02 , $244.02 , $230.46 , $5.95 , $250.33 , $257.57 , $230.46 , $252.15 , $252.15 , $257.57 , $260.28 , $221.84 , $244.02 , $230.46 , $214.19 , N/A , $219.43 , $219.43 , $257.57 , $232.66 , $5.84 , $260.28 
 Fac Plmt Urtrl Stent Prq New Access W/Sep Nfros Cath ,CPT® 50695,0761 - TREATMENT ROOM,N/A,N/A," $15,993.00 "," $10,395.45 "," $13,434.12 ", $324.19 ," $1,127.40 "," $12,922.34 "," $14,393.70 "," $13,539.67 "," $14,393.70 "," $14,393.70 "," $14,393.70 "," $13,594.05 "," $1,105.29 "," $14,766.34 "," $15,193.35 "," $13,594.05 "," $14,873.49 "," $14,873.49 "," $15,193.35 "," $15,353.28 "," $13,085.47 "," $14,393.70 "," $13,594.05 "," $12,634.47 ", N/A ," $12,943.13 "," $12,943.13 "," $15,193.35 "," $13,723.59 ", $324.19 ," $15,353.28 "
Imhistochem/Cytchm Ea Addl Antibody Slide,CPT® 88341,N/A,N/A,N/A, $488.00 , $317.20 , $315.72 , $85.14 , $52.77 , $266.11 , $307.40 , $453.84 , $439.20 , $439.20 , $390.40 , $390.40 , $52.77 , $450.57 , $463.60 , $439.20 , $439.20 , $439.20 , $453.84 , $468.48 , $596.48 , $414.80 , $415.15 , $323.06 , N/A , $248.35 , $248.35 , $463.60 , $272.93 , $52.77 , $596.48 
 Fac Gliadin Antibody Each Immunoglobulin Class ,CPT® 86258,0302 - LAB/IMMUNOLOGY,N/A,N/A, $136.00 , $88.40 , $114.24 , $12.29 , $11.76 , $109.89 , $122.40 , $115.14 , $122.40 , $122.40 , $122.40 , $115.60 , $11.53 , $125.57 , $129.20 , $115.60 , $126.48 , $126.48 , $129.20 , $130.56 , $111.28 , $122.40 , $115.60 , $107.44 , N/A , $110.06 , $110.06 , $129.20 , $116.70 , $11.53 , $130.56 
"Biopsy Forearm Soft Tissues,Superfic",CPT® 25065,N/A,N/A,N/A," $1,575.00 "," $1,023.75 ", $977.60 , $152.47 , $39.88 , $793.95 , $805.37 ," $1,464.75 "," $1,417.50 "," $1,417.50 "," $1,260.00 "," $1,260.00 ", $39.88 ," $1,454.20 "," $1,496.25 "," $1,417.50 "," $1,417.50 "," $1,417.50 "," $1,464.75 "," $1,512.00 ", $908.59 ," $1,338.75 ", $881.33 , $939.50 , N/A , $809.43 , $809.43 ," $1,496.25 ", $951.38 , $39.88 ," $1,512.00 "
"Removal Testis, Partial",CPT® 54522,N/A,N/A,N/A," $3,011.00 "," $1,957.15 "," $2,607.94 ", $561.49 , $334.60 ," $1,894.70 "," $1,956.35 "," $2,800.23 "," $2,709.90 "," $2,709.90 "," $2,408.80 "," $2,408.80 ", $334.60 ," $2,780.06 "," $2,860.45 "," $2,709.90 "," $2,709.90 "," $2,709.90 "," $2,800.23 "," $2,890.56 "," $2,452.52 "," $2,559.35 "," $3,123.90 "," $2,861.49 ", N/A ," $1,931.66 "," $1,931.66 "," $2,860.45 "," $2,315.20 ", $334.60 ," $3,123.90 "
"Assay, Aluminum",CPT® 82108,N/A,N/A,N/A, $226.00 , $146.90 , N/A , $25.99 , $25.99 , $144.14 , $172.42 , $210.18 , $203.40 , $203.40 , $180.80 , $180.80 , $25.99 , $208.67 , $214.70 , $203.40 , $203.40 , $203.40 , $210.18 , $216.96 , $170.14 , $192.10 , $167.05 , $92.40 , N/A , $134.52 , $134.52 , $214.70 , $147.00 , $25.99 , $216.96 
Incision of Iris,CPT® 66500,N/A,N/A,N/A," $3,488.00 "," $2,267.20 "," $2,467.92 ", $385.42 , $307.34 ," $1,999.13 "," $1,854.66 "," $3,243.84 "," $3,139.20 "," $3,139.20 "," $2,790.40 "," $2,790.40 ", $307.34 ," $3,220.47 "," $3,313.60 "," $3,139.20 "," $3,139.20 "," $3,139.20 "," $3,243.84 "," $3,348.48 "," $3,310.35 "," $2,964.80 "," $1,883.97 "," $2,543.47 ", N/A ," $2,038.13 "," $2,038.13 "," $3,313.60 "," $2,249.83 ", $307.34 ," $3,348.48 "
Int Hrhc by Ligation 2+ Hroid W/O Img Gdn,46946,N/A,N/A,N/A," $2,064.00 "," $1,341.60 "," $2,378.81 ", $367.27 , $268.05 ," $1,077.97 "," $1,110.04 "," $1,919.52 "," $1,857.60 "," $1,857.60 "," $1,651.20 "," $1,651.20 ", $268.05 ," $1,905.69 "," $1,960.80 "," $1,857.60 "," $1,857.60 "," $1,857.60 "," $1,919.52 "," $1,981.44 "," $1,699.57 "," $1,754.40 "," $1,214.95 "," $1,285.54 ", N/A ," $1,099.00 "," $1,099.00 "," $1,960.80 "," $1,149.43 ", $268.05 ," $2,378.81 "
 Fac Appl Rgd Tot Contact Leg Cst ,CPT® 29445,0761 - TREATMENT ROOM,N/A,N/A," $1,209.00 ", $785.85 ," $1,015.56 ", $94.45 , $147.47 , $976.87 ," $1,088.10 "," $1,023.54 "," $1,088.10 "," $1,088.10 "," $1,088.10 "," $1,027.65 ", $144.58 ," $1,116.27 "," $1,148.55 "," $1,027.65 "," $1,124.37 "," $1,124.37 "," $1,148.55 "," $1,160.64 ", $989.20 ," $1,088.10 "," $1,027.65 ", $955.11 , N/A , $978.44 , $978.44 ," $1,148.55 "," $1,037.44 ", $94.45 ," $1,160.64 "
 METOPROLOL SUCCINATE ER 25 MG PO TB24 ,HCPCS RXC637,0250 - PHARMACY,00904-6322-61,1 tablet, $6.37 , $4.14 , $5.35 , N/A , N/A , $5.15 , $5.73 , $5.39 , $5.73 , $5.73 , $5.73 , $5.41 , N/A , $5.88 , $6.05 , $5.41 , $5.92 , $5.92 , $6.05 , $6.12 , $5.21 , $5.73 , $5.41 , $5.03 , N/A , $5.16 , $5.16 , $6.05 , $5.47 , $5.03 , $6.12 
 Pro Lyr Clsr N/H/F/Xtrnl Gent 2.6 Cm-7.5 Cm ,CPT® 12042,0982 - PRO FEE/OUTPT,N/A,N/A," $1,172.00 ", $761.80 , $627.61 , $188.46 , $103.08 , $547.43 , $537.01 ," $1,089.96 "," $1,054.80 "," $1,054.80 ", $937.60 , $937.60 , $103.08 ," $1,082.11 "," $1,113.40 "," $1,054.80 "," $1,054.80 "," $1,054.80 "," $1,089.96 "," $1,125.12 ", $689.37 , $996.20 ," $1,066.87 ", $703.69 , N/A , $558.12 , $558.12 ," $1,113.40 ", $647.23 , $103.08 ," $1,125.12 "
"Osteotomy Lumb Sp,Post,1 Lvl",CPT® 22214,N/A,N/A,N/A," $9,730.00 "," $6,324.50 "," $8,912.41 "," $1,396.08 "," $1,930.42 "," $7,120.72 "," $7,031.60 "," $9,048.90 "," $8,757.00 "," $8,757.00 "," $7,784.00 "," $7,784.00 "," $1,930.42 "," $8,983.71 "," $9,243.50 "," $8,757.00 "," $8,757.00 "," $8,757.00 "," $9,048.90 "," $9,340.80 "," $8,290.73 "," $8,270.50 "," $7,849.88 "," $8,327.08 ", N/A ," $7,259.66 "," $7,259.66 "," $9,243.50 "," $8,532.68 "," $1,396.08 "," $9,340.80 "
Lens Bifocal Add Over 3.25d,HCPCS V2220,N/A,N/A,N/A, $7.00 , $4.55 , N/A , $51.60 , $48.98 , N/A , N/A , $6.51 , $6.30 , $6.30 , $5.60 , $5.60 , $48.98 , $6.46 , $6.65 , $6.30 , $6.30 , $6.30 , $6.51 , $6.72 , N/A , $5.95 , $7.00 , $46.89 , N/A , N/A , N/A , $6.65 , N/A , $5.60 , $51.60 
 Pro Insertion Picc W/O Img Gdn 5 Yr/> ,CPT® 36569,0982 - PRO FEE/OUTPT,N/A,N/A," $1,559.00 "," $1,013.35 ", $570.51 , $87.87 , $94.88 , $405.39 , $393.52 ," $1,449.87 "," $1,403.10 "," $1,403.10 "," $1,247.20 "," $1,247.20 ", $94.88 ," $1,439.42 "," $1,481.05 "," $1,403.10 "," $1,403.10 "," $1,403.10 "," $1,449.87 "," $1,496.64 ", $529.38 ," $1,325.15 ", $478.13 , $430.78 , N/A , $413.31 , $413.31 ," $1,481.05 ", $469.51 , $87.87 ," $1,496.64 "
 MRI Cardiac Imaging W/O Contrast ,CPT® 75557,0610 - MRI,N/A,N/A," $4,994.00 "," $3,246.10 "," $4,194.96 ", $286.77 , $378.54 ," $4,035.15 "," $4,494.60 "," $4,227.92 "," $4,494.60 "," $4,494.60 "," $4,494.60 "," $4,244.90 ", $371.12 ," $4,610.96 "," $4,744.30 "," $4,244.90 "," $4,644.42 "," $4,644.42 "," $4,744.30 "," $4,794.24 "," $4,086.09 "," $4,494.60 "," $4,244.90 "," $3,945.26 ", N/A ," $4,041.64 "," $4,041.64 "," $4,744.30 "," $4,285.35 ", $286.77 ," $4,794.24 "
"Transfusion,Blood",CPT® 36430,N/A,N/A,N/A, $381.00 , $247.65 , $236.54 , $37.97 , $21.99 , $147.20 , $150.13 , $354.33 , $342.90 , $342.90 , $304.80 , $304.80 , $21.99 , $351.78 , $361.95 , $342.90 , $342.90 , $342.90 , $354.33 , $365.76 , $209.61 , $323.85 , $181.97 , $174.23 , N/A , $150.07 , $150.07 , $361.95 , $170.48 , $21.99 , $365.76 
"Repair Rotator Cuff,Chronic",CPT® 23412,N/A,N/A,N/A," $5,635.00 "," $3,662.75 "," $5,174.20 ", $810.67 , $754.88 ," $4,110.06 "," $4,090.88 "," $5,240.55 "," $5,071.50 "," $5,071.50 "," $4,508.00 "," $4,508.00 ", $754.88 ," $5,202.80 "," $5,353.25 "," $5,071.50 "," $5,071.50 "," $5,071.50 "," $5,240.55 "," $5,409.60 "," $4,813.76 "," $4,789.75 "," $4,519.03 "," $4,843.14 ", N/A ," $4,190.25 "," $4,190.25 "," $5,353.25 "," $4,925.04 ", $754.88 ," $5,409.60 "
"Self Care/Home Mgmt Train,Ea 15 Min",CPT® 97535,N/A,N/A,N/A, $145.00 , $94.25 , $64.16 , $32.74 , $21.45 , $78.94 , $70.38 , $134.85 , $130.50 , $130.50 , $116.00 , $116.00 , $21.45 , $133.88 , $137.75 , $130.50 , $130.50 , $130.50 , $134.85 , $139.20 , $83.57 , $123.25 , $103.40 , $78.01 , N/A , $80.48 , $80.48 , $137.75 , $89.51 , $21.45 , $139.20 
"Excis Conjunc Lesn,=<1 Cm",68110,N/A,N/A,N/A," $2,184.00 "," $1,419.60 ", $908.96 , $143.24 , $93.05 , $840.25 , $798.27 ," $2,031.12 "," $1,965.60 "," $1,965.60 "," $1,747.20 "," $1,747.20 ", $93.05 ," $2,016.49 "," $2,074.80 "," $1,965.60 "," $1,965.60 "," $1,965.60 "," $2,031.12 "," $2,096.64 "," $1,249.67 "," $1,856.40 ", $827.81 ," $1,069.63 ", N/A , $856.64 , $856.64 ," $2,074.80 ", $945.61 , $93.05 ," $2,096.64 "
 Fac Islet Cell Antibody ,CPT® 86341,0302 - LAB/IMMUNOLOGY,N/A,N/A, $172.00 , $111.80 , $144.48 , $24.04 , $19.62 , $138.98 , $154.80 , $145.62 , $154.80 , $154.80 , $154.80 , $146.20 , $19.24 , $158.81 , $163.40 , $146.20 , $159.96 , $159.96 , $163.40 , $165.12 , $140.73 , $154.80 , $146.20 , $135.88 , N/A , $139.20 , $139.20 , $163.40 , $147.59 , $19.24 , $165.12 
 Fac Fetal Congenital Abnor Assay Four Anal ,CPT® 81511,0310 - PATHOLOGY LAB,N/A,N/A, $347.00 , $225.55 , $291.48 , $156.57 , $156.57 , $280.38 , $312.30 , $293.77 , $312.30 , $312.30 , $312.30 , $294.95 , $153.50 , $320.39 , $329.65 , $294.95 , $322.71 , $322.71 , $329.65 , $333.12 , $283.92 , $312.30 , $294.95 , $274.13 , N/A , $280.83 , $280.83 , $329.65 , $297.76 , $153.50 , $333.12 
 Pro Colonoscopy W/Biopsy Single/Multiple ,CPT® 45380,0982 - PRO FEE/OUTPT,N/A,N/A," $3,222.00 "," $2,094.30 "," $1,228.57 ", $189.88 , $603.31 ," $1,404.75 "," $1,401.29 "," $2,996.46 "," $2,899.80 "," $2,899.80 "," $2,577.60 "," $2,577.60 ", $603.31 ," $2,974.87 "," $3,060.90 "," $2,899.80 "," $2,899.80 "," $2,899.80 "," $2,996.46 "," $3,093.12 "," $1,727.67 "," $2,738.70 "," $1,379.08 "," $1,171.50 ", N/A ," $1,432.15 "," $1,432.15 "," $3,060.90 "," $1,651.84 ", $189.88 ," $3,093.12 "
 PHENOBARBITAL SODIUM 65 MG/ML IJ SOLN ,HCPCS J2560,0636 - DRUGS REQUIRING DETAILED CODIN,00641-0476-25,1 mL, $296.29 , $192.59 , $248.88 , $40.17 , $46.78 , $239.40 , $266.66 , $250.84 , $266.66 , $266.66 , $266.66 , $251.85 , $45.86 , $273.56 , $281.48 , $251.85 , $275.55 , $275.55 , $281.48 , $284.44 , $242.42 , $266.66 , $251.85 , $234.07 , N/A , $239.79 , $239.79 , $281.48 , $254.25 , $40.17 , $284.44 
 Pro Arthrp Kne Condyle&Platu Medial/Lat Cmprt ,CPT® 27446,0975 - PRO FEE/OR,N/A,N/A," $5,383.00 "," $3,498.95 "," $6,951.82 "," $1,081.92 ", $982.32 ," $5,602.81 "," $5,284.92 "," $5,006.19 "," $4,844.70 "," $4,844.70 "," $4,306.40 "," $4,306.40 ", $982.32 ," $4,970.12 "," $5,113.85 "," $4,844.70 "," $4,844.70 "," $4,844.70 "," $5,006.19 "," $5,167.68 "," $6,486.20 "," $4,575.55 "," $5,849.95 "," $6,586.66 ", N/A ," $5,712.14 "," $5,712.14 "," $5,113.85 "," $6,713.78 ", $982.32 ," $6,951.82 "
" Fac X-Rays, Bone Survey, Limited ",CPT® 77074,0320 - DX X-RAY,N/A,N/A, $708.00 , $460.20 , $594.72 , $64.13 , $52.24 , $572.06 , $637.20 , $599.39 , $637.20 , $637.20 , $637.20 , $601.80 , $51.22 , $653.70 , $672.60 , $601.80 , $658.44 , $658.44 , $672.60 , $679.68 , $579.29 , $637.20 , $601.80 , $559.32 , N/A , $572.98 , $572.98 , $672.60 , $607.53 , $51.22 , $679.68 
Incision Subcut Toe Tendon,CPT® 28010,N/A,N/A,N/A," $1,404.00 ", $912.60 ," $1,290.71 ", $202.90 , $76.84 ," $1,030.88 "," $1,033.73 "," $1,305.72 "," $1,263.60 "," $1,263.60 "," $1,123.20 "," $1,123.20 ", $76.84 ," $1,296.31 "," $1,333.80 "," $1,263.60 "," $1,263.60 "," $1,263.60 "," $1,305.72 "," $1,347.84 "," $1,196.63 "," $1,193.40 "," $1,116.82 "," $1,225.56 ", N/A ," $1,050.99 "," $1,050.99 "," $1,333.80 "," $1,235.28 ", $76.84 ," $1,347.84 "
Palmar Fasciectomy,CPT® 26121,N/A,N/A,N/A," $2,392.00 "," $1,554.80 "," $3,675.36 ", $577.80 , $768.40 ," $2,871.39 "," $2,868.14 "," $2,224.56 "," $2,152.80 "," $2,152.80 "," $1,913.60 "," $1,913.60 ", $768.40 ," $2,208.53 "," $2,272.40 "," $2,152.80 "," $2,152.80 "," $2,152.80 "," $2,224.56 "," $2,296.32 "," $3,414.48 "," $2,033.20 "," $3,154.23 "," $3,411.54 ", N/A ," $2,927.41 "," $2,927.41 "," $2,272.40 "," $3,440.75 ", $577.80 ," $3,675.36 "
"Assay Carbamazepine, Free",CPT® 80157,N/A,N/A,N/A, $121.00 , $78.65 , N/A , $13.52 , $13.52 , $75.01 , $89.70 , $112.53 , $108.90 , $108.90 , $96.80 , $96.80 , $13.52 , $111.72 , $114.95 , $108.90 , $108.90 , $108.90 , $112.53 , $116.16 , $88.47 , $102.85 , $87.58 , $48.05 , N/A , $70.00 , $70.00 , $114.95 , $76.49 , $13.52 , $116.16 
 Fac Drug Screening Tramadol ,CPT® 80373,0302 - LAB/IMMUNOLOGY,N/A,N/A, $194.00 , $126.10 , $162.96 , N/A , N/A , $156.75 , $174.60 , $164.24 , $174.60 , $174.60 , $174.60 , $164.90 , N/A , $179.12 , $184.30 , $164.90 , $180.42 , $180.42 , $184.30 , $186.24 , $158.73 , $174.60 , $164.90 , $153.26 , N/A , $157.00 , $157.00 , $184.30 , $166.47 , $153.26 , $186.24 
 MRI C-Spine W/O Contrast- Lh ,CPT® 72141,0972 - PRO FEE/RAD/DX,N/A,N/A, $873.00 , $567.45 ," $1,372.00 ", $195.41 , $423.92 ," $1,910.49 "," $2,009.89 ", $811.89 , $785.70 , $785.70 , $698.40 , $698.40 , $423.92 , $806.04 , $829.35 , $785.70 , $785.70 , $785.70 , $811.89 , $838.08 ," $2,401.56 ", $742.05 ," $2,191.84 "," $2,076.39 ", N/A ," $1,947.76 "," $1,947.76 ", $829.35 ," $2,291.47 ", $195.41 ," $2,401.56 "
 Pro Tx Inter/PR/Subtrchntric Fem Fx Screw Implt ,CPT® 27244,0982 - PRO FEE/OUTPT,N/A,N/A," $8,455.00 "," $5,495.75 "," $7,403.89 "," $1,157.71 "," $1,075.02 "," $5,946.99 "," $5,886.73 "," $7,863.15 "," $7,609.50 "," $7,609.50 "," $6,764.00 "," $6,764.00 "," $1,075.02 "," $7,806.50 "," $8,032.25 "," $7,609.50 "," $7,609.50 "," $7,609.50 "," $7,863.15 "," $8,116.80 "," $6,904.76 "," $7,186.75 "," $6,513.62 "," $6,990.58 ", N/A ," $6,063.03 "," $6,063.03 "," $8,032.25 "," $7,126.20 "," $1,075.02 "," $8,116.80 "
Exc Skin Benig 0.6-1cm Remaindr Body,CPT® 11421,N/A,N/A,N/A, $608.00 , $395.20 , $351.80 , $105.96 , $93.30 , $301.07 , $297.24 , $565.44 , $547.20 , $547.20 , $486.40 , $486.40 , $93.30 , $561.37 , $577.60 , $547.20 , $547.20 , $547.20 , $565.44 , $583.68 , $385.15 , $516.80 , $590.53 , $385.78 , N/A , $306.95 , $306.95 , $577.60 , $355.95 , $93.30 , $590.53 
 FOLIC ACID 1 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,69315-0127-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 SALINE 0.9% BOLUS (ANESTHESIA ONLY) ,HCPCS RXA258,0258 - IV SOLUTIONS,00990-7984-20,25 mL, $35.59 , $23.13 , $29.90 , N/A , N/A , $28.76 , $32.03 , $30.13 , $32.03 , $32.03 , $32.03 , $30.25 , N/A , $32.86 , $33.81 , $30.25 , $33.10 , $33.10 , $33.81 , $34.17 , $29.12 , $32.03 , $30.25 , $28.12 , N/A , $28.80 , $28.80 , $33.81 , $30.54 , $28.12 , $34.17 
Exploration of Vagina,CPT® 57000,N/A,N/A,N/A," $1,039.00 ", $675.35 , $958.90 , $194.21 , $536.08 , $752.83 , $773.63 , $966.27 , $935.10 , $935.10 , $831.20 , $831.20 , $536.08 , $959.31 , $987.05 , $935.10 , $935.10 , $935.10 , $966.27 , $997.44 , $989.97 , $883.15 ," $1,013.35 ", $772.85 , N/A , $767.52 , $767.52 , $987.05 , $920.60 , $194.21 ," $1,013.35 "
 Fac Path Consltj Surg Cytologic Xm Ea Sit ,CPT® 88334,0310 - PATHOLOGY LAB,N/A,N/A, $132.00 , $85.80 , $110.88 , $55.88 , $39.32 , $106.66 , $118.80 , $111.75 , $118.80 , $118.80 , $118.80 , $112.20 , $38.55 , $121.88 , $125.40 , $112.20 , $122.76 , $122.76 , $125.40 , $126.72 , $108.00 , $118.80 , $112.20 , $104.28 , N/A , $106.83 , $106.83 , $125.40 , $113.27 , $38.55 , $126.72 
Reconstruc Prostatic Urethra,CPT® 53415,N/A,N/A,N/A," $7,876.00 "," $5,119.40 "," $6,107.65 "," $1,072.64 ", $969.84 ," $5,530.88 "," $5,141.63 "," $7,324.68 "," $7,088.40 "," $7,088.40 "," $6,300.80 "," $6,300.80 ", $969.84 ," $7,271.91 "," $7,482.20 "," $7,088.40 "," $7,088.40 "," $7,088.40 "," $7,324.68 "," $7,560.96 "," $6,136.54 "," $6,694.60 "," $5,823.19 "," $6,955.75 ", N/A ," $5,638.80 "," $5,638.80 "," $7,482.20 "," $6,627.59 ", $969.84 ," $7,560.96 "
 Fac Spectrophotometry ,CPT® 84311,0301 - LAB/CHEMISTRY,N/A,N/A, $199.00 , $129.35 , $167.16 , $8.26 , $8.26 , $160.79 , $179.10 , $168.47 , $179.10 , $179.10 , $179.10 , $169.15 , $8.10 , $183.74 , $189.05 , $169.15 , $185.07 , $185.07 , $189.05 , $191.04 , $162.82 , $179.10 , $169.15 , $157.21 , N/A , $161.05 , $161.05 , $189.05 , $170.76 , $8.10 , $191.04 
 Pro Litholapaxy Smpl/Sm < 2.5 Cm ,CPT® 52317,0982 - PRO FEE/OUTPT,N/A,N/A," $2,556.00 "," $1,661.40 "," $1,859.72 ", $326.21 , $366.68 ," $1,705.97 "," $1,577.82 "," $2,377.08 "," $2,300.40 "," $2,300.40 "," $2,044.80 "," $2,044.80 ", $366.68 ," $2,359.95 "," $2,428.20 "," $2,300.40 "," $2,300.40 "," $2,300.40 "," $2,377.08 "," $2,453.76 "," $1,871.38 "," $2,172.60 "," $1,785.85 "," $2,138.57 ", N/A ," $1,739.25 "," $1,739.25 "," $2,428.20 "," $2,044.24 ", $326.21 ," $2,453.76 "
" Fac Tissue Culture, Lymphocyte ",CPT® 88230,0310 - PATHOLOGY LAB,N/A,N/A," $1,046.00 ", $679.90 , $878.64 , $118.82 , $69.14 , $845.17 , $941.40 , $885.54 , $941.40 , $941.40 , $941.40 , $889.10 , $67.78 , $965.77 , $993.70 , $889.10 , $972.78 , $972.78 , $993.70 ," $1,004.16 ", $855.84 , $941.40 , $889.10 , $826.34 , N/A , $846.53 , $846.53 , $993.70 , $897.57 , $67.78 ," $1,004.16 "
"Biopsy/Excision, Lymph Node(S)",38500,N/A,N/A,N/A," $3,098.00 "," $2,013.70 "," $1,178.95 ", $238.19 , $322.82 , $882.52 , $911.96 ," $2,881.14 "," $2,788.20 "," $2,788.20 "," $2,478.40 "," $2,478.40 ", $322.82 ," $2,860.38 "," $2,943.10 "," $2,788.20 "," $2,788.20 "," $2,788.20 "," $2,881.14 "," $2,974.08 "," $1,259.29 "," $2,633.30 "," $1,348.75 "," $1,222.60 ", N/A , $899.74 , $899.74 ," $2,943.10 "," $1,043.82 ", $238.19 ," $2,974.08 "
 SODIUM CHLORIDE 0.9% 10 ML FLUSH ,HCPCS RXA250,0250 - PHARMACY,64253-0111-30,10 mL, $18.75 , $12.19 , $15.75 , N/A , N/A , $15.15 , $16.88 , $15.87 , $16.88 , $16.88 , $16.88 , $15.94 , N/A , $17.31 , $17.81 , $15.94 , $17.44 , $17.44 , $17.81 , $18.00 , $15.34 , $16.88 , $15.94 , $14.81 , N/A , $15.17 , $15.17 , $17.81 , $16.09 , $14.81 , $18.00 
"Anter Vesicourethropexy,Simple",CPT® 51840,N/A,N/A,N/A," $4,577.00 "," $2,975.05 "," $3,796.61 ", $665.72 , $804.14 ," $3,203.68 "," $3,026.87 "," $4,256.61 "," $4,119.30 "," $4,119.30 "," $3,661.60 "," $3,661.60 ", $804.14 ," $4,225.94 "," $4,348.15 "," $4,119.30 "," $4,119.30 "," $4,119.30 "," $4,256.61 "," $4,393.92 "," $3,762.37 "," $3,890.45 "," $3,466.44 "," $4,012.69 ", N/A ," $3,266.19 "," $3,266.19 "," $4,348.15 "," $3,838.93 ", $665.72 ," $4,393.92 "
 BUPIVACAINE-EPINEPHRINE 0.25% -1:200000 IJ SOLN ,HCPCS RXA250,0250 - PHARMACY,00409-9043-01,50 mL, $36.73 , $23.87 , $30.85 , N/A , N/A , $29.68 , $33.06 , $31.10 , $33.06 , $33.06 , $33.06 , $31.22 , N/A , $33.91 , $34.89 , $31.22 , $34.16 , $34.16 , $34.89 , $35.26 , $30.05 , $33.06 , $31.22 , $29.02 , N/A , $29.73 , $29.73 , $34.89 , $31.52 , $29.02 , $35.26 
"Resec One Toe Phalangeal Base,Ea",CPT® 28126,N/A,N/A,N/A," $2,685.00 "," $1,745.25 "," $1,534.20 ", $241.47 , $274.91 ," $1,225.71 "," $1,224.70 "," $2,497.05 "," $2,416.50 "," $2,416.50 "," $2,148.00 "," $2,148.00 ", $274.91 ," $2,479.06 "," $2,550.75 "," $2,416.50 "," $2,416.50 "," $2,416.50 "," $2,497.05 "," $2,577.60 "," $1,420.31 "," $2,282.25 "," $1,323.78 "," $1,461.45 ", N/A ," $1,249.62 "," $1,249.62 "," $2,550.75 "," $1,468.75 ", $241.47 ," $2,577.60 "
Hot or Cold Packs Therapy,CPT® 97010,N/A,N/A,N/A, $31.00 , $20.15 , N/A , $6.12 , N/A , $13.36 , $12.13 , $28.83 , $27.90 , $27.90 , $24.80 , $24.80 , N/A , $28.62 , $29.45 , $27.90 , $27.90 , $27.90 , $28.83 , $29.76 , $15.01 , $26.35 , N/A , $15.09 , N/A , $13.62 , $13.62 , $29.45 , $15.13 , $6.12 , $29.76 
Pulmonary Ventilation & Perfusion Imaging,CPT® 78582,N/A,N/A,N/A," $3,175.00 "," $2,063.75 "," $1,779.96 ", $304.15 , $251.40 ," $1,647.98 "," $2,020.55 "," $2,952.75 "," $2,857.50 "," $2,857.50 "," $2,540.00 "," $2,540.00 ", $251.40 ," $2,931.48 "," $3,016.25 "," $2,857.50 "," $2,857.50 "," $2,857.50 "," $2,952.75 "," $3,048.00 "," $1,844.78 "," $2,698.75 "," $2,218.80 "," $2,248.96 ", N/A ," $1,680.14 "," $1,680.14 "," $3,016.25 "," $1,944.78 ", $251.40 ," $3,048.00 "
 Fac Intracardiac Ecg (Ice) ,CPT® 93662,0480 - CARDIOLOGY,N/A,N/A," $4,328.00 "," $2,813.20 "," $3,635.52 ", $306.62 , N/A ," $3,497.02 "," $3,895.20 "," $3,664.08 "," $3,895.20 "," $3,895.20 "," $3,895.20 "," $3,678.80 ", N/A ," $3,996.04 "," $4,111.60 "," $3,678.80 "," $4,025.04 "," $4,025.04 "," $4,111.60 "," $4,154.88 "," $3,541.17 "," $3,895.20 "," $3,678.80 "," $3,419.12 ", N/A ," $3,502.65 "," $3,502.65 "," $4,111.60 "," $3,713.86 ", $306.62 ," $4,154.88 "
"Thoracotomy,Major",CPT® 32110,N/A,N/A,N/A," $9,158.00 "," $5,952.70 "," $7,664.00 "," $1,339.76 "," $1,152.58 "," $5,525.35 "," $5,416.36 "," $8,516.94 "," $8,242.20 "," $8,242.20 "," $7,326.40 "," $7,326.40 "," $1,152.58 "," $8,455.58 "," $8,700.10 "," $8,242.20 "," $8,242.20 "," $8,242.20 "," $8,516.94 "," $8,791.68 "," $7,394.62 "," $7,784.30 "," $7,815.98 "," $7,274.74 ", N/A ," $5,633.16 "," $5,633.16 "," $8,700.10 "," $6,634.24 "," $1,152.58 "," $8,791.68 "
 POTASSIUM CHLORIDE 20 MEQ/100ML IV SOLN ,HCPCS J3480,0636 - DRUGS REQUIRING DETAILED CODIN,00990-7075-26,100 mL, $30.83 , $20.04 , $25.90 , $0.10 , $0.14 , $24.91 , $27.75 , $26.10 , $27.75 , $27.75 , $27.75 , $26.21 , $0.14 , $28.47 , $29.29 , $26.21 , $28.67 , $28.67 , $29.29 , $29.60 , $25.23 , $27.75 , $26.21 , $24.36 , N/A , $24.95 , $24.95 , $29.29 , $26.46 , $0.10 , $29.60 
"Suspension of Vagina,Abd Apprch",CPT® 57280,N/A,N/A,N/A," $5,844.00 "," $3,798.60 "," $4,564.50 ", $921.60 , $691.53 ," $3,889.05 "," $3,860.51 "," $5,434.92 "," $5,259.60 "," $5,259.60 "," $4,675.20 "," $4,675.20 ", $691.53 ," $5,395.77 "," $5,551.80 "," $5,259.60 "," $5,259.60 "," $5,259.60 "," $5,434.92 "," $5,610.24 "," $4,769.00 "," $4,967.40 "," $5,057.82 "," $3,910.91 ", N/A ," $3,964.94 "," $3,964.94 "," $5,551.80 "," $4,755.69 ", $691.53 ," $5,610.24 "
" Radiation Therapy,Dosimetry Plan ",CPT® 77300,0333 - RADIATION RX,N/A,N/A, $440.00 , $286.00 , $369.60 , $64.66 , $68.96 , $355.52 , $396.00 , $372.50 , $396.00 , $396.00 , $396.00 , $374.00 , $67.61 , $406.25 , $418.00 , $374.00 , $409.20 , $409.20 , $418.00 , $422.40 , $360.01 , $396.00 , $374.00 , $347.60 , N/A , $356.09 , $356.09 , $418.00 , $377.56 , $64.66 , $422.40 
 AMOXICILLIN 250 MG/5ML PO SUSR ,HCPCS RXC637,0250 - PHARMACY,00781-6041-58,80 mL, $27.13 , $17.63 , $22.79 , N/A , N/A , $21.92 , $24.42 , $22.97 , $24.42 , $24.42 , $24.42 , $23.06 , N/A , $25.05 , $25.77 , $23.06 , $25.23 , $25.23 , $25.77 , $26.04 , $22.20 , $24.42 , $23.06 , $21.43 , N/A , $21.96 , $21.96 , $25.77 , $23.28 , $21.43 , $26.04 
Office/Outpatient New Sf Mdm 15-29 Minutes,CPT® 99202,N/A,N/A,N/A, $191.00 , $124.15 , $97.59 , $46.48 , $50.34 , $86.35 , $86.61 , $177.63 , $171.90 , $171.90 , $152.80 , $152.80 , $50.34 , $176.35 , $181.45 , $171.90 , $171.90 , $171.90 , $177.63 , $183.36 , $89.09 , $162.35 , $108.02 , $109.92 , $42.00 , $88.04 , $88.04 , $181.45 , $101.55 , $42.00 , $183.36 
 Pet Imaging W/CT-Whole Body ,CPT® 78816,0404 - PET POSITIVE EMISSION TOMOGRAP,N/A,N/A," $8,342.00 "," $5,422.30 "," $7,007.28 "," $1,556.06 "," $1,056.59 "," $6,740.34 "," $7,507.80 "," $7,062.34 "," $7,507.80 "," $7,507.80 "," $7,507.80 "," $7,090.70 "," $1,035.87 "," $7,702.17 "," $7,924.90 "," $7,090.70 "," $7,758.06 "," $7,758.06 "," $7,924.90 "," $8,008.32 "," $6,825.42 "," $7,507.80 "," $7,090.70 "," $6,590.18 ", N/A ," $6,751.18 "," $6,751.18 "," $7,924.90 "," $7,158.27 "," $1,035.87 "," $8,008.32 "
Exc Tumor Soft Tissue Abdominal Wall Subq <3cm,22902,N/A,N/A,N/A," $2,901.00 "," $1,885.65 "," $2,014.87 ", $314.57 , $346.95 ," $1,587.40 "," $1,578.19 "," $2,697.93 "," $2,610.90 "," $2,610.90 "," $2,320.80 "," $2,320.80 ", $346.95 ," $2,678.49 "," $2,755.95 "," $2,610.90 "," $2,610.90 "," $2,610.90 "," $2,697.93 "," $2,784.96 "," $1,864.37 "," $2,465.85 "," $1,728.76 "," $1,864.11 ", N/A ," $1,618.38 "," $1,618.38 "," $2,755.95 "," $1,902.17 ", $314.57 ," $2,784.96 "
"Nasal Scopy,Remv Tiss Sphenoid",CPT® 31288,N/A,N/A,N/A," $1,829.00 "," $1,188.85 "," $1,261.67 ", $222.99 , $250.26 ," $1,029.14 "," $1,008.81 "," $1,700.97 "," $1,646.10 "," $1,646.10 "," $1,463.20 "," $1,463.20 ", $250.26 ," $1,688.72 "," $1,737.55 "," $1,646.10 "," $1,646.10 "," $1,646.10 "," $1,700.97 "," $1,755.84 "," $1,208.54 "," $1,554.65 "," $1,423.68 "," $1,193.53 ", N/A ," $1,049.22 "," $1,049.22 "," $1,737.55 "," $1,235.68 ", $222.99 ," $1,755.84 "
Treat Ankle Fracture,27816,N/A,N/A,N/A," $1,470.00 ", $955.50 ," $1,828.13 ", $288.74 , $384.19 ," $1,389.63 "," $1,401.19 "," $1,367.10 "," $1,323.00 "," $1,323.00 "," $1,176.00 "," $1,176.00 ", $384.19 ," $1,357.25 "," $1,396.50 "," $1,323.00 "," $1,323.00 "," $1,323.00 "," $1,367.10 "," $1,411.20 "," $1,683.83 "," $1,249.50 "," $1,534.30 "," $1,655.10 ", N/A ," $1,416.74 "," $1,416.74 "," $1,396.50 "," $1,665.18 ", $288.74 ," $1,828.13 "
 Pro Cltx Fx Grt Toe Phlx/Phlg W/O Mnpj ,CPT® 28490,0982 - PRO FEE/OUTPT,N/A,N/A, $959.00 , $623.35 , $772.46 , $123.06 , $85.41 , $611.90 , $626.73 , $891.87 , $863.10 , $863.10 , $767.20 , $767.20 , $85.41 , $885.44 , $911.05 , $863.10 , $863.10 , $863.10 , $891.87 , $920.64 , $710.88 , $815.15 , $681.51 , $728.10 , N/A , $623.83 , $623.83 , $911.05 , $733.23 , $85.41 , $920.64 
Adj Shoulder Ext/Flex Device,HCPCS E1840,N/A,N/A,N/A, $578.00 , $375.70 , N/A , $518.42 , N/A , N/A , N/A , $537.54 , $520.20 , $520.20 , $462.40 , $462.40 , N/A , $533.67 , $549.10 , $520.20 , $520.20 , $520.20 , $537.54 , $554.88 , N/A , $491.30 , N/A , $471.00 , N/A , N/A , N/A , $549.10 , N/A , $462.40 , $554.88 
Rpr 1 Transvns Eltrd Prm Pm/Pacing Implntbl Dfb,CPT® 33218,N/A,N/A,N/A," $4,248.00 "," $2,761.20 "," $2,327.91 ", $361.85 , $401.40 ," $1,713.99 "," $1,653.34 "," $3,950.64 "," $3,823.20 "," $3,823.20 "," $3,398.40 "," $3,398.40 ", $401.40 ," $3,922.18 "," $4,035.60 "," $3,823.20 "," $3,823.20 "," $3,823.20 "," $3,950.64 "," $4,078.08 "," $2,145.91 "," $3,610.80 "," $2,073.08 "," $1,882.68 ", N/A ," $1,747.43 "," $1,747.43 "," $4,035.60 "," $1,985.08 ", $361.85 ," $4,078.08 "
 OXYTOCIN 10 UNIT/ML IJ SOLN ,HCPCS RXA250,0250 - PHARMACY,63323-0012-11,1 mL, $21.27 , $13.83 , $17.87 , N/A , N/A , $17.19 , $19.14 , $18.01 , $19.14 , $19.14 , $19.14 , $18.08 , N/A , $19.64 , $20.21 , $18.08 , $19.78 , $19.78 , $20.21 , $20.42 , $17.40 , $19.14 , $18.08 , $16.80 , N/A , $17.21 , $17.21 , $20.21 , $18.25 , $16.80 , $20.42 
 Fac Blood Clot Factor VII Test ,CPT® 85230,0305 - LAB/HEMATOLOGY,N/A,N/A, $245.00 , $159.25 , $205.80 , $18.26 , $18.26 , $197.96 , $220.50 , $207.42 , $220.50 , $220.50 , $220.50 , $208.25 , $17.90 , $226.21 , $232.75 , $208.25 , $227.85 , $227.85 , $232.75 , $235.20 , $200.46 , $220.50 , $208.25 , $193.55 , N/A , $198.28 , $198.28 , $232.75 , $210.23 , $17.90 , $235.20 
" Fac Tcd, Vasoreactivity Study ",CPT® 93890,0921 - PERI VASCUL LAB,N/A,N/A, $780.00 , $507.00 , $655.20 , $273.17 , $206.71 , $630.24 , $702.00 , $660.35 , $702.00 , $702.00 , $702.00 , $663.00 , $202.66 , $720.17 , $741.00 , $663.00 , $725.40 , $725.40 , $741.00 , $748.80 , $638.20 , $702.00 , $663.00 , $616.20 , N/A , $631.25 , $631.25 , $741.00 , $669.32 , $202.66 , $748.80 
Activated Prot C (Apc) Resistnce Assay,CPT® 85307,N/A,N/A,N/A, $236.00 , $153.40 , N/A , $15.63 , $15.63 , $80.82 , $96.69 , $219.48 , $212.40 , $212.40 , $188.80 , $188.80 , $15.63 , $217.90 , $224.20 , $212.40 , $212.40 , $212.40 , $219.48 , $226.56 , $102.30 , $200.60 , $100.55 , $55.57 , N/A , $75.43 , $75.43 , $224.20 , $82.43 , $15.63 , $226.56 
 Pro Cholangrph&/Pcg Addl Set Intraop Rs&I ,CPT® 74301,0972 - PRO FEE/RAD/DX,N/A,N/A, $62.00 , $40.30 , $304.62 , $53.39 , $45.50 , $148.16 , $156.48 , $57.66 , $55.80 , $55.80 , $49.60 , $49.60 , $45.50 , $57.24 , $58.90 , $55.80 , $55.80 , $55.80 , $57.66 , $59.52 , $301.65 , $52.70 , $171.42 , $265.90 , N/A , $151.05 , $151.05 , $58.90 , $174.83 , $45.50 , $304.62 
"Remove Bladder Stone,<2.5cm",52317,N/A,N/A,N/A," $2,556.00 "," $1,661.40 "," $1,859.72 ", $326.21 , $366.68 ," $1,705.97 "," $1,577.82 "," $2,377.08 "," $2,300.40 "," $2,300.40 "," $2,044.80 "," $2,044.80 ", $366.68 ," $2,359.95 "," $2,428.20 "," $2,300.40 "," $2,300.40 "," $2,300.40 "," $2,377.08 "," $2,453.76 "," $1,871.38 "," $2,172.60 "," $1,785.85 "," $2,138.57 ", N/A ," $1,739.25 "," $1,739.25 "," $2,428.20 "," $2,044.24 ", $326.21 ," $2,453.76 "
 CARBIDOPA-LEVODOPA 25-250 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6238-61,1 tablet, $4.41 , $2.87 , $3.70 , N/A , N/A , $3.56 , $3.97 , $3.73 , $3.97 , $3.97 , $3.97 , $3.75 , N/A , $4.07 , $4.19 , $3.75 , $4.10 , $4.10 , $4.19 , $4.23 , $3.61 , $3.97 , $3.75 , $3.48 , N/A , $3.57 , $3.57 , $4.19 , $3.78 , $3.48 , $4.23 
 SALINE SPRAY 0.65 % NA SOLN ,HCPCS RXC637,0250 - PHARMACY,00904-3865-75,44 mL, $5.88 , $3.82 , $4.94 , N/A , N/A , $4.75 , $5.29 , $4.98 , $5.29 , $5.29 , $5.29 , $5.00 , N/A , $5.43 , $5.59 , $5.00 , $5.47 , $5.47 , $5.59 , $5.64 , $4.81 , $5.29 , $5.00 , $4.65 , N/A , $4.76 , $4.76 , $5.59 , $5.05 , $4.65 , $5.64 
 US Extremity Non Vascular Complete ,CPT® 76881,0402 - ULTRASOUND,N/A,N/A, $625.00 , $406.25 , $525.00 , $53.33 , $85.20 , $505.00 , $562.50 , $529.13 , $562.50 , $562.50 , $562.50 , $531.25 , $83.53 , $577.06 , $593.75 , $531.25 , $581.25 , $581.25 , $593.75 , $600.00 , $511.38 , $562.50 , $531.25 , $493.75 , N/A , $505.81 , $505.81 , $593.75 , $536.31 , $53.33 , $600.00 
"Excis Mouth Mucosa/Sub,Simpl Repair",CPT® 40812,N/A,N/A,N/A," $1,478.00 ", $960.70 ," $1,153.62 ", $178.98 , $90.72 , $960.66 , $982.24 ," $1,374.54 "," $1,330.20 "," $1,330.20 "," $1,182.40 "," $1,182.40 ", $90.72 ," $1,364.64 "," $1,404.10 "," $1,330.20 "," $1,330.20 "," $1,330.20 "," $1,374.54 "," $1,418.88 ", $832.14 ," $1,256.30 "," $1,070.44 "," $1,130.91 ", N/A , $979.41 , $979.41 ," $1,404.10 "," $1,024.36 ", $90.72 ," $1,418.88 "
 MAGNESIUM SULFATE 2 GM/50ML IV SOLN ,HCPCS J3475,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0106-05,50 mL, $98.89 , $64.28 , $83.07 , $0.95 , $0.81 , $79.90 , $89.00 , $83.72 , $89.00 , $89.00 , $89.00 , $84.06 , $0.79 , $91.31 , $93.95 , $84.06 , $91.97 , $91.97 , $93.95 , $94.93 , $80.91 , $89.00 , $84.06 , $78.12 , N/A , $80.03 , $80.03 , $93.95 , $84.86 , $0.79 , $94.93 
Lipoprotein Blood Quan Numbers & Subclasses,CPT® 83704,N/A,N/A,N/A, $283.00 , $183.95 , N/A , $34.87 , $34.87 , $178.48 , $213.47 , $263.19 , $254.70 , $254.70 , $226.40 , $226.40 , $34.87 , $261.29 , $268.85 , $254.70 , $254.70 , $254.70 , $263.19 , $271.68 , $228.29 , $240.55 , $205.97 , $114.40 , N/A , $166.57 , $166.57 , $268.85 , $182.02 , $34.87 , $271.68 
Treat Femoral Shft Fractr,CPT® 27500,N/A,N/A,N/A," $3,400.00 "," $2,210.00 "," $2,938.33 ", $463.26 , $614.70 ," $2,318.06 "," $2,302.07 "," $3,162.00 "," $3,060.00 "," $3,060.00 "," $2,720.00 "," $2,720.00 ", $614.70 ," $3,139.22 "," $3,230.00 "," $3,060.00 "," $3,060.00 "," $3,060.00 "," $3,162.00 "," $3,264.00 "," $2,729.51 "," $2,890.00 "," $2,538.72 "," $2,731.05 ", N/A ," $2,363.29 "," $2,363.29 "," $3,230.00 "," $2,777.72 ", $463.26 ," $3,264.00 "
"Insert,Temp Indwelling Blad Cath,Simple",CPT® 51702,N/A,N/A,N/A, $664.00 , $431.60 , $137.37 , $23.85 , $112.85 , $147.13 , $137.78 , $617.52 , $597.60 , $597.60 , $531.20 , $531.20 , $112.85 , $613.07 , $630.80 , $597.60 , $597.60 , $597.60 , $617.52 , $637.44 , $136.89 , $564.40 , $157.00 , $158.32 , N/A , $150.00 , $150.00 , $630.80 , $176.30 , $23.85 , $637.44 
Assay Blood Carbon Dioxide,CPT® 82374,N/A,N/A,N/A, $68.00 , $44.20 , N/A , $4.98 , $4.98 , $27.64 , $33.09 , $63.24 , $61.20 , $61.20 , $54.40 , $54.40 , $4.98 , $62.78 , $64.60 , $61.20 , $61.20 , $61.20 , $63.24 , $65.28 , $32.58 , $57.80 , $32.44 , $17.71 , N/A , $25.80 , $25.80 , $64.60 , $28.20 , $4.98 , $65.28 
"Lap,Diagnostic Abdomen",CPT® 49320,N/A,N/A,N/A," $3,463.00 "," $2,250.95 "," $1,970.02 ", $306.05 , $425.15 ," $1,539.20 "," $1,567.04 "," $3,220.59 "," $3,116.70 "," $3,116.70 "," $2,770.40 "," $2,770.40 ", $425.15 ," $3,197.39 "," $3,289.85 "," $3,116.70 "," $3,116.70 "," $3,116.70 "," $3,220.59 "," $3,324.48 "," $1,411.89 "," $2,943.55 "," $1,735.89 "," $1,827.52 ", N/A ," $1,569.24 "," $1,569.24 "," $3,289.85 "," $1,641.26 ", $306.05 ," $3,324.48 "
 Pro Rmvl FB Foot Dp ,CPT® 28192,0981 - PRO FEE/ER,N/A,N/A," $2,287.00 "," $1,486.55 "," $1,930.89 ", $301.68 , $190.55 ," $1,545.60 "," $1,551.74 "," $2,126.91 "," $2,058.30 "," $2,058.30 "," $1,829.60 "," $1,829.60 ", $190.55 ," $2,111.59 "," $2,172.65 "," $2,058.30 "," $2,058.30 "," $2,058.30 "," $2,126.91 "," $2,195.52 "," $1,797.60 "," $1,943.95 "," $1,680.59 "," $1,833.96 ", N/A ," $1,575.76 "," $1,575.76 "," $2,172.65 "," $1,852.06 ", $190.55 ," $2,195.52 "
Rad Resec Thigh/Knee Soft Tiss Tumr,CPT® 27329,N/A,N/A,N/A," $6,819.00 "," $4,432.35 "," $6,240.98 ", $974.63 , $781.00 ," $4,974.88 "," $4,934.29 "," $6,341.67 "," $6,137.10 "," $6,137.10 "," $5,455.20 "," $5,455.20 ", $781.00 ," $6,295.98 "," $6,478.05 "," $6,137.10 "," $6,137.10 "," $6,137.10 "," $6,341.67 "," $6,546.24 "," $5,794.00 "," $5,796.15 "," $5,468.16 "," $5,847.89 ", N/A ," $5,071.94 "," $5,071.94 "," $6,478.05 "," $5,961.33 ", $781.00 ," $6,546.24 "
 Pro Repair of Ruptured Tendon ,CPT® 24342,0982 - PRO FEE/OUTPT,N/A,N/A," $2,943.00 "," $1,912.95 "," $4,720.56 ", $739.12 , $922.06 ," $3,742.14 "," $3,726.16 "," $2,736.99 "," $2,648.70 "," $2,648.70 "," $2,354.40 "," $2,354.40 ", $922.06 ," $2,717.27 "," $2,795.85 "," $2,648.70 "," $2,648.70 "," $2,648.70 "," $2,736.99 "," $2,825.28 "," $4,392.97 "," $2,501.55 "," $4,114.05 "," $4,412.90 ", N/A ," $3,815.16 "," $3,815.16 "," $2,795.85 "," $4,484.16 ", $739.12 ," $4,720.56 "
 Fac Lig Div&Strip Long Saph Saphfem Junct Kne/Belw ,CPT® 37722,0360 - OR SERVICES,N/A,N/A," $2,882.00 "," $1,873.30 "," $2,420.88 ", $419.89 , $420.22 ," $2,328.66 "," $2,593.80 "," $2,439.90 "," $2,593.80 "," $2,593.80 "," $2,593.80 "," $2,449.70 ", $411.98 ," $2,660.95 "," $2,737.90 "," $2,449.70 "," $2,680.26 "," $2,680.26 "," $2,737.90 "," $2,766.72 "," $2,358.05 "," $2,593.80 "," $2,449.70 "," $2,276.78 ", N/A ," $2,332.40 "," $2,332.40 "," $2,737.90 "," $2,473.04 ", $411.98 ," $2,766.72 "
 DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN ,HCPCS RXC637,0250 - PHARMACY,24208-0486-10,10 mL, $346.69 , $225.35 , $291.22 , N/A , N/A , $280.13 , $312.02 , $293.51 , $312.02 , $312.02 , $312.02 , $294.69 , N/A , $320.10 , $329.36 , $294.69 , $322.42 , $322.42 , $329.36 , $332.82 , $283.66 , $312.02 , $294.69 , $273.89 , N/A , $280.58 , $280.58 , $329.36 , $297.49 , $273.89 , $332.82 
Iadna Sarscov2& Inf a&B Mult Amplified Probe Tq,CPT® 87636,N/A,N/A,N/A, $553.00 , $359.45 , N/A , $145.48 , $145.48 , N/A , N/A , $514.29 , $497.70 , $497.70 , $442.40 , $442.40 , $145.48 , $510.58 , $525.35 , $497.70 , $497.70 , $497.70 , $514.29 , $530.88 , N/A , $470.05 , $680.07 , $445.22 , N/A , $553.40 , $553.40 , $525.35 , $604.75 , $145.48 , $680.07 
"Hepatitis B Vaccine,Adult,Im",CPT® 90746,N/A,N/A,N/A, $206.00 , $133.90 , N/A , $71.79 , $79.58 , $130.18 , $182.31 , $191.58 , $185.40 , $185.40 , $164.80 , $164.80 , $79.58 , $190.20 , $195.70 , $185.40 , $185.40 , $185.40 , $191.58 , $197.76 , $90.55 , $175.10 , $177.40 , $105.99 , N/A , $132.71 , $132.71 , $195.70 , $154.73 , $71.79 , $197.76 
Emergency Department Visit May Not Req Phys/Qhp,CPT® 99281,N/A,N/A,N/A, $160.00 , $104.00 , $76.63 , $11.05 , $22.89 , $59.28 , $61.20 , $148.80 , $144.00 , $144.00 , $128.00 , $128.00 , $22.89 , $147.73 , $152.00 , $144.00 , $144.00 , $144.00 , $148.80 , $153.60 , $65.12 , $136.00 , $45.01 , $46.01 , $12.50 , $60.43 , $60.43 , $152.00 , $72.52 , $11.05 , $153.60 
 Nicu Recovery per Minute ,Custom 150008,0710 - RECOVERY ROOM,N/A,N/A, $18.00 , $11.70 , $15.12 , N/A , N/A , $14.54 , $16.20 , $15.24 , $16.20 , $16.20 , $16.20 , $15.30 , N/A , $16.62 , $17.10 , $15.30 , $16.74 , $16.74 , $17.10 , $17.28 , $14.73 , $16.20 , $15.30 , $14.22 , N/A , $14.57 , $14.57 , $17.10 , $15.45 , $14.22 , $17.28 
 THIAMINE 100 MG TABS (INPT) ,HCPCS RXC637,0250 - PHARMACY,50268-0851-15,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Dialysis Injection Administration Supply Charge ,CPT® A4657,0270 - MED-SUR SUPPLIES,N/A,N/A, $18.00 , $11.70 , $15.12 , N/A , N/A , $14.54 , $16.20 , $15.24 , $16.20 , $16.20 , $16.20 , $15.30 , N/A , $16.62 , $17.10 , $15.30 , $16.74 , $16.74 , $17.10 , $17.28 , $14.73 , $16.20 , $15.30 , $14.22 , N/A , $14.57 , $14.57 , $17.10 , $15.45 , $14.22 , $17.28 
 Pro Drainage of Pelvis Lesion ,CPT® 26990,0975 - PRO FEE/OR,N/A,N/A," $2,564.00 "," $1,666.60 "," $4,190.68 ", $652.59 , $200.70 ," $3,011.59 "," $3,015.22 "," $2,384.52 "," $2,307.60 "," $2,307.60 "," $2,051.20 "," $2,051.20 ", $200.70 ," $2,367.34 "," $2,435.80 "," $2,307.60 "," $2,307.60 "," $2,307.60 "," $2,384.52 "," $2,461.44 "," $3,832.32 "," $2,179.40 "," $3,325.50 "," $3,561.87 ", N/A ," $3,070.35 "," $3,070.35 "," $2,435.80 "," $3,608.76 ", $200.70 ," $4,190.68 "
 Fac Chg Iadna Dna/Rna Rsv Amplified Probe Technique ,CPT® 87634,0306 - LAB/BACT-MICRO,N/A,N/A, $138.00 , $89.70 , $115.92 , $71.60 , $70.72 , $111.50 , $124.20 , $116.83 , $124.20 , $124.20 , $124.20 , $117.30 , $69.33 , $127.42 , $131.10 , $117.30 , $128.34 , $128.34 , $131.10 , $132.48 , $112.91 , $124.20 , $117.30 , $109.02 , N/A , $111.68 , $111.68 , $131.10 , $118.42 , $69.33 , $132.48 
 Forearm Ap Lateral - Mh ,CPT® 73090,0972 - PRO FEE/RAD/DX,N/A,N/A, $136.00 , $88.40 , $163.79 , $28.73 , $26.20 , $121.74 , $148.62 , $126.48 , $122.40 , $122.40 , $108.80 , $108.80 , $26.20 , $125.57 , $129.20 , $122.40 , $122.40 , $122.40 , $126.48 , $130.56 , $159.36 , $115.60 , $163.71 , $129.73 , N/A , $124.12 , $124.12 , $129.20 , $143.67 , $26.20 , $163.79 
" Layer Closure Neck, Genitalia, Hands,Feet 7.6-12.5cm ",CPT® 12044,0981 - PRO FEE/ER,N/A,N/A," $1,440.00 ", $936.00 , $680.71 , $204.36 , $138.28 , $588.98 , $571.43 ," $1,339.20 "," $1,296.00 "," $1,296.00 "," $1,152.00 "," $1,152.00 ", $138.28 ," $1,329.55 "," $1,368.00 "," $1,296.00 "," $1,296.00 "," $1,296.00 "," $1,339.20 "," $1,382.40 ", $745.42 ," $1,224.00 "," $1,141.80 ", $753.29 , N/A , $600.46 , $600.46 ," $1,368.00 ", $696.35 , $138.28 ," $1,382.40 "
 Pro M/Phmtrc Alys Ish Ea Prb Mnl ,CPT® 88368,0971 - PRO FEE/LAB,N/A,N/A, $302.00 , $196.30 , $485.33 , $140.09 , $184.62 , $432.35 ," $1,060.24 ", $280.86 , $271.80 , $271.80 , $241.60 , $241.60 , $184.62 , $278.84 , $286.90 , $271.80 , $271.80 , $271.80 , $280.86 , $289.92 , $869.91 , $256.70 ," $1,106.10 ", $420.80 , N/A , $403.50 , $403.50 , $286.90 , $443.43 , $140.09 ," $1,106.10 "
 VALACYCLOVIR HCL 1 G PO TABS ,HCPCS RXA250,0250 - PHARMACY,68084-0309-21,1 tablet, $31.83 , $20.69 , $26.74 , N/A , N/A , $25.72 , $28.65 , $26.95 , $28.65 , $28.65 , $28.65 , $27.06 , N/A , $29.39 , $30.24 , $27.06 , $29.60 , $29.60 , $30.24 , $30.56 , $26.04 , $28.65 , $27.06 , $25.15 , N/A , $25.76 , $25.76 , $30.24 , $27.31 , $25.15 , $30.56 
 Retrograde Pyelogram With/Out Kub ,CPT® 74420,0320 - DX X-RAY,N/A,N/A," $2,398.00 "," $1,558.70 "," $2,014.32 ", $76.09 , $120.86 ," $1,937.58 "," $2,158.20 "," $2,030.15 "," $2,158.20 "," $2,158.20 "," $2,158.20 "," $2,038.30 ", $118.49 ," $2,214.07 "," $2,278.10 "," $2,038.30 "," $2,230.14 "," $2,230.14 "," $2,278.10 "," $2,302.08 "," $1,962.04 "," $2,158.20 "," $2,038.30 "," $1,894.42 ", N/A ," $1,940.70 "," $1,940.70 "," $2,278.10 "," $2,057.72 ", $76.09 ," $2,302.08 "
 Fac Physical Therapy Evaluation Mod Complex ,CPT® 97162,0424 - PHYS THERP/EVAL,N/A,N/A, $329.00 , $213.85 , $276.36 , $100.30 , $67.74 , $265.83 , $296.10 , $278.53 , $296.10 , $296.10 , $296.10 , $279.65 , $66.41 , $303.77 , $312.55 , $279.65 , $305.97 , $305.97 , $312.55 , $315.84 , $269.19 , $296.10 , $279.65 , $259.91 , N/A , $266.26 , $266.26 , $312.55 , $282.31 , $66.41 , $315.84 
 Fac Assay of Urea Nitrogen ,CPT® 84520,0301 - LAB/CHEMISTRY,N/A,N/A, $70.00 , $45.50 , $58.80 , $4.03 , $4.03 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $3.95 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $3.95 , $67.20 
Exc Skin Malig <5mm Remaindr Body,CPT® 11620,N/A,N/A,N/A, $886.00 , $575.90 , $394.23 , $118.18 , $121.61 , $330.64 , $325.35 , $823.98 , $797.40 , $797.40 , $708.80 , $708.80 , $121.61 , $818.04 , $841.70 , $797.40 , $797.40 , $797.40 , $823.98 , $850.56 , $432.38 , $753.10 , $647.62 , $423.95 , N/A , $337.08 , $337.08 , $841.70 , $390.90 , $118.18 , $850.56 
Varicella-Zoster,CPT® 86787,N/A,N/A,N/A, $126.00 , $81.90 , N/A , $13.14 , $8.07 , $32.88 , $39.34 , $117.18 , $113.40 , $113.40 , $100.80 , $100.80 , $8.07 , $116.34 , $119.70 , $113.40 , $113.40 , $113.40 , $117.18 , $120.96 , $86.00 , $107.10 , $84.34 , $46.70 , N/A , $30.69 , $30.69 , $119.70 , $33.54 , $8.07 , $120.96 
 Fac Sigmoidoscopy Flx Ndsc US Xm ,CPT® 45341,0360 - OR SERVICES,N/A,N/A," $1,815.00 "," $1,179.75 "," $1,524.60 ", $117.36 , $206.41 ," $1,466.52 "," $1,633.50 "," $1,536.58 "," $1,633.50 "," $1,633.50 "," $1,633.50 "," $1,542.75 ", $202.36 ," $1,675.79 "," $1,724.25 "," $1,542.75 "," $1,687.95 "," $1,687.95 "," $1,724.25 "," $1,742.40 "," $1,485.03 "," $1,633.50 "," $1,542.75 "," $1,433.85 ", N/A ," $1,468.88 "," $1,468.88 "," $1,724.25 "," $1,557.45 ", $117.36 ," $1,742.40 "
 Pro Shvg Skin Lesion 1 F/E/E/N/L/M Diam 0.6-1.0 Cm ,CPT® 11311,0982 - PRO FEE/OUTPT,N/A,N/A, $502.00 , $326.30 , $200.87 , $60.34 , $74.81 , $180.78 , $174.29 , $466.86 , $451.80 , $451.80 , $401.60 , $401.60 , $74.81 , $463.50 , $476.90 , $451.80 , $451.80 , $451.80 , $466.86 , $481.92 , $222.33 , $426.70 , $346.11 , $230.29 , N/A , $184.31 , $184.31 , $476.90 , $213.76 , $60.34 , $481.92 
Radiologic Exam Upr GI Trc Double Contrast Study,CPT® 74246,N/A,N/A,N/A," $2,228.00 "," $1,448.20 ", $816.99 , $139.68 , $103.92 , $608.23 , $684.72 ," $2,072.04 "," $2,005.20 "," $2,005.20 "," $1,782.40 "," $1,782.40 ", $103.92 ," $2,057.11 "," $2,116.60 "," $2,005.20 "," $2,005.20 "," $2,005.20 "," $2,072.04 "," $2,138.88 ", $796.92 ," $1,893.80 ", $747.30 , $639.07 , N/A , $620.10 , $620.10 ," $2,116.60 ", $717.77 , $103.92 ," $2,138.88 "
Prgrmg Dev Eval 1 Lead Pm/Ldls Pm 1 Car Chmbr IP,CPT® 93279,N/A,N/A,N/A, $648.00 , $421.20 , $438.49 , $67.13 , $42.62 , $269.26 , $278.80 , $602.64 , $583.20 , $583.20 , $518.40 , $518.40 , $42.62 , $598.30 , $615.60 , $583.20 , $583.20 , $583.20 , $602.64 , $622.08 , $408.55 , $550.80 , $260.47 , $187.91 , N/A , $274.52 , $274.52 , $615.60 , $304.30 , $42.62 , $622.08 
 Infant Upper Extremity Min 2 Views ,CPT® 73092,0320 - DX X-RAY,N/A,N/A, $282.00 , $183.30 , $236.88 , $31.03 , $27.29 , $227.86 , $253.80 , $238.74 , $253.80 , $253.80 , $253.80 , $239.70 , $26.75 , $260.37 , $267.90 , $239.70 , $262.26 , $262.26 , $267.90 , $270.72 , $230.73 , $253.80 , $239.70 , $222.78 , N/A , $228.22 , $228.22 , $267.90 , $241.98 , $26.75 , $270.72 
Colonoscopy Stoma Rmvl Les by Hot Biopsy Forceps,CPT® 44392,N/A,N/A,N/A," $3,608.00 "," $2,345.20 "," $1,205.04 ", $186.54 , $676.09 ," $1,040.99 "," $1,070.03 "," $3,355.44 "," $3,247.20 "," $3,247.20 "," $2,886.40 "," $2,886.40 ", $676.09 ," $3,331.27 "," $3,427.60 "," $3,247.20 "," $3,247.20 "," $3,247.20 "," $3,355.44 "," $3,463.68 ", $865.25 ," $3,066.80 "," $1,177.48 "," $1,147.91 ", N/A ," $1,061.30 "," $1,061.30 "," $3,427.60 "," $1,110.00 ", $186.54 ," $3,463.68 "
Tube Thoracostomy Includes Water Seal,CPT® 32551,N/A,N/A,N/A," $1,763.00 "," $1,145.95 ", $828.52 , $143.99 , $198.32 , $651.04 , $647.17 ," $1,639.59 "," $1,586.70 "," $1,586.70 "," $1,410.40 "," $1,410.40 ", $198.32 ," $1,627.78 "," $1,674.85 "," $1,586.70 "," $1,586.70 "," $1,586.70 "," $1,639.59 "," $1,692.48 ", $800.35 ," $1,498.55 ", $933.07 , $796.75 , N/A , $663.74 , $663.74 ," $1,674.85 ", $781.70 , $143.99 ," $1,692.48 "
 AMIODARONE HCL IN DEXTROSE 150-4.21 MG/100ML-% IV SOLN ,HCPCS J0283,0636 - DRUGS REQUIRING DETAILED CODIN,43066-0150-10,100 mL, $213.70 , $138.91 , $179.51 , N/A , $0.07 , $172.67 , $192.33 , $180.92 , $192.33 , $192.33 , $192.33 , $181.65 , $0.07 , $197.31 , $203.02 , $181.65 , $198.74 , $198.74 , $203.02 , $205.15 , $174.85 , $192.33 , $181.65 , $168.82 , N/A , $172.95 , $172.95 , $203.02 , $183.38 , $0.07 , $205.15 
 Mm I & D for Breast Abcess ,CPT® 19020,0360 - OR SERVICES,N/A,N/A," $4,194.00 "," $2,726.10 "," $3,522.96 ", $296.37 , $153.67 ," $3,388.75 "," $3,774.60 "," $3,550.64 "," $3,774.60 "," $3,774.60 "," $3,774.60 "," $3,564.90 ", $150.66 ," $3,872.32 "," $3,984.30 "," $3,564.90 "," $3,900.42 "," $3,900.42 "," $3,984.30 "," $4,026.24 "," $3,431.53 "," $3,774.60 "," $3,564.90 "," $3,313.26 ", N/A ," $3,394.20 "," $3,394.20 "," $3,984.30 "," $3,598.87 ", $150.66 ," $4,026.24 "
Open Rx Humeral Supracondylar Fx,CPT® 24545,N/A,N/A,N/A," $6,138.00 "," $3,989.70 "," $5,629.07 ", $881.28 , $768.38 ," $4,483.29 "," $4,452.62 "," $5,708.34 "," $5,524.20 "," $5,524.20 "," $4,910.40 "," $4,910.40 ", $768.38 ," $5,667.22 "," $5,831.10 "," $5,524.20 "," $5,524.20 "," $5,524.20 "," $5,708.34 "," $5,892.48 "," $5,241.06 "," $5,217.30 "," $4,920.45 "," $5,284.83 ", N/A ," $4,570.77 "," $4,570.77 "," $5,831.10 "," $5,372.28 ", $768.38 ," $5,892.48 "
 Pro Treat Humerus Fracture ,CPT® 23620,0982 - PRO FEE/OUTPT,N/A,N/A," $1,873.00 "," $1,217.45 "," $1,620.39 ", $256.76 , $122.93 ," $1,235.51 "," $1,257.69 "," $1,741.89 "," $1,685.70 "," $1,685.70 "," $1,498.40 "," $1,498.40 ", $122.93 ," $1,729.34 "," $1,779.35 "," $1,685.70 "," $1,685.70 "," $1,685.70 "," $1,741.89 "," $1,798.08 "," $1,489.07 "," $1,592.05 "," $1,380.87 "," $1,464.61 ", N/A ," $1,259.62 "," $1,259.62 "," $1,779.35 "," $1,480.49 ", $122.93 ," $1,798.08 "
"Inc/Drain Retropharyng Abscess,Ext",CPT® 42725,N/A,N/A,N/A," $5,360.00 "," $3,484.00 "," $4,908.09 ", $765.58 , $304.29 ," $3,939.86 "," $3,988.58 "," $4,984.80 "," $4,824.00 "," $4,824.00 "," $4,288.00 "," $4,288.00 ", $304.29 ," $4,948.89 "," $5,092.00 "," $4,824.00 "," $4,824.00 "," $4,824.00 "," $4,984.80 "," $5,145.60 "," $3,507.30 "," $4,556.00 "," $4,351.33 "," $4,634.16 ", N/A ," $4,016.74 "," $4,016.74 "," $5,092.00 "," $4,201.08 ", $304.29 ," $5,145.60 "
 Fac Magnetically Controlled Capsule Endoscopy W/I&R ,CPT® 0651T,0360 - OR SERVICES,N/A,N/A," $4,836.00 "," $3,143.40 "," $4,062.24 ", N/A , N/A ," $3,907.49 "," $4,352.40 "," $4,094.16 "," $4,352.40 "," $4,352.40 "," $4,352.40 "," $4,110.60 ", N/A ," $4,465.08 "," $4,594.20 "," $4,110.60 "," $4,497.48 "," $4,497.48 "," $4,594.20 "," $4,642.56 "," $3,956.82 "," $4,352.40 "," $4,110.60 "," $3,820.44 ", N/A ," $3,913.77 "," $3,913.77 "," $4,594.20 "," $4,149.77 "," $3,820.44 "," $4,642.56 "
 Pro Telhealth Inpt Consult 35min ,HCPCS G0408,0987 - PRO FEE/HOS VIS,N/A,N/A, $308.00 , $200.20 , $194.76 , $101.95 , N/A , $192.79 , N/A , $286.44 , $277.20 , $277.20 , $246.40 , $246.40 , N/A , $284.38 , $292.60 , $277.20 , $277.20 , $277.20 , $286.44 , $295.68 , $288.50 , $261.80 , $192.68 , $392.23 , N/A , $196.55 , $196.55 , $292.60 , $245.68 , $101.95 , $392.23 
Drug Screen Quant Amphetamines 1 or 2,CPT® 80324,N/A,N/A,N/A, $185.00 , $120.25 , N/A , N/A , N/A , N/A , N/A , $172.05 , $166.50 , $166.50 , $148.00 , $148.00 , N/A , $170.81 , $175.75 , $166.50 , $166.50 , $166.50 , $172.05 , $177.60 , N/A , $157.25 , $114.69 , $67.79 , N/A , $90.04 , $90.04 , $175.75 , $98.20 , $67.79 , $177.60 
Njx Aa&/Strd Tfrml Epi Lumbar/Sacral Ea Addl,CPT® 64484,N/A,N/A,N/A, $536.00 , $348.40 , $254.80 , $49.44 , $119.93 , $294.25 , $285.73 , $498.48 , $482.40 , $482.40 , $428.80 , $428.80 , $119.93 , $494.89 , $509.20 , $482.40 , $482.40 , $482.40 , $498.48 , $514.56 , $278.36 , $455.60 , $276.53 , $315.01 , N/A , $299.99 , $299.99 , $509.20 , $321.80 , $49.44 , $514.56 
Percut Rx Metatarsal Fx,28476,N/A,N/A,N/A," $2,332.00 "," $1,515.80 "," $2,426.32 ", $380.95 , $229.93 ," $1,706.74 "," $1,705.73 "," $2,168.76 "," $2,098.80 "," $2,098.80 "," $1,865.60 "," $1,865.60 ", $229.93 ," $2,153.14 "," $2,215.40 "," $2,098.80 "," $2,098.80 "," $2,098.80 "," $2,168.76 "," $2,238.72 "," $2,211.22 "," $1,982.20 "," $1,860.78 "," $2,025.70 ", N/A ," $1,740.04 "," $1,740.04 "," $2,215.40 "," $2,045.18 ", $229.93 ," $2,426.32 "
 OXYBUTYNIN CHLORIDE 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-7027-61,1 tablet, $3.70 , $2.41 , $3.11 , N/A , N/A , $2.99 , $3.33 , $3.13 , $3.33 , $3.33 , $3.33 , $3.15 , N/A , $3.42 , $3.52 , $3.15 , $3.44 , $3.44 , $3.52 , $3.55 , $3.03 , $3.33 , $3.15 , $2.92 , N/A , $2.99 , $2.99 , $3.52 , $3.17 , $2.92 , $3.55 
 Fac Insj Eltrd Car Ven Sys Tm Insj Cvdfb/Pm Pls Gen ,CPT® 33225,0360 - OR SERVICES,N/A,N/A," $6,206.00 "," $4,033.90 "," $5,213.04 ", $422.06 , $411.53 ," $5,014.45 "," $5,585.40 "," $5,254.00 "," $5,585.40 "," $5,585.40 "," $5,585.40 "," $5,275.10 ", $403.46 ," $5,730.00 "," $5,895.70 "," $5,275.10 "," $5,771.58 "," $5,771.58 "," $5,895.70 "," $5,957.76 "," $5,077.75 "," $5,585.40 "," $5,275.10 "," $4,902.74 ", N/A ," $5,022.52 "," $5,022.52 "," $5,895.70 "," $5,325.37 ", $403.46 ," $5,957.76 "
Esophagoscopy Flexible Transoral Diagnostic,CPT® 43200,N/A,N/A,N/A," $1,442.00 ", $937.30 , $532.61 , $82.66 , $188.18 , $447.63 , $512.50 ," $1,341.06 "," $1,297.80 "," $1,297.80 "," $1,153.60 "," $1,153.60 ", $188.18 ," $1,331.40 "," $1,369.90 "," $1,297.80 "," $1,297.80 "," $1,297.80 "," $1,341.06 "," $1,384.32 ", $381.10 ," $1,225.70 ", $560.20 , $500.68 , N/A , $456.37 , $456.37 ," $1,369.90 ", $477.31 , $82.66 ," $1,384.32 "
 Pro X-Ray Exam of Wrist ,CPT® 73100,0972 - PRO FEE/RAD/DX,N/A,N/A, $99.00 , $64.35 , $190.24 , $33.33 , $28.13 , $137.99 , $169.90 , $92.07 , $89.10 , $89.10 , $79.20 , $79.20 , $28.13 , $91.41 , $94.05 , $89.10 , $89.10 , $89.10 , $92.07 , $95.04 , $185.72 , $84.15 , $188.75 , $158.36 , N/A , $140.68 , $140.68 , $94.05 , $162.82 , $28.13 , $190.24 
Glucose Blood Test,CPT® 82962,N/A,N/A,N/A, $55.00 , $35.75 , N/A , $3.35 , $3.25 , $13.27 , $15.86 , $51.15 , $49.50 , $49.50 , $44.00 , $44.00 , $3.25 , $50.78 , $52.25 , $49.50 , $49.50 , $49.50 , $51.15 , $52.80 , $21.90 , $46.75 , $14.60 , $9.61 , N/A , $12.38 , $12.38 , $52.25 , $13.53 , $3.25 , $52.80 
"Hpv/ Human Papilloma Vacc, Im",CPT® 90649,N/A,N/A,N/A, $398.00 , $258.70 , N/A , N/A , $178.67 , $281.42 , $293.68 , $370.14 , $358.20 , $358.20 , $318.40 , $318.40 , $178.67 , $367.47 , $378.10 , $358.20 , $358.20 , $358.20 , $370.14 , $382.08 , N/A , $338.30 , $390.28 , $271.06 , N/A , $286.92 , $286.92 , $378.10 , $334.47 , $178.67 , $390.28 
Tot Disc Arthrp Ant Appr Disc 2nd Level Cervical,CPT® 22858,N/A,N/A,N/A," $3,539.00 "," $2,300.35 "," $2,924.42 ", $454.96 , $456.64 ," $2,789.77 "," $2,396.26 "," $3,291.27 "," $3,185.10 "," $3,185.10 "," $2,831.20 "," $2,831.20 ", $456.64 ," $3,267.56 "," $3,362.05 "," $3,185.10 "," $3,185.10 "," $3,185.10 "," $3,291.27 "," $3,397.44 "," $2,738.43 "," $3,008.15 "," $2,676.08 "," $2,819.77 ", N/A ," $2,844.20 "," $2,844.20 "," $3,362.05 "," $3,342.98 ", $454.96 ," $3,397.44 "
 FAMOTIDINE 20 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,63739-0645-10,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Cftr Gene Analysis Common Variants ,CPT® 81220,0310 - PATHOLOGY LAB,N/A,N/A, $746.00 , $484.90 , $626.64 , $567.73 , $214.20 , $602.77 , $671.40 , $631.56 , $671.40 , $671.40 , $671.40 , $634.10 , $210.00 , $688.78 , $708.70 , $634.10 , $693.78 , $693.78 , $708.70 , $716.16 , $610.38 , $671.40 , $634.10 , $589.34 , N/A , $603.74 , $603.74 , $708.70 , $640.14 , $210.00 , $716.16 
 LEVOTHYROXINE SODIUM 100 MCG IV SOLR ,HCPCS RXA250,0250 - PHARMACY,63323-0649-07,5 mL, $650.85 , $423.05 , $546.71 , N/A , N/A , $525.89 , $585.77 , $551.01 , $585.77 , $585.77 , $585.77 , $553.22 , N/A , $600.93 , $618.31 , $553.22 , $605.29 , $605.29 , $618.31 , $624.82 , $532.53 , $585.77 , $553.22 , $514.17 , N/A , $526.73 , $526.73 , $618.31 , $558.49 , $514.17 , $624.82 
 EPTINEZUMAB-JJMR 100 MG/ML IV SOLN ,HCPCS J3032,0636 - DRUGS REQUIRING DETAILED CODIN,67386-0130-51,1 mL," $5,021.94 "," $3,264.26 "," $4,218.43 ", $17.79 , $17.35 ," $4,057.73 "," $4,519.75 "," $4,251.57 "," $4,519.75 "," $4,519.75 "," $4,519.75 "," $4,268.65 ", $17.01 ," $4,636.76 "," $4,770.84 "," $4,268.65 "," $4,670.40 "," $4,670.40 "," $4,770.84 "," $4,821.06 "," $4,108.95 "," $4,519.75 "," $4,268.65 "," $3,967.33 ", N/A ," $4,064.26 "," $4,064.26 "," $4,770.84 "," $4,309.33 ", $17.01 ," $4,821.06 "
 METHYLPREDNISOLONE SODIUM SUCC 500 MG INJECTION (INPT) ,HCPCS J2930,0636 - DRUGS REQUIRING DETAILED CODIN,00009-0758-01,8 mL, $149.69 , $97.30 , $125.74 , $5.84 , $6.07 , $120.95 , $134.72 , $126.73 , $134.72 , $134.72 , $134.72 , $127.24 , $5.95 , $138.21 , $142.21 , $127.24 , $139.21 , $139.21 , $142.21 , $143.70 , $122.48 , $134.72 , $127.24 , $118.26 , N/A , $121.14 , $121.14 , $142.21 , $128.45 , $5.84 , $143.70 
Cryocautery of Cervix,57511,N/A,N/A,N/A, $927.00 , $602.55 , $701.00 , $142.02 , $69.95 , $538.37 , $542.75 , $862.11 , $834.30 , $834.30 , $741.60 , $741.60 , $69.95 , $855.90 , $880.65 , $834.30 , $834.30 , $834.30 , $862.11 , $889.92 , $717.51 , $787.95 , $711.84 , $541.15 , N/A , $548.87 , $548.87 , $880.65 , $658.34 , $69.95 , $889.92 
 Fac Slctv Cathj Ea 2nd+ Ord Thrc/Brch/Cphlc Brnch ,CPT® 36218,0360 - OR SERVICES,N/A,N/A," $1,192.00 ", $774.80 ," $1,001.28 ", $47.48 , $176.45 , $963.14 ," $1,072.80 "," $1,009.15 "," $1,072.80 "," $1,072.80 "," $1,072.80 "," $1,013.20 ", $172.99 ," $1,100.57 "," $1,132.40 "," $1,013.20 "," $1,108.56 "," $1,108.56 "," $1,132.40 "," $1,144.32 ", $975.29 ," $1,072.80 "," $1,013.20 ", $941.68 , N/A , $964.69 , $964.69 ," $1,132.40 "," $1,022.86 ", $47.48 ," $1,144.32 "
 Fac Cognitive Test by HC Pro ,CPT® 96125,0444 - SPEECH PATH/EVAL,N/A,N/A, $446.00 , $289.90 , $374.64 , $101.78 , $71.88 , $360.37 , $401.40 , $377.58 , $401.40 , $401.40 , $401.40 , $379.10 , $70.47 , $411.79 , $423.70 , $379.10 , $414.78 , $414.78 , $423.70 , $428.16 , $364.92 , $401.40 , $379.10 , $352.34 , N/A , $360.95 , $360.95 , $423.70 , $382.71 , $70.47 , $428.16 
Bone Age Studies,CPT® 77072,N/A,N/A,N/A, $480.00 , $312.00 , $147.09 , $25.50 , $18.38 , $108.45 , $122.56 , $446.40 , $432.00 , $432.00 , $384.00 , $384.00 , $18.38 , $443.18 , $456.00 , $432.00 , $432.00 , $432.00 , $446.40 , $460.80 , $142.74 , $408.00 , $134.82 , $115.64 , N/A , $110.56 , $110.56 , $456.00 , $127.98 , $18.38 , $460.80 
REVJ TOT KNE ARTHRP FEM&ENTIRE TIBL COMP,27503,N/A,N/A,N/A," $5,237.00 "," $3,404.05 "," $4,853.10 ", $762.36 , $714.06 ," $3,863.87 "," $3,851.70 "," $4,870.41 "," $4,713.30 "," $4,713.30 "," $4,189.60 "," $4,189.60 ", $714.06 ," $4,835.32 "," $4,975.15 "," $4,713.30 "," $4,713.30 "," $4,713.30 "," $4,870.41 "," $5,027.52 "," $4,528.67 "," $4,451.45 "," $4,256.78 "," $4,552.50 ", N/A ," $3,939.26 "," $3,939.26 "," $4,975.15 "," $4,630.02 ", $714.06 ," $5,027.52 "
Amputation Finger/Thumb+Flaps,CPT® 26952,N/A,N/A,N/A," $4,286.00 "," $2,785.90 "," $4,299.17 ", $669.14 , $336.65 ," $3,062.08 "," $3,105.60 "," $3,985.98 "," $3,857.40 "," $3,857.40 "," $3,428.80 "," $3,428.80 ", $336.65 ," $3,957.26 "," $4,071.70 "," $3,857.40 "," $3,857.40 "," $3,857.40 "," $3,985.98 "," $4,114.56 "," $3,934.94 "," $3,643.10 "," $3,405.78 "," $3,654.94 ", N/A ," $3,121.83 "," $3,121.83 "," $4,071.70 "," $3,669.26 ", $336.65 ," $4,299.17 "
 NITROGLYCERIN 0.1 MG/HR TD PT24 ,HCPCS RXC637,0250 - PHARMACY,00378-9102-93,1 patch, $9.55 , $6.21 , $8.02 , N/A , N/A , $7.72 , $8.60 , $8.09 , $8.60 , $8.60 , $8.60 , $8.12 , N/A , $8.82 , $9.07 , $8.12 , $8.88 , $8.88 , $9.07 , $9.17 , $7.81 , $8.60 , $8.12 , $7.54 , N/A , $7.73 , $7.73 , $9.07 , $8.19 , $7.54 , $9.17 
 Pro US in/Out Flow Abd Scrotum Retro Organ- Mh ,CPT® 93975,0972 - PRO FEE/RAD/DX,N/A,N/A, $771.00 , $501.15 ," $1,691.37 ", $260.97 , $229.87 ," $1,519.41 "," $2,067.78 ", $717.03 , $693.90 , $693.90 , $616.80 , $616.80 , $229.87 , $711.86 , $732.45 , $693.90 , $693.90 , $693.90 , $717.03 , $740.16 ," $1,192.71 ", $655.35 ," $1,100.89 "," $1,072.66 ", N/A ," $1,549.06 "," $1,549.06 ", $732.45 ," $1,717.16 ", $229.87 ," $2,067.78 "
Initial preventive exam,HCPCS G0402,N/A,N/A,N/A, $339.00 , $220.35 , $321.38 , $127.94 , N/A , $235.19 , $270.88 , $315.27 , $305.10 , $305.10 , $271.20 , $271.20 , N/A , $313.00 , $322.05 , $305.10 , $305.10 , $305.10 , $315.27 , $325.44 , $361.20 , $288.15 , $234.20 , $270.53 , N/A , $239.77 , $239.77 , $322.05 , $299.71 , $127.94 , $361.20 
 Fac Radiation Physics Consult ,CPT® 77370,0333 - RADIATION RX,N/A,N/A," $1,338.00 ", $869.70 ," $1,123.92 ", $133.19 , $129.51 ," $1,081.10 "," $1,204.20 "," $1,132.75 "," $1,204.20 "," $1,204.20 "," $1,204.20 "," $1,137.30 ", $126.97 ," $1,235.38 "," $1,271.10 "," $1,137.30 "," $1,244.34 "," $1,244.34 "," $1,271.10 "," $1,284.48 "," $1,094.75 "," $1,204.20 "," $1,137.30 "," $1,057.02 ", N/A ," $1,082.84 "," $1,082.84 "," $1,271.10 "," $1,148.14 ", $126.97 ," $1,284.48 "
 Fac Enteroscopy > 2nd Prtn W/Rmvl Lesion Cautery ,CPT® 44365,0360 - OR SERVICES,N/A,N/A," $2,542.00 "," $1,652.30 "," $2,135.28 ", $172.43 , $312.40 ," $2,053.94 "," $2,287.80 "," $2,152.06 "," $2,287.80 "," $2,287.80 "," $2,287.80 "," $2,160.70 ", $306.27 ," $2,347.03 "," $2,414.90 "," $2,160.70 "," $2,364.06 "," $2,364.06 "," $2,414.90 "," $2,440.32 "," $2,079.86 "," $2,287.80 "," $2,160.70 "," $2,008.18 ", N/A ," $2,057.24 "," $2,057.24 "," $2,414.90 "," $2,181.29 ", $172.43 ," $2,440.32 "
 Fac Rm Chg Nursery Level 3 ,Custom 1730000001,0173 - NURSERY LEVEL III,N/A,N/A," $2,637.00 "," $1,714.05 "," $2,215.08 ", N/A , N/A ," $2,130.70 "," $2,373.30 "," $2,232.48 "," $2,373.30 "," $2,373.30 "," $2,373.30 "," $2,241.45 ", N/A ," $2,434.74 "," $2,505.15 "," $2,241.45 "," $2,452.41 "," $2,452.41 "," $2,505.15 "," $2,531.52 "," $2,157.59 "," $2,373.30 "," $2,241.45 "," $2,083.23 ", N/A ," $2,134.12 "," $2,134.12 "," $2,505.15 "," $2,262.81 "," $2,083.23 "," $2,531.52 "
 Fac Automated Reticulocyte Count ,CPT® 85045,0305 - LAB/HEMATOLOGY,N/A,N/A, $85.00 , $55.25 , $71.40 , $4.07 , $4.07 , $68.68 , $76.50 , $71.96 , $76.50 , $76.50 , $76.50 , $72.25 , $3.99 , $78.48 , $80.75 , $72.25 , $79.05 , $79.05 , $80.75 , $81.60 , $69.55 , $76.50 , $72.25 , $67.15 , N/A , $68.79 , $68.79 , $80.75 , $72.94 , $3.99 , $81.60 
 Fac Injection Aa&/Strd Suprascapular Nerve ,CPT® 64418,0360 - OR SERVICES,N/A,N/A," $1,267.00 ", $823.55 ," $1,064.28 ", $53.45 , $118.05 ," $1,023.74 "," $1,140.30 "," $1,072.64 "," $1,140.30 "," $1,140.30 "," $1,140.30 "," $1,076.95 ", $115.74 ," $1,169.82 "," $1,203.65 "," $1,076.95 "," $1,178.31 "," $1,178.31 "," $1,203.65 "," $1,216.32 "," $1,036.66 "," $1,140.30 "," $1,076.95 "," $1,000.93 ", N/A ," $1,025.38 "," $1,025.38 "," $1,203.65 "," $1,087.21 ", $53.45 ," $1,216.32 "
 PROMETHAZINE HCL 12.5 MG RE SUPP ,HCPCS RXC637,0250 - PHARMACY,00713-0536-12,1 suppository, $90.95 , $59.12 , $76.40 , N/A , N/A , $73.49 , $81.86 , $77.00 , $81.86 , $81.86 , $81.86 , $77.31 , N/A , $83.97 , $86.40 , $77.31 , $84.58 , $84.58 , $86.40 , $87.31 , $74.42 , $81.86 , $77.31 , $71.85 , N/A , $73.61 , $73.61 , $86.40 , $78.04 , $71.85 , $87.31 
 Fac Ins Pm Pls Gen W/Exist Single Lead ,CPT® 33212,0360 - OR SERVICES,N/A,N/A," $5,064.00 "," $3,291.60 "," $4,253.76 ", $296.10 , $401.40 ," $4,091.71 "," $4,557.60 "," $4,287.18 "," $4,557.60 "," $4,557.60 "," $4,557.60 "," $4,304.40 ", $393.53 ," $4,675.59 "," $4,810.80 "," $4,304.40 "," $4,709.52 "," $4,709.52 "," $4,810.80 "," $4,861.44 "," $4,143.36 "," $4,557.60 "," $4,304.40 "," $4,000.56 ", N/A ," $4,098.30 "," $4,098.30 "," $4,810.80 "," $4,345.42 ", $296.10 ," $4,861.44 "
Treat Fibular Fracture,CPT® 27786,N/A,N/A,N/A," $2,086.00 "," $1,355.90 "," $1,797.25 ", $283.29 , $184.42 ," $1,381.41 "," $1,407.46 "," $1,939.98 "," $1,877.40 "," $1,877.40 "," $1,668.80 "," $1,668.80 ", $184.42 ," $1,926.00 "," $1,981.70 "," $1,877.40 "," $1,877.40 "," $1,877.40 "," $1,939.98 "," $2,002.56 "," $1,658.34 "," $1,773.10 "," $1,543.22 "," $1,637.46 ", N/A ," $1,408.37 "," $1,408.37 "," $1,981.70 "," $1,655.31 ", $184.42 ," $2,002.56 "
Electric Stimulation Therapy,CPT® 97014,N/A,N/A,N/A, $78.00 , $50.70 , $10.00 , $12.24 , N/A , $35.97 , $32.19 , $72.54 , $70.20 , $70.20 , $62.40 , $62.40 , N/A , $72.02 , $74.10 , $70.20 , $70.20 , $70.20 , $72.54 , $74.88 , $33.49 , $66.30 , $47.64 , $37.84 , N/A , $36.67 , $36.67 , $74.10 , $40.79 , $10.00 , $74.88 
 Pro Lung Perfusion Imaging ,CPT® 78580,0974 - PRO FEE/NUC MED,N/A,N/A, $305.00 , $198.25 ," $1,265.04 ", $216.90 , $175.15 ," $1,176.25 "," $1,269.63 ", $283.65 , $274.50 , $274.50 , $244.00 , $244.00 , $175.15 , $281.61 , $289.75 , $274.50 , $274.50 , $274.50 , $283.65 , $292.80 ," $1,309.16 ", $259.25 ," $1,384.82 "," $1,606.35 ", N/A ," $1,199.20 "," $1,199.20 ", $289.75 ," $1,388.12 ", $175.15 ," $1,606.35 "
 Fac Tcat IV Stent Crv Crtd Art Embolic Protecj ,CPT® 37215,0360 - OR SERVICES,N/A,N/A," $8,219.00 "," $5,342.35 "," $6,903.96 ", $885.88 , $982.81 ," $6,640.95 "," $7,397.10 "," $6,958.21 "," $7,397.10 "," $7,397.10 "," $7,397.10 "," $6,986.15 ", $963.54 ," $7,588.60 "," $7,808.05 "," $6,986.15 "," $7,643.67 "," $7,643.67 "," $7,808.05 "," $7,890.24 "," $6,724.79 "," $7,397.10 "," $6,986.15 "," $6,493.01 ", N/A ," $6,651.64 "," $6,651.64 "," $7,808.05 "," $7,052.72 ", $885.88 ," $7,890.24 "
"Flowcytometry/Read, 9-15 Markers",CPT® 88188,N/A,N/A,N/A, $534.00 , $347.10 , $221.82 , $60.52 , $86.85 , $366.76 , $401.62 , $496.62 , $480.60 , $480.60 , $427.20 , $427.20 , $86.85 , $493.04 , $507.30 , $480.60 , $480.60 , $480.60 , $496.62 , $512.64 , $403.77 , $453.90 , $418.44 , $227.55 , N/A , $342.28 , $342.28 , $507.30 , $376.15 , $60.52 , $512.64 
 Fac Rpsg Prev Implted Pm/Cvdfb R Atr/R Ventr Eltrd ,CPT® 33215,0360 - OR SERVICES,N/A,N/A," $3,442.00 "," $2,237.30 "," $2,891.28 ", $285.54 , $280.43 ," $2,781.14 "," $3,097.80 "," $2,914.00 "," $3,097.80 "," $3,097.80 "," $3,097.80 "," $2,925.70 ", $274.93 ," $3,178.00 "," $3,269.90 "," $2,925.70 "," $3,201.06 "," $3,201.06 "," $3,269.90 "," $3,304.32 "," $2,816.24 "," $3,097.80 "," $2,925.70 "," $2,719.18 ", N/A ," $2,785.61 "," $2,785.61 "," $3,269.90 "," $2,953.58 ", $274.93 ," $3,304.32 "
 Pro Dstr Nrolytc Agnt Parverteb Fct Addl Crvcl/Thora ,CPT® 64634,0982 - PRO FEE/OUTPT,N/A,N/A," $1,589.00 "," $1,032.85 ", $332.07 , $64.33 , $161.82 , $384.95 , $361.04 ," $1,477.77 "," $1,430.10 "," $1,430.10 "," $1,271.20 "," $1,271.20 ", $161.82 ," $1,467.12 "," $1,509.55 "," $1,430.10 "," $1,430.10 "," $1,430.10 "," $1,477.77 "," $1,525.44 ", $362.83 ," $1,350.65 ", $349.68 , $413.79 , N/A , $392.46 , $392.46 ," $1,509.55 ", $421.03 , $64.33 ," $1,525.44 "
"CT Angio, Abd, Combo,Incl Image Proc",CPT® 74175,N/A,N/A,N/A," $5,241.00 "," $3,406.65 "," $1,792.84 ", $259.04 , $394.70 ," $1,460.66 "," $2,138.51 "," $4,874.13 "," $4,716.90 "," $4,716.90 "," $4,192.80 "," $4,192.80 ", $394.70 ," $4,839.02 "," $4,978.95 "," $4,716.90 "," $4,716.90 "," $4,716.90 "," $4,874.13 "," $5,031.36 "," $1,816.98 "," $4,454.85 "," $2,332.44 "," $1,992.65 ", N/A ," $1,489.16 "," $1,489.16 "," $4,978.95 "," $1,723.74 ", $259.04 ," $5,031.36 "
Colonoscopy Flx Ablation Tumor Polyp/Other Les,45388,N/A,N/A,N/A," $3,381.00 "," $2,197.65 "," $1,652.56 ", $255.42 , $436.94 ," $1,543.62 "," $1,612.15 "," $3,144.33 "," $3,042.90 "," $3,042.90 "," $2,704.80 "," $2,704.80 ", $436.94 ," $3,121.68 "," $3,211.95 "," $3,042.90 "," $3,042.90 "," $3,042.90 "," $3,144.33 "," $3,245.76 "," $1,188.46 "," $2,873.85 "," $1,412.67 "," $1,573.02 ", N/A ," $1,573.74 "," $1,573.74 "," $3,211.95 "," $1,645.97 ", $255.42 ," $3,245.76 "
 RACEPINEPHRINE HCL 2.25 % INH NEBU ,HCPCS RXA250,0250 - PHARMACY,00487-2784-01,0.5 mL, $5.14 , $3.34 , $4.32 , N/A , N/A , $4.15 , $4.63 , $4.35 , $4.63 , $4.63 , $4.63 , $4.37 , N/A , $4.75 , $4.88 , $4.37 , $4.78 , $4.78 , $4.88 , $4.93 , $4.21 , $4.63 , $4.37 , $4.06 , N/A , $4.16 , $4.16 , $4.88 , $4.41 , $4.06 , $4.93 
Aminophyllin 250 Mg Inj,HCPCS J0280,N/A,N/A,N/A, $17.00 , $11.05 , N/A , $4.60 , $13.35 , N/A , N/A , $15.81 , $15.30 , $15.30 , $13.60 , $13.60 , $13.35 , $15.70 , $16.15 , $15.30 , $15.30 , $15.30 , $15.81 , $16.32 , $7.94 , $14.45 , $1.30 , $8.89 , N/A , N/A , N/A , $16.15 , N/A , $1.30 , $16.32 
" Sa Duplex Aorta,Ivc,Iliacs Limited ",CPT® 93979,0921 - PERI VASCUL LAB,N/A,N/A, $417.00 , $271.05 , $350.28 , $114.80 , $121.27 , $336.94 , $375.30 , $353.03 , $375.30 , $375.30 , $375.30 , $354.45 , $118.89 , $385.02 , $396.15 , $354.45 , $387.81 , $387.81 , $396.15 , $400.32 , $341.19 , $375.30 , $354.45 , $329.43 , N/A , $337.48 , $337.48 , $396.15 , $357.83 , $114.80 , $400.32 
"Nasal Scopy,Open Maxill Sinus",CPT® 31256,N/A,N/A,N/A," $1,557.00 "," $1,012.05 ", $969.74 , $171.71 , $275.40 , $759.45 ," $1,062.85 "," $1,448.01 "," $1,401.30 "," $1,401.30 "," $1,245.60 "," $1,245.60 ", $275.40 ," $1,437.58 "," $1,479.15 "," $1,401.30 "," $1,401.30 "," $1,401.30 "," $1,448.01 "," $1,494.72 ", $930.60 ," $1,323.45 "," $1,047.25 ", $918.32 , N/A , $774.27 , $774.27 ," $1,479.15 ", $911.87 , $171.71 ," $1,494.72 "
"Wrist Arthroscop,Excis Triang Cart",CPT® 29846,N/A,N/A,N/A," $3,447.00 "," $2,240.55 "," $3,196.70 ", $502.92 , $450.57 ," $2,510.74 "," $2,509.00 "," $3,205.71 "," $3,102.30 "," $3,102.30 "," $2,757.60 "," $2,757.60 ", $450.57 ," $3,182.62 "," $3,274.65 "," $3,102.30 "," $3,102.30 "," $3,102.30 "," $3,205.71 "," $3,309.12 "," $2,976.39 "," $2,929.95 "," $2,758.16 "," $2,986.96 ", N/A ," $2,559.73 "," $2,559.73 "," $3,274.65 "," $3,008.58 ", $450.57 ," $3,309.12 "
 COLESTIPOL HCL 1 G PO TABS ,HCPCS RXC637,0250 - PHARMACY,00009-0450-03,1 tablet, $13.72 , $8.92 , $11.52 , N/A , N/A , $11.09 , $12.35 , $11.62 , $12.35 , $12.35 , $12.35 , $11.66 , N/A , $12.67 , $13.03 , $11.66 , $12.76 , $12.76 , $13.03 , $13.17 , $11.23 , $12.35 , $11.66 , $10.84 , N/A , $11.10 , $11.10 , $13.03 , $11.77 , $10.84 , $13.17 
"Commun/Work Reintegratn,Ea 15 Min",CPT® 97537,N/A,N/A,N/A, $90.00 , $58.50 , $62.32 , $31.80 , $18.09 , $68.64 , $60.85 , $83.70 , $81.00 , $81.00 , $72.00 , $72.00 , $18.09 , $83.10 , $85.50 , $81.00 , $81.00 , $81.00 , $83.70 , $86.40 , $80.34 , $76.50 , $89.21 , $74.96 , N/A , $69.98 , $69.98 , $85.50 , $77.84 , $18.09 , $89.21 
Drain Abd Abscess Open,CPT® 49020,N/A,N/A,N/A," $10,319.00 "," $6,707.35 "," $9,504.30 "," $1,471.08 "," $1,551.09 "," $7,495.69 "," $7,542.30 "," $9,596.67 "," $9,287.10 "," $9,287.10 "," $8,255.20 "," $8,255.20 "," $1,551.09 "," $9,527.53 "," $9,803.05 "," $9,287.10 "," $9,287.10 "," $9,287.10 "," $9,596.67 "," $9,906.24 "," $6,812.66 "," $8,771.15 "," $8,379.75 "," $8,829.34 ", N/A ," $7,641.94 "," $7,641.94 "," $9,803.05 "," $7,992.64 "," $1,471.08 "," $9,906.24 "
 Simple Pneumonia And Pleurisy With McC ,MS DRG V40 (FY2023) 193,N/A,N/A,N/A," $21,979.58 "," $14,286.73 "," $18,462.85 ", N/A , N/A ," $17,759.50 "," $19,781.62 "," $18,607.91 "," $19,781.62 "," $19,781.62 "," $19,781.62 "," $18,682.64 ", N/A ," $20,293.75 "," $20,880.60 "," $18,682.64 "," $20,441.01 "," $20,441.01 "," $20,880.60 "," $21,100.40 "," $17,983.69 "," $19,781.62 "," $18,682.64 "," $17,363.87 ", N/A ," $17,788.07 "," $17,788.07 "," $20,880.60 "," $18,860.68 "," $17,363.87 "," $21,100.40 "
 NADOLOL 40 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-7071-61,1 tablet, $25.55 , $16.61 , $21.46 , N/A , N/A , $20.64 , $23.00 , $21.63 , $23.00 , $23.00 , $23.00 , $21.72 , N/A , $23.59 , $24.27 , $21.72 , $23.76 , $23.76 , $24.27 , $24.53 , $20.91 , $23.00 , $21.72 , $20.18 , N/A , $20.68 , $20.68 , $24.27 , $21.92 , $20.18 , $24.53 
Insert Vaginal Radiation Device,CPT® 57156,N/A,N/A,N/A," $1,119.00 ", $727.35 , $721.80 , $147.91 , $75.48 , $602.65 , $580.59 ," $1,040.67 "," $1,007.10 "," $1,007.10 ", $895.20 , $895.20 , $75.48 ," $1,033.17 "," $1,063.05 "," $1,007.10 "," $1,007.10 "," $1,007.10 "," $1,040.67 "," $1,074.24 ", $753.78 , $951.15 , $747.52 , $624.08 , N/A , $614.41 , $614.41 ," $1,063.05 ", $736.94 , $75.48 ," $1,074.24 "
X-Ray Cerv Spine 4 Vw,CPT® 72050,N/A,N/A,N/A, $425.00 , $276.25 , $301.19 , $52.56 , $50.07 , $212.95 , $290.14 , $395.25 , $382.50 , $382.50 , $340.00 , $340.00 , $50.07 , $392.40 , $403.75 , $382.50 , $382.50 , $382.50 , $395.25 , $408.00 , $290.59 , $361.25 , $281.20 , $228.27 , N/A , $217.11 , $217.11 , $403.75 , $251.30 , $50.07 , $408.00 
"Length/Short Leg/Ankl Tendon,Multi",CPT® 27686,N/A,N/A,N/A," $5,352.00 "," $3,478.80 "," $3,272.56 ", $507.81 , $537.90 ," $2,725.66 "," $2,669.92 "," $4,977.36 "," $4,816.80 "," $4,816.80 "," $4,281.60 "," $4,281.60 ", $537.90 ," $4,941.50 "," $5,084.40 "," $4,816.80 "," $4,816.80 "," $4,816.80 "," $4,977.36 "," $5,137.92 "," $3,064.31 "," $4,549.20 "," $2,931.22 "," $3,158.32 ", N/A ," $2,778.85 "," $2,778.85 "," $5,084.40 "," $3,266.11 ", $507.81 ," $5,137.92 "
 Fac Amb 911 Base Specialty Care Transfer Sct ,HCPCS A0434,0540 - AMBULANCE,N/A,N/A," $2,861.00 "," $1,859.65 "," $2,403.24 ", N/A , $699.74 ," $2,311.69 "," $2,574.90 "," $2,422.12 "," $2,574.90 "," $2,574.90 "," $2,574.90 "," $2,431.85 ", $686.02 ," $2,641.56 "," $2,717.95 "," $2,431.85 "," $2,660.73 "," $2,660.73 "," $2,717.95 "," $2,746.56 "," $2,340.87 "," $2,574.90 "," $2,431.85 "," $2,260.19 ", N/A ," $2,315.41 "," $2,315.41 "," $2,717.95 "," $2,455.02 ", $686.02 ," $2,746.56 "
 APRACLONIDINE HCL 1 % OP SOLN ,HCPCS RXA250,0250 - PHARMACY,82667-0200-01,2 each, $341.84 , $222.20 , $287.15 , N/A , N/A , $276.21 , $307.66 , $289.40 , $307.66 , $307.66 , $307.66 , $290.56 , N/A , $315.62 , $324.75 , $290.56 , $317.91 , $317.91 , $324.75 , $328.17 , $279.69 , $307.66 , $290.56 , $270.05 , N/A , $276.65 , $276.65 , $324.75 , $293.33 , $270.05 , $328.17 
Fx Cl Tuberosity W/O Mani,CPT® 23620,N/A,N/A,N/A," $1,873.00 "," $1,217.45 "," $1,620.39 ", $256.76 , $122.93 ," $1,235.51 "," $1,257.69 "," $1,741.89 "," $1,685.70 "," $1,685.70 "," $1,498.40 "," $1,498.40 ", $122.93 ," $1,729.34 "," $1,779.35 "," $1,685.70 "," $1,685.70 "," $1,685.70 "," $1,741.89 "," $1,798.08 "," $1,489.07 "," $1,592.05 "," $1,380.87 "," $1,464.61 ", N/A ," $1,259.62 "," $1,259.62 "," $1,779.35 "," $1,480.49 ", $122.93 ," $1,798.08 "
Remvl Perm Pm Pls Gen W/Repl Plse Gen 2 Lead Sys,CPT® 33228,N/A,N/A,N/A," $3,321.00 "," $2,158.65 "," $2,117.25 ", $327.07 , $402.33 ," $1,560.16 "," $1,514.34 "," $3,088.53 "," $2,988.90 "," $2,988.90 "," $2,656.80 "," $2,656.80 ", $402.33 ," $3,066.28 "," $3,154.95 "," $2,988.90 "," $2,988.90 "," $2,988.90 "," $3,088.53 "," $3,188.16 "," $1,952.45 "," $2,822.85 "," $1,903.60 "," $1,712.30 ", N/A ," $1,590.60 "," $1,590.60 "," $3,154.95 "," $1,806.91 ", $327.07 ," $3,188.16 "
 Fac Natriuretic Peptide ,CPT® 83880,0301 - LAB/CHEMISTRY,N/A,N/A, $302.00 , $196.30 , $253.68 , $40.05 , $40.05 , $244.02 , $271.80 , $255.67 , $271.80 , $271.80 , $271.80 , $256.70 , $39.26 , $278.84 , $286.90 , $256.70 , $280.86 , $280.86 , $286.90 , $289.92 , $247.10 , $271.80 , $256.70 , $238.58 , N/A , $244.41 , $244.41 , $286.90 , $259.15 , $39.26 , $289.92 
 VORICONAZOLE 200 MG IV SOLR ,HCPCS J3465,0636 - DRUGS REQUIRING DETAILED CODIN,00049-3190-28,20 mL, $371.71 , $241.61 , $312.24 , $1.24 , $1.17 , $300.34 , $334.54 , $314.69 , $334.54 , $334.54 , $334.54 , $315.95 , $1.15 , $343.20 , $353.12 , $315.95 , $345.69 , $345.69 , $353.12 , $356.84 , $304.13 , $334.54 , $315.95 , $293.65 , N/A , $300.82 , $300.82 , $353.12 , $318.96 , $1.15 , $356.84 
 Pro Total Hysterectomy ,CPT® 58150,0982 - PRO FEE/OUTPT,N/A,N/A," $5,971.00 "," $3,881.15 "," $4,754.80 ", $963.96 , $887.97 ," $4,111.31 "," $4,050.89 "," $5,553.03 "," $5,373.90 "," $5,373.90 "," $4,776.80 "," $4,776.80 ", $887.97 ," $5,513.02 "," $5,672.45 "," $5,373.90 "," $5,373.90 "," $5,373.90 "," $5,553.03 "," $5,732.16 "," $4,972.38 "," $5,075.35 "," $5,332.57 "," $4,130.51 ", N/A ," $4,191.52 "," $4,191.52 "," $5,672.45 "," $5,027.46 ", $887.97 ," $5,732.16 "
 Pro Insrt/Redo Spine N Generator ,CPT® 63685,0982 - PRO FEE/OUTPT,N/A,N/A," $2,405.00 "," $1,563.25 "," $1,742.99 ", $340.52 , $400.51 ," $2,020.96 "," $1,961.82 "," $2,236.65 "," $2,164.50 "," $2,164.50 "," $1,924.00 "," $1,924.00 ", $400.51 ," $2,220.54 "," $2,284.75 "," $2,164.50 "," $2,164.50 "," $2,164.50 "," $2,236.65 "," $2,308.80 "," $1,888.75 "," $2,044.25 "," $1,944.63 "," $2,124.75 ", N/A ," $2,060.40 "," $2,060.40 "," $2,284.75 "," $2,210.30 ", $340.52 ," $2,308.80 "
Protector Heel or Elbow,HCPCS E0191,N/A,N/A,N/A, $70.00 , $45.50 , N/A , $13.55 , $9.08 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $9.08 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , N/A , $12.32 , N/A , N/A , N/A , $66.50 , N/A , $9.08 , $67.20 
 Fac Cltx Mtcarphlngl Dislc 1 W/Mnpj W/O Anes ,CPT® 26700,0761 - TREATMENT ROOM,N/A,N/A," $1,527.00 ", $992.55 ," $1,282.68 ", $306.67 , $96.29 ," $1,233.82 "," $1,374.30 "," $1,292.76 "," $1,374.30 "," $1,374.30 "," $1,374.30 "," $1,297.95 ", $94.40 ," $1,409.88 "," $1,450.65 "," $1,297.95 "," $1,420.11 "," $1,420.11 "," $1,450.65 "," $1,465.92 "," $1,249.39 "," $1,374.30 "," $1,297.95 "," $1,206.33 ", N/A ," $1,235.80 "," $1,235.80 "," $1,450.65 "," $1,310.32 ", $94.40 ," $1,465.92 "
 IR Inj Non-Compounded Sclerosant Single Vein Inc Guidance ,CPT® 36465,0360 - OR SERVICES,N/A,N/A," $1,980.00 "," $1,287.00 "," $1,663.20 ", $108.66 , N/A ," $1,599.84 "," $1,782.00 "," $1,676.27 "," $1,782.00 "," $1,782.00 "," $1,782.00 "," $1,683.00 ", N/A ," $1,828.13 "," $1,881.00 "," $1,683.00 "," $1,841.40 "," $1,841.40 "," $1,881.00 "," $1,900.80 "," $1,620.04 "," $1,782.00 "," $1,683.00 "," $1,564.20 ", N/A ," $1,602.41 "," $1,602.41 "," $1,881.00 "," $1,699.04 ", $108.66 ," $1,900.80 "
Assay Iron,CPT® 83540,N/A,N/A,N/A, $51.00 , $33.15 , N/A , $6.60 , $6.60 , $36.62 , $43.83 , $47.43 , $45.90 , $45.90 , $40.80 , $40.80 , $6.60 , $47.09 , $48.45 , $45.90 , $45.90 , $45.90 , $47.43 , $48.96 , $43.20 , $43.35 , $42.17 , $23.47 , N/A , $34.18 , $34.18 , $48.45 , $37.35 , $6.60 , $48.96 
"Open Post Rx Thor Vert Fx,1 Lvl",CPT® 22327,N/A,N/A,N/A," $9,616.00 "," $6,250.40 "," $8,935.23 "," $1,402.02 "," $1,536.80 "," $7,162.04 "," $7,029.06 "," $8,942.88 "," $8,654.40 "," $8,654.40 "," $7,692.80 "," $7,692.80 "," $1,536.80 "," $8,878.45 "," $9,135.20 "," $8,654.40 "," $8,654.40 "," $8,654.40 "," $8,942.88 "," $9,231.36 "," $8,300.79 "," $8,173.60 "," $7,885.56 "," $8,293.06 ", N/A ," $7,301.79 "," $7,301.79 "," $9,135.20 "," $8,582.19 "," $1,402.02 "," $9,231.36 "
Assay Pyruvate,CPT® 84210,N/A,N/A,N/A, $132.00 , $85.80 , N/A , $14.77 , $14.77 , $61.41 , $73.46 , $122.76 , $118.80 , $118.80 , $105.60 , $105.60 , $14.77 , $121.88 , $125.40 , $118.80 , $118.80 , $118.80 , $122.76 , $126.72 , $96.69 , $112.20 , $71.36 , $42.53 , N/A , $57.31 , $57.31 , $125.40 , $62.62 , $14.77 , $126.72 
 Pro Exc H-F-Nk-Sp Mlg+Marg 1.1-2 ,CPT® 11622,0982 - PRO FEE/OUTPT,N/A,N/A," $1,169.00 ", $759.85 , $542.33 , $163.07 , $252.90 , $468.46 , $459.11 ," $1,087.17 "," $1,052.10 "," $1,052.10 ", $935.20 , $935.20 , $252.90 ," $1,079.34 "," $1,110.55 "," $1,052.10 "," $1,052.10 "," $1,052.10 "," $1,087.17 "," $1,122.24 ", $594.12 , $993.65 , $913.44 , $600.62 , N/A , $477.60 , $477.60 ," $1,110.55 ", $553.84 , $163.07 ," $1,122.24 "
 Acetylcholine Beaker1 ,CPT® 83516,0302 - LAB/IMMUNOLOGY,N/A,N/A, $136.00 , $88.40 , $114.24 , $11.76 , $11.76 , $109.89 , $122.40 , $115.14 , $122.40 , $122.40 , $122.40 , $115.60 , $11.53 , $125.57 , $129.20 , $115.60 , $126.48 , $126.48 , $129.20 , $130.56 , $111.28 , $122.40 , $115.60 , $107.44 , N/A , $110.06 , $110.06 , $129.20 , $116.70 , $11.53 , $130.56 
Njx Cholangio Prq W/Img Gid Rs&I Existing Access,CPT® 47531,N/A,N/A,N/A, $921.00 , $598.65 , $431.15 , $66.92 , $442.90 , $467.46 , $344.35 , $856.53 , $828.90 , $828.90 , $736.80 , $736.80 , $442.90 , $850.36 , $874.95 , $828.90 , $828.90 , $828.90 , $856.53 , $884.16 , $311.91 , $782.85 , $364.27 , $417.03 , N/A , $476.58 , $476.58 , $874.95 , $498.45 , $66.92 , $884.16 
Manipulate Wrist W/Anesthes,CPT® 25259,N/A,N/A,N/A," $2,512.00 "," $1,632.80 "," $2,670.79 ", $422.63 , $236.18 ," $2,010.77 "," $2,028.44 "," $2,336.16 "," $2,260.80 "," $2,260.80 "," $2,009.60 "," $2,009.60 ", $236.18 ," $2,319.33 "," $2,386.40 "," $2,260.80 "," $2,260.80 "," $2,260.80 "," $2,336.16 "," $2,411.52 "," $2,452.44 "," $2,135.20 "," $2,221.16 "," $2,390.11 ", N/A ," $2,050.01 "," $2,050.01 "," $2,386.40 "," $2,409.50 ", $236.18 ," $2,670.79 "
Elec Alys Implt Smpl Cn Npgt Prgrmg,CPT® 95976,N/A,N/A,N/A, $210.00 , $136.50 , $143.72 , $37.49 , $32.32 , $119.93 , N/A , $195.30 , $189.00 , $189.00 , $168.00 , $168.00 , $32.32 , $193.89 , $199.50 , $189.00 , $189.00 , $189.00 , $195.30 , $201.60 , $169.41 , $178.50 , $116.11 , $150.35 , N/A , $122.27 , $122.27 , $199.50 , $150.32 , $32.32 , $201.60 
 Fac Rmvl Nfros Tube Req Fluor Gid ,CPT® 50389,0360 - OR SERVICES,N/A,N/A," $5,965.00 "," $3,877.25 "," $5,010.60 ", $50.70 , $432.29 ," $4,819.72 "," $5,368.50 "," $5,049.97 "," $5,368.50 "," $5,368.50 "," $5,368.50 "," $5,070.25 ", $423.81 ," $5,507.48 "," $5,666.75 "," $5,070.25 "," $5,547.45 "," $5,547.45 "," $5,666.75 "," $5,726.40 "," $4,880.56 "," $5,368.50 "," $5,070.25 "," $4,712.35 ", N/A ," $4,827.47 "," $4,827.47 "," $5,666.75 "," $5,118.57 ", $50.70 ," $5,726.40 "
"Excis Mouth Mucosa/Sub,No Repair",CPT® 40810,N/A,N/A,N/A," $1,432.00 ", $930.80 , $757.97 , $119.56 , $46.08 , $623.48 , $644.77 ," $1,331.76 "," $1,288.80 "," $1,288.80 "," $1,145.60 "," $1,145.60 ", $46.08 ," $1,322.17 "," $1,360.40 "," $1,288.80 "," $1,288.80 "," $1,288.80 "," $1,331.76 "," $1,374.72 ", $542.69 ," $1,217.20 ", $702.92 , $733.18 , N/A , $635.65 , $635.65 ," $1,360.40 ", $664.80 , $46.08 ," $1,374.72 "
"Excis Benign Bone Lesn,Phalanx",CPT® 26210,N/A,N/A,N/A," $3,002.00 "," $1,951.30 "," $2,756.59 ", $435.10 , $384.19 ," $2,127.80 "," $2,131.42 "," $2,791.86 "," $2,701.80 "," $2,701.80 "," $2,401.60 "," $2,401.60 ", $384.19 ," $2,771.75 "," $2,851.90 "," $2,701.80 "," $2,701.80 "," $2,701.80 "," $2,791.86 "," $2,881.92 "," $2,555.66 "," $2,551.70 "," $2,340.69 "," $2,530.43 ", N/A ," $2,169.32 "," $2,169.32 "," $2,851.90 "," $2,549.73 ", $384.19 ," $2,881.92 "
Bone Length Studies,CPT® 77073,N/A,N/A,N/A, $797.00 , $518.05 , $254.39 , $44.12 , $34.41 , $172.01 , $201.49 , $741.21 , $717.30 , $717.30 , $637.60 , $637.60 , $34.41 , $735.87 , $757.15 , $717.30 , $717.30 , $717.30 , $741.21 , $765.12 , $247.78 , $677.45 , $223.42 , $181.39 , N/A , $175.36 , $175.36 , $757.15 , $203.00 , $34.41 , $765.12 
Debridement of Nails 1-6,11720,N/A,N/A,N/A, $125.00 , $81.25 , $46.82 , $13.79 , $19.04 , $41.04 , $39.04 , $116.25 , $112.50 , $112.50 , $100.00 , $100.00 , $19.04 , $115.41 , $118.75 , $112.50 , $112.50 , $112.50 , $116.25 , $120.00 , $51.62 , $106.25 , $76.71 , $52.68 , N/A , $41.84 , $41.84 , $118.75 , $48.53 , $13.79 , $120.00 
Treat Articular Fracture,CPT® 26742,N/A,N/A,N/A," $2,132.00 "," $1,385.80 "," $2,083.84 ", $329.17 , $168.45 ," $1,595.87 "," $1,612.46 "," $1,982.76 "," $1,918.80 "," $1,918.80 "," $1,705.60 "," $1,705.60 ", $168.45 ," $1,968.48 "," $2,025.40 "," $1,918.80 "," $1,918.80 "," $1,918.80 "," $1,982.76 "," $2,046.72 "," $1,930.83 "," $1,812.20 "," $1,771.58 "," $1,911.72 ", N/A ," $1,627.01 "," $1,627.01 "," $2,025.40 "," $1,912.32 ", $168.45 ," $2,083.84 "
 RAMUCIRUMAB 500 MG/50ML IV SOLN ,HCPCS J9308,0636 - DRUGS REQUIRING DETAILED CODIN,00002-7678-01,50 mL," $20,385.68 "," $13,250.69 "," $17,123.97 ", $70.25 , $68.20 ," $16,471.63 "," $18,347.11 "," $17,258.52 "," $18,347.11 "," $18,347.11 "," $18,347.11 "," $17,327.83 ", $66.86 ," $18,822.10 "," $19,366.40 "," $17,327.83 "," $18,958.68 "," $18,958.68 "," $19,366.40 "," $19,570.25 "," $16,679.56 "," $18,347.11 "," $17,327.83 "," $16,104.69 ", N/A ," $16,498.13 "," $16,498.13 "," $19,366.40 "," $17,492.95 ", $66.86 ," $19,570.25 "
Fx Carpal Bone W/O Manipu,25630,N/A,N/A,N/A," $1,172.00 ", $761.80 ," $1,768.39 ", $280.46 , $206.19 ," $1,350.10 "," $1,368.18 "," $1,089.96 "," $1,054.80 "," $1,054.80 ", $937.60 , $937.60 , $206.19 ," $1,082.11 "," $1,113.40 "," $1,054.80 "," $1,054.80 "," $1,054.80 "," $1,089.96 "," $1,125.12 "," $1,632.61 ", $996.20 ," $1,500.40 "," $1,608.26 ", N/A ," $1,376.44 "," $1,376.44 "," $1,113.40 "," $1,617.81 ", $206.19 ," $1,768.39 "
 Vas Lower Extremity Art. W Exercise ,CPT® 93924,0921 - PERI VASCUL LAB,N/A,N/A," $1,159.00 ", $753.35 , $973.56 , $153.65 , $163.90 , $936.47 ," $1,043.10 ", $981.21 ," $1,043.10 "," $1,043.10 "," $1,043.10 ", $985.15 , $160.69 ," $1,070.10 "," $1,101.05 ", $985.15 ," $1,077.87 "," $1,077.87 "," $1,101.05 "," $1,112.64 ", $948.29 ," $1,043.10 ", $985.15 , $915.61 , N/A , $937.98 , $937.98 ," $1,101.05 ", $994.54 , $153.65 ," $1,112.64 "
"Bladder Irrigation,Simple",51700,N/A,N/A,N/A, $288.00 , $187.20 , $164.05 , $28.50 , $18.87 , $219.00 , $200.92 , $267.84 , $259.20 , $259.20 , $230.40 , $230.40 , $18.87 , $265.91 , $273.60 , $259.20 , $259.20 , $259.20 , $267.84 , $276.48 , $164.92 , $244.80 , $228.36 , $187.29 , N/A , $223.27 , $223.27 , $273.60 , $262.41 , $18.87 , $276.48 
 ACETAMINOPHEN 325 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6773-61,1 tablet, $0.42 , $0.27 , $0.35 , N/A , N/A , $0.34 , $0.38 , $0.36 , $0.38 , $0.38 , $0.38 , $0.36 , N/A , $0.39 , $0.40 , $0.36 , $0.39 , $0.39 , $0.40 , $0.40 , $0.34 , $0.38 , $0.36 , $0.33 , N/A , $0.34 , $0.34 , $0.40 , $0.36 , $0.33 , $0.40 
 Eovist per Ml Gadoxetate Disodium ,HCPCS A9581,0636 - DRUGS REQUIRING DETAILED CODIN,N/A,N/A, $15.00 , $9.75 , $12.60 , $15.02 , $13.77 , $12.12 , $13.50 , $12.70 , $13.50 , $13.50 , $13.50 , $12.75 , $13.50 , $13.85 , $14.25 , $12.75 , $13.95 , $13.95 , $14.25 , $14.40 , $12.27 , $13.50 , $12.75 , $11.85 , N/A , $12.14 , $12.14 , $14.25 , $12.87 , $11.85 , $15.02 
 Fac Assay of Free Thyroxine ,CPT® 84439,0301 - LAB/CHEMISTRY,N/A,N/A, $106.00 , $68.90 , $89.04 , $9.20 , $9.20 , $85.65 , $95.40 , $89.74 , $95.40 , $95.40 , $95.40 , $90.10 , $9.02 , $97.87 , $100.70 , $90.10 , $98.58 , $98.58 , $100.70 , $101.76 , $86.73 , $95.40 , $90.10 , $83.74 , N/A , $85.79 , $85.79 , $100.70 , $90.96 , $9.02 , $101.76 
Diagnostic Bone Marrow Biopsies,38221,N/A,N/A,N/A," $1,202.00 ", $781.30 , $340.20 , $67.98 , $234.23 , $269.17 , $270.00 ," $1,117.86 "," $1,081.80 "," $1,081.80 ", $961.60 , $961.60 , $234.23 ," $1,109.81 "," $1,141.90 "," $1,081.80 "," $1,081.80 "," $1,081.80 "," $1,117.86 "," $1,153.92 ", $359.38 ," $1,021.70 ", $387.14 , $355.09 , N/A , $274.42 , $274.42 ," $1,141.90 ", $318.38 , $67.98 ," $1,153.92 "
 Fac Assay of Creatinine ,CPT® 82565,0301 - LAB/CHEMISTRY,N/A,N/A, $73.00 , $47.45 , $61.32 , $5.22 , $5.22 , $58.98 , $65.70 , $61.80 , $65.70 , $65.70 , $65.70 , $62.05 , $5.12 , $67.40 , $69.35 , $62.05 , $67.89 , $67.89 , $69.35 , $70.08 , $59.73 , $65.70 , $62.05 , $57.67 , N/A , $59.08 , $59.08 , $69.35 , $62.64 , $5.12 , $70.08 
 Fac Medication Admin & Hemodynamic Measurment ,CPT® 93463,0481 - CARDIAC CATH LAB,N/A,N/A," $3,861.00 "," $2,509.65 "," $3,243.24 ", $93.96 , $114.22 ," $3,119.69 "," $3,474.90 "," $3,268.72 "," $3,474.90 "," $3,474.90 "," $3,474.90 "," $3,281.85 ", $111.98 ," $3,564.86 "," $3,667.95 "," $3,281.85 "," $3,590.73 "," $3,590.73 "," $3,667.95 "," $3,706.56 "," $3,159.07 "," $3,474.90 "," $3,281.85 "," $3,050.19 ", N/A ," $3,124.71 "," $3,124.71 "," $3,667.95 "," $3,313.12 ", $93.96 ," $3,706.56 "
Hydroxyzine Hcl Injection,HCPCS J3410,N/A,N/A,N/A, $44.00 , $28.60 , N/A , $13.89 , $13.37 , N/A , N/A , $40.92 , $39.60 , $39.60 , $35.20 , $35.20 , $13.37 , $40.63 , $41.80 , $39.60 , $39.60 , $39.60 , $40.92 , $42.24 , $12.58 , $37.40 , $2.60 , $14.79 , N/A , N/A , N/A , $41.80 , N/A , $2.60 , $42.24 
 Fac Egd Deliver Thermal Energy Sphnctr/Cardia Gerd ,CPT® 43257,0360 - OR SERVICES,N/A,N/A, $770.00 , $500.50 , $646.80 , $218.70 , $274.68 , $622.16 , $693.00 , $651.88 , $693.00 , $693.00 , $693.00 , $654.50 , $269.29 , $710.94 , $731.50 , $654.50 , $716.10 , $716.10 , $731.50 , $739.20 , $630.01 , $693.00 , $654.50 , $608.30 , N/A , $623.16 , $623.16 , $731.50 , $660.74 , $218.70 , $739.20 
 Pro Remv Skin Tags ,CPT® 11200,0982 - PRO FEE/OUTPT,N/A,N/A, $163.00 , $105.95 , $244.80 , $74.08 , $40.50 , $199.18 , $197.46 , $151.59 , $146.70 , $146.70 , $130.40 , $130.40 , $40.50 , $150.50 , $154.85 , $146.70 , $146.70 , $146.70 , $151.59 , $156.48 , $265.13 , $138.55 , $390.71 , $259.40 , N/A , $203.07 , $203.07 , $154.85 , $235.48 , $40.50 , $390.71 
 Injection Single/Multiple Trigger Points - Mh ,CPT® 20552,0761 - TREATMENT ROOM,N/A,N/A, $472.00 , $306.80 , $396.48 , $35.51 , $26.41 , $381.38 , $424.80 , $399.60 , $424.80 , $424.80 , $424.80 , $401.20 , $25.89 , $435.80 , $448.40 , $401.20 , $438.96 , $438.96 , $448.40 , $453.12 , $386.19 , $424.80 , $401.20 , $372.88 , N/A , $381.99 , $381.99 , $448.40 , $405.02 , $25.89 , $453.12 
 BICALUTAMIDE 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,47335-0485-83,1 tablet, $95.21 , $61.89 , $79.98 , N/A , N/A , $76.93 , $85.69 , $80.60 , $85.69 , $85.69 , $85.69 , $80.93 , N/A , $87.91 , $90.45 , $80.93 , $88.55 , $88.55 , $90.45 , $91.40 , $77.90 , $85.69 , $80.93 , $75.22 , N/A , $77.05 , $77.05 , $90.45 , $81.70 , $75.22 , $91.40 
"Circumcision,Clamp,Newborn",CPT® 54150,N/A,N/A,N/A, $830.00 , $539.50 , $426.81 , $91.37 , $61.84 , $313.26 , $316.20 , $771.90 , $747.00 , $747.00 , $664.00 , $664.00 , $61.84 , $766.34 , $788.50 , $747.00 , $747.00 , $747.00 , $771.90 , $796.80 , $401.58 , $705.50 , $508.46 , $470.51 , N/A , $319.36 , $319.36 , $788.50 , $382.78 , $61.84 , $796.80 
Therapeutic Exercises,CPT® 97110,N/A,N/A,N/A, $145.00 , $94.25 , $69.17 , $29.46 , $32.01 , $73.08 , $64.93 , $134.85 , $130.50 , $130.50 , $116.00 , $116.00 , $32.01 , $133.88 , $137.75 , $130.50 , $130.50 , $130.50 , $134.85 , $139.20 , $75.10 , $123.25 , $95.29 , $69.32 , N/A , $74.51 , $74.51 , $137.75 , $82.86 , $29.46 , $139.20 
"Critical Care Interfacility Transport, <=24 Mo, 30-74 Min",CPT® 99466,N/A,N/A,N/A, $962.00 , $625.30 , $475.48 , $226.06 , N/A , $650.72 , $448.45 , $894.66 , $865.80 , $865.80 , $769.60 , $769.60 , N/A , $888.21 , $913.90 , $865.80 , $865.80 , $865.80 , $894.66 , $923.52 , $600.71 , $817.70 , $581.33 , $524.84 , N/A , $663.42 , $663.42 , $913.90 , $793.80 , $226.06 , $923.52 
 VITAMIN B-12 250 MCG PO TABS ,HCPCS RXC637,0250 - PHARMACY,50268-0853-15,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Exc/Destruction Open Abdominal Tumors >10.0 Cm,CPT® 49205,N/A,N/A,N/A," $11,376.00 "," $7,394.40 "," $10,411.96 "," $1,619.65 "," $1,716.13 "," $8,262.29 "," $8,274.88 "," $10,579.68 "," $10,238.40 "," $10,238.40 "," $9,100.80 "," $9,100.80 "," $1,716.13 "," $10,503.46 "," $10,807.20 "," $10,238.40 "," $10,238.40 "," $10,238.40 "," $10,579.68 "," $10,920.96 "," $7,477.36 "," $9,669.60 "," $9,193.28 "," $9,775.42 ", N/A ," $8,423.50 "," $8,423.50 "," $10,807.20 "," $8,810.08 "," $1,619.65 "," $10,920.96 "
 Fac 3d Render W/O Postprocess ,CPT® 76376,0480 - CARDIOLOGY,N/A,N/A, $714.00 , $464.10 , $599.76 , $23.55 , $71.81 , $576.91 , $642.60 , $604.47 , $642.60 , $642.60 , $642.60 , $606.90 , $70.40 , $659.24 , $678.30 , $606.90 , $664.02 , $664.02 , $678.30 , $685.44 , $584.19 , $642.60 , $606.90 , $564.06 , N/A , $577.84 , $577.84 , $678.30 , $612.68 , $23.55 , $685.44 
 Fac Insj Intraperitoneal Catheter W/Img Guid ,CPT® 49418,0361 - OR/MINOR,N/A,N/A," $9,649.00 "," $6,271.85 "," $8,105.16 ", $190.80 , $168.01 ," $7,796.39 "," $8,684.10 "," $8,168.84 "," $8,684.10 "," $8,684.10 "," $8,684.10 "," $8,201.65 ", $164.72 ," $8,908.92 "," $9,166.55 "," $8,201.65 "," $8,973.57 "," $8,973.57 "," $9,166.55 "," $9,263.04 "," $7,894.81 "," $8,684.10 "," $8,201.65 "," $7,622.71 ", N/A ," $7,808.94 "," $7,808.94 "," $9,166.55 "," $8,279.81 ", $164.72 ," $9,263.04 "
 Pro Smpl Rpr Supfc F/E/E/N/L/M 5.1cm-7.5cm ,CPT® 12014,0981 - PRO FEE/ER,N/A,N/A, $752.00 , $488.80 , $232.08 , $69.01 , $92.31 , $214.79 , $208.07 , $699.36 , $676.80 , $676.80 , $601.60 , $601.60 , $92.31 , $694.32 , $714.40 , $676.80 , $676.80 , $676.80 , $699.36 , $721.92 , $255.61 , $639.20 , $417.47 , $258.60 , N/A , $218.98 , $218.98 , $714.40 , $253.95 , $69.01 , $721.92 
 Pro Exc Face-Mm Malig+Marg 3.1-4 ,CPT® 11644,0982 - PRO FEE/OUTPT,N/A,N/A," $1,990.00 "," $1,293.50 ", $899.54 , $268.82 , $596.38 , $778.04 , $757.93 ," $1,850.70 "," $1,791.00 "," $1,791.00 "," $1,592.00 "," $1,592.00 ", $596.38 ," $1,837.37 "," $1,890.50 "," $1,791.00 "," $1,791.00 "," $1,791.00 "," $1,850.70 "," $1,910.40 ", $986.37 ," $1,691.50 "," $1,514.67 ", $995.32 , N/A , $793.23 , $793.23 ," $1,890.50 ", $919.88 , $268.82 ," $1,910.40 "
" Pro Removal Testis,Simple ",CPT® 54520,0975 - PRO FEE/OR,N/A,N/A," $2,806.00 "," $1,823.90 "," $1,453.43 ", $313.50 , $344.66 ," $1,044.20 "," $1,061.91 "," $2,609.58 "," $2,525.40 "," $2,525.40 "," $2,244.80 "," $2,244.80 ", $344.66 ," $2,590.78 "," $2,665.70 "," $2,525.40 "," $2,525.40 "," $2,525.40 "," $2,609.58 "," $2,693.76 "," $1,362.34 "," $2,385.10 "," $1,700.21 "," $1,576.27 ", N/A ," $1,064.58 "," $1,064.58 "," $2,665.70 "," $1,275.96 ", $313.50 ," $2,693.76 "
"MR Angio, Neck, Combo",CPT® 70549,N/A,N/A,N/A," $9,488.00 "," $6,167.20 "," $2,476.25 ", $354.34 , $616.14 ," $2,865.15 "," $3,669.14 "," $8,823.84 "," $8,539.20 "," $8,539.20 "," $7,590.40 "," $7,590.40 ", $616.14 ," $8,760.27 "," $9,013.60 "," $8,539.20 "," $8,539.20 "," $8,539.20 "," $8,823.84 "," $9,108.48 "," $2,113.64 "," $8,064.80 "," $3,996.54 "," $3,361.29 ", N/A ," $2,921.06 "," $2,921.06 "," $9,013.60 "," $3,381.19 ", $354.34 ," $9,108.48 "
 Pro Radiofrequency Abltj Nrv Nrvtg Si Jt W/Img Gdn ,CPT® 64625,0982 - PRO FEE/OUTPT,N/A,N/A," $4,849.00 "," $3,151.85 ", $966.63 , $188.08 , $393.42 ," $1,066.40 ", N/A ," $4,509.57 "," $4,364.10 "," $4,364.10 "," $3,879.20 "," $3,879.20 ", $393.42 ," $4,477.08 "," $4,606.55 "," $4,364.10 "," $4,364.10 "," $4,364.10 "," $4,509.57 "," $4,655.04 "," $1,037.55 "," $4,121.65 "," $1,021.74 "," $1,175.79 ", N/A ," $1,087.21 "," $1,087.21 "," $4,606.55 "," $1,166.27 ", $188.08 ," $4,655.04 "
 DIVALPROEX SODIUM ER 250 MG PO TB24 ,HCPCS RXC637,0250 - PHARMACY,00904-6363-61,1 tablet, $7.97 , $5.18 , $6.69 , N/A , N/A , $6.44 , $7.17 , $6.75 , $7.17 , $7.17 , $7.17 , $6.77 , N/A , $7.36 , $7.57 , $6.77 , $7.41 , $7.41 , $7.57 , $7.65 , $6.52 , $7.17 , $6.77 , $6.30 , N/A , $6.45 , $6.45 , $7.57 , $6.84 , $6.30 , $7.65 
 CEFOXITIN SODIUM 2 G IV SOLR ,HCPCS J0694,0636 - DRUGS REQUIRING DETAILED CODIN,25021-0110-20,10 mL, $61.65 , $40.07 , $51.79 , $5.10 , $5.26 , $49.81 , $55.49 , $52.19 , $55.49 , $55.49 , $55.49 , $52.40 , $5.16 , $56.92 , $58.57 , $52.40 , $57.33 , $57.33 , $58.57 , $59.18 , $50.44 , $55.49 , $52.40 , $48.70 , N/A , $49.89 , $49.89 , $58.57 , $52.90 , $5.10 , $59.18 
 Fac Blood Clot Inhibitor Assay ,CPT® 85305,0305 - LAB/HEMATOLOGY,N/A,N/A, $274.00 , $178.10 , $230.16 , $11.84 , $11.84 , $221.39 , $246.60 , $231.97 , $246.60 , $246.60 , $246.60 , $232.90 , $11.61 , $252.98 , $260.30 , $232.90 , $254.82 , $254.82 , $260.30 , $263.04 , $224.19 , $246.60 , $232.90 , $216.46 , N/A , $221.75 , $221.75 , $260.30 , $235.12 , $11.61 , $263.04 
 Fac Appl Long Leg Splnt Thi Ankle/Toes ,CPT® 29505,0761 - TREATMENT ROOM,N/A,N/A, $257.00 , $167.05 , $215.88 , $49.45 , $46.08 , $207.66 , $231.30 , $217.58 , $231.30 , $231.30 , $231.30 , $218.45 , $45.18 , $237.29 , $244.15 , $218.45 , $239.01 , $239.01 , $244.15 , $246.72 , $210.28 , $231.30 , $218.45 , $203.03 , N/A , $207.99 , $207.99 , $244.15 , $220.53 , $45.18 , $246.72 
Methylprednisolone 40 Mg Inj,HCPCS J1030,N/A,N/A,N/A, $25.00 , $16.25 , N/A , $7.76 , $8.24 , N/A , N/A , $23.25 , $22.50 , $22.50 , $20.00 , $20.00 , $8.24 , $23.08 , $23.75 , $22.50 , $22.50 , $22.50 , $23.25 , $24.00 , $7.22 , $21.25 , $5.19 , $9.71 , N/A , N/A , N/A , $23.75 , N/A , $5.19 , $24.00 
Nasal/Sinus Ndsc W/Lig Sphenopalatine Artery,CPT® 31241,N/A,N/A,N/A," $2,519.00 "," $1,637.35 "," $2,394.53 ", $422.76 , $344.93 ," $1,598.83 "," $1,616.88 "," $2,342.67 "," $2,267.10 "," $2,267.10 "," $2,015.20 "," $2,015.20 ", $344.93 ," $2,325.79 "," $2,393.05 "," $2,267.10 "," $2,267.10 "," $2,267.10 "," $2,342.67 "," $2,418.24 "," $2,294.96 "," $2,141.15 "," $2,347.34 "," $2,269.20 ", N/A ," $1,630.02 "," $1,630.02 "," $2,393.05 "," $1,919.70 ", $344.93 ," $2,418.24 "
 Fac Behavioral & Qualit Analysis Voice and Resonance ,CPT® 92524,0440 - SPEECH PATHOL,N/A,N/A, $444.00 , $288.60 , $372.96 , $109.16 , $86.24 , $358.75 , $399.60 , $375.89 , $399.60 , $399.60 , $399.60 , $377.40 , $84.55 , $409.95 , $421.80 , $377.40 , $412.92 , $412.92 , $421.80 , $426.24 , $363.28 , $399.60 , $377.40 , $350.76 , N/A , $359.33 , $359.33 , $421.80 , $381.00 , $84.55 , $426.24 
Pfizer Admin Peds First Dose,CPT® 0071A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $76.25 , $128.66 , N/A , $82.60 , $82.60 , $66.50 , $96.14 , $38.92 , $128.66 
 Pro Removal of Heel Spur ,CPT® 28119,0982 - PRO FEE/OUTPT,N/A,N/A," $3,308.00 "," $2,150.20 "," $2,257.00 ", $353.25 , $384.19 ," $1,779.50 "," $1,771.98 "," $3,076.44 "," $2,977.20 "," $2,977.20 "," $2,646.40 "," $2,646.40 ", $384.19 ," $3,054.28 "," $3,142.60 "," $2,977.20 "," $2,977.20 "," $2,977.20 "," $3,076.44 "," $3,175.68 "," $2,084.07 "," $2,811.80 "," $1,917.87 "," $2,110.43 ", N/A ," $1,814.22 "," $1,814.22 "," $3,142.60 "," $2,132.34 ", $353.25 ," $3,175.68 "
Post OP Wound Infct Drain,10180,N/A,N/A,N/A," $1,100.00 ", $715.00 , $560.69 , $168.12 , $111.13 , $482.45 , $474.37 ," $1,023.00 ", $990.00 , $990.00 , $880.00 , $880.00 , $111.13 ," $1,015.63 "," $1,045.00 ", $990.00 , $990.00 , $990.00 ," $1,023.00 "," $1,056.00 ", $615.17 , $935.00 , $954.47 , $613.85 , N/A , $491.86 , $491.86 ," $1,045.00 ", $570.41 , $111.13 ," $1,056.00 "
" Fac Hocm <=149 Mg/Ml Iodine, 1ml ",HCPCS Q9958,0255 - DRUGS/RADIOLOGY,N/A,N/A, $1.00 , $0.65 , $0.84 , $0.08 , $0.08 , $0.81 , $0.90 , $0.85 , $0.90 , $0.90 , $0.90 , $0.85 , $0.08 , $0.92 , $0.95 , $0.85 , $0.93 , $0.93 , $0.95 , $0.96 , $0.82 , $0.90 , $0.85 , $0.79 , N/A , $0.81 , $0.81 , $0.95 , $0.86 , $0.08 , $0.96 
 Fac Esophagoscopy Flexible Transoral Ultrasound Exam ,CPT® 43231,0360 - OR SERVICES,N/A,N/A," $2,260.00 "," $1,469.00 "," $1,898.40 ", $150.28 , $326.81 ," $1,826.08 "," $2,034.00 "," $1,913.32 "," $2,034.00 "," $2,034.00 "," $2,034.00 "," $1,921.00 ", $320.40 ," $2,086.66 "," $2,147.00 "," $1,921.00 "," $2,101.80 "," $2,101.80 "," $2,147.00 "," $2,169.60 "," $1,849.13 "," $2,034.00 "," $1,921.00 "," $1,785.40 ", N/A ," $1,829.02 "," $1,829.02 "," $2,147.00 "," $1,939.31 ", $150.28 ," $2,169.60 "
 Fac Bld# Spun Microhematocrit ,CPT® 85013,0300 - LABORATORY,N/A,N/A, $33.00 , $21.45 , $27.72 , $7.14 , $3.29 , $26.66 , $29.70 , $27.94 , $29.70 , $29.70 , $29.70 , $28.05 , $3.23 , $30.47 , $31.35 , $28.05 , $30.69 , $30.69 , $31.35 , $31.68 , $27.00 , $29.70 , $28.05 , $26.07 , N/A , $26.71 , $26.71 , $31.35 , $28.32 , $3.23 , $31.68 
" Fac Injection,Therap/Proph/Diagnost, IV Push, Ea Add, New Drug ",CPT® 96375,0260 - IV THERAPY,N/A,N/A, $204.00 , $132.60 , $171.36 , $15.06 , $21.95 , $164.83 , $183.60 , $172.71 , $183.60 , $183.60 , $183.60 , $173.40 , $21.52 , $188.35 , $193.80 , $173.40 , $189.72 , $189.72 , $193.80 , $195.84 , $166.91 , $183.60 , $173.40 , $161.16 , N/A , $165.10 , $165.10 , $193.80 , $175.05 , $15.06 , $195.84 
 Fac Colonoscopy Stoma W/Rmvl Tum Polyp/Oth Les Snare ,CPT® 44394,0360 - OR SERVICES,N/A,N/A," $2,958.00 "," $1,922.70 "," $2,484.72 ", $212.48 , $362.61 ," $2,390.06 "," $2,662.20 "," $2,504.24 "," $2,662.20 "," $2,662.20 "," $2,662.20 "," $2,514.30 ", $355.50 ," $2,731.12 "," $2,810.10 "," $2,514.30 "," $2,750.94 "," $2,750.94 "," $2,810.10 "," $2,839.68 "," $2,420.24 "," $2,662.20 "," $2,514.30 "," $2,336.82 ", N/A ," $2,393.91 "," $2,393.91 "," $2,810.10 "," $2,538.26 ", $212.48 ," $2,839.68 "
"Psychophysiol Therapy,20-30 Min",CPT® 90875,N/A,N/A,N/A, $249.00 , $161.85 , N/A , $58.00 , $55.74 , $137.05 , $135.45 , $231.57 , $224.10 , $224.10 , $199.20 , $199.20 , $55.74 , $229.90 , $236.55 , $224.10 , $224.10 , $224.10 , $231.57 , $239.04 , $148.63 , $211.65 , $179.43 , $233.13 , N/A , $139.72 , $139.72 , $236.55 , $162.87 , $55.74 , $239.04 
"T Cells, Total Count",CPT® 86359,N/A,N/A,N/A, $267.00 , $173.55 , N/A , $38.48 , $38.48 , $213.44 , $255.29 , $248.31 , $240.30 , $240.30 , $213.60 , $213.60 , $38.48 , $246.52 , $253.65 , $240.30 , $240.30 , $240.30 , $248.31 , $256.32 , $251.93 , $226.95 , $246.52 , $136.81 , N/A , $199.20 , $199.20 , $253.65 , $217.68 , $38.48 , $256.32 
"Anoscopy,W/Dilation",CPT® 46604,N/A,N/A,N/A, $424.00 , $275.60 , $401.12 , $62.18 , $38.12 , $319.26 , $323.94 , $394.32 , $381.60 , $381.60 , $339.20 , $339.20 , $38.12 , $391.48 , $402.80 , $381.60 , $381.60 , $381.60 , $394.32 , $407.04 , $284.85 , $360.40 , $355.03 , $378.92 , N/A , $325.49 , $325.49 , $402.80 , $340.41 , $38.12 , $407.04 
 Sc Bx Pleura Perc Ndl ,CPT® 32400,0761 - TREATMENT ROOM,N/A,N/A," $1,989.00 "," $1,292.85 "," $1,670.76 ", $80.52 , $153.67 ," $1,607.11 "," $1,790.10 "," $1,683.89 "," $1,790.10 "," $1,790.10 "," $1,790.10 "," $1,690.65 ", $150.66 ," $1,836.44 "," $1,889.55 "," $1,690.65 "," $1,849.77 "," $1,849.77 "," $1,889.55 "," $1,909.44 "," $1,627.40 "," $1,790.10 "," $1,690.65 "," $1,571.31 ", N/A ," $1,609.70 "," $1,609.70 "," $1,889.55 "," $1,706.76 ", $80.52 ," $1,909.44 "
 Fac Cytogenetics&Molec Cytogenetics I&R ,CPT® 88291,0310 - PATHOLOGY LAB,N/A,N/A, $457.00 , $297.05 , $383.88 , $31.99 , $5.77 , $369.26 , $411.30 , $386.90 , $411.30 , $411.30 , $411.30 , $388.45 , $5.66 , $421.95 , $434.15 , $388.45 , $425.01 , $425.01 , $434.15 , $438.72 , $373.92 , $411.30 , $388.45 , $361.03 , N/A , $369.85 , $369.85 , $434.15 , $392.15 , $5.66 , $438.72 
Open/Perq Placement Intravascular Stent Initial,CPT® 37236,N/A,N/A,N/A," $11,062.00 "," $7,190.30 "," $2,575.89 ", $396.08 , $520.66 ," $1,935.10 "," $2,026.54 "," $10,287.66 "," $9,955.80 "," $9,955.80 "," $8,849.60 "," $8,849.60 ", $520.66 ," $10,213.54 "," $10,508.90 "," $9,955.80 "," $9,955.80 "," $9,955.80 "," $10,287.66 "," $10,619.52 "," $2,393.73 "," $9,402.70 "," $2,285.15 "," $2,166.89 ", N/A ," $1,972.86 "," $1,972.86 "," $10,508.90 "," $2,241.17 ", $396.08 ," $10,619.52 "
 Pro Hepatobiliary Syst Imaging Including Gallbladder ,CPT® 78226,0972 - PRO FEE/RAD/DX,N/A,N/A, $305.00 , $198.25 ," $1,738.32 ", $297.35 , $256.59 ," $1,630.13 "," $2,004.88 ", $283.65 , $274.50 , $274.50 , $244.00 , $244.00 , $256.59 , $281.61 , $289.75 , $274.50 , $274.50 , $274.50 , $283.65 , $292.80 ," $1,810.79 ", $259.25 ," $2,205.32 "," $2,227.75 ", N/A ," $1,661.94 "," $1,661.94 ", $289.75 ," $1,923.71 ", $244.00 ," $2,227.75 "
"Fx Radial,Closed,W/O Mani",25600,N/A,N/A,N/A," $1,329.00 ", $863.85 ," $2,022.28 ", $320.97 , $171.85 ," $1,493.35 "," $1,527.62 "," $1,235.97 "," $1,196.10 "," $1,196.10 "," $1,063.20 "," $1,063.20 ", $171.85 ," $1,227.07 "," $1,262.55 "," $1,196.10 "," $1,196.10 "," $1,196.10 "," $1,235.97 "," $1,275.84 "," $1,852.86 "," $1,129.65 "," $1,673.45 "," $1,783.02 ", N/A ," $1,522.49 "," $1,522.49 "," $1,262.55 "," $1,789.47 ", $171.85 ," $2,022.28 "
" Fac Vein X-Ray, Liver With Hemodynamic Eval ",CPT® 75885,0320 - DX X-RAY,N/A,N/A," $1,224.00 ", $795.60 ," $1,028.16 ", $134.15 , $237.76 , $988.99 ," $1,101.60 "," $1,036.24 "," $1,101.60 "," $1,101.60 "," $1,101.60 "," $1,040.40 ", $233.10 ," $1,130.12 "," $1,162.80 "," $1,040.40 "," $1,138.32 "," $1,138.32 "," $1,162.80 "," $1,175.04 "," $1,001.48 "," $1,101.60 "," $1,040.40 ", $966.96 , N/A , $990.58 , $990.58 ," $1,162.80 "," $1,050.31 ", $134.15 ," $1,175.04 "
 Fac Cellular Function Assay Stimul&Detect Biomarker ,CPT® 86352,0310 - PATHOLOGY LAB,N/A,N/A, $209.00 , $135.85 , $175.56 , $138.58 , $99.25 , $168.87 , $188.10 , $176.94 , $188.10 , $188.10 , $188.10 , $177.65 , $97.30 , $192.97 , $198.55 , $177.65 , $194.37 , $194.37 , $198.55 , $200.64 , $171.00 , $188.10 , $177.65 , $165.11 , N/A , $169.14 , $169.14 , $198.55 , $179.34 , $97.30 , $200.64 
 SUCRALFATE 1 GM/10ML PO SUSP ,HCPCS RXC637,0250 - PHARMACY,00121-0974-94,10 mL, $55.79 , $36.26 , $46.86 , N/A , N/A , $45.08 , $50.21 , $47.23 , $50.21 , $50.21 , $50.21 , $47.42 , N/A , $51.51 , $53.00 , $47.42 , $51.88 , $51.88 , $53.00 , $53.56 , $45.65 , $50.21 , $47.42 , $44.07 , N/A , $45.15 , $45.15 , $53.00 , $47.87 , $44.07 , $53.56 
 Pro Sp Bone Algrft Morsel Add-On ,CPT® 20930,0982 - PRO FEE/OUTPT,N/A,N/A," $1,392.00 ", $904.80 , N/A , N/A , $382.01 , $584.90 , $571.27 ," $1,294.56 "," $1,252.80 "," $1,252.80 "," $1,113.60 "," $1,113.60 ", $382.01 ," $1,285.23 "," $1,322.40 "," $1,252.80 "," $1,252.80 "," $1,252.80 "," $1,294.56 "," $1,336.32 ", N/A ," $1,183.20 ", N/A , $681.93 , N/A , $596.32 , $596.32 ," $1,322.40 ", $700.88 , $382.01 ," $1,336.32 "
" Electrophoresis, Serum Immuno ",CPT® 86320,0302 - LAB/IMMUNOLOGY,N/A,N/A, $199.00 , $129.35 , $167.16 , $30.52 , $30.52 , $160.79 , $179.10 , $168.47 , $179.10 , $179.10 , $179.10 , $169.15 , $29.92 , $183.74 , $189.05 , $169.15 , $185.07 , $185.07 , $189.05 , $191.04 , $162.82 , $179.10 , $169.15 , $157.21 , N/A , $161.05 , $161.05 , $189.05 , $170.76 , $29.92 , $191.04 
 CAFFEINE-SODIUM BENZOATE 125-125 MG/ML IJ SOLN ,HCPCS RXA250,0250 - PHARMACY,00517-2502-10,2 mL, $182.53 , $118.64 , $153.33 , N/A , N/A , $147.48 , $164.28 , $154.53 , $164.28 , $164.28 , $164.28 , $155.15 , N/A , $168.53 , $173.40 , $155.15 , $169.75 , $169.75 , $173.40 , $175.23 , $149.35 , $164.28 , $155.15 , $144.20 , N/A , $147.72 , $147.72 , $173.40 , $156.63 , $144.20 , $175.23 
 TRANEXAMIC ACID 650 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,69918-0301-30,2 tablet, $53.57 , $34.82 , $45.00 , N/A , N/A , $43.28 , $48.21 , $45.35 , $48.21 , $48.21 , $48.21 , $45.53 , N/A , $49.46 , $50.89 , $45.53 , $49.82 , $49.82 , $50.89 , $51.43 , $43.83 , $48.21 , $45.53 , $42.32 , N/A , $43.35 , $43.35 , $50.89 , $45.97 , $42.32 , $51.43 
 Fac Motor &/Sens 9-10 Nrv Cndj Preconf Eltrode Limb ,CPT® 95911,0922 - EMG,N/A,N/A," $1,529.00 ", $993.85 ," $1,284.36 ", $208.77 , $174.53 ," $1,235.43 "," $1,376.10 "," $1,294.45 "," $1,376.10 "," $1,376.10 "," $1,376.10 "," $1,299.65 ", $171.11 ," $1,411.73 "," $1,452.55 "," $1,299.65 "," $1,421.97 "," $1,421.97 "," $1,452.55 "," $1,467.84 "," $1,251.03 "," $1,376.10 "," $1,299.65 "," $1,207.91 ", N/A ," $1,237.42 "," $1,237.42 "," $1,452.55 "," $1,312.03 ", $171.11 ," $1,467.84 "
 L Spine MRI Without & With Contrast ,CPT® 72158,0612 - MRI - SPINE,N/A,N/A," $6,206.00 "," $4,033.90 "," $5,213.04 ", $328.48 , $645.20 ," $5,014.45 "," $5,585.40 "," $5,254.00 "," $5,585.40 "," $5,585.40 "," $5,585.40 "," $5,275.10 ", $632.55 ," $5,730.00 "," $5,895.70 "," $5,275.10 "," $5,771.58 "," $5,771.58 "," $5,895.70 "," $5,957.76 "," $5,077.75 "," $5,585.40 "," $5,275.10 "," $4,902.74 ", N/A ," $5,022.52 "," $5,022.52 "," $5,895.70 "," $5,325.37 ", $328.48 ," $5,957.76 "
"Rout OB Care,Vag Deliv,Prev C-Sec",CPT® 59610,N/A,N/A,N/A," $7,887.00 "," $5,126.55 "," $6,763.08 "," $2,287.40 "," $1,247.00 "," $5,077.22 "," $5,362.18 "," $7,334.91 "," $7,098.30 "," $7,098.30 "," $6,309.60 "," $6,309.60 "," $1,247.00 "," $7,282.07 "," $7,492.65 "," $7,098.30 "," $7,098.30 "," $7,098.30 "," $7,334.91 "," $7,571.52 "," $6,830.99 "," $6,703.95 "," $11,819.42 "," $5,080.61 ", N/A ," $5,176.28 "," $5,176.28 "," $7,492.65 "," $5,984.27 "," $1,247.00 "," $11,819.42 "
"Treat Inter/Subtroch Fx,W/Plate/Screw",27244,N/A,N/A,N/A," $8,455.00 "," $5,495.75 "," $7,403.89 "," $1,157.71 "," $1,075.02 "," $5,946.99 "," $5,886.73 "," $7,863.15 "," $7,609.50 "," $7,609.50 "," $6,764.00 "," $6,764.00 "," $1,075.02 "," $7,806.50 "," $8,032.25 "," $7,609.50 "," $7,609.50 "," $7,609.50 "," $7,863.15 "," $8,116.80 "," $6,904.76 "," $7,186.75 "," $6,513.62 "," $6,990.58 ", N/A ," $6,063.03 "," $6,063.03 "," $8,032.25 "," $7,126.20 "," $1,075.02 "," $8,116.80 "
"MRI Lower Extrem Jt, W/O Contrast",CPT® 73721,N/A,N/A,N/A," $4,461.00 "," $2,899.65 "," $1,447.81 ", $207.55 , $411.63 ," $1,390.85 "," $1,461.33 "," $4,148.73 "," $4,014.90 "," $4,014.90 "," $3,568.80 "," $3,568.80 ", $411.63 ," $4,118.84 "," $4,237.95 "," $4,014.90 "," $4,014.90 "," $4,014.90 "," $4,148.73 "," $4,282.56 "," $2,529.09 "," $3,791.85 "," $1,596.69 "," $2,191.78 ", N/A ," $1,417.99 "," $1,417.99 "," $4,237.95 "," $1,668.22 ", $207.55 ," $4,282.56 "
Foot Lamin/Prepreg Composite,HCPCS L3031,N/A,N/A,N/A, $160.00 , $104.00 , N/A , $143.26 , $104.57 , N/A , N/A , $148.80 , $144.00 , $144.00 , $128.00 , $128.00 , $104.57 , $147.73 , $152.00 , $144.00 , $144.00 , $144.00 , $148.80 , $153.60 , N/A , $136.00 , $239.73 , $120.53 , N/A , N/A , N/A , $152.00 , N/A , $104.57 , $239.73 
Apply Long Leg Cast,CPT® 29345,N/A,N/A,N/A, $899.00 , $584.35 , $597.74 , $94.01 , $111.25 , $488.19 , $488.55 , $836.07 , $809.10 , $809.10 , $719.20 , $719.20 , $111.25 , $830.05 , $854.05 , $809.10 , $809.10 , $809.10 , $836.07 , $863.04 , $558.12 , $764.15 , $538.79 , $575.51 , N/A , $497.71 , $497.71 , $854.05 , $584.99 , $94.01 , $863.04 
Fillet Fingr/Toe Flap W Prep,CPT® 14350,N/A,N/A,N/A," $2,705.00 "," $1,758.25 "," $2,205.07 ", $654.72 , $401.40 ," $1,910.86 "," $1,889.87 "," $2,515.65 "," $2,434.50 "," $2,434.50 "," $2,164.00 "," $2,164.00 ", $401.40 ," $2,497.53 "," $2,569.75 "," $2,434.50 "," $2,434.50 "," $2,434.50 "," $2,515.65 "," $2,596.80 "," $2,414.98 "," $2,299.25 "," $3,757.24 "," $2,428.84 ", N/A ," $1,948.15 "," $1,948.15 "," $2,569.75 "," $2,259.20 ", $401.40 ," $3,757.24 "
 Fac Perq Device Placemt Breast Loc 1st Les W Guidnce ,CPT® 19281,0361 - OR/MINOR,N/A,N/A," $2,328.00 "," $1,513.20 "," $1,955.52 ", $95.05 , $77.40 ," $1,881.02 "," $2,095.20 "," $1,970.88 "," $2,095.20 "," $2,095.20 "," $2,095.20 "," $1,978.80 ", $75.88 ," $2,149.44 "," $2,211.60 "," $1,978.80 "," $2,165.04 "," $2,165.04 "," $2,211.60 "," $2,234.88 "," $1,904.77 "," $2,095.20 "," $1,978.80 "," $1,839.12 ", N/A ," $1,884.05 "," $1,884.05 "," $2,211.60 "," $1,997.66 ", $75.88 ," $2,234.88 "
 Pro Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn ,CPT® 62323,0982 - PRO FEE/OUTPT,N/A,N/A, $821.00 , $533.65 , $490.00 , $95.03 , $290.12 , $540.47 , $529.00 , $763.53 , $738.90 , $738.90 , $656.80 , $656.80 , $290.12 , $758.03 , $779.95 , $738.90 , $738.90 , $738.90 , $763.53 , $788.16 , $530.64 , $697.85 , $518.87 , $600.56 , N/A , $551.01 , $551.01 , $779.95 , $591.10 , $95.03 , $788.16 
 DIAZEPAM 2 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,51079-0284-20,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Blood Methemoglobin Assay ,CPT® 83050,0301 - LAB/CHEMISTRY,N/A,N/A, $155.00 , $100.75 , $130.20 , $8.36 , $4.07 , $125.24 , $139.50 , $131.22 , $139.50 , $139.50 , $139.50 , $131.75 , $3.99 , $143.11 , $147.25 , $131.75 , $144.15 , $144.15 , $147.25 , $148.80 , $126.82 , $139.50 , $131.75 , $122.45 , N/A , $125.44 , $125.44 , $147.25 , $133.01 , $3.99 , $148.80 
 Fac Cath Plmt R Hrt/Arts/Grfts W/Njx& Angio Img S&I ,CPT® 93457,0481 - CARDIAC CATH LAB,N/A,N/A," $9,311.00 "," $6,052.15 "," $7,821.24 "," $1,190.75 ", $904.93 ," $7,523.29 "," $8,379.90 "," $7,882.69 "," $8,379.90 "," $8,379.90 "," $8,379.90 "," $7,914.35 ", $887.19 ," $8,596.85 "," $8,845.45 "," $7,914.35 "," $8,659.23 "," $8,659.23 "," $8,845.45 "," $8,938.56 "," $7,618.26 "," $8,379.90 "," $7,914.35 "," $7,355.69 ", N/A ," $7,535.39 "," $7,535.39 "," $8,845.45 "," $7,989.77 ", $887.19 ," $8,938.56 "
Rplcmt Prost Aortic Valve Open Xcp Homogrf/Stent,CPT® 33405,N/A,N/A,N/A," $18,632.00 "," $12,110.80 "," $13,239.46 "," $2,044.56 "," $2,378.00 "," $9,691.12 "," $9,579.55 "," $17,327.76 "," $16,768.80 "," $16,768.80 "," $14,905.60 "," $14,905.60 "," $2,378.00 "," $17,202.93 "," $17,700.40 "," $16,768.80 "," $16,768.80 "," $16,768.80 "," $17,327.76 "," $17,886.72 "," $12,266.66 "," $15,837.20 "," $12,135.20 "," $10,871.66 ", N/A ," $9,880.22 "," $9,880.22 "," $17,700.40 "," $11,223.93 "," $2,044.56 "," $17,886.72 "
 Fac Iaad Ia Cryptosporidium ,CPT® 87328,0306 - LAB/BACT-MICRO,N/A,N/A, $111.00 , $72.15 , $93.24 , $14.10 , $14.10 , $89.69 , $99.90 , $93.97 , $99.90 , $99.90 , $99.90 , $94.35 , $13.82 , $102.49 , $105.45 , $94.35 , $103.23 , $103.23 , $105.45 , $106.56 , $90.82 , $99.90 , $94.35 , $87.69 , N/A , $89.83 , $89.83 , $105.45 , $95.25 , $13.82 , $106.56 
Pdt Dstr Prmlg Les Skn Illum/Activj per Day,CPT® 96567,N/A,N/A,N/A," $1,382.00 ", $898.30 , $335.11 , $138.03 , $58.15 , $297.14 , $322.33 ," $1,285.26 "," $1,243.80 "," $1,243.80 "," $1,105.60 "," $1,105.60 ", $58.15 ," $1,276.00 "," $1,312.90 "," $1,243.80 "," $1,243.80 "," $1,243.80 "," $1,285.26 "," $1,326.72 ", $440.85 ," $1,174.70 ", $428.80 , $430.91 , N/A , $302.94 , $302.94 ," $1,312.90 ", $353.17 , $58.15 ," $1,326.72 "
 PREDNISONE 20 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60687-0145-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
X-Ray Pelvis 3+ Vw,CPT® 72190,N/A,N/A,N/A, $415.00 , $269.75 , $238.55 , $41.70 , $38.00 , $181.69 , $229.84 , $385.95 , $373.50 , $373.50 , $332.00 , $332.00 , $38.00 , $383.17 , $394.25 , $373.50 , $373.50 , $373.50 , $385.95 , $398.40 , $230.13 , $352.75 , $254.24 , $191.00 , N/A , $185.23 , $185.23 , $394.25 , $214.42 , $38.00 , $398.40 
Inject Facet Joint Lumbar/Sacral,CPT® 64493,N/A,N/A,N/A, $814.00 , $529.10 , $445.43 , $86.57 , $126.53 , $511.48 , $503.33 , $757.02 , $732.60 , $732.60 , $651.20 , $651.20 , $126.53 , $751.57 , $773.30 , $732.60 , $732.60 , $732.60 , $757.02 , $781.44 , $484.01 , $691.90 , $490.62 , $548.86 , N/A , $521.47 , $521.47 , $773.30 , $559.41 , $86.57 , $781.44 
 LEVOTHYROXINE SODIUM 125 MCG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6955-61,1 tablet, $4.25 , $2.76 , $3.57 , N/A , N/A , $3.43 , $3.83 , $3.60 , $3.83 , $3.83 , $3.83 , $3.61 , N/A , $3.92 , $4.04 , $3.61 , $3.95 , $3.95 , $4.04 , $4.08 , $3.48 , $3.83 , $3.61 , $3.36 , N/A , $3.44 , $3.44 , $4.04 , $3.65 , $3.36 , $4.08 
Antidepressants Tricyclic Other Cyclicals 6/More,CPT® 80337,N/A,N/A,N/A, $193.00 , $125.45 , N/A , N/A , N/A , N/A , N/A , $179.49 , $173.70 , $173.70 , $154.40 , $154.40 , N/A , $178.20 , $183.35 , $173.70 , $173.70 , $173.70 , $179.49 , $185.28 , N/A , $164.05 , $154.40 , N/A , N/A , N/A , N/A , $183.35 , N/A , $154.40 , $185.28 
Duplex Extrem Venous Uni or Ltd(Cliniconly),CPT® 93971,N/A,N/A,N/A," $1,487.00 ", $966.55 , $757.84 , $117.01 , $110.85 , $649.39 , $655.74 ," $1,382.91 "," $1,338.30 "," $1,338.30 "," $1,189.60 "," $1,189.60 ", $110.85 ," $1,372.95 "," $1,412.65 "," $1,338.30 "," $1,338.30 "," $1,338.30 "," $1,382.91 "," $1,427.52 ", $529.14 ," $1,263.95 ", $348.72 , $456.86 , N/A , $662.05 , $662.05 ," $1,412.65 ", $733.92 , $110.85 ," $1,427.52 "
 CEPHALEXIN 500 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,60687-0163-01,1 capsule, $6.95 , $4.52 , $5.84 , N/A , N/A , $5.62 , $6.26 , $5.88 , $6.26 , $6.26 , $6.26 , $5.91 , N/A , $6.42 , $6.60 , $5.91 , $6.46 , $6.46 , $6.60 , $6.67 , $5.69 , $6.26 , $5.91 , $5.49 , N/A , $5.62 , $5.62 , $6.60 , $5.96 , $5.49 , $6.67 
 Venipuncture ,CPT® 36415,0300 - LABORATORY,N/A,N/A, $35.00 , $22.75 , $29.40 , $8.74 , N/A , $28.28 , $31.50 , $29.63 , $31.50 , $31.50 , $31.50 , $29.75 , N/A , $32.32 , $33.25 , $29.75 , $32.55 , $32.55 , $33.25 , $33.60 , $28.64 , $31.50 , $29.75 , $27.65 , N/A , $28.33 , $28.33 , $33.25 , $30.03 , $8.74 , $33.60 
 BENDAMUSTINE HCL 100 MG/4ML IV SOLN ,HCPCS J9058,0636 - DRUGS REQUIRING DETAILED CODIN,63459-0348-04,4 mL," $7,273.75 "," $4,727.94 "," $6,109.95 ", N/A , N/A ," $5,877.19 "," $6,546.38 "," $6,157.96 "," $6,546.38 "," $6,546.38 "," $6,546.38 "," $6,182.69 ", N/A ," $6,715.85 "," $6,910.06 "," $6,182.69 "," $6,764.59 "," $6,764.59 "," $6,910.06 "," $6,982.80 "," $5,951.38 "," $6,546.38 "," $6,182.69 "," $5,746.26 ", N/A ," $5,886.65 "," $5,886.65 "," $6,910.06 "," $6,241.60 "," $5,746.26 "," $6,982.80 "
"Inj Octafluoropropane Mic,Ml",HCPCS Q9956,N/A,N/A,N/A, $116.00 , $75.40 , N/A , $43.57 , $33.43 , N/A , N/A , $107.88 , $104.40 , $104.40 , $92.80 , $92.80 , $33.43 , $107.10 , $110.20 , $104.40 , $104.40 , $104.40 , $107.88 , $111.36 , $40.59 , $98.60 , $70.71 , $39.77 , N/A , N/A , N/A , $110.20 , N/A , $33.43 , $111.36 
"Needle Biopsy,Muscle",CPT® 20206,N/A,N/A,N/A, $918.00 , $596.70 , $353.73 , $55.01 , $134.06 , $292.48 , $286.69 , $853.74 , $826.20 , $826.20 , $734.40 , $734.40 , $134.06 , $847.59 , $872.10 , $826.20 , $826.20 , $826.20 , $853.74 , $881.28 , $328.65 , $780.30 , $308.64 , $344.99 , N/A , $298.19 , $298.19 , $872.10 , $350.47 , $55.01 , $881.28 
"Remv Synovium Knee,Anter & Post",CPT® 27335,N/A,N/A,N/A," $5,057.00 "," $3,287.05 "," $4,655.63 ", $729.61 ," $1,075.74 "," $3,680.68 "," $3,666.30 "," $4,703.01 "," $4,551.30 "," $4,551.30 "," $4,045.60 "," $4,045.60 "," $1,075.74 "," $4,669.13 "," $4,804.15 "," $4,551.30 "," $4,551.30 "," $4,551.30 "," $4,703.01 "," $4,854.72 "," $4,329.64 "," $4,298.45 "," $4,051.61 "," $4,336.69 ", N/A ," $3,752.50 "," $3,752.50 "," $4,804.15 "," $4,410.54 ", $729.61 ," $4,854.72 "
 KERR INSTA-CHAR IN SORBITOL 50 GM/240ML PO SUSP ,HCPCS RXA250,0250 - PHARMACY,66689-0203-08,240 mL, $208.36 , $135.43 , $175.02 , N/A , N/A , $168.35 , $187.52 , $176.40 , $187.52 , $187.52 , $187.52 , $177.11 , N/A , $192.38 , $197.94 , $177.11 , $193.77 , $193.77 , $197.94 , $200.03 , $170.48 , $187.52 , $177.11 , $164.60 , N/A , $168.63 , $168.63 , $197.94 , $178.79 , $164.60 , $200.03 
Mod Sed Other Phys/Qhp Initial 15 Mins 5/> Yrs,99156,N/A,N/A,N/A, $296.00 , $192.40 , $172.75 , $72.45 , $60.13 , $162.41 , $165.47 , $275.28 , $266.40 , $266.40 , $236.80 , $236.80 , $60.13 , $273.30 , $281.20 , $266.40 , $266.40 , $266.40 , $275.28 , $284.16 , $230.14 , $251.60 , $226.17 , $283.65 , N/A , $165.58 , $165.58 , $281.20 , $193.03 , $60.13 , $284.16 
"Thymectomy,Radical Mediast Disssec",CPT® 60522,N/A,N/A,N/A," $11,490.00 "," $7,468.50 "," $8,038.62 "," $1,241.13 "," $1,553.68 "," $6,983.02 "," $7,247.66 "," $10,685.70 "," $10,341.00 "," $10,341.00 "," $9,192.00 "," $9,192.00 "," $1,553.68 "," $10,608.72 "," $10,915.50 "," $10,341.00 "," $10,341.00 "," $10,341.00 "," $10,685.70 "," $11,030.40 "," $7,833.47 "," $9,766.50 "," $7,295.04 "," $6,716.20 ", N/A ," $7,119.28 "," $7,119.28 "," $10,915.50 "," $7,940.13 "," $1,241.13 "," $11,030.40 "
 POTASSIUM BICARB-CITRIC ACID 20 MEQ PO TBEF ,HCPCS RXC637,0250 - PHARMACY,51801-0012-30,1 tablet, $3.40 , $2.21 , $2.86 , N/A , N/A , $2.75 , $3.06 , $2.88 , $3.06 , $3.06 , $3.06 , $2.89 , N/A , $3.14 , $3.23 , $2.89 , $3.16 , $3.16 , $3.23 , $3.26 , $2.78 , $3.06 , $2.89 , $2.69 , N/A , $2.75 , $2.75 , $3.23 , $2.92 , $2.69 , $3.26 
 Fac Hpylori Brth Non-Radact Isotope ,CPT® 83013,0301 - LAB/CHEMISTRY,N/A,N/A, $281.00 , $182.65 , $236.04 , $68.71 , $68.71 , $227.05 , $252.90 , $237.89 , $252.90 , $252.90 , $252.90 , $238.85 , $67.36 , $259.45 , $266.95 , $238.85 , $261.33 , $261.33 , $266.95 , $269.76 , $229.91 , $252.90 , $238.85 , $221.99 , N/A , $227.41 , $227.41 , $266.95 , $241.13 , $67.36 , $269.76 
 ZOLEDRONIC ACID 4 MG/5ML IV CONC ,HCPCS J3489,0636 - DRUGS REQUIRING DETAILED CODIN,67457-0390-54,5 mL, $129.38 , $84.10 , $108.68 , $9.27 , $11.36 , $104.54 , $116.44 , $109.53 , $116.44 , $116.44 , $116.44 , $109.97 , $11.14 , $119.46 , $122.91 , $109.97 , $120.32 , $120.32 , $122.91 , $124.20 , $105.86 , $116.44 , $109.97 , $102.21 , N/A , $104.71 , $104.71 , $122.91 , $111.02 , $9.27 , $124.20 
Inj. Romosozumab-Aqqg 1 Mg,HCPCS J3111,N/A,N/A,N/A, $35.00 , $22.75 , N/A , $10.58 , $10.16 , N/A , N/A , $32.55 , $31.50 , $31.50 , $28.00 , $28.00 , $10.16 , $32.32 , $33.25 , $31.50 , $31.50 , $31.50 , $32.55 , $33.60 , $12.10 , $29.75 , $18.74 , $12.78 , N/A , N/A , N/A , $33.25 , N/A , $10.16 , $33.60 
 Pro Removal of Pilonidal Lesion ,CPT® 11771,0982 - PRO FEE/OUTPT,N/A,N/A," $3,137.00 "," $2,039.05 "," $1,420.35 ", $422.83 , $449.32 ," $1,170.22 "," $1,141.19 "," $2,917.41 "," $2,823.30 "," $2,823.30 "," $2,509.60 "," $2,509.60 ", $449.32 ," $2,896.39 "," $2,980.15 "," $2,823.30 "," $2,823.30 "," $2,823.30 "," $2,917.41 "," $3,011.52 "," $1,534.83 "," $2,666.45 "," $2,296.09 "," $1,490.58 ", N/A ," $1,193.05 "," $1,193.05 "," $2,980.15 "," $1,383.53 ", $422.83 ," $3,011.52 "
 Fac Intro Ndl/Intracath Aortic Translmbr ,CPT® 36160,0360 - OR SERVICES,N/A,N/A," $1,299.00 ", $844.35 ," $1,091.16 ", $114.87 , $153.67 ," $1,049.59 "," $1,169.10 "," $1,099.73 "," $1,169.10 "," $1,169.10 "," $1,169.10 "," $1,104.15 ", $150.66 ," $1,199.37 "," $1,234.05 "," $1,104.15 "," $1,208.07 "," $1,208.07 "," $1,234.05 "," $1,247.04 "," $1,062.84 "," $1,169.10 "," $1,104.15 "," $1,026.21 ", N/A ," $1,051.28 "," $1,051.28 "," $1,234.05 "," $1,114.67 ", $114.87 ," $1,247.04 "
"Naltrexone, Depot Form",HCPCS J2315,N/A,N/A,N/A, $6.00 , $3.90 , N/A , $4.02 , $3.81 , N/A , N/A , $5.58 , $5.40 , $5.40 , $4.80 , $4.80 , $3.81 , $5.54 , $5.70 , $5.40 , $5.40 , $5.40 , $5.58 , $5.76 , $4.47 , $5.10 , $5.19 , $4.88 , N/A , N/A , N/A , $5.70 , N/A , $3.81 , $5.76 
"Destruc Retinal Lesn,Cryotherapy",CPT® 67208,N/A,N/A,N/A," $5,483.00 "," $3,563.95 "," $3,551.28 ", $556.73 , $737.66 ," $3,268.35 "," $3,000.25 "," $5,099.19 "," $4,934.70 "," $4,934.70 "," $4,386.40 "," $4,386.40 ", $737.66 ," $5,062.45 "," $5,208.85 "," $4,934.70 "," $4,934.70 "," $4,934.70 "," $5,099.19 "," $5,263.68 "," $4,876.87 "," $4,660.55 "," $3,043.61 "," $4,156.70 ", N/A ," $3,332.12 "," $3,332.12 "," $5,208.85 "," $3,678.24 ", $556.73 ," $5,263.68 "
"Mmr Virus Immunization, Subcut",CPT® 90707,N/A,N/A,N/A, $234.00 , $152.10 , N/A , N/A , $79.35 , $111.48 , $115.95 , $217.62 , $210.60 , $210.60 , $187.20 , $187.20 , $79.35 , $216.05 , $222.30 , $210.60 , $210.60 , $210.60 , $217.62 , $224.64 , N/A , $198.90 , $154.08 , $145.55 , N/A , $113.65 , $113.65 , $222.30 , $132.49 , $79.35 , $224.64 
"Needle Biopsy Liver,W Othr Proc",CPT® 47001,N/A,N/A,N/A, $670.00 , $435.50 , $607.82 , $93.98 , $92.29 , $488.32 , $484.20 , $623.10 , $603.00 , $603.00 , $536.00 , $536.00 , $92.29 , $618.61 , $636.50 , $603.00 , $603.00 , $603.00 , $623.10 , $643.20 , $436.85 , $569.50 , $538.79 , $574.90 , N/A , $497.85 , $497.85 , $636.50 , $520.71 , $92.29 , $643.20 
Assay Histamine,CPT® 83088,N/A,N/A,N/A, $396.00 , $257.40 , N/A , $30.12 , $30.12 , $167.09 , $199.90 , $368.28 , $356.40 , $356.40 , $316.80 , $316.80 , $30.12 , $365.63 , $376.20 , $356.40 , $356.40 , $356.40 , $368.28 , $380.16 , $197.18 , $336.60 , $193.00 , $107.08 , N/A , $155.94 , $155.94 , $376.20 , $170.41 , $30.12 , $380.16 
 Fac MRI Breast Without Contrast Material Unilateral ,CPT® 77046,0610 - MRI,N/A,N/A," $4,759.00 "," $3,093.35 "," $3,997.56 ", $218.24 , $197.79 ," $3,845.27 "," $4,283.10 "," $4,028.97 "," $4,283.10 "," $4,283.10 "," $4,283.10 "," $4,045.15 ", $193.91 ," $4,393.98 "," $4,521.05 "," $4,045.15 "," $4,425.87 "," $4,425.87 "," $4,521.05 "," $4,568.64 "," $3,893.81 "," $4,283.10 "," $4,045.15 "," $3,759.61 ", N/A ," $3,851.46 "," $3,851.46 "," $4,521.05 "," $4,083.70 ", $193.91 ," $4,568.64 "
Simple Repair 2.6-7.5cm,12002,N/A,N/A,N/A, $574.00 , $373.10 , $183.91 , $54.60 , $67.36 , $160.40 , $155.64 , $533.82 , $516.60 , $516.60 , $459.20 , $459.20 , $67.36 , $529.97 , $545.30 , $516.60 , $516.60 , $516.60 , $533.82 , $551.04 , $201.24 , $487.90 , $312.21 , $204.29 , N/A , $163.53 , $163.53 , $545.30 , $189.63 , $54.60 , $551.04 
 Pro Fluoroscopic Guidance Needle Placement Add On ,CPT® 77002,0982 - PRO FEE/OUTPT,N/A,N/A, $629.00 , $408.85 , $659.69 , $114.76 , $61.30 , $439.87 , $414.49 , $584.97 , $566.10 , $566.10 , $503.20 , $503.20 , $61.30 , $580.76 , $597.55 , $566.10 , $566.10 , $566.10 , $584.97 , $603.84 , $642.09 , $534.65 , $452.62 , $476.71 , N/A , $448.45 , $448.45 , $597.55 , $519.08 , $61.30 , $659.69 
Pierce Earlobes,CPT® 69090,N/A,N/A,N/A, $170.00 , $110.50 , N/A , N/A , N/A , $148.54 , $155.10 , $158.10 , $153.00 , $153.00 , $136.00 , $136.00 , N/A , $156.96 , $161.50 , $153.00 , $153.00 , $153.00 , $158.10 , $163.20 , N/A , $144.50 , $171.27 , $145.23 , N/A , $151.44 , $151.44 , $161.50 , $172.92 , $136.00 , $172.92 
Apply Finger Splint,CPT® 29130,N/A,N/A,N/A, $268.00 , $174.20 , $175.70 , $27.56 , $10.31 , $137.91 , $137.01 , $249.24 , $241.20 , $241.20 , $214.40 , $214.40 , $10.31 , $247.44 , $254.60 , $241.20 , $241.20 , $241.20 , $249.24 , $257.28 , $162.22 , $227.80 , $149.86 , $165.82 , N/A , $140.61 , $140.61 , $254.60 , $165.26 , $10.31 , $257.28 
"Colposcopy,Cervix W/Adj Vagina, Curettag",CPT® 57456,N/A,N/A,N/A, $890.00 , $578.50 , $471.90 , $95.44 , $124.68 , $422.65 , $419.05 , $827.70 , $801.00 , $801.00 , $712.00 , $712.00 , $124.68 , $821.74 , $845.50 , $801.00 , $801.00 , $801.00 , $827.70 , $854.40 , $496.68 , $756.50 , $551.28 , $421.09 , N/A , $430.89 , $430.89 , $845.50 , $516.83 , $95.44 , $854.40 
Foot Longitudinal Arch Suppo,HCPCS L3010,N/A,N/A,N/A, $227.00 , $147.55 , N/A , $203.80 , $105.41 , N/A , N/A , $211.11 , $204.30 , $204.30 , $181.60 , $181.60 , $105.41 , $209.59 , $215.65 , $204.30 , $204.30 , $204.30 , $211.11 , $217.92 , N/A , $192.95 , $168.03 , $171.46 , N/A , N/A , N/A , $215.65 , N/A , $105.41 , $217.92 
 Fac Microsomal Antibody ,CPT® 86376,0302 - LAB/IMMUNOLOGY,N/A,N/A, $146.00 , $94.90 , $122.64 , $14.84 , $14.84 , $117.97 , $131.40 , $123.60 , $131.40 , $131.40 , $131.40 , $124.10 , $14.55 , $134.80 , $138.70 , $124.10 , $135.78 , $135.78 , $138.70 , $140.16 , $119.46 , $131.40 , $124.10 , $115.34 , N/A , $118.16 , $118.16 , $138.70 , $125.28 , $14.55 , $140.16 
Inj Hydroxyprogst Capoat Nos,HCPCS J1729,N/A,N/A,N/A, $20.00 , $13.00 , N/A , N/A , $28.65 , N/A , N/A , $18.60 , $18.00 , $18.00 , $16.00 , $16.00 , $28.65 , $18.47 , $19.00 , $18.00 , $18.00 , $18.00 , $18.60 , $19.20 , N/A , $17.00 , $16.00 , $18.32 , N/A , N/A , N/A , $19.00 , N/A , $16.00 , $28.65 
"Open Rx Femur,Distal End",CPT® 27514,N/A,N/A,N/A," $4,027.00 "," $2,617.55 "," $5,836.03 ", $911.01 ," $1,092.81 "," $4,669.43 "," $4,618.72 "," $3,745.11 "," $3,624.30 "," $3,624.30 "," $3,221.60 "," $3,221.60 "," $1,092.81 "," $3,718.13 "," $3,825.65 "," $3,624.30 "," $3,624.30 "," $3,624.30 "," $3,745.11 "," $3,865.92 "," $5,439.74 "," $3,422.95 "," $5,113.13 "," $5,484.79 ", N/A ," $4,760.54 "," $4,760.54 "," $3,825.65 "," $5,595.32 ", $911.01 ," $5,836.03 "
 Janssen Covid Vaccine Booster ,CPT® 0034A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
Pfizer Admin Peds Third Dose,CPT® 0073A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $76.25 , $128.02 , N/A , $79.82 , $79.82 , $66.50 , $92.91 , $38.92 , $128.02 
Slctv Cath 1stord W/WO Art Punct/Fluoro/S&I Un,CPT® 36251,N/A,N/A,N/A," $7,958.00 "," $5,172.70 "," $1,522.17 ", $234.65 ," $1,713.54 "," $1,215.41 "," $1,184.60 "," $7,400.94 "," $7,162.20 "," $7,162.20 "," $6,366.40 "," $6,366.40 "," $1,713.54 "," $7,347.62 "," $7,560.10 "," $7,162.20 "," $7,162.20 "," $7,162.20 "," $7,400.94 "," $7,639.68 "," $1,414.16 "," $6,764.30 "," $1,480.77 "," $1,278.60 ", N/A ," $1,239.13 "," $1,239.13 "," $7,560.10 "," $1,407.63 ", $234.65 ," $7,639.68 "
 Pro Insj Ant Sgm Drg Dev Trab Mw W/O Res&Ctrc Rmvl1+ ,CPT® 0671T,0975 - PRO FEE/OR,N/A,N/A," $7,994.00 "," $5,196.10 ", N/A , N/A , N/A , N/A , N/A ," $7,434.42 "," $7,194.60 "," $7,194.60 "," $6,395.20 "," $6,395.20 ", N/A ," $7,380.86 "," $7,594.30 "," $7,194.60 "," $7,194.60 "," $7,194.60 "," $7,434.42 "," $7,674.24 ", N/A ," $6,794.90 "," $1,869.34 "," $6,991.24 ", N/A ," $1,828.70 "," $1,828.70 "," $7,594.30 "," $2,128.64 "," $1,828.70 "," $7,674.24 "
 Fac Tx Tibl Shft Fx Imed Implt +-Screws&/Cerclage ,CPT® 27759,0361 - OR/MINOR,N/A,N/A," $5,067.00 "," $3,293.55 "," $4,256.28 ", $944.03 , $879.19 ," $4,094.14 "," $4,560.30 "," $4,289.72 "," $4,560.30 "," $4,560.30 "," $4,560.30 "," $4,306.95 ", $861.95 ," $4,678.36 "," $4,813.65 "," $4,306.95 "," $4,712.31 "," $4,712.31 "," $4,813.65 "," $4,864.32 "," $4,145.82 "," $4,560.30 "," $4,306.95 "," $4,002.93 ", N/A ," $4,100.72 "," $4,100.72 "," $4,813.65 "," $4,347.99 ", $861.95 ," $4,864.32 "
 BUPIVACAINE HCL 0.25 % IJ SOLN ,HCPCS J0665,0636 - DRUGS REQUIRING DETAILED CODIN,00409-1160-01,50 mL, $19.78 , $12.86 , $16.62 , N/A , N/A , $15.98 , $17.80 , $16.75 , $17.80 , $17.80 , $17.80 , $16.81 , N/A , $18.26 , $18.79 , $16.81 , $18.40 , $18.40 , $18.79 , $18.99 , $16.18 , $17.80 , $16.81 , $15.63 , N/A , $16.01 , $16.01 , $18.79 , $16.97 , $15.63 , $18.99 
 Fac Toxoplasma Antibody ,CPT® 86777,0300 - LABORATORY,N/A,N/A, $133.00 , $86.45 , $111.72 , $14.68 , $14.68 , $107.46 , $119.70 , $112.60 , $119.70 , $119.70 , $119.70 , $113.05 , $14.39 , $122.80 , $126.35 , $113.05 , $123.69 , $123.69 , $126.35 , $127.68 , $108.82 , $119.70 , $113.05 , $105.07 , N/A , $107.64 , $107.64 , $126.35 , $114.13 , $14.39 , $127.68 
"Eeg,W/Awake & Asleep Record",CPT® 95819,N/A,N/A,N/A," $1,789.00 "," $1,162.85 "," $1,648.55 ", $435.85 , $161.34 ," $1,302.48 "," $1,622.68 "," $1,663.77 "," $1,610.10 "," $1,610.10 "," $1,431.20 "," $1,431.20 ", $161.34 ," $1,651.78 "," $1,699.55 "," $1,610.10 "," $1,610.10 "," $1,610.10 "," $1,663.77 "," $1,717.44 "," $1,952.29 "," $1,520.65 "," $1,423.26 "," $1,598.45 ", N/A ," $1,327.89 "," $1,327.89 "," $1,699.55 "," $1,632.52 ", $161.34 ," $1,952.29 "
 Pap-Nap - Sleep Study Attended ,CPT® 95807,0920 - OTHER DX SVS,N/A,N/A," $3,794.00 "," $2,466.10 "," $3,186.96 ", $378.40 , $456.95 ," $3,065.55 "," $3,414.60 "," $3,212.00 "," $3,414.60 "," $3,414.60 "," $3,414.60 "," $3,224.90 ", $447.99 ," $3,503.00 "," $3,604.30 "," $3,224.90 "," $3,528.42 "," $3,528.42 "," $3,604.30 "," $3,642.24 "," $3,104.25 "," $3,414.60 "," $3,224.90 "," $2,997.26 ", N/A ," $3,070.48 "," $3,070.48 "," $3,604.30 "," $3,255.63 ", $378.40 ," $3,642.24 "
"Rep Tendon Finger,W/O Gra",26418,N/A,N/A,N/A," $2,087.00 "," $1,356.55 "," $3,954.41 ", $615.23 , $426.00 ," $2,746.72 "," $2,822.57 "," $1,940.91 "," $1,878.30 "," $1,878.30 "," $1,669.60 "," $1,669.60 ", $426.00 ," $1,926.93 "," $1,982.65 "," $1,878.30 "," $1,878.30 "," $1,878.30 "," $1,940.91 "," $2,003.52 "," $3,614.06 "," $1,773.95 "," $3,084.65 "," $3,289.40 ", N/A ," $2,800.31 "," $2,800.31 "," $1,982.65 "," $3,291.34 ", $426.00 ," $3,954.41 "
"Strapping,Unna Boot",CPT® 29580,N/A,N/A,N/A, $389.00 , $252.85 , $162.96 , $25.02 , $20.61 , $173.40 , $173.65 , $361.77 , $350.10 , $350.10 , $311.20 , $311.20 , $20.61 , $359.16 , $369.55 , $350.10 , $350.10 , $350.10 , $361.77 , $373.44 , $151.07 , $330.65 , $189.11 , $166.30 , N/A , $176.79 , $176.79 , $369.55 , $207.80 , $20.61 , $373.44 
"Control Throat Bleed,Surg Interventn",CPT® 42962,N/A,N/A,N/A," $3,455.00 "," $2,245.75 "," $3,181.04 ", $502.40 , $238.14 ," $2,500.34 "," $2,569.59 "," $3,213.15 "," $3,109.50 "," $3,109.50 "," $2,764.00 "," $2,764.00 ", $238.14 ," $3,190.00 "," $3,282.25 "," $3,109.50 "," $3,109.50 "," $3,109.50 "," $3,213.15 "," $3,316.80 "," $2,271.04 "," $2,936.75 "," $2,802.76 "," $2,936.96 ", N/A ," $2,549.13 "," $2,549.13 "," $3,282.25 "," $2,666.12 ", $238.14 ," $3,316.80 "
Nebulizer Administration Set,HCPCS A7003,N/A,N/A,N/A, $5.00 , $3.25 , N/A , $2.13 , $2.11 , N/A , N/A , $4.65 , $4.50 , $4.50 , $4.00 , $4.00 , $2.11 , $4.62 , $4.75 , $4.50 , $4.50 , $4.50 , $4.65 , $4.80 , N/A , $4.25 , $3.24 , $2.37 , N/A , N/A , N/A , $4.75 , N/A , $2.11 , $4.80 
Sigmoidoscopy Flx Control Bleeding,CPT® 45334,N/A,N/A,N/A," $3,466.00 "," $2,252.90 ", $721.57 , $111.58 , $218.09 , $773.87 , $797.61 ," $3,223.38 "," $3,119.40 "," $3,119.40 "," $2,772.80 "," $2,772.80 ", $218.09 ," $3,200.16 "," $3,292.70 "," $3,119.40 "," $3,119.40 "," $3,119.40 "," $3,223.38 "," $3,327.36 ", $516.93 ," $2,946.10 ", $872.41 , $685.75 , N/A , $788.96 , $788.96 ," $3,292.70 ", $825.16 , $111.58 ," $3,327.36 "
 Pro Laryngoscopy Flexible Diagnostic ,CPT® 31575,0982 - PRO FEE/OUTPT,N/A,N/A, $713.00 , $463.45 , $364.67 , $65.21 , $98.45 , $294.56 , $382.52 , $663.09 , $641.70 , $641.70 , $570.40 , $570.40 , $98.45 , $658.31 , $677.35 , $641.70 , $641.70 , $641.70 , $663.09 , $684.48 , $347.16 , $606.05 , $406.77 , $341.75 , N/A , $300.30 , $300.30 , $677.35 , $353.68 , $65.21 , $684.48 
"Pro Remv Thigh/Knee Tumor,Deep",27328,N/A,N/A,N/A," $4,643.00 "," $3,017.95 "," $3,762.07 ", $589.21 , $329.90 ," $2,980.00 "," $2,985.29 "," $4,317.99 "," $4,178.70 "," $4,178.70 "," $3,714.40 "," $3,714.40 ", $329.90 ," $4,286.88 "," $4,410.85 "," $4,178.70 "," $4,178.70 "," $4,178.70 "," $4,317.99 "," $4,457.28 "," $3,495.04 "," $3,946.55 "," $3,304.09 "," $3,516.17 ", N/A ," $3,038.14 "," $3,038.14 "," $4,410.85 "," $3,570.90 ", $329.90 ," $4,457.28 "
" Fac Varicella Zoster, Ag, If ",CPT® 87290,0306 - LAB/BACT-MICRO,N/A,N/A, $126.00 , $81.90 , $105.84 , $13.69 , $13.69 , $101.81 , $113.40 , $106.67 , $113.40 , $113.40 , $113.40 , $107.10 , $13.42 , $116.34 , $119.70 , $107.10 , $117.18 , $117.18 , $119.70 , $120.96 , $103.09 , $113.40 , $107.10 , $99.54 , N/A , $101.97 , $101.97 , $119.70 , $108.12 , $13.42 , $120.96 
 Pro Drainage of Gland Abscess ,CPT® 56420,0982 - PRO FEE/OUTPT,N/A,N/A, $690.00 , $448.50 , $529.30 , $107.00 , $49.34 , $372.48 , $373.89 , $641.70 , $621.00 , $621.00 , $552.00 , $552.00 , $49.34 , $637.08 , $655.50 , $621.00 , $621.00 , $621.00 , $641.70 , $662.40 , $537.13 , $586.50 , $490.62 , $372.95 , N/A , $379.75 , $379.75 , $655.50 , $455.49 , $49.34 , $662.40 
"Assay Troponin, Quant",CPT® 84484,N/A,N/A,N/A, $148.00 , $96.20 , N/A , $12.72 , $12.72 , $55.66 , $66.62 , $137.64 , $133.20 , $133.20 , $118.40 , $118.40 , $12.72 , $136.65 , $140.60 , $133.20 , $133.20 , $133.20 , $137.64 , $142.08 , $83.26 , $125.80 , $64.87 , $36.62 , N/A , $51.95 , $51.95 , $140.60 , $56.77 , $12.72 , $142.08 
"Rhythm Ecg, Report",CPT® 93042,N/A,N/A,N/A, $72.00 , $46.80 , $42.90 , $6.61 , $8.27 , $38.53 , $40.20 , $66.96 , $64.80 , $64.80 , $57.60 , $57.60 , $8.27 , $66.48 , $68.40 , $64.80 , $64.80 , $64.80 , $66.96 , $69.12 , $42.40 , $61.20 , $37.47 , $42.16 , N/A , $39.28 , $39.28 , $68.40 , $43.54 , $6.61 , $69.12 
Exc Skin Malig 2.1-3cm Remaindr Body,11623,N/A,N/A,N/A," $1,451.00 ", $943.15 , $668.78 , $200.83 , $288.68 , $579.96 , $565.03 ," $1,349.43 "," $1,305.90 "," $1,305.90 "," $1,160.80 "," $1,160.80 ", $288.68 ," $1,339.71 "," $1,378.45 "," $1,305.90 "," $1,305.90 "," $1,305.90 "," $1,349.43 "," $1,392.96 ", $734.78 ," $1,233.35 "," $1,127.53 ", $742.84 , N/A , $591.28 , $591.28 ," $1,378.45 ", $685.69 , $200.83 ," $1,392.96 "
Removal Impacted Cerumen Irrigation/Lvg Unilat,CPT® 69209,N/A,N/A,N/A, $111.00 , $72.15 , $72.25 , $14.88 , $9.93 , $59.81 , $59.38 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $9.93 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $77.94 , $94.35 , $81.74 , $68.74 , N/A , $60.98 , $60.98 , $105.45 , $69.62 , $9.93 , $106.56 
 VINORELBINE TARTRATE 50 MG/5ML IV SOLN ,HCPCS J9390,0636 - DRUGS REQUIRING DETAILED CODIN,25021-0204-05,5 mL, $264.63 , $172.01 , $222.29 , $8.44 , $9.44 , $213.82 , $238.17 , $224.04 , $238.17 , $238.17 , $238.17 , $224.94 , $9.25 , $244.33 , $251.40 , $224.94 , $246.11 , $246.11 , $251.40 , $254.04 , $216.52 , $238.17 , $224.94 , $209.06 , N/A , $214.17 , $214.17 , $251.40 , $227.08 , $8.44 , $254.04 
Ear and Throat Examination,CPT® 92502,N/A,N/A,N/A, $716.00 , $465.40 , $219.41 , $92.69 , $124.66 , $216.27 , $219.90 , $665.88 , $644.40 , $644.40 , $572.80 , $572.80 , $124.66 , $661.08 , $680.20 , $644.40 , $644.40 , $644.40 , $665.88 , $687.36 , $404.50 , $608.60 , $289.92 , $364.84 , N/A , $220.49 , $220.49 , $680.20 , $257.07 , $92.69 , $687.36 
 Fac Thiocyanate ,CPT® 84430,0301 - LAB/CHEMISTRY,N/A,N/A, $100.00 , $65.00 , $84.00 , $11.86 , $11.86 , $80.80 , $90.00 , $84.66 , $90.00 , $90.00 , $90.00 , $85.00 , $11.63 , $92.33 , $95.00 , $85.00 , $93.00 , $93.00 , $95.00 , $96.00 , $81.82 , $90.00 , $85.00 , $79.00 , N/A , $80.93 , $80.93 , $95.00 , $85.81 , $11.63 , $96.00 
"Repr Forearm Tend/Musc,Flex,Prim,Ea",25260,N/A,N/A,N/A," $3,546.00 "," $2,304.90 "," $3,892.40 ", $612.04 , $546.22 ," $3,033.01 "," $3,036.14 "," $3,297.78 "," $3,191.40 "," $3,191.40 "," $2,836.80 "," $2,836.80 ", $546.22 ," $3,274.02 "," $3,368.70 "," $3,191.40 "," $3,191.40 "," $3,191.40 "," $3,297.78 "," $3,404.16 "," $3,605.62 "," $3,014.10 "," $3,341.55 "," $3,595.95 ", N/A ," $3,092.19 "," $3,092.19 "," $3,368.70 "," $3,634.44 ", $546.22 ," $3,892.40 "
Layer Closure 20.1-30cm,CPT® 12036,N/A,N/A,N/A," $1,842.00 "," $1,197.30 ", $887.81 , $264.02 , $215.14 , $754.97 , $740.93 ," $1,713.06 "," $1,657.80 "," $1,657.80 "," $1,473.60 "," $1,473.60 ", $215.14 ," $1,700.72 "," $1,749.90 "," $1,657.80 "," $1,657.80 "," $1,657.80 "," $1,713.06 "," $1,768.32 ", $974.81 ," $1,565.70 "," $1,489.69 ", $970.85 , N/A , $769.70 , $769.70 ," $1,749.90 ", $892.60 , $215.14 ," $1,768.32 "
Removal of Scrotal for.Body,CPT® 55120,N/A,N/A,N/A," $2,079.00 "," $1,351.35 "," $1,578.54 ", $340.92 , $153.67 ," $1,148.01 "," $1,170.74 "," $1,933.47 "," $1,871.10 "," $1,871.10 "," $1,663.20 "," $1,663.20 ", $153.67 ," $1,919.54 "," $1,975.05 "," $1,871.10 "," $1,871.10 "," $1,871.10 "," $1,933.47 "," $1,995.84 "," $1,478.61 "," $1,767.15 "," $1,871.48 "," $1,716.77 ", N/A ," $1,170.42 "," $1,170.42 "," $1,975.05 "," $1,402.82 ", $153.67 ," $1,995.84 "
 Pro CT Orbit/Ear/Fossa W/Dye ,CPT® 70481,0972 - PRO FEE/RAD/DX,N/A,N/A, $824.00 , $535.60 ," $1,288.91 ", $184.73 , $297.22 ," $1,313.67 "," $1,692.62 ", $766.32 , $741.60 , $741.60 , $659.20 , $659.20 , $297.22 , $760.80 , $782.80 , $741.60 , $741.60 , $741.60 , $766.32 , $791.04 ," $1,088.37 ", $700.40 ," $1,845.15 "," $1,788.51 ", N/A ," $1,339.30 "," $1,339.30 ", $782.80 ," $1,550.27 ", $184.73 ," $1,845.15 "
"Nephelometry, Not Specified",CPT® 83883,N/A,N/A,N/A, $171.00 , $111.15 , N/A , $13.87 , $13.87 , $76.91 , $92.03 , $159.03 , $153.90 , $153.90 , $136.80 , $136.80 , $13.87 , $157.88 , $162.45 , $153.90 , $153.90 , $153.90 , $159.03 , $164.16 , $90.81 , $145.35 , $89.20 , $49.31 , N/A , $71.78 , $71.78 , $162.45 , $78.44 , $13.87 , $164.16 
Visual Ep Testing Cns Except Glaucoma W/I&R,CPT® 95930,N/A,N/A,N/A, $674.00 , $438.10 , $241.30 , $65.18 , $85.85 , $407.29 , $558.32 , $626.82 , $606.60 , $606.60 , $539.20 , $539.20 , $85.85 , $622.30 , $640.30 , $606.60 , $606.60 , $606.60 , $626.82 , $647.04 , $290.44 , $572.90 , $489.62 , $264.27 , N/A , $415.24 , $415.24 , $640.30 , $510.48 , $65.18 , $647.04 
Iaad Ia Not Otherwise Specified Each Organism,CPT® 87449,N/A,N/A,N/A, $169.00 , $109.85 , N/A , $12.22 , $12.22 , $67.85 , $81.18 , $157.17 , $152.10 , $152.10 , $135.20 , $135.20 , $12.22 , $156.04 , $160.55 , $152.10 , $152.10 , $152.10 , $157.17 , $162.24 , $79.99 , $143.65 , $77.85 , $43.47 , N/A , $63.32 , $63.32 , $160.55 , $69.20 , $12.22 , $162.24 
 Fac Sulfate Urine ,CPT® 84392,0301 - LAB/CHEMISTRY,N/A,N/A, $46.00 , $29.90 , $38.64 , $5.60 , $5.60 , $37.17 , $41.40 , $38.94 , $41.40 , $41.40 , $41.40 , $39.10 , $5.49 , $42.47 , $43.70 , $39.10 , $42.78 , $42.78 , $43.70 , $44.16 , $37.64 , $41.40 , $39.10 , $36.34 , N/A , $37.23 , $37.23 , $43.70 , $39.47 , $5.49 , $44.16 
 Fac Ercp Stent Placement Biliary/Pancreatic Duct ,CPT® 43274,0360 - OR SERVICES,N/A,N/A," $5,776.00 "," $3,754.40 "," $4,851.84 ", $437.40 , $363.34 ," $4,667.01 "," $5,198.40 "," $4,889.96 "," $5,198.40 "," $5,198.40 "," $5,198.40 "," $4,909.60 ", $356.22 ," $5,332.98 "," $5,487.20 "," $4,909.60 "," $5,371.68 "," $5,371.68 "," $5,487.20 "," $5,544.96 "," $4,725.92 "," $5,198.40 "," $4,909.60 "," $4,563.04 ", N/A ," $4,674.52 "," $4,674.52 "," $5,487.20 "," $4,956.39 ", $356.22 ," $5,544.96 "
 Pro Office/Outpatient New High Mdm 60-74 Minutes ,CPT® 99205,0982 - PRO FEE/OUTPT,N/A,N/A, $652.00 , $423.80 , $366.66 , $174.91 , $136.97 , $290.52 , $289.74 , $606.36 , $586.80 , $586.80 , $521.60 , $521.60 , $136.97 , $601.99 , $619.40 , $586.80 , $586.80 , $586.80 , $606.36 , $625.92 , $334.52 , $554.20 , $363.05 , $366.53 , $109.75 , $296.18 , $296.18 , $619.40 , $341.61 , $109.75 , $625.92 
 Fac Radiation Handling ,CPT® 77790,0333 - RADIATION RX,N/A,N/A, $734.00 , $477.10 , $616.56 , $16.64 , $79.92 , $593.07 , $660.60 , $621.40 , $660.60 , $660.60 , $660.60 , $623.90 , $78.35 , $677.70 , $697.30 , $623.90 , $682.62 , $682.62 , $697.30 , $704.64 , $600.56 , $660.60 , $623.90 , $579.86 , N/A , $594.03 , $594.03 , $697.30 , $629.85 , $16.64 , $704.64 
 ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY ,HCPCS J1650,0636 - DRUGS REQUIRING DETAILED CODIN,00781-3256-66,0.6 mL, $86.13 , $55.98 , $72.35 , $0.69 , $0.83 , $69.59 , $77.52 , $72.92 , $77.52 , $77.52 , $77.52 , $73.21 , $0.81 , $79.52 , $81.82 , $73.21 , $80.10 , $80.10 , $81.82 , $82.68 , $70.47 , $77.52 , $73.21 , $68.04 , N/A , $69.71 , $69.71 , $81.82 , $73.91 , $0.69 , $82.68 
Dstr Nrolytc Agnt Parverteb Fct Sngl Lmbr/Sacral,64635,N/A,N/A,N/A," $1,718.00 "," $1,116.70 ", $950.14 , $185.00 , $346.77 ," $1,260.86 "," $1,183.47 "," $1,597.74 "," $1,546.20 "," $1,546.20 "," $1,374.40 "," $1,374.40 ", $346.77 ," $1,586.23 "," $1,632.10 "," $1,546.20 "," $1,546.20 "," $1,546.20 "," $1,597.74 "," $1,649.28 "," $1,187.78 "," $1,460.30 "," $1,147.15 "," $1,349.13 ", N/A ," $1,285.46 "," $1,285.46 "," $1,632.10 "," $1,379.00 ", $185.00 ," $1,649.28 "
Treat Fibular Fracture,27786,N/A,N/A,N/A," $1,446.00 ", $939.90 ," $1,797.25 ", $283.29 , $184.42 ," $1,381.41 "," $1,407.46 "," $1,344.78 "," $1,301.40 "," $1,301.40 "," $1,156.80 "," $1,156.80 ", $184.42 ," $1,335.09 "," $1,373.70 "," $1,301.40 "," $1,301.40 "," $1,301.40 "," $1,344.78 "," $1,388.16 "," $1,658.34 "," $1,229.10 "," $1,543.22 "," $1,637.46 ", N/A ," $1,408.37 "," $1,408.37 "," $1,373.70 "," $1,655.31 ", $184.42 ," $1,797.25 "
 CT Multiplanar/3d Reconstruction ,CPT® 76377,0350 - CT SCAN,N/A,N/A," $1,210.00 ", $786.50 ," $1,016.40 ", $74.81 , $95.75 , $977.68 ," $1,089.00 "," $1,024.39 "," $1,089.00 "," $1,089.00 "," $1,089.00 "," $1,028.50 ", $93.87 ," $1,117.19 "," $1,149.50 "," $1,028.50 "," $1,125.30 "," $1,125.30 "," $1,149.50 "," $1,161.60 ", $990.02 ," $1,089.00 "," $1,028.50 ", $955.90 , N/A , $979.25 , $979.25 ," $1,149.50 "," $1,038.30 ", $74.81 ," $1,161.60 "
 Fac Cul Bact Stl Aerc Isol Salmonella&Shigella ,CPT® 87045,0306 - LAB/BACT-MICRO,N/A,N/A, $84.00 , $54.60 , $70.56 , $9.63 , $9.63 , $67.87 , $75.60 , $71.11 , $75.60 , $75.60 , $75.60 , $71.40 , $9.44 , $77.56 , $79.80 , $71.40 , $78.12 , $78.12 , $79.80 , $80.64 , $68.73 , $75.60 , $71.40 , $66.36 , N/A , $67.98 , $67.98 , $79.80 , $72.08 , $9.44 , $80.64 
Hand Tendon Pulley Reconstruction,CPT® 26500,N/A,N/A,N/A," $4,167.00 "," $2,708.55 "," $4,216.55 ", $649.06 , $230.52 ," $2,960.16 "," $3,010.85 "," $3,875.31 "," $3,750.30 "," $3,750.30 "," $3,333.60 "," $3,333.60 ", $230.52 ," $3,847.39 "," $3,958.65 "," $3,750.30 "," $3,750.30 "," $3,750.30 "," $3,875.31 "," $4,000.32 "," $3,823.34 "," $3,541.95 "," $3,302.30 "," $3,539.05 ", N/A ," $3,017.92 "," $3,017.92 "," $3,958.65 "," $3,547.13 ", $230.52 ," $4,216.55 "
Set Radn Therapy Field Complex,CPT® 77290,N/A,N/A,N/A," $5,701.00 "," $3,705.65 "," $2,570.33 ", $445.32 , $340.51 ," $2,427.68 "," $2,742.62 "," $5,301.93 "," $5,130.90 "," $5,130.90 "," $4,560.80 "," $4,560.80 ", $340.51 ," $5,263.73 "," $5,415.95 "," $5,130.90 "," $5,130.90 "," $5,130.90 "," $5,301.93 "," $5,472.96 "," $2,752.71 "," $4,845.85 "," $3,008.48 "," $2,917.90 ", N/A ," $2,475.04 "," $2,475.04 "," $5,415.95 "," $2,864.91 ", $340.51 ," $5,472.96 "
"Eeg,Coma/Sleep Record Only",CPT® 95822,N/A,N/A,N/A," $1,864.00 "," $1,211.60 "," $1,531.70 ", $408.27 , $161.34 ," $1,177.40 "," $1,450.65 "," $1,733.52 "," $1,677.60 "," $1,677.60 "," $1,491.20 "," $1,491.20 ", $161.34 ," $1,721.03 "," $1,770.80 "," $1,677.60 "," $1,677.60 "," $1,677.60 "," $1,733.52 "," $1,789.44 "," $1,780.47 "," $1,584.40 "," $1,272.21 "," $1,440.71 ", N/A ," $1,200.37 "," $1,200.37 "," $1,770.80 "," $1,475.74 ", $161.34 ," $1,789.44 "
Open Rx Bimalleolar Fx,CPT® 27814,N/A,N/A,N/A," $4,253.00 "," $2,764.45 "," $4,659.14 ", $730.07 , $675.04 ," $3,732.38 "," $3,721.69 "," $3,955.29 "," $3,827.70 "," $3,827.70 "," $3,402.40 "," $3,402.40 ", $675.04 ," $3,926.79 "," $4,040.35 "," $3,827.70 "," $3,827.70 "," $3,827.70 "," $3,955.29 "," $4,082.88 "," $4,338.92 "," $3,615.05 "," $4,106.92 "," $4,386.62 ", N/A ," $3,805.20 "," $3,805.20 "," $4,040.35 "," $4,472.48 ", $675.04 ," $4,659.14 "
 Fac Dir Rpr Arysm&Grf Insj Rptd Arysm Abdl Aorta ,CPT® 35082,0360 - OR SERVICES,N/A,N/A," $8,073.00 "," $5,247.45 "," $6,781.32 "," $1,921.06 "," $2,037.14 "," $6,522.98 "," $7,265.70 "," $6,834.60 "," $7,265.70 "," $7,265.70 "," $7,265.70 "," $6,862.05 "," $1,997.20 "," $7,453.80 "," $7,669.35 "," $6,862.05 "," $7,507.89 "," $7,507.89 "," $7,669.35 "," $7,750.08 "," $6,605.33 "," $7,265.70 "," $6,862.05 "," $6,377.67 ", N/A ," $6,533.48 "," $6,533.48 "," $7,669.35 "," $6,927.44 "," $1,921.06 "," $7,750.08 "
Assay Ldh Enzymes,CPT® 83625,N/A,N/A,N/A, $164.00 , $106.60 , N/A , $13.05 , $13.05 , $72.42 , $86.66 , $152.52 , $147.60 , $147.60 , $131.20 , $131.20 , $13.05 , $151.42 , $155.80 , $147.60 , $147.60 , $147.60 , $152.52 , $157.44 , $85.40 , $139.40 , $84.34 , $46.40 , N/A , $67.59 , $67.59 , $155.80 , $73.86 , $13.05 , $157.44 
"Preventive Visit,New,Age5-11",CPT® 99383,N/A,N/A,N/A, $357.00 , $232.05 , N/A , $115.67 , $62.20 , $185.45 , $186.86 , $332.01 , $321.30 , $321.30 , $285.60 , $285.60 , $62.20 , $329.62 , $339.15 , $321.30 , $321.30 , $321.30 , $332.01 , $342.72 , $229.57 , $303.45 , $186.78 , $185.13 , $134.50 , $189.06 , $189.06 , $339.15 , $227.07 , $62.20 , $342.72 
 VECURONIUM BROMIDE 10 MG IV SOLR ,HCPCS RXA250,0250 - PHARMACY,55150-0235-10,10 mL, $33.91 , $22.04 , $28.48 , N/A , N/A , $27.40 , $30.52 , $28.71 , $30.52 , $30.52 , $30.52 , $28.82 , N/A , $31.31 , $32.21 , $28.82 , $31.54 , $31.54 , $32.21 , $32.55 , $27.75 , $30.52 , $28.82 , $26.79 , N/A , $27.44 , $27.44 , $32.21 , $29.10 , $26.79 , $32.55 
 Fracture Other Toes Closed /W Manip - Mh ,CPT® 28515,0761 - TREATMENT ROOM,N/A,N/A," $1,455.00 ", $945.75 ," $1,222.20 ", $141.25 , $76.84 ," $1,175.64 "," $1,309.50 "," $1,231.80 "," $1,309.50 "," $1,309.50 "," $1,309.50 "," $1,236.75 ", $75.33 ," $1,343.40 "," $1,382.25 "," $1,236.75 "," $1,353.15 "," $1,353.15 "," $1,382.25 "," $1,396.80 "," $1,190.48 "," $1,309.50 "," $1,236.75 "," $1,149.45 ", N/A ," $1,177.53 "," $1,177.53 "," $1,382.25 "," $1,248.54 ", $75.33 ," $1,396.80 "
Closure of Vagina,CPT® 57120,N/A,N/A,N/A," $3,066.00 "," $1,992.90 "," $2,520.75 ", $509.81 , $989.73 ," $2,075.29 "," $2,077.48 "," $2,851.38 "," $2,759.40 "," $2,759.40 "," $2,452.80 "," $2,452.80 ", $989.73 ," $2,830.84 "," $2,912.70 "," $2,759.40 "," $2,759.40 "," $2,759.40 "," $2,851.38 "," $2,943.36 "," $2,618.03 "," $2,606.10 "," $2,726.05 "," $2,083.52 ", N/A ," $2,115.78 "," $2,115.78 "," $2,912.70 "," $2,537.75 ", $509.81 ," $2,943.36 "
 Sentinel Node Lymphoscintigram ,CPT® 78195,0340 - NUCLEAR MEDICINE,N/A,N/A," $3,051.00 "," $1,983.15 "," $2,562.84 ", $323.97 , $197.50 ," $2,465.21 "," $2,745.90 "," $2,582.98 "," $2,745.90 "," $2,745.90 "," $2,745.90 "," $2,593.35 ", $193.63 ," $2,816.99 "," $2,898.45 "," $2,593.35 "," $2,837.43 "," $2,837.43 "," $2,898.45 "," $2,928.96 "," $2,496.33 "," $2,745.90 "," $2,593.35 "," $2,410.29 ", N/A ," $2,469.17 "," $2,469.17 "," $2,898.45 "," $2,618.06 ", $193.63 ," $2,928.96 "
 Pro Injection for Myelogram ,CPT® 62284,0982 - PRO FEE/OUTPT,N/A,N/A," $1,070.00 ", $695.50 , $415.53 , $80.47 , $294.76 , $485.54 , $459.96 , $995.10 , $963.00 , $963.00 , $856.00 , $856.00 , $294.76 , $987.93 ," $1,016.50 ", $963.00 , $963.00 , $963.00 , $995.10 ," $1,027.20 ", $452.28 , $909.50 , $447.80 , $524.70 , N/A , $495.02 , $495.02 ," $1,016.50 ", $531.03 , $80.47 ," $1,027.20 "
Allergen Spec Ige Recombinant/Purified Compnt Ea,CPT® 86008,N/A,N/A,N/A, $359.00 , $233.35 , N/A , $18.29 , $18.06 , $92.04 , N/A , $333.87 , $323.10 , $323.10 , $287.20 , $287.20 , $18.06 , $331.46 , $341.05 , $323.10 , $323.10 , $323.10 , $333.87 , $344.64 , $119.72 , $305.15 , $85.61 , $65.03 , N/A , $85.90 , $85.90 , $341.05 , $93.87 , $18.06 , $344.64 
 Fac Implant Neuroelectrodes ,CPT® 63650,0360 - OR SERVICES,N/A,N/A," $3,791.00 "," $2,464.15 "," $3,184.44 ", $397.89 , $366.89 ," $3,063.13 "," $3,411.90 "," $3,209.46 "," $3,411.90 "," $3,411.90 "," $3,411.90 "," $3,222.35 ", $359.70 ," $3,500.23 "," $3,601.45 "," $3,222.35 "," $3,525.63 "," $3,525.63 "," $3,601.45 "," $3,639.36 "," $3,101.80 "," $3,411.90 "," $3,222.35 "," $2,994.89 ", N/A ," $3,068.06 "," $3,068.06 "," $3,601.45 "," $3,253.06 ", $359.70 ," $3,639.36 "
Psychologic Testing by Psych/Phys,CPT® 96101,N/A,N/A,N/A, $253.00 , $164.45 , N/A , N/A , N/A , $177.99 , $170.67 , $235.29 , $227.70 , $227.70 , $202.40 , $202.40 , N/A , $233.59 , $240.35 , $227.70 , $227.70 , $227.70 , $235.29 , $242.88 , N/A , $215.05 , N/A , N/A , N/A , N/A , N/A , $240.35 , N/A , $170.67 , $242.88 
" Fac C-Reactive Protein, Hs ",CPT® 86141,0302 - LAB/IMMUNOLOGY,N/A,N/A, $180.00 , $117.00 , $151.20 , $13.21 , $13.21 , $145.44 , $162.00 , $152.39 , $162.00 , $162.00 , $162.00 , $153.00 , $12.95 , $166.19 , $171.00 , $153.00 , $167.40 , $167.40 , $171.00 , $172.80 , $147.28 , $162.00 , $153.00 , $142.20 , N/A , $145.67 , $145.67 , $171.00 , $154.46 , $12.95 , $172.80 
Replace Aortic Valve Open Transaortic Approach,CPT® 33365,N/A,N/A,N/A," $21,363.00 "," $13,885.95 "," $8,320.20 "," $1,281.15 "," $1,333.99 "," $7,596.12 "," $7,388.93 "," $19,867.59 "," $19,226.70 "," $19,226.70 "," $17,090.40 "," $17,090.40 "," $1,333.99 "," $19,724.46 "," $20,294.85 "," $19,226.70 "," $19,226.70 "," $19,226.70 "," $19,867.59 "," $20,508.48 "," $7,700.89 "," $18,158.55 "," $9,373.47 "," $8,538.22 ", N/A ," $7,744.33 "," $7,744.33 "," $20,294.85 "," $8,797.57 "," $1,281.15 "," $20,508.48 "
 Fac Very Long Chain Fatty Acids ,CPT® 82726,0301 - LAB/CHEMISTRY,N/A,N/A, $224.00 , $145.60 , $188.16 , $20.15 , $20.15 , $180.99 , $201.60 , $189.64 , $201.60 , $201.60 , $201.60 , $190.40 , $19.75 , $206.82 , $212.80 , $190.40 , $208.32 , $208.32 , $212.80 , $215.04 , $183.28 , $201.60 , $190.40 , $176.96 , N/A , $181.28 , $181.28 , $212.80 , $192.21 , $19.75 , $215.04 
Layer Closure 7.6-12.5cm,CPT® 12034,N/A,N/A,N/A," $1,268.00 ", $824.20 , $654.87 , $196.65 , $122.93 , $564.34 , $550.50 ," $1,179.24 "," $1,141.20 "," $1,141.20 "," $1,014.40 "," $1,014.40 ", $122.93 ," $1,170.74 "," $1,204.60 "," $1,141.20 "," $1,141.20 "," $1,141.20 "," $1,179.24 "," $1,217.28 ", $719.01 ," $1,077.80 "," $1,100.77 ", $726.60 , N/A , $575.35 , $575.35 ," $1,204.60 ", $667.22 , $122.93 ," $1,217.28 "
 Fac Compre Ep Eval Abltj 3d Mapg Tx Svt ,CPT® 93653,0481 - CARDIAC CATH LAB,N/A,N/A," $21,536.00 "," $13,998.40 "," $18,090.24 ", $763.79 , $926.90 ," $17,401.09 "," $19,382.40 "," $18,232.38 "," $19,382.40 "," $19,382.40 "," $19,382.40 "," $18,305.60 ", $908.73 ," $19,884.19 "," $20,459.20 "," $18,305.60 "," $20,028.48 "," $20,028.48 "," $20,459.20 "," $20,674.56 "," $17,620.76 "," $19,382.40 "," $18,305.60 "," $17,013.44 ", N/A ," $17,429.08 "," $17,429.08 "," $20,459.20 "," $18,480.04 ", $763.79 ," $20,674.56 "
"Revis Colostomy,Repr Paracolo Hernia",CPT® 44346,N/A,N/A,N/A," $7,476.00 "," $4,859.40 "," $7,072.46 "," $1,097.78 ", $711.36 ," $5,586.32 "," $5,656.98 "," $6,952.68 "," $6,728.40 "," $6,728.40 "," $5,980.80 "," $5,980.80 ", $711.36 ," $6,902.59 "," $7,102.20 "," $6,728.40 "," $6,728.40 "," $6,728.40 "," $6,952.68 "," $7,176.96 "," $5,071.47 "," $6,354.60 "," $6,272.77 "," $6,610.34 ", N/A ," $5,695.32 "," $5,695.32 "," $7,102.20 "," $5,956.69 ", $711.36 ," $7,176.96 "
Perq Vert Agmntj Cavity Crtj Uni/Bi Cannulj Lmbr,CPT® 22514,N/A,N/A,N/A," $6,109.00 "," $3,970.85 "," $2,858.05 ", $445.26 ," $5,745.46 "," $2,336.16 "," $2,468.46 "," $5,681.37 "," $5,498.10 "," $5,498.10 "," $4,887.20 "," $4,887.20 "," $5,745.46 "," $5,640.44 "," $5,803.55 "," $5,498.10 "," $5,498.10 "," $5,498.10 "," $5,681.37 "," $5,864.64 "," $2,674.79 "," $5,192.65 "," $2,510.82 "," $2,752.56 ", N/A ," $2,381.74 "," $2,381.74 "," $5,803.55 "," $2,799.39 ", $445.26 ," $5,864.64 "
 Pro Remove Wrist/Forearm Lesion ,CPT® 25115,0982 - PRO FEE/OUTPT,N/A,N/A," $6,003.00 "," $3,901.95 "," $4,619.16 ", $726.54 , $691.53 ," $3,655.14 "," $3,641.07 "," $5,582.79 "," $5,402.70 "," $5,402.70 "," $4,802.40 "," $4,802.40 ", $691.53 ," $5,542.57 "," $5,702.85 "," $5,402.70 "," $5,402.70 "," $5,402.70 "," $5,582.79 "," $5,762.88 "," $4,299.45 "," $5,102.55 "," $4,005.22 "," $4,338.12 ", N/A ," $3,726.46 "," $3,726.46 "," $5,702.85 "," $4,379.93 ", $691.53 ," $5,762.88 "
 AMMONIUM LACTATE 12 % EX LOTN ,HCPCS RXC637,0250 - PHARMACY,00904-5984-26,226 gram, $196.20 , $127.53 , $164.81 , N/A , N/A , $158.53 , $176.58 , $166.10 , $176.58 , $176.58 , $176.58 , $166.77 , N/A , $181.15 , $186.39 , $166.77 , $182.47 , $182.47 , $186.39 , $188.35 , $160.53 , $176.58 , $166.77 , $155.00 , N/A , $158.78 , $158.78 , $186.39 , $168.36 , $155.00 , $188.35 
 Fac Cystatin C ,CPT® 82610,0301 - LAB/CHEMISTRY,N/A,N/A, $242.00 , $157.30 , $203.28 , $18.89 , $18.87 , $195.54 , $217.80 , $204.88 , $217.80 , $217.80 , $217.80 , $205.70 , $18.50 , $223.44 , $229.90 , $205.70 , $225.06 , $225.06 , $229.90 , $232.32 , $198.00 , $217.80 , $205.70 , $191.18 , N/A , $195.85 , $195.85 , $229.90 , $207.66 , $18.50 , $232.32 
Subsequent Ped Critical Care 29 Day Thru 24 Mo,CPT® 99472,N/A,N/A,N/A," $2,746.00 "," $1,784.90 ", $806.46 , $381.19 , $371.17 , $705.11 , $704.10 ," $2,553.78 "," $2,471.40 "," $2,471.40 "," $2,196.80 "," $2,196.80 ", $371.17 ," $2,535.38 "," $2,608.70 "," $2,471.40 "," $2,471.40 "," $2,471.40 "," $2,553.78 "," $2,636.16 "," $1,018.70 "," $2,334.10 ", $874.62 , $896.31 , N/A , $718.87 , $718.87 ," $2,608.70 ", $829.10 , $371.17 ," $2,636.16 "
Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/O Img Gdn,62322,N/A,N/A,N/A," $1,232.00 ", $800.80 , $397.54 , $76.88 , $185.09 , $472.56 , $461.97 ," $1,145.76 "," $1,108.80 "," $1,108.80 ", $985.60 , $985.60 , $185.09 ," $1,137.51 "," $1,170.40 "," $1,108.80 "," $1,108.80 "," $1,108.80 "," $1,145.76 "," $1,182.72 ", $432.18 ," $1,047.20 ", $422.91 , $524.46 , N/A , $481.78 , $481.78 ," $1,170.40 ", $516.83 , $76.88 ," $1,182.72 "
 Fac Byp W/Vein Aortoceliac/Aortomesenteric ,CPT® 35531,0360 - OR SERVICES,N/A,N/A," $11,977.00 "," $7,785.05 "," $10,060.68 "," $1,724.53 "," $1,993.16 "," $9,677.42 "," $10,779.30 "," $10,139.73 "," $10,779.30 "," $10,779.30 "," $10,779.30 "," $10,180.45 "," $1,954.08 "," $11,058.36 "," $11,378.15 "," $10,180.45 "," $11,138.61 "," $11,138.61 "," $11,378.15 "," $11,497.92 "," $9,799.58 "," $10,779.30 "," $10,180.45 "," $9,461.83 ", N/A ," $9,692.99 "," $9,692.99 "," $11,378.15 "," $10,277.46 "," $1,724.53 "," $11,497.92 "
 Fac Radiation Treatment Delivery ,CPT® 77412,0333 - RADIATION RX,N/A,N/A," $1,012.00 ", $657.80 , $850.08 , N/A , N/A , $817.70 , $910.80 , $856.76 , $910.80 , $910.80 , $910.80 , $860.20 , N/A , $934.38 , $961.40 , $860.20 , $941.16 , $941.16 , $961.40 , $971.52 , $828.02 , $910.80 , $860.20 , $799.48 , N/A , $819.01 , $819.01 , $961.40 , $868.40 , $799.48 , $971.52 
"Remv Kidney/Ureter,Same Incis",CPT® 50234,N/A,N/A,N/A," $9,039.00 "," $5,875.35 "," $7,023.74 "," $1,232.93 "," $1,536.80 "," $6,357.63 "," $5,905.87 "," $8,406.27 "," $8,135.10 "," $8,135.10 "," $7,231.20 "," $7,231.20 "," $1,536.80 "," $8,345.71 "," $8,587.05 "," $8,135.10 "," $8,135.10 "," $8,135.10 "," $8,406.27 "," $8,677.44 "," $7,043.86 "," $7,683.15 "," $6,697.38 "," $7,983.51 ", N/A ," $6,481.68 "," $6,481.68 "," $8,587.05 "," $7,618.27 "," $1,232.93 "," $8,677.44 "
Fx Radial Closed W Manipu,25605,N/A,N/A,N/A," $2,674.00 "," $1,738.10 "," $3,147.43 ", $496.56 , $388.30 ," $2,466.77 "," $2,502.71 "," $2,486.82 "," $2,406.60 "," $2,406.60 "," $2,139.20 "," $2,139.20 ", $388.30 ," $2,468.90 "," $2,540.30 "," $2,406.60 "," $2,406.60 "," $2,406.60 "," $2,486.82 "," $2,567.04 "," $2,912.52 "," $2,272.90 "," $2,754.59 "," $2,906.58 ", N/A ," $2,514.91 "," $2,514.91 "," $2,540.30 "," $2,955.90 ", $388.30 ," $3,147.43 "
 T Spine CT With Contrast ,CPT® 72129,0350 - CT SCAN,N/A,N/A," $3,356.00 "," $2,181.40 "," $2,819.04 ", $173.51 , $303.06 ," $2,711.65 "," $3,020.40 "," $2,841.19 "," $3,020.40 "," $3,020.40 "," $3,020.40 "," $2,852.60 ", $297.12 ," $3,098.59 "," $3,188.20 "," $2,852.60 "," $3,121.08 "," $3,121.08 "," $3,188.20 "," $3,221.76 "," $2,745.88 "," $3,020.40 "," $2,852.60 "," $2,651.24 ", N/A ," $2,716.01 "," $2,716.01 "," $3,188.20 "," $2,879.78 ", $173.51 ," $3,221.76 "
 Inj Eval of Exising Central Venous-C ,CPT® 36598,0761 - TREATMENT ROOM,N/A,N/A, $470.00 , $305.50 , $394.80 , $34.22 , $161.63 , $379.76 , $423.00 , $397.90 , $423.00 , $423.00 , $423.00 , $399.50 , $158.46 , $433.95 , $446.50 , $399.50 , $437.10 , $437.10 , $446.50 , $451.20 , $384.55 , $423.00 , $399.50 , $371.30 , N/A , $380.37 , $380.37 , $446.50 , $403.31 , $34.22 , $451.20 
 ECALLANTIDE 10 MG/ML SC SOLN ,HCPCS J1290,0636 - DRUGS REQUIRING DETAILED CODIN,47783-0101-01,3 mL," $47,447.80 "," $30,841.07 "," $39,856.15 ", $541.33 , $530.91 ," $38,337.82 "," $42,703.02 "," $40,169.31 "," $42,703.02 "," $42,703.02 "," $42,703.02 "," $40,330.63 ", $520.50 ," $43,808.55 "," $45,075.41 "," $40,330.63 "," $44,126.45 "," $44,126.45 "," $45,075.41 "," $45,549.89 "," $38,821.79 "," $42,703.02 "," $40,330.63 "," $37,483.76 ", N/A ," $38,399.50 "," $38,399.50 "," $45,075.41 "," $40,714.96 ", $520.50 ," $45,549.89 "
 Fac Assay RBC Protoporphyrin ,CPT® 84202,0301 - LAB/CHEMISTRY,N/A,N/A, $129.00 , $83.85 , $108.36 , $14.64 , $14.64 , $104.23 , $116.10 , $109.21 , $116.10 , $116.10 , $116.10 , $109.65 , $14.35 , $119.11 , $122.55 , $109.65 , $119.97 , $119.97 , $122.55 , $123.84 , $105.55 , $116.10 , $109.65 , $101.91 , N/A , $104.40 , $104.40 , $122.55 , $110.69 , $14.35 , $123.84 
 Pro Repair Forearm Tendon/Muscle ,CPT® 25260,0975 - PRO FEE/OR,N/A,N/A," $4,316.00 "," $2,805.40 "," $3,892.40 ", $612.04 , $546.22 ," $3,033.01 "," $3,036.14 "," $4,013.88 "," $3,884.40 "," $3,884.40 "," $3,452.80 "," $3,452.80 ", $546.22 ," $3,984.96 "," $4,100.20 "," $3,884.40 "," $3,884.40 "," $3,884.40 "," $4,013.88 "," $4,143.36 "," $3,605.62 "," $3,668.60 "," $3,341.55 "," $3,595.95 ", N/A ," $3,092.19 "," $3,092.19 "," $4,100.20 "," $3,634.44 ", $546.22 ," $4,143.36 "
 Fac Pmp22 Gene Analysis Full Sequence Analysis ,CPT® 81325,0310 - PATHOLOGY LAB,N/A,N/A, $18.00 , $11.70 , $15.12 , $784.97 , $272.87 , $14.54 , $16.20 , $15.24 , $16.20 , $16.20 , $16.20 , $15.30 , $267.52 , $16.62 , $17.10 , $15.30 , $16.74 , $16.74 , $17.10 , $17.28 , $14.73 , $16.20 , $15.30 , $14.22 , N/A , $14.57 , $14.57 , $17.10 , $15.45 , $14.22 , $784.97 
 Other Respiratory System Diagnoses Without McC ,MS DRG V40 (FY2023) 206,N/A,N/A,N/A," $25,180.52 "," $16,367.34 "," $21,151.64 ", N/A , N/A ," $20,345.86 "," $22,662.47 "," $21,317.83 "," $22,662.47 "," $22,662.47 "," $22,662.47 "," $21,403.44 ", N/A ," $23,249.17 "," $23,921.49 "," $21,403.44 "," $23,417.88 "," $23,417.88 "," $23,921.49 "," $24,173.30 "," $20,602.70 "," $22,662.47 "," $21,403.44 "," $19,892.61 ", N/A ," $20,378.59 "," $20,378.59 "," $23,921.49 "," $21,607.40 "," $19,892.61 "," $24,173.30 "
L Hrt Cath W/Njx L Ventriculography Img S&I,CPT® 93452,N/A,N/A,N/A," $6,033.00 "," $3,921.45 "," $5,852.47 ", $875.90 , $927.36 ," $4,732.75 "," $5,001.48 "," $5,610.69 "," $5,429.70 "," $5,429.70 "," $4,826.40 "," $4,826.40 ", $927.36 ," $5,570.27 "," $5,731.35 "," $5,429.70 "," $5,429.70 "," $5,429.70 "," $5,610.69 "," $5,791.68 "," $5,472.63 "," $5,128.05 "," $4,752.75 "," $4,877.23 ", N/A ," $4,825.09 "," $4,825.09 "," $5,731.35 "," $5,348.66 ", $875.90 ," $5,852.47 "
" Pro Intubation,Endotracheal ",CPT® 31500,0981 - PRO FEE/ER,N/A,N/A, $777.00 , $505.05 , $758.54 , $132.66 , $155.78 , $421.83 , $406.96 , $722.61 , $699.30 , $699.30 , $621.60 , $621.60 , $155.78 , $717.40 , $738.15 , $699.30 , $699.30 , $699.30 , $722.61 , $745.92 , $734.78 , $660.45 , $576.25 , $726.12 , N/A , $430.06 , $430.06 , $738.15 , $506.49 , $132.66 , $758.54 
"Puncture Abscesss,Cyst,He",10160,N/A,N/A,N/A, $490.00 , $318.50 , $307.12 , $92.99 , $30.77 , $262.79 , $257.92 , $455.70 , $441.00 , $441.00 , $392.00 , $392.00 , $30.77 , $452.42 , $465.50 , $441.00 , $441.00 , $441.00 , $455.70 , $470.40 , $335.46 , $416.50 , $510.24 , $335.24 , N/A , $267.91 , $267.91 , $465.50 , $310.70 , $30.77 , $510.24 
Cast Sup Sht Arm Splnt Ped F,HCPCS Q4024,N/A,N/A,N/A, $26.00 , $16.90 , N/A , $7.38 , $4.50 , N/A , N/A , $24.18 , $23.40 , $23.40 , $20.80 , $20.80 , $4.50 , $24.01 , $24.70 , $23.40 , $23.40 , $23.40 , $24.18 , $24.96 , N/A , $22.10 , $36.33 , $6.71 , N/A , N/A , N/A , $24.70 , N/A , $4.50 , $36.33 
 Pro Echo Exam of Heart ,CPT® 93308,0972 - PRO FEE/RAD/DX,N/A,N/A, $570.00 , $370.50 , $625.50 , $96.57 , $153.86 , $668.74 , $562.09 , $530.10 , $513.00 , $513.00 , $456.00 , $456.00 , $153.86 , $526.28 , $541.50 , $513.00 , $513.00 , $513.00 , $530.10 , $547.20 , $620.72 , $484.50 , $526.30 , $632.47 , N/A , $681.79 , $681.79 , $541.50 , $755.77 , $96.57 , $755.77 
Repair Foot Extensor Tend,CPT® 28208,N/A,N/A,N/A," $3,099.00 "," $2,014.35 "," $1,971.39 ", $312.25 , $184.42 ," $1,535.22 "," $1,513.61 "," $2,882.07 "," $2,789.10 "," $2,789.10 "," $2,479.20 "," $2,479.20 ", $184.42 ," $2,861.31 "," $2,944.05 "," $2,789.10 "," $2,789.10 "," $2,789.10 "," $2,882.07 "," $2,975.04 "," $1,826.40 "," $2,634.15 "," $1,641.34 "," $1,839.33 ", N/A ," $1,565.17 "," $1,565.17 "," $2,944.05 "," $1,839.62 ", $184.42 ," $2,975.04 "
 Renal Failure With Cc ,MS DRG V40 (FY2023) 683,N/A,N/A,N/A," $16,363.77 "," $10,636.45 "," $13,745.57 ", N/A , N/A ," $13,221.93 "," $14,727.39 "," $13,853.57 "," $14,727.39 "," $14,727.39 "," $14,727.39 "," $13,909.20 ", N/A ," $15,108.67 "," $15,545.58 "," $13,909.20 "," $15,218.31 "," $15,218.31 "," $15,545.58 "," $15,709.22 "," $13,388.84 "," $14,727.39 "," $13,909.20 "," $12,927.38 ", N/A ," $13,243.20 "," $13,243.20 "," $15,545.58 "," $14,041.75 "," $12,927.38 "," $15,709.22 "
Family Psychotherapy W/O Patient Present 50 Mins,90846,N/A,N/A,N/A, $166.00 , $107.90 , $127.89 , $94.88 , $120.80 , $229.22 , $178.96 , $154.38 , $149.40 , $149.40 , $132.80 , $132.80 , $120.80 , $153.27 , $157.70 , $149.40 , $149.40 , $149.40 , $154.38 , $159.36 , $244.70 , $141.10 , $233.15 , $387.85 , $122.00 , $233.69 , $233.69 , $157.70 , $272.45 , $94.88 , $387.85 
 PANITUMUMAB 100 MG/5ML IV SOLN ,HCPCS J9303,0636 - DRUGS REQUIRING DETAILED CODIN,55513-0954-01,5 mL," $4,614.70 "," $2,999.56 "," $3,876.35 ", $152.70 , $146.38 ," $3,728.68 "," $4,153.23 "," $3,906.81 "," $4,153.23 "," $4,153.23 "," $4,153.23 "," $3,922.50 ", $143.51 ," $4,260.75 "," $4,383.97 "," $3,922.50 "," $4,291.67 "," $4,291.67 "," $4,383.97 "," $4,430.11 "," $3,775.75 "," $4,153.23 "," $3,922.50 "," $3,645.61 ", N/A ," $3,734.68 "," $3,734.68 "," $4,383.97 "," $3,959.87 ", $143.51 ," $4,430.11 "
"Rep Tendon Finger,W/O Gra",CPT® 26418,N/A,N/A,N/A," $2,087.00 "," $1,356.55 "," $3,954.41 ", $615.23 , $426.00 ," $2,746.72 "," $2,822.57 "," $1,940.91 "," $1,878.30 "," $1,878.30 "," $1,669.60 "," $1,669.60 ", $426.00 ," $1,926.93 "," $1,982.65 "," $1,878.30 "," $1,878.30 "," $1,878.30 "," $1,940.91 "," $2,003.52 "," $3,614.06 "," $1,773.95 "," $3,084.65 "," $3,289.40 ", N/A ," $2,800.31 "," $2,800.31 "," $1,982.65 "," $3,291.34 ", $426.00 ," $3,954.41 "
" Fac Flowcytometry/ Tc, 1 Marker ",CPT® 88184,0311 - PATHOL/CYTOLOGY,N/A,N/A, $501.00 , $325.65 , $420.84 , $72.46 , $48.24 , $404.81 , $450.90 , $424.15 , $450.90 , $450.90 , $450.90 , $425.85 , $47.29 , $462.57 , $475.95 , $425.85 , $465.93 , $465.93 , $475.95 , $480.96 , $409.92 , $450.90 , $425.85 , $395.79 , N/A , $405.46 , $405.46 , $475.95 , $429.91 , $47.29 , $480.96 
 HYDROMORPHONE HCL PF 10 MG/ML IJ SOLN ,HCPCS J1170,0636 - DRUGS REQUIRING DETAILED CODIN,00409-2634-01,1.2 mL, $57.82 , $37.58 , $48.57 , $4.44 , $4.30 , $46.72 , $52.04 , $48.95 , $52.04 , $52.04 , $52.04 , $49.15 , $4.22 , $53.39 , $54.93 , $49.15 , $53.77 , $53.77 , $54.93 , $55.51 , $47.31 , $52.04 , $49.15 , $45.68 , N/A , $46.79 , $46.79 , $54.93 , $49.62 , $4.22 , $55.51 
Mast Smpl Compl,CPT® 19303,N/A,N/A,N/A," $4,281.00 "," $2,782.65 "," $2,989.89 ", $887.00 , $664.14 ," $2,713.01 "," $2,632.15 "," $3,981.33 "," $3,852.90 "," $3,852.90 "," $3,424.80 "," $3,424.80 ", $664.14 ," $3,952.65 "," $4,066.95 "," $3,852.90 "," $3,852.90 "," $3,852.90 "," $3,981.33 "," $4,109.76 "," $3,274.28 "," $3,638.85 "," $5,320.08 "," $3,254.96 ", N/A ," $2,765.94 "," $2,765.94 "," $4,066.95 "," $3,207.58 ", $664.14 ," $5,320.08 "
 Fac Assay of Lipase ,CPT® 83690,0301 - LAB/CHEMISTRY,N/A,N/A, $101.00 , $65.65 , $84.84 , $7.03 , $7.03 , $81.61 , $90.90 , $85.51 , $90.90 , $90.90 , $90.90 , $85.85 , $6.89 , $93.25 , $95.95 , $85.85 , $93.93 , $93.93 , $95.95 , $96.96 , $82.64 , $90.90 , $85.85 , $79.79 , N/A , $81.74 , $81.74 , $95.95 , $86.67 , $6.89 , $96.96 
 PHENYLEPHRINE 0.25 MG/ML INJ (FOR PRIAPISM) ,HCPCS RXA250,0250 - PHARMACY,00641-6142-01,10 mL, $117.62 , $76.45 , $98.80 , N/A , N/A , $95.04 , $105.86 , $99.58 , $105.86 , $105.86 , $105.86 , $99.98 , N/A , $108.60 , $111.74 , $99.98 , $109.39 , $109.39 , $111.74 , $112.92 , $96.24 , $105.86 , $99.98 , $92.92 , N/A , $95.19 , $95.19 , $111.74 , $100.93 , $92.92 , $112.92 
Moderna Admin Biv Booster 18 Yrs and Older,CPT® 0134A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $56.00 , $128.02 , N/A , N/A , N/A , $66.50 , N/A , $38.92 , $128.02 
"Laryngoscopy,Direct,Diagnostic",CPT® 31525,N/A,N/A,N/A," $1,411.00 ", $917.15 , $859.34 , $152.06 , $303.22 , $615.92 , $602.47 ," $1,312.23 "," $1,269.90 "," $1,269.90 "," $1,128.80 "," $1,128.80 ", $303.22 ," $1,302.78 "," $1,340.45 "," $1,269.90 "," $1,269.90 "," $1,269.90 "," $1,312.23 "," $1,354.56 ", $821.76 ," $1,199.35 ", $849.21 , $812.19 , N/A , $627.94 , $627.94 ," $1,340.45 ", $739.55 , $152.06 ," $1,354.56 "
 Fac Anosc Dilat ,CPT® 46604,0360 - OR SERVICES,N/A,N/A," $1,036.00 ", $673.40 , $870.24 , $62.18 , $38.12 , $837.09 , $932.40 , $877.08 , $932.40 , $932.40 , $932.40 , $880.60 , $37.37 , $956.54 , $984.20 , $880.60 , $963.48 , $963.48 , $984.20 , $994.56 , $847.66 , $932.40 , $880.60 , $818.44 , N/A , $838.43 , $838.43 , $984.20 , $888.99 , $37.37 , $994.56 
"Laryngoscopy,Dirct,OP,Remv Arytenod",CPT® 31560,N/A,N/A,N/A," $1,822.00 "," $1,184.30 "," $1,677.16 ", $296.34 , $768.38 ," $1,209.97 "," $1,182.40 "," $1,694.46 "," $1,639.80 "," $1,639.80 "," $1,457.60 "," $1,457.60 ", $768.38 ," $1,682.25 "," $1,730.90 "," $1,639.80 "," $1,639.80 "," $1,639.80 "," $1,694.46 "," $1,749.12 "," $1,605.62 "," $1,548.70 "," $1,666.32 "," $1,586.49 ", N/A ," $1,233.58 "," $1,233.58 "," $1,730.90 "," $1,452.80 ", $296.34 ," $1,749.12 "
Irrig Implanted Drug Delivery Device,CPT® 96523,N/A,N/A,N/A, $134.00 , $87.10 , $88.87 , $24.81 , $22.86 , $69.89 , $56.25 , $124.62 , $120.60 , $120.60 , $107.20 , $107.20 , $22.86 , $123.72 , $127.30 , $120.60 , $120.60 , $120.60 , $124.62 , $128.64 , $101.85 , $113.90 , $75.01 , $107.12 , N/A , $71.26 , $71.26 , $127.30 , $84.20 , $22.86 , $128.64 
"Laryngoscopy,Indirect+Inject Cord",CPT® 31513,N/A,N/A,N/A, $754.00 , $490.10 , $703.00 , $124.99 , $107.21 , $508.58 , $499.96 , $701.22 , $678.60 , $678.60 , $603.20 , $603.20 , $107.21 , $696.17 , $716.30 , $678.60 , $678.60 , $678.60 , $701.22 , $723.84 , $675.40 , $640.90 , $704.71 , $666.04 , N/A , $518.50 , $518.50 , $716.30 , $610.64 , $107.21 , $723.84 
"Urethrolysis,Transvag W Scope",CPT® 53500,N/A,N/A,N/A," $5,210.00 "," $3,386.50 "," $4,039.84 ", $711.76 , $719.70 ," $3,656.42 "," $3,426.15 "," $4,845.30 "," $4,689.00 "," $4,689.00 "," $4,168.00 "," $4,168.00 ", $719.70 ," $4,810.39 "," $4,949.50 "," $4,689.00 "," $4,689.00 "," $4,689.00 "," $4,845.30 "," $5,001.60 "," $4,055.41 "," $4,428.50 "," $3,901.75 "," $4,582.20 ", N/A ," $3,727.76 "," $3,727.76 "," $4,949.50 "," $4,381.44 ", $711.76 ," $5,001.60 "
"Removal,Complete CSF Shunt,W/O Replace",CPT® 62256,N/A,N/A,N/A," $3,864.00 "," $2,511.60 "," $2,836.18 ", $556.58 , $484.85 ," $3,253.39 "," $3,149.76 "," $3,593.52 "," $3,477.60 "," $3,477.60 "," $3,091.20 "," $3,091.20 ", $484.85 ," $3,567.63 "," $3,670.80 "," $3,477.60 "," $3,477.60 "," $3,477.60 "," $3,593.52 "," $3,709.44 "," $3,051.01 "," $3,284.40 "," $3,211.32 "," $3,379.79 ", N/A ," $3,316.87 "," $3,316.87 "," $3,670.80 "," $3,558.21 ", $484.85 ," $3,709.44 "
"Colposcopy,Entire Vagina",CPT® 57420,N/A,N/A,N/A, $696.00 , $452.40 , $416.80 , $84.62 , $157.58 , $372.94 , $365.34 , $647.28 , $626.40 , $626.40 , $556.80 , $556.80 , $157.58 , $642.62 , $661.20 , $626.40 , $626.40 , $626.40 , $647.28 , $668.16 , $439.20 , $591.60 , $479.91 , $373.85 , N/A , $380.21 , $380.21 , $661.20 , $456.03 , $84.62 , $668.16 
 OXYCODONE HCL ER 10 MG PO T12A ,HCPCS RXC637,0250 - PHARMACY,59011-0410-20,1 tablet, $30.96 , $20.12 , $26.01 , N/A , N/A , $25.02 , $27.86 , $26.21 , $27.86 , $27.86 , $27.86 , $26.32 , N/A , $28.59 , $29.41 , $26.32 , $28.79 , $28.79 , $29.41 , $29.72 , $25.33 , $27.86 , $26.32 , $24.46 , N/A , $25.06 , $25.06 , $29.41 , $26.57 , $24.46 , $29.72 
" Pro OB US Nuchal Meas, 1 Gest ",CPT® 76813,0972 - PRO FEE/RAD/DX,N/A,N/A, $405.00 , $263.25 , $674.71 , $116.52 , $103.10 , $582.30 , $644.48 , $376.65 , $364.50 , $364.50 , $324.00 , $324.00 , $103.10 , $373.94 , $384.75 , $364.50 , $364.50 , $364.50 , $376.65 , $388.80 , $679.62 , $344.25 , $703.01 , $684.25 , N/A , $593.66 , $593.66 , $384.75 , $687.17 , $103.10 , $703.01 
Splint,HCPCS A4570,N/A,N/A,N/A, $41.00 , $26.65 , N/A , N/A , N/A , N/A , N/A , $38.13 , $36.90 , $36.90 , $32.80 , $32.80 , N/A , $37.86 , $38.95 , $36.90 , $36.90 , $36.90 , $38.13 , $39.36 , N/A , $34.85 , $22.71 , $13.21 , N/A , N/A , N/A , $38.95 , N/A , $13.21 , $39.36 
Mod Sed Same Phys/Qhp Initial 15 Mins 5/> Yrs,99152,N/A,N/A,N/A, $119.00 , $77.35 , $28.01 , $11.70 , $40.63 , $26.51 , $27.37 , $110.67 , $107.10 , $107.10 , $95.20 , $95.20 , $40.63 , $109.87 , $113.05 , $107.10 , $107.10 , $107.10 , $110.67 , $114.24 , $37.64 , $101.15 , $37.36 , $46.92 , N/A , $27.03 , $27.03 , $113.05 , $31.50 , $11.70 , $114.24 
 Fac Comparative Anal Str Markers Patient&Comp Spec ,CPT® 81265,0310 - PATHOLOGY LAB,N/A,N/A," $1,741.00 "," $1,131.65 "," $1,462.44 ", $237.73 , $237.73 ," $1,406.73 "," $1,566.90 "," $1,473.93 "," $1,566.90 "," $1,566.90 "," $1,566.90 "," $1,479.85 ", $233.07 ," $1,607.47 "," $1,653.95 "," $1,479.85 "," $1,619.13 "," $1,619.13 "," $1,653.95 "," $1,671.36 "," $1,424.49 "," $1,566.90 "," $1,479.85 "," $1,375.39 ", N/A ," $1,408.99 "," $1,408.99 "," $1,653.95 "," $1,493.95 ", $233.07 ," $1,671.36 "
 METOPROLOL TARTARATE 6.25 MG TAB (COMES FROM 25 MG TABLET) ,HCPCS RXC637,0250 - PHARMACY,00001-0923-01,2 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
" Pro OB US >/= 14 Wks, Sngl Fetus ",CPT® 76805,0972 - PRO FEE/RAD/DX,N/A,N/A, $395.00 , $256.75 , $770.82 , $134.36 , $138.63 , $682.02 , $782.28 , $367.35 , $355.50 , $355.50 , $316.00 , $316.00 , $138.63 , $364.70 , $375.25 , $355.50 , $355.50 , $355.50 , $367.35 , $379.20 , $777.27 , $335.75 , $853.24 , $800.96 , N/A , $695.32 , $695.32 , $375.25 , $804.85 , $134.36 , $853.24 
Complex Repair 2.6-7.5cm,13152,N/A,N/A,N/A," $2,554.00 "," $1,660.10 "," $1,075.18 ", $321.34 , $282.60 , $954.01 , $856.35 ," $2,375.22 "," $2,298.60 "," $2,298.60 "," $2,043.20 "," $2,043.20 ", $282.60 ," $2,358.11 "," $2,426.30 "," $2,298.60 "," $2,298.60 "," $2,298.60 "," $2,375.22 "," $2,451.84 "," $1,184.60 "," $2,170.90 "," $1,705.57 "," $1,220.27 ", N/A , $972.62 , $972.62 ," $2,426.30 "," $1,127.91 ", $282.60 ," $2,451.84 "
 Pro Laparo Cholecystectomy/Graph ,CPT® 47563,0982 - PRO FEE/OUTPT,N/A,N/A," $7,409.00 "," $4,815.85 "," $4,291.24 ", $664.92 , $644.55 ," $4,426.73 "," $4,417.21 "," $6,890.37 "," $6,668.10 "," $6,668.10 "," $5,927.20 "," $5,927.20 ", $644.55 ," $6,840.73 "," $7,038.55 "," $6,668.10 "," $6,668.10 "," $6,668.10 "," $6,890.37 "," $7,112.64 "," $5,444.78 "," $6,297.65 "," $3,775.08 "," $3,957.32 ", N/A ," $4,513.10 "," $4,513.10 "," $7,038.55 "," $5,205.41 ", $644.55 ," $7,112.64 "
 Pro Remove Foreign Body From Eye ,CPT® 65205,0981 - PRO FEE/ER,N/A,N/A, $235.00 , $152.75 , $180.70 , $28.20 , $35.23 , $251.30 , $232.46 , $218.55 , $211.50 , $211.50 , $188.00 , $188.00 , $35.23 , $216.98 , $223.25 , $211.50 , $211.50 , $211.50 , $218.55 , $225.60 , $248.64 , $199.75 , $239.06 , $319.55 , N/A , $256.20 , $256.20 , $223.25 , $282.82 , $28.20 , $319.55 
Assay Urine Creatinine,CPT® 82570,N/A,N/A,N/A, $63.00 , $40.95 , N/A , $5.28 , $5.28 , $29.27 , $35.00 , $58.59 , $56.70 , $56.70 , $50.40 , $50.40 , $5.28 , $58.17 , $59.85 , $56.70 , $56.70 , $56.70 , $58.59 , $60.48 , $34.59 , $53.55 , $34.06 , $18.77 , N/A , $27.32 , $27.32 , $59.85 , $29.85 , $5.28 , $60.48 
 BENZOCAINE 20 % MT SOLN ,HCPCS RXC637,0250 - PHARMACY,00283-0610-26,1 each, $52.54 , $34.15 , $44.13 , N/A , N/A , $42.45 , $47.29 , $44.48 , $47.29 , $47.29 , $47.29 , $44.66 , N/A , $48.51 , $49.91 , $44.66 , $48.86 , $48.86 , $49.91 , $50.44 , $42.99 , $47.29 , $44.66 , $41.51 , N/A , $42.52 , $42.52 , $49.91 , $45.08 , $41.51 , $50.44 
 Fac Byp Oth/Thn Vein Crtd-Subcla ,CPT® 35606,0360 - OR SERVICES,N/A,N/A," $2,132.00 "," $1,385.80 "," $1,790.88 "," $1,045.20 "," $1,340.24 "," $1,722.66 "," $1,918.80 "," $1,804.95 "," $1,918.80 "," $1,918.80 "," $1,918.80 "," $1,812.20 "," $1,313.96 "," $1,968.48 "," $2,025.40 "," $1,812.20 "," $1,982.76 "," $1,982.76 "," $2,025.40 "," $2,046.72 "," $1,744.40 "," $1,918.80 "," $1,812.20 "," $1,684.28 ", N/A ," $1,725.43 "," $1,725.43 "," $2,025.40 "," $1,829.47 "," $1,045.20 "," $2,046.72 "
 Mra Abdomen W/O or With Contrast ,CPT® 74185,0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA-OTHER,N/A,N/A," $4,438.00 "," $2,884.70 "," $3,727.92 ", $346.46 , $464.63 ," $3,585.90 "," $3,994.20 "," $3,757.21 "," $3,994.20 "," $3,994.20 "," $3,994.20 "," $3,772.30 ", $455.52 ," $4,097.61 "," $4,216.10 "," $3,772.30 "," $4,127.34 "," $4,127.34 "," $4,216.10 "," $4,260.48 "," $3,631.17 "," $3,994.20 "," $3,772.30 "," $3,506.02 ", N/A ," $3,591.67 "," $3,591.67 "," $4,216.10 "," $3,808.25 ", $346.46 ," $4,260.48 "
 NIFEDIPINE ER 30 MG PO TB24 ,HCPCS RXC637,0250 - PHARMACY,50742-0620-01,1 tablet, $7.17 , $4.66 , $6.02 , N/A , N/A , $5.79 , $6.45 , $6.07 , $6.45 , $6.45 , $6.45 , $6.09 , N/A , $6.62 , $6.81 , $6.09 , $6.67 , $6.67 , $6.81 , $6.88 , $5.87 , $6.45 , $6.09 , $5.66 , N/A , $5.80 , $5.80 , $6.81 , $6.15 , $5.66 , $6.88 
"MR Angio, Neck",CPT® 70547,N/A,N/A,N/A," $3,539.00 "," $2,300.35 "," $1,547.63 ", $221.31 , $403.88 ," $1,872.42 "," $2,424.57 "," $3,291.27 "," $3,185.10 "," $3,185.10 "," $2,831.20 "," $2,831.20 ", $403.88 ," $3,267.56 "," $3,362.05 "," $3,185.10 "," $3,185.10 "," $3,185.10 "," $3,291.27 "," $3,397.44 "," $1,325.20 "," $3,008.15 "," $2,644.46 "," $2,201.78 ", N/A ," $1,908.95 "," $1,908.95 "," $3,362.05 "," $2,209.65 ", $221.31 ," $3,397.44 "
 ETHYL CHLORIDE EX AERO ,HCPCS RXA250,0250 - PHARMACY,00386-0001-02,207 mL, $457.77 , $297.55 , $384.53 , N/A , N/A , $369.88 , $411.99 , $387.55 , $411.99 , $411.99 , $411.99 , $389.10 , N/A , $422.66 , $434.88 , $389.10 , $425.73 , $425.73 , $434.88 , $439.46 , $374.55 , $411.99 , $389.10 , $361.64 , N/A , $370.47 , $370.47 , $434.88 , $392.81 , $361.64 , $439.46 
Therapeutic Spinal Puncture Drainage CSF,62272,N/A,N/A,N/A, $620.00 , $403.00 , $416.99 , $81.94 , $89.21 , $458.77 , $444.83 , $576.60 , $558.00 , $558.00 , $496.00 , $496.00 , $89.21 , $572.45 , $589.00 , $558.00 , $558.00 , $558.00 , $576.60 , $595.20 , $447.85 , $527.00 , $447.80 , $485.27 , N/A , $467.72 , $467.72 , $589.00 , $501.75 , $81.94 , $595.20 
"Preventive Visit,New,12-17",CPT® 99384,N/A,N/A,N/A, $419.00 , $272.35 , N/A , $130.19 , $62.20 , $217.41 , $220.24 , $389.67 , $377.10 , $377.10 , $335.20 , $335.20 , $62.20 , $386.86 , $398.05 , $377.10 , $377.10 , $377.10 , $389.67 , $402.24 , $269.36 , $356.15 , $220.53 , $217.38 , $146.00 , $221.66 , $221.66 , $398.05 , $266.22 , $62.20 , $402.24 
"Explor Penet Wound,Extrem",20103,N/A,N/A,N/A," $2,547.00 "," $1,655.55 "," $2,087.15 ", $325.90 , $335.70 ," $1,680.45 "," $1,671.86 "," $2,368.71 "," $2,292.30 "," $2,292.30 "," $2,037.60 "," $2,037.60 ", $335.70 ," $2,351.65 "," $2,419.65 "," $2,292.30 "," $2,292.30 "," $2,292.30 "," $2,368.71 "," $2,445.12 "," $1,945.11 "," $2,164.95 "," $1,846.51 "," $1,988.52 ", N/A ," $1,713.23 "," $1,713.23 "," $2,419.65 "," $2,013.66 ", $325.90 ," $2,445.12 "
"Immuniz Admin,1 Single/Comb Vac/Toxoid",90471,N/A,N/A,N/A, $70.00 , $45.50 , $40.23 , $19.78 , N/A , $57.67 , $59.77 , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , N/A , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , $59.44 , $59.50 , $77.04 , $64.43 , N/A , $58.79 , $58.79 , $66.50 , $69.67 , $19.78 , $77.04 
 Fac Motor &/Sens 7-8 Nrv Cndj Preconf Eltrode Limb ,CPT® 95910,0922 - EMG,N/A,N/A," $1,476.00 ", $959.40 ," $1,239.84 ", $172.89 , $144.37 ," $1,192.61 "," $1,328.40 "," $1,249.58 "," $1,328.40 "," $1,328.40 "," $1,328.40 "," $1,254.60 ", $141.54 ," $1,362.79 "," $1,402.20 "," $1,254.60 "," $1,372.68 "," $1,372.68 "," $1,402.20 "," $1,416.96 "," $1,207.66 "," $1,328.40 "," $1,254.60 "," $1,166.04 ", N/A ," $1,194.53 "," $1,194.53 "," $1,402.20 "," $1,266.56 ", $141.54 ," $1,416.96 "
 GUAIFENESIN 200 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-5154-60,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Allergen Spec Ige Qual Multiallergen Screen,CPT® 86005,N/A,N/A,N/A, $72.00 , $46.80 , N/A , $8.13 , $8.13 , $45.11 , $53.95 , $66.96 , $64.80 , $64.80 , $57.60 , $57.60 , $8.13 , $66.48 , $68.40 , $64.80 , $64.80 , $64.80 , $66.96 , $69.12 , $53.22 , $61.20 , $51.90 , $28.90 , N/A , $42.10 , $42.10 , $68.40 , $46.00 , $8.13 , $69.12 
DRAINAGE OF GUM LESION,42970,N/A,N/A,N/A," $2,706.00 "," $1,758.90 "," $2,541.11 ", $398.55 , $153.67 ," $1,998.27 "," $2,027.21 "," $2,516.58 "," $2,435.40 "," $2,435.40 "," $2,164.80 "," $2,164.80 ", $153.67 ," $2,498.45 "," $2,570.70 "," $2,435.40 "," $2,435.40 "," $2,435.40 "," $2,516.58 "," $2,597.76 "," $1,809.08 "," $2,300.10 "," $2,215.81 "," $2,341.88 ", N/A ," $2,037.26 "," $2,037.26 "," $2,570.70 "," $2,130.75 ", $153.67 ," $2,597.76 "
 Fac Urinalysis Nonauto W/O Scope ,CPT® 81002,0307 - LAB/UROLOGY,N/A,N/A, $46.00 , $29.90 , $38.64 , $3.55 , $3.55 , $37.17 , $41.40 , $38.94 , $41.40 , $41.40 , $41.40 , $39.10 , $3.48 , $42.47 , $43.70 , $39.10 , $42.78 , $42.78 , $43.70 , $44.16 , $37.64 , $41.40 , $39.10 , $36.34 , N/A , $37.23 , $37.23 , $43.70 , $39.47 , $3.48 , $44.16 
Influenza Virus Vac Quadrivalent Live Intranasal,CPT® 90672,N/A,N/A,N/A, $67.00 , $43.55 , N/A , $27.42 , $42.72 , $56.14 , $57.42 , $62.31 , $60.30 , $60.30 , $53.60 , $53.60 , $42.72 , $61.86 , $63.65 , $60.30 , $60.30 , $60.30 , $62.31 , $64.32 , $34.94 , $56.95 , $79.76 , $37.71 , N/A , $57.23 , $57.23 , $63.65 , $66.71 , $27.42 , $79.76 
Inj Heparin Sodium per 1000u,HCPCS J1644,N/A,N/A,N/A, $7.00 , $4.55 , N/A , $0.27 , $0.27 , N/A , N/A , $6.51 , $6.30 , $6.30 , $5.60 , $5.60 , $0.27 , $6.46 , $6.65 , $6.30 , $6.30 , $6.30 , $6.51 , $6.72 , $0.39 , $5.95 , $0.65 , $0.36 , N/A , N/A , N/A , $6.65 , N/A , $0.27 , $6.72 
 Fac Closed Rx Radial Shaft Fx W/Dislocation ,CPT® 25520,0761 - TREATMENT ROOM,N/A,N/A," $5,002.00 "," $3,251.30 "," $4,201.68 ", $528.07 , $485.34 ," $4,041.62 "," $4,501.80 "," $4,234.69 "," $4,501.80 "," $4,501.80 "," $4,501.80 "," $4,251.70 ", $475.82 ," $4,618.35 "," $4,751.90 "," $4,251.70 "," $4,651.86 "," $4,651.86 "," $4,751.90 "," $4,801.92 "," $4,092.64 "," $4,501.80 "," $4,251.70 "," $3,951.58 ", N/A ," $4,048.12 "," $4,048.12 "," $4,751.90 "," $4,292.22 ", $475.82 ," $4,801.92 "
"Destr Malig Face,Nose,Lip 0.6-1 Cm",CPT® 17281,N/A,N/A,N/A, $717.00 , $466.05 , $378.56 , $114.14 , $192.09 , $340.27 , $333.99 , $666.81 , $645.30 , $645.30 , $573.60 , $573.60 , $192.09 , $662.01 , $681.15 , $645.30 , $645.30 , $645.30 , $666.81 , $688.32 , $416.76 , $609.45 , $665.46 , $437.62 , N/A , $346.91 , $346.91 , $681.15 , $402.29 , $114.14 , $688.32 
 Fac Njx Aa&/Strd Tfrml Epi Cervical/Thoracic Ea Addl ,CPT® 64480,0761 - TREATMENT ROOM,N/A,N/A," $4,626.00 "," $3,006.90 "," $3,885.84 ", $58.87 , $200.42 ," $3,737.81 "," $4,163.40 "," $3,916.37 "," $4,163.40 "," $4,163.40 "," $4,163.40 "," $3,932.10 ", $196.49 ," $4,271.19 "," $4,394.70 "," $3,932.10 "," $4,302.18 "," $4,302.18 "," $4,394.70 "," $4,440.96 "," $3,784.99 "," $4,163.40 "," $3,932.10 "," $3,654.54 ", N/A ," $3,743.82 "," $3,743.82 "," $4,394.70 "," $3,969.57 ", $58.87 ," $4,440.96 "
"Excis Intrasp Lesn,Xdural,Lumbar",CPT® 63267,N/A,N/A,N/A," $8,918.00 "," $5,796.70 "," $6,385.60 "," $1,247.97 "," $2,008.31 "," $7,433.97 "," $7,179.38 "," $8,293.74 "," $8,026.20 "," $8,026.20 "," $7,134.40 "," $7,134.40 "," $2,008.31 "," $8,233.99 "," $8,472.10 "," $8,026.20 "," $8,026.20 "," $8,026.20 "," $8,293.74 "," $8,561.28 "," $6,898.27 "," $7,580.30 "," $7,321.80 "," $7,760.67 ", N/A ," $7,579.02 "," $7,579.02 "," $8,472.10 "," $8,130.50 "," $1,247.97 "," $8,561.28 "
Moderna Admin Second Dose Ages 6-11,CPT® 0092A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $56.00 , $128.02 , N/A , N/A , N/A , $66.50 , N/A , $38.92 , $128.02 
"Cysto/Uretero/Pyelosc,Bx &/or Fulg Lesn",CPT® 52354,N/A,N/A,N/A," $2,909.00 "," $1,890.85 "," $2,234.57 ", $391.90 ," $1,204.96 "," $2,048.20 "," $1,935.40 "," $2,705.37 "," $2,618.10 "," $2,618.10 "," $2,327.20 "," $2,327.20 "," $1,204.96 "," $2,685.88 "," $2,763.55 "," $2,618.10 "," $2,618.10 "," $2,618.10 "," $2,705.37 "," $2,792.64 "," $2,248.75 "," $2,472.65 "," $2,190.83 "," $2,569.47 ", N/A ," $2,088.16 "," $2,088.16 "," $2,763.55 "," $2,454.35 ", $391.90 ," $2,792.64 "
 Fac Fluorescent Nonnfct Agt Antb Scr Ea Antb ,CPT® 86255,0302 - LAB/IMMUNOLOGY,N/A,N/A, $146.00 , $94.90 , $122.64 , $12.29 , $12.29 , $117.97 , $131.40 , $123.60 , $131.40 , $131.40 , $131.40 , $124.10 , $12.05 , $134.80 , $138.70 , $124.10 , $135.78 , $135.78 , $138.70 , $140.16 , $119.46 , $131.40 , $124.10 , $115.34 , N/A , $118.16 , $118.16 , $138.70 , $125.28 , $12.05 , $140.16 
 PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-6187-61,1 capsule, $3.77 , $2.45 , $3.17 , N/A , N/A , $3.05 , $3.39 , $3.19 , $3.39 , $3.39 , $3.39 , $3.20 , N/A , $3.48 , $3.58 , $3.20 , $3.51 , $3.51 , $3.58 , $3.62 , $3.08 , $3.39 , $3.20 , $2.98 , N/A , $3.05 , $3.05 , $3.58 , $3.24 , $2.98 , $3.62 
" Fac Flowcytometry/ Tc, 1 Marker ",CPT® 88184,0311 - PATHOL/CYTOLOGY,N/A,N/A, $501.00 , $325.65 , $420.84 , $72.46 , $48.24 , $404.81 , $450.90 , $424.15 , $450.90 , $450.90 , $450.90 , $425.85 , $47.29 , $462.57 , $475.95 , $425.85 , $465.93 , $465.93 , $475.95 , $480.96 , $409.92 , $450.90 , $425.85 , $395.79 , N/A , $405.46 , $405.46 , $475.95 , $429.91 , $47.29 , $480.96 
Subsequent Intensive Care Infant 1500-2500 Grams,CPT® 99479,N/A,N/A,N/A, $797.00 , $518.05 , $249.23 , $118.25 , $120.22 , $329.91 , $343.76 , $741.21 , $717.30 , $717.30 , $637.60 , $637.60 , $120.22 , $735.87 , $757.15 , $717.30 , $717.30 , $717.30 , $741.21 , $765.12 , $313.26 , $677.45 , $275.29 , $412.33 , N/A , $336.35 , $336.35 , $757.15 , $402.43 , $118.25 , $765.12 
X-Ray Tmj Bilat,CPT® 70330,N/A,N/A,N/A, $699.00 , $454.35 , $302.70 , $52.18 , $45.11 , $221.55 , $257.85 , $650.07 , $629.10 , $629.10 , $559.20 , $559.20 , $45.11 , $645.39 , $664.05 , $629.10 , $629.10 , $629.10 , $650.07 , $671.04 , $294.02 , $594.15 , $283.13 , $237.78 , N/A , $225.87 , $225.87 , $664.05 , $261.44 , $45.11 , $671.04 
 Fac Opn Fem Art Expos Dlvr Evasc Prosth Uni ,CPT® 34812,0360 - OR SERVICES,N/A,N/A," $4,709.00 "," $3,060.85 "," $3,955.56 ", $182.28 , $253.14 ," $3,804.87 "," $4,238.10 "," $3,986.64 "," $4,238.10 "," $4,238.10 "," $4,238.10 "," $4,002.65 ", $248.18 ," $4,347.82 "," $4,473.55 "," $4,002.65 "," $4,379.37 "," $4,379.37 "," $4,473.55 "," $4,520.64 "," $3,852.90 "," $4,238.10 "," $4,002.65 "," $3,720.11 ", N/A ," $3,810.99 "," $3,810.99 "," $4,473.55 "," $4,040.79 ", $182.28 ," $4,520.64 "
" Pro Dress/Debrid P-Thick Burn, M ",CPT® 16025,0981 - PRO FEE/ER,N/A,N/A, $580.00 , $377.00 , $353.80 , $104.77 , $43.96 , $304.75 , $296.43 , $539.40 , $522.00 , $522.00 , $464.00 , $464.00 , $43.96 , $535.51 , $551.00 , $522.00 , $522.00 , $522.00 , $539.40 , $556.80 , $384.92 , $493.00 , $592.31 , $389.98 , N/A , $310.69 , $310.69 , $551.00 , $360.30 , $43.96 , $592.31 
RBC Antibody Elution,CPT® 86860,N/A,N/A,N/A, $220.00 , $143.00 , N/A , N/A , $19.38 , $89.55 , $102.91 , $204.60 , $198.00 , $198.00 , $176.00 , $176.00 , $19.38 , $203.13 , $209.00 , $198.00 , $198.00 , $198.00 , $204.60 , $211.20 , N/A , $187.00 , $103.80 , $94.10 , N/A , $83.57 , $83.57 , $209.00 , $91.33 , $19.38 , $211.20 
 DIPHENHYDRAMINE HCL 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,68094-0018-61,1 tablet, $1.36 , $0.88 , $1.14 , N/A , N/A , $1.10 , $1.22 , $1.15 , $1.22 , $1.22 , $1.22 , $1.16 , N/A , $1.26 , $1.29 , $1.16 , $1.26 , $1.26 , $1.29 , $1.31 , $1.11 , $1.22 , $1.16 , $1.07 , N/A , $1.10 , $1.10 , $1.29 , $1.17 , $1.07 , $1.31 
"Osteopathic Manip,9-10 Body Regn",CPT® 98929,N/A,N/A,N/A, $295.00 , $191.75 , $164.16 , $68.41 , $64.95 , $161.71 , $159.59 , $274.35 , $265.50 , $265.50 , $236.00 , $236.00 , $64.95 , $272.37 , $280.25 , $265.50 , $265.50 , $265.50 , $274.35 , $283.20 , $179.06 , $250.75 , $209.84 , $275.99 , N/A , $164.87 , $164.87 , $280.25 , $192.19 , $64.95 , $283.20 
" Fac Culture Type, Nucleic Acid ",CPT® 87149,0306 - LAB/BACT-MICRO,N/A,N/A, $185.00 , $120.25 , $155.40 , $20.45 , $20.45 , $149.48 , $166.50 , $156.62 , $166.50 , $166.50 , $166.50 , $157.25 , $20.05 , $170.81 , $175.75 , $157.25 , $172.05 , $172.05 , $175.75 , $177.60 , $151.37 , $166.50 , $157.25 , $146.15 , N/A , $149.72 , $149.72 , $175.75 , $158.75 , $20.05 , $177.60 
Thoracoscopy W/Dx Bx of Lung Infiltrate Unilatrl,CPT® 32607,N/A,N/A,N/A," $2,474.00 "," $1,608.10 "," $1,588.38 ", $277.77 , $236.72 ," $1,167.23 "," $1,182.17 "," $2,300.82 "," $2,226.60 "," $2,226.60 "," $1,979.20 "," $1,979.20 ", $236.72 ," $2,284.24 "," $2,350.30 "," $2,226.60 "," $2,226.60 "," $2,226.60 "," $2,300.82 "," $2,375.04 "," $1,538.94 "," $2,102.90 "," $1,709.13 "," $1,530.82 ", N/A ," $1,190.00 "," $1,190.00 "," $2,350.30 "," $1,401.47 ", $236.72 ," $2,375.04 "
 Pro Patellectomy/Hemipatellectomy ,CPT® 27350,0975 - PRO FEE/OR,N/A,N/A," $5,465.00 "," $3,552.25 "," $3,993.41 ", $626.67 , $768.38 ," $3,137.24 "," $3,139.29 "," $5,082.45 "," $4,918.50 "," $4,918.50 "," $4,372.00 "," $4,372.00 ", $768.38 ," $5,045.83 "," $5,191.75 "," $4,918.50 "," $4,918.50 "," $4,918.50 "," $5,082.45 "," $5,246.40 "," $3,702.64 "," $4,645.25 "," $3,464.65 "," $3,706.90 ", N/A ," $3,198.45 "," $3,198.45 "," $5,191.75 "," $3,759.32 ", $626.67 ," $5,246.40 "
Njx Aa&/Strd Tfrml Epi Cervical/Thoracic Ea Addl,64480,N/A,N/A,N/A, $700.00 , $455.00 , $303.16 , $58.87 , $200.42 , $354.71 , $349.10 , $651.00 , $630.00 , $630.00 , $560.00 , $560.00 , $200.42 , $646.31 , $665.00 , $630.00 , $630.00 , $630.00 , $651.00 , $672.00 , $332.04 , $595.00 , $346.11 , $379.46 , N/A , $361.63 , $361.63 , $665.00 , $387.93 , $58.87 , $672.00 
 Mi Imaging NM ,CPT® 78466,0340 - NUCLEAR MEDICINE,N/A,N/A," $1,806.00 "," $1,173.90 "," $1,517.04 ", $170.51 , $141.87 ," $1,459.25 "," $1,625.40 "," $1,528.96 "," $1,625.40 "," $1,625.40 "," $1,625.40 "," $1,535.10 ", $139.09 ," $1,667.48 "," $1,715.70 "," $1,535.10 "," $1,679.58 "," $1,679.58 "," $1,715.70 "," $1,733.76 "," $1,477.67 "," $1,625.40 "," $1,535.10 "," $1,426.74 ", N/A ," $1,461.60 "," $1,461.60 "," $1,715.70 "," $1,549.73 ", $139.09 ," $1,733.76 "
 Fac Sgmdsc Flx With Endoscopic Mucosal Resection ,CPT® 45349,0360 - OR SERVICES,N/A,N/A," $2,720.00 "," $1,768.00 "," $2,284.80 ", $187.96 , $133.80 ," $2,197.76 "," $2,448.00 "," $2,302.75 "," $2,448.00 "," $2,448.00 "," $2,448.00 "," $2,312.00 ", $131.18 ," $2,511.38 "," $2,584.00 "," $2,312.00 "," $2,529.60 "," $2,529.60 "," $2,584.00 "," $2,611.20 "," $2,225.50 "," $2,448.00 "," $2,312.00 "," $2,148.80 ", N/A ," $2,201.30 "," $2,201.30 "," $2,584.00 "," $2,334.03 ", $131.18 ," $2,611.20 "
Layer Closure 2.5cm or Le,12041,N/A,N/A,N/A," $1,004.00 ", $652.60 , $461.96 , $139.44 , $71.45 , $427.30 , $419.98 , $933.72 , $903.60 , $903.60 , $803.20 , $803.20 , $71.45 , $926.99 , $953.80 , $903.60 , $903.60 , $903.60 , $933.72 , $963.84 , $509.89 , $853.40 , $834.94 , $528.73 , N/A , $435.64 , $435.64 , $953.80 , $505.18 , $71.45 , $963.84 
Excision Chest Wall Tumor Including Ribs,CPT® 21601,N/A,N/A,N/A," $7,587.00 "," $4,931.55 "," $6,853.08 "," $1,054.95 ", $899.75 ," $5,541.47 ", N/A ," $7,055.91 "," $6,828.30 "," $6,828.30 "," $6,069.60 "," $6,069.60 ", $899.75 ," $7,005.08 "," $7,207.65 "," $6,828.30 "," $6,828.30 "," $6,828.30 "," $7,055.91 "," $7,283.52 "," $6,492.47 "," $6,448.95 "," $6,054.04 "," $6,635.16 ", N/A ," $5,649.59 "," $5,649.59 "," $7,207.65 "," $6,640.98 ", $899.75 ," $7,283.52 "
"Explor Maxill Sinus,Intranasal",CPT® 31020,N/A,N/A,N/A," $2,756.00 "," $1,791.40 "," $2,071.55 ", $349.07 , $230.52 ," $1,377.35 "," $1,393.29 "," $2,563.08 "," $2,480.40 "," $2,480.40 "," $2,204.80 "," $2,204.80 ", $230.52 ," $2,544.61 "," $2,618.20 "," $2,480.40 "," $2,480.40 "," $2,480.40 "," $2,563.08 "," $2,645.76 "," $2,069.98 "," $2,342.60 "," $1,955.33 "," $1,818.66 ", N/A ," $1,404.23 "," $1,404.23 "," $2,618.20 "," $1,653.76 ", $230.52 ," $2,645.76 "
 Pro Treat Clavicle Fracture ,CPT® 23500,0982 - PRO FEE/OUTPT,N/A,N/A, $820.00 , $533.00 ," $1,415.05 ", $225.64 , $69.88 ," $1,067.58 "," $1,092.79 ", $762.60 , $738.00 , $738.00 , $656.00 , $656.00 , $69.88 , $757.11 , $779.00 , $738.00 , $738.00 , $738.00 , $762.60 , $787.20 ," $1,301.54 ", $697.00 ," $1,197.11 "," $1,273.41 ", N/A ," $1,088.41 "," $1,088.41 ", $779.00 ," $1,279.27 ", $69.88 ," $1,415.05 "
Technetium Tc 99m Sestamibi,HCPCS A9500,N/A,N/A,N/A, $419.00 , $272.35 ," $9,626.25 ", $118.61 , $118.22 , N/A , N/A , $389.67 , $377.10 , $377.10 , $335.20 , $335.20 , $118.22 , $386.86 , $398.05 , $377.10 , $377.10 , $377.10 , $389.67 , $402.24 , $486.30 , $356.15 , $220.34 , $587.56 , N/A , N/A , N/A , $398.05 , N/A , $118.22 ," $9,626.25 "
 BELATACEPT 250 MG IV SOLR ,HCPCS J0485,0636 - DRUGS REQUIRING DETAILED CODIN,00003-0371-13,10 mL," $2,851.76 "," $1,853.64 "," $2,395.48 ", $3.86 , $3.87 ," $2,304.22 "," $2,566.58 "," $2,414.30 "," $2,566.58 "," $2,566.58 "," $2,566.58 "," $2,424.00 ", $3.79 ," $2,633.03 "," $2,709.17 "," $2,424.00 "," $2,652.14 "," $2,652.14 "," $2,709.17 "," $2,737.69 "," $2,333.31 "," $2,566.58 "," $2,424.00 "," $2,252.89 ", N/A ," $2,307.93 "," $2,307.93 "," $2,709.17 "," $2,447.10 ", $3.79 ," $2,737.69 "
 NM Bone Scan Whole Body ,CPT® 78306,0340 - NUCLEAR MEDICINE,N/A,N/A," $2,589.00 "," $1,682.85 "," $2,174.76 ", $270.63 , $214.25 ," $2,091.91 "," $2,330.10 "," $2,191.85 "," $2,330.10 "," $2,330.10 "," $2,330.10 "," $2,200.65 ", $210.05 ," $2,390.42 "," $2,459.55 "," $2,200.65 "," $2,407.77 "," $2,407.77 "," $2,459.55 "," $2,485.44 "," $2,118.32 "," $2,330.10 "," $2,200.65 "," $2,045.31 ", N/A ," $2,095.28 "," $2,095.28 "," $2,459.55 "," $2,221.62 ", $210.05 ," $2,485.44 "
Treat Fibula Fracture,27780,N/A,N/A,N/A," $2,004.00 "," $1,302.60 "," $1,775.74 ", $281.00 , $190.55 ," $1,342.07 "," $1,370.57 "," $1,863.72 "," $1,803.60 "," $1,803.60 "," $1,603.20 "," $1,603.20 ", $190.55 ," $1,850.29 "," $1,903.80 "," $1,803.60 "," $1,803.60 "," $1,803.60 "," $1,863.72 "," $1,923.84 "," $1,634.23 "," $1,703.40 "," $1,503.97 "," $1,596.71 ", N/A ," $1,368.26 "," $1,368.26 "," $1,903.80 "," $1,608.19 ", $190.55 ," $1,923.84 "
Biopsy Bone Open Superficial,CPT® 20240,N/A,N/A,N/A," $1,469.00 ", $954.85 , $868.34 , $134.08 , $153.67 ," $1,050.49 "," $1,072.56 "," $1,366.17 "," $1,322.10 "," $1,322.10 "," $1,175.20 "," $1,175.20 ", $153.67 ," $1,356.33 "," $1,395.55 "," $1,322.10 "," $1,322.10 "," $1,322.10 "," $1,366.17 "," $1,410.24 ", $815.67 ," $1,248.65 "," $1,177.48 ", $876.05 , N/A ," $1,070.98 "," $1,070.98 "," $1,395.55 "," $1,258.77 ", $134.08 ," $1,410.24 "
Punch Biopsy Skin Single Lesion,11104,N/A,N/A,N/A, $491.00 , $319.15 , $150.65 , $44.88 , $98.18 , $127.17 , N/A , $456.63 , $441.90 , $441.90 , $392.80 , $392.80 , $98.18 , $453.34 , $466.45 , $441.90 , $441.90 , $441.90 , $456.63 , $471.36 , $167.40 , $417.35 , $247.00 , $174.53 , N/A , $129.65 , $129.65 , $466.45 , $150.35 , $44.88 , $471.36 
Exc Skin Malig 2.1-3cm Remaindr Body,CPT® 11623,N/A,N/A,N/A," $1,451.00 ", $943.15 , $668.78 , $200.83 , $288.68 , $579.96 , $565.03 ," $1,349.43 "," $1,305.90 "," $1,305.90 "," $1,160.80 "," $1,160.80 ", $288.68 ," $1,339.71 "," $1,378.45 "," $1,305.90 "," $1,305.90 "," $1,305.90 "," $1,349.43 "," $1,392.96 ", $734.78 ," $1,233.35 "," $1,127.53 ", $742.84 , N/A , $591.28 , $591.28 ," $1,378.45 ", $685.69 , $200.83 ," $1,392.96 "
 Fac Admin Pneumococcal Vaccine ,HCPCS G0009,0771 - VACCINE ADMINISTRATION,N/A,N/A, $38.00 , $24.70 , $31.92 , N/A , N/A , $30.70 , $34.20 , $32.17 , $34.20 , $34.20 , $34.20 , $32.30 , N/A , $35.09 , $36.10 , $32.30 , $35.34 , $35.34 , $36.10 , $36.48 , $31.09 , $34.20 , $32.30 , $30.02 , N/A , $30.75 , $30.75 , $36.10 , $32.61 , $30.02 , $36.48 
Treat Fibula Fracture,27780,N/A,N/A,N/A," $1,353.00 ", $879.45 ," $1,775.74 ", $281.00 , $190.55 ," $1,342.07 "," $1,370.57 "," $1,258.29 "," $1,217.70 "," $1,217.70 "," $1,082.40 "," $1,082.40 ", $190.55 ," $1,249.22 "," $1,285.35 "," $1,217.70 "," $1,217.70 "," $1,217.70 "," $1,258.29 "," $1,298.88 "," $1,634.23 "," $1,150.05 "," $1,503.97 "," $1,596.71 ", N/A ," $1,368.26 "," $1,368.26 "," $1,285.35 "," $1,608.19 ", $190.55 ," $1,775.74 "
 Fac Esophagogastroduodenoscopy Submucosal Injection ,CPT® 43236,0360 - OR SERVICES,N/A,N/A," $1,991.00 "," $1,294.15 "," $1,672.44 ", $130.86 , $316.50 ," $1,608.73 "," $1,791.90 "," $1,685.58 "," $1,791.90 "," $1,791.90 "," $1,791.90 "," $1,692.35 ", $310.29 ," $1,838.29 "," $1,891.45 "," $1,692.35 "," $1,851.63 "," $1,851.63 "," $1,891.45 "," $1,911.36 "," $1,629.04 "," $1,791.90 "," $1,692.35 "," $1,572.89 ", N/A ," $1,611.32 "," $1,611.32 "," $1,891.45 "," $1,708.48 ", $130.86 ," $1,911.36 "
"Special Eye Eval,Goniscopy",CPT® 92020,N/A,N/A,N/A, $89.00 , $57.85 , $44.44 , $20.12 , $13.72 , $37.30 , $37.81 , $82.77 , $80.10 , $80.10 , $71.20 , $71.20 , $13.72 , $82.17 , $84.55 , $80.10 , $80.10 , $80.10 , $82.77 , $85.44 , $62.96 , $75.65 , $63.86 , $45.13 , N/A , $38.02 , $38.02 , $84.55 , $45.22 , $13.72 , $85.44 
 GLYBURIDE MICRONIZED 3 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00093-8035-01,1 tablet, $3.37 , $2.19 , $2.83 , N/A , N/A , $2.72 , $3.03 , $2.85 , $3.03 , $3.03 , $3.03 , $2.86 , N/A , $3.11 , $3.20 , $2.86 , $3.13 , $3.13 , $3.20 , $3.24 , $2.76 , $3.03 , $2.86 , $2.66 , N/A , $2.73 , $2.73 , $3.20 , $2.89 , $2.66 , $3.24 
Injection Aa&/Strd Greater Occipital Nerve,CPT® 64405,N/A,N/A,N/A, $503.00 , $326.95 , $249.86 , $48.34 , $45.90 , $348.30 , $335.31 , $467.79 , $452.70 , $452.70 , $402.40 , $402.40 , $45.90 , $464.42 , $477.85 , $452.70 , $452.70 , $452.70 , $467.79 , $482.88 , $272.99 , $427.55 , $335.40 , $370.40 , N/A , $355.10 , $355.10 , $477.85 , $380.94 , $45.90 , $482.88 
Radiologic Examination Osseous Survey Compl,CPT® 77075,N/A,N/A,N/A," $1,178.00 ", $765.70 , $563.35 , $98.14 , $72.60 , $414.49 , $561.69 ," $1,095.54 "," $1,060.20 "," $1,060.20 ", $942.40 , $942.40 , $72.60 ," $1,087.65 "," $1,119.10 "," $1,060.20 "," $1,060.20 "," $1,060.20 "," $1,095.54 "," $1,130.88 ", $544.27 ," $1,001.30 ", $612.48 , $442.04 , N/A , $422.58 , $422.58 ," $1,119.10 ", $489.13 , $72.60 ," $1,130.88 "
 BUPRENORPHINE HCL 8 MG SL SUBL ,HCPCS RXC637,0250 - PHARMACY,00054-0177-13,1 tablet, $39.76 , $25.84 , $33.40 , N/A , N/A , $32.13 , $35.78 , $33.66 , $35.78 , $35.78 , $35.78 , $33.80 , N/A , $36.71 , $37.77 , $33.80 , $36.98 , $36.98 , $37.77 , $38.17 , $32.53 , $35.78 , $33.80 , $31.41 , N/A , $32.18 , $32.18 , $37.77 , $34.12 , $31.41 , $38.17 
 Fac Body Fluid Hematocrit ,Custom 331235,0305 - LAB/HEMATOLOGY,N/A,N/A, $57.00 , $37.05 , $47.88 , N/A , N/A , $46.06 , $51.30 , $48.26 , $51.30 , $51.30 , $51.30 , $48.45 , N/A , $52.63 , $54.15 , $48.45 , $53.01 , $53.01 , $54.15 , $54.72 , $46.64 , $51.30 , $48.45 , $45.03 , N/A , $46.13 , $46.13 , $54.15 , $48.91 , $45.03 , $54.72 
 PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN ,HCPCS J7510,0636 - DRUGS REQUIRING DETAILED CODIN,17856-0759-05,2.5 mL, $6.25 , $4.06 , $5.25 , $0.26 , $0.27 , $5.05 , $5.63 , $5.29 , $5.63 , $5.63 , $5.63 , $5.31 , $0.26 , $5.77 , $5.94 , $5.31 , $5.81 , $5.81 , $5.94 , $6.00 , $5.11 , $5.63 , $5.31 , $4.94 , N/A , $5.06 , $5.06 , $5.94 , $5.36 , $0.26 , $6.00 
"FB Removal,Conreal",65220,N/A,N/A,N/A, $339.00 , $220.35 , $250.45 , $39.41 , $47.02 , $236.97 , $219.45 , $315.27 , $305.10 , $305.10 , $271.20 , $271.20 , $47.02 , $313.00 , $322.05 , $305.10 , $305.10 , $305.10 , $315.27 , $325.44 , $347.54 , $288.15 , $226.58 , $300.51 , N/A , $241.60 , $241.60 , $322.05 , $266.70 , $39.41 , $347.54 
 Pro Rmvl Embedded FB Vestibule Mouth Comp ,CPT® 40805,0981 - PRO FEE/ER,N/A,N/A," $1,272.00 ", $826.80 ," $1,229.09 ", $192.19 , $83.68 ," $1,139.42 "," $1,199.99 "," $1,182.96 "," $1,144.80 "," $1,144.80 "," $1,017.60 "," $1,017.60 ", $83.68 ," $1,174.44 "," $1,208.40 "," $1,144.80 "," $1,144.80 "," $1,144.80 "," $1,182.96 "," $1,221.12 ", $894.17 ," $1,081.20 "," $1,304.15 "," $1,323.00 ", N/A ," $1,161.65 "," $1,161.65 "," $1,208.40 "," $1,214.97 ", $83.68 ," $1,323.00 "
Remove Spinal Canal Catheter,CPT® 62355,N/A,N/A,N/A," $1,734.00 "," $1,127.10 "," $1,315.55 ", $259.34 , $369.45 ," $1,492.40 "," $1,423.83 "," $1,612.62 "," $1,560.60 "," $1,560.60 "," $1,387.20 "," $1,387.20 ", $369.45 ," $1,601.00 "," $1,647.30 "," $1,560.60 "," $1,560.60 "," $1,560.60 "," $1,612.62 "," $1,664.64 "," $1,419.91 "," $1,473.90 "," $1,407.63 "," $1,574.79 ", N/A ," $1,521.52 "," $1,521.52 "," $1,647.30 "," $1,632.24 ", $259.34 ," $1,664.64 "
Anticoagulant Mgmt for Pt Taking Warfarin,CPT® 93793,N/A,N/A,N/A, $15.00 , $9.75 , $70.85 , $11.26 , $9.52 , $61.32 , $66.04 , $13.95 , $13.50 , $13.50 , $12.00 , $12.00 , $9.52 , $13.85 , $14.25 , $13.50 , $13.50 , $13.50 , $13.95 , $14.40 , $70.07 , $12.75 , $60.42 , $45.53 , N/A , $62.51 , $62.51 , $14.25 , $69.32 , $9.52 , $70.85 
 Pro Sub Grft F/S/N/H/F/G/M/D /<100scm Ea Adl 25scm ,CPT® 15276,0982 - PRO FEE/OUTPT,N/A,N/A, $196.00 , $127.40 , $80.44 , $23.62 , $26.04 , $68.56 , $68.48 , $182.28 , $176.40 , $176.40 , $156.80 , $156.80 , $26.04 , $180.97 , $186.20 , $176.40 , $176.40 , $176.40 , $182.28 , $188.16 , $87.96 , $166.60 , $135.59 , $89.22 , N/A , $69.89 , $69.89 , $186.20 , $81.06 , $23.62 , $188.16 
Arthroplasty Patella With Implant,CPT® 27438,N/A,N/A,N/A," $5,525.00 "," $3,591.25 "," $5,100.94 ", $799.00 ," $1,237.16 "," $4,057.59 "," $4,034.75 "," $5,138.25 "," $4,972.50 "," $4,972.50 "," $4,420.00 "," $4,420.00 "," $1,237.16 "," $5,101.23 "," $5,248.75 "," $4,972.50 "," $4,972.50 "," $4,972.50 "," $5,138.25 "," $5,304.00 "," $4,747.30 "," $4,696.25 "," $4,460.16 "," $4,768.67 ", N/A ," $4,136.76 "," $4,136.76 "," $5,248.75 "," $4,862.17 ", $799.00 ," $5,304.00 "
Ins New/Rplcmt Prm Pm W/Transv Eltrd Atrial&Vent,CPT® 33208,N/A,N/A,N/A," $6,227.00 "," $4,047.55 "," $3,083.15 ", $476.01 , $771.82 ," $2,270.62 "," $2,192.66 "," $5,791.11 "," $5,604.30 "," $5,604.30 "," $4,981.60 "," $4,981.60 ", $771.82 ," $5,749.39 "," $5,915.65 "," $5,604.30 "," $5,604.30 "," $5,604.30 "," $5,791.11 "," $5,977.92 "," $2,855.11 "," $5,292.95 "," $2,756.38 "," $2,519.60 ", N/A ," $2,314.93 "," $2,314.93 "," $5,915.65 "," $2,629.75 ", $476.01 ," $5,977.92 "
Rpr Nsl Vlv Collapse Subq/Sbmcsl Lat Wall Implt,CPT® 30468,N/A,N/A,N/A," $18,609.00 "," $12,095.85 ", $906.89 , $161.87 , N/A , N/A , N/A ," $17,306.37 "," $16,748.10 "," $16,748.10 "," $14,887.20 "," $14,887.20 ", N/A ," $17,181.69 "," $17,678.55 "," $16,748.10 "," $16,748.10 "," $16,748.10 "," $17,306.37 "," $17,864.64 ", $869.68 ," $15,817.65 ", $897.36 , $886.17 , N/A , $595.97 , $595.97 ," $17,678.55 ", $703.29 , $161.87 ," $17,864.64 "
"Excis Benign Bone Lesn,Phalanx",26210,N/A,N/A,N/A," $3,002.00 "," $1,951.30 "," $2,756.59 ", $435.10 , $384.19 ," $2,127.80 "," $2,131.42 "," $2,791.86 "," $2,701.80 "," $2,701.80 "," $2,401.60 "," $2,401.60 ", $384.19 ," $2,771.75 "," $2,851.90 "," $2,701.80 "," $2,701.80 "," $2,701.80 "," $2,791.86 "," $2,881.92 "," $2,555.66 "," $2,551.70 "," $2,340.69 "," $2,530.43 ", N/A ," $2,169.32 "," $2,169.32 "," $2,851.90 "," $2,549.73 ", $384.19 ," $2,881.92 "
Explore/Treat Wrist Joint,CPT® 25040,N/A,N/A,N/A," $3,724.00 "," $2,420.60 "," $3,425.24 ", $537.67 , $614.70 ," $2,711.40 "," $2,701.18 "," $3,463.32 "," $3,351.60 "," $3,351.60 "," $2,979.20 "," $2,979.20 ", $614.70 ," $3,438.37 "," $3,537.80 "," $3,351.60 "," $3,351.60 "," $3,351.60 "," $3,463.32 "," $3,575.04 "," $3,186.76 "," $3,165.40 "," $2,972.25 "," $3,209.20 ", N/A ," $2,764.30 "," $2,764.30 "," $3,537.80 "," $3,249.04 ", $537.67 ," $3,575.04 "
Pfizer Admin Peds Booster Age 5-11,CPT® 0074A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $76.25 , $128.02 , N/A , $79.82 , $79.82 , $66.50 , $92.91 , $38.92 , $128.02 
" Pro Mast, Simple, Complete ",CPT® 19303,0982 - PRO FEE/OUTPT,N/A,N/A," $4,281.00 "," $2,782.65 "," $2,989.89 ", $887.00 , $664.14 ," $2,713.01 "," $2,632.15 "," $3,981.33 "," $3,852.90 "," $3,852.90 "," $3,424.80 "," $3,424.80 ", $664.14 ," $3,952.65 "," $4,066.95 "," $3,852.90 "," $3,852.90 "," $3,852.90 "," $3,981.33 "," $4,109.76 "," $3,274.28 "," $3,638.85 "," $5,320.08 "," $3,254.96 ", N/A ," $2,765.94 "," $2,765.94 "," $4,066.95 "," $3,207.58 ", $664.14 ," $5,320.08 "
Open Rx Lat Malleolus Fx,CPT® 27792,N/A,N/A,N/A," $3,584.00 "," $2,329.60 "," $3,947.78 ", $618.62 , $614.70 ," $3,155.71 "," $3,161.84 "," $3,333.12 "," $3,225.60 "," $3,225.60 "," $2,867.20 "," $2,867.20 ", $614.70 ," $3,309.11 "," $3,404.80 "," $3,225.60 "," $3,225.60 "," $3,225.60 "," $3,333.12 "," $3,440.64 "," $3,669.86 "," $3,046.40 "," $3,486.06 "," $3,704.75 ", N/A ," $3,217.28 "," $3,217.28 "," $3,404.80 "," $3,781.44 ", $614.70 ," $3,947.78 "
Closed Rx Prox/Neck Femur Fx,CPT® 27230,N/A,N/A,N/A," $3,022.00 "," $1,964.30 "," $2,930.20 ", $461.55 , $537.90 ," $2,269.62 "," $2,284.59 "," $2,810.46 "," $2,719.80 "," $2,719.80 "," $2,417.60 "," $2,417.60 ", $537.90 ," $2,790.21 "," $2,870.90 "," $2,719.80 "," $2,719.80 "," $2,719.80 "," $2,810.46 "," $2,901.12 "," $2,713.36 "," $2,568.70 "," $2,517.31 "," $2,686.42 ", N/A ," $2,313.90 "," $2,313.90 "," $2,870.90 "," $2,719.65 ", $461.55 ," $2,930.20 "
Treat Ankle Fracture,CPT® 27816,N/A,N/A,N/A," $2,108.00 "," $1,370.20 "," $1,828.13 ", $288.74 , $384.19 ," $1,389.63 "," $1,401.19 "," $1,960.44 "," $1,897.20 "," $1,897.20 "," $1,686.40 "," $1,686.40 ", $384.19 ," $1,946.32 "," $2,002.60 "," $1,897.20 "," $1,897.20 "," $1,897.20 "," $1,960.44 "," $2,023.68 "," $1,683.83 "," $1,791.80 "," $1,534.30 "," $1,655.10 ", N/A ," $1,416.74 "," $1,416.74 "," $2,002.60 "," $1,665.18 ", $288.74 ," $2,023.68 "
Cast Sup Sht Arm Adult Fbrgl,HCPCS Q4010,N/A,N/A,N/A, $116.00 , $75.40 , N/A , $23.60 , $15.28 , N/A , N/A , $107.88 , $104.40 , $104.40 , $92.80 , $92.80 , $15.28 , $107.10 , $110.20 , $104.40 , $104.40 , $104.40 , $107.88 , $111.36 , N/A , $98.60 , $88.23 , $21.45 , N/A , N/A , N/A , $110.20 , N/A , $15.28 , $111.36 
Excision Bn-Lesion.5cm Le,CPT® 11400,N/A,N/A,N/A, $486.00 , $315.90 , $269.31 , $81.33 , $48.12 , $218.95 , $215.53 , $451.98 , $437.40 , $437.40 , $388.80 , $388.80 , $48.12 , $448.72 , $461.70 , $437.40 , $437.40 , $437.40 , $451.98 , $466.56 , $293.40 , $413.10 , $426.39 , $284.49 , N/A , $223.23 , $223.23 , $461.70 , $258.85 , $48.12 , $466.56 
Drug/Substance Definitive Qual/Quant Nos 1-3,CPT® 80375,N/A,N/A,N/A, $265.00 , $172.25 , N/A , N/A , N/A , N/A , N/A , $246.45 , $238.50 , $238.50 , $212.00 , $212.00 , N/A , $244.67 , $251.75 , $238.50 , $238.50 , $238.50 , $246.45 , $254.40 , N/A , $225.25 , $114.69 , $67.79 , N/A , $90.04 , $90.04 , $251.75 , $98.20 , $67.79 , $254.40 
 Fac Colonoscopy Flx W/Endoscopic Mucosal Resection ,CPT® 45390,0360 - OR SERVICES,N/A,N/A," $3,951.00 "," $2,568.15 "," $3,318.84 ", $314.66 , $265.41 ," $3,192.41 "," $3,555.90 "," $3,344.92 "," $3,555.90 "," $3,555.90 "," $3,555.90 "," $3,358.35 ", $260.21 ," $3,647.96 "," $3,753.45 "," $3,358.35 "," $3,674.43 "," $3,674.43 "," $3,753.45 "," $3,792.96 "," $3,232.71 "," $3,555.90 "," $3,358.35 "," $3,121.29 ", N/A ," $3,197.54 "," $3,197.54 "," $3,753.45 "," $3,390.35 ", $260.21 ," $3,792.96 "
ER MD DRN Outr Ear Cnl Ls - Lh,69020,N/A,N/A,N/A, $697.00 , $453.05 , $686.75 , $140.65 , $30.71 , $684.27 , $713.79 , $648.21 , $627.30 , $627.30 , $557.60 , $557.60 , $30.71 , $643.54 , $662.15 , $627.30 , $627.30 , $627.30 , $648.21 , $669.12 , $743.03 , $592.45 , $777.85 , $687.84 , N/A , $697.62 , $697.62 , $662.15 , $796.57 , $30.71 , $796.57 
" Thoracic Spine, 1 View ",CPT® 72020,0320 - DX X-RAY,N/A,N/A, $208.00 , $135.20 , $174.72 , $24.13 , $22.94 , $168.06 , $187.20 , $176.09 , $187.20 , $187.20 , $187.20 , $176.80 , $22.49 , $192.05 , $197.60 , $176.80 , $193.44 , $193.44 , $197.60 , $199.68 , $170.19 , $187.20 , $176.80 , $164.32 , N/A , $168.33 , $168.33 , $197.60 , $178.48 , $22.49 , $199.68 
Cervical Semi-Rigid Adjustab,HCPCS L0140,N/A,N/A,N/A, $112.00 , $72.80 , N/A , $70.02 , $34.40 , N/A , N/A , $104.16 , $100.80 , $100.80 , $89.60 , $89.60 , $34.40 , $103.41 , $106.40 , $100.80 , $100.80 , $100.80 , $104.16 , $107.52 , N/A , $95.20 , $64.88 , $58.91 , N/A , N/A , N/A , $106.40 , N/A , $34.40 , $107.52 
 CT Lumb/Sacr Inj Single Level ,CPT® 64493,0761 - TREATMENT ROOM,N/A,N/A," $2,709.00 "," $1,760.85 "," $2,275.56 ", $86.57 , $126.53 ," $2,188.87 "," $2,438.10 "," $2,293.44 "," $2,438.10 "," $2,438.10 "," $2,438.10 "," $2,302.65 ", $124.05 ," $2,501.22 "," $2,573.55 "," $2,302.65 "," $2,519.37 "," $2,519.37 "," $2,573.55 "," $2,600.64 "," $2,216.50 "," $2,438.10 "," $2,302.65 "," $2,140.11 ", N/A ," $2,192.39 "," $2,192.39 "," $2,573.55 "," $2,324.59 ", $86.57 ," $2,600.64 "
Complex Repair 2.6-7.5cm,13101,N/A,N/A,N/A," $1,529.00 ", $993.85 , $797.06 , $238.06 , $175.19 , $693.43 , $680.66 ," $1,421.97 "," $1,376.10 "," $1,376.10 "," $1,223.20 "," $1,223.20 ", $175.19 ," $1,411.73 "," $1,452.55 "," $1,376.10 "," $1,376.10 "," $1,376.10 "," $1,421.97 "," $1,467.84 ", $882.35 ," $1,299.65 "," $1,355.89 ", $890.04 , N/A , $706.96 , $706.96 ," $1,452.55 ", $819.84 , $175.19 ," $1,467.84 "
 Fac Mod Sed Other Phys/Qhp Initial 15 Mins <5 Yrs ,CPT® 99155,0370 - ANESTHESIA,N/A,N/A, $108.00 , $70.20 , $90.72 , $79.01 , $73.59 , $87.26 , $97.20 , $91.43 , $97.20 , $97.20 , $97.20 , $91.80 , $72.15 , $99.72 , $102.60 , $91.80 , $100.44 , $100.44 , $102.60 , $103.68 , $88.37 , $97.20 , $91.80 , $85.32 , N/A , $87.40 , $87.40 , $102.60 , $92.67 , $72.15 , $103.68 
" Fac Immunoassay, Ria ",CPT® 83520,0302 - LAB/IMMUNOLOGY,N/A,N/A, $227.00 , $147.55 , $190.68 , $17.62 , $17.62 , $183.42 , $204.30 , $192.18 , $204.30 , $204.30 , $204.30 , $192.95 , $17.27 , $209.59 , $215.65 , $192.95 , $211.11 , $211.11 , $215.65 , $217.92 , $185.73 , $204.30 , $192.95 , $179.33 , N/A , $183.71 , $183.71 , $215.65 , $194.79 , $17.27 , $217.92 
 OMALIZUMAB 75 MG/0.5ML SC SOSY ,HCPCS J2357,0636 - DRUGS REQUIRING DETAILED CODIN,50242-0214-01,0.5 mL," $1,920.86 "," $1,248.56 "," $1,613.52 ", $40.17 , $38.96 ," $1,552.05 "," $1,728.77 "," $1,626.20 "," $1,728.77 "," $1,728.77 "," $1,728.77 "," $1,632.73 ", $38.20 ," $1,773.53 "," $1,824.82 "," $1,632.73 "," $1,786.40 "," $1,786.40 "," $1,824.82 "," $1,844.03 "," $1,571.65 "," $1,728.77 "," $1,632.73 "," $1,517.48 ", N/A ," $1,554.55 "," $1,554.55 "," $1,824.82 "," $1,648.29 ", $38.20 ," $1,844.03 "
 Fac B1 Marrow Smr Interpj ,CPT® 85097,0305 - LAB/HEMATOLOGY,N/A,N/A, $366.00 , $237.90 , $307.44 , $47.04 , $45.63 , $295.73 , $329.40 , $309.86 , $329.40 , $329.40 , $329.40 , $311.10 , $44.74 , $337.93 , $347.70 , $311.10 , $340.38 , $340.38 , $347.70 , $351.36 , $299.46 , $329.40 , $311.10 , $289.14 , N/A , $296.20 , $296.20 , $347.70 , $314.06 , $44.74 , $351.36 
I&D Rectal Submucosal Abscess,CPT® 45005,N/A,N/A,N/A," $1,730.00 "," $1,124.50 "," $1,018.10 ", $156.79 , $230.52 , $759.16 , $775.30 ," $1,608.90 "," $1,557.00 "," $1,557.00 "," $1,384.00 "," $1,384.00 ", $230.52 ," $1,597.31 "," $1,643.50 "," $1,557.00 "," $1,557.00 "," $1,557.00 "," $1,608.90 "," $1,660.80 ", $712.13 ," $1,470.50 ", $852.78 , $909.86 , N/A , $773.98 , $773.98 ," $1,643.50 ", $809.49 , $156.79 ," $1,660.80 "
External Ecg Rec>7d<15d Review & Interpretation,CPT® 93248,N/A,N/A,N/A, $394.00 , $256.10 , $169.52 , $25.47 , $21.14 , N/A , N/A , $366.42 , $354.60 , $354.60 , $315.20 , $315.20 , $21.14 , $363.78 , $374.30 , $354.60 , $354.60 , $354.60 , $366.42 , $378.24 , $167.68 , $334.90 , $135.05 , $168.81 , N/A , $141.16 , $141.16 , $374.30 , $156.63 , $21.14 , $378.24 
 Pro Prq Skel Fixj Metar Fx W/Mnpj ,CPT® 28476,0982 - PRO FEE/OUTPT,N/A,N/A," $2,332.00 "," $1,515.80 "," $2,426.32 ", $380.95 , $229.93 ," $1,706.74 "," $1,705.73 "," $2,168.76 "," $2,098.80 "," $2,098.80 "," $1,865.60 "," $1,865.60 ", $229.93 ," $2,153.14 "," $2,215.40 "," $2,098.80 "," $2,098.80 "," $2,098.80 "," $2,168.76 "," $2,238.72 "," $2,211.22 "," $1,982.20 "," $1,860.78 "," $2,025.70 ", N/A ," $1,740.04 "," $1,740.04 "," $2,215.40 "," $2,045.18 ", $229.93 ," $2,426.32 "
 KCL IN NACL 20-0.9 MEQ/L-% IV SOLN (INPT) ,HCPCS RXA258,0258 - IV SOLUTIONS,00990-7115-09,"1,000 mL", $106.42 , $69.17 , $89.39 , N/A , N/A , $85.99 , $95.78 , $90.10 , $95.78 , $95.78 , $95.78 , $90.46 , N/A , $98.26 , $101.10 , $90.46 , $98.97 , $98.97 , $101.10 , $102.16 , $87.07 , $95.78 , $90.46 , $84.07 , N/A , $86.13 , $86.13 , $101.10 , $91.32 , $84.07 , $102.16 
 Toe Min 2vw- Mh ,CPT® 73660,0972 - PRO FEE/RAD/DX,N/A,N/A, $65.00 , $42.25 , $163.39 , $28.68 , $23.98 , $131.67 , $162.41 , $60.45 , $58.50 , $58.50 , $52.00 , $52.00 , $23.98 , $60.01 , $61.75 , $58.50 , $58.50 , $58.50 , $60.45 , $62.40 , $159.02 , $55.25 , $179.12 , $141.99 , N/A , $134.23 , $134.23 , $61.75 , $155.38 , $23.98 , $179.12 
"Removal,Penile Prosthesis W/O Replacmt",CPT® 54415,N/A,N/A,N/A," $2,900.00 "," $1,885.00 "," $2,359.49 ", $508.56 , $510.11 ," $1,697.14 "," $1,715.59 "," $2,697.00 "," $2,610.00 "," $2,610.00 "," $2,320.00 "," $2,320.00 ", $510.11 ," $2,677.57 "," $2,755.00 "," $2,610.00 "," $2,610.00 "," $2,610.00 "," $2,697.00 "," $2,784.00 "," $2,210.11 "," $2,465.00 "," $2,733.19 "," $2,561.77 ", N/A ," $1,730.26 "," $1,730.26 "," $2,755.00 "," $2,073.82 ", $508.56 ," $2,784.00 "
" Fac Cmv Antibody, Igm ",CPT® 86645,0302 - LAB/IMMUNOLOGY,N/A,N/A, $159.00 , $103.35 , $133.56 , $17.19 , $8.07 , $128.47 , $143.10 , $134.61 , $143.10 , $143.10 , $143.10 , $135.15 , $7.91 , $146.80 , $151.05 , $135.15 , $147.87 , $147.87 , $151.05 , $152.64 , $130.09 , $143.10 , $135.15 , $125.61 , N/A , $128.68 , $128.68 , $151.05 , $136.44 , $7.91 , $152.64 
Repair Complex Trunk 5cm,13102,N/A,N/A,N/A, $557.00 , $362.05 , $228.24 , $67.58 , $75.77 , $202.55 , $195.28 , $518.01 , $501.30 , $501.30 , $445.60 , $445.60 , $75.77 , $514.28 , $529.15 , $501.30 , $501.30 , $501.30 , $518.01 , $534.72 , $251.34 , $473.45 , $392.49 , $258.78 , N/A , $206.50 , $206.50 , $529.15 , $239.47 , $67.58 , $534.72 
" Fac Locm 200-299mg/Ml Iodine,1ml ",HCPCS Q9966,0636 - DRUGS REQUIRING DETAILED CODIN,N/A,N/A, $5.00 , $3.25 , $4.20 , $0.38 , $0.52 , $4.04 , $4.50 , $4.23 , $4.50 , $4.50 , $4.50 , $4.25 , $0.51 , $4.62 , $4.75 , $4.25 , $4.65 , $4.65 , $4.75 , $4.80 , $4.09 , $4.50 , $4.25 , $3.95 , N/A , $4.05 , $4.05 , $4.75 , $4.29 , $0.38 , $4.80 
"Peri-Proc Prog Eval Implant Device,Cardvert/Defib",CPT® 93287,N/A,N/A,N/A, $347.00 , $225.55 , $348.99 , $52.88 , $34.25 , $195.33 , $195.39 , $322.71 , $312.30 , $312.30 , $277.60 , $277.60 , $34.25 , $320.39 , $329.65 , $312.30 , $312.30 , $312.30 , $322.71 , $333.12 , $324.20 , $294.95 , $181.97 , $144.09 , N/A , $199.14 , $199.14 , $329.65 , $220.75 , $34.25 , $348.99 
Rpr Aa Hernia Recr 3-10 Cm Ncrc8/Strangulated,CPT® 49616,N/A,N/A,N/A," $7,345.00 "," $4,774.25 ", N/A , $784.73 , $612.47 , N/A , N/A ," $6,830.85 "," $6,610.50 "," $6,610.50 "," $5,876.00 "," $5,876.00 ", $612.47 ," $6,781.64 "," $6,977.75 "," $6,610.50 "," $6,610.50 "," $6,610.50 "," $6,830.85 "," $7,051.20 ", N/A ," $6,243.25 "," $4,550.75 ", N/A , N/A ," $3,378.29 "," $3,378.29 "," $6,977.75 "," $3,536.78 ", $612.47 ," $7,051.20 "
Psychotherapy W/Patient W/E&M Srvcs 30 Min,CPT® 90833,N/A,N/A,N/A, $247.00 , $160.55 , $82.93 , $61.36 , $79.97 , $147.18 , $94.10 , $229.71 , $222.30 , $222.30 , $197.60 , $197.60 , $79.97 , $228.06 , $234.65 , $222.30 , $222.30 , $222.30 , $229.71 , $237.12 , $158.13 , $209.95 , $122.66 , $249.57 , $68.25 , $150.05 , $150.05 , $234.65 , $174.94 , $61.36 , $249.57 
 PRAZOSIN HCL 1 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,68084-0996-01,1 capsule, $9.17 , $5.96 , $7.70 , N/A , N/A , $7.41 , $8.25 , $7.76 , $8.25 , $8.25 , $8.25 , $7.79 , N/A , $8.47 , $8.71 , $7.79 , $8.53 , $8.53 , $8.71 , $8.80 , $7.50 , $8.25 , $7.79 , $7.24 , N/A , $7.42 , $7.42 , $8.71 , $7.87 , $7.24 , $8.80 
 Fac Evoked Otoacous Emijs Compre/Dx Eval ,CPT® 92588,0471 - AUDIOLOGY/DX,N/A,N/A, $369.00 , $239.85 , $309.96 , $33.68 , $79.52 , $298.15 , $332.10 , $312.40 , $332.10 , $332.10 , $332.10 , $313.65 , $77.96 , $340.70 , $350.55 , $313.65 , $343.17 , $343.17 , $350.55 , $354.24 , $301.92 , $332.10 , $313.65 , $291.51 , N/A , $298.63 , $298.63 , $350.55 , $316.64 , $33.68 , $354.24 
 PEMBROLIZUMAB 100 MG/4ML IV SOLN ,HCPCS J9271,0636 - DRUGS REQUIRING DETAILED CODIN,00006-3026-02,4 mL," $16,340.84 "," $10,621.55 "," $13,726.31 ", $55.91 , $56.53 ," $13,203.40 "," $14,706.76 "," $13,834.16 "," $14,706.76 "," $14,706.76 "," $14,706.76 "," $13,889.71 ", $55.42 ," $15,087.50 "," $15,523.80 "," $13,889.71 "," $15,196.98 "," $15,196.98 "," $15,523.80 "," $15,687.21 "," $13,370.08 "," $14,706.76 "," $13,889.71 "," $12,909.26 ", N/A ," $13,224.64 "," $13,224.64 "," $15,523.80 "," $14,022.07 ", $55.42 ," $15,687.21 "
Insertion Picc W/Rs&I 5 Yr/>,36573,N/A,N/A,N/A, $750.00 , $487.50 , $514.35 , $80.09 , $314.22 , $345.62 , N/A , $697.50 , $675.00 , $675.00 , $600.00 , $600.00 , $314.22 , $692.48 , $712.50 , $675.00 , $675.00 , $675.00 , $697.50 , $720.00 , $476.57 , $637.50 , $438.90 , $425.65 , N/A , $352.36 , $352.36 , $712.50 , $400.29 , $80.09 , $720.00 
 ONDANSETRON HCL 4 MG PO TABS ,HCPCS RXA250,0250 - PHARMACY,00904-6551-61,1 tablet, $3.82 , $2.48 , $3.21 , N/A , N/A , $3.09 , $3.44 , $3.23 , $3.44 , $3.44 , $3.44 , $3.25 , N/A , $3.53 , $3.63 , $3.25 , $3.55 , $3.55 , $3.63 , $3.67 , $3.13 , $3.44 , $3.25 , $3.02 , N/A , $3.09 , $3.09 , $3.63 , $3.28 , $3.02 , $3.67 
Drug Screen Quantitative Alcohols,CPT® 80320,N/A,N/A,N/A, $36.00 , $23.40 , N/A , N/A , N/A , N/A , N/A , $33.48 , $32.40 , $32.40 , $28.80 , $28.80 , N/A , $33.24 , $34.20 , $32.40 , $32.40 , $32.40 , $33.48 , $34.56 , N/A , $30.60 , $114.69 , $67.79 , N/A , $90.04 , $90.04 , $34.20 , $98.20 , $28.80 , $114.69 
Lens Polycarb or Equal,HCPCS V2784,N/A,N/A,N/A, $21.00 , $13.65 , N/A , $55.32 , N/A , N/A , N/A , $19.53 , $18.90 , $18.90 , $16.80 , $16.80 , N/A , $19.39 , $19.95 , $18.90 , $18.90 , $18.90 , $19.53 , $20.16 , N/A , $17.85 , $21.00 , $50.27 , N/A , N/A , N/A , $19.95 , N/A , $16.80 , $55.32 
"Intralesional Chemo Admin,<8 Lesn",CPT® 96405,N/A,N/A,N/A, $354.00 , $230.10 , $96.36 , $28.25 , N/A , $85.77 , $67.80 , $329.22 , $318.60 , $318.60 , $283.20 , $283.20 , N/A , $326.85 , $336.30 , $318.60 , $318.60 , $318.60 , $329.22 , $339.84 , $87.75 , $300.90 , $89.21 , $117.46 , N/A , $87.44 , $87.44 , $336.30 , $103.31 , $28.25 , $339.84 
 Hep C Geno . Beaker1 ,CPT® 87902,0300 - LABORATORY,N/A,N/A," $2,376.00 "," $1,544.40 "," $1,995.84 ", $262.60 , $262.60 ," $1,919.81 "," $2,138.40 "," $2,011.52 "," $2,138.40 "," $2,138.40 "," $2,138.40 "," $2,019.60 ", $257.45 ," $2,193.76 "," $2,257.20 "," $2,019.60 "," $2,209.68 "," $2,209.68 "," $2,257.20 "," $2,280.96 "," $1,944.04 "," $2,138.40 "," $2,019.60 "," $1,877.04 ", N/A ," $1,922.90 "," $1,922.90 "," $2,257.20 "," $2,038.85 ", $257.45 ," $2,280.96 "
 Fac Molecular Cyto Chrom 25- ,CPT® 88274,0310 - PATHOLOGY LAB,N/A,N/A, $432.00 , $280.80 , $362.88 , $43.23 , $43.23 , $349.06 , $388.80 , $365.73 , $388.80 , $388.80 , $388.80 , $367.20 , $42.38 , $398.87 , $410.40 , $367.20 , $401.76 , $401.76 , $410.40 , $414.72 , $353.46 , $388.80 , $367.20 , $341.28 , N/A , $349.62 , $349.62 , $410.40 , $370.70 , $42.38 , $414.72 
Change of Cystostomy Tube,51705,N/A,N/A,N/A, $431.00 , $280.15 , $277.44 , $49.05 , $89.32 , $253.25 , $237.97 , $400.83 , $387.90 , $387.90 , $344.80 , $344.80 , $89.32 , $397.94 , $409.45 , $387.90 , $387.90 , $387.90 , $400.83 , $413.76 , $278.88 , $366.35 , $269.39 , $320.52 , N/A , $258.19 , $258.19 , $409.45 , $303.46 , $49.05 , $413.76 
"Subsequent Hospital Care, Normal Newborn",CPT® 99462,N/A,N/A,N/A, $167.00 , $108.55 , $83.77 , $39.86 , $34.20 , $110.38 , $111.65 , $155.31 , $150.30 , $150.30 , $133.60 , $133.60 , $34.20 , $154.19 , $158.65 , $150.30 , $150.30 , $150.30 , $155.31 , $160.32 , $105.24 , $141.95 , $89.26 , $138.52 , N/A , $112.53 , $112.53 , $158.65 , $134.64 , $34.20 , $160.32 
 MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP ,HCPCS J1050,0636 - DRUGS REQUIRING DETAILED CODIN,00548-5400-25,1 mL, $277.40 , $180.31 , $233.02 , N/A , $0.58 , $224.14 , $249.66 , $234.85 , $249.66 , $249.66 , $249.66 , $235.79 , $0.57 , $256.12 , $263.53 , $235.79 , $257.98 , $257.98 , $263.53 , $266.30 , $226.97 , $249.66 , $235.79 , $219.15 , N/A , $224.50 , $224.50 , $263.53 , $238.04 , $0.57 , $266.30 
" Fac Blood Gases: Ph, Po2 & Pco2 ",CPT® 82803,0301 - LAB/CHEMISTRY,N/A,N/A, $228.00 , $148.20 , $191.52 , $26.59 , $26.59 , $184.22 , $205.20 , $193.02 , $205.20 , $205.20 , $205.20 , $193.80 , $26.07 , $210.51 , $216.60 , $193.80 , $212.04 , $212.04 , $216.60 , $218.88 , $186.55 , $205.20 , $193.80 , $180.12 , N/A , $184.52 , $184.52 , $216.60 , $195.65 , $26.07 , $218.88 
"Hysteroscopy,Rmv FB",58562,N/A,N/A,N/A," $2,832.00 "," $1,840.80 "," $1,031.85 ", $209.13 , $178.29 ," $1,181.14 "," $1,173.06 "," $2,633.76 "," $2,548.80 "," $2,548.80 "," $2,265.60 "," $2,265.60 ", $178.29 ," $2,614.79 "," $2,690.40 "," $2,548.80 "," $2,548.80 "," $2,548.80 "," $2,633.76 "," $2,718.72 "," $1,086.80 "," $2,407.20 "," $1,545.00 ", $924.84 , N/A ," $1,204.18 "," $1,204.18 "," $2,690.40 "," $1,444.34 ", $178.29 ," $2,718.72 "
 Fac Iaad Ia Hepatitis B Surface Ag Neutralization ,CPT® 87341,0300 - LABORATORY,N/A,N/A, $108.00 , $70.20 , $90.72 , $10.54 , $10.54 , $87.26 , $97.20 , $91.43 , $97.20 , $97.20 , $97.20 , $91.80 , $10.33 , $99.72 , $102.60 , $91.80 , $100.44 , $100.44 , $102.60 , $103.68 , $88.37 , $97.20 , $91.80 , $85.32 , N/A , $87.40 , $87.40 , $102.60 , $92.67 , $10.33 , $103.68 
Rtrvl Intrvas Vc Filtr W/WO Acs Vsl Selxn Rs&I,CPT® 37193,N/A,N/A,N/A," $2,208.00 "," $1,435.20 "," $2,084.68 ", $321.61 ," $1,330.85 "," $1,605.92 "," $1,575.26 "," $2,053.44 "," $1,987.20 "," $1,987.20 "," $1,766.40 "," $1,766.40 "," $1,330.85 "," $2,038.65 "," $2,097.60 "," $1,987.20 "," $1,987.20 "," $1,987.20 "," $2,053.44 "," $2,119.68 "," $1,935.94 "," $1,876.80 "," $1,946.41 "," $1,744.47 ", N/A ," $1,637.26 "," $1,637.26 "," $2,097.60 "," $1,859.92 ", $321.61 ," $2,119.68 "
 Pro Pnxr Aspir Absc Hmtma Bulla/Cst ,CPT® 10160,0981 - PRO FEE/ER,N/A,N/A, $490.00 , $318.50 , $307.12 , $92.99 , $30.77 , $262.79 , $257.92 , $455.70 , $441.00 , $441.00 , $392.00 , $392.00 , $30.77 , $452.42 , $465.50 , $441.00 , $441.00 , $441.00 , $455.70 , $470.40 , $335.46 , $416.50 , $510.24 , $335.24 , N/A , $267.91 , $267.91 , $465.50 , $310.70 , $30.77 , $510.24 
 FUROSEMIDE 10 MG/ML IJ SOLN ,HCPCS J1940,0636 - DRUGS REQUIRING DETAILED CODIN,71288-0203-11,2 mL, $16.68 , $10.84 , $14.01 , $0.51 , $0.67 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.66 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.51 , $16.01 
"Excis Chalazion,Single",67800,N/A,N/A,N/A, $968.00 , $629.20 , $629.59 , $98.86 , $67.40 , $584.99 , $551.22 , $900.24 , $871.20 , $871.20 , $774.40 , $774.40 , $67.40 , $893.75 , $919.60 , $871.20 , $871.20 , $871.20 , $900.24 , $929.28 , $869.30 , $822.80 , $569.12 , $744.29 , N/A , $596.41 , $596.41 , $919.60 , $658.35 , $67.40 , $929.28 
" Fac Radiotherapy Dose Plan, Imrt ",CPT® 77301,0333 - RADIATION RX,N/A,N/A," $19,854.00 "," $12,905.10 "," $16,677.36 "," $1,803.56 "," $1,386.70 "," $16,042.03 "," $17,868.60 "," $16,808.40 "," $17,868.60 "," $17,868.60 "," $17,868.60 "," $16,875.90 "," $1,359.51 "," $18,331.20 "," $18,861.30 "," $16,875.90 "," $18,464.22 "," $18,464.22 "," $18,861.30 "," $19,059.84 "," $16,244.54 "," $17,868.60 "," $16,875.90 "," $15,684.66 ", N/A ," $16,067.84 "," $16,067.84 "," $18,861.30 "," $17,036.72 "," $1,359.51 "," $19,059.84 "
 Pro Repair Arm Tendon/Muscle ,CPT® 24341,0982 - PRO FEE/OUTPT,N/A,N/A," $5,145.00 "," $3,344.25 "," $4,549.87 ", $717.73 , $725.22 ," $3,598.81 "," $3,610.29 "," $4,784.85 "," $4,630.50 "," $4,630.50 "," $4,116.00 "," $4,116.00 ", $725.22 ," $4,750.38 "," $4,887.75 "," $4,630.50 "," $4,630.50 "," $4,630.50 "," $4,784.85 "," $4,939.20 "," $4,232.68 "," $4,373.25 "," $3,980.25 "," $4,247.67 ", N/A ," $3,669.04 "," $3,669.04 "," $4,887.75 "," $4,312.40 ", $717.73 ," $4,939.20 "
"Closed Rx Elbow Dislocatn,Anesthesia",24605,N/A,N/A,N/A," $2,690.00 "," $1,748.50 "," $2,947.30 ", $463.23 , $252.67 ," $2,263.13 "," $2,273.77 "," $2,501.70 "," $2,421.00 "," $2,421.00 "," $2,152.00 "," $2,152.00 ", $252.67 ," $2,483.68 "," $2,555.50 "," $2,421.00 "," $2,421.00 "," $2,421.00 "," $2,501.70 "," $2,582.40 "," $2,726.01 "," $2,286.50 "," $2,503.04 "," $2,679.27 ", N/A ," $2,307.29 "," $2,307.29 "," $2,555.50 "," $2,711.89 ", $252.67 ," $2,947.30 "
 Pro Njx Aa&/Strd Tfrml Epi Lumbar/Sacral Ea Addl ,CPT® 64484,0982 - PRO FEE/OUTPT,N/A,N/A, $536.00 , $348.40 , $254.80 , $49.44 , $119.93 , $294.25 , $285.73 , $498.48 , $482.40 , $482.40 , $428.80 , $428.80 , $119.93 , $494.89 , $509.20 , $482.40 , $482.40 , $482.40 , $498.48 , $514.56 , $278.36 , $455.60 , $276.53 , $315.01 , N/A , $299.99 , $299.99 , $509.20 , $321.80 , $49.44 , $514.56 
Insj Prph Ctr Vad W/Subq Port Age 5 Yr/>,CPT® 36571,N/A,N/A,N/A," $7,340.00 "," $4,771.00 "," $1,881.75 ", $289.78 ," $1,103.81 "," $1,395.01 "," $1,385.28 "," $6,826.20 "," $6,606.00 "," $6,606.00 "," $5,872.00 "," $5,872.00 "," $1,103.81 "," $6,777.02 "," $6,973.00 "," $6,606.00 "," $6,606.00 "," $6,606.00 "," $6,826.20 "," $7,046.40 "," $1,734.58 "," $6,239.00 "," $1,725.19 "," $1,518.35 ", N/A ," $1,422.23 "," $1,422.23 "," $6,973.00 "," $1,615.65 ", $289.78 ," $7,046.40 "
 IPRATROPIUM-ALBUTEROL 20-100 MCG/ACT INH AERS ,HCPCS RXC637,0250 - PHARMACY,00597-0024-02,4 gram," $1,396.93 ", $908.00 ," $1,173.42 ", N/A , N/A ," $1,128.72 "," $1,257.24 "," $1,182.64 "," $1,257.24 "," $1,257.24 "," $1,257.24 "," $1,187.39 ", N/A ," $1,289.79 "," $1,327.08 "," $1,187.39 "," $1,299.14 "," $1,299.14 "," $1,327.08 "," $1,341.05 "," $1,142.97 "," $1,257.24 "," $1,187.39 "," $1,103.57 ", N/A ," $1,130.54 "," $1,130.54 "," $1,327.08 "," $1,198.71 "," $1,103.57 "," $1,341.05 "
 Pro Exc Tumor Soft Tissue Neck/Ant Thorax Subq 3+Cm ,CPT® 21552,0982 - PRO FEE/OUTPT,N/A,N/A," $2,968.00 "," $1,929.20 "," $2,694.19 ", $420.01 , $369.16 ," $2,137.02 "," $2,140.78 "," $2,760.24 "," $2,671.20 "," $2,671.20 "," $2,374.40 "," $2,374.40 ", $369.16 ," $2,740.35 "," $2,819.60 "," $2,671.20 "," $2,671.20 "," $2,671.20 "," $2,760.24 "," $2,849.28 "," $2,492.75 "," $2,522.80 "," $2,367.45 "," $2,512.02 ", N/A ," $2,178.72 "," $2,178.72 "," $2,819.60 "," $2,560.78 ", $369.16 ," $2,849.28 "
 Pro Imfluor Std Ea Antb Dir Meth ,CPT® 88346,0971 - PRO FEE/LAB,N/A,N/A, $342.00 , $222.30 , $546.60 , $149.59 , $52.81 , $437.85 , $500.55 , $318.06 , $307.80 , $307.80 , $273.60 , $273.60 , $52.81 , $315.77 , $324.90 , $307.80 , $307.80 , $307.80 , $318.06 , $328.32 , $924.39 , $290.70 , $520.61 , $326.92 , N/A , $408.63 , $408.63 , $324.90 , $449.06 , $52.81 , $924.39 
 BETAMETHASONE DIPROPIONATE 0.05 % EX CREA ,HCPCS RXC637,0250 - PHARMACY,70710-1233-01,15 gram, $226.00 , $146.90 , $189.84 , N/A , N/A , $182.61 , $203.40 , $191.33 , $203.40 , $203.40 , $203.40 , $192.10 , N/A , $208.67 , $214.70 , $192.10 , $210.18 , $210.18 , $214.70 , $216.96 , $184.91 , $203.40 , $192.10 , $178.54 , N/A , $182.90 , $182.90 , $214.70 , $193.93 , $178.54 , $216.96 
 Pro Dstr Nrolytc Agnt Parverteb Fct Addl Lmbr/Sacral ,CPT® 64636,0982 - PRO FEE/OUTPT,N/A,N/A, $528.00 , $343.20 , $292.60 , $56.72 , $145.70 , $338.44 , $317.36 , $491.04 , $475.20 , $475.20 , $422.40 , $422.40 , $145.70 , $487.50 , $501.60 , $475.20 , $475.20 , $475.20 , $491.04 , $506.88 , $319.39 , $448.80 , $306.86 , $361.90 , N/A , $345.04 , $345.04 , $501.60 , $370.15 , $56.72 , $506.88 
 BSS IO SOLN ,HCPCS RXA250,0250 - PHARMACY,00065-0795-15,15 mL, $70.74 , $45.98 , $59.42 , N/A , N/A , $57.16 , $63.67 , $59.89 , $63.67 , $63.67 , $63.67 , $60.13 , N/A , $65.31 , $67.20 , $60.13 , $65.79 , $65.79 , $67.20 , $67.91 , $57.88 , $63.67 , $60.13 , $55.88 , N/A , $57.25 , $57.25 , $67.20 , $60.70 , $55.88 , $67.91 
 Pro Exc Face-Mm B9+Marg > 4 Cm ,CPT® 11446,0982 - PRO FEE/OUTPT,N/A,N/A," $1,937.00 "," $1,259.05 "," $1,023.33 ", $303.00 , $321.15 , $886.77 , $858.68 ," $1,801.41 "," $1,743.30 "," $1,743.30 "," $1,549.60 "," $1,549.60 ", $321.15 ," $1,788.43 "," $1,840.15 "," $1,743.30 "," $1,743.30 "," $1,743.30 "," $1,801.41 "," $1,859.52 "," $1,126.21 "," $1,646.45 "," $1,716.27 "," $1,132.21 ", N/A , $904.07 , $904.07 ," $1,840.15 "," $1,048.41 ", $303.00 ," $1,859.52 "
 Pro Remove Foreign Body From Eye ,CPT® 65222,0982 - PRO FEE/OUTPT,N/A,N/A, $250.00 , $162.50 , $313.04 , $48.84 , $48.12 , $297.31 , $278.46 , $232.50 , $225.00 , $225.00 , $200.00 , $200.00 , $48.12 , $230.83 , $237.50 , $225.00 , $225.00 , $225.00 , $232.50 , $240.00 , $433.67 , $212.50 , $287.23 , $377.49 , N/A , $303.11 , $303.11 , $237.50 , $334.61 , $48.12 , $433.67 
"Lap,Abdomen,Aspirate Cyst",CPT® 49322,N/A,N/A,N/A," $2,444.00 "," $1,588.60 "," $2,248.29 ", $349.25 , $324.81 ," $1,740.58 "," $1,774.90 "," $2,272.92 "," $2,199.60 "," $2,199.60 "," $1,955.20 "," $1,955.20 ", $324.81 ," $2,256.55 "," $2,321.80 "," $2,199.60 "," $2,199.60 "," $2,199.60 "," $2,272.92 "," $2,346.24 "," $1,609.55 "," $2,077.40 "," $1,964.25 "," $2,074.70 ", N/A ," $1,774.54 "," $1,774.54 "," $2,321.80 "," $1,855.98 ", $324.81 ," $2,346.24 "
"Shav Skin Les <5mm Face,Facial",CPT® 11310,N/A,N/A,N/A, $450.00 , $292.50 , $146.03 , $43.84 , $52.47 , $128.91 , $124.83 , $418.50 , $405.00 , $405.00 , $360.00 , $360.00 , $52.47 , $415.49 , $427.50 , $405.00 , $405.00 , $405.00 , $418.50 , $432.00 , $161.07 , $382.50 , $247.98 , $166.84 , N/A , $131.42 , $131.42 , $427.50 , $152.41 , $43.84 , $432.00 
 Pro Incision of Thigh Tendon ,CPT® 27306,0982 - PRO FEE/OUTPT,N/A,N/A," $2,932.00 "," $1,905.80 "," $2,129.53 ", $329.40 , $230.52 ," $1,747.85 "," $1,751.15 "," $2,726.76 "," $2,638.80 "," $2,638.80 "," $2,345.60 "," $2,345.60 ", $230.52 ," $2,707.12 "," $2,785.40 "," $2,638.80 "," $2,638.80 "," $2,638.80 "," $2,726.76 "," $2,814.72 "," $1,951.62 "," $2,492.20 "," $1,932.14 "," $2,012.53 ", N/A ," $1,781.95 "," $1,781.95 "," $2,785.40 "," $2,094.44 ", $230.52 ," $2,814.72 "
 VALSARTAN 160 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00378-5814-77,1 tablet, $26.78 , $17.41 , $22.50 , N/A , N/A , $21.64 , $24.10 , $22.67 , $24.10 , $24.10 , $24.10 , $22.76 , N/A , $24.73 , $25.44 , $22.76 , $24.91 , $24.91 , $25.44 , $25.71 , $21.91 , $24.10 , $22.76 , $21.16 , N/A , $21.67 , $21.67 , $25.44 , $22.98 , $21.16 , $25.71 
 Veeg 12-26 Hours Unmonitored ,CPT® 95714,0740 - EEG,N/A,N/A," $2,698.00 "," $1,753.70 "," $2,266.32 ", $203.14 , $396.25 ," $2,179.98 "," $2,428.20 "," $2,284.13 "," $2,428.20 "," $2,428.20 "," $2,428.20 "," $2,293.30 ", $388.48 ," $2,491.06 "," $2,563.10 "," $2,293.30 "," $2,509.14 "," $2,509.14 "," $2,563.10 "," $2,590.08 "," $2,207.50 "," $2,428.20 "," $2,293.30 "," $2,131.42 ", N/A ," $2,183.49 "," $2,183.49 "," $2,563.10 "," $2,315.15 ", $203.14 ," $2,590.08 "
 Adm Pfizer Peds Covid Vac 6mo-4 Yr 3rd Dose ,CPT® 0083A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
Treatment Toe Fracture,28510,N/A,N/A,N/A, $558.00 , $362.70 , $743.67 , $118.80 , $61.48 , $587.40 , $600.10 , $518.94 , $502.20 , $502.20 , $446.40 , $446.40 , $61.48 , $515.20 , $530.10 , $502.20 , $502.20 , $502.20 , $518.94 , $535.68 , $688.46 , $474.30 , $651.18 , $699.92 , N/A , $598.86 , $598.86 , $530.10 , $703.87 , $61.48 , $743.67 
 ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN ,HCPCS J1806,0636 - DRUGS REQUIRING DETAILED CODIN,55150-0420-10,250 mL, $861.71 , $560.11 , $723.84 , N/A , N/A , $696.26 , $775.54 , $729.52 , $775.54 , $775.54 , $775.54 , $732.45 , N/A , $795.62 , $818.62 , $732.45 , $801.39 , $801.39 , $818.62 , $827.24 , $705.05 , $775.54 , $732.45 , $680.75 , N/A , $697.38 , $697.38 , $818.62 , $739.43 , $680.75 , $827.24 
"Fx Ulnar Styloid, Closed",CPT® 25650,N/A,N/A,N/A," $2,132.00 "," $1,385.80 "," $1,902.94 ", $302.14 , $151.20 ," $1,442.04 "," $1,468.96 "," $1,982.76 "," $1,918.80 "," $1,918.80 "," $1,705.60 "," $1,705.60 ", $151.20 ," $1,968.48 "," $2,025.40 "," $1,918.80 "," $1,918.80 "," $1,918.80 "," $1,982.76 "," $2,046.72 "," $1,751.68 "," $1,812.20 "," $1,611.01 "," $1,717.60 ", N/A ," $1,470.18 "," $1,470.18 "," $2,025.40 "," $1,727.98 ", $151.20 ," $2,046.72 "
"Lactoferrin, Fecal (Qual)",CPT® 83630,N/A,N/A,N/A, $181.00 , $117.65 , N/A , $20.09 , $16.61 , $111.04 , $132.83 , $168.33 , $162.90 , $162.90 , $144.80 , $144.80 , $16.61 , $167.12 , $171.95 , $162.90 , $162.90 , $162.90 , $168.33 , $173.76 , $131.54 , $153.85 , $128.13 , $71.19 , N/A , $103.63 , $103.63 , $171.95 , $113.25 , $16.61 , $173.76 
"Drainage of Kidney Abscess,Open",CPT® 50020,N/A,N/A,N/A," $7,199.00 "," $4,679.35 "," $5,493.09 ", $966.12 , $768.38 ," $4,949.75 "," $4,844.18 "," $6,695.07 "," $6,479.10 "," $6,479.10 "," $5,759.20 "," $5,759.20 ", $768.38 ," $6,646.84 "," $6,839.05 "," $6,479.10 "," $6,479.10 "," $6,479.10 "," $6,695.07 "," $6,911.04 "," $5,508.05 "," $6,119.15 "," $5,557.36 "," $6,226.22 ", N/A ," $5,046.33 "," $5,046.33 "," $6,839.05 "," $5,931.23 ", $768.38 ," $6,911.04 "
 Disorders Of Pancreas Except Malignancy Without Cc/McC ,MS DRG V40 (FY2023) 440,N/A,N/A,N/A," $16,318.24 "," $10,606.86 "," $13,707.32 ", N/A , N/A ," $13,185.14 "," $14,686.42 "," $13,815.02 "," $14,686.42 "," $14,686.42 "," $14,686.42 "," $13,870.50 ", N/A ," $15,066.63 "," $15,502.33 "," $13,870.50 "," $15,175.96 "," $15,175.96 "," $15,502.33 "," $15,665.51 "," $13,351.58 "," $14,686.42 "," $13,870.50 "," $12,891.41 ", N/A ," $13,206.35 "," $13,206.35 "," $15,502.33 "," $14,002.68 "," $12,891.41 "," $15,665.51 "
Assay Three Catecholamines,CPT® 82384,N/A,N/A,N/A, $264.00 , $171.60 , N/A , $25.76 , $25.76 , $142.85 , $170.90 , $245.52 , $237.60 , $237.60 , $211.20 , $211.20 , $25.76 , $243.75 , $250.80 , $237.60 , $237.60 , $237.60 , $245.52 , $253.44 , $168.60 , $224.40 , $165.43 , $91.58 , N/A , $133.32 , $133.32 , $250.80 , $145.69 , $25.76 , $253.44 
 Trauma 3 Activation W/O Pre-ED Notiification Lvl 1 -W/O Critical Care ,CPT® 99285,0450 - EMERGENCY SERVICES,N/A,N/A," $7,068.00 "," $4,594.20 "," $5,937.12 ", $168.76 , $44.31 ," $5,710.94 "," $6,361.20 "," $5,983.77 "," $6,361.20 "," $6,361.20 "," $6,361.20 "," $6,007.80 ", $43.44 ," $6,525.88 "," $6,714.60 "," $6,007.80 "," $6,573.24 "," $6,573.24 "," $6,714.60 "," $6,785.28 "," $5,783.04 "," $6,361.20 "," $6,007.80 "," $5,583.72 ", N/A ," $5,720.13 "," $5,720.13 "," $6,714.60 "," $6,065.05 ", $43.44 ," $6,785.28 "
Total Cortisol,CPT® 82533,N/A,N/A,N/A, $202.00 , $131.30 , N/A , $16.63 , $16.63 , $92.26 , $110.33 , $187.86 , $181.80 , $181.80 , $161.60 , $161.60 , $16.63 , $186.51 , $191.90 , $181.80 , $181.80 , $181.80 , $187.86 , $193.92 , $108.84 , $171.70 , $107.04 , $59.09 , N/A , $86.10 , $86.10 , $191.90 , $94.09 , $16.63 , $193.92 
"Anoscopy,FB Removal",46608,N/A,N/A,N/A, $622.00 , $404.30 , $498.75 , $77.52 , $60.48 , $396.14 , $392.69 , $578.46 , $559.80 , $559.80 , $497.60 , $497.60 , $60.48 , $574.29 , $590.90 , $559.80 , $559.80 , $559.80 , $578.46 , $597.12 , $356.23 , $528.70 , $433.53 , $465.58 , N/A , $403.86 , $403.86 , $590.90 , $422.41 , $60.48 , $597.12 
Open Rx Nose Fracture,CPT® 21325,N/A,N/A,N/A," $3,105.00 "," $2,018.25 "," $2,785.51 ", $435.25 , $681.17 ," $2,319.84 "," $2,329.83 "," $2,887.65 "," $2,794.50 "," $2,794.50 "," $2,484.00 "," $2,484.00 ", $681.17 ," $2,866.85 "," $2,949.75 "," $2,794.50 "," $2,794.50 "," $2,794.50 "," $2,887.65 "," $2,980.80 "," $2,576.81 "," $2,639.25 "," $2,544.08 "," $2,700.06 ", N/A ," $2,365.11 "," $2,365.11 "," $2,949.75 "," $2,779.84 ", $435.25 ," $2,980.80 "
Antibody Treponema Pallidum,CPT® 86780,N/A,N/A,N/A, $111.00 , $72.15 , N/A , $13.50 , $10.99 , $44.78 , $53.56 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $10.99 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $88.41 , $94.35 , $85.96 , $47.99 , N/A , $41.79 , $41.79 , $105.45 , $45.66 , $10.99 , $106.56 
Alanine Amino (Alt) (Sgpt),CPT® 84460,N/A,N/A,N/A, $43.00 , $27.95 , N/A , $5.41 , $5.41 , $29.97 , $35.79 , $39.99 , $38.70 , $38.70 , $34.40 , $34.40 , $5.41 , $39.70 , $40.85 , $38.70 , $38.70 , $38.70 , $39.99 , $41.28 , $35.39 , $36.55 , $34.06 , $19.21 , N/A , $27.97 , $27.97 , $40.85 , $30.57 , $5.41 , $41.28 
 ISOSORBIDE DINITRATE 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6619-61,1 tablet, $3.76 , $2.44 , $3.16 , N/A , N/A , $3.04 , $3.38 , $3.18 , $3.38 , $3.38 , $3.38 , $3.20 , N/A , $3.47 , $3.57 , $3.20 , $3.50 , $3.50 , $3.57 , $3.61 , $3.08 , $3.38 , $3.20 , $2.97 , N/A , $3.04 , $3.04 , $3.57 , $3.23 , $2.97 , $3.61 
 Pro Echo Exam of Heart ,CPT® 93308,0981 - PRO FEE/ER,N/A,N/A, $501.00 , $325.65 , $625.50 , $96.57 , $153.86 , $668.74 , $562.09 , $465.93 , $450.90 , $450.90 , $400.80 , $400.80 , $153.86 , $462.57 , $475.95 , $450.90 , $450.90 , $450.90 , $465.93 , $480.96 , $620.72 , $425.85 , $526.30 , $632.47 , N/A , $681.79 , $681.79 , $475.95 , $755.77 , $96.57 , $755.77 
Colonoscopy Flx Dx W/Collj Spec When Pfrmd,45378,N/A,N/A,N/A," $2,697.00 "," $1,753.05 "," $2,171.13 ", $174.38 , $351.69 ," $1,042.81 "," $1,052.25 "," $2,508.21 "," $2,427.30 "," $2,427.30 "," $2,157.60 "," $2,157.60 ", $351.69 ," $2,490.14 "," $2,562.15 "," $2,427.30 "," $2,427.30 "," $2,427.30 "," $2,508.21 "," $2,589.12 "," $1,335.02 "," $2,292.45 "," $1,156.07 "," $1,074.52 ", N/A ," $1,063.16 "," $1,063.16 "," $2,562.15 "," $1,276.23 ", $174.38 ," $2,589.12 "
 Pro New Patient Visit Level 3 ,CPT® 99203,0982 - PRO FEE/OUTPT,N/A,N/A, $291.00 , $189.15 , $165.80 , $79.48 , $75.25 , $131.82 , $131.48 , $270.63 , $261.90 , $261.90 , $232.80 , $232.80 , $75.25 , $268.68 , $276.45 , $261.90 , $261.90 , $261.90 , $270.63 , $279.36 , $150.96 , $247.35 , $165.77 , $165.41 , $52.50 , $134.39 , $134.39 , $276.45 , $155.01 , $52.50 , $279.36 
"X-Ray Arm, Infant",CPT® 73092,N/A,N/A,N/A, $197.00 , $128.05 , $178.87 , $31.03 , $27.29 , $128.52 , $173.15 , $183.21 , $177.30 , $177.30 , $157.60 , $157.60 , $27.29 , $181.89 , $187.15 , $177.30 , $177.30 , $177.30 , $183.21 , $189.12 , $172.54 , $167.45 , $190.68 , $136.90 , N/A , $131.02 , $131.02 , $187.15 , $151.65 , $27.29 , $190.68 
 BUMETANIDE 0.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00185-0128-01,1 tablet, $5.56 , $3.61 , $4.67 , N/A , N/A , $4.49 , $5.00 , $4.71 , $5.00 , $5.00 , $5.00 , $4.73 , N/A , $5.13 , $5.28 , $4.73 , $5.17 , $5.17 , $5.28 , $5.34 , $4.55 , $5.00 , $4.73 , $4.39 , N/A , $4.50 , $4.50 , $5.28 , $4.77 , $4.39 , $5.34 
 PHENOBARBITAL 100 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00143-1458-05,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Eeg Without Video 2-12 Hours; Intermittent ,CPT® 95706,0740 - EEG,N/A,N/A," $1,731.00 "," $1,125.15 "," $1,454.04 ", $266.66 , $206.53 ," $1,398.65 "," $1,557.90 "," $1,465.46 "," $1,557.90 "," $1,557.90 "," $1,557.90 "," $1,471.35 ", $202.48 ," $1,598.23 "," $1,644.45 "," $1,471.35 "," $1,609.83 "," $1,609.83 "," $1,644.45 "," $1,661.76 "," $1,416.30 "," $1,557.90 "," $1,471.35 "," $1,367.49 ", N/A ," $1,400.90 "," $1,400.90 "," $1,644.45 "," $1,485.37 ", $202.48 ," $1,661.76 "
 Pro Tx Supfc Dehsn Smpl Clsr ,CPT® 12020,0982 - PRO FEE/OUTPT,N/A,N/A," $1,121.00 ", $728.65 , $598.88 , $179.70 , $32.39 , $514.39 , $504.42 ," $1,042.53 "," $1,008.90 "," $1,008.90 ", $896.80 , $896.80 , $32.39 ," $1,035.02 "," $1,064.95 "," $1,008.90 "," $1,008.90 "," $1,008.90 "," $1,042.53 "," $1,076.16 ", $660.06 , $952.85 ," $1,004.43 ", $658.84 , N/A , $524.43 , $524.43 ," $1,064.95 ", $608.16 , $32.39 ," $1,076.16 "
 Pro Repair/Graft of Foot Tendon ,CPT® 28202,0982 - PRO FEE/OUTPT,N/A,N/A," $4,169.00 "," $2,709.85 "," $2,656.94 ", $418.34 , $614.70 ," $2,090.85 "," $2,076.38 "," $3,877.17 "," $3,752.10 "," $3,752.10 "," $3,335.20 "," $3,335.20 ", $614.70 ," $3,849.24 "," $3,960.55 "," $3,752.10 "," $3,752.10 "," $3,752.10 "," $3,877.17 "," $4,002.24 "," $2,479.61 "," $3,543.65 "," $2,244.35 "," $2,512.32 ", N/A ," $2,131.65 "," $2,131.65 "," $3,960.55 "," $2,505.44 ", $418.34 ," $4,002.24 "
Grafting of Autologous Fat by Lipo 50 Cc or Less,CPT® 15771,N/A,N/A,N/A," $3,999.00 "," $2,599.35 "," $1,573.35 ", $483.05 , $449.44 ," $1,276.31 ", N/A ," $3,719.07 "," $3,599.10 "," $3,599.10 "," $3,199.20 "," $3,199.20 ", $449.44 ," $3,692.28 "," $3,799.05 "," $3,599.10 "," $3,599.10 "," $3,599.10 "," $3,719.07 "," $3,839.04 "," $1,660.76 "," $3,399.15 "," $2,700.95 "," $1,664.86 ", N/A ," $1,301.21 "," $1,301.21 "," $3,799.05 "," $1,510.08 ", $449.44 ," $3,839.04 "
 Pro Injection Aa&/Strd Intercostal Nrv Single Lvl ,CPT® 64420,0982 - PRO FEE/OUTPT,N/A,N/A, $893.00 , $580.45 , $291.72 , $56.48 , $46.08 , $379.80 , $375.69 , $830.49 , $803.70 , $803.70 , $714.40 , $714.40 , $46.08 , $824.51 , $848.35 , $803.70 , $803.70 , $803.70 , $830.49 , $857.28 , $316.65 , $759.05 , $367.52 , $406.08 , N/A , $387.20 , $387.20 , $848.35 , $415.37 , $46.08 , $857.28 
 Fac Chemotherapy Injection ,CPT® 96542,0331 - CHEMOTHER/INJ,N/A,N/A, $600.00 , $390.00 , $504.00 , $40.70 , $101.52 , $484.80 , $540.00 , $507.96 , $540.00 , $540.00 , $540.00 , $510.00 , $99.53 , $553.98 , $570.00 , $510.00 , $558.00 , $558.00 , $570.00 , $576.00 , $490.92 , $540.00 , $510.00 , $474.00 , N/A , $485.58 , $485.58 , $570.00 , $514.86 , $40.70 , $576.00 
 Fac Endomysial Antibody Each Immunoglobulin Class ,CPT® 86231,0310 - PATHOLOGY LAB,N/A,N/A, $155.00 , $100.75 , $130.20 , $12.33 , $12.29 , $125.24 , $139.50 , $131.22 , $139.50 , $139.50 , $139.50 , $131.75 , $12.05 , $143.11 , $147.25 , $131.75 , $144.15 , $144.15 , $147.25 , $148.80 , $126.82 , $139.50 , $131.75 , $122.45 , N/A , $125.44 , $125.44 , $147.25 , $133.01 , $12.05 , $148.80 
 MIDAZOLAM HCL 2 MG/2 ML INJECTION (INPT) ,HCPCS J2250,0636 - DRUGS REQUIRING DETAILED CODIN,23155-0600-41,1 mL, $16.68 , $10.84 , $14.01 , $0.14 , $0.17 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.17 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.14 , $16.01 
"Dest,Choroid Lesn,Photodynamic Therapy",CPT® 67221,N/A,N/A,N/A," $2,623.00 "," $1,704.95 "," $1,284.27 ", $200.88 , $286.68 ," $1,212.67 "," $1,121.06 "," $2,439.39 "," $2,360.70 "," $2,360.70 "," $2,098.40 "," $2,098.40 ", $286.68 ," $2,421.82 "," $2,491.85 "," $2,360.70 "," $2,360.70 "," $2,360.70 "," $2,439.39 "," $2,518.08 "," $1,768.05 "," $2,229.55 "," $1,154.29 "," $1,535.59 ", N/A ," $1,236.33 "," $1,236.33 "," $2,491.85 "," $1,364.74 ", $200.88 ," $2,518.08 "
"Pneumococcal Vaccine,23-Valent,Adult",CPT® 90732,N/A,N/A,N/A, $176.00 , $114.40 , N/A , $136.14 , $107.94 , $169.16 , $200.62 , $163.68 , $158.40 , $158.40 , $140.80 , $140.80 , $107.94 , $162.50 , $167.20 , $158.40 , $158.40 , $158.40 , $163.68 , $168.96 , $163.70 , $149.60 , $195.65 , $192.36 , N/A , $172.46 , $172.46 , $167.20 , $201.04 , $107.94 , $201.04 
" Fac Antistreptolysin O, Screen ",CPT® 86063,0302 - LAB/IMMUNOLOGY,N/A,N/A, $98.00 , $63.70 , $82.32 , $5.89 , $5.89 , $79.18 , $88.20 , $82.97 , $88.20 , $88.20 , $88.20 , $83.30 , $5.77 , $90.48 , $93.10 , $83.30 , $91.14 , $91.14 , $93.10 , $94.08 , $80.18 , $88.20 , $83.30 , $77.42 , N/A , $79.31 , $79.31 , $93.10 , $84.09 , $5.77 , $94.08 
Simple Repair 12.6-20cm,12005,N/A,N/A,N/A, $896.00 , $582.40 , $295.26 , $87.55 , $142.50 , $269.43 , $261.25 , $833.28 , $806.40 , $806.40 , $716.80 , $716.80 , $142.50 , $827.28 , $851.20 , $806.40 , $806.40 , $806.40 , $833.28 , $860.16 , $326.46 , $761.60 , $524.51 , $329.30 , N/A , $274.68 , $274.68 , $851.20 , $318.54 , $87.55 , $860.16 
 Pro Plethysmography Lung Volumes W/WO Airway Resist ,CPT® 94726,0976 - PRO FEE/RESPIR,N/A,N/A, $464.00 , $301.60 , $125.62 , $52.99 , $41.90 , $116.47 , $135.63 , $431.52 , $417.60 , $417.60 , $371.20 , $371.20 , $41.90 , $428.41 , $440.80 , $417.60 , $417.60 , $417.60 , $431.52 , $445.44 , $164.71 , $394.40 , $181.46 , $207.76 , N/A , $118.75 , $118.75 , $440.80 , $138.43 , $41.90 , $445.44 
Colsc Flx With Directed Submucosal Njx Any Sbst,45381,N/A,N/A,N/A," $3,248.00 "," $2,111.20 "," $1,228.57 ", $189.78 , $386.96 ," $1,159.99 "," $1,194.71 "," $3,020.64 "," $2,923.20 "," $2,923.20 "," $2,598.40 "," $2,598.40 ", $386.96 ," $2,998.88 "," $3,085.60 "," $2,923.20 "," $2,923.20 "," $2,923.20 "," $3,020.64 "," $3,118.08 ", $883.57 ," $2,760.80 "," $1,309.50 "," $1,171.50 ", N/A ," $1,182.63 "," $1,182.63 "," $3,085.60 "," $1,236.91 ", $189.78 ," $3,118.08 "
 Fac Radiation Treatment Delivery ,CPT® 77402,0333 - RADIATION RX,N/A,N/A, $630.00 , $409.50 , $529.20 , N/A , N/A , $509.04 , $567.00 , $533.36 , $567.00 , $567.00 , $567.00 , $535.50 , N/A , $581.68 , $598.50 , $535.50 , $585.90 , $585.90 , $598.50 , $604.80 , $515.47 , $567.00 , $535.50 , $497.70 , N/A , $509.86 , $509.86 , $598.50 , $540.60 , $497.70 , $604.80 
" Fac Electrocardiogram, Tracing ",CPT® 93005,0730 - EKG/ECG,N/A,N/A, $190.00 , $123.50 , $159.60 , $6.02 , $16.74 , $153.52 , $171.00 , $160.85 , $171.00 , $171.00 , $171.00 , $161.50 , $16.41 , $175.43 , $180.50 , $161.50 , $176.70 , $176.70 , $180.50 , $182.40 , $155.46 , $171.00 , $161.50 , $150.10 , N/A , $153.77 , $153.77 , $180.50 , $163.04 , $6.02 , $182.40 
 Fac Rpr Tdn Xtnsr Foot 1/2 Ea Tdn ,CPT® 28208,0761 - TREATMENT ROOM,N/A,N/A," $2,664.00 "," $1,731.60 "," $2,237.76 ", $312.25 , $184.42 ," $2,152.51 "," $2,397.60 "," $2,255.34 "," $2,397.60 "," $2,397.60 "," $2,397.60 "," $2,264.40 ", $180.80 ," $2,459.67 "," $2,530.80 "," $2,264.40 "," $2,477.52 "," $2,477.52 "," $2,530.80 "," $2,557.44 "," $2,179.68 "," $2,397.60 "," $2,264.40 "," $2,104.56 ", N/A ," $2,155.98 "," $2,155.98 "," $2,530.80 "," $2,285.98 ", $180.80 ," $2,557.44 "
 ARIPIPRAZOLE LAUROXIL ER 662 MG/2.4ML IM PRSY ,HCPCS J1944,0636 - DRUGS REQUIRING DETAILED CODIN,65757-0402-03,2.4 mL," $6,619.26 "," $4,302.52 "," $5,560.18 ", $3.13 , $3.04 ," $5,348.36 "," $5,957.33 "," $5,603.87 "," $5,957.33 "," $5,957.33 "," $5,957.33 "," $5,626.37 ", $2.98 ," $6,111.56 "," $6,288.30 "," $5,626.37 "," $6,155.91 "," $6,155.91 "," $6,288.30 "," $6,354.49 "," $5,415.88 "," $5,957.33 "," $5,626.37 "," $5,229.22 ", N/A ," $5,356.97 "," $5,356.97 "," $6,288.30 "," $5,679.99 ", $2.98 ," $6,354.49 "
Assay of Gastrin,CPT® 82941,N/A,N/A,N/A, $174.00 , $113.10 , N/A , $17.98 , $17.98 , $99.78 , $119.35 , $161.82 , $156.60 , $156.60 , $139.20 , $139.20 , $17.98 , $160.65 , $165.30 , $156.60 , $156.60 , $156.60 , $161.82 , $167.04 , $117.72 , $147.90 , $115.15 , $63.94 , N/A , $93.12 , $93.12 , $165.30 , $101.76 , $17.98 , $167.04 
" Pro Magnetic Image, Jaw Joint ",CPT® 70336,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,428.00 ", $928.20 ," $1,926.54 ", $273.23 , $417.46 ," $1,524.33 "," $1,903.64 "," $1,328.04 "," $1,285.20 "," $1,285.20 "," $1,142.40 "," $1,142.40 ", $417.46 ," $1,318.47 "," $1,356.60 "," $1,285.20 "," $1,285.20 "," $1,285.20 "," $1,328.04 "," $1,370.88 "," $1,668.11 "," $1,213.80 "," $2,074.35 "," $2,972.40 ", N/A ," $1,554.07 "," $1,554.07 "," $1,356.60 "," $1,798.87 ", $273.23 ," $2,972.40 "
 Fac Chg Allergen Spec Ige Recombinant/Purified Compnt Ea ,CPT® 86008,0302 - LAB/IMMUNOLOGY,N/A,N/A, $359.00 , $233.35 , $301.56 , $18.29 , $18.06 , $290.07 , $323.10 , $303.93 , $323.10 , $323.10 , $323.10 , $305.15 , $17.71 , $331.46 , $341.05 , $305.15 , $333.87 , $333.87 , $341.05 , $344.64 , $293.73 , $323.10 , $305.15 , $283.61 , N/A , $290.54 , $290.54 , $341.05 , $308.06 , $17.71 , $344.64 
Lens Sphcyl Bifocal Over 12.,HCPCS V2214,N/A,N/A,N/A, $85.00 , $55.25 , N/A , $98.99 , N/A , N/A , N/A , $79.05 , $76.50 , $76.50 , $68.00 , $68.00 , N/A , $78.48 , $80.75 , $76.50 , $76.50 , $76.50 , $79.05 , $81.60 , N/A , $72.25 , $85.00 , $89.93 , N/A , N/A , N/A , $80.75 , N/A , $68.00 , $98.99 
Removal of Ankle Implant,CPT® 27704,N/A,N/A,N/A," $3,882.00 "," $2,523.30 "," $3,492.19 ", $545.22 , $467.11 ," $2,784.72 "," $2,830.99 "," $3,610.26 "," $3,493.80 "," $3,493.80 "," $3,105.60 "," $3,105.60 ", $467.11 ," $3,584.25 "," $3,687.90 "," $3,493.80 "," $3,493.80 "," $3,493.80 "," $3,610.26 "," $3,726.72 "," $3,247.98 "," $3,299.70 "," $3,116.76 "," $3,260.02 ", N/A ," $2,839.05 "," $2,839.05 "," $3,687.90 "," $3,336.88 ", $467.11 ," $3,726.72 "
"Destruc,Ciliary Body,Cyclophotocoag",CPT® 66710,N/A,N/A,N/A," $3,976.00 "," $2,584.40 "," $2,409.68 ", $378.15 , $502.07 ," $2,225.04 "," $2,109.10 "," $3,697.68 "," $3,578.40 "," $3,578.40 "," $3,180.80 "," $3,180.80 ", $502.07 ," $3,671.04 "," $3,777.20 "," $3,578.40 "," $3,578.40 "," $3,578.40 "," $3,697.68 "," $3,816.96 "," $3,306.10 "," $3,379.60 "," $2,189.05 "," $2,827.36 ", N/A ," $2,268.46 "," $2,268.46 "," $3,777.20 "," $2,504.06 ", $378.15 ," $3,816.96 "
Osteotomy Clavicle W Bone Graft,CPT® 23485,N/A,N/A,N/A," $6,315.00 "," $4,104.75 "," $5,759.91 ", $904.25 , $768.38 ," $4,598.62 "," $4,581.73 "," $5,872.95 "," $5,683.50 "," $5,683.50 "," $5,052.00 "," $5,052.00 ", $768.38 ," $5,830.64 "," $5,999.25 "," $5,683.50 "," $5,683.50 "," $5,683.50 "," $5,872.95 "," $6,062.40 "," $5,351.40 "," $5,367.75 "," $5,066.74 "," $5,403.40 ", N/A ," $4,688.34 "," $4,688.34 "," $5,999.25 "," $5,510.46 ", $768.38 ," $6,062.40 "
"Chemodenervation Parotid/Submandibular Salivary Glands,Bilateral",CPT® 64611,N/A,N/A,N/A, $717.00 , $466.05 , $525.46 , $102.78 , $64.04 , $546.65 , $522.60 , $666.81 , $645.30 , $645.30 , $573.60 , $573.60 , $64.04 , $662.01 , $681.15 , $645.30 , $645.30 , $645.30 , $666.81 , $688.32 , $553.14 , $609.45 , $522.73 , $587.56 , N/A , $557.32 , $557.32 , $681.15 , $597.86 , $64.04 , $688.32 
 Path Level VI 88309 Initial -Tech-Mh ,CPT® 88309,0310 - PATHOLOGY LAB,N/A,N/A," $1,518.00 ", $986.70 ," $1,275.12 ", $430.94 , $154.81 ," $1,226.54 "," $1,366.20 "," $1,285.14 "," $1,366.20 "," $1,366.20 "," $1,366.20 "," $1,290.30 ", $151.77 ," $1,401.57 "," $1,442.10 "," $1,290.30 "," $1,411.74 "," $1,411.74 "," $1,442.10 "," $1,457.28 "," $1,242.03 "," $1,366.20 "," $1,290.30 "," $1,199.22 ", N/A ," $1,228.52 "," $1,228.52 "," $1,442.10 "," $1,302.60 ", $151.77 ," $1,457.28 "
Slctv Cathj 3rd+ Ord Slctv Abdl Pel/Lxtr Brnch,CPT® 36247,N/A,N/A,N/A," $10,842.00 "," $7,047.30 "," $1,771.97 ", $273.70 ," $1,563.75 "," $1,381.09 "," $1,361.97 "," $10,083.06 "," $9,757.80 "," $9,757.80 "," $8,673.60 "," $8,673.60 "," $1,563.75 "," $10,010.42 "," $10,299.90 "," $9,757.80 "," $9,757.80 "," $9,757.80 "," $10,083.06 "," $10,408.32 "," $1,526.53 "," $9,215.70 "," $1,702.00 "," $1,486.89 ", N/A ," $1,408.04 "," $1,408.04 "," $10,299.90 "," $1,599.54 ", $273.70 ," $10,408.32 "
" Pro US Exam Abdo Back Wall, Comp ",CPT® 76770,0972 - PRO FEE/RAD/DX,N/A,N/A, $395.00 , $256.75 , $620.43 , $107.56 , $119.09 , $543.01 , $702.61 , $367.35 , $355.50 , $355.50 , $316.00 , $316.00 , $119.09 , $364.70 , $375.25 , $355.50 , $355.50 , $355.50 , $367.35 , $379.20 , $623.69 , $335.75 , $764.64 , $638.53 , N/A , $553.60 , $553.60 , $375.25 , $640.80 , $107.56 , $764.64 
 Fac Culture Type Immunofluoresc ,CPT® 87140,0306 - LAB/BACT-MICRO,N/A,N/A, $130.00 , $84.50 , $109.20 , $5.68 , $5.68 , $105.04 , $117.00 , $110.06 , $117.00 , $117.00 , $117.00 , $110.50 , $5.57 , $120.03 , $123.50 , $110.50 , $120.90 , $120.90 , $123.50 , $124.80 , $106.37 , $117.00 , $110.50 , $102.70 , N/A , $105.21 , $105.21 , $123.50 , $111.55 , $5.57 , $124.80 
 HYDROMORPHONE HCL PF 500 MG/50ML IJ SOLN ,HCPCS J1170,0636 - DRUGS REQUIRING DETAILED CODIN,00409-2634-50,50 mL," $1,377.19 ", $895.17 ," $1,156.84 ", $4.44 , $4.30 ," $1,112.77 "," $1,239.47 "," $1,165.93 "," $1,239.47 "," $1,239.47 "," $1,239.47 "," $1,170.61 ", $4.22 ," $1,271.56 "," $1,308.33 "," $1,170.61 "," $1,280.79 "," $1,280.79 "," $1,308.33 "," $1,322.10 "," $1,126.82 "," $1,239.47 "," $1,170.61 "," $1,087.98 ", N/A ," $1,114.56 "," $1,114.56 "," $1,308.33 "," $1,181.77 ", $4.22 ," $1,322.10 "
Ultraviolet Light Therapy,CPT® 96900,N/A,N/A,N/A, $87.00 , $56.55 , $55.01 , $23.76 , $6.36 , $44.90 , $49.25 , $80.91 , $78.30 , $78.30 , $69.60 , $69.60 , $6.36 , $80.33 , $82.65 , $78.30 , $78.30 , $78.30 , $80.91 , $83.52 , $69.95 , $73.95 , $65.89 , $77.79 , N/A , $45.77 , $45.77 , $82.65 , $53.35 , $6.36 , $83.52 
 HYDROCHLOROTHIAZIDE 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,16729-0183-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 TRIAMCINOLONE ACETONIDE 0.1 % EX OINT ,HCPCS RXC637,0250 - PHARMACY,51672-1284-01,15 gram, $29.75 , $19.34 , $24.99 , N/A , N/A , $24.04 , $26.78 , $25.19 , $26.78 , $26.78 , $26.78 , $25.29 , N/A , $27.47 , $28.26 , $25.29 , $27.67 , $27.67 , $28.26 , $28.56 , $24.34 , $26.78 , $25.29 , $23.50 , N/A , $24.08 , $24.08 , $28.26 , $25.53 , $23.50 , $28.56 
 LISINOPRIL 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6798-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
External Ecg Rec>48hr<7d Recording,CPT® 93242,N/A,N/A,N/A, $433.00 , $281.45 , $87.56 , $11.60 , $11.62 , N/A , N/A , $402.69 , $389.70 , $389.70 , $346.40 , $346.40 , $11.62 , $399.79 , $411.35 , $389.70 , $389.70 , $389.70 , $402.69 , $415.68 , $90.79 , $368.05 , $63.97 , $93.35 , N/A , $76.44 , $76.44 , $411.35 , $84.81 , $11.60 , $415.68 
 Fac Revsc Opn/Prq Fem/Pop W/Athrc/Angiop Sm Vsl ,CPT® 37225,0360 - OR SERVICES,N/A,N/A," $32,004.00 "," $20,802.60 "," $26,883.36 ", $536.49 , $454.16 ," $25,859.23 "," $28,803.60 "," $27,094.59 "," $28,803.60 "," $28,803.60 "," $28,803.60 "," $27,203.40 ", $445.25 ," $29,549.29 "," $30,403.80 "," $27,203.40 "," $29,763.72 "," $29,763.72 "," $30,403.80 "," $30,723.84 "," $26,185.67 "," $28,803.60 "," $27,203.40 "," $25,283.16 ", N/A ," $25,900.84 "," $25,900.84 "," $30,403.80 "," $27,462.63 ", $445.25 ," $30,723.84 "
Reconstruc Hip Socket,CPT® 27120,N/A,N/A,N/A," $8,648.00 "," $5,621.20 "," $7,832.18 "," $1,224.55 "," $1,536.80 "," $6,277.99 "," $6,159.79 "," $8,042.64 "," $7,783.20 "," $7,783.20 "," $6,918.40 "," $6,918.40 "," $1,536.80 "," $7,984.70 "," $8,215.60 "," $7,783.20 "," $7,783.20 "," $7,783.20 "," $8,042.64 "," $8,302.08 "," $7,301.15 "," $7,350.80 "," $6,818.69 "," $7,373.93 ", N/A ," $6,400.48 "," $6,400.48 "," $8,215.60 "," $7,522.85 "," $1,224.55 "," $8,302.08 "
 SODIUM HYALURONATE 9.6 MG/0.8ML IO SOSY ,HCPCS RXA250,0250 - PHARMACY,57770-0495-65,0.8 mL, $823.29 , $535.14 , $691.56 , N/A , N/A , $665.22 , $740.96 , $697.00 , $740.96 , $740.96 , $740.96 , $699.80 , N/A , $760.14 , $782.13 , $699.80 , $765.66 , $765.66 , $782.13 , $790.36 , $673.62 , $740.96 , $699.80 , $650.40 , N/A , $666.29 , $666.29 , $782.13 , $706.47 , $650.40 , $790.36 
Drug Assay Vedolizumab,CPT® 80280,N/A,N/A,N/A, $309.00 , $200.85 , N/A , $39.34 , $31.47 , $164.07 , N/A , $287.37 , $278.10 , $278.10 , $247.20 , $247.20 , $31.47 , $285.30 , $293.55 , $278.10 , $278.10 , $278.10 , $287.37 , $296.64 , $257.54 , $262.65 , $184.15 , $113.28 , N/A , $153.12 , $153.12 , $293.55 , $167.01 , $31.47 , $296.64 
 Fac Sub Grft F/S/N/H/F/G/M/D /<100scm Ea Adl 25scm ,CPT® 15276,0761 - TREATMENT ROOM,N/A,N/A," $1,701.00 "," $1,105.65 "," $1,428.84 ", $23.62 , $26.04 ," $1,374.41 "," $1,530.90 "," $1,440.07 "," $1,530.90 "," $1,530.90 "," $1,530.90 "," $1,445.85 ", $25.53 ," $1,570.53 "," $1,615.95 "," $1,445.85 "," $1,581.93 "," $1,581.93 "," $1,615.95 "," $1,632.96 "," $1,391.76 "," $1,530.90 "," $1,445.85 "," $1,343.79 ", N/A ," $1,376.62 "," $1,376.62 "," $1,615.95 "," $1,459.63 ", $23.62 ," $1,632.96 "
 Fac Thoracentesis Needle/Cath Pleura W/O Imaging ,CPT® 32554,0761 - TREATMENT ROOM,N/A,N/A, $817.00 , $531.05 , $686.28 , $84.12 , $196.83 , $660.14 , $735.30 , $691.67 , $735.30 , $735.30 , $735.30 , $694.45 , $192.97 , $754.34 , $776.15 , $694.45 , $759.81 , $759.81 , $776.15 , $784.32 , $668.47 , $735.30 , $694.45 , $645.43 , N/A , $661.20 , $661.20 , $776.15 , $701.07 , $84.12 , $784.32 
"Destr Malig Trunk,Extrem 2.1-3 Cm",CPT® 17263,N/A,N/A,N/A, $758.00 , $492.70 , $391.58 , $117.87 , $148.44 , $352.12 , $345.14 , $704.94 , $682.20 , $682.20 , $606.40 , $606.40 , $148.44 , $699.86 , $720.10 , $682.20 , $682.20 , $682.20 , $704.94 , $727.68 , $431.12 , $644.30 , $685.08 , $451.76 , N/A , $358.99 , $358.99 , $720.10 , $416.29 , $117.87 , $727.68 
Excis Intra/Extra Benign Bone Tumor,CPT® 61563,N/A,N/A,N/A," $12,692.00 "," $8,249.80 "," $9,022.62 "," $1,761.62 "," $2,378.00 "," $10,698.89 "," $10,176.70 "," $11,803.56 "," $11,422.80 "," $11,422.80 "," $10,153.60 "," $10,153.60 "," $2,378.00 "," $11,718.52 "," $12,057.40 "," $11,422.80 "," $11,422.80 "," $11,422.80 "," $11,803.56 "," $12,184.32 "," $9,745.53 "," $10,788.20 "," $10,476.02 "," $11,033.18 ", N/A ," $10,907.64 "," $10,907.64 "," $12,057.40 "," $11,701.35 "," $1,761.62 "," $12,184.32 "
 Fac Relocation of Skin Pocket for Pacemaker ,CPT® 33222,0360 - OR SERVICES,N/A,N/A," $5,351.00 "," $3,478.15 "," $4,494.84 ", $318.91 , $394.70 ," $4,323.61 "," $4,815.90 "," $4,530.16 "," $4,815.90 "," $4,815.90 "," $4,815.90 "," $4,548.35 ", $386.96 ," $4,940.58 "," $5,083.45 "," $4,548.35 "," $4,976.43 "," $4,976.43 "," $5,083.45 "," $5,136.96 "," $4,378.19 "," $4,815.90 "," $4,548.35 "," $4,227.29 ", N/A ," $4,330.56 "," $4,330.56 "," $5,083.45 "," $4,591.69 ", $318.91 ," $5,136.96 "
 Fac Gjb2 Gene Analysis Full Gene Sequence ,CPT® 81252,0310 - PATHOLOGY LAB,N/A,N/A, $2.00 , $1.30 , $1.68 , $103.14 , $103.14 , $1.62 , $1.80 , $1.69 , $1.80 , $1.80 , $1.80 , $1.70 , $101.12 , $1.85 , $1.90 , $1.70 , $1.86 , $1.86 , $1.90 , $1.92 , $1.64 , $1.80 , $1.70 , $1.58 , N/A , $1.62 , $1.62 , $1.90 , $1.72 , $1.58 , $103.14 
Simple Repair 12.6-20cm,12005,N/A,N/A,N/A, $896.00 , $582.40 , $295.26 , $87.55 , $142.50 , $269.43 , $261.25 , $833.28 , $806.40 , $806.40 , $716.80 , $716.80 , $142.50 , $827.28 , $851.20 , $806.40 , $806.40 , $806.40 , $833.28 , $860.16 , $326.46 , $761.60 , $524.51 , $329.30 , N/A , $274.68 , $274.68 , $851.20 , $318.54 , $87.55 , $860.16 
Arthroscopy Shoulder Surgical Biceps Tenodesis,29828,N/A,N/A,N/A," $3,351.00 "," $2,178.15 "," $5,560.17 ", $870.03 , $635.43 ," $4,411.27 "," $4,435.72 "," $3,116.43 "," $3,015.90 "," $3,015.90 "," $2,680.80 "," $2,680.80 ", $635.43 ," $3,093.98 "," $3,183.45 "," $3,015.90 "," $3,015.90 "," $3,015.90 "," $3,116.43 "," $3,216.96 "," $5,178.57 "," $2,848.35 "," $4,902.61 "," $5,209.04 ", N/A ," $4,497.34 "," $4,497.34 "," $3,183.45 "," $5,285.98 ", $635.43 ," $5,560.17 "
"Injection, Fulphila",HCPCS Q5108,N/A,N/A,N/A, $563.00 , $365.95 , N/A , $113.37 , $139.27 , N/A , N/A , $523.59 , $506.70 , $506.70 , $450.40 , $450.40 , $139.27 , $519.82 , $534.85 , $506.70 , $506.70 , $506.70 , $523.59 , $540.48 , $288.94 , $478.55 , $260.40 , $197.70 , N/A , N/A , N/A , $534.85 , N/A , $113.37 , $540.48 
 SODIUM BICARBONATE 8.4 % IV SOLN ,HCPCS RXA250,0250 - PHARMACY,76329-3352-01,50 mL, $100.43 , $65.28 , $84.36 , N/A , N/A , $81.15 , $90.39 , $85.02 , $90.39 , $90.39 , $90.39 , $85.37 , N/A , $92.73 , $95.41 , $85.37 , $93.40 , $93.40 , $95.41 , $96.41 , $82.17 , $90.39 , $85.37 , $79.34 , N/A , $81.28 , $81.28 , $95.41 , $86.18 , $79.34 , $96.41 
 Fac Assay of Porphobilinogen ,CPT® 84110,0301 - LAB/CHEMISTRY,N/A,N/A, $110.00 , $71.50 , $92.40 , $8.61 , $8.61 , $88.88 , $99.00 , $93.13 , $99.00 , $99.00 , $99.00 , $93.50 , $8.44 , $101.56 , $104.50 , $93.50 , $102.30 , $102.30 , $104.50 , $105.60 , $90.00 , $99.00 , $93.50 , $86.90 , N/A , $89.02 , $89.02 , $104.50 , $94.39 , $8.44 , $105.60 
Emergency Department Visit Low Mdm,CPT® 99283,N/A,N/A,N/A, $376.00 , $244.40 , $251.49 , $68.75 , $26.96 , $174.00 , $179.09 , $349.68 , $338.40 , $338.40 , $300.80 , $300.80 , $26.96 , $347.16 , $357.20 , $338.40 , $338.40 , $338.40 , $349.68 , $360.96 , $213.09 , $319.60 , $132.02 , $134.13 , $74.50 , $177.39 , $177.39 , $357.20 , $212.87 , $26.96 , $360.96 
Revise Acetabular Part of Total Hip,27137,N/A,N/A,N/A," $4,094.00 "," $2,661.10 "," $8,805.29 "," $1,374.83 "," $1,251.82 "," $7,118.56 "," $7,035.55 "," $3,807.42 "," $3,684.60 "," $3,684.60 "," $3,275.20 "," $3,275.20 "," $1,251.82 "," $3,779.99 "," $3,889.30 "," $3,684.60 "," $3,684.60 "," $3,684.60 "," $3,807.42 "," $3,930.24 "," $8,223.42 "," $3,479.90 "," $7,792.79 "," $8,363.90 ", N/A ," $7,257.45 "," $7,257.45 "," $3,889.30 "," $8,530.08 "," $1,251.82 "," $8,805.29 "
"Thymectomy,Transthoracic",CPT® 60521,N/A,N/A,N/A," $9,387.00 "," $6,101.55 "," $6,598.54 "," $1,025.49 "," $1,391.10 "," $5,763.35 "," $5,948.73 "," $8,729.91 "," $8,448.30 "," $8,448.30 "," $7,509.60 "," $7,509.60 "," $1,391.10 "," $8,667.02 "," $8,917.65 "," $8,448.30 "," $8,448.30 "," $8,448.30 "," $8,729.91 "," $9,011.52 "," $6,423.02 "," $7,978.95 "," $5,992.67 "," $5,514.96 ", N/A ," $5,875.80 "," $5,875.80 "," $8,917.65 "," $6,553.28 "," $1,025.49 "," $9,011.52 "
" Fac Assay, Aminolevulinic Acid ",CPT® 82135,0301 - LAB/CHEMISTRY,N/A,N/A, $150.00 , $97.50 , $126.00 , $16.78 , $16.78 , $121.20 , $135.00 , $126.99 , $135.00 , $135.00 , $135.00 , $127.50 , $16.45 , $138.50 , $142.50 , $127.50 , $139.50 , $139.50 , $142.50 , $144.00 , $122.73 , $135.00 , $127.50 , $118.50 , N/A , $121.40 , $121.40 , $142.50 , $128.72 , $16.45 , $144.00 
 ROPINIROLE HCL 2 MG PO TABS ,HCPCS RXA250,0250 - PHARMACY,43547-0271-10,1 tablet, $12.85 , $8.35 , $10.79 , N/A , N/A , $10.38 , $11.57 , $10.88 , $11.57 , $11.57 , $11.57 , $10.92 , N/A , $11.86 , $12.21 , $10.92 , $11.95 , $11.95 , $12.21 , $12.34 , $10.51 , $11.57 , $10.92 , $10.15 , N/A , $10.40 , $10.40 , $12.21 , $11.03 , $10.15 , $12.34 
 Fac Immunfix E-Phorsis/Urine/CSF ,CPT® 86335,0302 - LAB/IMMUNOLOGY,N/A,N/A, $270.00 , $175.50 , $226.80 , $29.94 , $29.94 , $218.16 , $243.00 , $228.58 , $243.00 , $243.00 , $243.00 , $229.50 , $29.35 , $249.29 , $256.50 , $229.50 , $251.10 , $251.10 , $256.50 , $259.20 , $220.91 , $243.00 , $229.50 , $213.30 , N/A , $218.51 , $218.51 , $256.50 , $231.69 , $29.35 , $259.20 
" Pro Tracheostomy,Emerg Proc. ",CPT® 31605,0981 - PRO FEE/ER,N/A,N/A," $2,135.00 "," $1,387.75 "," $1,748.06 ", $306.45 , $461.01 , $698.60 , $677.17 ," $1,985.55 "," $1,921.50 "," $1,921.50 "," $1,708.00 "," $1,708.00 ", $461.01 ," $1,971.25 "," $2,028.25 "," $1,921.50 "," $1,921.50 "," $1,921.50 "," $1,985.55 "," $2,049.60 "," $1,684.74 "," $1,814.75 ", $966.96 ," $1,676.07 ", N/A , $712.23 , $712.23 ," $2,028.25 ", $838.81 , $306.45 ," $2,049.60 "
"Lipopro Blood, Electrophor/ Quant",CPT® 83700,N/A,N/A,N/A, $97.00 , $63.05 , N/A , $11.49 , $11.49 , $63.69 , $76.16 , $90.21 , $87.30 , $87.30 , $77.60 , $77.60 , $11.49 , $89.56 , $92.15 , $87.30 , $87.30 , $87.30 , $90.21 , $93.12 , $75.19 , $82.45 , $72.98 , $40.82 , N/A , $59.44 , $59.44 , $92.15 , $64.96 , $11.49 , $93.12 
 Fac Prothrombin Test ,CPT® 85611,0305 - LAB/HEMATOLOGY,N/A,N/A, $93.00 , $60.45 , $78.12 , $4.02 , $4.02 , $75.14 , $83.70 , $78.73 , $83.70 , $83.70 , $83.70 , $79.05 , $3.94 , $85.87 , $88.35 , $79.05 , $86.49 , $86.49 , $88.35 , $89.28 , $76.09 , $83.70 , $79.05 , $73.47 , N/A , $75.26 , $75.26 , $88.35 , $79.80 , $3.94 , $89.28 
"Intracard Echo, Ther/Dx Intervent",CPT® 93662,N/A,N/A,N/A," $2,289.00 "," $1,487.85 "," $2,069.02 ", $306.62 , N/A ," $1,053.95 "," $1,037.60 "," $2,128.77 "," $2,060.10 "," $2,060.10 "," $1,831.20 "," $1,831.20 ", N/A ," $2,113.43 "," $2,174.55 "," $2,060.10 "," $2,060.10 "," $2,060.10 "," $2,128.77 "," $2,197.44 "," $2,167.62 "," $1,945.65 ", $975.88 ," $2,221.33 ", N/A ," $1,074.51 "," $1,074.51 "," $2,174.55 "," $1,191.10 ", $306.62 ," $2,221.33 "
 Pro Smpl Rpr Supfc S/N/Ax/G/T 7.6cm-12.5cm ,CPT® 12004,0982 - PRO FEE/OUTPT,N/A,N/A, $848.00 , $551.20 , $227.60 , $67.81 , $89.32 , $199.60 , $193.84 , $788.64 , $763.20 , $763.20 , $678.40 , $678.40 , $89.32 , $782.96 , $805.60 , $763.20 , $763.20 , $763.20 , $788.64 , $814.08 , $250.63 , $720.80 , $388.93 , $254.00 , N/A , $203.50 , $203.50 , $805.60 , $235.99 , $67.81 , $814.08 
 VALSARTAN 80 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00378-5813-77,1 tablet, $24.91 , $16.19 , $20.92 , N/A , N/A , $20.13 , $22.42 , $21.09 , $22.42 , $22.42 , $22.42 , $21.17 , N/A , $23.00 , $23.66 , $21.17 , $23.17 , $23.17 , $23.66 , $23.91 , $20.38 , $22.42 , $21.17 , $19.68 , N/A , $20.16 , $20.16 , $23.66 , $21.38 , $19.68 , $23.91 
"Closed Rx Hum Supracondylr Fx,Manipu",CPT® 24535,N/A,N/A,N/A," $3,918.00 "," $2,546.70 "," $3,493.49 ", $552.11 , $533.82 ," $2,721.20 "," $2,743.97 "," $3,643.74 "," $3,526.20 "," $3,526.20 "," $3,134.40 "," $3,134.40 ", $533.82 ," $3,617.49 "," $3,722.10 "," $3,526.20 "," $3,526.20 "," $3,526.20 "," $3,643.74 "," $3,761.28 "," $3,252.44 "," $3,330.30 "," $3,022.20 "," $3,233.03 ", N/A ," $2,774.30 "," $2,774.30 "," $3,722.10 "," $3,260.78 ", $533.82 ," $3,761.28 "
"Excis Distal Ulna,Part/Complete",CPT® 25240,N/A,N/A,N/A," $2,875.00 "," $1,868.75 "," $2,643.36 ", $416.48 , $384.19 ," $2,060.00 "," $2,064.91 "," $2,673.75 "," $2,587.50 "," $2,587.50 "," $2,300.00 "," $2,300.00 ", $384.19 ," $2,654.49 "," $2,731.25 "," $2,587.50 "," $2,587.50 "," $2,587.50 "," $2,673.75 "," $2,760.00 "," $2,453.76 "," $2,443.75 "," $2,267.55 "," $2,455.53 ", N/A ," $2,100.20 "," $2,100.20 "," $2,731.25 "," $2,468.47 ", $384.19 ," $2,760.00 "
Percut Fix Hum Supracondylar Fx,CPT® 24538,N/A,N/A,N/A," $5,114.00 "," $3,324.10 "," $4,844.58 ", $758.04 , $614.70 ," $3,584.14 "," $3,575.91 "," $4,756.02 "," $4,602.60 "," $4,602.60 "," $4,091.20 "," $4,091.20 ", $614.70 ," $4,721.76 "," $4,858.30 "," $4,602.60 "," $4,602.60 "," $4,602.60 "," $4,756.02 "," $4,909.44 "," $4,434.37 "," $4,346.90 "," $3,946.35 "," $4,222.59 ", N/A ," $3,654.08 "," $3,654.08 "," $4,858.30 "," $4,294.84 ", $614.70 ," $4,909.44 "
Prosthesis Removal Humeral and Glenoid Component,CPT® 23335,N/A,N/A,N/A," $8,037.00 "," $5,224.05 "," $7,653.88 "," $1,196.66 ", $949.63 ," $6,220.43 "," $6,232.94 "," $7,474.41 "," $7,233.30 "," $7,233.30 "," $6,429.60 "," $6,429.60 ", $949.63 ," $7,420.56 "," $7,635.15 "," $7,233.30 "," $7,233.30 "," $7,233.30 "," $7,474.41 "," $7,715.52 "," $7,136.52 "," $6,831.45 "," $6,734.61 "," $7,264.00 ", N/A ," $6,341.81 "," $6,341.81 "," $7,635.15 "," $7,453.87 ", $949.63 ," $7,715.52 "
"Closed Treat Vert Body Fx,Manipulatn",CPT® 22315,N/A,N/A,N/A," $5,061.00 "," $3,289.65 "," $4,641.46 ", $729.37 , $461.04 ," $3,706.82 "," $3,678.69 "," $4,706.73 "," $4,554.90 "," $4,554.90 "," $4,048.80 "," $4,048.80 ", $461.04 ," $4,672.82 "," $4,807.95 "," $4,554.90 "," $4,554.90 "," $4,554.90 "," $4,706.73 "," $4,858.56 "," $4,326.99 "," $4,301.85 "," $4,103.35 "," $4,329.90 ", N/A ," $3,779.15 "," $3,779.15 "," $4,807.95 "," $4,441.84 ", $461.04 ," $4,858.56 "
US Trnspl Kdn R-T Img +- Duplex Dop Std,CPT® 76776,N/A,N/A,N/A," $1,088.00 ", $707.20 , $849.99 , $146.44 , $101.34 , $750.63 , $814.90 ," $1,011.84 ", $979.20 , $979.20 , $870.40 , $870.40 , $101.34 ," $1,004.55 "," $1,033.60 ", $979.20 , $979.20 , $979.20 ," $1,011.84 "," $1,044.48 ", $859.96 , $924.80 , $885.98 , $883.73 , N/A , $765.28 , $765.28 ," $1,033.60 ", $885.83 , $101.34 ," $1,044.48 "
Spin Bone Autogrft Local,20936,N/A,N/A,N/A," $1,281.00 ", $832.65 , N/A , N/A , $464.89 , $614.93 , $595.80 ," $1,191.33 "," $1,152.90 "," $1,152.90 "," $1,024.80 "," $1,024.80 ", $464.89 ," $1,182.75 "," $1,216.95 "," $1,152.90 "," $1,152.90 "," $1,152.90 "," $1,191.33 "," $1,229.76 ", N/A ," $1,088.85 ", N/A , $721.19 , N/A , $626.92 , $626.92 ," $1,216.95 ", $736.86 , $464.89 ," $1,229.76 "
 Pro Removal of Tendon Lesion ,CPT® 27630,0982 - PRO FEE/OUTPT,N/A,N/A," $2,939.00 "," $1,910.35 "," $2,212.93 ", $344.18 , $324.97 ," $1,777.30 "," $1,779.67 "," $2,733.27 "," $2,645.10 "," $2,645.10 "," $2,351.20 "," $2,351.20 ", $324.97 ," $2,713.58 "," $2,792.05 "," $2,645.10 "," $2,645.10 "," $2,645.10 "," $2,733.27 "," $2,821.44 "," $2,063.34 "," $2,498.15 "," $1,948.20 "," $2,100.00 ", N/A ," $1,811.98 "," $1,811.98 "," $2,792.05 "," $2,129.71 ", $324.97 ," $2,821.44 "
 Fac Cytp Fine Ndl Aspirate Immt Cytohistologic Std ,CPT® 88172,0310 - PATHOLOGY LAB,N/A,N/A, $147.00 , $95.55 , $123.48 , $54.94 , $48.00 , $118.78 , $132.30 , $124.45 , $132.30 , $132.30 , $132.30 , $124.95 , $47.06 , $135.73 , $139.65 , $124.95 , $136.71 , $136.71 , $139.65 , $141.12 , $120.28 , $132.30 , $124.95 , $116.13 , N/A , $118.97 , $118.97 , $139.65 , $126.14 , $47.06 , $141.12 
" Layer Clousure Neck, Genitalia, Hands,Feet 2.6-7.5cm ",CPT® 12042,0981 - PRO FEE/ER,N/A,N/A," $1,172.00 ", $761.80 , $627.61 , $188.46 , $103.08 , $547.43 , $537.01 ," $1,089.96 "," $1,054.80 "," $1,054.80 ", $937.60 , $937.60 , $103.08 ," $1,082.11 "," $1,113.40 "," $1,054.80 "," $1,054.80 "," $1,054.80 "," $1,089.96 "," $1,125.12 ", $689.37 , $996.20 ," $1,066.87 ", $703.69 , N/A , $558.12 , $558.12 ," $1,113.40 ", $647.23 , $103.08 ," $1,125.12 "
Glucose Test,CPT® 82950,N/A,N/A,N/A, $70.00 , $45.50 , N/A , $4.85 , $4.85 , $26.85 , $32.15 , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $4.85 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , $31.72 , $59.50 , $30.82 , $17.18 , N/A , $25.06 , $25.06 , $66.50 , $27.39 , $4.85 , $67.20 
 Fac Teaec W/Graft Tibioperoneal Trunk Art ,CPT® 35304,0360 - OR SERVICES,N/A,N/A," $2,842.00 "," $1,847.30 "," $2,387.28 "," $1,129.73 "," $1,059.27 "," $2,296.34 "," $2,557.80 "," $2,406.04 "," $2,557.80 "," $2,557.80 "," $2,557.80 "," $2,415.70 "," $1,038.50 "," $2,624.02 "," $2,699.90 "," $2,415.70 "," $2,643.06 "," $2,643.06 "," $2,699.90 "," $2,728.32 "," $2,325.32 "," $2,557.80 "," $2,415.70 "," $2,245.18 ", N/A ," $2,300.03 "," $2,300.03 "," $2,699.90 "," $2,438.72 "," $1,038.50 "," $2,728.32 "
" Fac Program Eval Implant Device,Cardvert/Defib,2 Lead ",CPT® 93283,0480 - CARDIOLOGY,N/A,N/A, $466.00 , $302.90 , $391.44 , $97.76 , $66.57 , $376.53 , $419.40 , $394.52 , $419.40 , $419.40 , $419.40 , $396.10 , $65.26 , $430.26 , $442.70 , $396.10 , $433.38 , $433.38 , $442.70 , $447.36 , $381.28 , $419.40 , $396.10 , $368.14 , N/A , $377.13 , $377.13 , $442.70 , $399.87 , $65.26 , $447.36 
 DICYCLOMINE HCL 10 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-6987-61,1 capsule, $3.50 , $2.28 , $2.94 , N/A , N/A , $2.83 , $3.15 , $2.96 , $3.15 , $3.15 , $3.15 , $2.98 , N/A , $3.23 , $3.33 , $2.98 , $3.26 , $3.26 , $3.33 , $3.36 , $2.86 , $3.15 , $2.98 , $2.77 , N/A , $2.83 , $2.83 , $3.33 , $3.00 , $2.77 , $3.36 
 Pro Exc Tum Thi/Kne Area Dp Subfscal/Im ,CPT® 27328,0982 - PRO FEE/OUTPT,N/A,N/A," $4,875.00 "," $3,168.75 "," $3,762.07 ", $589.21 , $329.90 ," $2,980.00 "," $2,985.29 "," $4,533.75 "," $4,387.50 "," $4,387.50 "," $3,900.00 "," $3,900.00 ", $329.90 ," $4,501.09 "," $4,631.25 "," $4,387.50 "," $4,387.50 "," $4,387.50 "," $4,533.75 "," $4,680.00 "," $3,495.04 "," $4,143.75 "," $3,304.09 "," $3,516.17 ", N/A ," $3,038.14 "," $3,038.14 "," $4,631.25 "," $3,570.90 ", $329.90 ," $4,680.00 "
Repair Bowel-Bowel Fistula,CPT® 44650,N/A,N/A,N/A," $9,164.00 "," $5,956.60 "," $8,593.98 "," $1,329.46 ", $922.06 ," $6,842.27 "," $6,887.56 "," $8,522.52 "," $8,247.60 "," $8,247.60 "," $7,331.20 "," $7,331.20 ", $922.06 ," $8,461.12 "," $8,705.80 "," $8,247.60 "," $8,247.60 "," $8,247.60 "," $8,522.52 "," $8,797.44 "," $6,154.61 "," $7,789.40 "," $7,655.42 "," $8,057.22 ", N/A ," $6,975.78 "," $6,975.78 "," $8,705.80 "," $7,295.93 ", $922.06 ," $8,797.44 "
 Pulmonary Edema And Respiratory Failure ,MS DRG V40 (FY2023) 189,N/A,N/A,N/A," $13,941.98 "," $9,062.29 "," $11,711.26 ", N/A , N/A ," $11,265.12 "," $12,547.78 "," $11,803.28 "," $12,547.78 "," $12,547.78 "," $12,547.78 "," $11,850.68 ", N/A ," $12,872.63 "," $13,244.88 "," $11,850.68 "," $12,966.04 "," $12,966.04 "," $13,244.88 "," $13,384.30 "," $11,407.33 "," $12,547.78 "," $11,850.68 "," $11,014.16 ", N/A ," $11,283.24 "," $11,283.24 "," $13,244.88 "," $11,963.61 "," $11,014.16 "," $13,384.30 "
" Fac Cytogenetics, 25-99 ",CPT® 88274,0310 - PATHOLOGY LAB,N/A,N/A, $432.00 , $280.80 , $362.88 , $43.23 , $43.23 , $349.06 , $388.80 , $365.73 , $388.80 , $388.80 , $388.80 , $367.20 , $42.38 , $398.87 , $410.40 , $367.20 , $401.76 , $401.76 , $410.40 , $414.72 , $353.46 , $388.80 , $367.20 , $341.28 , N/A , $349.62 , $349.62 , $410.40 , $370.70 , $42.38 , $414.72 
Radex Hip Unilateral With Pelvis 2-3 Views,CPT® 73502,N/A,N/A,N/A, $310.00 , $201.50 , $319.41 , $46.24 , $32.45 , $196.69 , $208.03 , $288.30 , $279.00 , $279.00 , $248.00 , $248.00 , $32.45 , $286.22 , $294.50 , $279.00 , $279.00 , $279.00 , $288.30 , $297.60 , $256.15 , $263.50 , $270.49 , $208.99 , N/A , $200.52 , $200.52 , $294.50 , $232.11 , $32.45 , $319.41 
 Fac Iaad Ia Shiga-Like Toxin ,CPT® 87427,0306 - LAB/BACT-MICRO,N/A,N/A, $111.00 , $72.15 , $93.24 , $12.22 , $12.22 , $89.69 , $99.90 , $93.97 , $99.90 , $99.90 , $99.90 , $94.35 , $11.98 , $102.49 , $105.45 , $94.35 , $103.23 , $103.23 , $105.45 , $106.56 , $90.82 , $99.90 , $94.35 , $87.69 , N/A , $89.83 , $89.83 , $105.45 , $95.25 , $11.98 , $106.56 
"Biopsy, Nail Unit (Sep Proc)",CPT® 11755,N/A,N/A,N/A, $497.00 , $323.05 , $197.10 , $58.74 , $100.84 , $214.86 , $211.12 , $462.21 , $447.30 , $447.30 , $397.60 , $397.60 , $100.84 , $458.88 , $472.15 , $447.30 , $447.30 , $447.30 , $462.21 , $477.12 , $218.61 , $422.45 , $413.90 , $275.42 , N/A , $219.06 , $219.06 , $472.15 , $254.02 , $58.74 , $477.12 
 LATANOPROST 0.005 % OP SOLN ,HCPCS RXC637,0250 - PHARMACY,61314-0547-01,2.5 mL, $488.01 , $317.21 , $409.93 , N/A , N/A , $394.31 , $439.21 , $413.15 , $439.21 , $439.21 , $439.21 , $414.81 , N/A , $450.58 , $463.61 , $414.81 , $453.85 , $453.85 , $463.61 , $468.49 , $399.29 , $439.21 , $414.81 , $385.53 , N/A , $394.95 , $394.95 , $463.61 , $418.76 , $385.53 , $468.49 
 OXALIPLATIN 0.5 MG/ML ,HCPCS RXA250,0250 - PHARMACY,00001-0367-01,1 mL, $16.68 , $10.84 , $14.01 , N/A , N/A , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , N/A , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $13.18 , $16.01 
Perq Transcath Cls Paravalvr Leak 1 Mitral Valve,CPT® 93590,N/A,N/A,N/A," $7,350.00 "," $4,777.50 "," $6,671.80 "," $1,025.83 ", $925.65 ," $6,145.05 "," $6,011.82 "," $6,835.50 "," $6,615.00 "," $6,615.00 "," $5,880.00 "," $5,880.00 ", $925.65 ," $6,786.26 "," $6,982.50 "," $6,615.00 "," $6,615.00 "," $6,615.00 "," $6,835.50 "," $7,056.00 "," $6,189.37 "," $6,247.50 "," $5,556.50 "," $6,546.44 ", N/A ," $6,264.95 "," $6,264.95 "," $6,982.50 "," $6,944.78 ", $925.65 ," $7,056.00 "
Open Rx Metatarsal Fracture,CPT® 28485,N/A,N/A,N/A," $3,527.00 "," $2,292.55 "," $3,485.63 ", $546.26 , $384.19 ," $2,574.42 "," $2,574.82 "," $3,280.11 "," $3,174.30 "," $3,174.30 "," $2,821.60 "," $2,821.60 ", $384.19 ," $3,256.48 "," $3,350.65 "," $3,174.30 "," $3,174.30 "," $3,174.30 "," $3,280.11 "," $3,385.92 "," $3,222.61 "," $2,997.95 "," $2,804.55 "," $3,151.82 ", N/A ," $2,624.65 "," $2,624.65 "," $3,350.65 "," $3,084.91 ", $384.19 ," $3,485.63 "
 NALTREXONE HCL 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-7036-04,1 tablet, $11.01 , $7.16 , $9.25 , N/A , N/A , $8.90 , $9.91 , $9.32 , $9.91 , $9.91 , $9.91 , $9.36 , N/A , $10.17 , $10.46 , $9.36 , $10.24 , $10.24 , $10.46 , $10.57 , $9.01 , $9.91 , $9.36 , $8.70 , N/A , $8.91 , $8.91 , $10.46 , $9.45 , $8.70 , $10.57 
 Pro CT Angiograph Pelv W/O&W/Dye ,CPT® 72191,0972 - PRO FEE/RAD/DX,N/A,N/A, $952.00 , $618.80 ," $1,788.15 ", $258.04 , $394.70 ," $1,448.73 "," $2,115.07 ", $885.36 , $856.80 , $856.80 , $761.60 , $761.60 , $394.70 , $878.98 , $904.40 , $856.80 , $856.80 , $856.80 , $885.36 , $913.92 ," $1,816.87 ", $809.20 ," $2,303.55 "," $1,981.87 ", N/A ," $1,477.00 "," $1,477.00 ", $904.40 ," $1,709.66 ", $258.04 ," $2,303.55 "
Blood Gases W/O2 Saturation,CPT® 82805,N/A,N/A,N/A, $188.00 , $122.20 , N/A , $80.35 , $39.39 , $160.57 , $192.07 , $174.84 , $169.20 , $169.20 , $150.40 , $150.40 , $39.39 , $173.58 , $178.60 , $169.20 , $169.20 , $169.20 , $174.84 , $180.48 , $525.96 , $159.80 , $186.51 , $231.35 , N/A , $149.85 , $149.85 , $178.60 , $163.75 , $39.39 , $525.96 
 Fac Cltx Carpl B1 Fx W/O Mnpj Ea B1 ,CPT® 25630,0761 - TREATMENT ROOM,N/A,N/A," $2,821.00 "," $1,833.65 "," $2,369.64 ", $280.46 , $206.19 ," $2,279.37 "," $2,538.90 "," $2,388.26 "," $2,538.90 "," $2,538.90 "," $2,538.90 "," $2,397.85 ", $202.15 ," $2,604.63 "," $2,679.95 "," $2,397.85 "," $2,623.53 "," $2,623.53 "," $2,679.95 "," $2,708.16 "," $2,308.14 "," $2,538.90 "," $2,397.85 "," $2,228.59 ", N/A ," $2,283.04 "," $2,283.04 "," $2,679.95 "," $2,420.70 ", $202.15 ," $2,708.16 "
" Fac Culture Type, Immunologic ",CPT® 87147,0306 - LAB/BACT-MICRO,N/A,N/A, $62.00 , $40.30 , $52.08 , $5.28 , $5.28 , $50.10 , $55.80 , $52.49 , $55.80 , $55.80 , $55.80 , $52.70 , $5.18 , $57.24 , $58.90 , $52.70 , $57.66 , $57.66 , $58.90 , $59.52 , $50.73 , $55.80 , $52.70 , $48.98 , N/A , $50.18 , $50.18 , $58.90 , $53.20 , $5.18 , $59.52 
 Inj Proc for Cysto/Vcug ,CPT® 51600,0761 - TREATMENT ROOM,N/A,N/A," $2,099.00 "," $1,364.35 "," $1,763.16 ", $41.68 , $179.05 ," $1,695.99 "," $1,889.10 "," $1,777.01 "," $1,889.10 "," $1,889.10 "," $1,889.10 "," $1,784.15 ", $175.54 ," $1,938.01 "," $1,994.05 "," $1,784.15 "," $1,952.07 "," $1,952.07 "," $1,994.05 "," $2,015.04 "," $1,717.40 "," $1,889.10 "," $1,784.15 "," $1,658.21 ", N/A ," $1,698.72 "," $1,698.72 "," $1,994.05 "," $1,801.15 ", $41.68 ," $2,015.04 "
Reopen Recent Abd Exploratory,CPT® 49002,N/A,N/A,N/A," $6,333.00 "," $4,116.45 "," $6,206.92 ", $960.24 ," $1,020.31 "," $4,919.29 "," $4,954.58 "," $5,889.69 "," $5,699.70 "," $5,699.70 "," $5,066.40 "," $5,066.40 "," $1,020.31 "," $5,847.26 "," $6,016.35 "," $5,699.70 "," $5,699.70 "," $5,699.70 "," $5,889.69 "," $6,079.68 "," $4,455.04 "," $5,383.05 "," $5,510.97 "," $5,800.17 ", N/A ," $5,015.28 "," $5,015.28 "," $6,016.35 "," $5,245.45 ", $960.24 ," $6,206.92 "
"Assay Sngl Organic Acid, Quantitative",CPT® 83921,N/A,N/A,N/A, $151.00 , $98.15 , N/A , $21.63 , $21.63 , $93.08 , $111.36 , $140.43 , $135.90 , $135.90 , $120.80 , $120.80 , $21.63 , $139.42 , $143.45 , $135.90 , $135.90 , $135.90 , $140.43 , $144.96 , $141.62 , $128.35 , $107.04 , $62.29 , N/A , $86.87 , $86.87 , $143.45 , $94.93 , $21.63 , $144.96 
 Fac Blood Clot Inhibitor Test ,CPT® 85306,0305 - LAB/HEMATOLOGY,N/A,N/A, $284.00 , $184.60 , $238.56 , $15.63 , $15.63 , $229.47 , $255.60 , $240.43 , $255.60 , $255.60 , $255.60 , $241.40 , $15.32 , $262.22 , $269.80 , $241.40 , $264.12 , $264.12 , $269.80 , $272.64 , $232.37 , $255.60 , $241.40 , $224.36 , N/A , $229.84 , $229.84 , $269.80 , $243.70 , $15.32 , $272.64 
 Pulmonary Stress Testing Simple ,CPT® 94618,0460 - PULMONARY FUNC,N/A,N/A, $153.00 , $99.45 , $128.52 , $33.01 , $27.10 , $123.62 , $137.70 , $129.53 , $137.70 , $137.70 , $137.70 , $130.05 , $26.57 , $141.26 , $145.35 , $130.05 , $142.29 , $142.29 , $145.35 , $146.88 , $125.18 , $137.70 , $130.05 , $120.87 , N/A , $123.82 , $123.82 , $145.35 , $131.29 , $26.57 , $146.88 
TB Intradermal Test (Clinic),CPT® 86580,N/A,N/A,N/A, $59.00 , $38.35 , $36.56 , $9.63 , $9.39 , $30.69 , $37.89 , $54.87 , $53.10 , $53.10 , $47.20 , $47.20 , $9.39 , $54.47 , $56.05 , $53.10 , $53.10 , $53.10 , $54.87 , $56.64 , $62.16 , $50.15 , $38.92 , $22.57 , N/A , $28.64 , $28.64 , $56.05 , $31.30 , $9.39 , $62.16 
 Pro Treat Humerus Fracture ,CPT® 24516,0975 - PRO FEE/OR,N/A,N/A," $3,628.00 "," $2,358.20 "," $5,212.55 ", $816.69 , $881.43 ," $4,145.80 "," $4,120.69 "," $3,374.04 "," $3,265.20 "," $3,265.20 "," $2,902.40 "," $2,902.40 ", $881.43 ," $3,349.73 "," $3,446.60 "," $3,265.20 "," $3,265.20 "," $3,265.20 "," $3,374.04 "," $3,482.88 "," $4,853.59 "," $3,083.80 "," $4,552.93 "," $4,881.52 ", N/A ," $4,226.68 "," $4,226.68 "," $3,446.60 "," $4,967.85 ", $816.69 ," $5,212.55 "
 Fac Pten Gene Analysis Duplication/Deletion Variant ,CPT® 81323,0310 - PATHOLOGY LAB,N/A,N/A, $7.00 , $4.55 , $5.88 , $306.00 , $71.48 , $5.66 , $6.30 , $5.93 , $6.30 , $6.30 , $6.30 , $5.95 , $70.08 , $6.46 , $6.65 , $5.95 , $6.51 , $6.51 , $6.65 , $6.72 , $5.73 , $6.30 , $5.95 , $5.53 , N/A , $5.67 , $5.67 , $6.65 , $6.01 , $5.53 , $306.00 
"Whfo,No Joint, Prefabricated",HCPCS L3807,N/A,N/A,N/A, $380.00 , $247.00 , N/A , $266.19 , $145.69 , N/A , N/A , $353.40 , $342.00 , $342.00 , $304.00 , $304.00 , $145.69 , $350.85 , $361.00 , $342.00 , $342.00 , $342.00 , $353.40 , $364.80 , N/A , $323.00 , $219.93 , $223.95 , N/A , N/A , N/A , $361.00 , N/A , $145.69 , $364.80 
Treat Tibia Fracture,CPT® 27824,N/A,N/A,N/A," $1,511.00 ", $982.15 ," $1,893.39 ", $300.54 , $217.57 ," $1,463.07 "," $1,483.65 "," $1,405.23 "," $1,359.90 "," $1,359.90 "," $1,208.80 "," $1,208.80 ", $217.57 ," $1,395.11 "," $1,435.45 "," $1,359.90 "," $1,359.90 "," $1,359.90 "," $1,405.23 "," $1,450.56 "," $1,754.63 "," $1,284.35 "," $1,628.85 "," $1,745.36 ", N/A ," $1,491.62 "," $1,491.62 "," $1,435.45 "," $1,753.18 ", $217.57 ," $1,893.39 "
"Repair Femoral Hernia,Reducible",49550,N/A,N/A,N/A," $3,736.00 "," $2,428.40 "," $3,454.88 ", $536.56 , $537.90 ," $2,700.66 "," $2,744.73 "," $3,474.48 "," $3,362.40 "," $3,362.40 "," $2,988.80 "," $2,988.80 ", $537.90 ," $3,449.45 "," $3,549.20 "," $3,362.40 "," $3,362.40 "," $3,362.40 "," $3,474.48 "," $3,586.56 "," $2,471.26 "," $3,175.60 "," $3,047.18 "," $3,190.75 ", N/A ," $2,753.36 "," $2,753.36 "," $3,549.20 "," $2,879.72 ", $536.56 ," $3,586.56 "
 Fac Histoplasma ,CPT® 86698,0302 - LAB/IMMUNOLOGY,N/A,N/A, $140.00 , $91.00 , $117.60 , $14.07 , $14.07 , $113.12 , $126.00 , $118.52 , $126.00 , $126.00 , $126.00 , $119.00 , $13.79 , $129.26 , $133.00 , $119.00 , $130.20 , $130.20 , $133.00 , $134.40 , $114.55 , $126.00 , $119.00 , $110.60 , N/A , $113.30 , $113.30 , $133.00 , $120.13 , $13.79 , $134.40 
"Corneal Wedge,Correct Astigmatism",CPT® 65775,N/A,N/A,N/A," $5,046.00 "," $3,279.90 "," $3,552.45 ", $556.54 ," $1,227.29 "," $3,120.71 "," $2,869.94 "," $4,692.78 "," $4,541.40 "," $4,541.40 "," $4,036.80 "," $4,036.80 "," $1,227.29 "," $4,658.97 "," $4,793.70 "," $4,541.40 "," $4,541.40 "," $4,541.40 "," $4,692.78 "," $4,844.16 "," $4,832.87 "," $4,289.10 "," $2,913.38 "," $3,964.59 ", N/A ," $3,181.60 "," $3,181.60 "," $4,793.70 "," $3,512.08 ", $556.54 ," $4,844.16 "
 Path Level I 88300 Initial -Tech-Mh ,CPT® 88300,0310 - PATHOLOGY LAB,N/A,N/A, $113.00 , $73.45 , $94.92 , $15.46 , $10.46 , $91.30 , $101.70 , $95.67 , $101.70 , $101.70 , $101.70 , $96.05 , $10.25 , $104.33 , $107.35 , $96.05 , $105.09 , $105.09 , $107.35 , $108.48 , $92.46 , $101.70 , $96.05 , $89.27 , N/A , $91.45 , $91.45 , $107.35 , $96.97 , $10.25 , $108.48 
 Fac Carcinoembryonic Antigen ,CPT® 82378,0301 - LAB/CHEMISTRY,N/A,N/A, $203.00 , $131.95 , $170.52 , $19.34 , $19.34 , $164.02 , $182.70 , $171.86 , $182.70 , $182.70 , $182.70 , $172.55 , $18.96 , $187.43 , $192.85 , $172.55 , $188.79 , $188.79 , $192.85 , $194.88 , $166.09 , $182.70 , $172.55 , $160.37 , N/A , $164.29 , $164.29 , $192.85 , $174.19 , $18.96 , $194.88 
 Fac MRI Breast Without Contrast Material Bilateral ,CPT® 77047,0610 - MRI,N/A,N/A," $4,695.00 "," $3,051.75 "," $3,943.80 ", $226.15 , $203.14 ," $3,793.56 "," $4,225.50 "," $3,974.79 "," $4,225.50 "," $4,225.50 "," $4,225.50 "," $3,990.75 ", $199.16 ," $4,334.89 "," $4,460.25 "," $3,990.75 "," $4,366.35 "," $4,366.35 "," $4,460.25 "," $4,507.20 "," $3,841.45 "," $4,225.50 "," $3,990.75 "," $3,709.05 ", N/A ," $3,799.66 "," $3,799.66 "," $4,460.25 "," $4,028.78 ", $199.16 ," $4,507.20 "
 Other Digestive System Diagnoses With Cc ,MS DRG V40 (FY2023) 394,N/A,N/A,N/A," $14,085.72 "," $9,155.72 "," $11,832.00 ", N/A , N/A ," $11,381.26 "," $12,677.15 "," $11,924.97 "," $12,677.15 "," $12,677.15 "," $12,677.15 "," $11,972.86 ", N/A ," $13,005.35 "," $13,381.43 "," $11,972.86 "," $13,099.72 "," $13,099.72 "," $13,381.43 "," $13,522.29 "," $11,524.94 "," $12,677.15 "," $11,972.86 "," $11,127.72 ", N/A ," $11,399.57 "," $11,399.57 "," $13,381.43 "," $12,086.96 "," $11,127.72 "," $13,522.29 "
Partial Removal Olecrannon Process,CPT® 24147,N/A,N/A,N/A," $3,798.00 "," $2,468.70 "," $3,853.66 ", $605.35 , $384.19 ," $3,002.63 "," $2,996.34 "," $3,532.14 "," $3,418.20 "," $3,418.20 "," $3,038.40 "," $3,038.40 ", $384.19 ," $3,506.69 "," $3,608.10 "," $3,418.20 "," $3,418.20 "," $3,418.20 "," $3,532.14 "," $3,646.08 "," $3,576.58 "," $3,228.30 "," $3,300.52 "," $3,545.96 ", N/A ," $3,061.21 "," $3,061.21 "," $3,608.10 "," $3,598.02 ", $384.19 ," $3,853.66 "
Complex Repair 2.6-7.5cm,CPT® 13132,N/A,N/A,N/A," $2,805.00 "," $1,823.25 ", $971.79 , $290.72 , $268.64 , $861.57 , $839.43 ," $2,608.65 "," $2,524.50 "," $2,524.50 "," $2,244.00 "," $2,244.00 ", $268.64 ," $2,589.86 "," $2,664.75 "," $2,524.50 "," $2,524.50 "," $2,524.50 "," $2,608.65 "," $2,692.80 "," $1,069.42 "," $2,384.25 "," $1,671.67 "," $1,104.41 ", N/A , $878.38 , $878.38 ," $2,664.75 "," $1,018.64 ", $268.64 ," $2,692.80 "
 Fac Psychiatric Diagnostic Evaluation ,CPT® 90791,0900 - PSYCH TREATMENT,N/A,N/A, $247.00 , $160.55 , $207.48 , $150.56 , $119.19 , $199.58 , $222.30 , $209.11 , $222.30 , $222.30 , $222.30 , $209.95 , $116.85 , $228.06 , $234.65 , $209.95 , $229.71 , $229.71 , $234.65 , $237.12 , $202.10 , $222.30 , $209.95 , $195.13 , N/A , $199.90 , $199.90 , $234.65 , $211.95 , $116.85 , $237.12 
" Pro Venipuncture,Under Age 3 ",CPT® 36400,0981 - PRO FEE/ER,N/A,N/A, $176.00 , $114.40 , $117.78 , $18.17 , $52.35 , $84.79 , $84.06 , $163.68 , $158.40 , $158.40 , $140.80 , $140.80 , $52.35 , $162.50 , $167.20 , $158.40 , $158.40 , $158.40 , $163.68 , $168.96 , $109.26 , $149.60 , $103.48 , $94.31 , N/A , $86.44 , $86.44 , $167.20 , $98.20 , $18.17 , $168.96 
 Pro CT Pelvis W/Dye ,CPT® 72193,0972 - PRO FEE/RAD/DX,N/A,N/A, $653.00 , $424.45 ," $1,581.44 ", $228.79 , $287.44 ," $1,075.69 "," $1,390.35 ", $607.29 , $587.70 , $587.70 , $522.40 , $522.40 , $287.44 , $602.91 , $620.35 , $587.70 , $587.70 , $587.70 , $607.29 , $626.88 ," $1,375.00 ", $555.05 ," $1,573.58 "," $1,464.57 ", N/A ," $1,096.68 "," $1,096.68 ", $620.35 ," $1,269.43 ", $228.79 ," $1,581.44 "
"Exc Skin Malig <5mm Face,Facial",11640,N/A,N/A,N/A, $994.00 , $646.10 , $405.52 , $121.95 , $200.70 , $341.73 , $336.34 , $924.42 , $894.60 , $894.60 , $795.20 , $795.20 , $200.70 , $917.76 , $944.30 , $894.60 , $894.60 , $894.60 , $924.42 , $954.24 , $443.61 , $844.90 , $669.02 , $439.11 , N/A , $348.39 , $348.39 , $944.30 , $404.04 , $121.95 , $954.24 
 VERAPAMIL HCL 2.5 MG/ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00409-1144-05,2 mL, $181.08 , $117.70 , $152.11 , N/A , N/A , $146.31 , $162.97 , $153.30 , $162.97 , $162.97 , $162.97 , $153.92 , N/A , $167.19 , $172.03 , $153.92 , $168.40 , $168.40 , $172.03 , $173.84 , $148.16 , $162.97 , $153.92 , $143.05 , N/A , $146.55 , $146.55 , $172.03 , $155.38 , $143.05 , $173.84 
" Fac Nk Cells, Total Count ",CPT® 86357,0302 - LAB/IMMUNOLOGY,N/A,N/A, $348.00 , $226.20 , $292.32 , $38.48 , $38.48 , $281.18 , $313.20 , $294.62 , $313.20 , $313.20 , $313.20 , $295.80 , $37.73 , $321.31 , $330.60 , $295.80 , $323.64 , $323.64 , $330.60 , $334.08 , $284.73 , $313.20 , $295.80 , $274.92 , N/A , $281.64 , $281.64 , $330.60 , $298.62 , $37.73 , $334.08 
 Debridement/Dressing Burn Small - Mh ,CPT® 16020,0761 - TREATMENT ROOM,N/A,N/A, $400.00 , $260.00 , $336.00 , $52.76 , $30.25 , $323.20 , $360.00 , $338.64 , $360.00 , $360.00 , $360.00 , $340.00 , $29.66 , $369.32 , $380.00 , $340.00 , $372.00 , $372.00 , $380.00 , $384.00 , $327.28 , $360.00 , $340.00 , $316.00 , N/A , $323.72 , $323.72 , $380.00 , $343.24 , $29.66 , $384.00 
 Fac Tumor Immunohistochem/Manual ,CPT® 88360,0310 - PATHOLOGY LAB,N/A,N/A, $864.00 , $561.60 , $725.76 , $116.62 , $107.82 , $698.11 , $777.60 , $731.46 , $777.60 , $777.60 , $777.60 , $734.40 , $105.71 , $797.73 , $820.80 , $734.40 , $803.52 , $803.52 , $820.80 , $829.44 , $706.92 , $777.60 , $734.40 , $682.56 , N/A , $699.24 , $699.24 , $820.80 , $741.40 , $105.71 , $829.44 
M/Phmtrc Alys Ish Quant/Semiq Cptr Each Multiprb,CPT® 88374,N/A,N/A,N/A," $1,339.00 ", $870.35 ," $1,161.95 ", $298.01 , $160.85 , $811.11 , $930.40 ," $1,245.27 "," $1,205.10 "," $1,205.10 "," $1,071.20 "," $1,071.20 ", $160.85 ," $1,236.30 "," $1,272.05 "," $1,205.10 "," $1,205.10 "," $1,205.10 "," $1,245.27 "," $1,285.44 "," $2,226.25 "," $1,138.15 "," $1,460.29 "," $1,193.87 ", N/A , $756.98 , $756.98 ," $1,272.05 ", $831.89 , $160.85 ," $2,226.25 "
 Fac Imhistochem/Cytchm Ea Addl Antibody Slide ,CPT® 88341,0310 - PATHOLOGY LAB,N/A,N/A, $488.00 , $317.20 , $409.92 , $85.14 , $52.77 , $394.30 , $439.20 , $413.14 , $439.20 , $439.20 , $439.20 , $414.80 , $51.74 , $450.57 , $463.60 , $414.80 , $453.84 , $453.84 , $463.60 , $468.48 , $399.28 , $439.20 , $414.80 , $385.52 , N/A , $394.94 , $394.94 , $463.60 , $418.75 , $51.74 , $468.48 
 Fac Assay of Blood Pku ,CPT® 84030,0301 - LAB/CHEMISTRY,N/A,N/A, $57.00 , $37.05 , $47.88 , $5.61 , $5.61 , $46.06 , $51.30 , $48.26 , $51.30 , $51.30 , $51.30 , $48.45 , $5.50 , $52.63 , $54.15 , $48.45 , $53.01 , $53.01 , $54.15 , $54.72 , $46.64 , $51.30 , $48.45 , $45.03 , N/A , $46.13 , $46.13 , $54.15 , $48.91 , $5.50 , $54.72 
"Pro Rad Excis Wrist Synov/Tendon,Exten",25116,N/A,N/A,N/A," $1,401.00 ", $910.65 ," $3,698.70 ", $582.98 , $691.53 ," $2,887.82 "," $2,896.69 "," $1,302.93 "," $1,260.90 "," $1,260.90 "," $1,120.80 "," $1,120.80 ", $691.53 ," $1,293.54 "," $1,330.95 "," $1,260.90 "," $1,260.90 "," $1,260.90 "," $1,302.93 "," $1,344.96 "," $3,435.69 "," $1,190.85 "," $3,180.99 "," $3,437.40 ", N/A ," $2,944.17 "," $2,944.17 "," $1,330.95 "," $3,460.43 ", $582.98 ," $3,698.70 "
 VENLAFAXINE HCL 100 MG PO TABS ,HCPCS RXA250,0250 - PHARMACY,57237-0176-01,1 tablet, $11.89 , $7.73 , $9.99 , N/A , N/A , $9.61 , $10.70 , $10.07 , $10.70 , $10.70 , $10.70 , $10.11 , N/A , $10.98 , $11.30 , $10.11 , $11.06 , $11.06 , $11.30 , $11.41 , $9.73 , $10.70 , $10.11 , $9.39 , N/A , $9.62 , $9.62 , $11.30 , $10.20 , $9.39 , $11.41 
" Fac Fluorescent Antibody, Titer ",CPT® 86256,0302 - LAB/IMMUNOLOGY,N/A,N/A, $152.00 , $98.80 , $127.68 , $12.29 , $12.29 , $122.82 , $136.80 , $128.68 , $136.80 , $136.80 , $136.80 , $129.20 , $12.05 , $140.34 , $144.40 , $129.20 , $141.36 , $141.36 , $144.40 , $145.92 , $124.37 , $136.80 , $129.20 , $120.08 , N/A , $123.01 , $123.01 , $144.40 , $130.43 , $12.05 , $145.92 
Mpl Gene Analysis Common Variants,CPT® 81338,N/A,N/A,N/A, $764.00 , $496.60 , N/A , $153.34 , $122.67 , N/A , N/A , $710.52 , $687.60 , $687.60 , $611.20 , $611.20 , $122.67 , $705.40 , $725.80 , $687.60 , $687.60 , $687.60 , $710.52 , $733.44 ," $1,003.79 ", $649.40 , $717.22 , $441.52 , N/A , $596.81 , $596.81 , $725.80 , $650.93 , $122.67 ," $1,003.79 "
"Flowcytometry/ Tech Component, 1 Marker",CPT® 88184,N/A,N/A,N/A, $501.00 , $325.65 , $239.58 , $72.46 , $48.24 , $368.01 , $402.91 , $465.93 , $450.90 , $450.90 , $400.80 , $400.80 , $48.24 , $462.57 , $475.95 , $450.90 , $450.90 , $450.90 , $465.93 , $480.96 , $435.96 , $425.85 , $423.30 , $228.93 , N/A , $343.45 , $343.45 , $475.95 , $377.43 , $48.24 , $480.96 
 MIDAZOLAM HCL 10 MG/10ML IJ SOLN ,HCPCS J2250,0636 - DRUGS REQUIRING DETAILED CODIN,00641-6056-10,1 mL, $16.68 , $10.84 , $14.01 , $0.14 , $0.17 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.17 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.14 , $16.01 
Ko Elastic With Joints,HCPCS L1810,N/A,N/A,N/A, $181.00 , $117.65 , N/A , $120.42 , $80.40 , N/A , N/A , $168.33 , $162.90 , $162.90 , $144.80 , $144.80 , $80.40 , $167.12 , $171.95 , $162.90 , $162.90 , $162.90 , $168.33 , $173.76 , N/A , $153.85 , $99.26 , $101.31 , N/A , N/A , N/A , $171.95 , N/A , $80.40 , $173.76 
 Dna Probe Beaker1 ,CPT® 88271,0310 - PATHOLOGY LAB,N/A,N/A, $262.00 , $170.30 , $220.08 , $21.85 , $20.09 , $211.70 , $235.80 , $221.81 , $235.80 , $235.80 , $235.80 , $222.70 , $19.70 , $241.90 , $248.90 , $222.70 , $243.66 , $243.66 , $248.90 , $251.52 , $214.37 , $235.80 , $222.70 , $206.98 , N/A , $212.04 , $212.04 , $248.90 , $224.82 , $19.70 , $251.52 
 Fac Alpha-Fetoprotein Amniotic Flu ,CPT® 82106,0301 - LAB/CHEMISTRY,N/A,N/A, $145.00 , $94.25 , $121.80 , $17.34 , $17.34 , $117.16 , $130.50 , $122.76 , $130.50 , $130.50 , $130.50 , $123.25 , $17.00 , $133.88 , $137.75 , $123.25 , $134.85 , $134.85 , $137.75 , $139.20 , $118.64 , $130.50 , $123.25 , $114.55 , N/A , $117.35 , $117.35 , $137.75 , $124.42 , $17.00 , $139.20 
Insert Nasal Septal Prosthesis,CPT® 30220,N/A,N/A,N/A," $1,776.00 "," $1,154.40 ", $695.46 , $124.00 , $208.93 , $477.55 , $479.53 ," $1,651.68 "," $1,598.40 "," $1,598.40 "," $1,420.80 "," $1,420.80 ", $208.93 ," $1,639.78 "," $1,687.20 "," $1,598.40 "," $1,598.40 "," $1,598.40 "," $1,651.68 "," $1,704.96 ", $656.04 ," $1,509.60 ", $676.16 , $629.80 , N/A , $486.87 , $486.87 ," $1,687.20 ", $573.39 , $124.00 ," $1,704.96 "
 Fac Rm Chg Nursery Level 1 Normal ,Custom 1710000001,0171 - NURSERY/NEWBORN,N/A,N/A," $1,578.00 "," $1,025.70 "," $1,325.52 ", N/A , N/A ," $1,275.02 "," $1,420.20 "," $1,335.93 "," $1,420.20 "," $1,420.20 "," $1,420.20 "," $1,341.30 ", N/A ," $1,456.97 "," $1,499.10 "," $1,341.30 "," $1,467.54 "," $1,467.54 "," $1,499.10 "," $1,514.88 "," $1,291.12 "," $1,420.20 "," $1,341.30 "," $1,246.62 ", N/A ," $1,277.08 "," $1,277.08 "," $1,499.10 "," $1,354.08 "," $1,246.62 "," $1,514.88 "
"Pro Strapping,Knee",29530,N/A,N/A,N/A, $175.00 , $113.75 , $114.47 , $17.96 , $30.71 , $90.38 , $186.75 , $162.75 , $157.50 , $157.50 , $140.00 , $140.00 , $30.71 , $161.58 , $166.25 , $157.50 , $157.50 , $157.50 , $162.75 , $168.00 , $107.02 , $148.75 , $201.60 , $111.84 , N/A , $92.14 , $92.14 , $166.25 , $108.30 , $17.96 , $201.60 
Liver and Spleen Imaging,CPT® 78215,N/A,N/A,N/A," $1,887.00 "," $1,226.55 "," $1,051.08 ", $180.78 , $140.80 , $953.25 ," $1,041.73 "," $1,754.91 "," $1,698.30 "," $1,698.30 "," $1,509.60 "," $1,509.60 ", $140.80 ," $1,742.27 "," $1,792.65 "," $1,698.30 "," $1,698.30 "," $1,698.30 "," $1,754.91 "," $1,811.52 "," $1,082.87 "," $1,603.95 "," $1,138.29 "," $1,306.45 ", N/A , $971.85 , $971.85 ," $1,792.65 "," $1,124.95 ", $140.80 ," $1,811.52 "
 Fac Prq Trluml Coronry Tot Occlus Revasc Mi One Vsl ,CPT® 92941,0481 - CARDIAC CATH LAB,N/A,N/A," $10,798.00 "," $7,018.70 "," $9,070.32 ", $593.80 , $508.22 ," $8,724.78 "," $9,718.20 "," $9,141.59 "," $9,718.20 "," $9,718.20 "," $9,718.20 "," $9,178.30 ", $498.25 ," $9,969.79 "," $10,258.10 "," $9,178.30 "," $10,042.14 "," $10,042.14 "," $10,258.10 "," $10,366.08 "," $8,834.92 "," $9,718.20 "," $9,178.30 "," $8,530.42 ", N/A ," $8,738.82 "," $8,738.82 "," $10,258.10 "," $9,265.76 ", $498.25 ," $10,366.08 "
Sono Fetal Heart,CPT® 76825,N/A,N/A,N/A," $1,797.00 "," $1,168.05 "," $1,505.22 ", $259.55 , $128.65 ," $1,330.47 "," $1,151.00 "," $1,671.21 "," $1,617.30 "," $1,617.30 "," $1,437.60 "," $1,437.60 ", $128.65 ," $1,659.17 "," $1,707.15 "," $1,617.30 "," $1,617.30 "," $1,617.30 "," $1,671.21 "," $1,725.12 "," $1,527.77 "," $1,527.45 "," $1,255.78 "," $1,566.65 ", N/A ," $1,356.43 "," $1,356.43 "," $1,707.15 "," $1,570.10 ", $128.65 ," $1,725.12 "
 ASPIRIN 325 MG PO TBEC ,HCPCS RXC637,0250 - PHARMACY,00536-1232-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Drug Assay Itraconzaole ,CPT® 80189,0301 - LAB/CHEMISTRY,N/A,N/A, $438.00 , $284.70 , $367.92 , $27.65 , $27.65 , $353.90 , $394.20 , $370.81 , $394.20 , $394.20 , $394.20 , $372.30 , $27.11 , $404.41 , $416.10 , $372.30 , $407.34 , $407.34 , $416.10 , $420.48 , $358.37 , $394.20 , $372.30 , $346.02 , N/A , $354.47 , $354.47 , $416.10 , $375.85 , $27.11 , $420.48 
 Syncope And Collapse ,MS DRG V40 (FY2023) 312,N/A,N/A,N/A," $9,127.56 "," $5,932.91 "," $7,667.15 ", N/A , N/A ," $7,375.07 "," $8,214.80 "," $7,727.39 "," $8,214.80 "," $8,214.80 "," $8,214.80 "," $7,758.43 ", N/A ," $8,427.48 "," $8,671.18 "," $7,758.43 "," $8,488.63 "," $8,488.63 "," $8,671.18 "," $8,762.46 "," $7,468.17 "," $8,214.80 "," $7,758.43 "," $7,210.77 ", N/A ," $7,386.93 "," $7,386.93 "," $8,671.18 "," $7,832.36 "," $7,210.77 "," $8,762.46 "
 Pro Rpr Xtnsr Tdn Fngr 1/2 W/O Fr Grf Ea Tdn ,CPT® 26418,0982 - PRO FEE/OUTPT,N/A,N/A," $2,087.00 "," $1,356.55 "," $3,954.41 ", $615.23 , $426.00 ," $2,746.72 "," $2,822.57 "," $1,940.91 "," $1,878.30 "," $1,878.30 "," $1,669.60 "," $1,669.60 ", $426.00 ," $1,926.93 "," $1,982.65 "," $1,878.30 "," $1,878.30 "," $1,878.30 "," $1,940.91 "," $2,003.52 "," $3,614.06 "," $1,773.95 "," $3,084.65 "," $3,289.40 ", N/A ," $2,800.31 "," $2,800.31 "," $1,982.65 "," $3,291.34 ", $426.00 ," $3,954.41 "
 FENTANYL 50 MCG/HR TD PT72 ,HCPCS RXC637,0250 - PHARMACY,60505-7082-02,1 patch, $199.74 , $129.83 , $167.78 , N/A , N/A , $161.39 , $179.77 , $169.10 , $179.77 , $179.77 , $179.77 , $169.78 , N/A , $184.42 , $189.75 , $169.78 , $185.76 , $185.76 , $189.75 , $191.75 , $163.43 , $179.77 , $169.78 , $157.79 , N/A , $161.65 , $161.65 , $189.75 , $171.40 , $157.79 , $191.75 
 LIDOCAINE HCL (PF) 0.5 % IJ SOLN ,HCPCS J2001,0636 - DRUGS REQUIRING DETAILED CODIN,00409-4278-01,50 mL, $26.72 , $17.37 , $22.44 , $0.03 , $0.03 , $21.59 , $24.05 , $22.62 , $24.05 , $24.05 , $24.05 , $22.71 , $0.03 , $24.67 , $25.38 , $22.71 , $24.85 , $24.85 , $25.38 , $25.65 , $21.86 , $24.05 , $22.71 , $21.11 , N/A , $21.62 , $21.62 , $25.38 , $22.93 , $0.03 , $25.65 
"Shldr Arthroscop,Surg,Capsulorrhaphy",29806,N/A,N/A,N/A," $6,522.00 "," $4,239.30 "," $6,420.64 "," $1,003.45 ", $938.38 ," $5,120.46 "," $5,089.63 "," $6,065.46 "," $5,869.80 "," $5,869.80 "," $5,217.60 "," $5,217.60 ", $938.38 ," $6,021.76 "," $6,195.90 "," $5,869.80 "," $5,869.80 "," $5,869.80 "," $6,065.46 "," $6,261.12 "," $5,969.11 "," $5,543.70 "," $5,626.94 "," $6,023.78 ", N/A ," $5,220.37 "," $5,220.37 "," $6,195.90 "," $6,135.79 ", $938.38 ," $6,420.64 "
"Hosp Mand on Call Srvc,Out-of-Hosp,Ea Hr",CPT® 99027,N/A,N/A,N/A, $51.00 , $33.15 , N/A , N/A , N/A , N/A , N/A , $47.43 , $45.90 , $45.90 , $40.80 , $40.80 , N/A , $47.09 , $48.45 , $45.90 , $45.90 , $45.90 , $47.43 , $48.96 , N/A , $43.35 , $40.80 , N/A , N/A , N/A , N/A , $48.45 , N/A , $40.80 , $48.96 
Drug Screening Cannabinoids Natural,CPT® 80349,N/A,N/A,N/A, $156.00 , $101.40 , N/A , N/A , N/A , N/A , N/A , $145.08 , $140.40 , $140.40 , $124.80 , $124.80 , N/A , $144.03 , $148.20 , $140.40 , $140.40 , $140.40 , $145.08 , $149.76 , N/A , $132.60 , $114.69 , $67.79 , N/A , $90.04 , $90.04 , $148.20 , $98.20 , $67.79 , $149.76 
 Fac Exc Crtd Bdy Tum W/O Exc Crtd Art ,CPT® 60600,0360 - OR SERVICES,N/A,N/A," $3,578.00 "," $2,325.70 "," $3,005.52 "," $1,248.50 "," $1,075.74 "," $2,891.02 "," $3,220.20 "," $3,029.13 "," $3,220.20 "," $3,220.20 "," $3,220.20 "," $3,041.30 "," $1,054.65 "," $3,303.57 "," $3,399.10 "," $3,041.30 "," $3,327.54 "," $3,327.54 "," $3,399.10 "," $3,434.88 "," $2,927.52 "," $3,220.20 "," $3,041.30 "," $2,826.62 ", N/A ," $2,895.68 "," $2,895.68 "," $3,399.10 "," $3,070.28 "," $1,054.65 "," $3,434.88 "
"Explor/Repair Rectum,Inj,Colostomy",CPT® 45563,N/A,N/A,N/A," $10,335.00 "," $6,717.75 "," $9,896.25 "," $1,526.79 "," $2,027.06 "," $7,744.85 "," $7,822.29 "," $9,611.55 "," $9,301.50 "," $9,301.50 "," $8,268.00 "," $8,268.00 "," $2,027.06 "," $9,542.31 "," $9,818.25 "," $9,301.50 "," $9,301.50 "," $9,301.50 "," $9,611.55 "," $9,921.60 "," $7,100.53 "," $8,784.75 "," $8,702.67 "," $9,133.33 ", N/A ," $7,895.96 "," $7,895.96 "," $9,818.25 "," $8,258.33 "," $1,526.79 "," $9,921.60 "
"Removal, Abdomen Lymph Node,Staging",CPT® 38564,N/A,N/A,N/A," $3,840.00 "," $2,496.00 "," $3,254.40 ", $654.29 ," $1,082.29 "," $2,448.97 "," $2,500.74 "," $3,571.20 "," $3,456.00 "," $3,456.00 "," $3,072.00 "," $3,072.00 "," $1,082.29 "," $3,545.47 "," $3,648.00 "," $3,456.00 "," $3,456.00 "," $3,456.00 "," $3,571.20 "," $3,686.40 "," $3,488.94 "," $3,264.00 "," $3,693.01 "," $3,391.42 ", N/A ," $2,496.75 "," $2,496.75 "," $3,648.00 "," $2,896.56 ", $654.29 ," $3,693.01 "
" Fac B Cells, Total Count ",CPT® 86355,0302 - LAB/IMMUNOLOGY,N/A,N/A, $348.00 , $226.20 , $292.32 , $38.48 , $38.48 , $281.18 , $313.20 , $294.62 , $313.20 , $313.20 , $313.20 , $295.80 , $37.73 , $321.31 , $330.60 , $295.80 , $323.64 , $323.64 , $330.60 , $334.08 , $284.73 , $313.20 , $295.80 , $274.92 , N/A , $281.64 , $281.64 , $330.60 , $298.62 , $37.73 , $334.08 
Open Rx MC-P Disloc,CPT® 26715,N/A,N/A,N/A," $3,779.00 "," $2,456.35 "," $3,519.69 ", $554.05 , $497.02 ," $2,755.47 "," $2,772.41 "," $3,514.47 "," $3,401.10 "," $3,401.10 "," $3,023.20 "," $3,023.20 ", $497.02 ," $3,489.15 "," $3,590.05 "," $3,401.10 "," $3,401.10 "," $3,401.10 "," $3,514.47 "," $3,627.84 "," $3,267.75 "," $3,212.15 "," $3,048.97 "," $3,274.86 ", N/A ," $2,809.24 "," $2,809.24 "," $3,590.05 "," $3,301.84 ", $497.02 ," $3,627.84 "
Nerve Repair W/Conduit Ea Nerve,CPT® 64910,N/A,N/A,N/A," $5,440.00 "," $3,536.00 "," $3,768.91 ", $727.52 , $537.05 ," $4,553.10 "," $4,408.67 "," $5,059.20 "," $4,896.00 "," $4,896.00 "," $4,352.00 "," $4,352.00 ", $537.05 ," $5,022.75 "," $5,168.00 "," $4,896.00 "," $4,896.00 "," $4,896.00 "," $5,059.20 "," $5,222.40 "," $4,133.12 "," $4,624.00 "," $4,356.68 "," $4,758.68 ", N/A ," $4,641.94 "," $4,641.94 "," $5,168.00 "," $4,979.72 ", $537.05 ," $5,222.40 "
Emergency Anesthesia,CPT® 99140,N/A,N/A,N/A, $295.00 , $191.75 , N/A , N/A , $27.15 , N/A , N/A , $274.35 , $265.50 , $265.50 , $236.00 , $236.00 , $27.15 , $272.37 , $280.25 , $265.50 , $265.50 , $265.50 , $274.35 , $283.20 , N/A , $250.75 , N/A , N/A , N/A , N/A , N/A , $280.25 , N/A , $27.15 , $283.20 
 Pro Sgmdsc Flx Dired Sbmcsl Njx Any Sbst ,CPT® 45335,0982 - PRO FEE/OUTPT,N/A,N/A," $1,997.00 "," $1,298.05 ", $405.08 , $63.40 , $158.58 , $437.97 , $452.22 ," $1,857.21 "," $1,797.30 "," $1,797.30 "," $1,597.60 "," $1,597.60 ", $158.58 ," $1,843.83 "," $1,897.15 "," $1,797.30 "," $1,797.30 "," $1,797.30 "," $1,857.21 "," $1,917.12 ", $291.64 ," $1,697.45 ", $495.97 , $384.35 , N/A , $446.51 , $446.51 ," $1,897.15 ", $467.01 , $63.40 ," $1,917.12 "
 Fac Hematopoietic Nuclear Tx ,CPT® 79403,0342 - NUC MED/RX PROCEDURES,N/A,N/A, $536.00 , $348.40 , $450.24 , $196.63 , $207.24 , $433.09 , $482.40 , $453.78 , $482.40 , $482.40 , $482.40 , $455.60 , $203.18 , $494.89 , $509.20 , $455.60 , $498.48 , $498.48 , $509.20 , $514.56 , $438.56 , $482.40 , $455.60 , $423.44 , N/A , $433.78 , $433.78 , $509.20 , $459.94 , $196.63 , $514.56 
 Fac Appl Short Leg Splnt Calf Foot ,CPT® 29515,0761 - TREATMENT ROOM,N/A,N/A, $177.00 , $115.05 , $148.68 , $47.11 , $31.03 , $143.02 , $159.30 , $149.85 , $159.30 , $159.30 , $159.30 , $150.45 , $30.42 , $163.42 , $168.15 , $150.45 , $164.61 , $164.61 , $168.15 , $169.92 , $144.82 , $159.30 , $150.45 , $139.83 , N/A , $143.25 , $143.25 , $168.15 , $151.88 , $30.42 , $169.92 
 Fac Antinuclear Antibodies (Ana) ,CPT® 86039,0302 - LAB/IMMUNOLOGY,N/A,N/A, $120.00 , $78.00 , $100.80 , $11.38 , $11.38 , $96.96 , $108.00 , $101.59 , $108.00 , $108.00 , $108.00 , $102.00 , $11.16 , $110.80 , $114.00 , $102.00 , $111.60 , $111.60 , $114.00 , $115.20 , $98.18 , $108.00 , $102.00 , $94.80 , N/A , $97.12 , $97.12 , $114.00 , $102.97 , $11.16 , $115.20 
Remv Pilonidal Lesion Simple,11770,N/A,N/A,N/A," $2,166.00 "," $1,407.90 ", $585.48 , $173.87 , $218.61 , $497.89 , $486.86 ," $2,014.38 "," $1,949.40 "," $1,949.40 "," $1,732.80 "," $1,732.80 ", $218.61 ," $1,999.87 "," $2,057.70 "," $1,949.40 "," $1,949.40 "," $1,949.40 "," $2,014.38 "," $2,079.36 ", $641.69 ," $1,841.10 ", $979.45 , $633.57 , N/A , $507.60 , $507.60 ," $2,057.70 ", $588.65 , $173.87 ," $2,079.36 "
Revision of Upper Eyelid,CPT® 15822,N/A,N/A,N/A," $2,085.00 "," $1,355.25 "," $1,293.94 ", $387.20 , $614.70 ," $1,069.17 "," $1,072.20 "," $1,939.05 "," $1,876.50 "," $1,876.50 "," $1,668.00 "," $1,668.00 ", $614.70 ," $1,925.08 "," $1,980.75 "," $1,876.50 "," $1,876.50 "," $1,876.50 "," $1,939.05 "," $2,001.60 "," $1,408.82 "," $1,772.25 "," $2,139.09 "," $1,378.78 ", N/A ," $1,090.03 "," $1,090.03 "," $1,980.75 "," $1,264.07 ", $387.20 ," $2,139.09 "
"Culture Typing, Fluorescent",CPT® 87140,N/A,N/A,N/A, $130.00 , $84.50 , N/A , $5.68 , $5.68 , $25.78 , $30.88 , $120.90 , $117.00 , $117.00 , $104.00 , $104.00 , $5.68 , $120.03 , $123.50 , $117.00 , $117.00 , $117.00 , $120.90 , $124.80 , $37.19 , $110.50 , $37.30 , $20.21 , N/A , $24.06 , $24.06 , $123.50 , $26.29 , $5.68 , $124.80 
Removal Implantable Defib Pulse Generator Only,CPT® 33241,N/A,N/A,N/A," $3,175.00 "," $2,063.75 "," $1,289.02 ", $199.70 , $222.93 , $975.97 , $941.45 ," $2,952.75 "," $2,857.50 "," $2,857.50 "," $2,540.00 "," $2,540.00 ", $222.93 ," $2,931.48 "," $3,016.25 "," $2,857.50 "," $2,857.50 "," $2,857.50 "," $2,952.75 "," $3,048.00 "," $1,190.02 "," $2,698.75 "," $1,177.48 "," $1,047.31 ", N/A , $995.02 , $995.02 ," $3,016.25 "," $1,130.33 ", $199.70 ," $3,048.00 "
 Pro Exc H-F-Nk-Sp Mlg+Marg 3.1-4 ,CPT® 11624,0982 - PRO FEE/OUTPT,N/A,N/A," $1,694.00 "," $1,101.10 ", $758.13 , $226.87 , $390.36 , $655.26 , $637.05 ," $1,575.42 "," $1,524.60 "," $1,524.60 "," $1,355.20 "," $1,355.20 ", $390.36 ," $1,564.07 "," $1,609.30 "," $1,524.60 "," $1,524.60 "," $1,524.60 "," $1,575.42 "," $1,626.24 ", $830.47 ," $1,439.90 "," $1,273.82 ", $838.92 , N/A , $668.04 , $668.04 ," $1,609.30 ", $774.73 , $226.87 ," $1,626.24 "
Destruct Celiac Plexus Nerve,64680,N/A,N/A,N/A," $2,189.00 "," $1,422.85 ", $798.93 , $156.18 , $466.44 , $942.60 , $919.68 ," $2,035.77 "," $1,970.10 "," $1,970.10 "," $1,751.20 "," $1,751.20 ", $466.44 ," $2,021.10 "," $2,079.55 "," $1,970.10 "," $1,970.10 "," $1,970.10 "," $2,035.77 "," $2,101.44 ", $865.26 ," $1,860.65 ", $899.17 , $987.29 , N/A , $960.99 , $960.99 ," $2,079.55 "," $1,030.90 ", $156.18 ," $2,101.44 "
 HYDROXYZINE HCL 25 MG/ML IM SOLN ,HCPCS J3410,0636 - DRUGS REQUIRING DETAILED CODIN,00517-4201-25,1 mL, $157.25 , $102.21 , $132.09 , $13.89 , $13.37 , $127.06 , $141.53 , $133.13 , $141.53 , $141.53 , $141.53 , $133.66 , $13.11 , $145.19 , $149.39 , $133.66 , $146.24 , $146.24 , $149.39 , $150.96 , $128.66 , $141.53 , $133.66 , $124.23 , N/A , $127.26 , $127.26 , $149.39 , $134.94 , $13.11 , $150.96 
Fx Closed Humeral Shaft,24500,N/A,N/A,N/A," $1,318.00 ", $856.70 ," $2,076.69 ", $328.95 , $233.20 ," $1,570.20 "," $1,591.06 "," $1,225.74 "," $1,186.20 "," $1,186.20 "," $1,054.40 "," $1,054.40 ", $233.20 ," $1,216.91 "," $1,252.10 "," $1,186.20 "," $1,186.20 "," $1,186.20 "," $1,225.74 "," $1,265.28 "," $1,906.25 "," $1,120.30 "," $1,746.60 "," $1,865.54 ", N/A ," $1,600.84 "," $1,600.84 "," $1,252.10 "," $1,881.54 ", $233.20 ," $2,076.69 "
 Fac Assay of Testosterone ,CPT® 84402,0301 - LAB/CHEMISTRY,N/A,N/A, $226.00 , $146.90 , $189.84 , $25.98 , $25.98 , $182.61 , $203.40 , $191.33 , $203.40 , $203.40 , $203.40 , $192.10 , $25.47 , $208.67 , $214.70 , $192.10 , $210.18 , $210.18 , $214.70 , $216.96 , $184.91 , $203.40 , $192.10 , $178.54 , N/A , $182.90 , $182.90 , $214.70 , $193.93 , $25.47 , $216.96 
 Fac Prolact Cr per Ml ,Custom 2200000003,0220 - SPECIAL CHARGES,N/A,N/A, $75.00 , $48.75 , $63.00 , N/A , N/A , $60.60 , $67.50 , $63.50 , $67.50 , $67.50 , $67.50 , $63.75 , N/A , $69.25 , $71.25 , $63.75 , $69.75 , $69.75 , $71.25 , $72.00 , $61.37 , $67.50 , $63.75 , $59.25 , N/A , $60.70 , $60.70 , $71.25 , $64.36 , $59.25 , $72.00 
 Pro Exc Tr-Ext Mlg+Marg 0.6-1 Cm ,CPT® 11601,0982 - PRO FEE/OUTPT,N/A,N/A, $967.00 , $628.55 , $476.17 , $142.89 , $122.93 , $406.96 , $398.48 , $899.31 , $870.30 , $870.30 , $773.60 , $773.60 , $122.93 , $892.83 , $918.65 , $870.30 , $870.30 , $870.30 , $899.31 , $928.32 , $521.49 , $821.95 , $792.12 , $522.31 , N/A , $414.90 , $414.90 , $918.65 , $481.15 , $122.93 , $928.32 
"Replace,Inflatable Penile Prosthesis",CPT® 54410,N/A,N/A,N/A," $4,713.00 "," $3,063.45 "," $3,823.26 ", $823.02 , N/A ," $2,759.59 "," $2,782.78 "," $4,383.09 "," $4,241.70 "," $4,241.70 "," $3,770.40 "," $3,770.40 ", N/A ," $4,351.51 "," $4,477.35 "," $4,241.70 "," $4,241.70 "," $4,241.70 "," $4,383.09 "," $4,524.48 "," $3,587.93 "," $4,006.05 "," $4,433.40 "," $4,162.82 ", N/A ," $2,813.43 "," $2,813.43 "," $4,477.35 "," $3,372.06 ", $823.02 ," $4,524.48 "
Treat Hip Dislocation,27250,N/A,N/A,N/A," $1,278.00 ", $830.70 ," $1,065.87 ", $165.79 , $208.13 , $875.35 , $864.39 ," $1,188.54 "," $1,150.20 "," $1,150.20 "," $1,022.40 "," $1,022.40 ", $208.13 ," $1,179.98 "," $1,214.10 "," $1,150.20 "," $1,150.20 "," $1,150.20 "," $1,188.54 "," $1,226.88 ", $994.46 ," $1,086.30 ", $958.04 ," $1,022.68 ", N/A , $892.42 , $892.42 ," $1,214.10 "," $1,048.91 ", $165.79 ," $1,226.88 "
Njx Drg C-Cathj Nslctv P-Art Angiography,CPT® 93568,N/A,N/A,N/A," $3,457.00 "," $2,247.05 ", $279.05 , $42.66 , $151.05 , $253.26 , $243.21 ," $3,215.01 "," $3,111.30 "," $3,111.30 "," $2,765.60 "," $2,765.60 ", $151.05 ," $3,191.85 "," $3,284.15 "," $3,111.30 "," $3,111.30 "," $3,111.30 "," $3,215.01 "," $3,318.72 ", $275.36 ," $2,938.45 ", $228.36 , $273.28 , N/A , $258.20 , $258.20 ," $3,284.15 ", $286.20 , $42.66 ," $3,318.72 "
 Pt Ther Activit W/Exer ,CPT® 97530,0420 - PHYSICAL THERAPY,N/A,N/A, $126.00 , $81.90 , $105.84 , $36.99 , $33.60 , $101.81 , $113.40 , $106.67 , $113.40 , $113.40 , $113.40 , $107.10 , $32.94 , $116.34 , $119.70 , $107.10 , $117.18 , $117.18 , $119.70 , $120.96 , $103.09 , $113.40 , $107.10 , $99.54 , N/A , $101.97 , $101.97 , $119.70 , $108.12 , $32.94 , $120.96 
Perq Nl/Pl Lithotrp Simple Up to 2 Cm 1 Location,CPT® 50080,N/A,N/A,N/A," $6,055.00 "," $3,935.75 "," $4,696.14 ", $663.49 , $874.17 ," $4,253.91 "," $3,957.74 "," $5,631.15 "," $5,449.50 "," $5,449.50 "," $4,844.00 "," $4,844.00 ", $874.17 ," $5,590.58 "," $5,752.25 "," $5,449.50 "," $5,449.50 "," $5,449.50 "," $5,631.15 "," $5,812.80 "," $4,716.30 "," $5,146.75 "," $4,483.35 "," $5,347.58 ", N/A ," $4,336.91 "," $4,336.91 "," $5,752.25 "," $5,097.40 ", $663.49 ," $5,812.80 "
 HYDRALAZINE HCL 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6441-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Diagnostic Bone Marrow Biopsies & Aspirations ,CPT® 38222,0761 - TREATMENT ROOM,N/A,N/A," $1,440.00 ", $936.00 ," $1,209.60 ", $73.07 , $135.37 ," $1,163.52 "," $1,296.00 "," $1,219.10 "," $1,296.00 "," $1,296.00 "," $1,296.00 "," $1,224.00 ", $132.72 ," $1,329.55 "," $1,368.00 "," $1,224.00 "," $1,339.20 "," $1,339.20 "," $1,368.00 "," $1,382.40 "," $1,178.21 "," $1,296.00 "," $1,224.00 "," $1,137.60 ", N/A ," $1,165.39 "," $1,165.39 "," $1,368.00 "," $1,235.66 ", $73.07 ," $1,382.40 "
 Fac Trlml Balo Angiop Open/Perq W/Img S&I 1st Vein ,CPT® 37248,0360 - OR SERVICES,N/A,N/A," $21,121.00 "," $13,728.65 "," $17,741.64 ", $275.06 ," $1,752.00 "," $17,065.77 "," $19,008.90 "," $17,881.04 "," $19,008.90 "," $19,008.90 "," $19,008.90 "," $17,952.85 "," $1,717.65 "," $19,501.02 "," $20,064.95 "," $17,952.85 "," $19,642.53 "," $19,642.53 "," $20,064.95 "," $20,276.16 "," $17,281.20 "," $19,008.90 "," $17,952.85 "," $16,685.59 ", N/A ," $17,093.23 "," $17,093.23 "," $20,064.95 "," $18,123.93 ", $275.06 ," $20,276.16 "
"Repr Bow-Blad Fist,W/Intest/Blad Resect",CPT® 44661,N/A,N/A,N/A," $10,351.00 "," $6,728.15 "," $9,223.50 "," $1,428.52 "," $1,905.42 "," $7,340.50 "," $7,368.47 "," $9,626.43 "," $9,315.90 "," $9,315.90 "," $8,280.80 "," $8,280.80 "," $1,905.42 "," $9,557.08 "," $9,833.45 "," $9,315.90 "," $9,315.90 "," $9,315.90 "," $9,626.43 "," $9,936.96 "," $6,629.41 "," $8,798.35 "," $8,154.96 "," $8,678.96 ", N/A ," $7,483.73 "," $7,483.73 "," $9,833.45 "," $7,827.19 "," $1,428.52 "," $9,936.96 "
Static Afo,HCPCS L4396,N/A,N/A,N/A, $191.00 , $124.15 , N/A , $196.30 , $117.96 , N/A , N/A , $177.63 , $171.90 , $171.90 , $152.80 , $152.80 , $117.96 , $176.35 , $181.45 , $171.90 , $171.90 , $171.90 , $177.63 , $183.36 , N/A , $162.35 , $161.54 , $165.15 , N/A , N/A , N/A , $181.45 , N/A , $117.96 , $196.30 
Fx Cl Clavicular W Manipu,CPT® 23505,N/A,N/A,N/A," $2,284.00 "," $1,484.60 "," $2,069.73 ", $326.05 , $230.52 ," $1,600.02 "," $1,616.31 "," $2,124.12 "," $2,055.60 "," $2,055.60 "," $1,827.20 "," $1,827.20 ", $230.52 ," $2,108.82 "," $2,169.80 "," $2,055.60 "," $2,055.60 "," $2,055.60 "," $2,124.12 "," $2,192.64 "," $1,905.10 "," $1,941.40 "," $1,776.93 "," $1,889.14 ", N/A ," $1,631.24 "," $1,631.24 "," $2,169.80 "," $1,917.27 ", $230.52 ," $2,192.64 "
 Fac Compre Electrophysiol Xm W/Left Atrial Pacng/Rec ,CPT® 93621,0481 - CARDIAC CATH LAB,N/A,N/A," $11,415.00 "," $7,419.75 "," $9,588.60 ", $317.28 ," $2,378.00 "," $9,223.32 "," $10,273.50 "," $9,663.94 "," $10,273.50 "," $10,273.50 "," $10,273.50 "," $9,702.75 "," $2,331.37 "," $10,539.47 "," $10,844.25 "," $9,702.75 "," $10,615.95 "," $10,615.95 "," $10,844.25 "," $10,958.40 "," $9,339.75 "," $10,273.50 "," $9,702.75 "," $9,017.85 ", N/A ," $9,238.16 "," $9,238.16 "," $10,844.25 "," $9,795.21 ", $317.28 ," $10,958.40 "
 Fac Abdomen Surgery Procedure ,CPT® 49999,0361 - OR/MINOR,N/A,N/A, $472.00 , $306.80 , $396.48 , N/A , N/A , $381.38 , $424.80 , $399.60 , $424.80 , $424.80 , $424.80 , $401.20 , N/A , $435.80 , $448.40 , $401.20 , $438.96 , $438.96 , $448.40 , $453.12 , $386.19 , $424.80 , $401.20 , $372.88 , N/A , $381.99 , $381.99 , $448.40 , $405.02 , $372.88 , $453.12 
"Cystectomy,W/Continent Diversion",CPT® 51596,N/A,N/A,N/A," $16,376.00 "," $10,644.40 "," $12,680.42 "," $2,228.11 "," $2,151.50 "," $11,511.09 "," $10,683.96 "," $15,229.68 "," $14,738.40 "," $14,738.40 "," $13,100.80 "," $13,100.80 "," $2,151.50 "," $15,119.96 "," $15,557.20 "," $14,738.40 "," $14,738.40 "," $14,738.40 "," $15,229.68 "," $15,720.96 "," $12,745.03 "," $13,919.60 "," $12,103.09 "," $14,462.23 ", N/A ," $11,735.69 "," $11,735.69 "," $15,557.20 "," $13,793.62 "," $2,151.50 "," $15,720.96 "
 Flo Cytometry Cell Surf Marker Techl Only First ,CPT® 88184,0311 - PATHOL/CYTOLOGY,N/A,N/A, $501.00 , $325.65 , $420.84 , $72.46 , $48.24 , $404.81 , $450.90 , $424.15 , $450.90 , $450.90 , $450.90 , $425.85 , $47.29 , $462.57 , $475.95 , $425.85 , $465.93 , $465.93 , $475.95 , $480.96 , $409.92 , $450.90 , $425.85 , $395.79 , N/A , $405.46 , $405.46 , $475.95 , $429.91 , $47.29 , $480.96 
" Pro Hysteroscopy, Remove FB ",CPT® 58562,0982 - PRO FEE/OUTPT,N/A,N/A," $2,832.00 "," $1,840.80 "," $1,031.85 ", $209.13 , $178.29 ," $1,181.14 "," $1,173.06 "," $2,633.76 "," $2,548.80 "," $2,548.80 "," $2,265.60 "," $2,265.60 ", $178.29 ," $2,614.79 "," $2,690.40 "," $2,548.80 "," $2,548.80 "," $2,548.80 "," $2,633.76 "," $2,718.72 "," $1,086.80 "," $2,407.20 "," $1,545.00 ", $924.84 , N/A ," $1,204.18 "," $1,204.18 "," $2,690.40 "," $1,444.34 ", $178.29 ," $2,718.72 "
 PRENATAL 27-1 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,39328-0106-10,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Pro Drainage of Mouth Lesion ,CPT® 40800,0982 - PRO FEE/OUTPT,N/A,N/A, $572.00 , $371.80 , $740.22 , $115.73 , $30.71 , $643.19 , $665.31 , $531.96 , $514.80 , $514.80 , $457.60 , $457.60 , $30.71 , $528.13 , $543.40 , $514.80 , $514.80 , $514.80 , $531.96 , $549.12 , $540.50 , $486.20 , $726.11 , $759.67 , N/A , $655.74 , $655.74 , $543.40 , $685.83 , $30.71 , $759.67 
"Excis Interdigital Neuroma,Ea",CPT® 28080,N/A,N/A,N/A," $3,472.00 "," $2,256.80 "," $2,330.58 ", $367.59 , $266.92 ," $1,811.44 "," $1,818.56 "," $3,228.96 "," $3,124.80 "," $3,124.80 "," $2,777.60 "," $2,777.60 ", $266.92 ," $3,205.70 "," $3,298.40 "," $3,124.80 "," $3,124.80 "," $3,124.80 "," $3,228.96 "," $3,333.12 "," $2,147.71 "," $2,951.20 "," $1,969.61 "," $2,152.32 ", N/A ," $1,846.78 "," $1,846.78 "," $3,298.40 "," $2,170.62 ", $266.92 ," $3,333.12 "
"Shldr Arthroscop,Lyse Adhesns",CPT® 29825,N/A,N/A,N/A," $2,799.00 "," $1,819.35 "," $3,583.19 ", $561.48 , $420.46 ," $2,801.78 "," $2,823.75 "," $2,603.07 "," $2,519.10 "," $2,519.10 "," $2,239.20 "," $2,239.20 ", $420.46 ," $2,584.32 "," $2,659.05 "," $2,519.10 "," $2,519.10 "," $2,519.10 "," $2,603.07 "," $2,687.04 "," $3,335.66 "," $2,379.15 "," $3,116.76 "," $3,307.21 ", N/A ," $2,856.45 "," $2,856.45 "," $2,659.05 "," $3,357.35 ", $420.46 ," $3,583.19 "
Implantable Tissue Marker,HCPCS A4648,N/A,N/A,N/A, $364.00 , $236.60 , N/A , N/A , N/A , N/A , N/A , $338.52 , $327.60 , $327.60 , $291.20 , $291.20 , N/A , $336.08 , $345.80 , $327.60 , $327.60 , $327.60 , $338.52 , $349.44 , N/A , $309.40 , $291.20 , N/A , N/A , N/A , N/A , $345.80 , N/A , $291.20 , $349.44 
Assay Chromium,CPT® 82495,N/A,N/A,N/A, $149.00 , $96.85 , N/A , $20.69 , $10.10 , $41.16 , $49.19 , $138.57 , $134.10 , $134.10 , $119.20 , $119.20 , $10.10 , $137.57 , $141.55 , $134.10 , $134.10 , $134.10 , $138.57 , $143.04 , $135.41 , $126.65 , $132.99 , $73.54 , N/A , $38.41 , $38.41 , $141.55 , $41.98 , $10.10 , $143.04 
"Fx Ulnar,Closed,W/O Manip",24670,N/A,N/A,N/A," $1,004.00 ", $652.60 ," $1,666.60 ", $264.23 , $194.38 ," $1,264.93 "," $1,285.98 ", $933.72 , $903.60 , $903.60 , $803.20 , $803.20 , $194.38 , $926.99 , $953.80 , $903.60 , $903.60 , $903.60 , $933.72 , $963.84 ," $1,534.20 ", $853.40 ," $1,411.19 "," $1,501.55 ", N/A ," $1,289.61 "," $1,289.61 ", $953.80 ," $1,515.75 ", $194.38 ," $1,666.60 "
"Avulsion Nail Plate,Singl",11730,N/A,N/A,N/A, $385.00 , $250.25 , $174.35 , $51.83 , $42.84 , $140.67 , $134.38 , $358.05 , $346.50 , $346.50 , $308.00 , $308.00 , $42.84 , $355.47 , $365.75 , $346.50 , $346.50 , $346.50 , $358.05 , $369.60 , $192.28 , $327.25 , $262.26 , $198.13 , N/A , $143.42 , $143.42 , $365.75 , $166.31 , $42.84 , $369.60 
Anterior Colporraphy Rpr Cystocele W/Cysto,CPT® 57240,N/A,N/A,N/A," $4,005.00 "," $2,603.25 "," $2,907.05 ", $588.09 , $537.90 ," $2,738.88 "," $2,708.47 "," $3,724.65 "," $3,604.50 "," $3,604.50 "," $3,204.00 "," $3,204.00 ", $537.90 ," $3,697.82 "," $3,804.75 "," $3,604.50 "," $3,604.50 "," $3,604.50 "," $3,724.65 "," $3,844.80 "," $3,022.85 "," $3,404.25 "," $3,532.45 "," $2,428.96 ", N/A ," $2,792.33 "," $2,792.33 "," $3,804.75 "," $3,349.24 ", $537.90 ," $3,844.80 "
 OXALIPLATIN 0.05 MG/ML ,HCPCS RXA250,0250 - PHARMACY,00001-0366-01,1 mL, $16.68 , $10.84 , $14.01 , N/A , N/A , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , N/A , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $13.18 , $16.01 
 Fac Slctv Cathj Ea 2nd+ Ord Abdl Pel/Lxtr Art Brnch ,CPT® 36248,0761 - TREATMENT ROOM,N/A,N/A," $2,456.00 "," $1,596.40 "," $2,063.04 ", $45.41 , $110.48 ," $1,984.45 "," $2,210.40 "," $2,079.25 "," $2,210.40 "," $2,210.40 "," $2,210.40 "," $2,087.60 ", $108.31 ," $2,267.62 "," $2,333.20 "," $2,087.60 "," $2,284.08 "," $2,284.08 "," $2,333.20 "," $2,357.76 "," $2,009.50 "," $2,210.40 "," $2,087.60 "," $1,940.24 ", N/A ," $1,987.64 "," $1,987.64 "," $2,333.20 "," $2,107.49 ", $45.41 ," $2,357.76 "
Mobilize Splenic Flex,CPT® 44139,N/A,N/A,N/A, $956.00 , $621.40 , $712.92 , $109.98 , $227.01 , $570.81 , $569.61 , $889.08 , $860.40 , $860.40 , $764.80 , $764.80 , $227.01 , $882.67 , $908.20 , $860.40 , $860.40 , $860.40 , $889.08 , $917.76 , $511.72 , $812.60 , $633.34 , $673.06 , N/A , $581.95 , $581.95 , $908.20 , $608.66 , $109.98 , $917.76 
 Pro Revise Ulnar Nerve at Wrist ,CPT® 64719,0975 - PRO FEE/OR,N/A,N/A," $1,266.00 ", $822.90 ," $1,995.97 ", $392.48 , $549.85 ," $2,198.67 "," $2,142.58 "," $1,177.38 "," $1,139.40 "," $1,139.40 "," $1,012.80 "," $1,012.80 ", $549.85 ," $1,168.90 "," $1,202.70 "," $1,139.40 "," $1,139.40 "," $1,139.40 "," $1,177.38 "," $1,215.36 "," $2,144.33 "," $1,076.10 "," $2,119.47 "," $2,362.36 ", N/A ," $2,241.57 "," $2,241.57 "," $1,202.70 "," $2,404.68 ", $392.48 ," $2,404.68 "
Colonoscopy Stoma W/Rmvl Tum Polyp/Oth Les Snare,CPT® 44394,N/A,N/A,N/A," $3,608.00 "," $2,345.20 "," $1,376.83 ", $212.48 , $362.61 ," $1,213.88 "," $1,241.51 "," $3,355.44 "," $3,247.20 "," $3,247.20 "," $2,886.40 "," $2,886.40 ", $362.61 ," $3,331.27 "," $3,427.60 "," $3,247.20 "," $3,247.20 "," $3,247.20 "," $3,355.44 "," $3,463.68 ", $987.63 ," $3,066.80 "," $1,364.81 "," $1,311.20 ", N/A ," $1,237.57 "," $1,237.57 "," $3,427.60 "," $1,294.36 ", $212.48 ," $3,463.68 "
Colonoscopy Flx Ablation Tumor Polyp/Other Les,CPT® 45388,N/A,N/A,N/A," $3,381.00 "," $2,197.65 "," $1,652.56 ", $255.42 , $436.94 ," $1,543.62 "," $1,612.15 "," $3,144.33 "," $3,042.90 "," $3,042.90 "," $2,704.80 "," $2,704.80 ", $436.94 ," $3,121.68 "," $3,211.95 "," $3,042.90 "," $3,042.90 "," $3,042.90 "," $3,144.33 "," $3,245.76 "," $1,188.46 "," $2,873.85 "," $1,412.67 "," $1,573.02 ", N/A ," $1,573.74 "," $1,573.74 "," $3,211.95 "," $1,645.97 ", $255.42 ," $3,245.76 "
Musc/Tendon Repair Each; Arm/Elbow,CPT® 24341,N/A,N/A,N/A," $5,145.00 "," $3,344.25 "," $4,549.87 ", $717.73 , $725.22 ," $3,598.81 "," $3,610.29 "," $4,784.85 "," $4,630.50 "," $4,630.50 "," $4,116.00 "," $4,116.00 ", $725.22 ," $4,750.38 "," $4,887.75 "," $4,630.50 "," $4,630.50 "," $4,630.50 "," $4,784.85 "," $4,939.20 "," $4,232.68 "," $4,373.25 "," $3,980.25 "," $4,247.67 ", N/A ," $3,669.04 "," $3,669.04 "," $4,887.75 "," $4,312.40 ", $717.73 ," $4,939.20 "
 RITUXIMAB-ABBS 100 MG/10ML IV SOLN ,HCPCS Q5115,0636 - DRUGS REQUIRING DETAILED CODIN,63459-0103-10,10 mL," $2,486.19 "," $1,616.02 "," $2,088.40 ", $40.59 , $49.81 ," $2,008.84 "," $2,237.57 "," $2,104.81 "," $2,237.57 "," $2,237.57 "," $2,237.57 "," $2,113.26 ", $48.83 ," $2,295.50 "," $2,361.88 "," $2,113.26 "," $2,312.16 "," $2,312.16 "," $2,361.88 "," $2,386.74 "," $2,034.20 "," $2,237.57 "," $2,113.26 "," $1,964.09 ", N/A ," $2,012.07 "," $2,012.07 "," $2,361.88 "," $2,133.40 ", $40.59 ," $2,386.74 "
Allergen Spec Ige Crude Allergen Extract Each,CPT® 86003,N/A,N/A,N/A, $39.00 , $25.35 , N/A , $5.32 , $4.51 , $18.38 , $21.97 , $36.27 , $35.10 , $35.10 , $31.20 , $31.20 , $4.51 , $36.01 , $37.05 , $35.10 , $35.10 , $35.10 , $36.27 , $37.44 , $34.86 , $33.15 , $34.06 , $18.91 , N/A , $17.15 , $17.15 , $37.05 , $18.74 , $4.51 , $37.44 
 Knee Four or More Views ,CPT® 73564,0320 - DX X-RAY,N/A,N/A, $414.00 , $269.10 , $347.76 , $45.91 , $36.94 , $334.51 , $372.60 , $350.49 , $372.60 , $372.60 , $372.60 , $351.90 , $36.22 , $382.25 , $393.30 , $351.90 , $385.02 , $385.02 , $393.30 , $397.44 , $338.73 , $372.60 , $351.90 , $327.06 , N/A , $335.05 , $335.05 , $393.30 , $355.25 , $36.22 , $397.44 
" Fac Lactoferrin, Fecal (Qual) ",CPT® 83630,0301 - LAB/CHEMISTRY,N/A,N/A, $181.00 , $117.65 , $152.04 , $20.09 , $16.61 , $146.25 , $162.90 , $153.23 , $162.90 , $162.90 , $162.90 , $153.85 , $16.28 , $167.12 , $171.95 , $153.85 , $168.33 , $168.33 , $171.95 , $173.76 , $148.09 , $162.90 , $153.85 , $142.99 , N/A , $146.48 , $146.48 , $171.95 , $155.32 , $16.28 , $173.76 
 ANTIHEMOPHIL FACTOR (RAHF-PFM) 500 UNITS IV SOLR ,HCPCS J7211,0636 - DRUGS REQUIRING DETAILED CODIN,00026-3822-25,1 int'l unit, $35.00 , $22.75 , $29.40 , $1.47 , $1.37 , $28.28 , $31.50 , $29.63 , $31.50 , $31.50 , $31.50 , $29.75 , $1.34 , $32.32 , $33.25 , $29.75 , $32.55 , $32.55 , $33.25 , $33.60 , $28.64 , $31.50 , $29.75 , $27.65 , N/A , $28.33 , $28.33 , $33.25 , $30.03 , $1.34 , $33.60 
 Fac Teaec W/Graft Superficial Femoral Art ,CPT® 35302,0360 - OR SERVICES,N/A,N/A," $2,322.00 "," $1,509.30 "," $1,950.48 ", $996.78 , $926.39 ," $1,876.18 "," $2,089.80 "," $1,965.81 "," $2,089.80 "," $2,089.80 "," $2,089.80 "," $1,973.70 ", $908.23 ," $2,143.90 "," $2,205.90 "," $1,973.70 "," $2,159.46 "," $2,159.46 "," $2,205.90 "," $2,229.12 "," $1,899.86 "," $2,089.80 "," $1,973.70 "," $1,834.38 ", N/A ," $1,879.19 "," $1,879.19 "," $2,205.90 "," $1,992.51 ", $908.23 ," $2,229.12 "
Orthotics/Prosth Mgmt &/Trainj Sbsq Enctr 15 Min,CPT® 97763,N/A,N/A,N/A, $155.00 , $100.75 , $105.34 , $52.82 , $30.44 , $101.24 , $107.19 , $144.15 , $139.50 , $139.50 , $124.00 , $124.00 , $30.44 , $143.11 , $147.25 , $139.50 , $139.50 , $139.50 , $144.15 , $148.80 , $135.54 , $131.75 , $160.54 , $108.92 , N/A , $103.21 , $103.21 , $147.25 , $120.34 , $30.44 , $160.54 
 Pro Debride Skin/Tissue ,CPT® 11042,0982 - PRO FEE/OUTPT,N/A,N/A, $502.00 , $326.30 , $192.85 , $57.23 , $63.58 , $169.46 , $164.75 , $466.86 , $451.80 , $451.80 , $401.60 , $401.60 , $63.58 , $463.50 , $476.90 , $451.80 , $451.80 , $451.80 , $466.86 , $481.92 , $211.84 , $426.70 , $326.48 , $218.43 , N/A , $172.76 , $172.76 , $476.90 , $200.35 , $57.23 , $481.92 
"Incis/Drain Pelvis/Hip,Deep Abscess",CPT® 26990,N/A,N/A,N/A," $2,564.00 "," $1,666.60 "," $4,190.68 ", $652.59 , $200.70 ," $3,011.59 "," $3,015.22 "," $2,384.52 "," $2,307.60 "," $2,307.60 "," $2,051.20 "," $2,051.20 ", $200.70 ," $2,367.34 "," $2,435.80 "," $2,307.60 "," $2,307.60 "," $2,307.60 "," $2,384.52 "," $2,461.44 "," $3,832.32 "," $2,179.40 "," $3,325.50 "," $3,561.87 ", N/A ," $3,070.35 "," $3,070.35 "," $2,435.80 "," $3,608.76 ", $200.70 ," $4,190.68 "
"Realignment of Tendons,Hand",CPT® 26437,N/A,N/A,N/A," $4,099.00 "," $2,664.35 "," $4,203.49 ", $653.63 , $544.19 ," $2,959.04 "," $3,002.85 "," $3,812.07 "," $3,689.10 "," $3,689.10 "," $3,279.20 "," $3,279.20 ", $544.19 ," $3,784.61 "," $3,894.05 "," $3,689.10 "," $3,689.10 "," $3,689.10 "," $3,812.07 "," $3,935.04 "," $3,845.39 "," $3,484.15 "," $3,284.46 "," $3,535.71 ", N/A ," $3,016.77 "," $3,016.77 "," $3,894.05 "," $3,545.78 ", $544.19 ," $4,203.49 "
 Fac Unlis Px UR Sys ,CPT® 53899,0361 - OR/MINOR,N/A,N/A," $1,043.00 ", $677.95 , $876.12 , N/A , N/A , $842.74 , $938.70 , $883.00 , $938.70 , $938.70 , $938.70 , $886.55 , N/A , $963.00 , $990.85 , $886.55 , $969.99 , $969.99 , $990.85 ," $1,001.28 ", $853.38 , $938.70 , $886.55 , $823.97 , N/A , $844.10 , $844.10 , $990.85 , $895.00 , $823.97 ," $1,001.28 "
"Inhal Rx, Airway Obst/Dx Sputum Induct",CPT® 94640,N/A,N/A,N/A, $97.00 , $63.05 , $25.27 , $8.65 , $12.16 , $40.21 , $43.16 , $90.21 , $87.30 , $87.30 , $77.60 , $77.60 , $12.16 , $89.56 , $92.15 , $87.30 , $87.30 , $87.30 , $90.21 , $93.12 , $41.88 , $82.45 , $57.78 , $69.78 , N/A , $41.00 , $41.00 , $92.15 , $47.81 , $8.65 , $93.12 
 Fac Perc D-E Cor Revasc Chro Add ,HCPCS C9608,0481 - CARDIAC CATH LAB,N/A,N/A," $15,529.00 "," $10,093.85 "," $13,044.36 ", N/A , N/A ," $12,547.43 "," $13,976.10 "," $13,146.85 "," $13,976.10 "," $13,976.10 "," $13,976.10 "," $13,199.65 ", N/A ," $14,337.93 "," $14,752.55 "," $13,199.65 "," $14,441.97 "," $14,441.97 "," $14,752.55 "," $14,907.84 "," $12,705.83 "," $13,976.10 "," $13,199.65 "," $12,267.91 ", N/A ," $12,567.62 "," $12,567.62 "," $14,752.55 "," $13,325.43 "," $12,267.91 "," $14,907.84 "
 Fac Drug Tst Prsmv Instrmnt Chem Analyzers PR Date ,CPT® 80307,0301 - LAB/CHEMISTRY,N/A,N/A, $114.00 , $74.10 , $95.76 , $63.38 , $63.38 , $92.11 , $102.60 , $96.51 , $102.60 , $102.60 , $102.60 , $96.90 , $62.14 , $105.26 , $108.30 , $96.90 , $106.02 , $106.02 , $108.30 , $109.44 , $93.27 , $102.60 , $96.90 , $90.06 , N/A , $92.26 , $92.26 , $108.30 , $97.82 , $62.14 , $109.44 
"Poliomyelitis Immunizatn,Inactv,Sq",CPT® 90713,N/A,N/A,N/A, $90.00 , $58.50 , N/A , N/A , $40.63 , $63.14 , $65.60 , $83.70 , $81.00 , $81.00 , $72.00 , $72.00 , $40.63 , $83.10 , $85.50 , $81.00 , $81.00 , $81.00 , $83.70 , $86.40 , N/A , $76.50 , $87.18 , $63.65 , N/A , $64.38 , $64.38 , $85.50 , $75.04 , $40.63 , $87.18 
 Complex Repair Trunk 2.6-7.5cm ,CPT® 13101,0981 - PRO FEE/ER,N/A,N/A," $1,529.00 ", $993.85 , $797.06 , $238.06 , $175.19 , $693.43 , $680.66 ," $1,421.97 "," $1,376.10 "," $1,376.10 "," $1,223.20 "," $1,223.20 ", $175.19 ," $1,411.73 "," $1,452.55 "," $1,376.10 "," $1,376.10 "," $1,376.10 "," $1,421.97 "," $1,467.84 ", $882.35 ," $1,299.65 "," $1,355.89 ", $890.04 , N/A , $706.96 , $706.96 ," $1,452.55 ", $819.84 , $175.19 ," $1,467.84 "
Pro Cltx Prox Tibfib Jt Dislc Req Anes,27831,N/A,N/A,N/A," $2,264.00 "," $1,471.60 "," $2,519.27 ", $396.76 , $167.35 ," $1,928.06 "," $1,932.28 "," $2,105.52 "," $2,037.60 "," $2,037.60 "," $1,811.20 "," $1,811.20 ", $167.35 ," $2,090.35 "," $2,150.80 "," $2,037.60 "," $2,037.60 "," $2,037.60 "," $2,105.52 "," $2,173.44 "," $2,323.30 "," $1,924.40 "," $2,126.60 "," $2,280.72 ", N/A ," $1,965.68 "," $1,965.68 "," $2,150.80 "," $2,310.39 ", $167.35 ," $2,519.27 "
 Pro Ankle Arthroscopy/Surgery ,CPT® 29892,0981 - PRO FEE/ER,N/A,N/A," $5,544.00 "," $3,603.60 "," $3,941.67 ", $621.39 , $613.65 ," $3,098.15 "," $2,949.53 "," $5,155.92 "," $4,989.60 "," $4,989.60 "," $4,435.20 "," $4,435.20 ", $613.65 ," $5,118.78 "," $5,266.80 "," $4,989.60 "," $4,989.60 "," $4,989.60 "," $5,155.92 "," $5,322.24 "," $3,698.72 "," $4,712.40 "," $3,270.19 "," $3,856.93 ", N/A ," $3,158.60 "," $3,158.60 "," $5,266.80 "," $3,712.47 ", $613.65 ," $5,322.24 "
 Myocardial Perf Planar Mult ,CPT® 78454,0340 - NUCLEAR MEDICINE,N/A,N/A," $3,983.00 "," $2,588.95 "," $3,345.72 ", $398.86 , $159.47 ," $3,218.26 "," $3,584.70 "," $3,372.01 "," $3,584.70 "," $3,584.70 "," $3,584.70 "," $3,385.55 ", $156.34 ," $3,677.50 "," $3,783.85 "," $3,385.55 "," $3,704.19 "," $3,704.19 "," $3,783.85 "," $3,823.68 "," $3,258.89 "," $3,584.70 "," $3,385.55 "," $3,146.57 ", N/A ," $3,223.44 "," $3,223.44 "," $3,783.85 "," $3,417.81 ", $156.34 ," $3,823.68 "
Duplex Lo Extrem Art Bilat,CPT® 93925,N/A,N/A,N/A," $2,042.00 "," $1,327.30 "," $1,539.14 ", $235.61 , $209.65 ," $1,405.73 "," $1,423.41 "," $1,899.06 "," $1,837.80 "," $1,837.80 "," $1,633.60 "," $1,633.60 ", $209.65 ," $1,885.38 "," $1,939.90 "," $1,837.80 "," $1,837.80 "," $1,837.80 "," $1,899.06 "," $1,960.32 "," $1,092.19 "," $1,735.70 ", $765.36 , $989.11 , N/A ," $1,433.16 "," $1,433.16 "," $1,939.90 "," $1,588.67 ", $209.65 ," $1,960.32 "
 Fac Chemiluminescent Assay ,CPT® 82397,0302 - LAB/IMMUNOLOGY,N/A,N/A, $145.00 , $94.25 , $121.80 , $14.40 , $14.40 , $117.16 , $130.50 , $122.76 , $130.50 , $130.50 , $130.50 , $123.25 , $14.12 , $133.88 , $137.75 , $123.25 , $134.85 , $134.85 , $137.75 , $139.20 , $118.64 , $130.50 , $123.25 , $114.55 , N/A , $117.35 , $117.35 , $137.75 , $124.42 , $14.12 , $139.20 
Tmvi W/Prosthetic Valve Percutaneous Approach,CPT® 0483T,N/A,N/A,N/A," $8,647.00 "," $5,620.55 "," $8,302.26 "," $1,302.82 ", N/A , N/A , N/A ," $8,041.71 "," $7,782.30 "," $7,782.30 "," $6,917.60 "," $6,917.60 ", N/A ," $7,983.78 "," $8,214.65 "," $7,782.30 "," $7,782.30 "," $7,782.30 "," $8,041.71 "," $8,301.12 "," $7,646.11 "," $7,349.95 "," $2,603.38 "," $7,029.56 ", N/A ," $2,723.78 "," $2,723.78 "," $8,214.65 "," $3,170.54 "," $1,302.82 "," $8,302.26 "
 Fac Pltlt Aggregation Ea Agt ,CPT® 85576,0305 - LAB/HEMATOLOGY,N/A,N/A, $224.00 , $145.60 , $188.16 , $25.41 , $25.41 , $180.99 , $201.60 , $189.64 , $201.60 , $201.60 , $201.60 , $190.40 , $24.91 , $206.82 , $212.80 , $190.40 , $208.32 , $208.32 , $212.80 , $215.04 , $183.28 , $201.60 , $190.40 , $176.96 , N/A , $181.28 , $181.28 , $212.80 , $192.21 , $24.91 , $215.04 
"Macro Exam/Dissect/Prep for Non-Micro Study, Ea",CPT® 88387,N/A,N/A,N/A, $668.00 , $434.20 , $123.58 , $33.79 , $34.27 , $171.77 , $155.74 , $621.24 , $601.20 , $601.20 , $534.40 , $534.40 , $34.27 , $616.76 , $634.60 , $601.20 , $601.20 , $601.20 , $621.24 , $641.28 , $229.23 , $567.80 , $160.56 , $121.81 , N/A , $160.31 , $160.31 , $634.60 , $176.18 , $33.79 , $641.28 
 Fac Acetylcholinesterase ,CPT® 82013,0301 - LAB/CHEMISTRY,N/A,N/A, $96.00 , $62.40 , $80.64 , $12.54 , $12.54 , $77.57 , $86.40 , $81.27 , $86.40 , $86.40 , $86.40 , $81.60 , $12.29 , $88.64 , $91.20 , $81.60 , $89.28 , $89.28 , $91.20 , $92.16 , $78.55 , $86.40 , $81.60 , $75.84 , N/A , $77.69 , $77.69 , $91.20 , $82.38 , $12.29 , $92.16 
Splint Supplies Misc,HCPCS Q4051,N/A,N/A,N/A, $116.00 , $75.40 , N/A , N/A , N/A , N/A , N/A , $107.88 , $104.40 , $104.40 , $92.80 , $92.80 , N/A , $107.10 , $110.20 , $104.40 , $104.40 , $104.40 , $107.88 , $111.36 , N/A , $98.60 , $92.80 , N/A , N/A , N/A , N/A , $110.20 , N/A , $92.80 , $111.36 
"Hiv 1 Genotype, Dna/Rna, Other Regions",CPT® 87906,N/A,N/A,N/A, $249.00 , $161.85 , N/A , $131.30 , $131.30 , $728.30 , $871.15 , $231.57 , $224.10 , $224.10 , $199.20 , $199.20 , $131.30 , $229.90 , $236.55 , $224.10 , $224.10 , $224.10 , $231.57 , $239.04 , $859.56 , $211.65 , $843.36 , $466.75 , N/A , $679.70 , $679.70 , $236.55 , $742.76 , $131.30 , $871.15 
"Revise Knee Joint Replace,1 Part",CPT® 27486,N/A,N/A,N/A," $9,320.00 "," $6,058.00 "," $8,454.10 "," $1,321.56 "," $1,016.23 "," $6,796.02 "," $6,731.66 "," $8,667.60 "," $8,388.00 "," $8,388.00 "," $7,456.00 "," $7,456.00 "," $1,016.23 "," $8,605.16 "," $8,854.00 "," $8,388.00 "," $8,388.00 "," $8,388.00 "," $8,667.60 "," $8,947.20 "," $7,887.71 "," $7,922.00 "," $7,452.04 "," $7,996.34 ", N/A ," $6,928.63 "," $6,928.63 "," $8,854.00 "," $8,143.61 "," $1,016.23 "," $8,947.20 "
 Pro MRI Uppr Extremity W/O&W/Dye ,CPT® 73220,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,118.00 ", $726.70 ," $2,988.51 ", $423.69 , $515.74 ," $2,377.46 "," $3,018.30 "," $1,039.74 "," $1,006.20 "," $1,006.20 ", $894.40 , $894.40 , $515.74 ," $1,032.25 "," $1,062.10 "," $1,006.20 "," $1,006.20 "," $1,006.20 "," $1,039.74 "," $1,073.28 "," $2,591.04 ", $950.30 ," $3,291.61 "," $4,616.11 ", N/A ," $2,423.86 "," $2,423.86 "," $1,062.10 "," $2,805.66 ", $423.69 ," $4,616.11 "
 Fac Clsr Lac Vestibule Mouth 2.5 Cm/< ,CPT® 40830,0761 - TREATMENT ROOM,N/A,N/A," $1,684.00 "," $1,094.60 "," $1,414.56 ", $141.47 , $38.12 ," $1,360.67 "," $1,515.60 "," $1,425.67 "," $1,515.60 "," $1,515.60 "," $1,515.60 "," $1,431.40 ", $37.37 ," $1,554.84 "," $1,599.80 "," $1,431.40 "," $1,566.12 "," $1,566.12 "," $1,599.80 "," $1,616.64 "," $1,377.85 "," $1,515.60 "," $1,431.40 "," $1,330.36 ", N/A ," $1,362.86 "," $1,362.86 "," $1,599.80 "," $1,445.04 ", $37.37 ," $1,616.64 "
 ALPRAZOLAM 0.25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00781-1061-01,1 tablet, $3.58 , $2.33 , $3.01 , N/A , N/A , $2.89 , $3.22 , $3.03 , $3.22 , $3.22 , $3.22 , $3.04 , N/A , $3.31 , $3.40 , $3.04 , $3.33 , $3.33 , $3.40 , $3.44 , $2.93 , $3.22 , $3.04 , $2.83 , N/A , $2.90 , $2.90 , $3.40 , $3.07 , $2.83 , $3.44 
Excis Pterygium,CPT® 65420,N/A,N/A,N/A," $4,907.00 "," $3,189.55 "," $2,334.09 ", $367.51 , $354.63 ," $2,132.54 "," $1,985.61 "," $4,563.51 "," $4,416.30 "," $4,416.30 "," $3,925.60 "," $3,925.60 ", $354.63 ," $4,530.63 "," $4,661.65 "," $4,416.30 "," $4,416.30 "," $4,416.30 "," $4,563.51 "," $4,710.72 "," $3,202.05 "," $4,170.95 "," $2,035.62 "," $2,717.20 ", N/A ," $2,174.15 "," $2,174.15 "," $4,661.65 "," $2,399.98 ", $354.63 ," $4,710.72 "
Drug Test Prsmv Read Direct Optical Obs PR Date,CPT® 80305,N/A,N/A,N/A, $56.00 , $36.40 , N/A , $12.85 , $12.85 , $84.06 , N/A , $52.08 , $50.40 , $50.40 , $44.80 , $44.80 , $12.85 , $51.70 , $53.20 , $50.40 , $50.40 , $50.40 , $52.08 , $53.76 , $84.13 , $47.60 , $59.77 , $39.53 , N/A , $78.45 , $78.45 , $53.20 , $85.73 , $12.85 , $85.73 
Open Rx Periartic Fx/Disloc Elbow,CPT® 24586,N/A,N/A,N/A," $4,283.00 "," $2,783.95 "," $6,584.63 "," $1,029.82 ", $934.20 ," $5,225.54 "," $5,173.18 "," $3,983.19 "," $3,854.70 "," $3,854.70 "," $3,426.40 "," $3,426.40 ", $934.20 ," $3,954.49 "," $4,068.85 "," $3,854.70 "," $3,854.70 "," $3,854.70 "," $3,983.19 "," $4,111.68 "," $6,134.89 "," $3,640.55 "," $5,717.93 "," $6,164.46 ", N/A ," $5,327.49 "," $5,327.49 "," $4,068.85 "," $6,261.69 ", $934.20 ," $6,584.63 "
Simple Repair 2.6-5cm,12013,N/A,N/A,N/A, $802.00 , $521.30 , $180.71 , $53.74 , $76.93 , $169.97 , $163.73 , $745.86 , $721.80 , $721.80 , $641.60 , $641.60 , $76.93 , $740.49 , $761.90 , $721.80 , $721.80 , $721.80 , $745.86 , $769.92 , $198.93 , $681.70 , $328.27 , $200.67 , N/A , $173.28 , $173.28 , $761.90 , $200.96 , $53.74 , $769.92 
 Pro Insj Stablj Dev W/Dcmprn Lumbar Second Level ,CPT® 22868,0982 - PRO FEE/OUTPT,N/A,N/A," $2,401.00 "," $1,560.65 "," $1,391.98 ", $217.17 , N/A ," $1,119.62 "," $1,080.58 "," $2,232.93 "," $2,160.90 "," $2,160.90 "," $1,920.80 "," $1,920.80 ", N/A ," $2,216.84 "," $2,280.95 "," $2,160.90 "," $2,160.90 "," $2,160.90 "," $2,232.93 "," $2,304.96 "," $1,307.09 "," $2,040.85 "," $1,290.06 "," $1,319.64 ", N/A ," $1,141.46 "," $1,141.46 "," $2,280.95 "," $1,341.61 ", $217.17 ," $2,304.96 "
 Fac Molecular Pathology Procedure Level 7 ,CPT® 81406,0310 - PATHOLOGY LAB,N/A,N/A, $77.00 , $50.05 , $64.68 , $288.54 , $288.54 , $62.22 , $69.30 , $65.19 , $69.30 , $69.30 , $69.30 , $65.45 , $282.88 , $71.09 , $73.15 , $65.45 , $71.61 , $71.61 , $73.15 , $73.92 , $63.00 , $69.30 , $65.45 , $60.83 , N/A , $62.32 , $62.32 , $73.15 , $66.07 , $60.83 , $288.54 
Protein E-Phoresis/Urine/CSF,CPT® 84166,N/A,N/A,N/A, $166.00 , $107.90 , N/A , $18.19 , $18.19 , $100.90 , $120.71 , $154.38 , $149.40 , $149.40 , $132.80 , $132.80 , $18.19 , $153.27 , $157.70 , $149.40 , $149.40 , $149.40 , $154.38 , $159.36 , $119.05 , $141.10 , $212.46 , $64.64 , N/A , $94.17 , $94.17 , $157.70 , $102.90 , $18.19 , $212.46 
Revise/Remove Neurostim/Receiver,CPT® 63688,N/A,N/A,N/A," $2,457.00 "," $1,597.05 "," $1,790.20 ", $351.09 , $400.51 ," $2,042.54 "," $1,979.16 "," $2,285.01 "," $2,211.30 "," $2,211.30 "," $1,965.60 "," $1,965.60 ", $400.51 ," $2,268.55 "," $2,334.15 "," $2,211.30 "," $2,211.30 "," $2,211.30 "," $2,285.01 "," $2,358.72 "," $1,935.77 "," $2,088.45 "," $1,967.82 "," $2,176.52 ", N/A ," $2,082.39 "," $2,082.39 "," $2,334.15 "," $2,233.92 ", $351.09 ," $2,358.72 "
" Fac Blood Typing, Abo ",CPT® 86900,0300 - LABORATORY,N/A,N/A, $59.00 , $38.35 , $49.56 , $3.05 , $3.05 , $47.67 , $53.10 , $49.95 , $53.10 , $53.10 , $53.10 , $50.15 , $2.99 , $54.47 , $56.05 , $50.15 , $54.87 , $54.87 , $56.05 , $56.64 , $48.27 , $53.10 , $50.15 , $46.61 , N/A , $47.75 , $47.75 , $56.05 , $50.63 , $2.99 , $56.64 
Rho D Immune Globulin 50 Mcg,HCPCS J2788,N/A,N/A,N/A, $61.00 , $39.65 , N/A , $27.46 , $25.98 , N/A , N/A , $56.73 , $54.90 , $54.90 , $48.80 , $48.80 , $25.98 , $56.32 , $57.95 , $54.90 , $54.90 , $54.90 , $56.73 , $58.56 , $28.86 , $51.85 , $46.71 , $30.24 , N/A , N/A , N/A , $57.95 , N/A , $25.98 , $58.56 
 Pro Repair of Foot Tendon ,CPT® 28200,0975 - PRO FEE/OR,N/A,N/A," $2,984.00 "," $1,939.60 "," $2,025.27 ", $317.14 , $461.04 ," $1,578.99 "," $1,560.91 "," $2,775.12 "," $2,685.60 "," $2,685.60 "," $2,387.20 "," $2,387.20 ", $461.04 ," $2,755.13 "," $2,834.80 "," $2,685.60 "," $2,685.60 "," $2,685.60 "," $2,775.12 "," $2,864.64 "," $1,866.84 "," $2,536.40 "," $1,687.72 "," $1,889.38 ", N/A ," $1,609.80 "," $1,609.80 "," $2,834.80 "," $1,892.07 ", $317.14 ," $2,864.64 "
"Exc Skin Benig >4cm Face,Facial",CPT® 11446,N/A,N/A,N/A," $1,937.00 "," $1,259.05 "," $1,023.33 ", $303.00 , $321.15 , $886.77 , $858.68 ," $1,801.41 "," $1,743.30 "," $1,743.30 "," $1,549.60 "," $1,549.60 ", $321.15 ," $1,788.43 "," $1,840.15 "," $1,743.30 "," $1,743.30 "," $1,743.30 "," $1,801.41 "," $1,859.52 "," $1,126.21 "," $1,646.45 "," $1,716.27 "," $1,132.21 ", N/A , $904.07 , $904.07 ," $1,840.15 "," $1,048.41 ", $303.00 ," $1,859.52 "
"Reticyte, Hgb Concentrate",CPT® 85046,N/A,N/A,N/A, $48.00 , $31.20 , N/A , $5.68 , $5.68 , $31.56 , $37.76 , $44.64 , $43.20 , $43.20 , $38.40 , $38.40 , $5.68 , $44.32 , $45.60 , $43.20 , $43.20 , $43.20 , $44.64 , $46.08 , $37.19 , $40.80 , $37.30 , $20.21 , N/A , $29.45 , $29.45 , $45.60 , $32.18 , $5.68 , $46.08 
Prq Trluml Coronary Stent W/Angio Addl Art/Brnch,CPT® 92929,N/A,N/A,N/A," $1,335.00 ", $867.75 , N/A , N/A , $226.64 , N/A , N/A ," $1,241.55 "," $1,201.50 "," $1,201.50 "," $1,068.00 "," $1,068.00 ", $226.64 ," $1,232.61 "," $1,268.25 "," $1,201.50 "," $1,201.50 "," $1,201.50 "," $1,241.55 "," $1,281.60 ", N/A ," $1,134.75 ", N/A , N/A , N/A , N/A , N/A ," $1,268.25 ", N/A , $226.64 ," $1,281.60 "
Renal Scope,CPT® 50570,N/A,N/A,N/A," $3,427.00 "," $2,227.55 "," $2,631.49 ", $461.52 , $76.84 ," $2,413.45 "," $2,230.52 "," $3,187.11 "," $3,084.30 "," $3,084.30 "," $2,741.60 "," $2,741.60 ", $76.84 ," $3,164.15 "," $3,255.65 "," $3,084.30 "," $3,084.30 "," $3,084.30 "," $3,187.11 "," $3,289.92 "," $2,649.61 "," $2,912.95 "," $2,524.45 "," $3,026.60 ", N/A ," $2,460.54 "," $2,460.54 "," $3,255.65 "," $2,892.00 ", $76.84 ," $3,289.92 "
"Avulsion Nail Plate,Ea Ad",11732,N/A,N/A,N/A, $173.00 , $112.45 , $56.07 , $16.52 , $20.72 , $56.58 , $53.10 , $160.89 , $155.70 , $155.70 , $138.40 , $138.40 , $20.72 , $159.73 , $164.35 , $155.70 , $155.70 , $155.70 , $160.89 , $166.08 , $61.85 , $147.05 , $105.26 , $63.44 , N/A , $57.68 , $57.68 , $164.35 , $66.88 , $16.52 , $166.08 
Perq Vert Agmntj Cavity Crtj Uni/Bi Cannulation,CPT® 22513,N/A,N/A,N/A," $6,164.00 "," $4,006.60 "," $3,068.13 ", $477.25 ," $5,767.47 "," $2,501.30 "," $2,648.49 "," $5,732.52 "," $5,547.60 "," $5,547.60 "," $4,931.20 "," $4,931.20 "," $5,767.47 "," $5,691.22 "," $5,855.80 "," $5,547.60 "," $5,547.60 "," $5,547.60 "," $5,732.52 "," $5,917.44 "," $2,866.72 "," $5,239.40 "," $2,692.07 "," $2,956.45 ", N/A ," $2,550.10 "," $2,550.10 "," $5,855.80 "," $2,997.28 ", $477.25 ," $5,917.44 "
"Repair Detach Retina,W Vitrectomy",CPT® 67108,N/A,N/A,N/A," $10,484.00 "," $6,814.60 "," $7,316.60 "," $1,145.83 "," $1,312.65 "," $9,090.19 "," $8,447.12 "," $9,750.12 "," $9,435.60 "," $9,435.60 "," $8,387.20 "," $8,387.20 "," $1,312.65 "," $9,679.88 "," $9,959.80 "," $9,435.60 "," $9,435.60 "," $9,435.60 "," $9,750.12 "," $10,064.64 "," $10,063.94 "," $8,911.40 "," $8,686.61 "," $8,629.52 ", N/A ," $9,267.55 "," $9,267.55 "," $9,959.80 "," $10,230.18 "," $1,145.83 "," $10,230.18 "
 Cervical Spine Min 4vw- Mh ,CPT® 72050,0972 - PRO FEE/RAD/DX,N/A,N/A, $192.00 , $124.80 , $301.19 , $52.56 , $50.07 , $212.95 , $290.14 , $178.56 , $172.80 , $172.80 , $153.60 , $153.60 , $50.07 , $177.27 , $182.40 , $172.80 , $172.80 , $172.80 , $178.56 , $184.32 , $290.59 , $163.20 , $281.20 , $228.27 , N/A , $217.11 , $217.11 , $182.40 , $251.30 , $50.07 , $301.19 
" Fac Laryngoscopy,Direct,Diagnostic ",CPT® 31525,0761 - TREATMENT ROOM,N/A,N/A, $983.00 , $638.95 , $825.72 , $152.06 , $303.22 , $794.26 , $884.70 , $832.21 , $884.70 , $884.70 , $884.70 , $835.55 , $297.27 , $907.60 , $933.85 , $835.55 , $914.19 , $914.19 , $933.85 , $943.68 , $804.29 , $884.70 , $835.55 , $776.57 , N/A , $795.54 , $795.54 , $933.85 , $843.51 , $152.06 , $943.68 
 Fac Iaadiadoo Respiratory Synctial Virus ,CPT® 87807,0300 - LABORATORY,N/A,N/A, $120.00 , $78.00 , $100.80 , $13.36 , $13.36 , $96.96 , $108.00 , $101.59 , $108.00 , $108.00 , $108.00 , $102.00 , $13.10 , $110.80 , $114.00 , $102.00 , $111.60 , $111.60 , $114.00 , $115.20 , $98.18 , $108.00 , $102.00 , $94.80 , N/A , $97.12 , $97.12 , $114.00 , $102.97 , $13.10 , $115.20 
 PACLITAXEL PROTEIN-BOUND PART 100 MG IV SUSR ,HCPCS J9259,0636 - DRUGS REQUIRING DETAILED CODIN,60505-6230-04,20 mL," $4,413.58 "," $2,868.83 "," $3,707.41 ", N/A , N/A ," $3,566.17 "," $3,972.22 "," $3,736.54 "," $3,972.22 "," $3,972.22 "," $3,972.22 "," $3,751.54 ", N/A ," $4,075.06 "," $4,192.90 "," $3,751.54 "," $4,104.63 "," $4,104.63 "," $4,192.90 "," $4,237.04 "," $3,611.19 "," $3,972.22 "," $3,751.54 "," $3,486.73 ", N/A ," $3,571.91 "," $3,571.91 "," $4,192.90 "," $3,787.29 "," $3,486.73 "," $4,237.04 "
 Closed Tx Radius/Ulna Shaft W/ Manip -Mh ,CPT® 25565,0761 - TREATMENT ROOM,N/A,N/A," $2,217.00 "," $1,441.05 "," $1,862.28 ", $452.75 , $396.91 ," $1,791.34 "," $1,995.30 "," $1,876.91 "," $1,995.30 "," $1,995.30 "," $1,995.30 "," $1,884.45 ", $389.13 ," $2,046.96 "," $2,106.15 "," $1,884.45 "," $2,061.81 "," $2,061.81 "," $2,106.15 "," $2,128.32 "," $1,813.95 "," $1,995.30 "," $1,884.45 "," $1,751.43 ", N/A ," $1,794.22 "," $1,794.22 "," $2,106.15 "," $1,902.41 ", $389.13 ," $2,128.32 "
"Closed Rx Dist Fibula Fx,Manip",27788,N/A,N/A,N/A," $2,789.00 "," $1,812.85 "," $2,379.26 ", $375.59 , $230.52 ," $1,854.24 "," $1,880.56 "," $2,593.77 "," $2,510.10 "," $2,510.10 "," $2,231.20 "," $2,231.20 ", $230.52 ," $2,575.08 "," $2,649.55 "," $2,510.10 "," $2,510.10 "," $2,510.10 "," $2,593.77 "," $2,677.44 "," $2,201.70 "," $2,370.65 "," $2,065.95 "," $2,192.00 ", N/A ," $1,890.42 "," $1,890.42 "," $2,649.55 "," $2,221.92 ", $230.52 ," $2,677.44 "
Iridotomy/Iridectomy by Laser,66761,N/A,N/A,N/A," $2,518.00 "," $1,636.70 "," $1,457.17 ", $228.35 , $360.39 ," $1,335.82 "," $2,002.32 "," $2,341.74 "," $2,266.20 "," $2,266.20 "," $2,014.40 "," $2,014.40 ", $360.39 ," $2,324.87 "," $2,392.10 "," $2,266.20 "," $2,266.20 "," $2,266.20 "," $2,341.74 "," $2,417.28 "," $1,998.33 "," $2,140.30 "," $1,288.09 "," $1,696.80 ", N/A ," $1,361.88 "," $1,361.88 "," $2,392.10 "," $1,503.35 ", $228.35 ," $2,417.28 "
"Repair Collat Ankle Ligmnt,Secondary",CPT® 27698,N/A,N/A,N/A," $7,590.00 "," $4,933.50 "," $3,911.51 ", $614.64 , $580.96 ," $3,106.67 "," $3,115.72 "," $7,058.70 "," $6,831.00 "," $6,831.00 "," $6,072.00 "," $6,072.00 ", $580.96 ," $7,007.85 "," $7,210.50 "," $6,831.00 "," $6,831.00 "," $6,831.00 "," $7,058.70 "," $7,286.40 "," $3,640.57 "," $6,451.50 "," $3,416.48 "," $3,686.22 ", N/A ," $3,167.29 "," $3,167.29 "," $7,210.50 "," $3,722.69 ", $580.96 ," $7,286.40 "
"Culture Typing, Nucleic Acid Probe",CPT® 87149,N/A,N/A,N/A, $185.00 , $120.25 , N/A , $20.45 , $20.45 , $113.46 , $135.73 , $172.05 , $166.50 , $166.50 , $148.00 , $148.00 , $20.45 , $170.81 , $175.75 , $166.50 , $166.50 , $166.50 , $172.05 , $177.60 , $133.88 , $157.25 , $131.37 , $72.72 , N/A , $105.89 , $105.89 , $175.75 , $115.71 , $20.45 , $177.60 
 Janssen Single Dose Covid Vaccine Admin ,CPT® 0031A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
"Allergy Skin Tests,Allergens",CPT® 95004,N/A,N/A,N/A, $19.00 , $12.35 , $9.65 , $3.73 , $2.21 , $11.33 , $11.72 , $17.67 , $17.10 , $17.10 , $15.20 , $15.20 , $2.21 , $17.54 , $18.05 , $17.10 , $17.10 , $17.10 , $17.67 , $18.24 , $12.11 , $16.15 , $20.27 , $15.83 , N/A , $11.54 , $11.54 , $18.05 , $13.66 , $2.21 , $20.27 
 Pro Remove Foreign Body From Eye ,CPT® 65205,0982 - PRO FEE/OUTPT,N/A,N/A, $421.00 , $273.65 , $180.70 , $28.20 , $35.23 , $251.30 , $232.46 , $391.53 , $378.90 , $378.90 , $336.80 , $336.80 , $35.23 , $388.71 , $399.95 , $378.90 , $378.90 , $378.90 , $391.53 , $404.16 , $248.64 , $357.85 , $239.06 , $319.55 , N/A , $256.20 , $256.20 , $399.95 , $282.82 , $28.20 , $404.16 
"Electrocardiogram,Report",93010,N/A,N/A,N/A, $103.00 , $66.95 , $51.61 , $7.96 , $9.02 , $46.31 , $46.05 , $95.79 , $92.70 , $92.70 , $82.40 , $82.40 , $9.02 , $95.10 , $97.85 , $92.70 , $92.70 , $92.70 , $95.79 , $98.88 , $86.42 , $87.55 , $42.82 , $32.14 , N/A , $47.22 , $47.22 , $97.85 , $52.33 , $7.96 , $98.88 
 Fac Perq Sft Tiss Loc Device Plmt Add Les W/Gdnce ,CPT® 10036,0361 - OR/MINOR,N/A,N/A," $1,260.00 ", $819.00 ," $1,058.40 ", $40.65 , $368.36 ," $1,018.08 "," $1,134.00 "," $1,066.72 "," $1,134.00 "," $1,134.00 "," $1,134.00 "," $1,071.00 ", $361.14 ," $1,163.36 "," $1,197.00 "," $1,071.00 "," $1,171.80 "," $1,171.80 "," $1,197.00 "," $1,209.60 "," $1,030.93 "," $1,134.00 "," $1,071.00 ", $995.40 , N/A ," $1,019.72 "," $1,019.72 "," $1,197.00 "," $1,081.21 ", $40.65 ," $1,209.60 "
Glycated Protein,CPT® 82985,N/A,N/A,N/A, $110.00 , $71.50 , N/A , $17.10 , $16.40 , $66.85 , $79.96 , $102.30 , $99.00 , $99.00 , $88.00 , $88.00 , $16.40 , $101.56 , $104.50 , $99.00 , $99.00 , $99.00 , $102.30 , $105.60 , $111.91 , $93.50 , $98.93 , $54.55 , N/A , $62.39 , $62.39 , $104.50 , $68.18 , $16.40 , $111.91 
 Fac Ewho W/Joint(S) Cf ,HCPCS L3764,0274 - PROSTHETIC DEV,N/A,N/A, $877.00 , $570.05 , $736.68 , $833.73 , $385.69 , $708.62 , $789.30 , $742.47 , $789.30 , $789.30 , $789.30 , $745.45 , $378.13 , $809.73 , $833.15 , $745.45 , $815.61 , $815.61 , $833.15 , $841.92 , $717.56 , $789.30 , $745.45 , $692.83 , N/A , $709.76 , $709.76 , $833.15 , $752.55 , $378.13 , $841.92 
Fine Needle Aspiration Bx W/O Img Gdn 1st Lesion,10021,N/A,N/A,N/A, $684.00 , $444.60 , $175.24 , $52.22 , $77.05 , $190.96 , $184.90 , $636.12 , $615.60 , $615.60 , $547.20 , $547.20 , $77.05 , $631.54 , $649.80 , $615.60 , $615.60 , $615.60 , $636.12 , $656.64 , $183.62 , $581.40 , $371.09 , $242.14 , N/A , $194.69 , $194.69 , $649.80 , $225.77 , $52.22 , $656.64 
Dypd Gene Analysis Common Variants,CPT® 81232,N/A,N/A,N/A, $778.00 , $505.70 , N/A , $178.31 , N/A , $726.76 , N/A , $723.54 , $700.20 , $700.20 , $622.40 , $622.40 , N/A , $718.33 , $739.10 , $700.20 , $700.20 , $700.20 , $723.54 , $746.88 ," $1,167.25 ", $661.30 , $833.53 , $513.42 , N/A , $678.26 , $678.26 , $739.10 , $741.19 , $178.31 ," $1,167.25 "
Rmvl Impltbl Dfb Plse Gen W/Rplcmt Plse Gen 2 Ld,CPT® 33263,N/A,N/A,N/A," $3,597.00 "," $2,338.05 "," $2,316.93 ", $357.36 , $290.41 ," $1,706.42 "," $1,646.34 "," $3,345.21 "," $3,237.30 "," $3,237.30 "," $2,877.60 "," $2,877.60 ", $290.41 ," $3,321.11 "," $3,417.15 "," $3,237.30 "," $3,237.30 "," $3,237.30 "," $3,345.21 "," $3,453.12 "," $2,140.95 "," $3,057.45 "," $2,069.51 "," $1,879.25 ", N/A ," $1,739.71 "," $1,739.71 "," $3,417.15 "," $1,976.29 ", $290.41 ," $3,453.12 "
"Compatibility Test,Spin Tech",CPT® 86920,N/A,N/A,N/A, $160.00 , $104.00 , N/A , N/A , $7.29 , $100.93 , $114.19 , $148.80 , $144.00 , $144.00 , $128.00 , $128.00 , $7.29 , $147.73 , $152.00 , $144.00 , $144.00 , $144.00 , $148.80 , $153.60 , N/A , $136.00 , $115.15 , $104.23 , N/A , $94.19 , $94.19 , $152.00 , $102.93 , $7.29 , $153.60 
Refraction,CPT® 92015,N/A,N/A,N/A, $62.00 , $40.30 , $20.00 , $18.93 , $10.17 , $34.59 , $33.66 , $57.66 , $55.80 , $55.80 , $49.60 , $49.60 , $10.17 , $57.24 , $58.90 , $55.80 , $55.80 , $55.80 , $57.66 , $59.52 , $58.79 , $52.70 , $56.77 , $41.01 , N/A , $35.27 , $35.27 , $58.90 , $41.95 , $10.17 , $59.52 
 Fac Mod Sed Same Phys/Qhp Initial 15 Mins <5 Yrs ,CPT® 99151,0370 - ANESTHESIA,N/A,N/A, $181.00 , $117.65 , $152.04 , $23.62 , $60.95 , $146.25 , $162.90 , $153.23 , $162.90 , $162.90 , $162.90 , $153.85 , $59.75 , $167.12 , $171.95 , $153.85 , $168.33 , $168.33 , $171.95 , $173.76 , $148.09 , $162.90 , $153.85 , $142.99 , N/A , $146.48 , $146.48 , $171.95 , $155.32 , $23.62 , $173.76 
 Pro Lyr Clsr F/E/E/N/L/M&/Muc 5.1 Cm-7.5 Cm ,CPT® 12053,0982 - PRO FEE/OUTPT,N/A,N/A," $1,445.00 ", $939.25 , $685.07 , $206.62 , $153.67 , $595.05 , $580.29 ," $1,343.85 "," $1,300.50 "," $1,300.50 "," $1,156.00 "," $1,156.00 ", $153.67 ," $1,334.17 "," $1,372.75 "," $1,300.50 "," $1,300.50 "," $1,300.50 "," $1,343.85 "," $1,387.20 ", $753.04 ," $1,228.25 "," $1,156.07 ", $765.21 , N/A , $606.66 , $606.66 ," $1,372.75 ", $703.53 , $153.67 ," $1,387.20 "
Thiamine Hcl 100 Mg,HCPCS J3411,N/A,N/A,N/A, $35.00 , $22.75 , N/A , $2.55 , $2.86 , N/A , N/A , $32.55 , $31.50 , $31.50 , $28.00 , $28.00 , $2.86 , $32.32 , $33.25 , $31.50 , $31.50 , $31.50 , $32.55 , $33.60 , $4.36 , $29.75 , $7.14 , $3.76 , N/A , N/A , N/A , $33.25 , N/A , $2.55 , $33.60 
 Drainage of Tonsil Abscess ED Fac ,CPT® 42700,0761 - TREATMENT ROOM,N/A,N/A," $1,342.00 ", $872.30 ," $1,127.28 ", $131.69 , $124.27 ," $1,084.34 "," $1,207.80 "," $1,136.14 "," $1,207.80 "," $1,207.80 "," $1,207.80 "," $1,140.70 ", $121.83 ," $1,239.07 "," $1,274.90 "," $1,140.70 "," $1,248.06 "," $1,248.06 "," $1,274.90 "," $1,288.32 "," $1,098.02 "," $1,207.80 "," $1,140.70 "," $1,060.18 ", N/A ," $1,086.08 "," $1,086.08 "," $1,274.90 "," $1,151.57 ", $121.83 ," $1,288.32 "
Open Rx Prox Humerus Fx,23615,N/A,N/A,N/A," $4,807.00 "," $3,124.55 "," $5,362.96 ", $840.53 , $768.38 ," $4,266.68 "," $4,250.31 "," $4,470.51 "," $4,326.30 "," $4,326.30 "," $3,845.60 "," $3,845.60 ", $768.38 ," $4,438.30 "," $4,566.65 "," $4,326.30 "," $4,326.30 "," $4,326.30 "," $4,470.51 "," $4,614.72 "," $4,992.25 "," $4,085.95 "," $4,695.66 "," $5,029.04 ", N/A ," $4,349.94 "," $4,349.94 "," $4,566.65 "," $5,112.71 ", $768.38 ," $5,362.96 "
RBC Pretreatment/Chem or Drugs,CPT® 86970,N/A,N/A,N/A, $145.00 , $94.25 , N/A , N/A , N/A , $83.87 , $96.49 , $134.85 , $130.50 , $130.50 , $116.00 , $116.00 , N/A , $133.88 , $137.75 , $130.50 , $130.50 , $130.50 , $134.85 , $139.20 , N/A , $123.25 , $97.31 , $87.02 , N/A , $78.27 , $78.27 , $137.75 , $85.53 , $78.27 , $139.20 
Rheumatoid Factor Test,CPT® 86430,N/A,N/A,N/A, $58.00 , $37.70 , N/A , $6.26 , $6.26 , $32.09 , $38.40 , $53.94 , $52.20 , $52.20 , $46.40 , $46.40 , $6.26 , $53.55 , $55.10 , $52.20 , $52.20 , $52.20 , $53.94 , $55.68 , $41.00 , $49.30 , $37.30 , $20.56 , N/A , $29.95 , $29.95 , $55.10 , $32.73 , $6.26 , $55.68 
Tint Photochromatic Lens/Es,HCPCS V2744,N/A,N/A,N/A, $58.00 , $37.70 , N/A , $20.78 , N/A , N/A , N/A , $53.94 , $52.20 , $52.20 , $46.40 , $46.40 , N/A , $53.55 , $55.10 , $52.20 , $52.20 , $52.20 , $53.94 , $55.68 , N/A , $49.30 , $58.00 , $18.87 , N/A , N/A , N/A , $55.10 , N/A , $18.87 , $58.00 
 Pro Appl Fngr Splnt Static ,CPT® 29130,0981 - PRO FEE/ER,N/A,N/A, $268.00 , $174.20 , $175.70 , $27.56 , $10.31 , $137.91 , $137.01 , $249.24 , $241.20 , $241.20 , $214.40 , $214.40 , $10.31 , $247.44 , $254.60 , $241.20 , $241.20 , $241.20 , $249.24 , $257.28 , $162.22 , $227.80 , $149.86 , $165.82 , N/A , $140.61 , $140.61 , $254.60 , $165.26 , $10.31 , $257.28 
 DEFEROXAMINE MESYLATE 500 MG IJ SOLR ,HCPCS J0895,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0597-10,5.3 mL, $159.66 , $103.78 , $134.11 , $8.76 , $8.83 , $129.01 , $143.69 , $135.17 , $143.69 , $143.69 , $143.69 , $135.71 , $8.66 , $147.41 , $151.68 , $135.71 , $148.48 , $148.48 , $151.68 , $153.27 , $130.63 , $143.69 , $135.71 , $126.13 , N/A , $129.21 , $129.21 , $151.68 , $137.00 , $8.66 , $153.27 
 Pro Remove Eyelid Lining Lesion ,CPT® 68110,0982 - PRO FEE/OUTPT,N/A,N/A," $2,184.00 "," $1,419.60 ", $908.96 , $143.24 , $93.05 , $840.25 , $798.27 ," $2,031.12 "," $1,965.60 "," $1,965.60 "," $1,747.20 "," $1,747.20 ", $93.05 ," $2,016.49 "," $2,074.80 "," $1,965.60 "," $1,965.60 "," $1,965.60 "," $2,031.12 "," $2,096.64 "," $1,249.67 "," $1,856.40 ", $827.81 ," $1,069.63 ", N/A , $856.64 , $856.64 ," $2,074.80 ", $945.61 , $93.05 ," $2,096.64 "
Remove Abd Lymph Nodes Extensive,CPT® 38780,N/A,N/A,N/A," $6,224.00 "," $4,045.60 "," $4,839.65 ", $979.39 ," $2,378.00 "," $3,613.46 "," $3,678.36 "," $5,788.32 "," $5,601.60 "," $5,601.60 "," $4,979.20 "," $4,979.20 "," $2,378.00 "," $5,746.62 "," $5,912.80 "," $5,601.60 "," $5,601.60 "," $5,601.60 "," $5,788.32 "," $5,975.04 "," $5,177.57 "," $5,290.40 "," $5,355.76 "," $5,047.26 ", N/A ," $3,683.96 "," $3,683.96 "," $5,912.80 "," $4,273.87 ", $979.39 ," $5,975.04 "
Esophagogastroduodenoscopy Submucosal Injection,CPT® 43236,N/A,N/A,N/A," $2,594.00 "," $1,686.10 ", $846.69 , $130.86 , $316.50 , $706.97 , $851.21 ," $2,412.42 "," $2,334.60 "," $2,334.60 "," $2,075.20 "," $2,075.20 ", $316.50 ," $2,395.04 "," $2,464.30 "," $2,334.60 "," $2,334.60 "," $2,334.60 "," $2,412.42 "," $2,490.24 ", $609.64 ," $2,204.90 ", $933.07 , $808.87 , N/A , $720.76 , $720.76 ," $2,464.30 ", $753.83 , $130.86 ," $2,490.24 "
"Consult-Comprehensive,Ref",CPT® 88325,N/A,N/A,N/A," $1,136.00 ", $738.40 , $484.07 , $131.01 , $120.81 , $546.26 , $592.61 ," $1,056.48 "," $1,022.40 "," $1,022.40 ", $908.80 , $908.80 , $120.81 ," $1,048.87 "," $1,079.20 "," $1,022.40 "," $1,022.40 "," $1,022.40 "," $1,056.48 "," $1,090.56 ", $906.30 , $965.60 , $614.68 , $537.69 , N/A , $509.80 , $509.80 ," $1,079.20 ", $560.25 , $120.81 ," $1,090.56 "
Physician Telephone Evaluation 5-10 Min,CPT® 99441,N/A,N/A,N/A, $60.00 , $39.00 , $71.80 , $34.15 , $11.11 , $22.64 , $21.88 , $55.80 , $54.00 , $54.00 , $48.00 , $48.00 , $11.11 , $55.40 , $57.00 , $54.00 , $54.00 , $54.00 , $55.80 , $57.60 , $65.53 , $51.00 , $27.00 , $28.23 , $15.00 , $23.08 , $23.08 , $57.00 , $26.61 , $11.11 , $71.80 
 Skeletal Survey Infant ,CPT® 77076,0320 - DX X-RAY,N/A,N/A, $908.00 , $590.20 , $762.72 , $105.96 , $59.64 , $733.66 , $817.20 , $768.71 , $817.20 , $817.20 , $817.20 , $771.80 , $58.47 , $838.36 , $862.60 , $771.80 , $844.44 , $844.44 , $862.60 , $871.68 , $742.93 , $817.20 , $771.80 , $717.32 , N/A , $734.84 , $734.84 , $862.60 , $779.15 , $58.47 , $871.68 
 Renal Artery Duplex Scan-Complete ,CPT® 93975,0921 - PERI VASCUL LAB,N/A,N/A," $1,295.00 ", $841.75 ," $1,087.80 ", $260.97 , $229.87 ," $1,046.36 "," $1,165.50 "," $1,096.35 "," $1,165.50 "," $1,165.50 "," $1,165.50 "," $1,100.75 ", $225.36 ," $1,195.67 "," $1,230.25 "," $1,100.75 "," $1,204.35 "," $1,204.35 "," $1,230.25 "," $1,243.20 "," $1,059.57 "," $1,165.50 "," $1,100.75 "," $1,023.05 ", N/A ," $1,048.04 "," $1,048.04 "," $1,230.25 "," $1,111.24 ", $225.36 ," $1,243.20 "
 Pro Exc H-F-Nk-Sp B9+Marg > 4 Cm ,CPT® 11426,0982 - PRO FEE/OUTPT,N/A,N/A," $1,652.00 "," $1,073.80 ", $865.20 , $256.79 , $276.88 , $745.91 , $724.34 ," $1,536.36 "," $1,486.80 "," $1,486.80 "," $1,321.60 "," $1,321.60 ", $276.88 ," $1,525.29 "," $1,569.40 "," $1,486.80 "," $1,486.80 "," $1,486.80 "," $1,536.36 "," $1,585.92 ", $953.39 ," $1,404.20 "," $1,448.66 ", $954.50 , N/A , $760.46 , $760.46 ," $1,569.40 ", $881.89 , $256.79 ," $1,585.92 "
 RITUXIMAB 100 MG/10ML IV SOLN ,HCPCS J9312,0636 - DRUGS REQUIRING DETAILED CODIN,50242-0051-21,10 mL," $2,762.48 "," $1,795.61 "," $2,320.48 ", $82.66 , $83.39 ," $2,232.08 "," $2,486.23 "," $2,338.72 "," $2,486.23 "," $2,486.23 "," $2,486.23 "," $2,348.11 ", $81.75 ," $2,550.60 "," $2,624.36 "," $2,348.11 "," $2,569.11 "," $2,569.11 "," $2,624.36 "," $2,651.98 "," $2,260.26 "," $2,486.23 "," $2,348.11 "," $2,182.36 ", N/A ," $2,235.68 "," $2,235.68 "," $2,624.36 "," $2,370.48 ", $81.75 ," $2,651.98 "
"Repair Recurr Inguin Hern,Strang",49521,N/A,N/A,N/A," $4,746.00 "," $3,084.90 "," $4,277.98 ", $663.84 , $769.85 ," $3,357.69 "," $3,399.52 "," $4,413.78 "," $4,271.40 "," $4,271.40 "," $3,796.80 "," $3,796.80 ", $769.85 ," $4,381.98 "," $4,508.70 "," $4,271.40 "," $4,271.40 "," $4,271.40 "," $4,413.78 "," $4,556.16 "," $3,064.08 "," $4,034.10 "," $3,778.65 "," $3,968.11 ", N/A ," $3,423.20 "," $3,423.20 "," $4,508.70 "," $3,580.31 ", $663.84 ," $4,556.16 "
 Fac Ndl Emg Lmtd Std Musc 1 Xtr/Non-Limb Uni/Bi ,CPT® 95870,0922 - EMG,N/A,N/A, $227.00 , $147.55 , $190.68 , $81.74 , $26.12 , $183.42 , $204.30 , $192.18 , $204.30 , $204.30 , $204.30 , $192.95 , $25.61 , $209.59 , $215.65 , $192.95 , $211.11 , $211.11 , $215.65 , $217.92 , $185.73 , $204.30 , $192.95 , $179.33 , N/A , $183.71 , $183.71 , $215.65 , $194.79 , $25.61 , $217.92 
 Pro X-Ray Exam of Ribs ,CPT® 71110,0972 - PRO FEE/RAD/DX,N/A,N/A, $179.00 , $116.35 , $248.47 , $43.40 , $38.66 , $176.79 , $216.01 , $166.47 , $161.10 , $161.10 , $143.20 , $143.20 , $38.66 , $165.27 , $170.05 , $161.10 , $161.10 , $161.10 , $166.47 , $171.84 , $241.88 , $152.15 , $236.90 , $202.39 , N/A , $180.24 , $180.24 , $170.05 , $208.63 , $38.66 , $248.47 
 Fac Anoscopy Dx W/HRA &Chem Agnts Enhancement ,CPT® 46601,0360 - OR SERVICES,N/A,N/A," $1,367.00 ", $888.55 ," $1,148.28 ", $88.56 , $109.63 ," $1,104.54 "," $1,230.30 "," $1,157.30 "," $1,230.30 "," $1,230.30 "," $1,230.30 "," $1,161.95 ", $107.48 ," $1,262.15 "," $1,298.65 "," $1,161.95 "," $1,271.31 "," $1,271.31 "," $1,298.65 "," $1,312.32 "," $1,118.48 "," $1,230.30 "," $1,161.95 "," $1,079.93 ", N/A ," $1,106.31 "," $1,106.31 "," $1,298.65 "," $1,173.02 ", $88.56 ," $1,312.32 "
Complex Repair 1.1-2.5cm,13120,N/A,N/A,N/A," $1,366.00 ", $887.90 , $748.31 , $223.03 , $131.87 , $646.85 , $634.03 ," $1,270.38 "," $1,229.40 "," $1,229.40 "," $1,092.80 "," $1,092.80 ", $131.87 ," $1,261.23 "," $1,297.70 "," $1,229.40 "," $1,229.40 "," $1,229.40 "," $1,270.38 "," $1,311.36 ", $827.01 ," $1,161.10 "," $1,261.33 ", $830.94 , N/A , $659.47 , $659.47 ," $1,297.70 ", $764.75 , $131.87 ," $1,311.36 "
 SCOPOLAMINE 1 MG/3DAYS TD PT72 ,HCPCS RXC637,0250 - PHARMACY,50742-0505-10,1 patch, $118.02 , $76.71 , $99.14 , N/A , N/A , $95.36 , $106.22 , $99.92 , $106.22 , $106.22 , $106.22 , $100.32 , N/A , $108.97 , $112.12 , $100.32 , $109.76 , $109.76 , $112.12 , $113.30 , $96.56 , $106.22 , $100.32 , $93.24 , N/A , $95.51 , $95.51 , $112.12 , $101.27 , $93.24 , $113.30 
X-Ray Ribs 3 Vw Bilat,CPT® 71110,N/A,N/A,N/A, $301.00 , $195.65 , $248.47 , $43.40 , $38.66 , $176.79 , $216.01 , $279.93 , $270.90 , $270.90 , $240.80 , $240.80 , $38.66 , $277.91 , $285.95 , $270.90 , $270.90 , $270.90 , $279.93 , $288.96 , $241.88 , $255.85 , $236.90 , $202.39 , N/A , $180.24 , $180.24 , $285.95 , $208.63 , $38.66 , $288.96 
" HEPARIN SQ (GREATER THAN 5,000 UNIT) SYRINGE ",HCPCS RXA250,0250 - PHARMACY,00001-0309-01,1 mL, $50.97 , $33.13 , $42.81 , N/A , N/A , $41.18 , $45.87 , $43.15 , $45.87 , $45.87 , $45.87 , $43.32 , N/A , $47.06 , $48.42 , $43.32 , $47.40 , $47.40 , $48.42 , $48.93 , $41.70 , $45.87 , $43.32 , $40.27 , N/A , $41.25 , $41.25 , $48.42 , $43.74 , $40.27 , $48.93 
Fac Cltx Intercondylar Spi&/Tubrst Fx Kne +-Mnpj,27538,N/A,N/A,N/A," $2,318.00 "," $1,506.70 "," $2,792.79 ", $438.31 , $307.34 ," $2,139.92 "," $2,153.40 "," $2,155.74 "," $2,086.20 "," $2,086.20 "," $1,854.40 "," $1,854.40 ", $307.34 ," $2,140.21 "," $2,202.10 "," $2,086.20 "," $2,086.20 "," $2,086.20 "," $2,155.74 "," $2,225.28 "," $2,565.24 "," $1,970.30 "," $2,369.24 "," $2,529.06 ", N/A ," $2,181.67 "," $2,181.67 "," $2,202.10 "," $2,564.24 ", $307.34 ," $2,792.79 "
" Fac Assay, Glucose, Blood Quant ",CPT® 82947,0301 - LAB/CHEMISTRY,N/A,N/A, $65.00 , $42.25 , $54.60 , $4.01 , $4.01 , $52.52 , $58.50 , $55.03 , $58.50 , $58.50 , $58.50 , $55.25 , $3.93 , $60.01 , $61.75 , $55.25 , $60.45 , $60.45 , $61.75 , $62.40 , $53.18 , $58.50 , $55.25 , $51.35 , N/A , $52.60 , $52.60 , $61.75 , $55.78 , $3.93 , $62.40 
Inj Testosterone Cypionate,HCPCS J1071,N/A,N/A,N/A, $0.15 , $0.10 , N/A , $0.03 , $0.03 , N/A , N/A , $0.14 , $0.14 , $0.14 , $0.12 , $0.12 , $0.03 , $0.14 , $0.14 , $0.14 , $0.14 , $0.14 , $0.14 , $0.14 , $0.04 , $0.13 , $0.65 , $0.04 , N/A , N/A , N/A , $0.14 , N/A , $0.03 , $0.65 
"IV Infusion, Therap/Proph/Diagnost,Initial,Ea Add Hour",CPT® 96366,N/A,N/A,N/A, $126.00 , $81.90 , $48.84 , $20.12 , $21.27 , $41.66 , $49.06 , $117.18 , $113.40 , $113.40 , $100.80 , $100.80 , $21.27 , $116.34 , $119.70 , $113.40 , $113.40 , $113.40 , $117.18 , $120.96 , $80.17 , $107.10 , $64.88 , $82.85 , N/A , $42.47 , $42.47 , $119.70 , $49.50 , $20.12 , $120.96 
 Fac Expl Po Hemrrg Thrombosis/Infctj Xtr ,CPT® 35860,0360 - OR SERVICES,N/A,N/A," $4,605.00 "," $2,993.25 "," $3,868.20 ", $755.21 , $444.61 ," $3,720.84 "," $4,144.50 "," $3,898.59 "," $4,144.50 "," $4,144.50 "," $4,144.50 "," $3,914.25 ", $435.89 ," $4,251.80 "," $4,374.75 "," $3,914.25 "," $4,282.65 "," $4,282.65 "," $4,374.75 "," $4,420.80 "," $3,767.81 "," $4,144.50 "," $3,914.25 "," $3,637.95 ", N/A ," $3,726.83 "," $3,726.83 "," $4,374.75 "," $3,951.55 ", $435.89 ," $4,420.80 "
 Fac Emergency Level II ,CPT® 99282,0450 - EMERGENCY SERVICES,N/A,N/A, $562.00 , $365.30 , $472.08 , $40.13 , $25.96 , $454.10 , $505.80 , $475.79 , $505.80 , $505.80 , $505.80 , $477.70 , $25.45 , $518.89 , $533.90 , $477.70 , $522.66 , $522.66 , $533.90 , $539.52 , $459.83 , $505.80 , $477.70 , $443.98 , N/A , $454.83 , $454.83 , $533.90 , $482.25 , $25.45 , $539.52 
" Pro Repair Ing Hernia, Sliding ",CPT® 49525,0982 - PRO FEE/OUTPT,N/A,N/A," $3,730.00 "," $2,424.50 "," $3,437.14 ", $533.40 , $614.70 ," $2,688.86 "," $2,728.30 "," $3,468.90 "," $3,357.00 "," $3,357.00 "," $2,984.00 "," $2,984.00 ", $614.70 ," $3,443.91 "," $3,543.50 "," $3,357.00 "," $3,357.00 "," $3,357.00 "," $3,468.90 "," $3,580.80 "," $2,458.57 "," $3,170.50 "," $3,027.56 "," $3,176.35 ", N/A ," $2,741.32 "," $2,741.32 "," $3,543.50 "," $2,867.13 ", $533.40 ," $3,580.80 "
"Duplex Scan Extracranial,Bilat",CPT® 93880,N/A,N/A,N/A," $3,269.00 "," $2,124.85 "," $1,216.41 ", $187.12 , $169.41 ," $1,087.59 "," $1,368.20 "," $3,040.17 "," $2,942.10 "," $2,942.10 "," $2,615.20 "," $2,615.20 ", $169.41 ," $3,018.27 "," $3,105.55 "," $2,942.10 "," $2,942.10 "," $2,942.10 "," $3,040.17 "," $3,138.24 ", $858.22 ," $2,778.65 ", $727.85 , $771.42 , N/A ," $1,108.82 "," $1,108.82 "," $3,105.55 "," $1,229.13 ", $169.41 ," $3,138.24 "
 Pro Radex 1 Plne Bdy Sctj Oth/Thn Urograpy ,CPT® 76100,0972 - PRO FEE/RAD/DX,N/A,N/A, $185.00 , $120.25 , $508.89 , $88.57 , $82.25 , $440.50 , $535.95 , $172.05 , $166.50 , $166.50 , $148.00 , $148.00 , $82.25 , $170.81 , $175.75 , $166.50 , $166.50 , $166.50 , $172.05 , $177.60 , $518.25 , $157.25 , $587.44 , $461.58 , N/A , $449.09 , $449.09 , $175.75 , $519.82 , $82.25 , $587.44 
Excision Tumor Soft Tissue Back/Flank Subq 3+Cm,21931,N/A,N/A,N/A," $3,337.00 "," $2,169.05 "," $2,826.59 ", $440.04 , $385.71 ," $2,249.43 "," $2,252.29 "," $3,103.41 "," $3,003.30 "," $3,003.30 "," $2,669.60 "," $2,669.60 ", $385.71 ," $3,081.05 "," $3,170.15 "," $3,003.30 "," $3,003.30 "," $3,003.30 "," $3,103.41 "," $3,203.52 "," $2,619.84 "," $2,836.45 "," $2,495.91 "," $2,642.86 ", N/A ," $2,293.32 "," $2,293.32 "," $3,170.15 "," $2,695.47 ", $385.71 ," $3,203.52 "
X-Ray Oper Cholangiogram,CPT® 74300,N/A,N/A,N/A, $422.00 , $274.30 , $352.29 , $61.72 , $74.22 , $252.22 , $257.70 , $392.46 , $379.80 , $379.80 , $337.60 , $337.60 , $74.22 , $389.63 , $400.90 , $379.80 , $379.80 , $379.80 , $392.46 , $405.12 , $352.70 , $358.70 , $286.98 , $332.32 , N/A , $257.14 , $257.14 , $400.90 , $297.64 , $61.72 , $405.12 
"Excis Tendn/Capsule Lesn,Foot",28090,N/A,N/A,N/A," $3,132.00 "," $2,035.80 "," $1,904.44 ", $299.85 , $366.68 ," $1,519.87 "," $1,514.60 "," $2,912.76 "," $2,818.80 "," $2,818.80 "," $2,505.60 "," $2,505.60 ", $366.68 ," $2,891.78 "," $2,975.40 "," $2,818.80 "," $2,818.80 "," $2,818.80 "," $2,912.76 "," $3,006.72 "," $1,767.11 "," $2,662.20 "," $1,643.12 "," $1,801.79 ", N/A ," $1,549.53 "," $1,549.53 "," $2,975.40 "," $1,821.26 ", $299.85 ," $3,006.72 "
 BCG LIVE 50 MG IS SUSR ,HCPCS J9030,0636 - DRUGS REQUIRING DETAILED CODIN,00052-0602-02,0.2 mL, $92.37 , $60.04 , $77.59 , $2.95 , $2.93 , $74.63 , $83.13 , $78.20 , $83.13 , $83.13 , $83.13 , $78.51 , $2.87 , $85.29 , $87.75 , $78.51 , $85.90 , $85.90 , $87.75 , $88.68 , $75.58 , $83.13 , $78.51 , $72.97 , N/A , $74.76 , $74.76 , $87.75 , $79.26 , $2.87 , $88.68 
Albuterol Non-Compounded,HCPCS J7620,N/A,N/A,N/A, $24.00 , $15.60 , N/A , $0.13 , $0.13 , N/A , N/A , $22.32 , $21.60 , $21.60 , $19.20 , $19.20 , $0.13 , $22.16 , $22.80 , $21.60 , $21.60 , $21.60 , $22.32 , $23.04 , $0.16 , $20.40 , $0.65 , $0.17 , N/A , N/A , N/A , $22.80 , N/A , $0.13 , $23.04 
 Fac Sec Prq Trluml Thrmbc N-Coronary N-Intracranial ,CPT® 37186,0761 - TREATMENT ROOM,N/A,N/A," $2,236.00 "," $1,453.40 "," $1,878.24 ", $219.56 ," $1,698.65 "," $1,806.69 "," $2,012.40 "," $1,893.00 "," $2,012.40 "," $2,012.40 "," $2,012.40 "," $1,900.60 "," $1,665.34 "," $2,064.50 "," $2,124.20 "," $1,900.60 "," $2,079.48 "," $2,079.48 "," $2,124.20 "," $2,146.56 "," $1,829.50 "," $2,012.40 "," $1,900.60 "," $1,766.44 ", N/A ," $1,809.59 "," $1,809.59 "," $2,124.20 "," $1,918.71 ", $219.56 ," $2,146.56 "
Non-Waterproof Tape,HCPCS A4450,N/A,N/A,N/A, $13.00 , $8.45 , N/A , $0.14 , $0.12 , N/A , N/A , $12.09 , $11.70 , $11.70 , $10.40 , $10.40 , $0.12 , $12.00 , $12.35 , $11.70 , $11.70 , $11.70 , $12.09 , $12.48 , N/A , $11.05 , $0.65 , $0.13 , N/A , N/A , N/A , $12.35 , N/A , $0.12 , $12.48 
Ldct for Lung Ca Screen,HCPCS G0297,N/A,N/A,N/A, $334.00 , $217.10 , N/A , N/A , N/A , $366.31 , N/A , $310.62 , $300.60 , $300.60 , $267.20 , $267.20 , N/A , $308.38 , $317.30 , $300.60 , $300.60 , $300.60 , $310.62 , $320.64 , N/A , $283.90 , N/A , N/A , N/A , N/A , N/A , $317.30 , N/A , $267.20 , $366.31 
Release of Big Toe Tendn,CPT® 28240,N/A,N/A,N/A," $2,818.00 "," $1,831.70 "," $1,823.97 ", $285.40 , $230.52 ," $1,432.46 "," $1,411.39 "," $2,620.74 "," $2,536.20 "," $2,536.20 "," $2,254.40 "," $2,254.40 ", $230.52 ," $2,601.86 "," $2,677.10 "," $2,536.20 "," $2,536.20 "," $2,536.20 "," $2,620.74 "," $2,705.28 "," $1,694.92 "," $2,395.30 "," $1,527.16 "," $1,760.86 ", N/A ," $1,460.41 "," $1,460.41 "," $2,677.10 "," $1,716.49 ", $230.52 ," $2,705.28 "
"Reconstruc Toe Deform,Soft Tissue",CPT® 28313,N/A,N/A,N/A," $3,483.00 "," $2,263.95 "," $2,213.12 ", $348.37 , $615.42 ," $1,756.63 "," $1,741.32 "," $3,239.19 "," $3,134.70 "," $3,134.70 "," $2,786.40 "," $2,786.40 ", $615.42 ," $3,215.85 "," $3,308.85 "," $3,134.70 "," $3,134.70 "," $3,134.70 "," $3,239.19 "," $3,343.68 "," $2,058.22 "," $2,960.55 "," $1,898.24 "," $2,063.54 ", N/A ," $1,790.91 "," $1,790.91 "," $3,308.85 "," $2,104.96 ", $348.37 ," $3,343.68 "
 Path Her2 by Fish (Impath) -Mh ,CPT® 88365,0310 - PATHOLOGY LAB,N/A,N/A, $632.00 , $410.80 , $530.88 , $177.52 , $61.82 , $510.66 , $568.80 , $535.05 , $568.80 , $568.80 , $568.80 , $537.20 , $60.61 , $583.53 , $600.40 , $537.20 , $587.76 , $587.76 , $600.40 , $606.72 , $517.10 , $568.80 , $537.20 , $499.28 , N/A , $511.48 , $511.48 , $600.40 , $542.32 , $60.61 , $606.72 
Prq Plmt Biliary Drg Cath W/Img Gid Rs&I Externl,CPT® 47533,N/A,N/A,N/A," $8,784.00 "," $5,709.60 "," $1,620.65 ", $250.05 ," $1,058.43 "," $1,483.11 "," $1,305.89 "," $8,169.12 "," $7,905.60 "," $7,905.60 "," $7,027.20 "," $7,027.20 "," $1,058.43 "," $8,110.27 "," $8,344.80 "," $7,905.60 "," $7,905.60 "," $7,905.60 "," $8,169.12 "," $8,432.64 "," $1,169.53 "," $7,466.40 "," $1,368.25 "," $1,564.87 ", N/A ," $1,512.05 "," $1,512.05 "," $8,344.80 "," $1,581.46 ", $250.05 ," $8,432.64 "
 SUCRALFATE 1 G PO TABS ,HCPCS RXC637,0250 - PHARMACY,00093-2210-01,1 tablet, $4.12 , $2.68 , $3.46 , N/A , N/A , $3.33 , $3.71 , $3.49 , $3.71 , $3.71 , $3.71 , $3.50 , N/A , $3.80 , $3.91 , $3.50 , $3.83 , $3.83 , $3.91 , $3.96 , $3.37 , $3.71 , $3.50 , $3.25 , N/A , $3.33 , $3.33 , $3.91 , $3.54 , $3.25 , $3.96 
 TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN ,HCPCS J1071,0636 - DRUGS REQUIRING DETAILED CODIN,00409-6562-01,1 mL, $119.64 , $77.77 , $100.50 , $0.03 , $0.03 , $96.67 , $107.68 , $101.29 , $107.68 , $107.68 , $107.68 , $101.69 , $0.03 , $110.46 , $113.66 , $101.69 , $111.27 , $111.27 , $113.66 , $114.85 , $97.89 , $107.68 , $101.69 , $94.52 , N/A , $96.82 , $96.82 , $113.66 , $102.66 , $0.03 , $114.85 
 Fac Lipoprotein Blood Quan Numbers & Subclasses ,CPT® 83704,0301 - LAB/CHEMISTRY,N/A,N/A, $283.00 , $183.95 , $237.72 , $34.87 , $34.87 , $228.66 , $254.70 , $239.59 , $254.70 , $254.70 , $254.70 , $240.55 , $34.19 , $261.29 , $268.85 , $240.55 , $263.19 , $263.19 , $268.85 , $271.68 , $231.55 , $254.70 , $240.55 , $223.57 , N/A , $229.03 , $229.03 , $268.85 , $242.84 , $34.19 , $271.68 
 Fac Kras Gene Analysis Variants in Codons 12 & 13 ,CPT® 81275,0310 - PATHOLOGY LAB,N/A,N/A," $1,252.00 ", $813.80 ," $1,051.68 ", $197.12 , $161.14 ," $1,011.62 "," $1,126.80 "," $1,059.94 "," $1,126.80 "," $1,126.80 "," $1,126.80 "," $1,064.20 ", $157.98 ," $1,155.97 "," $1,189.40 "," $1,064.20 "," $1,164.36 "," $1,164.36 "," $1,189.40 "," $1,201.92 "," $1,024.39 "," $1,126.80 "," $1,064.20 ", $989.08 , N/A ," $1,013.24 "," $1,013.24 "," $1,189.40 "," $1,074.34 ", $157.98 ," $1,201.92 "
Treatmnt Superficial Wnd,12020,N/A,N/A,N/A," $1,121.00 ", $728.65 , $598.88 , $179.70 , $32.39 , $514.39 , $504.42 ," $1,042.53 "," $1,008.90 "," $1,008.90 ", $896.80 , $896.80 , $32.39 ," $1,035.02 "," $1,064.95 "," $1,008.90 "," $1,008.90 "," $1,008.90 "," $1,042.53 "," $1,076.16 ", $660.06 , $952.85 ," $1,004.43 ", $658.84 , N/A , $524.43 , $524.43 ," $1,064.95 ", $608.16 , $32.39 ," $1,076.16 "
Remove & Replace CSF Shunt,CPT® 62258,N/A,N/A,N/A," $7,020.00 "," $4,563.00 "," $5,133.80 "," $1,002.50 "," $1,060.70 "," $6,071.31 "," $5,841.45 "," $6,528.60 "," $6,318.00 "," $6,318.00 "," $5,616.00 "," $5,616.00 "," $1,060.70 "," $6,481.57 "," $6,669.00 "," $6,318.00 "," $6,318.00 "," $6,318.00 "," $6,528.60 "," $6,739.20 "," $5,552.91 "," $5,967.00 "," $5,985.54 "," $6,261.00 ", N/A ," $6,189.77 "," $6,189.77 "," $6,669.00 "," $6,640.17 "," $1,002.50 "," $6,739.20 "
"Release Tib/Fib/Ankle Flex Tendon,Ea",CPT® 27680,N/A,N/A,N/A," $4,061.00 "," $2,639.65 "," $2,574.85 ", $404.01 , $384.19 ," $2,091.70 "," $2,101.81 "," $3,776.73 "," $3,654.90 "," $3,654.90 "," $3,248.80 "," $3,248.80 ", $384.19 ," $3,749.52 "," $3,857.95 "," $3,654.90 "," $3,654.90 "," $3,654.90 "," $3,776.73 "," $3,898.56 "," $2,401.04 "," $3,451.85 "," $2,308.58 "," $2,449.22 ", N/A ," $2,132.52 "," $2,132.52 "," $3,857.95 "," $2,506.48 ", $384.19 ," $3,898.56 "
 NALTREXONE 380 MG IM SUSR ,HCPCS J2315,0636 - DRUGS REQUIRING DETAILED CODIN,65757-0300-01,4 mL," $4,675.74 "," $3,039.23 "," $3,927.62 ", $4.02 , $3.81 ," $3,778.00 "," $4,208.17 "," $3,958.48 "," $4,208.17 "," $4,208.17 "," $4,208.17 "," $3,974.38 ", $3.74 ," $4,317.11 "," $4,441.95 "," $3,974.38 "," $4,348.44 "," $4,348.44 "," $4,441.95 "," $4,488.71 "," $3,825.69 "," $4,208.17 "," $3,974.38 "," $3,693.83 ", N/A ," $3,784.08 "," $3,784.08 "," $4,441.95 "," $4,012.25 ", $3.74 ," $4,488.71 "
 KETOROLAC TROMETHAMINE 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00093-0314-01,1 tablet, $11.09 , $7.21 , $9.32 , N/A , N/A , $8.96 , $9.98 , $9.39 , $9.98 , $9.98 , $9.98 , $9.43 , N/A , $10.24 , $10.54 , $9.43 , $10.31 , $10.31 , $10.54 , $10.65 , $9.07 , $9.98 , $9.43 , $8.76 , N/A , $8.98 , $8.98 , $10.54 , $9.52 , $8.76 , $10.65 
 FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN ,HCPCS J1450,0636 - DRUGS REQUIRING DETAILED CODIN,69784-0002-06,100 mL, $36.99 , $24.04 , $31.07 , $2.73 , $2.50 , $29.89 , $33.29 , $31.32 , $33.29 , $33.29 , $33.29 , $31.44 , $2.45 , $34.15 , $35.14 , $31.44 , $34.40 , $34.40 , $35.14 , $35.51 , $30.27 , $33.29 , $31.44 , $29.22 , N/A , $29.94 , $29.94 , $35.14 , $31.74 , $2.45 , $35.51 
 Pro Removal of Anal Tags ,CPT® 46230,0975 - PRO FEE/OR,N/A,N/A," $1,800.00 "," $1,170.00 "," $1,055.93 ", $164.95 , $76.84 , $820.37 , $838.30 ," $1,674.00 "," $1,620.00 "," $1,620.00 "," $1,440.00 "," $1,440.00 ", $76.84 ," $1,661.94 "," $1,710.00 "," $1,620.00 "," $1,620.00 "," $1,620.00 "," $1,674.00 "," $1,728.00 ", $754.95 ," $1,530.00 ", $924.15 , $975.94 , N/A , $836.38 , $836.38 ," $1,710.00 ", $874.76 , $76.84 ," $1,728.00 "
Apply of Clubfoot Cast,CPT® 29450,N/A,N/A,N/A, $939.00 , $610.35 , $700.64 , $108.10 , $56.34 , $556.77 , $551.21 , $873.27 , $845.10 , $845.10 , $751.20 , $751.20 , $56.34 , $866.98 , $892.05 , $845.10 , $845.10 , $845.10 , $873.27 , $901.44 , $643.81 , $798.15 , $599.45 , $664.23 , N/A , $567.63 , $567.63 , $892.05 , $667.17 , $56.34 , $901.44 
 HYDRALAZINE HCL 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6442-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Rm Chg Nursery Level 4 ,Custom 1740000001,0174 - NURSERY LEVEL IV,N/A,N/A," $3,190.00 "," $2,073.50 "," $2,679.60 ", N/A , N/A ," $2,577.52 "," $2,871.00 "," $2,700.65 "," $2,871.00 "," $2,871.00 "," $2,871.00 "," $2,711.50 ", N/A ," $2,945.33 "," $3,030.50 "," $2,711.50 "," $2,966.70 "," $2,966.70 "," $3,030.50 "," $3,062.40 "," $2,610.06 "," $2,871.00 "," $2,711.50 "," $2,520.10 ", N/A ," $2,581.67 "," $2,581.67 "," $3,030.50 "," $2,737.34 "," $2,520.10 "," $3,062.40 "
" Pro N Block, Stellate Ganglion ",CPT® 64510,0982 - PRO FEE/OUTPT,N/A,N/A," $1,386.00 ", $900.90 , $381.37 , $74.23 , $129.25 , $412.03 , $403.28 ," $1,288.98 "," $1,247.40 "," $1,247.40 "," $1,108.80 "," $1,108.80 ", $129.25 ," $1,279.69 "," $1,316.70 "," $1,247.40 "," $1,247.40 "," $1,247.40 "," $1,288.98 "," $1,330.56 ", $411.36 ," $1,178.10 ", $394.28 , $446.07 , N/A , $420.07 , $420.07 ," $1,316.70 ", $450.63 , $74.23 ," $1,330.56 "
 Fac Plmt Seton ,CPT® 46020,0360 - OR SERVICES,N/A,N/A," $2,332.00 "," $1,515.80 "," $1,958.88 ", $109.47 , $204.23 ," $1,884.26 "," $2,098.80 "," $1,974.27 "," $2,098.80 "," $2,098.80 "," $2,098.80 "," $1,982.20 ", $200.23 ," $2,153.14 "," $2,215.40 "," $1,982.20 "," $2,168.76 "," $2,168.76 "," $2,215.40 "," $2,238.72 "," $1,908.04 "," $2,098.80 "," $1,982.20 "," $1,842.28 ", N/A ," $1,887.29 "," $1,887.29 "," $2,215.40 "," $2,001.09 ", $109.47 ," $2,238.72 "
 NEOSTIGMINE METHYLSULFATE 3 MG/3ML IV SOSY ,HCPCS J2710,0636 - DRUGS REQUIRING DETAILED CODIN,76045-0383-13,0.5 mL, $16.68 , $10.84 , $14.01 , N/A , $0.09 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.09 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.09 , $16.01 
 Pro Active Wound Care > 20 Cm ,CPT® 97598,0982 - PRO FEE/OUTPT,N/A,N/A, $209.00 , $135.85 , $56.54 , $23.51 , $55.15 , $26.06 , $22.25 , $194.37 , $188.10 , $188.10 , $167.20 , $167.20 , $55.15 , $192.97 , $198.55 , $188.10 , $188.10 , $188.10 , $194.37 , $200.64 , $75.48 , $177.65 , $33.45 , $25.64 , N/A , $26.57 , $26.57 , $198.55 , $29.54 , $22.25 , $200.64 
 OLANZAPINE 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6376-61,1 tablet, $67.89 , $44.13 , $57.03 , N/A , N/A , $54.86 , $61.10 , $57.48 , $61.10 , $61.10 , $61.10 , $57.71 , N/A , $62.68 , $64.50 , $57.71 , $63.14 , $63.14 , $64.50 , $65.17 , $55.55 , $61.10 , $57.71 , $53.63 , N/A , $54.94 , $54.94 , $64.50 , $58.26 , $53.63 , $65.17 
Open Rx Humeral Epicondylar Fx,CPT® 24575,N/A,N/A,N/A," $4,857.00 "," $3,157.05 "," $4,464.07 ", $701.15 , $614.70 ," $3,537.76 "," $3,530.52 "," $4,517.01 "," $4,371.30 "," $4,371.30 "," $3,885.60 "," $3,885.60 ", $614.70 ," $4,484.47 "," $4,614.15 "," $4,371.30 "," $4,371.30 "," $4,371.30 "," $4,517.01 "," $4,662.72 "," $4,145.30 "," $4,128.45 "," $3,894.61 "," $4,178.91 ", N/A ," $3,606.78 "," $3,606.78 "," $4,614.15 "," $4,239.27 ", $614.70 ," $4,662.72 "
Cast Sup Sht Arm Splint Plst,HCPCS Q4021,N/A,N/A,N/A, $24.00 , $15.60 , N/A , $8.17 , $4.99 , N/A , N/A , $22.32 , $21.60 , $21.60 , $19.20 , $19.20 , $4.99 , $22.16 , $22.80 , $21.60 , $21.60 , $21.60 , $22.32 , $23.04 , N/A , $20.40 , $33.74 , $7.42 , N/A , N/A , N/A , $22.80 , N/A , $4.99 , $33.74 
"Repair Flex Leg Tendon,Prim,Ea",27658,N/A,N/A,N/A," $2,504.00 "," $1,627.60 "," $2,276.69 ", $357.61 , $461.04 ," $1,822.74 "," $1,840.28 "," $2,328.72 "," $2,253.60 "," $2,253.60 "," $2,003.20 "," $2,003.20 ", $461.04 ," $2,311.94 "," $2,378.80 "," $2,253.60 "," $2,253.60 "," $2,253.60 "," $2,328.72 "," $2,403.84 "," $2,116.91 "," $2,128.40 "," $2,014.21 "," $2,144.57 ", N/A ," $1,858.31 "," $1,858.31 "," $2,378.80 "," $2,184.17 ", $357.61 ," $2,403.84 "
"Exc Skin Benig 3.1-4cm Face,Facial",11444,N/A,N/A,N/A," $1,358.00 ", $882.70 , $723.93 , $216.51 , $338.07 , $620.10 , $603.18 ," $1,262.94 "," $1,222.20 "," $1,222.20 "," $1,086.40 "," $1,086.40 ", $338.07 ," $1,253.84 "," $1,290.10 "," $1,222.20 "," $1,222.20 "," $1,222.20 "," $1,262.94 "," $1,303.68 ", $790.64 ," $1,154.30 "," $1,204.24 ", $791.21 , N/A , $632.21 , $632.21 ," $1,290.10 ", $733.14 , $216.51 ," $1,303.68 "
"Remv Vein Clot Cava-Iliac,Abd Incis",CPT® 34401,N/A,N/A,N/A," $9,326.00 "," $6,061.90 "," $8,689.66 "," $1,344.97 "," $1,075.74 "," $6,302.52 "," $6,247.41 "," $8,673.18 "," $8,393.40 "," $8,393.40 "," $7,460.80 "," $7,460.80 "," $1,075.74 "," $8,610.70 "," $8,859.70 "," $8,393.40 "," $8,393.40 "," $8,393.40 "," $8,673.18 "," $8,952.96 "," $7,970.54 "," $7,927.10 "," $7,844.53 "," $7,084.73 ", N/A ," $6,425.49 "," $6,425.49 "," $8,859.70 "," $7,299.36 "," $1,075.74 "," $8,952.96 "
Lipid Panel,CPT® 80061,N/A,N/A,N/A, $160.00 , $104.00 , N/A , $13.66 , $13.66 , $75.74 , $90.69 , $148.80 , $144.00 , $144.00 , $128.00 , $128.00 , $13.66 , $147.73 , $152.00 , $144.00 , $144.00 , $144.00 , $148.80 , $153.60 , $89.41 , $136.00 , $113.53 , $48.55 , N/A , $70.69 , $70.69 , $152.00 , $77.25 , $13.66 , $153.60 
Hepb Vaccine Adult 2/4 Dose Schedule for Im Use,CPT® 90739,N/A,N/A,N/A, $316.00 , $205.40 , N/A , $163.49 , $132.60 , $263.54 , N/A , $293.88 , $284.40 , $284.40 , $252.80 , $252.80 , $132.60 , $291.76 , $300.20 , $284.40 , $284.40 , $284.40 , $293.88 , $303.36 , $187.47 , $268.60 , $453.34 , $220.41 , N/A , $268.68 , $268.68 , $300.20 , $313.24 , $132.60 , $453.34 
Egd Transoral Endoscopic Mucosal Resection,CPT® 43254,N/A,N/A,N/A," $2,119.00 "," $1,377.35 "," $1,660.36 ", $255.85 , $211.95 ," $1,324.72 "," $1,392.74 "," $1,970.67 "," $1,907.10 "," $1,907.10 "," $1,695.20 "," $1,695.20 ", $211.95 ," $1,956.47 "," $2,013.05 "," $1,907.10 "," $1,907.10 "," $1,907.10 "," $1,970.67 "," $2,034.24 "," $1,191.11 "," $1,801.15 "," $1,405.56 "," $1,579.92 ", N/A ," $1,350.56 "," $1,350.56 "," $2,013.05 "," $1,412.55 ", $211.95 ," $2,034.24 "
 METHYLPHENIDATE HCL ER (LA) 10 MG PO CP24 ,HCPCS RXC637,0250 - PHARMACY,00781-2361-01,1 capsule, $52.77 , $34.30 , $44.33 , N/A , N/A , $42.64 , $47.49 , $44.68 , $47.49 , $47.49 , $47.49 , $44.85 , N/A , $48.72 , $50.13 , $44.85 , $49.08 , $49.08 , $50.13 , $50.66 , $43.18 , $47.49 , $44.85 , $41.69 , N/A , $42.71 , $42.71 , $50.13 , $45.28 , $41.69 , $50.66 
Tarsal Tunnel Release,CPT® 28035,N/A,N/A,N/A," $4,352.00 "," $2,828.80 "," $2,193.75 ", $347.09 , $461.04 ," $1,743.01 "," $1,734.80 "," $4,047.36 "," $3,916.80 "," $3,916.80 "," $3,481.60 "," $3,481.60 ", $461.04 ," $4,018.20 "," $4,134.40 "," $3,916.80 "," $3,916.80 "," $3,916.80 "," $4,047.36 "," $4,177.92 "," $2,046.05 "," $3,699.20 "," $1,889.32 "," $2,073.01 ", N/A ," $1,777.03 "," $1,777.03 "," $4,134.40 "," $2,088.63 ", $347.09 ," $4,177.92 "
"Echo Xthoracic,Cong Anom,Limited",CPT® 93304,N/A,N/A,N/A," $1,073.00 ", $697.45 , $999.12 , $152.66 , $170.29 , $833.18 , $732.89 , $997.89 , $965.70 , $965.70 , $858.40 , $858.40 , $170.29 , $990.70 ," $1,019.35 ", $965.70 , $965.70 , $965.70 , $997.89 ," $1,030.08 "," $1,002.75 ", $912.05 , $688.65 , $961.53 , N/A , $849.44 , $849.44 ," $1,019.35 ", $941.62 , $152.66 ," $1,030.08 "
"Placement,Seton",CPT® 46020,N/A,N/A,N/A, $834.00 , $542.10 , $699.53 , $109.47 , $204.23 ," $1,115.57 "," $1,151.67 ", $775.62 , $750.60 , $750.60 , $667.20 , $667.20 , $204.23 , $770.03 , $792.30 , $750.60 , $750.60 , $750.60 , $775.62 , $800.64 ," $1,047.15 ", $708.90 ," $1,264.90 "," $1,330.79 ", N/A ," $1,137.33 "," $1,137.33 ", $792.30 ," $1,189.53 ", $109.47 ," $1,330.79 "
 Red Blood Cell Disorders Without McC ,MS DRG V40 (FY2023) 812,N/A,N/A,N/A," $14,470.80 "," $9,406.02 "," $12,155.47 ", N/A , N/A ," $11,692.41 "," $13,023.72 "," $12,250.98 "," $13,023.72 "," $13,023.72 "," $13,023.72 "," $12,300.18 ", N/A ," $13,360.89 "," $13,747.26 "," $12,300.18 "," $13,457.84 "," $13,457.84 "," $13,747.26 "," $13,891.97 "," $11,840.01 "," $13,023.72 "," $12,300.18 "," $11,431.93 ", N/A ," $11,711.22 "," $11,711.22 "," $13,747.26 "," $12,417.39 "," $11,431.93 "," $13,891.97 "
 FLUOROMETHOLONE 0.1 % OP SUSP ,HCPCS RXC637,0250 - PHARMACY,60758-0880-05,5 mL, $477.37 , $310.29 , $400.99 , N/A , N/A , $385.71 , $429.63 , $404.14 , $429.63 , $429.63 , $429.63 , $405.76 , N/A , $440.76 , $453.50 , $405.76 , $443.95 , $443.95 , $453.50 , $458.28 , $390.58 , $429.63 , $405.76 , $377.12 , N/A , $386.34 , $386.34 , $453.50 , $409.63 , $377.12 , $458.28 
 PRAMIPEXOLE DIHYDROCHLORIDE 1 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,13668-0094-90,1 tablet, $15.16 , $9.85 , $12.73 , N/A , N/A , $12.25 , $13.64 , $12.83 , $13.64 , $13.64 , $13.64 , $12.89 , N/A , $14.00 , $14.40 , $12.89 , $14.10 , $14.10 , $14.40 , $14.55 , $12.40 , $13.64 , $12.89 , $11.98 , N/A , $12.27 , $12.27 , $14.40 , $13.01 , $11.98 , $14.55 
 Gastric Emptying ,CPT® 78264,0340 - NUCLEAR MEDICINE,N/A,N/A," $2,946.00 "," $1,914.90 "," $2,474.64 ", $302.36 , $203.93 ," $2,380.37 "," $2,651.40 "," $2,494.08 "," $2,651.40 "," $2,651.40 "," $2,651.40 "," $2,504.10 ", $199.93 ," $2,720.04 "," $2,798.70 "," $2,504.10 "," $2,739.78 "," $2,739.78 "," $2,798.70 "," $2,828.16 "," $2,410.42 "," $2,651.40 "," $2,504.10 "," $2,327.34 ", N/A ," $2,384.20 "," $2,384.20 "," $2,798.70 "," $2,527.96 ", $199.93 ," $2,828.16 "
 Fac Rp Loclzj Tum Spect W/CT 1 Area 1 Day Imaging ,CPT® 78830,0409 - OTHER IMAG SVS,N/A,N/A," $3,609.00 "," $2,345.85 "," $3,031.56 ", $439.62 , $393.09 ," $2,916.07 "," $3,248.10 "," $3,055.38 "," $3,248.10 "," $3,248.10 "," $3,248.10 "," $3,067.65 ", $385.38 ," $3,332.19 "," $3,428.55 "," $3,067.65 "," $3,356.37 "," $3,356.37 "," $3,428.55 "," $3,464.64 "," $2,952.88 "," $3,248.10 "," $3,067.65 "," $2,851.11 ", N/A ," $2,920.76 "," $2,920.76 "," $3,428.55 "," $3,096.88 ", $385.38 ," $3,464.64 "
Colonoscopy W/Biopsy Single/Multiple,CPT® 45380,N/A,N/A,N/A," $3,222.00 "," $2,094.30 "," $1,228.57 ", $189.88 , $603.31 ," $1,404.75 "," $1,401.29 "," $2,996.46 "," $2,899.80 "," $2,899.80 "," $2,577.60 "," $2,577.60 ", $603.31 ," $2,974.87 "," $3,060.90 "," $2,899.80 "," $2,899.80 "," $2,899.80 "," $2,996.46 "," $3,093.12 "," $1,727.67 "," $2,738.70 "," $1,379.08 "," $1,171.50 ", N/A ," $1,432.15 "," $1,432.15 "," $3,060.90 "," $1,651.84 ", $189.88 ," $3,093.12 "
 Fac Egd Transoral Biopsy Single/Multiple ,CPT® 43239,0360 - OR SERVICES,N/A,N/A," $2,066.00 "," $1,342.90 "," $1,735.44 ", $131.07 , $744.68 ," $1,669.33 "," $1,859.40 "," $1,749.08 "," $1,859.40 "," $1,859.40 "," $1,859.40 "," $1,756.10 ", $730.08 ," $1,907.54 "," $1,962.70 "," $1,756.10 "," $1,921.38 "," $1,921.38 "," $1,962.70 "," $1,983.36 "," $1,690.40 "," $1,859.40 "," $1,756.10 "," $1,632.14 ", N/A ," $1,672.01 "," $1,672.01 "," $1,962.70 "," $1,772.83 ", $131.07 ," $1,983.36 "
 TACROLIMUS 0.5 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-6623-61,1 capsule, $8.00 , $5.20 , $6.72 , N/A , N/A , $6.46 , $7.20 , $6.77 , $7.20 , $7.20 , $7.20 , $6.80 , N/A , $7.39 , $7.60 , $6.80 , $7.44 , $7.44 , $7.60 , $7.68 , $6.55 , $7.20 , $6.80 , $6.32 , N/A , $6.47 , $6.47 , $7.60 , $6.86 , $6.32 , $7.68 
 Fac Culture Type Immunofluoresc ,CPT® 87140,0306 - LAB/BACT-MICRO,N/A,N/A, $130.00 , $84.50 , $109.20 , $5.68 , $5.68 , $105.04 , $117.00 , $110.06 , $117.00 , $117.00 , $117.00 , $110.50 , $5.57 , $120.03 , $123.50 , $110.50 , $120.90 , $120.90 , $123.50 , $124.80 , $106.37 , $117.00 , $110.50 , $102.70 , N/A , $105.21 , $105.21 , $123.50 , $111.55 , $5.57 , $124.80 
 ACETAMINOPHEN 650 MG RE SUPP ,HCPCS RXC637,0250 - PHARMACY,45802-0730-30,1 suppository, $3.43 , $2.23 , $2.88 , N/A , N/A , $2.77 , $3.09 , $2.90 , $3.09 , $3.09 , $3.09 , $2.92 , N/A , $3.17 , $3.26 , $2.92 , $3.19 , $3.19 , $3.26 , $3.29 , $2.81 , $3.09 , $2.92 , $2.71 , N/A , $2.78 , $2.78 , $3.26 , $2.94 , $2.71 , $3.29 
 Pro Hepatobil Syst Imag Inc Gb W/Pharma Intervenj ,CPT® 78227,0972 - PRO FEE/RAD/DX,N/A,N/A, $371.00 , $241.15 ," $2,338.85 ", $399.41 , $351.35 ," $2,212.18 "," $2,716.78 ", $345.03 , $333.90 , $333.90 , $296.80 , $296.80 , $351.35 , $342.54 , $352.45 , $333.90 , $333.90 , $333.90 , $345.03 , $356.16 ," $2,439.87 ", $315.35 ," $2,985.36 "," $3,019.48 ", N/A ," $2,255.34 "," $2,255.34 ", $352.45 ," $2,610.61 ", $296.80 ," $3,019.48 "
 Fac Chemodenervation One Extremity 1-4 Muscle ,CPT® 64642,0360 - OR SERVICES,N/A,N/A," $1,341.00 ", $871.65 ," $1,126.44 ", $98.27 , $79.25 ," $1,083.53 "," $1,206.90 "," $1,135.29 "," $1,206.90 "," $1,206.90 "," $1,206.90 "," $1,139.85 ", $77.70 ," $1,238.15 "," $1,273.95 "," $1,139.85 "," $1,247.13 "," $1,247.13 "," $1,273.95 "," $1,287.36 "," $1,097.21 "," $1,206.90 "," $1,139.85 "," $1,059.39 ", N/A ," $1,085.27 "," $1,085.27 "," $1,273.95 "," $1,150.71 ", $77.70 ," $1,287.36 "
"Preventive Visit,Est,65 & Over",CPT® 99397,N/A,N/A,N/A, $405.00 , $263.25 , N/A , $130.52 , $37.32 , $217.41 , $220.24 , $376.65 , $364.50 , $364.50 , $324.00 , $324.00 , $37.32 , $373.94 , $384.75 , $364.50 , $364.50 , $364.50 , $376.65 , $388.80 , $269.36 , $344.25 , $220.53 , $217.38 , N/A , $221.66 , $221.66 , $384.75 , $266.22 , $37.32 , $388.80 
Fundal Photography,CPT® 92250,N/A,N/A,N/A, $308.00 , $200.20 , $80.75 , $36.70 , $25.41 , $137.98 , $143.47 , $286.44 , $277.20 , $277.20 , $246.40 , $246.40 , $25.41 , $284.38 , $292.60 , $277.20 , $277.20 , $277.20 , $286.44 , $295.68 , $119.58 , $261.80 , $242.28 , $120.20 , N/A , $140.67 , $140.67 , $292.60 , $167.32 , $25.41 , $295.68 
Inject Corpora Cavern Xray,CPT® 54230,N/A,N/A,N/A, $536.00 , $348.40 , $350.24 , $75.75 , $67.36 , $256.43 , $258.76 , $498.48 , $482.40 , $482.40 , $428.80 , $428.80 , $67.36 , $494.89 , $509.20 , $482.40 , $482.40 , $482.40 , $498.48 , $514.56 , $328.64 , $455.60 , $412.12 , $387.75 , N/A , $261.44 , $261.44 , $509.20 , $313.33 , $67.36 , $514.56 
 CT Destruction of C or T Facet Nerve Jts ,CPT® 64633,0360 - OR SERVICES,N/A,N/A," $3,297.00 "," $2,143.05 "," $2,769.48 ", $184.67 , $352.82 ," $2,663.98 "," $2,967.30 "," $2,791.24 "," $2,967.30 "," $2,967.30 "," $2,967.30 "," $2,802.45 ", $345.90 ," $3,044.12 "," $3,132.15 "," $2,802.45 "," $3,066.21 "," $3,066.21 "," $3,132.15 "," $3,165.12 "," $2,697.61 "," $2,967.30 "," $2,802.45 "," $2,604.63 ", N/A ," $2,668.26 "," $2,668.26 "," $3,132.15 "," $2,829.16 ", $184.67 ," $3,165.12 "
 Body Fluid Cell Count ,CPT® 89051,0300 - LABORATORY,N/A,N/A, $103.00 , $66.95 , $86.52 , $5.71 , $5.71 , $83.22 , $92.70 , $87.20 , $92.70 , $92.70 , $92.70 , $87.55 , $5.60 , $95.10 , $97.85 , $87.55 , $95.79 , $95.79 , $97.85 , $98.88 , $84.27 , $92.70 , $87.55 , $81.37 , N/A , $83.36 , $83.36 , $97.85 , $88.38 , $5.60 , $98.88 
 Pro Debride Tissue/Muscle/Bone ,CPT® 11044,0982 - PRO FEE/OUTPT,N/A,N/A," $1,788.00 "," $1,162.20 ", $710.09 , $211.81 , $318.61 , $632.19 , $613.32 ," $1,662.84 "," $1,609.20 "," $1,609.20 "," $1,430.40 "," $1,430.40 ", $318.61 ," $1,650.86 "," $1,698.60 "," $1,609.20 "," $1,609.20 "," $1,609.20 "," $1,662.84 "," $1,716.48 ", $780.34 ," $1,519.80 "," $1,231.00 ", $800.16 , N/A , $644.53 , $644.53 ," $1,698.60 ", $747.46 , $211.81 ," $1,716.48 "
" Fac Hemodialysis, One Evaluation ",CPT® 90935,0821 - HEMO/COMPOSITE,N/A,N/A," $1,585.00 "," $1,030.25 "," $1,331.40 ", $69.65 , $65.14 ," $1,280.68 "," $1,426.50 "," $1,341.86 "," $1,426.50 "," $1,426.50 "," $1,426.50 "," $1,347.25 ", $63.86 ," $1,463.43 "," $1,505.75 "," $1,347.25 "," $1,474.05 "," $1,474.05 "," $1,505.75 "," $1,521.60 "," $1,296.85 "," $1,426.50 "," $1,347.25 "," $1,252.15 ", N/A ," $1,282.74 "," $1,282.74 "," $1,505.75 "," $1,360.09 ", $63.86 ," $1,521.60 "
 ACETAMINOPHEN-CODEINE 300-30 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00406-0484-62,1 tablet, $4.71 , $3.06 , $3.96 , N/A , N/A , $3.81 , $4.24 , $3.99 , $4.24 , $4.24 , $4.24 , $4.00 , N/A , $4.35 , $4.47 , $4.00 , $4.38 , $4.38 , $4.47 , $4.52 , $3.85 , $4.24 , $4.00 , $3.72 , N/A , $3.81 , $3.81 , $4.47 , $4.04 , $3.72 , $4.52 
 Thoracic/Dorsal Spine 3 Views ,CPT® 72072,0320 - DX X-RAY,N/A,N/A, $345.00 , $224.25 , $289.80 , $38.71 , $36.41 , $278.76 , $310.50 , $292.08 , $310.50 , $310.50 , $310.50 , $293.25 , $35.70 , $318.54 , $327.75 , $293.25 , $320.85 , $320.85 , $327.75 , $331.20 , $282.28 , $310.50 , $293.25 , $272.55 , N/A , $279.21 , $279.21 , $327.75 , $296.04 , $35.70 , $331.20 
 Fac Igk@ Gene Rearrange Detect Abnormal Clonal Pop ,CPT® 81264,0310 - PATHOLOGY LAB,N/A,N/A, $332.00 , $215.80 , $278.88 , $176.18 , $166.24 , $268.26 , $298.80 , $281.07 , $298.80 , $298.80 , $298.80 , $282.20 , $162.98 , $306.54 , $315.40 , $282.20 , $308.76 , $308.76 , $315.40 , $318.72 , $271.64 , $298.80 , $282.20 , $262.28 , N/A , $268.69 , $268.69 , $315.40 , $284.89 , $162.98 , $318.72 
 Fac Fo Pip/Dip W/O Joint/Spring ,HCPCS L3927,0274 - PROSTHETIC DEV,N/A,N/A, $62.00 , $40.30 , $52.08 , $37.26 , $30.35 , $50.10 , $55.80 , $52.49 , $55.80 , $55.80 , $55.80 , $52.70 , $29.75 , $57.24 , $58.90 , $52.70 , $57.66 , $57.66 , $58.90 , $59.52 , $50.73 , $55.80 , $52.70 , $48.98 , N/A , $50.18 , $50.18 , $58.90 , $53.20 , $29.75 , $59.52 
"Excis Tongue Lesn,Ant 2/3+Clos",CPT® 41112,N/A,N/A,N/A," $2,203.00 "," $1,431.95 "," $1,508.91 ", $236.91 , $142.01 ," $1,234.74 "," $1,271.43 "," $2,048.79 "," $1,982.70 "," $1,982.70 "," $1,762.40 "," $1,762.40 ", $142.01 ," $2,034.03 "," $2,092.85 "," $1,982.70 "," $1,982.70 "," $1,982.70 "," $2,048.79 "," $2,114.88 "," $1,081.28 "," $1,872.55 "," $1,384.43 "," $1,453.26 ", N/A ," $1,258.84 "," $1,258.84 "," $2,092.85 "," $1,316.60 ", $142.01 ," $2,114.88 "
X-Ray Foot 2 Vw,CPT® 73620,N/A,N/A,N/A, $212.00 , $137.80 , $158.11 , $27.74 , $25.48 , $121.74 , $146.85 , $197.16 , $190.80 , $190.80 , $169.60 , $169.60 , $25.48 , $195.74 , $201.40 , $190.80 , $190.80 , $190.80 , $197.16 , $203.52 , $155.58 , $180.20 , $161.79 , $131.49 , N/A , $124.12 , $124.12 , $201.40 , $143.67 , $25.48 , $203.52 
Excise Ext. Hemorrhoid,46320,N/A,N/A,N/A, $748.00 , $486.20 , $692.64 , $107.89 , $165.14 , $525.60 , $539.21 , $695.64 , $673.20 , $673.20 , $598.40 , $598.40 , $165.14 , $690.63 , $710.60 , $673.20 , $673.20 , $673.20 , $695.64 , $718.08 , $493.49 , $635.80 , $594.09 , $627.81 , N/A , $535.85 , $535.85 , $710.60 , $560.45 , $107.89 , $718.08 
 Egfr Molecular Path Interp Rml G0452 ,HCPCS G0452,0310 - PATHOLOGY LAB,N/A,N/A, $77.00 , $50.05 , $64.68 , $49.22 , N/A , $62.22 , $69.30 , $65.19 , $69.30 , $69.30 , $69.30 , $65.45 , N/A , $71.09 , $73.15 , $65.45 , $71.61 , $71.61 , $73.15 , $73.92 , $63.00 , $69.30 , $65.45 , $60.83 , N/A , $62.32 , $62.32 , $73.15 , $66.07 , $49.22 , $73.92 
"Cardiac Stress Tst,Dr Superv Only",93016,N/A,N/A,N/A, $237.00 , $154.05 , $136.44 , $20.92 , $23.72 , $122.08 , $122.23 , $220.41 , $213.30 , $213.30 , $189.60 , $189.60 , $23.72 , $218.82 , $225.15 , $213.30 , $213.30 , $213.30 , $220.41 , $227.52 , $134.97 , $201.45 , $112.40 , $134.17 , N/A , $124.46 , $124.46 , $225.15 , $137.96 , $20.92 , $227.52 
 Pro Sbsq Hospital IP/Obs Care Mod Mdm 35 Minutes ,CPT® 99232,0987 - PRO FEE/HOS VIS,N/A,N/A, $239.00 , $155.35 , $142.19 , $76.95 , $35.12 , $125.33 , $124.56 , $222.27 , $215.10 , $215.10 , $191.20 , $191.20 , $35.12 , $220.67 , $227.05 , $215.10 , $215.10 , $215.10 , $222.27 , $229.44 , $181.02 , $203.15 , $154.52 , $159.28 , $104.50 , $127.78 , $127.78 , $227.05 , $147.38 , $35.12 , $229.44 
"Circumcision,Othr",54161,N/A,N/A,N/A," $1,514.00 ", $984.10 , $874.86 , $188.71 , $196.32 , $630.98 , $639.26 ," $1,408.02 "," $1,362.60 "," $1,362.60 "," $1,211.20 "," $1,211.20 ", $196.32 ," $1,397.88 "," $1,438.30 "," $1,362.60 "," $1,362.60 "," $1,362.60 "," $1,408.02 "," $1,453.44 ", $819.88 ," $1,286.90 "," $1,020.48 ", $952.70 , N/A , $643.29 , $643.29 ," $1,438.30 ", $771.01 , $188.71 ," $1,453.44 "
 CT Abd Pelvis W/Contrast ,CPT® 74177,0350 - CT SCAN,N/A,N/A," $4,652.00 "," $3,023.80 "," $3,907.68 ", $313.11 , $252.11 ," $3,758.82 "," $4,186.80 "," $3,938.38 "," $4,186.80 "," $4,186.80 "," $4,186.80 "," $3,954.20 ", $247.17 ," $4,295.19 "," $4,419.40 "," $3,954.20 "," $4,326.36 "," $4,326.36 "," $4,419.40 "," $4,465.92 "," $3,806.27 "," $4,186.80 "," $3,954.20 "," $3,675.08 ", N/A ," $3,764.86 "," $3,764.86 "," $4,419.40 "," $3,991.88 ", $247.17 ," $4,465.92 "
"Repr Bl Ves Direct,Chest",CPT® 35216,N/A,N/A,N/A," $13,122.00 "," $8,529.30 "," $12,253.54 "," $1,911.33 "," $2,378.00 "," $8,785.69 "," $8,685.82 "," $12,203.46 "," $11,809.80 "," $11,809.80 "," $10,497.60 "," $10,497.60 "," $2,378.00 "," $12,115.54 "," $12,465.90 "," $11,809.80 "," $11,809.80 "," $11,809.80 "," $12,203.46 "," $12,597.12 "," $11,313.88 "," $11,153.70 "," $10,982.70 "," $9,880.81 ", N/A ," $8,957.11 "," $8,957.11 "," $12,465.90 "," $10,175.28 "," $1,911.33 "," $12,597.12 "
Part Removal Colon W Anastomosis,CPT® 44140,N/A,N/A,N/A," $8,716.00 "," $5,665.40 "," $7,988.37 "," $1,236.44 "," $1,732.54 "," $6,310.85 "," $6,362.29 "," $8,105.88 "," $7,844.40 "," $7,844.40 "," $6,972.80 "," $6,972.80 "," $1,732.54 "," $8,047.48 "," $8,280.20 "," $7,844.40 "," $7,844.40 "," $7,844.40 "," $8,105.88 "," $8,367.36 "," $5,726.31 "," $7,408.60 "," $7,073.81 "," $7,446.99 ", N/A ," $6,433.98 "," $6,433.98 "," $8,280.20 "," $6,729.25 "," $1,236.44 "," $8,367.36 "
Assay Urine Porphyrins,CPT® 84120,N/A,N/A,N/A, $172.00 , $111.80 , N/A , $15.00 , $15.00 , $83.23 , $99.55 , $159.96 , $154.80 , $154.80 , $137.60 , $137.60 , $15.00 , $158.81 , $163.40 , $154.80 , $154.80 , $154.80 , $159.96 , $165.12 , $98.22 , $146.20 , $95.69 , $53.34 , N/A , $77.68 , $77.68 , $163.40 , $84.88 , $15.00 , $165.12 
"Ligate Fallopian Tube,Postpartum",CPT® 58605,N/A,N/A,N/A," $3,100.00 "," $2,015.00 "," $1,596.50 ", $323.07 , $298.57 ," $1,338.99 "," $1,342.83 "," $2,883.00 "," $2,790.00 "," $2,790.00 "," $2,480.00 "," $2,480.00 ", $298.57 ," $2,862.23 "," $2,945.00 "," $2,790.00 "," $2,790.00 "," $2,790.00 "," $2,883.00 "," $2,976.00 "," $1,661.40 "," $2,635.00 "," $1,762.66 "," $1,344.17 ", N/A ," $1,365.11 "," $1,365.11 "," $2,945.00 "," $1,637.37 ", $298.57 ," $2,976.00 "
Assay Nucleotidase,CPT® 83915,N/A,N/A,N/A, $187.00 , $121.55 , N/A , $11.37 , $11.37 , $63.11 , $75.48 , $173.91 , $168.30 , $168.30 , $149.60 , $149.60 , $11.37 , $172.66 , $177.65 , $168.30 , $168.30 , $168.30 , $173.91 , $179.52 , $74.45 , $158.95 , $72.98 , $40.44 , N/A , $58.90 , $58.90 , $177.65 , $64.36 , $11.37 , $179.52 
" Fac Detect Agent Nos, Dna, Amp ",CPT® 87798,0306 - LAB/BACT-MICRO,N/A,N/A, $315.00 , $204.75 , $264.60 , $35.79 , $35.79 , $254.52 , $283.50 , $266.68 , $283.50 , $283.50 , $283.50 , $267.75 , $35.09 , $290.84 , $299.25 , $267.75 , $292.95 , $292.95 , $299.25 , $302.40 , $257.73 , $283.50 , $267.75 , $248.85 , N/A , $254.93 , $254.93 , $299.25 , $270.30 , $35.09 , $302.40 
Treat Thumb Dislocation,26641,N/A,N/A,N/A," $1,822.00 "," $1,184.30 "," $2,367.82 ", $373.63 , $58.71 ," $1,653.94 "," $1,633.22 "," $1,694.46 "," $1,639.80 "," $1,639.80 "," $1,457.60 "," $1,457.60 ", $58.71 ," $1,682.25 "," $1,730.90 "," $1,639.80 "," $1,639.80 "," $1,639.80 "," $1,694.46 "," $1,749.12 "," $2,180.49 "," $1,548.70 "," $1,791.20 "," $1,971.42 ", N/A ," $1,686.21 "," $1,686.21 "," $1,730.90 "," $1,981.90 ", $58.71 ," $2,367.82 "
 Fac Removal Indwelling Ureteral Stent Prq ,CPT® 50384,0361 - OR/MINOR,N/A,N/A," $3,605.00 "," $2,343.25 "," $3,028.20 ", $215.04 ," $1,263.50 "," $2,912.84 "," $3,244.50 "," $3,051.99 "," $3,244.50 "," $3,244.50 "," $3,244.50 "," $3,064.25 "," $1,238.73 "," $3,328.50 "," $3,424.75 "," $3,064.25 "," $3,352.65 "," $3,352.65 "," $3,424.75 "," $3,460.80 "," $2,949.61 "," $3,244.50 "," $3,064.25 "," $2,847.95 ", N/A ," $2,917.53 "," $2,917.53 "," $3,424.75 "," $3,093.45 ", $215.04 ," $3,460.80 "
"Remove Foreign Body,Foot",28190,N/A,N/A,N/A," $1,705.00 "," $1,108.25 ", $821.41 , $128.35 , $42.71 , $660.87 , $659.35 ," $1,585.65 "," $1,534.50 "," $1,534.50 "," $1,364.00 "," $1,364.00 ", $42.71 ," $1,574.23 "," $1,619.75 "," $1,534.50 "," $1,534.50 "," $1,534.50 "," $1,585.65 "," $1,636.80 ", $767.83 ," $1,449.25 ", $713.63 , $787.33 , N/A , $673.77 , $673.77 ," $1,619.75 ", $791.93 , $42.71 ," $1,636.80 "
 Fac Compre Ep Eval Abltj Atr Fib Pulm Vein Isolation ,CPT® 93656,0481 - CARDIAC CATH LAB,N/A,N/A," $21,536.00 "," $13,998.40 "," $18,090.24 ", $866.04 , $824.90 ," $17,401.09 "," $19,382.40 "," $18,232.38 "," $19,382.40 "," $19,382.40 "," $19,382.40 "," $18,305.60 ", $808.73 ," $19,884.19 "," $20,459.20 "," $18,305.60 "," $20,028.48 "," $20,028.48 "," $20,459.20 "," $20,674.56 "," $17,620.76 "," $19,382.40 "," $18,305.60 "," $17,013.44 ", N/A ," $17,429.08 "," $17,429.08 "," $20,459.20 "," $18,480.04 ", $808.73 ," $20,674.56 "
Remove Intrauterine Device,58301,N/A,N/A,N/A, $571.00 , $371.15 , $309.85 , $62.49 , $89.76 , $276.75 , $274.64 , $531.03 , $513.90 , $513.90 , $456.80 , $456.80 , $89.76 , $527.20 , $542.45 , $513.90 , $513.90 , $513.90 , $531.03 , $548.16 , $326.54 , $485.35 , $362.17 , $277.36 , N/A , $282.15 , $282.15 , $542.45 , $338.42 , $62.49 , $548.16 
Drug Screening Tramadol,CPT® 80373,N/A,N/A,N/A, $194.00 , $126.10 , N/A , N/A , N/A , N/A , N/A , $180.42 , $174.60 , $174.60 , $155.20 , $155.20 , N/A , $179.12 , $184.30 , $174.60 , $174.60 , $174.60 , $180.42 , $186.24 , N/A , $164.90 , $114.69 , $67.79 , N/A , $90.04 , $90.04 , $184.30 , $98.20 , $67.79 , $186.24 
"Removal of Urethra,Male",CPT® 53215,N/A,N/A,N/A," $6,462.00 "," $4,200.30 "," $5,016.99 ", $882.14 ," $1,075.74 "," $4,541.15 "," $4,219.69 "," $6,009.66 "," $5,815.80 "," $5,815.80 "," $5,169.60 "," $5,169.60 "," $1,075.74 "," $5,966.36 "," $6,138.90 "," $5,815.80 "," $5,815.80 "," $5,815.80 "," $6,009.66 "," $6,203.52 "," $5,032.09 "," $5,492.70 "," $4,775.94 "," $5,706.15 ", N/A ," $4,629.76 "," $4,629.76 "," $6,138.90 "," $5,441.61 ", $882.14 ," $6,203.52 "
 Signs And Symptoms Without McC ,MS DRG V40 (FY2023) 948,N/A,N/A,N/A," $12,718.34 "," $8,266.92 "," $10,683.41 ", N/A , N/A ," $10,276.42 "," $11,446.51 "," $10,767.35 "," $11,446.51 "," $11,446.51 "," $11,446.51 "," $10,810.59 ", N/A ," $11,742.84 "," $12,082.42 "," $10,810.59 "," $11,828.06 "," $11,828.06 "," $12,082.42 "," $12,209.61 "," $10,406.15 "," $11,446.51 "," $10,810.59 "," $10,047.49 ", N/A ," $10,292.95 "," $10,292.95 "," $12,082.42 "," $10,913.61 "," $10,047.49 "," $12,209.61 "
 Fac Drug Test Def 8-14 Classes ,CPT® G0481,0301 - LAB/CHEMISTRY,N/A,N/A, $235.00 , $152.75 , $197.40 , $159.72 , $100.36 , $189.88 , $211.50 , $198.95 , $211.50 , $211.50 , $211.50 , $199.75 , $98.39 , $216.98 , $223.25 , $199.75 , $218.55 , $218.55 , $223.25 , $225.60 , $192.28 , $211.50 , $199.75 , $185.65 , N/A , $190.19 , $190.19 , $223.25 , $201.65 , $98.39 , $225.60 
 Pro Tendon Graft From a Distance ,CPT® 20924,0982 - PRO FEE/OUTPT,N/A,N/A," $3,973.00 "," $2,582.45 "," $3,081.78 ", $483.41 , $213.54 ," $2,455.07 "," $2,441.34 "," $3,694.89 "," $3,575.70 "," $3,575.70 "," $3,178.40 "," $3,178.40 ", $213.54 ," $3,668.27 "," $3,774.35 "," $3,575.70 "," $3,575.70 "," $3,575.70 "," $3,694.89 "," $3,814.08 "," $2,875.64 "," $3,377.05 "," $2,685.02 "," $2,894.84 ", N/A ," $2,502.98 "," $2,502.98 "," $3,774.35 "," $2,941.89 ", $213.54 ," $3,814.08 "
 TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN ,HCPCS J3260,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0306-02,2 mL, $20.90 , $13.59 , $17.56 , $2.70 , $2.77 , $16.89 , $18.81 , $17.69 , $18.81 , $18.81 , $18.81 , $17.77 , $2.72 , $19.30 , $19.86 , $17.77 , $19.44 , $19.44 , $19.86 , $20.06 , $17.10 , $18.81 , $17.77 , $16.51 , N/A , $16.91 , $16.91 , $19.86 , $17.93 , $2.70 , $20.06 
Sono Eye B-Scan,CPT® 76512,N/A,N/A,N/A, $642.00 , $417.30 , $270.51 , $47.48 , $89.10 , $449.52 , $497.27 , $597.06 , $577.80 , $577.80 , $513.60 , $513.60 , $89.10 , $592.76 , $609.90 , $577.80 , $577.80 , $577.80 , $597.06 , $616.32 , $273.28 , $545.70 , $543.14 , $423.34 , N/A , $458.29 , $458.29 , $609.90 , $530.47 , $47.48 , $616.32 
 CALCITRIOL 0.25 MCG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,60687-0345-01,1 capsule, $4.55 , $2.96 , $3.82 , N/A , N/A , $3.68 , $4.10 , $3.85 , $4.10 , $4.10 , $4.10 , $3.87 , N/A , $4.20 , $4.32 , $3.87 , $4.23 , $4.23 , $4.32 , $4.37 , $3.72 , $4.10 , $3.87 , $3.59 , N/A , $3.68 , $3.68 , $4.32 , $3.90 , $3.59 , $4.37 
 Fac Ko Elastic With Joints ,HCPCS L1810,0274 - PROSTHETIC DEV,N/A,N/A, $179.00 , $116.35 , $150.36 , $120.42 , $80.40 , $144.63 , $161.10 , $151.54 , $161.10 , $161.10 , $161.10 , $152.15 , $78.82 , $165.27 , $170.05 , $152.15 , $166.47 , $166.47 , $170.05 , $171.84 , $146.46 , $161.10 , $152.15 , $141.41 , N/A , $144.86 , $144.86 , $170.05 , $153.60 , $78.82 , $171.84 
 Fac Immunofluorescence per Spec Add Singl Antb Stain ,CPT® 88350,0312 - PATHOL/HISTOL,N/A,N/A, $292.00 , $189.80 , $245.28 , $114.53 , $57.02 , $235.94 , $262.80 , $247.21 , $262.80 , $262.80 , $262.80 , $248.20 , $55.90 , $269.60 , $277.40 , $248.20 , $271.56 , $271.56 , $277.40 , $280.32 , $238.91 , $262.80 , $248.20 , $230.68 , N/A , $236.32 , $236.32 , $277.40 , $250.57 , $55.90 , $280.32 
 Fac Esoph G-Esop Rflx Tlmtr Eltrd Plmt ,CPT® 91035,0750 - GASTR-INST SVS,N/A,N/A," $2,338.00 "," $1,519.70 "," $1,963.92 ", $455.01 , $409.86 ," $1,889.10 "," $2,104.20 "," $1,979.35 "," $2,104.20 "," $2,104.20 "," $2,104.20 "," $1,987.30 ", $401.82 ," $2,158.68 "," $2,221.10 "," $1,987.30 "," $2,174.34 "," $2,174.34 "," $2,221.10 "," $2,244.48 "," $1,912.95 "," $2,104.20 "," $1,987.30 "," $1,847.02 ", N/A ," $1,892.14 "," $1,892.14 "," $2,221.10 "," $2,006.24 ", $401.82 ," $2,244.48 "
 Pro CT Soft Tissue Neck W/O Dye ,CPT® 70490,0972 - PRO FEE/RAD/DX,N/A,N/A, $764.00 , $496.60 ," $1,068.83 ", $153.47 , $250.75 , $920.94 ," $1,170.42 ", $710.52 , $687.60 , $687.60 , $611.20 , $611.20 , $250.75 , $705.40 , $725.80 , $687.60 , $687.60 , $687.60 , $710.52 , $733.44 , $896.11 , $649.40 ," $1,276.97 "," $1,092.28 ", N/A , $938.91 , $938.91 , $725.80 ," $1,086.81 ", $153.47 ," $1,276.97 "
 Arterial Puncture - Mh ,CPT® 36600,0761 - TREATMENT ROOM,N/A,N/A, $116.00 , $75.40 , $97.44 , $14.57 , $37.12 , $93.73 , $104.40 , $98.21 , $104.40 , $104.40 , $104.40 , $98.60 , $36.39 , $107.10 , $110.20 , $98.60 , $107.88 , $107.88 , $110.20 , $111.36 , $94.91 , $104.40 , $98.60 , $91.64 , N/A , $93.88 , $93.88 , $110.20 , $99.54 , $14.57 , $111.36 
 Sarscov2 - Inf a/B Amp Prb Pbb ,CPT® 87636,0306 - LAB/BACT-MICRO,N/A,N/A, $553.00 , $359.45 , $464.52 , $145.48 , $145.48 , $446.82 , $497.70 , $468.17 , $497.70 , $497.70 , $497.70 , $470.05 , $142.63 , $510.58 , $525.35 , $470.05 , $514.29 , $514.29 , $525.35 , $530.88 , $452.46 , $497.70 , $470.05 , $436.87 , N/A , $447.54 , $447.54 , $525.35 , $474.53 , $142.63 , $530.88 
Biopsy of Floor of Mouth,CPT® 41108,N/A,N/A,N/A," $1,033.00 ", $671.45 , $557.64 , $88.46 , $76.84 , $440.21 , $452.84 , $960.69 , $929.70 , $929.70 , $826.40 , $826.40 , $76.84 , $953.77 , $981.35 , $929.70 , $929.70 , $929.70 , $960.69 , $991.68 , $401.19 , $878.05 , $494.19 , $516.43 , N/A , $448.80 , $448.80 , $981.35 , $469.39 , $76.84 , $991.68 
Rpr Aa Hernia 1st > 10 Cm Ncrc8/Strangulated,CPT® 49596,N/A,N/A,N/A," $8,397.00 "," $5,458.05 ", N/A , $936.84 , $731.20 , N/A , N/A ," $7,809.21 "," $7,557.30 "," $7,557.30 "," $6,717.60 "," $6,717.60 ", $731.20 ," $7,752.95 "," $7,977.15 "," $7,557.30 "," $7,557.30 "," $7,557.30 "," $7,809.21 "," $8,061.12 ", N/A ," $7,137.45 "," $5,419.68 ", N/A , N/A ," $4,033.18 "," $4,033.18 "," $7,977.15 "," $4,222.39 ", $731.20 ," $8,061.12 "
Treat Patellar Fracture,27520,N/A,N/A,N/A," $1,913.00 "," $1,243.45 "," $1,872.26 ", $296.68 , $195.27 ," $1,421.40 "," $1,446.93 "," $1,779.09 "," $1,721.70 "," $1,721.70 "," $1,530.40 "," $1,530.40 ", $195.27 ," $1,766.27 "," $1,817.35 "," $1,721.70 "," $1,721.70 "," $1,721.70 "," $1,779.09 "," $1,836.48 "," $1,721.73 "," $1,626.05 "," $1,589.60 "," $1,686.56 ", N/A ," $1,449.14 "," $1,449.14 "," $1,817.35 "," $1,703.25 ", $195.27 ," $1,872.26 "
 Fac Static Afo ,HCPCS L4396,0274 - PROSTHETIC DEV,N/A,N/A, $187.00 , $121.55 , $157.08 , $196.30 , $117.96 , $151.10 , $168.30 , $158.31 , $168.30 , $168.30 , $168.30 , $158.95 , $115.65 , $172.66 , $177.65 , $158.95 , $173.91 , $173.91 , $177.65 , $179.52 , $153.00 , $168.30 , $158.95 , $147.73 , N/A , $151.34 , $151.34 , $177.65 , $160.46 , $115.65 , $196.30 
Int Hrhc Transanal Hroid Dartlzj 2+ W/US Gdn,CPT® 46948,N/A,N/A,N/A," $2,851.00 "," $1,853.15 "," $2,744.37 ", $424.59 , $341.81 ," $2,047.06 ", N/A ," $2,651.43 "," $2,565.90 "," $2,565.90 "," $2,280.80 "," $2,280.80 ", $341.81 ," $2,632.33 "," $2,708.45 "," $2,565.90 "," $2,565.90 "," $2,565.90 "," $2,651.43 "," $2,736.96 "," $1,962.24 "," $2,423.35 "," $2,374.00 "," $2,492.91 ", N/A ," $2,087.01 "," $2,087.01 "," $2,708.45 "," $2,183.15 ", $341.81 ," $2,744.37 "
"Removal Foreign Body,Musc",CPT® 20525,N/A,N/A,N/A," $3,219.00 "," $2,092.35 "," $1,500.01 ", $234.49 , $305.27 ," $1,200.67 "," $1,201.07 "," $2,993.67 "," $2,897.10 "," $2,897.10 "," $2,575.20 "," $2,575.20 ", $305.27 ," $2,972.10 "," $3,058.05 "," $2,897.10 "," $2,897.10 "," $2,897.10 "," $2,993.67 "," $3,090.24 "," $1,395.55 "," $2,736.15 "," $1,323.78 "," $1,413.07 ", N/A ," $1,224.10 "," $1,224.10 "," $3,058.05 "," $1,438.75 ", $234.49 ," $3,090.24 "
 Pro Drainage of Hematoma/Fluid ,CPT® 10140,0982 - PRO FEE/OUTPT,N/A,N/A, $667.00 , $433.55 , $379.44 , $113.59 , $45.35 , $324.24 , $318.38 , $620.31 , $600.30 , $600.30 , $533.60 , $533.60 , $45.35 , $615.84 , $633.65 , $600.30 , $600.30 , $600.30 , $620.31 , $640.32 , $417.24 , $566.95 , $629.77 , $417.61 , N/A , $330.56 , $330.56 , $633.65 , $383.34 , $45.35 , $640.32 
 Fac Tcath Stent Placemt Antegrade Carotid/Innominate ,CPT® 37218,0360 - OR SERVICES,N/A,N/A," $5,183.00 "," $3,368.95 "," $4,353.72 ", $742.22 , $894.74 ," $4,187.86 "," $4,664.70 "," $4,387.93 "," $4,664.70 "," $4,664.70 "," $4,664.70 "," $4,405.55 ", $877.20 ," $4,785.46 "," $4,923.85 "," $4,405.55 "," $4,820.19 "," $4,820.19 "," $4,923.85 "," $4,975.68 "," $4,240.73 "," $4,664.70 "," $4,405.55 "," $4,094.57 ", N/A ," $4,194.60 "," $4,194.60 "," $4,923.85 "," $4,447.53 ", $742.22 ," $4,975.68 "
Immunoassay Tumor Antigen,CPT® 86316,N/A,N/A,N/A, $238.00 , $154.70 , N/A , $21.23 , $21.23 , $117.74 , $140.86 , $221.34 , $214.20 , $214.20 , $190.40 , $190.40 , $21.23 , $219.75 , $226.10 , $214.20 , $214.20 , $214.20 , $221.34 , $228.48 , $138.95 , $202.30 , $136.23 , $75.48 , N/A , $109.88 , $109.88 , $226.10 , $120.08 , $21.23 , $228.48 
Treatment Toe Fracture,CPT® 28510,N/A,N/A,N/A, $817.00 , $531.05 , $743.67 , $118.80 , $61.48 , $587.40 , $600.10 , $759.81 , $735.30 , $735.30 , $653.60 , $653.60 , $61.48 , $754.34 , $776.15 , $735.30 , $735.30 , $735.30 , $759.81 , $784.32 , $688.46 , $694.45 , $651.18 , $699.92 , N/A , $598.86 , $598.86 , $776.15 , $703.87 , $61.48 , $784.32 
 Fac Heparin Neutralization ,CPT® 85525,0305 - LAB/HEMATOLOGY,N/A,N/A, $154.00 , $100.10 , $129.36 , $12.08 , $12.08 , $124.43 , $138.60 , $130.38 , $138.60 , $138.60 , $138.60 , $130.90 , $11.84 , $142.19 , $146.30 , $130.90 , $143.22 , $143.22 , $146.30 , $147.84 , $126.00 , $138.60 , $130.90 , $121.66 , N/A , $124.63 , $124.63 , $146.30 , $132.15 , $11.84 , $147.84 
"RBC Sed Rate, Nonauto",CPT® 85651,N/A,N/A,N/A, $62.00 , $40.30 , N/A , $4.36 , $4.12 , $20.04 , $24.02 , $57.66 , $55.80 , $55.80 , $49.60 , $49.60 , $4.12 , $57.24 , $58.90 , $55.80 , $55.80 , $55.80 , $57.66 , $59.52 , $28.51 , $52.70 , $22.71 , $12.84 , N/A , $18.70 , $18.70 , $58.90 , $20.44 , $4.12 , $59.52 
 Fac Egd Intraluminal Tube/Catheter Insertion ,CPT® 43241,0360 - OR SERVICES,N/A,N/A," $1,940.00 "," $1,261.00 "," $1,629.60 ", $134.31 , $144.86 ," $1,567.52 "," $1,746.00 "," $1,642.40 "," $1,746.00 "," $1,746.00 "," $1,746.00 "," $1,649.00 ", $142.02 ," $1,791.20 "," $1,843.00 "," $1,649.00 "," $1,804.20 "," $1,804.20 "," $1,843.00 "," $1,862.40 "," $1,587.31 "," $1,746.00 "," $1,649.00 "," $1,532.60 ", N/A ," $1,570.04 "," $1,570.04 "," $1,843.00 "," $1,664.71 ", $134.31 ," $1,862.40 "
"Inj, Durolane 1 Mg",HCPCS J7318,N/A,N/A,N/A, $26.00 , $16.90 , N/A , $6.18 , $7.60 , N/A , N/A , $24.18 , $23.40 , $23.40 , $20.80 , $20.80 , $7.60 , $24.01 , $24.70 , $23.40 , $23.40 , $23.40 , $24.18 , $24.96 , N/A , $22.10 , $14.22 , $12.09 , N/A , N/A , N/A , $24.70 , N/A , $6.18 , $24.96 
 DARBEPOETIN ALFA 500 MCG/ML IJ SOSY ,HCPCS J0881,0636 - DRUGS REQUIRING DETAILED CODIN,55513-0032-01,1 mL," $11,379.01 "," $7,396.36 "," $9,558.37 ", $3.00 , $3.18 ," $9,194.24 "," $10,241.11 "," $9,633.47 "," $10,241.11 "," $10,241.11 "," $10,241.11 "," $9,672.16 ", $3.12 ," $10,506.24 "," $10,810.06 "," $9,672.16 "," $10,582.48 "," $10,582.48 "," $10,810.06 "," $10,923.85 "," $9,310.31 "," $10,241.11 "," $9,672.16 "," $8,989.42 ", N/A ," $9,209.03 "," $9,209.03 "," $10,810.06 "," $9,764.33 ", $3.00 ," $10,923.85 "
 Pro Clsd Tx Interphalangeal Jnt Dislocation W/O Anes ,CPT® 28660,0982 - PRO FEE/OUTPT,N/A,N/A, $758.00 , $492.70 , $565.96 , $89.32 , $69.38 , $431.41 , $434.98 , $704.94 , $682.20 , $682.20 , $606.40 , $606.40 , $69.38 , $699.86 , $720.10 , $682.20 , $682.20 , $682.20 , $704.94 , $727.68 , $522.51 , $644.30 , $476.35 , $510.98 , N/A , $439.83 , $439.83 , $720.10 , $516.96 , $69.38 , $727.68 
"Injection,Sacroiliac Joint",CPT® 27096,N/A,N/A,N/A," $1,152.00 ", $748.80 , $512.53 , $79.93 , $154.36 , $415.04 , $416.57 ," $1,071.36 "," $1,036.80 "," $1,036.80 ", $921.60 , $921.60 , $154.36 ," $1,063.64 "," $1,094.40 "," $1,036.80 "," $1,036.80 "," $1,036.80 "," $1,071.36 "," $1,105.92 ", $480.33 , $979.20 , $451.37 , $490.61 , N/A , $423.13 , $423.13 ," $1,094.40 ", $497.32 , $79.93 ," $1,105.92 "
"Ther Srvc,Non-Speech Gen Dev Use, W/Prog",CPT® 92609,N/A,N/A,N/A, $488.00 , $317.20 , $243.65 , $102.85 , $82.32 , $246.68 , $222.92 , $453.84 , $439.20 , $439.20 , $390.40 , $390.40 , $82.32 , $450.57 , $463.60 , $439.20 , $439.20 , $439.20 , $453.84 , $468.48 , $457.88 , $414.80 , $292.96 , $419.19 , N/A , $251.49 , $251.49 , $463.60 , $293.20 , $82.32 , $468.48 
 Sternum ,CPT® 71120,0320 - DX X-RAY,N/A,N/A, $269.00 , $174.85 , $225.96 , $33.07 , $30.96 , $217.35 , $242.10 , $227.74 , $242.10 , $242.10 , $242.10 , $228.65 , $30.35 , $248.37 , $255.55 , $228.65 , $250.17 , $250.17 , $255.55 , $258.24 , $220.10 , $242.10 , $228.65 , $212.51 , N/A , $217.70 , $217.70 , $255.55 , $230.83 , $30.35 , $258.24 
Opscpy Extnd Optic Nrv/Macula Drawing I&R Uni/Bi,CPT® 92202,N/A,N/A,N/A, $53.00 , $34.45 , $31.48 , $14.35 , $12.71 , $25.89 , N/A , $49.29 , $47.70 , $47.70 , $42.40 , $42.40 , $12.71 , $48.93 , $50.35 , $47.70 , $47.70 , $47.70 , $49.29 , $50.88 , $44.60 , $45.05 , $43.42 , $31.45 , N/A , $26.40 , $26.40 , $50.35 , $31.32 , $12.71 , $50.88 
 LACTASE 3000 UNITS PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-5224-52,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Infectious Agent Dna/Rna Influenza First 2 Types ,CPT® 87502,0306 - LAB/BACT-MICRO,N/A,N/A, $361.00 , $234.65 , $303.24 , $97.72 , $97.72 , $291.69 , $324.90 , $305.62 , $324.90 , $324.90 , $324.90 , $306.85 , $95.80 , $333.31 , $342.95 , $306.85 , $335.73 , $335.73 , $342.95 , $346.56 , $295.37 , $324.90 , $306.85 , $285.19 , N/A , $292.16 , $292.16 , $342.95 , $309.77 , $95.80 , $346.56 
Implant Neurostim/Receiver,CPT® 64590,N/A,N/A,N/A," $1,846.00 "," $1,199.90 ", $787.85 , $153.83 , $273.35 , $892.36 , $865.57 ," $1,716.78 "," $1,661.40 "," $1,661.40 "," $1,476.80 "," $1,476.80 ", $273.35 ," $1,704.41 "," $1,753.70 "," $1,661.40 "," $1,661.40 "," $1,661.40 "," $1,716.78 "," $1,772.16 ", $851.43 ," $1,569.10 ", $842.08 , $968.62 , N/A , $909.77 , $909.77 ," $1,753.70 ", $975.98 , $153.83 ," $1,772.16 "
Remove Mesh From Abd Wall,CPT® 11008,N/A,N/A,N/A," $1,717.00 "," $1,116.05 ", $839.60 , $247.58 , $258.21 , $741.30 , $709.97 ," $1,596.81 "," $1,545.30 "," $1,545.30 "," $1,373.60 "," $1,373.60 ", $258.21 ," $1,585.31 "," $1,631.15 "," $1,545.30 "," $1,545.30 "," $1,545.30 "," $1,596.81 "," $1,648.32 ", $922.00 ," $1,459.45 "," $1,439.74 ", $932.31 , N/A , $755.77 , $755.77 ," $1,631.15 ", $876.44 , $247.58 ," $1,648.32 "
 Fac Cath Plmt R Hrt & Arts W/Njx & Angio Img S&I ,CPT® 93456,0481 - CARDIAC CATH LAB,N/A,N/A," $5,748.00 "," $3,736.20 "," $4,828.32 "," $1,093.15 ", $798.55 ," $4,644.38 "," $5,173.20 "," $4,866.26 "," $5,173.20 "," $5,173.20 "," $5,173.20 "," $4,885.80 ", $782.89 ," $5,307.13 "," $5,460.60 "," $4,885.80 "," $5,345.64 "," $5,345.64 "," $5,460.60 "," $5,518.08 "," $4,703.01 "," $5,173.20 "," $4,885.80 "," $4,540.92 ", N/A ," $4,651.86 "," $4,651.86 "," $5,460.60 "," $4,932.36 ", $782.89 ," $5,518.08 "
 Fac Volatiles ,CPT® 84600,0301 - LAB/CHEMISTRY,N/A,N/A, $173.00 , $112.45 , $145.32 , $17.45 , $17.45 , $139.78 , $155.70 , $146.46 , $155.70 , $155.70 , $155.70 , $147.05 , $17.11 , $159.73 , $164.35 , $147.05 , $160.89 , $160.89 , $164.35 , $166.08 , $141.55 , $155.70 , $147.05 , $136.67 , N/A , $140.01 , $140.01 , $164.35 , $148.45 , $17.11 , $166.08 
 CHLORPROMAZINE HCL 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,50268-0163-11,1 tablet, $38.45 , $24.99 , $32.30 , N/A , N/A , $31.07 , $34.61 , $32.55 , $34.61 , $34.61 , $34.61 , $32.68 , N/A , $35.50 , $36.53 , $32.68 , $35.76 , $35.76 , $36.53 , $36.91 , $31.46 , $34.61 , $32.68 , $30.38 , N/A , $31.12 , $31.12 , $36.53 , $32.99 , $30.38 , $36.91 
Aldosterone,CPT® 82088,N/A,N/A,N/A, $365.00 , $237.25 , N/A , $41.57 , $41.57 , $230.57 , $275.82 , $339.45 , $328.50 , $328.50 , $292.00 , $292.00 , $41.57 , $337.00 , $346.75 , $328.50 , $328.50 , $328.50 , $339.45 , $350.40 , $272.10 , $310.25 , $267.60 , $147.76 , N/A , $215.18 , $215.18 , $346.75 , $235.15 , $41.57 , $350.40 
Pro Remove/Revise Cast Boot/Body,29700,N/A,N/A,N/A, $264.00 , $171.60 , $198.45 , $30.97 , $22.66 , $160.94 , $161.75 , $245.52 , $237.60 , $237.60 , $211.20 , $211.20 , $22.66 , $243.75 , $250.80 , $237.60 , $237.60 , $237.60 , $245.52 , $253.44 , $185.48 , $224.40 , $178.41 , $193.88 , N/A , $164.08 , $164.08 , $250.80 , $192.87 , $22.66 , $253.44 
 Pro Set Radiation Therapy Field ,CPT® 77290,0982 - PRO FEE/OUTPT,N/A,N/A, $526.00 , $341.90 ," $2,570.33 ", $445.32 , $340.51 ," $2,427.68 "," $2,742.62 ", $489.18 , $473.40 , $473.40 , $420.80 , $420.80 , $340.51 , $485.66 , $499.70 , $473.40 , $473.40 , $473.40 , $489.18 , $504.96 ," $2,752.71 ", $447.10 ," $3,008.48 "," $2,917.90 ", N/A ," $2,475.04 "," $2,475.04 ", $499.70 ," $2,864.91 ", $340.51 ," $3,008.48 "
 Pro Esoph Balloon Distension Tst ,CPT® 91040,0982 - PRO FEE/OUTPT,N/A,N/A," $2,252.00 "," $1,463.80 "," $1,284.26 ", $518.74 , $398.78 , $974.83 , $689.06 ," $2,094.36 "," $2,026.80 "," $2,026.80 "," $1,801.60 "," $1,801.60 ", $398.78 ," $2,079.27 "," $2,139.40 "," $2,026.80 "," $2,026.80 "," $2,026.80 "," $2,094.36 "," $2,161.92 "," $2,368.45 "," $1,914.20 ", $913.36 ," $1,699.33 ", N/A , $993.84 , $993.84 ," $2,139.40 "," $1,158.63 ", $398.78 ," $2,368.45 "
Open Rx Prox Ulna Fracture,24685,N/A,N/A,N/A," $3,825.00 "," $2,486.25 "," $3,995.68 ", $627.48 , $614.70 ," $3,150.32 "," $3,155.45 "," $3,557.25 "," $3,442.50 "," $3,442.50 "," $3,060.00 "," $3,060.00 ", $614.70 ," $3,531.62 "," $3,633.75 "," $3,442.50 "," $3,442.50 "," $3,442.50 "," $3,557.25 "," $3,672.00 "," $3,718.00 "," $3,251.25 "," $3,478.92 "," $3,726.44 ", N/A ," $3,211.79 "," $3,211.79 "," $3,633.75 "," $3,774.99 ", $614.70 ," $3,995.68 "
Imbricate Diaphragm,CPT® 39545,N/A,N/A,N/A," $5,436.00 "," $3,533.40 "," $3,585.96 ", $819.46 , $810.37 ," $3,129.13 "," $3,207.52 "," $5,055.48 "," $4,892.40 "," $4,892.40 "," $4,348.80 "," $4,348.80 ", $810.37 ," $5,019.06 "," $5,164.20 "," $4,892.40 "," $4,892.40 "," $4,892.40 "," $5,055.48 "," $5,218.56 "," $4,883.21 "," $4,620.60 "," $4,781.29 "," $4,076.35 ", N/A ," $3,190.18 "," $3,190.18 "," $5,164.20 "," $3,697.71 ", $810.37 ," $5,218.56 "
 CLOPIDOGREL BISULFATE 75 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6294-61,1 tablet, $22.41 , $14.57 , $18.82 , N/A , N/A , $18.11 , $20.17 , $18.97 , $20.17 , $20.17 , $20.17 , $19.05 , N/A , $20.69 , $21.29 , $19.05 , $20.84 , $20.84 , $21.29 , $21.51 , $18.34 , $20.17 , $19.05 , $17.70 , N/A , $18.14 , $18.14 , $21.29 , $19.23 , $17.70 , $21.51 
 Incision & Drainage Bartholins Gland Abscess - Mh ,CPT® 56420,0761 - TREATMENT ROOM,N/A,N/A, $917.00 , $596.05 , $770.28 , $107.00 , $49.34 , $740.94 , $825.30 , $776.33 , $825.30 , $825.30 , $825.30 , $779.45 , $48.37 , $846.67 , $871.15 , $779.45 , $852.81 , $852.81 , $871.15 , $880.32 , $750.29 , $825.30 , $779.45 , $724.43 , N/A , $742.13 , $742.13 , $871.15 , $786.88 , $48.37 , $880.32 
 Pro Rpr Cplx S/a/L Ea 5 Cm/< ,CPT® 13122,0982 - PRO FEE/OUTPT,N/A,N/A, $538.00 , $349.70 , $261.73 , $78.10 , $88.09 , $233.43 , $225.70 , $500.34 , $484.20 , $484.20 , $430.40 , $430.40 , $88.09 , $496.74 , $511.10 , $484.20 , $484.20 , $484.20 , $500.34 , $516.48 , $289.90 , $457.30 , $453.15 , $298.73 , N/A , $237.98 , $237.98 , $511.10 , $275.96 , $78.10 , $516.48 
Blink Reflex Test,CPT® 95933,N/A,N/A,N/A, $388.00 , $252.20 , $313.65 , $80.70 , $87.64 , $268.37 , $313.74 , $360.84 , $349.20 , $349.20 , $310.40 , $310.40 , $87.64 , $358.24 , $368.60 , $349.20 , $349.20 , $349.20 , $360.84 , $372.48 , $371.84 , $329.80 , $274.72 , $295.99 , N/A , $273.60 , $273.60 , $368.60 , $336.38 , $80.70 , $372.48 
Complex Cystometrogram W/Void Press&Urethral Profile,CPT® 51729,N/A,N/A,N/A," $3,519.00 "," $2,287.35 "," $2,189.26 ", $378.43 , $250.52 ," $1,643.19 "," $2,484.43 "," $3,272.67 "," $3,167.10 "," $3,167.10 "," $2,815.20 "," $2,815.20 ", $250.52 ," $3,249.09 "," $3,343.05 "," $3,167.10 "," $3,167.10 "," $3,167.10 "," $3,272.67 "," $3,378.24 "," $3,062.68 "," $2,991.15 "," $1,821.53 "," $2,099.02 ", N/A ," $1,675.25 "," $1,675.25 "," $3,343.05 "," $1,969.02 ", $250.52 ," $3,378.24 "
 CEFAZOLIN SODIUM 500 MG IJ SOLR ,HCPCS J0690,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9923-90,5 mL, $16.68 , $10.84 , $14.01 , $0.89 , $0.79 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.77 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.77 , $16.01 
 Fac Gentamicin ,CPT® 80170,0301 - LAB/CHEMISTRY,N/A,N/A, $152.00 , $98.80 , $127.68 , $16.71 , $16.71 , $122.82 , $136.80 , $128.68 , $136.80 , $136.80 , $136.80 , $129.20 , $16.38 , $140.34 , $144.40 , $129.20 , $141.36 , $141.36 , $144.40 , $145.92 , $124.37 , $136.80 , $129.20 , $120.08 , N/A , $123.01 , $123.01 , $144.40 , $130.43 , $16.38 , $145.92 
Aripirazole Lauroxil 1 Mg,HCPCS J1944,N/A,N/A,N/A, $4.00 , $2.60 , N/A , $3.13 , $3.04 , N/A , N/A , $3.72 , $3.60 , $3.60 , $3.20 , $3.20 , $3.04 , $3.69 , $3.80 , $3.60 , $3.60 , $3.60 , $3.72 , $3.84 , $3.77 , $3.40 , $5.82 , $3.87 , N/A , N/A , N/A , $3.80 , N/A , $3.04 , $5.82 
 Fac Lyme Disease Antibody ,CPT® 86618,0302 - LAB/IMMUNOLOGY,N/A,N/A, $174.00 , $113.10 , $146.16 , $17.37 , $17.37 , $140.59 , $156.60 , $147.31 , $156.60 , $156.60 , $156.60 , $147.90 , $17.03 , $160.65 , $165.30 , $147.90 , $161.82 , $161.82 , $165.30 , $167.04 , $142.37 , $156.60 , $147.90 , $137.46 , N/A , $140.82 , $140.82 , $165.30 , $149.31 , $17.03 , $167.04 
 Fac Drug Tst Prsmv Instrmnt Chem Analyzers PR Date ,CPT® 80307,0301 - LAB/CHEMISTRY,N/A,N/A, $118.00 , $76.70 , $99.12 , $63.38 , $63.38 , $95.34 , $106.20 , $99.90 , $106.20 , $106.20 , $106.20 , $100.30 , $62.14 , $108.95 , $112.10 , $100.30 , $109.74 , $109.74 , $112.10 , $113.28 , $96.55 , $106.20 , $100.30 , $93.22 , N/A , $95.50 , $95.50 , $112.10 , $101.26 , $62.14 , $113.28 
Iaad Ia Giardia,CPT® 87329,N/A,N/A,N/A, $111.00 , $72.15 , N/A , $12.22 , $12.22 , $67.85 , $81.18 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $12.22 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $79.99 , $94.35 , $77.85 , $43.47 , N/A , $63.32 , $63.32 , $105.45 , $69.20 , $12.22 , $106.56 
 CHLORDIAZEPOXIDE HCL 25 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00555-0159-02,1 capsule, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Surgical Arthroscopy Shoulder Lmtd Dbrdmt 1/2,29822,N/A,N/A,N/A," $2,772.00 "," $1,801.80 "," $3,304.02 ", $518.48 , $420.46 ," $2,747.80 "," $2,772.74 "," $2,577.96 "," $2,494.80 "," $2,494.80 "," $2,217.60 "," $2,217.60 ", $420.46 ," $2,559.39 "," $2,633.40 "," $2,494.80 "," $2,494.80 "," $2,494.80 "," $2,577.96 "," $2,661.12 "," $3,071.96 "," $2,356.20 "," $3,061.45 "," $3,256.81 ", N/A ," $2,801.42 "," $2,801.42 "," $2,633.40 "," $3,292.65 ", $420.46 ," $3,304.02 "
Fit/Insert Intravag Support Device,57160,N/A,N/A,N/A, $460.00 , $299.00 , $213.95 , $43.44 , $15.36 , $191.41 , $190.18 , $427.80 , $414.00 , $414.00 , $368.00 , $368.00 , $15.36 , $424.72 , $437.00 , $414.00 , $414.00 , $414.00 , $427.80 , $441.60 , $228.25 , $391.00 , $249.77 , $192.55 , N/A , $195.15 , $195.15 , $437.00 , $234.06 , $15.36 , $441.60 
 Fac Exc Xtrnl Hemorrhoid Tags&/Mlt Papillae ,CPT® 46230,0360 - OR SERVICES,N/A,N/A," $2,654.00 "," $1,725.10 "," $2,229.36 ", $164.95 , $76.84 ," $2,144.43 "," $2,388.60 "," $2,246.88 "," $2,388.60 "," $2,388.60 "," $2,388.60 "," $2,255.90 ", $75.33 ," $2,450.44 "," $2,521.30 "," $2,255.90 "," $2,468.22 "," $2,468.22 "," $2,521.30 "," $2,547.84 "," $2,171.50 "," $2,388.60 "," $2,255.90 "," $2,096.66 ", N/A ," $2,147.88 "," $2,147.88 "," $2,521.30 "," $2,277.40 ", $75.33 ," $2,547.84 "
 BENZOIN COMPOUND EX TINC ,HCPCS RXA250,0250 - PHARMACY,00395-0243-92,60 mL, $52.09 , $33.86 , $43.76 , N/A , N/A , $42.09 , $46.88 , $44.10 , $46.88 , $46.88 , $46.88 , $44.28 , N/A , $48.09 , $49.49 , $44.28 , $48.44 , $48.44 , $49.49 , $50.01 , $42.62 , $46.88 , $44.28 , $41.15 , N/A , $42.16 , $42.16 , $49.49 , $44.70 , $41.15 , $50.01 
"Excision of Nail,Permanen",11750,N/A,N/A,N/A, $813.00 , $528.45 , $330.85 , $98.28 , $111.46 , $478.76 , $468.04 , $756.09 , $731.70 , $731.70 , $650.40 , $650.40 , $111.46 , $750.64 , $772.35 , $731.70 , $731.70 , $731.70 , $756.09 , $780.48 , $362.83 , $691.05 , $918.79 , $362.76 , N/A , $488.10 , $488.10 , $772.35 , $566.03 , $98.28 , $918.79 
 Adm Moderna Sarscov2 50 Mcg/.5 Mlbst ,CPT® 0094A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , N/A , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , N/A , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $55.30 , $67.20 
Appendectomy,44950,N/A,N/A,N/A," $5,291.00 "," $3,439.15 "," $3,828.96 ", $593.06 , $549.85 ," $3,014.59 "," $3,043.40 "," $4,920.63 "," $4,761.90 "," $4,761.90 "," $4,232.80 "," $4,232.80 ", $549.85 ," $4,885.18 "," $5,026.45 "," $4,761.90 "," $4,761.90 "," $4,761.90 "," $4,920.63 "," $5,079.36 "," $2,744.68 "," $4,497.35 "," $3,386.15 "," $3,555.69 ", N/A ," $3,073.42 "," $3,073.42 "," $5,026.45 "," $3,214.46 ", $549.85 ," $5,079.36 "
 Fac Office/Outpatient Established Mod Mdm 30-39 Min ,CPT® 99214,0510 - CLINIC,N/A,N/A, $369.00 , $239.85 , $309.96 , $94.81 , $64.80 , $298.15 , $332.10 , N/A , $332.10 , $332.10 , $332.10 , $313.65 , $63.53 , $340.70 , $350.55 , $313.65 , $343.17 , $343.17 , $350.55 , $354.24 , $301.92 , $332.10 , $313.65 , $291.51 , N/A , $298.63 , $298.63 , $350.55 , $316.64 , $63.53 , $354.24 
Office/OP Consltj New/Est Pt Low Mdm 30 Minutes,CPT® 99243,N/A,N/A,N/A, $458.00 , $297.70 , N/A , $111.35 , $86.25 , $212.16 , $211.38 , $425.94 , $412.20 , $412.20 , $366.40 , $366.40 , $86.25 , $422.87 , $435.10 , $412.20 , $412.20 , $412.20 , $425.94 , $439.68 , $265.90 , $389.30 , $207.78 , $209.99 , $161.25 , $216.30 , $216.30 , $435.10 , $257.50 , $86.25 , $439.68 
 AMIODARONE HCL 100 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00245-0144-30,1 tablet, $38.17 , $24.81 , $32.06 , N/A , N/A , $30.84 , $34.35 , $32.31 , $34.35 , $34.35 , $34.35 , $32.44 , N/A , $35.24 , $36.26 , $32.44 , $35.50 , $35.50 , $36.26 , $36.64 , $31.23 , $34.35 , $32.44 , $30.15 , N/A , $30.89 , $30.89 , $36.26 , $32.75 , $30.15 , $36.64 
 Pro Optx Medial Ankle Fx ,CPT® 27766,0982 - PRO FEE/OUTPT,N/A,N/A," $4,074.00 "," $2,648.10 "," $3,702.66 ", $582.66 , $614.70 ," $2,952.59 "," $2,947.21 "," $3,788.82 "," $3,666.60 "," $3,666.60 "," $3,259.20 "," $3,259.20 ", $614.70 ," $3,761.52 "," $3,870.30 "," $3,666.60 "," $3,666.60 "," $3,666.60 "," $3,788.82 "," $3,911.04 "," $3,443.34 "," $3,462.90 "," $3,248.78 "," $3,462.61 ", N/A ," $3,010.20 "," $3,010.20 "," $3,870.30 "," $3,538.06 ", $582.66 ," $3,911.04 "
"Visual Field Exam,Limited",92081,N/A,N/A,N/A, $145.00 , $94.25 , $71.51 , $32.59 , $43.72 , $59.07 , $72.67 , $134.85 , $130.50 , $130.50 , $116.00 , $116.00 , $43.72 , $133.88 , $137.75 , $130.50 , $130.50 , $130.50 , $134.85 , $139.20 , $102.32 , $123.25 , $104.41 , $72.54 , N/A , $60.23 , $60.23 , $137.75 , $71.64 , $32.59 , $139.20 
"Excis Rectal Tumor, Transanal, Full Thickness",CPT® 45172,N/A,N/A,N/A," $5,450.00 "," $3,542.50 "," $5,051.41 ", $783.68 , $673.82 ," $3,858.08 "," $3,941.24 "," $5,068.50 "," $4,905.00 "," $4,905.00 "," $4,360.00 "," $4,360.00 ", $673.82 ," $5,031.99 "," $5,177.50 "," $4,905.00 "," $4,905.00 "," $4,905.00 "," $5,068.50 "," $5,232.00 "," $3,622.43 "," $4,632.50 "," $4,345.98 "," $4,610.68 ", N/A ," $3,933.35 "," $3,933.35 "," $5,177.50 "," $4,113.86 ", $673.82 ," $5,232.00 "
 Pro Bx/Exc Lymph Node Opn Dp Crv Node ,CPT® 38510,0982 - PRO FEE/OUTPT,N/A,N/A," $5,210.00 "," $3,386.50 "," $1,947.85 ", $395.28 , $512.47 ," $1,473.28 "," $1,516.59 "," $4,845.30 "," $4,689.00 "," $4,689.00 "," $4,168.00 "," $4,168.00 ", $512.47 ," $4,810.39 "," $4,949.50 "," $4,689.00 "," $4,689.00 "," $4,689.00 "," $4,845.30 "," $5,001.60 "," $2,076.31 "," $4,428.50 "," $2,231.86 "," $2,025.57 ", N/A ," $1,502.03 "," $1,502.03 "," $4,949.50 "," $1,742.55 ", $395.28 ," $5,001.60 "
Treat Phalangeal Fracture,26765,N/A,N/A,N/A," $3,278.00 "," $2,130.70 "," $3,092.25 ", $487.69 , $262.37 ," $2,411.56 "," $2,427.02 "," $3,048.54 "," $2,950.20 "," $2,950.20 "," $2,622.40 "," $2,622.40 ", $262.37 ," $3,026.58 "," $3,114.10 "," $2,950.20 "," $2,950.20 "," $2,950.20 "," $3,048.54 "," $3,146.88 "," $2,869.55 "," $2,786.30 "," $2,667.18 "," $2,865.11 ", N/A ," $2,458.61 "," $2,458.61 "," $3,114.10 "," $2,889.74 ", $262.37 ," $3,146.88 "
 Pro Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn ,CPT® 62323,0982 - PRO FEE/OUTPT,N/A,N/A, $821.00 , $533.65 , $490.00 , $95.03 , $290.12 , $540.47 , $529.00 , $763.53 , $738.90 , $738.90 , $656.80 , $656.80 , $290.12 , $758.03 , $779.95 , $738.90 , $738.90 , $738.90 , $763.53 , $788.16 , $530.64 , $697.85 , $518.87 , $600.56 , N/A , $551.01 , $551.01 , $779.95 , $591.10 , $95.03 , $788.16 
 Fac Path Consltj Surg Cytologic Xm 1st Sit ,CPT® 88333,0310 - PATHOLOGY LAB,N/A,N/A, $211.00 , $137.15 , $177.24 , $92.04 , $75.62 , $170.49 , $189.90 , $178.63 , $189.90 , $189.90 , $189.90 , $179.35 , $74.14 , $194.82 , $200.45 , $179.35 , $196.23 , $196.23 , $200.45 , $202.56 , $172.64 , $189.90 , $179.35 , $166.69 , N/A , $170.76 , $170.76 , $200.45 , $181.06 , $74.14 , $202.56 
 LABETALOL HCL 100 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60687-0439-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Drug Assay Salicylate ,CPT® 80179,0301 - LAB/CHEMISTRY,N/A,N/A, $159.00 , $103.35 , $133.56 , $19.01 , $15.21 , $128.47 , $143.10 , $134.61 , $143.10 , $143.10 , $143.10 , $135.15 , $14.91 , $146.80 , $151.05 , $135.15 , $147.87 , $147.87 , $151.05 , $152.64 , $130.09 , $143.10 , $135.15 , $125.61 , N/A , $128.68 , $128.68 , $151.05 , $136.44 , $14.91 , $152.64 
 Trauma 3 Activation W/O Pre-ED Notiification Lvl 1 -W/O Critical Care ,CPT® 99285,0450 - EMERGENCY SERVICES,N/A,N/A," $7,900.00 "," $5,135.00 "," $6,636.00 ", $168.76 , $44.31 ," $6,383.20 "," $7,110.00 "," $6,688.14 "," $7,110.00 "," $7,110.00 "," $7,110.00 "," $6,715.00 ", $43.44 ," $7,294.07 "," $7,505.00 "," $6,715.00 "," $7,347.00 "," $7,347.00 "," $7,505.00 "," $7,584.00 "," $6,463.78 "," $7,110.00 "," $6,715.00 "," $6,241.00 ", N/A ," $6,393.47 "," $6,393.47 "," $7,505.00 "," $6,778.99 ", $43.44 ," $7,584.00 "
Sgmdsc Flx Dired Sbmcsl Njx Any Sbst,45335,N/A,N/A,N/A," $1,997.00 "," $1,298.05 ", $405.08 , $63.40 , $158.58 , $437.97 , $452.22 ," $1,857.21 "," $1,797.30 "," $1,797.30 "," $1,597.60 "," $1,597.60 ", $158.58 ," $1,843.83 "," $1,897.15 "," $1,797.30 "," $1,797.30 "," $1,797.30 "," $1,857.21 "," $1,917.12 ", $291.64 ," $1,697.45 ", $495.97 , $384.35 , N/A , $446.51 , $446.51 ," $1,897.15 ", $467.01 , $63.40 ," $1,917.12 "
 Fac Dir Rpr Arysm&Grf Rptd Arysm Abdl Aorta Iliac ,CPT® 35103,0360 - OR SERVICES,N/A,N/A," $7,924.00 "," $5,150.60 "," $6,656.16 "," $1,970.96 "," $2,105.87 "," $6,402.59 "," $7,131.60 "," $6,708.46 "," $7,131.60 "," $7,131.60 "," $7,131.60 "," $6,735.40 "," $2,064.58 "," $7,316.23 "," $7,527.80 "," $6,735.40 "," $7,369.32 "," $7,369.32 "," $7,527.80 "," $7,607.04 "," $6,483.42 "," $7,131.60 "," $6,735.40 "," $6,259.96 ", N/A ," $6,412.89 "," $6,412.89 "," $7,527.80 "," $6,799.58 "," $1,970.96 "," $7,607.04 "
 Fac Imcytchm Tiss Immunoproxidase Ea Antb ,CPT® 88342,0310 - PATHOLOGY LAB,N/A,N/A, $430.00 , $279.50 , $361.20 , $98.62 , $54.62 , $347.44 , $387.00 , $364.04 , $387.00 , $387.00 , $387.00 , $365.50 , $53.55 , $397.02 , $408.50 , $365.50 , $399.90 , $399.90 , $408.50 , $412.80 , $351.83 , $387.00 , $365.50 , $339.70 , N/A , $348.00 , $348.00 , $408.50 , $368.98 , $53.55 , $412.80 
"Place Amniotic Membrane Ocular Surface Wound Healing, Self-Retaining",CPT® 65778,N/A,N/A,N/A," $11,050.00 "," $7,182.50 ", $334.23 , $51.74 , $53.96 , $401.29 , $373.65 ," $10,276.50 "," $9,945.00 "," $9,945.00 "," $8,840.00 "," $8,840.00 ", $53.96 ," $10,202.47 "," $10,497.50 "," $9,945.00 "," $9,945.00 "," $9,945.00 "," $10,276.50 "," $10,608.00 ", $459.84 ," $9,392.50 ", $387.14 , $405.39 , N/A , $409.13 , $409.13 ," $10,497.50 ", $451.62 , $51.74 ," $10,608.00 "
 Pro I & D of Vulva/Perineum ,CPT® 56405,0981 - PRO FEE/ER,N/A,N/A, $741.00 , $481.65 , $606.40 , $122.85 , $122.21 , $442.68 , $446.19 , $689.13 , $666.90 , $666.90 , $592.80 , $592.80 , $122.21 , $684.17 , $703.95 , $666.90 , $666.90 , $666.90 , $689.13 , $711.36 , $616.66 , $629.85 , $585.17 , $446.08 , N/A , $451.32 , $451.32 , $703.95 , $541.33 , $122.21 , $711.36 
Cystourethroscopy Inj Chemodenervation Bladder,CPT® 52287,N/A,N/A,N/A," $1,132.00 ", $735.80 , $907.75 , $159.39 , $129.26 , $828.77 , $766.41 ," $1,052.76 "," $1,018.80 "," $1,018.80 ", $905.60 , $905.60 , $129.26 ," $1,045.18 "," $1,075.40 "," $1,018.80 "," $1,018.80 "," $1,018.80 "," $1,052.76 "," $1,086.72 ", $911.85 , $962.20 , $870.62 ," $1,039.28 ", N/A , $844.94 , $844.94 ," $1,075.40 ", $993.10 , $129.26 ," $1,086.72 "
 CT Coronary Angio ,CPT® 75574,0350 - CT SCAN,N/A,N/A," $5,237.00 "," $3,404.05 "," $4,399.08 ", $286.09 , $382.14 ," $4,231.50 "," $4,713.30 "," $4,433.64 "," $4,713.30 "," $4,713.30 "," $4,713.30 "," $4,451.45 ", $374.65 ," $4,835.32 "," $4,975.15 "," $4,451.45 "," $4,870.41 "," $4,870.41 "," $4,975.15 "," $5,027.52 "," $4,284.91 "," $4,713.30 "," $4,451.45 "," $4,137.23 ", N/A ," $4,238.30 "," $4,238.30 "," $4,975.15 "," $4,493.87 ", $286.09 ," $5,027.52 "
US Breast Uni Real Time With Image Limited,CPT® 76642,N/A,N/A,N/A, $601.00 , $390.65 , $481.69 , $84.14 , $69.75 , $423.05 , $463.07 , $558.93 , $540.90 , $540.90 , $480.80 , $480.80 , $69.75 , $554.90 , $570.95 , $540.90 , $540.90 , $540.90 , $558.93 , $576.96 , $485.48 , $510.85 , $491.10 , $495.72 , N/A , $431.31 , $431.31 , $570.95 , $499.25 , $69.75 , $576.96 
 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM INJECTION (INPT) ,HCPCS 90715,0636 - DRUGS REQUIRING DETAILED CODIN,58160-0842-52,0.5 mL, $281.72 , $183.12 , $236.64 , $39.53 , $63.89 , $227.63 , $253.55 , $238.50 , $253.55 , $253.55 , $253.55 , $239.46 , $62.64 , $260.11 , $267.63 , $239.46 , $262.00 , $262.00 , $267.63 , $270.45 , $230.50 , $253.55 , $239.46 , $222.56 , N/A , $228.00 , $228.00 , $267.63 , $241.74 , $39.53 , $270.45 
 IBUTILIDE FUMARATE 1 MG/10ML IV SOLN ,HCPCS J1742,0636 - DRUGS REQUIRING DETAILED CODIN,00009-3794-22,10 mL," $3,383.25 "," $2,199.11 "," $2,841.93 ", N/A , $209.16 ," $2,733.67 "," $3,044.93 "," $2,864.26 "," $3,044.93 "," $3,044.93 "," $3,044.93 "," $2,875.76 ", $205.06 ," $3,123.75 "," $3,214.09 "," $2,875.76 "," $3,146.42 "," $3,146.42 "," $3,214.09 "," $3,247.92 "," $2,768.18 "," $3,044.93 "," $2,875.76 "," $2,672.77 ", N/A ," $2,738.06 "," $2,738.06 "," $3,214.09 "," $2,903.17 ", $205.06 ," $3,247.92 "
Apply/Remove Halo Cranial,CPT® 20661,N/A,N/A,N/A," $3,278.00 "," $2,130.70 "," $3,038.17 ", $483.08 , $586.10 ," $2,400.31 "," $2,426.05 "," $3,048.54 "," $2,950.20 "," $2,950.20 "," $2,622.40 "," $2,622.40 ", $586.10 ," $3,026.58 "," $3,114.10 "," $2,950.20 "," $2,950.20 "," $2,950.20 "," $3,048.54 "," $3,146.88 "," $2,813.03 "," $2,786.30 "," $2,713.56 "," $2,784.79 ", N/A ," $2,447.14 "," $2,447.14 "," $3,114.10 "," $2,876.27 ", $483.08 ," $3,146.88 "
 T Spine CT W/O With Contrast ,CPT® 72130,0350 - CT SCAN,N/A,N/A," $3,976.00 "," $2,584.40 "," $3,339.84 ", $203.81 , $368.56 ," $3,212.61 "," $3,578.40 "," $3,366.08 "," $3,578.40 "," $3,578.40 "," $3,578.40 "," $3,379.60 ", $361.33 ," $3,671.04 "," $3,777.20 "," $3,379.60 "," $3,697.68 "," $3,697.68 "," $3,777.20 "," $3,816.96 "," $3,253.16 "," $3,578.40 "," $3,379.60 "," $3,141.04 ", N/A ," $3,217.78 "," $3,217.78 "," $3,777.20 "," $3,411.81 ", $203.81 ," $3,816.96 "
Biopsy of Conjunctiva,CPT® 68100,N/A,N/A,N/A," $1,658.00 "," $1,077.70 ", $584.35 , $91.86 , $76.84 , $550.72 , $520.50 ," $1,541.94 "," $1,492.20 "," $1,492.20 "," $1,326.40 "," $1,326.40 ", $76.84 ," $1,530.83 "," $1,575.10 "," $1,492.20 "," $1,492.20 "," $1,492.20 "," $1,541.94 "," $1,591.68 ", $804.02 ," $1,409.30 ", $535.22 , $700.71 , N/A , $561.46 , $561.46 ," $1,575.10 ", $619.78 , $76.84 ," $1,591.68 "
" Fac Anoscopy,FB Removal ",CPT® 46608,0361 - OR/MINOR,N/A,N/A," $1,149.00 ", $746.85 , $965.16 , $77.52 , $60.48 , $928.39 ," $1,034.10 ", $972.74 ," $1,034.10 "," $1,034.10 "," $1,034.10 ", $976.65 , $59.29 ," $1,060.87 "," $1,091.55 ", $976.65 ," $1,068.57 "," $1,068.57 "," $1,091.55 "," $1,103.04 ", $940.11 ," $1,034.10 ", $976.65 , $907.71 , N/A , $929.89 , $929.89 ," $1,091.55 ", $985.96 , $59.29 ," $1,103.04 "
"Program Eval Implant Device,Pacemaker,Mult Lead",CPT® 93281,N/A,N/A,N/A, $902.00 , $586.30 , $548.41 , $83.77 , $59.19 , $369.43 , $375.61 , $838.86 , $811.80 , $811.80 , $721.60 , $721.60 , $59.19 , $832.82 , $856.90 , $811.80 , $811.80 , $811.80 , $838.86 , $865.92 , $515.08 , $766.70 , $349.68 , $240.25 , N/A , $376.65 , $376.65 , $856.90 , $417.52 , $59.19 , $865.92 
" Fac Assay of Protein, Urine ",CPT® 84156,0301 - LAB/CHEMISTRY,N/A,N/A, $68.00 , $44.20 , $57.12 , $3.74 , $3.74 , $54.94 , $61.20 , $57.57 , $61.20 , $61.20 , $61.20 , $57.80 , $3.67 , $62.78 , $64.60 , $57.80 , $63.24 , $63.24 , $64.60 , $65.28 , $55.64 , $61.20 , $57.80 , $53.72 , N/A , $55.03 , $55.03 , $64.60 , $58.35 , $3.67 , $65.28 
"Macroscopic Exam, Arthropod",CPT® 87168,N/A,N/A,N/A, $62.00 , $40.30 , N/A , $4.36 , $4.36 , $24.15 , $28.90 , $57.66 , $55.80 , $55.80 , $49.60 , $49.60 , $4.36 , $57.24 , $58.90 , $55.80 , $55.80 , $55.80 , $57.66 , $59.52 , $28.51 , $52.70 , $27.57 , $15.48 , N/A , $22.54 , $22.54 , $58.90 , $24.63 , $4.36 , $59.52 
Assay of Amylase,CPT® 82150,N/A,N/A,N/A, $92.00 , $59.80 , N/A , $6.61 , $6.61 , $36.67 , $43.87 , $85.56 , $82.80 , $82.80 , $73.60 , $73.60 , $6.61 , $84.94 , $87.40 , $82.80 , $82.80 , $82.80 , $85.56 , $88.32 , $43.27 , $78.20 , $42.17 , $23.50 , N/A , $34.22 , $34.22 , $87.40 , $37.40 , $6.61 , $88.32 
"Fusion Tendons Wrist,Fingr Extensors",CPT® 25301,N/A,N/A,N/A," $4,280.00 "," $2,782.00 "," $3,935.23 ", $618.67 , $614.70 ," $3,094.56 "," $3,087.95 "," $3,980.40 "," $3,852.00 "," $3,852.00 "," $3,424.00 "," $3,424.00 ", $614.70 ," $3,951.72 "," $4,066.00 "," $3,852.00 "," $3,852.00 "," $3,852.00 "," $3,980.40 "," $4,108.80 "," $3,661.36 "," $3,638.00 "," $3,400.43 "," $3,670.07 ", N/A ," $3,154.94 "," $3,154.94 "," $4,066.00 "," $3,708.18 ", $614.70 ," $4,108.80 "
 GLYCERIN (ADULT) 2 G RE SUPP ,HCPCS RXC637,0250 - PHARMACY,58980-0410-12,1 suppository, $12.52 , $8.14 , $10.52 , N/A , N/A , $10.12 , $11.27 , $10.60 , $11.27 , $11.27 , $11.27 , $10.64 , N/A , $11.56 , $11.89 , $10.64 , $11.64 , $11.64 , $11.89 , $12.02 , $10.24 , $11.27 , $10.64 , $9.89 , N/A , $10.13 , $10.13 , $11.89 , $10.74 , $9.89 , $12.02 
 Fac Exchange Nephrostomy Catheter Prq W/Img Gid Rs&I ,CPT® 50435,0761 - TREATMENT ROOM,N/A,N/A," $3,387.00 "," $2,201.55 "," $2,845.08 ", $94.85 , $374.42 ," $2,736.70 "," $3,048.30 "," $2,867.43 "," $3,048.30 "," $3,048.30 "," $3,048.30 "," $2,878.95 ", $367.08 ," $3,127.22 "," $3,217.65 "," $2,878.95 "," $3,149.91 "," $3,149.91 "," $3,217.65 "," $3,251.52 "," $2,771.24 "," $3,048.30 "," $2,878.95 "," $2,675.73 ", N/A ," $2,741.10 "," $2,741.10 "," $3,217.65 "," $2,906.38 ", $94.85 ," $3,251.52 "
"Remv Ext Canal F.B.,Gen Anesth",CPT® 69205,N/A,N/A,N/A, $576.00 , $374.40 , $449.55 , $92.71 , $88.68 , $486.89 , $503.30 , $535.68 , $518.40 , $518.40 , $460.80 , $460.80 , $88.68 , $531.82 , $547.20 , $518.40 , $518.40 , $518.40 , $535.68 , $552.96 , $496.80 , $489.60 , $549.49 , $489.43 , N/A , $496.39 , $496.39 , $547.20 , $566.80 , $88.68 , $566.80 
Moderna Admin Biv Booster 6 Months to 5 Years,CPT® 0164A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $56.00 , N/A , N/A , N/A , N/A , $66.50 , N/A , $38.92 , $67.20 
Simple Repair 2.6-7.5cm,CPT® 12002,N/A,N/A,N/A, $685.00 , $445.25 , $183.91 , $54.60 , $67.36 , $160.40 , $155.64 , $637.05 , $616.50 , $616.50 , $548.00 , $548.00 , $67.36 , $632.46 , $650.75 , $616.50 , $616.50 , $616.50 , $637.05 , $657.60 , $201.24 , $582.25 , $312.21 , $204.29 , N/A , $163.53 , $163.53 , $650.75 , $189.63 , $54.60 , $657.60 
 Fac Insulin Antibodies ,CPT® 86337,0302 - LAB/IMMUNOLOGY,N/A,N/A, $209.00 , $135.85 , $175.56 , $21.84 , $21.84 , $168.87 , $188.10 , $176.94 , $188.10 , $188.10 , $188.10 , $177.65 , $21.41 , $192.97 , $198.55 , $177.65 , $194.37 , $194.37 , $198.55 , $200.64 , $171.00 , $188.10 , $177.65 , $165.11 , N/A , $169.14 , $169.14 , $198.55 , $179.34 , $21.41 , $200.64 
 Aquaporin-4 Antibody Elisa Pbb ,CPT® 86051,0302 - LAB/IMMUNOLOGY,N/A,N/A, $136.00 , $88.40 , $114.24 , $11.76 , $11.76 , $109.89 , $122.40 , $115.14 , $122.40 , $122.40 , $122.40 , $115.60 , $11.53 , $125.57 , $129.20 , $115.60 , $126.48 , $126.48 , $129.20 , $130.56 , $111.28 , $122.40 , $115.60 , $107.44 , N/A , $110.06 , $110.06 , $129.20 , $116.70 , $11.53 , $130.56 
 Pro Smpl Rpr Supfc F/E/E/N/L/M 5.1cm-7.5cm ,CPT® 12014,0982 - PRO FEE/OUTPT,N/A,N/A, $597.00 , $388.05 , $232.08 , $69.01 , $92.31 , $214.79 , $208.07 , $555.21 , $537.30 , $537.30 , $477.60 , $477.60 , $92.31 , $551.21 , $567.15 , $537.30 , $537.30 , $537.30 , $555.21 , $573.12 , $255.61 , $507.45 , $417.47 , $258.60 , N/A , $218.98 , $218.98 , $567.15 , $253.95 , $69.01 , $573.12 
"Fitting of Glasses,Multifocal",CPT® 92342,N/A,N/A,N/A, $113.00 , $73.45 , N/A , $41.41 , $30.60 , $47.75 , $46.92 , $105.09 , $101.70 , $101.70 , $90.40 , $90.40 , $30.60 , $104.33 , $107.35 , $101.70 , $101.70 , $101.70 , $105.09 , $108.48 , N/A , $96.05 , $79.07 , $57.30 , N/A , $48.68 , $48.68 , $107.35 , $57.91 , $30.60 , $108.48 
"Lap,Cholecystectomy",CPT® 47562,N/A,N/A,N/A," $6,054.00 "," $3,935.10 "," $3,944.33 ", $610.67 , $630.06 ," $3,936.84 "," $3,928.65 "," $5,630.22 "," $5,448.60 "," $5,448.60 "," $4,843.20 "," $4,843.20 ", $630.06 ," $5,589.66 "," $5,751.30 "," $5,448.60 "," $5,448.60 "," $5,448.60 "," $5,630.22 "," $5,811.84 "," $4,842.72 "," $5,145.90 "," $3,477.14 "," $3,647.95 ", N/A ," $4,013.66 "," $4,013.66 "," $5,751.30 "," $4,629.35 ", $610.67 ," $5,811.84 "
 Cold Agglutinin Scr HB Lab ,CPT® 86156,0300 - LABORATORY,N/A,N/A, $57.00 , $37.05 , $47.88 , $8.23 , $8.07 , $46.06 , $51.30 , $48.26 , $51.30 , $51.30 , $51.30 , $48.45 , $7.91 , $52.63 , $54.15 , $48.45 , $53.01 , $53.01 , $54.15 , $54.72 , $46.64 , $51.30 , $48.45 , $45.03 , N/A , $46.13 , $46.13 , $54.15 , $48.91 , $7.91 , $54.72 
" Fac Immunoassay, Tumor, Ca 15-3 ",CPT® 86300,0302 - LAB/IMMUNOLOGY,N/A,N/A, $237.00 , $154.05 , $199.08 , $21.23 , $21.23 , $191.50 , $213.30 , $200.64 , $213.30 , $213.30 , $213.30 , $201.45 , $20.81 , $218.82 , $225.15 , $201.45 , $220.41 , $220.41 , $225.15 , $227.52 , $193.91 , $213.30 , $201.45 , $187.23 , N/A , $191.80 , $191.80 , $225.15 , $203.37 , $20.81 , $227.52 
 Fac Insj Intra-Aortic Balo Assist Dev Prq ,CPT® 33967,0360 - OR SERVICES,N/A,N/A," $4,999.00 "," $3,249.35 "," $4,199.16 ", $232.33 , $250.47 ," $4,039.19 "," $4,499.10 "," $4,232.15 "," $4,499.10 "," $4,499.10 "," $4,499.10 "," $4,249.15 ", $245.56 ," $4,615.58 "," $4,749.05 "," $4,249.15 "," $4,649.07 "," $4,649.07 "," $4,749.05 "," $4,799.04 "," $4,090.18 "," $4,499.10 "," $4,249.15 "," $3,949.21 ", N/A ," $4,045.69 "," $4,045.69 "," $4,749.05 "," $4,289.64 ", $232.33 ," $4,799.04 "
 MIDAZOLAM HCL 2 MG/ML PO SYRP ,HCPCS RXC637,0250 - PHARMACY,68094-0764-62,1 mL, $13.01 , $8.46 , $10.93 , N/A , N/A , $10.51 , $11.71 , $11.01 , $11.71 , $11.71 , $11.71 , $11.06 , N/A , $12.01 , $12.36 , $11.06 , $12.10 , $12.10 , $12.36 , $12.49 , $10.64 , $11.71 , $11.06 , $10.28 , N/A , $10.53 , $10.53 , $12.36 , $11.16 , $10.28 , $12.49 
Insj Tun Vad Req 2 Cath 2 Sits W/Subq Port,36566,N/A,N/A,N/A," $2,913.00 "," $1,893.45 "," $2,149.55 ", $332.35 ," $1,089.36 "," $1,666.24 "," $1,643.26 "," $2,709.09 "," $2,621.70 "," $2,621.70 "," $2,330.40 "," $2,330.40 "," $1,089.36 "," $2,689.57 "," $2,767.35 "," $2,621.70 "," $2,621.70 "," $2,621.70 "," $2,709.09 "," $2,796.48 "," $1,978.94 "," $2,476.05 "," $2,053.46 "," $1,786.63 ", N/A ," $1,698.75 "," $1,698.75 "," $2,767.35 "," $1,929.76 ", $332.35 ," $2,796.48 "
 Fac Pml/Raralpha Common Breakpoints Qual/Quant ,CPT® 81315,0310 - PATHOLOGY LAB,N/A,N/A," $1,951.00 "," $1,268.15 "," $1,638.84 ", $211.46 , $211.46 ," $1,576.41 "," $1,755.90 "," $1,651.72 "," $1,755.90 "," $1,755.90 "," $1,755.90 "," $1,658.35 ", $207.31 ," $1,801.36 "," $1,853.45 "," $1,658.35 "," $1,814.43 "," $1,814.43 "," $1,853.45 "," $1,872.96 "," $1,596.31 "," $1,755.90 "," $1,658.35 "," $1,541.29 ", N/A ," $1,578.94 "," $1,578.94 "," $1,853.45 "," $1,674.15 ", $207.31 ," $1,872.96 "
 Chest US to Include Mediastinum ,CPT® 76604,0402 - ULTRASOUND,N/A,N/A, $507.00 , $329.55 , $425.88 , $55.74 , $82.61 , $409.66 , $456.30 , $429.23 , $456.30 , $456.30 , $456.30 , $430.95 , $80.99 , $468.11 , $481.65 , $430.95 , $471.51 , $471.51 , $481.65 , $486.72 , $414.83 , $456.30 , $430.95 , $400.53 , N/A , $410.32 , $410.32 , $481.65 , $435.06 , $55.74 , $486.72 
" Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC ",MS DRG V40 (FY2023) 391,N/A,N/A,N/A," $24,779.26 "," $16,106.52 "," $20,814.58 ", N/A , N/A ," $20,021.64 "," $22,301.33 "," $20,978.12 "," $22,301.33 "," $22,301.33 "," $22,301.33 "," $21,062.37 ", N/A ," $22,878.69 "," $23,540.30 "," $21,062.37 "," $23,044.71 "," $23,044.71 "," $23,540.30 "," $23,788.09 "," $20,274.39 "," $22,301.33 "," $21,062.37 "," $19,575.62 ", N/A ," $20,053.86 "," $20,053.86 "," $23,540.30 "," $21,263.08 "," $19,575.62 "," $23,788.09 "
Thor Rib Belt Custom Fabrica,HCPCS L0220,N/A,N/A,N/A, $176.00 , $114.40 , N/A , $151.11 , $112.93 , N/A , N/A , $163.68 , $158.40 , $158.40 , $140.80 , $140.80 , $112.93 , $162.50 , $167.20 , $158.40 , $158.40 , $158.40 , $163.68 , $168.96 , N/A , $149.60 , $123.91 , $127.15 , N/A , N/A , N/A , $167.20 , N/A , $112.93 , $168.96 
Upg Pacemaker Sys Convert 1chmbr Sys 2chmbr Sys,CPT® 33214,N/A,N/A,N/A," $2,989.00 "," $1,942.85 "," $2,855.84 ", $442.58 , $725.22 ," $2,083.40 "," $2,026.65 "," $2,779.77 "," $2,690.10 "," $2,690.10 "," $2,391.20 "," $2,391.20 ", $725.22 ," $2,759.74 "," $2,839.55 "," $2,690.10 "," $2,690.10 "," $2,690.10 "," $2,779.77 "," $2,869.44 "," $2,642.27 "," $2,540.65 "," $2,544.08 "," $2,318.12 ", N/A ," $2,124.05 "," $2,124.05 "," $2,839.55 "," $2,412.91 ", $442.58 ," $2,869.44 "
Removal Deep Implant,20680,N/A,N/A,N/A," $4,124.00 "," $2,680.60 "," $2,551.97 ", $400.31 , $233.67 ," $2,051.77 "," $2,058.74 "," $3,835.32 "," $3,711.60 "," $3,711.60 "," $3,299.20 "," $3,299.20 ", $233.67 ," $3,807.69 "," $3,917.80 "," $3,711.60 "," $3,711.60 "," $3,711.60 "," $3,835.32 "," $3,959.04 "," $2,378.32 "," $3,505.40 "," $2,265.76 "," $2,423.60 ", N/A ," $2,091.80 "," $2,091.80 "," $3,917.80 "," $2,458.61 ", $233.67 ," $3,959.04 "
IP/Obs Consltj New/Est Pt Mod Mdm 60 Minutes,CPT® 99254,N/A,N/A,N/A, $625.00 , $406.25 , N/A , $136.25 , $96.53 , $364.57 , $363.08 , $581.25 , $562.50 , $562.50 , $500.00 , $500.00 , $96.53 , $577.06 , $593.75 , $562.50 , $562.50 , $562.50 , $581.25 , $600.00 , $464.02 , $531.25 , $352.55 , $366.73 , $174.75 , $371.69 , $371.69 , $593.75 , $442.48 , $96.53 , $600.00 
Optx Dstl Radl X-Artic Fx/Epiphysl Sep,CPT® 25607,N/A,N/A,N/A," $2,326.00 "," $1,511.90 "," $4,513.34 ", $710.41 , $535.03 ," $3,538.70 "," $3,537.04 "," $2,163.18 "," $2,093.40 "," $2,093.40 "," $1,860.80 "," $1,860.80 ", $535.03 ," $2,147.60 "," $2,209.70 "," $2,093.40 "," $2,093.40 "," $2,093.40 "," $2,163.18 "," $2,232.96 "," $4,189.23 "," $1,977.10 "," $3,898.18 "," $4,186.72 ", N/A ," $3,607.75 "," $3,607.75 "," $2,209.70 "," $4,240.40 ", $535.03 ," $4,513.34 "
 Pro Exc Face-Mm Malig+Marg 1.1-2 ,CPT® 11642,0982 - PRO FEE/OUTPT,N/A,N/A," $1,514.00 ", $984.10 , $582.11 , $174.71 , $228.52 , $502.44 , $491.79 ," $1,408.02 "," $1,362.60 "," $1,362.60 "," $1,211.20 "," $1,211.20 ", $228.52 ," $1,397.88 "," $1,438.30 "," $1,362.60 "," $1,362.60 "," $1,362.60 "," $1,408.02 "," $1,453.44 ", $637.97 ," $1,286.90 ", $977.67 , $643.58 , N/A , $512.24 , $512.24 ," $1,438.30 ", $594.04 , $174.71 ," $1,453.44 "
 Pro Office/Outpatient New Low Mdm 30-44 Minutes ,CPT® 99203,0982 - PRO FEE/OUTPT,N/A,N/A, $291.00 , $189.15 , $165.80 , $79.48 , $75.25 , $131.82 , $131.48 , $270.63 , $261.90 , $261.90 , $232.80 , $232.80 , $75.25 , $268.68 , $276.45 , $261.90 , $261.90 , $261.90 , $270.63 , $279.36 , $150.96 , $247.35 , $165.77 , $165.41 , $52.50 , $134.39 , $134.39 , $276.45 , $155.01 , $52.50 , $279.36 
 Pro Rmvl Impacted Cerumen Spx 1/Bth Ears ,CPT® 69210,0981 - PRO FEE/ER,N/A,N/A, $116.00 , $75.40 , $154.15 , $31.15 , $14.13 , $157.99 , $157.57 , $107.88 , $104.40 , $104.40 , $92.80 , $92.80 , $14.13 , $107.10 , $110.20 , $104.40 , $104.40 , $104.40 , $107.88 , $111.36 , $170.16 , $98.60 , $171.27 , $161.15 , N/A , $161.08 , $161.08 , $110.20 , $183.90 , $14.13 , $183.90 
 Fac Ercp Dx Collection Specimen Brushing/Washing ,CPT® 43260,0360 - OR SERVICES,N/A,N/A," $4,252.00 "," $2,763.80 "," $3,571.68 ", $305.03 , $325.31 ," $3,435.62 "," $3,826.80 "," $3,599.74 "," $3,826.80 "," $3,826.80 "," $3,826.80 "," $3,614.20 ", $318.93 ," $3,925.87 "," $4,039.40 "," $3,614.20 "," $3,954.36 "," $3,954.36 "," $4,039.40 "," $4,081.92 "," $3,478.99 "," $3,826.80 "," $3,614.20 "," $3,359.08 ", N/A ," $3,441.14 "," $3,441.14 "," $4,039.40 "," $3,648.64 ", $305.03 ," $4,081.92 "
"Ureteroileal Conduit,W/Bowel Anastomosis",CPT® 50820,N/A,N/A,N/A," $9,122.00 "," $5,929.30 "," $7,075.03 "," $1,244.12 "," $1,300.82 "," $6,433.98 "," $5,988.99 "," $8,483.46 "," $8,209.80 "," $8,209.80 "," $7,297.60 "," $7,297.60 "," $1,300.82 "," $8,422.34 "," $8,665.90 "," $8,209.80 "," $8,209.80 "," $8,209.80 "," $8,483.46 "," $8,757.12 "," $7,110.24 "," $7,753.70 "," $6,807.99 "," $8,056.60 ", N/A ," $6,559.52 "," $6,559.52 "," $8,665.90 "," $7,709.77 "," $1,244.12 "," $8,757.12 "
Screening Mammography Bi 2-View Breast Inc Cad,CPT® 77067,N/A,N/A,N/A, $666.00 , $432.90 , $726.51 , $126.63 , $108.04 , $629.01 , $696.92 , $619.38 , $599.40 , $599.40 , $532.80 , $532.80 , $108.04 , $614.92 , $632.70 , $599.40 , $599.40 , $599.40 , $619.38 , $639.36 , $727.53 , $566.10 , $738.57 , $745.21 , N/A , $641.28 , $641.28 , $632.70 , $742.30 , $108.04 , $745.21 
" Fac Cytopath, C/V, Thin Layer ",CPT® 88142,0310 - PATHOLOGY LAB,N/A,N/A, $228.00 , $148.20 , $191.52 , $20.67 , $20.67 , $184.22 , $205.20 , $193.02 , $205.20 , $205.20 , $205.20 , $193.80 , $20.26 , $210.51 , $216.60 , $193.80 , $212.04 , $212.04 , $216.60 , $218.88 , $186.55 , $205.20 , $193.80 , $180.12 , N/A , $184.52 , $184.52 , $216.60 , $195.65 , $20.26 , $218.88 
"Reconst Post Tib Tend,Excis Acc Tar Nav",CPT® 28238,N/A,N/A,N/A," $4,526.00 "," $2,941.90 "," $3,026.47 ", $475.58 , $461.04 ," $2,415.73 "," $2,363.76 "," $4,209.18 "," $4,073.40 "," $4,073.40 "," $3,620.80 "," $3,620.80 ", $461.04 ," $4,178.86 "," $4,299.70 "," $4,073.40 "," $4,073.40 "," $4,073.40 "," $4,209.18 "," $4,344.96 "," $2,782.30 "," $3,847.10 "," $2,565.48 "," $2,843.90 ", N/A ," $2,462.87 "," $2,462.87 "," $4,299.70 "," $2,894.75 ", $461.04 ," $4,344.96 "
"Exc Skin Malig 1.1-2cm Trunk,Arm,Leg",11602,N/A,N/A,N/A," $1,048.00 ", $681.20 , $518.53 , $155.71 , $188.41 , $446.50 , $437.08 , $974.64 , $943.20 , $943.20 , $838.40 , $838.40 , $188.41 , $967.62 , $995.60 , $943.20 , $943.20 , $943.20 , $974.64 ," $1,006.08 ", $568.24 , $890.80 , $870.62 , $574.73 , N/A , $455.21 , $455.21 , $995.60 , $527.89 , $155.71 ," $1,006.08 "
 CLINDAMYCIN 900 MG IV SOLN (INPT) ,HCPCS J0736,0636 - DRUGS REQUIRING DETAILED CODIN,00338-3814-24,50 mL, $80.40 , $52.26 , $67.54 , N/A , N/A , $64.96 , $72.36 , $68.07 , $72.36 , $72.36 , $72.36 , $68.34 , N/A , $74.23 , $76.38 , $68.34 , $74.77 , $74.77 , $76.38 , $77.18 , $65.78 , $72.36 , $68.34 , $63.52 , N/A , $65.07 , $65.07 , $76.38 , $68.99 , $63.52 , $77.18 
 Pro Femur Min 2 Views ,CPT® 73552,0972 - PRO FEE/RAD/DX,N/A,N/A, $111.00 , $72.15 , $238.98 , $35.01 , $25.42 , $154.06 , $163.24 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $25.42 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $193.51 , $94.35 , $205.26 , $165.69 , N/A , $157.07 , $157.07 , $105.45 , $181.81 , $25.42 , $238.98 
Manual Appl Stress Pfrmd Phys Joint Radiography,CPT® 77071,N/A,N/A,N/A, $335.00 , $217.75 , $306.36 , $53.02 , $24.76 , $228.60 , $267.59 , $311.55 , $301.50 , $301.50 , $268.00 , $268.00 , $24.76 , $309.31 , $318.25 , $301.50 , $301.50 , $301.50 , $311.55 , $321.60 , $298.38 , $284.75 , $296.61 , $240.64 , N/A , $233.05 , $233.05 , $318.25 , $269.79 , $24.76 , $321.60 
"Exc Skin Malig 2.1-3cm Face,Facial",11643,N/A,N/A,N/A," $1,730.00 "," $1,124.50 ", $726.61 , $217.56 , $390.36 , $630.37 , $614.15 ," $1,608.90 "," $1,557.00 "," $1,557.00 "," $1,384.00 "," $1,384.00 ", $390.36 ," $1,597.31 "," $1,643.50 "," $1,557.00 "," $1,557.00 "," $1,557.00 "," $1,608.90 "," $1,660.80 ", $796.89 ," $1,470.50 "," $1,225.65 ", $805.09 , N/A , $642.67 , $642.67 ," $1,643.50 ", $745.28 , $217.56 ," $1,660.80 "
 Pro Emergency Department Visit Straightforward Mdm ,CPT® 99282,0981 - PRO FEE/ER,N/A,N/A, $248.00 , $161.20 , $148.19 , $40.13 , $25.96 , $116.08 , $119.87 , $230.64 , $223.20 , $223.20 , $198.40 , $198.40 , $25.96 , $228.98 , $235.60 , $223.20 , $223.20 , $223.20 , $230.64 , $238.08 , $125.96 , $210.80 , $88.51 , $89.62 , $21.00 , $118.34 , $118.34 , $235.60 , $142.01 , $21.00 , $238.08 
Goserelin Acetate Implant,HCPCS J9202,N/A,N/A,N/A, $568.00 , $369.20 , N/A , $625.84 , N/A , N/A , N/A , $528.24 , $511.20 , $511.20 , $454.40 , $454.40 , N/A , $524.43 , $539.60 , $511.20 , $511.20 , $511.20 , $528.24 , $545.28 , $691.12 , $482.80 , $339.95 , $802.38 , N/A , N/A , N/A , $539.60 , N/A , $339.95 , $802.38 
 Fac Path Consltj Surg ,CPT® 88329,0310 - PATHOLOGY LAB,N/A,N/A, $93.00 , $60.45 , $78.12 , $34.43 , $32.74 , $75.14 , $83.70 , $78.73 , $83.70 , $83.70 , $83.70 , $79.05 , $32.10 , $85.87 , $88.35 , $79.05 , $86.49 , $86.49 , $88.35 , $89.28 , $76.09 , $83.70 , $79.05 , $73.47 , N/A , $75.26 , $75.26 , $88.35 , $79.80 , $32.10 , $89.28 
"Immuniz Admin,1 Single/Comb Vac/Toxoid",CPT® 90471,N/A,N/A,N/A, $70.00 , $45.50 , $40.23 , $19.78 , N/A , $57.67 , $59.77 , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , N/A , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , $59.44 , $59.50 , $77.04 , $64.43 , N/A , $58.79 , $58.79 , $66.50 , $69.67 , $19.78 , $77.04 
Open Bone Biop Vert Dorsal,20250,N/A,N/A,N/A," $2,624.00 "," $1,705.60 "," $2,304.90 ", $362.39 , $284.25 ," $1,872.62 "," $1,855.73 "," $2,440.32 "," $2,361.60 "," $2,361.60 "," $2,099.20 "," $2,099.20 ", $284.25 ," $2,422.74 "," $2,492.80 "," $2,361.60 "," $2,361.60 "," $2,361.60 "," $2,440.32 "," $2,519.04 "," $2,168.98 "," $2,230.40 "," $2,062.38 "," $2,166.38 ", N/A ," $1,909.16 "," $1,909.16 "," $2,492.80 "," $2,243.92 ", $284.25 ," $2,519.04 "
1st Hospital IP/Obs Care High Mdm 75 Minutes,99223,N/A,N/A,N/A, $653.00 , $424.45 , $394.93 , $168.79 , $103.99 , $349.44 , $349.53 , $607.29 , $587.70 , $587.70 , $522.40 , $522.40 , $103.99 , $602.91 , $620.35 , $587.70 , $587.70 , $587.70 , $607.29 , $626.88 , $504.25 , $555.05 , $436.56 , $443.19 , $206.25 , $356.26 , $356.26 , $620.35 , $410.90 , $103.99 , $626.88 
"Repair Bladder Wound/Inj,Simple",CPT® 51860,N/A,N/A,N/A," $9,079.00 "," $5,901.35 "," $4,015.46 ", $706.14 , $568.00 ," $3,616.28 "," $3,398.39 "," $8,443.47 "," $8,171.10 "," $8,171.10 "," $7,263.20 "," $7,263.20 ", $568.00 ," $8,382.64 "," $8,625.05 "," $8,171.10 "," $8,171.10 "," $8,171.10 "," $8,443.47 "," $8,715.84 "," $4,019.70 "," $7,717.15 "," $3,905.32 "," $4,517.50 ", N/A ," $3,686.84 "," $3,686.84 "," $8,625.05 "," $4,333.34 ", $568.00 ," $8,715.84 "
Rp Loclzj Tum Spect CT 2area/Sep Acquisj Img,CPT® 78832,N/A,N/A,N/A," $6,166.00 "," $4,007.90 "," $4,919.73 ", $831.35 , $739.48 ," $4,379.54 ", N/A ," $5,734.38 "," $5,549.40 "," $5,549.40 "," $4,932.80 "," $4,932.80 ", $739.48 ," $5,693.07 "," $5,857.70 "," $5,549.40 "," $5,549.40 "," $5,549.40 "," $5,734.38 "," $5,919.36 "," $5,121.34 "," $5,241.10 "," $4,861.11 "," $6,081.99 ", N/A ," $4,464.99 "," $4,464.99 "," $5,857.70 "," $5,174.48 ", $739.48 ," $6,081.99 "
Mitralplasty W Prosthetic Ring,CPT® 33426,N/A,N/A,N/A," $18,632.00 "," $12,110.80 "," $13,890.50 "," $2,145.10 "," $2,239.41 "," $10,169.33 "," $10,112.49 "," $17,327.76 "," $16,768.80 "," $16,768.80 "," $14,905.60 "," $14,905.60 "," $2,239.41 "," $17,202.93 "," $17,700.40 "," $16,768.80 "," $16,768.80 "," $16,768.80 "," $17,327.76 "," $17,886.72 "," $12,866.84 "," $15,837.20 "," $12,807.80 "," $11,423.95 ", N/A ," $10,367.75 "," $10,367.75 "," $17,700.40 "," $11,777.76 "," $2,145.10 "," $17,886.72 "
" Fac Complement, Antigen ",CPT® 86160,0302 - LAB/IMMUNOLOGY,N/A,N/A, $165.00 , $107.25 , $138.60 , $12.24 , $12.24 , $133.32 , $148.50 , $139.69 , $148.50 , $148.50 , $148.50 , $140.25 , $12.00 , $152.34 , $156.75 , $140.25 , $153.45 , $153.45 , $156.75 , $158.40 , $135.00 , $148.50 , $140.25 , $130.35 , N/A , $133.53 , $133.53 , $156.75 , $141.59 , $12.00 , $158.40 
 Pro Radiation Therapy Planning Intermediate ,CPT® 77262,0982 - PRO FEE/OUTPT,N/A,N/A, $720.00 , $468.00 , $603.32 , $105.78 , $126.83 , $543.97 , $553.85 , $669.60 , $648.00 , $648.00 , $576.00 , $576.00 , $126.83 , $664.78 , $684.00 , $648.00 , $648.00 , $648.00 , $669.60 , $691.20 , $602.75 , $612.00 , $608.63 , $596.44 , N/A , $554.59 , $554.59 , $684.00 , $641.92 , $105.78 , $691.20 
 DEXRAZOXANE HCL 500 MG IV SOLR ,HCPCS J1190,0636 - DRUGS REQUIRING DETAILED CODIN,72266-0101-01,50 mL," $2,826.36 "," $1,837.13 "," $2,374.14 ", $116.18 , $170.26 ," $2,283.70 "," $2,543.72 "," $2,392.80 "," $2,543.72 "," $2,543.72 "," $2,543.72 "," $2,402.41 ", $166.92 ," $2,609.58 "," $2,685.04 "," $2,402.41 "," $2,628.51 "," $2,628.51 "," $2,685.04 "," $2,713.31 "," $2,312.53 "," $2,543.72 "," $2,402.41 "," $2,232.82 ", N/A ," $2,287.37 "," $2,287.37 "," $2,685.04 "," $2,425.30 ", $116.18 ," $2,713.31 "
 SKIN ADHESIVE ,HCPCS RXA250,0250 - PHARMACY,00001-0674-02,1 each, $61.65 , $40.07 , $51.79 , N/A , N/A , $49.81 , $55.49 , $52.19 , $55.49 , $55.49 , $55.49 , $52.40 , N/A , $56.92 , $58.57 , $52.40 , $57.33 , $57.33 , $58.57 , $59.18 , $50.44 , $55.49 , $52.40 , $48.70 , N/A , $49.89 , $49.89 , $58.57 , $52.90 , $48.70 , $59.18 
 Pro Partial Removal of Foot Bone ,CPT® 28122,0982 - PRO FEE/OUTPT,N/A,N/A," $4,071.00 "," $2,646.15 "," $2,709.20 ", $424.70 , $384.19 ," $2,165.95 "," $2,162.58 "," $3,786.03 "," $3,663.90 "," $3,663.90 "," $3,256.80 "," $3,256.80 ", $384.19 ," $3,758.75 "," $3,867.45 "," $3,663.90 "," $3,663.90 "," $3,663.90 "," $3,786.03 "," $3,908.16 "," $2,515.35 "," $3,460.35 "," $2,346.04 "," $2,575.48 ", N/A ," $2,208.21 "," $2,208.21 "," $3,867.45 "," $2,595.42 ", $384.19 ," $3,908.16 "
 Fac Drug Assay Felbamate ,CPT® 80167,0301 - LAB/CHEMISTRY,N/A,N/A, $276.00 , $179.40 , $231.84 , $19.01 , $15.21 , $223.01 , $248.40 , $233.66 , $248.40 , $248.40 , $248.40 , $234.60 , $14.91 , $254.83 , $262.20 , $234.60 , $256.68 , $256.68 , $262.20 , $264.96 , $225.82 , $248.40 , $234.60 , $218.04 , N/A , $223.37 , $223.37 , $262.20 , $236.84 , $14.91 , $264.96 
 Fac Assay of Vasopressin ,CPT® 84588,0301 - LAB/CHEMISTRY,N/A,N/A, $314.00 , $204.10 , $263.76 , $34.62 , $34.62 , $253.71 , $282.60 , $265.83 , $282.60 , $282.60 , $282.60 , $266.90 , $33.94 , $289.92 , $298.30 , $266.90 , $292.02 , $292.02 , $298.30 , $301.44 , $256.91 , $282.60 , $266.90 , $248.06 , N/A , $254.12 , $254.12 , $298.30 , $269.44 , $33.94 , $301.44 
 Respiratory Neoplasms With McC ,MS DRG V40 (FY2023) 180,N/A,N/A,N/A," $21,947.63 "," $14,265.96 "," $18,436.01 ", N/A , N/A ," $17,733.69 "," $19,752.87 "," $18,580.86 "," $19,752.87 "," $19,752.87 "," $19,752.87 "," $18,655.49 ", N/A ," $20,264.25 "," $20,850.25 "," $18,655.49 "," $20,411.30 "," $20,411.30 "," $20,850.25 "," $21,069.72 "," $17,957.55 "," $19,752.87 "," $18,655.49 "," $17,338.63 ", N/A ," $17,762.22 "," $17,762.22 "," $20,850.25 "," $18,833.26 "," $17,338.63 "," $21,069.72 "
 Adm Moderna Peds Covid Vac 6mo-4 Yr 2nd Dose ,CPT® 0112A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
 Pro Computerized Ophthalmic Imaging Optic Nerve ,CPT® 92133,0962 - PRO FEE/EYE,N/A,N/A, $209.00 , $135.85 , $80.01 , $36.05 , $32.72 , $77.59 , $79.73 , $194.37 , $188.10 , $188.10 , $167.20 , $167.20 , $32.72 , $192.97 , $198.55 , $188.10 , $188.10 , $188.10 , $194.37 , $200.64 , $113.35 , $177.65 , $134.82 , $79.52 , N/A , $79.10 , $79.10 , $198.55 , $94.10 , $32.72 , $200.64 
Treatment Toe Fracture,28515,N/A,N/A,N/A," $1,059.00 ", $688.35 , $888.42 , $141.25 , $76.84 , $702.96 , $708.81 , $984.87 , $953.10 , $953.10 , $847.20 , $847.20 , $76.84 , $977.77 ," $1,006.05 ", $953.10 , $953.10 , $953.10 , $984.87 ," $1,016.64 ", $817.30 , $900.15 , $768.93 , $830.94 , N/A , $716.67 , $716.67 ," $1,006.05 ", $842.36 , $76.84 ," $1,016.64 "
 Fac Primatrix Skin Sub ,HCPCS Q4110,0636 - DRUGS REQUIRING DETAILED CODIN,N/A,N/A, $75.00 , $48.75 , $63.00 , $43.73 , N/A , $60.60 , $67.50 , $63.50 , $67.50 , $67.50 , $67.50 , $63.75 , N/A , $69.25 , $71.25 , $63.75 , $69.75 , $69.75 , $71.25 , $72.00 , $61.37 , $67.50 , $63.75 , $59.25 , N/A , $60.70 , $60.70 , $71.25 , $64.36 , $43.73 , $72.00 
Brain Shunt Tube/Reserv Injectn,CPT® 61070,N/A,N/A,N/A, $550.00 , $357.50 , $272.64 , $52.97 , $107.83 , $319.14 , $466.25 , $511.50 , $495.00 , $495.00 , $440.00 , $440.00 , $107.83 , $507.82 , $522.50 , $495.00 , $495.00 , $495.00 , $511.50 , $528.00 , $292.92 , $467.50 , $462.07 , $338.48 , N/A , $325.36 , $325.36 , $522.50 , $349.03 , $52.97 , $528.00 
 Pro Exc H-F-Nk-Sp B9+Marg 0.5 < ,CPT® 11420,0982 - PRO FEE/OUTPT,N/A,N/A, $490.00 , $318.50 , $266.56 , $79.82 , $70.33 , $222.80 , $220.55 , $455.70 , $441.00 , $441.00 , $392.00 , $392.00 , $70.33 , $452.42 , $465.50 , $441.00 , $441.00 , $441.00 , $455.70 , $470.40 , $290.68 , $416.50 , $435.31 , $287.24 , N/A , $227.15 , $227.15 , $465.50 , $263.42 , $70.33 , $470.40 
Duplex Extrem Venous Uni or Ltd(Cliniconly),93971,N/A,N/A,N/A, $210.00 , $136.50 , $757.84 , $117.01 , $110.85 , $649.39 , $655.74 , $195.30 , $189.00 , $189.00 , $168.00 , $168.00 , $110.85 , $193.89 , $199.50 , $189.00 , $189.00 , $189.00 , $195.30 , $201.60 , $529.14 , $178.50 , $348.72 , $456.86 , N/A , $662.05 , $662.05 , $199.50 , $733.92 , $110.85 , $757.84 
 ATROPINE SULFATE 1 % OP SOLN ,HCPCS RXA250,0250 - PHARMACY,60219-1749-03,5 mL, $299.90 , $194.94 , $251.92 , N/A , N/A , $242.32 , $269.91 , $253.90 , $269.91 , $269.91 , $269.91 , $254.92 , N/A , $276.90 , $284.91 , $254.92 , $278.91 , $278.91 , $284.91 , $287.90 , $245.38 , $269.91 , $254.92 , $236.92 , N/A , $242.71 , $242.71 , $284.91 , $257.34 , $236.92 , $287.90 
 Fac Rm Chg Nursery Level 2 ,Custom 1720000001,0172 - NURSERY LEVEL II,N/A,N/A," $2,085.00 "," $1,355.25 "," $1,751.40 ", N/A , N/A ," $1,684.68 "," $1,876.50 "," $1,765.16 "," $1,876.50 "," $1,876.50 "," $1,876.50 "," $1,772.25 ", N/A ," $1,925.08 "," $1,980.75 "," $1,772.25 "," $1,939.05 "," $1,939.05 "," $1,980.75 "," $2,001.60 "," $1,705.95 "," $1,876.50 "," $1,772.25 "," $1,647.15 ", N/A ," $1,687.39 "," $1,687.39 "," $1,980.75 "," $1,789.14 "," $1,647.15 "," $2,001.60 "
Total Knee Arthroplasty,27447,N/A,N/A,N/A," $10,215.00 "," $6,639.75 "," $7,722.20 "," $1,206.76 "," $1,363.53 "," $6,552.23 "," $7,354.80 "," $9,499.95 "," $9,193.50 "," $9,193.50 "," $8,172.00 "," $8,172.00 "," $1,363.53 "," $9,431.51 "," $9,704.25 "," $9,193.50 "," $9,193.50 "," $9,193.50 "," $9,499.95 "," $9,806.40 "," $9,322.23 "," $8,682.75 "," $8,142.47 "," $7,699.32 ", N/A ," $6,680.08 "," $6,680.08 "," $9,704.25 "," $7,851.46 "," $1,206.76 "," $9,806.40 "
 Fac Rmvl Tun Ctr Vad W/Subq Port/Pmp Ctr/Prph Insj ,CPT® 36590,0761 - TREATMENT ROOM,N/A,N/A," $3,146.00 "," $2,044.90 "," $2,642.64 ", $178.03 , $375.08 ," $2,541.97 "," $2,831.40 "," $2,663.40 "," $2,831.40 "," $2,831.40 "," $2,831.40 "," $2,674.10 ", $367.73 ," $2,904.70 "," $2,988.70 "," $2,674.10 "," $2,925.78 "," $2,925.78 "," $2,988.70 "," $3,020.16 "," $2,574.06 "," $2,831.40 "," $2,674.10 "," $2,485.34 ", N/A ," $2,546.06 "," $2,546.06 "," $2,988.70 "," $2,699.58 ", $178.03 ," $3,020.16 "
"Shldr Arthroscop,Surg,Repair,Slap Lesion",CPT® 29807,N/A,N/A,N/A," $5,961.00 "," $3,874.65 "," $6,265.87 ", $982.06 , $905.21 ," $4,999.52 "," $4,963.91 "," $5,543.73 "," $5,364.90 "," $5,364.90 "," $4,768.80 "," $4,768.80 ", $905.21 ," $5,503.79 "," $5,662.95 "," $5,364.90 "," $5,364.90 "," $5,364.90 "," $5,543.73 "," $5,722.56 "," $5,834.98 "," $5,066.85 "," $5,486.00 "," $5,884.18 ", N/A ," $5,097.07 "," $5,097.07 "," $5,662.95 "," $5,990.87 ", $905.21 ," $6,265.87 "
Treat Patellar Dislocatio,CPT® 27560,N/A,N/A,N/A," $1,854.00 "," $1,205.10 "," $2,081.63 ", $334.64 , $268.05 ," $1,598.33 "," $1,645.91 "," $1,724.22 "," $1,668.60 "," $1,668.60 "," $1,483.20 "," $1,483.20 ", $268.05 ," $1,711.80 "," $1,761.30 "," $1,668.60 "," $1,668.60 "," $1,668.60 "," $1,724.22 "," $1,779.84 "," $1,966.99 "," $1,575.90 "," $1,809.04 "," $1,917.68 ", N/A ," $1,629.51 "," $1,629.51 "," $1,761.30 "," $1,915.26 ", $268.05 ," $2,081.63 "
" Fac N Block Inj, Hypogas Plxs ",CPT® 64517,0360 - OR SERVICES,N/A,N/A," $1,413.00 ", $918.45 ," $1,186.92 ", $122.10 , $185.43 ," $1,141.70 "," $1,271.70 "," $1,196.25 "," $1,271.70 "," $1,271.70 "," $1,271.70 "," $1,201.05 ", $181.79 ," $1,304.62 "," $1,342.35 "," $1,201.05 "," $1,314.09 "," $1,314.09 "," $1,342.35 "," $1,356.48 "," $1,156.12 "," $1,271.70 "," $1,201.05 "," $1,116.27 ", N/A ," $1,143.54 "," $1,143.54 "," $1,342.35 "," $1,212.50 ", $122.10 ," $1,356.48 "
Remv Perm Xven Electrd/Thoracotmy,CPT® 33238,N/A,N/A,N/A," $5,642.00 "," $3,667.30 "," $5,595.85 ", $866.91 ," $2,008.33 "," $4,005.53 "," $3,996.73 "," $5,247.06 "," $5,077.80 "," $5,077.80 "," $4,513.60 "," $4,513.60 "," $2,008.33 "," $5,209.26 "," $5,359.90 "," $5,077.80 "," $5,077.80 "," $5,077.80 "," $5,247.06 "," $5,416.32 "," $5,159.62 "," $4,795.70 "," $5,041.77 "," $4,528.71 ", N/A ," $4,083.68 "," $4,083.68 "," $5,359.90 "," $4,639.06 ", $866.91 ," $5,595.85 "
 Pelvis MR Angiography ,HCPCS C8920,0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA-OTHER,N/A,N/A," $2,945.00 "," $1,914.25 "," $2,473.80 ", N/A , N/A ," $2,379.56 "," $2,650.50 "," $2,493.24 "," $2,650.50 "," $2,650.50 "," $2,650.50 "," $2,503.25 ", N/A ," $2,719.12 "," $2,797.75 "," $2,503.25 "," $2,738.85 "," $2,738.85 "," $2,797.75 "," $2,827.20 "," $2,409.60 "," $2,650.50 "," $2,503.25 "," $2,326.55 ", N/A ," $2,383.39 "," $2,383.39 "," $2,797.75 "," $2,527.10 "," $2,326.55 "," $2,827.20 "
"Echography,Chest,B-Scan&/or Real Time",CPT® 76604,N/A,N/A,N/A, $634.00 , $412.10 , $329.38 , $55.74 , $82.61 , $423.02 , $465.39 , $589.62 , $570.60 , $570.60 , $507.20 , $507.20 , $82.61 , $585.37 , $602.30 , $570.60 , $570.60 , $570.60 , $589.62 , $608.64 , $369.55 , $538.90 , $508.48 , $501.74 , N/A , $431.28 , $431.28 , $602.30 , $499.21 , $55.74 , $608.64 
"Injection-Tendon,Ligament",20550,N/A,N/A,N/A, $384.00 , $249.60 , $99.25 , $37.19 , $27.51 , $203.30 , $199.04 , $357.12 , $345.60 , $345.60 , $307.20 , $307.20 , $27.51 , $354.55 , $364.80 , $345.60 , $345.60 , $345.60 , $357.12 , $368.64 , $222.72 , $326.40 , $215.87 , $227.07 , N/A , $207.26 , $207.26 , $364.80 , $243.62 , $27.51 , $368.64 
"Removal Synovial Cyst,Knee",27345,N/A,N/A,N/A," $3,310.00 "," $2,151.50 "," $2,973.82 ", $467.50 , $461.04 ," $2,320.85 "," $2,315.25 "," $3,078.30 "," $2,979.00 "," $2,979.00 "," $2,648.00 "," $2,648.00 ", $461.04 ," $3,056.12 "," $3,144.50 "," $2,979.00 "," $2,979.00 "," $2,979.00 "," $3,078.30 "," $3,177.60 "," $2,753.55 "," $2,813.50 "," $2,554.78 "," $2,733.25 ", N/A ," $2,366.12 "," $2,366.12 "," $3,144.50 "," $2,781.06 ", $461.04 ," $3,177.60 "
 Pro Rpr Cplx F/C/C/M/N/Ax/G/H/F 2.6 Cm-7.5 Cm ,CPT® 13132,0982 - PRO FEE/OUTPT,N/A,N/A," $2,805.00 "," $1,823.25 ", $971.79 , $290.72 , $268.64 , $861.57 , $839.43 ," $2,608.65 "," $2,524.50 "," $2,524.50 "," $2,244.00 "," $2,244.00 ", $268.64 ," $2,589.86 "," $2,664.75 "," $2,524.50 "," $2,524.50 "," $2,524.50 "," $2,608.65 "," $2,692.80 "," $1,069.42 "," $2,384.25 "," $1,671.67 "," $1,104.41 ", N/A , $878.38 , $878.38 ," $2,664.75 "," $1,018.64 ", $268.64 ," $2,692.80 "
Rx Ectop Preg by Laparoscope,CPT® 59150,N/A,N/A,N/A," $4,113.00 "," $2,673.45 "," $2,146.56 ", $725.25 , $610.52 ," $1,780.55 "," $1,876.46 "," $3,825.09 "," $3,701.70 "," $3,701.70 "," $3,290.40 "," $3,290.40 ", $610.52 ," $3,797.53 "," $3,907.35 "," $3,701.70 "," $3,701.70 "," $3,701.70 "," $3,825.09 "," $3,948.48 "," $2,165.56 "," $3,496.05 "," $4,142.60 "," $3,310.57 ", N/A ," $1,815.29 "," $1,815.29 "," $3,907.35 "," $2,098.66 ", $610.52 ," $4,142.60 "
Endocervical Curettage,CPT® 57505,N/A,N/A,N/A, $748.00 , $486.20 , $522.60 , $105.92 , $61.61 , $376.27 , $378.97 , $695.64 , $673.20 , $673.20 , $598.40 , $598.40 , $61.61 , $690.63 , $710.60 , $673.20 , $673.20 , $673.20 , $695.64 , $718.08 , $527.83 , $635.80 , $495.97 , $379.07 , N/A , $383.61 , $383.61 , $710.60 , $460.12 , $61.61 , $718.08 
"Muscle Transfer,Shoulder/Arm,Single",CPT® 23395,N/A,N/A,N/A," $8,497.00 "," $5,523.05 "," $7,745.21 "," $1,213.62 "," $1,229.45 "," $6,198.87 "," $6,161.56 "," $7,902.21 "," $7,647.30 "," $7,647.30 "," $6,797.60 "," $6,797.60 "," $1,229.45 "," $7,845.28 "," $8,072.15 "," $7,647.30 "," $7,647.30 "," $7,647.30 "," $7,902.21 "," $8,157.12 "," $7,224.86 "," $7,222.45 "," $6,809.77 "," $7,293.20 ", N/A ," $6,319.82 "," $6,319.82 "," $8,072.15 "," $7,428.04 "," $1,213.62 "," $8,157.12 "
"Amputate Thigh,Secondry Closur",CPT® 27594,N/A,N/A,N/A," $3,320.00 "," $2,158.00 "," $3,052.73 ", $470.08 , $151.20 ," $2,439.78 "," $2,455.35 "," $3,087.60 "," $2,988.00 "," $2,988.00 "," $2,656.00 "," $2,656.00 ", $151.20 ," $3,065.36 "," $3,154.00 "," $2,988.00 "," $2,988.00 "," $2,988.00 "," $3,087.60 "," $3,187.20 "," $2,833.94 "," $2,822.00 "," $2,722.48 "," $2,841.27 ", N/A ," $2,487.39 "," $2,487.39 "," $3,154.00 "," $2,923.55 ", $151.20 ," $3,187.20 "
 Pro Smpl Rpr Supfc F/E/E/N/L/M 2.5cm/< ,CPT® 12011,0981 - PRO FEE/ER,N/A,N/A, $511.00 , $332.15 , $172.01 , $51.31 , $66.00 , $150.86 , $147.21 , $475.23 , $459.90 , $459.90 , $408.80 , $408.80 , $66.00 , $471.81 , $485.45 , $459.90 , $459.90 , $459.90 , $475.23 , $490.56 , $189.71 , $434.35 , $296.15 , $192.22 , N/A , $153.81 , $153.81 , $485.45 , $178.36 , $51.31 , $490.56 
 Fac Drug Test Def 1-7 Classes ,CPT® G0480,0301 - LAB/CHEMISTRY,N/A,N/A, $172.00 , $111.80 , $144.48 , $116.72 , $65.23 , $138.98 , $154.80 , $145.62 , $154.80 , $154.80 , $154.80 , $146.20 , $63.95 , $158.81 , $163.40 , $146.20 , $159.96 , $159.96 , $163.40 , $165.12 , $140.73 , $154.80 , $146.20 , $135.88 , N/A , $139.20 , $139.20 , $163.40 , $147.59 , $63.95 , $165.12 
Renal Function Panel,CPT® 80069,N/A,N/A,N/A, $153.00 , $99.45 , N/A , $8.85 , $8.85 , $49.14 , $58.78 , $142.29 , $137.70 , $137.70 , $122.40 , $122.40 , $8.85 , $141.26 , $145.35 , $137.70 , $137.70 , $137.70 , $142.29 , $146.88 , $57.96 , $130.05 , $56.76 , $31.48 , N/A , $45.86 , $45.86 , $145.35 , $50.12 , $8.85 , $146.88 
 Fac Vertebral Fracture Assessment via DXA ,CPT® 77086,0320 - DX X-RAY,N/A,N/A, $575.00 , $373.75 , $483.00 , $32.36 , $27.90 , $464.60 , $517.50 , $486.80 , $517.50 , $517.50 , $517.50 , $488.75 , $27.35 , $530.90 , $546.25 , $488.75 , $534.75 , $534.75 , $546.25 , $552.00 , $470.47 , $517.50 , $488.75 , $454.25 , N/A , $465.35 , $465.35 , $546.25 , $493.41 , $27.35 , $552.00 
"Bx/Remv,Lymph Node,Deep Axill",CPT® 38525,N/A,N/A,N/A," $5,210.00 "," $3,386.50 "," $2,030.20 ", $410.70 , $363.55 ," $1,513.82 "," $1,566.39 "," $4,845.30 "," $4,689.00 "," $4,689.00 "," $4,168.00 "," $4,168.00 ", $363.55 ," $4,810.39 "," $4,949.50 "," $4,689.00 "," $4,689.00 "," $4,689.00 "," $4,845.30 "," $5,001.60 "," $2,165.66 "," $4,428.50 "," $2,317.50 "," $2,097.50 ", N/A ," $1,543.35 "," $1,543.35 "," $4,949.50 "," $1,790.50 ", $363.55 ," $5,001.60 "
 PHENYLEPHRINE HCL 2.5 % OP SOLN ,HCPCS RXA250,0250 - PHARMACY,70756-0629-25,2 mL, $208.72 , $135.67 , $175.32 , N/A , N/A , $168.65 , $187.85 , $176.70 , $187.85 , $187.85 , $187.85 , $177.41 , N/A , $192.71 , $198.28 , $177.41 , $194.11 , $194.11 , $198.28 , $200.37 , $170.77 , $187.85 , $177.41 , $164.89 , N/A , $168.92 , $168.92 , $198.28 , $179.10 , $164.89 , $200.37 
 Fac Esophagoscopy Flex Transoral Lesion Ablation ,CPT® 43229,0360 - OR SERVICES,N/A,N/A," $2,690.00 "," $1,748.50 "," $2,259.60 ", $186.05 , $156.39 ," $2,173.52 "," $2,421.00 "," $2,277.35 "," $2,421.00 "," $2,421.00 "," $2,421.00 "," $2,286.50 ", $153.32 ," $2,483.68 "," $2,555.50 "," $2,286.50 "," $2,501.70 "," $2,501.70 "," $2,555.50 "," $2,582.40 "," $2,200.96 "," $2,421.00 "," $2,286.50 "," $2,125.10 ", N/A ," $2,177.02 "," $2,177.02 "," $2,555.50 "," $2,308.29 ", $153.32 ," $2,582.40 "
Apply Stereotactic Headframe for Radiosurgery,CPT® 61800,N/A,N/A,N/A," $1,083.00 ", $703.95 , $681.77 , $132.30 , $128.96 , $835.64 , $785.28 ," $1,007.19 ", $974.70 , $974.70 , $866.40 , $866.40 , $128.96 , $999.93 ," $1,028.85 ", $974.70 , $974.70 , $974.70 ," $1,007.19 "," $1,039.68 ", $746.25 , $920.55 , $804.61 , $860.04 , N/A , $851.95 , $851.95 ," $1,028.85 ", $913.93 , $128.96 ," $1,039.68 "
Physical Therapy Evaluation Mod Complex 30 Mins,CPT® 97162,N/A,N/A,N/A, $329.00 , $213.85 , $196.04 , $100.30 , $67.74 , $174.75 , $166.54 , $305.97 , $296.10 , $296.10 , $263.20 , $263.20 , $67.74 , $303.77 , $312.55 , $296.10 , $296.10 , $296.10 , $305.97 , $315.84 , $253.17 , $279.65 , $302.90 , $189.75 , N/A , $178.16 , $178.16 , $312.55 , $198.16 , $67.74 , $315.84 
 Pro X-Ray Exam of Breastbone ,CPT® 71130,0972 - PRO FEE/RAD/DX,N/A,N/A, $127.00 , $82.55 , $234.44 , $40.66 , $35.69 , $170.62 , $198.13 , $118.11 , $114.30 , $114.30 , $101.60 , $101.60 , $35.69 , $117.26 , $120.65 , $114.30 , $114.30 , $114.30 , $118.11 , $121.92 , $227.90 , $107.95 , $217.64 , $182.12 , N/A , $173.95 , $173.95 , $120.65 , $201.34 , $35.69 , $234.44 
"Gated Heart, Planar Single",CPT® 78472,N/A,N/A,N/A," $4,176.00 "," $2,714.40 "," $1,226.24 ", $209.10 , $242.57 ," $1,131.79 "," $1,233.82 "," $3,883.68 "," $3,758.40 "," $3,758.40 "," $3,340.80 "," $3,340.80 ", $242.57 ," $3,855.70 "," $3,967.20 "," $3,758.40 "," $3,758.40 "," $3,758.40 "," $3,883.68 "," $4,008.96 "," $1,262.97 "," $3,549.60 "," $1,350.16 "," $1,540.70 ", N/A ," $1,153.88 "," $1,153.88 "," $3,967.20 "," $1,335.64 ", $209.10 ," $4,008.96 "
 Pro Remove Drug Implant Device ,CPT® 11982,0981 - PRO FEE/ER,N/A,N/A, $576.00 , $374.40 , $232.87 , $69.06 , $93.57 , $272.59 , $254.08 , $535.68 , $518.40 , $518.40 , $460.80 , $460.80 , $93.57 , $531.82 , $547.20 , $518.40 , $518.40 , $518.40 , $535.68 , $552.96 , $258.07 , $489.60 , $504.89 , $345.36 , N/A , $277.91 , $277.91 , $547.20 , $322.29 , $69.06 , $552.96 
 Fac Somatosensory Testing ,CPT® 95925,0922 - EMG,N/A,N/A, $684.00 , $444.60 , $574.56 , $173.87 , $108.78 , $552.67 , $615.60 , $579.07 , $615.60 , $615.60 , $615.60 , $581.40 , $106.65 , $631.54 , $649.80 , $581.40 , $636.12 , $636.12 , $649.80 , $656.64 , $559.65 , $615.60 , $581.40 , $540.36 , N/A , $553.56 , $553.56 , $649.80 , $586.94 , $106.65 , $656.64 
 POTASSIUM PHOSPHATES(66 MEQ K) 45 MMOLE/15ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00409-7295-01,15 mL, $91.16 , $59.25 , $76.57 , N/A , N/A , $73.66 , $82.04 , $77.18 , $82.04 , $82.04 , $82.04 , $77.49 , N/A , $84.17 , $86.60 , $77.49 , $84.78 , $84.78 , $86.60 , $87.51 , $74.59 , $82.04 , $77.49 , $72.02 , N/A , $73.78 , $73.78 , $86.60 , $78.22 , $72.02 , $87.51 
Fx Cl Shouder W Man W Ane,23655,N/A,N/A,N/A," $2,591.00 "," $1,684.15 "," $2,524.02 ", $396.16 , $212.46 ," $1,931.47 "," $1,939.57 "," $2,409.63 "," $2,331.90 "," $2,331.90 "," $2,072.80 "," $2,072.80 ", $212.46 ," $2,392.27 "," $2,461.45 "," $2,331.90 "," $2,331.90 "," $2,331.90 "," $2,409.63 "," $2,487.36 "," $2,328.36 "," $2,202.35 "," $2,131.96 "," $2,289.60 ", N/A ," $1,969.16 "," $1,969.16 "," $2,461.45 "," $2,314.46 ", $212.46 ," $2,524.02 "
"MRI Upper Extr, W/Contrast",CPT® 73220,N/A,N/A,N/A," $7,321.00 "," $4,758.65 "," $2,988.51 ", $423.69 , $515.74 ," $2,377.46 "," $3,018.30 "," $6,808.53 "," $6,588.90 "," $6,588.90 "," $5,856.80 "," $5,856.80 ", $515.74 ," $6,759.48 "," $6,954.95 "," $6,588.90 "," $6,588.90 "," $6,588.90 "," $6,808.53 "," $7,028.16 "," $2,591.04 "," $6,222.85 "," $3,291.61 "," $4,616.11 ", N/A ," $2,423.86 "," $2,423.86 "," $6,954.95 "," $2,805.66 ", $423.69 ," $7,028.16 "
Infect Agent Enzymatic Activity Non-Virus,CPT® 87905,N/A,N/A,N/A, $109.00 , $70.85 , N/A , $12.46 , $12.46 , $69.13 , $82.71 , $101.37 , $98.10 , $98.10 , $87.20 , $87.20 , $12.46 , $100.64 , $103.55 , $98.10 , $98.10 , $98.10 , $101.37 , $104.64 , $81.60 , $92.65 , $79.47 , $44.29 , N/A , $64.52 , $64.52 , $103.55 , $70.51 , $12.46 , $104.64 
Urethral Meatal Revision,CPT® 53450,N/A,N/A,N/A," $2,851.00 "," $1,853.15 "," $2,225.94 ", $392.10 , $217.64 ," $1,999.95 "," $1,866.52 "," $2,651.43 "," $2,565.90 "," $2,565.90 "," $2,280.80 "," $2,280.80 ", $217.64 ," $2,632.33 "," $2,708.45 "," $2,565.90 "," $2,565.90 "," $2,565.90 "," $2,651.43 "," $2,736.96 "," $2,228.74 "," $2,423.35 "," $2,110.55 "," $2,517.22 ", N/A ," $2,038.97 "," $2,038.97 "," $2,708.45 "," $2,396.51 ", $217.64 ," $2,736.96 "
" Pro Rpr Rem Hernia, Init, Reduce ",CPT® 49550,0982 - PRO FEE/OUTPT,N/A,N/A," $3,736.00 "," $2,428.40 "," $3,454.88 ", $536.56 , $537.90 ," $2,700.66 "," $2,744.73 "," $3,474.48 "," $3,362.40 "," $3,362.40 "," $2,988.80 "," $2,988.80 ", $537.90 ," $3,449.45 "," $3,549.20 "," $3,362.40 "," $3,362.40 "," $3,362.40 "," $3,474.48 "," $3,586.56 "," $2,471.26 "," $3,175.60 "," $3,047.18 "," $3,190.75 ", N/A ," $2,753.36 "," $2,753.36 "," $3,549.20 "," $2,879.72 ", $536.56 ," $3,586.56 "
 Pro Tobacco Use Cessation Intermediate 3-10 Minutes ,CPT® 99406,0981 - PRO FEE/ER,N/A,N/A, $111.00 , $72.15 , $28.60 , $11.46 , N/A , $26.24 , $26.40 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , N/A , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $37.52 , $94.35 , $26.25 , $26.06 , N/A , $26.75 , $26.75 , $105.45 , $32.15 , $11.46 , $106.56 
 Adm Moderna Peds Covid Vac 6mo-4 Yr 3rd Dose ,CPT® 0113A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
 Trauma 2 Activation W/Pre-ED Notiification Lvl 1 -W/O Critical Care ,N/A,0682 - TRAUMA LEVEL II,N/A,N/A," $9,824.00 "," $6,385.60 "," $8,252.16 ", N/A , N/A ," $7,937.79 "," $8,841.60 "," $8,317.00 "," $8,841.60 "," $8,841.60 "," $8,841.60 "," $8,350.40 ", N/A ," $9,070.50 "," $9,332.80 "," $8,350.40 "," $9,136.32 "," $9,136.32 "," $9,332.80 "," $9,431.04 "," $8,038.00 "," $8,841.60 "," $8,350.40 "," $7,760.96 ", N/A ," $7,950.56 "," $7,950.56 "," $9,332.80 "," $8,429.97 "," $7,760.96 "," $9,431.04 "
"Treat Tibial Shaft Fx, Intramed Implant",27759,N/A,N/A,N/A," $3,746.00 "," $2,434.90 "," $6,032.59 ", $944.03 , $879.19 ," $4,820.61 "," $4,781.45 "," $3,483.78 "," $3,371.40 "," $3,371.40 "," $2,996.80 "," $2,996.80 ", $879.19 ," $3,458.68 "," $3,558.70 "," $3,371.40 "," $3,371.40 "," $3,371.40 "," $3,483.78 "," $3,596.16 "," $5,622.20 "," $3,184.10 "," $5,287.97 "," $5,671.47 ", N/A ," $4,914.67 "," $4,914.67 "," $3,558.70 "," $5,776.48 ", $879.19 ," $6,032.59 "
"MRI, Pelvis, W/O Contrast",CPT® 72195,N/A,N/A,N/A," $5,310.00 "," $3,451.50 "," $1,661.52 ", $235.76 , $417.22 ," $1,786.78 "," $2,241.95 "," $4,938.30 "," $4,779.00 "," $4,779.00 "," $4,248.00 "," $4,248.00 ", $417.22 ," $4,902.72 "," $5,044.50 "," $4,779.00 "," $4,779.00 "," $4,779.00 "," $4,938.30 "," $5,097.60 "," $1,430.53 "," $4,513.50 "," $2,446.07 "," $2,925.30 ", N/A ," $1,821.64 "," $1,821.64 "," $5,044.50 "," $2,108.60 ", $235.76 ," $5,097.60 "
 Pro Emergency Department Visit High Mdm ,CPT® 99285,0981 - PRO FEE/ER,N/A,N/A, $894.00 , $581.10 , $618.57 , $168.76 , $44.31 , $489.08 , $501.00 , $831.42 , $804.60 , $804.60 , $715.20 , $715.20 , $44.31 , $825.43 , $849.30 , $804.60 , $804.60 , $804.60 , $831.42 , $858.24 , $526.01 , $759.90 , $369.80 , $374.75 , $182.00 , $498.62 , $498.62 , $849.30 , $598.36 , $44.31 , $858.24 
 Fac in Situ Hybridization Ea Addl Probe Stain ,CPT® 88364,0310 - PATHOLOGY LAB,N/A,N/A, $332.00 , $215.80 , $278.88 , $134.42 , $76.36 , $268.26 , $298.80 , $281.07 , $298.80 , $298.80 , $298.80 , $282.20 , $74.86 , $306.54 , $315.40 , $282.20 , $308.76 , $308.76 , $315.40 , $318.72 , $271.64 , $298.80 , $282.20 , $262.28 , N/A , $268.69 , $268.69 , $315.40 , $284.89 , $74.86 , $318.72 
"Part Remv Vitreous,Ant Apprch",CPT® 67005,N/A,N/A,N/A," $4,207.00 "," $2,734.55 "," $2,920.06 ", $460.22 ," $1,072.19 "," $2,674.57 "," $2,542.34 "," $3,912.51 "," $3,786.30 "," $3,786.30 "," $3,365.60 "," $3,365.60 "," $1,072.19 "," $3,884.32 "," $3,996.65 "," $3,786.30 "," $3,786.30 "," $3,786.30 "," $3,912.51 "," $4,038.72 "," $3,997.63 "," $3,575.95 "," $2,645.77 "," $3,396.52 ", N/A ," $2,726.76 "," $2,726.76 "," $3,996.65 "," $3,010.00 ", $460.22 ," $4,038.72 "
 Pro Drainage Ext Ear Abscess-Hematoma ,CPT® 69000,0982 - PRO FEE/OUTPT,N/A,N/A," $1,057.00 ", $687.05 , $587.55 , $120.89 , $30.71 , $571.83 , $595.04 , $983.01 , $951.30 , $951.30 , $845.60 , $845.60 , $30.71 , $975.93 ," $1,004.15 ", $951.30 , $951.30 , $951.30 , $983.01 ," $1,014.72 ", $631.71 , $898.45 , $649.40 , $582.65 , N/A , $582.99 , $582.99 ," $1,004.15 ", $665.66 , $30.71 ," $1,014.72 "
"C-Laminoplasty W/Graft/Plate, 2 or More",CPT® 63051,N/A,N/A,N/A," $11,835.00 "," $7,692.75 "," $7,952.72 "," $1,550.83 "," $1,418.23 "," $9,322.73 "," $8,959.38 "," $11,006.55 "," $10,651.50 "," $10,651.50 "," $9,468.00 "," $9,468.00 "," $1,418.23 "," $10,927.26 "," $11,243.25 "," $10,651.50 "," $10,651.50 "," $10,651.50 "," $11,006.55 "," $11,361.60 "," $8,613.33 "," $10,059.75 "," $9,084.45 "," $9,772.17 ", N/A ," $9,504.63 "," $9,504.63 "," $11,243.25 "," $10,196.23 "," $1,418.23 "," $11,361.60 "
 Endocrine Disorders With Cc ,MS DRG V40 (FY2023) 644,N/A,N/A,N/A," $19,511.53 "," $12,682.49 "," $16,389.69 ", N/A , N/A ," $15,765.32 "," $17,560.38 "," $16,518.46 "," $17,560.38 "," $17,560.38 "," $17,560.38 "," $16,584.80 ", N/A ," $18,015.00 "," $18,535.95 "," $16,584.80 "," $18,145.72 "," $18,145.72 "," $18,535.95 "," $18,731.07 "," $15,964.33 "," $17,560.38 "," $16,584.80 "," $15,414.11 ", N/A ," $15,790.68 "," $15,790.68 "," $18,535.95 "," $16,742.84 "," $15,414.11 "," $18,731.07 "
 Pro Appl Short Leg Cst Belw Kne-Toe Walking/Ambl Typ ,CPT® 29425,0975 - PRO FEE/OR,N/A,N/A, $446.00 , $289.90 , $330.72 , $52.05 , $72.09 , $277.32 , $277.13 , $414.78 , $401.40 , $401.40 , $356.80 , $356.80 , $72.09 , $411.79 , $423.70 , $401.40 , $401.40 , $401.40 , $414.78 , $428.16 , $311.12 , $379.10 , $301.51 , $326.81 , N/A , $282.72 , $282.72 , $423.70 , $332.30 , $52.05 , $428.16 
"Antibiotic Sens,Mic,Each",CPT® 87186,N/A,N/A,N/A, $102.00 , $66.30 , N/A , $8.82 , $8.82 , $48.94 , $58.49 , $94.86 , $91.80 , $91.80 , $81.60 , $81.60 , $8.82 , $94.18 , $96.90 , $91.80 , $91.80 , $91.80 , $94.86 , $97.92 , $57.76 , $86.70 , $56.76 , $31.34 , N/A , $45.67 , $45.67 , $96.90 , $49.90 , $8.82 , $97.92 
Iron Binding Test,CPT® 83550,N/A,N/A,N/A, $82.00 , $53.30 , N/A , $8.91 , $8.91 , $49.47 , $59.18 , $76.26 , $73.80 , $73.80 , $65.60 , $65.60 , $8.91 , $75.71 , $77.90 , $73.80 , $73.80 , $73.80 , $76.26 , $78.72 , $58.36 , $69.70 , $56.76 , $31.69 , N/A , $46.17 , $46.17 , $77.90 , $50.46 , $8.91 , $78.72 
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 6/> Vw,CPT® 72084,N/A,N/A,N/A, $543.00 , $352.95 , $674.24 , $97.69 , $63.30 , $383.66 , $404.29 , $504.99 , $488.70 , $488.70 , $434.40 , $434.40 , $63.30 , $501.35 , $515.85 , $488.70 , $488.70 , $488.70 , $504.99 , $521.28 , $537.68 , $461.55 , $571.67 , $441.00 , N/A , $391.15 , $391.15 , $515.85 , $452.77 , $63.30 , $674.24 
 Fac Chg F9 Full Gene Sequence ,CPT® 81238,0310 - PATHOLOGY LAB,N/A,N/A, $14.00 , $9.10 , $11.76 , $612.00 , $489.60 , $11.31 , $12.60 , $11.85 , $12.60 , $12.60 , $12.60 , $11.90 , $480.00 , $12.93 , $13.30 , $11.90 , $13.02 , $13.02 , $13.30 , $13.44 , $11.45 , $12.60 , $11.90 , $11.06 , N/A , $11.33 , $11.33 , $13.30 , $12.01 , $11.06 , $612.00 
 Pro Rmvl FB Musc/Tdn Shth Smpl ,CPT® 20520,0981 - PRO FEE/ER,N/A,N/A," $1,338.00 ", $869.70 , $907.27 , $141.83 , $63.53 , $711.39 , $712.53 ," $1,244.34 "," $1,204.20 "," $1,204.20 "," $1,070.40 "," $1,070.40 ", $63.53 ," $1,235.38 "," $1,271.10 "," $1,204.20 "," $1,204.20 "," $1,204.20 "," $1,244.34 "," $1,284.48 ", $842.13 ," $1,137.30 ", $779.64 , $849.77 , N/A , $725.26 , $725.26 ," $1,271.10 ", $852.44 , $63.53 ," $1,284.48 "
 Fac Electron Microscopy ,CPT® 88348,0312 - PATHOL/HISTOL,N/A,N/A," $2,247.00 "," $1,460.55 "," $1,887.48 ", $463.41 , $141.98 ," $1,815.58 "," $2,022.30 "," $1,902.31 "," $2,022.30 "," $2,022.30 "," $2,022.30 "," $1,909.95 ", $139.20 ," $2,074.66 "," $2,134.65 "," $1,909.95 "," $2,089.71 "," $2,089.71 "," $2,134.65 "," $2,157.12 "," $1,838.50 "," $2,022.30 "," $1,909.95 "," $1,775.13 ", N/A ," $1,818.50 "," $1,818.50 "," $2,134.65 "," $1,928.15 ", $139.20 ," $2,157.12 "
 Pro Rplcmt Compl Tun Cvc W/O Subq Port/Pmp ,CPT® 36581,0982 - PRO FEE/OUTPT,N/A,N/A," $5,106.00 "," $3,318.90 "," $1,119.76 ", $173.23 , $938.62 , $861.03 , $855.68 ," $4,748.58 "," $4,595.40 "," $4,595.40 "," $4,084.80 "," $4,084.80 ", $938.62 ," $4,714.37 "," $4,850.70 "," $4,595.40 "," $4,595.40 "," $4,595.40 "," $4,748.58 "," $4,901.76 "," $1,036.21 "," $4,340.10 "," $1,049.03 ", $917.13 , N/A , $877.83 , $877.83 ," $4,850.70 ", $997.21 , $173.23 ," $4,901.76 "
 Pro Rpr Cplx Trnk Ea 5 Cm/< ,CPT® 13102,0975 - PRO FEE/OR,N/A,N/A, $557.00 , $362.05 , $228.24 , $67.58 , $75.77 , $202.55 , $195.28 , $518.01 , $501.30 , $501.30 , $445.60 , $445.60 , $75.77 , $514.28 , $529.15 , $501.30 , $501.30 , $501.30 , $518.01 , $534.72 , $251.34 , $473.45 , $392.49 , $258.78 , N/A , $206.50 , $206.50 , $529.15 , $239.47 , $67.58 , $534.72 
 Fac Attendance at Delivery W Initial Stabilization ,CPT® 99464,0722 - DELIVERY ROOM,N/A,N/A, $331.00 , $215.15 , $278.04 , $70.99 , $69.64 , $267.45 , $297.90 , $280.22 , $297.90 , $297.90 , $297.90 , $281.35 , $68.27 , $305.61 , $314.45 , $281.35 , $307.83 , $307.83 , $314.45 , $317.76 , $270.82 , $297.90 , $281.35 , $261.49 , N/A , $267.88 , $267.88 , $314.45 , $284.03 , $68.27 , $317.76 
 Pt Neg Pressure Wound Tx </= 50 Sq Cm -Mh ,CPT® 97605,0761 - TREATMENT ROOM,N/A,N/A, $218.00 , $141.70 , $183.12 , $24.70 , $29.41 , $176.14 , $196.20 , $184.56 , $196.20 , $196.20 , $196.20 , $185.30 , $28.83 , $201.28 , $207.10 , $185.30 , $202.74 , $202.74 , $207.10 , $209.28 , $178.37 , $196.20 , $185.30 , $172.22 , N/A , $176.43 , $176.43 , $207.10 , $187.07 , $24.70 , $209.28 
Lysis Adnexal Adhesions,CPT® 58740,N/A,N/A,N/A," $5,244.00 "," $3,408.60 "," $4,224.75 ", $856.27 , $684.55 ," $3,581.74 "," $3,556.19 "," $4,876.92 "," $4,719.60 "," $4,719.60 "," $4,195.20 "," $4,195.20 ", $684.55 ," $4,841.79 "," $4,981.80 "," $4,719.60 "," $4,719.60 "," $4,719.60 "," $4,876.92 "," $5,034.24 "," $4,410.32 "," $4,457.40 "," $4,688.52 "," $3,597.70 ", N/A ," $3,651.63 "," $3,651.63 "," $4,981.80 "," $4,379.92 ", $684.55 ," $5,034.24 "
 NM Pulmonary Quant Funct Perf&Vent ,CPT® 78598,0340 - NUCLEAR MEDICINE,N/A,N/A," $2,841.00 "," $1,846.65 "," $2,386.44 ", $276.85 , $236.29 ," $2,295.53 "," $2,556.90 "," $2,405.19 "," $2,556.90 "," $2,556.90 "," $2,556.90 "," $2,414.85 ", $231.66 ," $2,623.10 "," $2,698.95 "," $2,414.85 "," $2,642.13 "," $2,642.13 "," $2,698.95 "," $2,727.36 "," $2,324.51 "," $2,556.90 "," $2,414.85 "," $2,244.39 ", N/A ," $2,299.22 "," $2,299.22 "," $2,698.95 "," $2,437.86 ", $231.66 ," $2,727.36 "
 Mi Spect Imaging ,CPT® 78469,0340 - NUCLEAR MEDICINE,N/A,N/A," $2,027.00 "," $1,317.55 "," $1,702.68 ", $204.41 , $241.23 ," $1,637.82 "," $1,824.30 "," $1,716.06 "," $1,824.30 "," $1,824.30 "," $1,824.30 "," $1,722.95 ", $236.50 ," $1,871.53 "," $1,925.65 "," $1,722.95 "," $1,885.11 "," $1,885.11 "," $1,925.65 "," $1,945.92 "," $1,658.49 "," $1,824.30 "," $1,722.95 "," $1,601.33 ", N/A ," $1,640.45 "," $1,640.45 "," $1,925.65 "," $1,739.37 ", $204.41 ," $1,945.92 "
 BETHANECHOL CHLORIDE 50 MG PO TABS ,HCPCS RXA250,0250 - PHARMACY,00832-0513-01,1 tablet, $21.94 , $14.26 , $18.43 , N/A , N/A , $17.73 , $19.75 , $18.57 , $19.75 , $19.75 , $19.75 , $18.65 , N/A , $20.26 , $20.84 , $18.65 , $20.40 , $20.40 , $20.84 , $21.06 , $17.95 , $19.75 , $18.65 , $17.33 , N/A , $17.76 , $17.76 , $20.84 , $18.83 , $17.33 , $21.06 
Fx Radial Shaft Closed,25500,N/A,N/A,N/A," $1,243.00 ", $807.95 ," $1,601.34 ", $254.45 , $170.42 ," $1,203.90 "," $1,222.94 "," $1,155.99 "," $1,118.70 "," $1,118.70 ", $994.40 , $994.40 , $170.42 ," $1,147.66 "," $1,180.85 "," $1,118.70 "," $1,118.70 "," $1,118.70 "," $1,155.99 "," $1,193.28 "," $1,473.82 "," $1,056.55 "," $1,338.05 "," $1,436.19 ", N/A ," $1,227.40 "," $1,227.40 "," $1,180.85 "," $1,442.63 ", $170.42 ," $1,601.34 "
"Laminec/Facetect/Foramin,Thoracic",CPT® 63046,N/A,N/A,N/A," $7,842.00 "," $5,097.30 "," $5,732.74 "," $1,121.99 "," $1,027.27 "," $6,568.06 "," $6,337.20 "," $7,293.06 "," $7,057.80 "," $7,057.80 "," $6,273.60 "," $6,273.60 "," $1,027.27 "," $7,240.52 "," $7,449.90 "," $7,057.80 "," $7,057.80 "," $7,057.80 "," $7,293.06 "," $7,528.32 "," $6,201.66 "," $6,665.70 "," $6,433.33 "," $6,983.20 ", N/A ," $6,696.22 "," $6,696.22 "," $7,449.90 "," $7,183.47 "," $1,027.27 "," $7,528.32 "
 Retroperitoneal Complete US ,CPT® 76770,0402 - ULTRASOUND,N/A,N/A, $759.00 , $493.35 , $637.56 , $107.56 , $119.09 , $613.27 , $683.10 , $642.57 , $683.10 , $683.10 , $683.10 , $645.15 , $116.75 , $700.78 , $721.05 , $645.15 , $705.87 , $705.87 , $721.05 , $728.64 , $621.01 , $683.10 , $645.15 , $599.61 , N/A , $614.26 , $614.26 , $721.05 , $651.30 , $107.56 , $728.64 
 ALBUTEROL SULFATE 1.25 MG/3ML INH NEBU ,HCPCS RXC637,0250 - PHARMACY,00487-9904-01,3 mL, $8.19 , $5.32 , $6.88 , N/A , N/A , $6.62 , $7.37 , $6.93 , $7.37 , $7.37 , $7.37 , $6.96 , N/A , $7.56 , $7.78 , $6.96 , $7.62 , $7.62 , $7.78 , $7.86 , $6.70 , $7.37 , $6.96 , $6.47 , N/A , $6.63 , $6.63 , $7.78 , $7.03 , $6.47 , $7.86 
 Fac Remvl Perm Pm Pls Gen W/Repl Plse Gen 2 Lead Sys ,CPT® 33228,0360 - OR SERVICES,N/A,N/A," $8,679.00 "," $5,641.35 "," $7,290.36 ", $327.07 , $402.33 ," $7,012.63 "," $7,811.10 "," $7,347.64 "," $7,811.10 "," $7,811.10 "," $7,811.10 "," $7,377.15 ", $394.44 ," $8,013.32 "," $8,245.05 "," $7,377.15 "," $8,071.47 "," $8,071.47 "," $8,245.05 "," $8,331.84 "," $7,101.16 "," $7,811.10 "," $7,377.15 "," $6,856.41 ", N/A ," $7,023.91 "," $7,023.91 "," $8,245.05 "," $7,447.45 ", $327.07 ," $8,331.84 "
Proctosgmdsc Rigid Control Bleeding,CPT® 45317,N/A,N/A,N/A," $1,475.00 ", $958.75 , $672.10 , $104.40 , $143.08 , $561.19 , $575.84 ," $1,371.75 "," $1,327.50 "," $1,327.50 "," $1,180.00 "," $1,180.00 ", $143.08 ," $1,361.87 "," $1,401.25 "," $1,327.50 "," $1,327.50 "," $1,327.50 "," $1,371.75 "," $1,416.00 ", $481.26 ," $1,253.75 ", $633.34 , $639.02 , N/A , $572.15 , $572.15 ," $1,401.25 ", $598.41 , $104.40 ," $1,416.00 "
 Pro Transplant Hand Tendon ,CPT® 26480,0982 - PRO FEE/OUTPT,N/A,N/A," $4,268.00 "," $2,774.20 "," $4,952.81 ", $769.68 , $614.70 ," $3,575.48 "," $3,644.52 "," $3,969.24 "," $3,841.20 "," $3,841.20 "," $3,414.40 "," $3,414.40 ", $614.70 ," $3,940.64 "," $4,054.60 "," $3,841.20 "," $3,841.20 "," $3,841.20 "," $3,969.24 "," $4,097.28 "," $4,574.29 "," $3,627.80 "," $3,987.38 "," $4,288.31 ", N/A ," $3,645.24 "," $3,645.24 "," $4,054.60 "," $4,284.45 ", $614.70 ," $4,952.81 "
" Fac Immunohistochemistry, Tumor ",CPT® 88361,0310 - PATHOLOGY LAB,N/A,N/A, $916.00 , $595.40 , $769.44 , $116.79 , $135.03 , $740.13 , $824.40 , $775.49 , $824.40 , $824.40 , $824.40 , $778.60 , $132.38 , $845.74 , $870.20 , $778.60 , $851.88 , $851.88 , $870.20 , $879.36 , $749.47 , $824.40 , $778.60 , $723.64 , N/A , $741.32 , $741.32 , $870.20 , $786.02 , $116.79 , $879.36 
" Sa Duplex Aorta,Ivc,Iliacs Complete ",CPT® 93978,0921 - PERI VASCUL LAB,N/A,N/A," $1,431.00 ", $930.15 ," $1,202.04 ", $175.95 , $167.23 ," $1,156.25 "," $1,287.90 "," $1,211.48 "," $1,287.90 "," $1,287.90 "," $1,287.90 "," $1,216.35 ", $163.95 ," $1,321.24 "," $1,359.45 "," $1,216.35 "," $1,330.83 "," $1,330.83 "," $1,359.45 "," $1,373.76 "," $1,170.84 "," $1,287.90 "," $1,216.35 "," $1,130.49 ", N/A ," $1,158.11 "," $1,158.11 "," $1,359.45 "," $1,227.94 ", $163.95 ," $1,373.76 "
 Pro Cltx Metar Fx W/Mnpj ,CPT® 28475,0982 - PRO FEE/OUTPT,N/A,N/A," $1,739.00 "," $1,130.35 "," $1,407.45 ", $223.42 , $153.67 ," $1,112.20 "," $1,108.67 "," $1,617.27 "," $1,565.10 "," $1,565.10 "," $1,391.20 "," $1,391.20 ", $153.67 ," $1,605.62 "," $1,652.05 "," $1,565.10 "," $1,565.10 "," $1,565.10 "," $1,617.27 "," $1,669.44 "," $1,307.69 "," $1,478.15 "," $1,207.81 "," $1,312.14 ", N/A ," $1,133.90 "," $1,133.90 "," $1,652.05 "," $1,332.74 ", $153.67 ," $1,669.44 "
 OXYCODONE-ACETAMINOPHEN 10-325 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-7095-61,1 tablet, $7.39 , $4.80 , $6.21 , N/A , N/A , $5.97 , $6.65 , $6.26 , $6.65 , $6.65 , $6.65 , $6.28 , N/A , $6.82 , $7.02 , $6.28 , $6.87 , $6.87 , $7.02 , $7.09 , $6.05 , $6.65 , $6.28 , $5.84 , N/A , $5.98 , $5.98 , $7.02 , $6.34 , $5.84 , $7.09 
 Fac Assay of Aldosterone ,CPT® 82088,0301 - LAB/CHEMISTRY,N/A,N/A, $365.00 , $237.25 , $306.60 , $41.57 , $41.57 , $294.92 , $328.50 , $309.01 , $328.50 , $328.50 , $328.50 , $310.25 , $40.75 , $337.00 , $346.75 , $310.25 , $339.45 , $339.45 , $346.75 , $350.40 , $298.64 , $328.50 , $310.25 , $288.35 , N/A , $295.39 , $295.39 , $346.75 , $313.21 , $40.75 , $350.40 
"Preventive Visit,New,Age 1-4",CPT® 99382,N/A,N/A,N/A, $345.00 , $224.25 , N/A , $111.23 , $62.20 , $174.25 , $175.74 , $320.85 , $310.50 , $310.50 , $276.00 , $276.00 , $62.20 , $318.54 , $327.75 , $310.50 , $310.50 , $310.50 , $320.85 , $331.20 , $215.48 , $293.25 , $175.52 , $174.30 , N/A , $177.65 , $177.65 , $327.75 , $213.38 , $62.20 , $331.20 
Remove Eye Foreign Body,CPT® 65205,N/A,N/A,N/A, $421.00 , $273.65 , $180.70 , $28.20 , $35.23 , $251.30 , $232.46 , $391.53 , $378.90 , $378.90 , $336.80 , $336.80 , $35.23 , $388.71 , $399.95 , $378.90 , $378.90 , $378.90 , $391.53 , $404.16 , $248.64 , $357.85 , $239.06 , $319.55 , N/A , $256.20 , $256.20 , $399.95 , $282.82 , $28.20 , $404.16 
 Pro Spine/Lumbar Disk Surgery ,HCPCS C9757,0982 - PRO FEE/OUTPT,N/A,N/A," $8,357.00 "," $5,432.05 ", N/A , N/A , N/A , N/A , N/A ," $7,772.01 "," $7,521.30 "," $7,521.30 "," $6,685.60 "," $6,685.60 ", N/A ," $7,716.02 "," $7,939.15 "," $7,521.30 "," $7,521.30 "," $7,521.30 "," $7,772.01 "," $8,022.72 ", N/A ," $7,103.45 "," $6,685.60 ", N/A , N/A , N/A , N/A ," $7,939.15 ", N/A ," $6,685.60 "," $8,022.72 "
 Fac Assay of Total Thyroxine ,CPT® 84436,0301 - LAB/CHEMISTRY,N/A,N/A, $78.00 , $50.70 , $65.52 , $7.01 , $7.01 , $63.02 , $70.20 , $66.03 , $70.20 , $70.20 , $70.20 , $66.30 , $6.87 , $72.02 , $74.10 , $66.30 , $72.54 , $72.54 , $74.10 , $74.88 , $63.82 , $70.20 , $66.30 , $61.62 , N/A , $63.13 , $63.13 , $74.10 , $66.93 , $6.87 , $74.88 
" Fac Destruct Internal Hemorrhoid, Thermal ",CPT® 46930,0761 - TREATMENT ROOM,N/A,N/A," $1,031.00 ", $670.15 , $866.04 , $147.02 , $143.79 , $833.05 , $927.90 , $872.84 , $927.90 , $927.90 , $927.90 , $876.35 , $140.97 , $951.92 , $979.45 , $876.35 , $958.83 , $958.83 , $979.45 , $989.76 , $843.56 , $927.90 , $876.35 , $814.49 , N/A , $834.39 , $834.39 , $979.45 , $884.70 , $140.97 , $989.76 
"Venipuncture,Under Age 3",CPT® 36406,N/A,N/A,N/A, $143.00 , $92.95 , $55.97 , $8.63 , $26.81 , $43.35 , $41.66 , $132.99 , $128.70 , $128.70 , $114.40 , $114.40 , $26.81 , $132.03 , $135.85 , $128.70 , $128.70 , $128.70 , $132.99 , $137.28 , $50.00 , $121.55 , $51.74 , $44.41 , N/A , $44.20 , $44.20 , $135.85 , $50.22 , $8.63 , $137.28 
"Corneal Transplant,Pen,Pseudoaphak",CPT® 65755,N/A,N/A,N/A," $11,242.00 "," $7,307.30 "," $7,772.05 "," $1,215.84 "," $1,443.92 "," $6,951.07 "," $6,468.92 "," $10,455.06 "," $10,117.80 "," $10,117.80 "," $8,993.60 "," $8,993.60 "," $1,443.92 "," $10,379.74 "," $10,679.90 "," $10,117.80 "," $10,117.80 "," $10,117.80 "," $10,455.06 "," $10,792.32 "," $10,617.81 "," $9,555.70 "," $6,647.42 "," $8,817.24 ", N/A ," $7,086.70 "," $7,086.70 "," $10,679.90 "," $7,822.80 "," $1,215.84 "," $10,792.32 "
Motor &/Sens 9-10 Nrv Cndj Preconf Eltrode Limb,CPT® 95911,N/A,N/A,N/A," $1,207.00 ", $784.55 ," $1,055.95 ", $208.77 , $174.53 , $749.72 ," $1,931.50 "," $1,122.51 "," $1,086.30 "," $1,086.30 ", $965.60 , $965.60 , $174.53 ," $1,114.42 "," $1,146.65 "," $1,086.30 "," $1,086.30 "," $1,086.30 "," $1,122.51 "," $1,158.72 ", $982.20 ," $1,025.95 ", $663.98 , $902.12 , N/A , $764.35 , $764.35 ," $1,146.65 ", $939.69 , $174.53 ," $1,931.50 "
Drug Tst Prsmv Instrmnt Chem Analyzers PR Date,CPT® 80307,N/A,N/A,N/A, $167.00 , $108.55 , N/A , $63.38 , $63.38 , $448.38 , N/A , $155.31 , $150.30 , $150.30 , $133.60 , $133.60 , $63.38 , $154.19 , $158.65 , $150.30 , $150.30 , $150.30 , $155.31 , $160.32 , $414.92 , $141.95 , $295.61 , $210.96 , N/A , $418.46 , $418.46 , $158.65 , $457.28 , $63.38 , $457.28 
 Fac Obstetric Panel ,CPT® 80055,0300 - LABORATORY,N/A,N/A, $473.00 , $307.45 , $397.32 , $48.77 , $19.41 , $382.18 , $425.70 , $400.44 , $425.70 , $425.70 , $425.70 , $402.05 , $19.03 , $436.72 , $449.35 , $402.05 , $439.89 , $439.89 , $449.35 , $454.08 , $387.01 , $425.70 , $402.05 , $373.67 , N/A , $382.80 , $382.80 , $449.35 , $405.88 , $19.03 , $454.08 
 Fac Esophagoscopy Flexible W/Bleeding Control ,CPT® 43227,0360 - OR SERVICES,N/A,N/A," $2,275.00 "," $1,478.75 "," $1,911.00 ", $156.01 , $549.85 ," $1,838.20 "," $2,047.50 "," $1,926.02 "," $2,047.50 "," $2,047.50 "," $2,047.50 "," $1,933.75 ", $539.07 ," $2,100.51 "," $2,161.25 "," $1,933.75 "," $2,115.75 "," $2,115.75 "," $2,161.25 "," $2,184.00 "," $1,861.41 "," $2,047.50 "," $1,933.75 "," $1,797.25 ", N/A ," $1,841.16 "," $1,841.16 "," $2,161.25 "," $1,952.18 ", $156.01 ," $2,184.00 "
 KCL IN NACL 40-0.9 MEQ/L-% IV SOLN (INPT) ,HCPCS RXA258,0258 - IV SOLUTIONS,00990-7116-09,"1,000 mL", $133.03 , $86.47 , $111.75 , N/A , N/A , $107.49 , $119.73 , $112.62 , $119.73 , $119.73 , $119.73 , $113.08 , N/A , $122.83 , $126.38 , $113.08 , $123.72 , $123.72 , $126.38 , $127.71 , $108.85 , $119.73 , $113.08 , $105.09 , N/A , $107.66 , $107.66 , $126.38 , $114.15 , $105.09 , $127.71 
" Fac Cytopath Smear, Other Source ",CPT® 88160,0311 - PATHOL/CYTOLOGY,N/A,N/A, $484.00 , $314.60 , $406.56 , $73.76 , $30.70 , $391.07 , $435.60 , $409.75 , $435.60 , $435.60 , $435.60 , $411.40 , $30.10 , $446.88 , $459.80 , $411.40 , $450.12 , $450.12 , $459.80 , $464.64 , $396.01 , $435.60 , $411.40 , $382.36 , N/A , $391.70 , $391.70 , $459.80 , $415.32 , $30.10 , $464.64 
 Pro Reremove Wrist Tendon Lesion ,CPT® 25112,0982 - PRO FEE/OUTPT,N/A,N/A," $1,166.00 ", $757.90 ," $2,400.19 ", $378.50 , $384.35 ," $1,856.12 "," $1,867.08 "," $1,084.38 "," $1,049.40 "," $1,049.40 ", $932.80 , $932.80 , $384.35 ," $1,076.57 "," $1,107.70 "," $1,049.40 "," $1,049.40 "," $1,049.40 "," $1,084.38 "," $1,119.36 "," $2,219.90 ", $991.10 ," $2,053.46 "," $2,208.50 ", N/A ," $1,892.34 "," $1,892.34 "," $1,107.70 "," $2,224.18 ", $378.50 ," $2,400.19 "
 Pro CT Maxillofacial W/O & W/Dye ,CPT® 70488,0972 - PRO FEE/RAD/DX,N/A,N/A, $715.00 , $464.75 ," $1,322.02 ", $189.03 , $354.06 , $978.41 ," $1,743.72 ", $664.95 , $643.50 , $643.50 , $572.00 , $572.00 , $354.06 , $660.16 , $679.25 , $643.50 , $643.50 , $643.50 , $664.95 , $686.40 ," $1,116.39 ", $607.75 ," $1,899.08 "," $1,325.95 ", N/A , $997.50 , $997.50 , $679.25 ," $1,154.62 ", $189.03 ," $1,899.08 "
 Pro Drg Absc/Hmtma Nsl Int Appr ,CPT® 30000,0981 - PRO FEE/ER,N/A,N/A, $686.00 , $445.90 , $657.40 , $117.58 , $30.71 , $451.13 , $453.39 , $637.98 , $617.40 , $617.40 , $548.80 , $548.80 , $30.71 , $633.38 , $651.70 , $617.40 , $617.40 , $617.40 , $637.98 , $658.56 , $623.33 , $583.10 , $640.48 , $597.16 , N/A , $459.93 , $459.93 , $651.70 , $541.65 , $30.71 , $658.56 
"Meas,Post-Void Res,US,Non-Imaging",CPT® 51798,N/A,N/A,N/A, $213.00 , $138.45 , $56.81 , $10.29 , $13.26 , $89.64 , $90.20 , $198.09 , $191.70 , $191.70 , $170.40 , $170.40 , $13.26 , $196.66 , $202.35 , $191.70 , $191.70 , $191.70 , $198.09 , $204.48 , $55.26 , $181.05 , $103.48 , $95.62 , N/A , $91.40 , $91.40 , $202.35 , $107.40 , $10.29 , $204.48 
 Myocrd Strain Img Speckle Trck Assmt ,CPT® 93356,0483 - CARDIOLOGY – ECHOCARDIOLOGY,N/A,N/A, $290.00 , $188.50 , $243.60 , $11.14 , $31.51 , $234.32 , $261.00 , $245.51 , $261.00 , $261.00 , $261.00 , $246.50 , $30.89 , $267.76 , $275.50 , $246.50 , $269.70 , $269.70 , $275.50 , $278.40 , $237.28 , $261.00 , $246.50 , $229.10 , N/A , $234.70 , $234.70 , $275.50 , $248.85 , $11.14 , $278.40 
Echo Tee Guid Tcat Icar/Vessel Structural Intvn,CPT® 93355,N/A,N/A,N/A," $5,279.00 "," $3,431.35 "," $1,415.57 ", $216.97 , $182.63 ," $1,242.69 "," $1,292.68 "," $4,909.47 "," $4,751.10 "," $4,751.10 "," $4,223.20 "," $4,223.20 ", $182.63 ," $4,874.10 "," $5,015.05 "," $4,751.10 "," $4,751.10 "," $4,751.10 "," $4,909.47 "," $5,067.84 "," $1,399.31 "," $4,487.15 "," $1,167.45 "," $1,368.55 ", N/A ," $1,266.94 "," $1,266.94 "," $5,015.05 "," $1,404.43 ", $182.63 ," $5,067.84 "
 Xr Cervical Spine 6 or More Views ,CPT® 72052,0320 - DX X-RAY,N/A,N/A, $573.00 , $372.45 , $481.32 , $61.26 , $62.79 , $462.98 , $515.70 , $485.10 , $515.70 , $515.70 , $515.70 , $487.05 , $61.56 , $529.05 , $544.35 , $487.05 , $532.89 , $532.89 , $544.35 , $550.08 , $468.83 , $515.70 , $487.05 , $452.67 , N/A , $463.73 , $463.73 , $544.35 , $491.69 , $61.26 , $550.08 
Corrj Hallux Valgus W/Sesmdc W/Prox Phlnx Osteot,CPT® 28298,N/A,N/A,N/A," $5,608.00 "," $3,645.20 "," $3,102.13 ", $488.13 , $461.04 ," $2,483.56 "," $2,468.13 "," $5,215.44 "," $5,047.20 "," $5,047.20 "," $4,486.40 "," $4,486.40 ", $461.04 ," $5,177.87 "," $5,327.60 "," $5,047.20 "," $5,047.20 "," $5,047.20 "," $5,215.44 "," $5,383.68 "," $2,871.48 "," $4,766.80 "," $2,677.88 "," $2,903.54 ", N/A ," $2,532.03 "," $2,532.03 "," $5,327.60 "," $2,976.03 ", $461.04 ," $5,383.68 "
 CLOTRIMAZOLE 10 MG MT TROC ,HCPCS RXC637,0250 - PHARMACY,00054-8146-22,1 tablet, $17.65 , $11.47 , $14.83 , N/A , N/A , $14.26 , $15.89 , $14.94 , $15.89 , $15.89 , $15.89 , $15.00 , N/A , $16.30 , $16.77 , $15.00 , $16.41 , $16.41 , $16.77 , $16.94 , $14.44 , $15.89 , $15.00 , $13.94 , N/A , $14.28 , $14.28 , $16.77 , $15.15 , $13.94 , $16.94 
 DOXAZOSIN MESYLATE 4 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-5524-61,1 tablet, $5.28 , $3.43 , $4.44 , N/A , N/A , $4.27 , $4.75 , $4.47 , $4.75 , $4.75 , $4.75 , $4.49 , N/A , $4.88 , $5.02 , $4.49 , $4.91 , $4.91 , $5.02 , $5.07 , $4.32 , $4.75 , $4.49 , $4.17 , N/A , $4.27 , $4.27 , $5.02 , $4.53 , $4.17 , $5.07 
 Dtpa Aerosol for Lung Vent Up to 75 Mci ,HCPCS A9567,0343 - DIAGNOSTIC RADIOPHARMACEUTICALS,N/A,N/A, $501.00 , $325.65 , $420.84 , N/A , N/A , $404.81 , $450.90 , $424.15 , $450.90 , $450.90 , $450.90 , $425.85 , N/A , $462.57 , $475.95 , $425.85 , $465.93 , $465.93 , $475.95 , $480.96 , $409.92 , $450.90 , $425.85 , $395.79 , N/A , $405.46 , $405.46 , $475.95 , $429.91 , $395.79 , $480.96 
 T Spine MRI Without & With Contrast ,CPT® 72157,0612 - MRI - SPINE,N/A,N/A," $6,910.00 "," $4,491.50 "," $5,804.40 ", $329.80 , $655.99 ," $5,583.28 "," $6,219.00 "," $5,850.01 "," $6,219.00 "," $6,219.00 "," $6,219.00 "," $5,873.50 ", $643.13 ," $6,380.00 "," $6,564.50 "," $5,873.50 "," $6,426.30 "," $6,426.30 "," $6,564.50 "," $6,633.60 "," $5,653.76 "," $6,219.00 "," $5,873.50 "," $5,458.90 ", N/A ," $5,592.26 "," $5,592.26 "," $6,564.50 "," $5,929.47 ", $329.80 ," $6,633.60 "
Exc Tumor Soft Tissue Neck/Ant Thorax Subq 3+Cm,CPT® 21552,N/A,N/A,N/A," $2,968.00 "," $1,929.20 "," $2,694.19 ", $420.01 , $369.16 ," $2,137.02 "," $2,140.78 "," $2,760.24 "," $2,671.20 "," $2,671.20 "," $2,374.40 "," $2,374.40 ", $369.16 ," $2,740.35 "," $2,819.60 "," $2,671.20 "," $2,671.20 "," $2,671.20 "," $2,760.24 "," $2,849.28 "," $2,492.75 "," $2,522.80 "," $2,367.45 "," $2,512.02 ", N/A ," $2,178.72 "," $2,178.72 "," $2,819.60 "," $2,560.78 ", $369.16 ," $2,849.28 "
 Pro Abdom Paracentesis Dx/Ther W Imaging Guidance ,CPT® 49083,0981 - PRO FEE/ER,N/A,N/A, $956.00 , $621.40 , $655.33 , $101.73 , $362.06 , $531.21 , $543.60 , $889.08 , $860.40 , $860.40 , $764.80 , $764.80 , $362.06 , $882.67 , $908.20 , $860.40 , $860.40 , $860.40 , $889.08 , $917.76 , $471.73 , $812.60 , $586.96 , $631.12 , N/A , $541.58 , $541.58 , $908.20 , $566.43 , $101.73 , $917.76 
Full Excis 2 - 5 Metatarsal Heads,CPT® 28114,N/A,N/A,N/A," $7,172.00 "," $4,661.80 "," $5,141.96 ", $806.37 , $768.38 ," $4,117.63 "," $4,087.06 "," $6,669.96 "," $6,454.80 "," $6,454.80 "," $5,737.60 "," $5,737.60 ", $768.38 ," $6,621.91 "," $6,813.40 "," $6,454.80 "," $6,454.80 "," $6,454.80 "," $6,669.96 "," $6,885.12 "," $4,767.18 "," $6,096.20 "," $4,461.94 "," $4,852.92 ", N/A ," $4,197.97 "," $4,197.97 "," $6,813.40 "," $4,934.09 ", $768.38 ," $6,885.12 "
"Apply Finger Splint,Dynamic",CPT® 29131,N/A,N/A,N/A, $348.00 , $226.20 , $208.13 , $32.91 , $23.04 , $161.49 , $163.04 , $323.64 , $313.20 , $313.20 , $278.40 , $278.40 , $23.04 , $321.31 , $330.60 , $313.20 , $313.20 , $313.20 , $323.64 , $334.08 , $192.53 , $295.80 , $178.41 , $195.79 , N/A , $164.64 , $164.64 , $330.60 , $193.50 , $23.04 , $334.08 
Induced Ab by Vag Suppos,CPT® 59855,N/A,N/A,N/A," $1,968.00 "," $1,279.20 "," $1,152.45 ", $390.30 , $344.94 , $960.40 ," $1,014.50 "," $1,830.24 "," $1,771.20 "," $1,771.20 "," $1,574.40 "," $1,574.40 ", $344.94 ," $1,817.05 "," $1,869.60 "," $1,771.20 "," $1,771.20 "," $1,771.20 "," $1,830.24 "," $1,889.28 "," $1,164.30 "," $1,672.80 "," $2,237.22 "," $1,788.36 ", N/A , $979.14 , $979.14 ," $1,869.60 "," $1,131.99 ", $344.94 ," $2,237.22 "
Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging,CPT® 78804,N/A,N/A,N/A," $5,935.00 "," $3,857.75 "," $3,492.76 ", $591.15 , $218.99 ," $2,803.49 "," $3,040.71 "," $5,519.55 "," $5,341.50 "," $5,341.50 "," $4,748.00 "," $4,748.00 ", $218.99 ," $5,479.79 "," $5,638.25 "," $5,341.50 "," $5,341.50 "," $5,341.50 "," $5,519.55 "," $5,697.60 "," $3,652.76 "," $5,044.75 "," $3,318.57 "," $3,820.48 ", N/A ," $2,858.19 "," $2,858.19 "," $5,638.25 "," $3,308.40 ", $218.99 ," $5,697.60 "
 Fac IV Dop Vel&/or Press C/Flo Rsrv Meas Addl Vsl ,CPT® 93572,0481 - CARDIAC CATH LAB,N/A,N/A, $746.00 , $484.90 , $626.64 , N/A , $166.76 , $602.77 , $671.40 , $631.56 , $671.40 , $671.40 , $671.40 , $634.10 , $163.49 , $688.78 , $708.70 , $634.10 , $693.78 , $693.78 , $708.70 , $716.16 , $610.38 , $671.40 , $634.10 , $589.34 , N/A , $603.74 , $603.74 , $708.70 , $640.14 , $163.49 , $716.16 
 Pro Smpl Rpr Supfc S/N/Ax/G/T 12.6cm-20.0cm ,CPT® 12005,0981 - PRO FEE/ER,N/A,N/A, $896.00 , $582.40 , $295.26 , $87.55 , $142.50 , $269.43 , $261.25 , $833.28 , $806.40 , $806.40 , $716.80 , $716.80 , $142.50 , $827.28 , $851.20 , $806.40 , $806.40 , $806.40 , $833.28 , $860.16 , $326.46 , $761.60 , $524.51 , $329.30 , N/A , $274.68 , $274.68 , $851.20 , $318.54 , $87.55 , $860.16 
 Fac Assay of Androstenedione ,CPT® 82157,0301 - LAB/CHEMISTRY,N/A,N/A, $269.00 , $174.85 , $225.96 , $29.87 , $29.87 , $217.35 , $242.10 , $227.74 , $242.10 , $242.10 , $242.10 , $228.65 , $29.28 , $248.37 , $255.55 , $228.65 , $250.17 , $250.17 , $255.55 , $258.24 , $220.10 , $242.10 , $228.65 , $212.51 , N/A , $217.70 , $217.70 , $255.55 , $230.83 , $29.28 , $258.24 
Corrj Hallux Valgus W/Sesmdc W/2 Osteot,CPT® 28299,N/A,N/A,N/A," $7,130.00 "," $4,634.50 "," $3,638.77 ", $572.55 , $693.76 ," $3,341.29 "," $3,285.73 "," $6,630.90 "," $6,417.00 "," $6,417.00 "," $5,704.00 "," $5,704.00 ", $693.76 ," $6,583.13 "," $6,773.50 "," $6,417.00 "," $6,417.00 "," $6,417.00 "," $6,630.90 "," $6,844.80 "," $3,365.79 "," $6,060.50 "," $3,559.21 "," $3,402.13 ", N/A ," $3,406.48 "," $3,406.48 "," $6,773.50 "," $4,003.81 ", $572.55 ," $6,844.80 "
"Destr Malig Trunk,Extrem 0.6-1 Cm",CPT® 17261,N/A,N/A,N/A, $552.00 , $358.80 , $278.15 , $83.86 , $92.86 , $250.15 , $246.14 , $513.36 , $496.80 , $496.80 , $441.60 , $441.60 , $92.86 , $509.66 , $524.40 , $496.80 , $496.80 , $496.80 , $513.36 , $529.92 , $306.34 , $469.20 , $488.83 , $320.99 , N/A , $255.04 , $255.04 , $524.40 , $295.78 , $83.86 , $529.92 
X-Ray Sinuses <3 Vw,CPT® 70210,N/A,N/A,N/A, $442.00 , $287.30 , $182.82 , $31.70 , $28.75 , $140.44 , $164.46 , $411.06 , $397.80 , $397.80 , $353.60 , $353.60 , $28.75 , $408.10 , $419.90 , $397.80 , $397.80 , $397.80 , $411.06 , $424.32 , $176.44 , $375.70 , $181.05 , $149.48 , N/A , $143.19 , $143.19 , $419.90 , $165.74 , $28.75 , $424.32 
Derma-Fat-Fascia Graft,CPT® 15770,N/A,N/A,N/A," $5,220.00 "," $3,393.00 "," $2,151.25 ", $645.61 , $691.53 ," $1,825.86 "," $1,808.11 "," $4,854.60 "," $4,698.00 "," $4,698.00 "," $4,176.00 "," $4,176.00 ", $691.53 ," $4,819.63 "," $4,959.00 "," $4,698.00 "," $4,698.00 "," $4,698.00 "," $4,854.60 "," $5,011.20 "," $2,340.08 "," $4,437.00 "," $3,619.87 "," $2,315.00 ", N/A ," $1,861.49 "," $1,861.49 "," $4,959.00 "," $2,158.69 ", $645.61 ," $5,011.20 "
 Fac Collagen Crosslinks ,CPT® 82523,0301 - LAB/CHEMISTRY,N/A,N/A, $254.00 , $165.10 , $213.36 , $19.05 , $14.46 , $205.23 , $228.60 , $215.04 , $228.60 , $228.60 , $228.60 , $215.90 , $14.18 , $234.52 , $241.30 , $215.90 , $236.22 , $236.22 , $241.30 , $243.84 , $207.82 , $228.60 , $215.90 , $200.66 , N/A , $205.56 , $205.56 , $241.30 , $217.96 , $14.18 , $243.84 
Office/Outpatient New Low Mdm 30-44 Minutes,99203,N/A,N/A,N/A, $271.00 , $176.15 , $165.80 , $79.48 , $75.25 , $131.82 , $131.48 , $252.03 , $243.90 , $243.90 , $216.80 , $216.80 , $75.25 , $250.21 , $257.45 , $243.90 , $243.90 , $243.90 , $252.03 , $260.16 , $150.96 , $230.35 , $165.77 , $165.41 , $52.50 , $134.39 , $134.39 , $257.45 , $155.01 , $52.50 , $260.16 
 Iron Binding Capacity Beaker1 ,CPT® 83550,0301 - LAB/CHEMISTRY,N/A,N/A, $82.00 , $53.30 , $68.88 , $8.91 , $8.91 , $66.26 , $73.80 , $69.42 , $73.80 , $73.80 , $73.80 , $69.70 , $8.74 , $75.71 , $77.90 , $69.70 , $76.26 , $76.26 , $77.90 , $78.72 , $67.09 , $73.80 , $69.70 , $64.78 , N/A , $66.36 , $66.36 , $77.90 , $70.36 , $8.74 , $78.72 
 CLOPIDOGREL BISULFATE 300 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6467-10,1 tablet, $50.43 , $32.78 , $42.36 , N/A , N/A , $40.75 , $45.39 , $42.69 , $45.39 , $45.39 , $45.39 , $42.87 , N/A , $46.56 , $47.91 , $42.87 , $46.90 , $46.90 , $47.91 , $48.41 , $41.26 , $45.39 , $42.87 , $39.84 , N/A , $40.81 , $40.81 , $47.91 , $43.27 , $39.84 , $48.41 
"LAPAROSCOPY, GASTROSTOMY",43753,N/A,N/A,N/A, $198.00 , $128.70 , $130.52 , $20.03 , $15.22 , $103.82 , $99.92 , $184.14 , $178.20 , $178.20 , $158.40 , $158.40 , $15.22 , $182.81 , $188.10 , $178.20 , $178.20 , $178.20 , $184.14 , $190.08 , $94.16 , $168.30 , $107.04 , $124.36 , N/A , $105.84 , $105.84 , $188.10 , $110.70 , $15.22 , $190.08 
"Tumorimage Pet&CT, Skul-Thigh",CPT® 78815,N/A,N/A,N/A," $9,307.00 "," $6,049.55 "," $10,746.75 "," $1,555.08 "," $2,303.38 "," $4,838.11 "," $4,986.72 "," $8,655.51 "," $8,376.30 "," $8,376.30 "," $7,445.60 "," $7,445.60 "," $2,303.38 "," $8,593.15 "," $8,841.65 "," $8,376.30 "," $8,376.30 "," $8,376.30 "," $8,655.51 "," $8,934.72 "," $8,636.92 "," $7,910.95 "," $5,570.11 "," $5,827.23 ", N/A ," $4,932.51 "," $4,932.51 "," $8,841.65 "," $5,709.45 "," $1,555.08 "," $10,746.75 "
"Dtap Immunization, Im",CPT® 90700,N/A,N/A,N/A, $99.00 , $64.35 , N/A , N/A , $15.30 , $55.34 , $57.97 , $92.07 , $89.10 , $89.10 , $79.20 , $79.20 , $15.30 , $91.41 , $94.05 , $89.10 , $89.10 , $89.10 , $92.07 , $95.04 , N/A , $84.15 , $77.04 , $50.26 , N/A , $56.42 , $56.42 , $94.05 , $65.78 , $15.30 , $95.04 
 Pro MRI Breast Without Contrast Material Bilateral ,CPT® 77047,0972 - PRO FEE/RAD/DX,N/A,N/A, $840.00 , $546.00 ," $1,308.36 ", $226.15 , $203.14 ," $1,138.76 ", N/A , $781.20 , $756.00 , $756.00 , $672.00 , $672.00 , $203.14 , $775.57 , $798.00 , $756.00 , $756.00 , $756.00 , $781.20 , $806.40 ," $1,356.84 ", $714.00 ," $1,317.91 "," $4,974.27 ", N/A ," $1,160.97 "," $1,160.97 ", $798.00 ," $1,343.85 ", $203.14 ," $4,974.27 "
 NIVOLUMAB 100 MG/10ML IV SOLN ,HCPCS J9299,0636 - DRUGS REQUIRING DETAILED CODIN,00003-3774-12,10 mL," $8,990.20 "," $5,843.63 "," $7,551.77 ", $31.07 , $30.60 ," $7,264.08 "," $8,091.18 "," $7,611.10 "," $8,091.18 "," $8,091.18 "," $8,091.18 "," $7,641.67 ", $30.00 ," $8,300.65 "," $8,540.69 "," $7,641.67 "," $8,360.89 "," $8,360.89 "," $8,540.69 "," $8,630.59 "," $7,355.78 "," $8,091.18 "," $7,641.67 "," $7,102.26 ", N/A ," $7,275.77 "," $7,275.77 "," $8,540.69 "," $7,714.49 ", $30.00 ," $8,630.59 "
Inject Tendon Origin/Insert,CPT® 20551,N/A,N/A,N/A, $395.00 , $256.75 , $99.85 , $37.19 , $26.41 , $208.42 , $205.64 , $367.35 , $355.50 , $355.50 , $316.00 , $316.00 , $26.41 , $364.70 , $375.25 , $355.50 , $355.50 , $355.50 , $367.35 , $379.20 , $224.71 , $335.75 , $223.01 , $248.94 , N/A , $212.48 , $212.48 , $375.25 , $249.74 , $26.41 , $379.20 
Treat Articular Fracture,26740,N/A,N/A,N/A, $914.00 , $594.10 ," $1,375.21 ", $218.73 , $126.34 ," $1,034.45 "," $1,051.56 ", $850.02 , $822.60 , $822.60 , $731.20 , $731.20 , $126.34 , $843.90 , $868.30 , $822.60 , $822.60 , $822.60 , $850.02 , $877.44 ," $1,266.41 ", $776.90 ," $1,150.72 "," $1,238.55 ", N/A ," $1,054.63 "," $1,054.63 ", $868.30 ," $1,239.57 ", $126.34 ," $1,375.21 "
 Pro Mod Sed Same Phys/Qhp Initial 15 Mins <5 Yrs ,CPT® 99151,0981 - PRO FEE/ER,N/A,N/A, $232.00 , $150.80 , $57.38 , $23.62 , $60.95 , $50.47 , $53.68 , $215.76 , $208.80 , $208.80 , $185.60 , $185.60 , $60.95 , $214.21 , $220.40 , $208.80 , $208.80 , $208.80 , $215.76 , $222.72 , $75.59 , $197.20 , $72.70 , $92.02 , N/A , $51.45 , $51.45 , $220.40 , $59.99 , $23.62 , $222.72 
 VITAMIN D3 125 MCG (5000 UT) PO TABS ,HCPCS RXC637,0250 - PHARMACY,50268-0866-15,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Drug Screening Cocaine,CPT® 80353,N/A,N/A,N/A, $191.00 , $124.15 , N/A , N/A , N/A , N/A , N/A , $177.63 , $171.90 , $171.90 , $152.80 , $152.80 , N/A , $176.35 , $181.45 , $171.90 , $171.90 , $171.90 , $177.63 , $183.36 , N/A , $162.35 , $114.69 , $67.79 , N/A , $90.04 , $90.04 , $181.45 , $98.20 , $67.79 , $183.36 
 Fac Lactate (Ld) (Ldh) Enzyme ,CPT® 83615,0301 - LAB/CHEMISTRY,N/A,N/A, $78.00 , $50.70 , $65.52 , $6.16 , $6.16 , $63.02 , $70.20 , $66.03 , $70.20 , $70.20 , $70.20 , $66.30 , $6.04 , $72.02 , $74.10 , $66.30 , $72.54 , $72.54 , $74.10 , $74.88 , $63.82 , $70.20 , $66.30 , $61.62 , N/A , $63.13 , $63.13 , $74.10 , $66.93 , $6.04 , $74.88 
Injection Aa&/Strd Nerves Nrvtg Si Joint W/Img,CPT® 64451,N/A,N/A,N/A, $815.00 , $529.75 , $404.72 , $78.68 , $166.49 , $436.58 , N/A , $757.95 , $733.50 , $733.50 , $652.00 , $652.00 , $166.49 , $752.49 , $774.25 , $733.50 , $733.50 , $733.50 , $757.95 , $782.40 , $421.43 , $692.75 , $428.24 , $480.34 , N/A , $445.09 , $445.09 , $774.25 , $477.46 , $78.68 , $782.40 
Sbsq Hospital IP/Obs Care High Mdm 50 Minutes,99233,N/A,N/A,N/A, $344.00 , $223.60 , $204.50 , $115.78 , $54.97 , $180.73 , $179.46 , $319.92 , $309.60 , $309.60 , $275.20 , $275.20 , $54.97 , $317.62 , $326.80 , $309.60 , $309.60 , $309.60 , $319.92 , $330.24 , $260.33 , $292.40 , $222.78 , $228.27 , $107.50 , $184.26 , $184.26 , $326.80 , $212.51 , $54.97 , $330.24 
 DOXEPIN HCL 10 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-7052-61,1 capsule, $3.75 , $2.44 , $3.15 , N/A , N/A , $3.03 , $3.38 , $3.17 , $3.38 , $3.38 , $3.38 , $3.19 , N/A , $3.46 , $3.56 , $3.19 , $3.49 , $3.49 , $3.56 , $3.60 , $3.07 , $3.38 , $3.19 , $2.96 , N/A , $3.03 , $3.03 , $3.56 , $3.22 , $2.96 , $3.60 
 METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN ,HCPCS J9260,0636 - DRUGS REQUIRING DETAILED CODIN,16729-0277-30,2 mL, $25.18 , $16.37 , $21.15 , $2.76 , $2.50 , $20.35 , $22.66 , $21.32 , $22.66 , $22.66 , $22.66 , $21.40 , $2.45 , $23.25 , $23.92 , $21.40 , $23.42 , $23.42 , $23.92 , $24.17 , $20.60 , $22.66 , $21.40 , $19.89 , N/A , $20.38 , $20.38 , $23.92 , $21.61 , $2.45 , $24.17 
" Fac Program Eval Implant Device,Cardvert/Defib,1 Lead ",CPT® 93282,0480 - CARDIOLOGY,N/A,N/A, $396.00 , $257.40 , $332.64 , $79.84 , $54.59 , $319.97 , $356.40 , $335.25 , $356.40 , $356.40 , $356.40 , $336.60 , $53.52 , $365.63 , $376.20 , $336.60 , $368.28 , $368.28 , $376.20 , $380.16 , $324.01 , $356.40 , $336.60 , $312.84 , N/A , $320.48 , $320.48 , $376.20 , $339.81 , $53.52 , $380.16 
 Fac Urine Bacteria Culture ,CPT® 87088,0306 - LAB/BACT-MICRO,N/A,N/A, $109.00 , $70.85 , $91.56 , $8.25 , $8.25 , $88.07 , $98.10 , $92.28 , $98.10 , $98.10 , $98.10 , $92.65 , $8.09 , $100.64 , $103.55 , $92.65 , $101.37 , $101.37 , $103.55 , $104.64 , $89.18 , $98.10 , $92.65 , $86.11 , N/A , $88.21 , $88.21 , $103.55 , $93.53 , $8.09 , $104.64 
Simple Repair 20.1-30cm,CPT® 12006,N/A,N/A,N/A," $1,553.00 "," $1,009.45 ", $362.98 , $107.63 , $188.65 , $328.19 , $317.78 ," $1,444.29 "," $1,397.70 "," $1,397.70 "," $1,242.40 "," $1,242.40 ", $188.65 ," $1,433.88 "," $1,475.35 "," $1,397.70 "," $1,397.70 "," $1,397.70 "," $1,444.29 "," $1,490.88 ", $399.58 ," $1,320.05 ", $638.69 , $403.51 , N/A , $334.60 , $334.60 ," $1,475.35 ", $388.01 , $107.63 ," $1,490.88 "
 Chemodervate Facial/Trigem/Cerv Musc Migraine Pbb ,CPT® 64615,0761 - TREATMENT ROOM,N/A,N/A," $1,364.00 ", $886.60 ," $1,145.76 ", $109.75 , $96.09 ," $1,102.11 "," $1,227.60 "," $1,154.76 "," $1,227.60 "," $1,227.60 "," $1,227.60 "," $1,159.40 ", $94.21 ," $1,259.38 "," $1,295.80 "," $1,159.40 "," $1,268.52 "," $1,268.52 "," $1,295.80 "," $1,309.44 "," $1,116.02 "," $1,227.60 "," $1,159.40 "," $1,077.56 ", N/A ," $1,103.89 "," $1,103.89 "," $1,295.80 "," $1,170.45 ", $94.21 ," $1,309.44 "
"Repair Flexor Tendon,Sing",26350,N/A,N/A,N/A," $2,738.00 "," $1,779.70 "," $4,714.65 ", $732.16 , $601.86 ," $3,386.55 "," $3,457.42 "," $2,546.34 "," $2,464.20 "," $2,464.20 "," $2,190.40 "," $2,190.40 ", $601.86 ," $2,528.00 "," $2,601.10 "," $2,464.20 "," $2,464.20 "," $2,464.20 "," $2,546.34 "," $2,628.48 "," $4,337.17 "," $2,327.30 "," $3,784.00 "," $4,049.80 ", N/A ," $3,452.62 "," $3,452.62 "," $2,601.10 "," $4,058.05 ", $601.86 ," $4,714.65 "
"Repair Urethra Inj,Penile,Perineal",CPT® 53510,N/A,N/A,N/A," $4,403.00 "," $2,861.95 "," $3,432.75 ", $604.41 , $845.22 ," $3,087.78 "," $2,878.43 "," $4,094.79 "," $3,962.70 "," $3,962.70 "," $3,522.40 "," $3,522.40 ", $845.22 ," $4,065.29 "," $4,182.85 "," $3,962.70 "," $3,962.70 "," $3,962.70 "," $4,094.79 "," $4,226.88 "," $3,440.67 "," $3,742.55 "," $3,257.70 "," $3,887.28 ", N/A ," $3,148.03 "," $3,148.03 "," $4,182.85 "," $3,700.05 ", $604.41 ," $4,226.88 "
 Pro X-Ray Exam of Heel ,CPT® 73650,0972 - PRO FEE/RAD/DX,N/A,N/A, $99.00 , $64.35 , $161.88 , $28.08 , $25.85 , $126.81 , $152.13 , $92.07 , $89.10 , $89.10 , $79.20 , $79.20 , $25.85 , $91.41 , $94.05 , $89.10 , $89.10 , $89.10 , $92.07 , $95.04 , $157.47 , $84.15 , $167.57 , $136.90 , N/A , $129.28 , $129.28 , $94.05 , $149.66 , $25.85 , $167.57 
" Fac Artery X-Rays, Abdomen ",CPT® 75726,0320 - DX X-RAY,N/A,N/A," $1,302.00 ", $846.30 ," $1,093.68 ", $167.82 , $240.93 ," $1,052.02 "," $1,171.80 "," $1,102.27 "," $1,171.80 "," $1,171.80 "," $1,171.80 "," $1,106.70 ", $236.21 ," $1,202.14 "," $1,236.90 "," $1,106.70 "," $1,210.86 "," $1,210.86 "," $1,236.90 "," $1,249.92 "," $1,065.30 "," $1,171.80 "," $1,106.70 "," $1,028.58 ", N/A ," $1,053.71 "," $1,053.71 "," $1,236.90 "," $1,117.25 ", $167.82 ," $1,249.92 "
"Drug Assay Carbamazepine -10,11-Epoxide",CPT® 80161,N/A,N/A,N/A, $191.00 , $124.15 , N/A , $19.01 , $15.21 , N/A , N/A , $177.63 , $171.90 , $171.90 , $152.80 , $152.80 , $15.21 , $176.35 , $181.45 , $171.90 , $171.90 , $171.90 , $177.63 , $183.36 , $124.46 , $162.35 , $88.85 , $54.75 , N/A , $74.00 , $74.00 , $181.45 , $80.71 , $15.21 , $183.36 
"Gastrostomy,Open,W/O Tube Cnstr",CPT® 43830,N/A,N/A,N/A," $5,004.00 "," $3,252.60 "," $4,216.94 ", $653.35 , $876.31 ," $3,287.76 "," $3,340.33 "," $4,653.72 "," $4,503.60 "," $4,503.60 "," $4,003.20 "," $4,003.20 ", $876.31 ," $4,620.19 "," $4,753.80 "," $4,503.60 "," $4,503.60 "," $4,503.60 "," $4,653.72 "," $4,803.84 "," $3,019.48 "," $4,253.40 "," $3,705.50 "," $3,891.48 ", N/A ," $3,351.91 "," $3,351.91 "," $4,753.80 "," $3,505.75 ", $653.35 ," $4,803.84 "
" Repair Complex Scalp,Arm,Legs 2.6-7.5cm - Mh ",CPT® 13121,0761 - TREATMENT ROOM,N/A,N/A," $1,804.00 "," $1,172.60 "," $1,515.36 ", $247.45 , $218.65 ," $1,457.63 "," $1,623.60 "," $1,527.27 "," $1,623.60 "," $1,623.60 "," $1,623.60 "," $1,533.40 ", $214.36 ," $1,665.63 "," $1,713.80 "," $1,533.40 "," $1,677.72 "," $1,677.72 "," $1,713.80 "," $1,731.84 "," $1,476.03 "," $1,623.60 "," $1,533.40 "," $1,425.16 ", N/A ," $1,459.98 "," $1,459.98 "," $1,713.80 "," $1,548.01 ", $214.36 ," $1,731.84 "
 Fac Appl Cylinder Cst Thi Ankle ,CPT® 29365,0761 - TREATMENT ROOM,N/A,N/A, $732.00 , $475.80 , $614.88 , $82.35 , $131.64 , $591.46 , $658.80 , $619.71 , $658.80 , $658.80 , $658.80 , $622.20 , $129.06 , $675.86 , $695.40 , $622.20 , $680.76 , $680.76 , $695.40 , $702.72 , $598.92 , $658.80 , $622.20 , $578.28 , N/A , $592.41 , $592.41 , $695.40 , $628.13 , $82.35 , $702.72 
Somatostatin,CPT® 84307,N/A,N/A,N/A, $309.00 , $200.85 , N/A , $18.65 , $12.32 , $50.22 , $60.06 , $287.37 , $278.10 , $278.10 , $247.20 , $247.20 , $12.32 , $285.30 , $293.55 , $278.10 , $278.10 , $278.10 , $287.37 , $296.64 , $122.06 , $262.65 , $120.02 , $66.26 , N/A , $46.87 , $46.87 , $293.55 , $51.22 , $12.32 , $296.64 
" Fac Culture, Bacteria, Other ",CPT® 87070,0306 - LAB/BACT-MICRO,N/A,N/A, $116.00 , $75.40 , $97.44 , $8.79 , $8.79 , $93.73 , $104.40 , $98.21 , $104.40 , $104.40 , $104.40 , $98.60 , $8.62 , $107.10 , $110.20 , $98.60 , $107.88 , $107.88 , $110.20 , $111.36 , $94.91 , $104.40 , $98.60 , $91.64 , N/A , $93.88 , $93.88 , $110.20 , $99.54 , $8.62 , $111.36 
"Part Exc Tongue,Unilat Rad Neck",CPT® 41135,N/A,N/A,N/A," $14,896.00 "," $9,682.40 "," $13,364.39 "," $2,083.85 "," $1,383.11 "," $10,391.49 "," $10,598.21 "," $13,853.28 "," $13,406.40 "," $13,406.40 "," $11,916.80 "," $11,916.80 "," $1,383.11 "," $13,753.48 "," $14,151.20 "," $13,406.40 "," $13,406.40 "," $13,406.40 "," $13,853.28 "," $14,300.16 "," $9,610.02 "," $12,661.60 "," $11,571.44 "," $12,446.38 ", N/A ," $10,594.25 "," $10,594.25 "," $14,151.20 "," $11,080.45 "," $1,383.11 "," $14,300.16 "
"Acylcarnitines,Quant,Each Spec",CPT® 82017,N/A,N/A,N/A, $197.00 , $128.05 , N/A , $17.21 , $17.21 , $81.53 , $97.54 , $183.21 , $177.30 , $177.30 , $157.60 , $157.60 , $17.21 , $181.89 , $187.15 , $177.30 , $177.30 , $177.30 , $183.21 , $189.12 , $112.64 , $167.45 , $110.29 , $61.18 , N/A , $76.09 , $76.09 , $187.15 , $83.15 , $17.21 , $189.12 
"Echo Heart Xthoracic,Limited",CPT® 93308,N/A,N/A,N/A," $1,713.00 "," $1,113.45 ", $625.50 , $96.57 , $153.86 , $668.74 , $562.09 ," $1,593.09 "," $1,541.70 "," $1,541.70 "," $1,370.40 "," $1,370.40 ", $153.86 ," $1,581.61 "," $1,627.35 "," $1,541.70 "," $1,541.70 "," $1,541.70 "," $1,593.09 "," $1,644.48 ", $620.72 ," $1,456.05 ", $526.30 , $632.47 , N/A , $681.79 , $681.79 ," $1,627.35 ", $755.77 , $96.57 ," $1,644.48 "
 DIPHENOXYLATE-ATROPINE 2.5-0.025 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,59762-1061-01,1 tablet, $3.60 , $2.34 , $3.02 , N/A , N/A , $2.91 , $3.24 , $3.05 , $3.24 , $3.24 , $3.24 , $3.06 , N/A , $3.32 , $3.42 , $3.06 , $3.35 , $3.35 , $3.42 , $3.46 , $2.95 , $3.24 , $3.06 , $2.84 , N/A , $2.91 , $2.91 , $3.42 , $3.09 , $2.84 , $3.46 
Prgrmg Dev Eval Scrms Phys/Qhp in Person,93285,N/A,N/A,N/A, $569.00 , $369.85 , $394.42 , $60.01 , $35.04 , $228.23 , $230.08 , $529.17 , $512.10 , $512.10 , $455.20 , $455.20 , $35.04 , $525.36 , $540.55 , $512.10 , $512.10 , $512.10 , $529.17 , $546.24 , $364.94 , $483.65 , $214.09 , $161.80 , N/A , $232.69 , $232.69 , $540.55 , $257.93 , $35.04 , $546.24 
Whirlpool Therapy,CPT® 97022,N/A,N/A,N/A, $124.00 , $80.60 , $40.18 , $16.82 , $27.61 , $52.56 , $47.81 , $115.32 , $111.60 , $111.60 , $99.20 , $99.20 , $27.61 , $114.49 , $117.80 , $111.60 , $111.60 , $111.60 , $115.32 , $119.04 , $44.47 , $105.40 , $70.96 , $46.36 , N/A , $53.58 , $53.58 , $117.80 , $59.60 , $16.82 , $119.04 
Degarelix Injection,HCPCS J9155,N/A,N/A,N/A, $9.00 , $5.85 , N/A , $4.27 , $4.20 , N/A , N/A , $8.37 , $8.10 , $8.10 , $7.20 , $7.20 , $4.20 , $8.31 , $8.55 , $8.10 , $8.10 , $8.10 , $8.37 , $8.64 , $5.17 , $7.65 , $5.19 , $5.72 , N/A , N/A , N/A , $8.55 , N/A , $4.20 , $8.64 
 Fac Drug/Substance Definitive Qual/Quant Nos 1-3 ,CPT® 80375,0301 - LAB/CHEMISTRY,N/A,N/A, $265.00 , $172.25 , $222.60 , N/A , N/A , $214.12 , $238.50 , $224.35 , $238.50 , $238.50 , $238.50 , $225.25 , N/A , $244.67 , $251.75 , $225.25 , $246.45 , $246.45 , $251.75 , $254.40 , $216.82 , $238.50 , $225.25 , $209.35 , N/A , $214.46 , $214.46 , $251.75 , $227.40 , $209.35 , $254.40 
 Fac Special Teletx Port Plan ,CPT® 77321,0333 - RADIATION RX,N/A,N/A, $449.00 , $291.85 , $377.16 , $92.48 , $110.80 , $362.79 , $404.10 , $380.12 , $404.10 , $404.10 , $404.10 , $381.65 , $108.63 , $414.56 , $426.55 , $381.65 , $417.57 , $417.57 , $426.55 , $431.04 , $367.37 , $404.10 , $381.65 , $354.71 , N/A , $363.38 , $363.38 , $426.55 , $385.29 , $92.48 , $431.04 
"Circumcision,Othr,Newborn",CPT® 54160,N/A,N/A,N/A," $1,206.00 ", $783.90 , $644.56 , $138.98 , $68.73 , $461.99 , $465.60 ," $1,121.58 "," $1,085.40 "," $1,085.40 ", $964.80 , $964.80 , $68.73 ," $1,113.50 "," $1,145.70 "," $1,085.40 "," $1,085.40 "," $1,085.40 "," $1,121.58 "," $1,157.76 ", $604.61 ," $1,025.10 ", $742.17 , $696.14 , N/A , $471.01 , $471.01 ," $1,145.70 ", $564.51 , $68.73 ," $1,157.76 "
 SALINE 0.9% BOLUS ,HCPCS RXA258,0258 - IV SOLUTIONS,00990-7983-09,"1,000 mL", $79.82 , $51.88 , $67.05 , N/A , N/A , $64.49 , $71.84 , $67.58 , $71.84 , $71.84 , $71.84 , $67.85 , N/A , $73.70 , $75.83 , $67.85 , $74.23 , $74.23 , $75.83 , $76.63 , $65.31 , $71.84 , $67.85 , $63.06 , N/A , $64.60 , $64.60 , $75.83 , $68.49 , $63.06 , $76.63 
Full Thick Grft Trunk <20 Sqcm,CPT® 15200,N/A,N/A,N/A," $4,045.00 "," $2,629.25 "," $2,130.88 ", $638.47 , $371.14 ," $1,829.73 "," $1,795.33 "," $3,761.85 "," $3,640.50 "," $3,640.50 "," $3,236.00 "," $3,236.00 ", $371.14 ," $3,734.75 "," $3,842.75 "," $3,640.50 "," $3,640.50 "," $3,640.50 "," $3,761.85 "," $3,883.20 "," $2,336.21 "," $3,438.25 "," $3,593.10 "," $2,342.41 ", N/A ," $1,865.43 "," $1,865.43 "," $3,842.75 "," $2,163.27 ", $371.14 ," $3,883.20 "
 DILTIAZEM HCL 125 MG/25ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00641-6015-10,25 mL, $56.13 , $36.48 , $47.15 , N/A , N/A , $45.35 , $50.52 , $47.52 , $50.52 , $50.52 , $50.52 , $47.71 , N/A , $51.82 , $53.32 , $47.71 , $52.20 , $52.20 , $53.32 , $53.88 , $45.93 , $50.52 , $47.71 , $44.34 , N/A , $45.43 , $45.43 , $53.32 , $48.17 , $44.34 , $53.88 
 Fac Nonphysician Telephone Assessment 21-30 Min ,CPT® 98968,0420 - PHYSICAL THERAPY,N/A,N/A, $150.00 , $97.50 , $126.00 , $31.07 , N/A , $121.20 , $135.00 , $126.99 , $135.00 , $135.00 , $135.00 , $127.50 , N/A , $138.50 , $142.50 , $127.50 , $139.50 , $139.50 , $142.50 , $144.00 , $122.73 , $135.00 , $127.50 , $118.50 , N/A , $121.40 , $121.40 , $142.50 , $128.72 , $31.07 , $144.00 
 Pro Exc Face-Mm B9+Marg 2.1-3 Cm ,CPT® 11443,0982 - PRO FEE/OUTPT,N/A,N/A," $1,135.00 ", $737.75 , $572.42 , $172.25 , $230.52 , $484.65 , $476.60 ," $1,055.55 "," $1,021.50 "," $1,021.50 ", $908.00 , $908.00 , $230.52 ," $1,047.95 "," $1,078.25 "," $1,021.50 "," $1,021.50 "," $1,021.50 "," $1,055.55 "," $1,089.60 ", $624.02 , $964.75 , $950.91 , $621.47 , N/A , $494.11 , $494.11 ," $1,078.25 ", $573.01 , $172.25 ," $1,089.60 "
 DENOSUMAB 120 MG/1.7ML SC SOLN ,HCPCS J0897,0636 - DRUGS REQUIRING DETAILED CODIN,55513-0730-01,1.7 mL," $4,930.60 "," $3,204.89 "," $4,141.70 ", $24.67 , $23.53 ," $3,983.92 "," $4,437.54 "," $4,174.25 "," $4,437.54 "," $4,437.54 "," $4,437.54 "," $4,191.01 ", $23.07 ," $4,552.42 "," $4,684.07 "," $4,191.01 "," $4,585.46 "," $4,585.46 "," $4,684.07 "," $4,733.38 "," $4,034.22 "," $4,437.54 "," $4,191.01 "," $3,895.17 ", N/A ," $3,990.33 "," $3,990.33 "," $4,684.07 "," $4,230.95 ", $23.07 ," $4,733.38 "
 Pro Fusion of Foot Bones ,CPT® 28740,0975 - PRO FEE/OR,N/A,N/A," $5,084.00 "," $3,304.60 "," $3,797.24 ", $594.52 , $307.34 ," $3,046.33 "," $3,041.70 "," $4,728.12 "," $4,575.60 "," $4,575.60 "," $4,067.20 "," $4,067.20 ", $307.34 ," $4,694.06 "," $4,829.80 "," $4,575.60 "," $4,575.60 "," $4,575.60 "," $4,728.12 "," $4,880.64 "," $3,532.53 "," $4,321.40 "," $3,327.28 "," $3,605.31 ", N/A ," $3,105.77 "," $3,105.77 "," $4,829.80 "," $3,650.39 ", $307.34 ," $4,880.64 "
 BRIMONIDINE TARTRATE 0.2 % OP SOLN ,HCPCS RXC637,0250 - PHARMACY,61314-0143-05,5 mL, $167.72 , $109.02 , $140.88 , N/A , N/A , $135.52 , $150.95 , $141.99 , $150.95 , $150.95 , $150.95 , $142.56 , N/A , $154.86 , $159.33 , $142.56 , $155.98 , $155.98 , $159.33 , $161.01 , $137.23 , $150.95 , $142.56 , $132.50 , N/A , $135.74 , $135.74 , $159.33 , $143.92 , $132.50 , $161.01 
"Creatine, Mb Fraction",CPT® 82553,N/A,N/A,N/A, $132.00 , $85.80 , N/A , $11.78 , $8.55 , $34.83 , $41.65 , $122.76 , $118.80 , $118.80 , $105.60 , $105.60 , $8.55 , $121.88 , $125.40 , $118.80 , $118.80 , $118.80 , $122.76 , $126.72 , $77.12 , $112.20 , $76.23 , $41.88 , N/A , $32.51 , $32.51 , $125.40 , $35.53 , $8.55 , $126.72 
Remove Hemorrhoids & Fistula,CPT® 46258,N/A,N/A,N/A," $3,009.00 "," $1,955.85 "," $2,907.97 ", $451.38 , $614.70 ," $2,188.72 "," $2,246.00 "," $2,798.37 "," $2,708.10 "," $2,708.10 "," $2,407.20 "," $2,407.20 ", $614.70 ," $2,778.21 "," $2,858.55 "," $2,708.10 "," $2,708.10 "," $2,708.10 "," $2,798.37 "," $2,888.64 "," $2,064.54 "," $2,557.65 "," $2,486.99 "," $2,592.67 ", N/A ," $2,231.42 "," $2,231.42 "," $2,858.55 "," $2,333.84 ", $451.38 ," $2,907.97 "
 Fac L Hrt Cath W/Njx L Ventriculography Img S&I ,CPT® 93452,0481 - CARDIAC CATH LAB,N/A,N/A," $9,523.00 "," $6,189.95 "," $7,999.32 ", $875.90 , $927.36 ," $7,694.58 "," $8,570.70 "," $8,062.17 "," $8,570.70 "," $8,570.70 "," $8,570.70 "," $8,094.55 ", $909.18 ," $8,792.59 "," $9,046.85 "," $8,094.55 "," $8,856.39 "," $8,856.39 "," $9,046.85 "," $9,142.08 "," $7,791.72 "," $8,570.70 "," $8,094.55 "," $7,523.17 ", N/A ," $7,706.96 "," $7,706.96 "," $9,046.85 "," $8,171.69 ", $875.90 ," $9,142.08 "
 PEMETREXED DISODIUM 500 MG IV SOLR ,HCPCS J9296,0636 - DRUGS REQUIRING DETAILED CODIN,00002-7623-01,20 mL," $11,887.69 "," $7,727.00 "," $9,985.66 ", N/A , $9.93 ," $9,605.25 "," $10,698.92 "," $10,064.12 "," $10,698.92 "," $10,698.92 "," $10,698.92 "," $10,104.54 ", $9.74 ," $10,975.90 "," $11,293.31 "," $10,104.54 "," $11,055.55 "," $11,055.55 "," $11,293.31 "," $11,412.18 "," $9,726.51 "," $10,698.92 "," $10,104.54 "," $9,391.28 ", N/A ," $9,620.71 "," $9,620.71 "," $11,293.31 "," $10,200.83 ", $9.74 ," $11,412.18 "
Hepa Vaccine Ped/Adol-2 Dose,CPT® 90633,N/A,N/A,N/A, $113.00 , $73.45 , N/A , N/A , $15.30 , $74.06 , $77.04 , $105.09 , $101.70 , $101.70 , $90.40 , $90.40 , $15.30 , $104.33 , $107.35 , $101.70 , $101.70 , $101.70 , $105.09 , $108.48 , N/A , $96.05 , $102.39 , $59.59 , N/A , $75.50 , $75.50 , $107.35 , $88.03 , $15.30 , $108.48 
Ligatn Long Saphenous Vein,CPT® 37700,N/A,N/A,N/A," $1,744.00 "," $1,133.60 "," $1,445.93 ", $224.34 , $267.62 ," $1,079.60 "," $1,098.97 "," $1,621.92 "," $1,569.60 "," $1,569.60 "," $1,395.20 "," $1,395.20 ", $267.62 ," $1,610.24 "," $1,656.80 "," $1,569.60 "," $1,569.60 "," $1,569.60 "," $1,621.92 "," $1,674.24 "," $1,336.30 "," $1,482.40 "," $1,375.51 "," $1,196.07 ", N/A ," $1,100.66 "," $1,100.66 "," $1,656.80 "," $1,250.36 ", $224.34 ," $1,674.24 "
"Polysomnography, 4 or More",95810,N/A,N/A,N/A," $5,862.00 "," $3,810.30 "," $2,228.13 ", $595.03 ," $1,061.47 "," $1,978.65 "," $2,194.06 "," $5,451.66 "," $5,275.80 "," $5,275.80 "," $4,689.60 "," $4,689.60 "," $1,061.47 "," $5,412.38 "," $5,568.90 "," $5,275.80 "," $5,275.80 "," $5,275.80 "," $5,451.66 "," $5,627.52 "," $2,646.65 "," $4,982.70 "," $1,924.03 "," $2,362.52 ", N/A ," $2,017.26 "," $2,017.26 "," $5,568.90 "," $2,480.00 ", $595.03 ," $5,627.52 "
 DEXTROSE 5% IV SOLN (PVC-FREE) ,HCPCS J7060,0258 - IV SOLUTIONS,63323-0624-74,250 mL, $49.89 , $32.43 , $41.91 , $1.85 , $1.79 , $40.31 , $44.90 , $42.24 , $44.90 , $44.90 , $44.90 , $42.41 , $1.75 , $46.06 , $47.40 , $42.41 , $46.40 , $46.40 , $47.40 , $47.89 , $40.82 , $44.90 , $42.41 , $39.41 , N/A , $40.38 , $40.38 , $47.40 , $42.81 , $1.75 , $47.89 
Specimen Fat Stain,CPT® 89125,N/A,N/A,N/A, $75.00 , $48.75 , N/A , $6.00 , $6.00 , $24.19 , $29.20 , $69.75 , $67.50 , $67.50 , $60.00 , $60.00 , $6.00 , $69.25 , $71.25 , $67.50 , $67.50 , $67.50 , $69.75 , $72.00 , $39.26 , $63.75 , $27.57 , $17.27 , N/A , $22.58 , $22.58 , $71.25 , $24.81 , $6.00 , $72.00 
 Fac Clinical Chemistry Test ,CPT® 84999,0301 - LAB/CHEMISTRY,N/A,N/A, $190.00 , $123.50 , $159.60 , N/A , N/A , $153.52 , $171.00 , $160.85 , $171.00 , $171.00 , $171.00 , $161.50 , N/A , $175.43 , $180.50 , $161.50 , $176.70 , $176.70 , $180.50 , $182.40 , $155.46 , $171.00 , $161.50 , $150.10 , N/A , $153.77 , $153.77 , $180.50 , $163.04 , $150.10 , $182.40 
 Fac Anrct Xm Surg Req Anes General Spi/Edrl Dx ,CPT® 45990,0360 - OR SERVICES,N/A,N/A," $2,345.00 "," $1,524.25 "," $1,969.80 ", $98.63 , $89.21 ," $1,894.76 "," $2,110.50 "," $1,985.28 "," $2,110.50 "," $2,110.50 "," $2,110.50 "," $1,993.25 ", $87.46 ," $2,165.14 "," $2,227.75 "," $1,993.25 "," $2,180.85 "," $2,180.85 "," $2,227.75 "," $2,251.20 "," $1,918.68 "," $2,110.50 "," $1,993.25 "," $1,852.55 ", N/A ," $1,897.81 "," $1,897.81 "," $2,227.75 "," $2,012.24 ", $87.46 ," $2,251.20 "
Exc Tumor Soft Tiss Face&Scalp Subfascial < 2cm,CPT® 21013,N/A,N/A,N/A," $2,108.00 "," $1,370.20 "," $2,450.63 ", $385.25 , $404.24 ," $1,941.89 "," $1,940.12 "," $1,960.44 "," $1,897.20 "," $1,897.20 "," $1,686.40 "," $1,686.40 ", $404.24 ," $1,946.32 "," $2,002.60 "," $1,897.20 "," $1,897.20 "," $1,897.20 "," $1,960.44 "," $2,023.68 "," $2,269.67 "," $1,791.80 "," $2,124.82 "," $2,292.52 ", N/A ," $1,979.78 "," $1,979.78 "," $2,002.60 "," $2,326.93 ", $385.25 ," $2,450.63 "
"Repair Femoral Hernia,Reducible",CPT® 49550,N/A,N/A,N/A," $3,736.00 "," $2,428.40 "," $3,454.88 ", $536.56 , $537.90 ," $2,700.66 "," $2,744.73 "," $3,474.48 "," $3,362.40 "," $3,362.40 "," $2,988.80 "," $2,988.80 ", $537.90 ," $3,449.45 "," $3,549.20 "," $3,362.40 "," $3,362.40 "," $3,362.40 "," $3,474.48 "," $3,586.56 "," $2,471.26 "," $3,175.60 "," $3,047.18 "," $3,190.75 ", N/A ," $2,753.36 "," $2,753.36 "," $3,549.20 "," $2,879.72 ", $536.56 ," $3,586.56 "
 FERRIC CARBOXYMALTOSE 750 MG/15ML IV SOLN ,HCPCS J1439,0636 - DRUGS REQUIRING DETAILED CODIN,00517-0650-01,15 mL," $2,316.25 "," $1,505.56 "," $1,945.65 ", $1.15 , $1.15 ," $1,871.53 "," $2,084.63 "," $1,960.94 "," $2,084.63 "," $2,084.63 "," $2,084.63 "," $1,968.81 ", $1.13 ," $2,138.59 "," $2,200.44 "," $1,968.81 "," $2,154.11 "," $2,154.11 "," $2,200.44 "," $2,223.60 "," $1,895.16 "," $2,084.63 "," $1,968.81 "," $1,829.84 ", N/A ," $1,874.54 "," $1,874.54 "," $2,200.44 "," $1,987.57 ", $1.13 ," $2,223.60 "
 SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-2725-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 DIHYDROERGOTAMINE MESYLATE 1 MG/ML IJ SOLN ,HCPCS J1110,0636 - DRUGS REQUIRING DETAILED CODIN,81284-0411-05,0.5 mL, $240.41 , $156.27 , $201.94 , $51.60 , $58.96 , $194.25 , $216.37 , $203.53 , $216.37 , $216.37 , $216.37 , $204.35 , $57.80 , $221.97 , $228.39 , $204.35 , $223.58 , $223.58 , $228.39 , $230.79 , $196.70 , $216.37 , $204.35 , $189.92 , N/A , $194.56 , $194.56 , $228.39 , $206.30 , $51.60 , $230.79 
Assay CK (Cpk),CPT® 82550,N/A,N/A,N/A, $65.00 , $42.25 , N/A , $6.64 , $6.64 , $36.84 , $44.06 , $60.45 , $58.50 , $58.50 , $52.00 , $52.00 , $6.64 , $60.01 , $61.75 , $58.50 , $58.50 , $58.50 , $60.45 , $62.40 , $43.47 , $55.25 , $42.17 , $23.61 , N/A , $34.38 , $34.38 , $61.75 , $37.57 , $6.64 , $62.40 
Ntrprof Phone/Ntrnet/Ehr Assmt&Mgmt 11-20 Min,CPT® 99447,N/A,N/A,N/A, $91.00 , $59.15 , $68.80 , $34.37 , $28.73 , N/A , N/A , $84.63 , $81.90 , $81.90 , $72.80 , $72.80 , $28.73 , $84.02 , $86.45 , $81.90 , $81.90 , $81.90 , $84.63 , $87.36 , $60.74 , $77.35 , $78.45 , $78.60 , N/A , $54.70 , $54.70 , $86.45 , $63.10 , $28.73 , $87.36 
 Fac Slctv Cath Plmt Sgmtl/Subsgmtl P-Art ,CPT® 36015,0360 - OR SERVICES,N/A,N/A," $5,544.00 "," $3,603.60 "," $4,656.96 ", $160.14 , $225.32 ," $4,479.55 "," $4,989.60 "," $4,693.55 "," $4,989.60 "," $4,989.60 "," $4,989.60 "," $4,712.40 ", $220.90 ," $5,118.78 "," $5,266.80 "," $4,712.40 "," $5,155.92 "," $5,155.92 "," $5,266.80 "," $5,322.24 "," $4,536.10 "," $4,989.60 "," $4,712.40 "," $4,379.76 ", N/A ," $4,486.76 "," $4,486.76 "," $5,266.80 "," $4,757.31 ", $160.14 ," $5,322.24 "
Removal of Contraceptive Capsul,11976,N/A,N/A,N/A, $853.00 , $554.45 , $294.54 , $87.33 , N/A , $259.01 , $252.64 , $793.29 , $767.70 , $767.70 , $682.40 , $682.40 , N/A , $787.57 , $810.35 , $767.70 , $767.70 , $767.70 , $793.29 , $818.88 , $324.49 , $725.05 , $506.67 , $329.26 , N/A , $264.06 , $264.06 , $810.35 , $306.21 , $87.33 , $818.88 
 Fac Iadna Ehrlichia Chaffeensis Amplified Probe Tq ,CPT® 87484,0306 - LAB/BACT-MICRO,N/A,N/A, $53.00 , $34.45 , $44.52 , $35.79 , $35.79 , $42.82 , $47.70 , $44.87 , $47.70 , $47.70 , $47.70 , $45.05 , $35.09 , $48.93 , $50.35 , $45.05 , $49.29 , $49.29 , $50.35 , $50.88 , $43.36 , $47.70 , $45.05 , $41.87 , N/A , $42.89 , $42.89 , $50.35 , $45.48 , $35.09 , $50.88 
 BETAINE AND POLYHEXANIDE EX GEL 30 ML ,HCPCS RXA250,0250 - PHARMACY,08021-0002-45,30 mL, $30.83 , $20.04 , $25.90 , N/A , N/A , $24.91 , $27.75 , $26.10 , $27.75 , $27.75 , $27.75 , $26.21 , N/A , $28.47 , $29.29 , $26.21 , $28.67 , $28.67 , $29.29 , $29.60 , $25.23 , $27.75 , $26.21 , $24.36 , N/A , $24.95 , $24.95 , $29.29 , $26.46 , $24.36 , $29.60 
 Fac Use of Speech Device Service ,CPT® 92609,0441 - SPEECH PATH/VISIT,N/A,N/A, $488.00 , $317.20 , $409.92 , $102.85 , $82.32 , $394.30 , $439.20 , $413.14 , $439.20 , $439.20 , $439.20 , $414.80 , $80.71 , $450.57 , $463.60 , $414.80 , $453.84 , $453.84 , $463.60 , $468.48 , $399.28 , $439.20 , $414.80 , $385.52 , N/A , $394.94 , $394.94 , $463.60 , $418.75 , $80.71 , $468.48 
 LEVOTHYROXINE SODIUM 75 MCG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6951-61,1 tablet, $3.53 , $2.29 , $2.97 , N/A , N/A , $2.85 , $3.18 , $2.99 , $3.18 , $3.18 , $3.18 , $3.00 , N/A , $3.26 , $3.35 , $3.00 , $3.28 , $3.28 , $3.35 , $3.39 , $2.89 , $3.18 , $3.00 , $2.79 , N/A , $2.86 , $2.86 , $3.35 , $3.03 , $2.79 , $3.39 
Nuclear Matrix Protein 22 Nmp22 Qualitative,CPT® 86386,N/A,N/A,N/A, $161.00 , $104.65 , N/A , $22.22 , $18.45 , $90.34 , $108.07 , $149.73 , $144.90 , $144.90 , $128.80 , $128.80 , $18.45 , $148.65 , $152.95 , $144.90 , $144.90 , $144.90 , $149.73 , $154.56 , $145.43 , $136.85 , $105.42 , $63.97 , N/A , $84.31 , $84.31 , $152.95 , $92.14 , $18.45 , $154.56 
 MITOMYCIN 80 (2 X 40) MG UL SOLR ,HCPCS J9281,0250 - PHARMACY,72493-0103-03,1 mL," $3,414.74 "," $2,219.58 "," $2,868.38 ", $302.09 , $296.11 ," $2,759.11 "," $3,073.27 "," $2,890.92 "," $3,073.27 "," $3,073.27 "," $3,073.27 "," $2,902.53 ", $290.30 ," $3,152.83 "," $3,244.00 "," $2,902.53 "," $3,175.71 "," $3,175.71 "," $3,244.00 "," $3,278.15 "," $2,793.94 "," $3,073.27 "," $2,902.53 "," $2,697.64 ", N/A ," $2,763.55 "," $2,763.55 "," $3,244.00 "," $2,930.19 ", $290.30 ," $3,278.15 "
 Fac Immunotherapy Injections ,CPT® 95117,0761 - TREATMENT ROOM,N/A,N/A, $171.00 , $111.15 , $143.64 , $11.27 , $5.05 , $138.17 , $153.90 , $144.77 , $153.90 , $153.90 , $153.90 , $145.35 , $4.95 , $157.88 , $162.45 , $145.35 , $159.03 , $159.03 , $162.45 , $164.16 , $139.91 , $153.90 , $145.35 , $135.09 , N/A , $138.39 , $138.39 , $162.45 , $146.74 , $4.95 , $164.16 
"Destruc Retinal Lesn,Photocoag",CPT® 67210,N/A,N/A,N/A," $4,614.00 "," $2,999.10 "," $3,063.71 ", $481.39 , $564.38 ," $2,831.24 "," $2,651.50 "," $4,291.02 "," $4,152.60 "," $4,152.60 "," $3,691.20 "," $3,691.20 ", $564.38 ," $4,260.11 "," $4,383.30 "," $4,152.60 "," $4,152.60 "," $4,152.60 "," $4,291.02 "," $4,429.44 "," $4,209.99 "," $3,921.90 "," $2,729.62 "," $3,599.77 ", N/A ," $2,886.48 "," $2,886.48 "," $4,383.30 "," $3,186.29 ", $481.39 ," $4,429.44 "
" Fac West Nile Virus Ab, Igm ",CPT® 86788,0302 - LAB/IMMUNOLOGY,N/A,N/A, $137.00 , $89.05 , $115.08 , $17.19 , $8.07 , $110.70 , $123.30 , $115.98 , $123.30 , $123.30 , $123.30 , $116.45 , $7.91 , $126.49 , $130.15 , $116.45 , $127.41 , $127.41 , $130.15 , $131.52 , $112.09 , $123.30 , $116.45 , $108.23 , N/A , $110.87 , $110.87 , $130.15 , $117.56 , $7.91 , $131.52 
"Debridement, Skin, Sub-Q Tissue,Muscle,Each Add 20 Sq Cm",CPT® 11046,N/A,N/A,N/A, $375.00 , $243.75 , $172.48 , $50.80 , $27.29 , $152.39 , $146.54 , $348.75 , $337.50 , $337.50 , $300.00 , $300.00 , $27.29 , $346.24 , $356.25 , $337.50 , $337.50 , $337.50 , $348.75 , $360.00 , $190.23 , $318.75 , $294.37 , $193.78 , N/A , $155.37 , $155.37 , $356.25 , $180.17 , $27.29 , $360.00 
 Fac Glycated Protein ,CPT® 82985,0301 - LAB/CHEMISTRY,N/A,N/A, $110.00 , $71.50 , $92.40 , $17.10 , $16.40 , $88.88 , $99.00 , $93.13 , $99.00 , $99.00 , $99.00 , $93.50 , $16.08 , $101.56 , $104.50 , $93.50 , $102.30 , $102.30 , $104.50 , $105.60 , $90.00 , $99.00 , $93.50 , $86.90 , N/A , $89.02 , $89.02 , $104.50 , $94.39 , $16.08 , $105.60 
Antipsychotics Not Otherwise Specified 1-3,CPT® 80342,N/A,N/A,N/A, $202.00 , $131.30 , N/A , N/A , N/A , N/A , N/A , $187.86 , $181.80 , $181.80 , $161.60 , $161.60 , N/A , $186.51 , $191.90 , $181.80 , $181.80 , $181.80 , $187.86 , $193.92 , N/A , $171.70 , $114.69 , $67.79 , N/A , $90.04 , $90.04 , $191.90 , $98.20 , $67.79 , $193.92 
Cast Sup Lng Arm Splnt Ped F,HCPCS Q4020,N/A,N/A,N/A, $66.00 , $42.90 , N/A , $8.83 , $5.38 , N/A , N/A , $61.38 , $59.40 , $59.40 , $52.80 , $52.80 , $5.38 , $60.94 , $62.70 , $59.40 , $59.40 , $59.40 , $61.38 , $63.36 , N/A , $56.10 , $36.33 , $8.02 , N/A , N/A , N/A , $62.70 , N/A , $5.38 , $63.36 
Treat Metatarsal Fracture,CPT® 28475,N/A,N/A,N/A," $1,746.00 "," $1,134.90 "," $1,407.45 ", $223.42 , $153.67 ," $1,112.20 "," $1,108.67 "," $1,623.78 "," $1,571.40 "," $1,571.40 "," $1,396.80 "," $1,396.80 ", $153.67 ," $1,612.08 "," $1,658.70 "," $1,571.40 "," $1,571.40 "," $1,571.40 "," $1,623.78 "," $1,676.16 "," $1,307.69 "," $1,484.10 "," $1,207.81 "," $1,312.14 ", N/A ," $1,133.90 "," $1,133.90 "," $1,658.70 "," $1,332.74 ", $153.67 ," $1,676.16 "
Column Chromotography Quant,CPT® 82542,N/A,N/A,N/A, $292.00 , $189.80 , N/A , $24.57 , $24.57 , $102.19 , $122.20 , $271.56 , $262.80 , $262.80 , $233.60 , $233.60 , $24.57 , $269.60 , $277.40 , $262.80 , $262.80 , $262.80 , $271.56 , $280.32 , $160.85 , $248.20 , $118.39 , $70.75 , N/A , $95.37 , $95.37 , $277.40 , $104.22 , $24.57 , $280.32 
 BUDESONIDE 0.25 MG/2ML INH SUSP ,HCPCS RXC637,0250 - PHARMACY,00093-6815-55,2 mL, $48.33 , $31.41 , $40.60 , N/A , N/A , $39.05 , $43.50 , $40.92 , $43.50 , $43.50 , $43.50 , $41.08 , N/A , $44.62 , $45.91 , $41.08 , $44.95 , $44.95 , $45.91 , $46.40 , $39.54 , $43.50 , $41.08 , $38.18 , N/A , $39.11 , $39.11 , $45.91 , $41.47 , $38.18 , $46.40 
"Closed Rx Carpal Fx,Maipulatn",CPT® 25635,N/A,N/A,N/A," $3,008.00 "," $1,955.20 "," $2,617.36 ", $413.20 , $309.27 ," $1,904.63 "," $1,955.26 "," $2,797.44 "," $2,707.20 "," $2,707.20 "," $2,406.40 "," $2,406.40 ", $309.27 ," $2,777.29 "," $2,857.60 "," $2,707.20 "," $2,707.20 "," $2,707.20 "," $2,797.44 "," $2,887.68 "," $2,415.68 "," $2,556.80 "," $2,149.80 "," $2,366.40 ", N/A ," $1,941.79 "," $1,941.79 "," $2,857.60 "," $2,282.30 ", $309.27 ," $2,887.68 "
 NA HYALUR & NA CHOND-NA HYALUR 0.55-0.5 ML IO KIT ,HCPCS RXA250,0250 - PHARMACY,08065-1831-50,1 each," $1,541.12 "," $1,001.73 "," $1,294.54 ", N/A , N/A ," $1,245.22 "," $1,387.01 "," $1,304.71 "," $1,387.01 "," $1,387.01 "," $1,387.01 "," $1,309.95 ", N/A ," $1,422.92 "," $1,464.06 "," $1,309.95 "," $1,433.24 "," $1,433.24 "," $1,464.06 "," $1,479.48 "," $1,260.94 "," $1,387.01 "," $1,309.95 "," $1,217.48 ", N/A ," $1,247.23 "," $1,247.23 "," $1,464.06 "," $1,322.44 "," $1,217.48 "," $1,479.48 "
 Pro Excision Tumor Soft Tissue Pelvis&Hip Subq 3+Cm ,CPT® 27043,0982 - PRO FEE/OUTPT,N/A,N/A," $3,115.00 "," $2,024.75 "," $2,818.73 ", $440.04 , $385.10 ," $2,248.05 "," $2,253.94 "," $2,896.95 "," $2,803.50 "," $2,803.50 "," $2,492.00 "," $2,492.00 ", $385.10 ," $2,876.08 "," $2,959.25 "," $2,803.50 "," $2,803.50 "," $2,803.50 "," $2,896.95 "," $2,990.40 "," $2,609.95 "," $2,647.75 "," $2,497.69 "," $2,638.75 ", N/A ," $2,291.91 "," $2,291.91 "," $2,959.25 "," $2,693.81 ", $385.10 ," $2,990.40 "
Debridement of Nails 1-6,CPT® 11720,N/A,N/A,N/A, $125.00 , $81.25 , $46.82 , $13.79 , $19.04 , $41.04 , $39.04 , $116.25 , $112.50 , $112.50 , $100.00 , $100.00 , $19.04 , $115.41 , $118.75 , $112.50 , $112.50 , $112.50 , $116.25 , $120.00 , $51.62 , $106.25 , $76.71 , $52.68 , N/A , $41.84 , $41.84 , $118.75 , $48.53 , $13.79 , $120.00 
"I&D, Post Spine, Cerv/Thor/Cerv-Thor",CPT® 22010,N/A,N/A,N/A," $5,676.00 "," $3,689.40 "," $5,717.47 ", $894.70 ," $1,036.27 "," $4,543.29 "," $4,501.97 "," $5,278.68 "," $5,108.40 "," $5,108.40 "," $4,540.80 "," $4,540.80 "," $1,036.27 "," $5,240.65 "," $5,392.20 "," $5,108.40 "," $5,108.40 "," $5,108.40 "," $5,278.68 "," $5,448.96 "," $5,314.46 "," $4,824.60 "," $5,031.06 "," $5,302.41 ", N/A ," $4,631.94 "," $4,631.94 "," $5,392.20 "," $5,444.16 ", $894.70 ," $5,717.47 "
 Pro Egd Flexible Foreign Body Removal ,CPT® 43247,0982 - PRO FEE/OUTPT,N/A,N/A," $2,315.00 "," $1,504.75 "," $1,081.54 ", $167.00 , $186.68 , $894.33 , $972.62 ," $2,152.95 "," $2,083.50 "," $2,083.50 "," $1,852.00 "," $1,852.00 ", $186.68 ," $2,137.44 "," $2,199.25 "," $2,083.50 "," $2,083.50 "," $2,083.50 "," $2,152.95 "," $2,222.40 ", $777.60 ," $1,967.75 "," $1,066.87 "," $1,032.34 ", N/A , $911.79 , $911.79 ," $2,199.25 ", $953.64 , $167.00 ," $2,222.40 "
"Herpes Simplex Test, Type 2",CPT® 86696,N/A,N/A,N/A, $178.00 , $115.70 , N/A , $19.74 , $19.74 , $109.51 , $130.96 , $165.54 , $160.20 , $160.20 , $142.40 , $142.40 , $19.74 , $164.35 , $169.10 , $160.20 , $160.20 , $160.20 , $165.54 , $170.88 , $129.20 , $151.30 , $126.50 , $70.19 , N/A , $102.20 , $102.20 , $169.10 , $111.68 , $19.74 , $170.88 
 Fac Mecp2 Gene Analysis Duplication/Deletion Variant ,CPT® 81304,0310 - PATHOLOGY LAB,N/A,N/A, $3.00 , $1.95 , $2.52 , $153.00 , $78.42 , $2.42 , $2.70 , $2.54 , $2.70 , $2.70 , $2.70 , $2.55 , $76.88 , $2.77 , $2.85 , $2.55 , $2.79 , $2.79 , $2.85 , $2.88 , $2.45 , $2.70 , $2.55 , $2.37 , N/A , $2.43 , $2.43 , $2.85 , $2.57 , $2.37 , $153.00 
Neuropsychological Tst Eval Phys/Qhp Ea Addl Hr,CPT® 96133,N/A,N/A,N/A, $686.00 , $445.90 , $185.09 , $76.71 , $116.25 , $173.32 , N/A , $637.98 , $617.40 , $617.40 , $548.80 , $548.80 , $116.25 , $633.38 , $651.70 , $617.40 , $617.40 , $617.40 , $637.98 , $658.56 , $347.94 , $583.10 , $228.19 , $316.29 , $140.28 , $176.70 , $176.70 , $651.70 , $205.99 , $76.71 , $658.56 
Tgsap Hematolymphoid Neo/Do 5-50dna/Dna&Rna Alys,CPT® 81450,N/A,N/A,N/A," $3,414.00 "," $2,219.10 ", N/A , $774.72 , $774.72 , N/A , N/A ," $3,175.02 "," $3,072.60 "," $3,072.60 "," $2,731.20 "," $2,731.20 ", $774.72 ," $3,152.15 "," $3,243.30 "," $3,072.60 "," $3,072.60 "," $3,072.60 "," $3,175.02 "," $3,277.44 "," $5,071.55 "," $2,901.90 "," $3,620.04 "," $2,230.74 ", N/A ," $3,015.33 "," $3,015.33 "," $3,243.30 "," $3,288.76 ", $774.72 ," $5,071.55 "
" Fac Complete Cbc, Automated ",CPT® 85027,0305 - LAB/HEMATOLOGY,N/A,N/A, $91.00 , $59.15 , $76.44 , $6.60 , $6.60 , $73.53 , $81.90 , $77.04 , $81.90 , $81.90 , $81.90 , $77.35 , $6.47 , $84.02 , $86.45 , $77.35 , $84.63 , $84.63 , $86.45 , $87.36 , $74.46 , $81.90 , $77.35 , $71.89 , N/A , $73.65 , $73.65 , $86.45 , $78.09 , $6.47 , $87.36 
 Pro Revise/Remove Neuroelectrode ,CPT® 64585,0982 - PRO FEE/OUTPT,N/A,N/A," $1,869.00 "," $1,214.85 ", $704.81 , $137.16 , $251.04 , $799.16 , $785.64 ," $1,738.17 "," $1,682.10 "," $1,682.10 "," $1,495.20 "," $1,495.20 ", $251.04 ," $1,725.65 "," $1,775.55 "," $1,682.10 "," $1,682.10 "," $1,682.10 "," $1,738.17 "," $1,794.24 ", $762.60 ," $1,588.65 ", $767.15 , $861.71 , N/A , $814.76 , $814.76 ," $1,775.55 ", $874.04 , $137.16 ," $1,794.24 "
Biopsy of Lip,CPT® 40490,N/A,N/A,N/A, $867.00 , $563.55 , $425.82 , $66.79 , $46.08 , $351.54 , $356.81 , $806.31 , $780.30 , $780.30 , $693.60 , $693.60 , $46.08 , $800.50 , $823.65 , $780.30 , $780.30 , $780.30 , $806.31 , $832.32 , $308.10 , $736.95 , $390.71 , $417.97 , N/A , $358.40 , $358.40 , $823.65 , $374.86 , $46.08 , $832.32 
 Fac Plmt Prox Xtn Prosth Evasc Rpr Dta 1st Xtn ,CPT® 33883,0360 - OR SERVICES,N/A,N/A," $15,969.00 "," $10,379.85 "," $13,413.96 ", $995.27 ," $1,010.10 "," $12,902.95 "," $14,372.10 "," $13,519.36 "," $14,372.10 "," $14,372.10 "," $14,372.10 "," $13,573.65 ", $990.29 ," $14,744.18 "," $15,170.55 "," $13,573.65 "," $14,851.17 "," $14,851.17 "," $15,170.55 "," $15,330.24 "," $13,065.84 "," $14,372.10 "," $13,573.65 "," $12,615.51 ", N/A ," $12,923.71 "," $12,923.71 "," $15,170.55 "," $13,703.00 ", $990.29 ," $15,330.24 "
 Pro Xtrnl Oc Phtgrphy I&R Progress ,CPT® 92285,0962 - PRO FEE/EYE,N/A,N/A, $105.00 , $68.25 , $49.10 , $22.31 , $16.52 , $35.49 , $37.27 , $97.65 , $94.50 , $94.50 , $84.00 , $84.00 , $16.52 , $96.95 , $99.75 , $94.50 , $94.50 , $94.50 , $97.65 , $100.80 , $68.50 , $89.25 , $63.86 , $42.85 , N/A , $36.18 , $36.18 , $99.75 , $43.04 , $16.52 , $100.80 
Open Fix Gr Trochanteric Fx,CPT® 27248,N/A,N/A,N/A," $4,898.00 "," $3,183.70 "," $4,524.98 ", $706.58 , $824.74 ," $3,586.32 "," $3,555.48 "," $4,555.14 "," $4,408.20 "," $4,408.20 "," $3,918.40 "," $3,918.40 ", $824.74 ," $4,522.32 "," $4,653.10 "," $4,408.20 "," $4,408.20 "," $4,408.20 "," $4,555.14 "," $4,702.08 "," $4,204.96 "," $4,163.30 "," $3,932.08 "," $4,219.55 ", N/A ," $3,656.30 "," $3,656.30 "," $4,653.10 "," $4,297.46 ", $706.58 ," $4,702.08 "
Sgmdsc Flx Dired Sbmcsl Njx Any Sbst,CPT® 45335,N/A,N/A,N/A," $1,997.00 "," $1,298.05 ", $405.08 , $63.40 , $158.58 , $437.97 , $452.22 ," $1,857.21 "," $1,797.30 "," $1,797.30 "," $1,597.60 "," $1,597.60 ", $158.58 ," $1,843.83 "," $1,897.15 "," $1,797.30 "," $1,797.30 "," $1,797.30 "," $1,857.21 "," $1,917.12 ", $291.64 ," $1,697.45 ", $495.97 , $384.35 , N/A , $446.51 , $446.51 ," $1,897.15 ", $467.01 , $63.40 ," $1,917.12 "
" Fac Tcd, Emboli Detect W/O Inj ",CPT® 93892,0921 - PERI VASCUL LAB,N/A,N/A, $873.00 , $567.45 , $733.32 , $160.80 , $220.43 , $705.38 , $785.70 , $739.08 , $785.70 , $785.70 , $785.70 , $742.05 , $216.11 , $806.04 , $829.35 , $742.05 , $811.89 , $811.89 , $829.35 , $838.08 , $714.29 , $785.70 , $742.05 , $689.67 , N/A , $706.52 , $706.52 , $829.35 , $749.12 , $160.80 , $838.08 
 CLINIMIX/DEXTROSE (5/20) 5 % IV SOLN ,HCPCS RXA258,0258 - IV SOLUTIONS,00338-1101-04,"2,000 mL", $503.42 , $327.22 , $422.87 , N/A , N/A , $406.76 , $453.08 , $426.20 , $453.08 , $453.08 , $453.08 , $427.91 , N/A , $464.81 , $478.25 , $427.91 , $468.18 , $468.18 , $478.25 , $483.28 , $411.90 , $453.08 , $427.91 , $397.70 , N/A , $407.42 , $407.42 , $478.25 , $431.98 , $397.70 , $483.28 
"Bil Sal-Ooph W/Omentect,Tah,Rad Dis,Lymp",CPT® 58954,N/A,N/A,N/A," $12,603.00 "," $8,191.95 "," $10,141.45 "," $2,051.10 "," $2,003.62 "," $8,868.30 "," $8,568.41 "," $11,720.79 "," $11,342.70 "," $11,342.70 "," $10,082.40 "," $10,082.40 "," $2,003.62 "," $11,636.35 "," $11,972.85 "," $11,342.70 "," $11,342.70 "," $11,342.70 "," $11,720.79 "," $12,098.88 "," $10,612.31 "," $10,712.55 "," $11,285.99 "," $8,920.35 ", N/A ," $9,041.33 "," $9,041.33 "," $11,972.85 "," $10,844.53 "," $2,003.62 "," $12,098.88 "
 ONDANSETRON HCL 40 MG/20ML IJ SOLN ,HCPCS J2405,0636 - DRUGS REQUIRING DETAILED CODIN,16729-0298-05,2 mL, $16.68 , $10.84 , $14.01 , $0.11 , $0.09 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.09 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.09 , $16.01 
Radiologic Exam Esophagus Double Contrast Study,CPT® 74221,N/A,N/A,N/A," $1,169.00 ", $759.85 , $642.64 , $110.45 , $85.64 , $508.35 , N/A ," $1,087.17 "," $1,052.10 "," $1,052.10 ", $935.20 , $935.20 , $85.64 ," $1,079.34 "," $1,110.55 "," $1,052.10 "," $1,052.10 "," $1,052.10 "," $1,087.17 "," $1,122.24 ", $627.02 , $993.65 , $644.57 , $549.00 , N/A , $518.26 , $518.26 ," $1,110.55 ", $600.62 , $85.64 ," $1,122.24 "
" Pro Neg Press Wound Tx, < 50 Cm ",CPT® 97605,0982 - PRO FEE/OUTPT,N/A,N/A, $215.00 , $139.75 , $58.68 , $24.70 , $29.41 , $60.43 , $51.61 , $199.95 , $193.50 , $193.50 , $172.00 , $172.00 , $29.41 , $198.51 , $204.25 , $193.50 , $193.50 , $193.50 , $199.95 , $206.40 , $77.95 , $182.75 , $78.06 , $59.41 , N/A , $61.61 , $61.61 , $204.25 , $68.53 , $24.70 , $206.40 
Apply Short Leg Cast,29405,N/A,N/A,N/A, $685.00 , $445.25 , $353.21 , $55.88 , $70.65 , $291.95 , $292.92 , $637.05 , $616.50 , $616.50 , $548.00 , $548.00 , $70.65 , $632.46 , $650.75 , $616.50 , $616.50 , $616.50 , $637.05 , $657.60 , $330.82 , $582.25 , $319.35 , $344.75 , N/A , $297.65 , $297.65 , $650.75 , $349.86 , $55.88 , $657.60 
 Ac Joints Bil With/Without Wts ,CPT® 73050,0320 - DX X-RAY,N/A,N/A, $365.00 , $237.25 , $306.60 , $28.11 , $35.09 , $294.92 , $328.50 , $309.01 , $328.50 , $328.50 , $328.50 , $310.25 , $34.40 , $337.00 , $346.75 , $310.25 , $339.45 , $339.45 , $346.75 , $350.40 , $298.64 , $328.50 , $310.25 , $288.35 , N/A , $295.39 , $295.39 , $346.75 , $313.21 , $28.11 , $350.40 
"Femoral Fx, Open Tx",CPT® 27236,N/A,N/A,N/A," $6,378.00 "," $4,145.70 "," $7,201.29 "," $1,125.98 "," $1,044.67 "," $5,779.29 "," $5,726.62 "," $5,931.54 "," $5,740.20 "," $5,740.20 "," $5,102.40 "," $5,102.40 "," $1,044.67 "," $5,888.81 "," $6,059.10 "," $5,740.20 "," $5,740.20 "," $5,740.20 "," $5,931.54 "," $6,122.88 "," $6,711.45 "," $5,421.30 "," $6,337.00 "," $6,792.94 ", N/A ," $5,892.06 "," $5,892.06 "," $6,059.10 "," $6,925.28 "," $1,044.67 "," $7,201.29 "
"Removal Testis,Radical",CPT® 54530,N/A,N/A,N/A," $2,771.00 "," $1,801.15 "," $2,254.97 ", $486.50 , $504.14 ," $1,621.34 "," $1,643.03 "," $2,577.03 "," $2,493.90 "," $2,493.90 "," $2,216.80 "," $2,216.80 ", $504.14 ," $2,558.46 "," $2,632.45 "," $2,493.90 "," $2,493.90 "," $2,493.90 "," $2,577.03 "," $2,660.16 "," $2,115.11 "," $2,355.35 "," $2,620.79 "," $2,447.04 ", N/A ," $1,652.98 "," $1,652.98 "," $2,632.45 "," $1,981.19 ", $486.50 ," $2,660.16 "
 Pro Drain Rectal Abscess ,CPT® 46040,0981 - PRO FEE/ER,N/A,N/A," $2,569.00 "," $1,669.85 "," $2,598.90 ", $404.09 , $192.43 ," $1,960.97 "," $2,012.51 "," $2,389.17 "," $2,312.10 "," $2,312.10 "," $2,055.20 "," $2,055.20 ", $192.43 ," $2,371.96 "," $2,440.55 "," $2,312.10 "," $2,312.10 "," $2,312.10 "," $2,389.17 "," $2,466.24 "," $1,851.25 "," $2,183.65 "," $2,217.59 "," $2,340.82 ", N/A ," $1,999.23 "," $1,999.23 "," $2,440.55 "," $2,090.98 ", $192.43 ," $2,598.90 "
 Fac Drug Assay Lacosamide ,CPT® 80235,0301 - LAB/CHEMISTRY,N/A,N/A, $276.00 , $179.40 , $231.84 , $27.65 , $22.12 , $223.01 , $248.40 , $233.66 , $248.40 , $248.40 , $248.40 , $234.60 , $21.69 , $254.83 , $262.20 , $234.60 , $256.68 , $256.68 , $262.20 , $264.96 , $225.82 , $248.40 , $234.60 , $218.04 , N/A , $223.37 , $223.37 , $262.20 , $236.84 , $21.69 , $264.96 
"Shav Skin Les 11-20mm Trunk,Arm,Leg",CPT® 11302,N/A,N/A,N/A, $539.00 , $350.35 , $192.78 , $57.52 , $62.13 , $171.15 , $166.32 , $501.27 , $485.10 , $485.10 , $431.20 , $431.20 , $62.13 , $497.66 , $512.05 , $485.10 , $485.10 , $485.10 , $501.27 , $517.44 , $212.62 , $458.15 , $330.05 , $221.26 , N/A , $174.49 , $174.49 , $512.05 , $202.37 , $57.52 , $517.44 
Repair Intercarp/Carp-Metacarp Jt,CPT® 25447,N/A,N/A,N/A," $4,238.00 "," $2,754.70 "," $5,075.53 ", $797.62 , $618.57 ," $3,988.25 "," $3,968.44 "," $3,941.34 "," $3,814.20 "," $3,814.20 "," $3,390.40 "," $3,390.40 ", $618.57 ," $3,912.95 "," $4,026.10 "," $3,814.20 "," $3,814.20 "," $3,814.20 "," $3,941.34 "," $4,068.48 "," $4,717.59 "," $3,602.30 "," $4,365.60 "," $4,732.74 ", N/A ," $4,066.07 "," $4,066.07 "," $4,026.10 "," $4,779.07 ", $618.57 ," $5,075.53 "
"Immunofix E-Phoresis, Serum",CPT® 86334,N/A,N/A,N/A, $248.00 , $161.20 , N/A , $22.79 , $22.79 , $126.43 , $151.19 , $230.64 , $223.20 , $223.20 , $198.40 , $198.40 , $22.79 , $228.98 , $235.60 , $223.20 , $223.20 , $223.20 , $230.64 , $238.08 , $149.17 , $210.80 , $240.03 , $81.03 , N/A , $117.99 , $117.99 , $235.60 , $128.94 , $22.79 , $240.03 
 Sc Bx Abd/Retroperitoneal Mass ,CPT® 49180,0761 - TREATMENT ROOM,N/A,N/A," $1,462.00 ", $950.30 ," $1,228.08 ", $79.48 , $155.61 ," $1,181.30 "," $1,315.80 "," $1,237.73 "," $1,315.80 "," $1,315.80 "," $1,315.80 "," $1,242.70 ", $152.56 ," $1,349.86 "," $1,388.90 "," $1,242.70 "," $1,359.66 "," $1,359.66 "," $1,388.90 "," $1,403.52 "," $1,196.21 "," $1,315.80 "," $1,242.70 "," $1,154.98 ", N/A ," $1,183.20 "," $1,183.20 "," $1,388.90 "," $1,254.54 ", $79.48 ," $1,403.52 "
" Pro Medical Nutrition, Indiv, In ",CPT® 97802,0982 - PRO FEE/OUTPT,N/A,N/A, $136.00 , $88.40 , $75.82 , $32.22 , N/A , $73.03 , $73.92 , $126.48 , $122.40 , $122.40 , $108.80 , $108.80 , N/A , $125.57 , $129.20 , $122.40 , $122.40 , $122.40 , $126.48 , $130.56 , $100.67 , $115.60 , $97.32 , $124.09 , N/A , $74.46 , $74.46 , $129.20 , $86.80 , $32.22 , $130.56 
 BENRALIZUMAB 30 MG/ML SC SOSY ,HCPCS J0517,0636 - DRUGS REQUIRING DETAILED CODIN,00310-1730-30,1 mL," $16,205.27 "," $10,533.43 "," $13,612.43 ", $174.35 , $171.62 ," $13,093.86 "," $14,584.74 "," $13,719.38 "," $14,584.74 "," $14,584.74 "," $14,584.74 "," $13,774.48 ", $168.25 ," $14,962.33 "," $15,395.01 "," $13,774.48 "," $15,070.90 "," $15,070.90 "," $15,395.01 "," $15,557.06 "," $13,259.15 "," $14,584.74 "," $13,774.48 "," $12,802.16 ", N/A ," $13,114.93 "," $13,114.93 "," $15,395.01 "," $13,905.74 ", $168.25 ," $15,557.06 "
"Destr Malig Face,Nose,Lip 1.1-2 Cm",CPT® 17282,N/A,N/A,N/A, $774.00 , $503.10 , $437.21 , $131.76 , $262.91 , $393.99 , $385.35 , $719.82 , $696.60 , $696.60 , $619.20 , $619.20 , $262.91 , $714.63 , $735.30 , $696.60 , $696.60 , $696.60 , $719.82 , $743.04 , $482.22 , $657.90 , $765.36 , $504.47 , N/A , $401.68 , $401.68 , $735.30 , $465.80 , $131.76 , $765.36 
Arthrogram of Hip,CPT® 73525,N/A,N/A,N/A," $1,441.00 ", $936.65 , $764.27 , $128.89 , $92.85 , $481.48 , $562.70 ," $1,340.13 "," $1,296.90 "," $1,296.90 "," $1,152.80 "," $1,152.80 ", $92.85 ," $1,330.48 "," $1,368.95 "," $1,296.90 "," $1,296.90 "," $1,296.90 "," $1,340.13 "," $1,383.36 ", $740.65 ," $1,224.85 ", $616.33 , $520.36 , N/A , $490.88 , $490.88 ," $1,368.95 ", $568.21 , $92.85 ," $1,383.36 "
Cardiolipin Antibody,CPT® 86147,N/A,N/A,N/A, $261.00 , $169.65 , N/A , $25.96 , $8.07 , $32.88 , $39.34 , $242.73 , $234.90 , $234.90 , $208.80 , $208.80 , $8.07 , $240.98 , $247.95 , $234.90 , $234.90 , $234.90 , $242.73 , $250.56 , $169.94 , $221.85 , $167.05 , $92.28 , N/A , $30.69 , $30.69 , $247.95 , $33.54 , $8.07 , $250.56 
Ekg for Initial Prevent Exam,HCPCS G0403,N/A,N/A,N/A, $174.00 , $113.10 , $88.34 , $13.97 , N/A , $31.01 , N/A , $161.82 , $156.60 , $156.60 , $139.20 , $139.20 , N/A , $160.65 , $165.30 , $156.60 , $156.60 , $156.60 , $161.82 , $167.04 , $39.06 , $147.90 , $35.03 , $63.28 , N/A , $31.62 , $31.62 , $165.30 , $39.53 , $13.97 , $167.04 
 Pro Removal of Ovary(S) ,CPT® 58940,0982 - PRO FEE/OUTPT,N/A,N/A," $3,856.00 "," $2,506.40 "," $2,618.80 ", $529.82 , $453.02 ," $2,125.37 "," $2,110.65 "," $3,586.08 "," $3,470.40 "," $3,470.40 "," $3,084.80 "," $3,084.80 ", $453.02 ," $3,560.24 "," $3,663.20 "," $3,470.40 "," $3,470.40 "," $3,470.40 "," $3,586.08 "," $3,701.76 "," $2,710.00 "," $3,277.60 "," $2,783.14 "," $2,133.84 ", N/A ," $2,166.84 "," $2,166.84 "," $3,663.20 "," $2,598.98 ", $453.02 ," $3,701.76 "
Assay for Lead,CPT® 83655,N/A,N/A,N/A, $116.00 , $75.40 , N/A , $12.35 , $12.35 , $68.47 , $81.92 , $107.88 , $104.40 , $104.40 , $92.80 , $92.80 , $12.35 , $107.10 , $110.20 , $104.40 , $104.40 , $104.40 , $107.88 , $111.36 , $80.86 , $98.60 , $79.47 , $43.91 , N/A , $63.90 , $63.90 , $110.20 , $69.83 , $12.35 , $111.36 
Thyr Lobectomy+Part Remov Contra,CPT® 60225,N/A,N/A,N/A," $6,858.00 "," $4,457.70 "," $5,698.94 ", $884.65 , $922.06 ," $4,807.69 "," $4,989.11 "," $6,377.94 "," $6,172.20 "," $6,172.20 "," $5,486.40 "," $5,486.40 ", $922.06 ," $6,331.99 "," $6,515.10 "," $6,172.20 "," $6,172.20 "," $6,172.20 "," $6,377.94 "," $6,583.68 "," $5,470.62 "," $5,829.30 "," $4,950.78 "," $4,621.53 ", N/A ," $4,901.50 "," $4,901.50 "," $6,515.10 "," $5,466.65 ", $884.65 ," $6,583.68 "
 HYDROMORPHONE HCL 4 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,42858-0302-25,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Progressive Lens per Lens,HCPCS V2781,N/A,N/A,N/A, $180.00 , $117.00 , N/A , N/A , N/A , N/A , N/A , $167.40 , $162.00 , $162.00 , $144.00 , $144.00 , N/A , $166.19 , $171.00 , $162.00 , $162.00 , $162.00 , $167.40 , $172.80 , N/A , $153.00 , $180.00 , N/A , N/A , N/A , N/A , $171.00 , N/A , $144.00 , $180.00 
"Deep Dissec Foot Infec,1 Bursa",CPT® 28002,N/A,N/A,N/A," $3,028.00 "," $1,968.20 ", $878.67 , $135.60 , $144.17 ," $1,567.77 "," $1,570.89 "," $2,816.04 "," $2,725.20 "," $2,725.20 "," $2,422.40 "," $2,422.40 ", $144.17 ," $2,795.75 "," $2,876.60 "," $2,725.20 "," $2,725.20 "," $2,725.20 "," $2,816.04 "," $2,906.88 "," $1,817.97 "," $2,573.80 "," $1,707.35 "," $1,854.46 ", N/A ," $1,598.36 "," $1,598.36 "," $2,876.60 "," $1,878.65 ", $135.60 ," $2,906.88 "
Repair Peroneal Tendons,CPT® 27675,N/A,N/A,N/A," $3,276.00 "," $2,129.40 "," $3,038.56 ", $480.86 , $461.04 ," $2,355.53 "," $2,386.16 "," $3,046.68 "," $2,948.40 "," $2,948.40 "," $2,620.80 "," $2,620.80 ", $461.04 ," $3,024.73 "," $3,112.20 "," $2,948.40 "," $2,948.40 "," $2,948.40 "," $3,046.68 "," $3,144.96 "," $2,818.63 "," $2,784.60 "," $2,606.52 "," $2,833.71 ", N/A ," $2,401.50 "," $2,401.50 "," $3,112.20 "," $2,822.60 ", $461.04 ," $3,144.96 "
 Pro Cont Gluc Mntr Physician/Qhp Provided Equiptment ,CPT® 95250,0982 - PRO FEE/OUTPT,N/A,N/A, $926.00 , $601.90 , $340.54 , $141.63 , $50.79 , $346.25 , $372.69 , $861.18 , $833.40 , $833.40 , $740.80 , $740.80 , $50.79 , $854.98 , $879.70 , $833.40 , $833.40 , $833.40 , $861.18 , $888.96 , $465.73 , $787.10 , $495.71 , $576.31 , N/A , $353.01 , $353.01 , $879.70 , $411.55 , $50.79 , $888.96 
" Pro Hysteroscopy, Ablation ",CPT® 58563,0982 - PRO FEE/OUTPT,N/A,N/A," $7,123.00 "," $4,629.95 "," $1,145.00 ", $232.15 ," $1,306.81 "," $1,393.41 "," $1,387.53 "," $6,624.39 "," $6,410.70 "," $6,410.70 "," $5,698.40 "," $5,698.40 "," $1,306.81 "," $6,576.67 "," $6,766.85 "," $6,410.70 "," $6,410.70 "," $6,410.70 "," $6,624.39 "," $6,838.08 "," $1,207.19 "," $6,054.55 "," $1,826.88 "," $1,025.91 ", N/A ," $1,420.60 "," $1,420.60 "," $6,766.85 "," $1,703.93 ", $232.15 ," $6,838.08 "
 Fac R & L Hrt Cath Winjx Hrt Art& L Ventr Img ,CPT® 93460,0481 - CARDIAC CATH LAB,N/A,N/A," $17,487.00 "," $11,366.55 "," $14,689.08 "," $1,204.77 ", $909.21 ," $14,129.50 "," $15,738.30 "," $14,804.49 "," $15,738.30 "," $15,738.30 "," $15,738.30 "," $14,863.95 ", $891.38 ," $16,145.75 "," $16,612.65 "," $14,863.95 "," $16,262.91 "," $16,262.91 "," $16,612.65 "," $16,787.52 "," $14,307.86 "," $15,738.30 "," $14,863.95 "," $13,814.73 ", N/A ," $14,152.23 "," $14,152.23 "," $16,612.65 "," $15,005.59 ", $891.38 ," $16,787.52 "
" Pro Remove Lesion, Back or Flank ",CPT® 21930,0982 - PRO FEE/OUTPT,N/A,N/A," $3,153.00 "," $2,049.45 "," $2,206.04 ", $345.13 , $398.01 ," $1,751.41 "," $1,765.94 "," $2,932.29 "," $2,837.70 "," $2,837.70 "," $2,522.40 "," $2,522.40 ", $398.01 ," $2,911.16 "," $2,995.35 "," $2,837.70 "," $2,837.70 "," $2,837.70 "," $2,932.29 "," $3,026.88 "," $2,045.63 "," $2,680.05 "," $1,951.77 "," $2,069.50 ", N/A ," $1,785.59 "," $1,785.59 "," $2,995.35 "," $2,098.72 ", $345.13 ," $3,026.88 "
Part Removal Colon W End Colostomy,CPT® 44143,N/A,N/A,N/A," $10,866.00 "," $7,062.90 "," $9,859.59 "," $1,523.23 "," $1,844.17 "," $7,836.33 "," $7,911.58 "," $10,105.38 "," $9,779.40 "," $9,779.40 "," $8,692.80 "," $8,692.80 "," $1,844.17 "," $10,032.58 "," $10,322.70 "," $9,779.40 "," $9,779.40 "," $9,779.40 "," $10,105.38 "," $10,431.36 "," $7,093.88 "," $9,236.10 "," $8,795.44 "," $9,250.61 ", N/A ," $7,989.23 "," $7,989.23 "," $10,322.70 "," $8,355.89 "," $1,523.23 "," $10,431.36 "
Pelvic Examination W Anesth,57410,N/A,N/A,N/A, $734.00 , $477.10 , $494.30 , $100.19 , $97.25 , $439.23 , $436.23 , $682.62 , $660.60 , $660.60 , $587.20 , $587.20 , $97.25 , $677.70 , $697.30 , $660.60 , $660.60 , $660.60 , $682.62 , $704.64 , $518.63 , $623.90 , $572.68 , $441.63 , N/A , $447.80 , $447.80 , $697.30 , $537.11 , $97.25 , $704.64 
Thoracentesis Needle/Cath Pleura W/O Imaging,CPT® 32554,N/A,N/A,N/A," $3,519.00 "," $2,287.35 ", $486.39 , $84.12 , $196.83 , $347.08 , $337.80 ," $3,272.67 "," $3,167.10 "," $3,167.10 "," $2,815.20 "," $2,815.20 ", $196.83 ," $3,249.09 "," $3,343.05 "," $3,167.10 "," $3,167.10 "," $3,167.10 "," $3,272.67 "," $3,378.24 ", $471.39 ," $2,991.15 ", $470.99 , $466.30 , N/A , $353.86 , $353.86 ," $3,343.05 ", $416.75 , $84.12 ," $3,378.24 "
Open Rx Trimalleolar Fx,CPT® 27822,N/A,N/A,N/A," $3,239.00 "," $2,105.35 "," $5,376.22 ", $838.56 , $738.92 ," $4,063.25 "," $4,063.58 "," $3,012.27 "," $2,915.10 "," $2,915.10 "," $2,591.20 "," $2,591.20 ", $738.92 ," $2,990.57 "," $3,077.05 "," $2,915.10 "," $2,915.10 "," $2,915.10 "," $3,012.27 "," $3,109.44 "," $4,979.47 "," $2,753.15 "," $4,481.57 "," $4,894.21 ", N/A ," $4,142.53 "," $4,142.53 "," $3,077.05 "," $4,868.93 ", $738.92 ," $5,376.22 "
 Fac App Skn Sub Grft T/a/L Area/<100scm Ea Adl 25scm ,CPT® 15272,0761 - TREATMENT ROOM,N/A,N/A," $1,653.00 "," $1,074.45 "," $1,388.52 ", $15.78 , $21.08 ," $1,335.62 "," $1,487.70 "," $1,399.43 "," $1,487.70 "," $1,487.70 "," $1,487.70 "," $1,405.05 ", $20.67 ," $1,526.21 "," $1,570.35 "," $1,405.05 "," $1,537.29 "," $1,537.29 "," $1,570.35 "," $1,586.88 "," $1,352.48 "," $1,487.70 "," $1,405.05 "," $1,305.87 ", N/A ," $1,337.77 "," $1,337.77 "," $1,570.35 "," $1,418.44 ", $15.78 ," $1,586.88 "
Dx Ophthalmic US Ant Segment Immersion Uni/Bi,CPT® 76513,N/A,N/A,N/A, $633.00 , $411.45 , $427.92 , $74.15 , $82.60 , $462.51 , $516.77 , $588.69 , $569.70 , $569.70 , $506.40 , $506.40 , $82.60 , $584.45 , $601.35 , $569.70 , $569.70 , $569.70 , $588.69 , $607.68 , $435.68 , $538.05 , $564.33 , $540.80 , N/A , $471.53 , $471.53 , $601.35 , $545.82 , $74.15 , $607.68 
 Fac Assay of Alcohol (Ethanol) Spec Xcp UR&Breath Ia ,CPT® 82077,0301 - LAB/CHEMISTRY,N/A,N/A, $159.00 , $103.35 , $133.56 , $17.62 , $14.10 , $128.47 , $143.10 , $134.61 , $143.10 , $143.10 , $143.10 , $135.15 , $13.82 , $146.80 , $151.05 , $135.15 , $147.87 , $147.87 , $151.05 , $152.64 , $130.09 , $143.10 , $135.15 , $125.61 , N/A , $128.68 , $128.68 , $151.05 , $136.44 , $13.82 , $152.64 
 Fac Colonoscopy Flx Ablation Tumor Polyp/Other Les ,CPT® 45388,0360 - OR SERVICES,N/A,N/A," $3,509.00 "," $2,280.85 "," $2,947.56 ", $255.42 , $436.94 ," $2,835.27 "," $3,158.10 "," $2,970.72 "," $3,158.10 "," $3,158.10 "," $3,158.10 "," $2,982.65 ", $428.37 ," $3,239.86 "," $3,333.55 "," $2,982.65 "," $3,263.37 "," $3,263.37 "," $3,333.55 "," $3,368.64 "," $2,871.06 "," $3,158.10 "," $2,982.65 "," $2,772.11 ", N/A ," $2,839.83 "," $2,839.83 "," $3,333.55 "," $3,011.07 ", $255.42 ," $3,368.64 "
 LIDOCAINE-EPINEPHRINE 1.5 %-1:200000 IJ SOLN ,HCPCS RXA250,0250 - PHARMACY,00409-1209-01,5 mL, $33.45 , $21.74 , $28.10 , N/A , N/A , $27.03 , $30.11 , $28.32 , $30.11 , $30.11 , $30.11 , $28.43 , N/A , $30.88 , $31.78 , $28.43 , $31.11 , $31.11 , $31.78 , $32.11 , $27.37 , $30.11 , $28.43 , $26.43 , N/A , $27.07 , $27.07 , $31.78 , $28.70 , $26.43 , $32.11 
 Fac Cardiopulmonary Exercise Testing ,CPT® 94621,0460 - PULMONARY FUNC,N/A,N/A," $1,311.00 ", $852.15 ," $1,101.24 ", $149.55 , $125.77 ," $1,059.29 "," $1,179.90 "," $1,109.89 "," $1,179.90 "," $1,179.90 "," $1,179.90 "," $1,114.35 ", $123.30 ," $1,210.45 "," $1,245.45 "," $1,114.35 "," $1,219.23 "," $1,219.23 "," $1,245.45 "," $1,258.56 "," $1,072.66 "," $1,179.90 "," $1,114.35 "," $1,035.69 ", N/A ," $1,060.99 "," $1,060.99 "," $1,245.45 "," $1,124.97 ", $123.30 ," $1,258.56 "
" Pro Scope Bladder & Ureter, Insert Stent Into Ureter ",CPT® 52332,0982 - PRO FEE/OUTPT,N/A,N/A," $3,421.00 "," $2,223.65 ", $834.21 , $146.58 , $307.34 , $762.03 , $709.33 ," $3,181.53 "," $3,078.90 "," $3,078.90 "," $2,736.80 "," $2,736.80 ", $307.34 ," $3,158.61 "," $3,249.95 "," $3,078.90 "," $3,078.90 "," $3,078.90 "," $3,181.53 "," $3,284.16 ", $837.96 ," $2,907.85 ", $802.83 , $959.18 , N/A , $776.89 , $776.89 ," $3,249.95 ", $913.10 , $146.58 ," $3,284.16 "
Prq Balloon Valvuloplasty Aortic Valve,CPT® 92986,N/A,N/A,N/A," $9,943.00 "," $6,462.95 "," $7,771.40 "," $1,198.83 "," $1,298.19 "," $7,120.68 "," $7,230.26 "," $9,246.99 "," $8,948.70 "," $8,948.70 "," $7,954.40 "," $7,954.40 "," $1,298.19 "," $9,180.37 "," $9,445.85 "," $8,948.70 "," $8,948.70 "," $8,948.70 "," $9,246.99 "," $9,545.28 "," $7,165.53 "," $8,451.55 "," $7,016.72 "," $7,590.69 ", N/A ," $7,259.62 "," $7,259.62 "," $9,445.85 "," $8,047.36 "," $1,198.83 "," $9,545.28 "
" Pro Lap, Enterolysis ",CPT® 44180,0982 - PRO FEE/OUTPT,N/A,N/A," $6,009.00 "," $3,905.85 "," $5,476.71 ", $847.84 , $725.16 ," $4,320.07 "," $4,362.88 "," $5,588.37 "," $5,408.10 "," $5,408.10 "," $4,807.20 "," $4,807.20 ", $725.16 ," $5,548.11 "," $5,708.55 "," $5,408.10 "," $5,408.10 "," $5,408.10 "," $5,588.37 "," $5,768.64 "," $3,924.21 "," $5,107.65 "," $4,850.87 "," $5,104.87 ", N/A ," $4,404.36 "," $4,404.36 "," $5,708.55 "," $4,606.48 ", $725.16 ," $5,768.64 "
 PROPOFOL 200 MG/20ML IV EMUL ,HCPCS J2704,0636 - DRUGS REQUIRING DETAILED CODIN,25021-0608-20,20 mL, $35.96 , $23.37 , $30.21 , $0.10 , $0.14 , $29.06 , $32.36 , $30.44 , $32.36 , $32.36 , $32.36 , $30.57 , $0.14 , $33.20 , $34.16 , $30.57 , $33.44 , $33.44 , $34.16 , $34.52 , $29.42 , $32.36 , $30.57 , $28.41 , N/A , $29.10 , $29.10 , $34.16 , $30.86 , $0.10 , $34.52 
Methylergonovin Maleate Inj,HCPCS J2210,N/A,N/A,N/A, $45.00 , $29.25 , N/A , $21.31 , $21.28 , N/A , N/A , $41.85 , $40.50 , $40.50 , $36.00 , $36.00 , $21.28 , $41.55 , $42.75 , $40.50 , $40.50 , $40.50 , $41.85 , $43.20 , $25.05 , $38.25 , $7.79 , $26.60 , N/A , N/A , N/A , $42.75 , N/A , $7.79 , $43.20 
Open Fix Gr Trochanteric Fx,27248,N/A,N/A,N/A," $4,898.00 "," $3,183.70 "," $4,524.98 ", $706.58 , $824.74 ," $3,586.32 "," $3,555.48 "," $4,555.14 "," $4,408.20 "," $4,408.20 "," $3,918.40 "," $3,918.40 ", $824.74 ," $4,522.32 "," $4,653.10 "," $4,408.20 "," $4,408.20 "," $4,408.20 "," $4,555.14 "," $4,702.08 "," $4,204.96 "," $4,163.30 "," $3,932.08 "," $4,219.55 ", N/A ," $3,656.30 "," $3,656.30 "," $4,653.10 "," $4,297.46 ", $706.58 ," $4,702.08 "
Treat Patellar Dislocatio,27560,N/A,N/A,N/A," $1,854.00 "," $1,205.10 "," $2,081.63 ", $334.64 , $268.05 ," $1,598.33 "," $1,645.91 "," $1,724.22 "," $1,668.60 "," $1,668.60 "," $1,483.20 "," $1,483.20 ", $268.05 ," $1,711.80 "," $1,761.30 "," $1,668.60 "," $1,668.60 "," $1,668.60 "," $1,724.22 "," $1,779.84 "," $1,966.99 "," $1,575.90 "," $1,809.04 "," $1,917.68 ", N/A ," $1,629.51 "," $1,629.51 "," $1,761.30 "," $1,915.26 ", $268.05 ," $2,081.63 "
 LUSPATERCEPT-AAMT 75 MG SC SOLR ,HCPCS J0896,0636 - DRUGS REQUIRING DETAILED CODIN,59572-0775-01,1.5 mL," $33,518.63 "," $21,787.11 "," $28,155.65 ", $39.96 , $39.24 ," $27,083.05 "," $30,166.77 "," $28,376.87 "," $30,166.77 "," $30,166.77 "," $30,166.77 "," $28,490.84 ", $38.47 ," $30,947.75 "," $31,842.70 "," $28,490.84 "," $31,172.33 "," $31,172.33 "," $31,842.70 "," $32,177.88 "," $27,424.94 "," $30,166.77 "," $28,490.84 "," $26,479.72 ", N/A ," $27,126.63 "," $27,126.63 "," $31,842.70 "," $28,762.34 ", $38.47 ," $32,177.88 "
" Fac Molecular Cytogenetics; Interphase in Situ Hybridization, Analyze 100-300 Cells ",CPT® 88275,0310 - PATHOLOGY LAB,N/A,N/A, $456.00 , $296.40 , $383.04 , $52.21 , $52.21 , $368.45 , $410.40 , $386.05 , $410.40 , $410.40 , $410.40 , $387.60 , $51.19 , $421.02 , $433.20 , $387.60 , $424.08 , $424.08 , $433.20 , $437.76 , $373.10 , $410.40 , $387.60 , $360.24 , N/A , $369.04 , $369.04 , $433.20 , $391.29 , $51.19 , $437.76 
 Thorcom Major W/Car Massage ED Fac ,CPT® 32160,0360 - OR SERVICES,N/A,N/A," $4,554.00 "," $2,960.10 "," $3,825.36 ", $730.65 ," $1,004.81 "," $3,679.63 "," $4,098.60 "," $3,855.42 "," $4,098.60 "," $4,098.60 "," $4,098.60 "," $3,870.90 ", $985.11 ," $4,204.71 "," $4,326.30 "," $3,870.90 "," $4,235.22 "," $4,235.22 "," $4,326.30 "," $4,371.84 "," $3,726.08 "," $4,098.60 "," $3,870.90 "," $3,597.66 ", N/A ," $3,685.55 "," $3,685.55 "," $4,326.30 "," $3,907.79 ", $730.65 ," $4,371.84 "
"Cystourethroscopy,Fulgur 0.5-2cm Lesn",CPT® 52234,N/A,N/A,N/A," $1,651.00 "," $1,073.15 "," $1,317.84 ", $231.66 , $250.82 ," $1,207.45 "," $1,117.67 "," $1,535.43 "," $1,485.90 "," $1,485.90 "," $1,320.80 "," $1,320.80 ", $250.82 ," $1,524.37 "," $1,568.45 "," $1,485.90 "," $1,485.90 "," $1,485.90 "," $1,535.43 "," $1,584.96 "," $1,324.75 "," $1,403.35 "," $1,264.90 "," $1,516.12 ", N/A ," $1,231.01 "," $1,231.01 "," $1,568.45 "," $1,446.87 ", $231.66 ," $1,584.96 "
Treat Metatarsophalangeal,CPT® 28630,N/A,N/A,N/A," $1,110.00 ", $721.50 , $677.30 , $106.32 , $134.96 , $532.98 , $535.04 ," $1,032.30 ", $999.00 , $999.00 , $888.00 , $888.00 , $134.96 ," $1,024.86 "," $1,054.50 ", $999.00 , $999.00 , $999.00 ," $1,032.30 "," $1,065.60 ", $627.12 , $943.50 , $583.39 , $633.25 , N/A , $543.38 , $543.38 ," $1,054.50 ", $638.64 , $106.32 ," $1,065.60 "
 PR Anes Unlis Px ,CPT® 01999,0964 - PRO FEE/ANES CRNA,N/A,N/A, $22.00 , $14.30 , N/A , N/A , N/A , N/A , N/A , $20.46 , $19.80 , $19.80 , $17.60 , $17.60 , N/A , $20.31 , $20.90 , $19.80 , $19.80 , $19.80 , $20.46 , $21.12 , N/A , $18.70 , N/A , N/A , N/A , N/A , N/A , $20.90 , N/A , $17.60 , $21.12 
Surg Cleansing Abd Wall,CPT® 11005,N/A,N/A,N/A," $4,078.00 "," $2,650.70 "," $2,386.66 ", $703.47 , $690.32 ," $2,109.90 "," $2,020.69 "," $3,792.54 "," $3,670.20 "," $3,670.20 "," $3,262.40 "," $3,262.40 ", $690.32 ," $3,765.22 "," $3,874.10 "," $3,670.20 "," $3,670.20 "," $3,670.20 "," $3,792.54 "," $3,914.88 "," $2,626.79 "," $3,466.30 "," $4,098.00 "," $2,653.72 ", N/A ," $2,151.06 "," $2,151.06 "," $3,874.10 "," $2,494.51 ", $690.32 ," $4,098.00 "
 TRIAMCINOLONE ACETONIDE 0.1 % EX LOTN ,HCPCS RXC637,0250 - PHARMACY,70752-0130-05,60 mL, $462.32 , $300.51 , $388.35 , N/A , N/A , $373.55 , $416.09 , $391.40 , $416.09 , $416.09 , $416.09 , $392.97 , N/A , $426.86 , $439.20 , $392.97 , $429.96 , $429.96 , $439.20 , $443.83 , $378.27 , $416.09 , $392.97 , $365.23 , N/A , $374.16 , $374.16 , $439.20 , $396.72 , $365.23 , $443.83 
 Pro App Skn Sub Grft T/a/L Area/>100scm Adl 100scm ,CPT® 15274,0982 - PRO FEE/OUTPT,N/A,N/A, $447.00 , $290.55 , $140.28 , $41.10 , $54.02 , $124.25 , $109.80 , $415.71 , $402.30 , $402.30 , $357.60 , $357.60 , $54.02 , $412.72 , $424.65 , $402.30 , $402.30 , $402.30 , $415.71 , $429.12 , $153.97 , $379.95 , $217.66 , $157.09 , N/A , $126.67 , $126.67 , $424.65 , $146.90 , $41.10 , $429.12 
 Pro Colsc Flx With Directed Submucosal Njx Any Sbst ,CPT® 45381,0982 - PRO FEE/OUTPT,N/A,N/A," $3,248.00 "," $2,111.20 "," $1,228.57 ", $189.78 , $386.96 ," $1,159.99 "," $1,194.71 "," $3,020.64 "," $2,923.20 "," $2,923.20 "," $2,598.40 "," $2,598.40 ", $386.96 ," $2,998.88 "," $3,085.60 "," $2,923.20 "," $2,923.20 "," $2,923.20 "," $3,020.64 "," $3,118.08 ", $883.57 ," $2,760.80 "," $1,309.50 "," $1,171.50 ", N/A ," $1,182.63 "," $1,182.63 "," $3,085.60 "," $1,236.91 ", $189.78 ," $3,118.08 "
 Pro MR Angiography Neck W/Dye ,CPT® 70548,0972 - PRO FEE/RAD/DX,N/A,N/A, $560.00 , $364.00 ," $1,764.77 ", $252.14 , $476.52 ," $1,965.49 "," $2,564.76 ", $520.80 , $504.00 , $504.00 , $448.00 , $448.00 , $476.52 , $517.05 , $532.00 , $504.00 , $504.00 , $504.00 , $520.80 , $537.60 ," $1,495.05 ", $476.00 ," $2,796.61 "," $2,405.02 ", N/A ," $2,003.84 "," $2,003.84 ", $532.00 ," $2,319.47 ", $252.14 ," $2,796.61 "
Cleansing Tissue/Muscle/Bone,11044,N/A,N/A,N/A," $1,788.00 "," $1,162.20 ", $710.09 , $211.81 , $318.61 , $632.19 , $613.32 ," $1,662.84 "," $1,609.20 "," $1,609.20 "," $1,430.40 "," $1,430.40 ", $318.61 ," $1,650.86 "," $1,698.60 "," $1,609.20 "," $1,609.20 "," $1,609.20 "," $1,662.84 "," $1,716.48 ", $780.34 ," $1,519.80 "," $1,231.00 ", $800.16 , N/A , $644.53 , $644.53 ," $1,698.60 ", $747.46 , $211.81 ," $1,716.48 "
" Pro Debride Nail, 1-5 ",CPT® 11720,0982 - PRO FEE/OUTPT,N/A,N/A, $125.00 , $81.25 , $46.82 , $13.79 , $19.04 , $41.04 , $39.04 , $116.25 , $112.50 , $112.50 , $100.00 , $100.00 , $19.04 , $115.41 , $118.75 , $112.50 , $112.50 , $112.50 , $116.25 , $120.00 , $51.62 , $106.25 , $76.71 , $52.68 , N/A , $41.84 , $41.84 , $118.75 , $48.53 , $13.79 , $120.00 
 MENTHOL-ZINC OXIDE 0.44-20.6 % EX OINT ,HCPCS RXC637,0250 - PHARMACY,00799-0001-04,113 gram, $29.61 , $19.25 , $24.87 , N/A , N/A , $23.92 , $26.65 , $25.07 , $26.65 , $26.65 , $26.65 , $25.17 , N/A , $27.34 , $28.13 , $25.17 , $27.54 , $27.54 , $28.13 , $28.43 , $24.23 , $26.65 , $25.17 , $23.39 , N/A , $23.96 , $23.96 , $28.13 , $25.41 , $23.39 , $28.43 
" Fac Immunoassay,Infectious Agent ",CPT® 86317,0302 - LAB/IMMUNOLOGY,N/A,N/A, $138.00 , $89.70 , $115.92 , $15.29 , $15.29 , $111.50 , $124.20 , $116.83 , $124.20 , $124.20 , $124.20 , $117.30 , $14.99 , $127.42 , $131.10 , $117.30 , $128.34 , $128.34 , $131.10 , $132.48 , $112.91 , $124.20 , $117.30 , $109.02 , N/A , $111.68 , $111.68 , $131.10 , $118.42 , $14.99 , $132.48 
 Pro Cltx Fx Phlx/Phlg Oth/Thn Grt Toe W/O Mnpj ,CPT® 28510,0982 - PRO FEE/OUTPT,N/A,N/A, $817.00 , $531.05 , $743.67 , $118.80 , $61.48 , $587.40 , $600.10 , $759.81 , $735.30 , $735.30 , $653.60 , $653.60 , $61.48 , $754.34 , $776.15 , $735.30 , $735.30 , $735.30 , $759.81 , $784.32 , $688.46 , $694.45 , $651.18 , $699.92 , N/A , $598.86 , $598.86 , $776.15 , $703.87 , $61.48 , $784.32 
 ZONISAMIDE 100 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,50268-0816-15,1 capsule, $8.84 , $5.75 , $7.43 , N/A , N/A , $7.14 , $7.96 , $7.48 , $7.96 , $7.96 , $7.96 , $7.51 , N/A , $8.16 , $8.40 , $7.51 , $8.22 , $8.22 , $8.40 , $8.49 , $7.23 , $7.96 , $7.51 , $6.98 , N/A , $7.15 , $7.15 , $8.40 , $7.59 , $6.98 , $8.49 
Repair Scalp/Arm/Leg Addt,13122,N/A,N/A,N/A, $764.00 , $496.60 , $261.73 , $78.10 , $88.09 , $233.43 , $225.70 , $710.52 , $687.60 , $687.60 , $611.20 , $611.20 , $88.09 , $705.40 , $725.80 , $687.60 , $687.60 , $687.60 , $710.52 , $733.44 , $289.90 , $649.40 , $453.15 , $298.73 , N/A , $237.98 , $237.98 , $725.80 , $275.96 , $78.10 , $733.44 
Removal Superficial Implant,CPT® 20670,N/A,N/A,N/A," $2,609.00 "," $1,695.85 ", $884.65 , $139.34 , $54.21 , $713.22 , $723.32 ," $2,426.37 "," $2,348.10 "," $2,348.10 "," $2,087.20 "," $2,087.20 ", $54.21 ," $2,408.89 "," $2,478.55 "," $2,348.10 "," $2,348.10 "," $2,348.10 "," $2,426.37 "," $2,504.64 ", $826.94 ," $2,217.65 ", $792.12 , $845.36 , N/A , $727.14 , $727.14 ," $2,478.55 ", $854.63 , $54.21 ," $2,504.64 "
 Room Rate ,Custom 1110000001,0111 - MED-SUR-GY/PVT,N/A,N/A," $1,848.00 "," $1,201.20 "," $1,552.32 ", N/A , N/A ," $1,493.18 "," $1,663.20 "," $1,564.52 "," $1,663.20 "," $1,663.20 "," $1,663.20 "," $1,570.80 ", N/A ," $1,706.26 "," $1,755.60 "," $1,570.80 "," $1,718.64 "," $1,718.64 "," $1,755.60 "," $1,774.08 "," $1,512.03 "," $1,663.20 "," $1,570.80 "," $1,459.92 ", N/A ," $1,495.59 "," $1,495.59 "," $1,755.60 "," $1,585.77 "," $1,459.92 "," $1,774.08 "
Radex Hip Unilateral With Pelvis 1 View,CPT® 73501,N/A,N/A,N/A, $403.00 , $261.95 , $220.78 , $32.37 , $23.46 , $142.21 , $149.04 , $374.79 , $362.70 , $362.70 , $322.40 , $322.40 , $23.46 , $372.09 , $382.85 , $362.70 , $362.70 , $362.70 , $374.79 , $386.88 , $176.55 , $342.55 , $189.92 , $151.35 , N/A , $144.99 , $144.99 , $382.85 , $167.84 , $23.46 , $386.88 
 Pro Fluor Gid Ctr Vad Plmt Rplcmt/Rmvl ,CPT® 77001,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,054.00 ", $685.10 , $580.29 , $98.73 , $67.21 , $334.35 , $627.13 , $980.22 , $948.60 , $948.60 , $843.20 , $843.20 , $67.21 , $973.16 ," $1,001.30 ", $948.60 , $948.60 , $948.60 , $980.22 ," $1,011.84 ", $564.90 , $895.90 , $685.67 , $424.63 , N/A , $340.88 , $340.88 ," $1,001.30 ", $394.59 , $67.21 ," $1,011.84 "
Drug Screen Quantitative Everolimus,CPT® 80169,N/A,N/A,N/A, $152.00 , $98.80 , N/A , $14.00 , $14.00 , $77.71 , $92.22 , $141.36 , $136.80 , $136.80 , $121.60 , $121.60 , $14.00 , $140.34 , $144.40 , $136.80 , $136.80 , $136.80 , $141.36 , $145.92 , $91.68 , $129.20 , $66.23 , $49.81 , N/A , $72.52 , $72.52 , $144.40 , $79.25 , $14.00 , $145.92 
Blood Methemoglobin Assay,CPT® 83050,N/A,N/A,N/A, $155.00 , $100.75 , N/A , $8.36 , $4.07 , $16.59 , $19.85 , $144.15 , $139.50 , $139.50 , $124.00 , $124.00 , $4.07 , $143.11 , $147.25 , $139.50 , $139.50 , $139.50 , $144.15 , $148.80 , $54.75 , $131.75 , $48.66 , $26.58 , N/A , $15.48 , $15.48 , $147.25 , $16.92 , $4.07 , $148.80 
Open Tx Femoral Fracture Proximal End Head,CPT® 27269,N/A,N/A,N/A," $8,156.00 "," $5,301.40 "," $7,466.16 "," $1,167.46 ", $857.17 ," $6,007.75 "," $5,928.57 "," $7,585.08 "," $7,340.40 "," $7,340.40 "," $6,524.80 "," $6,524.80 ", $857.17 ," $7,530.43 "," $7,748.20 "," $7,340.40 "," $7,340.40 "," $7,340.40 "," $7,585.08 "," $7,829.76 "," $6,971.65 "," $6,932.60 "," $6,563.57 "," $7,056.06 ", N/A ," $6,124.97 "," $6,124.97 "," $7,748.20 "," $7,199.03 ", $857.17 ," $7,829.76 "
"Lap, Surg Jejunostomy",CPT® 44186,N/A,N/A,N/A," $4,256.00 "," $2,766.40 "," $3,890.45 ", $602.20 , $509.16 ," $3,064.39 "," $3,105.27 "," $3,958.08 "," $3,830.40 "," $3,830.40 "," $3,404.80 "," $3,404.80 ", $509.16 ," $3,929.56 "," $4,043.20 "," $3,830.40 "," $3,830.40 "," $3,830.40 "," $3,958.08 "," $4,085.76 "," $2,786.57 "," $3,617.60 "," $3,453.95 "," $3,605.06 ", N/A ," $3,124.18 "," $3,124.18 "," $4,043.20 "," $3,267.54 ", $509.16 ," $4,085.76 "
 Pro Bronchospasm Evaluation ,CPT® 94060,0976 - PRO FEE/RESPIR,N/A,N/A, $393.00 , $255.45 , $89.95 , $37.70 , $53.79 , $134.43 , $144.38 , $365.49 , $353.70 , $353.70 , $314.40 , $314.40 , $53.79 , $362.86 , $373.35 , $353.70 , $353.70 , $353.70 , $365.49 , $377.28 , $140.25 , $334.05 , $191.59 , $229.15 , N/A , $137.05 , $137.05 , $373.35 , $159.78 , $37.70 , $377.28 
Hfo W/Joint(S) Cf,HCPCS L3921,N/A,N/A,N/A, $365.00 , $237.25 , N/A , $341.97 , $236.85 , N/A , N/A , $339.45 , $328.50 , $328.50 , $292.00 , $292.00 , $236.85 , $337.00 , $346.75 , $328.50 , $328.50 , $328.50 , $339.45 , $350.40 , N/A , $310.25 , $282.21 , $287.70 , N/A , N/A , N/A , $346.75 , N/A , $236.85 , $350.40 
Psychotherapy W/Patient W/E&M Srvcs 45 Min,CPT® 90836,N/A,N/A,N/A, $308.00 , $200.20 , $104.83 , $77.70 , $101.25 , $186.07 , $154.16 , $286.44 , $277.20 , $277.20 , $246.40 , $246.40 , $101.25 , $284.38 , $292.60 , $277.20 , $277.20 , $277.20 , $286.44 , $295.68 , $200.04 , $261.80 , $200.72 , $315.10 , $102.25 , $189.70 , $189.70 , $292.60 , $221.16 , $77.70 , $315.10 
 Pro Appl Short Arm Splnt F/Arm-Hand Static ,CPT® 29125,0981 - PRO FEE/ER,N/A,N/A, $302.00 , $196.30 , $241.35 , $38.40 , $27.51 , $190.75 , $194.03 , $280.86 , $271.80 , $271.80 , $241.60 , $241.60 , $27.51 , $278.84 , $286.90 , $271.80 , $271.80 , $271.80 , $280.86 , $289.92 , $223.62 , $256.70 , $212.30 , $229.45 , N/A , $194.47 , $194.47 , $286.90 , $228.57 , $27.51 , $289.92 
 Pro Ekg Interpret & Report Preve ,HCPCS G0405,0985 - PRO FEE/EKG,N/A,N/A, $100.00 , $65.00 , $51.61 , $7.96 , N/A , $15.76 , N/A , $93.00 , $90.00 , $90.00 , $80.00 , $80.00 , N/A , $92.33 , $95.00 , $90.00 , $90.00 , $90.00 , $93.00 , $96.00 , $22.30 , $85.00 , $15.57 , $32.14 , N/A , $16.07 , $16.07 , $95.00 , $20.09 , $7.96 , $96.00 
"Program Eval Implant Device,Pacemaker,2 Lead",93280,N/A,N/A,N/A, $766.00 , $497.90 , $517.66 , $78.83 , $50.64 , $315.12 , $321.47 , $712.38 , $689.40 , $689.40 , $612.80 , $612.80 , $50.64 , $707.25 , $727.70 , $689.40 , $689.40 , $689.40 , $712.38 , $735.36 , $482.63 , $651.10 , $299.72 , $221.10 , N/A , $321.27 , $321.27 , $727.70 , $356.13 , $50.64 , $735.36 
Img Retina Detcj/Mntr Ds Rem Clin Staff Uni/Bi,CPT® 92227,N/A,N/A,N/A, $50.00 , $32.50 , $33.98 , $16.20 , $8.43 , $25.09 , $24.26 , $46.50 , $45.00 , $45.00 , $40.00 , $40.00 , $8.43 , $46.17 , $47.50 , $45.00 , $45.00 , $45.00 , $46.50 , $48.00 , $47.07 , $42.50 , $41.56 , $30.59 , N/A , $25.58 , $25.58 , $47.50 , $30.42 , $8.43 , $48.00 
 Pro Pelvic Examination ,CPT® 57410,0982 - PRO FEE/OUTPT,N/A,N/A, $734.00 , $477.10 , $494.30 , $100.19 , $97.25 , $439.23 , $436.23 , $682.62 , $660.60 , $660.60 , $587.20 , $587.20 , $97.25 , $677.70 , $697.30 , $660.60 , $660.60 , $660.60 , $682.62 , $704.64 , $518.63 , $623.90 , $572.68 , $441.63 , N/A , $447.80 , $447.80 , $697.30 , $537.11 , $97.25 , $704.64 
 Fac Elec Alys Implt Npgt Smpl Sp/Pn Npgt Prgrmg ,CPT® 95971,0360 - OR SERVICES,N/A,N/A, $830.00 , $539.50 , $697.20 , $37.57 , $50.32 , $670.64 , $747.00 , $702.68 , $747.00 , $747.00 , $747.00 , $705.50 , $49.33 , $766.34 , $788.50 , $705.50 , $771.90 , $771.90 , $788.50 , $796.80 , $679.11 , $747.00 , $705.50 , $655.70 , N/A , $671.72 , $671.72 , $788.50 , $712.22 , $37.57 , $796.80 
 Pro Treat Humerus Fracture ,CPT® 24535,0982 - PRO FEE/OUTPT,N/A,N/A," $4,107.00 "," $2,669.55 "," $3,493.49 ", $552.11 , $533.82 ," $2,721.20 "," $2,743.97 "," $3,819.51 "," $3,696.30 "," $3,696.30 "," $3,285.60 "," $3,285.60 ", $533.82 ," $3,791.99 "," $3,901.65 "," $3,696.30 "," $3,696.30 "," $3,696.30 "," $3,819.51 "," $3,942.72 "," $3,252.44 "," $3,490.95 "," $3,022.20 "," $3,233.03 ", N/A ," $2,774.30 "," $2,774.30 "," $3,901.65 "," $3,260.78 ", $533.82 ," $3,942.72 "
"Tenotomy Fingr Flex,Single,Open,Each",CPT® 26455,N/A,N/A,N/A," $2,760.00 "," $1,794.00 "," $2,901.93 ", $454.54 , $230.52 ," $1,920.03 "," $1,962.67 "," $2,566.80 "," $2,484.00 "," $2,484.00 "," $2,208.00 "," $2,208.00 ", $230.52 ," $2,548.31 "," $2,622.00 "," $2,484.00 "," $2,484.00 "," $2,484.00 "," $2,566.80 "," $2,649.60 "," $2,612.30 "," $2,346.00 "," $2,149.80 "," $2,296.63 ", N/A ," $1,957.49 "," $1,957.49 "," $2,622.00 "," $2,300.73 ", $230.52 ," $2,901.93 "
 Pro Removal of Anal Fissure ,CPT® 46200,0982 - PRO FEE/OUTPT,N/A,N/A," $2,948.00 "," $1,916.20 "," $2,088.39 ", $326.31 , $213.54 ," $1,549.52 "," $1,606.20 "," $2,741.64 "," $2,653.20 "," $2,653.20 "," $2,358.40 "," $2,358.40 ", $213.54 ," $2,721.89 "," $2,800.60 "," $2,653.20 "," $2,653.20 "," $2,653.20 "," $2,741.64 "," $2,830.08 "," $1,486.47 "," $2,505.80 "," $1,759.09 "," $1,859.79 ", N/A ," $1,579.75 "," $1,579.75 "," $2,800.60 "," $1,652.26 ", $213.54 ," $2,830.08 "
 DOXYCYCLINE HYCLATE 100 MG IV SOLR ,HCPCS RXA250,0250 - PHARMACY,63323-0130-11,10 mL, $162.31 , $105.50 , $136.34 , N/A , N/A , $131.15 , $146.08 , $137.41 , $146.08 , $146.08 , $146.08 , $137.96 , N/A , $149.86 , $154.19 , $137.96 , $150.95 , $150.95 , $154.19 , $155.82 , $132.80 , $146.08 , $137.96 , $128.22 , N/A , $131.36 , $131.36 , $154.19 , $139.28 , $128.22 , $155.82 
"Inject Facet Joint Cervical/Thorac, Cerv/Thorac, 1st Level",64490,N/A,N/A,N/A, $974.00 , $633.10 , $521.25 , $100.98 , $139.80 , $601.59 , $592.63 , $905.82 , $876.60 , $876.60 , $779.20 , $779.20 , $139.80 , $899.29 , $925.30 , $876.60 , $876.60 , $876.60 , $905.82 , $935.04 , $565.18 , $827.90 , $579.82 , $641.10 , N/A , $613.33 , $613.33 , $925.30 , $657.95 , $100.98 , $935.04 
 Pro Physician Telephone Evaluation 11-20 Min ,CPT® 99442,0982 - PRO FEE/OUTPT,N/A,N/A, $114.00 , $74.10 , $134.06 , $64.08 , $21.48 , $44.31 , $44.11 , $106.02 , $102.60 , $102.60 , $91.20 , $91.20 , $21.48 , $105.26 , $108.30 , $102.60 , $102.60 , $102.60 , $106.02 , $109.44 , $122.78 , $96.90 , $54.76 , $55.96 , $29.00 , $45.17 , $45.17 , $108.30 , $52.10 , $21.48 , $134.06 
"Fx Radial Head or Neck,Cl",24640,N/A,N/A,N/A, $599.00 , $389.35 , $507.52 , $78.44 , $62.26 , $453.97 , $465.63 , $557.07 , $539.10 , $539.10 , $479.20 , $479.20 , $62.26 , $553.06 , $569.05 , $539.10 , $539.10 , $539.10 , $557.07 , $575.04 , $464.54 , $509.15 , $512.03 , $456.76 , N/A , $462.82 , $462.82 , $569.05 , $543.97 , $62.26 , $575.04 
" Pro Fix Ectropion,Extensive ",CPT® 67917,0982 - PRO FEE/OUTPT,N/A,N/A," $2,129.00 "," $1,383.85 "," $2,801.70 ", $440.14 , $475.41 ," $2,593.20 "," $2,535.54 "," $1,979.97 "," $1,916.10 "," $1,916.10 "," $1,703.20 "," $1,703.20 ", $475.41 ," $1,965.71 "," $2,022.55 "," $1,916.10 "," $1,916.10 "," $1,916.10 "," $1,979.97 "," $2,043.84 "," $3,846.57 "," $1,809.65 "," $2,627.93 "," $3,289.59 ", N/A ," $2,643.80 "," $2,643.80 "," $2,022.55 "," $2,918.41 ", $440.14 ," $3,846.57 "
Eye Muscle Evaluation,CPT® 92265,N/A,N/A,N/A, $281.00 , $182.65 , $188.21 , $85.68 , $78.50 , $150.78 , $144.40 , $261.33 , $252.90 , $252.90 , $224.80 , $224.80 , $78.50 , $259.45 , $266.95 , $252.90 , $252.90 , $252.90 , $261.33 , $269.76 , $267.66 , $238.85 , $242.28 , $186.65 , N/A , $153.72 , $153.72 , $266.95 , $182.86 , $78.50 , $269.76 
" Ivl W/Atherectomy + Pta; Iliac, Fem Pop ",HCPCS C9766,0360 - OR SERVICES,N/A,N/A," $31,175.00 "," $20,263.75 "," $26,187.00 ", N/A , N/A ," $25,189.40 "," $28,057.50 "," $26,392.76 "," $28,057.50 "," $28,057.50 "," $28,057.50 "," $26,498.75 ", N/A ," $28,783.88 "," $29,616.25 "," $26,498.75 "," $28,992.75 "," $28,992.75 "," $29,616.25 "," $29,928.00 "," $25,507.39 "," $28,057.50 "," $26,498.75 "," $24,628.25 ", N/A ," $25,229.93 "," $25,229.93 "," $29,616.25 "," $26,751.27 "," $24,628.25 "," $29,928.00 "
"Echography,Spinal Canal & Contents",CPT® 76800,N/A,N/A,N/A," $1,053.00 ", $684.45 , $817.97 , $152.11 , $120.18 , $663.89 , $691.42 , $979.29 , $947.70 , $947.70 , $842.40 , $842.40 , $120.18 , $972.23 ," $1,000.35 ", $947.70 , $947.70 , $947.70 , $979.29 ," $1,010.88 ", $782.25 , $895.05 , $755.01 , $808.65 , N/A , $676.84 , $676.84 ," $1,000.35 ", $783.46 , $120.18 ," $1,010.88 "
" Pro Remove Lesion, Neck/Chest ",CPT® 21556,0982 - PRO FEE/OUTPT,N/A,N/A," $3,479.00 "," $2,261.35 "," $3,232.78 ", $505.10 , $358.52 ," $2,553.41 "," $2,574.55 "," $3,235.47 "," $3,131.10 "," $3,131.10 "," $2,783.20 "," $2,783.20 ", $358.52 ," $3,212.16 "," $3,305.05 "," $3,131.10 "," $3,131.10 "," $3,131.10 "," $3,235.47 "," $3,339.84 "," $2,984.35 "," $2,957.15 "," $2,842.01 "," $2,986.72 ", N/A ," $2,603.22 "," $2,603.22 "," $3,305.05 "," $3,059.73 ", $358.52 ," $3,339.84 "
Osteotomy Midtarsal Bones,CPT® 28304,N/A,N/A,N/A," $5,363.00 "," $3,485.95 "," $3,751.93 ", $590.90 , $461.04 ," $2,974.33 "," $2,896.47 "," $4,987.59 "," $4,826.70 "," $4,826.70 "," $4,290.40 "," $4,290.40 ", $461.04 ," $4,951.66 "," $5,094.85 "," $4,826.70 "," $4,826.70 "," $4,826.70 "," $4,987.59 "," $5,148.48 "," $3,468.47 "," $4,558.55 "," $3,159.58 "," $3,512.18 ", N/A ," $3,032.36 "," $3,032.36 "," $5,094.85 "," $3,564.10 ", $461.04 ," $5,148.48 "
 ED Change Bladder Tube ,CPT® 51710,0761 - TREATMENT ROOM,N/A,N/A, $499.00 , $324.35 , $419.16 , $75.87 , $125.78 , $403.19 , $449.10 , $422.45 , $449.10 , $449.10 , $449.10 , $424.15 , $123.31 , $460.73 , $474.05 , $424.15 , $464.07 , $464.07 , $474.05 , $479.04 , $408.28 , $449.10 , $424.15 , $394.21 , N/A , $403.84 , $403.84 , $474.05 , $428.19 , $75.87 , $479.04 
Ecg/Monitoring and Anaylysis,CPT® 93271,N/A,N/A,N/A," $1,585.00 "," $1,030.25 ", $952.06 , $143.28 , $221.82 , $911.56 ," $1,044.28 "," $1,474.05 "," $1,426.50 "," $1,426.50 "," $1,268.00 "," $1,268.00 ", $221.82 ," $1,463.43 "," $1,505.75 "," $1,426.50 "," $1,426.50 "," $1,426.50 "," $1,474.05 "," $1,521.60 "," $1,004.47 "," $1,347.25 ", $983.02 ," $1,019.51 ", N/A , $929.35 , $929.35 ," $1,505.75 "," $1,030.18 ", $143.28 ," $1,521.60 "
Ekg Interpret & Report Preve,HCPCS G0405,N/A,N/A,N/A, $100.00 , $65.00 , $51.61 , $7.96 , N/A , $15.76 , N/A , $93.00 , $90.00 , $90.00 , $80.00 , $80.00 , N/A , $92.33 , $95.00 , $90.00 , $90.00 , $90.00 , $93.00 , $96.00 , $22.30 , $85.00 , $15.57 , $32.14 , N/A , $16.07 , $16.07 , $95.00 , $20.09 , $7.96 , $96.00 
 Fac Psychotherapy W/Patient 60 Minutes ,CPT® 90837,0914 - PSYCH/INDIV RX,N/A,N/A, $211.00 , $137.15 , $177.24 , $129.40 , $115.70 , $170.49 , $189.90 , $178.63 , $189.90 , $189.90 , $189.90 , $179.35 , $113.43 , $194.82 , $200.45 , $179.35 , $196.23 , $196.23 , $200.45 , $202.56 , $172.64 , $189.90 , $179.35 , $166.69 , N/A , $170.76 , $170.76 , $200.45 , $181.06 , $113.43 , $202.56 
" Fac Bilirubin, Direct ",CPT® 82248,0301 - LAB/CHEMISTRY,N/A,N/A, $59.00 , $38.35 , $49.56 , $5.12 , $5.12 , $47.67 , $53.10 , $49.95 , $53.10 , $53.10 , $53.10 , $50.15 , $5.02 , $54.47 , $56.05 , $50.15 , $54.87 , $54.87 , $56.05 , $56.64 , $48.27 , $53.10 , $50.15 , $46.61 , N/A , $47.75 , $47.75 , $56.05 , $50.63 , $5.02 , $56.64 
" Chloride, Urine, Random Beaker1 ",CPT® 82436,0301 - LAB/CHEMISTRY,N/A,N/A, $62.00 , $40.30 , $52.08 , $5.87 , $5.87 , $50.10 , $55.80 , $52.49 , $55.80 , $55.80 , $55.80 , $52.70 , $5.75 , $57.24 , $58.90 , $52.70 , $57.66 , $57.66 , $58.90 , $59.52 , $50.73 , $55.80 , $52.70 , $48.98 , N/A , $50.18 , $50.18 , $58.90 , $53.20 , $5.75 , $59.52 
Pro Removal of Tendon for Graft,20924,N/A,N/A,N/A," $3,973.00 "," $2,582.45 "," $3,081.78 ", $483.41 , $213.54 ," $2,455.07 "," $2,441.34 "," $3,694.89 "," $3,575.70 "," $3,575.70 "," $3,178.40 "," $3,178.40 ", $213.54 ," $3,668.27 "," $3,774.35 "," $3,575.70 "," $3,575.70 "," $3,575.70 "," $3,694.89 "," $3,814.08 "," $2,875.64 "," $3,377.05 "," $2,685.02 "," $2,894.84 ", N/A ," $2,502.98 "," $2,502.98 "," $3,774.35 "," $2,941.89 ", $213.54 ," $3,814.08 "
 Fac PR Intravascular US Noncoronary Rs&I Addl Vessel ,CPT® 37253,0360 - OR SERVICES,N/A,N/A," $1,331.00 ", $865.15 ," $1,118.04 ", $64.41 , $170.41 ," $1,075.45 "," $1,197.90 "," $1,126.82 "," $1,197.90 "," $1,197.90 "," $1,197.90 "," $1,131.35 ", $167.07 ," $1,228.91 "," $1,264.45 "," $1,131.35 "," $1,237.83 "," $1,237.83 "," $1,264.45 "," $1,277.76 "," $1,089.02 "," $1,197.90 "," $1,131.35 "," $1,051.49 ", N/A ," $1,077.18 "," $1,077.18 "," $1,264.45 "," $1,142.13 ", $64.41 ," $1,277.76 "
Visit to Determ Ldct Elig,G0296,N/A,N/A,N/A, $177.00 , $115.05 , $124.60 , $24.98 , N/A , $99.64 , N/A , $164.61 , $159.30 , $159.30 , $141.60 , $141.60 , N/A , $163.42 , $168.15 , $159.30 , $159.30 , $159.30 , $164.61 , $169.92 , $47.78 , $150.45 , $49.11 , $56.46 , N/A , $101.59 , $101.59 , $168.15 , $126.97 , $24.98 , $169.92 
 Fac Hepatic Function Panel ,CPT® 80076,0301 - LAB/CHEMISTRY,N/A,N/A, $152.00 , $98.80 , $127.68 , $8.33 , $8.33 , $122.82 , $136.80 , $128.68 , $136.80 , $136.80 , $136.80 , $129.20 , $8.17 , $140.34 , $144.40 , $129.20 , $141.36 , $141.36 , $144.40 , $145.92 , $124.37 , $136.80 , $129.20 , $120.08 , N/A , $123.01 , $123.01 , $144.40 , $130.43 , $8.17 , $145.92 
Layer Closure 20.1-30cm,12036,N/A,N/A,N/A," $1,915.00 "," $1,244.75 ", $887.81 , $264.02 , $215.14 , $754.97 , $740.93 ," $1,780.95 "," $1,723.50 "," $1,723.50 "," $1,532.00 "," $1,532.00 ", $215.14 ," $1,768.12 "," $1,819.25 "," $1,723.50 "," $1,723.50 "," $1,723.50 "," $1,780.95 "," $1,838.40 ", $974.81 ," $1,627.75 "," $1,489.69 ", $970.85 , N/A , $769.70 , $769.70 ," $1,819.25 ", $892.60 , $215.14 ," $1,838.40 "
Removal of Anal Tab,46220,N/A,N/A,N/A, $896.00 , $582.40 , $739.57 , $115.93 , $177.84 , $563.82 , $580.24 , $833.28 , $806.40 , $806.40 , $716.80 , $716.80 , $177.84 , $827.28 , $851.20 , $806.40 , $806.40 , $806.40 , $833.28 , $860.16 , $526.83 , $761.60 , $638.69 , $670.94 , N/A , $574.82 , $574.82 , $851.20 , $601.19 , $115.93 , $860.16 
 NICOTINE POLACRILEX 4 MG MT GUM ,HCPCS RXA250,0250 - PHARMACY,00536-1372-34,20 each, $68.43 , $44.48 , $57.48 , N/A , N/A , $55.29 , $61.59 , $57.93 , $61.59 , $61.59 , $61.59 , $58.17 , N/A , $63.18 , $65.01 , $58.17 , $63.64 , $63.64 , $65.01 , $65.69 , $55.99 , $61.59 , $58.17 , $54.06 , N/A , $55.38 , $55.38 , $65.01 , $58.72 , $54.06 , $65.69 
Echo Transesophag R-T 2d Img Acquisj I&R Only,CPT® 93314,N/A,N/A,N/A," $1,840.00 "," $1,196.00 "," $1,448.66 ", $222.42 , $211.62 ," $1,587.87 "," $1,591.72 "," $1,711.20 "," $1,656.00 "," $1,656.00 "," $1,472.00 "," $1,472.00 ", $211.62 ," $1,698.87 "," $1,748.00 "," $1,656.00 "," $1,656.00 "," $1,656.00 "," $1,711.20 "," $1,766.40 "," $1,460.70 "," $1,564.00 "," $1,495.05 "," $1,421.22 ", N/A ," $1,618.85 "," $1,618.85 "," $1,748.00 "," $1,794.51 ", $211.62 ," $1,794.51 "
General Health Panel,CPT® 80050,N/A,N/A,N/A, $236.00 , $153.40 , N/A , N/A , $52.47 , $183.37 , $192.96 , $219.48 , $212.40 , $212.40 , $188.80 , $188.80 , $52.47 , $217.90 , $224.20 , $212.40 , $212.40 , $212.40 , $219.48 , $226.56 , N/A , $200.60 , $194.62 , $133.57 , N/A , $171.13 , $171.13 , $224.20 , $187.01 , $52.47 , $226.56 
I&D Rectal Abscess + Fistulectomy,CPT® 46060,N/A,N/A,N/A," $3,141.00 "," $2,041.65 "," $2,991.24 ", $466.02 , $380.93 ," $2,261.72 "," $2,320.23 "," $2,921.13 "," $2,826.90 "," $2,826.90 "," $2,512.80 "," $2,512.80 ", $380.93 ," $2,900.09 "," $2,983.95 "," $2,826.90 "," $2,826.90 "," $2,826.90 "," $2,921.13 "," $3,015.36 "," $2,131.13 "," $2,669.85 "," $2,554.78 "," $2,698.03 ", N/A ," $2,305.85 "," $2,305.85 "," $2,983.95 "," $2,411.69 ", $380.93 ," $3,015.36 "
" Fac Artery X-Rays, Pelvis ",CPT® 75736,0320 - DX X-RAY,N/A,N/A," $1,424.00 ", $925.60 ," $1,196.16 ", $139.43 , $241.71 ," $1,150.59 "," $1,281.60 "," $1,205.56 "," $1,281.60 "," $1,281.60 "," $1,281.60 "," $1,210.40 ", $236.97 ," $1,314.78 "," $1,352.80 "," $1,210.40 "," $1,324.32 "," $1,324.32 "," $1,352.80 "," $1,367.04 "," $1,165.12 "," $1,281.60 "," $1,210.40 "," $1,124.96 ", N/A ," $1,152.44 "," $1,152.44 "," $1,352.80 "," $1,221.93 ", $139.43 ," $1,367.04 "
Transurethral Resec Bladder Neck,52500,N/A,N/A,N/A," $3,272.00 "," $2,126.80 "," $2,667.89 ", $471.18 , $768.38 ," $2,386.11 "," $2,230.20 "," $3,042.96 "," $2,944.80 "," $2,944.80 "," $2,617.60 "," $2,617.60 ", $768.38 ," $3,021.04 "," $3,108.40 "," $2,944.80 "," $2,944.80 "," $2,944.80 "," $3,042.96 "," $3,141.12 "," $2,671.11 "," $2,781.20 "," $2,522.67 "," $3,004.95 ", N/A ," $2,432.66 "," $2,432.66 "," $3,108.40 "," $2,859.25 ", $471.18 ," $3,141.12 "
"Closed Rx Prox/Shaft Fib Fx,Manip",CPT® 27781,N/A,N/A,N/A," $2,802.00 "," $1,821.30 "," $2,480.21 ", $393.47 , $307.34 ," $1,890.96 "," $1,884.68 "," $2,605.86 "," $2,521.80 "," $2,521.80 "," $2,241.60 "," $2,241.60 ", $307.34 ," $2,587.09 "," $2,661.90 "," $2,521.80 "," $2,521.80 "," $2,521.80 "," $2,605.86 "," $2,689.92 "," $2,284.92 "," $2,381.70 "," $2,071.30 "," $2,258.37 ", N/A ," $1,927.85 "," $1,927.85 "," $2,661.90 "," $2,265.91 ", $307.34 ," $2,689.92 "
Treat Great Toe Fracture,28490,N/A,N/A,N/A, $559.00 , $363.35 , $772.46 , $123.06 , $85.41 , $611.90 , $626.73 , $519.87 , $503.10 , $503.10 , $447.20 , $447.20 , $85.41 , $516.12 , $531.05 , $503.10 , $503.10 , $503.10 , $519.87 , $536.64 , $710.88 , $475.15 , $681.51 , $728.10 , N/A , $623.83 , $623.83 , $531.05 , $733.23 , $85.41 , $772.46 
Partial Hemispherectomy,CPT® 61543,N/A,N/A,N/A," $13,841.00 "," $8,996.65 "," $9,880.78 "," $1,930.00 "," $2,378.00 "," $11,734.12 "," $11,158.50 "," $12,872.13 "," $12,456.90 "," $12,456.90 "," $11,072.80 "," $11,072.80 "," $2,378.00 "," $12,779.40 "," $13,148.95 "," $12,456.90 "," $12,456.90 "," $12,456.90 "," $12,872.13 "," $13,287.36 "," $10,675.89 "," $11,764.85 "," $11,487.59 "," $12,100.15 ", N/A ," $11,963.07 "," $11,963.07 "," $13,148.95 "," $12,833.58 "," $1,930.00 "," $13,287.36 "
 Fac Varicella-Zoster Antibody ,CPT® 86787,0302 - LAB/IMMUNOLOGY,N/A,N/A, $126.00 , $81.90 , $105.84 , $13.14 , $8.07 , $101.81 , $113.40 , $106.67 , $113.40 , $113.40 , $113.40 , $107.10 , $7.91 , $116.34 , $119.70 , $107.10 , $117.18 , $117.18 , $119.70 , $120.96 , $103.09 , $113.40 , $107.10 , $99.54 , N/A , $101.97 , $101.97 , $119.70 , $108.12 , $7.91 , $120.96 
Rmvl Tun Ctr Vad W/Subq Port/Pmp Ctr/Prph Insj,CPT® 36590,N/A,N/A,N/A," $1,813.00 "," $1,178.45 "," $1,149.27 ", $178.03 , $375.08 , $885.08 , $883.91 ," $1,686.09 "," $1,631.70 "," $1,631.70 "," $1,450.40 "," $1,450.40 ", $375.08 ," $1,673.94 "," $1,722.35 "," $1,631.70 "," $1,631.70 "," $1,631.70 "," $1,686.09 "," $1,740.48 "," $1,057.02 "," $1,541.05 "," $1,100.77 ", $935.17 , N/A , $902.35 , $902.35 ," $1,722.35 "," $1,025.04 ", $178.03 ," $1,740.48 "
 Fac Assay of Transferrin ,CPT® 84466,0301 - LAB/CHEMISTRY,N/A,N/A, $169.00 , $109.85 , $141.96 , $13.02 , $13.02 , $136.55 , $152.10 , $143.08 , $152.10 , $152.10 , $152.10 , $143.65 , $12.76 , $156.04 , $160.55 , $143.65 , $157.17 , $157.17 , $160.55 , $162.24 , $138.28 , $152.10 , $143.65 , $133.51 , N/A , $136.77 , $136.77 , $160.55 , $145.02 , $12.76 , $162.24 
 Fac Insj Implntbl Defib Pulse Gen W/Exist Multileads ,CPT® 33231,0360 - OR SERVICES,N/A,N/A," $5,615.00 "," $3,649.75 "," $4,716.60 ", $368.97 , $451.26 ," $4,536.92 "," $5,053.50 "," $4,753.66 "," $5,053.50 "," $5,053.50 "," $5,053.50 "," $4,772.75 ", $442.41 ," $5,184.33 "," $5,334.25 "," $4,772.75 "," $5,221.95 "," $5,221.95 "," $5,334.25 "," $5,390.40 "," $4,594.19 "," $5,053.50 "," $4,772.75 "," $4,435.85 ", N/A ," $4,544.22 "," $4,544.22 "," $5,334.25 "," $4,818.23 ", $368.97 ," $5,390.40 "
Colonoscopy Flx Dx W/Collj Spec When Pfrmd,CPT® 45378,N/A,N/A,N/A," $2,697.00 "," $1,753.05 "," $2,171.13 ", $174.38 , $351.69 ," $1,042.81 "," $1,052.25 "," $2,508.21 "," $2,427.30 "," $2,427.30 "," $2,157.60 "," $2,157.60 ", $351.69 ," $2,490.14 "," $2,562.15 "," $2,427.30 "," $2,427.30 "," $2,427.30 "," $2,508.21 "," $2,589.12 "," $1,335.02 "," $2,292.45 "," $1,156.07 "," $1,074.52 ", N/A ," $1,063.16 "," $1,063.16 "," $2,562.15 "," $1,276.23 ", $174.38 ," $2,589.12 "
CT Angio Abd&Plvis Cntrst Mtrl W/WO Cntrst Imges,CPT® 74174,N/A,N/A,N/A," $7,218.00 "," $4,691.70 "," $2,729.79 ", $389.73 , $439.35 ," $1,853.19 "," $2,633.37 "," $6,712.74 "," $6,496.20 "," $6,496.20 "," $5,774.40 "," $5,774.40 ", $439.35 ," $6,664.38 "," $6,857.10 "," $6,496.20 "," $6,496.20 "," $6,496.20 "," $6,712.74 "," $6,929.28 "," $2,264.47 "," $6,135.30 "," $2,869.80 "," $2,516.94 ", N/A ," $1,889.35 "," $1,889.35 "," $6,857.10 "," $2,186.95 ", $389.73 ," $6,929.28 "
" Pro US Guide, Vascular Access ",CPT® 76937,0981 - PRO FEE/ER,N/A,N/A, $177.00 , $115.05 , $222.14 , $38.38 , $33.32 , $151.94 , $188.43 , $164.61 , $159.30 , $159.30 , $141.60 , $141.60 , $33.32 , $163.42 , $168.15 , $159.30 , $159.30 , $159.30 , $164.61 , $169.92 , $211.85 , $150.45 , $206.09 , $176.02 , N/A , $154.91 , $154.91 , $168.15 , $179.33 , $33.32 , $222.14 
" Fac Toxoplasma Antibody, Igm ",CPT® 86778,0302 - LAB/IMMUNOLOGY,N/A,N/A, $137.00 , $89.05 , $115.08 , $14.70 , $14.70 , $110.70 , $123.30 , $115.98 , $123.30 , $123.30 , $123.30 , $116.45 , $14.41 , $126.49 , $130.15 , $116.45 , $127.41 , $127.41 , $130.15 , $131.52 , $112.09 , $123.30 , $116.45 , $108.23 , N/A , $110.87 , $110.87 , $130.15 , $117.56 , $14.41 , $131.52 
"Excis Benign Lesn,Tib/Fib",CPT® 27635,N/A,N/A,N/A," $3,974.00 "," $2,583.10 "," $3,548.68 ", $556.43 , $614.70 ," $2,838.95 "," $2,843.33 "," $3,695.82 "," $3,576.60 "," $3,576.60 "," $3,179.20 "," $3,179.20 ", $614.70 ," $3,669.19 "," $3,775.30 "," $3,576.60 "," $3,576.60 "," $3,576.60 "," $3,695.82 "," $3,815.04 "," $3,313.18 "," $3,377.90 "," $3,132.82 "," $3,343.20 ", N/A ," $2,894.34 "," $2,894.34 "," $3,775.30 "," $3,401.88 ", $556.43 ," $3,815.04 "
 Pro Lyr Clsr N/H/F/Xtrnl Gent 2.5 Cm/< ,CPT® 12041,0975 - PRO FEE/OR,N/A,N/A," $1,004.00 ", $652.60 , $461.96 , $139.44 , $71.45 , $427.30 , $419.98 , $933.72 , $903.60 , $903.60 , $803.20 , $803.20 , $71.45 , $926.99 , $953.80 , $903.60 , $903.60 , $903.60 , $933.72 , $963.84 , $509.89 , $853.40 , $834.94 , $528.73 , N/A , $435.64 , $435.64 , $953.80 , $505.18 , $71.45 , $963.84 
 CLINIMIX E/DEXTROSE (5/15) 5 % IV SOLN ,HCPCS RXA258,0258 - IV SOLUTIONS,00338-1123-04,"2,000 mL", $523.97 , $340.58 , $440.13 , N/A , N/A , $423.37 , $471.57 , $443.59 , $471.57 , $471.57 , $471.57 , $445.37 , N/A , $483.78 , $497.77 , $445.37 , $487.29 , $487.29 , $497.77 , $503.01 , $428.71 , $471.57 , $445.37 , $413.94 , N/A , $424.05 , $424.05 , $497.77 , $449.62 , $413.94 , $503.01 
 POLATUZUMAB VEDOTIN-PIIQ 30 MG IV SOLR ,HCPCS J9309,0636 - DRUGS REQUIRING DETAILED CODIN,50242-0103-01,1.5 mL," $10,427.65 "," $6,777.97 "," $8,759.23 ", $123.68 , $120.47 ," $8,425.54 "," $9,384.89 "," $8,828.05 "," $9,384.89 "," $9,384.89 "," $9,384.89 "," $8,863.50 ", $118.11 ," $9,627.85 "," $9,906.27 "," $8,863.50 "," $9,697.71 "," $9,697.71 "," $9,906.27 "," $10,010.54 "," $8,531.90 "," $9,384.89 "," $8,863.50 "," $8,237.84 ", N/A ," $8,439.10 "," $8,439.10 "," $9,906.27 "," $8,947.97 ", $118.11 ," $10,010.54 "
 Fac X-Ray Exam of Jaw Joint ,CPT® 70328,0320 - DX X-RAY,N/A,N/A, $122.00 , $79.30 , $102.48 , $34.02 , $28.76 , $98.58 , $109.80 , $103.29 , $109.80 , $109.80 , $109.80 , $103.70 , $28.20 , $112.64 , $115.90 , $103.70 , $113.46 , $113.46 , $115.90 , $117.12 , $99.82 , $109.80 , $103.70 , $96.38 , N/A , $98.73 , $98.73 , $115.90 , $104.69 , $28.20 , $117.12 
" Fac Quantitative Assay, Drug ",CPT® 80299,0301 - LAB/CHEMISTRY,N/A,N/A, $146.00 , $94.90 , $122.64 , $19.01 , $19.01 , $117.97 , $131.40 , $123.60 , $131.40 , $131.40 , $131.40 , $124.10 , $18.64 , $134.80 , $138.70 , $124.10 , $135.78 , $135.78 , $138.70 , $140.16 , $119.46 , $131.40 , $124.10 , $115.34 , N/A , $118.16 , $118.16 , $138.70 , $125.28 , $18.64 , $140.16 
Hepa/Hepb Vaccine Adult Im,CPT® 90636,N/A,N/A,N/A, $288.00 , $187.20 , N/A , N/A , $113.03 , $203.46 , $212.06 , $267.84 , $259.20 , $259.20 , $230.40 , $230.40 , $113.03 , $265.91 , $273.60 , $259.20 , $259.20 , $259.20 , $267.84 , $276.48 , N/A , $244.80 , $281.81 , $191.89 , N/A , $207.43 , $207.43 , $273.60 , $241.81 , $113.03 , $281.81 
Treat Tarsal Bone Fractur,28450,N/A,N/A,N/A," $1,439.00 ", $935.35 ," $1,193.60 ", $188.03 , $144.17 , $936.03 , $952.57 ," $1,338.27 "," $1,295.10 "," $1,295.10 "," $1,151.20 "," $1,151.20 ", $144.17 ," $1,328.63 "," $1,367.05 "," $1,295.10 "," $1,295.10 "," $1,295.10 "," $1,338.27 "," $1,381.44 "," $1,100.58 "," $1,223.15 "," $1,038.33 "," $1,108.30 ", N/A , $954.29 , $954.29 ," $1,367.05 "," $1,121.63 ", $144.17 ," $1,381.44 "
"Remove Spine Fix Dev,Post Sgmtal",CPT® 22852,N/A,N/A,N/A," $4,502.00 "," $2,926.30 "," $4,191.07 ", $656.37 , $480.44 ," $3,323.81 "," $3,294.29 "," $4,186.86 "," $4,051.80 "," $4,051.80 "," $3,601.60 "," $3,601.60 ", $480.44 ," $4,156.70 "," $4,276.90 "," $4,051.80 "," $4,051.80 "," $4,051.80 "," $4,186.86 "," $4,321.92 "," $3,890.23 "," $3,826.70 "," $3,682.31 "," $3,876.35 ", N/A ," $3,388.66 "," $3,388.66 "," $4,276.90 "," $3,982.89 ", $480.44 ," $4,321.92 "
 PILOCARPINE HCL 2 % OP SOLN ,HCPCS RXC637,0250 - PHARMACY,61314-0204-15,15 mL, $517.88 , $336.62 , $435.02 , N/A , N/A , $418.45 , $466.09 , $438.44 , $466.09 , $466.09 , $466.09 , $440.20 , N/A , $478.16 , $491.99 , $440.20 , $481.63 , $481.63 , $491.99 , $497.16 , $423.73 , $466.09 , $440.20 , $409.13 , N/A , $419.12 , $419.12 , $491.99 , $444.39 , $409.13 , $497.16 
Icar Catheter Ablation Atrioventr Node Function,CPT® 93650,N/A,N/A,N/A," $5,877.00 "," $3,820.05 "," $3,460.67 ", $532.37 , $584.47 ," $3,219.10 "," $3,160.04 "," $5,465.61 "," $5,289.30 "," $5,289.30 "," $4,701.60 "," $4,701.60 ", $584.47 ," $5,426.23 "," $5,583.15 "," $5,289.30 "," $5,289.30 "," $5,289.30 "," $5,465.61 "," $5,641.92 "," $3,425.65 "," $4,995.45 "," $3,070.37 "," $3,403.23 ", N/A ," $3,281.92 "," $3,281.92 "," $5,583.15 "," $3,638.02 ", $532.37 ," $5,641.92 "
" Fac Cytogenetics, 100-300 ",CPT® 88275,0310 - PATHOLOGY LAB,N/A,N/A, $456.00 , $296.40 , $383.04 , $52.21 , $52.21 , $368.45 , $410.40 , $386.05 , $410.40 , $410.40 , $410.40 , $387.60 , $51.19 , $421.02 , $433.20 , $387.60 , $424.08 , $424.08 , $433.20 , $437.76 , $373.10 , $410.40 , $387.60 , $360.24 , N/A , $369.04 , $369.04 , $433.20 , $391.29 , $51.19 , $437.76 
Repair Biceps Long Tendon,23430,N/A,N/A,N/A," $2,607.00 "," $1,694.55 "," $4,536.16 ", $711.01 , $537.90 ," $3,600.06 "," $3,601.50 "," $2,424.51 "," $2,346.30 "," $2,346.30 "," $2,085.60 "," $2,085.60 ", $537.90 ," $2,407.04 "," $2,476.65 "," $2,346.30 "," $2,346.30 "," $2,346.30 "," $2,424.51 "," $2,502.72 "," $4,217.37 "," $2,215.95 "," $3,974.89 "," $4,235.40 ", N/A ," $3,670.30 "," $3,670.30 "," $2,476.65 "," $4,313.89 ", $537.90 ," $4,536.16 "
Gastrojejunostomy,CPT® 43820,N/A,N/A,N/A," $8,660.00 "," $5,629.00 "," $7,987.46 "," $1,237.30 ", $822.01 ," $6,293.10 "," $6,340.18 "," $8,053.80 "," $7,794.00 "," $7,794.00 "," $6,928.00 "," $6,928.00 ", $822.01 ," $7,995.78 "," $8,227.00 "," $7,794.00 "," $7,794.00 "," $7,794.00 "," $8,053.80 "," $8,313.60 "," $5,725.15 "," $7,361.00 "," $7,059.54 "," $7,425.87 ", N/A ," $6,415.90 "," $6,415.90 "," $8,227.00 "," $6,710.33 ", $822.01 ," $8,313.60 "
Revision of Reconstructed Breast,CPT® 19380,N/A,N/A,N/A," $5,446.00 "," $3,539.90 "," $2,566.08 ", $769.00 , $495.41 ," $2,104.47 "," $2,067.39 "," $5,064.78 "," $4,901.40 "," $4,901.40 "," $4,356.80 "," $4,356.80 ", $495.41 ," $5,028.29 "," $5,173.70 "," $4,901.40 "," $4,901.40 "," $4,901.40 "," $5,064.78 "," $5,228.16 "," $2,815.27 "," $4,629.10 "," $4,147.95 "," $2,694.07 ", N/A ," $2,145.53 "," $2,145.53 "," $5,173.70 "," $2,488.09 ", $495.41 ," $5,228.16 "
Moderna Admin Biv Booster 6 Yrs to 11 Yrs,CPT® 0144A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $56.00 , $128.02 , N/A , N/A , N/A , $66.50 , N/A , $38.92 , $128.02 
 LISINOPRIL 20 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6799-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Cast Sup Lng Leg Splnt Ped F,HCPCS Q4044,N/A,N/A,N/A, $68.00 , $44.20 , N/A , $20.73 , $12.63 , N/A , N/A , $63.24 , $61.20 , $61.20 , $54.40 , $54.40 , $12.63 , $62.78 , $64.60 , $61.20 , $61.20 , $61.20 , $63.24 , $65.28 , N/A , $57.80 , $51.90 , $18.81 , N/A , N/A , N/A , $64.60 , N/A , $12.63 , $65.28 
"Bone Imaging, Whole Body",CPT® 78306,N/A,N/A,N/A," $2,888.00 "," $1,877.20 "," $1,585.95 ", $270.63 , $214.25 ," $1,239.14 "," $1,341.60 "," $2,685.84 "," $2,599.20 "," $2,599.20 "," $2,310.40 "," $2,310.40 ", $214.25 ," $2,666.49 "," $2,743.60 "," $2,599.20 "," $2,599.20 "," $2,599.20 "," $2,685.84 "," $2,772.48 "," $1,657.16 "," $2,454.80 "," $1,461.87 "," $2,042.81 ", N/A ," $1,263.31 "," $1,263.31 "," $2,743.60 "," $1,462.30 ", $214.25 ," $2,772.48 "
Simple Repair 2.5cm or Le,CPT® 12001,N/A,N/A,N/A, $567.00 , $368.55 , $140.22 , $41.72 , $52.39 , $121.02 , $117.45 , $527.31 , $510.30 , $510.30 , $453.60 , $453.60 , $52.39 , $523.51 , $538.65 , $510.30 , $510.30 , $510.30 , $527.31 , $544.32 , $152.67 , $481.95 , $235.50 , $154.59 , N/A , $123.38 , $123.38 , $538.65 , $143.07 , $41.72 , $544.32 
Part Excis Plantar Fascia,CPT® 28060,N/A,N/A,N/A," $3,499.00 "," $2,274.35 "," $2,235.68 ", $348.71 , $384.19 ," $1,753.65 "," $1,748.74 "," $3,254.07 "," $3,149.10 "," $3,149.10 "," $2,799.20 "," $2,799.20 ", $384.19 ," $3,230.63 "," $3,324.05 "," $3,149.10 "," $3,149.10 "," $3,149.10 "," $3,254.07 "," $3,359.04 "," $2,076.72 "," $2,974.15 "," $1,892.89 "," $2,088.62 ", N/A ," $1,787.87 "," $1,787.87 "," $3,324.05 "," $2,101.38 ", $348.71 ," $3,359.04 "
 Fac Physiologic Exercise Study & Hemodynamic Measu ,CPT® 93464,0481 - CARDIAC CATH LAB,N/A,N/A," $3,651.00 "," $2,373.15 "," $3,066.84 ", $215.22 , $183.53 ," $2,950.01 "," $3,285.90 "," $3,090.94 "," $3,285.90 "," $3,285.90 "," $3,285.90 "," $3,103.35 ", $179.93 ," $3,370.97 "," $3,468.45 "," $3,103.35 "," $3,395.43 "," $3,395.43 "," $3,468.45 "," $3,504.96 "," $2,987.25 "," $3,285.90 "," $3,103.35 "," $2,884.29 ", N/A ," $2,954.75 "," $2,954.75 "," $3,468.45 "," $3,132.92 ", $179.93 ," $3,504.96 "
 Fac Vasopneumatic Device Therapy ,CPT® 97016,0420 - PHYSICAL THERAPY,N/A,N/A, $79.00 , $51.35 , $66.36 , $11.59 , $26.98 , $63.83 , $71.10 , $66.88 , $71.10 , $71.10 , $71.10 , $67.15 , $26.45 , $72.94 , $75.05 , $67.15 , $73.47 , $73.47 , $75.05 , $75.84 , $64.64 , $71.10 , $67.15 , $62.41 , N/A , $63.93 , $63.93 , $75.05 , $67.79 , $11.59 , $75.84 
"Repair Exten Tendon,Distal Insert,Open",CPT® 26433,N/A,N/A,N/A," $2,022.00 "," $1,314.30 "," $3,621.09 ", $563.09 , $427.06 ," $2,527.61 "," $2,573.92 "," $1,880.46 "," $1,819.80 "," $1,819.80 "," $1,617.60 "," $1,617.60 ", $427.06 ," $1,866.91 "," $1,920.90 "," $1,819.80 "," $1,819.80 "," $1,819.80 "," $1,880.46 "," $1,941.12 "," $3,313.60 "," $1,718.70 "," $2,817.04 "," $3,012.70 ", N/A ," $2,576.93 "," $2,576.93 "," $1,920.90 "," $3,028.79 ", $427.06 ," $3,621.09 "
Perq Drainage Pleura Insert Cath W/O Imaging,CPT® 32556,N/A,N/A,N/A," $4,224.00 "," $2,745.60 ", $668.15 , $116.48 , $529.94 , $478.43 , $463.57 ," $3,928.32 "," $3,801.60 "," $3,801.60 "," $3,379.20 "," $3,379.20 ", $529.94 ," $3,900.02 "," $4,012.80 "," $3,801.60 "," $3,801.60 "," $3,801.60 "," $3,928.32 "," $4,055.04 ", $645.36 ," $3,590.40 ", $645.83 , $636.27 , N/A , $487.76 , $487.76 ," $4,012.80 ", $574.43 , $116.48 ," $4,055.04 "
 Fac Assay of Calcium in Urine ,CPT® 82340,0301 - LAB/CHEMISTRY,N/A,N/A, $68.00 , $44.20 , $57.12 , $6.15 , $6.15 , $54.94 , $61.20 , $57.57 , $61.20 , $61.20 , $61.20 , $57.80 , $6.03 , $62.78 , $64.60 , $57.80 , $63.24 , $63.24 , $64.60 , $65.28 , $55.64 , $61.20 , $57.80 , $53.72 , N/A , $55.03 , $55.03 , $64.60 , $58.35 , $6.03 , $65.28 
" Fac RBC Sed Rate, Automated ",CPT® 85652,0305 - LAB/HEMATOLOGY,N/A,N/A, $62.00 , $40.30 , $52.08 , $2.75 , $2.75 , $50.10 , $55.80 , $52.49 , $55.80 , $55.80 , $55.80 , $52.70 , $2.70 , $57.24 , $58.90 , $52.70 , $57.66 , $57.66 , $58.90 , $59.52 , $50.73 , $55.80 , $52.70 , $48.98 , N/A , $50.18 , $50.18 , $58.90 , $53.20 , $2.70 , $59.52 
 Contrast Eval of Perc Tube ,CPT® 49465,0750 - GASTR-INST SVS,N/A,N/A, $328.00 , $213.20 , $275.52 , $29.30 , $196.17 , $265.02 , $295.20 , $277.68 , $295.20 , $295.20 , $295.20 , $278.80 , $192.32 , $302.84 , $311.60 , $278.80 , $305.04 , $305.04 , $311.60 , $314.88 , $268.37 , $295.20 , $278.80 , $259.12 , N/A , $265.45 , $265.45 , $311.60 , $281.46 , $29.30 , $314.88 
 Fac Acetone/Oth Ketone Bodies Serum Qual ,CPT® 82009,0301 - LAB/CHEMISTRY,N/A,N/A, $65.00 , $42.25 , $54.60 , $4.61 , $4.61 , $52.52 , $58.50 , $55.03 , $58.50 , $58.50 , $58.50 , $55.25 , $4.52 , $60.01 , $61.75 , $55.25 , $60.45 , $60.45 , $61.75 , $62.40 , $53.18 , $58.50 , $55.25 , $51.35 , N/A , $52.60 , $52.60 , $61.75 , $55.78 , $4.52 , $62.40 
 Fac Xr Ribs Bilateral W Pa Chest Min 4v ,CPT® 71111,0320 - DX X-RAY,N/A,N/A, $444.00 , $288.60 , $372.96 , $51.78 , $49.93 , $358.75 , $399.60 , $375.89 , $399.60 , $399.60 , $399.60 , $377.40 , $48.95 , $409.95 , $421.80 , $377.40 , $412.92 , $412.92 , $421.80 , $426.24 , $363.28 , $399.60 , $377.40 , $350.76 , N/A , $359.33 , $359.33 , $421.80 , $381.00 , $48.95 , $426.24 
 Fac Microsomal Antibody ,CPT® 86376,0302 - LAB/IMMUNOLOGY,N/A,N/A, $146.00 , $94.90 , $122.64 , $14.84 , $14.84 , $117.97 , $131.40 , $123.60 , $131.40 , $131.40 , $131.40 , $124.10 , $14.55 , $134.80 , $138.70 , $124.10 , $135.78 , $135.78 , $138.70 , $140.16 , $119.46 , $131.40 , $124.10 , $115.34 , N/A , $118.16 , $118.16 , $138.70 , $125.28 , $14.55 , $140.16 
Ekg Tracing for Initial Prev,HCPCS G0404,N/A,N/A,N/A, $118.00 , $76.70 , $36.66 , $6.02 , N/A , $15.25 , N/A , $109.74 , $106.20 , $106.20 , $94.40 , $94.40 , N/A , $108.95 , $112.10 , $106.20 , $106.20 , $106.20 , $109.74 , $113.28 , $16.76 , $100.30 , $19.46 , $31.14 , N/A , $15.55 , $15.55 , $112.10 , $19.44 , $6.02 , $113.28 
 Rsv Antigen Pnw ,CPT® 87420,0300 - LABORATORY,N/A,N/A, $111.00 , $72.15 , $93.24 , $14.19 , $14.19 , $89.69 , $99.90 , $93.97 , $99.90 , $99.90 , $99.90 , $94.35 , $13.91 , $102.49 , $105.45 , $94.35 , $103.23 , $103.23 , $105.45 , $106.56 , $90.82 , $99.90 , $94.35 , $87.69 , N/A , $89.83 , $89.83 , $105.45 , $95.25 , $13.91 , $106.56 
" Fac Mra W/Cont, Lwr Ext ",HCPCS C8912,0616 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA-LOWER EXTREMITIES,N/A,N/A," $3,231.00 "," $2,100.15 "," $2,714.04 ", N/A , N/A ," $2,610.65 "," $2,907.90 "," $2,735.36 "," $2,907.90 "," $2,907.90 "," $2,907.90 "," $2,746.35 ", N/A ," $2,983.18 "," $3,069.45 "," $2,746.35 "," $3,004.83 "," $3,004.83 "," $3,069.45 "," $3,101.76 "," $2,643.60 "," $2,907.90 "," $2,746.35 "," $2,552.49 ", N/A ," $2,614.85 "," $2,614.85 "," $3,069.45 "," $2,772.52 "," $2,552.49 "," $3,101.76 "
 Duplex Bypass Graft - Bilateral ,CPT® 93925,0921 - PERI VASCUL LAB,N/A,N/A," $1,524.00 ", $990.60 ," $1,280.16 ", $235.61 , $209.65 ," $1,231.39 "," $1,371.60 "," $1,290.22 "," $1,371.60 "," $1,371.60 "," $1,371.60 "," $1,295.40 ", $205.54 ," $1,407.11 "," $1,447.80 "," $1,295.40 "," $1,417.32 "," $1,417.32 "," $1,447.80 "," $1,463.04 "," $1,246.94 "," $1,371.60 "," $1,295.40 "," $1,203.96 ", N/A ," $1,233.37 "," $1,233.37 "," $1,447.80 "," $1,307.74 ", $205.54 ," $1,463.04 "
 MIRTAZAPINE 30 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,51079-0087-20,1 tablet, $14.37 , $9.34 , $12.07 , N/A , N/A , $11.61 , $12.93 , $12.17 , $12.93 , $12.93 , $12.93 , $12.21 , N/A , $13.27 , $13.65 , $12.21 , $13.36 , $13.36 , $13.65 , $13.80 , $11.76 , $12.93 , $12.21 , $11.35 , N/A , $11.63 , $11.63 , $13.65 , $12.33 , $11.35 , $13.80 
 Pro Treat Knee Fracture ,CPT® 27535,0975 - PRO FEE/OR,N/A,N/A," $4,153.00 "," $2,699.45 "," $5,422.43 ", $846.80 , $708.49 ," $4,329.13 "," $4,286.16 "," $3,862.29 "," $3,737.70 "," $3,737.70 "," $3,322.40 "," $3,322.40 ", $708.49 ," $3,834.46 "," $3,945.35 "," $3,737.70 "," $3,737.70 "," $3,737.70 "," $3,862.29 "," $3,986.88 "," $5,055.76 "," $3,530.05 "," $4,743.83 "," $5,087.91 ", N/A ," $4,413.60 "," $4,413.60 "," $3,945.35 "," $5,187.56 ", $708.49 ," $5,422.43 "
 Finger Min 2vw- Mh ,CPT® 73140,0972 - PRO FEE/RAD/DX,N/A,N/A, $80.00 , $52.00 , $210.66 , $37.22 , $23.98 , $146.89 , $179.94 , $74.40 , $72.00 , $72.00 , $64.00 , $64.00 , $23.98 , $73.86 , $76.00 , $72.00 , $72.00 , $72.00 , $74.40 , $76.80 , $204.23 , $68.00 , $198.38 , $161.69 , N/A , $149.76 , $149.76 , $76.00 , $173.35 , $23.98 , $210.66 
 Fac Ionm 1 on 1 in or W/Attendance Each 15 Minutes ,CPT® 95940,0920 - OTHER DX SVS,N/A,N/A, $278.00 , $180.70 , $233.52 , $31.35 , $24.90 , $224.62 , $250.20 , $235.35 , $250.20 , $250.20 , $250.20 , $236.30 , $24.41 , $256.68 , $264.10 , $236.30 , $258.54 , $258.54 , $264.10 , $266.88 , $227.46 , $250.20 , $236.30 , $219.62 , N/A , $224.99 , $224.99 , $264.10 , $238.55 , $24.41 , $266.88 
 METHYLPHENIDATE HCL ER (OSM) 18 MG PO TBCR ,HCPCS RXC637,0250 - PHARMACY,31722-0952-01,1 tablet, $67.86 , $44.11 , $57.00 , N/A , N/A , $54.83 , $61.07 , $57.45 , $61.07 , $61.07 , $61.07 , $57.68 , N/A , $62.66 , $64.47 , $57.68 , $63.11 , $63.11 , $64.47 , $65.15 , $55.52 , $61.07 , $57.68 , $53.61 , N/A , $54.92 , $54.92 , $64.47 , $58.23 , $53.61 , $65.15 
 BUDESONIDE 0.5 MG/2ML INH SUSP ,HCPCS RXC637,0250 - PHARMACY,00093-6816-55,2 mL, $56.92 , $37.00 , $47.81 , N/A , N/A , $45.99 , $51.23 , $48.19 , $51.23 , $51.23 , $51.23 , $48.38 , N/A , $52.55 , $54.07 , $48.38 , $52.94 , $52.94 , $54.07 , $54.64 , $46.57 , $51.23 , $48.38 , $44.97 , N/A , $46.07 , $46.07 , $54.07 , $48.84 , $44.97 , $54.64 
Assay Phosphorus,CPT® 84100,N/A,N/A,N/A, $34.00 , $22.10 , N/A , $4.83 , $4.83 , $26.82 , $32.11 , $31.62 , $30.60 , $30.60 , $27.20 , $27.20 , $4.83 , $31.39 , $32.30 , $30.60 , $30.60 , $30.60 , $31.62 , $32.64 , $31.65 , $28.90 , $30.82 , $17.18 , N/A , $25.03 , $25.03 , $32.30 , $27.35 , $4.83 , $32.64 
 Pro Cltx Fem Shft Fx W/O Mnpj ,CPT® 27500,0981 - PRO FEE/ER,N/A,N/A," $3,015.00 "," $1,959.75 "," $2,938.33 ", $463.26 , $614.70 ," $2,318.06 "," $2,302.07 "," $2,803.95 "," $2,713.50 "," $2,713.50 "," $2,412.00 "," $2,412.00 ", $614.70 ," $2,783.75 "," $2,864.25 "," $2,713.50 "," $2,713.50 "," $2,713.50 "," $2,803.95 "," $2,894.40 "," $2,729.51 "," $2,562.75 "," $2,538.72 "," $2,731.05 ", N/A ," $2,363.29 "," $2,363.29 "," $2,864.25 "," $2,777.72 ", $463.26 ," $2,938.33 "
" Fac Immunoassay, Nonantibody ",CPT® 83519,0302 - LAB/IMMUNOLOGY,N/A,N/A, $217.00 , $141.05 , $182.28 , $18.77 , $18.76 , $175.34 , $195.30 , $183.71 , $195.30 , $195.30 , $195.30 , $184.45 , $18.39 , $200.36 , $206.15 , $184.45 , $201.81 , $201.81 , $206.15 , $208.32 , $177.55 , $195.30 , $184.45 , $171.43 , N/A , $175.62 , $175.62 , $206.15 , $186.21 , $18.39 , $208.32 
 MRI Orbit Face and/or Neck -Mh ,CPT® 70540,0972 - PRO FEE/RAD/DX,N/A,N/A, $783.00 , $508.95 ," $1,634.15 ", $232.84 , $411.48 ," $1,702.67 "," $2,149.78 ", $728.19 , $704.70 , $704.70 , $626.40 , $626.40 , $411.48 , $722.94 , $743.85 , $704.70 , $704.70 , $704.70 , $728.19 , $751.68 ," $1,407.95 ", $665.55 ," $2,343.99 "," $2,503.40 ", N/A ," $1,735.90 "," $1,735.90 ", $743.85 ," $2,009.33 ", $232.84 ," $2,503.40 "
Assay Growth Hormone (Hgh),CPT® 83003,N/A,N/A,N/A, $159.00 , $103.35 , N/A , $17.00 , $17.00 , $94.38 , $112.89 , $147.87 , $143.10 , $143.10 , $127.20 , $127.20 , $17.00 , $146.80 , $151.05 , $143.10 , $143.10 , $143.10 , $147.87 , $152.64 , $111.31 , $135.15 , $108.66 , $60.44 , N/A , $88.08 , $88.08 , $151.05 , $96.25 , $17.00 , $152.64 
 CT Abd Pelvis W/O Contrast ,CPT® 74176,0350 - CT SCAN,N/A,N/A," $3,642.00 "," $2,367.30 "," $3,059.28 ", $186.88 , $160.28 ," $2,942.74 "," $3,277.80 "," $3,083.32 "," $3,277.80 "," $3,277.80 "," $3,277.80 "," $3,095.70 ", $157.14 ," $3,362.66 "," $3,459.90 "," $3,095.70 "," $3,387.06 "," $3,387.06 "," $3,459.90 "," $3,496.32 "," $2,979.88 "," $3,277.80 "," $3,095.70 "," $2,877.18 ", N/A ," $2,947.47 "," $2,947.47 "," $3,459.90 "," $3,125.20 ", $157.14 ," $3,496.32 "
Drain Pilonidal Cyst Simpl,10080,N/A,N/A,N/A, $795.00 , $516.75 , $335.61 , $100.38 , $61.55 , $282.06 , $278.01 , $739.35 , $715.50 , $715.50 , $636.00 , $636.00 , $61.55 , $734.02 , $755.25 , $715.50 , $715.50 , $715.50 , $739.35 , $763.20 , $367.33 , $675.75 , $553.06 , $359.71 , N/A , $287.57 , $287.57 , $755.25 , $333.47 , $61.55 , $763.20 
 DICYCLOMINE HCL 10 MG/ML IM SOLN ,HCPCS J0500,0636 - DRUGS REQUIRING DETAILED CODIN,00517-1980-05,2 mL, $250.43 , $162.78 , $210.36 , $25.95 , $24.67 , $202.35 , $225.39 , $212.01 , $225.39 , $225.39 , $225.39 , $212.87 , $24.19 , $231.22 , $237.91 , $212.87 , $232.90 , $232.90 , $237.91 , $240.41 , $204.90 , $225.39 , $212.87 , $197.84 , N/A , $202.67 , $202.67 , $237.91 , $214.89 , $24.19 , $240.41 
 Fac Assay of Sweat Sodium ,CPT® 84302,0301 - LAB/CHEMISTRY,N/A,N/A, $57.00 , $37.05 , $47.88 , $4.96 , $4.96 , $46.06 , $51.30 , $48.26 , $51.30 , $51.30 , $51.30 , $48.45 , $4.86 , $52.63 , $54.15 , $48.45 , $53.01 , $53.01 , $54.15 , $54.72 , $46.64 , $51.30 , $48.45 , $45.03 , N/A , $46.13 , $46.13 , $54.15 , $48.91 , $4.86 , $54.72 
 CALCITONIN (SALMON) 200 UNIT/ML IJ SOLN ,HCPCS J0630,0636 - DRUGS REQUIRING DETAILED CODIN,67457-0675-02,2 mL," $9,209.36 "," $5,986.08 "," $7,735.86 "," $1,393.77 "," $1,976.65 "," $7,441.16 "," $8,288.42 "," $7,796.64 "," $8,288.42 "," $8,288.42 "," $8,288.42 "," $7,827.96 "," $1,937.89 "," $8,503.00 "," $8,748.89 "," $7,827.96 "," $8,564.70 "," $8,564.70 "," $8,748.89 "," $8,840.99 "," $7,535.10 "," $8,288.42 "," $7,827.96 "," $7,275.39 ", N/A ," $7,453.14 "," $7,453.14 "," $8,748.89 "," $7,902.55 "," $1,393.77 "," $8,840.99 "
 Fac Drug Screening Opiates 1 or More ,CPT® 80361,0301 - LAB/CHEMISTRY,N/A,N/A, $171.00 , $111.15 , $143.64 , N/A , N/A , $138.17 , $153.90 , $144.77 , $153.90 , $153.90 , $153.90 , $145.35 , N/A , $157.88 , $162.45 , $145.35 , $159.03 , $159.03 , $162.45 , $164.16 , $139.91 , $153.90 , $145.35 , $135.09 , N/A , $138.39 , $138.39 , $162.45 , $146.74 , $135.09 , $164.16 
Colonoscopy Flexible With Band Ligation(S),CPT® 45398,N/A,N/A,N/A," $4,078.00 "," $2,650.70 "," $1,427.53 ", $220.75 , $265.41 , N/A , N/A ," $3,792.54 "," $3,670.20 "," $3,670.20 "," $3,262.40 "," $3,262.40 ", $265.41 ," $3,765.22 "," $3,874.10 "," $3,670.20 "," $3,670.20 "," $3,670.20 "," $3,792.54 "," $3,914.88 "," $1,024.64 "," $3,466.30 "," $1,231.42 "," $1,353.91 ", N/A ," $1,041.60 "," $1,041.60 "," $3,874.10 "," $1,090.21 ", $220.75 ," $3,914.88 "
"Lap,Esophagogast Fundoplasty",43280,N/A,N/A,N/A," $7,050.00 "," $4,582.50 "," $6,400.42 ", $989.92 , $935.01 ," $5,079.56 "," $5,125.75 "," $6,556.50 "," $6,345.00 "," $6,345.00 "," $5,640.00 "," $5,640.00 ", $935.01 ," $6,509.27 "," $6,697.50 "," $6,345.00 "," $6,345.00 "," $6,345.00 "," $6,556.50 "," $6,768.00 "," $4,590.49 "," $5,992.50 "," $5,707.22 "," $5,982.17 ", N/A ," $5,178.67 "," $5,178.67 "," $6,697.50 "," $5,416.34 ", $935.01 ," $6,768.00 "
Open Rx Patella Fx,CPT® 27524,N/A,N/A,N/A," $3,130.00 "," $2,034.50 "," $4,581.46 ", $718.25 , $655.15 ," $3,631.50 "," $3,615.12 "," $2,910.90 "," $2,817.00 "," $2,817.00 "," $2,504.00 "," $2,504.00 ", $655.15 ," $2,889.93 "," $2,973.50 "," $2,817.00 "," $2,817.00 "," $2,817.00 "," $2,910.90 "," $3,004.80 "," $4,258.35 "," $2,660.50 "," $3,994.52 "," $4,273.47 ", N/A ," $3,702.36 "," $3,702.36 "," $2,973.50 "," $4,351.61 ", $655.15 ," $4,581.46 "
 Fac Blood Clot Inhibitor Antigen ,CPT® 85302,0305 - LAB/HEMATOLOGY,N/A,N/A, $239.00 , $155.35 , $200.76 , $12.25 , $12.25 , $193.11 , $215.10 , $202.34 , $215.10 , $215.10 , $215.10 , $203.15 , $12.01 , $220.67 , $227.05 , $203.15 , $222.27 , $222.27 , $227.05 , $229.44 , $195.55 , $215.10 , $203.15 , $188.81 , N/A , $193.42 , $193.42 , $227.05 , $205.09 , $12.01 , $229.44 
 Kyphoplasty-Thoracic ,CPT® 37217,0360 - OR SERVICES,N/A,N/A," $5,510.00 "," $3,581.50 "," $4,628.40 ", $964.70 ," $1,244.35 "," $4,452.08 "," $4,959.00 "," $4,664.77 "," $4,959.00 "," $4,959.00 "," $4,959.00 "," $4,683.50 "," $1,219.95 "," $5,087.38 "," $5,234.50 "," $4,683.50 "," $5,124.30 "," $5,124.30 "," $5,234.50 "," $5,289.60 "," $4,508.28 "," $4,959.00 "," $4,683.50 "," $4,352.90 ", N/A ," $4,459.24 "," $4,459.24 "," $5,234.50 "," $4,728.13 ", $964.70 ," $5,289.60 "
"Detect Agent, Mult Orgs, Dna, Amp",CPT® 87801,N/A,N/A,N/A, $648.00 , $421.20 , N/A , $71.60 , $49.97 , $397.12 , $475.06 , $602.64 , $583.20 , $583.20 , $518.40 , $518.40 , $49.97 , $598.30 , $615.60 , $583.20 , $583.20 , $583.20 , $602.64 , $622.08 , $468.74 , $550.80 , $460.60 , $254.52 , N/A , $370.62 , $370.62 , $615.60 , $405.00 , $49.97 , $622.08 
Prolonged Clinical Staff Svc Office/O/P 1st Hr,CPT® 99415,N/A,N/A,N/A, $37.00 , $24.05 , $20.08 , $18.17 , N/A , $18.27 , $18.44 , $34.41 , $33.30 , $33.30 , $29.60 , $29.60 , N/A , $34.16 , $35.15 , $33.30 , $33.30 , $33.30 , $34.41 , $35.52 , $17.70 , $31.45 , $41.84 , $21.18 , N/A , $18.63 , $18.63 , $35.15 , $22.38 , $17.70 , $41.84 
 Fac Needle Insertion W/O Injection 1 or 2 Muscles ,CPT® 20560,0761 - TREATMENT ROOM,N/A,N/A, $48.00 , $31.20 , $40.32 , $14.78 , N/A , $38.78 , $43.20 , $40.64 , $43.20 , $43.20 , $43.20 , $40.80 , N/A , $44.32 , $45.60 , $40.80 , $44.64 , $44.64 , $45.60 , $46.08 , $39.27 , $43.20 , $40.80 , $37.92 , N/A , $38.85 , $38.85 , $45.60 , $41.19 , $14.78 , $46.08 
 Chole in or 1 Set ,CPT® 74300,0320 - DX X-RAY,N/A,N/A, $267.00 , $173.55 , $224.28 , $61.72 , $74.22 , $215.74 , $240.30 , $226.04 , $240.30 , $240.30 , $240.30 , $226.95 , $72.76 , $246.52 , $253.65 , $226.95 , $248.31 , $248.31 , $253.65 , $256.32 , $218.46 , $240.30 , $226.95 , $210.93 , N/A , $216.08 , $216.08 , $253.65 , $229.11 , $61.72 , $256.32 
 Foot Min 3 Views ,CPT® 73630,0320 - DX X-RAY,N/A,N/A, $312.00 , $202.80 , $262.08 , $33.68 , $29.84 , $252.10 , $280.80 , $264.14 , $280.80 , $280.80 , $280.80 , $265.20 , $29.25 , $288.07 , $296.40 , $265.20 , $290.16 , $290.16 , $296.40 , $299.52 , $255.28 , $280.80 , $265.20 , $246.48 , N/A , $252.50 , $252.50 , $296.40 , $267.73 , $29.25 , $299.52 
 Cerv/Thor Inj Second Lev Rad ,CPT® 64491,0761 - TREATMENT ROOM,N/A,N/A, $834.00 , $542.10 , $700.56 , $56.83 , $69.04 , $673.87 , $750.60 , $706.06 , $750.60 , $750.60 , $750.60 , $708.90 , $67.69 , $770.03 , $792.30 , $708.90 , $775.62 , $775.62 , $792.30 , $800.64 , $682.38 , $750.60 , $708.90 , $658.86 , N/A , $674.96 , $674.96 , $792.30 , $715.66 , $56.83 , $800.64 
Revsc Opn/Prq Fem/Pop W/Stnt/Athrc/Angiop Sm Vsl,CPT® 37227,N/A,N/A,N/A," $70,553.00 "," $45,859.45 "," $4,184.57 ", $642.89 , $548.41 ," $3,217.85 "," $3,176.70 "," $65,614.29 "," $63,497.70 "," $63,497.70 "," $56,442.40 "," $56,442.40 ", $548.41 ," $65,141.58 "," $67,025.35 "," $63,497.70 "," $63,497.70 "," $63,497.70 "," $65,614.29 "," $67,730.88 "," $3,551.43 "," $59,970.05 "," $3,999.87 "," $3,524.28 ", N/A ," $3,280.64 "," $3,280.64 "," $67,025.35 "," $3,726.79 ", $548.41 ," $67,730.88 "
"Excis Foot Tumor,Deep",CPT® 28045,N/A,N/A,N/A," $3,379.00 "," $2,196.35 "," $2,144.16 ", $338.28 , $208.20 ," $1,711.51 "," $1,713.02 "," $3,142.47 "," $3,041.10 "," $3,041.10 "," $2,703.20 "," $2,703.20 ", $208.20 ," $3,119.83 "," $3,210.05 "," $3,041.10 "," $3,041.10 "," $3,041.10 "," $3,142.47 "," $3,243.84 "," $1,999.65 "," $2,872.15 "," $1,855.43 "," $2,046.38 ", N/A ," $1,744.90 "," $1,744.90 "," $3,210.05 "," $2,050.88 ", $208.20 ," $3,243.84 "
"Excis Benign Bone Lesn,Metacarpal",CPT® 26200,N/A,N/A,N/A," $2,884.00 "," $1,874.60 "," $2,761.98 ", $436.65 , $384.19 ," $2,159.38 "," $2,164.29 "," $2,682.12 "," $2,595.60 "," $2,595.60 "," $2,307.20 "," $2,307.20 ", $384.19 ," $2,662.80 "," $2,739.80 "," $2,595.60 "," $2,595.60 "," $2,595.60 "," $2,682.12 "," $2,768.64 "," $2,573.20 "," $2,451.40 "," $2,381.73 "," $2,571.36 ", N/A ," $2,201.51 "," $2,201.51 "," $2,739.80 "," $2,587.55 ", $384.19 ," $2,768.64 "
Layer Closure 20.1-30cm,CPT® 12046,N/A,N/A,N/A," $1,958.00 "," $1,272.70 ", $995.01 , $295.31 , $292.55 , $840.68 , $902.38 ," $1,820.94 "," $1,762.20 "," $1,762.20 "," $1,566.40 "," $1,566.40 ", $292.55 ," $1,807.82 "," $1,860.10 "," $1,762.20 "," $1,762.20 "," $1,762.20 "," $1,820.94 "," $1,879.68 "," $1,085.71 "," $1,664.30 "," $1,809.04 "," $1,062.50 ", N/A , $857.08 , $857.08 ," $1,860.10 ", $993.92 , $292.55 ," $1,879.68 "
 TOBRAMYCIN SULFATE 1.2 G IJ SOLR ,HCPCS J3260,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0303-51,30 mL, $245.52 , $159.59 , $206.24 , $2.70 , $2.77 , $198.38 , $220.97 , $207.86 , $220.97 , $220.97 , $220.97 , $208.69 , $2.72 , $226.69 , $233.24 , $208.69 , $228.33 , $228.33 , $233.24 , $235.70 , $200.88 , $220.97 , $208.69 , $193.96 , N/A , $198.70 , $198.70 , $233.24 , $210.68 , $2.70 , $235.70 
Treatment Toe Fracture,28515,N/A,N/A,N/A, $747.00 , $485.55 , $888.42 , $141.25 , $76.84 , $702.96 , $708.81 , $694.71 , $672.30 , $672.30 , $597.60 , $597.60 , $76.84 , $689.71 , $709.65 , $672.30 , $672.30 , $672.30 , $694.71 , $717.12 , $817.30 , $634.95 , $768.93 , $830.94 , N/A , $716.67 , $716.67 , $709.65 , $842.36 , $76.84 , $888.42 
 Fac Q Fever Antibody ,CPT® 86638,0302 - LAB/IMMUNOLOGY,N/A,N/A, $90.00 , $58.50 , $75.60 , $12.36 , $8.07 , $72.72 , $81.00 , $76.19 , $81.00 , $81.00 , $81.00 , $76.50 , $7.91 , $83.10 , $85.50 , $76.50 , $83.70 , $83.70 , $85.50 , $86.40 , $73.64 , $81.00 , $76.50 , $71.10 , N/A , $72.84 , $72.84 , $85.50 , $77.23 , $7.91 , $86.40 
 Pro US Lmtd Jt/Fcl Eval Nonvasc Xtr Strux R-T W/Img ,CPT® 76882,0972 - PRO FEE/RAD/DX,N/A,N/A, $281.00 , $182.65 , $317.55 , $41.46 , $22.10 , $173.77 , $182.06 , $261.33 , $252.90 , $252.90 , $224.80 , $224.80 , $22.10 , $259.45 , $266.95 , $252.90 , $252.90 , $252.90 , $261.33 , $269.76 , $312.59 , $238.85 , $200.31 , $323.37 , N/A , $177.15 , $177.15 , $266.95 , $205.07 , $22.10 , $323.37 
 OCTREOTIDE ACETATE 200 MCG/ML IJ SOLN ,HCPCS J2354,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0378-05,1 mL, $122.53 , $79.64 , $102.93 , $1.34 , $1.45 , $99.00 , $110.28 , $103.73 , $110.28 , $110.28 , $110.28 , $104.15 , $1.42 , $113.13 , $116.40 , $104.15 , $113.95 , $113.95 , $116.40 , $117.63 , $100.25 , $110.28 , $104.15 , $96.80 , N/A , $99.16 , $99.16 , $116.40 , $105.14 , $1.34 , $117.63 
 Trauma 3 Activation W/O Pre-ED Notiification Lvl 1 -W/O Critical Care ,CPT® 99285,0450 - EMERGENCY SERVICES,N/A,N/A," $5,044.00 "," $3,278.60 "," $4,236.96 ", $168.76 , $44.31 ," $4,075.55 "," $4,539.60 "," $4,270.25 "," $4,539.60 "," $4,539.60 "," $4,539.60 "," $4,287.40 ", $43.44 ," $4,657.13 "," $4,791.80 "," $4,287.40 "," $4,690.92 "," $4,690.92 "," $4,791.80 "," $4,842.24 "," $4,127.00 "," $4,539.60 "," $4,287.40 "," $3,984.76 ", N/A ," $4,082.11 "," $4,082.11 "," $4,791.80 "," $4,328.26 ", $43.44 ," $4,842.24 "
Insert Semi-Rigid Penile Prosthesis,CPT® 54400,N/A,N/A,N/A," $2,905.00 "," $1,888.25 "," $2,363.68 ", $508.52 , N/A ," $1,700.45 "," $1,717.09 "," $2,701.65 "," $2,614.50 "," $2,614.50 "," $2,324.00 "," $2,324.00 ", N/A ," $2,682.19 "," $2,759.75 "," $2,614.50 "," $2,614.50 "," $2,614.50 "," $2,701.65 "," $2,788.80 "," $2,214.58 "," $2,469.25 "," $2,733.19 "," $2,565.86 ", N/A ," $1,733.63 "," $1,733.63 "," $2,759.75 "," $2,077.86 ", $508.52 ," $2,788.80 "
"MRI, Joint Upper Extrem",CPT® 73221,N/A,N/A,N/A," $4,347.00 "," $2,825.55 "," $1,450.05 ", $207.89 , $411.27 ," $1,390.85 "," $1,461.33 "," $4,042.71 "," $3,912.30 "," $3,912.30 "," $3,477.60 "," $3,477.60 ", $411.27 ," $4,013.59 "," $4,129.65 "," $3,912.30 "," $3,912.30 "," $3,912.30 "," $4,042.71 "," $4,173.12 "," $2,532.90 "," $3,694.95 "," $1,596.69 "," $2,191.78 ", N/A ," $1,417.99 "," $1,417.99 "," $4,129.65 "," $1,668.22 ", $207.89 ," $4,173.12 "
Instill Anticancer Agent in Bladder,CPT® 51720,N/A,N/A,N/A, $748.00 , $486.20 , $235.23 , $41.44 , $34.30 , $393.98 , $363.86 , $695.64 , $673.20 , $673.20 , $598.40 , $598.40 , $34.30 , $690.63 , $710.60 , $673.20 , $673.20 , $673.20 , $695.64 , $718.08 , $236.46 , $635.80 , $412.12 , $321.58 , N/A , $401.67 , $401.67 , $710.60 , $472.10 , $34.30 , $718.08 
 Fac in Situ Hybridization Ea Multiplex Probe Stain ,CPT® 88366,0310 - PATHOLOGY LAB,N/A,N/A, $836.00 , $543.40 , $702.24 , $274.14 , $117.74 , $675.49 , $752.40 , $707.76 , $752.40 , $752.40 , $752.40 , $710.60 , $115.43 , $771.88 , $794.20 , $710.60 , $777.48 , $777.48 , $794.20 , $802.56 , $684.02 , $752.40 , $710.60 , $660.44 , N/A , $676.57 , $676.57 , $794.20 , $717.37 , $115.43 , $802.56 
 Fac Occupational Therapy Eval Low Complex ,CPT® 97165,0434 - OCCUP THERP/EVAL,N/A,N/A, $247.00 , $160.55 , $207.48 , $100.30 , $63.91 , $199.58 , $222.30 , $209.11 , $222.30 , $222.30 , $222.30 , $209.95 , $62.66 , $228.06 , $234.65 , $209.95 , $229.71 , $229.71 , $234.65 , $237.12 , $202.10 , $222.30 , $209.95 , $195.13 , N/A , $199.90 , $199.90 , $234.65 , $211.95 , $62.66 , $237.12 
" Tendonitis, Myositis And Bursitis Without McC ",MS DRG V40 (FY2023) 558,N/A,N/A,N/A," $20,725.72 "," $13,471.72 "," $17,409.60 ", N/A , N/A ," $16,746.38 "," $18,653.15 "," $17,546.39 "," $18,653.15 "," $18,653.15 "," $18,653.15 "," $17,616.86 ", N/A ," $19,136.06 "," $19,689.43 "," $17,616.86 "," $19,274.92 "," $19,274.92 "," $19,689.43 "," $19,896.69 "," $16,957.78 "," $18,653.15 "," $17,616.86 "," $16,373.32 ", N/A ," $16,773.33 "," $16,773.33 "," $19,689.43 "," $17,784.74 "," $16,373.32 "," $19,896.69 "
 ACD FORMULA A 0.73-2.45-2.2 GM/100ML VI SOLN ,HCPCS RXA250,0250 - PHARMACY,00942-0641-04,"1,000 mL", $61.65 , $40.07 , $51.79 , N/A , N/A , $49.81 , $55.49 , $52.19 , $55.49 , $55.49 , $55.49 , $52.40 , N/A , $56.92 , $58.57 , $52.40 , $57.33 , $57.33 , $58.57 , $59.18 , $50.44 , $55.49 , $52.40 , $48.70 , N/A , $49.89 , $49.89 , $58.57 , $52.90 , $48.70 , $59.18 
 UMECLIDINIUM-VILANTEROL 62.5-25 MCG/ACT INH AEPB ,HCPCS RXC637,0250 - PHARMACY,00173-0869-06,14 each, $325.79 , $211.76 , $273.66 , N/A , N/A , $263.24 , $293.21 , $275.81 , $293.21 , $293.21 , $293.21 , $276.92 , N/A , $300.80 , $309.50 , $276.92 , $302.98 , $302.98 , $309.50 , $312.76 , $266.56 , $293.21 , $276.92 , $257.37 , N/A , $263.66 , $263.66 , $309.50 , $279.56 , $257.37 , $312.76 
 Fac Acylcarnitines Quan Ea Spec ,CPT® 82017,0301 - LAB/CHEMISTRY,N/A,N/A, $197.00 , $128.05 , $165.48 , $17.21 , $17.21 , $159.18 , $177.30 , $166.78 , $177.30 , $177.30 , $177.30 , $167.45 , $16.87 , $181.89 , $187.15 , $167.45 , $183.21 , $183.21 , $187.15 , $189.12 , $161.19 , $177.30 , $167.45 , $155.63 , N/A , $159.43 , $159.43 , $187.15 , $169.05 , $16.87 , $189.12 
Assay Homocystine,CPT® 83090,N/A,N/A,N/A, $177.00 , $115.05 , N/A , $18.28 , $18.28 , $95.42 , $114.19 , $164.61 , $159.30 , $159.30 , $141.60 , $141.60 , $18.28 , $163.42 , $168.15 , $159.30 , $159.30 , $159.30 , $164.61 , $169.92 , $119.66 , $150.45 , $110.29 , $61.18 , N/A , $89.05 , $89.05 , $168.15 , $97.31 , $18.28 , $169.92 
 Fac Enteroscopy > 2nd Prtn Abltj Lesion ,CPT® 44369,0360 - OR SERVICES,N/A,N/A," $3,316.00 "," $2,155.40 "," $2,785.44 ", $232.72 , $720.30 ," $2,679.33 "," $2,984.40 "," $2,807.33 "," $2,984.40 "," $2,984.40 "," $2,984.40 "," $2,818.60 ", $706.18 ," $3,061.66 "," $3,150.20 "," $2,818.60 "," $3,083.88 "," $3,083.88 "," $3,150.20 "," $3,183.36 "," $2,713.15 "," $2,984.40 "," $2,818.60 "," $2,619.64 ", N/A ," $2,683.64 "," $2,683.64 "," $3,150.20 "," $2,845.46 ", $232.72 ," $3,183.36 "
Repair Nonunion Radius or Ulnaw/Graft,CPT® 25405,N/A,N/A,N/A," $7,185.00 "," $4,670.25 "," $6,304.35 ", $985.61 , $998.92 ," $4,987.85 "," $4,950.73 "," $6,682.05 "," $6,466.50 "," $6,466.50 "," $5,748.00 "," $5,748.00 ", $998.92 ," $6,633.91 "," $6,825.75 "," $6,466.50 "," $6,466.50 "," $6,466.50 "," $6,682.05 "," $6,897.60 "," $5,866.43 "," $6,107.25 "," $5,459.24 "," $5,902.65 ", N/A ," $5,085.17 "," $5,085.17 "," $6,825.75 "," $5,976.89 ", $985.61 ," $6,897.60 "
 DILTIAZEM HCL ER COATED BEADS 240 MG PO CP24 ,HCPCS RXC637,0250 - PHARMACY,63739-0016-10,1 capsule, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Bone Marrow Aspiration Bone Grfg Spi Surg Only,20939,N/A,N/A,N/A," $1,076.00 ", $699.40 , $403.00 , $63.16 , N/A , $306.57 , $314.49 ," $1,000.68 ", $968.40 , $968.40 , $860.80 , $860.80 , N/A , $993.47 ," $1,022.20 ", $968.40 , $968.40 , $968.40 ," $1,000.68 "," $1,032.96 ", $378.07 , $914.60 , $371.38 , $384.07 , N/A , $312.55 , $312.55 ," $1,022.20 ", $367.35 , $63.16 ," $1,032.96 "
Exc Sacr Press Ulc Bone/W Musc Flap,CPT® 15937,N/A,N/A,N/A," $5,579.00 "," $3,626.35 "," $3,317.11 ", $987.57 , $895.36 ," $2,782.42 "," $2,749.90 "," $5,188.47 "," $5,021.10 "," $5,021.10 "," $4,463.20 "," $4,463.20 ", $895.36 ," $5,151.09 "," $5,300.05 "," $5,021.10 "," $5,021.10 "," $5,021.10 "," $5,188.47 "," $5,355.84 "," $3,629.08 "," $4,742.15 "," $5,535.95 "," $3,560.25 ", N/A ," $2,836.71 "," $2,836.71 "," $5,300.05 "," $3,289.63 ", $895.36 ," $5,535.95 "
 Fac GI Trc Img Intral Esoph Thru Ile Phys I&R ,CPT® 91110,0750 - GASTR-INST SVS,N/A,N/A," $4,366.00 "," $2,837.90 "," $3,667.44 ", $735.36 , $830.89 ," $3,527.73 "," $3,929.40 "," $3,696.26 "," $3,929.40 "," $3,929.40 "," $3,929.40 "," $3,711.10 ", $814.60 ," $4,031.13 "," $4,147.70 "," $3,711.10 "," $4,060.38 "," $4,060.38 "," $4,147.70 "," $4,191.36 "," $3,572.26 "," $3,929.40 "," $3,711.10 "," $3,449.14 ", N/A ," $3,533.40 "," $3,533.40 "," $4,147.70 "," $3,746.46 ", $735.36 ," $4,191.36 "
Apply Short Arn Splint,CPT® 29125,N/A,N/A,N/A, $428.00 , $278.20 , $241.35 , $38.40 , $27.51 , $190.75 , $194.03 , $398.04 , $385.20 , $385.20 , $342.40 , $342.40 , $27.51 , $395.17 , $406.60 , $385.20 , $385.20 , $385.20 , $398.04 , $410.88 , $223.62 , $363.80 , $212.30 , $229.45 , N/A , $194.47 , $194.47 , $406.60 , $228.57 , $27.51 , $410.88 
" Pro Removal,Boot or Body Cast ",CPT® 29700,0982 - PRO FEE/OUTPT,N/A,N/A, $443.00 , $287.95 , $198.45 , $30.97 , $22.66 , $160.94 , $161.75 , $411.99 , $398.70 , $398.70 , $354.40 , $354.40 , $22.66 , $409.02 , $420.85 , $398.70 , $398.70 , $398.70 , $411.99 , $425.28 , $185.48 , $376.55 , $178.41 , $193.88 , N/A , $164.08 , $164.08 , $420.85 , $192.87 , $22.66 , $425.28 
"Collagenase, Clost Hist Inj",HCPCS J0775,N/A,N/A,N/A, $72.00 , $46.80 , N/A , $66.45 , $66.30 , N/A , N/A , $66.96 , $64.80 , $64.80 , $57.60 , $57.60 , $66.30 , $66.48 , $68.40 , $64.80 , $64.80 , $64.80 , $66.96 , $69.12 , $70.72 , $61.20 , $71.36 , $80.95 , N/A , N/A , N/A , $68.40 , N/A , $57.60 , $80.95 
 BISACODYL 5 MG PO TBEC ,HCPCS RXC637,0250 - PHARMACY,00904-6407-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Pro Rmvl FB Musc/Tdn Shth Dp/Comp ,CPT® 20525,0981 - PRO FEE/ER,N/A,N/A," $1,639.00 "," $1,065.35 "," $1,500.01 ", $234.49 , $305.27 ," $1,200.67 "," $1,201.07 "," $1,524.27 "," $1,475.10 "," $1,475.10 "," $1,311.20 "," $1,311.20 ", $305.27 ," $1,513.29 "," $1,557.05 "," $1,475.10 "," $1,475.10 "," $1,475.10 "," $1,524.27 "," $1,573.44 "," $1,395.55 "," $1,393.15 "," $1,323.78 "," $1,413.07 ", N/A ," $1,224.10 "," $1,224.10 "," $1,557.05 "," $1,438.75 ", $234.49 ," $1,573.44 "
" Fac Virus Inoculate Tissue, Addl ",CPT® 87253,0306 - LAB/BACT-MICRO,N/A,N/A, $192.00 , $124.80 , $161.28 , $20.60 , $19.36 , $155.14 , $172.80 , $162.55 , $172.80 , $172.80 , $172.80 , $163.20 , $18.98 , $177.27 , $182.40 , $163.20 , $178.56 , $178.56 , $182.40 , $184.32 , $157.09 , $172.80 , $163.20 , $151.68 , N/A , $155.39 , $155.39 , $182.40 , $164.76 , $18.98 , $184.32 
Consult-Material Req Slid,CPT® 88323,N/A,N/A,N/A, $794.00 , $516.10 , $409.15 , $113.71 , $112.79 , $609.70 , $653.24 , $738.42 , $714.60 , $714.60 , $635.20 , $635.20 , $112.79 , $733.10 , $754.30 , $714.60 , $714.60 , $714.60 , $738.42 , $762.24 , $742.31 , $674.90 , $674.69 , $430.11 , N/A , $569.01 , $569.01 , $754.30 , $625.32 , $112.79 , $762.24 
Skull Fx Elev/Compound,CPT® 62005,N/A,N/A,N/A," $8,601.00 "," $5,590.65 "," $5,824.47 "," $1,139.03 "," $1,459.97 "," $6,871.11 "," $6,563.61 "," $7,998.93 "," $7,740.90 "," $7,740.90 "," $6,880.80 "," $6,880.80 "," $1,459.97 "," $7,941.30 "," $8,170.95 "," $7,740.90 "," $7,740.90 "," $7,740.90 "," $7,998.93 "," $8,256.96 "," $6,283.89 "," $7,310.85 "," $6,741.98 "," $7,102.01 ", N/A ," $7,005.17 "," $7,005.17 "," $8,170.95 "," $7,514.90 "," $1,139.03 "," $8,256.96 "
Ewhfo Rigid W/O Jnts Cf,HCPCS L3765,N/A,N/A,N/A," $1,471.00 ", $956.15 , N/A ," $1,365.05 ", $183.66 , N/A , N/A ," $1,368.03 "," $1,323.90 "," $1,323.90 "," $1,176.80 "," $1,176.80 ", $183.66 ," $1,358.17 "," $1,397.45 "," $1,323.90 "," $1,323.90 "," $1,323.90 "," $1,368.03 "," $1,412.16 ", N/A ," $1,250.35 "," $1,126.88 "," $1,148.47 ", N/A , N/A , N/A ," $1,397.45 ", N/A , $183.66 ," $1,412.16 "
Acromio/Clavicular Canvas&We,HCPCS L3670,N/A,N/A,N/A, $180.00 , $117.00 , N/A , $121.02 , $78.83 , N/A , N/A , $167.40 , $162.00 , $162.00 , $144.00 , $144.00 , $78.83 , $166.19 , $171.00 , $162.00 , $162.00 , $162.00 , $167.40 , $172.80 , N/A , $153.00 , $111.59 , $101.83 , N/A , N/A , N/A , $171.00 , N/A , $78.83 , $172.80 
Excis Each Addnl Spinal Disk,63035,N/A,N/A,N/A," $1,392.00 ", $904.80 , $878.49 , $209.39 , $268.05 ," $1,043.99 ", $993.16 ," $1,294.56 "," $1,252.80 "," $1,252.80 "," $1,113.60 "," $1,113.60 ", $268.05 ," $1,285.23 "," $1,322.40 "," $1,252.80 "," $1,252.80 "," $1,252.80 "," $1,294.56 "," $1,336.32 ", $955.99 ," $1,183.20 "," $1,009.78 "," $1,090.14 ", N/A ," $1,064.37 "," $1,064.37 "," $1,322.40 "," $1,141.81 ", $209.39 ," $1,336.32 "
Covid-19 vaccine home admin,HCPCS M0201,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $67.85 , $112.26 , N/A , N/A , N/A , $66.50 , N/A , $38.92 , $112.26 
 ACETYLCYSTEINE 20 % INH SOLN ,HCPCS RXC637,0250 - PHARMACY,00517-7604-25,4 mL, $77.49 , $50.37 , $65.09 , N/A , N/A , $62.61 , $69.74 , $65.60 , $69.74 , $69.74 , $69.74 , $65.87 , N/A , $71.55 , $73.62 , $65.87 , $72.07 , $72.07 , $73.62 , $74.39 , $63.40 , $69.74 , $65.87 , $61.22 , N/A , $62.71 , $62.71 , $73.62 , $66.49 , $61.22 , $74.39 
 Adm Sarscov2 30mcg/0.3ml 3rd ,CPT® 0003A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
"Cystourethroscopy,Fulgur 0.5-2cm Lesn",52234,N/A,N/A,N/A," $1,651.00 "," $1,073.15 "," $1,317.84 ", $231.66 , $250.82 ," $1,207.45 "," $1,117.67 "," $1,535.43 "," $1,485.90 "," $1,485.90 "," $1,320.80 "," $1,320.80 ", $250.82 ," $1,524.37 "," $1,568.45 "," $1,485.90 "," $1,485.90 "," $1,485.90 "," $1,535.43 "," $1,584.96 "," $1,324.75 "," $1,403.35 "," $1,264.90 "," $1,516.12 ", N/A ," $1,231.01 "," $1,231.01 "," $1,568.45 "," $1,446.87 ", $231.66 ," $1,584.96 "
Tilt Table Evaluation,CPT® 93660,N/A,N/A,N/A," $1,097.00 ", $713.05 ," $1,002.43 ", $158.03 , $162.53 , $856.61 , $877.11 ," $1,020.21 ", $987.30 , $987.30 , $877.60 , $877.60 , $162.53 ," $1,012.86 "," $1,042.15 ", $987.30 , $987.30 , $987.30 ," $1,020.21 "," $1,053.12 ", $973.36 , $932.45 , $818.89 , $961.41 , N/A , $873.32 , $873.32 ," $1,042.15 ", $968.09 , $158.03 ," $1,053.12 "
 Ankle 2 Views ,CPT® 73600,0320 - DX X-RAY,N/A,N/A, $306.00 , $198.90 , $257.04 , $32.02 , $26.20 , $247.25 , $275.40 , $259.06 , $275.40 , $275.40 , $275.40 , $260.10 , $25.69 , $282.53 , $290.70 , $260.10 , $284.58 , $284.58 , $290.70 , $293.76 , $250.37 , $275.40 , $260.10 , $241.74 , N/A , $247.65 , $247.65 , $290.70 , $262.58 , $25.69 , $293.76 
 Fac Amb 911 Loaded Mileage Als ,HCPCS A0425,0540 - AMBULANCE,N/A,N/A, $29.00 , $18.85 , $24.36 , N/A , $7.08 , $23.43 , $26.10 , $24.55 , $26.10 , $26.10 , $26.10 , $24.65 , $6.94 , $26.78 , $27.55 , $24.65 , $26.97 , $26.97 , $27.55 , $27.84 , $23.73 , $26.10 , $24.65 , $22.91 , N/A , $23.47 , $23.47 , $27.55 , $24.88 , $6.94 , $27.84 
 Pro Reconstruct Head of Radius ,CPT® 24366,0982 - PRO FEE/OUTPT,N/A,N/A," $4,544.00 "," $2,953.60 "," $4,159.09 ", $651.40 , $926.05 ," $3,280.79 "," $3,258.84 "," $4,225.92 "," $4,089.60 "," $4,089.60 "," $3,635.20 "," $3,635.20 ", $926.05 ," $4,195.48 "," $4,316.80 "," $4,089.60 "," $4,089.60 "," $4,089.60 "," $4,225.92 "," $4,362.24 "," $3,864.80 "," $3,862.40 "," $3,594.89 "," $3,871.17 ", N/A ," $3,344.81 "," $3,344.81 "," $4,316.80 "," $3,931.36 ", $651.40 ," $4,362.24 "
 Lb-Rh Immune Globulin Dose ,HCPCS J2790,0636 - DRUGS REQUIRING DETAILED CODIN,N/A,N/A, $210.00 , $136.50 , $176.40 , $83.47 , $83.41 , $169.68 , $189.00 , $177.79 , $189.00 , $189.00 , $189.00 , $178.50 , $81.77 , $193.89 , $199.50 , $178.50 , $195.30 , $195.30 , $199.50 , $201.60 , $171.82 , $189.00 , $178.50 , $165.90 , N/A , $169.95 , $169.95 , $199.50 , $180.20 , $81.77 , $201.60 
" Injection,Subcut or Intramuscular ",CPT® 96372,0940 - OTHER RX SVS,N/A,N/A, $136.00 , $88.40 , $114.24 , $13.86 , $3.38 , $109.89 , $122.40 , $115.14 , $122.40 , $122.40 , $122.40 , $115.60 , $3.31 , $125.57 , $129.20 , $115.60 , $126.48 , $126.48 , $129.20 , $130.56 , $111.28 , $122.40 , $115.60 , $107.44 , N/A , $110.06 , $110.06 , $129.20 , $116.70 , $3.31 , $130.56 
Assay 5-Hiaa,CPT® 83497,N/A,N/A,N/A, $154.00 , $100.10 , N/A , $13.16 , $13.16 , $72.96 , $87.24 , $143.22 , $138.60 , $138.60 , $123.20 , $123.20 , $13.16 , $142.19 , $146.30 , $138.60 , $138.60 , $138.60 , $143.22 , $147.84 , $86.14 , $130.90 , $84.34 , $46.76 , N/A , $68.09 , $68.09 , $146.30 , $74.41 , $13.16 , $147.84 
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw,CPT® 72083,N/A,N/A,N/A, $229.00 , $148.85 , $538.02 , $77.99 , $53.16 , $322.28 , $339.81 , $212.97 , $206.10 , $206.10 , $183.20 , $183.20 , $53.16 , $211.44 , $217.55 , $206.10 , $206.10 , $206.10 , $212.97 , $219.84 , $436.60 , $194.65 , $454.65 , $378.99 , N/A , $328.57 , $328.57 , $217.55 , $380.32 , $53.16 , $538.02 
 NOREPINEPHRINE-DEXTROSE 4-5 MG/250ML-% IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00338-0112-20,250 mL, $154.11 , $100.17 , $129.45 , N/A , N/A , $124.52 , $138.70 , $130.47 , $138.70 , $138.70 , $138.70 , $130.99 , N/A , $142.29 , $146.40 , $130.99 , $143.32 , $143.32 , $146.40 , $147.95 , $126.09 , $138.70 , $130.99 , $121.75 , N/A , $124.72 , $124.72 , $146.40 , $132.24 , $121.75 , $147.95 
 Elastase Pancreatic Fecal Quantitative Pbb ,CPT® 82653,0302 - LAB/IMMUNOLOGY,N/A,N/A, $227.00 , $147.55 , $190.68 , $23.43 , $23.43 , $183.42 , $204.30 , $192.18 , $204.30 , $204.30 , $204.30 , $192.95 , $22.97 , $209.59 , $215.65 , $192.95 , $211.11 , $211.11 , $215.65 , $217.92 , $185.73 , $204.30 , $192.95 , $179.33 , N/A , $183.71 , $183.71 , $215.65 , $194.79 , $22.97 , $217.92 
" Pro Canalith Repositioning Procedure, per Day ",CPT® 95992,0981 - PRO FEE/ER,N/A,N/A, $357.00 , $232.05 , $134.86 , $35.56 , $75.25 , $120.93 , $126.97 , $332.01 , $321.30 , $321.30 , $285.60 , $285.60 , $75.25 , $329.62 , $339.15 , $321.30 , $321.30 , $321.30 , $332.01 , $342.72 , $159.90 , $303.45 , $110.49 , $143.70 , N/A , $123.29 , $123.29 , $339.15 , $151.56 , $35.56 , $342.72 
Treat Ankle Fracture,CPT® 27760,N/A,N/A,N/A," $2,203.00 "," $1,431.95 "," $1,916.98 ", $302.45 , $184.42 ," $1,467.45 "," $1,497.57 "," $2,048.79 "," $1,982.70 "," $1,982.70 "," $1,762.40 "," $1,762.40 ", $184.42 ," $2,034.03 "," $2,092.85 "," $1,982.70 "," $1,982.70 "," $1,982.70 "," $2,048.79 "," $2,114.88 "," $1,767.47 "," $1,872.55 "," $1,643.12 "," $1,745.36 ", N/A ," $1,496.08 "," $1,496.08 "," $2,092.85 "," $1,758.43 ", $184.42 ," $2,114.88 "
" Fac Fluorescent Antibody, Titer ",CPT® 86256,0302 - LAB/IMMUNOLOGY,N/A,N/A, $152.00 , $98.80 , $127.68 , $12.29 , $12.29 , $122.82 , $136.80 , $128.68 , $136.80 , $136.80 , $136.80 , $129.20 , $12.05 , $140.34 , $144.40 , $129.20 , $141.36 , $141.36 , $144.40 , $145.92 , $124.37 , $136.80 , $129.20 , $120.08 , N/A , $123.01 , $123.01 , $144.40 , $130.43 , $12.05 , $145.92 
Correct Lid Retractn,CPT® 67911,N/A,N/A,N/A," $5,003.00 "," $3,251.95 "," $3,437.01 ", $539.50 ," $1,030.98 "," $3,180.87 "," $3,000.17 "," $4,652.79 "," $4,502.70 "," $4,502.70 "," $4,002.40 "," $4,002.40 "," $1,030.98 "," $4,619.27 "," $4,752.85 "," $4,502.70 "," $4,502.70 "," $4,502.70 "," $4,652.79 "," $4,802.88 "," $4,725.45 "," $4,252.55 "," $3,111.41 "," $4,038.20 ", N/A ," $3,242.94 "," $3,242.94 "," $4,752.85 "," $3,579.76 ", $539.50 ," $4,802.88 "
 Fac Assay of G6pd Enzyme ,CPT® 82955,0301 - LAB/CHEMISTRY,N/A,N/A, $128.00 , $83.20 , $107.52 , $9.89 , $9.89 , $103.42 , $115.20 , $108.36 , $115.20 , $115.20 , $115.20 , $108.80 , $9.70 , $118.18 , $121.60 , $108.80 , $119.04 , $119.04 , $121.60 , $122.88 , $104.73 , $115.20 , $108.80 , $101.12 , N/A , $103.59 , $103.59 , $121.60 , $109.84 , $9.70 , $122.88 
"Ophthal Biometry,Intraoc Lens Pow Calc",92136,N/A,N/A,N/A, $282.00 , $183.30 , $108.52 , $46.46 , $75.68 , $157.42 , $164.65 , $262.26 , $253.80 , $253.80 , $225.60 , $225.60 , $75.68 , $260.37 , $267.90 , $253.80 , $253.80 , $253.80 , $262.26 , $270.72 , $167.21 , $239.70 , $277.76 , $165.78 , N/A , $160.48 , $160.48 , $267.90 , $190.91 , $46.46 , $277.76 
 Fac Amb 911 Loaded Mileage Bls ,HCPCS A0425,0540 - AMBULANCE,N/A,N/A, $29.00 , $18.85 , $24.36 , N/A , $7.08 , $23.43 , $26.10 , $24.55 , $26.10 , $26.10 , $26.10 , $24.65 , $6.94 , $26.78 , $27.55 , $24.65 , $26.97 , $26.97 , $27.55 , $27.84 , $23.73 , $26.10 , $24.65 , $22.91 , N/A , $23.47 , $23.47 , $27.55 , $24.88 , $6.94 , $27.84 
 Fac Transcath Closure of Asd ,CPT® 93580,0481 - CARDIAC CATH LAB,N/A,N/A," $12,507.00 "," $8,129.55 "," $10,505.88 ", $877.88 ," $1,491.66 "," $10,105.66 "," $11,256.30 "," $10,588.43 "," $11,256.30 "," $11,256.30 "," $11,256.30 "," $10,630.95 "," $1,462.41 "," $11,547.71 "," $11,881.65 "," $10,630.95 "," $11,631.51 "," $11,631.51 "," $11,881.65 "," $12,006.72 "," $10,233.23 "," $11,256.30 "," $10,630.95 "," $9,880.53 ", N/A ," $10,121.92 "," $10,121.92 "," $11,881.65 "," $10,732.26 ", $877.88 ," $12,006.72 "
 Room Rate ,Custom 1120000001,0112 - OB/PVT,N/A,N/A," $1,848.00 "," $1,201.20 "," $1,552.32 ", N/A , N/A ," $1,493.18 "," $1,663.20 "," $1,564.52 "," $1,663.20 "," $1,663.20 "," $1,663.20 "," $1,570.80 ", N/A ," $1,706.26 "," $1,755.60 "," $1,570.80 "," $1,718.64 "," $1,718.64 "," $1,755.60 "," $1,774.08 "," $1,512.03 "," $1,663.20 "," $1,570.80 "," $1,459.92 ", N/A ," $1,495.59 "," $1,495.59 "," $1,755.60 "," $1,585.77 "," $1,459.92 "," $1,774.08 "
"Fusion Foot Bones,Midtarsal,Multi",CPT® 28730,N/A,N/A,N/A," $6,265.00 "," $4,072.25 "," $4,489.49 ", $699.71 , $614.70 ," $3,560.42 "," $3,565.19 "," $5,826.45 "," $5,638.50 "," $5,638.50 "," $5,012.00 "," $5,012.00 ", $614.70 ," $5,784.47 "," $5,951.75 "," $5,638.50 "," $5,638.50 "," $5,638.50 "," $5,826.45 "," $6,014.40 "," $4,183.39 "," $5,325.25 "," $3,907.10 "," $4,237.78 ", N/A ," $3,629.89 "," $3,629.89 "," $5,951.75 "," $4,266.41 ", $614.70 ," $6,014.40 "
 Fac Cltx Prox Fibula/Shft Fx W/O Mnpj ,CPT® 27780,0761 - TREATMENT ROOM,N/A,N/A, $652.00 , $423.80 , $547.68 , $281.00 , $190.55 , $526.82 , $586.80 , $551.98 , $586.80 , $586.80 , $586.80 , $554.20 , $186.81 , $601.99 , $619.40 , $554.20 , $606.36 , $606.36 , $619.40 , $625.92 , $533.47 , $586.80 , $554.20 , $515.08 , N/A , $527.66 , $527.66 , $619.40 , $559.48 , $186.81 , $625.92 
"Laryngoscopy,Dirct,OP Scope,Biopsy",CPT® 31536,N/A,N/A,N/A," $1,201.00 ", $780.65 ," $1,130.05 ", $200.15 , $293.93 , $813.11 , $798.17 ," $1,116.93 "," $1,080.90 "," $1,080.90 ", $960.80 , $960.80 , $293.93 ," $1,108.88 "," $1,140.95 "," $1,080.90 "," $1,080.90 "," $1,080.90 "," $1,116.93 "," $1,152.96 "," $1,080.22 "," $1,020.85 "," $1,123.96 "," $1,068.50 ", N/A , $828.98 , $828.98 ," $1,140.95 ", $976.29 , $200.15 ," $1,152.96 "
"Repair Ing Hernia,6mo-5yr,Reduc",CPT® 49500,N/A,N/A,N/A," $3,145.00 "," $2,044.25 "," $2,500.68 ", $389.00 , $479.73 ," $1,933.89 "," $1,791.15 "," $2,924.85 "," $2,830.50 "," $2,830.50 "," $2,516.00 "," $2,516.00 ", $479.73 ," $2,903.78 "," $2,987.75 "," $2,830.50 "," $2,830.50 "," $2,830.50 "," $2,924.85 "," $3,019.20 "," $1,785.46 "," $2,673.25 "," $1,978.53 "," $2,290.03 ", N/A ," $1,971.62 "," $1,971.62 "," $2,987.75 "," $2,062.11 ", $389.00 ," $3,019.20 "
Presbyopia-Correct Function,HCPCS V2788,N/A,N/A,N/A," $3,483.00 "," $2,263.95 ", N/A , N/A , N/A , N/A , N/A ," $3,239.19 "," $3,134.70 "," $3,134.70 "," $2,786.40 "," $2,786.40 ", N/A ," $3,215.85 "," $3,308.85 "," $3,134.70 "," $3,134.70 "," $3,134.70 "," $3,239.19 "," $3,343.68 ", N/A ," $2,960.55 "," $3,483.00 ", N/A , N/A , N/A , N/A ," $3,308.85 ", N/A ," $2,786.40 "," $3,483.00 "
Fx Radial Closed W Manipu,25605,N/A,N/A,N/A," $2,147.00 "," $1,395.55 "," $3,147.43 ", $496.56 , $388.30 ," $2,466.77 "," $2,502.71 "," $1,996.71 "," $1,932.30 "," $1,932.30 "," $1,717.60 "," $1,717.60 ", $388.30 ," $1,982.33 "," $2,039.65 "," $1,932.30 "," $1,932.30 "," $1,932.30 "," $1,996.71 "," $2,061.12 "," $2,912.52 "," $1,824.95 "," $2,754.59 "," $2,906.58 ", N/A ," $2,514.91 "," $2,514.91 "," $2,039.65 "," $2,955.90 ", $388.30 ," $3,147.43 "
"Reimplant Ureter,Vesicopsoas Hitch",CPT® 50785,N/A,N/A,N/A," $8,423.00 "," $5,474.95 "," $6,538.96 "," $1,149.57 "," $1,459.97 "," $5,930.02 "," $5,499.41 "," $7,833.39 "," $7,580.70 "," $7,580.70 "," $6,738.40 "," $6,738.40 "," $1,459.97 "," $7,776.96 "," $8,001.85 "," $7,580.70 "," $7,580.70 "," $7,580.70 "," $7,833.39 "," $8,086.08 "," $6,559.36 "," $7,159.55 "," $6,235.30 "," $7,439.47 ", N/A ," $6,045.73 "," $6,045.73 "," $8,001.85 "," $7,105.86 "," $1,149.57 "," $8,086.08 "
 MARGETUXIMAB-CMKB 250 MG/10ML IV SOLN ,HCPCS J9353,0636 - DRUGS REQUIRING DETAILED CODIN,74527-0022-02,10 mL," $6,610.29 "," $4,296.69 "," $5,552.64 ", $46.80 , $45.94 ," $5,341.11 "," $5,949.26 "," $5,596.27 "," $5,949.26 "," $5,949.26 "," $5,949.26 "," $5,618.75 ", $45.04 ," $6,103.28 "," $6,279.78 "," $5,618.75 "," $6,147.57 "," $6,147.57 "," $6,279.78 "," $6,345.88 "," $5,408.54 "," $5,949.26 "," $5,618.75 "," $5,222.13 ", N/A ," $5,349.71 "," $5,349.71 "," $6,279.78 "," $5,672.29 ", $45.04 ," $6,345.88 "
Percut Rx Prox/Mid Fing Shft Fx,CPT® 26727,N/A,N/A,N/A," $2,052.00 "," $1,333.80 "," $2,930.72 ", $461.65 , $176.16 ," $2,255.38 "," $2,267.82 "," $1,908.36 "," $1,846.80 "," $1,846.80 "," $1,641.60 "," $1,641.60 ", $176.16 ," $1,894.61 "," $1,949.40 "," $1,846.80 "," $1,846.80 "," $1,846.80 "," $1,908.36 "," $1,969.92 "," $2,718.42 "," $1,744.20 "," $2,490.55 "," $2,682.13 ", N/A ," $2,299.38 "," $2,299.38 "," $1,949.40 "," $2,702.59 ", $176.16 ," $2,930.72 "
External Ecg Rec>7d<15d Recording,CPT® 93246,N/A,N/A,N/A, $433.00 , $281.45 , $87.56 , $11.60 , $11.62 , N/A , N/A , $402.69 , $389.70 , $389.70 , $346.40 , $346.40 , $11.62 , $399.79 , $411.35 , $389.70 , $389.70 , $389.70 , $402.69 , $415.68 , $90.79 , $368.05 , $63.97 , $93.35 , N/A , $76.44 , $76.44 , $411.35 , $84.81 , $11.60 , $415.68 
 Pro Xcapsl Ctrc Rmvl Insj Io Lens Prosth W/O Ecp ,CPT® 66984,0975 - PRO FEE/OR,N/A,N/A," $5,873.00 "," $3,817.45 "," $3,349.71 ", $525.67 , $430.89 ," $5,195.80 "," $5,432.88 "," $5,461.89 "," $5,285.70 "," $5,285.70 "," $4,698.40 "," $4,698.40 ", $430.89 ," $5,422.54 "," $5,579.35 "," $5,285.70 "," $5,285.70 "," $5,285.70 "," $5,461.89 "," $5,638.08 "," $6,836.31 "," $4,992.05 "," $3,502.12 "," $4,600.11 ", N/A ," $5,297.18 "," $5,297.18 "," $5,579.35 "," $6,231.98 ", $430.89 ," $6,836.31 "
 Inj Proc Elbow Arthro ,CPT® 24220,0329 - DX X-RAY/OTHER,N/A,N/A, $326.00 , $211.90 , $273.84 , $63.87 , $46.08 , $263.41 , $293.40 , $275.99 , $293.40 , $293.40 , $293.40 , $277.10 , $45.18 , $301.00 , $309.70 , $277.10 , $303.18 , $303.18 , $309.70 , $312.96 , $266.73 , $293.40 , $277.10 , $257.54 , N/A , $263.83 , $263.83 , $309.70 , $279.74 , $45.18 , $312.96 
"Blood Gases: Ph, Po2 & Pco2",CPT® 82803,N/A,N/A,N/A, $228.00 , $148.20 , N/A , $26.59 , $26.59 , $109.47 , $130.96 , $212.04 , $205.20 , $205.20 , $182.40 , $182.40 , $26.59 , $210.51 , $216.60 , $205.20 , $205.20 , $205.20 , $212.04 , $218.88 , $174.08 , $193.80 , $126.50 , $76.57 , N/A , $102.16 , $102.16 , $216.60 , $111.64 , $26.59 , $218.88 
 Fac Tissue Transglutaminase Ea Immunoglobulin Class ,CPT® 86364,0302 - LAB/IMMUNOLOGY,N/A,N/A, $136.00 , $88.40 , $114.24 , $11.76 , $11.76 , $109.89 , $122.40 , $115.14 , $122.40 , $122.40 , $122.40 , $115.60 , $11.53 , $125.57 , $129.20 , $115.60 , $126.48 , $126.48 , $129.20 , $130.56 , $111.28 , $122.40 , $115.60 , $107.44 , N/A , $110.06 , $110.06 , $129.20 , $116.70 , $11.53 , $130.56 
Open Skull Drain Supratent Absc,CPT® 61320,N/A,N/A,N/A," $12,125.00 "," $7,881.25 "," $8,618.22 "," $1,682.08 "," $1,604.07 "," $10,229.02 "," $9,798.94 "," $11,276.25 "," $10,912.50 "," $10,912.50 "," $9,700.00 "," $9,700.00 "," $1,604.07 "," $11,195.01 "," $11,518.75 "," $10,912.50 "," $10,912.50 "," $10,912.50 "," $11,276.25 "," $11,640.00 "," $9,334.12 "," $10,306.25 "," $10,074.61 "," $10,604.48 ", N/A ," $10,428.61 "," $10,428.61 "," $11,518.75 "," $11,187.46 "," $1,604.07 "," $11,640.00 "
Infect Agent Drug Susept by Phenotype Predict,CPT® 87900,N/A,N/A,N/A," $1,203.00 ", $781.95 , N/A , $132.96 , $132.96 , $737.44 , $882.13 ," $1,118.79 "," $1,082.70 "," $1,082.70 ", $962.40 , $962.40 , $132.96 ," $1,110.73 "," $1,142.85 "," $1,082.70 "," $1,082.70 "," $1,082.70 "," $1,118.79 "," $1,154.88 ", $870.38 ," $1,022.55 ", $854.71 , $472.62 , N/A , $688.23 , $688.23 ," $1,142.85 ", $752.09 , $132.96 ," $1,154.88 "
" Pro Scope Bladder, Insert Tube for Injection ",CPT® 52005,0982 - PRO FEE/OUTPT,N/A,N/A, $924.00 , $600.60 , $713.00 , $125.24 , $199.19 , $652.08 , $607.23 , $859.32 , $831.60 , $831.60 , $739.20 , $739.20 , $199.19 , $853.13 , $877.80 , $831.60 , $831.60 , $831.60 , $859.32 , $887.04 , $716.14 , $785.40 , $688.65 , $819.38 , N/A , $664.80 , $664.80 , $877.80 , $781.39 , $125.24 , $887.04 
 Pro Treatment of Ankle Fracture ,CPT® 27810,0975 - PRO FEE/OR,N/A,N/A," $1,113.00 ", $723.45 ," $2,621.26 ", $415.07 , $394.39 ," $2,044.66 "," $2,077.68 "," $1,035.09 "," $1,001.70 "," $1,001.70 ", $890.40 , $890.40 , $394.39 ," $1,027.63 "," $1,057.35 "," $1,001.70 "," $1,001.70 "," $1,001.70 "," $1,035.09 "," $1,068.48 "," $2,420.62 ", $946.05 ," $2,287.17 "," $2,409.72 ", N/A ," $2,084.56 "," $2,084.56 "," $1,057.35 "," $2,450.12 ", $394.39 ," $2,621.26 "
 ANTIHEMOPHIL FACTOR (RAHF-PFM) 1000 UNITS IV SOLR ,HCPCS J7211,0636 - DRUGS REQUIRING DETAILED CODIN,00026-3824-25,1 int'l unit, $35.00 , $22.75 , $29.40 , $1.47 , $1.37 , $28.28 , $31.50 , $29.63 , $31.50 , $31.50 , $31.50 , $29.75 , $1.34 , $32.32 , $33.25 , $29.75 , $32.55 , $32.55 , $33.25 , $33.60 , $28.64 , $31.50 , $29.75 , $27.65 , N/A , $28.33 , $28.33 , $33.25 , $30.03 , $1.34 , $33.60 
"Cystourethroscopy,Fulgur >5cm Lesn",52240,N/A,N/A,N/A," $3,316.00 "," $2,155.40 "," $2,100.25 ", $368.50 , $514.64 ," $1,924.93 "," $1,781.28 "," $3,083.88 "," $2,984.40 "," $2,984.40 "," $2,652.80 "," $2,652.80 ", $514.64 ," $3,061.66 "," $3,150.20 "," $2,984.40 "," $2,984.40 "," $2,984.40 "," $3,083.88 "," $3,183.36 "," $2,112.54 "," $2,818.60 "," $2,017.78 "," $2,413.34 ", N/A ," $1,962.49 "," $1,962.49 "," $3,150.20 "," $2,306.64 ", $368.50 ," $3,183.36 "
"Remove Bladder Stone,>2.5cm",CPT® 52318,N/A,N/A,N/A," $3,236.00 "," $2,103.40 "," $2,535.69 ", $444.83 , $458.36 ," $2,324.78 "," $2,148.77 "," $3,009.48 "," $2,912.40 "," $2,912.40 "," $2,588.80 "," $2,588.80 ", $458.36 ," $2,987.80 "," $3,074.20 "," $2,912.40 "," $2,912.40 "," $2,912.40 "," $3,009.48 "," $3,106.56 "," $2,553.36 "," $2,750.60 "," $2,433.46 "," $2,914.46 ", N/A ," $2,370.14 "," $2,370.14 "," $3,074.20 "," $2,785.75 ", $444.83 ," $3,106.56 "
 Prolact Rtf 24 per Ml ,Custom 2200000006,0220 - SPECIAL CHARGES,N/A,N/A, $5.00 , $3.25 , $4.20 , N/A , N/A , $4.04 , $4.50 , $4.23 , $4.50 , $4.50 , $4.50 , $4.25 , N/A , $4.62 , $4.75 , $4.25 , $4.65 , $4.65 , $4.75 , $4.80 , $4.09 , $4.50 , $4.25 , $3.95 , N/A , $4.05 , $4.05 , $4.75 , $4.29 , $3.95 , $4.80 
CT Scan of Abdomen Contrast,CPT® 74160,N/A,N/A,N/A," $4,135.00 "," $2,687.75 "," $1,618.68 ", $234.02 , $324.11 ," $1,099.56 "," $1,413.93 "," $3,845.55 "," $3,721.50 "," $3,721.50 "," $3,308.00 "," $3,308.00 ", $324.11 ," $3,817.85 "," $3,928.25 "," $3,721.50 "," $3,721.50 "," $3,721.50 "," $3,845.55 "," $3,969.60 "," $1,400.79 "," $3,514.75 "," $1,600.54 "," $1,497.83 ", N/A ," $1,121.02 "," $1,121.02 "," $3,928.25 "," $1,297.60 ", $234.02 ," $3,969.60 "
 SODIUM CHLORIDE (HYPERTONIC) 5 % OP OINT ,HCPCS RXC637,0250 - PHARMACY,00536-1253-91,3.5 gram, $62.63 , $40.71 , $52.61 , N/A , N/A , $50.61 , $56.37 , $53.02 , $56.37 , $56.37 , $56.37 , $53.24 , N/A , $57.83 , $59.50 , $53.24 , $58.25 , $58.25 , $59.50 , $60.12 , $51.24 , $56.37 , $53.24 , $49.48 , N/A , $50.69 , $50.69 , $59.50 , $53.74 , $49.48 , $60.12 
Fx Ulnar Shaft W/O Manipu,25530,N/A,N/A,N/A," $1,068.00 ", $694.20 ," $1,510.80 ", $240.36 , $154.82 ," $1,143.45 "," $1,163.91 ", $993.24 , $961.20 , $961.20 , $854.40 , $854.40 , $154.82 , $986.08 ," $1,014.60 ", $961.20 , $961.20 , $961.20 , $993.24 ," $1,025.28 "," $1,395.00 ", $907.80 ," $1,273.82 "," $1,362.13 ", N/A ," $1,165.76 "," $1,165.76 "," $1,014.60 "," $1,370.18 ", $154.82 ," $1,510.80 "
 Fac Njx Px Antegrde Nfrosgrm &/Urtrgrm Exstng Acess ,CPT® 50431,0761 - TREATMENT ROOM,N/A,N/A," $2,549.00 "," $1,656.85 "," $2,141.16 ", $62.86 , $128.46 ," $2,059.59 "," $2,294.10 "," $2,157.98 "," $2,294.10 "," $2,294.10 "," $2,294.10 "," $2,166.65 ", $125.94 ," $2,353.49 "," $2,421.55 "," $2,166.65 "," $2,370.57 "," $2,370.57 "," $2,421.55 "," $2,447.04 "," $2,085.59 "," $2,294.10 "," $2,166.65 "," $2,013.71 ", N/A ," $2,062.91 "," $2,062.91 "," $2,421.55 "," $2,187.30 ", $62.86 ," $2,447.04 "
" Pro Lap, Jejunostomy ",CPT® 44186,0982 - PRO FEE/OUTPT,N/A,N/A," $4,256.00 "," $2,766.40 "," $3,890.45 ", $602.20 , $509.16 ," $3,064.39 "," $3,105.27 "," $3,958.08 "," $3,830.40 "," $3,830.40 "," $3,404.80 "," $3,404.80 ", $509.16 ," $3,929.56 "," $4,043.20 "," $3,830.40 "," $3,830.40 "," $3,830.40 "," $3,958.08 "," $4,085.76 "," $2,786.57 "," $3,617.60 "," $3,453.95 "," $3,605.06 ", N/A ," $3,124.18 "," $3,124.18 "," $4,043.20 "," $3,267.54 ", $509.16 ," $4,085.76 "
"Exc Skin Benig >4cm Face,Facial",11446,N/A,N/A,N/A," $1,937.00 "," $1,259.05 "," $1,023.33 ", $303.00 , $321.15 , $886.77 , $858.68 ," $1,801.41 "," $1,743.30 "," $1,743.30 "," $1,549.60 "," $1,549.60 ", $321.15 ," $1,788.43 "," $1,840.15 "," $1,743.30 "," $1,743.30 "," $1,743.30 "," $1,801.41 "," $1,859.52 "," $1,126.21 "," $1,646.45 "," $1,716.27 "," $1,132.21 ", N/A , $904.07 , $904.07 ," $1,840.15 "," $1,048.41 ", $303.00 ," $1,859.52 "
 Pro Repair Wrist Joint(S) ,CPT® 25447,0975 - PRO FEE/OR,N/A,N/A," $4,238.00 "," $2,754.70 "," $5,075.53 ", $797.62 , $618.57 ," $3,988.25 "," $3,968.44 "," $3,941.34 "," $3,814.20 "," $3,814.20 "," $3,390.40 "," $3,390.40 ", $618.57 ," $3,912.95 "," $4,026.10 "," $3,814.20 "," $3,814.20 "," $3,814.20 "," $3,941.34 "," $4,068.48 "," $4,717.59 "," $3,602.30 "," $4,365.60 "," $4,732.74 ", N/A ," $4,066.07 "," $4,066.07 "," $4,026.10 "," $4,779.07 ", $618.57 ," $5,075.53 "
"Amputation Toe,Mt-P Jt",28820,N/A,N/A,N/A," $3,837.00 "," $2,494.05 "," $1,097.20 ", $170.21 , $184.42 ," $1,941.50 "," $1,962.17 "," $3,568.41 "," $3,453.30 "," $3,453.30 "," $3,069.60 "," $3,069.60 ", $184.42 ," $3,542.70 "," $3,645.15 "," $3,453.30 "," $3,453.30 "," $3,453.30 "," $3,568.41 "," $3,683.52 "," $1,030.80 "," $3,261.45 "," $2,146.23 "," $2,289.48 ", N/A ," $1,979.38 "," $1,979.38 "," $3,645.15 "," $2,326.47 ", $170.21 ," $3,683.52 "
"MRI, Face, Neck",CPT® 70540,N/A,N/A,N/A," $5,650.00 "," $3,672.50 "," $1,634.15 ", $232.84 , $411.48 ," $1,702.67 "," $2,149.78 "," $5,254.50 "," $5,085.00 "," $5,085.00 "," $4,520.00 "," $4,520.00 ", $411.48 ," $5,216.65 "," $5,367.50 "," $5,085.00 "," $5,085.00 "," $5,085.00 "," $5,254.50 "," $5,424.00 "," $1,407.95 "," $4,802.50 "," $2,343.99 "," $2,503.40 ", N/A ," $1,735.90 "," $1,735.90 "," $5,367.50 "," $2,009.33 ", $232.84 ," $5,424.00 "
Layer Closure 5.1-7.5cm,12053,N/A,N/A,N/A," $1,445.00 ", $939.25 , $685.07 , $206.62 , $153.67 , $595.05 , $580.29 ," $1,343.85 "," $1,300.50 "," $1,300.50 "," $1,156.00 "," $1,156.00 ", $153.67 ," $1,334.17 "," $1,372.75 "," $1,300.50 "," $1,300.50 "," $1,300.50 "," $1,343.85 "," $1,387.20 ", $753.04 ," $1,228.25 "," $1,156.07 ", $765.21 , N/A , $606.66 , $606.66 ," $1,372.75 ", $703.53 , $153.67 ," $1,387.20 "
Arthrocentesis-Major Jnt,20610,N/A,N/A,N/A, $378.00 , $245.70 , $274.69 , $42.73 , $65.94 , $223.70 , $219.57 , $351.54 , $340.20 , $340.20 , $302.40 , $302.40 , $65.94 , $349.01 , $359.10 , $340.20 , $340.20 , $340.20 , $351.54 , $362.88 , $257.37 , $321.30 , $240.85 , $264.61 , N/A , $228.06 , $228.06 , $359.10 , $268.04 , $42.73 , $362.88 
Apligraf Skin Sub,HCPCS Q4101,N/A,N/A,N/A, $96.00 , $62.40 , N/A , $31.03 , $31.79 , N/A , N/A , $89.28 , $86.40 , $86.40 , $76.80 , $76.80 , $31.79 , $88.64 , $91.20 , $86.40 , $86.40 , $86.40 , $89.28 , $92.16 , $39.56 , $81.60 , $75.26 , $39.79 , N/A , N/A , N/A , $91.20 , N/A , $31.03 , $92.16 
"Open Rx Shldr Disloc,Prox Hum Fx",23680,N/A,N/A,N/A," $6,093.00 "," $3,960.45 "," $5,622.70 ", $882.70 , $922.06 ," $4,483.23 "," $4,453.56 "," $5,666.49 "," $5,483.70 "," $5,483.70 "," $4,874.40 "," $4,874.40 ", $922.06 ," $5,625.67 "," $5,788.35 "," $5,483.70 "," $5,483.70 "," $5,483.70 "," $5,666.49 "," $5,849.28 "," $5,236.48 "," $5,179.05 "," $4,920.45 "," $5,279.41 ", N/A ," $4,570.71 "," $4,570.71 "," $5,788.35 "," $5,372.20 ", $882.70 ," $5,849.28 "
 TOBRAMYCIN 0.3 % OP SOLN ,HCPCS RXC637,0250 - PHARMACY,62332-0518-05,5 mL, $174.56 , $113.46 , $146.63 , N/A , N/A , $141.04 , $157.10 , $147.78 , $157.10 , $157.10 , $157.10 , $148.38 , N/A , $161.17 , $165.83 , $148.38 , $162.34 , $162.34 , $165.83 , $167.58 , $142.82 , $157.10 , $148.38 , $137.90 , N/A , $141.27 , $141.27 , $165.83 , $149.79 , $137.90 , $167.58 
 FENOFIBRATE 48 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60687-0618-21,1 tablet, $9.82 , $6.38 , $8.25 , N/A , N/A , $7.93 , $8.84 , $8.31 , $8.84 , $8.84 , $8.84 , $8.35 , N/A , $9.07 , $9.33 , $8.35 , $9.13 , $9.13 , $9.33 , $9.43 , $8.03 , $8.84 , $8.35 , $7.76 , N/A , $7.95 , $7.95 , $9.33 , $8.43 , $7.76 , $9.43 
 Gen Seq Analys ,CPT® 81455,0310 - PATHOLOGY LAB,N/A,N/A," $3,463.00 "," $2,250.95 "," $2,908.92 "," $2,977.99 "," $2,977.99 "," $2,798.10 "," $3,116.70 "," $2,931.78 "," $3,116.70 "," $3,116.70 "," $3,116.70 "," $2,943.55 "," $2,919.60 "," $3,197.39 "," $3,289.85 "," $2,943.55 "," $3,220.59 "," $3,220.59 "," $3,289.85 "," $3,324.48 "," $2,833.43 "," $3,116.70 "," $2,943.55 "," $2,735.77 ", N/A ," $2,802.61 "," $2,802.61 "," $3,289.85 "," $2,971.60 "," $2,735.77 "," $3,324.48 "
Orthovisc Inj per Dose,HCPCS J7324,N/A,N/A,N/A, $646.00 , $419.90 , N/A , $119.73 , $137.15 , N/A , N/A , $600.78 , $581.40 , $581.40 , $516.80 , $516.80 , $137.15 , $596.45 , $613.70 , $581.40 , $581.40 , $581.40 , $600.78 , $620.16 , $175.44 , $549.10 , $319.19 , $194.91 , N/A , N/A , N/A , $613.70 , N/A , $119.73 , $620.16 
Insert Subcut Reserv/Pump/Dev,CPT® 61215,N/A,N/A,N/A," $3,336.00 "," $2,168.40 "," $2,402.19 ", $473.43 , $402.67 ," $2,735.47 "," $2,670.34 "," $3,102.48 "," $3,002.40 "," $3,002.40 "," $2,668.80 "," $2,668.80 ", $402.67 ," $3,080.13 "," $3,169.20 "," $3,002.40 "," $3,002.40 "," $3,002.40 "," $3,102.48 "," $3,202.56 "," $2,567.06 "," $2,835.60 "," $2,713.56 "," $2,873.57 ", N/A ," $2,788.84 "," $2,788.84 "," $3,169.20 "," $2,991.79 ", $402.67 ," $3,202.56 "
 Fac Assay of Thyroglobulin ,CPT® 84432,0301 - LAB/CHEMISTRY,N/A,N/A, $181.00 , $117.65 , $152.04 , $16.38 , $16.38 , $146.25 , $162.90 , $153.23 , $162.90 , $162.90 , $162.90 , $153.85 , $16.06 , $167.12 , $171.95 , $153.85 , $168.33 , $168.33 , $171.95 , $173.76 , $148.09 , $162.90 , $153.85 , $142.99 , N/A , $146.48 , $146.48 , $171.95 , $155.32 , $16.06 , $173.76 
 Fac Enterosc >2nd Prtn W/Ileum W/WO Collj Spec Spx ,CPT® 44376,0360 - OR SERVICES,N/A,N/A," $3,732.00 "," $2,425.80 "," $3,134.88 ", $269.35 , $529.96 ," $3,015.46 "," $3,358.80 "," $3,159.51 "," $3,358.80 "," $3,358.80 "," $3,358.80 "," $3,172.20 ", $519.57 ," $3,445.76 "," $3,545.40 "," $3,172.20 "," $3,470.76 "," $3,470.76 "," $3,545.40 "," $3,582.72 "," $3,053.52 "," $3,358.80 "," $3,172.20 "," $2,948.28 ", N/A ," $3,020.31 "," $3,020.31 "," $3,545.40 "," $3,202.43 ", $269.35 ," $3,582.72 "
"Apply Forearm Splint,Dynamic",CPT® 29126,N/A,N/A,N/A, $509.00 , $330.85 , $299.46 , $47.25 , $23.04 , $236.84 , $238.38 , $473.37 , $458.10 , $458.10 , $407.20 , $407.20 , $23.04 , $469.96 , $483.55 , $458.10 , $458.10 , $458.10 , $473.37 , $488.64 , $274.00 , $432.65 , $260.47 , $283.20 , N/A , $241.46 , $241.46 , $483.55 , $283.78 , $23.04 , $488.64 
 Mh Semi-Private Room/OB ,Custom 139998,0122 - OB/2BED,N/A,N/A," $1,848.00 "," $1,201.20 "," $1,552.32 ", N/A , N/A ," $1,493.18 "," $1,663.20 "," $1,564.52 "," $1,663.20 "," $1,663.20 "," $1,663.20 "," $1,570.80 ", N/A ," $1,706.26 "," $1,755.60 "," $1,570.80 "," $1,718.64 "," $1,718.64 "," $1,755.60 "," $1,774.08 "," $1,512.03 "," $1,663.20 "," $1,570.80 "," $1,459.92 ", N/A ," $1,495.59 "," $1,495.59 "," $1,755.60 "," $1,585.77 "," $1,459.92 "," $1,774.08 "
 Pro Rpr Nail Bed ,CPT® 11760,0982 - PRO FEE/OUTPT,N/A,N/A, $840.00 , $546.00 , $358.36 , $106.67 , $42.71 , $359.65 , $359.77 , $781.20 , $756.00 , $756.00 , $672.00 , $672.00 , $42.71 , $775.57 , $798.00 , $756.00 , $756.00 , $756.00 , $781.20 , $806.40 , $400.51 , $714.00 , $715.41 , $401.98 , N/A , $366.67 , $366.67 , $798.00 , $425.20 , $42.71 , $806.40 
Explor Wrist Jt/Remv Synovium,CPT® 25105,N/A,N/A,N/A," $3,213.00 "," $2,088.45 "," $2,992.47 ", $471.87 , $614.70 ," $2,320.49 "," $2,328.46 "," $2,988.09 "," $2,891.70 "," $2,891.70 "," $2,570.40 "," $2,570.40 ", $614.70 ," $2,966.56 "," $3,052.35 "," $2,891.70 "," $2,891.70 "," $2,891.70 "," $2,988.09 "," $3,084.48 "," $2,778.14 "," $2,731.05 "," $2,560.13 "," $2,755.18 ", N/A ," $2,365.77 "," $2,365.77 "," $3,052.35 "," $2,780.62 ", $471.87 ," $3,084.48 "
 LITHIUM CARBONATE ER 450 MG PO TBCR ,HCPCS RXC637,0250 - PHARMACY,00378-1450-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Insj Tun Vad Req 2 Cath 2 Sits W/Subq Port,CPT® 36566,N/A,N/A,N/A," $2,913.00 "," $1,893.45 "," $2,149.55 ", $332.35 ," $1,089.36 "," $1,666.24 "," $1,643.26 "," $2,709.09 "," $2,621.70 "," $2,621.70 "," $2,330.40 "," $2,330.40 "," $1,089.36 "," $2,689.57 "," $2,767.35 "," $2,621.70 "," $2,621.70 "," $2,621.70 "," $2,709.09 "," $2,796.48 "," $1,978.94 "," $2,476.05 "," $2,053.46 "," $1,786.63 ", N/A ," $1,698.75 "," $1,698.75 "," $2,767.35 "," $1,929.76 ", $332.35 ," $2,796.48 "
Assay of Proinsulin,CPT® 84206,N/A,N/A,N/A, $247.00 , $160.55 , N/A , $27.22 , $24.72 , $100.78 , $120.57 , $229.71 , $222.30 , $222.30 , $197.60 , $197.60 , $24.72 , $228.06 , $234.65 , $222.30 , $222.30 , $222.30 , $229.71 , $237.12 , $178.22 , $209.95 , $116.77 , $78.39 , N/A , $94.05 , $94.05 , $234.65 , $102.78 , $24.72 , $237.12 
Pro Arthroscopy Ankle Exc Osteochondral Defect - Lh,29891,N/A,N/A,N/A," $6,601.00 "," $4,290.65 "," $4,111.25 ", $643.64 , $641.55 ," $3,301.98 "," $3,289.26 "," $6,138.93 "," $5,940.90 "," $5,940.90 "," $5,280.80 "," $5,280.80 ", $641.55 ," $6,094.70 "," $6,270.95 "," $5,940.90 "," $5,940.90 "," $5,940.90 "," $6,138.93 "," $6,336.96 "," $3,821.95 "," $5,610.85 "," $3,616.30 "," $3,862.17 ", N/A ," $3,366.41 "," $3,366.41 "," $6,270.95 "," $3,956.71 ", $641.55 ," $6,336.96 "
 MELATONIN 3 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,77333-0516-10,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Immuniz Admin,Intranasal/Oral,1 Vac/Tox",CPT® 90473,N/A,N/A,N/A, $71.00 , $46.15 , $40.23 , $16.17 , N/A , $57.67 , $59.77 , $66.03 , $63.90 , $63.90 , $56.80 , $56.80 , N/A , $65.55 , $67.45 , $63.90 , $63.90 , $63.90 , $66.03 , $68.16 , $59.44 , $60.35 , $77.04 , $64.43 , N/A , $58.79 , $58.79 , $67.45 , $69.67 , $16.17 , $77.04 
 Fac Radiation Treatment Aid(S) ,CPT® 77333,0333 - RADIATION RX,N/A,N/A," $1,241.00 ", $806.65 ," $1,042.44 ", $135.49 , $63.29 ," $1,002.73 "," $1,116.90 "," $1,050.63 "," $1,116.90 "," $1,116.90 "," $1,116.90 "," $1,054.85 ", $62.05 ," $1,145.82 "," $1,178.95 "," $1,054.85 "," $1,154.13 "," $1,154.13 "," $1,178.95 "," $1,191.36 "," $1,015.39 "," $1,116.90 "," $1,054.85 ", $980.39 , N/A ," $1,004.34 "," $1,004.34 "," $1,178.95 "," $1,064.90 ", $62.05 ," $1,191.36 "
 Fac Fructose Semen ,CPT® 82757,0301 - LAB/CHEMISTRY,N/A,N/A, $149.00 , $96.85 , $125.16 , $17.69 , $8.65 , $120.39 , $134.10 , $126.14 , $134.10 , $134.10 , $134.10 , $126.65 , $8.48 , $137.57 , $141.55 , $126.65 , $138.57 , $138.57 , $141.55 , $143.04 , $121.91 , $134.10 , $126.65 , $117.71 , N/A , $120.59 , $120.59 , $141.55 , $127.86 , $8.48 , $143.04 
Open Rx Bilat Tib Plat Fx,CPT® 27536,N/A,N/A,N/A," $5,606.00 "," $3,643.90 "," $7,163.98 "," $1,120.90 ", $845.22 ," $5,744.83 "," $5,698.26 "," $5,213.58 "," $5,045.40 "," $5,045.40 "," $4,484.80 "," $4,484.80 ", $845.22 ," $5,176.02 "," $5,325.70 "," $5,045.40 "," $5,045.40 "," $5,045.40 "," $5,213.58 "," $5,381.76 "," $6,666.68 "," $4,765.10 "," $6,303.10 "," $6,755.82 ", N/A ," $5,856.93 "," $5,856.93 "," $5,325.70 "," $6,883.96 ", $845.22 ," $7,163.98 "
"Destr Penis Lesn,Simpl,Elec-Dessic",CPT® 54055,N/A,N/A,N/A, $601.00 , $390.65 , $420.51 , $92.34 , $46.08 , $298.02 , $305.26 , $558.93 , $540.90 , $540.90 , $480.80 , $480.80 , $46.08 , $554.90 , $570.95 , $540.90 , $540.90 , $540.90 , $558.93 , $576.96 , $395.14 , $510.85 , $488.83 , $447.06 , N/A , $303.84 , $303.84 , $570.95 , $364.16 , $46.08 , $576.96 
 LIDOCAINE HCL (PF) 4 % IJ SOLN ,HCPCS RXA250,0250 - PHARMACY,00409-4283-01,5 mL, $29.80 , $19.37 , $25.03 , N/A , N/A , $24.08 , $26.82 , $25.23 , $26.82 , $26.82 , $26.82 , $25.33 , N/A , $27.51 , $28.31 , $25.33 , $27.71 , $27.71 , $28.31 , $28.61 , $24.38 , $26.82 , $25.33 , $23.54 , N/A , $24.12 , $24.12 , $28.31 , $25.57 , $23.54 , $28.61 
 Pro Pro Fee Residual Lung Cap ,CPT® 94727,0976 - PRO FEE/RESPIR,N/A,N/A, $179.00 , $116.35 , $101.11 , $42.70 , $32.97 , $93.09 , $106.20 , $166.47 , $161.10 , $161.10 , $143.20 , $143.20 , $32.97 , $165.27 , $170.05 , $161.10 , $161.10 , $161.10 , $166.47 , $171.84 , $133.23 , $152.15 , $141.92 , $166.44 , N/A , $94.91 , $94.91 , $170.05 , $110.62 , $32.97 , $171.84 
" Fac MRI W/O Fol W/Cont, Breast, ",HCPCS C8908,0614 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI-OTHER,N/A,N/A," $4,980.00 "," $3,237.00 "," $4,183.20 ", N/A , N/A ," $4,023.84 "," $4,482.00 "," $4,216.07 "," $4,482.00 "," $4,482.00 "," $4,482.00 "," $4,233.00 ", N/A ," $4,598.03 "," $4,731.00 "," $4,233.00 "," $4,631.40 "," $4,631.40 "," $4,731.00 "," $4,780.80 "," $4,074.64 "," $4,482.00 "," $4,233.00 "," $3,934.20 ", N/A ," $4,030.31 "," $4,030.31 "," $4,731.00 "," $4,273.34 "," $3,934.20 "," $4,780.80 "
"Circumcision,Clamp,Newborn",54150,N/A,N/A,N/A, $830.00 , $539.50 , $426.81 , $91.37 , $61.84 , $313.26 , $316.20 , $771.90 , $747.00 , $747.00 , $664.00 , $664.00 , $61.84 , $766.34 , $788.50 , $747.00 , $747.00 , $747.00 , $771.90 , $796.80 , $401.58 , $705.50 , $508.46 , $470.51 , N/A , $319.36 , $319.36 , $788.50 , $382.78 , $61.84 , $796.80 
Aspirat/Injection Ganglion Cyst(S),CPT® 20612,N/A,N/A,N/A, $397.00 , $258.05 , $250.97 , $39.08 , $50.15 , $203.91 , $200.35 , $369.21 , $357.30 , $357.30 , $317.60 , $317.60 , $50.15 , $366.55 , $377.15 , $357.30 , $357.30 , $357.30 , $369.21 , $381.12 , $234.59 , $337.45 , $217.66 , $243.04 , N/A , $207.89 , $207.89 , $377.15 , $244.35 , $39.08 , $381.12 
 Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC ,MS DRG V40 (FY2023) 097,N/A,N/A,N/A," $59,195.22 "," $38,476.89 "," $49,723.98 ", N/A , N/A ," $47,829.74 "," $53,275.70 "," $50,114.67 "," $53,275.70 "," $53,275.70 "," $53,275.70 "," $50,315.94 ", N/A ," $54,654.95 "," $56,235.46 "," $50,315.94 "," $55,051.55 "," $55,051.55 "," $56,235.46 "," $56,827.41 "," $48,433.53 "," $53,275.70 "," $50,315.94 "," $46,764.22 ", N/A ," $47,906.69 "," $47,906.69 "," $56,235.46 "," $50,795.42 "," $46,764.22 "," $56,827.41 "
"Exc Soft Tiss Tumor Shldr,Subq",23075,N/A,N/A,N/A," $3,149.00 "," $2,046.85 "," $2,002.85 ", $312.68 , $122.79 ," $1,565.39 "," $1,579.30 "," $2,928.57 "," $2,834.10 "," $2,834.10 "," $2,519.20 "," $2,519.20 ", $122.79 ," $2,907.47 "," $2,991.55 "," $2,834.10 "," $2,834.10 "," $2,834.10 "," $2,928.57 "," $3,023.04 "," $1,849.84 "," $2,676.65 "," $1,744.81 "," $1,856.79 ", N/A ," $1,595.93 "," $1,595.93 "," $2,991.55 "," $1,875.78 ", $122.79 ," $3,023.04 "
 Pro Dilation and Curettage ,CPT® 58120,0982 - PRO FEE/OUTPT,N/A,N/A," $1,880.00 "," $1,222.00 "," $1,105.05 ", $223.42 , $234.44 , $891.43 , $887.78 ," $1,748.40 "," $1,692.00 "," $1,692.00 "," $1,504.00 "," $1,504.00 ", $234.44 ," $1,735.80 "," $1,786.00 "," $1,692.00 "," $1,692.00 "," $1,692.00 "," $1,748.40 "," $1,804.80 "," $1,141.04 "," $1,598.00 "," $1,166.78 ", $894.68 , N/A , $908.82 , $908.82 ," $1,786.00 "," $1,090.09 ", $223.42 ," $1,804.80 "
Reinsert Spinal Fixation,CPT® 22849,N/A,N/A,N/A," $8,476.00 "," $5,509.40 "," $7,670.26 "," $1,197.99 "," $1,263.00 "," $6,227.75 "," $6,128.48 "," $7,882.68 "," $7,628.40 "," $7,628.40 "," $6,780.80 "," $6,780.80 "," $1,263.00 "," $7,825.89 "," $8,052.20 "," $7,628.40 "," $7,628.40 "," $7,628.40 "," $7,882.68 "," $8,136.96 "," $7,148.45 "," $7,204.60 "," $6,888.27 "," $7,221.76 ", N/A ," $6,349.26 "," $6,349.26 "," $8,052.20 "," $7,462.64 "," $1,197.99 "," $8,136.96 "
Release Foot/Toe Nerve,CPT® 64726,N/A,N/A,N/A," $1,883.00 "," $1,223.95 "," $1,342.33 ", $263.69 , $230.52 ," $1,541.87 "," $1,489.94 "," $1,751.19 "," $1,694.70 "," $1,694.70 "," $1,506.40 "," $1,506.40 ", $230.52 ," $1,738.57 "," $1,788.85 "," $1,694.70 "," $1,694.70 "," $1,694.70 "," $1,751.19 "," $1,807.68 "," $1,441.01 "," $1,600.55 "," $1,446.88 "," $1,645.77 ", N/A ," $1,571.95 "," $1,571.95 "," $1,788.85 "," $1,686.34 ", $230.52 ," $1,807.68 "
Ft Insert Ucb Berkeley Shell,HCPCS L3000,N/A,N/A,N/A, $243.00 , $157.95 , N/A , $367.46 , $126.91 , N/A , N/A , $225.99 , $218.70 , $218.70 , $194.40 , $194.40 , $126.91 , $224.36 , $230.85 , $218.70 , $218.70 , $218.70 , $225.99 , $233.28 , N/A , $206.55 , $303.62 , $309.16 , N/A , N/A , N/A , $230.85 , N/A , $126.91 , $367.46 
 Pro Drainage of Skin Abscess ,CPT® 10061,0981 - PRO FEE/ER,N/A,N/A, $834.00 , $542.10 , $590.92 , $177.26 , $93.30 , $490.97 , $481.05 , $775.62 , $750.60 , $750.60 , $667.20 , $667.20 , $93.30 , $770.03 , $792.30 , $750.60 , $750.60 , $750.60 , $775.62 , $800.64 , $644.00 , $708.90 , $950.91 , $632.67 , N/A , $500.54 , $500.54 , $792.30 , $580.46 , $93.30 , $950.91 
"Revise Urethra, 1st Stage",CPT® 53400,N/A,N/A,N/A," $5,584.00 "," $3,629.60 "," $4,330.73 ", $762.43 , $614.70 ," $3,915.60 "," $3,664.56 "," $5,193.12 "," $5,025.60 "," $5,025.60 "," $4,467.20 "," $4,467.20 ", $614.70 ," $5,155.71 "," $5,304.80 "," $5,025.60 "," $5,025.60 "," $5,025.60 "," $5,193.12 "," $5,360.64 "," $4,347.25 "," $4,746.40 "," $4,155.09 "," $4,921.18 ", N/A ," $3,992.01 "," $3,992.01 "," $5,304.80 "," $4,692.03 ", $614.70 ," $5,360.64 "
 Fac Chemotx Admn Pleural Cavity Req&W/Thoracnts ,CPT® 96440,0335 - CHEMOTHERP-IV,N/A,N/A," $1,040.00 ", $676.00 , $873.60 , $129.96 , $134.30 , $840.32 , $936.00 , $880.46 , $936.00 , $936.00 , $936.00 , $884.00 , $131.67 , $960.23 , $988.00 , $884.00 , $967.20 , $967.20 , $988.00 , $998.40 , $850.93 , $936.00 , $884.00 , $821.60 , N/A , $841.67 , $841.67 , $988.00 , $892.42 , $129.96 , $998.40 
"Neg Press Wound Tx, < 50 Cm",97605,N/A,N/A,N/A, $215.00 , $139.75 , $58.68 , $24.70 , $29.41 , $60.43 , $51.61 , $199.95 , $193.50 , $193.50 , $172.00 , $172.00 , $29.41 , $198.51 , $204.25 , $193.50 , $193.50 , $193.50 , $199.95 , $206.40 , $77.95 , $182.75 , $78.06 , $59.41 , N/A , $61.61 , $61.61 , $204.25 , $68.53 , $24.70 , $206.40 
 Pro Incisional Biopsy Skin Single Lesion ,CPT® 11106,0982 - PRO FEE/OUTPT,N/A,N/A, $600.00 , $390.00 , $182.51 , $53.95 , $118.70 , $154.51 , N/A , $558.00 , $540.00 , $540.00 , $480.00 , $480.00 , $118.70 , $553.98 , $570.00 , $540.00 , $540.00 , $540.00 , $558.00 , $576.00 , $203.73 , $510.00 , $296.75 , $211.83 , N/A , $157.53 , $157.53 , $570.00 , $182.68 , $53.95 , $576.00 
Drain Bartholin's Gland,56420,N/A,N/A,N/A, $690.00 , $448.50 , $529.30 , $107.00 , $49.34 , $372.48 , $373.89 , $641.70 , $621.00 , $621.00 , $552.00 , $552.00 , $49.34 , $637.08 , $655.50 , $621.00 , $621.00 , $621.00 , $641.70 , $662.40 , $537.13 , $586.50 , $490.62 , $372.95 , N/A , $379.75 , $379.75 , $655.50 , $455.49 , $49.34 , $662.40 
Excise Major Periph Neurofibroma,CPT® 64790,N/A,N/A,N/A," $5,893.00 "," $3,830.45 "," $4,013.67 ", $788.46 , $566.54 ," $4,583.02 "," $4,372.71 "," $5,480.49 "," $5,303.70 "," $5,303.70 "," $4,714.40 "," $4,714.40 ", $566.54 ," $5,441.01 "," $5,598.35 "," $5,303.70 "," $5,303.70 "," $5,303.70 "," $5,480.49 "," $5,657.28 "," $4,324.83 "," $5,009.05 "," $4,376.31 "," $4,865.72 ", N/A ," $4,672.44 "," $4,672.44 "," $5,598.35 "," $5,012.40 ", $566.54 ," $5,657.28 "
"Laryngoscopy,Indirect",CPT® 31505,N/A,N/A,N/A, $508.00 , $330.20 , $265.36 , $47.56 , $48.28 , $188.55 , $189.85 , $472.44 , $457.20 , $457.20 , $406.40 , $406.40 , $48.28 , $469.04 , $482.60 , $457.20 , $457.20 , $457.20 , $472.44 , $487.68 , $252.04 , $431.80 , $265.83 , $249.84 , N/A , $192.23 , $192.23 , $482.60 , $226.41 , $47.56 , $487.68 
Nasal/Sinus Ndsc Tot W/Sphendt W/Sphen Tiss Rmvl,CPT® 31259,N/A,N/A,N/A," $2,673.00 "," $1,737.45 "," $2,541.62 ", $448.65 , $366.10 ," $1,694.76 "," $1,716.06 "," $2,485.89 "," $2,405.70 "," $2,405.70 "," $2,138.40 "," $2,138.40 ", $366.10 ," $2,467.98 "," $2,539.35 "," $2,405.70 "," $2,405.70 "," $2,405.70 "," $2,485.89 "," $2,566.08 "," $2,438.94 "," $2,272.05 "," $2,491.27 "," $2,408.39 ", N/A ," $1,727.84 "," $1,727.84 "," $2,539.35 "," $2,034.88 ", $366.10 ," $2,566.08 "
 Fac Urine Culture/Colony Count ,CPT® 87086,0306 - LAB/BACT-MICRO,N/A,N/A, $113.00 , $73.45 , $94.92 , $8.23 , $8.23 , $91.30 , $101.70 , $95.67 , $101.70 , $101.70 , $101.70 , $96.05 , $8.07 , $104.33 , $107.35 , $96.05 , $105.09 , $105.09 , $107.35 , $108.48 , $92.46 , $101.70 , $96.05 , $89.27 , N/A , $91.45 , $91.45 , $107.35 , $96.97 , $8.07 , $108.48 
 Fac Assay of Myoglobin ,CPT® 83874,0301 - LAB/CHEMISTRY,N/A,N/A, $174.00 , $113.10 , $146.16 , $13.18 , $13.18 , $140.59 , $156.60 , $147.31 , $156.60 , $156.60 , $156.60 , $147.90 , $12.92 , $160.65 , $165.30 , $147.90 , $161.82 , $161.82 , $165.30 , $167.04 , $142.37 , $156.60 , $147.90 , $137.46 , N/A , $140.82 , $140.82 , $165.30 , $149.31 , $12.92 , $167.04 
Drug Screen Quantitative Oxcarbazepine,CPT® 80183,N/A,N/A,N/A, $145.00 , $94.25 , N/A , $13.52 , $13.52 , $75.01 , $89.06 , $134.85 , $130.50 , $130.50 , $116.00 , $116.00 , $13.52 , $133.88 , $137.75 , $130.50 , $130.50 , $130.50 , $134.85 , $139.20 , $88.47 , $123.25 , $63.00 , $48.05 , N/A , $70.00 , $70.00 , $137.75 , $76.49 , $13.52 , $139.20 
 AMPICILLIN SODIUM 1 G IJ SOLR ,HCPCS J0290,0636 - DRUGS REQUIRING DETAILED CODIN,00781-3404-95,8 mL, $44.36 , $28.83 , $37.26 , $0.80 , $0.94 , $35.84 , $39.92 , $37.56 , $39.92 , $39.92 , $39.92 , $37.71 , $0.92 , $40.96 , $42.14 , $37.71 , $41.25 , $41.25 , $42.14 , $42.59 , $36.30 , $39.92 , $37.71 , $35.04 , N/A , $35.90 , $35.90 , $42.14 , $38.07 , $0.80 , $42.59 
"Dest,Choroid Lesn,Photodyn Ther,2nd Eye",CPT® 67225,N/A,N/A,N/A, $274.00 , $178.10 , $169.85 , $26.53 , $86.70 , $158.64 , $143.12 , $254.82 , $246.60 , $246.60 , $219.20 , $219.20 , $86.70 , $252.98 , $260.30 , $246.60 , $246.60 , $246.60 , $254.82 , $263.04 , $233.65 , $232.90 , $146.29 , $202.37 , N/A , $161.73 , $161.73 , $260.30 , $178.54 , $26.53 , $263.04 
 Fac Arven Anast Opn Upr Arm Basilic Vein Trpos ,CPT® 36819,0360 - OR SERVICES,N/A,N/A," $6,966.00 "," $4,527.90 "," $5,851.44 ", $653.90 , $826.83 ," $5,628.53 "," $6,269.40 "," $5,897.42 "," $6,269.40 "," $6,269.40 "," $6,269.40 "," $5,921.10 ", $810.62 ," $6,431.71 "," $6,617.70 "," $5,921.10 "," $6,478.38 "," $6,478.38 "," $6,617.70 "," $6,687.36 "," $5,699.58 "," $6,269.40 "," $5,921.10 "," $5,503.14 ", N/A ," $5,637.58 "," $5,637.58 "," $6,617.70 "," $5,977.52 ", $653.90 ," $6,687.36 "
Myringoplasty,CPT® 69620,N/A,N/A,N/A," $4,108.00 "," $2,670.20 "," $2,365.80 ", $481.44 , $595.39 ," $2,351.97 "," $2,426.87 "," $3,820.44 "," $3,697.20 "," $3,697.20 "," $3,286.40 "," $3,286.40 ", $595.39 ," $3,792.92 "," $3,902.60 "," $3,697.20 "," $3,697.20 "," $3,697.20 "," $3,820.44 "," $3,943.68 "," $2,564.60 "," $3,491.80 "," $2,643.98 "," $2,358.80 ", N/A ," $2,397.87 "," $2,397.87 "," $3,902.60 "," $2,737.95 ", $481.44 ," $3,943.68 "
"Fix Non/Malunion Femur,W Graft",27472,N/A,N/A,N/A," $8,680.00 "," $5,642.00 "," $7,623.79 "," $1,193.44 "," $1,306.26 "," $6,107.01 "," $6,049.44 "," $8,072.40 "," $7,812.00 "," $7,812.00 "," $6,944.00 "," $6,944.00 "," $1,306.26 "," $8,014.24 "," $8,246.00 "," $7,812.00 "," $7,812.00 "," $7,812.00 "," $8,072.40 "," $8,332.80 "," $7,105.67 "," $7,378.00 "," $6,695.59 "," $7,167.78 ", N/A ," $6,226.17 "," $6,226.17 "," $8,246.00 "," $7,317.95 "," $1,193.44 "," $8,332.80 "
 Pro Pro Laps W/Vag Hyst 250 Gm/< Rmvl Tube&/Ovary ,CPT® 58552,0982 - PRO FEE/OUTPT,N/A,N/A," $5,883.00 "," $3,823.95 "," $4,609.25 ", $933.94 , $868.75 ," $4,012.25 "," $3,980.92 "," $5,471.19 "," $5,294.70 "," $5,294.70 "," $4,706.40 "," $4,706.40 ", $868.75 ," $5,431.77 "," $5,588.85 "," $5,294.70 "," $5,294.70 "," $5,294.70 "," $5,471.19 "," $5,647.68 "," $4,834.48 "," $5,000.55 "," $5,239.80 "," $4,021.65 ", N/A ," $4,090.54 "," $4,090.54 "," $5,588.85 "," $4,906.35 ", $868.75 ," $5,647.68 "
 SUCCIMER 100 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,55292-0201-11,1 capsule, $148.19 , $96.32 , $124.48 , N/A , N/A , $119.74 , $133.37 , $125.46 , $133.37 , $133.37 , $133.37 , $125.96 , N/A , $136.82 , $140.78 , $125.96 , $137.82 , $137.82 , $140.78 , $142.26 , $121.25 , $133.37 , $125.96 , $117.07 , N/A , $119.93 , $119.93 , $140.78 , $127.16 , $117.07 , $142.26 
 Unlisted Procedure Lungs and Pluera ,CPT® 32999,0761 - TREATMENT ROOM,N/A,N/A," $1,709.00 "," $1,110.85 "," $1,435.56 ", N/A , N/A ," $1,380.87 "," $1,538.10 "," $1,446.84 "," $1,538.10 "," $1,538.10 "," $1,538.10 "," $1,452.65 ", N/A ," $1,577.92 "," $1,623.55 "," $1,452.65 "," $1,589.37 "," $1,589.37 "," $1,623.55 "," $1,640.64 "," $1,398.30 "," $1,538.10 "," $1,452.65 "," $1,350.11 ", N/A ," $1,383.09 "," $1,383.09 "," $1,623.55 "," $1,466.49 "," $1,350.11 "," $1,640.64 "
 Fac Dbrdmt Nail Any Meth 1-5 ,CPT® 11720,0761 - TREATMENT ROOM,N/A,N/A, $109.00 , $70.85 , $91.56 , $13.79 , $19.04 , $88.07 , $98.10 , $92.28 , $98.10 , $98.10 , $98.10 , $92.65 , $18.67 , $100.64 , $103.55 , $92.65 , $101.37 , $101.37 , $103.55 , $104.64 , $89.18 , $98.10 , $92.65 , $86.11 , N/A , $88.21 , $88.21 , $103.55 , $93.53 , $13.79 , $104.64 
Breath Hydrogen Test,CPT® 91065,N/A,N/A,N/A, $319.00 , $207.35 , $212.69 , $82.65 , $59.99 , $243.11 , $225.01 , $296.67 , $287.10 , $287.10 , $255.20 , $255.20 , $59.99 , $294.53 , $303.05 , $287.10 , $287.10 , $287.10 , $296.67 , $306.24 , $396.28 , $271.15 , $299.05 , $272.70 , N/A , $247.86 , $247.86 , $303.05 , $291.62 , $59.99 , $396.28 
Behavior ID Assessment by Phys/Qhp Ea 15 Min,CPT® 97151,N/A,N/A,N/A, $120.00 , $78.00 , N/A , N/A , $24.31 , N/A , N/A , $111.60 , $108.00 , $108.00 , $96.00 , $96.00 , $24.31 , $110.80 , $114.00 , $108.00 , $108.00 , $108.00 , $111.60 , $115.20 , N/A , $102.00 , $96.00 , N/A , N/A , N/A , N/A , $114.00 , N/A , $24.31 , $115.20 
 SOTALOL HCL 80 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60505-0080-00,1 tablet, $13.17 , $8.56 , $11.06 , N/A , N/A , $10.64 , $11.85 , $11.15 , $11.85 , $11.85 , $11.85 , $11.19 , N/A , $12.16 , $12.51 , $11.19 , $12.25 , $12.25 , $12.51 , $12.64 , $10.78 , $11.85 , $11.19 , $10.40 , N/A , $10.66 , $10.66 , $12.51 , $11.30 , $10.40 , $12.64 
Wbc Antibody Identification,CPT® 86021,N/A,N/A,N/A, $276.00 , $179.40 , N/A , $15.35 , $15.35 , $85.18 , $101.90 , $256.68 , $248.40 , $248.40 , $220.80 , $220.80 , $15.35 , $254.83 , $262.20 , $248.40 , $248.40 , $248.40 , $256.68 , $264.96 , $100.49 , $234.60 , $98.93 , $54.60 , N/A , $79.50 , $79.50 , $262.20 , $86.88 , $15.35 , $264.96 
 Fac Thrmbc Artl/Ven Grf Oth/Thn Hemo Grf/Fstl ,CPT® 35875,0360 - OR SERVICES,N/A,N/A," $1,949.00 "," $1,266.85 "," $1,637.16 ", $531.09 ," $1,090.66 "," $1,574.79 "," $1,754.10 "," $1,650.02 "," $1,754.10 "," $1,754.10 "," $1,754.10 "," $1,656.65 "," $1,069.27 "," $1,799.51 "," $1,851.55 "," $1,656.65 "," $1,812.57 "," $1,812.57 "," $1,851.55 "," $1,871.04 "," $1,594.67 "," $1,754.10 "," $1,656.65 "," $1,539.71 ", N/A ," $1,577.33 "," $1,577.33 "," $1,851.55 "," $1,672.44 ", $531.09 ," $1,871.04 "
" Mra W/O & W/Contrast, Chest ",HCPCS C8911,0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA-OTHER,N/A,N/A," $3,827.00 "," $2,487.55 "," $3,214.68 ", N/A , N/A ," $3,092.22 "," $3,444.30 "," $3,239.94 "," $3,444.30 "," $3,444.30 "," $3,444.30 "," $3,252.95 ", N/A ," $3,533.47 "," $3,635.65 "," $3,252.95 "," $3,559.11 "," $3,559.11 "," $3,635.65 "," $3,673.92 "," $3,131.25 "," $3,444.30 "," $3,252.95 "," $3,023.33 ", N/A ," $3,097.19 "," $3,097.19 "," $3,635.65 "," $3,283.95 "," $3,023.33 "," $3,673.92 "
Insert Ao/Grt Vess Grft Cp Bypass,CPT® 33335,N/A,N/A,N/A," $11,461.00 "," $7,449.65 "," $10,915.26 "," $1,686.81 "," $1,760.46 "," $8,059.18 "," $7,967.90 "," $10,658.73 "," $10,314.90 "," $10,314.90 "," $9,168.80 "," $9,168.80 "," $1,760.46 "," $10,581.94 "," $10,887.95 "," $10,314.90 "," $10,314.90 "," $10,314.90 "," $10,658.73 "," $11,002.56 "," $10,104.55 "," $9,741.85 "," $10,092.45 "," $9,041.84 ", N/A ," $8,216.44 "," $8,216.44 "," $10,887.95 "," $9,333.88 "," $1,686.81 "," $11,002.56 "
"Exc Skin Benig <5mm Face,Facial",11440,N/A,N/A,N/A, $547.00 , $355.55 , $341.29 , $103.49 , $82.89 , $281.15 , $281.65 , $508.71 , $492.30 , $492.30 , $437.60 , $437.60 , $82.89 , $505.05 , $519.65 , $492.30 , $492.30 , $492.30 , $508.71 , $525.12 , $369.08 , $464.95 , $558.41 , $365.26 , N/A , $286.63 , $286.63 , $519.65 , $332.38 , $82.89 , $558.41 
Open Post Repair Ea Addn Vert Fx,CPT® 22328,N/A,N/A,N/A," $1,937.00 "," $1,259.05 "," $1,606.67 ", $250.69 , $400.05 ," $1,343.84 "," $1,309.00 "," $1,801.41 "," $1,743.30 "," $1,743.30 "," $1,549.60 "," $1,549.60 ", $400.05 ," $1,788.43 "," $1,840.15 "," $1,743.30 "," $1,743.30 "," $1,743.30 "," $1,801.41 "," $1,859.52 "," $1,505.82 "," $1,646.45 "," $1,487.91 "," $1,544.93 ", N/A ," $1,370.06 "," $1,370.06 "," $1,840.15 "," $1,610.32 ", $250.69 ," $1,859.52 "
 Pro Colonoscopy Stoma W/Rmvl Tum Polyp/Oth Les Snare ,CPT® 44394,0982 - PRO FEE/OUTPT,N/A,N/A," $3,608.00 "," $2,345.20 "," $1,376.83 ", $212.48 , $362.61 ," $1,213.88 "," $1,241.51 "," $3,355.44 "," $3,247.20 "," $3,247.20 "," $2,886.40 "," $2,886.40 ", $362.61 ," $3,331.27 "," $3,427.60 "," $3,247.20 "," $3,247.20 "," $3,247.20 "," $3,355.44 "," $3,463.68 ", $987.63 ," $3,066.80 "," $1,364.81 "," $1,311.20 ", N/A ," $1,237.57 "," $1,237.57 "," $3,427.60 "," $1,294.36 ", $212.48 ," $3,463.68 "
"Echography,Chest,B-Scan&/or Real Time",76604,N/A,N/A,N/A, $259.00 , $168.35 , $329.38 , $55.74 , $82.61 , $423.02 , $465.39 , $240.87 , $233.10 , $233.10 , $207.20 , $207.20 , $82.61 , $239.13 , $246.05 , $233.10 , $233.10 , $233.10 , $240.87 , $248.64 , $369.55 , $220.15 , $508.48 , $501.74 , N/A , $431.28 , $431.28 , $246.05 , $499.21 , $55.74 , $508.48 
 Fac Frsh Frozen Plsm Thawing Ea Unit ,CPT® 86927,0390 - BLOOD/STOR-PROC,N/A,N/A, $66.00 , $42.90 , $55.44 , N/A , $17.56 , $53.33 , $59.40 , $55.88 , $59.40 , $59.40 , $59.40 , $56.10 , $17.22 , $60.94 , $62.70 , $56.10 , $61.38 , $61.38 , $62.70 , $63.36 , $54.00 , $59.40 , $56.10 , $52.14 , N/A , $53.41 , $53.41 , $62.70 , $56.63 , $17.22 , $63.36 
"Incise Tendon/Muscle,Shldr,Single",CPT® 23405,N/A,N/A,N/A," $3,234.00 "," $2,102.10 "," $3,790.61 ", $591.33 , $461.04 ," $3,012.60 "," $3,015.25 "," $3,007.62 "," $2,910.60 "," $2,910.60 "," $2,587.20 "," $2,587.20 ", $461.04 ," $2,985.95 "," $3,072.30 "," $2,910.60 "," $2,910.60 "," $2,910.60 "," $3,007.62 "," $3,104.64 "," $3,522.94 "," $2,748.90 "," $3,327.28 "," $3,526.66 ", N/A ," $3,071.38 "," $3,071.38 "," $3,072.30 "," $3,609.96 ", $461.04 ," $3,790.61 "
Temp Closure Eyelid by Suture,CPT® 67875,N/A,N/A,N/A," $1,689.00 "," $1,097.85 ", $584.35 , $91.64 , $171.28 , $549.91 , $517.49 ," $1,570.77 "," $1,520.10 "," $1,520.10 "," $1,351.20 "," $1,351.20 ", $171.28 ," $1,559.45 "," $1,604.55 "," $1,520.10 "," $1,520.10 "," $1,520.10 "," $1,570.77 "," $1,621.44 ", $805.88 ," $1,435.65 ", $537.00 , $699.09 , N/A , $560.64 , $560.64 ," $1,604.55 ", $618.87 , $91.64 ," $1,621.44 "
" Pro Tomosynthesis, Mammo Diagnostic ",CPT® G0279,0972 - PRO FEE/RAD/DX,N/A,N/A, $141.00 , $91.65 , $217.43 , $52.04 , $105.44 , $102.62 , N/A , $131.13 , $126.90 , $126.90 , $112.80 , $112.80 , $105.44 , $130.19 , $133.95 , $126.90 , $126.90 , $126.90 , $131.13 , $135.36 , $301.25 , $119.85 , $102.09 , $299.38 , N/A , $104.62 , $104.62 , $133.95 , $130.79 , $52.04 , $301.25 
 Pro Chg Radiologic Exam Chest Single View ,CPT® 71045,0972 - PRO FEE/RAD/DX,N/A,N/A, $118.00 , $76.70 , $145.12 , $25.48 , $15.52 , $88.96 , $99.17 , $109.74 , $106.20 , $106.20 , $94.40 , $94.40 , $15.52 , $108.95 , $112.10 , $106.20 , $106.20 , $106.20 , $109.74 , $113.28 , $140.79 , $100.30 , $149.63 , $110.18 , N/A , $90.69 , $90.69 , $112.10 , $104.98 , $15.52 , $149.63 
" Pro Insertion Catheter, Artery ",CPT® 36620,0960 - PRO FEE,N/A,N/A, $617.00 , $401.05 , $273.33 , $42.54 , $73.68 , $223.80 , $217.36 , $573.81 , $555.30 , $555.30 , $493.60 , $493.60 , $73.68 , $569.68 , $586.15 , $555.30 , $555.30 , $555.30 , $573.81 , $592.32 , $253.56 , $524.45 , $265.83 , $223.05 , N/A , $228.17 , $228.17 , $586.15 , $259.19 , $42.54 , $592.32 
Fx Cl Humeral W/O Manipul,CPT® 24576,N/A,N/A,N/A," $2,245.00 "," $1,459.25 "," $1,950.91 ", $309.19 , $184.42 ," $1,473.39 "," $1,496.54 "," $2,087.85 "," $2,020.50 "," $2,020.50 "," $1,796.00 "," $1,796.00 ", $184.42 ," $2,072.81 "," $2,132.75 "," $2,020.50 "," $2,020.50 "," $2,020.50 "," $2,087.85 "," $2,155.20 "," $1,793.26 "," $1,908.25 "," $1,643.12 "," $1,749.60 ", N/A ," $1,502.13 "," $1,502.13 "," $2,132.75 "," $1,765.55 ", $184.42 ," $2,155.20 "
Excis Vaginal Septum,CPT® 57130,N/A,N/A,N/A," $1,496.00 ", $972.40 , $822.65 , $166.65 , $197.52 , $646.74 , $650.06 ," $1,391.28 "," $1,346.40 "," $1,346.40 "," $1,196.80 "," $1,196.80 ", $197.52 ," $1,381.26 "," $1,421.20 "," $1,346.40 "," $1,346.40 "," $1,346.40 "," $1,391.28 "," $1,436.16 ", $847.47 ," $1,271.60 ", $852.78 , $650.95 , N/A , $659.36 , $659.36 ," $1,421.20 ", $790.86 , $166.65 ," $1,436.16 "
Subsequent Intensive Care Infant 2501-5000 Grams,CPT® 99480,N/A,N/A,N/A, $765.00 , $497.25 , $239.00 , $113.80 , $115.59 , $316.51 , $321.10 , $711.45 , $688.50 , $688.50 , $612.00 , $612.00 , $115.59 , $706.32 , $726.75 , $688.50 , $688.50 , $688.50 , $711.45 , $734.40 , $301.11 , $650.25 , $257.29 , $397.34 , N/A , $322.69 , $322.69 , $726.75 , $386.10 , $113.80 , $734.40 
 Pro Removal of Nail Bed ,CPT® 11750,0981 - PRO FEE/ER,N/A,N/A, $813.00 , $528.45 , $330.85 , $98.28 , $111.46 , $478.76 , $468.04 , $756.09 , $731.70 , $731.70 , $650.40 , $650.40 , $111.46 , $750.64 , $772.35 , $731.70 , $731.70 , $731.70 , $756.09 , $780.48 , $362.83 , $691.05 , $918.79 , $362.76 , N/A , $488.10 , $488.10 , $772.35 , $566.03 , $98.28 , $918.79 
 Pro Revise Hip Joint Replacement ,CPT® 27138,0975 - PRO FEE/OR,N/A,N/A," $10,107.00 "," $6,569.55 "," $9,150.12 "," $1,427.88 "," $1,251.82 "," $7,397.03 "," $7,312.86 "," $9,399.51 "," $9,096.30 "," $9,096.30 "," $8,085.60 "," $8,085.60 "," $1,251.82 "," $9,331.79 "," $9,601.65 "," $9,096.30 "," $9,096.30 "," $9,096.30 "," $9,399.51 "," $9,702.72 "," $8,543.88 "," $8,590.95 "," $8,101.43 "," $8,692.39 ", N/A ," $7,541.36 "," $7,541.36 "," $9,601.65 "," $8,863.76 "," $1,251.82 "," $9,702.72 "
"Remove Foreign Body,Foot",28192,N/A,N/A,N/A," $3,173.00 "," $2,062.45 "," $1,930.89 ", $301.68 , $190.55 ," $1,545.60 "," $1,551.74 "," $2,950.89 "," $2,855.70 "," $2,855.70 "," $2,538.40 "," $2,538.40 ", $190.55 ," $2,929.63 "," $3,014.35 "," $2,855.70 "," $2,855.70 "," $2,855.70 "," $2,950.89 "," $3,046.08 "," $1,797.60 "," $2,697.05 "," $1,680.59 "," $1,833.96 ", N/A ," $1,575.76 "," $1,575.76 "," $3,014.35 "," $1,852.06 ", $190.55 ," $3,046.08 "
 Fac Drug Screening Barbiturates ,CPT® 80345,0301 - LAB/CHEMISTRY,N/A,N/A, $153.00 , $99.45 , $128.52 , N/A , N/A , $123.62 , $137.70 , $129.53 , $137.70 , $137.70 , $137.70 , $130.05 , N/A , $141.26 , $145.35 , $130.05 , $142.29 , $142.29 , $145.35 , $146.88 , $125.18 , $137.70 , $130.05 , $120.87 , N/A , $123.82 , $123.82 , $145.35 , $131.29 , $120.87 , $146.88 
"Remv Kidney/Ureter,Separ Incis",CPT® 50236,N/A,N/A,N/A," $10,209.00 "," $6,635.85 "," $7,909.47 "," $1,388.63 "," $1,536.80 "," $7,177.84 "," $6,661.80 "," $9,494.37 "," $9,188.10 "," $9,188.10 "," $8,167.20 "," $8,167.20 "," $1,536.80 "," $9,425.97 "," $9,698.55 "," $9,188.10 "," $9,188.10 "," $9,188.10 "," $9,494.37 "," $9,800.64 "," $7,944.01 "," $8,677.65 "," $7,546.59 "," $9,016.09 ", N/A ," $7,317.89 "," $7,317.89 "," $9,698.55 "," $8,601.11 "," $1,388.63 "," $9,800.64 "
" Pro Drain/Inject, Joint/Bursa ",CPT® 20610,0981 - PRO FEE/ER,N/A,N/A, $378.00 , $245.70 , $274.69 , $42.73 , $65.94 , $223.70 , $219.57 , $351.54 , $340.20 , $340.20 , $302.40 , $302.40 , $65.94 , $349.01 , $359.10 , $340.20 , $340.20 , $340.20 , $351.54 , $362.88 , $257.37 , $321.30 , $240.85 , $264.61 , N/A , $228.06 , $228.06 , $359.10 , $268.04 , $42.73 , $362.88 
 Pro Exc Face-Mm Malig+Marg 2.1-3 ,CPT® 11643,0982 - PRO FEE/OUTPT,N/A,N/A," $1,730.00 "," $1,124.50 ", $726.61 , $217.56 , $390.36 , $630.37 , $614.15 ," $1,608.90 "," $1,557.00 "," $1,557.00 "," $1,384.00 "," $1,384.00 ", $390.36 ," $1,597.31 "," $1,643.50 "," $1,557.00 "," $1,557.00 "," $1,557.00 "," $1,608.90 "," $1,660.80 ", $796.89 ," $1,470.50 "," $1,225.65 ", $805.09 , N/A , $642.67 , $642.67 ," $1,643.50 ", $745.28 , $217.56 ," $1,660.80 "
 Pro Irrigation of Bladder ,CPT® 51700,0981 - PRO FEE/ER,N/A,N/A, $288.00 , $187.20 , $164.05 , $28.50 , $18.87 , $219.00 , $200.92 , $267.84 , $259.20 , $259.20 , $230.40 , $230.40 , $18.87 , $265.91 , $273.60 , $259.20 , $259.20 , $259.20 , $267.84 , $276.48 , $164.92 , $244.80 , $228.36 , $187.29 , N/A , $223.27 , $223.27 , $273.60 , $262.41 , $18.87 , $276.48 
"Excis Chalazion,Mult,Same Lid",CPT® 67801,N/A,N/A,N/A," $1,463.00 ", $950.95 , $809.77 , $127.30 , $83.90 , $759.34 , $713.30 ," $1,360.59 "," $1,316.70 "," $1,316.70 "," $1,170.40 "," $1,170.40 ", $83.90 ," $1,350.79 "," $1,389.85 "," $1,316.70 "," $1,316.70 "," $1,316.70 "," $1,360.59 "," $1,404.48 "," $1,115.19 "," $1,243.55 ", $742.17 , $960.50 , N/A , $774.16 , $774.16 ," $1,389.85 ", $854.56 , $83.90 ," $1,404.48 "
" Pro N Block Inj, Celiac Pelus ",CPT® 64530,0982 - PRO FEE/OUTPT,N/A,N/A," $1,403.00 ", $911.95 , $468.05 , $90.93 , $158.01 , $517.86 , $512.95 ," $1,304.79 "," $1,262.70 "," $1,262.70 "," $1,122.40 "," $1,122.40 ", $158.01 ," $1,295.39 "," $1,332.85 "," $1,262.70 "," $1,262.70 "," $1,262.70 "," $1,304.79 "," $1,346.88 ", $504.95 ," $1,192.55 ", $499.54 , $551.57 , N/A , $527.97 , $527.97 ," $1,332.85 ", $566.37 , $90.93 ," $1,346.88 "
Blood Clot Factor VII Test,CPT® 85230,N/A,N/A,N/A, $245.00 , $159.25 , N/A , $18.26 , $18.26 , $101.32 , $121.17 , $227.85 , $220.50 , $220.50 , $196.00 , $196.00 , $18.26 , $226.21 , $232.75 , $220.50 , $220.50 , $220.50 , $227.85 , $235.20 , $119.52 , $208.25 , $116.77 , $64.91 , N/A , $94.56 , $94.56 , $232.75 , $103.33 , $18.26 , $235.20 
Exc Tumor Soft Tissue Neck/Ant Thorax Subfascial 5+Cm,CPT® 21554,N/A,N/A,N/A," $5,013.00 "," $3,258.45 "," $4,408.04 ", $688.01 , $607.30 ," $3,515.65 "," $3,494.74 "," $4,662.09 "," $4,511.70 "," $4,511.70 "," $4,010.40 "," $4,010.40 ", $607.30 ," $4,628.50 "," $4,762.35 "," $4,511.70 "," $4,511.70 "," $4,511.70 "," $4,662.09 "," $4,812.48 "," $4,080.46 "," $4,261.05 "," $3,860.71 "," $4,118.79 ", N/A ," $3,584.25 "," $3,584.25 "," $4,762.35 "," $4,212.78 ", $607.30 ," $4,812.48 "
 Chemiluminescent Assay Proib ,CPT® 82397,0301 - LAB/CHEMISTRY,N/A,N/A, $145.00 , $94.25 , $121.80 , $14.40 , $14.40 , $117.16 , $130.50 , $122.76 , $130.50 , $130.50 , $130.50 , $123.25 , $14.12 , $133.88 , $137.75 , $123.25 , $134.85 , $134.85 , $137.75 , $139.20 , $118.64 , $130.50 , $123.25 , $114.55 , N/A , $117.35 , $117.35 , $137.75 , $124.42 , $14.12 , $139.20 
 Pro Cltx Fx W8 Brg Artclr Prtn Dstl Tibia W/O Mnpj ,CPT® 27824,0982 - PRO FEE/OUTPT,N/A,N/A," $1,511.00 ", $982.15 ," $1,893.39 ", $300.54 , $217.57 ," $1,463.07 "," $1,483.65 "," $1,405.23 "," $1,359.90 "," $1,359.90 "," $1,208.80 "," $1,208.80 ", $217.57 ," $1,395.11 "," $1,435.45 "," $1,359.90 "," $1,359.90 "," $1,359.90 "," $1,405.23 "," $1,450.56 "," $1,754.63 "," $1,284.35 "," $1,628.85 "," $1,745.36 ", N/A ," $1,491.62 "," $1,491.62 "," $1,435.45 "," $1,753.18 ", $217.57 ," $1,893.39 "
Grafting of Autologous Soft Tiss by Direct Exc,CPT® 15769,N/A,N/A,N/A," $1,918.00 "," $1,246.70 "," $1,519.66 ", $456.37 , $374.36 ," $1,285.84 ", N/A ," $1,783.74 "," $1,726.20 "," $1,726.20 "," $1,534.40 "," $1,534.40 ", $374.36 ," $1,770.89 "," $1,822.10 "," $1,726.20 "," $1,726.20 "," $1,726.20 "," $1,783.74 "," $1,841.28 "," $1,673.85 "," $1,630.30 "," $2,557.02 "," $1,677.87 ", N/A ," $1,310.93 "," $1,310.93 "," $1,822.10 "," $1,521.36 ", $374.36 ," $2,557.02 "
 IV Urogram/Ivp/Infusion Pyelogram ,CPT® 74410,0320 - DX X-RAY,N/A,N/A," $1,406.00 ", $913.90 ," $1,181.04 ", $139.53 , $103.38 ," $1,136.05 "," $1,265.40 "," $1,190.32 "," $1,265.40 "," $1,265.40 "," $1,265.40 "," $1,195.10 ", $101.35 ," $1,298.16 "," $1,335.70 "," $1,195.10 "," $1,307.58 "," $1,307.58 "," $1,335.70 "," $1,349.76 "," $1,150.39 "," $1,265.40 "," $1,195.10 "," $1,110.74 ", N/A ," $1,137.88 "," $1,137.88 "," $1,335.70 "," $1,206.49 ", $101.35 ," $1,349.76 "
 Remove FB Corneal W/O Slit-Mh ,CPT® 65220,0761 - TREATMENT ROOM,N/A,N/A, $142.00 , $92.30 , $119.28 , $39.41 , $47.02 , $114.74 , $127.80 , $120.22 , $127.80 , $127.80 , $127.80 , $120.70 , $46.10 , $131.11 , $134.90 , $120.70 , $132.06 , $132.06 , $134.90 , $136.32 , $116.18 , $127.80 , $120.70 , $112.18 , N/A , $114.92 , $114.92 , $134.90 , $121.85 , $39.41 , $136.32 
 Fac Fibrinogen Test ,CPT® 85366,0305 - LAB/HEMATOLOGY,N/A,N/A, $97.00 , $63.05 , $81.48 , $82.07 , $11.95 , $78.38 , $87.30 , $82.12 , $87.30 , $87.30 , $87.30 , $82.45 , $11.72 , $89.56 , $92.15 , $82.45 , $90.21 , $90.21 , $92.15 , $93.12 , $79.37 , $87.30 , $82.45 , $76.63 , N/A , $78.50 , $78.50 , $92.15 , $83.24 , $11.72 , $93.12 
"Open Rx a-C Jt Disloc,Fascial Grft",CPT® 23552,N/A,N/A,N/A," $4,508.00 "," $2,930.20 "," $3,995.62 ", $621.15 , $768.38 ," $3,146.73 "," $3,159.48 "," $4,192.44 "," $4,057.20 "," $4,057.20 "," $3,606.40 "," $3,606.40 ", $768.38 ," $4,162.24 "," $4,282.60 "," $4,057.20 "," $4,057.20 "," $4,057.20 "," $4,192.44 "," $4,327.68 "," $3,712.64 "," $3,831.80 "," $3,486.06 "," $3,721.44 ", N/A ," $3,208.13 "," $3,208.13 "," $4,282.60 "," $3,770.70 ", $621.15 ," $4,327.68 "
"Excis Tumor,Soft Tiss Forearm/Wrist,Deep",25076,N/A,N/A,N/A," $3,840.00 "," $2,496.00 "," $3,163.62 ", $499.05 , $502.53 ," $2,486.17 "," $2,483.93 "," $3,571.20 "," $3,456.00 "," $3,456.00 "," $3,072.00 "," $3,072.00 ", $502.53 ," $3,545.47 "," $3,648.00 "," $3,456.00 "," $3,456.00 "," $3,456.00 "," $3,571.20 "," $3,686.40 "," $2,934.93 "," $3,264.00 "," $2,736.75 "," $2,956.63 ", N/A ," $2,534.68 "," $2,534.68 "," $3,648.00 "," $2,979.16 ", $499.05 ," $3,686.40 "
 Fac Cryoprecipitate Each Unit ,HCPCS P9012,0390 - BLOOD/STOR-PROC,N/A,N/A, $154.00 , $100.10 , $129.36 , N/A , N/A , $124.43 , $138.60 , $130.38 , $138.60 , $138.60 , $138.60 , $130.90 , N/A , $142.19 , $146.30 , $130.90 , $143.22 , $143.22 , $146.30 , $147.84 , $126.00 , $138.60 , $130.90 , $121.66 , N/A , $124.63 , $124.63 , $146.30 , $132.15 , $121.66 , $147.84 
 CAPSAICIN 0.075 % EX CREA ,HCPCS RXC637,0250 - PHARMACY,00536-1118-25,57 gram, $28.99 , $18.84 , $24.35 , N/A , N/A , $23.42 , $26.09 , $24.54 , $26.09 , $26.09 , $26.09 , $24.64 , N/A , $26.77 , $27.54 , $24.64 , $26.96 , $26.96 , $27.54 , $27.83 , $23.72 , $26.09 , $24.64 , $22.90 , N/A , $23.46 , $23.46 , $27.54 , $24.88 , $22.90 , $27.83 
 IXABEPILONE 15 MG IV SOLR ,HCPCS J9207,0636 - DRUGS REQUIRING DETAILED CODIN,70020-1910-01,7.5 mL," $5,427.48 "," $3,527.86 "," $4,559.08 ", $125.00 , $124.32 ," $4,385.40 "," $4,884.73 "," $4,594.90 "," $4,884.73 "," $4,884.73 "," $4,884.73 "," $4,613.36 ", $121.88 ," $5,011.19 "," $5,156.11 "," $4,613.36 "," $5,047.56 "," $5,047.56 "," $5,156.11 "," $5,210.38 "," $4,440.76 "," $4,884.73 "," $4,613.36 "," $4,287.71 ", N/A ," $4,392.46 "," $4,392.46 "," $5,156.11 "," $4,657.32 ", $121.88 ," $5,210.38 "
"Hla Typing, a,B,or C /Single",CPT® 86812,N/A,N/A,N/A, $200.00 , $130.00 , N/A , $26.33 , $26.33 , $146.01 , $174.68 , $186.00 , $180.00 , $180.00 , $160.00 , $160.00 , $26.33 , $184.66 , $190.00 , $180.00 , $180.00 , $180.00 , $186.00 , $192.00 , $172.34 , $170.00 , $168.67 , $93.57 , N/A , $136.27 , $136.27 , $190.00 , $148.91 , $26.33 , $192.00 
Fx Closed Clavicular,CPT® 23500,N/A,N/A,N/A, $820.00 , $533.00 ," $1,415.05 ", $225.64 , $69.88 ," $1,067.58 "," $1,092.79 ", $762.60 , $738.00 , $738.00 , $656.00 , $656.00 , $69.88 , $757.11 , $779.00 , $738.00 , $738.00 , $738.00 , $762.60 , $787.20 ," $1,301.54 ", $697.00 ," $1,197.11 "," $1,273.41 ", N/A ," $1,088.41 "," $1,088.41 ", $779.00 ," $1,279.27 ", $69.88 ," $1,415.05 "
Remove Drug Implant,HCPCS G0517,N/A,N/A,N/A, $960.00 , $624.00 , $363.22 , $107.71 , N/A , $212.37 , N/A , $892.80 , $864.00 , $864.00 , $768.00 , $768.00 , N/A , $886.37 , $912.00 , $864.00 , $864.00 , $864.00 , $892.80 , $921.60 , $370.94 , $816.00 , $210.00 , $429.50 , N/A , $216.52 , $216.52 , $912.00 , $270.65 , $107.71 , $921.60 
 DULOXETINE HCL 60 MG PO CPEP ,HCPCS RXC637,0250 - PHARMACY,57237-0019-30,1 capsule, $40.34 , $26.22 , $33.89 , N/A , N/A , $32.59 , $36.31 , $34.15 , $36.31 , $36.31 , $36.31 , $34.29 , N/A , $37.25 , $38.32 , $34.29 , $37.52 , $37.52 , $38.32 , $38.73 , $33.01 , $36.31 , $34.29 , $31.87 , N/A , $32.65 , $32.65 , $38.32 , $34.62 , $31.87 , $38.73 
 BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN ,HCPCS RXA250,0250 - PHARMACY,63323-0468-37,30 mL, $60.11 , $39.07 , $50.49 , N/A , N/A , $48.57 , $54.10 , $50.89 , $54.10 , $54.10 , $54.10 , $51.09 , N/A , $55.50 , $57.10 , $51.09 , $55.90 , $55.90 , $57.10 , $57.71 , $49.18 , $54.10 , $51.09 , $47.49 , N/A , $48.65 , $48.65 , $57.10 , $51.58 , $47.49 , $57.71 
 DURVALUMAB 500 MG/10ML IV SOLN ,HCPCS J9173,0636 - DRUGS REQUIRING DETAILED CODIN,00310-4611-50,10 mL," $11,609.09 "," $7,545.91 "," $9,751.64 ", $81.36 , $80.48 ," $9,380.14 "," $10,448.18 "," $9,828.26 "," $10,448.18 "," $10,448.18 "," $10,448.18 "," $9,867.73 ", $78.90 ," $10,718.67 "," $11,028.64 "," $9,867.73 "," $10,796.45 "," $10,796.45 "," $11,028.64 "," $11,144.73 "," $9,498.56 "," $10,448.18 "," $9,867.73 "," $9,171.18 ", N/A ," $9,395.24 "," $9,395.24 "," $11,028.64 "," $9,961.76 ", $78.90 ," $11,144.73 "
 Pro X-Ray Stress View ,CPT® 77071,0972 - PRO FEE/RAD/DX,N/A,N/A, $134.00 , $87.10 , $306.36 , $53.02 , $24.76 , $228.60 , $267.59 , $124.62 , $120.60 , $120.60 , $107.20 , $107.20 , $24.76 , $123.72 , $127.30 , $120.60 , $120.60 , $120.60 , $124.62 , $128.64 , $298.38 , $113.90 , $296.61 , $240.64 , N/A , $233.05 , $233.05 , $127.30 , $269.79 , $24.76 , $306.36 
 Whc Biopsy Bone Open Deep ,CPT® 20245,0361 - OR/MINOR,N/A,N/A," $5,721.00 "," $3,718.65 "," $4,805.64 ", $323.65 , $284.00 ," $4,622.57 "," $5,148.90 "," $4,843.40 "," $5,148.90 "," $5,148.90 "," $5,148.90 "," $4,862.85 ", $278.43 ," $5,282.20 "," $5,434.95 "," $4,862.85 "," $5,320.53 "," $5,320.53 "," $5,434.95 "," $5,492.16 "," $4,680.92 "," $5,148.90 "," $4,862.85 "," $4,519.59 ", N/A ," $4,630.01 "," $4,630.01 "," $5,434.95 "," $4,909.19 ", $278.43 ," $5,492.16 "
 HYDROCORTISONE (PERIANAL) 2.5 % EX CREA ,HCPCS RXC637,0250 - PHARMACY,69315-0312-28,28 gram, $431.50 , $280.48 , $362.46 , N/A , N/A , $348.65 , $388.35 , $365.31 , $388.35 , $388.35 , $388.35 , $366.78 , N/A , $398.40 , $409.93 , $366.78 , $401.30 , $401.30 , $409.93 , $414.24 , $353.05 , $388.35 , $366.78 , $340.89 , N/A , $349.21 , $349.21 , $409.93 , $370.27 , $340.89 , $414.24 
 IRINOTECAN HCL 40 MG/2ML IV SOLN ,HCPCS J9206,0636 - DRUGS REQUIRING DETAILED CODIN,25021-0230-02,2 mL, $35.00 , $22.75 , $29.40 , $3.06 , $2.48 , $28.28 , $31.50 , $29.63 , $31.50 , $31.50 , $31.50 , $29.75 , $2.43 , $32.32 , $33.25 , $29.75 , $32.55 , $32.55 , $33.25 , $33.60 , $28.64 , $31.50 , $29.75 , $27.65 , N/A , $28.33 , $28.33 , $33.25 , $30.03 , $2.43 , $33.60 
 Anoscopy Diagnostic ,CPT® 46600,0360 - OR SERVICES,N/A,N/A, $750.00 , $487.50 , $630.00 , $39.14 , $31.62 , $606.00 , $675.00 , $634.95 , $675.00 , $675.00 , $675.00 , $637.50 , $31.00 , $692.48 , $712.50 , $637.50 , $697.50 , $697.50 , $712.50 , $720.00 , $613.65 , $675.00 , $637.50 , $592.50 , N/A , $606.98 , $606.98 , $712.50 , $643.58 , $31.00 , $720.00 
 ALLOPURINOL 300 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6572-61,1 tablet, $4.16 , $2.70 , $3.49 , N/A , N/A , $3.36 , $3.74 , $3.52 , $3.74 , $3.74 , $3.74 , $3.54 , N/A , $3.84 , $3.95 , $3.54 , $3.87 , $3.87 , $3.95 , $3.99 , $3.40 , $3.74 , $3.54 , $3.29 , N/A , $3.37 , $3.37 , $3.95 , $3.57 , $3.29 , $3.99 
"Exc Skin Malig <5mm Trunk,Arm,Leg",11600,N/A,N/A,N/A, $885.00 , $575.25 , $391.95 , $117.50 , $92.19 , $326.56 , $319.86 , $823.05 , $796.50 , $796.50 , $708.00 , $708.00 , $92.19 , $817.12 , $840.75 , $796.50 , $796.50 , $796.50 , $823.05 , $849.60 , $429.85 , $752.25 , $636.91 , $419.71 , N/A , $332.94 , $332.94 , $840.75 , $386.10 , $92.19 , $849.60 
Cleansing Tissue/Muscle/Bone,CPT® 11044,N/A,N/A,N/A," $1,788.00 "," $1,162.20 ", $710.09 , $211.81 , $318.61 , $632.19 , $613.32 ," $1,662.84 "," $1,609.20 "," $1,609.20 "," $1,430.40 "," $1,430.40 ", $318.61 ," $1,650.86 "," $1,698.60 "," $1,609.20 "," $1,609.20 "," $1,609.20 "," $1,662.84 "," $1,716.48 ", $780.34 ," $1,519.80 "," $1,231.00 ", $800.16 , N/A , $644.53 , $644.53 ," $1,698.60 ", $747.46 , $211.81 ," $1,716.48 "
 Fac Analyze Spine Infusion Pump ,CPT® 62368,0360 - OR SERVICES,N/A,N/A," $1,009.00 ", $655.85 , $847.56 , $32.90 , $49.16 , $815.27 , $908.10 , $854.22 , $908.10 , $908.10 , $908.10 , $857.65 , $48.20 , $931.61 , $958.55 , $857.65 , $938.37 , $938.37 , $958.55 , $968.64 , $825.56 , $908.10 , $857.65 , $797.11 , N/A , $816.58 , $816.58 , $958.55 , $865.82 , $32.90 , $968.64 
Assay for Transcortin,CPT® 84449,N/A,N/A,N/A, $150.00 , $97.50 , N/A , $18.36 , $18.36 , $101.81 , $121.80 , $139.50 , $135.00 , $135.00 , $120.00 , $120.00 , $18.36 , $138.50 , $142.50 , $135.00 , $135.00 , $135.00 , $139.50 , $144.00 , $120.19 , $127.50 , $118.39 , $65.26 , N/A , $95.02 , $95.02 , $142.50 , $103.84 , $18.36 , $144.00 
" Pro Dress/Debrid P-Thick Burn, S ",CPT® 16020,0982 - PRO FEE/OUTPT,N/A,N/A, $364.00 , $236.60 , $173.81 , $52.76 , $30.25 , $148.68 , $145.73 , $338.52 , $327.60 , $327.60 , $291.20 , $291.20 , $30.25 , $336.08 , $345.80 , $327.60 , $327.60 , $327.60 , $338.52 , $349.44 , $191.27 , $309.40 , $289.02 , $192.11 , N/A , $151.58 , $151.58 , $345.80 , $175.80 , $30.25 , $349.44 
Apply Long Leg Splint,29505,N/A,N/A,N/A, $331.00 , $215.15 , $310.83 , $49.45 , $46.08 , $241.34 , $244.33 , $307.83 , $297.90 , $297.90 , $264.80 , $264.80 , $46.08 , $305.61 , $314.45 , $297.90 , $297.90 , $297.90 , $307.83 , $317.76 , $289.85 , $281.35 , $267.61 , $292.25 , N/A , $246.04 , $246.04 , $314.45 , $289.17 , $46.08 , $317.76 
" Pro Place Interst Rad Ther Guide, Perc 1+ ",CPT® 49411,0982 - PRO FEE/OUTPT,N/A,N/A," $4,150.00 "," $2,697.50 "," $1,130.94 ", $177.00 , $430.67 , $963.73 , $951.44 ," $3,859.50 "," $3,735.00 "," $3,735.00 "," $3,320.00 "," $3,320.00 ", $430.67 ," $3,831.70 "," $3,942.50 "," $3,735.00 "," $3,735.00 "," $3,735.00 "," $3,859.50 "," $3,984.00 ", $815.26 ," $3,527.50 "," $1,025.84 "," $1,077.05 ", N/A , $982.53 , $982.53 ," $3,942.50 "," $1,027.62 ", $177.00 ," $3,984.00 "
 BUSPIRONE HCL 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,51079-0986-20,1 tablet, $6.91 , $4.49 , $5.80 , N/A , N/A , $5.58 , $6.22 , $5.85 , $6.22 , $6.22 , $6.22 , $5.87 , N/A , $6.38 , $6.56 , $5.87 , $6.43 , $6.43 , $6.56 , $6.63 , $5.65 , $6.22 , $5.87 , $5.46 , N/A , $5.59 , $5.59 , $6.56 , $5.93 , $5.46 , $6.63 
Aquaporin-4 Antibody Flow Cytometry Each,CPT® 86053,N/A,N/A,N/A, $553.00 , $359.45 , N/A , $38.48 , $12.29 , N/A , N/A , $514.29 , $497.70 , $497.70 , $442.40 , $442.40 , $12.29 , $510.58 , $525.35 , $497.70 , $497.70 , $497.70 , $514.29 , $530.88 , N/A , $470.05 , $179.31 , $35.39 , N/A , $47.24 , $47.24 , $525.35 , $51.94 , $12.29 , $530.88 
Amnioexcel Biodexcel 1sq Cm,HCPCS Q4137,N/A,N/A,N/A, $238.00 , $154.70 , N/A , $106.44 , N/A , N/A , N/A , $221.34 , $214.20 , $214.20 , $190.40 , $190.40 , N/A , $219.75 , $226.10 , $214.20 , $214.20 , $214.20 , $221.34 , $228.48 , $114.08 , $202.30 , $190.62 , $126.97 , N/A , N/A , N/A , $226.10 , N/A , $106.44 , $228.48 
" Neisseria Gonorrhoeae, Amplified Beaker1 ",CPT® 87591,0306 - LAB/BACT-MICRO,N/A,N/A, $317.00 , $206.05 , $266.28 , $35.79 , $35.79 , $256.14 , $285.30 , $268.37 , $285.30 , $285.30 , $285.30 , $269.45 , $35.09 , $292.69 , $301.15 , $269.45 , $294.81 , $294.81 , $301.15 , $304.32 , $259.37 , $285.30 , $269.45 , $250.43 , N/A , $256.55 , $256.55 , $301.15 , $272.02 , $35.09 , $304.32 
 Fac Ins New/Rplc Prm Pacemaker W/Transv Eltrd Ventr ,CPT® 33207,0360 - OR SERVICES,N/A,N/A," $5,513.00 "," $3,583.45 "," $4,630.92 ", $439.76 ," $1,206.21 "," $4,454.50 "," $4,961.70 "," $4,667.31 "," $4,961.70 "," $4,961.70 "," $4,961.70 "," $4,686.05 "," $1,182.56 "," $5,090.15 "," $5,237.35 "," $4,686.05 "," $5,127.09 "," $5,127.09 "," $5,237.35 "," $5,292.48 "," $4,510.74 "," $4,961.70 "," $4,686.05 "," $4,355.27 ", N/A ," $4,461.67 "," $4,461.67 "," $5,237.35 "," $4,730.71 ", $439.76 ," $5,292.48 "
"Replacement, Pulmonary Valve",CPT® 33475,N/A,N/A,N/A," $17,336.00 "," $11,268.40 "," $13,559.85 "," $2,096.23 "," $2,378.00 "," $10,002.50 "," $9,945.87 "," $16,122.48 "," $15,602.40 "," $15,602.40 "," $13,868.80 "," $13,868.80 "," $2,378.00 "," $16,006.33 "," $16,469.20 "," $15,602.40 "," $15,602.40 "," $15,602.40 "," $16,122.48 "," $16,642.56 "," $12,577.76 "," $14,735.60 "," $12,625.82 "," $11,184.15 ", N/A ," $10,197.67 "," $10,197.67 "," $16,469.20 "," $11,584.54 "," $2,096.23 "," $16,642.56 "
"Split Grft,Trunk,Arm,Leg Ea 100sqcm",CPT® 15101,N/A,N/A,N/A," $1,171.00 ", $761.15 , $352.00 , $103.09 , $218.87 , $300.55 , $291.68 ," $1,089.03 "," $1,053.90 "," $1,053.90 ", $936.80 , $936.80 , $218.87 ," $1,081.18 "," $1,112.45 "," $1,053.90 "," $1,053.90 "," $1,053.90 "," $1,089.03 "," $1,124.16 ", $387.86 , $995.35 , $586.96 , $380.23 , N/A , $306.42 , $306.42 ," $1,112.45 ", $355.35 , $103.09 ," $1,124.16 "
 CHLORDIAZEPOXIDE HCL 10 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,51079-0375-20,1 capsule, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Excis Urethral Caruncle,CPT® 53265,N/A,N/A,N/A," $1,484.00 ", $964.60 ," $1,019.19 ", $180.35 , $107.56 , $906.93 , $851.71 ," $1,380.12 "," $1,335.60 "," $1,335.60 "," $1,187.20 "," $1,187.20 ", $107.56 ," $1,370.18 "," $1,409.80 "," $1,335.60 "," $1,335.60 "," $1,335.60 "," $1,380.12 "," $1,424.64 "," $1,019.38 "," $1,261.40 ", $966.96 ," $1,142.47 ", N/A , $924.62 , $924.62 ," $1,409.80 "," $1,086.77 ", $107.56 ," $1,424.64 "
Computed Tomography Thorax Lw Dose Lng Ca Scr C-,CPT® 71271,N/A,N/A,N/A," $1,080.00 ", $702.00 , $975.59 , $140.54 , $115.93 , N/A , N/A ," $1,004.40 ", $972.00 , $972.00 , $864.00 , $864.00 , $115.93 , $997.16 ," $1,026.00 ", $972.00 , $972.00 , $972.00 ," $1,004.40 "," $1,036.80 ", $818.47 , $918.00 , $819.14 ," $1,006.07 ", N/A , $684.12 , $684.12 ," $1,026.00 ", $792.15 , $115.93 ," $1,036.80 "
"Penis Plastic Surg,Correct Angulatn",CPT® 54360,N/A,N/A,N/A," $3,953.00 "," $2,569.45 "," $3,195.25 ", $687.88 , $536.08 ," $2,314.16 "," $2,333.36 "," $3,676.29 "," $3,557.70 "," $3,557.70 "," $3,162.40 "," $3,162.40 ", $536.08 ," $3,649.80 "," $3,755.35 "," $3,557.70 "," $3,557.70 "," $3,557.70 "," $3,676.29 "," $3,794.88 "," $3,001.34 "," $3,360.05 "," $3,717.99 "," $3,491.42 ", N/A ," $2,359.31 "," $2,359.31 "," $3,755.35 "," $2,827.77 ", $536.08 ," $3,794.88 "
 HYDROCODONE-ACETAMINOPHEN 7.5-325 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6826-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"PPPS, subseq visit",G0439,N/A,N/A,N/A, $190.00 , $123.50 , $315.63 , $126.78 , N/A , $212.88 , $247.86 , $176.70 , $171.00 , $171.00 , $152.00 , $152.00 , N/A , $175.43 , $180.50 , $171.00 , $171.00 , $171.00 , $176.70 , $182.40 , $353.13 , $161.50 , $213.44 , $248.08 , N/A , $217.03 , $217.03 , $180.50 , $271.27 , $126.78 , $353.13 
"Reinsert Bi/Triceps Tendon,Distal",24342,N/A,N/A,N/A," $2,943.00 "," $1,912.95 "," $4,720.56 ", $739.12 , $922.06 ," $3,742.14 "," $3,726.16 "," $2,736.99 "," $2,648.70 "," $2,648.70 "," $2,354.40 "," $2,354.40 ", $922.06 ," $2,717.27 "," $2,795.85 "," $2,648.70 "," $2,648.70 "," $2,648.70 "," $2,736.99 "," $2,825.28 "," $4,392.97 "," $2,501.55 "," $4,114.05 "," $4,412.90 ", N/A ," $3,815.16 "," $3,815.16 "," $2,795.85 "," $4,484.16 ", $739.12 ," $4,720.56 "
 STERILE WATER FOR IRRIGATION IR SOLN ,HCPCS RXA258,0258 - IV SOLUTIONS,00990-7139-09,"1,000 mL", $35.00 , $22.75 , $29.40 , N/A , N/A , $28.28 , $31.50 , $29.63 , $31.50 , $31.50 , $31.50 , $29.75 , N/A , $32.32 , $33.25 , $29.75 , $32.55 , $32.55 , $33.25 , $33.60 , $28.64 , $31.50 , $29.75 , $27.65 , N/A , $28.33 , $28.33 , $33.25 , $30.03 , $27.65 , $33.60 
 NIVOLUMAB-RELATLIMAB-RMBW 240-80 MG/20ML IV SOLN ,HCPCS J9298,0636 - DRUGS REQUIRING DETAILED CODIN,00003-7125-11,20 mL," $41,892.15 "," $27,229.90 "," $35,189.41 ", $187.30 , $183.99 ," $33,848.86 "," $37,702.94 "," $35,465.89 "," $37,702.94 "," $37,702.94 "," $37,702.94 "," $35,608.33 ", $180.38 ," $38,679.02 "," $39,797.54 "," $35,608.33 "," $38,959.70 "," $38,959.70 "," $39,797.54 "," $40,216.46 "," $34,276.16 "," $37,702.94 "," $35,608.33 "," $33,094.80 ", N/A ," $33,903.32 "," $33,903.32 "," $39,797.54 "," $35,947.65 ", $180.38 ," $40,216.46 "
Radiologic Exam Swallow Function Contrast Study,CPT® 74230,N/A,N/A,N/A," $1,560.00 "," $1,014.00 ", $737.06 , $125.26 , $81.46 , $609.02 , $484.52 ," $1,450.80 "," $1,404.00 "," $1,404.00 "," $1,248.00 "," $1,248.00 ", $81.46 ," $1,440.35 "," $1,482.00 "," $1,404.00 "," $1,404.00 "," $1,404.00 "," $1,450.80 "," $1,497.60 ", $736.12 ," $1,326.00 ", $527.74 , $653.26 , N/A , $620.91 , $620.91 ," $1,482.00 ", $718.71 , $81.46 ," $1,497.60 "
 Residential Treatment Center Room and Board Self Pay ,Custom 1002000001,1002 - BH R&B RES/CHEM,N/A,N/A, $45.00 , $29.25 , $37.80 , N/A , N/A , $36.36 , $40.50 , $38.10 , $40.50 , $40.50 , $40.50 , $38.25 , N/A , $41.55 , $42.75 , $38.25 , $41.85 , $41.85 , $42.75 , $43.20 , $36.82 , $40.50 , $38.25 , $35.55 , N/A , $36.42 , $36.42 , $42.75 , $38.61 , $35.55 , $43.20 
" Fac Muscle Test, Thor Paraspinal ",CPT® 95869,0922 - EMG,N/A,N/A, $291.00 , $189.15 , $244.44 , $94.22 , $48.07 , $235.13 , $261.90 , $246.36 , $261.90 , $261.90 , $261.90 , $247.35 , $47.13 , $268.68 , $276.45 , $247.35 , $270.63 , $270.63 , $276.45 , $279.36 , $238.10 , $261.90 , $247.35 , $229.89 , N/A , $235.51 , $235.51 , $276.45 , $249.71 , $47.13 , $279.36 
 LANREOTIDE ACETATE 120 MG/0.5ML SC SOLN ,HCPCS J1932,0636 - DRUGS REQUIRING DETAILED CODIN,69097-0870-67,0.5 mL," $26,147.20 "," $16,995.68 "," $21,963.65 ", $52.41 , $61.70 ," $21,126.94 "," $23,532.48 "," $22,136.22 "," $23,532.48 "," $23,532.48 "," $23,532.48 "," $22,225.12 ", $60.49 ," $24,141.71 "," $24,839.84 "," $22,225.12 "," $24,316.90 "," $24,316.90 "," $24,839.84 "," $25,101.31 "," $21,393.64 "," $23,532.48 "," $22,225.12 "," $20,656.29 ", N/A ," $21,160.93 "," $21,160.93 "," $24,839.84 "," $22,436.91 ", $52.41 ," $25,101.31 "
Img-Guide Fluid Collxn Drainag Cath Periton Perq,CPT® 49406,N/A,N/A,N/A," $2,390.00 "," $1,553.50 "," $1,198.54 ", $185.07 , $244.64 ," $1,041.92 "," $1,072.96 "," $2,222.70 "," $2,151.00 "," $2,151.00 "," $1,912.00 "," $1,912.00 ", $244.64 ," $2,206.69 "," $2,270.50 "," $2,151.00 "," $2,151.00 "," $2,151.00 "," $2,222.70 "," $2,294.40 ", $867.06 ," $2,031.50 "," $1,009.30 "," $1,155.04 ", N/A ," $1,062.26 "," $1,062.26 "," $2,270.50 "," $1,111.01 ", $185.07 ," $2,294.40 "
 HEPARIN NA (PORK) LOCK FLSH PF 100 UNIT/ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,64253-0333-35,1 mL, $5.81 , $3.78 , $4.88 , N/A , N/A , $4.69 , $5.23 , $4.92 , $5.23 , $5.23 , $5.23 , $4.94 , N/A , $5.36 , $5.52 , $4.94 , $5.40 , $5.40 , $5.52 , $5.58 , $4.75 , $5.23 , $4.94 , $4.59 , N/A , $4.70 , $4.70 , $5.52 , $4.99 , $4.59 , $5.58 
Hfo W/O Joints Cf,HCPCS L3913,N/A,N/A,N/A, $410.00 , $266.50 , N/A , $288.30 , $78.13 , N/A , N/A , $381.30 , $369.00 , $369.00 , $328.00 , $328.00 , $78.13 , $378.55 , $389.50 , $369.00 , $369.00 , $369.00 , $381.30 , $393.60 , N/A , $348.50 , $238.09 , $242.57 , N/A , N/A , N/A , $389.50 , N/A , $78.13 , $393.60 
 Pro Sbrt Management ,CPT® 77435,0982 - PRO FEE/OUTPT,N/A,N/A," $6,072.00 "," $3,946.80 "," $3,567.93 ", $627.36 , $544.53 ," $3,018.61 "," $3,127.83 "," $5,646.96 "," $5,464.80 "," $5,464.80 "," $4,857.60 "," $4,857.60 ", $544.53 ," $5,606.28 "," $5,768.40 "," $5,464.80 "," $5,464.80 "," $5,464.80 "," $5,646.96 "," $5,829.12 "," $3,566.59 "," $5,161.20 "," $3,428.35 "," $3,510.15 ", N/A ," $3,077.51 "," $3,077.51 "," $5,768.40 "," $3,562.28 ", $544.53 ," $5,829.12 "
Menacwyd/Menacwy-CRM Conj Vacc Grps Acwy Im Use,CPT® 90734,N/A,N/A,N/A, $270.00 , $175.50 , N/A , N/A , $136.15 , $211.26 , $219.69 , $251.10 , $243.00 , $243.00 , $216.00 , $216.00 , $136.15 , $249.29 , $256.50 , $243.00 , $243.00 , $243.00 , $251.10 , $259.20 , N/A , $229.50 , $291.95 , $236.89 , N/A , $215.38 , $215.38 , $256.50 , $251.08 , $136.15 , $291.95 
Eval Speech Sound Product Language Comprehension,CPT® 92523,N/A,N/A,N/A, $779.00 , $506.35 , $535.46 , $227.40 , $181.48 , $415.40 , $439.40 , $724.47 , $701.10 , $701.10 , $623.20 , $623.20 , $181.48 , $719.25 , $740.05 , $701.10 , $701.10 , $701.10 , $724.47 , $747.84 , $691.39 , $662.15 , $685.57 , $754.90 , N/A , $423.51 , $423.51 , $740.05 , $493.72 , $181.48 , $754.90 
Trim Nail(S),11719,N/A,N/A,N/A, $83.00 , $53.95 , $24.79 , $7.29 , $16.74 , $21.53 , $20.21 , $77.19 , $74.70 , $74.70 , $66.40 , $66.40 , $16.74 , $76.63 , $78.85 , $74.70 , $74.70 , $74.70 , $77.19 , $79.68 , $27.34 , $70.55 , $39.25 , $27.63 , N/A , $21.94 , $21.94 , $78.85 , $25.46 , $7.29 , $79.68 
 Fac Rpr Blvsl Dir Nck ,CPT® 35201,0360 - OR SERVICES,N/A,N/A," $5,728.00 "," $3,723.20 "," $4,811.52 ", $842.81 , $946.71 ," $4,628.22 "," $5,155.20 "," $4,849.32 "," $5,155.20 "," $5,155.20 "," $5,155.20 "," $4,868.80 ", $928.15 ," $5,288.66 "," $5,441.60 "," $4,868.80 "," $5,327.04 "," $5,327.04 "," $5,441.60 "," $5,498.88 "," $4,686.65 "," $5,155.20 "," $4,868.80 "," $4,525.12 ", N/A ," $4,635.67 "," $4,635.67 "," $5,441.60 "," $4,915.20 ", $842.81 ," $5,498.88 "
Simple Repair 2.5cm or Le,12001,N/A,N/A,N/A, $505.00 , $328.25 , $140.22 , $41.72 , $52.39 , $121.02 , $117.45 , $469.65 , $454.50 , $454.50 , $404.00 , $404.00 , $52.39 , $466.27 , $479.75 , $454.50 , $454.50 , $454.50 , $469.65 , $484.80 , $152.67 , $429.25 , $235.50 , $154.59 , N/A , $123.38 , $123.38 , $479.75 , $143.07 , $41.72 , $484.80 
Prq Trluml Coronary Byp Grft Revasc One Vessel,CPT® 92937,N/A,N/A,N/A," $4,972.00 "," $3,231.80 "," $3,435.45 ", $528.11 , $453.04 ," $3,229.05 "," $3,251.49 "," $4,623.96 "," $4,474.80 "," $4,474.80 "," $3,977.60 "," $3,977.60 ", $453.04 ," $4,590.65 "," $4,723.40 "," $4,474.80 "," $4,474.80 "," $4,474.80 "," $4,623.96 "," $4,773.12 "," $3,181.40 "," $4,226.20 "," $1,798.33 "," $3,387.71 ", N/A ," $3,292.05 "," $3,292.05 "," $4,723.40 "," $3,649.26 ", $453.04 ," $4,773.12 "
 Fac Replace Duodenostomy/Jejunostomy Tube Perq ,CPT® 49451,0750 - GASTR-INST SVS,N/A,N/A, $934.00 , $607.10 , $784.56 , $84.05 , $625.38 , $754.67 , $840.60 , $790.72 , $840.60 , $840.60 , $840.60 , $793.90 , $613.12 , $862.36 , $887.30 , $793.90 , $868.62 , $868.62 , $887.30 , $896.64 , $764.20 , $840.60 , $793.90 , $737.86 , N/A , $755.89 , $755.89 , $887.30 , $801.47 , $84.05 , $896.64 
 Pro Ex Tum/Vasc Malf Sft Tiss Hand/Fngr Subq 1.5+Cm ,CPT® 26111,0982 - PRO FEE/OUTPT,N/A,N/A," $1,744.00 "," $1,133.60 "," $2,539.36 ", $399.37 , $339.42 ," $2,015.05 "," $2,007.22 "," $1,621.92 "," $1,569.60 "," $1,569.60 "," $1,395.20 "," $1,395.20 ", $339.42 ," $1,610.24 "," $1,656.80 "," $1,569.60 "," $1,569.60 "," $1,569.60 "," $1,621.92 "," $1,674.24 "," $2,359.82 "," $1,482.40 "," $2,210.46 "," $2,388.56 ", N/A ," $2,054.36 "," $2,054.36 "," $1,656.80 "," $2,414.60 ", $339.42 ," $2,539.36 "
 OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60687-0642-01,1 tablet, $7.12 , $4.63 , $5.98 , N/A , N/A , $5.75 , $6.41 , $6.03 , $6.41 , $6.41 , $6.41 , $6.05 , N/A , $6.57 , $6.76 , $6.05 , $6.62 , $6.62 , $6.76 , $6.84 , $5.83 , $6.41 , $6.05 , $5.62 , N/A , $5.76 , $5.76 , $6.76 , $6.11 , $5.62 , $6.84 
 Moderna Pediatric Vaccine Admin Age 6-11 - Third Dose ,CPT® 0093A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
"Toxoplasma, Igm",CPT® 86778,N/A,N/A,N/A, $137.00 , $89.05 , N/A , $14.70 , $14.70 , $72.29 , $86.46 , $127.41 , $123.30 , $123.30 , $109.60 , $109.60 , $14.70 , $126.49 , $130.15 , $123.30 , $123.30 , $123.30 , $127.41 , $131.52 , $96.22 , $116.45 , $94.07 , $52.22 , N/A , $67.47 , $67.47 , $130.15 , $73.73 , $14.70 , $131.52 
"Cytomeg, Dna, Amp Probe",CPT® 87496,N/A,N/A,N/A, $245.00 , $159.25 , N/A , $35.79 , $35.79 , $198.56 , $237.51 , $227.85 , $220.50 , $220.50 , $196.00 , $196.00 , $35.79 , $226.21 , $232.75 , $220.50 , $220.50 , $220.50 , $227.85 , $235.20 , $234.30 , $208.25 , $230.30 , $127.26 , N/A , $185.31 , $185.31 , $232.75 , $202.50 , $35.79 , $237.51 
 SODIUM CHLORIDE 3 % IV SOLN ,HCPCS RXA258,0258 - IV SOLUTIONS,00338-0054-03,500 mL, $38.53 , $25.04 , $32.37 , N/A , N/A , $31.13 , $34.68 , $32.62 , $34.68 , $34.68 , $34.68 , $32.75 , N/A , $35.57 , $36.60 , $32.75 , $35.83 , $35.83 , $36.60 , $36.99 , $31.53 , $34.68 , $32.75 , $30.44 , N/A , $31.18 , $31.18 , $36.60 , $33.06 , $30.44 , $36.99 
 Vaginal Panel (Affirm) ,CPT® 87800,0300 - LABORATORY,N/A,N/A, $238.00 , $154.70 , $199.92 , $44.54 , $28.55 , $192.30 , $214.20 , $201.49 , $214.20 , $214.20 , $214.20 , $202.30 , $27.99 , $219.75 , $226.10 , $202.30 , $221.34 , $221.34 , $226.10 , $228.48 , $194.73 , $214.20 , $202.30 , $188.02 , N/A , $192.61 , $192.61 , $226.10 , $204.23 , $27.99 , $228.48 
Excise Neurofibroma Extensive,CPT® 64792,N/A,N/A,N/A," $7,616.00 "," $4,950.40 "," $5,091.27 ", $990.15 ," $1,212.86 "," $5,974.40 "," $6,173.07 "," $7,082.88 "," $6,854.40 "," $6,854.40 "," $6,092.80 "," $6,092.80 "," $1,212.86 "," $7,031.85 "," $7,235.20 "," $6,854.40 "," $6,854.40 "," $6,854.40 "," $7,082.88 "," $7,311.36 "," $5,504.66 "," $6,473.60 "," $6,326.29 "," $6,660.31 ", N/A ," $6,090.97 "," $6,090.97 "," $7,235.20 "," $6,534.20 ", $990.15 ," $7,311.36 "
"Cauterization,Cervix,Electro/Thermal",CPT® 57510,N/A,N/A,N/A, $792.00 , $514.80 , $527.20 , $107.02 , $64.62 , $471.02 , $470.44 , $736.56 , $712.80 , $712.80 , $633.60 , $633.60 , $64.62 , $731.25 , $752.40 , $712.80 , $712.80 , $712.80 , $736.56 , $760.32 , $555.00 , $673.20 , $619.07 , $473.03 , N/A , $480.22 , $480.22 , $752.40 , $575.99 , $64.62 , $760.32 
Radiation Therapy Management,CPT® 77431,N/A,N/A,N/A," $1,011.00 ", $657.15 , $595.43 , $104.79 , $105.06 , $489.80 , $507.35 , $940.23 , $909.90 , $909.90 , $808.80 , $808.80 , $105.06 , $933.46 , $960.45 , $909.90 , $909.90 , $909.90 , $940.23 , $970.56 , $592.87 , $859.35 , $554.70 , $568.78 , N/A , $499.36 , $499.36 , $960.45 , $578.01 , $104.79 , $970.56 
"Muscle Test, One Limb",CPT® 95860,N/A,N/A,N/A, $884.00 , $574.60 , $423.02 , $110.56 , $76.28 , $392.70 , $434.43 , $822.12 , $795.60 , $795.60 , $707.20 , $707.20 , $76.28 , $816.20 , $839.80 , $795.60 , $795.60 , $795.60 , $822.12 , $848.64 , $516.14 , $751.40 , $379.13 , $467.92 , N/A , $400.36 , $400.36 , $839.80 , $492.21 , $76.28 , $848.64 
"Scr C/V Cyto,Autosys and MD",HCPCS G0141,N/A,N/A,N/A, $187.00 , $121.55 , $79.51 , $22.56 , $21.43 , $58.91 , N/A , $173.91 , $168.30 , $168.30 , $149.60 , $149.60 , $21.43 , $172.66 , $177.65 , $168.30 , $168.30 , $168.30 , $173.91 , $179.52 , $140.29 , $158.95 , $60.33 , $112.96 , N/A , $60.06 , $60.06 , $177.65 , $75.07 , $21.43 , $179.52 
 Fac Open/Perq Placement Intravascular Stent Same 1st ,CPT® 37238,0360 - OR SERVICES,N/A,N/A," $25,019.00 "," $16,262.35 "," $21,015.96 ", $277.62 , $364.83 ," $20,215.35 "," $22,517.10 "," $21,181.09 "," $22,517.10 "," $22,517.10 "," $22,517.10 "," $21,266.15 ", $357.68 ," $23,100.04 "," $23,768.05 "," $21,266.15 "," $23,267.67 "," $23,267.67 "," $23,768.05 "," $24,018.24 "," $20,470.55 "," $22,517.10 "," $21,266.15 "," $19,765.01 ", N/A ," $20,247.88 "," $20,247.88 "," $23,768.05 "," $21,468.80 ", $277.62 ," $24,018.24 "
 Fac Programmed Stimj&Pacg After IV Drug Nfs ,CPT® 93623,0480 - CARDIOLOGY,N/A,N/A," $3,809.00 "," $2,475.85 "," $3,199.56 ", $247.05 , $380.96 ," $3,077.67 "," $3,428.10 "," $3,224.70 "," $3,428.10 "," $3,428.10 "," $3,428.10 "," $3,237.65 ", $373.49 ," $3,516.85 "," $3,618.55 "," $3,237.65 "," $3,542.37 "," $3,542.37 "," $3,618.55 "," $3,656.64 "," $3,116.52 "," $3,428.10 "," $3,237.65 "," $3,009.11 ", N/A ," $3,082.62 "," $3,082.62 "," $3,618.55 "," $3,268.50 ", $247.05 ," $3,656.64 "
Arterial Puncture,CPT® 36600,N/A,N/A,N/A, $266.00 , $172.90 , $95.81 , $14.57 , $37.12 , $67.69 , $67.39 , $247.38 , $239.40 , $239.40 , $212.80 , $212.80 , $37.12 , $245.60 , $252.70 , $239.40 , $239.40 , $239.40 , $247.38 , $255.36 , $88.93 , $226.10 , $82.07 , $78.58 , N/A , $69.00 , $69.00 , $252.70 , $78.40 , $14.57 , $255.36 
Aspergillus Antibody,CPT® 86606,N/A,N/A,N/A, $111.00 , $72.15 , N/A , $15.35 , $8.07 , $32.88 , $39.34 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $8.07 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $100.49 , $94.35 , $98.93 , $54.60 , N/A , $30.69 , $30.69 , $105.45 , $33.54 , $8.07 , $106.56 
Bx Synovium Interphalang Jt,CPT® 28054,N/A,N/A,N/A," $2,534.00 "," $1,647.10 "," $1,457.37 ", $228.45 , $230.52 ," $1,165.23 "," $1,161.56 "," $2,356.62 "," $2,280.60 "," $2,280.60 "," $2,027.20 "," $2,027.20 ", $230.52 ," $2,339.64 "," $2,407.30 "," $2,280.60 "," $2,280.60 "," $2,280.60 "," $2,356.62 "," $2,432.64 "," $1,353.73 "," $2,153.90 "," $1,250.63 "," $1,389.89 ", N/A ," $1,187.97 "," $1,187.97 "," $2,407.30 "," $1,396.30 ", $228.45 ," $2,432.64 "
 Fac Protozoa Antibody Nos ,CPT® 86753,0300 - LABORATORY,N/A,N/A, $177.00 , $115.05 , $148.68 , $12.64 , $8.07 , $143.02 , $159.30 , $149.85 , $159.30 , $159.30 , $159.30 , $150.45 , $7.91 , $163.42 , $168.15 , $150.45 , $164.61 , $164.61 , $168.15 , $169.92 , $144.82 , $159.30 , $150.45 , $139.83 , N/A , $143.25 , $143.25 , $168.15 , $151.88 , $7.91 , $169.92 
"Revision of Colostomy,Complicated",CPT® 44345,N/A,N/A,N/A," $6,990.00 "," $4,543.50 "," $6,297.53 ", $977.75 ," $1,032.56 "," $4,966.59 "," $5,031.69 "," $6,500.70 "," $6,291.00 "," $6,291.00 "," $5,592.00 "," $5,592.00 "," $1,032.56 "," $6,453.87 "," $6,640.50 "," $6,291.00 "," $6,291.00 "," $6,291.00 "," $6,500.70 "," $6,710.40 "," $4,507.49 "," $5,941.50 "," $5,582.34 "," $5,877.99 ", N/A ," $5,063.50 "," $5,063.50 "," $6,640.50 "," $5,295.87 ", $977.75 ," $6,710.40 "
Reagent Strip/Blood Glucose,CPT® 82948,N/A,N/A,N/A, $56.00 , $36.40 , N/A , $5.14 , $4.40 , $17.92 , $21.42 , $52.08 , $50.40 , $50.40 , $44.80 , $44.80 , $4.40 , $51.70 , $53.20 , $50.40 , $50.40 , $50.40 , $52.08 , $53.76 , $33.65 , $47.60 , $21.08 , $14.77 , N/A , $16.72 , $16.72 , $53.20 , $18.27 , $4.40 , $53.76 
 Bypass Graft; W/Vein; Brachial-Brachial ,CPT® 35526,0360 - OR SERVICES,N/A,N/A," $17,163.00 "," $11,155.95 "," $14,416.92 "," $1,561.29 "," $1,759.49 "," $13,867.70 "," $15,446.70 "," $14,530.20 "," $15,446.70 "," $15,446.70 "," $15,446.70 "," $14,588.55 "," $1,724.99 "," $15,846.60 "," $16,304.85 "," $14,588.55 "," $15,961.59 "," $15,961.59 "," $16,304.85 "," $16,476.48 "," $14,042.77 "," $15,446.70 "," $14,588.55 "," $13,558.77 ", N/A ," $13,890.02 "," $13,890.02 "," $16,304.85 "," $14,727.57 "," $1,561.29 "," $16,476.48 "
2019-ncov diagnostic p,HCPCS U0001,N/A,N/A,N/A, $221.00 , $143.65 , N/A , $36.64 , $36.63 , N/A , N/A , $205.53 , $198.90 , $198.90 , $176.80 , $176.80 , $36.63 , $204.05 , $209.95 , $198.90 , $198.90 , $198.90 , $205.53 , $212.16 , N/A , $187.85 , $68.49 , $105.47 , N/A , $152.20 , $152.20 , $209.95 , $166.33 , $36.63 , $212.16 
 Degenerative Nervous System Disorders With McC ,MS DRG V40 (FY2023) 056,N/A,N/A,N/A," $20,553.22 "," $13,359.59 "," $17,264.70 ", N/A , N/A ," $16,607.00 "," $18,497.90 "," $17,400.36 "," $18,497.90 "," $18,497.90 "," $18,497.90 "," $17,470.24 ", N/A ," $18,976.79 "," $19,525.56 "," $17,470.24 "," $19,114.49 "," $19,114.49 "," $19,525.56 "," $19,731.09 "," $16,816.64 "," $18,497.90 "," $17,470.24 "," $16,237.04 ", N/A ," $16,633.72 "," $16,633.72 "," $19,525.56 "," $17,636.72 "," $16,237.04 "," $19,731.09 "
 Pro Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/O Img Gdn ,CPT® 62320,0982 - PRO FEE/OUTPT,N/A,N/A," $1,653.00 "," $1,074.45 ", $487.55 , $95.25 , $132.09 , $548.33 , $533.94 ," $1,537.29 "," $1,487.70 "," $1,487.70 "," $1,322.40 "," $1,322.40 ", $132.09 ," $1,526.21 "," $1,570.35 "," $1,487.70 "," $1,487.70 "," $1,487.70 "," $1,537.29 "," $1,586.88 ", $524.37 ," $1,405.05 ", $529.53 , $606.17 , N/A , $559.03 , $559.03 ," $1,570.35 ", $599.72 , $95.25 ," $1,586.88 "
 SODIUM ZIRCONIUM CYCLOSILICATE 10 G PO PACK ,HCPCS RXC637,0250 - PHARMACY,00310-1110-39,1 packet, $160.56 , $104.36 , $134.87 , N/A , N/A , $129.73 , $144.50 , $135.93 , $144.50 , $144.50 , $144.50 , $136.48 , N/A , $148.25 , $152.53 , $136.48 , $149.32 , $149.32 , $152.53 , $154.14 , $131.37 , $144.50 , $136.48 , $126.84 , N/A , $129.94 , $129.94 , $152.53 , $137.78 , $126.84 , $154.14 
Dstr Nrolytc Agnt Parverteb Fct Sngl Lmbr/Sacral,CPT® 64635,N/A,N/A,N/A," $1,718.00 "," $1,116.70 ", $950.14 , $185.00 , $346.77 ," $1,260.86 "," $1,183.47 "," $1,597.74 "," $1,546.20 "," $1,546.20 "," $1,374.40 "," $1,374.40 ", $346.77 ," $1,586.23 "," $1,632.10 "," $1,546.20 "," $1,546.20 "," $1,546.20 "," $1,597.74 "," $1,649.28 "," $1,187.78 "," $1,460.30 "," $1,147.15 "," $1,349.13 ", N/A ," $1,285.46 "," $1,285.46 "," $1,632.10 "," $1,379.00 ", $185.00 ," $1,649.28 "
Rad Resection Tumor Soft Tiss Face/Scalp 2+Cm,21016,N/A,N/A,N/A," $6,915.00 "," $4,494.75 "," $6,099.93 ", $955.17 , $859.59 ," $4,935.77 "," $4,965.12 "," $6,430.95 "," $6,223.50 "," $6,223.50 "," $5,532.00 "," $5,532.00 ", $859.59 ," $6,384.62 "," $6,569.25 "," $6,223.50 "," $6,223.50 "," $6,223.50 "," $6,430.95 "," $6,638.40 "," $5,651.61 "," $5,877.75 "," $5,487.78 "," $5,771.92 ", N/A ," $5,032.07 "," $5,032.07 "," $6,569.25 "," $5,914.46 ", $859.59 ," $6,638.40 "
Treat Trochanteric Fractr,CPT® 27246,N/A,N/A,N/A," $2,659.00 "," $1,728.35 "," $2,370.10 ", $373.73 , $307.34 ," $1,863.09 "," $1,867.23 "," $2,472.87 "," $2,393.10 "," $2,393.10 "," $2,127.20 "," $2,127.20 ", $307.34 ," $2,455.05 "," $2,526.05 "," $2,393.10 "," $2,393.10 "," $2,393.10 "," $2,472.87 "," $2,552.64 "," $2,197.72 "," $2,260.15 "," $2,057.03 "," $2,199.33 ", N/A ," $1,899.44 "," $1,899.44 "," $2,526.05 "," $2,232.53 ", $307.34 ," $2,552.64 "
 Fac Contrast X-Ray of Wrist ,CPT® 73115,0320 - DX X-RAY,N/A,N/A," $1,277.00 ", $830.05 ," $1,072.68 ", $133.80 , $92.48 ," $1,031.82 "," $1,149.30 "," $1,081.11 "," $1,149.30 "," $1,149.30 "," $1,149.30 "," $1,085.45 ", $90.67 ," $1,179.05 "," $1,213.15 "," $1,085.45 "," $1,187.61 "," $1,187.61 "," $1,213.15 "," $1,225.92 "," $1,044.84 "," $1,149.30 "," $1,085.45 "," $1,008.83 ", N/A ," $1,033.48 "," $1,033.48 "," $1,213.15 "," $1,095.79 ", $90.67 ," $1,225.92 "
"CT Scan,Lumbar Spine,W/O Contrast",CPT® 72131,N/A,N/A,N/A," $3,007.00 "," $1,954.55 ", $919.73 , $131.98 , $250.57 , $853.40 ," $1,105.05 "," $2,796.51 "," $2,706.30 "," $2,706.30 "," $2,405.60 "," $2,405.60 ", $250.57 ," $2,776.36 "," $2,856.65 "," $2,706.30 "," $2,706.30 "," $2,706.30 "," $2,796.51 "," $2,886.72 ", $772.34 ," $2,555.95 "," $1,203.78 "," $1,166.51 ", N/A , $870.05 , $870.05 ," $2,856.65 "," $1,007.10 ", $131.98 ," $2,886.72 "
" Fac Assay, Blood Carbon Monoxide ",CPT® 82375,0301 - LAB/CHEMISTRY,N/A,N/A, $142.00 , $92.30 , $119.28 , $12.57 , $12.57 , $114.74 , $127.80 , $120.22 , $127.80 , $127.80 , $127.80 , $120.70 , $12.32 , $131.11 , $134.90 , $120.70 , $132.06 , $132.06 , $134.90 , $136.32 , $116.18 , $127.80 , $120.70 , $112.18 , N/A , $114.92 , $114.92 , $134.90 , $121.85 , $12.32 , $136.32 
 SODIUM HYPOCHLORITE 0.057 % EX LIQD ,HCPCS RXC637,0250 - PHARMACY,67180-0400-04,119 mL, $26.90 , $17.49 , $22.60 , N/A , N/A , $21.74 , $24.21 , $22.77 , $24.21 , $24.21 , $24.21 , $22.87 , N/A , $24.84 , $25.56 , $22.87 , $25.02 , $25.02 , $25.56 , $25.82 , $22.01 , $24.21 , $22.87 , $21.25 , N/A , $21.77 , $21.77 , $25.56 , $23.08 , $21.25 , $25.82 
"Hepatitis B , Dna, Quant",CPT® 87517,N/A,N/A,N/A, $396.00 , $257.40 , N/A , $43.70 , $43.70 , $242.34 , $289.89 , $368.28 , $356.40 , $356.40 , $316.80 , $316.80 , $43.70 , $365.63 , $376.20 , $356.40 , $356.40 , $356.40 , $368.28 , $380.16 , $286.05 , $336.60 , $280.58 , $155.31 , N/A , $226.17 , $226.17 , $376.20 , $247.15 , $43.70 , $380.16 
 AMPICILLIN SODIUM 250 MG IJ SOLR ,HCPCS J0290,0636 - DRUGS REQUIRING DETAILED CODIN,00781-3402-95,5 mL, $21.51 , $13.98 , $18.07 , $0.80 , $0.94 , $17.38 , $19.36 , $18.21 , $19.36 , $19.36 , $19.36 , $18.28 , $0.92 , $19.86 , $20.43 , $18.28 , $20.00 , $20.00 , $20.43 , $20.65 , $17.60 , $19.36 , $18.28 , $16.99 , N/A , $17.41 , $17.41 , $20.43 , $18.46 , $0.80 , $20.65 
 Pro Psychotherapy W/Patient 30 Minutes ,CPT® 90832,0961 - PRO FEE/PSYCH,N/A,N/A, $257.00 , $167.05 , $90.07 , $66.42 , $58.10 , $143.28 , $112.18 , $239.01 , $231.30 , $231.30 , $205.60 , $205.60 , $58.10 , $237.29 , $244.15 , $231.30 , $231.30 , $231.30 , $239.01 , $246.72 , $171.81 , $218.45 , $145.98 , $240.60 , $84.00 , $146.08 , $146.08 , $244.15 , $170.30 , $58.10 , $246.72 
Wedge Exc. of Skin of Nai,11765,N/A,N/A,N/A, $485.00 , $315.25 , $298.86 , $89.88 , $111.12 , $259.63 , $252.76 , $451.05 , $436.50 , $436.50 , $388.00 , $388.00 , $111.12 , $447.80 , $460.75 , $436.50 , $436.50 , $436.50 , $451.05 , $465.60 , $329.62 , $412.25 , $494.19 , $334.41 , N/A , $264.69 , $264.69 , $460.75 , $306.96 , $89.88 , $494.19 
 Fac F5 Coagulation Factor V Anal Leiden Variant ,CPT® 81241,0310 - PATHOLOGY LAB,N/A,N/A, $628.00 , $408.20 , $527.52 , $74.84 , $68.03 , $507.42 , $565.20 , $531.66 , $565.20 , $565.20 , $565.20 , $533.80 , $66.70 , $579.83 , $596.60 , $533.80 , $584.04 , $584.04 , $596.60 , $602.88 , $513.83 , $565.20 , $533.80 , $496.12 , N/A , $508.24 , $508.24 , $596.60 , $538.89 , $66.70 , $602.88 
Correct Skin Colr Defct 6.1-20sq Cm,CPT® 11921,N/A,N/A,N/A," $1,294.00 ", $841.10 , $409.63 , $123.71 , $155.37 , $366.12 , $359.33 ," $1,203.42 "," $1,164.60 "," $1,164.60 "," $1,035.20 "," $1,035.20 ", $155.37 ," $1,194.75 "," $1,229.30 "," $1,164.60 "," $1,164.60 "," $1,164.60 "," $1,203.42 "," $1,242.24 ", $451.76 ," $1,099.90 ", $722.55 , $466.55 , N/A , $373.27 , $373.27 ," $1,229.30 ", $432.87 , $123.71 ," $1,242.24 "
"Strapping,Wrist or Elbow",29260,N/A,N/A,N/A, $186.00 , $120.90 , $120.06 , $18.51 , $15.54 , $94.80 , $184.95 , $172.98 , $167.40 , $167.40 , $148.80 , $148.80 , $15.54 , $171.73 , $176.70 , $167.40 , $167.40 , $167.40 , $172.98 , $178.56 , $112.20 , $158.10 , $199.82 , $114.64 , N/A , $96.65 , $96.65 , $176.70 , $113.60 , $15.54 , $199.82 
 Pro Treat Humerus Fracture ,CPT® 24530,0982 - PRO FEE/OUTPT,N/A,N/A," $2,510.00 "," $1,631.50 "," $2,179.65 ", $345.51 , $245.89 ," $1,654.51 "," $1,676.86 "," $2,334.30 "," $2,259.00 "," $2,259.00 "," $2,008.00 "," $2,008.00 ", $245.89 ," $2,317.48 "," $2,384.50 "," $2,259.00 "," $2,259.00 "," $2,259.00 "," $2,334.30 "," $2,409.60 "," $2,006.52 "," $2,133.50 "," $1,841.15 "," $1,967.73 ", N/A ," $1,686.79 "," $1,686.79 "," $2,384.50 "," $1,982.57 ", $245.89 ," $2,409.60 "
Elec Alys Implt Npgt Smpl Sp/Pn Npgt Prgrmg,CPT® 95971,N/A,N/A,N/A, $239.00 , $155.35 , $144.10 , $37.57 , $50.32 , $130.97 , $136.51 , $222.27 , $215.10 , $215.10 , $191.20 , $191.20 , $50.32 , $220.67 , $227.05 , $215.10 , $215.10 , $215.10 , $222.27 , $229.44 , $171.33 , $203.15 , $118.60 , $154.65 , N/A , $133.53 , $133.53 , $227.05 , $164.15 , $37.57 , $229.44 
 Fac Njx 1/Mlt Trigger Point 3/> Musc ,CPT® 20553,0761 - TREATMENT ROOM,N/A,N/A, $539.00 , $350.35 , $452.76 , $40.47 , $26.41 , $435.51 , $485.10 , $456.32 , $485.10 , $485.10 , $485.10 , $458.15 , $25.89 , $497.66 , $512.05 , $458.15 , $501.27 , $501.27 , $512.05 , $517.44 , $441.01 , $485.10 , $458.15 , $425.81 , N/A , $436.21 , $436.21 , $512.05 , $462.52 , $25.89 , $517.44 
 Pro Treatment of Ankle Fracture ,CPT® 27814,0975 - PRO FEE/OR,N/A,N/A," $4,253.00 "," $2,764.45 "," $4,659.14 ", $730.07 , $675.04 ," $3,732.38 "," $3,721.69 "," $3,955.29 "," $3,827.70 "," $3,827.70 "," $3,402.40 "," $3,402.40 ", $675.04 ," $3,926.79 "," $4,040.35 "," $3,827.70 "," $3,827.70 "," $3,827.70 "," $3,955.29 "," $4,082.88 "," $4,338.92 "," $3,615.05 "," $4,106.92 "," $4,386.62 ", N/A ," $3,805.20 "," $3,805.20 "," $4,040.35 "," $4,472.48 ", $675.04 ," $4,659.14 "
 Fac 2d Com Transtho Echo W/Contr ,HCPCS C8923,0483 - CARDIOLOGY – ECHOCARDIOLOGY,N/A,N/A," $2,390.00 "," $1,553.50 "," $2,007.60 ", N/A , N/A ," $1,931.12 "," $2,151.00 "," $2,023.37 "," $2,151.00 "," $2,151.00 "," $2,151.00 "," $2,031.50 ", N/A ," $2,206.69 "," $2,270.50 "," $2,031.50 "," $2,222.70 "," $2,222.70 "," $2,270.50 "," $2,294.40 "," $1,955.50 "," $2,151.00 "," $2,031.50 "," $1,888.10 ", N/A ," $1,934.23 "," $1,934.23 "," $2,270.50 "," $2,050.86 "," $1,888.10 "," $2,294.40 "
Arthrodesis Combined Tq 1ntrspc Lumbar,CPT® 22633,N/A,N/A,N/A," $12,499.00 "," $8,124.35 "," $10,795.53 "," $1,647.88 "," $1,394.10 "," $8,860.28 "," $8,658.01 "," $11,624.07 "," $11,249.10 "," $11,249.10 "," $9,999.20 "," $9,999.20 "," $1,394.10 "," $11,540.33 "," $11,874.05 "," $11,249.10 "," $11,249.10 "," $11,249.10 "," $11,624.07 "," $11,999.04 "," $10,071.76 "," $10,624.15 "," $9,732.07 "," $10,256.80 ", N/A ," $9,033.16 "," $9,033.16 "," $11,874.05 "," $10,617.17 "," $1,394.10 "," $11,999.04 "
"Excise Lesn Neck/Chest,Subcutan",CPT® 21555,N/A,N/A,N/A," $2,785.00 "," $1,810.25 "," $1,869.34 ", $292.89 , $85.41 ," $1,477.58 "," $1,492.55 "," $2,590.05 "," $2,506.50 "," $2,506.50 "," $2,228.00 "," $2,228.00 ", $85.41 ," $2,571.39 "," $2,645.75 "," $2,506.50 "," $2,506.50 "," $2,506.50 "," $2,590.05 "," $2,673.60 "," $1,724.32 "," $2,367.25 "," $1,644.91 "," $1,734.16 ", N/A ," $1,506.41 "," $1,506.41 "," $2,645.75 "," $1,770.58 ", $85.41 ," $2,673.60 "
 Fac Fluor Needle/Cath Spine/Paraspinal Dx/Ther Addon ,CPT® 77003,0320 - DX X-RAY,N/A,N/A, $542.00 , $352.30 , $455.28 , $104.36 , $58.09 , $437.94 , $487.80 , $458.86 , $487.80 , $487.80 , $487.80 , $460.70 , $56.95 , $500.43 , $514.90 , $460.70 , $504.06 , $504.06 , $514.90 , $520.32 , $443.46 , $487.80 , $460.70 , $428.18 , N/A , $438.64 , $438.64 , $514.90 , $465.09 , $56.95 , $520.32 
"Removal Penis,Total",CPT® 54125,N/A,N/A,N/A," $4,454.00 "," $2,895.10 "," $3,626.85 ", $784.61 , $922.06 ," $2,606.45 "," $2,628.50 "," $4,142.22 "," $4,008.60 "," $4,008.60 "," $3,563.20 "," $3,563.20 ", $922.06 ," $4,112.38 "," $4,231.30 "," $4,008.60 "," $4,008.60 "," $4,008.60 "," $4,142.22 "," $4,275.84 "," $3,389.77 "," $3,785.90 "," $4,194.33 "," $3,933.90 ", N/A ," $2,657.30 "," $2,657.30 "," $4,231.30 "," $3,184.92 ", $784.61 ," $4,275.84 "
"Apply Forearm Splint,Dynamic",29126,N/A,N/A,N/A, $327.00 , $212.55 , $299.46 , $47.25 , $23.04 , $236.84 , $238.38 , $304.11 , $294.30 , $294.30 , $261.60 , $261.60 , $23.04 , $301.92 , $310.65 , $294.30 , $294.30 , $294.30 , $304.11 , $313.92 , $274.00 , $277.95 , $260.47 , $283.20 , N/A , $241.46 , $241.46 , $310.65 , $283.78 , $23.04 , $313.92 
NOVAVAX 5 MCG/0.5mL DOSAGE; FIRST DOSE,CPT® 0041A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $76.25 , $128.02 , N/A , $82.60 , $82.60 , $66.50 , $96.14 , $38.92 , $128.02 
"Remv Lens Material,Aspiratn",CPT® 66840,N/A,N/A,N/A," $6,162.00 "," $4,005.30 "," $4,265.76 ", $669.14 , $547.80 ," $3,942.90 "," $3,733.31 "," $5,730.66 "," $5,545.80 "," $5,545.80 "," $4,929.60 "," $4,929.60 ", $547.80 ," $5,689.37 "," $5,853.90 "," $5,545.80 "," $5,545.80 "," $5,545.80 "," $5,730.66 "," $5,915.52 "," $5,863.97 "," $5,237.70 "," $3,878.56 "," $5,009.24 ", N/A ," $4,019.83 "," $4,019.83 "," $5,853.90 "," $4,437.37 ", $547.80 ," $5,915.52 "
 DANTROLENE SODIUM 250 MG IV SUSR ,HCPCS RXA250,0250 - PHARMACY,42367-0540-32,5 mL," $19,274.05 "," $12,528.13 "," $16,190.20 ", N/A , N/A ," $15,573.43 "," $17,346.65 "," $16,317.41 "," $17,346.65 "," $17,346.65 "," $17,346.65 "," $16,382.94 ", N/A ," $17,795.73 "," $18,310.35 "," $16,382.94 "," $17,924.87 "," $17,924.87 "," $18,310.35 "," $18,503.09 "," $15,770.03 "," $17,346.65 "," $16,382.94 "," $15,226.50 ", N/A ," $15,598.49 "," $15,598.49 "," $18,310.35 "," $16,539.06 "," $15,226.50 "," $18,503.09 "
 Fac Artl Cathj/Cannulj Mntr/Transfusion Spx Prq ,CPT® 36620,0361 - OR/MINOR,N/A,N/A," $1,350.00 ", $877.50 ," $1,134.00 ", $42.54 , $73.68 ," $1,090.80 "," $1,215.00 "," $1,142.91 "," $1,215.00 "," $1,215.00 "," $1,215.00 "," $1,147.50 ", $72.24 ," $1,246.46 "," $1,282.50 "," $1,147.50 "," $1,255.50 "," $1,255.50 "," $1,282.50 "," $1,296.00 "," $1,104.57 "," $1,215.00 "," $1,147.50 "," $1,066.50 ", N/A ," $1,092.56 "," $1,092.56 "," $1,282.50 "," $1,158.44 ", $42.54 ," $1,296.00 "
Pfizer Administration Booster,CPT® 0004A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , N/A , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , N/A , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $76.25 , $128.02 , N/A , $163.02 , $163.02 , $66.50 , $178.15 , $56.00 , $178.15 
 HPV 9-VALENT RECOMB VACCINE IM SUSY ,HCPCS 90651,0636 - DRUGS REQUIRING DETAILED CODIN,00006-4121-02,0.5 mL," $1,771.67 "," $1,151.59 "," $1,488.20 ", N/A , $289.45 ," $1,431.51 "," $1,594.50 "," $1,499.90 "," $1,594.50 "," $1,594.50 "," $1,594.50 "," $1,505.92 ", $283.77 ," $1,635.78 "," $1,683.09 "," $1,505.92 "," $1,647.65 "," $1,647.65 "," $1,683.09 "," $1,700.80 "," $1,449.58 "," $1,594.50 "," $1,505.92 "," $1,399.62 ", N/A ," $1,433.81 "," $1,433.81 "," $1,683.09 "," $1,520.27 ", $283.77 ," $1,700.80 "
 Pro Mra Lxtr C+-Matrl ,CPT® 73725,0972 - PRO FEE/RAD/DX,N/A,N/A, $919.00 , $597.35 ," $2,412.69 ", $344.53 , $465.67 ," $1,916.91 "," $2,482.91 ", $854.67 , $827.10 , $827.10 , $735.20 , $735.20 , $465.67 , $848.51 , $873.05 , $827.10 , $827.10 , $827.10 , $854.67 , $882.24 ," $2,083.73 ", $781.15 ," $2,704.16 "," $2,683.10 ", N/A ," $1,954.31 "," $1,954.31 ", $873.05 ," $2,262.15 ", $344.53 ," $2,704.16 "
"Close Enterostomy,Resec+Anast",CPT® 44625,N/A,N/A,N/A," $6,707.00 "," $4,359.55 "," $6,066.13 ", $941.21 ," $1,383.09 "," $4,817.79 "," $4,869.56 "," $6,237.51 "," $6,036.30 "," $6,036.30 "," $5,365.60 "," $5,365.60 "," $1,383.09 "," $6,192.57 "," $6,371.65 "," $6,036.30 "," $6,036.30 "," $6,036.30 "," $6,237.51 "," $6,438.72 "," $4,349.25 "," $5,700.95 "," $5,400.36 "," $5,699.71 ", N/A ," $4,911.80 "," $4,911.80 "," $6,371.65 "," $5,137.24 ", $941.21 ," $6,438.72 "
 NITROGLYCERIN IN D5W 100-5 MCG/ML-% IV SOLN ,HCPCS J2305,0636 - DRUGS REQUIRING DETAILED CODIN,00338-1047-02,250 mL, $125.86 , $81.81 , $105.72 , N/A , N/A , $101.69 , $113.27 , $106.55 , $113.27 , $113.27 , $113.27 , $106.98 , N/A , $116.21 , $119.57 , $106.98 , $117.05 , $117.05 , $119.57 , $120.83 , $102.98 , $113.27 , $106.98 , $99.43 , N/A , $101.86 , $101.86 , $119.57 , $108.00 , $99.43 , $120.83 
Vitrectomy Pars Plana Remove Preretinal Membrane,CPT® 67041,N/A,N/A,N/A," $12,152.00 "," $7,898.80 "," $7,028.84 "," $1,101.54 ", $839.47 ," $6,531.57 "," $6,966.95 "," $11,301.36 "," $10,936.80 "," $10,936.80 "," $9,721.60 "," $9,721.60 ", $839.47 ," $11,219.94 "," $11,544.40 "," $10,936.80 "," $10,936.80 "," $10,936.80 "," $11,301.36 "," $11,665.92 "," $9,669.74 "," $10,329.20 "," $7,164.80 "," $8,284.40 ", N/A ," $6,659.01 "," $6,659.01 "," $11,544.40 "," $7,350.68 ", $839.47 ," $11,665.92 "
 Fac Perq Access & Closure Fem Art for Delivery Ndgft ,CPT® 34713,0360 - OR SERVICES,N/A,N/A, $537.00 , $349.05 , $451.08 , $109.23 , $97.91 , $433.90 , $483.30 , $454.62 , $483.30 , $483.30 , $483.30 , $456.45 , $95.99 , $495.81 , $510.15 , $456.45 , $499.41 , $499.41 , $510.15 , $515.52 , $439.37 , $483.30 , $456.45 , $424.23 , N/A , $434.59 , $434.59 , $510.15 , $460.80 , $95.99 , $515.52 
 Fac Drug Screening Ketamine and Norketamine ,CPT® 80357,0301 - LAB/CHEMISTRY,N/A,N/A, $255.00 , $165.75 , $214.20 , N/A , N/A , $206.04 , $229.50 , $215.88 , $229.50 , $229.50 , $229.50 , $216.75 , N/A , $235.44 , $242.25 , $216.75 , $237.15 , $237.15 , $242.25 , $244.80 , $208.64 , $229.50 , $216.75 , $201.45 , N/A , $206.37 , $206.37 , $242.25 , $218.82 , $201.45 , $244.80 
" Small Bowel, Sa ",CPT® 74250,0320 - DX X-RAY,N/A,N/A," $1,198.00 ", $778.70 ," $1,006.32 ", $122.45 , $77.22 , $967.98 ," $1,078.20 "," $1,014.23 "," $1,078.20 "," $1,078.20 "," $1,078.20 "," $1,018.30 ", $75.71 ," $1,106.11 "," $1,138.10 "," $1,018.30 "," $1,114.14 "," $1,114.14 "," $1,138.10 "," $1,150.08 ", $980.20 ," $1,078.20 "," $1,018.30 ", $946.42 , N/A , $969.54 , $969.54 ," $1,138.10 "," $1,028.00 ", $75.71 ," $1,150.08 "
Injection Into Skin Lesions,CPT® 11900,N/A,N/A,N/A, $234.00 , $152.10 , $95.06 , $28.80 , $24.16 , $85.56 , $82.69 , $217.62 , $210.60 , $210.60 , $187.20 , $187.20 , $24.16 , $216.05 , $222.30 , $210.60 , $210.60 , $210.60 , $217.62 , $224.64 , $106.07 , $198.90 , $165.92 , $109.74 , N/A , $87.22 , $87.22 , $222.30 , $101.15 , $24.16 , $224.64 
"Exc Skin Benig 0.6-1cm Trunk,Arm,Leg",11401,N/A,N/A,N/A, $590.00 , $383.50 , $339.42 , $102.35 , $82.94 , $283.30 , $279.16 , $548.70 , $531.00 , $531.00 , $472.00 , $472.00 , $82.94 , $544.75 , $560.50 , $531.00 , $531.00 , $531.00 , $548.70 , $566.40 , $369.90 , $501.50 , $554.84 , $364.24 , N/A , $288.83 , $288.83 , $560.50 , $334.93 , $82.94 , $566.40 
" Fac Chg Inject Radiopharm Non-Imaging Localization, IV ",CPT® 78808,0342 - NUC MED/RX PROCEDURES,N/A,N/A, $609.00 , $395.85 , $511.56 , $38.62 , N/A , $492.07 , $548.10 , $515.58 , $548.10 , $548.10 , $548.10 , $517.65 , N/A , $562.29 , $578.55 , $517.65 , $566.37 , $566.37 , $578.55 , $584.64 , $498.28 , $548.10 , $517.65 , $481.11 , N/A , $492.86 , $492.86 , $578.55 , $522.58 , $38.62 , $584.64 
"Revise Conjunc,Conjunc Grft",CPT® 68320,N/A,N/A,N/A," $6,769.00 "," $4,399.85 "," $3,315.85 ", $520.94 , $768.38 ," $3,049.58 "," $2,890.02 "," $6,295.17 "," $6,092.10 "," $6,092.10 "," $5,415.20 "," $5,415.20 ", $768.38 ," $6,249.82 "," $6,430.55 "," $6,092.10 "," $6,092.10 "," $6,092.10 "," $6,295.17 "," $6,498.24 "," $4,551.06 "," $5,753.65 "," $2,995.44 "," $3,878.24 ", N/A ," $3,109.08 "," $3,109.08 "," $6,430.55 "," $3,432.02 ", $520.94 ," $6,498.24 "
 Fac Chlamydia Igm Antibody ,CPT® 86632,0302 - LAB/IMMUNOLOGY,N/A,N/A, $111.00 , $72.15 , $93.24 , $12.93 , $8.07 , $89.69 , $99.90 , $93.97 , $99.90 , $99.90 , $99.90 , $94.35 , $7.91 , $102.49 , $105.45 , $94.35 , $103.23 , $103.23 , $105.45 , $106.56 , $90.82 , $99.90 , $94.35 , $87.69 , N/A , $89.83 , $89.83 , $105.45 , $95.25 , $7.91 , $106.56 
 GI Bleed Study NM ,CPT® 78278,0340 - NUCLEAR MEDICINE,N/A,N/A," $3,077.00 "," $2,000.05 "," $2,584.68 ", $319.13 , $245.08 ," $2,486.22 "," $2,769.30 "," $2,604.99 "," $2,769.30 "," $2,769.30 "," $2,769.30 "," $2,615.45 ", $240.27 ," $2,840.99 "," $2,923.15 "," $2,615.45 "," $2,861.61 "," $2,861.61 "," $2,923.15 "," $2,953.92 "," $2,517.60 "," $2,769.30 "," $2,615.45 "," $2,430.83 ", N/A ," $2,490.22 "," $2,490.22 "," $2,923.15 "," $2,640.37 ", $240.27 ," $2,953.92 "
 Fac Vit K ,CPT® 84597,0301 - LAB/CHEMISTRY,N/A,N/A, $197.00 , $128.05 , $165.48 , $13.99 , $13.99 , $159.18 , $177.30 , $166.78 , $177.30 , $177.30 , $177.30 , $167.45 , $13.72 , $181.89 , $187.15 , $167.45 , $183.21 , $183.21 , $187.15 , $189.12 , $161.19 , $177.30 , $167.45 , $155.63 , N/A , $159.43 , $159.43 , $187.15 , $169.05 , $13.72 , $189.12 
 Fac B-12 Binding Capacity ,CPT® 82608,0301 - LAB/CHEMISTRY,N/A,N/A, $236.00 , $153.40 , $198.24 , $14.61 , $14.61 , $190.69 , $212.40 , $199.80 , $212.40 , $212.40 , $212.40 , $200.60 , $14.32 , $217.90 , $224.20 , $200.60 , $219.48 , $219.48 , $224.20 , $226.56 , $193.10 , $212.40 , $200.60 , $186.44 , N/A , $190.99 , $190.99 , $224.20 , $202.51 , $14.32 , $226.56 
 Pro Smpl Rpr Supfc S/N/Ax/G/T > 30.0cm ,CPT® 12007,0981 - PRO FEE/ER,N/A,N/A," $1,347.00 ", $875.55 , $453.83 , $133.90 , $230.92 , $407.52 , $398.76 ," $1,252.71 "," $1,212.30 "," $1,212.30 "," $1,077.60 "," $1,077.60 ", $230.92 ," $1,243.69 "," $1,279.65 "," $1,212.30 "," $1,212.30 "," $1,212.30 "," $1,252.71 "," $1,293.12 ", $497.61 ," $1,144.95 ", $801.04 , $504.22 , N/A , $415.47 , $415.47 ," $1,279.65 ", $481.80 , $133.90 ," $1,293.12 "
 Pro Treatment of Ankle Fracture ,CPT® 27818,0975 - PRO FEE/OR,N/A,N/A," $1,305.00 ", $848.25 ," $2,689.44 ", $425.99 , $461.04 ," $2,091.91 "," $2,115.33 "," $1,213.65 "," $1,174.50 "," $1,174.50 "," $1,044.00 "," $1,044.00 ", $461.04 ," $1,204.91 "," $1,239.75 "," $1,174.50 "," $1,174.50 "," $1,174.50 "," $1,213.65 "," $1,252.80 "," $2,482.99 "," $1,109.25 "," $2,326.42 "," $2,473.59 ", N/A ," $2,132.73 "," $2,132.73 "," $1,239.75 "," $2,506.70 ", $425.99 ," $2,689.44 "
ED Temp External Pacing,92953,N/A,N/A,N/A, $4.00 , $2.60 , $5.01 , $0.79 , $17.40 , $61.26 , $59.80 , $3.72 , $3.60 , $3.60 , $3.20 , $3.20 , $17.40 , $3.69 , $3.80 , $3.60 , $3.60 , $3.60 , $3.72 , $3.84 , $4.97 , $3.40 , $55.31 , $5.07 , N/A , $62.45 , $62.45 , $3.80 , $69.24 , $0.79 , $69.24 
" Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC ",MS DRG V40 (FY2023) 563,N/A,N/A,N/A," $18,183.46 "," $11,819.25 "," $15,274.11 ", N/A , N/A ," $14,692.24 "," $16,365.11 "," $15,394.12 "," $16,365.11 "," $16,365.11 "," $16,365.11 "," $15,455.94 ", N/A ," $16,788.79 "," $17,274.29 "," $15,455.94 "," $16,910.62 "," $16,910.62 "," $17,274.29 "," $17,456.12 "," $14,877.71 "," $16,365.11 "," $15,455.94 "," $14,364.93 ", N/A ," $14,715.87 "," $14,715.87 "," $17,274.29 "," $15,603.23 "," $14,364.93 "," $17,456.12 "
 Pro Img-Guide Fluid Collxn Drainag Cath Periton Perq ,CPT® 49406,0982 - PRO FEE/OUTPT,N/A,N/A," $2,390.00 "," $1,553.50 "," $1,198.54 ", $185.07 , $244.64 ," $1,041.92 "," $1,072.96 "," $2,222.70 "," $2,151.00 "," $2,151.00 "," $1,912.00 "," $1,912.00 ", $244.64 ," $2,206.69 "," $2,270.50 "," $2,151.00 "," $2,151.00 "," $2,151.00 "," $2,222.70 "," $2,294.40 ", $867.06 ," $2,031.50 "," $1,009.30 "," $1,155.04 ", N/A ," $1,062.26 "," $1,062.26 "," $2,270.50 "," $1,111.01 ", $185.07 ," $2,294.40 "
Spin Bone Allogrft Morselized,CPT® 20930,N/A,N/A,N/A," $1,392.00 ", $904.80 , N/A , N/A , $382.01 , $584.90 , $571.27 ," $1,294.56 "," $1,252.80 "," $1,252.80 "," $1,113.60 "," $1,113.60 ", $382.01 ," $1,285.23 "," $1,322.40 "," $1,252.80 "," $1,252.80 "," $1,252.80 "," $1,294.56 "," $1,336.32 ", N/A ," $1,183.20 ", N/A , $681.93 , N/A , $596.32 , $596.32 ," $1,322.40 ", $700.88 , $382.01 ," $1,336.32 "
"US, Preg Uter,Fetal & Mat,1st Trim,Addl",CPT® 76802,N/A,N/A,N/A, $558.00 , $362.70 , $348.58 , $60.65 , $69.63 , $314.19 , $348.27 , $518.94 , $502.20 , $502.20 , $446.40 , $446.40 , $69.63 , $515.20 , $530.10 , $502.20 , $502.20 , $502.20 , $518.94 , $535.68 , $349.15 , $474.30 , $379.43 , $365.35 , N/A , $320.32 , $320.32 , $530.10 , $370.77 , $60.65 , $535.68 
"Repair Skull Defect,Up to 5cm",CPT® 62140,N/A,N/A,N/A," $6,721.00 "," $4,368.65 "," $4,749.84 ", $930.55 , $875.85 ," $5,609.52 "," $5,404.23 "," $6,250.53 "," $6,048.90 "," $6,048.90 "," $5,376.80 "," $5,376.80 ", $875.85 ," $6,205.50 "," $6,384.95 "," $6,048.90 "," $6,048.90 "," $6,048.90 "," $6,250.53 "," $6,452.16 "," $5,118.33 "," $5,712.85 "," $5,514.54 "," $5,802.66 ", N/A ," $5,718.97 "," $5,718.97 "," $6,384.95 "," $6,135.11 ", $875.85 ," $6,452.16 "
 DILTIAZEM HCL 25 MG/5ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00641-6013-10,5 mL, $21.09 , $13.71 , $17.72 , N/A , N/A , $17.04 , $18.98 , $17.85 , $18.98 , $18.98 , $18.98 , $17.93 , N/A , $19.47 , $20.04 , $17.93 , $19.61 , $19.61 , $20.04 , $20.25 , $17.26 , $18.98 , $17.93 , $16.66 , N/A , $17.07 , $17.07 , $20.04 , $18.10 , $16.66 , $20.25 
"Cytomed, Dna, Amp Probe",CPT® 87493,N/A,N/A,N/A, $261.00 , $169.65 , N/A , $38.02 , $38.02 , $198.56 , $237.51 , $242.73 , $234.90 , $234.90 , $208.80 , $208.80 , $38.02 , $240.98 , $247.95 , $234.90 , $234.90 , $234.90 , $242.73 , $250.56 , $248.86 , $221.85 , $230.30 , $127.26 , N/A , $185.31 , $185.31 , $247.95 , $202.50 , $38.02 , $250.56 
"Percut Implnt Neuroelect,Epidural",CPT® 63650,N/A,N/A,N/A," $8,360.00 "," $5,434.00 "," $2,045.78 ", $397.89 , $366.89 ," $2,322.82 "," $2,361.96 "," $7,774.80 "," $7,524.00 "," $7,524.00 "," $6,688.00 "," $6,688.00 ", $366.89 ," $7,718.79 "," $7,942.00 "," $7,524.00 "," $7,524.00 "," $7,524.00 "," $7,774.80 "," $8,025.60 "," $2,220.52 "," $7,106.00 "," $2,301.44 "," $2,487.64 ", N/A ," $2,368.14 "," $2,368.14 "," $7,942.00 "," $2,540.46 ", $366.89 ," $8,025.60 "
" Pro Rep Smpl Wnd Face, Eyelids,Nose,Ears,Lips 2.6-5.0 Cm ",CPT® 12013,0982 - PRO FEE/OUTPT,N/A,N/A, $802.00 , $521.30 , $180.71 , $53.74 , $76.93 , $169.97 , $163.73 , $745.86 , $721.80 , $721.80 , $641.60 , $641.60 , $76.93 , $740.49 , $761.90 , $721.80 , $721.80 , $721.80 , $745.86 , $769.92 , $198.93 , $681.70 , $328.27 , $200.67 , N/A , $173.28 , $173.28 , $761.90 , $200.96 , $53.74 , $769.92 
 Fac Byp Composit Prostc&Vein ,CPT® 35681,0360 - OR SERVICES,N/A,N/A, $796.00 , $517.40 , $668.64 , $70.59 ," $1,282.43 ", $643.17 , $716.40 , $673.89 , $716.40 , $716.40 , $716.40 , $676.60 ," $1,257.28 ", $734.95 , $756.20 , $676.60 , $740.28 , $740.28 , $756.20 , $764.16 , $651.29 , $716.40 , $676.60 , $628.84 , N/A , $644.20 , $644.20 , $756.20 , $683.05 , $70.59 ," $1,282.43 "
Iaad Ia Cryptococcus Neoformans,CPT® 87327,N/A,N/A,N/A, $103.00 , $66.95 , N/A , $13.69 , $13.69 , $67.85 , $81.18 , $95.79 , $92.70 , $92.70 , $82.40 , $82.40 , $13.69 , $95.10 , $97.85 , $92.70 , $92.70 , $92.70 , $95.79 , $98.88 , $89.61 , $87.55 , $77.85 , $43.47 , N/A , $63.32 , $63.32 , $97.85 , $69.20 , $13.69 , $98.88 
 Fac Chemotx Admn IV Push Tq Ea Sbst/Drug ,CPT® 96411,0331 - CHEMOTHER/INJ,N/A,N/A, $331.00 , $215.15 , $278.04 , $53.64 , $57.87 , $267.45 , $297.90 , $280.22 , $297.90 , $297.90 , $297.90 , $281.35 , $56.74 , $305.61 , $314.45 , $281.35 , $307.83 , $307.83 , $314.45 , $317.76 , $270.82 , $297.90 , $281.35 , $261.49 , N/A , $267.88 , $267.88 , $314.45 , $284.03 , $53.64 , $317.76 
"Chemother, IV Infusion, 1 Hr",CPT® 96413,N/A,N/A,N/A, $564.00 , $366.60 , $457.03 , $127.01 , $137.88 , $379.10 , $320.40 , $524.52 , $507.60 , $507.60 , $451.20 , $451.20 , $137.88 , $520.74 , $535.80 , $507.60 , $507.60 , $507.60 , $524.52 , $541.44 , $436.93 , $479.40 , $426.77 , $547.46 , N/A , $386.50 , $386.50 , $535.80 , $456.63 , $127.01 , $547.46 
 Moderna Pediatric Vaccine Admin Age 6-11 - First Dose ,CPT® 0091A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
 Fac Slings ,HCPCS A4565,0274 - PROSTHETIC DEV,N/A,N/A, $27.00 , $17.55 , $22.68 , $10.44 , N/A , $21.82 , $24.30 , $22.86 , $24.30 , $24.30 , $24.30 , $22.95 , N/A , $24.93 , $25.65 , $22.95 , $25.11 , $25.11 , $25.65 , $25.92 , $22.09 , $24.30 , $22.95 , $21.33 , N/A , $21.85 , $21.85 , $25.65 , $23.17 , $10.44 , $25.92 
Intrnsc Factor Antibodies,CPT® 86340,N/A,N/A,N/A, $195.00 , $126.75 , N/A , $15.38 , $14.10 , $57.45 , $68.69 , $181.35 , $175.50 , $175.50 , $156.00 , $156.00 , $14.10 , $180.04 , $185.25 , $175.50 , $175.50 , $175.50 , $181.35 , $187.20 , $100.69 , $165.75 , $98.93 , $54.66 , N/A , $53.62 , $53.62 , $185.25 , $58.60 , $14.10 , $187.20 
Drug Screening Barbiturates,CPT® 80345,N/A,N/A,N/A, $153.00 , $99.45 , N/A , N/A , N/A , N/A , N/A , $142.29 , $137.70 , $137.70 , $122.40 , $122.40 , N/A , $141.26 , $145.35 , $137.70 , $137.70 , $137.70 , $142.29 , $146.88 , N/A , $130.05 , $114.69 , $67.79 , N/A , $90.04 , $90.04 , $145.35 , $98.20 , $67.79 , $146.88 
Excise Adrenal Gland,CPT® 60540,N/A,N/A,N/A," $7,589.00 "," $4,932.85 "," $6,449.30 "," $1,001.56 "," $1,613.62 "," $5,452.34 "," $5,607.93 "," $7,057.77 "," $6,830.10 "," $6,830.10 "," $6,071.20 "," $6,071.20 "," $1,613.62 "," $7,006.92 "," $7,209.55 "," $6,830.10 "," $6,830.10 "," $6,830.10 "," $7,057.77 "," $7,285.44 "," $6,266.45 "," $6,450.65 "," $5,543.09 "," $5,312.95 ", N/A ," $5,558.73 "," $5,558.73 "," $7,209.55 "," $6,199.64 "," $1,001.56 "," $7,285.44 "
 Pro Img-Guide Fluid Collxn Drainag Cath Periton Perq ,CPT® 49406,0972 - PRO FEE/RAD/DX,N/A,N/A," $2,390.00 "," $1,553.50 "," $1,198.54 ", $185.07 , $244.64 ," $1,041.92 "," $1,072.96 "," $2,222.70 "," $2,151.00 "," $2,151.00 "," $1,912.00 "," $1,912.00 ", $244.64 ," $2,206.69 "," $2,270.50 "," $2,151.00 "," $2,151.00 "," $2,151.00 "," $2,222.70 "," $2,294.40 ", $867.06 ," $2,031.50 "," $1,009.30 "," $1,155.04 ", N/A ," $1,062.26 "," $1,062.26 "," $2,270.50 "," $1,111.01 ", $185.07 ," $2,294.40 "
 Fluorscopic Guidance for Needle Plac ,CPT® 77002,0320 - DX X-RAY,N/A,N/A, $639.00 , $415.35 , $536.76 , $114.76 , $61.30 , $516.31 , $575.10 , $540.98 , $575.10 , $575.10 , $575.10 , $543.15 , $60.10 , $589.99 , $607.05 , $543.15 , $594.27 , $594.27 , $607.05 , $613.44 , $522.83 , $575.10 , $543.15 , $504.81 , N/A , $517.14 , $517.14 , $607.05 , $548.33 , $60.10 , $613.44 
 Fac Esophagoscopy Flexible Transoral Diagnostic ,CPT® 43200,0360 - OR SERVICES,N/A,N/A," $1,323.00 ", $859.95 ," $1,111.32 ", $82.66 , $188.18 ," $1,068.98 "," $1,190.70 "," $1,120.05 "," $1,190.70 "," $1,190.70 "," $1,190.70 "," $1,124.55 ", $184.49 ," $1,221.53 "," $1,256.85 "," $1,124.55 "," $1,230.39 "," $1,230.39 "," $1,256.85 "," $1,270.08 "," $1,082.48 "," $1,190.70 "," $1,124.55 "," $1,045.17 ", N/A ," $1,070.70 "," $1,070.70 "," $1,256.85 "," $1,135.27 ", $82.66 ," $1,270.08 "
 Fac Urtrl Rflx Std Rp Voiding Cstogram ,CPT® 78740,0340 - NUCLEAR MEDICINE,N/A,N/A," $1,349.00 ", $876.85 ," $1,133.16 ", $199.97 , $114.82 ," $1,089.99 "," $1,214.10 "," $1,142.06 "," $1,214.10 "," $1,214.10 "," $1,214.10 "," $1,146.65 ", $112.57 ," $1,245.53 "," $1,281.55 "," $1,146.65 "," $1,254.57 "," $1,254.57 "," $1,281.55 "," $1,295.04 "," $1,103.75 "," $1,214.10 "," $1,146.65 "," $1,065.71 ", N/A ," $1,091.75 "," $1,091.75 "," $1,281.55 "," $1,157.58 ", $112.57 ," $1,295.04 "
" Fac Tissue Culture, Lymphocyte ",CPT® 88230,0310 - PATHOLOGY LAB,N/A,N/A," $1,046.00 ", $679.90 , $878.64 , $118.82 , $69.14 , $845.17 , $941.40 , $885.54 , $941.40 , $941.40 , $941.40 , $889.10 , $67.78 , $965.77 , $993.70 , $889.10 , $972.78 , $972.78 , $993.70 ," $1,004.16 ", $855.84 , $941.40 , $889.10 , $826.34 , N/A , $846.53 , $846.53 , $993.70 , $897.57 , $67.78 ," $1,004.16 "
"Cystourethroscopy,Fulgur 2-5cm Lesn",52235,N/A,N/A,N/A," $1,935.00 "," $1,257.75 "," $1,544.39 ", $271.60 , $294.09 ," $1,414.72 "," $1,312.81 "," $1,799.55 "," $1,741.50 "," $1,741.50 "," $1,548.00 "," $1,548.00 ", $294.09 ," $1,786.59 "," $1,838.25 "," $1,741.50 "," $1,741.50 "," $1,741.50 "," $1,799.55 "," $1,857.60 "," $1,553.70 "," $1,644.75 "," $1,486.13 "," $1,776.87 ", N/A ," $1,442.32 "," $1,442.32 "," $1,838.25 "," $1,695.24 ", $271.60 ," $1,857.60 "
 Pro Cltx Fx Phlx/Phlg Oth/Thn Grt Toe W/Mnpj ,CPT® 28515,0981 - PRO FEE/ER,N/A,N/A, $747.00 , $485.55 , $888.42 , $141.25 , $76.84 , $702.96 , $708.81 , $694.71 , $672.30 , $672.30 , $597.60 , $597.60 , $76.84 , $689.71 , $709.65 , $672.30 , $672.30 , $672.30 , $694.71 , $717.12 , $817.30 , $634.95 , $768.93 , $830.94 , N/A , $716.67 , $716.67 , $709.65 , $842.36 , $76.84 , $888.42 
 Pro Injection Aa&/Strd Other Peripheral Nerve/Branch ,CPT® 64450,0982 - PRO FEE/OUTPT,N/A,N/A, $402.00 , $261.30 , $207.58 , $40.26 , $113.79 , $255.83 , $245.04 , $373.86 , $361.80 , $361.80 , $321.60 , $321.60 , $113.79 , $371.17 , $381.90 , $361.80 , $361.80 , $361.80 , $373.86 , $385.92 , $225.30 , $341.70 , $237.28 , $273.66 , N/A , $260.82 , $260.82 , $381.90 , $279.80 , $40.26 , $385.92 
Sgmdsc Flx W/Dcmprn W/Plmt Dcmprn Tube,CPT® 45337,N/A,N/A,N/A, $988.00 , $642.20 , $703.04 , $108.03 , $682.55 , $675.32 , $693.52 , $918.84 , $889.20 , $889.20 , $790.40 , $790.40 , $682.55 , $912.22 , $938.60 , $889.20 , $889.20 , $889.20 , $918.84 , $948.48 , $504.51 , $839.80 , $763.58 , $667.28 , N/A , $688.49 , $688.49 , $938.60 , $720.11 , $108.03 , $948.48 
 T Spine MRI Without Contrast ,CPT® 72146,0612 - MRI - SPINE,N/A,N/A," $4,898.00 "," $3,183.70 "," $4,114.32 ", $195.41 , $423.92 ," $3,957.58 "," $4,408.20 "," $4,146.65 "," $4,408.20 "," $4,408.20 "," $4,408.20 "," $4,163.30 ", $415.61 ," $4,522.32 "," $4,653.10 "," $4,163.30 "," $4,555.14 "," $4,555.14 "," $4,653.10 "," $4,702.08 "," $4,007.54 "," $4,408.20 "," $4,163.30 "," $3,869.42 ", N/A ," $3,963.95 "," $3,963.95 "," $4,653.10 "," $4,202.97 ", $195.41 ," $4,702.08 "
Bronchoscopy W/Transbroncl Ndl Aspir Bx Ea Lobe,CPT® 31633,N/A,N/A,N/A, $513.00 , $333.45 , $345.98 , $59.73 , $88.94 , $246.93 , $240.56 , $477.09 , $461.70 , $461.70 , $410.40 , $410.40 , $88.94 , $473.65 , $487.35 , $461.70 , $461.70 , $461.70 , $477.09 , $492.48 , $337.54 , $436.05 , $333.62 , $332.57 , N/A , $251.74 , $251.74 , $487.35 , $296.48 , $59.73 , $492.48 
" Pro X-Rays, Bone Survey, Limited ",CPT® 77074,0972 - PRO FEE/RAD/DX,N/A,N/A, $211.00 , $137.15 , $369.92 , $64.13 , $52.24 , $302.75 , $373.53 , $196.23 , $189.90 , $189.90 , $168.80 , $168.80 , $52.24 , $194.82 , $200.45 , $189.90 , $189.90 , $189.90 , $196.23 , $202.56 , $359.12 , $179.35 , $404.47 , $324.94 , N/A , $308.66 , $308.66 , $200.45 , $357.28 , $52.24 , $404.47 
 Pro Repair of Hammertoe ,CPT® 28285,0982 - PRO FEE/OUTPT,N/A,N/A," $3,525.00 "," $2,291.25 "," $2,376.27 ", $373.93 , $280.42 ," $1,861.09 "," $1,848.26 "," $3,278.25 "," $3,172.50 "," $3,172.50 "," $2,820.00 "," $2,820.00 ", $280.42 ," $3,254.63 "," $3,348.75 "," $3,172.50 "," $3,172.50 "," $3,172.50 "," $3,278.25 "," $3,384.00 "," $2,197.00 "," $2,996.25 "," $1,999.94 "," $2,217.14 ", N/A ," $1,897.41 "," $1,897.41 "," $3,348.75 "," $2,230.13 ", $280.42 ," $3,384.00 "
"Ureterolithotomy,Lower 1/3",CPT® 50630,N/A,N/A,N/A," $6,221.00 "," $4,043.65 "," $4,824.37 ", $848.21 ," $1,229.45 "," $4,371.11 "," $4,062.87 "," $5,785.53 "," $5,598.90 "," $5,598.90 "," $4,976.80 "," $4,976.80 "," $1,229.45 "," $5,743.85 "," $5,909.95 "," $5,598.90 "," $5,598.90 "," $5,598.90 "," $5,785.53 "," $5,972.16 "," $4,844.01 "," $5,287.85 "," $4,599.32 "," $5,494.01 ", N/A ," $4,456.40 "," $4,456.40 "," $5,909.95 "," $5,237.88 ", $848.21 ," $5,972.16 "
 Fac Car Seat/Bed Test Inft Thru 12 Mo 60 Min ,CPT® 94780,0761 - TREATMENT ROOM,N/A,N/A, $196.00 , $127.40 , $164.64 , $22.94 , $39.68 , $158.37 , $176.40 , $165.93 , $176.40 , $176.40 , $176.40 , $166.60 , $38.90 , $180.97 , $186.20 , $166.60 , $182.28 , $182.28 , $186.20 , $188.16 , $160.37 , $176.40 , $166.60 , $154.84 , N/A , $158.62 , $158.62 , $186.20 , $168.19 , $22.94 , $188.16 
 PANTOPRAZOLE SODIUM 40 MG IV SOLR ,HCPCS C9113,0636 - DRUGS REQUIRING DETAILED CODIN,55150-0202-10,10 mL, $43.67 , $28.39 , $36.68 , N/A , N/A , $35.29 , $39.30 , $36.97 , $39.30 , $39.30 , $39.30 , $37.12 , N/A , $40.32 , $41.49 , $37.12 , $40.61 , $40.61 , $41.49 , $41.92 , $35.73 , $39.30 , $37.12 , $34.50 , N/A , $35.34 , $35.34 , $41.49 , $37.47 , $34.50 , $41.92 
"Excis Rectal Tumor, Transanal, Partial Thickness",CPT® 45171,N/A,N/A,N/A," $4,673.00 "," $3,037.45 "," $3,796.78 ", $588.55 , $490.70 ," $2,854.71 "," $2,930.72 "," $4,345.89 "," $4,205.70 "," $4,205.70 "," $3,738.40 "," $3,738.40 ", $490.70 ," $4,314.58 "," $4,439.35 "," $4,205.70 "," $4,205.70 "," $4,205.70 "," $4,345.89 "," $4,486.08 "," $2,723.38 "," $3,972.05 "," $3,227.37 "," $3,408.02 ", N/A ," $2,910.42 "," $2,910.42 "," $4,439.35 "," $3,044.00 ", $490.70 ," $4,486.08 "
Complete Cbc,CPT® 85027,N/A,N/A,N/A, $91.00 , $59.15 , N/A , $6.60 , $6.60 , $36.62 , $43.78 , $84.63 , $81.90 , $81.90 , $72.80 , $72.80 , $6.60 , $84.02 , $86.45 , $81.90 , $81.90 , $81.90 , $84.63 , $87.36 , $43.20 , $77.35 , $42.17 , $23.44 , N/A , $34.18 , $34.18 , $86.45 , $37.35 , $6.60 , $87.36 
Prep Site F/S/N/H/F/G/M/D Gt 1st 100 Sq Cm/1pct,CPT® 15004,N/A,N/A,N/A," $2,092.00 "," $1,359.80 ", $831.98 , $247.01 , $298.14 , $745.13 , $721.40 ," $1,945.56 "," $1,882.80 "," $1,882.80 "," $1,673.60 "," $1,673.60 ", $298.14 ," $1,931.54 "," $1,987.40 "," $1,882.80 "," $1,882.80 "," $1,882.80 "," $1,945.56 "," $2,008.32 ", $917.20 ," $1,778.20 "," $1,437.96 ", $941.84 , N/A , $759.67 , $759.67 ," $1,987.40 ", $880.97 , $247.01 ," $2,008.32 "
Initial Nursing Facility Care Sf/Low Mdm 25 Min,CPT® 99304,N/A,N/A,N/A, $238.00 , $154.70 , $177.68 , $78.33 , $56.66 , $157.92 , $161.31 , $221.34 , $214.20 , $214.20 , $190.40 , $190.40 , $56.66 , $219.75 , $226.10 , $214.20 , $214.20 , $214.20 , $221.34 , $228.48 , $226.20 , $202.30 , $201.78 , $193.61 , $90.00 , $161.00 , $161.00 , $226.10 , $185.68 , $56.66 , $228.48 
Antiepileptics Not Otherwise Specified 1-3,CPT® 80339,N/A,N/A,N/A, $55.00 , $35.75 , N/A , N/A , N/A , N/A , N/A , $51.15 , $49.50 , $49.50 , $44.00 , $44.00 , N/A , $50.78 , $52.25 , $49.50 , $49.50 , $49.50 , $51.15 , $52.80 , N/A , $46.75 , $114.69 , $67.79 , N/A , $90.04 , $90.04 , $52.25 , $98.20 , $44.00 , $114.69 
"Cysto/Uretero/Pyeloscopy, Calculus Tx",CPT® 52352,N/A,N/A,N/A," $3,336.00 "," $2,168.40 "," $1,897.67 ", $333.29 , $375.30 ," $1,738.68 "," $2,378.40 "," $3,102.48 "," $3,002.40 "," $3,002.40 "," $2,668.80 "," $2,668.80 ", $375.30 ," $3,080.13 "," $3,169.20 "," $3,002.40 "," $3,002.40 "," $3,002.40 "," $3,102.48 "," $3,202.56 "," $1,908.24 "," $2,835.60 "," $1,869.70 "," $2,182.87 ", N/A ," $1,772.61 "," $1,772.61 "," $3,169.20 "," $2,083.44 ", $333.29 ," $3,202.56 "
Cast Sup Lng Leg Ped Fbrgls,HCPCS Q4032,N/A,N/A,N/A, $75.00 , $48.75 , N/A , $46.12 , $29.84 , N/A , N/A , $69.75 , $67.50 , $67.50 , $60.00 , $60.00 , $29.84 , $69.25 , $71.25 , $67.50 , $67.50 , $67.50 , $69.75 , $72.00 , N/A , $63.75 , $79.15 , $41.91 , N/A , N/A , N/A , $71.25 , N/A , $29.84 , $79.15 
 Orbits CT Without Contrast ,CPT® 70480,0350 - CT SCAN,N/A,N/A," $3,325.00 "," $2,161.25 "," $2,793.00 ", $162.01 , $255.88 ," $2,686.60 "," $2,992.50 "," $2,814.95 "," $2,992.50 "," $2,992.50 "," $2,992.50 "," $2,826.25 ", $250.86 ," $3,069.97 "," $3,158.75 "," $2,826.25 "," $3,092.25 "," $3,092.25 "," $3,158.75 "," $3,192.00 "," $2,720.52 "," $2,992.50 "," $2,826.25 "," $2,626.75 ", N/A ," $2,690.92 "," $2,690.92 "," $3,158.75 "," $2,853.18 ", $162.01 ," $3,192.00 "
Rpr Ctr Vad W/Subq Port/Pmp Ctr/Prph Insj Sit,CPT® 36576,N/A,N/A,N/A," $2,363.00 "," $1,535.95 "," $1,108.90 ", $171.05 , $417.84 , $852.48 , $843.73 ," $2,197.59 "," $2,126.70 "," $2,126.70 "," $1,890.40 "," $1,890.40 ", $417.84 ," $2,181.76 "," $2,244.85 "," $2,126.70 "," $2,126.70 "," $2,126.70 "," $2,197.59 "," $2,268.48 "," $1,022.87 "," $2,008.55 "," $1,047.25 ", $900.74 , N/A , $869.12 , $869.12 ," $2,244.85 ", $987.30 , $171.05 ," $2,268.48 "
"Laminec/Facetect/Foramin,Cervical",CPT® 63045,N/A,N/A,N/A," $8,235.00 "," $5,352.75 "," $5,976.57 "," $1,168.79 "," $1,072.37 "," $6,902.75 "," $6,637.26 "," $7,658.55 "," $7,411.50 "," $7,411.50 "," $6,588.00 "," $6,588.00 "," $1,072.37 "," $7,603.38 "," $7,823.25 "," $7,411.50 "," $7,411.50 "," $7,411.50 "," $7,658.55 "," $7,905.60 "," $6,459.76 "," $6,999.75 "," $6,765.17 "," $7,284.03 ", N/A ," $7,037.43 "," $7,037.43 "," $7,823.25 "," $7,549.50 "," $1,072.37 "," $7,905.60 "
 Fac Trauma 2 Activation W/ Pre-ED Notification- Level II W/ Critical Care ,HCPCS G0390,0682 - TRAUMA LEVEL II,N/A,N/A," $5,108.00 "," $3,320.20 "," $4,290.72 ", N/A , N/A ," $4,127.26 "," $4,597.20 "," $4,324.43 "," $4,597.20 "," $4,597.20 "," $4,597.20 "," $4,341.80 ", N/A ," $4,716.22 "," $4,852.60 "," $4,341.80 "," $4,750.44 "," $4,750.44 "," $4,852.60 "," $4,903.68 "," $4,179.37 "," $4,597.20 "," $4,341.80 "," $4,035.32 ", N/A ," $4,133.90 "," $4,133.90 "," $4,852.60 "," $4,383.17 "," $4,035.32 "," $4,903.68 "
"Sling Operation,Correction,Male Incont",CPT® 53440,N/A,N/A,N/A," $5,327.00 "," $3,462.55 "," $4,079.22 ", $717.76 ," $1,229.45 "," $3,680.83 "," $3,431.91 "," $4,954.11 "," $4,794.30 "," $4,794.30 "," $4,261.60 "," $4,261.60 "," $1,229.45 "," $4,918.42 "," $5,060.65 "," $4,794.30 "," $4,794.30 "," $4,794.30 "," $4,954.11 "," $5,113.92 "," $4,094.28 "," $4,527.95 "," $3,885.69 "," $4,633.70 ", N/A ," $3,752.64 "," $3,752.64 "," $5,060.65 "," $4,410.70 ", $717.76 ," $5,113.92 "
"Esrd Services, per Month, 20+ Yr Old, 4+ Visits",CPT® 90960,N/A,N/A,N/A," $1,141.00 ", $741.65 , $827.42 , $344.74 , $276.43 , $633.45 , $637.90 ," $1,061.13 "," $1,026.90 "," $1,026.90 ", $912.80 , $912.80 , $276.43 ," $1,053.49 "," $1,083.95 "," $1,026.90 "," $1,026.90 "," $1,026.90 "," $1,061.13 "," $1,095.36 "," $1,092.88 ", $969.85 , $839.36 ," $1,073.82 ", N/A , $645.82 , $645.82 ," $1,083.95 ", $752.88 , $276.43 ," $1,095.36 "
" Pro US Exam Abdo Back Wall, Lim ",CPT® 76775,0981 - PRO FEE/ER,N/A,N/A, $348.00 , $226.20 , $327.35 , $58.03 , $88.69 , $276.72 , $576.01 , $323.64 , $313.20 , $313.20 , $278.40 , $278.40 , $88.69 , $321.31 , $330.60 , $313.20 , $313.20 , $313.20 , $323.64 , $334.08 , $324.22 , $295.80 , $627.89 , $326.12 , N/A , $282.12 , $282.12 , $330.60 , $326.56 , $58.03 , $627.89 
 Fac Cltx Sho Dislc W/Mnpj W/O Anes ,CPT® 23650,0361 - OR/MINOR,N/A,N/A," $2,728.00 "," $1,773.20 "," $2,291.52 ", $292.70 , $192.43 ," $2,204.22 "," $2,455.20 "," $2,309.52 "," $2,455.20 "," $2,455.20 "," $2,455.20 "," $2,318.80 ", $188.66 ," $2,518.76 "," $2,591.60 "," $2,318.80 "," $2,537.04 "," $2,537.04 "," $2,591.60 "," $2,618.88 "," $2,232.05 "," $2,455.20 "," $2,318.80 "," $2,155.12 ", N/A ," $2,207.77 "," $2,207.77 "," $2,591.60 "," $2,340.90 ", $188.66 ," $2,618.88 "
"Exc Skin Malig 2.1-3cm Trunk,Arm,Leg",CPT® 11603,N/A,N/A,N/A," $1,190.00 ", $773.50 , $618.19 , $185.66 , $250.91 , $533.33 , $520.40 ," $1,106.70 "," $1,071.00 "," $1,071.00 ", $952.00 , $952.00 , $250.91 ," $1,098.73 "," $1,130.50 "," $1,071.00 "," $1,071.00 "," $1,071.00 "," $1,106.70 "," $1,142.40 ", $677.73 ," $1,011.50 "," $1,034.76 ", $686.47 , N/A , $543.74 , $543.74 ," $1,130.50 ", $630.55 , $185.66 ," $1,142.40 "
" Pro Debridement, Skin, Sub-Q Tissue,Each Add 20 Sq Cm ",CPT® 11045,0975 - PRO FEE/OR,N/A,N/A, $152.00 , $98.80 , $81.91 , $23.74 , $12.63 , $71.63 , $71.08 , $141.36 , $136.80 , $136.80 , $121.60 , $121.60 , $12.63 , $140.34 , $144.40 , $136.80 , $136.80 , $136.80 , $141.36 , $145.92 , $90.34 , $129.20 , $144.51 , $91.36 , N/A , $73.03 , $73.03 , $144.40 , $84.69 , $12.63 , $145.92 
 Fac Drug Screening Tramadol ,CPT® 80373,0301 - LAB/CHEMISTRY,N/A,N/A, $194.00 , $126.10 , $162.96 , N/A , N/A , $156.75 , $174.60 , $164.24 , $174.60 , $174.60 , $174.60 , $164.90 , N/A , $179.12 , $184.30 , $164.90 , $180.42 , $180.42 , $184.30 , $186.24 , $158.73 , $174.60 , $164.90 , $153.26 , N/A , $157.00 , $157.00 , $184.30 , $166.47 , $153.26 , $186.24 
"Appendectomy,W Othr Proc",CPT® 44955,N/A,N/A,N/A," $1,048.00 ", $681.20 , $493.29 , $76.60 , $408.30 , $394.92 , $394.26 , $974.64 , $943.20 , $943.20 , $838.40 , $838.40 , $408.30 , $967.62 , $995.60 , $943.20 , $943.20 , $943.20 , $974.64 ," $1,006.08 ", $355.30 , $890.80 , $438.88 , $467.11 , N/A , $402.63 , $402.63 , $995.60 , $421.11 , $76.60 ," $1,006.08 "
 Pro Tangential Biopsy Skin Single Lesion ,CPT® 11102,0982 - PRO FEE/OUTPT,N/A,N/A, $122.00 , $79.30 , $121.11 , $36.38 , $78.04 , $101.29 , N/A , $113.46 , $109.80 , $109.80 , $97.60 , $97.60 , $78.04 , $112.64 , $115.90 , $109.80 , $109.80 , $109.80 , $113.46 , $117.12 , $134.04 , $103.70 , $199.02 , $138.93 , N/A , $103.26 , $103.26 , $115.90 , $119.75 , $36.38 , $199.02 
 CYCLOPHOSPHAMIDE 500 MG IJ SOLR ,HCPCS J9070,0636 - DRUGS REQUIRING DETAILED CODIN,10019-0955-01,25 mL," $2,257.66 "," $1,467.48 "," $1,896.43 ", $17.43 , $22.57 ," $1,824.19 "," $2,031.89 "," $1,911.33 "," $2,031.89 "," $2,031.89 "," $2,031.89 "," $1,919.01 ", $22.13 ," $2,084.50 "," $2,144.78 "," $1,919.01 "," $2,099.62 "," $2,099.62 "," $2,144.78 "," $2,167.35 "," $1,847.22 "," $2,031.89 "," $1,919.01 "," $1,783.55 ", N/A ," $1,827.12 "," $1,827.12 "," $2,144.78 "," $1,937.30 ", $17.43 ," $2,167.35 "
"Esrd Services, per Day,20+ Yr Old",CPT® 90970,N/A,N/A,N/A, $33.00 , $21.45 , $22.25 , $9.28 , $7.80 , $17.35 , $17.66 , $30.69 , $29.70 , $29.70 , $26.40 , $26.40 , $7.80 , $30.47 , $31.35 , $29.70 , $29.70 , $29.70 , $30.69 , $31.68 , $29.52 , $28.05 , $23.32 , $29.32 , N/A , $17.69 , $17.69 , $31.35 , $20.61 , $7.80 , $31.68 
 LIDOCAINE VISCOUS HCL 2 % MT SOLN ,HCPCS RXA250,0250 - PHARMACY,00121-0903-40,5 mL, $7.99 , $5.19 , $6.71 , N/A , N/A , $6.46 , $7.19 , $6.76 , $7.19 , $7.19 , $7.19 , $6.79 , N/A , $7.38 , $7.59 , $6.79 , $7.43 , $7.43 , $7.59 , $7.67 , $6.54 , $7.19 , $6.79 , $6.31 , N/A , $6.47 , $6.47 , $7.59 , $6.86 , $6.31 , $7.67 
 BISMUTH SUBSALICYLATE 262 MG/15ML PO SUSP ,HCPCS RXC637,0250 - PHARMACY,70000-0044-01,118 mL, $15.16 , $9.85 , $12.73 , N/A , N/A , $12.25 , $13.64 , $12.83 , $13.64 , $13.64 , $13.64 , $12.89 , N/A , $14.00 , $14.40 , $12.89 , $14.10 , $14.10 , $14.40 , $14.55 , $12.40 , $13.64 , $12.89 , $11.98 , N/A , $12.27 , $12.27 , $14.40 , $13.01 , $11.98 , $14.55 
 Wedge Excision of Skin of Nail Fold - Mh ,CPT® 11765,0761 - TREATMENT ROOM,N/A,N/A, $255.00 , $165.75 , $214.20 , $89.88 , $111.12 , $206.04 , $229.50 , $215.88 , $229.50 , $229.50 , $229.50 , $216.75 , $108.94 , $235.44 , $242.25 , $216.75 , $237.15 , $237.15 , $242.25 , $244.80 , $208.64 , $229.50 , $216.75 , $201.45 , N/A , $206.37 , $206.37 , $242.25 , $218.82 , $89.88 , $244.80 
 Pro Aspirate/Inj Ganglion Cyst ,CPT® 20612,0982 - PRO FEE/OUTPT,N/A,N/A, $397.00 , $258.05 , $250.97 , $39.08 , $50.15 , $203.91 , $200.35 , $369.21 , $357.30 , $357.30 , $317.60 , $317.60 , $50.15 , $366.55 , $377.15 , $357.30 , $357.30 , $357.30 , $369.21 , $381.12 , $234.59 , $337.45 , $217.66 , $243.04 , N/A , $207.89 , $207.89 , $377.15 , $244.35 , $39.08 , $381.12 
 DINOPROSTONE 10 MG VA INST ,HCPCS RXA250,0250 - PHARMACY,55566-2800-01,1 suppository," $1,481.43 ", $962.93 ," $1,244.40 ", N/A , N/A ," $1,197.00 "," $1,333.29 "," $1,254.18 "," $1,333.29 "," $1,333.29 "," $1,333.29 "," $1,259.22 ", N/A ," $1,367.80 "," $1,407.36 "," $1,259.22 "," $1,377.73 "," $1,377.73 "," $1,407.36 "," $1,422.17 "," $1,212.11 "," $1,333.29 "," $1,259.22 "," $1,170.33 ", N/A ," $1,198.92 "," $1,198.92 "," $1,407.36 "," $1,271.22 "," $1,170.33 "," $1,422.17 "
 Ot Contrast Bath/15 Min -Outpt ,CPT® 97034,0430 - OCCUPATION THER,N/A,N/A, $71.00 , $46.15 , $59.64 , $14.26 , $16.25 , $57.37 , $63.90 , $60.11 , $63.90 , $63.90 , $63.90 , $60.35 , $15.93 , $65.55 , $67.45 , $60.35 , $66.03 , $66.03 , $67.45 , $68.16 , $58.09 , $63.90 , $60.35 , $56.09 , N/A , $57.46 , $57.46 , $67.45 , $60.93 , $14.26 , $68.16 
 Rx Hyper Thyroid ,CPT® 79005,0344 - THERAPEUTIC RADIOPHARMACEUTICALS,N/A,N/A, $536.00 , $348.40 , $450.24 , $133.14 , $144.88 , $433.09 , $482.40 , $453.78 , $482.40 , $482.40 , $482.40 , $455.60 , $142.04 , $494.89 , $509.20 , $455.60 , $498.48 , $498.48 , $509.20 , $514.56 , $438.56 , $482.40 , $455.60 , $423.44 , N/A , $433.78 , $433.78 , $509.20 , $459.94 , $133.14 , $514.56 
"CT Scan,Abdomen,W/O Contrast",CPT® 74150,N/A,N/A,N/A," $2,267.00 "," $1,473.55 ", $974.05 , $139.75 , $242.66 , $713.75 , $936.69 ," $2,108.31 "," $2,040.30 "," $2,040.30 "," $1,813.60 "," $1,813.60 ", $242.66 ," $2,093.12 "," $2,153.65 "," $2,040.30 "," $2,040.30 "," $2,040.30 "," $2,108.31 "," $2,176.32 ", $815.95 ," $1,926.95 "," $1,018.88 ", $972.21 , N/A , $727.68 , $727.68 ," $2,153.65 ", $842.32 , $139.75 ," $2,176.32 "
" Fac Esophageal Motility Study, Manometry W Stimulation/Perfusion ",CPT® 91013,0750 - GASTR-INST SVS,N/A,N/A, $201.00 , $130.65 , $168.84 , $25.38 , $16.95 , $162.41 , $180.90 , $170.17 , $180.90 , $180.90 , $180.90 , $170.85 , $16.62 , $185.58 , $190.95 , $170.85 , $186.93 , $186.93 , $190.95 , $192.96 , $164.46 , $180.90 , $170.85 , $158.79 , N/A , $162.67 , $162.67 , $190.95 , $172.48 , $16.62 , $192.96 
Insertion Drug Delivery Implant,CPT® 11981,N/A,N/A,N/A, $532.00 , $345.80 , $198.32 , $58.65 , N/A , $225.31 , $211.21 , $494.76 , $478.80 , $478.80 , $425.60 , $425.60 , N/A , $491.20 , $505.40 , $478.80 , $478.80 , $478.80 , $494.76 , $510.72 , $219.57 , $452.20 , $422.82 , $287.39 , N/A , $229.70 , $229.70 , $505.40 , $266.39 , $58.65 , $510.72 
Abscess or Hematoma Ear,69000,N/A,N/A,N/A, $718.00 , $466.70 , $587.55 , $120.89 , $30.71 , $571.83 , $595.04 , $667.74 , $646.20 , $646.20 , $574.40 , $574.40 , $30.71 , $662.93 , $682.10 , $646.20 , $646.20 , $646.20 , $667.74 , $689.28 , $631.71 , $610.30 , $649.40 , $582.65 , N/A , $582.99 , $582.99 , $682.10 , $665.66 , $30.71 , $689.28 
 Pro Iridotomy/Irdec Laser Surg 1+ Sess ,CPT® 66761,0982 - PRO FEE/OUTPT,N/A,N/A," $2,518.00 "," $1,636.70 "," $1,457.17 ", $228.35 , $360.39 ," $1,335.82 "," $2,002.32 "," $2,341.74 "," $2,266.20 "," $2,266.20 "," $2,014.40 "," $2,014.40 ", $360.39 ," $2,324.87 "," $2,392.10 "," $2,266.20 "," $2,266.20 "," $2,266.20 "," $2,341.74 "," $2,417.28 "," $1,998.33 "," $2,140.30 "," $1,288.09 "," $1,696.80 ", N/A ," $1,361.88 "," $1,361.88 "," $2,392.10 "," $1,503.35 ", $228.35 ," $2,417.28 "
" Fac Assay, Blood Carbon Dioxide ",CPT® 82374,0301 - LAB/CHEMISTRY,N/A,N/A, $68.00 , $44.20 , $57.12 , $4.98 , $4.98 , $54.94 , $61.20 , $57.57 , $61.20 , $61.20 , $61.20 , $57.80 , $4.88 , $62.78 , $64.60 , $57.80 , $63.24 , $63.24 , $64.60 , $65.28 , $55.64 , $61.20 , $57.80 , $53.72 , N/A , $55.03 , $55.03 , $64.60 , $58.35 , $4.88 , $65.28 
"Clot Inhib Protein S,Total",CPT® 85305,N/A,N/A,N/A, $274.00 , $178.10 , N/A , $11.84 , $11.84 , $65.65 , $78.53 , $254.82 , $246.60 , $246.60 , $219.20 , $219.20 , $11.84 , $252.98 , $260.30 , $246.60 , $246.60 , $246.60 , $254.82 , $263.04 , $77.52 , $232.90 , $76.23 , $42.09 , N/A , $61.27 , $61.27 , $260.30 , $66.95 , $11.84 , $263.04 
 Fac Dstrj Nulyt Intercostal Nrv ,CPT® 64620,0361 - OR/MINOR,N/A,N/A," $2,522.00 "," $1,639.30 "," $2,118.48 ", $170.24 , $197.15 ," $2,037.78 "," $2,269.80 "," $2,135.13 "," $2,269.80 "," $2,269.80 "," $2,269.80 "," $2,143.70 ", $193.28 ," $2,328.56 "," $2,395.90 "," $2,143.70 "," $2,345.46 "," $2,345.46 "," $2,395.90 "," $2,421.12 "," $2,063.50 "," $2,269.80 "," $2,143.70 "," $1,992.38 ", N/A ," $2,041.05 "," $2,041.05 "," $2,395.90 "," $2,164.13 ", $170.24 ," $2,421.12 "
 Pro Fine Needle Aspiration Bx W/O Img Gdn 1st Lesion ,CPT® 10021,0982 - PRO FEE/OUTPT,N/A,N/A, $684.00 , $444.60 , $175.24 , $52.22 , $77.05 , $190.96 , $184.90 , $636.12 , $615.60 , $615.60 , $547.20 , $547.20 , $77.05 , $631.54 , $649.80 , $615.60 , $615.60 , $615.60 , $636.12 , $656.64 , $183.62 , $581.40 , $371.09 , $242.14 , N/A , $194.69 , $194.69 , $649.80 , $225.77 , $52.22 , $656.64 
 VORTIOXETINE HBR 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,64764-0720-30,1 tablet, $95.83 , $62.29 , $80.50 , N/A , N/A , $77.43 , $86.25 , $81.13 , $86.25 , $86.25 , $86.25 , $81.46 , N/A , $88.48 , $91.04 , $81.46 , $89.12 , $89.12 , $91.04 , $92.00 , $78.41 , $86.25 , $81.46 , $75.71 , N/A , $77.56 , $77.56 , $91.04 , $82.23 , $75.71 , $92.00 
" Fac Closed Rx Scapula Fx,Manipulatn ",CPT® 23575,0361 - OR/MINOR,N/A,N/A," $3,708.00 "," $2,410.20 "," $3,114.72 ", $370.40 , $184.42 ," $2,996.06 "," $3,337.20 "," $3,139.19 "," $3,337.20 "," $3,337.20 "," $3,337.20 "," $3,151.80 ", $180.80 ," $3,423.60 "," $3,522.60 "," $3,151.80 "," $3,448.44 "," $3,448.44 "," $3,522.60 "," $3,559.68 "," $3,033.89 "," $3,337.20 "," $3,151.80 "," $2,929.32 ", N/A ," $3,000.88 "," $3,000.88 "," $3,522.60 "," $3,181.83 ", $180.80 ," $3,559.68 "
"Reopen Fallopian Tube,Chromotubation",CPT® 58350,N/A,N/A,N/A," $1,213.00 ", $788.45 , $456.70 , $92.44 , N/A , $319.36 , $322.78 ," $1,128.09 "," $1,091.70 "," $1,091.70 ", $970.40 , $970.40 , N/A ," $1,119.96 "," $1,152.35 "," $1,091.70 "," $1,091.70 "," $1,091.70 "," $1,128.09 "," $1,164.48 ", $461.25 ," $1,031.05 ", $424.61 , $322.07 , N/A , $325.59 , $325.59 ," $1,152.35 ", $390.54 , $92.44 ," $1,164.48 "
 Pro Arthrp Glenohumrl Jt Tot Sho ,CPT® 23472,0975 - PRO FEE/OR,N/A,N/A," $4,870.00 "," $3,165.50 "," $8,726.19 "," $1,362.37 "," $1,327.39 "," $7,041.56 "," $6,985.49 "," $4,529.10 "," $4,383.00 "," $4,383.00 "," $3,896.00 "," $3,896.00 "," $1,327.39 "," $4,496.47 "," $4,626.50 "," $4,383.00 "," $4,383.00 "," $4,383.00 "," $4,529.10 "," $4,675.20 "," $8,144.18 "," $4,139.50 "," $7,732.13 "," $8,275.48 ", N/A ," $7,178.95 "," $7,178.95 "," $4,626.50 "," $8,437.82 "," $1,327.39 "," $8,726.19 "
Low Frequency Non-Thermal Ultrasound per Day,CPT® 97610,N/A,N/A,N/A, $412.00 , $267.80 , $42.86 , $17.87 , N/A , $39.42 , $35.42 , $383.16 , $370.80 , $370.80 , $329.60 , $329.60 , N/A , $380.40 , $391.40 , $370.80 , $370.80 , $370.80 , $383.16 , $395.52 , $56.90 , $350.20 , $53.51 , $38.16 , N/A , $40.19 , $40.19 , $391.40 , $44.72 , $17.87 , $395.52 
"Excis Uterine Fibroid,Vag Apprch",CPT® 58145,N/A,N/A,N/A," $3,306.00 "," $2,148.90 "," $2,696.10 ", $543.71 , $768.38 ," $2,228.30 "," $2,213.68 "," $3,074.58 "," $2,975.40 "," $2,975.40 "," $2,644.80 "," $2,644.80 ", $768.38 ," $3,052.43 "," $3,140.70 "," $2,975.40 "," $2,975.40 "," $2,975.40 "," $3,074.58 "," $3,173.76 "," $2,806.20 "," $2,810.10 "," $2,909.81 "," $2,240.18 ", N/A ," $2,271.78 "," $2,271.78 "," $3,140.70 "," $2,724.85 ", $543.71 ," $3,173.76 "
Betamethasone Acet&Sod Phosp,HCPCS J0702,N/A,N/A,N/A, $17.00 , $11.05 , N/A , $7.10 , $7.08 , N/A , N/A , $15.81 , $15.30 , $15.30 , $13.60 , $13.60 , $7.08 , $15.70 , $16.15 , $15.30 , $15.30 , $15.30 , $15.81 , $16.32 , $8.62 , $14.45 , $10.38 , $8.89 , N/A , N/A , N/A , $16.15 , N/A , $7.08 , $16.32 
Injection Aa&/Strd Sciatic Nerve W/Img Gdn,CPT® 64445,N/A,N/A,N/A," $1,653.00 "," $1,074.45 ", $264.94 , $69.92 , $46.08 , $404.19 , $385.85 ," $1,537.29 "," $1,487.70 "," $1,487.70 "," $1,322.40 "," $1,322.40 ", $46.08 ," $1,526.21 "," $1,570.35 "," $1,487.70 "," $1,487.70 "," $1,487.70 "," $1,537.29 "," $1,586.88 ", $287.54 ," $1,405.05 ", $378.22 , $437.51 , N/A , $412.08 , $412.08 ," $1,570.35 ", $442.06 , $46.08 ," $1,586.88 "
 Fac Tissue Exam by Pathologist ,CPT® 88305,0312 - PATHOL/HISTOL,N/A,N/A, $557.00 , $362.05 , $467.88 , $70.47 , $66.83 , $450.06 , $501.30 , $471.56 , $501.30 , $501.30 , $501.30 , $473.45 , $65.52 , $514.28 , $529.15 , $473.45 , $518.01 , $518.01 , $529.15 , $534.72 , $455.74 , $501.30 , $473.45 , $440.03 , N/A , $450.78 , $450.78 , $529.15 , $477.96 , $65.52 , $534.72 
Prolonged Inpatient/Observation Em Svc Ea 15 Min,CPT® 99418,N/A,N/A,N/A, $162.00 , $105.30 , N/A , $38.61 , N/A , N/A , N/A , $150.66 , $145.80 , $145.80 , $129.60 , $129.60 , N/A , $149.57 , $153.90 , $145.80 , $145.80 , $145.80 , $150.66 , $155.52 , N/A , $137.70 , $86.66 , N/A , N/A , $73.88 , $73.88 , $153.90 , $88.65 , $38.61 , $155.52 
Assay Total Testosterone,CPT® 84403,N/A,N/A,N/A, $184.00 , $119.60 , N/A , $26.33 , $26.33 , $142.60 , $170.59 , $171.12 , $165.60 , $165.60 , $147.20 , $147.20 , $26.33 , $169.89 , $174.80 , $165.60 , $165.60 , $165.60 , $171.12 , $176.64 , $172.34 , $156.40 , $168.67 , $93.60 , N/A , $133.08 , $133.08 , $174.80 , $145.43 , $26.33 , $176.64 
Arthrocnt Aspir&/Inj Small Jt/Bursaw/US Rec Rprt,CPT® 20604,N/A,N/A,N/A, $494.00 , $321.10 , $283.14 , $44.00 , $56.73 , $222.16 , $227.81 , $459.42 , $444.60 , $444.60 , $395.20 , $395.20 , $56.73 , $456.11 , $469.30 , $444.60 , $444.60 , $444.60 , $459.42 , $474.24 , $264.66 , $419.90 , $241.66 , $268.12 , N/A , $226.49 , $226.49 , $469.30 , $266.22 , $44.00 , $474.24 
 Pro Total Disc Arthrp Ant Single Interspace Lumbar ,CPT® 22857,0982 - PRO FEE/OUTPT,N/A,N/A," $10,895.00 "," $7,081.75 "," $10,617.36 "," $1,658.34 "," $1,160.02 "," $8,602.51 "," $6,752.99 "," $10,132.35 "," $9,805.50 "," $9,805.50 "," $8,716.00 "," $8,716.00 "," $1,160.02 "," $10,059.35 "," $10,350.25 "," $9,805.50 "," $9,805.50 "," $9,805.50 "," $10,132.35 "," $10,459.20 "," $9,913.39 "," $9,260.75 "," $7,548.38 "," $9,463.69 ", N/A ," $8,770.36 "," $8,770.36 "," $10,350.25 "," $10,308.28 "," $1,160.02 "," $10,617.36 "
" Pro Inj Dx/Ther Agnt Paravert Facet Joint, Cerv/Thorac, 1st Level ",CPT® 64490,0982 - PRO FEE/OUTPT,N/A,N/A, $974.00 , $633.10 , $521.25 , $100.98 , $139.80 , $601.59 , $592.63 , $905.82 , $876.60 , $876.60 , $779.20 , $779.20 , $139.80 , $899.29 , $925.30 , $876.60 , $876.60 , $876.60 , $905.82 , $935.04 , $565.18 , $827.90 , $579.82 , $641.10 , N/A , $613.33 , $613.33 , $925.30 , $657.95 , $100.98 , $935.04 
"Biopsy Vulva/Perineum,One Lesn",CPT® 56605,N/A,N/A,N/A, $498.00 , $323.70 , $276.15 , $56.07 , $75.29 , $247.42 , $244.27 , $463.14 , $448.20 , $448.20 , $398.40 , $398.40 , $75.29 , $459.80 , $473.10 , $448.20 , $448.20 , $448.20 , $463.14 , $478.08 , $291.64 , $423.30 , $321.13 , $247.71 , N/A , $252.25 , $252.25 , $473.10 , $302.56 , $56.07 , $478.08 
"Metabolic Panel,Basic",CPT® 80048,N/A,N/A,N/A, $138.00 , $89.70 , N/A , $8.63 , $8.63 , $47.85 , $57.25 , $128.34 , $124.20 , $124.20 , $110.40 , $110.40 , $8.63 , $127.42 , $131.10 , $124.20 , $124.20 , $124.20 , $128.34 , $132.48 , $56.49 , $117.30 , $55.14 , $30.66 , N/A , $44.66 , $44.66 , $131.10 , $48.80 , $8.63 , $132.48 
Shav Skin Les 11-20mm Remaindr Body,CPT® 11307,N/A,N/A,N/A, $547.00 , $355.55 , $203.76 , $60.52 , $58.11 , $181.46 , $176.49 , $508.71 , $492.30 , $492.30 , $437.60 , $437.60 , $58.11 , $505.05 , $519.65 , $492.30 , $492.30 , $492.30 , $508.71 , $525.12 , $225.97 , $464.95 , $349.68 , $235.87 , N/A , $185.01 , $185.01 , $519.65 , $214.54 , $58.11 , $525.12 
Rpr Aa Hernia 1st < 3 Cm Reducible,CPT® 49591,N/A,N/A,N/A," $3,176.00 "," $2,064.40 ", N/A , $313.35 , $244.58 , N/A , N/A ," $2,953.68 "," $2,858.40 "," $2,858.40 "," $2,540.80 "," $2,540.80 ", $244.58 ," $2,932.40 "," $3,017.20 "," $2,858.40 "," $2,858.40 "," $2,858.40 "," $2,953.68 "," $3,048.96 ", N/A ," $2,699.60 "," $1,812.48 ", N/A , N/A ," $1,349.03 "," $1,349.03 "," $3,017.20 "," $1,412.32 ", $244.58 ," $3,048.96 "
 VENLAFAXINE HCL ER 75 MG PO CP24 ,HCPCS RXC637,0250 - PHARMACY,68084-0709-01,1 capsule, $21.56 , $14.01 , $18.11 , N/A , N/A , $17.42 , $19.40 , $18.25 , $19.40 , $19.40 , $19.40 , $18.33 , N/A , $19.91 , $20.48 , $18.33 , $20.05 , $20.05 , $20.48 , $20.70 , $17.64 , $19.40 , $18.33 , $17.03 , N/A , $17.45 , $17.45 , $20.48 , $18.50 , $17.03 , $20.70 
 Pro Exc H-F-Nk-Sp Mlg+Marg 2.1-3 ,CPT® 11623,0982 - PRO FEE/OUTPT,N/A,N/A," $1,451.00 ", $943.15 , $668.78 , $200.83 , $288.68 , $579.96 , $565.03 ," $1,349.43 "," $1,305.90 "," $1,305.90 "," $1,160.80 "," $1,160.80 ", $288.68 ," $1,339.71 "," $1,378.45 "," $1,305.90 "," $1,305.90 "," $1,305.90 "," $1,349.43 "," $1,392.96 ", $734.78 ," $1,233.35 "," $1,127.53 ", $742.84 , N/A , $591.28 , $591.28 ," $1,378.45 ", $685.69 , $200.83 ," $1,392.96 "
 Fac Drug Assay Infliximab ,CPT® 80230,0301 - LAB/CHEMISTRY,N/A,N/A, $273.00 , $177.45 , $229.32 , $39.34 , $31.47 , $220.58 , $245.70 , $231.12 , $245.70 , $245.70 , $245.70 , $232.05 , $30.85 , $252.06 , $259.35 , $232.05 , $253.89 , $253.89 , $259.35 , $262.08 , $223.37 , $245.70 , $232.05 , $215.67 , N/A , $220.94 , $220.94 , $259.35 , $234.26 , $30.85 , $262.08 
 Bone Diseases And Arthropathies Without McC ,MS DRG V40 (FY2023) 554,N/A,N/A,N/A," $4,281.03 "," $2,782.67 "," $3,596.07 ", N/A , N/A ," $3,459.07 "," $3,852.93 "," $3,624.32 "," $3,852.93 "," $3,852.93 "," $3,852.93 "," $3,638.88 ", N/A ," $3,952.67 "," $4,066.98 "," $3,638.88 "," $3,981.36 "," $3,981.36 "," $4,066.98 "," $4,109.79 "," $3,502.74 "," $3,852.93 "," $3,638.88 "," $3,382.01 ", N/A ," $3,464.64 "," $3,464.64 "," $4,066.98 "," $3,673.55 "," $3,382.01 "," $4,109.79 "
 GABAPENTIN 100 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-6665-61,1 capsule, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Treat Patellar Fracture,CPT® 27520,N/A,N/A,N/A," $1,913.00 "," $1,243.45 "," $1,872.26 ", $296.68 , $195.27 ," $1,421.40 "," $1,446.93 "," $1,779.09 "," $1,721.70 "," $1,721.70 "," $1,530.40 "," $1,530.40 ", $195.27 ," $1,766.27 "," $1,817.35 "," $1,721.70 "," $1,721.70 "," $1,721.70 "," $1,779.09 "," $1,836.48 "," $1,721.73 "," $1,626.05 "," $1,589.60 "," $1,686.56 ", N/A ," $1,449.14 "," $1,449.14 "," $1,817.35 "," $1,703.25 ", $195.27 ," $1,872.26 "
 Fac Assay of Tyrosine ,CPT® 84510,0301 - LAB/CHEMISTRY,N/A,N/A, $95.00 , $61.75 , $79.80 , $10.84 , $10.84 , $76.76 , $85.50 , $80.43 , $85.50 , $85.50 , $85.50 , $80.75 , $10.63 , $87.71 , $90.25 , $80.75 , $88.35 , $88.35 , $90.25 , $91.20 , $77.73 , $85.50 , $80.75 , $75.05 , N/A , $76.88 , $76.88 , $90.25 , $81.52 , $10.63 , $91.20 
 CEFAZOLIN SODIUM 2 G VIAL (INPT) ,HCPCS J0690,0636 - DRUGS REQUIRING DETAILED CODIN,60505-6231-05,10 mL, $37.57 , $24.42 , $31.56 , $0.89 , $0.79 , $30.36 , $33.81 , $31.81 , $33.81 , $33.81 , $33.81 , $31.93 , $0.77 , $34.69 , $35.69 , $31.93 , $34.94 , $34.94 , $35.69 , $36.07 , $30.74 , $33.81 , $31.93 , $29.68 , N/A , $30.41 , $30.41 , $35.69 , $32.24 , $0.77 , $36.07 
 ANTIHEMOPHIL FACTOR (RAHF-PFM) 250 UNITS IV SOLR ,HCPCS J7211,0636 - DRUGS REQUIRING DETAILED CODIN,00026-3821-25,1 int'l unit, $35.00 , $22.75 , $29.40 , $1.47 , $1.37 , $28.28 , $31.50 , $29.63 , $31.50 , $31.50 , $31.50 , $29.75 , $1.34 , $32.32 , $33.25 , $29.75 , $32.55 , $32.55 , $33.25 , $33.60 , $28.64 , $31.50 , $29.75 , $27.65 , N/A , $28.33 , $28.33 , $33.25 , $30.03 , $1.34 , $33.60 
Perq Device Placemt Breast Loc 1st Les W Guidnce,CPT® 19281,N/A,N/A,N/A, $978.00 , $635.70 , $321.40 , $95.05 , $77.40 , $284.24 , $280.04 , $909.54 , $880.20 , $880.20 , $782.40 , $782.40 , $77.40 , $902.99 , $929.10 , $880.20 , $880.20 , $880.20 , $909.54 , $938.88 , $353.68 , $831.30 , $517.09 , $360.36 , N/A , $289.79 , $289.79 , $929.10 , $336.04 , $77.40 , $938.88 
Cast Sup Long Arm Ped Fbrgls,HCPCS Q4008,N/A,N/A,N/A, $116.00 , $75.40 , N/A , $17.70 , $11.44 , N/A , N/A , $107.88 , $104.40 , $104.40 , $92.80 , $92.80 , $11.44 , $107.10 , $110.20 , $104.40 , $104.40 , $104.40 , $107.88 , $111.36 , N/A , $98.60 , $56.44 , $16.07 , N/A , N/A , N/A , $110.20 , N/A , $11.44 , $111.36 
Physical Performance Test,CPT® 97750,N/A,N/A,N/A, $208.00 , $135.20 , $65.46 , $33.72 , $25.05 , $74.65 , $67.07 , $193.44 , $187.20 , $187.20 , $166.40 , $166.40 , $25.05 , $192.05 , $197.60 , $187.20 , $187.20 , $187.20 , $193.44 , $199.68 , $85.28 , $176.80 , $99.34 , $85.12 , N/A , $76.11 , $76.11 , $197.60 , $84.67 , $25.05 , $199.68 
 US-Guided Aspir and/or Inj Ganglion Cyst ,CPT® 20612,0761 - TREATMENT ROOM,N/A,N/A, $768.00 , $499.20 , $645.12 , $39.08 , $50.15 , $620.54 , $691.20 , $650.19 , $691.20 , $691.20 , $691.20 , $652.80 , $49.17 , $709.09 , $729.60 , $652.80 , $714.24 , $714.24 , $729.60 , $737.28 , $628.38 , $691.20 , $652.80 , $606.72 , N/A , $621.54 , $621.54 , $729.60 , $659.02 , $39.08 , $737.28 
 Pro Cltx Dstl Fibular Fx Lat Malls W/O Mnpj ,CPT® 27786,0981 - PRO FEE/ER,N/A,N/A," $1,446.00 ", $939.90 ," $1,797.25 ", $283.29 , $184.42 ," $1,381.41 "," $1,407.46 "," $1,344.78 "," $1,301.40 "," $1,301.40 "," $1,156.80 "," $1,156.80 ", $184.42 ," $1,335.09 "," $1,373.70 "," $1,301.40 "," $1,301.40 "," $1,301.40 "," $1,344.78 "," $1,388.16 "," $1,658.34 "," $1,229.10 "," $1,543.22 "," $1,637.46 ", N/A ," $1,408.37 "," $1,408.37 "," $1,373.70 "," $1,655.31 ", $184.42 ," $1,797.25 "
 IR Venous Thrombectomy ,CPT® 37799,0761 - TREATMENT ROOM,N/A,N/A, $215.00 , $139.75 , $180.60 , N/A , N/A , $173.72 , $193.50 , $182.02 , $193.50 , $193.50 , $193.50 , $182.75 , N/A , $198.51 , $204.25 , $182.75 , $199.95 , $199.95 , $204.25 , $206.40 , $175.91 , $193.50 , $182.75 , $169.85 , N/A , $174.00 , $174.00 , $204.25 , $184.49 , $169.85 , $206.40 
 COLCHICINE 0.3 MG TAB (COMES FROM 0.6 MG TABLET) ,HCPCS RXC637,0250 - PHARMACY,00001-0918-01,2 tablet, $88.66 , $57.63 , $74.47 , N/A , N/A , $71.64 , $79.79 , $75.06 , $79.79 , $79.79 , $79.79 , $75.36 , N/A , $81.86 , $84.23 , $75.36 , $82.45 , $82.45 , $84.23 , $85.11 , $72.54 , $79.79 , $75.36 , $70.04 , N/A , $71.75 , $71.75 , $84.23 , $76.08 , $70.04 , $85.11 
Inpt Telehealth Consult 50m,HCPCS G0426,N/A,N/A,N/A, $462.00 , $300.30 , $255.56 , $126.43 , N/A , $252.51 , N/A , $429.66 , $415.80 , $415.80 , $369.60 , $369.60 , N/A , $426.56 , $438.90 , $415.80 , $415.80 , $415.80 , $429.66 , $443.52 , $378.30 , $392.70 , $256.91 , $511.09 , N/A , $257.44 , $257.44 , $438.90 , $321.80 , $126.43 , $511.09 
 IBUPROFEN 200 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-7914-61,1 tablet, $0.42 , $0.27 , $0.35 , N/A , N/A , $0.34 , $0.38 , $0.36 , $0.38 , $0.38 , $0.38 , $0.36 , N/A , $0.39 , $0.40 , $0.36 , $0.39 , $0.39 , $0.40 , $0.40 , $0.34 , $0.38 , $0.36 , $0.33 , N/A , $0.34 , $0.34 , $0.40 , $0.36 , $0.33 , $0.40 
Compre Electrophysiol Xm W/Left Atrial Pacng/Rec,CPT® 93621,N/A,N/A,N/A," $2,289.00 "," $1,487.85 "," $2,104.70 ", $317.28 ," $2,378.00 ", $845.35 , $826.61 ," $2,128.77 "," $2,060.10 "," $2,060.10 "," $1,831.20 "," $1,831.20 "," $2,378.00 "," $2,113.43 "," $2,174.55 "," $2,060.10 "," $2,060.10 "," $2,060.10 "," $2,128.77 "," $2,197.44 "," $2,195.80 "," $1,945.65 ", $804.61 ," $2,072.01 ", N/A , $861.84 , $861.84 ," $2,174.55 ", $955.36 , $317.28 ," $2,378.00 "
 Fac Bile Acids Tot ,CPT® 82239,0301 - LAB/CHEMISTRY,N/A,N/A, $842.00 , $547.30 , $707.28 , $17.46 , $17.46 , $680.34 , $757.80 , $712.84 , $757.80 , $757.80 , $757.80 , $715.70 , $17.12 , $777.42 , $799.90 , $715.70 , $783.06 , $783.06 , $799.90 , $808.32 , $688.92 , $757.80 , $715.70 , $665.18 , N/A , $681.43 , $681.43 , $799.90 , $722.52 , $17.12 , $808.32 
Transurethral Elec-Surg Prostatectom,CPT® 52601,N/A,N/A,N/A," $5,717.00 "," $3,716.05 "," $3,943.35 ", $693.12 , $828.21 ," $4,135.92 "," $3,848.30 "," $5,316.81 "," $5,145.30 "," $5,145.30 "," $4,573.60 "," $4,573.60 ", $828.21 ," $5,278.51 "," $5,431.15 "," $5,145.30 "," $5,145.30 "," $5,145.30 "," $5,316.81 "," $5,488.32 "," $3,957.68 "," $4,859.45 "," $4,358.47 "," $4,486.52 ", N/A ," $4,216.62 "," $4,216.62 "," $5,431.15 "," $4,956.02 ", $693.12 ," $5,488.32 "
"Chest Wall Manipulation,Initial",CPT® 94667,N/A,N/A,N/A, $151.00 , $98.15 , $51.34 , $22.54 , $18.00 , $57.05 , $58.40 , $140.43 , $135.90 , $135.90 , $120.80 , $120.80 , $18.00 , $139.42 , $143.45 , $135.90 , $135.90 , $135.90 , $140.43 , $144.96 , $63.69 , $128.35 , $78.06 , $99.56 , N/A , $58.16 , $58.16 , $143.45 , $67.81 , $18.00 , $144.96 
Open Intern Fix Acetabular Wall Fx,CPT® 27226,N/A,N/A,N/A," $6,931.00 "," $4,505.15 "," $6,372.54 ", $996.94 ," $1,511.82 "," $5,106.80 "," $5,047.56 "," $6,445.83 "," $6,237.90 "," $6,237.90 "," $5,544.80 "," $5,544.80 "," $1,511.82 "," $6,399.39 "," $6,584.45 "," $6,237.90 "," $6,237.90 "," $6,237.90 "," $6,445.83 "," $6,653.76 "," $5,940.61 "," $5,891.35 "," $5,587.69 "," $5,975.34 ", N/A ," $5,206.45 "," $5,206.45 "," $6,584.45 "," $6,119.43 ", $996.94 ," $6,653.76 "
 FUROSEMIDE 40 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,51079-0073-20,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Pro Rmvl Embedded FB Vestibule Mouth Smpl ,CPT® 40804,0981 - PRO FEE/ER,N/A,N/A, $602.00 , $391.30 , $695.89 , $109.50 , $30.71 , $639.41 , $673.81 , $559.86 , $541.80 , $541.80 , $481.60 , $481.60 , $30.71 , $555.83 , $571.90 , $541.80 , $541.80 , $541.80 , $559.86 , $577.92 , $506.97 , $511.70 , $733.25 , $657.96 , N/A , $651.89 , $651.89 , $571.90 , $681.79 , $30.71 , $733.25 
 Pro Removal of Nail Plate ,CPT® 11730,0981 - PRO FEE/ER,N/A,N/A, $385.00 , $250.25 , $174.35 , $51.83 , $42.84 , $140.67 , $134.38 , $358.05 , $346.50 , $346.50 , $308.00 , $308.00 , $42.84 , $355.47 , $365.75 , $346.50 , $346.50 , $346.50 , $358.05 , $369.60 , $192.28 , $327.25 , $262.26 , $198.13 , N/A , $143.42 , $143.42 , $365.75 , $166.31 , $42.84 , $369.60 
 Fac Endoluminal Coronary Ivus Oct I&R Initial Vessel ,CPT® 92978,0402 - ULTRASOUND,N/A,N/A," $2,078.00 "," $1,350.70 "," $1,745.52 ", $273.77 , $268.59 ," $1,679.02 "," $1,870.20 "," $1,759.23 "," $1,870.20 "," $1,870.20 "," $1,870.20 "," $1,766.30 ", $263.32 ," $1,918.62 "," $1,974.10 "," $1,766.30 "," $1,932.54 "," $1,932.54 "," $1,974.10 "," $1,994.88 "," $1,700.22 "," $1,870.20 "," $1,766.30 "," $1,641.62 ", N/A ," $1,681.73 "," $1,681.73 "," $1,974.10 "," $1,783.13 ", $263.32 ," $1,994.88 "
Create Shunt:Ventric-Peritoneal,CPT® 62223,N/A,N/A,N/A," $6,846.00 "," $4,449.90 "," $4,828.51 ", $941.49 ," $2,378.00 "," $5,679.34 "," $5,508.11 "," $6,366.78 "," $6,161.40 "," $6,161.40 "," $5,476.80 "," $5,476.80 "," $2,378.00 "," $6,320.91 "," $6,503.70 "," $6,161.40 "," $6,161.40 "," $6,161.40 "," $6,366.78 "," $6,572.16 "," $5,206.21 "," $5,819.10 "," $5,626.94 "," $5,876.55 ", N/A ," $5,790.16 "," $5,790.16 "," $6,503.70 "," $6,211.47 ", $941.49 ," $6,572.16 "
 Fac Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/O Img Gdn ,CPT® 62322,0360 - OR SERVICES,N/A,N/A," $1,140.00 ", $741.00 , $957.60 , $76.88 , $185.09 , $921.12 ," $1,026.00 ", $965.12 ," $1,026.00 "," $1,026.00 "," $1,026.00 ", $969.00 , $181.46 ," $1,052.56 "," $1,083.00 ", $969.00 ," $1,060.20 "," $1,060.20 "," $1,083.00 "," $1,094.40 ", $932.75 ," $1,026.00 ", $969.00 , $900.60 , N/A , $922.60 , $922.60 ," $1,083.00 ", $978.23 , $76.88 ," $1,094.40 "
 Nonspecific Cerebrovascular Disorders With Cc ,MS DRG V40 (FY2023) 071,N/A,N/A,N/A," $48,512.43 "," $31,533.08 "," $40,750.44 ", N/A , N/A ," $39,198.04 "," $43,661.19 "," $41,070.62 "," $43,661.19 "," $43,661.19 "," $43,661.19 "," $41,235.57 ", N/A ," $44,791.53 "," $46,086.81 "," $41,235.57 "," $45,116.56 "," $45,116.56 "," $46,086.81 "," $46,571.93 "," $39,692.87 "," $43,661.19 "," $41,235.57 "," $38,324.82 ", N/A ," $39,261.11 "," $39,261.11 "," $46,086.81 "," $41,628.52 "," $38,324.82 "," $46,571.93 "
"Cabg, Artery-Vein, Single",CPT® 33517,N/A,N/A,N/A," $1,630.00 "," $1,059.50 "," $1,087.52 ", $166.95 , $188.15 , $800.99 , $790.51 ," $1,515.90 "," $1,467.00 "," $1,467.00 "," $1,304.00 "," $1,304.00 ", $188.15 ," $1,504.98 "," $1,548.50 "," $1,467.00 "," $1,467.00 "," $1,467.00 "," $1,515.90 "," $1,564.80 "," $1,007.74 "," $1,385.50 "," $1,002.64 ", $895.82 , N/A , $816.62 , $816.62 ," $1,548.50 ", $927.67 , $166.95 ," $1,564.80 "
Repair Intercarp/Carp-Metacarp Jt,25447,N/A,N/A,N/A," $4,238.00 "," $2,754.70 "," $5,075.53 ", $797.62 , $618.57 ," $3,988.25 "," $3,968.44 "," $3,941.34 "," $3,814.20 "," $3,814.20 "," $3,390.40 "," $3,390.40 ", $618.57 ," $3,912.95 "," $4,026.10 "," $3,814.20 "," $3,814.20 "," $3,814.20 "," $3,941.34 "," $4,068.48 "," $4,717.59 "," $3,602.30 "," $4,365.60 "," $4,732.74 ", N/A ," $4,066.07 "," $4,066.07 "," $4,026.10 "," $4,779.07 ", $618.57 ," $5,075.53 "
Plmt Urtrl Stent Prq Pre-Existing Nfros Tract,CPT® 50693,N/A,N/A,N/A," $6,846.00 "," $4,449.90 "," $1,101.01 ", $193.21 , $839.21 ," $1,085.34 ", $947.72 ," $6,366.78 "," $6,161.40 "," $6,161.40 "," $5,476.80 "," $5,476.80 ", $839.21 ," $6,320.91 "," $6,503.70 "," $6,161.40 "," $6,161.40 "," $6,161.40 "," $6,366.78 "," $6,572.16 "," $1,109.90 "," $5,819.10 "," $1,053.73 "," $1,272.25 ", N/A ," $1,106.52 "," $1,106.52 "," $6,503.70 "," $1,300.55 ", $193.21 ," $6,572.16 "
 Fac Intrnsc Factor Antibodies ,CPT® 86340,0302 - LAB/IMMUNOLOGY,N/A,N/A, $195.00 , $126.75 , $163.80 , $15.38 , $14.10 , $157.56 , $175.50 , $165.09 , $175.50 , $175.50 , $175.50 , $165.75 , $13.82 , $180.04 , $185.25 , $165.75 , $181.35 , $181.35 , $185.25 , $187.20 , $159.55 , $175.50 , $165.75 , $154.05 , N/A , $157.81 , $157.81 , $185.25 , $167.33 , $13.82 , $187.20 
 LIDO-EPINEPHRINE-TETRACAINE 4-0.05-0.5 % EX GEL (INPT) ,HCPCS RXA250,0250 - PHARMACY,70092-1611-44,3 mL, $92.98 , $60.44 , $78.10 , N/A , N/A , $75.13 , $83.68 , $78.72 , $83.68 , $83.68 , $83.68 , $79.03 , N/A , $85.85 , $88.33 , $79.03 , $86.47 , $86.47 , $88.33 , $89.26 , $76.08 , $83.68 , $79.03 , $73.45 , N/A , $75.25 , $75.25 , $88.33 , $79.79 , $73.45 , $89.26 
 Fac Tx Tarsal B1 Fx Xcp Talus&Calcn W/O Mnpj ,CPT® 28450,0761 - TREATMENT ROOM,N/A,N/A," $2,049.00 "," $1,331.85 "," $1,721.16 ", $188.03 , $144.17 ," $1,655.59 "," $1,844.10 "," $1,734.68 "," $1,844.10 "," $1,844.10 "," $1,844.10 "," $1,741.65 ", $141.34 ," $1,891.84 "," $1,946.55 "," $1,741.65 "," $1,905.57 "," $1,905.57 "," $1,946.55 "," $1,967.04 "," $1,676.49 "," $1,844.10 "," $1,741.65 "," $1,618.71 ", N/A ," $1,658.26 "," $1,658.26 "," $1,946.55 "," $1,758.25 ", $141.34 ," $1,967.04 "
 Pro I&D Pilonidal Cst Comp ,CPT® 10081,0981 - PRO FEE/ER,N/A,N/A," $1,278.00 ", $830.70 , $545.63 , $162.12 , $213.21 , $462.71 , $459.06 ," $1,188.54 "," $1,150.20 "," $1,150.20 "," $1,022.40 "," $1,022.40 ", $213.21 ," $1,179.98 "," $1,214.10 "," $1,150.20 "," $1,150.20 "," $1,150.20 "," $1,188.54 "," $1,226.88 ", $603.01 ," $1,086.30 ", $918.79 , $595.22 , N/A , $471.73 , $471.73 ," $1,214.10 ", $547.05 , $162.12 ," $1,226.88 "
 Microsatellite Instab Anal Mismatch Repair ,CPT® 81301,0310 - PATHOLOGY LAB,N/A,N/A," $2,464.00 "," $1,601.60 "," $2,069.76 ", $355.53 , $322.35 ," $1,990.91 "," $2,217.60 "," $2,086.02 "," $2,217.60 "," $2,217.60 "," $2,217.60 "," $2,094.40 ", $316.03 ," $2,275.01 "," $2,340.80 "," $2,094.40 "," $2,291.52 "," $2,291.52 "," $2,340.80 "," $2,365.44 "," $2,016.04 "," $2,217.60 "," $2,094.40 "," $1,946.56 ", N/A ," $1,994.12 "," $1,994.12 "," $2,340.80 "," $2,114.36 ", $316.03 ," $2,365.44 "
 Disorders Of Pancreas Except Malignancy With McC ,MS DRG V40 (FY2023) 438,N/A,N/A,N/A," $24,238.76 "," $15,755.19 "," $20,360.56 ", N/A , N/A ," $19,584.92 "," $21,814.88 "," $20,520.53 "," $21,814.88 "," $21,814.88 "," $21,814.88 "," $20,602.95 ", N/A ," $22,379.65 "," $23,026.82 "," $20,602.95 "," $22,542.05 "," $22,542.05 "," $23,026.82 "," $23,269.21 "," $19,832.15 "," $21,814.88 "," $20,602.95 "," $19,148.62 ", N/A ," $19,616.43 "," $19,616.43 "," $23,026.82 "," $20,799.28 "," $19,148.62 "," $23,269.21 "
Removal W/ Reinsert Drug Implant Device,CPT® 11983,N/A,N/A,N/A, $831.00 , $540.15 , $325.99 , $96.96 , $156.22 , $477.79 , $444.22 , $772.83 , $747.90 , $747.90 , $664.80 , $664.80 , $156.22 , $767.26 , $789.45 , $747.90 , $747.90 , $747.90 , $772.83 , $797.76 , $359.19 , $706.35 , $872.41 , $619.36 , N/A , $487.10 , $487.10 , $789.45 , $564.89 , $96.96 , $872.41 
 MESALAMINE 1.2 G PO TBEC ,HCPCS RXC637,0250 - PHARMACY,00904-6832-04,1 tablet, $76.99 , $50.04 , $64.67 , N/A , N/A , $62.21 , $69.29 , $65.18 , $69.29 , $69.29 , $69.29 , $65.44 , N/A , $71.08 , $73.14 , $65.44 , $71.60 , $71.60 , $73.14 , $73.91 , $62.99 , $69.29 , $65.44 , $60.82 , N/A , $62.31 , $62.31 , $73.14 , $66.07 , $60.82 , $73.91 
 Serum Electrophoresis ,CPT® 84165,0301 - LAB/CHEMISTRY,N/A,N/A, $132.00 , $85.80 , $110.88 , $10.95 , $10.95 , $106.66 , $118.80 , $111.75 , $118.80 , $118.80 , $118.80 , $112.20 , $10.74 , $121.88 , $125.40 , $112.20 , $122.76 , $122.76 , $125.40 , $126.72 , $108.00 , $118.80 , $112.20 , $104.28 , N/A , $106.83 , $106.83 , $125.40 , $113.27 , $10.74 , $126.72 
 Pro Injection Aa&/Strd Intercostal Nrv Ea Addl Lvl ,CPT® 64421,0982 - PRO FEE/OUTPT,N/A,N/A," $2,512.00 "," $1,632.80 ", $123.14 , $23.62 , $46.08 , $514.45 , $512.66 ," $2,336.16 "," $2,260.80 "," $2,260.80 "," $2,009.60 "," $2,009.60 ", $46.08 ," $2,319.33 "," $2,386.40 "," $2,260.80 "," $2,260.80 "," $2,260.80 "," $2,336.16 "," $2,411.52 ", $133.67 ," $2,135.20 ", $503.11 , $557.55 , N/A , $524.49 , $524.49 ," $2,386.40 ", $562.66 , $23.62 ," $2,411.52 "
Electro-Oculography,CPT® 92270,N/A,N/A,N/A, $336.00 , $218.40 , $236.86 , $107.46 , $53.38 , $161.41 , $165.41 , $312.48 , $302.40 , $302.40 , $268.80 , $268.80 , $53.38 , $310.23 , $319.20 , $302.40 , $302.40 , $302.40 , $312.48 , $322.56 , $315.46 , $285.60 , $279.79 , $196.55 , N/A , $164.56 , $164.56 , $319.20 , $195.74 , $53.38 , $322.56 
 ROPIV-EPI-CLONIDINE-KETOROLAC 123-0.25-0.04- 15 MG/50ML PA SOSY ,HCPCS RXA250,0250 - PHARMACY,70092-1433-50,100 mL, $704.27 , $457.78 , $591.59 , N/A , N/A , $569.05 , $633.84 , $596.23 , $633.84 , $633.84 , $633.84 , $598.63 , N/A , $650.25 , $669.06 , $598.63 , $654.97 , $654.97 , $669.06 , $676.10 , $576.23 , $633.84 , $598.63 , $556.37 , N/A , $569.97 , $569.97 , $669.06 , $604.33 , $556.37 , $676.10 
Chemother Hormon Antineopl Sub-Q/Im,CPT® 96402,N/A,N/A,N/A, $145.00 , $94.25 , $111.58 , $33.06 , $29.44 , $90.64 , $73.50 , $134.85 , $130.50 , $130.50 , $116.00 , $116.00 , $29.44 , $133.88 , $137.75 , $130.50 , $130.50 , $130.50 , $134.85 , $139.20 , $98.49 , $123.25 , $97.32 , $119.93 , N/A , $92.40 , $92.40 , $137.75 , $109.18 , $29.44 , $139.20 
 CT Bone Mineral Density (Hip/Spine) ,CPT® 77078,0350 - CT SCAN,N/A,N/A," $2,060.00 "," $1,339.00 "," $1,730.40 ", $95.54 , $83.80 ," $1,664.48 "," $1,854.00 "," $1,744.00 "," $1,854.00 "," $1,854.00 "," $1,854.00 "," $1,751.00 ", $82.16 ," $1,902.00 "," $1,957.00 "," $1,751.00 "," $1,915.80 "," $1,915.80 "," $1,957.00 "," $1,977.60 "," $1,685.49 "," $1,854.00 "," $1,751.00 "," $1,627.40 ", N/A ," $1,667.16 "," $1,667.16 "," $1,957.00 "," $1,767.69 ", $82.16 ," $1,977.60 "
Repair Nasal Cavity Stenosis,CPT® 30465,N/A,N/A,N/A," $5,951.00 "," $3,868.15 "," $5,707.74 "," $1,003.46 "," $1,080.89 "," $3,730.98 "," $3,739.64 "," $5,534.43 "," $5,355.90 "," $5,355.90 "," $4,760.80 "," $4,760.80 "," $1,080.89 "," $5,494.56 "," $5,653.45 "," $5,355.90 "," $5,355.90 "," $5,355.90 "," $5,534.43 "," $5,712.96 "," $5,422.64 "," $5,058.35 "," $5,271.91 "," $4,914.64 ", N/A ," $3,803.78 "," $3,803.78 "," $5,653.45 "," $4,479.75 "," $1,003.46 "," $5,712.96 "
Close Urethrovaginal Fist+Xplant,CPT® 57311,N/A,N/A,N/A," $3,221.00 "," $2,093.65 "," $2,650.05 ", $535.21 , $920.97 ," $2,160.99 "," $2,108.06 "," $2,995.53 "," $2,898.90 "," $2,898.90 "," $2,576.80 "," $2,576.80 ", $920.97 ," $2,973.95 "," $3,059.95 "," $2,898.90 "," $2,898.90 "," $2,898.90 "," $2,995.53 "," $3,092.16 "," $2,753.68 "," $2,737.85 "," $2,706.43 "," $2,206.16 ", N/A ," $2,203.16 "," $2,203.16 "," $3,059.95 "," $2,642.54 ", $535.21 ," $3,092.16 "
 Pro Injection Aa&/Strd Femoral Nerve W/Img Gdn ,CPT® 64447,0960 - PRO FEE,N/A,N/A," $1,537.00 ", $999.05 , $262.08 , $60.98 , $69.44 , $370.27 , $349.57 ," $1,429.41 "," $1,383.30 "," $1,383.30 "," $1,229.60 "," $1,229.60 ", $69.44 ," $1,419.11 "," $1,460.15 "," $1,383.30 "," $1,383.30 "," $1,383.30 "," $1,429.41 "," $1,475.52 ", $284.46 ," $1,306.45 ", $340.76 , $403.56 , N/A , $377.50 , $377.50 ," $1,460.15 ", $404.97 , $60.98 ," $1,475.52 "
Removal of Heel Spur,CPT® 28119,N/A,N/A,N/A," $3,506.00 "," $2,278.90 "," $2,257.00 ", $353.25 , $384.19 ," $1,779.50 "," $1,771.98 "," $3,260.58 "," $3,155.40 "," $3,155.40 "," $2,804.80 "," $2,804.80 ", $384.19 ," $3,237.09 "," $3,330.70 "," $3,155.40 "," $3,155.40 "," $3,155.40 "," $3,260.58 "," $3,365.76 "," $2,084.07 "," $2,980.10 "," $1,917.87 "," $2,110.43 ", N/A ," $1,814.22 "," $1,814.22 "," $3,330.70 "," $2,132.34 ", $353.25 ," $3,365.76 "
 Laryngoscopy-Flexible;Diagnost ,CPT® 31575,0361 - OR/MINOR,N/A,N/A, $411.00 , $267.15 , $345.24 , $65.21 , $98.45 , $332.09 , $369.90 , $347.95 , $369.90 , $369.90 , $369.90 , $349.35 , $96.52 , $379.48 , $390.45 , $349.35 , $382.23 , $382.23 , $390.45 , $394.56 , $336.28 , $369.90 , $349.35 , $324.69 , N/A , $332.62 , $332.62 , $390.45 , $352.68 , $65.21 , $394.56 
" Dir Rep Aneurysm, Pseudo, or Excision/Graft Insert, W/WO Patch Graft, Abd Aorta and Visceral ",CPT® 35091,0360 - OR SERVICES,N/A,N/A," $6,059.00 "," $3,938.35 "," $5,089.56 "," $1,578.13 "," $2,105.87 "," $4,895.67 "," $5,453.10 "," $5,129.55 "," $5,453.10 "," $5,453.10 "," $5,453.10 "," $5,150.15 "," $2,064.58 "," $5,594.27 "," $5,756.05 "," $5,150.15 "," $5,634.87 "," $5,634.87 "," $5,756.05 "," $5,816.64 "," $4,957.47 "," $5,453.10 "," $5,150.15 "," $4,786.61 ", N/A ," $4,903.55 "," $4,903.55 "," $5,756.05 "," $5,199.23 "," $1,578.13 "," $5,816.64 "
 ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT INH AERS ,HCPCS RXC637,0250 - PHARMACY,00173-0682-24,8 gram, $66.81 , $43.43 , $56.12 , N/A , N/A , $53.98 , $60.13 , $56.56 , $60.13 , $60.13 , $60.13 , $56.79 , N/A , $61.69 , $63.47 , $56.79 , $62.13 , $62.13 , $63.47 , $64.14 , $54.66 , $60.13 , $56.79 , $52.78 , N/A , $54.07 , $54.07 , $63.47 , $57.33 , $52.78 , $64.14 
"Excise Lesion,Back or Flank",CPT® 21930,N/A,N/A,N/A," $3,153.00 "," $2,049.45 "," $2,206.04 ", $345.13 , $398.01 ," $1,751.41 "," $1,765.94 "," $2,932.29 "," $2,837.70 "," $2,837.70 "," $2,522.40 "," $2,522.40 ", $398.01 ," $2,911.16 "," $2,995.35 "," $2,837.70 "," $2,837.70 "," $2,837.70 "," $2,932.29 "," $3,026.88 "," $2,045.63 "," $2,680.05 "," $1,951.77 "," $2,069.50 ", N/A ," $1,785.59 "," $1,785.59 "," $2,995.35 "," $2,098.72 ", $345.13 ," $3,026.88 "
 Fac Egd Band Ligation Esophgeal/Gastric Varices ,CPT® 43244,0360 - OR SERVICES,N/A,N/A," $3,300.00 "," $2,145.00 "," $2,772.00 ", $232.38 , $277.04 ," $2,666.40 "," $2,970.00 "," $2,793.78 "," $2,970.00 "," $2,970.00 "," $2,970.00 "," $2,805.00 ", $271.61 ," $3,046.89 "," $3,135.00 "," $2,805.00 "," $3,069.00 "," $3,069.00 "," $3,135.00 "," $3,168.00 "," $2,700.06 "," $2,970.00 "," $2,805.00 "," $2,607.00 ", N/A ," $2,670.69 "," $2,670.69 "," $3,135.00 "," $2,831.73 ", $232.38 ," $3,168.00 "
 Residential Treatment Center Partial Hospitalization Room Charge ,HCPCS H2306,0912 - BH/PARTIAL HOSP,N/A,N/A, $428.00 , $278.20 , $359.52 , N/A , N/A , $345.82 , $385.20 , $362.34 , $385.20 , $385.20 , $385.20 , $363.80 , N/A , $395.17 , $406.60 , $363.80 , $398.04 , $398.04 , $406.60 , $410.88 , $350.19 , $385.20 , $363.80 , $338.12 , N/A , $346.38 , $346.38 , $406.60 , $367.27 , $338.12 , $410.88 
"Virus ID,Non-Immunologic Method",CPT® 87255,N/A,N/A,N/A, $241.00 , $156.65 , N/A , $34.54 , $34.54 , $191.58 , $229.20 , $224.13 , $216.90 , $216.90 , $192.80 , $192.80 , $34.54 , $222.52 , $228.95 , $216.90 , $216.90 , $216.90 , $224.13 , $231.36 , $226.09 , $204.85 , $222.19 , $122.80 , N/A , $178.79 , $178.79 , $228.95 , $195.38 , $34.54 , $231.36 
 PHENYLEPHRINE HCL 1 % NA SOLN ,HCPCS RXC637,0250 - PHARMACY,70000-0132-01,30 mL, $24.05 , $15.63 , $20.20 , N/A , N/A , $19.43 , $21.65 , $20.36 , $21.65 , $21.65 , $21.65 , $20.44 , N/A , $22.21 , $22.85 , $20.44 , $22.37 , $22.37 , $22.85 , $23.09 , $19.68 , $21.65 , $20.44 , $19.00 , N/A , $19.46 , $19.46 , $22.85 , $20.64 , $19.00 , $23.09 
 LIDOCAINE 50 MG/5 ML INJECTION (INPT) ,HCPCS J2001,0636 - DRUGS REQUIRING DETAILED CODIN,00409-9137-05,5 mL, $63.11 , $41.02 , $53.01 , $0.03 , $0.03 , $50.99 , $56.80 , $53.43 , $56.80 , $56.80 , $56.80 , $53.64 , $0.03 , $58.27 , $59.95 , $53.64 , $58.69 , $58.69 , $59.95 , $60.59 , $51.64 , $56.80 , $53.64 , $49.86 , N/A , $51.07 , $51.07 , $59.95 , $54.15 , $0.03 , $60.59 
 ATORVASTATIN CALCIUM 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6290-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Eye Exam, New Patient,Intermed",92002,N/A,N/A,N/A, $254.00 , $165.10 , $101.72 , $45.41 , $37.71 , $85.23 , $85.30 , $236.22 , $228.60 , $228.60 , $203.20 , $203.20 , $37.71 , $234.52 , $241.30 , $228.60 , $228.60 , $228.60 , $236.22 , $243.84 , $132.42 , $215.90 , $143.95 , $102.11 , N/A , $86.89 , $86.89 , $241.30 , $103.36 , $37.71 , $243.84 
 Fac Slctv Cath Carotid/Innom Art Angio Intrcranl Art ,CPT® 36223,0360 - OR SERVICES,N/A,N/A," $8,745.00 "," $5,684.25 "," $7,345.80 ", $291.54 ," $1,518.86 "," $7,065.96 "," $7,870.50 "," $7,403.52 "," $7,870.50 "," $7,870.50 "," $7,870.50 "," $7,433.25 "," $1,489.08 "," $8,074.26 "," $8,307.75 "," $7,433.25 "," $8,132.85 "," $8,132.85 "," $8,307.75 "," $8,395.20 "," $7,155.16 "," $7,870.50 "," $7,433.25 "," $6,908.55 ", N/A ," $7,077.33 "," $7,077.33 "," $8,307.75 "," $7,504.08 ", $291.54 ," $8,395.20 "
 Pro Repair of Shoulder ,CPT® 23420,0982 - PRO FEE/OUTPT,N/A,N/A," $6,132.00 "," $3,985.80 "," $5,907.01 ", $925.61 , $848.58 ," $4,673.78 "," $4,650.13 "," $5,702.76 "," $5,518.80 "," $5,518.80 "," $4,905.60 "," $4,905.60 ", $848.58 ," $5,661.68 "," $5,825.40 "," $5,518.80 "," $5,518.80 "," $5,518.80 "," $5,702.76 "," $5,886.72 "," $5,493.61 "," $5,212.20 "," $5,138.10 "," $5,509.40 ", N/A ," $4,764.98 "," $4,764.98 "," $5,825.40 "," $5,600.56 ", $848.58 ," $5,907.01 "
 Veeg 2-12 Hours; With Intermittent Monitoring and Maintenance ,CPT® 95712,0740 - EEG,N/A,N/A," $1,731.00 "," $1,125.15 "," $1,454.04 ", $390.34 , $206.53 ," $1,398.65 "," $1,557.90 "," $1,465.46 "," $1,557.90 "," $1,557.90 "," $1,557.90 "," $1,471.35 ", $202.48 ," $1,598.23 "," $1,644.45 "," $1,471.35 "," $1,609.83 "," $1,609.83 "," $1,644.45 "," $1,661.76 "," $1,416.30 "," $1,557.90 "," $1,471.35 "," $1,367.49 ", N/A ," $1,400.90 "," $1,400.90 "," $1,644.45 "," $1,485.37 ", $202.48 ," $1,661.76 "
 NIFEDIPINE ER 90 MG PO TB24 ,HCPCS RXC637,0250 - PHARMACY,50742-0622-01,1 tablet, $15.58 , $10.13 , $13.09 , N/A , N/A , $12.59 , $14.02 , $13.19 , $14.02 , $14.02 , $14.02 , $13.24 , N/A , $14.39 , $14.80 , $13.24 , $14.49 , $14.49 , $14.80 , $14.96 , $12.75 , $14.02 , $13.24 , $12.31 , N/A , $12.61 , $12.61 , $14.80 , $13.37 , $12.31 , $14.96 
Xpedicul Decompress Throacic Cord,CPT® 63055,N/A,N/A,N/A," $10,509.00 "," $6,830.85 "," $7,487.32 "," $1,463.50 "," $2,008.31 "," $8,817.51 "," $8,432.34 "," $9,773.37 "," $9,458.10 "," $9,458.10 "," $8,407.20 "," $8,407.20 "," $2,008.31 "," $9,702.96 "," $9,983.55 "," $9,458.10 "," $9,458.10 "," $9,458.10 "," $9,773.37 "," $10,088.64 "," $8,105.08 "," $8,932.65 "," $8,618.81 "," $9,159.04 ", N/A ," $8,989.55 "," $8,989.55 "," $9,983.55 "," $9,643.68 "," $1,463.50 "," $10,088.64 "
Arthrocentesis Aspir&/Inj Major Jt/Bursa W/US,20611,N/A,N/A,N/A, $525.00 , $341.25 , $362.70 , $56.61 , $71.34 , $294.38 , $303.91 , $488.25 , $472.50 , $472.50 , $420.00 , $420.00 , $71.34 , $484.73 , $498.75 , $472.50 , $472.50 , $472.50 , $488.25 , $504.00 , $341.67 , $446.25 , $316.30 , $351.78 , N/A , $300.12 , $300.12 , $498.75 , $352.75 , $56.61 , $504.00 
 FLUDROCORTISONE ACETATE 0.1 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,68084-0288-01,1 tablet, $5.42 , $3.52 , $4.55 , N/A , N/A , $4.38 , $4.88 , $4.59 , $4.88 , $4.88 , $4.88 , $4.61 , N/A , $5.00 , $5.15 , $4.61 , $5.04 , $5.04 , $5.15 , $5.20 , $4.43 , $4.88 , $4.61 , $4.28 , N/A , $4.39 , $4.39 , $5.15 , $4.65 , $4.28 , $5.20 
X-Ray Tmj Unilat,CPT® 70328,N/A,N/A,N/A, $209.00 , $135.85 , $196.16 , $34.02 , $28.76 , $145.59 , $169.79 , $194.37 , $188.10 , $188.10 , $167.20 , $167.20 , $28.76 , $192.97 , $198.55 , $188.10 , $188.10 , $188.10 , $194.37 , $200.64 , $189.73 , $177.65 , $186.83 , $153.17 , N/A , $148.43 , $148.43 , $198.55 , $171.83 , $28.76 , $200.64 
Treat Hip Dislocation,27265,N/A,N/A,N/A," $2,643.00 "," $1,717.95 "," $2,514.92 ", $401.80 , $336.07 ," $1,923.46 "," $1,959.11 "," $2,457.99 "," $2,378.70 "," $2,378.70 "," $2,114.40 "," $2,114.40 ", $336.07 ," $2,440.28 "," $2,510.85 "," $2,378.70 "," $2,378.70 "," $2,378.70 "," $2,457.99 "," $2,537.28 "," $2,304.80 "," $2,246.55 "," $2,151.58 "," $2,290.13 ", N/A ," $1,960.98 "," $1,960.98 "," $2,510.85 "," $2,304.84 ", $336.07 ," $2,537.28 "
 Rt Lower Ext MRI W/O & W/Contrast ,CPT® 73720,0610 - MRI,N/A,N/A," $6,261.00 "," $4,069.65 "," $5,259.24 ", $347.83 , $515.74 ," $5,058.89 "," $5,634.90 "," $5,300.56 "," $5,634.90 "," $5,634.90 "," $5,634.90 "," $5,321.85 ", $505.63 ," $5,780.78 "," $5,947.95 "," $5,321.85 "," $5,822.73 "," $5,822.73 "," $5,947.95 "," $6,010.56 "," $5,122.75 "," $5,634.90 "," $5,321.85 "," $4,946.19 ", N/A ," $5,067.03 "," $5,067.03 "," $5,947.95 "," $5,372.56 ", $347.83 ," $6,010.56 "
" Fac Nras Gene Analysis Variants, in Exon 2&3 ",CPT® 81311,0310 - PATHOLOGY LAB,N/A,N/A," $1,230.00 ", $799.50 ," $1,033.20 ", $301.71 , $178.60 , $993.84 ," $1,107.00 "," $1,041.32 "," $1,107.00 "," $1,107.00 "," $1,107.00 "," $1,045.50 ", $175.10 ," $1,135.66 "," $1,168.50 "," $1,045.50 "," $1,143.90 "," $1,143.90 "," $1,168.50 "," $1,180.80 "," $1,006.39 "," $1,107.00 "," $1,045.50 ", $971.70 , N/A , $995.44 , $995.44 ," $1,168.50 "," $1,055.46 ", $175.10 ," $1,180.80 "
 Pro I&D Pilonidal Cst Comp ,CPT® 10081,0982 - PRO FEE/OUTPT,N/A,N/A," $1,111.00 ", $722.15 , $545.63 , $162.12 , $213.21 , $462.71 , $459.06 ," $1,033.23 ", $999.90 , $999.90 , $888.80 , $888.80 , $213.21 ," $1,025.79 "," $1,055.45 ", $999.90 , $999.90 , $999.90 ," $1,033.23 "," $1,066.56 ", $603.01 , $944.35 , $918.79 , $595.22 , N/A , $471.73 , $471.73 ," $1,055.45 ", $547.05 , $162.12 ," $1,066.56 "
" Pro Debride Skin/Muscle/Bone, Fx ",CPT® 11012,0975 - PRO FEE/OR,N/A,N/A," $3,578.00 "," $2,325.70 "," $1,302.44 ", $388.61 , $557.87 ," $1,152.59 "," $1,106.95 "," $3,327.54 "," $3,220.20 "," $3,220.20 "," $2,862.40 "," $2,862.40 ", $557.87 ," $3,303.57 "," $3,399.10 "," $3,220.20 "," $3,220.20 "," $3,220.20 "," $3,327.54 "," $3,434.88 "," $1,434.56 "," $3,041.30 "," $2,228.30 "," $1,465.64 ", N/A ," $1,175.08 "," $1,175.08 "," $3,399.10 "," $1,362.70 ", $388.61 ," $3,434.88 "
 ALLOPURINOL 100 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-7041-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Quantiferon TB ,CPT® 86481,0300 - LABORATORY,N/A,N/A, $179.00 , $116.35 , $150.36 , $102.00 , $88.96 , $144.63 , $161.10 , $151.54 , $161.10 , $161.10 , $161.10 , $152.15 , $87.22 , $165.27 , $170.05 , $152.15 , $166.47 , $166.47 , $170.05 , $171.84 , $146.46 , $161.10 , $152.15 , $141.41 , N/A , $144.86 , $144.86 , $170.05 , $153.60 , $87.22 , $171.84 
 Amputation; Thigh Through Femur; Any Level ,CPT® 27590,0360 - OR SERVICES,N/A,N/A," $6,297.00 "," $4,093.05 "," $5,289.48 ", $719.12 , $731.58 ," $5,087.98 "," $5,667.30 "," $5,331.04 "," $5,667.30 "," $5,667.30 "," $5,667.30 "," $5,352.45 ", $717.24 ," $5,814.02 "," $5,982.15 "," $5,352.45 "," $5,856.21 "," $5,856.21 "," $5,982.15 "," $6,045.12 "," $5,152.21 "," $5,667.30 "," $5,352.45 "," $4,974.63 ", N/A ," $5,096.16 "," $5,096.16 "," $5,982.15 "," $5,403.46 ", $717.24 ," $6,045.12 "
Set Radn Therapy Field 3d Recon,CPT® 77295,N/A,N/A,N/A," $5,494.00 "," $3,571.10 "," $2,656.40 ", $471.16 , $596.89 ," $2,331.43 "," $2,304.33 "," $5,109.42 "," $4,944.60 "," $4,944.60 "," $4,395.20 "," $4,395.20 ", $596.89 ," $5,072.61 "," $5,219.30 "," $4,944.60 "," $4,944.60 "," $4,944.60 "," $5,109.42 "," $5,274.24 "," $2,710.48 "," $4,669.90 "," $2,521.19 "," $2,764.66 ", N/A ," $2,376.92 "," $2,376.92 "," $5,219.30 "," $2,751.31 ", $471.16 ," $5,274.24 "
Coombs Test Direct,CPT® 86880,N/A,N/A,N/A, $72.00 , $46.80 , N/A , $5.50 , $5.50 , $24.32 , $29.05 , $66.96 , $64.80 , $64.80 , $57.60 , $57.60 , $5.50 , $66.48 , $68.40 , $64.80 , $64.80 , $64.80 , $66.96 , $69.12 , $35.99 , $61.20 , $35.68 , $19.53 , N/A , $22.70 , $22.70 , $68.40 , $24.80 , $5.50 , $69.12 
 DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN ,HCPCS J1100,0636 - DRUGS REQUIRING DETAILED CODIN,67457-0423-12,0.5 mL, $16.68 , $10.84 , $14.01 , $0.12 , $0.13 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.13 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.12 , $16.01 
"Cystoscopy,Dil Urethral Stricture",52281,N/A,N/A,N/A," $1,957.00 "," $1,272.05 ", $815.93 , $143.40 , $186.38 , $746.11 , $695.66 ," $1,820.01 "," $1,761.30 "," $1,761.30 "," $1,565.60 "," $1,565.60 ", $186.38 ," $1,806.90 "," $1,859.15 "," $1,761.30 "," $1,761.30 "," $1,761.30 "," $1,820.01 "," $1,878.72 ", $819.61 ," $1,663.45 ", $788.56 , $936.15 , N/A , $760.67 , $760.67 ," $1,859.15 ", $894.06 , $143.40 ," $1,878.72 "
 Fac Dialysis Procedure ,CPT® 90999,0851 - CCPD/COMPOSITE,N/A,N/A, $339.00 , $220.35 , $284.76 , N/A , N/A , $273.91 , $305.10 , $287.00 , $305.10 , $305.10 , $305.10 , $288.15 , N/A , $313.00 , $322.05 , $288.15 , $315.27 , $315.27 , $322.05 , $325.44 , $277.37 , $305.10 , $288.15 , $267.81 , N/A , $274.35 , $274.35 , $322.05 , $290.90 , $267.81 , $325.44 
"Reconstruction,Ext Auditory Canal",CPT® 69310,N/A,N/A,N/A," $7,222.00 "," $4,694.30 "," $5,431.10 "," $1,094.43 ", $457.58 ," $5,244.88 "," $5,467.13 "," $6,716.46 "," $6,499.80 "," $6,499.80 "," $5,777.60 "," $5,777.60 ", $457.58 ," $6,668.07 "," $6,860.90 "," $6,499.80 "," $6,499.80 "," $6,499.80 "," $6,716.46 "," $6,933.12 "," $5,918.96 "," $6,138.70 "," $5,955.21 "," $5,275.36 ", N/A ," $5,347.21 "," $5,347.21 "," $6,860.90 "," $6,105.59 ", $457.58 ," $6,933.12 "
 DEMECLOCYCLINE HCL 150 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,42806-0143-01,1 tablet, $96.59 , $62.78 , $81.14 , N/A , N/A , $78.04 , $86.93 , $81.77 , $86.93 , $86.93 , $86.93 , $82.10 , N/A , $89.18 , $91.76 , $82.10 , $89.83 , $89.83 , $91.76 , $92.73 , $79.03 , $86.93 , $82.10 , $76.31 , N/A , $78.17 , $78.17 , $91.76 , $82.88 , $76.31 , $92.73 
Lens Sphc Trifocal 4.25-7/>6,HCPCS V2310,N/A,N/A,N/A, $90.00 , $58.50 , N/A , $106.05 , N/A , N/A , N/A , $83.70 , $81.00 , $81.00 , $72.00 , $72.00 , N/A , $83.10 , $85.50 , $81.00 , $81.00 , $81.00 , $83.70 , $86.40 , N/A , $76.50 , $90.00 , $96.36 , N/A , N/A , N/A , $85.50 , N/A , $72.00 , $106.05 
Mycobacteria Identification,CPT® 87118,N/A,N/A,N/A, $152.00 , $98.80 , N/A , $14.90 , $14.90 , $61.94 , $74.04 , $141.36 , $136.80 , $136.80 , $121.60 , $121.60 , $14.90 , $140.34 , $144.40 , $136.80 , $136.80 , $136.80 , $141.36 , $145.92 , $97.55 , $129.20 , $71.36 , $42.91 , N/A , $57.81 , $57.81 , $144.40 , $63.18 , $14.90 , $145.92 
Removal of Fallopian Tube,58700,N/A,N/A,N/A," $4,604.00 "," $2,992.60 "," $3,760.20 ", $759.56 , $522.28 ," $3,167.84 "," $3,145.64 "," $4,281.72 "," $4,143.60 "," $4,143.60 "," $3,683.20 "," $3,683.20 ", $522.28 ," $4,250.87 "," $4,373.80 "," $4,143.60 "," $4,143.60 "," $4,143.60 "," $4,281.72 "," $4,419.84 "," $3,901.46 "," $3,913.40 "," $4,153.30 "," $3,158.26 ", N/A ," $3,229.65 "," $3,229.65 "," $4,373.80 "," $3,873.76 ", $522.28 ," $4,419.84 "
US Venous Duplex Upp/Low Ext Complete Bilateral Study,CPT® 93970,N/A,N/A,N/A," $2,522.00 "," $1,639.30 "," $1,195.35 ", $184.54 , $172.43 ," $1,061.24 "," $1,070.66 "," $2,345.46 "," $2,269.80 "," $2,269.80 "," $2,017.60 "," $2,017.60 ", $172.43 ," $2,328.56 "," $2,395.90 "," $2,269.80 "," $2,269.80 "," $2,269.80 "," $2,345.46 "," $2,421.12 ", $842.19 ," $2,143.70 ", $576.80 , $745.00 , N/A ," $1,081.95 "," $1,081.95 "," $2,395.90 "," $1,199.37 ", $172.43 ," $2,421.12 "
Gtt-Added Samples,CPT® 82952,N/A,N/A,N/A, $51.00 , $33.15 , N/A , $4.00 , $4.00 , $22.20 , $26.53 , $47.43 , $45.90 , $45.90 , $40.80 , $40.80 , $4.00 , $47.09 , $48.45 , $45.90 , $45.90 , $45.90 , $47.43 , $48.96 , $26.17 , $43.35 , $25.95 , $14.19 , N/A , $20.72 , $20.72 , $48.45 , $22.64 , $4.00 , $48.96 
 BENDAMUSTINE HCL 100 MG IV SOLR ,HCPCS J9058,0636 - DRUGS REQUIRING DETAILED CODIN,63459-0391-20,20 mL," $8,738.02 "," $5,679.71 "," $7,339.94 ", N/A , N/A ," $7,060.32 "," $7,864.22 "," $7,397.61 "," $7,864.22 "," $7,864.22 "," $7,864.22 "," $7,427.32 ", N/A ," $8,067.81 "," $8,301.12 "," $7,427.32 "," $8,126.36 "," $8,126.36 "," $8,301.12 "," $8,388.50 "," $7,149.45 "," $7,864.22 "," $7,427.32 "," $6,903.04 ", N/A ," $7,071.68 "," $7,071.68 "," $8,301.12 "," $7,498.09 "," $6,903.04 "," $8,388.50 "
 Cardiac Arrhythmia And Conduction Disorders Without Cc/McC ,MS DRG V40 (FY2023) 310,N/A,N/A,N/A," $8,073.10 "," $5,247.52 "," $6,781.40 ", N/A , N/A ," $6,523.06 "," $7,265.79 "," $6,834.69 "," $7,265.79 "," $7,265.79 "," $7,265.79 "," $6,862.14 ", N/A ," $7,453.89 "," $7,669.45 "," $6,862.14 "," $7,507.98 "," $7,507.98 "," $7,669.45 "," $7,750.18 "," $6,605.41 "," $7,265.79 "," $6,862.14 "," $6,377.75 ", N/A ," $6,533.56 "," $6,533.56 "," $7,669.45 "," $6,927.53 "," $6,377.75 "," $7,750.18 "
 Pro Hallux Rigidus W/Cheilectomy 1st Mp Jt W/O Implt ,CPT® 28289,0982 - PRO FEE/OUTPT,N/A,N/A," $4,911.00 "," $3,192.15 "," $2,833.68 ", $446.07 , $327.43 ," $2,688.04 "," $2,688.69 "," $4,567.23 "," $4,419.90 "," $4,419.90 "," $3,928.80 "," $3,928.80 ", $327.43 ," $4,534.33 "," $4,665.45 "," $4,419.90 "," $4,419.90 "," $4,419.90 "," $4,567.23 "," $4,714.56 "," $2,630.44 "," $4,174.35 "," $2,925.86 "," $2,700.48 ", N/A ," $2,740.49 "," $2,740.49 "," $4,665.45 "," $3,221.06 ", $327.43 ," $4,714.56 "
Grafix Stravix Prime Pl Sqcm,HCPCS Q4133,N/A,N/A,N/A, $646.00 , $419.90 , N/A , $140.12 , $173.97 , N/A , N/A , $600.78 , $581.40 , $581.40 , $516.80 , $516.80 , $173.97 , $596.45 , $613.70 , $581.40 , $581.40 , $581.40 , $600.78 , $620.16 , $177.40 , $549.10 , $261.70 , $176.59 , N/A , N/A , N/A , $613.70 , N/A , $140.12 , $620.16 
Cbc/Diffwbc W/O Platelet,HCPCS G0306,N/A,N/A,N/A, $55.00 , $35.75 , N/A , $7.93 , $7.93 , $20.01 , N/A , $51.15 , $49.50 , $49.50 , $44.00 , $44.00 , $7.93 , $50.78 , $52.25 , $49.50 , $49.50 , $49.50 , $51.15 , $52.80 , $51.88 , $46.75 , $20.11 , $28.17 , N/A , $20.39 , $20.39 , $52.25 , $25.49 , $7.93 , $52.80 
Hospital IP/Obs Care Same Date Mod Mdm 70 Min,99235,N/A,N/A,N/A, $531.00 , $345.15 , $329.62 , $155.20 , $193.93 , $292.56 , $291.18 , $493.83 , $477.90 , $477.90 , $424.80 , $424.80 , $193.93 , $490.27 , $504.45 , $477.90 , $477.90 , $477.90 , $493.83 , $509.76 , $495.29 , $451.35 , $362.30 , $370.50 , N/A , $298.27 , $298.27 , $504.45 , $344.01 , $155.20 , $509.76 
 RITUXIMAB-ABBS 500 MG/50ML IV SOLN ,HCPCS Q5115,0636 - DRUGS REQUIRING DETAILED CODIN,63459-0104-50,50 mL," $12,430.91 "," $8,080.09 "," $10,441.96 ", $40.59 , $49.81 ," $10,044.18 "," $11,187.82 "," $10,524.01 "," $11,187.82 "," $11,187.82 "," $11,187.82 "," $10,566.27 ", $48.83 ," $11,477.46 "," $11,809.36 "," $10,566.27 "," $11,560.75 "," $11,560.75 "," $11,809.36 "," $11,933.67 "," $10,170.97 "," $11,187.82 "," $10,566.27 "," $9,820.42 ", N/A ," $10,060.34 "," $10,060.34 "," $11,809.36 "," $10,666.96 ", $40.59 ," $11,933.67 "
" Pro Outpt Visit,Est,Levl IV ",CPT® 99214,0982 - PRO FEE/OUTPT,N/A,N/A, $293.00 , $190.45 , $198.24 , $94.81 , $64.80 , $135.34 , $135.69 , $272.49 , $263.70 , $263.70 , $234.40 , $234.40 , $64.80 , $270.53 , $278.35 , $263.70 , $263.70 , $263.70 , $272.49 , $281.28 , $181.36 , $249.05 , $168.77 , $172.04 , $74.50 , $137.99 , $137.99 , $278.35 , $159.15 , $64.80 , $281.28 
Reposition Gastrostomy Tube,CPT® 43761,N/A,N/A,N/A," $1,064.00 ", $691.60 , $628.10 , $97.25 , $114.19 , $499.84 , $498.19 , $989.52 , $957.60 , $957.60 , $851.20 , $851.20 , $114.19 , $982.39 ," $1,010.80 ", $957.60 , $957.60 , $957.60 , $989.52 ," $1,021.44 ", $452.11 , $904.40 , $540.57 , $592.95 , N/A , $509.59 , $509.59 ," $1,010.80 ", $532.99 , $97.25 ," $1,021.44 "
 DEFEROXAMINE MESYLATE 2 G IJ SOLR ,HCPCS J0895,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0599-30,21.1 mL, $317.46 , $206.35 , $266.67 , $8.76 , $8.83 , $256.51 , $285.71 , $268.76 , $285.71 , $285.71 , $285.71 , $269.84 , $8.66 , $293.11 , $301.59 , $269.84 , $295.24 , $295.24 , $301.59 , $304.76 , $259.75 , $285.71 , $269.84 , $250.79 , N/A , $256.92 , $256.92 , $301.59 , $272.41 , $8.66 , $304.76 
Sub Grft F/S/N/H/F/G/M/D /<100scm /<1st 25 Scm,15275,N/A,N/A,N/A, $915.00 , $594.75 , $300.97 , $89.29 , $118.92 , $266.16 , $273.31 , $850.95 , $823.50 , $823.50 , $732.00 , $732.00 , $118.92 , $844.82 , $869.25 , $823.50 , $823.50 , $823.50 , $850.95 , $878.40 , $332.78 , $777.75 , $549.49 , $339.41 , N/A , $271.36 , $271.36 , $869.25 , $314.69 , $89.29 , $878.40 
 LITHIUM CARBONATE 150 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00054-8526-25,1 capsule, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Physical Therapy Evaluation Low Complex 20 Mins,CPT® 97161,N/A,N/A,N/A, $255.00 , $165.75 , $196.04 , $100.30 , $67.74 , $174.75 , $166.54 , $237.15 , $229.50 , $229.50 , $204.00 , $204.00 , $67.74 , $235.44 , $242.25 , $229.50 , $229.50 , $229.50 , $237.15 , $244.80 , $253.17 , $216.75 , $302.90 , $189.75 , N/A , $178.16 , $178.16 , $242.25 , $198.16 , $67.74 , $302.90 
 SODIUM CHLORIDE 0.9 % IV SOLN ,HCPCS RXA258,0258 - IV SOLUTIONS,00990-7983-09,"1,000 mL", $79.82 , $51.88 , $67.05 , N/A , N/A , $64.49 , $71.84 , $67.58 , $71.84 , $71.84 , $71.84 , $67.85 , N/A , $73.70 , $75.83 , $67.85 , $74.23 , $74.23 , $75.83 , $76.63 , $65.31 , $71.84 , $67.85 , $63.06 , N/A , $64.60 , $64.60 , $75.83 , $68.49 , $63.06 , $76.63 
Antibody-Helicobacter Pyl,CPT® 86677,N/A,N/A,N/A, $120.00 , $78.00 , N/A , $17.19 , $8.07 , $32.88 , $39.34 , $111.60 , $108.00 , $108.00 , $96.00 , $96.00 , $8.07 , $110.80 , $114.00 , $108.00 , $108.00 , $108.00 , $111.60 , $115.20 , $112.51 , $102.00 , $95.69 , $52.60 , N/A , $30.69 , $30.69 , $114.00 , $33.54 , $8.07 , $115.20 
"Ca Screen,Flexi Sigmoidscope",G0104,N/A,N/A,N/A," $1,015.00 ", $659.75 , $126.46 , $53.21 , $103.39 , $117.23 , N/A , $943.95 , $913.50 , $913.50 , $812.00 , $812.00 , $103.39 , $937.15 , $964.25 , $913.50 , $913.50 , $913.50 , $943.95 , $974.40 , $165.85 , $862.75 , $124.56 , $325.47 , N/A , $119.52 , $119.52 , $964.25 , $149.41 , $53.21 , $974.40 
" Fac Assay, Carbamazepine, Total ",CPT® 80156,0301 - LAB/CHEMISTRY,N/A,N/A, $135.00 , $87.75 , $113.40 , $14.86 , $14.86 , $109.08 , $121.50 , $114.29 , $121.50 , $121.50 , $121.50 , $114.75 , $14.57 , $124.65 , $128.25 , $114.75 , $125.55 , $125.55 , $128.25 , $129.60 , $110.46 , $121.50 , $114.75 , $106.65 , N/A , $109.26 , $109.26 , $128.25 , $115.84 , $14.57 , $129.60 
"Inject Nerv Blck,Stellate Ganglion",64510,N/A,N/A,N/A," $1,386.00 ", $900.90 , $381.37 , $74.23 , $129.25 , $412.03 , $403.28 ," $1,288.98 "," $1,247.40 "," $1,247.40 "," $1,108.80 "," $1,108.80 ", $129.25 ," $1,279.69 "," $1,316.70 "," $1,247.40 "," $1,247.40 "," $1,247.40 "," $1,288.98 "," $1,330.56 ", $411.36 ," $1,178.10 ", $394.28 , $446.07 , N/A , $420.07 , $420.07 ," $1,316.70 ", $450.63 , $74.23 ," $1,330.56 "
 ALTEPLASE 2 MG IJ SOLR ,HCPCS J2997,0636 - DRUGS REQUIRING DETAILED CODIN,50242-0041-64,2 mL," $1,035.29 ", $672.94 , $869.64 , $90.93 , $89.79 , $836.51 , $931.76 , $876.48 , $931.76 , $931.76 , $931.76 , $880.00 , $88.03 , $955.88 , $983.53 , $880.00 , $962.82 , $962.82 , $983.53 , $993.88 , $847.07 , $931.76 , $880.00 , $817.88 , N/A , $837.86 , $837.86 , $983.53 , $888.38 , $88.03 , $993.88 
"Excision Meckel,Omphalomes Duct",CPT® 44800,N/A,N/A,N/A," $5,332.00 "," $3,465.80 "," $4,631.97 ", $720.54 , $768.38 ," $3,607.62 "," $3,650.35 "," $4,958.76 "," $4,798.80 "," $4,798.80 "," $4,265.60 "," $4,265.60 ", $768.38 ," $4,923.04 "," $5,065.40 "," $4,798.80 "," $4,798.80 "," $4,798.80 "," $4,958.76 "," $5,118.72 "," $3,314.61 "," $4,532.20 "," $4,046.26 "," $4,251.93 ", N/A ," $3,678.01 "," $3,678.01 "," $5,065.40 "," $3,846.81 ", $720.54 ," $5,118.72 "
"Insert Vert Fix Dev,Post,3-6 Sgmts",CPT® 22842,N/A,N/A,N/A," $5,291.00 "," $3,439.15 "," $4,383.67 ", $682.02 , $739.78 ," $3,650.82 "," $3,554.86 "," $4,920.63 "," $4,761.90 "," $4,761.90 "," $4,232.80 "," $4,232.80 ", $739.78 ," $4,885.18 "," $5,026.45 "," $4,761.90 "," $4,761.90 "," $4,761.90 "," $4,920.63 "," $5,079.36 "," $4,098.84 "," $4,497.35 "," $4,019.50 "," $4,211.39 ", N/A ," $3,722.06 "," $3,722.06 "," $5,026.45 "," $4,374.75 ", $682.02 ," $5,079.36 "
 Fac Chg G6pd Gene Analysis Full Gene Sequence ,CPT® 81249,0310 - PATHOLOGY LAB,N/A,N/A, $14.00 , $9.10 , $11.76 , $612.00 , $489.60 , $11.31 , $12.60 , $11.85 , $12.60 , $12.60 , $12.60 , $11.90 , $480.00 , $12.93 , $13.30 , $11.90 , $13.02 , $13.02 , $13.30 , $13.44 , $11.45 , $12.60 , $11.90 , $11.06 , N/A , $11.33 , $11.33 , $13.30 , $12.01 , $11.06 , $612.00 
"Intubation,Endotracheal",31500,N/A,N/A,N/A, $777.00 , $505.05 , $758.54 , $132.66 , $155.78 , $421.83 , $406.96 , $722.61 , $699.30 , $699.30 , $621.60 , $621.60 , $155.78 , $717.40 , $738.15 , $699.30 , $699.30 , $699.30 , $722.61 , $745.92 , $734.78 , $660.45 , $576.25 , $726.12 , N/A , $430.06 , $430.06 , $738.15 , $506.49 , $132.66 , $758.54 
CT Scan Head Combo,CPT® 70470,N/A,N/A,N/A," $3,373.00 "," $2,192.45 "," $1,239.84 ", $177.53 , $303.13 , $914.09 ," $1,152.82 "," $3,136.89 "," $3,035.70 "," $3,035.70 "," $2,698.40 "," $2,698.40 ", $303.13 ," $3,114.29 "," $3,204.35 "," $3,035.70 "," $3,035.70 "," $3,035.70 "," $3,136.89 "," $3,238.08 "," $1,042.93 "," $2,867.05 "," $1,255.78 "," $1,243.47 ", N/A , $931.93 , $931.93 ," $3,204.35 "," $1,078.73 ", $177.53 ," $3,238.08 "
Remove Rectal Obstruction,CPT® 45915,N/A,N/A,N/A," $2,159.00 "," $1,403.35 "," $1,410.24 ", $218.03 , $130.70 ," $1,084.36 "," $1,103.26 "," $2,007.87 "," $1,943.10 "," $1,943.10 "," $1,727.20 "," $1,727.20 ", $130.70 ," $1,993.40 "," $2,051.05 "," $1,943.10 "," $1,943.10 "," $1,943.10 "," $2,007.87 "," $2,072.64 "," $1,015.21 "," $1,835.15 "," $1,209.60 "," $1,299.70 ", N/A ," $1,105.51 "," $1,105.51 "," $2,051.05 "," $1,156.26 ", $130.70 ," $2,072.64 "
 Fac Fungus Isolation Culture ,CPT® 87102,0306 - LAB/BACT-MICRO,N/A,N/A, $121.00 , $78.65 , $101.64 , $8.58 , $8.58 , $97.77 , $108.90 , $102.44 , $108.90 , $108.90 , $108.90 , $102.85 , $8.41 , $111.72 , $114.95 , $102.85 , $112.53 , $112.53 , $114.95 , $116.16 , $99.00 , $108.90 , $102.85 , $95.59 , N/A , $97.93 , $97.93 , $114.95 , $103.83 , $8.41 , $116.16 
" Fac Cytopath Fl Nongyn, Smears ",CPT® 88104,0310 - PATHOLOGY LAB,N/A,N/A, $220.00 , $143.00 , $184.80 , $67.95 , $37.19 , $177.76 , $198.00 , $186.25 , $198.00 , $198.00 , $198.00 , $187.00 , $36.46 , $203.13 , $209.00 , $187.00 , $204.60 , $204.60 , $209.00 , $211.20 , $180.00 , $198.00 , $187.00 , $173.80 , N/A , $178.05 , $178.05 , $209.00 , $188.78 , $36.46 , $211.20 
 NOREPINEPHRINE-DEXTROSE 8-5 MG/250ML-% IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00338-0108-20,250 mL, $215.75 , $140.24 , $181.23 , N/A , N/A , $174.33 , $194.18 , $182.65 , $194.18 , $194.18 , $194.18 , $183.39 , N/A , $199.20 , $204.96 , $183.39 , $200.65 , $200.65 , $204.96 , $207.12 , $176.53 , $194.18 , $183.39 , $170.44 , N/A , $174.61 , $174.61 , $204.96 , $185.14 , $170.44 , $207.12 
 Thoracic Spine 3 Views- Mh ,CPT® 72072,0972 - PRO FEE/RAD/DX,N/A,N/A, $136.00 , $88.40 , $221.33 , $38.71 , $36.41 , $162.84 , $198.13 , $126.48 , $122.40 , $122.40 , $108.80 , $108.80 , $36.41 , $125.57 , $129.20 , $122.40 , $122.40 , $122.40 , $126.48 , $130.56 , $214.83 , $115.60 , $215.72 , $174.94 , N/A , $166.02 , $166.02 , $129.20 , $192.17 , $36.41 , $221.33 
 Pro Gastrointestinal Tract Imaging Esophagus ,CPT® 91111,0982 - PRO FEE/OUTPT,N/A,N/A," $4,289.00 "," $2,787.85 "," $1,974.82 ", $844.03 , $603.38 ," $1,622.73 "," $1,821.61 "," $3,988.77 "," $3,860.10 "," $3,860.10 "," $3,431.20 "," $3,431.20 ", $603.38 ," $3,960.03 "," $4,074.55 "," $3,860.10 "," $3,860.10 "," $3,860.10 "," $3,988.77 "," $4,117.44 "," $4,084.86 "," $3,645.65 "," $2,415.68 "," $2,826.03 ", N/A ," $1,654.39 "," $1,654.39 "," $4,074.55 "," $1,928.69 ", $603.38 ," $4,117.44 "
 Fac Antipsychotics Not Otherwise Specified 1-3 ,CPT® 80342,0301 - LAB/CHEMISTRY,N/A,N/A, $202.00 , $131.30 , $169.68 , N/A , N/A , $163.22 , $181.80 , $171.01 , $181.80 , $181.80 , $181.80 , $171.70 , N/A , $186.51 , $191.90 , $171.70 , $187.86 , $187.86 , $191.90 , $193.92 , $165.28 , $181.80 , $171.70 , $159.58 , N/A , $163.48 , $163.48 , $191.90 , $173.34 , $159.58 , $193.92 
Layer Closure 7.6-12.5cm,12044,N/A,N/A,N/A," $1,440.00 ", $936.00 , $680.71 , $204.36 , $138.28 , $588.98 , $571.43 ," $1,339.20 "," $1,296.00 "," $1,296.00 "," $1,152.00 "," $1,152.00 ", $138.28 ," $1,329.55 "," $1,368.00 "," $1,296.00 "," $1,296.00 "," $1,296.00 "," $1,339.20 "," $1,382.40 ", $745.42 ," $1,224.00 "," $1,141.80 ", $753.29 , N/A , $600.46 , $600.46 ," $1,368.00 ", $696.35 , $138.28 ," $1,382.40 "
Drug Screen Quant Amphetamines 3 or 4,CPT® 80325,N/A,N/A,N/A, $216.00 , $140.40 , N/A , N/A , N/A , N/A , N/A , $200.88 , $194.40 , $194.40 , $172.80 , $172.80 , N/A , $199.43 , $205.20 , $194.40 , $194.40 , $194.40 , $200.88 , $207.36 , N/A , $183.60 , $172.80 , N/A , N/A , N/A , N/A , $205.20 , N/A , $172.80 , $207.36 
Assay Oxalate,CPT® 83945,N/A,N/A,N/A, $128.00 , $83.20 , N/A , $14.74 , $14.74 , $72.84 , $87.10 , $119.04 , $115.20 , $115.20 , $102.40 , $102.40 , $14.74 , $118.18 , $121.60 , $115.20 , $115.20 , $115.20 , $119.04 , $122.88 , $96.49 , $108.80 , $84.34 , $46.67 , N/A , $67.98 , $67.98 , $121.60 , $74.28 , $14.74 , $122.88 
 Fac Appl Cst Hand&Lwr F/Arm Gauntlet ,CPT® 29085,0761 - TREATMENT ROOM,N/A,N/A, $603.00 , $391.95 , $506.52 , $63.77 , $47.27 , $487.22 , $542.70 , $510.50 , $542.70 , $542.70 , $542.70 , $512.55 , $46.34 , $556.75 , $572.85 , $512.55 , $560.79 , $560.79 , $572.85 , $578.88 , $493.37 , $542.70 , $512.55 , $476.37 , N/A , $488.01 , $488.01 , $572.85 , $517.43 , $46.34 , $578.88 
Blood Clot Factor XI Test,CPT® 85270,N/A,N/A,N/A, $279.00 , $181.35 , N/A , $18.26 , $18.26 , $101.32 , $121.17 , $259.47 , $251.10 , $251.10 , $223.20 , $223.20 , $18.26 , $257.60 , $265.05 , $251.10 , $251.10 , $251.10 , $259.47 , $267.84 , $119.52 , $237.15 , $116.77 , $64.91 , N/A , $94.56 , $94.56 , $265.05 , $103.33 , $18.26 , $267.84 
 Pro Arthrt Kne W/Jt Expl Bx/Rmvl Loose/FB ,CPT® 27331,0982 - PRO FEE/OUTPT,N/A,N/A," $2,975.00 "," $1,933.75 "," $2,915.84 ", $458.85 , $768.38 ," $2,293.03 "," $2,296.39 "," $2,766.75 "," $2,677.50 "," $2,677.50 "," $2,380.00 "," $2,380.00 ", $768.38 ," $2,746.82 "," $2,826.25 "," $2,677.50 "," $2,677.50 "," $2,677.50 "," $2,766.75 "," $2,856.00 "," $2,706.55 "," $2,528.75 "," $2,533.37 "," $2,698.28 ", N/A ," $2,337.77 "," $2,337.77 "," $2,826.25 "," $2,747.70 ", $458.85 ," $2,915.84 "
Potassium Hydroxide Preps,HCPCS Q0112,N/A,N/A,N/A, $41.00 , $26.65 , N/A , $5.95 , $5.93 , $7.55 , N/A , $38.13 , $36.90 , $36.90 , $32.80 , $32.80 , $5.93 , $37.86 , $38.95 , $36.90 , $36.90 , $36.90 , $38.13 , $39.36 , $38.93 , $34.85 , $11.03 , $17.09 , N/A , N/A , N/A , $38.95 , N/A , $5.93 , $39.36 
"Nasal Endoscopy,Dx",31231,N/A,N/A,N/A," $1,131.00 ", $735.15 , $300.20 , $61.54 , $207.30 , $250.32 , $243.40 ," $1,051.83 "," $1,017.90 "," $1,017.90 ", $904.80 , $904.80 , $207.30 ," $1,044.25 "," $1,074.45 "," $1,017.90 "," $1,017.90 "," $1,017.90 "," $1,051.83 "," $1,085.76 ", $331.89 , $961.35 , $340.76 , $328.59 , N/A , $255.20 , $255.20 ," $1,074.45 ", $300.54 , $61.54 ," $1,085.76 "
Closed Rx Femur Shaft Fx+Manip,CPT® 27502,N/A,N/A,N/A," $5,123.00 "," $3,329.95 "," $4,598.43 ", $716.33 , $686.41 ," $3,695.66 "," $3,694.69 "," $4,764.39 "," $4,610.70 "," $4,610.70 "," $4,098.40 "," $4,098.40 ", $686.41 ," $4,730.07 "," $4,866.85 "," $4,610.70 "," $4,610.70 "," $4,610.70 "," $4,764.39 "," $4,918.08 "," $4,261.85 "," $4,354.55 "," $4,083.72 "," $4,313.75 ", N/A ," $3,767.76 "," $3,767.76 "," $4,866.85 "," $4,428.46 ", $686.41 ," $4,918.08 "
 Pro Pvb Thoracic Single Injection Site W/Img Gid ,CPT® 64461,0964 - PRO FEE/ANES CRNA,N/A,N/A," $1,656.00 "," $1,076.40 ", $388.39 , $75.14 , $119.15 , $489.05 , $464.02 ," $1,540.08 "," $1,490.40 "," $1,490.40 "," $1,324.80 "," $1,324.80 ", $119.15 ," $1,528.98 "," $1,573.20 "," $1,490.40 "," $1,490.40 "," $1,490.40 "," $1,540.08 "," $1,589.76 ", $414.88 ," $1,407.60 ", $410.47 , $521.75 , N/A , $498.59 , $498.59 ," $1,573.20 ", $534.86 , $75.14 ," $1,589.76 "
 MINERAL OIL LIGHT OIL ,HCPCS RXA250,0250 - PHARMACY,63323-0254-10,30 mL, $324.24 , $210.76 , $272.36 , N/A , N/A , $261.99 , $291.82 , $274.50 , $291.82 , $291.82 , $291.82 , $275.60 , N/A , $299.37 , $308.03 , $275.60 , $301.54 , $301.54 , $308.03 , $311.27 , $265.29 , $291.82 , $275.60 , $256.15 , N/A , $262.41 , $262.41 , $308.03 , $278.23 , $256.15 , $311.27 
 Endo Aneur Rep Iliac Art; Other Than Rupture; Uni ,CPT® 34718,0360 - OR SERVICES,N/A,N/A," $1,787.00 "," $1,161.55 "," $1,501.08 "," $1,099.51 ", $934.31 ," $1,443.90 "," $1,608.30 "," $1,512.87 "," $1,608.30 "," $1,608.30 "," $1,608.30 "," $1,518.95 ", $915.99 ," $1,649.94 "," $1,697.65 "," $1,518.95 "," $1,661.91 "," $1,661.91 "," $1,697.65 "," $1,715.52 "," $1,462.12 "," $1,608.30 "," $1,518.95 "," $1,411.73 ", N/A ," $1,446.22 "," $1,446.22 "," $1,697.65 "," $1,533.42 ", $915.99 ," $1,715.52 "
 Debridement Skin and Subcutaneous Tissue - Mh ,CPT® 11042,0761 - TREATMENT ROOM,N/A,N/A," $1,234.00 ", $802.10 ," $1,036.56 ", $57.23 , $63.58 , $997.07 ," $1,110.60 "," $1,044.70 "," $1,110.60 "," $1,110.60 "," $1,110.60 "," $1,048.90 ", $62.33 ," $1,139.35 "," $1,172.30 "," $1,048.90 "," $1,147.62 "," $1,147.62 "," $1,172.30 "," $1,184.64 "," $1,009.66 "," $1,110.60 "," $1,048.90 ", $974.86 , N/A , $998.68 , $998.68 ," $1,172.30 "," $1,058.90 ", $57.23 ," $1,184.64 "
Prep Site T/a/L Addl 100 Sq Cm/1pct,15003,N/A,N/A,N/A, $418.00 , $271.70 , $140.28 , $41.42 , $54.78 , $124.64 , $119.24 , $388.74 , $376.20 , $376.20 , $334.40 , $334.40 , $54.78 , $385.94 , $397.10 , $376.20 , $376.20 , $376.20 , $388.74 , $401.28 , $155.20 , $355.30 , $240.85 , $157.89 , N/A , $127.07 , $127.07 , $397.10 , $147.36 , $41.42 , $401.28 
"Laminectomy,Thoracic",CPT® 63003,N/A,N/A,N/A," $7,384.00 "," $4,799.60 "," $5,711.26 "," $1,116.98 "," $1,536.80 "," $6,709.48 "," $6,443.55 "," $6,867.12 "," $6,645.60 "," $6,645.60 "," $5,907.20 "," $5,907.20 "," $1,536.80 "," $6,817.65 "," $7,014.80 "," $6,645.60 "," $6,645.60 "," $6,645.60 "," $6,867.12 "," $7,088.64 "," $6,178.60 "," $6,276.40 "," $6,570.71 "," $7,017.65 ", N/A ," $6,840.39 "," $6,840.39 "," $7,014.80 "," $7,338.14 "," $1,116.98 "," $7,338.14 "
Quant Assay Haptoglobin,CPT® 83010,N/A,N/A,N/A, $145.00 , $94.25 , N/A , $12.83 , $12.83 , $71.18 , $85.13 , $134.85 , $130.50 , $130.50 , $116.00 , $116.00 , $12.83 , $133.88 , $137.75 , $130.50 , $130.50 , $130.50 , $134.85 , $139.20 , $84.00 , $123.25 , $82.71 , $45.61 , N/A , $66.43 , $66.43 , $137.75 , $72.59 , $12.83 , $139.20 
 Fac Colsc Flexible W/Transendoscopic Balloon Dilat ,CPT® 45386,0360 - OR SERVICES,N/A,N/A," $2,854.00 "," $1,855.10 "," $2,397.36 ", $200.10 , $573.99 ," $2,306.03 "," $2,568.60 "," $2,416.20 "," $2,568.60 "," $2,568.60 "," $2,568.60 "," $2,425.90 ", $562.74 ," $2,635.10 "," $2,711.30 "," $2,425.90 "," $2,654.22 "," $2,654.22 "," $2,711.30 "," $2,739.84 "," $2,335.14 "," $2,568.60 "," $2,425.90 "," $2,254.66 ", N/A ," $2,309.74 "," $2,309.74 "," $2,711.30 "," $2,449.02 ", $200.10 ," $2,739.84 "
 LINACLOTIDE 145 MCG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00456-1201-30,1 capsule, $105.86 , $68.81 , $88.92 , N/A , N/A , $85.53 , $95.27 , $89.62 , $95.27 , $95.27 , $95.27 , $89.98 , N/A , $97.74 , $100.57 , $89.98 , $98.45 , $98.45 , $100.57 , $101.63 , $86.61 , $95.27 , $89.98 , $83.63 , N/A , $85.67 , $85.67 , $100.57 , $90.84 , $83.63 , $101.63 
Open Rx Condylar Fx+Extensn,CPT® 27513,N/A,N/A,N/A," $8,235.00 "," $5,352.75 "," $7,444.52 "," $1,161.18 "," $1,355.61 "," $5,990.12 "," $5,914.04 "," $7,658.55 "," $7,411.50 "," $7,411.50 "," $6,588.00 "," $6,588.00 "," $1,355.61 "," $7,603.38 "," $7,823.25 "," $7,411.50 "," $7,411.50 "," $7,411.50 "," $7,658.55 "," $7,905.60 "," $6,945.38 "," $6,999.75 "," $6,552.87 "," $7,030.44 ", N/A ," $6,106.99 "," $6,106.99 "," $7,823.25 "," $7,177.89 "," $1,161.18 "," $7,905.60 "
Peri-Px Dev Eval Pm/Ldls Pm Phys/Qhp in Person,CPT® 93286,N/A,N/A,N/A, $290.00 , $188.50 , $301.93 , $45.39 , $25.87 , $147.31 , $148.68 , $269.70 , $261.00 , $261.00 , $232.00 , $232.00 , $25.87 , $267.76 , $275.50 , $261.00 , $261.00 , $261.00 , $269.70 , $278.40 , $277.59 , $246.50 , $139.16 , $113.37 , N/A , $150.19 , $150.19 , $275.50 , $166.47 , $25.87 , $301.93 
 VITAMIN B-12 1000 MCG PO TABS ,HCPCS RXC637,0250 - PHARMACY,77333-0938-10,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Blood Fungus Culture,CPT® 87103,N/A,N/A,N/A, $118.00 , $76.70 , N/A , $20.87 , $12.52 , $51.01 , $61.06 , $109.74 , $106.20 , $106.20 , $94.40 , $94.40 , $12.52 , $108.95 , $112.10 , $106.20 , $106.20 , $106.20 , $109.74 , $113.28 , $136.62 , $100.30 , $58.39 , $60.09 , N/A , $47.61 , $47.61 , $112.10 , $52.02 , $12.52 , $136.62 
Int Hrhc by Ligation 2+ Hroid W/O Img Gdn,CPT® 46946,N/A,N/A,N/A," $2,064.00 "," $1,341.60 "," $2,378.81 ", $367.27 , $268.05 ," $1,077.97 "," $1,110.04 "," $1,919.52 "," $1,857.60 "," $1,857.60 "," $1,651.20 "," $1,651.20 ", $268.05 ," $1,905.69 "," $1,960.80 "," $1,857.60 "," $1,857.60 "," $1,857.60 "," $1,919.52 "," $1,981.44 "," $1,699.57 "," $1,754.40 "," $1,214.95 "," $1,285.54 ", N/A ," $1,099.00 "," $1,099.00 "," $1,960.80 "," $1,149.43 ", $268.05 ," $2,378.81 "
Prochlorperazine Injection,HCPCS J0780,N/A,N/A,N/A, $24.00 , $15.60 , N/A , $3.07 , $3.04 , N/A , N/A , $22.32 , $21.60 , $21.60 , $19.20 , $19.20 , $3.04 , $22.16 , $22.80 , $21.60 , $21.60 , $21.60 , $22.32 , $23.04 , $6.73 , $20.40 , $2.60 , $5.87 , N/A , N/A , N/A , $22.80 , N/A , $2.60 , $23.04 
Thoractomy W/Dx Bx Lung Infiltrate Unilateral,CPT® 32096,N/A,N/A,N/A," $6,455.00 "," $4,195.75 "," $4,152.19 ", $726.17 , $618.85 ," $3,041.00 "," $2,997.14 "," $6,003.15 "," $5,809.50 "," $5,809.50 "," $5,164.00 "," $5,164.00 ", $618.85 ," $5,959.90 "," $6,132.25 "," $5,809.50 "," $5,809.50 "," $5,809.50 "," $6,003.15 "," $6,196.80 "," $4,031.66 "," $5,486.75 "," $4,329.92 "," $3,993.40 ", N/A ," $3,100.33 "," $3,100.33 "," $6,132.25 "," $3,651.29 ", $618.85 ," $6,196.80 "
Open Rx Ulnar Styloid Fx,CPT® 25652,N/A,N/A,N/A," $4,143.00 "," $2,692.95 "," $3,814.79 ", $599.48 , $442.86 ," $3,000.99 "," $2,990.79 "," $3,852.99 "," $3,728.70 "," $3,728.70 "," $3,314.40 "," $3,314.40 ", $442.86 ," $3,825.23 "," $3,935.85 "," $3,728.70 "," $3,728.70 "," $3,728.70 "," $3,852.99 "," $3,977.28 "," $3,539.64 "," $3,521.55 "," $3,291.60 "," $3,549.30 ", N/A ," $3,059.54 "," $3,059.54 "," $3,935.85 "," $3,596.05 ", $442.86 ," $3,977.28 "
 Fac Assay of Vitamin D ,CPT® 82306,0301 - LAB/CHEMISTRY,N/A,N/A, $266.00 , $172.90 , $223.44 , $30.19 , $30.19 , $214.93 , $239.40 , $225.20 , $239.40 , $239.40 , $239.40 , $226.10 , $29.60 , $245.60 , $252.70 , $226.10 , $247.38 , $247.38 , $252.70 , $255.36 , $217.64 , $239.40 , $226.10 , $210.14 , N/A , $215.27 , $215.27 , $252.70 , $228.25 , $29.60 , $255.36 
 Fac Cerebrospinal Fluid Scan ,CPT® 78630,0340 - NUCLEAR MEDICINE,N/A,N/A," $3,298.00 "," $2,143.70 "," $2,770.32 ", $308.08 , $233.49 ," $2,664.78 "," $2,968.20 "," $2,792.09 "," $2,968.20 "," $2,968.20 "," $2,968.20 "," $2,803.30 ", $228.91 ," $3,045.04 "," $3,133.10 "," $2,803.30 "," $3,067.14 "," $3,067.14 "," $3,133.10 "," $3,166.08 "," $2,698.42 "," $2,968.20 "," $2,803.30 "," $2,605.42 ", N/A ," $2,669.07 "," $2,669.07 "," $3,133.10 "," $2,830.01 ", $228.91 ," $3,166.08 "
"Blood Serology, Quantitative",CPT® 86593,N/A,N/A,N/A, $55.00 , $35.75 , N/A , $4.49 , $4.49 , $24.90 , $29.79 , $51.15 , $49.50 , $49.50 , $44.00 , $44.00 , $4.49 , $50.78 , $52.25 , $49.50 , $49.50 , $49.50 , $51.15 , $52.80 , $29.38 , $46.75 , $29.19 , $15.98 , N/A , $23.24 , $23.24 , $52.25 , $25.40 , $4.49 , $52.80 
 Fac Spectrophotometry ,CPT® 84311,0301 - LAB/CHEMISTRY,N/A,N/A, $199.00 , $129.35 , $167.16 , $8.26 , $8.26 , $160.79 , $179.10 , $168.47 , $179.10 , $179.10 , $179.10 , $169.15 , $8.10 , $183.74 , $189.05 , $169.15 , $185.07 , $185.07 , $189.05 , $191.04 , $162.82 , $179.10 , $169.15 , $157.21 , N/A , $161.05 , $161.05 , $189.05 , $170.76 , $8.10 , $191.04 
 Fac Sulfate Urine ,CPT® 84392,0301 - LAB/CHEMISTRY,N/A,N/A, $46.00 , $29.90 , $38.64 , $5.60 , $5.60 , $37.17 , $41.40 , $38.94 , $41.40 , $41.40 , $41.40 , $39.10 , $5.49 , $42.47 , $43.70 , $39.10 , $42.78 , $42.78 , $43.70 , $44.16 , $37.64 , $41.40 , $39.10 , $36.34 , N/A , $37.23 , $37.23 , $43.70 , $39.47 , $5.49 , $44.16 
 Pro Exc Mal Les W/Mrgn S/N/H/F/G 0.6-1.0 Cm ,CPT® 11621,0975 - PRO FEE/OR,N/A,N/A, $967.00 , $628.55 , $478.45 , $143.68 , $205.43 , $408.92 , $401.24 , $899.31 , $870.30 , $870.30 , $773.60 , $773.60 , $205.43 , $892.83 , $918.65 , $870.30 , $870.30 , $870.30 , $899.31 , $928.32 , $522.79 , $821.95 , $797.48 , $525.32 , N/A , $416.89 , $416.89 , $918.65 , $483.46 , $143.68 , $928.32 
 Fac Assay of Progesterone ,CPT® 83498,0301 - LAB/CHEMISTRY,N/A,N/A, $250.00 , $162.50 , $210.00 , $27.71 , $27.71 , $202.00 , $225.00 , $211.65 , $225.00 , $225.00 , $225.00 , $212.50 , $27.17 , $230.83 , $237.50 , $212.50 , $232.50 , $232.50 , $237.50 , $240.00 , $204.55 , $225.00 , $212.50 , $197.50 , N/A , $202.33 , $202.33 , $237.50 , $214.53 , $27.17 , $240.00 
 DORNASE ALFA 2.5 MG/2.5ML INH SOLN ,HCPCS J7639,0636 - DRUGS REQUIRING DETAILED CODIN,50242-0100-40,3 mL, $932.75 , $606.29 , $783.51 , $53.27 , $51.12 , $753.66 , $839.48 , $789.67 , $839.48 , $839.48 , $839.48 , $792.84 , $50.12 , $861.21 , $886.11 , $792.84 , $867.46 , $867.46 , $886.11 , $895.44 , $763.18 , $839.48 , $792.84 , $736.87 , N/A , $754.87 , $754.87 , $886.11 , $800.39 , $50.12 , $895.44 
" Fac Assay of Protein, Serum ",CPT® 84155,0301 - LAB/CHEMISTRY,N/A,N/A, $92.00 , $59.80 , $77.28 , $3.74 , $3.74 , $74.34 , $82.80 , $77.89 , $82.80 , $82.80 , $82.80 , $78.20 , $3.67 , $84.94 , $87.40 , $78.20 , $85.56 , $85.56 , $87.40 , $88.32 , $75.27 , $82.80 , $78.20 , $72.68 , N/A , $74.46 , $74.46 , $87.40 , $78.95 , $3.67 , $88.32 
Injection Into Skin Lesions,11900,N/A,N/A,N/A, $234.00 , $152.10 , $95.06 , $28.80 , $24.16 , $85.56 , $82.69 , $217.62 , $210.60 , $210.60 , $187.20 , $187.20 , $24.16 , $216.05 , $222.30 , $210.60 , $210.60 , $210.60 , $217.62 , $224.64 , $106.07 , $198.90 , $165.92 , $109.74 , N/A , $87.22 , $87.22 , $222.30 , $101.15 , $24.16 , $224.64 
Convert Gastrostomy-Gastro-Jejunostomy Tube Perq,CPT® 49446,N/A,N/A,N/A," $5,464.00 "," $3,551.60 ", $899.80 , $139.02 , $843.35 , $796.88 , $792.43 ," $5,081.52 "," $4,917.60 "," $4,917.60 "," $4,371.20 "," $4,371.20 ", $843.35 ," $5,044.91 "," $5,190.80 "," $4,917.60 "," $4,917.60 "," $4,917.60 "," $5,081.52 "," $5,245.44 ", $651.12 ," $4,644.40 ", $852.78 , $868.92 , N/A , $812.43 , $812.43 ," $5,190.80 ", $849.72 , $139.02 ," $5,245.44 "
 FAT EMULSION PLANT BASED (SOY) 20 % IV EMUL ,HCPCS RXA258,0258 - IV SOLUTIONS,00338-0519-09,250 mL, $290.24 , $188.66 , $243.80 , N/A , N/A , $234.51 , $261.22 , $245.72 , $261.22 , $261.22 , $261.22 , $246.70 , N/A , $267.98 , $275.73 , $246.70 , $269.92 , $269.92 , $275.73 , $278.63 , $237.47 , $261.22 , $246.70 , $229.29 , N/A , $234.89 , $234.89 , $275.73 , $249.05 , $229.29 , $278.63 
Surgical Path Level 5,CPT® 88307,N/A,N/A,N/A, $699.00 , $454.35 ," $1,018.35 ", $284.70 , $115.67 ," $1,214.71 "," $1,358.34 ", $650.07 , $629.10 , $629.10 , $559.20 , $559.20 , $115.67 , $645.39 , $664.05 , $629.10 , $629.10 , $629.10 , $650.07 , $671.04 ," $1,835.50 ", $594.15 ," $1,417.49 ", $918.74 , N/A ," $1,133.64 "," $1,133.64 ", $664.05 ," $1,245.82 ", $115.67 ," $1,835.50 "
 Pro Repair of Achilles Tendon ,CPT® 27654,0982 - PRO FEE/OUTPT,N/A,N/A," $7,038.00 "," $4,574.70 "," $4,386.53 ", $688.37 , $845.22 ," $3,446.06 "," $3,425.52 "," $6,545.34 "," $6,334.20 "," $6,334.20 "," $5,630.40 "," $5,630.40 ", $845.22 ," $6,498.19 "," $6,686.10 "," $6,334.20 "," $6,334.20 "," $6,334.20 "," $6,545.34 "," $6,756.48 "," $4,068.90 "," $5,982.30 "," $3,746.53 "," $4,089.54 ", N/A ," $3,513.30 "," $3,513.30 "," $6,686.10 "," $4,129.36 ", $688.37 ," $6,756.48 "
Cytopatholgy-Concentr Tec,CPT® 88108,N/A,N/A,N/A, $363.00 , $235.95 , $229.59 , $65.00 , $38.28 , $335.18 , $360.23 , $337.59 , $326.70 , $326.70 , $290.40 , $290.40 , $38.28 , $335.16 , $344.85 , $326.70 , $326.70 , $326.70 , $337.59 , $348.48 , $404.57 , $308.55 , $376.27 , $211.83 , N/A , $312.81 , $312.81 , $344.85 , $343.77 , $38.28 , $404.57 
" Pro Debride Skin/Muscle, Fx ",CPT® 11011,0982 - PRO FEE/OUTPT,N/A,N/A," $3,260.00 "," $2,119.00 ", $929.12 , $276.29 , $407.24 , $805.58 , $781.43 ," $3,031.80 "," $2,934.00 "," $2,934.00 "," $2,608.00 "," $2,608.00 ", $407.24 ," $3,009.96 "," $3,097.00 "," $2,934.00 "," $2,934.00 "," $2,934.00 "," $3,031.80 "," $3,129.60 "," $1,025.13 "," $2,771.00 "," $1,577.11 "," $1,035.45 ", N/A , $821.30 , $821.30 ," $3,097.00 ", $952.43 , $276.29 ," $3,129.60 "
 Fracture Distal Radius Closed /W Manip - Mh ,CPT® 25605,0761 - TREATMENT ROOM,N/A,N/A," $4,581.00 "," $2,977.65 "," $3,848.04 ", $496.56 , $388.30 ," $3,701.45 "," $4,122.90 "," $3,878.27 "," $4,122.90 "," $4,122.90 "," $4,122.90 "," $3,893.85 ", $380.69 ," $4,229.64 "," $4,351.95 "," $3,893.85 "," $4,260.33 "," $4,260.33 "," $4,351.95 "," $4,397.76 "," $3,748.17 "," $4,122.90 "," $3,893.85 "," $3,618.99 ", N/A ," $3,707.40 "," $3,707.40 "," $4,351.95 "," $3,930.96 ", $380.69 ," $4,397.76 "
Foam Drsg <=16 Sq in W/O Bdr,HCPCS A6209,N/A,N/A,N/A, $23.00 , $14.95 , N/A , $10.14 , $5.49 , N/A , N/A , $21.39 , $20.70 , $20.70 , $18.40 , $18.40 , $5.49 , $21.24 , $21.85 , $20.70 , $20.70 , $20.70 , $21.39 , $22.08 , N/A , $19.55 , $9.08 , $9.21 , N/A , N/A , N/A , $21.85 , N/A , $5.49 , $22.08 
 Fac Office/Outpatient Est Pt May Not Req Phys/Qhp ,CPT® 99211,0510 - CLINIC,N/A,N/A, $142.00 , $92.30 , $119.28 , $8.63 , $16.58 , $114.74 , $127.80 , N/A , $127.80 , $127.80 , $127.80 , $120.70 , $16.25 , $131.11 , $134.90 , $120.70 , $132.06 , $132.06 , $134.90 , $136.32 , $116.18 , $127.80 , $120.70 , $112.18 , N/A , $114.92 , $114.92 , $134.90 , $121.85 , $8.63 , $136.32 
 Fac Assay of Tyrosine ,CPT® 84510,0301 - LAB/CHEMISTRY,N/A,N/A, $95.00 , $61.75 , $79.80 , $10.84 , $10.84 , $76.76 , $85.50 , $80.43 , $85.50 , $85.50 , $85.50 , $80.75 , $10.63 , $87.71 , $90.25 , $80.75 , $88.35 , $88.35 , $90.25 , $91.20 , $77.73 , $85.50 , $80.75 , $75.05 , N/A , $76.88 , $76.88 , $90.25 , $81.52 , $10.63 , $91.20 
Adm tixagevimab & cilgavimab,HCPCS M0220,N/A,N/A,N/A," $1,335.00 ", $867.75 , N/A , N/A , $153.51 , N/A , N/A ," $1,241.55 "," $1,201.50 "," $1,201.50 "," $1,068.00 "," $1,068.00 ", $153.51 ," $1,232.61 "," $1,268.25 "," $1,201.50 "," $1,201.50 "," $1,201.50 "," $1,241.55 "," $1,281.60 ", N/A ," $1,134.75 ", $286.90 , $572.98 , N/A , N/A , N/A ," $1,268.25 ", N/A , $153.51 ," $1,281.60 "
 Pro Drain Thigh/Knee Lesion ,CPT® 27301,0982 - PRO FEE/OUTPT,N/A,N/A," $4,454.00 "," $2,895.10 "," $3,080.29 ", $483.56 , $200.19 ," $2,384.48 "," $2,411.83 "," $4,142.22 "," $4,008.60 "," $4,008.60 "," $3,563.20 "," $3,563.20 ", $200.19 ," $4,112.38 "," $4,231.30 "," $4,008.60 "," $4,008.60 "," $4,008.60 "," $4,142.22 "," $4,275.84 "," $2,854.91 "," $3,785.90 "," $2,665.39 "," $2,851.17 ", N/A ," $2,431.01 "," $2,431.01 "," $4,231.30 "," $2,857.29 ", $200.19 ," $4,275.84 "
 Pro Cystouretero W/Stone Remove ,CPT® 52352,0982 - PRO FEE/OUTPT,N/A,N/A," $3,336.00 "," $2,168.40 "," $1,897.67 ", $333.29 , $375.30 ," $1,738.68 "," $2,378.40 "," $3,102.48 "," $3,002.40 "," $3,002.40 "," $2,668.80 "," $2,668.80 ", $375.30 ," $3,080.13 "," $3,169.20 "," $3,002.40 "," $3,002.40 "," $3,002.40 "," $3,102.48 "," $3,202.56 "," $1,908.24 "," $2,835.60 "," $1,869.70 "," $2,182.87 ", N/A ," $1,772.61 "," $1,772.61 "," $3,169.20 "," $2,083.44 ", $333.29 ," $3,202.56 "
"Lap, Surg Enterolysis",CPT® 44180,N/A,N/A,N/A," $6,009.00 "," $3,905.85 "," $5,476.71 ", $847.84 , $725.16 ," $4,320.07 "," $4,362.88 "," $5,588.37 "," $5,408.10 "," $5,408.10 "," $4,807.20 "," $4,807.20 ", $725.16 ," $5,548.11 "," $5,708.55 "," $5,408.10 "," $5,408.10 "," $5,408.10 "," $5,588.37 "," $5,768.64 "," $3,924.21 "," $5,107.65 "," $4,850.87 "," $5,104.87 ", N/A ," $4,404.36 "," $4,404.36 "," $5,708.55 "," $4,606.48 ", $725.16 ," $5,768.64 "
 Fac Duplex Scan Artl Infl&Ven O/F Hemo Compl Uni Std ,CPT® 93986,0921 - PERI VASCUL LAB,N/A,N/A," $1,936.00 "," $1,258.40 "," $1,626.24 ", $125.63 , $120.92 ," $1,564.29 "," $1,742.40 "," $1,639.02 "," $1,742.40 "," $1,742.40 "," $1,742.40 "," $1,645.60 ", $118.55 ," $1,787.51 "," $1,839.20 "," $1,645.60 "," $1,800.48 "," $1,800.48 "," $1,839.20 "," $1,858.56 "," $1,584.04 "," $1,742.40 "," $1,645.60 "," $1,529.44 ", N/A ," $1,566.80 "," $1,566.80 "," $1,839.20 "," $1,661.28 ", $118.55 ," $1,858.56 "
"Consult-Referred Slides,P",CPT® 88321,N/A,N/A,N/A, $670.00 , $435.50 , $297.78 , $81.51 , $77.65 , $347.23 , $382.69 , $623.10 , $603.00 , $603.00 , $536.00 , $536.00 , $77.65 , $618.61 , $636.50 , $603.00 , $603.00 , $603.00 , $623.10 , $643.20 , $541.79 , $569.50 , $397.35 , $301.50 , N/A , $324.06 , $324.06 , $636.50 , $356.13 , $77.65 , $643.20 
 Fac Assay of Biotinidase ,CPT® 82261,0301 - LAB/CHEMISTRY,N/A,N/A, $133.00 , $86.45 , $111.72 , $17.21 , $17.21 , $107.46 , $119.70 , $112.60 , $119.70 , $119.70 , $119.70 , $113.05 , $16.87 , $122.80 , $126.35 , $113.05 , $123.69 , $123.69 , $126.35 , $127.68 , $108.82 , $119.70 , $113.05 , $105.07 , N/A , $107.64 , $107.64 , $126.35 , $114.13 , $16.87 , $127.68 
Venogram Extrem Unilat,CPT® 75820,N/A,N/A,N/A," $1,370.00 ", $890.50 , $623.21 , $107.21 , $77.42 , $550.08 , $665.50 ," $1,274.10 "," $1,233.00 "," $1,233.00 "," $1,096.00 "," $1,096.00 ", $77.42 ," $1,264.92 "," $1,301.50 "," $1,233.00 "," $1,233.00 "," $1,233.00 "," $1,274.10 "," $1,315.20 ", $649.08 ," $1,164.50 ", $728.04 , $583.15 , N/A , $560.81 , $560.81 ," $1,301.50 ", $649.16 , $77.42 ," $1,315.20 "
Beta-2 Protein,CPT® 82232,N/A,N/A,N/A, $225.00 , $146.25 , N/A , $16.50 , $16.50 , $91.55 , $109.50 , $209.25 , $202.50 , $202.50 , $180.00 , $180.00 , $16.50 , $207.74 , $213.75 , $202.50 , $202.50 , $202.50 , $209.25 , $216.00 , $108.04 , $191.25 , $105.42 , $58.65 , N/A , $85.44 , $85.44 , $213.75 , $93.36 , $16.50 , $216.00 
 MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN ,HCPCS J2274,0636 - DRUGS REQUIRING DETAILED CODIN,00409-3815-12,10 mL, $102.12 , $66.38 , $85.78 , $16.01 , $17.04 , $82.51 , $91.91 , $86.45 , $91.91 , $91.91 , $91.91 , $86.80 , $16.71 , $94.29 , $97.01 , $86.80 , $94.97 , $94.97 , $97.01 , $98.04 , $83.55 , $91.91 , $86.80 , $80.67 , N/A , $82.65 , $82.65 , $97.01 , $87.63 , $16.01 , $98.04 
Cast Sup Lng Arm Splint Fbrg,HCPCS Q4018,N/A,N/A,N/A, $132.00 , $85.80 , N/A , $17.60 , $10.74 , N/A , N/A , $122.76 , $118.80 , $118.80 , $105.60 , $105.60 , $10.74 , $121.88 , $125.40 , $118.80 , $118.80 , $118.80 , $122.76 , $126.72 , N/A , $112.20 , $72.66 , $15.99 , N/A , N/A , N/A , $125.40 , N/A , $10.74 , $126.72 
" Fac Hiv-1, Dna, Quant ",CPT® 87536,0306 - LAB/BACT-MICRO,N/A,N/A, $785.00 , $510.25 , $659.40 , $86.80 , $86.80 , $634.28 , $706.50 , $664.58 , $706.50 , $706.50 , $706.50 , $667.25 , $85.10 , $724.79 , $745.75 , $667.25 , $730.05 , $730.05 , $745.75 , $753.60 , $642.29 , $706.50 , $667.25 , $620.15 , N/A , $635.30 , $635.30 , $745.75 , $673.61 , $85.10 , $753.60 
Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/Img Gdn,CPT® 62321,N/A,N/A,N/A, $887.00 , $576.55 , $529.36 , $102.63 , $196.67 , $591.06 , $573.29 , $824.91 , $798.30 , $798.30 , $709.60 , $709.60 , $196.67 , $818.97 , $842.65 , $798.30 , $798.30 , $798.30 , $824.91 , $851.52 , $575.81 , $753.95 , $559.74 , $650.84 , N/A , $602.59 , $602.59 , $842.65 , $646.43 , $102.63 , $851.52 
 HYDROMORPHONE HCL PF 50 MG/5ML IJ SOLN ,HCPCS J1170,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0851-15,1.2 mL, $45.01 , $29.26 , $37.81 , $4.44 , $4.30 , $36.37 , $40.51 , $38.11 , $40.51 , $40.51 , $40.51 , $38.26 , $4.22 , $41.56 , $42.76 , $38.26 , $41.86 , $41.86 , $42.76 , $43.21 , $36.83 , $40.51 , $38.26 , $35.56 , N/A , $36.43 , $36.43 , $42.76 , $38.62 , $4.22 , $43.21 
 TRAZODONE HCL 150 MG PO TABS ,HCPCS RXA250,0250 - PHARMACY,60687-0432-01,1 tablet, $7.55 , $4.91 , $6.34 , N/A , N/A , $6.10 , $6.80 , $6.39 , $6.80 , $6.80 , $6.80 , $6.42 , N/A , $6.97 , $7.17 , $6.42 , $7.02 , $7.02 , $7.17 , $7.25 , $6.18 , $6.80 , $6.42 , $5.96 , N/A , $6.11 , $6.11 , $7.17 , $6.48 , $5.96 , $7.25 
" Fac Hep B Core Antibody, Igm ",CPT® 86705,0302 - LAB/IMMUNOLOGY,N/A,N/A, $152.00 , $98.80 , $127.68 , $12.01 , $12.01 , $122.82 , $136.80 , $128.68 , $136.80 , $136.80 , $136.80 , $129.20 , $11.77 , $140.34 , $144.40 , $129.20 , $141.36 , $141.36 , $144.40 , $145.92 , $124.37 , $136.80 , $129.20 , $120.08 , N/A , $123.01 , $123.01 , $144.40 , $130.43 , $11.77 , $145.92 
 INFLIXIMAB-ABDA 100 MG IV SOLR ,HCPCS Q5104,0636 - DRUGS REQUIRING DETAILED CODIN,00006-4305-02,10 mL," $2,215.21 "," $1,439.89 "," $1,860.78 ", $36.26 , $46.38 ," $1,789.89 "," $1,993.69 "," $1,875.40 "," $1,993.69 "," $1,993.69 "," $1,993.69 "," $1,882.93 ", $45.47 ," $2,045.30 "," $2,104.45 "," $1,882.93 "," $2,060.15 "," $2,060.15 "," $2,104.45 "," $2,126.60 "," $1,812.48 "," $1,993.69 "," $1,882.93 "," $1,750.02 ", N/A ," $1,792.77 "," $1,792.77 "," $2,104.45 "," $1,900.87 ", $36.26 ," $2,126.60 "
Injection Aa&/Strd Trigeminal Nerve Each Branch,64400,N/A,N/A,N/A, $804.00 , $522.60 , $237.17 , $46.38 , $95.27 , $389.08 , $370.43 , $747.72 , $723.60 , $723.60 , $643.20 , $643.20 , $95.27 , $742.33 , $763.80 , $723.60 , $723.60 , $723.60 , $747.72 , $771.84 , $254.96 , $683.40 , $367.52 , $417.54 , N/A , $396.67 , $396.67 , $763.80 , $425.54 , $46.38 , $771.84 
 Pro MRI Brn Brn Stem C+ Matrl ,CPT® 70552,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,033.00 ", $671.45 ," $1,942.85 ", $277.80 , $506.39 ," $1,522.96 "," $2,537.94 ", $960.69 , $929.70 , $929.70 , $826.40 , $826.40 , $506.39 , $953.77 , $981.35 , $929.70 , $929.70 , $929.70 , $960.69 , $991.68 ," $1,663.93 ", $878.05 ," $2,763.87 "," $2,959.63 ", N/A ," $1,552.67 "," $1,552.67 ", $981.35 ," $1,797.26 ", $277.80 ," $2,959.63 "
"Full Thick Grft Scalp,Arm Add 20sqcm",CPT® 15221,N/A,N/A,N/A, $730.00 , $474.50 , $217.91 , $64.65 , $217.18 , $194.63 , $187.83 , $678.90 , $657.00 , $657.00 , $584.00 , $584.00 , $217.18 , $674.01 , $693.50 , $657.00 , $657.00 , $657.00 , $678.90 , $700.80 , $240.74 , $620.50 , $378.22 , $247.25 , N/A , $198.42 , $198.42 , $693.50 , $230.11 , $64.65 , $700.80 
" Pro Drainage of Finger Abscess, Simple ",CPT® 26010,0982 - PRO FEE/OUTPT,N/A,N/A, $817.00 , $531.05 , $867.23 , $136.36 , $30.71 , $664.95 , $677.89 , $759.81 , $735.30 , $735.30 , $653.60 , $653.60 , $30.71 , $754.34 , $776.15 , $735.30 , $735.30 , $735.30 , $759.81 , $784.32 , $800.12 , $694.45 , $742.17 , $793.35 , N/A , $677.92 , $677.92 , $776.15 , $796.82 , $30.71 , $867.23 
 BISACODYL 10 MG RE SUPP ,HCPCS RXC637,0250 - PHARMACY,00574-7050-12,1 suppository, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Collection Venous Blood,Venipuncture",CPT® 36415,N/A,N/A,N/A, $35.00 , $22.75 , $10.00 , $8.74 , N/A , $11.08 , $12.63 , $32.55 , $31.50 , $31.50 , $28.00 , $28.00 , N/A , $32.32 , $33.25 , $31.50 , $31.50 , $31.50 , $32.55 , $33.60 , $20.88 , $29.75 , $16.06 , $8.81 , N/A , $11.29 , $11.29 , $33.25 , $14.77 , $8.74 , $33.60 
"Remv Vert Body,Cerv,Each Addnl Sgmt",CPT® 63082,N/A,N/A,N/A," $2,234.00 "," $1,452.10 "," $1,215.97 ", $236.72 , $618.57 ," $1,450.38 "," $1,383.15 "," $2,077.62 "," $2,010.60 "," $2,010.60 "," $1,787.20 "," $1,787.20 ", $618.57 ," $2,062.65 "," $2,122.30 "," $2,010.60 "," $2,010.60 "," $2,010.60 "," $2,077.62 "," $2,144.64 "," $1,321.73 "," $1,898.90 "," $1,412.98 "," $1,514.03 ", N/A ," $1,478.68 "," $1,478.68 "," $2,122.30 "," $1,586.27 ", $236.72 ," $2,144.64 "
"Virus Identify,Inoc & Obs",CPT® 87252,N/A,N/A,N/A, $241.00 , $156.65 , N/A , $26.59 , $26.59 , $147.50 , $176.41 , $224.13 , $216.90 , $216.90 , $192.80 , $192.80 , $26.59 , $222.52 , $228.95 , $216.90 , $216.90 , $216.90 , $224.13 , $231.36 , $174.08 , $204.85 , $170.29 , $94.51 , N/A , $137.66 , $137.66 , $228.95 , $150.44 , $26.59 , $231.36 
 Fac Iaad Ia Not Otherwise Specified Each Organism ,CPT® 87449,0306 - LAB/BACT-MICRO,N/A,N/A, $169.00 , $109.85 , $141.96 , $12.22 , $12.22 , $136.55 , $152.10 , $143.08 , $152.10 , $152.10 , $152.10 , $143.65 , $11.98 , $156.04 , $160.55 , $143.65 , $157.17 , $157.17 , $160.55 , $162.24 , $138.28 , $152.10 , $143.65 , $133.51 , N/A , $136.77 , $136.77 , $160.55 , $145.02 , $11.98 , $162.24 
 Gft Sft Tiss 3sqcm Disk 18mm ,HCPCS Q4137,0636 - DRUGS REQUIRING DETAILED CODIN,N/A,N/A, $865.00 , $562.25 , $726.60 , $106.44 , N/A , $698.92 , $778.50 , $732.31 , $778.50 , $778.50 , $778.50 , $735.25 , N/A , $798.65 , $821.75 , $735.25 , $804.45 , $804.45 , $821.75 , $830.40 , $707.74 , $778.50 , $735.25 , $683.35 , N/A , $700.04 , $700.04 , $821.75 , $742.26 , $106.44 , $830.40 
"Fetal Fibronectin, Semi-Quant",CPT® 82731,N/A,N/A,N/A, $594.00 , $386.10 , N/A , $65.70 , $65.70 , $364.40 , $435.92 , $552.42 , $534.60 , $534.60 , $475.20 , $475.20 , $65.70 , $548.44 , $564.30 , $534.60 , $534.60 , $534.60 , $552.42 , $570.24 , $430.08 , $504.90 , $421.68 , $233.55 , N/A , $340.08 , $340.08 , $564.30 , $371.64 , $65.70 , $570.24 
 DEGARELIX ACETATE 80 MG SC SOLR ,HCPCS J9155,0636 - DRUGS REQUIRING DETAILED CODIN,55566-8303-01,4 mL," $3,010.93 "," $1,957.10 "," $2,529.18 ", $4.27 , $4.20 ," $2,432.83 "," $2,709.84 "," $2,549.05 "," $2,709.84 "," $2,709.84 "," $2,709.84 "," $2,559.29 ", $4.12 ," $2,779.99 "," $2,860.38 "," $2,559.29 "," $2,800.16 "," $2,800.16 "," $2,860.38 "," $2,890.49 "," $2,463.54 "," $2,709.84 "," $2,559.29 "," $2,378.63 ", N/A ," $2,436.75 "," $2,436.75 "," $2,860.38 "," $2,583.68 ", $4.12 ," $2,890.49 "
 Fac Amb 911 Base Rate Bls Non-Emergent ,HCPCS A0428,0540 - AMBULANCE,N/A,N/A, $887.00 , $576.55 , $745.08 , N/A , $215.30 , $716.70 , $798.30 , $750.93 , $798.30 , $798.30 , $798.30 , $753.95 , $211.08 , $818.97 , $842.65 , $753.95 , $824.91 , $824.91 , $842.65 , $851.52 , $725.74 , $798.30 , $753.95 , $700.73 , N/A , $717.85 , $717.85 , $842.65 , $761.13 , $211.08 , $851.52 
 Pro Anes Njx Spenopalatine Ganglion ,CPT® 64505,0964 - PRO FEE/ANES CRNA,N/A,N/A," $1,442.00 ", $937.30 , $493.38 , $96.56 , $76.84 , $484.32 , $470.40 ," $1,341.06 "," $1,297.80 "," $1,297.80 "," $1,153.60 "," $1,153.60 ", $76.84 ," $1,331.40 "," $1,369.90 "," $1,297.80 "," $1,297.80 "," $1,297.80 "," $1,341.06 "," $1,384.32 ", $520.28 ," $1,225.70 ", $456.72 , $535.18 , N/A , $493.77 , $493.77 ," $1,369.90 ", $529.70 , $76.84 ," $1,384.32 "
 Pro Treat Metacarpal Fracture ,CPT® 26605,0975 - PRO FEE/OR,N/A,N/A," $2,114.00 "," $1,374.10 "," $1,855.17 ", $293.60 , $235.17 ," $1,410.06 "," $1,432.50 "," $1,966.02 "," $1,902.60 "," $1,902.60 "," $1,691.20 "," $1,691.20 ", $235.17 ," $1,951.86 "," $2,008.30 "," $1,902.60 "," $1,902.60 "," $1,902.60 "," $1,966.02 "," $2,029.44 "," $1,703.17 "," $1,796.90 "," $1,571.76 "," $1,675.41 ", N/A ," $1,437.57 "," $1,437.57 "," $2,008.30 "," $1,689.69 ", $235.17 ," $2,029.44 "
" Pro Laparoscopy, Remove Adnexa ",CPT® 58661,0982 - PRO FEE/OUTPT,N/A,N/A," $4,820.00 "," $3,133.00 "," $3,064.85 ", $620.13 , $493.32 ," $2,634.66 "," $2,605.51 "," $4,482.60 "," $4,338.00 "," $4,338.00 "," $3,856.00 "," $3,856.00 ", $493.32 ," $4,450.31 "," $4,579.00 "," $4,338.00 "," $4,338.00 "," $4,338.00 "," $4,482.60 "," $4,627.20 "," $3,205.11 "," $4,097.00 "," $3,430.76 "," $2,642.78 ", N/A ," $2,686.07 "," $2,686.07 "," $4,579.00 "," $3,221.77 ", $493.32 ," $4,627.20 "
Escharotomy,CPT® 16035,N/A,N/A,N/A, $986.00 , $640.90 , $609.18 , $183.73 , $53.35 , $532.41 , $521.12 , $916.98 , $887.40 , $887.40 , $788.80 , $788.80 , $53.35 , $910.37 , $936.70 , $887.40 , $887.40 , $887.40 , $916.98 , $946.56 , $673.12 , $838.10 ," $1,047.25 ", $681.87 , N/A , $542.80 , $542.80 , $936.70 , $629.45 , $53.35 ," $1,047.25 "
 Fac Assay of Lithium ,CPT® 80178,0301 - LAB/CHEMISTRY,N/A,N/A, $80.00 , $52.00 , $67.20 , $6.74 , $6.74 , $64.64 , $72.00 , $67.73 , $72.00 , $72.00 , $72.00 , $68.00 , $6.61 , $73.86 , $76.00 , $68.00 , $74.40 , $74.40 , $76.00 , $76.80 , $65.46 , $72.00 , $68.00 , $63.20 , N/A , $64.74 , $64.74 , $76.00 , $68.65 , $6.61 , $76.80 
"Lap,Inguinal Hernia Repr,Recur",CPT® 49651,N/A,N/A,N/A," $3,627.00 "," $2,357.55 "," $3,390.21 ", $526.32 , $526.20 ," $2,612.42 "," $2,664.23 "," $3,373.11 "," $3,264.30 "," $3,264.30 "," $2,901.60 "," $2,901.60 ", $526.20 ," $3,348.81 "," $3,445.65 "," $3,264.30 "," $3,264.30 "," $3,264.30 "," $3,373.11 "," $3,481.92 "," $2,415.05 "," $3,082.95 "," $2,957.98 "," $3,089.28 ", N/A ," $2,663.40 "," $2,663.40 "," $3,445.65 "," $2,785.65 ", $526.20 ," $3,481.92 "
 CT Limited/Localized F/U Study ,CPT® 76380,0350 - CT SCAN,N/A,N/A," $1,870.00 "," $1,215.50 "," $1,570.80 ", $128.55 , $157.47 ," $1,510.96 "," $1,683.00 "," $1,583.14 "," $1,683.00 "," $1,683.00 "," $1,683.00 "," $1,589.50 ", $154.38 ," $1,726.57 "," $1,776.50 "," $1,589.50 "," $1,739.10 "," $1,739.10 "," $1,776.50 "," $1,795.20 "," $1,530.03 "," $1,683.00 "," $1,589.50 "," $1,477.30 ", N/A ," $1,513.39 "," $1,513.39 "," $1,776.50 "," $1,604.65 ", $128.55 ," $1,795.20 "
 Fac Egd Transoral Transmural Drainage Pseudocyst ,CPT® 43240,0360 - OR SERVICES,N/A,N/A," $5,099.00 "," $3,314.35 "," $4,283.16 ", $370.64 , $540.53 ," $4,119.99 "," $4,589.10 "," $4,316.81 "," $4,589.10 "," $4,589.10 "," $4,589.10 "," $4,334.15 ", $529.93 ," $4,707.91 "," $4,844.05 "," $4,334.15 "," $4,742.07 "," $4,742.07 "," $4,844.05 "," $4,895.04 "," $4,172.00 "," $4,589.10 "," $4,334.15 "," $4,028.21 ", N/A ," $4,126.62 "," $4,126.62 "," $4,844.05 "," $4,375.45 ", $370.64 ," $4,895.04 "
 HYDROCHLOROTHIAZIDE 12.5 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,50228-0146-01,1 capsule, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Repair Lac Floor of Mouth/Anterior Tongue <=2.5cm -Mh,41250,N/A,N/A,N/A, $910.00 , $591.50 , $929.57 , $146.64 , $61.48 , $746.18 , $778.43 , $846.30 , $819.00 , $819.00 , $728.00 , $728.00 , $61.48 , $840.20 , $864.50 , $819.00 , $819.00 , $819.00 , $846.30 , $873.60 , $673.07 , $773.50 , $852.78 , $890.69 , N/A , $760.74 , $760.74 , $864.50 , $795.64 , $61.48 , $929.57 
"Lap,Lysis of Adhesions",CPT® 58660,N/A,N/A,N/A," $5,027.00 "," $3,267.55 "," $3,185.90 ", $644.06 , $485.88 ," $2,736.67 "," $2,723.29 "," $4,675.11 "," $4,524.30 "," $4,524.30 "," $4,021.60 "," $4,021.60 ", $485.88 ," $4,641.43 "," $4,775.65 "," $4,524.30 "," $4,524.30 "," $4,524.30 "," $4,675.11 "," $4,825.92 "," $3,327.23 "," $4,272.95 "," $3,589.54 "," $2,741.53 ", N/A ," $2,790.06 "," $2,790.06 "," $4,775.65 "," $3,346.52 ", $485.88 ," $4,825.92 "
 Fac Bcr/Abl1 Minor Breakpnt Qualitative/Quantitative ,CPT® 81207,0310 - PATHOLOGY LAB,N/A,N/A," $1,297.00 ", $843.05 ," $1,089.48 ", $147.74 , $147.74 ," $1,047.98 "," $1,167.30 "," $1,098.04 "," $1,167.30 "," $1,167.30 "," $1,167.30 "," $1,102.45 ", $144.84 ," $1,197.52 "," $1,232.15 "," $1,102.45 "," $1,206.21 "," $1,206.21 "," $1,232.15 "," $1,245.12 "," $1,061.21 "," $1,167.30 "," $1,102.45 "," $1,024.63 ", N/A ," $1,049.66 "," $1,049.66 "," $1,232.15 "," $1,112.96 ", $144.84 ," $1,245.12 "
"Enterotomy,Non-Duod,Explor/Bx/FB Removal",CPT® 44020,N/A,N/A,N/A," $6,128.00 "," $3,983.20 "," $5,805.22 ", $897.19 ," $1,383.09 "," $4,578.70 "," $4,618.62 "," $5,699.04 "," $5,515.20 "," $5,515.20 "," $4,902.40 "," $4,902.40 "," $1,383.09 "," $5,657.98 "," $5,821.60 "," $5,515.20 "," $5,515.20 "," $5,515.20 "," $5,699.04 "," $5,882.88 "," $4,156.47 "," $5,208.80 "," $5,138.10 "," $5,391.58 ", N/A ," $4,668.04 "," $4,668.04 "," $5,821.60 "," $4,882.27 ", $897.19 ," $5,882.88 "
Tcat Mitral Valve Repair Initial Prosthesis,CPT® 33418,N/A,N/A,N/A," $23,096.00 "," $15,012.40 "," $10,538.32 "," $1,622.81 "," $1,371.00 "," $7,794.48 "," $8,055.47 "," $21,479.28 "," $20,786.40 "," $20,786.40 "," $18,476.80 "," $18,476.80 "," $1,371.00 "," $21,324.54 "," $21,941.20 "," $20,786.40 "," $20,786.40 "," $20,786.40 "," $21,479.28 "," $22,172.16 "," $9,746.92 "," $19,631.60 "," $9,334.28 "," $8,692.06 ", N/A ," $7,946.56 "," $7,946.56 "," $21,941.20 "," $9,027.29 "," $1,371.00 "," $22,172.16 "
Adenosine Inj 1mg,HCPCS J0153,N/A,N/A,N/A, $13.00 , $8.45 , N/A , $0.55 , $0.53 , N/A , N/A , $12.09 , $11.70 , $11.70 , $10.40 , $10.40 , $0.53 , $12.00 , $12.35 , $11.70 , $11.70 , $11.70 , $12.09 , $12.48 , $0.78 , $11.05 , $1.29 , $0.57 , N/A , N/A , N/A , $12.35 , N/A , $0.53 , $12.48 
Low-Level Laser Trmt 15 Min,HCPCS S8948,N/A,N/A,N/A, $28.00 , $18.20 , N/A , N/A , N/A , N/A , N/A , $26.04 , $25.20 , $25.20 , $22.40 , $22.40 , N/A , $25.85 , $26.60 , $25.20 , $25.20 , $25.20 , $26.04 , $26.88 , N/A , $23.80 , $22.40 , N/A , N/A , N/A , N/A , $26.60 , N/A , $22.40 , $26.88 
 ATOMOXETINE HCL 40 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,68462-0268-30,1 capsule, $79.45 , $51.64 , $66.74 , N/A , N/A , $64.20 , $71.51 , $67.26 , $71.51 , $71.51 , $71.51 , $67.53 , N/A , $73.36 , $75.48 , $67.53 , $73.89 , $73.89 , $75.48 , $76.27 , $65.01 , $71.51 , $67.53 , $62.77 , N/A , $64.30 , $64.30 , $75.48 , $68.18 , $62.77 , $76.27 
Echo Contrast Agent During Stress Echo,CPT® 93352,N/A,N/A,N/A, $786.00 , $510.90 , $209.37 , $33.06 , $32.46 , $182.40 , $194.16 , $730.98 , $707.40 , $707.40 , $628.80 , $628.80 , $32.46 , $725.71 , $746.70 , $707.40 , $707.40 , $707.40 , $730.98 , $754.56 , $204.97 , $668.10 , $181.97 , $201.19 , N/A , $185.96 , $185.96 , $746.70 , $206.13 , $32.46 , $754.56 
 MEMANTINE HCL 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00591-3870-44,1 tablet, $31.36 , $20.38 , $26.34 , N/A , N/A , $25.34 , $28.22 , $26.55 , $28.22 , $28.22 , $28.22 , $26.66 , N/A , $28.95 , $29.79 , $26.66 , $29.16 , $29.16 , $29.79 , $30.11 , $25.66 , $28.22 , $26.66 , $24.77 , N/A , $25.38 , $25.38 , $29.79 , $26.91 , $24.77 , $30.11 
 VANCOMYCIN HCL 1.25 G IV SOLR ,HCPCS J3371,0636 - DRUGS REQUIRING DETAILED CODIN,67457-0823-99,25 mL, $123.91 , $80.54 , $104.08 , $6.43 , $6.66 , $100.12 , $111.52 , $104.90 , $111.52 , $111.52 , $111.52 , $105.32 , $6.53 , $114.41 , $117.71 , $105.32 , $115.24 , $115.24 , $117.71 , $118.95 , $101.38 , $111.52 , $105.32 , $97.89 , N/A , $100.28 , $100.28 , $117.71 , $106.33 , $6.43 , $118.95 
 ANTIHEMOPHILIC FACTOR-VWF 1000-1000 UNITS IV KIT ,HCPCS J7183,0636 - DRUGS REQUIRING DETAILED CODIN,68982-0182-02,3 VWF, $35.00 , $22.75 , $29.40 , $1.29 , $1.29 , $28.28 , $31.50 , $29.63 , $31.50 , $31.50 , $31.50 , $29.75 , $1.26 , $32.32 , $33.25 , $29.75 , $32.55 , $32.55 , $33.25 , $33.60 , $28.64 , $31.50 , $29.75 , $27.65 , N/A , $28.33 , $28.33 , $33.25 , $30.03 , $1.26 , $33.60 
" Bladder Irrigation, Simple - Mh ",CPT® 51700,0761 - TREATMENT ROOM,N/A,N/A, $580.00 , $377.00 , $487.20 , $28.50 , $18.87 , $468.64 , $522.00 , $491.03 , $522.00 , $522.00 , $522.00 , $493.00 , $18.50 , $535.51 , $551.00 , $493.00 , $539.40 , $539.40 , $551.00 , $556.80 , $474.56 , $522.00 , $493.00 , $458.20 , N/A , $469.39 , $469.39 , $551.00 , $497.70 , $18.50 , $556.80 
Assay Zinc,CPT® 84630,N/A,N/A,N/A, $155.00 , $100.75 , N/A , $11.62 , $11.62 , $58.62 , $70.16 , $144.15 , $139.50 , $139.50 , $124.00 , $124.00 , $11.62 , $143.11 , $147.25 , $139.50 , $139.50 , $139.50 , $144.15 , $148.80 , $76.05 , $131.75 , $74.60 , $41.29 , N/A , $54.71 , $54.71 , $147.25 , $59.78 , $11.62 , $148.80 
Removal of Hip Joint Lining,CPT® 27054,N/A,N/A,N/A," $4,399.00 "," $2,859.35 "," $4,189.45 ", $658.36 , $587.93 ," $3,297.65 "," $3,294.55 "," $4,091.07 "," $3,959.10 "," $3,959.10 "," $3,519.20 "," $3,519.20 ", $587.93 ," $4,061.60 "," $4,179.05 "," $3,959.10 "," $3,959.10 "," $3,959.10 "," $4,091.07 "," $4,223.04 "," $3,892.46 "," $3,739.15 "," $3,637.71 "," $3,892.56 ", N/A ," $3,362.00 "," $3,362.00 "," $4,179.05 "," $3,951.53 ", $587.93 ," $4,223.04 "
Removal Tunneled Cv Cath,36589,N/A,N/A,N/A," $1,063.00 ", $690.95 , $835.71 , $129.12 , $231.82 , $600.86 , $603.93 , $988.59 , $956.70 , $956.70 , $850.40 , $850.40 , $231.82 , $981.47 ," $1,009.85 ", $956.70 , $956.70 , $956.70 , $988.59 ," $1,020.48 ", $775.29 , $903.55 , $747.52 , $680.36 , N/A , $612.58 , $612.58 ," $1,009.85 ", $695.91 , $129.12 ," $1,020.48 "
"Knee Scope,Med/Lat Menisectomy",CPT® 29881,N/A,N/A,N/A," $4,242.00 "," $2,757.30 "," $3,302.59 ", $518.48 , $554.63 ," $2,617.29 "," $2,621.37 "," $3,945.06 "," $3,817.80 "," $3,817.80 "," $3,393.60 "," $3,393.60 ", $554.63 ," $3,916.64 "," $4,029.90 "," $3,817.80 "," $3,817.80 "," $3,817.80 "," $3,945.06 "," $4,072.32 "," $3,585.30 "," $3,605.70 "," $2,891.97 "," $3,087.83 ", N/A ," $2,668.36 "," $2,668.36 "," $4,029.90 "," $3,136.28 ", $518.48 ," $4,072.32 "
 Pro Office/Outpatient Established Low Mdm 20-29 Min ,CPT® 99213,0982 - PRO FEE/OUTPT,N/A,N/A, $197.00 , $128.05 , $134.27 , $64.08 , $41.21 , $87.92 , $87.90 , $183.21 , $177.30 , $177.30 , $157.60 , $157.60 , $41.21 , $181.89 , $187.15 , $177.30 , $177.30 , $177.30 , $183.21 , $189.12 , $122.57 , $167.45 , $109.52 , $112.10 , $64.00 , $89.64 , $89.64 , $187.15 , $103.40 , $41.21 , $189.12 
 Fac Bx Breast W Device 1st Lesion Stereotactic Guide ,CPT® 19081,0320 - DX X-RAY,N/A,N/A," $5,424.00 "," $3,525.60 "," $4,556.16 ", $156.49 , $133.59 ," $4,382.59 "," $4,881.60 "," $4,591.96 "," $4,881.60 "," $4,881.60 "," $4,881.60 "," $4,610.40 ", $130.97 ," $5,007.98 "," $5,152.80 "," $4,610.40 "," $5,044.32 "," $5,044.32 "," $5,152.80 "," $5,207.04 "," $4,437.92 "," $4,881.60 "," $4,610.40 "," $4,284.96 ", N/A ," $4,389.64 "," $4,389.64 "," $5,152.80 "," $4,654.33 ", $130.97 ," $5,207.04 "
 Pro Laparo Hernia Repair Recur ,CPT® 49651,0982 - PRO FEE/OUTPT,N/A,N/A," $3,627.00 "," $2,357.55 "," $3,390.21 ", $526.32 , $526.20 ," $2,612.42 "," $2,664.23 "," $3,373.11 "," $3,264.30 "," $3,264.30 "," $2,901.60 "," $2,901.60 ", $526.20 ," $3,348.81 "," $3,445.65 "," $3,264.30 "," $3,264.30 "," $3,264.30 "," $3,373.11 "," $3,481.92 "," $2,415.05 "," $3,082.95 "," $2,957.98 "," $3,089.28 ", N/A ," $2,663.40 "," $2,663.40 "," $3,445.65 "," $2,785.65 ", $526.20 ," $3,481.92 "
Attendance at Delivery W Initial Stabilization,CPT® 99464,N/A,N/A,N/A, $392.00 , $254.80 , $149.50 , $70.99 , $69.64 , $196.85 , $206.18 , $364.56 , $352.80 , $352.80 , $313.60 , $313.60 , $69.64 , $361.93 , $372.40 , $352.80 , $352.80 , $352.80 , $364.56 , $376.32 , $188.58 , $333.20 , $164.27 , $248.01 , N/A , $200.69 , $200.69 , $372.40 , $240.12 , $69.64 , $376.32 
"Proctectomy,Partial",CPT® 45111,N/A,N/A,N/A," $7,157.00 "," $4,652.05 "," $6,549.79 "," $1,014.04 "," $1,229.45 "," $5,144.99 "," $5,209.10 "," $6,656.01 "," $6,441.30 "," $6,441.30 "," $5,725.60 "," $5,725.60 "," $1,229.45 "," $6,608.06 "," $6,799.15 "," $6,441.30 "," $6,441.30 "," $6,441.30 "," $6,656.01 "," $6,870.72 "," $4,678.46 "," $6,083.45 "," $5,775.02 "," $6,088.83 ", N/A ," $5,245.38 "," $5,245.38 "," $6,799.15 "," $5,486.10 "," $1,014.04 "," $6,870.72 "
Repair Complex Addt,CPT® 13133,N/A,N/A,N/A," $1,114.00 ", $724.10 , $400.49 , $119.01 , $130.42 , $358.67 , $346.07 ," $1,036.02 "," $1,002.60 "," $1,002.60 ", $891.20 , $891.20 , $130.42 ," $1,028.56 "," $1,058.30 "," $1,002.60 "," $1,002.60 "," $1,002.60 "," $1,036.02 "," $1,069.44 ", $443.31 , $946.90 , $692.22 , $459.37 , N/A , $365.66 , $365.66 ," $1,058.30 ", $424.04 , $119.01 ," $1,069.44 "
 Fac Byp W/Vein Fem-Fem ,CPT® 35558,0360 - OR SERVICES,N/A,N/A," $5,492.00 "," $3,569.80 "," $4,613.28 "," $1,098.33 "," $1,506.54 "," $4,437.54 "," $4,942.80 "," $4,649.53 "," $4,942.80 "," $4,942.80 "," $4,942.80 "," $4,668.20 "," $1,477.00 "," $5,070.76 "," $5,217.40 "," $4,668.20 "," $5,107.56 "," $5,107.56 "," $5,217.40 "," $5,272.32 "," $4,493.55 "," $4,942.80 "," $4,668.20 "," $4,338.68 ", N/A ," $4,444.68 "," $4,444.68 "," $5,217.40 "," $4,712.69 "," $1,098.33 "," $5,272.32 "
 Pro Pro Treat Shoulder Blade Fx ,CPT® 23570,0981 - PRO FEE/ER,N/A,N/A, $868.00 , $564.20 ," $1,508.00 ", $239.36 , $101.63 ," $1,150.84 "," $1,170.86 ", $807.24 , $781.20 , $781.20 , $694.40 , $694.40 , $101.63 , $801.42 , $824.60 , $781.20 , $781.20 , $781.20 , $807.24 , $833.28 ," $1,389.76 ", $737.80 ," $1,284.53 "," $1,368.26 ", N/A ," $1,173.30 "," $1,173.30 ", $824.60 ," $1,379.07 ", $101.63 ," $1,508.00 "
 Fac Int Hrhc by Ligation 2+ Hroid W/O Img Gdn ,CPT® 46946,0360 - OR SERVICES,N/A,N/A," $2,543.00 "," $1,652.95 "," $2,136.12 ", $367.27 , $268.05 ," $2,054.74 "," $2,288.70 "," $2,152.90 "," $2,288.70 "," $2,288.70 "," $2,288.70 "," $2,161.55 ", $262.79 ," $2,347.95 "," $2,415.85 "," $2,161.55 "," $2,364.99 "," $2,364.99 "," $2,415.85 "," $2,441.28 "," $2,080.68 "," $2,288.70 "," $2,161.55 "," $2,008.97 ", N/A ," $2,058.05 "," $2,058.05 "," $2,415.85 "," $2,182.15 ", $262.79 ," $2,441.28 "
Cath Plmt & Njx Coronary Art/Grft Angio Img S&I,CPT® 93455,N/A,N/A,N/A," $6,779.00 "," $4,406.35 "," $6,516.90 ", $978.61 , $744.66 ," $5,574.45 "," $5,956.31 "," $6,304.47 "," $6,101.10 "," $6,101.10 "," $5,423.20 "," $5,423.20 ", $744.66 ," $6,259.05 "," $6,440.05 "," $6,101.10 "," $6,101.10 "," $6,101.10 "," $6,304.47 "," $6,507.84 "," $6,148.52 "," $5,762.15 "," $5,655.48 "," $5,786.10 ", N/A ," $5,683.22 "," $5,683.22 "," $6,440.05 "," $6,299.90 ", $744.66 ," $6,516.90 "
 Fac Chg Radiologic Exam Abdomen 1 View ,CPT® 74018,0320 - DX X-RAY,N/A,N/A, $262.00 , $170.30 , $220.08 , $29.43 , $21.43 , $211.70 , $235.80 , $221.81 , $235.80 , $235.80 , $235.80 , $222.70 , $21.01 , $241.90 , $248.90 , $222.70 , $243.66 , $243.66 , $248.90 , $251.52 , $214.37 , $235.80 , $222.70 , $206.98 , N/A , $212.04 , $212.04 , $248.90 , $224.82 , $21.01 , $251.52 
Excis Bartholin Gland/Cyst,CPT® 56740,N/A,N/A,N/A," $1,779.00 "," $1,156.35 "," $1,493.75 ", $301.70 , $307.34 ," $1,220.88 "," $1,212.27 "," $1,654.47 "," $1,601.10 "," $1,601.10 "," $1,423.20 "," $1,423.20 ", $307.34 ," $1,642.55 "," $1,690.05 "," $1,601.10 "," $1,601.10 "," $1,601.10 "," $1,654.47 "," $1,707.84 "," $1,546.80 "," $1,512.15 "," $1,593.17 "," $1,224.92 ", N/A ," $1,244.70 "," $1,244.70 "," $1,690.05 "," $1,492.94 ", $301.70 ," $1,707.84 "
 Fac Perc Drug-El Cor Stent Bran ,HCPCS C9601,0481 - CARDIAC CATH LAB,N/A,N/A," $15,529.00 "," $10,093.85 "," $13,044.36 ", N/A , N/A ," $12,547.43 "," $13,976.10 "," $13,146.85 "," $13,976.10 "," $13,976.10 "," $13,976.10 "," $13,199.65 ", N/A ," $14,337.93 "," $14,752.55 "," $13,199.65 "," $14,441.97 "," $14,441.97 "," $14,752.55 "," $14,907.84 "," $12,705.83 "," $13,976.10 "," $13,199.65 "," $12,267.91 ", N/A ," $12,567.62 "," $12,567.62 "," $14,752.55 "," $13,325.43 "," $12,267.91 "," $14,907.84 "
 Cytology - Fna (Fine Needle Aspirate) - Mh ,CPT® 88173,0310 - PATHOLOGY LAB,N/A,N/A, $494.00 , $321.10 , $414.96 , $159.03 , $58.95 , $399.15 , $444.60 , $418.22 , $444.60 , $444.60 , $444.60 , $419.90 , $57.79 , $456.11 , $469.30 , $419.90 , $459.42 , $459.42 , $469.30 , $474.24 , $404.19 , $444.60 , $419.90 , $390.26 , N/A , $399.79 , $399.79 , $469.30 , $423.90 , $57.79 , $474.24 
 CT Angio Chest Non-Coronary ,CPT® 71275,0350 - CT SCAN,N/A,N/A," $3,348.00 "," $2,176.20 "," $2,812.32 ", $259.37 , $407.84 ," $2,705.18 "," $3,013.20 "," $2,834.42 "," $3,013.20 "," $3,013.20 "," $3,013.20 "," $2,845.80 ", $399.84 ," $3,091.21 "," $3,180.60 "," $2,845.80 "," $3,113.64 "," $3,113.64 "," $3,180.60 "," $3,214.08 "," $2,739.33 "," $3,013.20 "," $2,845.80 "," $2,644.92 ", N/A ," $2,709.54 "," $2,709.54 "," $3,180.60 "," $2,872.92 ", $259.37 ," $3,214.08 "
Myocrd Img Pet Prfuj Multiple Study Rest&Stress,CPT® 78492,N/A,N/A,N/A," $8,675.00 "," $5,638.75 "," $8,489.88 "," $1,235.77 ", $761.65 ," $2,709.82 "," $6,078.85 "," $8,067.75 "," $7,807.50 "," $7,807.50 "," $6,940.00 "," $6,940.00 ", $761.65 ," $8,009.63 "," $8,241.25 "," $7,807.50 "," $7,807.50 "," $7,807.50 "," $8,067.75 "," $8,328.00 "," $6,116.31 "," $7,373.75 "," $3,143.30 "," $5,712.02 ", N/A ," $2,762.70 "," $2,762.70 "," $8,241.25 "," $3,197.88 ", $761.65 ," $8,489.88 "
"Excis Tumor,Soft Tiss Forearm/Wrist,Deep",CPT® 25076,N/A,N/A,N/A," $3,840.00 "," $2,496.00 "," $3,163.62 ", $499.05 , $502.53 ," $2,486.17 "," $2,483.93 "," $3,571.20 "," $3,456.00 "," $3,456.00 "," $3,072.00 "," $3,072.00 ", $502.53 ," $3,545.47 "," $3,648.00 "," $3,456.00 "," $3,456.00 "," $3,456.00 "," $3,571.20 "," $3,686.40 "," $2,934.93 "," $3,264.00 "," $2,736.75 "," $2,956.63 ", N/A ," $2,534.68 "," $2,534.68 "," $3,648.00 "," $2,979.16 ", $499.05 ," $3,686.40 "
"Bladder Irrigation,Simple",CPT® 51700,N/A,N/A,N/A, $571.00 , $371.15 , $164.05 , $28.50 , $18.87 , $219.00 , $200.92 , $531.03 , $513.90 , $513.90 , $456.80 , $456.80 , $18.87 , $527.20 , $542.45 , $513.90 , $513.90 , $513.90 , $531.03 , $548.16 , $164.92 , $485.35 , $228.36 , $187.29 , N/A , $223.27 , $223.27 , $542.45 , $262.41 , $18.87 , $548.16 
 Fac Drainage of Eyelid Abscess ,CPT® 67700,0761 - TREATMENT ROOM,N/A,N/A, $591.00 , $384.15 , $496.44 , $112.63 , $30.71 , $477.53 , $531.90 , $500.34 , $531.90 , $531.90 , $531.90 , $502.35 , $30.11 , $545.67 , $561.45 , $502.35 , $549.63 , $549.63 , $561.45 , $567.36 , $483.56 , $531.90 , $502.35 , $466.89 , N/A , $478.30 , $478.30 , $561.45 , $507.14 , $30.11 , $567.36 
Assay Alkal Phosphatase,CPT® 84075,N/A,N/A,N/A, $38.00 , $24.70 , N/A , $5.28 , $5.28 , $29.27 , $35.00 , $35.34 , $34.20 , $34.20 , $30.40 , $30.40 , $5.28 , $35.09 , $36.10 , $34.20 , $34.20 , $34.20 , $35.34 , $36.48 , $34.59 , $32.30 , $34.06 , $18.77 , N/A , $27.32 , $27.32 , $36.10 , $29.85 , $5.28 , $36.48 
" Fac Debridement, Skin, Sub-Q Tissue,Muscle,Bone,Each Add 20 Sq Cm ",CPT® 11047,0761 - TREATMENT ROOM,N/A,N/A," $4,419.00 "," $2,872.35 "," $3,711.96 ", $89.66 , $47.16 ," $3,570.55 "," $3,977.10 "," $3,741.13 "," $3,977.10 "," $3,977.10 "," $3,977.10 "," $3,756.15 ", $46.24 ," $4,080.06 "," $4,198.05 "," $3,756.15 "," $4,109.67 "," $4,109.67 "," $4,198.05 "," $4,242.24 "," $3,615.63 "," $3,977.10 "," $3,756.15 "," $3,491.01 ", N/A ," $3,576.30 "," $3,576.30 "," $4,198.05 "," $3,791.94 ", $46.24 ," $4,242.24 "
 PIOGLITAZONE HCL 30 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,57237-0220-30,1 tablet, $55.00 , $35.75 , $46.20 , N/A , N/A , $44.44 , $49.50 , $46.56 , $49.50 , $49.50 , $49.50 , $46.75 , N/A , $50.78 , $52.25 , $46.75 , $51.15 , $51.15 , $52.25 , $52.80 , $45.00 , $49.50 , $46.75 , $43.45 , N/A , $44.51 , $44.51 , $52.25 , $47.20 , $43.45 , $52.80 
"Excis Stomach Ulcer,Lesn;Local",CPT® 43610,N/A,N/A,N/A," $6,372.00 "," $4,141.80 "," $5,830.76 ", $902.42 , $922.06 ," $4,608.99 "," $4,644.89 "," $5,925.96 "," $5,734.80 "," $5,734.80 "," $5,097.60 "," $5,097.60 ", $922.06 ," $5,883.27 "," $6,053.40 "," $5,734.80 "," $5,734.80 "," $5,734.80 "," $5,925.96 "," $6,117.12 "," $4,186.65 "," $5,416.20 "," $5,170.22 "," $5,420.01 ", N/A ," $4,698.92 "," $4,698.92 "," $6,053.40 "," $4,914.58 ", $902.42 ," $6,117.12 "
" Fac X-Ray Exam, Pituitary Saddle ",CPT® 70240,0320 - DX X-RAY,N/A,N/A, $120.00 , $78.00 , $100.80 , $32.40 , $27.44 , $96.96 , $108.00 , $101.59 , $108.00 , $108.00 , $108.00 , $102.00 , $26.90 , $110.80 , $114.00 , $102.00 , $111.60 , $111.60 , $114.00 , $115.20 , $98.18 , $108.00 , $102.00 , $94.80 , N/A , $97.12 , $97.12 , $114.00 , $102.97 , $26.90 , $115.20 
 Fac Rpr 1 Transvns Eltrd Prm Pm/Pacing Implntbl Dfb ,CPT® 33218,0360 - OR SERVICES,N/A,N/A," $4,248.00 "," $2,761.20 "," $3,568.32 ", $361.85 , $401.40 ," $3,432.38 "," $3,823.20 "," $3,596.36 "," $3,823.20 "," $3,823.20 "," $3,823.20 "," $3,610.80 ", $393.53 ," $3,922.18 "," $4,035.60 "," $3,610.80 "," $3,950.64 "," $3,950.64 "," $4,035.60 "," $4,078.08 "," $3,475.71 "," $3,823.20 "," $3,610.80 "," $3,355.92 ", N/A ," $3,437.91 "," $3,437.91 "," $4,035.60 "," $3,645.21 ", $361.85 ," $4,078.08 "
Drug Screening Benzodiazepines 13 or More,CPT® 80347,N/A,N/A,N/A, $186.00 , $120.90 , N/A , N/A , N/A , N/A , N/A , $172.98 , $167.40 , $167.40 , $148.80 , $148.80 , N/A , $171.73 , $176.70 , $167.40 , $167.40 , $167.40 , $172.98 , $178.56 , N/A , $158.10 , $148.80 , N/A , N/A , N/A , N/A , $176.70 , N/A , $148.80 , $178.56 
Pfizer-Biontech Admin Biv Booster 12 Yrs and Older,CPT® 0124A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $56.00 , $128.02 , N/A , N/A , N/A , $66.50 , N/A , $38.92 , $128.02 
Open Rx Traumatic Hip Dislocatn,27253,N/A,N/A,N/A," $6,312.00 "," $4,102.80 "," $5,694.20 ", $890.54 , $922.06 ," $4,538.07 "," $4,507.15 "," $5,870.16 "," $5,680.80 "," $5,680.80 "," $5,049.60 "," $5,049.60 ", $922.06 ," $5,827.87 "," $5,996.40 "," $5,680.80 "," $5,680.80 "," $5,680.80 "," $5,870.16 "," $6,059.52 "," $5,303.79 "," $5,365.20 "," $4,984.67 "," $5,329.82 ", N/A ," $4,626.61 "," $4,626.61 "," $5,996.40 "," $5,437.92 ", $890.54 ," $6,059.52 "
 Fac Injection Aa&/Strd Pudendal Nerve ,CPT® 64430,0761 - TREATMENT ROOM,N/A,N/A," $2,078.00 "," $1,350.70 "," $1,745.52 ", $52.29 , $61.84 ," $1,679.02 "," $1,870.20 "," $1,759.23 "," $1,870.20 "," $1,870.20 "," $1,870.20 "," $1,766.30 ", $60.63 ," $1,918.62 "," $1,974.10 "," $1,766.30 "," $1,932.54 "," $1,932.54 "," $1,974.10 "," $1,994.88 "," $1,700.22 "," $1,870.20 "," $1,766.30 "," $1,641.62 ", N/A ," $1,681.73 "," $1,681.73 "," $1,974.10 "," $1,783.13 ", $52.29 ," $1,994.88 "
Stereotactic Radn Trmt Cerebrl,CPT® 77432,N/A,N/A,N/A," $4,099.00 "," $2,664.35 "," $2,364.60 ", $415.56 , $506.87 ," $2,000.83 "," $2,073.16 "," $3,812.07 "," $3,689.10 "," $3,689.10 "," $3,279.20 "," $3,279.20 ", $506.87 ," $3,784.61 "," $3,894.05 "," $3,689.10 "," $3,689.10 "," $3,689.10 "," $3,812.07 "," $3,935.04 "," $2,363.59 "," $3,484.15 "," $2,270.80 "," $2,327.39 ", N/A ," $2,039.87 "," $2,039.87 "," $3,894.05 "," $2,361.21 ", $415.56 ," $3,935.04 "
 Pro Injection Treatment of Nerve ,CPT® 64680,0982 - PRO FEE/OUTPT,N/A,N/A," $2,189.00 "," $1,422.85 ", $798.93 , $156.18 , $466.44 , $942.60 , $919.68 ," $2,035.77 "," $1,970.10 "," $1,970.10 "," $1,751.20 "," $1,751.20 ", $466.44 ," $2,021.10 "," $2,079.55 "," $1,970.10 "," $1,970.10 "," $1,970.10 "," $2,035.77 "," $2,101.44 ", $865.26 ," $1,860.65 ", $899.17 , $987.29 , N/A , $960.99 , $960.99 ," $2,079.55 "," $1,030.90 ", $156.18 ," $2,101.44 "
Sigmoidoscopy Flx W/Rmvl Tumor by Hot Bx Forceps,CPT® 45333,N/A,N/A,N/A," $2,388.00 "," $1,552.20 ", $570.96 , $88.25 , $108.73 , $522.44 , $537.65 ," $2,220.84 "," $2,149.20 "," $2,149.20 "," $1,910.40 "," $1,910.40 ", $108.73 ," $2,204.84 "," $2,268.60 "," $2,149.20 "," $2,149.20 "," $2,149.20 "," $2,220.84 "," $2,292.48 ", $409.84 ," $2,029.80 ", $590.53 , $541.98 , N/A , $532.63 , $532.63 ," $2,268.60 ", $557.08 , $88.25 ," $2,292.48 "
 METOCLOPRAMIDE HCL 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,51079-0886-20,1 tablet, $4.64 , $3.02 , $3.90 , N/A , N/A , $3.75 , $4.18 , $3.93 , $4.18 , $4.18 , $4.18 , $3.94 , N/A , $4.28 , $4.41 , $3.94 , $4.32 , $4.32 , $4.41 , $4.45 , $3.80 , $4.18 , $3.94 , $3.67 , N/A , $3.76 , $3.76 , $4.41 , $3.98 , $3.67 , $4.45 
 Pro CT Procedure ,CPT® 76497,0972 - PRO FEE/RAD/DX,N/A,N/A, $111.00 , $72.15 , N/A , N/A , N/A , $467.08 , N/A , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , N/A , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , N/A , $94.35 , $633.06 , N/A , N/A , $476.20 , $476.20 , $105.45 , $551.20 , $88.80 , $633.06 
Drug Screening Pregabalin,CPT® 80366,N/A,N/A,N/A, $222.00 , $144.30 , N/A , N/A , N/A , N/A , N/A , $206.46 , $199.80 , $199.80 , $177.60 , $177.60 , N/A , $204.97 , $210.90 , $199.80 , $199.80 , $199.80 , $206.46 , $213.12 , N/A , $188.70 , $114.69 , $67.79 , N/A , $90.04 , $90.04 , $210.90 , $98.20 , $67.79 , $213.12 
Layer Closure 12.6-20cm,CPT® 12035,N/A,N/A,N/A," $1,518.00 ", $986.70 , $761.06 , $227.75 , $200.71 , $653.93 , $643.73 ," $1,411.74 "," $1,366.20 "," $1,366.20 "," $1,214.40 "," $1,214.40 ", $200.71 ," $1,401.57 "," $1,442.10 "," $1,366.20 "," $1,366.20 "," $1,366.20 "," $1,411.74 "," $1,457.28 ", $835.71 ," $1,290.30 "," $1,291.66 ", $837.00 , N/A , $666.69 , $666.69 ," $1,442.10 ", $773.15 , $200.71 ," $1,457.28 "
"Destruc Benign/Premal,15+ Lesions",CPT® 17004,N/A,N/A,N/A, $814.00 , $529.10 , $231.63 , $95.50 , $178.52 , $272.16 , $348.41 , $757.02 , $732.60 , $732.60 , $651.20 , $651.20 , $178.52 , $751.57 , $773.30 , $732.60 , $732.60 , $732.60 , $757.02 , $781.44 , $346.58 , $691.90 , $692.22 , $348.55 , N/A , $277.47 , $277.47 , $773.30 , $321.77 , $95.50 , $781.44 
 Fac Exc Infct Grf Abd ,CPT® 35907,0360 - OR SERVICES,N/A,N/A," $12,731.00 "," $8,275.15 "," $10,694.04 "," $1,686.48 "," $1,868.84 "," $10,286.65 "," $11,457.90 "," $10,778.06 "," $11,457.90 "," $11,457.90 "," $11,457.90 "," $10,821.35 "," $1,832.20 "," $11,754.53 "," $12,094.45 "," $10,821.35 "," $11,839.83 "," $11,839.83 "," $12,094.45 "," $12,221.76 "," $10,416.50 "," $11,457.90 "," $10,821.35 "," $10,057.49 ", N/A ," $10,303.20 "," $10,303.20 "," $12,094.45 "," $10,924.47 "," $1,686.48 "," $12,221.76 "
Estrone,CPT® 82679,N/A,N/A,N/A, $239.00 , $155.35 , N/A , $25.45 , $25.45 , $141.18 , $168.92 , $222.27 , $215.10 , $215.10 , $191.20 , $191.20 , $25.45 , $220.67 , $227.05 , $215.10 , $215.10 , $215.10 , $222.27 , $229.44 , $166.60 , $203.15 , $163.81 , $90.49 , N/A , $131.76 , $131.76 , $227.05 , $143.99 , $25.45 , $229.44 
 Pro Incise Finger Tendon Sheath ,CPT® 26055,0975 - PRO FEE/OR,N/A,N/A," $3,773.00 "," $2,452.45 "," $1,794.72 ", $283.56 , $307.34 ," $1,493.87 "," $1,512.21 "," $3,508.89 "," $3,395.70 "," $3,395.70 "," $3,018.40 "," $3,018.40 ", $307.34 ," $3,483.61 "," $3,584.35 "," $3,395.70 "," $3,395.70 "," $3,395.70 "," $3,508.89 "," $3,622.08 "," $1,666.47 "," $3,207.05 "," $1,657.40 "," $1,779.74 ", N/A ," $1,523.02 "," $1,523.02 "," $3,584.35 "," $1,790.08 ", $283.56 ," $3,622.08 "
 Fac Trauma 2 Activation With Critical Care ,HCPCS G0390,0683 - TRAUMA LEVEL III,N/A,N/A," $3,064.00 "," $1,991.60 "," $2,573.76 ", N/A , N/A ," $2,475.71 "," $2,757.60 "," $2,593.98 "," $2,757.60 "," $2,757.60 "," $2,757.60 "," $2,604.40 ", N/A ," $2,828.99 "," $2,910.80 "," $2,604.40 "," $2,849.52 "," $2,849.52 "," $2,910.80 "," $2,941.44 "," $2,506.96 "," $2,757.60 "," $2,604.40 "," $2,420.56 ", N/A ," $2,479.70 "," $2,479.70 "," $2,910.80 "," $2,629.22 "," $2,420.56 "," $2,941.44 "
 Pro Inj Nerve Block ,CPT® 64400,0982 - PRO FEE/OUTPT,N/A,N/A, $804.00 , $522.60 , $237.17 , $46.38 , $95.27 , $389.08 , $370.43 , $747.72 , $723.60 , $723.60 , $643.20 , $643.20 , $95.27 , $742.33 , $763.80 , $723.60 , $723.60 , $723.60 , $747.72 , $771.84 , $254.96 , $683.40 , $367.52 , $417.54 , N/A , $396.67 , $396.67 , $763.80 , $425.54 , $46.38 , $771.84 
Reconstruc Ant Male Urethra,CPT® 53410,N/A,N/A,N/A," $6,815.00 "," $4,429.75 "," $5,301.10 ", $931.40 , $998.92 ," $4,790.11 "," $4,461.02 "," $6,337.95 "," $6,133.50 "," $6,133.50 "," $5,452.00 "," $5,452.00 ", $998.92 ," $6,292.29 "," $6,474.25 "," $6,133.50 "," $6,133.50 "," $6,133.50 "," $6,337.95 "," $6,542.40 "," $5,321.46 "," $5,792.75 "," $5,050.69 "," $6,017.97 ", N/A ," $4,883.57 "," $4,883.57 "," $6,474.25 "," $5,739.93 ", $931.40 ," $6,542.40 "
"Esrd Services, Home Dialysis, per Month, 20+ Yr Old",CPT® 90966,N/A,N/A,N/A, $942.00 , $612.30 , $685.90 , $286.10 , $230.14 , $531.09 , $536.69 , $876.06 , $847.80 , $847.80 , $753.60 , $753.60 , $230.14 , $869.75 , $894.90 , $847.80 , $847.80 , $847.80 , $876.06 , $904.32 , $904.27 , $800.70 , $706.56 , $900.65 , N/A , $541.46 , $541.46 , $894.90 , $631.23 , $230.14 , $904.32 
 Sensipar 30 Mg ,HCPCS J0604,0636 - DRUGS REQUIRING DETAILED CODIN,N/A,N/A, $1.00 , $0.65 , $0.84 , N/A , N/A , $0.81 , $0.90 , $0.85 , $0.90 , $0.90 , $0.90 , $0.85 , N/A , $0.92 , $0.95 , $0.85 , $0.93 , $0.93 , $0.95 , $0.96 , $0.82 , $0.90 , $0.85 , $0.79 , N/A , $0.81 , $0.81 , $0.95 , $0.86 , $0.79 , $0.96 
" Fac Herpes Simplex 1, Ag, If ",CPT® 87274,0305 - LAB/HEMATOLOGY,N/A,N/A, $113.00 , $73.45 , $94.92 , $12.22 , $12.22 , $91.30 , $101.70 , $95.67 , $101.70 , $101.70 , $101.70 , $96.05 , $11.98 , $104.33 , $107.35 , $96.05 , $105.09 , $105.09 , $107.35 , $108.48 , $92.46 , $101.70 , $96.05 , $89.27 , N/A , $91.45 , $91.45 , $107.35 , $96.97 , $11.98 , $108.48 
 Pro Part Removal of Ankle/Heel ,CPT® 28120,0982 - PRO FEE/OUTPT,N/A,N/A," $4,464.00 "," $2,901.60 "," $3,061.44 ", $479.04 , $384.19 ," $2,434.25 "," $2,436.06 "," $4,151.52 "," $4,017.60 "," $4,017.60 "," $3,571.20 "," $3,571.20 ", $384.19 ," $4,121.61 "," $4,240.80 "," $4,017.60 "," $4,017.60 "," $4,017.60 "," $4,151.52 "," $4,285.44 "," $2,844.60 "," $3,794.40 "," $2,661.82 "," $2,885.84 ", N/A ," $2,481.75 "," $2,481.75 "," $4,240.80 "," $2,916.93 ", $384.19 ," $4,285.44 "
"Laminectomy,Cervical",CPT® 63001,N/A,N/A,N/A," $7,994.00 "," $5,196.10 "," $5,698.84 "," $1,113.14 "," $1,536.80 "," $6,718.36 "," $6,437.83 "," $7,434.42 "," $7,194.60 "," $7,194.60 "," $6,395.20 "," $6,395.20 "," $1,536.80 "," $7,380.86 "," $7,594.30 "," $7,194.60 "," $7,194.60 "," $7,194.60 "," $7,434.42 "," $7,674.24 "," $6,160.30 "," $6,794.90 "," $6,570.71 "," $6,987.21 ", N/A ," $6,849.45 "," $6,849.45 "," $7,594.30 "," $7,347.87 "," $1,113.14 "," $7,674.24 "
"Smear,Primary W/Interp",CPT® 87205,N/A,N/A,N/A, $80.00 , $52.00 , N/A , $4.36 , $4.36 , $24.15 , $28.90 , $74.40 , $72.00 , $72.00 , $64.00 , $64.00 , $4.36 , $73.86 , $76.00 , $72.00 , $72.00 , $72.00 , $74.40 , $76.80 , $28.51 , $68.00 , $27.57 , $15.48 , N/A , $22.54 , $22.54 , $76.00 , $24.63 , $4.36 , $76.80 
"Cult Epidrm Autogrft Trunk,Arm,Leg <26sqcm",CPT® 15150,N/A,N/A,N/A," $2,727.00 "," $1,772.55 "," $2,000.93 ", $592.52 , $568.05 ," $1,702.68 "," $1,659.61 "," $2,536.11 "," $2,454.30 "," $2,454.30 "," $2,181.60 "," $2,181.60 ", $568.05 ," $2,517.84 "," $2,590.65 "," $2,454.30 "," $2,454.30 "," $2,454.30 "," $2,536.11 "," $2,617.92 "," $2,186.67 "," $2,317.95 "," $3,348.69 "," $2,152.22 ", N/A ," $1,735.91 "," $1,735.91 "," $2,590.65 "," $2,013.08 ", $568.05 ," $3,348.69 "
 CLOTRIMAZOLE 2 % VA CREA ,HCPCS RXC637,0250 - PHARMACY,51672-2062-00,21 gram, $54.48 , $35.41 , $45.76 , N/A , N/A , $44.02 , $49.03 , $46.12 , $49.03 , $49.03 , $49.03 , $46.31 , N/A , $50.30 , $51.76 , $46.31 , $50.67 , $50.67 , $51.76 , $52.30 , $44.58 , $49.03 , $46.31 , $43.04 , N/A , $44.09 , $44.09 , $51.76 , $46.75 , $43.04 , $52.30 
"Repair Ing Hernia,5+Y/O,Strang",CPT® 49507,N/A,N/A,N/A," $3,844.00 "," $2,498.60 "," $3,519.62 ", $546.36 , $540.39 ," $2,746.91 "," $2,791.12 "," $3,574.92 "," $3,459.60 "," $3,459.60 "," $3,075.20 "," $3,075.20 ", $540.39 ," $3,549.17 "," $3,651.80 "," $3,459.60 "," $3,459.60 "," $3,459.60 "," $3,574.92 "," $3,690.24 "," $2,513.95 "," $3,267.40 "," $3,098.92 "," $3,250.04 ", N/A ," $2,800.50 "," $2,800.50 "," $3,651.80 "," $2,929.02 ", $540.39 ," $3,690.24 "
"Excis Lesn,Palate/Uvula",CPT® 42104,N/A,N/A,N/A, $960.00 , $624.00 , $831.29 , $130.74 , $240.54 , $675.18 , $699.56 , $892.80 , $864.00 , $864.00 , $768.00 , $768.00 , $240.54 , $886.37 , $912.00 , $864.00 , $864.00 , $864.00 , $892.80 , $921.60 , $594.53 , $816.00 , $763.58 , $796.77 , N/A , $688.36 , $688.36 , $912.00 , $719.94 , $130.74 , $921.60 
 HYDRALAZINE HCL 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6440-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Urine Macro and Microscopic Beaker1 ,CPT® 81001,0307 - LAB/UROLOGY,N/A,N/A, $60.00 , $39.00 , $50.40 , $3.23 , $3.23 , $48.48 , $54.00 , $50.80 , $54.00 , $54.00 , $54.00 , $51.00 , $3.17 , $55.40 , $57.00 , $51.00 , $55.80 , $55.80 , $57.00 , $57.60 , $49.09 , $54.00 , $51.00 , $47.40 , N/A , $48.56 , $48.56 , $57.00 , $51.49 , $3.17 , $57.60 
"Cytopatholgy,Smear W/Inte",CPT® 88104,N/A,N/A,N/A, $220.00 , $143.00 , $240.13 , $67.95 , $37.19 , $297.99 , $348.64 , $204.60 , $198.00 , $198.00 , $176.00 , $176.00 , $37.19 , $203.13 , $209.00 , $198.00 , $198.00 , $198.00 , $204.60 , $211.20 , $428.14 , $187.00 , $363.29 , $252.76 , N/A , $278.10 , $278.10 , $209.00 , $305.63 , $37.19 , $428.14 
 Fac Sewho Cap Design W/Jnt(S) Cf ,HCPCS L3971,0274 - PROSTHETIC DEV,N/A,N/A," $2,108.00 "," $1,370.20 "," $1,770.72 "," $2,004.52 "," $1,388.39 "," $1,703.26 "," $1,897.20 "," $1,784.63 "," $1,897.20 "," $1,897.20 "," $1,897.20 "," $1,791.80 "," $1,361.17 "," $1,946.32 "," $2,002.60 "," $1,791.80 "," $1,960.44 "," $1,960.44 "," $2,002.60 "," $2,023.68 "," $1,724.77 "," $1,897.20 "," $1,791.80 "," $1,665.32 ", N/A ," $1,706.00 "," $1,706.00 "," $2,002.60 "," $1,808.87 "," $1,361.17 "," $2,023.68 "
DXA Bone Density Study Axial Skeleton,CPT® 77085,N/A,N/A,N/A, $577.00 , $375.05 , $286.40 , $50.98 , $44.25 , $268.40 , $290.56 , $536.61 , $519.30 , $519.30 , $461.60 , $461.60 , $44.25 , $532.74 , $548.15 , $519.30 , $519.30 , $519.30 , $536.61 , $553.92 , $289.10 , $490.45 , $297.34 , $424.33 , N/A , $273.63 , $273.63 , $548.15 , $316.75 , $44.25 , $553.92 
Exc Tumor Soft Tissue Upper Arm/Elbow Subq 3+Cm,24071,N/A,N/A,N/A," $3,058.00 "," $1,987.70 "," $2,452.97 ", $382.32 , $332.95 ," $1,943.39 "," $1,947.61 "," $2,843.94 "," $2,752.20 "," $2,752.20 "," $2,446.40 "," $2,446.40 ", $332.95 ," $2,823.45 "," $2,905.10 "," $2,752.20 "," $2,752.20 "," $2,752.20 "," $2,843.94 "," $2,935.68 "," $2,274.55 "," $2,599.30 "," $2,155.15 "," $2,292.22 ", N/A ," $1,981.30 "," $1,981.30 "," $2,905.10 "," $2,328.72 ", $332.95 ," $2,935.68 "
 PREDNISONE 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00054-0017-20,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 PROPOFOL 1000 MG/100ML IV EMUL ,HCPCS J2704,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0269-65,100 mL, $184.93 , $120.20 , $155.34 , $0.10 , $0.14 , $149.42 , $166.44 , $156.56 , $166.44 , $166.44 , $166.44 , $157.19 , $0.14 , $170.75 , $175.68 , $157.19 , $171.98 , $171.98 , $175.68 , $177.53 , $151.31 , $166.44 , $157.19 , $146.09 , N/A , $149.66 , $149.66 , $175.68 , $158.69 , $0.10 , $177.53 
 DABIGATRAN ETEXILATE MESYLATE 150 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00597-0360-82,1 capsule, $20.39 , $13.25 , $17.13 , N/A , N/A , $16.48 , $18.35 , $17.26 , $18.35 , $18.35 , $18.35 , $17.33 , N/A , $18.83 , $19.37 , $17.33 , $18.96 , $18.96 , $19.37 , $19.57 , $16.68 , $18.35 , $17.33 , $16.11 , N/A , $16.50 , $16.50 , $19.37 , $17.50 , $16.11 , $19.57 
Bronchospasm Evaluation,94060,N/A,N/A,N/A, $389.00 , $252.85 , $89.95 , $37.70 , $53.79 , $134.43 , $144.38 , $361.77 , $350.10 , $350.10 , $311.20 , $311.20 , $53.79 , $359.16 , $369.55 , $350.10 , $350.10 , $350.10 , $361.77 , $373.44 , $140.25 , $330.65 , $191.59 , $229.15 , N/A , $137.05 , $137.05 , $369.55 , $159.78 , $37.70 , $373.44 
Iaad Ia Hpylori Stool,CPT® 87338,N/A,N/A,N/A, $193.00 , $125.45 , N/A , $14.67 , $14.67 , $81.36 , $97.34 , $179.49 , $173.70 , $173.70 , $154.40 , $154.40 , $14.67 , $178.20 , $183.35 , $173.70 , $173.70 , $173.70 , $179.49 , $185.28 , $96.02 , $164.05 , $94.07 , $52.16 , N/A , $75.93 , $75.93 , $183.35 , $82.98 , $14.67 , $185.28 
 Fac Assay of Blood Chloride ,CPT® 82435,0301 - LAB/CHEMISTRY,N/A,N/A, $79.00 , $51.35 , $66.36 , $4.69 , $4.69 , $63.83 , $71.10 , $66.88 , $71.10 , $71.10 , $71.10 , $67.15 , $4.60 , $72.94 , $75.05 , $67.15 , $73.47 , $73.47 , $75.05 , $75.84 , $64.64 , $71.10 , $67.15 , $62.41 , N/A , $63.93 , $63.93 , $75.05 , $67.79 , $4.60 , $75.84 
"Endovasc Dist Extens Taa Prosth, Delayed",CPT® 33886,N/A,N/A,N/A," $5,859.00 "," $3,808.35 "," $5,579.86 ", $859.12 , $871.69 ," $4,172.67 "," $4,172.33 "," $5,448.87 "," $5,273.10 "," $5,273.10 "," $4,687.20 "," $4,687.20 ", $871.69 ," $5,409.61 "," $5,566.05 "," $5,273.10 "," $5,273.10 "," $5,273.10 "," $5,448.87 "," $5,624.64 "," $5,112.08 "," $4,980.15 "," $5,280.83 "," $4,655.34 ", N/A ," $4,254.09 "," $4,254.09 "," $5,566.05 "," $4,832.63 ", $859.12 ," $5,624.64 "
Debridement Nails 6 or Mo,CPT® 11721,N/A,N/A,N/A, $171.00 , $111.15 , $78.23 , $23.04 , $33.71 , $69.12 , $65.79 , $159.03 , $153.90 , $153.90 , $136.80 , $136.80 , $33.71 , $157.88 , $162.45 , $153.90 , $153.90 , $153.90 , $159.03 , $164.16 , $86.28 , $145.35 , $128.45 , $88.53 , N/A , $70.47 , $70.47 , $162.45 , $81.72 , $23.04 , $164.16 
 Fac Rp Loclzj Tum Plnr 1 Area Single Day Imaging ,CPT® 78800,0340 - NUCLEAR MEDICINE,N/A,N/A," $1,728.00 "," $1,123.20 "," $1,451.52 ", $230.85 , $168.59 ," $1,396.22 "," $1,555.20 "," $1,462.92 "," $1,555.20 "," $1,555.20 "," $1,555.20 "," $1,468.80 ", $165.28 ," $1,595.46 "," $1,641.60 "," $1,468.80 "," $1,607.04 "," $1,607.04 "," $1,641.60 "," $1,658.88 "," $1,413.85 "," $1,555.20 "," $1,468.80 "," $1,365.12 ", N/A ," $1,398.47 "," $1,398.47 "," $1,641.60 "," $1,482.80 ", $165.28 ," $1,658.88 "
 Pro Chemodenervation Muscle Neck Unilat for Dystonia ,CPT® 64616,0982 - PRO FEE/OUTPT,N/A,N/A," $1,842.00 "," $1,197.30 ", $505.39 , $98.15 , $78.09 , $578.28 , $570.10 ," $1,713.06 "," $1,657.80 "," $1,657.80 "," $1,473.60 "," $1,473.60 ", $78.09 ," $1,700.72 "," $1,749.90 "," $1,657.80 "," $1,657.80 "," $1,657.80 "," $1,713.06 "," $1,768.32 ", $544.97 ," $1,565.70 ", $577.51 , $621.45 , N/A , $589.57 , $589.57 ," $1,749.90 ", $632.47 , $78.09 ," $1,768.32 "
 Pro Treatment of Ankle Fracture ,CPT® 27792,0975 - PRO FEE/OR,N/A,N/A," $3,584.00 "," $2,329.60 "," $3,947.78 ", $618.62 , $614.70 ," $3,155.71 "," $3,161.84 "," $3,333.12 "," $3,225.60 "," $3,225.60 "," $2,867.20 "," $2,867.20 ", $614.70 ," $3,309.11 "," $3,404.80 "," $3,225.60 "," $3,225.60 "," $3,225.60 "," $3,333.12 "," $3,440.64 "," $3,669.86 "," $3,046.40 "," $3,486.06 "," $3,704.75 ", N/A ," $3,217.28 "," $3,217.28 "," $3,404.80 "," $3,781.44 ", $614.70 ," $3,947.78 "
 Immunofl Study Ea Add Ab Stain ,CPT® 88350,0312 - PATHOL/HISTOL,N/A,N/A, $292.00 , $189.80 , $245.28 , $114.53 , $57.02 , $235.94 , $262.80 , $247.21 , $262.80 , $262.80 , $262.80 , $248.20 , $55.90 , $269.60 , $277.40 , $248.20 , $271.56 , $271.56 , $277.40 , $280.32 , $238.91 , $262.80 , $248.20 , $230.68 , N/A , $236.32 , $236.32 , $277.40 , $250.57 , $55.90 , $280.32 
Revise/Remove Neuroelectrode,CPT® 64585,N/A,N/A,N/A," $1,869.00 "," $1,214.85 ", $704.81 , $137.16 , $251.04 , $799.16 , $785.64 ," $1,738.17 "," $1,682.10 "," $1,682.10 "," $1,495.20 "," $1,495.20 ", $251.04 ," $1,725.65 "," $1,775.55 "," $1,682.10 "," $1,682.10 "," $1,682.10 "," $1,738.17 "," $1,794.24 ", $762.60 ," $1,588.65 ", $767.15 , $861.71 , N/A , $814.76 , $814.76 ," $1,775.55 ", $874.04 , $137.16 ," $1,794.24 "
Drainage Catheter Exchange,CPT® 49423,N/A,N/A,N/A," $3,875.00 "," $2,518.75 ", $431.73 , $67.09 , $765.94 , $354.12 , $351.18 ," $3,603.75 "," $3,487.50 "," $3,487.50 "," $3,100.00 "," $3,100.00 ", $765.94 ," $3,577.79 "," $3,681.25 "," $3,487.50 "," $3,487.50 "," $3,487.50 "," $3,603.75 "," $3,720.00 ", $313.45 ," $3,293.75 ", $378.22 , $417.21 , N/A , $361.04 , $361.04 ," $3,681.25 ", $377.58 , $67.09 ," $3,720.00 "
 Fac Evasc Rpr Dplmnt Aorto-Bi-Iliac Ndgft ,CPT® 34705,0360 - OR SERVICES,N/A,N/A," $2,157.00 "," $1,402.05 "," $1,811.88 "," $1,359.57 "," $1,158.01 "," $1,742.86 "," $1,941.30 "," $1,826.12 "," $1,941.30 "," $1,941.30 "," $1,941.30 "," $1,833.45 "," $1,135.30 "," $1,991.56 "," $2,049.15 "," $1,833.45 "," $2,006.01 "," $2,006.01 "," $2,049.15 "," $2,070.72 "," $1,764.86 "," $1,941.30 "," $1,833.45 "," $1,704.03 ", N/A ," $1,745.66 "," $1,745.66 "," $2,049.15 "," $1,850.92 "," $1,135.30 "," $2,070.72 "
Instrument Based Ocular Scr Bi W/Onsite Analysis,CPT® 99177,N/A,N/A,N/A, $49.00 , $31.85 , N/A , $4.38 , N/A , N/A , N/A , $45.57 , $44.10 , $44.10 , $39.20 , $39.20 , N/A , $45.24 , $46.55 , $44.10 , $44.10 , $44.10 , $45.57 , $47.04 , $11.77 , $41.65 , $14.14 , $9.88 , N/A , $8.94 , $8.94 , $46.55 , $10.38 , $4.38 , $47.04 
"Mirena, 52 Mg",HCPCS J7298,N/A,N/A,N/A," $1,179.00 ", $766.35 , N/A , N/A ," $1,123.73 ", N/A , N/A ," $1,096.47 "," $1,061.10 "," $1,061.10 ", $943.20 , $943.20 ," $1,123.73 "," $1,088.57 "," $1,120.05 "," $1,061.10 "," $1,061.10 "," $1,061.10 "," $1,096.47 "," $1,131.84 ", N/A ," $1,002.15 ", $943.20 ," $1,368.21 ", N/A , N/A , N/A ," $1,120.05 ", N/A , $943.20 ," $1,368.21 "
Remv Gallbladder W Cholangiogram,CPT® 47605,N/A,N/A,N/A," $7,156.00 "," $4,651.40 "," $6,717.82 "," $1,039.72 "," $1,274.24 "," $5,270.70 "," $5,328.86 "," $6,655.08 "," $6,440.40 "," $6,440.40 "," $5,724.80 "," $5,724.80 "," $1,274.24 "," $6,607.13 "," $6,798.20 "," $6,440.40 "," $6,440.40 "," $6,440.40 "," $6,655.08 "," $6,869.76 "," $4,807.77 "," $6,082.60 "," $5,932.01 "," $6,219.32 ", N/A ," $5,373.54 "," $5,373.54 "," $6,798.20 "," $5,620.15 "," $1,039.72 "," $6,869.76 "
Indwelling Catheter Latex,HCPCS A4338,N/A,N/A,N/A, $27.00 , $17.55 , N/A , $16.65 , $8.05 , N/A , N/A , $25.11 , $24.30 , $24.30 , $21.60 , $21.60 , $8.05 , $24.93 , $25.65 , $24.30 , $24.30 , $24.30 , $25.11 , $25.92 , N/A , $22.95 , $14.27 , $15.11 , N/A , N/A , N/A , $25.65 , N/A , $8.05 , $25.92 
 Fac Assay of Urine Creatinine ,CPT® 82570,0301 - LAB/CHEMISTRY,N/A,N/A, $63.00 , $40.95 , $52.92 , $5.28 , $5.28 , $50.90 , $56.70 , $53.34 , $56.70 , $56.70 , $56.70 , $53.55 , $5.18 , $58.17 , $59.85 , $53.55 , $58.59 , $58.59 , $59.85 , $60.48 , $51.55 , $56.70 , $53.55 , $49.77 , N/A , $50.99 , $50.99 , $59.85 , $54.06 , $5.18 , $60.48 
"Vaginal Hysterectomy,Uterus 250 Gms/<",CPT® 58260,N/A,N/A,N/A," $4,998.00 "," $3,248.70 "," $3,960.90 ", $800.93 , $749.46 ," $3,364.38 "," $3,358.75 "," $4,648.14 "," $4,498.20 "," $4,498.20 "," $3,998.40 "," $3,998.40 ", $749.46 ," $4,614.65 "," $4,748.10 "," $4,498.20 "," $4,498.20 "," $4,498.20 "," $4,648.14 "," $4,798.08 "," $4,137.45 "," $4,248.30 "," $4,417.34 "," $3,372.12 ", N/A ," $3,430.02 "," $3,430.02 "," $4,748.10 "," $4,114.10 ", $749.46 ," $4,798.08 "
 Fac Moblj Splenic Flxr Pfrmd Conjunct W/Prtl Colct ,CPT® 44139,0360 - OR SERVICES,N/A,N/A, $931.00 , $605.15 , $782.04 , $109.98 , $227.01 , $752.25 , $837.90 , $788.18 , $837.90 , $837.90 , $837.90 , $791.35 , $222.56 , $859.59 , $884.45 , $791.35 , $865.83 , $865.83 , $884.45 , $893.76 , $761.74 , $837.90 , $791.35 , $735.49 , N/A , $753.46 , $753.46 , $884.45 , $798.89 , $109.98 , $893.76 
"Part Remv Bladder,Simple",CPT® 51550,N/A,N/A,N/A," $6,671.00 "," $4,336.15 "," $5,187.13 ", $911.12 ," $1,075.74 "," $4,697.55 "," $4,391.48 "," $6,204.03 "," $6,003.90 "," $6,003.90 "," $5,336.80 "," $5,336.80 "," $1,075.74 "," $6,159.33 "," $6,337.45 "," $6,003.90 "," $6,003.90 "," $6,003.90 "," $6,204.03 "," $6,404.16 "," $5,200.05 "," $5,670.35 "," $5,015.00 "," $5,884.74 ", N/A ," $4,789.21 "," $4,789.21 "," $6,337.45 "," $5,629.02 ", $911.12 ," $6,404.16 "
 Fobt-Immunoassay ,HCPCS G0328,0305 - LAB/HEMATOLOGY,N/A,N/A, $128.00 , $83.20 , $107.52 , $18.41 , N/A , $103.42 , $115.20 , $108.36 , $115.20 , $115.20 , $115.20 , $108.80 , N/A , $118.18 , $121.60 , $108.80 , $119.04 , $119.04 , $121.60 , $122.88 , $104.73 , $115.20 , $108.80 , $101.12 , N/A , $103.59 , $103.59 , $121.60 , $109.84 , $18.41 , $122.88 
 Pro Removal of Support Implant ,CPT® 20670,0975 - PRO FEE/OR,N/A,N/A," $1,561.00 "," $1,014.65 ", $884.65 , $139.34 , $54.21 , $713.22 , $723.32 ," $1,451.73 "," $1,404.90 "," $1,404.90 "," $1,248.80 "," $1,248.80 ", $54.21 ," $1,441.27 "," $1,482.95 "," $1,404.90 "," $1,404.90 "," $1,404.90 "," $1,451.73 "," $1,498.56 ", $826.94 ," $1,326.85 ", $792.12 , $845.36 , N/A , $727.14 , $727.14 ," $1,482.95 ", $854.63 , $54.21 ," $1,498.56 "
 Pro Removal of Hemorrhoid Clot ,CPT® 46320,0982 - PRO FEE/OUTPT,N/A,N/A, $870.00 , $565.50 , $692.64 , $107.89 , $165.14 , $525.60 , $539.21 , $809.10 , $783.00 , $783.00 , $696.00 , $696.00 , $165.14 , $803.27 , $826.50 , $783.00 , $783.00 , $783.00 , $809.10 , $835.20 , $493.49 , $739.50 , $594.09 , $627.81 , N/A , $535.85 , $535.85 , $826.50 , $560.45 , $107.89 , $835.20 
 Fac Virus Antibody Nos ,CPT® 86790,0302 - LAB/IMMUNOLOGY,N/A,N/A, $189.00 , $122.85 , $158.76 , $13.14 , N/A , $152.71 , $170.10 , $160.01 , $170.10 , $170.10 , $170.10 , $160.65 , N/A , $174.50 , $179.55 , $160.65 , $175.77 , $175.77 , $179.55 , $181.44 , $154.64 , $170.10 , $160.65 , $149.31 , N/A , $152.96 , $152.96 , $179.55 , $162.18 , $13.14 , $181.44 
"Explor/Drain Knee,Infectn",27310,N/A,N/A,N/A," $2,796.00 "," $1,817.40 "," $4,454.78 ", $698.89 , $629.61 ," $3,520.59 "," $3,510.34 "," $2,600.28 "," $2,516.40 "," $2,516.40 "," $2,236.80 "," $2,236.80 ", $629.61 ," $2,581.55 "," $2,656.20 "," $2,516.40 "," $2,516.40 "," $2,516.40 "," $2,600.28 "," $2,684.16 "," $4,139.94 "," $2,376.60 "," $3,876.77 "," $4,152.70 ", N/A ," $3,589.29 "," $3,589.29 "," $2,656.20 "," $4,218.68 ", $629.61 ," $4,454.78 "
 Lb-Fish Probes Manual Initial ,CPT® 88368,0300 - LABORATORY,N/A,N/A, $513.00 , $333.45 , $430.92 , $140.09 , $184.62 , $414.50 , $461.70 , $434.31 , $461.70 , $461.70 , $461.70 , $436.05 , $181.00 , $473.65 , $487.35 , $436.05 , $477.09 , $477.09 , $487.35 , $492.48 , $419.74 , $461.70 , $436.05 , $405.27 , N/A , $415.17 , $415.17 , $487.35 , $440.21 , $140.09 , $492.48 
 MIDAZOLAM HCL 10 MG/2 ML INJECTION (INPT) ,HCPCS J2250,0636 - DRUGS REQUIRING DETAILED CODIN,00409-2308-02,1 mL, $16.68 , $10.84 , $14.01 , $0.14 , $0.17 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.17 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.14 , $16.01 
 Fac Thrmbc Opn Arven Fstl W/O Revj Dial Grf ,CPT® 36831,0360 - OR SERVICES,N/A,N/A," $6,299.00 "," $4,094.35 "," $5,291.16 ", $553.01 , $370.65 ," $5,089.59 "," $5,669.10 "," $5,332.73 "," $5,669.10 "," $5,669.10 "," $5,669.10 "," $5,354.15 ", $363.38 ," $5,815.87 "," $5,984.05 "," $5,354.15 "," $5,858.07 "," $5,858.07 "," $5,984.05 "," $6,047.04 "," $5,153.84 "," $5,669.10 "," $5,354.15 "," $4,976.21 ", N/A ," $5,097.78 "," $5,097.78 "," $5,984.05 "," $5,405.17 ", $363.38 ," $6,047.04 "
 Fac Perq Thrmbc/Nfs Dial Circuit Trluml Balo Angiop ,CPT® 36905,0360 - OR SERVICES,N/A,N/A," $29,829.00 "," $19,388.85 "," $25,056.36 ", $412.55 ," $2,681.78 "," $24,101.83 "," $26,846.10 "," $25,253.23 "," $26,846.10 "," $26,846.10 "," $26,846.10 "," $25,354.65 "," $2,629.20 "," $27,541.12 "," $28,337.55 "," $25,354.65 "," $27,740.97 "," $27,740.97 "," $28,337.55 "," $28,635.84 "," $24,406.09 "," $26,846.10 "," $25,354.65 "," $23,564.91 ", N/A ," $24,140.61 "," $24,140.61 "," $28,337.55 "," $25,596.26 ", $412.55 ," $28,635.84 "
 ASPIRIN 81 MG PO TBEC ,HCPCS RXC637,0250 - PHARMACY,00536-1234-41,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Pro Family Psychotherapy W/O Patient Present 50 Mins ,CPT® 90846,0916 - PSYCH/FAMILY RX,N/A,N/A, $415.00 , $269.75 , $348.60 , $94.88 , $120.80 , $335.32 , $373.50 , $351.34 , $373.50 , $373.50 , $373.50 , $352.75 , $118.43 , $383.17 , $394.25 , $352.75 , $385.95 , $385.95 , $394.25 , $398.40 , $339.55 , $373.50 , $352.75 , $327.85 , N/A , $335.86 , $335.86 , $394.25 , $356.11 , $94.88 , $398.40 
Care After Delivery Only,CPT® 59430,N/A,N/A,N/A, $674.00 , $438.10 , $482.67 , $162.66 , $104.66 , $324.25 , $338.50 , $626.82 , $606.60 , $606.60 , $539.20 , $539.20 , $104.66 , $622.30 , $640.30 , $606.60 , $606.60 , $606.60 , $626.82 , $647.04 , $491.79 , $572.90 , $749.31 , $598.64 , N/A , $330.57 , $330.57 , $640.30 , $382.18 , $104.66 , $749.31 
" Fac N Block, Lumbar/Thoracic ",CPT® 64520,0761 - TREATMENT ROOM,N/A,N/A," $1,027.00 ", $667.55 , $862.68 , $81.46 , $161.66 , $829.82 , $924.30 , $869.46 , $924.30 , $924.30 , $924.30 , $872.95 , $158.49 , $948.23 , $975.65 , $872.95 , $955.11 , $955.11 , $975.65 , $985.92 , $840.29 , $924.30 , $872.95 , $811.33 , N/A , $831.15 , $831.15 , $975.65 , $881.27 , $81.46 , $985.92 
 Fac Byp W/Vein Pop-Tibl-Proneal Art/Oth Dstl Vsl ,CPT® 35571,0360 - OR SERVICES,N/A,N/A," $5,435.00 "," $3,532.75 "," $4,565.40 "," $1,175.63 "," $1,340.24 "," $4,391.48 "," $4,891.50 "," $4,601.27 "," $4,891.50 "," $4,891.50 "," $4,891.50 "," $4,619.75 "," $1,313.96 "," $5,018.14 "," $5,163.25 "," $4,619.75 "," $5,054.55 "," $5,054.55 "," $5,163.25 "," $5,217.60 "," $4,446.92 "," $4,891.50 "," $4,619.75 "," $4,293.65 ", N/A ," $4,398.55 "," $4,398.55 "," $5,163.25 "," $4,663.77 "," $1,175.63 "," $5,217.60 "
 Fac Trauma 4 Activation W/ Pre-ED Notification- Level I W/Critical Care ,HCPCS G0390,0684 - TRAUMA LEVEL IV,N/A,N/A," $2,947.00 "," $1,915.55 "," $2,475.48 ", N/A , N/A ," $2,381.18 "," $2,652.30 "," $2,494.93 "," $2,652.30 "," $2,652.30 "," $2,652.30 "," $2,504.95 ", N/A ," $2,720.97 "," $2,799.65 "," $2,504.95 "," $2,740.71 "," $2,740.71 "," $2,799.65 "," $2,829.12 "," $2,411.24 "," $2,652.30 "," $2,504.95 "," $2,328.13 ", N/A ," $2,385.01 "," $2,385.01 "," $2,799.65 "," $2,528.82 "," $2,328.13 "," $2,829.12 "
Treat Phalangeal Shft Frc,26725,N/A,N/A,N/A," $1,012.00 ", $657.80 ," $1,888.97 ", $298.96 , $132.15 ," $1,457.95 "," $1,481.04 ", $941.16 , $910.80 , $910.80 , $809.60 , $809.60 , $132.15 , $934.38 , $961.40 , $910.80 , $910.80 , $910.80 , $941.16 , $971.52 ," $1,742.10 ", $860.20 ," $1,625.28 "," $1,732.55 ", N/A ," $1,486.40 "," $1,486.40 ", $961.40 ," $1,747.03 ", $132.15 ," $1,888.97 "
"Burn Dressing,Sm,W/O Anes",16020,N/A,N/A,N/A, $364.00 , $236.60 , $173.81 , $52.76 , $30.25 , $148.68 , $145.73 , $338.52 , $327.60 , $327.60 , $291.20 , $291.20 , $30.25 , $336.08 , $345.80 , $327.60 , $327.60 , $327.60 , $338.52 , $349.44 , $191.27 , $309.40 , $289.02 , $192.11 , N/A , $151.58 , $151.58 , $345.80 , $175.80 , $30.25 , $349.44 
"Thoracotomy,Postop Complicatns",CPT® 32120,N/A,N/A,N/A," $7,711.00 "," $5,012.15 "," $4,547.62 ", $796.00 ," $1,728.87 "," $3,287.90 "," $3,234.79 "," $7,171.23 "," $6,939.90 "," $6,939.90 "," $6,168.80 "," $6,168.80 "," $1,728.87 "," $7,119.57 "," $7,325.45 "," $6,939.90 "," $6,939.90 "," $6,939.90 "," $7,171.23 "," $7,402.56 "," $4,400.19 "," $6,554.35 "," $4,670.68 "," $4,335.20 ", N/A ," $3,352.06 "," $3,352.06 "," $7,325.45 "," $3,947.75 ", $796.00 ," $7,402.56 "
" Amputation, Thigh, Through Femur; Open, Circular ",CPT® 27592,0360 - OR SERVICES,N/A,N/A," $6,091.00 "," $3,959.15 "," $5,116.44 ", $618.45 ," $1,010.33 "," $4,921.53 "," $5,481.90 "," $5,156.64 "," $5,481.90 "," $5,481.90 "," $5,481.90 "," $5,177.35 ", $990.52 ," $5,623.82 "," $5,786.45 "," $5,177.35 "," $5,664.63 "," $5,664.63 "," $5,786.45 "," $5,847.36 "," $4,983.66 "," $5,481.90 "," $5,177.35 "," $4,811.89 ", N/A ," $4,929.45 "," $4,929.45 "," $5,786.45 "," $5,226.69 ", $618.45 ," $5,847.36 "
" Pro Treat Finger Fracture, Each ",CPT® 26746,0975 - PRO FEE/OR,N/A,N/A," $1,978.00 "," $1,285.70 "," $4,544.15 ", $713.02 , $381.08 ," $3,573.09 "," $3,558.02 "," $1,839.54 "," $1,780.20 "," $1,780.20 "," $1,582.40 "," $1,582.40 ", $381.08 ," $1,826.29 "," $1,879.10 "," $1,780.20 "," $1,780.20 "," $1,780.20 "," $1,839.54 "," $1,898.88 "," $4,226.05 "," $1,681.30 "," $3,916.02 "," $4,238.02 ", N/A ," $3,642.81 "," $3,642.81 "," $1,879.10 "," $4,281.58 ", $381.08 ," $4,544.15 "
 Fac Endoven Abltj Incmptnt Vein Xtr Rf 1st Vein ,CPT® 36475,0360 - OR SERVICES,N/A,N/A," $3,922.00 "," $2,549.30 "," $3,294.48 ", $251.72 ," $1,608.39 "," $3,168.98 "," $3,529.80 "," $3,320.37 "," $3,529.80 "," $3,529.80 "," $3,529.80 "," $3,333.70 "," $1,576.85 "," $3,621.18 "," $3,725.90 "," $3,333.70 "," $3,647.46 "," $3,647.46 "," $3,725.90 "," $3,765.12 "," $3,208.98 "," $3,529.80 "," $3,333.70 "," $3,098.38 ", N/A ," $3,174.07 "," $3,174.07 "," $3,725.90 "," $3,365.47 ", $251.72 ," $3,765.12 "
 FILGRASTIM-SNDZ 300 MCG/0.5ML IJ SOSY ,HCPCS Q5101,0636 - DRUGS REQUIRING DETAILED CODIN,61314-0318-01,0.5 mL, $806.70 , $524.36 , $677.63 , $0.18 , $0.24 , $651.81 , $726.03 , $682.95 , $726.03 , $726.03 , $726.03 , $685.70 , $0.24 , $744.83 , $766.37 , $685.70 , $750.23 , $750.23 , $766.37 , $774.43 , $660.04 , $726.03 , $685.70 , $637.29 , N/A , $652.86 , $652.86 , $766.37 , $692.23 , $0.18 , $774.43 
 Fac Removal Permanent Pacemaker Pulse Generator Only ,CPT® 33233,0360 - OR SERVICES,N/A,N/A," $3,447.00 "," $2,240.55 "," $2,895.48 ", $217.71 , $267.78 ," $2,785.18 "," $3,102.30 "," $2,918.23 "," $3,102.30 "," $3,102.30 "," $3,102.30 "," $2,929.95 ", $262.53 ," $3,182.62 "," $3,274.65 "," $2,929.95 "," $3,205.71 "," $3,205.71 "," $3,274.65 "," $3,309.12 "," $2,820.34 "," $3,102.30 "," $2,929.95 "," $2,723.13 ", N/A ," $2,789.66 "," $2,789.66 "," $3,274.65 "," $2,957.87 ", $217.71 ," $3,309.12 "
Revis Shoulder Arthrplsty Humeral&Glenoid Compnt,CPT® 23474,N/A,N/A,N/A," $11,310.00 "," $7,351.50 "," $10,480.73 "," $1,635.07 "," $1,347.83 "," $8,499.92 "," $8,398.02 "," $10,518.30 "," $10,179.00 "," $10,179.00 "," $9,048.00 "," $9,048.00 "," $1,347.83 "," $10,442.52 "," $10,744.50 "," $10,179.00 "," $10,179.00 "," $10,179.00 "," $10,518.30 "," $10,857.60 "," $9,790.40 "," $9,613.50 "," $9,303.89 "," $9,968.24 ", N/A ," $8,665.77 "," $8,665.77 "," $10,744.50 "," $10,185.36 "," $1,347.83 "," $10,857.60 "
"US, Preg Uter,Fetal & Mat,1st Trimest",76801,N/A,N/A,N/A, $410.00 , $266.50 , $670.60 , $116.85 , $118.45 , $595.71 , $671.89 , $381.30 , $369.00 , $369.00 , $328.00 , $328.00 , $118.45 , $378.55 , $389.50 , $369.00 , $369.00 , $369.00 , $381.30 , $393.60 , $675.55 , $348.50 , $729.97 , $695.54 , N/A , $607.33 , $607.33 , $389.50 , $702.99 , $116.85 , $729.97 
 Fac Alkaloids Not Otherwise Specified ,CPT® 80323,0301 - LAB/CHEMISTRY,N/A,N/A, $180.00 , $117.00 , $151.20 , N/A , N/A , $145.44 , $162.00 , $152.39 , $162.00 , $162.00 , $162.00 , $153.00 , N/A , $166.19 , $171.00 , $153.00 , $167.40 , $167.40 , $171.00 , $172.80 , $147.28 , $162.00 , $153.00 , $142.20 , N/A , $145.67 , $145.67 , $171.00 , $154.46 , $142.20 , $172.80 
Treat Coccygeal Fracture,27200,N/A,N/A,N/A, $846.00 , $549.90 ," $1,170.59 ", $184.65 , $153.67 , $906.11 , $916.94 , $786.78 , $761.40 , $761.40 , $676.80 , $676.80 , $153.67 , $781.11 , $803.70 , $761.40 , $761.40 , $761.40 , $786.78 , $812.16 ," $1,071.83 ", $719.10 ," $1,004.43 "," $1,083.76 ", N/A , $923.79 , $923.79 , $803.70 ," $1,085.79 ", $153.67 ," $1,170.59 "
 Pro Njx Cholangio Prq W/Img Gid Rs&I Existing Access ,CPT® 47531,0982 - PRO FEE/OUTPT,N/A,N/A, $921.00 , $598.65 , $431.15 , $66.92 , $442.90 , $467.46 , $344.35 , $856.53 , $828.90 , $828.90 , $736.80 , $736.80 , $442.90 , $850.36 , $874.95 , $828.90 , $828.90 , $828.90 , $856.53 , $884.16 , $311.91 , $782.85 , $364.27 , $417.03 , N/A , $476.58 , $476.58 , $874.95 , $498.45 , $66.92 , $884.16 
 DOCETAXEL 80 MG/4ML IV CONC ,HCPCS J9171,0636 - DRUGS REQUIRING DETAILED CODIN,25021-0245-04,4 mL, $140.25 , $91.16 , $117.81 , $0.96 , $0.59 , $113.32 , $126.23 , $118.74 , $126.23 , $126.23 , $126.23 , $119.21 , $0.58 , $129.49 , $133.24 , $119.21 , $130.43 , $130.43 , $133.24 , $134.64 , $114.75 , $126.23 , $119.21 , $110.80 , N/A , $113.50 , $113.50 , $133.24 , $120.35 , $0.58 , $134.64 
 CLOZAPINE 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-7089-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 RISPERIDONE 0.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6358-61,1 tablet, $20.20 , $13.13 , $16.97 , N/A , N/A , $16.32 , $18.18 , $17.10 , $18.18 , $18.18 , $18.18 , $17.17 , N/A , $18.65 , $19.19 , $17.17 , $18.79 , $18.79 , $19.19 , $19.39 , $16.53 , $18.18 , $17.17 , $15.96 , N/A , $16.35 , $16.35 , $19.19 , $17.33 , $15.96 , $19.39 
 Fac Assay of Urea Nitrogen ,CPT® 84520,0301 - LAB/CHEMISTRY,N/A,N/A, $70.00 , $45.50 , $58.80 , $4.03 , $4.03 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $3.95 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $3.95 , $67.20 
" Urethrocystogram, Retrograde ",CPT® 74450,0320 - DX X-RAY,N/A,N/A, $679.00 , $441.35 , $570.36 , $75.59 , $74.28 , $548.63 , $611.10 , $574.84 , $611.10 , $611.10 , $611.10 , $577.15 , $72.82 , $626.92 , $645.05 , $577.15 , $631.47 , $631.47 , $645.05 , $651.84 , $555.56 , $611.10 , $577.15 , $536.41 , N/A , $549.51 , $549.51 , $645.05 , $582.65 , $72.82 , $651.84 
Open Rx Dist Tib/Fib Jt Disrupt,27829,N/A,N/A,N/A," $3,591.00 "," $2,334.15 "," $4,358.71 ", $680.77 , $390.51 ," $3,306.79 "," $3,316.74 "," $3,339.63 "," $3,231.90 "," $3,231.90 "," $2,872.80 "," $2,872.80 ", $390.51 ," $3,315.57 "," $3,411.45 "," $3,231.90 "," $3,231.90 "," $3,231.90 "," $3,339.63 "," $3,447.36 "," $4,042.74 "," $3,052.35 "," $3,655.55 "," $3,972.04 ", N/A ," $3,371.32 "," $3,371.32 "," $3,411.45 "," $3,962.48 ", $390.51 ," $4,358.71 "
Assay Blood Carbon Monoxide,CPT® 82375,N/A,N/A,N/A, $142.00 , $92.30 , N/A , $12.57 , $12.57 , $69.72 , $83.41 , $132.06 , $127.80 , $127.80 , $113.60 , $113.60 , $12.57 , $131.11 , $134.90 , $127.80 , $127.80 , $127.80 , $132.06 , $136.32 , $82.26 , $120.70 , $81.09 , $44.67 , N/A , $65.07 , $65.07 , $134.90 , $71.10 , $12.57 , $136.32 
 Fac Exc B9 Les Mrgn Xcp Sk Tg S/N/H/F/G 0.6-1.0cm ,CPT® 11421,0761 - TREATMENT ROOM,N/A,N/A, $604.00 , $392.60 , $507.36 , $105.96 , $93.30 , $488.03 , $543.60 , $511.35 , $543.60 , $543.60 , $543.60 , $513.40 , $91.47 , $557.67 , $573.80 , $513.40 , $561.72 , $561.72 , $573.80 , $579.84 , $494.19 , $543.60 , $513.40 , $477.16 , N/A , $488.82 , $488.82 , $573.80 , $518.29 , $91.47 , $579.84 
Home/Res Visit Est Patient Mod Mdm 40 Minutes,CPT® 99349,N/A,N/A,N/A, $328.00 , $213.20 , $256.54 , $124.28 , $100.42 , $221.05 , $221.63 , $305.04 , $295.20 , $295.20 , $262.40 , $262.40 , $100.42 , $302.84 , $311.60 , $295.20 , $295.20 , $295.20 , $305.04 , $314.88 , $233.75 , $278.80 , $275.29 , $281.82 , $192.00 , $225.37 , $225.37 , $311.60 , $259.93 , $100.42 , $314.88 
App Skn Sub Grft T/a/L Area/>100scm 1st 100scm,CPT® 15273,N/A,N/A,N/A," $2,017.00 "," $1,311.05 ", $619.55 , $182.21 , $227.35 , $549.91 , $508.82 ," $1,875.81 "," $1,815.30 "," $1,815.30 "," $1,613.60 "," $1,613.60 ", $227.35 ," $1,862.30 "," $1,916.15 "," $1,815.30 "," $1,815.30 "," $1,815.30 "," $1,875.81 "," $1,936.32 ", $682.93 ," $1,714.45 "," $1,022.27 ", $702.31 , N/A , $560.64 , $560.64 ," $1,916.15 ", $650.16 , $182.21 ," $1,936.32 "
" Fac Cytomed, Dna, Amp Probe ",CPT® 87493,0306 - LAB/BACT-MICRO,N/A,N/A, $324.00 , $210.60 , $272.16 , $38.02 , $38.02 , $261.79 , $291.60 , $274.30 , $291.60 , $291.60 , $291.60 , $275.40 , $37.27 , $299.15 , $307.80 , $275.40 , $301.32 , $301.32 , $307.80 , $311.04 , $265.10 , $291.60 , $275.40 , $255.96 , N/A , $262.21 , $262.21 , $307.80 , $278.02 , $37.27 , $311.04 
Adj Tiss Xfer Trunk 10.1-30,14001,N/A,N/A,N/A," $4,196.00 "," $2,727.40 "," $2,066.42 ", $619.33 , $329.01 ," $1,779.65 "," $1,751.98 "," $3,902.28 "," $3,776.40 "," $3,776.40 "," $3,356.80 "," $3,356.80 ", $329.01 ," $3,874.17 "," $3,986.20 "," $3,776.40 "," $3,776.40 "," $3,776.40 "," $3,902.28 "," $4,028.16 "," $2,257.71 "," $3,566.60 "," $3,502.12 "," $2,284.00 ", N/A ," $1,814.37 "," $1,814.37 "," $3,986.20 "," $2,104.04 ", $329.01 ," $4,028.16 "
 Fac Slctv Cath Plmt Ven Sys 1st Order Branch ,CPT® 36011,0360 - OR SERVICES,N/A,N/A," $1,295.00 ", $841.75 ," $1,087.80 ", $143.95 , $828.27 ," $1,046.36 "," $1,165.50 "," $1,096.35 "," $1,165.50 "," $1,165.50 "," $1,165.50 "," $1,100.75 ", $812.03 ," $1,195.67 "," $1,230.25 "," $1,100.75 "," $1,204.35 "," $1,204.35 "," $1,230.25 "," $1,243.20 "," $1,059.57 "," $1,165.50 "," $1,100.75 "," $1,023.05 ", N/A ," $1,048.04 "," $1,048.04 "," $1,230.25 "," $1,111.24 ", $143.95 ," $1,243.20 "
 Regadenoson 0.1 Mg (Lexiscan) ,HCPCS J2785,0255 - DRUGS/RADIOLOGY,N/A,N/A, $336.00 , $218.40 , $282.24 , $63.53 , $63.23 , $271.49 , $302.40 , $284.46 , $302.40 , $302.40 , $302.40 , $285.60 , $61.99 , $310.23 , $319.20 , $285.60 , $312.48 , $312.48 , $319.20 , $322.56 , $274.92 , $302.40 , $285.60 , $265.44 , N/A , $271.92 , $271.92 , $319.20 , $288.32 , $61.99 , $322.56 
Rpr Aa Hernia Recr > 10 Cm Ncrc8/Strangulated,CPT® 49618,N/A,N/A,N/A," $10,170.00 "," $6,610.50 ", N/A ," $1,134.33 ", $885.34 , N/A , N/A ," $9,458.10 "," $9,153.00 "," $9,153.00 "," $8,136.00 "," $8,136.00 ", $885.34 ," $9,389.96 "," $9,661.50 "," $9,153.00 "," $9,153.00 "," $9,153.00 "," $9,458.10 "," $9,763.20 ", N/A ," $8,644.50 "," $6,567.58 ", N/A , N/A ," $4,883.41 "," $4,883.41 "," $9,661.50 "," $5,112.51 ", $885.34 ," $9,763.20 "
Repr Ao/Grt Vessel W Cp Bypass,CPT® 33322,N/A,N/A,N/A," $8,650.00 "," $5,622.50 "," $8,141.19 "," $1,257.64 "," $2,378.00 "," $5,920.31 "," $5,911.06 "," $8,044.50 "," $7,785.00 "," $7,785.00 "," $6,920.00 "," $6,920.00 "," $2,378.00 "," $7,986.55 "," $8,217.50 "," $7,785.00 "," $7,785.00 "," $7,785.00 "," $8,044.50 "," $8,304.00 "," $7,525.90 "," $7,352.50 "," $7,477.01 "," $6,668.35 ", N/A ," $6,035.83 "," $6,035.83 "," $8,217.50 "," $6,856.71 "," $1,257.64 "," $8,304.00 "
G Compression Stocking,HCPCS A6549,N/A,N/A,N/A, $139.00 , $90.35 , N/A , N/A , $152.59 , N/A , N/A , $129.27 , $125.10 , $125.10 , $111.20 , $111.20 , $152.59 , $128.34 , $132.05 , $125.10 , $125.10 , $125.10 , $129.27 , $133.44 , N/A , $118.15 , $111.20 , N/A , N/A , N/A , N/A , $132.05 , N/A , $111.20 , $152.59 
 Fac Perq Sac Agmntj Bi W/WO Balo/Mchnl Dev 2/> Ndls ,CPT® 0201T,0761 - TREATMENT ROOM,N/A,N/A," $11,758.00 "," $7,642.70 "," $9,876.72 "," $1,855.01 ", N/A ," $9,500.46 "," $10,582.20 "," $9,954.32 "," $10,582.20 "," $10,582.20 "," $10,582.20 "," $9,994.30 ", N/A ," $10,856.16 "," $11,170.10 "," $9,994.30 "," $10,934.94 "," $10,934.94 "," $11,170.10 "," $11,287.68 "," $9,620.40 "," $10,582.20 "," $9,994.30 "," $9,288.82 ", N/A ," $9,515.75 "," $9,515.75 "," $11,170.10 "," $10,089.54 "," $1,855.01 "," $11,287.68 "
 Implain Spine Infusion Pump ,CPT® 62362,0360 - OR SERVICES,N/A,N/A," $8,523.00 "," $5,539.95 "," $7,159.32 ", $360.80 , $356.53 ," $6,886.58 "," $7,670.70 "," $7,215.57 "," $7,670.70 "," $7,670.70 "," $7,670.70 "," $7,244.55 ", $349.54 ," $7,869.29 "," $8,096.85 "," $7,244.55 "," $7,926.39 "," $7,926.39 "," $8,096.85 "," $8,182.08 "," $6,973.52 "," $7,670.70 "," $7,244.55 "," $6,733.17 ", N/A ," $6,897.66 "," $6,897.66 "," $8,096.85 "," $7,313.59 ", $349.54 ," $8,182.08 "
"Repair Recurr Femoral Hernia,Strang",CPT® 49557,N/A,N/A,N/A," $4,542.00 "," $2,952.30 "," $4,325.49 ", $669.87 , $741.96 ," $3,395.58 "," $3,428.98 "," $4,224.06 "," $4,087.80 "," $4,087.80 "," $3,633.60 "," $3,633.60 ", $741.96 ," $4,193.63 "," $4,314.90 "," $4,087.80 "," $4,087.80 "," $4,087.80 "," $4,224.06 "," $4,360.32 "," $3,091.37 "," $3,860.70 "," $3,812.54 "," $4,005.57 ", N/A ," $3,461.84 "," $3,461.84 "," $4,314.90 "," $3,620.72 ", $669.87 ," $4,360.32 "
"Inject Nerv Blck,Paravert Sympath",CPT® 64520,N/A,N/A,N/A, $723.00 , $469.95 , $418.86 , $81.46 , $161.66 , $454.37 , $440.17 , $672.39 , $650.70 , $650.70 , $578.40 , $578.40 , $161.66 , $667.55 , $686.85 , $650.70 , $650.70 , $650.70 , $672.39 , $694.08 , $450.20 , $614.55 , $428.18 , $487.79 , N/A , $463.24 , $463.24 , $686.85 , $496.95 , $81.46 , $694.08 
Hydrocortisone Sodium Succ I,HCPCS J1720,N/A,N/A,N/A, $30.00 , $19.50 , N/A , $17.86 , $18.27 , N/A , N/A , $27.90 , $27.00 , $27.00 , $24.00 , $24.00 , $18.27 , $27.70 , $28.50 , $27.00 , $27.00 , $27.00 , $27.90 , $28.80 , $19.20 , $25.50 , $8.43 , $23.30 , N/A , N/A , N/A , $28.50 , N/A , $8.43 , $28.80 
 Fac Dialysis Procedure ,CPT® 90999,0470 - AUDIOLOGY,N/A,N/A, $651.00 , $423.15 , $546.84 , N/A , N/A , $526.01 , $585.90 , $551.14 , $585.90 , $585.90 , $585.90 , $553.35 , N/A , $601.07 , $618.45 , $553.35 , $605.43 , $605.43 , $618.45 , $624.96 , $532.65 , $585.90 , $553.35 , $514.29 , N/A , $526.85 , $526.85 , $618.45 , $558.62 , $514.29 , $624.96 
"Hiv 1,Phenotyp Analys Dna/Rna,1-10 Drugs",CPT® 87903,N/A,N/A,N/A," $4,508.00 "," $2,930.20 ", N/A , $498.43 , $498.43 ," $2,764.62 "," $3,306.97 "," $4,192.44 "," $4,057.20 "," $4,057.20 "," $3,606.40 "," $3,606.40 ", $498.43 ," $4,162.24 "," $4,282.60 "," $4,057.20 "," $4,057.20 "," $4,057.20 "," $4,192.44 "," $4,327.68 "," $3,262.89 "," $3,831.80 "," $3,201.52 "," $1,771.83 ", N/A ," $2,580.12 "," $2,580.12 "," $4,282.60 "," $2,819.52 ", $498.43 ," $4,327.68 "
" Anoscopy,Remove Lesn,Forceps/Cauter ",CPT® 46610,0360 - OR SERVICES,N/A,N/A," $4,052.00 "," $2,633.80 "," $3,403.68 ", $75.19 , $45.35 ," $3,274.02 "," $3,646.80 "," $3,430.42 "," $3,646.80 "," $3,646.80 "," $3,646.80 "," $3,444.20 ", $44.46 ," $3,741.21 "," $3,849.40 "," $3,444.20 "," $3,768.36 "," $3,768.36 "," $3,849.40 "," $3,889.92 "," $3,315.35 "," $3,646.80 "," $3,444.20 "," $3,201.08 ", N/A ," $3,279.28 "," $3,279.28 "," $3,849.40 "," $3,477.02 ", $44.46 ," $3,889.92 "
 METFORMIN HCL ER 500 MG PO TB24 ,HCPCS RXC637,0250 - PHARMACY,62756-0142-01,1 tablet, $3.83 , $2.49 , $3.22 , N/A , N/A , $3.09 , $3.45 , $3.24 , $3.45 , $3.45 , $3.45 , $3.26 , N/A , $3.54 , $3.64 , $3.26 , $3.56 , $3.56 , $3.64 , $3.68 , $3.13 , $3.45 , $3.26 , $3.03 , N/A , $3.10 , $3.10 , $3.64 , $3.29 , $3.03 , $3.68 
 Fac Prq Portal Vein Catheterization Any Method ,CPT® 36481,0360 - OR SERVICES,N/A,N/A," $1,588.00 "," $1,032.20 "," $1,333.92 ", $308.73 , $719.04 ," $1,283.10 "," $1,429.20 "," $1,344.40 "," $1,429.20 "," $1,429.20 "," $1,429.20 "," $1,349.80 ", $704.94 ," $1,466.20 "," $1,508.60 "," $1,349.80 "," $1,476.84 "," $1,476.84 "," $1,508.60 "," $1,524.48 "," $1,299.30 "," $1,429.20 "," $1,349.80 "," $1,254.52 ", N/A ," $1,285.17 "," $1,285.17 "," $1,508.60 "," $1,362.66 ", $308.73 ," $1,524.48 "
"Lap,Surg,Colectomy,W/Remvl Term Ileum",CPT® 44205,N/A,N/A,N/A," $9,356.00 "," $6,081.40 "," $7,983.76 "," $1,237.11 ", $953.25 ," $6,324.75 "," $6,381.30 "," $8,701.08 "," $8,420.40 "," $8,420.40 "," $7,484.80 "," $7,484.80 ", $953.25 ," $8,638.39 "," $8,888.20 "," $8,420.40 "," $8,420.40 "," $8,420.40 "," $8,701.08 "," $8,981.76 "," $5,722.40 "," $7,952.60 "," $7,080.95 "," $7,472.71 ", N/A ," $6,448.16 "," $6,448.16 "," $8,888.20 "," $6,744.10 ", $953.25 ," $8,981.76 "
" Fac Chg Methemoglobin, Transcutaneous, per Day ",CPT® 88741,0305 - LAB/HEMATOLOGY,N/A,N/A, $30.00 , $19.50 , $25.20 , $9.56 , $5.61 , $24.24 , $27.00 , $25.40 , $27.00 , $27.00 , $27.00 , $25.50 , $5.50 , $27.70 , $28.50 , $25.50 , $27.90 , $27.90 , $28.50 , $28.80 , $24.55 , $27.00 , $25.50 , $23.70 , N/A , $24.28 , $24.28 , $28.50 , $25.74 , $5.50 , $28.80 
Optx Dstl Radl I-Artic Fx/Epiphysl Sep 3 Frag,CPT® 25609,N/A,N/A,N/A," $4,563.00 "," $2,965.95 "," $6,398.99 "," $1,004.45 ", $779.80 ," $5,048.32 "," $5,020.87 "," $4,243.59 "," $4,106.70 "," $4,106.70 "," $3,650.40 "," $3,650.40 ", $779.80 ," $4,213.02 "," $4,334.85 "," $4,106.70 "," $4,106.70 "," $4,106.70 "," $4,243.59 "," $4,380.48 "," $5,947.48 "," $3,878.55 "," $5,535.95 "," $5,968.91 ", N/A ," $5,146.82 "," $5,146.82 "," $4,334.85 "," $6,049.35 ", $779.80 ," $6,398.99 "
Ureter Endoscopy,CPT® 50970,N/A,N/A,N/A," $2,585.00 "," $1,680.25 "," $1,986.74 ", $348.49 , $69.15 ," $1,820.77 "," $1,683.53 "," $2,404.05 "," $2,326.50 "," $2,326.50 "," $2,068.00 "," $2,068.00 ", $69.15 ," $2,386.73 "," $2,455.75 "," $2,326.50 "," $2,326.50 "," $2,326.50 "," $2,404.05 "," $2,481.60 "," $1,997.90 "," $2,197.25 "," $1,905.38 "," $2,283.75 ", N/A ," $1,856.30 "," $1,856.30 "," $2,455.75 "," $2,181.81 ", $69.15 ," $2,481.60 "
 MITOMYCIN 0.4 MG/ML EYE DROPS ,HCPCS J7315,0636 - DRUGS REQUIRING DETAILED CODIN,00001-0215-01,10 mL, $667.60 , $433.94 , $560.78 , N/A , N/A , $539.42 , $600.84 , $565.19 , $600.84 , $600.84 , $600.84 , $567.46 , N/A , $616.40 , $634.22 , $567.46 , $620.87 , $620.87 , $634.22 , $640.90 , $546.23 , $600.84 , $567.46 , $527.40 , N/A , $540.29 , $540.29 , $634.22 , $572.87 , $527.40 , $640.90 
 HEPATITIS A VACCINE 25 UNIT/0.5ML IM SUSP ,HCPCS RXC636,0636 - DRUGS REQUIRING DETAILED CODIN,00006-4831-41,0.5 mL, $231.84 , $150.70 , $194.75 , N/A , N/A , $187.33 , $208.66 , $196.28 , $208.66 , $208.66 , $208.66 , $197.06 , N/A , $214.06 , $220.25 , $197.06 , $215.61 , $215.61 , $220.25 , $222.57 , $189.69 , $208.66 , $197.06 , $183.15 , N/A , $187.63 , $187.63 , $220.25 , $198.94 , $183.15 , $222.57 
Iadna Human Papillomavirus High-Risk Types,CPT® 87624,N/A,N/A,N/A, $317.00 , $206.05 , N/A , $35.79 , $35.79 , $198.56 , $235.14 , $294.81 , $285.30 , $285.30 , $253.60 , $253.60 , $35.79 , $292.69 , $301.15 , $285.30 , $285.30 , $285.30 , $294.81 , $304.32 , $234.30 , $269.45 , $168.00 , $127.26 , N/A , $185.31 , $185.31 , $301.15 , $202.50 , $35.79 , $304.32 
 Pro Cltx Carp/Mtcrpl Dislc Thmb W/Mnpj ,CPT® 26641,0982 - PRO FEE/OUTPT,N/A,N/A," $2,457.00 "," $1,597.05 "," $2,367.82 ", $373.63 , $58.71 ," $1,653.94 "," $1,633.22 "," $2,285.01 "," $2,211.30 "," $2,211.30 "," $1,965.60 "," $1,965.60 ", $58.71 ," $2,268.55 "," $2,334.15 "," $2,211.30 "," $2,211.30 "," $2,211.30 "," $2,285.01 "," $2,358.72 "," $2,180.49 "," $2,088.45 "," $1,791.20 "," $1,971.42 ", N/A ," $1,686.21 "," $1,686.21 "," $2,334.15 "," $1,981.90 ", $58.71 ," $2,367.82 "
 Pro Removal of Nail Bed ,CPT® 11750,0975 - PRO FEE/OR,N/A,N/A, $813.00 , $528.45 , $330.85 , $98.28 , $111.46 , $478.76 , $468.04 , $756.09 , $731.70 , $731.70 , $650.40 , $650.40 , $111.46 , $750.64 , $772.35 , $731.70 , $731.70 , $731.70 , $756.09 , $780.48 , $362.83 , $691.05 , $918.79 , $362.76 , N/A , $488.10 , $488.10 , $772.35 , $566.03 , $98.28 , $918.79 
Intravascular US Noncoronary Rs&I Addl Vessel,CPT® 37253,N/A,N/A,N/A," $1,304.00 ", $847.60 , $416.85 , $64.41 , $170.41 , $317.08 , $306.66 ," $1,212.72 "," $1,173.60 "," $1,173.60 "," $1,043.20 "," $1,043.20 ", $170.41 ," $1,203.98 "," $1,238.80 "," $1,173.60 "," $1,173.60 "," $1,173.60 "," $1,212.72 "," $1,251.84 ", $387.94 ," $1,108.40 ", $366.05 , $354.24 , N/A , $323.26 , $323.26 ," $1,238.80 ", $367.23 , $64.41 ," $1,251.84 "
 Pro MRI Upper Extremity W/O Dye ,CPT® 73218,0972 - PRO FEE/RAD/DX,N/A,N/A," $2,668.00 "," $1,734.20 "," $1,992.48 ", $289.54 , $410.97 ," $1,731.44 "," $2,203.10 "," $2,481.24 "," $2,401.20 "," $2,401.20 "," $2,134.40 "," $2,134.40 ", $410.97 ," $2,463.36 "," $2,534.60 "," $2,401.20 "," $2,401.20 "," $2,401.20 "," $2,481.24 "," $2,561.28 "," $1,916.52 "," $2,267.80 "," $2,405.63 "," $3,384.37 ", N/A ," $1,765.22 "," $1,765.22 "," $2,534.60 "," $2,043.30 ", $289.54 ," $3,384.37 "
 Fac Rpr Lip Full Thkns > One-Half Ver H8/Cplx ,CPT® 40654,0761 - TREATMENT ROOM,N/A,N/A," $3,805.00 "," $2,473.25 "," $3,196.20 ", $411.10 , $539.88 ," $3,074.44 "," $3,424.50 "," $3,221.31 "," $3,424.50 "," $3,424.50 "," $3,424.50 "," $3,234.25 ", $529.29 ," $3,513.16 "," $3,614.75 "," $3,234.25 "," $3,538.65 "," $3,538.65 "," $3,614.75 "," $3,652.80 "," $3,113.25 "," $3,424.50 "," $3,234.25 "," $3,005.95 ", N/A ," $3,079.39 "," $3,079.39 "," $3,614.75 "," $3,265.07 ", $411.10 ," $3,652.80 "
Grad Comp Non-Elastic Bk,HCPCS A6545,N/A,N/A,N/A, $154.00 , $100.10 , N/A , $115.56 , $96.73 , N/A , N/A , $143.22 , $138.60 , $138.60 , $123.20 , $123.20 , $96.73 , $142.19 , $146.30 , $138.60 , $138.60 , $138.60 , $143.22 , $147.84 , N/A , $130.90 , $183.51 , $104.98 , N/A , N/A , N/A , $146.30 , N/A , $96.73 , $183.51 
 Fac Fmr1 Gene Analysis Characterization of Alleles ,CPT® 81244,0300 - LABORATORY,N/A,N/A, $369.00 , $239.85 , $309.96 , $45.79 , $45.79 , $298.15 , $332.10 , $312.40 , $332.10 , $332.10 , $332.10 , $313.65 , $44.89 , $340.70 , $350.55 , $313.65 , $343.17 , $343.17 , $350.55 , $354.24 , $301.92 , $332.10 , $313.65 , $291.51 , N/A , $298.63 , $298.63 , $350.55 , $316.64 , $44.89 , $354.24 
Sbsq Hospital IP/Obs Care Sf/Low Mdm 25 Minutes,CPT® 99231,N/A,N/A,N/A, $130.00 , $84.50 , $76.59 , $47.80 , $28.04 , $67.58 , $67.57 , $120.90 , $117.00 , $117.00 , $104.00 , $104.00 , $28.04 , $120.03 , $123.50 , $117.00 , $117.00 , $117.00 , $120.90 , $124.80 , $96.97 , $110.50 , $84.01 , $85.56 , $68.25 , $68.90 , $68.90 , $123.50 , $79.46 , $28.04 , $124.80 
Pcv15 Vaccine for Intramuscular Use,CPT® 90671,N/A,N/A,N/A, $318.00 , $206.70 , N/A , $251.12 , $235.71 , N/A , N/A , $295.74 , $286.20 , $286.20 , $254.40 , $254.40 , $235.71 , $293.61 , $302.10 , $286.20 , $286.20 , $286.20 , $295.74 , $305.28 , N/A , $270.30 , $734.03 , $355.04 , N/A , $506.31 , $506.31 , $302.10 , $589.37 , $235.71 , $734.03 
 Respiratory Infections And Inflammations With Cc ,MS DRG V40 (FY2023) 178,N/A,N/A,N/A," $24,169.84 "," $15,710.40 "," $20,302.67 ", N/A , N/A ," $19,529.23 "," $21,752.86 "," $20,462.19 "," $21,752.86 "," $21,752.86 "," $21,752.86 "," $20,544.36 ", N/A ," $22,316.01 "," $22,961.35 "," $20,544.36 "," $22,477.95 "," $22,477.95 "," $22,961.35 "," $23,203.05 "," $19,775.76 "," $21,752.86 "," $20,544.36 "," $19,094.17 ", N/A ," $19,560.65 "," $19,560.65 "," $22,961.35 "," $20,740.14 "," $19,094.17 "," $23,203.05 "
"Open Rx Trimalleolar Fx,Fix Post Lip",CPT® 27823,N/A,N/A,N/A," $6,706.00 "," $4,358.90 "," $6,030.18 ", $941.17 , $842.54 ," $4,620.81 "," $4,596.88 "," $6,236.58 "," $6,035.40 "," $6,035.40 "," $5,364.80 "," $5,364.80 ", $842.54 ," $6,191.65 "," $6,370.70 "," $6,035.40 "," $6,035.40 "," $6,035.40 "," $6,236.58 "," $6,437.76 "," $5,598.04 "," $5,700.10 "," $5,073.88 "," $5,538.36 ", N/A ," $4,710.97 "," $4,710.97 "," $6,370.70 "," $5,537.06 ", $842.54 ," $6,437.76 "
 Fac Veeg by Tech 2-12 Hr Continuous R-T Monitoring ,CPT® 95713,0740 - EEG,N/A,N/A," $1,731.00 "," $1,125.15 "," $1,454.04 ", $582.54 , $396.25 ," $1,398.65 "," $1,557.90 "," $1,465.46 "," $1,557.90 "," $1,557.90 "," $1,557.90 "," $1,471.35 ", $388.48 ," $1,598.23 "," $1,644.45 "," $1,471.35 "," $1,609.83 "," $1,609.83 "," $1,644.45 "," $1,661.76 "," $1,416.30 "," $1,557.90 "," $1,471.35 "," $1,367.49 ", N/A ," $1,400.90 "," $1,400.90 "," $1,644.45 "," $1,485.37 ", $388.48 ," $1,661.76 "
"Tint, Any Color/Solid/Grad",HCPCS V2745,N/A,N/A,N/A, $22.00 , $14.30 , N/A , $11.96 , N/A , N/A , N/A , $20.46 , $19.80 , $19.80 , $17.60 , $17.60 , N/A , $20.31 , $20.90 , $19.80 , $19.80 , $19.80 , $20.46 , $21.12 , N/A , $18.70 , $22.00 , $10.87 , N/A , N/A , N/A , $20.90 , N/A , $10.87 , $22.00 
 Fac Antidepressants Tricyclic Other Cyclicals 6/More ,CPT® 80337,0306 - LAB/BACT-MICRO,N/A,N/A, $193.00 , $125.45 , $162.12 , N/A , N/A , $155.94 , $173.70 , $163.39 , $173.70 , $173.70 , $173.70 , $164.05 , N/A , $178.20 , $183.35 , $164.05 , $179.49 , $179.49 , $183.35 , $185.28 , $157.91 , $173.70 , $164.05 , $152.47 , N/A , $156.19 , $156.19 , $183.35 , $165.61 , $152.47 , $185.28 
"Hep B Core Ab Test, Igm",CPT® 86705,N/A,N/A,N/A, $121.00 , $78.65 , N/A , $12.01 , $12.01 , $66.65 , $79.65 , $112.53 , $108.90 , $108.90 , $96.80 , $96.80 , $12.01 , $111.72 , $114.95 , $108.90 , $108.90 , $108.90 , $112.53 , $116.16 , $78.59 , $102.85 , $77.85 , $42.70 , N/A , $62.20 , $62.20 , $114.95 , $67.97 , $12.01 , $116.16 
"Fix Lid Ptosis,Fasanella-Servat",CPT® 67908,N/A,N/A,N/A," $4,832.00 "," $3,140.80 "," $2,661.82 ", $418.16 , $691.53 ," $2,401.42 "," $2,276.23 "," $4,493.76 "," $4,348.80 "," $4,348.80 "," $3,865.60 "," $3,865.60 ", $691.53 ," $4,461.39 "," $4,590.40 "," $4,348.80 "," $4,348.80 "," $4,348.80 "," $4,493.76 "," $4,638.72 "," $3,644.06 "," $4,107.20 "," $2,362.10 "," $3,053.09 ", N/A ," $2,448.27 "," $2,448.27 "," $4,590.40 "," $2,702.58 ", $418.16 ," $4,638.72 "
 ARIPIPRAZOLE 2 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,65162-0896-03,1 tablet, $164.77 , $107.10 , $138.41 , N/A , N/A , $133.13 , $148.29 , $139.49 , $148.29 , $148.29 , $148.29 , $140.05 , N/A , $152.13 , $156.53 , $140.05 , $153.24 , $153.24 , $156.53 , $158.18 , $134.81 , $148.29 , $140.05 , $130.17 , N/A , $133.35 , $133.35 , $156.53 , $141.39 , $130.17 , $158.18 
 Pro Removal of Breast Tissue ,CPT® 19300,0982 - PRO FEE/OUTPT,N/A,N/A," $3,111.00 "," $2,022.15 "," $1,372.89 ", $410.11 , $397.21 ," $1,113.74 "," $1,088.11 "," $2,893.23 "," $2,799.90 "," $2,799.90 "," $2,488.80 "," $2,488.80 ", $397.21 ," $2,872.39 "," $2,955.45 "," $2,799.90 "," $2,799.90 "," $2,799.90 "," $2,893.23 "," $2,986.56 "," $1,482.91 "," $2,644.35 "," $2,187.26 "," $1,423.88 ", N/A ," $1,135.47 "," $1,135.47 "," $2,955.45 "," $1,316.75 ", $397.21 ," $2,986.56 "
Incise/Drain Conjunctiva,CPT® 68020,N/A,N/A,N/A," $1,087.00 ", $706.55 , $682.05 , $106.98 , $76.21 , $624.75 , $587.61 ," $1,010.91 ", $978.30 , $978.30 , $869.60 , $869.60 , $76.21 ," $1,003.63 "," $1,032.65 ", $978.30 , $978.30 , $978.30 ," $1,010.91 "," $1,043.52 ", $938.49 , $923.95 , $603.01 , $794.82 , N/A , $636.95 , $636.95 ," $1,032.65 ", $703.08 , $76.21 ," $1,043.52 "
 Fac Assay of Ammonia ,CPT® 82140,0301 - LAB/CHEMISTRY,N/A,N/A, $135.00 , $87.75 , $113.40 , $14.86 , $14.86 , $109.08 , $121.50 , $114.29 , $121.50 , $121.50 , $121.50 , $114.75 , $14.57 , $124.65 , $128.25 , $114.75 , $125.55 , $125.55 , $128.25 , $129.60 , $110.46 , $121.50 , $114.75 , $106.65 , N/A , $109.26 , $109.26 , $128.25 , $115.84 , $14.57 , $129.60 
Telehealth Facility Fee,HCPCS Q3014,N/A,N/A,N/A, $78.00 , $50.70 , N/A , N/A , $23.14 , N/A , N/A , $72.54 , $70.20 , $70.20 , $62.40 , $62.40 , $23.14 , $72.02 , $74.10 , $70.20 , $70.20 , $70.20 , $72.54 , $74.88 , N/A , $66.30 , $54.92 , $99.64 , N/A , N/A , N/A , $74.10 , N/A , $23.14 , $99.64 
" Fac Immunoassay, Ria ",CPT® 83520,0302 - LAB/IMMUNOLOGY,N/A,N/A, $227.00 , $147.55 , $190.68 , $17.62 , $17.62 , $183.42 , $204.30 , $192.18 , $204.30 , $204.30 , $204.30 , $192.95 , $17.27 , $209.59 , $215.65 , $192.95 , $211.11 , $211.11 , $215.65 , $217.92 , $185.73 , $204.30 , $192.95 , $179.33 , N/A , $183.71 , $183.71 , $215.65 , $194.79 , $17.27 , $217.92 
" Fac Hsv, Dna, Amp Probe ",CPT® 87529,0300 - LABORATORY,N/A,N/A, $324.00 , $210.60 , $272.16 , $35.79 , $35.79 , $261.79 , $291.60 , $274.30 , $291.60 , $291.60 , $291.60 , $275.40 , $35.09 , $299.15 , $307.80 , $275.40 , $301.32 , $301.32 , $307.80 , $311.04 , $265.10 , $291.60 , $275.40 , $255.96 , N/A , $262.21 , $262.21 , $307.80 , $278.02 , $35.09 , $311.04 
Initial Nursing Facility Care Hi Mdm 45 Minutes,CPT® 99306,N/A,N/A,N/A, $442.00 , $287.30 , $329.36 , $177.88 , $92.90 , $288.18 , $289.89 , $411.06 , $397.80 , $397.80 , $353.60 , $353.60 , $92.90 , $408.10 , $419.90 , $397.80 , $397.80 , $397.80 , $411.06 , $424.32 , $420.19 , $375.70 , $362.30 , $354.95 , $330.00 , $293.81 , $293.81 , $419.90 , $338.87 , $92.90 , $424.32 
 Admin Pfizer-Biontech Bivalent Booster 12 Yrs and Older ,CPT® 0124A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
 Pro Excision Tumor Soft Tissue Foot/Toe Subq 1.5+Cm ,CPT® 28039,0982 - PRO FEE/OUTPT,N/A,N/A," $3,578.00 "," $2,325.70 "," $2,127.19 ", $329.68 , $397.09 ," $1,713.47 "," $1,737.33 "," $3,327.54 "," $3,220.20 "," $3,220.20 "," $2,862.40 "," $2,862.40 ", $397.09 ," $3,303.57 "," $3,399.10 "," $3,220.20 "," $3,220.20 "," $3,220.20 "," $3,327.54 "," $3,434.88 "," $1,977.95 "," $3,041.30 "," $1,882.19 "," $2,022.19 ", N/A ," $1,746.91 "," $1,746.91 "," $3,399.10 "," $2,053.23 ", $329.68 ," $3,434.88 "
 Fac Who W Nontor Jnt(S) Prefab ,HCPCS L3915,0274 - PROSTHETIC DEV,N/A,N/A, $596.00 , $387.40 , $500.64 , $565.90 , $391.96 , $481.57 , $536.40 , $504.57 , $536.40 , $536.40 , $536.40 , $506.60 , $384.27 , $550.29 , $566.20 , $506.60 , $554.28 , $554.28 , $566.20 , $572.16 , $487.65 , $536.40 , $506.60 , $470.84 , N/A , $482.34 , $482.34 , $566.20 , $511.43 , $384.27 , $572.16 
"Fix Collat Lig,MC-P Jt,I-P Jt",CPT® 26540,N/A,N/A,N/A," $4,337.00 "," $2,819.05 "," $4,405.25 ", $684.89 , $537.90 ," $3,119.30 "," $3,169.57 "," $4,033.41 "," $3,903.30 "," $3,903.30 "," $3,469.60 "," $3,469.60 ", $537.90 ," $4,004.35 "," $4,120.15 "," $3,903.30 "," $3,903.30 "," $3,903.30 "," $4,033.41 "," $4,163.52 "," $4,038.64 "," $3,686.45 "," $3,473.57 "," $3,729.96 ", N/A ," $3,180.16 "," $3,180.16 "," $4,120.15 "," $3,737.80 ", $537.90 ," $4,405.25 "
" Fac Virus Inoculation, Shell Via ",CPT® 87254,0305 - LAB/HEMATOLOGY,N/A,N/A, $202.00 , $131.30 , $169.68 , $19.95 , $6.97 , $163.22 , $181.80 , $171.01 , $181.80 , $181.80 , $181.80 , $171.70 , $6.83 , $186.51 , $191.90 , $171.70 , $187.86 , $187.86 , $191.90 , $193.92 , $165.28 , $181.80 , $171.70 , $159.58 , N/A , $163.48 , $163.48 , $191.90 , $173.34 , $6.83 , $193.92 
" Fac Tte W or W/O Fol W/Cont, F/U ",HCPCS C8922,0480 - CARDIOLOGY,N/A,N/A," $1,215.00 ", $789.75 ," $1,020.60 ", N/A , N/A , $981.72 ," $1,093.50 "," $1,028.62 "," $1,093.50 "," $1,093.50 "," $1,093.50 "," $1,032.75 ", N/A ," $1,121.81 "," $1,154.25 "," $1,032.75 "," $1,129.95 "," $1,129.95 "," $1,154.25 "," $1,166.40 ", $994.11 ," $1,093.50 "," $1,032.75 ", $959.85 , N/A , $983.30 , $983.30 ," $1,154.25 "," $1,042.59 ", $959.85 ," $1,166.40 "
Office/Outpatient Established High Mdm 40-54 Min,CPT® 99215,N/A,N/A,N/A, $394.00 , $256.10 , $292.89 , $139.34 , $94.97 , $192.33 , $191.18 , $366.42 , $354.60 , $354.60 , $315.20 , $315.20 , $94.97 , $363.78 , $374.30 , $354.60 , $354.60 , $354.60 , $366.42 , $378.24 , $266.74 , $334.90 , $237.78 , $242.86 , $128.75 , $196.08 , $196.08 , $374.30 , $226.13 , $94.97 , $378.24 
"Cholecystostomy,Percut",CPT® 47490,N/A,N/A,N/A," $2,372.00 "," $1,541.80 "," $2,067.07 ", $320.90 , $457.32 ," $1,616.47 "," $1,632.67 "," $2,205.96 "," $2,134.80 "," $2,134.80 "," $1,897.60 "," $1,897.60 ", $457.32 ," $2,190.07 "," $2,253.40 "," $2,134.80 "," $2,134.80 "," $2,134.80 "," $2,205.96 "," $2,277.12 "," $1,487.86 "," $2,016.20 "," $1,755.52 "," $1,925.21 ", N/A ," $1,648.00 "," $1,648.00 "," $2,253.40 "," $1,723.63 ", $320.90 ," $2,277.12 "
 Exc Abd Tumor/Cyst 5cm or Less; Open ,CPT® 49203,0360 - OR SERVICES,N/A,N/A," $8,321.00 "," $5,408.65 "," $6,989.64 "," $1,109.35 ", $814.42 ," $6,723.37 "," $7,488.90 "," $7,044.56 "," $7,488.90 "," $7,488.90 "," $7,488.90 "," $7,072.85 ", $798.45 ," $7,682.78 "," $7,904.95 "," $7,072.85 "," $7,738.53 "," $7,738.53 "," $7,904.95 "," $7,988.16 "," $6,808.24 "," $7,488.90 "," $7,072.85 "," $6,573.59 ", N/A ," $6,734.19 "," $6,734.19 "," $7,904.95 "," $7,140.25 ", $798.45 ," $7,988.16 "
 CARFILZOMIB 60 MG IV SOLR ,HCPCS J9047,0636 - DRUGS REQUIRING DETAILED CODIN,76075-0101-01,30 mL," $8,759.78 "," $5,693.86 "," $7,358.22 ", $47.98 , $45.96 ," $7,077.90 "," $7,883.80 "," $7,416.03 "," $7,883.80 "," $7,883.80 "," $7,883.80 "," $7,445.81 ", $45.06 ," $8,087.90 "," $8,321.79 "," $7,445.81 "," $8,146.60 "," $8,146.60 "," $8,321.79 "," $8,409.39 "," $7,167.25 "," $7,883.80 "," $7,445.81 "," $6,920.23 ", N/A ," $7,089.29 "," $7,089.29 "," $8,321.79 "," $7,516.77 ", $45.06 ," $8,409.39 "
 Fac Ft Arch Suprt Premold Longit ,HCPCS L3040,0274 - PROSTHETIC DEV,N/A,N/A, $94.00 , $61.10 , $78.96 , $55.06 , $38.14 , $75.95 , $84.60 , $79.58 , $84.60 , $84.60 , $84.60 , $79.90 , $37.39 , $86.79 , $89.30 , $79.90 , $87.42 , $87.42 , $89.30 , $90.24 , $76.91 , $84.60 , $79.90 , $74.26 , N/A , $76.07 , $76.07 , $89.30 , $80.66 , $37.39 , $90.24 
 Pro Removal Impacted Cerumen Irrigation/Lvg Unilat ,CPT® 69209,0982 - PRO FEE/OUTPT,N/A,N/A, $111.00 , $72.15 , $72.25 , $14.88 , $9.93 , $59.81 , $59.38 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $9.93 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $77.94 , $94.35 , $81.74 , $68.74 , N/A , $60.98 , $60.98 , $105.45 , $69.62 , $9.93 , $106.56 
 SODIUM CHLORIDE 0.9 % IR SOLN ,HCPCS RXA258,0258 - IV SOLUTIONS,00990-7138-09,"1,000 mL", $35.00 , $22.75 , $29.40 , N/A , N/A , $28.28 , $31.50 , $29.63 , $31.50 , $31.50 , $31.50 , $29.75 , N/A , $32.32 , $33.25 , $29.75 , $32.55 , $32.55 , $33.25 , $33.60 , $28.64 , $31.50 , $29.75 , $27.65 , N/A , $28.33 , $28.33 , $33.25 , $30.03 , $27.65 , $33.60 
Active Wound Care/20 Cm or <,97597,N/A,N/A,N/A, $242.00 , $157.30 , $82.90 , $34.49 , $43.20 , $54.44 , $46.92 , $225.06 , $217.80 , $217.80 , $193.60 , $193.60 , $43.20 , $223.44 , $229.90 , $217.80 , $217.80 , $217.80 , $225.06 , $232.32 , $109.43 , $205.70 , $69.95 , $54.53 , N/A , $55.50 , $55.50 , $229.90 , $61.73 , $34.49 , $232.32 
 Pro Arthrocnts Aspir&/Njx Intrm Jt/Bursa ,CPT® 20605,0982 - PRO FEE/OUTPT,N/A,N/A, $382.00 , $248.30 , $226.79 , $35.10 , $50.55 , $181.29 , $253.86 , $355.26 , $343.80 , $343.80 , $305.60 , $305.60 , $50.55 , $352.70 , $362.90 , $343.80 , $343.80 , $343.80 , $355.26 , $366.72 , $211.99 , $324.70 , $276.53 , $217.48 , N/A , $184.83 , $184.83 , $362.90 , $217.21 , $35.10 , $366.72 
 Koh/Calcaflour Beaker1 ,CPT® 87206,0306 - LAB/BACT-MICRO,N/A,N/A, $88.00 , $57.20 , $73.92 , $5.50 , $5.50 , $71.10 , $79.20 , $74.50 , $79.20 , $79.20 , $79.20 , $74.80 , $5.39 , $81.25 , $83.60 , $74.80 , $81.84 , $81.84 , $83.60 , $84.48 , $72.00 , $79.20 , $74.80 , $69.52 , N/A , $71.22 , $71.22 , $83.60 , $75.51 , $5.39 , $84.48 
Galactose-1-Phosphate Uridyl Trase Quan,CPT® 82775,N/A,N/A,N/A, $164.00 , $106.60 , N/A , $21.49 , $21.49 , $119.19 , $142.59 , $152.52 , $147.60 , $147.60 , $131.20 , $131.20 , $21.49 , $151.42 , $155.80 , $147.60 , $147.60 , $147.60 , $152.52 , $157.44 , $140.69 , $139.40 , $137.86 , $76.39 , N/A , $111.24 , $111.24 , $155.80 , $121.56 , $21.49 , $157.44 
 Sternum Min 2vw- Mh ,CPT® 71120,0972 - PRO FEE/RAD/DX,N/A,N/A, $124.00 , $80.60 , $190.70 , $33.07 , $30.96 , $138.99 , $168.19 , $115.32 , $111.60 , $111.60 , $99.20 , $99.20 , $30.96 , $114.49 , $117.80 , $111.60 , $111.60 , $111.60 , $115.32 , $119.04 , $184.35 , $105.40 , $182.97 , $149.74 , N/A , $141.70 , $141.70 , $117.80 , $164.02 , $30.96 , $190.70 
 Fac Nushield 1 Square Cm ,HCPCS Q4160,0636 - DRUGS REQUIRING DETAILED CODIN,N/A,N/A," $1,049.00 ", $681.85 , $881.16 , $94.77 , N/A , $847.59 , $944.10 , $888.08 , $944.10 , $944.10 , $944.10 , $891.65 , N/A , $968.54 , $996.55 , $891.65 , $975.57 , $975.57 , $996.55 ," $1,007.04 ", $858.29 , $944.10 , $891.65 , $828.71 , N/A , $848.96 , $848.96 , $996.55 , $900.15 , $94.77 ," $1,007.04 "
Ndsc Eval Intstinal Pouch W/Bx Single/Multiple,44386,N/A,N/A,N/A," $2,755.00 "," $1,790.75 ", $545.68 , $84.77 , $40.17 , $606.60 , $622.85 ," $2,562.15 "," $2,479.50 "," $2,479.50 "," $2,204.00 "," $2,204.00 ", $40.17 ," $2,543.69 "," $2,617.25 "," $2,479.50 "," $2,479.50 "," $2,479.50 "," $2,562.15 "," $2,644.80 ", $390.64 ," $2,341.75 ", $683.30 , $516.96 , N/A , $618.44 , $618.44 ," $2,617.25 ", $646.83 , $40.17 ," $2,644.80 "
 Fac Ercp W/Biopsy Single/Multiple ,CPT® 43261,0360 - OR SERVICES,N/A,N/A," $4,233.00 "," $2,751.45 "," $3,555.72 ", $320.21 , $474.19 ," $3,420.26 "," $3,809.70 "," $3,583.66 "," $3,809.70 "," $3,809.70 "," $3,809.70 "," $3,598.05 ", $464.89 ," $3,908.33 "," $4,021.35 "," $3,598.05 "," $3,936.69 "," $3,936.69 "," $4,021.35 "," $4,063.68 "," $3,463.44 "," $3,809.70 "," $3,598.05 "," $3,344.07 ", N/A ," $3,425.77 "," $3,425.77 "," $4,021.35 "," $3,632.34 ", $320.21 ," $4,063.68 "
"Destr Malig Trunk,Extrem <0.6 Cm",CPT® 17260,N/A,N/A,N/A, $512.00 , $332.80 , $228.04 , $68.42 , $73.88 , $190.38 , $186.72 , $476.16 , $460.80 , $460.80 , $409.60 , $409.60 , $73.88 , $472.73 , $486.40 , $460.80 , $460.80 , $460.80 , $476.16 , $491.52 , $249.07 , $435.20 , $371.09 , $245.29 , N/A , $194.08 , $194.08 , $486.40 , $225.08 , $68.42 , $491.52 
Remove Knee Cyst/Ganglion,CPT® 27347,N/A,N/A,N/A," $3,532.00 "," $2,295.80 "," $3,215.49 ", $507.35 , $284.75 ," $2,549.78 "," $2,548.63 "," $3,284.76 "," $3,178.80 "," $3,178.80 "," $2,825.60 "," $2,825.60 ", $284.75 ," $3,261.10 "," $3,355.40 "," $3,178.80 "," $3,178.80 "," $3,178.80 "," $3,284.76 "," $3,390.72 "," $2,993.87 "," $3,002.20 "," $2,811.68 "," $3,008.23 ", N/A ," $2,599.53 "," $2,599.53 "," $3,355.40 "," $3,055.38 ", $284.75 ," $3,390.72 "
"Hysteroscopy,Rmv Myoma",CPT® 58561,N/A,N/A,N/A," $4,458.00 "," $2,897.70 "," $1,666.25 ", $336.94 , $485.88 ," $2,227.26 "," $2,213.94 "," $4,145.94 "," $4,012.20 "," $4,012.20 "," $3,566.40 "," $3,566.40 ", $485.88 ," $4,116.07 "," $4,235.10 "," $4,012.20 "," $4,012.20 "," $4,012.20 "," $4,145.94 "," $4,279.68 "," $1,755.35 "," $3,789.30 "," $2,915.16 "," $1,488.80 ", N/A ," $2,270.72 "," $2,270.72 "," $4,235.10 "," $2,723.58 ", $336.94 ," $4,279.68 "
"Total Disc Arthroplasty, Cervical, Single",22856,N/A,N/A,N/A," $11,033.00 "," $7,171.45 "," $9,507.42 "," $1,481.65 "," $1,425.60 "," $7,694.81 "," $7,822.79 "," $10,260.69 "," $9,929.70 "," $9,929.70 "," $8,826.40 "," $8,826.40 "," $1,425.60 "," $10,186.77 "," $10,481.35 "," $9,929.70 "," $9,929.70 "," $9,929.70 "," $10,260.69 "," $10,591.68 "," $8,863.31 "," $9,378.05 "," $8,836.47 "," $9,023.67 ", N/A ," $7,844.95 "," $7,844.95 "," $10,481.35 "," $9,220.60 "," $1,425.60 "," $10,591.68 "
 Fac Hrhc Smpl ,CPT® 46255,0361 - OR/MINOR,N/A,N/A," $4,994.00 "," $3,246.10 "," $4,194.96 ", $338.94 , $398.66 ," $4,035.15 "," $4,494.60 "," $4,227.92 "," $4,494.60 "," $4,494.60 "," $4,494.60 "," $4,244.90 ", $390.84 ," $4,610.96 "," $4,744.30 "," $4,244.90 "," $4,644.42 "," $4,644.42 "," $4,744.30 "," $4,794.24 "," $4,086.09 "," $4,494.60 "," $4,244.90 "," $3,945.26 ", N/A ," $4,041.64 "," $4,041.64 "," $4,744.30 "," $4,285.35 ", $338.94 ," $4,794.24 "
 Fac Assay of Lactic Acid ,CPT® 83605,0301 - LAB/CHEMISTRY,N/A,N/A, $140.00 , $91.00 , $117.60 , $11.80 , $11.80 , $113.12 , $126.00 , $118.52 , $126.00 , $126.00 , $126.00 , $119.00 , $11.57 , $129.26 , $133.00 , $119.00 , $130.20 , $130.20 , $133.00 , $134.40 , $114.55 , $126.00 , $119.00 , $110.60 , N/A , $113.30 , $113.30 , $133.00 , $120.13 , $11.57 , $134.40 
Post OP Wound Infct Drain,10180,N/A,N/A,N/A," $1,179.00 ", $766.35 , $560.69 , $168.12 , $111.13 , $482.45 , $474.37 ," $1,096.47 "," $1,061.10 "," $1,061.10 ", $943.20 , $943.20 , $111.13 ," $1,088.57 "," $1,120.05 "," $1,061.10 "," $1,061.10 "," $1,061.10 "," $1,096.47 "," $1,131.84 ", $615.17 ," $1,002.15 ", $954.47 , $613.85 , N/A , $491.86 , $491.86 ," $1,120.05 ", $570.41 , $111.13 ," $1,131.84 "
"IV Infusion, Therap/Proph/Diagnost,Add Infusion,1st Hour",CPT® 96367,N/A,N/A,N/A, $131.00 , $85.15 , $69.48 , $28.35 , $34.83 , $66.64 , $71.99 , $121.83 , $117.90 , $117.90 , $104.80 , $104.80 , $34.83 , $120.95 , $124.45 , $117.90 , $117.90 , $117.90 , $121.83 , $125.76 , $114.19 , $111.35 , $95.29 , $118.05 , N/A , $67.93 , $67.93 , $124.45 , $79.20 , $28.35 , $125.76 
Home/Res Visit Est Patient High Mdm 60 Minutes,CPT® 99350,N/A,N/A,N/A, $452.00 , $293.80 , $354.21 , $181.33 , $148.39 , $305.54 , $307.42 , $420.36 , $406.80 , $406.80 , $361.60 , $361.60 , $148.39 , $417.33 , $429.40 , $406.80 , $406.80 , $406.80 , $420.36 , $433.92 , $323.15 , $384.20 , $382.55 , $391.52 , N/A , $311.50 , $311.50 , $429.40 , $359.26 , $148.39 , $433.92 
 Fac Rpr 2 Transvns Electrodes Prm Pm/Implantable Dfb ,CPT® 33220,0360 - OR SERVICES,N/A,N/A," $5,050.00 "," $3,282.50 "," $4,242.00 ", $346.98 , $502.07 ," $4,080.40 "," $4,545.00 "," $4,275.33 "," $4,545.00 "," $4,545.00 "," $4,545.00 "," $4,292.50 ", $492.23 ," $4,662.67 "," $4,797.50 "," $4,292.50 "," $4,696.50 "," $4,696.50 "," $4,797.50 "," $4,848.00 "," $4,131.91 "," $4,545.00 "," $4,292.50 "," $3,989.50 ", N/A ," $4,086.97 "," $4,086.97 "," $4,797.50 "," $4,333.41 ", $346.98 ," $4,848.00 "
"Place Cath Selective Art,Neck",CPT® 36215,N/A,N/A,N/A," $7,250.00 "," $4,712.50 "," $1,285.31 ", $198.04 ," $1,090.69 "," $1,029.46 "," $1,029.30 "," $6,742.50 "," $6,525.00 "," $6,525.00 "," $5,800.00 "," $5,800.00 "," $1,090.69 "," $6,693.93 "," $6,887.50 "," $6,525.00 "," $6,525.00 "," $6,525.00 "," $6,742.50 "," $6,960.00 "," $1,186.55 "," $6,162.50 "," $1,282.74 "," $1,055.14 ", N/A ," $1,049.55 "," $1,049.55 "," $6,887.50 "," $1,192.29 ", $198.04 ," $6,960.00 "
 Fac Dermagraft Skin Sub ,HCPCS Q4106,0636 - DRUGS REQUIRING DETAILED CODIN,N/A,N/A, $86.00 , $55.90 , $72.24 , $35.17 , $36.13 , $69.49 , $77.40 , $72.81 , $77.40 , $77.40 , $77.40 , $73.10 , $35.42 , $79.40 , $81.70 , $73.10 , $79.98 , $79.98 , $81.70 , $82.56 , $70.37 , $77.40 , $73.10 , $67.94 , N/A , $69.60 , $69.60 , $81.70 , $73.80 , $35.17 , $82.56 
RBC Leukoreduced Irradiated,HCPCS P9040,N/A,N/A,N/A, $658.00 , $427.70 , N/A , N/A , N/A , N/A , N/A , $611.94 , $592.20 , $592.20 , $526.40 , $526.40 , N/A , $607.53 , $625.10 , $592.20 , $592.20 , $592.20 , $611.94 , $631.68 , N/A , $559.30 , $526.40 , N/A , N/A , N/A , N/A , $625.10 , N/A , $526.40 , $631.68 
 IXABEPILONE 45 MG IV SOLR ,HCPCS J9207,0636 - DRUGS REQUIRING DETAILED CODIN,70020-1911-01,22.5 mL," $16,282.40 "," $10,583.56 "," $13,677.22 ", $125.00 , $124.32 ," $13,156.18 "," $14,654.16 "," $13,784.68 "," $14,654.16 "," $14,654.16 "," $14,654.16 "," $13,840.04 ", $121.88 ," $15,033.54 "," $15,468.28 "," $13,840.04 "," $15,142.63 "," $15,142.63 "," $15,468.28 "," $15,631.10 "," $13,322.26 "," $14,654.16 "," $13,840.04 "," $12,863.10 ", N/A ," $13,177.35 "," $13,177.35 "," $15,468.28 "," $13,971.93 ", $121.88 ," $15,631.10 "
 Kidney And Urinary Tract Neoplasms With McC ,MS DRG V40 (FY2023) 686,N/A,N/A,N/A," $40,403.15 "," $26,262.05 "," $33,938.65 ", N/A , N/A ," $32,645.75 "," $36,362.84 "," $34,205.31 "," $36,362.84 "," $36,362.84 "," $36,362.84 "," $34,342.68 ", N/A ," $37,304.23 "," $38,382.99 "," $34,342.68 "," $37,574.93 "," $37,574.93 "," $38,382.99 "," $38,787.02 "," $33,057.86 "," $36,362.84 "," $34,342.68 "," $31,918.49 ", N/A ," $32,698.27 "," $32,698.27 "," $38,382.99 "," $34,669.94 "," $31,918.49 "," $38,787.02 "
Office/OP Consltj New/Est Pt High Mdm 55 Minutes,99245,N/A,N/A,N/A, $917.00 , $596.05 , N/A , $207.53 , $108.89 , $419.36 , $417.44 , $852.81 , $825.30 , $825.30 , $733.60 , $733.60 , $108.89 , $846.67 , $871.15 , $825.30 , $825.30 , $825.30 , $852.81 , $880.32 , $528.96 , $779.45 , $408.06 , $417.70 , $275.00 , $427.54 , $427.54 , $871.15 , $509.00 , $108.89 , $880.32 
 US Extremity Non Vascular Limited ,CPT® 76882,0402 - ULTRASOUND,N/A,N/A, $365.00 , $237.25 , $306.60 , $41.46 , $22.10 , $294.92 , $328.50 , $309.01 , $328.50 , $328.50 , $328.50 , $310.25 , $21.67 , $337.00 , $346.75 , $310.25 , $339.45 , $339.45 , $346.75 , $350.40 , $298.64 , $328.50 , $310.25 , $288.35 , N/A , $295.39 , $295.39 , $346.75 , $313.21 , $21.67 , $350.40 
 Fac Glycoprotein Antibody ,CPT® 86146,0302 - LAB/IMMUNOLOGY,N/A,N/A, $261.00 , $169.65 , $219.24 , $25.96 , $8.07 , $210.89 , $234.90 , $220.96 , $234.90 , $234.90 , $234.90 , $221.85 , $7.91 , $240.98 , $247.95 , $221.85 , $242.73 , $242.73 , $247.95 , $250.56 , $213.55 , $234.90 , $221.85 , $206.19 , N/A , $211.23 , $211.23 , $247.95 , $223.96 , $7.91 , $250.56 
" Pro Shoulder Scope, Repair Cartilage Tear ",CPT® 29807,0975 - PRO FEE/OR,N/A,N/A," $5,961.00 "," $3,874.65 "," $6,265.87 ", $982.06 , $905.21 ," $4,999.52 "," $4,963.91 "," $5,543.73 "," $5,364.90 "," $5,364.90 "," $4,768.80 "," $4,768.80 ", $905.21 ," $5,503.79 "," $5,662.95 "," $5,364.90 "," $5,364.90 "," $5,364.90 "," $5,543.73 "," $5,722.56 "," $5,834.98 "," $5,066.85 "," $5,486.00 "," $5,884.18 ", N/A ," $5,097.07 "," $5,097.07 "," $5,662.95 "," $5,990.87 ", $905.21 ," $6,265.87 "
 Fac Drug Screening Pregabalin ,CPT® 80366,0301 - LAB/CHEMISTRY,N/A,N/A, $222.00 , $144.30 , $186.48 , N/A , N/A , $179.38 , $199.80 , $187.95 , $199.80 , $199.80 , $199.80 , $188.70 , N/A , $204.97 , $210.90 , $188.70 , $206.46 , $206.46 , $210.90 , $213.12 , $181.64 , $199.80 , $188.70 , $175.38 , N/A , $179.66 , $179.66 , $210.90 , $190.50 , $175.38 , $213.12 
Therapeutic Ivntj W/Focus on Cognitive Function,CPT® 97127,N/A,N/A,N/A, $434.00 , $282.10 , N/A , N/A , N/A , N/A , N/A , $403.62 , $390.60 , $390.60 , $347.20 , $347.20 , N/A , $400.71 , $412.30 , $390.60 , $390.60 , $390.60 , $403.62 , $416.64 , N/A , $368.90 , N/A , N/A , N/A , N/A , N/A , $412.30 , N/A , $347.20 , $416.64 
"Removal Synovial Cyst,Knee",CPT® 27345,N/A,N/A,N/A," $3,310.00 "," $2,151.50 "," $2,973.82 ", $467.50 , $461.04 ," $2,320.85 "," $2,315.25 "," $3,078.30 "," $2,979.00 "," $2,979.00 "," $2,648.00 "," $2,648.00 ", $461.04 ," $3,056.12 "," $3,144.50 "," $2,979.00 "," $2,979.00 "," $2,979.00 "," $3,078.30 "," $3,177.60 "," $2,753.55 "," $2,813.50 "," $2,554.78 "," $2,733.25 ", N/A ," $2,366.12 "," $2,366.12 "," $3,144.50 "," $2,781.06 ", $461.04 ," $3,177.60 "
" Fac Scope Bladder, Insert Tube for Injection ",CPT® 52005,0361 - OR/MINOR,N/A,N/A, $706.00 , $458.90 , $593.04 , $125.24 , $199.19 , $570.45 , $635.40 , $597.70 , $635.40 , $635.40 , $635.40 , $600.10 , $195.28 , $651.85 , $670.70 , $600.10 , $656.58 , $656.58 , $670.70 , $677.76 , $577.65 , $635.40 , $600.10 , $557.74 , N/A , $571.37 , $571.37 , $670.70 , $605.82 , $125.24 , $677.76 
 Upper Art Duplex Bilateral ,CPT® 93930,0921 - PERI VASCUL LAB,N/A,N/A," $2,245.00 "," $1,459.25 "," $1,885.80 ", $191.49 , $168.91 ," $1,813.96 "," $2,020.50 "," $1,900.62 "," $2,020.50 "," $2,020.50 "," $2,020.50 "," $1,908.25 ", $165.60 ," $2,072.81 "," $2,132.75 "," $1,908.25 "," $2,087.85 "," $2,087.85 "," $2,132.75 "," $2,155.20 "," $1,836.86 "," $2,020.50 "," $1,908.25 "," $1,773.55 ", N/A ," $1,816.88 "," $1,816.88 "," $2,132.75 "," $1,926.43 ", $165.60 ," $2,155.20 "
X-Ray Elbow 3+ Vw,CPT® 73080,N/A,N/A,N/A, $354.00 , $230.10 , $182.82 , $32.04 , $31.97 , $148.21 , $178.47 , $329.22 , $318.60 , $318.60 , $283.20 , $283.20 , $31.97 , $326.85 , $336.30 , $318.60 , $318.60 , $318.60 , $329.22 , $339.84 , $176.44 , $300.90 , $196.46 , $158.47 , N/A , $151.10 , $151.10 , $336.30 , $174.91 , $31.97 , $339.84 
"Capsulotomy Mt-P Jt,Foot,Each",28270,N/A,N/A,N/A," $3,273.00 "," $2,127.45 "," $2,068.24 ", $324.80 , $548.76 ," $1,645.97 "," $1,644.43 "," $3,043.89 "," $2,945.70 "," $2,945.70 "," $2,618.40 "," $2,618.40 ", $548.76 ," $3,021.96 "," $3,109.35 "," $2,945.70 "," $2,945.70 "," $2,945.70 "," $3,043.89 "," $3,142.08 "," $1,926.07 "," $2,782.05 "," $1,780.50 "," $1,961.47 ", N/A ," $1,678.08 "," $1,678.08 "," $3,109.35 "," $1,972.36 ", $324.80 ," $3,142.08 "
 ED Probe Nasolacrimal Duct ,CPT® 68810,0761 - TREATMENT ROOM,N/A,N/A," $1,232.00 ", $800.80 ," $1,034.88 ", $123.82 , $83.68 , $995.46 ," $1,108.80 "," $1,043.01 "," $1,108.80 "," $1,108.80 "," $1,108.80 "," $1,047.20 ", $82.04 ," $1,137.51 "," $1,170.40 "," $1,047.20 "," $1,145.76 "," $1,145.76 "," $1,170.40 "," $1,182.72 "," $1,008.02 "," $1,108.80 "," $1,047.20 ", $973.28 , N/A , $997.06 , $997.06 ," $1,170.40 "," $1,057.18 ", $82.04 ," $1,182.72 "
 Fac Enteroscopy > 2nd Prtn Ileum Control Bleeding ,CPT® 44378,0360 - OR SERVICES,N/A,N/A," $4,992.00 "," $3,244.80 "," $4,193.28 ", $363.96 , $630.39 ," $4,033.54 "," $4,492.80 "," $4,226.23 "," $4,492.80 "," $4,492.80 "," $4,492.80 "," $4,243.20 ", $618.03 ," $4,609.11 "," $4,742.40 "," $4,243.20 "," $4,642.56 "," $4,642.56 "," $4,742.40 "," $4,792.32 "," $4,084.45 "," $4,492.80 "," $4,243.20 "," $3,943.68 ", N/A ," $4,040.03 "," $4,040.03 "," $4,742.40 "," $4,283.64 ", $363.96 ," $4,792.32 "
" Fac Fluorescent Antibody, Titer ",CPT® 86256,0302 - LAB/IMMUNOLOGY,N/A,N/A, $152.00 , $98.80 , $127.68 , $12.29 , $12.29 , $122.82 , $136.80 , $128.68 , $136.80 , $136.80 , $136.80 , $129.20 , $12.05 , $140.34 , $144.40 , $129.20 , $141.36 , $141.36 , $144.40 , $145.92 , $124.37 , $136.80 , $129.20 , $120.08 , N/A , $123.01 , $123.01 , $144.40 , $130.43 , $12.05 , $145.92 
"Cerv C1-2 Fusn,Poster Tech",CPT® 22595,N/A,N/A,N/A," $10,480.00 "," $6,812.00 "," $8,779.16 "," $1,374.61 "," $2,378.00 "," $7,163.47 "," $7,053.10 "," $9,746.40 "," $9,432.00 "," $9,432.00 "," $8,384.00 "," $8,384.00 "," $2,378.00 "," $9,676.18 "," $9,956.00 "," $9,432.00 "," $9,432.00 "," $9,432.00 "," $9,746.40 "," $10,060.80 "," $8,147.91 "," $8,908.00 "," $7,985.47 "," $8,241.52 ", N/A ," $7,303.23 "," $7,303.23 "," $9,956.00 "," $8,583.91 "," $1,374.61 "," $10,060.80 "
"Autotransplant, Parathyroid",CPT® 60512,N/A,N/A,N/A," $1,667.00 "," $1,083.55 "," $1,437.93 ", $223.43 , $307.02 ," $1,252.32 "," $1,278.53 "," $1,550.31 "," $1,500.30 "," $1,500.30 "," $1,333.60 "," $1,333.60 ", $307.02 ," $1,539.14 "," $1,583.65 "," $1,500.30 "," $1,500.30 "," $1,500.30 "," $1,550.31 "," $1,600.32 "," $1,396.53 "," $1,416.95 "," $1,275.61 "," $1,201.44 ", N/A ," $1,276.75 "," $1,276.75 "," $1,583.65 "," $1,423.97 ", $223.43 ," $1,600.32 "
 FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN ,HCPCS J1652,0636 - DRUGS REQUIRING DETAILED CODIN,55111-0680-02,0.6 mL, $697.59 , $453.43 , $585.98 , $1.09 , $1.09 , $563.65 , $627.83 , $590.58 , $627.83 , $627.83 , $627.83 , $592.95 , $1.07 , $644.08 , $662.71 , $592.95 , $648.76 , $648.76 , $662.71 , $669.69 , $570.77 , $627.83 , $592.95 , $551.10 , N/A , $564.56 , $564.56 , $662.71 , $598.60 , $1.07 , $669.69 
 Fac Slctv Cathj 3rd+ Ord Slctv Abdl Pel/Lxtr Brnch ,CPT® 36247,0761 - TREATMENT ROOM,N/A,N/A," $3,166.00 "," $2,057.90 "," $2,659.44 ", $273.70 ," $1,563.75 "," $2,558.13 "," $2,849.40 "," $2,680.34 "," $2,849.40 "," $2,849.40 "," $2,849.40 "," $2,691.10 "," $1,533.09 "," $2,923.17 "," $3,007.70 "," $2,691.10 "," $2,944.38 "," $2,944.38 "," $3,007.70 "," $3,039.36 "," $2,590.42 "," $2,849.40 "," $2,691.10 "," $2,501.14 ", N/A ," $2,562.24 "," $2,562.24 "," $3,007.70 "," $2,716.74 ", $273.70 ," $3,039.36 "
Laps W/Bi Tot Pel Lmphadec & Omntc Lymph Bx,CPT® 38573,N/A,N/A,N/A," $20,943.00 "," $13,612.95 "," $5,472.00 "," $1,109.55 ", $897.40 ," $3,839.88 "," $4,069.03 "," $19,476.99 "," $18,848.70 "," $18,848.70 "," $16,754.40 "," $16,754.40 ", $897.40 ," $19,336.67 "," $19,895.85 "," $18,848.70 "," $18,848.70 "," $18,848.70 "," $19,476.99 "," $20,105.28 "," $5,845.43 "," $17,801.55 "," $6,215.75 "," $5,673.15 ", N/A ," $3,914.80 "," $3,914.80 "," $19,895.85 "," $4,541.69 ", $897.40 ," $20,105.28 "
 TRIPLE ANTIBIOTIC 3.5-400-5000 EX OINT ,HCPCS RXC637,0250 - PHARMACY,45802-0143-70,1 each, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Transfusion,Blood",36430,N/A,N/A,N/A, $383.00 , $248.95 , $236.54 , $37.97 , $21.99 , $147.20 , $150.13 , $356.19 , $344.70 , $344.70 , $306.40 , $306.40 , $21.99 , $353.62 , $363.85 , $344.70 , $344.70 , $344.70 , $356.19 , $367.68 , $209.61 , $325.55 , $181.97 , $174.23 , N/A , $150.07 , $150.07 , $363.85 , $170.48 , $21.99 , $367.68 
"Exc Skin Benig <5mm Face,Facial",CPT® 11440,N/A,N/A,N/A, $547.00 , $355.55 , $341.29 , $103.49 , $82.89 , $281.15 , $281.65 , $508.71 , $492.30 , $492.30 , $437.60 , $437.60 , $82.89 , $505.05 , $519.65 , $492.30 , $492.30 , $492.30 , $508.71 , $525.12 , $369.08 , $464.95 , $558.41 , $365.26 , N/A , $286.63 , $286.63 , $519.65 , $332.38 , $82.89 , $558.41 
 AMLODIPINE BESYLATE 2.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6369-61,1 tablet, $8.19 , $5.32 , $6.88 , N/A , N/A , $6.62 , $7.37 , $6.93 , $7.37 , $7.37 , $7.37 , $6.96 , N/A , $7.56 , $7.78 , $6.96 , $7.62 , $7.62 , $7.78 , $7.86 , $6.70 , $7.37 , $6.96 , $6.47 , N/A , $6.63 , $6.63 , $7.78 , $7.03 , $6.47 , $7.86 
Cast Sup Lng Arm Splnt Ped P,HCPCS Q4019,N/A,N/A,N/A, $16.00 , $10.40 , N/A , $5.53 , $3.38 , N/A , N/A , $14.88 , $14.40 , $14.40 , $12.80 , $12.80 , $3.38 , $14.77 , $15.20 , $14.40 , $14.40 , $14.40 , $14.88 , $15.36 , N/A , $13.60 , $16.87 , $5.03 , N/A , N/A , N/A , $15.20 , N/A , $3.38 , $16.87 
 Fac Pulm Compliance Std ,CPT® 94750,0460 - PULMONARY FUNC,N/A,N/A," $1,038.00 ", $674.70 , $871.92 , N/A , N/A , $838.70 , $934.20 , $878.77 , $934.20 , $934.20 , $934.20 , $882.30 , N/A , $958.39 , $986.10 , $882.30 , $965.34 , $965.34 , $986.10 , $996.48 , $849.29 , $934.20 , $882.30 , $820.02 , N/A , $840.05 , $840.05 , $986.10 , $890.71 , $820.02 , $996.48 
 Abd Chest for F.B.-Child Single View ,CPT® 76010,0320 - DX X-RAY,N/A,N/A, $249.00 , $161.85 , $209.16 , $29.43 , $26.96 , $201.19 , $224.10 , $210.80 , $224.10 , $224.10 , $224.10 , $211.65 , $26.43 , $229.90 , $236.55 , $211.65 , $231.57 , $231.57 , $236.55 , $239.04 , $203.73 , $224.10 , $211.65 , $196.71 , N/A , $201.52 , $201.52 , $236.55 , $213.67 , $26.43 , $239.04 
 LOXAPINE SUCCINATE 5 MG PO CAPS ,HCPCS RXA250,0250 - PHARMACY,00591-0369-01,1 capsule, $5.11 , $3.32 , $4.29 , N/A , N/A , $4.13 , $4.60 , $4.33 , $4.60 , $4.60 , $4.60 , $4.34 , N/A , $4.72 , $4.85 , $4.34 , $4.75 , $4.75 , $4.85 , $4.91 , $4.18 , $4.60 , $4.34 , $4.04 , N/A , $4.14 , $4.14 , $4.85 , $4.38 , $4.04 , $4.91 
 Fac Heparin Assay ,CPT® 85520,0305 - LAB/HEMATOLOGY,N/A,N/A, $230.00 , $149.50 , $193.20 , $13.35 , $13.35 , $185.84 , $207.00 , $194.72 , $207.00 , $207.00 , $207.00 , $195.50 , $13.09 , $212.36 , $218.50 , $195.50 , $213.90 , $213.90 , $218.50 , $220.80 , $188.19 , $207.00 , $195.50 , $181.70 , N/A , $186.14 , $186.14 , $218.50 , $197.36 , $13.09 , $220.80 
Colonoscopy Stoma W/Rmvl Tum Polyp/Oth Les Snare,44394,N/A,N/A,N/A," $3,608.00 "," $2,345.20 "," $1,376.83 ", $212.48 , $362.61 ," $1,213.88 "," $1,241.51 "," $3,355.44 "," $3,247.20 "," $3,247.20 "," $2,886.40 "," $2,886.40 ", $362.61 ," $3,331.27 "," $3,427.60 "," $3,247.20 "," $3,247.20 "," $3,247.20 "," $3,355.44 "," $3,463.68 ", $987.63 ," $3,066.80 "," $1,364.81 "," $1,311.20 ", N/A ," $1,237.57 "," $1,237.57 "," $3,427.60 "," $1,294.36 ", $212.48 ," $3,463.68 "
 RIZATRIPTAN BENZOATE 5 MG PO TBDP ,HCPCS RXC637,0250 - PHARMACY,33342-0093-41,1 tablet, $170.74 , $110.98 , $143.42 , N/A , N/A , $137.96 , $153.67 , $144.55 , $153.67 , $153.67 , $153.67 , $145.13 , N/A , $157.64 , $162.20 , $145.13 , $158.79 , $158.79 , $162.20 , $163.91 , $139.70 , $153.67 , $145.13 , $134.88 , N/A , $138.18 , $138.18 , $162.20 , $146.51 , $134.88 , $163.91 
Ext Ecg > 48hr to 21 Day Rcrd W/Conect Intl Rcrd,CPT® 0296T,N/A,N/A,N/A, $433.00 , $281.45 , N/A , N/A , N/A , N/A , N/A , $402.69 , $389.70 , $389.70 , $346.40 , $346.40 , N/A , $399.79 , $411.35 , $389.70 , $389.70 , $389.70 , $402.69 , $415.68 , N/A , $368.05 , N/A , N/A , N/A , N/A , N/A , $411.35 , N/A , $346.40 , $415.68 
Drug Screen Quantitative Clozapine,CPT® 80159,N/A,N/A,N/A, $176.00 , $114.40 , N/A , $20.55 , $20.55 , $104.64 , $124.23 , $163.68 , $158.40 , $158.40 , $140.80 , $140.80 , $20.55 , $162.50 , $167.20 , $158.40 , $158.40 , $158.40 , $163.68 , $168.96 , $134.55 , $149.60 , $95.31 , $67.05 , N/A , $97.66 , $97.66 , $167.20 , $106.72 , $20.55 , $168.96 
" Fac Chromosome Study, Additional ",CPT® 88289,0310 - PATHOLOGY LAB,N/A,N/A, $493.00 , $320.45 , $414.12 , $35.12 , $35.12 , $398.34 , $443.70 , $417.37 , $443.70 , $443.70 , $443.70 , $419.05 , $34.43 , $455.19 , $468.35 , $419.05 , $458.49 , $458.49 , $468.35 , $473.28 , $403.37 , $443.70 , $419.05 , $389.47 , N/A , $398.98 , $398.98 , $468.35 , $423.04 , $34.43 , $473.28 
Removal of Sperm Cord Lesion,CPT® 55520,N/A,N/A,N/A," $2,919.00 "," $1,897.35 "," $1,992.71 ", $428.06 , $401.40 ," $1,424.19 "," $1,467.59 "," $2,714.67 "," $2,627.10 "," $2,627.10 "," $2,335.20 "," $2,335.20 ", $401.40 ," $2,695.11 "," $2,773.05 "," $2,627.10 "," $2,627.10 "," $2,627.10 "," $2,714.67 "," $2,802.24 "," $1,854.97 "," $2,481.15 "," $2,406.70 "," $2,111.22 ", N/A ," $1,451.98 "," $1,451.98 "," $2,773.05 "," $1,740.27 ", $401.40 ," $2,802.24 "
Removal of Carpal Bone,25210,N/A,N/A,N/A," $3,303.00 "," $2,146.95 "," $3,029.13 ", $477.30 , $461.04 ," $2,346.85 "," $2,352.01 "," $3,071.79 "," $2,972.70 "," $2,972.70 "," $2,642.40 "," $2,642.40 ", $461.04 ," $3,049.66 "," $3,137.85 "," $2,972.70 "," $2,972.70 "," $2,972.70 "," $3,071.79 "," $3,170.88 "," $2,811.10 "," $2,807.55 "," $2,585.11 "," $2,792.89 ", N/A ," $2,392.64 "," $2,392.64 "," $3,137.85 "," $2,812.21 ", $461.04 ," $3,170.88 "
"Hfo, No Joint, Prefabricated",HCPCS L3923,N/A,N/A,N/A, $141.00 , $91.65 , N/A , $102.84 , $28.32 , N/A , N/A , $131.13 , $126.90 , $126.90 , $112.80 , $112.80 , $28.32 , $130.19 , $133.95 , $126.90 , $126.90 , $126.90 , $131.13 , $135.36 , N/A , $119.85 , $86.28 , $86.51 , N/A , N/A , N/A , $133.95 , N/A , $28.32 , $135.36 
"Part Remv Vitreous,Ant Apprch",67005,N/A,N/A,N/A," $4,207.00 "," $2,734.55 "," $2,920.06 ", $460.22 ," $1,072.19 "," $2,674.57 "," $2,542.34 "," $3,912.51 "," $3,786.30 "," $3,786.30 "," $3,365.60 "," $3,365.60 "," $1,072.19 "," $3,884.32 "," $3,996.65 "," $3,786.30 "," $3,786.30 "," $3,786.30 "," $3,912.51 "," $4,038.72 "," $3,997.63 "," $3,575.95 "," $2,645.77 "," $3,396.52 ", N/A ," $2,726.76 "," $2,726.76 "," $3,996.65 "," $3,010.00 ", $460.22 ," $4,038.72 "
" Fac Hep a Antibody, Total ",CPT® 86708,0302 - LAB/IMMUNOLOGY,N/A,N/A, $117.00 , $76.05 , $98.28 , $12.64 , $12.64 , $94.54 , $105.30 , $99.05 , $105.30 , $105.30 , $105.30 , $99.45 , $12.39 , $108.03 , $111.15 , $99.45 , $108.81 , $108.81 , $111.15 , $112.32 , $95.73 , $105.30 , $99.45 , $92.43 , N/A , $94.69 , $94.69 , $111.15 , $100.40 , $12.39 , $112.32 
 Fac Dial Oth/Thn Hemo Repeated Phys Evals ,CPT® 90947,0841 - CAPD/COMPOSITE,N/A,N/A, $608.00 , $395.20 , $510.72 , $118.94 , $109.65 , $491.26 , $547.20 , $514.73 , $547.20 , $547.20 , $547.20 , $516.80 , $107.50 , $561.37 , $577.60 , $516.80 , $565.44 , $565.44 , $577.60 , $583.68 , $497.47 , $547.20 , $516.80 , $480.32 , N/A , $492.05 , $492.05 , $577.60 , $521.72 , $107.50 , $583.68 
"Protein, Western Blot Test",CPT® 84182,N/A,N/A,N/A, $322.00 , $209.30 , N/A , $29.79 , $24.98 , $101.81 , $121.80 , $299.46 , $289.80 , $289.80 , $257.60 , $257.60 , $24.98 , $297.30 , $305.90 , $289.80 , $289.80 , $289.80 , $299.46 , $309.12 , $195.04 , $273.70 , $205.97 , $85.79 , N/A , $95.02 , $95.02 , $305.90 , $103.84 , $24.98 , $309.12 
"Amino Acids, 6+ Quant",CPT® 82139,N/A,N/A,N/A, $478.00 , $310.70 , N/A , $17.21 , $17.21 , $81.53 , $97.54 , $444.54 , $430.20 , $430.20 , $382.40 , $382.40 , $17.21 , $441.34 , $454.10 , $430.20 , $430.20 , $430.20 , $444.54 , $458.88 , $112.64 , $406.30 , $110.29 , $61.18 , N/A , $76.09 , $76.09 , $454.10 , $83.15 , $17.21 , $458.88 
 Fac Iadna Mycoplsm Pneumoniae Amp Prb ,CPT® 87581,0306 - LAB/BACT-MICRO,N/A,N/A, $242.00 , $157.30 , $203.28 , $35.79 , $35.79 , $195.54 , $217.80 , $204.88 , $217.80 , $217.80 , $217.80 , $205.70 , $35.09 , $223.44 , $229.90 , $205.70 , $225.06 , $225.06 , $229.90 , $232.32 , $198.00 , $217.80 , $205.70 , $191.18 , N/A , $195.85 , $195.85 , $229.90 , $207.66 , $35.09 , $232.32 
 Inj Proc Hysterosalphingram ,CPT® 58340,0761 - TREATMENT ROOM,N/A,N/A, $341.00 , $221.65 , $286.44 , $54.59 , $114.71 , $275.53 , $306.90 , $288.69 , $306.90 , $306.90 , $306.90 , $289.85 , $112.46 , $314.85 , $323.95 , $289.85 , $317.13 , $317.13 , $323.95 , $327.36 , $279.01 , $306.90 , $289.85 , $269.39 , N/A , $275.97 , $275.97 , $323.95 , $292.61 , $54.59 , $327.36 
Removal of Sperm Cord Lesion,55520,N/A,N/A,N/A," $2,919.00 "," $1,897.35 "," $1,992.71 ", $428.06 , $401.40 ," $1,424.19 "," $1,467.59 "," $2,714.67 "," $2,627.10 "," $2,627.10 "," $2,335.20 "," $2,335.20 ", $401.40 ," $2,695.11 "," $2,773.05 "," $2,627.10 "," $2,627.10 "," $2,627.10 "," $2,714.67 "," $2,802.24 "," $1,854.97 "," $2,481.15 "," $2,406.70 "," $2,111.22 ", N/A ," $1,451.98 "," $1,451.98 "," $2,773.05 "," $1,740.27 ", $401.40 ," $2,802.24 "
 MORPHINE SULFATE 4 MG/ML INJECTION (INPT) ,HCPCS J2270,0636 - DRUGS REQUIRING DETAILED CODIN,00641-6125-25,1 mL, $28.08 , $18.25 , $23.59 , $4.69 , $3.41 , $22.69 , $25.27 , $23.77 , $25.27 , $25.27 , $25.27 , $23.87 , $3.34 , $25.93 , $26.68 , $23.87 , $26.11 , $26.11 , $26.68 , $26.96 , $22.98 , $25.27 , $23.87 , $22.18 , N/A , $22.73 , $22.73 , $26.68 , $24.10 , $3.34 , $26.96 
"Open Rx Shldr Disloc,Prox Hum Fx",CPT® 23680,N/A,N/A,N/A," $6,093.00 "," $3,960.45 "," $5,622.70 ", $882.70 , $922.06 ," $4,483.23 "," $4,453.56 "," $5,666.49 "," $5,483.70 "," $5,483.70 "," $4,874.40 "," $4,874.40 ", $922.06 ," $5,625.67 "," $5,788.35 "," $5,483.70 "," $5,483.70 "," $5,483.70 "," $5,666.49 "," $5,849.28 "," $5,236.48 "," $5,179.05 "," $4,920.45 "," $5,279.41 ", N/A ," $4,570.71 "," $4,570.71 "," $5,788.35 "," $5,372.20 ", $882.70 ," $5,849.28 "
" Pro Repair Elbow W/Deb, Open ",CPT® 24358,0982 - PRO FEE/OUTPT,N/A,N/A," $3,464.00 "," $2,251.60 "," $3,246.69 ", $510.18 , $366.18 ," $2,520.37 "," $2,521.78 "," $3,221.52 "," $3,117.60 "," $3,117.60 "," $2,771.20 "," $2,771.20 ", $366.18 ," $3,198.31 "," $3,290.80 "," $3,117.60 "," $3,117.60 "," $3,117.60 "," $3,221.52 "," $3,325.44 "," $3,005.26 "," $2,944.40 "," $2,777.79 "," $2,984.45 ", N/A ," $2,569.55 "," $2,569.55 "," $3,290.80 "," $3,020.14 ", $366.18 ," $3,325.44 "
 Other Respiratory System Diagnoses With McC ,MS DRG V40 (FY2023) 205,N/A,N/A,N/A," $26,308.74 "," $17,100.68 "," $22,099.34 ", N/A , N/A ," $21,257.46 "," $23,677.87 "," $22,272.98 "," $23,677.87 "," $23,677.87 "," $23,677.87 "," $22,362.43 ", N/A ," $24,290.86 "," $24,993.30 "," $22,362.43 "," $24,467.13 "," $24,467.13 "," $24,993.30 "," $25,256.39 "," $21,525.81 "," $23,677.87 "," $22,362.43 "," $20,783.90 ", N/A ," $21,291.66 "," $21,291.66 "," $24,993.30 "," $22,575.53 "," $20,783.90 "," $25,256.39 "
"Destr Malig Trunk,Extrem >4.0 Cm",CPT® 17266,N/A,N/A,N/A, $984.00 , $639.60 , $491.30 , $148.04 , $208.51 , $441.67 , $430.29 , $915.12 , $885.60 , $885.60 , $787.20 , $787.20 , $208.51 , $908.53 , $934.80 , $885.60 , $885.60 , $885.60 , $915.12 , $944.64 , $541.46 , $836.40 , $854.57 , $565.42 , N/A , $450.28 , $450.28 , $934.80 , $522.16 , $148.04 , $944.64 
 Pro Smpl Rpr Supfc F/E/E/N/L/M 7.6cm-12.5cm ,CPT® 12015,0981 - PRO FEE/ER,N/A,N/A, $920.00 , $598.00 , $293.11 , $87.01 , $139.20 , $268.12 , $259.48 , $855.60 , $828.00 , $828.00 , $736.00 , $736.00 , $139.20 , $849.44 , $874.00 , $828.00 , $828.00 , $828.00 , $855.60 , $883.20 , $322.89 , $782.00 , $520.95 , $325.60 , N/A , $273.35 , $273.35 , $874.00 , $317.01 , $87.01 , $883.20 
Palmar Fasciectomy,26121,N/A,N/A,N/A," $2,392.00 "," $1,554.80 "," $3,675.36 ", $577.80 , $768.40 ," $2,871.39 "," $2,868.14 "," $2,224.56 "," $2,152.80 "," $2,152.80 "," $1,913.60 "," $1,913.60 ", $768.40 ," $2,208.53 "," $2,272.40 "," $2,152.80 "," $2,152.80 "," $2,152.80 "," $2,224.56 "," $2,296.32 "," $3,414.48 "," $2,033.20 "," $3,154.23 "," $3,411.54 ", N/A ," $2,927.41 "," $2,927.41 "," $2,272.40 "," $3,440.75 ", $577.80 ," $3,675.36 "
Exc Skin Benig 3.1-4cm Remaindr Body,11424,N/A,N/A,N/A," $1,175.00 ", $763.75 , $567.77 , $171.28 , $192.83 , $491.20 , $478.70 ," $1,092.75 "," $1,057.50 "," $1,057.50 ", $940.00 , $940.00 , $192.83 ," $1,084.88 "," $1,116.25 "," $1,057.50 "," $1,057.50 "," $1,057.50 "," $1,092.75 "," $1,128.00 ", $619.26 , $998.75 , $954.47 , $625.78 , N/A , $500.78 , $500.78 ," $1,116.25 ", $580.75 , $171.28 ," $1,128.00 "
"Open Rx Shldr Disloc,Gr Tub Fx",23670,N/A,N/A,N/A," $5,096.00 "," $3,312.40 "," $5,285.48 ", $828.89 , $845.22 ," $4,231.05 "," $4,213.90 "," $4,739.28 "," $4,586.40 "," $4,586.40 "," $4,076.80 "," $4,076.80 ", $845.22 ," $4,705.14 "," $4,841.20 "," $4,586.40 "," $4,586.40 "," $4,586.40 "," $4,739.28 "," $4,892.16 "," $4,923.49 "," $4,331.60 "," $4,656.41 "," $4,971.19 ", N/A ," $4,313.60 "," $4,313.60 "," $4,841.20 "," $5,070.01 ", $828.89 ," $5,285.48 "
 Fac Radiologic Exam Upr GI Trc Double Contrast Study ,CPT® 74246,0320 - DX X-RAY,N/A,N/A," $1,644.00 "," $1,068.60 "," $1,380.96 ", $139.68 , $103.92 ," $1,328.35 "," $1,479.60 "," $1,391.81 "," $1,479.60 "," $1,479.60 "," $1,479.60 "," $1,397.40 ", $101.88 ," $1,517.91 "," $1,561.80 "," $1,397.40 "," $1,528.92 "," $1,528.92 "," $1,561.80 "," $1,578.24 "," $1,345.12 "," $1,479.60 "," $1,397.40 "," $1,298.76 ", N/A ," $1,330.49 "," $1,330.49 "," $1,561.80 "," $1,410.72 ", $101.88 ," $1,578.24 "
 TENECTEPLASE 50 MG IV KIT ,HCPCS J3101,0636 - DRUGS REQUIRING DETAILED CODIN,50242-0120-47,6 mL," $13,016.63 "," $8,460.81 "," $10,933.97 ", $155.75 , $146.56 ," $10,517.44 "," $11,714.97 "," $11,019.88 "," $11,714.97 "," $11,714.97 "," $11,714.97 "," $11,064.14 ", $143.69 ," $12,018.25 "," $12,365.80 "," $11,064.14 "," $12,105.47 "," $12,105.47 "," $12,365.80 "," $12,495.96 "," $10,650.21 "," $11,714.97 "," $11,064.14 "," $10,283.14 ", N/A ," $10,534.36 "," $10,534.36 "," $12,365.80 "," $11,169.57 ", $143.69 ," $12,495.96 "
Replace Gastrostomy/Cecostomy Tube Percutaneous,CPT® 49450,N/A,N/A,N/A," $3,567.00 "," $2,318.55 ", $400.79 , $62.65 , $590.21 , $326.94 , $324.09 ," $3,317.31 "," $3,210.30 "," $3,210.30 "," $2,853.60 "," $2,853.60 ", $590.21 ," $3,293.41 "," $3,388.65 "," $3,210.30 "," $3,210.30 "," $3,210.30 "," $3,317.31 "," $3,424.32 ", $291.08 ," $3,031.95 ", $349.68 , $387.83 , N/A , $333.32 , $333.32 ," $3,388.65 ", $348.63 , $62.65 ," $3,424.32 "
 Pro Exc Face-Mm B9+Marg 1.1-2 Cm ,CPT® 11442,0982 - PRO FEE/OUTPT,N/A,N/A, $908.00 , $590.20 , $469.34 , $141.83 , $154.85 , $396.21 , $390.89 , $844.44 , $817.20 , $817.20 , $726.40 , $726.40 , $154.85 , $838.36 , $862.60 , $817.20 , $817.20 , $817.20 , $844.44 , $871.68 , $509.92 , $771.80 , $779.64 , $508.03 , N/A , $403.95 , $403.95 , $862.60 , $468.43 , $141.83 , $871.68 
"Repair Cornea Lac,Apply Glue",CPT® 65286,N/A,N/A,N/A," $6,423.00 "," $4,174.95 "," $3,057.28 ", $479.00 , $61.05 ," $2,808.35 "," $2,614.42 "," $5,973.39 "," $5,780.70 "," $5,780.70 "," $5,138.40 "," $5,138.40 ", $61.05 ," $5,930.36 "," $6,101.85 "," $5,780.70 "," $5,780.70 "," $5,780.70 "," $5,973.39 "," $6,166.08 "," $4,195.36 "," $5,459.55 "," $2,686.80 "," $3,564.32 ", N/A ," $2,863.14 "," $2,863.14 "," $6,101.85 "," $3,160.54 ", $61.05 ," $6,166.08 "
"Cautery Anal Fissure,Initial",CPT® 46940,N/A,N/A,N/A," $1,457.00 ", $947.05 , $885.37 , $138.88 , $63.53 , $699.34 , $712.30 ," $1,355.01 "," $1,311.30 "," $1,311.30 "," $1,165.60 "," $1,165.60 ", $63.53 ," $1,345.25 "," $1,384.15 "," $1,311.30 "," $1,311.30 "," $1,311.30 "," $1,355.01 "," $1,398.72 ", $636.06 ," $1,238.45 ", $781.42 , $831.76 , N/A , $712.98 , $712.98 ," $1,384.15 ", $745.70 , $63.53 ," $1,398.72 "
 Fac Eeg W/Rec Awake&Asleep ,CPT® 95819,0740 - EEG,N/A,N/A, $963.00 , $625.95 , $808.92 , $435.85 , $161.34 , $778.10 , $866.70 , $815.28 , $866.70 , $866.70 , $866.70 , $818.55 , $158.18 , $889.14 , $914.85 , $818.55 , $895.59 , $895.59 , $914.85 , $924.48 , $787.93 , $866.70 , $818.55 , $760.77 , N/A , $779.36 , $779.36 , $914.85 , $826.35 , $158.18 , $924.48 
"Release Ureter,Retroper Fibrosis",CPT® 50715,N/A,N/A,N/A," $8,244.00 "," $5,358.60 "," $6,437.64 "," $1,133.95 "," $1,075.74 "," $5,876.55 "," $5,439.37 "," $7,666.92 "," $7,419.60 "," $7,419.60 "," $6,595.20 "," $6,595.20 "," $1,075.74 "," $7,611.69 "," $7,831.80 "," $7,419.60 "," $7,419.60 "," $7,419.60 "," $7,666.92 "," $7,914.24 "," $6,439.50 "," $7,007.40 "," $6,269.20 "," $7,279.77 ", N/A ," $5,991.21 "," $5,991.21 "," $7,831.80 "," $7,041.80 "," $1,075.74 "," $7,914.24 "
 Pro Dstr Nrolytc Agnt Parverteb Fct Sngl Lmbr/Sacral ,CPT® 64635,0982 - PRO FEE/OUTPT,N/A,N/A," $1,718.00 "," $1,116.70 ", $950.14 , $185.00 , $346.77 ," $1,260.86 "," $1,183.47 "," $1,597.74 "," $1,546.20 "," $1,546.20 "," $1,374.40 "," $1,374.40 ", $346.77 ," $1,586.23 "," $1,632.10 "," $1,546.20 "," $1,546.20 "," $1,546.20 "," $1,597.74 "," $1,649.28 "," $1,187.78 "," $1,460.30 "," $1,147.15 "," $1,349.13 ", N/A ," $1,285.46 "," $1,285.46 "," $1,632.10 "," $1,379.00 ", $185.00 ," $1,649.28 "
 Renogram With Ace Inhibitors ,CPT® 78709,0340 - NUCLEAR MEDICINE,N/A,N/A," $2,966.00 "," $1,927.90 "," $2,491.44 ", $339.33 , $282.72 ," $2,396.53 "," $2,669.40 "," $2,511.02 "," $2,669.40 "," $2,669.40 "," $2,669.40 "," $2,521.10 ", $277.18 ," $2,738.51 "," $2,817.70 "," $2,521.10 "," $2,758.38 "," $2,758.38 "," $2,817.70 "," $2,847.36 "," $2,426.78 "," $2,669.40 "," $2,521.10 "," $2,343.14 ", N/A ," $2,400.38 "," $2,400.38 "," $2,817.70 "," $2,545.12 ", $277.18 ," $2,847.36 "
Scr Tst Pure Tone Air Only,CPT® 92551,N/A,N/A,N/A, $55.00 , $35.75 , N/A , $11.60 , $15.40 , $26.19 , $27.90 , $51.15 , $49.50 , $49.50 , $44.00 , $44.00 , $15.40 , $50.78 , $52.25 , $49.50 , $49.50 , $49.50 , $51.15 , $52.80 , $33.51 , $46.75 , $37.51 , $45.80 , N/A , $26.70 , $26.70 , $52.25 , $31.14 , $11.60 , $52.80 
Treat Interphalangeal Jnt,CPT® 28660,N/A,N/A,N/A, $758.00 , $492.70 , $565.96 , $89.32 , $69.38 , $431.41 , $434.98 , $704.94 , $682.20 , $682.20 , $606.40 , $606.40 , $69.38 , $699.86 , $720.10 , $682.20 , $682.20 , $682.20 , $704.94 , $727.68 , $522.51 , $644.30 , $476.35 , $510.98 , N/A , $439.83 , $439.83 , $720.10 , $516.96 , $69.38 , $727.68 
"Ligation,Fallopian Tube W/C-Section",CPT® 58611,N/A,N/A,N/A," $1,535.00 ", $997.75 , $352.85 , $71.22 , $71.63 , $315.61 , $313.18 ," $1,427.55 "," $1,381.50 "," $1,381.50 "," $1,228.00 "," $1,228.00 ", $71.63 ," $1,417.27 "," $1,458.25 "," $1,381.50 "," $1,381.50 "," $1,381.50 "," $1,427.55 "," $1,473.60 ", $373.00 ," $1,304.75 ", $412.12 , $315.01 , N/A , $321.78 , $321.78 ," $1,458.25 ", $385.94 , $71.22 ," $1,473.60 "
"Candida, Dna, Dir Probe",CPT® 87480,N/A,N/A,N/A, $118.00 , $76.70 , N/A , $20.45 , $20.45 , $113.46 , $135.73 , $109.74 , $106.20 , $106.20 , $94.40 , $94.40 , $20.45 , $108.95 , $112.10 , $106.20 , $106.20 , $106.20 , $109.74 , $113.28 , $133.88 , $100.30 , $131.37 , $72.72 , N/A , $105.89 , $105.89 , $112.10 , $115.71 , $20.45 , $135.73 
Affinity1 Square Cm,HCPCS Q4159,N/A,N/A,N/A, $898.50 , $584.03 , N/A , $428.95 , N/A , N/A , N/A , $835.61 , $808.65 , $808.65 , $718.80 , $718.80 , N/A , $829.59 , $853.58 , $808.65 , $808.65 , $808.65 , $835.61 , $862.56 , $758.77 , $763.73 , $878.13 , $614.09 , N/A , N/A , N/A , $853.58 , N/A , $428.95 , $878.13 
Removal of Carpal Bone,CPT® 25210,N/A,N/A,N/A," $3,303.00 "," $2,146.95 "," $3,029.13 ", $477.30 , $461.04 ," $2,346.85 "," $2,352.01 "," $3,071.79 "," $2,972.70 "," $2,972.70 "," $2,642.40 "," $2,642.40 ", $461.04 ," $3,049.66 "," $3,137.85 "," $2,972.70 "," $2,972.70 "," $2,972.70 "," $3,071.79 "," $3,170.88 "," $2,811.10 "," $2,807.55 "," $2,585.11 "," $2,792.89 ", N/A ," $2,392.64 "," $2,392.64 "," $3,137.85 "," $2,812.21 ", $461.04 ," $3,170.88 "
Office/Outpatient New Moderate Mdm 45-59 Minutes,99204,N/A,N/A,N/A, $499.00 , $324.35 , $270.10 , $128.82 , $107.66 , $223.51 , $224.94 , $464.07 , $449.10 , $449.10 , $399.20 , $399.20 , $107.66 , $460.73 , $474.05 , $449.10 , $449.10 , $449.10 , $464.07 , $479.04 , $246.36 , $424.15 , $282.79 , $280.74 , $94.75 , $227.86 , $227.86 , $474.05 , $262.80 , $94.75 , $479.04 
 Pro Injection Aa&/Strd Ilioinguinal Ih Nerves ,CPT® 64425,0982 - PRO FEE/OUTPT,N/A,N/A, $901.00 , $585.65 , $271.75 , $52.72 , $76.84 , $522.44 , $515.02 , $837.93 , $810.90 , $810.90 , $720.80 , $720.80 , $76.84 , $831.89 , $855.95 , $810.90 , $810.90 , $810.90 , $837.93 , $864.96 , $295.49 , $765.85 , $504.89 , $564.76 , N/A , $532.63 , $532.63 , $855.95 , $571.39 , $52.72 , $864.96 
"Injection Proc,Extremity,Venography",CPT® 36005,N/A,N/A,N/A," $2,176.00 "," $1,414.40 ", $286.59 , $44.21 , $318.79 , $211.99 , $204.84 ," $2,023.68 "," $1,958.40 "," $1,958.40 "," $1,740.80 "," $1,740.80 ", $318.79 ," $2,009.10 "," $2,067.20 "," $1,958.40 "," $1,958.40 "," $1,958.40 "," $2,023.68 "," $2,088.96 ", $266.48 ," $1,849.60 ", $253.34 , $237.75 , N/A , $216.12 , $216.12 ," $2,067.20 ", $245.52 , $44.21 ," $2,088.96 "
Fac Closed Rx Radial Shaft Fx W/Dislocation,25520,N/A,N/A,N/A," $2,730.00 "," $1,774.50 "," $3,351.79 ", $528.07 , $485.34 ," $2,588.85 "," $2,592.77 "," $2,538.90 "," $2,457.00 "," $2,457.00 "," $2,184.00 "," $2,184.00 ", $485.34 ," $2,520.61 "," $2,593.50 "," $2,457.00 "," $2,457.00 "," $2,457.00 "," $2,538.90 "," $2,620.80 "," $3,099.50 "," $2,320.50 "," $2,858.07 "," $3,059.47 ", N/A ," $2,639.36 "," $2,639.36 "," $2,593.50 "," $3,102.20 ", $485.34 ," $3,351.79 "
Mast Modf Rad W/Ax Lymph Nod W/WO Pect/Alis Min,19307,N/A,N/A,N/A," $6,301.00 "," $4,095.65 "," $3,694.44 "," $1,094.48 ", $842.85 ," $3,213.09 "," $3,125.50 "," $5,859.93 "," $5,670.90 "," $5,670.90 "," $5,040.80 "," $5,040.80 ", $842.85 ," $5,817.71 "," $5,985.95 "," $5,670.90 "," $5,670.90 "," $5,670.90 "," $5,859.93 "," $6,048.96 "," $4,052.16 "," $5,355.85 "," $6,310.23 "," $4,063.28 ", N/A ," $3,275.78 "," $3,275.78 "," $5,985.95 "," $3,798.81 ", $842.85 ," $6,310.23 "
Open Rx Ankle Dislocatn,CPT® 27846,N/A,N/A,N/A," $4,867.00 "," $3,163.55 "," $4,410.06 ", $687.91 , $768.38 ," $3,539.26 "," $3,524.52 "," $4,526.31 "," $4,380.30 "," $4,380.30 "," $3,893.60 "," $3,893.60 ", $768.38 ," $4,493.70 "," $4,623.65 "," $4,380.30 "," $4,380.30 "," $4,380.30 "," $4,526.31 "," $4,672.32 "," $4,069.38 "," $4,136.95 "," $3,889.26 "," $4,106.40 ", N/A ," $3,608.31 "," $3,608.31 "," $4,623.65 "," $4,241.05 ", $687.91 ," $4,672.32 "
 Pro Closed Tx Ulnar Fracture Prox End W/O Manipulate ,CPT® 24670,0982 - PRO FEE/OUTPT,N/A,N/A," $1,004.00 ", $652.60 ," $1,666.60 ", $264.23 , $194.38 ," $1,264.93 "," $1,285.98 ", $933.72 , $903.60 , $903.60 , $803.20 , $803.20 , $194.38 , $926.99 , $953.80 , $903.60 , $903.60 , $903.60 , $933.72 , $963.84 ," $1,534.20 ", $853.40 ," $1,411.19 "," $1,501.55 ", N/A ," $1,289.61 "," $1,289.61 ", $953.80 ," $1,515.75 ", $194.38 ," $1,666.60 "
Percut Drain/Inject Renal Cyst,CPT® 50390,N/A,N/A,N/A, $680.00 , $442.00 , $517.44 , $90.17 , $76.84 , $481.49 , $444.08 , $632.40 , $612.00 , $612.00 , $544.00 , $544.00 , $76.84 , $627.84 , $646.00 , $612.00 , $612.00 , $612.00 , $632.40 , $652.80 , $520.78 , $578.00 , $503.11 , $594.98 , N/A , $490.89 , $490.89 , $646.00 , $576.99 , $76.84 , $652.80 
 PHENYLEPHRINE 1 MG/10 ML INJECTION (ANES&INPT) ,HCPCS J2371,0636 - DRUGS REQUIRING DETAILED CODIN,70092-1191-46,10 mL, $36.58 , $23.78 , $30.73 , N/A , N/A , $29.56 , $32.92 , $30.97 , $32.92 , $32.92 , $32.92 , $31.09 , N/A , $33.77 , $34.75 , $31.09 , $34.02 , $34.02 , $34.75 , $35.12 , $29.93 , $32.92 , $31.09 , $28.90 , N/A , $29.60 , $29.60 , $34.75 , $31.39 , $28.90 , $35.12 
Ear Cartilage Graft to Face,CPT® 21235,N/A,N/A,N/A," $4,151.00 "," $2,698.15 "," $3,501.75 ", $550.73 , $614.70 ," $2,761.51 "," $2,800.44 "," $3,860.43 "," $3,735.90 "," $3,735.90 "," $3,320.80 "," $3,320.80 ", $614.70 ," $3,832.62 "," $3,943.45 "," $3,735.90 "," $3,735.90 "," $3,735.90 "," $3,860.43 "," $3,984.96 "," $3,222.49 "," $3,528.35 "," $3,061.45 "," $3,241.14 ", N/A ," $2,815.39 "," $2,815.39 "," $3,943.45 "," $3,309.10 ", $550.73 ," $3,984.96 "
Hydromorphone Injection,HCPCS J1170,N/A,N/A,N/A, $8.00 , $5.20 , N/A , $4.44 , $4.30 , N/A , N/A , $7.44 , $7.20 , $7.20 , $6.40 , $6.40 , $4.30 , $7.39 , $7.60 , $7.20 , $7.20 , $7.20 , $7.44 , $7.68 , $3.48 , $6.80 , $3.24 , $4.52 , N/A , N/A , N/A , $7.60 , N/A , $3.24 , $7.68 
 INSULIN REGULAR(HUMAN) IN NACL 100-0.9 UT/100ML-% IV SOLN ,HCPCS J1815,0636 - DRUGS REQUIRING DETAILED CODIN,00338-0126-12,100 mL, $215.75 , $140.24 , $181.23 , N/A , $0.92 , $174.33 , $194.18 , $182.65 , $194.18 , $194.18 , $194.18 , $183.39 , $0.90 , $199.20 , $204.96 , $183.39 , $200.65 , $200.65 , $204.96 , $207.12 , $176.53 , $194.18 , $183.39 , $170.44 , N/A , $174.61 , $174.61 , $204.96 , $185.14 , $0.90 , $207.12 
 Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC ,MS DRG V40 (FY2023) 872,N/A,N/A,N/A," $27,149.61 "," $17,647.25 "," $22,805.67 ", N/A , N/A ," $21,936.88 "," $24,434.65 "," $22,984.86 "," $24,434.65 "," $24,434.65 "," $24,434.65 "," $23,077.17 ", N/A ," $25,067.23 "," $25,792.13 "," $23,077.17 "," $25,249.14 "," $25,249.14 "," $25,792.13 "," $26,063.63 "," $22,213.81 "," $24,434.65 "," $23,077.17 "," $21,448.19 ", N/A ," $21,972.18 "," $21,972.18 "," $25,792.13 "," $23,297.08 "," $21,448.19 "," $26,063.63 "
 Radiology .5% Bupivcaine 5mg/Ml 10 Ml Vial ,Custom 2500000002,0250 - PHARMACY,N/A,N/A, $54.00 , $35.10 , $45.36 , N/A , N/A , $43.63 , $48.60 , $45.72 , $48.60 , $48.60 , $48.60 , $45.90 , N/A , $49.86 , $51.30 , $45.90 , $50.22 , $50.22 , $51.30 , $51.84 , $44.18 , $48.60 , $45.90 , $42.66 , N/A , $43.70 , $43.70 , $51.30 , $46.34 , $42.66 , $51.84 
 Nuc Kidney Flow Function Mult W and W/O- Mh ,CPT® 78709,0974 - PRO FEE/NUC MED,N/A,N/A, $473.00 , $307.45 ," $1,980.47 ", $339.33 , $282.72 ," $1,778.62 "," $1,965.46 ", $439.89 , $425.70 , $425.70 , $378.40 , $378.40 , $282.72 , $436.72 , $449.35 , $425.70 , $425.70 , $425.70 , $439.89 , $454.08 ," $2,039.55 ", $402.05 ," $2,141.76 "," $2,467.06 ", N/A ," $1,813.32 "," $1,813.32 ", $449.35 ," $2,098.96 ", $282.72 ," $2,467.06 "
Menb-Fhbp Recombnt Lipoprotein Vacc 2/3 Dose Im,CPT® 90621,N/A,N/A,N/A, $273.00 , $177.45 , N/A , N/A , $136.74 , N/A , N/A , $253.89 , $245.70 , $245.70 , $218.40 , $218.40 , $136.74 , $252.06 , $259.35 , $245.70 , $245.70 , $245.70 , $253.89 , $262.08 , N/A , $232.05 , $218.40 , $276.27 , N/A , N/A , N/A , $259.35 , N/A , $136.74 , $276.27 
"Self-Adher Band W>=3"" <5""/Yd",HCPCS A6454,N/A,N/A,N/A, $8.00 , $5.20 , N/A , $1.06 , N/A , N/A , N/A , $7.44 , $7.20 , $7.20 , $6.40 , $6.40 , N/A , $7.39 , $7.60 , $7.20 , $7.20 , $7.20 , $7.44 , $7.68 , N/A , $6.80 , $0.65 , $0.96 , N/A , N/A , N/A , $7.60 , N/A , $0.65 , $7.68 
" Pro X-Rays, Bone Survey Complete ",CPT® 77075,0972 - PRO FEE/RAD/DX,N/A,N/A, $334.00 , $217.10 , $563.35 , $98.14 , $72.60 , $414.49 , $561.69 , $310.62 , $300.60 , $300.60 , $267.20 , $267.20 , $72.60 , $308.38 , $317.30 , $300.60 , $300.60 , $300.60 , $310.62 , $320.64 , $544.27 , $283.90 , $612.48 , $442.04 , N/A , $422.58 , $422.58 , $317.30 , $489.13 , $72.60 , $612.48 
"Locm 200-299mg/Ml Iodine,1ml",HCPCS Q9966,N/A,N/A,N/A, $3.00 , $1.95 , N/A , $0.38 , $0.52 , N/A , N/A , $2.79 , $2.70 , $2.70 , $2.40 , $2.40 , $0.52 , $2.77 , $2.85 , $2.70 , $2.70 , $2.70 , $2.79 , $2.88 , $0.42 , $2.55 , $0.65 , $0.42 , N/A , N/A , N/A , $2.85 , N/A , $0.38 , $2.88 
"MRI, Lumbar Spine",CPT® 72148,N/A,N/A,N/A," $5,196.00 "," $3,377.40 "," $1,374.31 ", $196.06 , $417.97 ," $1,884.45 "," $1,982.74 "," $4,832.28 "," $4,676.40 "," $4,676.40 "," $4,156.80 "," $4,156.80 ", $417.97 ," $4,797.47 "," $4,936.20 "," $4,676.40 "," $4,676.40 "," $4,676.40 "," $4,832.28 "," $4,988.16 "," $2,390.10 "," $4,416.60 "," $2,162.95 "," $2,076.39 ", N/A ," $1,921.22 "," $1,921.22 "," $4,936.20 "," $2,260.27 ", $196.06 ," $4,988.16 "
" Thoracic/Dorsal Spine,2 Views ",CPT® 72070,0320 - DX X-RAY,N/A,N/A, $312.00 , $202.80 , $262.08 , $32.42 , $32.08 , $252.10 , $280.80 , $264.14 , $280.80 , $280.80 , $280.80 , $265.20 , $31.45 , $288.07 , $296.40 , $265.20 , $290.16 , $290.16 , $296.40 , $299.52 , $255.28 , $280.80 , $265.20 , $246.48 , N/A , $252.50 , $252.50 , $296.40 , $267.73 , $31.45 , $299.52 
"Assay, Free Thyroxine",CPT® 84439,N/A,N/A,N/A, $106.00 , $68.90 , N/A , $9.20 , $9.20 , $51.01 , $61.06 , $98.58 , $95.40 , $95.40 , $84.80 , $84.80 , $9.20 , $97.87 , $100.70 , $95.40 , $95.40 , $95.40 , $98.58 , $101.76 , $60.23 , $90.10 , $58.39 , $32.69 , N/A , $47.61 , $47.61 , $100.70 , $52.02 , $9.20 , $101.76 
 REMDESIVIR 100 MG IV SOLR ,HCPCS J0248,0636 - DRUGS REQUIRING DETAILED CODIN,61958-2901-02,20 mL," $1,680.34 "," $1,092.22 "," $1,411.49 ", $6.18 , $5.62 ," $1,357.71 "," $1,512.31 "," $1,422.58 "," $1,512.31 "," $1,512.31 "," $1,512.31 "," $1,428.29 ", $5.51 ," $1,551.46 "," $1,596.32 "," $1,428.29 "," $1,562.72 "," $1,562.72 "," $1,596.32 "," $1,613.13 "," $1,374.85 "," $1,512.31 "," $1,428.29 "," $1,327.47 ", N/A ," $1,359.90 "," $1,359.90 "," $1,596.32 "," $1,441.90 ", $5.51 ," $1,613.13 "
 LISDEXAMFETAMINE DIMESYLATE 30 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,59417-0103-10,1 capsule, $75.89 , $49.33 , $63.75 , N/A , N/A , $61.32 , $68.30 , $64.25 , $68.30 , $68.30 , $68.30 , $64.51 , N/A , $70.07 , $72.10 , $64.51 , $70.58 , $70.58 , $72.10 , $72.85 , $62.09 , $68.30 , $64.51 , $59.95 , N/A , $61.42 , $61.42 , $72.10 , $65.12 , $59.95 , $72.85 
 Pro X-Ray Exam of Ribs/Chest ,CPT® 71111,0972 - PRO FEE/RAD/DX,N/A,N/A, $198.00 , $128.70 , $298.00 , $51.78 , $49.93 , $224.57 , $284.73 , $184.14 , $178.20 , $178.20 , $158.40 , $158.40 , $49.93 , $182.81 , $188.10 , $178.20 , $178.20 , $178.20 , $184.14 , $190.08 , $289.33 , $168.30 , $310.09 , $237.31 , N/A , $228.95 , $228.95 , $188.10 , $265.01 , $49.93 , $310.09 
 DOXAZOSIN MESYLATE 1 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-5522-61,1 tablet, $5.23 , $3.40 , $4.39 , N/A , N/A , $4.23 , $4.71 , $4.43 , $4.71 , $4.71 , $4.71 , $4.45 , N/A , $4.83 , $4.97 , $4.45 , $4.86 , $4.86 , $4.97 , $5.02 , $4.28 , $4.71 , $4.45 , $4.13 , N/A , $4.23 , $4.23 , $4.97 , $4.49 , $4.13 , $5.02 
" Fac Vein X-Ray, Chest ",CPT® 75827,0320 - DX X-RAY,N/A,N/A," $1,287.00 ", $836.55 ," $1,081.08 ", $116.23 , $219.45 ," $1,039.90 "," $1,158.30 "," $1,089.57 "," $1,158.30 "," $1,158.30 "," $1,158.30 "," $1,093.95 ", $215.15 ," $1,188.29 "," $1,222.65 "," $1,093.95 "," $1,196.91 "," $1,196.91 "," $1,222.65 "," $1,235.52 "," $1,053.02 "," $1,158.30 "," $1,093.95 "," $1,016.73 ", N/A ," $1,041.57 "," $1,041.57 "," $1,222.65 "," $1,104.37 ", $116.23 ," $1,235.52 "
"Insert Vert Fix Dev,Ant,2-3 Sgmts",CPT® 22845,N/A,N/A,N/A," $5,373.00 "," $3,492.45 "," $4,166.83 ", $648.13 , $480.44 ," $3,488.22 "," $3,404.69 "," $4,996.89 "," $4,835.70 "," $4,835.70 "," $4,298.40 "," $4,298.40 ", $480.44 ," $4,960.89 "," $5,104.35 "," $4,835.70 "," $4,835.70 "," $4,835.70 "," $4,996.89 "," $5,158.08 "," $3,898.00 "," $4,567.05 "," $3,880.34 "," $4,005.94 ", N/A ," $3,556.28 "," $3,556.28 "," $5,104.35 "," $4,179.90 ", $480.44 ," $5,158.08 "
"Explore Undesc Testis,Inguin/Scrotal",CPT® 54550,N/A,N/A,N/A," $2,700.00 "," $1,755.00 "," $2,182.12 ", $470.32 , $461.04 ," $1,579.06 "," $1,597.31 "," $2,511.00 "," $2,430.00 "," $2,430.00 "," $2,160.00 "," $2,160.00 ", $461.04 ," $2,492.91 "," $2,565.00 "," $2,430.00 "," $2,430.00 "," $2,430.00 "," $2,511.00 "," $2,592.00 "," $2,050.41 "," $2,295.00 "," $2,544.08 "," $2,384.82 ", N/A ," $1,609.87 "," $1,609.87 "," $2,565.00 "," $1,929.52 ", $461.04 ," $2,592.00 "
 Fac Byp Oth/Thn Vein Fempop ,CPT® 35656,0360 - OR SERVICES,N/A,N/A," $4,707.00 "," $3,059.55 "," $3,953.88 ", $956.54 ," $1,067.65 "," $3,803.26 "," $4,236.30 "," $3,984.95 "," $4,236.30 "," $4,236.30 "," $4,236.30 "," $4,000.95 "," $1,046.72 "," $4,345.97 "," $4,471.65 "," $4,000.95 "," $4,377.51 "," $4,377.51 "," $4,471.65 "," $4,518.72 "," $3,851.27 "," $4,236.30 "," $4,000.95 "," $3,718.53 ", N/A ," $3,809.38 "," $3,809.38 "," $4,471.65 "," $4,039.08 ", $956.54 ," $4,518.72 "
 Prtx RBC Antb Dns Gradient Sep HB Lab ,CPT® 86972,0300 - LABORATORY,N/A,N/A, $134.00 , $87.10 , $112.56 , N/A , N/A , $108.27 , $120.60 , $113.44 , $120.60 , $120.60 , $120.60 , $113.90 , N/A , $123.72 , $127.30 , $113.90 , $124.62 , $124.62 , $127.30 , $128.64 , $109.64 , $120.60 , $113.90 , $105.86 , N/A , $108.45 , $108.45 , $127.30 , $114.99 , $105.86 , $128.64 
 Trauma 3 Activation W/O Pre-ED Notiification Lvl 1 -W/O Critical Care ,CPT® 99285,0450 - EMERGENCY SERVICES,N/A,N/A," $3,527.00 "," $2,292.55 "," $2,962.68 ", $168.76 , $44.31 ," $2,849.82 "," $3,174.30 "," $2,985.96 "," $3,174.30 "," $3,174.30 "," $3,174.30 "," $2,997.95 ", $43.44 ," $3,256.48 "," $3,350.65 "," $2,997.95 "," $3,280.11 "," $3,280.11 "," $3,350.65 "," $3,385.92 "," $2,885.79 "," $3,174.30 "," $2,997.95 "," $2,786.33 ", N/A ," $2,854.40 "," $2,854.40 "," $3,350.65 "," $3,026.52 ", $43.44 ," $3,385.92 "
 Fac Antineutrophil Cytoplasmic Antb Screen Ea Antb ,CPT® 86036,0302 - LAB/IMMUNOLOGY,N/A,N/A, $147.00 , $95.55 , $123.48 , $12.29 , $12.29 , $118.78 , $132.30 , $124.45 , $132.30 , $132.30 , $132.30 , $124.95 , $12.05 , $135.73 , $139.65 , $124.95 , $136.71 , $136.71 , $139.65 , $141.12 , $120.28 , $132.30 , $124.95 , $116.13 , N/A , $118.97 , $118.97 , $139.65 , $126.14 , $12.05 , $141.12 
 Fac RBC Antibody Elution ,CPT® 86860,0300 - LABORATORY,N/A,N/A, $220.00 , $143.00 , $184.80 , N/A , $19.38 , $177.76 , $198.00 , $186.25 , $198.00 , $198.00 , $198.00 , $187.00 , $19.00 , $203.13 , $209.00 , $187.00 , $204.60 , $204.60 , $209.00 , $211.20 , $180.00 , $198.00 , $187.00 , $173.80 , N/A , $178.05 , $178.05 , $209.00 , $188.78 , $19.00 , $211.20 
Prep Site F/S/N/H/F/G/M/D Gt 1st 100 Sq Cm/1pct,15004,N/A,N/A,N/A," $2,092.00 "," $1,359.80 ", $831.98 , $247.01 , $298.14 , $745.13 , $721.40 ," $1,945.56 "," $1,882.80 "," $1,882.80 "," $1,673.60 "," $1,673.60 ", $298.14 ," $1,931.54 "," $1,987.40 "," $1,882.80 "," $1,882.80 "," $1,882.80 "," $1,945.56 "," $2,008.32 ", $917.20 ," $1,778.20 "," $1,437.96 ", $941.84 , N/A , $759.67 , $759.67 ," $1,987.40 ", $880.97 , $247.01 ," $2,008.32 "
X-Ray Facial Bones <3 Vw,CPT® 70140,N/A,N/A,N/A, $418.00 , $271.70 , $181.13 , $31.74 , $28.06 , $140.60 , $159.35 , $388.74 , $376.20 , $376.20 , $334.40 , $334.40 , $28.06 , $385.94 , $397.10 , $376.20 , $376.20 , $376.20 , $388.74 , $401.28 , $176.67 , $355.30 , $175.27 , $149.63 , N/A , $143.34 , $143.34 , $397.10 , $165.93 , $28.06 , $401.28 
 Fac Drug Screen Quantitative Levetiracetam ,CPT® 80177,0301 - LAB/CHEMISTRY,N/A,N/A, $181.00 , $117.65 , $152.04 , $13.52 , $13.52 , $146.25 , $162.90 , $153.23 , $162.90 , $162.90 , $162.90 , $153.85 , $13.25 , $167.12 , $171.95 , $153.85 , $168.33 , $168.33 , $171.95 , $173.76 , $148.09 , $162.90 , $153.85 , $142.99 , N/A , $146.48 , $146.48 , $171.95 , $155.32 , $13.25 , $173.76 
" Ivl W/Pta; Tib, Peroneal ",HCPCS C9772,0360 - OR SERVICES,N/A,N/A," $15,277.00 "," $9,930.05 "," $12,832.68 ", N/A , N/A ," $12,343.82 "," $13,749.30 "," $12,933.51 "," $13,749.30 "," $13,749.30 "," $13,749.30 "," $12,985.45 ", N/A ," $14,105.25 "," $14,513.15 "," $12,985.45 "," $14,207.61 "," $14,207.61 "," $14,513.15 "," $14,665.92 "," $12,499.64 "," $13,749.30 "," $12,985.45 "," $12,068.83 ", N/A ," $12,363.68 "," $12,363.68 "," $14,513.15 "," $13,109.19 "," $12,068.83 "," $14,665.92 "
"Repair Shoulder Capsule,Bankart",CPT® 23455,N/A,N/A,N/A," $3,452.00 "," $2,243.80 "," $6,012.96 ", $937.96 , $887.64 ," $4,831.59 "," $4,793.08 "," $3,210.36 "," $3,106.80 "," $3,106.80 "," $2,761.60 "," $2,761.60 ", $887.64 ," $3,187.23 "," $3,279.40 "," $3,106.80 "," $3,106.80 "," $3,106.80 "," $3,210.36 "," $3,313.92 "," $5,605.93 "," $2,934.20 "," $5,300.45 "," $5,663.07 ", N/A ," $4,925.87 "," $4,925.87 "," $3,279.40 "," $5,789.65 ", $887.64 ," $6,012.96 "
Incision of Lip Fold,CPT® 40806,N/A,N/A,N/A," $1,019.00 ", $662.35 , $174.14 , $27.90 , $30.71 , $161.23 , $157.63 , $947.67 , $917.10 , $917.10 , $815.20 , $815.20 , $30.71 , $940.84 , $968.05 , $917.10 , $917.10 , $917.10 , $947.67 , $978.24 , $125.59 , $866.15 , $171.27 , $192.97 , N/A , $164.37 , $164.37 , $968.05 , $171.93 , $27.90 , $978.24 
 LACTATED RINGERS BOLUS ,HCPCS RXA258,0258 - IV SOLUTIONS,00990-7953-03,500 mL, $86.47 , $56.21 , $72.63 , N/A , N/A , $69.87 , $77.82 , $73.21 , $77.82 , $77.82 , $77.82 , $73.50 , N/A , $79.84 , $82.15 , $73.50 , $80.42 , $80.42 , $82.15 , $83.01 , $70.75 , $77.82 , $73.50 , $68.31 , N/A , $69.98 , $69.98 , $82.15 , $74.20 , $68.31 , $83.01 
"Hysteroscopy,Resect Septum",CPT® 58560,N/A,N/A,N/A," $3,929.00 "," $2,553.85 "," $1,455.95 ", $294.66 , $279.17 ," $1,571.22 "," $1,565.52 "," $3,653.97 "," $3,536.10 "," $3,536.10 "," $3,143.20 "," $3,143.20 ", $279.17 ," $3,627.65 "," $3,732.55 "," $3,536.10 "," $3,536.10 "," $3,536.10 "," $3,653.97 "," $3,771.84 "," $1,536.04 "," $3,339.65 "," $2,062.38 "," $1,301.86 ", N/A ," $1,601.87 "," $1,601.87 "," $3,732.55 "," $1,921.35 ", $279.17 ," $3,771.84 "
Pro Removal of Kneecap,27350,N/A,N/A,N/A," $5,465.00 "," $3,552.25 "," $3,993.41 ", $626.67 , $768.38 ," $3,137.24 "," $3,139.29 "," $5,082.45 "," $4,918.50 "," $4,918.50 "," $4,372.00 "," $4,372.00 ", $768.38 ," $5,045.83 "," $5,191.75 "," $4,918.50 "," $4,918.50 "," $4,918.50 "," $5,082.45 "," $5,246.40 "," $3,702.64 "," $4,645.25 "," $3,464.65 "," $3,706.90 ", N/A ," $3,198.45 "," $3,198.45 "," $5,191.75 "," $3,759.32 ", $626.67 ," $5,246.40 "
Assay of Sirolimus,CPT® 80195,N/A,N/A,N/A, $136.00 , $88.40 , N/A , $14.00 , $14.00 , $77.71 , $92.90 , $126.48 , $122.40 , $122.40 , $108.80 , $108.80 , $14.00 , $125.57 , $129.20 , $122.40 , $122.40 , $122.40 , $126.48 , $130.56 , $91.68 , $115.60 , $89.20 , $49.81 , N/A , $72.52 , $72.52 , $129.20 , $79.25 , $14.00 , $130.56 
"Exc Skin Benig 0.6-1cm Face,Facial",11441,N/A,N/A,N/A, $682.00 , $443.30 , $426.39 , $128.83 , $116.82 , $358.23 , $354.74 , $634.26 , $613.80 , $613.80 , $545.60 , $545.60 , $116.82 , $629.69 , $647.90 , $613.80 , $613.80 , $613.80 , $634.26 , $654.72 , $462.54 , $579.70 , $704.71 , $461.95 , N/A , $365.22 , $365.22 , $647.90 , $423.54 , $116.82 , $704.71 
"Immunoflourescent Stdy,Di",CPT® 88346,N/A,N/A,N/A, $418.00 , $271.70 , $546.60 , $149.59 , $52.81 , $437.85 , $500.55 , $388.74 , $376.20 , $376.20 , $334.40 , $334.40 , $52.81 , $385.94 , $397.10 , $376.20 , $376.20 , $376.20 , $388.74 , $401.28 , $924.39 , $355.30 , $520.61 , $326.92 , N/A , $408.63 , $408.63 , $397.10 , $449.06 , $52.81 , $924.39 
 LAMOTRIGINE 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-7007-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Pro Dilat Lacrimal Punctum +-Irrg ,CPT® 68801,0982 - PRO FEE/OUTPT,N/A,N/A, $398.00 , $258.70 , $484.45 , $77.05 , $44.63 , $607.38 , $577.04 , $370.14 , $358.20 , $358.20 , $318.40 , $318.40 , $44.63 , $367.47 , $378.10 , $358.20 , $358.20 , $358.20 , $370.14 , $382.08 , $663.69 , $338.30 , $594.09 , $566.45 , N/A , $619.24 , $619.24 , $378.10 , $683.56 , $44.63 , $683.56 
"Pro Venipuncture,Under Age 3",36400,N/A,N/A,N/A, $176.00 , $114.40 , $117.78 , $18.17 , $52.35 , $84.79 , $84.06 , $163.68 , $158.40 , $158.40 , $140.80 , $140.80 , $52.35 , $162.50 , $167.20 , $158.40 , $158.40 , $158.40 , $163.68 , $168.96 , $109.26 , $149.60 , $103.48 , $94.31 , N/A , $86.44 , $86.44 , $167.20 , $98.20 , $18.17 , $168.96 
 Pro Fluor Gid Ctr Vad Plmt Rplcmt/Rmvl ,CPT® 77001,0972 - PRO FEE/RAD/DX,N/A,N/A, $203.00 , $131.95 , $580.29 , $98.73 , $67.21 , $334.35 , $627.13 , $188.79 , $182.70 , $182.70 , $162.40 , $162.40 , $67.21 , $187.43 , $192.85 , $182.70 , $182.70 , $182.70 , $188.79 , $194.88 , $564.90 , $172.55 , $685.67 , $424.63 , N/A , $340.88 , $340.88 , $192.85 , $394.59 , $67.21 , $685.67 
Exc Tumor Soft Tiss Upper Arm/Elbw Subfasc 5+Cm,CPT® 24073,N/A,N/A,N/A," $7,475.00 "," $4,858.75 "," $4,183.86 ", $653.02 , $571.48 ," $3,336.04 "," $3,296.57 "," $6,951.75 "," $6,727.50 "," $6,727.50 "," $5,980.00 "," $5,980.00 ", $571.48 ," $6,901.67 "," $7,101.25 "," $6,727.50 "," $6,727.50 "," $6,727.50 "," $6,951.75 "," $7,176.00 "," $3,887.21 "," $6,353.75 "," $3,648.41 "," $3,914.25 ", N/A ," $3,401.13 "," $3,401.13 "," $7,101.25 "," $3,997.54 ", $571.48 ," $7,176.00 "
 LEVOTHYROXINE SODIUM 50 MCG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6950-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Exc Parotd,Total,Dissect 5th Nerv",CPT® 42420,N/A,N/A,N/A," $7,888.00 "," $5,127.20 "," $7,273.89 "," $1,138.67 "," $1,235.75 "," $5,701.34 "," $5,796.12 "," $7,335.84 "," $7,099.20 "," $7,099.20 "," $6,310.40 "," $6,310.40 "," $1,235.75 "," $7,282.99 "," $7,493.60 "," $7,099.20 "," $7,099.20 "," $7,099.20 "," $7,335.84 "," $7,572.48 "," $5,166.93 "," $6,704.80 "," $6,338.78 "," $6,676.00 ", N/A ," $5,812.58 "," $5,812.58 "," $7,493.60 "," $6,079.33 "," $1,138.67 "," $7,572.48 "
" Fac Insert Bladder Cath, Complex ",CPT® 51703,0361 - OR/MINOR,N/A,N/A, $488.00 , $317.20 , $409.92 , $72.47 , $143.34 , $394.30 , $439.20 , $413.14 , $439.20 , $439.20 , $439.20 , $414.80 , $140.53 , $450.57 , $463.60 , $414.80 , $453.84 , $453.84 , $463.60 , $468.48 , $399.28 , $439.20 , $414.80 , $385.52 , N/A , $394.94 , $394.94 , $463.60 , $418.75 , $72.47 , $468.48 
 Fac Bx Lvr Wedge ,CPT® 47100,0360 - OR SERVICES,N/A,N/A," $4,201.00 "," $2,730.65 "," $3,528.84 ", $788.33 , $370.79 ," $3,394.41 "," $3,780.90 "," $3,556.57 "," $3,780.90 "," $3,780.90 "," $3,780.90 "," $3,570.85 ", $363.52 ," $3,878.78 "," $3,990.95 "," $3,570.85 "," $3,906.93 "," $3,906.93 "," $3,990.95 "," $4,032.96 "," $3,437.26 "," $3,780.90 "," $3,570.85 "," $3,318.79 ", N/A ," $3,399.87 "," $3,399.87 "," $3,990.95 "," $3,604.88 ", $363.52 ," $4,032.96 "
Delivery/Birthing Room Resuscitation,CPT® 99465,N/A,N/A,N/A, $764.00 , $496.60 , $291.17 , $138.15 , $95.27 , $399.46 , $393.13 , $710.52 , $687.60 , $687.60 , $611.20 , $611.20 , $95.27 , $705.40 , $725.80 , $687.60 , $687.60 , $687.60 , $710.52 , $733.44 , $368.09 , $649.40 , $315.79 , $483.58 , N/A , $407.25 , $407.25 , $725.80 , $487.28 , $95.27 , $733.44 
"Fix Quad/Hamstr Musc Rupt,Primary",CPT® 27385,N/A,N/A,N/A," $4,171.00 "," $2,711.15 "," $3,746.99 ", $586.39 , $691.53 ," $2,772.28 "," $2,791.27 "," $3,879.03 "," $3,753.90 "," $3,753.90 "," $3,336.80 "," $3,336.80 ", $691.53 ," $3,851.08 "," $3,962.45 "," $3,753.90 "," $3,753.90 "," $3,753.90 "," $3,879.03 "," $4,004.16 "," $3,442.62 "," $3,545.35 "," $3,073.94 "," $3,274.26 ", N/A ," $2,826.38 "," $2,826.38 "," $3,962.45 "," $3,322.00 ", $586.39 ," $4,004.16 "
Surgical Path Level 3,CPT® 88304,N/A,N/A,N/A, $449.00 , $291.85 , $147.15 , $41.65 , $29.95 , $180.38 , $202.65 , $417.57 , $404.10 , $404.10 , $359.20 , $359.20 , $29.95 , $414.56 , $426.55 , $404.10 , $404.10 , $404.10 , $417.57 , $431.04 , $265.55 , $381.65 , $212.46 , $141.14 , N/A , $168.34 , $168.34 , $426.55 , $185.00 , $29.95 , $431.04 
 Pro Incision of Foot Fascia ,CPT® 28008,0982 - PRO FEE/OUTPT,N/A,N/A," $2,884.00 "," $1,874.60 "," $1,833.20 ", $287.22 , $153.67 ," $1,449.07 "," $1,435.73 "," $2,682.12 "," $2,595.60 "," $2,595.60 "," $2,307.20 "," $2,307.20 ", $153.67 ," $2,662.80 "," $2,739.80 "," $2,595.60 "," $2,595.60 "," $2,595.60 "," $2,682.12 "," $2,768.64 "," $1,706.91 "," $2,451.40 "," $1,552.14 "," $1,725.11 ", N/A ," $1,477.34 "," $1,477.34 "," $2,739.80 "," $1,736.38 ", $153.67 ," $2,768.64 "
" Fac Closed Rx Acetabular Fx,Manipulatn ",CPT® 27222,0360 - OR SERVICES,N/A,N/A," $7,198.00 "," $4,678.70 "," $6,046.32 ", $933.81 , $845.22 ," $5,815.98 "," $6,478.20 "," $6,093.83 "," $6,478.20 "," $6,478.20 "," $6,478.20 "," $6,118.30 ", $828.65 ," $6,645.91 "," $6,838.10 "," $6,118.30 "," $6,694.14 "," $6,694.14 "," $6,838.10 "," $6,910.08 "," $5,889.40 "," $6,478.20 "," $6,118.30 "," $5,686.42 ", N/A ," $5,825.34 "," $5,825.34 "," $6,838.10 "," $6,176.60 ", $828.65 ," $6,910.08 "
Repair Heart Wnd W Cp Bypass,CPT® 33305,N/A,N/A,N/A," $24,385.00 "," $15,850.25 "," $23,762.64 "," $3,665.97 "," $2,378.00 "," $17,515.50 "," $17,280.87 "," $22,678.05 "," $21,946.50 "," $21,946.50 "," $19,508.00 "," $19,508.00 "," $2,378.00 "," $22,514.67 "," $23,165.75 "," $21,946.50 "," $21,946.50 "," $21,946.50 "," $22,678.05 "," $23,409.60 "," $22,044.15 "," $20,727.25 "," $21,915.44 "," $19,622.78 ", N/A ," $17,857.26 "," $17,857.26 "," $23,165.75 "," $20,285.87 "," $2,378.00 "," $23,762.64 "
 Fac Chlamydia Antibody ,CPT® 86631,0302 - LAB/IMMUNOLOGY,N/A,N/A, $99.00 , $64.35 , $83.16 , $12.06 , $8.07 , $79.99 , $89.10 , $83.81 , $89.10 , $89.10 , $89.10 , $84.15 , $7.91 , $91.41 , $94.05 , $84.15 , $92.07 , $92.07 , $94.05 , $95.04 , $81.00 , $89.10 , $84.15 , $78.21 , N/A , $80.12 , $80.12 , $94.05 , $84.95 , $7.91 , $95.04 
Injection Aa&/Strd Suprascapular Nerve,CPT® 64418,N/A,N/A,N/A," $1,009.00 ", $655.85 , $277.21 , $53.45 , $118.05 , $429.58 , $407.95 , $938.37 , $908.10 , $908.10 , $807.20 , $807.20 , $118.05 , $931.61 , $958.55 , $908.10 , $908.10 , $908.10 , $938.37 , $968.64 , $303.89 , $857.65 , $397.85 , $372.13 , N/A , $437.96 , $437.96 , $958.55 , $469.81 , $53.45 , $968.64 
Open Rx Prox/Shaft Fibula Fx,27784,N/A,N/A,N/A," $4,718.00 "," $3,066.70 "," $4,319.12 ", $678.86 , $614.70 ," $3,457.33 "," $3,447.77 "," $4,387.74 "," $4,246.20 "," $4,246.20 "," $3,774.40 "," $3,774.40 ", $614.70 ," $4,356.13 "," $4,482.10 "," $4,246.20 "," $4,246.20 "," $4,246.20 "," $4,387.74 "," $4,529.28 "," $4,008.58 "," $4,010.30 "," $3,805.41 "," $4,051.11 ", N/A ," $3,524.79 "," $3,524.79 "," $4,482.10 "," $4,142.88 ", $614.70 ," $4,529.28 "
Amputation Ankle-Tib/Fib Malleoli,CPT® 27888,N/A,N/A,N/A," $4,557.00 "," $2,962.05 "," $3,934.45 ", $604.65 , $768.38 ," $3,331.96 "," $3,277.51 "," $4,238.01 "," $4,101.30 "," $4,101.30 "," $3,645.60 "," $3,645.60 ", $768.38 ," $4,207.48 "," $4,329.15 "," $4,101.30 "," $4,101.30 "," $4,101.30 "," $4,238.01 "," $4,374.72 "," $3,677.87 "," $3,873.45 "," $3,618.08 "," $3,836.01 ", N/A ," $3,396.97 "," $3,396.97 "," $4,329.15 "," $3,992.66 ", $604.65 ," $4,374.72 "
"Incis Thigh Tendon,Adduc/Hamst,Singl",CPT® 27306,N/A,N/A,N/A," $2,932.00 "," $1,905.80 "," $2,129.53 ", $329.40 , $230.52 ," $1,747.85 "," $1,751.15 "," $2,726.76 "," $2,638.80 "," $2,638.80 "," $2,345.60 "," $2,345.60 ", $230.52 ," $2,707.12 "," $2,785.40 "," $2,638.80 "," $2,638.80 "," $2,638.80 "," $2,726.76 "," $2,814.72 "," $1,951.62 "," $2,492.20 "," $1,932.14 "," $2,012.53 ", N/A ," $1,781.95 "," $1,781.95 "," $2,785.40 "," $2,094.44 ", $230.52 ," $2,814.72 "
 Fac Kinesis 20 ,Custom 500159,0990 - PT CONVENIENCE,N/A,N/A, $21.00 , $13.65 , $17.64 , N/A , N/A , $16.97 , $18.90 , $17.78 , $18.90 , $18.90 , $18.90 , $17.85 , N/A , $19.39 , $19.95 , $17.85 , $19.53 , $19.53 , $19.95 , $20.16 , $17.18 , $18.90 , $17.85 , $16.59 , N/A , $17.00 , $17.00 , $19.95 , $18.02 , $16.59 , $20.16 
" Pro Surg Dx Exam, Anorectal ",CPT® 45990,0982 - PRO FEE/OUTPT,N/A,N/A, $705.00 , $458.25 , $635.31 , $98.63 , $89.21 , $510.76 , $514.87 , $655.65 , $634.50 , $634.50 , $564.00 , $564.00 , $89.21 , $650.93 , $669.75 , $634.50 , $634.50 , $634.50 , $655.65 , $676.80 , $456.24 , $599.25 , $565.55 , $605.04 , N/A , $520.72 , $520.72 , $669.75 , $544.61 , $89.21 , $676.80 
 Fac Revj Opn Arven Fstl W/Thrmbc Dial Grf ,CPT® 36833,0360 - OR SERVICES,N/A,N/A," $8,159.00 "," $5,303.35 "," $6,853.56 ", $724.16 , $565.74 ," $6,592.47 "," $7,343.10 "," $6,907.41 "," $7,343.10 "," $7,343.10 "," $7,343.10 "," $6,935.15 ", $554.65 ," $7,533.20 "," $7,751.05 "," $6,935.15 "," $7,587.87 "," $7,587.87 "," $7,751.05 "," $7,832.64 "," $6,675.69 "," $7,343.10 "," $6,935.15 "," $6,445.61 ", N/A ," $6,603.08 "," $6,603.08 "," $7,751.05 "," $7,001.24 ", $554.65 ," $7,832.64 "
"Repair Shldr Capsu,Ant,Coracoid Xfer",CPT® 23462,N/A,N/A,N/A," $7,090.00 "," $4,608.50 "," $6,449.17 "," $1,008.69 "," $1,152.58 "," $5,132.08 "," $5,095.23 "," $6,593.70 "," $6,381.00 "," $6,381.00 "," $5,672.00 "," $5,672.00 "," $1,152.58 "," $6,546.20 "," $6,735.50 "," $6,381.00 "," $6,381.00 "," $6,381.00 "," $6,593.70 "," $6,806.40 "," $6,008.40 "," $6,026.50 "," $5,641.21 "," $6,028.19 ", N/A ," $5,232.21 "," $5,232.21 "," $6,735.50 "," $6,149.71 "," $1,008.69 "," $6,806.40 "
Remove Transplanted Kidney,CPT® 50370,N/A,N/A,N/A," $8,061.00 "," $5,239.65 "," $6,420.68 "," $1,127.32 "," $1,205.52 "," $5,755.03 "," $5,436.86 "," $7,496.73 "," $7,254.90 "," $7,254.90 "," $6,448.80 "," $6,448.80 "," $1,205.52 "," $7,442.72 "," $7,657.95 "," $7,254.90 "," $7,254.90 "," $7,254.90 "," $7,496.73 "," $7,738.56 "," $6,391.12 "," $6,851.85 "," $6,338.78 "," $7,118.57 ", N/A ," $5,867.33 "," $5,867.33 "," $7,657.95 "," $6,896.19 "," $1,127.32 "," $7,738.56 "
 Fac Assay of CSF Protein ,CPT® 83873,0301 - LAB/CHEMISTRY,N/A,N/A, $191.00 , $124.15 , $160.44 , $17.54 , $17.54 , $154.33 , $171.90 , $161.70 , $171.90 , $171.90 , $171.90 , $162.35 , $17.20 , $176.35 , $181.45 , $162.35 , $177.63 , $177.63 , $181.45 , $183.36 , $156.28 , $171.90 , $162.35 , $150.89 , N/A , $154.58 , $154.58 , $181.45 , $163.90 , $17.20 , $183.36 
 US Thoracentesis Tube Placement ,CPT® 32557,0972 - PRO FEE/RAD/DX,N/A,N/A," $5,397.00 "," $3,508.05 ", $818.57 , $142.63 , $559.75 , $599.80 , $602.46 ," $5,019.21 "," $4,857.30 "," $4,857.30 "," $4,317.60 "," $4,317.60 ", $559.75 ," $4,983.05 "," $5,127.15 "," $4,857.30 "," $4,857.30 "," $4,857.30 "," $5,019.21 "," $5,181.12 ", $795.48 ," $4,587.45 ", $870.62 , $797.92 , N/A , $611.50 , $611.50 ," $5,127.15 ", $720.18 , $142.63 ," $5,181.12 "
Explore W Removal Arm/Wri,CPT® 25248,N/A,N/A,N/A," $1,607.00 "," $1,044.55 "," $2,570.17 ", $399.62 , $329.90 ," $1,988.15 "," $1,985.72 "," $1,494.51 "," $1,446.30 "," $1,446.30 "," $1,285.60 "," $1,285.60 ", $329.90 ," $1,483.74 "," $1,526.65 "," $1,446.30 "," $1,446.30 "," $1,446.30 "," $1,494.51 "," $1,542.72 "," $2,374.70 "," $1,365.95 "," $2,190.83 "," $2,342.03 ", N/A ," $2,026.95 "," $2,026.95 "," $1,526.65 "," $2,382.38 ", $329.90 ," $2,570.17 "
 Fac Myelography via Lumbar Injection Rs&I Thoracic ,CPT® 62303,0361 - OR/MINOR,N/A,N/A," $1,869.00 "," $1,214.85 "," $1,569.96 ", $114.71 , $200.16 ," $1,510.15 "," $1,682.10 "," $1,582.30 "," $1,682.10 "," $1,682.10 "," $1,682.10 "," $1,588.65 ", $196.24 ," $1,725.65 "," $1,775.55 "," $1,588.65 "," $1,738.17 "," $1,738.17 "," $1,775.55 "," $1,794.24 "," $1,529.22 "," $1,682.10 "," $1,588.65 "," $1,476.51 ", N/A ," $1,512.58 "," $1,512.58 "," $1,775.55 "," $1,603.79 ", $114.71 ," $1,794.24 "
Clear Outer Ear Canal,69200,N/A,N/A,N/A, $711.00 , $462.15 , $222.00 , $45.22 , $46.62 , $277.17 , $286.82 , $661.23 , $639.90 , $639.90 , $568.80 , $568.80 , $46.62 , $656.47 , $675.45 , $639.90 , $639.90 , $639.90 , $661.23 , $682.56 , $241.42 , $604.35 , $312.21 , $230.70 , N/A , $282.58 , $282.58 , $675.45 , $322.66 , $45.22 , $682.56 
Thrombolysis Arterial Infusion Icra Rs&I Init Tx,CPT® 37211,N/A,N/A,N/A," $2,477.00 "," $1,610.05 "," $2,281.50 ", $351.92 , $272.54 ," $1,738.64 "," $1,711.94 "," $2,303.61 "," $2,229.30 "," $2,229.30 "," $1,981.60 "," $1,981.60 ", $272.54 ," $2,287.01 "," $2,353.15 "," $2,229.30 "," $2,229.30 "," $2,229.30 "," $2,303.61 "," $2,377.92 "," $2,113.97 "," $2,105.45 "," $2,131.96 "," $1,891.39 ", N/A ," $1,772.57 "," $1,772.57 "," $2,353.15 "," $2,013.63 ", $272.54 ," $2,377.92 "
 SODIUM TETRADECYL SULFATE 3 % IV SOLN ,HCPCS RXA250,0250 - PHARMACY,67457-0163-02,2 mL, $481.60 , $313.04 , $404.54 , N/A , N/A , $389.13 , $433.44 , $407.72 , $433.44 , $433.44 , $433.44 , $409.36 , N/A , $444.66 , $457.52 , $409.36 , $447.89 , $447.89 , $457.52 , $462.34 , $394.05 , $433.44 , $409.36 , $380.46 , N/A , $389.76 , $389.76 , $457.52 , $413.26 , $380.46 , $462.34 
"Lap,Cholecystectomy/Explore",CPT® 47564,N/A,N/A,N/A," $7,886.00 "," $5,125.90 "," $6,656.98 "," $1,031.45 ", $903.78 ," $5,220.90 "," $5,285.76 "," $7,333.98 "," $7,097.40 "," $7,097.40 "," $6,308.80 "," $6,308.80 ", $903.78 ," $7,281.14 "," $7,491.70 "," $7,097.40 "," $7,097.40 "," $7,097.40 "," $7,333.98 "," $7,570.56 "," $4,769.83 "," $6,703.10 "," $5,882.06 "," $6,162.87 ", N/A ," $5,322.76 "," $5,322.76 "," $7,491.70 "," $5,567.05 ", $903.78 ," $7,570.56 "
"Biopsy of Thyroid,Percut",CPT® 60100,N/A,N/A,N/A, $857.00 , $557.05 , $474.63 , $73.60 , $88.93 , $419.74 , $421.31 , $797.01 , $771.30 , $771.30 , $685.60 , $685.60 , $88.93 , $791.27 , $814.15 , $771.30 , $771.30 , $771.30 , $797.01 , $822.72 , $464.36 , $728.45 , $410.33 , $407.02 , N/A , $427.93 , $427.93 , $814.15 , $477.27 , $73.60 , $822.72 
"Cystoscopy,Tx Ureteral Stricture",CPT® 52341,N/A,N/A,N/A," $2,016.00 "," $1,310.40 "," $1,520.24 ", $267.51 , $372.95 ," $1,392.54 "," $1,316.04 "," $1,874.88 "," $1,814.40 "," $1,814.40 "," $1,612.80 "," $1,612.80 ", $372.95 ," $1,861.37 "," $1,915.20 "," $1,814.40 "," $1,814.40 "," $1,814.40 "," $1,874.88 "," $1,935.36 "," $1,529.45 "," $1,713.60 "," $1,489.69 "," $1,749.34 ", N/A ," $1,419.71 "," $1,419.71 "," $1,915.20 "," $1,668.67 ", $267.51 ," $1,935.36 "
Thoracoscopy Surg Exc Pericard Mass,CPT® 32661,N/A,N/A,N/A," $7,746.00 "," $5,034.90 "," $4,153.17 ", $726.21 , $892.57 ," $3,027.56 "," $2,956.40 "," $7,203.78 "," $6,971.40 "," $6,971.40 "," $6,196.80 "," $6,196.80 ", $892.57 ," $7,151.88 "," $7,358.70 "," $6,971.40 "," $6,971.40 "," $6,971.40 "," $7,203.78 "," $7,436.16 "," $4,016.28 "," $6,584.10 "," $4,269.27 "," $3,961.98 ", N/A ," $3,086.64 "," $3,086.64 "," $7,358.70 "," $3,635.16 ", $726.21 ," $7,436.16 "
 Pro Crystal ID Light Mic Alys Tissue/Any Flu ,CPT® 89060,0971 - PRO FEE/LAB,N/A,N/A, $126.00 , $81.90 , N/A , $7.48 , $7.48 , $40.07 , $48.39 , $117.18 , $113.40 , $113.40 , $100.80 , $100.80 , $7.48 , $116.34 , $119.70 , $113.40 , $113.40 , $113.40 , $117.18 , $120.96 , $48.94 , $107.10 , $141.10 , $25.93 , N/A , $37.40 , $37.40 , $119.70 , $41.10 , $7.48 , $141.10 
 Fac Nfct Ds Bct/Vir Respir Dna/Rna 22 Trgt Sarscov2 ,CPT® 0202U,0306 - LAB/BACT-MICRO,N/A,N/A," $1,542.00 "," $1,002.30 "," $1,295.28 ", $425.12 , N/A ," $1,245.94 "," $1,387.80 "," $1,305.46 "," $1,387.80 "," $1,387.80 "," $1,387.80 "," $1,310.70 ", N/A ," $1,423.73 "," $1,464.90 "," $1,310.70 "," $1,434.06 "," $1,434.06 "," $1,464.90 "," $1,480.32 "," $1,261.66 "," $1,387.80 "," $1,310.70 "," $1,218.18 ", N/A ," $1,247.94 "," $1,247.94 "," $1,464.90 "," $1,323.19 ", $425.12 ," $1,480.32 "
 ABLYSINOL IA SOLN ,HCPCS RXA250,0250 - PHARMACY,54288-0105-15,5 mL," $5,134.31 "," $3,337.30 "," $4,312.82 ", N/A , N/A ," $4,148.52 "," $4,620.88 "," $4,346.71 "," $4,620.88 "," $4,620.88 "," $4,620.88 "," $4,364.16 ", N/A ," $4,740.51 "," $4,877.59 "," $4,364.16 "," $4,774.91 "," $4,774.91 "," $4,877.59 "," $4,928.94 "," $4,200.89 "," $4,620.88 "," $4,364.16 "," $4,056.10 ", N/A ," $4,155.20 "," $4,155.20 "," $4,877.59 "," $4,405.75 "," $4,056.10 "," $4,928.94 "
 Ultra Tag per Study Dose/Tc Labled RBC ,HCPCS A9560,0343 - DIAGNOSTIC RADIOPHARMACEUTICALS,N/A,N/A, $417.00 , $271.05 , $350.28 , $108.74 , $86.88 , $336.94 , $375.30 , $353.03 , $375.30 , $375.30 , $375.30 , $354.45 , $85.18 , $385.02 , $396.15 , $354.45 , $387.81 , $387.81 , $396.15 , $400.32 , $341.19 , $375.30 , $354.45 , $329.43 , N/A , $337.48 , $337.48 , $396.15 , $357.83 , $85.18 , $400.32 
"CT Scan,Orbit/Sella/Post Fossa/Ear,W/O",CPT® 70480,N/A,N/A,N/A," $4,089.00 "," $2,657.85 "," $1,128.19 ", $162.01 , $255.88 ," $1,110.49 "," $1,461.33 "," $3,802.77 "," $3,680.10 "," $3,680.10 "," $3,271.20 "," $3,271.20 ", $255.88 ," $3,775.37 "," $3,884.55 "," $3,680.10 "," $3,680.10 "," $3,680.10 "," $3,802.77 "," $3,925.44 ", $945.11 ," $3,475.65 "," $1,592.84 "," $1,511.67 ", N/A ," $1,132.15 "," $1,132.15 "," $3,884.55 "," $1,310.50 ", $162.01 ," $3,925.44 "
 Pro Drainage of Eyelid Abscess ,CPT® 67700,0982 - PRO FEE/OUTPT,N/A,N/A, $887.00 , $576.55 , $714.22 , $112.63 , $30.71 , $656.29 , $616.74 , $824.91 , $798.30 , $798.30 , $709.60 , $709.60 , $30.71 , $818.97 , $842.65 , $798.30 , $798.30 , $798.30 , $824.91 , $851.52 , $979.92 , $753.95 , $636.91 , $838.47 , N/A , $669.09 , $669.09 , $842.65 , $738.60 , $30.71 , $979.92 
 Immunoglobulin E Beaker1 ,CPT® 82785,0301 - LAB/CHEMISTRY,N/A,N/A, $152.00 , $98.80 , $127.68 , $16.79 , $16.79 , $122.82 , $136.80 , $128.68 , $136.80 , $136.80 , $136.80 , $129.20 , $16.46 , $140.34 , $144.40 , $129.20 , $141.36 , $141.36 , $144.40 , $145.92 , $124.37 , $136.80 , $129.20 , $120.08 , N/A , $123.01 , $123.01 , $144.40 , $130.43 , $16.46 , $145.92 
 Pro CT Head/Brain W/O & W/Dye ,CPT® 70470,0972 - PRO FEE/RAD/DX,N/A,N/A, $757.00 , $492.05 ," $1,239.84 ", $177.53 , $303.13 , $914.09 ," $1,152.82 ", $704.01 , $681.30 , $681.30 , $605.60 , $605.60 , $303.13 , $698.94 , $719.15 , $681.30 , $681.30 , $681.30 , $704.01 , $726.72 ," $1,042.93 ", $643.45 ," $1,255.78 "," $1,243.47 ", N/A , $931.93 , $931.93 , $719.15 ," $1,078.73 ", $177.53 ," $1,255.78 "
 Fac Antb Inf Virus ,CPT® 86710,0302 - LAB/IMMUNOLOGY,N/A,N/A, $93.00 , $60.45 , $78.12 , $13.82 , $13.82 , $75.14 , $83.70 , $78.73 , $83.70 , $83.70 , $83.70 , $79.05 , $13.55 , $85.87 , $88.35 , $79.05 , $86.49 , $86.49 , $88.35 , $89.28 , $76.09 , $83.70 , $79.05 , $73.47 , N/A , $75.26 , $75.26 , $88.35 , $79.80 , $13.55 , $89.28 
"Repr Aneurysm/Grft Ins,Aneurysm Splenic",CPT® 35111,N/A,N/A,N/A," $8,778.00 "," $5,705.70 "," $7,637.18 "," $1,178.13 "," $1,340.24 "," $5,752.06 "," $5,691.39 "," $8,163.54 "," $7,900.20 "," $7,900.20 "," $7,022.40 "," $7,022.40 "," $1,340.24 "," $8,104.73 "," $8,339.10 "," $7,900.20 "," $7,900.20 "," $7,900.20 "," $8,163.54 "," $8,426.88 "," $7,046.28 "," $7,461.30 "," $7,175.51 "," $6,334.80 ", N/A ," $5,864.30 "," $5,864.30 "," $8,339.10 "," $6,661.83 "," $1,178.13 "," $8,426.88 "
 Fac Injection Aa&/Strd Lumbar Plexus Cont Nfs Cath ,CPT® 64449,0360 - OR SERVICES,N/A,N/A," $2,078.00 "," $1,350.70 "," $1,745.52 ", $59.65 , $153.39 ," $1,679.02 "," $1,870.20 "," $1,759.23 "," $1,870.20 "," $1,870.20 "," $1,870.20 "," $1,766.30 ", $150.38 ," $1,918.62 "," $1,974.10 "," $1,766.30 "," $1,932.54 "," $1,932.54 "," $1,974.10 "," $1,994.88 "," $1,700.22 "," $1,870.20 "," $1,766.30 "," $1,641.62 ", N/A ," $1,681.73 "," $1,681.73 "," $1,974.10 "," $1,783.13 ", $59.65 ," $1,994.88 "
DRAINAGE OF GUM LESION,42999,N/A,N/A,N/A, $765.00 , $497.25 , N/A , N/A , N/A , N/A , N/A , $711.45 , $688.50 , $688.50 , $612.00 , $612.00 , N/A , $706.32 , $726.75 , $688.50 , $688.50 , $688.50 , $711.45 , $734.40 , N/A , $650.25 , $612.00 , N/A , N/A , N/A , N/A , $726.75 , N/A , $612.00 , $734.40 
 Fac Cltx Humrl Epcndylr Fx Medial/Lat W/O Mnpj ,CPT® 24560,0361 - OR/MINOR,N/A,N/A," $1,448.00 ", $941.20 ," $1,216.32 ", $291.21 , $184.42 ," $1,169.98 "," $1,303.20 "," $1,225.88 "," $1,303.20 "," $1,303.20 "," $1,303.20 "," $1,230.80 ", $180.80 ," $1,336.94 "," $1,375.60 "," $1,230.80 "," $1,346.64 "," $1,346.64 "," $1,375.60 "," $1,390.08 "," $1,184.75 "," $1,303.20 "," $1,230.80 "," $1,143.92 ", N/A ," $1,171.87 "," $1,171.87 "," $1,375.60 "," $1,242.53 ", $180.80 ," $1,390.08 "
"Flow Cytometry,Interp,16+ Markers",CPT® 88189,N/A,N/A,N/A," $1,086.00 ", $705.90 , $299.48 , $81.96 , $114.42 , $454.17 , $490.37 ," $1,009.98 ", $977.40 , $977.40 , $868.80 , $868.80 , $114.42 ," $1,002.70 "," $1,031.70 ", $977.40 , $977.40 , $977.40 ," $1,009.98 "," $1,042.56 ", $544.93 , $923.10 , $507.64 , $304.33 , N/A , $423.86 , $423.86 ," $1,031.70 ", $465.81 , $81.96 ," $1,042.56 "
 BELIMUMAB 400 MG IV SOLR ,HCPCS J0490,0636 - DRUGS REQUIRING DETAILED CODIN,49401-0102-01,5 mL," $6,008.73 "," $3,905.67 "," $5,047.33 ", $51.95 , $51.21 ," $4,855.05 "," $5,407.86 "," $5,086.99 "," $5,407.86 "," $5,407.86 "," $5,407.86 "," $5,107.42 ", $50.21 ," $5,547.86 "," $5,708.29 "," $5,107.42 "," $5,588.12 "," $5,588.12 "," $5,708.29 "," $5,768.38 "," $4,916.34 "," $5,407.86 "," $5,107.42 "," $4,746.90 ", N/A ," $4,862.87 "," $4,862.87 "," $5,708.29 "," $5,156.09 ", $50.21 ," $5,768.38 "
 Elbow Min 3 Views ,CPT® 73080,0320 - DX X-RAY,N/A,N/A, $286.00 , $185.90 , $240.24 , $32.04 , $31.97 , $231.09 , $257.40 , $242.13 , $257.40 , $257.40 , $257.40 , $243.10 , $31.34 , $264.06 , $271.70 , $243.10 , $265.98 , $265.98 , $271.70 , $274.56 , $234.01 , $257.40 , $243.10 , $225.94 , N/A , $231.46 , $231.46 , $271.70 , $245.42 , $31.34 , $274.56 
 FENTANYL 50 MCG/ML DRIP ,HCPCS J3010,0636 - DRUGS REQUIRING DETAILED CODIN,00001-1013-01,30 mL, $159.20 , $103.48 , $133.73 , $0.86 , $1.00 , $128.63 , $143.28 , $134.78 , $143.28 , $143.28 , $143.28 , $135.32 , $0.98 , $146.99 , $151.24 , $135.32 , $148.06 , $148.06 , $151.24 , $152.83 , $130.26 , $143.28 , $135.32 , $125.77 , N/A , $128.84 , $128.84 , $151.24 , $136.61 , $0.86 , $152.83 
"Continent Diversion,W/Bowel Anastomosis",CPT® 50825,N/A,N/A,N/A," $11,503.00 "," $7,476.95 "," $8,884.67 "," $1,560.11 "," $2,378.00 "," $8,104.68 "," $7,532.61 "," $10,697.79 "," $10,352.70 "," $10,352.70 "," $9,202.40 "," $9,202.40 "," $2,378.00 "," $10,620.72 "," $10,927.85 "," $10,352.70 "," $10,352.70 "," $10,352.70 "," $10,697.79 "," $11,042.88 "," $8,956.35 "," $9,777.55 "," $8,551.02 "," $10,143.48 ", N/A ," $8,262.82 "," $8,262.82 "," $10,927.85 "," $9,711.75 "," $1,560.11 "," $11,042.88 "
Partial Removal of Hymen,CPT® 56700,N/A,N/A,N/A," $1,880.00 "," $1,222.00 ", $967.60 , $196.08 , $153.67 , $761.40 , $765.50 ," $1,748.40 "," $1,692.00 "," $1,692.00 "," $1,504.00 "," $1,504.00 ", $153.67 ," $1,735.80 "," $1,786.00 "," $1,692.00 "," $1,692.00 "," $1,692.00 "," $1,748.40 "," $1,804.80 ", $997.29 ," $1,598.00 "," $1,004.43 ", $764.68 , N/A , $776.26 , $776.26 ," $1,786.00 ", $931.08 , $153.67 ," $1,804.80 "
"Shldr Arthroscop,Surg,Capsulorrhaphy",CPT® 29806,N/A,N/A,N/A," $6,522.00 "," $4,239.30 "," $6,420.64 "," $1,003.45 ", $938.38 ," $5,120.46 "," $5,089.63 "," $6,065.46 "," $5,869.80 "," $5,869.80 "," $5,217.60 "," $5,217.60 ", $938.38 ," $6,021.76 "," $6,195.90 "," $5,869.80 "," $5,869.80 "," $5,869.80 "," $6,065.46 "," $6,261.12 "," $5,969.11 "," $5,543.70 "," $5,626.94 "," $6,023.78 ", N/A ," $5,220.37 "," $5,220.37 "," $6,195.90 "," $6,135.79 ", $938.38 ," $6,420.64 "
Cysto Insertion Transprostatic Implant Ea Addl,CPT® 52442,N/A,N/A,N/A," $6,191.00 "," $4,024.15 ", $271.17 , $47.71 , $755.04 , $356.79 , $286.58 ," $5,757.63 "," $5,571.90 "," $5,571.90 "," $4,952.80 "," $4,952.80 ", $755.04 ," $5,716.15 "," $5,881.45 "," $5,571.90 "," $5,571.90 "," $5,571.90 "," $5,757.63 "," $5,943.36 ", $275.67 ," $5,262.35 ", $262.99 , $371.02 , N/A , $363.75 , $363.75 ," $5,881.45 ", $427.52 , $47.71 ," $5,943.36 "
" CT Angio,Lower Extremity ",CPT® 73706,0350 - CT SCAN,N/A,N/A," $5,222.00 "," $3,394.30 "," $4,386.48 ", $262.47 , $354.97 ," $4,219.38 "," $4,699.80 "," $4,420.95 "," $4,699.80 "," $4,699.80 "," $4,699.80 "," $4,438.70 ", $348.01 ," $4,821.47 "," $4,960.90 "," $4,438.70 "," $4,856.46 "," $4,856.46 "," $4,960.90 "," $5,013.12 "," $4,272.64 "," $4,699.80 "," $4,438.70 "," $4,125.38 ", N/A ," $4,226.16 "," $4,226.16 "," $4,960.90 "," $4,481.00 ", $262.47 ," $5,013.12 "
Thyroglobulin Antibody,CPT® 86800,N/A,N/A,N/A, $147.00 , $95.55 , N/A , $16.23 , $16.23 , $90.01 , $107.63 , $136.71 , $132.30 , $132.30 , $117.60 , $117.60 , $16.23 , $135.73 , $139.65 , $132.30 , $132.30 , $132.30 , $136.71 , $141.12 , $106.23 , $124.95 , $103.80 , $57.68 , N/A , $84.00 , $84.00 , $139.65 , $91.80 , $16.23 , $141.12 
Inject Intravitreal Pharmcologic,CPT® 67028,N/A,N/A,N/A, $773.00 , $502.45 , $564.33 , $88.40 , $261.20 , $565.44 , $526.42 , $718.89 , $695.70 , $695.70 , $618.40 , $618.40 , $261.20 , $713.71 , $734.35 , $695.70 , $695.70 , $695.70 , $718.89 , $742.08 , $779.44 , $657.05 , $542.36 , $720.34 , N/A , $576.47 , $576.47 , $734.35 , $636.34 , $88.40 , $779.44 
R & L Hrt Cath Winjx Hrt Art& L Ventr Img,CPT® 93460,N/A,N/A,N/A," $8,357.00 "," $5,432.05 "," $8,018.79 "," $1,204.77 ", $909.21 ," $6,800.94 "," $7,255.93 "," $7,772.01 "," $7,521.30 "," $7,521.30 "," $6,685.60 "," $6,685.60 ", $909.21 ," $7,716.02 "," $7,939.15 "," $7,521.30 "," $7,521.30 "," $7,521.30 "," $7,772.01 "," $8,022.72 "," $7,580.44 "," $7,103.45 "," $6,895.41 "," $7,104.30 ", N/A ," $6,933.64 "," $6,933.64 "," $7,939.15 "," $7,686.02 ", $909.21 ," $8,022.72 "
 Pro Rpr Complex 1.1cm-2.5cm ,CPT® 13131,0982 - PRO FEE/OUTPT,N/A,N/A," $1,487.00 ", $966.55 , $776.05 , $231.89 , $176.33 , $684.64 , $667.66 ," $1,382.91 "," $1,338.30 "," $1,338.30 "," $1,189.60 "," $1,189.60 ", $176.33 ," $1,372.95 "," $1,412.65 "," $1,338.30 "," $1,338.30 "," $1,338.30 "," $1,382.91 "," $1,427.52 ", $855.05 ," $1,263.95 "," $1,330.91 ", $878.14 , N/A , $698.00 , $698.00 ," $1,412.65 ", $809.44 , $176.33 ," $1,427.52 "
 Fac Hep Be Antibody ,CPT® 86707,0302 - LAB/IMMUNOLOGY,N/A,N/A, $126.00 , $81.90 , $105.84 , $11.80 , $11.80 , $101.81 , $113.40 , $106.67 , $113.40 , $113.40 , $113.40 , $107.10 , $11.57 , $116.34 , $119.70 , $107.10 , $117.18 , $117.18 , $119.70 , $120.96 , $103.09 , $113.40 , $107.10 , $99.54 , N/A , $101.97 , $101.97 , $119.70 , $108.12 , $11.57 , $120.96 
"Self-Adher Band W <3""/Yd",HCPCS A6453,N/A,N/A,N/A, $8.00 , $5.20 , N/A , $0.86 , N/A , N/A , N/A , $7.44 , $7.20 , $7.20 , $6.40 , $6.40 , N/A , $7.39 , $7.60 , $7.20 , $7.20 , $7.20 , $7.44 , $7.68 , N/A , $6.80 , $0.65 , $0.77 , N/A , N/A , N/A , $7.60 , N/A , $0.65 , $7.68 
 Fac Transferase (Ast) (Sgot) ,CPT® 84450,0301 - LAB/CHEMISTRY,N/A,N/A, $71.00 , $46.15 , $59.64 , $5.28 , $5.28 , $57.37 , $63.90 , $60.11 , $63.90 , $63.90 , $63.90 , $60.35 , $5.18 , $65.55 , $67.45 , $60.35 , $66.03 , $66.03 , $67.45 , $68.16 , $58.09 , $63.90 , $60.35 , $56.09 , N/A , $57.46 , $57.46 , $67.45 , $60.93 , $5.18 , $68.16 
 Fac Psychotherapy W/Patient 30 Minutes ,CPT® 90832,0914 - PSYCH/INDIV RX,N/A,N/A, $107.00 , $69.55 , $89.88 , $66.42 , $58.10 , $86.46 , $96.30 , $90.59 , $96.30 , $96.30 , $96.30 , $90.95 , $56.96 , $98.79 , $101.65 , $90.95 , $99.51 , $99.51 , $101.65 , $102.72 , $87.55 , $96.30 , $90.95 , $84.53 , N/A , $86.60 , $86.60 , $101.65 , $91.82 , $56.96 , $102.72 
 Phys/Qhp Svcs OP Pulm Rehab W/Cont Oxmtry Mntr ,CPT® 94626,0948 - PULMONARY REHABILITATION,N/A,N/A, $297.00 , $193.05 , $249.48 , $26.36 , $125.77 , $239.98 , $267.30 , $251.44 , $267.30 , $267.30 , $267.30 , $252.45 , $123.30 , $274.22 , $282.15 , $252.45 , $276.21 , $276.21 , $282.15 , $285.12 , $243.01 , $267.30 , $252.45 , $234.63 , N/A , $240.36 , $240.36 , $282.15 , $254.86 , $26.36 , $285.12 
Mediastinoscopy With Lymph Node Biopsy/Ies,CPT® 39402,N/A,N/A,N/A," $5,988.00 "," $3,892.20 "," $1,592.23 ", $363.18 , $321.16 ," $1,430.98 "," $1,408.76 "," $5,568.84 "," $5,389.20 "," $5,389.20 "," $4,790.40 "," $4,790.40 ", $321.16 ," $5,528.72 "," $5,688.60 "," $5,389.20 "," $5,389.20 "," $5,389.20 "," $5,568.84 "," $5,748.48 "," $2,178.92 "," $5,089.80 "," $2,102.12 "," $1,844.50 ", N/A ," $1,458.90 "," $1,458.90 "," $5,688.60 "," $1,691.01 ", $321.16 ," $5,748.48 "
Brca1 Brca2 Gene Alys Full Seq Full Dup/Del Alys,CPT® 81162,N/A,N/A,N/A," $8,301.00 "," $5,395.65 ", N/A ," $1,861.38 "," $1,501.06 "," $7,647.81 ", N/A ," $7,719.93 "," $7,470.90 "," $7,470.90 "," $6,640.80 "," $6,640.80 "," $1,501.06 "," $7,664.31 "," $7,885.95 "," $7,470.90 "," $7,470.90 "," $7,470.90 "," $7,719.93 "," $7,968.96 "," $12,185.13 "," $7,055.85 "," $8,698.76 "," $6,616.86 ", N/A ," $7,137.42 "," $7,137.42 "," $7,885.95 "," $7,799.65 "," $1,501.06 "," $12,185.13 "
 Fac Bx Breast W Device Addl Lesion Stereotact Guide ,CPT® 19082,0361 - OR/MINOR,N/A,N/A," $1,959.00 "," $1,273.35 "," $1,645.56 ", $78.68 , $64.86 ," $1,582.87 "," $1,763.10 "," $1,658.49 "," $1,763.10 "," $1,763.10 "," $1,763.10 "," $1,665.15 ", $63.59 ," $1,808.74 "," $1,861.05 "," $1,665.15 "," $1,821.87 "," $1,821.87 "," $1,861.05 "," $1,880.64 "," $1,602.85 "," $1,763.10 "," $1,665.15 "," $1,547.61 ", N/A ," $1,585.42 "," $1,585.42 "," $1,861.05 "," $1,681.02 ", $63.59 ," $1,880.64 "
Biopsy Oropharynx,CPT® 42800,N/A,N/A,N/A, $990.00 , $643.50 , $714.42 , $113.02 , $61.84 , $540.49 , $561.43 , $920.70 , $891.00 , $891.00 , $792.00 , $792.00 , $61.84 , $914.07 , $940.50 , $891.00 , $891.00 , $891.00 , $920.70 , $950.40 , $501.53 , $841.50 , $613.72 , $634.30 , N/A , $551.03 , $551.03 , $940.50 , $576.34 , $61.84 , $950.40 
 Pro Diag Laparo Separate Proc ,CPT® 49320,0982 - PRO FEE/OUTPT,N/A,N/A," $3,463.00 "," $2,250.95 "," $1,970.02 ", $306.05 , $425.15 ," $1,539.20 "," $1,567.04 "," $3,220.59 "," $3,116.70 "," $3,116.70 "," $2,770.40 "," $2,770.40 ", $425.15 ," $3,197.39 "," $3,289.85 "," $3,116.70 "," $3,116.70 "," $3,116.70 "," $3,220.59 "," $3,324.48 "," $1,411.89 "," $2,943.55 "," $1,735.89 "," $1,827.52 ", N/A ," $1,569.24 "," $1,569.24 "," $3,289.85 "," $1,641.26 ", $306.05 ," $3,324.48 "
 Braf Gene Analysis V600e Vrint ,CPT® 81210,0310 - PATHOLOGY LAB,N/A,N/A," $1,101.00 ", $715.65 , $924.84 , $178.91 , $146.27 , $889.61 , $990.90 , $932.11 , $990.90 , $990.90 , $990.90 , $935.85 , $143.40 ," $1,016.55 "," $1,045.95 ", $935.85 ," $1,023.93 "," $1,023.93 "," $1,045.95 "," $1,056.96 ", $900.84 , $990.90 , $935.85 , $869.79 , N/A , $891.04 , $891.04 ," $1,045.95 ", $944.77 , $143.40 ," $1,056.96 "
"Grafix Core, Grafixpl Core",HCPCS Q4132,N/A,N/A,N/A, $390.00 , $253.50 , N/A , $291.47 , $173.97 , N/A , N/A , $362.70 , $351.00 , $351.00 , $312.00 , $312.00 , $173.97 , $360.09 , $370.50 , $351.00 , $351.00 , $351.00 , $362.70 , $374.40 , N/A , $331.50 , $712.07 , $393.98 , N/A , N/A , N/A , $370.50 , N/A , $173.97 , $712.07 
 Fac OB Holding First Hour ,CPT® 99211,0510 - CLINIC,N/A,N/A, $296.00 , $192.40 , $248.64 , $8.63 , $16.58 , $239.17 , $266.40 , N/A , $266.40 , $266.40 , $266.40 , $251.60 , $16.25 , $273.30 , $281.20 , $251.60 , $275.28 , $275.28 , $281.20 , $284.16 , $242.19 , $266.40 , $251.60 , $233.84 , N/A , $239.55 , $239.55 , $281.20 , $254.00 , $8.63 , $284.16 
Nushield 1 Square Cm,HCPCS Q4160,N/A,N/A,N/A, $477.00 , $310.05 , N/A , $94.77 , N/A , N/A , N/A , $443.61 , $429.30 , $429.30 , $381.60 , $381.60 , N/A , $440.41 , $453.15 , $429.30 , $429.30 , $429.30 , $443.61 , $457.92 , $120.59 , $405.45 , $179.63 , $122.35 , N/A , N/A , N/A , $453.15 , N/A , $94.77 , $457.92 
 CT Orbit Sella Post Fossa Iac/Ear Combin- Mh ,CPT® 70482,0972 - PRO FEE/RAD/DX,N/A,N/A, $857.00 , $557.05 ," $1,512.14 ", $215.63 , $355.58 ," $1,436.08 "," $1,877.13 ", $797.01 , $771.30 , $771.30 , $685.60 , $685.60 , $355.58 , $791.27 , $814.15 , $771.30 , $771.30 , $771.30 , $797.01 , $822.72 ," $1,278.96 ", $728.45 ," $2,043.53 "," $1,948.22 ", N/A ," $1,464.10 "," $1,464.10 ", $814.15 ," $1,694.72 ", $215.63 ," $2,043.53 "
Relieve Postop Bladder Contracture,CPT® 52640,N/A,N/A,N/A," $2,204.00 "," $1,432.60 "," $1,745.87 ", $309.45 , $614.70 ," $1,539.79 "," $1,447.15 "," $2,049.72 "," $1,983.60 "," $1,983.60 "," $1,763.20 "," $1,763.20 ", $614.70 ," $2,034.95 "," $2,093.80 "," $1,983.60 "," $1,983.60 "," $1,983.60 "," $2,049.72 "," $2,115.84 "," $1,740.00 "," $1,873.40 "," $1,635.99 "," $1,946.21 ", N/A ," $1,569.84 "," $1,569.84 "," $2,093.80 "," $1,845.13 ", $309.45 ," $2,115.84 "
 Amputation; Finger/Thumb ,CPT® 26951,0360 - OR SERVICES,N/A,N/A," $4,308.00 "," $2,800.20 "," $3,618.72 ", $685.79 , $230.52 ," $3,480.86 "," $3,877.20 "," $3,647.15 "," $3,877.20 "," $3,877.20 "," $3,877.20 "," $3,661.80 ", $226.00 ," $3,977.58 "," $4,092.60 "," $3,661.80 "," $4,006.44 "," $4,006.44 "," $4,092.60 "," $4,135.68 "," $3,524.81 "," $3,877.20 "," $3,661.80 "," $3,403.32 ", N/A ," $3,486.46 "," $3,486.46 "," $4,092.60 "," $3,696.69 ", $226.00 ," $4,135.68 "
"PPPS, subseq visit",HCPCS G0439,N/A,N/A,N/A, $190.00 , $123.50 , $315.63 , $126.78 , N/A , $212.88 , $247.86 , $176.70 , $171.00 , $171.00 , $152.00 , $152.00 , N/A , $175.43 , $180.50 , $171.00 , $171.00 , $171.00 , $176.70 , $182.40 , $353.13 , $161.50 , $213.44 , $248.08 , N/A , $217.03 , $217.03 , $180.50 , $271.27 , $126.78 , $353.13 
CLTX MTCARPHLNGL DISLC 1 W/MNPJ W/O ANES,26705,N/A,N/A,N/A," $1,932.00 "," $1,255.80 "," $2,391.87 ", $387.29 , $122.93 ," $1,826.84 "," $1,840.60 "," $1,796.76 "," $1,738.80 "," $1,738.80 "," $1,545.60 "," $1,545.60 ", $122.93 ," $1,783.82 "," $1,835.40 "," $1,738.80 "," $1,738.80 "," $1,738.80 "," $1,796.76 "," $1,854.72 "," $2,208.02 "," $1,642.20 "," $2,023.13 "," $2,163.52 ", N/A ," $1,862.48 "," $1,862.48 "," $1,835.40 "," $2,189.10 ", $122.93 ," $2,391.87 "
Drug Screening Benzodiazepines 1-12,CPT® 80346,N/A,N/A,N/A, $156.00 , $101.40 , N/A , N/A , N/A , N/A , N/A , $145.08 , $140.40 , $140.40 , $124.80 , $124.80 , N/A , $144.03 , $148.20 , $140.40 , $140.40 , $140.40 , $145.08 , $149.76 , N/A , $132.60 , $114.69 , $67.79 , N/A , $90.04 , $90.04 , $148.20 , $98.20 , $67.79 , $149.76 
CT Scan of Arm Contrast,CPT® 73201,N/A,N/A,N/A," $3,777.00 "," $2,455.05 "," $1,442.21 ", $206.46 , $289.97 ," $1,060.46 "," $1,351.78 "," $3,512.61 "," $3,399.30 "," $3,399.30 "," $3,021.60 "," $3,021.60 ", $289.97 ," $3,487.30 "," $3,588.15 "," $3,399.30 "," $3,399.30 "," $3,399.30 "," $3,512.61 "," $3,625.92 "," $1,224.35 "," $3,210.45 "," $1,473.42 "," $1,443.95 ", N/A ," $1,081.15 "," $1,081.15 "," $3,588.15 "," $1,251.44 ", $206.46 ," $3,625.92 "
Chemical Cauterization of Granulation Tissue,17250,N/A,N/A,N/A, $339.00 , $220.35 , $118.49 , $35.56 , $24.75 , $100.85 , $98.94 , $315.27 , $305.10 , $305.10 , $271.20 , $271.20 , $24.75 , $313.00 , $322.05 , $305.10 , $305.10 , $305.10 , $315.27 , $325.44 , $128.31 , $288.15 , $196.25 , $130.88 , N/A , $102.81 , $102.81 , $322.05 , $119.25 , $24.75 , $325.44 
 Fac Blastomyces Antibody ,CPT® 86612,0302 - LAB/IMMUNOLOGY,N/A,N/A, $141.00 , $91.65 , $118.44 , $13.16 , $8.07 , $113.93 , $126.90 , $119.37 , $126.90 , $126.90 , $126.90 , $119.85 , $7.91 , $130.19 , $133.95 , $119.85 , $131.13 , $131.13 , $133.95 , $135.36 , $115.37 , $126.90 , $119.85 , $111.39 , N/A , $114.11 , $114.11 , $133.95 , $120.99 , $7.91 , $135.36 
"Injection,Sacroiliac Joint",27096,N/A,N/A,N/A, $653.00 , $424.45 , $512.53 , $79.93 , $154.36 , $415.04 , $416.57 , $607.29 , $587.70 , $587.70 , $522.40 , $522.40 , $154.36 , $602.91 , $620.35 , $587.70 , $587.70 , $587.70 , $607.29 , $626.88 , $480.33 , $555.05 , $451.37 , $490.61 , N/A , $423.13 , $423.13 , $620.35 , $497.32 , $79.93 , $626.88 
"Excis Tumor,Soft Tiss Up Arm/Elbow,Deep",CPT® 24076,N/A,N/A,N/A," $3,974.00 "," $2,583.10 "," $3,314.74 ", $521.09 , $231.17 ," $2,602.41 "," $2,609.58 "," $3,695.82 "," $3,576.60 "," $3,576.60 "," $3,179.20 "," $3,179.20 ", $231.17 ," $3,669.19 "," $3,775.30 "," $3,576.60 "," $3,576.60 "," $3,576.60 "," $3,695.82 "," $3,815.04 "," $3,066.24 "," $3,377.90 "," $2,883.05 "," $3,084.79 ", N/A ," $2,653.19 "," $2,653.19 "," $3,775.30 "," $3,118.45 ", $231.17 ," $3,815.04 "
 OXYCODONE HCL ER 20 MG PO T12A ,HCPCS RXC637,0250 - PHARMACY,59011-0420-20,1 tablet, $57.69 , $37.50 , $48.46 , N/A , N/A , $46.61 , $51.92 , $48.84 , $51.92 , $51.92 , $51.92 , $49.04 , N/A , $53.27 , $54.81 , $49.04 , $53.65 , $53.65 , $54.81 , $55.38 , $47.20 , $51.92 , $49.04 , $45.58 , N/A , $46.69 , $46.69 , $54.81 , $49.50 , $45.58 , $55.38 
" Fac Assay of Phenytoin, Total ",CPT® 80185,0301 - LAB/CHEMISTRY,N/A,N/A, $133.00 , $86.45 , $111.72 , $13.52 , $13.52 , $107.46 , $119.70 , $112.60 , $119.70 , $119.70 , $119.70 , $113.05 , $13.25 , $122.80 , $126.35 , $113.05 , $123.69 , $123.69 , $126.35 , $127.68 , $108.82 , $119.70 , $113.05 , $105.07 , N/A , $107.64 , $107.64 , $126.35 , $114.13 , $13.25 , $127.68 
Home/Res Visit New Patient Mod Mdm 60 Minutes,CPT® 99344,N/A,N/A,N/A, $617.00 , $401.05 , $359.90 , $140.56 , $148.39 , $314.06 , $315.46 , $573.81 , $555.30 , $555.30 , $493.60 , $493.60 , $148.39 , $569.68 , $586.15 , $555.30 , $555.30 , $555.30 , $573.81 , $592.32 , $328.34 , $524.45 , $392.30 , $400.39 , N/A , $320.18 , $320.18 , $586.15 , $369.28 , $140.56 , $592.32 
 METHYLPREDNISOLONE SODIUM SUCC 2000 MG IJ SOLR ,HCPCS J2930,0636 - DRUGS REQUIRING DETAILED CODIN,00009-0850-01,30.6 mL, $580.98 , $377.64 , $488.02 , $5.84 , $6.07 , $469.43 , $522.88 , $491.86 , $522.88 , $522.88 , $522.88 , $493.83 , $5.95 , $536.42 , $551.93 , $493.83 , $540.31 , $540.31 , $551.93 , $557.74 , $475.36 , $522.88 , $493.83 , $458.97 , N/A , $470.19 , $470.19 , $551.93 , $498.54 , $5.84 , $557.74 
 Echo Tee Guid Tcat Icar/Vessel Strcturl Intvn ,CPT® 93355,0480 - CARDIOLOGY,N/A,N/A," $3,180.00 "," $2,067.00 "," $2,671.20 ", $216.97 , $182.63 ," $2,569.44 "," $2,862.00 "," $2,692.19 "," $2,862.00 "," $2,862.00 "," $2,862.00 "," $2,703.00 ", $179.05 ," $2,936.09 "," $3,021.00 "," $2,703.00 "," $2,957.40 "," $2,957.40 "," $3,021.00 "," $3,052.80 "," $2,601.88 "," $2,862.00 "," $2,703.00 "," $2,512.20 ", N/A ," $2,573.57 "," $2,573.57 "," $3,021.00 "," $2,728.76 ", $179.05 ," $3,052.80 "
 ASPIRIN 300 MG RE SUPP ,HCPCS RXC637,0250 - PHARMACY,00574-7034-12,1 suppository, $7.49 , $4.87 , $6.29 , N/A , N/A , $6.05 , $6.74 , $6.34 , $6.74 , $6.74 , $6.74 , $6.37 , N/A , $6.92 , $7.12 , $6.37 , $6.97 , $6.97 , $7.12 , $7.19 , $6.13 , $6.74 , $6.37 , $5.92 , N/A , $6.06 , $6.06 , $7.12 , $6.43 , $5.92 , $7.19 
 Fac Exchange Biliary Drg Catheter Prq W/Img Gid Rs&I ,CPT® 47536,0361 - OR/MINOR,N/A,N/A," $5,206.00 "," $3,383.90 "," $4,373.04 ", $124.56 , $646.34 ," $4,206.45 "," $4,685.40 "," $4,407.40 "," $4,685.40 "," $4,685.40 "," $4,685.40 "," $4,425.10 ", $633.67 ," $4,806.70 "," $4,945.70 "," $4,425.10 "," $4,841.58 "," $4,841.58 "," $4,945.70 "," $4,997.76 "," $4,259.55 "," $4,685.40 "," $4,425.10 "," $4,112.74 ", N/A ," $4,213.22 "," $4,213.22 "," $4,945.70 "," $4,467.27 ", $124.56 ," $4,997.76 "
" Fac Cytopath Smear, Other Source ",CPT® 88162,0310 - PATHOLOGY LAB,N/A,N/A, $136.00 , $88.40 , $114.24 , $116.89 , $55.03 , $109.89 , $122.40 , $115.14 , $122.40 , $122.40 , $122.40 , $115.60 , $53.95 , $125.57 , $129.20 , $115.60 , $126.48 , $126.48 , $129.20 , $130.56 , $111.28 , $122.40 , $115.60 , $107.44 , N/A , $110.06 , $110.06 , $129.20 , $116.70 , $53.95 , $130.56 
"Elbow Arthroscop,Remv Loose Body",CPT® 29834,N/A,N/A,N/A," $3,305.00 "," $2,148.25 "," $3,009.96 ", $473.11 , $500.35 ," $2,352.67 "," $2,367.22 "," $3,073.65 "," $2,974.50 "," $2,974.50 "," $2,644.00 "," $2,644.00 ", $500.35 ," $3,051.51 "," $3,139.75 "," $2,974.50 "," $2,974.50 "," $2,974.50 "," $3,073.65 "," $3,172.80 "," $2,803.63 "," $2,809.25 "," $2,610.09 "," $2,791.70 ", N/A ," $2,398.57 "," $2,398.57 "," $3,139.75 "," $2,819.18 ", $473.11 ," $3,172.80 "
" Fac Immunization Admin, Each Add ",CPT® 90472,0771 - VACCINE ADMINISTRATION,N/A,N/A, $48.00 , $31.20 , $40.32 , $14.16 , N/A , $38.78 , $43.20 , $40.64 , $43.20 , $43.20 , $43.20 , $40.80 , N/A , $44.32 , $45.60 , $40.80 , $44.64 , $44.64 , $45.60 , $46.08 , $39.27 , $43.20 , $40.80 , $37.92 , N/A , $38.85 , $38.85 , $45.60 , $41.19 , $14.16 , $46.08 
Low Cost Skin Substitute App,HCPCS C5275,N/A,N/A,N/A, $699.00 , $454.35 , N/A , N/A , N/A , N/A , N/A , $650.07 , $629.10 , $629.10 , $559.20 , $559.20 , N/A , $645.39 , $664.05 , $629.10 , $629.10 , $629.10 , $650.07 , $671.04 , N/A , $594.15 , $559.20 , N/A , N/A , N/A , N/A , $664.05 , N/A , $559.20 , $671.04 
 CT Cerv/Thor Inj Single Level ,CPT® 64490,0761 - TREATMENT ROOM,N/A,N/A," $3,625.00 "," $2,356.25 "," $3,045.00 ", $100.98 , $139.80 ," $2,929.00 "," $3,262.50 "," $3,068.93 "," $3,262.50 "," $3,262.50 "," $3,262.50 "," $3,081.25 ", $137.06 ," $3,346.96 "," $3,443.75 "," $3,081.25 "," $3,371.25 "," $3,371.25 "," $3,443.75 "," $3,480.00 "," $2,965.98 "," $3,262.50 "," $3,081.25 "," $2,863.75 ", N/A ," $2,933.71 "," $2,933.71 "," $3,443.75 "," $3,110.61 ", $100.98 ," $3,480.00 "
Surg Cleansing Abd Wall,11005,N/A,N/A,N/A," $4,078.00 "," $2,650.70 "," $2,386.66 ", $703.47 , $690.32 ," $2,109.90 "," $2,020.69 "," $3,792.54 "," $3,670.20 "," $3,670.20 "," $3,262.40 "," $3,262.40 ", $690.32 ," $3,765.22 "," $3,874.10 "," $3,670.20 "," $3,670.20 "," $3,670.20 "," $3,792.54 "," $3,914.88 "," $2,626.79 "," $3,466.30 "," $4,098.00 "," $2,653.72 ", N/A ," $2,151.06 "," $2,151.06 "," $3,874.10 "," $2,494.51 ", $690.32 ," $4,098.00 "
 BUPROPION HCL 75 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6635-61,1 tablet, $7.46 , $4.85 , $6.27 , N/A , N/A , $6.03 , $6.71 , $6.32 , $6.71 , $6.71 , $6.71 , $6.34 , N/A , $6.89 , $7.09 , $6.34 , $6.94 , $6.94 , $7.09 , $7.16 , $6.10 , $6.71 , $6.34 , $5.89 , N/A , $6.04 , $6.04 , $7.09 , $6.40 , $5.89 , $7.16 
"Repair of Hydrocele,Tunica",CPT® 55060,N/A,N/A,N/A," $2,086.00 "," $1,355.90 "," $1,688.05 ", $364.54 , $307.34 ," $1,221.36 "," $1,241.10 "," $1,939.98 "," $1,877.40 "," $1,877.40 "," $1,668.80 "," $1,668.80 ", $307.34 ," $1,926.00 "," $1,981.70 "," $1,877.40 "," $1,877.40 "," $1,877.40 "," $1,939.98 "," $2,002.56 "," $1,584.53 "," $1,773.10 "," $1,982.10 "," $1,842.68 ", N/A ," $1,245.19 "," $1,245.19 "," $1,981.70 "," $1,492.42 ", $307.34 ," $2,002.56 "
Exc Tumor Soft Tissue Leg/Ankle Subq 3+Cm,CPT® 27632,N/A,N/A,N/A," $2,772.00 "," $1,801.80 "," $2,491.71 ", $387.83 , $340.47 ," $1,993.17 "," $2,005.60 "," $2,577.96 "," $2,494.80 "," $2,494.80 "," $2,217.60 "," $2,217.60 ", $340.47 ," $2,559.39 "," $2,633.40 "," $2,494.80 "," $2,494.80 "," $2,494.80 "," $2,577.96 "," $2,661.12 "," $2,314.74 "," $2,356.20 "," $2,214.02 "," $2,347.15 ", N/A ," $2,032.06 "," $2,032.06 "," $2,633.40 "," $2,388.38 ", $340.47 ," $2,661.12 "
As-Aort Grf W/Card Byp F/Aortic Ds Oth/Thn Dsj,CPT® 33859,N/A,N/A,N/A," $17,431.00 "," $11,330.15 "," $14,193.08 "," $2,189.42 "," $1,841.77 "," $10,166.13 ", N/A ," $16,210.83 "," $15,687.90 "," $15,687.90 "," $13,944.80 "," $13,944.80 "," $1,841.77 "," $16,094.04 "," $16,559.45 "," $15,687.90 "," $15,687.90 "," $15,687.90 "," $16,210.83 "," $16,733.76 "," $13,157.43 "," $14,816.35 "," $12,671.38 "," $11,688.49 ", N/A ," $10,364.49 "," $10,364.49 "," $16,559.45 "," $11,771.52 "," $1,841.77 "," $16,733.76 "
"Program Eval Implant Device,Cardvert/Defib,Mult Lead",CPT® 93284,N/A,N/A,N/A," $1,240.00 ", $806.00 , $689.20 , $105.48 , $55.43 , $487.60 , $495.15 ," $1,153.20 "," $1,116.00 "," $1,116.00 ", $992.00 , $992.00 , $55.43 ," $1,144.89 "," $1,178.00 "," $1,116.00 "," $1,116.00 "," $1,116.00 "," $1,153.20 "," $1,190.40 ", $652.28 ," $1,054.00 ", $460.29 , $323.57 , N/A , $497.12 , $497.12 ," $1,178.00 ", $551.05 , $55.43 ," $1,190.40 "
Egd Partial/Compl Esophagogastric Fundoplasty,CPT® 43210,N/A,N/A,N/A," $2,821.00 "," $1,833.65 "," $2,594.67 ", $400.08 , N/A ," $2,070.77 "," $2,058.56 "," $2,623.53 "," $2,538.90 "," $2,538.90 "," $2,256.80 "," $2,256.80 ", N/A ," $2,604.63 "," $2,679.95 "," $2,538.90 "," $2,538.90 "," $2,538.90 "," $2,623.53 "," $2,708.16 "," $1,866.13 "," $2,397.85 "," $2,249.61 "," $2,479.40 ", N/A ," $2,111.17 "," $2,111.17 "," $2,679.95 "," $2,208.04 ", $400.08 ," $2,708.16 "
Arthrocentesis-Int. Joint,CPT® 20605,N/A,N/A,N/A, $382.00 , $248.30 , $226.79 , $35.10 , $50.55 , $181.29 , $253.86 , $355.26 , $343.80 , $343.80 , $305.60 , $305.60 , $50.55 , $352.70 , $362.90 , $343.80 , $343.80 , $343.80 , $355.26 , $366.72 , $211.99 , $324.70 , $276.53 , $217.48 , N/A , $184.83 , $184.83 , $362.90 , $217.21 , $35.10 , $366.72 
 GOSERELIN ACETATE 3.6 MG SC IMPL ,HCPCS J9202,0636 - DRUGS REQUIRING DETAILED CODIN,70720-0950-36,1 each," $2,532.18 "," $1,645.92 "," $2,127.03 ", $625.84 , N/A ," $2,046.00 "," $2,278.96 "," $2,143.74 "," $2,278.96 "," $2,278.96 "," $2,278.96 "," $2,152.35 ", N/A ," $2,337.96 "," $2,405.57 "," $2,152.35 "," $2,354.93 "," $2,354.93 "," $2,405.57 "," $2,430.89 "," $2,071.83 "," $2,278.96 "," $2,152.35 "," $2,000.42 ", N/A ," $2,049.29 "," $2,049.29 "," $2,405.57 "," $2,172.86 ", $625.84 ," $2,430.89 "
 Pro Appl Long Arm Splnt Sho Hand ,CPT® 29105,0981 - PRO FEE/ER,N/A,N/A, $382.00 , $248.30 , $248.63 , $39.02 , $45.35 , $288.42 , $289.62 , $355.26 , $343.80 , $343.80 , $305.60 , $305.60 , $45.35 , $352.70 , $362.90 , $343.80 , $343.80 , $343.80 , $355.26 , $366.72 , $235.01 , $324.70 , $317.56 , $339.98 , N/A , $294.05 , $294.05 , $362.90 , $345.59 , $39.02 , $366.72 
 VEDOLIZUMAB 300 MG IV SOLR ,HCPCS J3380,0636 - DRUGS REQUIRING DETAILED CODIN,64764-0300-20,5 mL," $24,040.04 "," $15,626.03 "," $20,193.63 ", $23.13 , $22.28 ," $19,424.35 "," $21,636.04 "," $20,352.30 "," $21,636.04 "," $21,636.04 "," $21,636.04 "," $20,434.03 ", $21.84 ," $22,196.17 "," $22,838.04 "," $20,434.03 "," $22,357.24 "," $22,357.24 "," $22,838.04 "," $23,078.44 "," $19,669.56 "," $21,636.04 "," $20,434.03 "," $18,991.63 ", N/A ," $19,455.60 "," $19,455.60 "," $22,838.04 "," $20,628.76 ", $21.84 ," $23,078.44 "
 CARBACHOL 0.01 % IO SOLN ,HCPCS RXA250,0250 - PHARMACY,00065-0023-15,1.5 mL, $259.83 , $168.89 , $218.26 , N/A , N/A , $209.94 , $233.85 , $219.97 , $233.85 , $233.85 , $233.85 , $220.86 , N/A , $239.90 , $246.84 , $220.86 , $241.64 , $241.64 , $246.84 , $249.44 , $212.59 , $233.85 , $220.86 , $205.27 , N/A , $210.28 , $210.28 , $246.84 , $222.96 , $205.27 , $249.44 
"Trim Hyperkeratotic Skin Lesion,>4",CPT® 11057,N/A,N/A,N/A, $290.00 , $188.50 , $93.74 , $27.83 , $47.37 , $83.10 , $78.91 , $269.70 , $261.00 , $261.00 , $232.00 , $232.00 , $47.37 , $267.76 , $275.50 , $261.00 , $261.00 , $261.00 , $269.70 , $278.40 , $103.39 , $246.50 , $153.43 , $107.09 , N/A , $84.72 , $84.72 , $275.50 , $98.25 , $27.83 , $278.40 
 Repair Scalp/Arm/Leg Addt - Urgent Care ,CPT® 13122,0761 - TREATMENT ROOM,N/A,N/A, $485.00 , $315.25 , $407.40 , $78.10 , $88.09 , $391.88 , $436.50 , $410.60 , $436.50 , $436.50 , $436.50 , $412.25 , $86.36 , $447.80 , $460.75 , $412.25 , $451.05 , $451.05 , $460.75 , $465.60 , $396.83 , $436.50 , $412.25 , $383.15 , N/A , $392.51 , $392.51 , $460.75 , $416.18 , $78.10 , $465.60 
"Laminotomy,Lumbar Disk,1 Intrsp",63030,N/A,N/A,N/A," $7,044.00 "," $4,578.60 "," $4,581.51 ", $841.63 , $819.07 ," $6,157.37 "," $5,077.89 "," $6,550.92 "," $6,339.60 "," $6,339.60 "," $5,635.20 "," $5,635.20 ", $819.07 ," $6,503.73 "," $6,691.80 "," $6,339.60 "," $6,339.60 "," $6,339.60 "," $6,550.92 "," $6,762.24 "," $7,853.05 "," $5,987.40 "," $5,141.67 "," $5,560.93 ", N/A ," $6,277.51 "," $6,277.51 "," $6,691.80 "," $7,385.31 ", $819.07 ," $7,853.05 "
"Revision Renal Pelvis,Complicated",CPT® 50405,N/A,N/A,N/A," $9,721.00 "," $6,318.65 "," $7,530.37 "," $1,323.07 "," $2,305.21 "," $6,843.48 "," $6,341.40 "," $9,040.53 "," $8,748.90 "," $8,748.90 "," $7,776.80 "," $7,776.80 "," $2,305.21 "," $8,975.40 "," $9,234.95 "," $8,748.90 "," $8,748.90 "," $8,748.90 "," $9,040.53 "," $9,332.16 "," $7,564.13 "," $8,262.85 "," $7,180.86 "," $8,584.31 ", N/A ," $6,977.01 "," $6,977.01 "," $9,234.95 "," $8,200.46 "," $1,323.07 "," $9,332.16 "
Explore Scrotum,CPT® 55110,N/A,N/A,N/A," $2,045.00 "," $1,329.25 "," $1,723.77 ", $371.85 , $310.97 ," $1,242.64 "," $1,261.50 "," $1,901.85 "," $1,840.50 "," $1,840.50 "," $1,636.00 "," $1,636.00 ", $310.97 ," $1,888.15 "," $1,942.75 "," $1,840.50 "," $1,840.50 "," $1,840.50 "," $1,901.85 "," $1,963.20 "," $1,615.41 "," $1,738.25 "," $2,015.99 "," $1,874.80 ", N/A ," $1,266.89 "," $1,266.89 "," $1,942.75 "," $1,518.45 ", $310.97 ," $2,015.99 "
 St Bedside Swallow Eval -Mh ,CPT® 92610,0444 - SPEECH PATH/EVAL,N/A,N/A, $637.00 , $414.05 , $535.08 , $69.67 , $77.36 , $514.70 , $573.30 , $539.28 , $573.30 , $573.30 , $573.30 , $541.45 , $75.84 , $588.14 , $605.15 , $541.45 , $592.41 , $592.41 , $605.15 , $611.52 , $521.19 , $573.30 , $541.45 , $503.23 , N/A , $515.52 , $515.52 , $605.15 , $546.61 , $69.67 , $611.52 
Excis Lesn Tendon Shealth Leg/Ankle,27630,N/A,N/A,N/A," $3,730.00 "," $2,424.50 "," $2,212.93 ", $344.18 , $324.97 ," $1,777.30 "," $1,779.67 "," $3,468.90 "," $3,357.00 "," $3,357.00 "," $2,984.00 "," $2,984.00 ", $324.97 ," $3,443.91 "," $3,543.50 "," $3,357.00 "," $3,357.00 "," $3,357.00 "," $3,468.90 "," $3,580.80 "," $2,063.34 "," $3,170.50 "," $1,948.20 "," $2,100.00 ", N/A ," $1,811.98 "," $1,811.98 "," $3,543.50 "," $2,129.71 ", $324.97 ," $3,580.80 "
 Fac Private Room - Imc/CAH ,Custom 2060000002,0206 - POST ICU,N/A,N/A," $2,353.00 "," $1,529.45 "," $1,976.52 ", N/A , N/A ," $1,901.22 "," $2,117.70 "," $1,992.05 "," $2,117.70 "," $2,117.70 "," $2,117.70 "," $2,000.05 ", N/A ," $2,172.52 "," $2,235.35 "," $2,000.05 "," $2,188.29 "," $2,188.29 "," $2,235.35 "," $2,258.88 "," $1,925.22 "," $2,117.70 "," $2,000.05 "," $1,858.87 ", N/A ," $1,904.28 "," $1,904.28 "," $2,235.35 "," $2,019.11 "," $1,858.87 "," $2,258.88 "
"Exc Sweat Gland Lesn Perineal,Simpl",CPT® 11470,N/A,N/A,N/A," $1,694.00 "," $1,101.10 ", $907.29 , $273.02 , $321.93 , $757.39 , $749.32 ," $1,575.42 "," $1,524.60 "," $1,524.60 "," $1,355.20 "," $1,355.20 ", $321.93 ," $1,564.07 "," $1,609.30 "," $1,524.60 "," $1,524.60 "," $1,524.60 "," $1,575.42 "," $1,626.24 ", $983.18 ," $1,439.90 "," $1,500.40 ", $972.51 , N/A , $772.16 , $772.16 ," $1,609.30 ", $895.45 , $273.02 ," $1,626.24 "
 Fac Replace Gastrostomy/Cecostomy Tube Percutaneous ,CPT® 49450,0750 - GASTR-INST SVS,N/A,N/A, $669.00 , $434.85 , $561.96 , $62.65 , $590.21 , $540.55 , $602.10 , $566.38 , $602.10 , $602.10 , $602.10 , $568.65 , $578.64 , $617.69 , $635.55 , $568.65 , $622.17 , $622.17 , $635.55 , $642.24 , $547.38 , $602.10 , $568.65 , $528.51 , N/A , $541.42 , $541.42 , $635.55 , $574.07 , $62.65 , $642.24 
Angio Aortogram Abd Serial,CPT® 75625,N/A,N/A,N/A," $1,845.00 "," $1,199.25 ", $711.78 , $122.22 , $227.72 , $659.09 , $809.65 ," $1,715.85 "," $1,660.50 "," $1,660.50 "," $1,476.00 "," $1,476.00 ", $227.72 ," $1,703.49 "," $1,752.75 "," $1,660.50 "," $1,660.50 "," $1,660.50 "," $1,715.85 "," $1,771.20 ", $731.08 ," $1,568.25 ", $889.83 , $686.78 , N/A , $671.94 , $671.94 ," $1,752.75 ", $777.77 , $122.22 ," $1,771.20 "
 Fac Needle Emg Nonextremty Mscles W/Nerve Conduction ,CPT® 95887,0922 - EMG,N/A,N/A, $278.00 , $180.70 , $233.52 , $82.44 , $61.15 , $224.62 , $250.20 , $235.35 , $250.20 , $250.20 , $250.20 , $236.30 , $59.95 , $256.68 , $264.10 , $236.30 , $258.54 , $258.54 , $264.10 , $266.88 , $227.46 , $250.20 , $236.30 , $219.62 , N/A , $224.99 , $224.99 , $264.10 , $238.55 , $59.95 , $266.88 
Close Mouth Laceration,CPT® 40831,N/A,N/A,N/A," $2,379.00 "," $1,546.35 "," $1,288.76 ", $195.75 , $89.66 ," $1,091.99 "," $1,130.85 "," $2,212.47 "," $2,141.10 "," $2,141.10 "," $1,903.20 "," $1,903.20 ", $89.66 ," $2,196.53 "," $2,260.05 "," $2,141.10 "," $2,141.10 "," $2,141.10 "," $2,212.47 "," $2,283.84 "," $1,003.12 "," $2,022.15 "," $1,236.36 "," $1,304.18 ", N/A ," $1,113.29 "," $1,113.29 "," $2,260.05 "," $1,164.39 ", $89.66 ," $2,283.84 "
"Self-Mgmt Educ & Train, 1 Pt, Ea 30 Min",CPT® 98960,N/A,N/A,N/A, $113.00 , $73.45 , N/A , $28.13 , N/A , $60.95 , $64.51 , $105.09 , $101.70 , $101.70 , $90.40 , $90.40 , N/A , $104.33 , $107.35 , $101.70 , $101.70 , $101.70 , $105.09 , $108.48 , $81.68 , $96.05 , N/A , $103.59 , N/A , $62.14 , $62.14 , $107.35 , $72.44 , $28.13 , $108.48 
 Fac Hemoglobin Chromotography ,CPT® 83021,0301 - LAB/CHEMISTRY,N/A,N/A, $169.00 , $109.85 , $141.96 , $18.42 , $18.42 , $136.55 , $152.10 , $143.08 , $152.10 , $152.10 , $152.10 , $143.65 , $18.06 , $156.04 , $160.55 , $143.65 , $157.17 , $157.17 , $160.55 , $162.24 , $138.28 , $152.10 , $143.65 , $133.51 , N/A , $136.77 , $136.77 , $160.55 , $145.02 , $18.06 , $162.24 
Molecular Pathology Procedure Level 3,CPT® 81402,N/A,N/A,N/A," $1,063.00 ", $690.95 , N/A , $153.34 , $153.34 , N/A , N/A , $988.59 , $956.70 , $956.70 , $850.40 , $850.40 , $153.34 , $981.47 ," $1,009.85 ", $956.70 , $956.70 , $956.70 , $988.59 ," $1,020.48 "," $1,003.79 ", $903.55 , $717.22 , $441.52 , N/A , $596.81 , $596.81 ," $1,009.85 ", $650.93 , $153.34 ," $1,020.48 "
Crit Care Telehea Consult 60,HCPCS G0508,N/A,N/A,N/A, $721.00 , $468.65 , $397.26 , $199.41 , N/A , $353.48 , N/A , $670.53 , $648.90 , $648.90 , $576.80 , $576.80 , N/A , $665.70 , $684.95 , $648.90 , $648.90 , $648.90 , $670.53 , $692.16 , $584.35 , $612.85 , $393.51 , $757.45 , N/A , $360.38 , $360.38 , $684.95 , $450.47 , $199.41 , $757.45 
Cftr Gene Analysis Full Gene Sequence,CPT® 81223,N/A,N/A,N/A," $2,262.00 "," $1,470.30 ", N/A , $508.98 , $508.98 , N/A , N/A ," $2,103.66 "," $2,035.80 "," $2,035.80 "," $1,809.60 "," $1,809.60 ", $508.98 ," $2,088.50 "," $2,148.90 "," $2,035.80 "," $2,035.80 "," $2,035.80 "," $2,103.66 "," $2,171.52 "," $3,331.93 "," $1,922.70 "," $2,379.44 "," $1,465.56 ", N/A ," $1,981.03 "," $1,981.03 "," $2,148.90 "," $2,160.67 ", $508.98 ," $3,331.93 "
" Pro Removal Testis,Radical ",CPT® 54530,0982 - PRO FEE/OUTPT,N/A,N/A," $2,771.00 "," $1,801.15 "," $2,254.97 ", $486.50 , $504.14 ," $1,621.34 "," $1,643.03 "," $2,577.03 "," $2,493.90 "," $2,493.90 "," $2,216.80 "," $2,216.80 ", $504.14 ," $2,558.46 "," $2,632.45 "," $2,493.90 "," $2,493.90 "," $2,493.90 "," $2,577.03 "," $2,660.16 "," $2,115.11 "," $2,355.35 "," $2,620.79 "," $2,447.04 ", N/A ," $1,652.98 "," $1,652.98 "," $2,632.45 "," $1,981.19 ", $486.50 ," $2,660.16 "
" Pro Inj Dx/Ther Agnt Paravert Facet Joint, Lumbar/Sac, Add Level ",CPT® 64495,0982 - PRO FEE/OUTPT,N/A,N/A, $536.00 , $348.40 , $256.46 , $49.77 , $62.93 , $296.18 , $287.57 , $498.48 , $482.40 , $482.40 , $428.80 , $428.80 , $62.93 , $494.89 , $509.20 , $482.40 , $482.40 , $482.40 , $498.48 , $514.56 , $280.21 , $455.60 , $278.31 , $317.90 , N/A , $301.95 , $301.95 , $509.20 , $323.93 , $49.77 , $514.56 
 METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN ,HCPCS J2210,0636 - DRUGS REQUIRING DETAILED CODIN,00517-0740-20,1 mL, $184.44 , $119.89 , $154.93 , $21.31 , $21.28 , $149.03 , $166.00 , $156.15 , $166.00 , $166.00 , $166.00 , $156.77 , $20.86 , $170.29 , $175.22 , $156.77 , $171.53 , $171.53 , $175.22 , $177.06 , $150.91 , $166.00 , $156.77 , $145.71 , N/A , $149.27 , $149.27 , $175.22 , $158.27 , $20.86 , $177.06 
 Fac Assay of Iron ,CPT® 83540,0301 - LAB/CHEMISTRY,N/A,N/A, $80.00 , $52.00 , $67.20 , $6.60 , $6.60 , $64.64 , $72.00 , $67.73 , $72.00 , $72.00 , $72.00 , $68.00 , $6.47 , $73.86 , $76.00 , $68.00 , $74.40 , $74.40 , $76.00 , $76.80 , $65.46 , $72.00 , $68.00 , $63.20 , N/A , $64.74 , $64.74 , $76.00 , $68.65 , $6.47 , $76.80 
 IOPAMIDOL 61 % IJ SOLN ,HCPCS Q9967,0255 - DRUGS/RADIOLOGY,00270-1412-15,15 mL, $529.36 , $344.08 , $444.66 , $0.13 , $0.17 , $427.72 , $476.42 , $448.16 , $476.42 , $476.42 , $476.42 , $449.96 , $0.17 , $488.76 , $502.89 , $449.96 , $492.30 , $492.30 , $502.89 , $508.19 , $433.12 , $476.42 , $449.96 , $418.19 , N/A , $428.41 , $428.41 , $502.89 , $454.24 , $0.13 , $508.19 
 Fac Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging ,CPT® 78804,0340 - NUCLEAR MEDICINE,N/A,N/A," $5,578.00 "," $3,625.70 "," $4,685.52 ", $591.15 , $218.99 ," $4,507.02 "," $5,020.20 "," $4,722.33 "," $5,020.20 "," $5,020.20 "," $5,020.20 "," $4,741.30 ", $214.70 ," $5,150.17 "," $5,299.10 "," $4,741.30 "," $5,187.54 "," $5,187.54 "," $5,299.10 "," $5,354.88 "," $4,563.92 "," $5,020.20 "," $4,741.30 "," $4,406.62 ", N/A ," $4,514.28 "," $4,514.28 "," $5,299.10 "," $4,786.48 ", $214.70 ," $5,354.88 "
 Pro Treat Fx Rad Intra-Articul ,CPT® 25608,0982 - PRO FEE/OUTPT,N/A,N/A," $3,236.00 "," $2,103.40 "," $5,041.66 ", $792.24 , $611.22 ," $3,971.14 "," $3,955.20 "," $3,009.48 "," $2,912.40 "," $2,912.40 "," $2,588.80 "," $2,588.80 ", $611.22 ," $2,987.80 "," $3,074.20 "," $2,912.40 "," $2,912.40 "," $2,912.40 "," $3,009.48 "," $3,106.56 "," $4,682.64 "," $2,750.60 "," $4,358.47 "," $4,694.37 ", N/A ," $4,048.63 "," $4,048.63 "," $3,074.20 "," $4,758.57 ", $611.22 ," $5,041.66 "
 Fac Polysomnography W/Cpap ,CPT® 95811,0920 - OTHER DX SVS,N/A,N/A," $5,067.00 "," $3,293.55 "," $4,256.28 ", $622.13 ," $1,159.73 "," $4,094.14 "," $4,560.30 "," $4,289.72 "," $4,560.30 "," $4,560.30 "," $4,560.30 "," $4,306.95 "," $1,136.99 "," $4,678.36 "," $4,813.65 "," $4,306.95 "," $4,712.31 "," $4,712.31 "," $4,813.65 "," $4,864.32 "," $4,145.82 "," $4,560.30 "," $4,306.95 "," $4,002.93 ", N/A ," $4,100.72 "," $4,100.72 "," $4,813.65 "," $4,347.99 ", $622.13 ," $4,864.32 "
Relocate Skin Pocket Implantable Defibrillator,CPT® 33223,N/A,N/A,N/A," $4,444.00 "," $2,888.60 "," $2,447.45 ", $378.64 , $408.15 ," $1,791.84 "," $1,738.21 "," $4,132.92 "," $3,999.60 "," $3,999.60 "," $3,555.20 "," $3,555.20 ", $408.15 ," $4,103.15 "," $4,221.80 "," $3,999.60 "," $3,999.60 "," $3,999.60 "," $4,132.92 "," $4,266.24 "," $2,261.93 "," $3,777.40 "," $2,183.69 "," $1,980.01 ", N/A ," $1,826.80 "," $1,826.80 "," $4,221.80 "," $2,075.26 ", $378.64 ," $4,266.24 "
Treat Metacarpal Fracture,CPT® 26600,N/A,N/A,N/A," $1,917.00 "," $1,246.05 "," $1,787.76 ", $284.00 , $155.34 ," $1,331.76 "," $1,361.00 "," $1,782.81 "," $1,725.30 "," $1,725.30 "," $1,533.60 "," $1,533.60 ", $155.34 ," $1,769.97 "," $1,821.15 "," $1,725.30 "," $1,725.30 "," $1,725.30 "," $1,782.81 "," $1,840.32 "," $1,640.20 "," $1,629.45 "," $1,491.48 "," $1,590.09 ", N/A ," $1,357.74 "," $1,357.74 "," $1,821.15 "," $1,595.82 ", $155.34 ," $1,840.32 "
 Path Special Stain Group I Initial -Tech-Mh ,CPT® 88312,0310 - PATHOLOGY LAB,N/A,N/A, $606.00 , $393.90 , $509.04 , $110.50 , $28.78 , $489.65 , $545.40 , $513.04 , $545.40 , $545.40 , $545.40 , $515.10 , $28.22 , $559.52 , $575.70 , $515.10 , $563.58 , $563.58 , $575.70 , $581.76 , $495.83 , $545.40 , $515.10 , $478.74 , N/A , $490.44 , $490.44 , $575.70 , $520.01 , $28.22 , $581.76 
Canthoplasty,CPT® 67950,N/A,N/A,N/A," $5,287.00 "," $3,436.55 "," $2,836.93 ", $445.61 ," $1,109.85 "," $2,619.10 "," $2,466.75 "," $4,916.91 "," $4,758.30 "," $4,758.30 "," $4,229.60 "," $4,229.60 "," $1,109.85 "," $4,881.49 "," $5,022.65 "," $4,758.30 "," $4,758.30 "," $4,758.30 "," $4,916.91 "," $5,075.52 "," $3,895.98 "," $4,493.95 "," $2,554.78 "," $3,323.28 ", N/A ," $2,670.20 "," $2,670.20 "," $5,022.65 "," $2,947.57 ", $445.61 ," $5,075.52 "
 Pro Appl Short Arm Splnt F/Arm-Hand Dynamic ,CPT® 29126,0982 - PRO FEE/OUTPT,N/A,N/A, $509.00 , $330.85 , $299.46 , $47.25 , $23.04 , $236.84 , $238.38 , $473.37 , $458.10 , $458.10 , $407.20 , $407.20 , $23.04 , $469.96 , $483.55 , $458.10 , $458.10 , $458.10 , $473.37 , $488.64 , $274.00 , $432.65 , $260.47 , $283.20 , N/A , $241.46 , $241.46 , $483.55 , $283.78 , $23.04 , $488.64 
Excis Each Addnl Spinal Disk,CPT® 63035,N/A,N/A,N/A," $1,392.00 ", $904.80 , $878.49 , $209.39 , $268.05 ," $1,043.99 ", $993.16 ," $1,294.56 "," $1,252.80 "," $1,252.80 "," $1,113.60 "," $1,113.60 ", $268.05 ," $1,285.23 "," $1,322.40 "," $1,252.80 "," $1,252.80 "," $1,252.80 "," $1,294.56 "," $1,336.32 ", $955.99 ," $1,183.20 "," $1,009.78 "," $1,090.14 ", N/A ," $1,064.37 "," $1,064.37 "," $1,322.40 "," $1,141.81 ", $209.39 ," $1,336.32 "
" Fac Subcut Infusion, Therap/Proph/Diagnost,Add Pump Set ",CPT® 96371,0260 - IV THERAPY,N/A,N/A, $307.00 , $199.55 , $257.88 , $55.16 , $54.24 , $248.06 , $276.30 , $259.91 , $276.30 , $276.30 , $276.30 , $260.95 , $53.18 , $283.45 , $291.65 , $260.95 , $285.51 , $285.51 , $291.65 , $294.72 , $251.19 , $276.30 , $260.95 , $242.53 , N/A , $248.46 , $248.46 , $291.65 , $263.44 , $53.18 , $294.72 
Sgmdsc Flx Rmvl Tum Polyp/Oth Les Snare Tq,45338,N/A,N/A,N/A," $2,391.00 "," $1,554.15 ", $736.26 , $113.74 , $150.61 , $669.17 , $687.26 ," $2,223.63 "," $2,151.90 "," $2,151.90 "," $1,912.80 "," $1,912.80 ", $150.61 ," $2,207.61 "," $2,271.45 "," $2,151.90 "," $2,151.90 "," $2,151.90 "," $2,223.63 "," $2,295.36 ", $528.04 ," $2,032.35 ", $752.88 , $700.61 , N/A , $682.23 , $682.23 ," $2,271.45 ", $713.53 , $113.74 ," $2,295.36 "
"Eeg,Extended Monitoring,41-60 Minutes",CPT® 95812,N/A,N/A,N/A," $1,634.00 "," $1,062.10 "," $1,274.03 ", $338.99 , $260.27 ," $1,331.79 "," $1,539.55 "," $1,519.62 "," $1,470.60 "," $1,470.60 "," $1,307.20 "," $1,307.20 ", $260.27 ," $1,508.67 "," $1,552.30 "," $1,470.60 "," $1,470.60 "," $1,470.60 "," $1,519.62 "," $1,568.64 "," $1,488.24 "," $1,388.90 "," $1,350.27 "," $1,220.35 ", N/A ," $1,357.77 "," $1,357.77 "," $1,552.30 "," $1,669.23 ", $260.27 ," $1,669.23 "
" Pro Excis Rectal Tumor, Transanal, Partial Thickness ",CPT® 45171,0982 - PRO FEE/OUTPT,N/A,N/A," $4,673.00 "," $3,037.45 "," $3,796.78 ", $588.55 , $490.70 ," $2,854.71 "," $2,930.72 "," $4,345.89 "," $4,205.70 "," $4,205.70 "," $3,738.40 "," $3,738.40 ", $490.70 ," $4,314.58 "," $4,439.35 "," $4,205.70 "," $4,205.70 "," $4,205.70 "," $4,345.89 "," $4,486.08 "," $2,723.38 "," $3,972.05 "," $3,227.37 "," $3,408.02 ", N/A ," $2,910.42 "," $2,910.42 "," $4,439.35 "," $3,044.00 ", $490.70 ," $4,486.08 "
 FAM-TRASTUZUMAB DERUXTEC-NXKI 100 MG IV SOLR ,HCPCS J9358,0636 - DRUGS REQUIRING DETAILED CODIN,65597-0406-01,5 mL," $7,788.57 "," $5,062.57 "," $6,542.40 ", $26.76 , $26.23 ," $6,293.16 "," $7,009.71 "," $6,593.80 "," $7,009.71 "," $7,009.71 "," $7,009.71 "," $6,620.28 ", $25.72 ," $7,191.19 "," $7,399.14 "," $6,620.28 "," $7,243.37 "," $7,243.37 "," $7,399.14 "," $7,477.03 "," $6,372.61 "," $7,009.71 "," $6,620.28 "," $6,152.97 ", N/A ," $6,303.29 "," $6,303.29 "," $7,399.14 "," $6,683.37 ", $25.72 ," $7,477.03 "
 Pro X-Ray Exam of Lower Spine ,CPT® 72120,0972 - PRO FEE/RAD/DX,N/A,N/A, $136.00 , $88.40 , $230.67 , $40.00 , $47.05 , $190.24 , $226.41 , $126.48 , $122.40 , $122.40 , $108.80 , $108.80 , $47.05 , $125.57 , $129.20 , $122.40 , $122.40 , $122.40 , $126.48 , $130.56 , $224.11 , $115.60 , $248.46 , $205.40 , N/A , $193.95 , $193.95 , $129.20 , $224.50 , $40.00 , $248.46 
 Fac Immunfix E-Phorsis/Urine/CSF ,CPT® 86335,0302 - LAB/IMMUNOLOGY,N/A,N/A, $270.00 , $175.50 , $226.80 , $29.94 , $29.94 , $218.16 , $243.00 , $228.58 , $243.00 , $243.00 , $243.00 , $229.50 , $29.35 , $249.29 , $256.50 , $229.50 , $251.10 , $251.10 , $256.50 , $259.20 , $220.91 , $243.00 , $229.50 , $213.30 , N/A , $218.51 , $218.51 , $256.50 , $231.69 , $29.35 , $259.20 
Open Rx Tibial Tuber Fx,CPT® 27540,N/A,N/A,N/A," $5,791.00 "," $3,764.15 "," $4,941.69 ", $775.43 , $845.22 ," $3,914.60 "," $3,891.72 "," $5,385.63 "," $5,211.90 "," $5,211.90 "," $4,632.80 "," $4,632.80 ", $845.22 ," $5,346.83 "," $5,501.45 "," $5,211.90 "," $5,211.90 "," $5,211.90 "," $5,385.63 "," $5,559.36 "," $4,599.78 "," $4,922.35 "," $4,299.59 "," $4,592.90 ", N/A ," $3,990.98 "," $3,990.98 "," $5,501.45 "," $4,690.83 ", $775.43 ," $5,559.36 "
Full Excis 1st Metatarsal Head,CPT® 28111,N/A,N/A,N/A," $3,381.00 "," $2,197.65 "," $1,990.30 ", $310.18 , $248.22 ," $1,609.11 "," $1,624.02 "," $3,144.33 "," $3,042.90 "," $3,042.90 "," $2,704.80 "," $2,704.80 ", $248.22 ," $3,121.68 "," $3,211.95 "," $3,042.90 "," $3,042.90 "," $3,042.90 "," $3,144.33 "," $3,245.76 "," $1,852.55 "," $2,873.85 "," $1,766.22 "," $1,896.17 ", N/A ," $1,640.51 "," $1,640.51 "," $3,211.95 "," $1,928.18 ", $248.22 ," $3,245.76 "
Nonphysician Telephone Assessment 21-30 Min,CPT® 98968,N/A,N/A,N/A, $156.00 , $101.40 , $74.23 , $31.07 , N/A , $86.14 , $84.65 , $145.08 , $140.40 , $140.40 , $124.80 , $124.80 , N/A , $144.03 , $148.20 , $140.40 , $140.40 , $140.40 , $145.08 , $149.76 , $68.86 , $132.60 , $111.51 , $145.02 , N/A , $87.82 , $87.82 , $148.20 , $102.38 , $31.07 , $149.76 
 Knees Bil Standing Ap ,CPT® 73565,0320 - DX X-RAY,N/A,N/A, $391.00 , $254.15 , $328.44 , $39.24 , $28.54 , $315.93 , $351.90 , $331.02 , $351.90 , $351.90 , $351.90 , $332.35 , $27.98 , $361.01 , $371.45 , $332.35 , $363.63 , $363.63 , $371.45 , $375.36 , $319.92 , $351.90 , $332.35 , $308.89 , N/A , $316.44 , $316.44 , $371.45 , $335.52 , $27.98 , $375.36 
Injection Aa&/Strd Other Peripheral Nerve/Branch,64450,N/A,N/A,N/A, $711.00 , $462.15 , $207.58 , $40.26 , $113.79 , $255.83 , $245.04 , $661.23 , $639.90 , $639.90 , $568.80 , $568.80 , $113.79 , $656.47 , $675.45 , $639.90 , $639.90 , $639.90 , $661.23 , $682.56 , $225.30 , $604.35 , $237.28 , $273.66 , N/A , $260.82 , $260.82 , $675.45 , $279.80 , $40.26 , $682.56 
 Colorectal Cancer Mut Panel Kras Add Var Rml 81276 ,CPT® 81276,0310 - PATHOLOGY LAB,N/A,N/A, $627.00 , $407.55 , $526.68 , $197.12 , $119.07 , $506.62 , $564.30 , $530.82 , $564.30 , $564.30 , $564.30 , $532.95 , $116.74 , $578.91 , $595.65 , $532.95 , $583.11 , $583.11 , $595.65 , $601.92 , $513.01 , $564.30 , $532.95 , $495.33 , N/A , $507.43 , $507.43 , $595.65 , $538.03 , $116.74 , $601.92 
" ED Fac I&D Mouth/Tong Extra,Submandibul ",CPT® 41017,0761 - TREATMENT ROOM,N/A,N/A," $3,275.00 "," $2,128.75 "," $2,751.00 ", $335.13 , $365.86 ," $2,646.20 "," $2,947.50 "," $2,772.62 "," $2,947.50 "," $2,947.50 "," $2,947.50 "," $2,783.75 ", $358.69 ," $3,023.81 "," $3,111.25 "," $2,783.75 "," $3,045.75 "," $3,045.75 "," $3,111.25 "," $3,144.00 "," $2,679.61 "," $2,947.50 "," $2,783.75 "," $2,587.25 ", N/A ," $2,650.46 "," $2,650.46 "," $3,111.25 "," $2,810.28 ", $335.13 ," $3,144.00 "
 ACETAZOLAMIDE SODIUM 500 MG IJ SOLR ,HCPCS J1120,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9503-01,5 mL, $270.97 , $176.13 , $227.61 , $30.29 , $29.59 , $218.94 , $243.87 , $229.40 , $243.87 , $243.87 , $243.87 , $230.32 , $29.01 , $250.19 , $257.42 , $230.32 , $252.00 , $252.00 , $257.42 , $260.13 , $221.71 , $243.87 , $230.32 , $214.07 , N/A , $219.30 , $219.30 , $257.42 , $232.52 , $29.01 , $260.13 
 Hernia US ,CPT® 76857,0402 - ULTRASOUND,N/A,N/A, $554.00 , $360.10 , $465.36 , $48.14 , $62.84 , $447.63 , $498.60 , $469.02 , $498.60 , $498.60 , $498.60 , $470.90 , $61.61 , $511.51 , $526.30 , $470.90 , $515.22 , $515.22 , $526.30 , $531.84 , $453.28 , $498.60 , $470.90 , $437.66 , N/A , $448.35 , $448.35 , $526.30 , $475.39 , $48.14 , $531.84 
 DEXAMETHASONE 0.4 MG OP INST ,HCPCS J1096,0636 - DRUGS REQUIRING DETAILED CODIN,70382-0204-01,1 each," $1,631.88 "," $1,060.72 "," $1,370.78 ", N/A , $137.39 ," $1,318.56 "," $1,468.69 "," $1,381.55 "," $1,468.69 "," $1,468.69 "," $1,468.69 "," $1,387.10 ", $134.70 ," $1,506.71 "," $1,550.29 "," $1,387.10 "," $1,517.65 "," $1,517.65 "," $1,550.29 "," $1,566.60 "," $1,335.20 "," $1,468.69 "," $1,387.10 "," $1,289.19 ", N/A ," $1,320.68 "," $1,320.68 "," $1,550.29 "," $1,400.32 ", $134.70 ," $1,566.60 "
" Pro OB US, Follow-Up, per Fetus ",CPT® 76816,0972 - PRO FEE/RAD/DX,N/A,N/A, $407.00 , $264.55 , $625.47 , $108.84 , $76.19 , $551.27 , $625.30 , $378.51 , $366.30 , $366.30 , $325.60 , $325.60 , $76.19 , $375.78 , $386.65 , $366.30 , $366.30 , $366.30 , $378.51 , $390.72 , $630.63 , $345.95 , $683.74 , $649.55 , N/A , $562.03 , $562.03 , $386.65 , $650.56 , $76.19 , $683.74 
 Fac Prq Trluml Coronary Byp Grft Revasc One Vessel ,CPT® 92937,0481 - CARDIAC CATH LAB,N/A,N/A," $10,591.00 "," $6,884.15 "," $8,896.44 ", $528.11 , $453.04 ," $8,557.53 "," $9,531.90 "," $8,966.34 "," $9,531.90 "," $9,531.90 "," $9,531.90 "," $9,002.35 ", $444.16 ," $9,778.67 "," $10,061.45 "," $9,002.35 "," $9,849.63 "," $9,849.63 "," $10,061.45 "," $10,167.36 "," $8,665.56 "," $9,531.90 "," $9,002.35 "," $8,366.89 ", N/A ," $8,571.30 "," $8,571.30 "," $10,061.45 "," $9,088.14 ", $444.16 ," $10,167.36 "
 ARGATROBAN 50 MG/50 ML IV (INPT) ,HCPCS J0883,0636 - DRUGS REQUIRING DETAILED CODIN,55150-0241-01,50 mL, $573.37 , $372.69 , $481.63 , N/A , $2.74 , $463.28 , $516.03 , $485.42 , $516.03 , $516.03 , $516.03 , $487.36 , $2.69 , $529.39 , $544.70 , $487.36 , $533.23 , $533.23 , $544.70 , $550.44 , $469.13 , $516.03 , $487.36 , $452.96 , N/A , $464.03 , $464.03 , $544.70 , $492.01 , $2.69 , $550.44 
Cytopatholgy Sele Cellula,CPT® 88112,N/A,N/A,N/A, $951.00 , $618.15 , $237.73 , $65.87 , $118.37 , $257.19 , $502.17 , $884.43 , $855.90 , $855.90 , $760.80 , $760.80 , $118.37 , $878.06 , $903.45 , $855.90 , $855.90 , $855.90 , $884.43 , $912.96 , $430.35 , $808.35 , $522.23 , $239.34 , N/A , $240.03 , $240.03 , $903.45 , $263.78 , $65.87 , $912.96 
Fac Cltx Patellar Dislc Req Anes,27562,N/A,N/A,N/A," $2,770.00 "," $1,800.50 "," $3,006.32 ", $473.55 , $268.05 ," $2,330.83 "," $2,330.76 "," $2,576.10 "," $2,493.00 "," $2,493.00 "," $2,216.00 "," $2,216.00 ", $268.05 ," $2,557.54 "," $2,631.50 "," $2,493.00 "," $2,493.00 "," $2,493.00 "," $2,576.10 "," $2,659.20 "," $2,781.27 "," $2,354.50 "," $2,569.05 "," $2,750.89 ", N/A ," $2,376.31 "," $2,376.31 "," $2,631.50 "," $2,793.00 ", $268.05 ," $3,006.32 "
 Fluoroscopy Time per 15 Min ,CPT® 76000,0320 - DX X-RAY,N/A,N/A, $435.00 , $282.75 , $365.40 , $42.11 , $59.59 , $351.48 , $391.50 , $368.27 , $391.50 , $391.50 , $391.50 , $369.75 , $58.42 , $401.64 , $413.25 , $369.75 , $404.55 , $404.55 , $413.25 , $417.60 , $355.92 , $391.50 , $369.75 , $343.65 , N/A , $352.05 , $352.05 , $413.25 , $373.27 , $42.11 , $417.60 
 Pro Open Tx Femoral Fracture Distal Med/Lat Condyle ,CPT® 27514,0982 - PRO FEE/OUTPT,N/A,N/A," $4,027.00 "," $2,617.55 "," $5,836.03 ", $911.01 ," $1,092.81 "," $4,669.43 "," $4,618.72 "," $3,745.11 "," $3,624.30 "," $3,624.30 "," $3,221.60 "," $3,221.60 "," $1,092.81 "," $3,718.13 "," $3,825.65 "," $3,624.30 "," $3,624.30 "," $3,624.30 "," $3,745.11 "," $3,865.92 "," $5,439.74 "," $3,422.95 "," $5,113.13 "," $5,484.79 ", N/A ," $4,760.54 "," $4,760.54 "," $3,825.65 "," $5,595.32 ", $911.01 ," $5,836.03 "
 Fac Slctv Cath Intrcrnl Brnch Angio Intrl Carot/Vert ,CPT® 36228,0360 - OR SERVICES,N/A,N/A," $3,462.00 "," $2,250.30 "," $2,908.08 ", $217.60 ," $1,159.65 "," $2,797.30 "," $3,115.80 "," $2,930.93 "," $3,115.80 "," $3,115.80 "," $3,115.80 "," $2,942.70 "," $1,136.91 "," $3,196.46 "," $3,288.90 "," $2,942.70 "," $3,219.66 "," $3,219.66 "," $3,288.90 "," $3,323.52 "," $2,832.61 "," $3,115.80 "," $2,942.70 "," $2,734.98 ", N/A ," $2,801.80 "," $2,801.80 "," $3,288.90 "," $2,970.74 ", $217.60 ," $3,323.52 "
"Culture Typing, Nucleic Acid Sequence, Each Isolate",CPT® 87153,N/A,N/A,N/A, $584.00 , $379.60 , N/A , $117.67 , $117.67 , $652.63 , $780.70 , $543.12 , $525.60 , $525.60 , $467.20 , $467.20 , $117.67 , $539.21 , $554.80 , $525.60 , $525.60 , $525.60 , $543.12 , $560.64 , $770.28 , $496.40 , $755.78 , $418.29 , N/A , $609.08 , $609.08 , $554.80 , $665.60 , $117.67 , $780.70 
Inject Carpal Tunnel,20526,N/A,N/A,N/A, $497.00 , $323.05 , $344.24 , $53.49 , $26.41 , $280.39 , $270.32 , $462.21 , $447.30 , $447.30 , $397.60 , $397.60 , $26.41 , $458.88 , $472.15 , $447.30 , $447.30 , $447.30 , $462.21 , $477.12 , $320.52 , $422.45 , $297.94 , $328.48 , N/A , $285.86 , $285.86 , $472.15 , $335.99 , $26.41 , $477.12 
 Fac Drug Test Def 15-21 Classes ,CPT® G0482,0301 - LAB/CHEMISTRY,N/A,N/A, $298.00 , $193.70 , $250.32 , $202.71 , $135.46 , $240.78 , $268.20 , $252.29 , $268.20 , $268.20 , $268.20 , $253.30 , $132.80 , $275.14 , $283.10 , $253.30 , $277.14 , $277.14 , $283.10 , $286.08 , $243.82 , $268.20 , $253.30 , $235.42 , N/A , $241.17 , $241.17 , $283.10 , $255.71 , $132.80 , $286.08 
 Mandible Min 4 Views ,CPT® 70110,0320 - DX X-RAY,N/A,N/A, $397.00 , $258.05 , $333.48 , $42.68 , $37.90 , $320.78 , $357.30 , $336.10 , $357.30 , $357.30 , $357.30 , $337.45 , $37.16 , $366.55 , $377.15 , $337.45 , $369.21 , $369.21 , $377.15 , $381.12 , $324.83 , $357.30 , $337.45 , $313.63 , N/A , $321.29 , $321.29 , $377.15 , $340.67 , $37.16 , $381.12 
"Nephrectomy, W/Part. Uretectomy",CPT® 50548,N/A,N/A,N/A," $9,191.00 "," $5,974.15 "," $7,239.65 "," $1,270.33 "," $1,985.35 "," $6,595.10 "," $6,115.63 "," $8,547.63 "," $8,271.90 "," $8,271.90 "," $7,352.80 "," $7,352.80 "," $1,985.35 "," $8,486.05 "," $8,731.45 "," $8,271.90 "," $8,271.90 "," $8,271.90 "," $8,547.63 "," $8,823.36 "," $7,281.87 "," $7,812.35 "," $6,929.31 "," $8,278.25 ", N/A ," $6,723.78 "," $6,723.78 "," $8,731.45 "," $7,902.82 "," $1,270.33 "," $8,823.36 "
Remove Extern Bone Fix Dev W Anesth,CPT® 20694,N/A,N/A,N/A," $2,810.00 "," $1,826.50 "," $2,077.73 ", $327.71 , $361.03 ," $1,632.54 "," $1,636.37 "," $2,613.30 "," $2,529.00 "," $2,529.00 "," $2,248.00 "," $2,248.00 ", $361.03 ," $2,594.47 "," $2,669.50 "," $2,529.00 "," $2,529.00 "," $2,529.00 "," $2,613.30 "," $2,697.60 "," $1,927.04 "," $2,388.50 "," $1,798.34 "," $1,936.80 ", N/A ," $1,664.40 "," $1,664.40 "," $2,669.50 "," $1,956.25 ", $327.71 ," $2,697.60 "
Assay Creatinine,CPT® 82565,N/A,N/A,N/A, $56.00 , $36.40 , N/A , $5.22 , $5.22 , $28.97 , $34.65 , $52.08 , $50.40 , $50.40 , $44.80 , $44.80 , $5.22 , $51.70 , $53.20 , $50.40 , $50.40 , $50.40 , $52.08 , $53.76 , $34.19 , $47.60 , $34.06 , $18.59 , N/A , $27.04 , $27.04 , $53.20 , $29.55 , $5.22 , $53.76 
 TORSEMIDE 20 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,50268-0756-15,1 tablet, $4.26 , $2.77 , $3.58 , N/A , N/A , $3.44 , $3.83 , $3.61 , $3.83 , $3.83 , $3.83 , $3.62 , N/A , $3.93 , $4.05 , $3.62 , $3.96 , $3.96 , $4.05 , $4.09 , $3.49 , $3.83 , $3.62 , $3.37 , N/A , $3.45 , $3.45 , $4.05 , $3.66 , $3.37 , $4.09 
 Fac Lipid Panel ,CPT® 80061,0301 - LAB/CHEMISTRY,N/A,N/A, $160.00 , $104.00 , $134.40 , $13.66 , $13.66 , $129.28 , $144.00 , $135.46 , $144.00 , $144.00 , $144.00 , $136.00 , $13.39 , $147.73 , $152.00 , $136.00 , $148.80 , $148.80 , $152.00 , $153.60 , $130.91 , $144.00 , $136.00 , $126.40 , N/A , $129.49 , $129.49 , $152.00 , $137.30 , $13.39 , $153.60 
"Incis/Drain Penis,Deep",CPT® 54015,N/A,N/A,N/A," $1,684.00 "," $1,094.60 "," $1,349.98 ", $290.51 , $76.84 , $982.36 ," $1,000.01 "," $1,566.12 "," $1,515.60 "," $1,515.60 "," $1,347.20 "," $1,347.20 ", $76.84 ," $1,554.84 "," $1,599.80 "," $1,515.60 "," $1,515.60 "," $1,515.60 "," $1,566.12 "," $1,616.64 "," $1,269.79 "," $1,431.40 "," $1,596.74 "," $1,487.55 ", N/A ," $1,001.53 "," $1,001.53 "," $1,599.80 "," $1,200.38 ", $76.84 ," $1,616.64 "
Added Skin Lesions Injection,CPT® 11901,N/A,N/A,N/A, $314.00 , $204.10 , $147.15 , $43.95 , $20.32 , $131.80 , $128.45 , $292.02 , $282.60 , $282.60 , $251.20 , $251.20 , $20.32 , $289.92 , $298.30 , $282.60 , $282.60 , $282.60 , $292.02 , $301.44 , $163.49 , $266.90 , $256.91 , $170.61 , N/A , $134.37 , $134.37 , $298.30 , $155.83 , $20.32 , $301.44 
 ALBUTEROL SULFATE 2.5 MG/0.5ML INH NEBU ,HCPCS RXC637,0250 - PHARMACY,00487-9901-30,0.5 mL, $4.63 , $3.01 , $3.89 , N/A , N/A , $3.74 , $4.17 , $3.92 , $4.17 , $4.17 , $4.17 , $3.94 , N/A , $4.27 , $4.40 , $3.94 , $4.31 , $4.31 , $4.40 , $4.44 , $3.79 , $4.17 , $3.94 , $3.66 , N/A , $3.75 , $3.75 , $4.40 , $3.97 , $3.66 , $4.44 
Antb Severe Aqt Respir Synd Sars-Cov-2 Covid-19,CPT® 86769,N/A,N/A,N/A, $163.00 , $105.95 , N/A , $42.97 , $42.97 , N/A , N/A , $151.59 , $146.70 , $146.70 , $130.40 , $130.40 , $42.97 , $150.50 , $154.85 , $146.70 , $146.70 , $146.70 , $151.59 , $156.48 , N/A , $138.55 , $200.31 , $123.74 , N/A , $163.46 , $163.46 , $154.85 , $178.63 , $42.97 , $200.31 
 Pro Incision of Achilles Tendon ,CPT® 27606,0982 - PRO FEE/OUTPT,N/A,N/A," $2,201.00 "," $1,430.65 "," $1,672.19 ", $259.46 , $169.04 ," $1,385.34 "," $1,381.21 "," $2,046.93 "," $1,980.90 "," $1,980.90 "," $1,760.80 "," $1,760.80 ", $169.04 ," $2,032.18 "," $2,090.95 "," $1,980.90 "," $1,980.90 "," $1,980.90 "," $2,046.93 "," $2,112.96 "," $1,562.47 "," $1,870.85 "," $1,518.24 "," $1,606.72 ", N/A ," $1,412.37 "," $1,412.37 "," $2,090.95 "," $1,660.04 ", $169.04 ," $2,112.96 "
"MRI, Lumbar Spine Combo",CPT® 72158,N/A,N/A,N/A," $7,561.00 "," $4,914.65 "," $2,302.86 ", $328.48 , $645.20 ," $2,762.80 "," $2,908.15 "," $7,031.73 "," $6,804.90 "," $6,804.90 "," $6,048.80 "," $6,048.80 ", $645.20 ," $6,981.07 "," $7,182.95 "," $6,804.90 "," $6,804.90 "," $6,804.90 "," $7,031.73 "," $7,258.56 "," $4,069.10 "," $6,426.85 "," $3,170.26 "," $3,505.04 ", N/A ," $2,816.70 "," $2,816.70 "," $7,182.95 "," $3,313.79 ", $328.48 ," $7,258.56 "
Diagnostic Mammography Computer-Aided Detcj Uni,CPT® 77065,N/A,N/A,N/A, $652.00 , $423.80 , $713.86 , $123.77 , $105.44 , $614.06 , $683.70 , $606.36 , $586.80 , $586.80 , $521.60 , $521.60 , $105.44 , $601.99 , $619.40 , $586.80 , $586.80 , $586.80 , $606.36 , $625.92 , $711.14 , $554.20 , $721.30 , $731.08 , N/A , $626.04 , $626.04 , $619.40 , $724.65 , $105.44 , $731.08 
 Pro Incision of Metatarsal ,CPT® 28308,0982 - PRO FEE/OUTPT,N/A,N/A," $3,731.00 "," $2,425.15 "," $2,379.91 ", $374.12 , $284.13 ," $1,848.67 "," $1,839.97 "," $3,469.83 "," $3,357.90 "," $3,357.90 "," $2,984.80 "," $2,984.80 ", $284.13 ," $3,444.83 "," $3,544.45 "," $3,357.90 "," $3,357.90 "," $3,357.90 "," $3,469.83 "," $3,581.76 "," $2,202.24 "," $3,171.35 "," $1,996.37 "," $2,208.03 ", N/A ," $1,884.75 "," $1,884.75 "," $3,544.45 "," $2,215.25 ", $284.13 ," $3,581.76 "
 Fac Intracranial Study ,CPT® 93888,0920 - OTHER DX SVS,N/A,N/A, $630.00 , $409.50 , $529.20 , $127.61 , $142.41 , $509.04 , $567.00 , $533.36 , $567.00 , $567.00 , $567.00 , $535.50 , $139.62 , $581.68 , $598.50 , $535.50 , $585.90 , $585.90 , $598.50 , $604.80 , $515.47 , $567.00 , $535.50 , $497.70 , N/A , $509.86 , $509.86 , $598.50 , $540.60 , $127.61 , $604.80 
 Pro Path Consltj Surg ,CPT® 88329,0971 - PRO FEE/LAB,N/A,N/A, $93.00 , $60.45 , $125.91 , $34.43 , $32.74 , $147.62 , $164.01 , $86.49 , $83.70 , $83.70 , $74.40 , $74.40 , $32.74 , $85.87 , $88.35 , $83.70 , $83.70 , $83.70 , $86.49 , $89.28 , $229.10 , $79.05 , $170.29 , $129.85 , N/A , $137.77 , $137.77 , $88.35 , $151.40 , $32.74 , $229.10 
Bleomycin Sulfate Injection,HCPCS J9040,N/A,N/A,N/A, $88.00 , $57.20 , N/A , $25.02 , $25.76 , N/A , N/A , $81.84 , $79.20 , $79.20 , $70.40 , $70.40 , $25.76 , $81.25 , $83.60 , $79.20 , $79.20 , $79.20 , $81.84 , $84.48 , $38.31 , $74.80 , $40.87 , $34.04 , N/A , N/A , N/A , $83.60 , N/A , $25.02 , $84.48 
" Fac Chemo, Anti-Neopl, Sq/Im ",CPT® 96401,0331 - CHEMOTHER/INJ,N/A,N/A, $460.00 , $299.00 , $386.40 , $70.74 , $54.43 , $371.68 , $414.00 , $389.44 , $414.00 , $414.00 , $414.00 , $391.00 , $53.36 , $424.72 , $437.00 , $391.00 , $427.80 , $427.80 , $437.00 , $441.60 , $376.37 , $414.00 , $391.00 , $363.40 , N/A , $372.28 , $372.28 , $437.00 , $394.73 , $53.36 , $441.60 
"Remv Resid Obstruc Prostate,>1 Yr",CPT® 52630,N/A,N/A,N/A," $2,726.00 "," $1,771.90 "," $2,199.72 ", $388.54 , $768.38 ," $1,956.64 "," $1,831.29 "," $2,535.18 "," $2,453.40 "," $2,453.40 "," $2,180.80 "," $2,180.80 ", $768.38 ," $2,516.92 "," $2,589.70 "," $2,453.40 "," $2,453.40 "," $2,453.40 "," $2,535.18 "," $2,616.96 "," $2,198.07 "," $2,317.10 "," $2,073.08 "," $2,465.35 ", N/A ," $1,994.81 "," $1,994.81 "," $2,589.70 "," $2,344.61 ", $388.54 ," $2,616.96 "
Incis Heart Sac Windw for Drain,CPT® 33025,N/A,N/A,N/A," $9,177.00 "," $5,965.05 "," $4,516.27 ", $699.62 ," $1,111.73 "," $3,408.75 "," $3,391.97 "," $8,534.61 "," $8,259.30 "," $8,259.30 "," $7,341.60 "," $7,341.60 "," $1,111.73 "," $8,473.12 "," $8,718.15 "," $8,259.30 "," $8,259.30 "," $8,259.30 "," $8,534.61 "," $8,809.92 "," $4,177.42 "," $7,800.45 "," $4,283.54 "," $3,828.63 ", N/A ," $3,475.26 "," $3,475.26 "," $8,718.15 "," $3,947.89 ", $699.62 ," $8,809.92 "
 Fac Chemotx Admn IV Push Tq 1/1st Sbst/Drug ,CPT® 96409,0331 - CHEMOTHER/INJ,N/A,N/A, $637.00 , $414.05 , $535.08 , $97.93 , $99.86 , $514.70 , $573.30 , $539.28 , $573.30 , $573.30 , $573.30 , $541.45 , $97.90 , $588.14 , $605.15 , $541.45 , $592.41 , $592.41 , $605.15 , $611.52 , $521.19 , $573.30 , $541.45 , $503.23 , N/A , $515.52 , $515.52 , $605.15 , $546.61 , $97.90 , $611.52 
 Pro Radiation Treatment Aid(S) ,CPT® 77334,0982 - PRO FEE/OUTPT,N/A,N/A, $483.00 , $313.95 , $695.13 , $123.37 , $151.86 , $725.00 , $777.34 , $449.19 , $434.70 , $434.70 , $386.40 , $386.40 , $151.86 , $445.95 , $458.85 , $434.70 , $434.70 , $434.70 , $449.19 , $463.68 , $707.65 , $410.55 , $849.38 , $721.74 , N/A , $739.15 , $739.15 , $458.85 , $855.59 , $123.37 , $855.59 
Thoracoscopy Surg Excis Bulae,CPT® 32655,N/A,N/A,N/A," $10,360.00 "," $6,734.00 "," $4,965.82 ", $869.85 ," $1,338.86 "," $3,611.69 "," $3,547.32 "," $9,634.80 "," $9,324.00 "," $9,324.00 "," $8,288.00 "," $8,288.00 "," $1,338.86 "," $9,565.39 "," $9,842.00 "," $9,324.00 "," $9,324.00 "," $9,324.00 "," $9,634.80 "," $9,945.60 "," $4,806.61 "," $8,806.00 "," $5,123.83 "," $4,745.78 ", N/A ," $3,682.16 "," $3,682.16 "," $9,842.00 "," $4,336.52 ", $869.85 ," $9,945.60 "
 Cltx Dstl Radiour Dislc W/Mnpj - Urgent Care ,CPT® 25675,0761 - TREATMENT ROOM,N/A,N/A," $2,022.00 "," $1,314.30 "," $1,698.48 ", $401.64 , $384.19 ," $1,633.78 "," $1,819.80 "," $1,711.83 "," $1,819.80 "," $1,819.80 "," $1,819.80 "," $1,718.70 ", $376.66 ," $1,866.91 "," $1,920.90 "," $1,718.70 "," $1,880.46 "," $1,880.46 "," $1,920.90 "," $1,941.12 "," $1,654.40 "," $1,819.80 "," $1,718.70 "," $1,597.38 ", N/A ," $1,636.40 "," $1,636.40 "," $1,920.90 "," $1,735.08 ", $376.66 ," $1,941.12 "
"CT Scan,Thoracic Spine,W/O Contrast",CPT® 72128,N/A,N/A,N/A," $3,021.00 "," $1,963.65 ", $921.97 , $132.63 , $250.57 , $858.48 ," $1,110.31 "," $2,809.53 "," $2,718.90 "," $2,718.90 "," $2,416.80 "," $2,416.80 ", $250.57 ," $2,789.29 "," $2,869.95 "," $2,718.90 "," $2,718.90 "," $2,718.90 "," $2,809.53 "," $2,900.16 ", $774.23 ," $2,567.85 "," $1,207.63 "," $1,171.10 ", N/A , $875.23 , $875.23 ," $2,869.95 "," $1,013.10 ", $132.63 ," $2,900.16 "
Treat Ankle Fracture,CPT® 27808,N/A,N/A,N/A," $2,205.00 "," $1,433.25 "," $1,908.27 ", $301.59 , $190.55 ," $1,449.98 "," $1,478.68 "," $2,050.65 "," $1,984.50 "," $1,984.50 "," $1,764.00 "," $1,764.00 ", $190.55 ," $2,035.88 "," $2,094.75 "," $1,984.50 "," $1,984.50 "," $1,984.50 "," $2,050.65 "," $2,116.80 "," $1,757.34 "," $1,874.25 "," $1,621.71 "," $1,717.78 ", N/A ," $1,478.27 "," $1,478.27 "," $2,094.75 "," $1,737.49 ", $190.55 ," $2,116.80 "
 PENICILLIN G POTASSIUM 5000000 UNITS IJ SOLR ,HCPCS J2540,0636 - DRUGS REQUIRING DETAILED CODIN,00049-0520-83,10 mL, $78.42 , $50.97 , $65.87 , $1.09 , $0.80 , $63.36 , $70.58 , $66.39 , $70.58 , $70.58 , $70.58 , $66.66 , $0.78 , $72.41 , $74.50 , $66.66 , $72.93 , $72.93 , $74.50 , $75.28 , $64.16 , $70.58 , $66.66 , $61.95 , N/A , $63.47 , $63.47 , $74.50 , $67.29 , $0.78 , $75.28 
"MRI, Abdomen, Combo",CPT® 74183,N/A,N/A,N/A," $7,671.00 "," $4,986.15 "," $2,450.70 ", $348.90 , $639.53 ," $2,413.20 "," $3,055.89 "," $7,134.03 "," $6,903.90 "," $6,903.90 "," $6,136.80 "," $6,136.80 ", $639.53 ," $7,082.63 "," $7,287.45 "," $6,903.90 "," $6,903.90 "," $6,903.90 "," $7,134.03 "," $7,364.16 "," $2,113.93 "," $6,520.35 "," $3,328.20 "," $3,943.59 ", N/A ," $2,460.29 "," $2,460.29 "," $7,287.45 "," $2,847.83 ", $348.90 ," $7,364.16 "
 DAPTOMYCIN 350 MG IV SOLR ,HCPCS J0878,0636 - DRUGS REQUIRING DETAILED CODIN,00409-0120-01,7 mL, $308.22 , $200.34 , $258.90 , $0.08 , $0.05 , $249.04 , $277.40 , $260.94 , $277.40 , $277.40 , $277.40 , $261.99 , $0.05 , $284.58 , $292.81 , $261.99 , $286.64 , $286.64 , $292.81 , $295.89 , $252.19 , $277.40 , $261.99 , $243.49 , N/A , $249.44 , $249.44 , $292.81 , $264.48 , $0.05 , $295.89 
 Fac Irrig Drug Delivery Device ,CPT® 96523,0761 - TREATMENT ROOM,N/A,N/A, $215.00 , $139.75 , $180.60 , $24.81 , $22.86 , $173.72 , $193.50 , $182.02 , $193.50 , $193.50 , $193.50 , $182.75 , $22.41 , $198.51 , $204.25 , $182.75 , $199.95 , $199.95 , $204.25 , $206.40 , $175.91 , $193.50 , $182.75 , $169.85 , N/A , $174.00 , $174.00 , $204.25 , $184.49 , $22.41 , $206.40 
 Fac R & L Hrt Cath W/Njx L Ventriculog Img S&I ,CPT® 93453,0481 - CARDIAC CATH LAB,N/A,N/A," $13,096.00 "," $8,512.40 "," $11,000.64 "," $1,112.69 "," $1,213.92 "," $10,581.57 "," $11,786.40 "," $11,087.07 "," $11,786.40 "," $11,786.40 "," $11,786.40 "," $11,131.60 "," $1,190.12 "," $12,091.54 "," $12,441.20 "," $11,131.60 "," $12,179.28 "," $12,179.28 "," $12,441.20 "," $12,572.16 "," $10,715.15 "," $11,786.40 "," $11,131.60 "," $10,345.84 ", N/A ," $10,598.59 "," $10,598.59 "," $12,441.20 "," $11,237.68 "," $1,112.69 "," $12,572.16 "
" Fac Oth Resp Proc, Indiv ",HCPCS G0238,0419 - OTHER RESPIRATORY SERVICES,N/A,N/A, $167.00 , $108.55 , $140.28 , $9.96 , N/A , $134.94 , $150.30 , $141.38 , $150.30 , $150.30 , $150.30 , $141.95 , N/A , $154.19 , $158.65 , $141.95 , $155.31 , $155.31 , $158.65 , $160.32 , $136.64 , $150.30 , $141.95 , $131.93 , N/A , $135.15 , $135.15 , $158.65 , $143.30 , $9.96 , $160.32 
"Program Eval Implant Device,Pacemaker,2 Lead",CPT® 93280,N/A,N/A,N/A, $766.00 , $497.90 , $517.66 , $78.83 , $50.64 , $315.12 , $321.47 , $712.38 , $689.40 , $689.40 , $612.80 , $612.80 , $50.64 , $707.25 , $727.70 , $689.40 , $689.40 , $689.40 , $712.38 , $735.36 , $482.63 , $651.10 , $299.72 , $221.10 , N/A , $321.27 , $321.27 , $727.70 , $356.13 , $50.64 , $735.36 
 SOD CITRATE-CITRIC ACID 500-334 MG/5ML PO SOLN ,HCPCS RXC637,0250 - PHARMACY,00121-1190-00,30 mL, $28.51 , $18.53 , $23.95 , N/A , N/A , $23.04 , $25.66 , $24.14 , $25.66 , $25.66 , $25.66 , $24.23 , N/A , $26.32 , $27.08 , $24.23 , $26.51 , $26.51 , $27.08 , $27.37 , $23.33 , $25.66 , $24.23 , $22.52 , N/A , $23.07 , $23.07 , $27.08 , $24.46 , $22.52 , $27.37 
"PFIZER-BIONTECH 30 mcg/0.3 mL DOSAGE, 3RD DOSE",CPT® 0053A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $76.25 , $128.66 , N/A , $79.82 , $79.82 , $66.50 , $92.91 , $38.92 , $128.66 
 Pro Fluorescein Angrph W/Multiframe I&R Uni/Bi ,CPT® 92235,0962 - PRO FEE/EYE,N/A,N/A, $505.00 , $328.25 , $273.04 , $135.16 , $110.62 , $192.81 , $226.40 , $469.65 , $454.50 , $454.50 , $404.00 , $404.00 , $110.62 , $466.27 , $479.75 , $454.50 , $454.50 , $454.50 , $469.65 , $484.80 , $358.70 , $429.25 , $337.57 , $182.01 , N/A , $196.57 , $196.57 , $479.75 , $233.83 , $110.62 , $484.80 
 Pro CT Maxillofacial W/O Dye ,CPT® 70486,0972 - PRO FEE/RAD/DX,N/A,N/A, $507.00 , $329.55 , $907.76 , $131.06 , $247.43 , $665.04 ," $1,202.45 ", $471.51 , $456.30 , $456.30 , $405.60 , $405.60 , $247.43 , $468.11 , $481.65 , $456.30 , $456.30 , $456.30 , $471.51 , $486.72 ," $1,375.32 ", $430.95 ," $1,309.71 ", $902.90 , N/A , $678.02 , $678.02 , $481.65 , $784.83 , $131.06 ," $1,375.32 "
Laryngoscopy Flexible Diagnostic,31575,N/A,N/A,N/A, $713.00 , $463.45 , $364.67 , $65.21 , $98.45 , $294.56 , $382.52 , $663.09 , $641.70 , $641.70 , $570.40 , $570.40 , $98.45 , $658.31 , $677.35 , $641.70 , $641.70 , $641.70 , $663.09 , $684.48 , $347.16 , $606.05 , $406.77 , $341.75 , N/A , $300.30 , $300.30 , $677.35 , $353.68 , $65.21 , $684.48 
 LEVOFLOXACIN 750 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6353-61,1 tablet, $126.44 , $82.19 , $106.21 , N/A , N/A , $102.16 , $113.80 , $107.04 , $113.80 , $113.80 , $113.80 , $107.47 , N/A , $116.74 , $120.12 , $107.47 , $117.59 , $117.59 , $120.12 , $121.38 , $103.45 , $113.80 , $107.47 , $99.89 , N/A , $102.33 , $102.33 , $120.12 , $108.50 , $99.89 , $121.38 
 Pro Clear Outer Ear Canal ,CPT® 69200,0982 - PRO FEE/OUTPT,N/A,N/A, $711.00 , $462.15 , $222.00 , $45.22 , $46.62 , $277.17 , $286.82 , $661.23 , $639.90 , $639.90 , $568.80 , $568.80 , $46.62 , $656.47 , $675.45 , $639.90 , $639.90 , $639.90 , $661.23 , $682.56 , $241.42 , $604.35 , $312.21 , $230.70 , N/A , $282.58 , $282.58 , $675.45 , $322.66 , $45.22 , $682.56 
 Fac Enteroscopy > 2nd Prtn W/Rmvl Foreign Body ,CPT® 44363,0360 - OR SERVICES,N/A,N/A," $3,058.00 "," $1,987.70 "," $2,568.72 ", $181.61 , $439.86 ," $2,470.86 "," $2,752.20 "," $2,588.90 "," $2,752.20 "," $2,752.20 "," $2,752.20 "," $2,599.30 ", $431.24 ," $2,823.45 "," $2,905.10 "," $2,599.30 "," $2,843.94 "," $2,843.94 "," $2,905.10 "," $2,935.68 "," $2,502.06 "," $2,752.20 "," $2,599.30 "," $2,415.82 ", N/A ," $2,474.84 "," $2,474.84 "," $2,905.10 "," $2,624.07 ", $181.61 ," $2,935.68 "
 COAGULATION FACTOR IX (RECOMB) 2000 UNITS IV KIT ,HCPCS J7195,0636 - DRUGS REQUIRING DETAILED CODIN,58394-0636-03,1 unit, $35.00 , $22.75 , $29.40 , $1.80 , $1.68 , $28.28 , $31.50 , $29.63 , $31.50 , $31.50 , $31.50 , $29.75 , $1.65 , $32.32 , $33.25 , $29.75 , $32.55 , $32.55 , $33.25 , $33.60 , $28.64 , $31.50 , $29.75 , $27.65 , N/A , $28.33 , $28.33 , $33.25 , $30.03 , $1.65 , $33.60 
 Fac Chrmsm Cnt 15-20 Cll 2karyotyp Banding ,CPT® 88262,0310 - PATHOLOGY LAB,N/A,N/A," $2,289.00 "," $1,487.85 "," $1,922.76 ", $128.00 , $128.00 ," $1,849.51 "," $2,060.10 "," $1,937.87 "," $2,060.10 "," $2,060.10 "," $2,060.10 "," $1,945.65 ", $125.49 ," $2,113.43 "," $2,174.55 "," $1,945.65 "," $2,128.77 "," $2,128.77 "," $2,174.55 "," $2,197.44 "," $1,872.86 "," $2,060.10 "," $1,945.65 "," $1,808.31 ", N/A ," $1,852.49 "," $1,852.49 "," $2,174.55 "," $1,964.19 ", $125.49 ," $2,197.44 "
 Fac X-Ray Exam of Kidney Lesion ,CPT® 74470,0329 - DX X-RAY/OTHER,N/A,N/A," $1,582.00 "," $1,028.30 "," $1,328.88 ", $76.11 , $77.22 ," $1,278.26 "," $1,423.80 "," $1,339.32 "," $1,423.80 "," $1,423.80 "," $1,423.80 "," $1,344.70 ", $75.71 ," $1,460.66 "," $1,502.90 "," $1,344.70 "," $1,471.26 "," $1,471.26 "," $1,502.90 "," $1,518.72 "," $1,294.39 "," $1,423.80 "," $1,344.70 "," $1,249.78 ", N/A ," $1,280.31 "," $1,280.31 "," $1,502.90 "," $1,357.51 ", $75.71 ," $1,518.72 "
"Aaa+Trauma Repr, Aorto-Bi-Iliac Pros",CPT® 34831,N/A,N/A,N/A," $12,080.00 "," $7,852.00 "," $11,078.28 "," $1,707.94 "," $2,090.15 "," $8,207.57 "," $8,185.75 "," $11,234.40 "," $10,872.00 "," $10,872.00 "," $9,664.00 "," $9,664.00 "," $2,090.15 "," $11,153.46 "," $11,476.00 "," $10,872.00 "," $10,872.00 "," $10,872.00 "," $11,234.40 "," $11,596.80 "," $10,211.00 "," $10,268.00 "," $10,390.39 "," $9,229.90 ", N/A ," $8,367.70 "," $8,367.70 "," $11,476.00 "," $9,505.71 "," $1,707.94 "," $11,596.80 "
 Pro Exc H-F-Nk-Sp B9+Marg 3.1-4 ,CPT® 11424,0982 - PRO FEE/OUTPT,N/A,N/A," $1,175.00 ", $763.75 , $567.77 , $171.28 , $192.83 , $491.20 , $478.70 ," $1,092.75 "," $1,057.50 "," $1,057.50 ", $940.00 , $940.00 , $192.83 ," $1,084.88 "," $1,116.25 "," $1,057.50 "," $1,057.50 "," $1,057.50 "," $1,092.75 "," $1,128.00 ", $619.26 , $998.75 , $954.47 , $625.78 , N/A , $500.78 , $500.78 ," $1,116.25 ", $580.75 , $171.28 ," $1,128.00 "
"Biopsy Salivary Gland,Needle",CPT® 42400,N/A,N/A,N/A, $553.00 , $359.45 , $325.52 , $51.14 , $76.84 , $266.57 , $273.46 , $514.29 , $497.70 , $497.70 , $442.40 , $442.40 , $76.84 , $510.58 , $525.35 , $497.70 , $497.70 , $497.70 , $514.29 , $530.88 , $233.28 , $470.05 , $296.15 , $313.85 , N/A , $271.77 , $271.77 , $525.35 , $284.25 , $51.14 , $530.88 
 Pro Tenotomy Elbow Lateral/Medial Percutaneous ,CPT® 24357,0982 - PRO FEE/OUTPT,N/A,N/A," $3,600.00 "," $2,340.00 "," $2,613.59 ", $409.40 , $311.91 ," $2,087.61 "," $2,128.22 "," $3,348.00 "," $3,240.00 "," $3,240.00 "," $2,880.00 "," $2,880.00 ", $311.91 ," $3,323.88 "," $3,420.00 "," $3,240.00 "," $3,240.00 "," $3,240.00 "," $3,348.00 "," $3,456.00 "," $2,416.76 "," $3,060.00 "," $2,342.48 "," $2,416.45 ", N/A ," $2,128.34 "," $2,128.34 "," $3,420.00 "," $2,501.57 ", $311.91 ," $3,456.00 "
 Pro Insert Temp Bladder Cath ,CPT® 51702,0981 - PRO FEE/ER,N/A,N/A, $239.00 , $155.35 , $137.37 , $23.85 , $112.85 , $147.13 , $137.78 , $222.27 , $215.10 , $215.10 , $191.20 , $191.20 , $112.85 , $220.67 , $227.05 , $215.10 , $215.10 , $215.10 , $222.27 , $229.44 , $136.89 , $203.15 , $157.00 , $158.32 , N/A , $150.00 , $150.00 , $227.05 , $176.30 , $23.85 , $229.44 
 Fac Tavr Transcarotid Approach ,CPT® 33999,0360 - OR SERVICES,N/A,N/A," $26,324.00 "," $17,110.60 "," $22,112.16 ", N/A , N/A ," $21,269.79 "," $23,691.60 "," $22,285.90 "," $23,691.60 "," $23,691.60 "," $23,691.60 "," $22,375.40 ", N/A ," $24,304.95 "," $25,007.80 "," $22,375.40 "," $24,481.32 "," $24,481.32 "," $25,007.80 "," $25,271.04 "," $21,538.30 "," $23,691.60 "," $22,375.40 "," $20,795.96 ", N/A ," $21,304.01 "," $21,304.01 "," $25,007.80 "," $22,588.62 "," $20,795.96 "," $25,271.04 "
 Bypass Graft; W/Vein; Iliofemoral ,CPT® 35565,0360 - OR SERVICES,N/A,N/A," $5,501.00 "," $3,575.65 "," $4,620.84 "," $1,165.34 "," $1,340.24 "," $4,444.81 "," $4,950.90 "," $4,657.15 "," $4,950.90 "," $4,950.90 "," $4,950.90 "," $4,675.85 "," $1,313.96 "," $5,079.07 "," $5,225.95 "," $4,675.85 "," $5,115.93 "," $5,115.93 "," $5,225.95 "," $5,280.96 "," $4,500.92 "," $4,950.90 "," $4,675.85 "," $4,345.79 ", N/A ," $4,451.96 "," $4,451.96 "," $5,225.95 "," $4,720.41 "," $1,165.34 "," $5,280.96 "
 TRIAMTERENE-HCTZ 37.5-25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,68084-0750-25,1 tablet, $4.58 , $2.98 , $3.85 , N/A , N/A , $3.70 , $4.12 , $3.88 , $4.12 , $4.12 , $4.12 , $3.89 , N/A , $4.23 , $4.35 , $3.89 , $4.26 , $4.26 , $4.35 , $4.40 , $3.75 , $4.12 , $3.89 , $3.62 , N/A , $3.71 , $3.71 , $4.35 , $3.93 , $3.62 , $4.40 
"Ankle Scope,Aid Repair Fx,Bone Defct",CPT® 29892,N/A,N/A,N/A," $7,011.00 "," $4,557.15 "," $3,941.67 ", $621.39 , $613.65 ," $3,098.15 "," $2,949.53 "," $6,520.23 "," $6,309.90 "," $6,309.90 "," $5,608.80 "," $5,608.80 ", $613.65 ," $6,473.26 "," $6,660.45 "," $6,309.90 "," $6,309.90 "," $6,309.90 "," $6,520.23 "," $6,730.56 "," $3,698.72 "," $5,959.35 "," $3,270.19 "," $3,856.93 ", N/A ," $3,158.60 "," $3,158.60 "," $6,660.45 "," $3,712.47 ", $613.65 ," $6,730.56 "
 BACITRACIN EX OINTMENT TUBE (INPT) ,HCPCS RXC637,0250 - PHARMACY,45802-0060-03,28 gram, $27.05 , $17.58 , $22.72 , N/A , N/A , $21.86 , $24.35 , $22.90 , $24.35 , $24.35 , $24.35 , $22.99 , N/A , $24.98 , $25.70 , $22.99 , $25.16 , $25.16 , $25.70 , $25.97 , $22.13 , $24.35 , $22.99 , $21.37 , N/A , $21.89 , $21.89 , $25.70 , $23.21 , $21.37 , $25.97 
" Fac Immunoassay, Ria ",CPT® 83520,0302 - LAB/IMMUNOLOGY,N/A,N/A, $227.00 , $147.55 , $190.68 , $17.62 , $17.62 , $183.42 , $204.30 , $192.18 , $204.30 , $204.30 , $204.30 , $192.95 , $17.27 , $209.59 , $215.65 , $192.95 , $211.11 , $211.11 , $215.65 , $217.92 , $185.73 , $204.30 , $192.95 , $179.33 , N/A , $183.71 , $183.71 , $215.65 , $194.79 , $17.27 , $217.92 
" Fac Artery X-Rays, Lungs ",CPT® 75743,0320 - DX X-RAY,N/A,N/A," $1,196.00 ", $777.40 ," $1,004.64 ", $145.58 , $257.40 , $966.37 ," $1,076.40 "," $1,012.53 "," $1,076.40 "," $1,076.40 "," $1,076.40 "," $1,016.60 ", $252.35 ," $1,104.27 "," $1,136.20 "," $1,016.60 "," $1,112.28 "," $1,112.28 "," $1,136.20 "," $1,148.16 ", $978.57 ," $1,076.40 "," $1,016.60 ", $944.84 , N/A , $967.92 , $967.92 ," $1,136.20 "," $1,026.29 ", $145.58 ," $1,148.16 "
 Xr Lumbar Sp Ap/Lat.Obls/Flex/Ext Min 6 Views ,CPT® 72114,0320 - DX X-RAY,N/A,N/A, $573.00 , $372.45 , $481.32 , $60.93 , $66.50 , $462.98 , $515.70 , $485.10 , $515.70 , $515.70 , $515.70 , $487.05 , $65.20 , $529.05 , $544.35 , $487.05 , $532.89 , $532.89 , $544.35 , $550.08 , $468.83 , $515.70 , $487.05 , $452.67 , N/A , $463.73 , $463.73 , $544.35 , $491.69 , $60.93 , $550.08 
Tcat Rmvl/Debulk Icar Mass Suction Device Perq,CPT® 0644T,N/A,N/A,N/A," $4,419.00 "," $2,872.35 ", N/A , $280.65 , N/A , N/A , N/A ," $4,109.67 "," $3,977.10 "," $3,977.10 "," $3,535.20 "," $3,535.20 ", N/A ," $4,080.06 "," $4,198.05 "," $3,977.10 "," $3,977.10 "," $3,977.10 "," $4,109.67 "," $4,242.24 ", N/A ," $3,756.15 "," $2,700.31 "," $6,435.57 ", N/A ," $2,707.54 "," $2,707.54 "," $4,198.05 "," $3,151.64 ", $280.65 ," $6,435.57 "
 Pro Tx Clsd Elbw Dislc W/O Anes ,CPT® 24600,0981 - PRO FEE/ER,N/A,N/A," $2,031.00 "," $1,320.15 "," $2,087.54 ", $333.10 , $76.84 ," $1,604.04 "," $1,632.03 "," $1,888.83 "," $1,827.90 "," $1,827.90 "," $1,624.80 "," $1,624.80 ", $76.84 ," $1,875.22 "," $1,929.45 "," $1,827.90 "," $1,827.90 "," $1,827.90 "," $1,888.83 "," $1,949.76 "," $1,919.14 "," $1,726.35 "," $1,791.20 "," $1,909.64 ", N/A ," $1,635.34 "," $1,635.34 "," $1,929.45 "," $1,922.11 ", $76.84 ," $2,087.54 "
"Ustekinumab Sub Cu Inj, 1 Mg",HCPCS J3357,N/A,N/A,N/A, $323.00 , $209.95 , N/A , $150.60 , $158.10 , N/A , N/A , $300.39 , $290.70 , $290.70 , $258.40 , $258.40 , $158.10 , $298.23 , $306.85 , $290.70 , $290.70 , $290.70 , $300.39 , $310.08 , $224.21 , $274.55 , $255.61 , $212.36 , N/A , N/A , N/A , $306.85 , N/A , $150.60 , $310.08 
Soft Interface Below Knee Se,HCPCS L2820,N/A,N/A,N/A, $144.00 , $93.60 , N/A , $94.98 , $109.05 , N/A , N/A , $133.92 , $129.60 , $129.60 , $115.20 , $115.20 , $109.05 , $132.96 , $136.80 , $129.60 , $129.60 , $129.60 , $133.92 , $138.24 , N/A , $122.40 , $87.58 , $79.91 , N/A , N/A , N/A , $136.80 , N/A , $79.91 , $138.24 
Intrgortion Dev Eval Cartd Sins Barreflx W/I&R,CPT® 0272T,N/A,N/A,N/A, $758.00 , $492.70 , N/A , N/A , N/A , N/A , N/A , $704.94 , $682.20 , $682.20 , $606.40 , $606.40 , N/A , $699.86 , $720.10 , $682.20 , $682.20 , $682.20 , $704.94 , $727.68 , N/A , $644.30 , $109.85 , $224.62 , N/A , $120.41 , $120.41 , $720.10 , $140.16 , $109.85 , $727.68 
 Pro Cltx Humrl Shft Fx W/O Mnpj ,CPT® 24500,0981 - PRO FEE/ER,N/A,N/A," $1,318.00 ", $856.70 ," $2,076.69 ", $328.95 , $233.20 ," $1,570.20 "," $1,591.06 "," $1,225.74 "," $1,186.20 "," $1,186.20 "," $1,054.40 "," $1,054.40 ", $233.20 ," $1,216.91 "," $1,252.10 "," $1,186.20 "," $1,186.20 "," $1,186.20 "," $1,225.74 "," $1,265.28 "," $1,906.25 "," $1,120.30 "," $1,746.60 "," $1,865.54 ", N/A ," $1,600.84 "," $1,600.84 "," $1,252.10 "," $1,881.54 ", $233.20 ," $2,076.69 "
 ANA ,CPT® 86038,0302 - LAB/IMMUNOLOGY,N/A,N/A, $104.00 , $67.60 , $87.36 , $12.33 , $12.33 , $84.03 , $93.60 , $88.05 , $93.60 , $93.60 , $93.60 , $88.40 , $12.09 , $96.02 , $98.80 , $88.40 , $96.72 , $96.72 , $98.80 , $99.84 , $85.09 , $93.60 , $88.40 , $82.16 , N/A , $84.17 , $84.17 , $98.80 , $89.24 , $12.09 , $99.84 
 Fac GI Transit & Pres Meas Wireless Capsule W/Interp ,CPT® 91112,0750 - GASTR-INST SVS,N/A,N/A," $7,705.00 "," $5,008.25 "," $6,472.20 "," $1,624.55 ", N/A ," $6,225.64 "," $6,934.50 "," $6,523.05 "," $6,934.50 "," $6,934.50 "," $6,934.50 "," $6,549.25 ", N/A ," $7,114.03 "," $7,319.75 "," $6,549.25 "," $7,165.65 "," $7,165.65 "," $7,319.75 "," $7,396.80 "," $6,304.23 "," $6,934.50 "," $6,549.25 "," $6,086.95 ", N/A ," $6,235.66 "," $6,235.66 "," $7,319.75 "," $6,611.66 "," $1,624.55 "," $7,396.80 "
Medical Genetics Counseling Ea 30 Min,CPT® 96040,N/A,N/A,N/A, $219.00 , $142.35 , N/A , $47.06 , N/A , $101.94 , $109.62 , $203.67 , $197.10 , $197.10 , $175.20 , $175.20 , N/A , $202.20 , $208.05 , $197.10 , $197.10 , $197.10 , $203.67 , $210.24 , $136.36 , $186.15 , N/A , $176.04 , N/A , $103.94 , $103.94 , $208.05 , $121.16 , $47.06 , $210.24 
 Sevoflurane per 30 Minutes ,Custom 3700000005,0370 - ANESTHESIA,N/A,N/A, $73.00 , $47.45 , $61.32 , N/A , N/A , $58.98 , $65.70 , $61.80 , $65.70 , $65.70 , $65.70 , $62.05 , N/A , $67.40 , $69.35 , $62.05 , $67.89 , $67.89 , $69.35 , $70.08 , $59.73 , $65.70 , $62.05 , $57.67 , N/A , $59.08 , $59.08 , $69.35 , $62.64 , $57.67 , $70.08 
Alteplase Recombinant,HCPCS J2997,N/A,N/A,N/A, $171.00 , $111.15 , N/A , $90.93 , $89.79 , N/A , N/A , $159.03 , $153.90 , $153.90 , $136.80 , $136.80 , $89.79 , $157.88 , $162.45 , $153.90 , $153.90 , $153.90 , $159.03 , $164.16 , $113.63 , $145.35 , $99.26 , $114.79 , N/A , N/A , N/A , $162.45 , N/A , $89.79 , $164.16 
"MRI, Chest, Combo",CPT® 71552,N/A,N/A,N/A," $8,454.00 "," $5,495.10 "," $3,213.70 ", $462.73 , $640.25 ," $2,758.45 "," $3,508.02 "," $7,862.22 "," $7,608.60 "," $7,608.60 "," $6,763.20 "," $6,763.20 ", $640.25 ," $7,805.58 "," $8,031.30 "," $7,608.60 "," $7,608.60 "," $7,608.60 "," $7,862.22 "," $8,115.84 "," $2,991.65 "," $7,185.90 "," $3,821.27 "," $5,346.70 ", N/A ," $2,812.27 "," $2,812.27 "," $8,031.30 "," $3,255.24 ", $462.73 ," $8,115.84 "
 Fac Office/Outpatient Established Sf Mdm 10-19 Min ,CPT® 99212,0510 - CLINIC,N/A,N/A, $178.00 , $115.70 , $149.52 , $34.37 , $29.87 , $143.82 , $160.20 , N/A , $160.20 , $160.20 , $160.20 , $151.30 , $29.28 , $164.35 , $169.10 , $151.30 , $165.54 , $165.54 , $169.10 , $170.88 , $145.64 , $160.20 , $151.30 , $140.62 , N/A , $144.06 , $144.06 , $169.10 , $152.74 , $29.28 , $170.88 
Fetal Congenital Abnor Assay Four Anal,CPT® 81511,N/A,N/A,N/A, $347.00 , $225.55 , N/A , $156.57 , $156.57 , N/A , N/A , $322.71 , $312.30 , $312.30 , $277.60 , $277.60 , $156.57 , $320.39 , $329.65 , $312.30 , $312.30 , $312.30 , $322.71 , $333.12 ," $1,024.95 ", $294.95 , $731.76 , $450.83 , N/A , $609.40 , $609.40 , $329.65 , $664.66 , $156.57 ," $1,024.95 "
 DILTIAZEM HCL 50 MG/10ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00641-6014-10,10 mL, $38.43 , $24.98 , $32.28 , N/A , N/A , $31.05 , $34.59 , $32.53 , $34.59 , $34.59 , $34.59 , $32.67 , N/A , $35.48 , $36.51 , $32.67 , $35.74 , $35.74 , $36.51 , $36.89 , $31.44 , $34.59 , $32.67 , $30.36 , N/A , $31.10 , $31.10 , $36.51 , $32.98 , $30.36 , $36.89 
Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins,CPT® 97760,N/A,N/A,N/A, $159.00 , $103.35 , $95.00 , $48.26 , $27.95 , $85.74 , $86.65 , $147.87 , $143.10 , $143.10 , $127.20 , $127.20 , $27.95 , $146.80 , $151.05 , $143.10 , $143.10 , $143.10 , $147.87 , $152.64 , $123.76 , $135.15 , $114.55 , $105.84 , N/A , $87.41 , $87.41 , $151.05 , $97.23 , $27.95 , $152.64 
 DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN ,HCPCS J1100,0636 - DRUGS REQUIRING DETAILED CODIN,70069-0021-25,1 mL, $32.31 , $21.00 , $27.14 , $0.12 , $0.13 , $26.11 , $29.08 , $27.35 , $29.08 , $29.08 , $29.08 , $27.46 , $0.13 , $29.83 , $30.69 , $27.46 , $30.05 , $30.05 , $30.69 , $31.02 , $26.44 , $29.08 , $27.46 , $25.52 , N/A , $26.15 , $26.15 , $30.69 , $27.73 , $0.12 , $31.02 
"Fibrin Degradation,Quant",CPT® 85379,N/A,N/A,N/A, $149.00 , $96.85 , N/A , $10.38 , $10.38 , $45.86 , $54.85 , $138.57 , $134.10 , $134.10 , $119.20 , $119.20 , $10.38 , $137.57 , $141.55 , $134.10 , $134.10 , $134.10 , $138.57 , $143.04 , $67.97 , $126.65 , $66.50 , $36.89 , N/A , $42.80 , $42.80 , $141.55 , $46.77 , $10.38 , $143.04 
 Pro Closure of Vagina ,CPT® 57120,0982 - PRO FEE/OUTPT,N/A,N/A," $3,066.00 "," $1,992.90 "," $2,520.75 ", $509.81 , $989.73 ," $2,075.29 "," $2,077.48 "," $2,851.38 "," $2,759.40 "," $2,759.40 "," $2,452.80 "," $2,452.80 ", $989.73 ," $2,830.84 "," $2,912.70 "," $2,759.40 "," $2,759.40 "," $2,759.40 "," $2,851.38 "," $2,943.36 "," $2,618.03 "," $2,606.10 "," $2,726.05 "," $2,083.52 ", N/A ," $2,115.78 "," $2,115.78 "," $2,912.70 "," $2,537.75 ", $509.81 ," $2,943.36 "
 PENTOXIFYLLINE ER 400 MG PO TBCR ,HCPCS RXC637,0250 - PHARMACY,00904-5448-61,1 tablet, $7.70 , $5.01 , $6.47 , N/A , N/A , $6.22 , $6.93 , $6.52 , $6.93 , $6.93 , $6.93 , $6.55 , N/A , $7.11 , $7.32 , $6.55 , $7.16 , $7.16 , $7.32 , $7.39 , $6.30 , $6.93 , $6.55 , $6.08 , N/A , $6.23 , $6.23 , $7.32 , $6.61 , $6.08 , $7.39 
 Fac Respiratory Motion Management Simulation ,CPT® 77293,0333 - RADIATION RX,N/A,N/A," $4,431.00 "," $2,880.15 "," $3,722.04 ", $406.68 , $371.36 ," $3,580.25 "," $3,987.90 "," $3,751.28 "," $3,987.90 "," $3,987.90 "," $3,987.90 "," $3,766.35 ", $364.08 ," $4,091.14 "," $4,209.45 "," $3,766.35 "," $4,120.83 "," $4,120.83 "," $4,209.45 "," $4,253.76 "," $3,625.44 "," $3,987.90 "," $3,766.35 "," $3,500.49 ", N/A ," $3,586.01 "," $3,586.01 "," $4,209.45 "," $3,802.24 ", $364.08 ," $4,253.76 "
 Fac Tilt Table Evaluation ,CPT® 93660,0480 - CARDIOLOGY,N/A,N/A," $1,148.00 ", $746.20 , $964.32 , $158.03 , $162.53 , $927.58 ," $1,033.20 ", $971.90 ," $1,033.20 "," $1,033.20 "," $1,033.20 ", $975.80 , $159.34 ," $1,059.95 "," $1,090.60 ", $975.80 ," $1,067.64 "," $1,067.64 "," $1,090.60 "," $1,102.08 ", $939.29 ," $1,033.20 ", $975.80 , $906.92 , N/A , $929.08 , $929.08 ," $1,090.60 ", $985.10 , $158.03 ," $1,102.08 "
 Fac Perq Breast Loc Device Placemt 1st Strtctc Guid ,CPT® 19283,0320 - DX X-RAY,N/A,N/A," $2,021.00 "," $1,313.65 "," $1,697.64 ", $95.27 , $78.20 ," $1,632.97 "," $1,818.90 "," $1,710.98 "," $1,818.90 "," $1,818.90 "," $1,818.90 "," $1,717.85 ", $76.67 ," $1,865.99 "," $1,919.95 "," $1,717.85 "," $1,879.53 "," $1,879.53 "," $1,919.95 "," $1,940.16 "," $1,653.58 "," $1,818.90 "," $1,717.85 "," $1,596.59 ", N/A ," $1,635.60 "," $1,635.60 "," $1,919.95 "," $1,734.22 ", $76.67 ," $1,940.16 "
 Pro Njx Aa&/Strd Tfrml Epi Cervical/Thoracic Ea Addl ,CPT® 64480,0982 - PRO FEE/OUTPT,N/A,N/A, $700.00 , $455.00 , $303.16 , $58.87 , $200.42 , $354.71 , $349.10 , $651.00 , $630.00 , $630.00 , $560.00 , $560.00 , $200.42 , $646.31 , $665.00 , $630.00 , $630.00 , $630.00 , $651.00 , $672.00 , $332.04 , $595.00 , $346.11 , $379.46 , N/A , $361.63 , $361.63 , $665.00 , $387.93 , $58.87 , $672.00 
 MAGNESIUM CHLORIDE 64 MG PO TBEC ,HCPCS RXC637,0250 - PHARMACY,68585-0005-75,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Bone Graft Femur Head/Neck/Ridge,CPT® 27170,N/A,N/A,N/A," $5,275.00 "," $3,428.75 "," $7,029.69 "," $1,103.31 "," $1,536.80 "," $5,685.54 "," $5,621.06 "," $4,905.75 "," $4,747.50 "," $4,747.50 "," $4,220.00 "," $4,220.00 "," $1,536.80 "," $4,870.41 "," $5,011.25 "," $4,747.50 "," $4,747.50 "," $4,747.50 "," $4,905.75 "," $5,064.00 "," $6,581.23 "," $4,483.75 "," $6,222.82 "," $6,673.89 ", N/A ," $5,796.48 "," $5,796.48 "," $5,011.25 "," $6,812.93 "," $1,103.31 "," $7,029.69 "
Revsc Opn/Prq Iliac Art W/Stnt & Angiop Ipsilatl,CPT® 37223,N/A,N/A,N/A," $4,493.00 "," $2,920.45 "," $1,228.89 ", $188.40 , $158.19 , $927.85 , $912.76 ," $4,178.49 "," $4,043.70 "," $4,043.70 "," $3,594.40 "," $3,594.40 ", $158.19 ," $4,148.39 "," $4,268.35 "," $4,043.70 "," $4,043.70 "," $4,043.70 "," $4,178.49 "," $4,313.28 "," $1,026.73 "," $3,819.05 "," $1,147.15 "," $1,031.99 ", N/A , $945.95 , $945.95 ," $4,268.35 "," $1,074.61 ", $158.19 ," $4,313.28 "
Fluor Gid Ctr Vad Plmt Rplcmt/Rmvl,77001,N/A,N/A,N/A, $203.00 , $131.95 , $580.29 , $98.73 , $67.21 , $334.35 , $627.13 , $188.79 , $182.70 , $182.70 , $162.40 , $162.40 , $67.21 , $187.43 , $192.85 , $182.70 , $182.70 , $182.70 , $188.79 , $194.88 , $564.90 , $172.55 , $685.67 , $424.63 , N/A , $340.88 , $340.88 , $192.85 , $394.59 , $67.21 , $685.67 
Removal Entire Oi Implt Skl Mag Tc Attch Esp>=100,CPT® 69728,N/A,N/A,N/A," $5,317.00 "," $3,456.05 ", N/A , $572.25 , $446.55 , N/A , N/A ," $4,944.81 "," $4,785.30 "," $4,785.30 "," $4,253.60 "," $4,253.60 ", $446.55 ," $4,909.19 "," $5,051.15 "," $4,785.30 "," $4,785.30 "," $4,785.30 "," $4,944.81 "," $5,104.32 ", N/A ," $4,519.45 "," $3,164.74 ", N/A , N/A ," $2,475.27 "," $2,475.27 "," $5,051.15 "," $2,828.01 ", $446.55 ," $5,104.32 "
 CARBAMAZEPINE 200 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6172-61,1 tablet, $5.75 , $3.74 , $4.83 , N/A , N/A , $4.65 , $5.18 , $4.87 , $5.18 , $5.18 , $5.18 , $4.89 , N/A , $5.31 , $5.46 , $4.89 , $5.35 , $5.35 , $5.46 , $5.52 , $4.70 , $5.18 , $4.89 , $4.54 , N/A , $4.65 , $4.65 , $5.46 , $4.93 , $4.54 , $5.52 
Complex Repair 1.1-2.5cm,CPT® 13151,N/A,N/A,N/A," $1,815.00 "," $1,179.75 ", $891.21 , $266.54 , $211.00 , $786.73 , $767.55 ," $1,687.95 "," $1,633.50 "," $1,633.50 "," $1,452.00 "," $1,452.00 ", $211.00 ," $1,675.79 "," $1,724.25 "," $1,633.50 "," $1,633.50 "," $1,633.50 "," $1,687.95 "," $1,742.40 ", $981.32 ," $1,542.75 "," $1,528.94 "," $1,006.77 ", N/A , $802.09 , $802.09 ," $1,724.25 ", $930.16 , $211.00 ," $1,742.40 "
Punc/Aspir Breast Cyst,19000,N/A,N/A,N/A, $563.00 , $365.95 , $136.68 , $40.41 , $37.38 , $120.05 , $114.08 , $523.59 , $506.70 , $506.70 , $450.40 , $450.40 , $37.38 , $519.82 , $534.85 , $506.70 , $506.70 , $506.70 , $523.59 , $540.48 , $151.14 , $478.55 , $224.79 , $153.32 , N/A , $122.40 , $122.40 , $534.85 , $141.95 , $37.38 , $540.48 
 Pro Myelography via Lumbar Inject Rs&I Lumbosacral ,CPT® 62304,0982 - PRO FEE/OUTPT,N/A,N/A," $1,746.00 "," $1,134.90 ", $583.39 , $113.00 , $189.79 , $678.54 , $680.21 ," $1,623.78 "," $1,571.40 "," $1,571.40 "," $1,396.80 "," $1,396.80 ", $189.79 ," $1,612.08 "," $1,658.70 "," $1,571.40 "," $1,571.40 "," $1,571.40 "," $1,623.78 "," $1,676.16 ", $633.19 ," $1,484.10 ", $616.60 , $728.91 , N/A , $691.79 , $691.79 ," $1,658.70 ", $742.13 , $113.00 ," $1,676.16 "
"Excise Excess Skin Tissue,Thigh",CPT® 15832,N/A,N/A,N/A," $4,185.00 "," $2,720.25 "," $2,906.59 ", $875.30 , $401.40 ," $2,487.83 "," $2,485.52 "," $3,892.05 "," $3,766.50 "," $3,766.50 "," $3,348.00 "," $3,348.00 ", $401.40 ," $3,864.01 "," $3,975.75 "," $3,766.50 "," $3,766.50 "," $3,766.50 "," $3,892.05 "," $4,017.60 "," $3,191.79 "," $3,557.25 "," $4,993.60 "," $3,164.14 ", N/A ," $2,536.37 "," $2,536.37 "," $3,975.75 "," $2,941.33 ", $401.40 ," $4,993.60 "
 Infant Lower Extremity Min 2 Views ,CPT® 73592,0320 - DX X-RAY,N/A,N/A, $312.00 , $202.80 , $262.08 , $31.03 , $27.65 , $252.10 , $280.80 , $264.14 , $280.80 , $280.80 , $280.80 , $265.20 , $27.11 , $288.07 , $296.40 , $265.20 , $290.16 , $290.16 , $296.40 , $299.52 , $255.28 , $280.80 , $265.20 , $246.48 , N/A , $252.50 , $252.50 , $296.40 , $267.73 , $27.11 , $299.52 
 Bronchitis And Asthma With Cc/McC ,MS DRG V40 (FY2023) 202,N/A,N/A,N/A," $9,901.72 "," $6,436.12 "," $8,317.44 ", N/A , N/A ," $8,000.59 "," $8,911.55 "," $8,382.80 "," $8,911.55 "," $8,911.55 "," $8,911.55 "," $8,416.46 ", N/A ," $9,142.26 "," $9,406.63 "," $8,416.46 "," $9,208.60 "," $9,208.60 "," $9,406.63 "," $9,505.65 "," $8,101.59 "," $8,911.55 "," $8,416.46 "," $7,822.36 ", N/A ," $8,013.46 "," $8,013.46 "," $9,406.63 "," $8,496.67 "," $7,822.36 "," $9,505.65 "
 Dermabond Repair ,HCPCS G0168,0761 - TREATMENT ROOM,N/A,N/A, $50.00 , $32.50 , $42.00 , $13.67 , N/A , $40.40 , $45.00 , $42.33 , $45.00 , $45.00 , $45.00 , $42.50 , N/A , $46.17 , $47.50 , $42.50 , $46.50 , $46.50 , $47.50 , $48.00 , $40.91 , $45.00 , $42.50 , $39.50 , N/A , $40.47 , $40.47 , $47.50 , $42.91 , $13.67 , $48.00 
 Pro Fusion of Big Toe Joint ,CPT® 28750,0982 - PRO FEE/OUTPT,N/A,N/A," $5,538.00 "," $3,599.70 "," $3,563.76 ", $556.74 , $273.33 ," $2,894.41 "," $2,906.69 "," $5,150.34 "," $4,984.20 "," $4,984.20 "," $4,430.40 "," $4,430.40 ", $273.33 ," $5,113.24 "," $5,261.10 "," $4,984.20 "," $4,984.20 "," $4,984.20 "," $5,150.34 "," $5,316.48 "," $3,324.03 "," $4,707.30 "," $3,184.55 "," $3,400.28 ", N/A ," $2,950.89 "," $2,950.89 "," $5,261.10 "," $3,468.35 ", $273.33 ," $5,316.48 "
Denosumab Injection,HCPCS J0897,N/A,N/A,N/A, $32.00 , $20.80 , N/A , $24.67 , $23.53 , N/A , N/A , $29.76 , $28.80 , $28.80 , $25.60 , $25.60 , $23.53 , $29.55 , $30.40 , $28.80 , $28.80 , $28.80 , $29.76 , $30.72 , $27.26 , $27.20 , $27.25 , $31.54 , N/A , N/A , N/A , $30.40 , N/A , $23.53 , $31.54 
"Interrog Eval, in Person,Cardvert/Defib",CPT® 93289,N/A,N/A,N/A, $758.00 , $492.70 , $470.80 , $71.78 , $57.30 , $354.43 , $360.59 , $704.94 , $682.20 , $682.20 , $606.40 , $606.40 , $57.30 , $699.86 , $720.10 , $682.20 , $682.20 , $682.20 , $704.94 , $727.68 , $440.49 , $644.30 , $337.19 , $206.32 , N/A , $361.35 , $361.35 , $720.10 , $400.56 , $57.30 , $727.68 
Complex Repair 2.6-7.5cm,13121,N/A,N/A,N/A," $1,861.00 "," $1,209.65 ", $826.64 , $247.45 , $218.65 , $731.79 , $713.39 ," $1,730.73 "," $1,674.90 "," $1,674.90 "," $1,488.80 "," $1,488.80 ", $218.65 ," $1,718.26 "," $1,767.95 "," $1,674.90 "," $1,674.90 "," $1,674.90 "," $1,730.73 "," $1,786.56 ", $912.10 ," $1,581.85 "," $1,421.90 ", $938.47 , N/A , $746.06 , $746.06 ," $1,767.95 ", $865.20 , $218.65 ," $1,786.56 "
 TICAGRELOR 90 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00186-0777-39,2 tablet, $90.01 , $58.51 , $75.61 , N/A , N/A , $72.73 , $81.01 , $76.20 , $81.01 , $81.01 , $81.01 , $76.51 , N/A , $83.11 , $85.51 , $76.51 , $83.71 , $83.71 , $85.51 , $86.41 , $73.65 , $81.01 , $76.51 , $71.11 , N/A , $72.85 , $72.85 , $85.51 , $77.24 , $71.11 , $86.41 
"Obste Care,Vag Deliv+Postpartum",CPT® 59410,N/A,N/A,N/A," $4,154.00 "," $2,700.10 "," $2,479.31 ", $965.34 , $674.01 ," $2,415.96 "," $2,529.39 "," $3,863.22 "," $3,738.60 "," $3,738.60 "," $3,323.20 "," $3,323.20 ", $674.01 ," $3,835.39 "," $3,946.30 "," $3,738.60 "," $3,738.60 "," $3,738.60 "," $3,863.22 "," $3,987.84 "," $2,906.31 "," $3,530.90 "," $5,591.26 "," $2,407.21 ", N/A ," $2,463.10 "," $2,463.10 "," $3,946.30 "," $2,847.57 ", $674.01 ," $5,591.26 "
 Fac Thoracentesis/Paracentesis Bedside ,Custom 3610000002,0361 - OR/MINOR,N/A,N/A, $769.00 , $499.85 , $645.96 , N/A , N/A , $621.35 , $692.10 , $651.04 , $692.10 , $692.10 , $692.10 , $653.65 , N/A , $710.02 , $730.55 , $653.65 , $715.17 , $715.17 , $730.55 , $738.24 , $629.20 , $692.10 , $653.65 , $607.51 , N/A , $622.35 , $622.35 , $730.55 , $659.88 , $607.51 , $738.24 
"Office Consultation,Level I",CPT® 99241,N/A,N/A,N/A, $184.00 , $119.60 , N/A , N/A , N/A , $72.65 , $72.20 , $171.12 , $165.60 , $165.60 , $147.20 , $147.20 , N/A , $169.89 , $174.80 , $165.60 , $165.60 , $165.60 , $171.12 , $176.64 , $90.33 , $156.40 , N/A , $71.43 , $56.50 , N/A , N/A , $174.80 , N/A , $56.50 , $176.64 
 Fac Imcytchm Tiss Immunoproxidase Ea Antb ,CPT® 88342,0306 - LAB/BACT-MICRO,N/A,N/A, $430.00 , $279.50 , $361.20 , $98.62 , $54.62 , $347.44 , $387.00 , $364.04 , $387.00 , $387.00 , $387.00 , $365.50 , $53.55 , $397.02 , $408.50 , $365.50 , $399.90 , $399.90 , $408.50 , $412.80 , $351.83 , $387.00 , $365.50 , $339.70 , N/A , $348.00 , $348.00 , $408.50 , $368.98 , $53.55 , $412.80 
 Thoracic Spine Min 4 Views ,CPT® 72074,0320 - DX X-RAY,N/A,N/A, $395.00 , $256.75 , $331.80 , $43.67 , $42.55 , $319.16 , $355.50 , $334.41 , $355.50 , $355.50 , $355.50 , $335.75 , $41.72 , $364.70 , $375.25 , $335.75 , $367.35 , $367.35 , $375.25 , $379.20 , $323.19 , $355.50 , $335.75 , $312.05 , N/A , $319.67 , $319.67 , $375.25 , $338.95 , $41.72 , $379.20 
Home sleep test/type 3 Porta,HCPCS G0399,N/A,N/A,N/A, $813.00 , $528.45 , $485.35 , $90.31 , N/A , N/A , N/A , $756.09 , $731.70 , $731.70 , $650.40 , $650.40 , N/A , $750.64 , $772.35 , $731.70 , $731.70 , $731.70 , $756.09 , $780.48 , $434.12 , $691.05 , $195.79 , $779.50 , N/A , $325.71 , $325.71 , $772.35 , $407.13 , $90.31 , $780.48 
Iridoplasty by Photocoag,CPT® 66762,N/A,N/A,N/A," $4,361.00 "," $2,834.65 "," $2,612.68 ", $410.42 , $384.19 ," $2,412.08 "," $2,246.87 "," $4,055.73 "," $3,924.90 "," $3,924.90 "," $3,488.80 "," $3,488.80 ", $384.19 ," $4,026.51 "," $4,142.95 "," $3,924.90 "," $3,924.90 "," $3,924.90 "," $4,055.73 "," $4,186.56 "," $3,587.20 "," $3,706.85 "," $2,303.23 "," $3,065.69 ", N/A ," $2,459.15 "," $2,459.15 "," $4,142.95 "," $2,714.58 ", $384.19 ," $4,186.56 "
"Repair Lip,>1/2 Vert Height",40654,N/A,N/A,N/A," $2,497.00 "," $1,623.05 "," $2,610.14 ", $411.10 , $539.88 ," $2,037.70 "," $2,097.65 "," $2,322.21 "," $2,247.30 "," $2,247.30 "," $1,997.60 "," $1,997.60 ", $539.88 ," $2,305.48 "," $2,372.15 "," $2,247.30 "," $2,247.30 "," $2,247.30 "," $2,322.21 "," $2,397.12 "," $1,858.88 "," $2,122.45 "," $2,301.44 "," $2,431.85 ", N/A ," $2,077.46 "," $2,077.46 "," $2,372.15 "," $2,172.81 ", $411.10 ," $2,610.14 "
 Fac Part Aggluj Scr Ea Antb ,CPT® 86403,0302 - LAB/IMMUNOLOGY,N/A,N/A, $83.00 , $53.95 , $69.72 , $11.77 , $11.77 , $67.06 , $74.70 , $70.27 , $74.70 , $74.70 , $74.70 , $70.55 , $11.54 , $76.63 , $78.85 , $70.55 , $77.19 , $77.19 , $78.85 , $79.68 , $67.91 , $74.70 , $70.55 , $65.57 , N/A , $67.17 , $67.17 , $78.85 , $71.22 , $11.54 , $79.68 
"Post Colporrhaphy,Rectum/Vagina",CPT® 57250,N/A,N/A,N/A," $4,028.00 "," $2,618.20 "," $2,917.65 ", $589.72 , $461.04 ," $2,754.11 "," $2,747.30 "," $3,746.04 "," $3,625.20 "," $3,625.20 "," $3,222.40 "," $3,222.40 ", $461.04 ," $3,719.05 "," $3,826.60 "," $3,625.20 "," $3,625.20 "," $3,625.20 "," $3,746.04 "," $3,866.88 "," $3,032.93 "," $3,423.80 "," $3,605.59 "," $2,437.43 ", N/A ," $2,807.84 "," $2,807.84 "," $3,826.60 "," $3,367.85 ", $461.04 ," $3,866.88 "
Aerosol/Vapor Inhalations,CPT® 94664,N/A,N/A,N/A, $115.00 , $74.75 , $38.59 , $16.52 , $17.33 , $37.88 , $41.63 , $106.95 , $103.50 , $103.50 , $92.00 , $92.00 , $17.33 , $106.18 , $109.25 , $103.50 , $103.50 , $103.50 , $106.95 , $110.40 , $50.19 , $97.75 , $55.75 , $64.44 , N/A , $38.62 , $38.62 , $109.25 , $45.03 , $16.52 , $110.40 
Drainage Deep Urethral Abscess,CPT® 53040,N/A,N/A,N/A," $2,738.00 "," $1,779.70 "," $2,130.38 ", $376.06 , $230.52 ," $1,919.14 "," $1,795.25 "," $2,546.34 "," $2,464.20 "," $2,464.20 "," $2,190.40 "," $2,190.40 ", $230.52 ," $2,528.00 "," $2,601.10 "," $2,464.20 "," $2,464.20 "," $2,464.20 "," $2,546.34 "," $2,628.48 "," $2,137.77 "," $2,327.30 "," $2,032.05 "," $2,417.91 ", N/A ," $1,956.58 "," $1,956.58 "," $2,601.10 "," $2,299.68 ", $230.52 ," $2,628.48 "
Long Chain Fatty Acids,CPT® 82726,N/A,N/A,N/A, $224.00 , $145.60 , N/A , $20.15 , $20.15 , $102.19 , $122.20 , $208.32 , $201.60 , $201.60 , $179.20 , $179.20 , $20.15 , $206.82 , $212.80 , $201.60 , $201.60 , $201.60 , $208.32 , $215.04 , $131.88 , $190.40 , $118.39 , $65.47 , N/A , $95.37 , $95.37 , $212.80 , $104.22 , $20.15 , $215.04 
"I&D Vaginal Hematoma, Non-OB",CPT® 57023,N/A,N/A,N/A," $1,861.00 "," $1,209.65 "," $1,512.45 ", $305.83 , $312.40 ," $1,262.69 "," $1,264.12 "," $1,730.73 "," $1,674.90 "," $1,674.90 "," $1,488.80 "," $1,488.80 ", $312.40 ," $1,718.26 "," $1,767.95 "," $1,674.90 "," $1,674.90 "," $1,674.90 "," $1,730.73 "," $1,786.56 "," $1,573.92 "," $1,581.85 "," $1,662.75 "," $1,266.34 ", N/A ," $1,287.32 "," $1,287.32 "," $1,767.95 "," $1,544.08 ", $305.83 ," $1,786.56 "
Assay Thyroid Hormone (T3 or T4),CPT® 84479,N/A,N/A,N/A, $73.00 , $47.45 , N/A , $6.60 , $6.60 , $36.62 , $43.78 , $67.89 , $65.70 , $65.70 , $58.40 , $58.40 , $6.60 , $67.40 , $69.35 , $65.70 , $65.70 , $65.70 , $67.89 , $70.08 , $43.20 , $62.05 , $42.17 , $23.44 , N/A , $34.18 , $34.18 , $69.35 , $37.35 , $6.60 , $70.08 
Oral Function Therapy,CPT® 92526,N/A,N/A,N/A, $373.00 , $242.45 , $200.16 , $84.52 , $66.75 , $192.30 , $175.12 , $346.89 , $335.70 , $335.70 , $298.40 , $298.40 , $66.75 , $344.39 , $354.35 , $335.70 , $335.70 , $335.70 , $346.89 , $358.08 , $371.26 , $317.05 , $230.11 , $327.59 , N/A , $196.06 , $196.06 , $354.35 , $228.55 , $66.75 , $371.26 
"Fusion Foot Bones,Triple",CPT® 28715,N/A,N/A,N/A," $9,506.00 "," $6,178.90 "," $5,738.53 ", $898.30 , $986.35 ," $4,560.14 "," $4,522.17 "," $8,840.58 "," $8,555.40 "," $8,555.40 "," $7,604.80 "," $7,604.80 ", $986.35 ," $8,776.89 "," $9,030.70 "," $8,555.40 "," $8,555.40 "," $8,555.40 "," $8,840.58 "," $9,125.76 "," $5,345.19 "," $8,080.10 "," $4,972.19 "," $5,383.32 ", N/A ," $4,649.11 "," $4,649.11 "," $9,030.70 "," $5,464.36 ", $898.30 ," $9,125.76 "
Vascular Embolization or Occlusion Arterial Rs&I,CPT® 37242,N/A,N/A,N/A," $3,823.00 "," $2,484.95 "," $2,840.63 ", $439.19 ," $2,378.00 "," $2,181.74 "," $2,215.75 "," $3,555.39 "," $3,440.70 "," $3,440.70 "," $3,058.40 "," $3,058.40 "," $2,378.00 "," $3,529.78 "," $3,631.85 "," $3,440.70 "," $3,440.70 "," $3,440.70 "," $3,555.39 "," $3,670.08 "," $2,639.22 "," $3,249.55 "," $2,464.62 "," $2,383.38 ", N/A ," $2,224.31 "," $2,224.31 "," $3,631.85 "," $2,526.82 ", $439.19 ," $3,670.08 "
Assay for Primidone,CPT® 80188,N/A,N/A,N/A, $149.00 , $96.85 , N/A , $16.92 , $16.92 , $93.87 , $112.30 , $138.57 , $134.10 , $134.10 , $119.20 , $119.20 , $16.92 , $137.57 , $141.55 , $134.10 , $134.10 , $134.10 , $138.57 , $143.04 , $110.78 , $126.65 , $108.66 , $60.15 , N/A , $87.61 , $87.61 , $141.55 , $95.74 , $16.92 , $143.04 
 Fac Drug Assay Acetaminophen ,CPT® 80143,0301 - LAB/CHEMISTRY,N/A,N/A, $156.00 , $101.40 , $131.04 , $19.01 , $15.21 , $126.05 , $140.40 , $132.07 , $140.40 , $140.40 , $140.40 , $132.60 , $14.91 , $144.03 , $148.20 , $132.60 , $145.08 , $145.08 , $148.20 , $149.76 , $127.64 , $140.40 , $132.60 , $123.24 , N/A , $126.25 , $126.25 , $148.20 , $133.86 , $14.91 , $149.76 
Psychiatric Diagnostic Evaluation,CPT® 90791,N/A,N/A,N/A, $548.00 , $356.20 , $202.62 , $150.56 , $119.19 , $284.43 , $267.70 , $509.64 , $493.20 , $493.20 , $438.40 , $438.40 , $119.19 , $505.97 , $520.60 , $493.20 , $493.20 , $493.20 , $509.64 , $526.08 , $389.05 , $465.80 , $348.72 , $483.05 , $210.00 , $289.98 , $289.98 , $520.60 , $338.06 , $119.19 , $526.08 
Proph Retinal Dtchmnt W/O Drg Photocoagulation,CPT® 67145,N/A,N/A,N/A," $4,834.00 "," $3,142.10 "," $1,332.50 ", $209.37 , $419.76 ," $2,818.97 "," $2,632.70 "," $4,495.62 "," $4,350.60 "," $4,350.60 "," $3,867.20 "," $3,867.20 ", $419.76 ," $4,463.23 "," $4,592.30 "," $4,350.60 "," $4,350.60 "," $4,350.60 "," $4,495.62 "," $4,640.64 "," $4,191.81 "," $4,108.90 "," $2,702.86 "," $3,583.29 ", N/A ," $2,873.97 "," $2,873.97 "," $4,592.30 "," $3,172.48 ", $209.37 ," $4,640.64 "
"Insert,Inflatable Penile Prosthesis",CPT® 54405,N/A,N/A,N/A," $4,433.00 "," $2,881.45 "," $3,579.80 ", $770.22 , N/A ," $2,595.96 "," $2,615.59 "," $4,122.69 "," $3,989.70 "," $3,989.70 "," $3,546.40 "," $3,546.40 ", N/A ," $4,092.99 "," $4,211.35 "," $3,989.70 "," $3,989.70 "," $3,989.70 "," $4,122.69 "," $4,255.68 "," $3,364.20 "," $3,768.05 "," $4,167.57 "," $3,915.23 ", N/A ," $2,646.60 "," $2,646.60 "," $4,211.35 "," $3,172.11 ", $770.22 ," $4,255.68 "
"Repair Recto-Vag Fistula,Abd Apprch",CPT® 57305,N/A,N/A,N/A," $5,409.00 "," $3,515.85 "," $4,630.95 ", $933.32 , $922.06 ," $3,790.31 "," $3,746.37 "," $5,030.37 "," $4,868.10 "," $4,868.10 "," $4,327.20 "," $4,327.20 ", $922.06 ," $4,994.13 "," $5,138.55 "," $4,868.10 "," $4,868.10 "," $4,868.10 "," $5,030.37 "," $5,192.64 "," $4,786.30 "," $4,597.65 "," $4,954.35 "," $3,777.88 ", N/A ," $3,864.27 "," $3,864.27 "," $5,138.55 "," $4,634.95 ", $922.06 ," $5,192.64 "
 Pro Colonoscopy Flexible With Decompression ,CPT® 45393,0982 - PRO FEE/OUTPT,N/A,N/A," $2,263.00 "," $1,470.95 "," $1,541.87 ", $237.46 , $265.41 , N/A , N/A ," $2,104.59 "," $2,036.70 "," $2,036.70 "," $1,810.40 "," $1,810.40 ", $265.41 ," $2,089.43 "," $2,149.85 "," $2,036.70 "," $2,036.70 "," $2,036.70 "," $2,104.59 "," $2,172.48 "," $1,108.62 "," $1,923.55 "," $1,311.38 "," $1,467.36 ", N/A ," $1,126.96 "," $1,126.96 "," $2,149.85 "," $1,179.56 ", $237.46 ," $2,172.48 "
 Herpes Simplex Igg I&II Beaker1 ,CPT® 86694,0302 - LAB/IMMUNOLOGY,N/A,N/A, $150.00 , $97.50 , $126.00 , $14.68 , $14.68 , $121.20 , $135.00 , $126.99 , $135.00 , $135.00 , $135.00 , $127.50 , $14.39 , $138.50 , $142.50 , $127.50 , $139.50 , $139.50 , $142.50 , $144.00 , $122.73 , $135.00 , $127.50 , $118.50 , N/A , $121.40 , $121.40 , $142.50 , $128.72 , $14.39 , $144.00 
 ALBUMIN HUMAN 25 % IV SOLN ,HCPCS P9047,0636 - DRUGS REQUIRING DETAILED CODIN,00944-0493-01,50 mL, $356.76 , $231.89 , $299.68 , $54.14 , $50.18 , $288.26 , $321.08 , $302.03 , $321.08 , $321.08 , $321.08 , $303.25 , $49.20 , $329.40 , $338.92 , $303.25 , $331.79 , $331.79 , $338.92 , $342.49 , $291.90 , $321.08 , $303.25 , $281.84 , N/A , $288.73 , $288.73 , $338.92 , $306.14 , $49.20 , $342.49 
Cysto Insertion Transprostatic Implant Single,CPT® 52441,N/A,N/A,N/A," $8,226.00 "," $5,346.90 "," $1,125.39 ", $197.54 , $978.11 ," $1,134.96 "," $1,071.32 "," $7,650.18 "," $7,403.40 "," $7,403.40 "," $6,580.80 "," $6,580.80 ", $978.11 ," $7,595.07 "," $7,814.70 "," $7,403.40 "," $7,403.40 "," $7,403.40 "," $7,650.18 "," $7,896.96 "," $1,132.54 "," $6,992.10 "," $1,087.49 "," $1,393.46 ", N/A ," $1,157.10 "," $1,157.10 "," $7,814.70 "," $1,360.03 ", $197.54 ," $7,896.96 "
 Home Sleep Study Test - 4 Chan ,HCPCS G0399,0920 - OTHER DX SVS,N/A,N/A, $841.00 , $546.65 , $706.44 , $90.31 , N/A , $679.53 , $756.90 , $711.99 , $756.90 , $756.90 , $756.90 , $714.85 , N/A , $776.50 , $798.95 , $714.85 , $782.13 , $782.13 , $798.95 , $807.36 , $688.11 , $756.90 , $714.85 , $664.39 , N/A , $680.62 , $680.62 , $798.95 , $721.66 , $90.31 , $807.36 
 Fac M/Phmtrc Alys Ish Quant/Semiq Mnl Each Multiprb ,CPT® 88377,0310 - PATHOLOGY LAB,N/A,N/A," $1,385.00 ", $900.25 ," $1,163.40 ", $389.56 , $168.73 ," $1,119.08 "," $1,246.50 "," $1,172.54 "," $1,246.50 "," $1,246.50 "," $1,246.50 "," $1,177.25 ", $165.42 ," $1,278.77 "," $1,315.75 "," $1,177.25 "," $1,288.05 "," $1,288.05 "," $1,315.75 "," $1,329.60 "," $1,133.21 "," $1,246.50 "," $1,177.25 "," $1,094.15 ", N/A ," $1,120.88 "," $1,120.88 "," $1,315.75 "," $1,188.47 ", $165.42 ," $1,329.60 "
 Pelvis MRI Without and With Contrast ,CPT® 72197,0614 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI-OTHER,N/A,N/A," $7,098.00 "," $4,613.70 "," $5,962.32 ", $347.59 , $639.90 ," $5,735.18 "," $6,388.20 "," $6,009.17 "," $6,388.20 "," $6,388.20 "," $6,388.20 "," $6,033.30 ", $627.35 ," $6,553.58 "," $6,743.10 "," $6,033.30 "," $6,601.14 "," $6,601.14 "," $6,743.10 "," $6,814.08 "," $5,807.58 "," $6,388.20 "," $6,033.30 "," $5,607.42 ", N/A ," $5,744.41 "," $5,744.41 "," $6,743.10 "," $6,090.79 ", $347.59 ," $6,814.08 "
 Pro CT Uxtr C-/C+ ,CPT® 73202,0972 - PRO FEE/RAD/DX,N/A,N/A, $421.00 , $273.65 ," $1,598.10 ", $231.52 , $355.39 ," $1,321.56 "," $1,720.24 ", $391.53 , $378.90 , $378.90 , $336.80 , $336.80 , $355.39 , $388.71 , $399.95 , $378.90 , $378.90 , $378.90 , $391.53 , $404.16 ," $1,528.86 ", $357.85 ," $1,875.96 "," $1,802.08 ", N/A ," $1,347.34 "," $1,347.34 ", $399.95 ," $1,559.57 ", $231.52 ," $1,875.96 "
Cmbnd Anterpost Colporraphy W/Cysto,CPT® 57260,N/A,N/A,N/A," $4,964.00 "," $3,226.60 "," $3,680.35 ", $744.02 , $768.38 ," $3,395.95 "," $3,378.00 "," $4,616.52 "," $4,467.60 "," $4,467.60 "," $3,971.20 "," $3,971.20 ", $768.38 ," $4,583.26 "," $4,715.80 "," $4,467.60 "," $4,467.60 "," $4,467.60 "," $4,616.52 "," $4,765.44 "," $3,841.26 "," $4,219.40 "," $4,435.18 "," $3,123.34 ", N/A ," $3,462.21 "," $3,462.21 "," $4,715.80 "," $4,152.72 ", $744.02 ," $4,765.44 "
 DEXRAZOXANE HCL 250 MG IV SOLR ,HCPCS J1190,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9247-01,25 mL," $1,690.60 "," $1,098.89 "," $1,420.10 ", $116.18 , $170.26 ," $1,366.00 "," $1,521.54 "," $1,431.26 "," $1,521.54 "," $1,521.54 "," $1,521.54 "," $1,437.01 ", $166.92 ," $1,560.93 "," $1,606.07 "," $1,437.01 "," $1,572.26 "," $1,572.26 "," $1,606.07 "," $1,622.98 "," $1,383.25 "," $1,521.54 "," $1,437.01 "," $1,335.57 ", N/A ," $1,368.20 "," $1,368.20 "," $1,606.07 "," $1,450.70 ", $116.18 ," $1,622.98 "
 BEVACIZUMAB-AWWB 400 MG/16ML IV SOLN ,HCPCS Q5107,0636 - DRUGS REQUIRING DETAILED CODIN,55513-0207-01,16 mL," $8,206.10 "," $5,333.97 "," $6,893.12 ", $28.97 , $32.33 ," $6,630.53 "," $7,385.49 "," $6,947.28 "," $7,385.49 "," $7,385.49 "," $7,385.49 "," $6,975.19 ", $31.70 ," $7,576.69 "," $7,795.80 "," $6,975.19 "," $7,631.67 "," $7,631.67 "," $7,795.80 "," $7,877.86 "," $6,714.23 "," $7,385.49 "," $6,975.19 "," $6,482.82 ", N/A ," $6,641.20 "," $6,641.20 "," $7,795.80 "," $7,041.65 ", $28.97 ," $7,877.86 "
Open Rx Humeral Condylar Fx,24579,N/A,N/A,N/A," $4,342.00 "," $2,822.30 "," $5,071.56 ", $796.59 , $614.70 ," $4,027.52 "," $4,012.85 "," $4,038.06 "," $3,907.80 "," $3,907.80 "," $3,473.60 "," $3,473.60 ", $614.70 ," $4,008.97 "," $4,124.90 "," $3,907.80 "," $3,907.80 "," $3,907.80 "," $4,038.06 "," $4,168.32 "," $4,715.18 "," $3,690.70 "," $4,429.83 "," $4,754.49 ", N/A ," $4,106.11 "," $4,106.11 "," $4,124.90 "," $4,826.14 ", $614.70 ," $5,071.56 "
 Fac Tcat Mitral Valve Repair Addl Prosthesis ,CPT® 33419,0360 - OR SERVICES,N/A,N/A," $5,645.00 "," $3,669.25 "," $4,741.80 ", $380.55 , $398.54 ," $4,561.16 "," $5,080.50 "," $4,779.06 "," $5,080.50 "," $5,080.50 "," $5,080.50 "," $4,798.25 ", $390.73 ," $5,212.03 "," $5,362.75 "," $4,798.25 "," $5,249.85 "," $5,249.85 "," $5,362.75 "," $5,419.20 "," $4,618.74 "," $5,080.50 "," $4,798.25 "," $4,459.55 ", N/A ," $4,568.50 "," $4,568.50 "," $5,362.75 "," $4,843.97 ", $380.55 ," $5,419.20 "
 Pro Psychotherapy W/Patient 45 Minutes ,CPT® 90834,0961 - PRO FEE/PSYCH,N/A,N/A, $345.00 , $224.25 , $118.65 , $87.92 , $77.18 , $189.56 , $168.47 , $320.85 , $310.50 , $310.50 , $276.00 , $276.00 , $77.18 , $318.54 , $327.75 , $310.50 , $310.50 , $310.50 , $320.85 , $331.20 , $226.17 , $293.25 , $218.96 , $320.51 , $167.50 , $193.26 , $193.26 , $327.75 , $225.28 , $77.18 , $331.20 
"Drainage Palm Bursa,Single",CPT® 26025,N/A,N/A,N/A," $2,567.00 "," $1,668.55 "," $2,583.82 ", $405.36 , $461.04 ," $2,034.59 "," $2,041.90 "," $2,387.31 "," $2,310.30 "," $2,310.30 "," $2,053.60 "," $2,053.60 ", $461.04 ," $2,370.11 "," $2,438.65 "," $2,310.30 "," $2,310.30 "," $2,310.30 "," $2,387.31 "," $2,464.32 "," $2,407.42 "," $2,181.95 "," $2,244.35 "," $2,409.72 ", N/A ," $2,074.29 "," $2,074.29 "," $2,438.65 "," $2,438.04 ", $405.36 ," $2,583.82 "
"Tissue,Situ Hybridization",CPT® 88365,N/A,N/A,N/A, $632.00 , $410.80 , $640.10 , $177.52 , $61.82 , $622.27 , $815.31 , $587.76 , $568.80 , $568.80 , $505.60 , $505.60 , $61.82 , $583.53 , $600.40 , $568.80 , $568.80 , $568.80 , $587.76 , $606.72 ," $1,175.66 ", $537.20 , $851.47 , $624.49 , N/A , $580.74 , $580.74 , $600.40 , $638.21 , $61.82 ," $1,175.66 "
 PREGABALIN 100 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-7001-61,1 capsule, $5.18 , $3.37 , $4.35 , N/A , N/A , $4.19 , $4.66 , $4.39 , $4.66 , $4.66 , $4.66 , $4.40 , N/A , $4.78 , $4.92 , $4.40 , $4.82 , $4.82 , $4.92 , $4.97 , $4.24 , $4.66 , $4.40 , $4.09 , N/A , $4.19 , $4.19 , $4.92 , $4.44 , $4.09 , $4.97 
"Alpha-1-Antitrypsin, Pheno",CPT® 82104,N/A,N/A,N/A, $214.00 , $139.10 , N/A , $14.75 , $14.75 , $81.82 , $97.87 , $199.02 , $192.60 , $192.60 , $171.20 , $171.20 , $14.75 , $197.59 , $203.30 , $192.60 , $192.60 , $192.60 , $199.02 , $205.44 , $96.55 , $181.90 , $94.07 , $52.45 , N/A , $76.36 , $76.36 , $203.30 , $83.44 , $14.75 , $205.44 
Drainage Anter Chambr of Eye,CPT® 65800,N/A,N/A,N/A," $1,097.00 ", $713.05 , $550.68 , $85.71 , $61.48 , $519.85 , $480.00 ," $1,020.21 ", $987.30 , $987.30 , $877.60 , $877.60 , $61.48 ," $1,012.86 "," $1,042.15 ", $987.30 , $987.30 , $987.30 ," $1,020.21 "," $1,053.12 ", $762.41 , $932.45 , $495.97 , $658.23 , N/A , $529.99 , $529.99 ," $1,042.15 ", $585.05 , $61.48 ," $1,053.12 "
 Fac Egd Removal Tumor Polyp/Other Lesion Snare Tech ,CPT® 43251,0360 - OR SERVICES,N/A,N/A," $2,690.00 "," $1,748.50 "," $2,259.60 ", $185.58 , $203.13 ," $2,173.52 "," $2,421.00 "," $2,277.35 "," $2,421.00 "," $2,421.00 "," $2,421.00 "," $2,286.50 ", $199.15 ," $2,483.68 "," $2,555.50 "," $2,286.50 "," $2,501.70 "," $2,501.70 "," $2,555.50 "," $2,582.40 "," $2,200.96 "," $2,421.00 "," $2,286.50 "," $2,125.10 ", N/A ," $2,177.02 "," $2,177.02 "," $2,555.50 "," $2,308.29 ", $185.58 ," $2,582.40 "
Layer Closure 2.6-7.5cm,12032,N/A,N/A,N/A," $1,160.00 ", $754.00 , $608.50 , $183.18 , $82.48 , $532.01 , $524.46 ," $1,078.80 "," $1,044.00 "," $1,044.00 ", $928.00 , $928.00 , $82.48 ," $1,071.03 "," $1,102.00 "," $1,044.00 "," $1,044.00 "," $1,044.00 "," $1,078.80 "," $1,113.60 ", $668.28 , $986.00 ," $1,043.68 ", $685.38 , N/A , $542.39 , $542.39 ," $1,102.00 ", $628.99 , $82.48 ," $1,113.60 "
 Fac Cns Dna/Rna Amp Probe Multiple Subtypes 12-25 ,CPT® 87483,0306 - LAB/BACT-MICRO,N/A,N/A," $3,562.00 "," $2,315.30 "," $2,992.08 ", $425.12 , $425.12 ," $2,878.10 "," $3,205.80 "," $3,015.59 "," $3,205.80 "," $3,205.80 "," $3,205.80 "," $3,027.70 ", $416.78 ," $3,288.79 "," $3,383.90 "," $3,027.70 "," $3,312.66 "," $3,312.66 "," $3,383.90 "," $3,419.52 "," $2,914.43 "," $3,205.80 "," $3,027.70 "," $2,813.98 ", N/A ," $2,882.73 "," $2,882.73 "," $3,383.90 "," $3,056.55 ", $416.78 ," $3,419.52 "
 Fac Revsc Opn/Prq Fem/Pop W/Stnt/Angiop Sm Vsl ,CPT® 37226,0360 - OR SERVICES,N/A,N/A," $27,351.00 "," $17,778.15 "," $22,974.84 ", $463.08 , $384.61 ," $22,099.61 "," $24,615.90 "," $23,155.36 "," $24,615.90 "," $24,615.90 "," $24,615.90 "," $23,248.35 ", $377.07 ," $25,253.18 "," $25,983.45 "," $23,248.35 "," $25,436.43 "," $25,436.43 "," $25,983.45 "," $26,256.96 "," $22,378.59 "," $24,615.90 "," $23,248.35 "," $21,607.29 ", N/A ," $22,135.16 "," $22,135.16 "," $25,983.45 "," $23,469.89 ", $377.07 ," $26,256.96 "
Office/OP Consltj New/Est Pt Low Mdm 30 Minutes,99243,N/A,N/A,N/A, $458.00 , $297.70 , N/A , $111.35 , $86.25 , $212.16 , $211.38 , $425.94 , $412.20 , $412.20 , $366.40 , $366.40 , $86.25 , $422.87 , $435.10 , $412.20 , $412.20 , $412.20 , $425.94 , $439.68 , $265.90 , $389.30 , $207.78 , $209.99 , $161.25 , $216.30 , $216.30 , $435.10 , $257.50 , $86.25 , $439.68 
"US, Preg Uter,Fetal & Mat,1st Trimest",CPT® 76801,N/A,N/A,N/A, $953.00 , $619.45 , $670.60 , $116.85 , $118.45 , $595.71 , $671.89 , $886.29 , $857.70 , $857.70 , $762.40 , $762.40 , $118.45 , $879.90 , $905.35 , $857.70 , $857.70 , $857.70 , $886.29 , $914.88 , $675.55 , $810.05 , $729.97 , $695.54 , N/A , $607.33 , $607.33 , $905.35 , $702.99 , $116.85 , $914.88 
"MRI, Abdomen W/Contrast",CPT® 74182,N/A,N/A,N/A," $4,161.00 "," $2,704.65 "," $2,190.93 ", $311.87 , $503.64 ," $2,162.27 "," $2,743.36 "," $3,869.73 "," $3,744.90 "," $3,744.90 "," $3,328.80 "," $3,328.80 ", $503.64 ," $3,841.85 "," $3,952.95 "," $3,744.90 "," $3,744.90 "," $3,744.90 "," $3,869.73 "," $3,994.56 "," $1,895.03 "," $3,536.85 "," $2,989.22 "," $3,535.59 ", N/A ," $2,204.47 "," $2,204.47 "," $3,952.95 "," $2,551.70 ", $311.87 ," $3,994.56 "
Assay Thiopurine S-Methyltransferase,CPT® 84433,N/A,N/A,N/A, $447.00 , $290.55 , N/A , $22.61 , $22.61 , N/A , N/A , $415.71 , $402.30 , $402.30 , $357.60 , $357.60 , $22.61 , $412.72 , $424.65 , $402.30 , $402.30 , $402.30 , $415.71 , $429.12 , N/A , $379.95 , $105.00 , N/A , N/A , $86.91 , $86.91 , $424.65 , $95.55 , $22.61 , $429.12 
Radiologic Exam Colon Single Contrast Study,CPT® 74270,N/A,N/A,N/A," $2,033.00 "," $1,321.45 ", $898.65 , $154.05 , $106.23 , $712.84 , $840.67 ," $1,890.69 "," $1,829.70 "," $1,829.70 "," $1,626.40 "," $1,626.40 ", $106.23 ," $1,877.07 "," $1,931.35 "," $1,829.70 "," $1,829.70 "," $1,829.70 "," $1,890.69 "," $1,951.68 ", $882.02 ," $1,728.05 ", $916.80 , $759.03 , N/A , $726.75 , $726.75 ," $1,931.35 ", $841.24 , $106.23 ," $1,951.68 "
 NYSTATIN/DIPHENHYDRAMINE/LIDOCAINE 180 ML SUSPENSION ,HCPCS RXC637,0250 - PHARMACY,00001-0075-01,180 mL, $35.00 , $22.75 , $29.40 , N/A , N/A , $28.28 , $31.50 , $29.63 , $31.50 , $31.50 , $31.50 , $29.75 , N/A , $32.32 , $33.25 , $29.75 , $32.55 , $32.55 , $33.25 , $33.60 , $28.64 , $31.50 , $29.75 , $27.65 , N/A , $28.33 , $28.33 , $33.25 , $30.03 , $27.65 , $33.60 
 Head MR Angiography W/O Contr ,CPT® 70544,0615 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA-HEAD AND NECK,N/A,N/A," $5,495.00 "," $3,571.75 "," $4,615.80 ", $220.97 , $403.88 ," $4,439.96 "," $4,945.50 "," $4,652.07 "," $4,945.50 "," $4,945.50 "," $4,945.50 "," $4,670.75 ", $395.96 ," $5,073.53 "," $5,220.25 "," $4,670.75 "," $5,110.35 "," $5,110.35 "," $5,220.25 "," $5,275.20 "," $4,496.01 "," $4,945.50 "," $4,670.75 "," $4,341.05 ", N/A ," $4,447.10 "," $4,447.10 "," $5,220.25 "," $4,715.26 ", $220.97 ," $5,275.20 "
Remove Foreign Body Simple,10120,N/A,N/A,N/A, $579.00 , $376.35 , $336.16 , $101.48 , $42.46 , $283.24 , $279.57 , $538.47 , $521.10 , $521.10 , $463.20 , $463.20 , $42.46 , $534.59 , $550.05 , $521.10 , $521.10 , $521.10 , $538.47 , $555.84 , $369.08 , $492.15 , $553.06 , $366.67 , N/A , $288.77 , $288.77 , $550.05 , $334.86 , $42.46 , $555.84 
"Removal, Pelvic Lymph Nodes,Staging",CPT® 38562,N/A,N/A,N/A," $3,883.00 "," $2,523.95 "," $3,302.40 ", $668.67 , $678.12 ," $2,460.97 "," $2,514.53 "," $3,611.19 "," $3,494.70 "," $3,494.70 "," $3,106.40 "," $3,106.40 ", $678.12 ," $3,585.17 "," $3,688.85 "," $3,494.70 "," $3,494.70 "," $3,494.70 "," $3,611.19 "," $3,727.68 "," $3,529.79 "," $3,300.55 "," $3,693.01 "," $3,429.23 ", N/A ," $2,508.99 "," $2,508.99 "," $3,688.85 "," $2,910.75 ", $668.67 ," $3,727.68 "
 INFUVITE ADULT IV INJ ,HCPCS RXA250,0250 - PHARMACY,54643-5649-01,10 mL, $82.45 , $53.59 , $69.26 , N/A , N/A , $66.62 , $74.21 , $69.80 , $74.21 , $74.21 , $74.21 , $70.08 , N/A , $76.13 , $78.33 , $70.08 , $76.68 , $76.68 , $78.33 , $79.15 , $67.46 , $74.21 , $70.08 , $65.14 , N/A , $66.73 , $66.73 , $78.33 , $70.75 , $65.14 , $79.15 
 Fac Molecular Pathology Procedure Level 9 ,CPT® 81408,0310 - PATHOLOGY LAB,N/A,N/A, $47.00 , $30.55 , $39.48 ," $2,040.00 "," $2,040.00 ", $37.98 , $42.30 , $39.79 , $42.30 , $42.30 , $42.30 , $39.95 ," $2,000.00 ", $43.40 , $44.65 , $39.95 , $43.71 , $43.71 , $44.65 , $45.12 , $38.46 , $42.30 , $39.95 , $37.13 , N/A , $38.04 , $38.04 , $44.65 , $40.33 , $37.13 ," $2,040.00 "
 Fac Ileoscopy Stoma W/Balloon Dilation ,CPT® 44381,0360 - OR SERVICES,N/A,N/A," $1,293.00 ", $840.45 ," $1,086.12 ", $80.30 , $129.09 ," $1,044.74 "," $1,163.70 "," $1,094.65 "," $1,163.70 "," $1,163.70 "," $1,163.70 "," $1,099.05 ", $126.56 ," $1,193.83 "," $1,228.35 "," $1,099.05 "," $1,202.49 "," $1,202.49 "," $1,228.35 "," $1,241.28 "," $1,057.93 "," $1,163.70 "," $1,099.05 "," $1,021.47 ", N/A ," $1,046.42 "," $1,046.42 "," $1,228.35 "," $1,109.52 ", $80.30 ," $1,241.28 "
 MEROPENEM 1 G IV SOLR ,HCPCS J2185,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0508-30,20 mL, $36.37 , $23.64 , $30.55 , $0.53 , $0.63 , $29.39 , $32.73 , $30.79 , $32.73 , $32.73 , $32.73 , $30.91 , $0.62 , $33.58 , $34.55 , $30.91 , $33.82 , $33.82 , $34.55 , $34.92 , $29.76 , $32.73 , $30.91 , $28.73 , N/A , $29.43 , $29.43 , $34.55 , $31.21 , $0.53 , $34.92 
"Synovectomy Flex Tendn Sheath,Foot",CPT® 28086,N/A,N/A,N/A," $3,629.00 "," $2,358.85 "," $2,193.82 ", $341.96 , $430.29 ," $1,773.09 "," $1,762.36 "," $3,374.97 "," $3,266.10 "," $3,266.10 "," $2,903.20 "," $2,903.20 ", $430.29 ," $3,350.66 "," $3,447.55 "," $3,266.10 "," $3,266.10 "," $3,266.10 "," $3,374.97 "," $3,483.84 "," $2,040.93 "," $3,084.65 "," $1,926.79 "," $2,083.02 ", N/A ," $1,807.69 "," $1,807.69 "," $3,447.55 "," $2,124.69 ", $341.96 ," $3,483.84 "
Layer Closure 5.1-7.5cm,CPT® 12053,N/A,N/A,N/A," $1,445.00 ", $939.25 , $685.07 , $206.62 , $153.67 , $595.05 , $580.29 ," $1,343.85 "," $1,300.50 "," $1,300.50 "," $1,156.00 "," $1,156.00 ", $153.67 ," $1,334.17 "," $1,372.75 "," $1,300.50 "," $1,300.50 "," $1,300.50 "," $1,343.85 "," $1,387.20 ", $753.04 ," $1,228.25 "," $1,156.07 ", $765.21 , N/A , $606.66 , $606.66 ," $1,372.75 ", $703.53 , $153.67 ," $1,387.20 "
 Pfizer Covid Vaccine Peds 5-11 Yrs 1st Dose ,CPT® 0071A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
Drain Skin Abscess Complic,10061,N/A,N/A,N/A, $834.00 , $542.10 , $590.92 , $177.26 , $93.30 , $490.97 , $481.05 , $775.62 , $750.60 , $750.60 , $667.20 , $667.20 , $93.30 , $770.03 , $792.30 , $750.60 , $750.60 , $750.60 , $775.62 , $800.64 , $644.00 , $708.90 , $950.91 , $632.67 , N/A , $500.54 , $500.54 , $792.30 , $580.46 , $93.30 , $950.91 
Impl Absrb Mesh/Prsth Dlyd Clsr Dfct Infctj/Trma,CPT® 15778,N/A,N/A,N/A," $3,082.00 "," $2,003.30 ", N/A , $353.54 , $275.94 , N/A , N/A ," $2,866.26 "," $2,773.80 "," $2,773.80 "," $2,465.60 "," $2,465.60 ", $275.94 ," $2,845.61 "," $2,927.90 "," $2,773.80 "," $2,773.80 "," $2,773.80 "," $2,866.26 "," $2,958.72 ", N/A ," $2,619.70 "," $2,032.82 ", N/A , N/A , $875.83 , $875.83 ," $2,927.90 "," $1,014.48 ", $275.94 ," $2,958.72 "
 MULTIVITAMIN PO LIQD ,HCPCS RXC637,0250 - PHARMACY,00001-1010-01,5 mL, $12.85 , $8.35 , $10.79 , N/A , N/A , $10.38 , $11.57 , $10.88 , $11.57 , $11.57 , $11.57 , $10.92 , N/A , $11.86 , $12.21 , $10.92 , $11.95 , $11.95 , $12.21 , $12.34 , $10.51 , $11.57 , $10.92 , $10.15 , N/A , $10.40 , $10.40 , $12.21 , $11.03 , $10.15 , $12.34 
 Pro CT Head/Brain W/O Dye ,CPT® 70450,0972 - PRO FEE/RAD/DX,N/A,N/A, $458.00 , $297.70 , $750.33 , $108.41 , $193.07 , $553.34 , $869.88 , $425.94 , $412.20 , $412.20 , $366.40 , $366.40 , $193.07 , $422.87 , $435.10 , $412.20 , $412.20 , $412.20 , $425.94 , $439.68 , $630.63 , $389.30 , $947.61 , $751.64 , N/A , $564.14 , $564.14 , $435.10 , $653.01 , $108.41 , $947.61 
Removal of Anal Tabs,CPT® 46230,N/A,N/A,N/A," $1,800.00 "," $1,170.00 "," $1,055.93 ", $164.95 , $76.84 , $820.37 , $838.30 ," $1,674.00 "," $1,620.00 "," $1,620.00 "," $1,440.00 "," $1,440.00 ", $76.84 ," $1,661.94 "," $1,710.00 "," $1,620.00 "," $1,620.00 "," $1,620.00 "," $1,674.00 "," $1,728.00 ", $754.95 ," $1,530.00 ", $924.15 , $975.94 , N/A , $836.38 , $836.38 ," $1,710.00 ", $874.76 , $76.84 ," $1,728.00 "
 LEVOTHYROXINE SODIUM 175 MCG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6957-61,1 tablet, $5.19 , $3.37 , $4.36 , N/A , N/A , $4.19 , $4.67 , $4.39 , $4.67 , $4.67 , $4.67 , $4.41 , N/A , $4.79 , $4.93 , $4.41 , $4.83 , $4.83 , $4.93 , $4.98 , $4.25 , $4.67 , $4.41 , $4.10 , N/A , $4.20 , $4.20 , $4.93 , $4.45 , $4.10 , $4.98 
"Urinalysis, Volume Measure",CPT® 81050,N/A,N/A,N/A, $53.00 , $34.45 , N/A , $3.71 , $3.71 , $16.96 , $20.29 , $49.29 , $47.70 , $47.70 , $42.40 , $42.40 , $3.71 , $48.93 , $50.35 , $47.70 , $47.70 , $47.70 , $49.29 , $50.88 , $24.31 , $45.05 , $19.46 , $10.90 , N/A , $15.83 , $15.83 , $50.35 , $17.30 , $3.71 , $50.88 
 Pro Cltx Sprcndylr/Trnscndylr Fem Fx W/O Mnpj ,CPT® 27501,0981 - PRO FEE/ER,N/A,N/A," $2,930.00 "," $1,904.50 "," $3,045.32 ", $478.84 , $451.87 ," $2,402.73 "," $2,405.11 "," $2,724.90 "," $2,637.00 "," $2,637.00 "," $2,344.00 "," $2,344.00 ", $451.87 ," $2,705.27 "," $2,783.50 "," $2,637.00 "," $2,637.00 "," $2,637.00 "," $2,724.90 "," $2,812.80 "," $2,825.08 "," $2,490.50 "," $2,654.69 "," $2,834.30 ", N/A ," $2,449.62 "," $2,449.62 "," $2,783.50 "," $2,879.15 ", $451.87 ," $3,045.32 "
 DIPYRIDAMOLE 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,64980-0133-01,1 tablet, $7.30 , $4.75 , $6.13 , N/A , N/A , $5.90 , $6.57 , $6.18 , $6.57 , $6.57 , $6.57 , $6.21 , N/A , $6.74 , $6.94 , $6.21 , $6.79 , $6.79 , $6.94 , $7.01 , $5.97 , $6.57 , $6.21 , $5.77 , N/A , $5.91 , $5.91 , $6.94 , $6.26 , $5.77 , $7.01 
Sigmoidoscopy Flx Ablation Tumor Polyp/Oth Les,CPT® 45346,N/A,N/A,N/A," $2,218.00 "," $1,441.70 ", $982.48 , $152.15 , $265.94 , $856.55 , $891.41 ," $2,062.74 "," $1,996.20 "," $1,996.20 "," $1,774.40 "," $1,774.40 ", $265.94 ," $2,047.88 "," $2,107.10 "," $1,996.20 "," $1,996.20 "," $1,996.20 "," $2,062.74 "," $2,129.28 ", $706.64 ," $1,885.30 ", $838.72 , $935.76 , N/A , $873.27 , $873.27 ," $2,107.10 ", $913.34 , $152.15 ," $2,129.28 "
" Sodium, Urine, Random Beaker1 ",CPT® 84300,0301 - LAB/CHEMISTRY,N/A,N/A, $71.00 , $46.15 , $59.64 , $5.16 , $5.16 , $57.37 , $63.90 , $60.11 , $63.90 , $63.90 , $63.90 , $60.35 , $5.06 , $65.55 , $67.45 , $60.35 , $66.03 , $66.03 , $67.45 , $68.16 , $58.09 , $63.90 , $60.35 , $56.09 , N/A , $57.46 , $57.46 , $67.45 , $60.93 , $5.06 , $68.16 
Vitamin B12 Injection,HCPCS J3420,N/A,N/A,N/A, $12.00 , $7.80 , N/A , $1.34 , $2.09 , N/A , N/A , $11.16 , $10.80 , $10.80 , $9.60 , $9.60 , $2.09 , $11.08 , $11.40 , $10.80 , $10.80 , $10.80 , $11.16 , $11.52 , $2.57 , $10.20 , $1.30 , $2.54 , N/A , N/A , N/A , $11.40 , N/A , $1.30 , $11.52 
Drainage Rectal Abscess,46050,N/A,N/A,N/A," $1,319.00 ", $857.35 , $612.76 , $96.47 , $68.62 , $463.98 , $481.35 ," $1,226.67 "," $1,187.10 "," $1,187.10 "," $1,055.20 "," $1,055.20 ", $68.62 ," $1,217.83 "," $1,253.05 "," $1,187.10 "," $1,187.10 "," $1,187.10 "," $1,226.67 "," $1,266.24 ", $436.34 ," $1,121.15 ", $529.87 , $552.66 , N/A , $473.03 , $473.03 ," $1,253.05 ", $494.75 , $68.62 ," $1,266.24 "
"Repair Lip,<1/2 Vert Height",40652,N/A,N/A,N/A," $2,052.00 "," $1,333.80 "," $2,193.43 ", $347.44 , $539.88 ," $1,707.57 "," $1,742.95 "," $1,908.36 "," $1,846.80 "," $1,846.80 "," $1,641.60 "," $1,641.60 ", $539.88 ," $1,894.61 "," $1,949.40 "," $1,846.80 "," $1,846.80 "," $1,846.80 "," $1,908.36 "," $1,969.92 "," $1,562.82 "," $1,744.20 "," $1,912.52 "," $2,020.07 ", N/A ," $1,740.89 "," $1,740.89 "," $1,949.40 "," $1,820.78 ", $347.44 ," $2,193.43 "
"Hep a Ab Test, Igm",CPT® 86709,N/A,N/A,N/A, $111.00 , $72.15 , N/A , $11.49 , $11.49 , $63.69 , $76.16 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $11.49 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $75.19 , $94.35 , $72.98 , $40.82 , N/A , $59.44 , $59.44 , $105.45 , $64.96 , $11.49 , $106.56 
 Ankle Minimum 3 Views ,CPT® 73610,0320 - DX X-RAY,N/A,N/A, $335.00 , $217.75 , $281.40 , $36.30 , $30.19 , $270.68 , $301.50 , $283.61 , $301.50 , $301.50 , $301.50 , $284.75 , $29.60 , $309.31 , $318.25 , $284.75 , $311.55 , $311.55 , $318.25 , $321.60 , $274.10 , $301.50 , $284.75 , $264.65 , N/A , $271.12 , $271.12 , $318.25 , $287.46 , $29.60 , $321.60 
Removal of Ovary(S),58940,N/A,N/A,N/A," $3,856.00 "," $2,506.40 "," $2,618.80 ", $529.82 , $453.02 ," $2,125.37 "," $2,110.65 "," $3,586.08 "," $3,470.40 "," $3,470.40 "," $3,084.80 "," $3,084.80 ", $453.02 ," $3,560.24 "," $3,663.20 "," $3,470.40 "," $3,470.40 "," $3,470.40 "," $3,586.08 "," $3,701.76 "," $2,710.00 "," $3,277.60 "," $2,783.14 "," $2,133.84 ", N/A ," $2,166.84 "," $2,166.84 "," $3,663.20 "," $2,598.98 ", $453.02 ," $3,701.76 "
 Organic Disturbances And Intellectual Disability ,MS DRG V40 (FY2023) 884,N/A,N/A,N/A," $20,288.14 "," $13,187.29 "," $17,042.04 ", N/A , N/A ," $16,392.82 "," $18,259.33 "," $17,175.94 "," $18,259.33 "," $18,259.33 "," $18,259.33 "," $17,244.92 ", N/A ," $18,732.04 "," $19,273.73 "," $17,244.92 "," $18,867.97 "," $18,867.97 "," $19,273.73 "," $19,476.61 "," $16,599.76 "," $18,259.33 "," $17,244.92 "," $16,027.63 ", N/A ," $16,419.19 "," $16,419.19 "," $19,273.73 "," $17,409.25 "," $16,027.63 "," $19,476.61 "
Tympanometry,CPT® 92567,N/A,N/A,N/A, $106.00 , $68.90 , $24.67 , $10.64 , $17.84 , $24.58 , $23.95 , $98.58 , $95.40 , $95.40 , $84.80 , $84.80 , $17.84 , $97.87 , $100.70 , $95.40 , $95.40 , $95.40 , $98.58 , $101.76 , $31.73 , $90.10 , $31.43 , $41.66 , N/A , $25.06 , $25.06 , $100.70 , $29.22 , $10.64 , $101.76 
Bx Synovium Tars/Tarsometa Jt,CPT® 28050,N/A,N/A,N/A," $3,106.00 "," $2,018.90 "," $1,734.79 ", $272.11 , $461.04 ," $1,530.70 "," $1,382.99 "," $2,888.58 "," $2,795.40 "," $2,795.40 "," $2,484.80 "," $2,484.80 ", $461.04 ," $2,867.77 "," $2,950.70 "," $2,795.40 "," $2,795.40 "," $2,795.40 "," $2,888.58 "," $2,981.76 "," $1,611.70 "," $2,640.10 "," $1,495.05 "," $1,652.95 ", N/A ," $1,560.57 "," $1,560.57 "," $2,950.70 "," $1,834.23 ", $272.11 ," $2,981.76 "
" Complex Repair Eyelids,Nose,Ears,Lips 2.6-7.5cm ",CPT® 13152,0981 - PRO FEE/ER,N/A,N/A," $2,554.00 "," $1,660.10 "," $1,075.18 ", $321.34 , $282.60 , $954.01 , $856.35 ," $2,375.22 "," $2,298.60 "," $2,298.60 "," $2,043.20 "," $2,043.20 ", $282.60 ," $2,358.11 "," $2,426.30 "," $2,298.60 "," $2,298.60 "," $2,298.60 "," $2,375.22 "," $2,451.84 "," $1,184.60 "," $2,170.90 "," $1,705.57 "," $1,220.27 ", N/A , $972.62 , $972.62 ," $2,426.30 "," $1,127.91 ", $282.60 ," $2,451.84 "
 Fac Injection Aa&/Strd Other Peripheral Nerve/Branch ,CPT® 64450,0761 - TREATMENT ROOM,N/A,N/A," $1,074.00 ", $698.10 , $902.16 , $40.26 , $113.79 , $867.79 , $966.60 , $909.25 , $966.60 , $966.60 , $966.60 , $912.90 , $111.56 , $991.62 ," $1,020.30 ", $912.90 , $998.82 , $998.82 ," $1,020.30 "," $1,031.04 ", $878.75 , $966.60 , $912.90 , $848.46 , N/A , $869.19 , $869.19 ," $1,020.30 ", $921.60 , $40.26 ," $1,031.04 "
"Cystoscopy,Dil Bladder,Local Anesth",CPT® 52265,N/A,N/A,N/A," $2,615.00 "," $1,699.75 ", $868.54 , $153.03 , $166.31 , $796.69 , $746.12 ," $2,431.95 "," $2,353.50 "," $2,353.50 "," $2,092.00 "," $2,092.00 ", $166.31 ," $2,414.43 "," $2,484.25 "," $2,353.50 "," $2,353.50 "," $2,353.50 "," $2,431.95 "," $2,510.40 ", $874.36 ," $2,222.75 ", $852.78 , $995.60 , N/A , $812.23 , $812.23 ," $2,484.25 ", $954.67 , $153.03 ," $2,510.40 "
"PFIZER-BIONTECH 30 mcg/0.3 mL DOSAGE, BOOSTER DOSE",CPT® 0054A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , N/A , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , N/A , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $76.25 , $128.66 , N/A , $79.82 , $79.82 , $66.50 , $92.91 , $56.00 , $128.66 
Prq Trluml Coronary Angioplasty Addl Branch,CPT® 92921,N/A,N/A,N/A," $2,511.00 "," $1,632.15 ", N/A , N/A , $161.36 , N/A , N/A ," $2,335.23 "," $2,259.90 "," $2,259.90 "," $2,008.80 "," $2,008.80 ", $161.36 ," $2,318.41 "," $2,385.45 "," $2,259.90 "," $2,259.90 "," $2,259.90 "," $2,335.23 "," $2,410.56 ", N/A ," $2,134.35 ", N/A , N/A , N/A , N/A , N/A ," $2,385.45 ", N/A , $161.36 ," $2,410.56 "
Vitrectomy Pars Plana Remove Int Memb Retina,CPT® 67042,N/A,N/A,N/A," $10,544.00 "," $6,853.60 "," $7,028.84 "," $1,101.21 ", $960.76 ," $6,531.57 "," $7,951.24 "," $9,805.92 "," $9,489.60 "," $9,489.60 "," $8,435.20 "," $8,435.20 ", $960.76 ," $9,735.28 "," $10,016.80 "," $9,489.60 "," $9,489.60 "," $9,489.60 "," $9,805.92 "," $10,122.24 "," $9,669.74 "," $8,962.40 "," $8,179.93 "," $8,284.40 ", N/A ," $6,659.01 "," $6,659.01 "," $10,016.80 "," $7,350.68 ", $960.76 ," $10,122.24 "
"Knee Scope,Part Synovect",29875,N/A,N/A,N/A," $2,306.00 "," $1,498.90 "," $3,028.48 ", $475.67 , $427.24 ," $2,393.20 "," $2,393.57 "," $2,144.58 "," $2,075.40 "," $2,075.40 "," $1,844.80 "," $1,844.80 ", $427.24 ," $2,129.13 "," $2,190.70 "," $2,075.40 "," $2,075.40 "," $2,075.40 "," $2,144.58 "," $2,213.76 "," $2,817.13 "," $1,960.10 "," $2,640.41 "," $2,823.34 ", N/A ," $2,439.90 "," $2,439.90 "," $2,190.70 "," $2,867.74 ", $427.24 ," $3,028.48 "
" Application of Finger Splint, Static -Mh ",CPT® 29130,0761 - TREATMENT ROOM,N/A,N/A, $141.00 , $91.65 , $118.44 , $27.56 , $10.31 , $113.93 , $126.90 , $119.37 , $126.90 , $126.90 , $126.90 , $119.85 , $10.11 , $130.19 , $133.95 , $119.85 , $131.13 , $131.13 , $133.95 , $135.36 , $115.37 , $126.90 , $119.85 , $111.39 , N/A , $114.11 , $114.11 , $133.95 , $120.99 , $10.11 , $135.36 
Inpt Telehealth Consult 30m,HCPCS G0425,N/A,N/A,N/A, $320.00 , $208.00 , $188.04 , $89.66 , N/A , $186.32 , N/A , $297.60 , $288.00 , $288.00 , $256.00 , $256.00 , N/A , $295.46 , $304.00 , $288.00 , $288.00 , $288.00 , $297.60 , $307.20 , $278.27 , $272.00 , $189.44 , $375.40 , N/A , $189.96 , $189.96 , $304.00 , $237.43 , $89.66 , $375.40 
Prep Site T/a/L Addl 100 Sq Cm/1pct,CPT® 15003,N/A,N/A,N/A, $418.00 , $271.70 , $140.28 , $41.42 , $54.78 , $124.64 , $119.24 , $388.74 , $376.20 , $376.20 , $334.40 , $334.40 , $54.78 , $385.94 , $397.10 , $376.20 , $376.20 , $376.20 , $388.74 , $401.28 , $155.20 , $355.30 , $240.85 , $157.89 , N/A , $127.07 , $127.07 , $397.10 , $147.36 , $41.42 , $401.28 
 MITOXANTRONE HCL 20 MG/10ML IV CONC ,HCPCS J9293,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0132-10,10 mL," $1,198.65 ", $779.12 ," $1,006.87 ", $29.64 , $55.98 , $968.51 ," $1,078.79 "," $1,014.78 "," $1,078.79 "," $1,078.79 "," $1,078.79 "," $1,018.85 ", $54.88 ," $1,106.71 "," $1,138.72 "," $1,018.85 "," $1,114.74 "," $1,114.74 "," $1,138.72 "," $1,150.70 ", $980.74 ," $1,078.79 "," $1,018.85 ", $946.93 , N/A , $970.07 , $970.07 ," $1,138.72 "," $1,028.56 ", $29.64 ," $1,150.70 "
 SERTRALINE HCL 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60687-0231-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Hepb Screen High Risk Indiv,HCPCS G0499,N/A,N/A,N/A, $337.00 , $219.05 , N/A , $28.84 , N/A , N/A , N/A , $313.41 , $303.30 , $303.30 , $269.60 , $269.60 , N/A , $311.15 , $320.15 , $303.30 , $303.30 , $303.30 , $313.41 , $323.52 , $188.77 , $286.45 , $53.63 , $102.50 , N/A , $52.27 , $52.27 , $320.15 , $65.32 , $28.84 , $323.52 
 Fac Test of Stool to Detect Blood ,CPT® 82270,0301 - LAB/CHEMISTRY,N/A,N/A, $40.00 , $26.00 , $33.60 , $4.47 , $3.69 , $32.32 , $36.00 , $33.86 , $36.00 , $36.00 , $36.00 , $34.00 , $3.62 , $36.93 , $38.00 , $34.00 , $37.20 , $37.20 , $38.00 , $38.40 , $32.73 , $36.00 , $34.00 , $31.60 , N/A , $32.37 , $32.37 , $38.00 , $34.32 , $3.62 , $38.40 
Surgical Path Level 6,CPT® 88309,N/A,N/A,N/A," $1,518.00 ", $986.70 ," $1,552.41 ", $430.94 , $154.81 ," $1,841.97 "," $2,053.31 "," $1,411.74 "," $1,366.20 "," $1,366.20 "," $1,214.40 "," $1,214.40 ", $154.81 ," $1,401.57 "," $1,442.10 "," $1,366.20 "," $1,366.20 "," $1,366.20 "," $1,411.74 "," $1,457.28 "," $2,802.83 "," $1,290.30 "," $2,142.45 "," $1,396.67 ", N/A ," $1,719.04 "," $1,719.04 "," $1,442.10 "," $1,889.16 ", $154.81 ," $2,802.83 "
"Revision of Colostomy,Simple",CPT® 44340,N/A,N/A,N/A," $4,135.00 "," $2,687.75 "," $3,777.93 ", $588.63 , $612.00 ," $2,948.20 "," $3,009.67 "," $3,845.55 "," $3,721.50 "," $3,721.50 "," $3,308.00 "," $3,308.00 ", $612.00 ," $3,817.85 "," $3,928.25 "," $3,721.50 "," $3,721.50 "," $3,721.50 "," $3,845.55 "," $3,969.60 "," $2,693.16 "," $3,514.75 "," $3,332.63 "," $3,491.62 ", N/A ," $3,005.72 "," $3,005.72 "," $3,928.25 "," $3,143.67 ", $588.63 ," $3,969.60 "
" Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC ",MS DRG V40 (FY2023) 392,N/A,N/A,N/A," $14,247.11 "," $9,260.62 "," $11,967.57 ", N/A , N/A ," $11,511.66 "," $12,822.40 "," $12,061.60 "," $12,822.40 "," $12,822.40 "," $12,822.40 "," $12,110.04 ", N/A ," $13,154.36 "," $13,534.75 "," $12,110.04 "," $13,249.81 "," $13,249.81 "," $13,534.75 "," $13,677.23 "," $11,656.99 "," $12,822.40 "," $12,110.04 "," $11,255.22 ", N/A ," $11,530.19 "," $11,530.19 "," $13,534.75 "," $12,225.45 "," $11,255.22 "," $13,677.23 "
 LORAZEPAM 4 MG/ML IJ SOLN ,HCPCS J2060,0636 - DRUGS REQUIRING DETAILED CODIN,00641-6049-25,1 mL, $20.24 , $13.16 , $17.00 , $0.87 , $1.20 , $16.35 , $18.22 , $17.14 , $18.22 , $18.22 , $18.22 , $17.20 , $1.18 , $18.69 , $19.23 , $17.20 , $18.82 , $18.82 , $19.23 , $19.43 , $16.56 , $18.22 , $17.20 , $15.99 , N/A , $16.38 , $16.38 , $19.23 , $17.37 , $0.87 , $19.43 
 Fac Ho W/O Joints Cf ,HCPCS L3919,0274 - PROSTHETIC DEV,N/A,N/A, $406.00 , $263.90 , $341.04 , $288.30 , $36.92 , $328.05 , $365.40 , $343.72 , $365.40 , $365.40 , $365.40 , $345.10 , $36.20 , $374.86 , $385.70 , $345.10 , $377.58 , $377.58 , $385.70 , $389.76 , $332.19 , $365.40 , $345.10 , $320.74 , N/A , $328.58 , $328.58 , $385.70 , $348.39 , $36.20 , $389.76 
MRI Brain Combo,CPT® 70553,N/A,N/A,N/A," $8,085.00 "," $5,255.25 "," $2,292.92 ", $327.49 , $644.90 ," $2,822.90 "," $2,971.00 "," $7,519.05 "," $7,276.50 "," $7,276.50 "," $6,468.00 "," $6,468.00 ", $644.90 ," $7,464.88 "," $7,680.75 "," $7,276.50 "," $7,276.50 "," $7,276.50 "," $7,519.05 "," $7,761.60 "," $4,060.76 "," $6,872.25 "," $3,237.68 "," $3,491.99 ", N/A ," $2,877.98 "," $2,877.98 "," $7,680.75 "," $3,385.86 ", $327.49 ," $7,761.60 "
 Fac Interstitial Dev Plmt Radiation Therapy 1/Mlt ,CPT® 49411,0761 - TREATMENT ROOM,N/A,N/A," $1,992.00 "," $1,294.80 "," $1,673.28 ", $177.00 , $430.67 ," $1,609.54 "," $1,792.80 "," $1,686.43 "," $1,792.80 "," $1,792.80 "," $1,792.80 "," $1,693.20 ", $422.23 ," $1,839.21 "," $1,892.40 "," $1,693.20 "," $1,852.56 "," $1,852.56 "," $1,892.40 "," $1,912.32 "," $1,629.85 "," $1,792.80 "," $1,693.20 "," $1,573.68 ", N/A ," $1,612.13 "," $1,612.13 "," $1,892.40 "," $1,709.34 ", $177.00 ," $1,912.32 "
"Lap,Vag Hyst,Uterus >250gms,Salp-Ooph",CPT® 58554,N/A,N/A,N/A," $7,830.00 "," $5,089.50 "," $6,125.45 "," $1,238.13 "," $1,171.49 "," $5,382.50 "," $5,336.31 "," $7,281.90 "," $7,047.00 "," $7,047.00 "," $6,264.00 "," $6,264.00 "," $1,171.49 "," $7,229.44 "," $7,438.50 "," $7,047.00 "," $7,047.00 "," $7,047.00 "," $7,281.90 "," $7,516.80 "," $6,433.43 "," $6,655.50 "," $7,025.64 "," $5,394.37 ", N/A ," $5,487.52 "," $5,487.52 "," $7,438.50 "," $6,581.95 "," $1,171.49 "," $7,516.80 "
"H. Pylori;Anal Urease Act,Non-Isotope",CPT® 83013,N/A,N/A,N/A, $281.00 , $182.65 , N/A , $68.71 , $68.71 , $381.07 , $455.87 , $261.33 , $252.90 , $252.90 , $224.80 , $224.80 , $68.71 , $259.45 , $266.95 , $252.90 , $252.90 , $252.90 , $261.33 , $269.76 , $449.78 , $238.85 , $441.14 , $244.24 , N/A , $355.64 , $355.64 , $266.95 , $388.64 , $68.71 , $455.87 
 Fac App Skn Sub Grft T/a/L Area/>100scm 1st 100scm ,CPT® 15273,0761 - TREATMENT ROOM,N/A,N/A," $2,281.00 "," $1,482.65 "," $1,916.04 ", $182.21 , $227.35 ," $1,843.05 "," $2,052.90 "," $1,931.09 "," $2,052.90 "," $2,052.90 "," $2,052.90 "," $1,938.85 ", $222.89 ," $2,106.05 "," $2,166.95 "," $1,938.85 "," $2,121.33 "," $2,121.33 "," $2,166.95 "," $2,189.76 "," $1,866.31 "," $2,052.90 "," $1,938.85 "," $1,801.99 ", N/A ," $1,846.01 "," $1,846.01 "," $2,166.95 "," $1,957.33 ", $182.21 ," $2,189.76 "
 Pro Tx Tarsal B1 Fx Xcp Talus&Calcn W/O Mnpj ,CPT® 28450,0982 - PRO FEE/OUTPT,N/A,N/A," $1,439.00 ", $935.35 ," $1,193.60 ", $188.03 , $144.17 , $936.03 , $952.57 ," $1,338.27 "," $1,295.10 "," $1,295.10 "," $1,151.20 "," $1,151.20 ", $144.17 ," $1,328.63 "," $1,367.05 "," $1,295.10 "," $1,295.10 "," $1,295.10 "," $1,338.27 "," $1,381.44 "," $1,100.58 "," $1,223.15 "," $1,038.33 "," $1,108.30 ", N/A , $954.29 , $954.29 ," $1,367.05 "," $1,121.63 ", $144.17 ," $1,381.44 "
 EPINEPHRINE 1 MG/ML PF INJECTION (ANES) ,HCPCS J0171,0636 - DRUGS REQUIRING DETAILED CODIN,54288-0103-10,0.1 mL, $16.68 , $10.84 , $14.01 , $0.74 , $0.75 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.74 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.74 , $16.01 
 PNEUMOCOCCAL 13-VAL CONJ VACC IM SUSP ,HCPCS 90670,0636 - DRUGS REQUIRING DETAILED CODIN,00005-1971-02,0.5 mL, $665.41 , $432.52 , $558.94 , $263.15 , $195.29 , $537.65 , $598.87 , $563.34 , $598.87 , $598.87 , $598.87 , $565.60 , $191.46 , $614.37 , $632.14 , $565.60 , $618.83 , $618.83 , $632.14 , $638.79 , $544.44 , $598.87 , $565.60 , $525.67 , N/A , $538.52 , $538.52 , $632.14 , $570.99 , $191.46 , $638.79 
Assay for Theophylline,CPT® 80198,N/A,N/A,N/A, $130.00 , $84.50 , N/A , $14.42 , $14.42 , $80.03 , $95.76 , $120.90 , $117.00 , $117.00 , $104.00 , $104.00 , $14.42 , $120.03 , $123.50 , $117.00 , $117.00 , $117.00 , $120.90 , $124.80 , $94.42 , $110.50 , $92.45 , $51.28 , N/A , $74.69 , $74.69 , $123.50 , $81.62 , $14.42 , $124.80 
 ACETAZOLAMIDE 250 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6663-61,1 tablet, $22.26 , $14.47 , $18.70 , N/A , N/A , $17.99 , $20.03 , $18.85 , $20.03 , $20.03 , $20.03 , $18.92 , N/A , $20.55 , $21.15 , $18.92 , $20.70 , $20.70 , $21.15 , $21.37 , $18.21 , $20.03 , $18.92 , $17.59 , N/A , $18.02 , $18.02 , $21.15 , $19.10 , $17.59 , $21.37 
 Pro Aspir/Rls Flu Pars Plna ,CPT® 67015,0982 - PRO FEE/OUTPT,N/A,N/A," $5,432.00 "," $3,530.80 "," $3,749.59 ", $587.04 , $515.48 ," $3,280.69 "," $3,070.50 "," $5,051.76 "," $4,888.80 "," $4,888.80 "," $4,345.60 "," $4,345.60 ", $515.48 ," $5,015.37 "," $5,160.40 "," $4,888.80 "," $4,888.80 "," $4,888.80 "," $5,051.76 "," $5,214.72 "," $5,098.36 "," $4,617.20 "," $3,154.23 "," $4,172.45 ", N/A ," $3,344.70 "," $3,344.70 "," $5,160.40 "," $3,692.12 ", $515.48 ," $5,214.72 "
"Dural Graft Repair,Spine Defect",CPT® 63710,N/A,N/A,N/A," $7,193.00 "," $4,675.45 "," $5,117.27 ", $998.62 ," $1,506.65 "," $5,894.89 "," $5,758.01 "," $6,689.49 "," $6,473.70 "," $6,473.70 "," $5,754.40 "," $5,754.40 "," $1,506.65 "," $6,641.30 "," $6,833.35 "," $6,473.70 "," $6,473.70 "," $6,473.70 "," $6,689.49 "," $6,905.28 "," $5,526.89 "," $6,114.05 "," $5,862.43 "," $6,206.34 ", N/A ," $6,009.90 "," $6,009.90 "," $6,833.35 "," $6,447.21 ", $998.62 ," $6,905.28 "
"Fix Non/Malunion Femur,W Graft",CPT® 27472,N/A,N/A,N/A," $8,680.00 "," $5,642.00 "," $7,623.79 "," $1,193.44 "," $1,306.26 "," $6,107.01 "," $6,049.44 "," $8,072.40 "," $7,812.00 "," $7,812.00 "," $6,944.00 "," $6,944.00 "," $1,306.26 "," $8,014.24 "," $8,246.00 "," $7,812.00 "," $7,812.00 "," $7,812.00 "," $8,072.40 "," $8,332.80 "," $7,105.67 "," $7,378.00 "," $6,695.59 "," $7,167.78 ", N/A ," $6,226.17 "," $6,226.17 "," $8,246.00 "," $7,317.95 "," $1,193.44 "," $8,332.80 "
"Fitting of Glasses,Bifocal",CPT® 92341,N/A,N/A,N/A, $61.00 , $39.65 , N/A , $38.68 , $30.60 , $42.62 , $41.65 , $56.73 , $54.90 , $54.90 , $48.80 , $48.80 , $30.60 , $56.32 , $57.95 , $54.90 , $54.90 , $54.90 , $56.73 , $58.56 , N/A , $51.85 , $69.95 , $50.45 , N/A , $43.45 , $43.45 , $57.95 , $51.71 , $30.60 , $69.95 
 Fac Rplcmt Compl Tun Cvc W/O Subq Port/Pmp ,CPT® 36581,0761 - TREATMENT ROOM,N/A,N/A," $4,570.00 "," $2,970.50 "," $3,838.80 ", $173.23 , $938.62 ," $3,692.56 "," $4,113.00 "," $3,868.96 "," $4,113.00 "," $4,113.00 "," $4,113.00 "," $3,884.50 ", $920.22 ," $4,219.48 "," $4,341.50 "," $3,884.50 "," $4,250.10 "," $4,250.10 "," $4,341.50 "," $4,387.20 "," $3,739.17 "," $4,113.00 "," $3,884.50 "," $3,610.30 ", N/A ," $3,698.50 "," $3,698.50 "," $4,341.50 "," $3,921.52 ", $173.23 ," $4,387.20 "
"Closed Rx Talus Fx,Manipulatn",CPT® 28435,N/A,N/A,N/A," $2,304.00 "," $1,497.60 "," $2,020.92 ", $319.64 , $307.34 ," $1,396.56 "," $1,566.98 "," $2,142.72 "," $2,073.60 "," $2,073.60 "," $1,843.20 "," $1,843.20 ", $307.34 ," $2,127.28 "," $2,188.80 "," $2,073.60 "," $2,073.60 "," $2,073.60 "," $2,142.72 "," $2,211.84 "," $1,686.24 "," $1,958.40 "," $1,723.41 "," $1,841.35 ", N/A ," $1,423.81 "," $1,423.81 "," $2,188.80 "," $1,673.47 ", $307.34 ," $2,211.84 "
 Pro X-Ray Exam of Neck Spine ,CPT® 72052,0972 - PRO FEE/RAD/DX,N/A,N/A, $223.00 , $144.95 , $350.67 , $61.26 , $62.79 , $265.81 , $372.87 , $207.39 , $200.70 , $200.70 , $178.40 , $178.40 , $62.79 , $205.90 , $211.85 , $200.70 , $200.70 , $200.70 , $207.39 , $214.08 , $341.82 , $189.55 , $362.10 , $282.37 , N/A , $270.99 , $270.99 , $211.85 , $313.70 , $61.26 , $372.87 
 Pro Mntr Ntrstl Flu Press Dev Cmprt Synd ,CPT® 20950,0981 - PRO FEE/ER,N/A,N/A, $558.00 , $362.70 , $530.40 , $83.05 , $190.55 , $439.01 , $444.26 , $518.94 , $502.20 , $502.20 , $446.40 , $446.40 , $190.55 , $515.20 , $530.10 , $502.20 , $502.20 , $502.20 , $518.94 , $535.68 , $494.55 , $474.30 , $488.83 , $517.30 , N/A , $447.57 , $447.57 , $530.10 , $526.07 , $83.05 , $535.68 
" Inj Anesthetic Femoral Nerve, Sg ",CPT® 64447,0761 - TREATMENT ROOM,N/A,N/A," $1,175.00 ", $763.75 , $987.00 , $60.98 , $69.44 , $949.40 ," $1,057.50 ", $994.76 ," $1,057.50 "," $1,057.50 "," $1,057.50 ", $998.75 , $68.08 ," $1,084.88 "," $1,116.25 ", $998.75 ," $1,092.75 "," $1,092.75 "," $1,116.25 "," $1,128.00 ", $961.39 ," $1,057.50 ", $998.75 , $928.25 , N/A , $950.93 , $950.93 ," $1,116.25 "," $1,008.27 ", $60.98 ," $1,128.00 "
 BUPIVACAINE HCL (PF) 0.5 % IJ SOLN ,HCPCS J0665,0636 - DRUGS REQUIRING DETAILED CODIN,00409-1162-02,30 mL, $16.68 , $10.84 , $14.01 , N/A , N/A , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , N/A , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $13.18 , $16.01 
 Pro Mod Sed Same Phys/Qhp Each Addl 15 Mins ,CPT® 99153,0981 - PRO FEE/ER,N/A,N/A, $103.00 , $66.95 , $23.95 , $10.39 , $8.53 , $22.93 , $23.60 , $95.79 , $92.70 , $92.70 , $82.40 , $82.40 , $8.53 , $95.10 , $97.85 , $92.70 , $92.70 , $92.70 , $95.79 , $98.88 , $31.53 , $87.55 , $33.32 , $40.46 , N/A , $23.38 , $23.38 , $97.85 , $27.25 , $8.53 , $98.88 
 Fac Oligoclonal Bands ,CPT® 83916,0301 - LAB/CHEMISTRY,N/A,N/A, $193.00 , $125.45 , $162.12 , $27.94 , $27.92 , $155.94 , $173.70 , $163.39 , $173.70 , $173.70 , $173.70 , $164.05 , $27.37 , $178.20 , $183.35 , $164.05 , $179.49 , $179.49 , $183.35 , $185.28 , $157.91 , $173.70 , $164.05 , $152.47 , N/A , $156.19 , $156.19 , $183.35 , $165.61 , $27.37 , $185.28 
Lens Sphcy Trifocal 4.0/.12-,HCPCS V2303,N/A,N/A,N/A, $90.00 , $58.50 , N/A , $80.27 , N/A , N/A , N/A , $83.70 , $81.00 , $81.00 , $72.00 , $72.00 , N/A , $83.10 , $85.50 , $81.00 , $81.00 , $81.00 , $83.70 , $86.40 , N/A , $76.50 , $90.00 , $72.94 , N/A , N/A , N/A , $85.50 , N/A , $72.00 , $90.00 
Injection Aa&/Strd Intercostal Nrv Ea Addl Lvl,CPT® 64421,N/A,N/A,N/A," $2,512.00 "," $1,632.80 ", $123.14 , $23.62 , $46.08 , $514.45 , $512.66 ," $2,336.16 "," $2,260.80 "," $2,260.80 "," $2,009.60 "," $2,009.60 ", $46.08 ," $2,319.33 "," $2,386.40 "," $2,260.80 "," $2,260.80 "," $2,260.80 "," $2,336.16 "," $2,411.52 ", $133.67 ," $2,135.20 ", $503.11 , $557.55 , N/A , $524.49 , $524.49 ," $2,386.40 ", $562.66 , $23.62 ," $2,411.52 "
Hallux Rigidus W/Cheilectomy 1st Mp Jt W/O Implt,28289,N/A,N/A,N/A," $4,911.00 "," $3,192.15 "," $2,833.68 ", $446.07 , $327.43 ," $2,688.04 "," $2,688.69 "," $4,567.23 "," $4,419.90 "," $4,419.90 "," $3,928.80 "," $3,928.80 ", $327.43 ," $4,534.33 "," $4,665.45 "," $4,419.90 "," $4,419.90 "," $4,419.90 "," $4,567.23 "," $4,714.56 "," $2,630.44 "," $4,174.35 "," $2,925.86 "," $2,700.48 ", N/A ," $2,740.49 "," $2,740.49 "," $4,665.45 "," $3,221.06 ", $327.43 ," $4,714.56 "
 Pro Spinal Disk Surgery Add-On ,CPT® 63035,0982 - PRO FEE/OUTPT,N/A,N/A," $1,392.00 ", $904.80 , $878.49 , $209.39 , $268.05 ," $1,043.99 ", $993.16 ," $1,294.56 "," $1,252.80 "," $1,252.80 "," $1,113.60 "," $1,113.60 ", $268.05 ," $1,285.23 "," $1,322.40 "," $1,252.80 "," $1,252.80 "," $1,252.80 "," $1,294.56 "," $1,336.32 ", $955.99 ," $1,183.20 "," $1,009.78 "," $1,090.14 ", N/A ," $1,064.37 "," $1,064.37 "," $1,322.40 "," $1,141.81 ", $209.39 ," $1,336.32 "
"Plastic Repr Cervix,Vag Apprch",CPT® 57720,N/A,N/A,N/A," $1,838.00 "," $1,194.70 "," $1,596.15 ", $322.80 , $307.34 ," $1,249.99 "," $1,257.70 "," $1,709.34 "," $1,654.20 "," $1,654.20 "," $1,470.40 "," $1,470.40 ", $307.34 ," $1,697.03 "," $1,746.10 "," $1,654.20 "," $1,654.20 "," $1,654.20 "," $1,709.34 "," $1,764.48 "," $1,644.83 "," $1,562.30 "," $1,648.48 "," $1,255.86 ", N/A ," $1,274.38 "," $1,274.38 "," $1,746.10 "," $1,528.53 ", $307.34 ," $1,764.48 "
 ARIPIPRAZOLE 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,65162-0898-03,1 tablet, $164.77 , $107.10 , $138.41 , N/A , N/A , $133.13 , $148.29 , $139.49 , $148.29 , $148.29 , $148.29 , $140.05 , N/A , $152.13 , $156.53 , $140.05 , $153.24 , $153.24 , $156.53 , $158.18 , $134.81 , $148.29 , $140.05 , $130.17 , N/A , $133.35 , $133.35 , $156.53 , $141.39 , $130.17 , $158.18 
Oversize Lens/Es,HCPCS V2780,N/A,N/A,N/A, $16.00 , $10.40 , N/A , $14.60 , N/A , N/A , N/A , $14.88 , $14.40 , $14.40 , $12.80 , $12.80 , N/A , $14.77 , $15.20 , $14.40 , $14.40 , $14.40 , $14.88 , $15.36 , N/A , $13.60 , $16.00 , $13.27 , N/A , N/A , N/A , $15.20 , N/A , $12.80 , $16.00 
"Exc Sweat Gland Lesn Axill,Simpl",CPT® 11450,N/A,N/A,N/A," $1,859.00 "," $1,208.35 ", $827.29 , $247.06 , $293.09 , $682.58 , $668.97 ," $1,728.87 "," $1,673.10 "," $1,673.10 "," $1,487.20 "," $1,487.20 ", $293.09 ," $1,716.41 "," $1,766.05 "," $1,673.10 "," $1,673.10 "," $1,673.10 "," $1,728.87 "," $1,784.64 ", $893.77 ," $1,580.15 "," $1,341.62 ", $873.32 , N/A , $695.91 , $695.91 ," $1,766.05 ", $807.00 , $247.06 ," $1,784.64 "
 Excision of Knee Cyst ,CPT® 27345,0360 - OR SERVICES,N/A,N/A," $2,786.00 "," $1,810.90 "," $2,340.24 ", $467.50 , $461.04 ," $2,251.09 "," $2,507.40 "," $2,358.63 "," $2,507.40 "," $2,507.40 "," $2,507.40 "," $2,368.10 ", $452.00 ," $2,572.31 "," $2,646.70 "," $2,368.10 "," $2,590.98 "," $2,590.98 "," $2,646.70 "," $2,674.56 "," $2,279.51 "," $2,507.40 "," $2,368.10 "," $2,200.94 ", N/A ," $2,254.71 "," $2,254.71 "," $2,646.70 "," $2,390.67 ", $452.00 ," $2,674.56 "
 Pro I&D Cplx Po Wnd Infctj ,CPT® 10180,0982 - PRO FEE/OUTPT,N/A,N/A," $1,179.00 ", $766.35 , $560.69 , $168.12 , $111.13 , $482.45 , $474.37 ," $1,096.47 "," $1,061.10 "," $1,061.10 ", $943.20 , $943.20 , $111.13 ," $1,088.57 "," $1,120.05 "," $1,061.10 "," $1,061.10 "," $1,061.10 "," $1,096.47 "," $1,131.84 ", $615.17 ," $1,002.15 ", $954.47 , $613.85 , N/A , $491.86 , $491.86 ," $1,120.05 ", $570.41 , $111.13 ," $1,131.84 "
"Transcran Dopp Intracran, Emboli W/O Inj",CPT® 93892,N/A,N/A,N/A," $2,064.00 "," $1,341.60 "," $1,050.79 ", $160.80 , $220.43 ," $1,814.00 "," $1,893.33 "," $1,919.52 "," $1,857.60 "," $1,857.60 "," $1,651.20 "," $1,651.20 ", $220.43 ," $1,905.69 "," $1,960.80 "," $1,857.60 "," $1,857.60 "," $1,857.60 "," $1,919.52 "," $1,981.44 "," $1,378.74 "," $1,754.40 "," $1,007.63 "," $1,214.24 ", N/A ," $1,849.39 "," $1,849.39 "," $1,960.80 "," $2,050.08 ", $160.80 ," $2,050.08 "
 Pro Acute GI Blood Loss Imaging ,CPT® 78278,0974 - PRO FEE/NUC MED,N/A,N/A, $323.00 , $209.95 ," $1,864.12 ", $319.13 , $245.08 ," $1,717.04 "," $1,864.02 ", $300.39 , $290.70 , $290.70 , $258.40 , $258.40 , $245.08 , $298.23 , $306.85 , $290.70 , $290.70 , $290.70 , $300.39 , $310.08 ," $1,928.61 ", $274.55 ," $2,033.90 "," $2,348.44 ", N/A ," $1,750.54 "," $1,750.54 ", $306.85 ," $2,026.27 ", $245.08 ," $2,348.44 "
 Pro Destruction Neurolytic Agt Genicular Nerve W/Img ,CPT® 64624,0982 - PRO FEE/OUTPT,N/A,N/A," $2,731.00 "," $1,775.15 ", $725.40 , $140.79 , $321.99 , $806.54 , N/A ," $2,539.83 "," $2,457.90 "," $2,457.90 "," $2,184.80 "," $2,184.80 ", $321.99 ," $2,521.53 "," $2,594.45 "," $2,457.90 "," $2,457.90 "," $2,457.90 "," $2,539.83 "," $2,621.76 ", $786.05 ," $2,321.35 ", $765.86 , $889.38 , N/A , $822.28 , $822.28 ," $2,594.45 ", $882.08 , $140.79 ," $2,621.76 "
Chromosome Anal-Addt Reso,CPT® 88289,N/A,N/A,N/A, $493.00 , $320.45 , N/A , $35.12 , $35.12 , $192.81 , $292.24 , $458.49 , $443.70 , $443.70 , $394.40 , $394.40 , $35.12 , $455.19 , $468.35 , $443.70 , $443.70 , $443.70 , $458.49 , $473.28 , $229.90 , $419.05 , $225.44 , $150.49 , N/A , $179.94 , $179.94 , $468.35 , $197.75 , $35.12 , $473.28 
Esophagoscopy Flexible Transnasal With Biopsy,CPT® 43198,N/A,N/A,N/A," $1,310.00 ", $851.50 , $599.82 , $93.53 , $155.04 , $457.95 , $477.03 ," $1,218.30 "," $1,179.00 "," $1,179.00 "," $1,048.00 "," $1,048.00 ", $155.04 ," $1,209.52 "," $1,244.50 "," $1,179.00 "," $1,179.00 "," $1,179.00 "," $1,218.30 "," $1,257.60 ", $428.02 ," $1,113.50 ", $518.87 , $558.85 , N/A , $466.89 , $466.89 ," $1,244.50 ", $488.32 , $93.53 ," $1,257.60 "
 Pro Incision of Rectal Abscess ,CPT® 46040,0982 - PRO FEE/OUTPT,N/A,N/A," $3,478.00 "," $2,260.70 "," $2,598.90 ", $404.09 , $192.43 ," $1,960.97 "," $2,012.51 "," $3,234.54 "," $3,130.20 "," $3,130.20 "," $2,782.40 "," $2,782.40 ", $192.43 ," $3,211.24 "," $3,304.10 "," $3,130.20 "," $3,130.20 "," $3,130.20 "," $3,234.54 "," $3,338.88 "," $1,851.25 "," $2,956.30 "," $2,217.59 "," $2,340.82 ", N/A ," $1,999.23 "," $1,999.23 "," $3,304.10 "," $2,090.98 ", $192.43 ," $3,338.88 "
 AMLODIPINE BESYLATE 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6371-61,1 tablet, $11.59 , $7.53 , $9.74 , N/A , N/A , $9.36 , $10.43 , $9.81 , $10.43 , $10.43 , $10.43 , $9.85 , N/A , $10.70 , $11.01 , $9.85 , $10.78 , $10.78 , $11.01 , $11.13 , $9.48 , $10.43 , $9.85 , $9.16 , N/A , $9.38 , $9.38 , $11.01 , $9.95 , $9.16 , $11.13 
"Noninvasv Extrem Exam,1level,Bilat",CPT® 93922,N/A,N/A,N/A," $2,020.00 "," $1,313.00 ", $515.13 , $79.89 , $83.57 , $480.19 , $525.74 ," $1,878.60 "," $1,818.00 "," $1,818.00 "," $1,616.00 "," $1,616.00 ", $83.57 ," $1,865.07 "," $1,919.00 "," $1,818.00 "," $1,818.00 "," $1,818.00 "," $1,878.60 "," $1,939.20 ", $364.33 ," $1,717.00 ", $280.80 , $332.58 , N/A , $489.56 , $489.56 ," $1,919.00 ", $542.68 , $79.89 ," $1,939.20 "
 Pro Incision of Toe Tendon ,CPT® 28232,0982 - PRO FEE/OUTPT,N/A,N/A," $2,630.00 "," $1,709.50 "," $1,495.26 ", $234.58 , $92.19 ," $1,198.78 "," $1,205.65 "," $2,445.90 "," $2,367.00 "," $2,367.00 "," $2,104.00 "," $2,104.00 ", $92.19 ," $2,428.28 "," $2,498.50 "," $2,367.00 "," $2,367.00 "," $2,367.00 "," $2,445.90 "," $2,524.80 "," $1,391.15 "," $2,235.50 "," $1,305.93 "," $1,427.25 ", N/A ," $1,222.18 "," $1,222.18 "," $2,498.50 "," $1,436.49 ", $92.19 ," $2,524.80 "
"Special Eye Exam, Subsequent",CPT® 92226,N/A,N/A,N/A, $113.00 , $73.45 , N/A , N/A , N/A , N/A , $33.45 , $105.09 , $101.70 , $101.70 , $90.40 , $90.40 , N/A , $104.33 , $107.35 , $101.70 , $101.70 , $101.70 , $105.09 , $108.48 , N/A , $96.05 , N/A , N/A , N/A , N/A , N/A , $107.35 , N/A , $33.45 , $108.48 
 TIZANIDINE HCL 2 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,57664-0502-89,1 tablet, $6.28 , $4.08 , $5.28 , N/A , N/A , $5.07 , $5.65 , $5.32 , $5.65 , $5.65 , $5.65 , $5.34 , N/A , $5.80 , $5.97 , $5.34 , $5.84 , $5.84 , $5.97 , $6.03 , $5.14 , $5.65 , $5.34 , $4.96 , N/A , $5.08 , $5.08 , $5.97 , $5.39 , $4.96 , $6.03 
Needle Insertion W/O Injection 1 or 2 Muscles,CPT® 20560,N/A,N/A,N/A, $50.00 , $32.50 , $94.51 , $14.78 , N/A , $78.65 , N/A , $46.50 , $45.00 , $45.00 , $40.00 , $40.00 , N/A , $46.17 , $47.50 , $45.00 , $45.00 , $45.00 , $46.50 , $48.00 , $90.69 , $42.50 , $78.19 , $95.51 , N/A , $80.18 , $80.18 , $47.50 , $94.26 , $14.78 , $95.51 
Aspiration Bladder Insert Suprapubic Catheter,51102,N/A,N/A,N/A, $988.00 , $642.20 , $783.04 , $136.64 , $260.59 , $710.60 , $662.44 , $918.84 , $889.20 , $889.20 , $790.40 , $790.40 , $260.59 , $912.22 , $938.60 , $889.20 , $889.20 , $889.20 , $918.84 , $948.48 , $788.37 , $839.80 , $752.88 , $887.47 , N/A , $724.46 , $724.46 , $938.60 , $851.52 , $136.64 , $948.48 
Ecmo/Ecls Daily Management Ea Day Veno-Arterial,CPT® 33949,N/A,N/A,N/A," $2,823.00 "," $1,834.95 "," $1,382.62 ", $213.11 , $282.04 ," $1,020.77 "," $1,039.49 "," $2,625.39 "," $2,540.70 "," $2,540.70 "," $2,258.40 "," $2,258.40 ", $282.04 ," $2,606.48 "," $2,681.85 "," $2,540.70 "," $2,540.70 "," $2,540.70 "," $2,625.39 "," $2,710.08 "," $1,282.77 "," $2,399.55 "," $1,199.44 "," $1,135.37 ", N/A ," $1,040.69 "," $1,040.69 "," $2,681.85 "," $1,182.21 ", $213.11 ," $2,710.08 "
 LETROZOLE 2.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,51991-0759-33,1 tablet, $93.06 , $60.49 , $78.17 , N/A , N/A , $75.19 , $83.75 , $78.78 , $83.75 , $83.75 , $83.75 , $79.10 , N/A , $85.92 , $88.41 , $79.10 , $86.55 , $86.55 , $88.41 , $89.34 , $76.14 , $83.75 , $79.10 , $73.52 , N/A , $75.31 , $75.31 , $88.41 , $79.85 , $73.52 , $89.34 
 Pro Family Psychotherapy W/Patient Present 50 Mins ,CPT® 90847,0961 - PRO FEE/PSYCH,N/A,N/A, $431.00 , $280.15 , $133.00 , $98.99 , $96.92 , $237.38 , $211.12 , $400.83 , $387.90 , $387.90 , $344.80 , $344.80 , $96.92 , $397.94 , $409.45 , $387.90 , $387.90 , $387.90 , $400.83 , $413.76 , $253.64 , $366.35 , $274.72 , $404.45 , $160.00 , $242.02 , $242.02 , $409.45 , $282.14 , $96.92 , $413.76 
 Pro Cltx Sprcndylr/Transcndylr Humrl Fx+-Mnpj ,CPT® 24530,0981 - PRO FEE/ER,N/A,N/A," $1,765.00 "," $1,147.25 "," $2,179.65 ", $345.51 , $245.89 ," $1,654.51 "," $1,676.86 "," $1,641.45 "," $1,588.50 "," $1,588.50 "," $1,412.00 "," $1,412.00 ", $245.89 ," $1,629.62 "," $1,676.75 "," $1,588.50 "," $1,588.50 "," $1,588.50 "," $1,641.45 "," $1,694.40 "," $2,006.52 "," $1,500.25 "," $1,841.15 "," $1,967.73 ", N/A ," $1,686.79 "," $1,686.79 "," $1,676.75 "," $1,982.57 ", $245.89 ," $2,179.65 "
Initial Ped Critical Care 29 Day Thru 24 Mo,CPT® 99471,N/A,N/A,N/A," $4,666.00 "," $3,032.90 "," $1,588.02 ", $754.64 , $745.70 ," $1,498.55 "," $1,482.23 "," $4,339.38 "," $4,199.40 "," $4,199.40 "," $3,732.80 "," $3,732.80 ", $745.70 ," $4,308.12 "," $4,432.70 "," $4,199.40 "," $4,199.40 "," $4,199.40 "," $4,339.38 "," $4,479.36 "," $2,002.62 "," $3,966.10 "," $1,840.01 "," $1,749.55 ", N/A ," $1,527.79 "," $1,527.79 "," $4,432.70 "," $1,762.06 ", $745.70 ," $4,479.36 "
 MAGNESIUM SULFATE IN D5W 1-5 GM/100ML-% IV SOLN ,HCPCS J3475,0636 - DRUGS REQUIRING DETAILED CODIN,44567-0410-24,100 mL, $19.53 , $12.69 , $16.41 , $0.95 , $0.81 , $15.78 , $17.58 , $16.53 , $17.58 , $17.58 , $17.58 , $16.60 , $0.79 , $18.03 , $18.55 , $16.60 , $18.16 , $18.16 , $18.55 , $18.75 , $15.98 , $17.58 , $16.60 , $15.43 , N/A , $15.81 , $15.81 , $18.55 , $16.76 , $0.79 , $18.75 
 GENTAMICIN SULFATE 10 MG/ML IJ SOLN ,HCPCS J1580,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0173-02,2 mL, $33.35 , $21.68 , $28.01 , $3.05 , $2.85 , $26.95 , $30.02 , $28.23 , $30.02 , $30.02 , $30.02 , $28.35 , $2.79 , $30.79 , $31.68 , $28.35 , $31.02 , $31.02 , $31.68 , $32.02 , $27.29 , $30.02 , $28.35 , $26.35 , N/A , $26.99 , $26.99 , $31.68 , $28.62 , $2.79 , $32.02 
 Fac Interrog Dev Eval Pm/Ldls Pm Phys/Qhp in Person ,CPT® 93288,0480 - CARDIOLOGY,N/A,N/A, $313.00 , $203.45 , $262.92 , $55.79 , $32.77 , $252.90 , $281.70 , $264.99 , $281.70 , $281.70 , $281.70 , $266.05 , $32.13 , $288.99 , $297.35 , $266.05 , $291.09 , $291.09 , $297.35 , $300.48 , $256.10 , $281.70 , $266.05 , $247.27 , N/A , $253.31 , $253.31 , $297.35 , $268.59 , $32.13 , $300.48 
"Cystourethroscopy,Fulgur <0.5cm Lesn",CPT® 52224,N/A,N/A,N/A," $2,813.00 "," $1,828.45 "," $1,090.26 ", $190.95 , $155.03 ," $1,000.80 ", $923.92 ," $2,616.09 "," $2,531.70 "," $2,531.70 "," $2,250.40 "," $2,250.40 ", $155.03 ," $2,597.24 "," $2,672.35 "," $2,531.70 "," $2,531.70 "," $2,531.70 "," $2,616.09 "," $2,700.48 "," $1,099.24 "," $2,391.05 "," $1,047.25 "," $1,253.67 ", N/A ," $1,020.32 "," $1,020.32 "," $2,672.35 "," $1,199.24 ", $155.03 ," $2,700.48 "
 WARFARIN SODIUM 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00832-1216-01,1 tablet, $3.53 , $2.29 , $2.97 , N/A , N/A , $2.85 , $3.18 , $2.99 , $3.18 , $3.18 , $3.18 , $3.00 , N/A , $3.26 , $3.35 , $3.00 , $3.28 , $3.28 , $3.35 , $3.39 , $2.89 , $3.18 , $3.00 , $2.79 , N/A , $2.86 , $2.86 , $3.35 , $3.03 , $2.79 , $3.39 
 US Inj Therapeutic Carpal Tunnel ,CPT® 20526,0761 - TREATMENT ROOM,N/A,N/A, $360.00 , $234.00 , $302.40 , $53.49 , $26.41 , $290.88 , $324.00 , $304.78 , $324.00 , $324.00 , $324.00 , $306.00 , $25.89 , $332.39 , $342.00 , $306.00 , $334.80 , $334.80 , $342.00 , $345.60 , $294.55 , $324.00 , $306.00 , $284.40 , N/A , $291.35 , $291.35 , $342.00 , $308.92 , $25.89 , $345.60 
"Thyroid Lobectomy,Unilat",CPT® 60220,N/A,N/A,N/A," $5,736.00 "," $3,728.40 "," $4,289.16 ", $669.53 , $674.26 ," $3,649.89 "," $3,798.50 "," $5,334.48 "," $5,162.40 "," $5,162.40 "," $4,588.80 "," $4,588.80 ", $674.26 ," $5,296.05 "," $5,449.20 "," $5,162.40 "," $5,162.40 "," $5,162.40 "," $5,334.48 "," $5,506.56 "," $4,138.84 "," $4,875.60 "," $3,764.38 "," $3,510.37 ", N/A ," $3,721.11 "," $3,721.11 "," $5,449.20 "," $4,150.13 ", $669.53 ," $5,506.56 "
 Pro Pnxr Aspir Absc Hmtma Bulla/Cst ,CPT® 10160,0982 - PRO FEE/OUTPT,N/A,N/A, $490.00 , $318.50 , $307.12 , $92.99 , $30.77 , $262.79 , $257.92 , $455.70 , $441.00 , $441.00 , $392.00 , $392.00 , $30.77 , $452.42 , $465.50 , $441.00 , $441.00 , $441.00 , $455.70 , $470.40 , $335.46 , $416.50 , $510.24 , $335.24 , N/A , $267.91 , $267.91 , $465.50 , $310.70 , $30.77 , $510.24 
"Suture Sm Intest,Multpl Perf",CPT® 44603,N/A,N/A,N/A," $10,536.00 "," $6,848.40 "," $9,608.56 "," $1,488.41 "," $1,578.99 "," $7,621.75 "," $7,658.71 "," $9,798.48 "," $9,482.40 "," $9,482.40 "," $8,428.80 "," $8,428.80 "," $1,578.99 "," $9,727.89 "," $10,009.20 "," $9,482.40 "," $9,482.40 "," $9,482.40 "," $9,798.48 "," $10,114.56 "," $6,900.45 "," $8,955.60 "," $8,520.69 "," $8,993.87 ", N/A ," $7,770.46 "," $7,770.46 "," $10,009.20 "," $8,127.07 "," $1,488.41 "," $10,114.56 "
 Fac Insj Perq Vad W/Rs&I L Hrt Arterial Access Only ,CPT® 33990,0360 - OR SERVICES,N/A,N/A," $1,582.00 "," $1,028.30 "," $1,328.88 ", $324.57 , $329.73 ," $1,278.26 "," $1,423.80 "," $1,339.32 "," $1,423.80 "," $1,423.80 "," $1,423.80 "," $1,344.70 ", $323.26 ," $1,460.66 "," $1,502.90 "," $1,344.70 "," $1,471.26 "," $1,471.26 "," $1,502.90 "," $1,518.72 "," $1,294.39 "," $1,423.80 "," $1,344.70 "," $1,249.78 ", N/A ," $1,280.31 "," $1,280.31 "," $1,502.90 "," $1,357.51 ", $323.26 ," $1,518.72 "
Leukocyte (Wbc) Count,CPT® 85048,N/A,N/A,N/A, $51.00 , $33.15 , N/A , $2.59 , $2.59 , $14.38 , $17.18 , $47.43 , $45.90 , $45.90 , $40.80 , $40.80 , $2.59 , $47.09 , $48.45 , $45.90 , $45.90 , $45.90 , $47.43 , $48.96 , $16.96 , $43.35 , $16.22 , $9.19 , N/A , $13.42 , $13.42 , $48.45 , $14.67 , $2.59 , $48.96 
"Closed Rx Bimalleolar Fx,Manip",CPT® 27810,N/A,N/A,N/A," $3,115.00 "," $2,024.75 "," $2,621.26 ", $415.07 , $394.39 ," $2,044.66 "," $2,077.68 "," $2,896.95 "," $2,803.50 "," $2,803.50 "," $2,492.00 "," $2,492.00 ", $394.39 ," $2,876.08 "," $2,959.25 "," $2,803.50 "," $2,803.50 "," $2,803.50 "," $2,896.95 "," $2,990.40 "," $2,420.62 "," $2,647.75 "," $2,287.17 "," $2,409.72 ", N/A ," $2,084.56 "," $2,084.56 "," $2,959.25 "," $2,450.12 ", $394.39 ," $2,990.40 "
" Fac Organic Acid, Single, Quant ",CPT® 83921,0301 - LAB/CHEMISTRY,N/A,N/A, $151.00 , $98.15 , $126.84 , $21.63 , $21.63 , $122.01 , $135.90 , $127.84 , $135.90 , $135.90 , $135.90 , $128.35 , $21.21 , $139.42 , $143.45 , $128.35 , $140.43 , $140.43 , $143.45 , $144.96 , $123.55 , $135.90 , $128.35 , $119.29 , N/A , $122.20 , $122.20 , $143.45 , $129.57 , $21.21 , $144.96 
Fx Cl Scapular W/O Manip,23570,N/A,N/A,N/A, $868.00 , $564.20 ," $1,508.00 ", $239.36 , $101.63 ," $1,150.84 "," $1,170.86 ", $807.24 , $781.20 , $781.20 , $694.40 , $694.40 , $101.63 , $801.42 , $824.60 , $781.20 , $781.20 , $781.20 , $807.24 , $833.28 ," $1,389.76 ", $737.80 ," $1,284.53 "," $1,368.26 ", N/A ," $1,173.30 "," $1,173.30 ", $824.60 ," $1,379.07 ", $101.63 ," $1,508.00 "
 DABIGATRAN ETEXILATE MESYLATE 75 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00597-0355-56,1 capsule, $20.39 , $13.25 , $17.13 , N/A , N/A , $16.48 , $18.35 , $17.26 , $18.35 , $18.35 , $18.35 , $17.33 , N/A , $18.83 , $19.37 , $17.33 , $18.96 , $18.96 , $19.37 , $19.57 , $16.68 , $18.35 , $17.33 , $16.11 , N/A , $16.50 , $16.50 , $19.37 , $17.50 , $16.11 , $19.57 
" Fac Genetic Counseling, 30 Min ",CPT® 96040,0510 - CLINIC,N/A,N/A, $423.00 , $274.95 , $355.32 , $47.06 , N/A , $341.78 , $380.70 , N/A , $380.70 , $380.70 , $380.70 , $359.55 , N/A , $390.56 , $401.85 , $359.55 , $393.39 , $393.39 , $401.85 , $406.08 , $346.10 , $380.70 , $359.55 , $334.17 , N/A , $342.33 , $342.33 , $401.85 , $362.98 , $47.06 , $406.08 
Insulin Antibodies,CPT® 86337,N/A,N/A,N/A, $209.00 , $135.85 , N/A , $21.84 , $21.84 , $121.10 , $144.89 , $194.37 , $188.10 , $188.10 , $167.20 , $167.20 , $21.84 , $192.97 , $198.55 , $188.10 , $188.10 , $188.10 , $194.37 , $200.64 , $142.96 , $177.65 , $141.10 , $77.62 , N/A , $113.02 , $113.02 , $198.55 , $123.51 , $21.84 , $200.64 
 Fac Colonoscopy Stoma W/Biopsy Single/Multiple ,CPT® 44389,0360 - OR SERVICES,N/A,N/A," $2,334.00 "," $1,517.10 "," $1,960.56 ", $162.03 , $362.74 ," $1,885.87 "," $2,100.60 "," $1,975.96 "," $2,100.60 "," $2,100.60 "," $2,100.60 "," $1,983.90 ", $355.63 ," $2,154.98 "," $2,217.30 "," $1,983.90 "," $2,170.62 "," $2,170.62 "," $2,217.30 "," $2,240.64 "," $1,909.68 "," $2,100.60 "," $1,983.90 "," $1,843.86 ", N/A ," $1,888.91 "," $1,888.91 "," $2,217.30 "," $2,002.81 ", $162.03 ," $2,240.64 "
Opscpy Extnd RTA Drawing & Scl Deprsn I&R Uni/Bi,92201,N/A,N/A,N/A, $79.00 , $51.35 , $49.21 , $21.92 , $19.95 , $39.94 , N/A , $73.47 , $71.10 , $71.10 , $63.20 , $63.20 , $19.95 , $72.94 , $75.05 , $71.10 , $71.10 , $71.10 , $73.47 , $75.84 , $69.70 , $67.15 , $66.64 , $48.46 , N/A , $40.72 , $40.72 , $75.05 , $48.33 , $19.95 , $75.84 
 Dtpa/Tc Pentetate per Study Dose ,HCPCS A9539,0343 - DIAGNOSTIC RADIOPHARMACEUTICALS,N/A,N/A, $145.00 , $94.25 , $121.80 , N/A , $13.26 , $117.16 , $130.50 , $122.76 , $130.50 , $130.50 , $130.50 , $123.25 , $13.00 , $133.88 , $137.75 , $123.25 , $134.85 , $134.85 , $137.75 , $139.20 , $118.64 , $130.50 , $123.25 , $114.55 , N/A , $117.35 , $117.35 , $137.75 , $124.42 , $13.00 , $139.20 
Critical Care E&M L1,99291,N/A,N/A,N/A," $1,220.00 ", $793.00 , $433.06 , $205.74 , $270.56 , $385.76 , $385.10 ," $1,134.60 "," $1,098.00 "," $1,098.00 ", $976.00 , $976.00 , $270.56 ," $1,126.43 "," $1,159.00 "," $1,098.00 "," $1,098.00 "," $1,098.00 "," $1,134.60 "," $1,171.20 ", $551.34 ," $1,037.00 ", $480.07 , $484.31 , N/A , $393.30 , $393.30 ," $1,159.00 ", $453.59 , $205.74 ," $1,171.20 "
 Fac Bronchoscopy Bronchial/Endobrncl Bx 1+ Sites ,CPT® 31625,0360 - OR SERVICES,N/A,N/A," $3,373.00 "," $2,192.45 "," $2,833.32 ", $148.07 , $466.98 ," $2,725.38 "," $3,035.70 "," $2,855.58 "," $3,035.70 "," $3,035.70 "," $3,035.70 "," $2,867.05 ", $457.82 ," $3,114.29 "," $3,204.35 "," $2,867.05 "," $3,136.89 "," $3,136.89 "," $3,204.35 "," $3,238.08 "," $2,759.79 "," $3,035.70 "," $2,867.05 "," $2,664.67 ", N/A ," $2,729.77 "," $2,729.77 "," $3,204.35 "," $2,894.37 ", $148.07 ," $3,238.08 "
"Lap,Diagnostic Abdomen",49320,N/A,N/A,N/A," $3,463.00 "," $2,250.95 "," $1,970.02 ", $306.05 , $425.15 ," $1,539.20 "," $1,567.04 "," $3,220.59 "," $3,116.70 "," $3,116.70 "," $2,770.40 "," $2,770.40 ", $425.15 ," $3,197.39 "," $3,289.85 "," $3,116.70 "," $3,116.70 "," $3,116.70 "," $3,220.59 "," $3,324.48 "," $1,411.89 "," $2,943.55 "," $1,735.89 "," $1,827.52 ", N/A ," $1,569.24 "," $1,569.24 "," $3,289.85 "," $1,641.26 ", $306.05 ," $3,324.48 "
Cryopreserv Cells Each Li,CPT® 88240,N/A,N/A,N/A, $143.00 , $92.95 , N/A , $13.33 , $9.70 , $39.13 , $86.59 , $132.99 , $128.70 , $128.70 , $114.40 , $114.40 , $9.70 , $132.03 , $135.85 , $128.70 , $128.70 , $128.70 , $132.99 , $137.28 , $87.27 , $121.55 , $66.50 , $46.27 , N/A , $36.52 , $36.52 , $135.85 , $40.13 , $9.70 , $137.28 
 Pro Carpal Tunnel Surgery ,CPT® 64721,0975 - PRO FEE/OR,N/A,N/A," $2,658.00 "," $1,727.70 "," $2,135.38 ", $420.71 , $355.74 ," $2,342.38 "," $2,296.44 "," $2,471.94 "," $2,392.20 "," $2,392.20 "," $2,126.40 "," $2,126.40 ", $355.74 ," $2,454.13 "," $2,525.10 "," $2,392.20 "," $2,392.20 "," $2,392.20 "," $2,471.94 "," $2,551.68 "," $2,295.69 "," $2,259.30 "," $2,272.90 "," $2,518.27 ", N/A ," $2,388.09 "," $2,388.09 "," $2,525.10 "," $2,561.83 ", $355.74 ," $2,561.83 "
Thyroidectomy Post Prev Thyr Surg,CPT® 60260,N/A,N/A,N/A," $7,056.00 "," $4,586.40 "," $6,584.63 "," $1,025.98 ", $922.06 ," $5,645.19 "," $5,835.69 "," $6,562.08 "," $6,350.40 "," $6,350.40 "," $5,644.80 "," $5,644.80 ", $922.06 ," $6,514.80 "," $6,703.20 "," $6,350.40 "," $6,350.40 "," $6,350.40 "," $6,562.08 "," $6,773.76 "," $6,366.52 "," $5,997.60 "," $5,785.72 "," $5,425.84 ", N/A ," $5,755.34 "," $5,755.34 "," $6,703.20 "," $6,418.93 ", $922.06 ," $6,773.76 "
Spacer Without Mask,HCPCS S8100,N/A,N/A,N/A, $46.00 , $29.90 , N/A , N/A , N/A , N/A , N/A , $42.78 , $41.40 , $41.40 , $36.80 , $36.80 , N/A , $42.47 , $43.70 , $41.40 , $41.40 , $41.40 , $42.78 , $44.16 , N/A , $39.10 , $36.80 , N/A , N/A , N/A , N/A , $43.70 , N/A , $36.80 , $44.16 
 CT Soft T Neck With Contrast ,CPT® 70491,0350 - CT SCAN,N/A,N/A," $2,721.00 "," $1,768.65 "," $2,285.64 ", $188.89 , $297.22 ," $2,198.57 "," $2,448.90 "," $2,303.60 "," $2,448.90 "," $2,448.90 "," $2,448.90 "," $2,312.85 ", $291.39 ," $2,512.30 "," $2,584.95 "," $2,312.85 "," $2,530.53 "," $2,530.53 "," $2,584.95 "," $2,612.16 "," $2,226.32 "," $2,448.90 "," $2,312.85 "," $2,149.59 ", N/A ," $2,202.11 "," $2,202.11 "," $2,584.95 "," $2,334.89 ", $188.89 ," $2,612.16 "
 WARFARIN SODIUM 1 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00832-1211-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Mod Sed Same Phys/Qhp Each Addl 15 Mins,99153,N/A,N/A,N/A, $83.00 , $53.95 , $23.95 , $10.39 , $8.53 , $22.93 , $23.60 , $77.19 , $74.70 , $74.70 , $66.40 , $66.40 , $8.53 , $76.63 , $78.85 , $74.70 , $74.70 , $74.70 , $77.19 , $79.68 , $31.53 , $70.55 , $33.32 , $40.46 , N/A , $23.38 , $23.38 , $78.85 , $27.25 , $8.53 , $79.68 
Apply Long Leg Cast,29345,N/A,N/A,N/A, $899.00 , $584.35 , $597.74 , $94.01 , $111.25 , $488.19 , $488.55 , $836.07 , $809.10 , $809.10 , $719.20 , $719.20 , $111.25 , $830.05 , $854.05 , $809.10 , $809.10 , $809.10 , $836.07 , $863.04 , $558.12 , $764.15 , $538.79 , $575.51 , N/A , $497.71 , $497.71 , $854.05 , $584.99 , $94.01 , $863.04 
 DURVALUMAB 120 MG/2.4ML IV SOLN ,HCPCS J9173,0636 - DRUGS REQUIRING DETAILED CODIN,00310-4500-12,2.4 mL," $2,786.20 "," $1,811.03 "," $2,340.41 ", $81.36 , $80.48 ," $2,251.25 "," $2,507.58 "," $2,358.80 "," $2,507.58 "," $2,507.58 "," $2,507.58 "," $2,368.27 ", $78.90 ," $2,572.50 "," $2,646.89 "," $2,368.27 "," $2,591.17 "," $2,591.17 "," $2,646.89 "," $2,674.75 "," $2,279.67 "," $2,507.58 "," $2,368.27 "," $2,201.10 ", N/A ," $2,254.87 "," $2,254.87 "," $2,646.89 "," $2,390.84 ", $78.90 ," $2,674.75 "
 CETIRIZINE HCL 5 MG/5ML PO SOLN ,HCPCS RXC637,0250 - PHARMACY,68094-0004-62,2.5 mL, $7.38 , $4.80 , $6.20 , N/A , N/A , $5.96 , $6.64 , $6.25 , $6.64 , $6.64 , $6.64 , $6.27 , N/A , $6.81 , $7.01 , $6.27 , $6.86 , $6.86 , $7.01 , $7.08 , $6.04 , $6.64 , $6.27 , $5.83 , N/A , $5.97 , $5.97 , $7.01 , $6.33 , $5.83 , $7.08 
 CELECOXIB 200 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,69097-0421-07,1 capsule, $38.94 , $25.31 , $32.71 , N/A , N/A , $31.46 , $35.05 , $32.97 , $35.05 , $35.05 , $35.05 , $33.10 , N/A , $35.95 , $36.99 , $33.10 , $36.21 , $36.21 , $36.99 , $37.38 , $31.86 , $35.05 , $33.10 , $30.76 , N/A , $31.51 , $31.51 , $36.99 , $33.41 , $30.76 , $37.38 
 Fac Culture Screen Only ,CPT® 87081,0306 - LAB/BACT-MICRO,N/A,N/A, $69.00 , $44.85 , $57.96 , $6.76 , $6.76 , $55.75 , $62.10 , $58.42 , $62.10 , $62.10 , $62.10 , $58.65 , $6.63 , $63.71 , $65.55 , $58.65 , $64.17 , $64.17 , $65.55 , $66.24 , $56.46 , $62.10 , $58.65 , $54.51 , N/A , $55.84 , $55.84 , $65.55 , $59.21 , $6.63 , $66.24 
Cyp2c19 Gene Analysis Common Variants,CPT® 81225,N/A,N/A,N/A, $808.00 , $525.20 , N/A , $297.19 , N/A ," $1,210.11 "," $1,433.05 ", $751.44 , $727.20 , $727.20 , $646.40 , $646.40 , N/A , $746.03 , $767.60 , $727.20 , $727.20 , $727.20 , $751.44 , $775.68 ," $1,945.48 ", $686.80 ," $1,389.22 ", $855.72 , N/A ," $1,129.35 "," $1,129.35 ", $767.60 ," $1,234.14 ", $297.19 ," $1,945.48 "
Prolong nursin fac eval 15m,HCPCS G0317,N/A,N/A,N/A, $122.00 , $79.30 , N/A , $29.73 , $24.23 , N/A , N/A , $113.46 , $109.80 , $109.80 , $97.60 , $97.60 , $24.23 , $112.64 , $115.90 , $109.80 , $109.80 , $109.80 , $113.46 , $117.12 , N/A , $103.70 , $58.15 , N/A , N/A , $50.15 , $50.15 , $115.90 , $62.69 , $24.23 , $117.12 
 Amputation; Toe; Metatarsophalangeal Joint ,CPT® 28820,0360 - OR SERVICES,N/A,N/A," $8,101.00 "," $5,265.65 "," $6,804.84 ", $170.21 , $184.42 ," $6,545.61 "," $7,290.90 "," $6,858.31 "," $7,290.90 "," $7,290.90 "," $7,290.90 "," $6,885.85 ", $180.80 ," $7,479.65 "," $7,695.95 "," $6,885.85 "," $7,533.93 "," $7,533.93 "," $7,695.95 "," $7,776.96 "," $6,628.24 "," $7,290.90 "," $6,885.85 "," $6,399.79 ", N/A ," $6,556.14 "," $6,556.14 "," $7,695.95 "," $6,951.47 ", $170.21 ," $7,776.96 "
"Adj Tiss Xfer Scalp,Extrem 10.1-30",14021,N/A,N/A,N/A," $4,360.00 "," $2,834.00 "," $2,261.44 ", $679.65 , $640.60 ," $1,962.55 "," $1,932.02 "," $4,054.80 "," $3,924.00 "," $3,924.00 "," $3,488.00 "," $3,488.00 ", $640.60 ," $4,025.59 "," $4,142.00 "," $3,924.00 "," $3,924.00 "," $3,924.00 "," $4,054.80 "," $4,185.60 "," $2,475.57 "," $3,706.00 "," $3,850.01 "," $2,514.00 ", N/A ," $2,000.85 "," $2,000.85 "," $4,142.00 "," $2,320.31 ", $640.60 ," $4,185.60 "
 Fac Rmvl FB Intransl Off Typ Px ,CPT® 30300,0761 - TREATMENT ROOM,N/A,N/A," $1,300.00 ", $845.00 ," $1,092.00 ", $121.29 , $64.81 ," $1,050.40 "," $1,170.00 "," $1,100.58 "," $1,170.00 "," $1,170.00 "," $1,170.00 "," $1,105.00 ", $63.54 ," $1,200.29 "," $1,235.00 "," $1,105.00 "," $1,209.00 "," $1,209.00 "," $1,235.00 "," $1,248.00 "," $1,063.66 "," $1,170.00 "," $1,105.00 "," $1,027.00 ", N/A ," $1,052.09 "," $1,052.09 "," $1,235.00 "," $1,115.53 ", $63.54 ," $1,248.00 "
Peri-Px Dev Eval Pm/Ldls Pm Phys/Qhp in Person,93286,N/A,N/A,N/A, $290.00 , $188.50 , $301.93 , $45.39 , $25.87 , $147.31 , $148.68 , $269.70 , $261.00 , $261.00 , $232.00 , $232.00 , $25.87 , $267.76 , $275.50 , $261.00 , $261.00 , $261.00 , $269.70 , $278.40 , $277.59 , $246.50 , $139.16 , $113.37 , N/A , $150.19 , $150.19 , $275.50 , $166.47 , $25.87 , $301.93 
Furosemide Injection,HCPCS J1940,N/A,N/A,N/A, $11.00 , $7.15 , N/A , $0.51 , $0.67 , N/A , N/A , $10.23 , $9.90 , $9.90 , $8.80 , $8.80 , $0.67 , $10.16 , $10.45 , $9.90 , $9.90 , $9.90 , $10.23 , $10.56 , $0.72 , $9.35 , $3.89 , $0.82 , N/A , N/A , N/A , $10.45 , N/A , $0.51 , $10.56 
 Pro Rpr Xtnsr Tdn Ctr Slip 2 Tiss W/Lat Band Ea Fngr ,CPT® 26426,0981 - PRO FEE/ER,N/A,N/A," $2,898.00 "," $1,883.70 "," $3,093.61 ", $487.06 , $480.44 ," $2,409.70 "," $2,410.15 "," $2,695.14 "," $2,608.20 "," $2,608.20 "," $2,318.40 "," $2,318.40 ", $480.44 ," $2,675.72 "," $2,753.10 "," $2,608.20 "," $2,608.20 "," $2,608.20 "," $2,695.14 "," $2,782.08 "," $2,870.76 "," $2,463.30 "," $2,651.12 "," $2,859.63 ", N/A ," $2,456.71 "," $2,456.71 "," $2,753.10 "," $2,887.52 ", $480.44 ," $3,093.61 "
 Pro Fusion of Finger Joint ,CPT® 26860,0975 - PRO FEE/OR,N/A,N/A," $1,911.00 "," $1,242.15 "," $3,869.91 ", $602.15 , $384.19 ," $2,683.79 "," $2,729.96 "," $1,777.23 "," $1,719.90 "," $1,719.90 "," $1,528.80 "," $1,528.80 ", $384.19 ," $1,764.43 "," $1,815.45 "," $1,719.90 "," $1,719.90 "," $1,719.90 "," $1,777.23 "," $1,834.56 "," $3,532.35 "," $1,624.35 "," $2,984.74 "," $3,214.26 ", N/A ," $2,736.16 "," $2,736.16 "," $1,815.45 "," $3,215.95 ", $384.19 ," $3,869.91 "
Leuprolide Acetate Injeciton,HCPCS J9218,N/A,N/A,N/A, $69.00 , $44.85 , N/A , $10.26 , $12.85 , N/A , N/A , $64.17 , $62.10 , $62.10 , $55.20 , $55.20 , $12.85 , $63.71 , $65.55 , $62.10 , $62.10 , $62.10 , $64.17 , $66.24 , $22.44 , $58.65 , $14.27 , $16.42 , N/A , N/A , N/A , $65.55 , N/A , $10.26 , $66.24 
 AGALSIDASE BETA 35 MG IV SOLR ,HCPCS J0180,0636 - DRUGS REQUIRING DETAILED CODIN,58468-0040-01,7 mL," $21,280.81 "," $13,832.53 "," $17,875.88 ", $219.69 , $212.49 ," $17,194.89 "," $19,152.73 "," $18,016.33 "," $19,152.73 "," $19,152.73 "," $19,152.73 "," $18,088.69 ", $208.32 ," $19,648.57 "," $20,216.77 "," $18,088.69 "," $19,791.15 "," $19,791.15 "," $20,216.77 "," $20,429.58 "," $17,411.96 "," $19,152.73 "," $18,088.69 "," $16,811.84 ", N/A ," $17,222.56 "," $17,222.56 "," $20,216.77 "," $18,261.06 ", $208.32 ," $20,429.58 "
Set Radn Therapy Field Simple,CPT® 77280,N/A,N/A,N/A," $3,215.00 "," $2,089.75 "," $1,506.72 ", $265.10 , $174.36 ," $1,287.32 ", $934.37 ," $2,989.95 "," $2,893.50 "," $2,893.50 "," $2,572.00 "," $2,572.00 ", $174.36 ," $2,968.41 "," $3,054.25 "," $2,893.50 "," $2,893.50 "," $2,893.50 "," $2,989.95 "," $3,086.40 "," $1,586.30 "," $2,732.75 "," $1,024.65 "," $1,556.33 ", N/A ," $1,312.44 "," $1,312.44 "," $3,054.25 "," $1,519.17 ", $174.36 ," $3,086.40 "
 Fac Colsc Flexible W/Control Bleeding Any Method ,CPT® 45382,0360 - OR SERVICES,N/A,N/A," $3,449.00 "," $2,241.85 "," $2,897.16 ", $245.20 , $640.60 ," $2,786.79 "," $3,104.10 "," $2,919.92 "," $3,104.10 "," $3,104.10 "," $3,104.10 "," $2,931.65 ", $628.04 ," $3,184.46 "," $3,276.55 "," $2,931.65 "," $3,207.57 "," $3,207.57 "," $3,276.55 "," $3,311.04 "," $2,821.97 "," $3,104.10 "," $2,931.65 "," $2,724.71 ", N/A ," $2,791.28 "," $2,791.28 "," $3,276.55 "," $2,959.59 ", $245.20 ," $3,311.04 "
Cytopathology Cerv/Vag,88141,N/A,N/A,N/A, $192.00 , $124.80 , $79.51 , $22.56 , $22.43 , $128.25 , $144.51 , $178.56 , $172.80 , $172.80 , $153.60 , $153.60 , $22.43 , $177.27 , $182.40 , $172.80 , $172.80 , $172.80 , $178.56 , $184.32 , $140.29 , $163.20 , $150.83 , $112.96 , N/A , $119.69 , $119.69 , $182.40 , $131.53 , $22.43 , $184.32 
"X-Ray Ribs, Chest 4+ Vw",CPT® 71111,N/A,N/A,N/A, $537.00 , $349.05 , $298.00 , $51.78 , $49.93 , $224.57 , $284.73 , $499.41 , $483.30 , $483.30 , $429.60 , $429.60 , $49.93 , $495.81 , $510.15 , $483.30 , $483.30 , $483.30 , $499.41 , $515.52 , $289.33 , $456.45 , $310.09 , $237.31 , N/A , $228.95 , $228.95 , $510.15 , $265.01 , $49.93 , $515.52 
Ho W/O Joints Cf,HCPCS L3919,N/A,N/A,N/A, $410.00 , $266.50 , N/A , $288.30 , $36.92 , N/A , N/A , $381.30 , $369.00 , $369.00 , $328.00 , $328.00 , $36.92 , $378.55 , $389.50 , $369.00 , $369.00 , $369.00 , $381.30 , $393.60 , N/A , $348.50 , $238.09 , $242.57 , N/A , N/A , N/A , $389.50 , N/A , $36.92 , $393.60 
" Pro Repair Rotator Cuff, Acute ",CPT® 23410,0975 - PRO FEE/OR,N/A,N/A," $5,049.00 "," $3,281.85 "," $4,981.80 ", $780.96 , $768.38 ," $3,961.97 "," $3,945.11 "," $4,695.57 "," $4,544.10 "," $4,544.10 "," $4,039.20 "," $4,039.20 ", $768.38 ," $4,661.74 "," $4,796.55 "," $4,544.10 "," $4,544.10 "," $4,544.10 "," $4,695.57 "," $4,847.04 "," $4,634.55 "," $4,291.65 "," $4,356.68 "," $4,667.26 ", N/A ," $4,039.28 "," $4,039.28 "," $4,796.55 "," $4,747.60 ", $768.38 ," $4,981.80 "
Introgation Dev Eval Cartd Sins Barreflx W/Prgrm,CPT® 0273T,N/A,N/A,N/A, $294.00 , $191.10 , N/A , N/A , N/A , N/A , N/A , $273.42 , $264.60 , $264.60 , $235.20 , $235.20 , N/A , $271.45 , $279.30 , $264.60 , $264.60 , $264.60 , $273.42 , $282.24 , N/A , $249.90 ," $13,122.89 ", $272.89 , N/A , $147.01 , $147.01 , $279.30 , $171.13 , $147.01 ," $13,122.89 "
 CALAMINE 8-8 % EX LOTN ,HCPCS RXC637,0250 - PHARMACY,00904-2533-21,177 mL, $11.82 , $7.68 , $9.93 , N/A , N/A , $9.55 , $10.64 , $10.01 , $10.64 , $10.64 , $10.64 , $10.05 , N/A , $10.91 , $11.23 , $10.05 , $10.99 , $10.99 , $11.23 , $11.35 , $9.67 , $10.64 , $10.05 , $9.34 , N/A , $9.57 , $9.57 , $11.23 , $10.14 , $9.34 , $11.35 
 DAUNORUBICIN-CYTARABINE LIPO 44-100 MG IV SUSR ,HCPCS J9153,0636 - DRUGS REQUIRING DETAILED CODIN,68727-0745-01,20 mL," $28,844.47 "," $18,748.91 "," $24,229.35 ", $231.77 , $223.52 ," $23,306.33 "," $25,960.02 "," $24,419.73 "," $25,960.02 "," $25,960.02 "," $25,960.02 "," $24,517.80 ", $219.14 ," $26,632.10 "," $27,402.25 "," $24,517.80 "," $26,825.36 "," $26,825.36 "," $27,402.25 "," $27,690.69 "," $23,600.55 "," $25,960.02 "," $24,517.80 "," $22,787.13 ", N/A ," $23,343.83 "," $23,343.83 "," $27,402.25 "," $24,751.44 ", $219.14 ," $27,690.69 "
Insj Ant Sgm Drg Dev Trab Mw W/O Res&Ctrc Rmvl1+,CPT® 0671T,N/A,N/A,N/A," $7,994.00 "," $5,196.10 ", N/A , N/A , N/A , N/A , N/A ," $7,434.42 "," $7,194.60 "," $7,194.60 "," $6,395.20 "," $6,395.20 ", N/A ," $7,380.86 "," $7,594.30 "," $7,194.60 "," $7,194.60 "," $7,194.60 "," $7,434.42 "," $7,674.24 ", N/A ," $6,794.90 "," $1,869.34 "," $6,991.24 ", N/A ," $1,828.70 "," $1,828.70 "," $7,594.30 "," $2,128.64 "," $1,828.70 "," $7,674.24 "
Compression Stocking Bk18-30,HCPCS A6530,N/A,N/A,N/A, $58.00 , $37.70 , N/A , N/A , $24.41 , N/A , N/A , $53.94 , $52.20 , $52.20 , $46.40 , $46.40 , $24.41 , $53.55 , $55.10 , $52.20 , $52.20 , $52.20 , $53.94 , $55.68 , N/A , $49.30 , $46.40 , N/A , N/A , N/A , N/A , $55.10 , N/A , $24.41 , $55.68 
Splint Elbow,HCPCS S8452,N/A,N/A,N/A, $43.00 , $27.95 , N/A , N/A , N/A , N/A , N/A , $39.99 , $38.70 , $38.70 , $34.40 , $34.40 , N/A , $39.70 , $40.85 , $38.70 , $38.70 , $38.70 , $39.99 , $41.28 , N/A , $36.55 , $34.40 , N/A , N/A , N/A , N/A , $40.85 , N/A , $34.40 , $41.28 
 ITRACONAZOLE 100 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,50268-0450-11,1 capsule, $29.06 , $18.89 , $24.41 , N/A , N/A , $23.48 , $26.15 , $24.60 , $26.15 , $26.15 , $26.15 , $24.70 , N/A , $26.83 , $27.61 , $24.70 , $27.03 , $27.03 , $27.61 , $27.90 , $23.78 , $26.15 , $24.70 , $22.96 , N/A , $23.52 , $23.52 , $27.61 , $24.94 , $22.96 , $27.90 
 Fac Hep C Screen High Risk/Other ,HCPCS G0472,0301 - LAB/CHEMISTRY,N/A,N/A, $182.00 , $118.30 , $152.88 , $47.28 , N/A , $147.06 , $163.80 , $154.08 , $163.80 , $163.80 , $163.80 , $154.70 , N/A , $168.04 , $172.90 , $154.70 , $169.26 , $169.26 , $172.90 , $174.72 , $148.91 , $163.80 , $154.70 , $143.78 , N/A , $147.29 , $147.29 , $172.90 , $156.17 , $47.28 , $174.72 
"Contrast Inj,Abscess/Cyst via Cath Tube",CPT® 49424,N/A,N/A,N/A," $1,021.00 ", $663.65 , $231.40 , $35.68 , $111.57 , $186.84 , $186.63 , $949.53 , $918.90 , $918.90 , $816.80 , $816.80 , $111.57 , $942.69 , $969.95 , $918.90 , $918.90 , $918.90 , $949.53 , $980.16 , $165.91 , $867.85 , $201.60 , $221.46 , N/A , $190.49 , $190.49 , $969.95 , $199.21 , $35.68 , $980.16 
X-Ray Eye for Foreign Body,CPT® 70030,N/A,N/A,N/A, $424.00 , $275.60 , $182.93 , $32.05 , $27.07 , $130.30 , $153.94 , $394.32 , $381.60 , $381.60 , $339.20 , $339.20 , $27.07 , $391.48 , $402.80 , $381.60 , $381.60 , $381.60 , $394.32 , $407.04 , $176.55 , $360.40 , $169.49 , $140.54 , N/A , $132.84 , $132.84 , $402.80 , $153.75 , $27.07 , $407.04 
" Fac Protein, Western Blot Test ",CPT® 84182,0301 - LAB/CHEMISTRY,N/A,N/A, $322.00 , $209.30 , $270.48 , $29.79 , $24.98 , $260.18 , $289.80 , $272.61 , $289.80 , $289.80 , $289.80 , $273.70 , $24.49 , $297.30 , $305.90 , $273.70 , $299.46 , $299.46 , $305.90 , $309.12 , $263.46 , $289.80 , $273.70 , $254.38 , N/A , $260.59 , $260.59 , $305.90 , $276.31 , $24.49 , $309.12 
Radiologic Exam Abdomen 2 Views,CPT® 74019,N/A,N/A,N/A, $322.00 , $209.30 , $208.05 , $36.40 , $26.24 , $149.66 , $167.44 , $299.46 , $289.80 , $289.80 , $257.60 , $257.60 , $26.24 , $297.30 , $305.90 , $289.80 , $289.80 , $289.80 , $299.46 , $309.12 , $203.49 , $273.70 , $212.94 , $167.88 , N/A , $152.58 , $152.58 , $305.90 , $176.61 , $26.24 , $309.12 
" Pro Vein X-Ray, Arms/Legs ",CPT® 75822,0972 - PRO FEE/RAD/DX,N/A,N/A, $985.00 , $640.25 , $756.09 , $130.39 , $118.18 , $653.80 , $830.60 , $916.05 , $886.50 , $886.50 , $788.00 , $788.00 , $118.18 , $909.45 , $935.75 , $886.50 , $886.50 , $886.50 , $916.05 , $945.60 , $776.98 , $837.25 , $905.24 , $684.71 , N/A , $666.56 , $666.56 , $935.75 , $771.56 , $118.18 , $945.60 
Simple Repair 20.1-30cm,12006,N/A,N/A,N/A," $1,509.00 ", $980.85 , $362.98 , $107.63 , $188.65 , $328.19 , $317.78 ," $1,403.37 "," $1,358.10 "," $1,358.10 "," $1,207.20 "," $1,207.20 ", $188.65 ," $1,393.26 "," $1,433.55 "," $1,358.10 "," $1,358.10 "," $1,358.10 "," $1,403.37 "," $1,448.64 ", $399.58 ," $1,282.65 ", $638.69 , $403.51 , N/A , $334.60 , $334.60 ," $1,433.55 ", $388.01 , $107.63 ," $1,448.64 "
 PANITUMUMAB 400 MG/20ML IV SOLN ,HCPCS J9303,0636 - DRUGS REQUIRING DETAILED CODIN,55513-0956-01,20 mL," $18,458.74 "," $11,998.18 "," $15,505.34 ", $152.70 , $146.38 ," $14,914.66 "," $16,612.87 "," $15,627.17 "," $16,612.87 "," $16,612.87 "," $16,612.87 "," $15,689.93 ", $143.51 ," $17,042.95 "," $17,535.80 "," $15,689.93 "," $17,166.63 "," $17,166.63 "," $17,535.80 "," $17,720.39 "," $15,102.94 "," $16,612.87 "," $15,689.93 "," $14,582.40 ", N/A ," $14,938.66 "," $14,938.66 "," $17,535.80 "," $15,839.44 ", $143.51 ," $17,720.39 "
 Fac Ablation Ther 1+ Pulm Tumors Perq Cryoablation ,CPT® 32994,0361 - OR/MINOR,N/A,N/A," $11,429.00 "," $7,428.85 "," $9,600.36 ", $415.92 ," $4,909.50 "," $9,234.63 "," $10,286.10 "," $9,675.79 "," $10,286.10 "," $10,286.10 "," $10,286.10 "," $9,714.65 "," $4,813.24 "," $10,552.40 "," $10,857.55 "," $9,714.65 "," $10,628.97 "," $10,628.97 "," $10,857.55 "," $10,971.84 "," $9,351.21 "," $10,286.10 "," $9,714.65 "," $9,028.91 ", N/A ," $9,249.49 "," $9,249.49 "," $10,857.55 "," $9,807.22 ", $415.92 ," $10,971.84 "
 Fac Endomysial Antibody Each Immunoglobulin Class ,CPT® 86231,0302 - LAB/IMMUNOLOGY,N/A,N/A, $155.00 , $100.75 , $130.20 , $12.33 , $12.29 , $125.24 , $139.50 , $131.22 , $139.50 , $139.50 , $139.50 , $131.75 , $12.05 , $143.11 , $147.25 , $131.75 , $144.15 , $144.15 , $147.25 , $148.80 , $126.82 , $139.50 , $131.75 , $122.45 , N/A , $125.44 , $125.44 , $147.25 , $133.01 , $12.05 , $148.80 
Assay Carnitine,CPT® 82379,N/A,N/A,N/A, $211.00 , $137.15 , N/A , $17.21 , $17.21 , $81.53 , $97.54 , $196.23 , $189.90 , $189.90 , $168.80 , $168.80 , $17.21 , $194.82 , $200.45 , $189.90 , $189.90 , $189.90 , $196.23 , $202.56 , $112.64 , $179.35 , $110.29 , $61.18 , N/A , $76.09 , $76.09 , $200.45 , $83.15 , $17.21 , $202.56 
 Fac Amino Acids 1 Quan Ea Spec ,CPT® 82131,0301 - LAB/CHEMISTRY,N/A,N/A, $187.00 , $121.55 , $157.08 , $23.44 , $20.74 , $151.10 , $168.30 , $158.31 , $168.30 , $168.30 , $168.30 , $158.95 , $20.33 , $172.66 , $177.65 , $158.95 , $173.91 , $173.91 , $177.65 , $179.52 , $153.00 , $168.30 , $158.95 , $147.73 , N/A , $151.34 , $151.34 , $177.65 , $160.46 , $20.33 , $179.52 
"I&D Finger Abscess,Simple",26010,N/A,N/A,N/A, $817.00 , $531.05 , $867.23 , $136.36 , $30.71 , $664.95 , $677.89 , $759.81 , $735.30 , $735.30 , $653.60 , $653.60 , $30.71 , $754.34 , $776.15 , $735.30 , $735.30 , $735.30 , $759.81 , $784.32 , $800.12 , $694.45 , $742.17 , $793.35 , N/A , $677.92 , $677.92 , $776.15 , $796.82 , $30.71 , $867.23 
" Fac Blood Serology, Quantitative ",CPT® 86593,0302 - LAB/IMMUNOLOGY,N/A,N/A, $55.00 , $35.75 , $46.20 , $4.49 , $4.49 , $44.44 , $49.50 , $46.56 , $49.50 , $49.50 , $49.50 , $46.75 , $4.40 , $50.78 , $52.25 , $46.75 , $51.15 , $51.15 , $52.25 , $52.80 , $45.00 , $49.50 , $46.75 , $43.45 , N/A , $44.51 , $44.51 , $52.25 , $47.20 , $4.40 , $52.80 
"Colposcopy,Cervix W/Adj Vag,W/Loop Bx",CPT® 57460,N/A,N/A,N/A," $2,072.00 "," $1,346.80 ", $742.05 , $150.76 , $267.45 , $664.42 , $661.84 ," $1,926.96 "," $1,864.80 "," $1,864.80 "," $1,657.60 "," $1,657.60 ", $267.45 ," $1,913.08 "," $1,968.40 "," $1,864.80 "," $1,864.80 "," $1,864.80 "," $1,926.96 "," $1,989.12 ", $784.19 ," $1,761.20 ", $872.41 , $664.90 , N/A , $677.38 , $677.38 ," $1,968.40 ", $812.47 , $150.76 ," $1,989.12 "
" Pro Scope Bladder, Destruction of Lesions ",CPT® 52214,0982 - PRO FEE/OUTPT,N/A,N/A," $4,647.00 "," $3,020.55 ", $943.63 , $164.94 , $155.03 , $863.18 , $796.57 ," $4,321.71 "," $4,182.30 "," $4,182.30 "," $3,717.60 "," $3,717.60 ", $155.03 ," $4,290.58 "," $4,414.65 "," $4,182.30 "," $4,182.30 "," $4,182.30 "," $4,321.71 "," $4,461.12 ", $951.06 ," $3,949.95 ", $902.74 ," $1,083.33 ", N/A , $880.02 , $880.02 ," $4,414.65 "," $1,034.33 ", $155.03 ," $4,461.12 "
"Remv Vert Body,Lower,Retroper,One",CPT® 63090,N/A,N/A,N/A," $12,939.00 "," $8,410.35 "," $9,208.16 "," $1,784.40 "," $1,713.54 "," $10,722.91 "," $10,345.27 "," $12,033.27 "," $11,645.10 "," $11,645.10 "," $10,351.20 "," $10,351.20 "," $1,713.54 "," $11,946.58 "," $12,292.05 "," $11,645.10 "," $11,645.10 "," $11,645.10 "," $12,033.27 "," $12,421.44 "," $9,989.64 "," $10,998.15 "," $10,392.17 "," $11,367.97 ", N/A ," $10,932.14 "," $10,932.14 "," $12,292.05 "," $11,727.61 "," $1,713.54 "," $12,421.44 "
 Pro Radiologic Examination Femur 1 View ,CPT® 73551,0972 - PRO FEE/RAD/DX,N/A,N/A, $87.00 , $56.55 , $197.68 , $28.73 , $21.76 , $131.90 , $139.97 , $80.91 , $78.30 , $78.30 , $69.60 , $69.60 , $21.76 , $80.33 , $82.65 , $78.30 , $78.30 , $78.30 , $80.91 , $83.52 , $161.25 , $73.95 , $168.82 , $140.49 , N/A , $134.47 , $134.47 , $82.65 , $155.66 , $21.76 , $197.68 
Etonogestrel Implant System,HCPCS J7307,N/A,N/A,N/A," $1,152.00 ", $748.80 , N/A , N/A ," $1,114.33 ", N/A , N/A ," $1,071.36 "," $1,036.80 "," $1,036.80 ", $921.60 , $921.60 ," $1,114.33 "," $1,063.64 "," $1,094.40 "," $1,036.80 "," $1,036.80 "," $1,036.80 "," $1,071.36 "," $1,105.92 ", N/A , $979.20 , $921.60 ," $1,467.33 ", N/A , N/A , N/A ," $1,094.40 ", N/A , $921.60 ," $1,467.33 "
Aminolevulinic Acid Hcl Top,HCPCS J7308,N/A,N/A,N/A, $422.00 , $274.30 , N/A , $399.05 , $399.53 , N/A , N/A , $392.46 , $379.80 , $379.80 , $337.60 , $337.60 , $399.53 , $389.63 , $400.90 , $379.80 , $379.80 , $379.80 , $392.46 , $405.12 , $496.77 , $358.70 , $306.21 , $513.07 , N/A , N/A , N/A , $400.90 , N/A , $306.21 , $513.07 
"Exc Skin Malig 2.1-3cm Face,Facial",CPT® 11643,N/A,N/A,N/A," $1,730.00 "," $1,124.50 ", $726.61 , $217.56 , $390.36 , $630.37 , $614.15 ," $1,608.90 "," $1,557.00 "," $1,557.00 "," $1,384.00 "," $1,384.00 ", $390.36 ," $1,597.31 "," $1,643.50 "," $1,557.00 "," $1,557.00 "," $1,557.00 "," $1,608.90 "," $1,660.80 ", $796.89 ," $1,470.50 "," $1,225.65 ", $805.09 , N/A , $642.67 , $642.67 ," $1,643.50 ", $745.28 , $217.56 ," $1,660.80 "
Sbsq Nursing Facility Care Mod Mdm 30 Minutes,CPT® 99309,N/A,N/A,N/A, $242.00 , $157.30 , $181.21 , $104.11 , $68.31 , $157.30 , $157.84 , $225.06 , $217.80 , $217.80 , $193.60 , $193.60 , $68.31 , $223.44 , $229.90 , $217.80 , $217.80 , $217.80 , $225.06 , $232.32 , $229.81 , $205.70 , $195.78 , $194.05 , $86.00 , $160.37 , $160.37 , $229.90 , $184.96 , $68.31 , $232.32 
Open Skull Supratent Explore,CPT® 61304,N/A,N/A,N/A," $10,544.00 "," $6,853.60 "," $7,492.42 "," $1,460.56 "," $1,376.94 "," $8,847.11 "," $8,465.98 "," $9,805.92 "," $9,489.60 "," $9,489.60 "," $8,435.20 "," $8,435.20 "," $1,376.94 "," $9,735.28 "," $10,016.80 "," $9,489.60 "," $9,489.60 "," $9,489.60 "," $9,805.92 "," $10,122.24 "," $8,099.93 "," $8,962.40 "," $8,690.18 "," $9,150.60 ", N/A ," $9,019.73 "," $9,019.73 "," $10,016.80 "," $9,676.06 "," $1,376.94 "," $10,122.24 "
"Ca Screen,Flexi Sigmoidscope",HCPCS G0104,N/A,N/A,N/A," $1,015.00 ", $659.75 , $126.46 , $53.21 , $103.39 , $117.23 , N/A , $943.95 , $913.50 , $913.50 , $812.00 , $812.00 , $103.39 , $937.15 , $964.25 , $913.50 , $913.50 , $913.50 , $943.95 , $974.40 , $165.85 , $862.75 , $124.56 , $325.47 , N/A , $119.52 , $119.52 , $964.25 , $149.41 , $53.21 , $974.40 
Esophagoscopy Flexible Transoral With Biopsy,CPT® 43202,N/A,N/A,N/A," $2,013.00 "," $1,308.45 ", $628.94 , $97.41 , $346.37 , $527.54 , $564.73 ," $1,872.09 "," $1,811.70 "," $1,811.70 "," $1,610.40 "," $1,610.40 ", $346.37 ," $1,858.60 "," $1,912.35 "," $1,811.70 "," $1,811.70 "," $1,811.70 "," $1,872.09 "," $1,932.48 ", $450.11 ," $1,711.05 ", $619.07 , $595.84 , N/A , $537.83 , $537.83 ," $1,912.35 ", $562.53 , $97.41 ," $1,932.48 "
 Fac Esophagoscopy Rigid Transoral With Biopsy ,CPT® 43193,0360 - OR SERVICES,N/A,N/A," $2,381.00 "," $1,547.65 "," $2,000.04 ", $161.53 , $136.33 ," $1,923.85 "," $2,142.90 "," $2,015.75 "," $2,142.90 "," $2,142.90 "," $2,142.90 "," $2,023.85 ", $133.66 ," $2,198.38 "," $2,261.95 "," $2,023.85 "," $2,214.33 "," $2,214.33 "," $2,261.95 "," $2,285.76 "," $1,948.13 "," $2,142.90 "," $2,023.85 "," $1,880.99 ", N/A ," $1,926.94 "," $1,926.94 "," $2,261.95 "," $2,043.14 ", $133.66 ," $2,285.76 "
Radiologic Exam Complete Acute Abdomen Series,CPT® 74022,N/A,N/A,N/A, $390.00 , $253.50 , $282.87 , $49.14 , $46.32 , $209.33 , $260.18 , $362.70 , $351.00 , $351.00 , $312.00 , $312.00 , $46.32 , $360.09 , $370.50 , $351.00 , $351.00 , $351.00 , $362.70 , $374.40 , $274.26 , $331.50 , $283.13 , $224.79 , N/A , $213.42 , $213.42 , $370.50 , $247.04 , $46.32 , $374.40 
 Pro Inj Tendon Origin/Insertion ,CPT® 20551,0981 - PRO FEE/ER,N/A,N/A, $342.00 , $222.30 , $99.85 , $37.19 , $26.41 , $208.42 , $205.64 , $318.06 , $307.80 , $307.80 , $273.60 , $273.60 , $26.41 , $315.77 , $324.90 , $307.80 , $307.80 , $307.80 , $318.06 , $328.32 , $224.71 , $290.70 , $223.01 , $248.94 , N/A , $212.48 , $212.48 , $324.90 , $249.74 , $26.41 , $328.32 
"Exc Skin Benig 3.1-4cm Trunk,Arm,Leg",CPT® 11404,N/A,N/A,N/A," $1,117.00 ", $726.05 , $522.78 , $157.18 , $175.90 , $439.00 , $431.68 ," $1,038.81 "," $1,005.30 "," $1,005.30 ", $893.60 , $893.60 , $175.90 ," $1,031.33 "," $1,061.15 "," $1,005.30 "," $1,005.30 "," $1,005.30 "," $1,038.81 "," $1,072.32 ", $569.24 , $949.45 , $863.49 , $563.64 , N/A , $447.56 , $447.56 ," $1,061.15 ", $519.02 , $157.18 ," $1,072.32 "
Removal of Added Skin Tags,11201,N/A,N/A,N/A, $149.00 , $96.85 , $52.16 , $15.71 , $15.36 , $45.31 , $43.98 , $138.57 , $134.10 , $134.10 , $119.20 , $119.20 , $15.36 , $137.57 , $141.55 , $134.10 , $134.10 , $134.10 , $138.57 , $143.04 , $57.50 , $126.65 , $87.42 , $59.64 , N/A , $46.20 , $46.20 , $141.55 , $53.57 , $15.36 , $143.04 
 Fac Rpr Blvsl Dir Uxtr ,CPT® 35206,0360 - OR SERVICES,N/A,N/A," $4,880.00 "," $3,172.00 "," $4,099.20 ", $712.87 , $775.02 ," $3,943.04 "," $4,392.00 "," $4,131.41 "," $4,392.00 "," $4,392.00 "," $4,392.00 "," $4,148.00 ", $759.82 ," $4,505.70 "," $4,636.00 "," $4,148.00 "," $4,538.40 "," $4,538.40 "," $4,636.00 "," $4,684.80 "," $3,992.82 "," $4,392.00 "," $4,148.00 "," $3,855.20 ", N/A ," $3,949.38 "," $3,949.38 "," $4,636.00 "," $4,187.53 ", $712.87 ," $4,684.80 "
Egd Esophagus Balloon Dilation 30 Mm or Larger,CPT® 43233,N/A,N/A,N/A," $1,552.00 "," $1,008.80 "," $1,391.98 ", $214.39 , $176.14 ," $1,114.79 "," $1,157.44 "," $1,443.36 "," $1,396.80 "," $1,396.80 "," $1,241.60 "," $1,241.60 ", $176.14 ," $1,432.96 "," $1,474.40 "," $1,396.80 "," $1,396.80 "," $1,396.80 "," $1,443.36 "," $1,489.92 ", $998.93 ," $1,319.20 "," $1,192.33 "," $1,324.47 ", N/A ," $1,136.54 "," $1,136.54 "," $1,474.40 "," $1,188.71 ", $176.14 ," $1,489.92 "
 Fac Drug Assay Adalimumab ,CPT® 80145,0301 - LAB/CHEMISTRY,N/A,N/A, $304.00 , $197.60 , $255.36 , $39.34 , $31.47 , $245.63 , $273.60 , $257.37 , $273.60 , $273.60 , $273.60 , $258.40 , $30.85 , $280.68 , $288.80 , $258.40 , $282.72 , $282.72 , $288.80 , $291.84 , $248.73 , $273.60 , $258.40 , $240.16 , N/A , $246.03 , $246.03 , $288.80 , $260.86 , $30.85 , $291.84 
 Fac Jak2 Targeted Sequence Analysis ,CPT® 81279,0310 - PATHOLOGY LAB,N/A,N/A," $1,097.00 ", $713.05 , $921.48 , $188.90 , $151.12 , $886.38 , $987.30 , $928.72 , $987.30 , $987.30 , $987.30 , $932.45 , $148.16 ," $1,012.86 "," $1,042.15 ", $932.45 ," $1,020.21 "," $1,020.21 "," $1,042.15 "," $1,053.12 ", $897.57 , $987.30 , $932.45 , $866.63 , N/A , $887.80 , $887.80 ," $1,042.15 ", $941.34 , $148.16 ," $1,053.12 "
Incise Infected Bursa,CPT® 28001,N/A,N/A,N/A," $1,830.00 "," $1,189.50 ", $602.36 , $93.09 , $46.08 , $846.97 , $824.16 ," $1,701.90 "," $1,647.00 "," $1,647.00 "," $1,464.00 "," $1,464.00 ", $46.08 ," $1,689.64 "," $1,738.50 "," $1,647.00 "," $1,647.00 "," $1,647.00 "," $1,701.90 "," $1,756.80 ", $970.48 ," $1,555.50 ", $888.46 , $991.70 , N/A , $863.50 , $863.50 ," $1,738.50 "," $1,014.92 ", $46.08 ," $1,756.80 "
"Colorectal Scrn, Hi Risk Ind",G0105,N/A,N/A,N/A," $2,426.00 "," $1,576.90 "," $2,171.13 ", $174.38 , $351.69 , $373.81 , N/A ," $2,256.18 "," $2,183.40 "," $2,183.40 "," $1,940.80 "," $1,940.80 ", $351.69 ," $2,239.93 "," $2,304.70 "," $2,183.40 "," $2,183.40 "," $2,183.40 "," $2,256.18 "," $2,328.96 ", $813.03 ," $2,062.10 ", $420.39 ," $1,073.81 ", N/A , $381.10 , $381.10 ," $2,304.70 ", $476.38 , $174.38 ," $2,328.96 "
"IV Infusion, Hydration, 31-60 Min",CPT® 96360,N/A,N/A,N/A, $241.00 , $156.65 , $78.77 , $31.93 , $51.59 , $125.97 , $130.76 , $224.13 , $216.90 , $216.90 , $192.80 , $192.80 , $51.59 , $222.52 , $228.95 , $216.90 , $216.90 , $216.90 , $224.13 , $231.36 , $128.99 , $204.85 , $174.36 , $175.22 , N/A , $128.43 , $128.43 , $228.95 , $149.71 , $31.93 , $231.36 
"Drain Mouth Absc/Cyst/Hematoma,Simpl",40800,N/A,N/A,N/A, $572.00 , $371.80 , $740.22 , $115.73 , $30.71 , $643.19 , $665.31 , $531.96 , $514.80 , $514.80 , $457.60 , $457.60 , $30.71 , $528.13 , $543.40 , $514.80 , $514.80 , $514.80 , $531.96 , $549.12 , $540.50 , $486.20 , $726.11 , $759.67 , N/A , $655.74 , $655.74 , $543.40 , $685.83 , $30.71 , $759.67 
 Pro Cltx Medial Ankle Fx ,CPT® 27760,0982 - PRO FEE/OUTPT,N/A,N/A," $2,203.00 "," $1,431.95 "," $1,916.98 ", $302.45 , $184.42 ," $1,467.45 "," $1,497.57 "," $2,048.79 "," $1,982.70 "," $1,982.70 "," $1,762.40 "," $1,762.40 ", $184.42 ," $2,034.03 "," $2,092.85 "," $1,982.70 "," $1,982.70 "," $1,982.70 "," $2,048.79 "," $2,114.88 "," $1,767.47 "," $1,872.55 "," $1,643.12 "," $1,745.36 ", N/A ," $1,496.08 "," $1,496.08 "," $2,092.85 "," $1,758.43 ", $184.42 ," $2,114.88 "
Belt Strap Sleev Grmnt Cover,HCPCS A4467,N/A,N/A,N/A, $25.00 , $16.25 , N/A , N/A , N/A , N/A , N/A , $23.25 , $22.50 , $22.50 , $20.00 , $20.00 , N/A , $23.08 , $23.75 , $22.50 , $22.50 , $22.50 , $23.25 , $24.00 , N/A , $21.25 , $20.00 , N/A , N/A , N/A , N/A , $23.75 , N/A , $20.00 , $24.00 
Replace Tricuspid W Cp Bypass,CPT® 33465,N/A,N/A,N/A," $25,301.00 "," $16,445.65 "," $16,048.18 "," $2,477.30 "," $2,378.00 "," $11,777.07 "," $11,683.30 "," $23,529.93 "," $22,770.90 "," $22,770.90 "," $20,240.80 "," $20,240.80 "," $2,378.00 "," $23,360.41 "," $24,035.95 "," $22,770.90 "," $22,770.90 "," $22,770.90 "," $23,529.93 "," $24,288.96 "," $14,874.07 "," $21,505.85 "," $14,813.08 "," $13,194.23 ", N/A ," $12,006.86 "," $12,006.86 "," $24,035.95 "," $13,639.81 "," $2,378.00 "," $24,288.96 "
 Pro Mod Sed Same Phys/Qhp Initial 15 Mins 5/> Yrs ,CPT® 99152,0982 - PRO FEE/OUTPT,N/A,N/A, $160.00 , $104.00 , $28.01 , $11.70 , $40.63 , $26.51 , $27.37 , $148.80 , $144.00 , $144.00 , $128.00 , $128.00 , $40.63 , $147.73 , $152.00 , $144.00 , $144.00 , $144.00 , $148.80 , $153.60 , $37.64 , $136.00 , $37.36 , $46.92 , N/A , $27.03 , $27.03 , $152.00 , $31.50 , $11.70 , $153.60 
 IMIPRAMINE HCL 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,49884-0056-01,1 tablet, $6.27 , $4.08 , $5.27 , N/A , N/A , $5.07 , $5.64 , $5.31 , $5.64 , $5.64 , $5.64 , $5.33 , N/A , $5.79 , $5.96 , $5.33 , $5.83 , $5.83 , $5.96 , $6.02 , $5.13 , $5.64 , $5.33 , $4.95 , N/A , $5.07 , $5.07 , $5.96 , $5.38 , $4.95 , $6.02 
 Fac Esoph G-Esop Rflx Ncath Eltrd Plmt ,CPT® 91034,0360 - OR SERVICES,N/A,N/A, $861.00 , $559.65 , $723.24 , $189.38 , $207.54 , $695.69 , $774.90 , $728.92 , $774.90 , $774.90 , $774.90 , $731.85 , $203.47 , $794.96 , $817.95 , $731.85 , $800.73 , $800.73 , $817.95 , $826.56 , $704.47 , $774.90 , $731.85 , $680.19 , N/A , $696.81 , $696.81 , $817.95 , $738.82 , $189.38 , $826.56 
 Ot Ultrasound/15 Min -Outpt ,CPT® 97035,0420 - PHYSICAL THERAPY,N/A,N/A, $99.00 , $64.35 , $83.16 , $14.26 , $19.80 , $79.99 , $89.10 , $83.81 , $89.10 , $89.10 , $89.10 , $84.15 , $19.41 , $91.41 , $94.05 , $84.15 , $92.07 , $92.07 , $94.05 , $95.04 , $81.00 , $89.10 , $84.15 , $78.21 , N/A , $80.12 , $80.12 , $94.05 , $84.95 , $14.26 , $95.04 
"Explor Postop Bleed,Infec,Clot-Extr",CPT® 35860,N/A,N/A,N/A," $4,852.00 "," $3,153.80 "," $4,882.93 ", $755.21 , $444.61 ," $3,631.42 "," $3,641.63 "," $4,512.36 "," $4,366.80 "," $4,366.80 "," $3,881.60 "," $3,881.60 ", $444.61 ," $4,479.85 "," $4,609.40 "," $4,366.80 "," $4,366.80 "," $4,366.80 "," $4,512.36 "," $4,657.92 "," $4,494.19 "," $4,124.20 "," $4,593.96 "," $4,039.79 ", N/A ," $3,702.28 "," $3,702.28 "," $4,609.40 "," $4,205.78 ", $444.61 ," $4,882.93 "
Lo Flexibl L1-Below L5 Pre,HCPCS L0625,N/A,N/A,N/A, $95.00 , $61.75 , N/A , $42.38 , $45.68 , N/A , N/A , $88.35 , $85.50 , $85.50 , $76.00 , $76.00 , $45.68 , $87.71 , $90.25 , $85.50 , $85.50 , $85.50 , $88.35 , $91.20 , N/A , $80.75 , $53.20 , $54.22 , N/A , N/A , N/A , $90.25 , N/A , $42.38 , $91.20 
 Forearm--2 Views ,CPT® 73090,0320 - DX X-RAY,N/A,N/A, $266.00 , $172.90 , $223.44 , $28.73 , $26.20 , $214.93 , $239.40 , $225.20 , $239.40 , $239.40 , $239.40 , $226.10 , $25.69 , $245.60 , $252.70 , $226.10 , $247.38 , $247.38 , $252.70 , $255.36 , $217.64 , $239.40 , $226.10 , $210.14 , N/A , $215.27 , $215.27 , $252.70 , $228.25 , $25.69 , $255.36 
Layer Closure 12.6-20cm,CPT® 12055,N/A,N/A,N/A," $1,896.00 "," $1,232.40 ", $942.68 , $283.32 , $288.68 , $824.87 , $801.32 ," $1,763.28 "," $1,706.40 "," $1,706.40 "," $1,516.80 "," $1,516.80 ", $288.68 ," $1,750.58 "," $1,801.20 "," $1,706.40 "," $1,706.40 "," $1,706.40 "," $1,763.28 "," $1,820.16 "," $1,033.61 "," $1,611.60 "," $1,598.52 "," $1,063.66 ", N/A , $840.96 , $840.96 ," $1,801.20 ", $975.24 , $283.32 ," $1,820.16 "
X-Ray Nasal Bones,CPT® 70160,N/A,N/A,N/A, $262.00 , $170.30 , $214.95 , $37.62 , $30.01 , $153.99 , $178.47 , $243.66 , $235.80 , $235.80 , $209.60 , $209.60 , $30.01 , $241.90 , $248.90 , $235.80 , $235.80 , $235.80 , $243.66 , $251.52 , $208.47 , $222.70 , $196.46 , $165.59 , N/A , $156.99 , $156.99 , $248.90 , $181.71 , $30.01 , $251.52 
 ARIPIPRAZOLE LAUROXIL ER 882 MG/3.2ML IM PRSY ,HCPCS J1944,0636 - DRUGS REQUIRING DETAILED CODIN,65757-0403-03,3.2 mL," $8,818.98 "," $5,732.34 "," $7,407.94 ", $3.13 , $3.04 ," $7,125.74 "," $7,937.08 "," $7,466.15 "," $7,937.08 "," $7,937.08 "," $7,937.08 "," $7,496.13 ", $2.98 ," $8,142.56 "," $8,378.03 "," $7,496.13 "," $8,201.65 "," $8,201.65 "," $8,378.03 "," $8,466.22 "," $7,215.69 "," $7,937.08 "," $7,496.13 "," $6,966.99 ", N/A ," $7,137.20 "," $7,137.20 "," $8,378.03 "," $7,567.57 ", $2.98 ," $8,466.22 "
 CLINDAMYCIN PHOSPHATE 900 MG/6ML IJ SOLN ,HCPCS J0736,0636 - DRUGS REQUIRING DETAILED CODIN,00009-5095-05,6 mL, $26.26 , $17.07 , $22.06 , N/A , N/A , $21.22 , $23.63 , $22.23 , $23.63 , $23.63 , $23.63 , $22.32 , N/A , $24.25 , $24.95 , $22.32 , $24.42 , $24.42 , $24.95 , $25.21 , $21.49 , $23.63 , $22.32 , $20.75 , N/A , $21.25 , $21.25 , $24.95 , $22.53 , $20.75 , $25.21 
Drug Screen Quantitative Lamotrigine,CPT® 80175,N/A,N/A,N/A, $63.00 , $40.95 , N/A , $13.52 , $13.52 , $75.01 , $89.06 , $58.59 , $56.70 , $56.70 , $50.40 , $50.40 , $13.52 , $58.17 , $59.85 , $56.70 , $56.70 , $56.70 , $58.59 , $60.48 , $88.47 , $53.55 , $63.00 , $48.05 , N/A , $70.00 , $70.00 , $59.85 , $76.49 , $13.52 , $89.06 
" Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC ",MS DRG V40 (FY2023) 562,N/A,N/A,N/A," $26,498.49 "," $17,224.02 "," $22,258.73 ", N/A , N/A ," $21,410.78 "," $23,848.64 "," $22,433.62 "," $23,848.64 "," $23,848.64 "," $23,848.64 "," $22,523.72 ", N/A ," $24,466.06 "," $25,173.57 "," $22,523.72 "," $24,643.60 "," $24,643.60 "," $25,173.57 "," $25,438.55 "," $21,681.06 "," $23,848.64 "," $22,523.72 "," $20,933.81 ", N/A ," $21,445.23 "," $21,445.23 "," $25,173.57 "," $22,738.35 "," $20,933.81 "," $25,438.55 "
"Exc Skin Malig 1.1-2cm Face,Facial",11642,N/A,N/A,N/A," $1,514.00 ", $984.10 , $582.11 , $174.71 , $228.52 , $502.44 , $491.79 ," $1,408.02 "," $1,362.60 "," $1,362.60 "," $1,211.20 "," $1,211.20 ", $228.52 ," $1,397.88 "," $1,438.30 "," $1,362.60 "," $1,362.60 "," $1,362.60 "," $1,408.02 "," $1,453.44 ", $637.97 ," $1,286.90 ", $977.67 , $643.58 , N/A , $512.24 , $512.24 ," $1,438.30 ", $594.04 , $174.71 ," $1,453.44 "
Fx Radial Closed W Manipu,CPT® 25605,N/A,N/A,N/A," $2,147.00 "," $1,395.55 "," $3,147.43 ", $496.56 , $388.30 ," $2,466.77 "," $2,502.71 "," $1,996.71 "," $1,932.30 "," $1,932.30 "," $1,717.60 "," $1,717.60 ", $388.30 ," $1,982.33 "," $2,039.65 "," $1,932.30 "," $1,932.30 "," $1,932.30 "," $1,996.71 "," $2,061.12 "," $2,912.52 "," $1,824.95 "," $2,754.59 "," $2,906.58 ", N/A ," $2,514.91 "," $2,514.91 "," $2,039.65 "," $2,955.90 ", $388.30 ," $3,147.43 "
"Electrocardiogram,Report",CPT® 93010,N/A,N/A,N/A, $102.00 , $66.30 , $51.61 , $7.96 , $9.02 , $46.31 , $46.05 , $94.86 , $91.80 , $91.80 , $81.60 , $81.60 , $9.02 , $94.18 , $96.90 , $91.80 , $91.80 , $91.80 , $94.86 , $97.92 , $86.42 , $86.70 , $42.82 , $32.14 , N/A , $47.22 , $47.22 , $96.90 , $52.33 , $7.96 , $97.92 
 Ercp Biliary Only ,CPT® 74328,0320 - DX X-RAY,N/A,N/A, $733.00 , $476.45 , $615.72 , $152.50 , $159.34 , $592.26 , $659.70 , $620.56 , $659.70 , $659.70 , $659.70 , $623.05 , $156.22 , $676.78 , $696.35 , $623.05 , $681.69 , $681.69 , $696.35 , $703.68 , $599.74 , $659.70 , $623.05 , $579.07 , N/A , $593.22 , $593.22 , $696.35 , $628.99 , $152.50 , $703.68 
" Fac Bone Marrow Imaging, Body ",CPT® 78104,0340 - NUCLEAR MEDICINE,N/A,N/A," $2,341.00 "," $1,521.65 "," $1,966.44 ", $230.14 , $203.20 ," $1,891.53 "," $2,106.90 "," $1,981.89 "," $2,106.90 "," $2,106.90 "," $2,106.90 "," $1,989.85 ", $199.22 ," $2,161.45 "," $2,223.95 "," $1,989.85 "," $2,177.13 "," $2,177.13 "," $2,223.95 "," $2,247.36 "," $1,915.41 "," $2,106.90 "," $1,989.85 "," $1,849.39 ", N/A ," $1,894.57 "," $1,894.57 "," $2,223.95 "," $2,008.81 ", $199.22 ," $2,247.36 "
 Pro Diagnostic Sigmoidoscopy ,CPT® 45330,0982 - PRO FEE/OUTPT,N/A,N/A," $1,000.00 ", $650.00 , $342.49 , $53.33 , $68.55 , $303.35 , $313.33 , $930.00 , $900.00 , $900.00 , $800.00 , $800.00 , $68.55 , $923.30 , $950.00 , $900.00 , $900.00 , $900.00 , $930.00 , $960.00 , $243.98 , $850.00 , $342.54 , $325.47 , N/A , $309.28 , $309.28 , $950.00 , $323.46 , $53.33 , $960.00 
Biopsy of Urethra,CPT® 53200,N/A,N/A,N/A," $1,088.00 ", $707.20 , $761.65 , $133.93 , $122.93 , $695.40 , $645.83 ," $1,011.84 ", $979.20 , $979.20 , $870.40 , $870.40 , $122.93 ," $1,004.55 "," $1,033.60 ", $979.20 , $979.20 , $979.20 ," $1,011.84 "," $1,044.48 ", $764.98 , $924.80 , $733.25 , $872.89 , N/A , $708.97 , $708.97 ," $1,033.60 ", $833.29 , $122.93 ," $1,044.48 "
 Pro Sbsq Hospital IP/Obs Care Sf/Low Mdm 25 Minutes ,CPT® 99231,0987 - PRO FEE/HOS VIS,N/A,N/A, $130.00 , $84.50 , $76.59 , $47.80 , $28.04 , $67.58 , $67.57 , $120.90 , $117.00 , $117.00 , $104.00 , $104.00 , $28.04 , $120.03 , $123.50 , $117.00 , $117.00 , $117.00 , $120.90 , $124.80 , $96.97 , $110.50 , $84.01 , $85.56 , $68.25 , $68.90 , $68.90 , $123.50 , $79.46 , $28.04 , $124.80 
 Arh Removl Subq Card Rythm Monitor ,CPT® 33286,0360 - OR SERVICES,N/A,N/A," $1,205.00 ", $783.25 ," $1,012.20 ", $78.86 , $102.59 , $973.64 ," $1,084.50 "," $1,020.15 "," $1,084.50 "," $1,084.50 "," $1,084.50 "," $1,024.25 ", $100.58 ," $1,112.58 "," $1,144.75 "," $1,024.25 "," $1,120.65 "," $1,120.65 "," $1,144.75 "," $1,156.80 ", $985.93 ," $1,084.50 "," $1,024.25 ", $951.95 , N/A , $975.21 , $975.21 ," $1,144.75 "," $1,034.01 ", $78.86 ," $1,156.80 "
Open Rx Nasal Septal Fracture,CPT® 21336,N/A,N/A,N/A," $4,280.00 "," $2,782.00 "," $4,015.64 ", $619.75 , $457.45 ," $3,142.32 "," $3,208.04 "," $3,980.40 "," $3,852.00 "," $3,852.00 "," $3,424.00 "," $3,424.00 ", $457.45 ," $3,951.72 "," $4,066.00 "," $3,852.00 "," $3,852.00 "," $3,852.00 "," $3,980.40 "," $4,108.80 "," $3,729.09 "," $3,638.00 "," $3,496.77 "," $3,690.15 ", N/A ," $3,203.63 "," $3,203.63 "," $4,066.00 "," $3,765.40 ", $457.45 ," $4,108.80 "
 DOCUSATE CALCIUM 240 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-6997-60,1 capsule, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Laser Surgery,Sever Vitreous Strands",CPT® 67031,N/A,N/A,N/A," $3,506.00 "," $2,278.90 "," $2,182.96 ", $342.19 , $515.48 ," $2,017.74 "," $1,884.26 "," $3,260.58 "," $3,155.40 "," $3,155.40 "," $2,804.80 "," $2,804.80 ", $515.48 ," $3,237.09 "," $3,330.70 "," $3,155.40 "," $3,155.40 "," $3,155.40 "," $3,260.58 "," $3,365.76 "," $3,005.74 "," $2,980.10 "," $1,933.93 "," $2,562.88 ", N/A ," $2,057.11 "," $2,057.11 "," $3,330.70 "," $2,270.79 ", $342.19 ," $3,365.76 "
 Admin Pfizer-Biontech Bivalent Booster 5 - 11 Yrs ,CPT® 0154A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
 Fac Tc99 Tilmanocept Diag 0.5mci ,HCPCS A9520,0343 - DIAGNOSTIC RADIOPHARMACEUTICALS,N/A,N/A," $1,265.00 ", $822.25 ," $1,062.60 ", N/A , N/A ," $1,022.12 "," $1,138.50 "," $1,070.95 "," $1,138.50 "," $1,138.50 "," $1,138.50 "," $1,075.25 ", N/A ," $1,167.97 "," $1,201.75 "," $1,075.25 "," $1,176.45 "," $1,176.45 "," $1,201.75 "," $1,214.40 "," $1,035.02 "," $1,138.50 "," $1,075.25 ", $999.35 , N/A ," $1,023.76 "," $1,023.76 "," $1,201.75 "," $1,085.50 ", $999.35 ," $1,214.40 "
" Pro OB US, Detailed, Sngl Fetus ",CPT® 76811,0972 - PRO FEE/RAD/DX,N/A,N/A, $819.00 , $532.35 , $989.13 , $174.57 , $190.41 , $876.31 , $987.19 , $761.67 , $737.10 , $737.10 , $655.20 , $655.20 , $190.41 , $756.18 , $778.05 , $737.10 , $737.10 , $737.10 , $761.67 , $786.24 , $982.99 , $696.15 ," $1,072.81 "," $1,025.68 ", N/A , $893.41 , $893.41 , $778.05 ," $1,034.14 ", $174.57 ," $1,072.81 "
RAD RESECTION TUMOR SOFT TISS FACE/SCALP 2+CM,21073,N/A,N/A,N/A," $1,993.00 "," $1,295.45 "," $1,530.36 ", $234.91 , $259.28 ," $1,241.61 "," $1,237.19 "," $1,853.49 "," $1,793.70 "," $1,793.70 "," $1,594.40 "," $1,594.40 ", $259.28 ," $1,840.14 "," $1,893.35 "," $1,793.70 "," $1,793.70 "," $1,793.70 "," $1,853.49 "," $1,913.28 "," $1,427.91 "," $1,694.05 "," $1,366.59 "," $1,448.28 ", N/A ," $1,265.84 "," $1,265.84 "," $1,893.35 "," $1,487.81 ", $234.91 ," $1,913.28 "
 TRASTUZUMAB-ANNS 420 MG IV SOLR ,HCPCS Q5117,0636 - DRUGS REQUIRING DETAILED CODIN,55513-0132-01,20 mL," $11,197.25 "," $7,278.21 "," $9,405.69 ", $24.44 , $34.04 ," $9,047.38 "," $10,077.53 "," $9,479.59 "," $10,077.53 "," $10,077.53 "," $10,077.53 "," $9,517.66 ", $33.37 ," $10,338.42 "," $10,637.39 "," $9,517.66 "," $10,413.44 "," $10,413.44 "," $10,637.39 "," $10,749.36 "," $9,161.59 "," $10,077.53 "," $9,517.66 "," $8,845.83 ", N/A ," $9,061.93 "," $9,061.93 "," $10,637.39 "," $9,608.36 ", $24.44 ," $10,749.36 "
 Pro Cltx Fx W8 Brg Artclr Prtn Dstl Tib W/Skel Tracj ,CPT® 27825,0982 - PRO FEE/OUTPT,N/A,N/A," $2,855.00 "," $1,855.75 "," $3,004.63 ", $474.54 , $435.12 ," $2,383.87 "," $2,374.71 "," $2,655.15 "," $2,569.50 "," $2,569.50 "," $2,284.00 "," $2,284.00 ", $435.12 ," $2,636.02 "," $2,712.25 "," $2,569.50 "," $2,569.50 "," $2,569.50 "," $2,655.15 "," $2,740.80 "," $2,791.58 "," $2,426.75 "," $2,619.01 "," $2,820.48 ", N/A ," $2,430.39 "," $2,430.39 "," $2,712.25 "," $2,856.59 ", $435.12 ," $3,004.63 "
"Triiodothyronine Total Assay, Tt-3",CPT® 84480,N/A,N/A,N/A, $160.00 , $104.00 , N/A , $14.46 , $14.46 , $80.20 , $95.96 , $148.80 , $144.00 , $144.00 , $128.00 , $128.00 , $14.46 , $147.73 , $152.00 , $144.00 , $144.00 , $144.00 , $148.80 , $153.60 , $94.68 , $136.00 , $92.45 , $51.43 , N/A , $74.85 , $74.85 , $152.00 , $81.79 , $14.46 , $153.60 
Pneumati Walking Boot Prefab,HCPCS L4360,N/A,N/A,N/A, $426.00 , $276.90 , N/A , $302.85 , $208.83 , N/A , N/A , $396.18 , $383.40 , $383.40 , $340.80 , $340.80 , $208.83 , $393.33 , $404.70 , $383.40 , $383.40 , $383.40 , $396.18 , $408.96 , N/A , $362.10 , $279.61 , $254.80 , N/A , N/A , N/A , $404.70 , N/A , $208.83 , $408.96 
 IOHEXOL 350 MG/ML IV SOLN ,HCPCS Q9967,0255 - DRUGS/RADIOLOGY,00407-1414-89,50 mL, $311.04 , $202.18 , $261.27 , $0.13 , $0.17 , $251.32 , $279.94 , $263.33 , $279.94 , $279.94 , $279.94 , $264.38 , $0.17 , $287.18 , $295.49 , $264.38 , $289.27 , $289.27 , $295.49 , $298.60 , $254.49 , $279.94 , $264.38 , $245.72 , N/A , $251.72 , $251.72 , $295.49 , $266.90 , $0.13 , $298.60 
"MRI, Lower Extr, W/O Contrast F/U by Contrast",CPT® 73720,N/A,N/A,N/A," $7,376.00 "," $4,794.40 "," $2,445.38 ", $347.83 , $515.74 ," $2,392.71 "," $3,041.08 "," $6,859.68 "," $6,638.40 "," $6,638.40 "," $5,900.80 "," $5,900.80 ", $515.74 ," $6,810.26 "," $7,007.20 "," $6,638.40 "," $6,638.40 "," $6,638.40 "," $6,859.68 "," $7,080.96 "," $2,109.58 "," $6,269.60 "," $3,312.79 "," $3,928.65 ", N/A ," $2,439.39 "," $2,439.39 "," $7,007.20 "," $2,823.63 ", $347.83 ," $7,080.96 "
"Removal of Hydrocele,Tunica,Bilat",55041,N/A,N/A,N/A," $2,687.00 "," $1,746.55 "," $2,274.10 ", $489.92 , $617.01 ," $1,637.18 "," $1,658.66 "," $2,498.91 "," $2,418.30 "," $2,418.30 "," $2,149.60 "," $2,149.60 ", $617.01 ," $2,480.91 "," $2,552.65 "," $2,418.30 "," $2,418.30 "," $2,418.30 "," $2,498.91 "," $2,579.52 "," $2,131.69 "," $2,283.95 "," $2,647.55 "," $2,467.53 ", N/A ," $1,669.13 "," $1,669.13 "," $2,552.65 "," $2,000.54 ", $489.92 ," $2,647.55 "
Pro Bx Soft Tiss Pelvis&Hip Area Dp Subfscal/Im,27041,N/A,N/A,N/A," $6,055.00 "," $3,935.75 "," $4,303.13 ", $675.68 , $208.93 ," $3,311.81 "," $3,283.07 "," $5,631.15 "," $5,449.50 "," $5,449.50 "," $4,844.00 "," $4,844.00 ", $208.93 ," $5,590.58 "," $5,752.25 "," $5,449.50 "," $5,449.50 "," $5,449.50 "," $5,631.15 "," $5,812.80 "," $3,975.25 "," $5,146.75 "," $3,614.51 "," $3,950.00 ", N/A ," $3,376.43 "," $3,376.43 "," $5,752.25 "," $3,968.52 ", $208.93 ," $5,812.80 "
Health Behavior Ivntj Indiv F2f Ea Addl 15 Min,CPT® 96159,N/A,N/A,N/A, $74.00 , $48.10 , $50.60 , $19.69 , $22.55 , $46.13 , N/A , $68.82 , $66.60 , $66.60 , $59.20 , $59.20 , $22.55 , $68.32 , $70.30 , $66.60 , $66.60 , $66.60 , $68.82 , $71.04 , $63.06 , $62.90 , $58.56 , $79.91 , N/A , $47.03 , $47.03 , $70.30 , $54.74 , $19.69 , $79.91 
 CEFAZOLIN SODIUM-DEXTROSE 2-3 GM-%(50ML) IV SOLR ,HCPCS J0690,0636 - DRUGS REQUIRING DETAILED CODIN,00264-3105-11,50 mL, $90.99 , $59.14 , $76.43 , $0.89 , $0.79 , $73.52 , $81.89 , $77.03 , $81.89 , $81.89 , $81.89 , $77.34 , $0.77 , $84.01 , $86.44 , $77.34 , $84.62 , $84.62 , $86.44 , $87.35 , $74.45 , $81.89 , $77.34 , $71.88 , N/A , $73.64 , $73.64 , $86.44 , $78.08 , $0.77 , $87.35 
 ARIPIPRAZOLE 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,65162-0897-03,1 tablet, $164.77 , $107.10 , $138.41 , N/A , N/A , $133.13 , $148.29 , $139.49 , $148.29 , $148.29 , $148.29 , $140.05 , N/A , $152.13 , $156.53 , $140.05 , $153.24 , $153.24 , $156.53 , $158.18 , $134.81 , $148.29 , $140.05 , $130.17 , N/A , $133.35 , $133.35 , $156.53 , $141.39 , $130.17 , $158.18 
Transplant Hand Tendon,26480,N/A,N/A,N/A," $4,268.00 "," $2,774.20 "," $4,952.81 ", $769.68 , $614.70 ," $3,575.48 "," $3,644.52 "," $3,969.24 "," $3,841.20 "," $3,841.20 "," $3,414.40 "," $3,414.40 ", $614.70 ," $3,940.64 "," $4,054.60 "," $3,841.20 "," $3,841.20 "," $3,841.20 "," $3,969.24 "," $4,097.28 "," $4,574.29 "," $3,627.80 "," $3,987.38 "," $4,288.31 ", N/A ," $3,645.24 "," $3,645.24 "," $4,054.60 "," $4,284.45 ", $614.70 ," $4,952.81 "
 Path/Fzn Sec 1st Specimen -Tech-Mh ,CPT® 88331,0310 - PATHOLOGY LAB,N/A,N/A, $712.00 , $462.80 , $598.08 , $100.89 , $81.44 , $575.30 , $640.80 , $602.78 , $640.80 , $640.80 , $640.80 , $605.20 , $79.84 , $657.39 , $676.40 , $605.20 , $662.16 , $662.16 , $676.40 , $683.52 , $582.56 , $640.80 , $605.20 , $562.48 , N/A , $576.22 , $576.22 , $676.40 , $610.97 , $79.84 , $683.52 
 SODIUM ZIRCONIUM CYCLOSILICATE 5 G PO PACK ,HCPCS RXC637,0250 - PHARMACY,00310-1105-01,1 packet, $160.58 , $104.38 , $134.89 , N/A , N/A , $129.75 , $144.52 , $135.95 , $144.52 , $144.52 , $144.52 , $136.49 , N/A , $148.26 , $152.55 , $136.49 , $149.34 , $149.34 , $152.55 , $154.16 , $131.39 , $144.52 , $136.49 , $126.86 , N/A , $129.96 , $129.96 , $152.55 , $137.79 , $126.86 , $154.16 
 Neck MR Angiography W/O & W Contrast ,CPT® 70549,0615 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA-HEAD AND NECK,N/A,N/A," $8,443.00 "," $5,487.95 "," $7,092.12 ", $354.34 , $616.14 ," $6,821.94 "," $7,598.70 "," $7,147.84 "," $7,598.70 "," $7,598.70 "," $7,598.70 "," $7,176.55 ", $604.06 ," $7,795.42 "," $8,020.85 "," $7,176.55 "," $7,851.99 "," $7,851.99 "," $8,020.85 "," $8,105.28 "," $6,908.06 "," $7,598.70 "," $7,176.55 "," $6,669.97 ", N/A ," $6,832.92 "," $6,832.92 "," $8,020.85 "," $7,244.94 ", $354.34 ," $8,105.28 "
"Open Rx Weightbear Tib,Fix Tib/Fib",CPT® 27828,N/A,N/A,N/A," $8,581.00 "," $5,577.65 "," $8,100.24 "," $1,262.57 "," $1,210.57 "," $6,257.89 "," $6,220.19 "," $7,980.33 "," $7,722.90 "," $7,722.90 "," $6,864.80 "," $6,864.80 "," $1,210.57 "," $7,922.84 "," $8,151.95 "," $7,722.90 "," $7,722.90 "," $7,722.90 "," $7,980.33 "," $8,237.76 "," $7,515.49 "," $7,293.85 "," $6,874.00 "," $7,468.19 ", N/A ," $6,379.99 "," $6,379.99 "," $8,151.95 "," $7,498.76 "," $1,210.57 "," $8,237.76 "
 Pro Cltx Sternum Fx ,CPT® 21820,0981 - PRO FEE/ER,N/A,N/A, $648.00 , $421.20 , $902.40 , $144.84 , $139.46 , $701.61 , $719.90 , $602.64 , $583.20 , $583.20 , $518.40 , $518.40 , $139.46 , $598.30 , $615.60 , $583.20 , $583.20 , $583.20 , $602.64 , $622.08 , $834.95 , $550.80 , $788.56 , $828.92 , N/A , $715.30 , $715.30 , $615.60 , $840.73 , $139.46 , $902.40 
" Other Injury, Poisoning And Toxic Effect Diagnoses Without McC ",MS DRG V40 (FY2023) 923,N/A,N/A,N/A," $13,880.85 "," $9,022.55 "," $11,659.91 ", N/A , N/A ," $11,215.73 "," $12,492.77 "," $11,751.53 "," $12,492.77 "," $12,492.77 "," $12,492.77 "," $11,798.72 ", N/A ," $12,816.19 "," $13,186.81 "," $11,798.72 "," $12,909.19 "," $12,909.19 "," $13,186.81 "," $13,325.62 "," $11,357.31 "," $12,492.77 "," $11,798.72 "," $10,965.87 ", N/A ," $11,233.77 "," $11,233.77 "," $13,186.81 "," $11,911.16 "," $10,965.87 "," $13,325.62 "
"Full Thick Grft Head,Fac,Ha Add 20sq",CPT® 15241,N/A,N/A,N/A," $1,343.00 ", $872.95 , $333.88 , $99.29 , $316.14 , $304.67 , $294.41 ," $1,248.99 "," $1,208.70 "," $1,208.70 "," $1,074.40 "," $1,074.40 ", $316.14 ," $1,239.99 "," $1,275.85 "," $1,208.70 "," $1,208.70 "," $1,208.70 "," $1,248.99 "," $1,289.28 ", $369.08 ," $1,141.55 ", $590.53 , $384.98 , N/A , $310.62 , $310.62 ," $1,275.85 ", $360.22 , $99.29 ," $1,289.28 "
 VITAMIN D3 1.25 MG (50000 UT) PO CAPS ,HCPCS RXC637,0250 - PHARMACY,80681-0174-00,1 capsule, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Bamlanivimab IV Infusion Therapy ,HCPCS M0239,0771 - VACCINE ADMINISTRATION,N/A,N/A," $1,335.00 ", $867.75 ," $1,121.40 ", N/A , N/A ," $1,078.68 "," $1,201.50 "," $1,130.21 "," $1,201.50 "," $1,201.50 "," $1,201.50 "," $1,134.75 ", N/A ," $1,232.61 "," $1,268.25 "," $1,134.75 "," $1,241.55 "," $1,241.55 "," $1,268.25 "," $1,281.60 "," $1,092.30 "," $1,201.50 "," $1,134.75 "," $1,054.65 ", N/A ," $1,080.42 "," $1,080.42 "," $1,268.25 "," $1,145.56 "," $1,054.65 "," $1,281.60 "
Thoracoscopy Surg Part Pleurectomy,CPT® 32656,N/A,N/A,N/A," $4,820.00 "," $3,133.00 "," $4,185.54 ", $732.44 , $797.74 ," $3,033.12 "," $2,961.34 "," $4,482.60 "," $4,338.00 "," $4,338.00 "," $3,856.00 "," $3,856.00 ", $797.74 ," $4,450.31 "," $4,579.00 "," $4,338.00 "," $4,338.00 "," $4,338.00 "," $4,482.60 "," $4,627.20 "," $4,042.18 "," $4,097.00 "," $4,267.48 "," $3,979.60 ", N/A ," $3,092.30 "," $3,092.30 "," $4,579.00 "," $3,641.83 ", $732.44 ," $4,627.20 "
 Pro Insj Tunneled Cvc W/O Subq Port/Pmp Age 5 Yr/> ,CPT® 36558,0982 - PRO FEE/OUTPT,N/A,N/A," $6,181.00 "," $4,017.65 "," $1,579.50 ", $244.84 ," $1,026.74 "," $1,210.08 "," $1,203.51 "," $5,748.33 "," $5,562.90 "," $5,562.90 "," $4,944.80 "," $4,944.80 "," $1,026.74 "," $5,706.92 "," $5,871.95 "," $5,562.90 "," $5,562.90 "," $5,562.90 "," $5,748.33 "," $5,933.76 "," $1,461.34 "," $5,253.85 "," $1,484.34 "," $1,306.67 ", N/A ," $1,233.69 "," $1,233.69 "," $5,871.95 "," $1,401.46 ", $244.84 ," $5,933.76 "
"Suture Esophagus Wound,Cerv Apprch",CPT® 43410,N/A,N/A,N/A," $7,206.00 "," $4,683.90 "," $6,327.69 ", $993.87 , $836.80 ," $4,951.84 "," $5,215.46 "," $6,701.58 "," $6,485.40 "," $6,485.40 "," $5,764.80 "," $5,764.80 ", $836.80 ," $6,653.30 "," $6,845.70 "," $6,485.40 "," $6,485.40 "," $6,485.40 "," $6,701.58 "," $6,917.76 "," $4,482.80 "," $6,125.10 "," $5,826.75 "," $5,796.99 ", N/A ," $5,048.46 "," $5,048.46 "," $6,845.70 "," $5,280.15 ", $836.80 ," $6,917.76 "
"CT Scan,Cervical Spine,W/O Contrast",CPT® 72125,N/A,N/A,N/A," $2,886.00 "," $1,875.90 ", $924.28 , $132.63 , $250.57 , $880.34 ," $1,131.84 "," $2,683.98 "," $2,597.40 "," $2,597.40 "," $2,308.80 "," $2,308.80 ", $250.57 ," $2,664.64 "," $2,741.70 "," $2,597.40 "," $2,597.40 "," $2,597.40 "," $2,683.98 "," $2,770.56 ", $776.12 ," $2,453.10 "," $1,232.67 "," $1,197.04 ", N/A , $897.52 , $897.52 ," $2,741.70 "," $1,038.91 ", $132.63 ," $2,770.56 "
" Pro Radiation Tx Management, X5 ",CPT® 77427,0982 - PRO FEE/OUTPT,N/A,N/A," $1,782.00 "," $1,158.30 "," $1,059.95 ", $186.95 , $169.21 , $889.66 , $922.52 ," $1,657.26 "," $1,603.80 "," $1,603.80 "," $1,425.60 "," $1,425.60 ", $169.21 ," $1,645.32 "," $1,692.90 "," $1,603.80 "," $1,603.80 "," $1,603.80 "," $1,657.26 "," $1,710.72 "," $1,056.97 "," $1,514.70 "," $1,009.25 "," $1,034.50 ", N/A , $907.03 , $907.03 ," $1,692.90 "," $1,049.90 ", $169.21 ," $1,710.72 "
 PENICILLIN G BENZATHINE 1200000 UNIT/2ML IM SUSY ,HCPCS J0561,0636 - DRUGS REQUIRING DETAILED CODIN,60793-0701-10,2 mL," $1,553.74 "," $1,009.93 "," $1,305.14 ", $20.57 , $18.96 ," $1,255.42 "," $1,398.37 "," $1,315.40 "," $1,398.37 "," $1,398.37 "," $1,398.37 "," $1,320.68 ", $18.59 ," $1,434.57 "," $1,476.05 "," $1,320.68 "," $1,444.98 "," $1,444.98 "," $1,476.05 "," $1,491.59 "," $1,271.27 "," $1,398.37 "," $1,320.68 "," $1,227.45 ", N/A ," $1,257.44 "," $1,257.44 "," $1,476.05 "," $1,333.26 ", $18.59 ," $1,491.59 "
 Lb-Gardnerella ,CPT® 87512,0300 - LABORATORY,N/A,N/A, $173.00 , $112.45 , $145.32 , $42.60 , $42.60 , $139.78 , $155.70 , $146.46 , $155.70 , $155.70 , $155.70 , $147.05 , $41.76 , $159.73 , $164.35 , $147.05 , $160.89 , $160.89 , $164.35 , $166.08 , $141.55 , $155.70 , $147.05 , $136.67 , N/A , $140.01 , $140.01 , $164.35 , $148.45 , $41.76 , $166.08 
 Pro Rpr Xtnsr Tdn Fngr 1/2 W/O Fr Grf Ea Tdn ,CPT® 26418,0981 - PRO FEE/ER,N/A,N/A," $2,087.00 "," $1,356.55 "," $3,954.41 ", $615.23 , $426.00 ," $2,746.72 "," $2,822.57 "," $1,940.91 "," $1,878.30 "," $1,878.30 "," $1,669.60 "," $1,669.60 ", $426.00 ," $1,926.93 "," $1,982.65 "," $1,878.30 "," $1,878.30 "," $1,878.30 "," $1,940.91 "," $2,003.52 "," $3,614.06 "," $1,773.95 "," $3,084.65 "," $3,289.40 ", N/A ," $2,800.31 "," $2,800.31 "," $1,982.65 "," $3,291.34 ", $426.00 ," $3,954.41 "
 DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN ,HCPCS J2597,0636 - DRUGS REQUIRING DETAILED CODIN,69918-0901-10,0.5 mL, $161.82 , $105.18 , $135.93 , $7.42 , $7.48 , $130.75 , $145.64 , $137.00 , $145.64 , $145.64 , $145.64 , $137.55 , $7.33 , $149.41 , $153.73 , $137.55 , $150.49 , $150.49 , $153.73 , $155.35 , $132.40 , $145.64 , $137.55 , $127.84 , N/A , $130.96 , $130.96 , $153.73 , $138.86 , $7.33 , $155.35 
 Kidney And Urinary Tract Infections With McC ,MS DRG V40 (FY2023) 689,N/A,N/A,N/A," $23,490.86 "," $15,269.06 "," $19,732.32 ", N/A , N/A ," $18,980.61 "," $21,141.77 "," $19,887.36 "," $21,141.77 "," $21,141.77 "," $21,141.77 "," $19,967.23 ", N/A ," $21,689.11 "," $22,316.32 "," $19,967.23 "," $21,846.50 "," $21,846.50 "," $22,316.32 "," $22,551.23 "," $19,220.22 "," $21,141.77 "," $19,967.23 "," $18,557.78 ", N/A ," $19,011.15 "," $19,011.15 "," $22,316.32 "," $20,157.51 "," $18,557.78 "," $22,551.23 "
"MR Angio, Neck W/Contrast",CPT® 70548,N/A,N/A,N/A," $2,656.00 "," $1,726.40 "," $1,764.77 ", $252.14 , $476.52 ," $1,965.49 "," $2,564.76 "," $2,470.08 "," $2,390.40 "," $2,390.40 "," $2,124.80 "," $2,124.80 ", $476.52 ," $2,452.28 "," $2,523.20 "," $2,390.40 "," $2,390.40 "," $2,390.40 "," $2,470.08 "," $2,549.76 "," $1,495.05 "," $2,257.60 "," $2,796.61 "," $2,405.02 ", N/A ," $2,003.84 "," $2,003.84 "," $2,523.20 "," $2,319.47 ", $252.14 ," $2,796.61 "
 Fac Ercp Remove Calculi/Debris Biliary/Pancreas Duct ,CPT® 43264,0360 - OR SERVICES,N/A,N/A," $4,701.00 "," $3,055.65 "," $3,948.84 ", $344.24 , $482.17 ," $3,798.41 "," $4,230.90 "," $3,979.87 "," $4,230.90 "," $4,230.90 "," $4,230.90 "," $3,995.85 ", $472.72 ," $4,340.43 "," $4,465.95 "," $3,995.85 "," $4,371.93 "," $4,371.93 "," $4,465.95 "," $4,512.96 "," $3,846.36 "," $4,230.90 "," $3,995.85 "," $3,713.79 ", N/A ," $3,804.52 "," $3,804.52 "," $4,465.95 "," $4,033.93 ", $344.24 ," $4,512.96 "
"Culture,Spec,Bacteria,Anaerobic",CPT® 87075,N/A,N/A,N/A, $150.00 , $97.50 , N/A , $9.66 , $9.66 , $53.54 , $64.05 , $139.50 , $135.00 , $135.00 , $120.00 , $120.00 , $9.66 , $138.50 , $142.50 , $135.00 , $135.00 , $135.00 , $139.50 , $144.00 , $63.23 , $127.50 , $61.63 , $34.33 , N/A , $49.97 , $49.97 , $142.50 , $54.61 , $9.66 , $144.00 
 DARATUMUMAB-HYALURONIDASE-FIHJ 1800-30000 MG-UT/15ML SC SOLN ,HCPCS J9144,0636 - DRUGS REQUIRING DETAILED CODIN,57894-0503-01,15 mL," $26,811.53 "," $17,427.49 "," $22,521.69 ", $50.10 , $49.17 ," $21,663.72 "," $24,130.38 "," $22,698.64 "," $24,130.38 "," $24,130.38 "," $24,130.38 "," $22,789.80 ", $48.21 ," $24,755.09 "," $25,470.95 "," $22,789.80 "," $24,934.72 "," $24,934.72 "," $25,470.95 "," $25,739.07 "," $21,937.19 "," $24,130.38 "," $22,789.80 "," $21,181.11 ", N/A ," $21,698.57 "," $21,698.57 "," $25,470.95 "," $23,006.97 ", $48.21 ," $25,739.07 "
"Shldr Arthroscop,Part Acromioplas",29826,N/A,N/A,N/A," $3,910.00 "," $2,541.50 "," $1,032.59 ", $160.23 , $582.25 , $850.38 , $834.76 ," $3,636.30 "," $3,519.00 "," $3,519.00 "," $3,128.00 "," $3,128.00 ", $582.25 ," $3,610.10 "," $3,714.50 "," $3,519.00 "," $3,519.00 "," $3,519.00 "," $3,636.30 "," $3,753.60 "," $1,910.28 "," $3,323.50 ", $925.93 , $996.64 , N/A , $866.98 , $866.98 ," $3,714.50 "," $1,019.01 ", $160.23 ," $3,753.60 "
"Exc Sweat Gland Lesn Inguin,Simpl",CPT® 11462,N/A,N/A,N/A," $1,717.00 "," $1,116.05 ", $789.38 , $235.20 , $494.84 , $649.15 , $641.06 ," $1,596.81 "," $1,545.30 "," $1,545.30 "," $1,373.60 "," $1,373.60 ", $494.84 ," $1,585.31 "," $1,631.15 "," $1,545.30 "," $1,545.30 "," $1,545.30 "," $1,596.81 "," $1,648.32 ", $850.29 ," $1,459.45 "," $1,284.53 ", $837.25 , N/A , $661.81 , $661.81 ," $1,631.15 ", $767.48 , $235.20 ," $1,648.32 "
 Pro Bone Marrow Aspiration Bone Grfg Spi Surg Only ,CPT® 20939,0982 - PRO FEE/OUTPT,N/A,N/A," $1,076.00 ", $699.40 , $403.00 , $63.16 , N/A , $306.57 , $314.49 ," $1,000.68 ", $968.40 , $968.40 , $860.80 , $860.80 , N/A , $993.47 ," $1,022.20 ", $968.40 , $968.40 , $968.40 ," $1,000.68 "," $1,032.96 ", $378.07 , $914.60 , $371.38 , $384.07 , N/A , $312.55 , $312.55 ," $1,022.20 ", $367.35 , $63.16 ," $1,032.96 "
Repair Foot Extensor Tend,28208,N/A,N/A,N/A," $3,099.00 "," $2,014.35 "," $1,971.39 ", $312.25 , $184.42 ," $1,535.22 "," $1,513.61 "," $2,882.07 "," $2,789.10 "," $2,789.10 "," $2,479.20 "," $2,479.20 ", $184.42 ," $2,861.31 "," $2,944.05 "," $2,789.10 "," $2,789.10 "," $2,789.10 "," $2,882.07 "," $2,975.04 "," $1,826.40 "," $2,634.15 "," $1,641.34 "," $1,839.33 ", N/A ," $1,565.17 "," $1,565.17 "," $2,944.05 "," $1,839.62 ", $184.42 ," $2,975.04 "
Sono Abdomen Limited,76705,N/A,N/A,N/A, $556.00 , $361.40 , $499.55 , $86.93 , $89.08 , $506.27 , $574.33 , $517.08 , $500.40 , $500.40 , $444.80 , $444.80 , $89.08 , $513.35 , $528.20 , $500.40 , $500.40 , $500.40 , $517.08 , $533.76 , $503.30 , $472.60 , $624.04 , $515.91 , N/A , $516.14 , $516.14 , $528.20 , $597.46 , $86.93 , $624.04 
 PRAVASTATIN SODIUM 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-5891-61,1 tablet, $14.87 , $9.67 , $12.49 , N/A , N/A , $12.01 , $13.38 , $12.59 , $13.38 , $13.38 , $13.38 , $12.64 , N/A , $13.73 , $14.13 , $12.64 , $13.83 , $13.83 , $14.13 , $14.28 , $12.17 , $13.38 , $12.64 , $11.75 , N/A , $12.03 , $12.03 , $14.13 , $12.76 , $11.75 , $14.28 
 Fac Rpr Blvsl Dir Lxtr ,CPT® 35226,0360 - OR SERVICES,N/A,N/A," $3,824.00 "," $2,485.60 "," $3,212.16 ", $746.44 , $479.52 ," $3,089.79 "," $3,441.60 "," $3,237.40 "," $3,441.60 "," $3,441.60 "," $3,441.60 "," $3,250.40 ", $470.12 ," $3,530.70 "," $3,632.80 "," $3,250.40 "," $3,556.32 "," $3,556.32 "," $3,632.80 "," $3,671.04 "," $3,128.80 "," $3,441.60 "," $3,250.40 "," $3,020.96 ", N/A ," $3,094.76 "," $3,094.76 "," $3,632.80 "," $3,281.37 ", $470.12 ," $3,671.04 "
X-Ray Humerus,CPT® 73060,N/A,N/A,N/A, $359.00 , $233.35 , $178.87 , $31.69 , $27.66 , $126.21 , $155.69 , $333.87 , $323.10 , $323.10 , $287.20 , $287.20 , $27.66 , $331.46 , $341.05 , $323.10 , $323.10 , $323.10 , $333.87 , $344.64 , $176.32 , $305.15 , $169.49 , $145.84 , N/A , $128.68 , $128.68 , $341.05 , $148.95 , $27.66 , $344.64 
"Canalith Repositioning Procedure, per Day",CPT® 95992,N/A,N/A,N/A, $361.00 , $234.65 , $134.86 , $35.56 , $75.25 , $120.93 , $126.97 , $335.73 , $324.90 , $324.90 , $288.80 , $288.80 , $75.25 , $333.31 , $342.95 , $324.90 , $324.90 , $324.90 , $335.73 , $346.56 , $159.90 , $306.85 , $110.49 , $143.70 , N/A , $123.29 , $123.29 , $342.95 , $151.56 , $35.56 , $346.56 
Lens Sphcy Bifocal 4.00d/2.1,HCPCS V2204,N/A,N/A,N/A, $85.00 , $55.25 , N/A , $64.65 , N/A , N/A , N/A , $79.05 , $76.50 , $76.50 , $68.00 , $68.00 , N/A , $78.48 , $80.75 , $76.50 , $76.50 , $76.50 , $79.05 , $81.60 , N/A , $72.25 , $85.00 , $58.75 , N/A , N/A , N/A , $80.75 , N/A , $58.75 , $85.00 
 Fac Cltx Patellar Dislc Req Anes ,CPT® 27562,0761 - TREATMENT ROOM,N/A,N/A," $4,648.00 "," $3,021.20 "," $3,904.32 ", $473.55 , $268.05 ," $3,755.58 "," $4,183.20 "," $3,935.00 "," $4,183.20 "," $4,183.20 "," $4,183.20 "," $3,950.80 ", $262.79 ," $4,291.50 "," $4,415.60 "," $3,950.80 "," $4,322.64 "," $4,322.64 "," $4,415.60 "," $4,462.08 "," $3,802.99 "," $4,183.20 "," $3,950.80 "," $3,671.92 ", N/A ," $3,761.63 "," $3,761.63 "," $4,415.60 "," $3,988.45 ", $262.79 ," $4,462.08 "
 Pro Sigmoidoscopy Flx Control Bleeding ,CPT® 45334,0982 - PRO FEE/OUTPT,N/A,N/A," $3,466.00 "," $2,252.90 ", $721.57 , $111.58 , $218.09 , $773.87 , $797.61 ," $3,223.38 "," $3,119.40 "," $3,119.40 "," $2,772.80 "," $2,772.80 ", $218.09 ," $3,200.16 "," $3,292.70 "," $3,119.40 "," $3,119.40 "," $3,119.40 "," $3,223.38 "," $3,327.36 ", $516.93 ," $2,946.10 ", $872.41 , $685.75 , N/A , $788.96 , $788.96 ," $3,292.70 ", $825.16 , $111.58 ," $3,327.36 "
 Pro Arthrs Kne Dbrdmt/Shvg Artclr Crtlg Chndpls ,CPT® 29877,0975 - PRO FEE/OR,N/A,N/A," $3,578.00 "," $2,325.70 "," $3,782.09 ", $593.21 , $532.53 ," $3,003.86 "," $3,004.89 "," $3,327.54 "," $3,220.20 "," $3,220.20 "," $2,862.40 "," $2,862.40 ", $532.53 ," $3,303.57 "," $3,399.10 "," $3,220.20 "," $3,220.20 "," $3,220.20 "," $3,327.54 "," $3,434.88 "," $3,519.69 "," $3,041.30 "," $3,316.57 "," $3,540.30 ", N/A ," $3,062.47 "," $3,062.47 "," $3,399.10 "," $3,599.50 ", $532.53 ," $3,782.09 "
 Fac Transcatheter Transapical Replacemt Aortic Valve ,CPT® 33366,0360 - OR SERVICES,N/A,N/A," $26,164.00 "," $17,006.60 "," $21,977.76 "," $1,411.29 "," $1,418.27 "," $21,140.51 "," $23,547.60 "," $22,150.44 "," $23,547.60 "," $23,547.60 "," $23,547.60 "," $22,239.40 "," $1,390.46 "," $24,157.22 "," $24,855.80 "," $22,239.40 "," $24,332.52 "," $24,332.52 "," $24,855.80 "," $25,117.44 "," $21,407.38 "," $23,547.60 "," $22,239.40 "," $20,669.56 ", N/A ," $21,174.53 "," $21,174.53 "," $24,855.80 "," $22,451.33 "," $1,390.46 "," $25,117.44 "
Motor &/Sens 11-12 Nrv Cndj Preconf Eltrode Limb,CPT® 95912,N/A,N/A,N/A," $1,420.00 ", $923.00 ," $1,229.90 ", $244.12 , $204.69 , $834.84 , $891.01 ," $1,320.60 "," $1,278.00 "," $1,278.00 "," $1,136.00 "," $1,136.00 ", $204.69 ," $1,311.09 "," $1,349.00 "," $1,278.00 "," $1,278.00 "," $1,278.00 "," $1,320.60 "," $1,363.20 "," $1,135.39 "," $1,207.00 ", $777.52 ," $1,001.18 ", N/A , $851.14 , $851.14 ," $1,349.00 "," $1,046.36 ", $204.69 ," $1,363.20 "
Assay for Phenytoin,CPT® 80185,N/A,N/A,N/A, $133.00 , $86.45 , N/A , $13.52 , $13.52 , $75.01 , $89.70 , $123.69 , $119.70 , $119.70 , $106.40 , $106.40 , $13.52 , $122.80 , $126.35 , $119.70 , $119.70 , $119.70 , $123.69 , $127.68 , $88.47 , $113.05 , $87.58 , $48.05 , N/A , $70.00 , $70.00 , $126.35 , $76.49 , $13.52 , $127.68 
"Bx/Excis Spinal Tumor,Xdural,Thor",CPT® 63276,N/A,N/A,N/A," $12,600.00 "," $8,190.00 "," $8,215.79 "," $1,603.70 "," $2,378.00 "," $9,659.56 "," $9,239.21 "," $11,718.00 "," $11,340.00 "," $11,340.00 "," $10,080.00 "," $10,080.00 "," $2,378.00 "," $11,633.58 "," $11,970.00 "," $11,340.00 "," $11,340.00 "," $11,340.00 "," $11,718.00 "," $12,096.00 "," $8,888.17 "," $10,710.00 "," $9,469.81 "," $10,008.30 ", N/A ," $9,848.03 "," $9,848.03 "," $11,970.00 "," $10,564.63 "," $1,603.70 "," $12,096.00 "
Cardiopulmonary Resuscita,CPT® 92950,N/A,N/A,N/A," $1,971.00 "," $1,281.15 "," $1,136.20 ", $175.23 , $189.13 ," $1,020.88 "," $1,025.94 "," $1,833.03 "," $1,773.90 "," $1,773.90 "," $1,576.80 "," $1,576.80 ", $189.13 ," $1,819.82 "," $1,872.45 "," $1,773.90 "," $1,773.90 "," $1,773.90 "," $1,833.03 "," $1,892.16 "," $1,120.89 "," $1,675.35 ", $961.61 ," $1,114.88 ", N/A ," $1,040.80 "," $1,040.80 "," $1,872.45 "," $1,153.73 ", $175.23 ," $1,892.16 "
"Split Grft,Head,Fac,Hand,Feet <100cm",15120,N/A,N/A,N/A," $4,851.00 "," $3,153.15 "," $2,194.60 ", $656.83 , $799.78 ," $1,903.99 "," $1,858.32 "," $4,511.43 "," $4,365.90 "," $4,365.90 "," $3,880.80 "," $3,880.80 ", $799.78 ," $4,478.93 "," $4,608.45 "," $4,365.90 "," $4,365.90 "," $4,365.90 "," $4,511.43 "," $4,656.96 "," $2,407.55 "," $4,123.35 "," $3,717.99 "," $2,420.90 ", N/A ," $1,941.14 "," $1,941.14 "," $4,608.45 "," $2,251.05 ", $656.83 ," $4,656.96 "
 Ot Manual Therapy 15 Min ,CPT® 97140,0420 - PHYSICAL THERAPY,N/A,N/A, $145.00 , $94.25 , $121.80 , $27.12 , $27.60 , $117.16 , $130.50 , $122.76 , $130.50 , $130.50 , $130.50 , $123.25 , $27.06 , $133.88 , $137.75 , $123.25 , $134.85 , $134.85 , $137.75 , $139.20 , $118.64 , $130.50 , $123.25 , $114.55 , N/A , $117.35 , $117.35 , $137.75 , $124.42 , $27.06 , $139.20 
"Exc Skin Malig 3.1-4cm Face,Facial",11644,N/A,N/A,N/A," $1,990.00 "," $1,293.50 ", $899.54 , $268.82 , $596.38 , $778.04 , $757.93 ," $1,850.70 "," $1,791.00 "," $1,791.00 "," $1,592.00 "," $1,592.00 ", $596.38 ," $1,837.37 "," $1,890.50 "," $1,791.00 "," $1,791.00 "," $1,791.00 "," $1,850.70 "," $1,910.40 ", $986.37 ," $1,691.50 "," $1,514.67 ", $995.32 , N/A , $793.23 , $793.23 ," $1,890.50 ", $919.88 , $268.82 ," $1,910.40 "
Eeg Phys/Qhp 2-12 Hr With Veeg,CPT® 95718,N/A,N/A,N/A," $2,576.00 "," $1,674.40 ", $487.69 , $128.20 , $107.84 , $293.71 , N/A ," $2,395.68 "," $2,318.40 "," $2,318.40 "," $2,060.80 "," $2,060.80 ", $107.84 ," $2,378.42 "," $2,447.20 "," $2,318.40 "," $2,318.40 "," $2,318.40 "," $2,395.68 "," $2,472.96 ", $572.21 ," $2,189.60 ", $393.77 , $507.42 , N/A , $299.45 , $299.45 ," $2,447.20 ", $348.50 , $107.84 ," $2,472.96 "
Jak2 Gene Analysis P.Val617phe Variant,CPT® 81270,N/A,N/A,N/A, $835.00 , $542.75 , N/A , $93.49 , $93.49 , $518.64 , $614.19 , $776.55 , $751.50 , $751.50 , $668.00 , $668.00 , $93.49 , $770.96 , $793.25 , $751.50 , $751.50 , $751.50 , $776.55 , $801.60 , $612.03 , $709.75 , $436.15 , $332.38 , N/A , $484.03 , $484.03 , $793.25 , $528.94 , $93.49 , $801.60 
 ZONISAMIDE 25 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,68462-0128-01,1 capsule, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
" Pro Treat Finger Fracture, Each ",CPT® 26735,0975 - PRO FEE/OR,N/A,N/A," $1,996.00 "," $1,297.40 "," $3,648.13 ", $573.87 , $307.34 ," $2,873.69 "," $2,876.39 "," $1,856.28 "," $1,796.40 "," $1,796.40 "," $1,596.80 "," $1,596.80 ", $307.34 ," $1,842.91 "," $1,896.20 "," $1,796.40 "," $1,796.40 "," $1,796.40 "," $1,856.28 "," $1,916.16 "," $3,390.43 "," $1,696.60 "," $3,164.93 "," $3,404.22 ", N/A ," $2,929.76 "," $2,929.76 "," $1,896.20 "," $3,443.51 ", $307.34 ," $3,648.13 "
" Fac Russell Viper Venom, Diluted ",CPT® 85613,0305 - LAB/HEMATOLOGY,N/A,N/A, $141.00 , $91.65 , $118.44 , $9.77 , $9.77 , $113.93 , $126.90 , $119.37 , $126.90 , $126.90 , $126.90 , $119.85 , $9.58 , $130.19 , $133.95 , $119.85 , $131.13 , $131.13 , $133.95 , $135.36 , $115.37 , $126.90 , $119.85 , $111.39 , N/A , $114.11 , $114.11 , $133.95 , $120.99 , $9.58 , $135.36 
" Fac Flowcytometry/Read, 16 & > ",CPT® 88189,0311 - PATHOL/CYTOLOGY,N/A,N/A," $1,086.00 ", $705.90 , $912.24 , $81.96 , $114.42 , $877.49 , $977.40 , $919.41 , $977.40 , $977.40 , $977.40 , $923.10 , $112.18 ," $1,002.70 "," $1,031.70 ", $923.10 ," $1,009.98 "," $1,009.98 "," $1,031.70 "," $1,042.56 ", $888.57 , $977.40 , $923.10 , $857.94 , N/A , $878.90 , $878.90 ," $1,031.70 ", $931.90 , $81.96 ," $1,042.56 "
" Fac Xray, Endovasc Thor Ao Repr ",CPT® 75957,0320 - DX X-RAY,N/A,N/A," $3,307.00 "," $2,149.55 "," $2,777.88 ", N/A , N/A ," $2,672.06 "," $2,976.30 "," $2,799.71 "," $2,976.30 "," $2,976.30 "," $2,976.30 "," $2,810.95 ", N/A ," $3,053.35 "," $3,141.65 "," $2,810.95 "," $3,075.51 "," $3,075.51 "," $3,141.65 "," $3,174.72 "," $2,705.79 "," $2,976.30 "," $2,810.95 "," $2,612.53 ", N/A ," $2,676.36 "," $2,676.36 "," $3,141.65 "," $2,837.74 "," $2,612.53 "," $3,174.72 "
 Pro Cytopath Smrs Any Oth Src Scr&Interp -Mh ,CPT® 88160,0971 - PRO FEE/LAB,N/A,N/A, $179.00 , $116.35 , $255.34 , $73.76 , $30.70 , $266.65 , $289.49 , $166.47 , $161.10 , $161.10 , $143.20 , $143.20 , $30.70 , $165.27 , $170.05 , $161.10 , $161.10 , $161.10 , $166.47 , $171.84 , $455.85 , $152.15 , $303.28 , $252.44 , N/A , $248.85 , $248.85 , $170.05 , $273.48 , $30.70 , $455.85 
 PRASUGREL HCL 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60505-4643-03,1 tablet, $84.79 , $55.11 , $71.22 , N/A , N/A , $68.51 , $76.31 , $71.78 , $76.31 , $76.31 , $76.31 , $72.07 , N/A , $78.29 , $80.55 , $72.07 , $78.85 , $78.85 , $80.55 , $81.40 , $69.38 , $76.31 , $72.07 , $66.98 , N/A , $68.62 , $68.62 , $80.55 , $72.76 , $66.98 , $81.40 
Polysom <6 Yrs Sleep Stage 4/> Addl Param Attnd,CPT® 95782,N/A,N/A,N/A, $602.00 , $391.30 ," $3,456.21 ", $929.80 ," $1,251.81 "," $2,008.42 "," $2,390.18 ", $559.86 , $541.80 , $541.80 , $481.60 , $481.60 ," $1,251.81 ", $555.83 , $571.90 , $541.80 , $541.80 , $541.80 , $559.86 , $577.92 ," $3,978.71 ", $511.70 ," $3,114.13 "," $3,456.96 ", N/A ," $2,047.60 "," $2,047.60 ", $571.90 ," $2,387.11 ", $481.60 ," $3,978.71 "
 Pro US Urine Capacity Measure ,CPT® 51798,0981 - PRO FEE/ER,N/A,N/A, $123.00 , $79.95 , $56.81 , $10.29 , $13.26 , $89.64 , $90.20 , $114.39 , $110.70 , $110.70 , $98.40 , $98.40 , $13.26 , $113.57 , $116.85 , $110.70 , $110.70 , $110.70 , $114.39 , $118.08 , $55.26 , $104.55 , $103.48 , $95.62 , N/A , $91.40 , $91.40 , $116.85 , $107.40 , $10.29 , $118.08 
Slctv Cathj Ea 1st Ord Abdl Pel/Lxtr Art Brnch,CPT® 36245,N/A,N/A,N/A," $6,879.00 "," $4,471.35 "," $1,399.45 ", $216.04 ," $1,347.70 "," $1,097.92 "," $1,026.15 "," $6,397.47 "," $6,191.10 "," $6,191.10 "," $5,503.20 "," $5,503.20 "," $1,347.70 "," $6,351.38 "," $6,535.05 "," $6,191.10 "," $6,191.10 "," $6,191.10 "," $6,397.47 "," $6,603.84 "," $1,211.05 "," $5,847.15 "," $1,282.74 "," $1,172.20 ", N/A ," $1,119.34 "," $1,119.34 "," $6,535.05 "," $1,271.57 ", $216.04 ," $6,603.84 "
 Pro CT Angio Hrt Cornry Art/Bypass Grfts Contrst 3d Post ,CPT® 75574,0982 - PRO FEE/OUTPT,N/A,N/A," $1,579.00 "," $1,026.35 "," $1,978.13 ", $286.09 , $382.14 ," $1,996.00 "," $2,401.02 "," $1,468.47 "," $1,421.10 "," $1,421.10 "," $1,263.20 "," $1,263.20 ", $382.14 ," $1,457.89 "," $1,500.05 "," $1,421.10 "," $1,421.10 "," $1,421.10 "," $1,468.47 "," $1,515.84 "," $2,202.18 "," $1,342.15 "," $2,621.34 "," $2,755.07 ", N/A ," $2,034.94 "," $2,034.94 "," $1,500.05 "," $2,355.49 ", $286.09 ," $2,755.07 "
 Fac Lymphocyte Tr Mitogen/Ag Induced Blastogenesis ,CPT® 86353,0302 - LAB/IMMUNOLOGY,N/A,N/A, $208.00 , $135.20 , $174.72 , $50.01 , $50.01 , $168.06 , $187.20 , $176.09 , $187.20 , $187.20 , $187.20 , $176.80 , $49.03 , $192.05 , $197.60 , $176.80 , $193.44 , $193.44 , $197.60 , $199.68 , $170.19 , $187.20 , $176.80 , $164.32 , N/A , $168.33 , $168.33 , $197.60 , $178.48 , $49.03 , $199.68 
 BENZTROPINE MESYLATE 1 MG/ML IJ SOLN ,HCPCS J0515,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9729-05,1 mL, $192.64 , $125.22 , $161.82 , $16.53 , $17.81 , $155.65 , $173.38 , $163.09 , $173.38 , $173.38 , $173.38 , $163.74 , $17.46 , $177.86 , $183.01 , $163.74 , $179.16 , $179.16 , $183.01 , $184.93 , $157.62 , $173.38 , $163.74 , $152.19 , N/A , $155.90 , $155.90 , $183.01 , $165.30 , $16.53 , $184.93 
 ASPIRIN 325 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,66553-0001-01,1 tablet, $0.42 , $0.27 , $0.35 , N/A , N/A , $0.34 , $0.38 , $0.36 , $0.38 , $0.38 , $0.38 , $0.36 , N/A , $0.39 , $0.40 , $0.36 , $0.39 , $0.39 , $0.40 , $0.40 , $0.34 , $0.38 , $0.36 , $0.33 , N/A , $0.34 , $0.34 , $0.40 , $0.36 , $0.33 , $0.40 
 SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00536-1248-10,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 MIRTAZAPINE 7.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,57664-0510-83,1 tablet, $13.53 , $8.79 , $11.37 , N/A , N/A , $10.93 , $12.18 , $11.45 , $12.18 , $12.18 , $12.18 , $11.50 , N/A , $12.49 , $12.85 , $11.50 , $12.58 , $12.58 , $12.85 , $12.99 , $11.07 , $12.18 , $11.50 , $10.69 , N/A , $10.95 , $10.95 , $12.85 , $11.61 , $10.69 , $12.99 
 Pro Att/Reargmt E/N/E/L Dfct 10 Cm/< ,CPT® 14060,0982 - PRO FEE/OUTPT,N/A,N/A," $4,113.00 "," $2,673.45 "," $2,129.25 ", $640.51 , $398.63 ," $1,843.34 "," $1,812.78 "," $3,825.09 "," $3,701.70 "," $3,701.70 "," $3,290.40 "," $3,290.40 ", $398.63 ," $3,797.53 "," $3,907.35 "," $3,701.70 "," $3,701.70 "," $3,701.70 "," $3,825.09 "," $3,948.48 "," $2,329.37 "," $3,496.05 "," $3,609.16 "," $2,361.62 ", N/A ," $1,879.30 "," $1,879.30 "," $3,907.35 "," $2,179.37 ", $398.63 ," $3,948.48 "
 Fac Total Cortisol ,CPT® 82533,0301 - LAB/CHEMISTRY,N/A,N/A, $202.00 , $131.30 , $169.68 , $16.63 , $16.63 , $163.22 , $181.80 , $171.01 , $181.80 , $181.80 , $181.80 , $171.70 , $16.30 , $186.51 , $191.90 , $171.70 , $187.86 , $187.86 , $191.90 , $193.92 , $165.28 , $181.80 , $171.70 , $159.58 , N/A , $163.48 , $163.48 , $191.90 , $173.34 , $16.30 , $193.92 
Antepartum Head Manipulation,CPT® 59412,N/A,N/A,N/A," $1,252.00 ", $813.80 , $273.09 , $92.55 , $92.65 , $240.23 , $251.94 ," $1,164.36 "," $1,126.80 "," $1,126.80 "," $1,001.60 "," $1,001.60 ", $92.65 ," $1,155.97 "," $1,189.40 "," $1,126.80 "," $1,126.80 "," $1,126.80 "," $1,164.36 "," $1,201.92 ", $278.44 ," $1,064.20 ", $556.63 , $444.36 , N/A , $244.92 , $244.92 ," $1,189.40 ", $283.17 , $92.55 ," $1,201.92 "
 Fac Assay of Thyroglobulin ,CPT® 84432,0301 - LAB/CHEMISTRY,N/A,N/A, $181.00 , $117.65 , $152.04 , $16.38 , $16.38 , $146.25 , $162.90 , $153.23 , $162.90 , $162.90 , $162.90 , $153.85 , $16.06 , $167.12 , $171.95 , $153.85 , $168.33 , $168.33 , $171.95 , $173.76 , $148.09 , $162.90 , $153.85 , $142.99 , N/A , $146.48 , $146.48 , $171.95 , $155.32 , $16.06 , $173.76 
X-Ray Knee 3 View,CPT® 73562,N/A,N/A,N/A, $256.00 , $166.40 , $230.20 , $39.93 , $32.71 , $161.83 , $199.83 , $238.08 , $230.40 , $230.40 , $204.80 , $204.80 , $32.71 , $236.36 , $243.20 , $230.40 , $230.40 , $230.40 , $238.08 , $245.76 , $221.77 , $217.60 , $221.49 , $180.04 , N/A , $164.99 , $164.99 , $243.20 , $190.99 , $32.71 , $245.76 
"Arthrodesis,Ankle,Open",27870,N/A,N/A,N/A," $8,183.00 "," $5,318.95 "," $6,159.86 ", $961.57 ," $1,075.74 "," $4,998.95 "," $4,982.21 "," $7,610.19 "," $7,364.70 "," $7,364.70 "," $6,546.40 "," $6,546.40 "," $1,075.74 "," $7,555.36 "," $7,773.85 "," $7,364.70 "," $7,364.70 "," $7,364.70 "," $7,610.19 "," $7,855.68 "," $5,745.61 "," $6,955.55 "," $5,494.92 "," $5,877.09 ", N/A ," $5,096.49 "," $5,096.49 "," $7,773.85 "," $5,990.20 ", $961.57 ," $7,855.68 "
 Iodine Beaker1 ,CPT® 83018,0301 - LAB/CHEMISTRY,N/A,N/A, $224.00 , $145.60 , $188.16 , $22.40 , $22.40 , $180.99 , $201.60 , $189.64 , $201.60 , $201.60 , $201.60 , $190.40 , $21.96 , $206.82 , $212.80 , $190.40 , $208.32 , $208.32 , $212.80 , $215.04 , $183.28 , $201.60 , $190.40 , $176.96 , N/A , $181.28 , $181.28 , $212.80 , $192.21 , $21.96 , $215.04 
" Fac Protein, Western Blot Test ",CPT® 84182,0302 - LAB/IMMUNOLOGY,N/A,N/A, $322.00 , $209.30 , $270.48 , $29.79 , $24.98 , $260.18 , $289.80 , $272.61 , $289.80 , $289.80 , $289.80 , $273.70 , $24.49 , $297.30 , $305.90 , $273.70 , $299.46 , $299.46 , $305.90 , $309.12 , $263.46 , $289.80 , $273.70 , $254.38 , N/A , $260.59 , $260.59 , $305.90 , $276.31 , $24.49 , $309.12 
Laparoscopy W Total Hysterectomy Uterus 250 G/<,CPT® 58570,N/A,N/A,N/A," $5,548.00 "," $3,606.20 "," $3,796.90 ", $769.70 , $654.44 ," $3,607.88 "," $3,772.97 "," $5,159.64 "," $4,993.20 "," $4,993.20 "," $4,438.40 "," $4,438.40 ", $654.44 ," $5,122.47 "," $5,270.60 "," $4,993.20 "," $4,993.20 "," $4,993.20 "," $5,159.64 "," $5,326.08 "," $3,948.49 "," $4,715.80 "," $4,965.05 "," $3,187.31 ", N/A ," $3,678.27 "," $3,678.27 "," $5,270.60 "," $4,411.87 ", $654.44 ," $5,326.08 "
 Fac M/Phmtrc Alys Ish Quant/Semiq Mnl Each Multiprb ,CPT® 88377,0310 - PATHOLOGY LAB,N/A,N/A," $1,385.00 ", $900.25 ," $1,163.40 ", $389.56 , $168.73 ," $1,119.08 "," $1,246.50 "," $1,172.54 "," $1,246.50 "," $1,246.50 "," $1,246.50 "," $1,177.25 ", $165.42 ," $1,278.77 "," $1,315.75 "," $1,177.25 "," $1,288.05 "," $1,288.05 "," $1,315.75 "," $1,329.60 "," $1,133.21 "," $1,246.50 "," $1,177.25 "," $1,094.15 ", N/A ," $1,120.88 "," $1,120.88 "," $1,315.75 "," $1,188.47 ", $165.42 ," $1,329.60 "
 Fac Rm Chg Nicu Level 2 ,Custom 1720000002,0172 - NURSERY LEVEL II,N/A,N/A," $5,808.00 "," $3,775.20 "," $4,878.72 ", N/A , N/A ," $4,692.86 "," $5,227.20 "," $4,917.05 "," $5,227.20 "," $5,227.20 "," $5,227.20 "," $4,936.80 ", N/A ," $5,362.53 "," $5,517.60 "," $4,936.80 "," $5,401.44 "," $5,401.44 "," $5,517.60 "," $5,575.68 "," $4,752.11 "," $5,227.20 "," $4,936.80 "," $4,588.32 ", N/A ," $4,700.41 "," $4,700.41 "," $5,517.60 "," $4,983.84 "," $4,588.32 "," $5,575.68 "
"Osteopathic Manip,1-2 Body Regn",CPT® 98925,N/A,N/A,N/A, $131.00 , $85.15 , $54.05 , $22.57 , $16.12 , $53.29 , $52.35 , $121.83 , $117.90 , $117.90 , $104.80 , $104.80 , $16.12 , $120.95 , $124.45 , $117.90 , $117.90 , $117.90 , $121.83 , $125.76 , $59.54 , $111.35 , $68.93 , $90.82 , N/A , $54.33 , $54.33 , $124.45 , $63.33 , $16.12 , $125.76 
"Extern Drain Prostate Absc,Simple",CPT® 55720,N/A,N/A,N/A," $2,482.00 "," $1,613.30 "," $2,008.36 ", $432.38 , $461.04 ," $1,451.79 "," $1,465.99 "," $2,308.26 "," $2,233.80 "," $2,233.80 "," $1,985.60 "," $1,985.60 ", $461.04 ," $2,291.63 "," $2,357.90 "," $2,233.80 "," $2,233.80 "," $2,233.80 "," $2,308.26 "," $2,382.72 "," $1,885.50 "," $2,109.70 "," $2,333.56 "," $2,192.65 ", N/A ," $1,480.12 "," $1,480.12 "," $2,357.90 "," $1,774.00 ", $432.38 ," $2,382.72 "
 Fac Ins Pacemaker Pulse Gen Only W/Exist Mult Leads ,CPT® 33221,0360 - OR SERVICES,N/A,N/A," $5,161.00 "," $3,354.65 "," $4,335.24 ", $332.38 , $404.35 ," $4,170.09 "," $4,644.90 "," $4,369.30 "," $4,644.90 "," $4,644.90 "," $4,644.90 "," $4,386.85 ", $396.42 ," $4,765.15 "," $4,902.95 "," $4,386.85 "," $4,799.73 "," $4,799.73 "," $4,902.95 "," $4,954.56 "," $4,222.73 "," $4,644.90 "," $4,386.85 "," $4,077.19 ", N/A ," $4,176.80 "," $4,176.80 "," $4,902.95 "," $4,428.65 ", $332.38 ," $4,954.56 "
Excision Turbinate,CPT® 30130,N/A,N/A,N/A," $2,330.00 "," $1,514.50 "," $2,343.30 ", $411.26 , $120.51 ," $1,453.32 "," $1,469.36 "," $2,166.90 "," $2,097.00 "," $2,097.00 "," $1,864.00 "," $1,864.00 ", $120.51 ," $2,151.29 "," $2,213.50 "," $2,097.00 "," $2,097.00 "," $2,097.00 "," $2,166.90 "," $2,236.80 "," $2,214.95 "," $1,980.50 "," $2,064.16 "," $1,923.94 ", N/A ," $1,481.68 "," $1,481.68 "," $2,213.50 "," $1,744.98 ", $120.51 ," $2,343.30 "
 Pro I&D Pilonidal Cst Comp ,CPT® 10081,0982 - PRO FEE/OUTPT,N/A,N/A," $1,111.00 ", $722.15 , $545.63 , $162.12 , $213.21 , $462.71 , $459.06 ," $1,033.23 ", $999.90 , $999.90 , $888.80 , $888.80 , $213.21 ," $1,025.79 "," $1,055.45 ", $999.90 , $999.90 , $999.90 ," $1,033.23 "," $1,066.56 ", $603.01 , $944.35 , $918.79 , $595.22 , N/A , $471.73 , $471.73 ," $1,055.45 ", $547.05 , $162.12 ," $1,066.56 "
Estradiol Valerate 10 Mg Inj,HCPCS J1380,N/A,N/A,N/A, $32.00 , $20.80 , N/A , $11.00 , $11.37 , N/A , N/A , $29.76 , $28.80 , $28.80 , $25.60 , $25.60 , $11.37 , $29.55 , $30.40 , $28.80 , $28.80 , $28.80 , $29.76 , $30.72 , $14.24 , $27.20 , $17.52 , $13.51 , N/A , N/A , N/A , $30.40 , N/A , $11.00 , $30.72 
" Fac Immunoassay, Nonantibody ",CPT® 83516,0302 - LAB/IMMUNOLOGY,N/A,N/A, $136.00 , $88.40 , $114.24 , $11.76 , $11.76 , $109.89 , $122.40 , $115.14 , $122.40 , $122.40 , $122.40 , $115.60 , $11.53 , $125.57 , $129.20 , $115.60 , $126.48 , $126.48 , $129.20 , $130.56 , $111.28 , $122.40 , $115.60 , $107.44 , N/A , $110.06 , $110.06 , $129.20 , $116.70 , $11.53 , $130.56 
"Fx Radial,Closed,W/O Mani",25600,N/A,N/A,N/A," $2,106.00 "," $1,368.90 "," $2,022.28 ", $320.97 , $171.85 ," $1,493.35 "," $1,527.62 "," $1,958.58 "," $1,895.40 "," $1,895.40 "," $1,684.80 "," $1,684.80 ", $171.85 ," $1,944.47 "," $2,000.70 "," $1,895.40 "," $1,895.40 "," $1,895.40 "," $1,958.58 "," $2,021.76 "," $1,852.86 "," $1,790.10 "," $1,673.45 "," $1,783.02 ", N/A ," $1,522.49 "," $1,522.49 "," $2,000.70 "," $1,789.47 ", $171.85 ," $2,022.28 "
"Work Hardening/Condn,Ea Addnl Hr",CPT® 97546,N/A,N/A,N/A, $265.00 , $172.25 , N/A , N/A , N/A , $118.56 , $105.62 , $246.45 , $238.50 , $238.50 , $212.00 , $212.00 , N/A , $244.67 , $251.75 , $238.50 , $238.50 , $238.50 , $246.45 , $254.40 , N/A , $225.25 , $158.14 , $132.70 , N/A , $120.88 , $120.88 , $251.75 , $134.44 , $105.62 , $254.40 
Iadna Candida Species Amp Prb,CPT® 87481,N/A,N/A,N/A, $263.00 , $170.95 , N/A , $35.79 , $35.79 , $198.56 , $237.51 , $244.59 , $236.70 , $236.70 , $210.40 , $210.40 , $35.79 , $242.83 , $249.85 , $236.70 , $236.70 , $236.70 , $244.59 , $252.48 , $234.30 , $223.55 , $230.30 , $127.26 , N/A , $185.31 , $185.31 , $249.85 , $202.50 , $35.79 , $252.48 
Wedge Exc. of Skin of Nai,11765,N/A,N/A,N/A, $485.00 , $315.25 , $298.86 , $89.88 , $111.12 , $259.63 , $252.76 , $451.05 , $436.50 , $436.50 , $388.00 , $388.00 , $111.12 , $447.80 , $460.75 , $436.50 , $436.50 , $436.50 , $451.05 , $465.60 , $329.62 , $412.25 , $494.19 , $334.41 , N/A , $264.69 , $264.69 , $460.75 , $306.96 , $89.88 , $494.19 
 Fac Assay of Thyroglobulin ,CPT® 84432,0301 - LAB/CHEMISTRY,N/A,N/A, $181.00 , $117.65 , $152.04 , $16.38 , $16.38 , $146.25 , $162.90 , $153.23 , $162.90 , $162.90 , $162.90 , $153.85 , $16.06 , $167.12 , $171.95 , $153.85 , $168.33 , $168.33 , $171.95 , $173.76 , $148.09 , $162.90 , $153.85 , $142.99 , N/A , $146.48 , $146.48 , $171.95 , $155.32 , $16.06 , $173.76 
 Fac Crrt Charge ,Custom 8090000001,0809 - DIALY/INPT/OTHER,N/A,N/A," $7,754.00 "," $5,040.10 "," $6,513.36 ", N/A , N/A ," $6,265.23 "," $6,978.60 "," $6,564.54 "," $6,978.60 "," $6,978.60 "," $6,978.60 "," $6,590.90 ", N/A ," $7,159.27 "," $7,366.30 "," $6,590.90 "," $7,211.22 "," $7,211.22 "," $7,366.30 "," $7,443.84 "," $6,344.32 "," $6,978.60 "," $6,590.90 "," $6,125.66 ", N/A ," $6,275.31 "," $6,275.31 "," $7,366.30 "," $6,653.71 "," $6,125.66 "," $7,443.84 "
"Exc Skin Malig 3.1-4cm Trunk,Arm,Leg",11604,N/A,N/A,N/A," $1,490.00 ", $968.50 , $679.52 , $203.78 , $369.39 , $587.14 , $572.25 ," $1,385.70 "," $1,341.00 "," $1,341.00 "," $1,192.00 "," $1,192.00 ", $369.39 ," $1,375.72 "," $1,415.50 "," $1,341.00 "," $1,341.00 "," $1,341.00 "," $1,385.70 "," $1,430.40 ", $745.34 ," $1,266.50 "," $1,141.80 ", $752.81 , N/A , $598.60 , $598.60 ," $1,415.50 ", $694.18 , $203.78 ," $1,430.40 "
" Ivl W/Stent + Atherectomy + Pta; Tib, Peroneal ",HCPCS C9775,0360 - OR SERVICES,N/A,N/A," $40,461.00 "," $26,299.65 "," $33,987.24 ", N/A , N/A ," $32,692.49 "," $36,414.90 "," $34,254.28 "," $36,414.90 "," $36,414.90 "," $36,414.90 "," $34,391.85 ", N/A ," $37,357.64 "," $38,437.95 "," $34,391.85 "," $37,628.73 "," $37,628.73 "," $38,437.95 "," $38,842.56 "," $33,105.19 "," $36,414.90 "," $34,391.85 "," $31,964.19 ", N/A ," $32,745.09 "," $32,745.09 "," $38,437.95 "," $34,719.58 "," $31,964.19 "," $38,842.56 "
 DEXAMETHASONE SODIUM PHOSPHATE 120 MG/30ML IJ SOLN ,HCPCS J1100,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0165-30,0.5 mL, $16.68 , $10.84 , $14.01 , $0.12 , $0.13 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.13 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.12 , $16.01 
 Pro Remove Nasal Foreign Body ,CPT® 30300,0982 - PRO FEE/OUTPT,N/A,N/A, $814.00 , $529.10 , $688.10 , $121.29 , $64.81 , $481.74 , $495.34 , $757.02 , $732.60 , $732.60 , $651.20 , $651.20 , $64.81 , $751.57 , $773.30 , $732.60 , $732.60 , $732.60 , $757.02 , $781.44 , $637.33 , $691.90 , $695.78 , $541.12 , N/A , $491.14 , $491.14 , $773.30 , $578.42 , $64.81 , $781.44 
Pro Control Nasal Hemorrhage,30906,N/A,N/A,N/A," $1,138.00 ", $739.70 , $727.95 , $126.25 , $301.31 , $501.10 , $487.02 ," $1,058.34 "," $1,024.20 "," $1,024.20 ", $910.40 , $910.40 , $301.31 ," $1,050.72 "," $1,081.10 "," $1,024.20 "," $1,024.20 "," $1,024.20 "," $1,058.34 "," $1,092.48 ", $700.97 , $967.30 , $688.65 , $689.87 , N/A , $510.88 , $510.88 ," $1,081.10 ", $601.68 , $126.25 ," $1,092.48 "
 LEVOTHYROXINE SODIUM 137 MCG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60687-0563-01,1 tablet, $4.42 , $2.87 , $3.71 , N/A , N/A , $3.57 , $3.98 , $3.74 , $3.98 , $3.98 , $3.98 , $3.76 , N/A , $4.08 , $4.20 , $3.76 , $4.11 , $4.11 , $4.20 , $4.24 , $3.62 , $3.98 , $3.76 , $3.49 , N/A , $3.58 , $3.58 , $4.20 , $3.79 , $3.49 , $4.24 
 Fac Ctrl Nsl Hemrrg Pst Pst Nsl Packs&/Caut 1st ,CPT® 30905,0761 - TREATMENT ROOM,N/A,N/A, $485.00 , $315.25 , $407.40 , $99.47 , $223.20 , $391.88 , $436.50 , $410.60 , $436.50 , $436.50 , $436.50 , $412.25 , $218.82 , $447.80 , $460.75 , $412.25 , $451.05 , $451.05 , $460.75 , $465.60 , $396.83 , $436.50 , $412.25 , $383.15 , N/A , $392.51 , $392.51 , $460.75 , $416.18 , $99.47 , $465.60 
" Fac Coombs Test, Direct ",CPT® 86880,0300 - LABORATORY,N/A,N/A, $72.00 , $46.80 , $60.48 , $5.50 , $5.50 , $58.18 , $64.80 , $60.96 , $64.80 , $64.80 , $64.80 , $61.20 , $5.39 , $66.48 , $68.40 , $61.20 , $66.96 , $66.96 , $68.40 , $69.12 , $58.91 , $64.80 , $61.20 , $56.88 , N/A , $58.27 , $58.27 , $68.40 , $61.78 , $5.39 , $69.12 
 Fac Assay for Phencyclidine ,CPT® 83992,0301 - LAB/CHEMISTRY,N/A,N/A, $155.00 , $100.75 , $130.20 , N/A , $20.40 , $125.24 , $139.50 , $131.22 , $139.50 , $139.50 , $139.50 , $131.75 , $20.00 , $143.11 , $147.25 , $131.75 , $144.15 , $144.15 , $147.25 , $148.80 , $126.82 , $139.50 , $131.75 , $122.45 , N/A , $125.44 , $125.44 , $147.25 , $133.01 , $20.00 , $148.80 
 Fac External Version ,Custom 7610000002,0761 - TREATMENT ROOM,N/A,N/A, $870.00 , $565.50 , $730.80 , N/A , N/A , $702.96 , $783.00 , $736.54 , $783.00 , $783.00 , $783.00 , $739.50 , N/A , $803.27 , $826.50 , $739.50 , $809.10 , $809.10 , $826.50 , $835.20 , $711.83 , $783.00 , $739.50 , $687.30 , N/A , $704.09 , $704.09 , $826.50 , $746.55 , $687.30 , $835.20 
 HYLAN G-F 20 48 MG/6ML IX SOSY ,HCPCS J7325,0636 - DRUGS REQUIRING DETAILED CODIN,58468-0090-03,6 mL," $8,442.65 "," $5,487.72 "," $7,091.83 ", $9.81 , $9.99 ," $6,821.66 "," $7,598.39 "," $7,147.55 "," $7,598.39 "," $7,598.39 "," $7,598.39 "," $7,176.25 ", $9.79 ," $7,795.10 "," $8,020.52 "," $7,176.25 "," $7,851.66 "," $7,851.66 "," $8,020.52 "," $8,104.94 "," $6,907.78 "," $7,598.39 "," $7,176.25 "," $6,669.69 ", N/A ," $6,832.64 "," $6,832.64 "," $8,020.52 "," $7,244.64 ", $9.79 ," $8,104.94 "
"Destr Penis Lesn,Extensive",CPT® 54065,N/A,N/A,N/A," $1,106.00 ", $718.90 , $761.59 , $166.02 , $106.76 , $552.03 , $571.07 ," $1,028.58 ", $995.40 , $995.40 , $884.80 , $884.80 , $106.76 ," $1,021.17 "," $1,050.70 ", $995.40 , $995.40 , $995.40 ," $1,028.58 "," $1,061.76 ", $710.84 , $940.10 , $918.79 , $827.72 , N/A , $562.81 , $562.81 ," $1,050.70 ", $674.55 , $106.76 ," $1,061.76 "
"Repr Forearm Tend/Musc,Exten,Prim,Ea",CPT® 25270,N/A,N/A,N/A," $3,478.00 "," $2,260.70 "," $3,035.24 ", $478.16 , $276.59 ," $2,358.82 "," $2,361.51 "," $3,234.54 "," $3,130.20 "," $3,130.20 "," $2,782.40 "," $2,782.40 ", $276.59 ," $3,211.24 "," $3,304.10 "," $3,130.20 "," $3,130.20 "," $3,130.20 "," $3,234.54 "," $3,338.88 "," $2,817.49 "," $2,956.30 "," $2,599.38 "," $2,803.20 ", N/A ," $2,404.84 "," $2,404.84 "," $3,304.10 "," $2,826.53 ", $276.59 ," $3,338.88 "
 Fac Chg Radiologic Exam Abdomen 2 Views ,CPT® 74019,0320 - DX X-RAY,N/A,N/A, $316.00 , $205.40 , $265.44 , $36.40 , $26.24 , $255.33 , $284.40 , $267.53 , $284.40 , $284.40 , $284.40 , $268.60 , $25.73 , $291.76 , $300.20 , $268.60 , $293.88 , $293.88 , $300.20 , $303.36 , $258.55 , $284.40 , $268.60 , $249.64 , N/A , $255.74 , $255.74 , $300.20 , $271.16 , $25.73 , $303.36 
" Fac Alpha-1-Antitrypsin, Total ",CPT® 82103,0301 - LAB/CHEMISTRY,N/A,N/A, $153.00 , $99.45 , $128.52 , $13.71 , $13.71 , $123.62 , $137.70 , $129.53 , $137.70 , $137.70 , $137.70 , $130.05 , $13.44 , $141.26 , $145.35 , $130.05 , $142.29 , $142.29 , $145.35 , $146.88 , $125.18 , $137.70 , $130.05 , $120.87 , N/A , $123.82 , $123.82 , $145.35 , $131.29 , $13.44 , $146.88 
"Excision Turbinate,Submucous",CPT® 30140,N/A,N/A,N/A," $2,517.00 "," $1,636.05 ", $961.00 , $170.42 , $230.52 ," $1,680.28 "," $1,718.60 "," $2,340.81 "," $2,265.30 "," $2,265.30 "," $2,013.60 "," $2,013.60 ", $230.52 ," $2,323.95 "," $2,391.15 "," $2,265.30 "," $2,265.30 "," $2,265.30 "," $2,340.81 "," $2,416.32 ", $922.08 ," $2,139.45 "," $2,410.27 ", $909.41 , N/A ," $1,713.06 "," $1,713.06 "," $2,391.15 "," $2,017.50 ", $170.42 ," $2,416.32 "
Dstrj All Prmlg 2-14 Ea,CPT® 17003,N/A,N/A,N/A, $74.00 , $48.10 , $5.10 , $2.04 , $6.46 , $6.51 , $11.67 , $68.82 , $66.60 , $66.60 , $59.20 , $59.20 , $6.46 , $68.32 , $70.30 , $66.60 , $66.60 , $66.60 , $68.82 , $71.04 , $7.62 , $62.90 , $23.19 , $8.16 , N/A , $6.65 , $6.65 , $70.30 , $7.71 , $2.04 , $71.04 
Deliver Placenta,CPT® 59414,N/A,N/A,N/A," $1,002.00 ", $651.30 , $240.33 , $81.44 , $357.17 , $212.37 , $222.24 , $931.86 , $901.80 , $901.80 , $801.60 , $801.60 , $357.17 , $925.15 , $951.90 , $901.80 , $901.80 , $901.80 , $931.86 , $961.92 , $246.29 , $851.70 , $492.40 , $393.91 , N/A , $216.52 , $216.52 , $951.90 , $250.31 , $81.44 , $961.92 
"Apply Forearm Splint,Dynamic",29126,N/A,N/A,N/A, $509.00 , $330.85 , $299.46 , $47.25 , $23.04 , $236.84 , $238.38 , $473.37 , $458.10 , $458.10 , $407.20 , $407.20 , $23.04 , $469.96 , $483.55 , $458.10 , $458.10 , $458.10 , $473.37 , $488.64 , $274.00 , $432.65 , $260.47 , $283.20 , N/A , $241.46 , $241.46 , $483.55 , $283.78 , $23.04 , $488.64 
 CARVEDILOL 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6303-61,1 tablet, $10.80 , $7.02 , $9.07 , N/A , N/A , $8.73 , $9.72 , $9.14 , $9.72 , $9.72 , $9.72 , $9.18 , N/A , $9.97 , $10.26 , $9.18 , $10.04 , $10.04 , $10.26 , $10.37 , $8.84 , $9.72 , $9.18 , $8.53 , N/A , $8.74 , $8.74 , $10.26 , $9.27 , $8.53 , $10.37 
 Pro I&D Bursa Foot ,CPT® 28001,0981 - PRO FEE/ER,N/A,N/A," $1,326.00 ", $861.90 , $602.36 , $93.09 , $46.08 , $846.97 , $824.16 ," $1,233.18 "," $1,193.40 "," $1,193.40 "," $1,060.80 "," $1,060.80 ", $46.08 ," $1,224.30 "," $1,259.70 "," $1,193.40 "," $1,193.40 "," $1,193.40 "," $1,233.18 "," $1,272.96 ", $970.48 ," $1,127.10 ", $888.46 , $991.70 , N/A , $863.50 , $863.50 ," $1,259.70 "," $1,014.92 ", $46.08 ," $1,272.96 "
 RISPERIDONE 1 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6359-61,1 tablet, $23.45 , $15.24 , $19.70 , N/A , N/A , $18.95 , $21.11 , $19.85 , $21.11 , $21.11 , $21.11 , $19.93 , N/A , $21.65 , $22.28 , $19.93 , $21.81 , $21.81 , $22.28 , $22.51 , $19.19 , $21.11 , $19.93 , $18.53 , N/A , $18.98 , $18.98 , $22.28 , $20.12 , $18.53 , $22.51 
"IV Infusion, Hydration, Ea Add Hour",CPT® 96361,N/A,N/A,N/A, $102.00 , $66.30 , $29.62 , $12.41 , $16.39 , $33.53 , $34.28 , $94.86 , $91.80 , $91.80 , $81.60 , $81.60 , $16.39 , $94.18 , $96.90 , $91.80 , $91.80 , $91.80 , $94.86 , $97.92 , $49.58 , $86.70 , $45.62 , $51.68 , N/A , $34.18 , $34.18 , $96.90 , $39.86 , $12.41 , $97.92 
Assay Porphobilinogen,CPT® 84110,N/A,N/A,N/A, $110.00 , $71.50 , N/A , $8.61 , $8.61 , $47.73 , $57.11 , $102.30 , $99.00 , $99.00 , $88.00 , $88.00 , $8.61 , $101.56 , $104.50 , $99.00 , $99.00 , $99.00 , $102.30 , $105.60 , $56.36 , $93.50 , $55.14 , $30.60 , N/A , $44.54 , $44.54 , $104.50 , $48.68 , $8.61 , $105.60 
 Pro Rpr Cplx Trnk 2.6 Cm-7.5 Cm ,CPT® 13101,0982 - PRO FEE/OUTPT,N/A,N/A," $1,529.00 ", $993.85 , $797.06 , $238.06 , $175.19 , $693.43 , $680.66 ," $1,421.97 "," $1,376.10 "," $1,376.10 "," $1,223.20 "," $1,223.20 ", $175.19 ," $1,411.73 "," $1,452.55 "," $1,376.10 "," $1,376.10 "," $1,376.10 "," $1,421.97 "," $1,467.84 ", $882.35 ," $1,299.65 "," $1,355.89 ", $890.04 , N/A , $706.96 , $706.96 ," $1,452.55 ", $819.84 , $175.19 ," $1,467.84 "
"Split Grft,Trunk,Arm,Leg <100sqcm",CPT® 15100,N/A,N/A,N/A," $4,851.00 "," $3,153.15 "," $2,265.05 ", $677.39 , $522.35 ," $1,945.58 "," $1,908.03 "," $4,511.43 "," $4,365.90 "," $4,365.90 "," $3,880.80 "," $3,880.80 ", $522.35 ," $4,478.93 "," $4,608.45 "," $4,365.90 "," $4,365.90 "," $4,365.90 "," $4,511.43 "," $4,656.96 "," $2,476.68 "," $4,123.35 "," $3,830.39 "," $2,471.69 ", N/A ," $1,983.54 "," $1,983.54 "," $4,608.45 "," $2,300.24 ", $522.35 ," $4,656.96 "
Anal Sphincterotomy,CPT® 46080,N/A,N/A,N/A," $2,676.00 "," $1,739.40 ", $954.01 , $149.01 , $76.84 , $752.34 , $765.98 ," $2,488.68 "," $2,408.40 "," $2,408.40 "," $2,140.80 "," $2,140.80 ", $76.84 ," $2,470.75 "," $2,542.20 "," $2,408.40 "," $2,408.40 "," $2,408.40 "," $2,488.68 "," $2,568.96 ", $684.09 ," $2,274.60 ", $847.43 , $892.58 , N/A , $767.02 , $767.02 ," $2,542.20 ", $802.20 , $76.84 ," $2,568.96 "
"Cysto/Ureteroscopy,Tx Intrarenal Strict",CPT® 52346,N/A,N/A,N/A," $3,145.00 "," $2,044.25 "," $2,392.29 ", $419.28 , $524.15 ," $2,197.61 "," $2,080.86 "," $2,924.85 "," $2,830.50 "," $2,830.50 "," $2,516.00 "," $2,516.00 ", $524.15 ," $2,903.78 "," $2,987.75 "," $2,830.50 "," $2,830.50 "," $2,830.50 "," $2,924.85 "," $3,019.20 "," $2,405.98 "," $2,673.25 "," $2,356.75 "," $2,750.13 ", N/A ," $2,240.49 "," $2,240.49 "," $2,987.75 "," $2,633.37 ", $419.28 ," $3,019.20 "
 Ot Neg Pressure Wound Tx > 50 Sq Cm Using Dme ,CPT® 97606,0761 - TREATMENT ROOM,N/A,N/A, $291.00 , $189.15 , $244.44 , $26.75 , $31.76 , $235.13 , $261.90 , $246.36 , $261.90 , $261.90 , $261.90 , $247.35 , $31.14 , $268.68 , $276.45 , $247.35 , $270.63 , $270.63 , $276.45 , $279.36 , $238.10 , $261.90 , $247.35 , $229.89 , N/A , $235.51 , $235.51 , $276.45 , $249.71 , $26.75 , $279.36 
Drain Rectal Abscess,46040,N/A,N/A,N/A," $3,478.00 "," $2,260.70 "," $2,598.90 ", $404.09 , $192.43 ," $1,960.97 "," $2,012.51 "," $3,234.54 "," $3,130.20 "," $3,130.20 "," $2,782.40 "," $2,782.40 ", $192.43 ," $3,211.24 "," $3,304.10 "," $3,130.20 "," $3,130.20 "," $3,130.20 "," $3,234.54 "," $3,338.88 "," $1,851.25 "," $2,956.30 "," $2,217.59 "," $2,340.82 ", N/A ," $1,999.23 "," $1,999.23 "," $3,304.10 "," $2,090.98 ", $192.43 ," $3,338.88 "
 Fac Assay Alkaline Phosphatases ,CPT® 84080,0301 - LAB/CHEMISTRY,N/A,N/A, $158.00 , $102.70 , $132.72 , $15.08 , $15.08 , $127.66 , $142.20 , $133.76 , $142.20 , $142.20 , $142.20 , $134.30 , $14.78 , $145.88 , $150.10 , $134.30 , $146.94 , $146.94 , $150.10 , $151.68 , $129.28 , $142.20 , $134.30 , $124.82 , N/A , $127.87 , $127.87 , $150.10 , $135.58 , $14.78 , $151.68 
 Fac M/Phmtrc Alys Ish Quant/Semiq Mnl Each Multiprb ,CPT® 88377,0310 - PATHOLOGY LAB,N/A,N/A," $1,385.00 ", $900.25 ," $1,163.40 ", $389.56 , $168.73 ," $1,119.08 "," $1,246.50 "," $1,172.54 "," $1,246.50 "," $1,246.50 "," $1,246.50 "," $1,177.25 ", $165.42 ," $1,278.77 "," $1,315.75 "," $1,177.25 "," $1,288.05 "," $1,288.05 "," $1,315.75 "," $1,329.60 "," $1,133.21 "," $1,246.50 "," $1,177.25 "," $1,094.15 ", N/A ," $1,120.88 "," $1,120.88 "," $1,315.75 "," $1,188.47 ", $165.42 ," $1,329.60 "
Cast Sup Sht Arm Splint Fbrg,HCPCS Q4022,N/A,N/A,N/A, $108.00 , $70.20 , N/A , $14.75 , $9.00 , N/A , N/A , $100.44 , $97.20 , $97.20 , $86.40 , $86.40 , $9.00 , $99.72 , $102.60 , $97.20 , $97.20 , $97.20 , $100.44 , $103.68 , N/A , $91.80 , $72.66 , $13.39 , N/A , N/A , N/A , $102.60 , N/A , $9.00 , $103.68 
 Path Level II 88302 Initial -Tech-Mh ,CPT® 88302,0310 - PATHOLOGY LAB,N/A,N/A, $351.00 , $228.15 , $294.84 , $31.97 , $20.63 , $283.61 , $315.90 , $297.16 , $315.90 , $315.90 , $315.90 , $298.35 , $20.23 , $324.08 , $333.45 , $298.35 , $326.43 , $326.43 , $333.45 , $336.96 , $287.19 , $315.90 , $298.35 , $277.29 , N/A , $284.06 , $284.06 , $333.45 , $301.19 , $20.23 , $336.96 
Assay Urea Nitrogen,CPT® 84520,N/A,N/A,N/A, $70.00 , $45.50 , N/A , $4.03 , $4.03 , $22.33 , $26.74 , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $4.03 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , $26.38 , $59.50 , $25.95 , $14.33 , N/A , $20.84 , $20.84 , $66.50 , $22.77 , $4.03 , $67.20 
 MITOMYCIN 20 MG IV SOLR ,HCPCS J9280,0636 - DRUGS REQUIRING DETAILED CODIN,16729-0108-11,40 mL," $1,734.35 "," $1,127.33 "," $1,456.85 ", $80.60 , $45.36 ," $1,401.35 "," $1,560.92 "," $1,468.30 "," $1,560.92 "," $1,560.92 "," $1,560.92 "," $1,474.20 ", $44.47 ," $1,601.33 "," $1,647.63 "," $1,474.20 "," $1,612.95 "," $1,612.95 "," $1,647.63 "," $1,664.98 "," $1,419.05 "," $1,560.92 "," $1,474.20 "," $1,370.14 ", N/A ," $1,403.61 "," $1,403.61 "," $1,647.63 "," $1,488.25 ", $44.47 ," $1,664.98 "
Exc Skin Benig 1.1-2cm Remaindr Body,11422,N/A,N/A,N/A, $702.00 , $456.30 , $435.54 , $131.06 , $143.41 , $370.23 , $364.50 , $652.86 , $631.80 , $631.80 , $561.60 , $561.60 , $143.41 , $648.16 , $666.90 , $631.80 , $631.80 , $631.80 , $652.86 , $673.92 , $475.45 , $596.70 , $726.11 , $478.34 , N/A , $377.45 , $377.45 , $666.90 , $437.72 , $131.06 , $726.11 
"Lap,Surg,Colectomy,W/Anast",CPT® 44207,N/A,N/A,N/A," $11,979.00 "," $7,786.35 "," $10,842.07 "," $1,679.90 "," $1,526.22 "," $8,629.88 "," $8,702.06 "," $11,140.47 "," $10,781.10 "," $10,781.10 "," $9,583.20 "," $9,583.20 "," $1,526.22 "," $11,060.21 "," $11,380.05 "," $10,781.10 "," $10,781.10 "," $10,781.10 "," $11,140.47 "," $11,499.84 "," $7,778.06 "," $10,182.15 "," $9,655.35 "," $10,197.17 ", N/A ," $8,798.26 "," $8,798.26 "," $11,380.05 "," $9,202.07 "," $1,526.22 "," $11,499.84 "
 Fac Imcytchm Tiss Immunoproxidase Ea Antb ,CPT® 88342,0310 - PATHOLOGY LAB,N/A,N/A, $430.00 , $279.50 , $361.20 , $98.62 , $54.62 , $347.44 , $387.00 , $364.04 , $387.00 , $387.00 , $387.00 , $365.50 , $53.55 , $397.02 , $408.50 , $365.50 , $399.90 , $399.90 , $408.50 , $412.80 , $351.83 , $387.00 , $365.50 , $339.70 , N/A , $348.00 , $348.00 , $408.50 , $368.98 , $53.55 , $412.80 
X-Ray Jaw <4 Vw,CPT® 70100,N/A,N/A,N/A, $483.00 , $313.95 , $216.92 , $37.96 , $29.85 , $155.77 , $183.82 , $449.19 , $434.70 , $434.70 , $386.40 , $386.40 , $29.85 , $445.95 , $458.85 , $434.70 , $434.70 , $434.70 , $449.19 , $463.68 , $210.48 , $410.55 , $202.23 , $165.69 , N/A , $158.81 , $158.81 , $458.85 , $183.80 , $29.85 , $463.68 
" Fac Varicella Zoster, Ag, If ",CPT® 87290,0305 - LAB/HEMATOLOGY,N/A,N/A, $126.00 , $81.90 , $105.84 , $13.69 , $13.69 , $101.81 , $113.40 , $106.67 , $113.40 , $113.40 , $113.40 , $107.10 , $13.42 , $116.34 , $119.70 , $107.10 , $117.18 , $117.18 , $119.70 , $120.96 , $103.09 , $113.40 , $107.10 , $99.54 , N/A , $101.97 , $101.97 , $119.70 , $108.12 , $13.42 , $120.96 
Exc Isch Pres Ulc Bone Myocut Flap,CPT® 15946,N/A,N/A,N/A," $6,296.00 "," $4,092.40 "," $5,126.28 "," $1,527.00 "," $1,266.47 "," $4,434.36 "," $4,332.59 "," $5,855.28 "," $5,666.40 "," $5,666.40 "," $5,036.80 "," $5,036.80 "," $1,266.47 "," $5,813.10 "," $5,981.20 "," $5,666.40 "," $5,666.40 "," $5,666.40 "," $5,855.28 "," $6,044.16 "," $5,611.05 "," $5,351.60 "," $8,720.50 "," $5,643.37 ", N/A ," $4,520.89 "," $4,520.89 "," $5,981.20 "," $5,242.71 "," $1,266.47 "," $8,720.50 "
"Nuclear Therapy, IV",CPT® 79101,N/A,N/A,N/A," $1,545.00 "," $1,004.25 ", $829.86 , $145.24 , $163.56 , $692.14 , $747.79 ," $1,436.85 "," $1,390.50 "," $1,390.50 "," $1,236.00 "," $1,236.00 ", $163.56 ," $1,426.50 "," $1,467.75 "," $1,390.50 "," $1,390.50 "," $1,390.50 "," $1,436.85 "," $1,483.20 ", $837.35 ," $1,313.25 ", $808.94 , $954.05 , N/A , $705.65 , $705.65 ," $1,467.75 ", $816.80 , $145.24 ," $1,483.20 "
 CEFTRIAXONE SODIUM 2 G IJ SOLR ,HCPCS J0696,0636 - DRUGS REQUIRING DETAILED CODIN,00409-7335-03,20 mL, $17.84 , $11.60 , $14.99 , $0.58 , $0.54 , $14.41 , $16.06 , $15.10 , $16.06 , $16.06 , $16.06 , $15.16 , $0.53 , $16.47 , $16.95 , $15.16 , $16.59 , $16.59 , $16.95 , $17.13 , $14.60 , $16.06 , $15.16 , $14.09 , N/A , $14.44 , $14.44 , $16.95 , $15.31 , $0.53 , $17.13 
 FLUTICASONE-SALMETEROL 100-50 MCG/ACT INH AEPB ,HCPCS RXC637,0250 - PHARMACY,00173-0695-04,14 each, $446.16 , $290.00 , $374.77 , N/A , N/A , $360.50 , $401.54 , $377.72 , $401.54 , $401.54 , $401.54 , $379.24 , N/A , $411.94 , $423.85 , $379.24 , $414.93 , $414.93 , $423.85 , $428.31 , $365.05 , $401.54 , $379.24 , $352.47 , N/A , $361.08 , $361.08 , $423.85 , $382.85 , $352.47 , $428.31 
 Pro US Pg Uter R-T Img Lmtd 1+ Fetuses ,CPT® 76815,0981 - PRO FEE/ER,N/A,N/A, $263.00 , $170.95 , $462.43 , $80.48 , $87.65 , $405.52 , $478.15 , $244.59 , $236.70 , $236.70 , $210.40 , $210.40 , $87.65 , $242.83 , $249.85 , $236.70 , $236.70 , $236.70 , $244.59 , $252.48 , $466.34 , $223.55 , $520.03 , $475.70 , N/A , $413.43 , $413.43 , $249.85 , $478.57 , $80.48 , $520.03 
"Laryngoscopy,Dirct,OP Scope,FB Remv",CPT® 31531,N/A,N/A,N/A," $1,175.00 ", $763.75 ," $1,134.19 ", $201.52 , $621.32 , $819.45 , $802.17 ," $1,092.75 "," $1,057.50 "," $1,057.50 ", $940.00 , $940.00 , $621.32 ," $1,084.88 "," $1,116.25 "," $1,057.50 "," $1,057.50 "," $1,057.50 "," $1,092.75 "," $1,128.00 "," $1,084.21 ", $998.75 ," $1,129.31 "," $1,077.90 ", N/A , $835.43 , $835.43 ," $1,116.25 ", $983.91 , $201.52 ," $1,134.19 "
Thoracotomy W/Therapeutic Wedge Resexn Initial,CPT® 32505,N/A,N/A,N/A," $7,598.00 "," $4,938.70 "," $4,840.18 ", $847.24 , $715.16 ," $3,520.64 "," $3,551.33 "," $7,066.14 "," $6,838.20 "," $6,838.20 "," $6,078.40 "," $6,078.40 ", $715.16 ," $7,015.23 "," $7,218.10 "," $6,838.20 "," $6,838.20 "," $6,838.20 "," $7,066.14 "," $7,294.08 "," $4,682.28 "," $6,458.30 "," $5,122.05 "," $4,623.99 ", N/A ," $3,589.33 "," $3,589.33 "," $7,218.10 "," $4,227.17 ", $715.16 ," $7,294.08 "
 Fac Revascularization Iliac Art Angiop Ea Ipsi Vsl ,CPT® 37222,0360 - OR SERVICES,N/A,N/A," $7,380.00 "," $4,797.00 "," $6,199.20 ", $165.85 , $139.05 ," $5,963.04 "," $6,642.00 "," $6,247.91 "," $6,642.00 "," $6,642.00 "," $6,642.00 "," $6,273.00 ", $136.32 ," $6,813.95 "," $7,011.00 "," $6,273.00 "," $6,863.40 "," $6,863.40 "," $7,011.00 "," $7,084.80 "," $6,038.32 "," $6,642.00 "," $6,273.00 "," $5,830.20 ", N/A ," $5,972.63 "," $5,972.63 "," $7,011.00 "," $6,332.78 ", $136.32 ," $7,084.80 "
 HAEMOPHILUS B POLYSAC CONJ VAC IM SOLR ,HCPCS 90648,0250 - PHARMACY,49281-0547-58,0.5 mL, $75.99 , $49.39 , $63.83 , N/A , $46.72 , $61.40 , $68.39 , $64.33 , $68.39 , $68.39 , $68.39 , $64.59 , $45.80 , $70.16 , $72.19 , $64.59 , $70.67 , $70.67 , $72.19 , $72.95 , $62.18 , $68.39 , $64.59 , $60.03 , N/A , $61.50 , $61.50 , $72.19 , $65.21 , $45.80 , $72.95 
Transferase (Ast) (Sgot),CPT® 84450,N/A,N/A,N/A, $43.00 , $27.95 , N/A , $5.28 , $5.28 , $29.27 , $35.00 , $39.99 , $38.70 , $38.70 , $34.40 , $34.40 , $5.28 , $39.70 , $40.85 , $38.70 , $38.70 , $38.70 , $39.99 , $41.28 , $34.59 , $36.55 , $34.06 , $18.77 , N/A , $27.32 , $27.32 , $40.85 , $29.85 , $5.28 , $41.28 
 Fac Afo Plastic Molded W/Ankle J ,HCPCS L1970,0274 - PROSTHETIC DEV,N/A,N/A," $1,130.00 ", $734.50 , $949.20 , $809.61 , $376.44 , $913.04 ," $1,017.00 ", $956.66 ," $1,017.00 "," $1,017.00 "," $1,017.00 ", $960.50 , $369.06 ," $1,043.33 "," $1,073.50 ", $960.50 ," $1,050.90 "," $1,050.90 "," $1,073.50 "," $1,084.80 ", $924.57 ," $1,017.00 ", $960.50 , $892.70 , N/A , $914.51 , $914.51 ," $1,073.50 ", $969.65 , $369.06 ," $1,084.80 "
 Fac Assay of Ethosuximide ,CPT® 80168,0301 - LAB/CHEMISTRY,N/A,N/A, $152.00 , $98.80 , $127.68 , $16.67 , $16.67 , $122.82 , $136.80 , $128.68 , $136.80 , $136.80 , $136.80 , $129.20 , $16.34 , $140.34 , $144.40 , $129.20 , $141.36 , $141.36 , $144.40 , $145.92 , $124.37 , $136.80 , $129.20 , $120.08 , N/A , $123.01 , $123.01 , $144.40 , $130.43 , $16.34 , $145.92 
 HALOPERIDOL 2 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,51079-0735-20,1 tablet, $3.47 , $2.26 , $2.91 , N/A , N/A , $2.80 , $3.12 , $2.94 , $3.12 , $3.12 , $3.12 , $2.95 , N/A , $3.20 , $3.30 , $2.95 , $3.23 , $3.23 , $3.30 , $3.33 , $2.84 , $3.12 , $2.95 , $2.74 , N/A , $2.81 , $2.81 , $3.30 , $2.98 , $2.74 , $3.33 
 Fac Mog-Igg1 Antibody Cell-Based Imfluor Assay Each ,CPT® 86362,0302 - LAB/IMMUNOLOGY,N/A,N/A, $78.00 , $50.70 , $65.52 , $12.29 , $12.29 , $63.02 , $70.20 , $66.03 , $70.20 , $70.20 , $70.20 , $66.30 , $12.05 , $72.02 , $74.10 , $66.30 , $72.54 , $72.54 , $74.10 , $74.88 , $63.82 , $70.20 , $66.30 , $61.62 , N/A , $63.13 , $63.13 , $74.10 , $66.93 , $12.05 , $74.88 
Excision Tumor Soft Tissue Back/Flank Subq 3+Cm,CPT® 21931,N/A,N/A,N/A," $3,337.00 "," $2,169.05 "," $2,826.59 ", $440.04 , $385.71 ," $2,249.43 "," $2,252.29 "," $3,103.41 "," $3,003.30 "," $3,003.30 "," $2,669.60 "," $2,669.60 ", $385.71 ," $3,081.05 "," $3,170.15 "," $3,003.30 "," $3,003.30 "," $3,003.30 "," $3,103.41 "," $3,203.52 "," $2,619.84 "," $2,836.45 "," $2,495.91 "," $2,642.86 ", N/A ," $2,293.32 "," $2,293.32 "," $3,170.15 "," $2,695.47 ", $385.71 ," $3,203.52 "
Crutch Underarm Pair Wood,HCPCS E0112,N/A,N/A,N/A, $55.00 , $35.75 , N/A , $42.68 , $31.33 , N/A , N/A , $51.15 , $49.50 , $49.50 , $44.00 , $44.00 , $31.33 , $50.78 , $52.25 , $49.50 , $49.50 , $49.50 , $51.15 , $52.80 , N/A , $46.75 , N/A , $38.76 , N/A , N/A , N/A , $52.25 , N/A , $31.33 , $52.80 
 Fac Enterosc >2nd Prtn W/Ileum W/Bx Single/Multiple ,CPT® 44377,0360 - OR SERVICES,N/A,N/A," $3,924.00 "," $2,550.60 "," $3,296.16 ", $283.06 , $836.81 ," $3,170.59 "," $3,531.60 "," $3,322.06 "," $3,531.60 "," $3,531.60 "," $3,531.60 "," $3,335.40 ", $820.40 ," $3,623.03 "," $3,727.80 "," $3,335.40 "," $3,649.32 "," $3,649.32 "," $3,727.80 "," $3,767.04 "," $3,210.62 "," $3,531.60 "," $3,335.40 "," $3,099.96 ", N/A ," $3,175.69 "," $3,175.69 "," $3,727.80 "," $3,367.18 ", $283.06 ," $3,767.04 "
 Pro Vis Fld Xm Uni/Bi I&R Extnd Xm ,CPT® 92083,0962 - PRO FEE/EYE,N/A,N/A, $232.00 , $150.80 , $136.22 , $61.50 , $30.53 , $112.81 , $112.62 , $215.76 , $208.80 , $208.80 , $185.60 , $185.60 , $30.53 , $214.21 , $220.40 , $208.80 , $208.80 , $208.80 , $215.76 , $222.72 , $192.94 , $197.20 , $198.69 , $135.34 , N/A , $115.01 , $115.01 , $220.40 , $136.81 , $30.53 , $222.72 
Reconstruc Female Urethra,CPT® 53430,N/A,N/A,N/A," $6,726.00 "," $4,371.90 "," $5,244.29 ", $922.85 , $845.22 ," $4,710.32 "," $4,407.38 "," $6,255.18 "," $6,053.40 "," $6,053.40 "," $5,380.80 "," $5,380.80 ", $845.22 ," $6,210.12 "," $6,389.70 "," $6,053.40 "," $6,053.40 "," $6,053.40 "," $6,255.18 "," $6,456.96 "," $5,264.37 "," $5,717.10 "," $5,018.57 "," $5,940.68 ", N/A ," $4,802.23 "," $4,802.23 "," $6,389.70 "," $5,644.34 ", $845.22 ," $6,456.96 "
 Fac Trauma 3 Eval W/ Pre-ED Notification-WO Critical Care ,N/A,0683 - TRAUMA LEVEL III,N/A,N/A," $1,225.00 ", $796.25 ," $1,029.00 ", N/A , N/A , $989.80 ," $1,102.50 "," $1,037.09 "," $1,102.50 "," $1,102.50 "," $1,102.50 "," $1,041.25 ", N/A ," $1,131.04 "," $1,163.75 "," $1,041.25 "," $1,139.25 "," $1,139.25 "," $1,163.75 "," $1,176.00 "," $1,002.30 "," $1,102.50 "," $1,041.25 ", $967.75 , N/A , $991.39 , $991.39 ," $1,163.75 "," $1,051.17 ", $967.75 ," $1,176.00 "
 Pro Lyr Clsr S/a/T/E 7.6 Cm-12.5 Cm ,CPT® 12034,0982 - PRO FEE/OUTPT,N/A,N/A," $1,268.00 ", $824.20 , $654.87 , $196.65 , $122.93 , $564.34 , $550.50 ," $1,179.24 "," $1,141.20 "," $1,141.20 "," $1,014.40 "," $1,014.40 ", $122.93 ," $1,170.74 "," $1,204.60 "," $1,141.20 "," $1,141.20 "," $1,141.20 "," $1,179.24 "," $1,217.28 ", $719.01 ," $1,077.80 "," $1,100.77 ", $726.60 , N/A , $575.35 , $575.35 ," $1,204.60 ", $667.22 , $122.93 ," $1,217.28 "
 Pro Drg Absc Cst Hmtma From Dentoalveolar Struxs ,CPT® 41800,0982 - PRO FEE/OUTPT,N/A,N/A, $731.00 , $475.15 , $949.52 , $149.06 , $30.71 , $713.43 , $755.10 , $679.83 , $657.90 , $657.90 , $584.80 , $584.80 , $30.71 , $674.93 , $694.45 , $657.90 , $657.90 , $657.90 , $679.83 , $701.76 , $697.11 , $621.35 , $824.24 , $871.64 , N/A , $727.36 , $727.36 , $694.45 , $760.72 , $30.71 , $949.52 
" Fac Thrombin Time, Plasma ",CPT® 85670,0305 - LAB/HEMATOLOGY,N/A,N/A, $115.00 , $74.75 , $96.60 , $5.89 , N/A , $92.92 , $103.50 , $97.36 , $103.50 , $103.50 , $103.50 , $97.75 , N/A , $106.18 , $109.25 , $97.75 , $106.95 , $106.95 , $109.25 , $110.40 , $94.09 , $103.50 , $97.75 , $90.85 , N/A , $93.07 , $93.07 , $109.25 , $98.68 , $5.89 , $110.40 
Drug Screen Quantitative Zonisamide,CPT® 80203,N/A,N/A,N/A, $260.00 , $169.00 , N/A , $13.52 , $13.52 , $75.01 , $89.06 , $241.80 , $234.00 , $234.00 , $208.00 , $208.00 , $13.52 , $240.06 , $247.00 , $234.00 , $234.00 , $234.00 , $241.80 , $249.60 , $88.47 , $221.00 , $63.00 , $48.05 , N/A , $70.00 , $70.00 , $247.00 , $76.49 , $13.52 , $249.60 
Egd Transoral Biopsy Single/Multiple,CPT® 43239,N/A,N/A,N/A," $2,363.00 "," $1,535.95 ", $847.99 , $131.07 , $744.68 , $879.24 , $836.03 ," $2,197.59 "," $2,126.70 "," $2,126.70 "," $1,890.40 "," $1,890.40 ", $744.68 ," $2,181.76 "," $2,244.85 "," $2,126.70 "," $2,126.70 "," $2,126.70 "," $2,197.59 "," $2,268.48 "," $1,125.61 "," $2,008.55 ", $915.22 , $806.86 , N/A , $896.40 , $896.40 ," $2,244.85 "," $1,076.03 ", $131.07 ," $2,268.48 "
Chromosome Anal-Addt Cnt.,CPT® 88285,N/A,N/A,N/A, $87.00 , $56.55 , N/A , $27.45 , $26.38 , $106.40 , $160.81 , $80.91 , $78.30 , $78.30 , $69.60 , $69.60 , $26.38 , $80.33 , $82.65 , $78.30 , $78.30 , $78.30 , $80.91 , $83.52 , $179.68 , $73.95 , $124.88 , $95.26 , N/A , $99.30 , $99.30 , $82.65 , $109.13 , $26.38 , $179.68 
Whfo W/Joint(S) Custom Fab,HCPCS L3806,N/A,N/A,N/A, $516.00 , $335.40 , N/A , $483.55 , $231.34 , N/A , N/A , $479.88 , $464.40 , $464.40 , $412.80 , $412.80 , $231.34 , $476.42 , $490.20 , $464.40 , $464.40 , $464.40 , $479.88 , $495.36 , N/A , $438.60 , $398.98 , $406.84 , N/A , N/A , N/A , $490.20 , N/A , $231.34 , $495.36 
"Cytopath,Auto Thnprep Pap",CPT® 88142,N/A,N/A,N/A, $228.00 , $148.20 , N/A , $20.67 , $20.67 , $113.44 , $171.63 , $212.04 , $205.20 , $205.20 , $182.40 , $182.40 , $20.67 , $210.51 , $216.60 , $205.20 , $205.20 , $205.20 , $212.04 , $218.88 , $135.28 , $193.80 , $132.99 , $88.54 , N/A , $105.87 , $105.87 , $216.60 , $116.35 , $20.67 , $218.88 
Repair of Sperm Duct,CPT® 55400,N/A,N/A,N/A," $2,736.00 "," $1,778.40 "," $2,217.13 ", $477.79 , N/A ," $1,600.01 "," $1,615.57 "," $2,544.48 "," $2,462.40 "," $2,462.40 "," $2,188.80 "," $2,188.80 ", N/A ," $2,526.15 "," $2,599.20 "," $2,462.40 "," $2,462.40 "," $2,462.40 "," $2,544.48 "," $2,626.56 "," $2,082.39 "," $2,325.60 "," $2,572.62 "," $2,416.40 ", N/A ," $1,631.23 "," $1,631.23 "," $2,599.20 "," $1,955.11 ", $477.79 ," $2,626.56 "
 Pro Injection Aa&/Strd Other Peripheral Nerve/Branch ,CPT® 64450,0981 - PRO FEE/ER,N/A,N/A, $711.00 , $462.15 , $207.58 , $40.26 , $113.79 , $255.83 , $245.04 , $661.23 , $639.90 , $639.90 , $568.80 , $568.80 , $113.79 , $656.47 , $675.45 , $639.90 , $639.90 , $639.90 , $661.23 , $682.56 , $225.30 , $604.35 , $237.28 , $273.66 , N/A , $260.82 , $260.82 , $675.45 , $279.80 , $40.26 , $682.56 
Open Rx Femur Fx+Intramed Rod,CPT® 27506,N/A,N/A,N/A," $7,157.00 "," $4,652.05 "," $8,070.34 "," $1,262.68 "," $1,092.81 "," $6,461.63 "," $6,404.97 "," $6,656.01 "," $6,441.30 "," $6,441.30 "," $5,725.60 "," $5,725.60 "," $1,092.81 "," $6,608.06 "," $6,799.15 "," $6,441.30 "," $6,441.30 "," $6,441.30 "," $6,656.01 "," $6,870.72 "," $7,519.11 "," $6,083.45 "," $7,086.30 "," $7,598.44 ", N/A ," $6,587.70 "," $6,587.70 "," $6,799.15 "," $7,742.88 "," $1,092.81 "," $8,070.34 "
Assay of Glucagon,CPT® 82943,N/A,N/A,N/A, $119.00 , $77.35 , N/A , $14.58 , $13.70 , $55.84 , $66.76 , $110.67 , $107.10 , $107.10 , $95.20 , $95.20 , $13.70 , $109.87 , $113.05 , $107.10 , $107.10 , $107.10 , $110.67 , $114.24 , $95.42 , $101.15 , $94.07 , $51.81 , N/A , $52.11 , $52.11 , $113.05 , $56.94 , $13.70 , $114.24 
Exc Tumor Soft Tissue Shoulder Subfascial 5+Cm,23073,N/A,N/A,N/A," $5,457.00 "," $3,547.05 "," $4,200.56 ", $655.86 , $568.22 ," $3,326.76 "," $3,305.98 "," $5,075.01 "," $4,911.30 "," $4,911.30 "," $4,365.60 "," $4,365.60 ", $568.22 ," $5,038.45 "," $5,184.15 "," $4,911.30 "," $4,911.30 "," $4,911.30 "," $5,075.01 "," $5,238.72 "," $3,901.55 "," $4,638.45 "," $3,660.90 "," $3,917.76 ", N/A ," $3,391.67 "," $3,391.67 "," $5,184.15 "," $3,986.41 ", $568.22 ," $5,238.72 "
 SODIUM HYPOCHLORITE 0.057 % EX LIQD ,HCPCS RXC637,0250 - PHARMACY,67180-0408-88,237 mL, $85.23 , $55.40 , $71.59 , N/A , N/A , $68.87 , $76.71 , $72.16 , $76.71 , $76.71 , $76.71 , $72.45 , N/A , $78.69 , $80.97 , $72.45 , $79.26 , $79.26 , $80.97 , $81.82 , $69.74 , $76.71 , $72.45 , $67.33 , N/A , $68.98 , $68.98 , $80.97 , $73.14 , $67.33 , $81.82 
 Pro Bld Bnk Physician Service Interp & Report ,CPT® 86078,0971 - PRO FEE/LAB,N/A,N/A, $258.00 , $167.70 , $176.53 , $48.03 , $45.87 , $210.93 , $237.63 , $239.94 , $232.20 , $232.20 , $206.40 , $206.40 , $45.87 , $238.21 , $245.10 , $232.20 , $232.20 , $232.20 , $239.94 , $247.68 , $323.44 , $219.30 , $236.79 , $151.81 , N/A , $196.85 , $196.85 , $245.10 , $215.12 , $45.87 , $323.44 
 Pro Appl Short Leg Splnt Calf Foot ,CPT® 29515,0981 - PRO FEE/ER,N/A,N/A, $350.00 , $227.50 , $298.68 , $47.11 , $31.03 , $240.63 , $243.68 , $325.50 , $315.00 , $315.00 , $280.00 , $280.00 , $31.03 , $323.16 , $332.50 , $315.00 , $315.00 , $315.00 , $325.50 , $336.00 , $277.19 , $297.50 , $265.83 , $288.50 , N/A , $245.33 , $245.33 , $332.50 , $288.36 , $31.03 , $336.00 
 PHENYLEPHRINE 10 MG/ML (ANES) ,HCPCS J2371,0636 - DRUGS REQUIRING DETAILED CODIN,71288-0807-02,1 mL, $16.68 , $10.84 , $14.01 , N/A , N/A , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , N/A , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $13.18 , $16.01 
Slitting of Prepuce,CPT® 54001,N/A,N/A,N/A," $1,015.00 ", $659.75 , $621.53 , $134.54 , $92.19 , $444.58 , $451.38 , $943.95 , $913.50 , $913.50 , $812.00 , $812.00 , $92.19 , $937.15 , $964.25 , $913.50 , $913.50 , $913.50 , $943.95 , $974.40 , $582.37 , $862.75 , $720.76 , $672.29 , N/A , $453.25 , $453.25 , $964.25 , $543.25 , $92.19 , $974.40 
 Pro Csto Mnpj W/O Rmvl Urtrl St1 ,CPT® 52330,0982 - PRO FEE/OUTPT,N/A,N/A," $3,997.00 "," $2,598.05 "," $1,411.11 ", $247.91 , $307.34 ," $1,294.89 "," $1,198.45 "," $3,717.21 "," $3,597.30 "," $3,597.30 "," $3,197.60 "," $3,197.60 ", $307.34 ," $3,690.43 "," $3,797.15 "," $3,597.30 "," $3,597.30 "," $3,597.30 "," $3,717.21 "," $3,837.12 "," $1,419.73 "," $3,397.45 "," $1,357.67 "," $1,625.31 ", N/A ," $1,320.16 "," $1,320.16 "," $3,797.15 "," $1,551.66 ", $247.91 ," $3,837.12 "
Office/OP Consltj New/Est Pt Sf Mdm 20 Minutes,CPT® 99242,N/A,N/A,N/A, $326.00 , $211.90 , N/A , $74.22 , $63.23 , $151.92 , $151.47 , $303.18 , $293.40 , $293.40 , $260.80 , $260.80 , $63.23 , $301.00 , $309.70 , $293.40 , $293.40 , $293.40 , $303.18 , $312.96 , $190.00 , $277.10 , $149.27 , $150.03 , $116.50 , $154.89 , $154.89 , $309.70 , $184.40 , $63.23 , $312.96 
 Pro Cardiovascular Stress Test ,CPT® 93016,0985 - PRO FEE/EKG,N/A,N/A, $237.00 , $154.05 , $136.44 , $20.92 , $23.72 , $122.08 , $122.23 , $220.41 , $213.30 , $213.30 , $189.60 , $189.60 , $23.72 , $218.82 , $225.15 , $213.30 , $213.30 , $213.30 , $220.41 , $227.52 , $134.97 , $201.45 , $112.40 , $134.17 , N/A , $124.46 , $124.46 , $225.15 , $137.96 , $20.92 , $227.52 
 Pro Cltx UR Shft Fx W/O Mnpj ,CPT® 25530,0981 - PRO FEE/ER,N/A,N/A," $1,068.00 ", $694.20 ," $1,510.80 ", $240.36 , $154.82 ," $1,143.45 "," $1,163.91 ", $993.24 , $961.20 , $961.20 , $854.40 , $854.40 , $154.82 , $986.08 ," $1,014.60 ", $961.20 , $961.20 , $961.20 , $993.24 ," $1,025.28 "," $1,395.00 ", $907.80 ," $1,273.82 "," $1,362.13 ", N/A ," $1,165.76 "," $1,165.76 "," $1,014.60 "," $1,370.18 ", $154.82 ," $1,510.80 "
Drain Bartholin's Gland,56420,N/A,N/A,N/A, $690.00 , $448.50 , $529.30 , $107.00 , $49.34 , $372.48 , $373.89 , $641.70 , $621.00 , $621.00 , $552.00 , $552.00 , $49.34 , $637.08 , $655.50 , $621.00 , $621.00 , $621.00 , $641.70 , $662.40 , $537.13 , $586.50 , $490.62 , $372.95 , N/A , $379.75 , $379.75 , $655.50 , $455.49 , $49.34 , $662.40 
 Pro Opscpy Extnd RTA Drawing & Scl Deprsn I&R Uni/Bi ,CPT® 92201,0962 - PRO FEE/EYE,N/A,N/A, $79.00 , $51.35 , $49.21 , $21.92 , $19.95 , $39.94 , N/A , $73.47 , $71.10 , $71.10 , $63.20 , $63.20 , $19.95 , $72.94 , $75.05 , $71.10 , $71.10 , $71.10 , $73.47 , $75.84 , $69.70 , $67.15 , $66.64 , $48.46 , N/A , $40.72 , $40.72 , $75.05 , $48.33 , $19.95 , $75.84 
 Pro Removal of Sperm Cord Lesion ,CPT® 55520,0982 - PRO FEE/OUTPT,N/A,N/A," $2,919.00 "," $1,897.35 "," $1,992.71 ", $428.06 , $401.40 ," $1,424.19 "," $1,467.59 "," $2,714.67 "," $2,627.10 "," $2,627.10 "," $2,335.20 "," $2,335.20 ", $401.40 ," $2,695.11 "," $2,773.05 "," $2,627.10 "," $2,627.10 "," $2,627.10 "," $2,714.67 "," $2,802.24 "," $1,854.97 "," $2,481.15 "," $2,406.70 "," $2,111.22 ", N/A ," $1,451.98 "," $1,451.98 "," $2,773.05 "," $1,740.27 ", $401.40 ," $2,802.24 "
 Pro Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw ,CPT® 72081,0972 - PRO FEE/RAD/DX,N/A,N/A, $161.00 , $104.65 , $290.36 , $42.04 , $30.44 , $184.46 , $194.97 , $149.73 , $144.90 , $144.90 , $128.80 , $128.80 , $30.44 , $148.65 , $152.95 , $144.90 , $144.90 , $144.90 , $149.73 , $154.56 , $232.08 , $136.85 , $245.55 , $193.86 , N/A , $188.06 , $188.06 , $152.95 , $217.69 , $30.44 , $290.36 
" Fac Assay of Protein, Urine ",CPT® 84156,0301 - LAB/CHEMISTRY,N/A,N/A, $68.00 , $44.20 , $57.12 , $3.74 , $3.74 , $54.94 , $61.20 , $57.57 , $61.20 , $61.20 , $61.20 , $57.80 , $3.67 , $62.78 , $64.60 , $57.80 , $63.24 , $63.24 , $64.60 , $65.28 , $55.64 , $61.20 , $57.80 , $53.72 , N/A , $55.03 , $55.03 , $64.60 , $58.35 , $3.67 , $65.28 
Tracheotomy Tube Change,CPT® 31502,N/A,N/A,N/A, $627.00 , $407.55 , $189.00 , $33.08 , $49.19 , $134.38 , $131.26 , $583.11 , $564.30 , $564.30 , $501.60 , $501.60 , $49.19 , $578.91 , $595.65 , $564.30 , $564.30 , $564.30 , $583.11 , $601.92 , $181.55 , $532.95 , $183.76 , $178.84 , N/A , $137.00 , $137.00 , $595.65 , $161.36 , $33.08 , $601.92 
 Fac Sclerotherapy Fluid Collection Prq W/Img Gid ,CPT® 49185,0361 - OR/MINOR,N/A,N/A," $2,855.00 "," $1,855.75 "," $2,398.20 ", $112.83 , $788.54 ," $2,306.84 "," $2,569.50 "," $2,417.04 "," $2,569.50 "," $2,569.50 "," $2,569.50 "," $2,426.75 ", $773.08 ," $2,636.02 "," $2,712.25 "," $2,426.75 "," $2,655.15 "," $2,655.15 "," $2,712.25 "," $2,740.80 "," $2,335.96 "," $2,569.50 "," $2,426.75 "," $2,255.45 ", N/A ," $2,310.55 "," $2,310.55 "," $2,712.25 "," $2,449.88 ", $112.83 ," $2,740.80 "
 Fac Destruct by Neuro Agent; Pudendal ,CPT® 64630,0360 - OR SERVICES,N/A,N/A," $3,151.00 "," $2,048.15 "," $2,646.84 ", $181.23 , $54.95 ," $2,546.01 "," $2,835.90 "," $2,667.64 "," $2,835.90 "," $2,835.90 "," $2,835.90 "," $2,678.35 ", $53.87 ," $2,909.32 "," $2,993.45 "," $2,678.35 "," $2,930.43 "," $2,930.43 "," $2,993.45 "," $3,024.96 "," $2,578.15 "," $2,835.90 "," $2,678.35 "," $2,489.29 ", N/A ," $2,550.10 "," $2,550.10 "," $2,993.45 "," $2,703.87 ", $53.87 ," $3,024.96 "
 Fac Nitric Oxide Expired Gas Determination ,CPT® 95012,0460 - PULMONARY FUNC,N/A,N/A, $271.00 , $176.15 , $227.64 , $18.17 , $14.99 , $218.97 , $243.90 , $229.43 , $243.90 , $243.90 , $243.90 , $230.35 , $14.70 , $250.21 , $257.45 , $230.35 , $252.03 , $252.03 , $257.45 , $260.16 , $221.73 , $243.90 , $230.35 , $214.09 , N/A , $219.32 , $219.32 , $257.45 , $232.55 , $14.70 , $260.16 
Revis Shoulder Arthrplsty Humeral/Glenoid Compnt,CPT® 23473,N/A,N/A,N/A," $10,862.00 "," $7,060.30 "," $9,715.55 "," $1,515.71 "," $1,248.49 "," $7,858.52 "," $7,778.60 "," $10,101.66 "," $9,775.80 "," $9,775.80 "," $8,689.60 "," $8,689.60 "," $1,248.49 "," $10,028.88 "," $10,318.90 "," $9,775.80 "," $9,775.80 "," $9,775.80 "," $10,101.66 "," $10,427.52 "," $9,076.87 "," $9,232.70 "," $8,611.68 "," $9,230.42 ", N/A ," $8,011.86 "," $8,011.86 "," $10,318.90 "," $9,416.78 "," $1,248.49 "," $10,427.52 "
 Pro Cltx Ankle Dislc W/O Anes ,CPT® 27840,0981 - PRO FEE/ER,N/A,N/A," $2,578.00 "," $1,675.70 "," $2,352.48 ", $375.49 , $153.67 ," $1,776.63 "," $1,824.43 "," $2,397.54 "," $2,320.20 "," $2,320.20 "," $2,062.40 "," $2,062.40 ", $153.67 ," $2,380.27 "," $2,449.10 "," $2,320.20 "," $2,320.20 "," $2,320.20 "," $2,397.54 "," $2,474.88 "," $2,156.14 "," $2,191.30 "," $2,001.72 "," $2,128.48 ", N/A ," $1,811.30 "," $1,811.30 "," $2,449.10 "," $2,128.91 ", $153.67 ," $2,474.88 "
D&C After Delivery,CPT® 59160,N/A,N/A,N/A," $1,495.00 ", $971.75 , $514.89 , $173.91 , $189.34 , $401.66 , $421.74 ," $1,390.35 "," $1,345.50 "," $1,345.50 "," $1,196.00 "," $1,196.00 ", $189.34 ," $1,380.33 "," $1,420.25 "," $1,345.50 "," $1,345.50 "," $1,345.50 "," $1,390.35 "," $1,435.20 ", $514.69 ," $1,270.75 ", $929.50 , $746.05 , N/A , $409.49 , $409.49 ," $1,420.25 ", $473.41 , $173.91 ," $1,435.20 "
"Ankle Scope,Aid Repair Fx,Bone Defct",29892,N/A,N/A,N/A," $7,011.00 "," $4,557.15 "," $3,941.67 ", $621.39 , $613.65 ," $3,098.15 "," $2,949.53 "," $6,520.23 "," $6,309.90 "," $6,309.90 "," $5,608.80 "," $5,608.80 ", $613.65 ," $6,473.26 "," $6,660.45 "," $6,309.90 "," $6,309.90 "," $6,309.90 "," $6,520.23 "," $6,730.56 "," $3,698.72 "," $5,959.35 "," $3,270.19 "," $3,856.93 ", N/A ," $3,158.60 "," $3,158.60 "," $6,660.45 "," $3,712.47 ", $613.65 ," $6,730.56 "
 LAYER CLOSURE Trunk 2.5CM OR LE ,CPT® 12031,0981 - PRO FEE/ER,N/A,N/A, $981.00 , $637.65 , $484.53 , $146.05 , $60.48 , $418.18 , $412.35 , $912.33 , $882.90 , $882.90 , $784.80 , $784.80 , $60.48 , $905.76 , $931.95 , $882.90 , $882.90 , $882.90 , $912.33 , $941.76 , $531.98 , $833.85 , $820.67 , $538.15 , N/A , $426.34 , $426.34 , $931.95 , $494.42 , $60.48 , $941.76 
 PRAZOSIN HCL 5 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-7022-61,1 capsule, $27.81 , $18.08 , $23.36 , N/A , N/A , $22.47 , $25.03 , $23.54 , $25.03 , $25.03 , $25.03 , $23.64 , N/A , $25.68 , $26.42 , $23.64 , $25.86 , $25.86 , $26.42 , $26.70 , $22.75 , $25.03 , $23.64 , $21.97 , N/A , $22.51 , $22.51 , $26.42 , $23.86 , $21.97 , $26.70 
" Pro CT Colonography Inc Image Process, Diagnostic, W/O Contrast ",CPT® 74261,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,641.00 "," $1,066.65 "," $1,258.37 ", $216.05 , $516.26 ," $2,316.80 "," $2,820.33 "," $1,526.13 "," $1,476.90 "," $1,476.90 "," $1,312.80 "," $1,312.80 ", $516.26 ," $1,515.14 "," $1,558.95 "," $1,476.90 "," $1,476.90 "," $1,476.90 "," $1,526.13 "," $1,575.36 "," $2,606.57 "," $1,394.85 "," $3,070.11 "," $3,154.64 ", N/A ," $2,362.00 "," $2,362.00 "," $1,558.95 "," $2,734.06 ", $216.05 ," $3,154.64 "
 Fac in Situ Hybridization Ea Multiplex Probe Stain ,CPT® 88366,0310 - PATHOLOGY LAB,N/A,N/A, $836.00 , $543.40 , $702.24 , $274.14 , $117.74 , $675.49 , $752.40 , $707.76 , $752.40 , $752.40 , $752.40 , $710.60 , $115.43 , $771.88 , $794.20 , $710.60 , $777.48 , $777.48 , $794.20 , $802.56 , $684.02 , $752.40 , $710.60 , $660.44 , N/A , $676.57 , $676.57 , $794.20 , $717.37 , $115.43 , $802.56 
 Fac Myocardial Perfusion Planar 1 Study Rest/Stress ,CPT® 78453,0340 - NUCLEAR MEDICINE,N/A,N/A," $2,520.00 "," $1,638.00 "," $2,116.80 ", $267.91 , $164.99 ," $2,036.16 "," $2,268.00 "," $2,133.43 "," $2,268.00 "," $2,268.00 "," $2,268.00 "," $2,142.00 ", $161.75 ," $2,326.72 "," $2,394.00 "," $2,142.00 "," $2,343.60 "," $2,343.60 "," $2,394.00 "," $2,419.20 "," $2,061.86 "," $2,268.00 "," $2,142.00 "," $1,990.80 ", N/A ," $2,039.44 "," $2,039.44 "," $2,394.00 "," $2,162.41 ", $161.75 ," $2,419.20 "
 CEFEPIME HCL 1 G IJ SOLR ,HCPCS J0692,0636 - DRUGS REQUIRING DETAILED CODIN,25021-0121-20,10 mL, $36.99 , $24.04 , $31.07 , $1.25 , $1.32 , $29.89 , $33.29 , $31.32 , $33.29 , $33.29 , $33.29 , $31.44 , $1.29 , $34.15 , $35.14 , $31.44 , $34.40 , $34.40 , $35.14 , $35.51 , $30.27 , $33.29 , $31.44 , $29.22 , N/A , $29.94 , $29.94 , $35.14 , $31.74 , $1.25 , $35.51 
Ndsc Eval Intstinal Pouch Dx W/Collj Spec Spx,CPT® 44385,N/A,N/A,N/A," $1,808.00 "," $1,175.20 ", $442.26 , $69.04 , $200.83 , $514.00 , $521.84 ," $1,681.44 "," $1,627.20 "," $1,627.20 "," $1,446.40 "," $1,446.40 ", $200.83 ," $1,669.33 "," $1,717.60 "," $1,627.20 "," $1,627.20 "," $1,627.20 "," $1,681.44 "," $1,735.68 ", $314.98 ," $1,536.80 ", $569.12 , $417.80 , N/A , $524.04 , $524.04 ," $1,717.60 ", $548.09 , $69.04 ," $1,735.68 "
Single Visn Sphere 4.12-7.00,HCPCS V2101,N/A,N/A,N/A, $55.00 , $35.75 , N/A , $52.05 , N/A , N/A , N/A , $51.15 , $49.50 , $49.50 , $44.00 , $44.00 , N/A , $50.78 , $52.25 , $49.50 , $49.50 , $49.50 , $51.15 , $52.80 , N/A , $46.75 , $55.00 , $47.29 , N/A , N/A , N/A , $52.25 , N/A , $44.00 , $55.00 
"Sleep Study, Unattended, Record Heart Rate/O2 Sat/Resp Anal/Sleep Time",CPT® 95800,N/A,N/A,N/A, $792.00 , $514.80 , $589.42 , $146.28 , $158.21 , $399.05 , $411.32 , $736.56 , $712.80 , $712.80 , $633.60 , $633.60 , $158.21 , $731.25 , $752.40 , $712.80 , $712.80 , $712.80 , $736.56 , $760.32 , $719.28 , $673.20 , $543.35 , $670.15 , N/A , $406.84 , $406.84 , $752.40 , $474.30 , $146.28 , $760.32 
Drainage of Hematoma/Fluid,10140,N/A,N/A,N/A, $667.00 , $433.55 , $379.44 , $113.59 , $45.35 , $324.24 , $318.38 , $620.31 , $600.30 , $600.30 , $533.60 , $533.60 , $45.35 , $615.84 , $633.65 , $600.30 , $600.30 , $600.30 , $620.31 , $640.32 , $417.24 , $566.95 , $629.77 , $417.61 , N/A , $330.56 , $330.56 , $633.65 , $383.34 , $45.35 , $640.32 
"GI Tract Imaging, Intraluminal",CPT® 91110,N/A,N/A,N/A," $4,138.00 "," $2,689.70 "," $1,830.46 ", $735.36 , $830.89 ," $2,416.32 "," $2,183.07 "," $3,848.34 "," $3,724.20 "," $3,724.20 "," $3,310.40 "," $3,310.40 ", $830.89 ," $3,820.62 "," $3,931.10 "," $3,724.20 "," $3,724.20 "," $3,724.20 "," $3,848.34 "," $3,972.48 "," $3,739.42 "," $3,517.30 "," $2,891.12 "," $3,433.56 ", N/A ," $2,463.47 "," $2,463.47 "," $3,931.10 "," $2,898.19 ", $735.36 ," $3,972.48 "
 Fluoro Guidance for Central Venous Access Dvice ,CPT® 77001,0320 - DX X-RAY,N/A,N/A, $851.00 , $553.15 , $714.84 , $98.73 , $67.21 , $687.61 , $765.90 , $720.46 , $765.90 , $765.90 , $765.90 , $723.35 , $65.89 , $785.73 , $808.45 , $723.35 , $791.43 , $791.43 , $808.45 , $816.96 , $696.29 , $765.90 , $723.35 , $672.29 , N/A , $688.71 , $688.71 , $808.45 , $730.24 , $65.89 , $816.96 
"Remove Foreign Body,Foot",CPT® 28190,N/A,N/A,N/A," $1,705.00 "," $1,108.25 ", $821.41 , $128.35 , $42.71 , $660.87 , $659.35 ," $1,585.65 "," $1,534.50 "," $1,534.50 "," $1,364.00 "," $1,364.00 ", $42.71 ," $1,574.23 "," $1,619.75 "," $1,534.50 "," $1,534.50 "," $1,534.50 "," $1,585.65 "," $1,636.80 ", $767.83 ," $1,449.25 ", $713.63 , $787.33 , N/A , $673.77 , $673.77 ," $1,619.75 ", $791.93 , $42.71 ," $1,636.80 "
 GLYBURIDE 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00093-9364-01,1 tablet, $4.00 , $2.60 , $3.36 , N/A , N/A , $3.23 , $3.60 , $3.39 , $3.60 , $3.60 , $3.60 , $3.40 , N/A , $3.69 , $3.80 , $3.40 , $3.72 , $3.72 , $3.80 , $3.84 , $3.27 , $3.60 , $3.40 , $3.16 , N/A , $3.24 , $3.24 , $3.80 , $3.43 , $3.16 , $3.84 
 NATALIZUMAB 300 MG/15ML IV CONC ,HCPCS J2323,0636 - DRUGS REQUIRING DETAILED CODIN,64406-0008-01,15 mL," $24,138.06 "," $15,689.74 "," $20,275.97 ", $25.36 , $24.47 ," $19,503.55 "," $21,724.25 "," $20,435.28 "," $21,724.25 "," $21,724.25 "," $21,724.25 "," $20,517.35 ", $23.99 ," $22,286.67 "," $22,931.16 "," $20,517.35 "," $22,448.40 "," $22,448.40 "," $22,931.16 "," $23,172.54 "," $19,749.76 "," $21,724.25 "," $20,517.35 "," $19,069.07 ", N/A ," $19,534.93 "," $19,534.93 "," $22,931.16 "," $20,712.87 ", $23.99 ," $23,172.54 "
 Fac Drug Screening Tramadol ,CPT® 80373,0301 - LAB/CHEMISTRY,N/A,N/A, $194.00 , $126.10 , $162.96 , N/A , N/A , $156.75 , $174.60 , $164.24 , $174.60 , $174.60 , $174.60 , $164.90 , N/A , $179.12 , $184.30 , $164.90 , $180.42 , $180.42 , $184.30 , $186.24 , $158.73 , $174.60 , $164.90 , $153.26 , N/A , $157.00 , $157.00 , $184.30 , $166.47 , $153.26 , $186.24 
"Create Eardrum Opening,Local Anesth",CPT® 69433,N/A,N/A,N/A," $1,156.00 ", $751.40 , $625.20 , $128.57 , $168.38 , $635.87 , $661.51 ," $1,075.08 "," $1,040.40 "," $1,040.40 ", $924.80 , $924.80 , $168.38 ," $1,067.33 "," $1,098.20 "," $1,040.40 "," $1,040.40 "," $1,040.40 "," $1,075.08 "," $1,109.76 ", $676.92 , $982.60 , $722.55 , $639.89 , N/A , $648.27 , $648.27 ," $1,098.20 ", $740.21 , $128.57 ," $1,109.76 "
"Omental Flap,Intra-Abdominal",CPT® 49905,N/A,N/A,N/A," $2,301.00 "," $1,495.65 "," $2,079.68 ", $321.91 , $702.90 ," $1,667.21 "," $1,662.36 "," $2,139.93 "," $2,070.90 "," $2,070.90 "," $1,840.80 "," $1,840.80 ", $702.90 ," $2,124.51 "," $2,185.95 "," $2,070.90 "," $2,070.90 "," $2,070.90 "," $2,139.93 "," $2,208.96 "," $1,496.61 "," $1,955.85 "," $1,844.72 "," $1,962.91 ", N/A ," $1,699.74 "," $1,699.74 "," $2,185.95 "," $1,777.74 ", $321.91 ," $2,208.96 "
Diaphragm,HCPCS A4266,N/A,N/A,N/A, $208.00 , $135.20 , N/A , N/A , $74.36 , N/A , N/A , $193.44 , $187.20 , $187.20 , $166.40 , $166.40 , $74.36 , $192.05 , $197.60 , $187.20 , $187.20 , $187.20 , $193.44 , $199.68 , N/A , $176.80 , $166.40 , N/A , N/A , N/A , N/A , $197.60 , N/A , $74.36 , $199.68 
 LIDOCAINE HCL (PF) 2 % IJ SOLN ,HCPCS RXA250,0250 - PHARMACY,55150-0165-05,5 mL, $18.50 , $12.03 , $15.54 , N/A , N/A , $14.95 , $16.65 , $15.66 , $16.65 , $16.65 , $16.65 , $15.73 , N/A , $17.08 , $17.58 , $15.73 , $17.21 , $17.21 , $17.58 , $17.76 , $15.14 , $16.65 , $15.73 , $14.62 , N/A , $14.97 , $14.97 , $17.58 , $15.87 , $14.62 , $17.76 
Cont Intraop Neuro Monitor,HCPCS G0453,N/A,N/A,N/A, $147.00 , $95.55 , $93.18 , $31.03 , N/A , $60.62 , N/A , $136.71 , $132.30 , $132.30 , $117.60 , $117.60 , N/A , $135.73 , $139.65 , $132.30 , $132.30 , $132.30 , $136.71 , $141.12 , $139.88 , $124.95 , $49.95 , $123.28 , N/A , $61.80 , $61.80 , $139.65 , $77.25 , $31.03 , $141.12 
 NICOTINE 7 MG/24HR TD PT24 ,HCPCS RXC637,0250 - PHARMACY,00536-5894-88,1 patch, $11.01 , $7.16 , $9.25 , N/A , N/A , $8.90 , $9.91 , $9.32 , $9.91 , $9.91 , $9.91 , $9.36 , N/A , $10.17 , $10.46 , $9.36 , $10.24 , $10.24 , $10.46 , $10.57 , $9.01 , $9.91 , $9.36 , $8.70 , N/A , $8.91 , $8.91 , $10.46 , $9.45 , $8.70 , $10.57 
Cytopathology-Filter Meth,CPT® 88106,N/A,N/A,N/A, $476.00 , $309.40 , $238.72 , $68.50 , $34.26 , $345.97 , $389.17 , $442.68 , $428.40 , $428.40 , $380.80 , $380.80 , $34.26 , $439.49 , $452.20 , $428.40 , $428.40 , $428.40 , $442.68 , $456.96 , $423.40 , $404.60 , $407.08 , $223.66 , N/A , $322.88 , $322.88 , $452.20 , $354.83 , $34.26 , $456.96 
Arthrodesis Pst/Pstlat Tq 1ntrspc Ea Addl Ntrspc,CPT® 22614,N/A,N/A,N/A," $2,709.00 "," $1,760.85 "," $2,245.10 ", $349.15 , $352.52 ," $1,871.35 "," $1,820.28 "," $2,519.37 "," $2,438.10 "," $2,438.10 "," $2,167.20 "," $2,167.20 ", $352.52 ," $2,501.22 "," $2,573.55 "," $2,438.10 "," $2,438.10 "," $2,438.10 "," $2,519.37 "," $2,600.64 "," $2,100.82 "," $2,302.65 "," $2,058.81 "," $2,156.96 ", N/A ," $1,907.86 "," $1,907.86 "," $2,573.55 "," $2,242.42 ", $349.15 ," $2,600.64 "
Active Wound Care/20 Cm or <,CPT® 97597,N/A,N/A,N/A, $230.00 , $149.50 , $82.90 , $34.49 , $43.20 , $54.44 , $46.92 , $213.90 , $207.00 , $207.00 , $184.00 , $184.00 , $43.20 , $212.36 , $218.50 , $207.00 , $207.00 , $207.00 , $213.90 , $220.80 , $109.43 , $195.50 , $69.95 , $54.53 , N/A , $55.50 , $55.50 , $218.50 , $61.73 , $34.49 , $220.80 
 Fac Assay of Ldh Enzymes ,CPT® 83625,0301 - LAB/CHEMISTRY,N/A,N/A, $164.00 , $106.60 , $137.76 , $13.05 , $13.05 , $132.51 , $147.60 , $138.84 , $147.60 , $147.60 , $147.60 , $139.40 , $12.79 , $151.42 , $155.80 , $139.40 , $152.52 , $152.52 , $155.80 , $157.44 , $134.18 , $147.60 , $139.40 , $129.56 , N/A , $132.73 , $132.73 , $155.80 , $140.73 , $12.79 , $157.44 
 Fac Amb 911 Base Rate Bls Emergent ,HCPCS A0429,0540 - AMBULANCE,N/A,N/A," $1,081.00 ", $702.65 , $908.04 , N/A , $344.49 , $873.45 , $972.90 , $915.17 , $972.90 , $972.90 , $972.90 , $918.85 , $337.74 , $998.09 ," $1,026.95 ", $918.85 ," $1,005.33 "," $1,005.33 "," $1,026.95 "," $1,037.76 ", $884.47 , $972.90 , $918.85 , $853.99 , N/A , $874.85 , $874.85 ," $1,026.95 ", $927.61 , $337.74 ," $1,037.76 "
 HEPATITIS B IMMUNE GLOBULIN 312 UNIT/ML IJ SOLN ,HCPCS J1571,0636 - DRUGS REQUIRING DETAILED CODIN,70257-0051-51,0.5 mL, $548.59 , $356.58 , $460.82 , $67.59 , $70.82 , $443.26 , $493.73 , $464.44 , $493.73 , $493.73 , $493.73 , $466.30 , $69.43 , $506.51 , $521.16 , $466.30 , $510.19 , $510.19 , $521.16 , $526.65 , $448.86 , $493.73 , $466.30 , $433.39 , N/A , $443.97 , $443.97 , $521.16 , $470.75 , $67.59 , $526.65 
 Fac Perq Breast Loc Device Placemt Ea Lesion Strtctc ,CPT® 19284,0361 - OR/MINOR,N/A,N/A," $2,392.00 "," $1,554.80 "," $2,009.28 ", $47.58 , $37.96 ," $1,932.74 "," $2,152.80 "," $2,025.07 "," $2,152.80 "," $2,152.80 "," $2,152.80 "," $2,033.20 ", $37.22 ," $2,208.53 "," $2,272.40 "," $2,033.20 "," $2,224.56 "," $2,224.56 "," $2,272.40 "," $2,296.32 "," $1,957.13 "," $2,152.80 "," $2,033.20 "," $1,889.68 ", N/A ," $1,935.85 "," $1,935.85 "," $2,272.40 "," $2,052.58 ", $37.22 ," $2,296.32 "
 Pro Est Pt Level 3 ,CPT® 99213,0982 - PRO FEE/OUTPT,N/A,N/A, $197.00 , $128.05 , $134.27 , $64.08 , $41.21 , $87.92 , $87.90 , $183.21 , $177.30 , $177.30 , $157.60 , $157.60 , $41.21 , $181.89 , $187.15 , $177.30 , $177.30 , $177.30 , $183.21 , $189.12 , $122.57 , $167.45 , $109.52 , $112.10 , $64.00 , $89.64 , $89.64 , $187.15 , $103.40 , $41.21 , $189.12 
Resec Cyst/Lesn Iris/Ciliary Body,CPT® 66770,N/A,N/A,N/A," $4,839.00 "," $3,145.35 "," $2,957.76 ", $465.12 , $461.04 ," $2,738.66 "," $2,515.53 "," $4,500.27 "," $4,355.10 "," $4,355.10 "," $3,871.20 "," $3,871.20 ", $461.04 ," $4,467.85 "," $4,597.05 "," $4,355.10 "," $4,355.10 "," $4,355.10 "," $4,500.27 "," $4,645.44 "," $4,067.00 "," $4,113.15 "," $2,553.00 "," $3,471.74 ", N/A ," $2,792.10 "," $2,792.10 "," $4,597.05 "," $3,082.13 ", $461.04 ," $4,645.44 "
 Fac Prq Transcatheter Rtrvl Intrvas FB With Imaging ,CPT® 37197,0361 - OR/MINOR,N/A,N/A," $6,763.00 "," $4,395.95 "," $5,680.92 ", $276.10 ," $1,507.49 "," $5,464.50 "," $6,086.70 "," $5,725.56 "," $6,086.70 "," $6,086.70 "," $6,086.70 "," $5,748.55 "," $1,477.93 "," $6,244.28 "," $6,424.85 "," $5,748.55 "," $6,289.59 "," $6,289.59 "," $6,424.85 "," $6,492.48 "," $5,533.49 "," $6,086.70 "," $5,748.55 "," $5,342.77 ", N/A ," $5,473.30 "," $5,473.30 "," $6,424.85 "," $5,803.33 ", $276.10 ," $6,492.48 "
Removal of Added Skin Tags,CPT® 11201,N/A,N/A,N/A, $149.00 , $96.85 , $52.16 , $15.71 , $15.36 , $45.31 , $43.98 , $138.57 , $134.10 , $134.10 , $119.20 , $119.20 , $15.36 , $137.57 , $141.55 , $134.10 , $134.10 , $134.10 , $138.57 , $143.04 , $57.50 , $126.65 , $87.42 , $59.64 , N/A , $46.20 , $46.20 , $141.55 , $53.57 , $15.36 , $143.04 
 LORAZEPAM 0.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6007-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Rpr Aa Hernia Recr < 3 Cm Reducible,CPT® 49613,N/A,N/A,N/A," $3,904.00 "," $2,537.60 ", N/A , $386.67 , $301.79 , N/A , N/A ," $3,630.72 "," $3,513.60 "," $3,513.60 "," $3,123.20 "," $3,123.20 ", $301.79 ," $3,604.56 "," $3,708.80 "," $3,513.60 "," $3,513.60 "," $3,513.60 "," $3,630.72 "," $3,747.84 ", N/A ," $3,318.40 "," $2,233.62 ", N/A , N/A ," $1,664.64 "," $1,664.64 "," $3,708.80 "," $1,742.73 ", $301.79 ," $3,747.84 "
Rpr Aa Hernia Recr < 3 Cm Ncrc8/Strangulated,CPT® 49614,N/A,N/A,N/A," $5,115.00 "," $3,324.75 ", N/A , $523.07 , $408.15 , N/A , N/A ," $4,756.95 "," $4,603.50 "," $4,603.50 "," $4,092.00 "," $4,092.00 ", $408.15 ," $4,722.68 "," $4,859.25 "," $4,603.50 "," $4,603.50 "," $4,603.50 "," $4,756.95 "," $4,910.40 ", N/A ," $4,347.75 "," $3,029.69 ", N/A , N/A ," $2,251.34 "," $2,251.34 "," $4,859.25 "," $2,356.96 ", $408.15 ," $4,910.40 "
 Fac Thyroglobulin Antibody ,CPT® 86800,0302 - LAB/IMMUNOLOGY,N/A,N/A, $147.00 , $95.55 , $123.48 , $16.23 , $16.23 , $118.78 , $132.30 , $124.45 , $132.30 , $132.30 , $132.30 , $124.95 , $15.91 , $135.73 , $139.65 , $124.95 , $136.71 , $136.71 , $139.65 , $141.12 , $120.28 , $132.30 , $124.95 , $116.13 , N/A , $118.97 , $118.97 , $139.65 , $126.14 , $15.91 , $141.12 
 Pro Prep Site T/a/L Addl 100 Sq Cm/1pct ,CPT® 15003,0982 - PRO FEE/OUTPT,N/A,N/A, $418.00 , $271.70 , $140.28 , $41.42 , $54.78 , $124.64 , $119.24 , $388.74 , $376.20 , $376.20 , $334.40 , $334.40 , $54.78 , $385.94 , $397.10 , $376.20 , $376.20 , $376.20 , $388.74 , $401.28 , $155.20 , $355.30 , $240.85 , $157.89 , N/A , $127.07 , $127.07 , $397.10 , $147.36 , $41.42 , $401.28 
Htt Gene Analysis Detect Abnormal Alleles,CPT® 81271,N/A,N/A,N/A, $977.00 , $635.05 , N/A , $139.74 , $111.79 , $569.57 , N/A , $908.61 , $879.30 , $879.30 , $781.60 , $781.60 , $111.79 , $902.06 , $928.15 , $879.30 , $879.30 , $879.30 , $908.61 , $937.92 , $914.78 , $830.45 , $652.61 , $402.37 , N/A , $531.56 , $531.56 , $928.15 , $580.88 , $111.79 , $937.92 
"Percut Implnt Neuroelect,Epidural",63650,N/A,N/A,N/A," $8,360.00 "," $5,434.00 "," $2,045.78 ", $397.89 , $366.89 ," $2,322.82 "," $2,361.96 "," $7,774.80 "," $7,524.00 "," $7,524.00 "," $6,688.00 "," $6,688.00 ", $366.89 ," $7,718.79 "," $7,942.00 "," $7,524.00 "," $7,524.00 "," $7,524.00 "," $7,774.80 "," $8,025.60 "," $2,220.52 "," $7,106.00 "," $2,301.44 "," $2,487.64 ", N/A ," $2,368.14 "," $2,368.14 "," $7,942.00 "," $2,540.46 ", $366.89 ," $8,025.60 "
 Pro Hystsc Bx Endometrium&/Polypc +-D&C ,CPT® 58558,0982 - PRO FEE/OUTPT,N/A,N/A," $2,752.00 "," $1,788.80 "," $1,075.35 ", $218.28 , $181.31 ," $1,086.05 "," $1,080.64 "," $2,559.36 "," $2,476.80 "," $2,476.80 "," $2,201.60 "," $2,201.60 ", $181.31 ," $2,540.92 "," $2,614.40 "," $2,476.80 "," $2,476.80 "," $2,476.80 "," $2,559.36 "," $2,641.92 "," $1,132.05 "," $2,339.20 "," $1,421.90 ", $962.97 , N/A ," $1,107.24 "," $1,107.24 "," $2,614.40 "," $1,328.05 ", $181.31 ," $2,641.92 "
"Clotting Function Activity Nos, Ea Analyt",CPT® 85397,N/A,N/A,N/A, $218.00 , $141.70 , N/A , $31.48 , $31.48 , $129.79 , $155.30 , $202.74 , $196.20 , $196.20 , $174.40 , $174.40 , $31.48 , $201.28 , $207.10 , $196.20 , $196.20 , $196.20 , $202.74 , $209.28 , $206.06 , $185.30 , $150.83 , $90.64 , N/A , $121.13 , $121.13 , $207.10 , $132.37 , $31.48 , $209.28 
Sternal Debridement,CPT® 21627,N/A,N/A,N/A," $3,662.00 "," $2,380.30 "," $3,276.91 ", $513.34 , $876.53 ," $2,612.06 "," $2,636.34 "," $3,405.66 "," $3,295.80 "," $3,295.80 "," $2,929.60 "," $2,929.60 ", $876.53 ," $3,381.12 "," $3,478.90 "," $3,295.80 "," $3,295.80 "," $3,295.80 "," $3,405.66 "," $3,515.52 "," $3,034.24 "," $3,112.70 "," $2,925.86 "," $3,043.08 ", N/A ," $2,663.02 "," $2,663.02 "," $3,478.90 "," $3,130.00 ", $513.34 ," $3,515.52 "
" Fac Russell Viper Venom, Diluted ",CPT® 85613,0305 - LAB/HEMATOLOGY,N/A,N/A, $141.00 , $91.65 , $118.44 , $9.77 , $9.77 , $113.93 , $126.90 , $119.37 , $126.90 , $126.90 , $126.90 , $119.85 , $9.58 , $130.19 , $133.95 , $119.85 , $131.13 , $131.13 , $133.95 , $135.36 , $115.37 , $126.90 , $119.85 , $111.39 , N/A , $114.11 , $114.11 , $133.95 , $120.99 , $9.58 , $135.36 
"Apply Cast,Finger-Elbow",29075,N/A,N/A,N/A, $595.00 , $386.75 , $373.23 , $59.32 , $54.80 , $299.54 , $303.79 , $553.35 , $535.50 , $535.50 , $476.00 , $476.00 , $54.80 , $549.36 , $565.25 , $535.50 , $535.50 , $535.50 , $553.35 , $571.20 , $349.50 , $505.75 , $333.62 , $357.56 , N/A , $305.39 , $305.39 , $565.25 , $358.95 , $54.80 , $571.20 
 Pro MRI Abd C+ Matrl ,CPT® 74182,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,150.00 ", $747.50 ," $2,190.93 ", $311.87 , $503.64 ," $2,162.27 "," $2,743.36 "," $1,069.50 "," $1,035.00 "," $1,035.00 ", $920.00 , $920.00 , $503.64 ," $1,061.80 "," $1,092.50 "," $1,035.00 "," $1,035.00 "," $1,035.00 "," $1,069.50 "," $1,104.00 "," $1,895.03 ", $977.50 ," $2,989.22 "," $3,535.59 ", N/A ," $2,204.47 "," $2,204.47 "," $1,092.50 "," $2,551.70 ", $311.87 ," $3,535.59 "
Inject Retrograde/Conduit X-Ray,CPT® 50690,N/A,N/A,N/A, $692.00 , $449.80 , $377.89 , $67.01 , $21.50 , $347.69 , $323.61 , $643.56 , $622.80 , $622.80 , $553.60 , $553.60 , $21.50 , $638.92 , $657.40 , $622.80 , $622.80 , $622.80 , $643.56 , $664.32 , $377.99 , $588.20 , $365.73 , $433.78 , N/A , $354.47 , $354.47 , $657.40 , $416.64 , $21.50 , $664.32 
"IV Infusion, Therap/Proph/Diagnost,Initial,1st Hour",CPT® 96365,N/A,N/A,N/A, $288.00 , $187.20 , $155.35 , $62.20 , $63.10 , $151.51 , $169.02 , $267.84 , $259.20 , $259.20 , $230.40 , $230.40 , $63.10 , $265.91 , $273.60 , $259.20 , $259.20 , $259.20 , $267.84 , $276.48 , $260.71 , $244.80 , $225.04 , $272.39 , N/A , $154.47 , $154.47 , $273.60 , $180.07 , $62.20 , $276.48 
 Glucose ,CPT® 82962,0301 - LAB/CHEMISTRY,N/A,N/A, $55.00 , $35.75 , $46.20 , $3.35 , $3.25 , $44.44 , $49.50 , $46.56 , $49.50 , $49.50 , $49.50 , $46.75 , $3.19 , $50.78 , $52.25 , $46.75 , $51.15 , $51.15 , $52.25 , $52.80 , $45.00 , $49.50 , $46.75 , $43.45 , N/A , $44.51 , $44.51 , $52.25 , $47.20 , $3.19 , $52.80 
" Pro CT Scan,Abdomen and Pelvis,W Contrast ",CPT® 74177,0972 - PRO FEE/RAD/DX,N/A,N/A, $986.00 , $640.90 ," $2,205.84 ", $313.11 , $252.11 ," $1,484.35 "," $1,762.67 ", $916.98 , $887.40 , $887.40 , $788.80 , $788.80 , $252.11 , $910.37 , $936.70 , $887.40 , $887.40 , $887.40 , $916.98 , $946.56 ," $1,837.67 ", $838.10 ," $1,979.97 "," $2,023.91 ", N/A ," $1,513.31 "," $1,513.31 ", $936.70 ," $1,751.68 ", $252.11 ," $2,205.84 "
 C Spine CT W/O-With Contrast ,CPT® 72127,0350 - CT SCAN,N/A,N/A," $4,067.00 "," $2,643.55 "," $3,416.28 ", $201.84 , $367.11 ," $3,286.14 "," $3,660.30 "," $3,443.12 "," $3,660.30 "," $3,660.30 "," $3,660.30 "," $3,456.95 ", $359.91 ," $3,755.06 "," $3,863.65 "," $3,456.95 "," $3,782.31 "," $3,782.31 "," $3,863.65 "," $3,904.32 "," $3,327.62 "," $3,660.30 "," $3,456.95 "," $3,212.93 ", N/A ," $3,291.42 "," $3,291.42 "," $3,863.65 "," $3,489.89 ", $201.84 ," $3,904.32 "
Assay Blood Pku,CPT® 84030,N/A,N/A,N/A, $57.00 , $37.05 , N/A , $5.61 , $5.61 , $31.10 , $37.22 , $53.01 , $51.30 , $51.30 , $45.60 , $45.60 , $5.61 , $52.63 , $54.15 , $51.30 , $51.30 , $51.30 , $53.01 , $54.72 , $36.72 , $48.45 , $35.68 , $19.94 , N/A , $29.02 , $29.02 , $54.15 , $31.72 , $5.61 , $54.72 
Change of Cystostomy Tube,51710,N/A,N/A,N/A, $895.00 , $581.75 , $428.61 , $75.87 , $125.78 , $392.45 , $365.81 , $832.35 , $805.50 , $805.50 , $716.00 , $716.00 , $125.78 , $826.35 , $850.25 , $805.50 , $805.50 , $805.50 , $832.35 , $859.20 , $429.64 , $760.75 , $413.90 , $492.61 , N/A , $400.11 , $400.11 , $850.25 , $470.28 , $75.87 , $859.20 
" Fac Immunoassay, Tumor, Ca 15-3 ",CPT® 86300,0302 - LAB/IMMUNOLOGY,N/A,N/A, $237.00 , $154.05 , $199.08 , $21.23 , $21.23 , $191.50 , $213.30 , $200.64 , $213.30 , $213.30 , $213.30 , $201.45 , $20.81 , $218.82 , $225.15 , $201.45 , $220.41 , $220.41 , $225.15 , $227.52 , $193.91 , $213.30 , $201.45 , $187.23 , N/A , $191.80 , $191.80 , $225.15 , $203.37 , $20.81 , $227.52 
 Fac Rpr Ctr Vad W/Subq Port/Pmp Ctr/Prph Insj Sit ,CPT® 36576,0761 - TREATMENT ROOM,N/A,N/A," $3,520.00 "," $2,288.00 "," $2,956.80 ", $171.05 , $417.84 ," $2,844.16 "," $3,168.00 "," $2,980.03 "," $3,168.00 "," $3,168.00 "," $3,168.00 "," $2,992.00 ", $409.65 ," $3,250.02 "," $3,344.00 "," $2,992.00 "," $3,273.60 "," $3,273.60 "," $3,344.00 "," $3,379.20 "," $2,880.06 "," $3,168.00 "," $2,992.00 "," $2,780.80 ", N/A ," $2,848.74 "," $2,848.74 "," $3,344.00 "," $3,020.51 ", $171.05 ," $3,379.20 "
 IBUPROFEN 600 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-5854-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Endoscopy Upper Small Intestine W/Biopsy,CPT® 44361,N/A,N/A,N/A," $1,176.00 ", $764.40 , $974.29 , $150.34 , $371.14 , $815.71 , $840.04 ," $1,093.68 "," $1,058.40 "," $1,058.40 ", $940.80 , $940.80 , $371.14 ," $1,085.80 "," $1,117.20 "," $1,058.40 "," $1,058.40 "," $1,058.40 "," $1,093.68 "," $1,128.96 ", $700.73 , $999.60 , $918.79 , $927.09 , N/A , $831.63 , $831.63 ," $1,117.20 ", $869.80 , $150.34 ," $1,128.96 "
Doppler Color Flow Velocity Map,CPT® 93325,N/A,N/A,N/A," $1,142.00 ", $742.30 , $151.39 , $23.10 , $70.32 , $139.55 , $108.94 ," $1,062.06 "," $1,027.80 "," $1,027.80 ", $913.60 , $913.60 , $70.32 ," $1,054.41 "," $1,084.90 "," $1,027.80 "," $1,027.80 "," $1,027.80 "," $1,062.06 "," $1,096.32 ", $153.91 , $970.70 , $105.26 , $154.33 , N/A , $142.27 , $142.27 ," $1,084.90 ", $157.73 , $23.10 ," $1,096.32 "
 SODIUM CHLORIDE 7 % INH NEBU ,HCPCS RXA250,0250 - PHARMACY,76204-0021-60,4 mL, $4.32 , $2.81 , $3.63 , N/A , N/A , $3.49 , $3.89 , $3.66 , $3.89 , $3.89 , $3.89 , $3.67 , N/A , $3.99 , $4.10 , $3.67 , $4.02 , $4.02 , $4.10 , $4.15 , $3.53 , $3.89 , $3.67 , $3.41 , N/A , $3.50 , $3.50 , $4.10 , $3.71 , $3.41 , $4.15 
 Fac Remvl Perm Pm Pls Gen W/Repl Plse Gen Mult Lead ,CPT® 33229,0360 - OR SERVICES,N/A,N/A," $9,319.00 "," $6,057.35 "," $7,827.96 ", $345.70 , $279.17 ," $7,529.75 "," $8,387.10 "," $7,889.47 "," $8,387.10 "," $8,387.10 "," $8,387.10 "," $7,921.15 ", $273.70 ," $8,604.23 "," $8,853.05 "," $7,921.15 "," $8,666.67 "," $8,666.67 "," $8,853.05 "," $8,946.24 "," $7,624.81 "," $8,387.10 "," $7,921.15 "," $7,362.01 ", N/A ," $7,541.87 "," $7,541.87 "," $8,853.05 "," $7,996.63 ", $273.70 ," $8,946.24 "
 IPILIMUMAB 50 MG/10ML IV SOLN ,HCPCS J9228,0636 - DRUGS REQUIRING DETAILED CODIN,00003-2327-11,10 mL," $24,596.28 "," $15,987.58 "," $20,660.88 ", $171.29 , $169.09 ," $19,873.79 "," $22,136.65 "," $20,823.21 "," $22,136.65 "," $22,136.65 "," $22,136.65 "," $20,906.84 ", $165.77 ," $22,709.75 "," $23,366.47 "," $20,906.84 "," $22,874.54 "," $22,874.54 "," $23,366.47 "," $23,612.43 "," $20,124.68 "," $22,136.65 "," $20,906.84 "," $19,431.06 ", N/A ," $19,905.77 "," $19,905.77 "," $23,366.47 "," $21,106.07 ", $165.77 ," $23,612.43 "
"Inject Nerv Blck,Sphenopalat Gangln",64505,N/A,N/A,N/A, $753.00 , $489.45 , $493.38 , $96.56 , $76.84 , $484.32 , $470.40 , $700.29 , $677.70 , $677.70 , $602.40 , $602.40 , $76.84 , $695.24 , $715.35 , $677.70 , $677.70 , $677.70 , $700.29 , $722.88 , $520.28 , $640.05 , $456.72 , $535.18 , N/A , $493.77 , $493.77 , $715.35 , $529.70 , $76.84 , $722.88 
" Fac Detect Agent Nos, Dna, Amp ",CPT® 87798,0306 - LAB/BACT-MICRO,N/A,N/A, $315.00 , $204.75 , $264.60 , $35.79 , $35.79 , $254.52 , $283.50 , $266.68 , $283.50 , $283.50 , $283.50 , $267.75 , $35.09 , $290.84 , $299.25 , $267.75 , $292.95 , $292.95 , $299.25 , $302.40 , $257.73 , $283.50 , $267.75 , $248.85 , N/A , $254.93 , $254.93 , $299.25 , $270.30 , $35.09 , $302.40 
 Pro X-Ray Exam of Skull ,CPT® 70250,0972 - PRO FEE/RAD/DX,N/A,N/A, $157.00 , $102.05 , $201.84 , $35.33 , $34.64 , $169.77 , $198.27 , $146.01 , $141.30 , $141.30 , $125.60 , $125.60 , $34.64 , $144.96 , $149.15 , $141.30 , $141.30 , $141.30 , $146.01 , $150.72 , $195.41 , $133.45 , $217.64 , $184.09 , N/A , $173.09 , $173.09 , $149.15 , $200.36 , $34.64 , $217.64 
"Cystoscopy,Resec Congen Mucosal Folds",CPT® 52400,N/A,N/A,N/A," $3,333.00 "," $2,166.45 "," $2,577.73 ", $453.40 , $689.23 ," $2,341.35 "," $2,176.48 "," $3,099.69 "," $2,999.70 "," $2,999.70 "," $2,666.40 "," $2,666.40 ", $689.23 ," $3,077.36 "," $3,166.35 "," $2,999.70 "," $2,999.70 "," $2,999.70 "," $3,099.69 "," $3,199.68 "," $2,586.84 "," $2,833.05 "," $2,463.79 "," $2,941.68 ", N/A ," $2,387.04 "," $2,387.04 "," $3,166.35 "," $2,805.62 ", $453.40 ," $3,199.68 "
 Fac Prtx RBC Antb Chem Agt/Drugs ,CPT® 86970,0300 - LABORATORY,N/A,N/A, $145.00 , $94.25 , $121.80 , N/A , N/A , $117.16 , $130.50 , $122.76 , $130.50 , $130.50 , $130.50 , $123.25 , N/A , $133.88 , $137.75 , $123.25 , $134.85 , $134.85 , $137.75 , $139.20 , $118.64 , $130.50 , $123.25 , $114.55 , N/A , $117.35 , $117.35 , $137.75 , $124.42 , $114.55 , $139.20 
 Fac Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/O Img Gdn ,CPT® 62320,0761 - TREATMENT ROOM,N/A,N/A," $1,167.00 ", $758.55 , $980.28 , $95.25 , $132.09 , $942.94 ," $1,050.30 ", $987.98 ," $1,050.30 "," $1,050.30 "," $1,050.30 ", $991.95 , $129.50 ," $1,077.49 "," $1,108.65 ", $991.95 ," $1,085.31 "," $1,085.31 "," $1,108.65 "," $1,120.32 ", $954.84 ," $1,050.30 ", $991.95 , $921.93 , N/A , $944.45 , $944.45 ," $1,108.65 "," $1,001.40 ", $95.25 ," $1,120.32 "
 Fac Tx Opn Xtnsr Foot/Toe Ea Tdn ,CPT® 28234,0761 - TREATMENT ROOM,N/A,N/A," $2,628.00 "," $1,708.20 "," $2,207.52 ", $261.45 , $61.48 ," $2,123.42 "," $2,365.20 "," $2,224.86 "," $2,365.20 "," $2,365.20 "," $2,365.20 "," $2,233.80 ", $60.27 ," $2,426.43 "," $2,496.60 "," $2,233.80 "," $2,444.04 "," $2,444.04 "," $2,496.60 "," $2,522.88 "," $2,150.23 "," $2,365.20 "," $2,233.80 "," $2,076.12 ", N/A ," $2,126.84 "," $2,126.84 "," $2,496.60 "," $2,255.09 ", $60.27 ," $2,522.88 "
" Fac Cortisol, Free ",CPT® 82530,0301 - LAB/CHEMISTRY,N/A,N/A, $314.00 , $204.10 , $263.76 , $17.04 , $17.04 , $253.71 , $282.60 , $265.83 , $282.60 , $282.60 , $282.60 , $266.90 , $16.71 , $289.92 , $298.30 , $266.90 , $292.02 , $292.02 , $298.30 , $301.44 , $256.91 , $282.60 , $266.90 , $248.06 , N/A , $254.12 , $254.12 , $298.30 , $269.44 , $16.71 , $301.44 
 TETRACAINE HCL 0.5 % OP SOLN ,HCPCS RXA250,0250 - PHARMACY,00065-0741-14,4 mL, $76.87 , $49.97 , $64.57 , N/A , N/A , $62.11 , $69.18 , $65.08 , $69.18 , $69.18 , $69.18 , $65.34 , N/A , $70.97 , $73.03 , $65.34 , $71.49 , $71.49 , $73.03 , $73.80 , $62.90 , $69.18 , $65.34 , $60.73 , N/A , $62.21 , $62.21 , $73.03 , $65.96 , $60.73 , $73.80 
 Fac Phospholipid Antibody ,CPT® 86148,0302 - LAB/IMMUNOLOGY,N/A,N/A, $114.00 , $74.10 , $95.76 , $16.39 , $8.07 , $92.11 , $102.60 , $96.51 , $102.60 , $102.60 , $102.60 , $96.90 , $7.91 , $105.26 , $108.30 , $96.90 , $106.02 , $106.02 , $108.30 , $109.44 , $93.27 , $102.60 , $96.90 , $90.06 , N/A , $92.26 , $92.26 , $108.30 , $97.82 , $7.91 , $109.44 
 Skeletal Survey Child or Adult ,CPT® 77075,0320 - DX X-RAY,N/A,N/A, $899.00 , $584.35 , $755.16 , $98.14 , $72.60 , $726.39 , $809.10 , $761.09 , $809.10 , $809.10 , $809.10 , $764.15 , $71.18 , $830.05 , $854.05 , $764.15 , $836.07 , $836.07 , $854.05 , $863.04 , $735.56 , $809.10 , $764.15 , $710.21 , N/A , $727.56 , $727.56 , $854.05 , $771.43 , $71.18 , $863.04 
 Thyroid Tc99m per Mci- CAH ,HCPCS A9512,0343 - DIAGNOSTIC RADIOPHARMACEUTICALS,N/A,N/A, $28.00 , $18.20 , $23.52 , $22.42 , $3.06 , $22.62 , $25.20 , $23.70 , $25.20 , $25.20 , $25.20 , $23.80 , $3.00 , $25.85 , $26.60 , $23.80 , $26.04 , $26.04 , $26.60 , $26.88 , $22.91 , $25.20 , $23.80 , $22.12 , N/A , $22.66 , $22.66 , $26.60 , $24.03 , $3.00 , $26.88 
 Brain MRI Without Contrast ,CPT® 70551,0611 - MRI - BRAIN/HEAD/NECK,N/A,N/A," $4,256.00 "," $2,766.40 "," $3,575.04 ", $200.99 , $418.18 ," $3,438.85 "," $3,830.40 "," $3,603.13 "," $3,830.40 "," $3,830.40 "," $3,830.40 "," $3,617.60 ", $409.98 ," $3,929.56 "," $4,043.20 "," $3,617.60 "," $3,958.08 "," $3,958.08 "," $4,043.20 "," $4,085.76 "," $3,482.26 "," $3,830.40 "," $3,617.60 "," $3,362.24 ", N/A ," $3,444.38 "," $3,444.38 "," $4,043.20 "," $3,652.07 ", $200.99 ," $4,085.76 "
" Drainage of Abscess of Mouth, Simple -Mh ",CPT® 40800,0761 - TREATMENT ROOM,N/A,N/A," $1,260.00 ", $819.00 ," $1,058.40 ", $115.73 , $30.71 ," $1,018.08 "," $1,134.00 "," $1,066.72 "," $1,134.00 "," $1,134.00 "," $1,134.00 "," $1,071.00 ", $30.11 ," $1,163.36 "," $1,197.00 "," $1,071.00 "," $1,171.80 "," $1,171.80 "," $1,197.00 "," $1,209.60 "," $1,030.93 "," $1,134.00 "," $1,071.00 ", $995.40 , N/A ," $1,019.72 "," $1,019.72 "," $1,197.00 "," $1,081.21 ", $30.11 ," $1,209.60 "
Layer Closure 30+Cm,CPT® 12057,N/A,N/A,N/A," $2,283.00 "," $1,483.95 "," $1,325.83 ", $397.09 , $549.47 ," $1,031.80 "," $1,005.38 "," $2,123.19 "," $2,054.70 "," $2,054.70 "," $1,826.40 "," $1,826.40 ", $549.47 ," $2,107.89 "," $2,168.85 "," $2,054.70 "," $2,054.70 "," $2,054.70 "," $2,123.19 "," $2,191.68 "," $1,465.17 "," $1,940.55 "," $1,992.80 "," $1,504.54 ", N/A ," $1,051.93 "," $1,051.93 "," $2,168.85 "," $1,219.89 ", $397.09 ," $2,191.68 "
"Revision of Scrotum,Simple",CPT® 55175,N/A,N/A,N/A," $1,994.00 "," $1,296.10 "," $1,621.12 ", $350.38 , $414.64 ," $1,163.56 "," $1,183.05 "," $1,854.42 "," $1,794.60 "," $1,794.60 "," $1,595.20 "," $1,595.20 ", $414.64 ," $1,841.06 "," $1,894.30 "," $1,794.60 "," $1,794.60 "," $1,794.60 "," $1,854.42 "," $1,914.24 "," $1,519.71 "," $1,694.90 "," $1,887.54 "," $1,760.51 ", N/A ," $1,186.27 "," $1,186.27 "," $1,894.30 "," $1,421.79 ", $350.38 ," $1,914.24 "
" Laceration Repair Trunk, Ext Simple 12.6-20 Cm - Mh ",CPT® 12005,0761 - TREATMENT ROOM,N/A,N/A, $578.00 , $375.70 , $485.52 , $87.55 , $142.50 , $467.02 , $520.20 , $489.33 , $520.20 , $520.20 , $520.20 , $491.30 , $139.71 , $533.67 , $549.10 , $491.30 , $537.54 , $537.54 , $549.10 , $554.88 , $472.92 , $520.20 , $491.30 , $456.62 , N/A , $467.78 , $467.78 , $549.10 , $495.98 , $87.55 , $554.88 
Prgrmg Dev Eval 1 Lead Pm/Ldls Pm 1 Car Chmbr IP,93279,N/A,N/A,N/A, $648.00 , $421.20 , $438.49 , $67.13 , $42.62 , $269.26 , $278.80 , $602.64 , $583.20 , $583.20 , $518.40 , $518.40 , $42.62 , $598.30 , $615.60 , $583.20 , $583.20 , $583.20 , $602.64 , $622.08 , $408.55 , $550.80 , $260.47 , $187.91 , N/A , $274.52 , $274.52 , $615.60 , $304.30 , $42.62 , $622.08 
" Fac Hbot, Full Body Chamber, 30m ",HCPCS G0277,0413 - HYPERBARIC OXYGEN,N/A,N/A, $900.00 , $585.00 , $756.00 , $166.37 , $36.60 , $727.20 , $810.00 , $761.94 , $810.00 , $810.00 , $810.00 , $765.00 , $35.88 , $830.97 , $855.00 , $765.00 , $837.00 , $837.00 , $855.00 , $864.00 , $736.38 , $810.00 , $765.00 , $711.00 , N/A , $728.37 , $728.37 , $855.00 , $772.29 , $35.88 , $864.00 
 Fac Assay of Lipoprotein(A) ,CPT® 83695,0301 - LAB/CHEMISTRY,N/A,N/A, $119.00 , $77.35 , $99.96 , $14.61 , $14.61 , $96.15 , $107.10 , $100.75 , $107.10 , $107.10 , $107.10 , $101.15 , $14.32 , $109.87 , $113.05 , $101.15 , $110.67 , $110.67 , $113.05 , $114.24 , $97.37 , $107.10 , $101.15 , $94.01 , N/A , $96.31 , $96.31 , $113.05 , $102.11 , $14.32 , $114.24 
"Reconstruc Hip Socket,Resec Fem Head",CPT® 27122,N/A,N/A,N/A," $7,035.00 "," $4,572.75 "," $6,670.56 "," $1,042.28 ", $969.07 ," $5,299.43 "," $5,259.86 "," $6,542.55 "," $6,331.50 "," $6,331.50 "," $5,628.00 "," $5,628.00 ", $969.07 ," $6,495.42 "," $6,683.25 "," $6,331.50 "," $6,331.50 "," $6,331.50 "," $6,542.55 "," $6,753.60 "," $6,204.73 "," $5,979.75 "," $5,817.83 "," $6,242.87 ", N/A ," $5,402.83 "," $5,402.83 "," $6,683.25 "," $6,350.25 ", $969.07 ," $6,753.60 "
 BUPROPION HCL ER (XL) 300 MG PO TB24 ,HCPCS RXC637,0250 - PHARMACY,00904-6573-04,1 tablet, $14.36 , $9.33 , $12.06 , N/A , N/A , $11.60 , $12.92 , $12.16 , $12.92 , $12.92 , $12.92 , $12.21 , N/A , $13.26 , $13.64 , $12.21 , $13.35 , $13.35 , $13.64 , $13.79 , $11.75 , $12.92 , $12.21 , $11.34 , N/A , $11.62 , $11.62 , $13.64 , $12.32 , $11.34 , $13.79 
"Laryngoscopy,Direct,Diagnostic",31525,N/A,N/A,N/A," $1,162.00 ", $755.30 , $859.34 , $152.06 , $303.22 , $615.92 , $602.47 ," $1,080.66 "," $1,045.80 "," $1,045.80 ", $929.60 , $929.60 , $303.22 ," $1,072.87 "," $1,103.90 "," $1,045.80 "," $1,045.80 "," $1,045.80 "," $1,080.66 "," $1,115.52 ", $821.76 , $987.70 , $849.21 , $812.19 , N/A , $627.94 , $627.94 ," $1,103.90 ", $739.55 , $152.06 ," $1,115.52 "
 Renogram (Flow/Function) With Lasix ,CPT® 78708,0340 - NUCLEAR MEDICINE,N/A,N/A," $1,238.00 ", $804.70 ," $1,039.92 ", $171.08 , $177.99 ," $1,000.30 "," $1,114.20 "," $1,048.09 "," $1,114.20 "," $1,114.20 "," $1,114.20 "," $1,052.30 ", $174.50 ," $1,143.05 "," $1,176.10 "," $1,052.30 "," $1,151.34 "," $1,151.34 "," $1,176.10 "," $1,188.48 "," $1,012.93 "," $1,114.20 "," $1,052.30 ", $978.02 , N/A ," $1,001.91 "," $1,001.91 "," $1,176.10 "," $1,062.33 ", $171.08 ," $1,188.48 "
Burr Hole Implant Cath/Device,CPT® 61210,N/A,N/A,N/A," $2,643.00 "," $1,717.95 "," $1,637.58 ", $319.29 ," $1,907.70 "," $1,985.02 "," $1,871.23 "," $2,457.99 "," $2,378.70 "," $2,378.70 "," $2,114.40 "," $2,114.40 "," $1,907.70 "," $2,440.28 "," $2,510.85 "," $2,378.70 "," $2,378.70 "," $2,378.70 "," $2,457.99 "," $2,537.28 "," $1,777.53 "," $2,246.55 "," $1,937.49 "," $2,043.11 ", N/A ," $2,023.76 "," $2,023.76 "," $2,510.85 "," $2,171.02 ", $319.29 ," $2,537.28 "
" Pro Wnd Prep, Ch/Inf, Trk/Arm/Lg ",CPT® 15002,0982 - PRO FEE/OUTPT,N/A,N/A," $1,756.00 "," $1,141.40 ", $690.40 , $205.46 , $247.27 , $617.89 , $603.46 ," $1,633.08 "," $1,580.40 "," $1,580.40 "," $1,404.80 "," $1,404.80 ", $247.27 ," $1,621.31 "," $1,668.20 "," $1,580.40 "," $1,580.40 "," $1,580.40 "," $1,633.08 "," $1,685.76 ", $763.53 ," $1,492.60 "," $1,209.60 ", $785.12 , N/A , $629.94 , $629.94 ," $1,668.20 ", $730.51 , $205.46 ," $1,685.76 "
 Fac Somatostatin ,CPT® 84307,0301 - LAB/CHEMISTRY,N/A,N/A, $309.00 , $200.85 , $259.56 , $18.65 , $12.32 , $249.67 , $278.10 , $261.60 , $278.10 , $278.10 , $278.10 , $262.65 , $12.08 , $285.30 , $293.55 , $262.65 , $287.37 , $287.37 , $293.55 , $296.64 , $252.82 , $278.10 , $262.65 , $244.11 , N/A , $250.07 , $250.07 , $293.55 , $265.15 , $12.08 , $296.64 
 Pro Cltx Iphal Jt Dislc W/O Anes ,CPT® 28660,0981 - PRO FEE/ER,N/A,N/A, $613.00 , $398.45 , $565.96 , $89.32 , $69.38 , $431.41 , $434.98 , $570.09 , $551.70 , $551.70 , $490.40 , $490.40 , $69.38 , $565.98 , $582.35 , $551.70 , $551.70 , $551.70 , $570.09 , $588.48 , $522.51 , $521.05 , $476.35 , $510.98 , N/A , $439.83 , $439.83 , $582.35 , $516.96 , $69.38 , $588.48 
 DORZOLAMIDE HCL 2 % OP SOLN ,HCPCS RXC637,0250 - PHARMACY,61314-0019-10,10 mL, $342.89 , $222.88 , $288.03 , N/A , N/A , $277.06 , $308.60 , $290.29 , $308.60 , $308.60 , $308.60 , $291.46 , N/A , $316.59 , $325.75 , $291.46 , $318.89 , $318.89 , $325.75 , $329.17 , $280.55 , $308.60 , $291.46 , $270.88 , N/A , $277.50 , $277.50 , $325.75 , $294.23 , $270.88 , $329.17 
 Pro Treat Finger Dislocation ,CPT® 26775,0982 - PRO FEE/OUTPT,N/A,N/A," $2,366.00 "," $1,537.90 "," $2,190.89 ", $348.94 , $96.07 ," $1,665.79 "," $1,696.44 "," $2,200.38 "," $2,129.40 "," $2,129.40 "," $1,892.80 "," $1,892.80 ", $96.07 ," $2,184.53 "," $2,247.70 "," $2,129.40 "," $2,129.40 "," $2,129.40 "," $2,200.38 "," $2,271.36 "," $2,017.00 "," $2,011.10 "," $1,860.78 "," $1,975.65 ", N/A ," $1,698.29 "," $1,698.29 "," $2,247.70 "," $1,996.10 ", $96.07 ," $2,271.36 "
 Pro Exc Face-Mm B9+Marg 0.5 < Cm ,CPT® 11440,0982 - PRO FEE/OUTPT,N/A,N/A, $547.00 , $355.55 , $341.29 , $103.49 , $82.89 , $281.15 , $281.65 , $508.71 , $492.30 , $492.30 , $437.60 , $437.60 , $82.89 , $505.05 , $519.65 , $492.30 , $492.30 , $492.30 , $508.71 , $525.12 , $369.08 , $464.95 , $558.41 , $365.26 , N/A , $286.63 , $286.63 , $519.65 , $332.38 , $82.89 , $558.41 
"Removal Anal Fistula,Submuscular",CPT® 46275,N/A,N/A,N/A," $3,501.00 "," $2,275.65 "," $2,603.19 ", $405.18 , $614.70 ," $1,969.92 "," $2,024.42 "," $3,255.93 "," $3,150.90 "," $3,150.90 "," $2,800.80 "," $2,800.80 ", $614.70 ," $3,232.47 "," $3,325.95 "," $3,150.90 "," $3,150.90 "," $3,150.90 "," $3,255.93 "," $3,360.96 "," $1,851.76 "," $2,975.85 "," $2,226.51 "," $2,352.03 ", N/A ," $2,008.35 "," $2,008.35 "," $3,325.95 "," $2,100.52 ", $405.18 ," $3,360.96 "
X-Ray Hysterosalpingogram,CPT® 74740,N/A,N/A,N/A, $570.00 , $370.50 , $556.39 , $94.56 , $72.27 , $357.36 , $411.32 , $530.10 , $513.00 , $513.00 , $456.00 , $456.00 , $72.27 , $526.28 , $541.50 , $513.00 , $513.00 , $513.00 , $530.10 , $547.20 , $539.23 , $484.50 , $448.77 , $377.44 , N/A , $364.33 , $364.33 , $541.50 , $421.71 , $72.27 , $556.39 
 Fac GI Tract Imaging Intraluminal Colon I&R ,CPT® 91113,0750 - GASTR-INST SVS,N/A,N/A," $4,241.00 "," $2,756.65 "," $3,562.44 ", $900.37 , $830.89 ," $3,426.73 "," $3,816.90 "," $3,590.43 "," $3,816.90 "," $3,816.90 "," $3,816.90 "," $3,604.85 ", $814.60 ," $3,915.72 "," $4,028.95 "," $3,604.85 "," $3,944.13 "," $3,944.13 "," $4,028.95 "," $4,071.36 "," $3,469.99 "," $3,816.90 "," $3,604.85 "," $3,350.39 ", N/A ," $3,432.24 "," $3,432.24 "," $4,028.95 "," $3,639.20 ", $814.60 ," $4,071.36 "
" Fac PR Program Eval Implant Device,Pacemaker,Mult Lead ",CPT® 93281,0480 - CARDIOLOGY,N/A,N/A, $410.00 , $266.50 , $344.40 , $83.77 , $59.19 , $331.28 , $369.00 , $347.11 , $369.00 , $369.00 , $369.00 , $348.50 , $58.03 , $378.55 , $389.50 , $348.50 , $381.30 , $381.30 , $389.50 , $393.60 , $335.46 , $369.00 , $348.50 , $323.90 , N/A , $331.81 , $331.81 , $389.50 , $351.82 , $58.03 , $393.60 
 KCL IN DEXTROSE-NACL 10-5-0.45 MEQ/L-%-% IV SOLN ,HCPCS RXA258,0258 - IV SOLUTIONS,00990-7993-09,"1,000 mL", $106.42 , $69.17 , $89.39 , N/A , N/A , $85.99 , $95.78 , $90.10 , $95.78 , $95.78 , $95.78 , $90.46 , N/A , $98.26 , $101.10 , $90.46 , $98.97 , $98.97 , $101.10 , $102.16 , $87.07 , $95.78 , $90.46 , $84.07 , N/A , $86.13 , $86.13 , $101.10 , $91.32 , $84.07 , $102.16 
Njx Aa&/Strd Tfrml Epi Lumbar/Sacral Ea Addl,64484,N/A,N/A,N/A, $536.00 , $348.40 , $254.80 , $49.44 , $119.93 , $294.25 , $285.73 , $498.48 , $482.40 , $482.40 , $428.80 , $428.80 , $119.93 , $494.89 , $509.20 , $482.40 , $482.40 , $482.40 , $498.48 , $514.56 , $278.36 , $455.60 , $276.53 , $315.01 , N/A , $299.99 , $299.99 , $509.20 , $321.80 , $49.44 , $514.56 
 Fac Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw ,CPT® 72081,0320 - DX X-RAY,N/A,N/A, $365.00 , $237.25 , $306.60 , $42.04 , $30.44 , $294.92 , $328.50 , $309.01 , $328.50 , $328.50 , $328.50 , $310.25 , $29.84 , $337.00 , $346.75 , $310.25 , $339.45 , $339.45 , $346.75 , $350.40 , $298.64 , $328.50 , $310.25 , $288.35 , N/A , $295.39 , $295.39 , $346.75 , $313.21 , $29.84 , $350.40 
 ROPIVACAINE HCL 5 MG/ML IJ SOLN ,HCPCS J2795,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0286-35,30 mL, $173.99 , $113.09 , $146.15 , $0.07 , $0.08 , $140.58 , $156.59 , $147.30 , $156.59 , $156.59 , $156.59 , $147.89 , $0.08 , $160.64 , $165.29 , $147.89 , $161.81 , $161.81 , $165.29 , $167.03 , $142.36 , $156.59 , $147.89 , $137.45 , N/A , $140.81 , $140.81 , $165.29 , $149.30 , $0.07 , $167.03 
Appendectomy,CPT® 44950,N/A,N/A,N/A," $5,291.00 "," $3,439.15 "," $3,828.96 ", $593.06 , $549.85 ," $3,014.59 "," $3,043.40 "," $4,920.63 "," $4,761.90 "," $4,761.90 "," $4,232.80 "," $4,232.80 ", $549.85 ," $4,885.18 "," $5,026.45 "," $4,761.90 "," $4,761.90 "," $4,761.90 "," $4,920.63 "," $5,079.36 "," $2,744.68 "," $4,497.35 "," $3,386.15 "," $3,555.69 ", N/A ," $3,073.42 "," $3,073.42 "," $5,026.45 "," $3,214.46 ", $549.85 ," $5,079.36 "
"Fusion Big Toe,I-P Joint",CPT® 28755,N/A,N/A,N/A," $3,399.00 "," $2,209.35 "," $2,070.12 ", $323.73 , $230.52 ," $1,623.04 "," $1,617.93 "," $3,161.07 "," $3,059.10 "," $3,059.10 "," $2,719.20 "," $2,719.20 ", $230.52 ," $3,138.30 "," $3,229.05 "," $3,059.10 "," $3,059.10 "," $3,059.10 "," $3,161.07 "," $3,263.04 "," $1,919.32 "," $2,889.15 "," $1,755.52 "," $1,936.57 ", N/A ," $1,654.70 "," $1,654.70 "," $3,229.05 "," $1,944.86 ", $230.52 ," $3,263.04 "
 Fac Drug Screen Quant Amphetamines 1 or 2 ,CPT® 80324,0301 - LAB/CHEMISTRY,N/A,N/A, $185.00 , $120.25 , $155.40 , N/A , N/A , $149.48 , $166.50 , $156.62 , $166.50 , $166.50 , $166.50 , $157.25 , N/A , $170.81 , $175.75 , $157.25 , $172.05 , $172.05 , $175.75 , $177.60 , $151.37 , $166.50 , $157.25 , $146.15 , N/A , $149.72 , $149.72 , $175.75 , $158.75 , $146.15 , $177.60 
 Fac Ercp Remove Foreign Body/Stent Biliary/Panc Duct ,CPT® 43275,0360 - OR SERVICES,N/A,N/A," $4,906.00 "," $3,188.90 "," $4,121.04 ", $355.69 , $299.58 ," $3,964.05 "," $4,415.40 "," $4,153.42 "," $4,415.40 "," $4,415.40 "," $4,415.40 "," $4,170.10 ", $293.71 ," $4,529.71 "," $4,660.70 "," $4,170.10 "," $4,562.58 "," $4,562.58 "," $4,660.70 "," $4,709.76 "," $4,014.09 "," $4,415.40 "," $4,170.10 "," $3,875.74 ", N/A ," $3,970.43 "," $3,970.43 "," $4,660.70 "," $4,209.84 ", $293.71 ," $4,709.76 "
US Lmtd Jt/Fcl Eval Nonvasc Xtr Strux R-T W/Img,76882,N/A,N/A,N/A, $277.00 , $180.05 , $317.55 , $41.46 , $22.10 , $173.77 , $182.06 , $257.61 , $249.30 , $249.30 , $221.60 , $221.60 , $22.10 , $255.75 , $263.15 , $249.30 , $249.30 , $249.30 , $257.61 , $265.92 , $312.59 , $235.45 , $200.31 , $323.37 , N/A , $177.15 , $177.15 , $263.15 , $205.07 , $22.10 , $323.37 
"Removal Esophagus,No Thoracotomy",CPT® 43107,N/A,N/A,N/A," $18,821.00 "," $12,233.65 "," $17,436.19 "," $2,700.97 "," $2,229.75 "," $12,055.31 "," $12,075.49 "," $17,503.53 "," $16,938.90 "," $16,938.90 "," $15,056.80 "," $15,056.80 "," $2,229.75 "," $17,377.43 "," $17,879.95 "," $16,938.90 "," $16,938.90 "," $16,938.90 "," $17,503.53 "," $18,068.16 "," $12,566.68 "," $15,997.85 "," $13,498.23 "," $16,461.80 ", N/A ," $12,290.53 "," $12,290.53 "," $17,879.95 "," $12,854.59 "," $2,229.75 "," $18,068.16 "
Ascend Aorta Grft,CPT® 33860,N/A,N/A,N/A," $20,753.00 "," $13,489.45 ", N/A , N/A , N/A , N/A ," $13,598.06 "," $19,300.29 "," $18,677.70 "," $18,677.70 "," $16,602.40 "," $16,602.40 ", N/A ," $19,161.24 "," $19,715.35 "," $18,677.70 "," $18,677.70 "," $18,677.70 "," $19,300.29 "," $19,922.88 ", N/A ," $17,640.05 ", N/A , N/A , N/A , N/A , N/A ," $19,715.35 ", N/A ," $13,598.06 "," $19,922.88 "
"Smear,Stain,Wet Mnt,Interp",CPT® 87210,N/A,N/A,N/A, $66.00 , $42.90 , N/A , $5.94 , $5.93 , $24.15 , $28.90 , $61.38 , $59.40 , $59.40 , $52.80 , $52.80 , $5.93 , $60.94 , $62.70 , $59.40 , $59.40 , $59.40 , $61.38 , $63.36 , $38.86 , $56.10 , $27.57 , $17.06 , N/A , $22.54 , $22.54 , $62.70 , $24.63 , $5.93 , $63.36 
"Anoscopy,FB Removal",CPT® 46608,N/A,N/A,N/A," $1,560.00 "," $1,014.00 ", $498.75 , $77.52 , $60.48 , $396.14 , $392.69 ," $1,450.80 "," $1,404.00 "," $1,404.00 "," $1,248.00 "," $1,248.00 ", $60.48 ," $1,440.35 "," $1,482.00 "," $1,404.00 "," $1,404.00 "," $1,404.00 "," $1,450.80 "," $1,497.60 ", $356.23 ," $1,326.00 ", $433.53 , $465.58 , N/A , $403.86 , $403.86 ," $1,482.00 ", $422.41 , $60.48 ," $1,497.60 "
" Fac Thromboplastin Time, Partial ",CPT® 85732,0305 - LAB/HEMATOLOGY,N/A,N/A, $118.00 , $76.70 , $99.12 , $6.60 , $6.60 , $95.34 , $106.20 , $99.90 , $106.20 , $106.20 , $106.20 , $100.30 , $6.47 , $108.95 , $112.10 , $100.30 , $109.74 , $109.74 , $112.10 , $113.28 , $96.55 , $106.20 , $100.30 , $93.22 , N/A , $95.50 , $95.50 , $112.10 , $101.26 , $6.47 , $113.28 
"CT Scan,Limited/Localized F/U Study",CPT® 76380,N/A,N/A,N/A," $2,440.00 "," $1,586.00 ", $857.85 , $128.55 , $157.47 , $697.54 , $874.33 ," $2,269.20 "," $2,196.00 "," $2,196.00 "," $1,952.00 "," $1,952.00 ", $157.47 ," $2,252.85 "," $2,318.00 "," $2,196.00 "," $2,196.00 "," $2,196.00 "," $2,269.20 "," $2,342.40 ", $790.90 ," $2,074.00 ", $949.54 , $941.75 , N/A , $711.15 , $711.15 ," $2,318.00 ", $823.18 , $128.55 ," $2,342.40 "
" Amputation; Thigh, Through Femur; Reamputation ",CPT® 27596,0360 - OR SERVICES,N/A,N/A," $5,164.00 "," $3,356.60 "," $4,337.76 ", $662.11 , $647.94 ," $4,172.51 "," $4,647.60 "," $4,371.84 "," $4,647.60 "," $4,647.60 "," $4,647.60 "," $4,389.40 ", $635.24 ," $4,767.92 "," $4,905.80 "," $4,389.40 "," $4,802.52 "," $4,802.52 "," $4,905.80 "," $4,957.44 "," $4,225.18 "," $4,647.60 "," $4,389.40 "," $4,079.56 ", N/A ," $4,179.23 "," $4,179.23 "," $4,905.80 "," $4,431.23 ", $635.24 ," $4,957.44 "
"Neg Press Wound Tx, < 50 Cm",CPT® 97605,N/A,N/A,N/A, $205.00 , $133.25 , $58.68 , $24.70 , $29.41 , $60.43 , $51.61 , $190.65 , $184.50 , $184.50 , $164.00 , $164.00 , $29.41 , $189.28 , $194.75 , $184.50 , $184.50 , $184.50 , $190.65 , $196.80 , $77.95 , $174.25 , $78.06 , $59.41 , N/A , $61.61 , $61.61 , $194.75 , $68.53 , $24.70 , $196.80 
" IR Cannulation, Thoracic Lymph Duct ",CPT® 38794,0360 - OR SERVICES,N/A,N/A," $1,422.00 ", $924.30 ," $1,194.48 ", $268.98 , $216.82 ," $1,148.98 "," $1,279.80 "," $1,203.87 "," $1,279.80 "," $1,279.80 "," $1,279.80 "," $1,208.70 ", $212.57 ," $1,312.93 "," $1,350.90 "," $1,208.70 "," $1,322.46 "," $1,322.46 "," $1,350.90 "," $1,365.12 "," $1,163.48 "," $1,279.80 "," $1,208.70 "," $1,123.38 ", N/A ," $1,150.82 "," $1,150.82 "," $1,350.90 "," $1,220.22 ", $212.57 ," $1,365.12 "
Amputation Finger/Thumb,CPT® 26951,N/A,N/A,N/A," $4,285.00 "," $2,785.25 "," $4,394.59 ", $685.79 , $230.52 ," $3,103.57 "," $3,158.66 "," $3,985.05 "," $3,856.50 "," $3,856.50 "," $3,428.00 "," $3,428.00 ", $230.52 ," $3,956.34 "," $4,070.75 "," $3,856.50 "," $3,856.50 "," $3,856.50 "," $3,985.05 "," $4,113.60 "," $4,014.84 "," $3,642.25 "," $3,461.08 "," $3,699.99 ", N/A ," $3,164.13 "," $3,164.13 "," $4,070.75 "," $3,718.97 ", $230.52 ," $4,394.59 "
Fetal Biophysical Profile,CPT® 76818,N/A,N/A,N/A, $960.00 , $624.00 , $651.05 , $115.42 , $106.98 , $581.96 , $653.05 , $892.80 , $864.00 , $864.00 , $768.00 , $768.00 , $106.98 , $886.37 , $912.00 , $864.00 , $864.00 , $864.00 , $892.80 , $921.60 , $648.62 , $816.00 , $712.64 , $691.01 , N/A , $593.31 , $593.31 , $912.00 , $686.77 , $106.98 , $921.60 
"Repair Exten Leg Tendn,Prim,Each",CPT® 27664,N/A,N/A,N/A," $3,521.00 "," $2,288.65 "," $2,246.73 ", $351.25 , $276.59 ," $1,769.17 "," $1,773.75 "," $3,274.53 "," $3,168.90 "," $3,168.90 "," $2,816.80 "," $2,816.80 ", $276.59 ," $3,250.94 "," $3,344.95 "," $3,168.90 "," $3,168.90 "," $3,168.90 "," $3,274.53 "," $3,380.16 "," $2,070.57 "," $2,992.85 "," $1,942.85 "," $2,085.58 ", N/A ," $1,803.69 "," $1,803.69 "," $3,344.95 "," $2,119.96 ", $276.59 ," $3,380.16 "
Reconstruct Radial Head W Implant,CPT® 24366,N/A,N/A,N/A," $4,544.00 "," $2,953.60 "," $4,159.09 ", $651.40 , $926.05 ," $3,280.79 "," $3,258.84 "," $4,225.92 "," $4,089.60 "," $4,089.60 "," $3,635.20 "," $3,635.20 ", $926.05 ," $4,195.48 "," $4,316.80 "," $4,089.60 "," $4,089.60 "," $4,089.60 "," $4,225.92 "," $4,362.24 "," $3,864.80 "," $3,862.40 "," $3,594.89 "," $3,871.17 ", N/A ," $3,344.81 "," $3,344.81 "," $4,316.80 "," $3,931.36 ", $651.40 ," $4,362.24 "
"Inject Nerv Blck,Celiac Plexus",64530,N/A,N/A,N/A," $1,403.00 ", $911.95 , $468.05 , $90.93 , $158.01 , $517.86 , $512.95 ," $1,304.79 "," $1,262.70 "," $1,262.70 "," $1,122.40 "," $1,122.40 ", $158.01 ," $1,295.39 "," $1,332.85 "," $1,262.70 "," $1,262.70 "," $1,262.70 "," $1,304.79 "," $1,346.88 ", $504.95 ," $1,192.55 ", $499.54 , $551.57 , N/A , $527.97 , $527.97 ," $1,332.85 ", $566.37 , $90.93 ," $1,346.88 "
Sono Pelvis Limited,CPT® 76857,N/A,N/A,N/A, $727.00 , $472.55 , $270.40 , $48.14 , $62.84 , $225.99 , $504.45 , $676.11 , $654.30 , $654.30 , $581.60 , $581.60 , $62.84 , $671.24 , $690.65 , $654.30 , $654.30 , $654.30 , $676.11 , $697.92 , $265.60 , $617.95 , $550.85 , $272.09 , N/A , $230.40 , $230.40 , $690.65 , $266.71 , $48.14 , $697.92 
Prostatic Microwave Thermotx,CPT® 53850,N/A,N/A,N/A," $14,892.00 "," $9,679.80 "," $1,924.70 ", $340.85 ," $2,378.14 "," $2,967.64 "," $2,777.12 "," $13,849.56 "," $13,402.80 "," $13,402.80 "," $11,913.60 "," $11,913.60 "," $2,378.14 "," $13,749.78 "," $14,147.40 "," $13,402.80 "," $13,402.80 "," $13,402.80 "," $13,849.56 "," $14,296.32 "," $1,922.80 "," $12,658.20 "," $3,143.52 "," $3,737.29 ", N/A ," $3,025.55 "," $3,025.55 "," $14,147.40 "," $3,556.09 ", $340.85 ," $14,296.32 "
Upp Ext Fx Orthosis Humeral,HCPCS L3980,N/A,N/A,N/A, $545.00 , $354.25 , N/A , $411.85 , $204.36 , N/A , N/A , $506.85 , $490.50 , $490.50 , $436.00 , $436.00 , $204.36 , $503.20 , $517.75 , $490.50 , $490.50 , $490.50 , $506.85 , $523.20 , N/A , $463.25 , $305.56 , $346.49 , N/A , N/A , N/A , $517.75 , N/A , $204.36 , $523.20 
"Closed Rx Tarsal Fx,Manip,Each",28455,N/A,N/A,N/A," $2,167.00 "," $1,408.55 "," $1,619.28 ", $257.53 , $153.67 ," $1,267.45 "," $1,157.12 "," $2,015.31 "," $1,950.30 "," $1,950.30 "," $1,733.60 "," $1,733.60 ", $153.67 ," $2,000.79 "," $2,058.65 "," $1,950.30 "," $1,950.30 "," $1,950.30 "," $2,015.31 "," $2,080.32 "," $1,492.56 "," $1,841.95 "," $1,261.33 "," $1,503.87 ", N/A ," $1,292.18 "," $1,292.18 "," $2,058.65 "," $1,518.76 ", $153.67 ," $2,080.32 "
Insj Biomchn Dev Intervertebral Dsc Spc W/Arthrd,CPT® 22853,N/A,N/A,N/A," $1,794.00 "," $1,166.10 "," $1,481.94 ", $230.73 , $199.49 ," $1,194.16 "," $1,149.23 "," $1,668.42 "," $1,614.60 "," $1,614.60 "," $1,435.20 "," $1,435.20 ", $199.49 ," $1,656.40 "," $1,704.30 "," $1,614.60 "," $1,614.60 "," $1,614.60 "," $1,668.42 "," $1,722.24 "," $1,387.35 "," $1,524.90 "," $1,364.69 "," $1,403.48 ", N/A ," $1,217.47 "," $1,217.47 "," $1,704.30 "," $1,430.96 ", $199.49 ," $1,722.24 "
Removal of Scrotum,CPT® 55150,N/A,N/A,N/A," $2,689.00 "," $1,747.85 "," $2,194.20 ", $472.16 , $489.14 ," $1,580.50 "," $1,598.60 "," $2,500.77 "," $2,420.10 "," $2,420.10 "," $2,151.20 "," $2,151.20 ", $489.14 ," $2,482.75 "," $2,554.55 "," $2,420.10 "," $2,420.10 "," $2,420.10 "," $2,500.77 "," $2,581.44 "," $2,049.36 "," $2,285.65 "," $2,553.00 "," $2,375.02 ", N/A ," $1,611.33 "," $1,611.33 "," $2,554.55 "," $1,931.29 ", $472.16 ," $2,581.44 "
Suspension of Breast,CPT® 19316,N/A,N/A,N/A," $6,146.00 "," $3,994.90 "," $2,506.89 ", $751.33 , $725.22 ," $2,091.63 "," $2,037.41 "," $5,715.78 "," $5,531.40 "," $5,531.40 "," $4,916.80 "," $4,916.80 ", $725.22 ," $5,674.60 "," $5,838.70 "," $5,531.40 "," $5,531.40 "," $5,531.40 "," $5,715.78 "," $5,900.16 "," $2,749.59 "," $5,224.10 "," $4,096.21 "," $2,666.63 ", N/A ," $2,132.44 "," $2,132.44 "," $5,838.70 "," $2,472.92 ", $725.22 ," $5,900.16 "
" Fac Transluminal Peripheral Atherectomy, Iliac Artery, Each ",CPT® 0238T,0360 - OR SERVICES,N/A,N/A," $15,580.00 "," $10,127.00 "," $13,087.20 "," $11,582.87 ", N/A ," $12,588.64 "," $14,022.00 "," $13,190.03 "," $14,022.00 "," $14,022.00 "," $14,022.00 "," $13,243.00 ", N/A ," $14,385.01 "," $14,801.00 "," $13,243.00 "," $14,489.40 "," $14,489.40 "," $14,801.00 "," $14,956.80 "," $12,747.56 "," $14,022.00 "," $13,243.00 "," $12,308.20 ", N/A ," $12,608.89 "," $12,608.89 "," $14,801.00 "," $13,369.20 "," $11,582.87 "," $14,956.80 "
 Fac Trim Nail(S) ,HCPCS G0127,0510 - CLINIC,N/A,N/A, $46.00 , $29.90 , $38.64 , $7.29 , N/A , $37.17 , $41.40 , N/A , $41.40 , $41.40 , $41.40 , $39.10 , N/A , $42.47 , $43.70 , $39.10 , $42.78 , $42.78 , $43.70 , $44.16 , $37.64 , $41.40 , $39.10 , $36.34 , N/A , $37.23 , $37.23 , $43.70 , $39.47 , $7.29 , $44.16 
 Pro Mlc Imrt Design & Construction per Imrt Plan ,CPT® 77338,0982 - PRO FEE/OUTPT,N/A,N/A," $1,434.00 ", $932.10 ," $2,563.08 ", $456.82 , $410.41 ," $2,409.96 "," $2,590.52 "," $1,333.62 "," $1,290.60 "," $1,290.60 "," $1,147.20 "," $1,147.20 ", $410.41 ," $1,324.01 "," $1,362.30 "," $1,290.60 "," $1,290.60 "," $1,290.60 "," $1,333.62 "," $1,376.64 "," $2,651.93 "," $1,218.90 "," $2,837.06 "," $2,862.80 ", N/A ," $2,456.99 "," $2,456.99 "," $1,362.30 "," $2,844.02 ", $410.41 ," $2,862.80 "
 IV Concurrent Infusion Therapy -ED-Mh ,CPT® 96368,0260 - IV THERAPY,N/A,N/A, $208.00 , $135.20 , $174.72 , $19.45 , $20.32 , $168.06 , $187.20 , $176.09 , $187.20 , $187.20 , $187.20 , $176.80 , $19.92 , $192.05 , $197.60 , $176.80 , $193.44 , $193.44 , $197.60 , $199.68 , $170.19 , $187.20 , $176.80 , $164.32 , N/A , $168.33 , $168.33 , $197.60 , $178.48 , $19.45 , $199.68 
 Ribs Unilateral (No Pa Cxr) ,CPT® 71100,0320 - DX X-RAY,N/A,N/A, $335.00 , $217.75 , $281.40 , $36.39 , $31.35 , $270.68 , $301.50 , $283.61 , $301.50 , $301.50 , $301.50 , $284.75 , $30.74 , $309.31 , $318.25 , $284.75 , $311.55 , $311.55 , $318.25 , $321.60 , $274.10 , $301.50 , $284.75 , $264.65 , N/A , $271.12 , $271.12 , $318.25 , $287.46 , $30.74 , $321.60 
 CINACALCET HCL 30 MG PO TABS ,HCPCS J0604,0250 - PHARMACY,70436-0007-04,1 tablet, $158.86 , $103.26 , $133.44 , N/A , N/A , $128.36 , $142.97 , $134.49 , $142.97 , $142.97 , $142.97 , $135.03 , N/A , $146.68 , $150.92 , $135.03 , $147.74 , $147.74 , $150.92 , $152.51 , $129.98 , $142.97 , $135.03 , $125.50 , N/A , $128.57 , $128.57 , $150.92 , $136.32 , $125.50 , $152.51 
 IRINOTECAN HCL 100 MG/5ML IV SOLN ,HCPCS J9206,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9701-01,5 mL, $103.13 , $67.03 , $86.63 , $3.06 , $2.48 , $83.33 , $92.82 , $87.31 , $92.82 , $92.82 , $92.82 , $87.66 , $2.43 , $95.22 , $97.97 , $87.66 , $95.91 , $95.91 , $97.97 , $99.00 , $84.38 , $92.82 , $87.66 , $81.47 , N/A , $83.46 , $83.46 , $97.97 , $88.50 , $2.43 , $99.00 
Incision of Eyelid Fold,67715,N/A,N/A,N/A, $560.00 , $364.00 , $657.22 , $103.64 , $151.20 , $611.81 , $583.74 , $520.80 , $504.00 , $504.00 , $448.00 , $448.00 , $151.20 , $517.05 , $532.00 , $504.00 , $504.00 , $504.00 , $520.80 , $537.60 , $902.48 , $476.00 , $604.80 , $773.22 , N/A , $623.75 , $623.75 , $532.00 , $688.52 , $103.64 , $902.48 
 BETAMETHASONE DIPROPIONATE AUG 0.05 % EX CREA ,HCPCS RXC637,0250 - PHARMACY,45802-0376-35,15 gram, $23.81 , $15.48 , $20.00 , N/A , N/A , $19.24 , $21.43 , $20.16 , $21.43 , $21.43 , $21.43 , $20.24 , N/A , $21.98 , $22.62 , $20.24 , $22.14 , $22.14 , $22.62 , $22.86 , $19.48 , $21.43 , $20.24 , $18.81 , N/A , $19.27 , $19.27 , $22.62 , $20.43 , $18.81 , $22.86 
 Injection Single Tendon ,CPT® 20551,0361 - OR/MINOR,N/A,N/A, $635.00 , $412.75 , $533.40 , $37.19 , $26.41 , $513.08 , $571.50 , $537.59 , $571.50 , $571.50 , $571.50 , $539.75 , $25.89 , $586.30 , $603.25 , $539.75 , $590.55 , $590.55 , $603.25 , $609.60 , $519.56 , $571.50 , $539.75 , $501.65 , N/A , $513.91 , $513.91 , $603.25 , $544.89 , $25.89 , $609.60 
 ROMIPLOSTIM 500 MCG SC SOLR ,HCPCS J2796,0636 - DRUGS REQUIRING DETAILED CODIN,55513-0222-01,1 mL," $14,025.10 "," $9,116.32 "," $11,781.08 ", $97.38 , $93.06 ," $11,332.28 "," $12,622.59 "," $11,873.65 "," $12,622.59 "," $12,622.59 "," $12,622.59 "," $11,921.34 ", $91.24 ," $12,949.37 "," $13,323.85 "," $11,921.34 "," $13,043.34 "," $13,043.34 "," $13,323.85 "," $13,464.10 "," $11,475.34 "," $12,622.59 "," $11,921.34 "," $11,079.83 ", N/A ," $11,350.51 "," $11,350.51 "," $13,323.85 "," $12,034.94 ", $91.24 ," $13,464.10 "
"Anoscopy,Remove Lesn,Snare",CPT® 46611,N/A,N/A,N/A," $1,170.00 ", $760.50 , $490.10 , $76.22 , $128.32 , $388.90 , $396.70 ," $1,088.10 "," $1,053.00 "," $1,053.00 ", $936.00 , $936.00 , $128.32 ," $1,080.26 "," $1,111.50 "," $1,053.00 "," $1,053.00 "," $1,053.00 "," $1,088.10 "," $1,123.20 ", $349.95 , $994.50 , $437.10 , $463.04 , N/A , $396.49 , $396.49 ," $1,111.50 ", $414.68 , $76.22 ," $1,123.20 "
Perq Vert Agmntj Cavity Crtj Uni/Bi Cannulation,22513,N/A,N/A,N/A," $6,164.00 "," $4,006.60 "," $3,068.13 ", $477.25 ," $5,767.47 "," $2,501.30 "," $2,648.49 "," $5,732.52 "," $5,547.60 "," $5,547.60 "," $4,931.20 "," $4,931.20 "," $5,767.47 "," $5,691.22 "," $5,855.80 "," $5,547.60 "," $5,547.60 "," $5,547.60 "," $5,732.52 "," $5,917.44 "," $2,866.72 "," $5,239.40 "," $2,692.07 "," $2,956.45 ", N/A ," $2,550.10 "," $2,550.10 "," $5,855.80 "," $2,997.28 ", $477.25 ," $5,917.44 "
Control Nasal Hemorrhage,30903,N/A,N/A,N/A, $736.00 , $478.40 , $411.13 , $72.80 , $61.84 , $302.11 , $295.94 , $684.48 , $662.40 , $662.40 , $588.80 , $588.80 , $61.84 , $679.55 , $699.20 , $662.40 , $662.40 , $662.40 , $684.48 , $706.56 , $397.68 , $625.60 , $419.26 , $398.37 , N/A , $308.01 , $308.01 , $699.20 , $362.73 , $61.84 , $706.56 
"Ecg Monitor/24 Hrs,Analy/Rprt",CPT® 93226,N/A,N/A,N/A, $776.00 , $504.40 , $235.89 , $35.24 , $82.91 , $202.35 , $221.10 , $721.68 , $698.40 , $698.40 , $620.80 , $620.80 , $82.91 , $716.48 , $737.20 , $698.40 , $698.40 , $698.40 , $721.68 , $744.96 , $247.95 , $659.60 , $208.74 , $223.86 , N/A , $206.30 , $206.30 , $737.20 , $228.69 , $35.24 , $744.96 
Iadna Streptococcus Group B Amplified Probe Tq,CPT® 87653,N/A,N/A,N/A, $324.00 , $210.60 , N/A , $35.79 , $35.79 , $198.56 , $237.51 , $301.32 , $291.60 , $291.60 , $259.20 , $259.20 , $35.79 , $299.15 , $307.80 , $291.60 , $291.60 , $291.60 , $301.32 , $311.04 , $234.30 , $275.40 , $230.30 , $127.26 , N/A , $185.31 , $185.31 , $307.80 , $202.50 , $35.79 , $311.04 
 Fac Cytog Alys Chrmoml Abnor Cpy Number&Snp Vrnt Cgh ,CPT® 81229,0310 - PATHOLOGY LAB,N/A,N/A," $3,798.00 "," $2,468.70 "," $3,190.32 "," $1,183.20 ", $620.16 ," $3,068.78 "," $3,418.20 "," $3,215.39 "," $3,418.20 "," $3,418.20 "," $3,418.20 "," $3,228.30 ", $608.00 ," $3,506.69 "," $3,608.10 "," $3,228.30 "," $3,532.14 "," $3,532.14 "," $3,608.10 "," $3,646.08 "," $3,107.52 "," $3,418.20 "," $3,228.30 "," $3,000.42 ", N/A ," $3,073.72 "," $3,073.72 "," $3,608.10 "," $3,259.06 ", $608.00 ," $3,646.08 "
Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level,64483,N/A,N/A,N/A," $1,016.00 ", $660.40 , $550.37 , $106.70 , $205.84 , $636.12 , $622.08 , $944.88 , $914.40 , $914.40 , $812.80 , $812.80 , $205.84 , $938.07 , $965.20 , $914.40 , $914.40 , $914.40 , $944.88 , $975.36 , $598.03 , $863.60 , $604.80 , $680.05 , N/A , $648.53 , $648.53 , $965.20 , $695.74 , $106.70 , $975.36 
 MOXIFLOXACIN HCL 5 MG/ML IO SOLN ,HCPCS RXA250,0250 - PHARMACY,71384-0511-01,0.2 mL, $28.51 , $18.53 , $23.95 , N/A , N/A , $23.04 , $25.66 , $24.14 , $25.66 , $25.66 , $25.66 , $24.23 , N/A , $26.32 , $27.08 , $24.23 , $26.51 , $26.51 , $27.08 , $27.37 , $23.33 , $25.66 , $24.23 , $22.52 , N/A , $23.07 , $23.07 , $27.08 , $24.46 , $22.52 , $27.37 
 Infec Agen Detec Ampli Probe Pbb ,HCPCS U0005,0306 - LAB/BACT-MICRO,N/A,N/A, $93.00 , $60.45 , $78.12 , $25.50 , $25.50 , $75.14 , $83.70 , $78.73 , $83.70 , $83.70 , $83.70 , $79.05 , $25.00 , $85.87 , $88.35 , $79.05 , $86.49 , $86.49 , $88.35 , $89.28 , $76.09 , $83.70 , $79.05 , $73.47 , N/A , $75.26 , $75.26 , $88.35 , $79.80 , $25.00 , $89.28 
"Inject Nerv Block, Hypogas Plexus",CPT® 64517,N/A,N/A,N/A," $1,273.00 ", $827.45 , $626.91 , $122.10 , $185.43 , $691.69 , $668.67 ," $1,183.89 "," $1,145.70 "," $1,145.70 "," $1,018.40 "," $1,018.40 ", $185.43 ," $1,175.36 "," $1,209.35 "," $1,145.70 "," $1,145.70 "," $1,145.70 "," $1,183.89 "," $1,222.08 ", $678.02 ," $1,082.05 ", $651.18 , $764.35 , N/A , $705.18 , $705.18 ," $1,209.35 ", $756.51 , $122.10 ," $1,222.08 "
 LIDOCAINE HCL 2 % IJ SOLN ,HCPCS RXA250,0250 - PHARMACY,63323-0486-27,20 mL, $23.63 , $15.36 , $19.85 , N/A , N/A , $19.09 , $21.27 , $20.01 , $21.27 , $21.27 , $21.27 , $20.09 , N/A , $21.82 , $22.45 , $20.09 , $21.98 , $21.98 , $22.45 , $22.68 , $19.33 , $21.27 , $20.09 , $18.67 , N/A , $19.12 , $19.12 , $22.45 , $20.28 , $18.67 , $22.68 
Ecg Recording,CPT® 93270,N/A,N/A,N/A, $340.00 , $221.00 , $51.55 , $7.99 , $46.97 , $48.58 , $52.29 , $316.20 , $306.00 , $306.00 , $272.00 , $272.00 , $46.97 , $313.92 , $323.00 , $306.00 , $306.00 , $306.00 , $316.20 , $326.40 , $53.04 , $289.00 , $49.95 , $53.40 , N/A , $49.54 , $49.54 , $323.00 , $54.91 , $7.99 , $326.40 
 Fac Dcmprn Fasct Leg Ant&/Lat Cmprts Only ,CPT® 27600,0360 - OR SERVICES,N/A,N/A," $1,841.00 "," $1,196.65 "," $1,546.44 ", $379.17 , $307.34 ," $1,487.53 "," $1,656.90 "," $1,558.59 "," $1,656.90 "," $1,656.90 "," $1,656.90 "," $1,564.85 ", $301.31 ," $1,699.80 "," $1,748.95 "," $1,564.85 "," $1,712.13 "," $1,712.13 "," $1,748.95 "," $1,767.36 "," $1,506.31 "," $1,656.90 "," $1,564.85 "," $1,454.39 ", N/A ," $1,489.92 "," $1,489.92 "," $1,748.95 "," $1,579.76 ", $301.31 ," $1,767.36 "
Cardioversion Elective Arrhythmia External,92960,N/A,N/A,N/A," $1,258.00 ", $817.70 , $675.35 , $104.47 , $244.76 , $670.27 , $674.00 ," $1,169.94 "," $1,132.20 "," $1,132.20 "," $1,006.40 "," $1,006.40 ", $244.76 ," $1,161.51 "," $1,195.10 "," $1,132.20 "," $1,132.20 "," $1,132.20 "," $1,169.94 "," $1,207.68 ", $666.44 ," $1,069.30 ", $627.99 , $661.06 , N/A , $683.35 , $683.35 ," $1,195.10 ", $757.50 , $104.47 ," $1,207.68 "
" Pro Drain/Inject, Joint/Bursa ",CPT® 20610,0982 - PRO FEE/OUTPT,N/A,N/A, $467.00 , $303.55 , $274.69 , $42.73 , $65.94 , $223.70 , $219.57 , $434.31 , $420.30 , $420.30 , $373.60 , $373.60 , $65.94 , $431.18 , $443.65 , $420.30 , $420.30 , $420.30 , $434.31 , $448.32 , $257.37 , $396.95 , $240.85 , $264.61 , N/A , $228.06 , $228.06 , $443.65 , $268.04 , $42.73 , $448.32 
 Pro Identify Sentinel Node ,CPT® 38792,0982 - PRO FEE/OUTPT,N/A,N/A, $763.00 , $495.95 , $154.55 , $30.89 , $36.29 , $140.90 , $148.11 , $709.59 , $686.70 , $686.70 , $610.40 , $610.40 , $36.29 , $704.48 , $724.85 , $686.70 , $686.70 , $686.70 , $709.59 , $732.48 , $166.47 , $648.55 , $215.87 , $197.75 , N/A , $143.66 , $143.66 , $724.85 , $166.67 , $30.89 , $732.48 
 Fac Prothrombin Tm ,CPT® 85610,0305 - LAB/HEMATOLOGY,N/A,N/A, $69.00 , $44.85 , $57.96 , $4.38 , $4.38 , $55.75 , $62.10 , $58.42 , $62.10 , $62.10 , $62.10 , $58.65 , $4.29 , $63.71 , $65.55 , $58.65 , $64.17 , $64.17 , $65.55 , $66.24 , $56.46 , $62.10 , $58.65 , $54.51 , N/A , $55.84 , $55.84 , $65.55 , $59.21 , $4.29 , $66.24 
Apply Short Leg Splint,29515,N/A,N/A,N/A, $473.00 , $307.45 , $298.68 , $47.11 , $31.03 , $240.63 , $243.68 , $439.89 , $425.70 , $425.70 , $378.40 , $378.40 , $31.03 , $436.72 , $449.35 , $425.70 , $425.70 , $425.70 , $439.89 , $454.08 , $277.19 , $402.05 , $265.83 , $288.50 , N/A , $245.33 , $245.33 , $449.35 , $288.36 , $31.03 , $454.08 
Egd Removal Tumor Polyp/Other Lesion Snare Tech,43251,N/A,N/A,N/A," $2,620.00 "," $1,703.00 "," $1,201.33 ", $185.58 , $203.13 , $998.36 ," $1,059.33 "," $2,436.60 "," $2,358.00 "," $2,358.00 "," $2,096.00 "," $2,096.00 ", $203.13 ," $2,419.05 "," $2,489.00 "," $2,358.00 "," $2,358.00 "," $2,358.00 "," $2,436.60 "," $2,515.20 ", $862.97 ," $2,227.00 "," $1,161.43 "," $1,145.55 ", N/A ," $1,017.84 "," $1,017.84 "," $2,489.00 "," $1,064.54 ", $185.58 ," $2,515.20 "
" Pro Debride Nail, 6 or More ",CPT® 11721,0982 - PRO FEE/OUTPT,N/A,N/A, $171.00 , $111.15 , $78.23 , $23.04 , $33.71 , $69.12 , $65.79 , $159.03 , $153.90 , $153.90 , $136.80 , $136.80 , $33.71 , $157.88 , $162.45 , $153.90 , $153.90 , $153.90 , $159.03 , $164.16 , $86.28 , $145.35 , $128.45 , $88.53 , N/A , $70.47 , $70.47 , $162.45 , $81.72 , $23.04 , $164.16 
Microscopic Exam of Urine,CPT® 81015,N/A,N/A,N/A, $33.00 , $21.45 , N/A , $3.11 , $3.11 , $17.21 , $20.58 , $30.69 , $29.70 , $29.70 , $26.40 , $26.40 , $3.11 , $30.47 , $31.35 , $29.70 , $29.70 , $29.70 , $30.69 , $31.68 , $20.37 , $28.05 , $19.46 , $11.02 , N/A , $16.06 , $16.06 , $31.35 , $17.55 , $3.11 , $31.68 
 Fac Drug Test Def 1-7 Classes ,CPT® G0480,0301 - LAB/CHEMISTRY,N/A,N/A, $193.00 , $125.45 , $162.12 , $116.72 , $65.23 , $155.94 , $173.70 , $163.39 , $173.70 , $173.70 , $173.70 , $164.05 , $63.95 , $178.20 , $183.35 , $164.05 , $179.49 , $179.49 , $183.35 , $185.28 , $157.91 , $173.70 , $164.05 , $152.47 , N/A , $156.19 , $156.19 , $183.35 , $165.61 , $63.95 , $185.28 
 Pro Radex Hips Bilateral With Pelvis 3-4 Views ,CPT® 73522,0972 - PRO FEE/RAD/DX,N/A,N/A, $179.00 , $116.35 , $366.03 , $52.93 , $38.29 , $232.10 , $245.04 , $166.47 , $161.10 , $161.10 , $143.20 , $143.20 , $38.29 , $165.27 , $170.05 , $161.10 , $161.10 , $161.10 , $166.47 , $171.84 , $294.60 , $152.15 , $308.86 , $245.99 , N/A , $236.63 , $236.63 , $170.05 , $273.90 , $38.29 , $366.03 
 HYDROCORTISONE ACETATE 25 MG RE SUPP ,HCPCS RXC637,0250 - PHARMACY,00713-0503-12,1 suppository, $116.34 , $75.62 , $97.73 , N/A , N/A , $94.00 , $104.71 , $98.49 , $104.71 , $104.71 , $104.71 , $98.89 , N/A , $107.42 , $110.52 , $98.89 , $108.20 , $108.20 , $110.52 , $111.69 , $95.19 , $104.71 , $98.89 , $91.91 , N/A , $94.15 , $94.15 , $110.52 , $99.83 , $91.91 , $111.69 
Dihydrotestosterone (Dht),CPT® 82642,N/A,N/A,N/A, $296.00 , $192.40 , N/A , $29.87 , $29.87 , $135.25 , N/A , $275.28 , $266.40 , $266.40 , $236.80 , $236.80 , $29.87 , $273.30 , $281.20 , $266.40 , $266.40 , $266.40 , $275.28 , $284.16 , $195.51 , $251.60 , $138.92 , $95.54 , N/A , $126.22 , $126.22 , $281.20 , $137.93 , $29.87 , $284.16 
 Pro Artl Pnxr W/Drawal Bld Dx ,CPT® 36600,0981 - PRO FEE/ER,N/A,N/A, $148.00 , $96.20 , $95.81 , $14.57 , $37.12 , $67.69 , $67.39 , $137.64 , $133.20 , $133.20 , $118.40 , $118.40 , $37.12 , $136.65 , $140.60 , $133.20 , $133.20 , $133.20 , $137.64 , $142.08 , $88.93 , $125.80 , $82.07 , $78.58 , N/A , $69.00 , $69.00 , $140.60 , $78.40 , $14.57 , $142.08 
" Fac Tomosynthesis, Mammo Diagnostic ",HCPCS G0279,0401 - MAMMOGRAPHY,N/A,N/A, $124.00 , $80.60 , $104.16 , $52.04 , $105.44 , $100.19 , $111.60 , $104.98 , $111.60 , $111.60 , $111.60 , $105.40 , $103.37 , $114.49 , $117.80 , $105.40 , $115.32 , $115.32 , $117.80 , $119.04 , $101.46 , $111.60 , $105.40 , $97.96 , N/A , $100.35 , $100.35 , $117.80 , $106.40 , $52.04 , $119.04 
 Removal Impacted Cerumen -Mh ,CPT® 69210,0761 - TREATMENT ROOM,N/A,N/A, $118.00 , $76.70 , $99.12 , $31.15 , $14.13 , $95.34 , $106.20 , $99.90 , $106.20 , $106.20 , $106.20 , $100.30 , $13.85 , $108.95 , $112.10 , $100.30 , $109.74 , $109.74 , $112.10 , $113.28 , $96.55 , $106.20 , $100.30 , $93.22 , N/A , $95.50 , $95.50 , $112.10 , $101.26 , $13.85 , $113.28 
 Nim Impulse Monitoring Fee Arh ,HCPCS G0453,0920 - OTHER DX SVS,N/A,N/A," $4,114.00 "," $2,674.10 "," $3,455.76 ", $31.03 , N/A ," $3,324.11 "," $3,702.60 "," $3,482.91 "," $3,702.60 "," $3,702.60 "," $3,702.60 "," $3,496.90 ", N/A ," $3,798.46 "," $3,908.30 "," $3,496.90 "," $3,826.02 "," $3,826.02 "," $3,908.30 "," $3,949.44 "," $3,366.07 "," $3,702.60 "," $3,496.90 "," $3,250.06 ", N/A ," $3,329.46 "," $3,329.46 "," $3,908.30 "," $3,530.22 ", $31.03 ," $3,949.44 "
Ablation & Rcnstj Atria Lmtd,CPT® 33254,N/A,N/A,N/A," $11,484.00 "," $7,464.60 "," $7,977.06 "," $1,229.59 "," $1,090.34 "," $5,806.13 "," $5,806.97 "," $10,680.12 "," $10,335.60 "," $10,335.60 "," $9,187.20 "," $9,187.20 "," $1,090.34 "," $10,603.18 "," $10,909.80 "," $10,335.60 "," $10,335.60 "," $10,335.60 "," $10,680.12 "," $11,024.64 "," $7,351.64 "," $9,761.40 "," $7,359.26 "," $6,522.45 ", N/A ," $5,919.42 "," $5,919.42 "," $10,909.80 "," $6,724.46 "," $1,090.34 "," $11,024.64 "
"Closed Rx Rad/Ulna Shaft Fx,Manip",25565,N/A,N/A,N/A," $2,412.00 "," $1,567.80 "," $2,866.37 ", $452.75 , $396.91 ," $2,261.48 "," $2,289.35 "," $2,243.16 "," $2,170.80 "," $2,170.80 "," $1,929.60 "," $1,929.60 ", $396.91 ," $2,227.00 "," $2,291.40 "," $2,170.80 "," $2,170.80 "," $2,170.80 "," $2,243.16 "," $2,315.52 "," $2,644.54 "," $2,050.20 "," $2,519.10 "," $2,656.81 ", N/A ," $2,305.61 "," $2,305.61 "," $2,291.40 "," $2,709.92 ", $396.91 ," $2,866.37 "
" Fac Cytopatholgy,Smear W/Inte ",CPT® 88104,0310 - PATHOLOGY LAB,N/A,N/A, $220.00 , $143.00 , $184.80 , $67.95 , $37.19 , $177.76 , $198.00 , $186.25 , $198.00 , $198.00 , $198.00 , $187.00 , $36.46 , $203.13 , $209.00 , $187.00 , $204.60 , $204.60 , $209.00 , $211.20 , $180.00 , $198.00 , $187.00 , $173.80 , N/A , $178.05 , $178.05 , $209.00 , $188.78 , $36.46 , $211.20 
 Fac Rmvl & Rplcmt Xtrnl Accessible Nephrourtrl Cath ,CPT® 50387,0320 - DX X-RAY,N/A,N/A," $4,143.00 "," $2,692.95 "," $3,480.12 ", $78.86 , $632.53 ," $3,347.54 "," $3,728.70 "," $3,507.46 "," $3,728.70 "," $3,728.70 "," $3,728.70 "," $3,521.55 ", $620.13 ," $3,825.23 "," $3,935.85 "," $3,521.55 "," $3,852.99 "," $3,852.99 "," $3,935.85 "," $3,977.28 "," $3,389.80 "," $3,728.70 "," $3,521.55 "," $3,272.97 ", N/A ," $3,352.93 "," $3,352.93 "," $3,935.85 "," $3,555.11 ", $78.86 ," $3,977.28 "
 Pro Cltx Metar Fx W/Mnpj ,CPT® 28475,0982 - PRO FEE/OUTPT,N/A,N/A," $1,739.00 "," $1,130.35 "," $1,407.45 ", $223.42 , $153.67 ," $1,112.20 "," $1,108.67 "," $1,617.27 "," $1,565.10 "," $1,565.10 "," $1,391.20 "," $1,391.20 ", $153.67 ," $1,605.62 "," $1,652.05 "," $1,565.10 "," $1,565.10 "," $1,565.10 "," $1,617.27 "," $1,669.44 "," $1,307.69 "," $1,478.15 "," $1,207.81 "," $1,312.14 ", N/A ," $1,133.90 "," $1,133.90 "," $1,652.05 "," $1,332.74 ", $153.67 ," $1,669.44 "
" Fac Cytogenetics, 100-300 ",CPT® 88275,0310 - PATHOLOGY LAB,N/A,N/A, $454.00 , $295.10 , $381.36 , $52.21 , $52.21 , $366.83 , $408.60 , $384.36 , $408.60 , $408.60 , $408.60 , $385.90 , $51.19 , $419.18 , $431.30 , $385.90 , $422.22 , $422.22 , $431.30 , $435.84 , $371.46 , $408.60 , $385.90 , $358.66 , N/A , $367.42 , $367.42 , $431.30 , $389.58 , $51.19 , $435.84 
 INDIGOTINDISULFONATE SODIUM 8 MG/ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,81284-0315-00,5 mL," $2,465.70 "," $1,602.71 "," $2,071.19 ", N/A , N/A ," $1,992.29 "," $2,219.13 "," $2,087.46 "," $2,219.13 "," $2,219.13 "," $2,219.13 "," $2,095.85 ", N/A ," $2,276.58 "," $2,342.42 "," $2,095.85 "," $2,293.10 "," $2,293.10 "," $2,342.42 "," $2,367.07 "," $2,017.44 "," $2,219.13 "," $2,095.85 "," $1,947.90 ", N/A ," $1,995.49 "," $1,995.49 "," $2,342.42 "," $2,115.82 "," $1,947.90 "," $2,367.07 "
" Fac Cytomeg, Dna, Quant ",CPT® 87497,0306 - LAB/BACT-MICRO,N/A,N/A, $433.00 , $281.45 , $363.72 , $43.70 , $43.70 , $349.86 , $389.70 , $366.58 , $389.70 , $389.70 , $389.70 , $368.05 , $42.84 , $399.79 , $411.35 , $368.05 , $402.69 , $402.69 , $411.35 , $415.68 , $354.28 , $389.70 , $368.05 , $342.07 , N/A , $350.43 , $350.43 , $411.35 , $371.56 , $42.84 , $415.68 
 Fac Teaec +-Patch Grf Cmbn Aortoiliac ,CPT® 35361,0360 - OR SERVICES,N/A,N/A," $2,129.00 "," $1,383.85 "," $1,788.36 "," $1,348.52 "," $1,340.24 "," $1,720.23 "," $1,916.10 "," $1,802.41 "," $1,916.10 "," $1,916.10 "," $1,916.10 "," $1,809.65 "," $1,313.96 "," $1,965.71 "," $2,022.55 "," $1,809.65 "," $1,979.97 "," $1,979.97 "," $2,022.55 "," $2,043.84 "," $1,741.95 "," $1,916.10 "," $1,809.65 "," $1,681.91 ", N/A ," $1,723.00 "," $1,723.00 "," $2,022.55 "," $1,826.89 "," $1,313.96 "," $2,043.84 "
Prep Site F/S/N/H/F/G/M/D Gt Addl 100 Sq Cm/1pct,CPT® 15005,N/A,N/A,N/A, $468.00 , $304.20 , $282.88 , $82.97 , $92.39 , $247.00 , $237.96 , $435.24 , $421.20 , $421.20 , $374.40 , $374.40 , $92.39 , $432.10 , $444.60 , $421.20 , $421.20 , $421.20 , $435.24 , $449.28 , $311.62 , $397.80 , $481.70 , $314.39 , N/A , $251.83 , $251.83 , $444.60 , $292.02 , $82.97 , $481.70 
"Remove Hip/Pelvis Tumor,Subcut",27047,N/A,N/A,N/A," $3,175.00 "," $2,063.75 "," $2,186.80 ", $341.08 , $106.76 ," $1,746.93 "," $1,746.14 "," $2,952.75 "," $2,857.50 "," $2,857.50 "," $2,540.00 "," $2,540.00 ", $106.76 ," $2,931.48 "," $3,016.25 "," $2,857.50 "," $2,857.50 "," $2,857.50 "," $2,952.75 "," $3,048.00 "," $2,019.83 "," $2,698.75 "," $1,932.14 "," $2,040.42 ", N/A ," $1,781.02 "," $1,781.02 "," $3,016.25 "," $2,093.33 ", $106.76 ," $3,048.00 "
Osteotomy Spine Posterior 3 Column Thoracic,CPT® 22206,N/A,N/A,N/A," $24,602.00 "," $15,991.30 "," $14,263.80 "," $2,225.63 "," $2,378.00 "," $11,675.26 "," $11,228.63 "," $22,879.86 "," $22,141.80 "," $22,141.80 "," $19,681.60 "," $19,681.60 "," $2,378.00 "," $22,715.03 "," $23,371.90 "," $22,141.80 "," $22,141.80 "," $22,141.80 "," $22,879.86 "," $23,617.92 "," $13,295.09 "," $20,911.70 "," $12,443.85 "," $13,517.71 ", N/A ," $11,903.06 "," $11,903.06 "," $23,371.90 "," $13,990.33 "," $2,225.63 "," $23,617.92 "
Fine Needle Eval W/Interp,CPT® 88173,N/A,N/A,N/A, $494.00 , $321.10 , $559.74 , $159.03 , $58.95 , $603.98 , $685.98 , $459.42 , $444.60 , $444.60 , $395.20 , $395.20 , $58.95 , $456.11 , $469.30 , $444.60 , $444.60 , $444.60 , $459.42 , $474.24 , $995.17 , $419.90 , $715.23 , $539.14 , N/A , $563.67 , $563.67 , $469.30 , $619.45 , $58.95 , $995.17 
 Fac CT Head/Brain W/Dye ,CPT® 70460,0350 - CT SCAN,N/A,N/A," $2,195.00 "," $1,426.75 "," $1,843.80 ", $151.13 , $251.09 ," $1,773.56 "," $1,975.50 "," $1,858.29 "," $1,975.50 "," $1,975.50 "," $1,975.50 "," $1,865.75 ", $246.17 ," $2,026.64 "," $2,085.25 "," $1,865.75 "," $2,041.35 "," $2,041.35 "," $2,085.25 "," $2,107.20 "," $1,795.95 "," $1,975.50 "," $1,865.75 "," $1,734.05 ", N/A ," $1,776.41 "," $1,776.41 "," $2,085.25 "," $1,883.53 ", $151.13 ," $2,107.20 "
 Room Rate ,Custom 2000000001,0200 - INTENSIVE CARE,N/A,N/A," $4,915.00 "," $3,194.75 "," $4,128.60 ", N/A , N/A ," $3,971.32 "," $4,423.50 "," $4,161.04 "," $4,423.50 "," $4,423.50 "," $4,423.50 "," $4,177.75 ", N/A ," $4,538.02 "," $4,669.25 "," $4,177.75 "," $4,570.95 "," $4,570.95 "," $4,669.25 "," $4,718.40 "," $4,021.45 "," $4,423.50 "," $4,177.75 "," $3,882.85 ", N/A ," $3,977.71 "," $3,977.71 "," $4,669.25 "," $4,217.56 "," $3,882.85 "," $4,718.40 "
"Pro Tracheostomy,Emerg Proc.",31605,N/A,N/A,N/A," $2,135.00 "," $1,387.75 "," $1,748.06 ", $306.45 , $461.01 , $698.60 , $677.17 ," $1,985.55 "," $1,921.50 "," $1,921.50 "," $1,708.00 "," $1,708.00 ", $461.01 ," $1,971.25 "," $2,028.25 "," $1,921.50 "," $1,921.50 "," $1,921.50 "," $1,985.55 "," $2,049.60 "," $1,684.74 "," $1,814.75 ", $966.96 ," $1,676.07 ", N/A , $712.23 , $712.23 ," $2,028.25 ", $838.81 , $306.45 ," $2,049.60 "
"Hysteroscopy,Dx,Sep Proc",CPT® 58555,N/A,N/A,N/A," $2,046.00 "," $1,329.90 ", $703.35 , $143.00 , $165.56 , $773.00 , $770.48 ," $1,902.78 "," $1,841.40 "," $1,841.40 "," $1,636.80 "," $1,636.80 ", $165.56 ," $1,889.07 "," $1,943.70 "," $1,841.40 "," $1,841.40 "," $1,841.40 "," $1,902.78 "," $1,964.16 ", $743.43 ," $1,739.10 "," $1,013.35 ", $631.69 , N/A , $788.08 , $788.08 ," $1,943.70 ", $945.25 , $143.00 ," $1,964.16 "
 ORA-PLUS PO LIQD ,HCPCS RXC637,0250 - PHARMACY,00395-0091-16,473 mL, $85.05 , $55.28 , $71.44 , N/A , N/A , $68.72 , $76.55 , $72.00 , $76.55 , $76.55 , $76.55 , $72.29 , N/A , $78.53 , $80.80 , $72.29 , $79.10 , $79.10 , $80.80 , $81.65 , $69.59 , $76.55 , $72.29 , $67.19 , N/A , $68.83 , $68.83 , $80.80 , $72.98 , $67.19 , $81.65 
"Appendectomy,Rupt Appendx+Abscess",CPT® 44960,N/A,N/A,N/A," $6,837.00 "," $4,444.05 "," $5,230.49 ", $808.44 , $701.02 ," $4,099.05 "," $4,138.01 "," $6,358.41 "," $6,153.30 "," $6,153.30 "," $5,469.60 "," $5,469.60 ", $701.02 ," $6,312.60 "," $6,495.15 "," $6,153.30 "," $6,153.30 "," $6,153.30 "," $6,358.41 "," $6,563.52 "," $3,739.93 "," $5,811.45 "," $4,606.45 "," $4,836.03 ", N/A ," $4,179.02 "," $4,179.02 "," $6,495.15 "," $4,370.81 ", $701.02 ," $6,563.52 "
"Ureterolithotomy,Middle 1/3",CPT® 50620,N/A,N/A,N/A," $6,299.00 "," $4,094.35 "," $4,881.87 ", $858.43 ," $1,075.74 "," $4,426.04 "," $4,113.09 "," $5,858.07 "," $5,669.10 "," $5,669.10 "," $5,039.20 "," $5,039.20 "," $1,075.74 "," $5,815.87 "," $5,984.05 "," $5,669.10 "," $5,669.10 "," $5,669.10 "," $5,858.07 "," $6,047.04 "," $4,904.26 "," $5,354.15 "," $4,656.41 "," $5,563.16 ", N/A ," $4,512.40 "," $4,512.40 "," $5,984.05 "," $5,303.68 ", $858.43 ," $6,047.04 "
 Pro Att/Reargmt Trnk Dfct 10.1 Cm-30.0 Cm ,CPT® 14001,0982 - PRO FEE/OUTPT,N/A,N/A," $4,196.00 "," $2,727.40 "," $2,066.42 ", $619.33 , $329.01 ," $1,779.65 "," $1,751.98 "," $3,902.28 "," $3,776.40 "," $3,776.40 "," $3,356.80 "," $3,356.80 ", $329.01 ," $3,874.17 "," $3,986.20 "," $3,776.40 "," $3,776.40 "," $3,776.40 "," $3,902.28 "," $4,028.16 "," $2,257.71 "," $3,566.60 "," $3,502.12 "," $2,284.00 ", N/A ," $1,814.37 "," $1,814.37 "," $3,986.20 "," $2,104.04 ", $329.01 ," $4,028.16 "
 Pro Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq ,CPT® 45385,0982 - PRO FEE/OUTPT,N/A,N/A," $3,621.00 "," $2,353.65 "," $1,559.74 ", $240.44 , $476.76 ," $1,453.13 "," $1,492.10 "," $3,367.53 "," $3,258.90 "," $3,258.90 "," $2,896.80 "," $2,896.80 ", $476.76 ," $3,343.27 "," $3,439.95 "," $3,258.90 "," $3,258.90 "," $3,258.90 "," $3,367.53 "," $3,476.16 "," $2,094.15 "," $3,077.85 "," $1,635.99 "," $1,482.99 ", N/A ," $1,481.48 "," $1,481.48 "," $3,439.95 "," $1,549.48 ", $240.44 ," $3,476.16 "
 Fac Other Bedside Procedures ,Custom 6200244,0760 - TREATMENT ROOM,N/A,N/A, $60.00 , $39.00 , $50.40 , N/A , N/A , $48.48 , $54.00 , $50.80 , $54.00 , $54.00 , $54.00 , $51.00 , N/A , $55.40 , $57.00 , $51.00 , $55.80 , $55.80 , $57.00 , $57.60 , $49.09 , $54.00 , $51.00 , $47.40 , N/A , $48.56 , $48.56 , $57.00 , $51.49 , $47.40 , $57.60 
 Fac Acute Hepatitis Panel ,CPT® 80074,0300 - LABORATORY,N/A,N/A, $434.00 , $282.10 , $364.56 , $48.58 , $48.58 , $350.67 , $390.60 , $367.42 , $390.60 , $390.60 , $390.60 , $368.90 , $47.63 , $400.71 , $412.30 , $368.90 , $403.62 , $403.62 , $412.30 , $416.64 , $355.10 , $390.60 , $368.90 , $342.86 , N/A , $351.24 , $351.24 , $412.30 , $372.42 , $47.63 , $416.64 
Mitochondrial Antibody Each,CPT® 86381,N/A,N/A,N/A, $136.00 , $88.40 , N/A , $25.96 , $17.25 , N/A , N/A , $126.48 , $122.40 , $122.40 , $108.80 , $108.80 , $17.25 , $125.57 , $129.20 , $122.40 , $122.40 , $122.40 , $126.48 , $130.56 , N/A , $115.60 , $121.15 , $74.75 , N/A , $99.76 , $99.76 , $129.20 , $109.69 , $17.25 , $130.56 
"Dil Urethra Stric,Male,Initial",CPT® 53600,N/A,N/A,N/A, $567.00 , $368.55 , $340.86 , $60.41 , $24.75 , $311.61 , $288.79 , $527.31 , $510.30 , $510.30 , $453.60 , $453.60 , $24.75 , $523.51 , $538.65 , $510.30 , $510.30 , $510.30 , $527.31 , $544.32 , $344.51 , $481.95 , $326.48 , $392.67 , N/A , $317.69 , $317.69 , $538.65 , $373.37 , $24.75 , $544.32 
Egd Deliver Thermal Energy Sphnctr/Cardia Gerd,CPT® 43257,N/A,N/A,N/A," $1,168.00 ", $759.20 ," $1,422.14 ", $218.70 , $274.68 ," $1,136.95 "," $1,570.98 "," $1,086.24 "," $1,051.20 "," $1,051.20 ", $934.40 , $934.40 , $274.68 ," $1,078.41 "," $1,109.60 "," $1,051.20 "," $1,051.20 "," $1,051.20 "," $1,086.24 "," $1,121.28 "," $1,019.34 ", $992.80 ," $1,719.84 "," $1,350.90 ", N/A ," $1,159.13 "," $1,159.13 "," $1,109.60 "," $1,212.32 ", $218.70 ," $1,719.84 "
 Pro New Patient Visit Level 4 ,CPT® 99204,0982 - PRO FEE/OUTPT,N/A,N/A, $499.00 , $324.35 , $270.10 , $128.82 , $107.66 , $223.51 , $224.94 , $464.07 , $449.10 , $449.10 , $399.20 , $399.20 , $107.66 , $460.73 , $474.05 , $449.10 , $449.10 , $449.10 , $464.07 , $479.04 , $246.36 , $424.15 , $282.79 , $280.74 , $94.75 , $227.86 , $227.86 , $474.05 , $262.80 , $94.75 , $479.04 
Molecular Pathology Procedure Level 7,CPT® 81406,N/A,N/A,N/A," $1,351.00 ", $878.15 , N/A , $288.54 , $288.54 , N/A , N/A ," $1,256.43 "," $1,215.90 "," $1,215.90 "," $1,080.80 "," $1,080.80 ", $288.54 ," $1,247.38 "," $1,283.45 "," $1,215.90 "," $1,215.90 "," $1,215.90 "," $1,256.43 "," $1,296.96 "," $1,888.85 "," $1,148.35 "," $1,348.83 ", $830.82 , N/A ," $1,123.03 "," $1,123.03 "," $1,283.45 "," $1,224.87 ", $288.54 ," $1,888.85 "
" Pro X-Ray Exam of Knee, 3 ",CPT® 73562,0972 - PRO FEE/RAD/DX,N/A,N/A, $111.00 , $72.15 , $230.20 , $39.93 , $32.71 , $161.83 , $199.83 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $32.71 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $221.77 , $94.35 , $221.49 , $180.04 , N/A , $164.99 , $164.99 , $105.45 , $190.99 , $32.71 , $230.20 
"Length/Short Leg/Ankl Tendon,Single",CPT® 27685,N/A,N/A,N/A," $4,621.00 "," $3,003.65 "," $2,865.66 ", $450.83 , $412.40 ," $2,262.67 "," $2,259.13 "," $4,297.53 "," $4,158.90 "," $4,158.90 "," $3,696.80 "," $3,696.80 ", $412.40 ," $4,266.57 "," $4,389.95 "," $4,158.90 "," $4,158.90 "," $4,158.90 "," $4,297.53 "," $4,436.16 "," $2,660.99 "," $3,927.85 "," $2,467.36 "," $2,688.27 ", N/A ," $2,306.82 "," $2,306.82 "," $4,389.95 "," $2,711.33 ", $412.40 ," $4,436.16 "
Sat Biopsy Prostate 1-20 Spc,HCPCS G0416,N/A,N/A,N/A," $1,613.00 "," $1,048.45 "," $1,267.21 ", $356.03 , N/A ," $1,178.82 ", N/A ," $1,500.09 "," $1,451.70 "," $1,451.70 "," $1,290.40 "," $1,290.40 ", N/A ," $1,489.28 "," $1,532.35 "," $1,451.70 "," $1,451.70 "," $1,451.70 "," $1,500.09 "," $1,548.48 "," $2,262.78 "," $1,371.05 "," $1,279.34 "," $1,483.22 ", N/A ," $1,201.82 "," $1,201.82 "," $1,532.35 "," $1,502.28 ", $356.03 ," $2,262.78 "
Lens Sphere Trifocal 4.00d,HCPCS V2300,N/A,N/A,N/A, $90.00 , $58.50 , N/A , $83.40 , N/A , N/A , N/A , $83.70 , $81.00 , $81.00 , $72.00 , $72.00 , N/A , $83.10 , $85.50 , $81.00 , $81.00 , $81.00 , $83.70 , $86.40 , N/A , $76.50 , $90.00 , $75.77 , N/A , N/A , N/A , $85.50 , N/A , $72.00 , $90.00 
"Hysteroscopy,W/Endometrial Ablation",CPT® 58563,N/A,N/A,N/A," $7,123.00 "," $4,629.95 "," $1,145.00 ", $232.15 ," $1,306.81 "," $1,393.41 "," $1,387.53 "," $6,624.39 "," $6,410.70 "," $6,410.70 "," $5,698.40 "," $5,698.40 "," $1,306.81 "," $6,576.67 "," $6,766.85 "," $6,410.70 "," $6,410.70 "," $6,410.70 "," $6,624.39 "," $6,838.08 "," $1,207.19 "," $6,054.55 "," $1,826.88 "," $1,025.91 ", N/A ," $1,420.60 "," $1,420.60 "," $6,766.85 "," $1,703.93 ", $232.15 ," $6,838.08 "
Ingestion Challenge Test Initial 120 Minutes,CPT® 95076,N/A,N/A,N/A, $524.00 , $340.60 , $186.84 , $72.53 , $56.55 , $135.51 , $128.00 , $487.32 , $471.60 , $471.60 , $419.20 , $419.20 , $56.55 , $483.81 , $497.80 , $471.60 , $471.60 , $471.60 , $487.32 , $503.04 , $233.88 , $445.40 , $213.89 , $235.21 , N/A , $138.15 , $138.15 , $497.80 , $163.38 , $56.55 , $503.04 
" Pro Fix Entropion,Extensive ",CPT® 67924,0982 - PRO FEE/OUTPT,N/A,N/A," $5,969.00 "," $3,879.85 "," $2,801.83 ", $440.25 , $614.67 ," $2,594.02 "," $2,397.47 "," $5,551.17 "," $5,372.10 "," $5,372.10 "," $4,775.20 "," $4,775.20 ", $614.67 ," $5,511.18 "," $5,670.55 "," $5,372.10 "," $5,372.10 "," $5,372.10 "," $5,551.17 "," $5,730.24 "," $3,848.52 "," $5,073.65 "," $2,488.77 "," $3,293.77 ", N/A ," $2,644.63 "," $2,644.63 "," $5,670.55 "," $2,919.31 ", $440.25 ," $5,730.24 "
"Excis Pterygium,W Graft",CPT® 65426,N/A,N/A,N/A," $6,124.00 "," $3,980.60 "," $2,941.90 ", $462.47 , $632.31 ," $2,708.99 "," $2,531.36 "," $5,695.32 "," $5,511.60 "," $5,511.60 "," $4,899.20 "," $4,899.20 ", $632.31 ," $5,654.29 "," $5,817.80 "," $5,511.60 "," $5,511.60 "," $5,511.60 "," $5,695.32 "," $5,879.04 "," $4,042.25 "," $5,205.40 "," $2,599.38 "," $3,444.64 ", N/A ," $2,761.84 "," $2,761.84 "," $5,817.80 "," $3,048.70 ", $462.47 ," $5,879.04 "
Biopsy of Mouth Lesion,CPT® 40808,N/A,N/A,N/A," $1,267.00 ", $823.55 , $540.15 , $86.19 , $46.08 , $528.81 , $549.31 ," $1,178.31 "," $1,140.30 "," $1,140.30 "," $1,013.60 "," $1,013.60 ", $46.08 ," $1,169.82 "," $1,203.65 "," $1,140.30 "," $1,140.30 "," $1,140.30 "," $1,178.31 "," $1,216.32 ", $384.45 ," $1,076.95 ", $595.88 , $622.62 , N/A , $539.13 , $539.13 ," $1,203.65 ", $563.88 , $46.08 ," $1,216.32 "
Revis/Remov Cranial Neurorcvr,CPT® 61888,N/A,N/A,N/A," $2,322.00 "," $1,509.30 "," $1,846.31 ", $360.53 , $400.51 ," $2,134.65 "," $2,049.96 "," $2,159.46 "," $2,089.80 "," $2,089.80 "," $1,857.60 "," $1,857.60 ", $400.51 ," $2,143.90 "," $2,205.90 "," $2,089.80 "," $2,089.80 "," $2,089.80 "," $2,159.46 "," $2,229.12 "," $1,983.86 "," $1,973.70 "," $2,087.35 "," $2,232.22 ", N/A ," $2,176.30 "," $2,176.30 "," $2,205.90 "," $2,334.68 ", $360.53 ," $2,334.68 "
"Incision,Hemorrhoid",46083,N/A,N/A,N/A, $693.00 , $450.45 , $672.56 , $104.60 , $84.21 , $505.76 , $520.72 , $644.49 , $623.70 , $623.70 , $554.40 , $554.40 , $84.21 , $639.85 , $658.35 , $623.70 , $623.70 , $623.70 , $644.49 , $665.28 , $478.52 , $589.05 , $570.90 , $608.17 , N/A , $515.63 , $515.63 , $658.35 , $539.29 , $84.21 , $672.56 
"Repair Cornea Lac,Nonperforating",CPT® 65275,N/A,N/A,N/A," $5,347.00 "," $3,475.55 "," $2,846.68 ", $445.36 , $137.47 ," $2,618.38 "," $2,364.37 "," $4,972.71 "," $4,812.30 "," $4,812.30 "," $4,277.60 "," $4,277.60 ", $137.47 ," $4,936.89 "," $5,079.65 "," $4,812.30 "," $4,812.30 "," $4,812.30 "," $4,972.71 "," $5,133.12 "," $3,908.40 "," $4,544.95 "," $2,429.90 "," $3,323.06 ", N/A ," $2,669.47 "," $2,669.47 "," $5,079.65 "," $2,946.75 ", $137.47 ," $5,133.12 "
" Fac Assay of Hemosiderin, Qual ",CPT® 83070,0301 - LAB/CHEMISTRY,N/A,N/A, $81.00 , $52.65 , $68.04 , $4.85 , $4.85 , $65.45 , $72.90 , $68.57 , $72.90 , $72.90 , $72.90 , $68.85 , $4.75 , $74.79 , $76.95 , $68.85 , $75.33 , $75.33 , $76.95 , $77.76 , $66.27 , $72.90 , $68.85 , $63.99 , N/A , $65.55 , $65.55 , $76.95 , $69.51 , $4.75 , $77.76 
Open Rx Ulna Shaft Fx,CPT® 25545,N/A,N/A,N/A," $2,420.00 "," $1,573.00 "," $3,823.82 ", $601.46 , $614.70 ," $3,002.80 "," $3,000.32 "," $2,250.60 "," $2,178.00 "," $2,178.00 "," $1,936.00 "," $1,936.00 ", $614.70 ," $2,234.39 "," $2,299.00 "," $2,178.00 "," $2,178.00 "," $2,178.00 "," $2,250.60 "," $2,323.20 "," $3,546.08 "," $2,057.00 "," $3,305.87 "," $3,546.50 ", N/A ," $3,061.39 "," $3,061.39 "," $2,299.00 "," $3,598.22 ", $601.46 ," $3,823.82 "
 Nervous System Neoplasms Without McC ,MS DRG V40 (FY2023) 055,N/A,N/A,N/A," $18,328.75 "," $11,913.69 "," $15,396.15 ", N/A , N/A ," $14,809.63 "," $16,495.88 "," $15,517.12 "," $16,495.88 "," $16,495.88 "," $16,495.88 "," $15,579.44 ", N/A ," $16,922.93 "," $17,412.31 "," $15,579.44 "," $17,045.74 "," $17,045.74 "," $17,412.31 "," $17,595.60 "," $14,996.58 "," $16,495.88 "," $15,579.44 "," $14,479.71 ", N/A ," $14,833.46 "," $14,833.46 "," $17,412.31 "," $15,727.90 "," $14,479.71 "," $17,595.60 "
" Fac X-Ray, Female Genital Tract ",CPT® 74740,0320 - DX X-RAY,N/A,N/A, $874.00 , $568.10 , $734.16 , $94.56 , $72.27 , $706.19 , $786.60 , $739.93 , $786.60 , $786.60 , $786.60 , $742.90 , $70.85 , $806.96 , $830.30 , $742.90 , $812.82 , $812.82 , $830.30 , $839.04 , $715.11 , $786.60 , $742.90 , $690.46 , N/A , $707.33 , $707.33 , $830.30 , $749.98 , $70.85 , $839.04 
" 5-Hiaa, Plasma ",CPT® 82542,0301 - LAB/CHEMISTRY,N/A,N/A, $292.00 , $189.80 , $245.28 , $24.57 , $24.57 , $235.94 , $262.80 , $247.21 , $262.80 , $262.80 , $262.80 , $248.20 , $24.09 , $269.60 , $277.40 , $248.20 , $271.56 , $271.56 , $277.40 , $280.32 , $238.91 , $262.80 , $248.20 , $230.68 , N/A , $236.32 , $236.32 , $277.40 , $250.57 , $24.09 , $280.32 
 Pro Care of Miscarriage ,CPT® 59820,0982 - PRO FEE/OUTPT,N/A,N/A," $1,724.00 "," $1,120.60 "," $1,061.25 ", $359.92 , $331.58 , $826.59 , $879.40 ," $1,603.32 "," $1,551.60 "," $1,551.60 "," $1,379.20 "," $1,379.20 ", $331.58 ," $1,591.77 "," $1,637.80 "," $1,551.60 "," $1,551.60 "," $1,551.60 "," $1,603.32 "," $1,655.04 "," $1,058.99 "," $1,465.40 "," $1,926.79 "," $1,545.07 ", N/A , $842.72 , $842.72 ," $1,637.80 ", $974.26 , $331.58 ," $1,926.79 "
 Fac Viscer and Infrarenal Abdom Aorta 4+ Prosthesis ,CPT® 34848,0360 - OR SERVICES,N/A,N/A," $5,892.00 "," $3,829.80 "," $4,949.28 "," $3,898.25 ", N/A ," $4,760.74 "," $5,302.80 "," $4,988.17 "," $5,302.80 "," $5,302.80 "," $5,302.80 "," $5,008.20 ", N/A ," $5,440.08 "," $5,597.40 "," $5,008.20 "," $5,479.56 "," $5,479.56 "," $5,597.40 "," $5,656.32 "," $4,820.83 "," $5,302.80 "," $5,008.20 "," $4,654.68 ", N/A ," $4,768.40 "," $4,768.40 "," $5,597.40 "," $5,055.93 "," $3,898.25 "," $5,656.32 "
 Pro MRI Any Jt Lxtr C+ Matrl ,CPT® 73722,0972 - PRO FEE/RAD/DX,N/A,N/A, $887.00 , $576.55 ," $2,285.22 ", $323.72 , $498.57 ," $1,816.15 "," $2,329.98 ", $824.91 , $798.30 , $798.30 , $709.60 , $709.60 , $498.57 , $818.97 , $842.65 , $798.30 , $798.30 , $798.30 , $824.91 , $851.52 ," $1,984.20 ", $753.95 ," $2,542.38 "," $3,526.32 ", N/A ," $1,851.60 "," $1,851.60 ", $842.65 ," $2,143.24 ", $323.72 ," $3,526.32 "
"Proctectomy,Ap Resect+Ostomy",CPT® 45110,N/A,N/A,N/A," $8,016.00 "," $5,210.40 "," $10,998.72 "," $1,705.65 "," $1,536.80 "," $8,772.72 "," $8,885.52 "," $7,454.88 "," $7,214.40 "," $7,214.40 "," $6,412.80 "," $6,412.80 "," $1,536.80 "," $7,401.17 "," $7,615.20 "," $7,214.40 "," $7,214.40 "," $7,214.40 "," $7,454.88 "," $7,695.36 "," $7,907.42 "," $6,813.60 "," $9,833.76 "," $10,385.48 ", N/A ," $8,943.90 "," $8,943.90 "," $7,615.20 "," $9,354.38 "," $1,536.80 "," $10,998.72 "
Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/O Img Gdn,CPT® 62324,N/A,N/A,N/A, $973.00 , $632.45 , $444.08 , $86.22 , $115.12 , $498.99 , $484.22 , $904.89 , $875.70 , $875.70 , $778.40 , $778.40 , $115.12 , $898.37 , $924.35 , $875.70 , $875.70 , $875.70 , $904.89 , $934.08 , $480.82 , $827.05 , $469.11 , $549.72 , N/A , $508.73 , $508.73 , $924.35 , $545.75 , $86.22 , $934.08 
MD Recertification Hha Pt,HCPCS G0179,N/A,N/A,N/A, $163.00 , $105.95 , $195.65 , $40.29 , N/A , $75.54 , N/A , $151.59 , $146.70 , $146.70 , $130.40 , $130.40 , N/A , $150.50 , $154.85 , $146.70 , $146.70 , $146.70 , $151.59 , $156.48 , $74.38 , $138.55 , $79.15 , $157.39 , N/A , $77.01 , $77.01 , $154.85 , $96.28 , $40.29 , $195.65 
 Fac Trpos&/Rimpltj Vrt Crtd Art ,CPT® 35691,0360 - OR SERVICES,N/A,N/A," $3,986.00 "," $2,590.90 "," $3,348.24 ", $841.15 ," $1,338.88 "," $3,220.69 "," $3,587.40 "," $3,374.55 "," $3,587.40 "," $3,587.40 "," $3,587.40 "," $3,388.10 "," $1,312.63 "," $3,680.27 "," $3,786.70 "," $3,388.10 "," $3,706.98 "," $3,706.98 "," $3,786.70 "," $3,826.56 "," $3,261.35 "," $3,587.40 "," $3,388.10 "," $3,148.94 ", N/A ," $3,225.87 "," $3,225.87 "," $3,786.70 "," $3,420.39 ", $841.15 ," $3,826.56 "
 Ilioinguinal Nerve Block ,CPT® 64425,0761 - TREATMENT ROOM,N/A,N/A, $944.00 , $613.60 , $792.96 , $52.72 , $76.84 , $762.75 , $849.60 , $799.19 , $849.60 , $849.60 , $849.60 , $802.40 , $75.33 , $871.60 , $896.80 , $802.40 , $877.92 , $877.92 , $896.80 , $906.24 , $772.38 , $849.60 , $802.40 , $745.76 , N/A , $763.98 , $763.98 , $896.80 , $810.05 , $52.72 , $906.24 
Injection Sclerosant Multiple Incmptnt Veins,CPT® 36471,N/A,N/A,N/A," $1,211.00 ", $787.15 , $447.20 , $69.44 , $76.21 , $431.60 , $432.80 ," $1,126.23 "," $1,089.90 "," $1,089.90 ", $968.80 , $968.80 , $76.21 ," $1,118.12 "," $1,150.45 "," $1,089.90 "," $1,089.90 "," $1,089.90 "," $1,126.23 "," $1,162.56 ", $414.20 ," $1,029.35 ", $542.36 , $372.68 , N/A , $440.02 , $440.02 ," $1,150.45 ", $499.87 , $69.44 ," $1,162.56 "
 Fac Drug Screening Methylphenidate ,CPT® 80360,0301 - LAB/CHEMISTRY,N/A,N/A, $189.00 , $122.85 , $158.76 , N/A , N/A , $152.71 , $170.10 , $160.01 , $170.10 , $170.10 , $170.10 , $160.65 , N/A , $174.50 , $179.55 , $160.65 , $175.77 , $175.77 , $179.55 , $181.44 , $154.64 , $170.10 , $160.65 , $149.31 , N/A , $152.96 , $152.96 , $179.55 , $162.18 , $149.31 , $181.44 
"Exc Skin Benig >4cm Trunk,Arm,Leg",CPT® 11406,N/A,N/A,N/A," $1,487.00 ", $966.55 , $784.82 , $234.46 , $381.08 , $667.03 , $648.45 ," $1,382.91 "," $1,338.30 "," $1,338.30 "," $1,189.60 "," $1,189.60 ", $381.08 ," $1,372.95 "," $1,412.65 "," $1,338.30 "," $1,338.30 "," $1,338.30 "," $1,382.91 "," $1,427.52 ", $857.06 ," $1,263.95 "," $1,302.37 ", $852.08 , N/A , $680.04 , $680.04 ," $1,412.65 ", $788.62 , $234.46 ," $1,427.52 "
 IV Therapy Add Seq Inf to 1 Hr -ED-Mh ,CPT® 96367,0260 - IV THERAPY,N/A,N/A, $199.00 , $129.35 , $167.16 , $28.35 , $34.83 , $160.79 , $179.10 , $168.47 , $179.10 , $179.10 , $179.10 , $169.15 , $34.15 , $183.74 , $189.05 , $169.15 , $185.07 , $185.07 , $189.05 , $191.04 , $162.82 , $179.10 , $169.15 , $157.21 , N/A , $161.05 , $161.05 , $189.05 , $170.76 , $28.35 , $191.04 
"Decompress Fasciotomy Leg,Ant/Lat",CPT® 27892,N/A,N/A,N/A," $3,689.00 "," $2,397.85 "," $3,250.13 ", $506.56 , $708.49 ," $2,645.87 "," $2,652.05 "," $3,430.77 "," $3,320.10 "," $3,320.10 "," $2,951.20 "," $2,951.20 ", $708.49 ," $3,406.05 "," $3,504.55 "," $3,320.10 "," $3,320.10 "," $3,320.10 "," $3,430.77 "," $3,541.44 "," $3,023.21 "," $3,135.65 "," $2,936.57 "," $3,181.32 ", N/A ," $2,697.49 "," $2,697.49 "," $3,504.55 "," $3,170.50 ", $506.56 ," $3,541.44 "
Secondary Closure-Surg Wn,13160,N/A,N/A,N/A," $3,043.00 "," $1,977.95 "," $2,534.63 ", $755.62 , $190.55 ," $2,192.28 "," $2,140.14 "," $2,829.99 "," $2,738.70 "," $2,738.70 "," $2,434.40 "," $2,434.40 ", $190.55 ," $2,809.60 "," $2,890.85 "," $2,738.70 "," $2,738.70 "," $2,738.70 "," $2,829.99 "," $2,921.28 "," $2,777.60 "," $2,586.55 "," $4,294.24 "," $2,769.01 ", N/A ," $2,235.05 "," $2,235.05 "," $2,890.85 "," $2,591.92 ", $190.55 ," $4,294.24 "
 Fac Esophgl Funcj G-Esop Rflx Impd Eltrd Plmt ,CPT® 91037,0750 - GASTR-INST SVS,N/A,N/A, $638.00 , $414.70 , $535.92 , $166.18 , $132.55 , $515.50 , $574.20 , $540.13 , $574.20 , $574.20 , $574.20 , $542.30 , $129.95 , $589.07 , $606.10 , $542.30 , $593.34 , $593.34 , $606.10 , $612.48 , $522.01 , $574.20 , $542.30 , $504.02 , N/A , $516.33 , $516.33 , $606.10 , $547.47 , $129.95 , $612.48 
Removal of Anal Tab,CPT® 46220,N/A,N/A,N/A, $896.00 , $582.40 , $739.57 , $115.93 , $177.84 , $563.82 , $580.24 , $833.28 , $806.40 , $806.40 , $716.80 , $716.80 , $177.84 , $827.28 , $851.20 , $806.40 , $806.40 , $806.40 , $833.28 , $860.16 , $526.83 , $761.60 , $638.69 , $670.94 , N/A , $574.82 , $574.82 , $851.20 , $601.19 , $115.93 , $860.16 
 Pro Simple Repair 7.6-12.5cm ,CPT® 12015,0982 - PRO FEE/OUTPT,N/A,N/A, $920.00 , $598.00 , $293.11 , $87.01 , $139.20 , $268.12 , $259.48 , $855.60 , $828.00 , $828.00 , $736.00 , $736.00 , $139.20 , $849.44 , $874.00 , $828.00 , $828.00 , $828.00 , $855.60 , $883.20 , $322.89 , $782.00 , $520.95 , $325.60 , N/A , $273.35 , $273.35 , $874.00 , $317.01 , $87.01 , $883.20 
 Pro Cltx Inter/Peri/Subtrochanteric Fem Fx W/O Mnpj ,CPT® 27238,0982 - PRO FEE/OUTPT,N/A,N/A," $3,558.00 "," $2,312.70 "," $2,867.28 ", $451.16 , $461.04 ," $2,218.00 "," $2,228.81 "," $3,308.94 "," $3,202.20 "," $3,202.20 "," $2,846.40 "," $2,846.40 ", $461.04 ," $3,285.10 "," $3,380.10 "," $3,202.20 "," $3,202.20 "," $3,202.20 "," $3,308.94 "," $3,415.68 "," $2,652.56 "," $3,024.30 "," $2,456.66 "," $2,621.53 ", N/A ," $2,261.28 "," $2,261.28 "," $3,380.10 "," $2,657.80 ", $451.16 ," $3,415.68 "
Drainage of Eyelid Abscess,CPT® 67700,N/A,N/A,N/A, $887.00 , $576.55 , $714.22 , $112.63 , $30.71 , $656.29 , $616.74 , $824.91 , $798.30 , $798.30 , $709.60 , $709.60 , $30.71 , $818.97 , $842.65 , $798.30 , $798.30 , $798.30 , $824.91 , $851.52 , $979.92 , $753.95 , $636.91 , $838.47 , N/A , $669.09 , $669.09 , $842.65 , $738.60 , $30.71 , $979.92 
"Laminectomy,Lumbar",CPT® 63005,N/A,N/A,N/A," $7,639.00 "," $4,965.35 "," $5,560.41 "," $1,088.16 "," $1,536.80 "," $6,407.15 "," $6,168.70 "," $7,104.27 "," $6,875.10 "," $6,875.10 "," $6,111.20 "," $6,111.20 "," $1,536.80 "," $7,053.09 "," $7,257.05 "," $6,875.10 "," $6,875.10 "," $6,875.10 "," $7,104.27 "," $7,333.44 "," $6,004.41 "," $6,493.15 "," $6,270.99 "," $6,708.43 ", N/A ," $6,532.17 "," $6,532.17 "," $7,257.05 "," $7,007.47 "," $1,088.16 "," $7,333.44 "
 Fac Insj Tunneled Cvc W/O Subq Port/Pmp Age 5 Yr/> ,CPT® 36558,0761 - TREATMENT ROOM,N/A,N/A," $5,139.00 "," $3,340.35 "," $4,316.76 ", $244.84 ," $1,026.74 "," $4,152.31 "," $4,625.10 "," $4,350.68 "," $4,625.10 "," $4,625.10 "," $4,625.10 "," $4,368.15 "," $1,006.61 "," $4,744.84 "," $4,882.05 "," $4,368.15 "," $4,779.27 "," $4,779.27 "," $4,882.05 "," $4,933.44 "," $4,204.73 "," $4,625.10 "," $4,368.15 "," $4,059.81 ", N/A ," $4,158.99 "," $4,158.99 "," $4,882.05 "," $4,409.78 ", $244.84 ," $4,933.44 "
Revise Total Hip Replacement,CPT® 27134,N/A,N/A,N/A," $12,712.00 "," $8,262.80 "," $11,425.05 "," $1,782.48 "," $1,728.39 "," $9,261.88 "," $9,138.53 "," $11,822.16 "," $11,440.80 "," $11,440.80 "," $10,169.60 "," $10,169.60 "," $1,728.39 "," $11,736.99 "," $12,076.40 "," $11,440.80 "," $11,440.80 "," $11,440.80 "," $11,822.16 "," $12,203.52 "," $10,674.47 "," $10,805.20 "," $10,128.13 "," $10,879.08 ", N/A ," $9,442.60 "," $9,442.60 "," $12,076.40 "," $11,098.39 "," $1,728.39 "," $12,203.52 "
Open Rod Fixatn Humeral Shaft Fx,24516,N/A,N/A,N/A," $5,912.00 "," $3,842.80 "," $5,212.55 ", $816.69 , $881.43 ," $4,145.80 "," $4,120.69 "," $5,498.16 "," $5,320.80 "," $5,320.80 "," $4,729.60 "," $4,729.60 ", $881.43 ," $5,458.55 "," $5,616.40 "," $5,320.80 "," $5,320.80 "," $5,320.80 "," $5,498.16 "," $5,675.52 "," $4,853.59 "," $5,025.20 "," $4,552.93 "," $4,881.52 ", N/A ," $4,226.68 "," $4,226.68 "," $5,616.40 "," $4,967.85 ", $816.69 ," $5,675.52 "
Exc Skin Malig 0.6-1cm Remaindr Body,CPT® 11621,N/A,N/A,N/A, $967.00 , $628.55 , $478.45 , $143.68 , $205.43 , $408.92 , $401.24 , $899.31 , $870.30 , $870.30 , $773.60 , $773.60 , $205.43 , $892.83 , $918.65 , $870.30 , $870.30 , $870.30 , $899.31 , $928.32 , $522.79 , $821.95 , $797.48 , $525.32 , N/A , $416.89 , $416.89 , $918.65 , $483.46 , $143.68 , $928.32 
 Egfr Gene Analysis Rml 81235 ,CPT® 81235,0300 - LABORATORY,N/A,N/A," $2,091.00 "," $1,359.15 "," $1,756.44 ", $331.07 , $269.29 ," $1,689.53 "," $1,881.90 "," $1,770.24 "," $1,881.90 "," $1,881.90 "," $1,881.90 "," $1,777.35 ", $264.01 ," $1,930.62 "," $1,986.45 "," $1,777.35 "," $1,944.63 "," $1,944.63 "," $1,986.45 "," $2,007.36 "," $1,710.86 "," $1,881.90 "," $1,777.35 "," $1,651.89 ", N/A ," $1,692.25 "," $1,692.25 "," $1,986.45 "," $1,794.29 ", $264.01 ," $2,007.36 "
"Auditory Evoked Potential, Limited",CPT® 92586,N/A,N/A,N/A, $356.00 , $231.40 , N/A , N/A , N/A , $182.87 , $200.29 , $331.08 , $320.40 , $320.40 , $284.80 , $284.80 , N/A , $328.69 , $338.20 , $320.40 , $320.40 , $320.40 , $331.08 , $341.76 , N/A , $302.60 , N/A , N/A , N/A , N/A , N/A , $338.20 , N/A , $182.87 , $341.76 
 Appl Cst Elbw Fngr Short Arm -Urgent Care ,CPT® 29075,0761 - TREATMENT ROOM,N/A,N/A, $527.00 , $342.55 , $442.68 , $59.32 , $54.80 , $425.82 , $474.30 , $446.16 , $474.30 , $474.30 , $474.30 , $447.95 , $53.73 , $486.58 , $500.65 , $447.95 , $490.11 , $490.11 , $500.65 , $505.92 , $431.19 , $474.30 , $447.95 , $416.33 , N/A , $426.50 , $426.50 , $500.65 , $452.22 , $53.73 , $505.92 
"Insert Vert Fix Dev,Post,7-12 Sgmts",CPT® 22843,N/A,N/A,N/A," $5,661.00 "," $3,679.65 "," $4,690.79 ", $729.92 ," $1,166.89 "," $3,909.14 "," $3,790.86 "," $5,264.73 "," $5,094.90 "," $5,094.90 "," $4,528.80 "," $4,528.80 "," $1,166.89 "," $5,226.80 "," $5,377.95 "," $5,094.90 "," $5,094.90 "," $5,094.90 "," $5,264.73 "," $5,434.56 "," $4,387.91 "," $4,811.85 "," $4,274.62 "," $4,509.60 ", N/A ," $3,985.42 "," $3,985.42 "," $5,377.95 "," $4,684.30 ", $729.92 ," $5,434.56 "
 Fac Blastomyces Antibody ,CPT® 86612,0300 - LABORATORY,N/A,N/A, $141.00 , $91.65 , $118.44 , $13.16 , $8.07 , $113.93 , $126.90 , $119.37 , $126.90 , $126.90 , $126.90 , $119.85 , $7.91 , $130.19 , $133.95 , $119.85 , $131.13 , $131.13 , $133.95 , $135.36 , $115.37 , $126.90 , $119.85 , $111.39 , N/A , $114.11 , $114.11 , $133.95 , $120.99 , $7.91 , $135.36 
"Trim Hyperkeratotic Skin Lesion, One",11055,N/A,N/A,N/A, $206.00 , $133.90 , $51.44 , $15.16 , $26.33 , $45.02 , $42.27 , $191.58 , $185.40 , $185.40 , $164.80 , $164.80 , $26.33 , $190.20 , $195.70 , $185.40 , $185.40 , $185.40 , $191.58 , $197.76 , $56.75 , $175.10 , $82.07 , $57.83 , N/A , $45.91 , $45.91 , $195.70 , $53.23 , $15.16 , $197.76 
 Fac Gastrointestinal Tract Imaging Esophagus ,CPT® 91111,0360 - OR SERVICES,N/A,N/A," $4,498.00 "," $2,923.70 "," $3,778.32 ", $844.03 , $603.38 ," $3,634.38 "," $4,048.20 "," $3,808.01 "," $4,048.20 "," $4,048.20 "," $4,048.20 "," $3,823.30 ", $591.55 ," $4,153.00 "," $4,273.10 "," $3,823.30 "," $4,183.14 "," $4,183.14 "," $4,273.10 "," $4,318.08 "," $3,680.26 "," $4,048.20 "," $3,823.30 "," $3,553.42 ", N/A ," $3,640.23 "," $3,640.23 "," $4,273.10 "," $3,859.73 ", $591.55 ," $4,318.08 "
 HALOPERIDOL 0.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,51079-0733-20,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Pro Myocardial Spect Multiple Studies ,CPT® 78452,0974 - PRO FEE/NUC MED,N/A,N/A," $1,016.00 ", $660.40 ," $2,536.80 ", $430.43 , $323.37 ," $2,327.23 "," $2,593.36 ", $944.88 , $914.40 , $914.40 , $812.80 , $812.80 , $323.37 , $938.07 , $965.20 , $914.40 , $914.40 , $914.40 , $944.88 , $975.36 ," $2,630.24 ", $863.60 ," $2,842.84 "," $3,192.61 ", N/A ," $2,372.64 "," $2,372.64 ", $965.20 ," $2,746.39 ", $323.37 ," $3,192.61 "
"Closed Rx Tibia Shaft Fx,Manipulatn",27752,N/A,N/A,N/A," $2,050.00 "," $1,332.50 "," $3,010.67 ", $474.05 , $502.11 ," $2,384.99 "," $2,399.89 "," $1,906.50 "," $1,845.00 "," $1,845.00 "," $1,640.00 "," $1,640.00 ", $502.11 ," $1,892.77 "," $1,947.50 "," $1,845.00 "," $1,845.00 "," $1,845.00 "," $1,906.50 "," $1,968.00 "," $2,794.53 "," $1,742.50 "," $2,643.98 "," $2,805.41 ", N/A ," $2,431.52 "," $2,431.52 "," $1,947.50 "," $2,857.92 ", $474.05 ," $3,010.67 "
Menb-4c Recombnt Prot & Outer Memb Vesic Vacc Im,CPT® 90620,N/A,N/A,N/A, $238.00 , $154.70 , N/A , N/A , $217.25 , N/A , N/A , $221.34 , $214.20 , $214.20 , $190.40 , $190.40 , $217.25 , $219.75 , $226.10 , $214.20 , $214.20 , $214.20 , $221.34 , $228.48 , N/A , $202.30 , $190.40 , $330.74 , N/A , N/A , N/A , $226.10 , N/A , $190.40 , $330.74 
 Fac Set Radiation Therapy Field ,CPT® 77290,0333 - RADIATION RX,N/A,N/A," $5,175.00 "," $3,363.75 "," $4,347.00 ", $445.32 , $340.51 ," $4,181.40 "," $4,657.50 "," $4,381.16 "," $4,657.50 "," $4,657.50 "," $4,657.50 "," $4,398.75 ", $333.83 ," $4,778.08 "," $4,916.25 "," $4,398.75 "," $4,812.75 "," $4,812.75 "," $4,916.25 "," $4,968.00 "," $4,234.19 "," $4,657.50 "," $4,398.75 "," $4,088.25 ", N/A ," $4,188.13 "," $4,188.13 "," $4,916.25 "," $4,440.67 ", $333.83 ," $4,968.00 "
 Fac Icar Catheter Ablation Arrhythmia Add On ,CPT® 93655,0481 - CARDIAC CATH LAB,N/A,N/A," $12,266.00 "," $7,972.90 "," $10,303.44 ", $280.41 , $309.02 ," $9,910.93 "," $11,039.40 "," $10,384.40 "," $11,039.40 "," $11,039.40 "," $11,039.40 "," $10,426.10 ", $302.96 ," $11,325.20 "," $11,652.70 "," $10,426.10 "," $11,407.38 "," $11,407.38 "," $11,652.70 "," $11,775.36 "," $10,036.04 "," $11,039.40 "," $10,426.10 "," $9,690.14 ", N/A ," $9,926.87 "," $9,926.87 "," $11,652.70 "," $10,525.45 ", $280.41 ," $11,775.36 "
 HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,43598-0721-01,1 tablet, $21.00 , $13.65 , $17.64 , N/A , N/A , $16.97 , $18.90 , $17.78 , $18.90 , $18.90 , $18.90 , $17.85 , N/A , $19.39 , $19.95 , $17.85 , $19.53 , $19.53 , $19.95 , $20.16 , $17.18 , $18.90 , $17.85 , $16.59 , N/A , $17.00 , $17.00 , $19.95 , $18.02 , $16.59 , $20.16 
 Removal Devitalized Tissue >20cm ,CPT® 97598,0981 - PRO FEE/ER,N/A,N/A, $221.00 , $143.65 , $56.54 , $23.51 , $55.15 , $26.06 , $22.25 , $205.53 , $198.90 , $198.90 , $176.80 , $176.80 , $55.15 , $204.05 , $209.95 , $198.90 , $198.90 , $198.90 , $205.53 , $212.16 , $75.48 , $187.85 , $33.45 , $25.64 , N/A , $26.57 , $26.57 , $209.95 , $29.54 , $22.25 , $212.16 
 DOFETILIDE 125 MCG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-6681-08,1 capsule, $31.83 , $20.69 , $26.74 , N/A , N/A , $25.72 , $28.65 , $26.95 , $28.65 , $28.65 , $28.65 , $27.06 , N/A , $29.39 , $30.24 , $27.06 , $29.60 , $29.60 , $30.24 , $30.56 , $26.04 , $28.65 , $27.06 , $25.15 , N/A , $25.76 , $25.76 , $30.24 , $27.31 , $25.15 , $30.56 
"Removal of Lung,Bilobectomy",CPT® 32482,N/A,N/A,N/A," $15,266.00 "," $9,922.90 "," $8,214.80 "," $1,432.43 "," $1,478.34 "," $5,985.55 "," $5,851.92 "," $14,197.38 "," $13,739.40 "," $13,739.40 "," $12,212.80 "," $12,212.80 "," $1,478.34 "," $14,095.10 "," $14,502.70 "," $13,739.40 "," $13,739.40 "," $13,739.40 "," $14,197.38 "," $14,655.36 "," $7,947.79 "," $12,976.10 "," $8,460.03 "," $7,844.15 ", N/A ," $6,102.34 "," $6,102.34 "," $14,502.70 "," $7,186.78 "," $1,432.43 "," $14,655.36 "
Perq Nl/Pl Lithotrp Complex >2 Cm Mlt Locations,CPT® 50081,N/A,N/A,N/A," $8,891.00 "," $5,779.15 "," $6,900.40 "," $1,068.84 "," $1,284.60 "," $6,248.73 "," $5,807.64 "," $8,268.63 "," $8,001.90 "," $8,001.90 "," $7,112.80 "," $7,112.80 "," $1,284.60 "," $8,209.06 "," $8,446.45 "," $8,001.90 "," $8,001.90 "," $8,001.90 "," $8,268.63 "," $8,535.36 "," $6,927.84 "," $7,557.35 "," $6,577.84 "," $7,852.04 ", N/A ," $6,370.66 "," $6,370.66 "," $8,446.45 "," $7,487.78 "," $1,068.84 "," $8,535.36 "
 PROPRANOLOL HCL 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6550-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"US,Preg Uter,Fet & Mat,+ Detl Fet,Addl",CPT® 76812,N/A,N/A,N/A," $1,462.00 ", $950.30 ," $1,101.88 ", $190.57 , $131.67 , $991.81 ," $1,124.76 "," $1,359.66 "," $1,315.80 "," $1,315.80 "," $1,169.60 "," $1,169.60 ", $131.67 ," $1,349.86 "," $1,388.90 "," $1,315.80 "," $1,315.80 "," $1,315.80 "," $1,359.66 "," $1,403.52 "," $1,107.79 "," $1,242.70 "," $1,224.96 "," $1,147.62 ", N/A ," $1,011.16 "," $1,011.16 "," $1,388.90 "," $1,170.44 ", $131.67 ," $1,403.52 "
 MRI Hip Knee or Ankle - Lh ,CPT® 73721,0972 - PRO FEE/RAD/DX,N/A,N/A, $801.00 , $520.65 ," $1,447.81 ", $207.55 , $411.63 ," $1,390.85 "," $1,461.33 ", $744.93 , $720.90 , $720.90 , $640.80 , $640.80 , $411.63 , $739.56 , $760.95 , $720.90 , $720.90 , $720.90 , $744.93 , $768.96 ," $2,529.09 ", $680.85 ," $1,596.69 "," $2,191.78 ", N/A ," $1,417.99 "," $1,417.99 ", $760.95 ," $1,668.22 ", $207.55 ," $2,529.09 "
Fusion of Tibiofibular Joint,CPT® 27871,N/A,N/A,N/A," $4,439.00 "," $2,885.35 "," $4,206.61 ", $660.68 , $427.06 ," $3,310.58 "," $3,312.11 "," $4,128.27 "," $3,995.10 "," $3,995.10 "," $3,551.20 "," $3,551.20 ", $427.06 ," $4,098.53 "," $4,217.05 "," $3,995.10 "," $3,995.10 "," $3,995.10 "," $4,128.27 "," $4,261.44 "," $3,904.03 "," $3,773.15 "," $3,657.33 "," $3,903.46 ", N/A ," $3,375.17 "," $3,375.17 "," $4,217.05 "," $3,967.04 ", $427.06 ," $4,261.44 "
 ISOSORBIDE MONONITRATE ER 30 MG PO TB24 ,HCPCS RXC637,0250 - PHARMACY,00904-6449-61,1 tablet, $8.53 , $5.54 , $7.17 , N/A , N/A , $6.89 , $7.68 , $7.22 , $7.68 , $7.68 , $7.68 , $7.25 , N/A , $7.88 , $8.10 , $7.25 , $7.93 , $7.93 , $8.10 , $8.19 , $6.98 , $7.68 , $7.25 , $6.74 , N/A , $6.90 , $6.90 , $8.10 , $7.32 , $6.74 , $8.19 
 ROPINIROLE HCL 1 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6374-61,1 tablet, $3.50 , $2.28 , $2.94 , N/A , N/A , $2.83 , $3.15 , $2.96 , $3.15 , $3.15 , $3.15 , $2.98 , N/A , $3.23 , $3.33 , $2.98 , $3.26 , $3.26 , $3.33 , $3.36 , $2.86 , $3.15 , $2.98 , $2.77 , N/A , $2.83 , $2.83 , $3.33 , $3.00 , $2.77 , $3.36 
Open Rx Femur Fx+Plate/Screw,CPT® 27507,N/A,N/A,N/A," $4,468.00 "," $2,904.20 "," $5,842.92 ", $913.43 , $865.46 ," $4,694.10 "," $4,649.94 "," $4,155.24 "," $4,021.20 "," $4,021.20 "," $3,574.40 "," $3,574.40 ", $865.46 ," $4,125.30 "," $4,244.60 "," $4,021.20 "," $4,021.20 "," $4,021.20 "," $4,155.24 "," $4,289.28 "," $5,449.56 "," $3,797.80 "," $5,147.02 "," $5,519.11 ", N/A ," $4,785.68 "," $4,785.68 "," $4,244.60 "," $5,624.88 ", $865.46 ," $5,842.92 "
"Revision Spinal Neurostim Electrode Perc Array, Incl Fluoro",CPT® 63663,N/A,N/A,N/A," $5,751.00 "," $3,738.15 "," $2,205.42 ", $429.55 , $673.61 ," $2,528.06 "," $2,520.03 "," $5,348.43 "," $5,175.90 "," $5,175.90 "," $4,600.80 "," $4,600.80 ", $673.61 ," $5,309.90 "," $5,463.45 "," $5,175.90 "," $5,175.90 "," $5,175.90 "," $5,348.43 "," $5,520.96 "," $2,396.22 "," $4,888.35 "," $2,485.20 "," $2,696.90 ", N/A ," $2,577.39 "," $2,577.39 "," $5,463.45 "," $2,764.92 ", $429.55 ," $5,520.96 "
"Cystoscopy,Intern Urethrotomy,Female",CPT® 52270,N/A,N/A,N/A," $2,575.00 "," $1,673.75 ", $973.30 , $171.04 , $307.34 , $891.73 , $828.57 ," $2,394.75 "," $2,317.50 "," $2,317.50 "," $2,060.00 "," $2,060.00 ", $307.34 ," $2,377.50 "," $2,446.25 "," $2,317.50 "," $2,317.50 "," $2,317.50 "," $2,394.75 "," $2,472.00 ", $980.86 ," $2,188.75 ", $938.42 ," $1,120.00 ", N/A , $909.13 , $909.13 ," $2,446.25 "," $1,068.55 ", $171.04 ," $2,472.00 "
 RIVAROXABAN 20 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,50458-0579-10,1 tablet, $111.46 , $72.45 , $93.63 , N/A , N/A , $90.06 , $100.31 , $94.36 , $100.31 , $100.31 , $100.31 , $94.74 , N/A , $102.91 , $105.89 , $94.74 , $103.66 , $103.66 , $105.89 , $107.00 , $91.20 , $100.31 , $94.74 , $88.05 , N/A , $90.20 , $90.20 , $105.89 , $95.64 , $88.05 , $107.00 
Full Field Electroretinography W/I&R,CPT® 92273,N/A,N/A,N/A, $420.00 , $273.00 , $275.20 , $124.65 , $106.90 , $218.36 , N/A , $390.60 , $378.00 , $378.00 , $336.00 , $336.00 , $106.90 , $387.79 , $399.00 , $378.00 , $378.00 , $378.00 , $390.60 , $403.20 , $400.20 , $357.00 , $381.65 , $280.94 , N/A , $222.62 , $222.62 , $399.00 , $264.82 , $106.90 , $403.20 
Transferrin,CPT® 84466,N/A,N/A,N/A, $169.00 , $109.85 , N/A , $13.02 , $13.02 , $72.25 , $86.41 , $157.17 , $152.10 , $152.10 , $135.20 , $135.20 , $13.02 , $156.04 , $160.55 , $152.10 , $152.10 , $152.10 , $157.17 , $162.24 , $85.20 , $143.65 , $84.34 , $46.29 , N/A , $67.43 , $67.43 , $160.55 , $73.69 , $13.02 , $162.24 
 Pro Cltx Carpl Scphd Navclr Fx W/O Mnpj ,CPT® 25622,0981 - PRO FEE/ER,N/A,N/A," $1,335.00 ", $867.75 ," $1,769.63 ", $281.15 , $206.19 ," $1,331.19 "," $1,359.46 "," $1,241.55 "," $1,201.50 "," $1,201.50 "," $1,068.00 "," $1,068.00 ", $206.19 ," $1,232.61 "," $1,268.25 "," $1,201.50 "," $1,201.50 "," $1,201.50 "," $1,241.55 "," $1,281.60 "," $1,628.51 "," $1,134.75 "," $1,491.48 "," $1,596.88 ", N/A ," $1,357.16 "," $1,357.16 "," $1,268.25 "," $1,595.16 ", $206.19 ," $1,769.63 "
 Pro CT Orbit/Ear/Fossa W/O Dye ,CPT® 70480,0972 - PRO FEE/RAD/DX,N/A,N/A, $764.00 , $496.60 ," $1,128.19 ", $162.01 , $255.88 ," $1,110.49 "," $1,461.33 ", $710.52 , $687.60 , $687.60 , $611.20 , $611.20 , $255.88 , $705.40 , $725.80 , $687.60 , $687.60 , $687.60 , $710.52 , $733.44 , $945.11 , $649.40 ," $1,592.84 "," $1,511.67 ", N/A ," $1,132.15 "," $1,132.15 ", $725.80 ," $1,310.50 ", $162.01 ," $1,592.84 "
 Gadoteridol(Prohance Multipac) per Ml ,HCPCS A9576,0255 - DRUGS/RADIOLOGY,N/A,N/A, $7.00 , $4.55 , $5.88 , $1.48 , $1.44 , $5.66 , $6.30 , $5.93 , $6.30 , $6.30 , $6.30 , $5.95 , $1.41 , $6.46 , $6.65 , $5.95 , $6.51 , $6.51 , $6.65 , $6.72 , $5.73 , $6.30 , $5.95 , $5.53 , N/A , $5.67 , $5.67 , $6.65 , $6.01 , $1.41 , $6.72 
 BACITRACIN 500 UNIT/GM OP OINT ,HCPCS RXC637,0250 - PHARMACY,00574-4022-35,3.5 gram, $666.20 , $433.03 , $559.61 , N/A , N/A , $538.29 , $599.58 , $564.00 , $599.58 , $599.58 , $599.58 , $566.27 , N/A , $615.10 , $632.89 , $566.27 , $619.57 , $619.57 , $632.89 , $639.55 , $545.08 , $599.58 , $566.27 , $526.30 , N/A , $539.16 , $539.16 , $632.89 , $571.67 , $526.30 , $639.55 
Change of Cystostomy Tube,CPT® 51710,N/A,N/A,N/A, $895.00 , $581.75 , $428.61 , $75.87 , $125.78 , $392.45 , $365.81 , $832.35 , $805.50 , $805.50 , $716.00 , $716.00 , $125.78 , $826.35 , $850.25 , $805.50 , $805.50 , $805.50 , $832.35 , $859.20 , $429.64 , $760.75 , $413.90 , $492.61 , N/A , $400.11 , $400.11 , $850.25 , $470.28 , $75.87 , $859.20 
 Pro Exploration of Knee Joint ,CPT® 27310,0975 - PRO FEE/OR,N/A,N/A," $2,796.00 "," $1,817.40 "," $4,454.78 ", $698.89 , $629.61 ," $3,520.59 "," $3,510.34 "," $2,600.28 "," $2,516.40 "," $2,516.40 "," $2,236.80 "," $2,236.80 ", $629.61 ," $2,581.55 "," $2,656.20 "," $2,516.40 "," $2,516.40 "," $2,516.40 "," $2,600.28 "," $2,684.16 "," $4,139.94 "," $2,376.60 "," $3,876.77 "," $4,152.70 ", N/A ," $3,589.29 "," $3,589.29 "," $2,656.20 "," $4,218.68 ", $629.61 ," $4,454.78 "
 Fac Assay of Alcohol (Ethanol) Breath ,CPT® 82075,0300 - LABORATORY,N/A,N/A, $41.00 , $26.65 , $34.44 , $30.60 , $16.73 , $33.13 , $36.90 , $34.71 , $36.90 , $36.90 , $36.90 , $34.85 , $16.40 , $37.86 , $38.95 , $34.85 , $38.13 , $38.13 , $38.95 , $39.36 , $33.55 , $36.90 , $34.85 , $32.39 , N/A , $33.18 , $33.18 , $38.95 , $35.18 , $16.40 , $39.36 
 Pro Injection Aa&/Strd Trigeminal Nerve Each Branch ,CPT® 64400,0982 - PRO FEE/OUTPT,N/A,N/A, $804.00 , $522.60 , $237.17 , $46.38 , $95.27 , $389.08 , $370.43 , $747.72 , $723.60 , $723.60 , $643.20 , $643.20 , $95.27 , $742.33 , $763.80 , $723.60 , $723.60 , $723.60 , $747.72 , $771.84 , $254.96 , $683.40 , $367.52 , $417.54 , N/A , $396.67 , $396.67 , $763.80 , $425.54 , $46.38 , $771.84 
Release MC-P Jt Contracture,CPT® 26520,N/A,N/A,N/A," $4,444.00 "," $2,888.60 "," $4,327.12 ", $671.13 , $537.90 ," $3,095.08 "," $3,157.14 "," $4,132.92 "," $3,999.60 "," $3,999.60 "," $3,555.20 "," $3,555.20 ", $537.90 ," $4,103.15 "," $4,221.80 "," $3,999.60 "," $3,999.60 "," $3,999.60 "," $4,132.92 "," $4,266.24 "," $3,991.40 "," $3,777.40 "," $3,453.95 "," $3,697.18 ", N/A ," $3,155.46 "," $3,155.46 "," $4,221.80 "," $3,708.79 ", $537.90 ," $4,327.12 "
"Closed Rx Trimalleolar Fx,Manip",CPT® 27818,N/A,N/A,N/A," $3,206.00 "," $2,083.90 "," $2,689.44 ", $425.99 , $461.04 ," $2,091.91 "," $2,115.33 "," $2,981.58 "," $2,885.40 "," $2,885.40 "," $2,564.80 "," $2,564.80 ", $461.04 ," $2,960.10 "," $3,045.70 "," $2,885.40 "," $2,885.40 "," $2,885.40 "," $2,981.58 "," $3,077.76 "," $2,482.99 "," $2,725.10 "," $2,326.42 "," $2,473.59 ", N/A ," $2,132.73 "," $2,132.73 "," $3,045.70 "," $2,506.70 ", $425.99 ," $3,077.76 "
"Revision of Eyelid,> 1/4 Lid Margin",67966,N/A,N/A,N/A," $7,010.00 "," $4,556.50 "," $4,017.85 ", $630.25 , $618.40 ," $3,722.71 "," $3,506.99 "," $6,519.30 "," $6,309.00 "," $6,309.00 "," $5,608.00 "," $5,608.00 ", $618.40 ," $6,472.33 "," $6,659.50 "," $6,309.00 "," $6,309.00 "," $6,309.00 "," $6,519.30 "," $6,729.60 "," $5,520.86 "," $5,958.50 "," $3,639.49 "," $4,720.30 ", N/A ," $3,795.34 "," $3,795.34 "," $6,659.50 "," $4,189.59 ", $618.40 ," $6,729.60 "
Inject Rx Other Periph Nerve,64640,N/A,N/A,N/A," $1,489.00 ", $967.85 , $587.34 , $114.17 , $160.13 , $520.91 , $518.16 ," $1,384.77 "," $1,340.10 "," $1,340.10 "," $1,191.20 "," $1,191.20 ", $160.13 ," $1,374.79 "," $1,414.55 "," $1,340.10 "," $1,340.10 "," $1,340.10 "," $1,384.77 "," $1,429.44 ", $635.03 ," $1,265.65 ", $503.11 , $565.00 , N/A , $531.08 , $531.08 ," $1,414.55 ", $569.71 , $114.17 ," $1,429.44 "
"Fungus Identification, Mold",CPT® 87107,N/A,N/A,N/A, $150.00 , $97.50 , N/A , $10.53 , $10.53 , $58.41 , $69.87 , $139.50 , $135.00 , $135.00 , $120.00 , $120.00 , $10.53 , $138.50 , $142.50 , $135.00 , $135.00 , $135.00 , $139.50 , $144.00 , $68.91 , $127.50 , $68.12 , $37.42 , N/A , $54.51 , $54.51 , $142.50 , $59.57 , $10.53 , $144.00 
 HEPATITIS A VACCINE 720 EL U/0.5ML IM SUSP ,HCPCS 90633,0636 - DRUGS REQUIRING DETAILED CODIN,58160-0825-52,0.5 mL, $226.84 , $147.45 , $190.55 , N/A , $15.30 , $183.29 , $204.16 , $192.04 , $204.16 , $204.16 , $204.16 , $192.81 , $15.00 , $209.44 , $215.50 , $192.81 , $210.96 , $210.96 , $215.50 , $217.77 , $185.60 , $204.16 , $192.81 , $179.20 , N/A , $183.58 , $183.58 , $215.50 , $194.65 , $15.00 , $217.77 
 Fac Revj Lxtr Artl Byp Opn W/Sgmtl Vein Interpos ,CPT® 35881,0360 - OR SERVICES,N/A,N/A," $2,887.00 "," $1,876.55 "," $2,425.08 ", $912.27 ," $1,078.16 "," $2,332.70 "," $2,598.30 "," $2,444.13 "," $2,598.30 "," $2,598.30 "," $2,598.30 "," $2,453.95 "," $1,057.02 "," $2,665.57 "," $2,742.65 "," $2,453.95 "," $2,684.91 "," $2,684.91 "," $2,742.65 "," $2,771.52 "," $2,362.14 "," $2,598.30 "," $2,453.95 "," $2,280.73 ", N/A ," $2,336.45 "," $2,336.45 "," $2,742.65 "," $2,477.33 ", $912.27 ," $2,771.52 "
Incision of Foot/Toe Fascia,28008,N/A,N/A,N/A," $2,884.00 "," $1,874.60 "," $1,833.20 ", $287.22 , $153.67 ," $1,449.07 "," $1,435.73 "," $2,682.12 "," $2,595.60 "," $2,595.60 "," $2,307.20 "," $2,307.20 ", $153.67 ," $2,662.80 "," $2,739.80 "," $2,595.60 "," $2,595.60 "," $2,595.60 "," $2,682.12 "," $2,768.64 "," $1,706.91 "," $2,451.40 "," $1,552.14 "," $1,725.11 ", N/A ," $1,477.34 "," $1,477.34 "," $2,739.80 "," $1,736.38 ", $153.67 ," $2,768.64 "
 Pt Non Selective Debridement ,CPT® 97602,0761 - TREATMENT ROOM,N/A,N/A, $169.00 , $109.85 , $141.96 , N/A , N/A , $136.55 , $152.10 , $143.08 , $152.10 , $152.10 , $152.10 , $143.65 , N/A , $156.04 , $160.55 , $143.65 , $157.17 , $157.17 , $160.55 , $162.24 , $138.28 , $152.10 , $143.65 , $133.51 , N/A , $136.77 , $136.77 , $160.55 , $145.02 , $133.51 , $162.24 
Laryngoscopy Flexible Diagnostic,CPT® 31575,N/A,N/A,N/A, $713.00 , $463.45 , $364.67 , $65.21 , $98.45 , $294.56 , $382.52 , $663.09 , $641.70 , $641.70 , $570.40 , $570.40 , $98.45 , $658.31 , $677.35 , $641.70 , $641.70 , $641.70 , $663.09 , $684.48 , $347.16 , $606.05 , $406.77 , $341.75 , N/A , $300.30 , $300.30 , $677.35 , $353.68 , $65.21 , $684.48 
"Cystoscopy,Rx Female Urethral Synd",CPT® 52285,N/A,N/A,N/A," $2,010.00 "," $1,306.50 "," $1,047.19 ", $184.38 , $184.42 , $961.78 , $893.24 ," $1,869.30 "," $1,809.00 "," $1,809.00 "," $1,608.00 "," $1,608.00 ", $184.42 ," $1,855.83 "," $1,909.50 "," $1,809.00 "," $1,809.00 "," $1,809.00 "," $1,869.30 "," $1,929.60 "," $1,055.15 "," $1,708.50 "," $1,015.13 "," $1,204.42 ", N/A , $980.54 , $980.54 ," $1,909.50 "," $1,152.48 ", $184.38 ," $1,929.60 "
"Removal Testis,Simple",54520,N/A,N/A,N/A," $2,806.00 "," $1,823.90 "," $1,453.43 ", $313.50 , $344.66 ," $1,044.20 "," $1,061.91 "," $2,609.58 "," $2,525.40 "," $2,525.40 "," $2,244.80 "," $2,244.80 ", $344.66 ," $2,590.78 "," $2,665.70 "," $2,525.40 "," $2,525.40 "," $2,525.40 "," $2,609.58 "," $2,693.76 "," $1,362.34 "," $2,385.10 "," $1,700.21 "," $1,576.27 ", N/A ," $1,064.58 "," $1,064.58 "," $2,665.70 "," $1,275.96 ", $313.50 ," $2,693.76 "
"Dest,Choroid Lesion,Photocoag",CPT® 67220,N/A,N/A,N/A," $4,887.00 "," $3,176.55 "," $3,063.71 ", $481.28 , $643.29 ," $2,831.24 "," $2,670.47 "," $4,544.91 "," $4,398.30 "," $4,398.30 "," $3,909.60 "," $3,909.60 ", $643.29 ," $4,512.17 "," $4,642.65 "," $4,398.30 "," $4,398.30 "," $4,398.30 "," $4,544.91 "," $4,691.52 "," $4,209.99 "," $4,153.95 "," $2,763.52 "," $3,599.77 ", N/A ," $2,886.48 "," $2,886.48 "," $4,642.65 "," $3,186.29 ", $481.28 ," $4,691.52 "
"Reprogramming,Programmable CSF Shunt",CPT® 62252,N/A,N/A,N/A, $397.00 , $258.05 , $391.09 , $77.88 , $88.34 , $462.17 , $462.98 , $369.21 , $357.30 , $357.30 , $317.60 , $317.60 , $88.34 , $366.55 , $377.15 , $357.30 , $357.30 , $357.30 , $369.21 , $381.12 , $418.97 , $337.45 , $463.86 , $485.02 , N/A , $471.19 , $471.19 , $377.15 , $505.47 , $77.88 , $505.47 
 Fac Brncspsm Provocation Eval Mlt Spmtry W/Admn Agt ,CPT® 94070,0460 - PULMONARY FUNC,N/A,N/A, $441.00 , $286.65 , $370.44 , $60.14 , $55.88 , $356.33 , $396.90 , $373.35 , $396.90 , $396.90 , $396.90 , $374.85 , $54.78 , $407.18 , $418.95 , $374.85 , $410.13 , $410.13 , $418.95 , $423.36 , $360.83 , $396.90 , $374.85 , $348.39 , N/A , $356.90 , $356.90 , $418.95 , $378.42 , $54.78 , $423.36 
" Fac Column Chromotography, Quant ",CPT® 82542,0301 - LAB/CHEMISTRY,N/A,N/A, $292.00 , $189.80 , $245.28 , $24.57 , $24.57 , $235.94 , $262.80 , $247.21 , $262.80 , $262.80 , $262.80 , $248.20 , $24.09 , $269.60 , $277.40 , $248.20 , $271.56 , $271.56 , $277.40 , $280.32 , $238.91 , $262.80 , $248.20 , $230.68 , N/A , $236.32 , $236.32 , $277.40 , $250.57 , $24.09 , $280.32 
 Pro Anes Patient Status ,Custom 00999,0964 - PRO FEE/ANES CRNA,N/A,N/A, $22.00 , $14.30 , N/A , N/A , N/A , N/A , N/A , $20.46 , $19.80 , $19.80 , $17.60 , $17.60 , N/A , $20.31 , $20.90 , $19.80 , $19.80 , $19.80 , $20.46 , $21.12 , N/A , $18.70 , N/A , N/A , N/A , N/A , N/A , $20.90 , N/A , $17.60 , $21.12 
 Fac Angiotensin I Enzyme Test ,CPT® 82164,0301 - LAB/CHEMISTRY,N/A,N/A, $205.00 , $133.25 , $172.20 , $14.89 , $14.89 , $165.64 , $184.50 , $173.55 , $184.50 , $184.50 , $184.50 , $174.25 , $14.60 , $189.28 , $194.75 , $174.25 , $190.65 , $190.65 , $194.75 , $196.80 , $167.73 , $184.50 , $174.25 , $161.95 , N/A , $165.91 , $165.91 , $194.75 , $175.91 , $14.60 , $196.80 
 Fac Destruction Neurolytic Agt Genicular Nerve W/Img ,CPT® 64624,0360 - OR SERVICES,N/A,N/A," $2,293.00 "," $1,490.45 "," $1,926.12 ", $140.79 , $321.99 ," $1,852.74 "," $2,063.70 "," $1,941.25 "," $2,063.70 "," $2,063.70 "," $2,063.70 "," $1,949.05 ", $315.68 ," $2,117.13 "," $2,178.35 "," $1,949.05 "," $2,132.49 "," $2,132.49 "," $2,178.35 "," $2,201.28 "," $1,876.13 "," $2,063.70 "," $1,949.05 "," $1,811.47 ", N/A ," $1,855.72 "," $1,855.72 "," $2,178.35 "," $1,967.62 ", $140.79 ," $2,201.28 "
 Pro Drain External Ear Lesion ,CPT® 69005,0981 - PRO FEE/ER,N/A,N/A," $1,033.00 ", $671.45 , $758.50 , $155.08 , $72.58 , $755.35 , $776.05 , $960.69 , $929.70 , $929.70 , $826.40 , $826.40 , $72.58 , $953.77 , $981.35 , $929.70 , $929.70 , $929.70 , $960.69 , $991.68 , $816.81 , $878.05 , $847.43 , $757.85 , N/A , $770.09 , $770.09 , $981.35 , $879.31 , $72.58 , $991.68 
X-Ray Thoracic Spine 4 Vw,CPT® 72074,N/A,N/A,N/A, $491.00 , $319.15 , $251.78 , $43.67 , $42.55 , $184.85 , $234.92 , $456.63 , $441.90 , $441.90 , $392.80 , $392.80 , $42.55 , $453.34 , $466.45 , $441.90 , $441.90 , $441.90 , $456.63 , $471.36 , $245.20 , $417.35 , $258.09 , $196.46 , N/A , $188.45 , $188.45 , $466.45 , $218.14 , $42.55 , $471.36 
 EUCERIN EX CREA ,HCPCS RXC637,0250 - PHARMACY,80681-0155-00,113 gram, $16.84 , $10.95 , $14.15 , N/A , N/A , $13.61 , $15.16 , $14.26 , $15.16 , $15.16 , $15.16 , $14.31 , N/A , $15.55 , $16.00 , $14.31 , $15.66 , $15.66 , $16.00 , $16.17 , $13.78 , $15.16 , $14.31 , $13.30 , N/A , $13.63 , $13.63 , $16.00 , $14.45 , $13.30 , $16.17 
 Pro Inpt Telehealth Consult 30m ,HCPCS G0425,0987 - PRO FEE/HOS VIS,N/A,N/A, $320.00 , $208.00 , $188.04 , $89.66 , N/A , $186.32 , N/A , $297.60 , $288.00 , $288.00 , $256.00 , $256.00 , N/A , $295.46 , $304.00 , $288.00 , $288.00 , $288.00 , $297.60 , $307.20 , $278.27 , $272.00 , $189.44 , $375.40 , N/A , $189.96 , $189.96 , $304.00 , $237.43 , $89.66 , $375.40 
Debridement-Skin & Tissue,11042,N/A,N/A,N/A, $502.00 , $326.30 , $192.85 , $57.23 , $63.58 , $169.46 , $164.75 , $466.86 , $451.80 , $451.80 , $401.60 , $401.60 , $63.58 , $463.50 , $476.90 , $451.80 , $451.80 , $451.80 , $466.86 , $481.92 , $211.84 , $426.70 , $326.48 , $218.43 , N/A , $172.76 , $172.76 , $476.90 , $200.35 , $57.23 , $481.92 
Arterial Catheterization,CPT® 36620,N/A,N/A,N/A, $606.00 , $393.90 , $273.33 , $42.54 , $73.68 , $223.80 , $217.36 , $563.58 , $545.40 , $545.40 , $484.80 , $484.80 , $73.68 , $559.52 , $575.70 , $545.40 , $545.40 , $545.40 , $563.58 , $581.76 , $253.56 , $515.10 , $265.83 , $223.05 , N/A , $228.17 , $228.17 , $575.70 , $259.19 , $42.54 , $581.76 
"Rsv-Igim, Im",CPT® 90378,N/A,N/A,N/A," $1,722.00 "," $1,119.30 ", N/A , N/A ," $1,703.29 ", N/A , N/A ," $1,601.46 "," $1,549.80 "," $1,549.80 "," $1,377.60 "," $1,377.60 "," $1,703.29 "," $1,589.92 "," $1,635.90 "," $1,549.80 "," $1,549.80 "," $1,549.80 "," $1,601.46 "," $1,653.12 ", N/A ," $1,463.70 "," $1,377.60 "," $2,948.41 ", N/A , N/A , N/A ," $1,635.90 ", N/A ," $1,377.60 "," $2,948.41 "
Removal Sutures/Staples Requiring Anesthesia,CPT® 15851,N/A,N/A,N/A, $405.00 , $263.25 , $145.32 , $62.64 , $19.04 , $125.72 , $122.84 , $376.65 , $364.50 , $364.50 , $324.00 , $324.00 , $19.04 , $373.94 , $384.75 , $364.50 , $364.50 , $364.50 , $376.65 , $388.80 , $160.66 , $344.25 , $244.42 , $162.53 , N/A , $128.17 , $128.17 , $384.75 , $148.66 , $19.04 , $388.80 
 Pro Esoph G-Esop Rflx Tlmtr Eltrd Plmt ,CPT® 91035,0982 - PRO FEE/OUTPT,N/A,N/A," $2,092.00 "," $1,359.80 "," $1,124.71 ", $455.01 , $409.86 ," $1,451.02 "," $1,181.73 "," $1,945.56 "," $1,882.80 "," $1,882.80 "," $1,673.60 "," $1,673.60 ", $409.86 ," $1,931.54 "," $1,987.40 "," $1,882.80 "," $1,882.80 "," $1,882.80 "," $1,945.56 "," $2,008.32 "," $2,177.10 "," $1,778.20 "," $1,566.19 "," $1,825.51 ", N/A ," $1,479.33 "," $1,479.33 "," $1,987.40 "," $1,740.40 ", $409.86 ," $2,177.10 "
Exchange Biliary Drg Catheter Prq W/Img Gid Rs&I,CPT® 47536,N/A,N/A,N/A," $5,291.00 "," $3,439.15 ", $804.38 , $124.56 , $646.34 , $720.65 , $649.48 ," $4,920.63 "," $4,761.90 "," $4,761.90 "," $4,232.80 "," $4,232.80 ", $646.34 ," $4,885.18 "," $5,026.45 "," $4,761.90 "," $4,761.90 "," $4,761.90 "," $4,920.63 "," $5,079.36 ", $581.23 ," $4,497.35 ", $680.57 , $778.54 , N/A , $734.72 , $734.72 ," $5,026.45 ", $768.46 , $124.56 ," $5,079.36 "
 Fac Assay of Cadmium ,CPT® 82300,0301 - LAB/CHEMISTRY,N/A,N/A, $262.00 , $170.30 , $220.08 , $24.11 , $24.11 , $211.70 , $235.80 , $221.81 , $235.80 , $235.80 , $235.80 , $222.70 , $23.64 , $241.90 , $248.90 , $222.70 , $243.66 , $243.66 , $248.90 , $251.52 , $214.37 , $235.80 , $222.70 , $206.98 , N/A , $212.04 , $212.04 , $248.90 , $224.82 , $23.64 , $251.52 
 Fac Perq Clsr Tcat L Atr Apndge W/Endocardial Implnt ,CPT® 33340,0360 - OR SERVICES,N/A,N/A," $13,124.00 "," $8,530.60 "," $11,024.16 ", $709.76 , $623.11 ," $10,604.19 "," $11,811.60 "," $11,110.78 "," $11,811.60 "," $11,811.60 "," $11,811.60 "," $11,155.40 ", $610.89 ," $12,117.39 "," $12,467.80 "," $11,155.40 "," $12,205.32 "," $12,205.32 "," $12,467.80 "," $12,599.04 "," $10,738.06 "," $11,811.60 "," $11,155.40 "," $10,367.96 ", N/A ," $10,621.25 "," $10,621.25 "," $12,467.80 "," $11,261.70 ", $610.89 ," $12,599.04 "
"Drain Abscess,Peritonsill",42700,N/A,N/A,N/A, $799.00 , $519.35 , $833.04 , $131.69 , $124.27 , $655.65 , $682.92 , $743.07 , $719.10 , $719.10 , $639.20 , $639.20 , $124.27 , $737.72 , $759.05 , $719.10 , $719.10 , $719.10 , $743.07 , $767.04 , $591.70 , $679.15 , $745.74 , $772.76 , N/A , $668.44 , $668.44 , $759.05 , $699.12 , $124.27 , $833.04 
"Part Remv Bone Metatarsal Head,Ea",CPT® 28288,N/A,N/A,N/A," $4,045.00 "," $2,629.25 "," $2,687.04 ", $421.68 , $272.17 ," $2,107.60 "," $2,111.56 "," $3,761.85 "," $3,640.50 "," $3,640.50 "," $3,236.00 "," $3,236.00 ", $272.17 ," $3,734.75 "," $3,842.75 "," $3,640.50 "," $3,640.50 "," $3,640.50 "," $3,761.85 "," $3,883.20 "," $2,494.68 "," $3,438.25 "," $2,292.52 "," $2,515.65 ", N/A ," $2,148.72 "," $2,148.72 "," $3,842.75 "," $2,525.50 ", $272.17 ," $3,883.20 "
"Excis Tendon Sheath Lesion, Hand/Finger",26160,N/A,N/A,N/A," $3,855.00 "," $2,505.75 "," $1,944.61 ", $307.22 , $319.22 ," $1,605.88 "," $1,621.13 "," $3,585.15 "," $3,469.50 "," $3,469.50 "," $3,084.00 "," $3,084.00 ", $319.22 ," $3,559.32 "," $3,662.25 "," $3,469.50 "," $3,469.50 "," $3,469.50 "," $3,585.15 "," $3,700.80 "," $1,806.58 "," $3,276.75 "," $1,778.71 "," $1,915.12 ", N/A ," $1,637.21 "," $1,637.21 "," $3,662.25 "," $1,924.31 ", $307.22 ," $3,700.80 "
 Fac Antb Francisella Tularensis ,CPT® 86668,0302 - LAB/IMMUNOLOGY,N/A,N/A, $92.00 , $59.80 , $77.28 , $14.44 , $14.44 , $74.34 , $82.80 , $77.89 , $82.80 , $82.80 , $82.80 , $78.20 , $14.16 , $84.94 , $87.40 , $78.20 , $85.56 , $85.56 , $87.40 , $88.32 , $75.27 , $82.80 , $78.20 , $72.68 , N/A , $74.46 , $74.46 , $87.40 , $78.95 , $14.16 , $88.32 
Abdom Paracentesis Dx/Ther W/O Imaging Guidance,49082,N/A,N/A,N/A," $1,172.00 ", $761.80 , $446.29 , $68.89 , $188.97 , $361.06 , $352.03 ," $1,089.96 "," $1,054.80 "," $1,054.80 ", $937.60 , $937.60 , $188.97 ," $1,082.11 "," $1,113.40 "," $1,054.80 "," $1,054.80 "," $1,054.80 "," $1,089.96 "," $1,125.12 ", $319.40 , $996.20 , $380.01 , $425.52 , N/A , $368.10 , $368.10 ," $1,113.40 ", $385.00 , $68.89 ," $1,125.12 "
 Sinuses Paranasal Min 3 Vw- Mh ,CPT® 70220,0972 - PRO FEE/RAD/DX,N/A,N/A, $164.00 , $106.60 , $213.61 , $37.05 , $37.18 , $176.62 , $207.11 , $152.52 , $147.60 , $147.60 , $131.20 , $131.20 , $37.18 , $151.42 , $155.80 , $147.60 , $147.60 , $147.60 , $152.52 , $157.44 , $207.15 , $139.40 , $227.27 , $189.55 , N/A , $180.07 , $180.07 , $155.80 , $208.42 , $37.05 , $227.27 
 CIPROFLOXACIN HCL 250 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00143-9927-01,1 tablet, $23.60 , $15.34 , $19.82 , N/A , N/A , $19.07 , $21.24 , $19.98 , $21.24 , $21.24 , $21.24 , $20.06 , N/A , $21.79 , $22.42 , $20.06 , $21.95 , $21.95 , $22.42 , $22.66 , $19.31 , $21.24 , $20.06 , $18.64 , N/A , $19.10 , $19.10 , $22.42 , $20.25 , $18.64 , $22.66 
 HYDROMORPHONE HCL 2 MG/ML IJ SOLN ,HCPCS J1170,0636 - DRUGS REQUIRING DETAILED CODIN,00409-1312-30,1 mL, $37.84 , $24.60 , $31.79 , $4.44 , $4.30 , $30.57 , $34.06 , $32.04 , $34.06 , $34.06 , $34.06 , $32.16 , $4.22 , $34.94 , $35.95 , $32.16 , $35.19 , $35.19 , $35.95 , $36.33 , $30.96 , $34.06 , $32.16 , $29.89 , N/A , $30.62 , $30.62 , $35.95 , $32.47 , $4.22 , $36.33 
 Fac Drug Assay Leflunomide ,CPT® 80193,0301 - LAB/CHEMISTRY,N/A,N/A, $152.00 , $98.80 , $127.68 , $39.34 , $39.34 , $122.82 , $136.80 , $128.68 , $136.80 , $136.80 , $136.80 , $129.20 , $38.57 , $140.34 , $144.40 , $129.20 , $141.36 , $141.36 , $144.40 , $145.92 , $124.37 , $136.80 , $129.20 , $120.08 , N/A , $123.01 , $123.01 , $144.40 , $130.43 , $38.57 , $145.92 
Telheath Inpt Consult 25min,HCPCS G0407,N/A,N/A,N/A, $211.00 , $137.15 , $135.42 , $70.03 , N/A , $133.69 , N/A , $196.23 , $189.90 , $189.90 , $168.80 , $168.80 , N/A , $194.82 , $200.45 , $189.90 , $189.90 , $189.90 , $196.23 , $202.56 , $200.61 , $179.35 , $133.64 , $273.40 , N/A , $136.30 , $136.30 , $200.45 , $170.39 , $70.03 , $273.40 
"Blood Serology, Qualitative",CPT® 86592,N/A,N/A,N/A, $59.00 , $38.35 , N/A , $4.36 , $4.36 , $24.15 , $28.90 , $54.87 , $53.10 , $53.10 , $47.20 , $47.20 , $4.36 , $54.47 , $56.05 , $53.10 , $53.10 , $53.10 , $54.87 , $56.64 , $28.51 , $50.15 , $27.57 , $15.48 , N/A , $22.54 , $22.54 , $56.05 , $24.63 , $4.36 , $56.64 
"Lap,Pelvic Lymphadenectomy/Bx",CPT® 38572,N/A,N/A,N/A," $16,336.00 "," $10,618.40 "," $4,246.60 ", $857.39 , $889.16 ," $3,434.99 "," $3,421.94 "," $15,192.48 "," $14,702.40 "," $14,702.40 "," $13,068.80 "," $13,068.80 ", $889.16 ," $15,083.03 "," $15,519.20 "," $14,702.40 "," $14,702.40 "," $14,702.40 "," $15,192.48 "," $15,682.56 "," $4,560.39 "," $13,885.60 "," $4,991.81 "," $4,513.46 ", N/A ," $3,502.01 "," $3,502.01 "," $15,519.20 "," $4,062.80 ", $857.39 ," $15,682.56 "
Prosthetics Training Initial Enctr Ea 15 Mins,CPT® 97761,N/A,N/A,N/A, $135.00 , $87.75 , $81.30 , $41.69 , $26.99 , $74.65 , $75.20 , $125.55 , $121.50 , $121.50 , $108.00 , $108.00 , $26.99 , $124.65 , $128.25 , $121.50 , $121.50 , $121.50 , $125.55 , $129.60 , $105.07 , $114.75 , $99.34 , $91.61 , N/A , $76.11 , $76.11 , $128.25 , $84.67 , $26.99 , $129.60 
 Fac Level 4 Delivery ,Custom 150326,0720 - DELIVROOM/LABOR,N/A,N/A," $5,293.00 "," $3,440.45 "," $4,446.12 ", N/A , N/A ," $4,276.74 "," $4,763.70 "," $4,481.05 "," $4,763.70 "," $4,763.70 "," $4,763.70 "," $4,499.05 ", N/A ," $4,887.03 "," $5,028.35 "," $4,499.05 "," $4,922.49 "," $4,922.49 "," $5,028.35 "," $5,081.28 "," $4,330.73 "," $4,763.70 "," $4,499.05 "," $4,181.47 ", N/A ," $4,283.62 "," $4,283.62 "," $5,028.35 "," $4,541.92 "," $4,181.47 "," $5,081.28 "
 FUROSEMIDE 10 MG TAB (COMES FROM 20 MG TABLET) ,HCPCS RXC637,0250 - PHARMACY,00001-0919-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Complex Repair 2.6-7.5cm,CPT® 13152,N/A,N/A,N/A," $3,546.00 "," $2,304.90 "," $1,075.18 ", $321.34 , $282.60 , $954.01 , $856.35 ," $3,297.78 "," $3,191.40 "," $3,191.40 "," $2,836.80 "," $2,836.80 ", $282.60 ," $3,274.02 "," $3,368.70 "," $3,191.40 "," $3,191.40 "," $3,191.40 "," $3,297.78 "," $3,404.16 "," $1,184.60 "," $3,014.10 "," $1,705.57 "," $1,220.27 ", N/A , $972.62 , $972.62 ," $3,368.70 "," $1,127.91 ", $282.60 ," $3,404.16 "
" Fac MR-Staph, Dna, Amp Probe ",CPT® 87641,0306 - LAB/BACT-MICRO,N/A,N/A, $324.00 , $210.60 , $272.16 , $35.79 , $35.79 , $261.79 , $291.60 , $274.30 , $291.60 , $291.60 , $291.60 , $275.40 , $35.09 , $299.15 , $307.80 , $275.40 , $301.32 , $301.32 , $307.80 , $311.04 , $265.10 , $291.60 , $275.40 , $255.96 , N/A , $262.21 , $262.21 , $307.80 , $278.02 , $35.09 , $311.04 
Fx Closed Humeral Shaft,CPT® 24500,N/A,N/A,N/A," $1,318.00 ", $856.70 ," $2,076.69 ", $328.95 , $233.20 ," $1,570.20 "," $1,591.06 "," $1,225.74 "," $1,186.20 "," $1,186.20 "," $1,054.40 "," $1,054.40 ", $233.20 ," $1,216.91 "," $1,252.10 "," $1,186.20 "," $1,186.20 "," $1,186.20 "," $1,225.74 "," $1,265.28 "," $1,906.25 "," $1,120.30 "," $1,746.60 "," $1,865.54 ", N/A ," $1,600.84 "," $1,600.84 "," $1,252.10 "," $1,881.54 ", $233.20 ," $2,076.69 "
"Adj Tiss Xfer Head,Fac,Hand 10.1-30",CPT® 14041,N/A,N/A,N/A," $4,937.00 "," $3,209.05 "," $2,438.31 ", $733.01 , $768.38 ," $2,127.30 "," $2,088.61 "," $4,591.41 "," $4,443.30 "," $4,443.30 "," $3,949.60 "," $3,949.60 ", $768.38 ," $4,558.33 "," $4,690.15 "," $4,443.30 "," $4,443.30 "," $4,443.30 "," $4,591.41 "," $4,739.52 "," $2,673.42 "," $4,196.45 "," $4,156.87 "," $2,727.53 ", N/A ," $2,168.81 "," $2,168.81 "," $4,690.15 "," $2,515.08 ", $733.01 ," $4,739.52 "
Acne Surgery of Skin Abscess,CPT® 10040,N/A,N/A,N/A, $414.00 , $269.10 , $167.86 , $49.94 , $23.37 , $240.50 , $236.12 , $385.02 , $372.60 , $372.60 , $331.20 , $331.20 , $23.37 , $382.25 , $393.30 , $372.60 , $372.60 , $372.60 , $385.02 , $397.44 , $185.10 , $351.90 , $469.21 , $250.81 , N/A , $245.19 , $245.19 , $393.30 , $284.35 , $23.37 , $469.21 
 Fac Assay of Prolactin ,CPT® 84146,0301 - LAB/CHEMISTRY,N/A,N/A, $181.00 , $117.65 , $152.04 , $19.77 , $19.77 , $146.25 , $162.90 , $153.23 , $162.90 , $162.90 , $162.90 , $153.85 , $19.38 , $167.12 , $171.95 , $153.85 , $168.33 , $168.33 , $171.95 , $173.76 , $148.09 , $162.90 , $153.85 , $142.99 , N/A , $146.48 , $146.48 , $171.95 , $155.32 , $19.38 , $173.76 
Evac. Subungual Hematoma,11740,N/A,N/A,N/A, $187.00 , $121.55 , $101.46 , $30.96 , $37.00 , $89.90 , $88.22 , $173.91 , $168.30 , $168.30 , $149.60 , $149.60 , $37.00 , $172.66 , $177.65 , $168.30 , $168.30 , $168.30 , $173.91 , $179.52 , $110.68 , $158.95 , $173.05 , $117.10 , N/A , $91.66 , $91.66 , $177.65 , $106.30 , $30.96 , $179.52 
Fx Cl Scapular W/O Manip,23570,N/A,N/A,N/A, $868.00 , $564.20 ," $1,508.00 ", $239.36 , $101.63 ," $1,150.84 "," $1,170.86 ", $807.24 , $781.20 , $781.20 , $694.40 , $694.40 , $101.63 , $801.42 , $824.60 , $781.20 , $781.20 , $781.20 , $807.24 , $833.28 ," $1,389.76 ", $737.80 ," $1,284.53 "," $1,368.26 ", N/A ," $1,173.30 "," $1,173.30 ", $824.60 ," $1,379.07 ", $101.63 ," $1,508.00 "
X-Ray Pelvis 1/2 Vw,CPT® 72170,N/A,N/A,N/A, $334.00 , $217.10 , $156.31 , $27.44 , $25.29 , $129.60 , $152.44 , $310.62 , $300.60 , $300.60 , $267.20 , $267.20 , $25.29 , $308.38 , $317.30 , $300.60 , $300.60 , $300.60 , $310.62 , $320.64 , $151.97 , $283.90 , $169.49 , $160.24 , N/A , $132.13 , $132.13 , $317.30 , $152.94 , $25.29 , $320.64 
Repr Elbow Lat Ligmnt W/Tiss,CPT® 24343,N/A,N/A,N/A," $4,734.00 "," $3,077.10 "," $4,367.81 ", $686.31 , $405.93 ," $3,404.38 "," $3,398.14 "," $4,402.62 "," $4,260.60 "," $4,260.60 "," $3,787.20 "," $3,787.20 ", $405.93 ," $4,370.90 "," $4,497.30 "," $4,260.60 "," $4,260.60 "," $4,260.60 "," $4,402.62 "," $4,544.64 "," $4,052.02 "," $4,023.90 "," $3,739.40 "," $4,029.84 ", N/A ," $3,470.80 "," $3,470.80 "," $4,497.30 "," $4,079.42 ", $405.93 ," $4,544.64 "
Laryngoscopy Flx/Rgd Telescopic W/Stroboscopy,CPT® 31579,N/A,N/A,N/A," $1,221.00 ", $793.65 , $643.77 , $114.65 , $151.13 , $541.78 , $533.68 ," $1,135.53 "," $1,098.90 "," $1,098.90 ", $976.80 , $976.80 , $151.13 ," $1,127.35 "," $1,159.95 "," $1,098.90 "," $1,098.90 "," $1,098.90 "," $1,135.53 "," $1,172.16 ", $615.53 ," $1,037.85 ", $752.88 , $608.57 , N/A , $552.34 , $552.34 ," $1,159.95 ", $650.51 , $114.65 ," $1,172.16 "
Ko W/ Adj Flex/Ext Rotat Cus,HCPCS L1845,N/A,N/A,N/A," $1,339.00 ", $870.35 , N/A , $979.86 , $633.70 , N/A , N/A ," $1,245.27 "," $1,205.10 "," $1,205.10 "," $1,071.20 "," $1,071.20 ", $633.70 ," $1,236.30 "," $1,272.05 "," $1,205.10 "," $1,205.10 "," $1,205.10 "," $1,245.27 "," $1,285.44 ", N/A ," $1,138.15 ", $825.86 , $824.39 , N/A , N/A , N/A ," $1,272.05 ", N/A , $633.70 ," $1,285.44 "
Slctv Cathj 2nd Order Abdl Pel/Lxtr Art Brnch,CPT® 36246,N/A,N/A,N/A," $6,414.00 "," $4,169.10 "," $1,480.38 ", $227.83 , $593.68 ," $1,161.87 "," $1,139.99 "," $5,965.02 "," $5,772.60 "," $5,772.60 "," $5,131.20 "," $5,131.20 ", $593.68 ," $5,922.05 "," $6,093.30 "," $5,772.60 "," $5,772.60 "," $5,772.60 "," $5,965.02 "," $6,157.44 "," $1,285.13 "," $5,451.90 "," $1,423.68 "," $1,239.62 ", N/A ," $1,184.54 "," $1,184.54 "," $6,093.30 "," $1,345.64 ", $227.83 ," $6,157.44 "
" Transposition Carotid to Subclav; Open; in Conj W/Tevar, Uni ",CPT® 33889,0360 - OR SERVICES,N/A,N/A," $8,107.00 "," $5,269.55 "," $6,809.88 ", $703.16 , $751.31 ," $6,550.46 "," $7,296.30 "," $6,863.39 "," $7,296.30 "," $7,296.30 "," $7,296.30 "," $6,890.95 ", $736.58 ," $7,485.19 "," $7,701.65 "," $6,890.95 "," $7,539.51 "," $7,539.51 "," $7,701.65 "," $7,782.72 "," $6,633.15 "," $7,296.30 "," $6,890.95 "," $6,404.53 ", N/A ," $6,561.00 "," $6,561.00 "," $7,701.65 "," $6,956.62 ", $703.16 ," $7,782.72 "
 PENICILLIN G POTASSIUM 20000000 UNITS IJ SOLR ,HCPCS J2540,0636 - DRUGS REQUIRING DETAILED CODIN,00049-0530-28,40 mL, $313.66 , $203.88 , $263.47 , $1.09 , $0.80 , $253.44 , $282.29 , $265.54 , $282.29 , $282.29 , $282.29 , $266.61 , $0.78 , $289.60 , $297.98 , $266.61 , $291.70 , $291.70 , $297.98 , $301.11 , $256.64 , $282.29 , $266.61 , $247.79 , N/A , $253.85 , $253.85 , $297.98 , $269.15 , $0.78 , $301.11 
"Zinc Paste Band W >=3""<5""/Yd",HCPCS A6456,N/A,N/A,N/A, $15.00 , $9.75 , N/A , $1.70 , $1.31 , N/A , N/A , $13.95 , $13.50 , $13.50 , $12.00 , $12.00 , $1.31 , $13.85 , $14.25 , $13.50 , $13.50 , $13.50 , $13.95 , $14.40 , N/A , $12.75 , $1.30 , $1.57 , N/A , N/A , N/A , $14.25 , N/A , $1.30 , $14.40 
"Immunotherapy, 2+ Injections",CPT® 95117,N/A,N/A,N/A, $62.00 , $40.30 , $28.24 , $11.27 , $5.05 , $18.37 , $18.87 , $57.66 , $55.80 , $55.80 , $49.60 , $49.60 , $5.05 , $57.24 , $58.90 , $55.80 , $55.80 , $55.80 , $57.66 , $59.52 , $24.53 , $52.70 , $32.44 , $31.18 , N/A , $18.72 , $18.72 , $58.90 , $22.13 , $5.05 , $59.52 
"Culture,Bacteria,Any Srce",CPT® 87070,N/A,N/A,N/A, $116.00 , $75.40 , N/A , $8.79 , $8.79 , $48.72 , $58.29 , $107.88 , $104.40 , $104.40 , $92.80 , $92.80 , $8.79 , $107.10 , $110.20 , $104.40 , $104.40 , $104.40 , $107.88 , $111.36 , $57.56 , $98.60 , $56.76 , $31.25 , N/A , $45.47 , $45.47 , $110.20 , $49.69 , $8.79 , $111.36 
Remv Benign Femur Lesion,27355,N/A,N/A,N/A," $3,843.00 "," $2,497.95 "," $3,714.04 ", $582.52 , $614.70 ," $2,906.38 "," $2,896.82 "," $3,573.99 "," $3,458.70 "," $3,458.70 "," $3,074.40 "," $3,074.40 ", $614.70 ," $3,548.24 "," $3,650.85 "," $3,458.70 "," $3,458.70 "," $3,458.70 "," $3,573.99 "," $3,689.28 "," $3,437.68 "," $3,266.55 "," $3,198.83 "," $3,432.46 ", N/A ," $2,963.10 "," $2,963.10 "," $3,650.85 "," $3,482.69 ", $582.52 ," $3,714.04 "
 Pro Repair Deformity of Toe ,CPT® 28313,0982 - PRO FEE/OUTPT,N/A,N/A," $3,483.00 "," $2,263.95 "," $2,213.12 ", $348.37 , $615.42 ," $1,756.63 "," $1,741.32 "," $3,239.19 "," $3,134.70 "," $3,134.70 "," $2,786.40 "," $2,786.40 ", $615.42 ," $3,215.85 "," $3,308.85 "," $3,134.70 "," $3,134.70 "," $3,134.70 "," $3,239.19 "," $3,343.68 "," $2,058.22 "," $2,960.55 "," $1,898.24 "," $2,063.54 ", N/A ," $1,790.91 "," $1,790.91 "," $3,308.85 "," $2,104.96 ", $348.37 ," $3,343.68 "
 Ins Tun Peritoneal Dialysis Cath; Open ,CPT® 49421,0360 - OR SERVICES,N/A,N/A," $2,635.00 "," $1,712.75 "," $2,213.40 ", $205.73 , $384.19 ," $2,129.08 "," $2,371.50 "," $2,230.79 "," $2,371.50 "," $2,371.50 "," $2,371.50 "," $2,239.75 ", $376.66 ," $2,432.90 "," $2,503.25 "," $2,239.75 "," $2,450.55 "," $2,450.55 "," $2,503.25 "," $2,529.60 "," $2,155.96 "," $2,371.50 "," $2,239.75 "," $2,081.65 ", N/A ," $2,132.51 "," $2,132.51 "," $2,503.25 "," $2,261.09 ", $205.73 ," $2,529.60 "
Thoracoscopy Surg Exc Mediast Mass,CPT® 32662,N/A,N/A,N/A," $5,572.00 "," $3,621.80 "," $4,641.40 ", $812.78 ," $1,355.60 "," $3,378.91 "," $3,297.68 "," $5,181.96 "," $5,014.80 "," $5,014.80 "," $4,457.60 "," $4,457.60 "," $1,355.60 "," $5,144.63 "," $5,293.40 "," $5,014.80 "," $5,014.80 "," $5,014.80 "," $5,181.96 "," $5,349.12 "," $4,490.71 "," $4,736.20 "," $4,761.67 "," $4,425.52 ", N/A ," $3,444.83 "," $3,444.83 "," $5,293.40 "," $4,057.01 ", $812.78 ," $5,349.12 "
 Pro Esophagogastroduodenoscopy Transoral Diagnostic ,CPT® 43235,0982 - PRO FEE/OUTPT,N/A,N/A," $2,046.00 "," $1,329.90 ", $751.66 , $116.11 , $398.41 , $626.38 , $707.63 ," $1,902.78 "," $1,841.40 "," $1,841.40 "," $1,636.80 "," $1,636.80 ", $398.41 ," $1,889.07 "," $1,943.70 "," $1,841.40 "," $1,841.40 "," $1,841.40 "," $1,902.78 "," $1,964.16 ", $539.11 ," $1,739.10 ", $776.07 , $715.24 , N/A , $638.60 , $638.60 ," $1,943.70 ", $667.92 , $116.11 ," $1,964.16 "
 Pro Cltx UR Styloid Fx ,CPT® 25650,0981 - PRO FEE/ER,N/A,N/A," $1,496.00 ", $972.40 ," $1,902.94 ", $302.14 , $151.20 ," $1,442.04 "," $1,468.96 "," $1,391.28 "," $1,346.40 "," $1,346.40 "," $1,196.80 "," $1,196.80 ", $151.20 ," $1,381.26 "," $1,421.20 "," $1,346.40 "," $1,346.40 "," $1,346.40 "," $1,391.28 "," $1,436.16 "," $1,751.68 "," $1,271.60 "," $1,611.01 "," $1,717.60 ", N/A ," $1,470.18 "," $1,470.18 "," $1,421.20 "," $1,727.98 ", $151.20 ," $1,902.94 "
Gerd Tst W/ Nasal Impedence Electrod,91037,N/A,N/A,N/A, $794.00 , $516.10 , $404.14 , $166.18 , $132.55 , $358.37 , $387.96 , $738.42 , $714.60 , $714.60 , $635.20 , $635.20 , $132.55 , $733.10 , $754.30 , $714.60 , $714.60 , $714.60 , $738.42 , $762.24 , $755.60 , $674.90 , $513.95 , $612.40 , N/A , $365.36 , $365.36 , $754.30 , $425.94 , $132.55 , $762.24 
"Blood Type Antigen Donor Reagent Serum, Ea Antigen",CPT® 86902,N/A,N/A,N/A, $62.00 , $40.30 , N/A , $6.48 , $5.30 , $21.62 , $25.85 , $57.66 , $55.80 , $55.80 , $49.60 , $49.60 , $5.30 , $57.24 , $58.90 , $55.80 , $55.80 , $55.80 , $57.66 , $59.52 , $42.40 , $52.70 , $24.33 , $18.65 , N/A , $20.18 , $20.18 , $58.90 , $22.05 , $5.30 , $59.52 
" Pro Shoulder Scope, Partial Removal Collar Bone ",CPT® 29824,0975 - PRO FEE/OR,N/A,N/A," $2,665.00 "," $1,732.25 "," $4,128.15 ", $647.79 , $403.88 ," $3,230.14 "," $3,267.77 "," $2,478.45 "," $2,398.50 "," $2,398.50 "," $2,132.00 "," $2,132.00 ", $403.88 ," $2,460.59 "," $2,531.75 "," $2,398.50 "," $2,398.50 "," $2,398.50 "," $2,478.45 "," $2,558.40 "," $3,835.87 "," $2,265.25 "," $3,607.38 "," $3,828.39 ", N/A ," $3,293.16 "," $3,293.16 "," $2,531.75 "," $3,870.64 ", $403.88 ," $4,128.15 "
 Pro Arthrp Acetblr/Prox Fem Prostc Agrft/Algrft ,CPT® 27130,0975 - PRO FEE/OR,N/A,N/A," $8,944.00 "," $5,813.60 "," $7,729.22 "," $1,207.86 "," $1,274.03 "," $6,553.93 "," $6,887.98 "," $8,317.92 "," $8,049.60 "," $8,049.60 "," $7,155.20 "," $7,155.20 "," $1,274.03 "," $8,258.00 "," $8,496.80 "," $8,049.60 "," $8,049.60 "," $8,049.60 "," $8,317.92 "," $8,586.24 "," $8,507.46 "," $7,602.40 "," $7,626.87 "," $7,706.23 ", N/A ," $6,681.80 "," $6,681.80 "," $8,496.80 "," $7,853.49 "," $1,207.86 "," $8,586.24 "
 Fac Ins New/Rplcmt Prm Pm W/Transv Eltrd Atrial&Vent ,CPT® 33208,0360 - OR SERVICES,N/A,N/A," $7,711.00 "," $5,012.15 "," $6,477.24 ", $476.01 , $771.82 ," $6,230.49 "," $6,939.90 "," $6,528.13 "," $6,939.90 "," $6,939.90 "," $6,939.90 "," $6,554.35 ", $756.69 ," $7,119.57 "," $7,325.45 "," $6,554.35 "," $7,171.23 "," $7,171.23 "," $7,325.45 "," $7,402.56 "," $6,309.14 "," $6,939.90 "," $6,554.35 "," $6,091.69 ", N/A ," $6,240.51 "," $6,240.51 "," $7,325.45 "," $6,616.81 ", $476.01 ," $7,402.56 "
Immunochemistry-Ea. Antib,CPT® 88342,N/A,N/A,N/A, $430.00 , $279.50 , $360.57 , $98.62 , $54.62 , $359.42 , $528.54 , $399.90 , $387.00 , $387.00 , $344.00 , $344.00 , $54.62 , $397.02 , $408.50 , $387.00 , $387.00 , $387.00 , $399.90 , $412.80 , $673.66 , $365.50 , $549.80 , $379.56 , N/A , $335.43 , $335.43 , $408.50 , $368.62 , $54.62 , $673.66 
Hzv Zoster Vacc Recombinant Adjuvanted Im Njx,CPT® 90750,N/A,N/A,N/A, $217.00 , $141.05 , N/A , N/A , $190.30 , N/A , N/A , $201.81 , $195.30 , $195.30 , $173.60 , $173.60 , $190.30 , $200.36 , $206.15 , $195.30 , $195.30 , $195.30 , $201.81 , $208.32 , N/A , $184.45 , $173.60 , $281.89 , N/A , N/A , N/A , $206.15 , N/A , $173.60 , $281.89 
 ASPIRIN-DIPYRIDAMOLE ER 25-200 MG PO CP12 ,HCPCS RXC637,0250 - PHARMACY,68462-0405-60,1 capsule, $42.92 , $27.90 , $36.05 , N/A , N/A , $34.68 , $38.63 , $36.34 , $38.63 , $38.63 , $38.63 , $36.48 , N/A , $39.63 , $40.77 , $36.48 , $39.92 , $39.92 , $40.77 , $41.20 , $35.12 , $38.63 , $36.48 , $33.91 , N/A , $34.74 , $34.74 , $40.77 , $36.83 , $33.91 , $41.20 
" Abscess,Fistula or Sinus Tract Study ",CPT® 76080,0320 - DX X-RAY,N/A,N/A, $438.00 , $284.70 , $367.92 , $58.94 , $60.89 , $353.90 , $394.20 , $370.81 , $394.20 , $394.20 , $394.20 , $372.30 , $59.70 , $404.41 , $416.10 , $372.30 , $407.34 , $407.34 , $416.10 , $420.48 , $358.37 , $394.20 , $372.30 , $346.02 , N/A , $354.47 , $354.47 , $416.10 , $375.85 , $58.94 , $420.48 
 MYCOPHENOLATE MOFETIL 500 MG PO TABS ,HCPCS J7517,0636 - DRUGS REQUIRING DETAILED CODIN,00904-7078-61,1 tablet, $5.85 , $3.80 , $4.91 , $0.21 , $0.22 , $4.73 , $5.27 , $4.95 , $5.27 , $5.27 , $5.27 , $4.97 , $0.22 , $5.40 , $5.56 , $4.97 , $5.44 , $5.44 , $5.56 , $5.62 , $4.79 , $5.27 , $4.97 , $4.62 , N/A , $4.73 , $4.73 , $5.56 , $5.02 , $0.21 , $5.62 
 Fac Arven Anast Opn Upr Arm Cephalic Vein Trpos ,CPT® 36818,0360 - OR SERVICES,N/A,N/A," $6,994.00 "," $4,546.10 "," $5,874.96 ", $618.66 , $652.76 ," $5,651.15 "," $6,294.60 "," $5,921.12 "," $6,294.60 "," $6,294.60 "," $6,294.60 "," $5,944.90 ", $639.96 ," $6,457.56 "," $6,644.30 "," $5,944.90 "," $6,504.42 "," $6,504.42 "," $6,644.30 "," $6,714.24 "," $5,722.49 "," $6,294.60 "," $5,944.90 "," $5,525.26 ", N/A ," $5,660.24 "," $5,660.24 "," $6,644.30 "," $6,001.55 ", $618.66 ," $6,714.24 "
Insertion Breast Implant Same Day of Mastectomy,CPT® 19340,N/A,N/A,N/A," $4,159.00 "," $2,703.35 "," $2,404.41 ", $721.51 , $549.47 ," $2,732.99 "," $2,679.65 "," $3,867.87 "," $3,743.10 "," $3,743.10 "," $3,327.20 "," $3,327.20 ", $549.47 ," $3,840.00 "," $3,951.05 "," $3,743.10 "," $3,743.10 "," $3,743.10 "," $3,867.87 "," $3,992.64 "," $2,633.70 "," $3,535.15 "," $5,380.74 "," $3,487.42 ", N/A ," $2,786.32 "," $2,786.32 "," $3,951.05 "," $3,231.18 ", $549.47 ," $5,380.74 "
Nipple Exploration,CPT® 19110,N/A,N/A,N/A," $1,187.00 ", $771.55 ," $1,110.47 ", $331.23 , $312.04 , $919.74 , $909.39 ," $1,103.91 "," $1,068.30 "," $1,068.30 ", $949.60 , $949.60 , $312.04 ," $1,095.96 "," $1,127.65 "," $1,068.30 "," $1,068.30 "," $1,068.30 "," $1,103.91 "," $1,139.52 "," $1,212.16 "," $1,008.95 "," $1,826.88 "," $1,174.09 ", N/A , $937.68 , $937.68 ," $1,127.65 "," $1,087.40 ", $312.04 ," $1,826.88 "
"Repair Compl Rotator Cuff Avulsn,Chr",CPT® 23420,N/A,N/A,N/A," $6,132.00 "," $3,985.80 "," $5,907.01 ", $925.61 , $848.58 ," $4,673.78 "," $4,650.13 "," $5,702.76 "," $5,518.80 "," $5,518.80 "," $4,905.60 "," $4,905.60 ", $848.58 ," $5,661.68 "," $5,825.40 "," $5,518.80 "," $5,518.80 "," $5,518.80 "," $5,702.76 "," $5,886.72 "," $5,493.61 "," $5,212.20 "," $5,138.10 "," $5,509.40 ", N/A ," $4,764.98 "," $4,764.98 "," $5,825.40 "," $5,600.56 ", $848.58 ," $5,907.01 "
 WARFARIN 1.5 MG TAB (COMES FROM 3 MG TABLET) ,HCPCS RXC637,0250 - PHARMACY,00001-0929-01,1 tablet, $3.40 , $2.21 , $2.86 , N/A , N/A , $2.75 , $3.06 , $2.88 , $3.06 , $3.06 , $3.06 , $2.89 , N/A , $3.14 , $3.23 , $2.89 , $3.16 , $3.16 , $3.23 , $3.26 , $2.78 , $3.06 , $2.89 , $2.69 , N/A , $2.75 , $2.75 , $3.23 , $2.92 , $2.69 , $3.26 
"Drain Ant Chmbr,Remv Blood",CPT® 65815,N/A,N/A,N/A," $5,870.00 "," $3,815.50 "," $2,932.15 ", $460.73 , $307.34 ," $2,704.54 "," $2,550.45 "," $5,459.10 "," $5,283.00 "," $5,283.00 "," $4,696.00 "," $4,696.00 ", $307.34 ," $5,419.77 "," $5,576.50 "," $5,283.00 "," $5,283.00 "," $5,283.00 "," $5,459.10 "," $5,635.20 "," $4,026.73 "," $4,989.50 "," $2,636.85 "," $3,436.51 ", N/A ," $2,757.31 "," $2,757.31 "," $5,576.50 "," $3,043.73 ", $307.34 ," $5,635.20 "
Computerized Ophthalmic Imaging Retina,CPT® 92134,N/A,N/A,N/A, $135.00 , $87.75 , $88.31 , $39.74 , $32.72 , $79.44 , $81.53 , $125.55 , $121.50 , $121.50 , $108.00 , $108.00 , $32.72 , $124.65 , $128.25 , $121.50 , $121.50 , $121.50 , $125.55 , $129.60 , $125.08 , $114.75 , $137.87 , $87.83 , N/A , $81.00 , $81.00 , $128.25 , $96.35 , $32.72 , $137.87 
 Fac Ablation Bone Tumor Rf Perq W/Img Gdn When Done ,CPT® 20982,0361 - OR/MINOR,N/A,N/A," $15,872.00 "," $10,316.80 "," $13,332.48 ", $344.45 ," $2,378.00 "," $12,824.58 "," $14,284.80 "," $13,437.24 "," $14,284.80 "," $14,284.80 "," $14,284.80 "," $13,491.20 "," $2,331.37 "," $14,654.62 "," $15,078.40 "," $13,491.20 "," $14,760.96 "," $14,760.96 "," $15,078.40 "," $15,237.12 "," $12,986.47 "," $14,284.80 "," $13,491.20 "," $12,538.88 ", N/A ," $12,845.21 "," $12,845.21 "," $15,078.40 "," $13,619.76 ", $344.45 ," $15,237.12 "
Supervision Interfacility Transport Init 30 Min,CPT® 99485,N/A,N/A,N/A, $504.00 , $327.60 , N/A , $71.98 , $58.33 , $132.93 , $132.03 , $468.72 , $453.60 , $453.60 , $403.20 , $403.20 , $58.33 , $465.34 , $478.80 , $453.60 , $453.60 , $453.60 , $468.72 , $483.84 , $192.90 , $428.40 , N/A , $168.67 , N/A , $135.52 , $135.52 , $478.80 , $156.29 , $58.33 , $483.84 
 Fac Intro Catheter Superior/Inferior Vena Cava ,CPT® 36010,0761 - TREATMENT ROOM,N/A,N/A," $1,486.00 ", $965.90 ," $1,248.24 ", $99.17 , $498.06 ," $1,200.69 "," $1,337.40 "," $1,258.05 "," $1,337.40 "," $1,337.40 "," $1,337.40 "," $1,263.10 ", $488.29 ," $1,372.02 "," $1,411.70 "," $1,263.10 "," $1,381.98 "," $1,381.98 "," $1,411.70 "," $1,426.56 "," $1,215.85 "," $1,337.40 "," $1,263.10 "," $1,173.94 ", N/A ," $1,202.62 "," $1,202.62 "," $1,411.70 "," $1,275.14 ", $99.17 ," $1,426.56 "
Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/Img Gdn,62321,N/A,N/A,N/A, $887.00 , $576.55 , $529.36 , $102.63 , $196.67 , $591.06 , $573.29 , $824.91 , $798.30 , $798.30 , $709.60 , $709.60 , $196.67 , $818.97 , $842.65 , $798.30 , $798.30 , $798.30 , $824.91 , $851.52 , $575.81 , $753.95 , $559.74 , $650.84 , N/A , $602.59 , $602.59 , $842.65 , $646.43 , $102.63 , $851.52 
Iaad Ia Influenza a/B Each,CPT® 87400,N/A,N/A,N/A, $88.00 , $57.20 , N/A , $14.41 , $8.63 , $67.85 , $81.18 , $81.84 , $79.20 , $79.20 , $70.40 , $70.40 , $8.63 , $81.25 , $83.60 , $79.20 , $79.20 , $79.20 , $81.84 , $84.48 , $94.35 , $74.80 , $77.85 , $43.47 , N/A , $63.32 , $63.32 , $83.60 , $69.20 , $8.63 , $94.35 
 Fac Compre Electrophysiologic W/O Arrhyt Induction ,CPT® 93619,0480 - CARDIOLOGY,N/A,N/A," $5,359.00 "," $3,483.35 "," $4,501.56 ", $673.70 ," $1,054.57 "," $4,330.07 "," $4,823.10 "," $4,536.93 "," $4,823.10 "," $4,823.10 "," $4,823.10 "," $4,555.15 "," $1,033.89 "," $4,947.96 "," $5,091.05 "," $4,555.15 "," $4,983.87 "," $4,983.87 "," $5,091.05 "," $5,144.64 "," $4,384.73 "," $4,823.10 "," $4,555.15 "," $4,233.61 ", N/A ," $4,337.04 "," $4,337.04 "," $5,091.05 "," $4,598.56 ", $673.70 ," $5,144.64 "
Wedging of Cast,29740,N/A,N/A,N/A, $519.00 , $337.35 , $413.47 , $64.41 , $15.36 , $339.04 , $316.55 , $482.67 , $467.10 , $467.10 , $415.20 , $415.20 , $15.36 , $479.19 , $493.05 , $467.10 , $467.10 , $467.10 , $482.67 , $498.24 , $385.84 , $441.15 , $347.89 , $398.97 , N/A , $345.65 , $345.65 , $493.05 , $406.28 , $15.36 , $498.24 
 Fac MRI Breast Without&With Contrast W/Cad Bilateral ,CPT® 77049,0614 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI-OTHER,N/A,N/A," $6,943.00 "," $4,512.95 "," $5,832.12 ", $353.78 , $320.77 ," $5,609.94 "," $6,248.70 "," $5,877.94 "," $6,248.70 "," $6,248.70 "," $6,248.70 "," $5,901.55 ", $314.48 ," $6,410.47 "," $6,595.85 "," $5,901.55 "," $6,456.99 "," $6,456.99 "," $6,595.85 "," $6,665.28 "," $5,680.76 "," $6,248.70 "," $5,901.55 "," $5,484.97 ", N/A ," $5,618.97 "," $5,618.97 "," $6,595.85 "," $5,957.79 ", $314.48 ," $6,665.28 "
"Closed Rx Mid Humerus Fx,Manipulatn",CPT® 24505,N/A,N/A,N/A," $3,293.00 "," $2,140.45 "," $2,790.13 ", $440.14 , $384.19 ," $2,171.23 "," $2,194.08 "," $3,062.49 "," $2,963.70 "," $2,963.70 "," $2,634.40 "," $2,634.40 ", $384.19 ," $3,040.43 "," $3,128.35 "," $2,963.70 "," $2,963.70 "," $2,963.70 "," $3,062.49 "," $3,161.28 "," $2,578.50 "," $2,799.05 "," $2,415.62 "," $2,549.14 ", N/A ," $2,213.60 "," $2,213.60 "," $3,128.35 "," $2,601.78 ", $384.19 ," $3,161.28 "
Angiotensin I Enzyme Test,CPT® 82164,N/A,N/A,N/A, $205.00 , $133.25 , N/A , $14.89 , $14.89 , $82.61 , $98.82 , $190.65 , $184.50 , $184.50 , $164.00 , $164.00 , $14.89 , $189.28 , $194.75 , $184.50 , $184.50 , $184.50 , $190.65 , $196.80 , $97.49 , $174.25 , $95.69 , $52.95 , N/A , $77.10 , $77.10 , $194.75 , $84.25 , $14.89 , $196.80 
Stapes Mobilization,CPT® 69650,N/A,N/A,N/A," $4,502.00 "," $2,926.30 "," $3,871.70 ", $784.21 ," $1,075.74 "," $3,865.17 "," $4,007.96 "," $4,186.86 "," $4,051.80 "," $4,051.80 "," $3,601.60 "," $3,601.60 "," $1,075.74 "," $4,156.70 "," $4,276.90 "," $4,051.80 "," $4,051.80 "," $4,051.80 "," $4,186.86 "," $4,321.92 "," $4,246.98 "," $3,826.70 "," $4,367.39 "," $3,881.94 ", N/A ," $3,940.58 "," $3,940.58 "," $4,276.90 "," $4,499.46 ", $784.21 ," $4,499.46 "
 ISOSORBIDE MONONITRATE 20 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00228-2620-11,1 tablet, $4.60 , $2.99 , $3.86 , N/A , N/A , $3.72 , $4.14 , $3.89 , $4.14 , $4.14 , $4.14 , $3.91 , N/A , $4.25 , $4.37 , $3.91 , $4.28 , $4.28 , $4.37 , $4.42 , $3.76 , $4.14 , $3.91 , $3.63 , N/A , $3.72 , $3.72 , $4.37 , $3.95 , $3.63 , $4.42 
Apply Short Leg Cast,CPT® 29405,N/A,N/A,N/A, $685.00 , $445.25 , $353.21 , $55.88 , $70.65 , $291.95 , $292.92 , $637.05 , $616.50 , $616.50 , $548.00 , $548.00 , $70.65 , $632.46 , $650.75 , $616.50 , $616.50 , $616.50 , $637.05 , $657.60 , $330.82 , $582.25 , $319.35 , $344.75 , N/A , $297.65 , $297.65 , $650.75 , $349.86 , $55.88 , $657.60 
 Immunoglobulin Light Chains Free Each Pbb ,CPT® 83521,0301 - LAB/CHEMISTRY,N/A,N/A, $227.00 , $147.55 , $190.68 , $17.62 , $17.62 , $183.42 , $204.30 , $192.18 , $204.30 , $204.30 , $204.30 , $192.95 , $17.27 , $209.59 , $215.65 , $192.95 , $211.11 , $211.11 , $215.65 , $217.92 , $185.73 , $204.30 , $192.95 , $179.33 , N/A , $183.71 , $183.71 , $215.65 , $194.79 , $17.27 , $217.92 
 MRI Any Joint Upper Extremity W/Contr- Lh ,CPT® 73222,0972 - PRO FEE/RAD/DX,N/A,N/A, $887.00 , $576.55 ," $2,280.60 ", $323.39 , $498.05 ," $1,799.91 "," $2,299.19 ", $824.91 , $798.30 , $798.30 , $709.60 , $709.60 , $498.05 , $818.97 , $842.65 , $798.30 , $798.30 , $798.30 , $824.91 , $851.52 ," $1,980.41 ", $753.95 ," $2,505.78 "," $3,503.53 ", N/A ," $1,835.03 "," $1,835.03 ", $842.65 ," $2,124.09 ", $323.39 ," $3,503.53 "
 Hand Min 3vw - Mh ,CPT® 73130,0972 - PRO FEE/RAD/DX,N/A,N/A, $140.00 , $91.00 , $205.49 , $36.30 , $29.84 , $143.83 , $173.22 , $130.20 , $126.00 , $126.00 , $112.00 , $112.00 , $29.84 , $129.26 , $133.00 , $126.00 , $126.00 , $126.00 , $130.20 , $134.40 , $199.02 , $119.00 , $190.68 , $160.24 , N/A , $146.64 , $146.64 , $133.00 , $169.73 , $29.84 , $205.49 
 HALOPERIDOL LACTATE 2 MG/ML PO CONC ,HCPCS RXC637,0250 - PHARMACY,54838-0501-40,1 mL, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Moderna Admin Peds 6m - 5y Second Dose,CPT® 0112A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $56.00 , $128.02 , N/A , N/A , N/A , $66.50 , N/A , $38.92 , $128.02 
 TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP ,HCPCS J3301,0636 - DRUGS REQUIRING DETAILED CODIN,00003-0293-05,0.5 mL, $28.85 , $18.75 , $24.23 , $1.03 , $1.14 , $23.31 , $25.97 , $24.42 , $25.97 , $25.97 , $25.97 , $24.52 , $1.12 , $26.64 , $27.41 , $24.52 , $26.83 , $26.83 , $27.41 , $27.70 , $23.61 , $25.97 , $24.52 , $22.79 , N/A , $23.35 , $23.35 , $27.41 , $24.76 , $1.03 , $27.70 
 Pro X-Ray Exam of Shoulder Blade ,CPT® 73010,0972 - PRO FEE/RAD/DX,N/A,N/A, $105.00 , $68.25 , $133.63 , $23.16 , $27.82 , $141.45 , $169.96 , $97.65 , $94.50 , $94.50 , $84.00 , $84.00 , $27.82 , $96.95 , $99.75 , $94.50 , $94.50 , $94.50 , $97.65 , $100.80 , $129.33 , $89.25 , $188.75 , $153.06 , N/A , $144.21 , $144.21 , $99.75 , $166.92 , $23.16 , $188.75 
Remove Armpits Lymph Nodes Complt,CPT® 38745,N/A,N/A,N/A," $4,576.00 "," $2,974.40 "," $4,041.55 ", $816.45 , $768.38 ," $3,035.08 "," $3,124.51 "," $4,255.68 "," $4,118.40 "," $4,118.40 "," $3,660.80 "," $3,660.80 ", $768.38 ," $4,225.02 "," $4,347.20 "," $4,118.40 "," $4,118.40 "," $4,118.40 "," $4,255.68 "," $4,392.96 "," $4,316.86 "," $3,889.60 "," $4,631.43 "," $4,199.95 ", N/A ," $3,094.30 "," $3,094.30 "," $4,347.20 "," $3,589.78 ", $768.38 ," $4,631.43 "
"Treat Tibial Shaft Fx, Intramed Implant",CPT® 27759,N/A,N/A,N/A," $3,746.00 "," $2,434.90 "," $6,032.59 ", $944.03 , $879.19 ," $4,820.61 "," $4,781.45 "," $3,483.78 "," $3,371.40 "," $3,371.40 "," $2,996.80 "," $2,996.80 ", $879.19 ," $3,458.68 "," $3,558.70 "," $3,371.40 "," $3,371.40 "," $3,371.40 "," $3,483.78 "," $3,596.16 "," $5,622.20 "," $3,184.10 "," $5,287.97 "," $5,671.47 ", N/A ," $4,914.67 "," $4,914.67 "," $3,558.70 "," $5,776.48 ", $879.19 ," $6,032.59 "
"Initial Normal Newborn Care, Same Day Discharge",CPT® 99463,N/A,N/A,N/A, $422.00 , $274.30 , $220.35 , $105.68 , $111.58 , $316.26 , $310.93 , $392.46 , $379.80 , $379.80 , $337.60 , $337.60 , $111.58 , $389.63 , $400.90 , $379.80 , $379.80 , $379.80 , $392.46 , $405.12 , $278.47 , $358.70 , $248.28 , $367.48 , N/A , $322.43 , $322.43 , $400.90 , $385.79 , $105.68 , $405.12 
"Strapping,Toes",29550,N/A,N/A,N/A, $110.00 , $71.50 , $70.27 , $10.83 , $30.11 , $56.85 , $96.67 , $102.30 , $99.00 , $99.00 , $88.00 , $88.00 , $30.11 , $101.56 , $104.50 , $99.00 , $99.00 , $99.00 , $102.30 , $105.60 , $65.68 , $93.50 , $103.48 , $67.45 , N/A , $57.96 , $57.96 , $104.50 , $68.13 , $10.83 , $105.60 
 Fac Reptilase Test ,CPT® 85635,0305 - LAB/HEMATOLOGY,N/A,N/A, $134.00 , $87.10 , $112.56 , $10.05 , $10.05 , $108.27 , $120.60 , $113.44 , $120.60 , $120.60 , $120.60 , $113.90 , $9.85 , $123.72 , $127.30 , $113.90 , $124.62 , $124.62 , $127.30 , $128.64 , $109.64 , $120.60 , $113.90 , $105.86 , N/A , $108.45 , $108.45 , $127.30 , $114.99 , $9.85 , $128.64 
 CYANOCOBALAMIN 1000 MCG/ML IJ SOLN ,HCPCS J3420,0636 - DRUGS REQUIRING DETAILED CODIN,00517-0031-25,1 mL, $44.90 , $29.19 , $37.72 , $1.34 , $2.09 , $36.28 , $40.41 , $38.01 , $40.41 , $40.41 , $40.41 , $38.17 , $2.05 , $41.46 , $42.66 , $38.17 , $41.76 , $41.76 , $42.66 , $43.10 , $36.74 , $40.41 , $38.17 , $35.47 , N/A , $36.34 , $36.34 , $42.66 , $38.53 , $1.34 , $43.10 
 Fac Mononuclear Cell Antigen Quantitative Nos Ea ,CPT® 86356,0302 - LAB/IMMUNOLOGY,N/A,N/A, $247.00 , $160.55 , $207.48 , $27.32 , $27.32 , $199.58 , $222.30 , $209.11 , $222.30 , $222.30 , $222.30 , $209.95 , $26.78 , $228.06 , $234.65 , $209.95 , $229.71 , $229.71 , $234.65 , $237.12 , $202.10 , $222.30 , $209.95 , $195.13 , N/A , $199.90 , $199.90 , $234.65 , $211.95 , $26.78 , $237.12 
 Fac Mycobacteria Culture ,CPT® 87116,0306 - LAB/BACT-MICRO,N/A,N/A, $136.00 , $88.40 , $114.24 , $11.02 , $11.02 , $109.89 , $122.40 , $115.14 , $122.40 , $122.40 , $122.40 , $115.60 , $10.80 , $125.57 , $129.20 , $115.60 , $126.48 , $126.48 , $129.20 , $130.56 , $111.28 , $122.40 , $115.60 , $107.44 , N/A , $110.06 , $110.06 , $129.20 , $116.70 , $10.80 , $130.56 
 Pro Rmvl FB Musc/Tdn Shth Dp/Comp ,CPT® 20525,0975 - PRO FEE/OR,N/A,N/A," $1,912.00 "," $1,242.80 "," $1,500.01 ", $234.49 , $305.27 ," $1,200.67 "," $1,201.07 "," $1,778.16 "," $1,720.80 "," $1,720.80 "," $1,529.60 "," $1,529.60 ", $305.27 ," $1,765.35 "," $1,816.40 "," $1,720.80 "," $1,720.80 "," $1,720.80 "," $1,778.16 "," $1,835.52 "," $1,395.55 "," $1,625.20 "," $1,323.78 "," $1,413.07 ", N/A ," $1,224.10 "," $1,224.10 "," $1,816.40 "," $1,438.75 ", $234.49 ," $1,835.52 "
Njx Aa&/Strd Tfrml Epi Cervical/Thoracic 1 Level,CPT® 64479,N/A,N/A,N/A," $1,229.00 ", $798.85 , $649.27 , $125.54 , $223.29 , $745.33 , $731.99 ," $1,142.97 "," $1,106.10 "," $1,106.10 ", $983.20 , $983.20 , $223.29 ," $1,134.74 "," $1,167.55 "," $1,106.10 "," $1,106.10 "," $1,106.10 "," $1,142.97 "," $1,179.84 ", $702.26 ," $1,044.65 ", $717.19 , $797.25 , N/A , $759.88 , $759.88 ," $1,167.55 ", $815.17 , $125.54 ," $1,179.84 "
"Proctosigmoidoscopy,Rigid,Diagnos",CPT® 45300,N/A,N/A,N/A, $785.00 , $510.25 , $291.14 , $45.70 , $61.84 , $258.00 , $265.83 , $730.05 , $706.50 , $706.50 , $628.00 , $628.00 , $61.84 , $724.79 , $745.75 , $706.50 , $706.50 , $706.50 , $730.05 , $753.60 , $209.38 , $667.25 , $290.80 , $309.54 , N/A , $263.04 , $263.04 , $745.75 , $275.09 , $45.70 , $753.60 
"Lap,Reimplant Ureter W/Cysto,Stent",CPT® 50947,N/A,N/A,N/A," $9,641.00 "," $6,266.65 "," $7,469.83 "," $1,310.67 "," $1,193.52 "," $6,797.06 "," $6,295.43 "," $8,966.13 "," $8,676.90 "," $8,676.90 "," $7,712.80 "," $7,712.80 "," $1,193.52 "," $8,901.54 "," $9,158.95 "," $8,676.90 "," $8,676.90 "," $8,676.90 "," $8,966.13 "," $9,255.36 "," $7,505.77 "," $8,194.85 "," $7,129.12 "," $8,514.73 ", N/A ," $6,929.69 "," $6,929.69 "," $9,158.95 "," $8,144.85 "," $1,193.52 "," $9,255.36 "
Screen Cerv/Vag Thin Layer,HCPCS G0123,N/A,N/A,N/A, $143.00 , $92.95 , N/A , $20.67 , $20.67 , $52.11 , N/A , $132.99 , $128.70 , $128.70 , $114.40 , $114.40 , $20.67 , $132.03 , $135.85 , $128.70 , $128.70 , $128.70 , $132.99 , $137.28 , $135.28 , $121.55 , $53.20 , $73.45 , N/A , $53.12 , $53.12 , $135.85 , $66.40 , $20.67 , $137.28 
 LEVOFLOXACIN 250 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6351-61,1 tablet, $75.65 , $49.17 , $63.55 , N/A , N/A , $61.13 , $68.09 , $64.05 , $68.09 , $68.09 , $68.09 , $64.30 , N/A , $69.85 , $71.87 , $64.30 , $70.35 , $70.35 , $71.87 , $72.62 , $61.90 , $68.09 , $64.30 , $59.76 , N/A , $61.22 , $61.22 , $71.87 , $64.92 , $59.76 , $72.62 
"Special Eye Eval,Goniscopy",92020,N/A,N/A,N/A, $89.00 , $57.85 , $44.44 , $20.12 , $13.72 , $37.30 , $37.81 , $82.77 , $80.10 , $80.10 , $71.20 , $71.20 , $13.72 , $82.17 , $84.55 , $80.10 , $80.10 , $80.10 , $82.77 , $85.44 , $62.96 , $75.65 , $63.86 , $45.13 , N/A , $38.02 , $38.02 , $84.55 , $45.22 , $13.72 , $85.44 
 Incision & Removal FB Complic - Mh ,CPT® 10121,0761 - TREATMENT ROOM,N/A,N/A," $4,385.00 "," $2,850.25 "," $3,683.40 ", $176.00 , $77.74 ," $3,543.08 "," $3,946.50 "," $3,712.34 "," $3,946.50 "," $3,946.50 "," $3,946.50 "," $3,727.25 ", $76.22 ," $4,048.67 "," $4,165.75 "," $3,727.25 "," $4,078.05 "," $4,078.05 "," $4,165.75 "," $4,209.60 "," $3,587.81 "," $3,946.50 "," $3,727.25 "," $3,464.15 ", N/A ," $3,548.78 "," $3,548.78 "," $4,165.75 "," $3,762.77 ", $76.22 ," $4,209.60 "
"Revise Wrist Joint,Carpal Instabil",CPT® 25320,N/A,N/A,N/A," $6,170.00 "," $4,010.50 "," $6,011.40 ", $947.70 , $643.30 ," $4,758.23 "," $4,754.85 "," $5,738.10 "," $5,553.00 "," $5,553.00 "," $4,936.00 "," $4,936.00 ", $643.30 ," $5,696.76 "," $5,861.50 "," $5,553.00 "," $5,553.00 "," $5,553.00 "," $5,738.10 "," $5,923.20 "," $5,588.40 "," $5,244.50 "," $5,227.31 "," $5,645.67 ", N/A ," $4,851.07 "," $4,851.07 "," $5,861.50 "," $5,701.72 ", $643.30 ," $6,011.40 "
 NOREPINEPHRINE-SODIUM CHLORIDE 4-0.9 MG/250ML-% IV SOLN ,HCPCS RXA250,0250 - PHARMACY,69374-0319-25,250 mL, $92.47 , $60.11 , $77.67 , N/A , N/A , $74.72 , $83.22 , $78.29 , $83.22 , $83.22 , $83.22 , $78.60 , N/A , $85.38 , $87.85 , $78.60 , $86.00 , $86.00 , $87.85 , $88.77 , $75.66 , $83.22 , $78.60 , $73.05 , N/A , $74.84 , $74.84 , $87.85 , $79.35 , $73.05 , $88.77 
 ACYCLOVIR 400 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-5790-61,1 tablet, $11.14 , $7.24 , $9.36 , N/A , N/A , $9.00 , $10.03 , $9.43 , $10.03 , $10.03 , $10.03 , $9.47 , N/A , $10.29 , $10.58 , $9.47 , $10.36 , $10.36 , $10.58 , $10.69 , $9.11 , $10.03 , $9.47 , $8.80 , N/A , $9.02 , $9.02 , $10.58 , $9.56 , $8.80 , $10.69 
 GLIMEPIRIDE 2 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,68084-0326-01,1 tablet, $4.54 , $2.95 , $3.81 , N/A , N/A , $3.67 , $4.09 , $3.84 , $4.09 , $4.09 , $4.09 , $3.86 , N/A , $4.19 , $4.31 , $3.86 , $4.22 , $4.22 , $4.31 , $4.36 , $3.71 , $4.09 , $3.86 , $3.59 , N/A , $3.67 , $3.67 , $4.31 , $3.90 , $3.59 , $4.36 
 Fac Assay of Serum Potassium ,CPT® 84132,0301 - LAB/CHEMISTRY,N/A,N/A, $65.00 , $42.25 , $54.60 , $4.86 , $4.86 , $52.52 , $58.50 , $55.03 , $58.50 , $58.50 , $58.50 , $55.25 , $4.76 , $60.01 , $61.75 , $55.25 , $60.45 , $60.45 , $61.75 , $62.40 , $53.18 , $58.50 , $55.25 , $51.35 , N/A , $52.60 , $52.60 , $61.75 , $55.78 , $4.76 , $62.40 
 HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN ,HCPCS J1643,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0540-15,10 mL, $44.80 , $29.12 , $37.63 , $6.21 , $0.27 , $36.20 , $40.32 , $37.93 , $40.32 , $40.32 , $40.32 , $38.08 , $0.26 , $41.36 , $42.56 , $38.08 , $41.66 , $41.66 , $42.56 , $43.01 , $36.66 , $40.32 , $38.08 , $35.39 , N/A , $36.26 , $36.26 , $42.56 , $38.44 , $0.26 , $43.01 
Explo/Drain Breast Abscess,CPT® 19020,N/A,N/A,N/A," $1,867.00 "," $1,213.55 ", $990.39 , $296.37 , $153.67 , $824.44 , $814.05 ," $1,736.31 "," $1,680.30 "," $1,680.30 "," $1,493.60 "," $1,493.60 ", $153.67 ," $1,723.80 "," $1,773.65 "," $1,680.30 "," $1,680.30 "," $1,680.30 "," $1,736.31 "," $1,792.32 "," $1,080.13 "," $1,586.95 "," $1,632.42 "," $1,056.70 ", N/A , $840.53 , $840.53 ," $1,773.65 ", $974.73 , $153.67 ," $1,792.32 "
 Pro Radex Hip Arthg Rs&I ,CPT® 73525,0972 - PRO FEE/RAD/DX,N/A,N/A, $285.00 , $185.25 , $764.27 , $128.89 , $92.85 , $481.48 , $562.70 , $265.05 , $256.50 , $256.50 , $228.00 , $228.00 , $92.85 , $263.14 , $270.75 , $256.50 , $256.50 , $256.50 , $265.05 , $273.60 , $740.65 , $242.25 , $616.33 , $520.36 , N/A , $490.88 , $490.88 , $270.75 , $568.21 , $92.85 , $764.27 
 ADENOSINE 6 MG/2ML IV SOLN ,HCPCS J0153,0636 - DRUGS REQUIRING DETAILED CODIN,67457-0855-02,2 mL, $38.53 , $25.04 , $32.37 , $0.55 , $0.53 , $31.13 , $34.68 , $32.62 , $34.68 , $34.68 , $34.68 , $32.75 , $0.52 , $35.57 , $36.60 , $32.75 , $35.83 , $35.83 , $36.60 , $36.99 , $31.53 , $34.68 , $32.75 , $30.44 , N/A , $31.18 , $31.18 , $36.60 , $33.06 , $0.52 , $36.99 
 Cltx Articular Fx Invg Mtcarphlngl/Iphal Jt W/ - Urgent Care ,CPT® 26742,0761 - TREATMENT ROOM,N/A,N/A," $1,713.00 "," $1,113.45 "," $1,438.92 ", $329.17 , $168.45 ," $1,384.10 "," $1,541.70 "," $1,450.23 "," $1,541.70 "," $1,541.70 "," $1,541.70 "," $1,456.05 ", $165.15 ," $1,581.61 "," $1,627.35 "," $1,456.05 "," $1,593.09 "," $1,593.09 "," $1,627.35 "," $1,644.48 "," $1,401.58 "," $1,541.70 "," $1,456.05 "," $1,353.27 ", N/A ," $1,386.33 "," $1,386.33 "," $1,627.35 "," $1,469.93 ", $165.15 ," $1,644.48 "
Rb82 Rubidium,HCPCS A9555,N/A,N/A,N/A," $1,694.00 "," $1,101.10 ", N/A , $543.30 , N/A , N/A , N/A ," $1,575.42 "," $1,524.60 "," $1,524.60 "," $1,355.20 "," $1,355.20 ", N/A ," $1,564.07 "," $1,609.30 "," $1,524.60 "," $1,524.60 "," $1,524.60 "," $1,575.42 "," $1,626.24 ", N/A ," $1,439.90 ", $903.33 , $678.38 , N/A , N/A , N/A ," $1,609.30 ", N/A , $543.30 ," $1,626.24 "
"Excis Rectal Tumor, Transanal, Partial Thickness",45171,N/A,N/A,N/A," $4,673.00 "," $3,037.45 "," $3,796.78 ", $588.55 , $490.70 ," $2,854.71 "," $2,930.72 "," $4,345.89 "," $4,205.70 "," $4,205.70 "," $3,738.40 "," $3,738.40 ", $490.70 ," $4,314.58 "," $4,439.35 "," $4,205.70 "," $4,205.70 "," $4,205.70 "," $4,345.89 "," $4,486.08 "," $2,723.38 "," $3,972.05 "," $3,227.37 "," $3,408.02 ", N/A ," $2,910.42 "," $2,910.42 "," $4,439.35 "," $3,044.00 ", $490.70 ," $4,486.08 "
 Disorders Of Pancreas Except Malignancy With Cc ,MS DRG V40 (FY2023) 439,N/A,N/A,N/A," $17,862.09 "," $11,610.36 "," $15,004.16 ", N/A , N/A ," $14,432.57 "," $16,075.88 "," $15,122.05 "," $16,075.88 "," $16,075.88 "," $16,075.88 "," $15,182.78 ", N/A ," $16,492.07 "," $16,968.99 "," $15,182.78 "," $16,611.74 "," $16,611.74 "," $16,968.99 "," $17,147.61 "," $14,614.76 "," $16,075.88 "," $15,182.78 "," $14,111.05 ", N/A ," $14,455.79 "," $14,455.79 "," $16,968.99 "," $15,327.46 "," $14,111.05 "," $17,147.61 "
"Fibrinogen Test,Paracoag",CPT® 85366,N/A,N/A,N/A, $97.00 , $63.05 , N/A , $82.07 , $11.95 , $48.72 , $58.29 , $90.21 , $87.30 , $87.30 , $77.60 , $77.60 , $11.95 , $89.56 , $92.15 , $87.30 , $87.30 , $87.30 , $90.21 , $93.12 , $537.25 , $82.45 , $56.76 , $236.31 , N/A , $45.47 , $45.47 , $92.15 , $49.69 , $11.95 , $537.25 
Repair Foot Flexor Tendon,28200,N/A,N/A,N/A," $3,193.00 "," $2,075.45 "," $2,025.27 ", $317.14 , $461.04 ," $1,578.99 "," $1,560.91 "," $2,969.49 "," $2,873.70 "," $2,873.70 "," $2,554.40 "," $2,554.40 ", $461.04 ," $2,948.10 "," $3,033.35 "," $2,873.70 "," $2,873.70 "," $2,873.70 "," $2,969.49 "," $3,065.28 "," $1,866.84 "," $2,714.05 "," $1,687.72 "," $1,889.38 ", N/A ," $1,609.80 "," $1,609.80 "," $3,033.35 "," $1,892.07 ", $317.14 ," $3,065.28 "
 Pro Rp Loclzj Tum Spect W/CT 1 Area/Acquisj 1day Img ,CPT® 78830,0972 - PRO FEE/RAD/DX,N/A,N/A, $541.00 , $351.65 ," $2,596.60 ", $439.62 , $393.09 ," $2,328.90 ", N/A , $503.13 , $486.90 , $486.90 , $432.80 , $432.80 , $393.09 , $499.51 , $513.95 , $486.90 , $486.90 , $486.90 , $503.13 , $519.36 ," $2,727.94 ", $459.85 ," $2,568.68 "," $3,233.31 ", N/A ," $2,374.34 "," $2,374.34 ", $513.95 ," $2,751.63 ", $393.09 ," $3,233.31 "
"US Guide,Vascular Access",76937,N/A,N/A,N/A, $177.00 , $115.05 , $222.14 , $38.38 , $33.32 , $151.94 , $188.43 , $164.61 , $159.30 , $159.30 , $141.60 , $141.60 , $33.32 , $163.42 , $168.15 , $159.30 , $159.30 , $159.30 , $164.61 , $169.92 , $211.85 , $150.45 , $206.09 , $176.02 , N/A , $154.91 , $154.91 , $168.15 , $179.33 , $33.32 , $222.14 
Endoluminal Coronary Ivus Oct I&R Initial Vessel,CPT® 92978,N/A,N/A,N/A," $1,799.00 "," $1,169.35 "," $1,755.91 ", $273.77 , $268.59 ," $1,485.28 "," $1,382.73 "," $1,673.07 "," $1,619.10 "," $1,619.10 "," $1,439.20 "," $1,439.20 ", $268.59 ," $1,661.02 "," $1,709.05 "," $1,619.10 "," $1,619.10 "," $1,619.10 "," $1,673.07 "," $1,727.04 "," $1,728.03 "," $1,529.15 "," $1,314.86 "," $1,634.01 ", N/A ," $1,514.26 "," $1,514.26 "," $1,709.05 "," $1,678.58 ", $268.59 ," $1,755.91 "
Cystourethroscopy,CPT® 52000,N/A,N/A,N/A," $1,443.00 ", $937.95 , $433.72 , $75.96 , $144.34 , $616.56 , $575.66 ," $1,341.99 "," $1,298.70 "," $1,298.70 "," $1,154.40 "," $1,154.40 ", $144.34 ," $1,332.32 "," $1,370.85 "," $1,298.70 "," $1,298.70 "," $1,298.70 "," $1,341.99 "," $1,385.28 ", $434.80 ," $1,226.55 ", $652.97 , $504.56 , N/A , $628.59 , $628.59 ," $1,370.85 ", $738.81 , $75.96 ," $1,385.28 "
 Pro Heart/Lung Resuscitation Cpr ,CPT® 92950,0981 - PRO FEE/ER,N/A,N/A," $1,990.00 "," $1,293.50 "," $1,136.20 ", $175.23 , $189.13 ," $1,020.88 "," $1,025.94 "," $1,850.70 "," $1,791.00 "," $1,791.00 "," $1,592.00 "," $1,592.00 ", $189.13 ," $1,837.37 "," $1,890.50 "," $1,791.00 "," $1,791.00 "," $1,791.00 "," $1,850.70 "," $1,910.40 "," $1,120.89 "," $1,691.50 ", $961.61 ," $1,114.88 ", N/A ," $1,040.80 "," $1,040.80 "," $1,890.50 "," $1,153.73 ", $175.23 ," $1,910.40 "
Active Wound Care > 20 Cm,CPT® 97598,N/A,N/A,N/A, $209.00 , $135.85 , $56.54 , $23.51 , $55.15 , $26.06 , $22.25 , $194.37 , $188.10 , $188.10 , $167.20 , $167.20 , $55.15 , $192.97 , $198.55 , $188.10 , $188.10 , $188.10 , $194.37 , $200.64 , $75.48 , $177.65 , $33.45 , $25.64 , N/A , $26.57 , $26.57 , $198.55 , $29.54 , $22.25 , $200.64 
Ndsc Dcmprn Spinal Cord 1 W/Lamot Ntrspc Lumbar,CPT® 62380,N/A,N/A,N/A," $13,228.00 "," $8,598.20 "," $7,431.37 "," $1,457.69 ", N/A ," $4,211.07 ", N/A ," $12,302.04 "," $11,905.20 "," $11,905.20 "," $10,582.40 "," $10,582.40 ", N/A ," $12,213.41 "," $12,566.60 "," $11,905.20 "," $11,905.20 "," $11,905.20 "," $12,302.04 "," $12,698.88 "," $8,007.40 "," $11,243.80 "," $6,960.29 "," $4,395.55 ", N/A ," $4,293.23 "," $4,293.23 "," $12,566.60 "," $4,605.64 "," $1,457.69 "," $12,698.88 "
Injection Aa&/Strd Intercostal Nrv Single Lvl,64420,N/A,N/A,N/A, $893.00 , $580.45 , $291.72 , $56.48 , $46.08 , $379.80 , $375.69 , $830.49 , $803.70 , $803.70 , $714.40 , $714.40 , $46.08 , $824.51 , $848.35 , $803.70 , $803.70 , $803.70 , $830.49 , $857.28 , $316.65 , $759.05 , $367.52 , $406.08 , N/A , $387.20 , $387.20 , $848.35 , $415.37 , $46.08 , $857.28 
Closed Rx Inter/Subtroch Femur Fx,CPT® 27238,N/A,N/A,N/A," $3,389.00 "," $2,202.85 "," $2,867.28 ", $451.16 , $461.04 ," $2,218.00 "," $2,228.81 "," $3,151.77 "," $3,050.10 "," $3,050.10 "," $2,711.20 "," $2,711.20 ", $461.04 ," $3,129.06 "," $3,219.55 "," $3,050.10 "," $3,050.10 "," $3,050.10 "," $3,151.77 "," $3,253.44 "," $2,652.56 "," $2,880.65 "," $2,456.66 "," $2,621.53 ", N/A ," $2,261.28 "," $2,261.28 "," $3,219.55 "," $2,657.80 ", $451.16 ," $3,253.44 "
"Remv Foreign Body,Knee/Thigh,Deep",27372,N/A,N/A,N/A," $3,994.00 "," $2,596.10 "," $2,450.96 ", $382.69 , $160.13 ," $1,950.30 "," $1,950.16 "," $3,714.42 "," $3,594.60 "," $3,594.60 "," $3,195.20 "," $3,195.20 ", $160.13 ," $3,687.66 "," $3,794.30 "," $3,594.60 "," $3,594.60 "," $3,594.60 "," $3,714.42 "," $3,834.24 "," $2,267.38 "," $3,394.90 "," $2,151.58 "," $2,264.21 ", N/A ," $1,988.36 "," $1,988.36 "," $3,794.30 "," $2,337.00 ", $160.13 ," $3,834.24 "
 Fac Sigmoidoscopy Flx Ablation Tumor Polyp/Oth Les ,CPT® 45346,0360 - OR SERVICES,N/A,N/A," $2,245.00 "," $1,459.25 "," $1,885.80 ", $152.15 , $265.94 ," $1,813.96 "," $2,020.50 "," $1,900.62 "," $2,020.50 "," $2,020.50 "," $2,020.50 "," $1,908.25 ", $260.73 ," $2,072.81 "," $2,132.75 "," $1,908.25 "," $2,087.85 "," $2,087.85 "," $2,132.75 "," $2,155.20 "," $1,836.86 "," $2,020.50 "," $1,908.25 "," $1,773.55 ", N/A ," $1,816.88 "," $1,816.88 "," $2,132.75 "," $1,926.43 ", $152.15 ," $2,155.20 "
X-Ray Facial Bones 3+ Vw,CPT® 70150,N/A,N/A,N/A, $314.00 , $204.10 , $268.95 , $46.31 , $40.44 , $195.31 , $228.20 , $292.02 , $282.60 , $282.60 , $251.20 , $251.20 , $40.44 , $289.92 , $298.30 , $282.60 , $282.60 , $282.60 , $292.02 , $301.44 , $260.39 , $266.90 , $248.46 , $209.30 , N/A , $199.13 , $199.13 , $298.30 , $230.50 , $40.44 , $301.44 
Remove Foreign Body Simple,CPT® 10120,N/A,N/A,N/A, $579.00 , $376.35 , $336.16 , $101.48 , $42.46 , $283.24 , $279.57 , $538.47 , $521.10 , $521.10 , $463.20 , $463.20 , $42.46 , $534.59 , $550.05 , $521.10 , $521.10 , $521.10 , $538.47 , $555.84 , $369.08 , $492.15 , $553.06 , $366.67 , N/A , $288.77 , $288.77 , $550.05 , $334.86 , $42.46 , $555.84 
 Pro Gastric Emptying Study ,CPT® 78264,0974 - PRO FEE/NUC MED,N/A,N/A," $2,241.00 "," $1,456.65 "," $1,767.26 ", $302.36 , $203.93 ," $1,423.12 "," $1,544.44 "," $2,084.13 "," $2,016.90 "," $2,016.90 "," $1,792.80 "," $1,792.80 ", $203.93 ," $2,069.12 "," $2,128.95 "," $2,016.90 "," $2,016.90 "," $2,016.90 "," $2,084.13 "," $2,151.36 "," $1,837.73 "," $1,904.85 "," $1,681.43 "," $2,260.44 ", N/A ," $1,450.89 "," $1,450.89 "," $2,128.95 "," $1,679.43 ", $203.93 ," $2,260.44 "
Revision of Unstable Patella,CPT® 27420,N/A,N/A,N/A," $4,978.00 "," $3,235.70 "," $4,522.38 ", $711.72 , $922.06 ," $3,562.89 "," $3,491.14 "," $4,629.54 "," $4,480.20 "," $4,480.20 "," $3,982.40 "," $3,982.40 ", $922.06 ," $4,596.19 "," $4,729.10 "," $4,480.20 "," $4,480.20 "," $4,480.20 "," $4,629.54 "," $4,778.88 "," $4,207.73 "," $4,231.30 "," $3,857.15 "," $4,222.23 ", N/A ," $3,632.41 "," $3,632.41 "," $4,729.10 "," $4,269.39 ", $711.72 ," $4,778.88 "
 MORPHINE SULFATE ER 100 MG PO TBCR ,HCPCS RXC637,0250 - PHARMACY,00904-6560-61,1 tablet, $21.61 , $14.05 , $18.15 , N/A , N/A , $17.46 , $19.45 , $18.30 , $19.45 , $19.45 , $19.45 , $18.37 , N/A , $19.95 , $20.53 , $18.37 , $20.10 , $20.10 , $20.53 , $20.75 , $17.68 , $19.45 , $18.37 , $17.07 , N/A , $17.49 , $17.49 , $20.53 , $18.54 , $17.07 , $20.75 
 Room Rate ,Custom 1180000001,0118 - R&B - PRIVATE (MEDICAL OR GENERAL) - REHABILITIATION,N/A,N/A," $1,848.00 "," $1,201.20 "," $1,552.32 ", N/A , N/A ," $1,493.18 "," $1,663.20 "," $1,564.52 "," $1,663.20 "," $1,663.20 "," $1,663.20 "," $1,570.80 ", N/A ," $1,706.26 "," $1,755.60 "," $1,570.80 "," $1,718.64 "," $1,718.64 "," $1,755.60 "," $1,774.08 "," $1,512.03 "," $1,663.20 "," $1,570.80 "," $1,459.92 ", N/A ," $1,495.59 "," $1,495.59 "," $1,755.60 "," $1,585.77 "," $1,459.92 "," $1,774.08 "
Insertion Central Vencath,CPT® 36556,N/A,N/A,N/A," $1,860.00 "," $1,209.00 ", $514.22 , $79.62 , $322.67 , $528.55 , $516.83 ," $1,729.80 "," $1,674.00 "," $1,674.00 "," $1,488.00 "," $1,488.00 ", $322.67 ," $1,717.34 "," $1,767.00 "," $1,674.00 "," $1,674.00 "," $1,674.00 "," $1,729.80 "," $1,785.60 ", $476.45 ," $1,581.00 ", $636.91 , $489.07 , N/A , $538.87 , $538.87 ," $1,767.00 ", $612.15 , $79.62 ," $1,785.60 "
Closed Tx Nasal Bone Fx W/Mnpj W/O Stabilization,CPT® 21315,N/A,N/A,N/A," $1,934.00 "," $1,257.10 ", $360.88 , $57.03 , $144.17 , $740.80 , $753.99 ," $1,798.62 "," $1,740.60 "," $1,740.60 "," $1,547.20 "," $1,547.20 ", $144.17 ," $1,785.66 "," $1,837.30 "," $1,740.60 "," $1,740.60 "," $1,740.60 "," $1,798.62 "," $1,856.64 ", $876.95 ," $1,643.90 ", $826.02 , $865.56 , N/A , $755.25 , $755.25 ," $1,837.30 ", $887.70 , $57.03 ," $1,856.64 "
 Pro Thyroid Imaging With Vascular Flow ,CPT® 78013,0974 - PRO FEE/NUC MED,N/A,N/A, $152.00 , $98.80 ," $1,037.74 ", $174.66 , $164.86 , $933.37 ," $1,084.43 ", $141.36 , $136.80 , $136.80 , $121.60 , $121.60 , $164.86 , $140.34 , $144.40 , $136.80 , $136.80 , $136.80 , $141.36 , $145.92 ," $1,080.86 ", $129.20 ," $1,188.37 "," $1,290.57 ", N/A , $951.58 , $951.58 , $144.40 ," $1,101.47 ", $121.60 ," $1,290.57 "
 Pro Fit Contact Lens Tx Ocular Surface Disease ,CPT® 92071,0962 - PRO FEE/EYE,N/A,N/A, $104.00 , $67.60 , $70.70 , $31.81 , $30.64 , $59.97 , $53.95 , $96.72 , $93.60 , $93.60 , $83.20 , $83.20 , $30.64 , $96.02 , $98.80 , $93.60 , $93.60 , $93.60 , $96.72 , $99.84 , $100.14 , $88.40 , $90.22 , $72.09 , N/A , $61.14 , $61.14 , $98.80 , $72.73 , $30.64 , $100.14 
Injection Aa&/Strd Fem Nrv Cont Nfs Cath Img Gdn,CPT® 64448,N/A,N/A,N/A," $1,154.00 ", $750.10 , $301.96 , $69.77 , $74.53 , $399.81 , $379.15 ," $1,073.22 "," $1,038.60 "," $1,038.60 ", $923.20 , $923.20 , $74.53 ," $1,065.49 "," $1,096.30 "," $1,038.60 "," $1,038.60 "," $1,038.60 "," $1,073.22 "," $1,107.84 ", $327.73 , $980.90 , $369.30 , $433.13 , N/A , $407.62 , $407.62 ," $1,096.30 ", $437.26 , $69.77 ," $1,107.84 "
Inject Third and Any Level Lumbar/Sacral,64495,N/A,N/A,N/A, $536.00 , $348.40 , $256.46 , $49.77 , $62.93 , $296.18 , $287.57 , $498.48 , $482.40 , $482.40 , $428.80 , $428.80 , $62.93 , $494.89 , $509.20 , $482.40 , $482.40 , $482.40 , $498.48 , $514.56 , $280.21 , $455.60 , $278.31 , $317.90 , N/A , $301.95 , $301.95 , $509.20 , $323.93 , $49.77 , $514.56 
" Fac Inj Perflutren Lip Micros,Ml ",HCPCS Q9957,0255 - DRUGS/RADIOLOGY,N/A,N/A, $339.00 , $220.35 , $284.76 , $43.57 , $50.04 , $273.91 , $305.10 , $287.00 , $305.10 , $305.10 , $305.10 , $288.15 , $49.06 , $313.00 , $322.05 , $288.15 , $315.27 , $315.27 , $322.05 , $325.44 , $277.37 , $305.10 , $288.15 , $267.81 , N/A , $274.35 , $274.35 , $322.05 , $290.90 , $43.57 , $325.44 
 Transvaginal Non OB ,CPT® 76830,0402 - ULTRASOUND,N/A,N/A, $615.00 , $399.75 , $516.60 , $118.64 , $99.44 , $496.92 , $553.50 , $520.66 , $553.50 , $553.50 , $553.50 , $522.75 , $97.49 , $567.83 , $584.25 , $522.75 , $571.95 , $571.95 , $584.25 , $590.40 , $503.19 , $553.50 , $522.75 , $485.85 , N/A , $497.72 , $497.72 , $584.25 , $527.73 , $97.49 , $590.40 
 Fac Phlebotomy ,CPT® 99195,0940 - OTHER RX SVS,N/A,N/A, $188.00 , $122.20 , $157.92 , $93.91 , $6.75 , $151.90 , $169.20 , $159.16 , $169.20 , $169.20 , $169.20 , $159.80 , $6.62 , $173.58 , $178.60 , $159.80 , $174.84 , $174.84 , $178.60 , $180.48 , $153.82 , $169.20 , $159.80 , $148.52 , N/A , $152.15 , $152.15 , $178.60 , $161.32 , $6.62 , $180.48 
Blood Clot Factor VIII Test,CPT® 85245,N/A,N/A,N/A, $236.00 , $153.40 , N/A , $23.40 , $23.40 , $129.79 , $155.30 , $219.48 , $212.40 , $212.40 , $188.80 , $188.80 , $23.40 , $217.90 , $224.20 , $212.40 , $212.40 , $212.40 , $219.48 , $226.56 , $153.18 , $200.60 , $150.83 , $83.18 , N/A , $121.13 , $121.13 , $224.20 , $132.37 , $23.40 , $226.56 
Microsatellite Instab Anal Mismatch Repair Def,CPT® 81301,N/A,N/A,N/A," $2,464.00 "," $1,601.60 ", N/A , $355.53 , $322.35 ," $1,638.24 "," $1,940.06 "," $2,291.52 "," $2,217.60 "," $2,217.60 "," $1,971.20 "," $1,971.20 ", $322.35 ," $2,275.01 "," $2,340.80 "," $2,217.60 "," $2,217.60 "," $2,217.60 "," $2,291.52 "," $2,365.44 "," $2,327.41 "," $2,094.40 "," $1,662.21 "," $1,049.92 ", N/A ," $1,528.91 "," $1,528.91 "," $2,340.80 "," $1,670.77 ", $322.35 ," $2,365.44 "
 Pro Cltx Articular Fx Invg Mtcarphlngl/Iphal Jt W/ ,CPT® 26742,0981 - PRO FEE/ER,N/A,N/A," $1,849.00 "," $1,201.85 "," $2,083.84 ", $329.17 , $168.45 ," $1,595.87 "," $1,612.46 "," $1,719.57 "," $1,664.10 "," $1,664.10 "," $1,479.20 "," $1,479.20 ", $168.45 ," $1,707.18 "," $1,756.55 "," $1,664.10 "," $1,664.10 "," $1,664.10 "," $1,719.57 "," $1,775.04 "," $1,930.83 "," $1,571.65 "," $1,771.58 "," $1,911.72 ", N/A ," $1,627.01 "," $1,627.01 "," $1,756.55 "," $1,912.32 ", $168.45 ," $2,083.84 "
"Explor Penetr Wound,Neck",CPT® 20100,N/A,N/A,N/A," $3,822.00 "," $2,484.30 "," $3,616.67 ", $558.24 , $644.64 ," $2,924.87 "," $2,858.17 "," $3,554.46 "," $3,439.80 "," $3,439.80 "," $3,057.60 "," $3,057.60 ", $644.64 ," $3,528.85 "," $3,630.90 "," $3,439.80 "," $3,439.80 "," $3,439.80 "," $3,554.46 "," $3,669.12 "," $3,359.28 "," $3,248.70 "," $3,166.71 "," $3,399.81 ", N/A ," $2,981.94 "," $2,981.94 "," $3,630.90 "," $3,504.84 ", $558.24 ," $3,669.12 "
 Pro Treat Fracture of Ulna ,CPT® 25530,0982 - PRO FEE/OUTPT,N/A,N/A," $1,720.00 "," $1,118.00 "," $1,510.80 ", $240.36 , $154.82 ," $1,143.45 "," $1,163.91 "," $1,599.60 "," $1,548.00 "," $1,548.00 "," $1,376.00 "," $1,376.00 ", $154.82 ," $1,588.08 "," $1,634.00 "," $1,548.00 "," $1,548.00 "," $1,548.00 "," $1,599.60 "," $1,651.20 "," $1,395.00 "," $1,462.00 "," $1,273.82 "," $1,362.13 ", N/A ," $1,165.76 "," $1,165.76 "," $1,634.00 "," $1,370.18 ", $154.82 ," $1,651.20 "
Stereotactic Body Radiation Management,CPT® 77435,N/A,N/A,N/A," $6,072.00 "," $3,946.80 "," $3,567.93 ", $627.36 , $544.53 ," $3,018.61 "," $3,127.83 "," $5,646.96 "," $5,464.80 "," $5,464.80 "," $4,857.60 "," $4,857.60 ", $544.53 ," $5,606.28 "," $5,768.40 "," $5,464.80 "," $5,464.80 "," $5,464.80 "," $5,646.96 "," $5,829.12 "," $3,566.59 "," $5,161.20 "," $3,428.35 "," $3,510.15 ", N/A ," $3,077.51 "," $3,077.51 "," $5,768.40 "," $3,562.28 ", $544.53 ," $5,829.12 "
Budesonide Inhalation Sol,HCPCS J7626,N/A,N/A,N/A, $14.00 , $9.10 , N/A , $0.90 , $0.92 , N/A , N/A , $13.02 , $12.60 , $12.60 , $11.20 , $11.20 , $0.92 , $12.93 , $13.30 , $12.60 , $12.60 , $12.60 , $13.02 , $13.44 , $1.74 , $11.90 , $9.73 , $1.25 , N/A , N/A , N/A , $13.30 , N/A , $0.90 , $13.44 
"Close Tear Duct Opening by Plug,Ea",68761,N/A,N/A,N/A, $637.00 , $414.05 , $727.87 , $114.29 , $97.37 , $673.05 , $636.84 , $592.41 , $573.30 , $573.30 , $509.60 , $509.60 , $97.37 , $588.14 , $605.15 , $573.30 , $573.30 , $573.30 , $592.41 , $611.52 , $998.63 , $541.45 , $654.75 , $859.42 , N/A , $686.18 , $686.18 , $605.15 , $757.46 , $97.37 , $998.63 
"Compatibility Test,Antiglob Tech",CPT® 86922,N/A,N/A,N/A, $112.00 , $72.80 , N/A , N/A , $43.30 , $106.60 , $122.22 , $104.16 , $100.80 , $100.80 , $89.60 , $89.60 , $43.30 , $103.41 , $106.40 , $100.80 , $100.80 , $100.80 , $104.16 , $107.52 , N/A , $95.20 , $123.26 , $111.31 , N/A , $99.49 , $99.49 , $106.40 , $108.72 , $43.30 , $123.26 
 PROPRANOLOL HCL ER 80 MG PO CP24 ,HCPCS RXC637,0250 - PHARMACY,51991-0818-01,1 capsule, $12.37 , $8.04 , $10.39 , N/A , N/A , $9.99 , $11.13 , $10.47 , $11.13 , $11.13 , $11.13 , $10.51 , N/A , $11.42 , $11.75 , $10.51 , $11.50 , $11.50 , $11.75 , $11.88 , $10.12 , $11.13 , $10.51 , $9.77 , N/A , $10.01 , $10.01 , $11.75 , $10.61 , $9.77 , $11.88 
 Fac Assay of Ferritin ,CPT® 82728,0301 - LAB/CHEMISTRY,N/A,N/A, $135.00 , $87.75 , $113.40 , $13.90 , $13.90 , $109.08 , $121.50 , $114.29 , $121.50 , $121.50 , $121.50 , $114.75 , $13.63 , $124.65 , $128.25 , $114.75 , $125.55 , $125.55 , $128.25 , $129.60 , $110.46 , $121.50 , $114.75 , $106.65 , N/A , $109.26 , $109.26 , $128.25 , $115.84 , $13.63 , $129.60 
" Fac Immunoassay, Tumor Other ",CPT® 86316,0302 - LAB/IMMUNOLOGY,N/A,N/A, $238.00 , $154.70 , $199.92 , $21.23 , $21.23 , $192.30 , $214.20 , $201.49 , $214.20 , $214.20 , $214.20 , $202.30 , $20.81 , $219.75 , $226.10 , $202.30 , $221.34 , $221.34 , $226.10 , $228.48 , $194.73 , $214.20 , $202.30 , $188.02 , N/A , $192.61 , $192.61 , $226.10 , $204.23 , $20.81 , $228.48 
 FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN ,HCPCS J1450,0636 - DRUGS REQUIRING DETAILED CODIN,25021-0184-67,200 mL, $26.72 , $17.37 , $22.44 , $2.73 , $2.50 , $21.59 , $24.05 , $22.62 , $24.05 , $24.05 , $24.05 , $22.71 , $2.45 , $24.67 , $25.38 , $22.71 , $24.85 , $24.85 , $25.38 , $25.65 , $21.86 , $24.05 , $22.71 , $21.11 , N/A , $21.62 , $21.62 , $25.38 , $22.93 , $2.45 , $25.65 
"Insert Endovasc Prosth, Taa",CPT® 33883,N/A,N/A,N/A," $6,784.00 "," $4,409.60 "," $6,460.81 ", $995.27 ," $1,010.10 "," $4,839.65 "," $4,802.19 "," $6,309.12 "," $6,105.60 "," $6,105.60 "," $5,427.20 "," $5,427.20 "," $1,010.10 "," $6,263.67 "," $6,444.80 "," $6,105.60 "," $6,105.60 "," $6,105.60 "," $6,309.12 "," $6,512.64 "," $5,982.93 "," $5,766.40 "," $6,058.68 "," $5,397.69 ", N/A ," $4,934.08 "," $4,934.08 "," $6,444.80 "," $5,605.12 ", $995.27 ," $6,512.64 "
"Closed Rx Weight Bear Dist Tib,Manip",CPT® 27825,N/A,N/A,N/A," $2,855.00 "," $1,855.75 "," $3,004.63 ", $474.54 , $435.12 ," $2,383.87 "," $2,374.71 "," $2,655.15 "," $2,569.50 "," $2,569.50 "," $2,284.00 "," $2,284.00 ", $435.12 ," $2,636.02 "," $2,712.25 "," $2,569.50 "," $2,569.50 "," $2,569.50 "," $2,655.15 "," $2,740.80 "," $2,791.58 "," $2,426.75 "," $2,619.01 "," $2,820.48 ", N/A ," $2,430.39 "," $2,430.39 "," $2,712.25 "," $2,856.59 ", $435.12 ," $3,004.63 "
 Fac Assay of Sex Hormone Globul ,CPT® 84270,0301 - LAB/CHEMISTRY,N/A,N/A, $210.00 , $136.50 , $176.40 , $22.16 , $22.16 , $169.68 , $189.00 , $177.79 , $189.00 , $189.00 , $189.00 , $178.50 , $21.73 , $193.89 , $199.50 , $178.50 , $195.30 , $195.30 , $199.50 , $201.60 , $171.82 , $189.00 , $178.50 , $165.90 , N/A , $169.95 , $169.95 , $199.50 , $180.20 , $21.73 , $201.60 
"Detect Agent Nos, Dna, Amp",CPT® 87798,N/A,N/A,N/A, $315.00 , $204.75 , N/A , $35.79 , $35.79 , $198.56 , $237.51 , $292.95 , $283.50 , $283.50 , $252.00 , $252.00 , $35.79 , $290.84 , $299.25 , $283.50 , $283.50 , $283.50 , $292.95 , $302.40 , $234.30 , $267.75 , $230.30 , $127.26 , N/A , $185.31 , $185.31 , $299.25 , $202.50 , $35.79 , $302.40 
 Fac Prolonged Office/Outpatient E/M Svc Ea 15 Min ,CPT® 99417,0510 - CLINIC,N/A,N/A, $82.00 , $53.30 , $68.88 , $30.39 , N/A , $66.26 , $73.80 , N/A , $73.80 , $73.80 , $73.80 , $69.70 , N/A , $75.71 , $77.90 , $69.70 , $76.26 , $76.26 , $77.90 , $78.72 , $67.09 , $73.80 , $69.70 , $64.78 , N/A , $66.36 , $66.36 , $77.90 , $70.36 , $30.39 , $78.72 
"Cystoscopy,Insert Urethral Stent",CPT® 52282,N/A,N/A,N/A," $2,351.00 "," $1,528.15 "," $1,799.87 ", $316.35 , $474.19 ," $1,652.97 "," $1,530.29 "," $2,186.43 "," $2,115.90 "," $2,115.90 "," $1,880.80 "," $1,880.80 ", $474.19 ," $2,170.68 "," $2,233.45 "," $2,115.90 "," $2,115.90 "," $2,115.90 "," $2,186.43 "," $2,256.96 "," $1,808.04 "," $1,998.35 "," $1,735.89 "," $2,068.67 ", N/A ," $1,685.23 "," $1,685.23 "," $2,233.45 "," $1,980.73 ", $316.35 ," $2,256.96 "
 Fac Alanine Amino (Alt) (Sgpt) ,CPT® 84460,0301 - LAB/CHEMISTRY,N/A,N/A, $63.00 , $40.95 , $52.92 , $5.41 , $5.41 , $50.90 , $56.70 , $53.34 , $56.70 , $56.70 , $56.70 , $53.55 , $5.30 , $58.17 , $59.85 , $53.55 , $58.59 , $58.59 , $59.85 , $60.48 , $51.55 , $56.70 , $53.55 , $49.77 , N/A , $50.99 , $50.99 , $59.85 , $54.06 , $5.30 , $60.48 
CT Guidance &Monitoring Visc Tiss Ablation,CPT® 77013,N/A,N/A,N/A," $4,713.00 "," $3,063.45 "," $3,568.39 ", $624.98 , N/A ," $2,655.23 "," $2,766.66 "," $4,383.09 "," $4,241.70 "," $4,241.70 "," $3,770.40 "," $3,770.40 ", N/A ," $4,351.51 "," $4,477.35 "," $4,241.70 "," $4,241.70 "," $4,241.70 "," $4,383.09 "," $4,524.48 "," $3,540.27 "," $4,006.05 "," $3,070.11 "," $4,064.19 ", N/A ," $2,707.04 "," $2,707.04 "," $4,477.35 "," $3,133.44 ", $624.98 ," $4,524.48 "
" Fac Subcut Infusion, Therap/Proph/Diagnost,Initial,1st Hour ",CPT® 96369,0260 - IV THERAPY,N/A,N/A, $458.00 , $297.70 , $384.72 , $136.74 , $140.09 , $370.06 , $412.20 , $387.74 , $412.20 , $412.20 , $412.20 , $389.30 , $137.34 , $422.87 , $435.10 , $389.30 , $425.94 , $425.94 , $435.10 , $439.68 , $374.74 , $412.20 , $389.30 , $361.82 , N/A , $370.66 , $370.66 , $435.10 , $393.01 , $136.74 , $439.68 
"Elbow Arthroscop,Remv Loose Body",29834,N/A,N/A,N/A," $3,305.00 "," $2,148.25 "," $3,009.96 ", $473.11 , $500.35 ," $2,352.67 "," $2,367.22 "," $3,073.65 "," $2,974.50 "," $2,974.50 "," $2,644.00 "," $2,644.00 ", $500.35 ," $3,051.51 "," $3,139.75 "," $2,974.50 "," $2,974.50 "," $2,974.50 "," $3,073.65 "," $3,172.80 "," $2,803.63 "," $2,809.25 "," $2,610.09 "," $2,791.70 ", N/A ," $2,398.57 "," $2,398.57 "," $3,139.75 "," $2,819.18 ", $473.11 ," $3,172.80 "
Exc Tumor Soft Tissue Abdominal Wall Subq <3cm,CPT® 22902,N/A,N/A,N/A," $2,901.00 "," $1,885.65 "," $2,014.87 ", $314.57 , $346.95 ," $1,587.40 "," $1,578.19 "," $2,697.93 "," $2,610.90 "," $2,610.90 "," $2,320.80 "," $2,320.80 ", $346.95 ," $2,678.49 "," $2,755.95 "," $2,610.90 "," $2,610.90 "," $2,610.90 "," $2,697.93 "," $2,784.96 "," $1,864.37 "," $2,465.85 "," $1,728.76 "," $1,864.11 ", N/A ," $1,618.38 "," $1,618.38 "," $2,755.95 "," $1,902.17 ", $314.57 ," $2,784.96 "
 Pro Arthrd Ankle Opn ,CPT® 27870,0975 - PRO FEE/OR,N/A,N/A," $8,183.00 "," $5,318.95 "," $6,159.86 ", $961.57 ," $1,075.74 "," $4,998.95 "," $4,982.21 "," $7,610.19 "," $7,364.70 "," $7,364.70 "," $6,546.40 "," $6,546.40 "," $1,075.74 "," $7,555.36 "," $7,773.85 "," $7,364.70 "," $7,364.70 "," $7,364.70 "," $7,610.19 "," $7,855.68 "," $5,745.61 "," $6,955.55 "," $5,494.92 "," $5,877.09 ", N/A ," $5,096.49 "," $5,096.49 "," $7,773.85 "," $5,990.20 ", $961.57 ," $7,855.68 "
Treat Femoral Fracture Fac,27232,N/A,N/A,N/A," $5,288.00 "," $3,437.20 "," $4,449.45 ", $684.77 , $768.38 ," $3,636.04 "," $3,641.78 "," $4,917.84 "," $4,759.20 "," $4,759.20 "," $4,230.40 "," $4,230.40 ", $768.38 ," $4,882.41 "," $5,023.60 "," $4,759.20 "," $4,759.20 "," $4,759.20 "," $4,917.84 "," $5,076.48 "," $4,159.59 "," $4,494.80 "," $4,028.42 "," $4,230.45 ", N/A ," $3,706.99 "," $3,706.99 "," $5,023.60 "," $4,357.03 ", $684.77 ," $5,076.48 "
 KETAMINE HCL-SODIUM CHLORIDE 50-0.9 MG/5ML-% IV SOSY ,HCPCS RXA250,0250 - PHARMACY,70092-1119-44,5 mL, $44.70 , $29.06 , $37.55 , N/A , N/A , $36.12 , $40.23 , $37.84 , $40.23 , $40.23 , $40.23 , $38.00 , N/A , $41.27 , $42.47 , $38.00 , $41.57 , $41.57 , $42.47 , $42.91 , $36.57 , $40.23 , $38.00 , $35.31 , N/A , $36.18 , $36.18 , $42.47 , $38.36 , $35.31 , $42.91 
" Pro Scope Bladder, Removal of Tumors, Large ",CPT® 52240,0982 - PRO FEE/OUTPT,N/A,N/A," $3,316.00 "," $2,155.40 "," $2,100.25 ", $368.50 , $514.64 ," $1,924.93 "," $1,781.28 "," $3,083.88 "," $2,984.40 "," $2,984.40 "," $2,652.80 "," $2,652.80 ", $514.64 ," $3,061.66 "," $3,150.20 "," $2,984.40 "," $2,984.40 "," $2,984.40 "," $3,083.88 "," $3,183.36 "," $2,112.54 "," $2,818.60 "," $2,017.78 "," $2,413.34 ", N/A ," $1,962.49 "," $1,962.49 "," $3,150.20 "," $2,306.64 ", $368.50 ," $3,183.36 "
 Fac Intracardiac Electrophysiologic 3d Mapping ,CPT® 93613,0480 - CARDIOLOGY,N/A,N/A," $5,942.00 "," $3,862.30 "," $4,991.28 ", $266.15 , $582.69 ," $4,801.14 "," $5,347.80 "," $5,030.50 "," $5,347.80 "," $5,347.80 "," $5,347.80 "," $5,050.70 ", $571.26 ," $5,486.25 "," $5,644.90 "," $5,050.70 "," $5,526.06 "," $5,526.06 "," $5,644.90 "," $5,704.32 "," $4,861.74 "," $5,347.80 "," $5,050.70 "," $4,694.18 ", N/A ," $4,808.86 "," $4,808.86 "," $5,644.90 "," $5,098.83 ", $266.15 ," $5,704.32 "
Molecular Pathology Procedure Level 4,CPT® 81403,N/A,N/A,N/A, $821.00 , $533.65 , N/A , $188.90 , $188.90 , N/A , N/A , $763.53 , $738.90 , $738.90 , $656.80 , $656.80 , $188.90 , $758.03 , $779.95 , $738.90 , $738.90 , $738.90 , $763.53 , $788.16 ," $1,236.62 ", $697.85 , $883.61 , $543.93 , N/A , $735.24 , $735.24 , $779.95 , $801.92 , $188.90 ," $1,236.62 "
 Bone Density Peripheral Skeleton ,CPT® 77081,0320 - DX X-RAY,N/A,N/A, $415.00 , $269.75 , $348.60 , $30.77 , $28.10 , $335.32 , $373.50 , $351.34 , $373.50 , $373.50 , $373.50 , $352.75 , $27.55 , $383.17 , $394.25 , $352.75 , $385.95 , $385.95 , $394.25 , $398.40 , $339.55 , $373.50 , $352.75 , $327.85 , N/A , $335.86 , $335.86 , $394.25 , $356.11 , $27.55 , $398.40 
 Fac CT Head/Brain W/O Dye ,CPT® 70450,0350 - CT SCAN,N/A,N/A," $1,868.00 "," $1,214.20 "," $1,569.12 ", $108.41 , $193.07 ," $1,509.34 "," $1,681.20 "," $1,581.45 "," $1,681.20 "," $1,681.20 "," $1,681.20 "," $1,587.80 ", $189.28 ," $1,724.72 "," $1,774.60 "," $1,587.80 "," $1,737.24 "," $1,737.24 "," $1,774.60 "," $1,793.28 "," $1,528.40 "," $1,681.20 "," $1,587.80 "," $1,475.72 ", N/A ," $1,511.77 "," $1,511.77 "," $1,774.60 "," $1,602.93 ", $108.41 ," $1,793.28 "
"Revise Knee Joint Replace,All Parts",CPT® 27487,N/A,N/A,N/A," $9,790.00 "," $6,363.50 "," $10,532.47 "," $1,644.52 "," $1,190.41 "," $8,494.01 "," $8,398.75 "," $9,104.70 "," $8,811.00 "," $8,811.00 "," $7,832.00 "," $7,832.00 "," $1,190.41 "," $9,039.11 "," $9,300.50 "," $8,811.00 "," $8,811.00 "," $8,811.00 "," $9,104.70 "," $9,398.40 "," $9,832.71 "," $8,321.50 "," $9,303.89 "," $9,988.20 ", N/A ," $8,659.75 "," $8,659.75 "," $9,300.50 "," $10,178.27 "," $1,190.41 "," $10,532.47 "
 MITOMYCIN 0.4 MG/ML (SW) OPHTHALMIC SOLUTION ,HCPCS J7315,0636 - DRUGS REQUIRING DETAILED CODIN,00001-0160-01,1 mL, $667.60 , $433.94 , $560.78 , N/A , N/A , $539.42 , $600.84 , $565.19 , $600.84 , $600.84 , $600.84 , $567.46 , N/A , $616.40 , $634.22 , $567.46 , $620.87 , $620.87 , $634.22 , $640.90 , $546.23 , $600.84 , $567.46 , $527.40 , N/A , $540.29 , $540.29 , $634.22 , $572.87 , $527.40 , $640.90 
 MICONAZOLE NITRATE 2 % EX CREA ,HCPCS RXC637,0250 - PHARMACY,51672-2001-01,15 gram, $26.97 , $17.53 , $22.65 , N/A , N/A , $21.79 , $24.27 , $22.83 , $24.27 , $24.27 , $24.27 , $22.92 , N/A , $24.90 , $25.62 , $22.92 , $25.08 , $25.08 , $25.62 , $25.89 , $22.07 , $24.27 , $22.92 , $21.31 , N/A , $21.83 , $21.83 , $25.62 , $23.14 , $21.31 , $25.89 
"Closed Rx Carpal Fx,Maipulatn",25635,N/A,N/A,N/A," $3,008.00 "," $1,955.20 "," $2,617.36 ", $413.20 , $309.27 ," $1,904.63 "," $1,955.26 "," $2,797.44 "," $2,707.20 "," $2,707.20 "," $2,406.40 "," $2,406.40 ", $309.27 ," $2,777.29 "," $2,857.60 "," $2,707.20 "," $2,707.20 "," $2,707.20 "," $2,797.44 "," $2,887.68 "," $2,415.68 "," $2,556.80 "," $2,149.80 "," $2,366.40 ", N/A ," $1,941.79 "," $1,941.79 "," $2,857.60 "," $2,282.30 ", $309.27 ," $2,887.68 "
Fac Cltx Intercondylar Spi&/Tubrst Fx Kne +-Mnpj,27538,N/A,N/A,N/A, $943.00 , $612.95 ," $2,792.79 ", $438.31 , $307.34 ," $2,139.92 "," $2,153.40 ", $876.99 , $848.70 , $848.70 , $754.40 , $754.40 , $307.34 , $870.67 , $895.85 , $848.70 , $848.70 , $848.70 , $876.99 , $905.28 ," $2,565.24 ", $801.55 ," $2,369.24 "," $2,529.06 ", N/A ," $2,181.67 "," $2,181.67 ", $895.85 ," $2,564.24 ", $307.34 ," $2,792.79 "
 Transcath Placement&Sbsq Removal Cepd Perq ,CPT® 33370,0360 - OR SERVICES,N/A,N/A," $3,050.00 "," $1,982.50 "," $2,562.00 ", $120.73 , N/A ," $2,464.40 "," $2,745.00 "," $2,582.13 "," $2,745.00 "," $2,745.00 "," $2,745.00 "," $2,592.50 ", N/A ," $2,816.07 "," $2,897.50 "," $2,592.50 "," $2,836.50 "," $2,836.50 "," $2,897.50 "," $2,928.00 "," $2,495.51 "," $2,745.00 "," $2,592.50 "," $2,409.50 ", N/A ," $2,468.37 "," $2,468.37 "," $2,897.50 "," $2,617.21 ", $120.73 ," $2,928.00 "
 Inj Proc Retro Urethrogram ,CPT® 51610,0761 - TREATMENT ROOM,N/A,N/A, $450.00 , $292.50 , $378.00 , $61.24 , $25.41 , $363.60 , $405.00 , $380.97 , $405.00 , $405.00 , $405.00 , $382.50 , $24.91 , $415.49 , $427.50 , $382.50 , $418.50 , $418.50 , $427.50 , $432.00 , $368.19 , $405.00 , $382.50 , $355.50 , N/A , $364.19 , $364.19 , $427.50 , $386.15 , $24.91 , $432.00 
 Fac Mlc Imrt Design & Construction per Imrt Plan ,CPT® 77338,0333 - RADIATION RX,N/A,N/A," $5,347.00 "," $3,475.55 "," $4,491.48 ", $456.82 , $410.41 ," $4,320.38 "," $4,812.30 "," $4,526.77 "," $4,812.30 "," $4,812.30 "," $4,812.30 "," $4,544.95 ", $402.36 ," $4,936.89 "," $5,079.65 "," $4,544.95 "," $4,972.71 "," $4,972.71 "," $5,079.65 "," $5,133.12 "," $4,374.92 "," $4,812.30 "," $4,544.95 "," $4,224.13 ", N/A ," $4,327.33 "," $4,327.33 "," $5,079.65 "," $4,588.26 ", $402.36 ," $5,133.12 "
 MODAFINIL 200 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,62332-0386-30,1 tablet, $171.23 , $111.30 , $143.83 , N/A , N/A , $138.35 , $154.11 , $144.96 , $154.11 , $154.11 , $154.11 , $145.55 , N/A , $158.10 , $162.67 , $145.55 , $159.24 , $159.24 , $162.67 , $164.38 , $140.10 , $154.11 , $145.55 , $135.27 , N/A , $138.58 , $138.58 , $162.67 , $146.93 , $135.27 , $164.38 
"Excise Varicocele,Abd Approach",CPT® 55535,N/A,N/A,N/A," $2,365.00 "," $1,537.25 "," $1,913.04 ", $412.73 , $614.70 ," $1,381.19 "," $1,398.61 "," $2,199.45 "," $2,128.50 "," $2,128.50 "," $1,892.00 "," $1,892.00 ", $614.70 ," $2,183.60 "," $2,246.75 "," $2,128.50 "," $2,128.50 "," $2,128.50 "," $2,199.45 "," $2,270.40 "," $1,794.89 "," $2,010.25 "," $2,226.51 "," $2,088.55 ", N/A ," $1,408.14 "," $1,408.14 "," $2,246.75 "," $1,687.73 ", $412.73 ," $2,270.40 "
Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/O Img Gdn,62320,N/A,N/A,N/A," $1,653.00 "," $1,074.45 ", $487.55 , $95.25 , $132.09 , $548.33 , $533.94 ," $1,537.29 "," $1,487.70 "," $1,487.70 "," $1,322.40 "," $1,322.40 ", $132.09 ," $1,526.21 "," $1,570.35 "," $1,487.70 "," $1,487.70 "," $1,487.70 "," $1,537.29 "," $1,586.88 ", $524.37 ," $1,405.05 ", $529.53 , $606.17 , N/A , $559.03 , $559.03 ," $1,570.35 ", $599.72 , $95.25 ," $1,586.88 "
 Fac Lig Div&/Exc Varicose Vein Cluster 1 Leg ,CPT® 37785,0360 - OR SERVICES,N/A,N/A," $5,017.00 "," $3,261.05 "," $4,214.28 ", $233.50 , $76.84 ," $4,053.74 "," $4,515.30 "," $4,247.39 "," $4,515.30 "," $4,515.30 "," $4,515.30 "," $4,264.45 ", $75.33 ," $4,632.20 "," $4,766.15 "," $4,264.45 "," $4,665.81 "," $4,665.81 "," $4,766.15 "," $4,816.32 "," $4,104.91 "," $4,515.30 "," $4,264.45 "," $3,963.43 ", N/A ," $4,060.26 "," $4,060.26 "," $4,766.15 "," $4,305.09 ", $75.33 ," $4,816.32 "
 Fac Prq Transluminal Mechanical Thrombectomy Vein ,CPT® 37187,0761 - TREATMENT ROOM,N/A,N/A," $2,491.00 "," $1,619.15 "," $2,092.44 ", $362.17 ," $2,378.00 "," $2,012.73 "," $2,241.90 "," $2,108.88 "," $2,241.90 "," $2,241.90 "," $2,241.90 "," $2,117.35 "," $2,331.37 "," $2,299.94 "," $2,366.45 "," $2,117.35 "," $2,316.63 "," $2,316.63 "," $2,366.45 "," $2,391.36 "," $2,038.14 "," $2,241.90 "," $2,117.35 "," $1,967.89 ", N/A ," $2,015.97 "," $2,015.97 "," $2,366.45 "," $2,137.53 ", $362.17 ," $2,391.36 "
 TRIAMCINOLONE ACETONIDE 10 MG/ML IJ SUSP ,HCPCS J3301,0636 - DRUGS REQUIRING DETAILED CODIN,50090-0295-01,0.25 mL, $16.68 , $10.84 , $14.01 , $1.03 , $1.14 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $1.12 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $1.03 , $16.01 
 Pro Apply Short Arm Splint ,CPT® 29125,0982 - PRO FEE/OUTPT,N/A,N/A, $428.00 , $278.20 , $241.35 , $38.40 , $27.51 , $190.75 , $194.03 , $398.04 , $385.20 , $385.20 , $342.40 , $342.40 , $27.51 , $395.17 , $406.60 , $385.20 , $385.20 , $385.20 , $398.04 , $410.88 , $223.62 , $363.80 , $212.30 , $229.45 , N/A , $194.47 , $194.47 , $406.60 , $228.57 , $27.51 , $410.88 
 Admin Moderna Bivalent Booster +/= 18 Yrs ,CPT® 0134A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
"Remv Lens Material,Phacofragmt",CPT® 66850,N/A,N/A,N/A," $7,070.00 "," $4,595.50 "," $4,851.93 ", $761.14 , $623.63 ," $4,487.04 "," $4,185.02 "," $6,575.10 "," $6,363.00 "," $6,363.00 "," $5,656.00 "," $5,656.00 ", $623.63 ," $6,527.73 "," $6,716.50 "," $6,363.00 "," $6,363.00 "," $6,363.00 "," $6,575.10 "," $6,787.20 "," $6,668.52 "," $6,009.50 "," $4,301.38 "," $5,700.06 ", N/A ," $4,574.59 "," $4,574.59 "," $6,716.50 "," $5,049.75 ", $623.63 ," $6,787.20 "
"Inject Nerv Blck,Sphenopalat Gangln",CPT® 64505,N/A,N/A,N/A, $753.00 , $489.45 , $493.38 , $96.56 , $76.84 , $484.32 , $470.40 , $700.29 , $677.70 , $677.70 , $602.40 , $602.40 , $76.84 , $695.24 , $715.35 , $677.70 , $677.70 , $677.70 , $700.29 , $722.88 , $520.28 , $640.05 , $456.72 , $535.18 , N/A , $493.77 , $493.77 , $715.35 , $529.70 , $76.84 , $722.88 
Vertebral Fracture Assessment via DXA,CPT® 77086,N/A,N/A,N/A, $755.00 , $490.75 , $182.82 , $32.36 , $27.90 , $169.21 , $183.18 , $702.15 , $679.50 , $679.50 , $604.00 , $604.00 , $27.90 , $697.09 , $717.25 , $679.50 , $679.50 , $679.50 , $702.15 , $724.80 , $184.00 , $641.75 , $189.92 , $271.09 , N/A , $172.52 , $172.52 , $717.25 , $199.68 , $27.90 , $724.80 
Spec coll snf/lab covid-19,HCPCS G2024,N/A,N/A,N/A, $32.00 , $20.80 , N/A , $25.97 , N/A , N/A , N/A , $29.76 , $28.80 , $28.80 , $25.60 , $25.60 , N/A , $29.55 , $30.40 , $28.80 , $28.80 , $28.80 , $29.76 , $30.72 , $170.00 , $27.20 , $48.46 , $74.78 , N/A , $107.91 , $107.91 , $30.40 , $117.93 , $25.60 , $170.00 
Partial Removal of Kidney,CPT® 50240,N/A,N/A,N/A," $9,210.00 "," $5,986.50 "," $7,159.84 "," $1,257.62 "," $1,986.03 "," $6,474.50 "," $6,019.51 "," $8,565.30 "," $8,289.00 "," $8,289.00 "," $7,368.00 "," $7,368.00 "," $1,986.03 "," $8,503.59 "," $8,749.50 "," $8,289.00 "," $8,289.00 "," $8,289.00 "," $8,565.30 "," $8,841.60 "," $7,180.52 "," $7,828.50 "," $6,820.48 "," $8,133.63 ", N/A ," $6,600.83 "," $6,600.83 "," $8,749.50 "," $7,758.32 "," $1,257.62 "," $8,841.60 "
 HALOPERIDOL DECANOATE 100 MG/ML IM SOLN ,HCPCS J1631,0636 - DRUGS REQUIRING DETAILED CODIN,70069-0383-01,1 mL, $249.14 , $161.94 , $209.28 , $8.50 , $7.80 , $201.31 , $224.23 , $210.92 , $224.23 , $224.23 , $224.23 , $211.77 , $7.65 , $230.03 , $236.68 , $211.77 , $231.70 , $231.70 , $236.68 , $239.17 , $203.85 , $224.23 , $211.77 , $196.82 , N/A , $201.63 , $201.63 , $236.68 , $213.79 , $7.65 , $239.17 
" Pro N Block, Lumbar/Thoracic ",CPT® 64520,0982 - PRO FEE/OUTPT,N/A,N/A, $723.00 , $469.95 , $418.86 , $81.46 , $161.66 , $454.37 , $440.17 , $672.39 , $650.70 , $650.70 , $578.40 , $578.40 , $161.66 , $667.55 , $686.85 , $650.70 , $650.70 , $650.70 , $672.39 , $694.08 , $450.20 , $614.55 , $428.18 , $487.79 , N/A , $463.24 , $463.24 , $686.85 , $496.95 , $81.46 , $694.08 
 RIFAXIMIN 200 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,65649-0301-03,1 tablet, $63.14 , $41.04 , $53.04 , N/A , N/A , $51.02 , $56.83 , $53.45 , $56.83 , $56.83 , $56.83 , $53.67 , N/A , $58.30 , $59.98 , $53.67 , $58.72 , $58.72 , $59.98 , $60.61 , $51.66 , $56.83 , $53.67 , $49.88 , N/A , $51.10 , $51.10 , $59.98 , $54.18 , $49.88 , $60.61 
"Exc Skin Benig <5mm Face,Facial",11440,N/A,N/A,N/A, $463.00 , $300.95 , $341.29 , $103.49 , $82.89 , $281.15 , $281.65 , $430.59 , $416.70 , $416.70 , $370.40 , $370.40 , $82.89 , $427.49 , $439.85 , $416.70 , $416.70 , $416.70 , $430.59 , $444.48 , $369.08 , $393.55 , $558.41 , $365.26 , N/A , $286.63 , $286.63 , $439.85 , $332.38 , $82.89 , $558.41 
 Fac Fo W/O Joints Cf ,HCPCS L3933,0274 - PROSTHETIC DEV,N/A,N/A, $319.00 , $207.35 , $267.96 , $227.14 , $59.69 , $257.75 , $287.10 , $270.07 , $287.10 , $287.10 , $287.10 , $271.15 , $58.52 , $294.53 , $303.05 , $271.15 , $296.67 , $296.67 , $303.05 , $306.24 , $261.01 , $287.10 , $271.15 , $252.01 , N/A , $258.17 , $258.17 , $303.05 , $273.73 , $58.52 , $306.24 
Impl Oi Implt Skull Mag Tc Attachment Esp>=100,CPT® 69729,N/A,N/A,N/A," $5,943.00 "," $3,862.95 ", N/A , $647.89 , $505.68 , N/A , N/A ," $5,526.99 "," $5,348.70 "," $5,348.70 "," $4,754.40 "," $4,754.40 ", $505.68 ," $5,487.17 "," $5,645.85 "," $5,348.70 "," $5,348.70 "," $5,348.70 "," $5,526.99 "," $5,705.28 ", N/A ," $5,051.55 "," $3,584.09 ", N/A , N/A ," $2,803.02 "," $2,803.02 "," $5,645.85 "," $3,202.47 ", $505.68 ," $5,705.28 "
"Burn Dressing,MD,W/O Anes",16025,N/A,N/A,N/A, $580.00 , $377.00 , $353.80 , $104.77 , $43.96 , $304.75 , $296.43 , $539.40 , $522.00 , $522.00 , $464.00 , $464.00 , $43.96 , $535.51 , $551.00 , $522.00 , $522.00 , $522.00 , $539.40 , $556.80 , $384.92 , $493.00 , $592.31 , $389.98 , N/A , $310.69 , $310.69 , $551.00 , $360.30 , $43.96 , $592.31 
 Pro Prolong Inpt Eval Add15 M ,HCPCS G0316,0987 - PRO FEE/HOS VIS,N/A,N/A, $154.00 , $100.10 , N/A , $29.73 , $24.23 , N/A , N/A , $143.22 , $138.60 , $138.60 , $123.20 , $123.20 , $24.23 , $142.19 , $146.30 , $138.60 , $138.60 , $138.60 , $143.22 , $147.84 , N/A , $130.90 , $58.15 , N/A , N/A , $50.15 , $50.15 , $146.30 , $62.69 , $24.23 , $147.84 
 Pro Inject Facet Joint Lumbar/Sacral ,CPT® 64493,0982 - PRO FEE/OUTPT,N/A,N/A, $814.00 , $529.10 , $445.43 , $86.57 , $126.53 , $511.48 , $503.33 , $757.02 , $732.60 , $732.60 , $651.20 , $651.20 , $126.53 , $751.57 , $773.30 , $732.60 , $732.60 , $732.60 , $757.02 , $781.44 , $484.01 , $691.90 , $490.62 , $548.86 , N/A , $521.47 , $521.47 , $773.30 , $559.41 , $86.57 , $781.44 
"Cystoscopy,Insert Ureteral Stent",CPT® 52332,N/A,N/A,N/A," $3,421.00 "," $2,223.65 ", $834.21 , $146.58 , $307.34 , $762.03 , $709.33 ," $3,181.53 "," $3,078.90 "," $3,078.90 "," $2,736.80 "," $2,736.80 ", $307.34 ," $3,158.61 "," $3,249.95 "," $3,078.90 "," $3,078.90 "," $3,078.90 "," $3,181.53 "," $3,284.16 ", $837.96 ," $2,907.85 ", $802.83 , $959.18 , N/A , $776.89 , $776.89 ," $3,249.95 ", $913.10 , $146.58 ," $3,284.16 "
 VINCRISTINE SULFATE 1 MG/ML IV SOLN ,HCPCS J9370,0636 - DRUGS REQUIRING DETAILED CODIN,61703-0309-06,2 mL, $41.12 , $26.73 , $34.54 , $7.64 , $5.04 , $33.22 , $37.01 , $34.81 , $37.01 , $37.01 , $37.01 , $34.95 , $4.94 , $37.97 , $39.06 , $34.95 , $38.24 , $38.24 , $39.06 , $39.48 , $33.64 , $37.01 , $34.95 , $32.48 , N/A , $33.28 , $33.28 , $39.06 , $35.29 , $4.94 , $39.48 
 Pro Revision of Bladder Neck ,CPT® 52500,0975 - PRO FEE/OR,N/A,N/A," $3,272.00 "," $2,126.80 "," $2,667.89 ", $471.18 , $768.38 ," $2,386.11 "," $2,230.20 "," $3,042.96 "," $2,944.80 "," $2,944.80 "," $2,617.60 "," $2,617.60 ", $768.38 ," $3,021.04 "," $3,108.40 "," $2,944.80 "," $2,944.80 "," $2,944.80 "," $3,042.96 "," $3,141.12 "," $2,671.11 "," $2,781.20 "," $2,522.67 "," $3,004.95 ", N/A ," $2,432.66 "," $2,432.66 "," $3,108.40 "," $2,859.25 ", $471.18 ," $3,141.12 "
Layer Closure 12.6-20cm,12035,N/A,N/A,N/A," $1,518.00 ", $986.70 , $761.06 , $227.75 , $200.71 , $653.93 , $643.73 ," $1,411.74 "," $1,366.20 "," $1,366.20 "," $1,214.40 "," $1,214.40 ", $200.71 ," $1,401.57 "," $1,442.10 "," $1,366.20 "," $1,366.20 "," $1,366.20 "," $1,411.74 "," $1,457.28 ", $835.71 ," $1,290.30 "," $1,291.66 ", $837.00 , N/A , $666.69 , $666.69 ," $1,442.10 ", $773.15 , $200.71 ," $1,457.28 "
 PIOGLITAZONE HCL 15 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-7090-61,1 tablet, $8.03 , $5.22 , $6.75 , N/A , N/A , $6.49 , $7.23 , $6.80 , $7.23 , $7.23 , $7.23 , $6.83 , N/A , $7.41 , $7.63 , $6.83 , $7.47 , $7.47 , $7.63 , $7.71 , $6.57 , $7.23 , $6.83 , $6.34 , N/A , $6.50 , $6.50 , $7.63 , $6.89 , $6.34 , $7.71 
Sbsq Nursing Facility Care Low Mdm 15 Minutes,CPT® 99308,N/A,N/A,N/A, $184.00 , $119.60 , $136.90 , $72.29 , $48.45 , $118.77 , $120.07 , $171.12 , $165.60 , $165.60 , $147.20 , $147.20 , $48.45 , $169.89 , $174.80 , $165.60 , $165.60 , $165.60 , $171.12 , $176.64 , $173.41 , $156.40 , $149.27 , $146.96 , $55.00 , $121.09 , $121.09 , $174.80 , $139.65 , $48.45 , $176.64 
 Fac Tissue Exam by Pathologist ,CPT® 88305,0312 - PATHOL/HISTOL,N/A,N/A, $557.00 , $362.05 , $467.88 , $70.47 , $66.83 , $450.06 , $501.30 , $471.56 , $501.30 , $501.30 , $501.30 , $473.45 , $65.52 , $514.28 , $529.15 , $473.45 , $518.01 , $518.01 , $529.15 , $534.72 , $455.74 , $501.30 , $473.45 , $440.03 , N/A , $450.78 , $450.78 , $529.15 , $477.96 , $65.52 , $534.72 
 Fac or Room Chg Lvl Min ,Custom OPTORMINLVL,0360 - OR SERVICES,N/A,N/A, $60.00 , $39.00 , $50.40 , N/A , N/A , $48.48 , $54.00 , $50.80 , $54.00 , $54.00 , $54.00 , $51.00 , N/A , $55.40 , $57.00 , $51.00 , $55.80 , $55.80 , $57.00 , $57.60 , $49.09 , $54.00 , $51.00 , $47.40 , N/A , $48.56 , $48.56 , $57.00 , $51.49 , $47.40 , $57.60 
Sec Prq Trluml Thrmbc N-Coronary N-Intracranial,CPT® 37186,N/A,N/A,N/A," $9,177.00 "," $5,965.05 "," $1,428.38 ", $219.56 ," $1,698.65 "," $1,077.30 "," $1,072.41 "," $8,534.61 "," $8,259.30 "," $8,259.30 "," $7,341.60 "," $7,341.60 "," $1,698.65 "," $8,473.12 "," $8,718.15 "," $8,259.30 "," $8,259.30 "," $8,259.30 "," $8,534.61 "," $8,809.92 "," $1,328.46 "," $7,800.45 "," $1,343.40 "," $1,192.28 ", N/A ," $1,098.31 "," $1,098.31 "," $8,718.15 "," $1,247.70 ", $219.56 ," $8,809.92 "
 Fac Iaad Ia Not Otherwise Specified Each Organism ,CPT® 87449,0306 - LAB/BACT-MICRO,N/A,N/A, $169.00 , $109.85 , $141.96 , $12.22 , $12.22 , $136.55 , $152.10 , $143.08 , $152.10 , $152.10 , $152.10 , $143.65 , $11.98 , $156.04 , $160.55 , $143.65 , $157.17 , $157.17 , $160.55 , $162.24 , $138.28 , $152.10 , $143.65 , $133.51 , N/A , $136.77 , $136.77 , $160.55 , $145.02 , $11.98 , $162.24 
Lens Sphere Bifocal 4.12-7.0,HCPCS V2201,N/A,N/A,N/A, $85.00 , $55.25 , N/A , $65.36 , N/A , N/A , N/A , $79.05 , $76.50 , $76.50 , $68.00 , $68.00 , N/A , $78.48 , $80.75 , $76.50 , $76.50 , $76.50 , $79.05 , $81.60 , N/A , $72.25 , $85.00 , $59.38 , N/A , N/A , N/A , $80.75 , N/A , $59.38 , $85.00 
 Fac Mumps Antibody ,CPT® 86735,0302 - LAB/IMMUNOLOGY,N/A,N/A, $128.00 , $83.20 , $107.52 , $13.31 , $13.31 , $103.42 , $115.20 , $108.36 , $115.20 , $115.20 , $115.20 , $108.80 , $13.05 , $118.18 , $121.60 , $108.80 , $119.04 , $119.04 , $121.60 , $122.88 , $104.73 , $115.20 , $108.80 , $101.12 , N/A , $103.59 , $103.59 , $121.60 , $109.84 , $13.05 , $122.88 
"Arthrodesis Ant Interbody Inc Discectomy, Cervical Below C2",22551,N/A,N/A,N/A," $11,469.00 "," $7,454.85 "," $9,883.19 "," $1,543.42 "," $1,205.54 "," $8,156.71 "," $8,031.40 "," $10,666.17 "," $10,322.10 "," $10,322.10 "," $9,175.20 "," $9,175.20 "," $1,205.54 "," $10,589.33 "," $10,895.55 "," $10,322.10 "," $10,322.10 "," $10,322.10 "," $10,666.17 "," $11,010.24 "," $9,216.13 "," $9,748.65 "," $9,089.81 "," $9,390.58 ", N/A ," $8,315.86 "," $8,315.86 "," $10,895.55 "," $9,774.11 "," $1,205.54 "," $11,010.24 "
 Fac Vnpnxr 3 Years/> Phys Skill ,CPT® 36410,0761 - TREATMENT ROOM,N/A,N/A, $391.00 , $254.15 , $328.44 , $8.74 , $16.64 , $315.93 , $351.90 , $331.02 , $351.90 , $351.90 , $351.90 , $332.35 , $16.31 , $361.01 , $371.45 , $332.35 , $363.63 , $363.63 , $371.45 , $375.36 , $319.92 , $351.90 , $332.35 , $308.89 , N/A , $316.44 , $316.44 , $371.45 , $335.52 , $8.74 , $375.36 
Grp Psyctx,CPT® 90853,N/A,N/A,N/A, $123.00 , $79.95 , $31.36 , $23.24 , $28.56 , $56.88 , $55.81 , $114.39 , $110.70 , $110.70 , $98.40 , $98.40 , $28.56 , $113.57 , $116.85 , $110.70 , $110.70 , $110.70 , $114.39 , $118.08 , $60.00 , $104.55 , $72.99 , $95.12 , $48.00 , $57.99 , $57.99 , $116.85 , $67.61 , $23.24 , $118.08 
 ATROPINE SULFATE 1 MG/ML INJECTION (INPT) ,HCPCS J0461,0636 - DRUGS REQUIRING DETAILED CODIN,16729-0526-08,1 mL, $116.14 , $75.49 , $97.56 , $0.09 , $0.10 , $93.84 , $104.53 , $98.32 , $104.53 , $104.53 , $104.53 , $98.72 , $0.10 , $107.23 , $110.33 , $98.72 , $108.01 , $108.01 , $110.33 , $111.49 , $95.03 , $104.53 , $98.72 , $91.75 , N/A , $93.99 , $93.99 , $110.33 , $99.66 , $0.09 , $111.49 
"C-Reactive Protein,High Sensitivity",CPT® 86141,N/A,N/A,N/A, $180.00 , $117.00 , N/A , $13.21 , $13.21 , $73.26 , $87.64 , $167.40 , $162.00 , $162.00 , $144.00 , $144.00 , $13.21 , $166.19 , $171.00 , $162.00 , $162.00 , $162.00 , $167.40 , $172.80 , $86.47 , $153.00 , $84.34 , $46.93 , N/A , $68.37 , $68.37 , $171.00 , $74.71 , $13.21 , $172.80 
Repair Foot Flexor Tendon,CPT® 28200,N/A,N/A,N/A," $3,193.00 "," $2,075.45 "," $2,025.27 ", $317.14 , $461.04 ," $1,578.99 "," $1,560.91 "," $2,969.49 "," $2,873.70 "," $2,873.70 "," $2,554.40 "," $2,554.40 ", $461.04 ," $2,948.10 "," $3,033.35 "," $2,873.70 "," $2,873.70 "," $2,873.70 "," $2,969.49 "," $3,065.28 "," $1,866.84 "," $2,714.05 "," $1,687.72 "," $1,889.38 ", N/A ," $1,609.80 "," $1,609.80 "," $3,033.35 "," $1,892.07 ", $317.14 ," $3,065.28 "
 VANCOMYCIN HCL 5 G IV SOLR ,HCPCS J3371,0636 - DRUGS REQUIRING DETAILED CODIN,00409-6509-01,100 mL, $556.38 , $361.65 , $467.36 , $6.43 , $6.66 , $449.56 , $500.74 , $471.03 , $500.74 , $500.74 , $500.74 , $472.92 , $6.53 , $513.71 , $528.56 , $472.92 , $517.43 , $517.43 , $528.56 , $534.12 , $455.23 , $500.74 , $472.92 , $439.54 , N/A , $450.28 , $450.28 , $528.56 , $477.43 , $6.43 , $534.12 
Fo Pip/Dip With Joint/Spring,HCPCS L3925,N/A,N/A,N/A, $88.00 , $57.20 , N/A , $69.93 , $34.16 , N/A , N/A , $81.84 , $79.20 , $79.20 , $70.40 , $70.40 , $34.16 , $81.25 , $83.60 , $79.20 , $79.20 , $79.20 , $81.84 , $84.48 , N/A , $74.80 , $48.66 , $58.84 , N/A , N/A , N/A , $83.60 , N/A , $34.16 , $84.48 
X-Ray Sacroiliac Jts <3 Vw,CPT® 72200,N/A,N/A,N/A, $528.00 , $343.20 , $184.67 , $32.36 , $28.03 , $133.67 , $157.45 , $491.04 , $475.20 , $475.20 , $422.40 , $422.40 , $28.03 , $487.50 , $501.60 , $475.20 , $475.20 , $475.20 , $491.04 , $506.88 , $180.22 , $448.80 , $173.34 , $142.36 , N/A , $136.28 , $136.28 , $501.60 , $157.75 , $28.03 , $506.88 
Treat Patellar Fracture,27520,N/A,N/A,N/A," $1,450.00 ", $942.50 ," $1,872.26 ", $296.68 , $195.27 ," $1,421.40 "," $1,446.93 "," $1,348.50 "," $1,305.00 "," $1,305.00 "," $1,160.00 "," $1,160.00 ", $195.27 ," $1,338.79 "," $1,377.50 "," $1,305.00 "," $1,305.00 "," $1,305.00 "," $1,348.50 "," $1,392.00 "," $1,721.73 "," $1,232.50 "," $1,589.60 "," $1,686.56 ", N/A ," $1,449.14 "," $1,449.14 "," $1,377.50 "," $1,703.25 ", $195.27 ," $1,872.26 "
MRI Brain,CPT® 70551,N/A,N/A,N/A," $5,129.00 "," $3,333.85 "," $1,403.99 ", $200.99 , $418.18 ," $2,157.44 "," $2,269.88 "," $4,769.97 "," $4,616.10 "," $4,616.10 "," $4,103.20 "," $4,103.20 ", $418.18 ," $4,735.61 "," $4,872.55 "," $4,616.10 "," $4,616.10 "," $4,616.10 "," $4,769.97 "," $4,923.84 "," $2,474.12 "," $4,359.65 "," $2,474.96 "," $2,135.03 ", N/A ," $2,199.54 "," $2,199.54 "," $4,872.55 "," $2,587.69 ", $200.99 ," $4,923.84 "
Punch Biopsy Skin Ea Sep/Additional Lesion,11105,N/A,N/A,N/A, $229.00 , $148.85 , $82.38 , $24.42 , $48.20 , $69.36 , N/A , $212.97 , $206.10 , $206.10 , $183.20 , $183.20 , $48.20 , $211.44 , $217.55 , $206.10 , $206.10 , $206.10 , $212.97 , $219.84 , $90.89 , $194.65 , $135.05 , $95.17 , N/A , $70.71 , $70.71 , $217.55 , $81.99 , $24.42 , $219.84 
"Gardner Vag, Dna, Dir Probe",CPT® 87510,N/A,N/A,N/A, $118.00 , $76.70 , N/A , $20.45 , $20.45 , $113.46 , $135.73 , $109.74 , $106.20 , $106.20 , $94.40 , $94.40 , $20.45 , $108.95 , $112.10 , $106.20 , $106.20 , $106.20 , $109.74 , $113.28 , $133.88 , $100.30 , $131.37 , $72.72 , N/A , $105.89 , $105.89 , $112.10 , $115.71 , $20.45 , $135.73 
Simple Repair 5.1-7.5cm,12014,N/A,N/A,N/A, $752.00 , $488.80 , $232.08 , $69.01 , $92.31 , $214.79 , $208.07 , $699.36 , $676.80 , $676.80 , $601.60 , $601.60 , $92.31 , $694.32 , $714.40 , $676.80 , $676.80 , $676.80 , $699.36 , $721.92 , $255.61 , $639.20 , $417.47 , $258.60 , N/A , $218.98 , $218.98 , $714.40 , $253.95 , $69.01 , $721.92 
 Mag3/Tc Mertiatide per Dose Up to 15 Mci ,HCPCS A9562,0343 - DIAGNOSTIC RADIOPHARMACEUTICALS,N/A,N/A, $830.00 , $539.50 , $697.20 , N/A , $480.15 , $670.64 , $747.00 , $702.68 , $747.00 , $747.00 , $747.00 , $705.50 , $470.74 , $766.34 , $788.50 , $705.50 , $771.90 , $771.90 , $788.50 , $796.80 , $679.11 , $747.00 , $705.50 , $655.70 , N/A , $671.72 , $671.72 , $788.50 , $712.22 , $470.74 , $796.80 
 Pro Bfb Traing W/Emg&/Manometry Ea Addl 15 Min Cntct ,CPT® 90913,0917 - PSYCH/BIOFEED,N/A,N/A, $152.00 , $98.80 , $127.68 , $23.62 , $25.77 , $122.82 , $136.80 , $128.68 , $136.80 , $136.80 , $136.80 , $129.20 , $25.26 , $140.34 , $144.40 , $129.20 , $141.36 , $141.36 , $144.40 , $145.92 , $124.37 , $136.80 , $129.20 , $120.08 , N/A , $123.01 , $123.01 , $144.40 , $130.43 , $23.62 , $145.92 
"Cystoscopy,Insert Ureteral Stent",52332,N/A,N/A,N/A," $3,421.00 "," $2,223.65 ", $834.21 , $146.58 , $307.34 , $762.03 , $709.33 ," $3,181.53 "," $3,078.90 "," $3,078.90 "," $2,736.80 "," $2,736.80 ", $307.34 ," $3,158.61 "," $3,249.95 "," $3,078.90 "," $3,078.90 "," $3,078.90 "," $3,181.53 "," $3,284.16 ", $837.96 ," $2,907.85 ", $802.83 , $959.18 , N/A , $776.89 , $776.89 ," $3,249.95 ", $913.10 , $146.58 ," $3,284.16 "
"Synovectomy Exten Tendn Sheath,Foot",CPT® 28088,N/A,N/A,N/A," $3,190.00 "," $2,073.50 "," $1,782.76 ", $282.77 , $307.34 ," $1,360.75 "," $1,488.27 "," $2,966.70 "," $2,871.00 "," $2,871.00 "," $2,552.00 "," $2,552.00 ", $307.34 ," $2,945.33 "," $3,030.50 "," $2,871.00 "," $2,871.00 "," $2,871.00 "," $2,966.70 "," $3,062.40 "," $1,620.86 "," $2,711.50 "," $1,621.71 "," $1,652.30 ", N/A ," $1,387.30 "," $1,387.30 "," $3,030.50 "," $1,630.57 ", $282.77 ," $3,062.40 "
Excis Soft Tissue Lesion Hand Subcut,CPT® 26115,N/A,N/A,N/A," $3,545.00 "," $2,304.25 "," $2,032.75 ", $321.14 , $112.10 ," $1,602.76 "," $1,606.38 "," $3,296.85 "," $3,190.50 "," $3,190.50 "," $2,836.00 "," $2,836.00 ", $112.10 ," $3,273.10 "," $3,367.75 "," $3,190.50 "," $3,190.50 "," $3,190.50 "," $3,296.85 "," $3,403.20 "," $1,888.95 "," $3,013.25 "," $1,764.44 "," $1,905.46 ", N/A ," $1,634.04 "," $1,634.04 "," $3,367.75 "," $1,920.58 ", $112.10 ," $3,403.20 "
" Fac Cytogenetics, 100-300 ",CPT® 88275,0310 - PATHOLOGY LAB,N/A,N/A, $454.00 , $295.10 , $381.36 , $52.21 , $52.21 , $366.83 , $408.60 , $384.36 , $408.60 , $408.60 , $408.60 , $385.90 , $51.19 , $419.18 , $431.30 , $385.90 , $422.22 , $422.22 , $431.30 , $435.84 , $371.46 , $408.60 , $385.90 , $358.66 , N/A , $367.42 , $367.42 , $431.30 , $389.58 , $51.19 , $435.84 
Drain Pilonidal Cyst Complic,10081,N/A,N/A,N/A," $1,278.00 ", $830.70 , $545.63 , $162.12 , $213.21 , $462.71 , $459.06 ," $1,188.54 "," $1,150.20 "," $1,150.20 "," $1,022.40 "," $1,022.40 ", $213.21 ," $1,179.98 "," $1,214.10 "," $1,150.20 "," $1,150.20 "," $1,150.20 "," $1,188.54 "," $1,226.88 ", $603.01 ," $1,086.30 ", $918.79 , $595.22 , N/A , $471.73 , $471.73 ," $1,214.10 ", $547.05 , $162.12 ," $1,226.88 "
Removal of Prox Row Carpal Bones,CPT® 25215,N/A,N/A,N/A," $4,113.00 "," $2,673.45 "," $3,793.47 ", $596.56 , $545.04 ," $2,973.15 "," $2,960.04 "," $3,825.09 "," $3,701.70 "," $3,701.70 "," $3,290.40 "," $3,290.40 ", $545.04 ," $3,797.53 "," $3,907.35 "," $3,701.70 "," $3,701.70 "," $3,701.70 "," $3,825.09 "," $3,948.48 "," $3,525.60 "," $3,496.05 "," $3,252.35 "," $3,529.70 ", N/A ," $3,031.16 "," $3,031.16 "," $3,907.35 "," $3,562.70 ", $545.04 ," $3,948.48 "
"Ecg Monitor/24 Hrs,Complete",CPT® 93224,N/A,N/A,N/A, $618.00 , $401.70 , $473.27 , $71.27 , $109.14 , $489.44 , $525.15 , $574.74 , $556.20 , $556.20 , $494.40 , $494.40 , $109.14 , $570.60 , $587.10 , $556.20 , $556.20 , $556.20 , $574.74 , $593.28 , $484.80 , $525.30 , $492.40 , $542.59 , N/A , $498.99 , $498.99 , $587.10 , $553.13 , $71.27 , $593.28 
" Pro Partial Removal, Collar Bone ",CPT® 23120,0975 - PRO FEE/OR,N/A,N/A," $3,847.00 "," $2,500.55 "," $3,590.15 ", $564.07 , $537.90 ," $2,815.43 "," $2,826.91 "," $3,577.71 "," $3,462.30 "," $3,462.30 "," $3,077.60 "," $3,077.60 ", $537.90 ," $3,551.94 "," $3,654.65 "," $3,462.30 "," $3,462.30 "," $3,462.30 "," $3,577.71 "," $3,693.12 "," $3,332.28 "," $3,269.95 "," $3,116.76 "," $3,327.06 ", N/A ," $2,870.37 "," $2,870.37 "," $3,654.65 "," $3,373.70 ", $537.90 ," $3,693.12 "
 Pro Treat Knee Fracture ,CPT® 27536,0975 - PRO FEE/OR,N/A,N/A," $8,891.00 "," $5,779.15 "," $7,163.98 "," $1,120.90 ", $845.22 ," $5,744.83 "," $5,698.26 "," $8,268.63 "," $8,001.90 "," $8,001.90 "," $7,112.80 "," $7,112.80 ", $845.22 ," $8,209.06 "," $8,446.45 "," $8,001.90 "," $8,001.90 "," $8,001.90 "," $8,268.63 "," $8,535.36 "," $6,666.68 "," $7,557.35 "," $6,303.10 "," $6,755.82 ", N/A ," $5,856.93 "," $5,856.93 "," $8,446.45 "," $6,883.96 ", $845.22 ," $8,535.36 "
Biopsy Bone Open Deep,20245,N/A,N/A,N/A," $4,143.00 "," $2,692.95 "," $2,091.25 ", $323.65 , $284.00 ," $2,980.23 "," $3,005.59 "," $3,852.99 "," $3,728.70 "," $3,728.70 "," $3,314.40 "," $3,314.40 ", $284.00 ," $3,825.23 "," $3,935.85 "," $3,728.70 "," $3,728.70 "," $3,728.70 "," $3,852.99 "," $3,977.28 "," $1,952.95 "," $3,521.55 "," $3,313.01 "," $2,013.43 ", N/A ," $3,038.38 "," $3,038.38 "," $3,935.85 "," $3,571.18 ", $284.00 ," $3,977.28 "
 Fac or Minor Procedure Rm Min ,Custom OPTORMPRMIN,0360 - OR SERVICES,N/A,N/A, $60.00 , $39.00 , $50.40 , N/A , N/A , $48.48 , $54.00 , $50.80 , $54.00 , $54.00 , $54.00 , $51.00 , N/A , $55.40 , $57.00 , $51.00 , $55.80 , $55.80 , $57.00 , $57.60 , $49.09 , $54.00 , $51.00 , $47.40 , N/A , $48.56 , $48.56 , $57.00 , $51.49 , $47.40 , $57.60 
 Pro Treat Knee Fracture ,CPT® 27532,0982 - PRO FEE/OUTPT,N/A,N/A," $4,361.00 "," $2,834.65 "," $3,542.63 ", $556.13 , $384.19 ," $2,787.61 "," $2,778.76 "," $4,055.73 "," $3,924.90 "," $3,924.90 "," $3,488.80 "," $3,488.80 ", $384.19 ," $4,026.51 "," $4,142.95 "," $3,924.90 "," $3,924.90 "," $3,924.90 "," $4,055.73 "," $4,186.56 "," $3,272.69 "," $3,706.85 "," $3,065.02 "," $3,276.05 ", N/A ," $2,842.00 "," $2,842.00 "," $4,142.95 "," $3,340.38 ", $384.19 ," $4,186.56 "
Abdom Paracentesis Dx/Ther W/O Imaging Guidance,49082,N/A,N/A,N/A, $593.00 , $385.45 , $446.29 , $68.89 , $188.97 , $361.06 , $352.03 , $551.49 , $533.70 , $533.70 , $474.40 , $474.40 , $188.97 , $547.52 , $563.35 , $533.70 , $533.70 , $533.70 , $551.49 , $569.28 , $319.40 , $504.05 , $380.01 , $425.52 , N/A , $368.10 , $368.10 , $563.35 , $385.00 , $68.89 , $569.28 
Sub Grft F/S/N/H/F/G/M/D /<100scm Ea Adl 25scm,15276,N/A,N/A,N/A, $196.00 , $127.40 , $80.44 , $23.62 , $26.04 , $68.56 , $68.48 , $182.28 , $176.40 , $176.40 , $156.80 , $156.80 , $26.04 , $180.97 , $186.20 , $176.40 , $176.40 , $176.40 , $182.28 , $188.16 , $87.96 , $166.60 , $135.59 , $89.22 , N/A , $69.89 , $69.89 , $186.20 , $81.06 , $23.62 , $188.16 
 Pro Colsc Flx W/Removal Lesion by Hot Bx Forceps ,CPT® 45384,0982 - PRO FEE/OUTPT,N/A,N/A," $3,451.00 "," $2,243.15 "," $1,385.61 ", $213.74 , $412.82 ," $1,575.38 "," $1,571.71 "," $3,209.43 "," $3,105.90 "," $3,105.90 "," $2,760.80 "," $2,760.80 ", $412.82 ," $3,186.31 "," $3,278.45 "," $3,105.90 "," $3,105.90 "," $3,105.90 "," $3,209.43 "," $3,312.96 "," $1,937.09 "," $2,933.35 "," $1,439.74 "," $1,320.64 ", N/A ," $1,606.11 "," $1,606.11 "," $3,278.45 "," $1,852.49 ", $213.74 ," $3,312.96 "
Injection Aa&/Strd Lumbar Plexus Cont Nfs Cath,CPT® 64449,N/A,N/A,N/A, $653.00 , $424.45 , $305.60 , $59.65 , $153.39 , $469.39 , $443.16 , $607.29 , $587.70 , $587.70 , $522.40 , $522.40 , $153.39 , $602.91 , $620.35 , $587.70 , $587.70 , $587.70 , $607.29 , $626.88 , $332.83 , $555.05 , $431.74 , $508.80 , N/A , $478.55 , $478.55 , $620.35 , $513.35 , $59.65 , $626.88 
Nonphysician Telephone Assessment 5-10 Min,CPT® 98966,N/A,N/A,N/A, $56.00 , $36.40 , $26.50 , $11.05 , N/A , $29.12 , $27.92 , $52.08 , $50.40 , $50.40 , $44.80 , $44.80 , N/A , $51.70 , $53.20 , $50.40 , $50.40 , $50.40 , $52.08 , $53.76 , $23.23 , $47.60 , $36.49 , $48.62 , N/A , $29.69 , $29.69 , $53.20 , $34.62 , $11.05 , $53.76 
 EZETIMIBE 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,67877-0490-90,1 tablet, $53.06 , $34.49 , $44.57 , N/A , N/A , $42.87 , $47.75 , $44.92 , $47.75 , $47.75 , $47.75 , $45.10 , N/A , $48.99 , $50.41 , $45.10 , $49.35 , $49.35 , $50.41 , $50.94 , $43.41 , $47.75 , $45.10 , $41.92 , N/A , $42.94 , $42.94 , $50.41 , $45.53 , $41.92 , $50.94 
 Pro Cltx Tibl Fx Prox W/O Mnpj ,CPT® 27530,0981 - PRO FEE/ER,N/A,N/A," $1,266.00 ", $822.90 ," $1,803.82 ", $285.61 , $164.92 ," $1,350.84 "," $1,377.36 "," $1,177.38 "," $1,139.40 "," $1,139.40 "," $1,012.80 "," $1,012.80 ", $164.92 ," $1,168.90 "," $1,202.70 "," $1,139.40 "," $1,139.40 "," $1,139.40 "," $1,177.38 "," $1,215.36 "," $1,654.54 "," $1,076.10 "," $1,511.10 "," $1,607.37 ", N/A ," $1,377.20 "," $1,377.20 "," $1,202.70 "," $1,618.70 ", $164.92 ," $1,803.82 "
 Gastrointestinal Hemorrhage With Cc ,MS DRG V40 (FY2023) 378,N/A,N/A,N/A," $13,005.86 "," $8,453.81 "," $10,924.92 ", N/A , N/A ," $10,508.73 "," $11,705.27 "," $11,010.76 "," $11,705.27 "," $11,705.27 "," $11,705.27 "," $11,054.98 ", N/A ," $12,008.31 "," $12,355.57 "," $11,054.98 "," $12,095.45 "," $12,095.45 "," $12,355.57 "," $12,485.63 "," $10,641.39 "," $11,705.27 "," $11,054.98 "," $10,274.63 ", N/A ," $10,525.64 "," $10,525.64 "," $12,355.57 "," $11,160.33 "," $10,274.63 "," $12,485.63 "
 Fac Radiologic Examination Femur 1 View ,CPT® 73551,0320 - DX X-RAY,N/A,N/A, $272.00 , $176.80 , $228.48 , $28.73 , $21.76 , $219.78 , $244.80 , $230.28 , $244.80 , $244.80 , $244.80 , $231.20 , $21.33 , $251.14 , $258.40 , $231.20 , $252.96 , $252.96 , $258.40 , $261.12 , $222.55 , $244.80 , $231.20 , $214.88 , N/A , $220.13 , $220.13 , $258.40 , $233.40 , $21.33 , $261.12 
 EPINEPHRINE 1 MG/10 ML INJECTION (INPT) ,HCPCS J0171,0636 - DRUGS REQUIRING DETAILED CODIN,00409-4933-01,10 mL, $47.26 , $30.72 , $39.70 , $0.74 , $0.75 , $38.19 , $42.53 , $40.01 , $42.53 , $42.53 , $42.53 , $40.17 , $0.74 , $43.64 , $44.90 , $40.17 , $43.95 , $43.95 , $44.90 , $45.37 , $38.67 , $42.53 , $40.17 , $37.34 , N/A , $38.25 , $38.25 , $44.90 , $40.55 , $0.74 , $45.37 
 Babesia Duncani Ab Igg by Ifa ,CPT® 86753,0302 - LAB/IMMUNOLOGY,N/A,N/A, $177.00 , $115.05 , $148.68 , $12.64 , $8.07 , $143.02 , $159.30 , $149.85 , $159.30 , $159.30 , $159.30 , $150.45 , $7.91 , $163.42 , $168.15 , $150.45 , $164.61 , $164.61 , $168.15 , $169.92 , $144.82 , $159.30 , $150.45 , $139.83 , N/A , $143.25 , $143.25 , $168.15 , $151.88 , $7.91 , $169.92 
 Fac Antineutrophil Cytoplasmic Antb Screen Ea Antb ,CPT® 86036,0302 - LAB/IMMUNOLOGY,N/A,N/A, $147.00 , $95.55 , $123.48 , $12.29 , $12.29 , $118.78 , $132.30 , $124.45 , $132.30 , $132.30 , $132.30 , $124.95 , $12.05 , $135.73 , $139.65 , $124.95 , $136.71 , $136.71 , $139.65 , $141.12 , $120.28 , $132.30 , $124.95 , $116.13 , N/A , $118.97 , $118.97 , $139.65 , $126.14 , $12.05 , $141.12 
 TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP SUSP ,HCPCS RXA250,0250 - PHARMACY,24208-0295-25,2.5 mL, $311.71 , $202.61 , $261.84 , N/A , N/A , $251.86 , $280.54 , $263.89 , $280.54 , $280.54 , $280.54 , $264.95 , N/A , $287.80 , $296.12 , $264.95 , $289.89 , $289.89 , $296.12 , $299.24 , $255.04 , $280.54 , $264.95 , $246.25 , N/A , $252.27 , $252.27 , $296.12 , $267.48 , $246.25 , $299.24 
Revise/Remove Neuroelectrode,64585,N/A,N/A,N/A," $1,869.00 "," $1,214.85 ", $704.81 , $137.16 , $251.04 , $799.16 , $785.64 ," $1,738.17 "," $1,682.10 "," $1,682.10 "," $1,495.20 "," $1,495.20 ", $251.04 ," $1,725.65 "," $1,775.55 "," $1,682.10 "," $1,682.10 "," $1,682.10 "," $1,738.17 "," $1,794.24 ", $762.60 ," $1,588.65 ", $767.15 , $861.71 , N/A , $814.76 , $814.76 ," $1,775.55 ", $874.04 , $137.16 ," $1,794.24 "
 Pro CT Lwr Extremity W/O&W/Dye ,CPT® 73702,0972 - PRO FEE/RAD/DX,N/A,N/A, $810.00 , $526.50 ," $1,390.48 ", $199.67 , $355.39 ," $1,301.24 "," $1,714.98 ", $753.30 , $729.00 , $729.00 , $648.00 , $648.00 , $355.39 , $747.87 , $769.50 , $729.00 , $729.00 , $729.00 , $753.30 , $777.60 ," $1,166.64 ", $688.50 ," $1,872.11 "," $1,779.20 ", N/A ," $1,326.63 "," $1,326.63 ", $769.50 ," $1,535.61 ", $199.67 ," $1,872.11 "
Abltj 1/> Renal Tumor Prq Uni Radiofrequency,CPT® 50592,N/A,N/A,N/A," $10,137.00 "," $6,589.05 "," $1,863.52 ", $326.72 ," $2,378.00 "," $1,803.61 "," $1,663.69 "," $9,427.41 "," $9,123.30 "," $9,123.30 "," $8,109.60 "," $8,109.60 "," $2,378.00 "," $9,359.49 "," $9,630.15 "," $9,123.30 "," $9,123.30 "," $9,123.30 "," $9,427.41 "," $9,731.52 "," $1,868.86 "," $8,616.45 "," $1,885.76 "," $2,132.37 ", N/A ," $1,838.80 "," $1,838.80 "," $9,630.15 "," $2,161.24 ", $326.72 ," $9,731.52 "
 Pro Repair of Foot Tendon ,CPT® 28208,0982 - PRO FEE/OUTPT,N/A,N/A," $3,099.00 "," $2,014.35 "," $1,971.39 ", $312.25 , $184.42 ," $1,535.22 "," $1,513.61 "," $2,882.07 "," $2,789.10 "," $2,789.10 "," $2,479.20 "," $2,479.20 ", $184.42 ," $2,861.31 "," $2,944.05 "," $2,789.10 "," $2,789.10 "," $2,789.10 "," $2,882.07 "," $2,975.04 "," $1,826.40 "," $2,634.15 "," $1,641.34 "," $1,839.33 ", N/A ," $1,565.17 "," $1,565.17 "," $2,944.05 "," $1,839.62 ", $184.42 ," $2,975.04 "
 Pro X-Rays for Bone Age ,CPT® 77072,0972 - PRO FEE/RAD/DX,N/A,N/A, $132.00 , $85.80 , $147.09 , $25.50 , $18.38 , $108.45 , $122.56 , $122.76 , $118.80 , $118.80 , $105.60 , $105.60 , $18.38 , $121.88 , $125.40 , $118.80 , $118.80 , $118.80 , $122.76 , $126.72 , $142.74 , $112.20 , $134.82 , $115.64 , N/A , $110.56 , $110.56 , $125.40 , $127.98 , $18.38 , $147.09 
"Remove Spine Fix Dev,Anterior",CPT® 22855,N/A,N/A,N/A," $8,135.00 "," $5,287.75 "," $6,501.76 "," $1,016.88 ", $475.67 ," $5,287.68 "," $5,262.58 "," $7,565.55 "," $7,321.50 "," $7,321.50 "," $6,508.00 "," $6,508.00 ", $475.67 ," $7,511.05 "," $7,728.25 "," $7,321.50 "," $7,321.50 "," $7,321.50 "," $7,565.55 "," $7,809.60 "," $6,058.66 "," $6,914.75 "," $5,944.50 "," $6,123.76 ", N/A ," $5,390.85 "," $5,390.85 "," $7,728.25 "," $6,336.18 ", $475.67 ," $7,809.60 "
Injection Aa&/Strd Other Peripheral Nerve/Branch,CPT® 64450,N/A,N/A,N/A, $402.00 , $261.30 , $207.58 , $40.26 , $113.79 , $255.83 , $245.04 , $373.86 , $361.80 , $361.80 , $321.60 , $321.60 , $113.79 , $371.17 , $381.90 , $361.80 , $361.80 , $361.80 , $373.86 , $385.92 , $225.30 , $341.70 , $237.28 , $273.66 , N/A , $260.82 , $260.82 , $381.90 , $279.80 , $40.26 , $385.92 
"Injection, Bupivicaine Hydro",HCPCS S0020,N/A,N/A,N/A, $21.00 , $13.65 , N/A , N/A , N/A , N/A , N/A , $19.53 , $18.90 , $18.90 , $16.80 , $16.80 , N/A , $19.39 , $19.95 , $18.90 , $18.90 , $18.90 , $19.53 , $20.16 , N/A , $17.85 , $16.80 , $4.02 , N/A , N/A , N/A , $19.95 , N/A , $4.02 , $20.16 
 Pneumothorax With McC ,MS DRG V40 (FY2023) 199,N/A,N/A,N/A," $55,712.23 "," $36,212.95 "," $46,798.27 ", N/A , N/A ," $45,015.48 "," $50,141.01 "," $47,165.97 "," $50,141.01 "," $50,141.01 "," $50,141.01 "," $47,355.40 ", N/A ," $51,439.10 "," $52,926.62 "," $47,355.40 "," $51,812.37 "," $51,812.37 "," $52,926.62 "," $53,483.74 "," $45,583.75 "," $50,141.01 "," $47,355.40 "," $44,012.66 ", N/A ," $45,087.91 "," $45,087.91 "," $52,926.62 "," $47,806.66 "," $44,012.66 "," $53,483.74 "
 POTASSIUM CITRATE ER 10 MEQ (1080 MG) PO TBCR ,HCPCS RXC637,0250 - PHARMACY,68084-0850-32,1 tablet, $14.87 , $9.67 , $12.49 , N/A , N/A , $12.01 , $13.38 , $12.59 , $13.38 , $13.38 , $13.38 , $12.64 , N/A , $13.73 , $14.13 , $12.64 , $13.83 , $13.83 , $14.13 , $14.28 , $12.17 , $13.38 , $12.64 , $11.75 , N/A , $12.03 , $12.03 , $14.13 , $12.76 , $11.75 , $14.28 
 PHENYLEPHRINE HCL 0.125 % NA SOLN ,HCPCS RXC637,0250 - PHARMACY,56184-0121-05,15 mL, $28.75 , $18.69 , $24.15 , N/A , N/A , $23.23 , $25.88 , $24.34 , $25.88 , $25.88 , $25.88 , $24.44 , N/A , $26.54 , $27.31 , $24.44 , $26.74 , $26.74 , $27.31 , $27.60 , $23.52 , $25.88 , $24.44 , $22.71 , N/A , $23.27 , $23.27 , $27.31 , $24.67 , $22.71 , $27.60 
"Makena, 10 Mg",HCPCS J1726,N/A,N/A,N/A, $41.00 , $26.65 , N/A , N/A , $31.77 , N/A , N/A , $38.13 , $36.90 , $36.90 , $32.80 , $32.80 , $31.77 , $37.86 , $38.95 , $36.90 , $36.90 , $36.90 , $38.13 , $39.36 , N/A , $34.85 , $32.80 , $36.67 , N/A , N/A , N/A , $38.95 , N/A , $31.77 , $39.36 
 Fac Hdr Rdncl Ntrstl/Intrcav Brachytx 2-12 Channel ,CPT® 77771,0342 - NUC MED/RX PROCEDURES,N/A,N/A," $4,617.00 "," $3,001.05 "," $3,878.28 ", $590.70 , $473.12 ," $3,730.54 "," $4,155.30 "," $3,908.75 "," $4,155.30 "," $4,155.30 "," $4,155.30 "," $3,924.45 ", $463.84 ," $4,262.88 "," $4,386.15 "," $3,924.45 "," $4,293.81 "," $4,293.81 "," $4,386.15 "," $4,432.32 "," $3,777.63 "," $4,155.30 "," $3,924.45 "," $3,647.43 ", N/A ," $3,736.54 "," $3,736.54 "," $4,386.15 "," $3,961.85 ", $463.84 ," $4,432.32 "
Aquaporin-4 Antibody Elisa,CPT® 86051,N/A,N/A,N/A, $136.00 , $88.40 , N/A , $11.76 , $11.76 , N/A , N/A , $126.48 , $122.40 , $122.40 , $108.80 , $108.80 , $11.76 , $125.57 , $129.20 , $122.40 , $122.40 , $122.40 , $126.48 , $130.56 , N/A , $115.60 , $54.92 , $33.86 , N/A , $45.20 , $45.20 , $129.20 , $49.69 , $11.76 , $130.56 
 Pro Treatment of Ankle Fracture ,CPT® 27788,0982 - PRO FEE/OUTPT,N/A,N/A," $2,789.00 "," $1,812.85 "," $2,379.26 ", $375.59 , $230.52 ," $1,854.24 "," $1,880.56 "," $2,593.77 "," $2,510.10 "," $2,510.10 "," $2,231.20 "," $2,231.20 ", $230.52 ," $2,575.08 "," $2,649.55 "," $2,510.10 "," $2,510.10 "," $2,510.10 "," $2,593.77 "," $2,677.44 "," $2,201.70 "," $2,370.65 "," $2,065.95 "," $2,192.00 ", N/A ," $1,890.42 "," $1,890.42 "," $2,649.55 "," $2,221.92 ", $230.52 ," $2,677.44 "
 SILDENAFIL CITRATE 20 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6671-06,1 tablet, $5.18 , $3.37 , $4.35 , N/A , N/A , $4.19 , $4.66 , $4.39 , $4.66 , $4.66 , $4.66 , $4.40 , N/A , $4.78 , $4.92 , $4.40 , $4.82 , $4.82 , $4.92 , $4.97 , $4.24 , $4.66 , $4.40 , $4.09 , N/A , $4.19 , $4.19 , $4.92 , $4.44 , $4.09 , $4.97 
 LURBINECTEDIN 4 MG IV SOLR ,HCPCS J9223,0636 - DRUGS REQUIRING DETAILED CODIN,68727-0712-01,8 mL," $23,022.65 "," $14,964.72 "," $19,339.03 ", $201.12 , $192.07 ," $18,602.30 "," $20,720.39 "," $19,490.98 "," $20,720.39 "," $20,720.39 "," $20,720.39 "," $19,569.25 ", $188.30 ," $21,256.81 "," $21,871.52 "," $19,569.25 "," $21,411.06 "," $21,411.06 "," $21,871.52 "," $22,101.74 "," $18,837.13 "," $20,720.39 "," $19,569.25 "," $18,187.89 ", N/A ," $18,632.23 "," $18,632.23 "," $21,871.52 "," $19,755.74 ", $188.30 ," $22,101.74 "
 Fac Colonoscopy Stoma W/Submucosal Injection ,CPT® 44404,0360 - OR SERVICES,N/A,N/A," $2,260.00 "," $1,469.00 "," $1,898.40 ", $162.36 , $210.78 ," $1,826.08 "," $2,034.00 "," $1,913.32 "," $2,034.00 "," $2,034.00 "," $2,034.00 "," $1,921.00 ", $206.65 ," $2,086.66 "," $2,147.00 "," $1,921.00 "," $2,101.80 "," $2,101.80 "," $2,147.00 "," $2,169.60 "," $1,849.13 "," $2,034.00 "," $1,921.00 "," $1,785.40 ", N/A ," $1,829.02 "," $1,829.02 "," $2,147.00 "," $1,939.31 ", $162.36 ," $2,169.60 "
 DESVENLAFAXINE SUCCINATE ER 25 MG PO TB24 ,HCPCS RXC637,0250 - PHARMACY,51991-0006-33,2 tablet, $117.88 , $76.62 , $99.02 , N/A , N/A , $95.25 , $106.09 , $99.80 , $106.09 , $106.09 , $106.09 , $100.20 , N/A , $108.84 , $111.99 , $100.20 , $109.63 , $109.63 , $111.99 , $113.16 , $96.45 , $106.09 , $100.20 , $93.13 , N/A , $95.40 , $95.40 , $111.99 , $101.15 , $93.13 , $113.16 
"Coccidioides, Antibody",CPT® 86635,N/A,N/A,N/A, $143.00 , $92.95 , N/A , $11.70 , $8.07 , $32.88 , $39.34 , $132.99 , $128.70 , $128.70 , $114.40 , $114.40 , $8.07 , $132.03 , $135.85 , $128.70 , $128.70 , $128.70 , $132.99 , $137.28 , $76.59 , $121.55 , $74.60 , $41.62 , N/A , $30.69 , $30.69 , $135.85 , $33.54 , $8.07 , $137.28 
"Inj Risperdal Consta, 0.5 Mg",HCPCS J2794,N/A,N/A,N/A, $12.00 , $7.80 , N/A , $12.26 , $11.82 , N/A , N/A , $11.16 , $10.80 , $10.80 , $9.60 , $9.60 , $11.82 , $11.08 , $11.40 , $10.80 , $10.80 , $10.80 , $11.16 , $11.52 , $14.25 , $10.20 , $11.03 , $15.11 , N/A , N/A , N/A , $11.40 , N/A , $9.60 , $15.11 
 US Thoracentesis for Asp Only ,CPT® 32555,0972 - PRO FEE/RAD/DX,N/A,N/A," $3,674.00 "," $2,388.10 ", $602.20 , $104.93 , $293.25 , $441.35 , $422.54 ," $3,416.82 "," $3,306.60 "," $3,306.60 "," $2,939.20 "," $2,939.20 ", $293.25 ," $3,392.20 "," $3,490.30 "," $3,306.60 "," $3,306.60 "," $3,306.60 "," $3,416.82 "," $3,527.04 ", $586.09 ," $3,122.90 ", $588.74 , $585.22 , N/A , $449.97 , $449.97 ," $3,490.30 ", $529.94 , $104.93 ," $3,527.04 "
Open Rx Mt-Phal Toe Dislocation,CPT® 28645,N/A,N/A,N/A," $4,347.00 "," $2,825.55 "," $2,998.58 ", $469.76 , $384.19 ," $2,376.83 "," $2,375.99 "," $4,042.71 "," $3,912.30 "," $3,912.30 "," $3,477.60 "," $3,477.60 ", $384.19 ," $4,013.59 "," $4,129.65 "," $3,912.30 "," $3,912.30 "," $3,912.30 "," $4,042.71 "," $4,173.12 "," $2,791.22 "," $3,694.95 "," $2,577.97 "," $2,817.80 ", N/A ," $2,423.21 "," $2,423.21 "," $4,129.65 "," $2,848.13 ", $384.19 ," $4,173.12 "
 US Umbilical Cord Doppler ,CPT® 76820,0402 - ULTRASOUND,N/A,N/A, $509.00 , $330.85 , $427.56 , $44.42 , $48.03 , $411.27 , $458.10 , $430.92 , $458.10 , $458.10 , $458.10 , $432.65 , $47.09 , $469.96 , $483.55 , $432.65 , $473.37 , $473.37 , $483.55 , $488.64 , $416.46 , $458.10 , $432.65 , $402.11 , N/A , $411.93 , $411.93 , $483.55 , $436.77 , $44.42 , $488.64 
"Perc Clos,Cong Interatrial Commun W/Impl",CPT® 93580,N/A,N/A,N/A," $19,414.00 "," $12,619.10 "," $5,704.99 ", $877.88 ," $1,491.66 "," $5,221.50 "," $5,299.90 "," $18,055.02 "," $17,472.60 "," $17,472.60 "," $15,531.20 "," $15,531.20 "," $1,491.66 "," $17,924.95 "," $18,443.30 "," $17,472.60 "," $17,472.60 "," $17,472.60 "," $18,055.02 "," $18,637.44 "," $5,279.17 "," $16,501.90 "," $5,155.95 "," $5,626.03 ", N/A ," $5,323.38 "," $5,323.38 "," $18,443.30 "," $5,901.01 ", $877.88 ," $18,637.44 "
 Fac Assay of Manganese ,CPT® 83785,0301 - LAB/CHEMISTRY,N/A,N/A, $209.00 , $135.85 , $175.56 , $27.18 , $27.18 , $168.87 , $188.10 , $176.94 , $188.10 , $188.10 , $188.10 , $177.65 , $26.65 , $192.97 , $198.55 , $177.65 , $194.37 , $194.37 , $198.55 , $200.64 , $171.00 , $188.10 , $177.65 , $165.11 , N/A , $169.14 , $169.14 , $198.55 , $179.34 , $26.65 , $200.64 
 Other Digestive System Diagnoses With McC ,MS DRG V40 (FY2023) 393,N/A,N/A,N/A," $20,541.78 "," $13,352.16 "," $17,255.10 ", N/A , N/A ," $16,597.76 "," $18,487.60 "," $17,390.67 "," $18,487.60 "," $18,487.60 "," $18,487.60 "," $17,460.51 ", N/A ," $18,966.23 "," $19,514.69 "," $17,460.51 "," $19,103.86 "," $19,103.86 "," $19,514.69 "," $19,720.11 "," $16,807.28 "," $18,487.60 "," $17,460.51 "," $16,228.01 ", N/A ," $16,624.46 "," $16,624.46 "," $19,514.69 "," $17,626.90 "," $16,228.01 "," $19,720.11 "
" Pro Trim Skin Lesions, 2 to 4 ",CPT® 11056,0982 - PRO FEE/OUTPT,N/A,N/A, $244.00 , $158.60 , $72.42 , $21.33 , $36.84 , $63.57 , $60.59 , $226.92 , $219.60 , $219.60 , $195.20 , $195.20 , $36.84 , $225.29 , $231.80 , $219.60 , $219.60 , $219.60 , $226.92 , $234.24 , $79.89 , $207.40 , $117.75 , $81.61 , N/A , $64.81 , $64.81 , $231.80 , $75.17 , $21.33 , $234.24 
"Fusion W/Tend Adv,Midtar Nav-Cuneiform",CPT® 28737,N/A,N/A,N/A," $4,572.00 "," $2,971.80 "," $4,236.25 ", $661.99 , $537.90 ," $3,394.97 "," $3,371.05 "," $4,251.96 "," $4,114.80 "," $4,114.80 "," $3,657.60 "," $3,657.60 ", $537.90 ," $4,221.33 "," $4,343.40 "," $4,114.80 "," $4,114.80 "," $4,114.80 "," $4,251.96 "," $4,389.12 "," $3,919.81 "," $3,886.20 "," $3,664.47 "," $4,038.00 ", N/A ," $3,461.21 "," $3,461.21 "," $4,343.40 "," $4,068.15 ", $537.90 ," $4,389.12 "
 Fac Varicella-Zoster Antibody ,CPT® 86787,0302 - LAB/IMMUNOLOGY,N/A,N/A, $126.00 , $81.90 , $105.84 , $13.14 , $8.07 , $101.81 , $113.40 , $106.67 , $113.40 , $113.40 , $113.40 , $107.10 , $7.91 , $116.34 , $119.70 , $107.10 , $117.18 , $117.18 , $119.70 , $120.96 , $103.09 , $113.40 , $107.10 , $99.54 , N/A , $101.97 , $101.97 , $119.70 , $108.12 , $7.91 , $120.96 
X-Ray Nose-Rectum Child F.B.,CPT® 76010,N/A,N/A,N/A, $307.00 , $199.55 , $167.79 , $29.43 , $26.96 , $123.60 , $143.51 , $285.51 , $276.30 , $276.30 , $245.60 , $245.60 , $26.96 , $283.45 , $291.65 , $276.30 , $276.30 , $276.30 , $285.51 , $294.72 , $163.37 , $260.95 , $156.01 , $131.65 , N/A , $126.01 , $126.01 , $291.65 , $145.86 , $26.96 , $294.72 
Repair Laceration/Conjunc,CPT® 65270,N/A,N/A,N/A," $2,619.00 "," $1,702.35 ", $867.49 , $136.56 , $76.84 , $797.38 , $743.91 ," $2,435.67 "," $2,357.10 "," $2,357.10 "," $2,095.20 "," $2,095.20 ", $76.84 ," $2,418.12 "," $2,488.05 "," $2,357.10 "," $2,357.10 "," $2,357.10 "," $2,435.67 "," $2,514.24 "," $1,194.58 "," $2,226.15 ", $765.36 ," $1,016.45 ", N/A , $812.95 , $812.95 ," $2,488.05 ", $897.37 , $76.84 ," $2,514.24 "
"Polysomnography, 4 or More",CPT® 95810,N/A,N/A,N/A," $5,862.00 "," $3,810.30 "," $2,228.13 ", $595.03 ," $1,061.47 "," $1,978.65 "," $2,194.06 "," $5,451.66 "," $5,275.80 "," $5,275.80 "," $4,689.60 "," $4,689.60 "," $1,061.47 "," $5,412.38 "," $5,568.90 "," $5,275.80 "," $5,275.80 "," $5,275.80 "," $5,451.66 "," $5,627.52 "," $2,646.65 "," $4,982.70 "," $1,924.03 "," $2,362.52 ", N/A ," $2,017.26 "," $2,017.26 "," $5,568.90 "," $2,480.00 ", $595.03 ," $5,627.52 "
"Open Rx Weightbear Tib,Fix Tib Only",27827,N/A,N/A,N/A," $4,215.00 "," $2,739.75 "," $6,846.58 "," $1,069.94 ", $946.73 ," $5,224.91 "," $5,223.20 "," $3,919.95 "," $3,793.50 "," $3,793.50 "," $3,372.00 "," $3,372.00 ", $946.73 ," $3,891.71 "," $4,004.25 "," $3,793.50 "," $3,793.50 "," $3,793.50 "," $3,919.95 "," $4,046.40 "," $6,349.41 "," $3,582.75 "," $5,767.88 "," $6,258.90 ", N/A ," $5,326.86 "," $5,326.86 "," $4,004.25 "," $6,260.96 ", $946.73 ," $6,846.58 "
Drainage of Hematoma/Fluid,CPT® 10140,N/A,N/A,N/A, $667.00 , $433.55 , $379.44 , $113.59 , $45.35 , $324.24 , $318.38 , $620.31 , $600.30 , $600.30 , $533.60 , $533.60 , $45.35 , $615.84 , $633.65 , $600.30 , $600.30 , $600.30 , $620.31 , $640.32 , $417.24 , $566.95 , $629.77 , $417.61 , N/A , $330.56 , $330.56 , $633.65 , $383.34 , $45.35 , $640.32 
" Blastomyces Antigen, Urine ",CPT® 87449,0306 - LAB/BACT-MICRO,N/A,N/A, $169.00 , $109.85 , $141.96 , $12.22 , $12.22 , $136.55 , $152.10 , $143.08 , $152.10 , $152.10 , $152.10 , $143.65 , $11.98 , $156.04 , $160.55 , $143.65 , $157.17 , $157.17 , $160.55 , $162.24 , $138.28 , $152.10 , $143.65 , $133.51 , N/A , $136.77 , $136.77 , $160.55 , $145.02 , $11.98 , $162.24 
"Fix Lid Ptosis,Frontalis Musc,Sut",CPT® 67901,N/A,N/A,N/A," $7,253.00 "," $4,714.45 "," $3,634.41 ", $570.08 , $907.22 ," $3,263.39 "," $3,084.41 "," $6,745.29 "," $6,527.70 "," $6,527.70 "," $5,802.40 "," $5,802.40 ", $907.22 ," $6,696.69 "," $6,890.35 "," $6,527.70 "," $6,527.70 "," $6,527.70 "," $6,745.29 "," $6,962.88 "," $4,965.93 "," $6,165.05 "," $3,202.39 "," $4,137.88 ", N/A ," $3,327.06 "," $3,327.06 "," $6,890.35 "," $3,672.65 ", $570.08 ," $6,962.88 "
 NM Pulmonary Perfusion Imaging Only ,CPT® 78580,0340 - NUCLEAR MEDICINE,N/A,N/A," $2,130.00 "," $1,384.50 "," $1,789.20 ", $216.90 , $175.15 ," $1,721.04 "," $1,917.00 "," $1,803.26 "," $1,917.00 "," $1,917.00 "," $1,917.00 "," $1,810.50 ", $171.72 ," $1,966.63 "," $2,023.50 "," $1,810.50 "," $1,980.90 "," $1,980.90 "," $2,023.50 "," $2,044.80 "," $1,742.77 "," $1,917.00 "," $1,810.50 "," $1,682.70 ", N/A ," $1,723.81 "," $1,723.81 "," $2,023.50 "," $1,827.75 ", $171.72 ," $2,044.80 "
 Fac Environmental Culture ,Custom 331576,0306 - LAB/BACT-MICRO,N/A,N/A, $28.00 , $18.20 , $23.52 , N/A , N/A , $22.62 , $25.20 , $23.70 , $25.20 , $25.20 , $25.20 , $23.80 , N/A , $25.85 , $26.60 , $23.80 , $26.04 , $26.04 , $26.60 , $26.88 , $22.91 , $25.20 , $23.80 , $22.12 , N/A , $22.66 , $22.66 , $26.60 , $24.03 , $22.12 , $26.88 
 Fac Exc B9 Les Mrgn Xcp Sk Tg T/a/L 1.1-2.0 Cm ,CPT® 11402,0761 - TREATMENT ROOM,N/A,N/A, $684.00 , $444.60 , $574.56 , $111.62 , $134.16 , $552.67 , $615.60 , $579.07 , $615.60 , $615.60 , $615.60 , $581.40 , $131.53 , $631.54 , $649.80 , $581.40 , $636.12 , $636.12 , $649.80 , $656.64 , $559.65 , $615.60 , $581.40 , $540.36 , N/A , $553.56 , $553.56 , $649.80 , $586.94 , $111.62 , $656.64 
Mast Prtl W/Ax Lmphadec,CPT® 19302,N/A,N/A,N/A," $5,270.00 "," $3,425.50 "," $2,835.74 ", $840.72 , $650.84 ," $2,414.95 "," $2,342.30 "," $4,901.10 "," $4,743.00 "," $4,743.00 "," $4,216.00 "," $4,216.00 ", $650.84 ," $4,865.79 "," $5,006.50 "," $4,743.00 "," $4,743.00 "," $4,743.00 "," $4,901.10 "," $5,059.20 "," $3,097.70 "," $4,479.50 "," $4,734.91 "," $3,048.24 ", N/A ," $2,462.06 "," $2,462.06 "," $5,006.50 "," $2,855.18 ", $650.84 ," $5,059.20 "
Ecmo/Ecls Insj of Prph Cannula 6 Yrs&Older Perq,CPT® 33952,N/A,N/A,N/A," $2,564.00 "," $1,666.60 "," $2,498.34 ", $384.54 , $470.28 ," $1,688.43 "," $1,859.95 "," $2,384.52 "," $2,307.60 "," $2,307.60 "," $2,051.20 "," $2,051.20 ", $470.28 ," $2,367.34 "," $2,435.80 "," $2,307.60 "," $2,307.60 "," $2,307.60 "," $2,384.52 "," $2,461.44 "," $2,312.58 "," $2,179.40 "," $2,217.63 "," $2,054.76 ", N/A ," $1,721.38 "," $1,721.38 "," $2,435.80 "," $1,955.47 ", $384.54 ," $2,498.34 "
 METHOTREXATE SODIUM (PF) 1 GM/40ML IJ SOLN ,HCPCS J9260,0636 - DRUGS REQUIRING DETAILED CODIN,61703-0408-41,40 mL, $226.44 , $147.19 , $190.21 , $2.76 , $2.50 , $182.96 , $203.80 , $191.70 , $203.80 , $203.80 , $203.80 , $192.47 , $2.45 , $209.07 , $215.12 , $192.47 , $210.59 , $210.59 , $215.12 , $217.38 , $185.27 , $203.80 , $192.47 , $178.89 , N/A , $183.26 , $183.26 , $215.12 , $194.31 , $2.45 , $217.38 
 DRONEDARONE HCL 400 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00024-4142-60,1 tablet, $78.09 , $50.76 , $65.60 , N/A , N/A , $63.10 , $70.28 , $66.11 , $70.28 , $70.28 , $70.28 , $66.38 , N/A , $72.10 , $74.19 , $66.38 , $72.62 , $72.62 , $74.19 , $74.97 , $63.89 , $70.28 , $66.38 , $61.69 , N/A , $63.20 , $63.20 , $74.19 , $67.01 , $61.69 , $74.97 
Assay Copper,CPT® 82525,N/A,N/A,N/A, $124.00 , $80.60 , N/A , $12.66 , $12.66 , $58.08 , $69.52 , $115.32 , $111.60 , $111.60 , $99.20 , $99.20 , $12.66 , $114.49 , $117.80 , $111.60 , $111.60 , $111.60 , $115.32 , $119.04 , $82.86 , $105.40 , $81.09 , $44.99 , N/A , $54.20 , $54.20 , $117.80 , $59.23 , $12.66 , $119.04 
Pro Rmvl Embedded FB Vestibule Mouth Comp,40805,N/A,N/A,N/A," $1,272.00 ", $826.80 ," $1,229.09 ", $192.19 , $83.68 ," $1,139.42 "," $1,199.99 "," $1,182.96 "," $1,144.80 "," $1,144.80 "," $1,017.60 "," $1,017.60 ", $83.68 ," $1,174.44 "," $1,208.40 "," $1,144.80 "," $1,144.80 "," $1,144.80 "," $1,182.96 "," $1,221.12 ", $894.17 ," $1,081.20 "," $1,304.15 "," $1,323.00 ", N/A ," $1,161.65 "," $1,161.65 "," $1,208.40 "," $1,214.97 ", $83.68 ," $1,323.00 "
" Fac Assay, Glucose, Blood Quant ",CPT® 82947,0301 - LAB/CHEMISTRY,N/A,N/A, $65.00 , $42.25 , $54.60 , $4.01 , $4.01 , $52.52 , $58.50 , $55.03 , $58.50 , $58.50 , $58.50 , $55.25 , $3.93 , $60.01 , $61.75 , $55.25 , $60.45 , $60.45 , $61.75 , $62.40 , $53.18 , $58.50 , $55.25 , $51.35 , N/A , $52.60 , $52.60 , $61.75 , $55.78 , $3.93 , $62.40 
"Hib Vaccine, Prp-T, Im",CPT® 90648,N/A,N/A,N/A, $84.00 , $54.60 , N/A , N/A , $46.72 , $59.24 , $61.79 , $78.12 , $75.60 , $75.60 , $67.20 , $67.20 , $46.72 , $77.56 , $79.80 , $75.60 , $75.60 , $75.60 , $78.12 , $80.64 , N/A , $71.40 , $82.11 , $24.84 , N/A , $60.40 , $60.40 , $79.80 , $70.41 , $24.84 , $82.11 
 Fac Drug Screening Gabapentin Non-Blood ,CPT® 80355,0301 - LAB/CHEMISTRY,N/A,N/A, $207.00 , $134.55 , $173.88 , N/A , N/A , $167.26 , $186.30 , $175.25 , $186.30 , $186.30 , $186.30 , $175.95 , N/A , $191.12 , $196.65 , $175.95 , $192.51 , $192.51 , $196.65 , $198.72 , $169.37 , $186.30 , $175.95 , $163.53 , N/A , $167.53 , $167.53 , $196.65 , $177.63 , $163.53 , $198.72 
"Remove Pelv/Hip F.B.,Deep",CPT® 27087,N/A,N/A,N/A," $4,151.00 "," $2,698.15 "," $3,702.92 ", $579.21 , $208.93 ," $3,008.69 "," $3,021.00 "," $3,860.43 "," $3,735.90 "," $3,735.90 "," $3,320.80 "," $3,320.80 ", $208.93 ," $3,832.62 "," $3,943.45 "," $3,735.90 "," $3,735.90 "," $3,735.90 "," $3,860.43 "," $3,984.96 "," $3,445.27 "," $3,528.35 "," $3,334.42 "," $3,475.54 ", N/A ," $3,067.40 "," $3,067.40 "," $3,943.45 "," $3,605.27 ", $208.93 ," $3,984.96 "
 Fac Platelet Antibodies ,CPT® 86022,0302 - LAB/IMMUNOLOGY,N/A,N/A, $325.00 , $211.25 , $273.00 , $18.74 , $18.74 , $262.60 , $292.50 , $275.15 , $292.50 , $292.50 , $292.50 , $276.25 , $18.37 , $300.07 , $308.75 , $276.25 , $302.25 , $302.25 , $308.75 , $312.00 , $265.92 , $292.50 , $276.25 , $256.75 , N/A , $263.02 , $263.02 , $308.75 , $278.88 , $18.37 , $312.00 
Exc Tumor Soft Tissue Leg/Ankle Subfasc 5+Cm,CPT® 27634,N/A,N/A,N/A," $4,734.00 "," $3,077.10 "," $4,092.79 ", $641.01 , $556.37 ," $3,299.36 "," $3,285.09 "," $4,402.62 "," $4,260.60 "," $4,260.60 "," $3,787.20 "," $3,787.20 ", $556.37 ," $4,370.90 "," $4,497.30 "," $4,260.60 "," $4,260.60 "," $4,260.60 "," $4,402.62 "," $4,544.64 "," $3,818.82 "," $4,023.90 "," $3,618.08 "," $3,867.23 ", N/A ," $3,363.73 "," $3,363.73 "," $4,497.30 "," $3,953.57 ", $556.37 ," $4,544.64 "
Part Remv Phalanx of Toe,CPT® 28124,N/A,N/A,N/A," $3,174.00 "," $2,063.10 "," $2,071.49 ", $325.03 , $230.52 ," $1,630.93 "," $1,622.56 "," $2,951.82 "," $2,856.60 "," $2,856.60 "," $2,539.20 "," $2,539.20 ", $230.52 ," $2,930.55 "," $3,015.30 "," $2,856.60 "," $2,856.60 "," $2,856.60 "," $2,951.82 "," $3,047.04 "," $1,921.13 "," $2,697.90 "," $1,751.95 "," $1,945.21 ", N/A ," $1,662.75 "," $1,662.75 "," $3,015.30 "," $1,954.34 ", $230.52 ," $3,047.04 "
 NM Lung Vent & Perfusion Aersol or Gas ,CPT® 78582,0340 - NUCLEAR MEDICINE,N/A,N/A," $2,804.00 "," $1,822.60 "," $2,355.36 ", $304.15 , $251.40 ," $2,265.63 "," $2,523.60 "," $2,373.87 "," $2,523.60 "," $2,523.60 "," $2,523.60 "," $2,383.40 ", $246.47 ," $2,588.93 "," $2,663.80 "," $2,383.40 "," $2,607.72 "," $2,607.72 "," $2,663.80 "," $2,691.84 "," $2,294.23 "," $2,523.60 "," $2,383.40 "," $2,215.16 ", N/A ," $2,269.28 "," $2,269.28 "," $2,663.80 "," $2,406.11 ", $246.47 ," $2,691.84 "
Behavior Counsel Obesity 15m,HCPCS G0447,N/A,N/A,N/A, $90.00 , $58.50 , $29.94 , $22.23 , N/A , $43.88 , N/A , $83.70 , $81.00 , $81.00 , $72.00 , $72.00 , N/A , $83.10 , $85.50 , $81.00 , $81.00 , $81.00 , $83.70 , $86.40 , $71.72 , $76.50 , $44.76 , $89.43 , N/A , $44.73 , $44.73 , $85.50 , $55.91 , $22.23 , $89.43 
 EPTIFIBATIDE 20 MG/10ML IV SOLN ,HCPCS J1327,0636 - DRUGS REQUIRING DETAILED CODIN,67457-0629-10,12.5 mL, $110.27 , $71.68 , $92.63 , N/A , $28.13 , $89.10 , $99.24 , $93.35 , $99.24 , $99.24 , $99.24 , $93.73 , $27.58 , $101.81 , $104.76 , $93.73 , $102.55 , $102.55 , $104.76 , $105.86 , $90.22 , $99.24 , $93.73 , $87.11 , N/A , $89.24 , $89.24 , $104.76 , $94.62 , $27.58 , $105.86 
 Fac Cor Ffr Cta Data Review W/Interpj & Final Report ,CPT® 0504T,0480 - CARDIOLOGY,N/A,N/A, $610.00 , $396.50 , $512.40 , $38.63 , N/A , $492.88 , $549.00 , $516.43 , $549.00 , $549.00 , $549.00 , $518.50 , N/A , $563.21 , $579.50 , $518.50 , $567.30 , $567.30 , $579.50 , $585.60 , $499.10 , $549.00 , $518.50 , $481.90 , N/A , $493.67 , $493.67 , $579.50 , $523.44 , $38.63 , $585.60 
"Cauter Turbinate Mucosa,Intramural",30802,N/A,N/A,N/A, $945.00 , $614.25 ," $1,132.00 ", $198.84 , $52.83 , $724.09 , $733.77 , $878.85 , $850.50 , $850.50 , $756.00 , $756.00 , $52.83 , $872.52 , $897.75 , $850.50 , $850.50 , $850.50 , $878.85 , $907.20 ," $1,074.19 ", $803.25 ," $1,031.19 ", $954.09 , N/A , $738.22 , $738.22 , $897.75 , $869.42 , $52.83 ," $1,132.00 "
Excise Cutaneous Neurofibroma,CPT® 64788,N/A,N/A,N/A," $2,816.00 "," $1,830.40 "," $1,968.93 ", $385.70 , $307.34 ," $2,236.99 "," $2,154.82 "," $2,618.88 "," $2,534.40 "," $2,534.40 "," $2,252.80 "," $2,252.80 ", $307.34 ," $2,600.01 "," $2,675.20 "," $2,534.40 "," $2,534.40 "," $2,534.40 "," $2,618.88 "," $2,703.36 "," $2,113.88 "," $2,393.60 "," $2,140.88 "," $2,325.15 ", N/A ," $2,280.64 "," $2,280.64 "," $2,675.20 "," $2,446.57 ", $307.34 ," $2,703.36 "
ACTH,CPT® 82024,N/A,N/A,N/A, $353.00 , $229.45 , N/A , $39.39 , $39.39 , $218.51 , $261.43 , $328.29 , $317.70 , $317.70 , $282.40 , $282.40 , $39.39 , $325.92 , $335.35 , $317.70 , $317.70 , $317.70 , $328.29 , $338.88 , $257.87 , $300.05 , $253.01 , $140.04 , N/A , $203.93 , $203.93 , $335.35 , $222.85 , $39.39 , $338.88 
 Fac Perq Vert Agmntj Cavity Crtj Uni/Bi Cannulation ,CPT® 22513,0361 - OR/MINOR,N/A,N/A," $29,733.00 "," $19,326.45 "," $24,975.72 ", $477.25 ," $5,767.47 "," $24,024.26 "," $26,759.70 "," $25,171.96 "," $26,759.70 "," $26,759.70 "," $26,759.70 "," $25,273.05 "," $5,654.38 "," $27,452.48 "," $28,246.35 "," $25,273.05 "," $27,651.69 "," $27,651.69 "," $28,246.35 "," $28,543.68 "," $24,327.54 "," $26,759.70 "," $25,273.05 "," $23,489.07 ", N/A ," $24,062.92 "," $24,062.92 "," $28,246.35 "," $25,513.89 ", $477.25 ," $28,543.68 "
Open Repair Clavicle Fracture,23515,N/A,N/A,N/A," $4,739.00 "," $3,080.35 "," $4,385.42 ", $688.96 , $614.70 ," $3,469.11 "," $3,468.64 "," $4,407.27 "," $4,265.10 "," $4,265.10 "," $3,791.20 "," $3,791.20 ", $614.70 ," $4,375.52 "," $4,502.05 "," $4,265.10 "," $4,265.10 "," $4,265.10 "," $4,407.27 "," $4,549.44 "," $4,077.69 "," $4,028.15 "," $3,828.60 "," $4,093.83 ", N/A ," $3,536.79 "," $3,536.79 "," $4,502.05 "," $4,156.99 ", $614.70 ," $4,549.44 "
 Cytp Concentration Smrs&Interp ,CPT® 88108,0971 - PRO FEE/LAB,N/A,N/A, $103.00 , $66.95 , $229.59 , $65.00 , $38.28 , $335.18 , $360.23 , $95.79 , $92.70 , $92.70 , $82.40 , $82.40 , $38.28 , $95.10 , $97.85 , $92.70 , $92.70 , $92.70 , $95.79 , $98.88 , $404.57 , $87.55 , $376.27 , $211.83 , N/A , $312.81 , $312.81 , $97.85 , $343.77 , $38.28 , $404.57 
"Culture,Stool,Bact,Aerobic,Addl",CPT® 87046,N/A,N/A,N/A, $100.00 , $65.00 , N/A , $9.63 , $3.36 , $53.43 , $63.85 , $93.00 , $90.00 , $90.00 , $80.00 , $80.00 , $3.36 , $92.33 , $95.00 , $90.00 , $90.00 , $90.00 , $93.00 , $96.00 , $63.03 , $85.00 , $61.63 , $34.25 , N/A , $49.86 , $49.86 , $95.00 , $54.48 , $3.36 , $96.00 
Evaluation of Speech Fluency (Stutter Clutter),CPT® 92521,N/A,N/A,N/A, $530.00 , $344.50 , $312.65 , $132.59 , $105.51 , $241.65 , $260.49 , $492.90 , $477.00 , $477.00 , $424.00 , $424.00 , $105.51 , $489.35 , $503.50 , $477.00 , $477.00 , $477.00 , $492.90 , $508.80 , $401.96 , $450.50 , $399.83 , $434.97 , N/A , $246.37 , $246.37 , $503.50 , $287.21 , $105.51 , $508.80 
Pro Excision Trochanteric Bursa/Calcification - Lh,27062,N/A,N/A,N/A," $3,630.00 "," $2,359.50 "," $2,786.10 ", $437.25 , $329.90 ," $2,199.19 "," $2,199.13 "," $3,375.90 "," $3,267.00 "," $3,267.00 "," $2,904.00 "," $2,904.00 ", $329.90 ," $3,351.58 "," $3,448.50 "," $3,267.00 "," $3,267.00 "," $3,267.00 "," $3,375.90 "," $3,484.80 "," $2,586.57 "," $3,085.50 "," $2,426.33 "," $2,590.31 ", N/A ," $2,242.09 "," $2,242.09 "," $3,448.50 "," $2,635.27 ", $329.90 ," $3,484.80 "
Bronchoscopy W/Plmt Fiducial Markers Single/Mult,CPT® 31626,N/A,N/A,N/A," $5,121.00 "," $3,328.65 "," $1,067.09 ", $185.24 , $362.71 , $822.61 , $787.37 ," $4,762.53 "," $4,608.90 "," $4,608.90 "," $4,096.80 "," $4,096.80 ", $362.71 ," $4,728.22 "," $4,864.95 "," $4,608.90 "," $4,608.90 "," $4,608.90 "," $4,762.53 "," $4,916.16 "," $1,037.78 "," $4,352.85 "," $1,091.85 "," $1,032.74 ", N/A , $838.66 , $838.66 ," $4,864.95 ", $987.71 , $185.24 ," $4,916.16 "
 INDAPAMIDE 2.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,62559-0511-01,1 tablet, $7.96 , $5.17 , $6.69 , N/A , N/A , $6.43 , $7.16 , $6.74 , $7.16 , $7.16 , $7.16 , $6.77 , N/A , $7.35 , $7.56 , $6.77 , $7.40 , $7.40 , $7.56 , $7.64 , $6.51 , $7.16 , $6.77 , $6.29 , N/A , $6.44 , $6.44 , $7.56 , $6.83 , $6.29 , $7.64 
 Pro Remove Foreign Body From Eye ,CPT® 65222,0981 - PRO FEE/ER,N/A,N/A, $250.00 , $162.50 , $313.04 , $48.84 , $48.12 , $297.31 , $278.46 , $232.50 , $225.00 , $225.00 , $200.00 , $200.00 , $48.12 , $230.83 , $237.50 , $225.00 , $225.00 , $225.00 , $232.50 , $240.00 , $433.67 , $212.50 , $287.23 , $377.49 , N/A , $303.11 , $303.11 , $237.50 , $334.61 , $48.12 , $433.67 
Pro Windowing of Cast,29730,N/A,N/A,N/A, $348.00 , $226.20 , $267.80 , $42.00 , $22.62 , $215.54 , $216.71 , $323.64 , $313.20 , $313.20 , $278.40 , $278.40 , $22.62 , $321.31 , $330.60 , $313.20 , $313.20 , $313.20 , $323.64 , $334.08 , $247.00 , $295.80 , $237.28 , $253.23 , N/A , $219.75 , $219.75 , $330.60 , $258.29 , $22.62 , $334.08 
"Part Removal Colon W Coloproc,Colost",CPT® 44146,N/A,N/A,N/A," $13,756.00 "," $8,941.40 "," $12,561.77 "," $1,942.74 "," $2,378.00 "," $10,034.47 "," $10,116.19 "," $12,793.08 "," $12,380.40 "," $12,380.40 "," $11,004.80 "," $11,004.80 "," $2,378.00 "," $12,700.91 "," $13,068.20 "," $12,380.40 "," $12,380.40 "," $12,380.40 "," $12,793.08 "," $13,205.76 "," $9,043.20 "," $11,692.60 "," $11,212.84 "," $11,848.41 ", N/A ," $10,230.26 "," $10,230.26 "," $13,068.20 "," $10,699.74 "," $1,942.74 "," $13,205.76 "
Identify Sentinel Node,38792,N/A,N/A,N/A, $763.00 , $495.95 , $154.55 , $30.89 , $36.29 , $140.90 , $148.11 , $709.59 , $686.70 , $686.70 , $610.40 , $610.40 , $36.29 , $704.48 , $724.85 , $686.70 , $686.70 , $686.70 , $709.59 , $732.48 , $166.47 , $648.55 , $215.87 , $197.75 , N/A , $143.66 , $143.66 , $724.85 , $166.67 , $30.89 , $732.48 
 Fac Covid-19 Vaccine Home Admin ,HCPCS M0201,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
 Pro Treat Shoulder Blade Fx ,CPT® 23570,0982 - PRO FEE/OUTPT,N/A,N/A, $868.00 , $564.20 ," $1,508.00 ", $239.36 , $101.63 ," $1,150.84 "," $1,170.86 ", $807.24 , $781.20 , $781.20 , $694.40 , $694.40 , $101.63 , $801.42 , $824.60 , $781.20 , $781.20 , $781.20 , $807.24 , $833.28 ," $1,389.76 ", $737.80 ," $1,284.53 "," $1,368.26 ", N/A ," $1,173.30 "," $1,173.30 ", $824.60 ," $1,379.07 ", $101.63 ," $1,508.00 "
Radiologic Small Intestine Follow-Through Study,CPT® 74248,N/A,N/A,N/A," $1,705.00 "," $1,108.25 ", $481.92 , $82.53 , $65.14 , $386.75 , N/A ," $1,585.65 "," $1,534.50 "," $1,534.50 "," $1,364.00 "," $1,364.00 ", $65.14 ," $1,574.23 "," $1,619.75 "," $1,534.50 "," $1,534.50 "," $1,534.50 "," $1,585.65 "," $1,636.80 ", $471.95 ," $1,449.25 ", $481.51 , $417.61 , N/A , $394.30 , $394.30 ," $1,619.75 ", $456.96 , $65.14 ," $1,636.80 "
 MONTELUKAST SODIUM 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6808-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
" Pro Critical Care, Add'l 30 Min ",CPT® 99292,0981 - PRO FEE/ER,N/A,N/A, $616.00 , $400.40 , $217.33 , $103.14 , $121.38 , $192.94 , $193.49 , $572.88 , $554.40 , $554.40 , $492.80 , $492.80 , $121.38 , $568.75 , $585.20 , $554.40 , $554.40 , $554.40 , $572.88 , $591.36 , $276.66 , $523.60 , $241.53 , $242.43 , N/A , $196.71 , $196.71 , $585.20 , $226.88 , $103.14 , $591.36 
Percut Fix Prox/Neck Femur Fx,27235,N/A,N/A,N/A," $4,908.00 "," $3,190.20 "," $5,495.75 ", $859.35 , $796.77 ," $4,386.19 "," $4,350.98 "," $4,564.44 "," $4,417.20 "," $4,417.20 "," $3,926.40 "," $3,926.40 ", $796.77 ," $4,531.56 "," $4,662.60 "," $4,417.20 "," $4,417.20 "," $4,417.20 "," $4,564.44 "," $4,711.68 "," $5,114.46 "," $4,171.80 "," $4,809.84 "," $5,158.64 ", N/A ," $4,471.77 "," $4,471.77 "," $4,662.60 "," $5,255.92 ", $796.77 ," $5,495.75 "
"Arthroplasty MC-P Jt,Implant",CPT® 26531,N/A,N/A,N/A," $3,991.00 "," $2,594.15 "," $3,871.73 ", $608.91 , $461.04 ," $2,999.35 "," $2,992.00 "," $3,711.63 "," $3,591.90 "," $3,591.90 "," $3,192.80 "," $3,192.80 ", $461.04 ," $3,684.89 "," $3,791.45 "," $3,591.90 "," $3,591.90 "," $3,591.90 "," $3,711.63 "," $3,831.36 "," $3,588.87 "," $3,392.35 "," $3,286.25 "," $3,569.20 ", N/A ," $3,057.87 "," $3,057.87 "," $3,791.45 "," $3,594.07 ", $461.04 ," $3,871.73 "
"Echo Heart Xthoracic,Limited",93308,N/A,N/A,N/A, $501.00 , $325.65 , $625.50 , $96.57 , $153.86 , $668.74 , $562.09 , $465.93 , $450.90 , $450.90 , $400.80 , $400.80 , $153.86 , $462.57 , $475.95 , $450.90 , $450.90 , $450.90 , $465.93 , $480.96 , $620.72 , $425.85 , $526.30 , $632.47 , N/A , $681.79 , $681.79 , $475.95 , $755.77 , $96.57 , $755.77 
 BUMETANIDE 1 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,69238-1490-01,1 tablet, $13.86 , $9.01 , $11.64 , N/A , N/A , $11.20 , $12.47 , $11.73 , $12.47 , $12.47 , $12.47 , $11.78 , N/A , $12.80 , $13.17 , $11.78 , $12.89 , $12.89 , $13.17 , $13.31 , $11.34 , $12.47 , $11.78 , $10.95 , N/A , $11.22 , $11.22 , $13.17 , $11.89 , $10.95 , $13.31 
Part Simple Remv Vulva,CPT® 56620,N/A,N/A,N/A," $3,720.00 "," $2,418.00 "," $2,791.00 ", $565.10 , $421.26 ," $2,103.49 "," $2,074.37 "," $3,459.60 "," $3,348.00 "," $3,348.00 "," $2,976.00 "," $2,976.00 ", $421.26 ," $3,434.68 "," $3,534.00 "," $3,348.00 "," $3,348.00 "," $3,348.00 "," $3,459.60 "," $3,571.20 "," $2,846.17 "," $3,162.00 "," $2,720.70 "," $2,124.60 ", N/A ," $2,144.53 "," $2,144.53 "," $3,534.00 "," $2,572.25 ", $421.26 ," $3,571.20 "
Percut Rx Prox/Mid Fing Shft Fx,26727,N/A,N/A,N/A," $2,052.00 "," $1,333.80 "," $2,930.72 ", $461.65 , $176.16 ," $2,255.38 "," $2,267.82 "," $1,908.36 "," $1,846.80 "," $1,846.80 "," $1,641.60 "," $1,641.60 ", $176.16 ," $1,894.61 "," $1,949.40 "," $1,846.80 "," $1,846.80 "," $1,846.80 "," $1,908.36 "," $1,969.92 "," $2,718.42 "," $1,744.20 "," $2,490.55 "," $2,682.13 ", N/A ," $2,299.38 "," $2,299.38 "," $1,949.40 "," $2,702.59 ", $176.16 ," $2,930.72 "
Pro Cltx Prox Tibfib Jt Dislc W/O Anes,27830,N/A,N/A,N/A," $1,894.00 "," $1,231.10 "," $2,228.01 ", $351.99 , $230.52 ," $1,693.54 "," $1,719.93 "," $1,761.42 "," $1,704.60 "," $1,704.60 "," $1,515.20 "," $1,515.20 ", $230.52 ," $1,748.73 "," $1,799.30 "," $1,704.60 "," $1,704.60 "," $1,704.60 "," $1,761.42 "," $1,818.24 "," $2,053.76 "," $1,609.90 "," $1,891.11 "," $2,023.56 ", N/A ," $1,726.59 "," $1,726.59 "," $1,799.30 "," $2,029.35 ", $230.52 ," $2,228.01 "
 Allergen 1 Beaker1 ,CPT® 86003,0302 - LAB/IMMUNOLOGY,N/A,N/A, $39.00 , $25.35 , $32.76 , $5.32 , $4.51 , $31.51 , $35.10 , $33.02 , $35.10 , $35.10 , $35.10 , $33.15 , $4.42 , $36.01 , $37.05 , $33.15 , $36.27 , $36.27 , $37.05 , $37.44 , $31.91 , $35.10 , $33.15 , $30.81 , N/A , $31.56 , $31.56 , $37.05 , $33.47 , $4.42 , $37.44 
Explor Metatarso-Phalang Jt,CPT® 28022,N/A,N/A,N/A," $3,208.00 "," $2,085.20 "," $2,019.16 ", $317.15 , $276.59 ," $1,602.01 "," $1,599.79 "," $2,983.44 "," $2,887.20 "," $2,887.20 "," $2,566.40 "," $2,566.40 ", $276.59 ," $2,961.95 "," $3,047.60 "," $2,887.20 "," $2,887.20 "," $2,887.20 "," $2,983.44 "," $3,079.68 "," $1,873.65 "," $2,726.80 "," $1,732.33 "," $1,887.23 ", N/A ," $1,633.27 "," $1,633.27 "," $3,047.60 "," $1,919.68 ", $276.59 ," $3,079.68 "
 RIFAMPIN 150 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,60687-0575-21,1 capsule, $10.22 , $6.64 , $8.58 , N/A , N/A , $8.26 , $9.20 , $8.65 , $9.20 , $9.20 , $9.20 , $8.69 , N/A , $9.44 , $9.71 , $8.69 , $9.50 , $9.50 , $9.71 , $9.81 , $8.36 , $9.20 , $8.69 , $8.07 , N/A , $8.27 , $8.27 , $9.71 , $8.77 , $8.07 , $9.81 
 Fac Sub Grft F/S/N/H/F/G/M/D /<100scm /<1st 25 Scm ,CPT® 15275,0761 - TREATMENT ROOM,N/A,N/A," $1,725.00 "," $1,121.25 "," $1,449.00 ", $89.29 , $118.92 ," $1,393.80 "," $1,552.50 "," $1,460.39 "," $1,552.50 "," $1,552.50 "," $1,552.50 "," $1,466.25 ", $116.59 ," $1,592.69 "," $1,638.75 "," $1,466.25 "," $1,604.25 "," $1,604.25 "," $1,638.75 "," $1,656.00 "," $1,411.40 "," $1,552.50 "," $1,466.25 "," $1,362.75 ", N/A ," $1,396.04 "," $1,396.04 "," $1,638.75 "," $1,480.22 ", $89.29 ," $1,656.00 "
"Lap,Fulgurate/Excise Lesions",CPT® 58662,N/A,N/A,N/A," $5,509.00 "," $3,580.85 "," $3,344.60 ", $677.43 , $641.08 ," $2,883.03 "," $2,860.11 "," $5,123.37 "," $4,958.10 "," $4,958.10 "," $4,407.20 "," $4,407.20 ", $641.08 ," $5,086.46 "," $5,233.55 "," $4,958.10 "," $4,958.10 "," $4,958.10 "," $5,123.37 "," $5,288.64 "," $3,501.14 "," $4,682.65 "," $3,764.38 "," $2,893.05 ", N/A ," $2,939.29 "," $2,939.29 "," $5,233.55 "," $3,525.49 ", $641.08 ," $5,288.64 "
Perq Access & Closure Fem Art for Delivery Ndgft,CPT® 34713,N/A,N/A,N/A, $758.00 , $492.70 , $710.39 , $109.23 , $97.91 , $518.62 , $526.20 , $704.94 , $682.20 , $682.20 , $606.40 , $606.40 , $97.91 , $699.86 , $720.10 , $682.20 , $682.20 , $682.20 , $704.94 , $727.68 , $662.32 , $644.30 , $637.92 , $622.52 , N/A , $528.74 , $528.74 , $720.10 , $600.65 , $97.91 , $727.68 
"Suture Sm Intest,Single Perf",CPT® 44602,N/A,N/A,N/A," $9,109.00 "," $5,920.85 "," $8,344.57 "," $1,289.87 "," $1,376.42 "," $6,625.65 "," $6,659.32 "," $8,471.37 "," $8,198.10 "," $8,198.10 "," $7,287.20 "," $7,287.20 "," $1,376.42 "," $8,410.34 "," $8,653.55 "," $8,198.10 "," $8,198.10 "," $8,198.10 "," $8,471.37 "," $8,744.64 "," $5,988.38 "," $7,742.65 "," $7,414.57 "," $7,814.23 ", N/A ," $6,754.94 "," $6,754.94 "," $8,653.55 "," $7,064.94 "," $1,289.87 "," $8,744.64 "
 Fac Spectrophotometry ,CPT® 84311,0301 - LAB/CHEMISTRY,N/A,N/A, $199.00 , $129.35 , $167.16 , $8.26 , $8.26 , $160.79 , $179.10 , $168.47 , $179.10 , $179.10 , $179.10 , $169.15 , $8.10 , $183.74 , $189.05 , $169.15 , $185.07 , $185.07 , $189.05 , $191.04 , $162.82 , $179.10 , $169.15 , $157.21 , N/A , $161.05 , $161.05 , $189.05 , $170.76 , $8.10 , $191.04 
"Biopsy of Prostate,Needle/Punch",CPT® 55700,N/A,N/A,N/A, $726.00 , $471.90 , $572.27 , $122.83 , $109.97 , $448.37 , $451.52 , $675.18 , $653.40 , $653.40 , $580.80 , $580.80 , $109.97 , $670.32 , $689.70 , $653.40 , $653.40 , $653.40 , $675.18 , $696.96 , $539.43 , $617.10 , $718.98 , $633.08 , N/A , $457.12 , $457.12 , $689.70 , $547.87 , $109.97 , $718.98 
Egd Injection Sclerosis Esophgl/Gastric Varices,43243,N/A,N/A,N/A," $2,660.00 "," $1,729.00 "," $1,451.45 ", $224.05 , $249.97 ," $1,200.18 "," $1,294.30 "," $2,473.80 "," $2,394.00 "," $2,394.00 "," $2,128.00 "," $2,128.00 ", $249.97 ," $2,455.98 "," $2,527.00 "," $2,394.00 "," $2,394.00 "," $2,394.00 "," $2,473.80 "," $2,553.60 "," $1,042.92 "," $2,261.00 "," $1,420.11 "," $1,383.06 ", N/A ," $1,223.59 "," $1,223.59 "," $2,527.00 "," $1,279.76 ", $224.05 ," $2,553.60 "
Fusion of Wrist Joint,CPT® 25800,N/A,N/A,N/A," $4,872.00 "," $3,166.80 "," $4,468.23 ", $701.77 , $644.79 ," $3,524.43 "," $3,508.28 "," $4,530.96 "," $4,384.80 "," $4,384.80 "," $3,897.60 "," $3,897.60 ", $644.79 ," $4,498.32 "," $4,628.40 "," $4,384.80 "," $4,384.80 "," $4,384.80 "," $4,530.96 "," $4,677.12 "," $4,159.10 "," $4,141.20 "," $3,862.50 "," $4,181.18 ", N/A ," $3,593.20 "," $3,593.20 "," $4,628.40 "," $4,223.29 ", $644.79 ," $4,677.12 "
 Pro Incision of Anal Abscess ,CPT® 46050,0982 - PRO FEE/OUTPT,N/A,N/A," $1,319.00 ", $857.35 , $612.76 , $96.47 , $68.62 , $463.98 , $481.35 ," $1,226.67 "," $1,187.10 "," $1,187.10 "," $1,055.20 "," $1,055.20 ", $68.62 ," $1,217.83 "," $1,253.05 "," $1,187.10 "," $1,187.10 "," $1,187.10 "," $1,226.67 "," $1,266.24 ", $436.34 ," $1,121.15 ", $529.87 , $552.66 , N/A , $473.03 , $473.03 ," $1,253.05 ", $494.75 , $68.62 ," $1,266.24 "
"Prothrombin Test,Substi,Fractn",CPT® 85611,N/A,N/A,N/A, $93.00 , $60.45 , N/A , $4.02 , $4.02 , $22.29 , $26.69 , $86.49 , $83.70 , $83.70 , $74.40 , $74.40 , $4.02 , $85.87 , $88.35 , $83.70 , $83.70 , $83.70 , $86.49 , $89.28 , $26.31 , $79.05 , $25.95 , $14.30 , N/A , $20.80 , $20.80 , $88.35 , $22.73 , $4.02 , $89.28 
" Fac Alpha-1-Antitrypsin, Total ",CPT® 82103,0301 - LAB/CHEMISTRY,N/A,N/A, $153.00 , $99.45 , $128.52 , $13.71 , $13.71 , $123.62 , $137.70 , $129.53 , $137.70 , $137.70 , $137.70 , $130.05 , $13.44 , $141.26 , $145.35 , $130.05 , $142.29 , $142.29 , $145.35 , $146.88 , $125.18 , $137.70 , $130.05 , $120.87 , N/A , $123.82 , $123.82 , $145.35 , $131.29 , $13.44 , $146.88 
Pro Cltx Sho Dislc W/Fx Humrl Tubrst W/Mnpj,23665,N/A,N/A,N/A," $2,159.00 "," $1,403.35 "," $2,467.60 ", $389.31 , $184.42 ," $1,901.37 "," $1,920.74 "," $2,007.87 "," $1,943.10 "," $1,943.10 "," $1,727.20 "," $1,727.20 ", $184.42 ," $1,993.40 "," $2,051.05 "," $1,943.10 "," $1,943.10 "," $1,943.10 "," $2,007.87 "," $2,072.64 "," $2,273.04 "," $1,835.15 "," $2,112.33 "," $2,250.81 ", N/A ," $1,938.47 "," $1,938.47 "," $2,051.05 "," $2,278.39 ", $184.42 ," $2,467.60 "
Biopsy of Uterus Lining,CPT® 58100,N/A,N/A,N/A, $654.00 , $425.10 , $296.20 , $59.65 , $56.34 , $358.12 , $356.64 , $608.22 , $588.60 , $588.60 , $523.20 , $523.20 , $56.34 , $603.84 , $621.30 , $588.60 , $588.60 , $588.60 , $608.22 , $627.84 , $312.12 , $555.90 , $469.21 , $357.89 , N/A , $365.10 , $365.10 , $621.30 , $437.94 , $56.34 , $627.84 
Omalizumab Injection,HCPCS J2357,N/A,N/A,N/A, $48.00 , $31.20 , N/A , $40.17 , $38.96 , N/A , N/A , $44.64 , $43.20 , $43.20 , $38.40 , $38.40 , $38.96 , $44.32 , $45.60 , $43.20 , $43.20 , $43.20 , $44.64 , $46.08 , $49.26 , $40.80 , $44.76 , $50.40 , N/A , N/A , N/A , $45.60 , N/A , $38.40 , $50.40 
"Bypass Graft Othr,Fem-Fem",CPT® 35661,N/A,N/A,N/A," $6,712.00 "," $4,362.80 "," $6,270.68 ", $966.18 ," $1,340.24 "," $4,714.71 "," $4,725.94 "," $6,242.16 "," $6,040.80 "," $6,040.80 "," $5,369.60 "," $5,369.60 "," $1,340.24 "," $6,197.19 "," $6,376.40 "," $6,040.80 "," $6,040.80 "," $6,040.80 "," $6,242.16 "," $6,443.52 "," $5,801.48 "," $5,705.20 "," $5,971.26 "," $5,218.70 ", N/A ," $4,806.70 "," $4,806.70 "," $6,376.40 "," $5,460.42 ", $966.18 ," $6,443.52 "
 Fac Assay of Urine/Uric Acid ,CPT® 84560,0301 - LAB/CHEMISTRY,N/A,N/A, $68.00 , $44.20 , $57.12 , $5.18 , $5.18 , $54.94 , $61.20 , $57.57 , $61.20 , $61.20 , $61.20 , $57.80 , $5.08 , $62.78 , $64.60 , $57.80 , $63.24 , $63.24 , $64.60 , $65.28 , $55.64 , $61.20 , $57.80 , $53.72 , N/A , $55.03 , $55.03 , $64.60 , $58.35 , $5.08 , $65.28 
 Sinuses Paranasal Less Than 3 Vw- Mh ,CPT® 70210,0972 - PRO FEE/RAD/DX,N/A,N/A, $111.00 , $72.15 , $182.82 , $31.70 , $28.75 , $140.44 , $164.46 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $28.75 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $176.44 , $94.35 , $181.05 , $149.48 , N/A , $143.19 , $143.19 , $105.45 , $165.74 , $28.75 , $182.82 
Explore/Release Post Cap Ankle Jt,CPT® 27612,N/A,N/A,N/A," $3,608.00 "," $2,345.20 "," $3,445.91 ", $546.26 , $768.38 ," $2,751.28 "," $2,711.58 "," $3,355.44 "," $3,247.20 "," $3,247.20 "," $2,886.40 "," $2,886.40 ", $768.38 ," $3,331.27 "," $3,427.60 "," $3,247.20 "," $3,247.20 "," $3,247.20 "," $3,355.44 "," $3,463.68 "," $3,193.51 "," $3,066.80 "," $2,965.11 "," $3,241.20 ", N/A ," $2,804.96 "," $2,804.96 "," $3,427.60 "," $3,296.82 ", $546.26 ," $3,463.68 "
 Fac Fetal Non-Stress Test ,CPT® 59025,0720 - DELIVROOM/LABOR,N/A,N/A, $441.00 , $286.65 , $370.44 , $46.00 , $50.89 , $356.33 , $396.90 , $373.35 , $396.90 , $396.90 , $396.90 , $374.85 , $49.89 , $407.18 , $418.95 , $374.85 , $410.13 , $410.13 , $418.95 , $423.36 , $360.83 , $396.90 , $374.85 , $348.39 , N/A , $356.90 , $356.90 , $418.95 , $378.42 , $46.00 , $423.36 
 Endo Rep Iliac Art W/Aorto-Iiac Endograft Placement; Add on Code ,CPT® 34717,0360 - OR SERVICES,N/A,N/A, $521.00 , $338.65 , $437.64 , $392.32 , $334.04 , $420.97 , $468.90 , $441.08 , $468.90 , $468.90 , $468.90 , $442.85 , $327.49 , $481.04 , $494.95 , $442.85 , $484.53 , $484.53 , $494.95 , $500.16 , $426.28 , $468.90 , $442.85 , $411.59 , N/A , $421.65 , $421.65 , $494.95 , $447.07 , $327.49 , $500.16 
X-Ray Spine One View,CPT® 72020,N/A,N/A,N/A, $301.00 , $195.65 , $137.29 , $24.13 , $22.94 , $103.05 , $124.00 , $279.93 , $270.90 , $270.90 , $240.80 , $240.80 , $22.94 , $277.91 , $285.95 , $270.90 , $270.90 , $270.90 , $279.93 , $288.96 , $134.89 , $255.85 , $136.75 , $111.74 , N/A , $105.06 , $105.06 , $285.95 , $121.62 , $22.94 , $288.96 
Non Coring Needle or Stylet,HCPCS A4212,N/A,N/A,N/A, $23.00 , $14.95 , N/A , N/A , N/A , N/A , N/A , $21.39 , $20.70 , $20.70 , $18.40 , $18.40 , N/A , $21.24 , $21.85 , $20.70 , $20.70 , $20.70 , $21.39 , $22.08 , N/A , $19.55 , $11.03 , $6.42 , N/A , N/A , N/A , $21.85 , N/A , $6.42 , $22.08 
"Post Capsular Release,Knee",CPT® 27435,N/A,N/A,N/A," $6,485.00 "," $4,215.25 "," $4,901.46 ", $773.19 , $768.38 ," $3,890.20 "," $3,893.80 "," $6,031.05 "," $5,836.50 "," $5,836.50 "," $5,188.00 "," $5,188.00 ", $768.38 ," $5,987.60 "," $6,160.75 "," $5,836.50 "," $5,836.50 "," $5,836.50 "," $6,031.05 "," $6,225.60 "," $4,583.03 "," $5,512.25 "," $4,299.59 "," $4,592.78 ", N/A ," $3,966.10 "," $3,966.10 "," $6,160.75 "," $4,661.59 ", $768.38 ," $6,225.60 "
 Fac Assay of Magnesium ,CPT® 83735,0301 - LAB/CHEMISTRY,N/A,N/A, $80.00 , $52.00 , $67.20 , $6.83 , $6.83 , $64.64 , $72.00 , $67.73 , $72.00 , $72.00 , $72.00 , $68.00 , $6.70 , $73.86 , $76.00 , $68.00 , $74.40 , $74.40 , $76.00 , $76.80 , $65.46 , $72.00 , $68.00 , $63.20 , N/A , $64.74 , $64.74 , $76.00 , $68.65 , $6.70 , $76.80 
 PHENYLEPHRINE HCL 0.25 % NA SOLN ,HCPCS RXC637,0250 - PHARMACY,00225-0800-47,15 mL, $20.12 , $13.08 , $16.90 , N/A , N/A , $16.26 , $18.11 , $17.03 , $18.11 , $18.11 , $18.11 , $17.10 , N/A , $18.58 , $19.11 , $17.10 , $18.71 , $18.71 , $19.11 , $19.32 , $16.46 , $18.11 , $17.10 , $15.89 , N/A , $16.28 , $16.28 , $19.11 , $17.26 , $15.89 , $19.32 
Assay for Phencyclidine,CPT® 83992,N/A,N/A,N/A, $155.00 , $100.75 , N/A , N/A , $20.40 , $83.15 , $99.45 , $144.15 , $139.50 , $139.50 , $124.00 , $124.00 , $20.40 , $143.11 , $147.25 , $139.50 , $139.50 , $139.50 , $144.15 , $148.80 , N/A , $131.75 , $95.69 , $121.42 , N/A , $77.60 , $77.60 , $147.25 , $84.80 , $20.40 , $148.80 
 C Spine MRI Without & With Contrast ,CPT® 72156,0612 - MRI - SPINE,N/A,N/A," $6,557.00 "," $4,262.05 "," $5,507.88 ", $329.13 , $655.99 ," $5,298.06 "," $5,901.30 "," $5,551.16 "," $5,901.30 "," $5,901.30 "," $5,901.30 "," $5,573.45 ", $643.13 ," $6,054.08 "," $6,229.15 "," $5,573.45 "," $6,098.01 "," $6,098.01 "," $6,229.15 "," $6,294.72 "," $5,364.94 "," $5,901.30 "," $5,573.45 "," $5,180.03 ", N/A ," $5,306.58 "," $5,306.58 "," $6,229.15 "," $5,626.56 ", $329.13 ," $6,294.72 "
" Fac MRI, Face, Neck W/Contrast ",CPT® 70542,0611 - MRI - BRAIN/HEAD/NECK,N/A,N/A," $4,660.00 "," $3,029.00 "," $3,914.40 ", $276.76 , $497.69 ," $3,765.28 "," $4,194.00 "," $3,945.16 "," $4,194.00 "," $4,194.00 "," $4,194.00 "," $3,961.00 ", $487.93 ," $4,302.58 "," $4,427.00 "," $3,961.00 "," $4,333.80 "," $4,333.80 "," $4,427.00 "," $4,473.60 "," $3,812.81 "," $4,194.00 "," $3,961.00 "," $3,681.40 ", N/A ," $3,771.34 "," $3,771.34 "," $4,427.00 "," $3,998.75 ", $276.76 ," $4,473.60 "
Office/Outpatient Established Low Mdm 20-29 Min,99213,N/A,N/A,N/A, $197.00 , $128.05 , $134.27 , $64.08 , $41.21 , $87.92 , $87.90 , $183.21 , $177.30 , $177.30 , $157.60 , $157.60 , $41.21 , $181.89 , $187.15 , $177.30 , $177.30 , $177.30 , $183.21 , $189.12 , $122.57 , $167.45 , $109.52 , $112.10 , $64.00 , $89.64 , $89.64 , $187.15 , $103.40 , $41.21 , $189.12 
"Specimen Concentrat, Infect Agents",CPT® 87015,N/A,N/A,N/A, $89.00 , $57.85 , N/A , $6.81 , $5.18 , $21.12 , $25.25 , $82.77 , $80.10 , $80.10 , $71.20 , $71.20 , $5.18 , $82.17 , $84.55 , $80.10 , $80.10 , $80.10 , $82.77 , $85.44 , $44.60 , $75.65 , $43.79 , $24.20 , N/A , $19.71 , $19.71 , $84.55 , $21.54 , $5.18 , $85.44 
Laparoscopy Total Hysterectomy Uterus > 250 G,CPT® 58572,N/A,N/A,N/A," $6,937.00 "," $4,509.05 "," $4,879.40 ", $987.20 , $812.48 ," $4,543.61 "," $4,692.92 "," $6,451.41 "," $6,243.30 "," $6,243.30 "," $5,549.60 "," $5,549.60 ", $812.48 ," $6,404.93 "," $6,590.15 "," $6,243.30 "," $6,243.30 "," $6,243.30 "," $6,451.41 "," $6,659.52 "," $5,096.64 "," $5,896.45 "," $6,176.43 "," $4,170.81 ", N/A ," $4,632.26 "," $4,632.26 "," $6,590.15 "," $5,556.13 ", $812.48 ," $6,659.52 "
Arthroplasty Patella,CPT® 27437,N/A,N/A,N/A," $4,208.00 "," $2,735.20 "," $4,023.57 ", $631.94 ," $1,237.16 "," $3,185.23 "," $3,166.81 "," $3,913.44 "," $3,787.20 "," $3,787.20 "," $3,366.40 "," $3,366.40 "," $1,237.16 "," $3,885.25 "," $3,997.60 "," $3,787.20 "," $3,787.20 "," $3,787.20 "," $3,913.44 "," $4,039.68 "," $3,744.04 "," $3,576.80 "," $3,498.55 "," $3,751.88 ", N/A ," $3,247.38 "," $3,247.38 "," $3,997.60 "," $3,816.84 ", $631.94 ," $4,039.68 "
"Placental Alpha Microglobulin,Cervicovaginal Qualitative",CPT® 84112,N/A,N/A,N/A, $594.00 , $386.10 , N/A , $100.07 , $89.40 , $364.40 , $435.92 , $552.42 , $534.60 , $534.60 , $475.20 , $475.20 , $89.40 , $548.44 , $564.30 , $534.60 , $534.60 , $534.60 , $552.42 , $570.24 , $655.10 , $504.90 , $421.68 , $288.15 , N/A , $340.08 , $340.08 , $564.30 , $371.64 , $89.40 , $655.10 
 Fac Prothrombin Tm ,CPT® 85610,0300 - LABORATORY,N/A,N/A, $69.00 , $44.85 , $57.96 , $4.38 , $4.38 , $55.75 , $62.10 , $58.42 , $62.10 , $62.10 , $62.10 , $58.65 , $4.29 , $63.71 , $65.55 , $58.65 , $64.17 , $64.17 , $65.55 , $66.24 , $56.46 , $62.10 , $58.65 , $54.51 , N/A , $55.84 , $55.84 , $65.55 , $59.21 , $4.29 , $66.24 
Urinary Leg Bag,HCPCS A5112,N/A,N/A,N/A, $83.00 , $53.95 , N/A , $46.12 , $28.50 , N/A , N/A , $77.19 , $74.70 , $74.70 , $66.40 , $66.40 , $28.50 , $76.63 , $78.85 , $74.70 , $74.70 , $74.70 , $77.19 , $79.68 , N/A , $70.55 , $40.87 , $41.91 , N/A , N/A , N/A , $78.85 , N/A , $28.50 , $79.68 
Radiologic Exam Abdomen 1 View,CPT® 74018,N/A,N/A,N/A, $286.00 , $185.90 , $169.65 , $29.43 , $21.43 , $122.30 , $136.70 , $265.98 , $257.40 , $257.40 , $228.80 , $228.80 , $21.43 , $264.06 , $271.70 , $257.40 , $257.40 , $257.40 , $265.98 , $274.56 , $163.37 , $243.10 , $172.65 , $137.06 , N/A , $124.69 , $124.69 , $271.70 , $144.32 , $21.43 , $274.56 
 Fac Tiss Cul Neo Disorders B1 Marrow Bld Cells ,CPT® 88237,0310 - PATHOLOGY LAB,N/A,N/A," $1,445.00 ", $939.25 ," $1,213.80 ", $146.63 , $69.14 ," $1,167.56 "," $1,300.50 "," $1,223.34 "," $1,300.50 "," $1,300.50 "," $1,300.50 "," $1,228.25 ", $67.78 ," $1,334.17 "," $1,372.75 "," $1,228.25 "," $1,343.85 "," $1,343.85 "," $1,372.75 "," $1,387.20 "," $1,182.30 "," $1,300.50 "," $1,228.25 "," $1,141.55 ", N/A ," $1,169.44 "," $1,169.44 "," $1,372.75 "," $1,239.95 ", $67.78 ," $1,387.20 "
 LEUCOVORIN CALCIUM 50 MG IJ SOLR ,HCPCS J0640,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9555-01,5 mL, $61.65 , $40.07 , $51.79 , $4.79 , $3.67 , $49.81 , $55.49 , $52.19 , $55.49 , $55.49 , $55.49 , $52.40 , $3.60 , $56.92 , $58.57 , $52.40 , $57.33 , $57.33 , $58.57 , $59.18 , $50.44 , $55.49 , $52.40 , $48.70 , N/A , $49.89 , $49.89 , $58.57 , $52.90 , $3.60 , $59.18 
 FLUTICASONE PROPIONATE (INHAL) 100 MCG/ACT INH AEPB ,HCPCS RXC637,0250 - PHARMACY,00173-0602-02,60 each, $601.45 , $390.94 , $505.22 , N/A , N/A , $485.97 , $541.31 , $509.19 , $541.31 , $541.31 , $541.31 , $511.23 , N/A , $555.32 , $571.38 , $511.23 , $559.35 , $559.35 , $571.38 , $577.39 , $492.11 , $541.31 , $511.23 , $475.15 , N/A , $486.75 , $486.75 , $571.38 , $516.10 , $475.15 , $577.39 
 Pro Fluoro Guide Localization Needle Tip-Mh ,CPT® 77003,0972 - PRO FEE/RAD/DX,N/A,N/A, $382.00 , $248.30 , $597.98 , $104.36 , $58.09 , $406.50 , $492.04 , $355.26 , $343.80 , $343.80 , $305.60 , $305.60 , $58.09 , $352.70 , $362.90 , $343.80 , $343.80 , $343.80 , $355.26 , $366.72 , $578.77 , $324.70 , $543.14 , $478.37 , N/A , $414.43 , $414.43 , $362.90 , $479.72 , $58.09 , $597.98 
Open Rx Rad/Ulna Shaft Fx+Fix Both,CPT® 25575,N/A,N/A,N/A," $5,916.00 "," $3,845.40 "," $5,497.12 ", $862.51 , $768.38 ," $4,339.20 "," $4,318.83 "," $5,501.88 "," $5,324.40 "," $5,324.40 "," $4,732.80 "," $4,732.80 ", $768.38 ," $5,462.24 "," $5,620.20 "," $5,324.40 "," $5,324.40 "," $5,324.40 "," $5,501.88 "," $5,679.36 "," $5,113.07 "," $5,028.60 "," $4,765.24 "," $5,119.25 ", N/A ," $4,423.87 "," $4,423.87 "," $5,620.20 "," $5,199.62 ", $768.38 ," $5,679.36 "
 Pro Removal of Pilonidal Lesion ,CPT® 11770,0982 - PRO FEE/OUTPT,N/A,N/A," $2,166.00 "," $1,407.90 ", $585.48 , $173.87 , $218.61 , $497.89 , $486.86 ," $2,014.38 "," $1,949.40 "," $1,949.40 "," $1,732.80 "," $1,732.80 ", $218.61 ," $1,999.87 "," $2,057.70 "," $1,949.40 "," $1,949.40 "," $1,949.40 "," $2,014.38 "," $2,079.36 ", $641.69 ," $1,841.10 ", $979.45 , $633.57 , N/A , $507.60 , $507.60 ," $2,057.70 ", $588.65 , $173.87 ," $2,079.36 "
"Repair Femoral Hernia,Strang",CPT® 49553,N/A,N/A,N/A," $4,200.00 "," $2,730.00 "," $3,788.79 ", $587.40 , $630.39 ," $2,961.23 "," $3,003.41 "," $3,906.00 "," $3,780.00 "," $3,780.00 "," $3,360.00 "," $3,360.00 ", $630.39 ," $3,877.86 "," $3,990.00 "," $3,780.00 "," $3,780.00 "," $3,780.00 "," $3,906.00 "," $4,032.00 "," $2,707.11 "," $3,570.00 "," $3,336.20 "," $3,500.00 ", N/A ," $3,019.02 "," $3,019.02 "," $3,990.00 "," $3,157.56 ", $587.40 ," $4,032.00 "
" Complex Repair Eyelids,Nose,Ears,Lips 1.1-2.5cm ",CPT® 13151,0981 - PRO FEE/ER,N/A,N/A," $1,815.00 "," $1,179.75 ", $891.21 , $266.54 , $211.00 , $786.73 , $767.55 ," $1,687.95 "," $1,633.50 "," $1,633.50 "," $1,452.00 "," $1,452.00 ", $211.00 ," $1,675.79 "," $1,724.25 "," $1,633.50 "," $1,633.50 "," $1,633.50 "," $1,687.95 "," $1,742.40 ", $981.32 ," $1,542.75 "," $1,528.94 "," $1,006.77 ", N/A , $802.09 , $802.09 ," $1,724.25 ", $930.16 , $211.00 ," $1,742.40 "
Assay Serum Albumin,CPT® 82040,N/A,N/A,N/A, $62.00 , $40.30 , N/A , $5.05 , $5.05 , $27.98 , $33.48 , $57.66 , $55.80 , $55.80 , $49.60 , $49.60 , $5.05 , $57.24 , $58.90 , $55.80 , $55.80 , $55.80 , $57.66 , $59.52 , $33.05 , $52.70 , $32.44 , $17.95 , N/A , $26.11 , $26.11 , $58.90 , $28.54 , $5.05 , $59.52 
 EPINEPHRINE 30 MG/30 ML INJECTION (INPT) ,HCPCS J0171,0636 - DRUGS REQUIRING DETAILED CODIN,42023-0168-01,0.2 mL, $16.68 , $10.84 , $14.01 , $0.74 , $0.75 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.74 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.74 , $16.01 
 Fac Halopridol ,CPT® 80173,0301 - LAB/CHEMISTRY,N/A,N/A, $73.00 , $47.45 , $61.32 , $16.10 , $16.10 , $58.98 , $65.70 , $61.80 , $65.70 , $65.70 , $65.70 , $62.05 , $15.78 , $67.40 , $69.35 , $62.05 , $67.89 , $67.89 , $69.35 , $70.08 , $59.73 , $65.70 , $62.05 , $57.67 , N/A , $59.08 , $59.08 , $69.35 , $62.64 , $15.78 , $70.08 
 PRIMIDONE 250 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,53746-0545-01,1 tablet, $5.12 , $3.33 , $4.30 , N/A , N/A , $4.14 , $4.61 , $4.33 , $4.61 , $4.61 , $4.61 , $4.35 , N/A , $4.73 , $4.86 , $4.35 , $4.76 , $4.76 , $4.86 , $4.92 , $4.19 , $4.61 , $4.35 , $4.04 , N/A , $4.14 , $4.14 , $4.86 , $4.39 , $4.04 , $4.92 
Immunfix E-Phorsis/Urine/CSF,CPT® 86335,N/A,N/A,N/A, $270.00 , $175.50 , N/A , $29.94 , $29.94 , $166.05 , $198.62 , $251.10 , $243.00 , $243.00 , $216.00 , $216.00 , $29.94 , $249.29 , $256.50 , $243.00 , $243.00 , $243.00 , $251.10 , $259.20 , $195.98 , $229.50 , $288.69 , $106.41 , N/A , $154.97 , $154.97 , $256.50 , $169.35 , $29.94 , $288.69 
 Pro Psychotherapy W/Patient W/E&M Srvcs 60 Min ,CPT® 90838,0916 - PSYCH/FAMILY RX,N/A,N/A, $445.00 , $289.25 , $373.80 , $103.04 , $133.44 , $359.56 , $400.50 , $376.74 , $400.50 , $400.50 , $400.50 , $378.25 , $130.82 , $410.87 , $422.75 , $378.25 , $413.85 , $413.85 , $422.75 , $427.20 , $364.10 , $400.50 , $378.25 , $351.55 , N/A , $360.14 , $360.14 , $422.75 , $381.85 , $103.04 , $427.20 
 TORSEMIDE 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,31722-0530-01,1 tablet, $3.62 , $2.35 , $3.04 , N/A , N/A , $2.92 , $3.26 , $3.06 , $3.26 , $3.26 , $3.26 , $3.08 , N/A , $3.34 , $3.44 , $3.08 , $3.37 , $3.37 , $3.44 , $3.48 , $2.96 , $3.26 , $3.08 , $2.86 , N/A , $2.93 , $2.93 , $3.44 , $3.11 , $2.86 , $3.48 
Mast Rad W/Pectoral Musc Ax Lymph Nod,CPT® 19305,N/A,N/A,N/A," $5,108.00 "," $3,320.20 "," $3,591.73 "," $1,068.51 ", $806.22 ," $3,029.99 "," $2,948.43 "," $4,750.44 "," $4,597.20 "," $4,597.20 "," $4,086.40 "," $4,086.40 ", $806.22 ," $4,716.22 "," $4,852.60 "," $4,597.20 "," $4,597.20 "," $4,597.20 "," $4,750.44 "," $4,903.68 "," $3,917.72 "," $4,341.80 "," $5,958.77 "," $3,837.78 ", N/A ," $3,089.11 "," $3,089.11 "," $4,852.60 "," $3,582.32 ", $806.22 ," $5,958.77 "
"Shav Skin Les >21mm Trunk,Arm,Leg",11303,N/A,N/A,N/A, $590.00 , $383.50 , $227.73 , $68.04 , $115.78 , $203.77 , $196.36 , $548.70 , $531.00 , $531.00 , $472.00 , $472.00 , $115.78 , $544.75 , $560.50 , $531.00 , $531.00 , $531.00 , $548.70 , $566.40 , $251.56 , $501.50 , $392.49 , $259.98 , N/A , $207.74 , $207.74 , $560.50 , $240.90 , $68.04 , $566.40 
"Incision Subcut Toe Tendon,>1",CPT® 28011,N/A,N/A,N/A," $1,920.00 "," $1,248.00 "," $1,737.39 ", $271.81 , $115.24 ," $1,418.22 "," $1,427.92 "," $1,785.60 "," $1,728.00 "," $1,728.00 "," $1,536.00 "," $1,536.00 ", $115.24 ," $1,772.74 "," $1,824.00 "," $1,728.00 "," $1,728.00 "," $1,728.00 "," $1,785.60 "," $1,843.20 "," $1,614.71 "," $1,632.00 "," $1,550.35 "," $1,673.75 ", N/A ," $1,445.89 "," $1,445.89 "," $1,824.00 "," $1,699.44 ", $115.24 ," $1,843.20 "
Removal of Elbow Bursa,CPT® 24105,N/A,N/A,N/A," $1,330.00 ", $864.50 ," $2,218.19 ", $350.16 , $307.34 ," $1,687.87 "," $1,703.38 "," $1,236.90 "," $1,197.00 "," $1,197.00 "," $1,064.00 "," $1,064.00 ", $307.34 ," $1,227.99 "," $1,263.50 "," $1,197.00 "," $1,197.00 "," $1,197.00 "," $1,236.90 "," $1,276.80 "," $2,049.06 "," $1,130.50 "," $1,871.48 "," $2,003.84 ", N/A ," $1,720.80 "," $1,720.80 "," $1,263.50 "," $2,022.56 ", $307.34 ," $2,218.19 "
Injection Aa&/Strd Greater Occipital Nerve,64405,N/A,N/A,N/A, $503.00 , $326.95 , $249.86 , $48.34 , $45.90 , $348.30 , $335.31 , $467.79 , $452.70 , $452.70 , $402.40 , $402.40 , $45.90 , $464.42 , $477.85 , $452.70 , $452.70 , $452.70 , $467.79 , $482.88 , $272.99 , $427.55 , $335.40 , $370.40 , N/A , $355.10 , $355.10 , $477.85 , $380.94 , $45.90 , $482.88 
 METOLAZONE 2.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00185-5050-01,1 tablet, $10.65 , $6.92 , $8.95 , N/A , N/A , $8.61 , $9.59 , $9.02 , $9.59 , $9.59 , $9.59 , $9.05 , N/A , $9.83 , $10.12 , $9.05 , $9.90 , $9.90 , $10.12 , $10.22 , $8.71 , $9.59 , $9.05 , $8.41 , N/A , $8.62 , $8.62 , $10.12 , $9.14 , $8.41 , $10.22 
"Blood,Occult,by Peroxid,Feces,1-3 Simult",CPT® 82270,N/A,N/A,N/A, $40.00 , $26.00 , N/A , $4.47 , $3.69 , $18.42 , $22.06 , $37.20 , $36.00 , $36.00 , $32.00 , $32.00 , $3.69 , $36.93 , $38.00 , $36.00 , $36.00 , $36.00 , $37.20 , $38.40 , $29.25 , $34.00 , $21.08 , $12.84 , N/A , $17.19 , $17.19 , $38.00 , $18.78 , $3.69 , $38.40 
Drain Skin Abscess Complic,10061,N/A,N/A,N/A, $834.00 , $542.10 , $590.92 , $177.26 , $93.30 , $490.97 , $481.05 , $775.62 , $750.60 , $750.60 , $667.20 , $667.20 , $93.30 , $770.03 , $792.30 , $750.60 , $750.60 , $750.60 , $775.62 , $800.64 , $644.00 , $708.90 , $950.91 , $632.67 , N/A , $500.54 , $500.54 , $792.30 , $580.46 , $93.30 , $950.91 
 COLLAGENASE 250 UNIT/GM EX OINT ,HCPCS RXC637,0250 - PHARMACY,50484-0010-30,30 gram," $1,775.00 "," $1,153.75 "," $1,491.00 ", N/A , N/A ," $1,434.20 "," $1,597.50 "," $1,502.72 "," $1,597.50 "," $1,597.50 "," $1,597.50 "," $1,508.75 ", N/A ," $1,638.86 "," $1,686.25 "," $1,508.75 "," $1,650.75 "," $1,650.75 "," $1,686.25 "," $1,704.00 "," $1,452.31 "," $1,597.50 "," $1,508.75 "," $1,402.25 ", N/A ," $1,436.51 "," $1,436.51 "," $1,686.25 "," $1,523.13 "," $1,402.25 "," $1,704.00 "
 Fac Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT ,CPT® 78433,0404 - PET POSITIVE EMISSION TOMOGRAP,N/A,N/A," $12,041.00 "," $7,826.65 "," $10,114.44 "," $1,922.12 "," $2,215.97 "," $9,729.13 "," $10,836.90 "," $10,193.91 "," $10,836.90 "," $10,836.90 "," $10,836.90 "," $10,234.85 "," $2,172.52 "," $11,117.46 "," $11,438.95 "," $10,234.85 "," $11,198.13 "," $11,198.13 "," $11,438.95 "," $11,559.36 "," $9,851.95 "," $10,836.90 "," $10,234.85 "," $9,512.39 ", N/A ," $9,744.78 "," $9,744.78 "," $11,438.95 "," $10,332.38 "," $1,922.12 "," $11,559.36 "
Cftr Gene Analysis Common Variants,CPT® 81220,N/A,N/A,N/A, $746.00 , $484.90 , N/A , $567.73 , $214.20 , N/A , N/A , $693.78 , $671.40 , $671.40 , $596.80 , $596.80 , $214.20 , $688.78 , $708.70 , $671.40 , $671.40 , $671.40 , $693.78 , $716.16 ," $3,716.54 ", $634.10 ," $2,654.05 "," $1,634.73 ", N/A ," $2,209.70 "," $2,209.70 ", $708.70 ," $2,410.08 ", $214.20 ," $3,716.54 "
 Pro Treat Fx Distal Radial ,CPT® 25606,0975 - PRO FEE/OR,N/A,N/A," $4,248.00 "," $2,761.20 "," $4,083.11 ", $642.81 , $530.72 ," $3,188.66 "," $3,190.39 "," $3,950.64 "," $3,823.20 "," $3,823.20 "," $3,398.40 "," $3,398.40 ", $530.72 ," $3,922.18 "," $4,035.60 "," $3,823.20 "," $3,823.20 "," $3,823.20 "," $3,950.64 "," $4,078.08 "," $3,783.27 "," $3,610.80 "," $3,514.61 "," $3,771.96 ", N/A ," $3,250.87 "," $3,250.87 "," $4,035.60 "," $3,820.94 ", $530.72 ," $4,083.11 "
Treat Ankle Fracture,27808,N/A,N/A,N/A," $2,205.00 "," $1,433.25 "," $1,908.27 ", $301.59 , $190.55 ," $1,449.98 "," $1,478.68 "," $2,050.65 "," $1,984.50 "," $1,984.50 "," $1,764.00 "," $1,764.00 ", $190.55 ," $2,035.88 "," $2,094.75 "," $1,984.50 "," $1,984.50 "," $1,984.50 "," $2,050.65 "," $2,116.80 "," $1,757.34 "," $1,874.25 "," $1,621.71 "," $1,717.78 ", N/A ," $1,478.27 "," $1,478.27 "," $2,094.75 "," $1,737.49 ", $190.55 ," $2,116.80 "
 Fac Proctosgmdsc Rgd Dx +-Collj Spec Br/Wa Spx ,CPT® 45300,0360 - OR SERVICES,N/A,N/A, $996.00 , $647.40 , $836.64 , $45.70 , $61.84 , $804.77 , $896.40 , $843.21 , $896.40 , $896.40 , $896.40 , $846.60 , $60.63 , $919.61 , $946.20 , $846.60 , $926.28 , $926.28 , $946.20 , $956.16 , $814.93 , $896.40 , $846.60 , $786.84 , N/A , $806.06 , $806.06 , $946.20 , $854.67 , $45.70 , $956.16 
"Dtap-Hib-Ipv Vaccine, Im",CPT® 90698,N/A,N/A,N/A, $235.00 , $152.75 , N/A , N/A , $15.30 , $166.82 , $173.93 , $218.55 , $211.50 , $211.50 , $188.00 , $188.00 , $15.30 , $216.98 , $223.25 , $211.50 , $211.50 , $211.50 , $218.55 , $225.60 , N/A , $199.75 , $231.13 , $174.45 , N/A , $170.08 , $170.08 , $223.25 , $198.27 , $15.30 , $231.13 
Eye Exam Established Pt,CPT® 92012,N/A,N/A,N/A, $264.00 , $171.60 , $110.70 , $49.63 , $30.59 , $93.38 , $93.76 , $245.52 , $237.60 , $237.60 , $211.20 , $211.20 , $30.59 , $243.75 , $250.80 , $237.60 , $237.60 , $237.60 , $245.52 , $253.44 , $144.13 , $224.40 , $158.14 , $112.11 , N/A , $95.20 , $95.20 , $250.80 , $113.26 , $30.59 , $253.44 
 Pro Smpl Rpr Supfc S/N/Ax/G/T 12.6cm-20.0cm ,CPT® 12005,0982 - PRO FEE/OUTPT,N/A,N/A, $896.00 , $582.40 , $295.26 , $87.55 , $142.50 , $269.43 , $261.25 , $833.28 , $806.40 , $806.40 , $716.80 , $716.80 , $142.50 , $827.28 , $851.20 , $806.40 , $806.40 , $806.40 , $833.28 , $860.16 , $326.46 , $761.60 , $524.51 , $329.30 , N/A , $274.68 , $274.68 , $851.20 , $318.54 , $87.55 , $860.16 
Inj Dobutamine Hcl/250 Mg,HCPCS J1250,N/A,N/A,N/A, $34.00 , $22.10 , N/A , $9.01 , $7.11 , N/A , N/A , $31.62 , $30.60 , $30.60 , $27.20 , $27.20 , $7.11 , $31.39 , $32.30 , $30.60 , $30.60 , $30.60 , $31.62 , $32.64 , $9.05 , $28.90 , $10.38 , $8.53 , N/A , N/A , N/A , $32.30 , N/A , $7.11 , $32.64 
 Fac Laps Surg W/Aspir Cavity/Cst 1/Mlt ,CPT® 49322,0361 - OR/MINOR,N/A,N/A," $1,478.00 ", $960.70 ," $1,241.52 ", $349.25 , $324.81 ," $1,194.22 "," $1,330.20 "," $1,251.27 "," $1,330.20 "," $1,330.20 "," $1,330.20 "," $1,256.30 ", $318.44 ," $1,364.64 "," $1,404.10 "," $1,256.30 "," $1,374.54 "," $1,374.54 "," $1,404.10 "," $1,418.88 "," $1,209.30 "," $1,330.20 "," $1,256.30 "," $1,167.62 ", N/A ," $1,196.15 "," $1,196.15 "," $1,404.10 "," $1,268.27 ", $318.44 ," $1,418.88 "
 Pro Removal of Nail Plate ,CPT® 11730,0982 - PRO FEE/OUTPT,N/A,N/A, $385.00 , $250.25 , $174.35 , $51.83 , $42.84 , $140.67 , $134.38 , $358.05 , $346.50 , $346.50 , $308.00 , $308.00 , $42.84 , $355.47 , $365.75 , $346.50 , $346.50 , $346.50 , $358.05 , $369.60 , $192.28 , $327.25 , $262.26 , $198.13 , N/A , $143.42 , $143.42 , $365.75 , $166.31 , $42.84 , $369.60 
"Alpha-Fetoprotein, Serum",CPT® 82105,N/A,N/A,N/A, $190.00 , $123.50 , N/A , $17.11 , $17.11 , $94.91 , $113.53 , $176.70 , $171.00 , $171.00 , $152.00 , $152.00 , $17.11 , $175.43 , $180.50 , $171.00 , $171.00 , $171.00 , $176.70 , $182.40 , $111.98 , $161.50 , $110.29 , $60.83 , N/A , $88.58 , $88.58 , $180.50 , $96.80 , $17.11 , $182.40 
 Pro Treatment of Tibia Fracture ,CPT® 27750,0975 - PRO FEE/OR,N/A,N/A," $2,288.00 "," $1,487.20 "," $2,003.43 ", $317.27 , $156.40 ," $1,532.38 "," $1,554.50 "," $2,127.84 "," $2,059.20 "," $2,059.20 "," $1,830.40 "," $1,830.40 ", $156.40 ," $2,112.51 "," $2,173.60 "," $2,059.20 "," $2,059.20 "," $2,059.20 "," $2,127.84 "," $2,196.48 "," $1,847.67 "," $1,944.80 "," $1,707.35 "," $1,815.91 ", N/A ," $1,562.28 "," $1,562.28 "," $2,173.60 "," $1,836.23 ", $156.40 ," $2,196.48 "
Treat Phalangeal Fracture,CPT® 26750,N/A,N/A,N/A," $1,206.00 ", $783.90 ," $1,175.53 ", $187.84 , $59.10 , $887.15 , $909.28 ," $1,121.58 "," $1,085.40 "," $1,085.40 ", $964.80 , $964.80 , $59.10 ," $1,113.50 "," $1,145.70 "," $1,085.40 "," $1,085.40 "," $1,085.40 "," $1,121.58 "," $1,157.76 "," $1,079.00 "," $1,025.10 ", $995.51 ," $1,062.31 ", N/A , $904.46 , $904.46 ," $1,145.70 "," $1,063.07 ", $59.10 ," $1,175.53 "
Stab Phlebotomy Veins-Extrem 1-20,CPT® 37765,N/A,N/A,N/A," $4,167.00 "," $2,708.55 "," $1,598.87 ", $246.37 , $460.89 ," $1,951.15 "," $1,952.07 "," $3,875.31 "," $3,750.30 "," $3,750.30 "," $3,333.60 "," $3,333.60 ", $460.89 ," $3,847.39 "," $3,958.65 "," $3,750.30 "," $3,750.30 "," $3,750.30 "," $3,875.31 "," $4,000.32 "," $1,474.08 "," $3,541.95 "," $2,442.38 "," $2,180.01 ", N/A ," $1,989.23 "," $1,989.23 "," $3,958.65 "," $2,259.73 ", $246.37 ," $4,000.32 "
Debridement-Skin & Tissue,11042,N/A,N/A,N/A, $502.00 , $326.30 , $192.85 , $57.23 , $63.58 , $169.46 , $164.75 , $466.86 , $451.80 , $451.80 , $401.60 , $401.60 , $63.58 , $463.50 , $476.90 , $451.80 , $451.80 , $451.80 , $466.86 , $481.92 , $211.84 , $426.70 , $326.48 , $218.43 , N/A , $172.76 , $172.76 , $476.90 , $200.35 , $57.23 , $481.92 
 LAMOTRIGINE 150 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,68382-0009-14,1 tablet, $29.25 , $19.01 , $24.57 , N/A , N/A , $23.63 , $26.33 , $24.76 , $26.33 , $26.33 , $26.33 , $24.86 , N/A , $27.01 , $27.79 , $24.86 , $27.20 , $27.20 , $27.79 , $28.08 , $23.93 , $26.33 , $24.86 , $23.11 , N/A , $23.67 , $23.67 , $27.79 , $25.10 , $23.11 , $28.08 
Laps Total Hysterectomy 250 G/< W Tube/Ovary,CPT® 58571,N/A,N/A,N/A," $6,179.00 "," $4,016.35 "," $4,274.80 ", $864.79 , $718.13 ," $4,110.90 "," $4,210.54 "," $5,746.47 "," $5,561.10 "," $5,561.10 "," $4,943.20 "," $4,943.20 ", $718.13 ," $5,705.07 "," $5,870.05 "," $5,561.10 "," $5,561.10 "," $5,561.10 "," $5,746.47 "," $5,931.84 "," $4,449.41 "," $5,252.15 "," $5,539.52 "," $3,629.53 ", N/A ," $4,191.11 "," $4,191.11 "," $5,870.05 "," $5,026.98 ", $718.13 ," $5,931.84 "
 VALACYCLOVIR HCL 500 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,59746-0324-30,1 tablet, $37.11 , $24.12 , $31.17 , N/A , N/A , $29.98 , $33.40 , $31.42 , $33.40 , $33.40 , $33.40 , $31.54 , N/A , $34.26 , $35.25 , $31.54 , $34.51 , $34.51 , $35.25 , $35.63 , $30.36 , $33.40 , $31.54 , $29.32 , N/A , $30.03 , $30.03 , $35.25 , $31.84 , $29.32 , $35.63 
 Fac Assay of Urine/Uric Acid ,CPT® 84560,0301 - LAB/CHEMISTRY,N/A,N/A, $68.00 , $44.20 , $57.12 , $5.18 , $5.18 , $54.94 , $61.20 , $57.57 , $61.20 , $61.20 , $61.20 , $57.80 , $5.08 , $62.78 , $64.60 , $57.80 , $63.24 , $63.24 , $64.60 , $65.28 , $55.64 , $61.20 , $57.80 , $53.72 , N/A , $55.03 , $55.03 , $64.60 , $58.35 , $5.08 , $65.28 
" Pro Destruct Lesion, 15 or More ",CPT® 17111,0982 - PRO FEE/OUTPT,N/A,N/A, $708.00 , $460.20 , $193.25 , $79.93 , $55.78 , $233.67 , $232.11 , $658.44 , $637.20 , $637.20 , $566.40 , $566.40 , $55.78 , $653.70 , $672.60 , $637.20 , $637.20 , $637.20 , $658.44 , $679.68 , $287.04 , $601.80 , $458.50 , $302.36 , N/A , $238.23 , $238.23 , $672.60 , $276.29 , $55.78 , $679.68 
"Destr, Benign Lesions, 15 or More",CPT® 17111,N/A,N/A,N/A, $708.00 , $460.20 , $193.25 , $79.93 , $55.78 , $233.67 , $232.11 , $658.44 , $637.20 , $637.20 , $566.40 , $566.40 , $55.78 , $653.70 , $672.60 , $637.20 , $637.20 , $637.20 , $658.44 , $679.68 , $287.04 , $601.80 , $458.50 , $302.36 , N/A , $238.23 , $238.23 , $672.60 , $276.29 , $55.78 , $679.68 
"Finger Splint, Static",HCPCS Q4049,N/A,N/A,N/A, $29.00 , $18.85 , N/A , $2.55 , $1.57 , N/A , N/A , $26.97 , $26.10 , $26.10 , $23.20 , $23.20 , $1.57 , $26.78 , $27.55 , $26.10 , $26.10 , $26.10 , $26.97 , $27.84 , N/A , $24.65 , $3.88 , $2.32 , N/A , N/A , N/A , $27.55 , N/A , $1.57 , $27.84 
"Closed Rx Trimalleolar Fx,Manip",27818,N/A,N/A,N/A," $3,206.00 "," $2,083.90 "," $2,689.44 ", $425.99 , $461.04 ," $2,091.91 "," $2,115.33 "," $2,981.58 "," $2,885.40 "," $2,885.40 "," $2,564.80 "," $2,564.80 ", $461.04 ," $2,960.10 "," $3,045.70 "," $2,885.40 "," $2,885.40 "," $2,885.40 "," $2,981.58 "," $3,077.76 "," $2,482.99 "," $2,725.10 "," $2,326.42 "," $2,473.59 ", N/A ," $2,132.73 "," $2,132.73 "," $3,045.70 "," $2,506.70 ", $425.99 ," $3,077.76 "
Toxoplasma,CPT® 86777,N/A,N/A,N/A, $133.00 , $86.45 , N/A , $14.68 , $14.68 , $81.40 , $97.43 , $123.69 , $119.70 , $119.70 , $106.40 , $106.40 , $14.68 , $122.80 , $126.35 , $119.70 , $119.70 , $119.70 , $123.69 , $127.68 , $96.09 , $113.05 , $94.07 , $52.19 , N/A , $75.97 , $75.97 , $126.35 , $83.02 , $14.68 , $127.68 
 Pro Fp Removal/Corneal ,CPT® 65222,0982 - PRO FEE/OUTPT,N/A,N/A, $250.00 , $162.50 , $313.04 , $48.84 , $48.12 , $297.31 , $278.46 , $232.50 , $225.00 , $225.00 , $200.00 , $200.00 , $48.12 , $230.83 , $237.50 , $225.00 , $225.00 , $225.00 , $232.50 , $240.00 , $433.67 , $212.50 , $287.23 , $377.49 , N/A , $303.11 , $303.11 , $237.50 , $334.61 , $48.12 , $433.67 
Spacer With Mask,HCPCS S8101,N/A,N/A,N/A, $46.00 , $29.90 , N/A , N/A , $48.89 , N/A , N/A , $42.78 , $41.40 , $41.40 , $36.80 , $36.80 , $48.89 , $42.47 , $43.70 , $41.40 , $41.40 , $41.40 , $42.78 , $44.16 , N/A , $39.10 , $36.80 , N/A , N/A , N/A , N/A , $43.70 , N/A , $36.80 , $48.89 
"Post Colporrhaphy,Rectum/Vagina",57250,N/A,N/A,N/A," $4,028.00 "," $2,618.20 "," $2,917.65 ", $589.72 , $461.04 ," $2,754.11 "," $2,747.30 "," $3,746.04 "," $3,625.20 "," $3,625.20 "," $3,222.40 "," $3,222.40 ", $461.04 ," $3,719.05 "," $3,826.60 "," $3,625.20 "," $3,625.20 "," $3,625.20 "," $3,746.04 "," $3,866.88 "," $3,032.93 "," $3,423.80 "," $3,605.59 "," $2,437.43 ", N/A ," $2,807.84 "," $2,807.84 "," $3,826.60 "," $3,367.85 ", $461.04 ," $3,866.88 "
"Blood Typing, Rh (D)",CPT® 86901,N/A,N/A,N/A, $59.00 , $38.35 , N/A , $3.05 , $3.05 , $15.50 , $18.56 , $54.87 , $53.10 , $53.10 , $47.20 , $47.20 , $3.05 , $54.47 , $56.05 , $53.10 , $53.10 , $53.10 , $54.87 , $56.64 , $19.96 , $50.15 , $19.46 , $10.84 , N/A , $14.47 , $14.47 , $56.05 , $15.82 , $3.05 , $56.64 
Cystourethroscopy,52000,N/A,N/A,N/A," $1,443.00 ", $937.95 , $433.72 , $75.96 , $144.34 , $616.56 , $575.66 ," $1,341.99 "," $1,298.70 "," $1,298.70 "," $1,154.40 "," $1,154.40 ", $144.34 ," $1,332.32 "," $1,370.85 "," $1,298.70 "," $1,298.70 "," $1,298.70 "," $1,341.99 "," $1,385.28 ", $434.80 ," $1,226.55 ", $652.97 , $504.56 , N/A , $628.59 , $628.59 ," $1,370.85 ", $738.81 , $75.96 ," $1,385.28 "
 CT Extremity Upper Without Contrast ,CPT® 73200,0350 - CT SCAN,N/A,N/A," $2,596.00 "," $1,687.40 "," $2,180.64 ", $150.37 , $242.16 ," $2,097.57 "," $2,336.40 "," $2,197.77 "," $2,336.40 "," $2,336.40 "," $2,336.40 "," $2,206.60 ", $237.41 ," $2,396.89 "," $2,466.20 "," $2,206.60 "," $2,414.28 "," $2,414.28 "," $2,466.20 "," $2,492.16 "," $2,124.05 "," $2,336.40 "," $2,206.60 "," $2,050.84 ", N/A ," $2,100.94 "," $2,100.94 "," $2,466.20 "," $2,227.63 ", $150.37 ," $2,492.16 "
 Fac Amb Ift 911 Base Rate Als Emergent ,HCPCS A0427,0540 - AMBULANCE,N/A,N/A," $3,100.00 "," $2,015.00 "," $2,604.00 ", N/A , $409.08 ," $2,504.80 "," $2,790.00 "," $2,624.46 "," $2,790.00 "," $2,790.00 "," $2,790.00 "," $2,635.00 ", $401.06 ," $2,862.23 "," $2,945.00 "," $2,635.00 "," $2,883.00 "," $2,883.00 "," $2,945.00 "," $2,976.00 "," $2,536.42 "," $2,790.00 "," $2,635.00 "," $2,449.00 ", N/A ," $2,508.83 "," $2,508.83 "," $2,945.00 "," $2,660.11 ", $401.06 ," $2,976.00 "
"Cystoscopy,Tx Intrarenal Stricture",CPT® 52343,N/A,N/A,N/A," $2,438.00 "," $1,584.70 "," $1,843.57 ", $323.85 , $372.95 ," $1,690.73 "," $1,588.42 "," $2,267.34 "," $2,194.20 "," $2,194.20 "," $1,950.40 "," $1,950.40 ", $372.95 ," $2,251.01 "," $2,316.10 "," $2,194.20 "," $2,194.20 "," $2,194.20 "," $2,267.34 "," $2,340.48 "," $1,853.27 "," $2,072.30 "," $1,800.12 "," $2,120.36 ", N/A ," $1,723.73 "," $1,723.73 "," $2,316.10 "," $2,025.99 ", $323.85 ," $2,340.48 "
 Fac Njx Anes Sphenopalatine Ganglion ,CPT® 64505,0761 - TREATMENT ROOM,N/A,N/A, $868.00 , $564.20 , $729.12 , $96.56 , $76.84 , $701.34 , $781.20 , $734.85 , $781.20 , $781.20 , $781.20 , $737.80 , $75.33 , $801.42 , $824.60 , $737.80 , $807.24 , $807.24 , $824.60 , $833.28 , $710.20 , $781.20 , $737.80 , $685.72 , N/A , $702.47 , $702.47 , $824.60 , $744.83 , $75.33 , $833.28 
 Pro Exc Tum/Vasc Malfrmj Soft Tiss Hand/Fngr Dp ,CPT® 26116,0975 - PRO FEE/OR,N/A,N/A," $4,602.00 "," $2,991.30 "," $3,213.93 ", $506.16 , $286.14 ," $2,537.04 "," $2,534.12 "," $4,279.86 "," $4,141.80 "," $4,141.80 "," $3,681.60 "," $3,681.60 ", $286.14 ," $4,249.03 "," $4,371.90 "," $4,141.80 "," $4,141.80 "," $4,141.80 "," $4,279.86 "," $4,417.92 "," $2,989.89 "," $3,911.70 "," $2,784.92 "," $3,015.20 ", N/A ," $2,586.54 "," $2,586.54 "," $4,371.90 "," $3,040.13 ", $286.14 ," $4,417.92 "
Repair of Cardiac Wound,CPT® 33300,N/A,N/A,N/A," $15,082.00 "," $9,803.30 "," $14,232.86 "," $2,189.80 "," $2,378.00 "," $10,452.01 "," $10,339.16 "," $14,026.26 "," $13,573.80 "," $13,573.80 "," $12,065.60 "," $12,065.60 "," $2,378.00 "," $13,925.21 "," $14,327.90 "," $13,573.80 "," $13,573.80 "," $13,573.80 "," $14,026.26 "," $14,478.72 "," $13,208.68 "," $12,819.70 "," $13,098.60 "," $11,729.93 ", N/A ," $10,655.95 "," $10,655.95 "," $14,327.90 "," $12,105.14 "," $2,189.80 "," $14,478.72 "
 Fac Central Line/Picc ,Custom 3610000001,0361 - OR/MINOR,N/A,N/A, $744.00 , $483.60 , $624.96 , N/A , N/A , $601.15 , $669.60 , $629.87 , $669.60 , $669.60 , $669.60 , $632.40 , N/A , $686.94 , $706.80 , $632.40 , $691.92 , $691.92 , $706.80 , $714.24 , $608.74 , $669.60 , $632.40 , $587.76 , N/A , $602.12 , $602.12 , $706.80 , $638.43 , $587.76 , $714.24 
Prep Site T/a/L 1st 100 Sq Cm/1pct,15002,N/A,N/A,N/A," $1,756.00 "," $1,141.40 ", $690.40 , $205.46 , $247.27 , $617.89 , $603.46 ," $1,633.08 "," $1,580.40 "," $1,580.40 "," $1,404.80 "," $1,404.80 ", $247.27 ," $1,621.31 "," $1,668.20 "," $1,580.40 "," $1,580.40 "," $1,580.40 "," $1,633.08 "," $1,685.76 ", $763.53 ," $1,492.60 "," $1,209.60 ", $785.12 , N/A , $629.94 , $629.94 ," $1,668.20 ", $730.51 , $205.46 ," $1,685.76 "
"Repair of Hammertoe,One",CPT® 28285,N/A,N/A,N/A," $3,525.00 "," $2,291.25 "," $2,376.27 ", $373.93 , $280.42 ," $1,861.09 "," $1,848.26 "," $3,278.25 "," $3,172.50 "," $3,172.50 "," $2,820.00 "," $2,820.00 ", $280.42 ," $3,254.63 "," $3,348.75 "," $3,172.50 "," $3,172.50 "," $3,172.50 "," $3,278.25 "," $3,384.00 "," $2,197.00 "," $2,996.25 "," $1,999.94 "," $2,217.14 ", N/A ," $1,897.41 "," $1,897.41 "," $3,348.75 "," $2,230.13 ", $280.42 ," $3,384.00 "
Assay Urine Vma,CPT® 84585,N/A,N/A,N/A, $180.00 , $117.00 , N/A , $15.81 , $15.81 , $87.68 , $104.87 , $167.40 , $162.00 , $162.00 , $144.00 , $144.00 , $15.81 , $166.19 , $171.00 , $162.00 , $162.00 , $162.00 , $167.40 , $172.80 , $103.50 , $153.00 , $102.18 , $56.18 , N/A , $81.83 , $81.83 , $171.00 , $89.42 , $15.81 , $172.80 
 Pro Treat Humerus Fracture ,CPT® 24545,0982 - PRO FEE/OUTPT,N/A,N/A," $6,138.00 "," $3,989.70 "," $5,629.07 ", $881.28 , $768.38 ," $4,483.29 "," $4,452.62 "," $5,708.34 "," $5,524.20 "," $5,524.20 "," $4,910.40 "," $4,910.40 ", $768.38 ," $5,667.22 "," $5,831.10 "," $5,524.20 "," $5,524.20 "," $5,524.20 "," $5,708.34 "," $5,892.48 "," $5,241.06 "," $5,217.30 "," $4,920.45 "," $5,284.83 ", N/A ," $4,570.77 "," $4,570.77 "," $5,831.10 "," $5,372.28 ", $768.38 ," $5,892.48 "
 Pro DXA Bone Density/Peripheral ,CPT® 77081,0972 - PRO FEE/RAD/DX,N/A,N/A, $198.00 , $128.70 , $173.71 , $30.77 , $28.10 , $134.07 , $147.30 , $184.14 , $178.20 , $178.20 , $158.40 , $158.40 , $28.10 , $182.81 , $188.10 , $178.20 , $178.20 , $178.20 , $184.14 , $190.08 , $173.00 , $168.30 , $161.79 , $210.82 , N/A , $136.69 , $136.69 , $188.10 , $158.22 , $28.10 , $210.82 
"Cystoscopy,Intern Urethrotomy,Male",52275,N/A,N/A,N/A," $3,422.00 "," $2,224.30 "," $1,331.76 ", $233.75 , $307.34 ," $1,220.96 "," $1,129.99 "," $3,182.46 "," $3,079.80 "," $3,079.80 "," $2,737.60 "," $2,737.60 ", $307.34 ," $3,159.53 "," $3,250.90 "," $3,079.80 "," $3,079.80 "," $3,079.80 "," $3,182.46 "," $3,285.12 "," $1,337.47 "," $2,908.70 "," $1,279.17 "," $1,531.88 ", N/A ," $1,244.79 "," $1,244.79 "," $3,250.90 "," $1,463.06 ", $233.75 ," $3,285.12 "
Exc Tumor Soft Tissue Pelvis & Hip Subfasc 5+Cm,CPT® 27045,N/A,N/A,N/A," $4,979.00 "," $3,236.35 "," $4,429.23 ", $692.39 , $612.42 ," $3,599.11 "," $3,557.85 "," $4,630.47 "," $4,481.10 "," $4,481.10 "," $3,983.20 "," $3,983.20 ", $612.42 ," $4,597.11 "," $4,730.05 "," $4,481.10 "," $4,481.10 "," $4,481.10 "," $4,630.47 "," $4,779.84 "," $4,120.66 "," $4,232.15 "," $3,941.00 "," $4,211.15 ", N/A ," $3,669.34 "," $3,669.34 "," $4,730.05 "," $4,312.78 ", $612.42 ," $4,779.84 "
Fac Cytopatholgy Sele Cellula,CPT® 88112,N/A,N/A,N/A, $951.00 , $618.15 , N/A , N/A , N/A , N/A , N/A , $884.43 , $855.90 , $855.90 , $760.80 , $760.80 , N/A , $878.06 , $903.45 , $855.90 , $855.90 , $855.90 , $884.43 , $912.96 , N/A , $808.35 , N/A , N/A , N/A , N/A , N/A , $903.45 , N/A , $760.80 , $912.96 
"Exc Skin Benig 1.1-2cm Trunk,Arm,Leg",11402,N/A,N/A,N/A, $661.00 , $429.65 , $371.55 , $111.62 , $134.16 , $310.37 , $305.45 , $614.73 , $594.90 , $594.90 , $528.80 , $528.80 , $134.16 , $610.30 , $627.95 , $594.90 , $594.90 , $594.90 , $614.73 , $634.56 , $405.71 , $561.85 , $608.37 , $400.75 , N/A , $316.43 , $316.43 , $627.95 , $366.95 , $111.62 , $634.56 
 ED Fac Drg Tdn Shth Dgt&/Palm Ea ,CPT® 26020,0361 - OR/MINOR,N/A,N/A," $4,910.00 "," $3,191.50 "," $4,124.40 ", $536.98 , $338.07 ," $3,967.28 "," $4,419.00 "," $4,156.81 "," $4,419.00 "," $4,419.00 "," $4,419.00 "," $4,173.50 ", $331.44 ," $4,533.40 "," $4,664.50 "," $4,173.50 "," $4,566.30 "," $4,566.30 "," $4,664.50 "," $4,713.60 "," $4,017.36 "," $4,419.00 "," $4,173.50 "," $3,878.90 ", N/A ," $3,973.66 "," $3,973.66 "," $4,664.50 "," $4,213.27 ", $331.44 ," $4,713.60 "
Critical Care E&M L1,CPT® 99291,N/A,N/A,N/A," $1,220.00 ", $793.00 , $433.06 , $205.74 , $270.56 , $385.76 , $385.10 ," $1,134.60 "," $1,098.00 "," $1,098.00 ", $976.00 , $976.00 , $270.56 ," $1,126.43 "," $1,159.00 "," $1,098.00 "," $1,098.00 "," $1,098.00 "," $1,134.60 "," $1,171.20 ", $551.34 ," $1,037.00 ", $480.07 , $484.31 , N/A , $393.30 , $393.30 ," $1,159.00 ", $453.59 , $205.74 ," $1,171.20 "
 Shoulder Min 2vw- Mh ,CPT® 73030,0972 - PRO FEE/RAD/DX,N/A,N/A, $93.00 , $60.45 , $194.24 , $34.02 , $28.56 , $136.45 , $163.02 , $86.49 , $83.70 , $83.70 , $74.40 , $74.40 , $28.56 , $85.87 , $88.35 , $83.70 , $83.70 , $83.70 , $86.49 , $89.28 , $187.84 , $79.05 , $181.05 , $147.76 , N/A , $139.11 , $139.11 , $88.35 , $161.02 , $28.56 , $194.24 
"Exc Skin Malig <5mm Face,Facial",CPT® 11640,N/A,N/A,N/A, $994.00 , $646.10 , $405.52 , $121.95 , $200.70 , $341.73 , $336.34 , $924.42 , $894.60 , $894.60 , $795.20 , $795.20 , $200.70 , $917.76 , $944.30 , $894.60 , $894.60 , $894.60 , $924.42 , $954.24 , $443.61 , $844.90 , $669.02 , $439.11 , N/A , $348.39 , $348.39 , $944.30 , $404.04 , $121.95 , $954.24 
 Fac Admin Hepatitis B Vaccine ,HCPCS G0010,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , N/A , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , N/A , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $55.30 , $67.20 
" Fac Russell Viper Venom, Diluted ",CPT® 85613,0305 - LAB/HEMATOLOGY,N/A,N/A, $141.00 , $91.65 , $118.44 , $9.77 , $9.77 , $113.93 , $126.90 , $119.37 , $126.90 , $126.90 , $126.90 , $119.85 , $9.58 , $130.19 , $133.95 , $119.85 , $131.13 , $131.13 , $133.95 , $135.36 , $115.37 , $126.90 , $119.85 , $111.39 , N/A , $114.11 , $114.11 , $133.95 , $120.99 , $9.58 , $135.36 
"Remv Stomach,Part,Distal,Gastroduod",CPT® 43631,N/A,N/A,N/A," $9,123.00 "," $5,929.95 "," $8,606.72 "," $1,330.66 "," $1,269.74 "," $6,807.44 "," $6,860.25 "," $8,484.39 "," $8,210.70 "," $8,210.70 "," $7,298.40 "," $7,298.40 "," $1,269.74 "," $8,423.27 "," $8,666.85 "," $8,210.70 "," $8,210.70 "," $8,210.70 "," $8,484.39 "," $8,758.08 "," $6,175.95 "," $7,754.55 "," $7,641.15 "," $8,013.51 ", N/A ," $6,940.26 "," $6,940.26 "," $8,666.85 "," $7,258.79 "," $1,269.74 "," $8,758.08 "
Rem Interrog Pm/Ldls Pm/Ids <90 D Phys/Qhp,CPT® 93296,N/A,N/A,N/A, $161.00 , $104.65 , $144.76 , $21.78 , $27.22 , $137.80 , $145.23 , $149.73 , $144.90 , $144.90 , $128.80 , $128.80 , $27.22 , $148.65 , $152.95 , $144.90 , $144.90 , $144.90 , $149.73 , $154.56 , $153.65 , $136.85 , $137.37 , $99.10 , N/A , $140.48 , $140.48 , $152.95 , $155.73 , $21.78 , $155.73 
"Excise Lesn Neck/Chest,Deep",21556,N/A,N/A,N/A," $3,479.00 "," $2,261.35 "," $3,232.78 ", $505.10 , $358.52 ," $2,553.41 "," $2,574.55 "," $3,235.47 "," $3,131.10 "," $3,131.10 "," $2,783.20 "," $2,783.20 ", $358.52 ," $3,212.16 "," $3,305.05 "," $3,131.10 "," $3,131.10 "," $3,131.10 "," $3,235.47 "," $3,339.84 "," $2,984.35 "," $2,957.15 "," $2,842.01 "," $2,986.72 ", N/A ," $2,603.22 "," $2,603.22 "," $3,305.05 "," $3,059.73 ", $358.52 ," $3,339.84 "
 Fac Assay for Phencyclidine ,CPT® 83992,0301 - LAB/CHEMISTRY,N/A,N/A, $155.00 , $100.75 , $130.20 , N/A , $20.40 , $125.24 , $139.50 , $131.22 , $139.50 , $139.50 , $139.50 , $131.75 , $20.00 , $143.11 , $147.25 , $131.75 , $144.15 , $144.15 , $147.25 , $148.80 , $126.82 , $139.50 , $131.75 , $122.45 , N/A , $125.44 , $125.44 , $147.25 , $133.01 , $20.00 , $148.80 
Layer Closure 20.1-30cm,12036,N/A,N/A,N/A," $1,842.00 "," $1,197.30 ", $887.81 , $264.02 , $215.14 , $754.97 , $740.93 ," $1,713.06 "," $1,657.80 "," $1,657.80 "," $1,473.60 "," $1,473.60 ", $215.14 ," $1,700.72 "," $1,749.90 "," $1,657.80 "," $1,657.80 "," $1,657.80 "," $1,713.06 "," $1,768.32 ", $974.81 ," $1,565.70 "," $1,489.69 ", $970.85 , N/A , $769.70 , $769.70 ," $1,749.90 ", $892.60 , $215.14 ," $1,768.32 "
Tangential Biopsy Skin Single Lesion,11102,N/A,N/A,N/A, $122.00 , $79.30 , $121.11 , $36.38 , $78.04 , $101.29 , N/A , $113.46 , $109.80 , $109.80 , $97.60 , $97.60 , $78.04 , $112.64 , $115.90 , $109.80 , $109.80 , $109.80 , $113.46 , $117.12 , $134.04 , $103.70 , $199.02 , $138.93 , N/A , $103.26 , $103.26 , $115.90 , $119.75 , $36.38 , $199.02 
 FENTANYL 1500 MCG/30 ML PCA (INPT) ,HCPCS J3010,0636 - DRUGS REQUIRING DETAILED CODIN,70092-1099-49,30 mL, $290.34 , $188.72 , $243.89 , $0.86 , $1.00 , $234.59 , $261.31 , $245.80 , $261.31 , $261.31 , $261.31 , $246.79 , $0.98 , $268.07 , $275.82 , $246.79 , $270.02 , $270.02 , $275.82 , $278.73 , $237.56 , $261.31 , $246.79 , $229.37 , N/A , $234.97 , $234.97 , $275.82 , $249.14 , $0.86 , $278.73 
Hla Class II Typing High Resolution One Locus Ea,CPT® 81382,N/A,N/A,N/A," $1,389.00 ", $902.85 , N/A , $126.15 , $126.15 , $699.74 , $828.65 ," $1,291.77 "," $1,250.10 "," $1,250.10 "," $1,111.20 "," $1,111.20 ", $126.15 ," $1,282.46 "," $1,319.55 "," $1,250.10 "," $1,250.10 "," $1,250.10 "," $1,291.77 "," $1,333.44 ", $825.84 ," $1,180.65 ", $589.61 , $448.45 , N/A , $653.04 , $653.04 ," $1,319.55 ", $713.63 , $126.15 ," $1,333.44 "
 Pro Amputation Thru Metatarsal ,CPT® 28805,0982 - PRO FEE/OUTPT,N/A,N/A," $5,026.00 "," $3,266.90 "," $4,360.85 ", $677.03 , $537.90 ," $3,579.67 "," $3,592.06 "," $4,674.18 "," $4,523.40 "," $4,523.40 "," $4,020.80 "," $4,020.80 ", $537.90 ," $4,640.51 "," $4,774.70 "," $4,523.40 "," $4,523.40 "," $4,523.40 "," $4,674.18 "," $4,824.96 "," $4,063.23 "," $4,272.10 "," $3,958.84 "," $4,200.30 ", N/A ," $3,649.51 "," $3,649.51 "," $4,774.70 "," $4,289.47 ", $537.90 ," $4,824.96 "
 BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR ,HCPCS J0583,0636 - DRUGS REQUIRING DETAILED CODIN,00781-3158-95,5 mL," $2,786.61 "," $1,811.30 "," $2,340.75 ", $0.24 , $0.27 ," $2,251.58 "," $2,507.95 "," $2,359.14 "," $2,507.95 "," $2,507.95 "," $2,507.95 "," $2,368.62 ", $0.26 ," $2,572.88 "," $2,647.28 "," $2,368.62 "," $2,591.55 "," $2,591.55 "," $2,647.28 "," $2,675.15 "," $2,280.00 "," $2,507.95 "," $2,368.62 "," $2,201.42 ", N/A ," $2,255.20 "," $2,255.20 "," $2,647.28 "," $2,391.19 ", $0.24 ," $2,675.15 "
 Fac Antepartum Manipulation ,CPT® 59412,0720 - DELIVROOM/LABOR,N/A,N/A," $2,508.00 "," $1,630.20 "," $2,106.72 ", $92.55 , $92.65 ," $2,026.46 "," $2,257.20 "," $2,123.27 "," $2,257.20 "," $2,257.20 "," $2,257.20 "," $2,131.80 ", $90.83 ," $2,315.64 "," $2,382.60 "," $2,131.80 "," $2,332.44 "," $2,332.44 "," $2,382.60 "," $2,407.68 "," $2,052.05 "," $2,257.20 "," $2,131.80 "," $1,981.32 ", N/A ," $2,029.72 "," $2,029.72 "," $2,382.60 "," $2,152.11 ", $90.83 ," $2,407.68 "
 CEFTAZIDIME 1 G IJ SOLR ,HCPCS J0713,0636 - DRUGS REQUIRING DETAILED CODIN,00409-5082-16,10 mL, $26.29 , $17.09 , $22.08 , $1.88 , $2.02 , $21.24 , $23.66 , $22.26 , $23.66 , $23.66 , $23.66 , $22.35 , $1.98 , $24.27 , $24.98 , $22.35 , $24.45 , $24.45 , $24.98 , $25.24 , $21.51 , $23.66 , $22.35 , $20.77 , N/A , $21.28 , $21.28 , $24.98 , $22.56 , $1.88 , $25.24 
 Pro Removal Forearm Lesion Deep ,CPT® 25076,0982 - PRO FEE/OUTPT,N/A,N/A," $3,840.00 "," $2,496.00 "," $3,163.62 ", $499.05 , $502.53 ," $2,486.17 "," $2,483.93 "," $3,571.20 "," $3,456.00 "," $3,456.00 "," $3,072.00 "," $3,072.00 ", $502.53 ," $3,545.47 "," $3,648.00 "," $3,456.00 "," $3,456.00 "," $3,456.00 "," $3,571.20 "," $3,686.40 "," $2,934.93 "," $3,264.00 "," $2,736.75 "," $2,956.63 ", N/A ," $2,534.68 "," $2,534.68 "," $3,648.00 "," $2,979.16 ", $499.05 ," $3,686.40 "
Spherocylinder 4.00d/4.25-6d,HCPCS V2105,N/A,N/A,N/A, $55.00 , $35.75 , N/A , $55.92 , N/A , N/A , N/A , $51.15 , $49.50 , $49.50 , $44.00 , $44.00 , N/A , $50.78 , $52.25 , $49.50 , $49.50 , $49.50 , $51.15 , $52.80 , N/A , $46.75 , $55.00 , $50.79 , N/A , N/A , N/A , $52.25 , N/A , $44.00 , $55.92 
 DARATUMUMAB 100 MG/5ML IV SOLN ,HCPCS J9145,0636 - DRUGS REQUIRING DETAILED CODIN,57894-0502-05,5 mL," $1,967.07 "," $1,278.60 "," $1,652.34 ", $63.02 , $61.99 ," $1,589.39 "," $1,770.36 "," $1,665.32 "," $1,770.36 "," $1,770.36 "," $1,770.36 "," $1,672.01 ", $60.77 ," $1,816.20 "," $1,868.72 "," $1,672.01 "," $1,829.38 "," $1,829.38 "," $1,868.72 "," $1,888.39 "," $1,609.46 "," $1,770.36 "," $1,672.01 "," $1,553.99 ", N/A ," $1,591.95 "," $1,591.95 "," $1,868.72 "," $1,687.94 ", $60.77 ," $1,888.39 "
 Fac Electrophysiologic Follow-Up W/Pac/Rec W/Arrhyt ,CPT® 93624,0481 - CARDIAC CATH LAB,N/A,N/A," $10,882.00 "," $7,073.30 "," $9,140.88 ", $309.75 , $348.66 ," $8,792.66 "," $9,793.80 "," $9,212.70 "," $9,793.80 "," $9,793.80 "," $9,793.80 "," $9,249.70 ", $341.82 ," $10,047.35 "," $10,337.90 "," $9,249.70 "," $10,120.26 "," $10,120.26 "," $10,337.90 "," $10,446.72 "," $8,903.65 "," $9,793.80 "," $9,249.70 "," $8,596.78 ", N/A ," $8,806.80 "," $8,806.80 "," $10,337.90 "," $9,337.84 ", $309.75 ," $10,446.72 "
"Pro Lap,Vag Hyst,Uterus 250gms/<",CPT® 58550,N/A,N/A,N/A," $5,280.00 "," $3,432.00 "," $4,149.20 ", $840.11 , $801.05 ," $3,590.13 "," $3,584.20 "," $4,910.40 "," $4,752.00 "," $4,752.00 "," $4,224.00 "," $4,224.00 ", $801.05 ," $4,875.02 "," $5,016.00 "," $4,752.00 "," $4,752.00 "," $4,752.00 "," $4,910.40 "," $5,068.80 "," $4,347.98 "," $4,488.00 "," $4,715.28 "," $3,598.17 ", N/A ," $3,660.19 "," $3,660.19 "," $5,016.00 "," $4,390.16 ", $801.05 ," $5,068.80 "
 Fac Molecular Pathology Procedure Level 4 ,CPT® 81403,0310 - PATHOLOGY LAB,N/A,N/A, $821.00 , $533.65 , $689.64 , $188.90 , $188.90 , $663.37 , $738.90 , $695.06 , $738.90 , $738.90 , $738.90 , $697.85 , $185.20 , $758.03 , $779.95 , $697.85 , $763.53 , $763.53 , $779.95 , $788.16 , $671.74 , $738.90 , $697.85 , $648.59 , N/A , $664.44 , $664.44 , $779.95 , $704.50 , $185.20 , $788.16 
 Eeg Without Video 2-12 Hours; Unmonitored ,CPT® 95705,0740 - EEG,N/A,N/A," $1,731.00 "," $1,125.15 "," $1,454.04 ", $81.77 , $206.53 ," $1,398.65 "," $1,557.90 "," $1,465.46 "," $1,557.90 "," $1,557.90 "," $1,557.90 "," $1,471.35 ", $202.48 ," $1,598.23 "," $1,644.45 "," $1,471.35 "," $1,609.83 "," $1,609.83 "," $1,644.45 "," $1,661.76 "," $1,416.30 "," $1,557.90 "," $1,471.35 "," $1,367.49 ", N/A ," $1,400.90 "," $1,400.90 "," $1,644.45 "," $1,485.37 ", $81.77 ," $1,661.76 "
"Combined Vaccine,Mmr+Varicella,Sq",CPT® 90710,N/A,N/A,N/A, $380.00 , $247.00 , N/A , N/A , $198.95 , $296.22 , $308.94 , $353.40 , $342.00 , $342.00 , $304.00 , $304.00 , $198.95 , $350.85 , $361.00 , $342.00 , $342.00 , $342.00 , $353.40 , $364.80 , N/A , $323.00 , $410.55 , $431.07 , N/A , $302.00 , $302.00 , $361.00 , $352.07 , $198.95 , $431.07 
 Pro X-Ray Exam of Neck ,CPT® 70360,0972 - PRO FEE/RAD/DX,N/A,N/A, $111.00 , $72.15 , $177.25 , $31.07 , $26.21 , $131.98 , $148.70 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $26.21 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $172.77 , $94.35 , $161.79 , $142.36 , N/A , $134.56 , $134.56 , $105.45 , $155.74 , $26.21 , $177.25 
 PAROXETINE HCL 20 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-5677-61,1 tablet, $15.09 , $9.81 , $12.68 , N/A , N/A , $12.19 , $13.58 , $12.78 , $13.58 , $13.58 , $13.58 , $12.83 , N/A , $13.93 , $14.34 , $12.83 , $14.03 , $14.03 , $14.34 , $14.49 , $12.35 , $13.58 , $12.83 , $11.92 , N/A , $12.21 , $12.21 , $14.34 , $12.95 , $11.92 , $14.49 
 Fac Elec Alys Implt Npgt Phys/Qhp W/O Programming ,CPT® 95970,0360 - OR SERVICES,N/A,N/A, $407.00 , $264.55 , $341.88 , $17.79 , $18.88 , $328.86 , $366.30 , $344.57 , $366.30 , $366.30 , $366.30 , $345.95 , $18.51 , $375.78 , $386.65 , $345.95 , $378.51 , $378.51 , $386.65 , $390.72 , $333.01 , $366.30 , $345.95 , $321.53 , N/A , $329.39 , $329.39 , $386.65 , $349.25 , $17.79 , $390.72 
Injection Aa&/Strd Axillary Nerve W/Img Gdn,CPT® 64417,N/A,N/A,N/A," $1,860.00 "," $1,209.00 ", $302.22 , $61.03 , $46.08 , $396.12 , $376.64 ," $1,729.80 "," $1,674.00 "," $1,674.00 "," $1,488.00 "," $1,488.00 ", $46.08 ," $1,717.34 "," $1,767.00 "," $1,674.00 "," $1,674.00 "," $1,674.00 "," $1,729.80 "," $1,785.60 ", $326.16 ," $1,581.00 ", $369.30 , $426.36 , N/A , $403.84 , $403.84 ," $1,767.00 ", $433.22 , $46.08 ," $1,785.60 "
 Pulmonary Embolism Without McC ,MS DRG V40 (FY2023) 176,N/A,N/A,N/A," $16,479.77 "," $10,711.85 "," $13,843.01 ", N/A , N/A ," $13,315.65 "," $14,831.79 "," $13,951.77 "," $14,831.79 "," $14,831.79 "," $14,831.79 "," $14,007.80 ", N/A ," $15,215.77 "," $15,655.78 "," $14,007.80 "," $15,326.19 "," $15,326.19 "," $15,655.78 "," $15,820.58 "," $13,483.75 "," $14,831.79 "," $14,007.80 "," $13,019.02 ", N/A ," $13,337.08 "," $13,337.08 "," $15,655.78 "," $14,141.29 "," $13,019.02 "," $15,820.58 "
" Fac Phospholipid Neutralization,Hexagonal Phospholipid ",CPT® 85598,0305 - LAB/HEMATOLOGY,N/A,N/A, $177.00 , $115.05 , $148.68 , $18.34 , $18.34 , $143.02 , $159.30 , $149.85 , $159.30 , $159.30 , $159.30 , $150.45 , $17.98 , $163.42 , $168.15 , $150.45 , $164.61 , $164.61 , $168.15 , $169.92 , $144.82 , $159.30 , $150.45 , $139.83 , N/A , $143.25 , $143.25 , $168.15 , $151.88 , $17.98 , $169.92 
Mononuclear Cell Antigen Quantitative Nos Ea,CPT® 86356,N/A,N/A,N/A, $190.00 , $123.50 , N/A , $27.32 , $27.32 , $151.50 , $181.18 , $176.70 , $171.00 , $171.00 , $152.00 , $152.00 , $27.32 , $175.43 , $180.50 , $171.00 , $171.00 , $171.00 , $176.70 , $182.40 , $178.82 , $161.50 , $175.16 , $97.10 , N/A , $141.39 , $141.39 , $180.50 , $154.51 , $27.32 , $182.40 
" Pro Excision of Nail Fold, Toe ",CPT® 11765,0975 - PRO FEE/OR,N/A,N/A, $485.00 , $315.25 , $298.86 , $89.88 , $111.12 , $259.63 , $252.76 , $451.05 , $436.50 , $436.50 , $388.00 , $388.00 , $111.12 , $447.80 , $460.75 , $436.50 , $436.50 , $436.50 , $451.05 , $465.60 , $329.62 , $412.25 , $494.19 , $334.41 , N/A , $264.69 , $264.69 , $460.75 , $306.96 , $89.88 , $494.19 
Dstr Nrolytc Agnt Parverteb Fct Sngl Crvcl/Thora,64633,N/A,N/A,N/A," $1,746.00 "," $1,134.90 ", $948.95 , $184.67 , $352.82 ," $1,276.16 "," $1,199.66 "," $1,623.78 "," $1,571.40 "," $1,571.40 "," $1,396.80 "," $1,396.80 ", $352.82 ," $1,612.08 "," $1,658.70 "," $1,571.40 "," $1,571.40 "," $1,571.40 "," $1,623.78 "," $1,676.16 "," $1,203.74 "," $1,484.10 "," $1,164.99 "," $1,367.43 ", N/A ," $1,301.06 "," $1,301.06 "," $1,658.70 "," $1,395.72 ", $184.67 ," $1,676.16 "
Electrolyte Panel,CPT® 80051,N/A,N/A,N/A, $94.00 , $61.10 , N/A , $7.15 , $7.15 , $39.70 , $47.46 , $87.42 , $84.60 , $84.60 , $75.20 , $75.20 , $7.15 , $86.79 , $89.30 , $84.60 , $84.60 , $84.60 , $87.42 , $90.24 , $46.81 , $79.90 , $45.41 , $25.43 , N/A , $37.05 , $37.05 , $89.30 , $40.49 , $7.15 , $90.24 
 Pro Evac Subungual Hemato ,CPT® 11740,0982 - PRO FEE/OUTPT,N/A,N/A, $187.00 , $121.55 , $101.46 , $30.96 , $37.00 , $89.90 , $88.22 , $173.91 , $168.30 , $168.30 , $149.60 , $149.60 , $37.00 , $172.66 , $177.65 , $168.30 , $168.30 , $168.30 , $173.91 , $179.52 , $110.68 , $158.95 , $173.05 , $117.10 , N/A , $91.66 , $91.66 , $177.65 , $106.30 , $30.96 , $179.52 
" Complex Repair Face,Neck,Genitalia,Hands,Feet 2.6-7.5cm ",CPT® 13132,0981 - PRO FEE/ER,N/A,N/A," $2,287.00 "," $1,486.55 ", $971.79 , $290.72 , $268.64 , $861.57 , $839.43 ," $2,126.91 "," $2,058.30 "," $2,058.30 "," $1,829.60 "," $1,829.60 ", $268.64 ," $2,111.59 "," $2,172.65 "," $2,058.30 "," $2,058.30 "," $2,058.30 "," $2,126.91 "," $2,195.52 "," $1,069.42 "," $1,943.95 "," $1,671.67 "," $1,104.41 ", N/A , $878.38 , $878.38 ," $2,172.65 "," $1,018.64 ", $268.64 ," $2,195.52 "
" Fac Hepatitis, Delta Agent ",CPT® 86692,0305 - LAB/HEMATOLOGY,N/A,N/A, $191.00 , $124.15 , $160.44 , $17.50 , $17.50 , $154.33 , $171.90 , $161.70 , $171.90 , $171.90 , $171.90 , $162.35 , $17.16 , $176.35 , $181.45 , $162.35 , $177.63 , $177.63 , $181.45 , $183.36 , $156.28 , $171.90 , $162.35 , $150.89 , N/A , $154.58 , $154.58 , $181.45 , $163.90 , $17.16 , $183.36 
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj,CPT® 78227,N/A,N/A,N/A," $4,238.00 "," $2,754.70 "," $2,338.85 ", $399.41 , $351.35 ," $2,212.18 "," $2,716.78 "," $3,941.34 "," $3,814.20 "," $3,814.20 "," $3,390.40 "," $3,390.40 ", $351.35 ," $3,912.95 "," $4,026.10 "," $3,814.20 "," $3,814.20 "," $3,814.20 "," $3,941.34 "," $4,068.48 "," $2,439.87 "," $3,602.30 "," $2,985.36 "," $3,019.48 ", N/A ," $2,255.34 "," $2,255.34 "," $4,026.10 "," $2,610.61 ", $351.35 ," $4,068.48 "
 Fac Njx Sel R Vent/Atrial Angio Hrt Cath W/S&I ,CPT® 93566,0481 - CARDIAC CATH LAB,N/A,N/A," $1,910.00 "," $1,241.50 "," $1,604.40 ", $24.28 , $168.87 ," $1,543.28 "," $1,719.00 "," $1,617.01 "," $1,719.00 "," $1,719.00 "," $1,719.00 "," $1,623.50 ", $165.56 ," $1,763.50 "," $1,814.50 "," $1,623.50 "," $1,776.30 "," $1,776.30 "," $1,814.50 "," $1,833.60 "," $1,562.76 "," $1,719.00 "," $1,623.50 "," $1,508.90 ", N/A ," $1,545.76 "," $1,545.76 "," $1,814.50 "," $1,638.97 ", $24.28 ," $1,833.60 "
 Pro Injection Aa&/Strd Femoral Nerve W/Img Gdn ,CPT® 64447,0982 - PRO FEE/OUTPT,N/A,N/A, $751.00 , $488.15 , $262.08 , $60.98 , $69.44 , $370.27 , $349.57 , $698.43 , $675.90 , $675.90 , $600.80 , $600.80 , $69.44 , $693.40 , $713.45 , $675.90 , $675.90 , $675.90 , $698.43 , $720.96 , $284.46 , $638.35 , $340.76 , $403.56 , N/A , $377.50 , $377.50 , $713.45 , $404.97 , $60.98 , $720.96 
"Repair of Perineum,Non Obstetrical",CPT® 56810,N/A,N/A,N/A," $1,926.00 "," $1,251.90 "," $1,287.30 ", $260.52 , $312.40 ," $1,059.45 "," $1,055.59 "," $1,791.18 "," $1,733.40 "," $1,733.40 "," $1,540.80 "," $1,540.80 ", $312.40 ," $1,778.28 "," $1,829.70 "," $1,733.40 "," $1,733.40 "," $1,733.40 "," $1,791.18 "," $1,848.96 "," $1,332.55 "," $1,637.10 "," $1,384.43 "," $1,065.06 ", N/A ," $1,080.12 "," $1,080.12 "," $1,829.70 "," $1,295.55 ", $260.52 ," $1,848.96 "
 Fac Enzyme Cell Activity ,CPT® 84433,0301 - LAB/CHEMISTRY,N/A,N/A, $447.00 , $290.55 , $375.48 , $22.61 , $22.61 , $361.18 , $402.30 , $378.43 , $402.30 , $402.30 , $402.30 , $379.95 , $22.17 , $412.72 , $424.65 , $379.95 , $415.71 , $415.71 , $424.65 , $429.12 , $365.74 , $402.30 , $379.95 , $353.13 , N/A , $361.76 , $361.76 , $424.65 , $383.57 , $22.17 , $429.12 
 Fac Cacna1a Gene Analysis Full Gene Sequence ,CPT® 81185,0310 - PATHOLOGY LAB,N/A,N/A, $20.00 , $13.00 , $16.80 , $863.20 , $690.55 , $16.16 , $18.00 , $16.93 , $18.00 , $18.00 , $18.00 , $17.00 , $677.01 , $18.47 , $19.00 , $17.00 , $18.60 , $18.60 , $19.00 , $19.20 , $16.36 , $18.00 , $17.00 , $15.80 , N/A , $16.19 , $16.19 , $19.00 , $17.16 , $15.80 , $863.20 
"Close Enterostomy,Resec+Colorec Anas",CPT® 44626,N/A,N/A,N/A," $10,481.00 "," $6,812.65 "," $9,483.37 "," $1,466.85 "," $2,175.68 "," $7,550.09 "," $7,601.81 "," $9,747.33 "," $9,432.90 "," $9,432.90 "," $8,384.80 "," $8,384.80 "," $2,175.68 "," $9,677.11 "," $9,956.95 "," $9,432.90 "," $9,432.90 "," $9,432.90 "," $9,747.33 "," $10,061.76 "," $6,806.75 "," $8,908.85 "," $8,458.25 "," $8,906.32 ", N/A ," $7,697.40 "," $7,697.40 "," $9,956.95 "," $8,050.65 "," $1,466.85 "," $10,061.76 "
 Fac Chemodenervation of Trunk 6 or More Muscles ,CPT® 64647,0360 - OR SERVICES,N/A,N/A, $891.00 , $579.15 , $748.44 , $121.37 , $99.05 , $719.93 , $801.90 , $754.32 , $801.90 , $801.90 , $801.90 , $757.35 , $97.11 , $822.66 , $846.45 , $757.35 , $828.63 , $828.63 , $846.45 , $855.36 , $729.02 , $801.90 , $757.35 , $703.89 , N/A , $721.09 , $721.09 , $846.45 , $764.57 , $97.11 , $855.36 
"Amputate Thigh,Thru Femur",CPT® 27590,N/A,N/A,N/A," $4,140.00 "," $2,691.00 "," $4,656.08 ", $719.12 , $731.58 ," $3,876.48 "," $3,889.47 "," $3,850.20 "," $3,726.00 "," $3,726.00 "," $3,312.00 "," $3,312.00 ", $731.58 ," $3,822.46 "," $3,933.00 "," $3,726.00 "," $3,726.00 "," $3,726.00 "," $3,850.20 "," $3,974.40 "," $4,329.70 "," $3,519.00 "," $4,335.28 "," $4,462.71 ", N/A ," $3,952.12 "," $3,952.12 "," $3,933.00 "," $4,645.15 ", $719.12 ," $4,656.08 "
 ALDESLEUKIN 22000000 UNITS IV SOLR ,HCPCS J9015,0636 - DRUGS REQUIRING DETAILED CODIN,76310-0022-01,1.2 mL," $16,323.05 "," $10,609.98 "," $13,711.36 ", N/A ," $2,152.84 "," $13,189.02 "," $14,690.75 "," $13,819.09 "," $14,690.75 "," $14,690.75 "," $14,690.75 "," $13,874.59 "," $2,110.63 "," $15,071.07 "," $15,506.90 "," $13,874.59 "," $15,180.44 "," $15,180.44 "," $15,506.90 "," $15,670.13 "," $13,355.52 "," $14,690.75 "," $13,874.59 "," $12,895.21 ", N/A ," $13,210.24 "," $13,210.24 "," $15,506.90 "," $14,006.81 "," $2,110.63 "," $15,670.13 "
Acute GI Blood Loss Imaging,CPT® 78278,N/A,N/A,N/A," $3,400.00 "," $2,210.00 "," $1,864.12 ", $319.13 , $245.08 ," $1,717.04 "," $1,864.02 "," $3,162.00 "," $3,060.00 "," $3,060.00 "," $2,720.00 "," $2,720.00 ", $245.08 ," $3,139.22 "," $3,230.00 "," $3,060.00 "," $3,060.00 "," $3,060.00 "," $3,162.00 "," $3,264.00 "," $1,928.61 "," $2,890.00 "," $2,033.90 "," $2,348.44 ", N/A ," $1,750.54 "," $1,750.54 "," $3,230.00 "," $2,026.27 ", $245.08 ," $3,264.00 "
Excision Skin of Nose,CPT® 30120,N/A,N/A,N/A," $3,001.00 "," $1,950.65 "," $2,291.26 ", $405.58 , $537.90 ," $1,661.75 "," $1,669.78 "," $2,790.93 "," $2,700.90 "," $2,700.90 "," $2,400.80 "," $2,400.80 ", $537.90 ," $2,770.82 "," $2,850.95 "," $2,700.90 "," $2,700.90 "," $2,700.90 "," $2,790.93 "," $2,880.96 "," $2,226.96 "," $2,550.85 "," $2,356.75 "," $2,229.72 ", N/A ," $1,694.17 "," $1,694.17 "," $2,850.95 "," $1,995.24 ", $405.58 ," $2,880.96 "
Incis Achilles Tendon+Local Anesth,27605,N/A,N/A,N/A," $1,727.00 "," $1,122.55 "," $1,138.87 ", $178.40 , $76.84 , $903.28 , $904.73 ," $1,606.11 "," $1,554.30 "," $1,554.30 "," $1,381.60 "," $1,381.60 ", $76.84 ," $1,594.54 "," $1,640.65 "," $1,554.30 "," $1,554.30 "," $1,554.30 "," $1,606.11 "," $1,657.92 "," $1,066.53 "," $1,467.95 ", $984.80 ," $1,085.90 ", N/A , $920.91 , $920.91 ," $1,640.65 "," $1,082.38 ", $76.84 ," $1,657.92 "
 Pro Revision of Upper Eyelid ,CPT® 15822,0975 - PRO FEE/OR,N/A,N/A," $2,085.00 "," $1,355.25 "," $1,293.94 ", $387.20 , $614.70 ," $1,069.17 "," $1,072.20 "," $1,939.05 "," $1,876.50 "," $1,876.50 "," $1,668.00 "," $1,668.00 ", $614.70 ," $1,925.08 "," $1,980.75 "," $1,876.50 "," $1,876.50 "," $1,876.50 "," $1,939.05 "," $2,001.60 "," $1,408.82 "," $1,772.25 "," $2,139.09 "," $1,378.78 ", N/A ," $1,090.03 "," $1,090.03 "," $1,980.75 "," $1,264.07 ", $387.20 ," $2,139.09 "
 Pro Exc H-F-Nk-Sp B9+Marg 1.1-2 ,CPT® 11422,0982 - PRO FEE/OUTPT,N/A,N/A, $702.00 , $456.30 , $435.54 , $131.06 , $143.41 , $370.23 , $364.50 , $652.86 , $631.80 , $631.80 , $561.60 , $561.60 , $143.41 , $648.16 , $666.90 , $631.80 , $631.80 , $631.80 , $652.86 , $673.92 , $475.45 , $596.70 , $726.11 , $478.34 , N/A , $377.45 , $377.45 , $666.90 , $437.72 , $131.06 , $726.11 
Culture Fungi-Skin Hair Nails,CPT® 87101,N/A,N/A,N/A, $115.00 , $74.75 , N/A , $7.86 , $7.86 , $43.61 , $52.18 , $106.95 , $103.50 , $103.50 , $92.00 , $92.00 , $7.86 , $106.18 , $109.25 , $103.50 , $103.50 , $103.50 , $106.95 , $110.40 , $51.48 , $97.75 , $50.28 , $27.93 , N/A , $40.70 , $40.70 , $109.25 , $44.48 , $7.86 , $110.40 
 Lymph Node Biopsy ,CPT® 38505,0761 - TREATMENT ROOM,N/A,N/A," $1,258.00 ", $817.70 ," $1,056.72 ", $82.42 , $208.20 ," $1,016.46 "," $1,132.20 "," $1,065.02 "," $1,132.20 "," $1,132.20 "," $1,132.20 "," $1,069.30 ", $204.12 ," $1,161.51 "," $1,195.10 "," $1,069.30 "," $1,169.94 "," $1,169.94 "," $1,195.10 "," $1,207.68 "," $1,029.30 "," $1,132.20 "," $1,069.30 ", $993.82 , N/A ," $1,018.10 "," $1,018.10 "," $1,195.10 "," $1,079.49 ", $82.42 ," $1,207.68 "
Drainage of Hematoma/Fluid,10140,N/A,N/A,N/A, $667.00 , $433.55 , $379.44 , $113.59 , $45.35 , $324.24 , $318.38 , $620.31 , $600.30 , $600.30 , $533.60 , $533.60 , $45.35 , $615.84 , $633.65 , $600.30 , $600.30 , $600.30 , $620.31 , $640.32 , $417.24 , $566.95 , $629.77 , $417.61 , N/A , $330.56 , $330.56 , $633.65 , $383.34 , $45.35 , $640.32 
 Fac Hdr Rdncl Ntrstl/Intrcav Brachytx 1 Channel ,CPT® 77770,0342 - NUC MED/RX PROCEDURES,N/A,N/A," $3,622.00 "," $2,354.30 "," $3,042.48 ", $340.26 , $253.88 ," $2,926.58 "," $3,259.80 "," $3,066.39 "," $3,259.80 "," $3,259.80 "," $3,259.80 "," $3,078.70 ", $248.90 ," $3,344.19 "," $3,440.90 "," $3,078.70 "," $3,368.46 "," $3,368.46 "," $3,440.90 "," $3,477.12 "," $2,963.52 "," $3,259.80 "," $3,078.70 "," $2,861.38 ", N/A ," $2,931.28 "," $2,931.28 "," $3,440.90 "," $3,108.04 ", $248.90 ," $3,477.12 "
 PENICILLIN V POTASSIUM 250 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,65862-0175-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Pro Open Tx Fracture Great Toe/Phalanx/Phalanges ,CPT® 28505,0982 - PRO FEE/OUTPT,N/A,N/A," $4,469.00 "," $2,904.85 "," $3,079.57 ", $479.38 , $230.52 ," $2,473.79 "," $2,437.68 "," $4,156.17 "," $4,022.10 "," $4,022.10 "," $3,575.20 "," $3,575.20 ", $230.52 ," $4,126.23 "," $4,245.55 "," $4,022.10 "," $4,022.10 "," $4,022.10 "," $4,156.17 "," $4,290.24 "," $2,849.00 "," $3,798.65 "," $2,654.69 "," $2,904.02 ", N/A ," $2,522.06 "," $2,522.06 "," $4,245.55 "," $2,964.32 ", $230.52 ," $4,290.24 "
 FLUCONAZOLE 150 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,57237-0005-11,1 tablet, $71.58 , $46.53 , $60.13 , N/A , N/A , $57.84 , $64.42 , $60.60 , $64.42 , $64.42 , $64.42 , $60.84 , N/A , $66.09 , $68.00 , $60.84 , $66.57 , $66.57 , $68.00 , $68.72 , $58.57 , $64.42 , $60.84 , $56.55 , N/A , $57.93 , $57.93 , $68.00 , $61.42 , $56.55 , $68.72 
 MICAFUNGIN SODIUM 100 MG IV SOLR ,HCPCS J2247,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0729-10,5 mL," $1,152.72 ", $749.27 , $968.28 , $0.30 , $0.38 , $931.40 ," $1,037.45 ", $975.89 ," $1,037.45 "," $1,037.45 "," $1,037.45 ", $979.81 , $0.37 ," $1,064.31 "," $1,095.08 ", $979.81 ," $1,072.03 "," $1,072.03 "," $1,095.08 "," $1,106.61 ", $943.16 ," $1,037.45 ", $979.81 , $910.65 , N/A , $932.90 , $932.90 ," $1,095.08 ", $989.15 , $0.30 ," $1,106.61 "
Sigmoidoscopy Flx Control Bleeding,45334,N/A,N/A,N/A," $3,466.00 "," $2,252.90 ", $721.57 , $111.58 , $218.09 , $773.87 , $797.61 ," $3,223.38 "," $3,119.40 "," $3,119.40 "," $2,772.80 "," $2,772.80 ", $218.09 ," $3,200.16 "," $3,292.70 "," $3,119.40 "," $3,119.40 "," $3,119.40 "," $3,223.38 "," $3,327.36 ", $516.93 ," $2,946.10 ", $872.41 , $685.75 , N/A , $788.96 , $788.96 ," $3,292.70 ", $825.16 , $111.58 ," $3,327.36 "
Apply Patella Tendon Bearing Cast,CPT® 29435,N/A,N/A,N/A, $789.00 , $512.85 , $482.17 , $76.78 , $83.85 , $404.67 , $410.72 , $733.77 , $710.10 , $710.10 , $631.20 , $631.20 , $83.85 , $728.48 , $749.55 , $710.10 , $710.10 , $710.10 , $733.77 , $757.44 , $455.26 , $670.65 , $453.15 , $478.09 , N/A , $412.56 , $412.56 , $749.55 , $484.91 , $76.78 , $757.44 
 Fac Follow-Up Angiography ,CPT® 75898,0320 - DX X-RAY,N/A,N/A," $4,893.00 "," $3,180.45 "," $4,110.12 ", $126.07 , $129.32 ," $3,953.54 "," $4,403.70 "," $4,142.41 "," $4,403.70 "," $4,403.70 "," $4,403.70 "," $4,159.05 ", $126.78 ," $4,517.71 "," $4,648.35 "," $4,159.05 "," $4,550.49 "," $4,550.49 "," $4,648.35 "," $4,697.28 "," $4,003.45 "," $4,403.70 "," $4,159.05 "," $3,865.47 ", N/A ," $3,959.90 "," $3,959.90 "," $4,648.35 "," $4,198.68 ", $126.07 ," $4,697.28 "
"US,Head/Neck Tissues,B-Scan/Real Time",76536,N/A,N/A,N/A, $256.00 , $166.40 , $637.19 , $109.87 , $87.55 , $555.80 , $647.71 , $238.08 , $230.40 , $230.40 , $204.80 , $204.80 , $87.55 , $236.36 , $243.20 , $230.40 , $230.40 , $230.40 , $238.08 , $245.76 , $644.21 , $217.60 , $706.86 , $655.97 , N/A , $566.64 , $566.64 , $243.20 , $655.90 , $87.55 , $706.86 
 OXYBUTYNIN CHLORIDE ER 5 MG PO TB24 ,HCPCS RXC637,0250 - PHARMACY,00904-6570-61,1 tablet, $14.12 , $9.18 , $11.86 , N/A , N/A , $11.41 , $12.71 , $11.95 , $12.71 , $12.71 , $12.71 , $12.00 , N/A , $13.04 , $13.41 , $12.00 , $13.13 , $13.13 , $13.41 , $13.56 , $11.55 , $12.71 , $12.00 , $11.15 , N/A , $11.43 , $11.43 , $13.41 , $12.12 , $11.15 , $13.56 
"Igg1, 2, 3 or 4, Each",CPT® 82787,N/A,N/A,N/A, $174.00 , $113.10 , N/A , $8.18 , $5.82 , $23.73 , $28.36 , $161.82 , $156.60 , $156.60 , $139.20 , $139.20 , $5.82 , $160.65 , $165.30 , $156.60 , $156.60 , $156.60 , $161.82 , $167.04 , $53.55 , $147.90 , $51.90 , $29.08 , N/A , $22.15 , $22.15 , $165.30 , $24.21 , $5.82 , $167.04 
"Prevent Counsel,Indiv,45 Min",CPT® 99403,N/A,N/A,N/A, $286.00 , $185.90 , N/A , $84.38 , $29.03 , $159.20 , $160.90 , $265.98 , $257.40 , $257.40 , $228.80 , $228.80 , $29.03 , $264.06 , $271.70 , $257.40 , $257.40 , $257.40 , $265.98 , $274.56 , $197.72 , $243.10 , $161.27 , $159.33 , N/A , $162.31 , $162.31 , $271.70 , $194.95 , $29.03 , $274.56 
Remove Impacted Cerumen,69210,N/A,N/A,N/A, $289.00 , $187.85 , $154.15 , $31.15 , $14.13 , $157.99 , $157.57 , $268.77 , $260.10 , $260.10 , $231.20 , $231.20 , $14.13 , $266.83 , $274.55 , $260.10 , $260.10 , $260.10 , $268.77 , $277.44 , $170.16 , $245.65 , $171.27 , $161.15 , N/A , $161.08 , $161.08 , $274.55 , $183.90 , $14.13 , $277.44 
"US,Pregnant Uterus,Limited, 1/> Fetuses",CPT® 76815,N/A,N/A,N/A, $708.00 , $460.20 , $462.43 , $80.48 , $87.65 , $405.52 , $478.15 , $658.44 , $637.20 , $637.20 , $566.40 , $566.40 , $87.65 , $653.70 , $672.60 , $637.20 , $637.20 , $637.20 , $658.44 , $679.68 , $466.34 , $601.80 , $520.03 , $475.70 , N/A , $413.43 , $413.43 , $672.60 , $478.57 , $80.48 , $679.68 
"Revise Eyelashes,Forceps",CPT® 67820,N/A,N/A,N/A, $356.00 , $231.40 , $136.89 , $21.46 , $24.58 , $302.85 , $286.04 , $331.08 , $320.40 , $320.40 , $284.80 , $284.80 , $24.58 , $328.69 , $338.20 , $320.40 , $320.40 , $320.40 , $331.08 , $341.76 , $191.25 , $302.60 , $294.37 , $308.28 , N/A , $308.77 , $308.77 , $338.20 , $340.84 , $21.46 , $341.76 
 Sc Bx Bone Superficial ,CPT® 20220,0361 - OR/MINOR,N/A,N/A, $758.00 , $492.70 , $636.72 , $84.16 , $94.28 , $612.46 , $682.20 , $641.72 , $682.20 , $682.20 , $682.20 , $644.30 , $92.43 , $699.86 , $720.10 , $644.30 , $704.94 , $704.94 , $720.10 , $727.68 , $620.20 , $682.20 , $644.30 , $598.82 , N/A , $613.45 , $613.45 , $720.10 , $650.44 , $84.16 , $727.68 
"Destruct,Vaginal Lesion(S),Extensive",CPT® 57065,N/A,N/A,N/A," $2,212.00 "," $1,437.80 ", $882.75 , $179.03 , $306.23 , $710.08 , $700.54 ," $2,057.16 "," $1,990.80 "," $1,990.80 "," $1,769.60 "," $1,769.60 ", $306.23 ," $2,042.34 "," $2,101.40 "," $1,990.80 "," $1,990.80 "," $1,990.80 "," $2,057.16 "," $2,123.52 ", $911.85 ," $1,880.20 ", $918.79 , $711.20 , N/A , $723.93 , $723.93 ," $2,101.40 ", $868.32 , $179.03 ," $2,123.52 "
Correct Skin Colr Defct Addn 20sq Cm,CPT® 11922,N/A,N/A,N/A, $447.00 , $290.55 , $91.83 , $27.21 , $48.11 , $81.19 , $78.55 , $415.71 , $402.30 , $402.30 , $357.60 , $357.60 , $48.11 , $412.72 , $424.65 , $402.30 , $402.30 , $402.30 , $415.71 , $429.12 , $101.27 , $379.95 , $157.00 , $103.80 , N/A , $82.77 , $82.77 , $424.65 , $96.00 , $27.21 , $429.12 
 NIVOLUMAB 240 MG/24ML IV SOLN ,HCPCS J9299,0636 - DRUGS REQUIRING DETAILED CODIN,00003-3734-13,24 mL," $21,576.54 "," $14,024.75 "," $18,124.29 ", $31.07 , $30.60 ," $17,433.84 "," $19,418.89 "," $18,266.70 "," $19,418.89 "," $19,418.89 "," $19,418.89 "," $18,340.06 ", $30.00 ," $19,921.62 "," $20,497.71 "," $18,340.06 "," $20,066.18 "," $20,066.18 "," $20,497.71 "," $20,713.48 "," $17,653.93 "," $19,418.89 "," $18,340.06 "," $17,045.47 ", N/A ," $17,461.89 "," $17,461.89 "," $20,497.71 "," $18,514.83 ", $30.00 ," $20,713.48 "
Methotrexate Sodium Inj,HCPCS J9260,N/A,N/A,N/A, $9.00 , $5.85 , N/A , $2.76 , $2.50 , N/A , N/A , $8.37 , $8.10 , $8.10 , $7.20 , $7.20 , $2.50 , $8.31 , $8.55 , $8.10 , $8.10 , $8.10 , $8.37 , $8.64 , $2.90 , $7.65 , $3.89 , $3.67 , N/A , N/A , N/A , $8.55 , N/A , $2.50 , $8.64 
Destruc Mouth Lesion/Scar,CPT® 40820,N/A,N/A,N/A," $1,856.00 "," $1,206.40 "," $1,059.50 ", $162.76 , $30.71 , $844.72 , $887.08 ," $1,726.08 "," $1,670.40 "," $1,670.40 "," $1,484.80 "," $1,484.80 ", $30.71 ," $1,713.64 "," $1,763.20 "," $1,670.40 "," $1,670.40 "," $1,670.40 "," $1,726.08 "," $1,781.76 ", $765.18 ," $1,577.60 ", $963.39 , $995.17 , N/A , $861.20 , $861.20 ," $1,763.20 ", $900.72 , $30.71 ," $1,781.76 "
"Knee Scope, W/Lateral Release",CPT® 29873,N/A,N/A,N/A," $3,447.00 "," $2,240.55 "," $3,291.41 ", $516.47 , $452.38 ," $2,534.68 "," $2,544.11 "," $3,205.71 "," $3,102.30 "," $3,102.30 "," $2,757.60 "," $2,757.60 ", $452.38 ," $3,182.62 "," $3,274.65 "," $3,102.30 "," $3,102.30 "," $3,102.30 "," $3,205.71 "," $3,309.12 "," $3,043.70 "," $2,929.95 "," $2,802.76 "," $2,997.14 ", N/A ," $2,584.13 "," $2,584.13 "," $3,274.65 "," $3,037.27 ", $452.38 ," $3,309.12 "
 LACTATED RINGERS BOLUS ,HCPCS RXA258,0258 - IV SOLUTIONS,00338-0117-04,"1,000 mL", $79.82 , $51.88 , $67.05 , N/A , N/A , $64.49 , $71.84 , $67.58 , $71.84 , $71.84 , $71.84 , $67.85 , N/A , $73.70 , $75.83 , $67.85 , $74.23 , $74.23 , $75.83 , $76.63 , $65.31 , $71.84 , $67.85 , $63.06 , N/A , $64.60 , $64.60 , $75.83 , $68.49 , $63.06 , $76.63 
Repair Fibula Nonunion/Malunion W Int Fixation,CPT® 27726,N/A,N/A,N/A," $6,348.00 "," $4,126.20 "," $5,812.17 ", $908.28 , $639.90 ," $4,666.78 "," $4,672.79 "," $5,903.64 "," $5,713.20 "," $5,713.20 "," $5,078.40 "," $5,078.40 ", $639.90 ," $5,861.11 "," $6,030.60 "," $5,713.20 "," $5,713.20 "," $5,713.20 "," $5,903.64 "," $6,094.08 "," $5,410.15 "," $5,395.80 "," $5,166.65 "," $5,462.45 ", N/A ," $4,757.83 "," $4,757.83 "," $6,030.60 "," $5,592.14 ", $639.90 ," $6,094.08 "
"Vag Hyst,Rmv Tube/Ovary,Fix Enteroce",CPT® 58263,N/A,N/A,N/A," $6,571.00 "," $4,271.15 "," $4,685.20 ", $947.74 , $997.91 ," $4,026.77 "," $4,017.69 "," $6,111.03 "," $5,913.90 "," $5,913.90 "," $5,256.80 "," $5,256.80 ", $997.91 ," $6,067.00 "," $6,242.45 "," $5,913.90 "," $5,913.90 "," $5,913.90 "," $6,111.03 "," $6,308.16 "," $4,904.76 "," $5,585.35 "," $5,286.18 "," $4,035.30 ", N/A ," $4,105.35 "," $4,105.35 "," $6,242.45 "," $4,924.10 ", $947.74 ," $6,308.16 "
Hereditary Colon Ca Synd Dup/Del Analys 8 Genes,CPT® 81436,N/A,N/A,N/A," $3,167.00 "," $2,058.55 ", N/A , $596.60 , $596.60 , N/A , N/A ," $2,945.31 "," $2,850.30 "," $2,850.30 "," $2,533.60 "," $2,533.60 ", $596.60 ," $2,924.09 "," $3,008.65 "," $2,850.30 "," $2,850.30 "," $2,850.30 "," $2,945.31 "," $3,040.32 "," $3,905.51 "," $2,691.95 "," $2,788.13 "," $2,120.81 ", N/A ," $2,322.05 "," $2,322.05 "," $3,008.65 "," $2,532.62 ", $596.60 ," $3,905.51 "
 Pt Diathermy ,CPT® 97024,0420 - PHYSICAL THERAPY,N/A,N/A, $126.00 , $81.90 , $105.84 , $7.11 , $20.39 , $101.81 , $113.40 , $106.67 , $113.40 , $113.40 , $113.40 , $107.10 , $19.99 , $116.34 , $119.70 , $107.10 , $117.18 , $117.18 , $119.70 , $120.96 , $103.09 , $113.40 , $107.10 , $99.54 , N/A , $101.97 , $101.97 , $119.70 , $108.12 , $7.11 , $120.96 
 Fac Imhistochem/Cytchm Ea Addl Antibody Slide ,CPT® 88341,0310 - PATHOLOGY LAB,N/A,N/A, $488.00 , $317.20 , $409.92 , $85.14 , $52.77 , $394.30 , $439.20 , $413.14 , $439.20 , $439.20 , $439.20 , $414.80 , $51.74 , $450.57 , $463.60 , $414.80 , $453.84 , $453.84 , $463.60 , $468.48 , $399.28 , $439.20 , $414.80 , $385.52 , N/A , $394.94 , $394.94 , $463.60 , $418.75 , $51.74 , $468.48 
"Hepatitis C, Rna, Quant",CPT® 87522,N/A,N/A,N/A, $396.00 , $257.40 , N/A , $43.70 , $43.70 , $242.34 , $289.89 , $368.28 , $356.40 , $356.40 , $316.80 , $316.80 , $43.70 , $365.63 , $376.20 , $356.40 , $356.40 , $356.40 , $368.28 , $380.16 , $286.05 , $336.60 , $280.58 , $155.31 , N/A , $226.17 , $226.17 , $376.20 , $247.15 , $43.70 , $380.16 
 Duplex of Abd Retroperitoneal Ltd ,CPT® 93976,0921 - PERI VASCUL LAB,N/A,N/A," $1,224.00 ", $795.60 ," $1,028.16 ", $140.61 , $182.49 , $988.99 ," $1,101.60 "," $1,036.24 "," $1,101.60 "," $1,101.60 "," $1,101.60 "," $1,040.40 ", $178.91 ," $1,130.12 "," $1,162.80 "," $1,040.40 "," $1,138.32 "," $1,138.32 "," $1,162.80 "," $1,175.04 "," $1,001.48 "," $1,101.60 "," $1,040.40 ", $966.96 , N/A , $990.58 , $990.58 ," $1,162.80 "," $1,050.31 ", $140.61 ," $1,175.04 "
 Hysterosonography US ,CPT® 76831,0402 - ULTRASOUND,N/A,N/A, $584.00 , $379.60 , $490.56 , $115.52 , $86.37 , $471.87 , $525.60 , $494.41 , $525.60 , $525.60 , $525.60 , $496.40 , $84.68 , $539.21 , $554.80 , $496.40 , $543.12 , $543.12 , $554.80 , $560.64 , $477.83 , $525.60 , $496.40 , $461.36 , N/A , $472.63 , $472.63 , $554.80 , $501.13 , $84.68 , $560.64 
 EPHEDRINE SULFATE-NACL 50-0.9 MG/5ML-% IV SOSY ,HCPCS RXA250,0250 - PHARMACY,70004-0605-09,0.5 mL, $27.84 , $18.10 , $23.39 , N/A , N/A , $22.49 , $25.06 , $23.57 , $25.06 , $25.06 , $25.06 , $23.66 , N/A , $25.70 , $26.45 , $23.66 , $25.89 , $25.89 , $26.45 , $26.73 , $22.78 , $25.06 , $23.66 , $21.99 , N/A , $22.53 , $22.53 , $26.45 , $23.89 , $21.99 , $26.73 
 Pro Appl Short Arm Splnt F/Arm-Hand Static ,CPT® 29125,0982 - PRO FEE/OUTPT,N/A,N/A, $428.00 , $278.20 , $241.35 , $38.40 , $27.51 , $190.75 , $194.03 , $398.04 , $385.20 , $385.20 , $342.40 , $342.40 , $27.51 , $395.17 , $406.60 , $385.20 , $385.20 , $385.20 , $398.04 , $410.88 , $223.62 , $363.80 , $212.30 , $229.45 , N/A , $194.47 , $194.47 , $406.60 , $228.57 , $27.51 , $410.88 
" Fac Immunoassay,Infectious Agent ",CPT® 86317,0302 - LAB/IMMUNOLOGY,N/A,N/A, $138.00 , $89.70 , $115.92 , $15.29 , $15.29 , $111.50 , $124.20 , $116.83 , $124.20 , $124.20 , $124.20 , $117.30 , $14.99 , $127.42 , $131.10 , $117.30 , $128.34 , $128.34 , $131.10 , $132.48 , $112.91 , $124.20 , $117.30 , $109.02 , N/A , $111.68 , $111.68 , $131.10 , $118.42 , $14.99 , $132.48 
" NIPPLE OINTMENT (BETAMETHASONE, MUPIROCIN, MICONAZOLE) 2.5 G ",HCPCS RXC637,0250 - PHARMACY,00001-1008-01,2.5 gram, $73.31 , $47.65 , $61.58 , N/A , N/A , $59.23 , $65.98 , $62.06 , $65.98 , $65.98 , $65.98 , $62.31 , N/A , $67.69 , $69.64 , $62.31 , $68.18 , $68.18 , $69.64 , $70.38 , $59.98 , $65.98 , $62.31 , $57.91 , N/A , $59.33 , $59.33 , $69.64 , $62.91 , $57.91 , $70.38 
 IMIPRAMINE HCL 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,49884-0055-01,1 tablet, $3.69 , $2.40 , $3.10 , N/A , N/A , $2.98 , $3.32 , $3.12 , $3.32 , $3.32 , $3.32 , $3.14 , N/A , $3.41 , $3.51 , $3.14 , $3.43 , $3.43 , $3.51 , $3.54 , $3.02 , $3.32 , $3.14 , $2.92 , N/A , $2.99 , $2.99 , $3.51 , $3.17 , $2.92 , $3.54 
Ko Immobilizer Canvas Longit,HCPCS L1830,N/A,N/A,N/A, $151.00 , $98.15 , N/A , $75.49 , $53.78 , N/A , N/A , $140.43 , $135.90 , $135.90 , $120.80 , $120.80 , $53.78 , $139.42 , $143.45 , $135.90 , $135.90 , $135.90 , $140.43 , $144.96 , N/A , $128.35 , $88.23 , $81.87 , N/A , N/A , N/A , $143.45 , N/A , $53.78 , $144.96 
Office/Outpatient New Low Mdm 30-44 Minutes,99203,N/A,N/A,N/A, $291.00 , $189.15 , $165.80 , $79.48 , $75.25 , $131.82 , $131.48 , $270.63 , $261.90 , $261.90 , $232.80 , $232.80 , $75.25 , $268.68 , $276.45 , $261.90 , $261.90 , $261.90 , $270.63 , $279.36 , $150.96 , $247.35 , $165.77 , $165.41 , $52.50 , $134.39 , $134.39 , $276.45 , $155.01 , $52.50 , $279.36 
"Reconstruc Eyelid,Second Stage",CPT® 67975,N/A,N/A,N/A," $6,089.00 "," $3,957.85 "," $4,185.09 ", $656.63 , $122.93 ," $3,877.35 "," $3,660.44 "," $5,662.77 "," $5,480.10 "," $5,480.10 "," $4,871.20 "," $4,871.20 ", $122.93 ," $5,621.97 "," $5,784.55 "," $5,480.10 "," $5,480.10 "," $5,480.10 "," $5,662.77 "," $5,845.44 "," $5,749.10 "," $5,175.65 "," $3,803.62 "," $4,914.10 ", N/A ," $3,953.01 "," $3,953.01 "," $5,784.55 "," $4,363.60 ", $122.93 ," $5,845.44 "
Rem Interrog Pm/Ldls Pm <90 D Phys/Qhp,CPT® 93294,N/A,N/A,N/A, $297.00 , $193.05 , $188.50 , $29.05 , $28.70 , $184.96 , $183.96 , $276.21 , $267.30 , $267.30 , $237.60 , $237.60 , $28.70 , $274.22 , $282.15 , $267.30 , $267.30 , $267.30 , $276.21 , $285.12 , $186.42 , $252.45 , $171.27 , $116.12 , N/A , $188.57 , $188.57 , $282.15 , $209.02 , $28.70 , $285.12 
"Colposcopy,Vulva,W/Biopsy(S)",CPT® 56821,N/A,N/A,N/A, $880.00 , $572.00 , $528.60 , $106.83 , $135.52 , $469.97 , $464.00 , $818.40 , $792.00 , $792.00 , $704.00 , $704.00 , $135.52 , $812.50 , $836.00 , $792.00 , $792.00 , $792.00 , $818.40 , $844.80 , $554.22 , $748.00 , $610.15 , $471.32 , N/A , $479.15 , $479.15 , $836.00 , $574.70 , $106.83 , $844.80 
Drain Skin Abscess Simple,10060,N/A,N/A,N/A, $464.00 , $301.60 , $340.58 , $102.58 , $41.23 , $265.18 , $259.37 , $431.52 , $417.60 , $417.60 , $371.20 , $371.20 , $41.23 , $428.41 , $440.80 , $417.60 , $417.60 , $417.60 , $431.52 , $445.44 , $366.26 , $394.40 , $512.03 , $344.96 , N/A , $270.35 , $270.35 , $440.80 , $313.53 , $41.23 , $512.03 
 Fac Viscer and Infrarenal Abdom Aorta 2 Prosthesis ,CPT® 34846,0360 - OR SERVICES,N/A,N/A," $4,739.00 "," $3,080.35 "," $3,980.76 "," $3,124.30 ", N/A ," $3,829.11 "," $4,265.10 "," $4,012.04 "," $4,265.10 "," $4,265.10 "," $4,265.10 "," $4,028.15 ", N/A ," $4,375.52 "," $4,502.05 "," $4,028.15 "," $4,407.27 "," $4,407.27 "," $4,502.05 "," $4,549.44 "," $3,877.45 "," $4,265.10 "," $4,028.15 "," $3,743.81 ", N/A ," $3,835.27 "," $3,835.27 "," $4,502.05 "," $4,066.54 "," $3,124.30 "," $4,549.44 "
 Fac Byp Oth/Thn Vein Aortoceliac Aortomsn Aortornl ,CPT® 35631,0360 - OR SERVICES,N/A,N/A," $2,691.00 "," $1,749.15 "," $2,260.44 "," $1,640.80 "," $1,993.16 "," $2,174.33 "," $2,421.90 "," $2,278.20 "," $2,421.90 "," $2,421.90 "," $2,421.90 "," $2,287.35 "," $1,954.08 "," $2,484.60 "," $2,556.45 "," $2,287.35 "," $2,502.63 "," $2,502.63 "," $2,556.45 "," $2,583.36 "," $2,201.78 "," $2,421.90 "," $2,287.35 "," $2,125.89 ", N/A ," $2,177.83 "," $2,177.83 "," $2,556.45 "," $2,309.15 "," $1,640.80 "," $2,583.36 "
"Remove FB,Intranasal",CPT® 30300,N/A,N/A,N/A, $814.00 , $529.10 , $688.10 , $121.29 , $64.81 , $481.74 , $495.34 , $757.02 , $732.60 , $732.60 , $651.20 , $651.20 , $64.81 , $751.57 , $773.30 , $732.60 , $732.60 , $732.60 , $757.02 , $781.44 , $637.33 , $691.90 , $695.78 , $541.12 , N/A , $491.14 , $491.14 , $773.30 , $578.42 , $64.81 , $781.44 
"Lap, Repair Paraesophageal Hernia, Incl Fundoplasty W/ Mesh",43282,N/A,N/A,N/A," $11,471.00 "," $7,456.15 "," $10,226.26 "," $1,580.54 "," $1,453.36 "," $8,156.96 "," $8,197.06 "," $10,668.03 "," $10,323.90 "," $10,323.90 "," $9,176.80 "," $9,176.80 "," $1,453.36 "," $10,591.17 "," $10,897.45 "," $10,323.90 "," $10,323.90 "," $10,323.90 "," $10,668.03 "," $11,012.16 "," $7,344.18 "," $9,750.35 "," $9,137.98 "," $9,590.48 ", N/A ," $8,316.11 "," $8,316.11 "," $10,897.45 "," $8,697.77 "," $1,453.36 "," $11,012.16 "
Mod Sed Same Phys/Qhp Initial 15 Mins 5/> Yrs,CPT® 99152,N/A,N/A,N/A, $160.00 , $104.00 , $28.01 , $11.70 , $40.63 , $26.51 , $27.37 , $148.80 , $144.00 , $144.00 , $128.00 , $128.00 , $40.63 , $147.73 , $152.00 , $144.00 , $144.00 , $144.00 , $148.80 , $153.60 , $37.64 , $136.00 , $37.36 , $46.92 , N/A , $27.03 , $27.03 , $152.00 , $31.50 , $11.70 , $153.60 
Nipple Exploration,19110,N/A,N/A,N/A," $1,187.00 ", $771.55 ," $1,110.47 ", $331.23 , $312.04 , $919.74 , $909.39 ," $1,103.91 "," $1,068.30 "," $1,068.30 ", $949.60 , $949.60 , $312.04 ," $1,095.96 "," $1,127.65 "," $1,068.30 "," $1,068.30 "," $1,068.30 "," $1,103.91 "," $1,139.52 "," $1,212.16 "," $1,008.95 "," $1,826.88 "," $1,174.09 ", N/A , $937.68 , $937.68 ," $1,127.65 "," $1,087.40 ", $312.04 ," $1,826.88 "
" Fac Blood Serology, Quantitative ",CPT® 86593,0302 - LAB/IMMUNOLOGY,N/A,N/A, $55.00 , $35.75 , $46.20 , $4.49 , $4.49 , $44.44 , $49.50 , $46.56 , $49.50 , $49.50 , $49.50 , $46.75 , $4.40 , $50.78 , $52.25 , $46.75 , $51.15 , $51.15 , $52.25 , $52.80 , $45.00 , $49.50 , $46.75 , $43.45 , N/A , $44.51 , $44.51 , $52.25 , $47.20 , $4.40 , $52.80 
 Pro Diagnostic Lumbar Spinal Puncture ,CPT® 62270,0982 - PRO FEE/OUTPT,N/A,N/A," $1,057.00 ", $687.05 , $298.01 , $58.13 , $157.45 , $435.77 , $418.02 , $983.01 , $951.30 , $951.30 , $845.60 , $845.60 , $157.45 , $975.93 ," $1,004.15 ", $951.30 , $951.30 , $951.30 , $983.01 ," $1,014.72 ", $322.97 , $898.45 , $413.90 , $464.99 , N/A , $444.28 , $444.28 ," $1,004.15 ", $476.62 , $58.13 ," $1,014.72 "
"Shldr Arthroscop,Diagnostic",CPT® 29805,N/A,N/A,N/A," $3,101.00 "," $2,015.65 "," $2,865.27 ", $450.43 , $220.85 ," $2,279.09 "," $2,278.31 "," $2,883.93 "," $2,790.90 "," $2,790.90 "," $2,480.80 "," $2,480.80 ", $220.85 ," $2,863.15 "," $2,945.95 "," $2,790.90 "," $2,790.90 "," $2,790.90 "," $2,883.93 "," $2,976.96 "," $2,675.10 "," $2,635.85 "," $2,513.75 "," $2,686.95 ", N/A ," $2,323.56 "," $2,323.56 "," $2,945.95 "," $2,731.01 ", $220.85 ," $2,976.96 "
"Exc Skin Malig >4cm Face,Facial",CPT® 11646,N/A,N/A,N/A," $2,592.00 "," $1,684.80 "," $1,240.69 ", $369.64 , $684.49 ," $1,081.06 "," $1,046.74 "," $2,410.56 "," $2,332.80 "," $2,332.80 "," $2,073.60 "," $2,073.60 ", $684.49 ," $2,393.19 "," $2,462.40 "," $2,332.80 "," $2,332.80 "," $2,332.80 "," $2,410.56 "," $2,488.32 "," $1,362.75 "," $2,203.20 "," $2,094.49 "," $1,374.50 ", N/A ," $1,102.15 "," $1,102.15 "," $2,462.40 "," $1,278.11 ", $369.64 ," $2,488.32 "
Repair Non/Malunion Humerus,CPT® 24430,N/A,N/A,N/A," $7,268.00 "," $4,724.20 "," $6,389.50 "," $1,000.90 "," $1,075.74 "," $5,098.31 "," $5,062.82 "," $6,759.24 "," $6,541.20 "," $6,541.20 "," $5,814.40 "," $5,814.40 "," $1,075.74 "," $6,710.54 "," $6,904.60 "," $6,541.20 "," $6,541.20 "," $6,541.20 "," $6,759.24 "," $6,977.28 "," $5,950.43 "," $6,177.80 "," $5,596.61 "," $6,000.96 ", N/A ," $5,197.80 "," $5,197.80 "," $6,904.60 "," $6,109.24 "," $1,000.90 "," $6,977.28 "
 Fac Assay of Homocystine ,CPT® 83090,0301 - LAB/CHEMISTRY,N/A,N/A, $177.00 , $115.05 , $148.68 , $18.28 , $18.28 , $143.02 , $159.30 , $149.85 , $159.30 , $159.30 , $159.30 , $150.45 , $17.92 , $163.42 , $168.15 , $150.45 , $164.61 , $164.61 , $168.15 , $169.92 , $144.82 , $159.30 , $150.45 , $139.83 , N/A , $143.25 , $143.25 , $168.15 , $151.88 , $17.92 , $169.92 
 LINEZOLID 600 MG/300ML IV SOLN ,HCPCS J2020,0636 - DRUGS REQUIRING DETAILED CODIN,00009-5140-04,300 mL, $203.43 , $132.23 , $170.88 , $3.54 , $3.50 , $164.37 , $183.09 , $172.22 , $183.09 , $183.09 , $183.09 , $172.92 , $3.43 , $187.83 , $193.26 , $172.92 , $189.19 , $189.19 , $193.26 , $195.29 , $166.45 , $183.09 , $172.92 , $160.71 , N/A , $164.64 , $164.64 , $193.26 , $174.56 , $3.43 , $195.29 
 TOCILIZUMAB 400 MG/20ML IV SOLN ,HCPCS J3262,0636 - DRUGS REQUIRING DETAILED CODIN,50242-0137-01,20 mL," $7,808.93 "," $5,075.80 "," $6,559.50 ", $6.03 , $6.11 ," $6,309.62 "," $7,028.04 "," $6,611.04 "," $7,028.04 "," $7,028.04 "," $7,028.04 "," $6,637.59 ", $5.99 ," $7,209.99 "," $7,418.48 "," $6,637.59 "," $7,262.30 "," $7,262.30 "," $7,418.48 "," $7,496.57 "," $6,389.27 "," $7,028.04 "," $6,637.59 "," $6,169.05 ", N/A ," $6,319.77 "," $6,319.77 "," $7,418.48 "," $6,700.84 ", $5.99 ," $7,496.57 "
 Pro Removal of Skin Tags ,CPT® 11200,0982 - PRO FEE/OUTPT,N/A,N/A, $337.00 , $219.05 , $244.80 , $74.08 , $40.50 , $199.18 , $197.46 , $313.41 , $303.30 , $303.30 , $269.60 , $269.60 , $40.50 , $311.15 , $320.15 , $303.30 , $303.30 , $303.30 , $313.41 , $323.52 , $265.13 , $286.45 , $390.71 , $259.40 , N/A , $203.07 , $203.07 , $320.15 , $235.48 , $40.50 , $390.71 
 Fac Water Culture ,Custom 331577,0306 - LAB/BACT-MICRO,N/A,N/A, $27.00 , $17.55 , $22.68 , N/A , N/A , $21.82 , $24.30 , $22.86 , $24.30 , $24.30 , $24.30 , $22.95 , N/A , $24.93 , $25.65 , $22.95 , $25.11 , $25.11 , $25.65 , $25.92 , $22.09 , $24.30 , $22.95 , $21.33 , N/A , $21.85 , $21.85 , $25.65 , $23.17 , $21.33 , $25.92 
Atria Ablate &Rcnstj W Other Px Extensive W Byp,CPT® 33259,N/A,N/A,N/A," $5,822.00 "," $3,784.30 "," $4,974.06 ", $770.29 , $648.33 ," $3,609.62 "," $3,614.58 "," $5,414.46 "," $5,239.80 "," $5,239.80 "," $4,657.60 "," $4,657.60 ", $648.33 ," $5,375.45 "," $5,530.90 "," $5,239.80 "," $5,239.80 "," $5,239.80 "," $5,414.46 "," $5,589.12 "," $4,597.71 "," $4,948.70 "," $4,565.42 "," $4,067.14 ", N/A ," $3,680.05 "," $3,680.05 "," $5,530.90 "," $4,180.55 ", $648.33 ," $5,589.12 "
 Fac Afo Plastic ,HCPCS L1930,0274 - PROSTHETIC DEV,N/A,N/A, $311.00 , $202.15 , $261.24 , $294.69 , $172.96 , $251.29 , $279.90 , $263.29 , $279.90 , $279.90 , $279.90 , $264.35 , $169.57 , $287.15 , $295.45 , $264.35 , $289.23 , $289.23 , $295.45 , $298.56 , $254.46 , $279.90 , $264.35 , $245.69 , N/A , $251.69 , $251.69 , $295.45 , $266.87 , $169.57 , $298.56 
Immunoassay Nonantibody,CPT® 83519,N/A,N/A,N/A, $217.00 , $141.05 , N/A , $18.77 , $18.76 , $76.45 , $91.43 , $201.81 , $195.30 , $195.30 , $173.60 , $173.60 , $18.76 , $200.36 , $206.15 , $195.30 , $195.30 , $195.30 , $201.81 , $208.32 , $122.86 , $184.45 , $89.20 , $54.04 , N/A , $71.35 , $71.35 , $206.15 , $77.97 , $18.76 , $208.32 
Inj Testostero Enanthate 1mg,HCPCS J3121,N/A,N/A,N/A, $0.15 , $0.10 , N/A , $0.05 , $0.05 , N/A , N/A , $0.14 , $0.14 , $0.14 , $0.12 , $0.12 , $0.05 , $0.14 , $0.14 , $0.14 , $0.14 , $0.14 , $0.14 , $0.14 , $0.07 , $0.13 , $0.65 , $0.07 , N/A , N/A , N/A , $0.14 , N/A , $0.05 , $0.65 
"Repr,Dural/CSF Leak,W/Laminectomy",CPT® 63709,N/A,N/A,N/A," $7,180.00 "," $4,667.00 "," $5,231.46 "," $1,021.87 ", $933.03 ," $5,987.76 "," $5,790.15 "," $6,677.40 "," $6,462.00 "," $6,462.00 "," $5,744.00 "," $5,744.00 ", $933.03 ," $6,629.29 "," $6,821.00 "," $6,462.00 "," $6,462.00 "," $6,462.00 "," $6,677.40 "," $6,892.80 "," $5,636.32 "," $6,103.00 "," $5,864.22 "," $6,300.75 ", N/A ," $6,104.59 "," $6,104.59 "," $6,821.00 "," $6,548.80 ", $933.03 ," $6,892.80 "
 ENOXAPARIN SODIUM 100 MG/ML IJ SOSY ,HCPCS J1650,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0586-96,1 mL, $57.46 , $37.35 , $48.27 , $0.69 , $0.83 , $46.43 , $51.71 , $48.65 , $51.71 , $51.71 , $51.71 , $48.84 , $0.81 , $53.05 , $54.59 , $48.84 , $53.44 , $53.44 , $54.59 , $55.16 , $47.01 , $51.71 , $48.84 , $45.39 , N/A , $46.50 , $46.50 , $54.59 , $49.31 , $0.69 , $55.16 
 Fac Assay of Serum Sodium ,CPT® 84295,0301 - LAB/CHEMISTRY,N/A,N/A, $63.00 , $40.95 , $52.92 , $4.91 , $4.91 , $50.90 , $56.70 , $53.34 , $56.70 , $56.70 , $56.70 , $53.55 , $4.81 , $58.17 , $59.85 , $53.55 , $58.59 , $58.59 , $59.85 , $60.48 , $51.55 , $56.70 , $53.55 , $49.77 , N/A , $50.99 , $50.99 , $59.85 , $54.06 , $4.81 , $60.48 
Cast Sup Sht Leg Splnt Fbrgl,HCPCS Q4046,N/A,N/A,N/A, $41.00 , $26.65 , N/A , $22.63 , $13.82 , N/A , N/A , $38.13 , $36.90 , $36.90 , $32.80 , $32.80 , $13.82 , $37.86 , $38.95 , $36.90 , $36.90 , $36.90 , $38.13 , $39.36 , N/A , $34.85 , $67.47 , $20.56 , N/A , N/A , N/A , $38.95 , N/A , $13.82 , $67.47 
 PREGABALIN 150 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-7002-61,1 capsule, $5.87 , $3.82 , $4.93 , N/A , N/A , $4.74 , $5.28 , $4.97 , $5.28 , $5.28 , $5.28 , $4.99 , N/A , $5.42 , $5.58 , $4.99 , $5.46 , $5.46 , $5.58 , $5.64 , $4.80 , $5.28 , $4.99 , $4.64 , N/A , $4.75 , $4.75 , $5.58 , $5.04 , $4.64 , $5.64 
 Fac Assay Activated Protein C ,CPT® 85307,0305 - LAB/HEMATOLOGY,N/A,N/A, $236.00 , $153.40 , $198.24 , $15.63 , $15.63 , $190.69 , $212.40 , $199.80 , $212.40 , $212.40 , $212.40 , $200.60 , $15.32 , $217.90 , $224.20 , $200.60 , $219.48 , $219.48 , $224.20 , $226.56 , $193.10 , $212.40 , $200.60 , $186.44 , N/A , $190.99 , $190.99 , $224.20 , $202.51 , $15.32 , $226.56 
"PPPS, initial visit",G0438,N/A,N/A,N/A, $276.00 , $179.40 , $402.88 , $161.76 , N/A , $315.97 , $372.56 , $256.68 , $248.40 , $248.40 , $220.80 , $220.80 , N/A , $254.83 , $262.20 , $248.40 , $248.40 , $248.40 , $256.68 , $264.96 , $449.07 , $234.60 , $323.08 , $365.15 , N/A , $322.13 , $322.13 , $262.20 , $402.66 , $161.76 , $449.07 
 HYDROXYUREA 500 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-6939-61,1 capsule, $5.95 , $3.87 , $5.00 , N/A , N/A , $4.81 , $5.36 , $5.04 , $5.36 , $5.36 , $5.36 , $5.06 , N/A , $5.49 , $5.65 , $5.06 , $5.53 , $5.53 , $5.65 , $5.71 , $4.87 , $5.36 , $5.06 , $4.70 , N/A , $4.82 , $4.82 , $5.65 , $5.11 , $4.70 , $5.71 
 Fac Assay of Iron ,CPT® 83540,0301 - LAB/CHEMISTRY,N/A,N/A, $80.00 , $52.00 , $67.20 , $6.60 , $6.60 , $64.64 , $72.00 , $67.73 , $72.00 , $72.00 , $72.00 , $68.00 , $6.47 , $73.86 , $76.00 , $68.00 , $74.40 , $74.40 , $76.00 , $76.80 , $65.46 , $72.00 , $68.00 , $63.20 , N/A , $64.74 , $64.74 , $76.00 , $68.65 , $6.47 , $76.80 
Ex Tum/Vasc Malf Sft Tiss Hand/Fngr Subq 1.5+Cm,CPT® 26111,N/A,N/A,N/A," $1,744.00 "," $1,133.60 "," $2,539.36 ", $399.37 , $339.42 ," $2,015.05 "," $2,007.22 "," $1,621.92 "," $1,569.60 "," $1,569.60 "," $1,395.20 "," $1,395.20 ", $339.42 ," $1,610.24 "," $1,656.80 "," $1,569.60 "," $1,569.60 "," $1,569.60 "," $1,621.92 "," $1,674.24 "," $2,359.82 "," $1,482.40 "," $2,210.46 "," $2,388.56 ", N/A ," $2,054.36 "," $2,054.36 "," $1,656.80 "," $2,414.60 ", $339.42 ," $2,539.36 "
Drug Test Def Simple All Cl,HCPCS G0659,N/A,N/A,N/A, $515.00 , $334.75 , N/A , $63.38 , $63.38 , $196.01 , N/A , $478.95 , $463.50 , $463.50 , $412.00 , $412.00 , $63.38 , $475.50 , $489.25 , $463.50 , $463.50 , $463.50 , $478.95 , $494.40 , $414.92 , $437.75 , $118.25 , $210.96 , N/A , $199.84 , $199.84 , $489.25 , $249.80 , $63.38 , $494.40 
 ELOTUZUMAB 300 MG IV SOLR ,HCPCS J9176,0636 - DRUGS REQUIRING DETAILED CODIN,00003-2291-11,12 mL," $6,305.21 "," $4,098.39 "," $5,296.38 ", $7.33 , $7.20 ," $5,094.61 "," $5,674.69 "," $5,337.99 "," $5,674.69 "," $5,674.69 "," $5,674.69 "," $5,359.43 ", $7.06 ," $5,821.60 "," $5,989.95 "," $5,359.43 "," $5,863.85 "," $5,863.85 "," $5,989.95 "," $6,053.00 "," $5,158.92 "," $5,674.69 "," $5,359.43 "," $4,981.12 ", N/A ," $5,102.81 "," $5,102.81 "," $5,989.95 "," $5,410.50 ", $7.06 ," $6,053.00 "
 Pro Cytogenetics & Molecular Cytogenetics Intrp/Rprt ,CPT® 88291,0971 - PRO FEE/LAB,N/A,N/A, $457.00 , $297.05 , $117.55 , $31.99 , $5.77 , $127.51 , $140.52 , $425.01 , $411.30 , $411.30 , $365.60 , $365.60 , $5.77 , $421.95 , $434.15 , $411.30 , $411.30 , $411.30 , $425.01 , $438.72 , $213.87 , $388.45 , $145.97 , $115.94 , N/A , $119.00 , $119.00 , $434.15 , $130.77 , $5.77 , $438.72 
"Enzyme Cell Activity, Each",CPT® 82657,N/A,N/A,N/A, $447.00 , $290.55 , N/A , $22.61 , $22.61 , $102.19 , $122.20 , $415.71 , $402.30 , $402.30 , $357.60 , $357.60 , $22.61 , $412.72 , $424.65 , $402.30 , $402.30 , $402.30 , $415.71 , $429.12 , $148.03 , $379.95 , $118.39 , $65.47 , N/A , $95.37 , $95.37 , $424.65 , $104.22 , $22.61 , $429.12 
Methylprednisolone 20 Mg Inj,HCPCS J1020,N/A,N/A,N/A, $12.00 , $7.80 , N/A , $7.31 , $4.70 , N/A , N/A , $11.16 , $10.80 , $10.80 , $9.60 , $9.60 , $4.70 , $11.08 , $11.40 , $10.80 , $10.80 , $10.80 , $11.16 , $11.52 , $3.94 , $10.20 , $5.84 , $1.94 , N/A , N/A , N/A , $11.40 , N/A , $1.94 , $11.52 
" Neck, Soft Tissue 1 or 2 Views ",CPT® 70360,0320 - DX X-RAY,N/A,N/A, $314.00 , $204.10 , $263.76 , $31.07 , $26.21 , $253.71 , $282.60 , $265.83 , $282.60 , $282.60 , $282.60 , $266.90 , $25.70 , $289.92 , $298.30 , $266.90 , $292.02 , $292.02 , $298.30 , $301.44 , $256.91 , $282.60 , $266.90 , $248.06 , N/A , $254.12 , $254.12 , $298.30 , $269.44 , $25.70 , $301.44 
 Pro Office/Outpatient New Moderate Mdm 45-59 Minutes ,CPT® 99204,0982 - PRO FEE/OUTPT,N/A,N/A, $499.00 , $324.35 , $270.10 , $128.82 , $107.66 , $223.51 , $224.94 , $464.07 , $449.10 , $449.10 , $399.20 , $399.20 , $107.66 , $460.73 , $474.05 , $449.10 , $449.10 , $449.10 , $464.07 , $479.04 , $246.36 , $424.15 , $282.79 , $280.74 , $94.75 , $227.86 , $227.86 , $474.05 , $262.80 , $94.75 , $479.04 
"Intubation,Endotracheal",CPT® 31500,N/A,N/A,N/A, $777.00 , $505.05 , $758.54 , $132.66 , $155.78 , $421.83 , $406.96 , $722.61 , $699.30 , $699.30 , $621.60 , $621.60 , $155.78 , $717.40 , $738.15 , $699.30 , $699.30 , $699.30 , $722.61 , $745.92 , $734.78 , $660.45 , $576.25 , $726.12 , N/A , $430.06 , $430.06 , $738.15 , $506.49 , $132.66 , $758.54 
"TB Test,Cell Immun Meas by Gamma Interfron",CPT® 86480,N/A,N/A,N/A, $243.00 , $157.95 , N/A , $63.22 , $63.22 , $350.68 , $419.48 , $225.99 , $218.70 , $218.70 , $194.40 , $194.40 , $63.22 , $224.36 , $230.85 , $218.70 , $218.70 , $218.70 , $225.99 , $233.28 , $413.85 , $206.55 , $405.46 , $224.74 , N/A , $327.28 , $327.28 , $230.85 , $357.64 , $63.22 , $419.48 
Ecmo/Ecls Rmvl of Prph Cannula Prq 6 Yrs & Older,CPT® 33966,N/A,N/A,N/A," $1,414.00 ", $919.10 ," $1,381.19 ", $212.70 , $341.19 ," $1,250.03 "," $1,026.24 "," $1,315.02 "," $1,272.60 "," $1,272.60 "," $1,131.20 "," $1,131.20 ", $341.19 ," $1,305.55 "," $1,343.30 "," $1,272.60 "," $1,272.60 "," $1,272.60 "," $1,315.02 "," $1,357.44 "," $1,282.00 "," $1,201.90 "," $1,224.31 "," $1,140.34 ", N/A ," $1,274.43 "," $1,274.43 "," $1,343.30 "," $1,447.74 ", $212.70 ," $1,447.74 "
 Fac Therapeutic Spinal Pnxr Drainage CSF W/Fluor/CT ,CPT® 62329,0361 - OR/MINOR,N/A,N/A," $1,662.00 "," $1,080.30 "," $1,396.08 ", $100.56 , $251.39 ," $1,342.90 "," $1,495.80 "," $1,407.05 "," $1,495.80 "," $1,495.80 "," $1,495.80 "," $1,412.70 ", $246.46 ," $1,534.52 "," $1,578.90 "," $1,412.70 "," $1,545.66 "," $1,545.66 "," $1,578.90 "," $1,595.52 "," $1,359.85 "," $1,495.80 "," $1,412.70 "," $1,312.98 ", N/A ," $1,345.06 "," $1,345.06 "," $1,578.90 "," $1,426.16 ", $100.56 ," $1,595.52 "
Excis Lesn Tendon Shealth Leg/Ankle,CPT® 27630,N/A,N/A,N/A," $3,730.00 "," $2,424.50 "," $2,212.93 ", $344.18 , $324.97 ," $1,777.30 "," $1,779.67 "," $3,468.90 "," $3,357.00 "," $3,357.00 "," $2,984.00 "," $2,984.00 ", $324.97 ," $3,443.91 "," $3,543.50 "," $3,357.00 "," $3,357.00 "," $3,357.00 "," $3,468.90 "," $3,580.80 "," $2,063.34 "," $3,170.50 "," $1,948.20 "," $2,100.00 ", N/A ," $1,811.98 "," $1,811.98 "," $3,543.50 "," $2,129.71 ", $324.97 ," $3,580.80 "
Injection Aa&/Strd Intercostal Nrv Single Lvl,CPT® 64420,N/A,N/A,N/A, $893.00 , $580.45 , $291.72 , $56.48 , $46.08 , $379.80 , $375.69 , $830.49 , $803.70 , $803.70 , $714.40 , $714.40 , $46.08 , $824.51 , $848.35 , $803.70 , $803.70 , $803.70 , $830.49 , $857.28 , $316.65 , $759.05 , $367.52 , $406.08 , N/A , $387.20 , $387.20 , $848.35 , $415.37 , $46.08 , $857.28 
 Fac Assay of Vitamin E ,CPT® 84446,0301 - LAB/CHEMISTRY,N/A,N/A, $167.00 , $108.55 , $140.28 , $14.46 , $14.46 , $134.94 , $150.30 , $141.38 , $150.30 , $150.30 , $150.30 , $141.95 , $14.18 , $154.19 , $158.65 , $141.95 , $155.31 , $155.31 , $158.65 , $160.32 , $136.64 , $150.30 , $141.95 , $131.93 , N/A , $135.15 , $135.15 , $158.65 , $143.30 , $14.18 , $160.32 
 Pro Contrast X-Ray of Shoulder ,CPT® 73040,0972 - PRO FEE/RAD/DX,N/A,N/A, $334.00 , $217.10 , $752.32 , $129.87 , $101.89 , $476.41 , $566.20 , $310.62 , $300.60 , $300.60 , $267.20 , $267.20 , $101.89 , $308.38 , $317.30 , $300.60 , $300.60 , $300.60 , $310.62 , $320.64 , $723.06 , $283.90 , $618.26 , $511.89 , N/A , $485.71 , $485.71 , $317.30 , $562.21 , $101.89 , $752.32 
Thoracoscopy Surg Part Pulm Decort,CPT® 32651,N/A,N/A,N/A," $7,196.00 "," $4,677.40 "," $5,682.32 ", $993.17 ," $1,026.47 "," $4,141.71 "," $4,050.50 "," $6,692.28 "," $6,476.40 "," $6,476.40 "," $5,756.80 "," $5,756.80 "," $1,026.47 "," $6,644.07 "," $6,836.20 "," $6,476.40 "," $6,476.40 "," $6,476.40 "," $6,692.28 "," $6,908.16 "," $5,498.28 "," $6,116.60 "," $5,848.16 "," $5,431.09 ", N/A ," $4,222.52 "," $4,222.52 "," $6,836.20 "," $4,972.93 ", $993.17 ," $6,908.16 "
Hallux Rigidus W/Cheilectomy 1st Mp Jt W/O Implt,CPT® 28289,N/A,N/A,N/A," $4,911.00 "," $3,192.15 "," $2,833.68 ", $446.07 , $327.43 ," $2,688.04 "," $2,688.69 "," $4,567.23 "," $4,419.90 "," $4,419.90 "," $3,928.80 "," $3,928.80 ", $327.43 ," $4,534.33 "," $4,665.45 "," $4,419.90 "," $4,419.90 "," $4,419.90 "," $4,567.23 "," $4,714.56 "," $2,630.44 "," $4,174.35 "," $2,925.86 "," $2,700.48 ", N/A ," $2,740.49 "," $2,740.49 "," $4,665.45 "," $3,221.06 ", $327.43 ," $4,714.56 "
"Repair Compl Rotator Cuff Avulsn,Chr",23420,N/A,N/A,N/A," $6,132.00 "," $3,985.80 "," $5,907.01 ", $925.61 , $848.58 ," $4,673.78 "," $4,650.13 "," $5,702.76 "," $5,518.80 "," $5,518.80 "," $4,905.60 "," $4,905.60 ", $848.58 ," $5,661.68 "," $5,825.40 "," $5,518.80 "," $5,518.80 "," $5,518.80 "," $5,702.76 "," $5,886.72 "," $5,493.61 "," $5,212.20 "," $5,138.10 "," $5,509.40 ", N/A ," $4,764.98 "," $4,764.98 "," $5,825.40 "," $5,600.56 ", $848.58 ," $5,907.01 "
 Remove Single/Dual Icd Electrode; by Transven Extraction ,CPT® 33244,0360 - OR SERVICES,N/A,N/A," $3,331.00 "," $2,165.15 "," $2,798.04 ", $795.89 , $840.15 ," $2,691.45 "," $2,997.90 "," $2,820.02 "," $2,997.90 "," $2,997.90 "," $2,997.90 "," $2,831.35 ", $823.68 ," $3,075.51 "," $3,164.45 "," $2,831.35 "," $3,097.83 "," $3,097.83 "," $3,164.45 "," $3,197.76 "," $2,725.42 "," $2,997.90 "," $2,831.35 "," $2,631.49 ", N/A ," $2,695.78 "," $2,695.78 "," $3,164.45 "," $2,858.33 ", $795.89 ," $3,197.76 "
 Fac Parathyr Img ,CPT® 78070,0341 - NUC MED/DX PROCEDURES,N/A,N/A," $2,664.00 "," $1,731.60 "," $2,237.76 ", $268.56 , $99.64 ," $2,152.51 "," $2,397.60 "," $2,255.34 "," $2,397.60 "," $2,397.60 "," $2,397.60 "," $2,264.40 ", $97.69 ," $2,459.67 "," $2,530.80 "," $2,264.40 "," $2,477.52 "," $2,477.52 "," $2,530.80 "," $2,557.44 "," $2,179.68 "," $2,397.60 "," $2,264.40 "," $2,104.56 ", N/A ," $2,155.98 "," $2,155.98 "," $2,530.80 "," $2,285.98 ", $97.69 ," $2,557.44 "
 Thoracentesi ,CPT® 33016,0761 - TREATMENT ROOM,N/A,N/A," $1,945.00 "," $1,264.25 "," $1,633.80 ", $212.20 , $179.74 ," $1,571.56 "," $1,750.50 "," $1,646.64 "," $1,750.50 "," $1,750.50 "," $1,750.50 "," $1,653.25 ", $176.22 ," $1,795.82 "," $1,847.75 "," $1,653.25 "," $1,808.85 "," $1,808.85 "," $1,847.75 "," $1,867.20 "," $1,591.40 "," $1,750.50 "," $1,653.25 "," $1,536.55 ", N/A ," $1,574.09 "," $1,574.09 "," $1,847.75 "," $1,669.00 ", $176.22 ," $1,867.20 "
 Fac Antb Bacterium Nes ,CPT® 86609,0302 - LAB/IMMUNOLOGY,N/A,N/A, $138.00 , $89.70 , $115.92 , $13.14 , $8.07 , $111.50 , $124.20 , $116.83 , $124.20 , $124.20 , $124.20 , $117.30 , $7.91 , $127.42 , $131.10 , $117.30 , $128.34 , $128.34 , $131.10 , $132.48 , $112.91 , $124.20 , $117.30 , $109.02 , N/A , $111.68 , $111.68 , $131.10 , $118.42 , $7.91 , $132.48 
 Fac Sincalide Injection ,HCPCS J2805,0636 - DRUGS REQUIRING DETAILED CODIN,N/A,N/A, $253.00 , $164.45 , $212.52 , $136.21 , $125.55 , $204.42 , $227.70 , $214.19 , $227.70 , $227.70 , $227.70 , $215.05 , $123.09 , $233.59 , $240.35 , $215.05 , $235.29 , $235.29 , $240.35 , $242.88 , $207.00 , $227.70 , $215.05 , $199.87 , N/A , $204.75 , $204.75 , $240.35 , $217.10 , $123.09 , $242.88 
"Excis Tumor,Soft Tiss Up Arm/Elbow,Subq",CPT® 24075,N/A,N/A,N/A," $3,344.00 "," $2,173.60 "," $2,007.46 ", $314.81 , $80.09 ," $1,581.67 "," $1,597.42 "," $3,109.92 "," $3,009.60 "," $3,009.60 "," $2,675.20 "," $2,675.20 ", $80.09 ," $3,087.52 "," $3,176.80 "," $3,009.60 "," $3,009.60 "," $3,009.60 "," $3,109.92 "," $3,210.24 "," $1,858.16 "," $2,842.40 "," $1,762.66 "," $1,876.09 ", N/A ," $1,612.53 "," $1,612.53 "," $3,176.80 "," $1,895.29 ", $80.09 ," $3,210.24 "
 Pro MRI Lwr Extremity W/O&W/Dye ,CPT® 73720,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,115.00 ", $724.75 ," $2,445.38 ", $347.83 , $515.74 ," $2,392.71 "," $3,041.08 "," $1,036.95 "," $1,003.50 "," $1,003.50 ", $892.00 , $892.00 , $515.74 ," $1,029.48 "," $1,059.25 "," $1,003.50 "," $1,003.50 "," $1,003.50 "," $1,036.95 "," $1,070.40 "," $2,109.58 ", $947.75 ," $3,312.79 "," $3,928.65 ", N/A ," $2,439.39 "," $2,439.39 "," $1,059.25 "," $2,823.63 ", $347.83 ," $3,928.65 "
 DICLOXACILLIN SODIUM 250 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00093-3123-01,1 capsule, $7.72 , $5.02 , $6.48 , N/A , N/A , $6.24 , $6.95 , $6.54 , $6.95 , $6.95 , $6.95 , $6.56 , N/A , $7.13 , $7.33 , $6.56 , $7.18 , $7.18 , $7.33 , $7.41 , $6.32 , $6.95 , $6.56 , $6.10 , N/A , $6.25 , $6.25 , $7.33 , $6.62 , $6.10 , $7.41 
 Fac Drug Screening Benzodiazepines 1-12 ,CPT® 80346,0301 - LAB/CHEMISTRY,N/A,N/A, $156.00 , $101.40 , $131.04 , N/A , N/A , $126.05 , $140.40 , $132.07 , $140.40 , $140.40 , $140.40 , $132.60 , N/A , $144.03 , $148.20 , $132.60 , $145.08 , $145.08 , $148.20 , $149.76 , $127.64 , $140.40 , $132.60 , $123.24 , N/A , $126.25 , $126.25 , $148.20 , $133.86 , $123.24 , $149.76 
"Cholesterol Total, Serum or Whole",CPT® 82465,N/A,N/A,N/A, $53.00 , $34.45 , N/A , $4.44 , $4.44 , $24.61 , $29.44 , $49.29 , $47.70 , $47.70 , $42.40 , $42.40 , $4.44 , $48.93 , $50.35 , $47.70 , $47.70 , $47.70 , $49.29 , $50.88 , $29.05 , $45.05 , $29.19 , $15.77 , N/A , $22.97 , $22.97 , $50.35 , $25.10 , $4.44 , $50.88 
 SACUBITRIL-VALSARTAN 49-51 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00078-0777-20,1 tablet, $68.63 , $44.61 , $57.65 , N/A , N/A , $55.45 , $61.77 , $58.10 , $61.77 , $61.77 , $61.77 , $58.34 , N/A , $63.37 , $65.20 , $58.34 , $63.83 , $63.83 , $65.20 , $65.88 , $56.15 , $61.77 , $58.34 , $54.22 , N/A , $55.54 , $55.54 , $65.20 , $58.89 , $54.22 , $65.88 
 Fac Private Room - Icu/CAH ,Custom 2000000002,0200 - INTENSIVE CARE,N/A,N/A," $2,589.00 "," $1,682.85 "," $2,174.76 ", N/A , N/A ," $2,091.91 "," $2,330.10 "," $2,191.85 "," $2,330.10 "," $2,330.10 "," $2,330.10 "," $2,200.65 ", N/A ," $2,390.42 "," $2,459.55 "," $2,200.65 "," $2,407.77 "," $2,407.77 "," $2,459.55 "," $2,485.44 "," $2,118.32 "," $2,330.10 "," $2,200.65 "," $2,045.31 ", N/A ," $2,095.28 "," $2,095.28 "," $2,459.55 "," $2,221.62 "," $2,045.31 "," $2,485.44 "
Myd88 Gene Analysis P.Leu265 (L265p) Variant,CPT® 81305,N/A,N/A,N/A, $781.00 , $507.65 , N/A , $178.91 , $143.13 , $729.22 , N/A , $726.33 , $702.90 , $702.90 , $624.80 , $624.80 , $143.13 , $721.10 , $741.95 , $702.90 , $702.90 , $702.90 , $726.33 , $749.76 ," $1,171.18 ", $663.85 , $836.76 , $515.15 , N/A , $680.55 , $680.55 , $741.95 , $743.70 , $143.13 ," $1,171.18 "
Surgical Path Level 1,CPT® 88300,N/A,N/A,N/A, $113.00 , $73.45 , $53.21 , $15.46 , $10.46 , $59.88 , $65.67 , $105.09 , $101.70 , $101.70 , $90.40 , $90.40 , $10.46 , $104.33 , $107.35 , $101.70 , $101.70 , $101.70 , $105.09 , $108.48 , $96.82 , $96.05 , $69.74 , $56.22 , N/A , $55.88 , $55.88 , $107.35 , $61.41 , $10.46 , $108.48 
Chemodenervation of Trunk Muscle 1-5 Muscles,CPT® 64646,N/A,N/A,N/A, $962.00 , $625.30 , $545.17 , $105.62 , $85.80 , $641.84 , $626.72 , $894.66 , $865.80 , $865.80 , $769.60 , $769.60 , $85.80 , $888.21 , $913.90 , $865.80 , $865.80 , $865.80 , $894.66 , $923.52 , $589.86 , $817.70 , $613.05 , $670.93 , N/A , $654.37 , $654.37 , $913.90 , $701.97 , $85.80 , $923.52 
 CEPHALEXIN 250 MG/5ML PO SUSR ,HCPCS RXC637,0250 - PHARMACY,67877-0545-88,100 mL, $117.64 , $76.47 , $98.82 , N/A , N/A , $95.05 , $105.88 , $99.59 , $105.88 , $105.88 , $105.88 , $99.99 , N/A , $108.62 , $111.76 , $99.99 , $109.41 , $109.41 , $111.76 , $112.93 , $96.25 , $105.88 , $99.99 , $92.94 , N/A , $95.21 , $95.21 , $111.76 , $100.95 , $92.94 , $112.93 
 PALIPERIDONE PALMITATE ER 78 MG/0.5ML IM SUSY ,HCPCS J2426,0636 - DRUGS REQUIRING DETAILED CODIN,50458-0561-01,0.5 mL," $3,281.42 "," $2,132.92 "," $2,756.39 ", $14.50 , $13.92 ," $2,651.39 "," $2,953.28 "," $2,778.05 "," $2,953.28 "," $2,953.28 "," $2,953.28 "," $2,789.21 ", $13.65 ," $3,029.74 "," $3,117.35 "," $2,789.21 "," $3,051.72 "," $3,051.72 "," $3,117.35 "," $3,150.16 "," $2,684.86 "," $2,953.28 "," $2,789.21 "," $2,592.32 ", N/A ," $2,655.65 "," $2,655.65 "," $3,117.35 "," $2,815.79 ", $13.65 ," $3,150.16 "
 Fac Injection Aa&/Strd Axillary Nerve ,CPT® 64417,0360 - OR SERVICES,N/A,N/A," $1,906.00 "," $1,238.90 "," $1,601.04 ", $61.03 , $46.08 ," $1,540.05 "," $1,715.40 "," $1,613.62 "," $1,715.40 "," $1,715.40 "," $1,715.40 "," $1,620.10 ", $45.18 ," $1,759.81 "," $1,810.70 "," $1,620.10 "," $1,772.58 "," $1,772.58 "," $1,810.70 "," $1,829.76 "," $1,559.49 "," $1,715.40 "," $1,620.10 "," $1,505.74 ", N/A ," $1,542.53 "," $1,542.53 "," $1,810.70 "," $1,635.54 ", $45.18 ," $1,829.76 "
 Transplanted Kidney US Duplex Doppler ,CPT® 76776,0402 - ULTRASOUND,N/A,N/A, $769.00 , $499.85 , $645.96 , $146.44 , $101.34 , $621.35 , $692.10 , $651.04 , $692.10 , $692.10 , $692.10 , $653.65 , $99.35 , $710.02 , $730.55 , $653.65 , $715.17 , $715.17 , $730.55 , $738.24 , $629.20 , $692.10 , $653.65 , $607.51 , N/A , $622.35 , $622.35 , $730.55 , $659.88 , $99.35 , $738.24 
"Lyme Dis, Dna, Amp Probe",CPT® 87476,N/A,N/A,N/A, $387.00 , $251.55 , N/A , $35.79 , $35.79 , $198.56 , $237.51 , $359.91 , $348.30 , $348.30 , $309.60 , $309.60 , $35.79 , $357.32 , $367.65 , $348.30 , $348.30 , $348.30 , $359.91 , $371.52 , $234.30 , $328.95 , $230.30 , $127.26 , N/A , $185.31 , $185.31 , $367.65 , $202.50 , $35.79 , $371.52 
"MRI, Joint Upper Extrem Combo",CPT® 73223,N/A,N/A,N/A," $8,080.00 "," $5,252.00 "," $2,824.22 ", $400.04 , $633.95 ," $2,231.93 "," $2,844.80 "," $7,514.40 "," $7,272.00 "," $7,272.00 "," $6,464.00 "," $6,464.00 ", $633.95 ," $7,460.26 "," $7,676.00 "," $7,272.00 "," $7,272.00 "," $7,272.00 "," $7,514.40 "," $7,756.80 "," $2,446.75 "," $6,868.00 "," $3,102.85 "," $4,345.63 ", N/A ," $2,275.48 "," $2,275.48 "," $7,676.00 "," $2,633.91 ", $400.04 ," $7,756.80 "
 Pro Repair Intermediate Wound ,CPT® 12052,0982 - PRO FEE/OUTPT,N/A,N/A, $952.00 , $618.80 , $637.70 , $191.98 , $151.59 , $557.59 , $545.09 , $885.36 , $856.80 , $856.80 , $761.60 , $761.60 , $151.59 , $878.98 , $904.40 , $856.80 , $856.80 , $856.80 , $885.36 , $913.92 , $700.90 , $809.20 ," $1,084.71 ", $716.31 , N/A , $568.47 , $568.47 , $904.40 , $659.24 , $151.59 ," $1,084.71 "
 Fac Direct Admit Hospital Observ ,HCPCS G0379,0762 - OBSERVATION,N/A,N/A, $315.00 , $204.75 , $264.60 , N/A , N/A , $254.52 , $283.50 , $266.68 , $283.50 , $283.50 , $283.50 , $267.75 , N/A , $290.84 , $299.25 , $267.75 , $292.95 , $292.95 , $299.25 , $302.40 , $257.73 , $283.50 , $267.75 , $248.85 , N/A , $254.93 , $254.93 , $299.25 , $270.30 , $248.85 , $302.40 
Arterial Catheterization,36620,N/A,N/A,N/A, $479.00 , $311.35 , $273.33 , $42.54 , $73.68 , $223.80 , $217.36 , $445.47 , $431.10 , $431.10 , $383.20 , $383.20 , $73.68 , $442.26 , $455.05 , $431.10 , $431.10 , $431.10 , $445.47 , $459.84 , $253.56 , $407.15 , $265.83 , $223.05 , N/A , $228.17 , $228.17 , $455.05 , $259.19 , $42.54 , $459.84 
"Destr Penis Lesn,Simpl,Cryosurg",CPT® 54056,N/A,N/A,N/A, $714.00 , $464.10 , $491.39 , $108.17 , $46.08 , $353.05 , $369.21 , $664.02 , $642.60 , $642.60 , $571.20 , $571.20 , $46.08 , $659.24 , $678.30 , $642.60 , $642.60 , $642.60 , $664.02 , $685.44 , $457.02 , $606.90 , $595.88 , $533.47 , N/A , $359.94 , $359.94 , $678.30 , $431.42 , $46.08 , $685.44 
 Fac Edg US Exam Surgical Alter Stom Duodenum/Jejunum ,CPT® 43259,0360 - OR SERVICES,N/A,N/A," $3,092.00 "," $2,009.80 "," $2,597.28 ", $214.03 , $284.28 ," $2,498.34 "," $2,782.80 "," $2,617.69 "," $2,782.80 "," $2,782.80 "," $2,782.80 "," $2,628.20 ", $278.71 ," $2,854.84 "," $2,937.40 "," $2,628.20 "," $2,875.56 "," $2,875.56 "," $2,937.40 "," $2,968.32 "," $2,529.87 "," $2,782.80 "," $2,628.20 "," $2,442.68 ", N/A ," $2,502.36 "," $2,502.36 "," $2,937.40 "," $2,653.25 ", $214.03 ," $2,968.32 "
Deep Incis Shldr Bone Cortex,23040,N/A,N/A,N/A," $4,732.00 "," $3,075.80 "," $4,380.35 ", $685.55 , $768.38 ," $3,463.41 "," $3,454.45 "," $4,400.76 "," $4,258.80 "," $4,258.80 "," $3,785.60 "," $3,785.60 ", $768.38 ," $4,369.06 "," $4,495.40 "," $4,258.80 "," $4,258.80 "," $4,258.80 "," $4,400.76 "," $4,542.72 "," $4,061.84 "," $4,022.20 "," $3,814.33 "," $4,076.13 ", N/A ," $3,530.99 "," $3,530.99 "," $4,495.40 "," $4,150.15 ", $685.55 ," $4,542.72 "
" Pro Inj Dx/Ther Agnt Paravert Facet Joint, Lumbar/Sac, 2nd Level ",CPT® 64494,0982 - PRO FEE/OUTPT,N/A,N/A, $536.00 , $348.40 , $253.08 , $49.11 , $62.02 , $292.30 , $282.07 , $498.48 , $482.40 , $482.40 , $428.80 , $428.80 , $62.02 , $494.89 , $509.20 , $482.40 , $482.40 , $482.40 , $498.48 , $514.56 , $276.51 , $455.60 , $274.75 , $313.65 , N/A , $298.00 , $298.00 , $509.20 , $319.69 , $49.11 , $514.56 
 Fac Njx Cntrst Medium Dacryocstograpy ,CPT® 68850,0360 - OR SERVICES,N/A,N/A," $1,028.00 ", $668.20 , $863.52 , $50.08 , $46.08 , $830.62 , $925.20 , $870.30 , $925.20 , $925.20 , $925.20 , $873.80 , $45.18 , $949.15 , $976.60 , $873.80 , $956.04 , $956.04 , $976.60 , $986.88 , $841.11 , $925.20 , $873.80 , $812.12 , N/A , $831.96 , $831.96 , $976.60 , $882.13 , $45.18 , $986.88 
Perq Clsr Tcat L Atr Apndge W/Endocardial Implnt,CPT® 33340,N/A,N/A,N/A," $10,338.00 "," $6,719.70 "," $4,614.42 ", $709.76 , $623.11 ," $3,295.07 "," $3,243.64 "," $9,614.34 "," $9,304.20 "," $9,304.20 "," $8,270.40 "," $8,270.40 ", $623.11 ," $9,545.08 "," $9,821.10 "," $9,304.20 "," $9,304.20 "," $9,304.20 "," $9,614.34 "," $9,924.48 "," $4,284.40 "," $8,787.30 "," $4,079.86 "," $3,837.39 ", N/A ," $3,359.37 "," $3,359.37 "," $9,821.10 "," $3,816.26 ", $623.11 ," $9,924.48 "
Destruc Conjunc Lesn,CPT® 68135,N/A,N/A,N/A," $1,416.00 ", $920.40 , $918.39 , $144.67 , $30.71 , $852.79 , $798.55 ," $1,316.88 "," $1,274.40 "," $1,274.40 "," $1,132.80 "," $1,132.80 ", $30.71 ," $1,307.39 "," $1,345.20 "," $1,274.40 "," $1,274.40 "," $1,274.40 "," $1,316.88 "," $1,359.36 "," $1,265.45 "," $1,203.60 ", $820.67 ," $1,086.47 ", N/A , $869.43 , $869.43 ," $1,345.20 ", $959.73 , $30.71 ," $1,359.36 "
Chromosome Anal-Situ Amni,CPT® 88269,N/A,N/A,N/A," $1,230.00 ", $799.50 , N/A , $177.13 , $177.13 , $931.30 ," $1,413.27 "," $1,143.90 "," $1,107.00 "," $1,107.00 ", $984.00 , $984.00 , $177.13 ," $1,135.66 "," $1,168.50 "," $1,107.00 "," $1,107.00 "," $1,107.00 "," $1,143.90 "," $1,180.80 "," $1,159.57 "," $1,045.50 "," $1,089.88 ", $726.90 , N/A , $869.15 , $869.15 ," $1,168.50 ", $955.15 , $177.13 ," $1,413.27 "
Drain External Ear Lesion,CPT® 69005,N/A,N/A,N/A," $1,762.00 "," $1,145.30 ", $758.50 , $155.08 , $72.58 , $755.35 , $776.05 ," $1,638.66 "," $1,585.80 "," $1,585.80 "," $1,409.60 "," $1,409.60 ", $72.58 ," $1,626.85 "," $1,673.90 "," $1,585.80 "," $1,585.80 "," $1,585.80 "," $1,638.66 "," $1,691.52 ", $816.81 ," $1,497.70 ", $847.43 , $757.85 , N/A , $770.09 , $770.09 ," $1,673.90 ", $879.31 , $72.58 ," $1,691.52 "
 Lb-Candida Probe ,CPT® 87481,0300 - LABORATORY,N/A,N/A, $146.00 , $94.90 , $122.64 , $35.79 , $35.79 , $117.97 , $131.40 , $123.60 , $131.40 , $131.40 , $131.40 , $124.10 , $35.09 , $134.80 , $138.70 , $124.10 , $135.78 , $135.78 , $138.70 , $140.16 , $119.46 , $131.40 , $124.10 , $115.34 , N/A , $118.16 , $118.16 , $138.70 , $125.28 , $35.09 , $140.16 
" Fac Semen Anal, Sperm Detection ",CPT® 89321,0300 - LABORATORY,N/A,N/A, $161.00 , $104.65 , $135.24 , $12.29 , $12.29 , $130.09 , $144.90 , $136.30 , $144.90 , $144.90 , $144.90 , $136.85 , $12.05 , $148.65 , $152.95 , $136.85 , $149.73 , $149.73 , $152.95 , $154.56 , $131.73 , $144.90 , $136.85 , $127.19 , N/A , $130.30 , $130.30 , $152.95 , $138.15 , $12.05 , $154.56 
"Immunoassay, Ria",CPT® 83520,N/A,N/A,N/A, $227.00 , $147.55 , N/A , $17.62 , $17.62 , $73.26 , $87.64 , $211.11 , $204.30 , $204.30 , $181.60 , $181.60 , $17.62 , $209.59 , $215.65 , $204.30 , $204.30 , $204.30 , $211.11 , $217.92 , $115.32 , $192.95 , $84.34 , $50.72 , N/A , $68.37 , $68.37 , $215.65 , $74.71 , $17.62 , $217.92 
Onco (Ovarian) Biochemical Assay Five Proteins,CPT® 81503,N/A,N/A,N/A," $4,009.00 "," $2,605.85 ", N/A , $914.94 , $914.94 , N/A , N/A ," $3,728.37 "," $3,608.10 "," $3,608.10 "," $3,207.20 "," $3,207.20 ", $914.94 ," $3,701.51 "," $3,808.55 "," $3,608.10 "," $3,608.10 "," $3,608.10 "," $3,728.37 "," $3,848.64 "," $5,989.47 "," $3,407.65 "," $4,275.88 "," $2,634.49 ", N/A ," $3,561.09 "," $3,561.09 "," $3,808.55 "," $3,884.01 ", $914.94 ," $5,989.47 "
"Inj,Neurolytic,Epid/Lumb/Caudal",CPT® 62282,N/A,N/A,N/A," $1,905.00 "," $1,238.25 ", $713.02 , $137.22 , $211.74 , $815.93 , $783.92 ," $1,771.65 "," $1,714.50 "," $1,714.50 "," $1,524.00 "," $1,524.00 ", $211.74 ," $1,758.89 "," $1,809.75 "," $1,714.50 "," $1,714.50 "," $1,714.50 "," $1,771.65 "," $1,828.80 ", $780.01 ," $1,619.25 ", $768.93 , $872.12 , N/A , $831.85 , $831.85 ," $1,809.75 ", $892.39 , $137.22 ," $1,828.80 "
 Fac RBC Antibody Screen ,CPT® 86850,0300 - LABORATORY,N/A,N/A, $141.00 , $91.65 , $118.44 , $9.97 , $5.31 , $113.93 , $126.90 , $119.37 , $126.90 , $126.90 , $126.90 , $119.85 , $5.21 , $130.19 , $133.95 , $119.85 , $131.13 , $131.13 , $133.95 , $135.36 , $115.37 , $126.90 , $119.85 , $111.39 , N/A , $114.11 , $114.11 , $133.95 , $120.99 , $5.21 , $135.36 
Initial preventive exam,G0402,N/A,N/A,N/A, $339.00 , $220.35 , $321.38 , $127.94 , N/A , $235.19 , $270.88 , $315.27 , $305.10 , $305.10 , $271.20 , $271.20 , N/A , $313.00 , $322.05 , $305.10 , $305.10 , $305.10 , $315.27 , $325.44 , $361.20 , $288.15 , $234.20 , $270.53 , N/A , $239.77 , $239.77 , $322.05 , $299.71 , $127.94 , $361.20 
 Fac Cltx Sprcndylr/Transcndylr Humrl Fx+-Mnpj ,CPT® 24530,0361 - OR/MINOR,N/A,N/A," $1,739.00 "," $1,130.35 "," $1,460.76 ", $345.51 , $245.89 ," $1,405.11 "," $1,565.10 "," $1,472.24 "," $1,565.10 "," $1,565.10 "," $1,565.10 "," $1,478.15 ", $241.07 ," $1,605.62 "," $1,652.05 "," $1,478.15 "," $1,617.27 "," $1,617.27 "," $1,652.05 "," $1,669.44 "," $1,422.85 "," $1,565.10 "," $1,478.15 "," $1,373.81 ", N/A ," $1,407.37 "," $1,407.37 "," $1,652.05 "," $1,492.24 ", $241.07 ," $1,669.44 "
Repair Nail Bed,CPT® 11760,N/A,N/A,N/A, $840.00 , $546.00 , $358.36 , $106.67 , $42.71 , $359.65 , $359.77 , $781.20 , $756.00 , $756.00 , $672.00 , $672.00 , $42.71 , $775.57 , $798.00 , $756.00 , $756.00 , $756.00 , $781.20 , $806.40 , $400.51 , $714.00 , $715.41 , $401.98 , N/A , $366.67 , $366.67 , $798.00 , $425.20 , $42.71 , $806.40 
 Pro Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm ,CPT® 97607,0982 - PRO FEE/OUTPT,N/A,N/A, $422.00 , $274.30 , $49.32 , $20.51 , $31.76 , $99.25 , N/A , $392.46 , $379.80 , $379.80 , $337.60 , $337.60 , $31.76 , $389.63 , $400.90 , $379.80 , $379.80 , $379.80 , $392.46 , $405.12 , $65.81 , $358.70 , $65.63 , $95.09 , N/A , $101.19 , $101.19 , $400.90 , $112.54 , $20.51 , $405.12 
 Fac Egd Injection Sclerosis Esophgl/Gastric Varices ,CPT® 43243,0360 - OR SERVICES,N/A,N/A," $3,137.00 "," $2,039.05 "," $2,635.08 ", $224.05 , $249.97 ," $2,534.70 "," $2,823.30 "," $2,655.78 "," $2,823.30 "," $2,823.30 "," $2,823.30 "," $2,666.45 ", $245.07 ," $2,896.39 "," $2,980.15 "," $2,666.45 "," $2,917.41 "," $2,917.41 "," $2,980.15 "," $3,011.52 "," $2,566.69 "," $2,823.30 "," $2,666.45 "," $2,478.23 ", N/A ," $2,538.77 "," $2,538.77 "," $2,980.15 "," $2,691.86 ", $224.05 ," $3,011.52 "
X-Ray Wrist 2 Vw,CPT® 73100,N/A,N/A,N/A, $244.00 , $158.60 , $190.24 , $33.33 , $28.13 , $137.99 , $169.90 , $226.92 , $219.60 , $219.60 , $195.20 , $195.20 , $28.13 , $225.29 , $231.80 , $219.60 , $219.60 , $219.60 , $226.92 , $234.24 , $185.72 , $207.40 , $188.75 , $158.36 , N/A , $140.68 , $140.68 , $231.80 , $162.82 , $28.13 , $234.24 
Menacwy-Tt Conj Vacc Serogroups Acwy for Im Use,CPT® 90619,N/A,N/A,N/A, $244.00 , $158.60 , N/A , N/A , $166.98 , N/A , N/A , $226.92 , $219.60 , $219.60 , $195.20 , $195.20 , $166.98 , $225.29 , $231.80 , $219.60 , $219.60 , $219.60 , $226.92 , $234.24 , N/A , $207.40 , $195.20 , $244.33 , N/A , N/A , N/A , $231.80 , N/A , $166.98 , $244.33 
 TAMOXIFEN CITRATE 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,63739-0269-10,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Fungus Isolation Culture ,CPT® 87102,0306 - LAB/BACT-MICRO,N/A,N/A, $121.00 , $78.65 , $101.64 , $8.58 , $8.58 , $97.77 , $108.90 , $102.44 , $108.90 , $108.90 , $108.90 , $102.85 , $8.41 , $111.72 , $114.95 , $102.85 , $112.53 , $112.53 , $114.95 , $116.16 , $99.00 , $108.90 , $102.85 , $95.59 , N/A , $97.93 , $97.93 , $114.95 , $103.83 , $8.41 , $116.16 
Office/Outpatient Established Sf Mdm 10-19 Min,CPT® 99212,N/A,N/A,N/A, $119.00 , $77.35 , $72.24 , $34.37 , $29.87 , $44.01 , $43.22 , $110.67 , $107.10 , $107.10 , $95.20 , $95.20 , $29.87 , $109.87 , $113.05 , $107.10 , $107.10 , $107.10 , $110.67 , $114.24 , $65.53 , $101.15 , $54.01 , $55.40 , $64.00 , $44.87 , $44.87 , $113.05 , $51.74 , $29.87 , $114.24 
" Fac TB Test, Cell Immun Measure ",CPT® 86480,0302 - LAB/IMMUNOLOGY,N/A,N/A, $243.00 , $157.95 , $204.12 , $63.22 , $63.22 , $196.34 , $218.70 , $205.72 , $218.70 , $218.70 , $218.70 , $206.55 , $61.98 , $224.36 , $230.85 , $206.55 , $225.99 , $225.99 , $230.85 , $233.28 , $198.82 , $218.70 , $206.55 , $191.97 , N/A , $196.66 , $196.66 , $230.85 , $208.52 , $61.98 , $233.28 
"Remvl,Inflat Penile Prosth W/O Replacmt",CPT® 54406,N/A,N/A,N/A," $4,008.00 "," $2,605.20 "," $3,240.13 ", $697.70 , $689.13 ," $2,343.84 "," $2,363.45 "," $3,727.44 "," $3,607.20 "," $3,607.20 "," $3,206.40 "," $3,206.40 ", $689.13 ," $3,700.59 "," $3,807.60 "," $3,607.20 "," $3,607.20 "," $3,607.20 "," $3,727.44 "," $3,847.68 "," $3,042.62 "," $3,406.80 "," $3,766.16 "," $3,538.86 ", N/A ," $2,389.58 "," $2,389.58 "," $3,807.60 "," $2,864.04 ", $689.13 ," $3,847.68 "
Emergency Department Visit May Not Req Phys/Qhp,99281,N/A,N/A,N/A, $160.00 , $104.00 , $76.63 , $11.05 , $22.89 , $59.28 , $61.20 , $148.80 , $144.00 , $144.00 , $128.00 , $128.00 , $22.89 , $147.73 , $152.00 , $144.00 , $144.00 , $144.00 , $148.80 , $153.60 , $65.12 , $136.00 , $45.01 , $46.01 , $12.50 , $60.43 , $60.43 , $152.00 , $72.52 , $11.05 , $153.60 
 Fac Assay of Primidone ,CPT® 80188,0301 - LAB/CHEMISTRY,N/A,N/A, $149.00 , $96.85 , $125.16 , $16.92 , $16.92 , $120.39 , $134.10 , $126.14 , $134.10 , $134.10 , $134.10 , $126.65 , $16.59 , $137.57 , $141.55 , $126.65 , $138.57 , $138.57 , $141.55 , $143.04 , $121.91 , $134.10 , $126.65 , $117.71 , N/A , $120.59 , $120.59 , $141.55 , $127.86 , $16.59 , $143.04 
"Bronchoscopy,Rx Stenosis",CPT® 31641,N/A,N/A,N/A," $3,771.00 "," $2,451.15 "," $1,388.74 ", $241.01 , $367.75 , $998.01 , $973.41 ," $3,507.03 "," $3,393.90 "," $3,393.90 "," $3,016.80 "," $3,016.80 ", $367.75 ," $3,481.76 "," $3,582.45 "," $3,393.90 "," $3,393.90 "," $3,393.90 "," $3,507.03 "," $3,620.16 "," $1,343.94 "," $3,205.35 "," $1,368.38 "," $1,334.85 ", N/A ," $1,017.48 "," $1,017.48 "," $3,582.45 "," $1,198.31 ", $241.01 ," $3,620.16 "
"Lap, Repair Paraesophageal Hernia, Incl Fundoplasty W/O Mesh",CPT® 43281,N/A,N/A,N/A," $10,192.00 "," $6,624.80 "," $9,099.87 "," $1,405.68 "," $1,292.22 "," $7,254.46 "," $7,295.52 "," $9,478.56 "," $9,172.80 "," $9,172.80 "," $8,153.60 "," $8,153.60 "," $1,292.22 "," $9,410.27 "," $9,682.40 "," $9,172.80 "," $9,172.80 "," $9,172.80 "," $9,478.56 "," $9,784.32 "," $6,537.25 "," $8,663.20 "," $8,131.76 "," $8,532.66 ", N/A ," $7,396.00 "," $7,396.00 "," $9,682.40 "," $7,735.44 "," $1,292.22 "," $9,784.32 "
Fx Cl Prox Humeral W/O MA,CPT® 23600,N/A,N/A,N/A," $1,196.00 ", $777.40 ," $1,967.03 ", $311.94 , $245.89 ," $1,478.02 "," $1,510.03 "," $1,112.28 "," $1,076.40 "," $1,076.40 ", $956.80 , $956.80 , $245.89 ," $1,104.27 "," $1,136.20 "," $1,076.40 "," $1,076.40 "," $1,076.40 "," $1,112.28 "," $1,148.16 "," $1,808.38 "," $1,016.60 "," $1,657.40 "," $1,760.08 ", N/A ," $1,506.86 "," $1,506.86 "," $1,136.20 "," $1,771.09 ", $245.89 ," $1,967.03 "
"Adj Tiss Xfer Head,Fac,Hand 10.1-30",14041,N/A,N/A,N/A," $4,937.00 "," $3,209.05 "," $2,438.31 ", $733.01 , $768.38 ," $2,127.30 "," $2,088.61 "," $4,591.41 "," $4,443.30 "," $4,443.30 "," $3,949.60 "," $3,949.60 ", $768.38 ," $4,558.33 "," $4,690.15 "," $4,443.30 "," $4,443.30 "," $4,443.30 "," $4,591.41 "," $4,739.52 "," $2,673.42 "," $4,196.45 "," $4,156.87 "," $2,727.53 ", N/A ," $2,168.81 "," $2,168.81 "," $4,690.15 "," $2,515.08 ", $733.01 ," $4,739.52 "
"Bx Thigh/Knee Soft Tissues,Deep",CPT® 27324,N/A,N/A,N/A," $2,560.00 "," $1,664.00 "," $2,474.75 ", $391.37 , $200.70 ," $1,904.50 "," $1,899.74 "," $2,380.80 "," $2,304.00 "," $2,304.00 "," $2,048.00 "," $2,048.00 ", $200.70 ," $2,363.65 "," $2,432.00 "," $2,304.00 "," $2,304.00 "," $2,304.00 "," $2,380.80 "," $2,457.60 "," $2,293.35 "," $2,176.00 "," $2,099.84 "," $2,265.41 ", N/A ," $1,941.66 "," $1,941.66 "," $2,432.00 "," $2,282.12 ", $200.70 ," $2,474.75 "
 Pro Exc H-F-Nk-Sp B9+Marg 2.1-3 ,CPT® 11423,0982 - PRO FEE/OUTPT,N/A,N/A," $1,032.00 ", $670.80 , $498.95 , $150.64 , $167.14 , $428.81 , $422.17 , $959.76 , $928.80 , $928.80 , $825.60 , $825.60 , $167.14 , $952.85 , $980.40 , $928.80 , $928.80 , $928.80 , $959.76 , $990.72 , $545.40 , $877.20 , $840.29 , $546.89 , N/A , $437.17 , $437.17 , $980.40 , $506.99 , $150.64 , $990.72 
Exc Skin Malig >4cm Remaindr Body,CPT® 11626,N/A,N/A,N/A," $2,096.00 "," $1,362.40 ", $925.79 , $275.85 , $457.12 , $801.49 , $778.13 ," $1,949.28 "," $1,886.40 "," $1,886.40 "," $1,676.80 "," $1,676.80 ", $457.12 ," $1,935.24 "," $1,991.20 "," $1,886.40 "," $1,886.40 "," $1,886.40 "," $1,949.28 "," $2,012.16 "," $1,014.19 "," $1,781.60 "," $1,559.27 "," $1,020.08 ", N/A , $817.13 , $817.13 ," $1,991.20 ", $947.60 , $275.85 ," $2,012.16 "
"Debridement, Skin, Sub-Q Tissue,Each Add 20 Sq Cm",11045,N/A,N/A,N/A, $152.00 , $98.80 , $81.91 , $23.74 , $12.63 , $71.63 , $71.08 , $141.36 , $136.80 , $136.80 , $121.60 , $121.60 , $12.63 , $140.34 , $144.40 , $136.80 , $136.80 , $136.80 , $141.36 , $145.92 , $90.34 , $129.20 , $144.51 , $91.36 , N/A , $73.03 , $73.03 , $144.40 , $84.69 , $12.63 , $145.92 
Fx Ulnar Shaft W/O Manipu,25530,N/A,N/A,N/A," $1,720.00 "," $1,118.00 "," $1,510.80 ", $240.36 , $154.82 ," $1,143.45 "," $1,163.91 "," $1,599.60 "," $1,548.00 "," $1,548.00 "," $1,376.00 "," $1,376.00 ", $154.82 ," $1,588.08 "," $1,634.00 "," $1,548.00 "," $1,548.00 "," $1,548.00 "," $1,599.60 "," $1,651.20 "," $1,395.00 "," $1,462.00 "," $1,273.82 "," $1,362.13 ", N/A ," $1,165.76 "," $1,165.76 "," $1,634.00 "," $1,370.18 ", $154.82 ," $1,651.20 "
 Pro Egd Flex Removal Lesion(S) by Hot Biopsy Forceps ,CPT® 43250,0982 - PRO FEE/OUTPT,N/A,N/A," $2,545.00 "," $1,654.25 "," $1,032.98 ", $159.86 , $295.67 , $862.02 , $916.97 ," $2,366.85 "," $2,290.50 "," $2,290.50 "," $2,036.00 "," $2,036.00 ", $295.67 ," $2,349.80 "," $2,417.75 "," $2,290.50 "," $2,290.50 "," $2,290.50 "," $2,366.85 "," $2,443.20 ", $744.02 ," $2,163.25 "," $1,008.00 ", $984.49 , N/A , $878.84 , $878.84 ," $2,417.75 ", $919.17 , $159.86 ," $2,443.20 "
 LITHIUM CARBONATE ER 300 MG PO TBCR ,HCPCS RXC637,0250 - PHARMACY,68084-0640-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Exc Skin Malig >4cm Face,Facial",11646,N/A,N/A,N/A," $2,592.00 "," $1,684.80 "," $1,240.69 ", $369.64 , $684.49 ," $1,081.06 "," $1,046.74 "," $2,410.56 "," $2,332.80 "," $2,332.80 "," $2,073.60 "," $2,073.60 ", $684.49 ," $2,393.19 "," $2,462.40 "," $2,332.80 "," $2,332.80 "," $2,332.80 "," $2,410.56 "," $2,488.32 "," $1,362.75 "," $2,203.20 "," $2,094.49 "," $1,374.50 ", N/A ," $1,102.15 "," $1,102.15 "," $2,462.40 "," $1,278.11 ", $369.64 ," $2,488.32 "
 Liver US ,CPT® 76705,0402 - ULTRASOUND,N/A,N/A, $564.00 , $366.60 , $473.76 , $86.93 , $89.08 , $455.71 , $507.60 , $477.48 , $507.60 , $507.60 , $507.60 , $479.40 , $87.33 , $520.74 , $535.80 , $479.40 , $524.52 , $524.52 , $535.80 , $541.44 , $461.46 , $507.60 , $479.40 , $445.56 , N/A , $456.45 , $456.45 , $535.80 , $483.97 , $86.93 , $541.44 
 Pro Binoc Mic ,CPT® 92504,0982 - PRO FEE/OUTPT,N/A,N/A, $79.00 , $51.35 , $21.46 , $9.28 , $24.58 , $21.39 , $21.61 , $73.47 , $71.10 , $71.10 , $63.20 , $63.20 , $24.58 , $72.94 , $75.05 , $71.10 , $71.10 , $71.10 , $73.47 , $75.84 , $40.25 , $67.15 , $28.38 , $36.21 , N/A , $21.81 , $21.81 , $75.05 , $25.43 , $9.28 , $75.84 
Respiratory Motion Management Simulation,CPT® 77293,N/A,N/A,N/A," $5,504.00 "," $3,577.60 "," $2,345.29 ", $406.68 , $371.36 ," $2,205.04 "," $2,230.07 "," $5,118.72 "," $4,953.60 "," $4,953.60 "," $4,403.20 "," $4,403.20 ", $371.36 ," $5,081.84 "," $5,228.80 "," $4,953.60 "," $4,953.60 "," $4,953.60 "," $5,118.72 "," $5,283.84 "," $2,496.09 "," $4,678.40 "," $2,371.09 "," $2,628.89 ", N/A ," $2,248.06 "," $2,248.06 "," $5,228.80 "," $2,602.16 ", $371.36 ," $5,283.84 "
Simple Repair 7.6-12.5cm,CPT® 12004,N/A,N/A,N/A, $848.00 , $551.20 , $227.60 , $67.81 , $89.32 , $199.60 , $193.84 , $788.64 , $763.20 , $763.20 , $678.40 , $678.40 , $89.32 , $782.96 , $805.60 , $763.20 , $763.20 , $763.20 , $788.64 , $814.08 , $250.63 , $720.80 , $388.93 , $254.00 , N/A , $203.50 , $203.50 , $805.60 , $235.99 , $67.81 , $814.08 
Dstr Nrolytc Agnt Parverteb Fct Sngl Crvcl/Thora,CPT® 64633,N/A,N/A,N/A," $1,746.00 "," $1,134.90 ", $948.95 , $184.67 , $352.82 ," $1,276.16 "," $1,199.66 "," $1,623.78 "," $1,571.40 "," $1,571.40 "," $1,396.80 "," $1,396.80 ", $352.82 ," $1,612.08 "," $1,658.70 "," $1,571.40 "," $1,571.40 "," $1,571.40 "," $1,623.78 "," $1,676.16 "," $1,203.74 "," $1,484.10 "," $1,164.99 "," $1,367.43 ", N/A ," $1,301.06 "," $1,301.06 "," $1,658.70 "," $1,395.72 ", $184.67 ," $1,676.16 "
 Pro Smpl Rpr Supfc S/N/Ax/G/T 2.5cm/< ,CPT® 12001,0982 - PRO FEE/OUTPT,N/A,N/A, $567.00 , $368.55 , $140.22 , $41.72 , $52.39 , $121.02 , $117.45 , $527.31 , $510.30 , $510.30 , $453.60 , $453.60 , $52.39 , $523.51 , $538.65 , $510.30 , $510.30 , $510.30 , $527.31 , $544.32 , $152.67 , $481.95 , $235.50 , $154.59 , N/A , $123.38 , $123.38 , $538.65 , $143.07 , $41.72 , $544.32 
Radiologic Exam Upr GI Trc Single Contrast Study,CPT® 74240,N/A,N/A,N/A," $2,463.00 "," $1,600.95 ", $715.66 , $123.09 , $96.74 , $539.54 , $605.85 ," $2,290.59 "," $2,216.70 "," $2,216.70 "," $1,970.40 "," $1,970.40 ", $96.74 ," $2,274.09 "," $2,339.85 "," $2,216.70 "," $2,216.70 "," $2,216.70 "," $2,290.59 "," $2,364.48 ", $694.06 ," $2,093.55 ", $662.56 , $571.04 , N/A , $550.07 , $550.07 ," $2,339.85 ", $636.71 , $96.74 ," $2,364.48 "
 Fac Chrmsm Cnt 15-20 Cll 2karyotyp Banding ,CPT® 88262,0310 - PATHOLOGY LAB,N/A,N/A," $2,289.00 "," $1,487.85 "," $1,922.76 ", $128.00 , $128.00 ," $1,849.51 "," $2,060.10 "," $1,937.87 "," $2,060.10 "," $2,060.10 "," $2,060.10 "," $1,945.65 ", $125.49 ," $2,113.43 "," $2,174.55 "," $1,945.65 "," $2,128.77 "," $2,128.77 "," $2,174.55 "," $2,197.44 "," $1,872.86 "," $2,060.10 "," $1,945.65 "," $1,808.31 ", N/A ," $1,852.49 "," $1,852.49 "," $2,174.55 "," $1,964.19 ", $125.49 ," $2,197.44 "
"Post Tibial Neurostimulation,Perc Needle Electrode",CPT® 64566,N/A,N/A,N/A, $905.00 , $588.25 , $148.36 , $28.50 , $21.84 , $169.76 , $160.28 , $841.65 , $814.50 , $814.50 , $724.00 , $724.00 , $21.84 , $835.59 , $859.75 , $814.50 , $814.50 , $814.50 , $841.65 , $868.80 , $161.04 , $769.25 , $155.21 , $184.43 , N/A , $173.07 , $173.07 , $859.75 , $185.67 , $21.84 , $868.80 
Xcapsl Ctrc Rmvl Insj Io Lens Prsth Cplx Insj 1+,66989,N/A,N/A,N/A," $8,476.00 "," $5,509.40 "," $5,267.47 ", $825.16 , $590.85 , N/A , N/A ," $7,882.68 "," $7,628.40 "," $7,628.40 "," $6,780.80 "," $6,780.80 ", $590.85 ," $7,825.89 "," $8,052.20 "," $7,628.40 "," $7,628.40 "," $7,628.40 "," $7,882.68 "," $8,136.96 ", N/A ," $7,204.60 "," $4,460.13 "," $6,233.11 ", N/A ," $4,495.88 "," $4,495.88 "," $8,052.20 "," $4,964.19 ", $590.85 ," $8,136.96 "
Sbsq Hospital IP/Obs Care Sf/Low Mdm 25 Minutes,99231,N/A,N/A,N/A, $130.00 , $84.50 , $76.59 , $47.80 , $28.04 , $67.58 , $67.57 , $120.90 , $117.00 , $117.00 , $104.00 , $104.00 , $28.04 , $120.03 , $123.50 , $117.00 , $117.00 , $117.00 , $120.90 , $124.80 , $96.97 , $110.50 , $84.01 , $85.56 , $68.25 , $68.90 , $68.90 , $123.50 , $79.46 , $28.04 , $124.80 
 Pro Dstr Nrolytc Agnt Parverteb Fct Sngl Crvcl/Thora ,CPT® 64633,0982 - PRO FEE/OUTPT,N/A,N/A," $1,746.00 "," $1,134.90 ", $948.95 , $184.67 , $352.82 ," $1,276.16 "," $1,199.66 "," $1,623.78 "," $1,571.40 "," $1,571.40 "," $1,396.80 "," $1,396.80 ", $352.82 ," $1,612.08 "," $1,658.70 "," $1,571.40 "," $1,571.40 "," $1,571.40 "," $1,623.78 "," $1,676.16 "," $1,203.74 "," $1,484.10 "," $1,164.99 "," $1,367.43 ", N/A ," $1,301.06 "," $1,301.06 "," $1,658.70 "," $1,395.72 ", $184.67 ," $1,676.16 "
Cytog Alys Chrmoml Abnor Copy Number Vrnt Cgh,CPT® 81228,N/A,N/A,N/A," $4,024.00 "," $2,615.60 ", N/A , $918.00 , $527.25 , N/A , N/A ," $3,742.32 "," $3,621.60 "," $3,621.60 "," $3,219.20 "," $3,219.20 ", $527.25 ," $3,715.36 "," $3,822.80 "," $3,621.60 "," $3,621.60 "," $3,621.60 "," $3,742.32 "," $3,863.04 "," $6,009.50 "," $3,420.40 "," $4,290.42 "," $2,643.30 ", N/A ," $3,573.00 "," $3,573.00 "," $3,822.80 "," $3,897.00 ", $527.25 ," $6,009.50 "
 Pro Office/Outpatient Established Sf Mdm 10-19 Min ,CPT® 99212,0982 - PRO FEE/OUTPT,N/A,N/A, $119.00 , $77.35 , $72.24 , $34.37 , $29.87 , $44.01 , $43.22 , $110.67 , $107.10 , $107.10 , $95.20 , $95.20 , $29.87 , $109.87 , $113.05 , $107.10 , $107.10 , $107.10 , $110.67 , $114.24 , $65.53 , $101.15 , $54.01 , $55.40 , $64.00 , $44.87 , $44.87 , $113.05 , $51.74 , $29.87 , $114.24 
"Vag Deliv Only,Prev C-Sectn",CPT® 59612,N/A,N/A,N/A," $3,342.00 "," $2,172.30 "," $2,407.02 ", $812.60 , $668.56 ," $2,120.34 "," $2,219.11 "," $3,108.06 "," $3,007.80 "," $3,007.80 "," $2,673.60 "," $2,673.60 ", $668.56 ," $3,085.67 "," $3,174.90 "," $3,007.80 "," $3,007.80 "," $3,007.80 "," $3,108.06 "," $3,208.32 "," $2,455.37 "," $2,840.70 "," $4,922.23 "," $2,107.37 ", N/A ," $2,161.71 "," $2,161.71 "," $3,174.90 "," $2,499.16 ", $668.56 ," $4,922.23 "
 HYDROXYZINE HCL 10 MG/5ML PO SYRP ,HCPCS RXC637,0250 - PHARMACY,54838-0502-80,5 mL, $6.40 , $4.16 , $5.38 , N/A , N/A , $5.17 , $5.76 , $5.42 , $5.76 , $5.76 , $5.76 , $5.44 , N/A , $5.91 , $6.08 , $5.44 , $5.95 , $5.95 , $6.08 , $6.14 , $5.24 , $5.76 , $5.44 , $5.06 , N/A , $5.18 , $5.18 , $6.08 , $5.49 , $5.06 , $6.14 
 BETHANECHOL CHLORIDE 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,51293-0645-01,1 tablet, $4.63 , $3.01 , $3.89 , N/A , N/A , $3.74 , $4.17 , $3.92 , $4.17 , $4.17 , $4.17 , $3.94 , N/A , $4.27 , $4.40 , $3.94 , $4.31 , $4.31 , $4.40 , $4.44 , $3.79 , $4.17 , $3.94 , $3.66 , N/A , $3.75 , $3.75 , $4.40 , $3.97 , $3.66 , $4.44 
 Pro Radex Kne Arthg Rs&I ,CPT® 73580,0972 - PRO FEE/RAD/DX,N/A,N/A, $164.00 , $106.60 , $841.06 , $125.57 , $118.67 , $546.48 , $695.12 , $152.52 , $147.60 , $147.60 , $131.20 , $131.20 , $118.67 , $151.42 , $155.80 , $147.60 , $147.60 , $147.60 , $152.52 , $157.44 , $804.66 , $139.40 , $764.64 , $590.16 , N/A , $557.14 , $557.14 , $155.80 , $644.91 , $118.67 , $841.06 
"Part Remv Bone,Distal Phalanx",26236,N/A,N/A,N/A," $1,674.00 "," $1,088.10 "," $2,714.99 ", $426.37 , $307.34 ," $2,121.75 "," $2,123.66 "," $1,556.82 "," $1,506.60 "," $1,506.60 "," $1,339.20 "," $1,339.20 ", $307.34 ," $1,545.60 "," $1,590.30 "," $1,506.60 "," $1,506.60 "," $1,506.60 "," $1,556.82 "," $1,607.04 "," $2,519.51 "," $1,422.90 "," $2,333.56 "," $2,521.61 ", N/A ," $2,163.15 "," $2,163.15 "," $1,590.30 "," $2,542.45 ", $307.34 ," $2,714.99 "
 Shoulder One View ,CPT® 73020,0320 - DX X-RAY,N/A,N/A, $213.00 , $138.45 , $178.92 , $21.17 , $22.57 , $172.10 , $191.70 , $180.33 , $191.70 , $191.70 , $191.70 , $181.05 , $22.13 , $196.66 , $202.35 , $181.05 , $198.09 , $198.09 , $202.35 , $204.48 , $174.28 , $191.70 , $181.05 , $168.27 , N/A , $172.38 , $172.38 , $202.35 , $182.78 , $21.17 , $204.48 
 I&D Abscess Simple or Single ,CPT® 10060,0761 - TREATMENT ROOM,N/A,N/A, $559.00 , $363.35 , $469.56 , $102.58 , $41.23 , $451.67 , $503.10 , $473.25 , $503.10 , $503.10 , $503.10 , $475.15 , $40.42 , $516.12 , $531.05 , $475.15 , $519.87 , $519.87 , $531.05 , $536.64 , $457.37 , $503.10 , $475.15 , $441.61 , N/A , $452.40 , $452.40 , $531.05 , $479.68 , $40.42 , $536.64 
" Lac Repair Trunk, Extrem Interm 7.6-12.5cm - Mh ",CPT® 12034,0761 - TREATMENT ROOM,N/A,N/A," $1,123.00 ", $729.95 , $943.32 , $196.65 , $122.93 , $907.38 ," $1,010.70 ", $950.73 ," $1,010.70 "," $1,010.70 "," $1,010.70 ", $954.55 , $120.52 ," $1,036.87 "," $1,066.85 ", $954.55 ," $1,044.39 "," $1,044.39 "," $1,066.85 "," $1,078.08 ", $918.84 ," $1,010.70 ", $954.55 , $887.17 , N/A , $908.84 , $908.84 ," $1,066.85 ", $963.65 , $120.52 ," $1,078.08 "
"Mass Spectrometry Quant,Nonspec",CPT® 83789,N/A,N/A,N/A, $174.00 , $113.10 , N/A , $24.59 , $24.59 , $102.19 , $122.20 , $161.82 , $156.60 , $156.60 , $139.20 , $139.20 , $24.59 , $160.65 , $165.30 , $156.60 , $156.60 , $156.60 , $161.82 , $167.04 , $160.99 , $147.90 , $118.39 , $70.81 , N/A , $95.37 , $95.37 , $165.30 , $104.22 , $24.59 , $167.04 
 CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN ,HCPCS J3230,0636 - DRUGS REQUIRING DETAILED CODIN,00641-1398-35,2 mL, $204.05 , $132.63 , $171.40 , $36.67 , $37.10 , $164.87 , $183.65 , $172.75 , $183.65 , $183.65 , $183.65 , $173.44 , $36.37 , $188.40 , $193.85 , $173.44 , $189.77 , $189.77 , $193.85 , $195.89 , $166.95 , $183.65 , $173.44 , $161.20 , N/A , $165.14 , $165.14 , $193.85 , $175.10 , $36.37 , $195.89 
Fx Cl Scapular W/O Manip,CPT® 23570,N/A,N/A,N/A, $868.00 , $564.20 ," $1,508.00 ", $239.36 , $101.63 ," $1,150.84 "," $1,170.86 ", $807.24 , $781.20 , $781.20 , $694.40 , $694.40 , $101.63 , $801.42 , $824.60 , $781.20 , $781.20 , $781.20 , $807.24 , $833.28 ," $1,389.76 ", $737.80 ," $1,284.53 "," $1,368.26 ", N/A ," $1,173.30 "," $1,173.30 ", $824.60 ," $1,379.07 ", $101.63 ," $1,508.00 "
"Fusion Foot Bones,Subtalar",CPT® 28725,N/A,N/A,N/A," $7,522.00 "," $4,889.30 "," $4,754.69 ", $745.14 , $768.38 ," $3,781.83 "," $3,762.66 "," $6,995.46 "," $6,769.80 "," $6,769.80 "," $6,017.60 "," $6,017.60 ", $768.38 ," $6,945.06 "," $7,145.90 "," $6,769.80 "," $6,769.80 "," $6,769.80 "," $6,995.46 "," $7,221.12 "," $4,420.81 "," $6,393.70 "," $4,122.97 "," $4,473.55 ", N/A ," $3,855.61 "," $3,855.61 "," $7,145.90 "," $4,531.72 ", $745.14 ," $7,221.12 "
 Pro CT Angio Abdom W/O & W/Dye ,CPT® 74175,0972 - PRO FEE/RAD/DX,N/A,N/A, $986.00 , $640.90 ," $1,792.84 ", $259.04 , $394.70 ," $1,460.66 "," $2,138.51 ", $916.98 , $887.40 , $887.40 , $788.80 , $788.80 , $394.70 , $910.37 , $936.70 , $887.40 , $887.40 , $887.40 , $916.98 , $946.56 ," $1,816.98 ", $838.10 ," $2,332.44 "," $1,992.65 ", N/A ," $1,489.16 "," $1,489.16 ", $936.70 ," $1,723.74 ", $259.04 ," $2,332.44 "
 Pro Perq Vert Agmntj Cavity Crtj Uni/Bi Cannulation ,CPT® 22513,0982 - PRO FEE/OUTPT,N/A,N/A," $6,164.00 "," $4,006.60 "," $3,068.13 ", $477.25 ," $5,767.47 "," $2,501.30 "," $2,648.49 "," $5,732.52 "," $5,547.60 "," $5,547.60 "," $4,931.20 "," $4,931.20 "," $5,767.47 "," $5,691.22 "," $5,855.80 "," $5,547.60 "," $5,547.60 "," $5,547.60 "," $5,732.52 "," $5,917.44 "," $2,866.72 "," $5,239.40 "," $2,692.07 "," $2,956.45 ", N/A ," $2,550.10 "," $2,550.10 "," $5,855.80 "," $2,997.28 ", $477.25 ," $5,917.44 "
 Fac Assay of Ggt ,CPT® 82977,0301 - LAB/CHEMISTRY,N/A,N/A, $80.00 , $52.00 , $67.20 , $7.34 , $7.34 , $64.64 , $72.00 , $67.73 , $72.00 , $72.00 , $72.00 , $68.00 , $7.20 , $73.86 , $76.00 , $68.00 , $74.40 , $74.40 , $76.00 , $76.80 , $65.46 , $72.00 , $68.00 , $63.20 , N/A , $64.74 , $64.74 , $76.00 , $68.65 , $7.20 , $76.80 
Aortic Dysfunction/Dilation Dup/Del Analysis,CPT® 81411,N/A,N/A,N/A," $5,957.00 "," $3,872.05 ", N/A ," $1,377.19 "," $1,377.19 ", N/A , N/A ," $5,540.01 "," $5,361.30 "," $5,361.30 "," $4,765.60 "," $4,765.60 "," $1,377.19 "," $5,500.10 "," $5,659.15 "," $5,361.30 "," $5,361.30 "," $5,361.30 "," $5,540.01 "," $5,718.72 "," $9,015.52 "," $5,063.45 "," $6,435.63 "," $3,965.51 ", N/A ," $5,360.25 "," $5,360.25 "," $5,659.15 "," $5,846.32 "," $1,377.19 "," $9,015.52 "
 CT Extrem Lower W/O-W/Contrast ,CPT® 73702,0350 - CT SCAN,N/A,N/A," $4,263.00 "," $2,770.95 "," $3,580.92 ", $199.67 , $355.39 ," $3,444.50 "," $3,836.70 "," $3,609.06 "," $3,836.70 "," $3,836.70 "," $3,836.70 "," $3,623.55 ", $348.42 ," $3,936.03 "," $4,049.85 "," $3,623.55 "," $3,964.59 "," $3,964.59 "," $4,049.85 "," $4,092.48 "," $3,487.99 "," $3,836.70 "," $3,623.55 "," $3,367.77 ", N/A ," $3,450.05 "," $3,450.05 "," $4,049.85 "," $3,658.08 ", $199.67 ," $4,092.48 "
 PANCRELIPASE (LIP-PROT-AMYL) 6000-19000 UNITS PO CPEP ,HCPCS RXC637,0250 - PHARMACY,00032-1206-01,1 capsule, $12.21 , $7.94 , $10.26 , N/A , N/A , $9.87 , $10.99 , $10.34 , $10.99 , $10.99 , $10.99 , $10.38 , N/A , $11.27 , $11.60 , $10.38 , $11.36 , $11.36 , $11.60 , $11.72 , $9.99 , $10.99 , $10.38 , $9.65 , N/A , $9.88 , $9.88 , $11.60 , $10.48 , $9.65 , $11.72 
Bronchoscopy Bronchial/Endobrncl Bx 1+ Sites,CPT® 31625,N/A,N/A,N/A," $2,177.00 "," $1,415.05 ", $856.52 , $148.07 , $466.98 , $663.26 , $648.90 ," $2,024.61 "," $1,959.30 "," $1,959.30 "," $1,741.60 "," $1,741.60 ", $466.98 ," $2,010.02 "," $2,068.15 "," $1,959.30 "," $1,959.30 "," $1,959.30 "," $2,024.61 "," $2,089.92 ", $828.12 ," $1,850.45 ", $904.52 , $818.61 , N/A , $676.21 , $676.21 ," $2,068.15 ", $796.37 , $148.07 ," $2,089.92 "
"Endometrial Ablation, Thermal",CPT® 58353,N/A,N/A,N/A," $6,329.00 "," $4,113.85 "," $1,095.35 ", $221.80 , $803.33 , $892.41 , $891.99 ," $5,885.97 "," $5,696.10 "," $5,696.10 "," $5,063.20 "," $5,063.20 ", $803.33 ," $5,843.57 "," $6,012.55 "," $5,696.10 "," $5,696.10 "," $5,696.10 "," $5,885.97 "," $6,075.84 "," $1,135.97 "," $5,379.65 "," $1,173.91 ", $893.01 , N/A , $909.82 , $909.82 ," $6,012.55 "," $1,091.27 ", $221.80 ," $6,075.84 "
 Pbb Drug Test Def 15-21 Classes ,HCPCS G0482,0301 - LAB/CHEMISTRY,N/A,N/A, $298.00 , $193.70 , $250.32 , $202.71 , $135.46 , $240.78 , $268.20 , $252.29 , $268.20 , $268.20 , $268.20 , $253.30 , $132.80 , $275.14 , $283.10 , $253.30 , $277.14 , $277.14 , $283.10 , $286.08 , $243.82 , $268.20 , $253.30 , $235.42 , N/A , $241.17 , $241.17 , $283.10 , $255.71 , $132.80 , $286.08 
Moderna Admin Third Dose Ages 6-11,CPT® 0093A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $56.00 , $128.02 , N/A , N/A , N/A , $66.50 , N/A , $38.92 , $128.02 
Rho D Immune Globulin Inj,HCPCS J2790,N/A,N/A,N/A, $210.00 , $136.50 , N/A , $83.47 , $83.41 , N/A , N/A , $195.30 , $189.00 , $189.00 , $168.00 , $168.00 , $83.41 , $193.89 , $199.50 , $189.00 , $189.00 , $189.00 , $195.30 , $201.60 , $100.79 , $178.50 , $160.89 , $104.85 , N/A , N/A , N/A , $199.50 , N/A , $83.41 , $201.60 
 Fac Iaad Ia Rotavirus ,CPT® 87425,0306 - LAB/BACT-MICRO,N/A,N/A, $111.00 , $72.15 , $93.24 , $12.22 , $12.22 , $89.69 , $99.90 , $93.97 , $99.90 , $99.90 , $99.90 , $94.35 , $11.98 , $102.49 , $105.45 , $94.35 , $103.23 , $103.23 , $105.45 , $106.56 , $90.82 , $99.90 , $94.35 , $87.69 , N/A , $89.83 , $89.83 , $105.45 , $95.25 , $11.98 , $106.56 
Blood Clot Factor VIII Test,CPT® 85246,N/A,N/A,N/A, $348.00 , $226.20 , N/A , $23.40 , $23.40 , $129.79 , $155.30 , $323.64 , $313.20 , $313.20 , $278.40 , $278.40 , $23.40 , $321.31 , $330.60 , $313.20 , $313.20 , $313.20 , $323.64 , $334.08 , $153.18 , $295.80 , $150.83 , $83.18 , N/A , $121.13 , $121.13 , $330.60 , $132.37 , $23.40 , $334.08 
Close Kidney-Skin Fistula,CPT® 50520,N/A,N/A,N/A," $7,680.00 "," $4,992.00 "," $6,101.56 "," $1,067.53 "," $1,229.45 "," $5,070.25 "," $4,712.35 "," $7,142.40 "," $6,912.00 "," $6,912.00 "," $6,144.00 "," $6,144.00 "," $1,229.45 "," $7,090.94 "," $7,296.00 "," $6,912.00 "," $6,912.00 "," $6,912.00 "," $7,142.40 "," $7,372.80 "," $6,086.79 "," $6,528.00 "," $5,336.14 "," $6,782.60 ", N/A ," $5,169.18 "," $5,169.18 "," $7,296.00 "," $6,075.64 "," $1,067.53 "," $7,372.80 "
"Russell Viper Venom, Diluted",CPT® 85613,N/A,N/A,N/A, $141.00 , $91.65 , N/A , $9.77 , $9.77 , $54.18 , $64.80 , $131.13 , $126.90 , $126.90 , $112.80 , $112.80 , $9.77 , $130.19 , $133.95 , $126.90 , $126.90 , $126.90 , $131.13 , $135.36 , $63.97 , $119.85 , $63.25 , $34.74 , N/A , $50.56 , $50.56 , $133.95 , $55.25 , $9.77 , $135.36 
 Pro Antepartum Manipulation ,CPT® 59412,0982 - PRO FEE/OUTPT,N/A,N/A," $1,252.00 ", $813.80 , $273.09 , $92.55 , $92.65 , $240.23 , $251.94 ," $1,164.36 "," $1,126.80 "," $1,126.80 "," $1,001.60 "," $1,001.60 ", $92.65 ," $1,155.97 "," $1,189.40 "," $1,126.80 "," $1,126.80 "," $1,126.80 "," $1,164.36 "," $1,201.92 ", $278.44 ," $1,064.20 ", $556.63 , $444.36 , N/A , $244.92 , $244.92 ," $1,189.40 ", $283.17 , $92.55 ," $1,201.92 "
Methylprednisolone Injection,HCPCS J2920,N/A,N/A,N/A, $11.00 , $7.15 , N/A , $4.32 , $4.21 , N/A , N/A , $10.23 , $9.90 , $9.90 , $8.80 , $8.80 , $4.21 , $10.16 , $10.45 , $9.90 , $9.90 , $9.90 , $10.23 , $10.56 , $5.24 , $9.35 , $3.24 , $5.58 , N/A , N/A , N/A , $10.45 , N/A , $3.24 , $10.56 
Peri-Implant Capsulectomy Breast Complete,CPT® 19371,N/A,N/A,N/A," $5,835.00 "," $3,792.75 "," $2,262.46 ", $678.19 , $495.41 ," $2,135.75 "," $2,097.46 "," $5,426.55 "," $5,251.50 "," $5,251.50 "," $4,668.00 "," $4,668.00 ", $495.41 ," $5,387.46 "," $5,543.25 "," $5,251.50 "," $5,251.50 "," $5,251.50 "," $5,426.55 "," $5,601.60 "," $2,482.37 "," $4,959.75 "," $4,208.61 "," $2,727.46 ", N/A ," $2,177.43 "," $2,177.43 "," $5,543.25 "," $2,525.08 ", $495.41 ," $5,601.60 "
 NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP OINT ,HCPCS RXC637,0250 - PHARMACY,61314-0631-36,3.5 gram, $226.02 , $146.91 , $189.86 , N/A , N/A , $182.62 , $203.42 , $191.35 , $203.42 , $203.42 , $203.42 , $192.12 , N/A , $208.68 , $214.72 , $192.12 , $210.20 , $210.20 , $214.72 , $216.98 , $184.93 , $203.42 , $192.12 , $178.56 , N/A , $182.92 , $182.92 , $214.72 , $193.95 , $178.56 , $216.98 
Assay Urine Chloride,CPT® 82436,N/A,N/A,N/A, $62.00 , $40.30 , N/A , $5.87 , $5.87 , $28.48 , $34.02 , $57.66 , $55.80 , $55.80 , $49.60 , $49.60 , $5.87 , $57.24 , $58.90 , $55.80 , $55.80 , $55.80 , $57.66 , $59.52 , $38.39 , $52.70 , $32.44 , $18.24 , N/A , $26.58 , $26.58 , $58.90 , $29.04 , $5.87 , $59.52 
 Pro CT Sft Tsue Nck W/O & W/Dye ,CPT® 70492,0972 - PRO FEE/RAD/DX,N/A,N/A, $967.00 , $628.55 ," $1,584.66 ", $227.17 , $355.58 ," $1,322.70 "," $1,686.11 ", $899.31 , $870.30 , $870.30 , $773.60 , $773.60 , $355.58 , $892.83 , $918.65 , $870.30 , $870.30 , $870.30 , $899.31 , $928.32 ," $1,341.31 ", $821.95 ," $1,837.44 "," $1,590.16 ", N/A ," $1,348.52 "," $1,348.52 ", $918.65 ," $1,560.92 ", $227.17 ," $1,837.44 "
 Skull Min 4 Views Complete ,CPT® 70260,0320 - DX X-RAY,N/A,N/A, $435.00 , $282.75 , $365.40 , $44.04 , $45.27 , $351.48 , $391.50 , $368.27 , $391.50 , $391.50 , $391.50 , $369.75 , $44.38 , $401.64 , $413.25 , $369.75 , $404.55 , $404.55 , $413.25 , $417.60 , $355.92 , $391.50 , $369.75 , $343.65 , N/A , $352.05 , $352.05 , $413.25 , $373.27 , $44.04 , $417.60 
"Shldr Arthroscop,Surg,W/Rotat Cuff Repr",29827,N/A,N/A,N/A," $5,840.00 "," $3,796.00 "," $6,477.90 "," $1,013.19 ", $952.41 ," $5,119.72 "," $5,149.96 "," $5,431.20 "," $5,256.00 "," $5,256.00 "," $4,672.00 "," $4,672.00 ", $952.41 ," $5,392.07 "," $5,548.00 "," $5,256.00 "," $5,256.00 "," $5,256.00 "," $5,431.20 "," $5,606.40 "," $6,032.45 "," $4,964.00 "," $5,696.52 "," $6,048.21 ", N/A ," $5,219.61 "," $5,219.61 "," $5,548.00 "," $6,134.91 ", $952.41 ," $6,477.90 "
 Fac Cardiolipin Antibody ,CPT® 86147,0302 - LAB/IMMUNOLOGY,N/A,N/A, $261.00 , $169.65 , $219.24 , $25.96 , $8.07 , $210.89 , $234.90 , $220.96 , $234.90 , $234.90 , $234.90 , $221.85 , $7.91 , $240.98 , $247.95 , $221.85 , $242.73 , $242.73 , $247.95 , $250.56 , $213.55 , $234.90 , $221.85 , $206.19 , N/A , $211.23 , $211.23 , $247.95 , $223.96 , $7.91 , $250.56 
 SEVOFLURANE INH SOLN ,HCPCS RXA250,0250 - PHARMACY,00074-4456-04,28 each," $1,762.02 "," $1,145.31 "," $1,480.10 ", N/A , N/A ," $1,423.71 "," $1,585.82 "," $1,491.73 "," $1,585.82 "," $1,585.82 "," $1,585.82 "," $1,497.72 ", N/A ," $1,626.87 "," $1,673.92 "," $1,497.72 "," $1,638.68 "," $1,638.68 "," $1,673.92 "," $1,691.54 "," $1,441.68 "," $1,585.82 "," $1,497.72 "," $1,392.00 ", N/A ," $1,426.00 "," $1,426.00 "," $1,673.92 "," $1,511.99 "," $1,392.00 "," $1,691.54 "
Spherocylinder 4.25d/4.25-6d,HCPCS V2109,N/A,N/A,N/A, $55.00 , $35.75 , N/A , $77.03 , N/A , N/A , N/A , $51.15 , $49.50 , $49.50 , $44.00 , $44.00 , N/A , $50.78 , $52.25 , $49.50 , $49.50 , $49.50 , $51.15 , $52.80 , N/A , $46.75 , $55.00 , $69.98 , N/A , N/A , N/A , $52.25 , N/A , $44.00 , $77.03 
 Fac Rmvl Embedded FB Vestibule Mouth Smpl ,CPT® 40804,0761 - TREATMENT ROOM,N/A,N/A," $1,179.00 ", $766.35 , $990.36 , $109.50 , $30.71 , $952.63 ," $1,061.10 ", $998.14 ," $1,061.10 "," $1,061.10 "," $1,061.10 "," $1,002.15 ", $30.11 ," $1,088.57 "," $1,120.05 "," $1,002.15 "," $1,096.47 "," $1,096.47 "," $1,120.05 "," $1,131.84 ", $964.66 ," $1,061.10 "," $1,002.15 ", $931.41 , N/A , $954.16 , $954.16 ," $1,120.05 "," $1,011.70 ", $30.11 ," $1,131.84 "
" Pro Fix Entropion,Excis Tarsal Wedge ",CPT® 67923,0982 - PRO FEE/OUTPT,N/A,N/A," $5,624.00 "," $3,655.60 "," $2,640.04 ", $414.85 , $461.04 ," $2,439.53 "," $2,491.22 "," $5,230.32 "," $5,061.60 "," $5,061.60 "," $4,499.20 "," $4,499.20 ", $461.04 ," $5,192.64 "," $5,342.80 "," $5,061.60 "," $5,061.60 "," $5,061.60 "," $5,230.32 "," $5,399.04 "," $3,624.90 "," $4,780.40 "," $2,581.54 "," $3,097.33 ", N/A ," $2,487.13 "," $2,487.13 "," $5,342.80 "," $2,745.46 ", $414.85 ," $5,399.04 "
"Imp Stim,Cranial,Subq,1 Array",CPT® 61885,N/A,N/A,N/A," $3,445.00 "," $2,239.25 "," $2,465.37 ", $483.86 , $206.41 ," $2,798.90 "," $2,748.93 "," $3,203.85 "," $3,100.50 "," $3,100.50 "," $2,756.00 "," $2,756.00 ", $206.41 ," $3,180.77 "," $3,272.75 "," $3,100.50 "," $3,100.50 "," $3,100.50 "," $3,203.85 "," $3,307.20 "," $2,648.44 "," $2,928.25 "," $2,788.49 "," $2,926.26 ", N/A ," $2,853.51 "," $2,853.51 "," $3,272.75 "," $3,061.15 ", $206.41 ," $3,307.20 "
"Destr Malig Scal,Nck,Hand 0.6-1 Cm",CPT® 17271,N/A,N/A,N/A, $627.00 , $407.55 , $335.72 , $101.70 , $118.93 , $302.92 , $298.00 , $583.11 , $564.30 , $564.30 , $501.60 , $501.60 , $118.93 , $578.91 , $595.65 , $564.30 , $564.30 , $564.30 , $583.11 , $601.92 , $370.64 , $532.95 , $592.31 , $388.32 , N/A , $308.83 , $308.83 , $595.65 , $358.12 , $101.70 , $601.92 
"Remove Foreign Body,Foot",CPT® 28193,N/A,N/A,N/A," $3,608.00 "," $2,345.20 "," $2,279.29 ", $356.58 , $214.44 ," $1,826.54 "," $1,823.32 "," $3,355.44 "," $3,247.20 "," $3,247.20 "," $2,886.40 "," $2,886.40 ", $214.44 ," $3,331.27 "," $3,427.60 "," $3,247.20 "," $3,247.20 "," $3,247.20 "," $3,355.44 "," $3,463.68 "," $2,124.63 "," $3,066.80 "," $1,971.39 "," $2,164.89 ", N/A ," $1,862.17 "," $1,862.17 "," $3,427.60 "," $2,188.72 ", $214.44 ," $3,463.68 "
"Reconstruc Toe Deform,Soft Tissue",28313,N/A,N/A,N/A," $3,483.00 "," $2,263.95 "," $2,213.12 ", $348.37 , $615.42 ," $1,756.63 "," $1,741.32 "," $3,239.19 "," $3,134.70 "," $3,134.70 "," $2,786.40 "," $2,786.40 ", $615.42 ," $3,215.85 "," $3,308.85 "," $3,134.70 "," $3,134.70 "," $3,134.70 "," $3,239.19 "," $3,343.68 "," $2,058.22 "," $2,960.55 "," $1,898.24 "," $2,063.54 ", N/A ," $1,790.91 "," $1,790.91 "," $3,308.85 "," $2,104.96 ", $348.37 ," $3,343.68 "
 EMPAGLIFLOZIN 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00597-0152-30,1 tablet, $121.91 , $79.24 , $102.40 , N/A , N/A , $98.50 , $109.72 , $103.21 , $109.72 , $109.72 , $109.72 , $103.62 , N/A , $112.56 , $115.81 , $103.62 , $113.38 , $113.38 , $115.81 , $117.03 , $99.75 , $109.72 , $103.62 , $96.31 , N/A , $98.66 , $98.66 , $115.81 , $104.61 , $96.31 , $117.03 
 Fac Nuclear Antigen Antibody ,CPT® 86235,0302 - LAB/IMMUNOLOGY,N/A,N/A, $167.00 , $108.55 , $140.28 , $18.29 , $18.29 , $134.94 , $150.30 , $141.38 , $150.30 , $150.30 , $150.30 , $141.95 , $17.93 , $154.19 , $158.65 , $141.95 , $155.31 , $155.31 , $158.65 , $160.32 , $136.64 , $150.30 , $141.95 , $131.93 , N/A , $135.15 , $135.15 , $158.65 , $143.30 , $17.93 , $160.32 
"Prolonged Serv,No Contct,Ea Add 1/2",CPT® 99359,N/A,N/A,N/A, $201.00 , $130.65 , $106.79 , $41.46 , N/A , $91.04 , $91.57 , $186.93 , $180.90 , $180.90 , $160.80 , $160.80 , N/A , $185.58 , $190.95 , $180.90 , $180.90 , $180.90 , $186.93 , $192.96 , $96.89 , $170.85 , N/A , $117.62 , N/A , $92.81 , $92.81 , $190.95 , $107.06 , $41.46 , $192.96 
 Fac Assay of Magnesium ,CPT® 83735,0301 - LAB/CHEMISTRY,N/A,N/A, $80.00 , $52.00 , $67.20 , $6.83 , $6.83 , $64.64 , $72.00 , $67.73 , $72.00 , $72.00 , $72.00 , $68.00 , $6.70 , $73.86 , $76.00 , $68.00 , $74.40 , $74.40 , $76.00 , $76.80 , $65.46 , $72.00 , $68.00 , $63.20 , N/A , $64.74 , $64.74 , $76.00 , $68.65 , $6.70 , $76.80 
"Immuniz Admin, Thru Age 18, Any Route,W Counsel, 1st Vaccine/Toxoid",CPT® 90460,N/A,N/A,N/A, $92.00 , $59.80 , $40.23 , $21.97 , N/A , $57.67 , $59.77 , $85.56 , $82.80 , $82.80 , $73.60 , $73.60 , N/A , $84.94 , $87.40 , $82.80 , $82.80 , $82.80 , $85.56 , $88.32 , $59.44 , $78.20 , $77.04 , $64.43 , N/A , $58.79 , $58.79 , $87.40 , $69.67 , $21.97 , $88.32 
 Orbit/Face/Neck MRI Without Contrast ,CPT® 70540,0610 - MRI,N/A,N/A," $4,867.00 "," $3,163.55 "," $4,088.28 ", $232.84 , $411.48 ," $3,932.54 "," $4,380.30 "," $4,120.40 "," $4,380.30 "," $4,380.30 "," $4,380.30 "," $4,136.95 ", $403.41 ," $4,493.70 "," $4,623.65 "," $4,136.95 "," $4,526.31 "," $4,526.31 "," $4,623.65 "," $4,672.32 "," $3,982.18 "," $4,380.30 "," $4,136.95 "," $3,844.93 ", N/A ," $3,938.86 "," $3,938.86 "," $4,623.65 "," $4,176.37 ", $232.84 ," $4,672.32 "
Lanreotide Injection,HCPCS J1930,N/A,N/A,N/A, $131.00 , $85.15 , N/A , $55.26 , $62.79 , N/A , N/A , $121.83 , $117.90 , $117.90 , $104.80 , $104.80 , $62.79 , $120.95 , $124.45 , $117.90 , $117.90 , $117.90 , $121.83 , $125.76 , $89.05 , $111.35 , $66.82 , $83.04 , N/A , N/A , N/A , $124.45 , N/A , $55.26 , $125.76 
 Facial Bones Min 3 Views Complete ,CPT® 70150,0320 - DX X-RAY,N/A,N/A, $440.00 , $286.00 , $369.60 , $46.31 , $40.44 , $355.52 , $396.00 , $372.50 , $396.00 , $396.00 , $396.00 , $374.00 , $39.65 , $406.25 , $418.00 , $374.00 , $409.20 , $409.20 , $418.00 , $422.40 , $360.01 , $396.00 , $374.00 , $347.60 , N/A , $356.09 , $356.09 , $418.00 , $377.56 , $39.65 , $422.40 
 Pro Rmvl FB Intransl Off Typ Px ,CPT® 30300,0981 - PRO FEE/ER,N/A,N/A, $522.00 , $339.30 , $688.10 , $121.29 , $64.81 , $481.74 , $495.34 , $485.46 , $469.80 , $469.80 , $417.60 , $417.60 , $64.81 , $481.96 , $495.90 , $469.80 , $469.80 , $469.80 , $485.46 , $501.12 , $637.33 , $443.70 , $695.78 , $541.12 , N/A , $491.14 , $491.14 , $495.90 , $578.42 , $64.81 , $695.78 
"Echo Heart Xthoracic, Stress/Rest, W Contin Ecg",CPT® 93351,N/A,N/A,N/A," $4,111.00 "," $2,672.15 "," $1,485.84 ", $228.39 , $215.52 ," $1,457.91 "," $1,314.15 "," $3,823.23 "," $3,699.90 "," $3,699.90 "," $3,288.80 "," $3,288.80 ", $215.52 ," $3,795.69 "," $3,905.45 "," $3,699.90 "," $3,699.90 "," $3,699.90 "," $3,823.23 "," $3,946.56 "," $1,470.27 "," $3,494.35 "," $1,229.22 "," $1,402.09 ", N/A ," $1,486.35 "," $1,486.35 "," $3,905.45 "," $1,647.63 ", $215.52 ," $3,946.56 "
 Fac Assay of Urine Sodium ,CPT® 84300,0301 - LAB/CHEMISTRY,N/A,N/A, $71.00 , $46.15 , $59.64 , $5.16 , $5.16 , $57.37 , $63.90 , $60.11 , $63.90 , $63.90 , $63.90 , $60.35 , $5.06 , $65.55 , $67.45 , $60.35 , $66.03 , $66.03 , $67.45 , $68.16 , $58.09 , $63.90 , $60.35 , $56.09 , N/A , $57.46 , $57.46 , $67.45 , $60.93 , $5.06 , $68.16 
 DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV INJ ,HCPCS Q2050,0636 - DRUGS REQUIRING DETAILED CODIN,43598-0283-35,10 mL," $1,323.15 ", $860.05 ," $1,111.45 ", $89.74 , $104.28 ," $1,069.11 "," $1,190.84 "," $1,120.18 "," $1,190.84 "," $1,190.84 "," $1,190.84 "," $1,124.68 ", $102.24 ," $1,221.66 "," $1,256.99 "," $1,124.68 "," $1,230.53 "," $1,230.53 "," $1,256.99 "," $1,270.22 "," $1,082.60 "," $1,190.84 "," $1,124.68 "," $1,045.29 ", N/A ," $1,070.83 "," $1,070.83 "," $1,256.99 "," $1,135.40 ", $89.74 ," $1,270.22 "
 CLONAZEPAM 0.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60687-0544-01,1 tablet, $3.64 , $2.37 , $3.06 , N/A , N/A , $2.94 , $3.28 , $3.08 , $3.28 , $3.28 , $3.28 , $3.09 , N/A , $3.36 , $3.46 , $3.09 , $3.39 , $3.39 , $3.46 , $3.49 , $2.98 , $3.28 , $3.09 , $2.88 , N/A , $2.95 , $2.95 , $3.46 , $3.12 , $2.88 , $3.49 
 Pro Emergency Department Visit May Not Req Phys/Qhp ,CPT® 99281,0981 - PRO FEE/ER,N/A,N/A, $160.00 , $104.00 , $76.63 , $11.05 , $22.89 , $59.28 , $61.20 , $148.80 , $144.00 , $144.00 , $128.00 , $128.00 , $22.89 , $147.73 , $152.00 , $144.00 , $144.00 , $144.00 , $148.80 , $153.60 , $65.12 , $136.00 , $45.01 , $46.01 , $12.50 , $60.43 , $60.43 , $152.00 , $72.52 , $11.05 , $153.60 
Excis Testis Extraparenchymal Lesion,CPT® 54512,N/A,N/A,N/A," $2,959.00 "," $1,923.35 "," $2,381.96 ", $513.06 , $358.03 ," $1,734.78 "," $1,747.72 "," $2,751.87 "," $2,663.10 "," $2,663.10 "," $2,367.20 "," $2,367.20 ", $358.03 ," $2,732.04 "," $2,811.05 "," $2,663.10 "," $2,663.10 "," $2,663.10 "," $2,751.87 "," $2,840.64 "," $2,242.61 "," $2,515.15 "," $2,786.71 "," $2,612.71 ", N/A ," $1,768.63 "," $1,768.63 "," $2,811.05 "," $2,119.81 ", $358.03 ," $2,840.64 "
X-Ray Cystogram,CPT® 74430,N/A,N/A,N/A, $451.00 , $293.15 , $229.91 , $40.61 , $59.34 , $177.18 , $218.13 , $419.43 , $405.90 , $405.90 , $360.80 , $360.80 , $59.34 , $416.41 , $428.45 , $405.90 , $405.90 , $405.90 , $419.43 , $432.96 , $225.26 , $383.35 , $234.98 , $192.51 , N/A , $180.64 , $180.64 , $428.45 , $209.09 , $40.61 , $432.96 
 Fac Ezh2 Gene Analysis Full Gene Sequence ,CPT® 81236,0310 - PATHOLOGY LAB,N/A,N/A, $6.00 , $3.90 , $5.04 , $288.54 , N/A , $4.85 , $5.40 , $5.08 , $5.40 , $5.40 , $5.40 , $5.10 , N/A , $5.54 , $5.70 , $5.10 , $5.58 , $5.58 , $5.70 , $5.76 , $4.91 , $5.40 , $5.10 , $4.74 , N/A , $4.86 , $4.86 , $5.70 , $5.15 , $4.74 , $288.54 
 Ot Neg Pressure Wound Therapy Non/Dme </= 50 Sq Cm ,CPT® 97607,0761 - TREATMENT ROOM,N/A,N/A, $422.00 , $274.30 , $354.48 , $20.51 , $31.76 , $340.98 , $379.80 , $357.27 , $379.80 , $379.80 , $379.80 , $358.70 , $31.14 , $389.63 , $400.90 , $358.70 , $392.46 , $392.46 , $400.90 , $405.12 , $345.28 , $379.80 , $358.70 , $333.38 , N/A , $341.52 , $341.52 , $400.90 , $362.12 , $20.51 , $405.12 
 REGADENOSON 0.4 MG/5ML IV SOLN ,HCPCS J2785,0636 - DRUGS REQUIRING DETAILED CODIN,00469-6501-89,5 mL," $1,588.89 "," $1,032.78 "," $1,334.67 ", $63.53 , $63.23 ," $1,283.82 "," $1,430.00 "," $1,345.15 "," $1,430.00 "," $1,430.00 "," $1,430.00 "," $1,350.56 ", $61.99 ," $1,467.02 "," $1,509.45 "," $1,350.56 "," $1,477.67 "," $1,477.67 "," $1,509.45 "," $1,525.33 "," $1,300.03 "," $1,430.00 "," $1,350.56 "," $1,255.22 ", N/A ," $1,285.89 "," $1,285.89 "," $1,509.45 "," $1,363.43 ", $61.99 ," $1,525.33 "
"CT Scan,Abdomen and Pelvis,W/O Contrast",CPT® 74176,N/A,N/A,N/A," $4,279.00 "," $2,781.35 "," $1,300.39 ", $186.88 , $160.28 , $956.40 ," $1,210.07 "," $3,979.47 "," $3,851.10 "," $3,851.10 "," $3,423.20 "," $3,423.20 ", $160.28 ," $3,950.80 "," $4,065.05 "," $3,851.10 "," $3,851.10 "," $3,851.10 "," $3,979.47 "," $4,107.84 "," $1,090.32 "," $3,637.15 "," $1,315.49 "," $1,303.47 ", N/A , $975.06 , $975.06 ," $4,065.05 "," $1,128.64 ", $160.28 ," $4,107.84 "
 HYDROCHLOROTHIAZIDE 12.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,69315-0155-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
" Fac Assay, Dipropylacetic Acid ",CPT® 80164,0301 - LAB/CHEMISTRY,N/A,N/A, $133.00 , $86.45 , $111.72 , $13.81 , $13.81 , $107.46 , $119.70 , $112.60 , $119.70 , $119.70 , $119.70 , $113.05 , $13.54 , $122.80 , $126.35 , $113.05 , $123.69 , $123.69 , $126.35 , $127.68 , $108.82 , $119.70 , $113.05 , $105.07 , N/A , $107.64 , $107.64 , $126.35 , $114.13 , $13.54 , $127.68 
" Fac Complement, Antigen ",CPT® 86160,0300 - LABORATORY,N/A,N/A, $165.00 , $107.25 , $138.60 , $12.24 , $12.24 , $133.32 , $148.50 , $139.69 , $148.50 , $148.50 , $148.50 , $140.25 , $12.00 , $152.34 , $156.75 , $140.25 , $153.45 , $153.45 , $156.75 , $158.40 , $135.00 , $148.50 , $140.25 , $130.35 , N/A , $133.53 , $133.53 , $156.75 , $141.59 , $12.00 , $158.40 
 DICLOFENAC SODIUM 0.1 % OP SOLN ,HCPCS RXC637,0250 - PHARMACY,61314-0014-25,2.5 mL, $229.98 , $149.49 , $193.18 , N/A , N/A , $185.82 , $206.98 , $194.70 , $206.98 , $206.98 , $206.98 , $195.48 , N/A , $212.34 , $218.48 , $195.48 , $213.88 , $213.88 , $218.48 , $220.78 , $188.17 , $206.98 , $195.48 , $181.68 , N/A , $186.12 , $186.12 , $218.48 , $197.35 , $181.68 , $220.78 
 Nuc Kidney Flow Function W Lasix/Captopr- Mh ,CPT® 78708,0974 - PRO FEE/NUC MED,N/A,N/A, $524.00 , $340.60 , $980.55 , $171.08 , $177.99 , $854.01 , $912.30 , $487.32 , $471.60 , $471.60 , $419.20 , $419.20 , $177.99 , $483.81 , $497.80 , $471.60 , $471.60 , $471.60 , $487.32 , $503.04 , $978.69 , $445.40 , $991.91 ," $1,176.95 ", N/A , $870.68 , $870.68 , $497.80 ," $1,007.81 ", $171.08 ," $1,176.95 "
Incis Achilles Tendon+Gen Anesth,27606,N/A,N/A,N/A," $2,201.00 "," $1,430.65 "," $1,672.19 ", $259.46 , $169.04 ," $1,385.34 "," $1,381.21 "," $2,046.93 "," $1,980.90 "," $1,980.90 "," $1,760.80 "," $1,760.80 ", $169.04 ," $2,032.18 "," $2,090.95 "," $1,980.90 "," $1,980.90 "," $1,980.90 "," $2,046.93 "," $2,112.96 "," $1,562.47 "," $1,870.85 "," $1,518.24 "," $1,606.72 ", N/A ," $1,412.37 "," $1,412.37 "," $2,090.95 "," $1,660.04 ", $169.04 ," $2,112.96 "
Inject Second Level Lumbar/Sacral,CPT® 64494,N/A,N/A,N/A, $536.00 , $348.40 , $253.08 , $49.11 , $62.02 , $292.30 , $282.07 , $498.48 , $482.40 , $482.40 , $428.80 , $428.80 , $62.02 , $494.89 , $509.20 , $482.40 , $482.40 , $482.40 , $498.48 , $514.56 , $276.51 , $455.60 , $274.75 , $313.65 , N/A , $298.00 , $298.00 , $509.20 , $319.69 , $49.11 , $514.56 
"Burn,Initial Treatment",CPT® 16000,N/A,N/A,N/A, $277.00 , $180.05 , $143.24 , $43.12 , $29.25 , $126.05 , $122.05 , $257.61 , $249.30 , $249.30 , $221.60 , $221.60 , $29.25 , $255.75 , $263.15 , $249.30 , $249.30 , $249.30 , $257.61 , $265.92 , $157.17 , $235.45 , $242.63 , $162.35 , N/A , $128.51 , $128.51 , $263.15 , $149.03 , $29.25 , $265.92 
"Remv Cataract Intracap,Insert Lens",CPT® 66983,N/A,N/A,N/A," $5,621.00 "," $3,653.65 ", N/A , N/A , $281.58 ," $4,167.66 "," $3,900.44 "," $5,227.53 "," $5,058.90 "," $5,058.90 "," $4,496.80 "," $4,496.80 ", $281.58 ," $5,189.87 "," $5,339.95 "," $5,058.90 "," $5,058.90 "," $5,058.90 "," $5,227.53 "," $5,396.16 ", N/A ," $4,777.85 "," $3,962.41 "," $5,357.14 ", N/A ," $4,248.97 "," $4,248.97 "," $5,339.95 "," $4,690.31 ", $281.58 ," $5,396.16 "
Biopsy of Uterus Lining,58100,N/A,N/A,N/A, $654.00 , $425.10 , $296.20 , $59.65 , $56.34 , $358.12 , $356.64 , $608.22 , $588.60 , $588.60 , $523.20 , $523.20 , $56.34 , $603.84 , $621.30 , $588.60 , $588.60 , $588.60 , $608.22 , $627.84 , $312.12 , $555.90 , $469.21 , $357.89 , N/A , $365.10 , $365.10 , $621.30 , $437.94 , $56.34 , $627.84 
 Fac Trluml Balo Angiop Ctr Dialysis Seg W/Img S&I ,CPT® 36907,0360 - OR SERVICES,N/A,N/A," $1,214.00 ", $789.10 ," $1,019.76 ", $135.39 , $573.66 , $980.91 ," $1,092.60 "," $1,027.77 "," $1,092.60 "," $1,092.60 "," $1,092.60 "," $1,031.90 ", $562.41 ," $1,120.89 "," $1,153.30 "," $1,031.90 "," $1,129.02 "," $1,129.02 "," $1,153.30 "," $1,165.44 ", $993.29 ," $1,092.60 "," $1,031.90 ", $959.06 , N/A , $982.49 , $982.49 ," $1,153.30 "," $1,041.73 ", $135.39 ," $1,165.44 "
Cast Sup Sht Leg Splnt Plstr,HCPCS Q4045,N/A,N/A,N/A, $58.00 , $37.70 , N/A , $14.08 , $8.59 , N/A , N/A , $53.94 , $52.20 , $52.20 , $46.40 , $46.40 , $8.59 , $53.55 , $55.10 , $52.20 , $52.20 , $52.20 , $53.94 , $55.68 , N/A , $49.30 , $31.79 , $12.79 , N/A , N/A , N/A , $55.10 , N/A , $8.59 , $55.68 
 DAPTOMYCIN 500 MG IV SOLR ,HCPCS J0877,0636 - DRUGS REQUIRING DETAILED CODIN,00409-0122-01,10 mL, $486.98 , $316.54 , $409.06 , $0.07 , $0.08 , $393.48 , $438.28 , $412.28 , $438.28 , $438.28 , $438.28 , $413.93 , $0.08 , $449.63 , $462.63 , $413.93 , $452.89 , $452.89 , $462.63 , $467.50 , $398.45 , $438.28 , $413.93 , $384.71 , N/A , $394.11 , $394.11 , $462.63 , $417.88 , $0.07 , $467.50 
" Pro Strapping,Toes ",CPT® 29550,0981 - PRO FEE/ER,N/A,N/A, $110.00 , $71.50 , $70.27 , $10.83 , $30.11 , $56.85 , $96.67 , $102.30 , $99.00 , $99.00 , $88.00 , $88.00 , $30.11 , $101.56 , $104.50 , $99.00 , $99.00 , $99.00 , $102.30 , $105.60 , $65.68 , $93.50 , $103.48 , $67.45 , N/A , $57.96 , $57.96 , $104.50 , $68.13 , $10.83 , $105.60 
 Fac Stab Phlebt Varicose Veins 1 Xtr > 20 Incs ,CPT® 37766,0360 - OR SERVICES,N/A,N/A," $2,933.00 "," $1,906.45 "," $2,463.72 ", $301.84 , $561.28 ," $2,369.86 "," $2,639.70 "," $2,483.08 "," $2,639.70 "," $2,639.70 "," $2,639.70 "," $2,493.05 ", $550.27 ," $2,708.04 "," $2,786.35 "," $2,493.05 "," $2,727.69 "," $2,727.69 "," $2,786.35 "," $2,815.68 "," $2,399.78 "," $2,639.70 "," $2,493.05 "," $2,317.07 ", N/A ," $2,373.68 "," $2,373.68 "," $2,786.35 "," $2,516.81 ", $301.84 ," $2,815.68 "
"Antepartum Care Only, 4-6 Visits",CPT® 59425,N/A,N/A,N/A," $2,078.00 "," $1,350.70 "," $1,166.91 ", $393.54 , $301.67 , $828.68 , $867.62 ," $1,932.54 "," $1,870.20 "," $1,870.20 "," $1,662.40 "," $1,662.40 ", $301.67 ," $1,918.62 "," $1,974.10 "," $1,870.20 "," $1,870.20 "," $1,870.20 "," $1,932.54 "," $1,994.88 "," $1,190.99 "," $1,766.30 "," $1,917.87 "," $1,536.52 ", N/A , $844.85 , $844.85 ," $1,974.10 ", $976.74 , $301.67 ," $1,994.88 "
"Protozoa, Not Elsewhere",CPT® 86753,N/A,N/A,N/A, $177.00 , $115.05 , N/A , $12.64 , $8.07 , $32.88 , $39.34 , $164.61 , $159.30 , $159.30 , $141.60 , $141.60 , $8.07 , $163.42 , $168.15 , $159.30 , $159.30 , $159.30 , $164.61 , $169.92 , $82.73 , $150.45 , $81.09 , $44.91 , N/A , $30.69 , $30.69 , $168.15 , $33.54 , $8.07 , $169.92 
Molecular Cyto Dna Probe,CPT® 88271,N/A,N/A,N/A, $262.00 , $170.30 , N/A , $21.85 , $20.09 , $81.06 , $182.45 , $243.66 , $235.80 , $235.80 , $209.60 , $209.60 , $20.09 , $241.90 , $248.90 , $235.80 , $235.80 , $235.80 , $243.66 , $251.52 , $143.03 , $222.70 , $141.10 , $93.60 , N/A , $75.65 , $75.65 , $248.90 , $83.13 , $20.09 , $251.52 
" Fac IV Infusion, Hydration, 31-60 Min ",CPT® 96360,0260 - IV THERAPY,N/A,N/A, $398.00 , $258.70 , $334.32 , $31.93 , $51.59 , $321.58 , $358.20 , $336.95 , $358.20 , $358.20 , $358.20 , $338.30 , $50.58 , $367.47 , $378.10 , $338.30 , $370.14 , $370.14 , $378.10 , $382.08 , $325.64 , $358.20 , $338.30 , $314.42 , N/A , $322.10 , $322.10 , $378.10 , $341.52 , $31.93 , $382.08 
 Fac Drug Assay Posaconazole ,CPT® 80187,0301 - LAB/CHEMISTRY,N/A,N/A, $167.00 , $108.55 , $140.28 , $27.65 , $22.12 , $134.94 , $150.30 , $141.38 , $150.30 , $150.30 , $150.30 , $141.95 , $21.69 , $154.19 , $158.65 , $141.95 , $155.31 , $155.31 , $158.65 , $160.32 , $136.64 , $150.30 , $141.95 , $131.93 , N/A , $135.15 , $135.15 , $158.65 , $143.30 , $21.69 , $160.32 
 Pro Insj Prph Ctr Vad W/Subq Port Age 5 Yr/> ,CPT® 36571,0982 - PRO FEE/OUTPT,N/A,N/A," $7,340.00 "," $4,771.00 "," $1,881.75 ", $289.78 ," $1,103.81 "," $1,395.01 "," $1,385.28 "," $6,826.20 "," $6,606.00 "," $6,606.00 "," $5,872.00 "," $5,872.00 "," $1,103.81 "," $6,777.02 "," $6,973.00 "," $6,606.00 "," $6,606.00 "," $6,606.00 "," $6,826.20 "," $7,046.40 "," $1,734.58 "," $6,239.00 "," $1,725.19 "," $1,518.35 ", N/A ," $1,422.23 "," $1,422.23 "," $6,973.00 "," $1,615.65 ", $289.78 ," $7,046.40 "
" Pro Cytopathology, Fluids Nongyn, Smears ",CPT® 88104,0971 - PRO FEE/LAB,N/A,N/A, $130.00 , $84.50 , $240.13 , $67.95 , $37.19 , $297.99 , $348.64 , $120.90 , $117.00 , $117.00 , $104.00 , $104.00 , $37.19 , $120.03 , $123.50 , $117.00 , $117.00 , $117.00 , $120.90 , $124.80 , $428.14 , $110.50 , $363.29 , $252.76 , N/A , $278.10 , $278.10 , $123.50 , $305.63 , $37.19 , $428.14 
" WATER FOR IRRIGATION, STERILE IR SOLN ",HCPCS RXA250,0250 - PHARMACY,00990-7973-08,"3,000 mL", $61.65 , $40.07 , $51.79 , N/A , N/A , $49.81 , $55.49 , $52.19 , $55.49 , $55.49 , $55.49 , $52.40 , N/A , $56.92 , $58.57 , $52.40 , $57.33 , $57.33 , $58.57 , $59.18 , $50.44 , $55.49 , $52.40 , $48.70 , N/A , $49.89 , $49.89 , $58.57 , $52.90 , $48.70 , $59.18 
 Fac Drug Test Def 1-7 Classes ,CPT® G0480,0301 - LAB/CHEMISTRY,N/A,N/A, $172.00 , $111.80 , $144.48 , $116.72 , $65.23 , $138.98 , $154.80 , $145.62 , $154.80 , $154.80 , $154.80 , $146.20 , $63.95 , $158.81 , $163.40 , $146.20 , $159.96 , $159.96 , $163.40 , $165.12 , $140.73 , $154.80 , $146.20 , $135.88 , N/A , $139.20 , $139.20 , $163.40 , $147.59 , $63.95 , $165.12 
"Inject Nerv Blck,Paravert Sympath",64520,N/A,N/A,N/A, $723.00 , $469.95 , $418.86 , $81.46 , $161.66 , $454.37 , $440.17 , $672.39 , $650.70 , $650.70 , $578.40 , $578.40 , $161.66 , $667.55 , $686.85 , $650.70 , $650.70 , $650.70 , $672.39 , $694.08 , $450.20 , $614.55 , $428.18 , $487.79 , N/A , $463.24 , $463.24 , $686.85 , $496.95 , $81.46 , $694.08 
 Fac Epstein-Barr Antibody ,CPT® 86663,0302 - LAB/IMMUNOLOGY,N/A,N/A, $155.00 , $100.75 , $130.20 , $13.38 , $13.38 , $125.24 , $139.50 , $131.22 , $139.50 , $139.50 , $139.50 , $131.75 , $13.12 , $143.11 , $147.25 , $131.75 , $144.15 , $144.15 , $147.25 , $148.80 , $126.82 , $139.50 , $131.75 , $122.45 , N/A , $125.44 , $125.44 , $147.25 , $133.01 , $13.12 , $148.80 
Open Rx IP Jt Dislocation,CPT® 26785,N/A,N/A,N/A," $3,565.00 "," $2,317.25 "," $3,357.64 ", $530.22 , $230.52 ," $2,631.06 "," $2,641.31 "," $3,315.45 "," $3,208.50 "," $3,208.50 "," $2,852.00 "," $2,852.00 ", $230.52 ," $3,291.56 "," $3,386.75 "," $3,208.50 "," $3,208.50 "," $3,208.50 "," $3,315.45 "," $3,422.40 "," $3,120.23 "," $3,030.25 "," $2,902.67 "," $3,127.39 ", N/A ," $2,682.40 "," $2,682.40 "," $3,386.75 "," $3,152.78 ", $230.52 ," $3,422.40 "
 Fac Byp Oth/Thn Vein Aortofem ,CPT® 35647,0360 - OR SERVICES,N/A,N/A," $6,433.00 "," $4,181.45 "," $5,403.72 "," $1,379.51 "," $1,287.39 "," $5,197.86 "," $5,789.70 "," $5,446.18 "," $5,789.70 "," $5,789.70 "," $5,789.70 "," $5,468.05 "," $1,262.15 "," $5,939.59 "," $6,111.35 "," $5,468.05 "," $5,982.69 "," $5,982.69 "," $6,111.35 "," $6,175.68 "," $5,263.48 "," $5,789.70 "," $5,468.05 "," $5,082.07 ", N/A ," $5,206.23 "," $5,206.23 "," $6,111.35 "," $5,520.16 "," $1,262.15 "," $6,175.68 "
"Repair Lip,<1/2 Vert Height",CPT® 40652,N/A,N/A,N/A," $3,464.00 "," $2,251.60 "," $2,193.43 ", $347.44 , $539.88 ," $1,707.57 "," $1,742.95 "," $3,221.52 "," $3,117.60 "," $3,117.60 "," $2,771.20 "," $2,771.20 ", $539.88 ," $3,198.31 "," $3,290.80 "," $3,117.60 "," $3,117.60 "," $3,117.60 "," $3,221.52 "," $3,325.44 "," $1,562.82 "," $2,944.40 "," $1,912.52 "," $2,020.07 ", N/A ," $1,740.89 "," $1,740.89 "," $3,290.80 "," $1,820.78 ", $347.44 ," $3,325.44 "
 Pro Shvg Skin Lesion 1 Trunk/Arm/Leg Diam >2.0 Cm ,CPT® 11303,0982 - PRO FEE/OUTPT,N/A,N/A, $590.00 , $383.50 , $227.73 , $68.04 , $115.78 , $203.77 , $196.36 , $548.70 , $531.00 , $531.00 , $472.00 , $472.00 , $115.78 , $544.75 , $560.50 , $531.00 , $531.00 , $531.00 , $548.70 , $566.40 , $251.56 , $501.50 , $392.49 , $259.98 , N/A , $207.74 , $207.74 , $560.50 , $240.90 , $68.04 , $566.40 
 CT Guided Aspir &/or Inj Interm Jt ,CPT® 20605,0761 - TREATMENT ROOM,N/A,N/A, $429.00 , $278.85 , $360.36 , $35.10 , $50.55 , $346.63 , $386.10 , $363.19 , $386.10 , $386.10 , $386.10 , $364.65 , $49.56 , $396.10 , $407.55 , $364.65 , $398.97 , $398.97 , $407.55 , $411.84 , $351.01 , $386.10 , $364.65 , $338.91 , N/A , $347.19 , $347.19 , $407.55 , $368.12 , $35.10 , $411.84 
Sbsq Hospital IP/Obs Care Mod Mdm 35 Minutes,99232,N/A,N/A,N/A, $239.00 , $155.35 , $142.19 , $76.95 , $35.12 , $125.33 , $124.56 , $222.27 , $215.10 , $215.10 , $191.20 , $191.20 , $35.12 , $220.67 , $227.05 , $215.10 , $215.10 , $215.10 , $222.27 , $229.44 , $181.02 , $203.15 , $154.52 , $159.28 , $104.50 , $127.78 , $127.78 , $227.05 , $147.38 , $35.12 , $229.44 
Ambulatory Surgical Boot Eac,HCPCS L3260,N/A,N/A,N/A, $65.00 , $42.25 , N/A , N/A , $22.00 , N/A , N/A , $60.45 , $58.50 , $58.50 , $52.00 , $52.00 , $22.00 , $60.01 , $61.75 , $58.50 , $58.50 , $58.50 , $60.45 , $62.40 , N/A , $55.25 , $24.00 , $12.93 , N/A , N/A , N/A , $61.75 , N/A , $12.93 , $62.40 
"Fracture Head/Neck,Closed",CPT® 24650,N/A,N/A,N/A, $957.00 , $622.05 ," $1,529.32 ", $243.22 , $194.38 ," $1,155.93 "," $1,180.19 ", $890.01 , $861.30 , $861.30 , $765.60 , $765.60 , $194.38 , $883.60 , $909.15 , $861.30 , $861.30 , $861.30 , $890.01 , $918.72 ," $1,410.37 ", $813.45 ," $1,291.66 "," $1,377.14 ", N/A ," $1,178.49 "," $1,178.49 ", $909.15 ," $1,385.17 ", $194.38 ," $1,529.32 "
Excise Breast Cyst,19120,N/A,N/A,N/A," $3,216.00 "," $2,090.40 "," $1,309.41 ", $390.34 , $312.04 ," $1,110.98 "," $1,084.83 "," $2,990.88 "," $2,894.40 "," $2,894.40 "," $2,572.80 "," $2,572.80 ", $312.04 ," $2,969.33 "," $3,055.20 "," $2,894.40 "," $2,894.40 "," $2,894.40 "," $2,990.88 "," $3,087.36 "," $1,429.95 "," $2,733.60 "," $2,185.48 "," $1,408.87 ", N/A ," $1,132.66 "," $1,132.66 "," $3,055.20 "," $1,313.51 ", $312.04 ," $3,087.36 "
 Pro Shvg Skn Les 1 Les S/N/H/F/G Diam 0.5 Cm/< ,CPT® 11305,0982 - PRO FEE/OUTPT,N/A,N/A, $411.00 , $267.15 , $123.52 , $36.29 , $46.39 , $107.98 , $103.20 , $382.23 , $369.90 , $369.90 , $328.80 , $328.80 , $46.39 , $379.48 , $390.45 , $369.90 , $369.90 , $369.90 , $382.23 , $394.56 , $135.45 , $349.35 , $201.60 , $138.82 , N/A , $110.08 , $110.08 , $390.45 , $127.66 , $36.29 , $394.56 
 Pro Prep Site F/S/N/H/F/G/M/D Gt 1st 100 Sq Cm/1pct ,CPT® 15004,0975 - PRO FEE/OR,N/A,N/A," $2,092.00 "," $1,359.80 ", $831.98 , $247.01 , $298.14 , $745.13 , $721.40 ," $1,945.56 "," $1,882.80 "," $1,882.80 "," $1,673.60 "," $1,673.60 ", $298.14 ," $1,931.54 "," $1,987.40 "," $1,882.80 "," $1,882.80 "," $1,882.80 "," $1,945.56 "," $2,008.32 ", $917.20 ," $1,778.20 "," $1,437.96 ", $941.84 , N/A , $759.67 , $759.67 ," $1,987.40 ", $880.97 , $247.01 ," $2,008.32 "
Primatrix Skin Sub,HCPCS Q4110,N/A,N/A,N/A, $73.00 , $47.45 , N/A , $43.73 , N/A , N/A , N/A , $67.89 , $65.70 , $65.70 , $58.40 , $58.40 , N/A , $67.40 , $69.35 , $65.70 , $65.70 , $65.70 , $67.89 , $70.08 , $53.76 , $62.05 , $65.52 , $55.30 , N/A , N/A , N/A , $69.35 , N/A , $43.73 , $70.08 
Assay Blood Uric Acid,CPT® 84550,N/A,N/A,N/A, $45.00 , $29.25 , N/A , $4.61 , $4.61 , $25.57 , $30.58 , $41.85 , $40.50 , $40.50 , $36.00 , $36.00 , $4.61 , $41.55 , $42.75 , $40.50 , $40.50 , $40.50 , $41.85 , $43.20 , $30.18 , $38.25 , $29.19 , $16.39 , N/A , $23.86 , $23.86 , $42.75 , $26.08 , $4.61 , $43.20 
 HYDROCORTISONE SOD SUC (PF) 250 MG IJ SOLR ,HCPCS J1720,0636 - DRUGS REQUIRING DETAILED CODIN,00009-0013-05,1.6 mL, $177.29 , $115.24 , $148.92 , $17.86 , $18.27 , $143.25 , $159.56 , $150.09 , $159.56 , $159.56 , $159.56 , $150.70 , $17.91 , $163.69 , $168.43 , $150.70 , $164.88 , $164.88 , $168.43 , $170.20 , $145.06 , $159.56 , $150.70 , $140.06 , N/A , $143.48 , $143.48 , $168.43 , $152.13 , $17.86 , $170.20 
 AMPHETAMINE-DEXTROAMPHETAMINE 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00555-0971-02,1 tablet, $8.81 , $5.73 , $7.40 , N/A , N/A , $7.12 , $7.93 , $7.46 , $7.93 , $7.93 , $7.93 , $7.49 , N/A , $8.13 , $8.37 , $7.49 , $8.19 , $8.19 , $8.37 , $8.46 , $7.21 , $7.93 , $7.49 , $6.96 , N/A , $7.13 , $7.13 , $8.37 , $7.56 , $6.96 , $8.46 
 Fac Evasc Rpr Dta Coverage Art Origin 1st Endoprosth ,CPT® 33880,0360 - OR SERVICES,N/A,N/A," $26,540.00 "," $17,251.00 "," $22,293.60 "," $1,596.65 "," $2,378.00 "," $21,444.32 "," $23,886.00 "," $22,468.76 "," $23,886.00 "," $23,886.00 "," $23,886.00 "," $22,559.00 "," $2,331.37 "," $24,504.38 "," $25,213.00 "," $22,559.00 "," $24,682.20 "," $24,682.20 "," $25,213.00 "," $25,478.40 "," $21,715.03 "," $23,886.00 "," $22,559.00 "," $20,966.60 ", N/A ," $21,478.82 "," $21,478.82 "," $25,213.00 "," $22,773.97 "," $1,596.65 "," $25,478.40 "
Surgical Arthroscopy Shoulder Lmtd Dbrdmt 1/2,CPT® 29822,N/A,N/A,N/A," $2,772.00 "," $1,801.80 "," $3,304.02 ", $518.48 , $420.46 ," $2,747.80 "," $2,772.74 "," $2,577.96 "," $2,494.80 "," $2,494.80 "," $2,217.60 "," $2,217.60 ", $420.46 ," $2,559.39 "," $2,633.40 "," $2,494.80 "," $2,494.80 "," $2,494.80 "," $2,577.96 "," $2,661.12 "," $3,071.96 "," $2,356.20 "," $3,061.45 "," $3,256.81 ", N/A ," $2,801.42 "," $2,801.42 "," $2,633.40 "," $3,292.65 ", $420.46 ," $3,304.02 "
Rplcmt Compl Tun Cvc W/O Subq Port/Pmp,CPT® 36581,N/A,N/A,N/A," $5,106.00 "," $3,318.90 "," $1,119.76 ", $173.23 , $938.62 , $861.03 , $855.68 ," $4,748.58 "," $4,595.40 "," $4,595.40 "," $4,084.80 "," $4,084.80 ", $938.62 ," $4,714.37 "," $4,850.70 "," $4,595.40 "," $4,595.40 "," $4,595.40 "," $4,748.58 "," $4,901.76 "," $1,036.21 "," $4,340.10 "," $1,049.03 ", $917.13 , N/A , $877.83 , $877.83 ," $4,850.70 ", $997.21 , $173.23 ," $4,901.76 "
Pro Cytopath-Eval Fine Needle Aspirate,CPT® 88172,N/A,N/A,N/A, $320.00 , $208.00 , N/A , N/A , N/A , N/A , N/A , $297.60 , $288.00 , $288.00 , $256.00 , $256.00 , N/A , $295.46 , $304.00 , $288.00 , $288.00 , $288.00 , $297.60 , $307.20 , N/A , $272.00 , N/A , N/A , N/A , N/A , N/A , $304.00 , N/A , $256.00 , $307.20 
 Voltage-Gtd Ca Chnl Antb Ea ,CPT® 86596,0302 - LAB/IMMUNOLOGY,N/A,N/A, $83.00 , $53.95 , $69.72 , $12.29 , $12.29 , $67.06 , $74.70 , $70.27 , $74.70 , $74.70 , $74.70 , $70.55 , $12.05 , $76.63 , $78.85 , $70.55 , $77.19 , $77.19 , $78.85 , $79.68 , $67.91 , $74.70 , $70.55 , $65.57 , N/A , $67.17 , $67.17 , $78.85 , $71.22 , $12.05 , $79.68 
 MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY ,HCPCS 90620,0636 - DRUGS REQUIRING DETAILED CODIN,58160-0976-02,0.5 mL," $1,301.87 ", $846.22 ," $1,093.57 ", N/A , $217.25 ," $1,051.91 "," $1,171.68 "," $1,102.16 "," $1,171.68 "," $1,171.68 "," $1,171.68 "," $1,106.59 ", $212.99 ," $1,202.02 "," $1,236.78 "," $1,106.59 "," $1,210.74 "," $1,210.74 "," $1,236.78 "," $1,249.80 "," $1,065.19 "," $1,171.68 "," $1,106.59 "," $1,028.48 ", N/A ," $1,053.60 "," $1,053.60 "," $1,236.78 "," $1,117.13 ", $212.99 ," $1,249.80 "
Cryotherapy Acne,CPT® 17340,N/A,N/A,N/A, $264.00 , $171.60 , $158.03 , $47.40 , $20.61 , $133.97 , $129.63 , $245.52 , $237.60 , $237.60 , $211.20 , $211.20 , $20.61 , $243.75 , $250.80 , $237.60 , $237.60 , $237.60 , $245.52 , $253.44 , $173.05 , $224.40 , $256.91 , $172.03 , N/A , $136.58 , $136.58 , $250.80 , $158.40 , $20.61 , $256.91 
Assay for Tacrolimus,CPT® 80197,N/A,N/A,N/A, $111.00 , $72.15 , N/A , $14.00 , $14.00 , $77.71 , $92.90 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $14.00 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $91.68 , $94.35 , $89.20 , $49.81 , N/A , $72.52 , $72.52 , $105.45 , $79.25 , $14.00 , $106.56 
Tp53 Gene Analysis Targeted Sequence Analysis,CPT® 81352,N/A,N/A,N/A," $1,338.00 ", $869.70 , N/A , $336.10 , $336.10 , N/A , N/A ," $1,244.34 "," $1,204.20 "," $1,204.20 "," $1,070.40 "," $1,070.40 ", $336.10 ," $1,235.38 "," $1,271.10 "," $1,204.20 "," $1,204.20 "," $1,204.20 "," $1,244.34 "," $1,284.48 "," $2,200.21 "," $1,137.30 "," $1,570.14 ", $967.77 , N/A ," $1,291.68 "," $1,291.68 "," $1,271.10 "," $1,420.19 ", $336.10 ," $2,200.21 "
 Pro Esophagus Motility Study ,CPT® 91010,0982 - PRO FEE/OUTPT,N/A,N/A, $838.00 , $544.70 , $531.00 , $218.16 , $175.19 , $533.47 , $422.52 , $779.34 , $754.20 , $754.20 , $670.40 , $670.40 , $175.19 , $773.73 , $796.10 , $754.20 , $754.20 , $754.20 , $779.34 , $804.48 , $961.96 , $712.30 , $559.57 , $670.34 , N/A , $543.88 , $543.88 , $796.10 , $639.86 , $175.19 , $961.96 
 MORPHINE SULFATE 15 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00054-0235-24,1 tablet, $4.67 , $3.04 , $3.92 , N/A , N/A , $3.77 , $4.20 , $3.95 , $4.20 , $4.20 , $4.20 , $3.97 , N/A , $4.31 , $4.44 , $3.97 , $4.34 , $4.34 , $4.44 , $4.48 , $3.82 , $4.20 , $3.97 , $3.69 , N/A , $3.78 , $3.78 , $4.44 , $4.01 , $3.69 , $4.48 
Buprenorph Xr 100 Mg or Less,HCPCS Q9991,N/A,N/A,N/A," $2,478.00 "," $1,610.70 ", N/A ," $1,924.10 "," $1,862.35 ", N/A , N/A ," $2,304.54 "," $2,230.20 "," $2,230.20 "," $1,982.40 "," $1,982.40 "," $1,862.35 "," $2,287.94 "," $2,354.10 "," $2,230.20 "," $2,230.20 "," $2,230.20 "," $2,304.54 "," $2,378.88 "," $2,361.65 "," $2,106.30 "," $3,481.52 "," $2,402.20 ", N/A , N/A , N/A ," $2,354.10 ", N/A ," $1,862.35 "," $3,481.52 "
"Cystectomy,Ileal Conduit/Sigmoid Bladder",CPT® 51590,N/A,N/A,N/A," $13,449.00 "," $8,741.85 "," $10,399.57 "," $1,824.94 "," $2,151.50 "," $9,460.93 "," $8,770.50 "," $12,507.57 "," $12,104.10 "," $12,104.10 "," $10,759.20 "," $10,759.20 "," $2,151.50 "," $12,417.46 "," $12,776.55 "," $12,104.10 "," $12,104.10 "," $12,104.10 "," $12,507.57 "," $12,911.04 "," $10,456.73 "," $11,431.65 "," $9,944.37 "," $11,877.68 ", N/A ," $9,645.53 "," $9,645.53 "," $12,776.55 "," $11,336.92 "," $1,824.94 "," $12,911.04 "
 Pro Meckel's Divert Exam ,CPT® 78290,0974 - PRO FEE/NUC MED,N/A,N/A, $218.00 , $141.70 ," $1,760.30 ", $301.84 , $156.54 ," $1,634.73 "," $1,794.16 ", $202.74 , $196.20 , $196.20 , $174.40 , $174.40 , $156.54 , $201.28 , $207.10 , $196.20 , $196.20 , $196.20 , $202.74 , $209.28 ," $1,827.07 ", $185.30 ," $1,954.93 "," $2,227.15 ", N/A ," $1,666.62 "," $1,666.62 ", $207.10 ," $1,929.14 ", $156.54 ," $2,227.15 "
Exploratory Retroperitoneal,CPT® 49010,N/A,N/A,N/A," $6,144.00 "," $3,993.60 "," $5,489.06 ", $847.34 , $684.55 ," $4,388.47 "," $4,442.05 "," $5,713.92 "," $5,529.60 "," $5,529.60 "," $4,915.20 "," $4,915.20 ", $684.55 ," $5,672.76 "," $5,836.80 "," $5,529.60 "," $5,529.60 "," $5,529.60 "," $5,713.92 "," $5,898.24 "," $3,935.74 "," $5,222.40 "," $4,931.15 "," $5,185.81 ", N/A ," $4,474.10 "," $4,474.10 "," $5,836.80 "," $4,679.44 ", $684.55 ," $5,898.24 "
Fx Cl Prox Humeral W/O MA,23600,N/A,N/A,N/A," $1,196.00 ", $777.40 ," $1,967.03 ", $311.94 , $245.89 ," $1,478.02 "," $1,510.03 "," $1,112.28 "," $1,076.40 "," $1,076.40 ", $956.80 , $956.80 , $245.89 ," $1,104.27 "," $1,136.20 "," $1,076.40 "," $1,076.40 "," $1,076.40 "," $1,112.28 "," $1,148.16 "," $1,808.38 "," $1,016.60 "," $1,657.40 "," $1,760.08 ", N/A ," $1,506.86 "," $1,506.86 "," $1,136.20 "," $1,771.09 ", $245.89 ," $1,967.03 "
 Lb-Fish Prb Addtnl X4 ,CPT® 88369,0300 - LABORATORY,N/A,N/A, $464.00 , $301.60 , $389.76 , $120.30 , $57.95 , $374.91 , $417.60 , $392.82 , $417.60 , $417.60 , $417.60 , $394.40 , $56.81 , $428.41 , $440.80 , $394.40 , $431.52 , $431.52 , $440.80 , $445.44 , $379.64 , $417.60 , $394.40 , $366.56 , N/A , $375.52 , $375.52 , $440.80 , $398.16 , $56.81 , $445.44 
"Immunoassay, Tumor Antigen, Ca 19-9",CPT® 86301,N/A,N/A,N/A, $222.00 , $144.30 , N/A , $21.23 , $21.23 , $117.74 , $140.86 , $206.46 , $199.80 , $199.80 , $177.60 , $177.60 , $21.23 , $204.97 , $210.90 , $199.80 , $199.80 , $199.80 , $206.46 , $213.12 , $138.95 , $188.70 , $136.23 , $75.48 , N/A , $109.88 , $109.88 , $210.90 , $120.08 , $21.23 , $213.12 
 Fac Ko Adj Jnt POS R Sup Pre Ots ,HCPCS L1833,0274 - PROSTHETIC DEV,N/A,N/A, $787.00 , $511.55 , $661.08 , $570.00 , $272.48 , $635.90 , $708.30 , $666.27 , $708.30 , $708.30 , $708.30 , $668.95 , $267.14 , $726.64 , $747.65 , $668.95 , $731.91 , $731.91 , $747.65 , $755.52 , $643.92 , $708.30 , $668.95 , $621.73 , N/A , $636.92 , $636.92 , $747.65 , $675.32 , $267.14 , $755.52 
"Repair Recurr Inguin Hern,Strang",CPT® 49521,N/A,N/A,N/A," $4,746.00 "," $3,084.90 "," $4,277.98 ", $663.84 , $769.85 ," $3,357.69 "," $3,399.52 "," $4,413.78 "," $4,271.40 "," $4,271.40 "," $3,796.80 "," $3,796.80 ", $769.85 ," $4,381.98 "," $4,508.70 "," $4,271.40 "," $4,271.40 "," $4,271.40 "," $4,413.78 "," $4,556.16 "," $3,064.08 "," $4,034.10 "," $3,778.65 "," $3,968.11 ", N/A ," $3,423.20 "," $3,423.20 "," $4,508.70 "," $3,580.31 ", $663.84 ," $4,556.16 "
 HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN ,HCPCS J1643,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0262-06,1 mL, $25.65 , $16.67 , $21.55 , $6.21 , $0.27 , $20.73 , $23.09 , $21.72 , $23.09 , $23.09 , $23.09 , $21.80 , $0.26 , $23.68 , $24.37 , $21.80 , $23.85 , $23.85 , $24.37 , $24.62 , $20.99 , $23.09 , $21.80 , $20.26 , N/A , $20.76 , $20.76 , $24.37 , $22.01 , $0.26 , $24.62 
 Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours ,MS DRG V40 (FY2023) 065,N/A,N/A,N/A," $33,536.97 "," $21,799.03 "," $28,171.05 ", N/A , N/A ," $27,097.87 "," $30,183.27 "," $28,392.40 "," $30,183.27 "," $30,183.27 "," $30,183.27 "," $28,506.42 ", N/A ," $30,964.68 "," $31,860.12 "," $28,506.42 "," $31,189.38 "," $31,189.38 "," $31,860.12 "," $32,195.49 "," $27,439.95 "," $30,183.27 "," $28,506.42 "," $26,494.21 ", N/A ," $27,141.47 "," $27,141.47 "," $31,860.12 "," $28,778.07 "," $26,494.21 "," $32,195.49 "
Antistreptolysin O Titer,CPT® 86060,N/A,N/A,N/A, $122.00 , $79.30 , N/A , $7.45 , $7.45 , $41.33 , $49.39 , $113.46 , $109.80 , $109.80 , $97.60 , $97.60 , $7.45 , $112.64 , $115.90 , $109.80 , $109.80 , $109.80 , $113.46 , $117.12 , $48.74 , $103.70 , $47.03 , $26.46 , N/A , $38.57 , $38.57 , $115.90 , $42.15 , $7.45 , $117.12 
Surg Nasopharyngoscopy Dilat Eustachian Tube Uni,CPT® 69705,N/A,N/A,N/A," $18,983.00 "," $12,338.95 ", $816.05 , $166.16 , N/A , N/A , N/A ," $17,654.19 "," $17,084.70 "," $17,084.70 "," $15,186.40 "," $15,186.40 ", N/A ," $17,527.00 "," $18,033.85 "," $17,084.70 "," $17,084.70 "," $17,084.70 "," $17,654.19 "," $18,223.68 ", $890.48 ," $16,135.55 ", $922.23 , $874.44 , N/A , $772.46 , $772.46 ," $18,033.85 ", $883.55 , $166.16 ," $18,223.68 "
 Pro Apply Long Arm Splint ,CPT® 29105,0982 - PRO FEE/OUTPT,N/A,N/A, $580.00 , $377.00 , $248.63 , $39.02 , $45.35 , $288.42 , $289.62 , $539.40 , $522.00 , $522.00 , $464.00 , $464.00 , $45.35 , $535.51 , $551.00 , $522.00 , $522.00 , $522.00 , $539.40 , $556.80 , $235.01 , $493.00 , $317.56 , $339.98 , N/A , $294.05 , $294.05 , $551.00 , $345.59 , $39.02 , $556.80 
 Influenza a&B Antigen ,CPT® 87400,0300 - LABORATORY,N/A,N/A, $88.00 , $57.20 , $73.92 , $14.41 , $8.63 , $71.10 , $79.20 , $74.50 , $79.20 , $79.20 , $79.20 , $74.80 , $8.46 , $81.25 , $83.60 , $74.80 , $81.84 , $81.84 , $83.60 , $84.48 , $72.00 , $79.20 , $74.80 , $69.52 , N/A , $71.22 , $71.22 , $83.60 , $75.51 , $8.46 , $84.48 
 Sputum Collection - Lh ,CPT® 94640,0410 - RESPIRATORY SVC,N/A,N/A, $114.00 , $74.10 , $95.76 , $8.65 , $12.16 , $92.11 , $102.60 , $96.51 , $102.60 , $102.60 , $102.60 , $96.90 , $11.92 , $105.26 , $108.30 , $96.90 , $106.02 , $106.02 , $108.30 , $109.44 , $93.27 , $102.60 , $96.90 , $90.06 , N/A , $92.26 , $92.26 , $108.30 , $97.82 , $8.65 , $109.44 
Image-Guided Catheter Fluid Collection Drainage,10030,N/A,N/A,N/A," $1,274.00 ", $828.10 , $436.46 , $129.07 , $117.73 , $439.51 , $425.90 ," $1,184.82 "," $1,146.60 "," $1,146.60 "," $1,019.20 "," $1,019.20 ", $117.73 ," $1,176.28 "," $1,210.30 "," $1,146.60 "," $1,146.60 "," $1,146.60 "," $1,184.82 "," $1,223.04 ", $481.77 ," $1,082.90 ", $707.22 , $492.62 , N/A , $448.08 , $448.08 ," $1,210.30 ", $519.65 , $117.73 ," $1,223.04 "
 Rad Therapy Plan Complex ,CPT® 77263,0333 - RADIATION RX,N/A,N/A, $676.00 , $439.40 , $567.84 , $164.77 , $189.11 , $546.21 , $608.40 , $572.30 , $608.40 , $608.40 , $608.40 , $574.60 , $185.40 , $624.15 , $642.20 , $574.60 , $628.68 , $628.68 , $642.20 , $648.96 , $553.10 , $608.40 , $574.60 , $534.04 , N/A , $547.09 , $547.09 , $642.20 , $580.08 , $164.77 , $648.96 
 ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY ,HCPCS J1650,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0559-93,0.3 mL, $17.08 , $11.10 , $14.35 , $0.69 , $0.83 , $13.80 , $15.37 , $14.46 , $15.37 , $15.37 , $15.37 , $14.52 , $0.81 , $15.77 , $16.23 , $14.52 , $15.88 , $15.88 , $16.23 , $16.40 , $13.97 , $15.37 , $14.52 , $13.49 , N/A , $13.82 , $13.82 , $16.23 , $14.66 , $0.69 , $16.40 
 Pro Radiologic Exam Upr GI Trc Single Contrast Study ,CPT® 74240,0972 - PRO FEE/RAD/DX,N/A,N/A, $518.00 , $336.70 , $715.66 , $123.09 , $96.74 , $539.54 , $605.85 , $481.74 , $466.20 , $466.20 , $414.40 , $414.40 , $96.74 , $478.27 , $492.10 , $466.20 , $466.20 , $466.20 , $481.74 , $497.28 , $694.06 , $440.30 , $662.56 , $571.04 , N/A , $550.07 , $550.07 , $492.10 , $636.71 , $96.74 , $715.66 
"Osteotomy Thor Sp,Post,1 Lvl",CPT® 22212,N/A,N/A,N/A," $9,317.00 "," $6,056.05 "," $8,907.02 "," $1,396.15 "," $2,378.00 "," $7,125.48 "," $7,005.76 "," $8,664.81 "," $8,385.30 "," $8,385.30 "," $7,453.60 "," $7,453.60 "," $2,378.00 "," $8,602.39 "," $8,851.15 "," $8,385.30 "," $8,385.30 "," $8,385.30 "," $8,664.81 "," $8,944.32 "," $8,271.93 "," $7,919.45 "," $7,810.63 "," $8,312.07 ", N/A ," $7,264.51 "," $7,264.51 "," $8,851.15 "," $8,538.38 "," $1,396.15 "," $8,944.32 "
Radiologic Exam Chest 3 Views,CPT® 71047,N/A,N/A,N/A, $550.00 , $357.50 , $238.79 , $41.73 , $30.77 , $175.36 , $196.37 , $511.50 , $495.00 , $495.00 , $440.00 , $440.00 , $30.77 , $507.82 , $522.50 , $495.00 , $495.00 , $495.00 , $511.50 , $528.00 , $234.09 , $467.50 , $243.63 , $196.88 , N/A , $178.79 , $178.79 , $522.50 , $206.94 , $30.77 , $528.00 
 Fac Culture Screen Only ,CPT® 87081,0306 - LAB/BACT-MICRO,N/A,N/A, $69.00 , $44.85 , $57.96 , $6.76 , $6.76 , $55.75 , $62.10 , $58.42 , $62.10 , $62.10 , $62.10 , $58.65 , $6.63 , $63.71 , $65.55 , $58.65 , $64.17 , $64.17 , $65.55 , $66.24 , $56.46 , $62.10 , $58.65 , $54.51 , N/A , $55.84 , $55.84 , $65.55 , $59.21 , $6.63 , $66.24 
 Fac Anal/Urinary Muscle Study ,CPT® 51785,0922 - EMG,N/A,N/A, $721.00 , $468.65 , $605.64 , $421.81 , $343.39 , $582.57 , $648.90 , $610.40 , $648.90 , $648.90 , $648.90 , $612.85 , $336.66 , $665.70 , $684.95 , $612.85 , $670.53 , $670.53 , $684.95 , $692.16 , $589.92 , $648.90 , $612.85 , $569.59 , N/A , $583.51 , $583.51 , $684.95 , $618.69 , $336.66 , $692.16 
"Surg Cleans Abd Wall,Genital, Perin",CPT® 11006,N/A,N/A,N/A," $2,741.00 "," $1,781.65 "," $2,176.20 ", $642.46 , $636.08 ," $1,907.54 "," $1,833.23 "," $2,549.13 "," $2,466.90 "," $2,466.90 "," $2,192.80 "," $2,192.80 ", $636.08 ," $2,530.77 "," $2,603.95 "," $2,466.90 "," $2,466.90 "," $2,466.90 "," $2,549.13 "," $2,631.36 "," $2,397.62 "," $2,329.85 "," $3,684.09 "," $2,420.28 ", N/A ," $1,944.76 "," $1,944.76 "," $2,603.95 "," $2,255.29 ", $636.08 ," $3,684.09 "
 Hematocrit Beaker1 ,CPT® 85014,0305 - LAB/HEMATOLOGY,N/A,N/A, $59.00 , $38.35 , $49.56 , $2.42 , $2.42 , $47.67 , $53.10 , $49.95 , $53.10 , $53.10 , $53.10 , $50.15 , $2.37 , $54.47 , $56.05 , $50.15 , $54.87 , $54.87 , $56.05 , $56.64 , $48.27 , $53.10 , $50.15 , $46.61 , N/A , $47.75 , $47.75 , $56.05 , $50.63 , $2.37 , $56.64 
Apply-Shoudler to Hand,29065,N/A,N/A,N/A, $638.00 , $414.70 , $411.13 , $64.54 , $78.67 , $331.65 , $332.74 , $593.34 , $574.20 , $574.20 , $510.40 , $510.40 , $78.67 , $589.07 , $606.10 , $574.20 , $574.20 , $574.20 , $593.34 , $612.48 , $381.08 , $542.30 , $365.73 , $390.75 , N/A , $338.12 , $338.12 , $606.10 , $397.43 , $64.54 , $612.48 
Diagnostic Bone Marrow Biopsies & Aspirations,CPT® 38222,N/A,N/A,N/A," $1,202.00 ", $781.30 , $365.65 , $73.07 , $135.37 , $262.85 , $282.49 ," $1,117.86 "," $1,081.80 "," $1,081.80 ", $961.60 , $961.60 , $135.37 ," $1,109.81 "," $1,141.90 "," $1,081.80 "," $1,081.80 "," $1,081.80 "," $1,117.86 "," $1,153.92 ", $395.53 ," $1,021.70 ", $396.26 , $393.86 , N/A , $267.98 , $267.98 ," $1,141.90 ", $310.89 , $73.07 ," $1,153.92 "
 EPINEPHRINE PF 1 MG/ML IJ SOLN ,HCPCS J0171,0636 - DRUGS REQUIRING DETAILED CODIN,54288-0103-10,0.2 mL, $17.98 , $11.69 , $15.10 , $0.74 , $0.75 , $14.53 , $16.18 , $15.22 , $16.18 , $16.18 , $16.18 , $15.28 , $0.74 , $16.60 , $17.08 , $15.28 , $16.72 , $16.72 , $17.08 , $17.26 , $14.71 , $16.18 , $15.28 , $14.20 , N/A , $14.55 , $14.55 , $17.08 , $15.43 , $0.74 , $17.26 
 Fac Ercp W/Sphincterotomy/Papillotomy ,CPT® 43262,0360 - OR SERVICES,N/A,N/A," $4,628.00 "," $3,008.20 "," $3,887.52 ", $337.89 , $401.59 ," $3,739.42 "," $4,165.20 "," $3,918.06 "," $4,165.20 "," $4,165.20 "," $4,165.20 "," $3,933.80 ", $393.72 ," $4,273.03 "," $4,396.60 "," $3,933.80 "," $4,304.04 "," $4,304.04 "," $4,396.60 "," $4,442.88 "," $3,786.63 "," $4,165.20 "," $3,933.80 "," $3,656.12 ", N/A ," $3,745.44 "," $3,745.44 "," $4,396.60 "," $3,971.29 ", $337.89 ," $4,442.88 "
Biopsy of Cornea,CPT® 65410,N/A,N/A,N/A," $1,305.00 ", $848.25 , $626.15 , $98.31 , $61.48 , $592.67 , $558.66 ," $1,213.65 "," $1,174.50 "," $1,174.50 "," $1,044.00 "," $1,044.00 ", $61.48 ," $1,204.91 "," $1,239.75 "," $1,174.50 "," $1,174.50 "," $1,174.50 "," $1,213.65 "," $1,252.80 ", $864.51 ," $1,109.25 ", $583.39 , $750.95 , N/A , $604.24 , $604.24 ," $1,239.75 ", $666.99 , $61.48 ," $1,252.80 "
 Pro Corrj Trichiasis Epilation Forceps Only ,CPT® 67820,0982 - PRO FEE/OUTPT,N/A,N/A, $356.00 , $231.40 , $136.89 , $21.46 , $24.58 , $302.85 , $286.04 , $331.08 , $320.40 , $320.40 , $284.80 , $284.80 , $24.58 , $328.69 , $338.20 , $320.40 , $320.40 , $320.40 , $331.08 , $341.76 , $191.25 , $302.60 , $294.37 , $308.28 , N/A , $308.77 , $308.77 , $338.20 , $340.84 , $21.46 , $341.76 
 Fac Assay of Urine Porphyrins ,CPT® 84120,0301 - LAB/CHEMISTRY,N/A,N/A, $172.00 , $111.80 , $144.48 , $15.00 , $15.00 , $138.98 , $154.80 , $145.62 , $154.80 , $154.80 , $154.80 , $146.20 , $14.71 , $158.81 , $163.40 , $146.20 , $159.96 , $159.96 , $163.40 , $165.12 , $140.73 , $154.80 , $146.20 , $135.88 , N/A , $139.20 , $139.20 , $163.40 , $147.59 , $14.71 , $165.12 
Radiologic Examination Osseous Survey Limited,CPT® 77074,N/A,N/A,N/A, $887.00 , $576.55 , $369.92 , $64.13 , $52.24 , $302.75 , $373.53 , $824.91 , $798.30 , $798.30 , $709.60 , $709.60 , $52.24 , $818.97 , $842.65 , $798.30 , $798.30 , $798.30 , $824.91 , $851.52 , $359.12 , $753.95 , $404.47 , $324.94 , N/A , $308.66 , $308.66 , $842.65 , $357.28 , $52.24 , $851.52 
" Fac Colon Ca Scrn, Barium Enema ",HCPCS G0120,0320 - DX X-RAY,N/A,N/A," $2,496.00 "," $1,622.40 "," $2,096.64 ", $221.19 , $127.04 ," $2,016.77 "," $2,246.40 "," $2,113.11 "," $2,246.40 "," $2,246.40 "," $2,246.40 "," $2,121.60 ", $124.55 ," $2,304.56 "," $2,371.20 "," $2,121.60 "," $2,321.28 "," $2,321.28 "," $2,371.20 "," $2,396.16 "," $2,042.23 "," $2,246.40 "," $2,121.60 "," $1,971.84 ", N/A ," $2,020.01 "," $2,020.01 "," $2,371.20 "," $2,141.82 ", $124.55 ," $2,396.16 "
"Injection,Therap/Proph/Diagnost, IV Push, Ea Add, Same Drug",CPT® 96376,N/A,N/A,N/A, $199.00 , $129.35 , N/A , N/A , $24.64 , $30.99 , $32.54 , $185.07 , $179.10 , $179.10 , $159.20 , $159.20 , $24.64 , $183.74 , $189.05 , $179.10 , $179.10 , $179.10 , $185.07 , $191.04 , N/A , $169.15 , $43.59 , $45.10 , N/A , $31.60 , $31.60 , $189.05 , $36.84 , $24.64 , $191.04 
 Pro MRI Chest Spine W/Dye ,CPT® 72147,0972 - PRO FEE/RAD/DX,N/A,N/A, $920.00 , $598.00 ," $1,967.98 ", $280.87 , $513.47 ," $1,530.43 "," $2,286.61 ", $855.60 , $828.00 , $828.00 , $736.00 , $736.00 , $513.47 , $849.44 , $874.00 , $828.00 , $828.00 , $828.00 , $855.60 , $883.20 ," $1,692.18 ", $782.00 ," $2,490.37 "," $2,992.26 ", N/A ," $1,560.29 "," $1,560.29 ", $874.00 ," $1,806.05 ", $280.87 ," $2,992.26 "
 Fac Blood Culture for Bacteria ,CPT® 87040,0306 - LAB/BACT-MICRO,N/A,N/A, $130.00 , $84.50 , $109.20 , $10.53 , $10.53 , $105.04 , $117.00 , $110.06 , $117.00 , $117.00 , $117.00 , $110.50 , $10.32 , $120.03 , $123.50 , $110.50 , $120.90 , $120.90 , $123.50 , $124.80 , $106.37 , $117.00 , $110.50 , $102.70 , N/A , $105.21 , $105.21 , $123.50 , $111.55 , $10.32 , $124.80 
 Fac Appl on-Body Injector for Timed Subq Injection ,CPT® 96377,0361 - OR/MINOR,N/A,N/A, $154.00 , $100.10 , $129.36 , $18.14 , N/A , $124.43 , $138.60 , $130.38 , $138.60 , $138.60 , $138.60 , $130.90 , N/A , $142.19 , $146.30 , $130.90 , $143.22 , $143.22 , $146.30 , $147.84 , $126.00 , $138.60 , $130.90 , $121.66 , N/A , $124.63 , $124.63 , $146.30 , $132.15 , $18.14 , $147.84 
 DEXTROSE 50 % IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00409-7517-16,50 mL, $82.97 , $53.93 , $69.69 , N/A , N/A , $67.04 , $74.67 , $70.24 , $74.67 , $74.67 , $74.67 , $70.52 , N/A , $76.61 , $78.82 , $70.52 , $77.16 , $77.16 , $78.82 , $79.65 , $67.89 , $74.67 , $70.52 , $65.55 , N/A , $67.15 , $67.15 , $78.82 , $71.20 , $65.55 , $79.65 
Ingestion Challenge Test Each Addl 60 Minutes,CPT® 95079,N/A,N/A,N/A, $289.00 , $187.85 , $172.12 , $66.74 , $52.19 , $124.50 , $118.14 , $268.77 , $260.10 , $260.10 , $231.20 , $231.20 , $52.19 , $266.83 , $274.55 , $260.10 , $260.10 , $260.10 , $268.77 , $277.44 , $215.01 , $245.65 , $196.66 , $215.52 , N/A , $126.93 , $126.93 , $274.55 , $150.09 , $52.19 , $277.44 
 NITROGLYCERIN 0.4 MG SL (SINGLE DOSE) ,HCPCS RXC637,0250 - PHARMACY,00001-0153-01,1 tablet, $9.49 , $6.17 , $7.97 , N/A , N/A , $7.67 , $8.54 , $8.03 , $8.54 , $8.54 , $8.54 , $8.07 , N/A , $8.76 , $9.02 , $8.07 , $8.83 , $8.83 , $9.02 , $9.11 , $7.76 , $8.54 , $8.07 , $7.50 , N/A , $7.68 , $7.68 , $9.02 , $8.14 , $7.50 , $9.11 
 Special Stain Group II - Mh ,CPT® 88313,0310 - PATHOLOGY LAB,N/A,N/A, $438.00 , $284.70 , $367.92 , $80.10 , $16.43 , $353.90 , $394.20 , $370.81 , $394.20 , $394.20 , $394.20 , $372.30 , $16.11 , $404.41 , $416.10 , $372.30 , $407.34 , $407.34 , $416.10 , $420.48 , $358.37 , $394.20 , $372.30 , $346.02 , N/A , $354.47 , $354.47 , $416.10 , $375.85 , $16.11 , $420.48 
"Full Excis 2,3 or 4th Metatar Head",CPT® 28112,N/A,N/A,N/A," $3,270.00 "," $2,125.50 "," $1,934.27 ", $304.14 , $276.59 ," $1,545.72 "," $1,546.95 "," $3,041.10 "," $2,943.00 "," $2,943.00 "," $2,616.00 "," $2,616.00 ", $276.59 ," $3,019.19 "," $3,106.50 "," $2,943.00 "," $2,943.00 "," $2,943.00 "," $3,041.10 "," $3,139.20 "," $1,791.69 "," $2,779.50 "," $1,680.59 "," $1,826.04 ", N/A ," $1,575.88 "," $1,575.88 "," $3,106.50 "," $1,852.20 ", $276.59 ," $3,139.20 "
 Fac Flo Cytometry Cell Surf Marker Techl Only Ea ,CPT® 88185,0311 - PATHOL/CYTOLOGY,N/A,N/A, $373.00 , $242.45 , $313.32 , $23.32 , $23.70 , $301.38 , $335.70 , $315.78 , $335.70 , $335.70 , $335.70 , $317.05 , $23.24 , $344.39 , $354.35 , $317.05 , $346.89 , $346.89 , $354.35 , $358.08 , $305.19 , $335.70 , $317.05 , $294.67 , N/A , $301.87 , $301.87 , $354.35 , $320.07 , $23.24 , $358.08 
Spherocylindr 4.00d/12-2.00d,HCPCS V2103,N/A,N/A,N/A, $55.00 , $35.75 , N/A , $45.60 , N/A , N/A , N/A , $51.15 , $49.50 , $49.50 , $44.00 , $44.00 , N/A , $50.78 , $52.25 , $49.50 , $49.50 , $49.50 , $51.15 , $52.80 , N/A , $46.75 , $55.00 , $41.42 , N/A , N/A , N/A , $52.25 , N/A , $41.42 , $55.00 
Assay Progesterone,CPT® 84144,N/A,N/A,N/A, $181.00 , $117.65 , N/A , $21.28 , $21.28 , $105.27 , $125.89 , $168.33 , $162.90 , $162.90 , $144.80 , $144.80 , $21.28 , $167.12 , $171.95 , $162.90 , $162.90 , $162.90 , $168.33 , $173.76 , $139.29 , $153.85 , $136.23 , $75.66 , N/A , $98.24 , $98.24 , $171.95 , $107.36 , $21.28 , $173.76 
Cath Plmt R Hrt/Arts/Grfts W/Njx& Angio Img S&I,CPT® 93457,N/A,N/A,N/A," $8,295.00 "," $5,391.75 "," $7,938.97 "," $1,190.75 ", $904.93 ," $6,768.43 "," $7,250.16 "," $7,714.35 "," $7,465.50 "," $7,465.50 "," $6,636.00 "," $6,636.00 ", $904.93 ," $7,658.77 "," $7,880.25 "," $7,465.50 "," $7,465.50 "," $7,465.50 "," $7,714.35 "," $7,963.20 "," $7,524.11 "," $7,050.75 "," $6,884.70 "," $7,083.16 ", N/A ," $6,900.49 "," $6,900.49 "," $7,880.25 "," $7,649.26 ", $904.93 ," $7,963.20 "
 Fac Antb Helminth Nes ,CPT® 86682,0302 - LAB/IMMUNOLOGY,N/A,N/A, $205.00 , $133.25 , $172.20 , $13.27 , $8.07 , $165.64 , $184.50 , $173.55 , $184.50 , $184.50 , $184.50 , $174.25 , $7.91 , $189.28 , $194.75 , $174.25 , $190.65 , $190.65 , $194.75 , $196.80 , $167.73 , $184.50 , $174.25 , $161.95 , N/A , $165.91 , $165.91 , $194.75 , $175.91 , $7.91 , $196.80 
 MICONAZOLE NITRATE 2 % EX POWD ,HCPCS RXC637,0250 - PHARMACY,70000-0323-01,71 gram, $35.75 , $23.24 , $30.03 , N/A , N/A , $28.89 , $32.18 , $30.27 , $32.18 , $32.18 , $32.18 , $30.39 , N/A , $33.01 , $33.96 , $30.39 , $33.25 , $33.25 , $33.96 , $34.32 , $29.25 , $32.18 , $30.39 , $28.24 , N/A , $28.93 , $28.93 , $33.96 , $30.68 , $28.24 , $34.32 
 L Spine CT With Contrast ,CPT® 72132,0350 - CT SCAN,N/A,N/A," $3,251.00 "," $2,113.15 "," $2,730.84 ", $172.75 , $302.34 ," $2,626.81 "," $2,925.90 "," $2,752.30 "," $2,925.90 "," $2,925.90 "," $2,925.90 "," $2,763.35 ", $296.41 ," $3,001.65 "," $3,088.45 "," $2,763.35 "," $3,023.43 "," $3,023.43 "," $3,088.45 "," $3,120.96 "," $2,659.97 "," $2,925.90 "," $2,763.35 "," $2,568.29 ", N/A ," $2,631.03 "," $2,631.03 "," $3,088.45 "," $2,789.68 ", $172.75 ," $3,120.96 "
" Pro I & D Hematoma, Seroma or Fluid ",CPT® 10140,0982 - PRO FEE/OUTPT,N/A,N/A, $667.00 , $433.55 , $379.44 , $113.59 , $45.35 , $324.24 , $318.38 , $620.31 , $600.30 , $600.30 , $533.60 , $533.60 , $45.35 , $615.84 , $633.65 , $600.30 , $600.30 , $600.30 , $620.31 , $640.32 , $417.24 , $566.95 , $629.77 , $417.61 , N/A , $330.56 , $330.56 , $633.65 , $383.34 , $45.35 , $640.32 
Remv for.Body Deep Penile Tiss,CPT® 54115,N/A,N/A,N/A," $2,483.00 "," $1,613.95 "," $1,894.05 ", $408.71 , $206.19 ," $1,360.70 "," $1,379.51 "," $2,309.19 "," $2,234.70 "," $2,234.70 "," $1,986.40 "," $1,986.40 ", $206.19 ," $2,292.55 "," $2,358.85 "," $2,234.70 "," $2,234.70 "," $2,234.70 "," $2,309.19 "," $2,383.68 "," $1,774.10 "," $2,110.55 "," $2,196.18 "," $2,058.95 ", N/A ," $1,387.25 "," $1,387.25 "," $2,358.85 "," $1,662.69 ", $206.19 ," $2,383.68 "
 RISPERIDONE MICROSPHERES ER 50 MG IM SRER ,HCPCS J2794,0636 - DRUGS REQUIRING DETAILED CODIN,50458-0308-11,2 mL," $3,614.26 "," $2,349.27 "," $3,035.98 ", $12.26 , $11.82 ," $2,920.32 "," $3,252.83 "," $3,059.83 "," $3,252.83 "," $3,252.83 "," $3,252.83 "," $3,072.12 ", $11.59 ," $3,337.05 "," $3,433.55 "," $3,072.12 "," $3,361.26 "," $3,361.26 "," $3,433.55 "," $3,469.69 "," $2,957.19 "," $3,252.83 "," $3,072.12 "," $2,855.27 ", N/A ," $2,925.02 "," $2,925.02 "," $3,433.55 "," $3,101.40 ", $11.59 ," $3,469.69 "
 Bone Marrow Aspiration-CT ,CPT® 38220,0761 - TREATMENT ROOM,N/A,N/A, $999.00 , $649.35 , $839.16 , $65.55 , $305.29 , $807.19 , $899.10 , $845.75 , $899.10 , $899.10 , $899.10 , $849.15 , $299.30 , $922.38 , $949.05 , $849.15 , $929.07 , $929.07 , $949.05 , $959.04 , $817.38 , $899.10 , $849.15 , $789.21 , N/A , $808.49 , $808.49 , $949.05 , $857.24 , $65.55 , $959.04 
Insert Cervical Dilator,59200,N/A,N/A,N/A, $360.00 , $234.00 , $118.11 , $39.87 , $65.80 , $103.98 , $109.38 , $334.80 , $324.00 , $324.00 , $288.00 , $288.00 , $65.80 , $332.39 , $342.00 , $324.00 , $324.00 , $324.00 , $334.80 , $345.60 , $121.08 , $306.00 , $242.63 , $192.75 , N/A , $106.01 , $106.01 , $342.00 , $122.55 , $39.87 , $345.60 
Office/Outpatient Established Mod Mdm 30-39 Min,CPT® 99214,N/A,N/A,N/A, $293.00 , $190.45 , $198.24 , $94.81 , $64.80 , $135.34 , $135.69 , $272.49 , $263.70 , $263.70 , $234.40 , $234.40 , $64.80 , $270.53 , $278.35 , $263.70 , $263.70 , $263.70 , $272.49 , $281.28 , $181.36 , $249.05 , $168.77 , $172.04 , $74.50 , $137.99 , $137.99 , $278.35 , $159.15 , $64.80 , $281.28 
"Oth Resp Proc, Group",HCPCS G0239,N/A,N/A,N/A, $62.00 , $40.30 , $29.18 , $12.26 , N/A , $23.65 , N/A , $57.66 , $55.80 , $55.80 , $49.60 , $49.60 , N/A , $57.24 , $58.90 , $55.80 , $55.80 , $55.80 , $57.66 , $59.52 , $35.65 , $52.70 , $24.65 , $48.47 , N/A , $24.11 , $24.11 , $58.90 , $30.14 , $12.26 , $59.52 
 LIDOCAINE HCL 4% EX SOLN (ANES) ,HCPCS RXA250,0250 - PHARMACY,76329-6300-05,52 mL, $664.20 , $431.73 , $557.93 , N/A , N/A , $536.67 , $597.78 , $562.31 , $597.78 , $597.78 , $597.78 , $564.57 , N/A , $613.26 , $630.99 , $564.57 , $617.71 , $617.71 , $630.99 , $637.63 , $543.45 , $597.78 , $564.57 , $524.72 , N/A , $537.54 , $537.54 , $630.99 , $569.95 , $524.72 , $637.63 
" Pro Burn,Initial Treatment ",CPT® 16000,0982 - PRO FEE/OUTPT,N/A,N/A, $161.00 , $104.65 , $143.24 , $43.12 , $29.25 , $126.05 , $122.05 , $149.73 , $144.90 , $144.90 , $128.80 , $128.80 , $29.25 , $148.65 , $152.95 , $144.90 , $144.90 , $144.90 , $149.73 , $154.56 , $157.17 , $136.85 , $242.63 , $162.35 , N/A , $128.51 , $128.51 , $152.95 , $149.03 , $29.25 , $242.63 
Open Rx Med Malleolus Fx,27766,N/A,N/A,N/A," $4,074.00 "," $2,648.10 "," $3,702.66 ", $582.66 , $614.70 ," $2,952.59 "," $2,947.21 "," $3,788.82 "," $3,666.60 "," $3,666.60 "," $3,259.20 "," $3,259.20 ", $614.70 ," $3,761.52 "," $3,870.30 "," $3,666.60 "," $3,666.60 "," $3,666.60 "," $3,788.82 "," $3,911.04 "," $3,443.34 "," $3,462.90 "," $3,248.78 "," $3,462.61 ", N/A ," $3,010.20 "," $3,010.20 "," $3,870.30 "," $3,538.06 ", $582.66 ," $3,911.04 "
 METOPROLOL SUCCINATE ER 12.5 MG TAB (COMES FROM 25 MG TABLET) ,HCPCS RXC637,0250 - PHARMACY,00001-0930-01,2 tablet, $12.73 , $8.27 , $10.69 , N/A , N/A , $10.29 , $11.46 , $10.78 , $11.46 , $11.46 , $11.46 , $10.82 , N/A , $11.75 , $12.09 , $10.82 , $11.84 , $11.84 , $12.09 , $12.22 , $10.42 , $11.46 , $10.82 , $10.06 , N/A , $10.30 , $10.30 , $12.09 , $10.92 , $10.06 , $12.22 
 Fractures Of Hip And Pelvis Without McC ,MS DRG V40 (FY2023) 536,N/A,N/A,N/A," $22,687.35 "," $14,746.78 "," $19,057.37 ", N/A , N/A ," $18,331.38 "," $20,418.62 "," $19,207.11 "," $20,418.62 "," $20,418.62 "," $20,418.62 "," $19,284.25 ", N/A ," $20,947.23 "," $21,552.98 "," $19,284.25 "," $21,099.24 "," $21,099.24 "," $21,552.98 "," $21,779.86 "," $18,562.79 "," $20,418.62 "," $19,284.25 "," $17,923.01 ", N/A ," $18,360.87 "," $18,360.87 "," $21,552.98 "," $19,468.02 "," $17,923.01 "," $21,779.86 "
 Pro MRI Pelvis W/O Dye ,CPT® 72195,0972 - PRO FEE/RAD/DX,N/A,N/A, $760.00 , $494.00 ," $1,661.52 ", $235.76 , $417.22 ," $1,786.78 "," $2,241.95 ", $706.80 , $684.00 , $684.00 , $608.00 , $608.00 , $417.22 , $701.71 , $722.00 , $684.00 , $684.00 , $684.00 , $706.80 , $729.60 ," $1,430.53 ", $646.00 ," $2,446.07 "," $2,925.30 ", N/A ," $1,821.64 "," $1,821.64 ", $722.00 ," $2,108.60 ", $235.76 ," $2,925.30 "
 Pro Inject Sacroiliac Joint ,CPT® 27096,0975 - PRO FEE/OR,N/A,N/A," $1,152.00 ", $748.80 , $512.53 , $79.93 , $154.36 , $415.04 , $416.57 ," $1,071.36 "," $1,036.80 "," $1,036.80 ", $921.60 , $921.60 , $154.36 ," $1,063.64 "," $1,094.40 "," $1,036.80 "," $1,036.80 "," $1,036.80 "," $1,071.36 "," $1,105.92 ", $480.33 , $979.20 , $451.37 , $490.61 , N/A , $423.13 , $423.13 ," $1,094.40 ", $497.32 , $79.93 ," $1,105.92 "
 GOSERELIN ACETATE 10.8 MG SC IMPL ,HCPCS J9202,0636 - DRUGS REQUIRING DETAILED CODIN,70720-0951-30,1 each," $7,099.56 "," $4,614.71 "," $5,963.63 ", $625.84 , N/A ," $5,736.44 "," $6,389.60 "," $6,010.49 "," $6,389.60 "," $6,389.60 "," $6,389.60 "," $6,034.63 ", N/A ," $6,555.02 "," $6,744.58 "," $6,034.63 "," $6,602.59 "," $6,602.59 "," $6,744.58 "," $6,815.58 "," $5,808.86 "," $6,389.60 "," $6,034.63 "," $5,608.65 ", N/A ," $5,745.67 "," $5,745.67 "," $6,744.58 "," $6,092.13 ", $625.84 ," $6,815.58 "
"Shav Skin Les <5mm Trunk,Arm,Leg",11300,N/A,N/A,N/A, $382.00 , $248.30 , $109.62 , $32.66 , $50.40 , $96.10 , $92.59 , $355.26 , $343.80 , $343.80 , $305.60 , $305.60 , $50.40 , $352.70 , $362.90 , $343.80 , $343.80 , $343.80 , $355.26 , $366.72 , $120.13 , $324.70 , $183.76 , $124.39 , N/A , $97.98 , $97.98 , $362.90 , $113.63 , $32.66 , $366.72 
Elec Stim Other Than Wound,HCPCS G0283,N/A,N/A,N/A, $113.00 , $73.45 , $28.49 , $11.91 , $23.97 , $25.49 , N/A , $105.09 , $101.70 , $101.70 , $90.40 , $90.40 , $23.97 , $104.33 , $107.35 , $101.70 , $101.70 , $101.70 , $105.09 , $108.48 , $32.64 , $96.05 , $25.95 , $56.20 , N/A , $25.99 , $25.99 , $107.35 , $32.49 , $11.91 , $108.48 
Repair Nonunion Radius and Ulna,25415,N/A,N/A,N/A," $6,480.00 "," $4,212.00 "," $5,870.54 ", $918.50 , $804.14 ," $4,661.35 "," $4,617.26 "," $6,026.40 "," $5,832.00 "," $5,832.00 "," $5,184.00 "," $5,184.00 ", $804.14 ," $5,982.98 "," $6,156.00 "," $5,832.00 "," $5,832.00 "," $5,832.00 "," $6,026.40 "," $6,220.80 "," $5,463.48 "," $5,508.00 "," $5,105.99 "," $5,481.87 ", N/A ," $4,752.30 "," $4,752.30 "," $6,156.00 "," $5,585.65 ", $804.14 ," $6,220.80 "
" Pro Medicare Annual Wellness Visit, Subsequent ",HCPCS G0439,0982 - PRO FEE/OUTPT,N/A,N/A, $190.00 , $123.50 , $315.63 , $126.78 , N/A , $212.88 , $247.86 , $176.70 , $171.00 , $171.00 , $152.00 , $152.00 , N/A , $175.43 , $180.50 , $171.00 , $171.00 , $171.00 , $176.70 , $182.40 , $353.13 , $161.50 , $213.44 , $248.08 , N/A , $217.03 , $217.03 , $180.50 , $271.27 , $126.78 , $353.13 
 Fac Therapeutic Exercises ,CPT® 97110,0420 - PHYSICAL THERAPY,N/A,N/A, $145.00 , $94.25 , $121.80 , $29.46 , $32.01 , $117.16 , $130.50 , $122.76 , $130.50 , $130.50 , $130.50 , $123.25 , $31.38 , $133.88 , $137.75 , $123.25 , $134.85 , $134.85 , $137.75 , $139.20 , $118.64 , $130.50 , $123.25 , $114.55 , N/A , $117.35 , $117.35 , $137.75 , $124.42 , $29.46 , $139.20 
 Application of Short Arm Splint Static ,CPT® 29125,0761 - TREATMENT ROOM,N/A,N/A, $307.00 , $199.55 , $257.88 , $38.40 , $27.51 , $248.06 , $276.30 , $259.91 , $276.30 , $276.30 , $276.30 , $260.95 , $26.97 , $283.45 , $291.65 , $260.95 , $285.51 , $285.51 , $291.65 , $294.72 , $251.19 , $276.30 , $260.95 , $242.53 , N/A , $248.46 , $248.46 , $291.65 , $263.44 , $26.97 , $294.72 
Cysto/Uretero W/Lithotripsy &Indwell Stent Insrt,52356,N/A,N/A,N/A," $2,817.00 "," $1,831.05 "," $2,227.03 ", $390.60 , $312.75 ," $2,036.34 "," $1,954.34 "," $2,619.81 "," $2,535.30 "," $2,535.30 "," $2,253.60 "," $2,253.60 ", $312.75 ," $2,600.94 "," $2,676.15 "," $2,535.30 "," $2,535.30 "," $2,535.30 "," $2,619.81 "," $2,704.32 "," $2,241.18 "," $2,394.45 "," $2,151.88 "," $2,560.84 ", N/A ," $2,076.07 "," $2,076.07 "," $2,676.15 "," $2,440.12 ", $312.75 ," $2,704.32 "
F2 Gene Analysis 20210g >a Variant,CPT® 81240,N/A,N/A,N/A, $556.00 , $361.40 , N/A , $67.00 , $54.77 , $278.38 , $329.67 , $517.08 , $500.40 , $500.40 , $444.80 , $444.80 , $54.77 , $513.35 , $528.20 , $500.40 , $500.40 , $500.40 , $517.08 , $533.76 , $438.63 , $472.60 , $313.38 , $192.93 , N/A , $259.80 , $259.80 , $528.20 , $283.91 , $54.77 , $533.76 
 Pro Anes Peripheral Sngl Nrv Inj ,CPT® 64450,0982 - PRO FEE/OUTPT,N/A,N/A, $402.00 , $261.30 , $207.58 , $40.26 , $113.79 , $255.83 , $245.04 , $373.86 , $361.80 , $361.80 , $321.60 , $321.60 , $113.79 , $371.17 , $381.90 , $361.80 , $361.80 , $361.80 , $373.86 , $385.92 , $225.30 , $341.70 , $237.28 , $273.66 , N/A , $260.82 , $260.82 , $381.90 , $279.80 , $40.26 , $385.92 
" Fac Assay of Psa, Free ",CPT® 84154,0301 - LAB/CHEMISTRY,N/A,N/A, $171.00 , $111.15 , $143.64 , $18.76 , $18.76 , $138.17 , $153.90 , $144.77 , $153.90 , $153.90 , $153.90 , $145.35 , $18.39 , $157.88 , $162.45 , $145.35 , $159.03 , $159.03 , $162.45 , $164.16 , $139.91 , $153.90 , $145.35 , $135.09 , N/A , $138.39 , $138.39 , $162.45 , $146.74 , $18.39 , $164.16 
"Exc Skin Benig 2.1-3cm Face,Facial",CPT® 11443,N/A,N/A,N/A," $1,135.00 ", $737.75 , $572.42 , $172.25 , $230.52 , $484.65 , $476.60 ," $1,055.55 "," $1,021.50 "," $1,021.50 ", $908.00 , $908.00 , $230.52 ," $1,047.95 "," $1,078.25 "," $1,021.50 "," $1,021.50 "," $1,021.50 "," $1,055.55 "," $1,089.60 ", $624.02 , $964.75 , $950.91 , $621.47 , N/A , $494.11 , $494.11 ," $1,078.25 ", $573.01 , $172.25 ," $1,089.60 "
Part Remv Talus or Calcaneus,28120,N/A,N/A,N/A," $4,464.00 "," $2,901.60 "," $3,061.44 ", $479.04 , $384.19 ," $2,434.25 "," $2,436.06 "," $4,151.52 "," $4,017.60 "," $4,017.60 "," $3,571.20 "," $3,571.20 ", $384.19 ," $4,121.61 "," $4,240.80 "," $4,017.60 "," $4,017.60 "," $4,017.60 "," $4,151.52 "," $4,285.44 "," $2,844.60 "," $3,794.40 "," $2,661.82 "," $2,885.84 ", N/A ," $2,481.75 "," $2,481.75 "," $4,240.80 "," $2,916.93 ", $384.19 ," $4,285.44 "
 OXALIPLATIN 50 MG/10ML IV SOLN ,HCPCS J9263,0636 - DRUGS REQUIRING DETAILED CODIN,16729-0332-03,0.1 mL, $16.68 , $10.84 , $14.01 , $0.07 , $0.08 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.08 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.07 , $16.01 
 Fibrinolysins/Coagulopath Scr I&R ,CPT® 85390,0971 - PRO FEE/LAB,N/A,N/A, $83.00 , $53.95 , N/A , $15.79 , $7.18 , $29.27 , $34.95 , $77.19 , $74.70 , $74.70 , $66.40 , $66.40 , $7.18 , $76.63 , $78.85 , $74.70 , $74.70 , $74.70 , $77.19 , $79.68 , $103.36 , $70.55 , $129.75 , $45.46 , N/A , $27.32 , $27.32 , $78.85 , $29.85 , $7.18 , $129.75 
 Fac Gadobutrol Injection ,HCPCS A9585,0255 - DRUGS/RADIOLOGY,N/A,N/A, $2.00 , $1.30 , $1.68 , $0.36 , $0.37 , $1.62 , $1.80 , $1.69 , $1.80 , $1.80 , $1.80 , $1.70 , $0.36 , $1.85 , $1.90 , $1.70 , $1.86 , $1.86 , $1.90 , $1.92 , $1.64 , $1.80 , $1.70 , $1.58 , N/A , $1.62 , $1.62 , $1.90 , $1.72 , $0.36 , $1.92 
 Pro Treat Hip Dislocation ,CPT® 27252,0982 - PRO FEE/OUTPT,N/A,N/A," $2,787.00 "," $1,811.55 "," $4,583.22 ", $714.45 , $532.53 ," $3,661.56 "," $3,638.25 "," $2,591.91 "," $2,508.30 "," $2,508.30 "," $2,229.60 "," $2,229.60 ", $532.53 ," $2,573.24 "," $2,647.65 "," $2,508.30 "," $2,508.30 "," $2,508.30 "," $2,591.91 "," $2,675.52 "," $4,261.18 "," $2,368.95 "," $4,021.28 "," $4,294.62 ", N/A ," $3,733.01 "," $3,733.01 "," $2,647.65 "," $4,387.60 ", $532.53 ," $4,583.22 "
"Excision Nose Polyp(S),Simple",CPT® 30110,N/A,N/A,N/A," $1,330.00 ", $864.50 , $719.56 , $128.54 , $107.56 , $497.68 , $498.65 ," $1,236.90 "," $1,197.00 "," $1,197.00 "," $1,064.00 "," $1,064.00 ", $107.56 ," $1,227.99 "," $1,263.50 "," $1,197.00 "," $1,197.00 "," $1,197.00 "," $1,236.90 "," $1,276.80 ", $681.27 ," $1,130.50 ", $701.14 , $655.64 , N/A , $507.40 , $507.40 ," $1,263.50 ", $597.56 , $107.56 ," $1,276.80 "
 DEXTROSE 5% AND SALINE 0.2% WITH KCL 20 MEQ (ANES) ,HCPCS RXA258,0258 - IV SOLUTIONS,00264-7645-00,"1,000 mL", $133.03 , $86.47 , $111.75 , N/A , N/A , $107.49 , $119.73 , $112.62 , $119.73 , $119.73 , $119.73 , $113.08 , N/A , $122.83 , $126.38 , $113.08 , $123.72 , $123.72 , $126.38 , $127.71 , $108.85 , $119.73 , $113.08 , $105.09 , N/A , $107.66 , $107.66 , $126.38 , $114.15 , $105.09 , $127.71 
Cath Placement & Njx Coronary Art Angio Img S&I,CPT® 93454,N/A,N/A,N/A," $6,039.00 "," $3,925.35 "," $5,861.38 ", $878.92 , $638.27 ," $4,788.50 "," $5,125.08 "," $5,616.27 "," $5,435.10 "," $5,435.10 "," $4,831.20 "," $4,831.20 ", $638.27 ," $5,575.81 "," $5,737.05 "," $5,435.10 "," $5,435.10 "," $5,435.10 "," $5,616.27 "," $5,797.44 "," $5,477.59 "," $5,133.15 "," $4,866.93 "," $4,943.77 ", N/A ," $4,881.93 "," $4,881.93 "," $5,737.05 "," $5,411.68 ", $638.27 ," $5,861.38 "
"Sigmoidoscopy,Biopsy",45331,N/A,N/A,N/A," $1,411.00 ", $917.15 , $440.31 , $68.50 , $109.66 , $358.68 , $372.82 ," $1,312.23 "," $1,269.90 "," $1,269.90 "," $1,128.80 "," $1,128.80 ", $109.66 ," $1,302.78 "," $1,340.45 "," $1,269.90 "," $1,269.90 "," $1,269.90 "," $1,312.23 "," $1,354.56 ", $315.49 ," $1,199.35 ", $408.55 , $417.80 , N/A , $365.67 , $365.67 ," $1,340.45 ", $382.45 , $68.50 ," $1,354.56 "
Injection Sclerosant Single Incmptnt Vein,CPT® 36470,N/A,N/A,N/A, $878.00 , $570.70 , $224.64 , $35.00 , $50.81 , $362.05 , $371.98 , $816.54 , $790.20 , $790.20 , $702.40 , $702.40 , $50.81 , $810.66 , $834.10 , $790.20 , $790.20 , $790.20 , $816.54 , $842.88 , $209.01 , $746.30 , $462.07 , $186.11 , N/A , $369.12 , $369.12 , $834.10 , $419.32 , $35.00 , $842.88 
Tympanoplasty,CPT® 69631,N/A,N/A,N/A," $7,130.00 "," $4,634.50 "," $4,295.75 ", $870.44 , $766.64 ," $4,256.89 "," $4,430.72 "," $6,630.90 "," $6,417.00 "," $6,417.00 "," $5,704.00 "," $5,704.00 ", $766.64 ," $6,583.13 "," $6,773.50 "," $6,417.00 "," $6,417.00 "," $6,417.00 "," $6,630.90 "," $6,844.80 "," $4,722.65 "," $6,060.50 "," $4,825.89 "," $4,273.03 ", N/A ," $4,339.95 "," $4,339.95 "," $6,773.50 "," $4,955.49 ", $766.64 ," $6,844.80 "
 ARTIFICIAL TEARS OPHTHALMIC DROPS (INPT) ,HCPCS RXC637,0250 - PHARMACY,00536-1325-94,15 mL, $32.29 , $20.99 , $27.12 , N/A , N/A , $26.09 , $29.06 , $27.34 , $29.06 , $29.06 , $29.06 , $27.45 , N/A , $29.81 , $30.68 , $27.45 , $30.03 , $30.03 , $30.68 , $31.00 , $26.42 , $29.06 , $27.45 , $25.51 , N/A , $26.13 , $26.13 , $30.68 , $27.71 , $25.51 , $31.00 
" Pro Removal of Hydrocele,Tunica,Unilat ",CPT® 55040,0982 - PRO FEE/OUTPT,N/A,N/A," $3,208.00 "," $2,085.20 "," $1,504.47 ", $324.04 , $333.51 ," $1,083.03 "," $1,102.68 "," $2,983.44 "," $2,887.20 "," $2,887.20 "," $2,566.40 "," $2,566.40 ", $333.51 ," $2,961.95 "," $3,047.60 "," $2,887.20 "," $2,887.20 "," $2,887.20 "," $2,983.44 "," $3,079.68 "," $1,410.36 "," $2,726.80 "," $1,764.44 "," $1,634.50 ", N/A ," $1,104.16 "," $1,104.16 "," $3,047.60 "," $1,323.40 ", $324.04 ," $3,079.68 "
 Fac Trauma 2 Eval W/ Pre-ED Notification W/Critical Care ,HCPCS G0390,0682 - TRAUMA LEVEL II,N/A,N/A," $2,044.00 "," $1,328.60 "," $1,716.96 ", N/A , N/A ," $1,651.55 "," $1,839.60 "," $1,730.45 "," $1,839.60 "," $1,839.60 "," $1,839.60 "," $1,737.40 ", N/A ," $1,887.23 "," $1,941.80 "," $1,737.40 "," $1,900.92 "," $1,900.92 "," $1,941.80 "," $1,962.24 "," $1,672.40 "," $1,839.60 "," $1,737.40 "," $1,614.76 ", N/A ," $1,654.21 "," $1,654.21 "," $1,941.80 "," $1,753.96 "," $1,614.76 "," $1,962.24 "
Drug Assay Salicylate,CPT® 80179,N/A,N/A,N/A, $159.00 , $103.35 , N/A , $19.01 , $15.21 , N/A , N/A , $147.87 , $143.10 , $143.10 , $127.20 , $127.20 , $15.21 , $146.80 , $151.05 , $143.10 , $143.10 , $143.10 , $147.87 , $152.64 , $124.46 , $135.15 , $88.85 , $54.75 , N/A , $74.00 , $74.00 , $151.05 , $80.71 , $15.21 , $152.64 
Office/Outpatient New High Mdm 60-74 Minutes,99205,N/A,N/A,N/A, $652.00 , $423.80 , $366.66 , $174.91 , $136.97 , $290.52 , $289.74 , $606.36 , $586.80 , $586.80 , $521.60 , $521.60 , $136.97 , $601.99 , $619.40 , $586.80 , $586.80 , $586.80 , $606.36 , $625.92 , $334.52 , $554.20 , $363.05 , $366.53 , $109.75 , $296.18 , $296.18 , $619.40 , $341.61 , $109.75 , $625.92 
3d Rendering W/ Image Postprocess,CPT® 76377,N/A,N/A,N/A," $1,470.00 ", $955.50 , $407.33 , $74.81 , $95.75 , $307.48 , $429.58 ," $1,367.10 "," $1,323.00 "," $1,323.00 "," $1,176.00 "," $1,176.00 ", $95.75 ," $1,357.25 "," $1,396.50 "," $1,323.00 "," $1,323.00 "," $1,323.00 "," $1,367.10 "," $1,411.20 ", $394.48 ," $1,249.50 ", $468.03 , $459.97 , N/A , $313.48 , $313.48 ," $1,396.50 ", $362.85 , $74.81 ," $1,411.20 "
"Pessary Rubber, Any Type",HCPCS A4561,N/A,N/A,N/A, $80.00 , $52.00 , N/A , $27.81 , $15.57 , N/A , N/A , $74.40 , $72.00 , $72.00 , $64.00 , $64.00 , $15.57 , $73.86 , $76.00 , $72.00 , $72.00 , $72.00 , $74.40 , $76.80 , N/A , $68.00 , $25.30 , $25.26 , N/A , N/A , N/A , $76.00 , N/A , $15.57 , $76.80 
Electric Current Therapy,CPT® 97033,N/A,N/A,N/A, $152.00 , $98.80 , $46.10 , $19.60 , $23.98 , $73.48 , $66.44 , $141.36 , $136.80 , $136.80 , $121.60 , $121.60 , $23.98 , $140.34 , $144.40 , $136.80 , $136.80 , $136.80 , $141.36 , $145.92 , $50.88 , $129.20 , $98.33 , $50.99 , N/A , $74.92 , $74.92 , $144.40 , $83.32 , $19.60 , $145.92 
 EYE WASH OP SOLN ,HCPCS RXC637,0250 - PHARMACY,00536-1224-97,118 mL, $18.80 , $12.22 , $15.79 , N/A , N/A , $15.19 , $16.92 , $15.92 , $16.92 , $16.92 , $16.92 , $15.98 , N/A , $17.36 , $17.86 , $15.98 , $17.48 , $17.48 , $17.86 , $18.05 , $15.38 , $16.92 , $15.98 , $14.85 , N/A , $15.21 , $15.21 , $17.86 , $16.13 , $14.85 , $18.05 
Egd Transoral Biopsy Single/Multiple,43239,N/A,N/A,N/A," $2,363.00 "," $1,535.95 ", $847.99 , $131.07 , $744.68 , $879.24 , $836.03 ," $2,197.59 "," $2,126.70 "," $2,126.70 "," $1,890.40 "," $1,890.40 ", $744.68 ," $2,181.76 "," $2,244.85 "," $2,126.70 "," $2,126.70 "," $2,126.70 "," $2,197.59 "," $2,268.48 "," $1,125.61 "," $2,008.55 ", $915.22 , $806.86 , N/A , $896.40 , $896.40 ," $2,244.85 "," $1,076.03 ", $131.07 ," $2,268.48 "
Tobacco Use Cessation Intermediate 3-10 Minutes,99406,N/A,N/A,N/A, $111.00 , $72.15 , $28.60 , $11.46 , N/A , $26.24 , $26.40 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , N/A , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $37.52 , $94.35 , $26.25 , $26.06 , N/A , $26.75 , $26.75 , $105.45 , $32.15 , $11.46 , $106.56 
 CYCLOPHOSPHAMIDE 1 G IJ SOLR ,HCPCS J9070,0636 - DRUGS REQUIRING DETAILED CODIN,10019-0956-01,50 mL," $4,515.31 "," $2,934.95 "," $3,792.86 ", $17.43 , $22.57 ," $3,648.37 "," $4,063.78 "," $3,822.66 "," $4,063.78 "," $4,063.78 "," $4,063.78 "," $3,838.01 ", $22.13 ," $4,168.99 "," $4,289.54 "," $3,838.01 "," $4,199.24 "," $4,199.24 "," $4,289.54 "," $4,334.70 "," $3,694.43 "," $4,063.78 "," $3,838.01 "," $3,567.09 ", N/A ," $3,654.24 "," $3,654.24 "," $4,289.54 "," $3,874.59 ", $17.43 ," $4,334.70 "
Control Nasal Hemorrhage,30901,N/A,N/A,N/A, $781.00 , $507.65 , $301.30 , $53.21 , $34.36 , $216.79 , $209.25 , $726.33 , $702.90 , $702.90 , $624.80 , $624.80 , $34.36 , $721.10 , $741.95 , $702.90 , $702.90 , $702.90 , $726.33 , $749.76 , $289.39 , $663.85 , $296.15 , $286.56 , N/A , $221.02 , $221.02 , $741.95 , $260.29 , $34.36 , $749.76 
"Tumor Image Pet&CT, Full Body",CPT® 78816,N/A,N/A,N/A," $9,409.00 "," $6,115.85 "," $10,755.99 "," $1,556.06 "," $1,056.59 "," $4,880.21 "," $5,030.21 "," $8,750.37 "," $8,468.10 "," $8,468.10 "," $7,527.20 "," $7,527.20 "," $1,056.59 "," $8,687.33 "," $8,938.55 "," $8,468.10 "," $8,468.10 "," $8,468.10 "," $8,750.37 "," $9,032.64 "," $8,642.65 "," $7,997.65 "," $5,618.26 "," $5,833.20 ", N/A ," $4,975.43 "," $4,975.43 "," $8,938.55 "," $5,759.14 "," $1,056.59 "," $10,755.99 "
 Fac Assay of Urine Chloride ,CPT® 82436,0301 - LAB/CHEMISTRY,N/A,N/A, $62.00 , $40.30 , $52.08 , $5.87 , $5.87 , $50.10 , $55.80 , $52.49 , $55.80 , $55.80 , $55.80 , $52.70 , $5.75 , $57.24 , $58.90 , $52.70 , $57.66 , $57.66 , $58.90 , $59.52 , $50.73 , $55.80 , $52.70 , $48.98 , N/A , $50.18 , $50.18 , $58.90 , $53.20 , $5.75 , $59.52 
" Fac Legion Pneumophilia Ag, If ",CPT® 87278,0305 - LAB/HEMATOLOGY,N/A,N/A, $115.00 , $74.75 , $96.60 , $15.91 , $15.91 , $92.92 , $103.50 , $97.36 , $103.50 , $103.50 , $103.50 , $97.75 , $15.60 , $106.18 , $109.25 , $97.75 , $106.95 , $106.95 , $109.25 , $110.40 , $94.09 , $103.50 , $97.75 , $90.85 , N/A , $93.07 , $93.07 , $109.25 , $98.68 , $15.60 , $110.40 
 Wound Removal of Skin Tags ,CPT® 11200,0761 - TREATMENT ROOM,N/A,N/A, $160.00 , $104.00 , $134.40 , $74.08 , $40.50 , $129.28 , $144.00 , $135.46 , $144.00 , $144.00 , $144.00 , $136.00 , $39.71 , $147.73 , $152.00 , $136.00 , $148.80 , $148.80 , $152.00 , $153.60 , $130.91 , $144.00 , $136.00 , $126.40 , N/A , $129.49 , $129.49 , $152.00 , $137.30 , $39.71 , $153.60 
 Pro Lower Ext Art Bil Single -Mh ,CPT® 93922,0972 - PRO FEE/RAD/DX,N/A,N/A, $194.00 , $126.10 , $515.13 , $79.89 , $83.57 , $480.19 , $525.74 , $180.42 , $174.60 , $174.60 , $155.20 , $155.20 , $83.57 , $179.12 , $184.30 , $174.60 , $174.60 , $174.60 , $180.42 , $186.24 , $364.33 , $164.90 , $280.80 , $332.58 , N/A , $489.56 , $489.56 , $184.30 , $542.68 , $79.89 , $542.68 
"Echo,Pelvic (Nonobstetric)",CPT® 76856,N/A,N/A,N/A, $889.00 , $577.85 , $604.71 , $104.51 , $99.44 , $525.68 , $660.93 , $826.77 , $800.10 , $800.10 , $711.20 , $711.20 , $99.44 , $820.81 , $844.55 , $800.10 , $800.10 , $800.10 , $826.77 , $853.44 , $608.05 , $755.65 , $718.41 , $620.29 , N/A , $535.94 , $535.94 , $844.55 , $620.37 , $99.44 , $853.44 
 AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR ,HCPCS RXC637,0250 - PHARMACY,65862-0534-01,100 mL, $353.94 , $230.06 , $297.31 , N/A , N/A , $285.98 , $318.55 , $299.65 , $318.55 , $318.55 , $318.55 , $300.85 , N/A , $326.79 , $336.24 , $300.85 , $329.16 , $329.16 , $336.24 , $339.78 , $289.59 , $318.55 , $300.85 , $279.61 , N/A , $286.44 , $286.44 , $336.24 , $303.72 , $279.61 , $339.78 
Renal Biopsy Prq Trocar/Needle,CPT® 50200,N/A,N/A,N/A," $4,086.00 "," $2,655.90 ", $692.76 , $120.88 , $142.19 , $705.63 , $659.06 ," $3,799.98 "," $3,677.40 "," $3,677.40 "," $3,268.80 "," $3,268.80 ", $142.19 ," $3,772.60 "," $3,881.70 "," $3,677.40 "," $3,677.40 "," $3,677.40 "," $3,799.98 "," $3,922.56 ", $695.74 ," $3,473.10 ", $752.88 , $794.23 , N/A , $719.40 , $719.40 ," $3,881.70 ", $845.54 , $120.88 ," $3,922.56 "
 Bammab/Etesevimab IV Infusion Therapy ,HCPCS M0245,0771 - VACCINE ADMINISTRATION,N/A,N/A," $1,335.00 ", $867.75 ," $1,121.40 ", N/A , $459.00 ," $1,078.68 "," $1,201.50 "," $1,130.21 "," $1,201.50 "," $1,201.50 "," $1,201.50 "," $1,134.75 ", $450.00 ," $1,232.61 "," $1,268.25 "," $1,134.75 "," $1,241.55 "," $1,241.55 "," $1,268.25 "," $1,281.60 "," $1,092.30 "," $1,201.50 "," $1,134.75 "," $1,054.65 ", N/A ," $1,080.42 "," $1,080.42 "," $1,268.25 "," $1,145.56 ", $450.00 ," $1,281.60 "
 Fac Assay of Selenium ,CPT® 84255,0301 - LAB/CHEMISTRY,N/A,N/A, $234.00 , $152.10 , $196.56 , $26.04 , $26.04 , $189.07 , $210.60 , $198.10 , $210.60 , $210.60 , $210.60 , $198.90 , $25.53 , $216.05 , $222.30 , $198.90 , $217.62 , $217.62 , $222.30 , $224.64 , $191.46 , $210.60 , $198.90 , $184.86 , N/A , $189.38 , $189.38 , $222.30 , $200.80 , $25.53 , $224.64 
"Closed Rx Prox Ulna Fx,Manipulatn",CPT® 24675,N/A,N/A,N/A," $3,107.00 "," $2,019.55 "," $2,599.22 ", $407.47 , $230.52 ," $1,998.44 "," $2,019.52 "," $2,889.51 "," $2,796.30 "," $2,796.30 "," $2,485.60 "," $2,485.60 ", $230.52 ," $2,868.69 "," $2,951.65 "," $2,796.30 "," $2,796.30 "," $2,796.30 "," $2,889.51 "," $2,982.72 "," $2,376.39 "," $2,640.95 "," $2,221.16 "," $2,356.63 ", N/A ," $2,037.43 "," $2,037.43 "," $2,951.65 "," $2,394.74 ", $230.52 ," $2,982.72 "
 Pro Remove Femur Lesion ,CPT® 27355,0975 - PRO FEE/OR,N/A,N/A," $1,766.00 "," $1,147.90 "," $3,714.04 ", $582.52 , $614.70 ," $2,906.38 "," $2,896.82 "," $1,642.38 "," $1,589.40 "," $1,589.40 "," $1,412.80 "," $1,412.80 ", $614.70 ," $1,630.55 "," $1,677.70 "," $1,589.40 "," $1,589.40 "," $1,589.40 "," $1,642.38 "," $1,695.36 "," $3,437.68 "," $1,501.10 "," $3,198.83 "," $3,432.46 ", N/A ," $2,963.10 "," $2,963.10 "," $1,677.70 "," $3,482.69 ", $582.52 ," $3,714.04 "
Open Bone Biop Vert Dorsal,CPT® 20250,N/A,N/A,N/A," $2,624.00 "," $1,705.60 "," $2,304.90 ", $362.39 , $284.25 ," $1,872.62 "," $1,855.73 "," $2,440.32 "," $2,361.60 "," $2,361.60 "," $2,099.20 "," $2,099.20 ", $284.25 ," $2,422.74 "," $2,492.80 "," $2,361.60 "," $2,361.60 "," $2,361.60 "," $2,440.32 "," $2,519.04 "," $2,168.98 "," $2,230.40 "," $2,062.38 "," $2,166.38 ", N/A ," $1,909.16 "," $1,909.16 "," $2,492.80 "," $2,243.92 ", $284.25 ," $2,519.04 "
 CYCLOSPORINE 25 MG PO CAPS ,HCPCS J7515,0636 - DRUGS REQUIRING DETAILED CODIN,68084-0879-25,1 capsule, $26.06 , $16.94 , $21.89 , $0.77 , $0.77 , $21.06 , $23.45 , $22.06 , $23.45 , $23.45 , $23.45 , $22.15 , $0.75 , $24.06 , $24.76 , $22.15 , $24.24 , $24.24 , $24.76 , $25.02 , $21.32 , $23.45 , $22.15 , $20.59 , N/A , $21.09 , $21.09 , $24.76 , $22.36 , $0.75 , $25.02 
 Fac Njx Px Lymphangrph ,CPT® 38790,0360 - OR SERVICES,N/A,N/A, $435.00 , $282.75 , $365.40 , $77.62 , $429.22 , $351.48 , $391.50 , $368.27 , $391.50 , $391.50 , $391.50 , $369.75 , $420.80 , $401.64 , $413.25 , $369.75 , $404.55 , $404.55 , $413.25 , $417.60 , $355.92 , $391.50 , $369.75 , $343.65 , N/A , $352.05 , $352.05 , $413.25 , $373.27 , $77.62 , $429.22 
 Pro Destruct Premalg Lesion ,CPT® 17000,0982 - PRO FEE/OUTPT,N/A,N/A, $337.00 , $219.05 , $130.35 , $53.25 , $48.35 , $144.21 , $151.73 , $313.41 , $303.30 , $303.30 , $269.60 , $269.60 , $48.35 , $311.15 , $320.15 , $303.30 , $303.30 , $303.30 , $313.41 , $323.52 , $191.09 , $286.45 , $299.72 , $185.66 , N/A , $147.02 , $147.02 , $320.15 , $170.50 , $48.35 , $323.52 
Prep Site T/a/L 1st 100 Sq Cm/1pct,CPT® 15002,N/A,N/A,N/A," $1,756.00 "," $1,141.40 ", $690.40 , $205.46 , $247.27 , $617.89 , $603.46 ," $1,633.08 "," $1,580.40 "," $1,580.40 "," $1,404.80 "," $1,404.80 ", $247.27 ," $1,621.31 "," $1,668.20 "," $1,580.40 "," $1,580.40 "," $1,580.40 "," $1,633.08 "," $1,685.76 ", $763.53 ," $1,492.60 "," $1,209.60 ", $785.12 , N/A , $629.94 , $629.94 ," $1,668.20 ", $730.51 , $205.46 ," $1,685.76 "
 Fac Stent Plmt Central Diaylsis Seg Pfrmd Dial Cir ,CPT® 36908,0360 - OR SERVICES,N/A,N/A," $15,057.00 "," $9,787.05 "," $12,647.88 ", $189.96 ," $2,119.05 "," $12,166.06 "," $13,551.30 "," $12,747.26 "," $13,551.30 "," $13,551.30 "," $13,551.30 "," $12,798.45 "," $2,077.50 "," $13,902.13 "," $14,304.15 "," $12,798.45 "," $14,003.01 "," $14,003.01 "," $14,304.15 "," $14,454.72 "," $12,319.64 "," $13,551.30 "," $12,798.45 "," $11,895.03 ", N/A ," $12,185.63 "," $12,185.63 "," $14,304.15 "," $12,920.41 ", $189.96 ," $14,454.72 "
 Fac Insj Non-Tun Ctr Cvc Age 5 Yr/> ,CPT® 36556,0761 - TREATMENT ROOM,N/A,N/A," $2,638.00 "," $1,714.70 "," $2,215.92 ", $79.62 , $322.67 ," $2,131.50 "," $2,374.20 "," $2,233.33 "," $2,374.20 "," $2,374.20 "," $2,374.20 "," $2,242.30 ", $316.34 ," $2,435.67 "," $2,506.10 "," $2,242.30 "," $2,453.34 "," $2,453.34 "," $2,506.10 "," $2,532.48 "," $2,158.41 "," $2,374.20 "," $2,242.30 "," $2,084.02 ", N/A ," $2,134.93 "," $2,134.93 "," $2,506.10 "," $2,263.67 ", $79.62 ," $2,532.48 "
 Lower Leg Ap Lateral - Mh ,CPT® 73590,0972 - PRO FEE/RAD/DX,N/A,N/A, $99.00 , $64.35 , $177.02 , $31.03 , $26.21 , $126.21 , $146.94 , $92.07 , $89.10 , $89.10 , $79.20 , $79.20 , $26.21 , $91.41 , $94.05 , $89.10 , $89.10 , $89.10 , $92.07 , $95.04 , $172.54 , $84.15 , $161.79 , $144.02 , N/A , $128.68 , $128.68 , $94.05 , $148.95 , $26.21 , $177.02 
 GALANTAMINE HYDROBROMIDE 8 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,70436-0005-06,1 tablet, $16.36 , $10.63 , $13.74 , N/A , N/A , $13.22 , $14.72 , $13.85 , $14.72 , $14.72 , $14.72 , $13.91 , N/A , $15.11 , $15.54 , $13.91 , $15.21 , $15.21 , $15.54 , $15.71 , $13.39 , $14.72 , $13.91 , $12.92 , N/A , $13.24 , $13.24 , $15.54 , $14.04 , $12.92 , $15.71 
" Pro Pet Image W/CT, Lmtd ",CPT® 78814,0972 - PRO FEE/RAD/DX,N/A,N/A, $739.00 , $480.35 ," $10,669.61 "," $1,544.06 ", N/A ," $4,407.82 "," $4,515.37 ", $687.27 , $665.10 , $665.10 , $591.20 , $591.20 , N/A , $682.32 , $702.05 , $665.10 , $665.10 , $665.10 , $687.27 , $709.44 ," $8,567.58 ", $628.15 ," $5,040.45 "," $5,780.46 ", N/A ," $4,493.83 "," $4,493.83 ", $702.05 ," $5,201.71 ", $591.20 ," $10,669.61 "
"Detect Agent, Mult Orgs, Dna, Dir",CPT® 87800,N/A,N/A,N/A, $346.00 , $224.90 , N/A , $44.54 , $28.55 , $226.96 , $271.48 , $321.78 , $311.40 , $311.40 , $276.80 , $276.80 , $28.55 , $319.46 , $328.70 , $311.40 , $311.40 , $311.40 , $321.78 , $332.16 , $291.59 , $294.10 , $262.74 , $145.47 , N/A , $211.81 , $211.81 , $328.70 , $231.46 , $28.55 , $332.16 
 Fac TB Intradermal Test ,CPT® 86580,0300 - LABORATORY,N/A,N/A, $59.00 , $38.35 , $49.56 , $9.63 , $9.39 , $47.67 , $53.10 , $49.95 , $53.10 , $53.10 , $53.10 , $50.15 , $9.21 , $54.47 , $56.05 , $50.15 , $54.87 , $54.87 , $56.05 , $56.64 , $48.27 , $53.10 , $50.15 , $46.61 , N/A , $47.75 , $47.75 , $56.05 , $50.63 , $9.21 , $56.64 
"Open Fix Inter/Subtroch Fx,Implnt",27245,N/A,N/A,N/A," $5,558.00 "," $3,612.70 "," $7,400.45 "," $1,157.06 "," $1,107.65 "," $5,945.99 "," $5,888.38 "," $5,168.94 "," $5,002.20 "," $5,002.20 "," $4,446.40 "," $4,446.40 "," $1,107.65 "," $5,131.70 "," $5,280.10 "," $5,002.20 "," $5,002.20 "," $5,002.20 "," $5,168.94 "," $5,335.68 "," $6,899.58 "," $4,724.30 "," $6,515.40 "," $6,990.58 ", N/A ," $6,062.00 "," $6,062.00 "," $5,280.10 "," $7,125.01 "," $1,107.65 "," $7,400.45 "
 Fac Mod Sedat Endo Service >5yrs ,HCPCS G0500,0372 - ANESTHESIA – ANESTHESIA INCIDENT TO OTHER DIAGNOSTIC SERVICES,N/A,N/A, $229.00 , $148.85 , $192.36 , $4.99 , N/A , $185.03 , $206.10 , $193.87 , $206.10 , $206.10 , $206.10 , $194.65 , N/A , $211.44 , $217.55 , $194.65 , $212.97 , $212.97 , $217.55 , $219.84 , $187.37 , $206.10 , $194.65 , $180.91 , N/A , $185.33 , $185.33 , $217.55 , $196.50 , $4.99 , $219.84 
Tumor Immunohistochem/Manual,CPT® 88360,N/A,N/A,N/A, $864.00 , $561.60 , $431.64 , $116.62 , $107.82 , $540.73 , $582.72 , $803.52 , $777.60 , $777.60 , $691.20 , $691.20 , $107.82 , $797.73 , $820.80 , $777.60 , $777.60 , $777.60 , $803.52 , $829.44 , $794.19 , $734.40 , $606.57 , $464.55 , N/A , $504.64 , $504.64 , $820.80 , $554.58 , $107.82 , $829.44 
Transplant Hand Tendon,CPT® 26480,N/A,N/A,N/A," $4,268.00 "," $2,774.20 "," $4,952.81 ", $769.68 , $614.70 ," $3,575.48 "," $3,644.52 "," $3,969.24 "," $3,841.20 "," $3,841.20 "," $3,414.40 "," $3,414.40 ", $614.70 ," $3,940.64 "," $4,054.60 "," $3,841.20 "," $3,841.20 "," $3,841.20 "," $3,969.24 "," $4,097.28 "," $4,574.29 "," $3,627.80 "," $3,987.38 "," $4,288.31 ", N/A ," $3,645.24 "," $3,645.24 "," $4,054.60 "," $4,284.45 ", $614.70 ," $4,952.81 "
 Pro Injection Aa&/Strd Greater Occipital Nerve ,CPT® 64405,0981 - PRO FEE/ER,N/A,N/A, $503.00 , $326.95 , $249.86 , $48.34 , $45.90 , $348.30 , $335.31 , $467.79 , $452.70 , $452.70 , $402.40 , $402.40 , $45.90 , $464.42 , $477.85 , $452.70 , $452.70 , $452.70 , $467.79 , $482.88 , $272.99 , $427.55 , $335.40 , $370.40 , N/A , $355.10 , $355.10 , $477.85 , $380.94 , $45.90 , $482.88 
 Fac Lyr Clsr N/H/F/Xtrnl Gent 2.6 Cm-7.5 Cm ,CPT® 12042,0761 - TREATMENT ROOM,N/A,N/A, $435.00 , $282.75 , $365.40 , $188.46 , $103.08 , $351.48 , $391.50 , $368.27 , $391.50 , $391.50 , $391.50 , $369.75 , $101.06 , $401.64 , $413.25 , $369.75 , $404.55 , $404.55 , $413.25 , $417.60 , $355.92 , $391.50 , $369.75 , $343.65 , N/A , $352.05 , $352.05 , $413.25 , $373.27 , $101.06 , $417.60 
 SINCALIDE 5 MCG IJ SOLR ,HCPCS J2805,0636 - DRUGS REQUIRING DETAILED CODIN,00270-0556-15,5 mL, $780.79 , $507.51 , $655.86 , $136.21 , $125.55 , $630.88 , $702.71 , $661.02 , $702.71 , $702.71 , $702.71 , $663.67 , $123.09 , $720.90 , $741.75 , $663.67 , $726.13 , $726.13 , $741.75 , $749.56 , $638.84 , $702.71 , $663.67 , $616.82 , N/A , $631.89 , $631.89 , $741.75 , $670.00 , $123.09 , $749.56 
" Pro US Exam, Scrotum ",CPT® 76870,0972 - PRO FEE/RAD/DX,N/A,N/A, $419.00 , $272.35 , $575.77 , $99.83 , $95.93 , $321.21 , $658.06 , $389.67 , $377.10 , $377.10 , $335.20 , $335.20 , $95.93 , $386.86 , $398.05 , $377.10 , $377.10 , $377.10 , $389.67 , $402.24 , $581.12 , $356.15 , $718.41 , $380.72 , N/A , $327.48 , $327.48 , $398.05 , $379.04 , $95.93 , $718.41 
Iadna Respiratry Probe & Rev Trnscr 6-11 Targets,CPT® 87632,N/A,N/A,N/A," $1,541.00 "," $1,001.65 ", N/A , $222.42 , $222.42 ," $1,207.54 "," $1,444.38 "," $1,433.13 "," $1,386.90 "," $1,386.90 "," $1,232.80 "," $1,232.80 ", $222.42 ," $1,422.81 "," $1,463.95 "," $1,386.90 "," $1,386.90 "," $1,386.90 "," $1,433.13 "," $1,479.36 "," $1,456.04 "," $1,309.85 "," $1,398.03 ", $773.87 , N/A ," $1,126.95 "," $1,126.95 "," $1,463.95 "," $1,231.51 ", $222.42 ," $1,479.36 "
 Fac Non-Pneum Walk Boot Pre Ots ,HCPCS L4387,0274 - PROSTHETIC DEV,N/A,N/A, $192.00 , $124.80 , $161.28 , $185.47 , $95.04 , $155.14 , $172.80 , $162.55 , $172.80 , $172.80 , $172.80 , $163.20 , $93.18 , $177.27 , $182.40 , $163.20 , $178.56 , $178.56 , $182.40 , $184.32 , $157.09 , $172.80 , $163.20 , $151.68 , N/A , $155.39 , $155.39 , $182.40 , $164.76 , $93.18 , $185.47 
 Fac Urine Pregnancy Tst Vis Color Cmprsn Meths ,CPT® 81025,0300 - LABORATORY,N/A,N/A, $97.00 , $63.05 , $81.48 , $8.78 , $8.78 , $78.38 , $87.30 , $82.12 , $87.30 , $87.30 , $87.30 , $82.45 , $8.61 , $89.56 , $92.15 , $82.45 , $90.21 , $90.21 , $92.15 , $93.12 , $79.37 , $87.30 , $82.45 , $76.63 , N/A , $78.50 , $78.50 , $92.15 , $83.24 , $8.61 , $93.12 
Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq,CPT® 45385,N/A,N/A,N/A," $3,621.00 "," $2,353.65 "," $1,559.74 ", $240.44 , $476.76 ," $1,453.13 "," $1,492.10 "," $3,367.53 "," $3,258.90 "," $3,258.90 "," $2,896.80 "," $2,896.80 ", $476.76 ," $3,343.27 "," $3,439.95 "," $3,258.90 "," $3,258.90 "," $3,258.90 "," $3,367.53 "," $3,476.16 "," $2,094.15 "," $3,077.85 "," $1,635.99 "," $1,482.99 ", N/A ," $1,481.48 "," $1,481.48 "," $3,439.95 "," $1,549.48 ", $240.44 ," $3,476.16 "
Mog-Igg1 Antibody Flow Cytometry Each,CPT® 86363,N/A,N/A,N/A, $887.00 , $576.55 , N/A , $38.48 , $12.29 , N/A , N/A , $824.91 , $798.30 , $798.30 , $709.60 , $709.60 , $12.29 , $818.97 , $842.65 , $798.30 , $798.30 , $798.30 , $824.91 , $851.52 , N/A , $753.95 , $179.31 , $35.39 , N/A , $47.24 , $47.24 , $842.65 , $51.94 , $12.29 , $851.52 
 Fac Assay of Total Thyroxine ,CPT® 84436,0301 - LAB/CHEMISTRY,N/A,N/A, $78.00 , $50.70 , $65.52 , $7.01 , $7.01 , $63.02 , $70.20 , $66.03 , $70.20 , $70.20 , $70.20 , $66.30 , $6.87 , $72.02 , $74.10 , $66.30 , $72.54 , $72.54 , $74.10 , $74.88 , $63.82 , $70.20 , $66.30 , $61.62 , N/A , $63.13 , $63.13 , $74.10 , $66.93 , $6.87 , $74.88 
Pfizer Admin Peds Second Dose,CPT® 0072A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $76.25 , $128.66 , N/A , $82.60 , $82.60 , $66.50 , $96.14 , $38.92 , $128.66 
 ISOFLURANE INH SOLN ,HCPCS RXA250,0250 - PHARMACY,66794-0017-10,20 each, $186.05 , $120.93 , $156.28 , N/A , N/A , $150.33 , $167.45 , $157.51 , $167.45 , $167.45 , $167.45 , $158.14 , N/A , $171.78 , $176.75 , $158.14 , $173.03 , $173.03 , $176.75 , $178.61 , $152.23 , $167.45 , $158.14 , $146.98 , N/A , $150.57 , $150.57 , $176.75 , $159.65 , $146.98 , $178.61 
Cast Sup Sht Arm Ped Fbrglas,HCPCS Q4012,N/A,N/A,N/A, $116.00 , $75.40 , N/A , $11.83 , $7.64 , N/A , N/A , $107.88 , $104.40 , $104.40 , $92.80 , $92.80 , $7.64 , $107.10 , $110.20 , $104.40 , $104.40 , $104.40 , $107.88 , $111.36 , N/A , $98.60 , $44.12 , $10.74 , N/A , N/A , N/A , $110.20 , N/A , $7.64 , $111.36 
 Pro Urtrl Rflx Std Rp Voiding Cstogram ,CPT® 78740,0974 - PRO FEE/NUC MED,N/A,N/A, $210.00 , $136.50 ," $1,166.73 ", $199.97 , $114.82 ," $1,074.05 "," $1,236.84 ", $195.30 , $189.00 , $189.00 , $168.00 , $168.00 , $114.82 , $193.89 , $199.50 , $189.00 , $189.00 , $189.00 , $195.30 , $201.60 ," $1,221.25 ", $178.50 ," $1,350.16 "," $1,467.31 ", N/A ," $1,095.01 "," $1,095.01 ", $199.50 ," $1,267.49 ", $114.82 ," $1,467.31 "
 Pro Breast Placement Loc Device W US Guideance ,CPT® 19285,0972 - PRO FEE/RAD/DX,N/A,N/A," $2,038.00 "," $1,324.70 ", $273.56 , $81.07 , $66.33 , $242.33 , $239.96 ," $1,895.34 "," $1,834.20 "," $1,834.20 "," $1,630.40 "," $1,630.40 ", $66.33 ," $1,881.69 "," $1,936.10 "," $1,834.20 "," $1,834.20 "," $1,834.20 "," $1,895.34 "," $1,956.48 ", $302.18 ," $1,732.30 ", $444.24 , $308.27 , N/A , $247.06 , $247.06 ," $1,936.10 ", $286.51 , $66.33 ," $1,956.48 "
 Pro Treat Humerus Fracture ,CPT® 24579,0982 - PRO FEE/OUTPT,N/A,N/A," $4,342.00 "," $2,822.30 "," $5,071.56 ", $796.59 , $614.70 ," $4,027.52 "," $4,012.85 "," $4,038.06 "," $3,907.80 "," $3,907.80 "," $3,473.60 "," $3,473.60 ", $614.70 ," $4,008.97 "," $4,124.90 "," $3,907.80 "," $3,907.80 "," $3,907.80 "," $4,038.06 "," $4,168.32 "," $4,715.18 "," $3,690.70 "," $4,429.83 "," $4,754.49 ", N/A ," $4,106.11 "," $4,106.11 "," $4,124.90 "," $4,826.14 ", $614.70 ," $5,071.56 "
Cast Sup Long Arm Adult Fbrg,HCPCS Q4006,N/A,N/A,N/A, $58.00 , $37.70 , N/A , $35.41 , $22.92 , N/A , N/A , $53.94 , $52.20 , $52.20 , $46.40 , $46.40 , $22.92 , $53.55 , $55.10 , $52.20 , $52.20 , $52.20 , $53.94 , $55.68 , N/A , $49.30 , $113.53 , $32.17 , N/A , N/A , N/A , $55.10 , N/A , $22.92 , $113.53 
CT Scans Face/Jaw Combo,CPT® 70488,N/A,N/A,N/A," $2,540.00 "," $1,651.00 "," $1,322.02 ", $189.03 , $354.06 , $978.41 ," $1,743.72 "," $2,362.20 "," $2,286.00 "," $2,286.00 "," $2,032.00 "," $2,032.00 ", $354.06 ," $2,345.18 "," $2,413.00 "," $2,286.00 "," $2,286.00 "," $2,286.00 "," $2,362.20 "," $2,438.40 "," $1,116.39 "," $2,159.00 "," $1,899.08 "," $1,325.95 ", N/A , $997.50 , $997.50 ," $2,413.00 "," $1,154.62 ", $189.03 ," $2,438.40 "
Vitamin K Phytonadione Inj,HCPCS J3430,N/A,N/A,N/A, $5.00 , $3.25 , N/A , $2.93 , $3.25 , N/A , N/A , $4.65 , $4.50 , $4.50 , $4.00 , $4.00 , $3.25 , $4.62 , $4.75 , $4.50 , $4.50 , $4.50 , $4.65 , $4.80 , $4.78 , $4.25 , $2.60 , $4.32 , N/A , N/A , N/A , $4.75 , N/A , $2.60 , $4.80 
 Fac Pathogen Test for Platelets ,HCPCS P9100,0302 - LAB/IMMUNOLOGY,N/A,N/A, $106.00 , $68.90 , $89.04 , N/A , $60.16 , $85.65 , $95.40 , $89.74 , $95.40 , $95.40 , $95.40 , $90.10 , $58.98 , $97.87 , $100.70 , $90.10 , $98.58 , $98.58 , $100.70 , $101.76 , $86.73 , $95.40 , $90.10 , $83.74 , N/A , $85.79 , $85.79 , $100.70 , $90.96 , $58.98 , $101.76 
Ft Arch Suprt Premold Longit,HCPCS L3040,N/A,N/A,N/A, $96.00 , $62.40 , N/A , $55.06 , $38.14 , N/A , N/A , $89.28 , $86.40 , $86.40 , $76.80 , $76.80 , $38.14 , $88.64 , $91.20 , $86.40 , $86.40 , $86.40 , $89.28 , $92.16 , N/A , $81.60 , $45.41 , $46.33 , N/A , N/A , N/A , $91.20 , N/A , $38.14 , $92.16 
Obstetric Panel,CPT® 80081,N/A,N/A,N/A, $886.00 , $575.90 , N/A , $76.36 , $76.36 , $423.93 , N/A , $823.98 , $797.40 , $797.40 , $708.80 , $708.80 , $76.36 , $818.04 , $841.70 , $797.40 , $797.40 , $797.40 , $823.98 , $850.56 , $499.86 , $753.10 , $357.00 , $271.44 , N/A , $395.64 , $395.64 , $841.70 , $432.35 , $76.36 , $850.56 
 Fac Chemotx Admn Ia Push Tq ,CPT® 96420,0331 - CHEMOTHER/INJ,N/A,N/A, $627.00 , $407.55 , $526.68 , $99.79 , $28.96 , $506.62 , $564.30 , $530.82 , $564.30 , $564.30 , $564.30 , $532.95 , $28.39 , $578.91 , $595.65 , $532.95 , $583.11 , $583.11 , $595.65 , $601.92 , $513.01 , $564.30 , $532.95 , $495.33 , N/A , $507.43 , $507.43 , $595.65 , $538.03 , $28.39 , $601.92 
 TIMOLOL MALEATE 0.25 % OP SOLN ,HCPCS RXC637,0250 - PHARMACY,61314-0226-05,5 mL, $77.06 , $50.09 , $64.73 , N/A , N/A , $62.26 , $69.35 , $65.24 , $69.35 , $69.35 , $69.35 , $65.50 , N/A , $71.15 , $73.21 , $65.50 , $71.67 , $71.67 , $73.21 , $73.98 , $63.05 , $69.35 , $65.50 , $60.88 , N/A , $62.36 , $62.36 , $73.21 , $66.13 , $60.88 , $73.98 
Spherocylindr 7.25d/2.25-4d,HCPCS V2112,N/A,N/A,N/A, $55.00 , $35.75 , N/A , $85.17 , N/A , N/A , N/A , $51.15 , $49.50 , $49.50 , $44.00 , $44.00 , N/A , $50.78 , $52.25 , $49.50 , $49.50 , $49.50 , $51.15 , $52.80 , N/A , $46.75 , $55.00 , $77.37 , N/A , N/A , N/A , $52.25 , N/A , $44.00 , $85.17 
Nasal/Sinus Ndsc W/Partial Ethmoidectomy,CPT® 31254,N/A,N/A,N/A," $2,439.00 "," $1,585.35 "," $1,310.48 ", $231.82 , $380.56 ," $1,044.32 "," $1,024.52 "," $2,268.27 "," $2,195.10 "," $2,195.10 "," $1,951.20 "," $1,951.20 ", $380.56 ," $2,251.93 "," $2,317.05 "," $2,195.10 "," $2,195.10 "," $2,195.10 "," $2,268.27 "," $2,341.44 "," $1,256.46 "," $2,073.15 "," $1,443.31 "," $1,241.93 ", N/A ," $1,064.70 "," $1,064.70 "," $2,317.05 "," $1,253.92 ", $231.82 ," $2,341.44 "
 DTAP-IPV VACCINE 0.5 ML IM SUSY ,HCPCS 90696,0636 - DRUGS REQUIRING DETAILED CODIN,58160-0812-52,0.5 mL, $363.00 , $235.95 , $304.92 , N/A , $15.30 , $293.30 , $326.70 , $307.32 , $326.70 , $326.70 , $326.70 , $308.55 , $15.00 , $335.16 , $344.85 , $308.55 , $337.59 , $337.59 , $344.85 , $348.48 , $297.01 , $326.70 , $308.55 , $286.77 , N/A , $293.78 , $293.78 , $344.85 , $311.49 , $15.00 , $348.48 
"Physician Standby Serv,Ea 30 Min",CPT® 99360,N/A,N/A,N/A, $323.00 , $209.95 , N/A , $57.34 , $101.89 , $106.51 , $106.16 , $300.39 , $290.70 , $290.70 , $258.40 , $258.40 , $101.89 , $298.23 , $306.85 , $290.70 , $290.70 , $290.70 , $300.39 , $310.08 , $153.84 , $274.55 , $132.77 , $135.34 , N/A , $108.59 , $108.59 , $306.85 , $125.25 , $57.34 , $310.08 
 Ventilation Assist & Mgmt Subs Day -Mh ,CPT® 94003,0410 - RESPIRATORY SVC,N/A,N/A," $1,400.00 ", $910.00 ," $1,176.00 ", $62.01 , $52.26 ," $1,131.20 "," $1,260.00 "," $1,185.24 "," $1,260.00 "," $1,260.00 "," $1,260.00 "," $1,190.00 ", $51.24 ," $1,292.62 "," $1,330.00 "," $1,190.00 "," $1,302.00 "," $1,302.00 "," $1,330.00 "," $1,344.00 "," $1,145.48 "," $1,260.00 "," $1,190.00 "," $1,106.00 ", N/A ," $1,133.02 "," $1,133.02 "," $1,330.00 "," $1,201.34 ", $51.24 ," $1,344.00 "
Sbsq Hospital IP/Obs Care Mod Mdm 35 Minutes,CPT® 99232,N/A,N/A,N/A, $239.00 , $155.35 , $142.19 , $76.95 , $35.12 , $125.33 , $124.56 , $222.27 , $215.10 , $215.10 , $191.20 , $191.20 , $35.12 , $220.67 , $227.05 , $215.10 , $215.10 , $215.10 , $222.27 , $229.44 , $181.02 , $203.15 , $154.52 , $159.28 , $104.50 , $127.78 , $127.78 , $227.05 , $147.38 , $35.12 , $229.44 
"Pure Tone Audiometry, Air",CPT® 92552,N/A,N/A,N/A, $110.00 , $71.50 , $76.92 , $34.59 , $16.90 , $67.51 , $72.14 , $102.30 , $99.00 , $99.00 , $88.00 , $88.00 , $16.90 , $101.56 , $104.50 , $99.00 , $99.00 , $99.00 , $102.30 , $105.60 , $93.86 , $93.50 , $96.30 , $119.10 , N/A , $68.83 , $68.83 , $104.50 , $80.23 , $16.90 , $119.10 
 Pro Insj Stablj Dev W/Dcmprn Lumbar Single Level ,CPT® 22867,0982 - PRO FEE/OUTPT,N/A,N/A," $9,765.00 "," $6,347.25 "," $6,293.95 ", $984.97 , N/A ," $4,498.27 "," $4,315.19 "," $9,081.45 "," $8,788.50 "," $8,788.50 "," $7,812.00 "," $7,812.00 ", N/A ," $9,016.02 "," $9,276.75 "," $8,788.50 "," $8,788.50 "," $8,788.50 "," $9,081.45 "," $9,374.40 "," $5,374.48 "," $8,300.25 "," $5,753.74 "," $5,269.88 ", N/A ," $4,586.04 "," $4,586.04 "," $9,276.75 "," $5,390.25 ", $984.97 ," $9,374.40 "
 Fac Ecmo/Ecls Initiation Veno-Arterial ,CPT® 33947,0360 - OR SERVICES,N/A,N/A, $943.00 , $612.95 , $792.12 , $309.60 , $408.32 , $761.94 , $848.70 , $798.34 , $848.70 , $848.70 , $848.70 , $801.55 , $400.31 , $870.67 , $895.85 , $801.55 , $876.99 , $876.99 , $895.85 , $905.28 , $771.56 , $848.70 , $801.55 , $744.97 , N/A , $763.17 , $763.17 , $895.85 , $809.19 , $309.60 , $905.28 
Xcapsl Ctrc Rmvl Insj Io Lens Prsth Cplx Insj 1+,CPT® 66989,N/A,N/A,N/A," $8,476.00 "," $5,509.40 "," $5,267.47 ", $825.16 , $590.85 , N/A , N/A ," $7,882.68 "," $7,628.40 "," $7,628.40 "," $6,780.80 "," $6,780.80 ", $590.85 ," $7,825.89 "," $8,052.20 "," $7,628.40 "," $7,628.40 "," $7,628.40 "," $7,882.68 "," $8,136.96 ", N/A ," $7,204.60 "," $4,460.13 "," $6,233.11 ", N/A ," $4,495.88 "," $4,495.88 "," $8,052.20 "," $4,964.19 ", $590.85 ," $8,136.96 "
 Fac Wearable Mobile Cv Telemetry W/Technical Support ,CPT® 93229,0731 - HOLTER MONT,N/A,N/A, $426.00 , $276.90 , $357.84 , $821.02 , N/A , $344.21 , $383.40 , $360.65 , $383.40 , $383.40 , $383.40 , $362.10 , N/A , $393.33 , $404.70 , $362.10 , $396.18 , $396.18 , $404.70 , $408.96 , $348.55 , $383.40 , $362.10 , $336.54 , N/A , $344.76 , $344.76 , $404.70 , $365.55 , $336.54 , $821.02 
"Drain Mouth Absc/Cyst/Hemat,Complx",CPT® 40801,N/A,N/A,N/A," $1,918.00 "," $1,246.70 "," $1,224.86 ", $192.24 , $137.47 ," $1,085.71 "," $1,105.11 "," $1,783.74 "," $1,726.20 "," $1,726.20 "," $1,534.40 "," $1,534.40 ", $137.47 ," $1,770.89 "," $1,822.10 "," $1,726.20 "," $1,726.20 "," $1,726.20 "," $1,783.74 "," $1,841.28 ", $892.63 ," $1,630.30 "," $1,206.03 "," $1,273.86 ", N/A ," $1,106.89 "," $1,106.89 "," $1,822.10 "," $1,157.70 ", $137.47 ," $1,841.28 "
 Fac Ethylene Glycol ,CPT® 82693,0301 - LAB/CHEMISTRY,N/A,N/A, $181.00 , $117.65 , $152.04 , $15.20 , $7.84 , $146.25 , $162.90 , $153.23 , $162.90 , $162.90 , $162.90 , $153.85 , $7.69 , $167.12 , $171.95 , $153.85 , $168.33 , $168.33 , $171.95 , $173.76 , $148.09 , $162.90 , $153.85 , $142.99 , N/A , $146.48 , $146.48 , $171.95 , $155.32 , $7.69 , $173.76 
" Fac Srs, Linear Based ",CPT® 77372,0333 - RADIATION RX,N/A,N/A," $13,011.00 "," $8,457.15 "," $10,929.24 ", $946.12 , $707.21 ," $10,512.89 "," $11,709.90 "," $11,015.11 "," $11,709.90 "," $11,709.90 "," $11,709.90 "," $11,059.35 ", $693.34 ," $12,013.06 "," $12,360.45 "," $11,059.35 "," $12,100.23 "," $12,100.23 "," $12,360.45 "," $12,490.56 "," $10,645.60 "," $11,709.90 "," $11,059.35 "," $10,278.69 ", N/A ," $10,529.80 "," $10,529.80 "," $12,360.45 "," $11,164.74 ", $693.34 ," $12,490.56 "
" Fac Cortisol, Free ",CPT® 82530,0301 - LAB/CHEMISTRY,N/A,N/A, $314.00 , $204.10 , $263.76 , $17.04 , $17.04 , $253.71 , $282.60 , $265.83 , $282.60 , $282.60 , $282.60 , $266.90 , $16.71 , $289.92 , $298.30 , $266.90 , $292.02 , $292.02 , $298.30 , $301.44 , $256.91 , $282.60 , $266.90 , $248.06 , N/A , $254.12 , $254.12 , $298.30 , $269.44 , $16.71 , $301.44 
Wedge Biopsy of Liver,CPT® 47100,N/A,N/A,N/A," $5,471.00 "," $3,556.15 "," $5,089.24 ", $788.33 , $370.79 ," $3,975.59 "," $4,037.66 "," $5,088.03 "," $4,923.90 "," $4,923.90 "," $4,376.80 "," $4,376.80 ", $370.79 ," $5,051.37 "," $5,197.45 "," $4,923.90 "," $4,923.90 "," $4,923.90 "," $5,088.03 "," $5,252.16 "," $3,648.75 "," $4,650.35 "," $4,479.78 "," $4,695.04 ", N/A ," $4,053.16 "," $4,053.16 "," $5,197.45 "," $4,239.18 ", $370.79 ," $5,252.16 "
 Fac Mnpj Ch Wall Facilitate Lng Funcj 1 Demo&/Eval ,CPT® 94667,0412 - INHALATION SVC,N/A,N/A, $154.00 , $100.10 , $129.36 , $22.54 , $18.00 , $124.43 , $138.60 , $130.38 , $138.60 , $138.60 , $138.60 , $130.90 , $17.65 , $142.19 , $146.30 , $130.90 , $143.22 , $143.22 , $146.30 , $147.84 , $126.00 , $138.60 , $130.90 , $121.66 , N/A , $124.63 , $124.63 , $146.30 , $132.15 , $17.65 , $147.84 
 TIZANIDINE HCL 4 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6418-61,1 tablet, $9.06 , $5.89 , $7.61 , N/A , N/A , $7.32 , $8.15 , $7.67 , $8.15 , $8.15 , $8.15 , $7.70 , N/A , $8.37 , $8.61 , $7.70 , $8.43 , $8.43 , $8.61 , $8.70 , $7.41 , $8.15 , $7.70 , $7.16 , N/A , $7.33 , $7.33 , $8.61 , $7.77 , $7.16 , $8.70 
 Pro Cltx Hip Dislc Traumtc W/O Anes ,CPT® 27250,0981 - PRO FEE/ER,N/A,N/A," $1,278.00 ", $830.70 ," $1,065.87 ", $165.79 , $208.13 , $875.35 , $864.39 ," $1,188.54 "," $1,150.20 "," $1,150.20 "," $1,022.40 "," $1,022.40 ", $208.13 ," $1,179.98 "," $1,214.10 "," $1,150.20 "," $1,150.20 "," $1,150.20 "," $1,188.54 "," $1,226.88 ", $994.46 ," $1,086.30 ", $958.04 ," $1,022.68 ", N/A , $892.42 , $892.42 ," $1,214.10 "," $1,048.91 ", $165.79 ," $1,226.88 "
 BUPIVACAINE-EPINEPHRINE (PF) 0.5% -1:200000 IJ SOLN ,HCPCS RXA250,0250 - PHARMACY,00409-9045-17,30 mL, $16.96 , $11.02 , $14.25 , N/A , N/A , $13.70 , $15.26 , $14.36 , $15.26 , $15.26 , $15.26 , $14.42 , N/A , $15.66 , $16.11 , $14.42 , $15.77 , $15.77 , $16.11 , $16.28 , $13.88 , $15.26 , $14.42 , $13.40 , N/A , $13.73 , $13.73 , $16.11 , $14.55 , $13.40 , $16.28 
 CT Dest of Facet J L S Add Level ,CPT® 64636,0360 - OR SERVICES,N/A,N/A," $1,680.00 "," $1,092.00 "," $1,411.20 ", $56.72 , $145.70 ," $1,357.44 "," $1,512.00 "," $1,422.29 "," $1,512.00 "," $1,512.00 "," $1,512.00 "," $1,428.00 ", $142.84 ," $1,551.14 "," $1,596.00 "," $1,428.00 "," $1,562.40 "," $1,562.40 "," $1,596.00 "," $1,612.80 "," $1,374.58 "," $1,512.00 "," $1,428.00 "," $1,327.20 ", N/A ," $1,359.62 "," $1,359.62 "," $1,596.00 "," $1,441.61 ", $56.72 ," $1,612.80 "
" Ear, Nose, Mouth And Throat Malignancy With Cc ",MS DRG V40 (FY2023) 147,N/A,N/A,N/A," $17,355.12 "," $11,280.83 "," $14,578.30 ", N/A , N/A ," $14,022.94 "," $15,619.61 "," $14,692.84 "," $15,619.61 "," $15,619.61 "," $15,619.61 "," $14,751.85 ", N/A ," $16,023.98 "," $16,487.36 "," $14,751.85 "," $16,140.26 "," $16,140.26 "," $16,487.36 "," $16,660.92 "," $14,199.96 "," $15,619.61 "," $14,751.85 "," $13,710.54 ", N/A ," $14,045.50 "," $14,045.50 "," $16,487.36 "," $14,892.43 "," $13,710.54 "," $16,660.92 "
"Anal/Urinary Muscle Study,Needle",CPT® 51785,N/A,N/A,N/A," $2,400.00 "," $1,560.00 "," $2,475.78 ", $421.81 , $343.39 ," $1,207.82 "," $1,199.87 "," $2,232.00 "," $2,160.00 "," $2,160.00 "," $1,920.00 "," $1,920.00 ", $343.39 ," $2,215.92 "," $2,280.00 "," $2,160.00 "," $2,160.00 "," $2,160.00 "," $2,232.00 "," $2,304.00 "," $2,376.92 "," $2,040.00 "," $1,361.24 "," $1,647.53 ", N/A ," $1,231.38 "," $1,231.38 "," $2,280.00 "," $1,447.31 ", $343.39 ," $2,475.78 "
Mthfr Gene Analysis Common Variants,CPT® 81291,N/A,N/A,N/A, $674.00 , $438.10 , N/A , $66.65 , N/A , $246.95 , $292.45 , $626.82 , $606.60 , $606.60 , $539.20 , $539.20 , N/A , $622.30 , $640.30 , $606.60 , $606.60 , $606.60 , $626.82 , $647.04 , $436.29 , $572.90 , $311.77 , $191.90 , N/A , $230.47 , $230.47 , $640.30 , $251.86 , $66.65 , $647.04 
 QUETIAPINE FUMARATE 300 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60687-0371-01,1 tablet, $82.30 , $53.50 , $69.13 , N/A , N/A , $66.50 , $74.07 , $69.68 , $74.07 , $74.07 , $74.07 , $69.96 , N/A , $75.99 , $78.19 , $69.96 , $76.54 , $76.54 , $78.19 , $79.01 , $67.34 , $74.07 , $69.96 , $65.02 , N/A , $66.61 , $66.61 , $78.19 , $70.62 , $65.02 , $79.01 
 Tx Opn Tdn Flxr Toe 1 Tdn Spx Pain ,CPT® 28232,0360 - OR SERVICES,N/A,N/A, $392.00 , $254.80 , $329.28 , $234.58 , $92.19 , $316.74 , $352.80 , $331.87 , $352.80 , $352.80 , $352.80 , $333.20 , $90.38 , $361.93 , $372.40 , $333.20 , $364.56 , $364.56 , $372.40 , $376.32 , $320.73 , $352.80 , $333.20 , $309.68 , N/A , $317.25 , $317.25 , $372.40 , $336.38 , $90.38 , $376.32 
 Fac Assay of Urine Osmolality ,CPT® 83935,0301 - LAB/CHEMISTRY,N/A,N/A, $108.00 , $70.20 , $90.72 , $6.96 , $6.96 , $87.26 , $97.20 , $91.43 , $97.20 , $97.20 , $97.20 , $91.80 , $6.82 , $99.72 , $102.60 , $91.80 , $100.44 , $100.44 , $102.60 , $103.68 , $88.37 , $97.20 , $91.80 , $85.32 , N/A , $87.40 , $87.40 , $102.60 , $92.67 , $6.82 , $103.68 
 Koh Prep Skin Hair or Nails ,CPT® 87220,0306 - LAB/BACT-MICRO,N/A,N/A, $68.00 , $44.20 , $57.12 , $4.36 , $4.36 , $54.94 , $61.20 , $57.57 , $61.20 , $61.20 , $61.20 , $57.80 , $4.27 , $62.78 , $64.60 , $57.80 , $63.24 , $63.24 , $64.60 , $65.28 , $55.64 , $61.20 , $57.80 , $53.72 , N/A , $55.03 , $55.03 , $64.60 , $58.35 , $4.27 , $65.28 
 Fac Prq Plmt Biliary Drg Cath W/Img Gid Rs&I Int-Ext ,CPT® 47534,0361 - OR/MINOR,N/A,N/A," $12,905.00 "," $8,388.25 "," $10,840.20 ", $349.97 ," $1,304.35 "," $10,427.24 "," $11,614.50 "," $10,925.37 "," $11,614.50 "," $11,614.50 "," $11,614.50 "," $10,969.25 "," $1,278.77 "," $11,915.19 "," $12,259.75 "," $10,969.25 "," $12,001.65 "," $12,001.65 "," $12,259.75 "," $12,388.80 "," $10,558.87 "," $11,614.50 "," $10,969.25 "," $10,194.95 ", N/A ," $10,444.02 "," $10,444.02 "," $12,259.75 "," $11,073.78 ", $349.97 ," $12,388.80 "
Full Excis 5th Metatarsal Head,CPT® 28113,N/A,N/A,N/A," $3,966.00 "," $2,577.90 "," $2,635.49 ", $414.95 , $92.19 ," $2,103.59 "," $2,100.19 "," $3,688.38 "," $3,569.40 "," $3,569.40 "," $3,172.80 "," $3,172.80 ", $92.19 ," $3,661.81 "," $3,767.70 "," $3,569.40 "," $3,569.40 "," $3,569.40 "," $3,688.38 "," $3,807.36 "," $2,445.75 "," $3,371.10 "," $2,276.47 "," $2,487.41 ", N/A ," $2,144.64 "," $2,144.64 "," $3,767.70 "," $2,520.72 ", $92.19 ," $3,807.36 "
 OCTREOTIDE ACETATE 20 MG IM KIT ,HCPCS J2353,0636 - DRUGS REQUIRING DETAILED CODIN,00078-0818-81,1 each," $13,046.29 "," $8,480.09 "," $10,958.88 ", $212.28 , $209.76 ," $10,541.40 "," $11,741.66 "," $11,044.99 "," $11,741.66 "," $11,741.66 "," $11,741.66 "," $11,089.35 ", $205.65 ," $12,045.64 "," $12,393.98 "," $11,089.35 "," $12,133.05 "," $12,133.05 "," $12,393.98 "," $12,524.44 "," $10,674.47 "," $11,741.66 "," $11,089.35 "," $10,306.57 ", N/A ," $10,558.36 "," $10,558.36 "," $12,393.98 "," $11,195.02 ", $205.65 ," $12,524.44 "
 DICLOFENAC SODIUM 25 MG PO TBEC ,HCPCS RXC637,0250 - PHARMACY,16571-0203-10,1 tablet, $7.31 , $4.75 , $6.14 , N/A , N/A , $5.91 , $6.58 , $6.19 , $6.58 , $6.58 , $6.58 , $6.21 , N/A , $6.75 , $6.94 , $6.21 , $6.80 , $6.80 , $6.94 , $7.02 , $5.98 , $6.58 , $6.21 , $5.77 , N/A , $5.92 , $5.92 , $6.94 , $6.27 , $5.77 , $7.02 
 Toxin a&B ,CPT® 87324,0306 - LAB/BACT-MICRO,N/A,N/A, $116.00 , $75.40 , $97.44 , $12.22 , $12.22 , $93.73 , $104.40 , $98.21 , $104.40 , $104.40 , $104.40 , $98.60 , $11.98 , $107.10 , $110.20 , $98.60 , $107.88 , $107.88 , $110.20 , $111.36 , $94.91 , $104.40 , $98.60 , $91.64 , N/A , $93.88 , $93.88 , $110.20 , $99.54 , $11.98 , $111.36 
 Fac Carnitine Quan Ea Spec ,CPT® 82379,0301 - LAB/CHEMISTRY,N/A,N/A, $211.00 , $137.15 , $177.24 , $17.21 , $17.21 , $170.49 , $189.90 , $178.63 , $189.90 , $189.90 , $189.90 , $179.35 , $16.87 , $194.82 , $200.45 , $179.35 , $196.23 , $196.23 , $200.45 , $202.56 , $172.64 , $189.90 , $179.35 , $166.69 , N/A , $170.76 , $170.76 , $200.45 , $181.06 , $16.87 , $202.56 
Inject Proc Penile Plaque,CPT® 54200,N/A,N/A,N/A, $584.00 , $379.60 , $382.44 , $83.23 , $30.71 , $268.24 , $275.35 , $543.12 , $525.60 , $525.60 , $467.20 , $467.20 , $30.71 , $539.21 , $554.80 , $525.60 , $525.60 , $525.60 , $543.12 , $560.64 , $355.97 , $496.40 , $437.10 , $407.90 , N/A , $273.48 , $273.48 , $554.80 , $327.77 , $30.71 , $560.64 
Incision Flex Foot Tendon(S),CPT® 28230,N/A,N/A,N/A," $1,072.00 ", $696.80 ," $1,762.41 ", $277.41 , $184.42 ," $1,404.59 "," $1,381.13 ", $996.96 , $964.80 , $964.80 , $857.60 , $857.60 , $184.42 , $989.78 ," $1,018.40 ", $964.80 , $964.80 , $964.80 , $996.96 ," $1,029.12 "," $1,636.77 ", $911.20 ," $1,493.26 "," $1,664.75 ", N/A ," $1,432.00 "," $1,432.00 "," $1,018.40 "," $1,683.10 ", $184.42 ," $1,762.41 "
 Pro Anoscopy ,CPT® 46615,0982 - PRO FEE/OUTPT,N/A,N/A, $621.00 , $403.65 , $560.50 , $86.09 , $211.99 , $441.56 , $448.25 , $577.53 , $558.90 , $558.90 , $496.80 , $496.80 , $211.99 , $573.37 , $589.95 , $558.90 , $558.90 , $558.90 , $577.53 , $596.16 , $400.77 , $527.85 , $495.97 , $522.69 , N/A , $450.17 , $450.17 , $589.95 , $470.84 , $86.09 , $596.16 
Repair Tear Ducts,CPT® 68700,N/A,N/A,N/A," $5,381.00 "," $3,497.65 "," $3,705.20 ", $581.29 , $951.31 ," $3,417.52 "," $3,234.15 "," $5,004.33 "," $4,842.90 "," $4,842.90 "," $4,304.80 "," $4,304.80 ", $951.31 ," $4,968.28 "," $5,111.95 "," $4,842.90 "," $4,842.90 "," $4,842.90 "," $5,004.33 "," $5,165.76 "," $5,089.58 "," $4,573.85 "," $3,357.61 "," $4,343.62 ", N/A ," $3,484.21 "," $3,484.21 "," $5,111.95 "," $3,846.12 ", $581.29 ," $5,165.76 "
 PERPHENAZINE 2 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6599-61,1 tablet, $9.24 , $6.01 , $7.76 , N/A , N/A , $7.47 , $8.32 , $7.82 , $8.32 , $8.32 , $8.32 , $7.85 , N/A , $8.53 , $8.78 , $7.85 , $8.59 , $8.59 , $8.78 , $8.87 , $7.56 , $8.32 , $7.85 , $7.30 , N/A , $7.48 , $7.48 , $8.78 , $7.93 , $7.30 , $8.87 
 Fac Antithrombin III Test ,CPT® 85301,0305 - LAB/HEMATOLOGY,N/A,N/A, $222.00 , $144.30 , $186.48 , $11.03 , $11.03 , $179.38 , $199.80 , $187.95 , $199.80 , $199.80 , $199.80 , $188.70 , $10.81 , $204.97 , $210.90 , $188.70 , $206.46 , $206.46 , $210.90 , $213.12 , $181.64 , $199.80 , $188.70 , $175.38 , N/A , $179.66 , $179.66 , $210.90 , $190.50 , $10.81 , $213.12 
"Strapping,Unna Boot",29580,N/A,N/A,N/A, $168.00 , $109.20 , $162.96 , $25.02 , $20.61 , $173.40 , $173.65 , $156.24 , $151.20 , $151.20 , $134.40 , $134.40 , $20.61 , $155.11 , $159.60 , $151.20 , $151.20 , $151.20 , $156.24 , $161.28 , $151.07 , $142.80 , $189.11 , $166.30 , N/A , $176.79 , $176.79 , $159.60 , $207.80 , $20.61 , $207.80 
 OB US Detailed Single Fetus ,CPT® 76811,0402 - ULTRASOUND,N/A,N/A, $948.00 , $616.20 , $796.32 , $174.57 , $190.41 , $765.98 , $853.20 , $802.58 , $853.20 , $853.20 , $853.20 , $805.80 , $186.68 , $875.29 , $900.60 , $805.80 , $881.64 , $881.64 , $900.60 , $910.08 , $775.65 , $853.20 , $805.80 , $748.92 , N/A , $767.22 , $767.22 , $900.60 , $813.48 , $174.57 , $910.08 
Mog-Igg1 Antibody Cell-Based Imfluor Assay Each,CPT® 86362,N/A,N/A,N/A, $78.00 , $50.70 , N/A , $12.29 , $12.29 , N/A , N/A , $72.54 , $70.20 , $70.20 , $62.40 , $62.40 , $12.29 , $72.02 , $74.10 , $70.20 , $70.20 , $70.20 , $72.54 , $74.88 , N/A , $66.30 , $58.15 , $35.39 , N/A , $47.24 , $47.24 , $74.10 , $51.94 , $12.29 , $74.88 
 Fac Opening of Esophagus ,CPT® 43450,0360 - OR SERVICES,N/A,N/A," $1,278.00 ", $830.70 ," $1,073.52 ", $75.97 , $229.55 ," $1,032.62 "," $1,150.20 "," $1,081.95 "," $1,150.20 "," $1,150.20 "," $1,150.20 "," $1,086.30 ", $225.05 ," $1,179.98 "," $1,214.10 "," $1,086.30 "," $1,188.54 "," $1,188.54 "," $1,214.10 "," $1,226.88 "," $1,045.66 "," $1,150.20 "," $1,086.30 "," $1,009.62 ", N/A ," $1,034.29 "," $1,034.29 "," $1,214.10 "," $1,096.65 ", $75.97 ," $1,226.88 "
Insj Stablj Dev W/Dcmprn Lumbar Single Level,22867,N/A,N/A,N/A," $9,765.00 "," $6,347.25 "," $6,293.95 ", $984.97 , N/A ," $4,498.27 "," $4,315.19 "," $9,081.45 "," $8,788.50 "," $8,788.50 "," $7,812.00 "," $7,812.00 ", N/A ," $9,016.02 "," $9,276.75 "," $8,788.50 "," $8,788.50 "," $8,788.50 "," $9,081.45 "," $9,374.40 "," $5,374.48 "," $8,300.25 "," $5,753.74 "," $5,269.88 ", N/A ," $4,586.04 "," $4,586.04 "," $9,276.75 "," $5,390.25 ", $984.97 ," $9,374.40 "
 Pro Placemnt Ndl Intraoss ,CPT® 36680,0981 - PRO FEE/ER,N/A,N/A, $557.00 , $362.05 , $352.37 , $55.03 , $56.64 , $254.33 , $251.09 , $518.01 , $501.30 , $501.30 , $445.60 , $445.60 , $56.64 , $514.28 , $529.15 , $501.30 , $501.30 , $501.30 , $518.01 , $534.72 , $324.91 , $473.45 , $314.00 , $287.54 , N/A , $259.29 , $259.29 , $529.15 , $294.56 , $55.03 , $534.72 
 VITAMIN E 180 MG (400 UNIT) PO CAPS ,HCPCS RXC637,0250 - PHARMACY,77333-0951-10,1 capsule, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Pro Incise Thigh Tendon & Fascia ,CPT® 27305,0982 - PRO FEE/OUTPT,N/A,N/A," $3,369.00 "," $2,189.85 "," $2,955.16 ", $465.14 , $461.04 ," $2,323.35 "," $2,329.29 "," $3,133.17 "," $3,032.10 "," $3,032.10 "," $2,695.20 "," $2,695.20 ", $461.04 ," $3,110.60 "," $3,200.55 "," $3,032.10 "," $3,032.10 "," $3,032.10 "," $3,133.17 "," $3,234.24 "," $2,737.46 "," $2,863.65 "," $2,569.05 "," $2,729.02 ", N/A ," $2,368.68 "," $2,368.68 "," $3,200.55 "," $2,784.04 ", $461.04 ," $3,234.24 "
" Fac Mra W/O Fol W/Cont, Abd ",HCPCS C8902,0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA-OTHER,N/A,N/A," $4,069.00 "," $2,644.85 "," $3,417.96 ", N/A , N/A ," $3,287.75 "," $3,662.10 "," $3,444.82 "," $3,662.10 "," $3,662.10 "," $3,662.10 "," $3,458.65 ", N/A ," $3,756.91 "," $3,865.55 "," $3,458.65 "," $3,784.17 "," $3,784.17 "," $3,865.55 "," $3,906.24 "," $3,329.26 "," $3,662.10 "," $3,458.65 "," $3,214.51 ", N/A ," $3,293.04 "," $3,293.04 "," $3,865.55 "," $3,491.61 "," $3,214.51 "," $3,906.24 "
Thoracoscopy W/Dx Wedge Resexn Anato Lung Resexn,CPT® 32668,N/A,N/A,N/A, $884.00 , $574.60 , $804.89 , $139.75 , $120.31 , $593.28 , $607.28 , $822.12 , $795.60 , $795.60 , $707.20 , $707.20 , $120.31 , $816.20 , $839.80 , $795.60 , $795.60 , $795.60 , $822.12 , $848.64 , $780.54 , $751.40 , $883.11 , $774.25 , N/A , $604.86 , $604.86 , $839.80 , $712.35 , $120.31 , $883.11 
Repair Non/Malunion Metatarsal,CPT® 28322,N/A,N/A,N/A," $5,215.00 "," $3,389.75 "," $3,534.51 ", $555.99 , $384.19 ," $2,819.67 "," $2,804.16 "," $4,849.95 "," $4,693.50 "," $4,693.50 "," $4,172.00 "," $4,172.00 ", $384.19 ," $4,815.01 "," $4,954.25 "," $4,693.50 "," $4,693.50 "," $4,693.50 "," $4,849.95 "," $5,006.40 "," $3,287.51 "," $4,432.75 "," $3,073.94 "," $3,330.09 ", N/A ," $2,874.68 "," $2,874.68 "," $4,954.25 "," $3,378.78 ", $384.19 ," $5,006.40 "
Incisional Biopsy Skin Single Lesion,CPT® 11106,N/A,N/A,N/A, $600.00 , $390.00 , $182.51 , $53.95 , $118.70 , $154.51 , N/A , $558.00 , $540.00 , $540.00 , $480.00 , $480.00 , $118.70 , $553.98 , $570.00 , $540.00 , $540.00 , $540.00 , $558.00 , $576.00 , $203.73 , $510.00 , $296.75 , $211.83 , N/A , $157.53 , $157.53 , $570.00 , $182.68 , $53.95 , $576.00 
 PRAVASTATIN SODIUM 20 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-5892-61,1 tablet, $12.82 , $8.33 , $10.77 , N/A , N/A , $10.36 , $11.54 , $10.85 , $11.54 , $11.54 , $11.54 , $10.90 , N/A , $11.84 , $12.18 , $10.90 , $11.92 , $11.92 , $12.18 , $12.31 , $10.49 , $11.54 , $10.90 , $10.13 , N/A , $10.38 , $10.38 , $12.18 , $11.00 , $10.13 , $12.31 
Eeg Extended Monitoring 61-119 Minutes,CPT® 95813,N/A,N/A,N/A," $1,908.00 "," $1,240.20 "," $1,577.11 ", $421.36 , $344.42 ," $1,593.72 "," $1,770.44 "," $1,774.44 "," $1,717.20 "," $1,717.20 "," $1,526.40 "," $1,526.40 ", $344.42 ," $1,761.66 "," $1,812.60 "," $1,717.20 "," $1,717.20 "," $1,717.20 "," $1,774.44 "," $1,831.68 "," $1,831.36 "," $1,621.80 "," $1,552.00 "," $1,533.43 ", N/A ," $1,624.81 "," $1,624.81 "," $1,812.60 "," $1,997.54 ", $344.42 ," $1,997.54 "
 Pro Psychotherapy W/Patient W/E&M Srvcs 45 Min ,CPT® 90836,0961 - PRO FEE/PSYCH,N/A,N/A, $308.00 , $200.20 , $104.83 , $77.70 , $101.25 , $186.07 , $154.16 , $286.44 , $277.20 , $277.20 , $246.40 , $246.40 , $101.25 , $284.38 , $292.60 , $277.20 , $277.20 , $277.20 , $286.44 , $295.68 , $200.04 , $261.80 , $200.72 , $315.10 , $102.25 , $189.70 , $189.70 , $292.60 , $221.16 , $77.70 , $315.10 
 Fac Iadna Streptococcus Grp Amp Prb ,CPT® 87651,0306 - LAB/BACT-MICRO,N/A,N/A, $140.00 , $91.00 , $117.60 , $35.79 , $35.79 , $113.12 , $126.00 , $118.52 , $126.00 , $126.00 , $126.00 , $119.00 , $35.09 , $129.26 , $133.00 , $119.00 , $130.20 , $130.20 , $133.00 , $134.40 , $114.55 , $126.00 , $119.00 , $110.60 , N/A , $113.30 , $113.30 , $133.00 , $120.13 , $35.09 , $134.40 
Assay for Topiramate,CPT® 80201,N/A,N/A,N/A, $140.00 , $91.00 , N/A , $12.16 , $12.16 , $67.47 , $80.69 , $130.20 , $126.00 , $126.00 , $112.00 , $112.00 , $12.16 , $129.26 , $133.00 , $126.00 , $126.00 , $126.00 , $130.20 , $134.40 , $79.59 , $119.00 , $77.85 , $43.23 , N/A , $62.97 , $62.97 , $133.00 , $68.82 , $12.16 , $134.40 
"Amniocentesis,Diagnostic",CPT® 59000,N/A,N/A,N/A, $647.00 , $420.55 , $213.81 , $72.71 , $55.92 , $187.20 , $197.36 , $601.71 , $582.30 , $582.30 , $517.60 , $517.60 , $55.92 , $597.38 , $614.65 , $582.30 , $582.30 , $582.30 , $601.71 , $621.12 , $217.02 , $549.95 , $435.31 , $348.01 , N/A , $190.86 , $190.86 , $614.65 , $220.65 , $55.92 , $621.12 
"Fix Patella Tendn,Secondary",CPT® 27381,N/A,N/A,N/A," $5,102.00 "," $3,316.30 "," $5,031.26 ", $785.47 , $937.47 ," $3,839.82 "," $3,835.72 "," $4,744.86 "," $4,591.80 "," $4,591.80 "," $4,081.60 "," $4,081.60 ", $937.47 ," $4,710.68 "," $4,846.90 "," $4,591.80 "," $4,591.80 "," $4,591.80 "," $4,744.86 "," $4,897.92 "," $4,651.72 "," $4,336.70 "," $4,235.37 "," $4,536.83 ", N/A ," $3,914.74 "," $3,914.74 "," $4,846.90 "," $4,601.21 ", $785.47 ," $5,031.26 "
" Fac Chromosome Count, Additional ",CPT® 88285,0310 - PATHOLOGY LAB,N/A,N/A, $87.00 , $56.55 , $73.08 , $27.45 , $26.38 , $70.30 , $78.30 , $73.65 , $78.30 , $78.30 , $78.30 , $73.95 , $25.86 , $80.33 , $82.65 , $73.95 , $80.91 , $80.91 , $82.65 , $83.52 , $71.18 , $78.30 , $73.95 , $68.73 , N/A , $70.41 , $70.41 , $82.65 , $74.65 , $25.86 , $83.52 
 Fac Trauma 4 Eval W/ Pre-ED Notification W/Critical Care ,HCPCS G0390,0684 - TRAUMA LEVEL IV,N/A,N/A, $613.00 , $398.45 , $514.92 , N/A , N/A , $495.30 , $551.70 , $518.97 , $551.70 , $551.70 , $551.70 , $521.05 , N/A , $565.98 , $582.35 , $521.05 , $570.09 , $570.09 , $582.35 , $588.48 , $501.56 , $551.70 , $521.05 , $484.27 , N/A , $496.10 , $496.10 , $582.35 , $526.02 , $484.27 , $588.48 
 Fac Physical Therapy Evaluation Low Complex ,CPT® 97161,0424 - PHYS THERP/EVAL,N/A,N/A, $255.00 , $165.75 , $214.20 , $100.30 , $67.74 , $206.04 , $229.50 , $215.88 , $229.50 , $229.50 , $229.50 , $216.75 , $66.41 , $235.44 , $242.25 , $216.75 , $237.15 , $237.15 , $242.25 , $244.80 , $208.64 , $229.50 , $216.75 , $201.45 , N/A , $206.37 , $206.37 , $242.25 , $218.82 , $66.41 , $244.80 
"Laryngoscopy,Dirct,OP Scop,Exc Tumr",CPT® 31541,N/A,N/A,N/A," $1,513.00 ", $983.45 ," $1,413.24 ", $250.31 , $931.98 ," $1,017.30 ", $998.87 ," $1,407.09 "," $1,361.70 "," $1,361.70 "," $1,210.40 "," $1,210.40 ", $931.98 ," $1,396.95 "," $1,437.35 "," $1,361.70 "," $1,361.70 "," $1,361.70 "," $1,407.09 "," $1,452.48 "," $1,352.46 "," $1,286.05 "," $1,407.63 "," $1,336.23 ", N/A ," $1,037.15 "," $1,037.15 "," $1,437.35 "," $1,221.47 ", $250.31 ," $1,452.48 "
 Fac Ekg Tracing for Initial Prev ,HCPCS G0404,0730 - EKG/ECG,N/A,N/A, $55.00 , $35.75 , $46.20 , $6.02 , N/A , $44.44 , $49.50 , $46.56 , $49.50 , $49.50 , $49.50 , $46.75 , N/A , $50.78 , $52.25 , $46.75 , $51.15 , $51.15 , $52.25 , $52.80 , $45.00 , $49.50 , $46.75 , $43.45 , N/A , $44.51 , $44.51 , $52.25 , $47.20 , $6.02 , $52.80 
 Fac Iaadiadoo Not Otherwise Specified ,CPT® 87899,0306 - LAB/BACT-MICRO,N/A,N/A, $111.00 , $72.15 , $93.24 , $16.39 , $16.39 , $89.69 , $99.90 , $93.97 , $99.90 , $99.90 , $99.90 , $94.35 , $16.07 , $102.49 , $105.45 , $94.35 , $103.23 , $103.23 , $105.45 , $106.56 , $90.82 , $99.90 , $94.35 , $87.69 , N/A , $89.83 , $89.83 , $105.45 , $95.25 , $16.07 , $106.56 
" Aspir Abcess, Hemoto, Bulla Cyst ",CPT® 10160,0761 - TREATMENT ROOM,N/A,N/A, $785.00 , $510.25 , $659.40 , $92.99 , $30.77 , $634.28 , $706.50 , $664.58 , $706.50 , $706.50 , $706.50 , $667.25 , $30.17 , $724.79 , $745.75 , $667.25 , $730.05 , $730.05 , $745.75 , $753.60 , $642.29 , $706.50 , $667.25 , $620.15 , N/A , $635.30 , $635.30 , $745.75 , $673.61 , $30.17 , $753.60 
Repair/Graft Flex Foot Tendon,28202,N/A,N/A,N/A," $4,169.00 "," $2,709.85 "," $2,656.94 ", $418.34 , $614.70 ," $2,090.85 "," $2,076.38 "," $3,877.17 "," $3,752.10 "," $3,752.10 "," $3,335.20 "," $3,335.20 ", $614.70 ," $3,849.24 "," $3,960.55 "," $3,752.10 "," $3,752.10 "," $3,752.10 "," $3,877.17 "," $4,002.24 "," $2,479.61 "," $3,543.65 "," $2,244.35 "," $2,512.32 ", N/A ," $2,131.65 "," $2,131.65 "," $3,960.55 "," $2,505.44 ", $418.34 ," $4,002.24 "
 Fac Tumor Immunohistochem/Comput ,CPT® 88361,0310 - PATHOLOGY LAB,N/A,N/A, $916.00 , $595.40 , $769.44 , $116.79 , $135.03 , $740.13 , $824.40 , $775.49 , $824.40 , $824.40 , $824.40 , $778.60 , $132.38 , $845.74 , $870.20 , $778.60 , $851.88 , $851.88 , $870.20 , $879.36 , $749.47 , $824.40 , $778.60 , $723.64 , N/A , $741.32 , $741.32 , $870.20 , $786.02 , $116.79 , $879.36 
 Pt Active Wound Mgmt Ea Addl 20 Sqm ,CPT® 97598,0761 - TREATMENT ROOM,N/A,N/A, $209.00 , $135.85 , $175.56 , $23.51 , $55.15 , $168.87 , $188.10 , $176.94 , $188.10 , $188.10 , $188.10 , $177.65 , $54.07 , $192.97 , $198.55 , $177.65 , $194.37 , $194.37 , $198.55 , $200.64 , $171.00 , $188.10 , $177.65 , $165.11 , N/A , $169.14 , $169.14 , $198.55 , $179.34 , $23.51 , $200.64 
 Pro Cltx Post Hip Arthrp Dislc W/O Anes ,CPT® 27265,0981 - PRO FEE/ER,N/A,N/A," $2,643.00 "," $1,717.95 "," $2,514.92 ", $401.80 , $336.07 ," $1,923.46 "," $1,959.11 "," $2,457.99 "," $2,378.70 "," $2,378.70 "," $2,114.40 "," $2,114.40 ", $336.07 ," $2,440.28 "," $2,510.85 "," $2,378.70 "," $2,378.70 "," $2,378.70 "," $2,457.99 "," $2,537.28 "," $2,304.80 "," $2,246.55 "," $2,151.58 "," $2,290.13 ", N/A ," $1,960.98 "," $1,960.98 "," $2,510.85 "," $2,304.84 ", $336.07 ," $2,537.28 "
Injection Aa&/Strd Trigeminal Nerve Each Branch,CPT® 64400,N/A,N/A,N/A, $804.00 , $522.60 , $237.17 , $46.38 , $95.27 , $389.08 , $370.43 , $747.72 , $723.60 , $723.60 , $643.20 , $643.20 , $95.27 , $742.33 , $763.80 , $723.60 , $723.60 , $723.60 , $747.72 , $771.84 , $254.96 , $683.40 , $367.52 , $417.54 , N/A , $396.67 , $396.67 , $763.80 , $425.54 , $46.38 , $771.84 
 MORPHINE SULFATE ER 30 MG PO TBCR ,HCPCS RXC637,0250 - PHARMACY,00904-6558-61,1 tablet, $7.72 , $5.02 , $6.48 , N/A , N/A , $6.24 , $6.95 , $6.54 , $6.95 , $6.95 , $6.95 , $6.56 , N/A , $7.13 , $7.33 , $6.56 , $7.18 , $7.18 , $7.33 , $7.41 , $6.32 , $6.95 , $6.56 , $6.10 , N/A , $6.25 , $6.25 , $7.33 , $6.62 , $6.10 , $7.41 
Myocrd Strain Img Speckle Trck Assmt Myocrd Mech,CPT® 93356,N/A,N/A,N/A," $1,397.00 ", $908.05 , $74.36 , $11.14 , $31.51 , $63.62 , N/A ," $1,299.21 "," $1,257.30 "," $1,257.30 "," $1,117.60 "," $1,117.60 ", $31.51 ," $1,289.85 "," $1,327.15 "," $1,257.30 "," $1,257.30 "," $1,257.30 "," $1,299.21 "," $1,341.12 ", $73.57 ," $1,187.45 ", $60.42 , $71.18 , N/A , $64.85 , $64.85 ," $1,327.15 ", $71.92 , $11.14 ," $1,341.12 "
 Pro Temporary Transcutaneous Pacing ,CPT® 92953,0981 - PRO FEE/ER,N/A,N/A, $4.00 , $2.60 , $5.01 , $0.79 , $17.40 , $61.26 , $59.80 , $3.72 , $3.60 , $3.60 , $3.20 , $3.20 , $17.40 , $3.69 , $3.80 , $3.60 , $3.60 , $3.60 , $3.72 , $3.84 , $4.97 , $3.40 , $55.31 , $5.07 , N/A , $62.45 , $62.45 , $3.80 , $69.24 , $0.79 , $69.24 
 DTAP-HEPATITIS B RECOMB-IPV IM SUSY ,HCPCS 90723,0636 - DRUGS REQUIRING DETAILED CODIN,58160-0811-52,0.5 mL, $567.17 , $368.66 , $476.42 , N/A , $15.30 , $458.27 , $510.45 , $480.17 , $510.45 , $510.45 , $510.45 , $482.09 , $15.00 , $523.67 , $538.81 , $482.09 , $527.47 , $527.47 , $538.81 , $544.48 , $464.06 , $510.45 , $482.09 , $448.06 , N/A , $459.01 , $459.01 , $538.81 , $486.69 , $15.00 , $544.48 
Contact Laser Surgery of Prostate,CPT® 52648,N/A,N/A,N/A," $13,624.00 "," $8,855.60 "," $3,750.27 ", $660.31 , $970.33 ," $3,376.37 "," $3,147.82 "," $12,670.32 "," $12,261.60 "," $12,261.60 "," $10,899.20 "," $10,899.20 ", $970.33 ," $12,579.04 "," $12,942.80 "," $12,261.60 "," $12,261.60 "," $12,261.60 "," $12,670.32 "," $13,079.04 "," $3,757.85 "," $11,580.40 "," $3,564.56 "," $4,247.48 ", N/A ," $3,442.24 "," $3,442.24 "," $12,942.80 "," $4,045.86 ", $660.31 ," $13,079.04 "
 Fac Colonoscopy Flx Dx W/Collj Spec When Pfrmd ,CPT® 45378,0360 - OR SERVICES,N/A,N/A," $2,513.00 "," $1,633.45 "," $2,110.92 ", $174.38 , $351.69 ," $2,030.50 "," $2,261.70 "," $2,127.51 "," $2,261.70 "," $2,261.70 "," $2,261.70 "," $2,136.05 ", $344.79 ," $2,320.25 "," $2,387.35 "," $2,136.05 "," $2,337.09 "," $2,337.09 "," $2,387.35 "," $2,412.48 "," $2,056.14 "," $2,261.70 "," $2,136.05 "," $1,985.27 ", N/A ," $2,033.77 "," $2,033.77 "," $2,387.35 "," $2,156.41 ", $174.38 ," $2,412.48 "
Hepatitis B Surface Ab Test,CPT® 86706,N/A,N/A,N/A, $111.00 , $72.15 , N/A , $10.95 , $10.95 , $60.79 , $72.67 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $10.95 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $71.71 , $94.35 , $69.74 , $38.94 , N/A , $56.73 , $56.73 , $105.45 , $61.99 , $10.95 , $106.56 
 MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR ,HCPCS 90734,0636 - DRUGS REQUIRING DETAILED CODIN,58160-0955-09,0.5 mL, $914.55 , $594.46 , $768.22 , N/A , $136.15 , $738.96 , $823.10 , $774.26 , $823.10 , $823.10 , $823.10 , $777.37 , $133.48 , $844.40 , $868.82 , $777.37 , $850.53 , $850.53 , $868.82 , $877.97 , $748.28 , $823.10 , $777.37 , $722.49 , N/A , $740.15 , $740.15 , $868.82 , $784.78 , $133.48 , $877.97 
"Close Urethrostomy/Fistula,Male",CPT® 53520,N/A,N/A,N/A," $3,880.00 "," $2,522.00 "," $3,033.30 ", $534.66 , $461.04 ," $2,722.23 "," $2,540.43 "," $3,608.40 "," $3,492.00 "," $3,492.00 "," $3,104.00 "," $3,104.00 ", $461.04 ," $3,582.40 "," $3,686.00 "," $3,492.00 "," $3,492.00 "," $3,492.00 "," $3,608.40 "," $3,724.80 "," $3,039.07 "," $3,298.00 "," $2,874.13 "," $3,426.34 ", N/A ," $2,775.34 "," $2,775.34 "," $3,686.00 "," $3,262.04 ", $461.04 ," $3,724.80 "
Prq Trluml Coronary Angio/Atherect One Art/Brnch,CPT® 92924,N/A,N/A,N/A," $3,958.00 "," $2,572.70 "," $3,684.46 ", $566.56 , $638.01 ," $3,458.36 "," $3,483.67 "," $3,680.94 "," $3,562.20 "," $3,562.20 "," $3,166.40 "," $3,166.40 ", $638.01 ," $3,654.42 "," $3,760.10 "," $3,562.20 "," $3,562.20 "," $3,562.20 "," $3,680.94 "," $3,799.68 "," $3,413.73 "," $3,364.30 "," $1,927.07 "," $3,632.83 ", N/A ," $3,525.84 "," $3,525.84 "," $3,760.10 "," $3,908.41 ", $566.56 ," $3,908.41 "
 Fac Colsc Flx W/US Guid Ndl Aspir/Bx W/US Rctm Et Al ,CPT® 45392,0360 - OR SERVICES,N/A,N/A," $3,952.00 "," $2,568.80 "," $3,319.68 ", $288.12 , $321.98 ," $3,193.22 "," $3,556.80 "," $3,345.76 "," $3,556.80 "," $3,556.80 "," $3,556.80 "," $3,359.20 ", $315.67 ," $3,648.88 "," $3,754.40 "," $3,359.20 "," $3,675.36 "," $3,675.36 "," $3,754.40 "," $3,793.92 "," $3,233.53 "," $3,556.80 "," $3,359.20 "," $3,122.08 ", N/A ," $3,198.35 "," $3,198.35 "," $3,754.40 "," $3,391.21 ", $288.12 ," $3,793.92 "
 Collect Blood From Picc -Mh ,CPT® 36592,0761 - TREATMENT ROOM,N/A,N/A, $181.00 , $117.65 , $152.04 , $28.35 , $19.66 , $146.25 , $162.90 , $153.23 , $162.90 , $162.90 , $162.90 , $153.85 , $19.27 , $167.12 , $171.95 , $153.85 , $168.33 , $168.33 , $171.95 , $173.76 , $148.09 , $162.90 , $153.85 , $142.99 , N/A , $146.48 , $146.48 , $171.95 , $155.32 , $19.27 , $173.76 
Removal of Impacted Wax MD,HCPCS G0268,N/A,N/A,N/A, $202.00 , $131.30 , $74.78 , $31.69 , N/A , $61.79 , N/A , $187.86 , $181.80 , $181.80 , $161.60 , $161.60 , N/A , $186.51 , $191.90 , $181.80 , $181.80 , $181.80 , $187.86 , $193.92 , $98.27 , $171.70 , $60.98 , $123.93 , N/A , $63.00 , $63.00 , $191.90 , $78.75 , $31.69 , $193.92 
 PT Gait Training ,CPT® 97116,0420 - PHYSICAL THERAPY,N/A,N/A, $146.00 , $94.90 , $122.64 , $29.46 , $31.19 , $117.97 , $131.40 , $123.60 , $131.40 , $131.40 , $131.40 , $124.10 , $30.58 , $134.80 , $138.70 , $124.10 , $135.78 , $135.78 , $138.70 , $140.16 , $119.46 , $131.40 , $124.10 , $115.34 , N/A , $118.16 , $118.16 , $138.70 , $125.28 , $29.46 , $140.16 
" Pro Electrocardiogram,Report ",CPT® 93010,0981 - PRO FEE/ER,N/A,N/A, $103.00 , $66.95 , $51.61 , $7.96 , $9.02 , $46.31 , $46.05 , $95.79 , $92.70 , $92.70 , $82.40 , $82.40 , $9.02 , $95.10 , $97.85 , $92.70 , $92.70 , $92.70 , $95.79 , $98.88 , $86.42 , $87.55 , $42.82 , $32.14 , N/A , $47.22 , $47.22 , $97.85 , $52.33 , $7.96 , $98.88 
 Ot Self Care/Home Mgt 15 Min -Mh ,CPT® 97535,0430 - OCCUPATION THER,N/A,N/A, $145.00 , $94.25 , $121.80 , $32.74 , $21.45 , $117.16 , $130.50 , $122.76 , $130.50 , $130.50 , $130.50 , $123.25 , $21.03 , $133.88 , $137.75 , $123.25 , $134.85 , $134.85 , $137.75 , $139.20 , $118.64 , $130.50 , $123.25 , $114.55 , N/A , $117.35 , $117.35 , $137.75 , $124.42 , $21.03 , $139.20 
 PHENYTOIN 125 MG/5ML PO SUSP ,HCPCS RXC637,0250 - PHARMACY,00904-7079-57,5 mL, $37.74 , $24.53 , $31.70 , N/A , N/A , $30.49 , $33.97 , $31.95 , $33.97 , $33.97 , $33.97 , $32.08 , N/A , $34.85 , $35.85 , $32.08 , $35.10 , $35.10 , $35.85 , $36.23 , $30.88 , $33.97 , $32.08 , $29.81 , N/A , $30.54 , $30.54 , $35.85 , $32.38 , $29.81 , $36.23 
"Bypass Graft Othr,Aorto-Subcl",CPT® 35626,N/A,N/A,N/A," $9,527.00 "," $6,192.55 "," $9,303.84 "," $1,427.89 "," $1,718.25 "," $6,804.83 "," $6,755.52 "," $8,860.11 "," $8,574.30 "," $8,574.30 "," $7,621.60 "," $7,621.60 "," $1,718.25 "," $8,796.28 "," $9,050.65 "," $8,574.30 "," $8,574.30 "," $8,574.30 "," $8,860.11 "," $9,145.92 "," $8,599.66 "," $8,097.95 "," $8,556.37 "," $7,602.75 ", N/A ," $6,937.61 "," $6,937.61 "," $9,050.65 "," $7,881.14 "," $1,427.89 "," $9,303.84 "
Rigid Eo WO Joints,HCPCS L3762,N/A,N/A,N/A, $160.00 , $104.00 , N/A , $114.45 , $44.73 , N/A , N/A , $148.80 , $144.00 , $144.00 , $128.00 , $128.00 , $44.73 , $147.73 , $152.00 , $144.00 , $144.00 , $144.00 , $148.80 , $153.60 , N/A , $136.00 , $94.72 , $96.30 , N/A , N/A , N/A , $152.00 , N/A , $44.73 , $153.60 
"Insert Infusn Pump,Programmable",CPT® 62362,N/A,N/A,N/A," $2,570.00 "," $1,670.50 "," $1,842.78 ", $360.80 , $356.53 ," $2,131.41 "," $2,082.86 "," $2,390.10 "," $2,313.00 "," $2,313.00 "," $2,056.00 "," $2,056.00 ", $356.53 ," $2,372.88 "," $2,441.50 "," $2,313.00 "," $2,313.00 "," $2,313.00 "," $2,390.10 "," $2,467.20 "," $1,998.91 "," $2,184.50 "," $2,073.08 "," $2,242.51 ", N/A ," $2,173.00 "," $2,173.00 "," $2,441.50 "," $2,331.12 ", $356.53 ," $2,467.20 "
 Fac Hfe Hemochromatosis Gene Anal Common Variants ,CPT® 81256,0310 - PATHOLOGY LAB,N/A,N/A, $603.00 , $391.95 , $506.52 , $66.67 , $66.67 , $487.22 , $542.70 , $510.50 , $542.70 , $542.70 , $542.70 , $512.55 , $65.36 , $556.75 , $572.85 , $512.55 , $560.79 , $560.79 , $572.85 , $578.88 , $493.37 , $542.70 , $512.55 , $476.37 , N/A , $488.01 , $488.01 , $572.85 , $517.43 , $65.36 , $578.88 
" Pro Scope Bladder, Removal of Lesions, Small ",CPT® 52224,0975 - PRO FEE/OR,N/A,N/A," $2,813.00 "," $1,828.45 "," $1,090.26 ", $190.95 , $155.03 ," $1,000.80 ", $923.92 ," $2,616.09 "," $2,531.70 "," $2,531.70 "," $2,250.40 "," $2,250.40 ", $155.03 ," $2,597.24 "," $2,672.35 "," $2,531.70 "," $2,531.70 "," $2,531.70 "," $2,616.09 "," $2,700.48 "," $1,099.24 "," $2,391.05 "," $1,047.25 "," $1,253.67 ", N/A ," $1,020.32 "," $1,020.32 "," $2,672.35 "," $1,199.24 ", $155.03 ," $2,700.48 "
 VERAPAMIL HCL ER 120 MG PO TBCR ,HCPCS RXC637,0250 - PHARMACY,68462-0292-01,1 tablet, $5.52 , $3.59 , $4.64 , N/A , N/A , $4.46 , $4.97 , $4.67 , $4.97 , $4.97 , $4.97 , $4.69 , N/A , $5.10 , $5.24 , $4.69 , $5.13 , $5.13 , $5.24 , $5.30 , $4.52 , $4.97 , $4.69 , $4.36 , N/A , $4.47 , $4.47 , $5.24 , $4.74 , $4.36 , $5.30 
Revise Acetabular Part of Total Hip,CPT® 27137,N/A,N/A,N/A," $4,094.00 "," $2,661.10 "," $8,805.29 "," $1,374.83 "," $1,251.82 "," $7,118.56 "," $7,035.55 "," $3,807.42 "," $3,684.60 "," $3,684.60 "," $3,275.20 "," $3,275.20 "," $1,251.82 "," $3,779.99 "," $3,889.30 "," $3,684.60 "," $3,684.60 "," $3,684.60 "," $3,807.42 "," $3,930.24 "," $8,223.42 "," $3,479.90 "," $7,792.79 "," $8,363.90 ", N/A ," $7,257.45 "," $7,257.45 "," $3,889.30 "," $8,530.08 "," $1,251.82 "," $8,805.29 "
Thyroidectomy,CPT® 60240,N/A,N/A,N/A," $7,767.00 "," $5,048.55 "," $5,538.65 ", $862.18 , $858.01 ," $4,735.76 "," $4,904.25 "," $7,223.31 "," $6,990.30 "," $6,990.30 "," $6,213.60 "," $6,213.60 ", $858.01 ," $7,171.27 "," $7,378.65 "," $6,990.30 "," $6,990.30 "," $6,990.30 "," $7,223.31 "," $7,456.32 "," $5,350.71 "," $6,601.95 "," $4,874.06 "," $4,553.58 ", N/A ," $4,828.16 "," $4,828.16 "," $7,378.65 "," $5,384.84 ", $858.01 ," $7,456.32 "
 CAFFEINE CITRATE 60 MG/3ML IV SOLN ,HCPCS J0706,0636 - DRUGS REQUIRING DETAILED CODIN,51754-0500-01,3 mL, $147.95 , $96.17 , $124.28 , N/A , $0.56 , $119.54 , $133.16 , $125.25 , $133.16 , $133.16 , $133.16 , $125.76 , $0.55 , $136.60 , $140.55 , $125.76 , $137.59 , $137.59 , $140.55 , $142.03 , $121.05 , $133.16 , $125.76 , $116.88 , N/A , $119.74 , $119.74 , $140.55 , $126.96 , $0.55 , $142.03 
"US,Abdom,B-Scan &/or Real Time,Complete",CPT® 76700,N/A,N/A,N/A," $1,230.00 ", $799.50 , $670.36 , $115.56 , $122.89 , $617.33 , $743.41 ," $1,143.90 "," $1,107.00 "," $1,107.00 ", $984.00 , $984.00 , $122.89 ," $1,135.66 "," $1,168.50 "," $1,107.00 "," $1,107.00 "," $1,107.00 "," $1,143.90 "," $1,180.80 ", $675.38 ," $1,045.50 ", $810.86 , $690.50 , N/A , $629.38 , $629.38 ," $1,168.50 ", $728.53 , $115.56 ," $1,180.80 "
 OXYCODONE HCL ER 80 MG PO T12A ,HCPCS RXC637,0250 - PHARMACY,59011-0480-20,1 tablet, $172.38 , $112.05 , $144.80 , N/A , N/A , $139.28 , $155.14 , $145.94 , $155.14 , $155.14 , $155.14 , $146.52 , N/A , $159.16 , $163.76 , $146.52 , $160.31 , $160.31 , $163.76 , $165.48 , $141.04 , $155.14 , $146.52 , $136.18 , N/A , $139.51 , $139.51 , $163.76 , $147.92 , $136.18 , $165.48 
 Fac Eeg W/Rec Awake&Drowsy ,CPT® 95816,0740 - EEG,N/A,N/A, $818.00 , $531.70 , $687.12 , $375.76 , $161.81 , $660.94 , $736.20 , $692.52 , $736.20 , $736.20 , $736.20 , $695.30 , $158.64 , $755.26 , $777.10 , $695.30 , $760.74 , $760.74 , $777.10 , $785.28 , $669.29 , $736.20 , $695.30 , $646.22 , N/A , $662.01 , $662.01 , $777.10 , $701.93 , $158.64 , $785.28 
 CARVEDILOL 12.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6302-61,1 tablet, $10.80 , $7.02 , $9.07 , N/A , N/A , $8.73 , $9.72 , $9.14 , $9.72 , $9.72 , $9.72 , $9.18 , N/A , $9.97 , $10.26 , $9.18 , $10.04 , $10.04 , $10.26 , $10.37 , $8.84 , $9.72 , $9.18 , $8.53 , N/A , $8.74 , $8.74 , $10.26 , $9.27 , $8.53 , $10.37 
 Pro Treat Shoulder Dislocation ,CPT® 23655,0982 - PRO FEE/OUTPT,N/A,N/A," $2,591.00 "," $1,684.15 "," $2,524.02 ", $396.16 , $212.46 ," $1,931.47 "," $1,939.57 "," $2,409.63 "," $2,331.90 "," $2,331.90 "," $2,072.80 "," $2,072.80 ", $212.46 ," $2,392.27 "," $2,461.45 "," $2,331.90 "," $2,331.90 "," $2,331.90 "," $2,409.63 "," $2,487.36 "," $2,328.36 "," $2,202.35 "," $2,131.96 "," $2,289.60 ", N/A ," $1,969.16 "," $1,969.16 "," $2,461.45 "," $2,314.46 ", $212.46 ," $2,524.02 "
"CT Scan,Head/Brain,W/O Contrast Matl",CPT® 70450,N/A,N/A,N/A," $2,224.00 "," $1,445.60 ", $750.33 , $108.41 , $193.07 , $553.34 , $869.88 ," $2,068.32 "," $2,001.60 "," $2,001.60 "," $1,779.20 "," $1,779.20 ", $193.07 ," $2,053.42 "," $2,112.80 "," $2,001.60 "," $2,001.60 "," $2,001.60 "," $2,068.32 "," $2,135.04 ", $630.63 ," $1,890.40 ", $947.61 , $751.64 , N/A , $564.14 , $564.14 ," $2,112.80 ", $653.01 , $108.41 ," $2,135.04 "
 Eeg Without Video 2-12 Hours; Continuous ,CPT® 95707,0740 - EEG,N/A,N/A," $1,731.00 "," $1,125.15 "," $1,454.04 ", $367.07 , $206.53 ," $1,398.65 "," $1,557.90 "," $1,465.46 "," $1,557.90 "," $1,557.90 "," $1,557.90 "," $1,471.35 ", $202.48 ," $1,598.23 "," $1,644.45 "," $1,471.35 "," $1,609.83 "," $1,609.83 "," $1,644.45 "," $1,661.76 "," $1,416.30 "," $1,557.90 "," $1,471.35 "," $1,367.49 ", N/A ," $1,400.90 "," $1,400.90 "," $1,644.45 "," $1,485.37 ", $202.48 ," $1,661.76 "
 THIAMINE HCL 100 MG/ML IJ SOLN ,HCPCS J3411,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0013-02,1 mL, $30.67 , $19.94 , $25.76 , $2.55 , $2.86 , $24.78 , $27.60 , $25.97 , $27.60 , $27.60 , $27.60 , $26.07 , $2.80 , $28.32 , $29.14 , $26.07 , $28.52 , $28.52 , $29.14 , $29.44 , $25.09 , $27.60 , $26.07 , $24.23 , N/A , $24.82 , $24.82 , $29.14 , $26.32 , $2.55 , $29.44 
Manipulatn Knee Jt+Anesthesia,27570,N/A,N/A,N/A, $479.00 , $311.35 , $931.58 , $147.22 , $151.20 , $726.41 , $730.37 , $445.47 , $431.10 , $431.10 , $383.20 , $383.20 , $151.20 , $442.26 , $455.05 , $431.10 , $431.10 , $431.10 , $445.47 , $459.84 , $859.06 , $407.15 , $802.83 , $858.23 , N/A , $740.58 , $740.58 , $455.05 , $870.45 , $147.22 , $931.58 
 Fac CT Guide for Tissue Ablation ,CPT® 77013,0350 - CT SCAN,N/A,N/A," $4,718.00 "," $3,066.70 "," $3,963.12 ", $624.98 , N/A ," $3,812.14 "," $4,246.20 "," $3,994.26 "," $4,246.20 "," $4,246.20 "," $4,246.20 "," $4,010.30 ", N/A ," $4,356.13 "," $4,482.10 "," $4,010.30 "," $4,387.74 "," $4,387.74 "," $4,482.10 "," $4,529.28 "," $3,860.27 "," $4,246.20 "," $4,010.30 "," $3,727.22 ", N/A ," $3,818.28 "," $3,818.28 "," $4,482.10 "," $4,048.52 ", $624.98 ," $4,529.28 "
" Trauma To The Skin, Subcutaneous Tissue And Breast With McC ",MS DRG V40 (FY2023) 604,N/A,N/A,N/A," $12,774.19 "," $8,303.22 "," $10,730.32 ", N/A , N/A ," $10,321.55 "," $11,496.77 "," $10,814.63 "," $11,496.77 "," $11,496.77 "," $11,496.77 "," $10,858.06 ", N/A ," $11,794.41 "," $12,135.48 "," $10,858.06 "," $11,880.00 "," $11,880.00 "," $12,135.48 "," $12,263.22 "," $10,451.84 "," $11,496.77 "," $10,858.06 "," $10,091.61 ", N/A ," $10,338.15 "," $10,338.15 "," $12,135.48 "," $10,961.53 "," $10,091.61 "," $12,263.22 "
Treat Metatarsal Fracture,28470,N/A,N/A,N/A, $971.00 , $631.15 ," $1,281.15 ", $202.14 , $155.34 , $994.98 ," $1,021.36 ", $903.03 , $873.90 , $873.90 , $776.80 , $776.80 , $155.34 , $896.52 , $922.45 , $873.90 , $873.90 , $873.90 , $903.03 , $932.16 ," $1,181.08 ", $825.35 ," $1,115.04 "," $1,181.65 ", N/A ," $1,014.40 "," $1,014.40 ", $922.45 ," $1,192.29 ", $155.34 ," $1,281.15 "
 ANASTROZOLE 1 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60687-0112-21,1 tablet, $10.65 , $6.92 , $8.95 , N/A , N/A , $8.61 , $9.59 , $9.02 , $9.59 , $9.59 , $9.59 , $9.05 , N/A , $9.83 , $10.12 , $9.05 , $9.90 , $9.90 , $10.12 , $10.22 , $8.71 , $9.59 , $9.05 , $8.41 , N/A , $8.62 , $8.62 , $10.12 , $9.14 , $8.41 , $10.22 
Assay Mercury,CPT® 83825,N/A,N/A,N/A, $165.00 , $107.25 , N/A , $16.59 , $16.59 , $91.97 , $110.04 , $153.45 , $148.50 , $148.50 , $132.00 , $132.00 , $16.59 , $152.34 , $156.75 , $148.50 , $148.50 , $148.50 , $153.45 , $158.40 , $108.57 , $140.25 , $107.04 , $58.95 , N/A , $85.83 , $85.83 , $156.75 , $93.79 , $16.59 , $158.40 
 Fac Drug Screening Benzodiazepines 1-12 ,CPT® 80346,0301 - LAB/CHEMISTRY,N/A,N/A, $156.00 , $101.40 , $131.04 , N/A , N/A , $126.05 , $140.40 , $132.07 , $140.40 , $140.40 , $140.40 , $132.60 , N/A , $144.03 , $148.20 , $132.60 , $145.08 , $145.08 , $148.20 , $149.76 , $127.64 , $140.40 , $132.60 , $123.24 , N/A , $126.25 , $126.25 , $148.20 , $133.86 , $123.24 , $149.76 
Open Rx Bilat Tib Plat Fx,27536,N/A,N/A,N/A," $5,606.00 "," $3,643.90 "," $7,163.98 "," $1,120.90 ", $845.22 ," $5,744.83 "," $5,698.26 "," $5,213.58 "," $5,045.40 "," $5,045.40 "," $4,484.80 "," $4,484.80 ", $845.22 ," $5,176.02 "," $5,325.70 "," $5,045.40 "," $5,045.40 "," $5,045.40 "," $5,213.58 "," $5,381.76 "," $6,666.68 "," $4,765.10 "," $6,303.10 "," $6,755.82 ", N/A ," $5,856.93 "," $5,856.93 "," $5,325.70 "," $6,883.96 ", $845.22 ," $7,163.98 "
"Lap, Surg Enterolysis",44180,N/A,N/A,N/A," $6,009.00 "," $3,905.85 "," $5,476.71 ", $847.84 , $725.16 ," $4,320.07 "," $4,362.88 "," $5,588.37 "," $5,408.10 "," $5,408.10 "," $4,807.20 "," $4,807.20 ", $725.16 ," $5,548.11 "," $5,708.55 "," $5,408.10 "," $5,408.10 "," $5,408.10 "," $5,588.37 "," $5,768.64 "," $3,924.21 "," $5,107.65 "," $4,850.87 "," $5,104.87 ", N/A ," $4,404.36 "," $4,404.36 "," $5,708.55 "," $4,606.48 ", $725.16 ," $5,768.64 "
 METRONIDAZOLE IN NACL 500 MG/100 ML IV PREMIX (INPT) ,HCPCS J1836,0636 - DRUGS REQUIRING DETAILED CODIN,00338-1055-48,100 mL, $16.68 , $10.84 , $14.01 , N/A , N/A , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , N/A , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $13.18 , $16.01 
"Octreotide Inj, Non-Depot",HCPCS J2354,N/A,N/A,N/A, $17.00 , $11.05 , N/A , $1.34 , $1.45 , N/A , N/A , $15.81 , $15.30 , $15.30 , $13.60 , $13.60 , $1.45 , $15.70 , $16.15 , $15.30 , $15.30 , $15.30 , $15.81 , $16.32 , $1.35 , $14.45 , $2.60 , $1.57 , N/A , N/A , N/A , $16.15 , N/A , $1.34 , $16.32 
" Pro X-Ray Exam of Knee, 1 or 2 ",CPT® 73560,0972 - PRO FEE/RAD/DX,N/A,N/A, $99.00 , $64.35 , $192.15 , $33.66 , $27.82 , $138.06 , $164.70 , $92.07 , $89.10 , $89.10 , $79.20 , $79.20 , $27.82 , $91.41 , $94.05 , $89.10 , $89.10 , $89.10 , $92.07 , $95.04 , $187.61 , $84.15 , $182.97 , $156.60 , N/A , $140.75 , $140.75 , $94.05 , $162.93 , $27.82 , $192.15 
 HYDROCORTISONE 1 % CREAM (INPT) ,HCPCS RXC637,0250 - PHARMACY,00536-1277-80,28 gram, $8.92 , $5.80 , $7.49 , N/A , N/A , $7.21 , $8.03 , $7.55 , $8.03 , $8.03 , $8.03 , $7.58 , N/A , $8.24 , $8.47 , $7.58 , $8.30 , $8.30 , $8.47 , $8.56 , $7.30 , $8.03 , $7.58 , $7.05 , N/A , $7.22 , $7.22 , $8.47 , $7.65 , $7.05 , $8.56 
 LORATADINE 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6852-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Urinalysis, Auto, W/Scope",CPT® 81001,N/A,N/A,N/A, $60.00 , $39.00 , N/A , $3.23 , $3.23 , $17.92 , $21.42 , $55.80 , $54.00 , $54.00 , $48.00 , $48.00 , $3.23 , $55.40 , $57.00 , $54.00 , $54.00 , $54.00 , $55.80 , $57.60 , $21.17 , $51.00 , $21.08 , $11.49 , N/A , $16.72 , $16.72 , $57.00 , $18.27 , $3.23 , $57.60 
Cytopath Man Scrn W/Phys,CPT® 88164,N/A,N/A,N/A, $146.00 , $94.90 , N/A , $17.66 , $14.67 , $59.17 , $89.67 , $135.78 , $131.40 , $131.40 , $116.80 , $116.80 , $14.67 , $134.80 , $138.70 , $131.40 , $131.40 , $131.40 , $135.78 , $140.16 , $101.16 , $124.10 , $69.74 , $51.86 , N/A , $55.22 , $55.22 , $138.70 , $60.68 , $14.67 , $140.16 
 Pro Appl Fngr Splnt Static ,CPT® 29130,0982 - PRO FEE/OUTPT,N/A,N/A, $268.00 , $174.20 , $175.70 , $27.56 , $10.31 , $137.91 , $137.01 , $249.24 , $241.20 , $241.20 , $214.40 , $214.40 , $10.31 , $247.44 , $254.60 , $241.20 , $241.20 , $241.20 , $249.24 , $257.28 , $162.22 , $227.80 , $149.86 , $165.82 , N/A , $140.61 , $140.61 , $254.60 , $165.26 , $10.31 , $257.28 
 Removal FB External Eye Conjunc Superf ,CPT® 65205,0361 - OR/MINOR,N/A,N/A, $200.00 , $130.00 , $168.00 , $28.20 , $35.23 , $161.60 , $180.00 , $169.32 , $180.00 , $180.00 , $180.00 , $170.00 , $34.54 , $184.66 , $190.00 , $170.00 , $186.00 , $186.00 , $190.00 , $192.00 , $163.64 , $180.00 , $170.00 , $158.00 , N/A , $161.86 , $161.86 , $190.00 , $171.62 , $28.20 , $192.00 
 Septicemia Or Severe Sepsis Without Mv >96 Hours With McC ,MS DRG V40 (FY2023) 871,N/A,N/A,N/A," $26,069.26 "," $16,945.02 "," $21,898.18 ", N/A , N/A ," $21,063.96 "," $23,462.33 "," $22,070.24 "," $23,462.33 "," $23,462.33 "," $23,462.33 "," $22,158.87 ", N/A ," $24,069.75 "," $24,765.80 "," $22,158.87 "," $24,244.41 "," $24,244.41 "," $24,765.80 "," $25,026.49 "," $21,329.87 "," $23,462.33 "," $22,158.87 "," $20,594.72 ", N/A ," $21,097.85 "," $21,097.85 "," $24,765.80 "," $22,370.03 "," $20,594.72 "," $25,026.49 "
 Pro Expl Pentrg Wnd Spx Xtr ,CPT® 20103,0982 - PRO FEE/OUTPT,N/A,N/A," $3,902.00 "," $2,536.30 "," $2,087.15 ", $325.90 , $335.70 ," $1,680.45 "," $1,671.86 "," $3,628.86 "," $3,511.80 "," $3,511.80 "," $3,121.60 "," $3,121.60 ", $335.70 ," $3,602.72 "," $3,706.90 "," $3,511.80 "," $3,511.80 "," $3,511.80 "," $3,628.86 "," $3,745.92 "," $1,945.11 "," $3,316.70 "," $1,846.51 "," $1,988.52 ", N/A ," $1,713.23 "," $1,713.23 "," $3,706.90 "," $2,013.66 ", $325.90 ," $3,745.92 "
 DIGOXIN 250 MCG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-5922-61,1 tablet, $8.66 , $5.63 , $7.27 , N/A , N/A , $7.00 , $7.79 , $7.33 , $7.79 , $7.79 , $7.79 , $7.36 , N/A , $8.00 , $8.23 , $7.36 , $8.05 , $8.05 , $8.23 , $8.31 , $7.09 , $7.79 , $7.36 , $6.84 , N/A , $7.01 , $7.01 , $8.23 , $7.43 , $6.84 , $8.31 
Bronchoscopy W/Removal Foreign Body,CPT® 31635,N/A,N/A,N/A," $2,502.00 "," $1,626.30 ", $954.21 , $165.46 , $856.82 , $730.57 , $712.63 ," $2,326.86 "," $2,251.80 "," $2,251.80 "," $2,001.60 "," $2,001.60 ", $856.82 ," $2,310.10 "," $2,376.90 "," $2,251.80 "," $2,251.80 "," $2,251.80 "," $2,326.86 "," $2,401.92 ", $923.46 ," $2,126.70 ", $999.08 , $913.55 , N/A , $744.82 , $744.82 ," $2,376.90 ", $877.19 , $165.46 ," $2,401.92 "
Open Big Toe Fx,28505,N/A,N/A,N/A," $4,469.00 "," $2,904.85 "," $3,079.57 ", $479.38 , $230.52 ," $2,473.79 "," $2,437.68 "," $4,156.17 "," $4,022.10 "," $4,022.10 "," $3,575.20 "," $3,575.20 ", $230.52 ," $4,126.23 "," $4,245.55 "," $4,022.10 "," $4,022.10 "," $4,022.10 "," $4,156.17 "," $4,290.24 "," $2,849.00 "," $3,798.65 "," $2,654.69 "," $2,904.02 ", N/A ," $2,522.06 "," $2,522.06 "," $4,245.55 "," $2,964.32 ", $230.52 ," $4,290.24 "
Pulmonary Stress Testing,CPT® 94618,N/A,N/A,N/A, $286.00 , $185.90 , $77.38 , $33.01 , $27.10 , $71.69 , $75.59 , $265.98 , $257.40 , $257.40 , $228.80 , $228.80 , $27.10 , $264.06 , $271.70 , $257.40 , $257.40 , $257.40 , $265.98 , $274.56 , $101.72 , $243.10 , $100.97 , $129.58 , N/A , $73.09 , $73.09 , $271.70 , $85.21 , $27.10 , $274.56 
 Pro App Skn Sub Grft T/a/L Area/>100scm 1st 100scm ,CPT® 15273,0982 - PRO FEE/OUTPT,N/A,N/A," $2,017.00 "," $1,311.05 ", $619.55 , $182.21 , $227.35 , $549.91 , $508.82 ," $1,875.81 "," $1,815.30 "," $1,815.30 "," $1,613.60 "," $1,613.60 ", $227.35 ," $1,862.30 "," $1,916.15 "," $1,815.30 "," $1,815.30 "," $1,815.30 "," $1,875.81 "," $1,936.32 ", $682.93 ," $1,714.45 "," $1,022.27 ", $702.31 , N/A , $560.64 , $560.64 ," $1,916.15 ", $650.16 , $182.21 ," $1,936.32 "
Excis Soft Tissue Lesion Hand Subcut,26115,N/A,N/A,N/A," $3,545.00 "," $2,304.25 "," $2,032.75 ", $321.14 , $112.10 ," $1,602.76 "," $1,606.38 "," $3,296.85 "," $3,190.50 "," $3,190.50 "," $2,836.00 "," $2,836.00 ", $112.10 ," $3,273.10 "," $3,367.75 "," $3,190.50 "," $3,190.50 "," $3,190.50 "," $3,296.85 "," $3,403.20 "," $1,888.95 "," $3,013.25 "," $1,764.44 "," $1,905.46 ", N/A ," $1,634.04 "," $1,634.04 "," $3,367.75 "," $1,920.58 ", $112.10 ," $3,403.20 "
 Fac Drug Tst Prsmv Read Instrmnt Asstd Dir Opt Obs ,CPT® 80306,0301 - LAB/CHEMISTRY,N/A,N/A, $150.00 , $97.50 , $126.00 , $17.48 , $17.48 , $121.20 , $135.00 , $126.99 , $135.00 , $135.00 , $135.00 , $127.50 , $17.14 , $138.50 , $142.50 , $127.50 , $139.50 , $139.50 , $142.50 , $144.00 , $122.73 , $135.00 , $127.50 , $118.50 , N/A , $121.40 , $121.40 , $142.50 , $128.72 , $17.14 , $144.00 
 SIMETHICONE 40 MG/0.6ML PO SUSP ,HCPCS RXC637,0250 - PHARMACY,70000-0051-01,30 mL, $43.62 , $28.35 , $36.64 , N/A , N/A , $35.24 , $39.26 , $36.93 , $39.26 , $39.26 , $39.26 , $37.08 , N/A , $40.27 , $41.44 , $37.08 , $40.57 , $40.57 , $41.44 , $41.88 , $35.69 , $39.26 , $37.08 , $34.46 , N/A , $35.30 , $35.30 , $41.44 , $37.43 , $34.46 , $41.88 
Body Fluid Cell Count W Diff,CPT® 89051,N/A,N/A,N/A, $103.00 , $66.95 , N/A , $5.71 , $5.71 , $30.82 , $37.27 , $95.79 , $92.70 , $92.70 , $82.40 , $82.40 , $5.71 , $95.10 , $97.85 , $92.70 , $92.70 , $92.70 , $95.79 , $98.88 , $37.39 , $87.55 , $35.68 , $19.97 , N/A , $28.76 , $28.76 , $97.85 , $31.61 , $5.71 , $98.88 
 Fac Egd Balloon Dilation Esophagus <30 Mm Diam ,CPT® 43249,0360 - OR SERVICES,N/A,N/A," $3,472.00 "," $2,256.80 "," $2,916.48 ", $145.24 , $162.52 ," $2,805.38 "," $3,124.80 "," $2,939.40 "," $3,124.80 "," $3,124.80 "," $3,124.80 "," $2,951.20 ", $159.33 ," $3,205.70 "," $3,298.40 "," $2,951.20 "," $3,228.96 "," $3,228.96 "," $3,298.40 "," $3,333.12 "," $2,840.79 "," $3,124.80 "," $2,951.20 "," $2,742.88 ", N/A ," $2,809.89 "," $2,809.89 "," $3,298.40 "," $2,979.32 ", $145.24 ," $3,333.12 "
 Pro MR Angiography Neck W/O Dye ,CPT® 70547,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,415.00 ", $919.75 ," $1,547.63 ", $221.31 , $403.88 ," $1,872.42 "," $2,424.57 "," $1,315.95 "," $1,273.50 "," $1,273.50 "," $1,132.00 "," $1,132.00 ", $403.88 ," $1,306.47 "," $1,344.25 "," $1,273.50 "," $1,273.50 "," $1,273.50 "," $1,315.95 "," $1,358.40 "," $1,325.20 "," $1,202.75 "," $2,644.46 "," $2,201.78 ", N/A ," $1,908.95 "," $1,908.95 "," $1,344.25 "," $2,209.65 ", $221.31 ," $2,644.46 "
 Pro Diab Manage Trn per Indiv ,HCPCS G0108,0982 - PRO FEE/OUTPT,N/A,N/A, $210.00 , $136.50 , $128.40 , $53.88 , N/A , $97.34 , N/A , $195.30 , $189.00 , $189.00 , $168.00 , $168.00 , N/A , $193.89 , $199.50 , $189.00 , $189.00 , $189.00 , $195.30 , $201.60 , $169.46 , $178.50 , $99.26 , $203.23 , N/A , $99.24 , $99.24 , $199.50 , $124.04 , $53.88 , $203.23 
Assay for Pregnenolone,CPT® 84140,N/A,N/A,N/A, $193.00 , $125.45 , N/A , $21.08 , $21.08 , $116.94 , $139.93 , $179.49 , $173.70 , $173.70 , $154.40 , $154.40 , $21.08 , $178.20 , $183.35 , $173.70 , $173.70 , $173.70 , $179.49 , $185.28 , $138.02 , $164.05 , $136.23 , $74.95 , N/A , $109.14 , $109.14 , $183.35 , $119.27 , $21.08 , $185.28 
 Pro Exc Face-Mm B9+Marg 0.6-1 Cm ,CPT® 11441,0982 - PRO FEE/OUTPT,N/A,N/A, $682.00 , $443.30 , $426.39 , $128.83 , $116.82 , $358.23 , $354.74 , $634.26 , $613.80 , $613.80 , $545.60 , $545.60 , $116.82 , $629.69 , $647.90 , $613.80 , $613.80 , $613.80 , $634.26 , $654.72 , $462.54 , $579.70 , $704.71 , $461.95 , N/A , $365.22 , $365.22 , $647.90 , $423.54 , $116.82 , $704.71 
 Pro Arthrt W/Exc Semilunar Crtlg Kne Medial/Lat ,CPT® 27332,0982 - PRO FEE/OUTPT,N/A,N/A," $5,233.00 "," $3,401.45 "," $3,937.96 ", $618.11 , $844.00 ," $3,093.66 "," $3,081.39 "," $4,866.69 "," $4,709.70 "," $4,709.70 "," $4,186.40 "," $4,186.40 ", $844.00 ," $4,831.63 "," $4,971.35 "," $4,709.70 "," $4,709.70 "," $4,709.70 "," $4,866.69 "," $5,023.68 "," $3,656.72 "," $4,448.05 "," $3,400.43 "," $3,654.64 ", N/A ," $3,154.02 "," $3,154.02 "," $4,971.35 "," $3,707.08 ", $618.11 ," $5,023.68 "
Triamcinolone Hexacetonl Inj,HCPCS J3303,N/A,N/A,N/A, $12.00 , $7.80 , N/A , N/A , $3.68 , N/A , N/A , $11.16 , $10.80 , $10.80 , $9.60 , $9.60 , $3.68 , $11.08 , $11.40 , $10.80 , $10.80 , $10.80 , $11.16 , $11.52 , N/A , $10.20 , $3.24 , $10.91 , N/A , N/A , N/A , $11.40 , N/A , $3.24 , $11.52 
 Fac Cntrst Njx Assmt Absc/Cst via Drg Cath/Tube Spx ,CPT® 49424,0761 - TREATMENT ROOM,N/A,N/A," $1,013.00 ", $658.45 , $850.92 , $35.68 , $111.57 , $818.50 , $911.70 , $857.61 , $911.70 , $911.70 , $911.70 , $861.05 , $109.38 , $935.30 , $962.35 , $861.05 , $942.09 , $942.09 , $962.35 , $972.48 , $828.84 , $911.70 , $861.05 , $800.27 , N/A , $819.82 , $819.82 , $962.35 , $869.26 , $35.68 , $972.48 
 Hgb Fxj&Quan Electrophoresis Pro ,CPT® 83020,0971 - PRO FEE/LAB,N/A,N/A, $126.00 , $81.90 , N/A , $13.13 , $6.32 , $25.78 , $30.88 , $117.18 , $113.40 , $113.40 , $100.80 , $100.80 , $6.32 , $116.34 , $119.70 , $113.40 , $113.40 , $113.40 , $117.18 , $120.96 , $85.94 , $107.10 , $180.02 , $46.67 , N/A , $24.06 , $24.06 , $119.70 , $26.29 , $6.32 , $180.02 
 DIATRIZOATE MEGLUMINE & SODIUM 66-10 % PO SOLN ,HCPCS Q9963,0255 - DRUGS/RADIOLOGY,00270-0445-35,30 mL, $149.03 , $96.87 , $125.19 , $0.21 , $0.21 , $120.42 , $134.13 , $126.17 , $134.13 , $134.13 , $134.13 , $126.68 , $0.21 , $137.60 , $141.58 , $126.68 , $138.60 , $138.60 , $141.58 , $143.07 , $121.94 , $134.13 , $126.68 , $117.73 , N/A , $120.61 , $120.61 , $141.58 , $127.88 , $0.21 , $143.07 
" Aftercare, Musculoskeletal System And Connective Tissue With Cc ",MS DRG V40 (FY2023) 560,N/A,N/A,N/A," $11,044.89 "," $7,179.18 "," $9,277.71 ", N/A , N/A ," $8,924.27 "," $9,940.40 "," $9,350.60 "," $9,940.40 "," $9,940.40 "," $9,940.40 "," $9,388.16 ", N/A ," $10,197.75 "," $10,492.65 "," $9,388.16 "," $10,271.75 "," $10,271.75 "," $10,492.65 "," $10,603.09 "," $9,036.93 "," $9,940.40 "," $9,388.16 "," $8,725.46 ", N/A ," $8,938.63 "," $8,938.63 "," $10,492.65 "," $9,477.62 "," $8,725.46 "," $10,603.09 "
 General Health Panel -Mh ,CPT® 80050,0301 - LAB/CHEMISTRY,N/A,N/A, $236.00 , $153.40 , $198.24 , N/A , $52.47 , $190.69 , $212.40 , $199.80 , $212.40 , $212.40 , $212.40 , $200.60 , $51.44 , $217.90 , $224.20 , $200.60 , $219.48 , $219.48 , $224.20 , $226.56 , $193.10 , $212.40 , $200.60 , $186.44 , N/A , $190.99 , $190.99 , $224.20 , $202.51 , $51.44 , $226.56 
X-Ray Sternum 2+ Vw,CPT® 71120,N/A,N/A,N/A, $368.00 , $239.20 , $190.70 , $33.07 , $30.96 , $138.99 , $168.19 , $342.24 , $331.20 , $331.20 , $294.40 , $294.40 , $30.96 , $339.77 , $349.60 , $331.20 , $331.20 , $331.20 , $342.24 , $353.28 , $184.35 , $312.80 , $182.97 , $149.74 , N/A , $141.70 , $141.70 , $349.60 , $164.02 , $30.96 , $353.28 
Perq Replacement Gtube Req Revj Gstrst Trc,CPT® 43763,N/A,N/A,N/A," $4,101.00 "," $2,665.65 ", $511.81 , $81.55 , $261.98 , $371.96 , N/A ," $3,813.93 "," $3,690.90 "," $3,690.90 "," $3,280.80 "," $3,280.80 ", $261.98 ," $3,786.45 "," $3,895.95 "," $3,690.90 "," $3,690.90 "," $3,690.90 "," $3,813.93 "," $3,936.96 ", $364.60 ," $3,485.85 ", $460.23 , $476.79 , N/A , $379.23 , $379.23 ," $3,895.95 ", $396.62 , $81.55 ," $3,936.96 "
Treat Great Toe Fracture,28490,N/A,N/A,N/A, $959.00 , $623.35 , $772.46 , $123.06 , $85.41 , $611.90 , $626.73 , $891.87 , $863.10 , $863.10 , $767.20 , $767.20 , $85.41 , $885.44 , $911.05 , $863.10 , $863.10 , $863.10 , $891.87 , $920.64 , $710.88 , $815.15 , $681.51 , $728.10 , N/A , $623.83 , $623.83 , $911.05 , $733.23 , $85.41 , $920.64 
 GLYCOPYRROLATE 0.2 MG/ML IJ SOLN ,HCPCS RXA250,0250 - PHARMACY,00143-9682-25,1 mL, $16.68 , $10.84 , $14.01 , N/A , N/A , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , N/A , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $13.18 , $16.01 
 NAFCILLIN SODIUM 10 G IV SOLR ,HCPCS RXA250,0250 - PHARMACY,55150-0124-99,100 mL, $708.89 , $460.78 , $595.47 , N/A , N/A , $572.78 , $638.00 , $600.15 , $638.00 , $638.00 , $638.00 , $602.56 , N/A , $654.52 , $673.45 , $602.56 , $659.27 , $659.27 , $673.45 , $680.53 , $580.01 , $638.00 , $602.56 , $560.02 , N/A , $573.70 , $573.70 , $673.45 , $608.30 , $560.02 , $680.53 
" Fac Xray, Place Prox Ext Thor Ao ",CPT® 75958,0320 - DX X-RAY,N/A,N/A," $2,201.00 "," $1,430.65 "," $1,848.84 ", N/A , N/A ," $1,778.41 "," $1,980.90 "," $1,863.37 "," $1,980.90 "," $1,980.90 "," $1,980.90 "," $1,870.85 ", N/A ," $2,032.18 "," $2,090.95 "," $1,870.85 "," $2,046.93 "," $2,046.93 "," $2,090.95 "," $2,112.96 "," $1,800.86 "," $1,980.90 "," $1,870.85 "," $1,738.79 ", N/A ," $1,781.27 "," $1,781.27 "," $2,090.95 "," $1,888.68 "," $1,738.79 "," $2,112.96 "
"Amputation Toe,I-P Jt",CPT® 28825,N/A,N/A,N/A," $3,679.00 "," $2,391.35 "," $1,067.04 ", $165.33 , $153.67 ," $1,823.42 "," $1,834.23 "," $3,421.47 "," $3,311.10 "," $3,311.10 "," $2,943.20 "," $2,943.20 ", $153.67 ," $3,396.82 "," $3,495.05 "," $3,311.10 "," $3,311.10 "," $3,311.10 "," $3,421.47 "," $3,531.84 "," $1,000.61 "," $3,127.15 "," $2,003.50 "," $2,152.14 ", N/A ," $1,859.00 "," $1,859.00 "," $3,495.05 "," $2,185.00 ", $153.67 ," $3,531.84 "
 Pro Appl Fngr Splnt Dynamic ,CPT® 29131,0982 - PRO FEE/OUTPT,N/A,N/A, $348.00 , $226.20 , $208.13 , $32.91 , $23.04 , $161.49 , $163.04 , $323.64 , $313.20 , $313.20 , $278.40 , $278.40 , $23.04 , $321.31 , $330.60 , $313.20 , $313.20 , $313.20 , $323.64 , $334.08 , $192.53 , $295.80 , $178.41 , $195.79 , N/A , $164.64 , $164.64 , $330.60 , $193.50 , $23.04 , $334.08 
"Echo Heart Xthoracic,Complete W Doppler",CPT® 93306,N/A,N/A,N/A," $3,712.00 "," $2,412.80 "," $1,263.28 ", $193.19 , $335.09 ," $1,223.05 "," $1,062.67 "," $3,452.16 "," $3,340.80 "," $3,340.80 "," $2,969.60 "," $2,969.60 ", $335.09 ," $3,427.29 "," $3,526.40 "," $3,340.80 "," $3,340.80 "," $3,340.80 "," $3,452.16 "," $3,563.52 "," $1,257.77 "," $3,155.20 ", $993.72 ," $1,255.10 ", N/A ," $1,246.92 "," $1,246.92 "," $3,526.40 "," $1,382.22 ", $193.19 ," $3,563.52 "
 ADENOSINE 12 MG/4ML IV SOLN ,HCPCS J0153,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0651-90,2 mL, $79.83 , $51.89 , $67.06 , $0.55 , $0.53 , $64.50 , $71.85 , $67.58 , $71.85 , $71.85 , $71.85 , $67.86 , $0.52 , $73.71 , $75.84 , $67.86 , $74.24 , $74.24 , $75.84 , $76.64 , $65.32 , $71.85 , $67.86 , $63.07 , N/A , $64.61 , $64.61 , $75.84 , $68.50 , $0.52 , $76.64 
Interrog Dev Eval Scrms Phys/Qhp in Person,CPT® 93291,N/A,N/A,N/A, $476.00 , $309.40 , $324.03 , $49.12 , $39.27 , $195.15 , $199.03 , $442.68 , $428.40 , $428.40 , $380.80 , $380.80 , $39.27 , $439.49 , $452.20 , $428.40 , $428.40 , $428.40 , $442.68 , $456.96 , $297.36 , $404.60 , $185.54 , $124.44 , N/A , $198.96 , $198.96 , $452.20 , $220.55 , $39.27 , $456.96 
 Fac Echo Transesophag Montr Cardiac Pump Functj ,CPT® 93318,0480 - CARDIOLOGY,N/A,N/A," $3,111.00 "," $2,022.15 "," $2,613.24 ", $402.56 , N/A ," $2,513.69 "," $2,799.90 "," $2,633.77 "," $2,799.90 "," $2,799.90 "," $2,799.90 "," $2,644.35 ", N/A ," $2,872.39 "," $2,955.45 "," $2,644.35 "," $2,893.23 "," $2,893.23 "," $2,955.45 "," $2,986.56 "," $2,545.42 "," $2,799.90 "," $2,644.35 "," $2,457.69 ", N/A ," $2,517.73 "," $2,517.73 "," $2,955.45 "," $2,669.55 ", $402.56 ," $2,986.56 "
Revsc Opn/Prq Iliac Art W/Stnt Plmt & Angioplsty,CPT® 37221,N/A,N/A,N/A," $20,423.00 "," $13,274.95 "," $2,863.06 ", $440.14 , $374.92 ," $2,208.37 "," $2,162.52 "," $18,993.39 "," $18,380.70 "," $18,380.70 "," $16,338.40 "," $16,338.40 ", $374.92 ," $18,856.56 "," $19,401.85 "," $18,380.70 "," $18,380.70 "," $18,380.70 "," $18,993.39 "," $19,606.08 "," $2,439.85 "," $17,359.55 "," $2,708.21 "," $2,399.88 ", N/A ," $2,251.45 "," $2,251.45 "," $19,401.85 "," $2,557.66 ", $374.92 ," $19,606.08 "
 Fac Assay of Myoglobin ,CPT® 83874,0301 - LAB/CHEMISTRY,N/A,N/A, $174.00 , $113.10 , $146.16 , $13.18 , $13.18 , $140.59 , $156.60 , $147.31 , $156.60 , $156.60 , $156.60 , $147.90 , $12.92 , $160.65 , $165.30 , $147.90 , $161.82 , $161.82 , $165.30 , $167.04 , $142.37 , $156.60 , $147.90 , $137.46 , N/A , $140.82 , $140.82 , $165.30 , $149.31 , $12.92 , $167.04 
" Fac Vein X-Ray, Neck ",CPT® 75860,0320 - DX X-RAY,N/A,N/A," $1,234.00 ", $802.10 ," $1,036.56 ", $123.45 , $225.76 , $997.07 ," $1,110.60 "," $1,044.70 "," $1,110.60 "," $1,110.60 "," $1,110.60 "," $1,048.90 ", $221.33 ," $1,139.35 "," $1,172.30 "," $1,048.90 "," $1,147.62 "," $1,147.62 "," $1,172.30 "," $1,184.64 "," $1,009.66 "," $1,110.60 "," $1,048.90 ", $974.86 , N/A , $998.68 , $998.68 ," $1,172.30 "," $1,058.90 ", $123.45 ," $1,184.64 "
 Fac Telethx Isodose Pln Smpl W/Dosimetry Calculation ,CPT® 77306,0333 - RADIATION RX,N/A,N/A," $1,091.00 ", $709.15 , $916.44 , $145.47 , $113.93 , $881.53 , $981.90 , $923.64 , $981.90 , $981.90 , $981.90 , $927.35 , $111.70 ," $1,007.32 "," $1,036.45 ", $927.35 ," $1,014.63 "," $1,014.63 "," $1,036.45 "," $1,047.36 ", $892.66 , $981.90 , $927.35 , $861.89 , N/A , $882.95 , $882.95 ," $1,036.45 ", $936.19 , $111.70 ," $1,047.36 "
 Fac Rplcmt Compl Tun Ctr Vad W/Subq Port ,CPT® 36582,0761 - TREATMENT ROOM,N/A,N/A," $3,553.00 "," $2,309.45 "," $2,984.52 ", $268.28 ," $1,170.87 "," $2,870.82 "," $3,197.70 "," $3,007.97 "," $3,197.70 "," $3,197.70 "," $3,197.70 "," $3,020.05 "," $1,147.91 "," $3,280.48 "," $3,375.35 "," $3,020.05 "," $3,304.29 "," $3,304.29 "," $3,375.35 "," $3,410.88 "," $2,907.06 "," $3,197.70 "," $3,020.05 "," $2,806.87 ", N/A ," $2,875.44 "," $2,875.44 "," $3,375.35 "," $3,048.83 ", $268.28 ," $3,410.88 "
 Fac Drug Assay Voriconazole ,CPT® 80285,0301 - LAB/CHEMISTRY,N/A,N/A, $170.00 , $110.50 , $142.80 , $27.65 , $22.12 , $137.36 , $153.00 , $143.92 , $153.00 , $153.00 , $153.00 , $144.50 , $21.69 , $156.96 , $161.50 , $144.50 , $158.10 , $158.10 , $161.50 , $163.20 , $139.09 , $153.00 , $144.50 , $134.30 , N/A , $137.58 , $137.58 , $161.50 , $145.88 , $21.69 , $163.20 
 TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP OINT ,HCPCS RXA250,0250 - PHARMACY,00078-0876-01,3.5 gram," $1,623.31 "," $1,055.15 "," $1,363.58 ", N/A , N/A ," $1,311.63 "," $1,460.98 "," $1,374.29 "," $1,460.98 "," $1,460.98 "," $1,460.98 "," $1,379.81 ", N/A ," $1,498.80 "," $1,542.14 "," $1,379.81 "," $1,509.68 "," $1,509.68 "," $1,542.14 "," $1,558.38 "," $1,328.19 "," $1,460.98 "," $1,379.81 "," $1,282.41 ", N/A ," $1,313.74 "," $1,313.74 "," $1,542.14 "," $1,392.96 "," $1,282.41 "," $1,558.38 "
 Diabetes Without Cc/McC ,MS DRG V40 (FY2023) 639,N/A,N/A,N/A," $19,554.87 "," $12,710.67 "," $16,426.09 ", N/A , N/A ," $15,800.33 "," $17,599.38 "," $16,555.15 "," $17,599.38 "," $17,599.38 "," $17,599.38 "," $16,621.64 ", N/A ," $18,055.01 "," $18,577.13 "," $16,621.64 "," $18,186.03 "," $18,186.03 "," $18,577.13 "," $18,772.68 "," $15,999.79 "," $17,599.38 "," $16,621.64 "," $15,448.35 ", N/A ," $15,825.76 "," $15,825.76 "," $18,577.13 "," $16,780.03 "," $15,448.35 "," $18,772.68 "
 Pro Bldr Instlj Anticarcinogenic Agt ,CPT® 51720,0982 - PRO FEE/OUTPT,N/A,N/A, $748.00 , $486.20 , $235.23 , $41.44 , $34.30 , $393.98 , $363.86 , $695.64 , $673.20 , $673.20 , $598.40 , $598.40 , $34.30 , $690.63 , $710.60 , $673.20 , $673.20 , $673.20 , $695.64 , $718.08 , $236.46 , $635.80 , $412.12 , $321.58 , N/A , $401.67 , $401.67 , $710.60 , $472.10 , $34.30 , $718.08 
Rem Interrog Scrms <30 D Phys/Qhp,CPT® 93298,N/A,N/A,N/A, $390.00 , $253.50 , $164.13 , $25.31 , $28.92 , $144.72 , $143.91 , $362.70 , $351.00 , $351.00 , $312.00 , $312.00 , $28.92 , $360.09 , $370.50 , $351.00 , $351.00 , $351.00 , $362.70 , $374.40 , $162.32 , $331.50 , $133.80 , $101.85 , N/A , $147.54 , $147.54 , $370.50 , $163.55 , $25.31 , $374.40 
 Fac Hla Class II Typing High Resolution One Locus Ea ,CPT® 81382,0310 - PATHOLOGY LAB,N/A,N/A," $1,389.00 ", $902.85 ," $1,166.76 ", $126.15 , $126.15 ," $1,122.31 "," $1,250.10 "," $1,175.93 "," $1,250.10 "," $1,250.10 "," $1,250.10 "," $1,180.65 ", $123.68 ," $1,282.46 "," $1,319.55 "," $1,180.65 "," $1,291.77 "," $1,291.77 "," $1,319.55 "," $1,333.44 "," $1,136.48 "," $1,250.10 "," $1,180.65 "," $1,097.31 ", N/A ," $1,124.12 "," $1,124.12 "," $1,319.55 "," $1,191.90 ", $123.68 ," $1,333.44 "
 Pro MRI Upper Extremity W/Dye ,CPT® 73219,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,066.00 ", $692.90 ," $2,406.11 ", $342.65 , $498.05 ," $1,918.70 "," $2,448.15 ", $991.38 , $959.40 , $959.40 , $852.80 , $852.80 , $498.05 , $984.24 ," $1,012.70 ", $959.40 , $959.40 , $959.40 , $991.38 ," $1,023.36 "," $2,091.52 ", $906.10 ," $2,669.49 "," $3,721.81 ", N/A ," $1,956.14 "," $1,956.14 "," $1,012.70 "," $2,264.27 ", $342.65 ," $3,721.81 "
 Fac Islet Cell Antibody ,CPT® 86341,0300 - LABORATORY,N/A,N/A, $172.00 , $111.80 , $144.48 , $24.04 , $19.62 , $138.98 , $154.80 , $145.62 , $154.80 , $154.80 , $154.80 , $146.20 , $19.24 , $158.81 , $163.40 , $146.20 , $159.96 , $159.96 , $163.40 , $165.12 , $140.73 , $154.80 , $146.20 , $135.88 , N/A , $139.20 , $139.20 , $163.40 , $147.59 , $19.24 , $165.12 
 Pro Dup-Scan Uxtr Art/Artl Bpgs Compl Bi Std ,CPT® 93930,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,326.00 ", $861.90 ," $1,243.84 ", $191.49 , $168.91 ," $1,126.68 "," $1,368.99 "," $1,233.18 "," $1,193.40 "," $1,193.40 "," $1,060.80 "," $1,060.80 ", $168.91 ," $1,224.30 "," $1,259.70 "," $1,193.40 "," $1,193.40 "," $1,193.40 "," $1,233.18 "," $1,272.96 ", $882.57 ," $1,127.10 ", $730.89 , $791.88 , N/A ," $1,148.67 "," $1,148.67 "," $1,259.70 "," $1,273.31 ", $168.91 ," $1,368.99 "
Excis Thyroid Duct Cyst/Sinus,CPT® 60280,N/A,N/A,N/A," $3,058.00 "," $1,987.70 "," $2,800.79 ", $439.30 , $386.21 ," $2,308.57 "," $2,424.84 "," $2,843.94 "," $2,752.20 "," $2,752.20 "," $2,446.40 "," $2,446.40 ", $386.21 ," $2,823.45 "," $2,905.10 "," $2,752.20 "," $2,752.20 "," $2,752.20 "," $2,843.94 "," $2,935.68 "," $2,671.58 "," $2,599.30 "," $2,379.94 "," $2,212.02 ", N/A ," $2,353.61 "," $2,353.61 "," $2,905.10 "," $2,624.98 ", $386.21 ," $2,935.68 "
Bronchoscopy W/Transbronchial Lung Bx 1 Lobe,CPT® 31628,N/A,N/A,N/A," $2,611.00 "," $1,697.15 ", $966.58 , $167.67 , $560.37 , $740.33 , $724.67 ," $2,428.23 "," $2,349.90 "," $2,349.90 "," $2,088.80 "," $2,088.80 ", $560.37 ," $2,410.74 "," $2,480.45 "," $2,349.90 "," $2,349.90 "," $2,349.90 "," $2,428.23 "," $2,506.56 ", $936.74 ," $2,219.35 "," $1,006.21 ", $925.97 , N/A , $754.77 , $754.77 ," $2,480.45 ", $888.91 , $167.67 ," $2,506.56 "
Cardioversion Elective Arrhythmia External,92960,N/A,N/A,N/A, $956.00 , $621.40 , $675.35 , $104.47 , $244.76 , $670.27 , $674.00 , $889.08 , $860.40 , $860.40 , $764.80 , $764.80 , $244.76 , $882.67 , $908.20 , $860.40 , $860.40 , $860.40 , $889.08 , $917.76 , $666.44 , $812.60 , $627.99 , $661.06 , N/A , $683.35 , $683.35 , $908.20 , $757.50 , $104.47 , $917.76 
 Pro Computerized Ophthalmic Imaging Retina ,CPT® 92134,0962 - PRO FEE/EYE,N/A,N/A, $135.00 , $87.75 , $88.31 , $39.74 , $32.72 , $79.44 , $81.53 , $125.55 , $121.50 , $121.50 , $108.00 , $108.00 , $32.72 , $124.65 , $128.25 , $121.50 , $121.50 , $121.50 , $125.55 , $129.60 , $125.08 , $114.75 , $137.87 , $87.83 , N/A , $81.00 , $81.00 , $128.25 , $96.35 , $32.72 , $137.87 
Tenotomy Elbow Lateral/Medial Debride Repair,CPT® 24359,N/A,N/A,N/A," $2,636.00 "," $1,713.40 "," $4,047.88 ", $635.64 , $449.83 ," $3,174.98 "," $3,166.00 "," $2,451.48 "," $2,372.40 "," $2,372.40 "," $2,108.80 "," $2,108.80 ", $449.83 ," $2,433.82 "," $2,504.20 "," $2,372.40 "," $2,372.40 "," $2,372.40 "," $2,451.48 "," $2,530.56 "," $3,758.14 "," $2,240.60 "," $3,489.63 "," $3,759.09 ", N/A ," $3,236.93 "," $3,236.93 "," $2,504.20 "," $3,804.54 ", $449.83 ," $4,047.88 "
Fac Clsr Lac Vestibule Mouth 2.5 Cm/<,40830,N/A,N/A,N/A, $803.00 , $521.95 , $917.61 , $141.47 , $38.12 , $806.63 , $841.57 , $746.79 , $722.70 , $722.70 , $642.40 , $642.40 , $38.12 , $741.41 , $762.85 , $722.70 , $722.70 , $722.70 , $746.79 , $770.88 , $727.42 , $682.55 , $920.58 , $966.62 , N/A , $822.37 , $822.37 , $762.85 , $860.11 , $38.12 , $966.62 
" Fac Immunoassay, Nonantibody ",CPT® 83519,0302 - LAB/IMMUNOLOGY,N/A,N/A, $217.00 , $141.05 , $182.28 , $18.77 , $18.76 , $175.34 , $195.30 , $183.71 , $195.30 , $195.30 , $195.30 , $184.45 , $18.39 , $200.36 , $206.15 , $184.45 , $201.81 , $201.81 , $206.15 , $208.32 , $177.55 , $195.30 , $184.45 , $171.43 , N/A , $175.62 , $175.62 , $206.15 , $186.21 , $18.39 , $208.32 
Puraply Xt 1 Sq Cm,HCPCS Q4197,N/A,N/A,N/A, $421.00 , $273.65 , N/A , $150.10 , N/A , N/A , N/A , $391.53 , $378.90 , $378.90 , $336.80 , $336.80 , N/A , $388.71 , $399.95 , $378.90 , $378.90 , $378.90 , $391.53 , $404.16 , N/A , $357.85 , $339.88 , $335.78 , N/A , N/A , N/A , $399.95 , N/A , $150.10 , $404.16 
 Fac Circumcision W/Regionl Block ,CPT® 54150,0723 - CIRCUMCISION,N/A,N/A, $777.00 , $505.05 , $652.68 , $91.37 , $61.84 , $627.82 , $699.30 , $657.81 , $699.30 , $699.30 , $699.30 , $660.45 , $60.63 , $717.40 , $738.15 , $660.45 , $722.61 , $722.61 , $738.15 , $745.92 , $635.74 , $699.30 , $660.45 , $613.83 , N/A , $628.83 , $628.83 , $738.15 , $666.74 , $60.63 , $745.92 
Physician Telephone Evaluation 21-30 Min,99443,N/A,N/A,N/A, $171.00 , $111.15 , $198.24 , $94.59 , $31.65 , $66.94 , $66.34 , $159.03 , $153.90 , $153.90 , $136.80 , $136.80 , $31.65 , $157.88 , $162.45 , $153.90 , $153.90 , $153.90 , $159.03 , $164.16 , $181.57 , $145.35 , $82.51 , $84.19 , $44.00 , $68.24 , $68.24 , $162.45 , $78.72 , $31.65 , $198.24 
"Placement,Seton",46020,N/A,N/A,N/A, $834.00 , $542.10 , $699.53 , $109.47 , $204.23 ," $1,115.57 "," $1,151.67 ", $775.62 , $750.60 , $750.60 , $667.20 , $667.20 , $204.23 , $770.03 , $792.30 , $750.60 , $750.60 , $750.60 , $775.62 , $800.64 ," $1,047.15 ", $708.90 ," $1,264.90 "," $1,330.79 ", N/A ," $1,137.33 "," $1,137.33 ", $792.30 ," $1,189.53 ", $109.47 ," $1,330.79 "
"Hysteroscopy,W/Endo Bx",58558,N/A,N/A,N/A," $2,752.00 "," $1,788.80 "," $1,075.35 ", $218.28 , $181.31 ," $1,086.05 "," $1,080.64 "," $2,559.36 "," $2,476.80 "," $2,476.80 "," $2,201.60 "," $2,201.60 ", $181.31 ," $2,540.92 "," $2,614.40 "," $2,476.80 "," $2,476.80 "," $2,476.80 "," $2,559.36 "," $2,641.92 "," $1,132.05 "," $2,339.20 "," $1,421.90 ", $962.97 , N/A ," $1,107.24 "," $1,107.24 "," $2,614.40 "," $1,328.05 ", $181.31 ," $2,641.92 "
Temporal Artery Ligatn or Bx,37609,N/A,N/A,N/A," $1,952.00 "," $1,268.80 "," $1,228.76 ", $191.29 , $190.55 , $893.52 , $904.87 ," $1,815.36 "," $1,756.80 "," $1,756.80 "," $1,561.60 "," $1,561.60 ", $190.55 ," $1,802.28 "," $1,854.40 "," $1,756.80 "," $1,756.80 "," $1,756.80 "," $1,815.36 "," $1,873.92 "," $1,133.39 "," $1,659.20 "," $1,131.10 "," $1,009.19 ", N/A , $910.96 , $910.96 ," $1,854.40 "," $1,034.85 ", $190.55 ," $1,873.92 "
Cefazolin Sodium Injection,HCPCS J0690,N/A,N/A,N/A, $12.00 , $7.80 , N/A , $0.89 , $0.79 , N/A , N/A , $11.16 , $10.80 , $10.80 , $9.60 , $9.60 , $0.79 , $11.08 , $11.40 , $10.80 , $10.80 , $10.80 , $11.16 , $11.52 , $1.04 , $10.20 , $1.30 , $0.94 , N/A , N/A , N/A , $11.40 , N/A , $0.79 , $11.52 
 R/L Hrt Cath Chd Img Cath Trgt Zone Nml Nt Connj ,CPT® 93596,0480 - CARDIOLOGY,N/A,N/A," $15,799.00 "," $10,269.35 "," $13,271.16 ", N/A ," $2,378.00 "," $12,765.59 "," $14,219.10 "," $13,375.43 "," $14,219.10 "," $14,219.10 "," $14,219.10 "," $13,429.15 "," $2,331.37 "," $14,587.22 "," $15,009.05 "," $13,429.15 "," $14,693.07 "," $14,693.07 "," $15,009.05 "," $15,167.04 "," $12,926.74 "," $14,219.10 "," $13,429.15 "," $12,481.21 ", N/A ," $12,786.13 "," $12,786.13 "," $15,009.05 "," $13,557.12 "," $2,331.37 "," $15,167.04 "
Adjust Extern Bone Fix Dev W Anesth,CPT® 20693,N/A,N/A,N/A," $1,861.00 "," $1,209.65 "," $2,715.90 ", $426.09 , $398.01 ," $2,168.79 "," $2,198.21 "," $1,730.73 "," $1,674.90 "," $1,674.90 "," $1,488.80 "," $1,488.80 ", $398.01 ," $1,718.26 "," $1,767.95 "," $1,674.90 "," $1,674.90 "," $1,674.90 "," $1,730.73 "," $1,786.56 "," $2,523.60 "," $1,581.85 "," $2,417.41 "," $2,544.91 ", N/A ," $2,211.10 "," $2,211.10 "," $1,767.95 "," $2,598.84 ", $398.01 ," $2,715.90 "
"Cauter Turbinate Mucosa,Superficial",CPT® 30801,N/A,N/A,N/A," $1,217.00 ", $791.05 , $855.43 , $149.94 , $102.53 , $522.79 , $537.78 ," $1,131.81 "," $1,095.30 "," $1,095.30 ", $973.60 , $973.60 , $102.53 ," $1,123.66 "," $1,156.15 "," $1,095.30 "," $1,095.30 "," $1,095.30 "," $1,131.81 "," $1,168.32 ", $808.87 ," $1,034.45 ", $754.66 , $692.10 , N/A , $532.99 , $532.99 ," $1,156.15 ", $627.70 , $102.53 ," $1,168.32 "
Elastase Pancreatic Fecal Quantitative,CPT® 82653,N/A,N/A,N/A, $227.00 , $147.55 , N/A , $23.43 , $23.43 , N/A , N/A , $211.11 , $204.30 , $204.30 , $181.60 , $181.60 , $23.43 , $209.59 , $215.65 , $204.30 , $204.30 , $204.30 , $211.11 , $217.92 , N/A , $192.95 , $109.85 , $67.46 , N/A , $90.04 , $90.04 , $215.65 , $99.00 , $23.43 , $217.92 
 Fac Trauma 2 Eval W/ Pre-ED Notification-WO Critical Care ,Custom 1000567,0682 - TRAUMA LEVEL II,N/A,N/A," $2,044.00 "," $1,328.60 "," $1,716.96 ", N/A , N/A ," $1,651.55 "," $1,839.60 "," $1,730.45 "," $1,839.60 "," $1,839.60 "," $1,839.60 "," $1,737.40 ", N/A ," $1,887.23 "," $1,941.80 "," $1,737.40 "," $1,900.92 "," $1,900.92 "," $1,941.80 "," $1,962.24 "," $1,672.40 "," $1,839.60 "," $1,737.40 "," $1,614.76 ", N/A ," $1,654.21 "," $1,654.21 "," $1,941.80 "," $1,753.96 "," $1,614.76 "," $1,962.24 "
 CLONAZEPAM 1 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60687-0555-01,1 tablet, $3.64 , $2.37 , $3.06 , N/A , N/A , $2.94 , $3.28 , $3.08 , $3.28 , $3.28 , $3.28 , $3.09 , N/A , $3.36 , $3.46 , $3.09 , $3.39 , $3.39 , $3.46 , $3.49 , $2.98 , $3.28 , $3.09 , $2.88 , N/A , $2.95 , $2.95 , $3.46 , $3.12 , $2.88 , $3.49 
 FAMOTIDINE (PF) 20 MG/2ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00641-6022-25,2 mL, $16.68 , $10.84 , $14.01 , N/A , N/A , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , N/A , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $13.18 , $16.01 
 Fac Non Negative Rapid Specimen Mro Occ Hlth ,Custom 3000000003,0300 - LABORATORY,N/A,N/A, $49.00 , $31.85 , $41.16 , N/A , N/A , $39.59 , $44.10 , $41.48 , $44.10 , $44.10 , $44.10 , $41.65 , N/A , $45.24 , $46.55 , $41.65 , $45.57 , $45.57 , $46.55 , $47.04 , $40.09 , $44.10 , $41.65 , $38.71 , N/A , $39.66 , $39.66 , $46.55 , $42.05 , $38.71 , $47.04 
 Fac Prq Balloon Valvuloplasty Aortic Valve ,CPT® 92986,0481 - CARDIAC CATH LAB,N/A,N/A," $7,435.00 "," $4,832.75 "," $6,245.40 "," $1,198.83 "," $1,298.19 "," $6,007.48 "," $6,691.50 "," $6,294.47 "," $6,691.50 "," $6,691.50 "," $6,691.50 "," $6,319.75 "," $1,272.74 "," $6,864.74 "," $7,063.25 "," $6,319.75 "," $6,914.55 "," $6,914.55 "," $7,063.25 "," $7,137.60 "," $6,083.32 "," $6,691.50 "," $6,319.75 "," $5,873.65 ", N/A ," $6,017.15 "," $6,017.15 "," $7,063.25 "," $6,379.97 "," $1,198.83 "," $7,137.60 "
 MORPHINE SULFATE ER 15 MG PO TBCR ,HCPCS RXC637,0250 - PHARMACY,00904-6557-61,1 tablet, $7.06 , $4.59 , $5.93 , N/A , N/A , $5.70 , $6.35 , $5.98 , $6.35 , $6.35 , $6.35 , $6.00 , N/A , $6.52 , $6.71 , $6.00 , $6.57 , $6.57 , $6.71 , $6.78 , $5.78 , $6.35 , $6.00 , $5.58 , N/A , $5.71 , $5.71 , $6.71 , $6.06 , $5.58 , $6.78 
 HYDROXYZINE HCL 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6617-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Removal of Elbow Bursa,24105,N/A,N/A,N/A," $1,330.00 ", $864.50 ," $2,218.19 ", $350.16 , $307.34 ," $1,687.87 "," $1,703.38 "," $1,236.90 "," $1,197.00 "," $1,197.00 "," $1,064.00 "," $1,064.00 ", $307.34 ," $1,227.99 "," $1,263.50 "," $1,197.00 "," $1,197.00 "," $1,197.00 "," $1,236.90 "," $1,276.80 "," $2,049.06 "," $1,130.50 "," $1,871.48 "," $2,003.84 ", N/A ," $1,720.80 "," $1,720.80 "," $1,263.50 "," $2,022.56 ", $307.34 ," $2,218.19 "
 Maa/Tc Macro Albumin per Study Dose Up to 10 Mci ,HCPCS A9540,0343 - DIAGNOSTIC RADIOPHARMACEUTICALS,N/A,N/A, $653.00 , $424.45 , $548.52 , N/A , $17.56 , $527.62 , $587.70 , $552.83 , $587.70 , $587.70 , $587.70 , $555.05 , $17.22 , $602.91 , $620.35 , $555.05 , $607.29 , $607.29 , $620.35 , $626.88 , $534.28 , $587.70 , $555.05 , $515.87 , N/A , $528.47 , $528.47 , $620.35 , $560.34 , $17.22 , $626.88 
Incobotulinumtoxin A,HCPCS J0588,N/A,N/A,N/A, $11.00 , $7.15 , N/A , $5.30 , $5.30 , N/A , N/A , $10.23 , $9.90 , $9.90 , $8.80 , $8.80 , $5.30 , $10.16 , $10.45 , $9.90 , $9.90 , $9.90 , $10.23 , $10.56 , $6.55 , $9.35 , $8.43 , $6.59 , N/A , N/A , N/A , $10.45 , N/A , $5.30 , $10.56 
 Pro Rp Loclzj Tum Spect 1 Area/Acquisj 1 Day Img ,CPT® 78803,0972 - PRO FEE/RAD/DX,N/A,N/A, $449.00 , $291.85 ," $2,054.36 ", $349.18 , $314.32 ," $1,674.53 "," $1,817.43 ", $417.57 , $404.10 , $404.10 , $359.20 , $359.20 , $314.32 , $414.56 , $426.55 , $404.10 , $404.10 , $404.10 , $417.57 , $431.04 ," $2,144.47 ", $381.65 ," $1,983.82 "," $2,305.81 ", N/A ," $1,707.20 "," $1,707.20 ", $426.55 ," $1,976.12 ", $314.32 ," $2,305.81 "
Exc Skin Malig 1.1-2cm Remaindr Body,11622,N/A,N/A,N/A," $1,169.00 ", $759.85 , $542.33 , $163.07 , $252.90 , $468.46 , $459.11 ," $1,087.17 "," $1,052.10 "," $1,052.10 ", $935.20 , $935.20 , $252.90 ," $1,079.34 "," $1,110.55 "," $1,052.10 "," $1,052.10 "," $1,052.10 "," $1,087.17 "," $1,122.24 ", $594.12 , $993.65 , $913.44 , $600.62 , N/A , $477.60 , $477.60 ," $1,110.55 ", $553.84 , $163.07 ," $1,122.24 "
Advance Care Planning Discuss Documented in Medical Record,CPT® 1158F,N/A,N/A,N/A, $5.00 , $3.25 , N/A , N/A , N/A , N/A , N/A , $4.65 , $4.50 , $4.50 , $4.00 , $4.00 , N/A , $4.62 , $4.75 , $4.50 , $4.50 , $4.50 , $4.65 , $4.80 , N/A , $4.25 , N/A , N/A , N/A , N/A , N/A , $4.75 , N/A , $4.00 , $4.80 
 Pro Arthrs Kne Surg W/Meniscectomy Med/Lat W/Shvg ,CPT® 29881,0975 - PRO FEE/OR,N/A,N/A," $4,242.00 "," $2,757.30 "," $3,302.59 ", $518.48 , $554.63 ," $2,617.29 "," $2,621.37 "," $3,945.06 "," $3,817.80 "," $3,817.80 "," $3,393.60 "," $3,393.60 ", $554.63 ," $3,916.64 "," $4,029.90 "," $3,817.80 "," $3,817.80 "," $3,817.80 "," $3,945.06 "," $4,072.32 "," $3,585.30 "," $3,605.70 "," $2,891.97 "," $3,087.83 ", N/A ," $2,668.36 "," $2,668.36 "," $4,029.90 "," $3,136.28 ", $518.48 ," $4,072.32 "
" Pro Hemorrhoidectomy,Int/Ext,Complx ",CPT® 46260,0982 - PRO FEE/OUTPT,N/A,N/A," $3,579.00 "," $2,326.35 "," $2,955.75 ", $458.53 , $387.88 ," $2,254.34 "," $2,301.47 "," $3,328.47 "," $3,221.10 "," $3,221.10 "," $2,863.20 "," $2,863.20 ", $387.88 ," $3,304.49 "," $3,400.05 "," $3,221.10 "," $3,221.10 "," $3,221.10 "," $3,328.47 "," $3,435.84 "," $2,108.62 "," $3,042.15 "," $2,536.94 "," $2,681.16 ", N/A ," $2,298.33 "," $2,298.33 "," $3,400.05 "," $2,403.80 ", $387.88 ," $3,435.84 "
 Fac Iaad Ia Hpylori Stool ,CPT® 87338,0306 - LAB/BACT-MICRO,N/A,N/A, $193.00 , $125.45 , $162.12 , $14.67 , $14.67 , $155.94 , $173.70 , $163.39 , $173.70 , $173.70 , $173.70 , $164.05 , $14.38 , $178.20 , $183.35 , $164.05 , $179.49 , $179.49 , $183.35 , $185.28 , $157.91 , $173.70 , $164.05 , $152.47 , N/A , $156.19 , $156.19 , $183.35 , $165.61 , $14.38 , $185.28 
 Fac Plasma 1 Donor Frz W/in 8 Hr ,HCPCS P9017,0390 - BLOOD/STOR-PROC,N/A,N/A, $194.00 , $126.10 , $162.96 , N/A , $39.42 , $156.75 , $174.60 , $164.24 , $174.60 , $174.60 , $174.60 , $164.90 , $38.65 , $179.12 , $184.30 , $164.90 , $180.42 , $180.42 , $184.30 , $186.24 , $158.73 , $174.60 , $164.90 , $153.26 , N/A , $157.00 , $157.00 , $184.30 , $166.47 , $38.65 , $186.24 
 NOREPINEPHRINE-SODIUM CHLORIDE 8-0.9 MG/250ML-% IV SOLN ,HCPCS RXA250,0250 - PHARMACY,69374-0316-25,250 mL, $114.30 , $74.30 , $96.01 , N/A , N/A , $92.35 , $102.87 , $96.77 , $102.87 , $102.87 , $102.87 , $97.16 , N/A , $105.53 , $108.59 , $97.16 , $106.30 , $106.30 , $108.59 , $109.73 , $93.52 , $102.87 , $97.16 , $90.30 , N/A , $92.50 , $92.50 , $108.59 , $98.08 , $90.30 , $109.73 
 Fac Cltx Inter/Peri/Subtrochanteric Fem Fx W/O Mnpj ,CPT® 27238,0761 - TREATMENT ROOM,N/A,N/A," $3,718.00 "," $2,416.70 "," $3,123.12 ", $451.16 , $461.04 ," $3,004.14 "," $3,346.20 "," $3,147.66 "," $3,346.20 "," $3,346.20 "," $3,346.20 "," $3,160.30 ", $452.00 ," $3,432.83 "," $3,532.10 "," $3,160.30 "," $3,457.74 "," $3,457.74 "," $3,532.10 "," $3,569.28 "," $3,042.07 "," $3,346.20 "," $3,160.30 "," $2,937.22 ", N/A ," $3,008.98 "," $3,008.98 "," $3,532.10 "," $3,190.42 ", $451.16 ," $3,569.28 "
 NIFEDIPINE 10 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,23155-0194-01,1 capsule, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
" Bilirubin, Total Beaker1 ",CPT® 82247,0301 - LAB/CHEMISTRY,N/A,N/A, $70.00 , $45.50 , $58.80 , $5.12 , $5.12 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $5.02 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $5.02 , $67.20 
 Fac Rm Chg Nicu Level 3 ,Custom 1730000002,0173 - NURSERY LEVEL III,N/A,N/A," $6,286.00 "," $4,085.90 "," $5,280.24 ", N/A , N/A ," $5,079.09 "," $5,657.40 "," $5,321.73 "," $5,657.40 "," $5,657.40 "," $5,657.40 "," $5,343.10 ", N/A ," $5,803.86 "," $5,971.70 "," $5,343.10 "," $5,845.98 "," $5,845.98 "," $5,971.70 "," $6,034.56 "," $5,143.21 "," $5,657.40 "," $5,343.10 "," $4,965.94 ", N/A ," $5,087.26 "," $5,087.26 "," $5,971.70 "," $5,394.02 "," $4,965.94 "," $6,034.56 "
 Pro Lyr Clsr N/H/F/Xtrnl Gent 7.6 Cm-12.5 Cm ,CPT® 12044,0982 - PRO FEE/OUTPT,N/A,N/A," $1,440.00 ", $936.00 , $680.71 , $204.36 , $138.28 , $588.98 , $571.43 ," $1,339.20 "," $1,296.00 "," $1,296.00 "," $1,152.00 "," $1,152.00 ", $138.28 ," $1,329.55 "," $1,368.00 "," $1,296.00 "," $1,296.00 "," $1,296.00 "," $1,339.20 "," $1,382.40 ", $745.42 ," $1,224.00 "," $1,141.80 ", $753.29 , N/A , $600.46 , $600.46 ," $1,368.00 ", $696.35 , $138.28 ," $1,382.40 "
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw,CPT® 72081,N/A,N/A,N/A, $364.00 , $236.60 , $290.36 , $42.04 , $30.44 , $184.46 , $194.97 , $338.52 , $327.60 , $327.60 , $291.20 , $291.20 , $30.44 , $336.08 , $345.80 , $327.60 , $327.60 , $327.60 , $338.52 , $349.44 , $232.08 , $309.40 , $245.55 , $193.86 , N/A , $188.06 , $188.06 , $345.80 , $217.69 , $30.44 , $349.44 
 Resp Virus 6-11 Targets ,CPT® 87632,0300 - LABORATORY,N/A,N/A," $1,541.00 "," $1,001.65 "," $1,294.44 ", $222.42 , $222.42 ," $1,245.13 "," $1,386.90 "," $1,304.61 "," $1,386.90 "," $1,386.90 "," $1,386.90 "," $1,309.85 ", $218.06 ," $1,422.81 "," $1,463.95 "," $1,309.85 "," $1,433.13 "," $1,433.13 "," $1,463.95 "," $1,479.36 "," $1,260.85 "," $1,386.90 "," $1,309.85 "," $1,217.39 ", N/A ," $1,247.13 "," $1,247.13 "," $1,463.95 "," $1,322.33 ", $218.06 ," $1,479.36 "
 Fac Endomyocardial Biopsy ,CPT® 93505,0481 - CARDIAC CATH LAB,N/A,N/A," $6,190.00 "," $4,023.50 "," $5,199.60 ", $624.92 , $471.35 ," $5,001.52 "," $5,571.00 "," $5,240.45 "," $5,571.00 "," $5,571.00 "," $5,571.00 "," $5,261.50 ", $462.11 ," $5,715.23 "," $5,880.50 "," $5,261.50 "," $5,756.70 "," $5,756.70 "," $5,880.50 "," $5,942.40 "," $5,064.66 "," $5,571.00 "," $5,261.50 "," $4,890.10 ", N/A ," $5,009.57 "," $5,009.57 "," $5,880.50 "," $5,311.64 ", $462.11 ," $5,942.40 "
 Cystogram Min 3 Views ,CPT® 74430,0320 - DX X-RAY,N/A,N/A, $316.00 , $205.40 , $265.44 , $40.61 , $59.34 , $255.33 , $284.40 , $267.53 , $284.40 , $284.40 , $284.40 , $268.60 , $58.18 , $291.76 , $300.20 , $268.60 , $293.88 , $293.88 , $300.20 , $303.36 , $258.55 , $284.40 , $268.60 , $249.64 , N/A , $255.74 , $255.74 , $300.20 , $271.16 , $40.61 , $303.36 
Injection Rx Extremity Pseudoaneurysm,CPT® 36002,N/A,N/A,N/A," $1,020.00 ", $663.00 , $625.50 , $97.28 , $106.54 , $466.26 , $460.01 , $948.60 , $918.00 , $918.00 , $816.00 , $816.00 , $106.54 , $941.77 , $969.00 , $918.00 , $918.00 , $918.00 , $948.60 , $979.20 , $579.61 , $867.00 , $567.33 , $524.73 , N/A , $475.35 , $475.35 , $969.00 , $540.00 , $97.28 , $979.20 
 Fac Prim Prq Trluml Mchnl Thrmbc N-Cor N-Icra Sbsq ,CPT® 37185,0761 - TREATMENT ROOM,N/A,N/A," $1,870.00 "," $1,215.50 "," $1,570.80 ", $147.35 , $822.25 ," $1,510.96 "," $1,683.00 "," $1,583.14 "," $1,683.00 "," $1,683.00 "," $1,683.00 "," $1,589.50 ", $806.13 ," $1,726.57 "," $1,776.50 "," $1,589.50 "," $1,739.10 "," $1,739.10 "," $1,776.50 "," $1,795.20 "," $1,530.03 "," $1,683.00 "," $1,589.50 "," $1,477.30 ", N/A ," $1,513.39 "," $1,513.39 "," $1,776.50 "," $1,604.65 ", $147.35 ," $1,795.20 "
 TOPOTECAN HCL 4 MG IV SOLR ,HCPCS J9351,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0762-10,4 mL," $1,448.60 ", $941.59 ," $1,216.82 ", $0.51 , $1.20 ," $1,170.47 "," $1,303.74 "," $1,226.38 "," $1,303.74 "," $1,303.74 "," $1,303.74 "," $1,231.31 ", $1.18 ," $1,337.49 "," $1,376.17 "," $1,231.31 "," $1,347.20 "," $1,347.20 "," $1,376.17 "," $1,390.66 "," $1,185.24 "," $1,303.74 "," $1,231.31 "," $1,144.39 ", N/A ," $1,172.35 "," $1,172.35 "," $1,376.17 "," $1,243.04 ", $0.51 ," $1,390.66 "
Bevacizumab Injection,HCPCS J9035,N/A,N/A,N/A, $338.00 , $219.70 , N/A , $75.05 , $72.78 , N/A , N/A , $314.34 , $304.20 , $304.20 , $270.40 , $270.40 , $72.78 , $312.08 , $321.10 , $304.20 , $304.20 , $304.20 , $314.34 , $324.48 , $91.78 , $287.30 , $120.67 , $97.68 , N/A , N/A , N/A , $321.10 , N/A , $72.78 , $324.48 
"Closed Rx Femur,Distal+Manip",27510,N/A,N/A,N/A," $4,322.00 "," $2,809.30 "," $4,123.21 ", $649.41 , $804.14 ," $3,298.21 "," $3,295.28 "," $4,019.46 "," $3,889.80 "," $3,889.80 "," $3,457.60 "," $3,457.60 ", $804.14 ," $3,990.50 "," $4,105.90 "," $3,889.80 "," $3,889.80 "," $3,889.80 "," $4,019.46 "," $4,149.12 "," $3,845.81 "," $3,673.70 "," $3,639.49 "," $3,885.11 ", N/A ," $3,362.57 "," $3,362.57 "," $4,105.90 "," $3,952.22 ", $649.41 ," $4,149.12 "
 Pro Cltx Dstl Xtnsr Tdn Insj +-Prq Pinning ,CPT® 26432,0982 - PRO FEE/OUTPT,N/A,N/A," $2,574.00 "," $1,673.10 "," $3,451.37 ", $536.34 , $414.43 ," $2,376.11 "," $2,426.04 "," $2,393.82 "," $2,316.60 "," $2,316.60 "," $2,059.20 "," $2,059.20 ", $414.43 ," $2,376.57 "," $2,445.30 "," $2,316.60 "," $2,316.60 "," $2,316.60 "," $2,393.82 "," $2,471.04 "," $3,147.05 "," $2,187.90 "," $2,651.12 "," $2,837.40 ", N/A ," $2,422.47 "," $2,422.47 "," $2,445.30 "," $2,847.28 ", $414.43 ," $3,451.37 "
Remove Impacted Cerumen,69210,N/A,N/A,N/A, $116.00 , $75.40 , $154.15 , $31.15 , $14.13 , $157.99 , $157.57 , $107.88 , $104.40 , $104.40 , $92.80 , $92.80 , $14.13 , $107.10 , $110.20 , $104.40 , $104.40 , $104.40 , $107.88 , $111.36 , $170.16 , $98.60 , $171.27 , $161.15 , N/A , $161.08 , $161.08 , $110.20 , $183.90 , $14.13 , $183.90 
 Complex Repair Scalp/Arm/Leg 2.6-7.5cm ,CPT® 13121,0981 - PRO FEE/ER,N/A,N/A," $1,861.00 "," $1,209.65 ", $826.64 , $247.45 , $218.65 , $731.79 , $713.39 ," $1,730.73 "," $1,674.90 "," $1,674.90 "," $1,488.80 "," $1,488.80 ", $218.65 ," $1,718.26 "," $1,767.95 "," $1,674.90 "," $1,674.90 "," $1,674.90 "," $1,730.73 "," $1,786.56 ", $912.10 ," $1,581.85 "," $1,421.90 ", $938.47 , N/A , $746.06 , $746.06 ," $1,767.95 ", $865.20 , $218.65 ," $1,786.56 "
Mycoplasma Culture,CPT® 87109,N/A,N/A,N/A, $204.00 , $132.60 , N/A , $15.70 , $13.83 , $56.37 , $67.39 , $189.72 , $183.60 , $183.60 , $163.20 , $163.20 , $13.83 , $188.35 , $193.80 , $183.60 , $183.60 , $183.60 , $189.72 , $195.84 , $102.76 , $173.40 , $100.55 , $55.80 , N/A , $52.61 , $52.61 , $193.80 , $57.49 , $13.83 , $195.84 
" Colon/Barium Enema, Noncovered ",HCPCS G0122,0320 - DX X-RAY,N/A,N/A," $1,702.00 "," $1,106.30 "," $1,429.68 ", $321.32 , $22.30 ," $1,375.22 "," $1,531.80 "," $1,440.91 "," $1,531.80 "," $1,531.80 "," $1,531.80 "," $1,446.70 ", $21.86 ," $1,571.46 "," $1,616.90 "," $1,446.70 "," $1,582.86 "," $1,582.86 "," $1,616.90 "," $1,633.92 "," $1,392.58 "," $1,531.80 "," $1,446.70 "," $1,344.58 ", N/A ," $1,377.43 "," $1,377.43 "," $1,616.90 "," $1,460.49 ", $21.86 ," $1,633.92 "
"Lap,Appendectomy",CPT® 44970,N/A,N/A,N/A," $5,469.00 "," $3,554.85 "," $3,603.80 ", $559.02 , $505.80 ," $2,823.58 "," $2,862.61 "," $5,086.17 "," $4,922.10 "," $4,922.10 "," $4,375.20 "," $4,375.20 ", $505.80 ," $5,049.53 "," $5,195.55 "," $4,922.10 "," $4,922.10 "," $4,922.10 "," $5,086.17 "," $5,250.24 "," $2,577.70 "," $4,648.65 "," $3,179.20 "," $3,336.46 ", N/A ," $2,878.67 "," $2,878.67 "," $5,195.55 "," $3,010.78 ", $505.80 ," $5,250.24 "
"Close Med Sternotomy Sep, W/WO Debride",CPT® 21750,N/A,N/A,N/A," $5,891.00 "," $3,829.15 "," $4,011.35 ", $621.14 , $954.83 ," $3,277.50 "," $3,278.71 "," $5,478.63 "," $5,301.90 "," $5,301.90 "," $4,712.80 "," $4,712.80 ", $954.83 ," $5,439.16 "," $5,596.45 "," $5,301.90 "," $5,301.90 "," $5,301.90 "," $5,478.63 "," $5,655.36 "," $3,734.09 "," $5,007.35 "," $3,671.60 "," $3,813.49 ", N/A ," $3,341.45 "," $3,341.45 "," $5,596.45 "," $3,927.39 ", $621.14 ," $5,655.36 "
Saline Infusion Sonohysterography,CPT® 76831,N/A,N/A,N/A, $924.00 , $600.60 , $665.55 , $115.52 , $86.37 , $569.55 , $668.15 , $859.32 , $831.60 , $831.60 , $739.20 , $739.20 , $86.37 , $853.13 , $877.80 , $831.60 , $831.60 , $831.60 , $859.32 , $887.04 , $670.57 , $785.40 , $729.97 , $672.66 , N/A , $580.66 , $580.66 , $877.80 , $672.12 , $86.37 , $887.04 
 Fac in Situ Hybridization Ea Multiplex Probe Stain ,CPT® 88366,0310 - PATHOLOGY LAB,N/A,N/A, $836.00 , $543.40 , $702.24 , $274.14 , $117.74 , $675.49 , $752.40 , $707.76 , $752.40 , $752.40 , $752.40 , $710.60 , $115.43 , $771.88 , $794.20 , $710.60 , $777.48 , $777.48 , $794.20 , $802.56 , $684.02 , $752.40 , $710.60 , $660.44 , N/A , $676.57 , $676.57 , $794.20 , $717.37 , $115.43 , $802.56 
" Fac Cytopath, C/V, Interpret ",CPT® 88141,0310 - PATHOLOGY LAB,N/A,N/A, $192.00 , $124.80 , $161.28 , $22.56 , $22.43 , $155.14 , $172.80 , $162.55 , $172.80 , $172.80 , $172.80 , $163.20 , $21.99 , $177.27 , $182.40 , $163.20 , $178.56 , $178.56 , $182.40 , $184.32 , $157.09 , $172.80 , $163.20 , $151.68 , N/A , $155.39 , $155.39 , $182.40 , $164.76 , $21.99 , $184.32 
Dilation Rectal Stricture W Anest,45910,N/A,N/A,N/A," $1,299.00 ", $844.35 ," $1,180.79 ", $183.62 , $133.31 , $928.53 , $952.03 ," $1,208.07 "," $1,169.10 "," $1,169.10 "," $1,039.20 "," $1,039.20 ", $133.31 ," $1,199.37 "," $1,234.05 "," $1,169.10 "," $1,169.10 "," $1,169.10 "," $1,208.07 "," $1,247.04 ", $840.60 ," $1,104.15 "," $1,045.46 "," $1,098.70 ", N/A , $946.64 , $946.64 ," $1,234.05 ", $990.08 , $133.31 ," $1,247.04 "
" Pro CT Angiography, Neck ",CPT® 70498,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,043.00 ", $677.95 ," $1,769.74 ", $256.30 , $377.53 ," $1,392.40 "," $2,729.49 ", $969.99 , $938.70 , $938.70 , $834.40 , $834.40 , $377.53 , $963.00 , $990.85 , $938.70 , $938.70 , $938.70 , $969.99 ," $1,001.28 "," $1,635.33 ", $886.55 ," $2,975.73 "," $1,895.67 ", N/A ," $1,419.57 "," $1,419.57 ", $990.85 ," $1,643.18 ", $256.30 ," $2,975.73 "
Punch Biopsy Skin Ea Sep/Additional Lesion,CPT® 11105,N/A,N/A,N/A, $229.00 , $148.85 , $82.38 , $24.42 , $48.20 , $69.36 , N/A , $212.97 , $206.10 , $206.10 , $183.20 , $183.20 , $48.20 , $211.44 , $217.55 , $206.10 , $206.10 , $206.10 , $212.97 , $219.84 , $90.89 , $194.65 , $135.05 , $95.17 , N/A , $70.71 , $70.71 , $217.55 , $81.99 , $24.42 , $219.84 
 Other Infectious And Parasitic Diseases Diagnoses With Cc ,MS DRG V40 (FY2023) 868,N/A,N/A,N/A," $20,981.71 "," $13,638.11 "," $17,624.64 ", N/A , N/A ," $16,953.22 "," $18,883.54 "," $17,763.12 "," $18,883.54 "," $18,883.54 "," $18,883.54 "," $17,834.45 ", N/A ," $19,372.41 "," $19,932.62 "," $17,834.45 "," $19,512.99 "," $19,512.99 "," $19,932.62 "," $20,142.44 "," $17,167.24 "," $18,883.54 "," $17,834.45 "," $16,575.55 ", N/A ," $16,980.50 "," $16,980.50 "," $19,932.62 "," $18,004.41 "," $16,575.55 "," $20,142.44 "
Evacuate Mole of Uterus,CPT® 59870,N/A,N/A,N/A," $2,119.00 "," $1,377.35 "," $1,483.80 ", $501.65 , $366.32 ," $1,092.41 "," $1,161.47 "," $1,970.67 "," $1,907.10 "," $1,907.10 "," $1,695.20 "," $1,695.20 ", $366.32 ," $1,956.47 "," $2,013.05 "," $1,907.10 "," $1,907.10 "," $1,907.10 "," $1,970.67 "," $2,034.24 "," $1,468.49 "," $1,801.15 "," $2,549.43 "," $2,042.95 ", N/A ," $1,113.73 "," $1,113.73 "," $2,013.05 "," $1,287.58 ", $366.32 ," $2,549.43 "
Lens Sphcy Bifocal 4.00d/4.2,HCPCS V2205,N/A,N/A,N/A, $85.00 , $55.25 , N/A , $71.68 , N/A , N/A , N/A , $79.05 , $76.50 , $76.50 , $68.00 , $68.00 , N/A , $78.48 , $80.75 , $76.50 , $76.50 , $76.50 , $79.05 , $81.60 , N/A , $72.25 , $85.00 , $65.12 , N/A , N/A , N/A , $80.75 , N/A , $65.12 , $85.00 
M/Phmtrc Alys Ish Quant/Semiq Mnl Each Multiprb,CPT® 88377,N/A,N/A,N/A," $1,385.00 ", $900.25 ," $1,442.41 ", $389.56 , $168.73 , $850.80 , $976.01 ," $1,288.05 "," $1,246.50 "," $1,246.50 "," $1,108.00 "," $1,108.00 ", $168.73 ," $1,278.77 "," $1,315.75 "," $1,246.50 "," $1,246.50 "," $1,246.50 "," $1,288.05 "," $1,329.60 "," $2,683.91 "," $1,177.25 "," $1,907.75 "," $1,419.29 ", N/A , $794.02 , $794.02 ," $1,315.75 ", $872.60 , $168.73 ," $2,683.91 "
 Fac Gas Dilut/Washout Lung Vol W/WO Distrib Vent&Vol ,CPT® 94727,0460 - PULMONARY FUNC,N/A,N/A, $446.00 , $289.90 , $374.64 , $42.70 , $32.97 , $360.37 , $401.40 , $377.58 , $401.40 , $401.40 , $401.40 , $379.10 , $32.32 , $411.79 , $423.70 , $379.10 , $414.78 , $414.78 , $423.70 , $428.16 , $364.92 , $401.40 , $379.10 , $352.34 , N/A , $360.95 , $360.95 , $423.70 , $382.71 , $32.32 , $428.16 
 Neck MR Angio With Contrast ,CPT® 70548,0615 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA-HEAD AND NECK,N/A,N/A," $5,945.00 "," $3,864.25 "," $4,993.80 ", $252.14 , $476.52 ," $4,803.56 "," $5,350.50 "," $5,033.04 "," $5,350.50 "," $5,350.50 "," $5,350.50 "," $5,053.25 ", $467.18 ," $5,489.02 "," $5,647.75 "," $5,053.25 "," $5,528.85 "," $5,528.85 "," $5,647.75 "," $5,707.20 "," $4,864.20 "," $5,350.50 "," $5,053.25 "," $4,696.55 ", N/A ," $4,811.29 "," $4,811.29 "," $5,647.75 "," $5,101.40 ", $252.14 ," $5,707.20 "
"Leukocyte Assessment,Fecal",CPT® 89055,N/A,N/A,N/A, $70.00 , $45.50 , N/A , $4.36 , $4.36 , $23.91 , $28.90 , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $4.36 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , $28.51 , $59.50 , $27.57 , $15.45 , N/A , $22.31 , $22.31 , $66.50 , $24.52 , $4.36 , $67.20 
"Excis Chalazion,Mult,Both Lids",CPT® 67805,N/A,N/A,N/A," $1,819.00 "," $1,182.35 "," $1,006.40 ", $158.24 , $91.58 , $933.61 , $880.63 ," $1,691.67 "," $1,637.10 "," $1,637.10 "," $1,455.20 "," $1,455.20 ", $91.58 ," $1,679.48 "," $1,728.05 "," $1,637.10 "," $1,637.10 "," $1,637.10 "," $1,691.67 "," $1,746.24 "," $1,380.06 "," $1,546.15 ", $915.22 ," $1,181.83 ", N/A , $951.82 , $951.82 ," $1,728.05 "," $1,050.69 ", $91.58 ," $1,746.24 "
Transurethral Resec Bladder Neck,CPT® 52500,N/A,N/A,N/A," $3,272.00 "," $2,126.80 "," $2,667.89 ", $471.18 , $768.38 ," $2,386.11 "," $2,230.20 "," $3,042.96 "," $2,944.80 "," $2,944.80 "," $2,617.60 "," $2,617.60 ", $768.38 ," $3,021.04 "," $3,108.40 "," $2,944.80 "," $2,944.80 "," $2,944.80 "," $3,042.96 "," $3,141.12 "," $2,671.11 "," $2,781.20 "," $2,522.67 "," $3,004.95 ", N/A ," $2,432.66 "," $2,432.66 "," $3,108.40 "," $2,859.25 ", $471.18 ," $3,141.12 "
 Pro Lyr Clsr S/a/T/E 2.5 Cm/< ,CPT® 12031,0982 - PRO FEE/OUTPT,N/A,N/A, $981.00 , $637.65 , $484.53 , $146.05 , $60.48 , $418.18 , $412.35 , $912.33 , $882.90 , $882.90 , $784.80 , $784.80 , $60.48 , $905.76 , $931.95 , $882.90 , $882.90 , $882.90 , $912.33 , $941.76 , $531.98 , $833.85 , $820.67 , $538.15 , N/A , $426.34 , $426.34 , $931.95 , $494.42 , $60.48 , $941.76 
Qual Nonmd Est Pt 21>Min,HCPCS G2063,N/A,N/A,N/A, $87.00 , $56.55 , N/A , N/A , N/A , $59.88 , N/A , $80.91 , $78.30 , $78.30 , $69.60 , $69.60 , N/A , $80.33 , $82.65 , $78.30 , $78.30 , $78.30 , $80.91 , $83.52 , N/A , $73.95 , N/A , N/A , N/A , N/A , N/A , $82.65 , N/A , $59.88 , $83.52 
 Pro Cltx Kne Dislc W/O Anes ,CPT® 27550,0981 - PRO FEE/ER,N/A,N/A," $2,646.00 "," $1,719.90 "," $2,906.74 ", $457.68 , $230.52 ," $2,249.22 "," $2,237.47 "," $2,460.78 "," $2,381.40 "," $2,381.40 "," $2,116.80 "," $2,116.80 ", $230.52 ," $2,443.05 "," $2,513.70 "," $2,381.40 "," $2,381.40 "," $2,381.40 "," $2,460.78 "," $2,540.16 "," $2,767.41 "," $2,249.10 "," $2,462.01 "," $2,706.32 ", N/A ," $2,293.11 "," $2,293.11 "," $2,513.70 "," $2,695.20 ", $230.52 ," $2,906.74 "
Penicillin G Benzathine Inj,HCPCS J0561,N/A,N/A,N/A, $14.00 , $9.10 , N/A , $20.57 , $18.96 , N/A , N/A , $13.02 , $12.60 , $12.60 , $11.20 , $11.20 , $18.96 , $12.93 , $13.30 , $12.60 , $12.60 , $12.60 , $13.02 , $13.44 , $19.75 , $11.90 , $9.08 , $21.82 , N/A , N/A , N/A , $13.30 , N/A , $9.08 , $21.82 
Hiv-1,CPT® 86701,N/A,N/A,N/A, $133.00 , $86.45 , N/A , $9.07 , $9.07 , $50.26 , $60.11 , $123.69 , $119.70 , $119.70 , $106.40 , $106.40 , $9.07 , $122.80 , $126.35 , $119.70 , $119.70 , $119.70 , $123.69 , $127.68 , $59.36 , $113.05 , $58.39 , $32.22 , N/A , $46.91 , $46.91 , $126.35 , $51.26 , $9.07 , $127.68 
" Reduction Nursemaids Elbow, Child -Mh ",CPT® 24640,0361 - OR/MINOR,N/A,N/A, $616.00 , $400.40 , $517.44 , $78.44 , $62.26 , $497.73 , $554.40 , $521.51 , $554.40 , $554.40 , $554.40 , $523.60 , $61.04 , $568.75 , $585.20 , $523.60 , $572.88 , $572.88 , $585.20 , $591.36 , $504.01 , $554.40 , $523.60 , $486.64 , N/A , $498.53 , $498.53 , $585.20 , $528.59 , $61.04 , $591.36 
 Fac Blastomyces Antibody ,CPT® 86612,0300 - LABORATORY,N/A,N/A, $141.00 , $91.65 , $118.44 , $13.16 , $8.07 , $113.93 , $126.90 , $119.37 , $126.90 , $126.90 , $126.90 , $119.85 , $7.91 , $130.19 , $133.95 , $119.85 , $131.13 , $131.13 , $133.95 , $135.36 , $115.37 , $126.90 , $119.85 , $111.39 , N/A , $114.11 , $114.11 , $133.95 , $120.99 , $7.91 , $135.36 
"Removal Spleen, Partial",CPT® 38101,N/A,N/A,N/A," $6,057.00 "," $3,937.05 "," $5,306.45 "," $1,066.59 ", $922.06 ," $4,038.84 "," $4,124.75 "," $5,633.01 "," $5,451.30 "," $5,451.30 "," $4,845.60 "," $4,845.60 ", $922.06 ," $5,592.43 "," $5,754.15 "," $5,451.30 "," $5,451.30 "," $5,451.30 "," $5,633.01 "," $5,814.72 "," $5,681.68 "," $5,148.45 "," $6,126.48 "," $5,563.41 ", N/A ," $4,117.64 "," $4,117.64 "," $5,754.15 "," $4,777.01 ", $922.06 ," $6,126.48 "
 DARBEPOETIN ALFA 100 MCG/0.5ML IJ SOSY ,HCPCS J0882,0636 - DRUGS REQUIRING DETAILED CODIN,55513-0025-04,0.5 mL," $2,275.81 "," $1,479.28 "," $1,911.68 ", $3.00 , N/A ," $1,838.85 "," $2,048.23 "," $1,926.70 "," $2,048.23 "," $2,048.23 "," $2,048.23 "," $1,934.44 ", N/A ," $2,101.26 "," $2,162.02 "," $1,934.44 "," $2,116.50 "," $2,116.50 "," $2,162.02 "," $2,184.78 "," $1,862.07 "," $2,048.23 "," $1,934.44 "," $1,797.89 ", N/A ," $1,841.81 "," $1,841.81 "," $2,162.02 "," $1,952.87 ", $3.00 ," $2,184.78 "
 Pro Office/OP Consltj New/Est Pt Low Mdm 30 Minutes ,CPT® 99243,0988 - PRO FEE/CONSULT,N/A,N/A, $458.00 , $297.70 , N/A , $111.35 , $86.25 , $212.16 , $211.38 , $425.94 , $412.20 , $412.20 , $366.40 , $366.40 , $86.25 , $422.87 , $435.10 , $412.20 , $412.20 , $412.20 , $425.94 , $439.68 , $265.90 , $389.30 , $207.78 , $209.99 , $161.25 , $216.30 , $216.30 , $435.10 , $257.50 , $86.25 , $439.68 
 Fac Assay of Oxalate ,CPT® 83945,0306 - LAB/BACT-MICRO,N/A,N/A, $128.00 , $83.20 , $107.52 , $14.74 , $14.74 , $103.42 , $115.20 , $108.36 , $115.20 , $115.20 , $115.20 , $108.80 , $14.45 , $118.18 , $121.60 , $108.80 , $119.04 , $119.04 , $121.60 , $122.88 , $104.73 , $115.20 , $108.80 , $101.12 , N/A , $103.59 , $103.59 , $121.60 , $109.84 , $14.45 , $122.88 
Knee Scope/Surg/Incond Fx Aid+Fixat,CPT® 29851,N/A,N/A,N/A," $6,168.00 "," $4,009.20 "," $5,621.79 ", $880.69 , $998.57 ," $4,501.03 "," $4,461.37 "," $5,736.24 "," $5,551.20 "," $5,551.20 "," $4,934.40 "," $4,934.40 ", $998.57 ," $5,694.91 "," $5,859.60 "," $5,551.20 "," $5,551.20 "," $5,551.20 "," $5,736.24 "," $5,921.28 "," $5,238.11 "," $5,242.80 "," $4,932.94 "," $5,296.27 ", N/A ," $4,588.85 "," $4,588.85 "," $5,859.60 "," $5,393.54 ", $880.69 ," $5,921.28 "
 Pro Treat Fracture of Radius ,CPT® 25515,0982 - PRO FEE/OUTPT,N/A,N/A," $3,334.00 "," $2,167.10 "," $4,092.14 ", $643.00 , $614.70 ," $3,224.60 "," $3,220.84 "," $3,100.62 "," $3,000.60 "," $3,000.60 "," $2,667.20 "," $2,667.20 ", $614.70 ," $3,078.28 "," $3,167.30 "," $3,000.60 "," $3,000.60 "," $3,000.60 "," $3,100.62 "," $3,200.64 "," $3,797.55 "," $2,833.90 "," $3,550.29 "," $3,809.50 ", N/A ," $3,287.51 "," $3,287.51 "," $3,167.30 "," $3,864.00 ", $614.70 ," $4,092.14 "
 Fac Nasal/Sinus Ndsc Surg W/Dilation Maxillary Sinus ,CPT® 31295,0761 - TREATMENT ROOM,N/A,N/A, $905.00 , $588.25 , $760.20 , $150.53 , $127.09 , $731.24 , $814.50 , $766.17 , $814.50 , $814.50 , $814.50 , $769.25 , $124.60 , $835.59 , $859.75 , $769.25 , $841.65 , $841.65 , $859.75 , $868.80 , $740.47 , $814.50 , $769.25 , $714.95 , N/A , $732.42 , $732.42 , $859.75 , $776.58 , $124.60 , $868.80 
 Pro Repair Superficial Wound 7.8-12.5cm ,CPT® 12004,0982 - PRO FEE/OUTPT,N/A,N/A, $848.00 , $551.20 , $227.60 , $67.81 , $89.32 , $199.60 , $193.84 , $788.64 , $763.20 , $763.20 , $678.40 , $678.40 , $89.32 , $782.96 , $805.60 , $763.20 , $763.20 , $763.20 , $788.64 , $814.08 , $250.63 , $720.80 , $388.93 , $254.00 , N/A , $203.50 , $203.50 , $805.60 , $235.99 , $67.81 , $814.08 
 Pro CT Angio Upr Extrm W/O&W/Dye ,CPT® 73206,0972 - PRO FEE/RAD/DX,N/A,N/A, $944.00 , $613.60 ," $1,784.30 ", $258.04 , $354.97 ," $1,553.66 "," $1,932.34 ", $877.92 , $849.60 , $849.60 , $755.20 , $755.20 , $354.97 , $871.60 , $896.80 , $849.60 , $849.60 , $849.60 , $877.92 , $906.24 ," $1,801.11 ", $802.40 ," $2,103.24 "," $2,127.75 ", N/A ," $1,583.97 "," $1,583.97 ", $896.80 ," $1,833.50 ", $258.04 ," $2,127.75 "
 Fac Demo&/Eval of Pt Utiliz Aersl Gen/Neb/Inhlr/Ippb ,CPT® 94664,0410 - RESPIRATORY SVC,N/A,N/A, $241.00 , $156.65 , $202.44 , $16.52 , $17.33 , $194.73 , $216.90 , $204.03 , $216.90 , $216.90 , $216.90 , $204.85 , $16.99 , $222.52 , $228.95 , $204.85 , $224.13 , $224.13 , $228.95 , $231.36 , $197.19 , $216.90 , $204.85 , $190.39 , N/A , $195.04 , $195.04 , $228.95 , $206.80 , $16.52 , $231.36 
 Pro CT Abdomen W/Dye ,CPT® 74160,0972 - PRO FEE/RAD/DX,N/A,N/A, $715.00 , $464.75 ," $1,618.68 ", $234.02 , $324.11 ," $1,099.56 "," $1,413.93 ", $664.95 , $643.50 , $643.50 , $572.00 , $572.00 , $324.11 , $660.16 , $679.25 , $643.50 , $643.50 , $643.50 , $664.95 , $686.40 ," $1,400.79 ", $607.75 ," $1,600.54 "," $1,497.83 ", N/A ," $1,121.02 "," $1,121.02 ", $679.25 ," $1,297.60 ", $234.02 ," $1,618.68 "
"Blood Lipoprotein,Hdl Cholest",CPT® 83718,N/A,N/A,N/A, $87.00 , $56.55 , N/A , $8.35 , $8.35 , $46.31 , $55.44 , $80.91 , $78.30 , $78.30 , $69.60 , $69.60 , $8.35 , $80.33 , $82.65 , $78.30 , $78.30 , $78.30 , $80.91 , $83.52 , $54.69 , $73.95 , $53.52 , $29.72 , N/A , $43.22 , $43.22 , $82.65 , $47.23 , $8.35 , $83.52 
Afo Sing Upright W/ Adjust S,HCPCS L1920,N/A,N/A,N/A, $536.00 , $348.40 , N/A , $480.53 , $216.99 , N/A , N/A , $498.48 , $482.40 , $482.40 , $428.80 , $428.80 , $216.99 , $494.89 , $509.20 , $482.40 , $482.40 , $482.40 , $498.48 , $514.56 , N/A , $455.60 , $353.57 , $404.29 , N/A , N/A , N/A , $509.20 , N/A , $216.99 , $514.56 
Simple Repair 21.1-30cm,12017,N/A,N/A,N/A," $1,403.00 ", $911.95 , $471.41 , $141.05 , $247.42 , $417.96 , $400.18 ," $1,304.79 "," $1,262.70 "," $1,262.70 "," $1,122.40 "," $1,122.40 ", $247.42 ," $1,295.39 "," $1,332.85 "," $1,262.70 "," $1,262.70 "," $1,262.70 "," $1,304.79 "," $1,346.88 ", $519.15 ," $1,192.55 ", $806.40 , $526.37 , N/A , $426.12 , $426.12 ," $1,332.85 ", $494.15 , $141.05 ," $1,346.88 "
Repr Ao/Grt Vessel,CPT® 33320,N/A,N/A,N/A," $6,629.00 "," $4,308.85 "," $6,193.66 ", $967.81 ," $2,378.00 "," $4,539.74 "," $4,473.69 "," $6,164.97 "," $5,966.10 "," $5,966.10 "," $5,303.20 "," $5,303.20 "," $2,378.00 "," $6,120.56 "," $6,297.55 "," $5,966.10 "," $5,966.10 "," $5,966.10 "," $6,164.97 "," $6,363.84 "," $5,730.08 "," $5,634.65 "," $5,646.56 "," $5,072.55 ", N/A ," $4,628.31 "," $4,628.31 "," $6,297.55 "," $5,257.75 ", $967.81 ," $6,363.84 "
 Pro Cltx Sho Dislc W/Surg/Antmcl Nck Fx W/Mnpj ,CPT® 23675,0981 - PRO FEE/ER,N/A,N/A," $2,914.00 "," $1,894.10 "," $3,078.60 ", $484.34 , $245.89 ," $2,419.08 "," $2,413.79 "," $2,710.02 "," $2,622.60 "," $2,622.60 "," $2,331.20 "," $2,331.20 ", $245.89 ," $2,690.50 "," $2,768.30 "," $2,622.60 "," $2,622.60 "," $2,622.60 "," $2,710.02 "," $2,797.44 "," $2,846.83 "," $2,476.90 "," $2,658.26 "," $2,834.01 ", N/A ," $2,466.29 "," $2,466.29 "," $2,768.30 "," $2,898.76 ", $245.89 ," $3,078.60 "
 Fac Inhibin ,CPT® 86336,0302 - LAB/IMMUNOLOGY,N/A,N/A, $135.00 , $87.75 , $113.40 , $15.90 , $15.90 , $109.08 , $121.50 , $114.29 , $121.50 , $121.50 , $121.50 , $114.75 , $15.59 , $124.65 , $128.25 , $114.75 , $125.55 , $125.55 , $128.25 , $129.60 , $110.46 , $121.50 , $114.75 , $106.65 , N/A , $109.26 , $109.26 , $128.25 , $115.84 , $15.59 , $129.60 
 Pro Incision of Anal Sphincter ,CPT® 46080,0982 - PRO FEE/OUTPT,N/A,N/A," $2,676.00 "," $1,739.40 ", $954.01 , $149.01 , $76.84 , $752.34 , $765.98 ," $2,488.68 "," $2,408.40 "," $2,408.40 "," $2,140.80 "," $2,140.80 ", $76.84 ," $2,470.75 "," $2,542.20 "," $2,408.40 "," $2,408.40 "," $2,408.40 "," $2,488.68 "," $2,568.96 ", $684.09 ," $2,274.60 ", $847.43 , $892.58 , N/A , $767.02 , $767.02 ," $2,542.20 ", $802.20 , $76.84 ," $2,568.96 "
 Fac Amb 911 Base Rate Als2 ,HCPCS A0433,0540 - AMBULANCE,N/A,N/A," $2,616.00 "," $1,700.40 "," $2,197.44 ", N/A , $592.09 ," $2,113.73 "," $2,354.40 "," $2,214.71 "," $2,354.40 "," $2,354.40 "," $2,354.40 "," $2,223.60 ", $580.48 ," $2,415.35 "," $2,485.20 "," $2,223.60 "," $2,432.88 "," $2,432.88 "," $2,485.20 "," $2,511.36 "," $2,140.41 "," $2,354.40 "," $2,223.60 "," $2,066.64 ", N/A ," $2,117.13 "," $2,117.13 "," $2,485.20 "," $2,244.79 ", $580.48 ," $2,511.36 "
 Fac Endomysial Antibody Each Immunoglobulin Class ,CPT® 86231,0310 - PATHOLOGY LAB,N/A,N/A, $155.00 , $100.75 , $130.20 , $12.33 , $12.29 , $125.24 , $139.50 , $131.22 , $139.50 , $139.50 , $139.50 , $131.75 , $12.05 , $143.11 , $147.25 , $131.75 , $144.15 , $144.15 , $147.25 , $148.80 , $126.82 , $139.50 , $131.75 , $122.45 , N/A , $125.44 , $125.44 , $147.25 , $133.01 , $12.05 , $148.80 
Debride Assoc Fx/Dislo Skin/Mus/Bone,11012,N/A,N/A,N/A," $3,578.00 "," $2,325.70 "," $1,302.44 ", $388.61 , $557.87 ," $1,152.59 "," $1,106.95 "," $3,327.54 "," $3,220.20 "," $3,220.20 "," $2,862.40 "," $2,862.40 ", $557.87 ," $3,303.57 "," $3,399.10 "," $3,220.20 "," $3,220.20 "," $3,220.20 "," $3,327.54 "," $3,434.88 "," $1,434.56 "," $3,041.30 "," $2,228.30 "," $1,465.64 ", N/A ," $1,175.08 "," $1,175.08 "," $3,399.10 "," $1,362.70 ", $388.61 ," $3,434.88 "
Ewho W/Joint(S) Cf,HCPCS L3764,N/A,N/A,N/A, $899.00 , $584.35 , N/A , $833.73 , $385.69 , N/A , N/A , $836.07 , $809.10 , $809.10 , $719.20 , $719.20 , $385.69 , $830.05 , $854.05 , $809.10 , $809.10 , $809.10 , $836.07 , $863.04 , N/A , $764.15 , $730.49 , $701.44 , N/A , N/A , N/A , $854.05 , N/A , $385.69 , $863.04 
Insert Mesh/Pelvic Flr Addon,CPT® 57267,N/A,N/A,N/A," $1,916.00 "," $1,245.40 "," $1,171.90 ", $236.47 , $253.19 ," $1,047.90 "," $1,033.72 "," $1,781.88 "," $1,724.40 "," $1,724.40 "," $1,532.80 "," $1,532.80 ", $253.19 ," $1,769.04 "," $1,820.20 "," $1,724.40 "," $1,724.40 "," $1,724.40 "," $1,781.88 "," $1,839.36 "," $1,237.29 "," $1,628.60 "," $1,352.32 "," $1,053.42 ", N/A ," $1,068.35 "," $1,068.35 "," $1,820.20 "," $1,281.42 ", $236.47 ," $1,839.36 "
Cytopathology-Other Sourc,CPT® 88160,N/A,N/A,N/A, $484.00 , $314.60 , $255.34 , $73.76 , $30.70 , $266.65 , $289.49 , $450.12 , $435.60 , $435.60 , $387.20 , $387.20 , $30.70 , $446.88 , $459.80 , $435.60 , $435.60 , $435.60 , $450.12 , $464.64 , $455.85 , $411.40 , $303.28 , $252.44 , N/A , $248.85 , $248.85 , $459.80 , $273.48 , $30.70 , $464.64 
 Pro Repair Hand Tendon ,CPT® 26410,0982 - PRO FEE/OUTPT,N/A,N/A," $3,183.00 "," $2,068.95 "," $3,809.13 ", $591.56 , $390.36 ," $2,681.89 "," $2,743.57 "," $2,960.19 "," $2,864.70 "," $2,864.70 "," $2,546.40 "," $2,546.40 ", $390.36 ," $2,938.86 "," $3,023.85 "," $2,864.70 "," $2,864.70 "," $2,864.70 "," $2,960.19 "," $3,055.68 "," $3,496.67 "," $2,705.55 "," $3,000.80 "," $3,216.59 ", N/A ," $2,734.22 "," $2,734.22 "," $3,023.85 "," $3,213.66 ", $390.36 ," $3,809.13 "
Treat Tibial Fracture,27530,N/A,N/A,N/A," $1,636.00 "," $1,063.40 "," $1,803.82 ", $285.61 , $164.92 ," $1,350.84 "," $1,377.36 "," $1,521.48 "," $1,472.40 "," $1,472.40 "," $1,308.80 "," $1,308.80 ", $164.92 ," $1,510.52 "," $1,554.20 "," $1,472.40 "," $1,472.40 "," $1,472.40 "," $1,521.48 "," $1,570.56 "," $1,654.54 "," $1,390.60 "," $1,511.10 "," $1,607.37 ", N/A ," $1,377.20 "," $1,377.20 "," $1,554.20 "," $1,618.70 ", $164.92 ," $1,803.82 "
Phospholipid Antibody,CPT® 86148,N/A,N/A,N/A, $114.00 , $74.10 , N/A , $16.39 , $8.07 , $32.88 , $39.34 , $106.02 , $102.60 , $102.60 , $91.20 , $91.20 , $8.07 , $105.26 , $108.30 , $102.60 , $102.60 , $102.60 , $106.02 , $109.44 , $107.30 , $96.90 , $105.42 , $58.27 , N/A , $30.69 , $30.69 , $108.30 , $33.54 , $8.07 , $109.44 
Brnchsc Ebus Guided Sampl 1/2 Node Station/Strux,CPT® 31652,N/A,N/A,N/A," $6,800.00 "," $4,420.00 "," $1,209.69 ", $209.61 , $718.85 , $911.41 , $831.75 ," $6,324.00 "," $6,120.00 "," $6,120.00 "," $5,440.00 "," $5,440.00 ", $718.85 ," $6,278.44 "," $6,460.00 "," $6,120.00 "," $6,120.00 "," $6,120.00 "," $6,324.00 "," $6,528.00 "," $1,174.29 "," $5,780.00 "," $1,142.57 "," $1,160.10 ", N/A , $929.20 , $929.20 ," $6,460.00 "," $1,094.34 ", $209.61 ," $6,528.00 "
"Echo,Transrectal",CPT® 76872,N/A,N/A,N/A," $1,120.00 ", $728.00 , $790.71 , $135.16 , $99.44 , $450.22 , $470.92 ," $1,041.60 "," $1,008.00 "," $1,008.00 ", $896.00 , $896.00 , $99.44 ," $1,034.10 "," $1,064.00 "," $1,008.00 "," $1,008.00 "," $1,008.00 "," $1,041.60 "," $1,075.20 "," $1,041.95 ", $952.00 , $416.03 , $545.73 , N/A , $459.00 , $459.00 ," $1,064.00 ", $531.29 , $99.44 ," $1,075.20 "
Injection Aa&/Strd Brachial Plexus W/Img Gdn,CPT® 64415,N/A,N/A,N/A," $1,504.00 ", $977.60 , $313.20 , $67.27 , $76.84 , $364.26 , $347.59 ," $1,398.72 "," $1,353.60 "," $1,353.60 "," $1,203.20 "," $1,203.20 ", $76.84 ," $1,388.64 "," $1,428.80 "," $1,353.60 "," $1,353.60 "," $1,353.60 "," $1,398.72 "," $1,443.84 ", $339.93 ," $1,278.40 ", $337.19 , $394.87 , N/A , $371.36 , $371.36 ," $1,428.80 ", $398.39 , $67.27 ," $1,443.84 "
 Fac Macroscopic Exam Arthropod ,CPT® 87168,0306 - LAB/BACT-MICRO,N/A,N/A, $62.00 , $40.30 , $52.08 , $4.36 , $4.36 , $50.10 , $55.80 , $52.49 , $55.80 , $55.80 , $55.80 , $52.70 , $4.27 , $57.24 , $58.90 , $52.70 , $57.66 , $57.66 , $58.90 , $59.52 , $50.73 , $55.80 , $52.70 , $48.98 , N/A , $50.18 , $50.18 , $58.90 , $53.20 , $4.27 , $59.52 
Lidocaine Injection,HCPCS J2001,N/A,N/A,N/A, $13.00 , $8.45 , N/A , $0.03 , $0.03 , N/A , N/A , $12.09 , $11.70 , $11.70 , $10.40 , $10.40 , $0.03 , $12.00 , $12.35 , $11.70 , $11.70 , $11.70 , $12.09 , $12.48 , $0.04 , $11.05 , $0.65 , $0.04 , N/A , N/A , N/A , $12.35 , N/A , $0.03 , $12.48 
"Transcran Doppl Intracran, Vasoreact",CPT® 93890,N/A,N/A,N/A," $1,850.00 "," $1,202.50 "," $1,749.54 ", $273.17 , $206.71 ," $1,564.75 "," $1,676.73 "," $1,720.50 "," $1,665.00 "," $1,665.00 "," $1,480.00 "," $1,480.00 ", $206.71 ," $1,708.11 "," $1,757.50 "," $1,665.00 "," $1,665.00 "," $1,665.00 "," $1,720.50 "," $1,776.00 "," $1,228.63 "," $1,572.50 ", $892.07 ," $1,059.98 ", N/A ," $1,595.28 "," $1,595.28 "," $1,757.50 "," $1,768.37 ", $206.71 ," $1,776.00 "
" Rem Intra-Aortic Balloon Assist Device Inc Repair Fem Artery, Open ",CPT® 33971,0360 - OR SERVICES,N/A,N/A," $6,709.00 "," $4,360.85 "," $5,635.56 ", $643.60 , $200.71 ," $5,420.87 "," $6,038.10 "," $5,679.84 "," $6,038.10 "," $6,038.10 "," $6,038.10 "," $5,702.65 ", $196.77 ," $6,194.42 "," $6,373.55 "," $5,702.65 "," $6,239.37 "," $6,239.37 "," $6,373.55 "," $6,440.64 "," $5,489.30 "," $6,038.10 "," $5,702.65 "," $5,300.11 ", N/A ," $5,429.59 "," $5,429.59 "," $6,373.55 "," $5,756.99 ", $196.77 ," $6,440.64 "
"Remove Bladder Stone,<2.5cm",CPT® 52317,N/A,N/A,N/A," $2,556.00 "," $1,661.40 "," $1,859.72 ", $326.21 , $366.68 ," $1,705.97 "," $1,577.82 "," $2,377.08 "," $2,300.40 "," $2,300.40 "," $2,044.80 "," $2,044.80 ", $366.68 ," $2,359.95 "," $2,428.20 "," $2,300.40 "," $2,300.40 "," $2,300.40 "," $2,377.08 "," $2,453.76 "," $1,871.38 "," $2,172.60 "," $1,785.85 "," $2,138.57 ", N/A ," $1,739.25 "," $1,739.25 "," $2,428.20 "," $2,044.24 ", $326.21 ," $2,453.76 "
 KCL IN DEXTROSE-NACL 20-5-0.2(25) MEQ/L-%-% IV SOLN (INPT) ,HCPCS RXA258,0258 - IV SOLUTIONS,00990-7901-09,"1,000 mL", $119.72 , $77.82 , $100.56 , N/A , N/A , $96.73 , $107.75 , $101.35 , $107.75 , $107.75 , $107.75 , $101.76 , N/A , $110.54 , $113.73 , $101.76 , $111.34 , $111.34 , $113.73 , $114.93 , $97.95 , $107.75 , $101.76 , $94.58 , N/A , $96.89 , $96.89 , $113.73 , $102.73 , $94.58 , $114.93 
Application Topical Fluoride Varnish by Phs/Qhp,CPT® 99188,N/A,N/A,N/A, $29.00 , $18.85 , N/A , $11.62 , $13.15 , N/A , N/A , $26.97 , $26.10 , $26.10 , $23.20 , $23.20 , $13.15 , $26.78 , $27.55 , $26.10 , $26.10 , $26.10 , $26.97 , $27.84 , $57.32 , $24.65 , $29.28 , $38.99 , N/A , $21.64 , $21.64 , $27.55 , $25.15 , $11.62 , $57.32 
 Fac Hla I Typing High Resolution 1 Allele/Allele Grp ,CPT® 81381,0300 - LABORATORY,N/A,N/A, $395.00 , $256.75 , $331.80 , $173.30 , $105.28 , $319.16 , $355.50 , $334.41 , $355.50 , $355.50 , $355.50 , $335.75 , $103.22 , $364.70 , $375.25 , $335.75 , $367.35 , $367.35 , $375.25 , $379.20 , $323.19 , $355.50 , $335.75 , $312.05 , N/A , $319.67 , $319.67 , $375.25 , $338.95 , $103.22 , $379.20 
Assay Serum Cholinesterase,CPT® 82480,N/A,N/A,N/A, $100.00 , $65.00 , N/A , $8.03 , $8.03 , $44.56 , $53.32 , $93.00 , $90.00 , $90.00 , $80.00 , $80.00 , $8.03 , $92.33 , $95.00 , $90.00 , $90.00 , $90.00 , $93.00 , $96.00 , $52.55 , $85.00 , $51.90 , $28.55 , N/A , $41.59 , $41.59 , $95.00 , $45.45 , $8.03 , $96.00 
 Fac Measure Blood Oxygen Level ,CPT® 94760,0460 - PULMONARY FUNC,N/A,N/A, $31.00 , $20.15 , $26.04 , $2.08 , $7.12 , $25.05 , $27.90 , $26.24 , $27.90 , $27.90 , $27.90 , $26.35 , $6.98 , $28.62 , $29.45 , $26.35 , $28.83 , $28.83 , $29.45 , $29.76 , $25.36 , $27.90 , $26.35 , $24.49 , N/A , $25.09 , $25.09 , $29.45 , $26.60 , $2.08 , $29.76 
 Pro Shaving Skin Lesion 1 F/E/E/N/L/M Diam 0.5 Cm/< ,CPT® 11310,0982 - PRO FEE/OUTPT,N/A,N/A, $450.00 , $292.50 , $146.03 , $43.84 , $52.47 , $128.91 , $124.83 , $418.50 , $405.00 , $405.00 , $360.00 , $360.00 , $52.47 , $415.49 , $427.50 , $405.00 , $405.00 , $405.00 , $418.50 , $432.00 , $161.07 , $382.50 , $247.98 , $166.84 , N/A , $131.42 , $131.42 , $427.50 , $152.41 , $43.84 , $432.00 
Remove Mesh From Abd Wall,11008,N/A,N/A,N/A," $1,717.00 "," $1,116.05 ", $839.60 , $247.58 , $258.21 , $741.30 , $709.97 ," $1,596.81 "," $1,545.30 "," $1,545.30 "," $1,373.60 "," $1,373.60 ", $258.21 ," $1,585.31 "," $1,631.15 "," $1,545.30 "," $1,545.30 "," $1,545.30 "," $1,596.81 "," $1,648.32 ", $922.00 ," $1,459.45 "," $1,439.74 ", $932.31 , N/A , $755.77 , $755.77 ," $1,631.15 ", $876.44 , $247.58 ," $1,648.32 "
"Plasty Knee,Med or Lat Compartmt",CPT® 27446,N/A,N/A,N/A," $6,460.00 "," $4,199.00 "," $6,951.82 "," $1,081.92 ", $982.32 ," $5,602.81 "," $5,284.92 "," $6,007.80 "," $5,814.00 "," $5,814.00 "," $5,168.00 "," $5,168.00 ", $982.32 ," $5,964.52 "," $6,137.00 "," $5,814.00 "," $5,814.00 "," $5,814.00 "," $6,007.80 "," $6,201.60 "," $6,486.20 "," $5,491.00 "," $5,849.95 "," $6,586.66 ", N/A ," $5,712.14 "," $5,712.14 "," $6,137.00 "," $6,713.78 ", $982.32 ," $6,951.82 "
Fix Non/Malunion Tibia,CPT® 27720,N/A,N/A,N/A," $4,068.00 "," $2,644.20 "," $5,310.89 ", $830.79 ," $1,075.74 "," $4,226.95 "," $4,217.75 "," $3,783.24 "," $3,661.20 "," $3,661.20 "," $3,254.40 "," $3,254.40 "," $1,075.74 "," $3,755.98 "," $3,864.60 "," $3,661.20 "," $3,661.20 "," $3,661.20 "," $3,783.24 "," $3,905.28 "," $4,946.27 "," $3,457.80 "," $4,658.19 "," $4,965.05 ", N/A ," $4,309.43 "," $4,309.43 "," $3,864.60 "," $5,065.10 ", $830.79 ," $5,310.89 "
Excise Breast Les Xray Mark Addnl,CPT® 19126,N/A,N/A,N/A," $1,692.00 "," $1,099.80 ", $493.20 , $145.21 , $142.31 , $434.60 , $413.75 ," $1,573.56 "," $1,522.80 "," $1,522.80 "," $1,353.60 "," $1,353.60 ", $142.31 ," $1,562.22 "," $1,607.40 "," $1,522.80 "," $1,522.80 "," $1,522.80 "," $1,573.56 "," $1,624.32 ", $541.98 ," $1,438.20 ", $842.08 , $543.99 , N/A , $443.08 , $443.08 ," $1,607.40 ", $513.82 , $142.31 ," $1,624.32 "
 Pro CT Lower Extremity W/Dye ,CPT® 73701,0972 - PRO FEE/RAD/DX,N/A,N/A, $653.00 , $424.45 ," $1,188.95 ", $170.34 , $292.14 ," $1,075.69 "," $1,372.82 ", $607.29 , $587.70 , $587.70 , $522.40 , $522.40 , $292.14 , $602.91 , $620.35 , $587.70 , $587.70 , $587.70 , $607.29 , $626.88 ," $1,000.23 ", $555.05 ," $1,494.61 "," $1,464.57 ", N/A ," $1,096.68 "," $1,096.68 ", $620.35 ," $1,269.43 ", $170.34 ," $1,494.61 "
 Pro X-Ray Exam of Lower Spine ,CPT® 72110,0972 - PRO FEE/RAD/DX,N/A,N/A, $192.00 , $124.80 , $289.71 , $50.58 , $51.88 , $231.57 , $260.36 , $178.56 , $172.80 , $172.80 , $153.60 , $153.60 , $51.88 , $177.27 , $182.40 , $172.80 , $172.80 , $172.80 , $178.56 , $184.32 , $279.18 , $163.20 , $285.05 , $246.15 , N/A , $236.09 , $236.09 , $182.40 , $273.27 , $50.58 , $289.71 
"Endovenous Rf, 1st Vein",36475,N/A,N/A,N/A," $11,345.00 "," $7,374.25 "," $1,630.53 ", $251.72 ," $1,608.39 "," $1,210.78 "," $1,503.17 "," $10,550.85 "," $10,210.50 "," $10,210.50 "," $9,076.00 "," $9,076.00 "," $1,608.39 "," $10,474.84 "," $10,777.75 "," $10,210.50 "," $10,210.50 "," $10,210.50 "," $10,550.85 "," $10,891.20 "," $1,513.97 "," $9,643.25 "," $1,892.89 "," $1,357.13 ", N/A ," $1,234.41 "," $1,234.41 "," $10,777.75 "," $1,402.29 ", $251.72 ," $10,891.20 "
Total Knee Arthroplasty,CPT® 27447,N/A,N/A,N/A," $10,215.00 "," $6,639.75 "," $7,722.20 "," $1,206.76 "," $1,363.53 "," $6,552.23 "," $7,354.80 "," $9,499.95 "," $9,193.50 "," $9,193.50 "," $8,172.00 "," $8,172.00 "," $1,363.53 "," $9,431.51 "," $9,704.25 "," $9,193.50 "," $9,193.50 "," $9,193.50 "," $9,499.95 "," $9,806.40 "," $9,322.23 "," $8,682.75 "," $8,142.47 "," $7,699.32 ", N/A ," $6,680.08 "," $6,680.08 "," $9,704.25 "," $7,851.46 "," $1,206.76 "," $9,806.40 "
Eye Exam Established Pt,92012,N/A,N/A,N/A, $264.00 , $171.60 , $110.70 , $49.63 , $30.59 , $93.38 , $93.76 , $245.52 , $237.60 , $237.60 , $211.20 , $211.20 , $30.59 , $243.75 , $250.80 , $237.60 , $237.60 , $237.60 , $245.52 , $253.44 , $144.13 , $224.40 , $158.14 , $112.11 , N/A , $95.20 , $95.20 , $250.80 , $113.26 , $30.59 , $253.44 
Urine Specimen Collect Mult,HCPCS P9615,N/A,N/A,N/A, $11.00 , $7.15 , N/A , $8.74 , $3.06 , $3.91 , N/A , $10.23 , $9.90 , $9.90 , $8.80 , $8.80 , $3.06 , $10.16 , $10.45 , $9.90 , $9.90 , $9.90 , $10.23 , $10.56 , $9.48 , $9.35 , $16.15 , $8.81 , N/A , N/A , N/A , $10.45 , N/A , $3.06 , $16.15 
Assay Vitamin B-6,CPT® 84207,N/A,N/A,N/A, $265.00 , $172.25 , N/A , $28.66 , $28.66 , $158.98 , $190.14 , $246.45 , $238.50 , $238.50 , $212.00 , $212.00 , $28.66 , $244.67 , $251.75 , $238.50 , $238.50 , $238.50 , $246.45 , $254.40 , $187.63 , $225.25 , $184.89 , $101.88 , N/A , $148.37 , $148.37 , $251.75 , $162.14 , $28.66 , $254.40 
Repair Lumbar Hernia,CPT® 49540,N/A,N/A,N/A," $4,514.00 "," $2,934.10 "," $4,055.42 ", $630.73 , $468.75 ," $3,156.09 "," $3,213.75 "," $4,198.02 "," $4,062.60 "," $4,062.60 "," $3,611.20 "," $3,611.20 ", $468.75 ," $4,167.78 "," $4,288.30 "," $4,062.60 "," $4,062.60 "," $4,062.60 "," $4,198.02 "," $4,333.44 "," $2,914.44 "," $3,836.90 "," $3,569.91 "," $3,723.82 ", N/A ," $3,217.67 "," $3,217.67 "," $4,288.30 "," $3,365.36 ", $468.75 ," $4,333.44 "
 Adm Moderna Peds Covid Vac 6mo-4 Yr 1st Dose ,CPT® 0111A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
"CT Scan,Lower Extremity,W/O Contrast",CPT® 73700,N/A,N/A,N/A," $3,007.00 "," $1,954.55 ", $919.73 , $132.30 , $242.52 , $853.40 ," $1,105.30 "," $2,796.51 "," $2,706.30 "," $2,706.30 "," $2,405.60 "," $2,405.60 ", $242.52 ," $2,776.36 "," $2,856.65 "," $2,706.30 "," $2,706.30 "," $2,706.30 "," $2,796.51 "," $2,886.72 ", $772.34 ," $2,555.95 "," $1,203.78 "," $1,166.51 ", N/A , $870.05 , $870.05 ," $2,856.65 "," $1,007.10 ", $132.30 ," $2,886.72 "
 Fac Assay of Blood/Uric Acid ,CPT® 84550,0301 - LAB/CHEMISTRY,N/A,N/A, $76.00 , $49.40 , $63.84 , $4.61 , $4.61 , $61.41 , $68.40 , $64.34 , $68.40 , $68.40 , $68.40 , $64.60 , $4.52 , $70.17 , $72.20 , $64.60 , $70.68 , $70.68 , $72.20 , $72.96 , $62.18 , $68.40 , $64.60 , $60.04 , N/A , $61.51 , $61.51 , $72.20 , $65.22 , $4.52 , $72.96 
 GENTIAN VIOLET 1 % EX SOLN ,HCPCS RXC637,0250 - PHARMACY,00395-1003-92,60 mL, $86.92 , $56.50 , $73.01 , N/A , N/A , $70.23 , $78.23 , $73.59 , $78.23 , $78.23 , $78.23 , $73.88 , N/A , $80.25 , $82.57 , $73.88 , $80.84 , $80.84 , $82.57 , $83.44 , $71.12 , $78.23 , $73.88 , $68.67 , N/A , $70.34 , $70.34 , $82.57 , $74.59 , $68.67 , $83.44 
Initial Ped Critical Care 2 Yr Thru 5 Yr,CPT® 99475,N/A,N/A,N/A," $3,166.00 "," $2,057.90 "," $1,136.86 ", $540.48 , $745.70 , $997.14 , $972.68 ," $2,944.38 "," $2,849.40 "," $2,849.40 "," $2,532.80 "," $2,532.80 ", $745.70 ," $2,923.17 "," $3,007.70 "," $2,849.40 "," $2,849.40 "," $2,849.40 "," $2,944.38 "," $3,039.36 "," $1,441.57 "," $2,691.10 "," $1,214.42 "," $1,231.37 ", N/A ," $1,016.59 "," $1,016.59 "," $3,007.70 "," $1,172.48 ", $540.48 ," $3,039.36 "
 Head CT Scn Without/With Contrst ,CPT® 70470,0350 - CT SCAN,N/A,N/A," $2,616.00 "," $1,700.40 "," $2,197.44 ", $177.53 , $303.13 ," $2,113.73 "," $2,354.40 "," $2,214.71 "," $2,354.40 "," $2,354.40 "," $2,354.40 "," $2,223.60 ", $297.19 ," $2,415.35 "," $2,485.20 "," $2,223.60 "," $2,432.88 "," $2,432.88 "," $2,485.20 "," $2,511.36 "," $2,140.41 "," $2,354.40 "," $2,223.60 "," $2,066.64 ", N/A ," $2,117.13 "," $2,117.13 "," $2,485.20 "," $2,244.79 ", $177.53 ," $2,511.36 "
 Fac Esophagoscopy Flexible Transoral Mucosal Resexn ,CPT® 43211,0750 - GASTR-INST SVS,N/A,N/A," $3,092.00 "," $2,009.80 "," $2,597.28 ", $222.73 , $184.78 ," $2,498.34 "," $2,782.80 "," $2,617.69 "," $2,782.80 "," $2,782.80 "," $2,782.80 "," $2,628.20 ", $181.16 ," $2,854.84 "," $2,937.40 "," $2,628.20 "," $2,875.56 "," $2,875.56 "," $2,937.40 "," $2,968.32 "," $2,529.87 "," $2,782.80 "," $2,628.20 "," $2,442.68 ", N/A ," $2,502.36 "," $2,502.36 "," $2,937.40 "," $2,653.25 ", $181.16 ," $2,968.32 "
Treat Articular Fracture,26742,N/A,N/A,N/A," $1,849.00 "," $1,201.85 "," $2,083.84 ", $329.17 , $168.45 ," $1,595.87 "," $1,612.46 "," $1,719.57 "," $1,664.10 "," $1,664.10 "," $1,479.20 "," $1,479.20 ", $168.45 ," $1,707.18 "," $1,756.55 "," $1,664.10 "," $1,664.10 "," $1,664.10 "," $1,719.57 "," $1,775.04 "," $1,930.83 "," $1,571.65 "," $1,771.58 "," $1,911.72 ", N/A ," $1,627.01 "," $1,627.01 "," $1,756.55 "," $1,912.32 ", $168.45 ," $2,083.84 "
"Inject Facet Joint Cervical/Thorac, Cerv/Thorac, 1st Level",CPT® 64490,N/A,N/A,N/A, $974.00 , $633.10 , $521.25 , $100.98 , $139.80 , $601.59 , $592.63 , $905.82 , $876.60 , $876.60 , $779.20 , $779.20 , $139.80 , $899.29 , $925.30 , $876.60 , $876.60 , $876.60 , $905.82 , $935.04 , $565.18 , $827.90 , $579.82 , $641.10 , N/A , $613.33 , $613.33 , $925.30 , $657.95 , $100.98 , $935.04 
Radiologic Exam Esophagus Single Contrast Study,CPT® 74220,N/A,N/A,N/A," $1,066.00 ", $692.90 , $569.62 , $98.12 , $72.27 , $420.62 , $487.52 , $991.38 , $959.40 , $959.40 , $852.80 , $852.80 , $72.27 , $984.24 ," $1,012.70 ", $959.40 , $959.40 , $959.40 , $991.38 ," $1,023.36 ", $558.02 , $906.10 , $531.59 , $446.77 , N/A , $428.82 , $428.82 ," $1,012.70 ", $496.36 , $72.27 ," $1,023.36 "
 Pro Att/Reargmt S/a/L Dfct 10 Cm/< ,CPT® 14020,0982 - PRO FEE/OUTPT,N/A,N/A," $3,209.00 "," $2,085.85 "," $1,804.62 ", $543.35 , $371.14 ," $1,551.36 "," $1,532.17 "," $2,984.37 "," $2,888.10 "," $2,888.10 "," $2,567.20 "," $2,567.20 ", $371.14 ," $2,962.87 "," $3,048.55 "," $2,888.10 "," $2,888.10 "," $2,888.10 "," $2,984.37 "," $3,080.64 "," $1,971.71 "," $2,727.65 "," $3,054.32 "," $1,986.10 ", N/A ," $1,581.63 "," $1,581.63 "," $3,048.55 "," $1,834.16 ", $371.14 ," $3,080.64 "
"Remv Nasal for Body,Gen Anesth",CPT® 30310,N/A,N/A,N/A," $1,170.00 ", $760.50 ," $1,162.48 ", $204.41 , $153.67 , $780.52 , $799.14 ," $1,088.10 "," $1,053.00 "," $1,053.00 ", $936.00 , $936.00 , $153.67 ," $1,080.26 "," $1,111.50 "," $1,053.00 "," $1,053.00 "," $1,053.00 "," $1,088.10 "," $1,123.20 "," $1,103.74 ", $994.50 ," $1,122.18 "," $1,021.17 ", N/A , $795.75 , $795.75 ," $1,111.50 ", $937.16 , $153.67 ," $1,162.48 "
 PREDNISOLONE ACETATE 1 % OP SUSP ,HCPCS RXC637,0250 - PHARMACY,61314-0637-05,5 mL, $284.18 , $184.72 , $238.71 , N/A , N/A , $229.62 , $255.76 , $240.59 , $255.76 , $255.76 , $255.76 , $241.55 , N/A , $262.38 , $269.97 , $241.55 , $264.29 , $264.29 , $269.97 , $272.81 , $232.52 , $255.76 , $241.55 , $224.50 , N/A , $229.99 , $229.99 , $269.97 , $243.85 , $224.50 , $272.81 
" Pro Contrst X-Ray, Urinary Tract ",CPT® 74420,0972 - PRO FEE/RAD/DX,N/A,N/A, $321.00 , $208.65 , $435.12 , $76.09 , $120.86 , $567.25 , $597.15 , $298.53 , $288.90 , $288.90 , $256.80 , $256.80 , $120.86 , $296.38 , $304.95 , $288.90 , $288.90 , $288.90 , $298.53 , $308.16 , $424.05 , $272.85 , $668.34 ," $2,360.61 ", N/A , $578.31 , $578.31 , $304.95 , $669.40 , $76.09 ," $2,360.61 "
 Eeg Without Video 12-26 Hours; Continuous ,CPT® 95710,0740 - EEG,N/A,N/A," $2,698.00 "," $1,753.70 "," $2,266.32 ", $615.12 , $396.25 ," $2,179.98 "," $2,428.20 "," $2,284.13 "," $2,428.20 "," $2,428.20 "," $2,428.20 "," $2,293.30 ", $388.48 ," $2,491.06 "," $2,563.10 "," $2,293.30 "," $2,509.14 "," $2,509.14 "," $2,563.10 "," $2,590.08 "," $2,207.50 "," $2,428.20 "," $2,293.30 "," $2,131.42 ", N/A ," $2,183.49 "," $2,183.49 "," $2,563.10 "," $2,315.15 ", $388.48 ," $2,590.08 "
 Fac Group Therapeutic Exercise ,CPT® 97150,0420 - PHYSICAL THERAPY,N/A,N/A, $143.00 , $92.95 , $120.12 , $17.69 , $17.14 , $115.54 , $128.70 , $121.06 , $128.70 , $128.70 , $128.70 , $121.55 , $16.80 , $132.03 , $135.85 , $121.55 , $132.99 , $132.99 , $135.85 , $137.28 , $117.00 , $128.70 , $121.55 , $112.97 , N/A , $115.73 , $115.73 , $135.85 , $122.71 , $16.80 , $137.28 
 PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY ,HCPCS 90677,0636 - DRUGS REQUIRING DETAILED CODIN,00005-2000-02,0.5 mL, $769.75 , $500.34 , $646.59 , $294.43 , $246.26 , $621.96 , $692.78 , $651.67 , $692.78 , $692.78 , $692.78 , $654.29 , $241.43 , $710.71 , $731.26 , $654.29 , $715.87 , $715.87 , $731.26 , $738.96 , $629.81 , $692.78 , $654.29 , $608.10 , N/A , $622.96 , $622.96 , $731.26 , $660.52 , $241.43 , $738.96 
Nasal/Sinus Endoscopy Dx Maxillary Sinusoscopy,CPT® 31233,N/A,N/A,N/A," $1,527.00 ", $992.55 , $727.61 , $129.17 , $145.05 , $523.05 , $515.91 ," $1,420.11 "," $1,374.30 "," $1,374.30 "," $1,221.60 "," $1,221.60 ", $145.05 ," $1,409.88 "," $1,450.65 "," $1,374.30 "," $1,374.30 "," $1,374.30 "," $1,420.11 "," $1,465.92 ", $696.32 ," $1,297.95 ", $727.90 , $686.85 , N/A , $533.25 , $533.25 ," $1,450.65 ", $628.01 , $129.17 ," $1,465.92 "
Cardiopulmonary Exercise Testing,CPT® 94621,N/A,N/A,N/A," $1,062.00 ", $690.30 , $358.20 , $149.55 , $125.77 , $363.13 , $377.84 , $987.66 , $955.80 , $955.80 , $849.60 , $849.60 , $125.77 , $980.54 ," $1,008.90 ", $955.80 , $955.80 , $955.80 , $987.66 ," $1,019.52 ", $478.84 , $902.70 , $498.75 , $625.36 , N/A , $370.22 , $370.22 ," $1,008.90 ", $431.60 , $125.77 ," $1,019.52 "
 Fac Prtl Exc B1 Phalanx Toe ,CPT® 28124,0761 - TREATMENT ROOM,N/A,N/A," $2,475.00 "," $1,608.75 "," $2,079.00 ", $325.03 , $230.52 ," $1,999.80 "," $2,227.50 "," $2,095.34 "," $2,227.50 "," $2,227.50 "," $2,227.50 "," $2,103.75 ", $226.00 ," $2,285.17 "," $2,351.25 "," $2,103.75 "," $2,301.75 "," $2,301.75 "," $2,351.25 "," $2,376.00 "," $2,025.05 "," $2,227.50 "," $2,103.75 "," $1,955.25 ", N/A ," $2,003.02 "," $2,003.02 "," $2,351.25 "," $2,123.80 ", $226.00 ," $2,376.00 "
 PREDNISONE 2.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00054-8740-25,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Assay of Body Fluid Acidity ,CPT® 83986,0301 - LAB/CHEMISTRY,N/A,N/A, $61.00 , $39.65 , $51.24 , $3.65 , $3.65 , $49.29 , $54.90 , $51.64 , $54.90 , $54.90 , $54.90 , $51.85 , $3.58 , $56.32 , $57.95 , $51.85 , $56.73 , $56.73 , $57.95 , $58.56 , $49.91 , $54.90 , $51.85 , $48.19 , N/A , $49.37 , $49.37 , $57.95 , $52.34 , $3.58 , $58.56 
Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/O Img Gdn,CPT® 62322,N/A,N/A,N/A," $1,232.00 ", $800.80 , $397.54 , $76.88 , $185.09 , $472.56 , $461.97 ," $1,145.76 "," $1,108.80 "," $1,108.80 ", $985.60 , $985.60 , $185.09 ," $1,137.51 "," $1,170.40 "," $1,108.80 "," $1,108.80 "," $1,108.80 "," $1,145.76 "," $1,182.72 ", $432.18 ," $1,047.20 ", $422.91 , $524.46 , N/A , $481.78 , $481.78 ," $1,170.40 ", $516.83 , $76.88 ," $1,182.72 "
Prq Trluml Coronary Stent W/Angio One Art/Brnch,CPT® 92928,N/A,N/A,N/A," $4,976.00 "," $3,234.40 "," $3,439.80 ", $528.78 , $815.59 ," $3,232.91 "," $3,253.47 "," $4,627.68 "," $4,478.40 "," $4,478.40 "," $3,980.80 "," $3,980.80 ", $815.59 ," $4,594.34 "," $4,727.20 "," $4,478.40 "," $4,478.40 "," $4,478.40 "," $4,627.68 "," $4,776.96 "," $3,185.46 "," $4,229.60 "," $1,800.36 "," $3,392.05 ", N/A ," $3,295.99 "," $3,295.99 "," $4,727.20 "," $3,653.66 ", $528.78 ," $4,776.96 "
Active Wound Care > 20 Cm,97598,N/A,N/A,N/A, $221.00 , $143.65 , $56.54 , $23.51 , $55.15 , $26.06 , $22.25 , $205.53 , $198.90 , $198.90 , $176.80 , $176.80 , $55.15 , $204.05 , $209.95 , $198.90 , $198.90 , $198.90 , $205.53 , $212.16 , $75.48 , $187.85 , $33.45 , $25.64 , N/A , $26.57 , $26.57 , $209.95 , $29.54 , $22.25 , $212.16 
Lap Esophageal Lengthening,CPT® 43283,N/A,N/A,N/A," $1,022.00 ", $664.30 , $924.11 , $141.96 , $115.75 , $746.11 , $738.05 , $950.46 , $919.80 , $919.80 , $817.60 , $817.60 , $115.75 , $943.61 , $970.90 , $919.80 , $919.80 , $919.80 , $950.46 , $981.12 , $665.07 , $868.70 , $824.24 , $871.16 , N/A , $760.67 , $760.67 , $970.90 , $795.58 , $115.75 , $981.12 
Radiologic Examination Femur Minimum 2 Views,CPT® 73552,N/A,N/A,N/A, $247.00 , $160.55 , $238.98 , $35.01 , $25.42 , $154.06 , $163.24 , $229.71 , $222.30 , $222.30 , $197.60 , $197.60 , $25.42 , $228.06 , $234.65 , $222.30 , $222.30 , $222.30 , $229.71 , $237.12 , $193.51 , $209.95 , $205.26 , $165.69 , N/A , $157.07 , $157.07 , $234.65 , $181.81 , $25.42 , $238.98 
 SITAGLIPTIN PHOSPHATE 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00006-0221-31,1 tablet, $112.44 , $73.09 , $94.45 , N/A , N/A , $90.85 , $101.20 , $95.19 , $101.20 , $101.20 , $101.20 , $95.57 , N/A , $103.82 , $106.82 , $95.57 , $104.57 , $104.57 , $106.82 , $107.94 , $92.00 , $101.20 , $95.57 , $88.83 , N/A , $91.00 , $91.00 , $106.82 , $96.48 , $88.83 , $107.94 
Colonoscopy Flexible With Band Ligation(S),45398,N/A,N/A,N/A," $4,078.00 "," $2,650.70 "," $1,427.53 ", $220.75 , $265.41 , N/A , N/A ," $3,792.54 "," $3,670.20 "," $3,670.20 "," $3,262.40 "," $3,262.40 ", $265.41 ," $3,765.22 "," $3,874.10 "," $3,670.20 "," $3,670.20 "," $3,670.20 "," $3,792.54 "," $3,914.88 "," $1,024.64 "," $3,466.30 "," $1,231.42 "," $1,353.91 ", N/A ," $1,041.60 "," $1,041.60 "," $3,874.10 "," $1,090.21 ", $220.75 ," $3,914.88 "
 LOSARTAN 12.5 MG TAB (COMES FROM 25 MG TABLET) ,HCPCS RXC637,0250 - PHARMACY,00001-0921-01,2 tablet, $7.16 , $4.65 , $6.01 , N/A , N/A , $5.79 , $6.44 , $6.06 , $6.44 , $6.44 , $6.44 , $6.09 , N/A , $6.61 , $6.80 , $6.09 , $6.66 , $6.66 , $6.80 , $6.87 , $5.86 , $6.44 , $6.09 , $5.66 , N/A , $5.79 , $5.79 , $6.80 , $6.14 , $5.66 , $6.87 
Simple Repair 21.1-30cm,CPT® 12017,N/A,N/A,N/A," $1,403.00 ", $911.95 , $471.41 , $141.05 , $247.42 , $417.96 , $400.18 ," $1,304.79 "," $1,262.70 "," $1,262.70 "," $1,122.40 "," $1,122.40 ", $247.42 ," $1,295.39 "," $1,332.85 "," $1,262.70 "," $1,262.70 "," $1,262.70 "," $1,304.79 "," $1,346.88 ", $519.15 ," $1,192.55 ", $806.40 , $526.37 , N/A , $426.12 , $426.12 ," $1,332.85 ", $494.15 , $141.05 ," $1,346.88 "
"Dil Urethra Stric,Male,Subseq",CPT® 53601,N/A,N/A,N/A, $567.00 , $368.55 , $285.83 , $50.61 , $22.66 , $261.71 , $242.30 , $527.31 , $510.30 , $510.30 , $453.60 , $453.60 , $22.66 , $523.51 , $538.65 , $510.30 , $510.30 , $510.30 , $527.31 , $544.32 , $288.51 , $481.95 , $272.96 , $330.72 , N/A , $266.81 , $266.81 , $538.65 , $313.61 , $22.66 , $544.32 
 CAMPHOR-MENTHOL 0.5-0.5 % EX LOTN ,HCPCS RXC637,0250 - PHARMACY,00316-0229-75,222 mL, $47.90 , $31.14 , $40.24 , N/A , N/A , $38.70 , $43.11 , $40.55 , $43.11 , $43.11 , $43.11 , $40.72 , N/A , $44.23 , $45.51 , $40.72 , $44.55 , $44.55 , $45.51 , $45.98 , $39.19 , $43.11 , $40.72 , $37.84 , N/A , $38.77 , $38.77 , $45.51 , $41.10 , $37.84 , $45.98 
 Fetal Congenital ABN Assay 4 Analysis Beaker1 ,CPT® 81511,0310 - PATHOLOGY LAB,N/A,N/A, $347.00 , $225.55 , $291.48 , $156.57 , $156.57 , $280.38 , $312.30 , $293.77 , $312.30 , $312.30 , $312.30 , $294.95 , $153.50 , $320.39 , $329.65 , $294.95 , $322.71 , $322.71 , $329.65 , $333.12 , $283.92 , $312.30 , $294.95 , $274.13 , N/A , $280.83 , $280.83 , $329.65 , $297.76 , $153.50 , $333.12 
Insj 2 Transvns Eltrd Perm Pacemaker/Impltbl Dfb,CPT® 33217,N/A,N/A,N/A," $4,056.00 "," $2,636.40 "," $2,202.92 ", $340.98 , $794.95 ," $1,602.44 "," $1,566.63 "," $3,772.08 "," $3,650.40 "," $3,650.40 "," $3,244.80 "," $3,244.80 ", $794.95 ," $3,744.90 "," $3,853.20 "," $3,650.40 "," $3,650.40 "," $3,650.40 "," $3,772.08 "," $3,893.76 "," $2,031.92 "," $3,447.60 "," $1,966.04 "," $1,764.04 ", N/A ," $1,633.70 "," $1,633.70 "," $3,853.20 "," $1,855.90 ", $340.98 ," $3,893.76 "
 Pro Arthrs Aided Ant Cruciate Ligm Rpr/Agmntj/Rcnstj ,CPT® 29888,0982 - PRO FEE/OUTPT,N/A,N/A," $6,537.00 "," $4,249.05 "," $5,922.48 ", $925.28 , $869.33 ," $4,755.46 "," $4,743.68 "," $6,079.41 "," $5,883.30 "," $5,883.30 "," $5,229.60 "," $5,229.60 ", $869.33 ," $6,035.61 "," $6,210.15 "," $5,883.30 "," $5,883.30 "," $5,883.30 "," $6,079.41 "," $6,275.52 "," $6,519.97 "," $5,556.45 "," $5,245.15 "," $5,597.70 ", N/A ," $4,848.25 "," $4,848.25 "," $6,210.15 "," $5,698.42 ", $869.33 ," $6,519.97 "
 Signs And Symptoms With McC ,MS DRG V40 (FY2023) 947,N/A,N/A,N/A," $19,113.16 "," $12,423.55 "," $16,055.05 ", N/A , N/A ," $15,443.43 "," $17,201.84 "," $16,181.20 "," $17,201.84 "," $17,201.84 "," $17,201.84 "," $16,246.19 ", N/A ," $17,647.18 "," $18,157.50 "," $16,246.19 "," $17,775.24 "," $17,775.24 "," $18,157.50 "," $18,348.63 "," $15,638.39 "," $17,201.84 "," $16,246.19 "," $15,099.40 ", N/A ," $15,468.28 "," $15,468.28 "," $18,157.50 "," $16,401.00 "," $15,099.40 "," $18,348.63 "
 Pro Quant Differential Pulm Perfusion W/WO Imaging ,CPT® 78597,0972 - PRO FEE/RAD/DX,N/A,N/A, $498.00 , $323.70 ," $1,080.54 ", $184.41 , $153.94 , $996.26 ," $1,257.19 ", $463.14 , $448.20 , $448.20 , $398.40 , $398.40 , $153.94 , $459.80 , $473.10 , $448.20 , $448.20 , $448.20 , $463.14 , $478.08 ," $1,119.08 ", $423.30 ," $1,380.97 "," $1,366.56 ", N/A ," $1,015.70 "," $1,015.70 ", $473.10 ," $1,175.69 ", $153.94 ," $1,380.97 "
"Repair Achilles Tendon,Primary",CPT® 27650,N/A,N/A,N/A," $4,457.00 "," $2,897.05 "," $4,053.47 ", $634.54 , $588.80 ," $3,200.62 "," $3,230.07 "," $4,145.01 "," $4,011.30 "," $4,011.30 "," $3,565.60 "," $3,565.60 ", $588.80 ," $4,115.15 "," $4,234.15 "," $4,011.30 "," $4,011.30 "," $4,011.30 "," $4,145.01 "," $4,278.72 "," $3,765.19 "," $3,788.45 "," $3,543.15 "," $3,785.55 ", N/A ," $3,263.07 "," $3,263.07 "," $4,234.15 "," $3,835.26 ", $588.80 ," $4,278.72 "
Assay Vitamin B-1,CPT® 84425,N/A,N/A,N/A, $205.00 , $133.25 , N/A , $21.65 , $21.65 , $120.11 , $143.72 , $190.65 , $184.50 , $184.50 , $164.00 , $164.00 , $21.65 , $189.28 , $194.75 , $184.50 , $184.50 , $184.50 , $190.65 , $196.80 , $141.76 , $174.25 , $139.48 , $76.98 , N/A , $112.09 , $112.09 , $194.75 , $122.49 , $21.65 , $196.80 
 GENTAMICIN SULFATE 0.1 % EX OINT ,HCPCS RXC637,0250 - PHARMACY,00713-0682-15,15 gram, $253.66 , $164.88 , $213.07 , N/A , N/A , $204.96 , $228.29 , $214.75 , $228.29 , $228.29 , $228.29 , $215.61 , N/A , $234.20 , $240.98 , $215.61 , $235.90 , $235.90 , $240.98 , $243.51 , $207.54 , $228.29 , $215.61 , $200.39 , N/A , $205.29 , $205.29 , $240.98 , $217.67 , $200.39 , $243.51 
 Pro Incise External Hemorrhoid ,CPT® 46083,0982 - PRO FEE/OUTPT,N/A,N/A," $1,180.00 ", $767.00 , $672.56 , $104.60 , $84.21 , $505.76 , $520.72 ," $1,097.40 "," $1,062.00 "," $1,062.00 ", $944.00 , $944.00 , $84.21 ," $1,089.49 "," $1,121.00 "," $1,062.00 "," $1,062.00 "," $1,062.00 "," $1,097.40 "," $1,132.80 ", $478.52 ," $1,003.00 ", $570.90 , $608.17 , N/A , $515.63 , $515.63 ," $1,121.00 ", $539.29 , $84.21 ," $1,132.80 "
Chemodenervation 1 Extremity 5 or More Muscles,CPT® 64644,N/A,N/A,N/A, $974.00 , $633.10 , $559.00 , $107.42 , $86.61 , $649.01 , $632.68 , $905.82 , $876.60 , $876.60 , $779.20 , $779.20 , $86.61 , $899.29 , $925.30 , $876.60 , $876.60 , $876.60 , $905.82 , $935.04 , $604.30 , $827.90 , $613.05 , $689.29 , N/A , $661.68 , $661.68 , $925.30 , $709.81 , $86.61 , $935.04 
Hospital IP/Obs Discharge Day Mgmt 30 Min/<,99238,N/A,N/A,N/A, $284.00 , $184.60 , $143.56 , $78.65 , $51.64 , $125.27 , $125.75 , $264.12 , $255.60 , $255.60 , $227.20 , $227.20 , $51.64 , $262.22 , $269.80 , $255.60 , $255.60 , $255.60 , $264.12 , $272.64 , $181.90 , $241.40 , $156.02 , $160.16 , $97.00 , $127.71 , $127.71 , $269.80 , $147.30 , $51.64 , $272.64 
 Pro Clsr Lacrimal Punctum Plug Ea ,CPT® 68761,0982 - PRO FEE/OUTPT,N/A,N/A, $637.00 , $414.05 , $727.87 , $114.29 , $97.37 , $673.05 , $636.84 , $592.41 , $573.30 , $573.30 , $509.60 , $509.60 , $97.37 , $588.14 , $605.15 , $573.30 , $573.30 , $573.30 , $592.41 , $611.52 , $998.63 , $541.45 , $654.75 , $859.42 , N/A , $686.18 , $686.18 , $605.15 , $757.46 , $97.37 , $998.63 
 Upper GI W/Air- Mh ,CPT® 74246,0972 - PRO FEE/RAD/DX,N/A,N/A, $584.00 , $379.60 , $816.99 , $139.68 , $103.92 , $608.23 , $684.72 , $543.12 , $525.60 , $525.60 , $467.20 , $467.20 , $103.92 , $539.21 , $554.80 , $525.60 , $525.60 , $525.60 , $543.12 , $560.64 , $796.92 , $496.40 , $747.30 , $639.07 , N/A , $620.10 , $620.10 , $554.80 , $717.77 , $103.92 , $816.99 
"Critical Care Interfacility Transport, <=24 Mo, Ea Add 30 Min",CPT® 99467,N/A,N/A,N/A, $439.00 , $285.35 , $239.00 , $113.80 , N/A , $326.86 , $212.24 , $408.27 , $395.10 , $395.10 , $351.20 , $351.20 , N/A , $405.33 , $417.05 , $395.10 , $395.10 , $395.10 , $408.27 , $421.44 , $301.11 , $373.15 , $263.29 , $262.44 , N/A , $333.24 , $333.24 , $417.05 , $398.72 , $113.80 , $421.44 
"Transposition, Ovary(S)",CPT® 58825,N/A,N/A,N/A," $3,737.00 "," $2,429.05 "," $3,355.25 ", $678.12 , $449.36 ," $3,026.94 "," $2,822.48 "," $3,475.41 "," $3,363.30 "," $3,363.30 "," $2,989.60 "," $2,989.60 ", $449.36 ," $3,450.37 "," $3,550.15 "," $3,363.30 "," $3,363.30 "," $3,363.30 "," $3,475.41 "," $3,587.52 "," $3,501.50 "," $3,176.45 "," $3,710.85 "," $2,829.76 ", N/A ," $3,086.00 "," $3,086.00 "," $3,550.15 "," $3,701.45 ", $449.36 ," $3,710.85 "
Mnt Subs Tx for Change Dx,HCPCS G0270,N/A,N/A,N/A, $121.00 , $78.65 , $134.30 , $27.15 , N/A , $50.86 , N/A , $112.53 , $108.90 , $108.90 , $96.80 , $96.80 , N/A , $111.72 , $114.95 , $108.90 , $108.90 , $108.90 , $112.53 , $116.16 , $85.60 , $102.85 , $53.20 , $104.94 , N/A , $51.85 , $51.85 , $114.95 , $64.82 , $27.15 , $134.30 
Chemiluminescent Assay,CPT® 82397,N/A,N/A,N/A, $100.00 , $65.00 , N/A , $14.40 , $14.40 , $79.90 , $95.61 , $93.00 , $90.00 , $90.00 , $80.00 , $80.00 , $14.40 , $92.33 , $95.00 , $90.00 , $90.00 , $90.00 , $93.00 , $96.00 , $94.28 , $85.00 , $92.45 , $51.19 , N/A , $74.57 , $74.57 , $95.00 , $81.49 , $14.40 , $96.00 
CT Scan Skull Combo,CPT® 70482,N/A,N/A,N/A," $5,462.00 "," $3,550.30 "," $1,512.14 ", $215.63 , $355.58 ," $1,436.08 "," $1,877.13 "," $5,079.66 "," $4,915.80 "," $4,915.80 "," $4,369.60 "," $4,369.60 ", $355.58 ," $5,043.06 "," $5,188.90 "," $4,915.80 "," $4,915.80 "," $4,915.80 "," $5,079.66 "," $5,243.52 "," $1,278.96 "," $4,642.70 "," $2,043.53 "," $1,948.22 ", N/A ," $1,464.10 "," $1,464.10 "," $5,188.90 "," $1,694.72 ", $215.63 ," $5,243.52 "
 Fac Ther Ivntj Cog Funcj Cntct 1st 15 Minutes ,CPT® 97129,0430 - OCCUPATION THER,N/A,N/A, $266.00 , $172.90 , $223.44 , $22.32 , $19.24 , $214.93 , $239.40 , $225.20 , $239.40 , $239.40 , $239.40 , $226.10 , $18.86 , $245.60 , $252.70 , $226.10 , $247.38 , $247.38 , $252.70 , $255.36 , $217.64 , $239.40 , $226.10 , $210.14 , N/A , $215.27 , $215.27 , $252.70 , $228.25 , $18.86 , $255.36 
Open Repair Clavicle Fracture,CPT® 23515,N/A,N/A,N/A," $4,739.00 "," $3,080.35 "," $4,385.42 ", $688.96 , $614.70 ," $3,469.11 "," $3,468.64 "," $4,407.27 "," $4,265.10 "," $4,265.10 "," $3,791.20 "," $3,791.20 ", $614.70 ," $4,375.52 "," $4,502.05 "," $4,265.10 "," $4,265.10 "," $4,265.10 "," $4,407.27 "," $4,549.44 "," $4,077.69 "," $4,028.15 "," $3,828.60 "," $4,093.83 ", N/A ," $3,536.79 "," $3,536.79 "," $4,502.05 "," $4,156.99 ", $614.70 ," $4,549.44 "
Remov/Foreign Body/Ear,67938,N/A,N/A,N/A, $642.00 , $417.30 , $725.34 , $114.79 , $66.00 , $652.93 , $615.59 , $597.06 , $577.80 , $577.80 , $513.60 , $513.60 , $66.00 , $592.76 , $609.90 , $577.80 , $577.80 , $577.80 , $597.06 , $616.32 , $992.25 , $545.70 , $635.13 , $841.40 , N/A , $665.67 , $665.67 , $609.90 , $734.83 , $66.00 , $992.25 
Drainage of Gums Cyst,41800,N/A,N/A,N/A, $609.00 , $395.85 , $949.52 , $149.06 , $30.71 , $713.43 , $755.10 , $566.37 , $548.10 , $548.10 , $487.20 , $487.20 , $30.71 , $562.29 , $578.55 , $548.10 , $548.10 , $548.10 , $566.37 , $584.64 , $697.11 , $517.65 , $824.24 , $871.64 , N/A , $727.36 , $727.36 , $578.55 , $760.72 , $30.71 , $949.52 
"Incision of Urethra,Perineal",CPT® 53010,N/A,N/A,N/A," $2,056.00 "," $1,336.40 "," $1,612.70 ", $285.33 , $384.19 ," $1,439.28 "," $1,351.38 "," $1,912.08 "," $1,850.40 "," $1,850.40 "," $1,644.80 "," $1,644.80 ", $384.19 ," $1,898.30 "," $1,953.20 "," $1,850.40 "," $1,850.40 "," $1,850.40 "," $1,912.08 "," $1,973.76 "," $1,611.77 "," $1,747.60 "," $1,527.16 "," $1,815.55 ", N/A ," $1,467.37 "," $1,467.37 "," $1,953.20 "," $1,724.67 ", $285.33 ," $1,973.76 "
" Fac Virus Inoculation, Tissue ",CPT® 87252,0306 - LAB/BACT-MICRO,N/A,N/A, $241.00 , $156.65 , $202.44 , $26.59 , $26.59 , $194.73 , $216.90 , $204.03 , $216.90 , $216.90 , $216.90 , $204.85 , $26.07 , $222.52 , $228.95 , $204.85 , $224.13 , $224.13 , $228.95 , $231.36 , $197.19 , $216.90 , $204.85 , $190.39 , N/A , $195.04 , $195.04 , $228.95 , $206.80 , $26.07 , $231.36 
"Knee Scope,Full Synovect",29876,N/A,N/A,N/A," $4,129.00 "," $2,683.85 "," $3,974.17 ", $622.54 , $562.99 ," $3,175.92 "," $3,161.93 "," $3,839.97 "," $3,716.10 "," $3,716.10 "," $3,303.20 "," $3,303.20 ", $562.99 ," $3,812.31 "," $3,922.55 "," $3,716.10 "," $3,716.10 "," $3,716.10 "," $3,839.97 "," $3,963.84 "," $3,697.88 "," $3,509.65 "," $3,491.41 "," $3,737.52 ", N/A ," $3,237.88 "," $3,237.88 "," $3,922.55 "," $3,805.67 ", $562.99 ," $3,974.17 "
" Removal Toenail Simple, Single - Mh ",CPT® 11730,0761 - TREATMENT ROOM,N/A,N/A, $377.00 , $245.05 , $316.68 , $51.83 , $42.84 , $304.62 , $339.30 , $319.17 , $339.30 , $339.30 , $339.30 , $320.45 , $42.00 , $348.08 , $358.15 , $320.45 , $350.61 , $350.61 , $358.15 , $361.92 , $308.46 , $339.30 , $320.45 , $297.83 , N/A , $305.11 , $305.11 , $358.15 , $323.50 , $42.00 , $361.92 
" Pro Pet Image W/CT, Full Body ",CPT® 78816,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,067.00 ", $693.55 ," $10,755.99 "," $1,556.06 "," $1,056.59 "," $4,880.21 "," $5,030.21 ", $992.31 , $960.30 , $960.30 , $853.60 , $853.60 ," $1,056.59 ", $985.16 ," $1,013.65 ", $960.30 , $960.30 , $960.30 , $992.31 ," $1,024.32 "," $8,642.65 ", $906.95 ," $5,618.26 "," $5,833.20 ", N/A ," $4,975.43 "," $4,975.43 "," $1,013.65 "," $5,759.14 ", $853.60 ," $10,755.99 "
 Pro Colonoscopy Flx Ablation Tumor Polyp/Other Les ,CPT® 45388,0982 - PRO FEE/OUTPT,N/A,N/A," $3,381.00 "," $2,197.65 "," $1,652.56 ", $255.42 , $436.94 ," $1,543.62 "," $1,612.15 "," $3,144.33 "," $3,042.90 "," $3,042.90 "," $2,704.80 "," $2,704.80 ", $436.94 ," $3,121.68 "," $3,211.95 "," $3,042.90 "," $3,042.90 "," $3,042.90 "," $3,144.33 "," $3,245.76 "," $1,188.46 "," $2,873.85 "," $1,412.67 "," $1,573.02 ", N/A ," $1,573.74 "," $1,573.74 "," $3,211.95 "," $1,645.97 ", $255.42 ," $3,245.76 "
Bx Breast W Device 1st Lesion Magnetic Res Guide,CPT® 19085,N/A,N/A,N/A," $4,069.00 "," $2,644.85 ", $584.29 , $172.52 , $146.68 , $570.24 , $530.48 ," $3,784.17 "," $3,662.10 "," $3,662.10 "," $3,255.20 "," $3,255.20 ", $146.68 ," $3,756.91 "," $3,865.55 "," $3,662.10 "," $3,662.10 "," $3,662.10 "," $3,784.17 "," $3,906.24 ", $645.26 ," $3,458.65 ", $936.45 , $656.49 , N/A , $581.36 , $581.36 ," $3,865.55 ", $674.19 , $146.68 ," $3,906.24 "
 Pro Removal of Shoulder Lesion ,CPT® 23076,0982 - PRO FEE/OUTPT,N/A,N/A," $3,553.00 "," $2,309.45 "," $3,291.02 ", $515.17 , $184.20 ," $2,586.31 "," $2,586.00 "," $3,304.29 "," $3,197.70 "," $3,197.70 "," $2,842.40 "," $2,842.40 ", $184.20 ," $3,280.48 "," $3,375.35 "," $3,197.70 "," $3,197.70 "," $3,197.70 "," $3,304.29 "," $3,410.88 "," $3,046.23 "," $3,020.05 "," $2,859.85 "," $3,051.01 ", N/A ," $2,636.77 "," $2,636.77 "," $3,375.35 "," $3,099.15 ", $184.20 ," $3,410.88 "
 METHYLPREDNISOLONE 4 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6914-61,1 tablet, $11.44 , $7.44 , $9.61 , N/A , N/A , $9.24 , $10.30 , $9.69 , $10.30 , $10.30 , $10.30 , $9.72 , N/A , $10.56 , $10.87 , $9.72 , $10.64 , $10.64 , $10.87 , $10.98 , $9.36 , $10.30 , $9.72 , $9.04 , N/A , $9.26 , $9.26 , $10.87 , $9.82 , $9.04 , $10.98 
Resec Ovar Malig+Tah+Pelv Nodes,CPT® 58951,N/A,N/A,N/A," $8,420.00 "," $5,473.00 "," $6,768.80 "," $1,369.25 "," $2,085.76 "," $5,840.53 "," $5,660.97 "," $7,830.60 "," $7,578.00 "," $7,578.00 "," $6,736.00 "," $6,736.00 "," $2,085.76 "," $7,774.19 "," $7,999.00 "," $7,578.00 "," $7,578.00 "," $7,578.00 "," $7,830.60 "," $8,083.20 "," $7,059.86 "," $7,157.00 "," $7,455.60 "," $5,873.86 ", N/A ," $5,954.49 "," $5,954.49 "," $7,999.00 "," $7,142.03 "," $1,369.25 "," $8,083.20 "
 VITAMIN B-6 100 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,50268-0859-15,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
X-Ray Ac Jts,CPT® 73050,N/A,N/A,N/A, $408.00 , $265.20 , $160.20 , $28.11 , $35.09 , $169.76 , $213.99 , $379.44 , $367.20 , $367.20 , $326.40 , $326.40 , $35.09 , $376.71 , $387.60 , $367.20 , $367.20 , $367.20 , $379.44 , $391.68 , $155.81 , $346.80 , $236.90 , $180.19 , N/A , $173.07 , $173.07 , $387.60 , $200.35 , $28.11 , $391.68 
" Apply Cast,Finger-Elbow ",CPT® 29075,0981 - PRO FEE/ER,N/A,N/A, $339.00 , $220.35 , $373.23 , $59.32 , $54.80 , $299.54 , $303.79 , $315.27 , $305.10 , $305.10 , $271.20 , $271.20 , $54.80 , $313.00 , $322.05 , $305.10 , $305.10 , $305.10 , $315.27 , $325.44 , $349.50 , $288.15 , $333.62 , $357.56 , N/A , $305.39 , $305.39 , $322.05 , $358.95 , $54.80 , $373.23 
 Fac Teaec +-Patch Grf Common Fem ,CPT® 35371,0360 - OR SERVICES,N/A,N/A," $3,413.00 "," $2,218.45 "," $2,866.92 ", $726.96 , $804.14 ," $2,757.70 "," $3,071.70 "," $2,889.45 "," $3,071.70 "," $3,071.70 "," $3,071.70 "," $2,901.05 ", $788.37 ," $3,151.22 "," $3,242.35 "," $2,901.05 "," $3,174.09 "," $3,174.09 "," $3,242.35 "," $3,276.48 "," $2,792.52 "," $3,071.70 "," $2,901.05 "," $2,696.27 ", N/A ," $2,762.14 "," $2,762.14 "," $3,242.35 "," $2,928.70 ", $726.96 ," $3,276.48 "
"Endovenous Rf, 1st Vein",CPT® 36475,N/A,N/A,N/A," $11,345.00 "," $7,374.25 "," $1,630.53 ", $251.72 ," $1,608.39 "," $1,210.78 "," $1,503.17 "," $10,550.85 "," $10,210.50 "," $10,210.50 "," $9,076.00 "," $9,076.00 "," $1,608.39 "," $10,474.84 "," $10,777.75 "," $10,210.50 "," $10,210.50 "," $10,210.50 "," $10,550.85 "," $10,891.20 "," $1,513.97 "," $9,643.25 "," $1,892.89 "," $1,357.13 ", N/A ," $1,234.41 "," $1,234.41 "," $10,777.75 "," $1,402.29 ", $251.72 ," $10,891.20 "
 Fac Iaad Ia Not Otherwise Specified Each Organism ,CPT® 87449,0306 - LAB/BACT-MICRO,N/A,N/A, $169.00 , $109.85 , $141.96 , $12.22 , $12.22 , $136.55 , $152.10 , $143.08 , $152.10 , $152.10 , $152.10 , $143.65 , $11.98 , $156.04 , $160.55 , $143.65 , $157.17 , $157.17 , $160.55 , $162.24 , $138.28 , $152.10 , $143.65 , $133.51 , N/A , $136.77 , $136.77 , $160.55 , $145.02 , $11.98 , $162.24 
 Immunofixation Only - Serum Beaker1 ,CPT® 86334,0302 - LAB/IMMUNOLOGY,N/A,N/A, $248.00 , $161.20 , $208.32 , $22.79 , $22.79 , $200.38 , $223.20 , $209.96 , $223.20 , $223.20 , $223.20 , $210.80 , $22.34 , $228.98 , $235.60 , $210.80 , $230.64 , $230.64 , $235.60 , $238.08 , $202.91 , $223.20 , $210.80 , $195.92 , N/A , $200.71 , $200.71 , $235.60 , $212.81 , $22.34 , $238.08 
 Fac Lipid Panel ,CPT® 80061,0301 - LAB/CHEMISTRY,N/A,N/A, $160.00 , $104.00 , $134.40 , $13.66 , $13.66 , $129.28 , $144.00 , $135.46 , $144.00 , $144.00 , $144.00 , $136.00 , $13.39 , $147.73 , $152.00 , $136.00 , $148.80 , $148.80 , $152.00 , $153.60 , $130.91 , $144.00 , $136.00 , $126.40 , N/A , $129.49 , $129.49 , $152.00 , $137.30 , $13.39 , $153.60 
"Repair Achilles Tendon,Secondary",CPT® 27654,N/A,N/A,N/A," $7,038.00 "," $4,574.70 "," $4,386.53 ", $688.37 , $845.22 ," $3,446.06 "," $3,425.52 "," $6,545.34 "," $6,334.20 "," $6,334.20 "," $5,630.40 "," $5,630.40 ", $845.22 ," $6,498.19 "," $6,686.10 "," $6,334.20 "," $6,334.20 "," $6,334.20 "," $6,545.34 "," $6,756.48 "," $4,068.90 "," $5,982.30 "," $3,746.53 "," $4,089.54 ", N/A ," $3,513.30 "," $3,513.30 "," $6,686.10 "," $4,129.36 ", $688.37 ," $6,756.48 "
 Pro Radex Hip Unilateral With Pelvis 1 View ,CPT® 73501,0972 - PRO FEE/RAD/DX,N/A,N/A, $111.00 , $72.15 , $220.78 , $32.37 , $23.46 , $142.21 , $149.04 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $23.46 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $176.55 , $94.35 , $189.92 , $151.35 , N/A , $144.99 , $144.99 , $105.45 , $167.84 , $23.46 , $220.78 
Bx Breast W Device 1st Lesion Ultrasound Guide,CPT® 19083,N/A,N/A,N/A," $2,485.00 "," $1,615.25 ", $500.04 , $147.29 , $125.44 , $453.36 , $453.66 ," $2,311.05 "," $2,236.50 "," $2,236.50 "," $1,988.00 "," $1,988.00 ", $125.44 ," $2,294.40 "," $2,360.75 "," $2,236.50 "," $2,236.50 "," $2,236.50 "," $2,311.05 "," $2,385.60 ", $551.50 ," $2,112.25 ", $804.96 , $560.67 , N/A , $462.20 , $462.20 ," $2,360.75 ", $536.00 , $125.44 ," $2,385.60 "
"Trim Hyperkeratotic Skin Lesion,2-4",CPT® 11056,N/A,N/A,N/A, $244.00 , $158.60 , $72.42 , $21.33 , $36.84 , $63.57 , $60.59 , $226.92 , $219.60 , $219.60 , $195.20 , $195.20 , $36.84 , $225.29 , $231.80 , $219.60 , $219.60 , $219.60 , $226.92 , $234.24 , $79.89 , $207.40 , $117.75 , $81.61 , N/A , $64.81 , $64.81 , $231.80 , $75.17 , $21.33 , $234.24 
 Fac Colonoscopy Ca Scrn Not Hi Rsk Ind ,HCPCS G0121,0360 - OR SERVICES,N/A,N/A," $2,513.00 "," $1,633.45 "," $2,110.92 ", $174.48 , $351.69 ," $2,030.50 "," $2,261.70 "," $2,127.51 "," $2,261.70 "," $2,261.70 "," $2,261.70 "," $2,136.05 ", $344.79 ," $2,320.25 "," $2,387.35 "," $2,136.05 "," $2,337.09 "," $2,337.09 "," $2,387.35 "," $2,412.48 "," $2,056.14 "," $2,261.70 "," $2,136.05 "," $1,985.27 ", N/A ," $2,033.77 "," $2,033.77 "," $2,387.35 "," $2,156.41 ", $174.48 ," $2,412.48 "
 RIVAROXABAN 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,50458-0580-10,1 tablet, $111.46 , $72.45 , $93.63 , N/A , N/A , $90.06 , $100.31 , $94.36 , $100.31 , $100.31 , $100.31 , $94.74 , N/A , $102.91 , $105.89 , $94.74 , $103.66 , $103.66 , $105.89 , $107.00 , $91.20 , $100.31 , $94.74 , $88.05 , N/A , $90.20 , $90.20 , $105.89 , $95.64 , $88.05 , $107.00 
 Fac Amb Ift 911 Non-Covered Mileage Ground ,HCPCS A0888,0540 - AMBULANCE,N/A,N/A, $41.00 , $26.65 , $34.44 , N/A , N/A , $33.13 , $36.90 , $34.71 , $36.90 , $36.90 , $36.90 , $34.85 , N/A , $37.86 , $38.95 , $34.85 , $38.13 , $38.13 , $38.95 , $39.36 , $33.55 , $36.90 , $34.85 , $32.39 , N/A , $33.18 , $33.18 , $38.95 , $35.18 , $32.39 , $39.36 
 Pro Laryngoscopy Flexible Diagnostic ,CPT® 31575,0981 - PRO FEE/ER,N/A,N/A, $427.00 , $277.55 , $364.67 , $65.21 , $98.45 , $294.56 , $382.52 , $397.11 , $384.30 , $384.30 , $341.60 , $341.60 , $98.45 , $394.25 , $405.65 , $384.30 , $384.30 , $384.30 , $397.11 , $409.92 , $347.16 , $362.95 , $406.77 , $341.75 , N/A , $300.30 , $300.30 , $405.65 , $353.68 , $65.21 , $409.92 
 Ep Eval Sub Q Impl Defib ,CPT® 93644,0480 - CARDIOLOGY,N/A,N/A," $1,738.00 "," $1,129.70 "," $1,459.92 ", $189.35 , $236.35 ," $1,404.30 "," $1,564.20 "," $1,471.39 "," $1,564.20 "," $1,564.20 "," $1,564.20 "," $1,477.30 ", $231.72 ," $1,604.70 "," $1,651.10 "," $1,477.30 "," $1,616.34 "," $1,616.34 "," $1,651.10 "," $1,668.48 "," $1,422.03 "," $1,564.20 "," $1,477.30 "," $1,373.02 ", N/A ," $1,406.56 "," $1,406.56 "," $1,651.10 "," $1,491.38 ", $189.35 ," $1,668.48 "
Abdom Paracentesis Dx/Ther W Imaging Guidance,CPT® 49083,N/A,N/A,N/A," $2,090.00 "," $1,358.50 ", $655.33 , $101.73 , $362.06 , $531.21 , $543.60 ," $1,943.70 "," $1,881.00 "," $1,881.00 "," $1,672.00 "," $1,672.00 ", $362.06 ," $1,929.70 "," $1,985.50 "," $1,881.00 "," $1,881.00 "," $1,881.00 "," $1,943.70 "," $2,006.40 ", $471.73 ," $1,776.50 ", $586.96 , $631.12 , N/A , $541.58 , $541.58 ," $1,985.50 ", $566.43 , $101.73 ," $2,006.40 "
"Injection,Ant Chamber,Eye,Air/Liquid",CPT® 66020,N/A,N/A,N/A," $1,799.00 "," $1,169.35 ", $804.90 , $126.95 , $137.47 , $744.18 , $683.62 ," $1,673.07 "," $1,619.10 "," $1,619.10 "," $1,439.20 "," $1,439.20 ", $137.47 ," $1,661.02 "," $1,709.05 "," $1,619.10 "," $1,619.10 "," $1,619.10 "," $1,673.07 "," $1,727.04 "," $1,105.52 "," $1,529.15 ", $694.00 , $945.55 , N/A , $758.70 , $758.70 ," $1,709.05 ", $837.50 , $126.95 ," $1,727.04 "
 Fac Remove Infusn Device/Pump ,CPT® 62365,0360 - OR SERVICES,N/A,N/A," $7,319.00 "," $4,757.35 "," $6,147.96 ", $277.72 , $367.42 ," $5,913.75 "," $6,587.10 "," $6,196.27 "," $6,587.10 "," $6,587.10 "," $6,587.10 "," $6,221.15 ", $360.22 ," $6,757.63 "," $6,953.05 "," $6,221.15 "," $6,806.67 "," $6,806.67 "," $6,953.05 "," $7,026.24 "," $5,988.41 "," $6,587.10 "," $6,221.15 "," $5,782.01 ", N/A ," $5,923.27 "," $5,923.27 "," $6,953.05 "," $6,280.43 ", $277.72 ," $7,026.24 "
"Thyroidectomy,Malig,Ltd Neck Surg",CPT® 60252,N/A,N/A,N/A," $8,880.00 "," $5,772.00 "," $7,965.43 "," $1,240.89 "," $1,229.45 "," $6,806.04 "," $7,036.36 "," $8,258.40 "," $7,992.00 "," $7,992.00 "," $7,104.00 "," $7,104.00 "," $1,229.45 "," $8,198.90 "," $8,436.00 "," $7,992.00 "," $7,992.00 "," $7,992.00 "," $8,258.40 "," $8,524.80 "," $7,693.53 "," $7,548.00 "," $6,984.61 "," $6,543.67 ", N/A ," $6,938.84 "," $6,938.84 "," $8,436.00 "," $7,738.90 "," $1,229.45 "," $8,524.80 "
 Drug Assay Methotrexate Pbb ,CPT® 80204,0301 - LAB/CHEMISTRY,N/A,N/A, $173.00 , $112.45 , $145.32 , $39.34 , $39.34 , $139.78 , $155.70 , $146.46 , $155.70 , $155.70 , $155.70 , $147.05 , $38.57 , $159.73 , $164.35 , $147.05 , $160.89 , $160.89 , $164.35 , $166.08 , $141.55 , $155.70 , $147.05 , $136.67 , N/A , $140.01 , $140.01 , $164.35 , $148.45 , $38.57 , $166.08 
 Thrombin Time ,CPT® 85670,0305 - LAB/HEMATOLOGY,N/A,N/A, $115.00 , $74.75 , $96.60 , $5.89 , N/A , $92.92 , $103.50 , $97.36 , $103.50 , $103.50 , $103.50 , $97.75 , N/A , $106.18 , $109.25 , $97.75 , $106.95 , $106.95 , $109.25 , $110.40 , $94.09 , $103.50 , $97.75 , $90.85 , N/A , $93.07 , $93.07 , $109.25 , $98.68 , $5.89 , $110.40 
" Fac Brachytx, Non-Str,Hdr IR-192 ",HCPCS C1717,0278 - SUPPLY/IMPLANTS,N/A,N/A," $1,036.00 ", $673.40 , $870.24 , N/A , N/A , $837.09 , $932.40 , $877.08 , $932.40 , $932.40 , $932.40 , $880.60 , N/A , $956.54 , $984.20 , $880.60 , $963.48 , $963.48 , $984.20 , $994.56 , $847.66 , $932.40 , $880.60 , $818.44 , N/A , $838.43 , $838.43 , $984.20 , $888.99 , $818.44 , $994.56 
 Fac Drug Screen Quantitative Oxcarbazepine ,CPT® 80183,0301 - LAB/CHEMISTRY,N/A,N/A, $145.00 , $94.25 , $121.80 , $13.52 , $13.52 , $117.16 , $130.50 , $122.76 , $130.50 , $130.50 , $130.50 , $123.25 , $13.25 , $133.88 , $137.75 , $123.25 , $134.85 , $134.85 , $137.75 , $139.20 , $118.64 , $130.50 , $123.25 , $114.55 , N/A , $117.35 , $117.35 , $137.75 , $124.42 , $13.25 , $139.20 
Home/Res Visit Est Patient Sf Mdm 20 Minutes,CPT® 99347,N/A,N/A,N/A, $146.00 , $94.90 , $110.04 , $44.02 , $40.81 , $95.28 , $96.34 , $135.78 , $131.40 , $131.40 , $116.80 , $116.80 , $40.81 , $134.80 , $138.70 , $131.40 , $131.40 , $131.40 , $135.78 , $140.16 , $99.81 , $124.10 , $120.02 , $120.72 , $58.00 , $97.14 , $97.14 , $138.70 , $112.03 , $40.81 , $140.16 
 OBINUTUZUMAB 1000 MG/40ML IV SOLN ,HCPCS J9301,0636 - DRUGS REQUIRING DETAILED CODIN,50242-0070-01,40 mL," $22,861.91 "," $14,860.24 "," $19,204.00 ", $71.96 , $68.29 ," $18,472.42 "," $20,575.72 "," $19,354.89 "," $20,575.72 "," $20,575.72 "," $20,575.72 "," $19,432.62 ", $66.95 ," $21,108.40 "," $21,718.81 "," $19,432.62 "," $21,261.58 "," $21,261.58 "," $21,718.81 "," $21,947.43 "," $18,705.61 "," $20,575.72 "," $19,432.62 "," $18,060.91 ", N/A ," $18,502.14 "," $18,502.14 "," $21,718.81 "," $19,617.80 ", $66.95 ," $21,947.43 "
 Fac Assay Alkaline Phosphatases ,CPT® 84080,0301 - LAB/CHEMISTRY,N/A,N/A, $158.00 , $102.70 , $132.72 , $15.08 , $15.08 , $127.66 , $142.20 , $133.76 , $142.20 , $142.20 , $142.20 , $134.30 , $14.78 , $145.88 , $150.10 , $134.30 , $146.94 , $146.94 , $150.10 , $151.68 , $129.28 , $142.20 , $134.30 , $124.82 , N/A , $127.87 , $127.87 , $150.10 , $135.58 , $14.78 , $151.68 
 DIMETHYL SULFOXIDE 50 % IS SOLN ,HCPCS J1212,0636 - DRUGS REQUIRING DETAILED CODIN,67457-0177-50,50 mL," $4,079.96 "," $2,651.97 "," $3,427.17 ", $696.17 , $651.47 ," $3,296.61 "," $3,671.96 "," $3,454.09 "," $3,671.96 "," $3,671.96 "," $3,671.96 "," $3,467.97 ", $638.70 ," $3,767.03 "," $3,875.96 "," $3,467.97 "," $3,794.36 "," $3,794.36 "," $3,875.96 "," $3,916.76 "," $3,338.22 "," $3,671.96 "," $3,467.97 "," $3,223.17 ", N/A ," $3,301.91 "," $3,301.91 "," $3,875.96 "," $3,501.01 ", $638.70 ," $3,916.76 "
"Exc Skin Malig 2.1-3cm Trunk,Arm,Leg",11603,N/A,N/A,N/A," $1,190.00 ", $773.50 , $618.19 , $185.66 , $250.91 , $533.33 , $520.40 ," $1,106.70 "," $1,071.00 "," $1,071.00 ", $952.00 , $952.00 , $250.91 ," $1,098.73 "," $1,130.50 "," $1,071.00 "," $1,071.00 "," $1,071.00 "," $1,106.70 "," $1,142.40 ", $677.73 ," $1,011.50 "," $1,034.76 ", $686.47 , N/A , $543.74 , $543.74 ," $1,130.50 ", $630.55 , $185.66 ," $1,142.40 "
 MIRTAZAPINE 15 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6519-61,1 tablet, $14.69 , $9.55 , $12.34 , N/A , N/A , $11.87 , $13.22 , $12.44 , $13.22 , $13.22 , $13.22 , $12.49 , N/A , $13.56 , $13.96 , $12.49 , $13.66 , $13.66 , $13.96 , $14.10 , $12.02 , $13.22 , $12.49 , $11.61 , N/A , $11.89 , $11.89 , $13.96 , $12.61 , $11.61 , $14.10 
 Pro Cltx Intr/Peri/Sbtrchntc Fem Fx W/Mnpj ,CPT® 27240,0975 - PRO FEE/OR,N/A,N/A," $8,544.00 "," $5,553.60 "," $5,807.95 ", $906.37 , $824.74 ," $4,618.26 "," $4,602.97 "," $7,945.92 "," $7,689.60 "," $7,689.60 "," $6,835.20 "," $6,835.20 ", $824.74 ," $7,888.68 "," $8,116.80 "," $7,689.60 "," $7,689.60 "," $7,689.60 "," $7,945.92 "," $8,202.24 "," $5,407.50 "," $7,262.40 "," $5,088.15 "," $5,444.46 ", N/A ," $4,708.37 "," $4,708.37 "," $8,116.80 "," $5,534.00 ", $824.74 ," $8,202.24 "
Arthrocentisis-Sm Joint,CPT® 20600,N/A,N/A,N/A, $360.00 , $234.00 , $218.01 , $33.86 , $39.50 , $174.29 , $169.45 , $334.80 , $324.00 , $324.00 , $288.00 , $288.00 , $39.50 , $332.39 , $342.00 , $324.00 , $324.00 , $324.00 , $334.80 , $345.60 , $203.80 , $306.00 , $183.76 , $206.34 , N/A , $177.69 , $177.69 , $342.00 , $208.86 , $33.86 , $345.60 
 Fac Assay of Progesterone ,CPT® 84144,0301 - LAB/CHEMISTRY,N/A,N/A, $181.00 , $117.65 , $152.04 , $21.28 , $21.28 , $146.25 , $162.90 , $153.23 , $162.90 , $162.90 , $162.90 , $153.85 , $20.86 , $167.12 , $171.95 , $153.85 , $168.33 , $168.33 , $171.95 , $173.76 , $148.09 , $162.90 , $153.85 , $142.99 , N/A , $146.48 , $146.48 , $171.95 , $155.32 , $20.86 , $173.76 
 L Spine MRI Without Contrast ,CPT® 72148,0612 - MRI - SPINE,N/A,N/A," $4,318.00 "," $2,806.70 "," $3,627.12 ", $196.06 , $417.97 ," $3,488.94 "," $3,886.20 "," $3,655.62 "," $3,886.20 "," $3,886.20 "," $3,886.20 "," $3,670.30 ", $409.77 ," $3,986.81 "," $4,102.10 "," $3,670.30 "," $4,015.74 "," $4,015.74 "," $4,102.10 "," $4,145.28 "," $3,532.99 "," $3,886.20 "," $3,670.30 "," $3,411.22 ", N/A ," $3,494.56 "," $3,494.56 "," $4,102.10 "," $3,705.28 ", $196.06 ," $4,145.28 "
 DICLOXACILLIN SODIUM 500 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00093-3125-01,1 capsule, $14.03 , $9.12 , $11.79 , N/A , N/A , $11.34 , $12.63 , $11.88 , $12.63 , $12.63 , $12.63 , $11.93 , N/A , $12.95 , $13.33 , $11.93 , $13.05 , $13.05 , $13.33 , $13.47 , $11.48 , $12.63 , $11.93 , $11.08 , N/A , $11.35 , $11.35 , $13.33 , $12.04 , $11.08 , $13.47 
Closed Rx Femur Shaft Fx+Manip,27502,N/A,N/A,N/A," $5,123.00 "," $3,329.95 "," $4,598.43 ", $716.33 , $686.41 ," $3,695.66 "," $3,694.69 "," $4,764.39 "," $4,610.70 "," $4,610.70 "," $4,098.40 "," $4,098.40 ", $686.41 ," $4,730.07 "," $4,866.85 "," $4,610.70 "," $4,610.70 "," $4,610.70 "," $4,764.39 "," $4,918.08 "," $4,261.85 "," $4,354.55 "," $4,083.72 "," $4,313.75 ", N/A ," $3,767.76 "," $3,767.76 "," $4,866.85 "," $4,428.46 ", $686.41 ," $4,918.08 "
 BARICITINIB 2 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00002-4182-30,1 tablet, $538.76 , $350.19 , $452.56 , N/A , N/A , $435.32 , $484.88 , $456.11 , $484.88 , $484.88 , $484.88 , $457.95 , N/A , $497.44 , $511.82 , $457.95 , $501.05 , $501.05 , $511.82 , $517.21 , $440.81 , $484.88 , $457.95 , $425.62 , N/A , $436.02 , $436.02 , $511.82 , $462.31 , $425.62 , $517.21 
 ZOLEDRONIC ACID 4 MG/100ML IV SOLN ,HCPCS J3489,0636 - DRUGS REQUIRING DETAILED CODIN,25021-0826-67,100 mL, $176.42 , $114.67 , $148.19 , $9.27 , $11.36 , $142.55 , $158.78 , $149.36 , $158.78 , $158.78 , $158.78 , $149.96 , $11.14 , $162.89 , $167.60 , $149.96 , $164.07 , $164.07 , $167.60 , $169.36 , $144.35 , $158.78 , $149.96 , $139.37 , N/A , $142.78 , $142.78 , $167.60 , $151.39 , $9.27 , $169.36 
Layer Closure 2.5cm or Le,12041,N/A,N/A,N/A," $1,004.00 ", $652.60 , $461.96 , $139.44 , $71.45 , $427.30 , $419.98 , $933.72 , $903.60 , $903.60 , $803.20 , $803.20 , $71.45 , $926.99 , $953.80 , $903.60 , $903.60 , $903.60 , $933.72 , $963.84 , $509.89 , $853.40 , $834.94 , $528.73 , N/A , $435.64 , $435.64 , $953.80 , $505.18 , $71.45 , $963.84 
 Fac Sigmoidoscopy Flx Placement of Endoscopic Stent ,CPT® 45347,0360 - OR SERVICES,N/A,N/A," $2,141.00 "," $1,391.65 "," $1,798.44 ", $145.98 , $133.80 ," $1,729.93 "," $1,926.90 "," $1,812.57 "," $1,926.90 "," $1,926.90 "," $1,926.90 "," $1,819.85 ", $131.18 ," $1,976.79 "," $2,033.95 "," $1,819.85 "," $1,991.13 "," $1,991.13 "," $2,033.95 "," $2,055.36 "," $1,751.77 "," $1,926.90 "," $1,819.85 "," $1,691.39 ", N/A ," $1,732.71 "," $1,732.71 "," $2,033.95 "," $1,837.19 ", $131.18 ," $2,055.36 "
Exc Tumor Soft Tiss Back/Flank Subfascial 5+Cm,CPT® 21933,N/A,N/A,N/A," $4,898.00 "," $3,183.70 "," $4,435.41 ", $690.51 , $610.14 ," $3,538.64 "," $3,518.47 "," $4,555.14 "," $4,408.20 "," $4,408.20 "," $3,918.40 "," $3,918.40 ", $610.14 ," $4,522.32 "," $4,653.10 "," $4,408.20 "," $4,408.20 "," $4,408.20 "," $4,555.14 "," $4,702.08 "," $4,111.98 "," $4,163.30 "," $3,905.32 "," $4,146.38 ", N/A ," $3,607.68 "," $3,607.68 "," $4,653.10 "," $4,240.30 ", $610.14 ," $4,702.08 "
 Pro Cltx Carpl B1 Fx W/O Mnpj Ea B1 ,CPT® 25630,0981 - PRO FEE/ER,N/A,N/A," $1,446.00 ", $939.90 ," $1,768.39 ", $280.46 , $206.19 ," $1,350.10 "," $1,368.18 "," $1,344.78 "," $1,301.40 "," $1,301.40 "," $1,156.80 "," $1,156.80 ", $206.19 ," $1,335.09 "," $1,373.70 "," $1,301.40 "," $1,301.40 "," $1,301.40 "," $1,344.78 "," $1,388.16 "," $1,632.61 "," $1,229.10 "," $1,500.40 "," $1,608.26 ", N/A ," $1,376.44 "," $1,376.44 "," $1,373.70 "," $1,617.81 ", $206.19 ," $1,768.39 "
 Fac Assay 17- Ketosteroids ,CPT® 83586,0301 - LAB/CHEMISTRY,N/A,N/A, $132.00 , $85.80 , $110.88 , $13.06 , $13.06 , $106.66 , $118.80 , $111.75 , $118.80 , $118.80 , $118.80 , $112.20 , $12.80 , $121.88 , $125.40 , $112.20 , $122.76 , $122.76 , $125.40 , $126.72 , $108.00 , $118.80 , $112.20 , $104.28 , N/A , $106.83 , $106.83 , $125.40 , $113.27 , $12.80 , $126.72 
 Pro Remove Tendon Sheath Lesion ,CPT® 26160,0975 - PRO FEE/OR,N/A,N/A," $3,855.00 "," $2,505.75 "," $1,944.61 ", $307.22 , $319.22 ," $1,605.88 "," $1,621.13 "," $3,585.15 "," $3,469.50 "," $3,469.50 "," $3,084.00 "," $3,084.00 ", $319.22 ," $3,559.32 "," $3,662.25 "," $3,469.50 "," $3,469.50 "," $3,469.50 "," $3,585.15 "," $3,700.80 "," $1,806.58 "," $3,276.75 "," $1,778.71 "," $1,915.12 ", N/A ," $1,637.21 "," $1,637.21 "," $3,662.25 "," $1,924.31 ", $307.22 ," $3,700.80 "
Echo Transesophag Congen Probe Plcmt Only,CPT® 93316,N/A,N/A,N/A, $342.00 , $222.30 , $161.59 , $24.79 , N/A , $207.99 , $233.20 , $318.06 , $307.80 , $307.80 , $273.60 , $273.60 , N/A , $315.77 , $324.90 , $307.80 , $307.80 , $307.80 , $318.06 , $328.32 , $166.08 , $290.70 , $219.44 , $163.13 , N/A , $212.05 , $212.05 , $324.90 , $235.05 , $24.79 , $328.32 
"Shav Skin Les >21mm Trunk,Arm,Leg",CPT® 11303,N/A,N/A,N/A, $590.00 , $383.50 , $227.73 , $68.04 , $115.78 , $203.77 , $196.36 , $548.70 , $531.00 , $531.00 , $472.00 , $472.00 , $115.78 , $544.75 , $560.50 , $531.00 , $531.00 , $531.00 , $548.70 , $566.40 , $251.56 , $501.50 , $392.49 , $259.98 , N/A , $207.74 , $207.74 , $560.50 , $240.90 , $68.04 , $566.40 
"Destr Malig Scal,Nck,Hand <0.6 Cm",CPT® 17270,N/A,N/A,N/A, $562.00 , $365.30 , $303.93 , $91.89 , $78.10 , $273.12 , $267.70 , $522.66 , $505.80 , $505.80 , $449.60 , $449.60 , $78.10 , $518.89 , $533.90 , $505.80 , $505.80 , $505.80 , $522.66 , $539.52 , $334.75 , $477.70 , $533.44 , $350.21 , N/A , $278.45 , $278.45 , $533.90 , $322.91 , $78.10 , $539.52 
 Fac Perq Transcath Cls Paravalvr Leak 1 Aortic Valve ,CPT® 93591,0360 - OR SERVICES,N/A,N/A," $32,497.00 "," $21,123.05 "," $27,297.48 ", $847.80 , $768.23 ," $26,257.58 "," $29,247.30 "," $27,511.96 "," $29,247.30 "," $29,247.30 "," $29,247.30 "," $27,622.45 ", $753.17 ," $30,004.48 "," $30,872.15 "," $27,622.45 "," $30,222.21 "," $30,222.21 "," $30,872.15 "," $31,197.12 "," $26,589.05 "," $29,247.30 "," $27,622.45 "," $25,672.63 ", N/A ," $26,299.82 "," $26,299.82 "," $30,872.15 "," $27,885.68 ", $753.17 ," $31,197.12 "
 DISULFIRAM 250 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00054-0356-13,1 tablet, $20.76 , $13.49 , $17.44 , N/A , N/A , $16.77 , $18.68 , $17.58 , $18.68 , $18.68 , $18.68 , $17.65 , N/A , $19.17 , $19.72 , $17.65 , $19.31 , $19.31 , $19.72 , $19.93 , $16.99 , $18.68 , $17.65 , $16.40 , N/A , $16.80 , $16.80 , $19.72 , $17.81 , $16.40 , $19.93 
 Fac Assay of Urine Potassium ,CPT® 84133,0301 - LAB/CHEMISTRY,N/A,N/A, $55.00 , $35.75 , $46.20 , $4.82 , $4.82 , $44.44 , $49.50 , $46.56 , $49.50 , $49.50 , $49.50 , $46.75 , $4.73 , $50.78 , $52.25 , $46.75 , $51.15 , $51.15 , $52.25 , $52.80 , $45.00 , $49.50 , $46.75 , $43.45 , N/A , $44.51 , $44.51 , $52.25 , $47.20 , $4.73 , $52.80 
Ins New/Rplc Prm Pacemaker W/Transv Eltrd Ventr,CPT® 33207,N/A,N/A,N/A," $5,925.00 "," $3,851.25 "," $2,842.71 ", $439.76 ," $1,206.21 "," $2,097.52 "," $2,029.37 "," $5,510.25 "," $5,332.50 "," $5,332.50 "," $4,740.00 "," $4,740.00 "," $1,206.21 "," $5,470.55 "," $5,628.75 "," $5,332.50 "," $5,332.50 "," $5,332.50 "," $5,510.25 "," $5,688.00 "," $2,631.45 "," $5,036.25 "," $2,551.21 "," $2,324.93 ", N/A ," $2,138.45 "," $2,138.45 "," $5,628.75 "," $2,429.27 ", $439.76 ," $5,688.00 "
Chemodenervation Muscle Neck Unilat for Dystonia,CPT® 64616,N/A,N/A,N/A, $772.00 , $501.80 , $505.39 , $98.15 , $78.09 , $578.28 , $570.10 , $717.96 , $694.80 , $694.80 , $617.60 , $617.60 , $78.09 , $712.79 , $733.40 , $694.80 , $694.80 , $694.80 , $717.96 , $741.12 , $544.97 , $656.20 , $577.51 , $621.45 , N/A , $589.57 , $589.57 , $733.40 , $632.47 , $78.09 , $741.12 
" Fac Evaluation of Fna Smear to Determine Adequacy, Ea Add Eval ",CPT® 88177,0310 - PATHOLOGY LAB,N/A,N/A, $162.00 , $105.30 , $136.08 , $29.07 , $20.60 , $130.90 , $145.80 , $137.15 , $145.80 , $145.80 , $145.80 , $137.70 , $20.20 , $149.57 , $153.90 , $137.70 , $150.66 , $150.66 , $153.90 , $155.52 , $132.55 , $145.80 , $137.70 , $127.98 , N/A , $131.11 , $131.11 , $153.90 , $139.01 , $20.20 , $155.52 
 Pro Cltx Rdl Shft Fx W/O Mnpj ,CPT® 25500,0983 - PRO FEE/CLINIC,N/A,N/A," $1,781.00 "," $1,157.65 "," $1,601.34 ", $254.45 , $170.42 ," $1,203.90 "," $1,222.94 "," $1,656.33 "," $1,602.90 "," $1,602.90 "," $1,424.80 "," $1,424.80 ", $170.42 ," $1,644.40 "," $1,691.95 "," $1,602.90 "," $1,602.90 "," $1,602.90 "," $1,656.33 "," $1,709.76 "," $1,473.82 "," $1,513.85 "," $1,338.05 "," $1,436.19 ", N/A ," $1,227.40 "," $1,227.40 "," $1,691.95 "," $1,442.63 ", $170.42 ," $1,709.76 "
 PROBENECID 500 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00591-5347-01,1 tablet, $5.05 , $3.28 , $4.24 , N/A , N/A , $4.08 , $4.55 , $4.28 , $4.55 , $4.55 , $4.55 , $4.29 , N/A , $4.66 , $4.80 , $4.29 , $4.70 , $4.70 , $4.80 , $4.85 , $4.13 , $4.55 , $4.29 , $3.99 , N/A , $4.09 , $4.09 , $4.80 , $4.33 , $3.99 , $4.85 
Cath Indw Foley 2 Way Silicn,HCPCS A4344,N/A,N/A,N/A, $36.00 , $23.40 , N/A , $21.72 , $9.73 , N/A , N/A , $33.48 , $32.40 , $32.40 , $28.80 , $28.80 , $9.73 , $33.24 , $34.20 , $32.40 , $32.40 , $32.40 , $33.48 , $34.56 , N/A , $30.60 , $18.81 , $19.73 , N/A , N/A , N/A , $34.20 , N/A , $9.73 , $34.56 
 Fac Dermavest 1 Square Cm ,HCPCS Q4153,0636 - DRUGS REQUIRING DETAILED CODIN,N/A,N/A," $1,216.00 ", $790.40 ," $1,021.44 ", $136.51 , N/A , $982.53 ," $1,094.40 "," $1,029.47 "," $1,094.40 "," $1,094.40 "," $1,094.40 "," $1,033.60 ", N/A ," $1,122.73 "," $1,155.20 "," $1,033.60 "," $1,130.88 "," $1,130.88 "," $1,155.20 "," $1,167.36 ", $994.93 ," $1,094.40 "," $1,033.60 ", $960.64 , N/A , $984.11 , $984.11 ," $1,155.20 "," $1,043.45 ", $136.51 ," $1,167.36 "
Drain External Ear Lesion,69005,N/A,N/A,N/A," $1,033.00 ", $671.45 , $758.50 , $155.08 , $72.58 , $755.35 , $776.05 , $960.69 , $929.70 , $929.70 , $826.40 , $826.40 , $72.58 , $953.77 , $981.35 , $929.70 , $929.70 , $929.70 , $960.69 , $991.68 , $816.81 , $878.05 , $847.43 , $757.85 , N/A , $770.09 , $770.09 , $981.35 , $879.31 , $72.58 , $991.68 
Full Thick Grft Trunk Add 20 Sqcm,CPT® 15201,N/A,N/A,N/A, $607.00 , $394.55 , $238.27 , $71.33 , $216.82 , $214.23 , $208.02 , $564.51 , $546.30 , $546.30 , $485.60 , $485.60 , $216.82 , $560.44 , $576.65 , $546.30 , $546.30 , $546.30 , $564.51 , $582.72 , $266.47 , $515.95 , $419.26 , $273.07 , N/A , $218.41 , $218.41 , $576.65 , $253.26 , $71.33 , $582.72 
 ERYTHROMYCIN BASE 250 MG PO CPEP ,HCPCS RXC637,0250 - PHARMACY,68308-0250-10,1 capsule, $47.25 , $30.71 , $39.69 , N/A , N/A , $38.18 , $42.53 , $40.00 , $42.53 , $42.53 , $42.53 , $40.16 , N/A , $43.63 , $44.89 , $40.16 , $43.94 , $43.94 , $44.89 , $45.36 , $38.66 , $42.53 , $40.16 , $37.33 , N/A , $38.24 , $38.24 , $44.89 , $40.55 , $37.33 , $45.36 
"Med Nutr Ther, 1st, Indiv, Ea 15 Min",97802,N/A,N/A,N/A, $136.00 , $88.40 , $75.82 , $32.22 , N/A , $73.03 , $73.92 , $126.48 , $122.40 , $122.40 , $108.80 , $108.80 , N/A , $125.57 , $129.20 , $122.40 , $122.40 , $122.40 , $126.48 , $130.56 , $100.67 , $115.60 , $97.32 , $124.09 , N/A , $74.46 , $74.46 , $129.20 , $86.80 , $32.22 , $130.56 
 Fac Fetal Congenital Abnor Assay Four Anal ,CPT® 81511,0310 - PATHOLOGY LAB,N/A,N/A, $347.00 , $225.55 , $291.48 , $156.57 , $156.57 , $280.38 , $312.30 , $293.77 , $312.30 , $312.30 , $312.30 , $294.95 , $153.50 , $320.39 , $329.65 , $294.95 , $322.71 , $322.71 , $329.65 , $333.12 , $283.92 , $312.30 , $294.95 , $274.13 , N/A , $280.83 , $280.83 , $329.65 , $297.76 , $153.50 , $333.12 
 NM Hepatobiliary Imaging Including Gb ,CPT® 78226,0340 - NUCLEAR MEDICINE,N/A,N/A," $3,099.00 "," $2,014.35 "," $2,603.16 ", $297.35 , $256.59 ," $2,503.99 "," $2,789.10 "," $2,623.61 "," $2,789.10 "," $2,789.10 "," $2,789.10 "," $2,634.15 ", $251.56 ," $2,861.31 "," $2,944.05 "," $2,634.15 "," $2,882.07 "," $2,882.07 "," $2,944.05 "," $2,975.04 "," $2,535.60 "," $2,789.10 "," $2,634.15 "," $2,448.21 ", N/A ," $2,508.02 "," $2,508.02 "," $2,944.05 "," $2,659.25 ", $251.56 ," $2,975.04 "
"Program Eval Implant Device,Cardvert/Defib,2 Lead",93283,N/A,N/A,N/A," $1,010.00 ", $656.50 , $639.21 , $97.76 , $66.57 , $443.04 , $448.84 , $939.30 , $909.00 , $909.00 , $808.00 , $808.00 , $66.57 , $932.53 , $959.50 , $909.00 , $909.00 , $909.00 , $939.30 , $969.60 , $602.81 , $858.50 , $417.47 , $297.15 , N/A , $451.68 , $451.68 , $959.50 , $500.69 , $66.57 , $969.60 
Emergency Department Visit Moderate Mdm,CPT® 99284,N/A,N/A,N/A, $633.00 , $411.45 , $426.57 , $116.35 , $31.98 , $331.78 , $340.64 , $588.69 , $569.70 , $569.70 , $506.40 , $506.40 , $31.98 , $584.45 , $601.35 , $569.70 , $569.70 , $569.70 , $588.69 , $607.68 , $362.22 , $538.05 , $252.79 , $254.40 , $117.00 , $338.26 , $338.26 , $601.35 , $405.90 , $31.98 , $607.68 
Eye Allergy Tests,CPT® 95060,N/A,N/A,N/A, $119.00 , $77.35 , $90.95 , $36.56 , $11.69 , $62.68 , $61.92 , $110.67 , $107.10 , $107.10 , $95.20 , $95.20 , $11.69 , $109.87 , $113.05 , $107.10 , $107.10 , $107.10 , $110.67 , $114.24 , $112.07 , $101.15 , $105.43 , $109.24 , N/A , $63.91 , $63.91 , $113.05 , $75.56 , $11.69 , $114.24 
"I&D Finger Abscess,Simple",26010,N/A,N/A,N/A, $817.00 , $531.05 , $867.23 , $136.36 , $30.71 , $664.95 , $677.89 , $759.81 , $735.30 , $735.30 , $653.60 , $653.60 , $30.71 , $754.34 , $776.15 , $735.30 , $735.30 , $735.30 , $759.81 , $784.32 , $800.12 , $694.45 , $742.17 , $793.35 , N/A , $677.92 , $677.92 , $776.15 , $796.82 , $30.71 , $867.23 
Int Hrhc by Ligation Single Hroid W/O Img Gdn,CPT® 46945,N/A,N/A,N/A," $2,014.00 "," $1,309.10 "," $2,113.80 ", $328.01 , $46.08 ," $1,075.09 "," $1,124.62 "," $1,873.02 "," $1,812.60 "," $1,812.60 "," $1,611.20 "," $1,611.20 ", $46.08 ," $1,859.53 "," $1,913.30 "," $1,812.60 "," $1,812.60 "," $1,812.60 "," $1,873.02 "," $1,933.44 "," $1,509.86 "," $1,711.90 "," $1,229.22 "," $1,288.72 ", N/A ," $1,096.07 "," $1,096.07 "," $1,913.30 "," $1,146.38 ", $46.08 ," $2,113.80 "
 ATOMOXETINE HCL 10 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,68462-0265-30,1 capsule, $73.12 , $47.53 , $61.42 , N/A , N/A , $59.08 , $65.81 , $61.90 , $65.81 , $65.81 , $65.81 , $62.15 , N/A , $67.51 , $69.46 , $62.15 , $68.00 , $68.00 , $69.46 , $70.20 , $59.83 , $65.81 , $62.15 , $57.76 , N/A , $59.18 , $59.18 , $69.46 , $62.74 , $57.76 , $70.20 
Splint Wrist or Ankle,HCPCS S8451,N/A,N/A,N/A, $41.00 , $26.65 , N/A , N/A , N/A , N/A , N/A , $38.13 , $36.90 , $36.90 , $32.80 , $32.80 , N/A , $37.86 , $38.95 , $36.90 , $36.90 , $36.90 , $38.13 , $39.36 , N/A , $34.85 , $32.80 , N/A , N/A , N/A , N/A , $38.95 , N/A , $32.80 , $39.36 
Laps Surg Prst8ect Smpl Stot Robotic Assistance,CPT® 55867,N/A,N/A,N/A," $9,845.00 "," $6,399.25 ", N/A , $996.86 , N/A , N/A , N/A ," $9,155.85 "," $8,860.50 "," $8,860.50 "," $7,876.00 "," $7,876.00 ", N/A ," $9,089.89 "," $9,352.75 "," $8,860.50 "," $8,860.50 "," $8,860.50 "," $9,155.85 "," $9,451.20 ", N/A ," $8,368.25 "," $5,488.98 ", N/A , N/A ," $2,871.62 "," $2,871.62 "," $9,352.75 "," $3,443.83 ", $996.86 ," $9,451.20 "
Drainage of Kidney,CPT® 50040,N/A,N/A,N/A," $6,438.00 "," $4,184.70 "," $5,005.20 ", $880.21 ," $1,229.45 "," $4,535.37 "," $4,216.10 "," $5,987.34 "," $5,794.20 "," $5,794.20 "," $5,150.40 "," $5,150.40 "," $1,229.45 "," $5,944.21 "," $6,116.10 "," $5,794.20 "," $5,794.20 "," $5,794.20 "," $5,987.34 "," $6,180.48 "," $5,017.07 "," $5,472.30 "," $4,779.51 "," $5,684.93 ", N/A ," $4,623.86 "," $4,623.86 "," $6,116.10 "," $5,434.69 ", $880.21 ," $6,180.48 "
Removal Permanent Pacemaker Pulse Generator Only,CPT® 33233,N/A,N/A,N/A," $2,096.00 "," $1,362.40 "," $1,403.29 ", $217.71 , $267.78 ," $1,036.64 "," $1,000.82 "," $1,949.28 "," $1,886.40 "," $1,886.40 "," $1,676.80 "," $1,676.80 ", $267.78 ," $1,935.24 "," $1,991.20 "," $1,886.40 "," $1,886.40 "," $1,886.40 "," $1,949.28 "," $2,012.16 "," $1,290.73 "," $1,781.60 "," $1,252.41 "," $1,121.07 ", N/A ," $1,056.87 "," $1,056.87 "," $1,991.20 "," $1,200.62 ", $217.71 ," $2,012.16 "
Blood Clot Factor VIII Test,CPT® 85240,N/A,N/A,N/A, $284.00 , $184.60 , N/A , $18.26 , $9.71 , $39.58 , $47.32 , $264.12 , $255.60 , $255.60 , $227.20 , $227.20 , $9.71 , $262.22 , $269.80 , $255.60 , $255.60 , $255.60 , $264.12 , $272.64 , $119.52 , $241.40 , $116.77 , $64.91 , N/A , $36.94 , $36.94 , $269.80 , $40.36 , $9.71 , $272.64 
"Removal of Hydrocele,Tunica,Bilat",CPT® 55041,N/A,N/A,N/A," $2,687.00 "," $1,746.55 "," $2,274.10 ", $489.92 , $617.01 ," $1,637.18 "," $1,658.66 "," $2,498.91 "," $2,418.30 "," $2,418.30 "," $2,149.60 "," $2,149.60 ", $617.01 ," $2,480.91 "," $2,552.65 "," $2,418.30 "," $2,418.30 "," $2,418.30 "," $2,498.91 "," $2,579.52 "," $2,131.69 "," $2,283.95 "," $2,647.55 "," $2,467.53 ", N/A ," $1,669.13 "," $1,669.13 "," $2,552.65 "," $2,000.54 ", $489.92 ," $2,647.55 "
Ndsc Ablation & Rcnstj Atria Lmtd W/O Bypass,CPT® 33265,N/A,N/A,N/A," $8,532.00 "," $5,545.80 "," $7,970.04 "," $1,232.55 "," $1,090.34 "," $5,807.64 "," $5,768.34 "," $7,934.76 "," $7,678.80 "," $7,678.80 "," $6,825.60 "," $6,825.60 "," $1,090.34 "," $7,877.60 "," $8,105.40 "," $7,678.80 "," $7,678.80 "," $7,678.80 "," $7,934.76 "," $8,190.72 "," $7,377.17 "," $7,252.20 "," $7,291.47 "," $6,532.95 ", N/A ," $5,920.96 "," $5,920.96 "," $8,105.40 "," $6,726.21 "," $1,090.34 "," $8,190.72 "
 Renal Failure Without Cc/McC ,MS DRG V40 (FY2023) 684,N/A,N/A,N/A," $12,444.88 "," $8,089.17 "," $10,453.70 ", N/A , N/A ," $10,055.46 "," $11,200.39 "," $10,535.84 "," $11,200.39 "," $11,200.39 "," $11,200.39 "," $10,578.15 ", N/A ," $11,490.36 "," $11,822.64 "," $10,578.15 "," $11,573.74 "," $11,573.74 "," $11,822.64 "," $11,947.08 "," $10,182.40 "," $11,200.39 "," $10,578.15 "," $9,831.46 ", N/A ," $10,071.64 "," $10,071.64 "," $11,822.64 "," $10,678.95 "," $9,831.46 "," $11,947.08 "
 Pro Cerumen Rmv/Uni/Bil ,CPT® 69210,0982 - PRO FEE/OUTPT,N/A,N/A, $289.00 , $187.85 , $154.15 , $31.15 , $14.13 , $157.99 , $157.57 , $268.77 , $260.10 , $260.10 , $231.20 , $231.20 , $14.13 , $266.83 , $274.55 , $260.10 , $260.10 , $260.10 , $268.77 , $277.44 , $170.16 , $245.65 , $171.27 , $161.15 , N/A , $161.08 , $161.08 , $274.55 , $183.90 , $14.13 , $277.44 
 STERILE WATER FOR INJECTION IJ SOLN ,HCPCS RXA250,0250 - PHARMACY,00409-4887-10,10 mL, $16.68 , $10.84 , $14.01 , N/A , N/A , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , N/A , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $13.18 , $16.01 
Motor &/Sens 5-6 Nrv Cndj Preconf Eltrode Limb,CPT® 95909,N/A,N/A,N/A, $723.00 , $469.95 , $669.50 , $132.07 , $109.68 , $474.66 ," $1,073.06 ", $672.39 , $650.70 , $650.70 , $578.40 , $578.40 , $109.68 , $667.55 , $686.85 , $650.70 , $650.70 , $650.70 , $672.39 , $694.08 , $622.83 , $614.55 , $416.64 , $573.87 , N/A , $483.92 , $483.92 , $686.85 , $594.92 , $109.68 ," $1,073.06 "
 LIDOCAINE IN D5W 4-5 MG/ML-% IV SOLN ,HCPCS J2001,0636 - DRUGS REQUIRING DETAILED CODIN,00338-0409-03,500 mL, $41.10 , $26.72 , $34.52 , $0.03 , $0.03 , $33.21 , $36.99 , $34.80 , $36.99 , $36.99 , $36.99 , $34.94 , $0.03 , $37.95 , $39.05 , $34.94 , $38.22 , $38.22 , $39.05 , $39.46 , $33.63 , $36.99 , $34.94 , $32.47 , N/A , $33.26 , $33.26 , $39.05 , $35.27 , $0.03 , $39.46 
"Med Nutr Ther, Subsq, Indiv, Ea 15 Min",CPT® 97803,N/A,N/A,N/A, $113.00 , $73.45 , $64.46 , $27.15 , N/A , $61.35 , $62.99 , $105.09 , $101.70 , $101.70 , $90.40 , $90.40 , N/A , $104.33 , $107.35 , $101.70 , $101.70 , $101.70 , $105.09 , $108.48 , $85.60 , $96.05 , $83.12 , $104.94 , N/A , $62.56 , $62.56 , $107.35 , $72.92 , $27.15 , $108.48 
Colsc Flexible W/Control Bleeding Any Method,CPT® 45382,N/A,N/A,N/A," $4,300.00 "," $2,795.00 "," $1,590.62 ", $245.20 , $640.60 ," $1,556.09 "," $1,600.72 "," $3,999.00 "," $3,870.00 "," $3,870.00 "," $3,440.00 "," $3,440.00 ", $640.60 ," $3,970.19 "," $4,085.00 "," $3,870.00 "," $3,870.00 "," $3,870.00 "," $3,999.00 "," $4,128.00 "," $1,141.26 "," $3,655.00 "," $1,753.73 "," $1,513.55 ", N/A ," $1,586.45 "," $1,586.45 "," $4,085.00 "," $1,659.27 ", $245.20 ," $4,128.00 "
"Ligmt Revision,Knee,Extra-Artic",CPT® 27427,N/A,N/A,N/A," $4,740.00 "," $3,081.00 "," $4,331.60 ", $678.84 , $998.92 ," $3,439.54 "," $3,440.81 "," $4,408.20 "," $4,266.00 "," $4,266.00 "," $3,792.00 "," $3,792.00 ", $998.92 ," $4,376.44 "," $4,503.00 "," $4,266.00 "," $4,266.00 "," $4,266.00 "," $4,408.20 "," $4,550.40 "," $4,037.32 "," $4,029.00 "," $3,801.84 "," $4,039.19 ", N/A ," $3,506.65 "," $3,506.65 "," $4,503.00 "," $4,121.58 ", $678.84 ," $4,550.40 "
Osteotomy Metatarsal (Not 1st),CPT® 28308,N/A,N/A,N/A," $3,731.00 "," $2,425.15 "," $2,379.91 ", $374.12 , $284.13 ," $1,848.67 "," $1,839.97 "," $3,469.83 "," $3,357.90 "," $3,357.90 "," $2,984.80 "," $2,984.80 ", $284.13 ," $3,444.83 "," $3,544.45 "," $3,357.90 "," $3,357.90 "," $3,357.90 "," $3,469.83 "," $3,581.76 "," $2,202.24 "," $3,171.35 "," $1,996.37 "," $2,208.03 ", N/A ," $1,884.75 "," $1,884.75 "," $3,544.45 "," $2,215.25 ", $284.13 ," $3,581.76 "
"Repair Femoral Hernia,Strang",49553,N/A,N/A,N/A," $4,200.00 "," $2,730.00 "," $3,788.79 ", $587.40 , $630.39 ," $2,961.23 "," $3,003.41 "," $3,906.00 "," $3,780.00 "," $3,780.00 "," $3,360.00 "," $3,360.00 ", $630.39 ," $3,877.86 "," $3,990.00 "," $3,780.00 "," $3,780.00 "," $3,780.00 "," $3,906.00 "," $4,032.00 "," $2,707.11 "," $3,570.00 "," $3,336.20 "," $3,500.00 ", N/A ," $3,019.02 "," $3,019.02 "," $3,990.00 "," $3,157.56 ", $587.40 ," $4,032.00 "
Incise Infected Bursa,28001,N/A,N/A,N/A," $1,326.00 ", $861.90 , $602.36 , $93.09 , $46.08 , $846.97 , $824.16 ," $1,233.18 "," $1,193.40 "," $1,193.40 "," $1,060.80 "," $1,060.80 ", $46.08 ," $1,224.30 "," $1,259.70 "," $1,193.40 "," $1,193.40 "," $1,193.40 "," $1,233.18 "," $1,272.96 ", $970.48 ," $1,127.10 ", $888.46 , $991.70 , N/A , $863.50 , $863.50 ," $1,259.70 "," $1,014.92 ", $46.08 ," $1,272.96 "
 Fac Motor &/Sens 5-6 Nrv Cndj Preconf Eltrode Limb ,CPT® 95909,0922 - EMG,N/A,N/A," $1,444.00 ", $938.60 ," $1,212.96 ", $132.07 , $109.68 ," $1,166.75 "," $1,299.60 "," $1,222.49 "," $1,299.60 "," $1,299.60 "," $1,299.60 "," $1,227.40 ", $107.53 ," $1,333.25 "," $1,371.80 "," $1,227.40 "," $1,342.92 "," $1,342.92 "," $1,371.80 "," $1,386.24 "," $1,181.48 "," $1,299.60 "," $1,227.40 "," $1,140.76 ", N/A ," $1,168.63 "," $1,168.63 "," $1,371.80 "," $1,239.10 ", $107.53 ," $1,386.24 "
"Revision of Ileostomy,Simple",CPT® 44312,N/A,N/A,N/A," $3,768.00 "," $2,449.20 "," $3,608.61 ", $559.13 , $65.97 ," $2,801.86 "," $2,839.69 "," $3,504.24 "," $3,391.20 "," $3,391.20 "," $3,014.40 "," $3,014.40 ", $65.97 ," $3,478.99 "," $3,579.60 "," $3,391.20 "," $3,391.20 "," $3,391.20 "," $3,504.24 "," $3,617.28 "," $2,574.49 "," $3,202.80 "," $3,129.25 "," $3,333.22 ", N/A ," $2,856.53 "," $2,856.53 "," $3,579.60 "," $2,987.63 ", $65.97 ," $3,617.28 "
"Closed Rx Hum Supracondylr Fx,Manipu",24535,N/A,N/A,N/A," $3,918.00 "," $2,546.70 "," $3,493.49 ", $552.11 , $533.82 ," $2,721.20 "," $2,743.97 "," $3,643.74 "," $3,526.20 "," $3,526.20 "," $3,134.40 "," $3,134.40 ", $533.82 ," $3,617.49 "," $3,722.10 "," $3,526.20 "," $3,526.20 "," $3,526.20 "," $3,643.74 "," $3,761.28 "," $3,252.44 "," $3,330.30 "," $3,022.20 "," $3,233.03 ", N/A ," $2,774.30 "," $2,774.30 "," $3,722.10 "," $3,260.78 ", $533.82 ," $3,761.28 "
 Fac Muramidase ,CPT® 85549,0301 - LAB/CHEMISTRY,N/A,N/A, $176.00 , $114.40 , $147.84 , $19.13 , $19.13 , $142.21 , $158.40 , $149.00 , $158.40 , $158.40 , $158.40 , $149.60 , $18.75 , $162.50 , $167.20 , $149.60 , $163.68 , $163.68 , $167.20 , $168.96 , $144.00 , $158.40 , $149.60 , $139.04 , N/A , $142.44 , $142.44 , $167.20 , $151.03 , $18.75 , $168.96 
 Fac Non-Pneum Walk Boot Prefab ,HCPCS L4386,0274 - PROSTHETIC DEV,N/A,N/A, $257.00 , $167.05 , $215.88 , $185.47 , $131.51 , $207.66 , $231.30 , $217.58 , $231.30 , $231.30 , $231.30 , $218.45 , $128.93 , $237.29 , $244.15 , $218.45 , $239.01 , $239.01 , $244.15 , $246.72 , $210.28 , $231.30 , $218.45 , $203.03 , N/A , $207.99 , $207.99 , $244.15 , $220.53 , $128.93 , $246.72 
 MIDAZOLAM HCL 50 MG/10ML IJ SOLN ,HCPCS J2250,0636 - DRUGS REQUIRING DETAILED CODIN,00641-6060-10,10 mL, $77.58 , $50.43 , $65.17 , $0.14 , $0.17 , $62.68 , $69.82 , $65.68 , $69.82 , $69.82 , $69.82 , $65.94 , $0.17 , $71.63 , $73.70 , $65.94 , $72.15 , $72.15 , $73.70 , $74.48 , $63.48 , $69.82 , $65.94 , $61.29 , N/A , $62.79 , $62.79 , $73.70 , $66.57 , $0.14 , $74.48 
" Fac Phospholipid Neutralization,Platelet ",CPT® 85597,0305 - LAB/HEMATOLOGY,N/A,N/A, $180.00 , $117.00 , $151.20 , $18.34 , $18.34 , $145.44 , $162.00 , $152.39 , $162.00 , $162.00 , $162.00 , $153.00 , $17.98 , $166.19 , $171.00 , $153.00 , $167.40 , $167.40 , $171.00 , $172.80 , $147.28 , $162.00 , $153.00 , $142.20 , N/A , $145.67 , $145.67 , $171.00 , $154.46 , $17.98 , $172.80 
 PYRIDOSTIGMINE BROMIDE 60 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6622-61,1 tablet, $8.29 , $5.39 , $6.96 , N/A , N/A , $6.70 , $7.46 , $7.02 , $7.46 , $7.46 , $7.46 , $7.05 , N/A , $7.65 , $7.88 , $7.05 , $7.71 , $7.71 , $7.88 , $7.96 , $6.78 , $7.46 , $7.05 , $6.55 , N/A , $6.71 , $6.71 , $7.88 , $7.11 , $6.55 , $7.96 
 Fac or Room Chg Lvl3 Base ,Custom OPTORBASELVL3,0360 - OR SERVICES,N/A,N/A," $7,295.00 "," $4,741.75 "," $6,127.80 ", N/A , N/A ," $5,894.36 "," $6,565.50 "," $6,175.95 "," $6,565.50 "," $6,565.50 "," $6,565.50 "," $6,200.75 ", N/A ," $6,735.47 "," $6,930.25 "," $6,200.75 "," $6,784.35 "," $6,784.35 "," $6,930.25 "," $7,003.20 "," $5,968.77 "," $6,565.50 "," $6,200.75 "," $5,763.05 ", N/A ," $5,903.84 "," $5,903.84 "," $6,930.25 "," $6,259.84 "," $5,763.05 "," $7,003.20 "
"Lap,Dx Surgical Abd W/Biopsy",CPT® 49321,N/A,N/A,N/A," $3,508.00 "," $2,280.20 "," $2,070.64 ", $321.57 , $373.69 ," $1,625.05 "," $1,656.01 "," $3,262.44 "," $3,157.20 "," $3,157.20 "," $2,806.40 "," $2,806.40 ", $373.69 ," $3,238.94 "," $3,332.60 "," $3,157.20 "," $3,157.20 "," $3,157.20 "," $3,262.44 "," $3,367.68 "," $1,484.93 "," $2,981.80 "," $1,839.37 "," $1,929.04 ", N/A ," $1,656.76 "," $1,656.76 "," $3,332.60 "," $1,732.81 ", $321.57 ," $3,367.68 "
 Fac Perq Thrmbc/Nfs Dial Circuit Tcat Plmt IV Stent ,CPT® 36906,0360 - OR SERVICES,N/A,N/A," $33,218.00 "," $21,591.70 "," $27,903.12 ", $473.76 ," $8,018.88 "," $26,840.14 "," $29,896.20 "," $28,122.36 "," $29,896.20 "," $29,896.20 "," $29,896.20 "," $28,235.30 "," $7,861.65 "," $30,670.18 "," $31,557.10 "," $28,235.30 "," $30,892.74 "," $30,892.74 "," $31,557.10 "," $31,889.28 "," $27,178.97 "," $29,896.20 "," $28,235.30 "," $26,242.22 ", N/A ," $26,883.33 "," $26,883.33 "," $31,557.10 "," $28,504.37 ", $473.76 ," $31,889.28 "
"Apply Cast,Finger (Contracture)",CPT® 29086,N/A,N/A,N/A, $532.00 , $345.80 , $301.60 , $47.81 , $25.19 , $246.25 , $252.58 , $494.76 , $478.80 , $478.80 , $425.60 , $425.60 , $25.19 , $491.20 , $505.40 , $478.80 , $478.80 , $478.80 , $494.76 , $510.72 , $276.71 , $452.20 , $276.53 , $301.13 , N/A , $251.06 , $251.06 , $505.40 , $295.08 , $25.19 , $510.72 
 POTASSIUM & SODIUM PHOSPHATES 280-160-250 MG PO PACK ,HCPCS RXC637,0250 - PHARMACY,60258-0006-01,1 packet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Injection Aa&/Strd Nerves Nrvtg Si Joint W/Img ,CPT® 64451,0360 - OR SERVICES,N/A,N/A," $1,805.00 "," $1,173.25 "," $1,516.20 ", $78.68 , $166.49 ," $1,458.44 "," $1,624.50 "," $1,528.11 "," $1,624.50 "," $1,624.50 "," $1,624.50 "," $1,534.25 ", $163.23 ," $1,666.56 "," $1,714.75 "," $1,534.25 "," $1,678.65 "," $1,678.65 "," $1,714.75 "," $1,732.80 "," $1,476.85 "," $1,624.50 "," $1,534.25 "," $1,425.95 ", N/A ," $1,460.79 "," $1,460.79 "," $1,714.75 "," $1,548.87 ", $78.68 ," $1,732.80 "
 Inj Proc for Myelography and/or CT ,CPT® 62284,0761 - TREATMENT ROOM,N/A,N/A, $888.00 , $577.20 , $745.92 , $80.47 , $294.76 , $717.50 , $799.20 , $751.78 , $799.20 , $799.20 , $799.20 , $754.80 , $288.98 , $819.89 , $843.60 , $754.80 , $825.84 , $825.84 , $843.60 , $852.48 , $726.56 , $799.20 , $754.80 , $701.52 , N/A , $718.66 , $718.66 , $843.60 , $761.99 , $80.47 , $852.48 
 Pro Cltx Trimal Ankle Fx W/O Mnpj ,CPT® 27816,0981 - PRO FEE/ER,N/A,N/A," $1,470.00 ", $955.50 ," $1,828.13 ", $288.74 , $384.19 ," $1,389.63 "," $1,401.19 "," $1,367.10 "," $1,323.00 "," $1,323.00 "," $1,176.00 "," $1,176.00 ", $384.19 ," $1,357.25 "," $1,396.50 "," $1,323.00 "," $1,323.00 "," $1,323.00 "," $1,367.10 "," $1,411.20 "," $1,683.83 "," $1,249.50 "," $1,534.30 "," $1,655.10 ", N/A ," $1,416.74 "," $1,416.74 "," $1,396.50 "," $1,665.18 ", $288.74 ," $1,828.13 "
Debridement-Skin & Tissue,CPT® 11042,N/A,N/A,N/A, $502.00 , $326.30 , $192.85 , $57.23 , $63.58 , $169.46 , $164.75 , $466.86 , $451.80 , $451.80 , $401.60 , $401.60 , $63.58 , $463.50 , $476.90 , $451.80 , $451.80 , $451.80 , $466.86 , $481.92 , $211.84 , $426.70 , $326.48 , $218.43 , N/A , $172.76 , $172.76 , $476.90 , $200.35 , $57.23 , $481.92 
Atropine Sulfate Injection,HCPCS J0461,N/A,N/A,N/A, $4.00 , $2.60 , N/A , $0.09 , $0.10 , N/A , N/A , $3.72 , $3.60 , $3.60 , $3.20 , $3.20 , $0.10 , $3.69 , $3.80 , $3.60 , $3.60 , $3.60 , $3.72 , $3.84 , $0.13 , $3.40 , $0.65 , $0.09 , N/A , N/A , N/A , $3.80 , N/A , $0.09 , $3.84 
"Repr Bl Ves Direct,Neck",CPT® 35201,N/A,N/A,N/A," $5,729.00 "," $3,723.85 "," $5,504.85 ", $842.81 , $946.71 ," $4,142.06 "," $4,073.38 "," $5,327.97 "," $5,156.10 "," $5,156.10 "," $4,583.20 "," $4,583.20 ", $946.71 ," $5,289.59 "," $5,442.55 "," $5,156.10 "," $5,156.10 "," $5,156.10 "," $5,327.97 "," $5,499.84 "," $5,098.68 "," $4,869.65 "," $5,130.97 "," $4,522.97 ", N/A ," $4,222.88 "," $4,222.88 "," $5,442.55 "," $4,797.18 ", $842.81 ," $5,504.85 "
Core Needle Bx Lung/Mediastinum Perq W/Img,CPT® 32408,N/A,N/A,N/A," $1,552.00 "," $1,008.80 ", $836.11 , $145.68 , $741.88 , N/A , N/A ," $1,443.36 "," $1,396.80 "," $1,396.80 "," $1,241.60 "," $1,241.60 ", $741.88 ," $1,432.96 "," $1,474.40 "," $1,396.80 "," $1,396.80 "," $1,396.80 "," $1,443.36 "," $1,489.92 ", $810.69 ," $1,319.20 ", $794.29 , $805.24 , N/A , $555.56 , $555.56 ," $1,474.40 ", $655.58 , $145.68 ," $1,489.92 "
 Fac Bronchoscopy W/Transbronchial Lung Bx 1 Lobe ,CPT® 31628,0360 - OR SERVICES,N/A,N/A," $2,951.00 "," $1,918.15 "," $2,478.84 ", $167.67 , $560.37 ," $2,384.41 "," $2,655.90 "," $2,498.32 "," $2,655.90 "," $2,655.90 "," $2,655.90 "," $2,508.35 ", $549.38 ," $2,724.66 "," $2,803.45 "," $2,508.35 "," $2,744.43 "," $2,744.43 "," $2,803.45 "," $2,832.96 "," $2,414.51 "," $2,655.90 "," $2,508.35 "," $2,331.29 ", N/A ," $2,388.24 "," $2,388.24 "," $2,803.45 "," $2,532.25 ", $167.67 ," $2,832.96 "
Rsv Monoclonal Antb Seasonal Dose 1 Ml Im Use,CPT® 90381,N/A,N/A,N/A," $1,575.00 "," $1,023.75 ", N/A , N/A , N/A , N/A , N/A ," $1,464.75 "," $1,417.50 "," $1,417.50 "," $1,260.00 "," $1,260.00 ", N/A ," $1,454.20 "," $1,496.25 "," $1,417.50 "," $1,417.50 "," $1,417.50 "," $1,464.75 "," $1,512.00 ", N/A ," $1,338.75 ", N/A , N/A , N/A , N/A , N/A ," $1,496.25 ", N/A ," $1,260.00 "," $1,512.00 "
 Fac Motor &/Sens 11-12 Nrv Cndj Preconf Eltrode Limb ,CPT® 95912,0922 - EMG,N/A,N/A," $3,019.00 "," $1,962.35 "," $2,535.96 ", $244.12 , $204.69 ," $2,439.35 "," $2,717.10 "," $2,555.89 "," $2,717.10 "," $2,717.10 "," $2,717.10 "," $2,566.15 ", $200.68 ," $2,787.44 "," $2,868.05 "," $2,566.15 "," $2,807.67 "," $2,807.67 "," $2,868.05 "," $2,898.24 "," $2,470.15 "," $2,717.10 "," $2,566.15 "," $2,385.01 ", N/A ," $2,443.28 "," $2,443.28 "," $2,868.05 "," $2,590.60 ", $200.68 ," $2,898.24 "
Routine Ophthalmological Exa,HCPCS S0620,N/A,N/A,N/A, $507.00 , $329.55 , N/A , N/A , N/A , N/A , N/A , $471.51 , $456.30 , $456.30 , $405.60 , $405.60 , N/A , $468.11 , $481.65 , $456.30 , $456.30 , $456.30 , $471.51 , $486.72 , N/A , $430.95 , $405.60 , N/A , N/A , N/A , N/A , $481.65 , N/A , $405.60 , $486.72 
"Removal Foreign Body,Musc",20525,N/A,N/A,N/A," $3,219.00 "," $2,092.35 "," $1,500.01 ", $234.49 , $305.27 ," $1,200.67 "," $1,201.07 "," $2,993.67 "," $2,897.10 "," $2,897.10 "," $2,575.20 "," $2,575.20 ", $305.27 ," $2,972.10 "," $3,058.05 "," $2,897.10 "," $2,897.10 "," $2,897.10 "," $2,993.67 "," $3,090.24 "," $1,395.55 "," $2,736.15 "," $1,323.78 "," $1,413.07 ", N/A ," $1,224.10 "," $1,224.10 "," $3,058.05 "," $1,438.75 ", $234.49 ," $3,090.24 "
 Lb-Cell Count (Body Fluid) ,CPT® 89050,0300 - LABORATORY,N/A,N/A, $46.00 , $29.90 , $38.64 , $4.81 , $4.81 , $37.17 , $41.40 , $38.94 , $41.40 , $41.40 , $41.40 , $39.10 , $4.72 , $42.47 , $43.70 , $39.10 , $42.78 , $42.78 , $43.70 , $44.16 , $37.64 , $41.40 , $39.10 , $36.34 , N/A , $37.23 , $37.23 , $43.70 , $39.47 , $4.72 , $44.16 
"Remv Thigh/Knee Tumor,Subcutaneous",CPT® 27327,N/A,N/A,N/A," $4,268.00 "," $2,774.20 "," $1,912.82 ", $300.22 , $32.04 ," $1,507.88 "," $1,515.87 "," $3,969.24 "," $3,841.20 "," $3,841.20 "," $3,414.40 "," $3,414.40 ", $32.04 ," $3,940.64 "," $4,054.60 "," $3,841.20 "," $3,841.20 "," $3,841.20 "," $3,969.24 "," $4,097.28 "," $1,763.13 "," $3,627.80 "," $1,671.67 "," $1,778.91 ", N/A ," $1,537.31 "," $1,537.31 "," $4,054.60 "," $1,806.88 ", $32.04 ," $4,097.28 "
 Pro Remove Foreign Body ,CPT® 10120,0981 - PRO FEE/ER,N/A,N/A, $579.00 , $376.35 , $336.16 , $101.48 , $42.46 , $283.24 , $279.57 , $538.47 , $521.10 , $521.10 , $463.20 , $463.20 , $42.46 , $534.59 , $550.05 , $521.10 , $521.10 , $521.10 , $538.47 , $555.84 , $369.08 , $492.15 , $553.06 , $366.67 , N/A , $288.77 , $288.77 , $550.05 , $334.86 , $42.46 , $555.84 
 INSULIN ASPART 100 UNIT/ML SC SOPN ,HCPCS RXC637,0250 - PHARMACY,00169-6339-10,3 mL, $688.97 , $447.83 , $578.73 , N/A , N/A , $556.69 , $620.07 , $583.28 , $620.07 , $620.07 , $620.07 , $585.62 , N/A , $636.13 , $654.52 , $585.62 , $640.74 , $640.74 , $654.52 , $661.41 , $563.72 , $620.07 , $585.62 , $544.29 , N/A , $557.58 , $557.58 , $654.52 , $591.21 , $544.29 , $661.41 
Open Treatment Posterior Malleolus Fracture,27769,N/A,N/A,N/A," $6,273.00 "," $4,077.45 "," $4,436.97 ", $693.56 , $478.61 ," $3,494.63 "," $3,524.02 "," $5,833.89 "," $5,645.70 "," $5,645.70 "," $5,018.40 "," $5,018.40 ", $478.61 ," $5,791.86 "," $5,959.35 "," $5,645.70 "," $5,645.70 "," $5,645.70 "," $5,833.89 "," $6,022.08 "," $4,137.71 "," $5,332.05 "," $3,892.83 "," $4,153.59 ", N/A ," $3,562.82 "," $3,562.82 "," $5,959.35 "," $4,187.57 ", $478.61 ," $6,022.08 "
Layer Closure 2.5cm or Le,12031,N/A,N/A,N/A, $518.00 , $336.70 , $484.53 , $146.05 , $60.48 , $418.18 , $412.35 , $481.74 , $466.20 , $466.20 , $414.40 , $414.40 , $60.48 , $478.27 , $492.10 , $466.20 , $466.20 , $466.20 , $481.74 , $497.28 , $531.98 , $440.30 , $820.67 , $538.15 , N/A , $426.34 , $426.34 , $492.10 , $494.42 , $60.48 , $820.67 
 LACOSAMIDE 100 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00131-2478-60,1 tablet, $119.49 , $77.67 , $100.37 , N/A , N/A , $96.55 , $107.54 , $101.16 , $107.54 , $107.54 , $107.54 , $101.57 , N/A , $110.33 , $113.52 , $101.57 , $111.13 , $111.13 , $113.52 , $114.71 , $97.77 , $107.54 , $101.57 , $94.40 , N/A , $96.70 , $96.70 , $113.52 , $102.53 , $94.40 , $114.71 
Motor &/Sens 1-2 Nrv Cndj Preconf Eltrode Limb,CPT® 95907,N/A,N/A,N/A, $444.00 , $288.60 , $447.80 , $88.30 , $74.18 , $311.78 , $321.93 , $412.92 , $399.60 , $399.60 , $355.20 , $355.20 , $74.18 , $409.95 , $421.80 , $399.60 , $399.60 , $399.60 , $412.92 , $426.24 , $412.22 , $377.40 , $281.81 , $371.38 , N/A , $317.86 , $317.86 , $421.80 , $390.78 , $74.18 , $447.80 
 Fac Exc B9 Les Mrgn Xcp Sk Tg T/a/L 0.6-1.0 Cm ,CPT® 11401,0761 - TREATMENT ROOM,N/A,N/A, $527.00 , $342.55 , $442.68 , $102.35 , $82.94 , $425.82 , $474.30 , $446.16 , $474.30 , $474.30 , $474.30 , $447.95 , $81.31 , $486.58 , $500.65 , $447.95 , $490.11 , $490.11 , $500.65 , $505.92 , $431.19 , $474.30 , $447.95 , $416.33 , N/A , $426.50 , $426.50 , $500.65 , $452.22 , $81.31 , $505.92 
Ex Tum/Vasc Malf Sft Tiss Hand/Fngr Subq 1.5+Cm,26111,N/A,N/A,N/A," $1,744.00 "," $1,133.60 "," $2,539.36 ", $399.37 , $339.42 ," $2,015.05 "," $2,007.22 "," $1,621.92 "," $1,569.60 "," $1,569.60 "," $1,395.20 "," $1,395.20 ", $339.42 ," $1,610.24 "," $1,656.80 "," $1,569.60 "," $1,569.60 "," $1,569.60 "," $1,621.92 "," $1,674.24 "," $2,359.82 "," $1,482.40 "," $2,210.46 "," $2,388.56 ", N/A ," $2,054.36 "," $2,054.36 "," $1,656.80 "," $2,414.60 ", $339.42 ," $2,539.36 "
 Pro 1st Hospital IP/Obs Care Sf/Low Mdm 40 Minutes ,CPT® 99221,0987 - PRO FEE/HOS VIS,N/A,N/A, $324.00 , $210.60 , $197.44 , $79.64 , $82.46 , $174.68 , $174.13 , $301.32 , $291.60 , $291.60 , $259.20 , $259.20 , $82.46 , $299.15 , $307.80 , $291.60 , $291.60 , $291.60 , $301.32 , $311.04 , $251.10 , $275.40 , $219.03 , $219.35 , $40.00 , $178.09 , $178.09 , $307.80 , $205.40 , $40.00 , $311.04 
" Fac Muscle Test, 2 Limbs ",CPT® 95861,0922 - EMG,N/A,N/A, $951.00 , $618.15 , $798.84 , $158.19 , $111.74 , $768.41 , $855.90 , $805.12 , $855.90 , $855.90 , $855.90 , $808.35 , $109.55 , $878.06 , $903.45 , $808.35 , $884.43 , $884.43 , $903.45 , $912.96 , $778.11 , $855.90 , $808.35 , $751.29 , N/A , $769.64 , $769.64 , $903.45 , $816.05 , $109.55 , $912.96 
 CUPRIC CHLORIDE 0.4 MG/ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00409-4092-01,10 mL, $161.56 , $105.01 , $135.71 , N/A , N/A , $130.54 , $145.40 , $136.78 , $145.40 , $145.40 , $145.40 , $137.33 , N/A , $149.17 , $153.48 , $137.33 , $150.25 , $150.25 , $153.48 , $155.10 , $132.19 , $145.40 , $137.33 , $127.63 , N/A , $130.75 , $130.75 , $153.48 , $138.63 , $127.63 , $155.10 
Rpr Aa Hernia 1st 3-10 Cm Reducible,CPT® 49593,N/A,N/A,N/A," $5,019.00 "," $3,262.35 ", N/A , $524.39 , $409.20 , N/A , N/A ," $4,667.67 "," $4,517.10 "," $4,517.10 "," $4,015.20 "," $4,015.20 ", $409.20 ," $4,634.04 "," $4,768.05 "," $4,517.10 "," $4,517.10 "," $4,517.10 "," $4,667.67 "," $4,818.24 ", N/A ," $4,266.15 "," $3,036.80 ", N/A , N/A ," $2,257.10 "," $2,257.10 "," $4,768.05 "," $2,362.99 ", $409.20 ," $4,818.24 "
 Pro Treatment of Thigh Fracture ,CPT® 27507,0982 - PRO FEE/OUTPT,N/A,N/A," $8,958.00 "," $5,822.70 "," $5,842.92 ", $913.43 , $865.46 ," $4,694.10 "," $4,649.94 "," $8,330.94 "," $8,062.20 "," $8,062.20 "," $7,166.40 "," $7,166.40 ", $865.46 ," $8,270.92 "," $8,510.10 "," $8,062.20 "," $8,062.20 "," $8,062.20 "," $8,330.94 "," $8,599.68 "," $5,449.56 "," $7,614.30 "," $5,147.02 "," $5,519.11 ", N/A ," $4,785.68 "," $4,785.68 "," $8,510.10 "," $5,624.88 ", $865.46 ," $8,599.68 "
Surg Rx Incomplete Abortn,CPT® 59812,N/A,N/A,N/A," $1,456.00 ", $946.40 , $839.34 , $283.49 , $277.44 , $684.18 , $723.33 ," $1,354.08 "," $1,310.40 "," $1,310.40 "," $1,164.80 "," $1,164.80 ", $277.44 ," $1,344.32 "," $1,383.20 "," $1,310.40 "," $1,310.40 "," $1,310.40 "," $1,354.08 "," $1,397.76 ", $845.06 ," $1,237.60 "," $1,589.60 "," $1,276.50 ", N/A , $697.53 , $697.53 ," $1,383.20 ", $806.42 , $277.44 ," $1,589.60 "
 Fac Ctrl Nsl Hemrrg Ant Smpl Lmtd Caut&/Packing ,CPT® 30901,0761 - TREATMENT ROOM,N/A,N/A, $130.00 , $84.50 , $109.20 , $53.21 , $34.36 , $105.04 , $117.00 , $110.06 , $117.00 , $117.00 , $117.00 , $110.50 , $33.69 , $120.03 , $123.50 , $110.50 , $120.90 , $120.90 , $123.50 , $124.80 , $106.37 , $117.00 , $110.50 , $102.70 , N/A , $105.21 , $105.21 , $123.50 , $111.55 , $33.69 , $124.80 
 Pro Treat Fracture Radius/Ulna ,CPT® 25600,0975 - PRO FEE/OR,N/A,N/A," $2,106.00 "," $1,368.90 "," $2,022.28 ", $320.97 , $171.85 ," $1,493.35 "," $1,527.62 "," $1,958.58 "," $1,895.40 "," $1,895.40 "," $1,684.80 "," $1,684.80 ", $171.85 ," $1,944.47 "," $2,000.70 "," $1,895.40 "," $1,895.40 "," $1,895.40 "," $1,958.58 "," $2,021.76 "," $1,852.86 "," $1,790.10 "," $1,673.45 "," $1,783.02 ", N/A ," $1,522.49 "," $1,522.49 "," $2,000.70 "," $1,789.47 ", $171.85 ," $2,022.28 "
" Fac Varicella Zoster, Ag, If ",CPT® 87290,0305 - LAB/HEMATOLOGY,N/A,N/A, $126.00 , $81.90 , $105.84 , $13.69 , $13.69 , $101.81 , $113.40 , $106.67 , $113.40 , $113.40 , $113.40 , $107.10 , $13.42 , $116.34 , $119.70 , $107.10 , $117.18 , $117.18 , $119.70 , $120.96 , $103.09 , $113.40 , $107.10 , $99.54 , N/A , $101.97 , $101.97 , $119.70 , $108.12 , $13.42 , $120.96 
Psychotherapy W/Patient 45 Minutes,CPT® 90834,N/A,N/A,N/A, $345.00 , $224.25 , $118.65 , $87.92 , $77.18 , $189.56 , $168.47 , $320.85 , $310.50 , $310.50 , $276.00 , $276.00 , $77.18 , $318.54 , $327.75 , $310.50 , $310.50 , $310.50 , $320.85 , $331.20 , $226.17 , $293.25 , $218.96 , $320.51 , $167.50 , $193.26 , $193.26 , $327.75 , $225.28 , $77.18 , $331.20 
 OXYTOCIN-SODIUM CHLORIDE 30-0.9 UT/500ML-% IV SOLN ,HCPCS RXA250,0250 - PHARMACY,70092-1068-07,500 mL, $156.68 , $101.84 , $131.61 , N/A , N/A , $126.60 , $141.01 , $132.65 , $141.01 , $141.01 , $141.01 , $133.18 , N/A , $144.66 , $148.85 , $133.18 , $145.71 , $145.71 , $148.85 , $150.41 , $128.20 , $141.01 , $133.18 , $123.78 , N/A , $126.80 , $126.80 , $148.85 , $134.45 , $123.78 , $150.41 
 Pro Special Radiation Treatment ,CPT® 77470,0982 - PRO FEE/OUTPT,N/A,N/A, $705.00 , $458.25 , $763.16 , $137.14 , $219.71 , $745.25 , $786.79 , $655.65 , $634.50 , $634.50 , $564.00 , $564.00 , $219.71 , $650.93 , $669.75 , $634.50 , $634.50 , $634.50 , $655.65 , $676.80 , $747.73 , $599.25 , $857.09 , $763.43 , N/A , $759.78 , $759.78 , $669.75 , $879.47 , $137.14 , $879.47 
Depo-Estradiol Cypionate Inj,HCPCS J1000,N/A,N/A,N/A, $35.00 , $22.75 , N/A , $31.29 , $30.29 , N/A , N/A , $32.55 , $31.50 , $31.50 , $28.00 , $28.00 , $30.29 , $32.32 , $33.25 , $31.50 , $31.50 , $31.50 , $32.55 , $33.60 , $31.40 , $29.75 , $14.27 , $34.49 , N/A , N/A , N/A , $33.25 , N/A , $14.27 , $34.49 
Exc Skin Malig 0.6-1cm Remaindr Body,11621,N/A,N/A,N/A, $967.00 , $628.55 , $478.45 , $143.68 , $205.43 , $408.92 , $401.24 , $899.31 , $870.30 , $870.30 , $773.60 , $773.60 , $205.43 , $892.83 , $918.65 , $870.30 , $870.30 , $870.30 , $899.31 , $928.32 , $522.79 , $821.95 , $797.48 , $525.32 , N/A , $416.89 , $416.89 , $918.65 , $483.46 , $143.68 , $928.32 
 CARBAMAZEPINE ER 100 MG PO TB12 ,HCPCS RXC637,0250 - PHARMACY,51672-4123-01,1 tablet, $5.88 , $3.82 , $4.94 , N/A , N/A , $4.75 , $5.29 , $4.98 , $5.29 , $5.29 , $5.29 , $5.00 , N/A , $5.43 , $5.59 , $5.00 , $5.47 , $5.47 , $5.59 , $5.64 , $4.81 , $5.29 , $5.00 , $4.65 , N/A , $4.76 , $4.76 , $5.59 , $5.05 , $4.65 , $5.64 
"Closed Rx Trauma Hip Disloc,Anesth",27252,N/A,N/A,N/A," $5,024.00 "," $3,265.60 "," $4,583.22 ", $714.45 , $532.53 ," $3,661.56 "," $3,638.25 "," $4,672.32 "," $4,521.60 "," $4,521.60 "," $4,019.20 "," $4,019.20 ", $532.53 ," $4,638.66 "," $4,772.80 "," $4,521.60 "," $4,521.60 "," $4,521.60 "," $4,672.32 "," $4,823.04 "," $4,261.18 "," $4,270.40 "," $4,021.28 "," $4,294.62 ", N/A ," $3,733.01 "," $3,733.01 "," $4,772.80 "," $4,387.60 ", $532.53 ," $4,823.04 "
"Adj Tiss Xfer Lid,Nos,Ear <10sqcm",CPT® 14060,N/A,N/A,N/A," $4,113.00 "," $2,673.45 "," $2,129.25 ", $640.51 , $398.63 ," $1,843.34 "," $1,812.78 "," $3,825.09 "," $3,701.70 "," $3,701.70 "," $3,290.40 "," $3,290.40 ", $398.63 ," $3,797.53 "," $3,907.35 "," $3,701.70 "," $3,701.70 "," $3,701.70 "," $3,825.09 "," $3,948.48 "," $2,329.37 "," $3,496.05 "," $3,609.16 "," $2,361.62 ", N/A ," $1,879.30 "," $1,879.30 "," $3,907.35 "," $2,179.37 ", $398.63 ," $3,948.48 "
Sono Guide Amniocentesis,CPT® 76946,N/A,N/A,N/A," $1,003.00 ", $651.95 , $181.42 , $32.40 , $39.54 , $157.66 , $169.50 , $932.79 , $902.70 , $902.70 , $802.40 , $802.40 , $39.54 , $926.07 , $952.85 , $902.70 , $902.70 , $902.70 , $932.79 , $962.88 , $180.74 , $852.55 , $184.90 , $182.10 , N/A , $160.74 , $160.74 , $952.85 , $186.06 , $32.40 , $962.88 
 ERTAPENEM  312.5 MG/ML IM IN LIDOCAINE SYRINGE ,HCPCS RXA250,0250 - PHARMACY,00001-0058-01,3.2 mL, $793.10 , $515.52 , $666.20 , N/A , N/A , $640.82 , $713.79 , $671.44 , $713.79 , $713.79 , $713.79 , $674.14 , N/A , $732.27 , $753.45 , $674.14 , $737.58 , $737.58 , $753.45 , $761.38 , $648.91 , $713.79 , $674.14 , $626.55 , N/A , $641.86 , $641.86 , $753.45 , $680.56 , $626.55 , $761.38 
 Fac Perc D-E Cor Revasc W Ami S ,HCPCS C9606,0481 - CARDIAC CATH LAB,N/A,N/A," $15,529.00 "," $10,093.85 "," $13,044.36 ", N/A , N/A ," $12,547.43 "," $13,976.10 "," $13,146.85 "," $13,976.10 "," $13,976.10 "," $13,976.10 "," $13,199.65 ", N/A ," $14,337.93 "," $14,752.55 "," $13,199.65 "," $14,441.97 "," $14,441.97 "," $14,752.55 "," $14,907.84 "," $12,705.83 "," $13,976.10 "," $13,199.65 "," $12,267.91 ", N/A ," $12,567.62 "," $12,567.62 "," $14,752.55 "," $13,325.43 "," $12,267.91 "," $14,907.84 "
Rpr Retinal Dtchmnt Drg Subretinal Fluid Pc,CPT® 67105,N/A,N/A,N/A," $4,767.00 "," $3,098.55 "," $1,690.33 ", $265.79 , $768.38 ," $3,645.37 "," $3,400.04 "," $4,433.31 "," $4,290.30 "," $4,290.30 "," $3,813.60 "," $3,813.60 ", $768.38 ," $4,401.37 "," $4,528.65 "," $4,290.30 "," $4,290.30 "," $4,290.30 "," $4,433.31 "," $4,576.32 "," $2,322.99 "," $4,051.95 "," $3,494.98 "," $1,979.00 ", N/A ," $3,716.50 "," $3,716.50 "," $4,528.65 "," $4,102.53 ", $265.79 ," $4,576.32 "
Fp Removal/Corneal,CPT® 65222,N/A,N/A,N/A, $250.00 , $162.50 , $313.04 , $48.84 , $48.12 , $297.31 , $278.46 , $232.50 , $225.00 , $225.00 , $200.00 , $200.00 , $48.12 , $230.83 , $237.50 , $225.00 , $225.00 , $225.00 , $232.50 , $240.00 , $433.67 , $212.50 , $287.23 , $377.49 , N/A , $303.11 , $303.11 , $237.50 , $334.61 , $48.12 , $433.67 
Revision of Horseshoe Kidney,CPT® 50540,N/A,N/A,N/A," $7,995.00 "," $5,196.75 "," $6,194.07 "," $1,088.43 "," $1,536.80 "," $5,617.54 "," $5,217.00 "," $7,435.35 "," $7,195.50 "," $7,195.50 "," $6,396.00 "," $6,396.00 "," $1,536.80 "," $7,381.78 "," $7,595.25 "," $7,195.50 "," $7,195.50 "," $7,195.50 "," $7,435.35 "," $7,675.20 "," $6,219.61 "," $6,795.75 "," $5,905.25 "," $7,060.38 ", N/A ," $5,727.14 "," $5,727.14 "," $7,595.25 "," $6,731.43 "," $1,088.43 "," $7,675.20 "
 Aftercare With Cc/McC ,MS DRG V40 (FY2023) 949,N/A,N/A,N/A," $27,102.16 "," $17,616.40 "," $22,765.81 ", N/A , N/A ," $21,898.55 "," $24,391.94 "," $22,944.69 "," $24,391.94 "," $24,391.94 "," $24,391.94 "," $23,036.84 ", N/A ," $25,023.42 "," $25,747.05 "," $23,036.84 "," $25,205.01 "," $25,205.01 "," $25,747.05 "," $26,018.07 "," $22,174.99 "," $24,391.94 "," $23,036.84 "," $21,410.71 ", N/A ," $21,933.78 "," $21,933.78 "," $25,747.05 "," $23,256.36 "," $21,410.71 "," $26,018.07 "
 Fac Assay of Body Fluid Acidity ,CPT® 83986,0301 - LAB/CHEMISTRY,N/A,N/A, $61.00 , $39.65 , $51.24 , $3.65 , $3.65 , $49.29 , $54.90 , $51.64 , $54.90 , $54.90 , $54.90 , $51.85 , $3.58 , $56.32 , $57.95 , $51.85 , $56.73 , $56.73 , $57.95 , $58.56 , $49.91 , $54.90 , $51.85 , $48.19 , N/A , $49.37 , $49.37 , $57.95 , $52.34 , $3.58 , $58.56 
 METOPROLOL TARTRATE 100 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00378-0047-01,1 tablet, $4.12 , $2.68 , $3.46 , N/A , N/A , $3.33 , $3.71 , $3.49 , $3.71 , $3.71 , $3.71 , $3.50 , N/A , $3.80 , $3.91 , $3.50 , $3.83 , $3.83 , $3.91 , $3.96 , $3.37 , $3.71 , $3.50 , $3.25 , N/A , $3.33 , $3.33 , $3.91 , $3.54 , $3.25 , $3.96 
 PHENTOLAMINE MESYLATE 5 MG IJ SOLR ,HCPCS J2760,0636 - DRUGS REQUIRING DETAILED CODIN,51224-0012-20,1 mL," $2,587.75 "," $1,682.04 "," $2,173.71 ", $467.34 , $461.47 ," $2,090.90 "," $2,328.98 "," $2,190.79 "," $2,328.98 "," $2,328.98 "," $2,328.98 "," $2,199.59 ", $452.42 ," $2,389.27 "," $2,458.36 "," $2,199.59 "," $2,406.61 "," $2,406.61 "," $2,458.36 "," $2,484.24 "," $2,117.30 "," $2,328.98 "," $2,199.59 "," $2,044.32 ", N/A ," $2,094.27 "," $2,094.27 "," $2,458.36 "," $2,220.55 ", $452.42 ," $2,484.24 "
 Fac Occupational Ther Re-Eval Est Plan Care ,CPT® 97168,0434 - OCCUP THERP/EVAL,N/A,N/A, $181.00 , $117.65 , $152.04 , $68.75 , $63.91 , $146.25 , $162.90 , $153.23 , $162.90 , $162.90 , $162.90 , $153.85 , $62.66 , $167.12 , $171.95 , $153.85 , $168.33 , $168.33 , $171.95 , $173.76 , $148.09 , $162.90 , $153.85 , $142.99 , N/A , $146.48 , $146.48 , $171.95 , $155.32 , $62.66 , $173.76 
 Pro Arthrs Kne Surg W/Meniscus Rpr Med/Lat ,CPT® 29882,0982 - PRO FEE/OUTPT,N/A,N/A," $5,144.00 "," $3,343.60 "," $4,191.01 ", $657.29 , $600.95 ," $3,377.99 "," $3,369.07 "," $4,783.92 "," $4,629.60 "," $4,629.60 "," $4,115.20 "," $4,115.20 ", $600.95 ," $4,749.46 "," $4,886.80 "," $4,629.60 "," $4,629.60 "," $4,629.60 "," $4,783.92 "," $4,938.24 "," $3,909.75 "," $4,372.40 "," $3,721.56 "," $3,975.62 ", N/A ," $3,443.90 "," $3,443.90 "," $4,886.80 "," $4,047.80 ", $600.95 ," $4,938.24 "
 Pt Prosthetic Trng Ea 15 Mn ,CPT® 97761,0420 - PHYSICAL THERAPY,N/A,N/A, $135.00 , $87.75 , $113.40 , $41.69 , $26.99 , $109.08 , $121.50 , $114.29 , $121.50 , $121.50 , $121.50 , $114.75 , $26.46 , $124.65 , $128.25 , $114.75 , $125.55 , $125.55 , $128.25 , $129.60 , $110.46 , $121.50 , $114.75 , $106.65 , N/A , $109.26 , $109.26 , $128.25 , $115.84 , $26.46 , $129.60 
 Pro Drainage of Breast Lesion ,CPT® 19000,0982 - PRO FEE/OUTPT,N/A,N/A, $563.00 , $365.95 , $136.68 , $40.41 , $37.38 , $120.05 , $114.08 , $523.59 , $506.70 , $506.70 , $450.40 , $450.40 , $37.38 , $519.82 , $534.85 , $506.70 , $506.70 , $506.70 , $523.59 , $540.48 , $151.14 , $478.55 , $224.79 , $153.32 , N/A , $122.40 , $122.40 , $534.85 , $141.95 , $37.38 , $540.48 
Fluor Needle/Cath Spine/Paraspinal Dx/Ther Addon,CPT® 77003,N/A,N/A,N/A, $924.00 , $600.60 , $597.98 , $104.36 , $58.09 , $406.50 , $492.04 , $859.32 , $831.60 , $831.60 , $739.20 , $739.20 , $58.09 , $853.13 , $877.80 , $831.60 , $831.60 , $831.60 , $859.32 , $887.04 , $578.77 , $785.40 , $543.14 , $478.37 , N/A , $414.43 , $414.43 , $877.80 , $479.72 , $58.09 , $887.04 
Cath Plmt L Hrt & Arts W/Njx & Angio Img S&I,CPT® 93458,N/A,N/A,N/A," $6,819.00 "," $4,432.35 "," $6,716.32 "," $1,009.01 ", $769.71 ," $5,739.29 "," $6,134.31 "," $6,341.67 "," $6,137.10 "," $6,137.10 "," $5,455.20 "," $5,455.20 ", $769.71 ," $6,295.98 "," $6,478.05 "," $6,137.10 "," $6,137.10 "," $6,137.10 "," $6,341.67 "," $6,546.24 "," $6,325.78 "," $5,796.15 "," $5,828.54 "," $5,956.43 ", N/A ," $5,851.28 "," $5,851.28 "," $6,478.05 "," $6,486.20 ", $769.71 ," $6,716.32 "
 Pro Att/Reargmt F/C/C/M/N/Ax/G/H/F 10.1cm-30.0cm ,CPT® 14041,0982 - PRO FEE/OUTPT,N/A,N/A," $4,937.00 "," $3,209.05 "," $2,438.31 ", $733.01 , $768.38 ," $2,127.30 "," $2,088.61 "," $4,591.41 "," $4,443.30 "," $4,443.30 "," $3,949.60 "," $3,949.60 ", $768.38 ," $4,558.33 "," $4,690.15 "," $4,443.30 "," $4,443.30 "," $4,443.30 "," $4,591.41 "," $4,739.52 "," $2,673.42 "," $4,196.45 "," $4,156.87 "," $2,727.53 ", N/A ," $2,168.81 "," $2,168.81 "," $4,690.15 "," $2,515.08 ", $733.01 ," $4,739.52 "
 Fac Sulfate Urine ,CPT® 84392,0301 - LAB/CHEMISTRY,N/A,N/A, $46.00 , $29.90 , $38.64 , $5.60 , $5.60 , $37.17 , $41.40 , $38.94 , $41.40 , $41.40 , $41.40 , $39.10 , $5.49 , $42.47 , $43.70 , $39.10 , $42.78 , $42.78 , $43.70 , $44.16 , $37.64 , $41.40 , $39.10 , $36.34 , N/A , $37.23 , $37.23 , $43.70 , $39.47 , $5.49 , $44.16 
" Fac Injection,Therap/Proph/Diagnost, IV Push, Initial Drug ",CPT® 96374,0260 - IV THERAPY,N/A,N/A, $220.00 , $143.00 , $184.80 , $36.32 , $47.13 , $177.76 , $198.00 , $186.25 , $198.00 , $198.00 , $198.00 , $187.00 , $46.21 , $203.13 , $209.00 , $187.00 , $204.60 , $204.60 , $209.00 , $211.20 , $180.00 , $198.00 , $187.00 , $173.80 , N/A , $178.05 , $178.05 , $209.00 , $188.78 , $36.32 , $211.20 
 Pro X-Ray Exam of Shoulders ,CPT® 73050,0972 - PRO FEE/RAD/DX,N/A,N/A, $157.00 , $102.05 , $160.20 , $28.11 , $35.09 , $169.76 , $213.99 , $146.01 , $141.30 , $141.30 , $125.60 , $125.60 , $35.09 , $144.96 , $149.15 , $141.30 , $141.30 , $141.30 , $146.01 , $150.72 , $155.81 , $133.45 , $236.90 , $180.19 , N/A , $173.07 , $173.07 , $149.15 , $200.35 , $28.11 , $236.90 
 Other Musculoskeletal System And Connective Tissue Diagnoses With Cc ,MS DRG V40 (FY2023) 565,N/A,N/A,N/A," $25,618.21 "," $16,651.84 "," $21,519.30 ", N/A , N/A ," $20,699.51 "," $23,056.39 "," $21,688.38 "," $23,056.39 "," $23,056.39 "," $23,056.39 "," $21,775.48 ", N/A ," $23,653.29 "," $24,337.30 "," $21,775.48 "," $23,824.94 "," $23,824.94 "," $24,337.30 "," $24,593.48 "," $20,960.82 "," $23,056.39 "," $21,775.48 "," $20,238.39 ", N/A ," $20,732.82 "," $20,732.82 "," $24,337.30 "," $21,982.99 "," $20,238.39 "," $24,593.48 "
Fine Needle Asp;W/Imaging Guidance,CPT® 10022,N/A,N/A,N/A, $616.00 , $400.40 , N/A , N/A , N/A , $182.52 , $171.69 , $572.88 , $554.40 , $554.40 , $492.80 , $492.80 , N/A , $568.75 , $585.20 , $554.40 , $554.40 , $554.40 , $572.88 , $591.36 , N/A , $523.60 , N/A , N/A , N/A , N/A , N/A , $585.20 , N/A , $171.69 , $591.36 
Insj Stablj Dev W/Dcmprn Lumbar Second Level,22868,N/A,N/A,N/A," $2,401.00 "," $1,560.65 "," $1,391.98 ", $217.17 , N/A ," $1,119.62 "," $1,080.58 "," $2,232.93 "," $2,160.90 "," $2,160.90 "," $1,920.80 "," $1,920.80 ", N/A ," $2,216.84 "," $2,280.95 "," $2,160.90 "," $2,160.90 "," $2,160.90 "," $2,232.93 "," $2,304.96 "," $1,307.09 "," $2,040.85 "," $1,290.06 "," $1,319.64 ", N/A ," $1,141.46 "," $1,141.46 "," $2,280.95 "," $1,341.61 ", $217.17 ," $2,304.96 "
 PILOCARPINE HCL 4 % OP SOLN ,HCPCS RXC637,0250 - PHARMACY,61314-0206-15,15 mL, $542.92 , $352.90 , $456.05 , N/A , N/A , $438.68 , $488.63 , $459.64 , $488.63 , $488.63 , $488.63 , $461.48 , N/A , $501.28 , $515.77 , $461.48 , $504.92 , $504.92 , $515.77 , $521.20 , $444.22 , $488.63 , $461.48 , $428.91 , N/A , $439.39 , $439.39 , $515.77 , $465.88 , $428.91 , $521.20 
 BUPRENORPHINE HCL 0.3 MG/ML IJ SOLN ,HCPCS J0592,0636 - DRUGS REQUIRING DETAILED CODIN,42023-0179-05,1 mL, $83.96 , $54.57 , $70.53 , $4.14 , $4.12 , $67.84 , $75.56 , $71.08 , $75.56 , $75.56 , $75.56 , $71.37 , $4.04 , $77.52 , $79.76 , $71.37 , $78.08 , $78.08 , $79.76 , $80.60 , $68.70 , $75.56 , $71.37 , $66.33 , N/A , $67.95 , $67.95 , $79.76 , $72.05 , $4.04 , $80.60 
Bilirubin Direct,CPT® 82248,N/A,N/A,N/A, $59.00 , $38.35 , N/A , $5.12 , $5.12 , $28.39 , $33.97 , $54.87 , $53.10 , $53.10 , $47.20 , $47.20 , $5.12 , $54.47 , $56.05 , $53.10 , $53.10 , $53.10 , $54.87 , $56.64 , $33.52 , $50.15 , $32.44 , $18.18 , N/A , $26.50 , $26.50 , $56.05 , $28.96 , $5.12 , $56.64 
 Fac Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn ,CPT® 62327,0360 - OR SERVICES,N/A,N/A," $2,434.00 "," $1,582.10 "," $2,044.56 ", $101.56 , $177.70 ," $1,966.67 "," $2,190.60 "," $2,060.62 "," $2,190.60 "," $2,190.60 "," $2,190.60 "," $2,068.90 ", $174.22 ," $2,247.31 "," $2,312.30 "," $2,068.90 "," $2,263.62 "," $2,263.62 "," $2,312.30 "," $2,336.64 "," $1,991.50 "," $2,190.60 "," $2,068.90 "," $1,922.86 ", N/A ," $1,969.84 "," $1,969.84 "," $2,312.30 "," $2,088.62 ", $101.56 ," $2,336.64 "
 PROTAMINE SULFATE 10 MG/ML IV SOLN ,HCPCS J2720,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0229-05,3 mL, $41.24 , $26.81 , $34.64 , $0.97 , $1.04 , $33.32 , $37.12 , $34.91 , $37.12 , $37.12 , $37.12 , $35.05 , $1.02 , $38.08 , $39.18 , $35.05 , $38.35 , $38.35 , $39.18 , $39.59 , $33.74 , $37.12 , $35.05 , $32.58 , N/A , $33.38 , $33.38 , $39.18 , $35.39 , $0.97 , $39.59 
 Fracture Great Toe Closed /W Manip ,CPT® 28495,0761 - TREATMENT ROOM,N/A,N/A," $1,542.00 "," $1,002.30 "," $1,295.28 ", $146.49 , $142.01 ," $1,245.94 "," $1,387.80 "," $1,305.46 "," $1,387.80 "," $1,387.80 "," $1,387.80 "," $1,310.70 ", $139.23 ," $1,423.73 "," $1,464.90 "," $1,310.70 "," $1,434.06 "," $1,434.06 "," $1,464.90 "," $1,480.32 "," $1,261.66 "," $1,387.80 "," $1,310.70 "," $1,218.18 ", N/A ," $1,247.94 "," $1,247.94 "," $1,464.90 "," $1,323.19 ", $139.23 ," $1,480.32 "
 Pro Smpl Rpr Supfc S/N/Ax/G/T 2.6cm-7.5cm ,CPT® 12002,0982 - PRO FEE/OUTPT,N/A,N/A, $685.00 , $445.25 , $183.91 , $54.60 , $67.36 , $160.40 , $155.64 , $637.05 , $616.50 , $616.50 , $548.00 , $548.00 , $67.36 , $632.46 , $650.75 , $616.50 , $616.50 , $616.50 , $637.05 , $657.60 , $201.24 , $582.25 , $312.21 , $204.29 , N/A , $163.53 , $163.53 , $650.75 , $189.63 , $54.60 , $657.60 
 Pro Tlh W/T/O 250 G or Less ,CPT® 58571,0975 - PRO FEE/OR,N/A,N/A," $6,179.00 "," $4,016.35 "," $4,274.80 ", $864.79 , $718.13 ," $4,110.90 "," $4,210.54 "," $5,746.47 "," $5,561.10 "," $5,561.10 "," $4,943.20 "," $4,943.20 ", $718.13 ," $5,705.07 "," $5,870.05 "," $5,561.10 "," $5,561.10 "," $5,561.10 "," $5,746.47 "," $5,931.84 "," $4,449.41 "," $5,252.15 "," $5,539.52 "," $3,629.53 ", N/A ," $4,191.11 "," $4,191.11 "," $5,870.05 "," $5,026.98 ", $718.13 ," $5,931.84 "
"Excision of Nail,Permanen",11750,N/A,N/A,N/A, $813.00 , $528.45 , $330.85 , $98.28 , $111.46 , $478.76 , $468.04 , $756.09 , $731.70 , $731.70 , $650.40 , $650.40 , $111.46 , $750.64 , $772.35 , $731.70 , $731.70 , $731.70 , $756.09 , $780.48 , $362.83 , $691.05 , $918.79 , $362.76 , N/A , $488.10 , $488.10 , $772.35 , $566.03 , $98.28 , $918.79 
Prism Lens/Es,HCPCS V2715,N/A,N/A,N/A, $6.00 , $3.90 , N/A , $16.79 , N/A , N/A , N/A , $5.58 , $5.40 , $5.40 , $4.80 , $4.80 , N/A , $5.54 , $5.70 , $5.40 , $5.40 , $5.40 , $5.58 , $5.76 , N/A , $5.10 , $6.00 , $15.25 , N/A , N/A , N/A , $5.70 , N/A , $4.80 , $16.79 
Excis Urethral Caruncle,53265,N/A,N/A,N/A," $1,484.00 ", $964.60 ," $1,019.19 ", $180.35 , $107.56 , $906.93 , $851.71 ," $1,380.12 "," $1,335.60 "," $1,335.60 "," $1,187.20 "," $1,187.20 ", $107.56 ," $1,370.18 "," $1,409.80 "," $1,335.60 "," $1,335.60 "," $1,335.60 "," $1,380.12 "," $1,424.64 "," $1,019.38 "," $1,261.40 ", $966.96 ," $1,142.47 ", N/A , $924.62 , $924.62 ," $1,409.80 "," $1,086.77 ", $107.56 ," $1,424.64 "
"Avulsion Nail Plate,Ea Ad",CPT® 11732,N/A,N/A,N/A, $153.00 , $99.45 , $56.07 , $16.52 , $20.72 , $56.58 , $53.10 , $142.29 , $137.70 , $137.70 , $122.40 , $122.40 , $20.72 , $141.26 , $145.35 , $137.70 , $137.70 , $137.70 , $142.29 , $146.88 , $61.85 , $130.05 , $105.26 , $63.44 , N/A , $57.68 , $57.68 , $145.35 , $66.88 , $16.52 , $146.88 
 DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN ,HCPCS J1100,0636 - DRUGS REQUIRING DETAILED CODIN,67457-0422-54,0.5 mL, $16.68 , $10.84 , $14.01 , $0.12 , $0.13 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.13 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.12 , $16.01 
 Fac Assay of Calcium in Urine ,CPT® 82340,0301 - LAB/CHEMISTRY,N/A,N/A, $68.00 , $44.20 , $57.12 , $6.15 , $6.15 , $54.94 , $61.20 , $57.57 , $61.20 , $61.20 , $61.20 , $57.80 , $6.03 , $62.78 , $64.60 , $57.80 , $63.24 , $63.24 , $64.60 , $65.28 , $55.64 , $61.20 , $57.80 , $53.72 , N/A , $55.03 , $55.03 , $64.60 , $58.35 , $6.03 , $65.28 
 Fac Drug/Substance Definitive Qual/Quant Nos 1-3 ,CPT® 80375,0301 - LAB/CHEMISTRY,N/A,N/A, $265.00 , $172.25 , $222.60 , N/A , N/A , $214.12 , $238.50 , $224.35 , $238.50 , $238.50 , $238.50 , $225.25 , N/A , $244.67 , $251.75 , $225.25 , $246.45 , $246.45 , $251.75 , $254.40 , $216.82 , $238.50 , $225.25 , $209.35 , N/A , $214.46 , $214.46 , $251.75 , $227.40 , $209.35 , $254.40 
 Fac Convert Gastrostomy-Gastro-Jejunostomy Tube Perq ,CPT® 49446,0750 - GASTR-INST SVS,N/A,N/A," $1,449.00 ", $941.85 ," $1,217.16 ", $139.02 , $843.35 ," $1,170.79 "," $1,304.10 "," $1,226.72 "," $1,304.10 "," $1,304.10 "," $1,304.10 "," $1,231.65 ", $826.81 ," $1,337.86 "," $1,376.55 "," $1,231.65 "," $1,347.57 "," $1,347.57 "," $1,376.55 "," $1,391.04 "," $1,185.57 "," $1,304.10 "," $1,231.65 "," $1,144.71 ", N/A ," $1,172.68 "," $1,172.68 "," $1,376.55 "," $1,243.39 ", $139.02 ," $1,391.04 "
Corrj Hallux Valgus W/Sesmdc W/Dist Metar Osteot,CPT® 28296,N/A,N/A,N/A," $5,597.00 "," $3,638.05 "," $3,182.60 ", $498.54 , $618.63 ," $2,572.39 "," $2,550.03 "," $5,205.21 "," $5,037.30 "," $5,037.30 "," $4,477.60 "," $4,477.60 ", $618.63 ," $5,167.71 "," $5,317.15 "," $5,037.30 "," $5,037.30 "," $5,037.30 "," $5,205.21 "," $5,373.12 "," $2,957.23 "," $4,757.45 "," $2,756.38 "," $3,026.64 ", N/A ," $2,622.59 "," $2,622.59 "," $5,317.15 "," $3,082.47 ", $498.54 ," $5,373.12 "
Chemodenervation One Extremity 1-4 Muscle,CPT® 64642,N/A,N/A,N/A, $890.00 , $578.50 , $510.95 , $98.27 , $79.25 , $591.97 , $578.87 , $827.70 , $801.00 , $801.00 , $712.00 , $712.00 , $79.25 , $821.74 , $845.50 , $801.00 , $801.00 , $801.00 , $827.70 , $854.40 , $550.96 , $756.50 , $561.51 , $630.94 , N/A , $603.51 , $603.51 , $845.50 , $647.43 , $79.25 , $854.40 
" Fac Chemo, IV Infusion, 1 Hr ",CPT® 96413,0335 - CHEMOTHERP-IV,N/A,N/A, $840.00 , $546.00 , $705.60 , $127.01 , $137.88 , $678.72 , $756.00 , $711.14 , $756.00 , $756.00 , $756.00 , $714.00 , $135.18 , $775.57 , $798.00 , $714.00 , $781.20 , $781.20 , $798.00 , $806.40 , $687.29 , $756.00 , $714.00 , $663.60 , N/A , $679.81 , $679.81 , $798.00 , $720.80 , $127.01 , $806.40 
Rubeola,CPT® 86765,N/A,N/A,N/A, $134.00 , $87.10 , N/A , $13.14 , $13.14 , $72.88 , $87.20 , $124.62 , $120.60 , $120.60 , $107.20 , $107.20 , $13.14 , $123.72 , $127.30 , $120.60 , $120.60 , $120.60 , $124.62 , $128.64 , $86.00 , $113.90 , $84.34 , $46.70 , N/A , $68.02 , $68.02 , $127.30 , $74.33 , $13.14 , $128.64 
"Bx Low Leg Soft Tissue,Deep",CPT® 27614,N/A,N/A,N/A," $3,855.00 "," $2,505.75 "," $2,522.46 ", $399.48 , $213.54 ," $1,949.03 "," $1,980.60 "," $3,585.15 "," $3,469.50 "," $3,469.50 "," $3,084.00 "," $3,084.00 ", $213.54 ," $3,559.32 "," $3,662.25 "," $3,469.50 "," $3,469.50 "," $3,469.50 "," $3,585.15 "," $3,700.80 "," $2,329.75 "," $3,276.75 "," $2,178.34 "," $2,336.31 ", N/A ," $1,987.07 "," $1,987.07 "," $3,662.25 "," $2,335.51 ", $213.54 ," $3,700.80 "
 Pro Arthrp Kne Condyle&Platu Medial&Lat Cmprts ,CPT® 27447,0975 - PRO FEE/OR,N/A,N/A," $10,215.00 "," $6,639.75 "," $7,722.20 "," $1,206.76 "," $1,363.53 "," $6,552.23 "," $7,354.80 "," $9,499.95 "," $9,193.50 "," $9,193.50 "," $8,172.00 "," $8,172.00 "," $1,363.53 "," $9,431.51 "," $9,704.25 "," $9,193.50 "," $9,193.50 "," $9,193.50 "," $9,499.95 "," $9,806.40 "," $9,322.23 "," $8,682.75 "," $8,142.47 "," $7,699.32 ", N/A ," $6,680.08 "," $6,680.08 "," $9,704.25 "," $7,851.46 "," $1,206.76 "," $9,806.40 "
Excis Recurrent Ganglion Wrist,CPT® 25112,N/A,N/A,N/A," $1,166.00 ", $757.90 ," $2,400.19 ", $378.50 , $384.35 ," $1,856.12 "," $1,867.08 "," $1,084.38 "," $1,049.40 "," $1,049.40 ", $932.80 , $932.80 , $384.35 ," $1,076.57 "," $1,107.70 "," $1,049.40 "," $1,049.40 "," $1,049.40 "," $1,084.38 "," $1,119.36 "," $2,219.90 ", $991.10 ," $2,053.46 "," $2,208.50 ", N/A ," $1,892.34 "," $1,892.34 "," $1,107.70 "," $2,224.18 ", $378.50 ," $2,400.19 "
"Allergy Immunology Serv,Unlisted",CPT® 95199,N/A,N/A,N/A, $220.00 , $143.00 , N/A , N/A , N/A , N/A , N/A , $204.60 , $198.00 , $198.00 , $176.00 , $176.00 , N/A , $203.13 , $209.00 , $198.00 , $198.00 , $198.00 , $204.60 , $211.20 , N/A , $187.00 , $176.00 , N/A , N/A , N/A , N/A , $209.00 , N/A , $176.00 , $211.20 
" Fac Complement, Total (Ch50) ",CPT® 86162,0300 - LABORATORY,N/A,N/A, $256.00 , $166.40 , $215.04 , $20.73 , $20.73 , $206.85 , $230.40 , $216.73 , $230.40 , $230.40 , $230.40 , $217.60 , $20.32 , $236.36 , $243.20 , $217.60 , $238.08 , $238.08 , $243.20 , $245.76 , $209.46 , $230.40 , $217.60 , $202.24 , N/A , $207.18 , $207.18 , $243.20 , $219.67 , $20.32 , $245.76 
"Adj Tiss Xfer Scalp,Extrem <10sqcm",14020,N/A,N/A,N/A," $3,209.00 "," $2,085.85 "," $1,804.62 ", $543.35 , $371.14 ," $1,551.36 "," $1,532.17 "," $2,984.37 "," $2,888.10 "," $2,888.10 "," $2,567.20 "," $2,567.20 ", $371.14 ," $2,962.87 "," $3,048.55 "," $2,888.10 "," $2,888.10 "," $2,888.10 "," $2,984.37 "," $3,080.64 "," $1,971.71 "," $2,727.65 "," $3,054.32 "," $1,986.10 ", N/A ," $1,581.63 "," $1,581.63 "," $3,048.55 "," $1,834.16 ", $371.14 ," $3,080.64 "
 IBUPROFEN 100 MG/5ML PO SUSP ,HCPCS RXC637,0250 - PHARMACY,68094-0494-61,20 mL, $19.32 , $12.56 , $16.23 , N/A , N/A , $15.61 , $17.39 , $16.36 , $17.39 , $17.39 , $17.39 , $16.42 , N/A , $17.84 , $18.35 , $16.42 , $17.97 , $17.97 , $18.35 , $18.55 , $15.81 , $17.39 , $16.42 , $15.26 , N/A , $15.64 , $15.64 , $18.35 , $16.58 , $15.26 , $18.55 
 Fac Kinesis 40 ,Custom 500158,0990 - PT CONVENIENCE,N/A,N/A, $42.00 , $27.30 , $35.28 , N/A , N/A , $33.94 , $37.80 , $35.56 , $37.80 , $37.80 , $37.80 , $35.70 , N/A , $38.78 , $39.90 , $35.70 , $39.06 , $39.06 , $39.90 , $40.32 , $34.36 , $37.80 , $35.70 , $33.18 , N/A , $33.99 , $33.99 , $39.90 , $36.04 , $33.18 , $40.32 
"Resect Diaphram,Complx Rep",CPT® 39561,N/A,N/A,N/A," $7,215.00 "," $4,689.75 "," $5,005.22 "," $1,151.10 "," $1,122.31 "," $4,335.55 "," $4,466.63 "," $6,709.95 "," $6,493.50 "," $6,493.50 "," $5,772.00 "," $5,772.00 "," $1,122.31 "," $6,661.61 "," $6,854.25 "," $6,493.50 "," $6,493.50 "," $6,493.50 "," $6,709.95 "," $6,926.40 "," $6,821.66 "," $6,132.75 "," $6,629.58 "," $5,684.43 ", N/A ," $4,420.15 "," $4,420.15 "," $6,854.25 "," $5,123.36 "," $1,122.31 "," $6,926.40 "
 Pro X-Ray Exam of Fistula ,CPT® 76080,0972 - PRO FEE/RAD/DX,N/A,N/A, $165.00 , $107.25 , $342.03 , $58.94 , $60.89 , $263.86 , $319.87 , $153.45 , $148.50 , $148.50 , $132.00 , $132.00 , $60.89 , $152.34 , $156.75 , $148.50 , $148.50 , $148.50 , $153.45 , $158.40 , $333.16 , $140.25 , $348.61 , $277.33 , N/A , $269.01 , $269.01 , $156.75 , $311.39 , $58.94 , $348.61 
Admin Hepatitis B Vaccine,HCPCS G0010,N/A,N/A,N/A, $49.00 , $31.85 , N/A , N/A , N/A , $46.14 , $59.77 , $45.57 , $44.10 , $44.10 , $39.20 , $39.20 , N/A , $45.24 , $46.55 , $44.10 , $44.10 , $44.10 , $45.57 , $47.04 , N/A , $41.65 , $49.31 , $64.43 , N/A , $47.04 , $47.04 , $46.55 , $58.79 , $39.20 , $64.43 
Reduction Rectal Prolapse W Anesthe,CPT® 45900,N/A,N/A,N/A," $1,283.00 ", $833.95 ," $1,276.21 ", $198.18 , $133.31 , $963.93 , $986.90 ," $1,193.19 "," $1,154.70 "," $1,154.70 "," $1,026.40 "," $1,026.40 ", $133.31 ," $1,184.59 "," $1,218.85 "," $1,154.70 "," $1,154.70 "," $1,154.70 "," $1,193.19 "," $1,231.68 ", $913.47 ," $1,090.55 "," $1,088.28 "," $1,173.80 ", N/A , $982.74 , $982.74 ," $1,218.85 "," $1,027.85 ", $133.31 ," $1,276.21 "
 Sternoclavicular Joints Bil ,CPT® 71130,0320 - DX X-RAY,N/A,N/A, $400.00 , $260.00 , $336.00 , $40.66 , $35.69 , $323.20 , $360.00 , $338.64 , $360.00 , $360.00 , $360.00 , $340.00 , $34.99 , $369.32 , $380.00 , $340.00 , $372.00 , $372.00 , $380.00 , $384.00 , $327.28 , $360.00 , $340.00 , $316.00 , N/A , $323.72 , $323.72 , $380.00 , $343.24 , $34.99 , $384.00 
App Skn Sub Grft T/a/L Area/<100scm /<1st 25 Scm,15271,N/A,N/A,N/A, $858.00 , $557.70 , $266.19 , $78.87 , $111.11 , $232.17 , $227.23 , $797.94 , $772.20 , $772.20 , $686.40 , $686.40 , $111.11 , $792.19 , $815.10 , $772.20 , $772.20 , $772.20 , $797.94 , $823.68 , $292.36 , $729.30 , $454.94 , $295.22 , N/A , $236.70 , $236.70 , $815.10 , $274.49 , $78.87 , $823.68 
 Pro Drg Fngr Absc Comp ,CPT® 26011,0981 - PRO FEE/ER,N/A,N/A," $1,072.00 ", $696.80 ," $1,138.61 ", $178.74 , $161.97 , $890.56 , $896.50 , $996.96 , $964.80 , $964.80 , $857.60 , $857.60 , $161.97 , $989.78 ," $1,018.40 ", $964.80 , $964.80 , $964.80 , $996.96 ," $1,029.12 "," $1,057.07 ", $911.20 , $983.02 ," $1,060.93 ", N/A , $907.94 , $907.94 ," $1,018.40 "," $1,067.16 ", $161.97 ," $1,138.61 "
 Flow Cell Phenotyping ,Custom 3000000002,0300 - LABORATORY,N/A,N/A, $474.00 , $308.10 , $398.16 , N/A , N/A , $382.99 , $426.60 , $401.29 , $426.60 , $426.60 , $426.60 , $402.90 , N/A , $437.64 , $450.30 , $402.90 , $440.82 , $440.82 , $450.30 , $455.04 , $387.83 , $426.60 , $402.90 , $374.46 , N/A , $383.61 , $383.61 , $450.30 , $406.74 , $374.46 , $455.04 
 Fac Drug Screening Cocaine ,CPT® 80353,0301 - LAB/CHEMISTRY,N/A,N/A, $191.00 , $124.15 , $160.44 , N/A , N/A , $154.33 , $171.90 , $161.70 , $171.90 , $171.90 , $171.90 , $162.35 , N/A , $176.35 , $181.45 , $162.35 , $177.63 , $177.63 , $181.45 , $183.36 , $156.28 , $171.90 , $162.35 , $150.89 , N/A , $154.58 , $154.58 , $181.45 , $163.90 , $150.89 , $183.36 
 Trauma 3 Activation W/O Pre-ED Notiification Lvl 1 -W/O Critical Care ,CPT® 99285,0450 - EMERGENCY SERVICES,N/A,N/A," $2,008.00 "," $1,305.20 "," $1,686.72 ", $168.76 , $44.31 ," $1,622.46 "," $1,807.20 "," $1,699.97 "," $1,807.20 "," $1,807.20 "," $1,807.20 "," $1,706.80 ", $43.44 ," $1,853.99 "," $1,907.60 "," $1,706.80 "," $1,867.44 "," $1,867.44 "," $1,907.60 "," $1,927.68 "," $1,642.95 "," $1,807.20 "," $1,706.80 "," $1,586.32 ", N/A ," $1,625.07 "," $1,625.07 "," $1,907.60 "," $1,723.06 ", $43.44 ," $1,927.68 "
 Fac Enterovirus Antibody ,CPT® 86658,0302 - LAB/IMMUNOLOGY,N/A,N/A, $116.00 , $75.40 , $97.44 , $13.29 , $8.07 , $93.73 , $104.40 , $98.21 , $104.40 , $104.40 , $104.40 , $98.60 , $7.91 , $107.10 , $110.20 , $98.60 , $107.88 , $107.88 , $110.20 , $111.36 , $94.91 , $104.40 , $98.60 , $91.64 , N/A , $93.88 , $93.88 , $110.20 , $99.54 , $7.91 , $111.36 
 Inj Proc Extremity Venogram ,CPT® 36005,0360 - OR SERVICES,N/A,N/A," $1,835.00 "," $1,192.75 "," $1,541.40 ", $44.21 , $318.79 ," $1,482.68 "," $1,651.50 "," $1,553.51 "," $1,651.50 "," $1,651.50 "," $1,651.50 "," $1,559.75 ", $312.54 ," $1,694.26 "," $1,743.25 "," $1,559.75 "," $1,706.55 "," $1,706.55 "," $1,743.25 "," $1,761.60 "," $1,501.40 "," $1,651.50 "," $1,559.75 "," $1,449.65 ", N/A ," $1,485.07 "," $1,485.07 "," $1,743.25 "," $1,574.61 ", $44.21 ," $1,761.60 "
 CELECOXIB 100 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-6502-61,1 capsule, $22.43 , $14.58 , $18.84 , N/A , N/A , $18.12 , $20.19 , $18.99 , $20.19 , $20.19 , $20.19 , $19.07 , N/A , $20.71 , $21.31 , $19.07 , $20.86 , $20.86 , $21.31 , $21.53 , $18.35 , $20.19 , $19.07 , $17.72 , N/A , $18.15 , $18.15 , $21.31 , $19.25 , $17.72 , $21.53 
Pneumococcal Conj Vaccine 13 Valent Im,CPT® 90670,N/A,N/A,N/A, $376.00 , $244.40 , N/A , $263.15 , $195.29 , $335.19 , $418.03 , $349.68 , $338.40 , $338.40 , $300.80 , $300.80 , $195.29 , $347.16 , $357.20 , $338.40 , $338.40 , $338.40 , $349.68 , $360.96 , $313.79 , $319.60 , $408.53 , $372.02 , N/A , $341.73 , $341.73 , $357.20 , $398.40 , $195.29 , $418.03 
Esophagoscopy Intra/Transmural Needle Aspirat/Bx,CPT® 43232,N/A,N/A,N/A," $1,759.00 "," $1,143.35 "," $1,225.51 ", $187.98 , $494.52 , $968.76 ," $1,261.63 "," $1,635.87 "," $1,583.10 "," $1,583.10 "," $1,407.20 "," $1,407.20 ", $494.52 ," $1,624.08 "," $1,671.05 "," $1,583.10 "," $1,583.10 "," $1,583.10 "," $1,635.87 "," $1,688.64 ", $879.94 ," $1,495.15 "," $1,384.43 "," $1,164.60 ", N/A , $987.67 , $987.67 ," $1,671.05 "," $1,032.98 ", $187.98 ," $1,688.64 "
Garamycin Gentamicin Inj,HCPCS J1580,N/A,N/A,N/A, $35.00 , $22.75 , N/A , $3.05 , $2.85 , N/A , N/A , $32.55 , $31.50 , $31.50 , $28.00 , $28.00 , $2.85 , $32.32 , $33.25 , $31.50 , $31.50 , $31.50 , $32.55 , $33.60 , $2.46 , $29.75 , $1.95 , $3.47 , N/A , N/A , N/A , $33.25 , N/A , $1.95 , $33.60 
 Fac Ctr Motr Ep Std Transcrnl Motr Stim Upr&Low Limb ,CPT® 95939,0922 - EMG,N/A,N/A," $3,258.00 "," $2,117.70 "," $2,736.72 ", $536.38 , $361.94 ," $2,632.46 "," $2,932.20 "," $2,758.22 "," $2,932.20 "," $2,932.20 "," $2,932.20 "," $2,769.30 ", $354.84 ," $3,008.11 "," $3,095.10 "," $2,769.30 "," $3,029.94 "," $3,029.94 "," $3,095.10 "," $3,127.68 "," $2,665.70 "," $2,932.20 "," $2,769.30 "," $2,573.82 ", N/A ," $2,636.70 "," $2,636.70 "," $3,095.10 "," $2,795.69 ", $354.84 ," $3,127.68 "
Ablation & Rcnstj Atria X10sv W/Bypass,CPT® 33256,N/A,N/A,N/A," $17,055.00 "," $11,085.75 "," $11,262.75 "," $1,740.40 "," $1,568.54 "," $8,310.51 "," $8,261.54 "," $15,861.15 "," $15,349.50 "," $15,349.50 "," $13,644.00 "," $13,644.00 "," $1,568.54 "," $15,746.88 "," $16,202.25 "," $15,349.50 "," $15,349.50 "," $15,349.50 "," $15,861.15 "," $16,372.80 "," $10,499.31 "," $14,496.75 "," $10,486.73 "," $9,296.24 ", N/A ," $8,472.66 "," $8,472.66 "," $16,202.25 "," $9,624.94 "," $1,568.54 "," $16,372.80 "
Perq Vert Agmntj Cavity Crtj Uni/Bi Cannulj Each,CPT® 22515,N/A,N/A,N/A," $1,494.00 ", $971.10 ," $1,300.65 ", $201.67 ," $3,485.63 "," $1,042.50 "," $1,111.83 "," $1,389.42 "," $1,344.60 "," $1,344.60 "," $1,195.20 "," $1,195.20 "," $3,485.63 "," $1,379.41 "," $1,419.30 "," $1,344.60 "," $1,344.60 "," $1,344.60 "," $1,389.42 "," $1,434.24 "," $1,219.89 "," $1,269.90 "," $1,147.91 "," $1,265.72 ", N/A ," $1,062.85 "," $1,062.85 "," $1,419.30 "," $1,249.22 ", $201.67 ," $3,485.63 "
Hla Class II Typing Low Resolution One Locus Ea,CPT® 81376,N/A,N/A,N/A, $862.00 , $560.30 , N/A , $124.66 , $124.66 , $691.47 , $818.86 , $801.66 , $775.80 , $775.80 , $689.60 , $689.60 , $124.66 , $795.88 , $818.90 , $775.80 , $775.80 , $775.80 , $801.66 , $827.52 , $816.09 , $732.70 , $583.15 , $443.16 , N/A , $645.32 , $645.32 , $818.90 , $705.20 , $124.66 , $827.52 
 Pro Magnetically Contrld Capsule Endoscopy W/I&R ,CPT® 0651T,0982 - PRO FEE/OUTPT,N/A,N/A," $4,387.00 "," $2,851.55 ", N/A , N/A , N/A , N/A , N/A ," $4,079.91 "," $3,948.30 "," $3,948.30 "," $3,509.60 "," $3,509.60 ", N/A ," $4,050.52 "," $4,167.65 "," $3,948.30 "," $3,948.30 "," $3,948.30 "," $4,079.91 "," $4,211.52 ", N/A ," $3,728.95 ", $472.34 ," $1,471.31 ", N/A , $478.65 , $478.65 ," $4,167.65 ", $557.16 , $472.34 ," $4,211.52 "
Drainage Skenes Gland Abscess,CPT® 53060,N/A,N/A,N/A," $1,286.00 ", $835.90 , $891.65 , $158.16 , $76.84 , $805.53 , $749.34 ," $1,195.98 "," $1,157.40 "," $1,157.40 "," $1,028.80 "," $1,028.80 ", $76.84 ," $1,187.36 "," $1,221.70 "," $1,157.40 "," $1,157.40 "," $1,157.40 "," $1,195.98 "," $1,234.56 ", $893.10 ," $1,093.10 ", $861.70 , $996.60 , N/A , $821.25 , $821.25 ," $1,221.70 ", $965.24 , $76.84 ," $1,234.56 "
 Fac Remove Foreign Body From Eye ,CPT® 65235,0761 - TREATMENT ROOM,N/A,N/A," $7,099.00 "," $4,614.35 "," $5,963.16 ", $708.69 , $768.38 ," $5,735.99 "," $6,389.10 "," $6,010.01 "," $6,389.10 "," $6,389.10 "," $6,389.10 "," $6,034.15 ", $753.31 ," $6,554.51 "," $6,744.05 "," $6,034.15 "," $6,602.07 "," $6,602.07 "," $6,744.05 "," $6,815.04 "," $5,808.40 "," $6,389.10 "," $6,034.15 "," $5,608.21 ", N/A ," $5,745.22 "," $5,745.22 "," $6,744.05 "," $6,091.65 ", $708.69 ," $6,815.04 "
"Calculus Assay,Infrared Spectr",CPT® 82365,N/A,N/A,N/A, $160.00 , $104.00 , N/A , $13.16 , $13.16 , $72.96 , $87.24 , $148.80 , $144.00 , $144.00 , $128.00 , $128.00 , $13.16 , $147.73 , $152.00 , $144.00 , $144.00 , $144.00 , $148.80 , $153.60 , $86.14 , $136.00 , $84.34 , $46.76 , N/A , $68.09 , $68.09 , $152.00 , $74.41 , $13.16 , $153.60 
 Fac Iaad Ia Aspergillus ,CPT® 87305,0306 - LAB/BACT-MICRO,N/A,N/A, $193.00 , $125.45 , $162.12 , $12.22 , $12.22 , $155.94 , $173.70 , $163.39 , $173.70 , $173.70 , $173.70 , $164.05 , $11.98 , $178.20 , $183.35 , $164.05 , $179.49 , $179.49 , $183.35 , $185.28 , $157.91 , $173.70 , $164.05 , $152.47 , N/A , $156.19 , $156.19 , $183.35 , $165.61 , $11.98 , $185.28 
 Pro Set Radiation Therapy Field ,CPT® 77295,0982 - PRO FEE/OUTPT,N/A,N/A," $1,532.00 ", $995.80 ," $2,656.40 ", $471.16 , $596.89 ," $2,331.43 "," $2,304.33 "," $1,424.76 "," $1,378.80 "," $1,378.80 "," $1,225.60 "," $1,225.60 ", $596.89 ," $1,414.50 "," $1,455.40 "," $1,378.80 "," $1,378.80 "," $1,378.80 "," $1,424.76 "," $1,470.72 "," $2,710.48 "," $1,302.20 "," $2,521.19 "," $2,764.66 ", N/A ," $2,376.92 "," $2,376.92 "," $1,455.40 "," $2,751.31 ", $471.16 ," $2,764.66 "
 Fac Esophagoscopy Rig Transoral Removal Foreign Body ,CPT® 43194,0360 - OR SERVICES,N/A,N/A," $2,140.00 "," $1,391.00 "," $1,797.60 ", $181.14 , $123.56 ," $1,729.12 "," $1,926.00 "," $1,811.72 "," $1,926.00 "," $1,926.00 "," $1,926.00 "," $1,819.00 ", $121.14 ," $1,975.86 "," $2,033.00 "," $1,819.00 "," $1,990.20 "," $1,990.20 "," $2,033.00 "," $2,054.40 "," $1,750.95 "," $1,926.00 "," $1,819.00 "," $1,690.60 ", N/A ," $1,731.90 "," $1,731.90 "," $2,033.00 "," $1,836.33 ", $121.14 ," $2,054.40 "
"Lap, Repair Paraesophageal Hernia, Incl Fundoplasty W/ Mesh",CPT® 43282,N/A,N/A,N/A," $11,471.00 "," $7,456.15 "," $10,226.26 "," $1,580.54 "," $1,453.36 "," $8,156.96 "," $8,197.06 "," $10,668.03 "," $10,323.90 "," $10,323.90 "," $9,176.80 "," $9,176.80 "," $1,453.36 "," $10,591.17 "," $10,897.45 "," $10,323.90 "," $10,323.90 "," $10,323.90 "," $10,668.03 "," $11,012.16 "," $7,344.18 "," $9,750.35 "," $9,137.98 "," $9,590.48 ", N/A ," $8,316.11 "," $8,316.11 "," $10,897.45 "," $8,697.77 "," $1,453.36 "," $11,012.16 "
 Fac Prq Trluml Coronary Angio/Atherect One Art/Brnch ,CPT® 92924,0481 - CARDIAC CATH LAB,N/A,N/A," $16,871.00 "," $10,966.15 "," $14,171.64 ", $566.56 , $638.01 ," $13,631.77 "," $15,183.90 "," $14,282.99 "," $15,183.90 "," $15,183.90 "," $15,183.90 "," $14,340.35 ", $625.50 ," $15,576.99 "," $16,027.45 "," $14,340.35 "," $15,690.03 "," $15,690.03 "," $16,027.45 "," $16,196.16 "," $13,803.85 "," $15,183.90 "," $14,340.35 "," $13,328.09 ", N/A ," $13,653.70 "," $13,653.70 "," $16,027.45 "," $14,477.01 ", $566.56 ," $16,196.16 "
 Rt Joint Upper Extrem W/O Contrast ,CPT® 73221,0610 - MRI,N/A,N/A," $3,813.00 "," $2,478.45 "," $3,202.92 ", $207.89 , $411.27 ," $3,080.90 "," $3,431.70 "," $3,228.09 "," $3,431.70 "," $3,431.70 "," $3,431.70 "," $3,241.05 ", $403.21 ," $3,520.54 "," $3,622.35 "," $3,241.05 "," $3,546.09 "," $3,546.09 "," $3,622.35 "," $3,660.48 "," $3,119.80 "," $3,431.70 "," $3,241.05 "," $3,012.27 ", N/A ," $3,085.86 "," $3,085.86 "," $3,622.35 "," $3,271.94 ", $207.89 ," $3,660.48 "
 Pro Online Digital E/M Svc Est Pt <7 D 11-20 Minutes ,CPT® 99422,0982 - PRO FEE/OUTPT,N/A,N/A, $77.00 , $50.05 , $51.58 , $24.61 , $23.72 , $45.29 , N/A , $71.61 , $69.30 , $69.30 , $61.60 , $61.60 , $23.72 , $71.09 , $73.15 , $69.30 , $69.30 , $69.30 , $71.61 , $73.92 , $47.07 , $65.45 , $56.03 , $58.07 , N/A , $46.18 , $46.18 , $73.15 , $53.00 , $23.72 , $73.92 
Hemicortical Intercalary Allograft Partial,CPT® 20933,N/A,N/A,N/A," $4,341.00 "," $2,821.65 "," $4,134.33 ", $642.45 , $511.93 ," $2,951.05 ", N/A ," $4,037.13 "," $3,906.90 "," $3,906.90 "," $3,472.80 "," $3,472.80 ", $511.93 ," $4,008.05 "," $4,123.95 "," $3,906.90 "," $3,906.90 "," $3,906.90 "," $4,037.13 "," $4,167.36 "," $3,870.22 "," $3,689.85 "," $3,651.62 "," $3,732.82 ", N/A ," $3,008.64 "," $3,008.64 "," $4,123.95 "," $3,536.22 ", $511.93 ," $4,167.36 "
"Osteopathic Manip,3-4 Body Regn",CPT® 98926,N/A,N/A,N/A, $180.00 , $117.00 , $81.86 , $34.17 , $29.91 , $80.40 , $79.08 , $167.40 , $162.00 , $162.00 , $144.00 , $144.00 , $29.91 , $166.19 , $171.00 , $162.00 , $162.00 , $162.00 , $167.40 , $172.80 , $88.87 , $153.00 , $103.40 , $136.78 , N/A , $81.96 , $81.96 , $171.00 , $95.56 , $29.91 , $172.80 
 Shuntogram ,CPT® 75809,0320 - DX X-RAY,N/A,N/A," $1,130.00 ", $734.50 , $949.20 , $80.82 , $56.78 , $913.04 ," $1,017.00 ", $956.66 ," $1,017.00 "," $1,017.00 "," $1,017.00 ", $960.50 , $55.67 ," $1,043.33 "," $1,073.50 ", $960.50 ," $1,050.90 "," $1,050.90 "," $1,073.50 "," $1,084.80 ", $924.57 ," $1,017.00 ", $960.50 , $892.70 , N/A , $914.51 , $914.51 ," $1,073.50 ", $969.65 , $55.67 ," $1,084.80 "
Fx Cl Shouder Disl W Mani,23650,N/A,N/A,N/A," $2,008.00 "," $1,305.20 "," $1,823.71 ", $292.70 , $192.43 ," $1,386.81 "," $1,412.59 "," $1,867.44 "," $1,807.20 "," $1,807.20 "," $1,606.40 "," $1,606.40 ", $192.43 ," $1,853.99 "," $1,907.60 "," $1,807.20 "," $1,807.20 "," $1,807.20 "," $1,867.44 "," $1,927.68 "," $1,671.17 "," $1,706.80 "," $1,548.57 "," $1,654.68 ", N/A ," $1,413.87 "," $1,413.87 "," $1,907.60 "," $1,661.81 ", $192.43 ," $1,927.68 "
 SODIUM PHOSPHATES 15 MMOLE/5ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,63323-0884-06,5 mL, $104.98 , $68.24 , $88.18 , N/A , N/A , $84.82 , $94.48 , $88.88 , $94.48 , $94.48 , $94.48 , $89.23 , N/A , $96.93 , $99.73 , $89.23 , $97.63 , $97.63 , $99.73 , $100.78 , $85.89 , $94.48 , $89.23 , $82.93 , N/A , $84.96 , $84.96 , $99.73 , $90.08 , $82.93 , $100.78 
Sono Eye Biometry,CPT® 76516,N/A,N/A,N/A, $527.00 , $342.55 , $261.12 , $45.89 , $67.24 , $378.63 , $419.50 , $490.11 , $474.30 , $474.30 , $421.60 , $421.60 , $67.24 , $486.58 , $500.65 , $474.30 , $474.30 , $474.30 , $490.11 , $505.92 , $258.21 , $447.95 , $458.40 , $356.69 , N/A , $386.02 , $386.02 , $500.65 , $446.82 , $45.89 , $505.92 
"Injection, Famotidine, 20 Mg",HCPCS S0028,N/A,N/A,N/A, $3.00 , $1.95 , N/A , N/A , N/A , N/A , N/A , $2.79 , $2.70 , $2.70 , $2.40 , $2.40 , N/A , $2.77 , $2.85 , $2.70 , $2.70 , $2.70 , $2.79 , $2.88 , N/A , $2.55 , $3.24 , $1.16 , N/A , N/A , N/A , $2.85 , N/A , $1.16 , $3.24 
 Fac Imhistochem/Cytchm Ea Multiplex Antibody Slide ,CPT® 88344,0310 - PATHOLOGY LAB,N/A,N/A, $490.00 , $318.50 , $411.60 , $165.40 , $92.01 , $395.92 , $441.00 , $414.83 , $441.00 , $441.00 , $441.00 , $416.50 , $90.21 , $452.42 , $465.50 , $416.50 , $455.70 , $455.70 , $465.50 , $470.40 , $400.92 , $441.00 , $416.50 , $387.10 , N/A , $396.56 , $396.56 , $465.50 , $420.47 , $90.21 , $470.40 
 Rt Galactogram Mammary Mult Ducts ,CPT® 77054,0320 - DX X-RAY,N/A,N/A," $1,065.00 ", $692.25 , $894.60 , $68.10 , $91.48 , $860.52 , $958.50 , $901.63 , $958.50 , $958.50 , $958.50 , $905.25 , $89.69 , $983.31 ," $1,011.75 ", $905.25 , $990.45 , $990.45 ," $1,011.75 "," $1,022.40 ", $871.38 , $958.50 , $905.25 , $841.35 , N/A , $861.90 , $861.90 ," $1,011.75 ", $913.88 , $68.10 ," $1,022.40 "
" Pro Burn Dressing,MD,W/O Anes ",CPT® 16025,0982 - PRO FEE/OUTPT,N/A,N/A, $402.00 , $261.30 , $353.80 , $104.77 , $43.96 , $304.75 , $296.43 , $373.86 , $361.80 , $361.80 , $321.60 , $321.60 , $43.96 , $371.17 , $381.90 , $361.80 , $361.80 , $361.80 , $373.86 , $385.92 , $384.92 , $341.70 , $592.31 , $389.98 , N/A , $310.69 , $310.69 , $381.90 , $360.30 , $43.96 , $592.31 
"Inject Nerv Blck,Stellate Ganglion",CPT® 64510,N/A,N/A,N/A," $1,386.00 ", $900.90 , $381.37 , $74.23 , $129.25 , $412.03 , $403.28 ," $1,288.98 "," $1,247.40 "," $1,247.40 "," $1,108.80 "," $1,108.80 ", $129.25 ," $1,279.69 "," $1,316.70 "," $1,247.40 "," $1,247.40 "," $1,247.40 "," $1,288.98 "," $1,330.56 ", $411.36 ," $1,178.10 ", $394.28 , $446.07 , N/A , $420.07 , $420.07 ," $1,316.70 ", $450.63 , $74.23 ," $1,330.56 "
"Partial Excis Lip,V-Exc Prim Clos",CPT® 40520,N/A,N/A,N/A," $3,242.00 "," $2,107.30 "," $2,194.14 ", $345.44 , $411.80 ," $1,724.71 "," $1,770.87 "," $3,015.06 "," $2,917.80 "," $2,917.80 "," $2,593.60 "," $2,593.60 ", $411.80 ," $2,993.34 "," $3,079.90 "," $2,917.80 "," $2,917.80 "," $2,917.80 "," $3,015.06 "," $3,112.32 "," $1,562.26 "," $2,755.70 "," $1,939.28 "," $2,035.35 ", N/A ," $1,758.36 "," $1,758.36 "," $3,079.90 "," $1,839.06 ", $345.44 ," $3,112.32 "
" Fac Immunoassay, Ria ",CPT® 83520,0302 - LAB/IMMUNOLOGY,N/A,N/A, $227.00 , $147.55 , $190.68 , $17.62 , $17.62 , $183.42 , $204.30 , $192.18 , $204.30 , $204.30 , $204.30 , $192.95 , $17.27 , $209.59 , $215.65 , $192.95 , $211.11 , $211.11 , $215.65 , $217.92 , $185.73 , $204.30 , $192.95 , $179.33 , N/A , $183.71 , $183.71 , $215.65 , $194.79 , $17.27 , $217.92 
"Dil Urethra,Gen/Spinal Anesth",CPT® 53665,N/A,N/A,N/A, $268.00 , $174.20 , $205.85 , $35.89 , $137.47 , $189.74 , $175.05 , $249.24 , $241.20 , $241.20 , $214.40 , $214.40 , $137.47 , $247.44 , $254.60 , $241.20 , $241.20 , $241.20 , $249.24 , $257.28 , $206.94 , $227.80 , $199.82 , $236.48 , N/A , $193.44 , $193.44 , $254.60 , $227.36 , $35.89 , $257.28 
Behavioral & Qualit Analysis Voice and Resonance,CPT® 92524,N/A,N/A,N/A, $462.00 , $300.30 , $257.90 , $109.16 , $86.24 , $197.24 , $218.98 , $429.66 , $415.80 , $415.80 , $369.60 , $369.60 , $86.24 , $426.56 , $438.90 , $415.80 , $415.80 , $415.80 , $429.66 , $443.52 , $328.57 , $392.70 , $330.16 , $334.86 , N/A , $201.09 , $201.09 , $438.90 , $234.44 , $86.24 , $443.52 
"Removal Salivary Stone,Uncomplic",CPT® 42330,N/A,N/A,N/A," $1,128.00 ", $733.20 ," $1,018.49 ", $160.51 , $105.69 , $796.97 , $820.56 ," $1,049.04 "," $1,015.20 "," $1,015.20 ", $902.40 , $902.40 , $105.69 ," $1,041.48 "," $1,071.60 "," $1,015.20 "," $1,015.20 "," $1,015.20 "," $1,049.04 "," $1,082.88 ", $721.94 , $958.80 , $895.60 , $935.17 , N/A , $812.52 , $812.52 ," $1,071.60 ", $849.82 , $105.69 ," $1,082.88 "
" Fac Hep a Antibody, Igm ",CPT® 86709,0302 - LAB/IMMUNOLOGY,N/A,N/A, $111.00 , $72.15 , $93.24 , $11.49 , $11.49 , $89.69 , $99.90 , $93.97 , $99.90 , $99.90 , $99.90 , $94.35 , $11.26 , $102.49 , $105.45 , $94.35 , $103.23 , $103.23 , $105.45 , $106.56 , $90.82 , $99.90 , $94.35 , $87.69 , N/A , $89.83 , $89.83 , $105.45 , $95.25 , $11.26 , $106.56 
 LOPERAMIDE HCL 1 MG/7.5ML PO SOLN ,HCPCS RXC637,0250 - PHARMACY,68094-0129-62,15 mL, $16.34 , $10.62 , $13.73 , N/A , N/A , $13.20 , $14.71 , $13.83 , $14.71 , $14.71 , $14.71 , $13.89 , N/A , $15.09 , $15.52 , $13.89 , $15.20 , $15.20 , $15.52 , $15.69 , $13.37 , $14.71 , $13.89 , $12.91 , N/A , $13.22 , $13.22 , $15.52 , $14.02 , $12.91 , $15.69 
"Removal Testis,Simple",CPT® 54520,N/A,N/A,N/A," $2,806.00 "," $1,823.90 "," $1,453.43 ", $313.50 , $344.66 ," $1,044.20 "," $1,061.91 "," $2,609.58 "," $2,525.40 "," $2,525.40 "," $2,244.80 "," $2,244.80 ", $344.66 ," $2,590.78 "," $2,665.70 "," $2,525.40 "," $2,525.40 "," $2,525.40 "," $2,609.58 "," $2,693.76 "," $1,362.34 "," $2,385.10 "," $1,700.21 "," $1,576.27 ", N/A ," $1,064.58 "," $1,064.58 "," $2,665.70 "," $1,275.96 ", $313.50 ," $2,693.76 "
 Fac Insert Temp Bladder Cath ,CPT® 51702,0761 - TREATMENT ROOM,N/A,N/A, $236.00 , $153.40 , $198.24 , $23.85 , $112.85 , $190.69 , $212.40 , $199.80 , $212.40 , $212.40 , $212.40 , $200.60 , $110.64 , $217.90 , $224.20 , $200.60 , $219.48 , $219.48 , $224.20 , $226.56 , $193.10 , $212.40 , $200.60 , $186.44 , N/A , $190.99 , $190.99 , $224.20 , $202.51 , $23.85 , $226.56 
Treat Ankle Dislocation,27840,N/A,N/A,N/A," $2,578.00 "," $1,675.70 "," $2,352.48 ", $375.49 , $153.67 ," $1,776.63 "," $1,824.43 "," $2,397.54 "," $2,320.20 "," $2,320.20 "," $2,062.40 "," $2,062.40 ", $153.67 ," $2,380.27 "," $2,449.10 "," $2,320.20 "," $2,320.20 "," $2,320.20 "," $2,397.54 "," $2,474.88 "," $2,156.14 "," $2,191.30 "," $2,001.72 "," $2,128.48 ", N/A ," $1,811.30 "," $1,811.30 "," $2,449.10 "," $2,128.91 ", $153.67 ," $2,474.88 "
"Incis Tendon Sheath,Radial Styloid",25000,N/A,N/A,N/A," $2,059.00 "," $1,338.35 "," $2,132.91 ", $337.40 , $307.34 ," $1,618.68 "," $1,636.56 "," $1,914.87 "," $1,853.10 "," $1,853.10 "," $1,647.20 "," $1,647.20 ", $307.34 ," $1,901.07 "," $1,956.05 "," $1,853.10 "," $1,853.10 "," $1,853.10 "," $1,914.87 "," $1,976.64 "," $1,968.73 "," $1,750.15 "," $1,792.98 "," $1,930.07 ", N/A ," $1,650.26 "," $1,650.26 "," $1,956.05 "," $1,939.63 ", $307.34 ," $2,132.91 "
 Fac Low Frequency Non-Thermal Ultrasound per Day ,CPT® 97610,0761 - TREATMENT ROOM,N/A,N/A, $243.00 , $157.95 , $204.12 , $17.87 , N/A , $196.34 , $218.70 , $205.72 , $218.70 , $218.70 , $218.70 , $206.55 , N/A , $224.36 , $230.85 , $206.55 , $225.99 , $225.99 , $230.85 , $233.28 , $198.82 , $218.70 , $206.55 , $191.97 , N/A , $196.66 , $196.66 , $230.85 , $208.52 , $17.87 , $233.28 
 Fac Glycoprotein Antibody ,CPT® 86146,0302 - LAB/IMMUNOLOGY,N/A,N/A, $261.00 , $169.65 , $219.24 , $25.96 , $8.07 , $210.89 , $234.90 , $220.96 , $234.90 , $234.90 , $234.90 , $221.85 , $7.91 , $240.98 , $247.95 , $221.85 , $242.73 , $242.73 , $247.95 , $250.56 , $213.55 , $234.90 , $221.85 , $206.19 , N/A , $211.23 , $211.23 , $247.95 , $223.96 , $7.91 , $250.56 
"Biopsy of Vagina,Extensive",CPT® 57105,N/A,N/A,N/A," $1,222.00 ", $794.30 , $699.55 , $141.88 , $117.23 , $512.77 , $513.53 ," $1,136.46 "," $1,099.80 "," $1,099.80 ", $977.60 , $977.60 , $117.23 ," $1,128.27 "," $1,160.90 "," $1,099.80 "," $1,099.80 "," $1,099.80 "," $1,136.46 "," $1,173.12 ", $710.88 ," $1,038.70 ", $672.59 , $519.24 , N/A , $522.78 , $522.78 ," $1,160.90 ", $627.03 , $117.23 ," $1,173.12 "
 Fac Brachytx Isodose Pln Smpl W/Dosimetry Cal ,CPT® 77316,0333 - RADIATION RX,N/A,N/A," $1,931.00 "," $1,255.15 "," $1,622.04 ", $239.92 , $145.63 ," $1,560.25 "," $1,737.90 "," $1,634.78 "," $1,737.90 "," $1,737.90 "," $1,737.90 "," $1,641.35 ", $142.77 ," $1,782.89 "," $1,834.45 "," $1,641.35 "," $1,795.83 "," $1,795.83 "," $1,834.45 "," $1,853.76 "," $1,579.94 "," $1,737.90 "," $1,641.35 "," $1,525.49 ", N/A ," $1,562.76 "," $1,562.76 "," $1,834.45 "," $1,656.99 ", $142.77 ," $1,853.76 "
 BEVACIZUMAB 100 MG/4ML IV SOLN ,HCPCS J9035,0636 - DRUGS REQUIRING DETAILED CODIN,50242-0060-01,2 mL," $1,171.64 ", $761.57 , $984.18 , $75.05 , $72.78 , $946.69 ," $1,054.48 ", $991.91 ," $1,054.48 "," $1,054.48 "," $1,054.48 ", $995.89 , $71.35 ," $1,081.78 "," $1,113.06 ", $995.89 ," $1,089.63 "," $1,089.63 "," $1,113.06 "," $1,124.77 ", $958.64 ," $1,054.48 ", $995.89 , $925.60 , N/A , $948.21 , $948.21 ," $1,113.06 "," $1,005.38 ", $71.35 ," $1,124.77 "
Bis Extracellular Fluid Alys Lymphedema Assmnt,CPT® 93702,N/A,N/A,N/A, $234.00 , $152.10 , $880.69 , $125.65 , N/A , $608.60 , $633.70 , $217.62 , $210.60 , $210.60 , $187.20 , $187.20 , N/A , $216.05 , $222.30 , $210.60 , $210.60 , $210.60 , $217.62 , $224.64 , $629.44 , $198.90 , $682.35 , $464.71 , N/A , $620.47 , $620.47 , $222.30 , $687.80 , $125.65 , $880.69 
Exc Skin Malig 1.1-2cm Remaindr Body,CPT® 11622,N/A,N/A,N/A," $1,169.00 ", $759.85 , $542.33 , $163.07 , $252.90 , $468.46 , $459.11 ," $1,087.17 "," $1,052.10 "," $1,052.10 ", $935.20 , $935.20 , $252.90 ," $1,079.34 "," $1,110.55 "," $1,052.10 "," $1,052.10 "," $1,052.10 "," $1,087.17 "," $1,122.24 ", $594.12 , $993.65 , $913.44 , $600.62 , N/A , $477.60 , $477.60 ," $1,110.55 ", $553.84 , $163.07 ," $1,122.24 "
"Rx Retinopathy Progressv,Photocoag",CPT® 67228,N/A,N/A,N/A," $6,971.00 "," $4,531.15 "," $1,866.15 ", $292.46 , $614.70 ," $5,368.82 "," $5,003.55 "," $6,483.03 "," $6,273.90 "," $6,273.90 "," $5,576.80 "," $5,576.80 ", $614.70 ," $6,436.32 "," $6,622.45 "," $6,273.90 "," $6,273.90 "," $6,273.90 "," $6,483.03 "," $6,692.16 "," $2,566.92 "," $5,925.35 "," $5,161.30 "," $2,207.81 ", N/A ," $5,473.57 "," $5,473.57 "," $6,622.45 "," $6,042.11 ", $292.46 ," $6,692.16 "
 Fac Veeg by Tech Ea Incr 12-26 Hr Cont R-T Mntr ,CPT® 95716,0740 - EEG,N/A,N/A," $2,698.00 "," $1,753.70 "," $2,266.32 ", $843.89 , $741.70 ," $2,179.98 "," $2,428.20 "," $2,284.13 "," $2,428.20 "," $2,428.20 "," $2,428.20 "," $2,293.30 ", $727.16 ," $2,491.06 "," $2,563.10 "," $2,293.30 "," $2,509.14 "," $2,509.14 "," $2,563.10 "," $2,590.08 "," $2,207.50 "," $2,428.20 "," $2,293.30 "," $2,131.42 ", N/A ," $2,183.49 "," $2,183.49 "," $2,563.10 "," $2,315.15 ", $727.16 ," $2,590.08 "
 Pro Drainage of Gums Cyst ,CPT® 41800,0981 - PRO FEE/ER,N/A,N/A, $609.00 , $395.85 , $949.52 , $149.06 , $30.71 , $713.43 , $755.10 , $566.37 , $548.10 , $548.10 , $487.20 , $487.20 , $30.71 , $562.29 , $578.55 , $548.10 , $548.10 , $548.10 , $566.37 , $584.64 , $697.11 , $517.65 , $824.24 , $871.64 , N/A , $727.36 , $727.36 , $578.55 , $760.72 , $30.71 , $949.52 
 BENZOCAINE-MENTHOL 20-0.5 % EX AERO ,HCPCS RXC637,0250 - PHARMACY,16864-0680-03,85 gram, $34.06 , $22.14 , $28.61 , N/A , N/A , $27.52 , $30.65 , $28.84 , $30.65 , $30.65 , $30.65 , $28.95 , N/A , $31.45 , $32.36 , $28.95 , $31.68 , $31.68 , $32.36 , $32.70 , $27.87 , $30.65 , $28.95 , $26.91 , N/A , $27.56 , $27.56 , $32.36 , $29.23 , $26.91 , $32.70 
 Fac Assay of Citrate ,CPT® 82507,0301 - LAB/CHEMISTRY,N/A,N/A, $250.00 , $162.50 , $210.00 , $28.36 , $28.36 , $202.00 , $225.00 , $211.65 , $225.00 , $225.00 , $225.00 , $212.50 , $27.80 , $230.83 , $237.50 , $212.50 , $232.50 , $232.50 , $237.50 , $240.00 , $204.55 , $225.00 , $212.50 , $197.50 , N/A , $202.33 , $202.33 , $237.50 , $214.53 , $27.80 , $240.00 
"Eval of Bronchospasm,Prolonged",CPT® 94070,N/A,N/A,N/A, $626.00 , $406.90 , $143.66 , $60.14 , $55.88 , $131.43 , $137.90 , $582.18 , $563.40 , $563.40 , $500.80 , $500.80 , $55.88 , $577.99 , $594.70 , $563.40 , $563.40 , $563.40 , $582.18 , $600.96 , $189.75 , $532.10 , $182.47 , $229.42 , N/A , $133.99 , $133.99 , $594.70 , $156.22 , $55.88 , $600.96 
"Close Blad-Vag Fistula,Vag Apprch",CPT® 57320,N/A,N/A,N/A," $3,276.00 "," $2,129.40 "," $2,677.90 ", $541.69 , $922.06 ," $2,172.82 "," $2,140.80 "," $3,046.68 "," $2,948.40 "," $2,948.40 "," $2,620.80 "," $2,620.80 ", $922.06 ," $3,024.73 "," $3,112.20 "," $2,948.40 "," $2,948.40 "," $2,948.40 "," $3,046.68 "," $3,144.96 "," $2,774.01 "," $2,784.60 "," $2,768.87 "," $2,210.65 ", N/A ," $2,215.21 "," $2,215.21 "," $3,112.20 "," $2,657.02 ", $541.69 ," $3,144.96 "
Cerv Flexible Non-Adjustable,HCPCS L0120,N/A,N/A,N/A, $46.00 , $29.90 , N/A , $30.94 , $15.29 , N/A , N/A , $42.78 , $41.40 , $41.40 , $36.80 , $36.80 , $15.29 , $42.47 , $43.70 , $41.40 , $41.40 , $41.40 , $42.78 , $44.16 , N/A , $39.10 , $26.60 , $26.03 , N/A , N/A , N/A , $43.70 , N/A , $15.29 , $44.16 
Sio Flex Pelvisacral Prefab,HCPCS L0621,N/A,N/A,N/A, $95.00 , $61.75 , N/A , $72.18 , N/A , N/A , N/A , $88.35 , $85.50 , $85.50 , $76.00 , $76.00 , N/A , $87.71 , $90.25 , $85.50 , $85.50 , $85.50 , $88.35 , $91.20 , N/A , $80.75 , $93.42 , $84.86 , N/A , N/A , N/A , $90.25 , N/A , $72.18 , $93.42 
 ESTRADIOL 0.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00555-0899-02,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Pro Deter Refractive State ,CPT® 92015,0962 - PRO FEE/EYE,N/A,N/A, $62.00 , $40.30 , $20.00 , $18.93 , $10.17 , $34.59 , $33.66 , $57.66 , $55.80 , $55.80 , $49.60 , $49.60 , $10.17 , $57.24 , $58.90 , $55.80 , $55.80 , $55.80 , $57.66 , $59.52 , $58.79 , $52.70 , $56.77 , $41.01 , N/A , $35.27 , $35.27 , $58.90 , $41.95 , $10.17 , $59.52 
 Fac Q Fever Antibody ,CPT® 86638,0302 - LAB/IMMUNOLOGY,N/A,N/A, $90.00 , $58.50 , $75.60 , $12.36 , $8.07 , $72.72 , $81.00 , $76.19 , $81.00 , $81.00 , $81.00 , $76.50 , $7.91 , $83.10 , $85.50 , $76.50 , $83.70 , $83.70 , $85.50 , $86.40 , $73.64 , $81.00 , $76.50 , $71.10 , N/A , $72.84 , $72.84 , $85.50 , $77.23 , $7.91 , $86.40 
 Medical Back Problems Without McC ,MS DRG V40 (FY2023) 552,N/A,N/A,N/A," $25,215.20 "," $16,389.88 "," $21,180.77 ", N/A , N/A ," $20,373.88 "," $22,693.68 "," $21,347.19 "," $22,693.68 "," $22,693.68 "," $22,693.68 "," $21,432.92 ", N/A ," $23,281.19 "," $23,954.44 "," $21,432.92 "," $23,450.14 "," $23,450.14 "," $23,954.44 "," $24,206.59 "," $20,631.08 "," $22,693.68 "," $21,432.92 "," $19,920.01 ", N/A ," $20,406.66 "," $20,406.66 "," $23,954.44 "," $21,637.16 "," $19,920.01 "," $24,206.59 "
"Immuniz,Admin,Each Addl",CPT® 90472,N/A,N/A,N/A, $47.00 , $30.55 , $30.35 , $14.16 , N/A , $28.51 , $29.13 , $43.71 , $42.30 , $42.30 , $37.60 , $37.60 , N/A , $43.40 , $44.65 , $42.30 , $42.30 , $42.30 , $43.71 , $45.12 , $44.86 , $39.95 , $37.51 , $39.95 , N/A , $29.07 , $29.07 , $44.65 , $34.44 , $14.16 , $45.12 
 Pro Hospital IP/Obs Discharge Day Mgmt 30 Min/< ,CPT® 99238,0987 - PRO FEE/HOS VIS,N/A,N/A, $284.00 , $184.60 , $143.56 , $78.65 , $51.64 , $125.27 , $125.75 , $264.12 , $255.60 , $255.60 , $227.20 , $227.20 , $51.64 , $262.22 , $269.80 , $255.60 , $255.60 , $255.60 , $264.12 , $272.64 , $181.90 , $241.40 , $156.02 , $160.16 , $97.00 , $127.71 , $127.71 , $269.80 , $147.30 , $51.64 , $272.64 
Cesarean Delivery Only,CPT® 59514,N/A,N/A,N/A," $4,114.00 "," $2,674.10 "," $2,096.07 ", $816.07 , $630.92 ," $2,125.87 "," $2,227.82 "," $3,826.02 "," $3,702.60 "," $3,702.60 "," $3,291.20 "," $3,291.20 ", $630.92 ," $3,798.46 "," $3,908.30 "," $3,702.60 "," $3,702.60 "," $3,702.60 "," $3,826.02 "," $3,949.44 "," $2,467.11 "," $3,496.90 "," $4,934.72 "," $2,114.58 ", N/A ," $2,167.35 "," $2,167.35 "," $3,908.30 "," $2,505.67 ", $630.92 ," $4,934.72 "
 ROSUVASTATIN CALCIUM 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,16729-0285-15,1 tablet, $45.95 , $29.87 , $38.60 , N/A , N/A , $37.13 , $41.36 , $38.90 , $41.36 , $41.36 , $41.36 , $39.06 , N/A , $42.43 , $43.65 , $39.06 , $42.73 , $42.73 , $43.65 , $44.11 , $37.60 , $41.36 , $39.06 , $36.30 , N/A , $37.19 , $37.19 , $43.65 , $39.43 , $36.30 , $44.11 
Replace Non-Tun Cv Cath,CPT® 36580,N/A,N/A,N/A," $1,317.00 ", $856.05 , $399.23 , $61.68 , $315.95 , $294.84 , $287.74 ," $1,224.81 "," $1,185.30 "," $1,185.30 "," $1,053.60 "," $1,053.60 ", $315.95 ," $1,215.99 "," $1,251.15 "," $1,185.30 "," $1,185.30 "," $1,185.30 "," $1,224.81 "," $1,264.32 ", $371.08 ," $1,119.45 ", $353.24 , $332.37 , N/A , $300.59 , $300.59 ," $1,251.15 ", $341.46 , $61.68 ," $1,264.32 "
 Fac Amb Ift 911 Base Rate Als2 ,HCPCS A0433,0540 - AMBULANCE,N/A,N/A," $3,200.00 "," $2,080.00 "," $2,688.00 ", N/A , $592.09 ," $2,585.60 "," $2,880.00 "," $2,709.12 "," $2,880.00 "," $2,880.00 "," $2,880.00 "," $2,720.00 ", $580.48 ," $2,954.56 "," $3,040.00 "," $2,720.00 "," $2,976.00 "," $2,976.00 "," $3,040.00 "," $3,072.00 "," $2,618.24 "," $2,880.00 "," $2,720.00 "," $2,528.00 ", N/A ," $2,589.76 "," $2,589.76 "," $3,040.00 "," $2,745.92 ", $580.48 ," $3,072.00 "
 Fac Cltx Grter Humrl Tubrst Fx W/O Mnpj ,CPT® 23620,0361 - OR/MINOR,N/A,N/A," $1,202.00 ", $781.30 ," $1,009.68 ", $256.76 , $122.93 , $971.22 ," $1,081.80 "," $1,017.61 "," $1,081.80 "," $1,081.80 "," $1,081.80 "," $1,021.70 ", $120.52 ," $1,109.81 "," $1,141.90 "," $1,021.70 "," $1,117.86 "," $1,117.86 "," $1,141.90 "," $1,153.92 ", $983.48 ," $1,081.80 "," $1,021.70 ", $949.58 , N/A , $972.78 , $972.78 ," $1,141.90 "," $1,031.44 ", $120.52 ," $1,153.92 "
Colonoscopy Stoma W/Biopsy Single/Multiple,CPT® 44389,N/A,N/A,N/A," $3,109.00 "," $2,020.85 "," $1,048.58 ", $162.03 , $362.74 , $877.22 , $900.47 ," $2,891.37 "," $2,798.10 "," $2,798.10 "," $2,487.20 "," $2,487.20 ", $362.74 ," $2,870.54 "," $2,953.55 "," $2,798.10 "," $2,798.10 "," $2,798.10 "," $2,891.37 "," $2,984.64 ", $754.30 ," $2,642.65 ", $988.37 , $999.00 , N/A , $894.34 , $894.34 ," $2,953.55 ", $935.39 , $162.03 ," $2,984.64 "
 Fac Assay RBC Protoporphyrin ,CPT® 84202,0301 - LAB/CHEMISTRY,N/A,N/A, $129.00 , $83.85 , $108.36 , $14.64 , $14.64 , $104.23 , $116.10 , $109.21 , $116.10 , $116.10 , $116.10 , $109.65 , $14.35 , $119.11 , $122.55 , $109.65 , $119.97 , $119.97 , $122.55 , $123.84 , $105.55 , $116.10 , $109.65 , $101.91 , N/A , $104.40 , $104.40 , $122.55 , $110.69 , $14.35 , $123.84 
" Pro Venipuncture,Over Age 3 ",CPT® 36410,0981 - PRO FEE/ER,N/A,N/A, $82.00 , $53.30 , $56.68 , $8.74 , $16.64 , $40.95 , $40.19 , $76.26 , $73.80 , $73.80 , $65.60 , $65.60 , $16.64 , $75.71 , $77.90 , $73.80 , $73.80 , $73.80 , $76.26 , $78.72 , $52.57 , $69.70 , $49.95 , $46.82 , N/A , $41.76 , $41.76 , $77.90 , $47.42 , $8.74 , $78.72 
 Fac Wbc Antibody Identification ,CPT® 86021,0302 - LAB/IMMUNOLOGY,N/A,N/A, $276.00 , $179.40 , $231.84 , $15.35 , $15.35 , $223.01 , $248.40 , $233.66 , $248.40 , $248.40 , $248.40 , $234.60 , $15.05 , $254.83 , $262.20 , $234.60 , $256.68 , $256.68 , $262.20 , $264.96 , $225.82 , $248.40 , $234.60 , $218.04 , N/A , $223.37 , $223.37 , $262.20 , $236.84 , $15.05 , $264.96 
Care Mgmt Services Behavioral Hlth Cond 20 Mins,CPT® 99484,N/A,N/A,N/A, $131.00 , $85.15 , $58.04 , $28.74 , N/A , $52.43 , $55.57 , $121.83 , $117.90 , $117.90 , $104.80 , $104.80 , N/A , $120.95 , $124.45 , $117.90 , $117.90 , $117.90 , $121.83 , $125.76 , $55.63 , $111.35 , $65.00 , $70.56 , N/A , $53.46 , $53.46 , $124.45 , $61.65 , $28.74 , $125.76 
 Pro Sub Grft F/S/N/H/F/G/M/D /<100scm /<1st 25 Scm ,CPT® 15275,0975 - PRO FEE/OR,N/A,N/A, $915.00 , $594.75 , $300.97 , $89.29 , $118.92 , $266.16 , $273.31 , $850.95 , $823.50 , $823.50 , $732.00 , $732.00 , $118.92 , $844.82 , $869.25 , $823.50 , $823.50 , $823.50 , $850.95 , $878.40 , $332.78 , $777.75 , $549.49 , $339.41 , N/A , $271.36 , $271.36 , $869.25 , $314.69 , $89.29 , $878.40 
 Pro Biopsy of Vulva/Perineum ,CPT® 56605,0982 - PRO FEE/OUTPT,N/A,N/A, $498.00 , $323.70 , $276.15 , $56.07 , $75.29 , $247.42 , $244.27 , $463.14 , $448.20 , $448.20 , $398.40 , $398.40 , $75.29 , $459.80 , $473.10 , $448.20 , $448.20 , $448.20 , $463.14 , $478.08 , $291.64 , $423.30 , $321.13 , $247.71 , N/A , $252.25 , $252.25 , $473.10 , $302.56 , $56.07 , $478.08 
" Pro Bone Imaging, Limited Area ",CPT® 78300,0974 - PRO FEE/NUC MED,N/A,N/A, $248.00 , $161.20 ," $1,220.15 ", $207.83 , $132.28 , $887.60 , $962.08 , $230.64 , $223.20 , $223.20 , $198.40 , $198.40 , $132.28 , $228.98 , $235.60 , $223.20 , $223.20 , $223.20 , $230.64 , $238.08 ," $1,270.13 ", $210.80 ," $1,049.69 "," $1,553.71 ", N/A , $904.91 , $904.91 , $235.60 ," $1,047.45 ", $132.28 ," $1,553.71 "
Exc Tumor Soft Tissue Thigh/Knee Subfasc 5+Cm,CPT® 27339,N/A,N/A,N/A," $5,818.00 "," $3,781.70 "," $4,545.32 ", $707.82 , $618.82 ," $3,616.46 "," $3,590.82 "," $5,410.74 "," $5,236.20 "," $5,236.20 "," $4,654.40 "," $4,654.40 ", $618.82 ," $5,371.76 "," $5,527.10 "," $5,236.20 "," $5,236.20 "," $5,236.20 "," $5,410.74 "," $5,585.28 "," $4,210.08 "," $4,945.30 "," $3,978.46 "," $4,247.73 ", N/A ," $3,687.03 "," $3,687.03 "," $5,527.10 "," $4,333.59 ", $618.82 ," $5,585.28 "
 THERA M PLUS PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-5492-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Prq Trluml Coronary Stent W/Angio One Art/Brnch ,CPT® 92928,0481 - CARDIAC CATH LAB,N/A,N/A," $10,827.00 "," $7,037.55 "," $9,094.68 ", $528.78 , $815.59 ," $8,748.22 "," $9,744.30 "," $9,166.14 "," $9,744.30 "," $9,744.30 "," $9,744.30 "," $9,202.95 ", $799.60 ," $9,996.57 "," $10,285.65 "," $9,202.95 "," $10,069.11 "," $10,069.11 "," $10,285.65 "," $10,393.92 "," $8,858.65 "," $9,744.30 "," $9,202.95 "," $8,553.33 ", N/A ," $8,762.29 "," $8,762.29 "," $10,285.65 "," $9,290.65 ", $528.78 ," $10,393.92 "
"Chemother,Non-Hormone Anti-Neopl, Sub-Q/Im",CPT® 96401,N/A,N/A,N/A, $319.00 , $207.35 , $254.28 , $70.74 , $54.43 , $208.71 , $169.47 , $296.67 , $287.10 , $287.10 , $255.20 , $255.20 , $54.43 , $294.53 , $303.05 , $287.10 , $287.10 , $287.10 , $296.67 , $306.24 , $242.98 , $271.15 , $226.06 , $309.03 , N/A , $212.78 , $212.78 , $303.05 , $251.40 , $54.43 , $309.03 
Neurectomy Intrinsic Musculature of Foot,CPT® 28055,N/A,N/A,N/A," $2,468.00 "," $1,604.20 "," $2,374.45 ", $373.33 , $313.94 ," $1,872.28 "," $1,842.97 "," $2,295.24 "," $2,221.20 "," $2,221.20 "," $1,974.40 "," $1,974.40 ", $313.94 ," $2,278.70 "," $2,344.60 "," $2,221.20 "," $2,221.20 "," $2,221.20 "," $2,295.24 "," $2,369.28 "," $2,228.69 "," $2,097.80 "," $1,989.23 "," $2,233.59 ", N/A ," $1,908.82 "," $1,908.82 "," $2,344.60 "," $2,243.54 ", $313.94 ," $2,374.45 "
"Rheumatoid Factor, Quant",CPT® 86431,N/A,N/A,N/A, $87.00 , $56.55 , N/A , $5.78 , $5.78 , $32.09 , $38.40 , $80.91 , $78.30 , $78.30 , $69.60 , $69.60 , $5.78 , $80.33 , $82.65 , $78.30 , $78.30 , $78.30 , $80.91 , $83.52 , $37.86 , $73.95 , $37.30 , $20.56 , N/A , $29.95 , $29.95 , $82.65 , $32.73 , $5.78 , $83.52 
Herpes Simplex Test,CPT® 86695,N/A,N/A,N/A, $146.00 , $94.90 , N/A , $13.45 , $13.45 , $74.63 , $89.27 , $135.78 , $131.40 , $131.40 , $116.80 , $116.80 , $13.45 , $134.80 , $138.70 , $131.40 , $131.40 , $131.40 , $135.78 , $140.16 , $88.07 , $124.10 , $85.96 , $47.81 , N/A , $69.65 , $69.65 , $138.70 , $76.11 , $13.45 , $140.16 
 Pro New Patient Visit Level 5 ,CPT® 99205,0982 - PRO FEE/OUTPT,N/A,N/A, $652.00 , $423.80 , $366.66 , $174.91 , $136.97 , $290.52 , $289.74 , $606.36 , $586.80 , $586.80 , $521.60 , $521.60 , $136.97 , $601.99 , $619.40 , $586.80 , $586.80 , $586.80 , $606.36 , $625.92 , $334.52 , $554.20 , $363.05 , $366.53 , $109.75 , $296.18 , $296.18 , $619.40 , $341.61 , $109.75 , $625.92 
 Fac Blood Clot Factor II Test ,CPT® 85210,0305 - LAB/HEMATOLOGY,N/A,N/A, $160.00 , $104.00 , $134.40 , $13.24 , $8.07 , $129.28 , $144.00 , $135.46 , $144.00 , $144.00 , $144.00 , $136.00 , $7.91 , $147.73 , $152.00 , $136.00 , $148.80 , $148.80 , $152.00 , $153.60 , $130.91 , $144.00 , $136.00 , $126.40 , N/A , $129.49 , $129.49 , $152.00 , $137.30 , $7.91 , $153.60 
 Pro Obtaining Screen Pap Smear ,HCPCS Q0091,0982 - PRO FEE/OUTPT,N/A,N/A, $150.00 , $97.50 , $88.90 , $17.93 , N/A , N/A , N/A , $139.50 , $135.00 , $135.00 , $120.00 , $120.00 , N/A , $138.50 , $142.50 , $135.00 , $135.00 , $135.00 , $139.50 , $144.00 , $119.72 , $127.50 , $36.33 , $41.27 , N/A , N/A , N/A , $142.50 , N/A , $17.93 , $144.00 
Deep Incis Foot Bone Infectn,CPT® 28005,N/A,N/A,N/A," $3,938.00 "," $2,559.70 "," $3,567.01 ", $555.52 , $415.11 ," $2,853.30 "," $2,830.99 "," $3,662.34 "," $3,544.20 "," $3,544.20 "," $3,150.40 "," $3,150.40 ", $415.11 ," $3,635.96 "," $3,741.10 "," $3,544.20 "," $3,544.20 "," $3,544.20 "," $3,662.34 "," $3,780.48 "," $3,320.53 "," $3,347.30 "," $3,072.16 "," $3,368.47 ", N/A ," $2,908.97 "," $2,908.97 "," $3,741.10 "," $3,419.07 ", $415.11 ," $3,780.48 "
Pemetrexed Injection,HCPCS J9305,N/A,N/A,N/A, $206.00 , $133.90 , N/A , $8.09 , $28.23 , N/A , N/A , $191.58 , $185.40 , $185.40 , $164.80 , $164.80 , $28.23 , $190.20 , $195.70 , $185.40 , $185.40 , $185.40 , $191.58 , $197.76 , $96.46 , $175.10 , $110.94 , $66.90 , N/A , N/A , N/A , $195.70 , N/A , $8.09 , $197.76 
 Fac Egd Insert Guide Wire Dilator Passage Esophagus ,CPT® 43248,0360 - OR SERVICES,N/A,N/A," $2,422.00 "," $1,574.30 "," $2,034.48 ", $157.25 , $176.60 ," $1,956.98 "," $2,179.80 "," $2,050.47 "," $2,179.80 "," $2,179.80 "," $2,179.80 "," $2,058.70 ", $173.14 ," $2,236.23 "," $2,300.90 "," $2,058.70 "," $2,252.46 "," $2,252.46 "," $2,300.90 "," $2,325.12 "," $1,981.68 "," $2,179.80 "," $2,058.70 "," $1,913.38 ", N/A ," $1,960.12 "," $1,960.12 "," $2,300.90 "," $2,078.32 ", $157.25 ," $2,325.12 "
 PANCRELIPASE (LIP-PROT-AMYL) 10440-39150 UNITS PO TABS ,HCPCS RXC637,0250 - PHARMACY,73562-0104-10,1 tablet, $23.79 , $15.46 , $19.98 , N/A , N/A , $19.22 , $21.41 , $20.14 , $21.41 , $21.41 , $21.41 , $20.22 , N/A , $21.97 , $22.60 , $20.22 , $22.12 , $22.12 , $22.60 , $22.84 , $19.46 , $21.41 , $20.22 , $18.79 , N/A , $19.25 , $19.25 , $22.60 , $20.41 , $18.79 , $22.84 
X-Ray Neck Soft Tissue,CPT® 70360,N/A,N/A,N/A, $251.00 , $163.15 , $177.25 , $31.07 , $26.21 , $131.98 , $148.70 , $233.43 , $225.90 , $225.90 , $200.80 , $200.80 , $26.21 , $231.75 , $238.45 , $225.90 , $225.90 , $225.90 , $233.43 , $240.96 , $172.77 , $213.35 , $161.79 , $142.36 , N/A , $134.56 , $134.56 , $238.45 , $155.74 , $26.21 , $240.96 
 Closed Tx Distal Phalangeal Fx W/O Manip Ea -Mh ,CPT® 26755,0761 - TREATMENT ROOM,N/A,N/A," $2,695.00 "," $1,751.75 "," $2,263.80 ", $269.64 , $63.53 ," $2,177.56 "," $2,425.50 "," $2,281.59 "," $2,425.50 "," $2,425.50 "," $2,425.50 "," $2,290.75 ", $62.28 ," $2,488.29 "," $2,560.25 "," $2,290.75 "," $2,506.35 "," $2,506.35 "," $2,560.25 "," $2,587.20 "," $2,205.05 "," $2,425.50 "," $2,290.75 "," $2,129.05 ", N/A ," $2,181.06 "," $2,181.06 "," $2,560.25 "," $2,312.58 ", $62.28 ," $2,587.20 "
Drainage Abscess Palate/Uvula,CPT® 42000,N/A,N/A,N/A," $1,044.00 ", $678.60 , $662.94 , $105.41 , $30.71 , $503.81 , $578.02 , $970.92 , $939.60 , $939.60 , $835.20 , $835.20 , $30.71 , $963.93 , $991.80 , $939.60 , $939.60 , $939.60 , $970.92 ," $1,002.24 ", $464.99 , $887.40 , $627.99 , $586.64 , N/A , $513.65 , $513.65 , $991.80 , $537.20 , $30.71 ," $1,002.24 "
"Lap,Rmv Adnexal Structure",58661,N/A,N/A,N/A," $4,820.00 "," $3,133.00 "," $3,064.85 ", $620.13 , $493.32 ," $2,634.66 "," $2,605.51 "," $4,482.60 "," $4,338.00 "," $4,338.00 "," $3,856.00 "," $3,856.00 ", $493.32 ," $4,450.31 "," $4,579.00 "," $4,338.00 "," $4,338.00 "," $4,338.00 "," $4,482.60 "," $4,627.20 "," $3,205.11 "," $4,097.00 "," $3,430.76 "," $2,642.78 ", N/A ," $2,686.07 "," $2,686.07 "," $4,579.00 "," $3,221.77 ", $493.32 ," $4,627.20 "
 IMIPRAMINE HCL 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,49884-0054-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Electrop Tq Nes ,CPT® 82664,0301 - LAB/CHEMISTRY,N/A,N/A, $296.00 , $192.40 , $248.64 , $62.73 , $47.69 , $239.17 , $266.40 , $250.59 , $266.40 , $266.40 , $266.40 , $251.60 , $46.75 , $273.30 , $281.20 , $251.60 , $275.28 , $275.28 , $281.20 , $284.16 , $242.19 , $266.40 , $251.60 , $233.84 , N/A , $239.55 , $239.55 , $281.20 , $254.00 , $46.75 , $284.16 
Drain Pilonidal Cyst Complic,10081,N/A,N/A,N/A," $1,111.00 ", $722.15 , $545.63 , $162.12 , $213.21 , $462.71 , $459.06 ," $1,033.23 ", $999.90 , $999.90 , $888.80 , $888.80 , $213.21 ," $1,025.79 "," $1,055.45 ", $999.90 , $999.90 , $999.90 ," $1,033.23 "," $1,066.56 ", $603.01 , $944.35 , $918.79 , $595.22 , N/A , $471.73 , $471.73 ," $1,055.45 ", $547.05 , $162.12 ," $1,066.56 "
" Fac Complement, Antigen ",CPT® 86160,0302 - LAB/IMMUNOLOGY,N/A,N/A, $165.00 , $107.25 , $138.60 , $12.24 , $12.24 , $133.32 , $148.50 , $139.69 , $148.50 , $148.50 , $148.50 , $140.25 , $12.00 , $152.34 , $156.75 , $140.25 , $153.45 , $153.45 , $156.75 , $158.40 , $135.00 , $148.50 , $140.25 , $130.35 , N/A , $133.53 , $133.53 , $156.75 , $141.59 , $12.00 , $158.40 
 Fac Fluorescent Nonnfct Agt Antb Scr Ea Antb ,CPT® 86255,0302 - LAB/IMMUNOLOGY,N/A,N/A, $146.00 , $94.90 , $122.64 , $12.29 , $12.29 , $117.97 , $131.40 , $123.60 , $131.40 , $131.40 , $131.40 , $124.10 , $12.05 , $134.80 , $138.70 , $124.10 , $135.78 , $135.78 , $138.70 , $140.16 , $119.46 , $131.40 , $124.10 , $115.34 , N/A , $118.16 , $118.16 , $138.70 , $125.28 , $12.05 , $140.16 
 Pro Incision of Tendon & Muscle ,CPT® 23405,0975 - PRO FEE/OR,N/A,N/A," $2,776.00 "," $1,804.40 "," $3,790.61 ", $591.33 , $461.04 ," $3,012.60 "," $3,015.25 "," $2,581.68 "," $2,498.40 "," $2,498.40 "," $2,220.80 "," $2,220.80 ", $461.04 ," $2,563.08 "," $2,637.20 "," $2,498.40 "," $2,498.40 "," $2,498.40 "," $2,581.68 "," $2,664.96 "," $3,522.94 "," $2,359.60 "," $3,327.28 "," $3,526.66 ", N/A ," $3,071.38 "," $3,071.38 "," $2,637.20 "," $3,609.96 ", $461.04 ," $3,790.61 "
Rpr Retinal Dtchmnt Drg Subretinal Fluid Crtx,CPT® 67101,N/A,N/A,N/A," $5,194.00 "," $3,376.10 "," $1,746.88 ", $275.29 , $614.70 ," $3,814.84 "," $3,594.16 "," $4,830.42 "," $4,674.60 "," $4,674.60 "," $4,155.20 "," $4,155.20 ", $614.70 ," $4,795.62 "," $4,934.30 "," $4,674.60 "," $4,674.60 "," $4,674.60 "," $4,830.42 "," $4,986.24 "," $2,404.59 "," $4,414.90 "," $3,719.77 "," $2,049.31 ", N/A ," $3,889.28 "," $3,889.28 "," $4,934.30 "," $4,293.26 ", $275.29 ," $4,986.24 "
Braf Gene Analysis V600e Variant,CPT® 81210,N/A,N/A,N/A," $1,044.00 ", $678.60 , N/A , $178.91 , $146.27 , $743.35 , $880.30 , $970.92 , $939.60 , $939.60 , $835.20 , $835.20 , $146.27 , $963.93 , $991.80 , $939.60 , $939.60 , $939.60 , $970.92 ," $1,002.24 "," $1,171.18 ", $887.40 , $836.76 , $515.15 , N/A , $693.74 , $693.74 , $991.80 , $758.11 , $146.27 ," $1,171.18 "
Pfizer Administration First Dose,CPT® 0001A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $76.25 , $128.02 , N/A , $79.82 , $79.82 , $66.50 , $92.91 , $38.92 , $128.02 
 Pro Revj Tot Kne Arthrp Fem&Entire Tibl Comp ,CPT® 27487,0982 - PRO FEE/OUTPT,N/A,N/A," $9,790.00 "," $6,363.50 "," $10,532.47 "," $1,644.52 "," $1,190.41 "," $8,494.01 "," $8,398.75 "," $9,104.70 "," $8,811.00 "," $8,811.00 "," $7,832.00 "," $7,832.00 "," $1,190.41 "," $9,039.11 "," $9,300.50 "," $8,811.00 "," $8,811.00 "," $8,811.00 "," $9,104.70 "," $9,398.40 "," $9,832.71 "," $8,321.50 "," $9,303.89 "," $9,988.20 ", N/A ," $8,659.75 "," $8,659.75 "," $9,300.50 "," $10,178.27 "," $1,190.41 "," $10,532.47 "
" Fac Virus Inoculation, Shell Via ",CPT® 87254,0305 - LAB/HEMATOLOGY,N/A,N/A, $202.00 , $131.30 , $169.68 , $19.95 , $6.97 , $163.22 , $181.80 , $171.01 , $181.80 , $181.80 , $181.80 , $171.70 , $6.83 , $186.51 , $191.90 , $171.70 , $187.86 , $187.86 , $191.90 , $193.92 , $165.28 , $181.80 , $171.70 , $159.58 , N/A , $163.48 , $163.48 , $191.90 , $173.34 , $6.83 , $193.92 
 Fac Assay of Gammaglobulin Igm ,CPT® 82784,0301 - LAB/CHEMISTRY,N/A,N/A, $114.00 , $74.10 , $95.76 , $9.49 , $9.49 , $92.11 , $102.60 , $96.51 , $102.60 , $102.60 , $102.60 , $96.90 , $9.30 , $105.26 , $108.30 , $96.90 , $106.02 , $106.02 , $108.30 , $109.44 , $93.27 , $102.60 , $96.90 , $90.06 , N/A , $92.26 , $92.26 , $108.30 , $97.82 , $9.30 , $109.44 
Fetal Congenital Abnor Assay Two Proteins,CPT® 81508,N/A,N/A,N/A, $390.00 , $253.50 , N/A , $55.39 , $55.39 , N/A , N/A , $362.70 , $351.00 , $351.00 , $312.00 , $312.00 , $55.39 , $360.09 , $370.50 , $351.00 , $351.00 , $351.00 , $362.70 , $374.40 , $362.57 , $331.50 , $258.46 , $159.48 , N/A , $215.57 , $215.57 , $370.50 , $235.12 , $55.39 , $374.40 
"Canalith Repositioning Procedure, per Day",95992,N/A,N/A,N/A, $357.00 , $232.05 , $134.86 , $35.56 , $75.25 , $120.93 , $126.97 , $332.01 , $321.30 , $321.30 , $285.60 , $285.60 , $75.25 , $329.62 , $339.15 , $321.30 , $321.30 , $321.30 , $332.01 , $342.72 , $159.90 , $303.45 , $110.49 , $143.70 , N/A , $123.29 , $123.29 , $339.15 , $151.56 , $35.56 , $342.72 
"Shldr Arthroscop,Surg,Repair,Slap Lesion",29807,N/A,N/A,N/A," $5,961.00 "," $3,874.65 "," $6,265.87 ", $982.06 , $905.21 ," $4,999.52 "," $4,963.91 "," $5,543.73 "," $5,364.90 "," $5,364.90 "," $4,768.80 "," $4,768.80 ", $905.21 ," $5,503.79 "," $5,662.95 "," $5,364.90 "," $5,364.90 "," $5,364.90 "," $5,543.73 "," $5,722.56 "," $5,834.98 "," $5,066.85 "," $5,486.00 "," $5,884.18 ", N/A ," $5,097.07 "," $5,097.07 "," $5,662.95 "," $5,990.87 ", $905.21 ," $6,265.87 "
 Pro Bfb Traing W/Emg &/Manometry 1st 15 Min Cntct ,CPT® 90912,0917 - PSYCH/BIOFEED,N/A,N/A, $152.00 , $98.80 , $127.68 , $42.05 , $63.61 , $122.82 , $136.80 , $128.68 , $136.80 , $136.80 , $136.80 , $129.20 , $62.36 , $140.34 , $144.40 , $129.20 , $141.36 , $141.36 , $144.40 , $145.92 , $124.37 , $136.80 , $129.20 , $120.08 , N/A , $123.01 , $123.01 , $144.40 , $130.43 , $42.05 , $145.92 
Open Rx Prox/Mid Fing Shft Fx,CPT® 26735,N/A,N/A,N/A," $2,395.00 "," $1,556.75 "," $3,648.13 ", $573.87 , $307.34 ," $2,873.69 "," $2,876.39 "," $2,227.35 "," $2,155.50 "," $2,155.50 "," $1,916.00 "," $1,916.00 ", $307.34 ," $2,211.30 "," $2,275.25 "," $2,155.50 "," $2,155.50 "," $2,155.50 "," $2,227.35 "," $2,299.20 "," $3,390.43 "," $2,035.75 "," $3,164.93 "," $3,404.22 ", N/A ," $2,929.76 "," $2,929.76 "," $2,275.25 "," $3,443.51 ", $307.34 ," $3,648.13 "
Office/OP Consltj New/Est Pt Mod Mdm 40 Minutes,99244,N/A,N/A,N/A, $735.00 , $477.75 , N/A , $159.18 , $107.79 , $337.93 , $336.49 , $683.55 , $661.50 , $661.50 , $588.00 , $588.00 , $107.79 , $678.63 , $698.25 , $661.50 , $661.50 , $661.50 , $683.55 , $705.60 , $427.34 , $624.75 , $328.55 , $337.38 , $233.00 , $344.53 , $344.53 , $698.25 , $410.14 , $107.79 , $705.60 
 VANCOMYCIN HCL 125 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00121-0867-20,1 capsule, $160.82 , $104.53 , $135.09 , N/A , N/A , $129.94 , $144.74 , $136.15 , $144.74 , $144.74 , $144.74 , $136.70 , N/A , $148.49 , $152.78 , $136.70 , $149.56 , $149.56 , $152.78 , $154.39 , $131.58 , $144.74 , $136.70 , $127.05 , N/A , $130.15 , $130.15 , $152.78 , $138.00 , $127.05 , $154.39 
"Knee Scope,Med or Lat Menis Repair",29882,N/A,N/A,N/A," $5,144.00 "," $3,343.60 "," $4,191.01 ", $657.29 , $600.95 ," $3,377.99 "," $3,369.07 "," $4,783.92 "," $4,629.60 "," $4,629.60 "," $4,115.20 "," $4,115.20 ", $600.95 ," $4,749.46 "," $4,886.80 "," $4,629.60 "," $4,629.60 "," $4,629.60 "," $4,783.92 "," $4,938.24 "," $3,909.75 "," $4,372.40 "," $3,721.56 "," $3,975.62 ", N/A ," $3,443.90 "," $3,443.90 "," $4,886.80 "," $4,047.80 ", $600.95 ," $4,938.24 "
Excise Breast Les Xray Mark Addnl,19126,N/A,N/A,N/A," $1,692.00 "," $1,099.80 ", $493.20 , $145.21 , $142.31 , $434.60 , $413.75 ," $1,573.56 "," $1,522.80 "," $1,522.80 "," $1,353.60 "," $1,353.60 ", $142.31 ," $1,562.22 "," $1,607.40 "," $1,522.80 "," $1,522.80 "," $1,522.80 "," $1,573.56 "," $1,624.32 ", $541.98 ," $1,438.20 ", $842.08 , $543.99 , N/A , $443.08 , $443.08 ," $1,607.40 ", $513.82 , $142.31 ," $1,624.32 "
Injection Aa&/Strd Pudendal Nerve,64430,N/A,N/A,N/A, $944.00 , $613.60 , $267.18 , $52.29 , $61.84 , $465.02 , $442.31 , $877.92 , $849.60 , $849.60 , $755.20 , $755.20 , $61.84 , $871.60 , $896.80 , $849.60 , $849.60 , $849.60 , $877.92 , $906.24 , $291.12 , $802.40 , $429.96 , $485.39 , N/A , $474.09 , $474.09 , $896.80 , $508.59 , $52.29 , $906.24 
 Iadna Human Papillomavirus for Types 16 & 18 Only ,CPT® 87625,0300 - LABORATORY,N/A,N/A, $286.00 , $185.90 , $240.24 , $41.36 , $39.07 , $231.09 , $257.40 , $242.13 , $257.40 , $257.40 , $257.40 , $243.10 , $38.30 , $264.06 , $271.70 , $243.10 , $265.98 , $265.98 , $271.70 , $274.56 , $234.01 , $257.40 , $243.10 , $225.94 , N/A , $231.46 , $231.46 , $271.70 , $245.42 , $38.30 , $274.56 
"Mccd,Maintenance Rate",HCPCS G9002,N/A,N/A,N/A, $101.00 , $65.65 , N/A , N/A , N/A , N/A , N/A , $93.93 , $90.90 , $90.90 , $80.80 , $80.80 , N/A , $93.25 , $95.95 , $90.90 , $90.90 , $90.90 , $93.93 , $96.96 , N/A , $85.85 , $80.80 , N/A , N/A , N/A , N/A , $95.95 , N/A , $80.80 , $96.96 
Prq Trluml Coronry Chronic Occlus Revasc One Vsl,CPT® 92943,N/A,N/A,N/A," $5,575.00 "," $3,623.75 "," $3,862.89 ", $593.80 , $508.22 ," $3,620.10 "," $3,647.46 "," $5,184.75 "," $5,017.50 "," $5,017.50 "," $4,460.00 "," $4,460.00 ", $508.22 ," $5,147.40 "," $5,296.25 "," $5,017.50 "," $5,017.50 "," $5,017.50 "," $5,184.75 "," $5,352.00 "," $3,579.27 "," $4,738.75 "," $2,017.29 "," $3,810.80 ", N/A ," $3,690.74 "," $3,690.74 "," $5,296.25 "," $4,091.22 ", $508.22 ," $5,352.00 "
 CLINDAMYCIN HCL 300 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,68084-0244-01,1 capsule, $6.67 , $4.34 , $5.60 , N/A , N/A , $5.39 , $6.00 , $5.65 , $6.00 , $6.00 , $6.00 , $5.67 , N/A , $6.16 , $6.34 , $5.67 , $6.20 , $6.20 , $6.34 , $6.40 , $5.46 , $6.00 , $5.67 , $5.27 , N/A , $5.40 , $5.40 , $6.34 , $5.72 , $5.27 , $6.40 
 Aldosterone Beaker1 ,CPT® 82088,0301 - LAB/CHEMISTRY,N/A,N/A, $365.00 , $237.25 , $306.60 , $41.57 , $41.57 , $294.92 , $328.50 , $309.01 , $328.50 , $328.50 , $328.50 , $310.25 , $40.75 , $337.00 , $346.75 , $310.25 , $339.45 , $339.45 , $346.75 , $350.40 , $298.64 , $328.50 , $310.25 , $288.35 , N/A , $295.39 , $295.39 , $346.75 , $313.21 , $40.75 , $350.40 
 Pro Inpt Telehealth Con 70/>M ,HCPCS G0427,0987 - PRO FEE/HOS VIS,N/A,N/A, $680.00 , $442.00 , $376.12 , $181.23 , N/A , $372.74 , N/A , $632.40 , $612.00 , $612.00 , $544.00 , $544.00 , N/A , $627.84 , $646.00 , $612.00 , $612.00 , $612.00 , $632.40 , $652.80 , $558.81 , $578.00 , $377.57 , $761.47 , N/A , $380.01 , $380.01 , $646.00 , $475.01 , $181.23 , $761.47 
 Pro Ndsc Eval Intstinal Pouch W/Bx Single/Multiple ,CPT® 44386,0982 - PRO FEE/OUTPT,N/A,N/A," $2,755.00 "," $1,790.75 ", $545.68 , $84.77 , $40.17 , $606.60 , $622.85 ," $2,562.15 "," $2,479.50 "," $2,479.50 "," $2,204.00 "," $2,204.00 ", $40.17 ," $2,543.69 "," $2,617.25 "," $2,479.50 "," $2,479.50 "," $2,479.50 "," $2,562.15 "," $2,644.80 ", $390.64 ," $2,341.75 ", $683.30 , $516.96 , N/A , $618.44 , $618.44 ," $2,617.25 ", $646.83 , $40.17 ," $2,644.80 "
 Fac Radiation Treatment Aid(S) ,CPT® 77334,0333 - RADIATION RX,N/A,N/A," $1,326.00 ", $861.90 ," $1,113.84 ", $123.37 , $151.86 ," $1,071.41 "," $1,193.40 "," $1,122.59 "," $1,193.40 "," $1,193.40 "," $1,193.40 "," $1,127.10 ", $148.88 ," $1,224.30 "," $1,259.70 "," $1,127.10 "," $1,233.18 "," $1,233.18 "," $1,259.70 "," $1,272.96 "," $1,084.93 "," $1,193.40 "," $1,127.10 "," $1,047.54 ", N/A ," $1,073.13 "," $1,073.13 "," $1,259.70 "," $1,137.84 ", $123.37 ," $1,272.96 "
Total Disc Arthrp Ant Single Interspace Lumbar,CPT® 22857,N/A,N/A,N/A," $10,895.00 "," $7,081.75 "," $10,617.36 "," $1,658.34 "," $1,160.02 "," $8,602.51 "," $6,752.99 "," $10,132.35 "," $9,805.50 "," $9,805.50 "," $8,716.00 "," $8,716.00 "," $1,160.02 "," $10,059.35 "," $10,350.25 "," $9,805.50 "," $9,805.50 "," $9,805.50 "," $10,132.35 "," $10,459.20 "," $9,913.39 "," $9,260.75 "," $7,548.38 "," $9,463.69 ", N/A ," $8,770.36 "," $8,770.36 "," $10,350.25 "," $10,308.28 "," $1,160.02 "," $10,617.36 "
 MEPERIDINE HCL 100 MG/ML IJ SOLN ,HCPCS J2175,0636 - DRUGS REQUIRING DETAILED CODIN,00641-6054-25,1 mL, $32.56 , $21.16 , $27.35 , $7.46 , $9.78 , $26.31 , $29.30 , $27.57 , $29.30 , $29.30 , $29.30 , $27.68 , $9.59 , $30.06 , $30.93 , $27.68 , $30.28 , $30.28 , $30.93 , $31.26 , $26.64 , $29.30 , $27.68 , $25.72 , N/A , $26.35 , $26.35 , $30.93 , $27.94 , $7.46 , $31.26 
"Colposcopy,Cervix W/Adj Vagina",CPT® 57452,N/A,N/A,N/A, $770.00 , $500.50 , $423.40 , $86.09 , $88.00 , $377.47 , $374.23 , $716.10 , $693.00 , $693.00 , $616.00 , $616.00 , $88.00 , $710.94 , $731.50 , $693.00 , $693.00 , $693.00 , $716.10 , $739.20 , $445.63 , $654.50 , $490.62 , $378.85 , N/A , $384.83 , $384.83 , $731.50 , $461.58 , $86.09 , $739.20 
 Fac Drug Screening Cocaine ,CPT® 80353,0301 - LAB/CHEMISTRY,N/A,N/A, $191.00 , $124.15 , $160.44 , N/A , N/A , $154.33 , $171.90 , $161.70 , $171.90 , $171.90 , $171.90 , $162.35 , N/A , $176.35 , $181.45 , $162.35 , $177.63 , $177.63 , $181.45 , $183.36 , $156.28 , $171.90 , $162.35 , $150.89 , N/A , $154.58 , $154.58 , $181.45 , $163.90 , $150.89 , $183.36 
 Pro X-Ray Exam of Salivary Duct ,CPT® 70390,0972 - PRO FEE/RAD/DX,N/A,N/A, $111.00 , $72.15 , $683.07 , $116.57 , $90.84 , $444.35 , $541.25 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $90.84 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $661.63 , $94.35 , $591.29 , $475.93 , N/A , $453.02 , $453.02 , $105.45 , $524.38 , $88.80 , $683.07 
 Pro Colonoscopy Flexible With Band Ligation(S) ,CPT® 45398,0982 - PRO FEE/OUTPT,N/A,N/A," $4,078.00 "," $2,650.70 "," $1,427.53 ", $220.75 , $265.41 , N/A , N/A ," $3,792.54 "," $3,670.20 "," $3,670.20 "," $3,262.40 "," $3,262.40 ", $265.41 ," $3,765.22 "," $3,874.10 "," $3,670.20 "," $3,670.20 "," $3,670.20 "," $3,792.54 "," $3,914.88 "," $1,024.64 "," $3,466.30 "," $1,231.42 "," $1,353.91 ", N/A ," $1,041.60 "," $1,041.60 "," $3,874.10 "," $1,090.21 ", $220.75 ," $3,914.88 "
" Pro US Exam, Chest ",CPT® 76604,0981 - PRO FEE/ER,N/A,N/A, $259.00 , $168.35 , $329.38 , $55.74 , $82.61 , $423.02 , $465.39 , $240.87 , $233.10 , $233.10 , $207.20 , $207.20 , $82.61 , $239.13 , $246.05 , $233.10 , $233.10 , $233.10 , $240.87 , $248.64 , $369.55 , $220.15 , $508.48 , $501.74 , N/A , $431.28 , $431.28 , $246.05 , $499.21 , $55.74 , $508.48 
"Shav Skin Les <5mm Trunk,Arm,Leg",CPT® 11300,N/A,N/A,N/A, $382.00 , $248.30 , $109.62 , $32.66 , $50.40 , $96.10 , $92.59 , $355.26 , $343.80 , $343.80 , $305.60 , $305.60 , $50.40 , $352.70 , $362.90 , $343.80 , $343.80 , $343.80 , $355.26 , $366.72 , $120.13 , $324.70 , $183.76 , $124.39 , N/A , $97.98 , $97.98 , $362.90 , $113.63 , $32.66 , $366.72 
 GALANTAMINE HYDROBROMIDE 4 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,68084-0729-21,1 tablet, $21.58 , $14.03 , $18.13 , N/A , N/A , $17.44 , $19.42 , $18.27 , $19.42 , $19.42 , $19.42 , $18.34 , N/A , $19.92 , $20.50 , $18.34 , $20.07 , $20.07 , $20.50 , $20.72 , $17.66 , $19.42 , $18.34 , $17.05 , N/A , $17.46 , $17.46 , $20.50 , $18.52 , $17.05 , $20.72 
"Knee Scope,Shave Articular Cart",CPT® 29877,N/A,N/A,N/A," $3,578.00 "," $2,325.70 "," $3,782.09 ", $593.21 , $532.53 ," $3,003.86 "," $3,004.89 "," $3,327.54 "," $3,220.20 "," $3,220.20 "," $2,862.40 "," $2,862.40 ", $532.53 ," $3,303.57 "," $3,399.10 "," $3,220.20 "," $3,220.20 "," $3,220.20 "," $3,327.54 "," $3,434.88 "," $3,519.69 "," $3,041.30 "," $3,316.57 "," $3,540.30 ", N/A ," $3,062.47 "," $3,062.47 "," $3,399.10 "," $3,599.50 ", $532.53 ," $3,782.09 "
 Fac Bartonella Antibody ,CPT® 86611,0302 - LAB/IMMUNOLOGY,N/A,N/A, $153.00 , $99.45 , $128.52 , $10.38 , $8.07 , $123.62 , $137.70 , $129.53 , $137.70 , $137.70 , $137.70 , $130.05 , $7.91 , $141.26 , $145.35 , $130.05 , $142.29 , $142.29 , $145.35 , $146.88 , $125.18 , $137.70 , $130.05 , $120.87 , N/A , $123.82 , $123.82 , $145.35 , $131.29 , $7.91 , $146.88 
 Fac Somatosensory Testing ,CPT® 95926,0922 - EMG,N/A,N/A, $945.00 , $614.25 , $793.80 , $151.98 , $58.49 , $763.56 , $850.50 , $800.04 , $850.50 , $850.50 , $850.50 , $803.25 , $57.34 , $872.52 , $897.75 , $803.25 , $878.85 , $878.85 , $897.75 , $907.20 , $773.20 , $850.50 , $803.25 , $746.55 , N/A , $764.79 , $764.79 , $897.75 , $810.90 , $57.34 , $907.20 
Repair of Biceps Tendon at Elbow,CPT® 24340,N/A,N/A,N/A," $4,044.00 "," $2,628.60 "," $3,776.57 ", $577.75 , $691.53 ," $2,948.30 "," $2,956.74 "," $3,760.92 "," $3,639.60 "," $3,639.60 "," $3,235.20 "," $3,235.20 ", $691.53 ," $3,733.83 "," $3,841.80 "," $3,639.60 "," $3,639.60 "," $3,639.60 "," $3,760.92 "," $3,882.24 "," $3,509.21 "," $3,437.40 "," $3,263.05 "," $3,491.27 ", N/A ," $3,005.83 "," $3,005.83 "," $3,841.80 "," $3,532.92 ", $577.75 ," $3,882.24 "
 DINOPROSTONE 0.5 MG/3GM VA GEL ,HCPCS RXA250,0250 - PHARMACY,00009-3359-01,1 each," $4,449.97 "," $2,892.48 "," $3,737.97 ", N/A , N/A ," $3,595.58 "," $4,004.97 "," $3,767.34 "," $4,004.97 "," $4,004.97 "," $4,004.97 "," $3,782.47 ", N/A ," $4,108.66 "," $4,227.47 "," $3,782.47 "," $4,138.47 "," $4,138.47 "," $4,227.47 "," $4,271.97 "," $3,640.97 "," $4,004.97 "," $3,782.47 "," $3,515.48 ", N/A ," $3,601.36 "," $3,601.36 "," $4,227.47 "," $3,818.52 "," $3,515.48 "," $4,271.97 "
"Biopsy of Testis,Needle",CPT® 54500,N/A,N/A,N/A, $487.00 , $316.55 , $326.98 , $70.77 , $30.71 , $240.61 , $241.91 , $452.91 , $438.30 , $438.30 , $389.60 , $389.60 , $30.71 , $449.65 , $462.65 , $438.30 , $438.30 , $438.30 , $452.91 , $467.52 , $306.76 , $413.95 , $383.57 , $362.03 , N/A , $245.30 , $245.30 , $462.65 , $294.02 , $30.71 , $467.52 
Open Rx Complx Cheek Bone Frac,CPT® 21365,N/A,N/A,N/A," $6,891.00 "," $4,479.15 "," $6,654.25 "," $1,039.36 ", $966.37 ," $5,408.53 "," $5,390.69 "," $6,408.63 "," $6,201.90 "," $6,201.90 "," $5,512.80 "," $5,512.80 ", $966.37 ," $6,362.46 "," $6,546.45 "," $6,201.90 "," $6,201.90 "," $6,201.90 "," $6,408.63 "," $6,615.36 "," $6,211.60 "," $5,857.35 "," $5,928.45 "," $6,364.36 ", N/A ," $5,514.06 "," $5,514.06 "," $6,546.45 "," $6,480.99 ", $966.37 ," $6,654.25 "
"Subsequent Hosp Neonate 28 Day or Less, Critically Ill",CPT® 99469,N/A,N/A,N/A," $2,334.00 "," $1,517.10 "," $1,058.96 ", $377.26 , $362.49 ," $1,053.04 "," $1,061.54 "," $2,170.62 "," $2,100.60 "," $2,100.60 "," $1,867.20 "," $1,867.20 ", $362.49 ," $2,154.98 "," $2,217.30 "," $2,100.60 "," $2,100.60 "," $2,100.60 "," $2,170.62 "," $2,240.64 "," $1,000.73 "," $1,983.90 ", $848.37 ," $1,320.20 ", N/A ," $1,073.58 "," $1,073.58 "," $2,217.30 "," $1,284.57 ", $362.49 ," $2,240.64 "
 Pro Inpt Telehealth Consult 50m ,HCPCS G0426,0987 - PRO FEE/HOS VIS,N/A,N/A, $462.00 , $300.30 , $255.56 , $126.43 , N/A , $252.51 , N/A , $429.66 , $415.80 , $415.80 , $369.60 , $369.60 , N/A , $426.56 , $438.90 , $415.80 , $415.80 , $415.80 , $429.66 , $443.52 , $378.30 , $392.70 , $256.91 , $511.09 , N/A , $257.44 , $257.44 , $438.90 , $321.80 , $126.43 , $511.09 
"Exc Skin Benig 2.1-3cm Face,Facial",11443,N/A,N/A,N/A," $1,135.00 ", $737.75 , $572.42 , $172.25 , $230.52 , $484.65 , $476.60 ," $1,055.55 "," $1,021.50 "," $1,021.50 ", $908.00 , $908.00 , $230.52 ," $1,047.95 "," $1,078.25 "," $1,021.50 "," $1,021.50 "," $1,021.50 "," $1,055.55 "," $1,089.60 ", $624.02 , $964.75 , $950.91 , $621.47 , N/A , $494.11 , $494.11 ," $1,078.25 ", $573.01 , $172.25 ," $1,089.60 "
 Pro Cltx Tarsal B1 Dislc Oth/Thn Talotarsal W/O Anes ,CPT® 28540,0981 - PRO FEE/ER,N/A,N/A," $1,049.00 ", $681.85 ," $1,098.57 ", $173.53 , $153.67 , $857.01 , $866.99 , $975.57 , $944.10 , $944.10 , $839.20 , $839.20 , $153.67 , $968.54 , $996.55 , $944.10 , $944.10 , $944.10 , $975.57 ," $1,007.04 "," $1,011.76 ", $891.65 , $938.42 ," $1,024.89 ", N/A , $873.74 , $873.74 , $996.55 ," $1,026.95 ", $153.67 ," $1,098.57 "
 Fac Drg Fngr Absc Comp ,CPT® 26011,0361 - OR/MINOR,N/A,N/A," $1,766.00 "," $1,147.90 "," $1,483.44 ", $178.74 , $161.97 ," $1,426.93 "," $1,589.40 "," $1,495.10 "," $1,589.40 "," $1,589.40 "," $1,589.40 "," $1,501.10 ", $158.79 ," $1,630.55 "," $1,677.70 "," $1,501.10 "," $1,642.38 "," $1,642.38 "," $1,677.70 "," $1,695.36 "," $1,444.94 "," $1,589.40 "," $1,501.10 "," $1,395.14 ", N/A ," $1,429.22 "," $1,429.22 "," $1,677.70 "," $1,515.40 ", $158.79 ," $1,695.36 "
 NICOTINE 14 MG/24HR TD PT24 ,HCPCS RXC637,0250 - PHARMACY,00536-5895-88,1 patch, $11.01 , $7.16 , $9.25 , N/A , N/A , $8.90 , $9.91 , $9.32 , $9.91 , $9.91 , $9.91 , $9.36 , N/A , $10.17 , $10.46 , $9.36 , $10.24 , $10.24 , $10.46 , $10.57 , $9.01 , $9.91 , $9.36 , $8.70 , N/A , $8.91 , $8.91 , $10.46 , $9.45 , $8.70 , $10.57 
 Rt Joint Lower Ext MRI W/O Contrast ,CPT® 73721,0610 - MRI,N/A,N/A," $3,813.00 "," $2,478.45 "," $3,202.92 ", $207.55 , $411.63 ," $3,080.90 "," $3,431.70 "," $3,228.09 "," $3,431.70 "," $3,431.70 "," $3,431.70 "," $3,241.05 ", $403.56 ," $3,520.54 "," $3,622.35 "," $3,241.05 "," $3,546.09 "," $3,546.09 "," $3,622.35 "," $3,660.48 "," $3,119.80 "," $3,431.70 "," $3,241.05 "," $3,012.27 ", N/A ," $3,085.86 "," $3,085.86 "," $3,622.35 "," $3,271.94 ", $207.55 ," $3,660.48 "
 Fac Assay of Mercury ,CPT® 83825,0301 - LAB/CHEMISTRY,N/A,N/A, $348.00 , $226.20 , $292.32 , $16.59 , $16.59 , $281.18 , $313.20 , $294.62 , $313.20 , $313.20 , $313.20 , $295.80 , $16.26 , $321.31 , $330.60 , $295.80 , $323.64 , $323.64 , $330.60 , $334.08 , $284.73 , $313.20 , $295.80 , $274.92 , N/A , $281.64 , $281.64 , $330.60 , $298.62 , $16.26 , $334.08 
Apply Short Leg Cast,CPT® 29425,N/A,N/A,N/A, $636.00 , $413.40 , $330.72 , $52.05 , $72.09 , $277.32 , $277.13 , $591.48 , $572.40 , $572.40 , $508.80 , $508.80 , $72.09 , $587.22 , $604.20 , $572.40 , $572.40 , $572.40 , $591.48 , $610.56 , $311.12 , $540.60 , $301.51 , $326.81 , N/A , $282.72 , $282.72 , $604.20 , $332.30 , $52.05 , $610.56 
Infectious Agent Dna/Rna Influenza First 2 Types,CPT® 87502,N/A,N/A,N/A, $361.00 , $234.65 , N/A , $97.72 , $97.72 , $481.43 , $575.85 , $335.73 , $324.90 , $324.90 , $288.80 , $288.80 , $97.72 , $333.31 , $342.95 , $324.90 , $324.90 , $324.90 , $335.73 , $346.56 , $639.68 , $306.85 , $557.91 , $308.56 , N/A , $449.30 , $449.30 , $342.95 , $490.99 , $97.72 , $639.68 
" Pro Colorectal Scrn, Hi Risk Ind ",HCPCS G0105,0982 - PRO FEE/OUTPT,N/A,N/A," $2,426.00 "," $1,576.90 "," $2,171.13 ", $174.38 , $351.69 , $373.81 , N/A ," $2,256.18 "," $2,183.40 "," $2,183.40 "," $1,940.80 "," $1,940.80 ", $351.69 ," $2,239.93 "," $2,304.70 "," $2,183.40 "," $2,183.40 "," $2,183.40 "," $2,256.18 "," $2,328.96 ", $813.03 ," $2,062.10 ", $420.39 ," $1,073.81 ", N/A , $381.10 , $381.10 ," $2,304.70 ", $476.38 , $174.38 ," $2,328.96 "
Removal of Anal Fissure,46200,N/A,N/A,N/A," $2,948.00 "," $1,916.20 "," $2,088.39 ", $326.31 , $213.54 ," $1,549.52 "," $1,606.20 "," $2,741.64 "," $2,653.20 "," $2,653.20 "," $2,358.40 "," $2,358.40 ", $213.54 ," $2,721.89 "," $2,800.60 "," $2,653.20 "," $2,653.20 "," $2,653.20 "," $2,741.64 "," $2,830.08 "," $1,486.47 "," $2,505.80 "," $1,759.09 "," $1,859.79 ", N/A ," $1,579.75 "," $1,579.75 "," $2,800.60 "," $1,652.26 ", $213.54 ," $2,830.08 "
Fo W/O Joints Cf,HCPCS L3933,N/A,N/A,N/A, $322.00 , $209.30 , N/A , $227.14 , $59.69 , N/A , N/A , $299.46 , $289.80 , $289.80 , $257.60 , $257.60 , $59.69 , $297.30 , $305.90 , $289.80 , $289.80 , $289.80 , $299.46 , $309.12 , N/A , $273.70 , $187.49 , $191.11 , N/A , N/A , N/A , $305.90 , N/A , $59.69 , $309.12 
Hospital IP/Obs Care Same Date High Mdm 85 Min,99236,N/A,N/A,N/A, $675.00 , $438.75 , $422.12 , $203.44 , $233.79 , $376.83 , $376.09 , $627.75 , $607.50 , $607.50 , $540.00 , $540.00 , $233.79 , $623.23 , $641.25 , $607.50 , $607.50 , $607.50 , $627.75 , $648.00 , $635.81 , $573.75 , $468.07 , $478.40 , $285.00 , $384.18 , $384.18 , $641.25 , $443.09 , $203.44 , $648.00 
 Pro CT Pelvis W/O & W/Dye ,CPT® 72194,0972 - PRO FEE/RAD/DX,N/A,N/A, $834.00 , $542.10 ," $1,598.10 ", $231.85 , $366.31 ," $1,238.63 "," $1,590.56 ", $775.62 , $750.60 , $750.60 , $667.20 , $667.20 , $366.31 , $770.03 , $792.30 , $750.60 , $750.60 , $750.60 , $775.62 , $800.64 ," $1,530.75 ", $708.90 ," $1,764.25 "," $1,687.54 ", N/A ," $1,262.80 "," $1,262.80 ", $792.30 ," $1,461.71 ", $231.85 ," $1,764.25 "
 NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP SUSP ,HCPCS RXC637,0250 - PHARMACY,24208-0830-60,5 mL, $102.02 , $66.31 , $85.70 , N/A , N/A , $82.43 , $91.82 , $86.37 , $91.82 , $91.82 , $91.82 , $86.72 , N/A , $94.20 , $96.92 , $86.72 , $94.88 , $94.88 , $96.92 , $97.94 , $83.47 , $91.82 , $86.72 , $80.60 , N/A , $82.56 , $82.56 , $96.92 , $87.54 , $80.60 , $97.94 
 Fac Drug Screening Cannabinoids Natural ,CPT® 80349,0301 - LAB/CHEMISTRY,N/A,N/A, $156.00 , $101.40 , $131.04 , N/A , N/A , $126.05 , $140.40 , $132.07 , $140.40 , $140.40 , $140.40 , $132.60 , N/A , $144.03 , $148.20 , $132.60 , $145.08 , $145.08 , $148.20 , $149.76 , $127.64 , $140.40 , $132.60 , $123.24 , N/A , $126.25 , $126.25 , $148.20 , $133.86 , $123.24 , $149.76 
Neg Pressure Wound Therapy Non Dme >50 Sq Cm,CPT® 97608,N/A,N/A,N/A, $472.00 , $306.80 , $55.27 , $23.23 , $31.76 , $108.66 , N/A , $438.96 , $424.80 , $424.80 , $377.60 , $377.60 , $31.76 , $435.80 , $448.40 , $424.80 , $424.80 , $424.80 , $438.96 , $453.12 , $73.43 , $401.20 , $75.73 , $100.75 , N/A , $110.78 , $110.78 , $448.40 , $123.20 , $23.23 , $453.12 
 Fac Ewho Rigid W/O Jnts Cf ,HCPCS L3763,0274 - PROSTHETIC DEV,N/A,N/A, $838.00 , $544.70 , $703.92 , $796.66 , $163.06 , $677.10 , $754.20 , $709.45 , $754.20 , $754.20 , $754.20 , $712.30 , $159.86 , $773.73 , $796.10 , $712.30 , $779.34 , $779.34 , $796.10 , $804.48 , $685.65 , $754.20 , $712.30 , $662.02 , N/A , $678.19 , $678.19 , $796.10 , $719.09 , $159.86 , $804.48 
Transj Care Mgmt Mod Mdm F2f 14 Cal D Discharge,CPT® 99495,N/A,N/A,N/A, $428.00 , $278.20 , $275.20 , $136.47 , N/A , $191.49 , $238.41 , $398.04 , $385.20 , $385.20 , $342.40 , $342.40 , N/A , $395.17 , $406.60 , $385.20 , $385.20 , $385.20 , $398.04 , $410.88 , $263.38 , $363.80 , $297.04 , $242.30 , N/A , $195.23 , $195.23 , $406.60 , $225.14 , $136.47 , $410.88 
 Fac Assay of Vitamin B-2 ,CPT® 84252,0301 - LAB/CHEMISTRY,N/A,N/A, $282.00 , $183.30 , $236.88 , $20.64 , $20.64 , $227.86 , $253.80 , $238.74 , $253.80 , $253.80 , $253.80 , $239.70 , $20.24 , $260.37 , $267.90 , $239.70 , $262.26 , $262.26 , $267.90 , $270.72 , $230.73 , $253.80 , $239.70 , $222.78 , N/A , $228.22 , $228.22 , $267.90 , $241.98 , $20.24 , $270.72 
 Fac Hemiphalangc/Iphal Jt Exc Toe ,CPT® 28160,0761 - TREATMENT ROOM,N/A,N/A, $758.00 , $492.70 , $636.72 , $259.18 , $183.20 , $612.46 , $682.20 , $641.72 , $682.20 , $682.20 , $682.20 , $644.30 , $179.61 , $699.86 , $720.10 , $644.30 , $704.94 , $704.94 , $720.10 , $727.68 , $620.20 , $682.20 , $644.30 , $598.82 , N/A , $613.45 , $613.45 , $720.10 , $650.44 , $179.61 , $727.68 
 CT Thoracentesis and Tube Placement ,CPT® 32557,0320 - DX X-RAY,N/A,N/A," $3,020.00 "," $1,963.00 "," $2,536.80 ", $142.63 , $559.75 ," $2,440.16 "," $2,718.00 "," $2,556.73 "," $2,718.00 "," $2,718.00 "," $2,718.00 "," $2,567.00 ", $548.77 ," $2,788.37 "," $2,869.00 "," $2,567.00 "," $2,808.60 "," $2,808.60 "," $2,869.00 "," $2,899.20 "," $2,470.96 "," $2,718.00 "," $2,567.00 "," $2,385.80 ", N/A ," $2,444.09 "," $2,444.09 "," $2,869.00 "," $2,591.46 ", $142.63 ," $2,899.20 "
 VENLAFAXINE HCL 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,57237-0174-01,1 tablet, $10.59 , $6.88 , $8.90 , N/A , N/A , $8.56 , $9.53 , $8.97 , $9.53 , $9.53 , $9.53 , $9.00 , N/A , $9.78 , $10.06 , $9.00 , $9.85 , $9.85 , $10.06 , $10.17 , $8.66 , $9.53 , $9.00 , $8.37 , N/A , $8.57 , $8.57 , $10.06 , $9.09 , $8.37 , $10.17 
 Fac Assay of Chromium ,CPT® 82495,0301 - LAB/CHEMISTRY,N/A,N/A, $149.00 , $96.85 , $125.16 , $20.69 , $10.10 , $120.39 , $134.10 , $126.14 , $134.10 , $134.10 , $134.10 , $126.65 , $9.90 , $137.57 , $141.55 , $126.65 , $138.57 , $138.57 , $141.55 , $143.04 , $121.91 , $134.10 , $126.65 , $117.71 , N/A , $120.59 , $120.59 , $141.55 , $127.86 , $9.90 , $143.04 
 Fac Assay of Thyroid (T3 or T4) ,CPT® 84479,0301 - LAB/CHEMISTRY,N/A,N/A, $73.00 , $47.45 , $61.32 , $6.60 , $6.60 , $58.98 , $65.70 , $61.80 , $65.70 , $65.70 , $65.70 , $62.05 , $6.47 , $67.40 , $69.35 , $62.05 , $67.89 , $67.89 , $69.35 , $70.08 , $59.73 , $65.70 , $62.05 , $57.67 , N/A , $59.08 , $59.08 , $69.35 , $62.64 , $6.47 , $70.08 
Create T-E Fistula+Speech Prosthesis,CPT® 31611,N/A,N/A,N/A," $2,871.00 "," $1,866.15 "," $2,963.32 ", $522.43 , $795.80 ," $2,063.27 "," $2,080.07 "," $2,670.03 "," $2,583.90 "," $2,583.90 "," $2,296.80 "," $2,296.80 ", $795.80 ," $2,650.79 "," $2,727.45 "," $2,583.90 "," $2,583.90 "," $2,583.90 "," $2,670.03 "," $2,756.16 "," $2,844.04 "," $2,440.35 "," $2,922.30 "," $2,717.67 ", N/A ," $2,103.52 "," $2,103.52 "," $2,727.45 "," $2,477.33 ", $522.43 ," $2,963.32 "
" Fac Occult Bld Feces, 1-3 Tests ",CPT® 82272,0301 - LAB/CHEMISTRY,N/A,N/A, $52.00 , $33.80 , $43.68 , $4.31 , $4.21 , $42.02 , $46.80 , $44.02 , $46.80 , $46.80 , $46.80 , $44.20 , $4.13 , $48.01 , $49.40 , $44.20 , $48.36 , $48.36 , $49.40 , $49.92 , $42.55 , $46.80 , $44.20 , $41.08 , N/A , $42.08 , $42.08 , $49.40 , $44.62 , $4.13 , $49.92 
Iadna Sars-Cov-2 Covid-19 Amplified Probe Tq,CPT® 87635,N/A,N/A,N/A, $221.00 , $143.65 , N/A , $52.34 , $52.34 , N/A , N/A , $205.53 , $198.90 , $198.90 , $176.80 , $176.80 , $52.34 , $204.05 , $209.95 , $198.90 , $198.90 , $198.90 , $205.53 , $212.16 , N/A , $187.85 , $243.92 , $150.70 , N/A , $199.08 , $199.08 , $209.95 , $217.55 , $52.34 , $243.92 
"Lap,Myomectomy 1-4,Tot Wt 250 Gms",CPT® 58545,N/A,N/A,N/A," $6,723.00 "," $4,369.95 "," $4,231.45 ", $856.31 , $794.27 ," $3,670.13 "," $3,629.99 "," $6,252.39 "," $6,050.70 "," $6,050.70 "," $5,378.40 "," $5,378.40 ", $794.27 ," $6,207.35 "," $6,386.85 "," $6,050.70 "," $6,050.70 "," $6,050.70 "," $6,252.39 "," $6,454.08 "," $4,430.07 "," $5,714.55 "," $4,779.51 "," $3,667.57 ", N/A ," $3,741.74 "," $3,741.74 "," $6,386.85 "," $4,487.98 ", $794.27 ," $6,454.08 "
Excision of Uvula,CPT® 42140,N/A,N/A,N/A," $1,796.00 "," $1,167.40 ", $993.79 , $157.68 , $46.08 , $749.51 , $788.69 ," $1,670.28 "," $1,616.40 "," $1,616.40 "," $1,436.80 "," $1,436.80 ", $46.08 ," $1,658.25 "," $1,706.20 "," $1,616.40 "," $1,616.40 "," $1,616.40 "," $1,670.28 "," $1,724.16 ", $696.46 ," $1,526.60 ", $859.92 , $881.49 , N/A , $764.13 , $764.13 ," $1,706.20 ", $799.21 , $46.08 ," $1,724.16 "
App Skn Sub Grft T/a/L Area/>100scm 1st 100scm,15273,N/A,N/A,N/A," $2,017.00 "," $1,311.05 ", $619.55 , $182.21 , $227.35 , $549.91 , $508.82 ," $1,875.81 "," $1,815.30 "," $1,815.30 "," $1,613.60 "," $1,613.60 ", $227.35 ," $1,862.30 "," $1,916.15 "," $1,815.30 "," $1,815.30 "," $1,815.30 "," $1,875.81 "," $1,936.32 ", $682.93 ," $1,714.45 "," $1,022.27 ", $702.31 , N/A , $560.64 , $560.64 ," $1,916.15 ", $650.16 , $182.21 ," $1,936.32 "
 LEVOTHYROXINE SODIUM 100 MCG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6953-61,1 tablet, $3.62 , $2.35 , $3.04 , N/A , N/A , $2.92 , $3.26 , $3.06 , $3.26 , $3.26 , $3.26 , $3.08 , N/A , $3.34 , $3.44 , $3.08 , $3.37 , $3.37 , $3.44 , $3.48 , $2.96 , $3.26 , $3.08 , $2.86 , N/A , $2.93 , $2.93 , $3.44 , $3.11 , $2.86 , $3.48 
 Pro Lyr Clsr N/H/F/Xtrnl Gent > 30.0 Cm ,CPT® 12047,0981 - PRO FEE/ER,N/A,N/A," $2,292.00 "," $1,489.80 "," $1,103.67 ", $327.50 , $279.47 ," $1,027.93 "," $1,001.77 "," $2,131.56 "," $2,062.80 "," $2,062.80 "," $1,833.60 "," $1,833.60 ", $279.47 ," $2,116.20 "," $2,177.40 "," $2,062.80 "," $2,062.80 "," $2,062.80 "," $2,131.56 "," $2,200.32 "," $1,205.95 "," $1,948.20 "," $2,008.86 "," $1,184.56 ", N/A ," $1,047.99 "," $1,047.99 "," $2,177.40 "," $1,215.31 ", $279.47 ," $2,200.32 "
Bronchoscopy W/Ther Aspir Trachbrncl Tree 1st,CPT® 31645,N/A,N/A,N/A," $2,066.00 "," $1,342.90 ", $803.39 , $139.59 , $279.26 , $628.22 , $614.43 ," $1,921.38 "," $1,859.40 "," $1,859.40 "," $1,652.80 "," $1,652.80 ", $279.26 ," $1,907.54 "," $1,962.70 "," $1,859.40 "," $1,859.40 "," $1,859.40 "," $1,921.38 "," $1,983.36 ", $776.44 ," $1,756.10 ", $856.35 , $766.71 , N/A , $640.47 , $640.47 ," $1,962.70 ", $754.29 , $139.59 ," $1,983.36 "
 CT Abd Pelvis Endovascular Protocol ,CPT® 74174,0350 - CT SCAN,N/A,N/A," $6,422.00 "," $4,174.30 "," $5,394.48 ", $389.73 , $439.35 ," $5,188.98 "," $5,779.80 "," $5,436.87 "," $5,779.80 "," $5,779.80 "," $5,779.80 "," $5,458.70 ", $430.74 ," $5,929.43 "," $6,100.90 "," $5,458.70 "," $5,972.46 "," $5,972.46 "," $6,100.90 "," $6,165.12 "," $5,254.48 "," $5,779.80 "," $5,458.70 "," $5,073.38 ", N/A ," $5,197.32 "," $5,197.32 "," $6,100.90 "," $5,510.72 ", $389.73 ," $6,165.12 "
Remove Cerclage Suture,CPT® 59871,N/A,N/A,N/A, $618.00 , $401.70 , $354.00 , $120.08 , $167.35 , $310.53 , $327.66 , $574.74 , $556.20 , $556.20 , $494.40 , $494.40 , $167.35 , $570.60 , $587.10 , $556.20 , $556.20 , $556.20 , $574.74 , $593.28 , $360.55 , $525.30 , $722.55 , $576.44 , N/A , $316.60 , $316.60 , $587.10 , $366.01 , $120.08 , $722.55 
 MEXILETINE HCL 150 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00093-8739-01,1 capsule, $13.03 , $8.47 , $10.95 , N/A , N/A , $10.53 , $11.73 , $11.03 , $11.73 , $11.73 , $11.73 , $11.08 , N/A , $12.03 , $12.38 , $11.08 , $12.12 , $12.12 , $12.38 , $12.51 , $10.66 , $11.73 , $11.08 , $10.29 , N/A , $10.55 , $10.55 , $12.38 , $11.18 , $10.29 , $12.51 
 Fac Sec Clsr Surg Wnd/Dehsn X10sv/Comp ,CPT® 13160,0761 - TREATMENT ROOM,N/A,N/A," $2,038.00 "," $1,324.70 "," $1,711.92 ", $755.62 , $190.55 ," $1,646.70 "," $1,834.20 "," $1,725.37 "," $1,834.20 "," $1,834.20 "," $1,834.20 "," $1,732.30 ", $186.81 ," $1,881.69 "," $1,936.10 "," $1,732.30 "," $1,895.34 "," $1,895.34 "," $1,936.10 "," $1,956.48 "," $1,667.49 "," $1,834.20 "," $1,732.30 "," $1,610.02 ", N/A ," $1,649.35 "," $1,649.35 "," $1,936.10 "," $1,748.81 ", $186.81 ," $1,956.48 "
"Removal Nodes, Neck,Cerv Mod Rad",CPT® 38724,N/A,N/A,N/A," $8,067.00 "," $5,243.55 "," $6,823.85 "," $1,387.69 "," $1,899.39 "," $5,142.05 "," $5,298.88 "," $7,502.31 "," $7,260.30 "," $7,260.30 "," $6,453.60 "," $6,453.60 "," $1,899.39 "," $7,448.26 "," $7,663.65 "," $7,260.30 "," $7,260.30 "," $7,260.30 "," $7,502.31 "," $7,744.32 "," $7,242.13 "," $6,856.95 "," $7,735.70 "," $7,055.64 ", N/A ," $5,242.38 "," $5,242.38 "," $7,663.65 "," $6,081.85 "," $1,387.69 "," $7,744.32 "
 Pro Tube Thoracostomy Includes Water Seal ,CPT® 32551,0982 - PRO FEE/OUTPT,N/A,N/A," $1,763.00 "," $1,145.95 ", $828.52 , $143.99 , $198.32 , $651.04 , $647.17 ," $1,639.59 "," $1,586.70 "," $1,586.70 "," $1,410.40 "," $1,410.40 ", $198.32 ," $1,627.78 "," $1,674.85 "," $1,586.70 "," $1,586.70 "," $1,586.70 "," $1,639.59 "," $1,692.48 ", $800.35 ," $1,498.55 ", $933.07 , $796.75 , N/A , $663.74 , $663.74 ," $1,674.85 ", $781.70 , $143.99 ," $1,692.48 "
" Pro Destroy Nerve, Face Muscle ",CPT® 64612,0982 - PRO FEE/OUTPT,N/A,N/A, $731.00 , $475.15 , $572.10 , $112.30 , $185.45 , $639.64 , $644.20 , $679.83 , $657.90 , $657.90 , $584.80 , $584.80 , $185.45 , $674.93 , $694.45 , $657.90 , $657.90 , $657.90 , $679.83 , $701.76 , $614.83 , $621.35 , $654.75 , $689.66 , N/A , $652.12 , $652.12 , $694.45 , $699.57 , $112.30 , $701.76 
Insulin Injection,HCPCS J1815,N/A,N/A,N/A, $5.00 , $3.25 , N/A , N/A , $0.92 , N/A , N/A , $4.65 , $4.50 , $4.50 , $4.00 , $4.00 , $0.92 , $4.62 , $4.75 , $4.50 , $4.50 , $4.50 , $4.65 , $4.80 , $1.13 , $4.25 , $1.30 , $0.64 , N/A , N/A , N/A , $4.75 , N/A , $0.64 , $4.80 
Fetal Non-Stress Test,59025,N/A,N/A,N/A, $295.00 , $191.75 , $134.01 , $46.00 , $50.89 , $111.46 , $119.70 , $274.35 , $265.50 , $265.50 , $236.00 , $236.00 , $50.89 , $272.37 , $280.25 , $265.50 , $265.50 , $265.50 , $274.35 , $283.20 , $137.25 , $250.75 , $258.69 , $211.43 , N/A , $113.63 , $113.63 , $280.25 , $131.36 , $46.00 , $283.20 
DXA Bone Density Study 1+ Sits Axial Skel,77080,N/A,N/A,N/A, $363.00 , $235.95 , $207.70 , $37.34 , $90.07 , $191.46 , $259.32 , $337.59 , $326.70 , $326.70 , $290.40 , $290.40 , $90.07 , $335.16 , $344.85 , $326.70 , $326.70 , $326.70 , $337.59 , $348.48 , $341.81 , $308.55 , $285.05 , $313.78 , N/A , $195.20 , $195.20 , $344.85 , $225.93 , $37.34 , $348.48 
Doppler Fetal Umbilical Artery,CPT® 76820,N/A,N/A,N/A, $713.00 , $463.45 , $257.17 , $44.42 , $48.03 , $227.31 , $212.43 , $663.09 , $641.70 , $641.70 , $570.40 , $570.40 , $48.03 , $658.31 , $677.35 , $641.70 , $641.70 , $641.70 , $663.09 , $684.48 , $258.10 , $606.05 , $231.13 , $268.82 , N/A , $231.74 , $231.74 , $677.35 , $268.25 , $44.42 , $684.48 
 Fac Assay of Calcium ,CPT® 82330,0301 - LAB/CHEMISTRY,N/A,N/A, $166.00 , $107.90 , $139.44 , $13.95 , $13.95 , $134.13 , $149.40 , $140.54 , $149.40 , $149.40 , $149.40 , $141.10 , $13.68 , $153.27 , $157.70 , $141.10 , $154.38 , $154.38 , $157.70 , $159.36 , $135.82 , $149.40 , $141.10 , $131.14 , N/A , $134.34 , $134.34 , $157.70 , $142.44 , $13.68 , $159.36 
 MITOMYCIN 40 MG IV SOLR ,HCPCS J9280,0636 - DRUGS REQUIRING DETAILED CODIN,16729-0116-38,20 mL," $3,468.69 "," $2,254.65 "," $2,913.70 ", $80.60 , $45.36 ," $2,802.70 "," $3,121.82 "," $2,936.59 "," $3,121.82 "," $3,121.82 "," $3,121.82 "," $2,948.39 ", $44.47 ," $3,202.64 "," $3,295.26 "," $2,948.39 "," $3,225.88 "," $3,225.88 "," $3,295.26 "," $3,329.94 "," $2,838.08 "," $3,121.82 "," $2,948.39 "," $2,740.27 ", N/A ," $2,807.21 "," $2,807.21 "," $3,295.26 "," $2,976.48 ", $44.47 ," $3,329.94 "
 Knee Arthrography ,CPT® 73580,0320 - DX X-RAY,N/A,N/A," $1,631.00 "," $1,060.15 "," $1,370.04 ", $125.57 , $118.67 ," $1,317.85 "," $1,467.90 "," $1,380.80 "," $1,467.90 "," $1,467.90 "," $1,467.90 "," $1,386.35 ", $116.34 ," $1,505.90 "," $1,549.45 "," $1,386.35 "," $1,516.83 "," $1,516.83 "," $1,549.45 "," $1,565.76 "," $1,334.48 "," $1,467.90 "," $1,386.35 "," $1,288.49 ", N/A ," $1,319.97 "," $1,319.97 "," $1,549.45 "," $1,399.56 ", $116.34 ," $1,565.76 "
 MICROCYN 0.023 % EX LIQD ,HCPCS RXA250,0250 - PHARMACY,89116-0000-50,236 mL, $112.75 , $73.29 , $94.71 , N/A , N/A , $91.10 , $101.48 , $95.45 , $101.48 , $101.48 , $101.48 , $95.84 , N/A , $104.10 , $107.11 , $95.84 , $104.86 , $104.86 , $107.11 , $108.24 , $92.25 , $101.48 , $95.84 , $89.07 , N/A , $91.25 , $91.25 , $107.11 , $96.75 , $89.07 , $108.24 
"Repair Ing Hernia,5+Y/O,Reducibl",49505,N/A,N/A,N/A," $3,355.00 "," $2,180.75 "," $3,134.37 ", $486.32 , $438.54 ," $2,443.03 "," $2,485.13 "," $3,120.15 "," $3,019.50 "," $3,019.50 "," $2,684.00 "," $2,684.00 ", $438.54 ," $3,097.67 "," $3,187.25 "," $3,019.50 "," $3,019.50 "," $3,019.50 "," $3,120.15 "," $3,220.80 "," $2,239.61 "," $2,851.75 "," $2,756.38 "," $2,889.05 ", N/A ," $2,490.70 "," $2,490.70 "," $3,187.25 "," $2,605.01 ", $438.54 ," $3,220.80 "
 Fac Revj Opn Arven Fstl W/O Thrmbc Dial Grf ,CPT® 36832,0360 - OR SERVICES,N/A,N/A," $5,822.00 "," $3,784.30 "," $4,890.48 ", $678.78 , $547.54 ," $4,704.18 "," $5,239.80 "," $4,928.91 "," $5,239.80 "," $5,239.80 "," $5,239.80 "," $4,948.70 ", $536.80 ," $5,375.45 "," $5,530.90 "," $4,948.70 "," $5,414.46 "," $5,414.46 "," $5,530.90 "," $5,589.12 "," $4,763.56 "," $5,239.80 "," $4,948.70 "," $4,599.38 ", N/A ," $4,711.74 "," $4,711.74 "," $5,530.90 "," $4,995.86 ", $536.80 ," $5,589.12 "
Repair Lv Outflow Obstr Patch Enlg,CPT® 33414,N/A,N/A,N/A," $27,619.00 "," $17,952.35 "," $12,495.15 "," $1,927.15 "," $2,378.00 "," $9,148.89 "," $9,099.90 "," $25,685.67 "," $24,857.10 "," $24,857.10 "," $22,095.20 "," $22,095.20 "," $2,378.00 "," $25,500.62 "," $26,238.05 "," $24,857.10 "," $24,857.10 "," $24,857.10 "," $25,685.67 "," $26,514.24 "," $11,593.88 "," $23,476.15 "," $11,560.74 "," $10,292.06 ", N/A ," $9,327.40 "," $9,327.40 "," $26,238.05 "," $10,595.92 "," $1,927.15 "," $26,514.24 "
 Pro Remov FB/Eye/Ext Eye/Embe ,CPT® 65210,0982 - PRO FEE/OUTPT,N/A,N/A, $519.00 , $337.35 , $224.64 , $34.99 , $48.54 , $303.27 , $280.98 , $482.67 , $467.10 , $467.10 , $415.20 , $415.20 , $48.54 , $479.19 , $493.05 , $467.10 , $467.10 , $467.10 , $482.67 , $498.24 , $311.97 , $441.15 , $289.02 , $382.47 , N/A , $309.18 , $309.18 , $493.05 , $341.30 , $34.99 , $498.24 
 Pro Contrast X-Ray of Wrist ,CPT® 73115,0972 - PRO FEE/RAD/DX,N/A,N/A, $334.00 , $217.10 , $780.68 , $133.80 , $92.48 , $508.56 , $595.99 , $310.62 , $300.60 , $300.60 , $267.20 , $267.20 , $92.48 , $308.38 , $317.30 , $300.60 , $300.60 , $300.60 , $310.62 , $320.64 , $755.09 , $283.90 , $651.00 , $539.39 , N/A , $518.48 , $518.48 , $317.30 , $600.16 , $92.48 , $780.68 
 Fac Intro Cath Dialysis Circuit W/Trluml Balo Angiop ,CPT® 36902,0360 - OR SERVICES,N/A,N/A," $16,020.00 "," $10,413.00 "," $13,456.80 ", $222.38 , $958.60 ," $12,944.16 "," $14,418.00 "," $13,562.53 "," $14,418.00 "," $14,418.00 "," $14,418.00 "," $13,617.00 ", $939.80 ," $14,791.27 "," $15,219.00 "," $13,617.00 "," $14,898.60 "," $14,898.60 "," $15,219.00 "," $15,379.20 "," $13,107.56 "," $14,418.00 "," $13,617.00 "," $12,655.80 ", N/A ," $12,964.99 "," $12,964.99 "," $15,219.00 "," $13,746.76 ", $222.38 ," $15,379.20 "
Treat Ankle Fracture,27760,N/A,N/A,N/A," $1,536.00 ", $998.40 ," $1,916.98 ", $302.45 , $184.42 ," $1,467.45 "," $1,497.57 "," $1,428.48 "," $1,382.40 "," $1,382.40 "," $1,228.80 "," $1,228.80 ", $184.42 ," $1,418.19 "," $1,459.20 "," $1,382.40 "," $1,382.40 "," $1,382.40 "," $1,428.48 "," $1,474.56 "," $1,767.47 "," $1,305.60 "," $1,643.12 "," $1,745.36 ", N/A ," $1,496.08 "," $1,496.08 "," $1,459.20 "," $1,758.43 ", $184.42 ," $1,916.98 "
 Pro Injection Treatment of Nerve ,CPT® 64640,0982 - PRO FEE/OUTPT,N/A,N/A," $1,489.00 ", $967.85 , $587.34 , $114.17 , $160.13 , $520.91 , $518.16 ," $1,384.77 "," $1,340.10 "," $1,340.10 "," $1,191.20 "," $1,191.20 ", $160.13 ," $1,374.79 "," $1,414.55 "," $1,340.10 "," $1,340.10 "," $1,340.10 "," $1,384.77 "," $1,429.44 ", $635.03 ," $1,265.65 ", $503.11 , $565.00 , N/A , $531.08 , $531.08 ," $1,414.55 ", $569.71 , $114.17 ," $1,429.44 "
 Lac Repair Neck Hands Complex 1.1-2.5cm - Mh ,CPT® 13131,0761 - TREATMENT ROOM,N/A,N/A, $930.00 , $604.50 , $781.20 , $231.89 , $176.33 , $751.44 , $837.00 , $787.34 , $837.00 , $837.00 , $837.00 , $790.50 , $172.87 , $858.67 , $883.50 , $790.50 , $864.90 , $864.90 , $883.50 , $892.80 , $760.93 , $837.00 , $790.50 , $734.70 , N/A , $752.65 , $752.65 , $883.50 , $798.03 , $172.87 , $892.80 
 Fac Anes IV Service ,Custom 4009001,0370 - ANESTHESIA,N/A,N/A, $190.00 , $123.50 , $159.60 , N/A , N/A , $153.52 , $171.00 , $160.85 , $171.00 , $171.00 , $171.00 , $161.50 , N/A , $175.43 , $180.50 , $161.50 , $176.70 , $176.70 , $180.50 , $182.40 , $155.46 , $171.00 , $161.50 , $150.10 , N/A , $153.77 , $153.77 , $180.50 , $163.04 , $150.10 , $182.40 
 ORA-SWEET PO SYRP ,HCPCS RXC637,0250 - PHARMACY,00395-0090-16,473 mL, $85.05 , $55.28 , $71.44 , N/A , N/A , $68.72 , $76.55 , $72.00 , $76.55 , $76.55 , $76.55 , $72.29 , N/A , $78.53 , $80.80 , $72.29 , $79.10 , $79.10 , $80.80 , $81.65 , $69.59 , $76.55 , $72.29 , $67.19 , N/A , $68.83 , $68.83 , $80.80 , $72.98 , $67.19 , $81.65 
 CYCLOBENZAPRINE HCL 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,10702-0006-01,1 tablet, $8.91 , $5.79 , $7.48 , N/A , N/A , $7.20 , $8.02 , $7.54 , $8.02 , $8.02 , $8.02 , $7.57 , N/A , $8.23 , $8.46 , $7.57 , $8.29 , $8.29 , $8.46 , $8.55 , $7.29 , $8.02 , $7.57 , $7.04 , N/A , $7.21 , $7.21 , $8.46 , $7.65 , $7.04 , $8.55 
Arthrodesis Sacroiliac Joint Percutaneous,CPT® 27279,N/A,N/A,N/A," $5,023.00 "," $3,264.95 "," $5,013.26 ", $765.90 , $446.60 ," $2,728.42 "," $2,760.71 "," $4,671.39 "," $4,520.70 "," $4,520.70 "," $4,018.40 "," $4,018.40 ", $446.60 ," $4,637.74 "," $4,771.85 "," $4,520.70 "," $4,520.70 "," $4,520.70 "," $4,671.39 "," $4,822.08 "," $4,775.86 "," $4,269.55 "," $4,335.74 "," $3,861.63 ", N/A ," $2,781.66 "," $2,781.66 "," $4,771.85 "," $3,269.43 ", $446.60 ," $5,013.26 "
"Mycobact Culture,Isolatn",CPT® 87116,N/A,N/A,N/A, $136.00 , $88.40 , N/A , $11.02 , $11.02 , $61.12 , $73.12 , $126.48 , $122.40 , $122.40 , $108.80 , $108.80 , $11.02 , $125.57 , $129.20 , $122.40 , $122.40 , $122.40 , $126.48 , $130.56 , $72.11 , $115.60 , $71.36 , $39.18 , N/A , $57.04 , $57.04 , $129.20 , $62.33 , $11.02 , $130.56 
" Amputation; Leg, Tib/Fib; Sec Closure or Scar Revision ",CPT® 27884,0360 - OR SERVICES,N/A,N/A," $3,002.00 "," $1,951.30 "," $2,521.68 ", $537.71 , $320.30 ," $2,425.62 "," $2,701.80 "," $2,541.49 "," $2,701.80 "," $2,701.80 "," $2,701.80 "," $2,551.70 ", $314.02 ," $2,771.75 "," $2,851.90 "," $2,551.70 "," $2,791.86 "," $2,791.86 "," $2,851.90 "," $2,881.92 "," $2,456.24 "," $2,701.80 "," $2,551.70 "," $2,371.58 ", N/A ," $2,429.52 "," $2,429.52 "," $2,851.90 "," $2,576.02 ", $314.02 ," $2,881.92 "
"Bx/Remv,Lymph Node,Deep Cerv/Scal",CPT® 38520,N/A,N/A,N/A," $2,557.00 "," $1,662.05 "," $2,165.35 ", $440.98 , $265.64 ," $1,617.23 "," $1,676.38 "," $2,378.01 "," $2,301.30 "," $2,301.30 "," $2,045.60 "," $2,045.60 ", $265.64 ," $2,360.88 "," $2,429.15 "," $2,301.30 "," $2,301.30 "," $2,301.30 "," $2,378.01 "," $2,454.72 "," $2,306.98 "," $2,173.45 "," $2,476.28 "," $2,236.83 ", N/A ," $1,648.78 "," $1,648.78 "," $2,429.15 "," $1,912.82 ", $265.64 ," $2,476.28 "
 Fac Office/Outpatient New High Mdm 60-74 Minutes ,CPT® 99205,0510 - CLINIC,N/A,N/A, $693.00 , $450.45 , $582.12 , $174.91 , $136.97 , $559.94 , $623.70 , N/A , $623.70 , $623.70 , $623.70 , $589.05 , $134.28 , $639.85 , $658.35 , $589.05 , $644.49 , $644.49 , $658.35 , $665.28 , $567.01 , $623.70 , $589.05 , $547.47 , N/A , $560.84 , $560.84 , $658.35 , $594.66 , $134.28 , $665.28 
" Pro Repair of Leg Tendon, Each ",CPT® 27658,0982 - PRO FEE/OUTPT,N/A,N/A," $2,504.00 "," $1,627.60 "," $2,276.69 ", $357.61 , $461.04 ," $1,822.74 "," $1,840.28 "," $2,328.72 "," $2,253.60 "," $2,253.60 "," $2,003.20 "," $2,003.20 ", $461.04 ," $2,311.94 "," $2,378.80 "," $2,253.60 "," $2,253.60 "," $2,253.60 "," $2,328.72 "," $2,403.84 "," $2,116.91 "," $2,128.40 "," $2,014.21 "," $2,144.57 ", N/A ," $1,858.31 "," $1,858.31 "," $2,378.80 "," $2,184.17 ", $357.61 ," $2,403.84 "
" Fac Gardner Vag, Dna, Dir Probe ",CPT® 87510,0306 - LAB/BACT-MICRO,N/A,N/A, $118.00 , $76.70 , $99.12 , $20.45 , $20.45 , $95.34 , $106.20 , $99.90 , $106.20 , $106.20 , $106.20 , $100.30 , $20.05 , $108.95 , $112.10 , $100.30 , $109.74 , $109.74 , $112.10 , $113.28 , $96.55 , $106.20 , $100.30 , $93.22 , N/A , $95.50 , $95.50 , $112.10 , $101.26 , $20.05 , $113.28 
"Radiation,Mangement,5 Tx's",CPT® 77427,N/A,N/A,N/A," $2,233.00 "," $1,451.45 "," $1,059.95 ", $186.95 , $169.21 , $889.66 , $922.52 ," $2,076.69 "," $2,009.70 "," $2,009.70 "," $1,786.40 "," $1,786.40 ", $169.21 ," $2,061.73 "," $2,121.35 "," $2,009.70 "," $2,009.70 "," $2,009.70 "," $2,076.69 "," $2,143.68 "," $1,056.97 "," $1,898.05 "," $1,009.25 "," $1,034.50 ", N/A , $907.03 , $907.03 ," $2,121.35 "," $1,049.90 ", $169.21 ," $2,143.68 "
 Fac Assay of Lead ,CPT® 83655,0301 - LAB/CHEMISTRY,N/A,N/A, $116.00 , $75.40 , $97.44 , $12.35 , $12.35 , $93.73 , $104.40 , $98.21 , $104.40 , $104.40 , $104.40 , $98.60 , $12.11 , $107.10 , $110.20 , $98.60 , $107.88 , $107.88 , $110.20 , $111.36 , $94.91 , $104.40 , $98.60 , $91.64 , N/A , $93.88 , $93.88 , $110.20 , $99.54 , $12.11 , $111.36 
Motor &/Sens 13/> Nrv Cndj Preconf Eltrode Limb,CPT® 95913,N/A,N/A,N/A," $1,558.00 "," $1,012.70 "," $1,422.85 ", $282.07 , $237.04 , $949.81 ," $2,789.94 "," $1,448.94 "," $1,402.20 "," $1,402.20 "," $1,246.40 "," $1,246.40 ", $237.04 ," $1,438.50 "," $1,480.10 "," $1,402.20 "," $1,402.20 "," $1,402.20 "," $1,448.94 "," $1,495.68 "," $1,319.06 "," $1,324.30 ", $901.19 ," $1,155.25 ", N/A , $968.34 , $968.34 ," $1,480.10 "," $1,190.46 ", $237.04 ," $2,789.94 "
 Pro Removal of Lens Material ,CPT® 66840,0962 - PRO FEE/EYE,N/A,N/A," $6,162.00 "," $4,005.30 "," $4,265.76 ", $669.14 , $547.80 ," $3,942.90 "," $3,733.31 "," $5,730.66 "," $5,545.80 "," $5,545.80 "," $4,929.60 "," $4,929.60 ", $547.80 ," $5,689.37 "," $5,853.90 "," $5,545.80 "," $5,545.80 "," $5,545.80 "," $5,730.66 "," $5,915.52 "," $5,863.97 "," $5,237.70 "," $3,878.56 "," $5,009.24 ", N/A ," $4,019.83 "," $4,019.83 "," $5,853.90 "," $4,437.37 ", $547.80 ," $5,915.52 "
Art Press Waveform Analys Central Art Pressure,CPT® 93050,N/A,N/A,N/A, $110.00 , $71.50 , $98.93 , $15.29 , N/A , $94.90 , $95.77 , $102.30 , $99.00 , $99.00 , $88.00 , $88.00 , N/A , $101.56 , $104.50 , $99.00 , $99.00 , $99.00 , $102.30 , $105.60 , $97.80 , $93.50 , $83.52 , $97.88 , N/A , $96.75 , $96.75 , $104.50 , $107.24 , $15.29 , $107.24 
 Fac Blood Clot Factor V Test ,CPT® 85220,0305 - LAB/HEMATOLOGY,N/A,N/A, $254.00 , $165.10 , $213.36 , $18.00 , $18.00 , $205.23 , $228.60 , $215.04 , $228.60 , $228.60 , $228.60 , $215.90 , $17.65 , $234.52 , $241.30 , $215.90 , $236.22 , $236.22 , $241.30 , $243.84 , $207.82 , $228.60 , $215.90 , $200.66 , N/A , $205.56 , $205.56 , $241.30 , $217.96 , $17.65 , $243.84 
" Fac IV Infusion, Therap/Proph/Diagnost,Initial,Ea Add Hour ",CPT® 96366,0260 - IV THERAPY,N/A,N/A, $132.00 , $85.80 , $110.88 , $20.12 , $21.27 , $106.66 , $118.80 , $111.75 , $118.80 , $118.80 , $118.80 , $112.20 , $20.85 , $121.88 , $125.40 , $112.20 , $122.76 , $122.76 , $125.40 , $126.72 , $108.00 , $118.80 , $112.20 , $104.28 , N/A , $106.83 , $106.83 , $125.40 , $113.27 , $20.12 , $126.72 
Assay of Lipoprotein(A),CPT® 83695,N/A,N/A,N/A, $119.00 , $77.35 , N/A , $14.61 , $14.61 , $73.26 , $87.64 , $110.67 , $107.10 , $107.10 , $95.20 , $95.20 , $14.61 , $109.87 , $113.05 , $107.10 , $107.10 , $107.10 , $110.67 , $114.24 , $95.62 , $101.15 , $84.34 , $46.93 , N/A , $68.37 , $68.37 , $113.05 , $74.71 , $14.61 , $114.24 
Spherocylindr 7.25d/.25-2.25,HCPCS V2111,N/A,N/A,N/A, $55.00 , $35.75 , N/A , $75.40 , N/A , N/A , N/A , $51.15 , $49.50 , $49.50 , $44.00 , $44.00 , N/A , $50.78 , $52.25 , $49.50 , $49.50 , $49.50 , $51.15 , $52.80 , N/A , $46.75 , $55.00 , $68.49 , N/A , N/A , N/A , $52.25 , N/A , $44.00 , $75.40 
 VALSARTAN 40 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00378-5807-93,1 tablet, $20.84 , $13.55 , $17.51 , N/A , N/A , $16.84 , $18.76 , $17.64 , $18.76 , $18.76 , $18.76 , $17.71 , N/A , $19.24 , $19.80 , $17.71 , $19.38 , $19.38 , $19.80 , $20.01 , $17.05 , $18.76 , $17.71 , $16.46 , N/A , $16.87 , $16.87 , $19.80 , $17.88 , $16.46 , $20.01 
 THIORIDAZINE HCL 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,51079-0566-20,1 tablet, $3.92 , $2.55 , $3.29 , N/A , N/A , $3.17 , $3.53 , $3.32 , $3.53 , $3.53 , $3.53 , $3.33 , N/A , $3.62 , $3.72 , $3.33 , $3.65 , $3.65 , $3.72 , $3.76 , $3.21 , $3.53 , $3.33 , $3.10 , N/A , $3.17 , $3.17 , $3.72 , $3.36 , $3.10 , $3.76 
"Visual Screening Test, Bilat",CPT® 99173,N/A,N/A,N/A, $40.00 , $26.00 , N/A , $2.73 , $19.38 , $6.70 , $6.54 , $37.20 , $36.00 , $36.00 , $32.00 , $32.00 , $19.38 , $36.93 , $38.00 , $36.00 , $36.00 , $36.00 , $37.20 , $38.40 , $7.93 , $34.00 , $9.12 , $6.26 , N/A , $6.83 , $6.83 , $38.00 , $7.97 , $2.73 , $38.40 
 Knee (Any 3 Views) ,CPT® 73562,0320 - DX X-RAY,N/A,N/A, $380.00 , $247.00 , $319.20 , $39.93 , $32.71 , $307.04 , $342.00 , $321.71 , $342.00 , $342.00 , $342.00 , $323.00 , $32.07 , $350.85 , $361.00 , $323.00 , $353.40 , $353.40 , $361.00 , $364.80 , $310.92 , $342.00 , $323.00 , $300.20 , N/A , $307.53 , $307.53 , $361.00 , $326.08 , $32.07 , $364.80 
 Fac Balloon Dilat Biliary Duct/Ampulla Prq Each Duct ,CPT® 47542,0361 - OR/MINOR,N/A,N/A," $2,144.00 "," $1,393.60 "," $1,800.96 ", $128.58 , $405.60 ," $1,732.35 "," $1,929.60 "," $1,815.11 "," $1,929.60 "," $1,929.60 "," $1,929.60 "," $1,822.40 ", $397.65 ," $1,979.56 "," $2,036.80 "," $1,822.40 "," $1,993.92 "," $1,993.92 "," $2,036.80 "," $2,058.24 "," $1,754.22 "," $1,929.60 "," $1,822.40 "," $1,693.76 ", N/A ," $1,735.14 "," $1,735.14 "," $2,036.80 "," $1,839.77 ", $128.58 ," $2,058.24 "
"Blood, Occult, by Peroxid, Feces, Single",CPT® 82272,N/A,N/A,N/A, $52.00 , $33.80 , N/A , $4.31 , $4.21 , $18.42 , $22.06 , $48.36 , $46.80 , $46.80 , $41.60 , $41.60 , $4.21 , $48.01 , $49.40 , $46.80 , $46.80 , $46.80 , $48.36 , $49.92 , $28.24 , $44.20 , $21.08 , $12.40 , N/A , $17.19 , $17.19 , $49.40 , $18.78 , $4.21 , $49.92 
Supervision Interfacility Transport Addl 30 Min,CPT® 99486,N/A,N/A,N/A, $252.00 , $163.80 , N/A , $62.22 , $50.71 , $115.64 , $114.78 , $234.36 , $226.80 , $226.80 , $201.60 , $201.60 , $50.71 , $232.67 , $239.40 , $226.80 , $226.80 , $226.80 , $234.36 , $241.92 , $166.86 , $214.20 , N/A , $146.79 , N/A , $117.89 , $117.89 , $239.40 , $135.97 , $50.71 , $241.92 
"Epstein-Barr Antibody,V Capsid",CPT® 86665,N/A,N/A,N/A, $159.00 , $103.35 , N/A , $18.50 , $18.50 , $102.65 , $122.79 , $147.87 , $143.10 , $143.10 , $127.20 , $127.20 , $18.50 , $146.80 , $151.05 , $143.10 , $143.10 , $143.10 , $147.87 , $152.64 , $121.12 , $135.15 , $118.39 , $65.79 , N/A , $95.80 , $95.80 , $151.05 , $104.69 , $18.50 , $152.64 
 Fac Esophagoscopy Flexible Transoral W Submucous Inj ,CPT® 43201,0360 - OR SERVICES,N/A,N/A," $1,530.00 ", $994.50 ," $1,285.20 ", $97.62 , $228.21 ," $1,236.24 "," $1,377.00 "," $1,295.30 "," $1,377.00 "," $1,377.00 "," $1,377.00 "," $1,300.50 ", $223.74 ," $1,412.65 "," $1,453.50 "," $1,300.50 "," $1,422.90 "," $1,422.90 "," $1,453.50 "," $1,468.80 "," $1,251.85 "," $1,377.00 "," $1,300.50 "," $1,208.70 ", N/A ," $1,238.23 "," $1,238.23 "," $1,453.50 "," $1,312.89 ", $97.62 ," $1,468.80 "
Psychotherapy W/Patient W/E&M Srvcs 30 Min,90833,N/A,N/A,N/A, $136.00 , $88.40 , $82.93 , $61.36 , $79.97 , $147.18 , $94.10 , $126.48 , $122.40 , $122.40 , $108.80 , $108.80 , $79.97 , $125.57 , $129.20 , $122.40 , $122.40 , $122.40 , $126.48 , $130.56 , $158.13 , $115.60 , $122.66 , $249.57 , $68.25 , $150.05 , $150.05 , $129.20 , $174.94 , $61.36 , $249.57 
 Fac Antb Helminth Nes ,CPT® 86682,0302 - LAB/IMMUNOLOGY,N/A,N/A, $205.00 , $133.25 , $172.20 , $13.27 , $8.07 , $165.64 , $184.50 , $173.55 , $184.50 , $184.50 , $184.50 , $174.25 , $7.91 , $189.28 , $194.75 , $174.25 , $190.65 , $190.65 , $194.75 , $196.80 , $167.73 , $184.50 , $174.25 , $161.95 , N/A , $165.91 , $165.91 , $194.75 , $175.91 , $7.91 , $196.80 
 Pro Radex Hip Unilateral With Pelvis 2-3 Views ,CPT® 73502,0972 - PRO FEE/RAD/DX,N/A,N/A, $136.00 , $88.40 , $319.41 , $46.24 , $32.45 , $196.69 , $208.03 , $126.48 , $122.40 , $122.40 , $108.80 , $108.80 , $32.45 , $125.57 , $129.20 , $122.40 , $122.40 , $122.40 , $126.48 , $130.56 , $256.15 , $115.60 , $270.49 , $208.99 , N/A , $200.52 , $200.52 , $129.20 , $232.11 , $32.45 , $319.41 
"Rhythm Ecg, Tracing",CPT® 93041,N/A,N/A,N/A, $70.00 , $45.50 , $34.58 , $5.69 , $5.70 , $29.61 , $33.33 , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $5.70 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , $34.17 , $59.50 , $32.11 , $32.32 , N/A , $30.18 , $30.18 , $66.50 , $33.47 , $5.69 , $67.20 
 HYOSCYAMINE SULFATE 0.125 MG SL SUBL ,HCPCS RXA250,0250 - PHARMACY,47781-0011-01,1 tablet, $4.37 , $2.84 , $3.67 , N/A , N/A , $3.53 , $3.93 , $3.70 , $3.93 , $3.93 , $3.93 , $3.71 , N/A , $4.03 , $4.15 , $3.71 , $4.06 , $4.06 , $4.15 , $4.20 , $3.58 , $3.93 , $3.71 , $3.45 , N/A , $3.54 , $3.54 , $4.15 , $3.75 , $3.45 , $4.20 
 Pro Treat Wrist Bone Fracture ,CPT® 25622,0982 - PRO FEE/OUTPT,N/A,N/A," $1,996.00 "," $1,297.40 "," $1,769.63 ", $281.15 , $206.19 ," $1,331.19 "," $1,359.46 "," $1,856.28 "," $1,796.40 "," $1,796.40 "," $1,596.80 "," $1,596.80 ", $206.19 ," $1,842.91 "," $1,896.20 "," $1,796.40 "," $1,796.40 "," $1,796.40 "," $1,856.28 "," $1,916.16 "," $1,628.51 "," $1,696.60 "," $1,491.48 "," $1,596.88 ", N/A ," $1,357.16 "," $1,357.16 "," $1,896.20 "," $1,595.16 ", $206.19 ," $1,916.16 "
"Cysto/Ureteroscopy,Tx Uret/Pelv Strict",CPT® 52345,N/A,N/A,N/A," $2,826.00 "," $1,836.90 "," $2,112.09 ", $370.56 , $524.15 ," $1,935.57 "," $1,841.83 "," $2,628.18 "," $2,543.40 "," $2,543.40 "," $2,260.80 "," $2,260.80 ", $524.15 ," $2,609.25 "," $2,684.70 "," $2,543.40 "," $2,543.40 "," $2,543.40 "," $2,628.18 "," $2,712.96 "," $2,126.30 "," $2,402.10 "," $2,085.57 "," $2,428.93 ", N/A ," $1,973.34 "," $1,973.34 "," $2,684.70 "," $2,319.37 ", $370.56 ," $2,712.96 "
 Verigene Stool Pcr Test ,CPT® 87506,0300 - LABORATORY,N/A,N/A," $1,405.00 ", $913.25 ," $1,180.20 ", $268.25 , $237.60 ," $1,135.24 "," $1,264.50 "," $1,189.47 "," $1,264.50 "," $1,264.50 "," $1,264.50 "," $1,194.25 ", $232.94 ," $1,297.24 "," $1,334.75 "," $1,194.25 "," $1,306.65 "," $1,306.65 "," $1,334.75 "," $1,348.80 "," $1,149.57 "," $1,264.50 "," $1,194.25 "," $1,109.95 ", N/A ," $1,137.07 "," $1,137.07 "," $1,334.75 "," $1,205.63 ", $232.94 ," $1,348.80 "
Tc99m Labeled RBC,HCPCS A9560,N/A,N/A,N/A, $224.00 , $145.60 , $533.05 , $108.74 , $86.88 , N/A , N/A , $208.32 , $201.60 , $201.60 , $179.20 , $179.20 , $86.88 , $206.82 , $212.80 , $201.60 , $201.60 , $201.60 , $208.32 , $215.04 , $403.94 , $190.40 , $199.02 , $138.85 , N/A , N/A , N/A , $212.80 , N/A , $86.88 , $533.05 
Open Rx Metatarsal Fracture,28485,N/A,N/A,N/A," $3,527.00 "," $2,292.55 "," $3,485.63 ", $546.26 , $384.19 ," $2,574.42 "," $2,574.82 "," $3,280.11 "," $3,174.30 "," $3,174.30 "," $2,821.60 "," $2,821.60 ", $384.19 ," $3,256.48 "," $3,350.65 "," $3,174.30 "," $3,174.30 "," $3,174.30 "," $3,280.11 "," $3,385.92 "," $3,222.61 "," $2,997.95 "," $2,804.55 "," $3,151.82 ", N/A ," $2,624.65 "," $2,624.65 "," $3,350.65 "," $3,084.91 ", $384.19 ," $3,485.63 "
 ALPRAZOLAM 0.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,65862-0677-01,1 tablet, $4.80 , $3.12 , $4.03 , N/A , N/A , $3.88 , $4.32 , $4.06 , $4.32 , $4.32 , $4.32 , $4.08 , N/A , $4.43 , $4.56 , $4.08 , $4.46 , $4.46 , $4.56 , $4.61 , $3.93 , $4.32 , $4.08 , $3.79 , N/A , $3.88 , $3.88 , $4.56 , $4.12 , $3.79 , $4.61 
Computerized Ophthalmic Imaging Optic Nerve,92133,N/A,N/A,N/A, $209.00 , $135.85 , $80.01 , $36.05 , $32.72 , $77.59 , $79.73 , $194.37 , $188.10 , $188.10 , $167.20 , $167.20 , $32.72 , $192.97 , $198.55 , $188.10 , $188.10 , $188.10 , $194.37 , $200.64 , $113.35 , $177.65 , $134.82 , $79.52 , N/A , $79.10 , $79.10 , $198.55 , $94.10 , $32.72 , $200.64 
"Immunotherapy, One Injection",CPT® 95115,N/A,N/A,N/A, $43.00 , $27.95 , $23.14 , $9.63 , $3.80 , $15.79 , $16.49 , $39.99 , $38.70 , $38.70 , $34.40 , $34.40 , $3.80 , $39.70 , $40.85 , $38.70 , $38.70 , $38.70 , $39.99 , $41.28 , $19.98 , $36.55 , $28.38 , $26.78 , N/A , $16.10 , $16.10 , $40.85 , $19.04 , $3.80 , $41.28 
Dilation Anal Sphincter W Anesth,CPT® 45905,N/A,N/A,N/A," $1,420.00 ", $923.00 ," $1,034.80 ", $162.29 , $133.31 , $805.24 , $823.27 ," $1,320.60 "," $1,278.00 "," $1,278.00 "," $1,136.00 "," $1,136.00 ", $133.31 ," $1,311.09 "," $1,349.00 "," $1,278.00 "," $1,278.00 "," $1,278.00 "," $1,320.60 "," $1,363.20 ", $739.24 ," $1,207.00 ", $904.52 , $959.60 , N/A , $820.96 , $820.96 ," $1,349.00 ", $858.62 , $133.31 ," $1,363.20 "
 Fac Bcr/Abl1 Minor Breakpnt Qualitative/Quantitative ,CPT® 81207,0310 - PATHOLOGY LAB,N/A,N/A," $1,297.00 ", $843.05 ," $1,089.48 ", $147.74 , $147.74 ," $1,047.98 "," $1,167.30 "," $1,098.04 "," $1,167.30 "," $1,167.30 "," $1,167.30 "," $1,102.45 ", $144.84 ," $1,197.52 "," $1,232.15 "," $1,102.45 "," $1,206.21 "," $1,206.21 "," $1,232.15 "," $1,245.12 "," $1,061.21 "," $1,167.30 "," $1,102.45 "," $1,024.63 ", N/A ," $1,049.66 "," $1,049.66 "," $1,232.15 "," $1,112.96 ", $144.84 ," $1,245.12 "
 Fac Drg Absc Cst Hmtma From Dentoalveolar Struxs ,CPT® 41800,0761 - TREATMENT ROOM,N/A,N/A," $1,956.00 "," $1,271.40 "," $1,643.04 ", $149.06 , $30.71 ," $1,580.45 "," $1,760.40 "," $1,655.95 "," $1,760.40 "," $1,760.40 "," $1,760.40 "," $1,662.60 ", $30.11 ," $1,805.97 "," $1,858.20 "," $1,662.60 "," $1,819.08 "," $1,819.08 "," $1,858.20 "," $1,877.76 "," $1,600.40 "," $1,760.40 "," $1,662.60 "," $1,545.24 ", N/A ," $1,582.99 "," $1,582.99 "," $1,858.20 "," $1,678.44 ", $30.11 ," $1,877.76 "
 Fac Part Removal Colon W Anastomosis ,CPT® 44140,0360 - OR SERVICES,N/A,N/A," $13,369.00 "," $8,689.85 "," $11,229.96 "," $1,236.44 "," $1,732.54 "," $10,802.15 "," $12,032.10 "," $11,318.20 "," $12,032.10 "," $12,032.10 "," $12,032.10 "," $11,363.65 "," $1,698.57 "," $12,343.60 "," $12,700.55 "," $11,363.65 "," $12,433.17 "," $12,433.17 "," $12,700.55 "," $12,834.24 "," $10,938.52 "," $12,032.10 "," $11,363.65 "," $10,561.51 ", N/A ," $10,819.53 "," $10,819.53 "," $12,700.55 "," $11,471.94 "," $1,236.44 "," $12,834.24 "
"Semen Analysis, Sperm Eval",CPT® 89321,N/A,N/A,N/A, $161.00 , $104.65 , N/A , $12.29 , $12.29 , $67.48 , $81.59 , $149.73 , $144.90 , $144.90 , $128.80 , $128.80 , $12.29 , $148.65 , $152.95 , $144.90 , $144.90 , $144.90 , $149.73 , $154.56 , $70.41 , $136.85 , $79.47 , $43.70 , N/A , $62.98 , $62.98 , $152.95 , $69.21 , $12.29 , $154.56 
" Fac Hocm 350-399mg/Ml Iodine,1ml ",HCPCS Q9963,0255 - DRUGS/RADIOLOGY,N/A,N/A, $1.00 , $0.65 , $0.84 , $0.21 , $0.21 , $0.81 , $0.90 , $0.85 , $0.90 , $0.90 , $0.90 , $0.85 , $0.21 , $0.92 , $0.95 , $0.85 , $0.93 , $0.93 , $0.95 , $0.96 , $0.82 , $0.90 , $0.85 , $0.79 , N/A , $0.81 , $0.81 , $0.95 , $0.86 , $0.21 , $0.96 
Special Radiation Dosimetry,CPT® 77331,N/A,N/A,N/A, $706.00 , $458.90 , $360.99 , $63.78 , $62.97 , $306.42 , $321.52 , $656.58 , $635.40 , $635.40 , $564.80 , $564.80 , $62.97 , $651.85 , $670.70 , $635.40 , $635.40 , $635.40 , $656.58 , $677.76 , $364.54 , $600.10 , $350.54 , $359.99 , N/A , $312.40 , $312.40 , $670.70 , $361.61 , $62.97 , $677.76 
Simple Repair 2.5cm or Le,12001,N/A,N/A,N/A, $567.00 , $368.55 , $140.22 , $41.72 , $52.39 , $121.02 , $117.45 , $527.31 , $510.30 , $510.30 , $453.60 , $453.60 , $52.39 , $523.51 , $538.65 , $510.30 , $510.30 , $510.30 , $527.31 , $544.32 , $152.67 , $481.95 , $235.50 , $154.59 , N/A , $123.38 , $123.38 , $538.65 , $143.07 , $41.72 , $544.32 
"Conization Cervix,Knife/Laser",CPT® 57520,N/A,N/A,N/A," $1,931.00 "," $1,255.15 "," $1,405.10 ", $285.27 , $276.68 ," $1,116.88 "," $1,114.54 "," $1,795.83 "," $1,737.90 "," $1,737.90 "," $1,544.80 "," $1,544.80 ", $276.68 ," $1,782.89 "," $1,834.45 "," $1,737.90 "," $1,737.90 "," $1,737.90 "," $1,795.83 "," $1,853.76 "," $1,450.34 "," $1,641.35 "," $1,461.15 "," $1,127.53 ", N/A ," $1,138.66 "," $1,138.66 "," $1,834.45 "," $1,365.76 ", $276.68 ," $1,853.76 "
 HALOPERIDOL 1 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,51079-0734-20,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Antineutrophil Cytoplasmic Antb Screen Ea Antb,CPT® 86036,N/A,N/A,N/A, $147.00 , $95.55 , N/A , $12.29 , $12.29 , N/A , N/A , $136.71 , $132.30 , $132.30 , $117.60 , $117.60 , $12.29 , $135.73 , $139.65 , $132.30 , $132.30 , $132.30 , $136.71 , $141.12 , N/A , $124.95 , $58.15 , $35.39 , N/A , $47.24 , $47.24 , $139.65 , $51.94 , $12.29 , $141.12 
 Fac Dir Rpr Arysm&Grf Insj Abdl Aorta Iliac Vsl ,CPT® 35102,0360 - OR SERVICES,N/A,N/A," $6,724.00 "," $4,370.60 "," $5,648.16 "," $1,665.41 "," $2,105.87 "," $5,432.99 "," $6,051.60 "," $5,692.54 "," $6,051.60 "," $6,051.60 "," $6,051.60 "," $5,715.40 "," $2,064.58 "," $6,208.27 "," $6,387.80 "," $5,715.40 "," $6,253.32 "," $6,253.32 "," $6,387.80 "," $6,455.04 "," $5,501.58 "," $6,051.60 "," $5,715.40 "," $5,311.96 ", N/A ," $5,441.73 "," $5,441.73 "," $6,387.80 "," $5,769.86 "," $1,665.41 "," $6,455.04 "
Close Cystostomy,CPT® 51880,N/A,N/A,N/A," $3,245.00 "," $2,109.25 "," $2,519.54 ", $442.90 , $461.04 ," $2,284.59 "," $2,137.52 "," $3,017.85 "," $2,920.50 "," $2,920.50 "," $2,596.00 "," $2,596.00 ", $461.04 ," $2,996.11 "," $3,082.75 "," $2,920.50 "," $2,920.50 "," $2,920.50 "," $3,017.85 "," $3,115.20 "," $2,528.26 "," $2,758.25 "," $2,440.60 "," $2,854.95 ", N/A ," $2,329.16 "," $2,329.16 "," $3,082.75 "," $2,737.58 ", $442.90 ," $3,115.20 "
"US Guide,Vascular Access",CPT® 76937,N/A,N/A,N/A, $379.00 , $246.35 , $222.14 , $38.38 , $33.32 , $151.94 , $188.43 , $352.47 , $341.10 , $341.10 , $303.20 , $303.20 , $33.32 , $349.93 , $360.05 , $341.10 , $341.10 , $341.10 , $352.47 , $363.84 , $211.85 , $322.15 , $206.09 , $176.02 , N/A , $154.91 , $154.91 , $360.05 , $179.33 , $33.32 , $363.84 
 DIPHENHYDRAMINE/MAALOX/LIDOCAINE (EPE) ,HCPCS RXC637,0250 - PHARMACY,00001-0021-01,180 mL, $169.21 , $109.99 , $142.14 , N/A , N/A , $136.72 , $152.29 , $143.25 , $152.29 , $152.29 , $152.29 , $143.83 , N/A , $156.23 , $160.75 , $143.83 , $157.37 , $157.37 , $160.75 , $162.44 , $138.45 , $152.29 , $143.83 , $133.68 , N/A , $136.94 , $136.94 , $160.75 , $145.20 , $133.68 , $162.44 
 CT Lumb/Sacr Inj Second Level ,CPT® 64494,0761 - TREATMENT ROOM,N/A,N/A," $1,688.00 "," $1,097.20 "," $1,417.92 ", $49.11 , $62.02 ," $1,363.90 "," $1,519.20 "," $1,429.06 "," $1,519.20 "," $1,519.20 "," $1,519.20 "," $1,434.80 ", $60.80 ," $1,558.53 "," $1,603.60 "," $1,434.80 "," $1,569.84 "," $1,569.84 "," $1,603.60 "," $1,620.48 "," $1,381.12 "," $1,519.20 "," $1,434.80 "," $1,333.52 ", N/A ," $1,366.10 "," $1,366.10 "," $1,603.60 "," $1,448.47 ", $49.11 ," $1,620.48 "
US Breast Uni Real Time With Image Complete,CPT® 76641,N/A,N/A,N/A, $775.00 , $503.75 , $588.12 , $102.29 , $84.87 , $514.85 , $562.42 , $720.75 , $697.50 , $697.50 , $620.00 , $620.00 , $84.87 , $715.56 , $736.25 , $697.50 , $697.50 , $697.50 , $720.75 , $744.00 , $589.65 , $658.75 , $596.61 , $604.81 , N/A , $524.90 , $524.90 , $736.25 , $607.58 , $84.87 , $744.00 
"Endoscopy W/Video-Asst Vein Harvest,Cabg",CPT® 33508,N/A,N/A,N/A," $1,164.00 ", $756.60 , $94.12 , $14.43 , $15.26 , $68.19 , $67.74 ," $1,082.52 "," $1,047.60 "," $1,047.60 ", $931.20 , $931.20 , $15.26 ," $1,074.72 "," $1,105.80 "," $1,047.60 "," $1,047.60 "," $1,047.60 "," $1,082.52 "," $1,117.44 ", $86.06 , $989.40 , $85.64 , $77.51 , N/A , $69.52 , $69.52 ," $1,105.80 ", $78.96 , $14.43 ," $1,117.44 "
 Shoulder Minimum of 2 Views ,CPT® 73030,0320 - DX X-RAY,N/A,N/A, $282.00 , $183.30 , $236.88 , $34.02 , $28.56 , $227.86 , $253.80 , $238.74 , $253.80 , $253.80 , $253.80 , $239.70 , $28.00 , $260.37 , $267.90 , $239.70 , $262.26 , $262.26 , $267.90 , $270.72 , $230.73 , $253.80 , $239.70 , $222.78 , N/A , $228.22 , $228.22 , $267.90 , $241.98 , $28.00 , $270.72 
Removal Colon/Proctectomy/Ileostomy,CPT® 44155,N/A,N/A,N/A," $13,212.00 "," $8,587.80 "," $12,419.75 "," $1,920.80 "," $1,708.25 "," $9,868.78 "," $9,974.31 "," $12,287.16 "," $11,890.80 "," $11,890.80 "," $10,569.60 "," $10,569.60 "," $1,708.25 "," $12,198.64 "," $12,551.40 "," $11,890.80 "," $11,890.80 "," $11,890.80 "," $12,287.16 "," $12,683.52 "," $8,917.65 "," $11,230.20 "," $11,034.44 "," $11,682.88 ", N/A ," $10,061.33 "," $10,061.33 "," $12,551.40 "," $10,523.08 "," $1,708.25 "," $12,683.52 "
 Pro Apply Bone Fixation Device ,CPT® 20690,0975 - PRO FEE/OR,N/A,N/A," $3,849.00 "," $2,501.85 "," $3,613.81 ", $565.91 , $479.56 ," $2,868.20 "," $2,830.07 "," $3,579.57 "," $3,464.10 "," $3,464.10 "," $3,079.20 "," $3,079.20 ", $479.56 ," $3,553.78 "," $3,656.55 "," $3,464.10 "," $3,464.10 "," $3,464.10 "," $3,579.57 "," $3,695.04 "," $3,363.02 "," $3,271.65 "," $3,123.90 "," $3,380.26 ", N/A ," $2,924.17 "," $2,924.17 "," $3,656.55 "," $3,436.94 ", $479.56 ," $3,695.04 "
"Apply Cast,Finger-Elbow",CPT® 29075,N/A,N/A,N/A, $595.00 , $386.75 , $373.23 , $59.32 , $54.80 , $299.54 , $303.79 , $553.35 , $535.50 , $535.50 , $476.00 , $476.00 , $54.80 , $549.36 , $565.25 , $535.50 , $535.50 , $535.50 , $553.35 , $571.20 , $349.50 , $505.75 , $333.62 , $357.56 , N/A , $305.39 , $305.39 , $565.25 , $358.95 , $54.80 , $571.20 
" Pro Ther Injection, Carp Tunnel ",CPT® 20526,0982 - PRO FEE/OUTPT,N/A,N/A, $498.00 , $323.70 , $344.24 , $53.49 , $26.41 , $280.39 , $270.32 , $463.14 , $448.20 , $448.20 , $398.40 , $398.40 , $26.41 , $459.80 , $473.10 , $448.20 , $448.20 , $448.20 , $463.14 , $478.08 , $320.52 , $423.30 , $297.94 , $328.48 , N/A , $285.86 , $285.86 , $473.10 , $335.99 , $26.41 , $478.08 
"Visual Field Exam,Limited",CPT® 92081,N/A,N/A,N/A, $145.00 , $94.25 , $71.51 , $32.59 , $43.72 , $59.07 , $72.67 , $134.85 , $130.50 , $130.50 , $116.00 , $116.00 , $43.72 , $133.88 , $137.75 , $130.50 , $130.50 , $130.50 , $134.85 , $139.20 , $102.32 , $123.25 , $104.41 , $72.54 , N/A , $60.23 , $60.23 , $137.75 , $71.64 , $32.59 , $139.20 
 RISPERIDONE 2 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6360-61,1 tablet, $36.27 , $23.58 , $30.47 , N/A , N/A , $29.31 , $32.64 , $30.71 , $32.64 , $32.64 , $32.64 , $30.83 , N/A , $33.49 , $34.46 , $30.83 , $33.73 , $33.73 , $34.46 , $34.82 , $29.68 , $32.64 , $30.83 , $28.65 , N/A , $29.35 , $29.35 , $34.46 , $31.12 , $28.65 , $34.82 
 Fac Remvl Perm Pm Plse Gen W/Repl Plse Gen Sngl Lead ,CPT® 33227,0360 - OR SERVICES,N/A,N/A," $8,679.00 "," $5,641.35 "," $7,290.36 ", $313.04 , $257.25 ," $7,012.63 "," $7,811.10 "," $7,347.64 "," $7,811.10 "," $7,811.10 "," $7,811.10 "," $7,377.15 ", $252.21 ," $8,013.32 "," $8,245.05 "," $7,377.15 "," $8,071.47 "," $8,071.47 "," $8,245.05 "," $8,331.84 "," $7,101.16 "," $7,811.10 "," $7,377.15 "," $6,856.41 ", N/A ," $7,023.91 "," $7,023.91 "," $8,245.05 "," $7,447.45 ", $252.21 ," $8,331.84 "
"Sigmoidoscopy,Biopsy",CPT® 45331,N/A,N/A,N/A," $1,411.00 ", $917.15 , $440.31 , $68.50 , $109.66 , $358.68 , $372.82 ," $1,312.23 "," $1,269.90 "," $1,269.90 "," $1,128.80 "," $1,128.80 ", $109.66 ," $1,302.78 "," $1,340.45 "," $1,269.90 "," $1,269.90 "," $1,269.90 "," $1,312.23 "," $1,354.56 ", $315.49 ," $1,199.35 ", $408.55 , $417.80 , N/A , $365.67 , $365.67 ," $1,340.45 ", $382.45 , $68.50 ," $1,354.56 "
Breast Augmentation With Implant,CPT® 19325,N/A,N/A,N/A," $2,437.00 "," $1,584.05 "," $1,957.18 ", $587.01 , $920.99 ," $1,748.50 "," $1,724.72 "," $2,266.41 "," $2,193.30 "," $2,193.30 "," $1,949.60 "," $1,949.60 ", $920.99 ," $2,250.08 "," $2,315.15 "," $2,193.30 "," $2,193.30 "," $2,193.30 "," $2,266.41 "," $2,339.52 "," $2,142.38 "," $2,071.45 "," $3,461.08 "," $2,237.81 ", N/A ," $1,782.61 "," $1,782.61 "," $2,315.15 "," $2,067.23 ", $587.01 ," $3,461.08 "
Contact Layer >16<= 48 Sq In,HCPCS A6207,N/A,N/A,N/A, $16.00 , $10.40 , N/A , $9.97 , $1.73 , N/A , N/A , $14.88 , $14.40 , $14.40 , $12.80 , $12.80 , $1.73 , $14.77 , $15.20 , $14.40 , $14.40 , $14.40 , $14.88 , $15.36 , N/A , $13.60 , $8.43 , $9.04 , N/A , N/A , N/A , $15.20 , N/A , $1.73 , $15.36 
 Fac Bronchoscopy W/Removal Foreign Body ,CPT® 31635,0360 - OR SERVICES,N/A,N/A," $2,970.00 "," $1,930.50 "," $2,494.80 ", $165.46 , $856.82 ," $2,399.76 "," $2,673.00 "," $2,514.40 "," $2,673.00 "," $2,673.00 "," $2,673.00 "," $2,524.50 ", $840.02 ," $2,742.20 "," $2,821.50 "," $2,524.50 "," $2,762.10 "," $2,762.10 "," $2,821.50 "," $2,851.20 "," $2,430.05 "," $2,673.00 "," $2,524.50 "," $2,346.30 ", N/A ," $2,403.62 "," $2,403.62 "," $2,821.50 "," $2,548.56 ", $165.46 ," $2,851.20 "
 LEUCOVORIN CALCIUM 200 MG IJ SOLR ,HCPCS J0640,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9553-01,20 mL, $147.95 , $96.17 , $124.28 , $4.79 , $3.67 , $119.54 , $133.16 , $125.25 , $133.16 , $133.16 , $133.16 , $125.76 , $3.60 , $136.60 , $140.55 , $125.76 , $137.59 , $137.59 , $140.55 , $142.03 , $121.05 , $133.16 , $125.76 , $116.88 , N/A , $119.74 , $119.74 , $140.55 , $126.96 , $3.60 , $142.03 
" Fac Polysomnography, 4 or More ",CPT® 95810,0920 - OTHER DX SVS,N/A,N/A," $4,711.00 "," $3,062.15 "," $3,957.24 ", $595.03 ," $1,061.47 "," $3,806.49 "," $4,239.90 "," $3,988.33 "," $4,239.90 "," $4,239.90 "," $4,239.90 "," $4,004.35 "," $1,040.66 "," $4,349.67 "," $4,475.45 "," $4,004.35 "," $4,381.23 "," $4,381.23 "," $4,475.45 "," $4,522.56 "," $3,854.54 "," $4,239.90 "," $4,004.35 "," $3,721.69 ", N/A ," $3,812.61 "," $3,812.61 "," $4,475.45 "," $4,042.51 ", $595.03 ," $4,522.56 "
Debride Assoc Fx/Disloc Skin/Muscle,CPT® 11011,N/A,N/A,N/A," $3,260.00 "," $2,119.00 ", $929.12 , $276.29 , $407.24 , $805.58 , $781.43 ," $3,031.80 "," $2,934.00 "," $2,934.00 "," $2,608.00 "," $2,608.00 ", $407.24 ," $3,009.96 "," $3,097.00 "," $2,934.00 "," $2,934.00 "," $2,934.00 "," $3,031.80 "," $3,129.60 "," $1,025.13 "," $2,771.00 "," $1,577.11 "," $1,035.45 ", N/A , $821.30 , $821.30 ," $3,097.00 ", $952.43 , $276.29 ," $3,129.60 "
Repair Sliding Inguinal Hernia,CPT® 49525,N/A,N/A,N/A," $3,730.00 "," $2,424.50 "," $3,437.14 ", $533.40 , $614.70 ," $2,688.86 "," $2,728.30 "," $3,468.90 "," $3,357.00 "," $3,357.00 "," $2,984.00 "," $2,984.00 ", $614.70 ," $3,443.91 "," $3,543.50 "," $3,357.00 "," $3,357.00 "," $3,357.00 "," $3,468.90 "," $3,580.80 "," $2,458.57 "," $3,170.50 "," $3,027.56 "," $3,176.35 ", N/A ," $2,741.32 "," $2,741.32 "," $3,543.50 "," $2,867.13 ", $533.40 ," $3,580.80 "
"Incis Thigh Tendon,Adduc/Hamst,Singl",27306,N/A,N/A,N/A," $2,932.00 "," $1,905.80 "," $2,129.53 ", $329.40 , $230.52 ," $1,747.85 "," $1,751.15 "," $2,726.76 "," $2,638.80 "," $2,638.80 "," $2,345.60 "," $2,345.60 ", $230.52 ," $2,707.12 "," $2,785.40 "," $2,638.80 "," $2,638.80 "," $2,638.80 "," $2,726.76 "," $2,814.72 "," $1,951.62 "," $2,492.20 "," $1,932.14 "," $2,012.53 ", N/A ," $1,781.95 "," $1,781.95 "," $2,785.40 "," $2,094.44 ", $230.52 ," $2,814.72 "
Magnetically Controlled Capsule Endoscopy W/I&R,CPT® 0651T,N/A,N/A,N/A," $4,387.00 "," $2,851.55 ", N/A , N/A , N/A , N/A , N/A ," $4,079.91 "," $3,948.30 "," $3,948.30 "," $3,509.60 "," $3,509.60 ", N/A ," $4,050.52 "," $4,167.65 "," $3,948.30 "," $3,948.30 "," $3,948.30 "," $4,079.91 "," $4,211.52 ", N/A ," $3,728.95 ", $472.34 ," $1,471.31 ", N/A , $478.65 , $478.65 ," $4,167.65 ", $557.16 , $472.34 ," $4,211.52 "
 Iadna S Aureus Amp Probe Tq Beaker1 ,CPT® 87640,0306 - LAB/BACT-MICRO,N/A,N/A, $324.00 , $210.60 , $272.16 , $35.79 , $35.79 , $261.79 , $291.60 , $274.30 , $291.60 , $291.60 , $291.60 , $275.40 , $35.09 , $299.15 , $307.80 , $275.40 , $301.32 , $301.32 , $307.80 , $311.04 , $265.10 , $291.60 , $275.40 , $255.96 , N/A , $262.21 , $262.21 , $307.80 , $278.02 , $35.09 , $311.04 
 HEPATITIS A VACCINE 1440 EL U/ML IM SUSP ,HCPCS 90632,0636 - DRUGS REQUIRING DETAILED CODIN,58160-0826-52,1 mL, $490.58 , $318.88 , $412.09 , $73.29 , $69.06 , $396.39 , $441.52 , $415.33 , $441.52 , $441.52 , $441.52 , $416.99 , $67.71 , $452.95 , $466.05 , $416.99 , $456.24 , $456.24 , $466.05 , $470.96 , $401.39 , $441.52 , $416.99 , $387.56 , N/A , $397.03 , $397.03 , $466.05 , $420.97 , $67.71 , $470.96 
 Pd-L1 22c3 Interp Rml 88360 ,CPT® 88360,0310 - PATHOLOGY LAB,N/A,N/A, $864.00 , $561.60 , $725.76 , $116.62 , $107.82 , $698.11 , $777.60 , $731.46 , $777.60 , $777.60 , $777.60 , $734.40 , $105.71 , $797.73 , $820.80 , $734.40 , $803.52 , $803.52 , $820.80 , $829.44 , $706.92 , $777.60 , $734.40 , $682.56 , N/A , $699.24 , $699.24 , $820.80 , $741.40 , $105.71 , $829.44 
 US Guidance for Vascular Access ,CPT® 76937,0402 - ULTRASOUND,N/A,N/A, $409.00 , $265.85 , $343.56 , $38.38 , $33.32 , $330.47 , $368.10 , $346.26 , $368.10 , $368.10 , $368.10 , $347.65 , $32.67 , $377.63 , $388.55 , $347.65 , $380.37 , $380.37 , $388.55 , $392.64 , $334.64 , $368.10 , $347.65 , $323.11 , N/A , $331.00 , $331.00 , $388.55 , $350.96 , $32.67 , $392.64 
" Ivl W/Stent + Pta; Iliac, Fem Pop ",HCPCS C9765,0360 - OR SERVICES,N/A,N/A," $26,642.00 "," $17,317.30 "," $22,379.28 ", N/A , N/A ," $21,526.74 "," $23,977.80 "," $22,555.12 "," $23,977.80 "," $23,977.80 "," $23,977.80 "," $22,645.70 ", N/A ," $24,598.56 "," $25,309.90 "," $22,645.70 "," $24,777.06 "," $24,777.06 "," $25,309.90 "," $25,576.32 "," $21,798.48 "," $23,977.80 "," $22,645.70 "," $21,047.18 ", N/A ," $21,561.37 "," $21,561.37 "," $25,309.90 "," $22,861.50 "," $21,047.18 "," $25,576.32 "
 ETOPOSIDE 100 MG/5ML IV SOLN ,HCPCS J9181,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9510-01,5 mL, $57.74 , $37.53 , $48.50 , $0.71 , $0.91 , $46.65 , $51.97 , $48.88 , $51.97 , $51.97 , $51.97 , $49.08 , $0.89 , $53.31 , $54.85 , $49.08 , $53.70 , $53.70 , $54.85 , $55.43 , $47.24 , $51.97 , $49.08 , $45.61 , N/A , $46.73 , $46.73 , $54.85 , $49.55 , $0.71 , $55.43 
Photochemotherapy With Uv-B,CPT® 96910,N/A,N/A,N/A, $441.00 , $286.65 , $272.76 , $115.47 , $25.41 , $156.37 , $170.54 , $410.13 , $396.90 , $396.90 , $352.80 , $352.80 , $25.41 , $407.18 , $418.95 , $396.90 , $396.90 , $396.90 , $410.13 , $423.36 , $362.21 , $374.85 , $227.07 , $426.07 , N/A , $159.41 , $159.41 , $418.95 , $185.87 , $25.41 , $426.07 
Open Rx a-C Jt Disloc,CPT® 23550,N/A,N/A,N/A," $3,920.00 "," $2,548.00 "," $3,502.46 ", $549.97 , $614.70 ," $2,732.52 "," $2,741.82 "," $3,645.60 "," $3,528.00 "," $3,528.00 "," $3,136.00 "," $3,136.00 ", $614.70 ," $3,619.34 "," $3,724.00 "," $3,528.00 "," $3,528.00 "," $3,528.00 "," $3,645.60 "," $3,763.20 "," $3,250.87 "," $3,332.00 "," $3,023.99 "," $3,205.33 ", N/A ," $2,785.84 "," $2,785.84 "," $3,724.00 "," $3,274.33 ", $549.97 ," $3,763.20 "
 Fac Opn Ax/Subcla Art Expos Dlvr Evasc Prosth Uni ,CPT® 34715,0360 - OR SERVICES,N/A,N/A, $679.00 , $441.35 , $570.36 , $264.83 , $231.06 , $548.63 , $611.10 , $574.84 , $611.10 , $611.10 , $611.10 , $577.15 , $226.53 , $626.92 , $645.05 , $577.15 , $631.47 , $631.47 , $645.05 , $651.84 , $555.56 , $611.10 , $577.15 , $536.41 , N/A , $549.51 , $549.51 , $645.05 , $582.65 , $226.53 , $651.84 
 Pro Breast Placement Loc Device W Mammo Guide ,CPT® 19281,0972 - PRO FEE/RAD/DX,N/A,N/A, $302.00 , $196.30 , $321.40 , $95.05 , $77.40 , $284.24 , $280.04 , $280.86 , $271.80 , $271.80 , $241.60 , $241.60 , $77.40 , $278.84 , $286.90 , $271.80 , $271.80 , $271.80 , $280.86 , $289.92 , $353.68 , $256.70 , $517.09 , $360.36 , N/A , $289.79 , $289.79 , $286.90 , $336.04 , $77.40 , $517.09 
 Fac Cv Strs Tst Xers&/or Rx Cont Ecg Trcg Only ,CPT® 93017,0482 - STRESS TEST,N/A,N/A," $1,150.00 ", $747.50 , $966.00 , $34.70 , $64.05 , $929.20 ," $1,035.00 ", $973.59 ," $1,035.00 "," $1,035.00 "," $1,035.00 ", $977.50 , $62.79 ," $1,061.80 "," $1,092.50 ", $977.50 ," $1,069.50 "," $1,069.50 "," $1,092.50 "," $1,104.00 ", $940.93 ," $1,035.00 ", $977.50 , $908.50 , N/A , $930.70 , $930.70 ," $1,092.50 ", $986.82 , $34.70 ," $1,104.00 "
 DEXTROSE 10 % IV SOLN ,HCPCS RXA258,0258 - IV SOLUTIONS,00990-7930-09,"1,000 mL", $79.82 , $51.88 , $67.05 , N/A , N/A , $64.49 , $71.84 , $67.58 , $71.84 , $71.84 , $71.84 , $67.85 , N/A , $73.70 , $75.83 , $67.85 , $74.23 , $74.23 , $75.83 , $76.63 , $65.31 , $71.84 , $67.85 , $63.06 , N/A , $64.60 , $64.60 , $75.83 , $68.49 , $63.06 , $76.63 
"Closed Rx Femur,Distal+Manip",CPT® 27510,N/A,N/A,N/A," $4,728.00 "," $3,073.20 "," $4,123.21 ", $649.41 , $804.14 ," $3,298.21 "," $3,295.28 "," $4,397.04 "," $4,255.20 "," $4,255.20 "," $3,782.40 "," $3,782.40 ", $804.14 ," $4,365.36 "," $4,491.60 "," $4,255.20 "," $4,255.20 "," $4,255.20 "," $4,397.04 "," $4,538.88 "," $3,845.81 "," $4,018.80 "," $3,639.49 "," $3,885.11 ", N/A ," $3,362.57 "," $3,362.57 "," $4,491.60 "," $3,952.22 ", $649.41 ," $4,538.88 "
 Pro Insj Tunneled Ctr Vad W/Subq Port Age 5 Yr/> ,CPT® 36561,0982 - PRO FEE/OUTPT,N/A,N/A," $7,501.00 "," $4,875.65 "," $2,016.17 ", $311.47 ," $1,557.13 "," $1,534.48 "," $1,527.96 "," $6,975.93 "," $6,750.90 "," $6,750.90 "," $6,000.80 "," $6,000.80 "," $1,557.13 "," $6,925.67 "," $7,125.95 "," $6,750.90 "," $6,750.90 "," $6,750.90 "," $6,975.93 "," $7,200.96 "," $1,865.19 "," $6,375.85 "," $1,901.81 "," $1,665.73 ", N/A ," $1,564.42 "," $1,564.42 "," $7,125.95 "," $1,777.17 ", $311.47 ," $7,200.96 "
Colonoscopy Flx W/Endoscopic Mucosal Resection,45390,N/A,N/A,N/A," $2,139.00 "," $1,390.35 "," $2,040.42 ", $314.66 , $265.41 , N/A , N/A ," $1,989.27 "," $1,925.10 "," $1,925.10 "," $1,711.20 "," $1,711.20 ", $265.41 ," $1,974.94 "," $2,032.05 "," $1,925.10 "," $1,925.10 "," $1,925.10 "," $1,989.27 "," $2,053.44 "," $1,466.15 "," $1,818.15 "," $1,730.74 "," $1,945.15 ", N/A ," $1,490.41 "," $1,490.41 "," $2,032.05 "," $1,559.96 ", $265.41 ," $2,053.44 "
 KETOTIFEN FUMARATE 0.035 % OP SOLN ,HCPCS RXC637,0250 - PHARMACY,00536-1252-40,5 mL, $65.35 , $42.48 , $54.89 , N/A , N/A , $52.80 , $58.82 , $55.33 , $58.82 , $58.82 , $58.82 , $55.55 , N/A , $60.34 , $62.08 , $55.55 , $60.78 , $60.78 , $62.08 , $62.74 , $53.47 , $58.82 , $55.55 , $51.63 , N/A , $52.89 , $52.89 , $62.08 , $56.08 , $51.63 , $62.74 
 CEFTAZIDIME 2 G IV SOLR ,HCPCS J0713,0636 - DRUGS REQUIRING DETAILED CODIN,44567-0236-10,11.5 mL, $61.65 , $40.07 , $51.79 , $1.88 , $2.02 , $49.81 , $55.49 , $52.19 , $55.49 , $55.49 , $55.49 , $52.40 , $1.98 , $56.92 , $58.57 , $52.40 , $57.33 , $57.33 , $58.57 , $59.18 , $50.44 , $55.49 , $52.40 , $48.70 , N/A , $49.89 , $49.89 , $58.57 , $52.90 , $1.88 , $59.18 
"Cystoscopy,Remv Calculus,Simple",52310,N/A,N/A,N/A," $1,227.00 ", $797.55 , $811.61 , $142.63 , $249.02 , $741.48 , $689.79 ," $1,141.11 "," $1,104.30 "," $1,104.30 ", $981.60 , $981.60 , $249.02 ," $1,132.89 "," $1,165.65 "," $1,104.30 "," $1,104.30 "," $1,104.30 "," $1,141.11 "," $1,177.92 ", $815.26 ," $1,042.95 ", $783.20 , $931.02 , N/A , $755.96 , $755.96 ," $1,165.65 ", $888.49 , $142.63 ," $1,177.92 "
Drainage Scrotal Wall Abscess,55100,N/A,N/A,N/A," $1,116.00 ", $725.40 , $740.16 , $160.07 , $30.71 , $530.69 , $546.97 ," $1,037.88 "," $1,004.40 "," $1,004.40 ", $892.80 , $892.80 , $30.71 ," $1,030.40 "," $1,060.20 "," $1,004.40 "," $1,004.40 "," $1,004.40 "," $1,037.88 "," $1,071.36 ", $691.67 , $948.60 , $875.98 , $802.59 , N/A , $541.04 , $541.04 ," $1,060.20 ", $648.45 , $30.71 ," $1,071.36 "
"Excision Nose Polyp(S),Simple",30110,N/A,N/A,N/A, $803.00 , $521.95 , $719.56 , $128.54 , $107.56 , $497.68 , $498.65 , $746.79 , $722.70 , $722.70 , $642.40 , $642.40 , $107.56 , $741.41 , $762.85 , $722.70 , $722.70 , $722.70 , $746.79 , $770.88 , $681.27 , $682.55 , $701.14 , $655.64 , N/A , $507.40 , $507.40 , $762.85 , $597.56 , $107.56 , $770.88 
Complex Cystometrogram Urethral Press Profile,CPT® 51727,N/A,N/A,N/A," $2,154.00 "," $1,400.10 "," $2,056.66 ", $358.59 , $248.22 ," $1,504.70 "," $1,482.09 "," $2,003.22 "," $1,938.60 "," $1,938.60 "," $1,723.20 "," $1,723.20 ", $248.22 ," $1,988.79 "," $2,046.30 "," $1,938.60 "," $1,938.60 "," $1,938.60 "," $2,003.22 "," $2,067.84 "," $2,040.37 "," $1,830.90 "," $1,682.37 "," $1,918.17 ", N/A ," $1,534.06 "," $1,534.06 "," $2,046.30 "," $1,803.06 ", $248.22 ," $2,067.84 "
" Fac Tte W or W/O Fol W/Cont, Com ",HCPCS C8921,0480 - CARDIOLOGY,N/A,N/A," $2,336.00 "," $1,518.40 "," $1,962.24 ", N/A , N/A ," $1,887.49 "," $2,102.40 "," $1,977.66 "," $2,102.40 "," $2,102.40 "," $2,102.40 "," $1,985.60 ", N/A ," $2,156.83 "," $2,219.20 "," $1,985.60 "," $2,172.48 "," $2,172.48 "," $2,219.20 "," $2,242.56 "," $1,911.32 "," $2,102.40 "," $1,985.60 "," $1,845.44 ", N/A ," $1,890.52 "," $1,890.52 "," $2,219.20 "," $2,004.52 "," $1,845.44 "," $2,242.56 "
 Abdomen MRI Without Contrast ,CPT® 74181,0614 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI-OTHER,N/A,N/A," $4,632.00 "," $3,010.80 "," $3,890.88 ", $201.61 , $416.70 ," $3,742.66 "," $4,168.80 "," $3,921.45 "," $4,168.80 "," $4,168.80 "," $4,168.80 "," $3,937.20 ", $408.53 ," $4,276.73 "," $4,400.40 "," $3,937.20 "," $4,307.76 "," $4,307.76 "," $4,400.40 "," $4,446.72 "," $3,789.90 "," $4,168.80 "," $3,937.20 "," $3,659.28 ", N/A ," $3,748.68 "," $3,748.68 "," $4,400.40 "," $3,974.72 ", $201.61 ," $4,446.72 "
"Repair Ing Hernia,5+Y/O,Strang",49507,N/A,N/A,N/A," $3,844.00 "," $2,498.60 "," $3,519.62 ", $546.36 , $540.39 ," $2,746.91 "," $2,791.12 "," $3,574.92 "," $3,459.60 "," $3,459.60 "," $3,075.20 "," $3,075.20 ", $540.39 ," $3,549.17 "," $3,651.80 "," $3,459.60 "," $3,459.60 "," $3,459.60 "," $3,574.92 "," $3,690.24 "," $2,513.95 "," $3,267.40 "," $3,098.92 "," $3,250.04 ", N/A ," $2,800.50 "," $2,800.50 "," $3,651.80 "," $2,929.02 ", $540.39 ," $3,690.24 "
Lens Sphere Trifocal 4.12-7.,HCPCS V2301,N/A,N/A,N/A, $90.00 , $58.50 , N/A , $102.29 , N/A , N/A , N/A , $83.70 , $81.00 , $81.00 , $72.00 , $72.00 , N/A , $83.10 , $85.50 , $81.00 , $81.00 , $81.00 , $83.70 , $86.40 , N/A , $76.50 , $90.00 , $92.92 , N/A , N/A , N/A , $85.50 , N/A , $72.00 , $102.29 
 LISDEXAMFETAMINE DIMESYLATE 20 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,59417-0102-10,1 capsule, $75.89 , $49.33 , $63.75 , N/A , N/A , $61.32 , $68.30 , $64.25 , $68.30 , $68.30 , $68.30 , $64.51 , N/A , $70.07 , $72.10 , $64.51 , $70.58 , $70.58 , $72.10 , $72.85 , $62.09 , $68.30 , $64.51 , $59.95 , N/A , $61.42 , $61.42 , $72.10 , $65.12 , $59.95 , $72.85 
Needle Emg Ea Extremity W/Paraspinl Area Limited,CPT® 95885,N/A,N/A,N/A, $412.00 , $267.80 , $239.67 , $61.13 , $43.69 , $186.88 , $208.50 , $383.16 , $370.80 , $370.80 , $329.60 , $329.60 , $43.69 , $380.40 , $391.40 , $370.80 , $370.80 , $370.80 , $383.16 , $395.52 , $288.52 , $350.20 , $182.47 , $224.27 , N/A , $190.53 , $190.53 , $391.40 , $234.23 , $43.69 , $395.52 
Njx Aa&/Strd Plantar Common Digital Nerves,CPT® 64455,N/A,N/A,N/A, $327.00 , $212.55 , $167.49 , $32.49 , $46.56 , $195.24 , $188.41 , $304.11 , $294.30 , $294.30 , $261.60 , $261.60 , $46.56 , $301.92 , $310.65 , $294.30 , $294.30 , $294.30 , $304.11 , $313.92 , $182.48 , $277.95 , $183.76 , $211.36 , N/A , $199.05 , $199.05 , $310.65 , $213.53 , $32.49 , $313.92 
Rmvl of Subq Implantable Defibrillator Electrode,CPT® 33272,N/A,N/A,N/A," $2,203.00 "," $1,431.95 "," $2,069.47 ", $319.67 , $318.69 ," $1,730.11 "," $1,577.16 "," $2,048.79 "," $1,982.70 "," $1,982.70 "," $1,762.40 "," $1,762.40 ", $318.69 ," $2,034.03 "," $2,092.85 "," $1,982.70 "," $1,982.70 "," $1,982.70 "," $2,048.79 "," $2,114.88 "," $1,907.47 "," $1,872.55 "," $1,823.14 "," $1,695.95 ", N/A ," $1,763.87 "," $1,763.87 "," $2,092.85 "," $2,003.77 ", $318.69 ," $2,114.88 "
Normal Saline Solution Infus,HCPCS J7030,N/A,N/A,N/A, $27.00 , $17.55 , N/A , $2.59 , $2.69 , N/A , N/A , $25.11 , $24.30 , $24.30 , $21.60 , $21.60 , $2.69 , $24.93 , $25.65 , $24.30 , $24.30 , $24.30 , $25.11 , $25.92 , $3.76 , $22.95 , $1.95 , $3.54 , N/A , N/A , N/A , $25.65 , N/A , $1.95 , $25.92 
 Pfizer Covid Booster Tris-Sucrose Formulation ,CPT® 0054A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , N/A , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , N/A , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $55.30 , $67.20 
 Fac Njx Cholangio Prq W/Img Gid Rs&I New Access ,CPT® 47532,0361 - OR/MINOR,N/A,N/A," $4,675.00 "," $3,038.75 "," $3,927.00 ", $199.29 , $973.75 ," $3,777.40 "," $4,207.50 "," $3,957.86 "," $4,207.50 "," $4,207.50 "," $4,207.50 "," $3,973.75 ", $954.66 ," $4,316.43 "," $4,441.25 "," $3,973.75 "," $4,347.75 "," $4,347.75 "," $4,441.25 "," $4,488.00 "," $3,825.09 "," $4,207.50 "," $3,973.75 "," $3,693.25 ", N/A ," $3,783.48 "," $3,783.48 "," $4,441.25 "," $4,011.62 ", $199.29 ," $4,488.00 "
 Pro Lumbar Spine Fusion ,CPT® 22558,0982 - PRO FEE/OUTPT,N/A,N/A," $10,107.00 "," $6,569.55 "," $9,007.51 "," $1,403.90 "," $1,324.58 "," $7,391.14 "," $7,300.82 "," $9,399.51 "," $9,096.30 "," $9,096.30 "," $8,085.60 "," $8,085.60 "," $1,324.58 "," $9,331.79 "," $9,601.65 "," $9,096.30 "," $9,096.30 "," $9,096.30 "," $9,399.51 "," $9,702.72 "," $8,402.03 "," $8,590.95 "," $8,162.09 "," $8,574.83 ", N/A ," $7,535.35 "," $7,535.35 "," $9,601.65 "," $8,856.71 "," $1,324.58 "," $9,702.72 "
 Fac Assay of Digoxin ,CPT® 80162,0301 - LAB/CHEMISTRY,N/A,N/A, $124.00 , $80.60 , $104.16 , $13.55 , $13.55 , $100.19 , $111.60 , $104.98 , $111.60 , $111.60 , $111.60 , $105.40 , $13.28 , $114.49 , $117.80 , $105.40 , $115.32 , $115.32 , $117.80 , $119.04 , $101.46 , $111.60 , $105.40 , $97.96 , N/A , $100.35 , $100.35 , $117.80 , $106.40 , $13.28 , $119.04 
 Pro Removal Impacted Cerumen Irrig/Lavg ,CPT® 69209,0982 - PRO FEE/OUTPT,N/A,N/A, $111.00 , $72.15 , $72.25 , $14.88 , $9.93 , $59.81 , $59.38 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $9.93 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $77.94 , $94.35 , $81.74 , $68.74 , N/A , $60.98 , $60.98 , $105.45 , $69.62 , $9.93 , $106.56 
 Pro Laparoscopic Cholecystectomy ,CPT® 47562,0982 - PRO FEE/OUTPT,N/A,N/A," $6,054.00 "," $3,935.10 "," $3,944.33 ", $610.67 , $630.06 ," $3,936.84 "," $3,928.65 "," $5,630.22 "," $5,448.60 "," $5,448.60 "," $4,843.20 "," $4,843.20 ", $630.06 ," $5,589.66 "," $5,751.30 "," $5,448.60 "," $5,448.60 "," $5,448.60 "," $5,630.22 "," $5,811.84 "," $4,842.72 "," $5,145.90 "," $3,477.14 "," $3,647.95 ", N/A ," $4,013.66 "," $4,013.66 "," $5,751.30 "," $4,629.35 ", $610.67 ," $5,811.84 "
 Pro Cryocautery of Cervix ,CPT® 57511,0982 - PRO FEE/OUTPT,N/A,N/A, $927.00 , $602.55 , $701.00 , $142.02 , $69.95 , $538.37 , $542.75 , $862.11 , $834.30 , $834.30 , $741.60 , $741.60 , $69.95 , $855.90 , $880.65 , $834.30 , $834.30 , $834.30 , $862.11 , $889.92 , $717.51 , $787.95 , $711.84 , $541.15 , N/A , $548.87 , $548.87 , $880.65 , $658.34 , $69.95 , $889.92 
Removal of Anal Fissure,CPT® 46200,N/A,N/A,N/A," $2,948.00 "," $1,916.20 "," $2,088.39 ", $326.31 , $213.54 ," $1,549.52 "," $1,606.20 "," $2,741.64 "," $2,653.20 "," $2,653.20 "," $2,358.40 "," $2,358.40 ", $213.54 ," $2,721.89 "," $2,800.60 "," $2,653.20 "," $2,653.20 "," $2,653.20 "," $2,741.64 "," $2,830.08 "," $1,486.47 "," $2,505.80 "," $1,759.09 "," $1,859.79 ", N/A ," $1,579.75 "," $1,579.75 "," $2,800.60 "," $1,652.26 ", $213.54 ," $2,830.08 "
 Other Kidney And Urinary Tract Diagnoses With McC ,MS DRG V40 (FY2023) 698,N/A,N/A,N/A," $19,446.86 "," $12,640.46 "," $16,335.36 ", N/A , N/A ," $15,713.06 "," $17,502.17 "," $16,463.71 "," $17,502.17 "," $17,502.17 "," $17,502.17 "," $16,529.83 ", N/A ," $17,955.29 "," $18,474.52 "," $16,529.83 "," $18,085.58 "," $18,085.58 "," $18,474.52 "," $18,668.99 "," $15,911.42 "," $17,502.17 "," $16,529.83 "," $15,363.02 ", N/A ," $15,738.34 "," $15,738.34 "," $18,474.52 "," $16,687.35 "," $15,363.02 "," $18,668.99 "
"Removal,Inflatable Sphincter",CPT® 53446,N/A,N/A,N/A," $4,474.00 "," $2,908.10 "," $3,488.99 ", $613.82 , $696.25 ," $3,140.41 "," $2,931.64 "," $4,160.82 "," $4,026.60 "," $4,026.60 "," $3,579.20 "," $3,579.20 ", $696.25 ," $4,130.84 "," $4,250.30 "," $4,026.60 "," $4,026.60 "," $4,026.60 "," $4,160.82 "," $4,295.04 "," $3,497.20 "," $3,802.90 "," $3,320.14 "," $3,951.17 ", N/A ," $3,201.68 "," $3,201.68 "," $4,250.30 "," $3,763.13 ", $613.82 ," $4,295.04 "
 CT Virtual Colon Diag W/O Contrast ,CPT® 74261,0350 - CT SCAN,N/A,N/A," $6,941.00 "," $4,511.65 "," $5,830.44 ", $216.05 , $516.26 ," $5,608.33 "," $6,246.90 "," $5,876.25 "," $6,246.90 "," $6,246.90 "," $6,246.90 "," $5,899.85 ", $506.14 ," $6,408.63 "," $6,593.95 "," $5,899.85 "," $6,455.13 "," $6,455.13 "," $6,593.95 "," $6,663.36 "," $5,679.13 "," $6,246.90 "," $5,899.85 "," $5,483.39 ", N/A ," $5,617.35 "," $5,617.35 "," $6,593.95 "," $5,956.07 ", $216.05 ," $6,663.36 "
 Thoracic Spine 2 Views- Mh ,CPT® 72070,0972 - PRO FEE/RAD/DX,N/A,N/A, $136.00 , $88.40 , $185.02 , $32.42 , $32.08 , $148.61 , $178.84 , $126.48 , $122.40 , $122.40 , $108.80 , $108.80 , $32.08 , $125.57 , $129.20 , $122.40 , $122.40 , $122.40 , $126.48 , $130.56 , $178.67 , $115.60 , $196.46 , $171.36 , N/A , $151.51 , $151.51 , $129.20 , $175.38 , $32.08 , $196.46 
"Exc Skin Malig >4cm Trunk,Arm,Leg",CPT® 11606,N/A,N/A,N/A," $1,933.00 "," $1,256.45 "," $1,003.41 ", $298.77 , $439.58 , $869.82 , $842.77 ," $1,797.69 "," $1,739.70 "," $1,739.70 "," $1,546.40 "," $1,546.40 ", $439.58 ," $1,784.74 "," $1,836.35 "," $1,739.70 "," $1,739.70 "," $1,739.70 "," $1,797.69 "," $1,855.68 "," $1,100.70 "," $1,643.05 "," $1,689.51 "," $1,111.40 ", N/A , $886.79 , $886.79 ," $1,836.35 "," $1,028.36 ", $298.77 ," $1,855.68 "
"Fusion Foot Bones,Midtarsal,Osteotmy",CPT® 28735,N/A,N/A,N/A," $7,240.00 "," $4,706.00 "," $4,799.80 ", $748.74 , $768.38 ," $3,816.01 "," $3,795.73 "," $6,733.20 "," $6,516.00 "," $6,516.00 "," $5,792.00 "," $5,792.00 ", $768.38 ," $6,684.69 "," $6,878.00 "," $6,516.00 "," $6,516.00 "," $6,516.00 "," $6,733.20 "," $6,950.40 "," $4,451.90 "," $6,154.00 "," $4,155.09 "," $4,519.07 ", N/A ," $3,890.46 "," $3,890.46 "," $6,878.00 "," $4,572.67 ", $748.74 ," $6,950.40 "
Rp Loclzj Tum Plnr Whole Body Single Day Imaging,CPT® 78802,N/A,N/A,N/A," $2,743.00 "," $1,782.95 "," $1,660.89 ", $283.34 , $262.76 ," $1,594.84 "," $1,725.37 "," $2,550.99 "," $2,468.70 "," $2,468.70 "," $2,194.40 "," $2,194.40 ", $262.76 ," $2,532.61 "," $2,605.85 "," $2,468.70 "," $2,468.70 "," $2,468.70 "," $2,550.99 "," $2,633.28 "," $1,733.66 "," $2,331.55 "," $1,883.67 "," $2,178.44 ", N/A ," $1,625.97 "," $1,625.97 "," $2,605.85 "," $1,882.09 ", $262.76 ," $2,633.28 "
 Fac Cytogenetics&Molec Cytogenetics I&R ,CPT® 88291,0310 - PATHOLOGY LAB,N/A,N/A, $457.00 , $297.05 , $383.88 , $31.99 , $5.77 , $369.26 , $411.30 , $386.90 , $411.30 , $411.30 , $411.30 , $388.45 , $5.66 , $421.95 , $434.15 , $388.45 , $425.01 , $425.01 , $434.15 , $438.72 , $373.92 , $411.30 , $388.45 , $361.03 , N/A , $369.85 , $369.85 , $434.15 , $392.15 , $5.66 , $438.72 
Methylprednisolone 80 Mg Inj,HCPCS J1040,N/A,N/A,N/A, $32.00 , $20.80 , N/A , $12.15 , $13.01 , N/A , N/A , $29.76 , $28.80 , $28.80 , $25.60 , $25.60 , $13.01 , $29.55 , $30.40 , $28.80 , $28.80 , $28.80 , $29.76 , $30.72 , $13.53 , $27.20 , $10.38 , $15.11 , N/A , N/A , N/A , $30.40 , N/A , $10.38 , $30.72 
 POTASSIUM BICARB-CITRIC ACID 10 MEQ PO TBEF ,HCPCS RXC637,0250 - PHARMACY,51801-0014-30,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Revision Vaginal Graft,CPT® 57295,N/A,N/A,N/A," $2,942.00 "," $1,912.30 "," $2,385.00 ", $482.42 , $410.72 ," $1,950.59 "," $1,942.07 "," $2,736.06 "," $2,647.80 "," $2,647.80 "," $2,353.60 "," $2,353.60 ", $410.72 ," $2,716.35 "," $2,794.90 "," $2,647.80 "," $2,647.80 "," $2,647.80 "," $2,736.06 "," $2,824.32 "," $2,473.28 "," $2,500.70 "," $2,538.72 "," $1,964.70 ", N/A ," $1,988.65 "," $1,988.65 "," $2,794.90 "," $2,385.25 ", $410.72 ," $2,824.32 "
 Pro Prolonged Inpatient/Observation Em Svc Ea 15 Min ,CPT® 99418,0987 - PRO FEE/HOS VIS,N/A,N/A, $162.00 , $105.30 , N/A , $38.61 , N/A , N/A , N/A , $150.66 , $145.80 , $145.80 , $129.60 , $129.60 , N/A , $149.57 , $153.90 , $145.80 , $145.80 , $145.80 , $150.66 , $155.52 , N/A , $137.70 , $86.66 , N/A , N/A , $73.88 , $73.88 , $153.90 , $88.65 , $38.61 , $155.52 
 Fac Iaad Ia Not Otherwise Specified Each Organism ,CPT® 87449,0306 - LAB/BACT-MICRO,N/A,N/A, $169.00 , $109.85 , $141.96 , $12.22 , $12.22 , $136.55 , $152.10 , $143.08 , $152.10 , $152.10 , $152.10 , $143.65 , $11.98 , $156.04 , $160.55 , $143.65 , $157.17 , $157.17 , $160.55 , $162.24 , $138.28 , $152.10 , $143.65 , $133.51 , N/A , $136.77 , $136.77 , $160.55 , $145.02 , $11.98 , $162.24 
Assay Thyroid Stim Hormone,CPT® 84443,N/A,N/A,N/A, $168.00 , $109.20 , N/A , $17.14 , $17.14 , $95.09 , $113.73 , $156.24 , $151.20 , $151.20 , $134.40 , $134.40 , $17.14 , $155.11 , $159.60 , $151.20 , $151.20 , $151.20 , $156.24 , $161.28 , $112.18 , $142.80 , $110.29 , $60.94 , N/A , $88.74 , $88.74 , $159.60 , $96.97 , $17.14 , $161.28 
 Lt Joint Upper Extrem W/Contrast ,CPT® 73222,0610 - MRI,N/A,N/A," $6,724.00 "," $4,370.60 "," $5,648.16 ", $323.39 , $498.05 ," $5,432.99 "," $6,051.60 "," $5,692.54 "," $6,051.60 "," $6,051.60 "," $6,051.60 "," $5,715.40 ", $488.28 ," $6,208.27 "," $6,387.80 "," $5,715.40 "," $6,253.32 "," $6,253.32 "," $6,387.80 "," $6,455.04 "," $5,501.58 "," $6,051.60 "," $5,715.40 "," $5,311.96 ", N/A ," $5,441.73 "," $5,441.73 "," $6,387.80 "," $5,769.86 ", $323.39 ," $6,455.04 "
"Destr Corneal Lesn,Cryo,Photo,Therm",CPT® 65450,N/A,N/A,N/A," $2,936.00 "," $1,908.40 "," $1,979.58 ", $312.56 , $61.48 ," $1,816.91 "," $1,710.02 "," $2,730.48 "," $2,642.40 "," $2,642.40 "," $2,348.80 "," $2,348.80 ", $61.48 ," $2,710.81 "," $2,789.20 "," $2,642.40 "," $2,642.40 "," $2,642.40 "," $2,730.48 "," $2,818.56 "," $2,718.96 "," $2,495.60 "," $1,753.73 "," $2,316.42 ", N/A ," $1,852.36 "," $1,852.36 "," $2,789.20 "," $2,044.76 ", $61.48 ," $2,818.56 "
 Pfizer Third Dose Tris-Sucrose Formulation ,CPT® 0053A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
Fine Needle Aspiration Bx W/O Img Gdn 1st Lesion,10021,N/A,N/A,N/A, $492.00 , $319.80 , $175.24 , $52.22 , $77.05 , $190.96 , $184.90 , $457.56 , $442.80 , $442.80 , $393.60 , $393.60 , $77.05 , $454.26 , $467.40 , $442.80 , $442.80 , $442.80 , $457.56 , $472.32 , $183.62 , $418.20 , $371.09 , $242.14 , N/A , $194.69 , $194.69 , $467.40 , $225.77 , $52.22 , $472.32 
 Pro Home/Res Visit Est Patient High Mdm 60 Minutes ,CPT® 99350,0987 - PRO FEE/HOS VIS,N/A,N/A, $452.00 , $293.80 , $354.21 , $181.33 , $148.39 , $305.54 , $307.42 , $420.36 , $406.80 , $406.80 , $361.60 , $361.60 , $148.39 , $417.33 , $429.40 , $406.80 , $406.80 , $406.80 , $420.36 , $433.92 , $323.15 , $384.20 , $382.55 , $391.52 , N/A , $311.50 , $311.50 , $429.40 , $359.26 , $148.39 , $433.92 
 F2 Gene Analy 20210g >a Variant Beaker1 ,CPT® 81240,0310 - PATHOLOGY LAB,N/A,N/A, $556.00 , $361.40 , $467.04 , $67.00 , $54.77 , $449.25 , $500.40 , $470.71 , $500.40 , $500.40 , $500.40 , $472.60 , $53.70 , $513.35 , $528.20 , $472.60 , $517.08 , $517.08 , $528.20 , $533.76 , $454.92 , $500.40 , $472.60 , $439.24 , N/A , $449.97 , $449.97 , $528.20 , $477.10 , $53.70 , $533.76 
Assay of Ethosuximide,CPT® 80168,N/A,N/A,N/A, $152.00 , $98.80 , N/A , $16.67 , $16.67 , $92.46 , $110.62 , $141.36 , $136.80 , $136.80 , $121.60 , $121.60 , $16.67 , $140.34 , $144.40 , $136.80 , $136.80 , $136.80 , $141.36 , $145.92 , $109.11 , $129.20 , $107.04 , $59.24 , N/A , $86.29 , $86.29 , $144.40 , $94.30 , $16.67 , $145.92 
"Assay Alkal Phosphatase,Isoenzymes",CPT® 84080,N/A,N/A,N/A, $158.00 , $102.70 , N/A , $15.08 , $15.08 , $83.65 , $100.09 , $146.94 , $142.20 , $142.20 , $126.40 , $126.40 , $15.08 , $145.88 , $150.10 , $142.20 , $142.20 , $142.20 , $146.94 , $151.68 , $98.69 , $134.30 , $97.31 , $53.60 , N/A , $78.07 , $78.07 , $150.10 , $85.31 , $15.08 , $151.68 
" Drainage of Finger Abscess, Simple -Mh ",CPT® 26010,0361 - OR/MINOR,N/A,N/A, $739.00 , $480.35 , $620.76 , $136.36 , $30.71 , $597.11 , $665.10 , $625.64 , $665.10 , $665.10 , $665.10 , $628.15 , $30.11 , $682.32 , $702.05 , $628.15 , $687.27 , $687.27 , $702.05 , $709.44 , $604.65 , $665.10 , $628.15 , $583.81 , N/A , $598.07 , $598.07 , $702.05 , $634.14 , $30.11 , $709.44 
 OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN ,HCPCS J2354,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0377-01,0.4 mL, $122.53 , $79.64 , $102.93 , $1.34 , $1.45 , $99.00 , $110.28 , $103.73 , $110.28 , $110.28 , $110.28 , $104.15 , $1.42 , $113.13 , $116.40 , $104.15 , $113.95 , $113.95 , $116.40 , $117.63 , $100.25 , $110.28 , $104.15 , $96.80 , N/A , $99.16 , $99.16 , $116.40 , $105.14 , $1.34 , $117.63 
 PROPRANOLOL HCL 80 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00603-5486-21,1 tablet, $4.98 , $3.24 , $4.18 , N/A , N/A , $4.02 , $4.48 , $4.22 , $4.48 , $4.48 , $4.48 , $4.23 , N/A , $4.60 , $4.73 , $4.23 , $4.63 , $4.63 , $4.73 , $4.78 , $4.07 , $4.48 , $4.23 , $3.93 , N/A , $4.03 , $4.03 , $4.73 , $4.27 , $3.93 , $4.78 
Correct Lagophthalmos W Implant,CPT® 67912,N/A,N/A,N/A," $8,381.00 "," $5,447.65 "," $2,976.87 ", $467.69 , $955.68 ," $2,766.75 "," $2,582.16 "," $7,794.33 "," $7,542.90 "," $7,542.90 "," $6,704.80 "," $6,704.80 ", $955.68 ," $7,738.18 "," $7,961.95 "," $7,542.90 "," $7,542.90 "," $7,542.90 "," $7,794.33 "," $8,045.76 "," $4,079.77 "," $7,123.85 "," $2,656.47 "," $3,483.24 ", N/A ," $2,820.74 "," $2,820.74 "," $7,961.95 "," $3,113.72 ", $467.69 ," $8,045.76 "
 Pro Fixation of Knee Joint ,CPT® 27570,0982 - PRO FEE/OUTPT,N/A,N/A, $479.00 , $311.35 , $931.58 , $147.22 , $151.20 , $726.41 , $730.37 , $445.47 , $431.10 , $431.10 , $383.20 , $383.20 , $151.20 , $442.26 , $455.05 , $431.10 , $431.10 , $431.10 , $445.47 , $459.84 , $859.06 , $407.15 , $802.83 , $858.23 , N/A , $740.58 , $740.58 , $455.05 , $870.45 , $147.22 , $931.58 
 Fac in Situ Hybridization Ea Multiplex Probe Stain ,CPT® 88366,0310 - PATHOLOGY LAB,N/A,N/A, $836.00 , $543.40 , $702.24 , $274.14 , $117.74 , $675.49 , $752.40 , $707.76 , $752.40 , $752.40 , $752.40 , $710.60 , $115.43 , $771.88 , $794.20 , $710.60 , $777.48 , $777.48 , $794.20 , $802.56 , $684.02 , $752.40 , $710.60 , $660.44 , N/A , $676.57 , $676.57 , $794.20 , $717.37 , $115.43 , $802.56 
"Polarization, Any Lens",HCPCS V2762,N/A,N/A,N/A, $58.00 , $37.70 , N/A , $69.86 , N/A , N/A , N/A , $53.94 , $52.20 , $52.20 , $46.40 , $46.40 , N/A , $53.55 , $55.10 , $52.20 , $52.20 , $52.20 , $53.94 , $55.68 , N/A , $49.30 , $58.00 , $63.48 , N/A , N/A , N/A , $55.10 , N/A , $46.40 , $69.86 
 KCL IN DEXTROSE-NACL 40-5-0.45 MEQ/L-%-% IV SOLN ,HCPCS RXA258,0258 - IV SOLUTIONS,00990-7904-09,"1,000 mL", $106.42 , $69.17 , $89.39 , N/A , N/A , $85.99 , $95.78 , $90.10 , $95.78 , $95.78 , $95.78 , $90.46 , N/A , $98.26 , $101.10 , $90.46 , $98.97 , $98.97 , $101.10 , $102.16 , $87.07 , $95.78 , $90.46 , $84.07 , N/A , $86.13 , $86.13 , $101.10 , $91.32 , $84.07 , $102.16 
 Pro Arthrs Elbw Surg Synvct Compl ,CPT® 29836,0982 - PRO FEE/OUTPT,N/A,N/A," $3,728.00 "," $2,423.20 "," $3,574.61 ", $561.03 , $630.68 ," $2,782.10 "," $2,772.14 "," $3,467.04 "," $3,355.20 "," $3,355.20 "," $2,982.40 "," $2,982.40 ", $630.68 ," $3,442.06 "," $3,541.60 "," $3,355.20 "," $3,355.20 "," $3,355.20 "," $3,467.04 "," $3,578.88 "," $3,312.52 "," $3,168.80 "," $3,059.67 "," $3,310.25 ", N/A ," $2,836.38 "," $2,836.38 "," $3,541.60 "," $3,333.77 ", $561.03 ," $3,578.88 "
"Repair Profundus Tendon,Primary",CPT® 26370,N/A,N/A,N/A," $5,211.00 "," $3,387.15 "," $4,948.91 ", $767.49 , $774.05 ," $3,614.46 "," $3,659.57 "," $4,846.23 "," $4,689.90 "," $4,689.90 "," $4,168.80 "," $4,168.80 ", $774.05 ," $4,811.32 "," $4,950.45 "," $4,689.90 "," $4,689.90 "," $4,689.90 "," $4,846.23 "," $5,002.56 "," $4,573.27 "," $4,429.35 "," $4,012.36 "," $4,303.50 ", N/A ," $3,684.98 "," $3,684.98 "," $4,950.45 "," $4,331.14 ", $767.49 ," $5,002.56 "
 Pro US Head/Neck Thyroid or Neck Mass- Lh ,CPT® 76536,0972 - PRO FEE/RAD/DX,N/A,N/A, $357.00 , $232.05 , $637.19 , $109.87 , $87.55 , $555.80 , $647.71 , $332.01 , $321.30 , $321.30 , $285.60 , $285.60 , $87.55 , $329.62 , $339.15 , $321.30 , $321.30 , $321.30 , $332.01 , $342.72 , $644.21 , $303.45 , $706.86 , $655.97 , N/A , $566.64 , $566.64 , $339.15 , $655.90 , $87.55 , $706.86 
 Inj Proc Shoulder Arthro ,CPT® 23350,0761 - TREATMENT ROOM,N/A,N/A, $415.00 , $269.75 , $348.60 , $48.12 , $41.91 , $335.32 , $373.50 , $351.34 , $373.50 , $373.50 , $373.50 , $352.75 , $41.09 , $383.17 , $394.25 , $352.75 , $385.95 , $385.95 , $394.25 , $398.40 , $339.55 , $373.50 , $352.75 , $327.85 , N/A , $335.86 , $335.86 , $394.25 , $356.11 , $41.09 , $398.40 
Complement/Function Activity,CPT® 86161,N/A,N/A,N/A, $190.00 , $123.50 , N/A , $12.24 , $12.24 , $67.89 , $81.23 , $176.70 , $171.00 , $171.00 , $152.00 , $152.00 , $12.24 , $175.43 , $180.50 , $171.00 , $171.00 , $171.00 , $176.70 , $182.40 , $80.13 , $161.50 , $77.85 , $43.50 , N/A , $63.36 , $63.36 , $180.50 , $69.24 , $12.24 , $182.40 
Moderna Admin Peds 6m - 5y First Dose,CPT® 0111A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $56.00 , $128.02 , N/A , N/A , N/A , $66.50 , N/A , $38.92 , $128.02 
 METOPROLOL SUCCINATE ER 100 MG PO TB24 ,HCPCS RXC637,0250 - PHARMACY,00904-6324-61,1 tablet, $9.58 , $6.23 , $8.05 , N/A , N/A , $7.74 , $8.62 , $8.11 , $8.62 , $8.62 , $8.62 , $8.14 , N/A , $8.85 , $9.10 , $8.14 , $8.91 , $8.91 , $9.10 , $9.20 , $7.84 , $8.62 , $8.14 , $7.57 , N/A , $7.75 , $7.75 , $9.10 , $8.22 , $7.57 , $9.20 
 Fac Needle Emg Ea Extremty W/Paraspinl Area Complete ,CPT® 95886,0922 - EMG,N/A,N/A, $339.00 , $220.35 , $284.76 , $96.17 , $68.64 , $273.91 , $305.10 , $287.00 , $305.10 , $305.10 , $305.10 , $288.15 , $67.29 , $313.00 , $322.05 , $288.15 , $315.27 , $315.27 , $322.05 , $325.44 , $277.37 , $305.10 , $288.15 , $267.81 , N/A , $274.35 , $274.35 , $322.05 , $290.90 , $67.29 , $325.44 
 Fac Ins Pacemaker Pulse Gen Only W/Exist Dual Leads ,CPT® 33213,0360 - OR SERVICES,N/A,N/A," $4,414.00 "," $2,869.10 "," $3,707.76 ", $309.91 , $569.99 ," $3,566.51 "," $3,972.60 "," $3,736.89 "," $3,972.60 "," $3,972.60 "," $3,972.60 "," $3,751.90 ", $558.81 ," $4,075.45 "," $4,193.30 "," $3,751.90 "," $4,105.02 "," $4,105.02 "," $4,193.30 "," $4,237.44 "," $3,611.53 "," $3,972.60 "," $3,751.90 "," $3,487.06 ", N/A ," $3,572.25 "," $3,572.25 "," $4,193.30 "," $3,787.65 ", $309.91 ," $4,237.44 "
" Fac Vein X-Ray, Adrenal Gland ",CPT® 75840,0320 - DX X-RAY,N/A,N/A, $756.00 , $491.40 , $635.04 , $127.62 , $220.37 , $610.85 , $680.40 , $640.03 , $680.40 , $680.40 , $680.40 , $642.60 , $216.05 , $698.01 , $718.20 , $642.60 , $703.08 , $703.08 , $718.20 , $725.76 , $618.56 , $680.40 , $642.60 , $597.24 , N/A , $611.83 , $611.83 , $718.20 , $648.72 , $127.62 , $725.76 
 Pro Sigmoidoscopy Flx Ablation Tumor Polyp/Oth Les ,CPT® 45346,0982 - PRO FEE/OUTPT,N/A,N/A," $2,218.00 "," $1,441.70 ", $982.48 , $152.15 , $265.94 , $856.55 , $891.41 ," $2,062.74 "," $1,996.20 "," $1,996.20 "," $1,774.40 "," $1,774.40 ", $265.94 ," $2,047.88 "," $2,107.10 "," $1,996.20 "," $1,996.20 "," $1,996.20 "," $2,062.74 "," $2,129.28 ", $706.64 ," $1,885.30 ", $838.72 , $935.76 , N/A , $873.27 , $873.27 ," $2,107.10 ", $913.34 , $152.15 ," $2,129.28 "
Coombs Test Indirect Titer,CPT® 86886,N/A,N/A,N/A, $115.00 , $74.75 , N/A , $5.28 , $5.28 , $29.27 , $35.00 , $106.95 , $103.50 , $103.50 , $92.00 , $92.00 , $5.28 , $106.18 , $109.25 , $103.50 , $103.50 , $103.50 , $106.95 , $110.40 , $34.59 , $97.75 , $34.06 , $18.77 , N/A , $27.32 , $27.32 , $109.25 , $29.85 , $5.28 , $110.40 
Removal of Lung,CPT® 32440,N/A,N/A,N/A," $15,266.00 "," $9,922.90 "," $8,141.20 "," $1,419.34 "," $2,305.21 "," $5,907.60 "," $5,777.67 "," $14,197.38 "," $13,739.40 "," $13,739.40 "," $12,212.80 "," $12,212.80 "," $2,305.21 "," $14,095.10 "," $14,502.70 "," $13,739.40 "," $13,739.40 "," $13,739.40 "," $14,197.38 "," $14,655.36 "," $7,874.03 "," $12,976.10 "," $8,354.77 "," $7,758.45 ", N/A ," $6,022.87 "," $6,022.87 "," $14,502.70 "," $7,093.21 "," $1,419.34 "," $14,655.36 "
Amputate Metacarpal+Finger,26910,N/A,N/A,N/A," $3,619.00 "," $2,352.35 "," $4,771.39 ", $742.52 , $461.04 ," $3,401.19 "," $3,432.13 "," $3,365.67 "," $3,257.10 "," $3,257.10 "," $2,895.20 "," $2,895.20 ", $461.04 ," $3,341.42 "," $3,438.05 "," $3,257.10 "," $3,257.10 "," $3,257.10 "," $3,365.67 "," $3,474.24 "," $4,375.01 "," $3,076.15 "," $3,773.30 "," $4,090.43 ", N/A ," $3,467.56 "," $3,467.56 "," $3,438.05 "," $4,075.60 ", $461.04 ," $4,771.39 "
Fac Mod Sed Same Phys/Qhp Initial 15 Mins <5 Yrs,99151,N/A,N/A,N/A, $232.00 , $150.80 , $57.38 , $23.62 , $60.95 , $50.47 , $53.68 , $215.76 , $208.80 , $208.80 , $185.60 , $185.60 , $60.95 , $214.21 , $220.40 , $208.80 , $208.80 , $208.80 , $215.76 , $222.72 , $75.59 , $197.20 , $72.70 , $92.02 , N/A , $51.45 , $51.45 , $220.40 , $59.99 , $23.62 , $222.72 
 Fac Xray Control Catheter Change ,CPT® 75984,0320 - DX X-RAY,N/A,N/A, $962.00 , $625.30 , $808.08 , $94.90 , $110.10 , $777.30 , $865.80 , $814.43 , $865.80 , $865.80 , $865.80 , $817.70 , $107.94 , $888.21 , $913.90 , $817.70 , $894.66 , $894.66 , $913.90 , $923.52 , $787.11 , $865.80 , $817.70 , $759.98 , N/A , $778.55 , $778.55 , $913.90 , $825.49 , $94.90 , $923.52 
"Repair Flex Leg Tendon,Prim,Ea",CPT® 27658,N/A,N/A,N/A," $2,504.00 "," $1,627.60 "," $2,276.69 ", $357.61 , $461.04 ," $1,822.74 "," $1,840.28 "," $2,328.72 "," $2,253.60 "," $2,253.60 "," $2,003.20 "," $2,003.20 ", $461.04 ," $2,311.94 "," $2,378.80 "," $2,253.60 "," $2,253.60 "," $2,253.60 "," $2,328.72 "," $2,403.84 "," $2,116.91 "," $2,128.40 "," $2,014.21 "," $2,144.57 ", N/A ," $1,858.31 "," $1,858.31 "," $2,378.80 "," $2,184.17 ", $357.61 ," $2,403.84 "
Neurobehavioral Status Xm Phys/Qhp Ea Addl Hour,CPT® 96121,N/A,N/A,N/A, $367.00 , $238.55 , $165.89 , $67.10 , $94.91 , $163.49 , N/A , $341.31 , $330.30 , $330.30 , $293.60 , $293.60 , $94.91 , $338.85 , $348.65 , $330.30 , $330.30 , $330.30 , $341.31 , $352.32 , $319.16 , $311.95 , $199.91 , $297.96 , $115.00 , $166.68 , $166.68 , $348.65 , $194.30 , $67.10 , $352.32 
"Removal of Lung,Segmentectomy",CPT® 32484,N/A,N/A,N/A," $12,256.00 "," $7,966.40 "," $7,424.17 "," $1,295.16 "," $1,562.01 "," $5,426.37 "," $5,298.89 "," $11,398.08 "," $11,030.40 "," $11,030.40 "," $9,804.80 "," $9,804.80 "," $1,562.01 "," $11,315.96 "," $11,643.20 "," $11,030.40 "," $11,030.40 "," $11,030.40 "," $11,398.08 "," $11,765.76 "," $7,183.19 "," $10,417.60 "," $7,664.34 "," $7,103.50 ", N/A ," $5,532.25 "," $5,532.25 "," $11,643.20 "," $6,515.39 "," $1,295.16 "," $11,765.76 "
 Pro Injection Aa&/Strd Other Peripheral Nerve/Branch ,CPT® 64450,0960 - PRO FEE,N/A,N/A, $835.00 , $542.75 , $207.58 , $40.26 , $113.79 , $255.83 , $245.04 , $776.55 , $751.50 , $751.50 , $668.00 , $668.00 , $113.79 , $770.96 , $793.25 , $751.50 , $751.50 , $751.50 , $776.55 , $801.60 , $225.30 , $709.75 , $237.28 , $273.66 , N/A , $260.82 , $260.82 , $793.25 , $279.80 , $40.26 , $801.60 
Drug Assay Flecainide,CPT® 80181,N/A,N/A,N/A, $149.00 , $96.85 , N/A , $19.01 , $15.21 , N/A , N/A , $138.57 , $134.10 , $134.10 , $119.20 , $119.20 , $15.21 , $137.57 , $141.55 , $134.10 , $134.10 , $134.10 , $138.57 , $143.04 , $124.46 , $126.65 , $88.85 , $54.75 , N/A , $74.00 , $74.00 , $141.55 , $80.71 , $15.21 , $143.04 
 Fac Insj Transvns Intrahepatc Portosysic Shunt ,CPT® 37182,0360 - OR SERVICES,N/A,N/A," $4,861.00 "," $3,159.65 "," $4,083.24 ", $771.61 , $820.79 ," $3,927.69 "," $4,374.90 "," $4,115.32 "," $4,374.90 "," $4,374.90 "," $4,374.90 "," $4,131.85 ", $804.70 ," $4,488.16 "," $4,617.95 "," $4,131.85 "," $4,520.73 "," $4,520.73 "," $4,617.95 "," $4,666.56 "," $3,977.27 "," $4,374.90 "," $4,131.85 "," $3,840.19 ", N/A ," $3,934.01 "," $3,934.01 "," $4,617.95 "," $4,171.22 ", $771.61 ," $4,666.56 "
"Burn,Initial Treatment",16000,N/A,N/A,N/A, $277.00 , $180.05 , $143.24 , $43.12 , $29.25 , $126.05 , $122.05 , $257.61 , $249.30 , $249.30 , $221.60 , $221.60 , $29.25 , $255.75 , $263.15 , $249.30 , $249.30 , $249.30 , $257.61 , $265.92 , $157.17 , $235.45 , $242.63 , $162.35 , N/A , $128.51 , $128.51 , $263.15 , $149.03 , $29.25 , $265.92 
 PEGFILGRASTIM 6 MG/0.6ML SC PSKT ,HCPCS J2506,0636 - DRUGS REQUIRING DETAILED CODIN,55513-0192-01,0.6 mL," $18,870.90 "," $12,266.09 "," $15,851.56 ", $87.42 , $137.87 ," $15,247.69 "," $16,983.81 "," $15,976.10 "," $16,983.81 "," $16,983.81 "," $16,983.81 "," $16,040.27 ", $135.17 ," $17,423.50 "," $17,927.36 "," $16,040.27 "," $17,549.94 "," $17,549.94 "," $17,927.36 "," $18,116.06 "," $15,440.17 "," $16,983.81 "," $16,040.27 "," $14,908.01 ", N/A ," $15,272.22 "," $15,272.22 "," $17,927.36 "," $16,193.12 ", $87.42 ," $18,116.06 "
Insertion Picc W/O Img Gdn 5 Yr/>,36569,N/A,N/A,N/A, $908.00 , $590.20 , $570.51 , $87.87 , $94.88 , $405.39 , $393.52 , $844.44 , $817.20 , $817.20 , $726.40 , $726.40 , $94.88 , $838.36 , $862.60 , $817.20 , $817.20 , $817.20 , $844.44 , $871.68 , $529.38 , $771.80 , $478.13 , $430.78 , N/A , $413.31 , $413.31 , $862.60 , $469.51 , $87.87 , $871.68 
 BUPIVACAINE-EPINEPHRINE 0.5% -1:200000 IJ SOLN ,HCPCS RXA250,0250 - PHARMACY,00409-1755-50,50 mL, $91.44 , $59.44 , $76.81 , N/A , N/A , $73.88 , $82.30 , $77.41 , $82.30 , $82.30 , $82.30 , $77.72 , N/A , $84.43 , $86.87 , $77.72 , $85.04 , $85.04 , $86.87 , $87.78 , $74.82 , $82.30 , $77.72 , $72.24 , N/A , $74.00 , $74.00 , $86.87 , $78.46 , $72.24 , $87.78 
Explore/Treat Ankle Joint,CPT® 27610,N/A,N/A,N/A," $4,875.00 "," $3,168.75 "," $3,961.23 ", $618.19 , $571.40 ," $3,154.02 "," $3,135.23 "," $4,533.75 "," $4,387.50 "," $4,387.50 "," $3,900.00 "," $3,900.00 ", $571.40 ," $4,501.09 "," $4,631.25 "," $4,387.50 "," $4,387.50 "," $4,387.50 "," $4,533.75 "," $4,680.00 "," $3,690.35 "," $4,143.75 "," $3,452.16 "," $3,710.11 ", N/A ," $3,215.56 "," $3,215.56 "," $4,631.25 "," $3,779.43 ", $571.40 ," $4,680.00 "
 Fac Thrombolysis Art/Venous Infsn W/Image Subsq Tx ,CPT® 37213,0360 - OR SERVICES,N/A,N/A," $8,128.00 "," $5,283.20 "," $6,827.52 ", $211.51 , $285.82 ," $6,567.42 "," $7,315.20 "," $6,881.16 "," $7,315.20 "," $7,315.20 "," $7,315.20 "," $6,908.80 ", $280.22 ," $7,504.58 "," $7,721.60 "," $6,908.80 "," $7,559.04 "," $7,559.04 "," $7,721.60 "," $7,802.88 "," $6,650.33 "," $7,315.20 "," $6,908.80 "," $6,421.12 ", N/A ," $6,577.99 "," $6,577.99 "," $7,721.60 "," $6,974.64 ", $211.51 ," $7,802.88 "
 Pro Mod Sed Other Phys/Qhp Each Addl 15 Mins ,CPT® 99157,0981 - PRO FEE/ER,N/A,N/A, $582.00 , $378.30 , $142.51 , $59.83 , $45.63 , $123.23 , $126.41 , $541.26 , $523.80 , $523.80 , $465.60 , $465.60 , $45.63 , $537.36 , $552.90 , $523.80 , $523.80 , $523.80 , $541.26 , $558.72 , $190.57 , $494.70 , $184.77 , $216.69 , N/A , $125.64 , $125.64 , $552.90 , $146.45 , $45.63 , $558.72 
"Antithrombin III Test,Antigen",CPT® 85301,N/A,N/A,N/A, $222.00 , $144.30 , N/A , $11.03 , $11.03 , $61.15 , $73.17 , $206.46 , $199.80 , $199.80 , $177.60 , $177.60 , $11.03 , $204.97 , $210.90 , $199.80 , $199.80 , $199.80 , $206.46 , $213.12 , $72.18 , $188.70 , $71.36 , $39.21 , N/A , $57.07 , $57.07 , $210.90 , $62.37 , $11.03 , $213.12 
 Eeg Without Video 12-26 Hours; Unmonitored ,CPT® 95708,0740 - EEG,N/A,N/A," $2,698.00 "," $1,753.70 "," $2,266.32 ", $138.64 , $396.25 ," $2,179.98 "," $2,428.20 "," $2,284.13 "," $2,428.20 "," $2,428.20 "," $2,428.20 "," $2,293.30 ", $388.48 ," $2,491.06 "," $2,563.10 "," $2,293.30 "," $2,509.14 "," $2,509.14 "," $2,563.10 "," $2,590.08 "," $2,207.50 "," $2,428.20 "," $2,293.30 "," $2,131.42 ", N/A ," $2,183.49 "," $2,183.49 "," $2,563.10 "," $2,315.15 ", $138.64 ," $2,590.08 "
 Pro Treat Metacarpal Fracture ,CPT® 26608,0982 - PRO FEE/OUTPT,N/A,N/A," $3,152.00 "," $2,048.80 "," $2,975.31 ", $468.01 , $412.82 ," $2,289.81 "," $2,307.09 "," $2,931.36 "," $2,836.80 "," $2,836.80 "," $2,521.60 "," $2,521.60 ", $412.82 ," $2,910.24 "," $2,994.40 "," $2,836.80 "," $2,836.80 "," $2,836.80 "," $2,931.36 "," $3,025.92 "," $2,760.18 "," $2,679.20 "," $2,535.16 "," $2,718.95 ", N/A ," $2,334.49 "," $2,334.49 "," $2,994.40 "," $2,743.86 ", $412.82 ," $3,025.92 "
Remove Eyelid Lesn (Not Chalazion),CPT® 67840,N/A,N/A,N/A," $2,601.00 "," $1,690.65 ", $967.33 , $152.02 , $78.75 , $897.04 , $841.30 ," $2,418.93 "," $2,340.90 "," $2,340.90 "," $2,080.80 "," $2,080.80 ", $78.75 ," $2,401.50 "," $2,470.95 "," $2,340.90 "," $2,340.90 "," $2,340.90 "," $2,418.93 "," $2,496.96 "," $1,326.31 "," $2,210.85 ", $867.06 ," $1,135.98 ", N/A , $914.53 , $914.53 ," $2,470.95 "," $1,009.55 ", $78.75 ," $2,496.96 "
 Pro Fluoro Exam of G/Colon Tube ,CPT® 49465,0972 - PRO FEE/RAD/DX,N/A,N/A, $130.00 , $84.50 , $187.27 , $29.30 , $196.17 , $151.97 , $149.16 , $120.90 , $117.00 , $117.00 , $104.00 , $104.00 , $196.17 , $120.03 , $123.50 , $117.00 , $117.00 , $117.00 , $120.90 , $124.80 , $136.61 , $110.50 , $158.78 , $180.05 , N/A , $154.94 , $154.94 , $123.50 , $162.04 , $29.30 , $196.17 
"Fusion Finger Joint,Each Addnl",26861,N/A,N/A,N/A, $712.00 , $462.80 , $611.91 , $94.71 , $186.84 , $499.38 , $488.06 , $662.16 , $640.80 , $640.80 , $569.60 , $569.60 , $186.84 , $657.39 , $676.40 , $640.80 , $640.80 , $640.80 , $662.16 , $683.52 , $573.91 , $605.20 , $540.57 , $587.19 , N/A , $509.12 , $509.12 , $676.40 , $598.41 , $94.71 , $683.52 
Radiologic Exam Chest 4+ Views,CPT® 71048,N/A,N/A,N/A, $406.00 , $263.90 , $261.93 , $45.74 , $33.05 , $188.36 , $210.93 , $377.58 , $365.40 , $365.40 , $324.80 , $324.80 , $33.05 , $374.86 , $385.70 , $365.40 , $365.40 , $365.40 , $377.58 , $389.76 , $251.51 , $345.10 , $266.65 , $211.48 , N/A , $192.04 , $192.04 , $385.70 , $222.29 , $33.05 , $389.76 
 Fac Glutathione ,CPT® 82978,0301 - LAB/CHEMISTRY,N/A,N/A, $112.00 , $72.80 , $94.08 , $15.76 , $15.76 , $90.50 , $100.80 , $94.82 , $100.80 , $100.80 , $100.80 , $95.20 , $15.45 , $103.41 , $106.40 , $95.20 , $104.16 , $104.16 , $106.40 , $107.52 , $91.64 , $100.80 , $95.20 , $88.48 , N/A , $90.64 , $90.64 , $106.40 , $96.11 , $15.45 , $107.52 
 CYCLOBENZAPRINE HCL 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,69097-0846-07,1 tablet, $5.95 , $3.87 , $5.00 , N/A , N/A , $4.81 , $5.36 , $5.04 , $5.36 , $5.36 , $5.36 , $5.06 , N/A , $5.49 , $5.65 , $5.06 , $5.53 , $5.53 , $5.65 , $5.71 , $4.87 , $5.36 , $5.06 , $4.70 , N/A , $4.82 , $4.82 , $5.65 , $5.11 , $4.70 , $5.71 
Esophagogastroduodenoscopy Transoral Diagnostic,43235,N/A,N/A,N/A," $2,046.00 "," $1,329.90 ", $751.66 , $116.11 , $398.41 , $626.38 , $707.63 ," $1,902.78 "," $1,841.40 "," $1,841.40 "," $1,636.80 "," $1,636.80 ", $398.41 ," $1,889.07 "," $1,943.70 "," $1,841.40 "," $1,841.40 "," $1,841.40 "," $1,902.78 "," $1,964.16 ", $539.11 ," $1,739.10 ", $776.07 , $715.24 , N/A , $638.60 , $638.60 ," $1,943.70 ", $667.92 , $116.11 ," $1,964.16 "
 CT Chest Combined- Mh ,CPT® 71270,0972 - PRO FEE/RAD/DX,N/A,N/A, $777.00 , $505.05 ," $1,406.86 ", $201.03 , $373.42 ," $1,310.28 "," $1,677.60 ", $722.61 , $699.30 , $699.30 , $621.60 , $621.60 , $373.42 , $717.40 , $738.15 , $699.30 , $699.30 , $699.30 , $722.61 , $745.92 ," $1,187.73 ", $660.45 ," $1,827.81 "," $1,527.30 ", N/A ," $1,335.85 "," $1,335.85 ", $738.15 ," $1,546.29 ", $201.03 ," $1,827.81 "
 Fac Psychiatric Diagnostic Eval W/Medical Services ,CPT® 90792,0914 - PSYCH/INDIV RX,N/A,N/A, $382.00 , $248.30 , $320.88 , $170.04 , $177.53 , $308.66 , $343.80 , $323.40 , $343.80 , $343.80 , $343.80 , $324.70 , $174.05 , $352.70 , $362.90 , $324.70 , $355.26 , $355.26 , $362.90 , $366.72 , $312.55 , $343.80 , $324.70 , $301.78 , N/A , $309.15 , $309.15 , $362.90 , $327.79 , $170.04 , $366.72 
"Cystoscopy,Manipulatn",52330,N/A,N/A,N/A," $3,997.00 "," $2,598.05 "," $1,411.11 ", $247.91 , $307.34 ," $1,294.89 "," $1,198.45 "," $3,717.21 "," $3,597.30 "," $3,597.30 "," $3,197.60 "," $3,197.60 ", $307.34 ," $3,690.43 "," $3,797.15 "," $3,597.30 "," $3,597.30 "," $3,597.30 "," $3,717.21 "," $3,837.12 "," $1,419.73 "," $3,397.45 "," $1,357.67 "," $1,625.31 ", N/A ," $1,320.16 "," $1,320.16 "," $3,797.15 "," $1,551.66 ", $247.91 ," $3,837.12 "
 Fac Calprotectin Fecal ,CPT® 83993,0301 - LAB/CHEMISTRY,N/A,N/A, $319.00 , $207.35 , $267.96 , $20.02 , $20.02 , $257.75 , $287.10 , $270.07 , $287.10 , $287.10 , $287.10 , $271.15 , $19.63 , $294.53 , $303.05 , $271.15 , $296.67 , $296.67 , $303.05 , $306.24 , $261.01 , $287.10 , $271.15 , $252.01 , N/A , $258.17 , $258.17 , $303.05 , $273.73 , $19.63 , $306.24 
 DILTIAZEM HCL 60 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00093-0319-01,1 tablet, $8.05 , $5.23 , $6.76 , N/A , N/A , $6.50 , $7.25 , $6.82 , $7.25 , $7.25 , $7.25 , $6.84 , N/A , $7.43 , $7.65 , $6.84 , $7.49 , $7.49 , $7.65 , $7.73 , $6.59 , $7.25 , $6.84 , $6.36 , N/A , $6.51 , $6.51 , $7.65 , $6.91 , $6.36 , $7.73 
"B Cells, Total Count",CPT® 86355,N/A,N/A,N/A, $348.00 , $226.20 , N/A , $38.48 , $38.48 , $213.44 , $255.29 , $323.64 , $313.20 , $313.20 , $278.40 , $278.40 , $38.48 , $321.31 , $330.60 , $313.20 , $313.20 , $313.20 , $323.64 , $334.08 , $251.93 , $295.80 , $246.52 , $136.81 , N/A , $199.20 , $199.20 , $330.60 , $217.68 , $38.48 , $334.08 
 Pro Dbrdmt W/Rmvl Fm Fx&/Dislc Skn&Subq Tiss ,CPT® 11010,0982 - PRO FEE/OUTPT,N/A,N/A," $1,592.00 "," $1,034.80 ", $871.93 , $261.22 , $345.88 , $760.78 , $739.10 ," $1,480.56 "," $1,432.80 "," $1,432.80 "," $1,273.60 "," $1,273.60 ", $345.88 ," $1,469.89 "," $1,512.40 "," $1,432.80 "," $1,432.80 "," $1,432.80 "," $1,480.56 "," $1,528.32 ", $953.65 ," $1,353.20 "," $1,482.56 ", $983.21 , N/A , $775.62 , $775.62 ," $1,512.40 ", $899.45 , $261.22 ," $1,528.32 "
Surg Cleansing Genitalia & Perineum,CPT® 11004,N/A,N/A,N/A," $2,863.00 "," $1,860.95 "," $1,779.59 ", $525.47 , $507.48 ," $1,576.38 "," $1,504.65 "," $2,662.59 "," $2,576.70 "," $2,576.70 "," $2,290.40 "," $2,290.40 ", $507.48 ," $2,643.41 "," $2,719.85 "," $2,576.70 "," $2,576.70 "," $2,576.70 "," $2,662.59 "," $2,748.48 "," $1,960.44 "," $2,433.55 "," $3,022.20 "," $1,989.15 ", N/A ," $1,607.14 "," $1,607.14 "," $2,719.85 "," $1,863.75 ", $507.48 ," $3,022.20 "
Analyze Infusn Pump,CPT® 62367,N/A,N/A,N/A, $291.00 , $189.15 , $122.30 , $23.48 , $34.37 , $141.11 , $137.34 , $270.63 , $261.90 , $261.90 , $232.80 , $232.80 , $34.37 , $268.68 , $276.45 , $261.90 , $261.90 , $261.90 , $270.63 , $279.36 , $74.31 , $247.35 , $133.80 , $152.76 , N/A , $143.86 , $143.86 , $276.45 , $154.34 , $23.48 , $279.36 
"Hep B Vaccine,Ped/Adol,Im",CPT® 90744,N/A,N/A,N/A, $121.00 , $78.65 , N/A , $30.50 , $40.00 , $53.01 , $73.99 , $112.53 , $108.90 , $108.90 , $96.80 , $96.80 , $40.00 , $111.72 , $114.95 , $108.90 , $108.90 , $108.90 , $112.53 , $116.16 , $36.69 , $102.85 , $71.97 , $43.29 , N/A , $54.04 , $54.04 , $114.95 , $63.00 , $30.50 , $116.16 
 Pro Esophagoscopy Flexible Removal Foreign Body ,CPT® 43215,0982 - PRO FEE/OUTPT,N/A,N/A," $2,231.00 "," $1,450.15 ", $857.42 , $132.36 , $142.67 , $710.20 , $749.12 ," $2,074.83 "," $2,007.90 "," $2,007.90 "," $1,784.80 "," $1,784.80 ", $142.67 ," $2,059.88 "," $2,119.45 "," $2,007.90 "," $2,007.90 "," $2,007.90 "," $2,074.83 "," $2,141.76 ", $615.50 ," $1,896.35 ", $822.45 , $813.17 , N/A , $724.06 , $724.06 ," $2,119.45 ", $757.29 , $132.36 ," $2,141.76 "
 GENTAMICIN SULFATE 10 MG/ML IJ SOLN UNDILUTED ,HCPCS J1580,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0173-02,20 mg, $33.35 , $21.68 , $28.01 , $3.05 , $2.85 , $26.95 , $30.02 , $28.23 , $30.02 , $30.02 , $30.02 , $28.35 , $2.79 , $30.79 , $31.68 , $28.35 , $31.02 , $31.02 , $31.68 , $32.02 , $27.29 , $30.02 , $28.35 , $26.35 , N/A , $26.99 , $26.99 , $31.68 , $28.62 , $2.79 , $32.02 
Computerized Ophthalmic Imaging Anterior Segment,CPT® 92132,N/A,N/A,N/A, $104.00 , $67.60 , $67.84 , $30.95 , $26.60 , $61.08 , $63.82 , $96.72 , $93.60 , $93.60 , $83.20 , $83.20 , $26.60 , $96.02 , $98.80 , $93.60 , $93.60 , $93.60 , $96.72 , $99.84 , $96.09 , $88.40 , $108.47 , $65.89 , N/A , $62.26 , $62.26 , $98.80 , $74.08 , $26.60 , $108.47 
 Sc Bx Renal Perc ,CPT® 50200,0761 - TREATMENT ROOM,N/A,N/A," $1,632.00 "," $1,060.80 "," $1,370.88 ", $120.88 , $142.19 ," $1,318.66 "," $1,468.80 "," $1,381.65 "," $1,468.80 "," $1,468.80 "," $1,468.80 "," $1,387.20 ", $139.40 ," $1,506.83 "," $1,550.40 "," $1,387.20 "," $1,517.76 "," $1,517.76 "," $1,550.40 "," $1,566.72 "," $1,335.30 "," $1,468.80 "," $1,387.20 "," $1,289.28 ", N/A ," $1,320.78 "," $1,320.78 "," $1,550.40 "," $1,400.42 ", $120.88 ," $1,566.72 "
"Infectious Agent Dna/Rna Influenza >2 Types, Ea Add",CPT® 87503,N/A,N/A,N/A, $209.00 , $135.85 , N/A , $29.80 , $28.83 , $117.49 , $140.56 , $194.37 , $188.10 , $188.10 , $167.20 , $167.20 , $28.83 , $192.97 , $198.55 , $188.10 , $188.10 , $188.10 , $194.37 , $200.64 , $195.11 , $177.65 , $136.23 , $85.82 , N/A , $109.65 , $109.65 , $198.55 , $119.82 , $28.83 , $200.64 
Meperidine Hydrochl /100 Mg,HCPCS J2175,N/A,N/A,N/A, $14.00 , $9.10 , N/A , $7.46 , $9.78 , N/A , N/A , $13.02 , $12.60 , $12.60 , $11.20 , $11.20 , $9.78 , $12.93 , $13.30 , $12.60 , $12.60 , $12.60 , $13.02 , $13.44 , $8.39 , $11.90 , $3.89 , $7.81 , N/A , N/A , N/A , $13.30 , N/A , $3.89 , $13.44 
Treat Articular Fracture,26740,N/A,N/A,N/A," $1,456.00 ", $946.40 ," $1,375.21 ", $218.73 , $126.34 ," $1,034.45 "," $1,051.56 "," $1,354.08 "," $1,310.40 "," $1,310.40 "," $1,164.80 "," $1,164.80 ", $126.34 ," $1,344.32 "," $1,383.20 "," $1,310.40 "," $1,310.40 "," $1,310.40 "," $1,354.08 "," $1,397.76 "," $1,266.41 "," $1,237.60 "," $1,150.72 "," $1,238.55 ", N/A ," $1,054.63 "," $1,054.63 "," $1,383.20 "," $1,239.57 ", $126.34 ," $1,397.76 "
 Fac Drug Screen Quant Alcohols Biomarkers 1 or 2 ,CPT® 80321,0301 - LAB/CHEMISTRY,N/A,N/A, $270.00 , $175.50 , $226.80 , N/A , N/A , $218.16 , $243.00 , $228.58 , $243.00 , $243.00 , $243.00 , $229.50 , N/A , $249.29 , $256.50 , $229.50 , $251.10 , $251.10 , $256.50 , $259.20 , $220.91 , $243.00 , $229.50 , $213.30 , N/A , $218.51 , $218.51 , $256.50 , $231.69 , $213.30 , $259.20 
Place Ng/Og Tube by Phys W Fluoro,CPT® 43752,N/A,N/A,N/A, $342.00 , $222.30 , $247.52 , $38.28 , $41.38 , $196.57 , $196.16 , $318.06 , $307.80 , $307.80 , $273.60 , $273.60 , $41.38 , $315.77 , $324.90 , $307.80 , $307.80 , $307.80 , $318.06 , $328.32 , $178.55 , $290.70 , $212.30 , $236.86 , N/A , $200.41 , $200.41 , $324.90 , $209.62 , $38.28 , $328.32 
Drainage Scrotal Wall Abscess,55100,N/A,N/A,N/A," $1,088.00 ", $707.20 , $740.16 , $160.07 , $30.71 , $530.69 , $546.97 ," $1,011.84 ", $979.20 , $979.20 , $870.40 , $870.40 , $30.71 ," $1,004.55 "," $1,033.60 ", $979.20 , $979.20 , $979.20 ," $1,011.84 "," $1,044.48 ", $691.67 , $924.80 , $875.98 , $802.59 , N/A , $541.04 , $541.04 ," $1,033.60 ", $648.45 , $30.71 ," $1,044.48 "
 Pro Remove Foreign Body ,CPT® 10121,0982 - PRO FEE/OUTPT,N/A,N/A," $1,048.00 ", $681.20 , $588.68 , $176.00 , $77.74 , $505.10 , $497.82 , $974.64 , $943.20 , $943.20 , $838.40 , $838.40 , $77.74 , $967.62 , $995.60 , $943.20 , $943.20 , $943.20 , $974.64 ," $1,006.08 ", $648.05 , $890.80 , $990.16 , $647.57 , N/A , $514.96 , $514.96 , $995.60 , $597.18 , $77.74 ," $1,006.08 "
"Hiv 1, Genotype Anal Dna",CPT® 87901,N/A,N/A,N/A," $2,376.00 "," $1,544.40 ", N/A , $262.60 , $262.60 ," $1,456.57 "," $1,742.30 "," $2,209.68 "," $2,138.40 "," $2,138.40 "," $1,900.80 "," $1,900.80 ", $262.60 ," $2,193.76 "," $2,257.20 "," $2,138.40 "," $2,138.40 "," $2,138.40 "," $2,209.68 "," $2,280.96 "," $1,719.05 "," $2,019.60 "," $1,686.72 ", $933.50 , N/A ," $1,359.36 "," $1,359.36 "," $2,257.20 "," $1,485.48 ", $262.60 ," $2,280.96 "
"Hysteroscopy,Rmv Myoma",58561,N/A,N/A,N/A," $4,458.00 "," $2,897.70 "," $1,666.25 ", $336.94 , $485.88 ," $2,227.26 "," $2,213.94 "," $4,145.94 "," $4,012.20 "," $4,012.20 "," $3,566.40 "," $3,566.40 ", $485.88 ," $4,116.07 "," $4,235.10 "," $4,012.20 "," $4,012.20 "," $4,012.20 "," $4,145.94 "," $4,279.68 "," $1,755.35 "," $3,789.30 "," $2,915.16 "," $1,488.80 ", N/A ," $2,270.72 "," $2,270.72 "," $4,235.10 "," $2,723.58 ", $336.94 ," $4,279.68 "
Delayed Creation Exit Site Embedded Catheter,CPT® 49436,N/A,N/A,N/A," $1,176.00 ", $764.40 ," $1,128.99 ", $172.77 , $136.98 , $878.52 , $898.80 ," $1,093.68 "," $1,058.40 "," $1,058.40 ", $940.80 , $940.80 , $136.98 ," $1,085.80 "," $1,117.20 "," $1,058.40 "," $1,058.40 "," $1,058.40 "," $1,093.68 "," $1,128.96 ", $807.26 , $999.60 , $999.08 ," $1,035.40 ", N/A , $895.66 , $895.66 ," $1,117.20 ", $936.76 , $136.98 ," $1,128.99 "
 DOXYCYCLINE HYCLATE 100 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00143-9803-50,1 capsule, $28.42 , $18.47 , $23.87 , N/A , N/A , $22.96 , $25.58 , $24.06 , $25.58 , $25.58 , $25.58 , $24.16 , N/A , $26.24 , $27.00 , $24.16 , $26.43 , $26.43 , $27.00 , $27.28 , $23.25 , $25.58 , $24.16 , $22.45 , N/A , $23.00 , $23.00 , $27.00 , $24.39 , $22.45 , $27.28 
Open Rx Talus Fx,CPT® 28445,N/A,N/A,N/A," $7,093.00 "," $4,610.45 "," $6,258.46 ", $991.62 , $845.22 ," $5,175.56 "," $5,132.82 "," $6,596.49 "," $6,383.70 "," $6,383.70 "," $5,674.40 "," $5,674.40 ", $845.22 ," $6,548.97 "," $6,738.35 "," $6,383.70 "," $6,383.70 "," $6,383.70 "," $6,596.49 "," $6,809.28 "," $5,831.54 "," $6,029.05 "," $5,653.70 "," $6,040.23 ", N/A ," $5,276.54 "," $5,276.54 "," $6,738.35 "," $6,201.82 ", $845.22 ," $6,809.28 "
 Pro Treat Metacarpal Fracture ,CPT® 26615,0982 - PRO FEE/OUTPT,N/A,N/A," $2,386.00 "," $1,550.90 "," $3,532.95 ", $555.54 , $461.04 ," $2,775.50 "," $2,780.71 "," $2,218.98 "," $2,147.40 "," $2,147.40 "," $1,908.80 "," $1,908.80 ", $461.04 ," $2,202.99 "," $2,266.70 "," $2,147.40 "," $2,147.40 "," $2,147.40 "," $2,218.98 "," $2,290.56 "," $3,283.35 "," $2,028.10 "," $3,056.10 "," $3,289.76 ", N/A ," $2,829.65 "," $2,829.65 "," $2,266.70 "," $3,325.85 ", $461.04 ," $3,532.95 "
"Fibrinogen, Activity",CPT® 85384,N/A,N/A,N/A, $118.00 , $76.70 , N/A , $9.91 , $9.91 , $48.06 , $57.52 , $109.74 , $106.20 , $106.20 , $94.40 , $94.40 , $9.91 , $108.95 , $112.10 , $106.20 , $106.20 , $106.20 , $109.74 , $113.28 , $64.90 , $100.30 , $55.14 , $30.81 , N/A , $44.85 , $44.85 , $112.10 , $49.01 , $9.91 , $113.28 
Active Wound Care/20 Cm or <,97597,N/A,N/A,N/A, $242.00 , $157.30 , $82.90 , $34.49 , $43.20 , $54.44 , $46.92 , $225.06 , $217.80 , $217.80 , $193.60 , $193.60 , $43.20 , $223.44 , $229.90 , $217.80 , $217.80 , $217.80 , $225.06 , $232.32 , $109.43 , $205.70 , $69.95 , $54.53 , N/A , $55.50 , $55.50 , $229.90 , $61.73 , $34.49 , $232.32 
Foot Arch Support Remov Prem,HCPCS L3030,N/A,N/A,N/A, $365.00 , $237.25 , N/A , $89.25 , $94.21 , N/A , N/A , $339.45 , $328.50 , $328.50 , $292.00 , $292.00 , $94.21 , $337.00 , $346.75 , $328.50 , $328.50 , $328.50 , $339.45 , $350.40 , N/A , $310.25 , $73.96 , $75.10 , N/A , N/A , N/A , $346.75 , N/A , $73.96 , $350.40 
 CLINIMIX/DEXTROSE (5/15) 5 % IV SOLN ,HCPCS RXA258,0258 - IV SOLUTIONS,00338-1099-04,"2,000 mL", $493.14 , $320.54 , $414.24 , N/A , N/A , $398.46 , $443.83 , $417.49 , $443.83 , $443.83 , $443.83 , $419.17 , N/A , $455.32 , $468.48 , $419.17 , $458.62 , $458.62 , $468.48 , $473.41 , $403.49 , $443.83 , $419.17 , $389.58 , N/A , $399.10 , $399.10 , $468.48 , $423.16 , $389.58 , $473.41 
 ZIPRASIDONE MESYLATE 20 MG IM SOLR ,HCPCS J3486,0636 - DRUGS REQUIRING DETAILED CODIN,72266-0160-10,0.5 mL, $101.07 , $65.70 , $84.90 , $9.79 , $10.36 , $81.66 , $90.96 , $85.57 , $90.96 , $90.96 , $90.96 , $85.91 , $10.16 , $93.32 , $96.02 , $85.91 , $94.00 , $94.00 , $96.02 , $97.03 , $82.70 , $90.96 , $85.91 , $79.85 , N/A , $81.80 , $81.80 , $96.02 , $86.73 , $9.79 , $97.03 
Radn Treatment Aid(S) Complx,CPT® 77334,N/A,N/A,N/A," $1,809.00 "," $1,175.85 ", $695.13 , $123.37 , $151.86 , $725.00 , $777.34 ," $1,682.37 "," $1,628.10 "," $1,628.10 "," $1,447.20 "," $1,447.20 ", $151.86 ," $1,670.25 "," $1,718.55 "," $1,628.10 "," $1,628.10 "," $1,628.10 "," $1,682.37 "," $1,736.64 ", $707.65 ," $1,537.65 ", $849.38 , $721.74 , N/A , $739.15 , $739.15 ," $1,718.55 ", $855.59 , $123.37 ," $1,736.64 "
 Pro Chemical Cauterization of Granulation Tissue ,CPT® 17250,0982 - PRO FEE/OUTPT,N/A,N/A, $338.00 , $219.70 , $118.49 , $35.56 , $24.75 , $100.85 , $98.94 , $314.34 , $304.20 , $304.20 , $270.40 , $270.40 , $24.75 , $312.08 , $321.10 , $304.20 , $304.20 , $304.20 , $314.34 , $324.48 , $128.31 , $287.30 , $196.25 , $130.88 , N/A , $102.81 , $102.81 , $321.10 , $119.25 , $24.75 , $324.48 
 Pro Rpr Xtnsr Tdn Hand 1/2 W/O Fr Grf Ea Tdn ,CPT® 26410,0981 - PRO FEE/ER,N/A,N/A," $2,283.00 "," $1,483.95 "," $3,809.13 ", $591.56 , $390.36 ," $2,681.89 "," $2,743.57 "," $2,123.19 "," $2,054.70 "," $2,054.70 "," $1,826.40 "," $1,826.40 ", $390.36 ," $2,107.89 "," $2,168.85 "," $2,054.70 "," $2,054.70 "," $2,054.70 "," $2,123.19 "," $2,191.68 "," $3,496.67 "," $1,940.55 "," $3,000.80 "," $3,216.59 ", N/A ," $2,734.22 "," $2,734.22 "," $2,168.85 "," $3,213.66 ", $390.36 ," $3,809.13 "
 Fac Iaad Ia Histoplasm Capsulatum ,CPT® 87385,0306 - LAB/BACT-MICRO,N/A,N/A, $179.00 , $116.35 , $150.36 , $13.52 , $13.52 , $144.63 , $161.10 , $151.54 , $161.10 , $161.10 , $161.10 , $152.15 , $13.25 , $165.27 , $170.05 , $152.15 , $166.47 , $166.47 , $170.05 , $171.84 , $146.46 , $161.10 , $152.15 , $141.41 , N/A , $144.86 , $144.86 , $170.05 , $153.60 , $13.25 , $171.84 
"Repair Exten Leg Tendn,Second,Ea",CPT® 27665,N/A,N/A,N/A," $2,770.00 "," $1,800.50 "," $2,594.67 ", $406.77 , $276.59 ," $1,991.94 "," $2,022.65 "," $2,576.10 "," $2,493.00 "," $2,493.00 "," $2,216.00 "," $2,216.00 ", $276.59 ," $2,557.54 "," $2,631.50 "," $2,493.00 "," $2,493.00 "," $2,493.00 "," $2,576.10 "," $2,659.20 "," $2,409.17 "," $2,354.50 "," $2,215.81 "," $2,382.01 ", N/A ," $2,030.80 "," $2,030.80 "," $2,631.50 "," $2,386.92 ", $276.59 ," $2,659.20 "
 NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OP SUSP ,HCPCS RXC637,0250 - PHARMACY,61314-0641-75,7.5 mL, $874.56 , $568.46 , $734.63 , N/A , N/A , $706.64 , $787.10 , $740.40 , $787.10 , $787.10 , $787.10 , $743.38 , N/A , $807.48 , $830.83 , $743.38 , $813.34 , $813.34 , $830.83 , $839.58 , $715.56 , $787.10 , $743.38 , $690.90 , N/A , $707.78 , $707.78 , $830.83 , $750.46 , $690.90 , $839.58 
 ENOXAPARIN SODIUM 120 MG/0.8ML IJ SOSY ,HCPCS J1650,0636 - DRUGS REQUIRING DETAILED CODIN,00955-1012-10,0.8 mL, $158.05 , $102.73 , $132.76 , $0.69 , $0.83 , $127.70 , $142.25 , $133.81 , $142.25 , $142.25 , $142.25 , $134.34 , $0.81 , $145.93 , $150.15 , $134.34 , $146.99 , $146.99 , $150.15 , $151.73 , $129.32 , $142.25 , $134.34 , $124.86 , N/A , $127.91 , $127.91 , $150.15 , $135.62 , $0.69 , $151.73 
 Fac Rmvl Impltbl Dfb Pls Gen W/Rplcmt Pls Gen Mlt Ld ,CPT® 33264,0360 - OR SERVICES,N/A,N/A," $9,134.00 "," $5,937.10 "," $7,672.56 ", $372.82 , $301.38 ," $7,380.27 "," $8,220.60 "," $7,732.84 "," $8,220.60 "," $8,220.60 "," $8,220.60 "," $7,763.90 ", $295.47 ," $8,433.42 "," $8,677.30 "," $7,763.90 "," $8,494.62 "," $8,494.62 "," $8,677.30 "," $8,768.64 "," $7,473.44 "," $8,220.60 "," $7,763.90 "," $7,215.86 ", N/A ," $7,392.15 "," $7,392.15 "," $8,677.30 "," $7,837.89 ", $295.47 ," $8,768.64 "
" Fx Ulnar,Closed,W/O Manip ",CPT® 24670,0981 - PRO FEE/ER,N/A,N/A," $1,130.00 ", $734.50 ," $1,666.60 ", $264.23 , $194.38 ," $1,264.93 "," $1,285.98 "," $1,050.90 "," $1,017.00 "," $1,017.00 ", $904.00 , $904.00 , $194.38 ," $1,043.33 "," $1,073.50 "," $1,017.00 "," $1,017.00 "," $1,017.00 "," $1,050.90 "," $1,084.80 "," $1,534.20 ", $960.50 ," $1,411.19 "," $1,501.55 ", N/A ," $1,289.61 "," $1,289.61 "," $1,073.50 "," $1,515.75 ", $194.38 ," $1,666.60 "
 PROPRANOLOL HCL 20 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00115-1660-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Pro Imhistochem/Cytchm Ea Multiplex Antibody Slide ,CPT® 88344,0971 - PRO FEE/LAB,N/A,N/A, $202.00 , $131.30 , $607.13 , $165.40 , $92.01 , $463.97 , $533.14 , $187.86 , $181.80 , $181.80 , $161.60 , $161.60 , $92.01 , $186.51 , $191.90 , $181.80 , $181.80 , $181.80 , $187.86 , $193.92 ," $1,128.92 ", $171.70 , $809.30 , $606.79 , N/A , $433.01 , $433.01 , $191.90 , $475.86 , $92.01 ," $1,128.92 "
"Excis Mouth Mucosa/Sub,No Repair",40810,N/A,N/A,N/A, $612.00 , $397.80 , $757.97 , $119.56 , $46.08 , $623.48 , $644.77 , $569.16 , $550.80 , $550.80 , $489.60 , $489.60 , $46.08 , $565.06 , $581.40 , $550.80 , $550.80 , $550.80 , $569.16 , $587.52 , $542.69 , $520.20 , $702.92 , $733.18 , N/A , $635.65 , $635.65 , $581.40 , $664.80 , $46.08 , $757.97 
 Fac Analyze Spine Infusion Pump ,CPT® 62367,0360 - OR SERVICES,N/A,N/A, $910.00 , $591.50 , $764.40 , $23.48 , $34.37 , $735.28 , $819.00 , $770.41 , $819.00 , $819.00 , $819.00 , $773.50 , $33.70 , $840.20 , $864.50 , $773.50 , $846.30 , $846.30 , $864.50 , $873.60 , $744.56 , $819.00 , $773.50 , $718.90 , N/A , $736.46 , $736.46 , $864.50 , $780.87 , $23.48 , $873.60 
 IBUPROFEN 800 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-5855-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Sq/Im Chemo Admin Hormonal -Mh ,CPT® 96402,0331 - CHEMOTHER/INJ,N/A,N/A, $155.00 , $100.75 , $130.20 , $33.06 , $29.44 , $125.24 , $139.50 , $131.22 , $139.50 , $139.50 , $139.50 , $131.75 , $28.86 , $143.11 , $147.25 , $131.75 , $144.15 , $144.15 , $147.25 , $148.80 , $126.82 , $139.50 , $131.75 , $122.45 , N/A , $125.44 , $125.44 , $147.25 , $133.01 , $28.86 , $148.80 
Basic Metabolic Panel Calcium Ionized,CPT® 80047,N/A,N/A,N/A, $112.00 , $72.80 , N/A , $14.00 , $11.74 , $47.85 , $57.25 , $104.16 , $100.80 , $100.80 , $89.60 , $89.60 , $11.74 , $103.41 , $106.40 , $100.80 , $100.80 , $100.80 , $104.16 , $107.52 , $91.68 , $95.20 , $55.14 , $40.33 , N/A , $44.66 , $44.66 , $106.40 , $48.80 , $11.74 , $107.52 
 SODIUM CHLORIDE 0.9% 10 ML FLUSH (STERILE FIELD) ,HCPCS RXA250,0250 - PHARMACY,08290-3065-53,10 mL, $7.61 , $4.95 , $6.39 , N/A , N/A , $6.15 , $6.85 , $6.44 , $6.85 , $6.85 , $6.85 , $6.47 , N/A , $7.03 , $7.23 , $6.47 , $7.08 , $7.08 , $7.23 , $7.31 , $6.23 , $6.85 , $6.47 , $6.01 , N/A , $6.16 , $6.16 , $7.23 , $6.53 , $6.01 , $7.31 
"Cystotomy,Excis Bladder Tic",CPT® 51525,N/A,N/A,N/A," $5,973.00 "," $3,882.45 "," $4,648.07 ", $817.18 ," $1,075.74 "," $4,200.20 "," $3,913.55 "," $5,554.89 "," $5,375.70 "," $5,375.70 "," $4,778.40 "," $4,778.40 "," $1,075.74 "," $5,514.87 "," $5,674.35 "," $5,375.70 "," $5,375.70 "," $5,375.70 "," $5,554.89 "," $5,734.08 "," $4,666.08 "," $5,077.05 "," $4,436.97 "," $5,275.49 ", N/A ," $4,282.15 "," $4,282.15 "," $5,674.35 "," $5,033.06 ", $817.18 ," $5,734.08 "
ER MD Closed Tx Carpometacarpal-Lh,26670,N/A,N/A,N/A," $1,780.00 "," $1,157.00 "," $1,932.00 ", $304.70 , $101.43 ," $1,473.39 "," $1,459.87 "," $1,655.40 "," $1,602.00 "," $1,602.00 "," $1,424.00 "," $1,424.00 ", $101.43 ," $1,643.47 "," $1,691.00 "," $1,602.00 "," $1,602.00 "," $1,602.00 "," $1,655.40 "," $1,708.80 "," $1,780.30 "," $1,513.00 "," $1,602.09 "," $1,770.69 ", N/A ," $1,502.13 "," $1,502.13 "," $1,691.00 "," $1,765.55 ", $101.43 ," $1,932.00 "
Theraputic Fracture of Nose,CPT® 30930,N/A,N/A,N/A, $713.00 , $463.45 , $643.02 , $114.66 , $137.18 , $470.47 , $477.69 , $663.09 , $641.70 , $641.70 , $570.40 , $570.40 , $137.18 , $658.31 , $677.35 , $641.70 , $641.70 , $641.70 , $663.09 , $684.48 , $617.30 , $606.05 , $672.59 , $622.37 , N/A , $479.65 , $479.65 , $677.35 , $564.88 , $114.66 , $684.48 
" Ivl W/Atherectomy + Pta; Tib, Peroneal ",HCPCS C9774,0360 - OR SERVICES,N/A,N/A," $20,287.00 "," $13,186.55 "," $17,041.08 ", N/A , N/A ," $16,391.90 "," $18,258.30 "," $17,174.97 "," $18,258.30 "," $18,258.30 "," $18,258.30 "," $17,243.95 ", N/A ," $18,730.99 "," $19,272.65 "," $17,243.95 "," $18,866.91 "," $18,866.91 "," $19,272.65 "," $19,475.52 "," $16,598.82 "," $18,258.30 "," $17,243.95 "," $16,026.73 ", N/A ," $16,418.27 "," $16,418.27 "," $19,272.65 "," $17,408.27 "," $16,026.73 "," $19,475.52 "
Part Removal Colon W Colostomy,CPT® 44141,N/A,N/A,N/A," $11,848.00 "," $7,701.20 "," $10,825.23 "," $1,671.77 "," $1,229.45 "," $8,599.26 "," $8,691.56 "," $11,018.64 "," $10,663.20 "," $10,663.20 "," $9,478.40 "," $9,478.40 "," $1,229.45 "," $10,939.26 "," $11,255.60 "," $10,663.20 "," $10,663.20 "," $10,663.20 "," $11,018.64 "," $11,374.08 "," $7,786.43 "," $10,070.80 "," $9,658.92 "," $10,157.70 ", N/A ," $8,767.04 "," $8,767.04 "," $11,255.60 "," $9,169.40 "," $1,229.45 "," $11,374.08 "
 Fac Byp Oth/Thn Vein Fem-Fem ,CPT® 35661,0360 - OR SERVICES,N/A,N/A," $13,880.00 "," $9,022.00 "," $11,659.20 ", $966.18 ," $1,340.24 "," $11,215.04 "," $12,492.00 "," $11,750.81 "," $12,492.00 "," $12,492.00 "," $12,492.00 "," $11,798.00 "," $1,313.96 "," $12,815.40 "," $13,186.00 "," $11,798.00 "," $12,908.40 "," $12,908.40 "," $13,186.00 "," $13,324.80 "," $11,356.62 "," $12,492.00 "," $11,798.00 "," $10,965.20 ", N/A ," $11,233.08 "," $11,233.08 "," $13,186.00 "," $11,910.43 ", $966.18 ," $13,324.80 "
 Pro Clsd Tx Interphalangeal Joint W Manip WO Anes ,CPT® 26770,0982 - PRO FEE/OUTPT,N/A,N/A," $1,789.00 "," $1,162.85 "," $1,609.47 ", $257.24 , $74.85 ," $1,227.08 "," $1,253.31 "," $1,663.77 "," $1,610.10 "," $1,610.10 "," $1,431.20 "," $1,431.20 ", $74.85 ," $1,651.78 "," $1,699.55 "," $1,610.10 "," $1,610.10 "," $1,610.10 "," $1,663.77 "," $1,717.44 "," $1,478.71 "," $1,520.65 "," $1,373.73 "," $1,463.84 ", N/A ," $1,251.03 "," $1,251.03 "," $1,699.55 "," $1,470.39 ", $74.85 ," $1,717.44 "
 LOSARTAN POTASSIUM 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-7047-61,1 tablet, $3.58 , $2.33 , $3.01 , N/A , N/A , $2.89 , $3.22 , $3.03 , $3.22 , $3.22 , $3.22 , $3.04 , N/A , $3.31 , $3.40 , $3.04 , $3.33 , $3.33 , $3.40 , $3.44 , $2.93 , $3.22 , $3.04 , $2.83 , N/A , $2.90 , $2.90 , $3.40 , $3.07 , $2.83 , $3.44 
 ENFORTUMAB VEDOTIN-EJFV 30 MG IV SOLR ,HCPCS J9177,0636 - DRUGS REQUIRING DETAILED CODIN,51144-0030-01,3 mL," $12,146.43 "," $7,895.18 "," $10,203.00 ", $34.50 , $34.49 ," $9,814.32 "," $10,931.79 "," $10,283.17 "," $10,931.79 "," $10,931.79 "," $10,931.79 "," $10,324.47 ", $33.81 ," $11,214.80 "," $11,539.11 "," $10,324.47 "," $11,296.18 "," $11,296.18 "," $11,539.11 "," $11,660.57 "," $9,938.21 "," $10,931.79 "," $10,324.47 "," $9,595.68 ", N/A ," $9,830.11 "," $9,830.11 "," $11,539.11 "," $10,422.85 ", $33.81 ," $11,660.57 "
" Fac Artery X-Rays, Lung ",CPT® 75741,0320 - DX X-RAY,N/A,N/A," $1,383.00 ", $898.95 ," $1,161.72 ", $128.35 , $231.06 ," $1,117.46 "," $1,244.70 "," $1,170.85 "," $1,244.70 "," $1,244.70 "," $1,244.70 "," $1,175.55 ", $226.53 ," $1,276.92 "," $1,313.85 "," $1,175.55 "," $1,286.19 "," $1,286.19 "," $1,313.85 "," $1,327.68 "," $1,131.57 "," $1,244.70 "," $1,175.55 "," $1,092.57 ", N/A ," $1,119.26 "," $1,119.26 "," $1,313.85 "," $1,186.75 ", $128.35 ," $1,327.68 "
Polysomnography W/Cpap,CPT® 95811,N/A,N/A,N/A," $6,369.00 "," $4,139.85 "," $2,325.90 ", $622.13 ," $1,159.73 "," $2,077.89 "," $2,300.90 "," $5,923.17 "," $5,732.10 "," $5,732.10 "," $5,095.20 "," $5,095.20 "," $1,159.73 "," $5,880.50 "," $6,050.55 "," $5,732.10 "," $5,732.10 "," $5,732.10 "," $5,923.17 "," $6,114.24 "," $2,763.52 "," $5,413.65 "," $2,018.31 "," $2,480.88 ", N/A ," $2,118.44 "," $2,118.44 "," $6,050.55 "," $2,604.38 ", $622.13 ," $6,114.24 "
 Gastroesophageal Reflux Study ,CPT® 78262,0340 - NUCLEAR MEDICINE,N/A,N/A," $2,325.00 "," $1,511.25 "," $1,953.00 ", $225.99 , $203.17 ," $1,878.60 "," $2,092.50 "," $1,968.35 "," $2,092.50 "," $2,092.50 "," $2,092.50 "," $1,976.25 ", $199.19 ," $2,146.67 "," $2,208.75 "," $1,976.25 "," $2,162.25 "," $2,162.25 "," $2,208.75 "," $2,232.00 "," $1,902.32 "," $2,092.50 "," $1,976.25 "," $1,836.75 ", N/A ," $1,881.62 "," $1,881.62 "," $2,208.75 "," $1,995.08 ", $199.19 ," $2,232.00 "
 Fac Assay of Serum Albumin ,CPT® 82040,0301 - LAB/CHEMISTRY,N/A,N/A, $62.00 , $40.30 , $52.08 , $5.05 , $5.05 , $50.10 , $55.80 , $52.49 , $55.80 , $55.80 , $55.80 , $52.70 , $4.95 , $57.24 , $58.90 , $52.70 , $57.66 , $57.66 , $58.90 , $59.52 , $50.73 , $55.80 , $52.70 , $48.98 , N/A , $50.18 , $50.18 , $58.90 , $53.20 , $4.95 , $59.52 
"Pessary, Non Rubber,Any Type",HCPCS A4562,N/A,N/A,N/A, $121.00 , $78.65 , N/A , $69.07 , $17.42 , N/A , N/A , $112.53 , $108.90 , $108.90 , $96.80 , $96.80 , $17.42 , $111.72 , $114.95 , $108.90 , $108.90 , $108.90 , $112.53 , $116.16 , N/A , $102.85 , $62.93 , $62.75 , N/A , N/A , N/A , $114.95 , N/A , $17.42 , $116.16 
 ZALEPLON 5 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,29300-0131-01,1 capsule, $18.94 , $12.31 , $15.91 , N/A , N/A , $15.30 , $17.05 , $16.03 , $17.05 , $17.05 , $17.05 , $16.10 , N/A , $17.49 , $17.99 , $16.10 , $17.61 , $17.61 , $17.99 , $18.18 , $15.50 , $17.05 , $16.10 , $14.96 , N/A , $15.33 , $15.33 , $17.99 , $16.25 , $14.96 , $18.18 
"Locm 100-199mg/Ml Iodine,1ml",HCPCS Q9965,N/A,N/A,N/A, $3.00 , $1.95 , N/A , $1.34 , $1.58 , N/A , N/A , $2.79 , $2.70 , $2.70 , $2.40 , $2.40 , $1.58 , $2.77 , $2.85 , $2.70 , $2.70 , $2.70 , $2.79 , $2.88 , $0.72 , $2.55 , $1.95 , $1.02 , N/A , N/A , N/A , $2.85 , N/A , $0.72 , $2.88 
Ipratropium Brom Inh Sol U D,HCPCS J7644,N/A,N/A,N/A, $9.00 , $5.85 , N/A , $0.27 , $0.24 , N/A , N/A , $8.37 , $8.10 , $8.10 , $7.20 , $7.20 , $0.24 , $8.31 , $8.55 , $8.10 , $8.10 , $8.10 , $8.37 , $8.64 , $0.26 , $7.65 , $0.65 , $0.27 , N/A , N/A , N/A , $8.55 , N/A , $0.24 , $8.64 
 Fac Radex Hip Unilateral With Pelvis 1 View ,CPT® 73501,0320 - DX X-RAY,N/A,N/A, $292.00 , $189.80 , $245.28 , $32.37 , $23.46 , $235.94 , $262.80 , $247.21 , $262.80 , $262.80 , $262.80 , $248.20 , $23.00 , $269.60 , $277.40 , $248.20 , $271.56 , $271.56 , $277.40 , $280.32 , $238.91 , $262.80 , $248.20 , $230.68 , N/A , $236.32 , $236.32 , $277.40 , $250.57 , $23.00 , $280.32 
 LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY ,HCPCS RXA250,0250 - PHARMACY,25021-0673-77,11 mL, $39.16 , $25.45 , $32.89 , N/A , N/A , $31.64 , $35.24 , $33.15 , $35.24 , $35.24 , $35.24 , $33.29 , N/A , $36.16 , $37.20 , $33.29 , $36.42 , $36.42 , $37.20 , $37.59 , $32.04 , $35.24 , $33.29 , $30.94 , N/A , $31.69 , $31.69 , $37.20 , $33.60 , $30.94 , $37.59 
Blood Platelet Aggregation,CPT® 85576,N/A,N/A,N/A, $224.00 , $145.60 , N/A , $25.41 , $25.41 , $121.56 , $145.40 , $208.32 , $201.60 , $201.60 , $179.20 , $179.20 , $25.41 , $206.82 , $212.80 , $201.60 , $201.60 , $201.60 , $208.32 , $215.04 , $166.33 , $190.40 , $236.79 , $77.89 , N/A , $113.45 , $113.45 , $212.80 , $123.98 , $25.41 , $236.79 
" Fac Eeg, 41-60 Minutes ",CPT® 95812,0740 - EEG,N/A,N/A," $1,496.00 ", $972.40 ," $1,256.64 ", $338.99 , $260.27 ," $1,208.77 "," $1,346.40 "," $1,266.51 "," $1,346.40 "," $1,346.40 "," $1,346.40 "," $1,271.60 ", $255.17 ," $1,381.26 "," $1,421.20 "," $1,271.60 "," $1,391.28 "," $1,391.28 "," $1,421.20 "," $1,436.16 "," $1,224.03 "," $1,346.40 "," $1,271.60 "," $1,181.84 ", N/A ," $1,210.71 "," $1,210.71 "," $1,421.20 "," $1,283.72 ", $255.17 ," $1,436.16 "
 Pro US Ndl Plmt Img S&I ,CPT® 76942,0972 - PRO FEE/RAD/DX,N/A,N/A, $399.00 , $259.35 , $326.54 , $57.19 , $98.27 , $290.60 ," $1,078.86 ", $371.07 , $359.10 , $359.10 , $319.20 , $319.20 , $98.27 , $368.40 , $379.05 , $359.10 , $359.10 , $359.10 , $371.07 , $383.04 , $319.64 , $339.15 ," $1,180.66 ", $336.85 , N/A , $296.28 , $296.28 , $379.05 , $342.94 , $57.19 ," $1,180.66 "
"Closed Rx Trimalleolar Fx,Manip",27818,N/A,N/A,N/A," $2,722.00 "," $1,769.30 "," $2,689.44 ", $425.99 , $461.04 ," $2,091.91 "," $2,115.33 "," $2,531.46 "," $2,449.80 "," $2,449.80 "," $2,177.60 "," $2,177.60 ", $461.04 ," $2,513.22 "," $2,585.90 "," $2,449.80 "," $2,449.80 "," $2,449.80 "," $2,531.46 "," $2,613.12 "," $2,482.99 "," $2,313.70 "," $2,326.42 "," $2,473.59 ", N/A ," $2,132.73 "," $2,132.73 "," $2,585.90 "," $2,506.70 ", $425.99 ," $2,689.44 "
 GUAIFENESIN-DM 100-10 MG/5ML PO SYRP ,HCPCS RXC637,0250 - PHARMACY,00121-0638-00,5 mL, $12.82 , $8.33 , $10.77 , N/A , N/A , $10.36 , $11.54 , $10.85 , $11.54 , $11.54 , $11.54 , $10.90 , N/A , $11.84 , $12.18 , $10.90 , $11.92 , $11.92 , $12.18 , $12.31 , $10.49 , $11.54 , $10.90 , $10.13 , N/A , $10.38 , $10.38 , $12.18 , $11.00 , $10.13 , $12.31 
"Incis/Drain Pelvis/Hip,Deep Abscess",26990,N/A,N/A,N/A," $2,564.00 "," $1,666.60 "," $4,190.68 ", $652.59 , $200.70 ," $3,011.59 "," $3,015.22 "," $2,384.52 "," $2,307.60 "," $2,307.60 "," $2,051.20 "," $2,051.20 ", $200.70 ," $2,367.34 "," $2,435.80 "," $2,307.60 "," $2,307.60 "," $2,307.60 "," $2,384.52 "," $2,461.44 "," $3,832.32 "," $2,179.40 "," $3,325.50 "," $3,561.87 ", N/A ," $3,070.35 "," $3,070.35 "," $2,435.80 "," $3,608.76 ", $200.70 ," $4,190.68 "
Assay Blood Chloride,CPT® 82435,N/A,N/A,N/A, $79.00 , $51.35 , N/A , $4.69 , $4.69 , $26.03 , $31.11 , $73.47 , $71.10 , $71.10 , $63.20 , $63.20 , $4.69 , $72.94 , $75.05 , $71.10 , $71.10 , $71.10 , $73.47 , $75.84 , $30.72 , $67.15 , $30.82 , $16.68 , N/A , $24.29 , $24.29 , $75.05 , $26.54 , $4.69 , $75.84 
Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes,CPT® 97130,N/A,N/A,N/A, $266.00 , $172.90 , $28.86 , $21.62 , $18.37 , $51.37 , N/A , $247.38 , $239.40 , $239.40 , $212.80 , $212.80 , $18.37 , $245.60 , $252.70 , $239.40 , $239.40 , $239.40 , $247.38 , $255.36 , $55.72 , $226.10 , $64.62 , $52.05 , N/A , $52.37 , $52.37 , $252.70 , $58.17 , $18.37 , $255.36 
 GENTAMICIN SULFATE 40 MG/ML IJ SOLN ,HCPCS J1580,0636 - DRUGS REQUIRING DETAILED CODIN,00409-1207-03,2 mL, $16.68 , $10.84 , $14.01 , $3.05 , $2.85 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $2.79 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $2.79 , $16.01 
 Pro MRI Breast Without Contrast Material Unilateral ,CPT® 77046,0972 - PRO FEE/RAD/DX,N/A,N/A, $686.00 , $445.90 ," $1,272.58 ", $218.24 , $197.79 ," $1,108.41 ", N/A , $637.98 , $617.40 , $617.40 , $548.80 , $548.80 , $197.79 , $633.38 , $651.70 , $617.40 , $617.40 , $617.40 , $637.98 , $658.56 ," $1,319.30 ", $583.10 ," $1,271.87 "," $4,997.15 ", N/A ," $1,130.04 "," $1,130.04 ", $651.70 ," $1,308.05 ", $197.79 ," $4,997.15 "
Acupunct W/ Elec Stimul 15 Min,CPT® 97813,N/A,N/A,N/A, $246.00 , $159.90 , $65.36 , $32.75 , N/A , $74.39 , $73.22 , $228.78 , $221.40 , $221.40 , $196.80 , $196.80 , N/A , $227.13 , $233.70 , $221.40 , $221.40 , $221.40 , $228.78 , $236.16 , $183.54 , $209.10 , $96.30 , $125.75 , N/A , $75.85 , $75.85 , $233.70 , $88.42 , $32.75 , $236.16 
Fmr1 Analysis Eval to Detect Abnormal Alleles,CPT® 81243,N/A,N/A,N/A, $687.00 , $446.55 , N/A , $58.18 , $55.55 , N/A , N/A , $638.91 , $618.30 , $618.30 , $549.60 , $549.60 , $55.55 , $634.31 , $652.65 , $618.30 , $618.30 , $618.30 , $638.91 , $659.52 , $380.87 , $583.95 , $271.38 , $167.53 , N/A , $226.45 , $226.45 , $652.65 , $246.98 , $55.55 , $659.52 
 Fac Appl Long Leg Cst Thi-Toe ,CPT® 29345,0761 - TREATMENT ROOM,N/A,N/A, $517.00 , $336.05 , $434.28 , $94.01 , $111.25 , $417.74 , $465.30 , $437.69 , $465.30 , $465.30 , $465.30 , $439.45 , $109.07 , $477.35 , $491.15 , $439.45 , $480.81 , $480.81 , $491.15 , $496.32 , $423.01 , $465.30 , $439.45 , $408.43 , N/A , $418.41 , $418.41 , $491.15 , $443.64 , $94.01 , $496.32 
 Thyroid Bx Perc Core Needle ,CPT® 60100,0761 - TREATMENT ROOM,N/A,N/A," $1,117.00 ", $726.05 , $938.28 , $73.60 , $88.93 , $902.54 ," $1,005.30 ", $945.65 ," $1,005.30 "," $1,005.30 "," $1,005.30 ", $949.45 , $87.19 ," $1,031.33 "," $1,061.15 ", $949.45 ," $1,038.81 "," $1,038.81 "," $1,061.15 "," $1,072.32 ", $913.93 ," $1,005.30 ", $949.45 , $882.43 , N/A , $903.99 , $903.99 ," $1,061.15 ", $958.50 , $73.60 ," $1,072.32 "
 KCL IN DEXTROSE-NACL 40-5-0.9 MEQ/L-%-% IV SOLN ,HCPCS RXA258,0258 - IV SOLUTIONS,00990-7109-09,"1,000 mL", $133.03 , $86.47 , $111.75 , N/A , N/A , $107.49 , $119.73 , $112.62 , $119.73 , $119.73 , $119.73 , $113.08 , N/A , $122.83 , $126.38 , $113.08 , $123.72 , $123.72 , $126.38 , $127.71 , $108.85 , $119.73 , $113.08 , $105.09 , N/A , $107.66 , $107.66 , $126.38 , $114.15 , $105.09 , $127.71 
 Pro Prq Skel Fixj Tibl Shft Fx ,CPT® 27756,0975 - PRO FEE/OR,N/A,N/A," $4,389.00 "," $2,852.85 "," $3,545.75 ", $554.33 , $768.38 ," $2,782.84 "," $2,791.04 "," $4,081.77 "," $3,950.10 "," $3,950.10 "," $3,511.20 "," $3,511.20 ", $768.38 ," $4,052.36 "," $4,169.55 "," $3,950.10 "," $3,950.10 "," $3,950.10 "," $4,081.77 "," $4,213.44 "," $3,274.31 "," $3,730.65 "," $3,079.29 "," $3,299.59 ", N/A ," $2,837.13 "," $2,837.13 "," $4,169.55 "," $3,334.64 ", $554.33 ," $4,213.44 "
Injection Aa&/Strd Pudendal Nerve,CPT® 64430,N/A,N/A,N/A, $944.00 , $613.60 , $267.18 , $52.29 , $61.84 , $465.02 , $442.31 , $877.92 , $849.60 , $849.60 , $755.20 , $755.20 , $61.84 , $871.60 , $896.80 , $849.60 , $849.60 , $849.60 , $877.92 , $906.24 , $291.12 , $802.40 , $429.96 , $485.39 , N/A , $474.09 , $474.09 , $896.80 , $508.59 , $52.29 , $906.24 
 Fac Vascular Embolization or Occlusion Venous Rs&I ,CPT® 37241,0360 - OR SERVICES,N/A,N/A," $15,641.00 "," $10,166.65 "," $13,138.44 ", $397.11 ," $2,378.00 "," $12,637.93 "," $14,076.90 "," $13,241.67 "," $14,076.90 "," $14,076.90 "," $14,076.90 "," $13,294.85 "," $2,331.37 "," $14,441.34 "," $14,858.95 "," $13,294.85 "," $14,546.13 "," $14,546.13 "," $14,858.95 "," $15,015.36 "," $12,797.47 "," $14,076.90 "," $13,294.85 "," $12,356.39 ", N/A ," $12,658.26 "," $12,658.26 "," $14,858.95 "," $13,421.54 ", $397.11 ," $15,015.36 "
 Pro Cltx Humrl Cndylr Fx Medial/Lat W/O Mnpj ,CPT® 24576,0981 - PRO FEE/ER,N/A,N/A," $1,464.00 ", $951.60 ," $1,950.91 ", $309.19 , $184.42 ," $1,473.39 "," $1,496.54 "," $1,361.52 "," $1,317.60 "," $1,317.60 "," $1,171.20 "," $1,171.20 ", $184.42 ," $1,351.71 "," $1,390.80 "," $1,317.60 "," $1,317.60 "," $1,317.60 "," $1,361.52 "," $1,405.44 "," $1,793.26 "," $1,244.40 "," $1,643.12 "," $1,749.60 ", N/A ," $1,502.13 "," $1,502.13 "," $1,390.80 "," $1,765.55 ", $184.42 ," $1,950.91 "
Removal of Ovary(S),CPT® 58940,N/A,N/A,N/A," $3,856.00 "," $2,506.40 "," $2,618.80 ", $529.82 , $453.02 ," $2,125.37 "," $2,110.65 "," $3,586.08 "," $3,470.40 "," $3,470.40 "," $3,084.80 "," $3,084.80 ", $453.02 ," $3,560.24 "," $3,663.20 "," $3,470.40 "," $3,470.40 "," $3,470.40 "," $3,586.08 "," $3,701.76 "," $2,710.00 "," $3,277.60 "," $2,783.14 "," $2,133.84 ", N/A ," $2,166.84 "," $2,166.84 "," $3,663.20 "," $2,598.98 ", $453.02 ," $3,701.76 "
 Fac Psychotherapy W/Patient W/E&M Srvcs 45 Min ,CPT® 90836,0914 - PSYCH/INDIV RX,N/A,N/A, $177.00 , $115.05 , $148.68 , $77.70 , $101.25 , $143.02 , $159.30 , $149.85 , $159.30 , $159.30 , $159.30 , $150.45 , $99.26 , $163.42 , $168.15 , $150.45 , $164.61 , $164.61 , $168.15 , $169.92 , $144.82 , $159.30 , $150.45 , $139.83 , N/A , $143.25 , $143.25 , $168.15 , $151.88 , $77.70 , $169.92 
 HYDROMORPHONE HCL-NACL 10-0.9 MG/50ML-% IV SOSY ,HCPCS RXA250,0250 - PHARMACY,70092-9114-50,50 mL, $102.23 , $66.45 , $85.87 , N/A , N/A , $82.60 , $92.01 , $86.55 , $92.01 , $92.01 , $92.01 , $86.90 , N/A , $94.39 , $97.12 , $86.90 , $95.07 , $95.07 , $97.12 , $98.14 , $83.64 , $92.01 , $86.90 , $80.76 , N/A , $82.73 , $82.73 , $97.12 , $87.72 , $80.76 , $98.14 
Drug Screening Opiates 1 or More,CPT® 80361,N/A,N/A,N/A, $171.00 , $111.15 , N/A , N/A , N/A , N/A , N/A , $159.03 , $153.90 , $153.90 , $136.80 , $136.80 , N/A , $157.88 , $162.45 , $153.90 , $153.90 , $153.90 , $159.03 , $164.16 , N/A , $145.35 , $114.69 , $67.79 , N/A , $90.04 , $90.04 , $162.45 , $98.20 , $67.79 , $164.16 
 NAFCILLIN SODIUM 2 G IJ SOLR ,HCPCS RXA250,0250 - PHARMACY,55150-0123-15,8 mL, $77.06 , $50.09 , $64.73 , N/A , N/A , $62.26 , $69.35 , $65.24 , $69.35 , $69.35 , $69.35 , $65.50 , N/A , $71.15 , $73.21 , $65.50 , $71.67 , $71.67 , $73.21 , $73.98 , $63.05 , $69.35 , $65.50 , $60.88 , N/A , $62.36 , $62.36 , $73.21 , $66.13 , $60.88 , $73.98 
 Fac Assay of Copper ,CPT® 82525,0301 - LAB/CHEMISTRY,N/A,N/A, $124.00 , $80.60 , $104.16 , $12.66 , $12.66 , $100.19 , $111.60 , $104.98 , $111.60 , $111.60 , $111.60 , $105.40 , $12.41 , $114.49 , $117.80 , $105.40 , $115.32 , $115.32 , $117.80 , $119.04 , $101.46 , $111.60 , $105.40 , $97.96 , N/A , $100.35 , $100.35 , $117.80 , $106.40 , $12.41 , $119.04 
Perq Prcrd Drg 6yr+ W/O Congenital Car Anomaly,CPT® 33017,N/A,N/A,N/A," $2,126.00 "," $1,381.90 "," $1,446.32 ", $222.87 , $187.36 ," $1,028.81 ", N/A ," $1,977.18 "," $1,913.40 "," $1,913.40 "," $1,700.80 "," $1,700.80 ", $187.36 ," $1,962.94 "," $2,019.70 "," $1,913.40 "," $1,913.40 "," $1,913.40 "," $1,977.18 "," $2,040.96 "," $1,335.40 "," $1,807.10 "," $1,279.40 "," $1,188.44 ", N/A ," $1,048.88 "," $1,048.88 "," $2,019.70 "," $1,191.27 ", $187.36 ," $2,040.96 "
 Pro CT Soft Tissue Neck W/Dye ,CPT® 70491,0972 - PRO FEE/RAD/DX,N/A,N/A, $824.00 , $535.60 ," $1,319.01 ", $188.89 , $297.22 ," $1,122.44 "," $1,411.23 ", $766.32 , $741.60 , $741.60 , $659.20 , $659.20 , $297.22 , $760.80 , $782.80 , $741.60 , $741.60 , $741.60 , $766.32 , $791.04 ," $1,110.14 ", $700.40 ," $1,538.91 "," $1,318.77 ", N/A ," $1,144.34 "," $1,144.34 ", $782.80 ," $1,324.60 ", $188.89 ," $1,538.91 "
Iadna Enterovirus Amplified Probe Technique,CPT® 87498,N/A,N/A,N/A, $302.00 , $196.30 , N/A , $35.79 , $35.79 , $198.56 , $237.51 , $280.86 , $271.80 , $271.80 , $241.60 , $241.60 , $35.79 , $278.84 , $286.90 , $271.80 , $271.80 , $271.80 , $280.86 , $289.92 , $234.30 , $256.70 , $230.30 , $127.26 , N/A , $185.31 , $185.31 , $286.90 , $202.50 , $35.79 , $289.92 
 Pro Radiologic Small Intestine Follow-Through Study ,CPT® 74248,0972 - PRO FEE/RAD/DX,N/A,N/A, $433.00 , $281.45 , $481.92 , $82.53 , $65.14 , $386.75 , N/A , $402.69 , $389.70 , $389.70 , $346.40 , $346.40 , $65.14 , $399.79 , $411.35 , $389.70 , $389.70 , $389.70 , $402.69 , $415.68 , $471.95 , $368.05 , $481.51 , $417.61 , N/A , $394.30 , $394.30 , $411.35 , $456.96 , $65.14 , $481.92 
Egd Dilation Gastric/Duodenal Stricture,43245,N/A,N/A,N/A," $2,546.00 "," $1,654.90 "," $1,069.77 ", $165.31 , $174.43 , $889.63 , $911.65 ," $2,367.78 "," $2,291.40 "," $2,291.40 "," $2,036.80 "," $2,036.80 ", $174.43 ," $2,350.72 "," $2,418.70 "," $2,291.40 "," $2,291.40 "," $2,291.40 "," $2,367.78 "," $2,444.16 ", $770.53 ," $2,164.10 "," $1,000.86 "," $1,018.00 ", N/A , $906.99 , $906.99 ," $2,418.70 ", $948.60 , $165.31 ," $2,444.16 "
"Surg Implnt Neuroelect,Epidural",CPT® 63655,N/A,N/A,N/A," $5,789.00 "," $3,762.85 "," $3,920.44 ", $768.30 , $714.02 ," $4,494.06 "," $4,353.00 "," $5,383.77 "," $5,210.10 "," $5,210.10 "," $4,631.20 "," $4,631.20 ", $714.02 ," $5,344.98 "," $5,499.55 "," $5,210.10 "," $5,210.10 "," $5,210.10 "," $5,383.77 "," $5,557.44 "," $4,227.21 "," $4,920.65 "," $4,417.34 "," $4,722.88 ", N/A ," $4,581.74 "," $4,581.74 "," $5,499.55 "," $4,915.13 ", $714.02 ," $5,557.44 "
 POLYMYXIN B-TRIMETHOPRIM 10000-0.1 UNIT/ML-% OP SOLN ,HCPCS RXC637,0250 - PHARMACY,60758-0908-10,10 mL, $67.14 , $43.64 , $56.40 , N/A , N/A , $54.25 , $60.43 , $56.84 , $60.43 , $60.43 , $60.43 , $57.07 , N/A , $61.99 , $63.78 , $57.07 , $62.44 , $62.44 , $63.78 , $64.45 , $54.93 , $60.43 , $57.07 , $53.04 , N/A , $54.34 , $54.34 , $63.78 , $57.61 , $53.04 , $64.45 
Amputation Low Leg Thru Tib/Fib,CPT® 27880,N/A,N/A,N/A," $6,151.00 "," $3,998.15 "," $5,330.46 ", $826.47 , $823.62 ," $4,446.27 "," $4,418.90 "," $5,720.43 "," $5,535.90 "," $5,535.90 "," $4,920.80 "," $4,920.80 ", $823.62 ," $5,679.22 "," $5,843.45 "," $5,535.90 "," $5,535.90 "," $5,535.90 "," $5,720.43 "," $5,904.96 "," $4,966.70 "," $5,228.35 "," $4,924.02 "," $5,128.96 ", N/A ," $4,533.03 "," $4,533.03 "," $5,843.45 "," $5,327.92 ", $823.62 ," $5,904.96 "
Revis/Repair OP Wound Anter Sgmt,66250,N/A,N/A,N/A," $6,873.00 "," $4,467.45 "," $3,422.77 ", $537.39 , $620.01 ," $3,153.41 "," $2,988.49 "," $6,391.89 "," $6,185.70 "," $6,185.70 "," $5,498.40 "," $5,498.40 ", $620.01 ," $6,345.84 "," $6,529.35 "," $6,185.70 "," $6,185.70 "," $6,185.70 "," $6,391.89 "," $6,598.08 "," $4,701.06 "," $5,842.05 "," $3,102.49 "," $4,008.02 ", N/A ," $3,214.94 "," $3,214.94 "," $6,529.35 "," $3,548.88 ", $537.39 ," $6,598.08 "
" Pro Prev Visit, Est, Age 65& Over ",CPT® 99397,0982 - PRO FEE/OUTPT,N/A,N/A, $405.00 , $263.25 , N/A , $130.52 , $37.32 , $217.41 , $220.24 , $376.65 , $364.50 , $364.50 , $324.00 , $324.00 , $37.32 , $373.94 , $384.75 , $364.50 , $364.50 , $364.50 , $376.65 , $388.80 , $269.36 , $344.25 , $220.53 , $217.38 , N/A , $221.66 , $221.66 , $384.75 , $266.22 , $37.32 , $388.80 
Assay Acid Phosphatase,CPT® 84060,N/A,N/A,N/A, $68.00 , $44.20 , N/A , $7.79 , $7.79 , $41.78 , $49.97 , $63.24 , $61.20 , $61.20 , $54.40 , $54.40 , $7.79 , $62.78 , $64.60 , $61.20 , $61.20 , $61.20 , $63.24 , $65.28 , $51.01 , $57.80 , $48.66 , $26.79 , N/A , $38.99 , $38.99 , $64.60 , $42.61 , $7.79 , $65.28 
Drain Skin Abscess Simple,10060,N/A,N/A,N/A, $464.00 , $301.60 , $340.58 , $102.58 , $41.23 , $265.18 , $259.37 , $431.52 , $417.60 , $417.60 , $371.20 , $371.20 , $41.23 , $428.41 , $440.80 , $417.60 , $417.60 , $417.60 , $431.52 , $445.44 , $366.26 , $394.40 , $512.03 , $344.96 , N/A , $270.35 , $270.35 , $440.80 , $313.53 , $41.23 , $512.03 
 DIAZEPAM 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,51079-0285-20,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Complex Repair 1.1-2.5cm,CPT® 13100,N/A,N/A,N/A," $1,319.00 ", $857.35 , $642.26 , $192.43 , $105.47 , $564.30 , $548.16 ," $1,226.67 "," $1,187.10 "," $1,187.10 "," $1,055.20 "," $1,055.20 ", $105.47 ," $1,217.83 "," $1,253.05 "," $1,187.10 "," $1,187.10 "," $1,187.10 "," $1,226.67 "," $1,266.24 ", $707.52 ," $1,121.15 "," $1,093.63 ", $722.14 , N/A , $575.31 , $575.31 ," $1,253.05 ", $667.17 , $105.47 ," $1,266.24 "
 POTASSIUM CL IN DEXTROSE 5% 20 MEQ/L IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00338-0683-04,"1,000 mL", $159.63 , $103.76 , $134.09 , N/A , N/A , $128.98 , $143.67 , $135.14 , $143.67 , $143.67 , $143.67 , $135.69 , N/A , $147.39 , $151.65 , $135.69 , $148.46 , $148.46 , $151.65 , $153.24 , $130.61 , $143.67 , $135.69 , $126.11 , N/A , $129.19 , $129.19 , $151.65 , $136.98 , $126.11 , $153.24 
TREAT ELBOW FRACTURE,24620,N/A,N/A,N/A," $3,455.00 "," $2,245.75 "," $3,455.21 ", $566.73 , $307.34 ," $2,627.39 "," $2,671.21 "," $3,213.15 "," $3,109.50 "," $3,109.50 "," $2,764.00 "," $2,764.00 ", $307.34 ," $3,190.00 "," $3,282.25 "," $3,109.50 "," $3,109.50 "," $3,109.50 "," $3,213.15 "," $3,316.80 "," $3,190.31 "," $2,936.75 "," $2,941.92 "," $3,146.52 ", N/A ," $2,678.66 "," $2,678.66 "," $3,282.25 "," $3,148.38 ", $307.34 ," $3,455.21 "
 Fac Rp Loclzj Tum Plnr 2+Area 1+D Img/1 Area Img>2+D ,CPT® 78801,0340 - NUCLEAR MEDICINE,N/A,N/A," $2,403.00 "," $1,561.95 "," $2,018.52 ", $250.71 , $208.51 ," $1,941.62 "," $2,162.70 "," $2,034.38 "," $2,162.70 "," $2,162.70 "," $2,162.70 "," $2,042.55 ", $204.42 ," $2,218.69 "," $2,282.85 "," $2,042.55 "," $2,234.79 "," $2,234.79 "," $2,282.85 "," $2,306.88 "," $1,966.13 "," $2,162.70 "," $2,042.55 "," $1,898.37 ", N/A ," $1,944.75 "," $1,944.75 "," $2,282.85 "," $2,062.01 ", $204.42 ," $2,306.88 "
Cast Sup Shrt Leg Fiberglass,HCPCS Q4038,N/A,N/A,N/A, $75.00 , $48.75 , N/A , $49.95 , $32.31 , N/A , N/A , $69.75 , $67.50 , $67.50 , $60.00 , $60.00 , $32.31 , $69.25 , $71.25 , $67.50 , $67.50 , $67.50 , $69.75 , $72.00 , N/A , $63.75 , $181.00 , $45.38 , N/A , N/A , N/A , $71.25 , N/A , $32.31 , $181.00 
Autolog prp not diab ulcer,HCPCS G0460,N/A,N/A,N/A, $496.00 , $322.40 , N/A , N/A , N/A , N/A , N/A , $461.28 , $446.40 , $446.40 , $396.80 , $396.80 , N/A , $457.96 , $471.20 , $446.40 , $446.40 , $446.40 , $461.28 , $476.16 , N/A , $421.60 ," $1,482.29 ", $455.00 , N/A , $149.48 , $149.48 , $471.20 , $186.86 , $149.48 ," $1,482.29 "
 DARBEPOETIN ALFA 200 MCG/0.4ML IJ SOSY ,HCPCS J0882,0636 - DRUGS REQUIRING DETAILED CODIN,55513-0028-01,0.4 mL," $4,551.61 "," $2,958.55 "," $3,823.35 ", $3.00 , N/A ," $3,677.70 "," $4,096.45 "," $3,853.39 "," $4,096.45 "," $4,096.45 "," $4,096.45 "," $3,868.87 ", N/A ," $4,202.50 "," $4,324.03 "," $3,868.87 "," $4,233.00 "," $4,233.00 "," $4,324.03 "," $4,369.55 "," $3,724.13 "," $4,096.45 "," $3,868.87 "," $3,595.77 ", N/A ," $3,683.62 "," $3,683.62 "," $4,324.03 "," $3,905.74 ", $3.00 ," $4,369.55 "
"Closed Rx Med Malleolus Fx,Manip",27762,N/A,N/A,N/A," $1,416.00 ", $920.40 ," $2,693.02 ", $424.52 , $423.69 ," $2,081.98 "," $2,113.34 "," $1,316.88 "," $1,274.40 "," $1,274.40 "," $1,132.80 "," $1,132.80 ", $423.69 ," $1,307.39 "," $1,345.20 "," $1,274.40 "," $1,274.40 "," $1,274.40 "," $1,316.88 "," $1,359.36 "," $2,468.04 "," $1,203.60 "," $2,322.85 "," $2,446.54 ", N/A ," $2,122.61 "," $2,122.61 "," $1,345.20 "," $2,494.81 ", $423.69 ," $2,693.02 "
 Pro Exc Tumor Soft Tissue Abdominal Wall Subq <3cm ,CPT® 22902,0975 - PRO FEE/OR,N/A,N/A," $2,901.00 "," $1,885.65 "," $2,014.87 ", $314.57 , $346.95 ," $1,587.40 "," $1,578.19 "," $2,697.93 "," $2,610.90 "," $2,610.90 "," $2,320.80 "," $2,320.80 ", $346.95 ," $2,678.49 "," $2,755.95 "," $2,610.90 "," $2,610.90 "," $2,610.90 "," $2,697.93 "," $2,784.96 "," $1,864.37 "," $2,465.85 "," $1,728.76 "," $1,864.11 ", N/A ," $1,618.38 "," $1,618.38 "," $2,755.95 "," $1,902.17 ", $314.57 ," $2,784.96 "
Open Biopsy/Excision Inguinofemoral Nodes,CPT® 38531,N/A,N/A,N/A," $2,330.00 "," $1,514.50 "," $2,060.60 ", $417.36 , $340.63 ," $1,423.95 ", N/A ," $2,166.90 "," $2,097.00 "," $2,097.00 "," $1,864.00 "," $1,864.00 ", $340.63 ," $2,151.29 "," $2,213.50 "," $2,097.00 "," $2,097.00 "," $2,097.00 "," $2,166.90 "," $2,236.80 "," $2,198.51 "," $1,980.50 "," $2,381.10 "," $2,126.69 ", N/A ," $1,451.74 "," $1,451.74 "," $2,213.50 "," $1,684.19 ", $340.63 ," $2,381.10 "
 Fac Brnchsc Ebus Guided Sampl 3/> Node Station/Strux ,CPT® 31653,0360 - OR SERVICES,N/A,N/A," $3,268.00 "," $2,124.20 "," $2,745.12 ", $232.37 , $763.89 ," $2,640.54 "," $2,941.20 "," $2,766.69 "," $2,941.20 "," $2,941.20 "," $2,941.20 "," $2,777.80 ", $748.91 ," $3,017.34 "," $3,104.60 "," $2,777.80 "," $3,039.24 "," $3,039.24 "," $3,104.60 "," $3,137.28 "," $2,673.88 "," $2,941.20 "," $2,777.80 "," $2,581.72 ", N/A ," $2,644.79 "," $2,644.79 "," $3,104.60 "," $2,804.27 ", $232.37 ," $3,137.28 "
 Hemoglobin Beaker1 ,CPT® 85018,0305 - LAB/HEMATOLOGY,N/A,N/A, $53.00 , $34.45 , $44.52 , $2.42 , $2.42 , $42.82 , $47.70 , $44.87 , $47.70 , $47.70 , $47.70 , $45.05 , $2.37 , $48.93 , $50.35 , $45.05 , $49.29 , $49.29 , $50.35 , $50.88 , $43.36 , $47.70 , $45.05 , $41.87 , N/A , $42.89 , $42.89 , $50.35 , $45.48 , $2.37 , $50.88 
Layer Clousre 2.6-7.5cm,12042,N/A,N/A,N/A," $1,172.00 ", $761.80 , $627.61 , $188.46 , $103.08 , $547.43 , $537.01 ," $1,089.96 "," $1,054.80 "," $1,054.80 ", $937.60 , $937.60 , $103.08 ," $1,082.11 "," $1,113.40 "," $1,054.80 "," $1,054.80 "," $1,054.80 "," $1,089.96 "," $1,125.12 ", $689.37 , $996.20 ," $1,066.87 ", $703.69 , N/A , $558.12 , $558.12 ," $1,113.40 ", $647.23 , $103.08 ," $1,125.12 "
 Fac I&D Cplx Po Wnd Infctj ,CPT® 10180,0761 - TREATMENT ROOM,N/A,N/A," $3,588.00 "," $2,332.20 "," $3,013.92 ", $168.12 , $111.13 ," $2,899.10 "," $3,229.20 "," $3,037.60 "," $3,229.20 "," $3,229.20 "," $3,229.20 "," $3,049.80 ", $108.95 ," $3,312.80 "," $3,408.60 "," $3,049.80 "," $3,336.84 "," $3,336.84 "," $3,408.60 "," $3,444.48 "," $2,935.70 "," $3,229.20 "," $3,049.80 "," $2,834.52 ", N/A ," $2,903.77 "," $2,903.77 "," $3,408.60 "," $3,078.86 ", $108.95 ," $3,444.48 "
 Fac Diab Manage Trn Ind/Group ,HCPCS G0109,0942 - EDUC/TRAINING,N/A,N/A, $44.00 , $28.60 , $36.96 , $15.32 , N/A , $35.55 , $39.60 , $37.25 , $39.60 , $39.60 , $39.60 , $37.40 , N/A , $40.63 , $41.80 , $37.40 , $40.92 , $40.92 , $41.80 , $42.24 , $36.00 , $39.60 , $37.40 , $34.76 , N/A , $35.61 , $35.61 , $41.80 , $37.76 , $15.32 , $42.24 
Endoscopic Harvest Uxtr Artery 1 Segment Cab Px,CPT® 33509,N/A,N/A,N/A," $1,055.00 ", $685.75 ," $1,004.51 ", $154.77 , $190.25 , N/A , N/A , $981.15 , $949.50 , $949.50 , $844.00 , $844.00 , $190.25 , $974.08 ," $1,002.25 ", $949.50 , $949.50 , $949.50 , $981.15 ," $1,012.80 ", N/A , $896.75 , $899.13 , $833.53 , N/A , $655.53 , $655.53 ," $1,002.25 ", $744.84 , $154.77 ," $1,012.80 "
Mirror Coating,HCPCS V2761,N/A,N/A,N/A, $9.00 , $5.85 , N/A , N/A , N/A , N/A , N/A , $8.37 , $8.10 , $8.10 , $7.20 , $7.20 , N/A , $8.31 , $8.55 , $8.10 , $8.10 , $8.10 , $8.37 , $8.64 , N/A , $7.65 , $9.00 , $12.45 , N/A , N/A , N/A , $8.55 , N/A , $7.20 , $12.45 
THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING,35207,N/A,N/A,N/A," $4,132.00 "," $2,685.80 "," $4,582.11 ", $720.22 , $621.96 ," $3,247.95 "," $3,225.51 "," $3,842.76 "," $3,718.80 "," $3,718.80 "," $3,305.60 "," $3,305.60 ", $621.96 ," $3,815.08 "," $3,925.40 "," $3,718.80 "," $3,718.80 "," $3,718.80 "," $3,842.76 "," $3,966.72 "," $4,226.21 "," $3,512.20 "," $4,001.66 "," $3,722.89 ", N/A ," $3,311.32 "," $3,311.32 "," $3,925.40 "," $3,761.66 ", $621.96 ," $4,582.11 "
 Pfizer Second Dose Tris-Sucrose Formulation ,CPT® 0052A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
 Fac Colonoscopy Stoma Rmvl Les by Hot Biopsy Forceps ,CPT® 44392,0360 - OR SERVICES,N/A,N/A," $2,523.00 "," $1,639.95 "," $2,119.32 ", $186.54 , $676.09 ," $2,038.58 "," $2,270.70 "," $2,135.97 "," $2,270.70 "," $2,270.70 "," $2,270.70 "," $2,144.55 ", $662.83 ," $2,329.49 "," $2,396.85 "," $2,144.55 "," $2,346.39 "," $2,346.39 "," $2,396.85 "," $2,422.08 "," $2,064.32 "," $2,270.70 "," $2,144.55 "," $1,993.17 ", N/A ," $2,041.86 "," $2,041.86 "," $2,396.85 "," $2,164.99 ", $186.54 ," $2,422.08 "
Treat Tibial Fracture,CPT® 27530,N/A,N/A,N/A," $1,636.00 "," $1,063.40 "," $1,803.82 ", $285.61 , $164.92 ," $1,350.84 "," $1,377.36 "," $1,521.48 "," $1,472.40 "," $1,472.40 "," $1,308.80 "," $1,308.80 ", $164.92 ," $1,510.52 "," $1,554.20 "," $1,472.40 "," $1,472.40 "," $1,472.40 "," $1,521.48 "," $1,570.56 "," $1,654.54 "," $1,390.60 "," $1,511.10 "," $1,607.37 ", N/A ," $1,377.20 "," $1,377.20 "," $1,554.20 "," $1,618.70 ", $164.92 ," $1,803.82 "
Layer Closure 30+Cm,CPT® 12037,N/A,N/A,N/A," $1,866.00 "," $1,212.90 "," $1,027.96 ", $306.27 , $258.15 , $892.94 , $855.00 ," $1,735.38 "," $1,679.40 "," $1,679.40 "," $1,492.80 "," $1,492.80 ", $258.15 ," $1,722.88 "," $1,772.70 "," $1,679.40 "," $1,679.40 "," $1,679.40 "," $1,735.38 "," $1,791.36 "," $1,129.34 "," $1,586.10 "," $1,719.84 "," $1,133.19 ", N/A , $910.36 , $910.36 ," $1,772.70 "," $1,055.71 ", $258.15 ," $1,791.36 "
 MRI Shoulder Elbow or Wrist- Lh ,CPT® 73221,0972 - PRO FEE/RAD/DX,N/A,N/A, $805.00 , $523.25 ," $1,450.05 ", $207.89 , $411.27 ," $1,390.85 "," $1,461.33 ", $748.65 , $724.50 , $724.50 , $644.00 , $644.00 , $411.27 , $743.26 , $764.75 , $724.50 , $724.50 , $724.50 , $748.65 , $772.80 ," $2,532.90 ", $684.25 ," $1,596.69 "," $2,191.78 ", N/A ," $1,417.99 "," $1,417.99 ", $764.75 ," $1,668.22 ", $207.89 ," $2,532.90 "
 CT Guided Aspir &/or Inj Small Jt ,CPT® 20600,0761 - TREATMENT ROOM,N/A,N/A, $548.00 , $356.20 , $460.32 , $33.86 , $39.50 , $442.78 , $493.20 , $463.94 , $493.20 , $493.20 , $493.20 , $465.80 , $38.73 , $505.97 , $520.60 , $465.80 , $509.64 , $509.64 , $520.60 , $526.08 , $448.37 , $493.20 , $465.80 , $432.92 , N/A , $443.50 , $443.50 , $520.60 , $470.24 , $33.86 , $526.08 
Ablate L/R Atrial Fibril W/Isolated Pulm Vein,CPT® 93657,N/A,N/A,N/A," $2,560.00 "," $1,664.00 "," $1,822.47 ", $280.41 , $309.17 ," $2,255.47 "," $2,218.59 "," $2,380.80 "," $2,304.00 "," $2,304.00 "," $2,048.00 "," $2,048.00 ", $309.17 ," $2,363.65 "," $2,432.00 "," $2,304.00 "," $2,304.00 "," $2,304.00 "," $2,380.80 "," $2,457.60 "," $2,461.60 "," $2,176.00 "," $2,158.72 "," $2,050.45 ", N/A ," $2,299.48 "," $2,299.48 "," $2,432.00 "," $2,549.01 ", $280.41 ," $2,549.01 "
Assay Vitamin-A,CPT® 84590,N/A,N/A,N/A, $186.00 , $120.90 , N/A , $11.84 , $11.84 , $65.65 , $78.53 , $172.98 , $167.40 , $167.40 , $148.80 , $148.80 , $11.84 , $171.73 , $176.70 , $167.40 , $167.40 , $167.40 , $172.98 , $178.56 , $77.52 , $158.10 , $76.23 , $42.09 , N/A , $61.27 , $61.27 , $176.70 , $66.95 , $11.84 , $178.56 
Treat Metatarsophalangeal,28630,N/A,N/A,N/A, $837.00 , $544.05 , $677.30 , $106.32 , $134.96 , $532.98 , $535.04 , $778.41 , $753.30 , $753.30 , $669.60 , $669.60 , $134.96 , $772.80 , $795.15 , $753.30 , $753.30 , $753.30 , $778.41 , $803.52 , $627.12 , $711.45 , $583.39 , $633.25 , N/A , $543.38 , $543.38 , $795.15 , $638.64 , $106.32 , $803.52 
" Rt Mra W/O & W/Contrast, Lower Ext ",HCPCS C8914,0616 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA-LOWER EXTREMITIES,N/A,N/A," $3,916.00 "," $2,545.40 "," $3,289.44 ", N/A , N/A ," $3,164.13 "," $3,524.40 "," $3,315.29 "," $3,524.40 "," $3,524.40 "," $3,524.40 "," $3,328.60 ", N/A ," $3,615.64 "," $3,720.20 "," $3,328.60 "," $3,641.88 "," $3,641.88 "," $3,720.20 "," $3,759.36 "," $3,204.07 "," $3,524.40 "," $3,328.60 "," $3,093.64 ", N/A ," $3,169.22 "," $3,169.22 "," $3,720.20 "," $3,360.32 "," $3,093.64 "," $3,759.36 "
 Fac Cor Ffr Cta Data Alys & Gnrj Estimated Ffr Model ,CPT® 0503T,0350 - CT SCAN,N/A,N/A," $4,120.00 "," $2,678.00 "," $3,460.80 ", $872.58 , N/A ," $3,328.96 "," $3,708.00 "," $3,487.99 "," $3,708.00 "," $3,708.00 "," $3,708.00 "," $3,502.00 ", N/A ," $3,804.00 "," $3,914.00 "," $3,502.00 "," $3,831.60 "," $3,831.60 "," $3,914.00 "," $3,955.20 "," $3,370.98 "," $3,708.00 "," $3,502.00 "," $3,254.80 ", N/A ," $3,334.32 "," $3,334.32 "," $3,914.00 "," $3,535.37 ", $872.58 ," $3,955.20 "
 Abdomen Complete US ,CPT® 76700,0402 - ULTRASOUND,N/A,N/A, $816.00 , $530.40 , $685.44 , $115.56 , $122.89 , $659.33 , $734.40 , $690.83 , $734.40 , $734.40 , $734.40 , $693.60 , $120.48 , $753.41 , $775.20 , $693.60 , $758.88 , $758.88 , $775.20 , $783.36 , $667.65 , $734.40 , $693.60 , $644.64 , N/A , $660.39 , $660.39 , $775.20 , $700.21 , $115.56 , $783.36 
 Chronic Obstructive Pulmonary Disease With McC ,MS DRG V40 (FY2023) 190,N/A,N/A,N/A," $8,434.88 "," $5,482.67 "," $7,085.30 ", N/A , N/A ," $6,815.38 "," $7,591.39 "," $7,140.97 "," $7,591.39 "," $7,591.39 "," $7,591.39 "," $7,169.65 ", N/A ," $7,787.92 "," $8,013.14 "," $7,169.65 "," $7,844.44 "," $7,844.44 "," $8,013.14 "," $8,097.48 "," $6,901.42 "," $7,591.39 "," $7,169.65 "," $6,663.56 ", N/A ," $6,826.35 "," $6,826.35 "," $8,013.14 "," $7,237.97 "," $6,663.56 "," $8,097.48 "
Complete Cbc & Auto Diff Wbc,CPT® 85025,N/A,N/A,N/A, $119.00 , $77.35 , N/A , $7.93 , $7.93 , $43.99 , $52.64 , $110.67 , $107.10 , $107.10 , $95.20 , $95.20 , $7.93 , $109.87 , $113.05 , $107.10 , $107.10 , $107.10 , $110.67 , $114.24 , $51.88 , $101.15 , $50.28 , $28.17 , N/A , $41.05 , $41.05 , $113.05 , $44.86 , $7.93 , $114.24 
" Pro Biopsy of Breast, Open ",CPT® 19101,0982 - PRO FEE/OUTPT,N/A,N/A," $2,251.00 "," $1,463.15 ", $703.90 , $208.99 , $274.21 , $596.28 , $581.14 ," $2,093.43 "," $2,025.90 "," $2,025.90 "," $1,800.80 "," $1,800.80 ", $274.21 ," $2,078.35 "," $2,138.45 "," $2,025.90 "," $2,025.90 "," $2,025.90 "," $2,093.43 "," $2,160.96 ", $769.07 ," $1,913.35 "," $1,170.35 ", $755.64 , N/A , $607.92 , $607.92 ," $2,138.45 ", $704.98 , $208.99 ," $2,160.96 "
 CALCIUM ACETATE (PHOS BINDER) 667 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,68084-0479-01,1 capsule, $8.63 , $5.61 , $7.25 , N/A , N/A , $6.97 , $7.77 , $7.31 , $7.77 , $7.77 , $7.77 , $7.34 , N/A , $7.97 , $8.20 , $7.34 , $8.03 , $8.03 , $8.20 , $8.28 , $7.06 , $7.77 , $7.34 , $6.82 , N/A , $6.98 , $6.98 , $8.20 , $7.41 , $6.82 , $8.28 
 Pro Oph US Dx B-Scan +-a-Scan ,CPT® 76512,0981 - PRO FEE/ER,N/A,N/A, $376.00 , $244.40 , $270.51 , $47.48 , $89.10 , $449.52 , $497.27 , $349.68 , $338.40 , $338.40 , $300.80 , $300.80 , $89.10 , $347.16 , $357.20 , $338.40 , $338.40 , $338.40 , $349.68 , $360.96 , $273.28 , $319.60 , $543.14 , $423.34 , N/A , $458.29 , $458.29 , $357.20 , $530.47 , $47.48 , $543.14 
Exploration of Spinal Fusion,CPT® 22830,N/A,N/A,N/A," $5,288.00 "," $3,437.20 "," $4,855.05 ", $760.54 , $497.88 ," $3,893.07 "," $3,857.76 "," $4,917.84 "," $4,759.20 "," $4,759.20 "," $4,230.40 "," $4,230.40 ", $497.88 ," $4,882.41 "," $5,023.60 "," $4,759.20 "," $4,759.20 "," $4,759.20 "," $4,917.84 "," $5,076.48 "," $4,516.92 "," $4,494.80 "," $4,315.65 "," $4,541.00 ", N/A ," $3,969.04 "," $3,969.04 "," $5,023.60 "," $4,665.03 ", $497.88 ," $5,076.48 "
Rpr Nsl Vlv Collapse Lw Nrg Subq/Sbmcsl Rmdlg,CPT® 30469,N/A,N/A,N/A," $19,181.00 "," $12,467.65 ", N/A , $143.63 , N/A , N/A , N/A ," $17,838.33 "," $17,262.90 "," $17,262.90 "," $15,344.80 "," $15,344.80 ", N/A ," $17,709.82 "," $18,221.95 "," $17,262.90 "," $17,262.90 "," $17,262.90 "," $17,838.33 "," $18,413.76 ", N/A ," $16,303.85 ", $796.07 , N/A , N/A , $495.94 , $495.94 ," $18,221.95 ", $585.24 , $143.63 ," $18,413.76 "
Ekg Interpret & Report Preve,G0405,N/A,N/A,N/A, $100.00 , $65.00 , $51.61 , $7.96 , N/A , $15.76 , N/A , $93.00 , $90.00 , $90.00 , $80.00 , $80.00 , N/A , $92.33 , $95.00 , $90.00 , $90.00 , $90.00 , $93.00 , $96.00 , $22.30 , $85.00 , $15.57 , $32.14 , N/A , $16.07 , $16.07 , $95.00 , $20.09 , $7.96 , $96.00 
Treat Calcaneal Fracture,28400,N/A,N/A,N/A," $1,673.00 "," $1,087.45 "," $1,427.86 ", $226.27 , $230.52 ," $1,105.57 "," $1,134.26 "," $1,555.89 "," $1,505.70 "," $1,505.70 "," $1,338.40 "," $1,338.40 ", $230.52 ," $1,544.68 "," $1,589.35 "," $1,505.70 "," $1,505.70 "," $1,505.70 "," $1,555.89 "," $1,606.08 "," $1,314.98 "," $1,422.05 "," $1,238.14 "," $1,313.86 ", N/A ," $1,127.14 "," $1,127.14 "," $1,589.35 "," $1,324.78 ", $226.27 ," $1,606.08 "
Remv Pilonidal Lesion Simple,CPT® 11770,N/A,N/A,N/A," $2,166.00 "," $1,407.90 ", $585.48 , $173.87 , $218.61 , $497.89 , $486.86 ," $2,014.38 "," $1,949.40 "," $1,949.40 "," $1,732.80 "," $1,732.80 ", $218.61 ," $1,999.87 "," $2,057.70 "," $1,949.40 "," $1,949.40 "," $1,949.40 "," $2,014.38 "," $2,079.36 ", $641.69 ," $1,841.10 ", $979.45 , $633.57 , N/A , $507.60 , $507.60 ," $2,057.70 ", $588.65 , $173.87 ," $2,079.36 "
 PHENYTOIN 50 MG PO CHEW ,HCPCS RXC637,0250 - PHARMACY,60687-0156-25,1 tablet, $9.25 , $6.01 , $7.77 , N/A , N/A , $7.47 , $8.33 , $7.83 , $8.33 , $8.33 , $8.33 , $7.86 , N/A , $8.54 , $8.79 , $7.86 , $8.60 , $8.60 , $8.79 , $8.88 , $7.57 , $8.33 , $7.86 , $7.31 , N/A , $7.49 , $7.49 , $8.79 , $7.94 , $7.31 , $8.88 
 Pro Remove Eyelid Lesion ,CPT® 67840,0982 - PRO FEE/OUTPT,N/A,N/A," $2,601.00 "," $1,690.65 ", $967.33 , $152.02 , $78.75 , $897.04 , $841.30 ," $2,418.93 "," $2,340.90 "," $2,340.90 "," $2,080.80 "," $2,080.80 ", $78.75 ," $2,401.50 "," $2,470.95 "," $2,340.90 "," $2,340.90 "," $2,340.90 "," $2,418.93 "," $2,496.96 "," $1,326.31 "," $2,210.85 ", $867.06 ," $1,135.98 ", N/A , $914.53 , $914.53 ," $2,470.95 "," $1,009.55 ", $78.75 ," $2,496.96 "
"Laminectomy,>2 Sgmt,Lumbar",CPT® 63017,N/A,N/A,N/A," $8,113.00 "," $5,273.45 "," $5,841.68 "," $1,143.40 "," $1,536.80 "," $6,787.62 "," $6,540.57 "," $7,545.09 "," $7,301.70 "," $7,301.70 "," $6,490.40 "," $6,490.40 "," $1,536.80 "," $7,490.73 "," $7,707.35 "," $7,301.70 "," $7,301.70 "," $7,301.70 "," $7,545.09 "," $7,788.48 "," $6,311.54 "," $6,896.05 "," $6,663.48 "," $7,092.64 ", N/A ," $6,920.07 "," $6,920.07 "," $7,707.35 "," $7,423.59 "," $1,143.40 "," $7,788.48 "
 INSULIN NPH (HUMAN) (ISOPHANE) 100 UNIT/ML SC SUPN ,HCPCS RXC637,0250 - PHARMACY,00002-8805-59,3 mL, $581.05 , $377.68 , $488.08 , N/A , N/A , $469.49 , $522.95 , $491.92 , $522.95 , $522.95 , $522.95 , $493.89 , N/A , $536.48 , $552.00 , $493.89 , $540.38 , $540.38 , $552.00 , $557.81 , $475.42 , $522.95 , $493.89 , $459.03 , N/A , $470.24 , $470.24 , $552.00 , $498.60 , $459.03 , $557.81 
 Pro Radiologic Exam Colon Double Contrast Study ,CPT® 74280,0972 - PRO FEE/RAD/DX,N/A,N/A, $612.00 , $397.80 ," $1,293.81 ", $221.19 , $143.92 ," $1,011.71 "," $1,176.83 ", $569.16 , $550.80 , $550.80 , $489.60 , $489.60 , $143.92 , $565.06 , $581.40 , $550.80 , $550.80 , $550.80 , $569.16 , $587.52 ," $1,274.49 ", $520.20 ," $1,280.82 "," $1,077.89 ", N/A ," $1,031.45 "," $1,031.45 ", $581.40 ," $1,193.94 ", $143.92 ," $1,293.81 "
 Pro Removal of Support Implant ,CPT® 20670,0981 - PRO FEE/ER,N/A,N/A, $816.00 , $530.40 , $884.65 , $139.34 , $54.21 , $713.22 , $723.32 , $758.88 , $734.40 , $734.40 , $652.80 , $652.80 , $54.21 , $753.41 , $775.20 , $734.40 , $734.40 , $734.40 , $758.88 , $783.36 , $826.94 , $693.60 , $792.12 , $845.36 , N/A , $727.14 , $727.14 , $775.20 , $854.63 , $54.21 , $884.65 
 Fac Visual Ep Testing Cns Except Glaucoma W/I&R ,CPT® 95930,0922 - EMG,N/A,N/A, $392.00 , $254.80 , $329.28 , $65.18 , $85.85 , $316.74 , $352.80 , $331.87 , $352.80 , $352.80 , $352.80 , $333.20 , $84.17 , $361.93 , $372.40 , $333.20 , $364.56 , $364.56 , $372.40 , $376.32 , $320.73 , $352.80 , $333.20 , $309.68 , N/A , $317.25 , $317.25 , $372.40 , $336.38 , $65.18 , $376.32 
 Fac Endoluminal Bx Urtr &/Rnl Pelvis Nonendoscopic ,CPT® 50606,0360 - OR SERVICES,N/A,N/A," $4,639.00 "," $3,015.35 "," $3,896.76 ", $130.64 , $418.70 ," $3,748.31 "," $4,175.10 "," $3,927.38 "," $4,175.10 "," $4,175.10 "," $4,175.10 "," $3,943.15 ", $410.49 ," $4,283.19 "," $4,407.05 "," $3,943.15 "," $4,314.27 "," $4,314.27 "," $4,407.05 "," $4,453.44 "," $3,795.63 "," $4,175.10 "," $3,943.15 "," $3,664.81 ", N/A ," $3,754.34 "," $3,754.34 "," $4,407.05 "," $3,980.73 ", $130.64 ," $4,453.44 "
 Pro Partial Removal of Eye Fluid ,CPT® 67005,0982 - PRO FEE/OUTPT,N/A,N/A," $4,207.00 "," $2,734.55 "," $2,920.06 ", $460.22 ," $1,072.19 "," $2,674.57 "," $2,542.34 "," $3,912.51 "," $3,786.30 "," $3,786.30 "," $3,365.60 "," $3,365.60 "," $1,072.19 "," $3,884.32 "," $3,996.65 "," $3,786.30 "," $3,786.30 "," $3,786.30 "," $3,912.51 "," $4,038.72 "," $3,997.63 "," $3,575.95 "," $2,645.77 "," $3,396.52 ", N/A ," $2,726.76 "," $2,726.76 "," $3,996.65 "," $3,010.00 ", $460.22 ," $4,038.72 "
"Removal Anal Fistula,Complex/Multi",CPT® 46280,N/A,N/A,N/A," $3,058.00 "," $1,987.70 "," $2,962.77 ", $461.13 , $496.45 ," $2,235.55 "," $2,292.59 "," $2,843.94 "," $2,752.20 "," $2,752.20 "," $2,446.40 "," $2,446.40 ", $496.45 ," $2,823.45 "," $2,905.10 "," $2,752.20 "," $2,752.20 "," $2,752.20 "," $2,843.94 "," $2,935.68 "," $2,106.99 "," $2,599.30 "," $2,520.88 "," $2,668.71 ", N/A ," $2,279.17 "," $2,279.17 "," $2,905.10 "," $2,383.77 ", $461.13 ," $2,962.77 "
 Pro Cltx Mtcrpl Fx 1 W/Mnpj Ea B1 ,CPT® 26605,0981 - PRO FEE/ER,N/A,N/A," $1,450.00 ", $942.50 ," $1,855.17 ", $293.60 , $235.17 ," $1,410.06 "," $1,432.50 "," $1,348.50 "," $1,305.00 "," $1,305.00 "," $1,160.00 "," $1,160.00 ", $235.17 ," $1,338.79 "," $1,377.50 "," $1,305.00 "," $1,305.00 "," $1,305.00 "," $1,348.50 "," $1,392.00 "," $1,703.17 "," $1,232.50 "," $1,571.76 "," $1,675.41 ", N/A ," $1,437.57 "," $1,437.57 "," $1,377.50 "," $1,689.69 ", $235.17 ," $1,855.17 "
Remv Pilonidal Lesion Extens,CPT® 11771,N/A,N/A,N/A," $3,137.00 "," $2,039.05 "," $1,420.35 ", $422.83 , $449.32 ," $1,170.22 "," $1,141.19 "," $2,917.41 "," $2,823.30 "," $2,823.30 "," $2,509.60 "," $2,509.60 ", $449.32 ," $2,896.39 "," $2,980.15 "," $2,823.30 "," $2,823.30 "," $2,823.30 "," $2,917.41 "," $3,011.52 "," $1,534.83 "," $2,666.45 "," $2,296.09 "," $1,490.58 ", N/A ," $1,193.05 "," $1,193.05 "," $2,980.15 "," $1,383.53 ", $422.83 ," $3,011.52 "
 FILGRASTIM-SNDZ 480 MCG/0.8ML IJ SOSY ,HCPCS Q5101,0636 - DRUGS REQUIRING DETAILED CODIN,61314-0326-01,0.8 mL," $1,290.75 ", $838.99 ," $1,084.23 ", $0.18 , $0.24 ," $1,042.93 "," $1,161.68 "," $1,092.75 "," $1,161.68 "," $1,161.68 "," $1,161.68 "," $1,097.14 ", $0.24 ," $1,191.75 "," $1,226.21 "," $1,097.14 "," $1,200.40 "," $1,200.40 "," $1,226.21 "," $1,239.12 "," $1,056.09 "," $1,161.68 "," $1,097.14 "," $1,019.69 ", N/A ," $1,044.60 "," $1,044.60 "," $1,226.21 "," $1,107.59 ", $0.18 ," $1,239.12 "
 Fac Oncoprotein Her-2/Neu ,CPT® 83950,0301 - LAB/CHEMISTRY,N/A,N/A, $631.00 , $410.15 , $530.04 , $65.70 , $65.70 , $509.85 , $567.90 , $534.20 , $567.90 , $567.90 , $567.90 , $536.35 , $64.41 , $582.60 , $599.45 , $536.35 , $586.83 , $586.83 , $599.45 , $605.76 , $516.28 , $567.90 , $536.35 , $498.49 , N/A , $510.67 , $510.67 , $599.45 , $541.46 , $64.41 , $605.76 
 ESTROGENS CONJUGATED 25 MG IJ SOLR ,HCPCS J1410,0636 - DRUGS REQUIRING DETAILED CODIN,00046-0749-05,5 mL," $2,202.69 "," $1,431.75 "," $1,850.26 ", $379.33 , $362.90 ," $1,779.77 "," $1,982.42 "," $1,864.80 "," $1,982.42 "," $1,982.42 "," $1,982.42 "," $1,872.29 ", $355.78 ," $2,033.74 "," $2,092.56 "," $1,872.29 "," $2,048.50 "," $2,048.50 "," $2,092.56 "," $2,114.58 "," $1,802.24 "," $1,982.42 "," $1,872.29 "," $1,740.13 ", N/A ," $1,782.64 "," $1,782.64 "," $2,092.56 "," $1,890.13 ", $355.78 ," $2,114.58 "
 Fac Assay of Somatomedin ,CPT® 84305,0301 - LAB/CHEMISTRY,N/A,N/A, $281.00 , $182.65 , $236.04 , $21.69 , $21.69 , $227.05 , $252.90 , $237.89 , $252.90 , $252.90 , $252.90 , $238.85 , $21.26 , $259.45 , $266.95 , $238.85 , $261.33 , $261.33 , $266.95 , $269.76 , $229.91 , $252.90 , $238.85 , $221.99 , N/A , $227.41 , $227.41 , $266.95 , $241.13 , $21.26 , $269.76 
 ANTIHEMOPHILIC FACTOR-VWF 500-500 UNITS IV KIT ,HCPCS J7183,0636 - DRUGS REQUIRING DETAILED CODIN,68982-0182-01,1 unit, $35.00 , $22.75 , $29.40 , $1.29 , $1.29 , $28.28 , $31.50 , $29.63 , $31.50 , $31.50 , $31.50 , $29.75 , $1.26 , $32.32 , $33.25 , $29.75 , $32.55 , $32.55 , $33.25 , $33.60 , $28.64 , $31.50 , $29.75 , $27.65 , N/A , $28.33 , $28.33 , $33.25 , $30.03 , $1.26 , $33.60 
"Femoral Fx, Open Tx",27236,N/A,N/A,N/A," $6,378.00 "," $4,145.70 "," $7,201.29 "," $1,125.98 "," $1,044.67 "," $5,779.29 "," $5,726.62 "," $5,931.54 "," $5,740.20 "," $5,740.20 "," $5,102.40 "," $5,102.40 "," $1,044.67 "," $5,888.81 "," $6,059.10 "," $5,740.20 "," $5,740.20 "," $5,740.20 "," $5,931.54 "," $6,122.88 "," $6,711.45 "," $5,421.30 "," $6,337.00 "," $6,792.94 ", N/A ," $5,892.06 "," $5,892.06 "," $6,059.10 "," $6,925.28 "," $1,044.67 "," $7,201.29 "
Blood Bank Investig Trans,CPT® 86078,N/A,N/A,N/A, $258.00 , $167.70 , $176.53 , $48.03 , $45.87 , $210.93 , $237.63 , $239.94 , $232.20 , $232.20 , $206.40 , $206.40 , $45.87 , $238.21 , $245.10 , $232.20 , $232.20 , $232.20 , $239.94 , $247.68 , $323.44 , $219.30 , $236.79 , $151.81 , N/A , $196.85 , $196.85 , $245.10 , $215.12 , $45.87 , $323.44 
"Biopsy of Kidney,Open Expos",CPT® 50205,N/A,N/A,N/A," $5,047.00 "," $3,280.55 "," $3,979.86 ", $698.51 , $461.04 ," $3,607.74 "," $3,393.75 "," $4,693.71 "," $4,542.30 "," $4,542.30 "," $4,037.60 "," $4,037.60 ", $461.04 ," $4,659.90 "," $4,794.65 "," $4,542.30 "," $4,542.30 "," $4,542.30 "," $4,693.71 "," $4,845.12 "," $3,970.23 "," $4,289.95 "," $3,957.05 "," $4,455.11 ", N/A ," $3,678.14 "," $3,678.14 "," $4,794.65 "," $4,323.11 ", $461.04 ," $4,845.12 "
"Amputation Foot,Transmetatarsal",28805,N/A,N/A,N/A," $5,026.00 "," $3,266.90 "," $4,360.85 ", $677.03 , $537.90 ," $3,579.67 "," $3,592.06 "," $4,674.18 "," $4,523.40 "," $4,523.40 "," $4,020.80 "," $4,020.80 ", $537.90 ," $4,640.51 "," $4,774.70 "," $4,523.40 "," $4,523.40 "," $4,523.40 "," $4,674.18 "," $4,824.96 "," $4,063.23 "," $4,272.10 "," $3,958.84 "," $4,200.30 ", N/A ," $3,649.51 "," $3,649.51 "," $4,774.70 "," $4,289.47 ", $537.90 ," $4,824.96 "
 MISOPROSTOL 200 MCG PO TABS ,HCPCS RXC637,0250 - PHARMACY,59762-5008-01,1 tablet, $6.16 , $4.00 , $5.17 , N/A , N/A , $4.98 , $5.54 , $5.22 , $5.54 , $5.54 , $5.54 , $5.24 , N/A , $5.69 , $5.85 , $5.24 , $5.73 , $5.73 , $5.85 , $5.91 , $5.04 , $5.54 , $5.24 , $4.87 , N/A , $4.99 , $4.99 , $5.85 , $5.29 , $4.87 , $5.91 
 Pro Initial Preventive Exam (Welcome to Medicare) ,HCPCS G0402,0982 - PRO FEE/OUTPT,N/A,N/A, $339.00 , $220.35 , $321.38 , $127.94 , N/A , $235.19 , $270.88 , $315.27 , $305.10 , $305.10 , $271.20 , $271.20 , N/A , $313.00 , $322.05 , $305.10 , $305.10 , $305.10 , $315.27 , $325.44 , $361.20 , $288.15 , $234.20 , $270.53 , N/A , $239.77 , $239.77 , $322.05 , $299.71 , $127.94 , $361.20 
 CLINIMIX E/DEXTROSE (4.25/10) 4.25 % IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00338-1115-04,"2,000 mL", $503.42 , $327.22 , $422.87 , N/A , N/A , $406.76 , $453.08 , $426.20 , $453.08 , $453.08 , $453.08 , $427.91 , N/A , $464.81 , $478.25 , $427.91 , $468.18 , $468.18 , $478.25 , $483.28 , $411.90 , $453.08 , $427.91 , $397.70 , N/A , $407.42 , $407.42 , $478.25 , $431.98 , $397.70 , $483.28 
 Fac Drug Screening Cannabinoids Natural ,CPT® 80349,0301 - LAB/CHEMISTRY,N/A,N/A, $156.00 , $101.40 , $131.04 , N/A , N/A , $126.05 , $140.40 , $132.07 , $140.40 , $140.40 , $140.40 , $132.60 , N/A , $144.03 , $148.20 , $132.60 , $145.08 , $145.08 , $148.20 , $149.76 , $127.64 , $140.40 , $132.60 , $123.24 , N/A , $126.25 , $126.25 , $148.20 , $133.86 , $123.24 , $149.76 
 Pro Removal of Support Implant ,CPT® 20680,0975 - PRO FEE/OR,N/A,N/A," $4,124.00 "," $2,680.60 "," $2,551.97 ", $400.31 , $233.67 ," $2,051.77 "," $2,058.74 "," $3,835.32 "," $3,711.60 "," $3,711.60 "," $3,299.20 "," $3,299.20 ", $233.67 ," $3,807.69 "," $3,917.80 "," $3,711.60 "," $3,711.60 "," $3,711.60 "," $3,835.32 "," $3,959.04 "," $2,378.32 "," $3,505.40 "," $2,265.76 "," $2,423.60 ", N/A ," $2,091.80 "," $2,091.80 "," $3,917.80 "," $2,458.61 ", $233.67 ," $3,959.04 "
"Injection, Udenyca 0.5 Mg",HCPCS Q5111,N/A,N/A,N/A, $596.00 , $387.40 , N/A , $127.28 , $143.99 , N/A , N/A , $554.28 , $536.40 , $536.40 , $476.80 , $476.80 , $143.99 , $550.29 , $566.20 , $536.40 , $536.40 , $536.40 , $554.28 , $572.16 , $327.26 , $506.60 , $262.34 , $229.20 , N/A , N/A , N/A , $566.20 , N/A , $127.28 , $572.16 
 Dry Needling 15 Min ,CPT® 97799,0420 - PHYSICAL THERAPY,N/A,N/A, $50.00 , $32.50 , $42.00 , N/A , $94.49 , $40.40 , $45.00 , $42.33 , $45.00 , $45.00 , $45.00 , $42.50 , $92.64 , $46.17 , $47.50 , $42.50 , $46.50 , $46.50 , $47.50 , $48.00 , $40.91 , $45.00 , $42.50 , $39.50 , N/A , $40.47 , $40.47 , $47.50 , $42.91 , $39.50 , $94.49 
 SODIUM HYALURONATE (VISCOSUP) 20 MG/2ML IX SOSY ,HCPCS J7321,0636 - DRUGS REQUIRING DETAILED CODIN,89122-0724-20,2 mL," $1,171.21 ", $761.29 , $983.82 , $74.95 , $80.25 , $946.34 ," $1,054.09 ", $991.55 ," $1,054.09 "," $1,054.09 "," $1,054.09 ", $995.53 , $78.68 ," $1,081.38 "," $1,112.65 ", $995.53 ," $1,089.23 "," $1,089.23 "," $1,112.65 "," $1,124.36 ", $958.28 ," $1,054.09 ", $995.53 , $925.26 , N/A , $947.86 , $947.86 ," $1,112.65 "," $1,005.02 ", $74.95 ," $1,124.36 "
Pro Remove/Revise Cast Boot/Body,29700,N/A,N/A,N/A, $443.00 , $287.95 , $198.45 , $30.97 , $22.66 , $160.94 , $161.75 , $411.99 , $398.70 , $398.70 , $354.40 , $354.40 , $22.66 , $409.02 , $420.85 , $398.70 , $398.70 , $398.70 , $411.99 , $425.28 , $185.48 , $376.55 , $178.41 , $193.88 , N/A , $164.08 , $164.08 , $420.85 , $192.87 , $22.66 , $425.28 
Arthroscopy Shoulder Surgical Biceps Tenodesis,CPT® 29828,N/A,N/A,N/A," $3,351.00 "," $2,178.15 "," $5,560.17 ", $870.03 , $635.43 ," $4,411.27 "," $4,435.72 "," $3,116.43 "," $3,015.90 "," $3,015.90 "," $2,680.80 "," $2,680.80 ", $635.43 ," $3,093.98 "," $3,183.45 "," $3,015.90 "," $3,015.90 "," $3,015.90 "," $3,116.43 "," $3,216.96 "," $5,178.57 "," $2,848.35 "," $4,902.61 "," $5,209.04 ", N/A ," $4,497.34 "," $4,497.34 "," $3,183.45 "," $5,285.98 ", $635.43 ," $5,560.17 "
 ACETIC ACID 2 % OT SOLN ,HCPCS RXC637,0250 - PHARMACY,60432-0741-16,15 mL, $205.51 , $133.58 , $172.63 , N/A , N/A , $166.05 , $184.96 , $173.98 , $184.96 , $184.96 , $184.96 , $174.68 , N/A , $189.75 , $195.23 , $174.68 , $191.12 , $191.12 , $195.23 , $197.29 , $168.15 , $184.96 , $174.68 , $162.35 , N/A , $166.32 , $166.32 , $195.23 , $176.35 , $162.35 , $197.29 
 Fac Esphgoscopy Flex W/Band Ligation Esophgl Varices ,CPT® 43205,0360 - OR SERVICES,N/A,N/A," $2,037.00 "," $1,324.05 "," $1,711.08 ", $133.90 , $340.29 ," $1,645.90 "," $1,833.30 "," $1,724.52 "," $1,833.30 "," $1,833.30 "," $1,833.30 "," $1,731.45 ", $333.62 ," $1,880.76 "," $1,935.15 "," $1,731.45 "," $1,894.41 "," $1,894.41 "," $1,935.15 "," $1,955.52 "," $1,666.67 "," $1,833.30 "," $1,731.45 "," $1,609.23 ", N/A ," $1,648.54 "," $1,648.54 "," $1,935.15 "," $1,747.95 ", $133.90 ," $1,955.52 "
 Facial Bones Less Than 3 Views ,CPT® 70140,0320 - DX X-RAY,N/A,N/A, $294.00 , $191.10 , $246.96 , $31.74 , $28.06 , $237.55 , $264.60 , $248.90 , $264.60 , $264.60 , $264.60 , $249.90 , $27.51 , $271.45 , $279.30 , $249.90 , $273.42 , $273.42 , $279.30 , $282.24 , $240.55 , $264.60 , $249.90 , $232.26 , N/A , $237.93 , $237.93 , $279.30 , $252.28 , $27.51 , $282.24 
 Fac Biopsy Bone Open Superficial ,CPT® 20240,0361 - OR/MINOR,N/A,N/A," $5,721.00 "," $3,718.65 "," $4,805.64 ", $134.08 , $153.67 ," $4,622.57 "," $5,148.90 "," $4,843.40 "," $5,148.90 "," $5,148.90 "," $5,148.90 "," $4,862.85 ", $150.66 ," $5,282.20 "," $5,434.95 "," $4,862.85 "," $5,320.53 "," $5,320.53 "," $5,434.95 "," $5,492.16 "," $4,680.92 "," $5,148.90 "," $4,862.85 "," $4,519.59 ", N/A ," $4,630.01 "," $4,630.01 "," $5,434.95 "," $4,909.19 ", $134.08 ," $5,492.16 "
Treat Interphalangeal Jnt,26770,N/A,N/A,N/A," $1,789.00 "," $1,162.85 "," $1,609.47 ", $257.24 , $74.85 ," $1,227.08 "," $1,253.31 "," $1,663.77 "," $1,610.10 "," $1,610.10 "," $1,431.20 "," $1,431.20 ", $74.85 ," $1,651.78 "," $1,699.55 "," $1,610.10 "," $1,610.10 "," $1,610.10 "," $1,663.77 "," $1,717.44 "," $1,478.71 "," $1,520.65 "," $1,373.73 "," $1,463.84 ", N/A ," $1,251.03 "," $1,251.03 "," $1,699.55 "," $1,470.39 ", $74.85 ," $1,717.44 "
Revise/Remove Neurostim/Receiver,CPT® 64595,N/A,N/A,N/A," $1,840.00 "," $1,196.00 ", $621.82 , $122.03 , $184.10 , $703.32 , $687.99 ," $1,711.20 "," $1,656.00 "," $1,656.00 "," $1,472.00 "," $1,472.00 ", $184.10 ," $1,698.87 "," $1,748.00 "," $1,656.00 "," $1,656.00 "," $1,656.00 "," $1,711.20 "," $1,766.40 ", $673.04 ," $1,564.00 ", $670.81 , $760.71 , N/A , $717.04 , $717.04 ," $1,748.00 ", $769.22 , $122.03 ," $1,766.40 "
 Fac Eeg Nonicra Surg ,CPT® 95955,0740 - EEG,N/A,N/A," $1,517.00 ", $986.05 ," $1,274.28 ", $189.45 , $117.20 ," $1,225.74 "," $1,365.30 "," $1,284.29 "," $1,365.30 "," $1,365.30 "," $1,365.30 "," $1,289.45 ", $114.90 ," $1,400.65 "," $1,441.15 "," $1,289.45 "," $1,410.81 "," $1,410.81 "," $1,441.15 "," $1,456.32 "," $1,241.21 "," $1,365.30 "," $1,289.45 "," $1,198.43 ", N/A ," $1,227.71 "," $1,227.71 "," $1,441.15 "," $1,301.74 ", $114.90 ," $1,456.32 "
X-Ray Knee Bilat Standing,CPT® 73565,N/A,N/A,N/A, $242.00 , $157.30 , $228.06 , $39.24 , $28.54 , $154.98 , $189.24 , $225.06 , $217.80 , $217.80 , $193.60 , $193.60 , $28.54 , $223.44 , $229.90 , $217.80 , $217.80 , $217.80 , $225.06 , $232.32 , $223.43 , $205.70 , $211.86 , $179.83 , N/A , $158.01 , $158.01 , $229.90 , $182.89 , $28.54 , $232.32 
Sarscov2 Vaccine 25 Mcg/0.25 Ml for Im Use,CPT® 91321,N/A,N/A,N/A, $173.00 , $112.45 , N/A , N/A , N/A , N/A , N/A , $160.89 , $155.70 , $155.70 , $138.40 , $138.40 , N/A , $159.73 , $164.35 , $155.70 , $155.70 , $155.70 , $160.89 , $166.08 , N/A , $147.05 , N/A , N/A , N/A , N/A , N/A , $164.35 , N/A , $138.40 , $166.08 
 ATOMOXETINE HCL 25 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,68462-0267-30,1 capsule, $73.12 , $47.53 , $61.42 , N/A , N/A , $59.08 , $65.81 , $61.90 , $65.81 , $65.81 , $65.81 , $62.15 , N/A , $67.51 , $69.46 , $62.15 , $68.00 , $68.00 , $69.46 , $70.20 , $59.83 , $65.81 , $62.15 , $57.76 , N/A , $59.18 , $59.18 , $69.46 , $62.74 , $57.76 , $70.20 
"Remv Foreign Body,Knee/Thigh,Deep",CPT® 27372,N/A,N/A,N/A," $3,994.00 "," $2,596.10 "," $2,450.96 ", $382.69 , $160.13 ," $1,950.30 "," $1,950.16 "," $3,714.42 "," $3,594.60 "," $3,594.60 "," $3,195.20 "," $3,195.20 ", $160.13 ," $3,687.66 "," $3,794.30 "," $3,594.60 "," $3,594.60 "," $3,594.60 "," $3,714.42 "," $3,834.24 "," $2,267.38 "," $3,394.90 "," $2,151.58 "," $2,264.21 ", N/A ," $1,988.36 "," $1,988.36 "," $3,794.30 "," $2,337.00 ", $160.13 ," $3,834.24 "
Percut Rx Dist Fingr Fx,CPT® 26756,N/A,N/A,N/A," $2,779.00 "," $1,806.35 "," $2,630.75 ", $414.79 , $63.53 ," $2,006.48 "," $2,030.94 "," $2,584.47 "," $2,501.10 "," $2,501.10 "," $2,223.20 "," $2,223.20 ", $63.53 ," $2,565.85 "," $2,640.05 "," $2,501.10 "," $2,501.10 "," $2,501.10 "," $2,584.47 "," $2,667.84 "," $2,432.19 "," $2,362.15 "," $2,228.30 "," $2,385.17 ", N/A ," $2,045.63 "," $2,045.63 "," $2,640.05 "," $2,404.32 ", $63.53 ," $2,667.84 "
 RITUXIMAB-PVVR 500 MG/50ML IV SOLN ,HCPCS Q5119,0636 - DRUGS REQUIRING DETAILED CODIN,00069-0249-01,50 mL," $10,538.08 "," $6,849.75 "," $8,851.99 ", $28.06 , $33.33 ," $8,514.77 "," $9,484.27 "," $8,921.54 "," $9,484.27 "," $9,484.27 "," $9,484.27 "," $8,957.37 ", $32.68 ," $9,729.81 "," $10,011.18 "," $8,957.37 "," $9,800.41 "," $9,800.41 "," $10,011.18 "," $10,116.56 "," $8,622.26 "," $9,484.27 "," $8,957.37 "," $8,325.08 ", N/A ," $8,528.47 "," $8,528.47 "," $10,011.18 "," $9,042.73 ", $28.06 ," $10,116.56 "
 Bladder Cath Placement Straight ,CPT® 51701,0761 - TREATMENT ROOM,N/A,N/A, $284.00 , $184.60 , $238.56 , $23.95 , $87.96 , $229.47 , $255.60 , $240.43 , $255.60 , $255.60 , $255.60 , $241.40 , $86.24 , $262.22 , $269.80 , $241.40 , $264.12 , $264.12 , $269.80 , $272.64 , $232.37 , $255.60 , $241.40 , $224.36 , N/A , $229.84 , $229.84 , $269.80 , $243.70 , $23.95 , $272.64 
Treat Phalangeal Shft Frc,CPT® 26725,N/A,N/A,N/A," $1,012.00 ", $657.80 ," $1,888.97 ", $298.96 , $132.15 ," $1,457.95 "," $1,481.04 ", $941.16 , $910.80 , $910.80 , $809.60 , $809.60 , $132.15 , $934.38 , $961.40 , $910.80 , $910.80 , $910.80 , $941.16 , $971.52 ," $1,742.10 ", $860.20 ," $1,625.28 "," $1,732.55 ", N/A ," $1,486.40 "," $1,486.40 ", $961.40 ," $1,747.03 ", $132.15 ," $1,888.97 "
 Fac Chg Radiologic Exam Abdomen 3+ Views ,CPT® 74021,0320 - DX X-RAY,N/A,N/A, $423.00 , $274.95 , $355.32 , $42.39 , $30.59 , $341.78 , $380.70 , $358.11 , $380.70 , $380.70 , $380.70 , $359.55 , $29.99 , $390.56 , $401.85 , $359.55 , $393.39 , $393.39 , $401.85 , $406.08 , $346.10 , $380.70 , $359.55 , $334.17 , N/A , $342.33 , $342.33 , $401.85 , $362.98 , $29.99 , $406.08 
"Knee Scope,Aid Ant Cruciate Repair",29888,N/A,N/A,N/A," $6,537.00 "," $4,249.05 "," $5,922.48 ", $925.28 , $869.33 ," $4,755.46 "," $4,743.68 "," $6,079.41 "," $5,883.30 "," $5,883.30 "," $5,229.60 "," $5,229.60 ", $869.33 ," $6,035.61 "," $6,210.15 "," $5,883.30 "," $5,883.30 "," $5,883.30 "," $6,079.41 "," $6,275.52 "," $6,519.97 "," $5,556.45 "," $5,245.15 "," $5,597.70 ", N/A ," $4,848.25 "," $4,848.25 "," $6,210.15 "," $5,698.42 ", $869.33 ," $6,519.97 "
Excis Supratent Brain Tumor,CPT® 61510,N/A,N/A,N/A," $13,995.00 "," $9,096.75 "," $10,040.99 "," $1,962.68 "," $2,378.00 "," $11,783.90 "," $11,284.13 "," $13,015.35 "," $12,595.50 "," $12,595.50 "," $11,196.00 "," $11,196.00 "," $2,378.00 "," $12,921.58 "," $13,295.25 "," $12,595.50 "," $12,595.50 "," $12,595.50 "," $13,015.35 "," $13,435.20 "," $10,835.64 "," $11,895.75 "," $11,596.42 "," $12,190.67 ", N/A ," $12,013.82 "," $12,013.82 "," $13,295.25 "," $12,888.02 "," $1,962.68 "," $13,435.20 "
 Fac Ehrlichia Antibody ,CPT® 86666,0302 - LAB/IMMUNOLOGY,N/A,N/A, $155.00 , $100.75 , $130.20 , $10.38 , $8.07 , $125.24 , $139.50 , $131.22 , $139.50 , $139.50 , $139.50 , $131.75 , $7.91 , $143.11 , $147.25 , $131.75 , $144.15 , $144.15 , $147.25 , $148.80 , $126.82 , $139.50 , $131.75 , $122.45 , N/A , $125.44 , $125.44 , $147.25 , $133.01 , $7.91 , $148.80 
 Pro Insertion Picc W/Rs&I 5 Yr/> ,CPT® 36573,0982 - PRO FEE/OUTPT,N/A,N/A," $1,998.00 "," $1,298.70 ", $514.35 , $80.09 , $314.22 , $345.62 , N/A ," $1,858.14 "," $1,798.20 "," $1,798.20 "," $1,598.40 "," $1,598.40 ", $314.22 ," $1,844.75 "," $1,898.10 "," $1,798.20 "," $1,798.20 "," $1,798.20 "," $1,858.14 "," $1,918.08 ", $476.57 ," $1,698.30 ", $438.90 , $425.65 , N/A , $352.36 , $352.36 ," $1,898.10 ", $400.29 , $80.09 ," $1,918.08 "
Assay Selenium,CPT® 84255,N/A,N/A,N/A, $234.00 , $152.10 , N/A , $26.04 , $26.04 , $144.43 , $172.81 , $217.62 , $210.60 , $210.60 , $187.20 , $187.20 , $26.04 , $216.05 , $222.30 , $210.60 , $210.60 , $210.60 , $217.62 , $224.64 , $170.47 , $198.90 , $167.05 , $92.57 , N/A , $134.79 , $134.79 , $222.30 , $147.30 , $26.04 , $224.64 
Complex Repair 2.6-7.5cm,13132,N/A,N/A,N/A," $2,805.00 "," $1,823.25 ", $971.79 , $290.72 , $268.64 , $861.57 , $839.43 ," $2,608.65 "," $2,524.50 "," $2,524.50 "," $2,244.00 "," $2,244.00 ", $268.64 ," $2,589.86 "," $2,664.75 "," $2,524.50 "," $2,524.50 "," $2,524.50 "," $2,608.65 "," $2,692.80 "," $1,069.42 "," $2,384.25 "," $1,671.67 "," $1,104.41 ", N/A , $878.38 , $878.38 ," $2,664.75 "," $1,018.64 ", $268.64 ," $2,692.80 "
Ureterotomy to Insert Stent,CPT® 50605,N/A,N/A,N/A," $6,666.00 "," $4,332.90 "," $5,297.59 ", $930.70 ," $1,075.41 "," $4,738.60 "," $4,423.18 "," $6,199.38 "," $5,999.40 "," $5,999.40 "," $5,332.80 "," $5,332.80 "," $1,075.41 "," $6,154.72 "," $6,332.70 "," $5,999.40 "," $5,999.40 "," $5,999.40 "," $6,199.38 "," $6,399.36 "," $5,271.93 "," $5,666.10 "," $5,105.99 "," $5,887.56 ", N/A ," $4,831.06 "," $4,831.06 "," $6,332.70 "," $5,678.20 ", $930.70 ," $6,399.36 "
"Program Eval Implant Device,Pacemaker,Mult Lead",93281,N/A,N/A,N/A, $902.00 , $586.30 , $548.41 , $83.77 , $59.19 , $369.43 , $375.61 , $838.86 , $811.80 , $811.80 , $721.60 , $721.60 , $59.19 , $832.82 , $856.90 , $811.80 , $811.80 , $811.80 , $838.86 , $865.92 , $515.08 , $766.70 , $349.68 , $240.25 , N/A , $376.65 , $376.65 , $856.90 , $417.52 , $59.19 , $865.92 
Enteroscopy > 2nd Prtn W/Control Bleeding,CPT® 44366,N/A,N/A,N/A," $1,764.00 "," $1,146.60 "," $1,471.86 ", $227.50 , $615.81 ," $1,219.48 "," $1,258.11 "," $1,640.52 "," $1,587.60 "," $1,587.60 "," $1,411.20 "," $1,411.20 ", $615.81 ," $1,628.70 "," $1,675.80 "," $1,587.60 "," $1,587.60 "," $1,587.60 "," $1,640.52 "," $1,693.44 "," $1,058.59 "," $1,499.40 "," $1,379.08 "," $1,404.23 ", N/A ," $1,243.28 "," $1,243.28 "," $1,675.80 "," $1,300.34 ", $227.50 ," $1,693.44 "
 Fac Flo Cytometry Cell Surf Marker Techl Only Ea ,CPT® 88185,0311 - PATHOL/CYTOLOGY,N/A,N/A, $373.00 , $242.45 , $313.32 , $23.32 , $23.70 , $301.38 , $335.70 , $315.78 , $335.70 , $335.70 , $335.70 , $317.05 , $23.24 , $344.39 , $354.35 , $317.05 , $346.89 , $346.89 , $354.35 , $358.08 , $305.19 , $335.70 , $317.05 , $294.67 , N/A , $301.87 , $301.87 , $354.35 , $320.07 , $23.24 , $358.08 
 Ercp Biliary and Pancreatic ,CPT® 74330,0320 - DX X-RAY,N/A,N/A, $733.00 , $476.45 , $615.72 , $156.80 , $161.87 , $592.26 , $659.70 , $620.56 , $659.70 , $659.70 , $659.70 , $623.05 , $158.70 , $676.78 , $696.35 , $623.05 , $681.69 , $681.69 , $696.35 , $703.68 , $599.74 , $659.70 , $623.05 , $579.07 , N/A , $593.22 , $593.22 , $696.35 , $628.99 , $156.80 , $703.68 
"Excision,Benign Tumor,Mandible",CPT® 21040,N/A,N/A,N/A," $2,416.00 "," $1,570.40 "," $2,277.99 ", $354.32 , $384.19 ," $2,052.11 "," $2,050.43 "," $2,246.88 "," $2,174.40 "," $2,174.40 "," $1,932.80 "," $1,932.80 ", $384.19 ," $2,230.69 "," $2,295.20 "," $2,174.40 "," $2,174.40 "," $2,174.40 "," $2,246.88 "," $2,319.36 "," $2,169.58 "," $2,053.60 "," $2,242.57 "," $2,401.25 ", N/A ," $2,092.15 "," $2,092.15 "," $2,295.20 "," $2,459.02 ", $354.32 ," $2,459.02 "
Inject Second Level Cervical/Thoracic,64491,N/A,N/A,N/A, $622.00 , $404.30 , $294.27 , $56.83 , $69.04 , $339.59 , $330.47 , $578.46 , $559.80 , $559.80 , $497.60 , $497.60 , $69.04 , $574.29 , $590.90 , $559.80 , $559.80 , $559.80 , $578.46 , $597.12 , $320.57 , $528.70 , $322.92 , $364.80 , N/A , $346.22 , $346.22 , $590.90 , $371.43 , $56.83 , $597.12 
 Pro Remove Foreign Body ,CPT® 10120,0982 - PRO FEE/OUTPT,N/A,N/A, $579.00 , $376.35 , $336.16 , $101.48 , $42.46 , $283.24 , $279.57 , $538.47 , $521.10 , $521.10 , $463.20 , $463.20 , $42.46 , $534.59 , $550.05 , $521.10 , $521.10 , $521.10 , $538.47 , $555.84 , $369.08 , $492.15 , $553.06 , $366.67 , N/A , $288.77 , $288.77 , $550.05 , $334.86 , $42.46 , $555.84 
Sub Grft F/S/N/H/F/G/M/D />100scm 1st 100scm,CPT® 15277,N/A,N/A,N/A," $2,293.00 "," $1,490.45 ", $706.66 , $209.45 , $229.39 , $615.40 , $572.66 ," $2,132.49 "," $2,063.70 "," $2,063.70 "," $1,834.40 "," $1,834.40 ", $229.39 ," $2,117.13 "," $2,178.35 "," $2,063.70 "," $2,063.70 "," $2,063.70 "," $2,132.49 "," $2,201.28 ", $777.03 ," $1,949.05 "," $1,141.80 ", $794.80 , N/A , $627.41 , $627.41 ," $2,178.35 ", $727.58 , $209.45 ," $2,201.28 "
Simple Repair 2.5cm or Le,12011,N/A,N/A,N/A, $511.00 , $332.15 , $172.01 , $51.31 , $66.00 , $150.86 , $147.21 , $475.23 , $459.90 , $459.90 , $408.80 , $408.80 , $66.00 , $471.81 , $485.45 , $459.90 , $459.90 , $459.90 , $475.23 , $490.56 , $189.71 , $434.35 , $296.15 , $192.22 , N/A , $153.81 , $153.81 , $485.45 , $178.36 , $51.31 , $490.56 
Layer Closure 2.5cm or Le,CPT® 12041,N/A,N/A,N/A," $1,004.00 ", $652.60 , $461.96 , $139.44 , $71.45 , $427.30 , $419.98 , $933.72 , $903.60 , $903.60 , $803.20 , $803.20 , $71.45 , $926.99 , $953.80 , $903.60 , $903.60 , $903.60 , $933.72 , $963.84 , $509.89 , $853.40 , $834.94 , $528.73 , N/A , $435.64 , $435.64 , $953.80 , $505.18 , $71.45 , $963.84 
 Pro Treat Humerus Fracture ,CPT® 23600,0982 - PRO FEE/OUTPT,N/A,N/A," $1,196.00 ", $777.40 ," $1,967.03 ", $311.94 , $245.89 ," $1,478.02 "," $1,510.03 "," $1,112.28 "," $1,076.40 "," $1,076.40 ", $956.80 , $956.80 , $245.89 ," $1,104.27 "," $1,136.20 "," $1,076.40 "," $1,076.40 "," $1,076.40 "," $1,112.28 "," $1,148.16 "," $1,808.38 "," $1,016.60 "," $1,657.40 "," $1,760.08 ", N/A ," $1,506.86 "," $1,506.86 "," $1,136.20 "," $1,771.09 ", $245.89 ," $1,967.03 "
Exc Tumor Soft Tissue Neck/Ant Thorax Subq 3+Cm,21552,N/A,N/A,N/A," $2,968.00 "," $1,929.20 "," $2,694.19 ", $420.01 , $369.16 ," $2,137.02 "," $2,140.78 "," $2,760.24 "," $2,671.20 "," $2,671.20 "," $2,374.40 "," $2,374.40 ", $369.16 ," $2,740.35 "," $2,819.60 "," $2,671.20 "," $2,671.20 "," $2,671.20 "," $2,760.24 "," $2,849.28 "," $2,492.75 "," $2,522.80 "," $2,367.45 "," $2,512.02 ", N/A ," $2,178.72 "," $2,178.72 "," $2,819.60 "," $2,560.78 ", $369.16 ," $2,849.28 "
Assay of Calcitonin,CPT® 82308,N/A,N/A,N/A, $286.00 , $185.90 , N/A , $27.33 , $27.33 , $151.54 , $181.28 , $265.98 , $257.40 , $257.40 , $228.80 , $228.80 , $27.33 , $264.06 , $271.70 , $257.40 , $257.40 , $257.40 , $265.98 , $274.56 , $178.88 , $243.10 , $175.16 , $97.16 , N/A , $141.43 , $141.43 , $271.70 , $154.55 , $27.33 , $274.56 
"Tympanoplas/Mastoid,Intct Wall,Rebld",CPT® 69644,N/A,N/A,N/A," $8,381.00 "," $5,447.65 "," $7,283.25 "," $1,471.30 "," $1,302.22 "," $7,130.89 "," $7,356.47 "," $7,794.33 "," $7,542.90 "," $7,542.90 "," $6,704.80 "," $6,704.80 "," $1,302.22 "," $7,738.18 "," $7,961.95 "," $7,542.90 "," $7,542.90 "," $7,542.90 "," $7,794.33 "," $8,045.76 "," $7,926.06 "," $7,123.85 "," $8,015.80 "," $7,145.70 ", N/A ," $7,270.03 "," $7,270.03 "," $7,961.95 "," $8,301.10 "," $1,302.22 "," $8,301.10 "
" Fac Immunoassay, Tumor, Ca 15-3 ",CPT® 86300,0302 - LAB/IMMUNOLOGY,N/A,N/A, $237.00 , $154.05 , $199.08 , $21.23 , $21.23 , $191.50 , $213.30 , $200.64 , $213.30 , $213.30 , $213.30 , $201.45 , $20.81 , $218.82 , $225.15 , $201.45 , $220.41 , $220.41 , $225.15 , $227.52 , $193.91 , $213.30 , $201.45 , $187.23 , N/A , $191.80 , $191.80 , $225.15 , $203.37 , $20.81 , $227.52 
 SULFACETAMIDE SODIUM 10 % OP SOLN ,HCPCS RXC637,0250 - PHARMACY,24208-0670-04,15 mL, $313.38 , $203.70 , $263.24 , N/A , N/A , $253.21 , $282.04 , $265.31 , $282.04 , $282.04 , $282.04 , $266.37 , N/A , $289.34 , $297.71 , $266.37 , $291.44 , $291.44 , $297.71 , $300.84 , $256.41 , $282.04 , $266.37 , $247.57 , N/A , $253.62 , $253.62 , $297.71 , $268.91 , $247.57 , $300.84 
"Fix Entropion,Suture",CPT® 67921,N/A,N/A,N/A," $4,410.00 "," $2,866.50 "," $1,913.86 ", $301.83 , $602.94 ," $1,753.44 "," $1,453.10 "," $4,101.30 "," $3,969.00 "," $3,969.00 "," $3,528.00 "," $3,528.00 ", $602.94 ," $4,071.75 "," $4,189.50 "," $3,969.00 "," $3,969.00 "," $3,969.00 "," $4,101.30 "," $4,233.60 "," $2,628.57 "," $3,748.50 "," $1,509.32 "," $2,233.15 ", N/A ," $1,787.66 "," $1,787.66 "," $4,189.50 "," $1,973.36 ", $301.83 ," $4,233.60 "
X-Ray Forearm 2 Vw,CPT® 73090,N/A,N/A,N/A, $322.00 , $209.30 , $163.79 , $28.73 , $26.20 , $121.74 , $148.62 , $299.46 , $289.80 , $289.80 , $257.60 , $257.60 , $26.20 , $297.30 , $305.90 , $289.80 , $289.80 , $289.80 , $299.46 , $309.12 , $159.36 , $273.70 , $163.71 , $129.73 , N/A , $124.12 , $124.12 , $305.90 , $143.67 , $26.20 , $309.12 
US Lmtd Jt/Fcl Eval Nonvasc Xtr Strux R-T W/Img,CPT® 76882,N/A,N/A,N/A, $342.00 , $222.30 , $317.55 , $41.46 , $22.10 , $173.77 , $182.06 , $318.06 , $307.80 , $307.80 , $273.60 , $273.60 , $22.10 , $315.77 , $324.90 , $307.80 , $307.80 , $307.80 , $318.06 , $328.32 , $312.59 , $290.70 , $200.31 , $323.37 , N/A , $177.15 , $177.15 , $324.90 , $205.07 , $22.10 , $328.32 
 Fac Assay of Apolipoprotein ,CPT® 82172,0301 - LAB/CHEMISTRY,N/A,N/A, $150.00 , $97.50 , $126.00 , $21.51 , $21.51 , $121.20 , $135.00 , $126.99 , $135.00 , $135.00 , $135.00 , $127.50 , $21.09 , $138.50 , $142.50 , $127.50 , $139.50 , $139.50 , $142.50 , $144.00 , $122.73 , $135.00 , $127.50 , $118.50 , N/A , $121.40 , $121.40 , $142.50 , $128.72 , $21.09 , $144.00 
Pro Cltx Tmprmand Dislc 1st/Sbsq,21480,N/A,N/A,N/A, $284.00 , $184.60 , $184.80 , $28.96 , $50.81 , $155.45 , $153.79 , $264.12 , $255.60 , $255.60 , $227.20 , $227.20 , $50.81 , $262.22 , $269.80 , $255.60 , $255.60 , $255.60 , $264.12 , $272.64 , $173.97 , $241.40 , $169.49 , $182.68 , N/A , $158.49 , $158.49 , $269.80 , $186.28 , $28.96 , $272.64 
" Fac Assay, Growth Hormone (Hgh) ",CPT® 83003,0301 - LAB/CHEMISTRY,N/A,N/A, $159.00 , $103.35 , $133.56 , $17.00 , $17.00 , $128.47 , $143.10 , $134.61 , $143.10 , $143.10 , $143.10 , $135.15 , $16.67 , $146.80 , $151.05 , $135.15 , $147.87 , $147.87 , $151.05 , $152.64 , $130.09 , $143.10 , $135.15 , $125.61 , N/A , $128.68 , $128.68 , $151.05 , $136.44 , $16.67 , $152.64 
 EPOETIN ALFA-EPBX 4000 UNIT/ML IJ SOLN ,HCPCS Q5105,0636 - DRUGS REQUIRING DETAILED CODIN,00069-1307-10,1 mL, $129.73 , $84.32 , $108.97 , $0.77 , N/A , $104.82 , $116.76 , $109.83 , $116.76 , $116.76 , $116.76 , $110.27 , N/A , $119.78 , $123.24 , $110.27 , $120.65 , $120.65 , $123.24 , $124.54 , $106.15 , $116.76 , $110.27 , $102.49 , N/A , $104.99 , $104.99 , $123.24 , $111.32 , $0.77 , $124.54 
Physician Telephone Evaluation 5-10 Min,99441,N/A,N/A,N/A, $60.00 , $39.00 , $71.80 , $34.15 , $11.11 , $22.64 , $21.88 , $55.80 , $54.00 , $54.00 , $48.00 , $48.00 , $11.11 , $55.40 , $57.00 , $54.00 , $54.00 , $54.00 , $55.80 , $57.60 , $65.53 , $51.00 , $27.00 , $28.23 , $15.00 , $23.08 , $23.08 , $57.00 , $26.61 , $11.11 , $71.80 
" Pro X-Ray, Female Genital Tract ",CPT® 74740,0972 - PRO FEE/RAD/DX,N/A,N/A, $235.00 , $152.75 , $556.39 , $94.56 , $72.27 , $357.36 , $411.32 , $218.55 , $211.50 , $211.50 , $188.00 , $188.00 , $72.27 , $216.98 , $223.25 , $211.50 , $211.50 , $211.50 , $218.55 , $225.60 , $539.23 , $199.75 , $448.77 , $377.44 , N/A , $364.33 , $364.33 , $223.25 , $421.71 , $72.27 , $556.39 
 GLIPIZIDE ER 5 MG PO TB24 ,HCPCS RXC637,0250 - PHARMACY,59651-0269-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Lap,Gastrostomy,W/O Tube Constr",CPT® 43653,N/A,N/A,N/A," $3,740.00 "," $2,431.00 "," $3,474.84 ", $538.65 , $781.95 ," $2,690.76 "," $2,750.20 "," $3,478.20 "," $3,366.00 "," $3,366.00 "," $2,992.00 "," $2,992.00 ", $781.95 ," $3,453.14 "," $3,553.00 "," $3,366.00 "," $3,366.00 "," $3,366.00 "," $3,478.20 "," $3,590.40 "," $2,485.12 "," $3,179.00 "," $3,052.53 "," $3,189.39 ", N/A ," $2,743.26 "," $2,743.26 "," $3,553.00 "," $2,869.17 ", $538.65 ," $3,590.40 "
 RIZATRIPTAN BENZOATE 10 MG PO TBDP ,HCPCS RXC637,0250 - PHARMACY,33342-0094-41,1 tablet, $170.74 , $110.98 , $143.42 , N/A , N/A , $137.96 , $153.67 , $144.55 , $153.67 , $153.67 , $153.67 , $145.13 , N/A , $157.64 , $162.20 , $145.13 , $158.79 , $158.79 , $162.20 , $163.91 , $139.70 , $153.67 , $145.13 , $134.88 , N/A , $138.18 , $138.18 , $162.20 , $146.51 , $134.88 , $163.91 
 CITALOPRAM HYDROBROMIDE 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6084-61,1 tablet, $12.47 , $8.11 , $10.47 , N/A , N/A , $10.08 , $11.22 , $10.56 , $11.22 , $11.22 , $11.22 , $10.60 , N/A , $11.51 , $11.85 , $10.60 , $11.60 , $11.60 , $11.85 , $11.97 , $10.20 , $11.22 , $10.60 , $9.85 , N/A , $10.09 , $10.09 , $11.85 , $10.70 , $9.85 , $11.97 
 MANNITOL 20 % IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00990-7715-03,500 mL, $118.15 , $76.80 , $99.25 , N/A , N/A , $95.47 , $106.34 , $100.03 , $106.34 , $106.34 , $106.34 , $100.43 , N/A , $109.09 , $112.24 , $100.43 , $109.88 , $109.88 , $112.24 , $113.42 , $96.67 , $106.34 , $100.43 , $93.34 , N/A , $95.62 , $95.62 , $112.24 , $101.38 , $93.34 , $113.42 
Pt/Caregiver Trainj for Initiation Home Inr Mntr,CPT® 93792,N/A,N/A,N/A, $68.00 , $44.20 , $392.54 , $68.07 , N/A , $271.02 , $293.27 , $63.24 , $61.20 , $61.20 , $54.40 , $54.40 , N/A , $62.78 , $64.60 , $61.20 , $61.20 , $61.20 , $63.24 , $65.28 , $400.77 , $57.80 , $373.16 , $202.19 , N/A , $276.31 , $276.31 , $64.60 , $306.28 , $54.40 , $400.77 
Sbsq Hospital IP/Obs Care High Mdm 50 Minutes,CPT® 99233,N/A,N/A,N/A, $344.00 , $223.60 , $204.50 , $115.78 , $54.97 , $180.73 , $179.46 , $319.92 , $309.60 , $309.60 , $275.20 , $275.20 , $54.97 , $317.62 , $326.80 , $309.60 , $309.60 , $309.60 , $319.92 , $330.24 , $260.33 , $292.40 , $222.78 , $228.27 , $107.50 , $184.26 , $184.26 , $326.80 , $212.51 , $54.97 , $330.24 
 CLINIMIX/DEXTROSE (4.25/5) 4.25 % IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00338-1089-04,"2,000 mL", $462.32 , $300.51 , $388.35 , N/A , N/A , $373.55 , $416.09 , $391.40 , $416.09 , $416.09 , $416.09 , $392.97 , N/A , $426.86 , $439.20 , $392.97 , $429.96 , $429.96 , $439.20 , $443.83 , $378.27 , $416.09 , $392.97 , $365.23 , N/A , $374.16 , $374.16 , $439.20 , $396.72 , $365.23 , $443.83 
 Fac Lyr Clsr F/E/E/N/L/M&/Muc 2.5 Cm/< ,CPT® 12051,0761 - TREATMENT ROOM,N/A,N/A," $1,342.00 ", $872.30 ," $1,127.28 ", $162.92 , $106.23 ," $1,084.34 "," $1,207.80 "," $1,136.14 "," $1,207.80 "," $1,207.80 "," $1,207.80 "," $1,140.70 ", $104.15 ," $1,239.07 "," $1,274.90 "," $1,140.70 "," $1,248.06 "," $1,248.06 "," $1,274.90 "," $1,288.32 "," $1,098.02 "," $1,207.80 "," $1,140.70 "," $1,060.18 ", N/A ," $1,086.08 "," $1,086.08 "," $1,274.90 "," $1,151.57 ", $104.15 ," $1,288.32 "
"Thyroidectomy,Substernal,Transthor App",CPT® 60270,N/A,N/A,N/A," $8,972.00 "," $5,831.80 "," $8,200.60 "," $1,274.21 "," $1,283.08 "," $7,054.49 "," $7,288.56 "," $8,343.96 "," $8,074.80 "," $8,074.80 "," $7,177.60 "," $7,177.60 "," $1,283.08 "," $8,283.85 "," $8,523.40 "," $8,074.80 "," $8,074.80 "," $8,074.80 "," $8,343.96 "," $8,613.12 "," $7,945.64 "," $7,626.20 "," $7,259.36 "," $6,775.16 ", N/A ," $7,192.14 "," $7,192.14 "," $8,523.40 "," $8,021.40 "," $1,274.21 "," $8,613.12 "
 Fac Trlml Balo Angiop Open/Perq Img S&I 1st Art ,CPT® 37246,0360 - OR SERVICES,N/A,N/A," $17,372.00 "," $11,291.80 "," $14,592.48 ", $316.71 ," $2,532.15 "," $14,036.58 "," $15,634.80 "," $14,707.14 "," $15,634.80 "," $15,634.80 "," $15,634.80 "," $14,766.20 "," $2,482.50 "," $16,039.57 "," $16,503.40 "," $14,766.20 "," $16,155.96 "," $16,155.96 "," $16,503.40 "," $16,677.12 "," $14,213.77 "," $15,634.80 "," $14,766.20 "," $13,723.88 ", N/A ," $14,059.16 "," $14,059.16 "," $16,503.40 "," $14,906.91 ", $316.71 ," $16,677.12 "
 Fac Exc B9 Les Mrgn Xcp Sk Tg T/a/L 0.5 Cm/< ,CPT® 11400,0761 - TREATMENT ROOM,N/A,N/A, $460.00 , $299.00 , $386.40 , $81.33 , $48.12 , $371.68 , $414.00 , $389.44 , $414.00 , $414.00 , $414.00 , $391.00 , $47.18 , $424.72 , $437.00 , $391.00 , $427.80 , $427.80 , $437.00 , $441.60 , $376.37 , $414.00 , $391.00 , $363.40 , N/A , $372.28 , $372.28 , $437.00 , $394.73 , $47.18 , $441.60 
 NYSTATIN 100000 UNIT/ML MT SUSP ,HCPCS RXC637,0250 - PHARMACY,00121-0868-00,5 mL, $8.51 , $5.53 , $7.15 , N/A , N/A , $6.88 , $7.66 , $7.20 , $7.66 , $7.66 , $7.66 , $7.23 , N/A , $7.86 , $8.08 , $7.23 , $7.91 , $7.91 , $8.08 , $8.17 , $6.96 , $7.66 , $7.23 , $6.72 , N/A , $6.89 , $6.89 , $8.08 , $7.30 , $6.72 , $8.17 
 ANTIHEMOPHIL FACTOR (RAHF-PFM) 2000 UNITS IV SOLR ,HCPCS J7211,0636 - DRUGS REQUIRING DETAILED CODIN,00026-3826-50,1 int'l unit, $35.00 , $22.75 , $29.40 , $1.47 , $1.37 , $28.28 , $31.50 , $29.63 , $31.50 , $31.50 , $31.50 , $29.75 , $1.34 , $32.32 , $33.25 , $29.75 , $32.55 , $32.55 , $33.25 , $33.60 , $28.64 , $31.50 , $29.75 , $27.65 , N/A , $28.33 , $28.33 , $33.25 , $30.03 , $1.34 , $33.60 
Drainage of Eyelid Abscess,67700,N/A,N/A,N/A, $636.00 , $413.40 , $714.22 , $112.63 , $30.71 , $656.29 , $616.74 , $591.48 , $572.40 , $572.40 , $508.80 , $508.80 , $30.71 , $587.22 , $604.20 , $572.40 , $572.40 , $572.40 , $591.48 , $610.56 , $979.92 , $540.60 , $636.91 , $838.47 , N/A , $669.09 , $669.09 , $604.20 , $738.60 , $30.71 , $979.92 
Explore/Treat Wrist Joint,25040,N/A,N/A,N/A," $3,724.00 "," $2,420.60 "," $3,425.24 ", $537.67 , $614.70 ," $2,711.40 "," $2,701.18 "," $3,463.32 "," $3,351.60 "," $3,351.60 "," $2,979.20 "," $2,979.20 ", $614.70 ," $3,438.37 "," $3,537.80 "," $3,351.60 "," $3,351.60 "," $3,351.60 "," $3,463.32 "," $3,575.04 "," $3,186.76 "," $3,165.40 "," $2,972.25 "," $3,209.20 ", N/A ," $2,764.30 "," $2,764.30 "," $3,537.80 "," $3,249.04 ", $537.67 ," $3,575.04 "
 CLINIMIX E/DEXTROSE (2.75/5) 2.75 % IV SOLN ,HCPCS RXA258,0258 - IV SOLUTIONS,00338-1142-03,"1,000 mL", $272.26 , $176.97 , $228.70 , N/A , N/A , $219.99 , $245.03 , $230.50 , $245.03 , $245.03 , $245.03 , $231.42 , N/A , $251.38 , $258.65 , $231.42 , $253.20 , $253.20 , $258.65 , $261.37 , $222.76 , $245.03 , $231.42 , $215.09 , N/A , $220.34 , $220.34 , $258.65 , $233.63 , $215.09 , $261.37 
 Fac Revascularization Iliac Artery Angiop 1st Vsl ,CPT® 37220,0360 - OR SERVICES,N/A,N/A," $12,918.00 "," $8,396.70 "," $10,851.12 ", $358.06 , $306.51 ," $10,437.74 "," $11,626.20 "," $10,936.38 "," $11,626.20 "," $11,626.20 "," $11,626.20 "," $10,980.30 ", $300.50 ," $11,927.19 "," $12,272.10 "," $10,980.30 "," $12,013.74 "," $12,013.74 "," $12,272.10 "," $12,401.28 "," $10,569.51 "," $11,626.20 "," $10,980.30 "," $10,205.22 ", N/A ," $10,454.54 "," $10,454.54 "," $12,272.10 "," $11,084.94 ", $300.50 ," $12,401.28 "
Fixatn of Testis Opp Torsn,CPT® 54620,N/A,N/A,N/A," $1,645.00 "," $1,069.25 "," $1,322.63 ", $284.89 , $461.01 , $963.00 , $972.12 ," $1,529.85 "," $1,480.50 "," $1,480.50 "," $1,316.00 "," $1,316.00 ", $461.01 ," $1,518.83 "," $1,562.75 "," $1,480.50 "," $1,480.50 "," $1,480.50 "," $1,529.85 "," $1,579.20 "," $1,244.49 "," $1,398.25 "," $1,546.78 "," $1,452.91 ", N/A , $981.79 , $981.79 ," $1,562.75 "," $1,176.74 ", $284.89 ," $1,579.20 "
Treat Fibular Fracture,27786,N/A,N/A,N/A," $2,086.00 "," $1,355.90 "," $1,797.25 ", $283.29 , $184.42 ," $1,381.41 "," $1,407.46 "," $1,939.98 "," $1,877.40 "," $1,877.40 "," $1,668.80 "," $1,668.80 ", $184.42 ," $1,926.00 "," $1,981.70 "," $1,877.40 "," $1,877.40 "," $1,877.40 "," $1,939.98 "," $2,002.56 "," $1,658.34 "," $1,773.10 "," $1,543.22 "," $1,637.46 ", N/A ," $1,408.37 "," $1,408.37 "," $1,981.70 "," $1,655.31 ", $184.42 ," $2,002.56 "
 Dpyd Gene Common Variants ,CPT® 81232,0309 - LAB/OTHER,N/A,N/A, $778.00 , $505.70 , $653.52 , $178.31 , N/A , $628.62 , $700.20 , $658.65 , $700.20 , $700.20 , $700.20 , $661.30 , N/A , $718.33 , $739.10 , $661.30 , $723.54 , $723.54 , $739.10 , $746.88 , $636.56 , $700.20 , $661.30 , $614.62 , N/A , $629.64 , $629.64 , $739.10 , $667.60 , $178.31 , $746.88 
Apply Short Arn Splint,29125,N/A,N/A,N/A, $302.00 , $196.30 , $241.35 , $38.40 , $27.51 , $190.75 , $194.03 , $280.86 , $271.80 , $271.80 , $241.60 , $241.60 , $27.51 , $278.84 , $286.90 , $271.80 , $271.80 , $271.80 , $280.86 , $289.92 , $223.62 , $256.70 , $212.30 , $229.45 , N/A , $194.47 , $194.47 , $286.90 , $228.57 , $27.51 , $289.92 
 Fac Open/Perq Placement Intravascular Stent Ea Addl ,CPT® 37237,0360 - OR SERVICES,N/A,N/A," $9,654.00 "," $6,275.10 "," $8,109.36 ", $187.98 , $242.65 ," $7,800.43 "," $8,688.60 "," $8,173.08 "," $8,688.60 "," $8,688.60 "," $8,688.60 "," $8,205.90 ", $237.89 ," $8,913.54 "," $9,171.30 "," $8,205.90 "," $8,978.22 "," $8,978.22 "," $9,171.30 "," $9,267.84 "," $7,898.90 "," $8,688.60 "," $8,205.90 "," $7,626.66 ", N/A ," $7,812.98 "," $7,812.98 "," $9,171.30 "," $8,284.10 ", $187.98 ," $9,267.84 "
 Fac Smn1 Gene Analysis Dosage/Delet Alys W/Smn2 Alys ,CPT® 81329,0310 - PATHOLOGY LAB,N/A,N/A, $633.00 , $411.45 , $531.72 , $139.74 , $111.79 , $511.46 , $569.70 , $535.90 , $569.70 , $569.70 , $569.70 , $538.05 , $109.60 , $584.45 , $601.35 , $538.05 , $588.69 , $588.69 , $601.35 , $607.68 , $517.92 , $569.70 , $538.05 , $500.07 , N/A , $512.29 , $512.29 , $601.35 , $543.18 , $109.60 , $607.68 
 Pro Apply Unna Boot ,CPT® 29580,0982 - PRO FEE/OUTPT,N/A,N/A, $168.00 , $109.20 , $162.96 , $25.02 , $20.61 , $173.40 , $173.65 , $156.24 , $151.20 , $151.20 , $134.40 , $134.40 , $20.61 , $155.11 , $159.60 , $151.20 , $151.20 , $151.20 , $156.24 , $161.28 , $151.07 , $142.80 , $189.11 , $166.30 , N/A , $176.79 , $176.79 , $159.60 , $207.80 , $20.61 , $207.80 
 Fac Slctv Cath Intrnl Carotid Art Angio Intrcrnl Art ,CPT® 36224,0360 - OR SERVICES,N/A,N/A," $13,142.00 "," $8,542.30 "," $11,039.28 ", $325.97 ," $1,670.26 "," $10,618.74 "," $11,827.80 "," $11,126.02 "," $11,827.80 "," $11,827.80 "," $11,827.80 "," $11,170.70 "," $1,637.51 "," $12,134.01 "," $12,484.90 "," $11,170.70 "," $12,222.06 "," $12,222.06 "," $12,484.90 "," $12,616.32 "," $10,752.78 "," $11,827.80 "," $11,170.70 "," $10,382.18 ", N/A ," $10,635.82 "," $10,635.82 "," $12,484.90 "," $11,277.15 ", $325.97 ," $12,616.32 "
Perq Breast Loc Device Placemt 1st Strtctc Guid,CPT® 19283,N/A,N/A,N/A," $1,020.00 ", $663.00 , $322.08 , $95.27 , $78.20 , $285.19 , $282.91 , $948.60 , $918.00 , $918.00 , $816.00 , $816.00 , $78.20 , $941.77 , $969.00 , $918.00 , $918.00 , $918.00 , $948.60 , $979.20 , $355.25 , $867.00 , $520.64 , $360.47 , N/A , $290.75 , $290.75 , $969.00 , $337.18 , $78.20 , $979.20 
"Program Eval Implant Device,Cardvert/Defib,1 Lead",CPT® 93282,N/A,N/A,N/A, $834.00 , $542.10 , $522.99 , $79.84 , $54.59 , $344.32 , $346.75 , $775.62 , $750.60 , $750.60 , $667.20 , $667.20 , $54.59 , $770.03 , $792.30 , $750.60 , $750.60 , $750.60 , $775.62 , $800.64 , $489.96 , $708.90 , $324.70 , $232.24 , N/A , $351.04 , $351.04 , $792.30 , $389.12 , $54.59 , $800.64 
Revision Peri-Implant Capsule Breast,CPT® 19370,N/A,N/A,N/A," $4,531.00 "," $2,945.15 "," $2,134.25 ", $639.81 , $495.41 ," $1,866.54 "," $1,833.10 "," $4,213.83 "," $4,077.90 "," $4,077.90 "," $3,624.80 "," $3,624.80 ", $495.41 ," $4,183.47 "," $4,304.45 "," $4,077.90 "," $4,077.90 "," $4,077.90 "," $4,213.83 "," $4,349.76 "," $2,336.92 "," $3,851.35 "," $3,678.74 "," $2,388.70 ", N/A ," $1,902.96 "," $1,902.96 "," $4,304.45 "," $2,206.79 ", $495.41 ," $4,349.76 "
Antb Hiv-2,CPT® 86702,N/A,N/A,N/A, $133.00 , $86.45 , N/A , $13.79 , $13.79 , $76.45 , $91.48 , $123.69 , $119.70 , $119.70 , $106.40 , $106.40 , $13.79 , $122.80 , $126.35 , $119.70 , $119.70 , $119.70 , $123.69 , $127.68 , $90.28 , $113.05 , $89.20 , $49.02 , N/A , $71.35 , $71.35 , $126.35 , $77.97 , $13.79 , $127.68 
"Cath, Vein Umbilical Newborn",36510,N/A,N/A,N/A, $481.00 , $312.65 , $335.27 , $51.68 , $150.54 , $251.47 , $253.54 , $447.33 , $432.90 , $432.90 , $384.80 , $384.80 , $150.54 , $444.11 , $456.95 , $432.90 , $432.90 , $432.90 , $447.33 , $461.76 , $307.81 , $408.85 , $319.35 , $272.58 , N/A , $256.38 , $256.38 , $456.95 , $291.24 , $51.68 , $461.76 
 Fac Tumor Immunohistochem/Manual ,CPT® 88360,0310 - PATHOLOGY LAB,N/A,N/A, $864.00 , $561.60 , $725.76 , $116.62 , $107.82 , $698.11 , $777.60 , $731.46 , $777.60 , $777.60 , $777.60 , $734.40 , $105.71 , $797.73 , $820.80 , $734.40 , $803.52 , $803.52 , $820.80 , $829.44 , $706.92 , $777.60 , $734.40 , $682.56 , N/A , $699.24 , $699.24 , $820.80 , $741.40 , $105.71 , $829.44 
 ACETAZOLAMIDE ER 500 MG PO CP12 ,HCPCS RXC637,0250 - PHARMACY,50742-0233-01,1 capsule, $22.06 , $14.34 , $18.53 , N/A , N/A , $17.82 , $19.85 , $18.68 , $19.85 , $19.85 , $19.85 , $18.75 , N/A , $20.37 , $20.96 , $18.75 , $20.52 , $20.52 , $20.96 , $21.18 , $18.05 , $19.85 , $18.75 , $17.43 , N/A , $17.85 , $17.85 , $20.96 , $18.93 , $17.43 , $21.18 
 MYCOPHENOLATE SODIUM 180 MG PO TBEC ,HCPCS RXC637,0250 - PHARMACY,00904-6785-61,1 tablet, $30.29 , $19.69 , $25.44 , N/A , N/A , $24.47 , $27.26 , $25.64 , $27.26 , $27.26 , $27.26 , $25.75 , N/A , $27.97 , $28.78 , $25.75 , $28.17 , $28.17 , $28.78 , $29.08 , $24.78 , $27.26 , $25.75 , $23.93 , N/A , $24.51 , $24.51 , $28.78 , $25.99 , $23.93 , $29.08 
Mycoplasma,CPT® 86738,N/A,N/A,N/A, $128.00 , $83.20 , N/A , $13.50 , $13.50 , $74.92 , $89.60 , $119.04 , $115.20 , $115.20 , $102.40 , $102.40 , $13.50 , $118.18 , $121.60 , $115.20 , $115.20 , $115.20 , $119.04 , $122.88 , $88.41 , $108.80 , $85.96 , $47.99 , N/A , $69.92 , $69.92 , $121.60 , $76.40 , $13.50 , $122.88 
Debridement Nails 6 or Mo,11721,N/A,N/A,N/A, $171.00 , $111.15 , $78.23 , $23.04 , $33.71 , $69.12 , $65.79 , $159.03 , $153.90 , $153.90 , $136.80 , $136.80 , $33.71 , $157.88 , $162.45 , $153.90 , $153.90 , $153.90 , $159.03 , $164.16 , $86.28 , $145.35 , $128.45 , $88.53 , N/A , $70.47 , $70.47 , $162.45 , $81.72 , $23.04 , $164.16 
Ephys Eval Pacg Cvdfb Lds W/Tstg of Pulse Gen,CPT® 93641,N/A,N/A,N/A," $3,984.00 "," $2,589.60 "," $3,732.63 ", $580.07 , $594.19 ," $3,347.59 "," $3,306.19 "," $3,705.12 "," $3,585.60 "," $3,585.60 "," $3,187.20 "," $3,187.20 ", $594.19 ," $3,678.43 "," $3,784.80 "," $3,585.60 "," $3,585.60 "," $3,585.60 "," $3,705.12 "," $3,824.64 "," $3,680.93 "," $3,386.40 "," $3,197.04 "," $3,522.67 ", N/A ," $3,412.91 "," $3,412.91 "," $3,784.80 "," $3,783.25 ", $580.07 ," $3,824.64 "
 Pro Diagnostic Lumbar Spinal Puncture W/Fluor or CT ,CPT® 62328,0982 - PRO FEE/OUTPT,N/A,N/A," $1,145.00 ", $744.25 , $428.12 , $82.55 , $204.50 , $488.43 , N/A ," $1,064.85 "," $1,030.50 "," $1,030.50 ", $916.00 , $916.00 , $204.50 ," $1,057.18 "," $1,087.75 "," $1,030.50 "," $1,030.50 "," $1,030.50 "," $1,064.85 "," $1,099.20 ", $465.26 , $973.25 , $453.12 , $533.88 , N/A , $497.95 , $497.95 ," $1,087.75 ", $534.18 , $82.55 ," $1,099.20 "
 Exploration W-W/O Lysis of Artery; Other Vessels ,CPT® 35702,0360 - OR SERVICES,N/A,N/A," $1,719.00 "," $1,117.35 "," $1,443.96 ", $375.12 , $312.52 ," $1,388.95 "," $1,547.10 "," $1,455.31 "," $1,547.10 "," $1,547.10 "," $1,547.10 "," $1,461.15 ", $306.39 ," $1,587.15 "," $1,633.05 "," $1,461.15 "," $1,598.67 "," $1,598.67 "," $1,633.05 "," $1,650.24 "," $1,406.49 "," $1,547.10 "," $1,461.15 "," $1,358.01 ", N/A ," $1,391.19 "," $1,391.19 "," $1,633.05 "," $1,475.07 ", $306.39 ," $1,650.24 "
 Fac Protozoa Antibody Nos ,CPT® 86753,0302 - LAB/IMMUNOLOGY,N/A,N/A, $177.00 , $115.05 , $148.68 , $12.64 , $8.07 , $143.02 , $159.30 , $149.85 , $159.30 , $159.30 , $159.30 , $150.45 , $7.91 , $163.42 , $168.15 , $150.45 , $164.61 , $164.61 , $168.15 , $169.92 , $144.82 , $159.30 , $150.45 , $139.83 , N/A , $143.25 , $143.25 , $168.15 , $151.88 , $7.91 , $169.92 
"Unlisted Laparoscopy Proc,Intestine",44238,N/A,N/A,N/A, $421.00 , $273.65 , N/A , N/A , N/A , N/A , N/A , $391.53 , $378.90 , $378.90 , $336.80 , $336.80 , N/A , $388.71 , $399.95 , $378.90 , $378.90 , $378.90 , $391.53 , $404.16 , N/A , $357.85 , $336.80 , N/A , N/A , N/A , N/A , $399.95 , N/A , $336.80 , $404.16 
Afo Molded Ankle Gauntlet,HCPCS L1904,N/A,N/A,N/A, $137.00 , $89.05 , N/A , $527.98 , $462.93 , N/A , N/A , $127.41 , $123.30 , $123.30 , $109.60 , $109.60 , $462.93 , $126.49 , $130.15 , $123.30 , $123.30 , $123.30 , $127.41 , $131.52 , N/A , $116.45 , $475.53 , $444.21 , N/A , N/A , N/A , $130.15 , N/A , $109.60 , $527.98 
 OYSTER CALCIUM 500 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-1883-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Injection Aa&/Strd Ilioinguinal Ih Nerves,CPT® 64425,N/A,N/A,N/A, $901.00 , $585.65 , $271.75 , $52.72 , $76.84 , $522.44 , $515.02 , $837.93 , $810.90 , $810.90 , $720.80 , $720.80 , $76.84 , $831.89 , $855.95 , $810.90 , $810.90 , $810.90 , $837.93 , $864.96 , $295.49 , $765.85 , $504.89 , $564.76 , N/A , $532.63 , $532.63 , $855.95 , $571.39 , $52.72 , $864.96 
"Cysto/Uretero/Pyeloscopy, Dx",52351,N/A,N/A,N/A," $2,491.00 "," $1,619.15 "," $1,620.98 ", $284.82 , $319.64 ," $1,485.02 "," $1,405.94 "," $2,316.63 "," $2,241.90 "," $2,241.90 "," $1,992.80 "," $1,992.80 ", $319.64 ," $2,299.94 "," $2,366.45 "," $2,241.90 "," $2,241.90 "," $2,241.90 "," $2,316.63 "," $2,391.36 "," $1,630.11 "," $2,117.35 "," $1,591.39 "," $1,864.92 ", N/A ," $1,513.99 "," $1,513.99 "," $2,366.45 "," $1,779.48 ", $284.82 ," $2,391.36 "
X-Ray Exam Sella,CPT® 70240,N/A,N/A,N/A, $183.00 , $118.95 , $186.82 , $32.40 , $27.44 , $141.61 , $159.35 , $170.19 , $164.70 , $164.70 , $146.40 , $146.40 , $27.44 , $168.96 , $173.85 , $164.70 , $164.70 , $164.70 , $170.19 , $175.68 , $182.34 , $155.55 , $175.27 , $155.04 , N/A , $144.37 , $144.37 , $173.85 , $167.12 , $27.44 , $186.82 
 Fac Slctv Cath 1stord W/WO Art Punct/Fluoro/S&I Un ,CPT® 36251,0761 - TREATMENT ROOM,N/A,N/A," $5,878.00 "," $3,820.70 "," $4,937.52 ", $234.65 ," $1,713.54 "," $4,749.42 "," $5,290.20 "," $4,976.31 "," $5,290.20 "," $5,290.20 "," $5,290.20 "," $4,996.30 "," $1,679.94 "," $5,427.16 "," $5,584.10 "," $4,996.30 "," $5,466.54 "," $5,466.54 "," $5,584.10 "," $5,642.88 "," $4,809.38 "," $5,290.20 "," $4,996.30 "," $4,643.62 ", N/A ," $4,757.07 "," $4,757.07 "," $5,584.10 "," $5,043.91 ", $234.65 ," $5,642.88 "
 Pro Cltx Phlngl Fx Prox/Middle Px/F/T W/Mnpj Ea ,CPT® 26725,0975 - PRO FEE/OR,N/A,N/A," $1,012.00 ", $657.80 ," $1,888.97 ", $298.96 , $132.15 ," $1,457.95 "," $1,481.04 ", $941.16 , $910.80 , $910.80 , $809.60 , $809.60 , $132.15 , $934.38 , $961.40 , $910.80 , $910.80 , $910.80 , $941.16 , $971.52 ," $1,742.10 ", $860.20 ," $1,625.28 "," $1,732.55 ", N/A ," $1,486.40 "," $1,486.40 ", $961.40 ," $1,747.03 ", $132.15 ," $1,888.97 "
 Pro Appl Cst Elbw Fngr Short Arm ,CPT® 29075,0982 - PRO FEE/OUTPT,N/A,N/A, $595.00 , $386.75 , $373.23 , $59.32 , $54.80 , $299.54 , $303.79 , $553.35 , $535.50 , $535.50 , $476.00 , $476.00 , $54.80 , $549.36 , $565.25 , $535.50 , $535.50 , $535.50 , $553.35 , $571.20 , $349.50 , $505.75 , $333.62 , $357.56 , N/A , $305.39 , $305.39 , $565.25 , $358.95 , $54.80 , $571.20 
"Removal Arm/Elbow F.B.,Superficial",CPT® 24200,N/A,N/A,N/A," $1,355.00 ", $880.75 , $867.10 , $133.90 , $65.65 , $676.19 , $678.21 ," $1,260.15 "," $1,219.50 "," $1,219.50 "," $1,084.00 "," $1,084.00 ", $65.65 ," $1,251.07 "," $1,287.25 "," $1,219.50 "," $1,219.50 "," $1,219.50 "," $1,260.15 "," $1,300.80 ", $803.92 ," $1,151.75 ", $743.95 , $802.46 , N/A , $689.38 , $689.38 ," $1,287.25 ", $810.26 , $65.65 ," $1,300.80 "
"Lap,Gastrostomy,W/O Tube Constr",43653,N/A,N/A,N/A," $3,740.00 "," $2,431.00 "," $3,474.84 ", $538.65 , $781.95 ," $2,690.76 "," $2,750.20 "," $3,478.20 "," $3,366.00 "," $3,366.00 "," $2,992.00 "," $2,992.00 ", $781.95 ," $3,453.14 "," $3,553.00 "," $3,366.00 "," $3,366.00 "," $3,366.00 "," $3,478.20 "," $3,590.40 "," $2,485.12 "," $3,179.00 "," $3,052.53 "," $3,189.39 ", N/A ," $2,743.26 "," $2,743.26 "," $3,553.00 "," $2,869.17 ", $538.65 ," $3,590.40 "
 Pro Incise Inner Eye Adhesions ,CPT® 65875,0982 - PRO FEE/OUTPT,N/A,N/A," $5,665.00 "," $3,682.25 "," $3,917.81 ", $614.57 , $614.70 ," $3,562.54 "," $3,333.22 "," $5,268.45 "," $5,098.50 "," $5,098.50 "," $4,532.00 "," $4,532.00 ", $614.70 ," $5,230.49 "," $5,381.75 "," $5,098.50 "," $5,098.50 "," $5,098.50 "," $5,268.45 "," $5,438.40 "," $5,375.39 "," $4,815.25 "," $3,423.62 "," $4,532.87 ", N/A ," $3,632.05 "," $3,632.05 "," $5,381.75 "," $4,009.32 ", $614.57 ," $5,438.40 "
 Fac Replace Aorta Valve W/Byp Cntrl Art/Venous Aprch ,CPT® 33369,0360 - OR SERVICES,N/A,N/A," $15,582.00 "," $10,128.30 "," $13,088.88 ", $874.26 , $748.90 ," $12,590.26 "," $14,023.80 "," $13,191.72 "," $14,023.80 "," $14,023.80 "," $14,023.80 "," $13,244.70 ", $734.22 ," $14,386.86 "," $14,802.90 "," $13,244.70 "," $14,491.26 "," $14,491.26 "," $14,802.90 "," $14,958.72 "," $12,749.19 "," $14,023.80 "," $13,244.70 "," $12,309.78 ", N/A ," $12,610.51 "," $12,610.51 "," $14,802.90 "," $13,370.91 ", $734.22 ," $14,958.72 "
 ZINC OXIDE 20 % EX OINT ,HCPCS RXC637,0250 - PHARMACY,00536-1316-28,30 gram, $12.64 , $8.22 , $10.62 , N/A , N/A , $10.21 , $11.38 , $10.70 , $11.38 , $11.38 , $11.38 , $10.74 , N/A , $11.67 , $12.01 , $10.74 , $11.76 , $11.76 , $12.01 , $12.13 , $10.34 , $11.38 , $10.74 , $9.99 , N/A , $10.23 , $10.23 , $12.01 , $10.85 , $9.99 , $12.13 
"Bacterium, Antibody",CPT® 86609,N/A,N/A,N/A, $138.00 , $89.70 , N/A , $13.14 , $8.07 , $32.88 , $39.34 , $128.34 , $124.20 , $124.20 , $110.40 , $110.40 , $8.07 , $127.42 , $131.10 , $124.20 , $124.20 , $124.20 , $128.34 , $132.48 , $86.00 , $117.30 , $84.34 , $46.70 , N/A , $30.69 , $30.69 , $131.10 , $33.54 , $8.07 , $132.48 
 Pro Exc Tumor Soft Tissue Neck/Ant Thorax Subfascial 5+Cm ,CPT® 21554,0982 - PRO FEE/OUTPT,N/A,N/A," $5,013.00 "," $3,258.45 "," $4,408.04 ", $688.01 , $607.30 ," $3,515.65 "," $3,494.74 "," $4,662.09 "," $4,511.70 "," $4,511.70 "," $4,010.40 "," $4,010.40 ", $607.30 ," $4,628.50 "," $4,762.35 "," $4,511.70 "," $4,511.70 "," $4,511.70 "," $4,662.09 "," $4,812.48 "," $4,080.46 "," $4,261.05 "," $3,860.71 "," $4,118.79 ", N/A ," $3,584.25 "," $3,584.25 "," $4,762.35 "," $4,212.78 ", $607.30 ," $4,812.48 "
 Fac Drug Screening Cocaine ,CPT® 80353,0301 - LAB/CHEMISTRY,N/A,N/A, $191.00 , $124.15 , $160.44 , N/A , N/A , $154.33 , $171.90 , $161.70 , $171.90 , $171.90 , $171.90 , $162.35 , N/A , $176.35 , $181.45 , $162.35 , $177.63 , $177.63 , $181.45 , $183.36 , $156.28 , $171.90 , $162.35 , $150.89 , N/A , $154.58 , $154.58 , $181.45 , $163.90 , $150.89 , $183.36 
Percut Fixatn Humeral Epicondylar Fx,CPT® 24566,N/A,N/A,N/A," $4,621.00 "," $3,003.65 "," $4,400.83 ", $691.38 , $407.24 ," $3,455.90 "," $3,455.86 "," $4,297.53 "," $4,158.90 "," $4,158.90 "," $3,696.80 "," $3,696.80 ", $407.24 ," $4,266.57 "," $4,389.95 "," $4,158.90 "," $4,158.90 "," $4,158.90 "," $4,297.53 "," $4,436.16 "," $4,091.43 "," $3,927.85 "," $3,812.54 "," $4,078.93 ", N/A ," $3,523.32 "," $3,523.32 "," $4,389.95 "," $4,141.17 ", $407.24 ," $4,436.16 "
"Biopsy/Excision, Lymph Node(S)",CPT® 38500,N/A,N/A,N/A," $3,098.00 "," $2,013.70 "," $1,178.95 ", $238.19 , $322.82 , $882.52 , $911.96 ," $2,881.14 "," $2,788.20 "," $2,788.20 "," $2,478.40 "," $2,478.40 ", $322.82 ," $2,860.38 "," $2,943.10 "," $2,788.20 "," $2,788.20 "," $2,788.20 "," $2,881.14 "," $2,974.08 "," $1,259.29 "," $2,633.30 "," $1,348.75 "," $1,222.60 ", N/A , $899.74 , $899.74 ," $2,943.10 "," $1,043.82 ", $238.19 ," $2,974.08 "
"Remv Stomach,Part,Distal,Gastrojejun",CPT® 43632,N/A,N/A,N/A," $12,706.00 "," $8,258.90 "," $12,026.76 "," $1,862.89 "," $1,269.74 "," $9,533.98 "," $9,571.37 "," $11,816.58 "," $11,435.40 "," $11,435.40 "," $10,164.80 "," $10,164.80 "," $1,269.74 "," $11,731.45 "," $12,070.70 "," $11,435.40 "," $11,435.40 "," $11,435.40 "," $11,816.58 "," $12,197.76 "," $8,622.80 "," $10,800.10 "," $10,666.92 "," $11,224.32 ", N/A ," $9,720.00 "," $9,720.00 "," $12,070.70 "," $10,166.08 "," $1,269.74 "," $12,197.76 "
Debride Assoc Fx/Disloc Skin/Subq,CPT® 11010,N/A,N/A,N/A," $1,592.00 "," $1,034.80 ", $871.93 , $261.22 , $345.88 , $760.78 , $739.10 ," $1,480.56 "," $1,432.80 "," $1,432.80 "," $1,273.60 "," $1,273.60 ", $345.88 ," $1,469.89 "," $1,512.40 "," $1,432.80 "," $1,432.80 "," $1,432.80 "," $1,480.56 "," $1,528.32 ", $953.65 ," $1,353.20 "," $1,482.56 ", $983.21 , N/A , $775.62 , $775.62 ," $1,512.40 ", $899.45 , $261.22 ," $1,528.32 "
Punch Biopsy Skin Single Lesion,CPT® 11104,N/A,N/A,N/A, $491.00 , $319.15 , $150.65 , $44.88 , $98.18 , $127.17 , N/A , $456.63 , $441.90 , $441.90 , $392.80 , $392.80 , $98.18 , $453.34 , $466.45 , $441.90 , $441.90 , $441.90 , $456.63 , $471.36 , $167.40 , $417.35 , $247.00 , $174.53 , N/A , $129.65 , $129.65 , $466.45 , $150.35 , $44.88 , $471.36 
 Fac Herpes Simplex Test ,CPT® 86695,0302 - LAB/IMMUNOLOGY,N/A,N/A, $146.00 , $94.90 , $122.64 , $13.45 , $13.45 , $117.97 , $131.40 , $123.60 , $131.40 , $131.40 , $131.40 , $124.10 , $13.19 , $134.80 , $138.70 , $124.10 , $135.78 , $135.78 , $138.70 , $140.16 , $119.46 , $131.40 , $124.10 , $115.34 , N/A , $118.16 , $118.16 , $138.70 , $125.28 , $13.19 , $140.16 
Prim Prq Trluml Mchnl Thrmbc N-Cor N-Icra 1st,CPT® 37184,N/A,N/A,N/A," $14,801.00 "," $9,620.65 "," $2,532.79 ", $391.68 ," $2,378.00 "," $1,991.30 "," $1,944.08 "," $13,764.93 "," $13,320.90 "," $13,320.90 "," $11,840.80 "," $11,840.80 "," $2,378.00 "," $13,665.76 "," $14,060.95 "," $13,320.90 "," $13,320.90 "," $13,320.90 "," $13,764.93 "," $14,208.96 "," $2,346.43 "," $12,580.85 "," $2,419.19 "," $2,180.06 ", N/A ," $2,030.15 "," $2,030.15 "," $14,060.95 "," $2,306.26 ", $391.68 ," $14,208.96 "
"CT Angio,Lower Extrem,Combo,Image Prc",CPT® 73706,N/A,N/A,N/A," $2,985.00 "," $1,940.25 "," $1,812.93 ", $262.47 , $354.97 ," $1,671.84 "," $2,134.00 "," $2,776.05 "," $2,686.50 "," $2,686.50 "," $2,388.00 "," $2,388.00 ", $354.97 ," $2,756.05 "," $2,835.75 "," $2,686.50 "," $2,686.50 "," $2,686.50 "," $2,776.05 "," $2,865.60 "," $1,950.90 "," $2,537.25 "," $2,328.58 "," $2,304.48 ", N/A ," $1,704.47 "," $1,704.47 "," $2,835.75 "," $1,972.93 ", $262.47 ," $2,865.60 "
 MORPHINE SULFATE 2 MG/ML INJECTION (INPT) ,HCPCS J2270,0636 - DRUGS REQUIRING DETAILED CODIN,00409-1890-01,1 mL, $23.94 , $15.56 , $20.11 , $4.69 , $3.41 , $19.34 , $21.55 , $20.27 , $21.55 , $21.55 , $21.55 , $20.35 , $3.34 , $22.10 , $22.74 , $20.35 , $22.26 , $22.26 , $22.74 , $22.98 , $19.59 , $21.55 , $20.35 , $18.91 , N/A , $19.37 , $19.37 , $22.74 , $20.54 , $3.34 , $22.98 
 PREDNISONE 1 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00054-8739-25,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Egd Percutaneous Placement Gastrostomy Tube ,CPT® 43246,0360 - OR SERVICES,N/A,N/A," $2,601.00 "," $1,690.65 "," $2,184.84 ", $187.69 , $744.68 ," $2,101.61 "," $2,340.90 "," $2,202.01 "," $2,340.90 "," $2,340.90 "," $2,340.90 "," $2,210.85 ", $730.08 ," $2,401.50 "," $2,470.95 "," $2,210.85 "," $2,418.93 "," $2,418.93 "," $2,470.95 "," $2,496.96 "," $2,128.14 "," $2,340.90 "," $2,210.85 "," $2,054.79 ", N/A ," $2,104.99 "," $2,104.99 "," $2,470.95 "," $2,231.92 ", $187.69 ," $2,496.96 "
Cholera Vaccine Adult 1 Dose Live for Oral Use,CPT® 90625,N/A,N/A,N/A, $435.00 , $282.75 , N/A , N/A , N/A , N/A , N/A , $404.55 , $391.50 , $391.50 , $348.00 , $348.00 , N/A , $401.64 , $413.25 , $391.50 , $391.50 , $391.50 , $404.55 , $417.60 , N/A , $369.75 , $348.00 , $465.38 , N/A , N/A , N/A , $413.25 , N/A , $348.00 , $465.38 
 RIZATRIPTAN BENZOATE 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00093-7471-43,1 tablet, $170.82 , $111.03 , $143.49 , N/A , N/A , $138.02 , $153.74 , $144.62 , $153.74 , $153.74 , $153.74 , $145.20 , N/A , $157.72 , $162.28 , $145.20 , $158.86 , $158.86 , $162.28 , $163.99 , $139.76 , $153.74 , $145.20 , $134.95 , N/A , $138.24 , $138.24 , $162.28 , $146.58 , $134.95 , $163.99 
 Polysom Stage4 or>W/Cpap <6yr ,CPT® 95783,0920 - OTHER DX SVS,N/A,N/A," $6,598.00 "," $4,288.70 "," $5,542.32 ", $985.03 , $873.70 ," $5,331.18 "," $5,938.20 "," $5,585.87 "," $5,938.20 "," $5,938.20 "," $5,938.20 "," $5,608.30 ", $856.57 ," $6,091.93 "," $6,268.10 "," $5,608.30 "," $6,136.14 "," $6,136.14 "," $6,268.10 "," $6,334.08 "," $5,398.48 "," $5,938.20 "," $5,608.30 "," $5,212.42 ", N/A ," $5,339.76 "," $5,339.76 "," $6,268.10 "," $5,661.74 ", $856.57 ," $6,334.08 "
" Removal FB Eye, Corneal /W Slit Lamp - Mh ",CPT® 65222,0761 - TREATMENT ROOM,N/A,N/A, $370.00 , $240.50 , $310.80 , $48.84 , $48.12 , $298.96 , $333.00 , $313.24 , $333.00 , $333.00 , $333.00 , $314.50 , $47.18 , $341.62 , $351.50 , $314.50 , $344.10 , $344.10 , $351.50 , $355.20 , $302.73 , $333.00 , $314.50 , $292.30 , N/A , $299.44 , $299.44 , $351.50 , $317.50 , $47.18 , $355.20 
Assay of Alcohol (Ethanol) Spec Xcp UR&Breath Ia,CPT® 82077,N/A,N/A,N/A, $159.00 , $103.35 , N/A , $17.62 , $14.10 , N/A , N/A , $147.87 , $143.10 , $143.10 , $127.20 , $127.20 , $14.10 , $146.80 , $151.05 , $143.10 , $143.10 , $143.10 , $147.87 , $152.64 , $115.32 , $135.15 , $82.38 , $50.72 , N/A , $68.56 , $68.56 , $151.05 , $74.78 , $14.10 , $152.64 
 Pro M/Phmtrc Alys Tum Imhchem Ea Antb Cptr ,CPT® 88361,0971 - PRO FEE/LAB,N/A,N/A, $920.00 , $598.00 , $431.16 , $116.79 , $135.03 , $672.08 , $715.54 , $855.60 , $828.00 , $828.00 , $736.00 , $736.00 , $135.03 , $849.44 , $874.00 , $828.00 , $828.00 , $828.00 , $855.60 , $883.20 , $791.18 , $782.00 , $746.05 , $505.34 , N/A , $627.23 , $627.23 , $874.00 , $689.30 , $116.79 , $883.20 
" Fac Colon Ca Screen, Barium Enema ",HCPCS G0106,0320 - DX X-RAY,N/A,N/A, $799.00 , $519.35 , $671.16 , $221.19 , $127.04 , $645.59 , $719.10 , $676.43 , $719.10 , $719.10 , $719.10 , $679.15 , $124.55 , $737.72 , $759.05 , $679.15 , $743.07 , $743.07 , $759.05 , $767.04 , $653.74 , $719.10 , $679.15 , $631.21 , N/A , $646.63 , $646.63 , $759.05 , $685.62 , $124.55 , $767.04 
Treatment Toe Fracture,CPT® 28515,N/A,N/A,N/A," $1,059.00 ", $688.35 , $888.42 , $141.25 , $76.84 , $702.96 , $708.81 , $984.87 , $953.10 , $953.10 , $847.20 , $847.20 , $76.84 , $977.77 ," $1,006.05 ", $953.10 , $953.10 , $953.10 , $984.87 ," $1,016.64 ", $817.30 , $900.15 , $768.93 , $830.94 , N/A , $716.67 , $716.67 ," $1,006.05 ", $842.36 , $76.84 ," $1,016.64 "
"Cystourethroscopy,Fulguratn",52214,N/A,N/A,N/A," $4,647.00 "," $3,020.55 ", $943.63 , $164.94 , $155.03 , $863.18 , $796.57 ," $4,321.71 "," $4,182.30 "," $4,182.30 "," $3,717.60 "," $3,717.60 ", $155.03 ," $4,290.58 "," $4,414.65 "," $4,182.30 "," $4,182.30 "," $4,182.30 "," $4,321.71 "," $4,461.12 ", $951.06 ," $3,949.95 ", $902.74 ," $1,083.33 ", N/A , $880.02 , $880.02 ," $4,414.65 "," $1,034.33 ", $155.03 ," $4,461.12 "
 Fac Open/Perq Placement Intravasc Stent Same Ea Addl ,CPT® 37239,0360 - OR SERVICES,N/A,N/A," $8,405.00 "," $5,463.25 "," $7,060.20 ", $135.87 , $169.33 ," $6,791.24 "," $7,564.50 "," $7,115.67 "," $7,564.50 "," $7,564.50 "," $7,564.50 "," $7,144.25 ", $166.01 ," $7,760.34 "," $7,984.75 "," $7,144.25 "," $7,816.65 "," $7,816.65 "," $7,984.75 "," $8,068.80 "," $6,876.97 "," $7,564.50 "," $7,144.25 "," $6,639.95 ", N/A ," $6,802.17 "," $6,802.17 "," $7,984.75 "," $7,212.33 ", $135.87 ," $8,068.80 "
 INSULIN REGULAR HUMAN 100 UNIT/ML SUBQ DOSE ,HCPCS RXC637,0250 - PHARMACY,00001-0150-01,1 mL, $84.89 , $55.18 , $71.31 , N/A , N/A , $68.59 , $76.40 , $71.87 , $76.40 , $76.40 , $76.40 , $72.16 , N/A , $78.38 , $80.65 , $72.16 , $78.95 , $78.95 , $80.65 , $81.49 , $69.46 , $76.40 , $72.16 , $67.06 , N/A , $68.70 , $68.70 , $80.65 , $72.84 , $67.06 , $81.49 
Treat Great Toe Fracture,28495,N/A,N/A,N/A, $801.00 , $520.65 , $927.29 , $146.49 , $142.01 , $741.74 , $744.49 , $744.93 , $720.90 , $720.90 , $640.80 , $640.80 , $142.01 , $739.56 , $760.95 , $720.90 , $720.90 , $720.90 , $744.93 , $768.96 , $853.03 , $680.85 , $808.18 , $870.51 , N/A , $756.22 , $756.22 , $760.95 , $888.84 , $142.01 , $927.29 
" Fac Prolonged IV Inf, Req Pump ",HCPCS C8957,0260 - IV THERAPY,N/A,N/A, $328.00 , $213.20 , $275.52 , N/A , N/A , $265.02 , $295.20 , $277.68 , $295.20 , $295.20 , $295.20 , $278.80 , N/A , $302.84 , $311.60 , $278.80 , $305.04 , $305.04 , $311.60 , $314.88 , $268.37 , $295.20 , $278.80 , $259.12 , N/A , $265.45 , $265.45 , $311.60 , $281.46 , $259.12 , $314.88 
Musc/Tendon Repair Each; Arm/Elbow,24341,N/A,N/A,N/A," $4,271.00 "," $2,776.15 "," $4,549.87 ", $717.73 , $725.22 ," $3,598.81 "," $3,610.29 "," $3,972.03 "," $3,843.90 "," $3,843.90 "," $3,416.80 "," $3,416.80 ", $725.22 ," $3,943.41 "," $4,057.45 "," $3,843.90 "," $3,843.90 "," $3,843.90 "," $3,972.03 "," $4,100.16 "," $4,232.68 "," $3,630.35 "," $3,980.25 "," $4,247.67 ", N/A ," $3,669.04 "," $3,669.04 "," $4,057.45 "," $4,312.40 ", $717.73 ," $4,549.87 "
 COSYNTROPIN 0.25 MG IJ SOLR ,HCPCS J0834,0636 - DRUGS REQUIRING DETAILED CODIN,00781-3440-95,1 mL, $494.38 , $321.35 , $415.28 , $28.44 , $25.28 , $399.46 , $444.94 , $418.54 , $444.94 , $444.94 , $444.94 , $420.22 , $24.78 , $456.46 , $469.66 , $420.22 , $459.77 , $459.77 , $469.66 , $474.60 , $404.50 , $444.94 , $420.22 , $390.56 , N/A , $400.10 , $400.10 , $469.66 , $424.23 , $24.78 , $474.60 
"Assay Protein,Total,Other Source",CPT® 84157,N/A,N/A,N/A, $50.00 , $32.50 , N/A , $4.08 , $4.08 , $20.74 , $24.81 , $46.50 , $45.00 , $45.00 , $40.00 , $40.00 , $4.08 , $46.17 , $47.50 , $45.00 , $45.00 , $45.00 , $46.50 , $48.00 , $26.71 , $42.50 , $24.33 , $13.30 , N/A , $19.36 , $19.36 , $47.50 , $21.16 , $4.08 , $48.00 
 Pro US Guided Fna Frst Lesion W/Uidance ,CPT® 10005,0972 - PRO FEE/RAD/DX,N/A,N/A, $341.00 , $221.65 , $237.56 , $70.37 , $100.23 , $188.19 , N/A , $317.13 , $306.90 , $306.90 , $272.80 , $272.80 , $100.23 , $314.85 , $323.95 , $306.90 , $306.90 , $306.90 , $317.13 , $327.36 , $244.10 , $289.85 , $387.37 , $258.53 , N/A , $191.86 , $191.86 , $323.95 , $222.49 , $70.37 , $387.37 
" Pro Radiologic Examination, Abdomen, 2 Views ",CPT® 74019,0972 - PRO FEE/RAD/DX,N/A,N/A, $142.00 , $92.30 , $208.05 , $36.40 , $26.24 , $149.66 , $167.44 , $132.06 , $127.80 , $127.80 , $113.60 , $113.60 , $26.24 , $131.11 , $134.90 , $127.80 , $127.80 , $127.80 , $132.06 , $136.32 , $203.49 , $120.70 , $212.94 , $167.88 , N/A , $152.58 , $152.58 , $134.90 , $176.61 , $26.24 , $212.94 
"Destr Penis Lesn,Simpl,Chemical",CPT® 54050,N/A,N/A,N/A, $670.00 , $435.50 , $469.95 , $103.24 , $23.04 , $337.39 , $347.89 , $623.10 , $603.00 , $603.00 , $536.00 , $536.00 , $23.04 , $618.61 , $636.50 , $603.00 , $603.00 , $603.00 , $623.10 , $643.20 , $440.18 , $569.50 , $558.41 , $509.08 , N/A , $343.97 , $343.97 , $636.50 , $412.29 , $23.04 , $643.20 
"Removal Penis,Radical+Nodes",CPT® 54130,N/A,N/A,N/A," $6,544.00 "," $4,253.60 "," $5,271.85 "," $1,133.26 "," $1,536.80 "," $3,833.71 "," $3,855.12 "," $6,085.92 "," $5,889.60 "," $5,889.60 "," $5,235.20 "," $5,235.20 "," $1,536.80 "," $6,042.08 "," $6,216.80 "," $5,889.60 "," $5,889.60 "," $5,889.60 "," $6,085.92 "," $6,282.24 "," $4,954.91 "," $5,562.40 "," $6,144.32 "," $5,778.60 ", N/A ," $3,908.51 "," $3,908.51 "," $6,216.80 "," $4,684.58 "," $1,133.26 "," $6,282.24 "
 Prolact Rtf 26 per Ml ,Custom 2200000007,0220 - SPECIAL CHARGES,N/A,N/A, $7.00 , $4.55 , $5.88 , N/A , N/A , $5.66 , $6.30 , $5.93 , $6.30 , $6.30 , $6.30 , $5.95 , N/A , $6.46 , $6.65 , $5.95 , $6.51 , $6.51 , $6.65 , $6.72 , $5.73 , $6.30 , $5.95 , $5.53 , N/A , $5.67 , $5.67 , $6.65 , $6.01 , $5.53 , $6.72 
 Fac Immune Complex Assay ,CPT® 86332,0302 - LAB/IMMUNOLOGY,N/A,N/A, $242.00 , $157.30 , $203.28 , $24.86 , $24.86 , $195.54 , $217.80 , $204.88 , $217.80 , $217.80 , $217.80 , $205.70 , $24.37 , $223.44 , $229.90 , $205.70 , $225.06 , $225.06 , $229.90 , $232.32 , $198.00 , $217.80 , $205.70 , $191.18 , N/A , $195.85 , $195.85 , $229.90 , $207.66 , $24.37 , $232.32 
 Fac Esophagoscopy Flexible Transoral With Biopsy ,CPT® 43202,0360 - OR SERVICES,N/A,N/A," $1,532.00 ", $995.80 ," $1,286.88 ", $97.41 , $346.37 ," $1,237.86 "," $1,378.80 "," $1,296.99 "," $1,378.80 "," $1,378.80 "," $1,378.80 "," $1,302.20 ", $339.58 ," $1,414.50 "," $1,455.40 "," $1,302.20 "," $1,424.76 "," $1,424.76 "," $1,455.40 "," $1,470.72 "," $1,253.48 "," $1,378.80 "," $1,302.20 "," $1,210.28 ", N/A ," $1,239.85 "," $1,239.85 "," $1,455.40 "," $1,314.61 ", $97.41 ," $1,470.72 "
 NORTRIPTYLINE HCL 10 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,60687-0281-01,1 capsule, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Immunofluorescence per Spec Add Singl Antb Stain ,CPT® 88350,0312 - PATHOL/HISTOL,N/A,N/A, $292.00 , $189.80 , $245.28 , $114.53 , $57.02 , $235.94 , $262.80 , $247.21 , $262.80 , $262.80 , $262.80 , $248.20 , $55.90 , $269.60 , $277.40 , $248.20 , $271.56 , $271.56 , $277.40 , $280.32 , $238.91 , $262.80 , $248.20 , $230.68 , N/A , $236.32 , $236.32 , $277.40 , $250.57 , $55.90 , $280.32 
 METOPROLOL TARTRATE 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,51079-0255-20,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 METHYLENE BLUE (ANTIDOTE) 50 MG/10ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00517-0374-05,10 mL," $1,605.38 "," $1,043.50 "," $1,348.52 ", N/A , N/A ," $1,297.15 "," $1,444.84 "," $1,359.11 "," $1,444.84 "," $1,444.84 "," $1,444.84 "," $1,364.57 ", N/A ," $1,482.25 "," $1,525.11 "," $1,364.57 "," $1,493.00 "," $1,493.00 "," $1,525.11 "," $1,541.16 "," $1,313.52 "," $1,444.84 "," $1,364.57 "," $1,268.25 ", N/A ," $1,299.23 "," $1,299.23 "," $1,525.11 "," $1,377.58 "," $1,268.25 "," $1,541.16 "
 METRONIDAZOLE 0.75 % VA GEL ,HCPCS RXC637,0250 - PHARMACY,00245-0860-70,70 gram, $837.47 , $544.36 , $703.47 , N/A , N/A , $676.68 , $753.72 , $709.00 , $753.72 , $753.72 , $753.72 , $711.85 , N/A , $773.24 , $795.60 , $711.85 , $778.85 , $778.85 , $795.60 , $803.97 , $685.22 , $753.72 , $711.85 , $661.60 , N/A , $677.76 , $677.76 , $795.60 , $718.63 , $661.60 , $803.97 
Removal Tissue Expander W/O Insertion Implant,CPT® 11971,N/A,N/A,N/A," $1,999.00 "," $1,299.35 "," $1,750.59 ", $527.23 , $173.19 , $868.68 , $866.01 ," $1,859.07 "," $1,799.10 "," $1,799.10 "," $1,599.20 "," $1,599.20 ", $173.19 ," $1,845.68 "," $1,899.05 "," $1,799.10 "," $1,799.10 "," $1,799.10 "," $1,859.07 "," $1,919.04 "," $1,912.50 "," $1,699.15 "," $1,726.97 "," $1,114.88 ", N/A , $885.63 , $885.63 ," $1,899.05 "," $1,027.04 ", $173.19 ," $1,919.04 "
 Fac Prolact +8 H2mf per Ml ,Custom 2200000002,0220 - SPECIAL CHARGES,N/A,N/A, $30.00 , $19.50 , $25.20 , N/A , N/A , $24.24 , $27.00 , $25.40 , $27.00 , $27.00 , $27.00 , $25.50 , N/A , $27.70 , $28.50 , $25.50 , $27.90 , $27.90 , $28.50 , $28.80 , $24.55 , $27.00 , $25.50 , $23.70 , N/A , $24.28 , $24.28 , $28.50 , $25.74 , $23.70 , $28.80 
 Fac Open/Perq Placement Intravascular Stent Initial ,CPT® 37236,0360 - OR SERVICES,N/A,N/A," $24,034.00 "," $15,622.10 "," $20,188.56 ", $396.08 , $520.66 ," $19,419.47 "," $21,630.60 "," $20,347.18 "," $21,630.60 "," $21,630.60 "," $21,630.60 "," $20,428.90 ", $510.45 ," $22,190.59 "," $22,832.30 "," $20,428.90 "," $22,351.62 "," $22,351.62 "," $22,832.30 "," $23,072.64 "," $19,664.62 "," $21,630.60 "," $20,428.90 "," $18,986.86 ", N/A ," $19,450.72 "," $19,450.72 "," $22,832.30 "," $20,623.58 ", $396.08 ," $23,072.64 "
Alcohol and/or Drug Services,HCPCS H0005,N/A,N/A,N/A, $43.00 , $27.95 , N/A , N/A , $3.90 , N/A , N/A , $39.99 , $38.70 , $38.70 , $34.40 , $34.40 , $3.90 , $39.70 , $40.85 , $38.70 , $38.70 , $38.70 , $39.99 , $41.28 , N/A , $36.55 , $34.40 , N/A , N/A , N/A , N/A , $40.85 , N/A , $3.90 , $41.28 
 Fac Byp Oth/Thn Vein Aortobifem ,CPT® 35646,0360 - OR SERVICES,N/A,N/A," $6,990.00 "," $4,543.50 "," $5,871.60 "," $1,515.31 "," $1,340.24 "," $5,647.92 "," $6,291.00 "," $5,917.73 "," $6,291.00 "," $6,291.00 "," $6,291.00 "," $5,941.50 "," $1,313.96 "," $6,453.87 "," $6,640.50 "," $5,941.50 "," $6,500.70 "," $6,500.70 "," $6,640.50 "," $6,710.40 "," $5,719.22 "," $6,291.00 "," $5,941.50 "," $5,522.10 ", N/A ," $5,657.01 "," $5,657.01 "," $6,640.50 "," $5,998.12 "," $1,313.96 "," $6,710.40 "
 SIMPLE SYRUP PO SYRP ,HCPCS RXC637,0250 - PHARMACY,00395-2661-16,473 mL, $87.48 , $56.86 , $73.48 , N/A , N/A , $70.68 , $78.73 , $74.06 , $78.73 , $78.73 , $78.73 , $74.36 , N/A , $80.77 , $83.11 , $74.36 , $81.36 , $81.36 , $83.11 , $83.98 , $71.58 , $78.73 , $74.36 , $69.11 , N/A , $70.80 , $70.80 , $83.11 , $75.07 , $69.11 , $83.98 
Slctv Cath 1stord W/WO Art Punct/Fluor/S&I Bil,CPT® 36252,N/A,N/A,N/A," $9,999.00 "," $6,499.35 "," $2,091.38 ", $321.27 ," $1,252.47 "," $1,608.01 "," $1,541.65 "," $9,299.07 "," $8,999.10 "," $8,999.10 "," $7,999.20 "," $7,999.20 "," $1,252.47 "," $9,232.08 "," $9,499.05 "," $8,999.10 "," $8,999.10 "," $8,999.10 "," $9,299.07 "," $9,599.04 "," $1,940.25 "," $8,499.15 "," $1,926.79 "," $1,742.98 ", N/A ," $1,639.39 "," $1,639.39 "," $9,499.05 "," $1,862.35 ", $321.27 ," $9,599.04 "
"Cabg, Vein, Two",CPT® 33511,N/A,N/A,N/A," $18,632.00 "," $12,110.80 "," $12,392.45 "," $1,913.79 "," $2,198.03 "," $9,069.16 "," $9,017.27 "," $17,327.76 "," $16,768.80 "," $16,768.80 "," $14,905.60 "," $14,905.60 "," $2,198.03 "," $17,202.93 "," $17,700.40 "," $16,768.80 "," $16,768.80 "," $16,768.80 "," $17,327.76 "," $17,886.72 "," $11,477.02 "," $15,837.20 "," $11,419.79 "," $10,180.75 ", N/A ," $9,246.11 "," $9,246.11 "," $17,700.40 "," $10,503.58 "," $1,913.79 "," $17,886.72 "
"CT Angio Aortobifemoral, Combo",CPT® 75635,N/A,N/A,N/A," $6,795.00 "," $4,416.75 "," $1,973.58 ", $285.11 , $432.47 ," $1,807.76 "," $2,366.72 "," $6,319.35 "," $6,115.50 "," $6,115.50 "," $5,436.00 "," $5,436.00 ", $432.47 ," $6,273.82 "," $6,455.25 "," $6,115.50 "," $6,115.50 "," $6,115.50 "," $6,319.35 "," $6,523.20 "," $2,452.59 "," $5,775.75 "," $2,578.97 "," $2,859.83 ", N/A ," $1,843.04 "," $1,843.04 "," $6,455.25 "," $2,133.34 ", $285.11 ," $6,523.20 "
"Revision of Scrotum,Complicated",CPT® 55180,N/A,N/A,N/A," $3,752.00 "," $2,438.80 "," $3,061.11 ", $657.36 , $621.96 ," $2,211.14 "," $2,238.38 "," $3,489.36 "," $3,376.80 "," $3,376.80 "," $3,001.60 "," $3,001.60 ", $621.96 ," $3,464.22 "," $3,564.40 "," $3,376.80 "," $3,376.80 "," $3,376.80 "," $3,489.36 "," $3,601.92 "," $2,870.82 "," $3,189.20 "," $3,578.83 "," $3,313.33 ", N/A ," $2,254.28 "," $2,254.28 "," $3,564.40 "," $2,701.88 ", $621.96 ," $3,601.92 "
Noncontact Laser Surgery Prostate,CPT® 52647,N/A,N/A,N/A," $13,143.00 "," $8,542.95 "," $3,519.00 ", $620.10 , $935.38 ," $3,166.14 "," $2,951.58 "," $12,222.99 "," $11,828.70 "," $11,828.70 "," $10,514.40 "," $10,514.40 ", $935.38 ," $12,134.93 "," $12,485.85 "," $11,828.70 "," $11,828.70 "," $11,828.70 "," $12,222.99 "," $12,617.28 "," $3,526.60 "," $11,171.55 "," $3,341.55 "," $3,985.65 ", N/A ," $3,227.91 "," $3,227.91 "," $12,485.85 "," $3,793.95 ", $620.10 ," $12,617.28 "
 Fac Trauma 4 Eval W/ Pre-ED Notification-WO Critical Care ,Custom 1000812,0684 - TRAUMA LEVEL IV,N/A,N/A, $613.00 , $398.45 , $514.92 , N/A , N/A , $495.30 , $551.70 , $518.97 , $551.70 , $551.70 , $551.70 , $521.05 , N/A , $565.98 , $582.35 , $521.05 , $570.09 , $570.09 , $582.35 , $588.48 , $501.56 , $551.70 , $521.05 , $484.27 , N/A , $496.10 , $496.10 , $582.35 , $526.02 , $484.27 , $588.48 
 Fac Cltng Factor XII Hageman ,CPT® 85280,0305 - LAB/HEMATOLOGY,N/A,N/A, $211.00 , $137.15 , $177.24 , $19.74 , $19.74 , $170.49 , $189.90 , $178.63 , $189.90 , $189.90 , $189.90 , $179.35 , $19.35 , $194.82 , $200.45 , $179.35 , $196.23 , $196.23 , $200.45 , $202.56 , $172.64 , $189.90 , $179.35 , $166.69 , N/A , $170.76 , $170.76 , $200.45 , $181.06 , $19.35 , $202.56 
 Pro Cltx Rdl Shft Fx W/O Mnpj ,CPT® 25500,0981 - PRO FEE/ER,N/A,N/A," $1,243.00 ", $807.95 ," $1,601.34 ", $254.45 , $170.42 ," $1,203.90 "," $1,222.94 "," $1,155.99 "," $1,118.70 "," $1,118.70 ", $994.40 , $994.40 , $170.42 ," $1,147.66 "," $1,180.85 "," $1,118.70 "," $1,118.70 "," $1,118.70 "," $1,155.99 "," $1,193.28 "," $1,473.82 "," $1,056.55 "," $1,338.05 "," $1,436.19 ", N/A ," $1,227.40 "," $1,227.40 "," $1,180.85 "," $1,442.63 ", $170.42 ," $1,601.34 "
Fluoroscopic Guidance Needle Placement Add On,77002,N/A,N/A,N/A, $629.00 , $408.85 , $659.69 , $114.76 , $61.30 , $439.87 , $414.49 , $584.97 , $566.10 , $566.10 , $503.20 , $503.20 , $61.30 , $580.76 , $597.55 , $566.10 , $566.10 , $566.10 , $584.97 , $603.84 , $642.09 , $534.65 , $452.62 , $476.71 , N/A , $448.45 , $448.45 , $597.55 , $519.08 , $61.30 , $659.69 
 Pro Prp I/Hern Init Reduc >5 Yr ,CPT® 49505,0982 - PRO FEE/OUTPT,N/A,N/A," $3,355.00 "," $2,180.75 "," $3,134.37 ", $486.32 , $438.54 ," $2,443.03 "," $2,485.13 "," $3,120.15 "," $3,019.50 "," $3,019.50 "," $2,684.00 "," $2,684.00 ", $438.54 ," $3,097.67 "," $3,187.25 "," $3,019.50 "," $3,019.50 "," $3,019.50 "," $3,120.15 "," $3,220.80 "," $2,239.61 "," $2,851.75 "," $2,756.38 "," $2,889.05 ", N/A ," $2,490.70 "," $2,490.70 "," $3,187.25 "," $2,605.01 ", $438.54 ," $3,220.80 "
 IR CT Guided Pericardial Drainage W/Drain Plcmnt ,CPT® 33019,0360 - OR SERVICES,N/A,N/A," $2,042.00 "," $1,327.30 "," $1,715.28 ", $199.68 , $173.82 ," $1,649.94 "," $1,837.80 "," $1,728.76 "," $1,837.80 "," $1,837.80 "," $1,837.80 "," $1,735.70 ", $170.41 ," $1,885.38 "," $1,939.90 "," $1,735.70 "," $1,899.06 "," $1,899.06 "," $1,939.90 "," $1,960.32 "," $1,670.76 "," $1,837.80 "," $1,735.70 "," $1,613.18 ", N/A ," $1,652.59 "," $1,652.59 "," $1,939.90 "," $1,752.24 ", $170.41 ," $1,960.32 "
 Heart Failure And Shock With McC ,MS DRG V40 (FY2023) 291,N/A,N/A,N/A," $18,633.93 "," $12,112.05 "," $15,652.50 ", N/A , N/A ," $15,056.22 "," $16,770.54 "," $15,775.49 "," $16,770.54 "," $16,770.54 "," $16,770.54 "," $15,838.84 ", N/A ," $17,204.71 "," $17,702.23 "," $15,838.84 "," $17,329.55 "," $17,329.55 "," $17,702.23 "," $17,888.57 "," $15,246.28 "," $16,770.54 "," $15,838.84 "," $14,720.80 ", N/A ," $15,080.44 "," $15,080.44 "," $17,702.23 "," $15,989.78 "," $14,720.80 "," $17,888.57 "
 Ins/Repl Sub Q Defib Sys W/Electrode ,CPT® 33270,0360 - OR SERVICES,N/A,N/A," $6,435.00 "," $4,182.75 "," $5,405.40 ", $517.28 , $485.96 ," $5,199.48 "," $5,791.50 "," $5,447.87 "," $5,791.50 "," $5,791.50 "," $5,791.50 "," $5,469.75 ", $476.43 ," $5,941.44 "," $6,113.25 "," $5,469.75 "," $5,984.55 "," $5,984.55 "," $6,113.25 "," $6,177.60 "," $5,265.12 "," $5,791.50 "," $5,469.75 "," $5,083.65 ", N/A ," $5,207.85 "," $5,207.85 "," $6,113.25 "," $5,521.87 ", $476.43 ," $6,177.60 "
 AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00093-2274-34,1 tablet, $19.45 , $12.64 , $16.34 , N/A , N/A , $15.72 , $17.51 , $16.47 , $17.51 , $17.51 , $17.51 , $16.53 , N/A , $17.96 , $18.48 , $16.53 , $18.09 , $18.09 , $18.48 , $18.67 , $15.91 , $17.51 , $16.53 , $15.37 , N/A , $15.74 , $15.74 , $18.48 , $16.69 , $15.37 , $18.67 
"Repair Detacd Retina,Inject Air/Gas",CPT® 67110,N/A,N/A,N/A," $8,037.00 "," $5,224.05 "," $5,002.01 ", $785.80 , $768.20 ," $4,387.87 "," $4,081.98 "," $7,474.41 "," $7,233.30 "," $7,233.30 "," $6,429.60 "," $6,429.60 ", $768.20 ," $7,420.56 "," $7,635.15 "," $7,233.30 "," $7,233.30 "," $7,233.30 "," $7,474.41 "," $7,715.52 "," $6,874.13 "," $6,831.45 "," $4,185.41 "," $5,848.74 ", N/A ," $4,473.49 "," $4,473.49 "," $7,635.15 "," $4,938.15 ", $768.20 ," $7,715.52 "
 Brain MRI Without and With Contrast ,CPT® 70553,0611 - MRI - BRAIN/HEAD/NECK,N/A,N/A," $6,731.00 "," $4,375.15 "," $5,654.04 ", $327.49 , $644.90 ," $5,438.65 "," $6,057.90 "," $5,698.46 "," $6,057.90 "," $6,057.90 "," $6,057.90 "," $5,721.35 ", $632.25 ," $6,214.73 "," $6,394.45 "," $5,721.35 "," $6,259.83 "," $6,259.83 "," $6,394.45 "," $6,461.76 "," $5,507.30 "," $6,057.90 "," $5,721.35 "," $5,317.49 ", N/A ," $5,447.40 "," $5,447.40 "," $6,394.45 "," $5,775.87 ", $327.49 ," $6,461.76 "
Drainage of Eyelid Abscess,67700,N/A,N/A,N/A, $887.00 , $576.55 , $714.22 , $112.63 , $30.71 , $656.29 , $616.74 , $824.91 , $798.30 , $798.30 , $709.60 , $709.60 , $30.71 , $818.97 , $842.65 , $798.30 , $798.30 , $798.30 , $824.91 , $851.52 , $979.92 , $753.95 , $636.91 , $838.47 , N/A , $669.09 , $669.09 , $842.65 , $738.60 , $30.71 , $979.92 
"Destr Malig Scal,Nck,Hand 2.1-3 Cm",CPT® 17273,N/A,N/A,N/A, $880.00 , $572.00 , $439.48 , $132.11 , $167.35 , $394.99 , $386.29 , $818.40 , $792.00 , $792.00 , $704.00 , $704.00 , $167.35 , $812.50 , $836.00 , $792.00 , $792.00 , $792.00 , $818.40 , $844.80 , $484.74 , $748.00 , $768.93 , $507.05 , N/A , $402.70 , $402.70 , $836.00 , $466.99 , $132.11 , $844.80 
"Cystoscopy,Resec Extern Sphincter",CPT® 52277,N/A,N/A,N/A," $2,269.00 "," $1,474.85 "," $1,731.73 ", $304.25 , $384.19 ," $1,587.11 "," $1,483.59 "," $2,110.17 "," $2,042.10 "," $2,042.10 "," $1,815.20 "," $1,815.20 ", $384.19 ," $2,094.97 "," $2,155.55 "," $2,042.10 "," $2,042.10 "," $2,042.10 "," $2,110.17 "," $2,178.24 "," $1,741.43 "," $1,928.65 "," $1,680.59 "," $1,990.57 ", N/A ," $1,618.07 "," $1,618.07 "," $2,155.55 "," $1,901.81 ", $304.25 ," $2,178.24 "
 Fac Ndsc Eval Intstinal Pouch W/Bx Single/Multiple ,CPT® 44386,0360 - OR SERVICES,N/A,N/A," $1,297.00 ", $843.05 ," $1,089.48 ", $84.77 , $40.17 ," $1,047.98 "," $1,167.30 "," $1,098.04 "," $1,167.30 "," $1,167.30 "," $1,167.30 "," $1,102.45 ", $39.38 ," $1,197.52 "," $1,232.15 "," $1,102.45 "," $1,206.21 "," $1,206.21 "," $1,232.15 "," $1,245.12 "," $1,061.21 "," $1,167.30 "," $1,102.45 "," $1,024.63 ", N/A ," $1,049.66 "," $1,049.66 "," $1,232.15 "," $1,112.96 ", $39.38 ," $1,245.12 "
 OB Transvaginal US ,CPT® 76817,0402 - ULTRASOUND,N/A,N/A, $472.00 , $306.80 , $396.48 , $91.81 , $86.65 , $381.38 , $424.80 , $399.60 , $424.80 , $424.80 , $424.80 , $401.20 , $84.95 , $435.80 , $448.40 , $401.20 , $438.96 , $438.96 , $448.40 , $453.12 , $386.19 , $424.80 , $401.20 , $372.88 , N/A , $381.99 , $381.99 , $448.40 , $405.02 , $84.95 , $453.12 
 Rt Upper Extremity W/O & W/Contrast ,CPT® 73220,0610 - MRI,N/A,N/A," $8,576.00 "," $5,574.40 "," $7,203.84 ", $423.69 , $515.74 ," $6,929.41 "," $7,718.40 "," $7,260.44 "," $7,718.40 "," $7,718.40 "," $7,718.40 "," $7,289.60 ", $505.63 ," $7,918.22 "," $8,147.20 "," $7,289.60 "," $7,975.68 "," $7,975.68 "," $8,147.20 "," $8,232.96 "," $7,016.88 "," $7,718.40 "," $7,289.60 "," $6,775.04 ", N/A ," $6,940.56 "," $6,940.56 "," $8,147.20 "," $7,359.07 ", $423.69 ," $8,232.96 "
 Fac Perc Drug-El Cor Stent Sing ,HCPCS C9600,0481 - CARDIAC CATH LAB,N/A,N/A," $15,529.00 "," $10,093.85 "," $13,044.36 ", N/A , N/A ," $12,547.43 "," $13,976.10 "," $13,146.85 "," $13,976.10 "," $13,976.10 "," $13,976.10 "," $13,199.65 ", N/A ," $14,337.93 "," $14,752.55 "," $13,199.65 "," $14,441.97 "," $14,441.97 "," $14,752.55 "," $14,907.84 "," $12,705.83 "," $13,976.10 "," $13,199.65 "," $12,267.91 ", N/A ," $12,567.62 "," $12,567.62 "," $14,752.55 "," $13,325.43 "," $12,267.91 "," $14,907.84 "
Diagnostic Lumbar Spinal Puncture,62270,N/A,N/A,N/A," $1,057.00 ", $687.05 , $298.01 , $58.13 , $157.45 , $435.77 , $418.02 , $983.01 , $951.30 , $951.30 , $845.60 , $845.60 , $157.45 , $975.93 ," $1,004.15 ", $951.30 , $951.30 , $951.30 , $983.01 ," $1,014.72 ", $322.97 , $898.45 , $413.90 , $464.99 , N/A , $444.28 , $444.28 ," $1,004.15 ", $476.62 , $58.13 ," $1,014.72 "
"Repr Forearm Tend/Musc,Flex,Prim,Ea",CPT® 25260,N/A,N/A,N/A," $4,316.00 "," $2,805.40 "," $3,892.40 ", $612.04 , $546.22 ," $3,033.01 "," $3,036.14 "," $4,013.88 "," $3,884.40 "," $3,884.40 "," $3,452.80 "," $3,452.80 ", $546.22 ," $3,984.96 "," $4,100.20 "," $3,884.40 "," $3,884.40 "," $3,884.40 "," $4,013.88 "," $4,143.36 "," $3,605.62 "," $3,668.60 "," $3,341.55 "," $3,595.95 ", N/A ," $3,092.19 "," $3,092.19 "," $4,100.20 "," $3,634.44 ", $546.22 ," $4,143.36 "
 Fac Drug Screen Quantitative Everolimus ,CPT® 80169,0301 - LAB/CHEMISTRY,N/A,N/A, $152.00 , $98.80 , $127.68 , $14.00 , $14.00 , $122.82 , $136.80 , $128.68 , $136.80 , $136.80 , $136.80 , $129.20 , $13.73 , $140.34 , $144.40 , $129.20 , $141.36 , $141.36 , $144.40 , $145.92 , $124.37 , $136.80 , $129.20 , $120.08 , N/A , $123.01 , $123.01 , $144.40 , $130.43 , $13.73 , $145.92 
"Colposcopy,Vulva",CPT® 56820,N/A,N/A,N/A, $666.00 , $432.90 , $392.95 , $79.85 , $100.24 , $352.70 , $345.41 , $619.38 , $599.40 , $599.40 , $532.80 , $532.80 , $100.24 , $614.92 , $632.70 , $599.40 , $599.40 , $599.40 , $619.38 , $639.36 , $413.02 , $566.10 , $456.72 , $351.51 , N/A , $359.58 , $359.58 , $632.70 , $431.30 , $79.85 , $639.36 
" Oxalate, Urine Beaker1 ",CPT® 83945,0301 - LAB/CHEMISTRY,N/A,N/A, $128.00 , $83.20 , $107.52 , $14.74 , $14.74 , $103.42 , $115.20 , $108.36 , $115.20 , $115.20 , $115.20 , $108.80 , $14.45 , $118.18 , $121.60 , $108.80 , $119.04 , $119.04 , $121.60 , $122.88 , $104.73 , $115.20 , $108.80 , $101.12 , N/A , $103.59 , $103.59 , $121.60 , $109.84 , $14.45 , $122.88 
" Spinal Puncture, Lumbar, Diagnostic ",CPT® 62270,0761 - TREATMENT ROOM,N/A,N/A," $1,170.00 ", $760.50 , $982.80 , $58.13 , $157.45 , $945.36 ," $1,053.00 ", $990.52 ," $1,053.00 "," $1,053.00 "," $1,053.00 ", $994.50 , $154.36 ," $1,080.26 "," $1,111.50 ", $994.50 ," $1,088.10 "," $1,088.10 "," $1,111.50 "," $1,123.20 ", $957.29 ," $1,053.00 ", $994.50 , $924.30 , N/A , $946.88 , $946.88 ," $1,111.50 "," $1,003.98 ", $58.13 ," $1,123.20 "
"MRI, Joint of Leg. Combo",CPT® 73723,N/A,N/A,N/A," $7,264.00 "," $4,721.60 "," $2,815.05 ", $398.73 , $634.32 ," $2,242.08 "," $2,844.80 "," $6,755.52 "," $6,537.60 "," $6,537.60 "," $5,811.20 "," $5,811.20 ", $634.32 ," $6,706.85 "," $6,900.80 "," $6,537.60 "," $6,537.60 "," $6,537.60 "," $6,755.52 "," $6,973.44 "," $2,439.19 "," $6,174.40 "," $3,100.93 "," $4,339.10 ", N/A ," $2,285.83 "," $2,285.83 "," $6,900.80 "," $2,645.90 ", $398.73 ," $6,973.44 "
 METHYLPREDNISOLONE 4 MG PO TBPK ,HCPCS RXC637,0250 - PHARMACY,59746-0001-03,1 tablet, $178.00 , $115.70 , $149.52 , N/A , N/A , $143.82 , $160.20 , $150.69 , $160.20 , $160.20 , $160.20 , $151.30 , N/A , $164.35 , $169.10 , $151.30 , $165.54 , $165.54 , $169.10 , $170.88 , $145.64 , $160.20 , $151.30 , $140.62 , N/A , $144.06 , $144.06 , $169.10 , $152.74 , $140.62 , $170.88 
Layer Closure 2.6-5cm,12052,N/A,N/A,N/A, $952.00 , $618.80 , $637.70 , $191.98 , $151.59 , $557.59 , $545.09 , $885.36 , $856.80 , $856.80 , $761.60 , $761.60 , $151.59 , $878.98 , $904.40 , $856.80 , $856.80 , $856.80 , $885.36 , $913.92 , $700.90 , $809.20 ," $1,084.71 ", $716.31 , N/A , $568.47 , $568.47 , $904.40 , $659.24 , $151.59 ," $1,084.71 "
Biopsy of Eyelid,CPT® 67810,N/A,N/A,N/A," $1,035.00 ", $672.75 , $418.99 , $65.63 , $73.26 , $401.93 , $368.31 , $962.55 , $931.50 , $931.50 , $828.00 , $828.00 , $73.26 , $955.62 , $983.25 , $931.50 , $931.50 , $931.50 , $962.55 , $993.60 , $579.42 , $879.75 , $381.79 , $506.54 , N/A , $409.78 , $409.78 , $983.25 , $452.33 , $65.63 , $993.60 
Digital Breast Tomosynthesis Bilateral,CPT® 77062,N/A,N/A,N/A, $695.00 , $451.75 , N/A , N/A , $320.77 , $614.77 , $665.51 , $646.35 , $625.50 , $625.50 , $556.00 , $556.00 , $320.77 , $641.69 , $660.25 , $625.50 , $625.50 , $625.50 , $646.35 , $667.20 , N/A , $590.75 , $909.30 , $911.01 , N/A , $626.77 , $626.77 , $660.25 , $725.49 , $320.77 , $911.01 
Radiofrequency Abltj Nrv Nrvtg Si Jt W/Img Gdn,CPT® 64625,N/A,N/A,N/A," $4,849.00 "," $3,151.85 ", $966.63 , $188.08 , $393.42 ," $1,066.40 ", N/A ," $4,509.57 "," $4,364.10 "," $4,364.10 "," $3,879.20 "," $3,879.20 ", $393.42 ," $4,477.08 "," $4,606.55 "," $4,364.10 "," $4,364.10 "," $4,364.10 "," $4,509.57 "," $4,655.04 "," $1,037.55 "," $4,121.65 "," $1,021.74 "," $1,175.79 ", N/A ," $1,087.21 "," $1,087.21 "," $4,606.55 "," $1,166.27 ", $188.08 ," $4,655.04 "
 MRI Abdomen W/O Contrast Then W/Constras- Mh ,CPT® 74183,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,143.00 ", $742.95 ," $2,450.70 ", $348.90 , $639.53 ," $2,413.20 "," $3,055.89 "," $1,062.99 "," $1,028.70 "," $1,028.70 ", $914.40 , $914.40 , $639.53 ," $1,055.33 "," $1,085.85 "," $1,028.70 "," $1,028.70 "," $1,028.70 "," $1,062.99 "," $1,097.28 "," $2,113.93 ", $971.55 ," $3,328.20 "," $3,943.59 ", N/A ," $2,460.29 "," $2,460.29 "," $1,085.85 "," $2,847.83 ", $348.90 ," $3,943.59 "
"Emg,1 Extrem,Nonparaspinal",CPT® 95870,N/A,N/A,N/A, $769.00 , $499.85 , $318.63 , $81.74 , $26.12 , $280.52 , $311.35 , $715.17 , $692.10 , $692.10 , $615.20 , $615.20 , $26.12 , $710.02 , $730.55 , $692.10 , $692.10 , $692.10 , $715.17 , $738.24 , $393.86 , $653.65 , $272.69 , $359.46 , N/A , $285.99 , $285.99 , $730.55 , $351.58 , $26.12 , $738.24 
"Open Rx I-P Jt,Toe Dislocation",CPT® 28675,N/A,N/A,N/A," $3,904.00 "," $2,537.60 "," $2,539.62 ", $399.96 , $230.52 ," $2,034.00 "," $1,999.24 "," $3,630.72 "," $3,513.60 "," $3,513.60 "," $3,123.20 "," $3,123.20 ", $230.52 ," $3,604.56 "," $3,708.80 "," $3,513.60 "," $3,513.60 "," $3,513.60 "," $3,630.72 "," $3,747.84 "," $2,322.52 "," $3,318.40 "," $2,180.13 "," $2,362.53 ", N/A ," $2,073.69 "," $2,073.69 "," $3,708.80 "," $2,437.32 ", $230.52 ," $3,747.84 "
Treat Metacarpal Fracture,26605,N/A,N/A,N/A," $2,114.00 "," $1,374.10 "," $1,855.17 ", $293.60 , $235.17 ," $1,410.06 "," $1,432.50 "," $1,966.02 "," $1,902.60 "," $1,902.60 "," $1,691.20 "," $1,691.20 ", $235.17 ," $1,951.86 "," $2,008.30 "," $1,902.60 "," $1,902.60 "," $1,902.60 "," $1,966.02 "," $2,029.44 "," $1,703.17 "," $1,796.90 "," $1,571.76 "," $1,675.41 ", N/A ," $1,437.57 "," $1,437.57 "," $2,008.30 "," $1,689.69 ", $235.17 ," $2,029.44 "
 Fac Gonadotropin (Fsh) ,CPT® 83001,0301 - LAB/CHEMISTRY,N/A,N/A, $173.00 , $112.45 , $145.32 , $18.95 , $18.95 , $139.78 , $155.70 , $146.46 , $155.70 , $155.70 , $155.70 , $147.05 , $18.58 , $159.73 , $164.35 , $147.05 , $160.89 , $160.89 , $164.35 , $166.08 , $141.55 , $155.70 , $147.05 , $136.67 , N/A , $140.01 , $140.01 , $164.35 , $148.45 , $18.58 , $166.08 
Assay RBC Protoporphyrin,CPT® 84202,N/A,N/A,N/A, $129.00 , $83.85 , N/A , $14.64 , $14.64 , $81.16 , $97.10 , $119.97 , $116.10 , $116.10 , $103.20 , $103.20 , $14.64 , $119.11 , $122.55 , $116.10 , $116.10 , $116.10 , $119.97 , $123.84 , $95.82 , $109.65 , $94.07 , $52.01 , N/A , $75.74 , $75.74 , $122.55 , $82.76 , $14.64 , $123.84 
 Microsatellite Instab Anal Mismatch Repair ,CPT® 81301,0310 - PATHOLOGY LAB,N/A,N/A," $2,464.00 "," $1,601.60 "," $2,069.76 ", $355.53 , $322.35 ," $1,990.91 "," $2,217.60 "," $2,086.02 "," $2,217.60 "," $2,217.60 "," $2,217.60 "," $2,094.40 ", $316.03 ," $2,275.01 "," $2,340.80 "," $2,094.40 "," $2,291.52 "," $2,291.52 "," $2,340.80 "," $2,365.44 "," $2,016.04 "," $2,217.60 "," $2,094.40 "," $1,946.56 ", N/A ," $1,994.12 "," $1,994.12 "," $2,340.80 "," $2,114.36 ", $316.03 ," $2,365.44 "
 SODIUM CHLORIDE 1 G PO TABS ,HCPCS RXC637,0250 - PHARMACY,69367-0220-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Remv Post Eye Implnt Mater,Extraocul",CPT® 67120,N/A,N/A,N/A," $6,074.00 "," $3,948.10 "," $3,414.26 ", $535.74 , $614.70 ," $3,159.36 "," $2,995.48 "," $5,648.82 "," $5,466.60 "," $5,466.60 "," $4,859.20 "," $4,859.20 ", $614.70 ," $5,608.12 "," $5,770.30 "," $5,466.60 "," $5,466.60 "," $5,466.60 "," $5,648.82 "," $5,831.04 "," $4,689.44 "," $5,162.90 "," $3,109.62 "," $4,005.46 ", N/A ," $3,220.99 "," $3,220.99 "," $5,770.30 "," $3,555.55 ", $535.74 ," $5,831.04 "
"Cystoscopy,Inject Implnt Material",CPT® 52327,N/A,N/A,N/A," $1,829.00 "," $1,188.85 "," $1,405.76 ", $244.00 , $378.28 ," $1,284.48 "," $1,189.58 "," $1,700.97 "," $1,646.10 "," $1,646.10 "," $1,463.20 "," $1,463.20 ", $378.28 ," $1,688.72 "," $1,737.55 "," $1,646.10 "," $1,646.10 "," $1,646.10 "," $1,700.97 "," $1,755.84 "," $1,416.92 "," $1,554.65 "," $1,350.54 "," $1,613.24 ", N/A ," $1,309.55 "," $1,309.55 "," $1,737.55 "," $1,539.18 ", $244.00 ," $1,755.84 "
Ntrprof Phone/Ntrnet/Ehr Assmt&Mgmt 31/> Min,CPT® 99449,N/A,N/A,N/A, $326.00 , $211.90 , $139.58 , $69.62 , $57.36 , N/A , N/A , $303.18 , $293.40 , $293.40 , $260.80 , $260.80 , $57.36 , $301.00 , $309.70 , $293.40 , $293.40 , $293.40 , $303.18 , $312.96 , $131.91 , $277.10 , $158.39 , $157.98 , N/A , $118.79 , $118.79 , $309.70 , $137.00 , $57.36 , $312.96 
 Fac Flo Cytometry Cell Surf Marker Techl Only Ea ,CPT® 88185,0311 - PATHOL/CYTOLOGY,N/A,N/A, $373.00 , $242.45 , $313.32 , $23.32 , $23.70 , $301.38 , $335.70 , $315.78 , $335.70 , $335.70 , $335.70 , $317.05 , $23.24 , $344.39 , $354.35 , $317.05 , $346.89 , $346.89 , $354.35 , $358.08 , $305.19 , $335.70 , $317.05 , $294.67 , N/A , $301.87 , $301.87 , $354.35 , $320.07 , $23.24 , $358.08 
Assay for Vancomycin,CPT® 80202,N/A,N/A,N/A, $136.00 , $88.40 , N/A , $13.81 , $13.81 , $76.67 , $91.72 , $126.48 , $122.40 , $122.40 , $108.80 , $108.80 , $13.81 , $125.57 , $129.20 , $122.40 , $122.40 , $122.40 , $126.48 , $130.56 , $90.41 , $115.60 , $89.20 , $49.11 , N/A , $71.55 , $71.55 , $129.20 , $78.19 , $13.81 , $130.56 
Place Ng/Og Tube by Phys W Fluoro,43752,N/A,N/A,N/A, $342.00 , $222.30 , $247.52 , $38.28 , $41.38 , $196.57 , $196.16 , $318.06 , $307.80 , $307.80 , $273.60 , $273.60 , $41.38 , $315.77 , $324.90 , $307.80 , $307.80 , $307.80 , $318.06 , $328.32 , $178.55 , $290.70 , $212.30 , $236.86 , N/A , $200.41 , $200.41 , $324.90 , $209.62 , $38.28 , $328.32 
 Pro Biopsy of Uterus Lining ,CPT® 58100,0982 - PRO FEE/OUTPT,N/A,N/A, $654.00 , $425.10 , $296.20 , $59.65 , $56.34 , $358.12 , $356.64 , $608.22 , $588.60 , $588.60 , $523.20 , $523.20 , $56.34 , $603.84 , $621.30 , $588.60 , $588.60 , $588.60 , $608.22 , $627.84 , $312.12 , $555.90 , $469.21 , $357.89 , N/A , $365.10 , $365.10 , $621.30 , $437.94 , $56.34 , $627.84 
Car Seat/Bed Test Inft Thru 12 Mo Ea Addl 30 Min,CPT® 94781,N/A,N/A,N/A, $76.00 , $49.40 , $19.06 , $7.96 , $15.45 , $19.79 , $18.51 , $70.68 , $68.40 , $68.40 , $60.80 , $60.80 , $15.45 , $70.17 , $72.20 , $68.40 , $68.40 , $68.40 , $70.68 , $72.96 , $25.32 , $64.60 , $24.33 , $32.14 , N/A , $20.18 , $20.18 , $72.20 , $23.51 , $7.96 , $72.96 
Biopsy/Excis Cervical Lesn,CPT® 57500,N/A,N/A,N/A, $815.00 , $529.75 , $349.90 , $71.12 , $57.90 , $310.78 , $309.96 , $757.95 , $733.50 , $733.50 , $652.00 , $652.00 , $57.90 , $752.49 , $774.25 , $733.50 , $733.50 , $733.50 , $757.95 , $782.40 , $366.99 , $692.75 , $406.77 , $310.78 , N/A , $316.85 , $316.85 , $774.25 , $380.04 , $57.90 , $782.40 
 CIPROFLOXACIN HCL 0.3 % OP SOLN ,HCPCS RXA250,0250 - PHARMACY,69315-0308-02,2.5 mL, $64.73 , $42.07 , $54.37 , N/A , N/A , $52.30 , $58.26 , $54.80 , $58.26 , $58.26 , $58.26 , $55.02 , N/A , $59.77 , $61.49 , $55.02 , $60.20 , $60.20 , $61.49 , $62.14 , $52.96 , $58.26 , $55.02 , $51.14 , N/A , $52.39 , $52.39 , $61.49 , $55.54 , $51.14 , $62.14 
 CT Soft T Neck W/O Contrast ,CPT® 70490,0350 - CT SCAN,N/A,N/A," $2,062.00 "," $1,340.30 "," $1,732.08 ", $153.47 , $250.75 ," $1,666.10 "," $1,855.80 "," $1,745.69 "," $1,855.80 "," $1,855.80 "," $1,855.80 "," $1,752.70 ", $245.83 ," $1,903.84 "," $1,958.90 "," $1,752.70 "," $1,917.66 "," $1,917.66 "," $1,958.90 "," $1,979.52 "," $1,687.13 "," $1,855.80 "," $1,752.70 "," $1,628.98 ", N/A ," $1,668.78 "," $1,668.78 "," $1,958.90 "," $1,769.40 ", $153.47 ," $1,979.52 "
 AMINOPHYLLINE 25 MG/ML IV SOLN ,HCPCS J0280,0636 - DRUGS REQUIRING DETAILED CODIN,00409-5921-01,10 mL, $88.21 , $57.34 , $74.10 , $4.60 , $13.35 , $71.27 , $79.39 , $74.68 , $79.39 , $79.39 , $79.39 , $74.98 , $13.09 , $81.44 , $83.80 , $74.98 , $82.04 , $82.04 , $83.80 , $84.68 , $72.17 , $79.39 , $74.98 , $69.69 , N/A , $71.39 , $71.39 , $83.80 , $75.69 , $4.60 , $84.68 
 Fac Extended Recovery per Min ,Custom 6200054,0710 - RECOVERY ROOM,N/A,N/A, $2.00 , $1.30 , $1.68 , N/A , N/A , $1.62 , $1.80 , $1.69 , $1.80 , $1.80 , $1.80 , $1.70 , N/A , $1.85 , $1.90 , $1.70 , $1.86 , $1.86 , $1.90 , $1.92 , $1.64 , $1.80 , $1.70 , $1.58 , N/A , $1.62 , $1.62 , $1.90 , $1.72 , $1.58 , $1.92 
" Pro X-Ray Exam, Breast Specimen ",CPT® 76098,0972 - PRO FEE/RAD/DX,N/A,N/A, $99.00 , $64.35 , $228.52 , $41.25 , $18.97 , $77.74 , $97.79 , $92.07 , $89.10 , $89.10 , $79.20 , $79.20 , $18.97 , $91.41 , $94.05 , $89.10 , $89.10 , $89.10 , $92.07 , $95.04 , $231.39 , $84.15 , $107.86 , $84.98 , N/A , $79.26 , $79.26 , $94.05 , $91.75 , $18.97 , $231.39 
 Pro Est Patient Visit Level ,CPT® 99212,0982 - PRO FEE/OUTPT,N/A,N/A, $119.00 , $77.35 , $72.24 , $34.37 , $29.87 , $44.01 , $43.22 , $110.67 , $107.10 , $107.10 , $95.20 , $95.20 , $29.87 , $109.87 , $113.05 , $107.10 , $107.10 , $107.10 , $110.67 , $114.24 , $65.53 , $101.15 , $54.01 , $55.40 , $64.00 , $44.87 , $44.87 , $113.05 , $51.74 , $29.87 , $114.24 
"Fx Scaphoid,Closed W/O MA",25622,N/A,N/A,N/A," $1,996.00 "," $1,297.40 "," $1,769.63 ", $281.15 , $206.19 ," $1,331.19 "," $1,359.46 "," $1,856.28 "," $1,796.40 "," $1,796.40 "," $1,596.80 "," $1,596.80 ", $206.19 ," $1,842.91 "," $1,896.20 "," $1,796.40 "," $1,796.40 "," $1,796.40 "," $1,856.28 "," $1,916.16 "," $1,628.51 "," $1,696.60 "," $1,491.48 "," $1,596.88 ", N/A ," $1,357.16 "," $1,357.16 "," $1,896.20 "," $1,595.16 ", $206.19 ," $1,916.16 "
 Pro Removal of Anal Fistula ,CPT® 46270,0982 - PRO FEE/OUTPT,N/A,N/A," $3,284.00 "," $2,134.60 "," $2,461.03 ", $383.31 , $153.67 ," $1,857.21 "," $1,907.18 "," $3,054.12 "," $2,955.60 "," $2,955.60 "," $2,627.20 "," $2,627.20 ", $153.67 ," $3,032.12 "," $3,119.80 "," $2,955.60 "," $2,955.60 "," $2,955.60 "," $3,054.12 "," $3,152.64 "," $1,752.81 "," $2,791.40 "," $2,101.63 "," $2,214.04 ", N/A ," $1,893.46 "," $1,893.46 "," $3,119.80 "," $1,980.35 ", $153.67 ," $3,152.64 "
 Fac Chg Idh2 Common Variants ,CPT® 81121,0310 - PATHOLOGY LAB,N/A,N/A," $1,399.00 ", $909.35 ," $1,175.16 ", $301.71 , $241.36 ," $1,130.39 "," $1,259.10 "," $1,184.39 "," $1,259.10 "," $1,259.10 "," $1,259.10 "," $1,189.15 ", $236.63 ," $1,291.70 "," $1,329.05 "," $1,189.15 "," $1,301.07 "," $1,301.07 "," $1,329.05 "," $1,343.04 "," $1,144.66 "," $1,259.10 "," $1,189.15 "," $1,105.21 ", N/A ," $1,132.21 "," $1,132.21 "," $1,329.05 "," $1,200.48 ", $236.63 ," $1,343.04 "
 Pro Remv Nasal FB ,CPT® 30300,0982 - PRO FEE/OUTPT,N/A,N/A, $814.00 , $529.10 , $688.10 , $121.29 , $64.81 , $481.74 , $495.34 , $757.02 , $732.60 , $732.60 , $651.20 , $651.20 , $64.81 , $751.57 , $773.30 , $732.60 , $732.60 , $732.60 , $757.02 , $781.44 , $637.33 , $691.90 , $695.78 , $541.12 , N/A , $491.14 , $491.14 , $773.30 , $578.42 , $64.81 , $781.44 
 HAEMOPHILUS B POLYSAC CONJ VAC 7.5 MCG/0.5 ML IM SUSP ,HCPCS 90647,0636 - DRUGS REQUIRING DETAILED CODIN,00006-4897-00,0.5 mL, $182.37 , $118.54 , $153.19 , N/A , $42.80 , $147.35 , $164.13 , $154.39 , $164.13 , $164.13 , $164.13 , $155.01 , $41.96 , $168.38 , $173.25 , $155.01 , $169.60 , $169.60 , $173.25 , $175.08 , $149.22 , $164.13 , $155.01 , $144.07 , N/A , $147.59 , $147.59 , $173.25 , $156.49 , $41.96 , $175.08 
 Pro Removal of Foot Lesion ,CPT® 28090,0975 - PRO FEE/OR,N/A,N/A," $2,848.00 "," $1,851.20 "," $1,904.44 ", $299.85 , $366.68 ," $1,519.87 "," $1,514.60 "," $2,648.64 "," $2,563.20 "," $2,563.20 "," $2,278.40 "," $2,278.40 ", $366.68 ," $2,629.56 "," $2,705.60 "," $2,563.20 "," $2,563.20 "," $2,563.20 "," $2,648.64 "," $2,734.08 "," $1,767.11 "," $2,420.80 "," $1,643.12 "," $1,801.79 ", N/A ," $1,549.53 "," $1,549.53 "," $2,705.60 "," $1,821.26 ", $299.85 ," $2,734.08 "
 PROPOFOL INFUSION 10 MG/ML (ANES) ,HCPCS J2704,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0269-50,50 mL, $92.47 , $60.11 , $77.67 , $0.10 , $0.14 , $74.72 , $83.22 , $78.29 , $83.22 , $83.22 , $83.22 , $78.60 , $0.14 , $85.38 , $87.85 , $78.60 , $86.00 , $86.00 , $87.85 , $88.77 , $75.66 , $83.22 , $78.60 , $73.05 , N/A , $74.84 , $74.84 , $87.85 , $79.35 , $0.10 , $88.77 
Motor &/Sens 3-4 Nrv Cndj Preconf Eltrode Limb,CPT® 95908,N/A,N/A,N/A, $587.00 , $381.55 , $558.40 , $110.08 , $91.60 , $400.54 , $643.83 , $545.91 , $528.30 , $528.30 , $469.60 , $469.60 , $91.60 , $541.98 , $557.65 , $528.30 , $528.30 , $528.30 , $545.91 , $563.52 , $520.70 , $498.95 , $347.70 , $481.27 , N/A , $408.36 , $408.36 , $557.65 , $502.03 , $91.60 , $643.83 
 NM Lung Perfusion With Quantative Diff ,CPT® 78597,0340 - NUCLEAR MEDICINE,N/A,N/A," $1,762.00 "," $1,145.30 "," $1,480.08 ", $184.41 , $153.94 ," $1,423.70 "," $1,585.80 "," $1,491.71 "," $1,585.80 "," $1,585.80 "," $1,585.80 "," $1,497.70 ", $150.92 ," $1,626.85 "," $1,673.90 "," $1,497.70 "," $1,638.66 "," $1,638.66 "," $1,673.90 "," $1,691.52 "," $1,441.67 "," $1,585.80 "," $1,497.70 "," $1,391.98 ", N/A ," $1,425.99 "," $1,425.99 "," $1,673.90 "," $1,511.97 ", $150.92 ," $1,691.52 "
Conv Prev Hip Surg to Tot Hip Arthroplas,CPT® 27132,N/A,N/A,N/A," $11,059.00 "," $7,188.35 "," $10,041.85 "," $1,568.75 "," $1,489.94 "," $8,093.29 "," $8,006.43 "," $10,284.87 "," $9,953.10 "," $9,953.10 "," $8,847.20 "," $8,847.20 "," $1,489.94 "," $10,210.77 "," $10,506.05 "," $9,953.10 "," $9,953.10 "," $9,953.10 "," $10,284.87 "," $10,616.64 "," $9,370.76 "," $9,400.15 "," $8,866.80 "," $9,513.68 ", N/A ," $8,251.20 "," $8,251.20 "," $10,506.05 "," $9,698.10 "," $1,489.94 "," $10,616.64 "
 Pro X-Ray Exam of Salivary Gland ,CPT® 70380,0972 - PRO FEE/RAD/DX,N/A,N/A, $54.00 , $35.10 , $213.03 , $36.95 , $35.73 , $168.53 , $208.27 , $50.22 , $48.60 , $48.60 , $43.20 , $43.20 , $35.73 , $49.86 , $51.30 , $48.60 , $48.60 , $48.60 , $50.22 , $51.84 , $206.58 , $45.90 , $229.20 , $162.00 , N/A , $171.82 , $171.82 , $51.30 , $198.87 , $35.73 , $229.20 
"Corneal Transplant,Lamellar",CPT® 65710,N/A,N/A,N/A," $10,110.00 "," $6,571.50 "," $7,067.78 "," $1,105.53 "," $1,340.24 "," $6,263.89 "," $5,839.84 "," $9,402.30 "," $9,099.00 "," $9,099.00 "," $8,088.00 "," $8,088.00 "," $1,340.24 "," $9,334.56 "," $9,604.50 "," $9,099.00 "," $9,099.00 "," $9,099.00 "," $9,402.30 "," $9,705.60 "," $9,645.61 "," $8,593.50 "," $5,999.81 "," $7,944.05 ", N/A ," $6,386.11 "," $6,386.11 "," $9,604.50 "," $7,049.42 "," $1,105.53 "," $9,705.60 "
 Excision Ben Lesion .5cm ,CPT® 11440,0981 - PRO FEE/ER,N/A,N/A, $463.00 , $300.95 , $341.29 , $103.49 , $82.89 , $281.15 , $281.65 , $430.59 , $416.70 , $416.70 , $370.40 , $370.40 , $82.89 , $427.49 , $439.85 , $416.70 , $416.70 , $416.70 , $430.59 , $444.48 , $369.08 , $393.55 , $558.41 , $365.26 , N/A , $286.63 , $286.63 , $439.85 , $332.38 , $82.89 , $558.41 
 DEXTROSE-NACL 5-0.2(25) % IV SOLN (INPT) ,HCPCS RXA258,0258 - IV SOLUTIONS,00990-7924-09,"1,000 mL", $79.82 , $51.88 , $67.05 , N/A , N/A , $64.49 , $71.84 , $67.58 , $71.84 , $71.84 , $71.84 , $67.85 , N/A , $73.70 , $75.83 , $67.85 , $74.23 , $74.23 , $75.83 , $76.63 , $65.31 , $71.84 , $67.85 , $63.06 , N/A , $64.60 , $64.60 , $75.83 , $68.49 , $63.06 , $76.63 
" Fac Med Nutrition, Indiv, Subseq ",CPT® 97803,0942 - EDUC/TRAINING,N/A,N/A, $49.00 , $31.85 , $41.16 , $27.15 , N/A , $39.59 , $44.10 , $41.48 , $44.10 , $44.10 , $44.10 , $41.65 , N/A , $45.24 , $46.55 , $41.65 , $45.57 , $45.57 , $46.55 , $47.04 , $40.09 , $44.10 , $41.65 , $38.71 , N/A , $39.66 , $39.66 , $46.55 , $42.05 , $27.15 , $47.04 
 IRON DEXTRAN 50 MG/ML IJ SOLN ,HCPCS J1750,0636 - DRUGS REQUIRING DETAILED CODIN,00023-6082-10,1 mL, $104.23 , $67.75 , $87.55 , $17.52 , $16.91 , $84.22 , $93.81 , $88.24 , $93.81 , $93.81 , $93.81 , $88.60 , $16.58 , $96.24 , $99.02 , $88.60 , $96.93 , $96.93 , $99.02 , $100.06 , $85.28 , $93.81 , $88.60 , $82.34 , N/A , $84.35 , $84.35 , $99.02 , $89.44 , $16.58 , $100.06 
 VANCOMYCIN 1.25 G IN 250 ML ,HCPCS J3370,0636 - DRUGS REQUIRING DETAILED CODIN,70092-1054-05,250 mL, $61.65 , $40.07 , $51.79 , $2.46 , $2.92 , $49.81 , $55.49 , $52.19 , $55.49 , $55.49 , $55.49 , $52.40 , $2.86 , $56.92 , $58.57 , $52.40 , $57.33 , $57.33 , $58.57 , $59.18 , $50.44 , $55.49 , $52.40 , $48.70 , N/A , $49.89 , $49.89 , $58.57 , $52.90 , $2.46 , $59.18 
Breathing Capacity Test,CPT® 94010,N/A,N/A,N/A, $295.00 , $191.75 , $61.56 , $26.12 , $42.71 , $79.51 , $83.80 , $274.35 , $265.50 , $265.50 , $236.00 , $236.00 , $42.71 , $272.37 , $280.25 , $265.50 , $265.50 , $265.50 , $274.35 , $283.20 , $89.01 , $250.75 , $111.51 , $135.23 , N/A , $81.06 , $81.06 , $280.25 , $94.49 , $26.12 , $283.20 
Open Rx Traumatic Hip Dislocatn,CPT® 27253,N/A,N/A,N/A," $6,312.00 "," $4,102.80 "," $5,694.20 ", $890.54 , $922.06 ," $4,538.07 "," $4,507.15 "," $5,870.16 "," $5,680.80 "," $5,680.80 "," $5,049.60 "," $5,049.60 ", $922.06 ," $5,827.87 "," $5,996.40 "," $5,680.80 "," $5,680.80 "," $5,680.80 "," $5,870.16 "," $6,059.52 "," $5,303.79 "," $5,365.20 "," $4,984.67 "," $5,329.82 ", N/A ," $4,626.61 "," $4,626.61 "," $5,996.40 "," $5,437.92 ", $890.54 ," $6,059.52 "
 MRI Lower Extremity (Non-Joint)W/Contras- Mh ,CPT® 73719,0972 - PRO FEE/RAD/DX,N/A,N/A, $921.00 , $598.65 ," $1,899.52 ", $270.51 , $497.69 ," $1,921.77 "," $2,490.20 ", $856.53 , $828.90 , $828.90 , $736.80 , $736.80 , $497.69 , $850.36 , $874.95 , $828.90 , $828.90 , $828.90 , $856.53 , $884.16 ," $1,637.62 ", $782.85 ," $2,713.79 "," $3,158.14 ", N/A ," $1,959.27 "," $1,959.27 ", $874.95 ," $2,267.89 ", $270.51 ," $3,158.14 "
 Fac Optime Anes Reginal Tech ,Custom OPTANESREGIONAL,0370 - ANESTHESIA,N/A,N/A, $639.00 , $415.35 , $536.76 , N/A , N/A , $516.31 , $575.10 , $540.98 , $575.10 , $575.10 , $575.10 , $543.15 , N/A , $589.99 , $607.05 , $543.15 , $594.27 , $594.27 , $607.05 , $613.44 , $522.83 , $575.10 , $543.15 , $504.81 , N/A , $517.14 , $517.14 , $607.05 , $548.33 , $504.81 , $613.44 
 Fac Drug Screening Methadone ,CPT® 80358,0301 - LAB/CHEMISTRY,N/A,N/A, $166.00 , $107.90 , $139.44 , N/A , N/A , $134.13 , $149.40 , $140.54 , $149.40 , $149.40 , $149.40 , $141.10 , N/A , $153.27 , $157.70 , $141.10 , $154.38 , $154.38 , $157.70 , $159.36 , $135.82 , $149.40 , $141.10 , $131.14 , N/A , $134.34 , $134.34 , $157.70 , $142.44 , $131.14 , $159.36 
"Removal,FB,Intraocular,Ant Chamber/Lens",CPT® 65235,N/A,N/A,N/A," $6,512.00 "," $4,232.80 "," $4,518.61 ", $708.69 , $768.38 ," $4,023.43 "," $3,761.02 "," $6,056.16 "," $5,860.80 "," $5,860.80 "," $5,209.60 "," $5,209.60 ", $768.38 ," $6,012.53 "," $6,186.40 "," $5,860.80 "," $5,860.80 "," $5,860.80 "," $6,056.16 "," $6,251.52 "," $6,167.25 "," $5,535.20 "," $3,862.50 "," $5,103.14 ", N/A ," $4,101.94 "," $4,101.94 "," $6,186.40 "," $4,528.00 ", $708.69 ," $6,251.52 "
 Pro Cltx Fx Phlx/Phlg Oth/Thn Grt Toe W/Mnpj ,CPT® 28515,0982 - PRO FEE/OUTPT,N/A,N/A," $1,059.00 ", $688.35 , $888.42 , $141.25 , $76.84 , $702.96 , $708.81 , $984.87 , $953.10 , $953.10 , $847.20 , $847.20 , $76.84 , $977.77 ," $1,006.05 ", $953.10 , $953.10 , $953.10 , $984.87 ," $1,016.64 ", $817.30 , $900.15 , $768.93 , $830.94 , N/A , $716.67 , $716.67 ," $1,006.05 ", $842.36 , $76.84 ," $1,016.64 "
"Hysteroscopy,Lysis Adhesions",CPT® 58559,N/A,N/A,N/A," $1,715.00 "," $1,114.75 "," $1,325.20 ", $267.99 , $266.09 ," $1,389.09 "," $1,388.90 "," $1,594.95 "," $1,543.50 "," $1,543.50 "," $1,372.00 "," $1,372.00 ", $266.09 ," $1,583.46 "," $1,629.25 "," $1,543.50 "," $1,543.50 "," $1,543.50 "," $1,594.95 "," $1,646.40 "," $1,395.47 "," $1,457.75 "," $1,828.67 "," $1,190.09 ", N/A ," $1,416.20 "," $1,416.20 "," $1,629.25 "," $1,698.64 ", $266.09 ," $1,828.67 "
 L Spine CT Without Contrast ,CPT® 72131,0350 - CT SCAN,N/A,N/A," $2,640.00 "," $1,716.00 "," $2,217.60 ", $131.98 , $250.57 ," $2,133.12 "," $2,376.00 "," $2,235.02 "," $2,376.00 "," $2,376.00 "," $2,376.00 "," $2,244.00 ", $245.66 ," $2,437.51 "," $2,508.00 "," $2,244.00 "," $2,455.20 "," $2,455.20 "," $2,508.00 "," $2,534.40 "," $2,160.05 "," $2,376.00 "," $2,244.00 "," $2,085.60 ", N/A ," $2,136.55 "," $2,136.55 "," $2,508.00 "," $2,265.38 ", $131.98 ," $2,534.40 "
 Fac Rubeola Antibody ,CPT® 86765,0302 - LAB/IMMUNOLOGY,N/A,N/A, $134.00 , $87.10 , $112.56 , $13.14 , $13.14 , $108.27 , $120.60 , $113.44 , $120.60 , $120.60 , $120.60 , $113.90 , $12.88 , $123.72 , $127.30 , $113.90 , $124.62 , $124.62 , $127.30 , $128.64 , $109.64 , $120.60 , $113.90 , $105.86 , N/A , $108.45 , $108.45 , $127.30 , $114.99 , $12.88 , $128.64 
Leuprolide Acetate Suspnsion,HCPCS J9217,N/A,N/A,N/A," $1,171.00 ", $761.15 , N/A , $169.18 , $192.10 , N/A , N/A ," $1,089.03 "," $1,053.90 "," $1,053.90 ", $936.80 , $936.80 , $192.10 ," $1,081.18 "," $1,112.45 "," $1,053.90 "," $1,053.90 "," $1,053.90 "," $1,089.03 "," $1,124.16 ", $187.80 , $995.35 , $410.01 , $233.22 , N/A , N/A , N/A ," $1,112.45 ", N/A , $169.18 ," $1,124.16 "
US Fetal Nuchal Translucency 1st Gestation,CPT® 76813,N/A,N/A,N/A, $948.00 , $616.20 , $674.71 , $116.52 , $103.10 , $582.30 , $644.48 , $881.64 , $853.20 , $853.20 , $758.40 , $758.40 , $103.10 , $875.29 , $900.60 , $853.20 , $853.20 , $853.20 , $881.64 , $910.08 , $679.62 , $805.80 , $703.01 , $684.25 , N/A , $593.66 , $593.66 , $900.60 , $687.17 , $103.10 , $910.08 
"MRI, Upper Extrem W/Contrast",CPT® 73219,N/A,N/A,N/A," $1,066.00 ", $692.90 ," $2,406.11 ", $342.65 , $498.05 ," $1,918.70 "," $2,448.15 ", $991.38 , $959.40 , $959.40 , $852.80 , $852.80 , $498.05 , $984.24 ," $1,012.70 ", $959.40 , $959.40 , $959.40 , $991.38 ," $1,023.36 "," $2,091.52 ", $906.10 ," $2,669.49 "," $3,721.81 ", N/A ," $1,956.14 "," $1,956.14 "," $1,012.70 "," $2,264.27 ", $342.65 ," $3,721.81 "
"Open Rx Weightbear Tib,Fix Tib/Fib",27828,N/A,N/A,N/A," $8,581.00 "," $5,577.65 "," $8,100.24 "," $1,262.57 "," $1,210.57 "," $6,257.89 "," $6,220.19 "," $7,980.33 "," $7,722.90 "," $7,722.90 "," $6,864.80 "," $6,864.80 "," $1,210.57 "," $7,922.84 "," $8,151.95 "," $7,722.90 "," $7,722.90 "," $7,722.90 "," $7,980.33 "," $8,237.76 "," $7,515.49 "," $7,293.85 "," $6,874.00 "," $7,468.19 ", N/A ," $6,379.99 "," $6,379.99 "," $8,151.95 "," $7,498.76 "," $1,210.57 "," $8,237.76 "
 Pro Release of Foot Contracture ,CPT® 28270,0982 - PRO FEE/OUTPT,N/A,N/A," $3,273.00 "," $2,127.45 "," $2,068.24 ", $324.80 , $548.76 ," $1,645.97 "," $1,644.43 "," $3,043.89 "," $2,945.70 "," $2,945.70 "," $2,618.40 "," $2,618.40 ", $548.76 ," $3,021.96 "," $3,109.35 "," $2,945.70 "," $2,945.70 "," $2,945.70 "," $3,043.89 "," $3,142.08 "," $1,926.07 "," $2,782.05 "," $1,780.50 "," $1,961.47 ", N/A ," $1,678.08 "," $1,678.08 "," $3,109.35 "," $1,972.36 ", $324.80 ," $3,142.08 "
Hepa Vaccine Adult Im,CPT® 90632,N/A,N/A,N/A, $208.00 , $135.20 , N/A , $73.29 , $69.06 , $110.70 , $155.61 , $193.44 , $187.20 , $187.20 , $166.40 , $166.40 , $69.06 , $192.05 , $197.60 , $187.20 , $187.20 , $187.20 , $193.44 , $199.68 , $81.78 , $176.80 , $152.06 , $125.99 , N/A , $112.86 , $112.86 , $197.60 , $131.56 , $69.06 , $199.68 
Iadna Anaplasma Phagocytophilum Amplifed Prb Tq,CPT® 87468,N/A,N/A,N/A, $53.00 , $34.45 , N/A , $35.79 , $35.79 , N/A , N/A , $49.29 , $47.70 , $47.70 , $42.40 , $42.40 , $35.79 , $48.93 , $50.35 , $47.70 , $47.70 , $47.70 , $49.29 , $50.88 , N/A , $45.05 , $168.00 , N/A , N/A , $137.55 , $137.55 , $50.35 , $151.24 , $35.79 , $168.00 
 KETOROLAC TROMETHAMINE 0.5 % OP SOLN ,HCPCS RXC637,0250 - PHARMACY,42571-0137-25,5 mL, $544.51 , $353.93 , $457.39 , N/A , N/A , $439.96 , $490.06 , $460.98 , $490.06 , $490.06 , $490.06 , $462.83 , N/A , $502.75 , $517.28 , $462.83 , $506.39 , $506.39 , $517.28 , $522.73 , $445.52 , $490.06 , $462.83 , $430.16 , N/A , $440.67 , $440.67 , $517.28 , $467.24 , $430.16 , $522.73 
 FOMEPIZOLE 1.5 GM/1.5ML IV SOLN ,HCPCS J1451,0636 - DRUGS REQUIRING DETAILED CODIN,70710-1478-01,1.5 mL," $9,246.37 "," $6,010.14 "," $7,766.95 ", N/A , $6.83 ," $7,471.07 "," $8,321.73 "," $7,827.98 "," $8,321.73 "," $8,321.73 "," $8,321.73 "," $7,859.41 ", $6.70 ," $8,537.17 "," $8,784.05 "," $7,859.41 "," $8,599.12 "," $8,599.12 "," $8,784.05 "," $8,876.52 "," $7,565.38 "," $8,321.73 "," $7,859.41 "," $7,304.63 ", N/A ," $7,483.09 "," $7,483.09 "," $8,784.05 "," $7,934.31 ", $6.70 ," $8,876.52 "
"MRI, Face, Neck W/Contrast",CPT® 70542,N/A,N/A,N/A," $3,245.00 "," $2,109.25 "," $1,942.22 ", $276.76 , $497.69 ," $1,915.00 "," $2,420.12 "," $3,017.85 "," $2,920.50 "," $2,920.50 "," $2,596.00 "," $2,596.00 ", $497.69 ," $2,996.11 "," $3,082.75 "," $2,920.50 "," $2,920.50 "," $2,920.50 "," $3,017.85 "," $3,115.20 "," $1,675.27 "," $2,758.25 "," $2,640.60 "," $2,969.18 ", N/A ," $1,952.36 "," $1,952.36 "," $3,082.75 "," $2,259.89 ", $276.76 ," $3,115.20 "
 Pro Home/Res Visit Est Patient Low Mdm 30 Minutes ,CPT® 99348,0987 - PRO FEE/HOS VIS,N/A,N/A, $216.00 , $140.40 , $166.66 , $74.72 , $64.77 , $144.60 , $146.00 , $200.88 , $194.40 , $194.40 , $172.80 , $172.80 , $64.77 , $199.43 , $205.20 , $194.40 , $194.40 , $194.40 , $200.88 , $207.36 , $152.12 , $183.60 , $181.53 , $184.12 , $206.00 , $147.42 , $147.42 , $205.20 , $170.05 , $64.77 , $207.36 
Cerv Col Thermplas Foam 2 Pi,HCPCS L0172,N/A,N/A,N/A, $164.00 , $106.60 , N/A , $165.67 , $72.87 , N/A , N/A , $152.52 , $147.60 , $147.60 , $131.20 , $131.20 , $72.87 , $151.42 , $155.80 , $147.60 , $147.60 , $147.60 , $152.52 , $157.44 , N/A , $139.40 , $128.45 , $139.38 , N/A , N/A , N/A , $155.80 , N/A , $72.87 , $165.67 
Laps Esophgl Sphnctr Agmntj Plmt Dev Crrpl,CPT® 43284,N/A,N/A,N/A," $4,111.00 "," $2,672.15 "," $3,891.42 ", $603.19 , N/A ," $2,940.70 "," $2,981.20 "," $3,823.23 "," $3,699.90 "," $3,699.90 "," $3,288.80 "," $3,288.80 ", N/A ," $3,795.69 "," $3,905.45 "," $3,699.90 "," $3,699.90 "," $3,699.90 "," $3,823.23 "," $3,946.56 "," $2,784.66 "," $3,494.35 "," $3,470.37 "," $3,604.77 ", N/A ," $2,998.08 "," $2,998.08 "," $3,905.45 "," $3,135.66 ", $603.19 ," $3,946.56 "
 Pro X-Ray Exam of Knees ,CPT® 73565,0972 - PRO FEE/RAD/DX,N/A,N/A, $99.00 , $64.35 , $228.06 , $39.24 , $28.54 , $154.98 , $189.24 , $92.07 , $89.10 , $89.10 , $79.20 , $79.20 , $28.54 , $91.41 , $94.05 , $89.10 , $89.10 , $89.10 , $92.07 , $95.04 , $223.43 , $84.15 , $211.86 , $179.83 , N/A , $158.01 , $158.01 , $94.05 , $182.89 , $28.54 , $228.06 
Excision Tumor Soft Tissue Shoulder Subq 3+Cm,CPT® 23071,N/A,N/A,N/A," $3,297.00 "," $2,143.05 "," $2,536.63 ", $395.70 , $342.80 ," $2,010.77 "," $2,011.47 "," $3,066.21 "," $2,967.30 "," $2,967.30 "," $2,637.60 "," $2,637.60 ", $342.80 ," $3,044.12 "," $3,132.15 "," $2,967.30 "," $2,967.30 "," $2,967.30 "," $3,066.21 "," $3,165.12 "," $2,350.06 "," $2,802.45 "," $2,226.51 "," $2,366.34 ", N/A ," $2,050.01 "," $2,050.01 "," $3,132.15 "," $2,409.50 ", $342.80 ," $3,165.12 "
 Teeth Full Mouth-C ,CPT® 70320,0320 - DX X-RAY,N/A,N/A, $326.00 , $211.90 , $273.84 , $51.83 , $41.12 , $263.41 , $293.40 , $275.99 , $293.40 , $293.40 , $293.40 , $277.10 , $40.31 , $301.00 , $309.70 , $277.10 , $303.18 , $303.18 , $309.70 , $312.96 , $266.73 , $293.40 , $277.10 , $257.54 , N/A , $263.83 , $263.83 , $309.70 , $279.74 , $40.31 , $312.96 
Blood Clot Factor VIII Test,CPT® 85247,N/A,N/A,N/A, $333.00 , $216.45 , N/A , $23.40 , $23.40 , $129.79 , $155.30 , $309.69 , $299.70 , $299.70 , $266.40 , $266.40 , $23.40 , $307.46 , $316.35 , $299.70 , $299.70 , $299.70 , $309.69 , $319.68 , $153.18 , $283.05 , $150.83 , $83.18 , N/A , $121.13 , $121.13 , $316.35 , $132.37 , $23.40 , $319.68 
Closed Tx Distal Phalangeal Fx W/O Manip Ea -Mh,26755,N/A,N/A,N/A," $1,167.00 ", $758.55 ," $1,701.51 ", $269.64 , $63.53 ," $1,312.50 "," $1,334.43 "," $1,085.31 "," $1,050.30 "," $1,050.30 ", $933.60 , $933.60 , $63.53 ," $1,077.49 "," $1,108.65 "," $1,050.30 "," $1,050.30 "," $1,050.30 "," $1,085.31 "," $1,120.32 "," $1,574.04 ", $991.95 ," $1,464.72 "," $1,562.15 ", N/A ," $1,338.12 "," $1,338.12 "," $1,108.65 "," $1,572.76 ", $63.53 ," $1,701.51 "
 Microdissection Prep Identified Target Mnl ,CPT® 88381,0310 - PATHOLOGY LAB,N/A,N/A, $668.00 , $434.20 , $561.12 , $197.49 , $163.84 , $539.74 , $601.20 , $565.53 , $601.20 , $601.20 , $601.20 , $567.80 , $160.63 , $616.76 , $634.60 , $567.80 , $621.24 , $621.24 , $634.60 , $641.28 , $546.56 , $601.20 , $567.80 , $527.72 , N/A , $540.61 , $540.61 , $634.60 , $573.21 , $160.63 , $641.28 
 Fac Hiv-1 ,CPT® 86701,0302 - LAB/IMMUNOLOGY,N/A,N/A, $133.00 , $86.45 , $111.72 , $9.07 , $9.07 , $107.46 , $119.70 , $112.60 , $119.70 , $119.70 , $119.70 , $113.05 , $8.89 , $122.80 , $126.35 , $113.05 , $123.69 , $123.69 , $126.35 , $127.68 , $108.82 , $119.70 , $113.05 , $105.07 , N/A , $107.64 , $107.64 , $126.35 , $114.13 , $8.89 , $127.68 
Exc Tumor Soft Tiss Back/Flank Subfascial <5cm,CPT® 21932,N/A,N/A,N/A," $4,345.00 "," $2,824.25 "," $3,993.21 ", $624.03 , $553.47 ," $3,166.77 "," $3,157.52 "," $4,040.85 "," $3,910.50 "," $3,910.50 "," $3,476.00 "," $3,476.00 ", $553.47 ," $4,011.74 "," $4,127.75 "," $3,910.50 "," $3,910.50 "," $3,910.50 "," $4,040.85 "," $4,171.20 "," $3,697.22 "," $3,693.25 "," $3,503.90 "," $3,719.35 ", N/A ," $3,228.56 "," $3,228.56 "," $4,127.75 "," $3,794.70 ", $553.47 ," $4,171.20 "
Paravaginal Defect Repair Vaginal Approach,57285,N/A,N/A,N/A," $4,164.00 "," $2,706.60 "," $3,283.90 ", $663.38 , $478.13 ," $2,742.44 "," $2,730.71 "," $3,872.52 "," $3,747.60 "," $3,747.60 "," $3,331.20 "," $3,331.20 ", $478.13 ," $3,844.62 "," $3,955.80 "," $3,747.60 "," $3,747.60 "," $3,747.60 "," $3,872.52 "," $3,997.44 "," $3,424.48 "," $3,539.40 "," $3,575.26 "," $2,763.61 ", N/A ," $2,795.95 "," $2,795.95 "," $3,955.80 "," $3,353.56 ", $478.13 ," $3,997.44 "
Excise Breast Les W Xray Marker,19125,N/A,N/A,N/A," $3,858.00 "," $2,507.70 "," $1,447.92 ", $430.51 , $347.51 ," $1,232.96 "," $1,203.57 "," $3,587.94 "," $3,472.20 "," $3,472.20 "," $3,086.40 "," $3,086.40 ", $347.51 ," $3,562.09 "," $3,665.10 "," $3,472.20 "," $3,472.20 "," $3,472.20 "," $3,587.94 "," $3,703.68 "," $1,579.49 "," $3,279.30 "," $2,426.33 "," $1,559.65 ", N/A ," $1,257.02 "," $1,257.02 "," $3,665.10 "," $1,457.72 ", $347.51 ," $3,703.68 "
"Tdap Vaccine, >7 Yrs, Im",CPT® 90715,N/A,N/A,N/A, $114.00 , $74.10 , N/A , $39.53 , $63.89 , $78.73 , $101.46 , $106.02 , $102.60 , $102.60 , $91.20 , $91.20 , $63.89 , $105.26 , $108.30 , $102.60 , $102.60 , $102.60 , $106.02 , $109.44 , $46.35 , $96.90 , $99.34 , $78.27 , N/A , $80.27 , $80.27 , $108.30 , $93.59 , $39.53 , $109.44 
" Fac Cytopath Tbs, C/V, Manual ",CPT® 88164,0310 - PATHOLOGY LAB,N/A,N/A, $146.00 , $94.90 , $122.64 , $17.66 , $14.67 , $117.97 , $131.40 , $123.60 , $131.40 , $131.40 , $131.40 , $124.10 , $14.38 , $134.80 , $138.70 , $124.10 , $135.78 , $135.78 , $138.70 , $140.16 , $119.46 , $131.40 , $124.10 , $115.34 , N/A , $118.16 , $118.16 , $138.70 , $125.28 , $14.38 , $140.16 
Intraoperative Sentinel Lymph Node ID W Dye Injection,38900,N/A,N/A,N/A," $1,996.00 "," $1,297.40 ", $623.05 , $124.89 , $96.51 , $477.03 , $483.19 ," $1,856.28 "," $1,796.40 "," $1,796.40 "," $1,596.80 "," $1,596.80 ", $96.51 ," $1,842.91 "," $1,896.20 "," $1,796.40 "," $1,796.40 "," $1,796.40 "," $1,856.28 "," $1,916.16 ", $666.95 ," $1,696.60 ", $718.98 , $654.97 , N/A , $486.34 , $486.34 ," $1,896.20 ", $564.22 , $96.51 ," $1,916.16 "
"Surg Diagnostic Exam, Anorectal",CPT® 45990,N/A,N/A,N/A, $705.00 , $458.25 , $635.31 , $98.63 , $89.21 , $510.76 , $514.87 , $655.65 , $634.50 , $634.50 , $564.00 , $564.00 , $89.21 , $650.93 , $669.75 , $634.50 , $634.50 , $634.50 , $655.65 , $676.80 , $456.24 , $599.25 , $565.55 , $605.04 , N/A , $520.72 , $520.72 , $669.75 , $544.61 , $89.21 , $676.80 
 Fac Chg Hbb Common Variants ,CPT® 81361,0300 - LABORATORY,N/A,N/A, $828.00 , $538.20 , $695.52 , $178.31 , $142.64 , $669.02 , $745.20 , $700.98 , $745.20 , $745.20 , $745.20 , $703.80 , $139.84 , $764.49 , $786.60 , $703.80 , $770.04 , $770.04 , $786.60 , $794.88 , $677.47 , $745.20 , $703.80 , $654.12 , N/A , $670.10 , $670.10 , $786.60 , $710.51 , $139.84 , $794.88 
 Fac Iaad Ia Hiv-1 Ag W/Hiv-1 & Hiv-2 Antbdy Single ,CPT® 87389,0306 - LAB/BACT-MICRO,N/A,N/A, $222.00 , $144.30 , $186.48 , $24.56 , $24.56 , $179.38 , $199.80 , $187.95 , $199.80 , $199.80 , $199.80 , $188.70 , $24.08 , $204.97 , $210.90 , $188.70 , $206.46 , $206.46 , $210.90 , $213.12 , $181.64 , $199.80 , $188.70 , $175.38 , N/A , $179.66 , $179.66 , $210.90 , $190.50 , $24.08 , $213.12 
Ins New/Rplcmt Prm Pacemakr W/Trans Eltrd Atrial,CPT® 33206,N/A,N/A,N/A," $4,986.00 "," $3,240.90 "," $2,715.38 ", $420.14 , $445.14 ," $1,973.93 "," $1,917.69 "," $4,636.98 "," $4,487.40 "," $4,487.40 "," $3,988.80 "," $3,988.80 ", $445.14 ," $4,603.57 "," $4,736.70 "," $4,487.40 "," $4,487.40 "," $4,487.40 "," $4,636.98 "," $4,786.56 "," $2,508.08 "," $4,238.10 "," $2,408.49 "," $2,189.89 ", N/A ," $2,012.45 "," $2,012.45 "," $4,736.70 "," $2,286.14 ", $420.14 ," $4,786.56 "
TEMPORAL ARTERY PROCEDURE,37618,N/A,N/A,N/A," $2,793.00 "," $1,815.45 "," $2,319.01 ", $360.01 , $628.86 ," $1,651.03 "," $1,679.44 "," $2,597.49 "," $2,513.70 "," $2,513.70 "," $2,234.40 "," $2,234.40 ", $628.86 ," $2,578.78 "," $2,653.35 "," $2,513.70 "," $2,513.70 "," $2,513.70 "," $2,597.49 "," $2,681.28 "," $2,140.23 "," $2,374.05 "," $2,105.20 "," $1,856.09 ", N/A ," $1,683.25 "," $1,683.25 "," $2,653.35 "," $1,912.15 ", $360.01 ," $2,681.28 "
 METOPROLOL TARTRATE 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,51079-0801-20,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Neutralization Test, Viral",CPT® 86382,N/A,N/A,N/A, $137.00 , $89.05 , N/A , $17.25 , $17.25 , $95.66 , $114.47 , $127.41 , $123.30 , $123.30 , $109.60 , $109.60 , $17.25 , $126.49 , $130.15 , $123.30 , $123.30 , $123.30 , $127.41 , $131.52 , $112.91 , $116.45 , $110.29 , $61.32 , N/A , $89.28 , $89.28 , $130.15 , $97.56 , $17.25 , $131.52 
"Amputation Metatarsal+Toe,Single",CPT® 28810,N/A,N/A,N/A," $3,343.00 "," $2,172.95 "," $2,591.23 ", $403.35 , $384.19 ," $2,103.13 "," $2,129.13 "," $3,108.99 "," $3,008.70 "," $3,008.70 "," $2,674.40 "," $2,674.40 ", $384.19 ," $3,086.59 "," $3,175.85 "," $3,008.70 "," $3,008.70 "," $3,008.70 "," $3,108.99 "," $3,209.28 "," $2,408.99 "," $2,841.55 "," $2,344.26 "," $2,463.28 ", N/A ," $2,144.16 "," $2,144.16 "," $3,175.85 "," $2,520.16 ", $384.19 ," $3,209.28 "
"Repair Exten Tendon,Dorsum Fingr,Grft",CPT® 26420,N/A,N/A,N/A," $4,702.00 "," $3,056.30 "," $4,691.90 ", $726.62 , $461.04 ," $3,367.03 "," $3,417.38 "," $4,372.86 "," $4,231.80 "," $4,231.80 "," $3,761.60 "," $3,761.60 ", $461.04 ," $4,341.36 "," $4,466.90 "," $4,231.80 "," $4,231.80 "," $4,231.80 "," $4,372.86 "," $4,513.92 "," $4,313.97 "," $3,996.70 "," $3,753.67 "," $4,041.87 ", N/A ," $3,432.73 "," $3,432.73 "," $4,466.90 "," $4,034.67 ", $461.04 ," $4,691.90 "
 LEUPROLIDE ACETATE 3.75 MG IM KIT ,HCPCS J1950,0636 - DRUGS REQUIRING DETAILED CODIN,00074-3641-03,1 each," $4,803.47 "," $3,122.26 "," $4,034.91 "," $1,574.39 "," $1,510.51 "," $3,881.20 "," $4,323.12 "," $4,066.62 "," $4,323.12 "," $4,323.12 "," $4,323.12 "," $4,082.95 "," $1,480.89 "," $4,435.04 "," $4,563.30 "," $4,082.95 "," $4,467.23 "," $4,467.23 "," $4,563.30 "," $4,611.33 "," $3,930.20 "," $4,323.12 "," $4,082.95 "," $3,794.74 ", N/A ," $3,887.45 "," $3,887.45 "," $4,563.30 "," $4,121.86 "," $1,480.89 "," $4,611.33 "
 FUROSEMIDE 80 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,51079-0527-20,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Hemodialysis, One Evaluation",CPT® 90935,N/A,N/A,N/A, $413.00 , $268.45 , $167.38 , $69.65 , $65.14 , $161.92 , $161.51 , $384.09 , $371.70 , $371.70 , $330.40 , $330.40 , $65.14 , $381.32 , $392.35 , $371.70 , $371.70 , $371.70 , $384.09 , $396.48 , $221.23 , $351.05 , $211.87 , $275.72 , N/A , $165.08 , $165.08 , $392.35 , $192.45 , $65.14 , $396.48 
 FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP ,HCPCS RXC637,0250 - PHARMACY,60505-0829-01,16 gram, $208.92 , $135.80 , $175.49 , N/A , N/A , $168.81 , $188.03 , $176.87 , $188.03 , $188.03 , $188.03 , $177.58 , N/A , $192.90 , $198.47 , $177.58 , $194.30 , $194.30 , $198.47 , $200.56 , $170.94 , $188.03 , $177.58 , $165.05 , N/A , $169.08 , $169.08 , $198.47 , $179.27 , $165.05 , $200.56 
 Pro Lyr Closure Wound-Lh ,CPT® 12041,0982 - PRO FEE/OUTPT,N/A,N/A," $1,004.00 ", $652.60 , $461.96 , $139.44 , $71.45 , $427.30 , $419.98 , $933.72 , $903.60 , $903.60 , $803.20 , $803.20 , $71.45 , $926.99 , $953.80 , $903.60 , $903.60 , $903.60 , $933.72 , $963.84 , $509.89 , $853.40 , $834.94 , $528.73 , N/A , $435.64 , $435.64 , $953.80 , $505.18 , $71.45 , $963.84 
"Destruction,Lesion(S),Vulva;Extensive",CPT® 56515,N/A,N/A,N/A," $1,928.00 "," $1,253.20 "," $1,008.40 ", $204.49 , $199.78 , $820.44 , $812.65 ," $1,793.04 "," $1,735.20 "," $1,735.20 "," $1,542.40 "," $1,542.40 ", $199.78 ," $1,780.12 "," $1,831.60 "," $1,735.20 "," $1,735.20 "," $1,735.20 "," $1,793.04 "," $1,850.88 "," $1,042.12 "," $1,638.80 "," $1,065.09 ", $822.79 , N/A , $836.45 , $836.45 ," $1,831.60 "," $1,003.29 ", $199.78 ," $1,850.88 "
Remove Infusn Device/Pump,62365,N/A,N/A,N/A," $1,951.00 "," $1,268.15 "," $1,417.21 ", $277.72 , $367.42 ," $1,640.15 "," $1,582.65 "," $1,814.43 "," $1,755.90 "," $1,755.90 "," $1,560.80 "," $1,560.80 ", $367.42 ," $1,801.36 "," $1,853.45 "," $1,755.90 "," $1,755.90 "," $1,755.90 "," $1,814.43 "," $1,872.96 "," $1,535.22 "," $1,658.35 "," $1,569.98 "," $1,729.45 ", N/A ," $1,672.15 "," $1,672.15 "," $1,853.45 "," $1,793.82 ", $277.72 ," $1,872.96 "
 Pro Egd Dilation Gastric/Duodenal Stricture ,CPT® 43245,0982 - PRO FEE/OUTPT,N/A,N/A," $2,546.00 "," $1,654.90 "," $1,069.77 ", $165.31 , $174.43 , $889.63 , $911.65 ," $2,367.78 "," $2,291.40 "," $2,291.40 "," $2,036.80 "," $2,036.80 ", $174.43 ," $2,350.72 "," $2,418.70 "," $2,291.40 "," $2,291.40 "," $2,291.40 "," $2,367.78 "," $2,444.16 ", $770.53 ," $2,164.10 "," $1,000.86 "," $1,018.00 ", N/A , $906.99 , $906.99 ," $2,418.70 ", $948.60 , $165.31 ," $2,444.16 "
" Fac Complement, Total (Ch50) ",CPT® 86162,0300 - LABORATORY,N/A,N/A, $256.00 , $166.40 , $215.04 , $20.73 , $20.73 , $206.85 , $230.40 , $216.73 , $230.40 , $230.40 , $230.40 , $217.60 , $20.32 , $236.36 , $243.20 , $217.60 , $238.08 , $238.08 , $243.20 , $245.76 , $209.46 , $230.40 , $217.60 , $202.24 , N/A , $207.18 , $207.18 , $243.20 , $219.67 , $20.32 , $245.76 
 Fac Prothrombin F2 Gene Analysis 20210g >a Variant ,CPT® 81240,0310 - PATHOLOGY LAB,N/A,N/A," $2,030.00 "," $1,319.50 "," $1,705.20 ", $67.00 , $54.77 ," $1,640.24 "," $1,827.00 "," $1,718.60 "," $1,827.00 "," $1,827.00 "," $1,827.00 "," $1,725.50 ", $53.70 ," $1,874.30 "," $1,928.50 "," $1,725.50 "," $1,887.90 "," $1,887.90 "," $1,928.50 "," $1,948.80 "," $1,660.95 "," $1,827.00 "," $1,725.50 "," $1,603.70 ", N/A ," $1,642.88 "," $1,642.88 "," $1,928.50 "," $1,741.94 ", $53.70 ," $1,948.80 "
 DIPHENHYDRAMINE HCL 12.5 MG/5ML PO ELIX ,HCPCS RXC637,0250 - PHARMACY,00121-0489-00,5 mL, $23.38 , $15.20 , $19.64 , N/A , N/A , $18.89 , $21.04 , $19.79 , $21.04 , $21.04 , $21.04 , $19.87 , N/A , $21.59 , $22.21 , $19.87 , $21.74 , $21.74 , $22.21 , $22.44 , $19.13 , $21.04 , $19.87 , $18.47 , N/A , $18.92 , $18.92 , $22.21 , $20.06 , $18.47 , $22.44 
"Preventive Visit,New,Infant < 1 Yr",CPT® 99381,N/A,N/A,N/A, $324.00 , $210.60 , N/A , $106.46 , $62.20 , $163.06 , $164.73 , $301.32 , $291.60 , $291.60 , $259.20 , $259.20 , $62.20 , $299.15 , $307.80 , $291.60 , $291.60 , $291.60 , $301.32 , $311.04 , $202.15 , $275.40 , $165.77 , $163.22 , N/A , $166.24 , $166.24 , $307.80 , $199.66 , $62.20 , $311.04 
Inject Platelet Rich Plasma W/Img Harvest/Preparatoin,CPT® 0232T,N/A,N/A,N/A, $878.00 , $570.70 , N/A , N/A , N/A , N/A , N/A , $816.54 , $790.20 , $790.20 , $702.40 , $702.40 , N/A , $810.66 , $834.10 , $790.20 , $790.20 , $790.20 , $816.54 , $842.88 , N/A , $746.30 , $339.23 , $277.72 , N/A , $340.17 , $340.17 , $834.10 , $395.96 , $277.72 , $842.88 
 HEPATITIS B VAC RECOMBINANT 20 MCG/ML INJECTION (INPT) ,HCPCS 90746,0636 - DRUGS REQUIRING DETAILED CODIN,58160-0821-11,1 mL, $411.29 , $267.34 , $345.48 , $71.79 , $79.58 , $332.32 , $370.16 , $348.20 , $370.16 , $370.16 , $370.16 , $349.60 , $78.02 , $379.74 , $390.73 , $349.60 , $382.50 , $382.50 , $390.73 , $394.84 , $336.52 , $370.16 , $349.60 , $324.92 , N/A , $332.86 , $332.86 , $390.73 , $352.93 , $71.79 , $394.84 
"Repair Skull Defect,>5cm",CPT® 62141,N/A,N/A,N/A," $7,367.00 "," $4,788.55 "," $5,278.21 "," $1,032.80 ", $962.56 ," $6,190.09 "," $5,951.45 "," $6,851.31 "," $6,630.30 "," $6,630.30 "," $5,893.60 "," $5,893.60 ", $962.56 ," $6,801.95 "," $6,998.65 "," $6,630.30 "," $6,630.30 "," $6,630.30 "," $6,851.31 "," $7,072.32 "," $5,705.72 "," $6,261.95 "," $6,080.09 "," $6,408.71 ", N/A ," $6,310.87 "," $6,310.87 "," $6,998.65 "," $6,770.07 ", $962.56 ," $7,072.32 "
" Pro Rpr Fem Hernia, Init Blocked ",CPT® 49553,0982 - PRO FEE/OUTPT,N/A,N/A," $4,200.00 "," $2,730.00 "," $3,788.79 ", $587.40 , $630.39 ," $2,961.23 "," $3,003.41 "," $3,906.00 "," $3,780.00 "," $3,780.00 "," $3,360.00 "," $3,360.00 ", $630.39 ," $3,877.86 "," $3,990.00 "," $3,780.00 "," $3,780.00 "," $3,780.00 "," $3,906.00 "," $4,032.00 "," $2,707.11 "," $3,570.00 "," $3,336.20 "," $3,500.00 ", N/A ," $3,019.02 "," $3,019.02 "," $3,990.00 "," $3,157.56 ", $587.40 ," $4,032.00 "
 Pro Rpr Cplx F/C/C/M/N/Ax/G/H/F 1.1 Cm-2.5 Cm ,CPT® 13131,0982 - PRO FEE/OUTPT,N/A,N/A," $1,487.00 ", $966.55 , $776.05 , $231.89 , $176.33 , $684.64 , $667.66 ," $1,382.91 "," $1,338.30 "," $1,338.30 "," $1,189.60 "," $1,189.60 ", $176.33 ," $1,372.95 "," $1,412.65 "," $1,338.30 "," $1,338.30 "," $1,338.30 "," $1,382.91 "," $1,427.52 ", $855.05 ," $1,263.95 "," $1,330.91 ", $878.14 , N/A , $698.00 , $698.00 ," $1,412.65 ", $809.44 , $176.33 ," $1,427.52 "
 Fac Colonoscopy Flx W/Removal of Foreign Body(S) ,CPT® 45379,0360 - OR SERVICES,N/A,N/A," $3,165.00 "," $2,057.25 "," $2,658.60 ", $225.60 , $599.30 ," $2,557.32 "," $2,848.50 "," $2,679.49 "," $2,848.50 "," $2,848.50 "," $2,848.50 "," $2,690.25 ", $587.55 ," $2,922.24 "," $3,006.75 "," $2,690.25 "," $2,943.45 "," $2,943.45 "," $3,006.75 "," $3,038.40 "," $2,589.60 "," $2,848.50 "," $2,690.25 "," $2,500.35 ", N/A ," $2,561.43 "," $2,561.43 "," $3,006.75 "," $2,715.89 ", $225.60 ," $3,038.40 "
 Private Room ,Custom 1140000001,0114 - PSYCH/PVT,N/A,N/A," $1,848.00 "," $1,201.20 "," $1,552.32 ", N/A , N/A ," $1,493.18 "," $1,663.20 "," $1,564.52 "," $1,663.20 "," $1,663.20 "," $1,663.20 "," $1,570.80 ", N/A ," $1,706.26 "," $1,755.60 "," $1,570.80 "," $1,718.64 "," $1,718.64 "," $1,755.60 "," $1,774.08 "," $1,512.03 "," $1,663.20 "," $1,570.80 "," $1,459.92 ", N/A ," $1,495.59 "," $1,495.59 "," $1,755.60 "," $1,585.77 "," $1,459.92 "," $1,774.08 "
Low Cost Skin Substitute App,HCPCS C5271,N/A,N/A,N/A, $655.00 , $425.75 , N/A , N/A , N/A , N/A , N/A , $609.15 , $589.50 , $589.50 , $524.00 , $524.00 , N/A , $604.76 , $622.25 , $589.50 , $589.50 , $589.50 , $609.15 , $628.80 , N/A , $556.75 , $524.00 , N/A , N/A , N/A , N/A , $622.25 , N/A , $524.00 , $628.80 
 AZITHROMYCIN 500 MG IV SOLR ,HCPCS J0456,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0398-10,5 mL, $45.81 , $29.78 , $38.48 , $2.84 , $2.64 , $37.01 , $41.23 , $38.78 , $41.23 , $41.23 , $41.23 , $38.94 , $2.59 , $42.30 , $43.52 , $38.94 , $42.60 , $42.60 , $43.52 , $43.98 , $37.48 , $41.23 , $38.94 , $36.19 , N/A , $37.07 , $37.07 , $43.52 , $39.31 , $2.59 , $43.98 
 Fac Byp W/Vein Aortofemoral ,CPT® 35539,0360 - OR SERVICES,N/A,N/A," $4,685.00 "," $3,045.25 "," $3,935.40 "," $1,937.19 "," $1,999.81 "," $3,785.48 "," $4,216.50 "," $3,966.32 "," $4,216.50 "," $4,216.50 "," $4,216.50 "," $3,982.25 "," $1,960.60 "," $4,325.66 "," $4,450.75 "," $3,982.25 "," $4,357.05 "," $4,357.05 "," $4,450.75 "," $4,497.60 "," $3,833.27 "," $4,216.50 "," $3,982.25 "," $3,701.15 ", N/A ," $3,791.57 "," $3,791.57 "," $4,450.75 "," $4,020.20 "," $1,937.19 "," $4,497.60 "
Family Adapt Bhv Tx Gdn Phys/Qhp Ea 15 Min,CPT® 97156,N/A,N/A,N/A, $120.00 , $78.00 , N/A , N/A , $26.30 , N/A , N/A , $111.60 , $108.00 , $108.00 , $96.00 , $96.00 , $26.30 , $110.80 , $114.00 , $108.00 , $108.00 , $108.00 , $111.60 , $115.20 , N/A , $102.00 , $96.00 , N/A , N/A , N/A , N/A , $114.00 , N/A , $26.30 , $115.20 
 Pro Closed Tx Phalage Shaft Fx ,CPT® 26725,0982 - PRO FEE/OUTPT,N/A,N/A," $1,012.00 ", $657.80 ," $1,888.97 ", $298.96 , $132.15 ," $1,457.95 "," $1,481.04 ", $941.16 , $910.80 , $910.80 , $809.60 , $809.60 , $132.15 , $934.38 , $961.40 , $910.80 , $910.80 , $910.80 , $941.16 , $971.52 ," $1,742.10 ", $860.20 ," $1,625.28 "," $1,732.55 ", N/A ," $1,486.40 "," $1,486.40 ", $961.40 ," $1,747.03 ", $132.15 ," $1,888.97 "
 Fac Radex Hip Unilateral With Pelvis 2-3 Views ,CPT® 73502,0320 - DX X-RAY,N/A,N/A, $435.00 , $282.75 , $365.40 , $46.24 , $32.45 , $351.48 , $391.50 , $368.27 , $391.50 , $391.50 , $391.50 , $369.75 , $31.81 , $401.64 , $413.25 , $369.75 , $404.55 , $404.55 , $413.25 , $417.60 , $355.92 , $391.50 , $369.75 , $343.65 , N/A , $352.05 , $352.05 , $413.25 , $373.27 , $31.81 , $417.60 
 Fac Assay of Aluminum ,CPT® 82108,0301 - LAB/CHEMISTRY,N/A,N/A, $226.00 , $146.90 , $189.84 , $25.99 , $25.99 , $182.61 , $203.40 , $191.33 , $203.40 , $203.40 , $203.40 , $192.10 , $25.48 , $208.67 , $214.70 , $192.10 , $210.18 , $210.18 , $214.70 , $216.96 , $184.91 , $203.40 , $192.10 , $178.54 , N/A , $182.90 , $182.90 , $214.70 , $193.93 , $25.48 , $216.96 
DXA Bone Density Study 1+ Sits Axial Skel,CPT® 77080,N/A,N/A,N/A, $941.00 , $611.65 , $207.70 , $37.34 , $90.07 , $191.46 , $259.32 , $875.13 , $846.90 , $846.90 , $752.80 , $752.80 , $90.07 , $868.83 , $893.95 , $846.90 , $846.90 , $846.90 , $875.13 , $903.36 , $341.81 , $799.85 , $285.05 , $313.78 , N/A , $195.20 , $195.20 , $893.95 , $225.93 , $37.34 , $903.36 
Revise Ulnar Nerve at Elbow,64718,N/A,N/A,N/A," $3,886.00 "," $2,525.90 "," $2,935.92 ", $578.30 , $486.60 ," $3,246.74 "," $3,188.24 "," $3,613.98 "," $3,497.40 "," $3,497.40 "," $3,108.80 "," $3,108.80 ", $486.60 ," $3,587.94 "," $3,691.70 "," $3,497.40 "," $3,497.40 "," $3,497.40 "," $3,613.98 "," $3,730.56 "," $3,158.37 "," $3,303.10 "," $3,161.36 "," $3,490.52 ", N/A ," $3,310.09 "," $3,310.09 "," $3,691.70 "," $3,550.93 ", $486.60 ," $3,730.56 "
"Bx/Remv,Lymph Node,Deep Axill",38525,N/A,N/A,N/A," $5,210.00 "," $3,386.50 "," $2,030.20 ", $410.70 , $363.55 ," $1,513.82 "," $1,566.39 "," $4,845.30 "," $4,689.00 "," $4,689.00 "," $4,168.00 "," $4,168.00 ", $363.55 ," $4,810.39 "," $4,949.50 "," $4,689.00 "," $4,689.00 "," $4,689.00 "," $4,845.30 "," $5,001.60 "," $2,165.66 "," $4,428.50 "," $2,317.50 "," $2,097.50 ", N/A ," $1,543.35 "," $1,543.35 "," $4,949.50 "," $1,790.50 ", $363.55 ," $5,001.60 "
"Rx Ectop Preg by Scope,Rmv Tube/Ovry",CPT® 59151,N/A,N/A,N/A," $5,135.00 "," $3,337.75 "," $2,099.97 ", $709.62 , $610.52 ," $1,731.35 "," $1,822.20 "," $4,775.55 "," $4,621.50 "," $4,621.50 "," $4,108.00 "," $4,108.00 ", $610.52 ," $4,741.15 "," $4,878.25 "," $4,621.50 "," $4,621.50 "," $4,621.50 "," $4,775.55 "," $4,929.60 "," $2,114.15 "," $4,364.75 "," $4,024.85 "," $3,213.24 ", N/A ," $1,765.14 "," $1,765.14 "," $4,878.25 "," $2,040.67 ", $610.52 ," $4,929.60 "
X-Ray Hand 3+ Vw,CPT® 73130,N/A,N/A,N/A, $334.00 , $217.10 , $205.49 , $36.30 , $29.84 , $143.83 , $173.22 , $310.62 , $300.60 , $300.60 , $267.20 , $267.20 , $29.84 , $308.38 , $317.30 , $300.60 , $300.60 , $300.60 , $310.62 , $320.64 , $199.02 , $283.90 , $190.68 , $160.24 , N/A , $146.64 , $146.64 , $317.30 , $169.73 , $29.84 , $320.64 
 Fac Amb Ift 911 Base Rate Bls Emergent ,HCPCS A0429,0540 - AMBULANCE,N/A,N/A," $1,290.00 ", $838.50 ," $1,083.60 ", N/A , $344.49 ," $1,042.32 "," $1,161.00 "," $1,092.11 "," $1,161.00 "," $1,161.00 "," $1,161.00 "," $1,096.50 ", $337.74 ," $1,191.06 "," $1,225.50 "," $1,096.50 "," $1,199.70 "," $1,199.70 "," $1,225.50 "," $1,238.40 "," $1,055.48 "," $1,161.00 "," $1,096.50 "," $1,019.10 ", N/A ," $1,044.00 "," $1,044.00 "," $1,225.50 "," $1,106.95 ", $337.74 ," $1,238.40 "
 WARFARIN SODIUM 2.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00832-1213-01,1 tablet, $3.40 , $2.21 , $2.86 , N/A , N/A , $2.75 , $3.06 , $2.88 , $3.06 , $3.06 , $3.06 , $2.89 , N/A , $3.14 , $3.23 , $2.89 , $3.16 , $3.16 , $3.23 , $3.26 , $2.78 , $3.06 , $2.89 , $2.69 , N/A , $2.75 , $2.75 , $3.23 , $2.92 , $2.69 , $3.26 
 Pro Xcapsl Ctrc Rmvl Insj Io Lens Prosth Insj 1+ ,CPT® 66991,0975 - PRO FEE/OR,N/A,N/A," $7,064.00 "," $4,591.60 "," $4,206.54 ", $659.93 , $430.89 , N/A , N/A ," $6,569.52 "," $6,357.60 "," $6,357.60 "," $5,651.20 "," $5,651.20 ", $430.89 ," $6,522.19 "," $6,710.80 "," $6,357.60 "," $6,357.60 "," $6,357.60 "," $6,569.52 "," $6,781.44 ", N/A ," $6,004.40 "," $3,564.55 "," $4,978.77 ", N/A ," $3,590.35 "," $3,590.35 "," $6,710.80 "," $3,964.34 ", $430.89 ," $6,781.44 "
 Fac Assay of Dihydroxyvitamin D ,CPT® 82652,0301 - LAB/CHEMISTRY,N/A,N/A, $356.00 , $231.40 , $299.04 , $39.27 , $39.27 , $287.65 , $320.40 , $301.39 , $320.40 , $320.40 , $320.40 , $302.60 , $38.50 , $328.69 , $338.20 , $302.60 , $331.08 , $331.08 , $338.20 , $341.76 , $291.28 , $320.40 , $302.60 , $281.24 , N/A , $288.11 , $288.11 , $338.20 , $305.48 , $38.50 , $341.76 
 AMLODIPINE BESYLATE 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6370-61,1 tablet, $8.44 , $5.49 , $7.09 , N/A , N/A , $6.82 , $7.60 , $7.15 , $7.60 , $7.60 , $7.60 , $7.17 , N/A , $7.79 , $8.02 , $7.17 , $7.85 , $7.85 , $8.02 , $8.10 , $6.91 , $7.60 , $7.17 , $6.67 , N/A , $6.83 , $6.83 , $8.02 , $7.24 , $6.67 , $8.10 
Part Removal Colon W Ostomy/Mucofist,CPT® 44144,N/A,N/A,N/A," $11,535.00 "," $7,497.75 "," $10,495.29 "," $1,625.47 "," $1,229.45 "," $8,329.35 "," $8,411.18 "," $10,727.55 "," $10,381.50 "," $10,381.50 "," $9,228.00 "," $9,228.00 "," $1,229.45 "," $10,650.27 "," $10,958.25 "," $10,381.50 "," $10,381.50 "," $10,381.50 "," $10,727.55 "," $11,073.60 "," $7,541.20 "," $9,804.75 "," $9,355.63 "," $9,829.34 ", N/A ," $8,491.87 "," $8,491.87 "," $10,958.25 "," $8,881.60 "," $1,229.45 "," $11,073.60 "
 Fac Misc Dialysis Supplies Noc ,CPT® A4913,0270 - MED-SUR SUPPLIES,N/A,N/A, $18.00 , $11.70 , $15.12 , N/A , N/A , $14.54 , $16.20 , $15.24 , $16.20 , $16.20 , $16.20 , $15.30 , N/A , $16.62 , $17.10 , $15.30 , $16.74 , $16.74 , $17.10 , $17.28 , $14.73 , $16.20 , $15.30 , $14.22 , N/A , $14.57 , $14.57 , $17.10 , $15.45 , $14.22 , $17.28 
 OB Less Than 14 Wks 1st Tri US ,CPT® 76801,0402 - ULTRASOUND,N/A,N/A, $591.00 , $384.15 , $496.44 , $116.85 , $118.45 , $477.53 , $531.90 , $500.34 , $531.90 , $531.90 , $531.90 , $502.35 , $116.13 , $545.67 , $561.45 , $502.35 , $549.63 , $549.63 , $561.45 , $567.36 , $483.56 , $531.90 , $502.35 , $466.89 , N/A , $478.30 , $478.30 , $561.45 , $507.14 , $116.13 , $567.36 
"CT Scan,Abdomen and Pelvis,Combo",CPT® 74178,N/A,N/A,N/A," $6,042.00 "," $3,927.30 "," $2,470.93 ", $350.88 , $319.24 ," $1,680.49 "," $2,072.72 "," $5,619.06 "," $5,437.80 "," $5,437.80 "," $4,833.60 "," $4,833.60 ", $319.24 ," $5,578.58 "," $5,739.90 "," $5,437.80 "," $5,437.80 "," $5,437.80 "," $5,619.06 "," $5,800.32 "," $2,062.13 "," $5,135.70 "," $2,318.95 "," $2,291.05 ", N/A ," $1,713.28 "," $1,713.28 "," $5,739.90 "," $1,983.16 ", $319.24 ," $5,800.32 "
"Excise Excess Skin Tissue,Arm",CPT® 15836,N/A,N/A,N/A," $2,949.00 "," $1,916.85 "," $2,534.05 ", $759.94 , $401.40 ," $2,147.84 "," $2,110.65 "," $2,742.57 "," $2,654.10 "," $2,654.10 "," $2,359.20 "," $2,359.20 ", $401.40 ," $2,722.81 "," $2,801.55 "," $2,654.10 "," $2,654.10 "," $2,654.10 "," $2,742.57 "," $2,831.04 "," $2,620.06 "," $2,506.65 "," $4,235.37 "," $2,747.29 ", N/A ," $2,189.75 "," $2,189.75 "," $2,801.55 "," $2,539.38 ", $401.40 ," $4,235.37 "
 Pt Mechanical Traction -Outpt ,CPT® 97012,0420 - PHYSICAL THERAPY,N/A,N/A, $89.00 , $57.85 , $74.76 , $14.33 , $26.30 , $71.91 , $80.10 , $75.35 , $80.10 , $80.10 , $80.10 , $75.65 , $25.78 , $82.17 , $84.55 , $75.65 , $82.77 , $82.77 , $84.55 , $85.44 , $72.82 , $80.10 , $75.65 , $70.31 , N/A , $72.03 , $72.03 , $84.55 , $76.37 , $14.33 , $85.44 
" Pro Treat Finger Fracture, Each ",CPT® 26765,0982 - PRO FEE/OUTPT,N/A,N/A," $3,278.00 "," $2,130.70 "," $3,092.25 ", $487.69 , $262.37 ," $2,411.56 "," $2,427.02 "," $3,048.54 "," $2,950.20 "," $2,950.20 "," $2,622.40 "," $2,622.40 ", $262.37 ," $3,026.58 "," $3,114.10 "," $2,950.20 "," $2,950.20 "," $2,950.20 "," $3,048.54 "," $3,146.88 "," $2,869.55 "," $2,786.30 "," $2,667.18 "," $2,865.11 ", N/A ," $2,458.61 "," $2,458.61 "," $3,114.10 "," $2,889.74 ", $262.37 ," $3,146.88 "
Ko Adj Jnt POS R Sup Pre Ots,HCPCS L1833,N/A,N/A,N/A, $806.00 , $523.90 , N/A , $570.00 , $272.48 , N/A , N/A , $749.58 , $725.40 , $725.40 , $644.80 , $644.80 , $272.48 , $744.18 , $765.70 , $725.40 , $725.40 , $725.40 , $749.58 , $773.76 , N/A , $685.10 , $925.95 , $677.88 , N/A , N/A , N/A , $765.70 , N/A , $272.48 , $925.95 
"Percut Implant,Neuroelec,Sacral Nerve",CPT® 64561,N/A,N/A,N/A," $6,136.00 "," $3,988.40 "," $1,483.46 ", $288.45 , $788.34 ," $1,686.69 "," $2,136.23 "," $5,706.48 "," $5,522.40 "," $5,522.40 "," $4,908.80 "," $4,908.80 ", $788.34 ," $5,665.37 "," $5,829.20 "," $5,522.40 "," $5,522.40 "," $5,522.40 "," $5,706.48 "," $5,890.56 "," $1,606.53 "," $5,215.60 "," $2,074.87 "," $1,827.68 ", N/A ," $1,719.61 "," $1,719.61 "," $5,829.20 "," $1,844.74 ", $288.45 ," $5,890.56 "
 Chest CT Scan Without/With Contrast ,CPT® 71270,0350 - CT SCAN,N/A,N/A," $3,277.00 "," $2,130.05 "," $2,752.68 ", $201.03 , $373.42 ," $2,647.82 "," $2,949.30 "," $2,774.31 "," $2,949.30 "," $2,949.30 "," $2,949.30 "," $2,785.45 ", $366.10 ," $3,025.65 "," $3,113.15 "," $2,785.45 "," $3,047.61 "," $3,047.61 "," $3,113.15 "," $3,145.92 "," $2,681.24 "," $2,949.30 "," $2,785.45 "," $2,588.83 ", N/A ," $2,652.08 "," $2,652.08 "," $3,113.15 "," $2,811.99 ", $201.03 ," $3,145.92 "
RBC Sickle Cell Test,CPT® 85660,N/A,N/A,N/A, $66.00 , $42.90 , N/A , $5.62 , $5.62 , $31.18 , $37.37 , $61.38 , $59.40 , $59.40 , $52.80 , $52.80 , $5.62 , $60.94 , $62.70 , $59.40 , $59.40 , $59.40 , $61.38 , $63.36 , $36.79 , $56.10 , $35.68 , $19.97 , N/A , $29.10 , $29.10 , $62.70 , $31.80 , $5.62 , $63.36 
 FENTANYL 50 MCG/ML INJECTION (ANES&INPT) ,HCPCS J3010,0636 - DRUGS REQUIRING DETAILED CODIN,00409-9094-22,2 mL, $17.32 , $11.26 , $14.55 , $0.86 , $1.00 , $13.99 , $15.59 , $14.66 , $15.59 , $15.59 , $15.59 , $14.72 , $0.98 , $15.99 , $16.45 , $14.72 , $16.11 , $16.11 , $16.45 , $16.63 , $14.17 , $15.59 , $14.72 , $13.68 , N/A , $14.02 , $14.02 , $16.45 , $14.86 , $0.86 , $16.63 
Removal Deep Implant,CPT® 20680,N/A,N/A,N/A," $4,124.00 "," $2,680.60 "," $2,551.97 ", $400.31 , $233.67 ," $2,051.77 "," $2,058.74 "," $3,835.32 "," $3,711.60 "," $3,711.60 "," $3,299.20 "," $3,299.20 ", $233.67 ," $3,807.69 "," $3,917.80 "," $3,711.60 "," $3,711.60 "," $3,711.60 "," $3,835.32 "," $3,959.04 "," $2,378.32 "," $3,505.40 "," $2,265.76 "," $2,423.60 ", N/A ," $2,091.80 "," $2,091.80 "," $3,917.80 "," $2,458.61 ", $233.67 ," $3,959.04 "
Xcapsl Ctrc Rmvl Insj Io Lens Prosth Cplx WO Ecp,CPT® 66982,N/A,N/A,N/A," $6,377.00 "," $4,145.05 "," $4,590.24 ", $719.58 , $590.85 ," $4,503.46 "," $4,211.34 "," $5,930.61 "," $5,739.30 "," $5,739.30 "," $5,101.60 "," $5,101.60 ", $590.85 ," $5,887.88 "," $6,058.15 "," $5,739.30 "," $5,739.30 "," $5,739.30 "," $5,930.61 "," $6,121.92 "," $6,310.51 "," $5,420.45 "," $4,344.20 "," $5,713.83 ", N/A ," $4,591.33 "," $4,591.33 "," $6,058.15 "," $5,068.22 ", $590.85 ," $6,310.51 "
 Bone Age Study ,CPT® 77072,0320 - DX X-RAY,N/A,N/A, $348.00 , $226.20 , $292.32 , $25.50 , $18.38 , $281.18 , $313.20 , $294.62 , $313.20 , $313.20 , $313.20 , $295.80 , $18.02 , $321.31 , $330.60 , $295.80 , $323.64 , $323.64 , $330.60 , $334.08 , $284.73 , $313.20 , $295.80 , $274.92 , N/A , $281.64 , $281.64 , $330.60 , $298.62 , $18.02 , $334.08 
 Other Multiple Significant Trauma Without Cc/McC ,MS DRG V40 (FY2023) 965,N/A,N/A,N/A," $21,967.13 "," $14,278.63 "," $18,452.39 ", N/A , N/A ," $17,749.44 "," $19,770.42 "," $18,597.37 "," $19,770.42 "," $19,770.42 "," $19,770.42 "," $18,672.06 ", N/A ," $20,282.25 "," $20,868.77 "," $18,672.06 "," $20,429.43 "," $20,429.43 "," $20,868.77 "," $21,088.44 "," $17,973.51 "," $19,770.42 "," $18,672.06 "," $17,354.03 ", N/A ," $17,778.00 "," $17,778.00 "," $20,868.77 "," $18,849.99 "," $17,354.03 "," $21,088.44 "
Diagnostic Mammography Computer-Aided Detcj Bi,CPT® 77066,N/A,N/A,N/A, $824.00 , $535.60 , $901.96 , $156.27 , $133.81 , $779.21 , $864.47 , $766.32 , $741.60 , $741.60 , $659.20 , $659.20 , $133.81 , $760.80 , $782.80 , $741.60 , $741.60 , $741.60 , $766.32 , $791.04 , $900.41 , $700.40 , $909.30 , $924.37 , N/A , $794.41 , $794.41 , $782.80 , $919.55 , $133.81 , $924.37 
Knee Orth POS Locking Joint,HCPCS L1831,N/A,N/A,N/A, $368.00 , $239.20 , N/A , $344.27 , $108.17 , N/A , N/A , $342.24 , $331.20 , $331.20 , $294.40 , $294.40 , $108.17 , $339.77 , $349.60 , $331.20 , $331.20 , $331.20 , $342.24 , $353.28 , N/A , $312.80 , $284.15 , $289.65 , N/A , N/A , N/A , $349.60 , N/A , $108.17 , $353.28 
 Fac Tobramycin ,CPT® 80200,0301 - LAB/CHEMISTRY,N/A,N/A, $136.00 , $88.40 , $114.24 , $16.45 , $16.45 , $109.89 , $122.40 , $115.14 , $122.40 , $122.40 , $122.40 , $115.60 , $16.13 , $125.57 , $129.20 , $115.60 , $126.48 , $126.48 , $129.20 , $130.56 , $111.28 , $122.40 , $115.60 , $107.44 , N/A , $110.06 , $110.06 , $129.20 , $116.70 , $16.13 , $130.56 
 HEPATITIS A-HEP B RECOMB VAC 720-20 ELU-MCG/ML IM SUSY ,HCPCS 90636,0636 - DRUGS REQUIRING DETAILED CODIN,58160-0815-52,1 mL, $746.80 , $485.42 , $627.31 , N/A , $113.03 , $603.41 , $672.12 , $632.24 , $672.12 , $672.12 , $672.12 , $634.78 , $110.81 , $689.52 , $709.46 , $634.78 , $694.52 , $694.52 , $709.46 , $716.93 , $611.03 , $672.12 , $634.78 , $589.97 , N/A , $604.39 , $604.39 , $709.46 , $640.83 , $110.81 , $716.93 
 Fac Lamotrigine (Lamictal) ,CPT® 86885,0300 - LABORATORY,N/A,N/A, $76.00 , $49.40 , $63.84 , $5.83 , $5.83 , $61.41 , $68.40 , $64.34 , $68.40 , $68.40 , $68.40 , $64.60 , $5.72 , $70.17 , $72.20 , $64.60 , $70.68 , $70.68 , $72.20 , $72.96 , $62.18 , $68.40 , $64.60 , $60.04 , N/A , $61.51 , $61.51 , $72.20 , $65.22 , $5.72 , $72.96 
 FENTANYL 100 MCG/HR TD PT72 ,HCPCS RXC637,0250 - PHARMACY,60505-7084-02,1 patch, $404.34 , $262.82 , $339.65 , N/A , N/A , $326.71 , $363.91 , $342.31 , $363.91 , $363.91 , $363.91 , $343.69 , N/A , $373.33 , $384.12 , $343.69 , $376.04 , $376.04 , $384.12 , $388.17 , $330.83 , $363.91 , $343.69 , $319.43 , N/A , $327.23 , $327.23 , $384.12 , $346.96 , $319.43 , $388.17 
Drain Vulva Abscess,56405,N/A,N/A,N/A, $741.00 , $481.65 , $606.40 , $122.85 , $122.21 , $442.68 , $446.19 , $689.13 , $666.90 , $666.90 , $592.80 , $592.80 , $122.21 , $684.17 , $703.95 , $666.90 , $666.90 , $666.90 , $689.13 , $711.36 , $616.66 , $629.85 , $585.17 , $446.08 , N/A , $451.32 , $451.32 , $703.95 , $541.33 , $122.21 , $711.36 
Open Rx Nose Fx Complicated,CPT® 21330,N/A,N/A,N/A," $3,768.00 "," $2,449.20 "," $3,336.78 ", $521.64 , $780.98 ," $2,789.51 "," $2,810.00 "," $3,504.24 "," $3,391.20 "," $3,391.20 "," $3,014.40 "," $3,014.40 ", $780.98 ," $3,478.99 "," $3,579.60 "," $3,391.20 "," $3,391.20 "," $3,391.20 "," $3,504.24 "," $3,617.28 "," $3,084.26 "," $3,202.80 "," $3,057.89 "," $3,250.07 ", N/A ," $2,843.94 "," $2,843.94 "," $3,579.60 "," $3,342.64 ", $521.64 ," $3,617.28 "
"Fx Ulnar Styloid, Closed",25650,N/A,N/A,N/A," $1,496.00 ", $972.40 ," $1,902.94 ", $302.14 , $151.20 ," $1,442.04 "," $1,468.96 "," $1,391.28 "," $1,346.40 "," $1,346.40 "," $1,196.80 "," $1,196.80 ", $151.20 ," $1,381.26 "," $1,421.20 "," $1,346.40 "," $1,346.40 "," $1,346.40 "," $1,391.28 "," $1,436.16 "," $1,751.68 "," $1,271.60 "," $1,611.01 "," $1,717.60 ", N/A ," $1,470.18 "," $1,470.18 "," $1,421.20 "," $1,727.98 ", $151.20 ," $1,902.94 "
In Situ Hybridization Ea Multiplex Probe Stain,CPT® 88366,N/A,N/A,N/A, $836.00 , $543.40 ," $1,015.47 ", $274.14 , $117.74 , $593.70 , $683.82 , $777.48 , $752.40 , $752.40 , $668.80 , $668.80 , $117.74 , $771.88 , $794.20 , $752.40 , $752.40 , $752.40 , $777.48 , $802.56 ," $1,856.53 ", $710.60 ," $1,342.37 ", $912.29 , N/A , $554.08 , $554.08 , $794.20 , $608.91 , $117.74 ," $1,856.53 "
 Pro Vag Hyst W/Enterocele Repair ,CPT® 58270,0982 - PRO FEE/OUTPT,N/A,N/A," $5,266.00 "," $3,422.90 "," $4,225.55 ", $854.14 , $802.87 ," $3,588.29 "," $3,575.10 "," $4,897.38 "," $4,739.40 "," $4,739.40 "," $4,212.80 "," $4,212.80 ", $802.87 ," $4,862.10 "," $5,002.70 "," $4,739.40 "," $4,739.40 "," $4,739.40 "," $4,897.38 "," $5,055.36 "," $4,407.76 "," $4,476.10 "," $4,702.79 "," $3,597.61 ", N/A ," $3,658.30 "," $3,658.30 "," $5,002.70 "," $4,387.91 ", $802.87 ," $5,055.36 "
" Fac Complement, Antigen ",CPT® 86160,0301 - LAB/CHEMISTRY,N/A,N/A, $165.00 , $107.25 , $138.60 , $12.24 , $12.24 , $133.32 , $148.50 , $139.69 , $148.50 , $148.50 , $148.50 , $140.25 , $12.00 , $152.34 , $156.75 , $140.25 , $153.45 , $153.45 , $156.75 , $158.40 , $135.00 , $148.50 , $140.25 , $130.35 , N/A , $133.53 , $133.53 , $156.75 , $141.59 , $12.00 , $158.40 
" Pro Inj Trigger Point, 1/2 Muscl ",CPT® 20552,0982 - PRO FEE/OUTPT,N/A,N/A, $360.00 , $234.00 , $95.85 , $35.51 , $26.41 , $186.23 , $182.64 , $334.80 , $324.00 , $324.00 , $288.00 , $288.00 , $26.41 , $332.39 , $342.00 , $324.00 , $324.00 , $324.00 , $334.80 , $345.60 , $215.67 , $306.00 , $199.82 , $220.70 , N/A , $189.86 , $189.86 , $342.00 , $223.15 , $26.41 , $345.60 
Foot Plastic Heel Stabilizer,HCPCS L3170,N/A,N/A,N/A, $78.00 , $50.70 , N/A , $59.50 , $30.50 , N/A , N/A , $72.54 , $70.20 , $70.20 , $62.40 , $62.40 , $30.50 , $72.02 , $74.10 , $70.20 , $70.20 , $70.20 , $72.54 , $74.88 , N/A , $66.30 , $49.31 , $50.06 , N/A , N/A , N/A , $74.10 , N/A , $30.50 , $74.88 
Laps Abltj Uterine Fibroids W/Intraop US Gdn,CPT® 58674,N/A,N/A,N/A," $5,017.00 "," $3,261.05 "," $3,829.20 ", $774.66 , $425.15 ," $3,211.12 "," $3,176.33 "," $4,665.81 "," $4,515.30 "," $4,515.30 "," $4,013.60 "," $4,013.60 ", $425.15 ," $4,632.20 "," $4,766.15 "," $4,515.30 "," $4,515.30 "," $4,515.30 "," $4,665.81 "," $4,816.32 "," $4,014.75 "," $4,264.45 "," $4,337.52 "," $3,326.20 ", N/A ," $3,273.77 "," $3,273.77 "," $4,766.15 "," $3,926.68 ", $425.15 ," $4,816.32 "
Analyze Infusn Pump+Reprogram,CPT® 62368,N/A,N/A,N/A, $374.00 , $243.10 , $171.13 , $32.90 , $49.16 , $197.60 , $189.11 , $347.82 , $336.60 , $336.60 , $299.20 , $299.20 , $49.16 , $345.31 , $355.30 , $336.60 , $336.60 , $336.60 , $347.82 , $359.04 , $104.88 , $317.90 , $181.97 , $211.36 , N/A , $201.45 , $201.45 , $355.30 , $216.12 , $32.90 , $359.04 
" Fac Immunoassay, Nonantibody ",CPT® 83519,0302 - LAB/IMMUNOLOGY,N/A,N/A, $217.00 , $141.05 , $182.28 , $18.77 , $18.76 , $175.34 , $195.30 , $183.71 , $195.30 , $195.30 , $195.30 , $184.45 , $18.39 , $200.36 , $206.15 , $184.45 , $201.81 , $201.81 , $206.15 , $208.32 , $177.55 , $195.30 , $184.45 , $171.43 , N/A , $175.62 , $175.62 , $206.15 , $186.21 , $18.39 , $208.32 
Revise Eyelashes,CPT® 67825,N/A,N/A,N/A," $1,211.00 ", $787.15 , $748.54 , $117.93 , $61.48 , $686.31 , $650.74 ," $1,126.23 "," $1,089.90 "," $1,089.90 ", $968.80 , $968.80 , $61.48 ," $1,118.12 "," $1,150.45 "," $1,089.90 "," $1,089.90 "," $1,089.90 "," $1,126.23 "," $1,162.56 "," $1,027.11 "," $1,029.35 ", $674.38 , $875.68 , N/A , $699.70 , $699.70 ," $1,150.45 ", $772.39 , $61.48 ," $1,162.56 "
" Pro Vein X-Ray, Arm/Leg ",CPT® 75820,0972 - PRO FEE/RAD/DX,N/A,N/A, $308.00 , $200.20 , $623.21 , $107.21 , $77.42 , $550.08 , $665.50 , $286.44 , $277.20 , $277.20 , $246.40 , $246.40 , $77.42 , $284.38 , $292.60 , $277.20 , $277.20 , $277.20 , $286.44 , $295.68 , $649.08 , $261.80 , $728.04 , $583.15 , N/A , $560.81 , $560.81 , $292.60 , $649.16 , $77.42 , $728.04 
 LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN ,HCPCS RXA250,0250 - PHARMACY,63323-0482-27,20 mL, $26.61 , $17.30 , $22.35 , N/A , N/A , $21.50 , $23.95 , $22.53 , $23.95 , $23.95 , $23.95 , $22.62 , N/A , $24.57 , $25.28 , $22.62 , $24.75 , $24.75 , $25.28 , $25.55 , $21.77 , $23.95 , $22.62 , $21.02 , N/A , $21.54 , $21.54 , $25.28 , $22.83 , $21.02 , $25.55 
"Special Eye Exam, Initial",CPT® 92225,N/A,N/A,N/A, $66.00 , $42.90 , N/A , N/A , N/A , N/A , $38.43 , $61.38 , $59.40 , $59.40 , $52.80 , $52.80 , N/A , $60.94 , $62.70 , $59.40 , $59.40 , $59.40 , $61.38 , $63.36 , N/A , $56.10 , N/A , N/A , N/A , N/A , N/A , $62.70 , N/A , $38.43 , $63.36 
Molecular Cyto Chrom 25-,CPT® 88274,N/A,N/A,N/A, $432.00 , $280.80 , N/A , $43.23 , $43.23 , $194.91 , $295.33 , $401.76 , $388.80 , $388.80 , $345.60 , $345.60 , $43.23 , $398.87 , $410.40 , $388.80 , $388.80 , $388.80 , $401.76 , $414.72 , $282.98 , $367.20 , $228.68 , $152.15 , N/A , $181.90 , $181.90 , $410.40 , $199.90 , $43.23 , $414.72 
" Fac IV Infusion, Therap/Proph/Diagnost,Initial,1st Hour ",CPT® 96365,0260 - IV THERAPY,N/A,N/A, $438.00 , $284.70 , $367.92 , $62.20 , $63.10 , $353.90 , $394.20 , $370.81 , $394.20 , $394.20 , $394.20 , $372.30 , $61.86 , $404.41 , $416.10 , $372.30 , $407.34 , $407.34 , $416.10 , $420.48 , $358.37 , $394.20 , $372.30 , $346.02 , N/A , $354.47 , $354.47 , $416.10 , $375.85 , $61.86 , $420.48 
"Electrodes, Pair",HCPCS A4556,N/A,N/A,N/A, $101.00 , $65.65 , N/A , $16.47 , $4.13 , N/A , N/A , $93.93 , $90.90 , $90.90 , $80.80 , $80.80 , $4.13 , $93.25 , $95.95 , $90.90 , $90.90 , $90.90 , $93.93 , $96.96 , N/A , $85.85 , $14.27 , $14.97 , N/A , N/A , N/A , $95.95 , N/A , $4.13 , $96.96 
 Fac C-Reactive Protein ,CPT® 86140,0302 - LAB/IMMUNOLOGY,N/A,N/A, $82.00 , $53.30 , $68.88 , $5.28 , $5.28 , $66.26 , $73.80 , $69.42 , $73.80 , $73.80 , $73.80 , $69.70 , $5.18 , $75.71 , $77.90 , $69.70 , $76.26 , $76.26 , $77.90 , $78.72 , $67.09 , $73.80 , $69.70 , $64.78 , N/A , $66.36 , $66.36 , $77.90 , $70.36 , $5.18 , $78.72 
"Fix Depress Skull Fx,Repr Dura",CPT® 62010,N/A,N/A,N/A," $10,361.00 "," $6,734.65 "," $7,034.09 "," $1,374.33 "," $1,265.46 "," $8,280.69 "," $7,900.00 "," $9,635.73 "," $9,324.90 "," $9,324.90 "," $8,288.80 "," $8,288.80 "," $1,265.46 "," $9,566.31 "," $9,842.95 "," $9,324.90 "," $9,324.90 "," $9,324.90 "," $9,635.73 "," $9,946.56 "," $7,585.91 "," $8,806.85 "," $8,119.28 "," $8,555.46 ", N/A ," $8,442.25 "," $8,442.25 "," $9,842.95 "," $9,056.57 "," $1,265.46 "," $9,946.56 "
 Bx-Salivary Gland ,CPT® 42400,0761 - TREATMENT ROOM,N/A,N/A," $3,033.00 "," $1,971.45 "," $2,547.72 ", $51.14 , $76.84 ," $2,450.66 "," $2,729.70 "," $2,567.74 "," $2,729.70 "," $2,729.70 "," $2,729.70 "," $2,578.05 ", $75.33 ," $2,800.37 "," $2,881.35 "," $2,578.05 "," $2,820.69 "," $2,820.69 "," $2,881.35 "," $2,911.68 "," $2,481.60 "," $2,729.70 "," $2,578.05 "," $2,396.07 ", N/A ," $2,454.61 "," $2,454.61 "," $2,881.35 "," $2,602.62 ", $51.14 ," $2,911.68 "
 Pro Drainage of Gum Lesion ,CPT® 41800,0982 - PRO FEE/OUTPT,N/A,N/A, $731.00 , $475.15 , $949.52 , $149.06 , $30.71 , $713.43 , $755.10 , $679.83 , $657.90 , $657.90 , $584.80 , $584.80 , $30.71 , $674.93 , $694.45 , $657.90 , $657.90 , $657.90 , $679.83 , $701.76 , $697.11 , $621.35 , $824.24 , $871.64 , N/A , $727.36 , $727.36 , $694.45 , $760.72 , $30.71 , $949.52 
 IRINOTECAN HCL LIPOSOME 43 MG/10ML IV INJ ,HCPCS J9205,0636 - DRUGS REQUIRING DETAILED CODIN,15054-0043-01,10 mL," $17,050.30 "," $11,082.70 "," $14,322.25 ", $63.20 , $61.26 ," $13,776.64 "," $15,345.27 "," $14,434.78 "," $15,345.27 "," $15,345.27 "," $15,345.27 "," $14,492.76 ", $60.06 ," $15,742.54 "," $16,197.79 "," $14,492.76 "," $15,856.78 "," $15,856.78 "," $16,197.79 "," $16,368.29 "," $13,950.56 "," $15,345.27 "," $14,492.76 "," $13,469.74 ", N/A ," $13,798.81 "," $13,798.81 "," $16,197.79 "," $14,630.86 ", $60.06 ," $16,368.29 "
Drain Bartholin's Gland,CPT® 56420,N/A,N/A,N/A, $690.00 , $448.50 , $529.30 , $107.00 , $49.34 , $372.48 , $373.89 , $641.70 , $621.00 , $621.00 , $552.00 , $552.00 , $49.34 , $637.08 , $655.50 , $621.00 , $621.00 , $621.00 , $641.70 , $662.40 , $537.13 , $586.50 , $490.62 , $372.95 , N/A , $379.75 , $379.75 , $655.50 , $455.49 , $49.34 , $662.40 
 Fac Dlyd Placement Xtn Prosth for Evasc Rpr Ea Addl ,CPT® 34711,0360 - OR SERVICES,N/A,N/A, $357.00 , $232.05 , $299.88 , $260.67 , $224.92 , $288.46 , $321.30 , $302.24 , $321.30 , $321.30 , $321.30 , $303.45 , $220.51 , $329.62 , $339.15 , $303.45 , $332.01 , $332.01 , $339.15 , $342.72 , $292.10 , $321.30 , $303.45 , $282.03 , N/A , $288.92 , $288.92 , $339.15 , $306.34 , $220.51 , $342.72 
 NAPHAZOLINE-PHENIRAMINE 0.025-0.3 % OP SOLN ,HCPCS RXC637,0250 - PHARMACY,12547-0493-78,15 mL, $32.60 , $21.19 , $27.38 , N/A , N/A , $26.34 , $29.34 , $27.60 , $29.34 , $29.34 , $29.34 , $27.71 , N/A , $30.10 , $30.97 , $27.71 , $30.32 , $30.32 , $30.97 , $31.30 , $26.67 , $29.34 , $27.71 , $25.75 , N/A , $26.38 , $26.38 , $30.97 , $27.97 , $25.75 , $31.30 
"MRI, Dorsal Spine Combo",CPT® 72157,N/A,N/A,N/A," $8,097.00 "," $5,263.05 "," $2,312.03 ", $329.80 , $655.99 ," $1,810.96 "," $2,764.24 "," $7,530.21 "," $7,287.30 "," $7,287.30 "," $6,477.60 "," $6,477.60 ", $655.99 ," $7,475.96 "," $7,692.15 "," $7,287.30 "," $7,287.30 "," $7,287.30 "," $7,530.21 "," $7,773.12 "," $1,989.35 "," $6,882.45 "," $3,010.40 "," $3,518.00 ", N/A ," $1,846.29 "," $1,846.29 "," $7,692.15 "," $2,137.13 ", $329.80 ," $7,773.12 "
 Fac Factor Nhbtor Tst ,CPT® 85335,0305 - LAB/HEMATOLOGY,N/A,N/A, $173.00 , $112.45 , $145.32 , $13.13 , $13.13 , $139.78 , $155.70 , $146.46 , $155.70 , $155.70 , $155.70 , $147.05 , $12.87 , $159.73 , $164.35 , $147.05 , $160.89 , $160.89 , $164.35 , $166.08 , $141.55 , $155.70 , $147.05 , $136.67 , N/A , $140.01 , $140.01 , $164.35 , $148.45 , $12.87 , $166.08 
Rmvl & Rplcmt Xtrnl Accessible Nephrourtrl Cath,CPT® 50387,N/A,N/A,N/A, $743.00 , $482.95 , $451.95 , $78.86 , $632.53 , $486.94 , $452.39 , $690.99 , $668.70 , $668.70 , $594.40 , $594.40 , $632.53 , $686.01 , $705.85 , $668.70 , $668.70 , $668.70 , $690.99 , $713.28 , $455.03 , $631.55 , $513.81 , $522.39 , N/A , $496.43 , $496.43 , $705.85 , $583.50 , $78.86 , $713.28 
Exc Skin Benig 3.1-4cm Remaindr Body,CPT® 11424,N/A,N/A,N/A," $1,175.00 ", $763.75 , $567.77 , $171.28 , $192.83 , $491.20 , $478.70 ," $1,092.75 "," $1,057.50 "," $1,057.50 ", $940.00 , $940.00 , $192.83 ," $1,084.88 "," $1,116.25 "," $1,057.50 "," $1,057.50 "," $1,057.50 "," $1,092.75 "," $1,128.00 ", $619.26 , $998.75 , $954.47 , $625.78 , N/A , $500.78 , $500.78 ," $1,116.25 ", $580.75 , $171.28 ," $1,128.00 "
 Lt Joint Lower Ext MRI W/Contrast ,CPT® 73722,0610 - MRI,N/A,N/A," $6,969.00 "," $4,529.85 "," $5,853.96 ", $323.72 , $498.57 ," $5,630.95 "," $6,272.10 "," $5,899.96 "," $6,272.10 "," $6,272.10 "," $6,272.10 "," $5,923.65 ", $488.79 ," $6,434.48 "," $6,620.55 "," $5,923.65 "," $6,481.17 "," $6,481.17 "," $6,620.55 "," $6,690.24 "," $5,702.04 "," $6,272.10 "," $5,923.65 "," $5,505.51 ", N/A ," $5,640.01 "," $5,640.01 "," $6,620.55 "," $5,980.10 ", $323.72 ," $6,690.24 "
 Fac Hrhc Cplx/X10sv W/Fissurectomy ,CPT® 46261,0360 - OR SERVICES,N/A,N/A," $7,369.00 "," $4,789.85 "," $6,189.96 ", $504.85 , $614.70 ," $5,954.15 "," $6,632.10 "," $6,238.60 "," $6,632.10 "," $6,632.10 "," $6,632.10 "," $6,263.65 ", $602.65 ," $6,803.80 "," $7,000.55 "," $6,263.65 "," $6,853.17 "," $6,853.17 "," $7,000.55 "," $7,074.24 "," $6,029.32 "," $6,632.10 "," $6,263.65 "," $5,821.51 ", N/A ," $5,963.73 "," $5,963.73 "," $7,000.55 "," $6,323.34 ", $504.85 ," $7,074.24 "
 BUPIVACAINE IN DEXTROSE 0.75-8.25 % IT SOLN ,HCPCS RXA250,0250 - PHARMACY,00409-1761-10,1.4 mL, $21.52 , $13.99 , $18.08 , N/A , N/A , $17.39 , $19.37 , $18.22 , $19.37 , $19.37 , $19.37 , $18.29 , N/A , $19.87 , $20.44 , $18.29 , $20.01 , $20.01 , $20.44 , $20.66 , $17.61 , $19.37 , $18.29 , $17.00 , N/A , $17.42 , $17.42 , $20.44 , $18.47 , $17.00 , $20.66 
" Fac Smear, Gram Stain ",CPT® 87205,0306 - LAB/BACT-MICRO,N/A,N/A, $80.00 , $52.00 , $67.20 , $4.36 , $4.36 , $64.64 , $72.00 , $67.73 , $72.00 , $72.00 , $72.00 , $68.00 , $4.27 , $73.86 , $76.00 , $68.00 , $74.40 , $74.40 , $76.00 , $76.80 , $65.46 , $72.00 , $68.00 , $63.20 , N/A , $64.74 , $64.74 , $76.00 , $68.65 , $4.27 , $76.80 
Lens Sphcyl Trifocal 4.00/>6,HCPCS V2306,N/A,N/A,N/A, $90.00 , $58.50 , N/A , $93.42 , N/A , N/A , N/A , $83.70 , $81.00 , $81.00 , $72.00 , $72.00 , N/A , $83.10 , $85.50 , $81.00 , $81.00 , $81.00 , $83.70 , $86.40 , N/A , $76.50 , $90.00 , $84.87 , N/A , N/A , N/A , $85.50 , N/A , $72.00 , $93.42 
 Fac Drug Screening Methylphenidate ,CPT® 80360,0301 - LAB/CHEMISTRY,N/A,N/A, $189.00 , $122.85 , $158.76 , N/A , N/A , $152.71 , $170.10 , $160.01 , $170.10 , $170.10 , $170.10 , $160.65 , N/A , $174.50 , $179.55 , $160.65 , $175.77 , $175.77 , $179.55 , $181.44 , $154.64 , $170.10 , $160.65 , $149.31 , N/A , $152.96 , $152.96 , $179.55 , $162.18 , $149.31 , $181.44 
 Fac Gonorrhea Chlamydia Testing ,CPT® 87591,0306 - LAB/BACT-MICRO,N/A,N/A, $317.00 , $206.05 , $266.28 , $35.79 , $35.79 , $256.14 , $285.30 , $268.37 , $285.30 , $285.30 , $285.30 , $269.45 , $35.09 , $292.69 , $301.15 , $269.45 , $294.81 , $294.81 , $301.15 , $304.32 , $259.37 , $285.30 , $269.45 , $250.43 , N/A , $256.55 , $256.55 , $301.15 , $272.02 , $35.09 , $304.32 
 Pro Remove Prostate Regrowth ,CPT® 52630,0982 - PRO FEE/OUTPT,N/A,N/A," $2,726.00 "," $1,771.90 "," $2,199.72 ", $388.54 , $768.38 ," $1,956.64 "," $1,831.29 "," $2,535.18 "," $2,453.40 "," $2,453.40 "," $2,180.80 "," $2,180.80 ", $768.38 ," $2,516.92 "," $2,589.70 "," $2,453.40 "," $2,453.40 "," $2,453.40 "," $2,535.18 "," $2,616.96 "," $2,198.07 "," $2,317.10 "," $2,073.08 "," $2,465.35 ", N/A ," $1,994.81 "," $1,994.81 "," $2,589.70 "," $2,344.61 ", $388.54 ," $2,616.96 "
 Fac Slctv Cath Subclavian Art Angio Vertebral Artery ,CPT® 36225,0360 - OR SERVICES,N/A,N/A," $16,786.00 "," $10,910.90 "," $14,100.24 ", $288.79 ," $1,503.96 "," $13,563.09 "," $15,107.40 "," $14,211.03 "," $15,107.40 "," $15,107.40 "," $15,107.40 "," $14,268.10 "," $1,474.47 "," $15,498.51 "," $15,946.70 "," $14,268.10 "," $15,610.98 "," $15,610.98 "," $15,946.70 "," $16,114.56 "," $13,734.31 "," $15,107.40 "," $14,268.10 "," $13,260.94 ", N/A ," $13,584.91 "," $13,584.91 "," $15,946.70 "," $14,404.07 ", $288.79 ," $16,114.56 "
"Cystoscopy,Resect Ortho Ureterocele",CPT® 52300,N/A,N/A,N/A," $1,979.00 "," $1,286.35 "," $1,499.77 ", $263.80 , $307.34 ," $1,376.78 "," $1,297.34 "," $1,840.47 "," $1,781.10 "," $1,781.10 "," $1,583.20 "," $1,583.20 ", $307.34 ," $1,827.21 "," $1,880.05 "," $1,781.10 "," $1,781.10 "," $1,781.10 "," $1,840.47 "," $1,899.84 "," $1,510.02 "," $1,682.15 "," $1,473.64 "," $1,727.31 ", N/A ," $1,403.65 "," $1,403.65 "," $1,880.05 "," $1,649.80 ", $263.80 ," $1,899.84 "
 At Initial Eval Moderate Complexity 15 Min ,CPT® 97763,0430 - OCCUPATION THER,N/A,N/A, $155.00 , $100.75 , $130.20 , $52.82 , $30.44 , $125.24 , $139.50 , $131.22 , $139.50 , $139.50 , $139.50 , $131.75 , $29.84 , $143.11 , $147.25 , $131.75 , $144.15 , $144.15 , $147.25 , $148.80 , $126.82 , $139.50 , $131.75 , $122.45 , N/A , $125.44 , $125.44 , $147.25 , $133.01 , $29.84 , $148.80 
 VANCOMYCIN HCL IN NACL 1-0.9 GM/250ML-% IV SOLN ,HCPCS J3370,0636 - DRUGS REQUIRING DETAILED CODIN,70092-9053-05,250 mL, $151.54 , $98.50 , $127.29 , $2.46 , $2.92 , $122.44 , $136.39 , $128.29 , $136.39 , $136.39 , $136.39 , $128.81 , $2.86 , $139.92 , $143.96 , $128.81 , $140.93 , $140.93 , $143.96 , $145.48 , $123.99 , $136.39 , $128.81 , $119.72 , N/A , $122.64 , $122.64 , $143.96 , $130.04 , $2.46 , $145.48 
Drug Screening Methylphenidate,CPT® 80360,N/A,N/A,N/A, $189.00 , $122.85 , N/A , N/A , N/A , N/A , N/A , $175.77 , $170.10 , $170.10 , $151.20 , $151.20 , N/A , $174.50 , $179.55 , $170.10 , $170.10 , $170.10 , $175.77 , $181.44 , N/A , $160.65 , $114.69 , $67.79 , N/A , $90.04 , $90.04 , $179.55 , $98.20 , $67.79 , $181.44 
"Thoracoscopy,Dx No Bx",CPT® 32601,N/A,N/A,N/A," $2,374.00 "," $1,543.10 "," $1,590.28 ", $277.99 , $390.51 ," $1,166.19 "," $1,139.99 "," $2,207.82 "," $2,136.60 "," $2,136.60 "," $1,899.20 "," $1,899.20 ", $390.51 ," $2,191.91 "," $2,255.30 "," $2,136.60 "," $2,136.60 "," $2,136.60 "," $2,207.82 "," $2,279.04 "," $1,540.77 "," $2,017.90 "," $1,648.48 "," $1,532.63 ", N/A ," $1,188.94 "," $1,188.94 "," $2,255.30 "," $1,400.21 ", $277.99 ," $2,279.04 "
 Fac Lyme Disease Antibody ,CPT® 86618,0302 - LAB/IMMUNOLOGY,N/A,N/A, $174.00 , $113.10 , $146.16 , $17.37 , $17.37 , $140.59 , $156.60 , $147.31 , $156.60 , $156.60 , $156.60 , $147.90 , $17.03 , $160.65 , $165.30 , $147.90 , $161.82 , $161.82 , $165.30 , $167.04 , $142.37 , $156.60 , $147.90 , $137.46 , N/A , $140.82 , $140.82 , $165.30 , $149.31 , $17.03 , $167.04 
 AMOXICILLIN 250 MG PO CHEW ,HCPCS RXC637,0250 - PHARMACY,00093-2268-01,1 tablet, $3.78 , $2.46 , $3.18 , N/A , N/A , $3.05 , $3.40 , $3.20 , $3.40 , $3.40 , $3.40 , $3.21 , N/A , $3.49 , $3.59 , $3.21 , $3.52 , $3.52 , $3.59 , $3.63 , $3.09 , $3.40 , $3.21 , $2.99 , N/A , $3.06 , $3.06 , $3.59 , $3.24 , $2.99 , $3.63 
 Fac Iaad Ia Not Otherwise Specified Each Organism ,CPT® 87449,0306 - LAB/BACT-MICRO,N/A,N/A, $169.00 , $109.85 , $141.96 , $12.22 , $12.22 , $136.55 , $152.10 , $143.08 , $152.10 , $152.10 , $152.10 , $143.65 , $11.98 , $156.04 , $160.55 , $143.65 , $157.17 , $157.17 , $160.55 , $162.24 , $138.28 , $152.10 , $143.65 , $133.51 , N/A , $136.77 , $136.77 , $160.55 , $145.02 , $11.98 , $162.24 
 Scapula ,CPT® 73010,0320 - DX X-RAY,N/A,N/A, $312.00 , $202.80 , $262.08 , $23.16 , $27.82 , $252.10 , $280.80 , $264.14 , $280.80 , $280.80 , $280.80 , $265.20 , $27.27 , $288.07 , $296.40 , $265.20 , $290.16 , $290.16 , $296.40 , $299.52 , $255.28 , $280.80 , $265.20 , $246.48 , N/A , $252.50 , $252.50 , $296.40 , $267.73 , $23.16 , $299.52 
Rmvl Ruptured Breast Implant W/Implant Contents,CPT® 19330,N/A,N/A,N/A," $4,279.00 "," $2,781.35 "," $2,054.04 ", $615.55 , $453.60 ," $1,722.05 "," $1,690.14 "," $3,979.47 "," $3,851.10 "," $3,851.10 "," $3,423.20 "," $3,423.20 ", $453.60 ," $3,950.80 "," $4,065.05 "," $3,851.10 "," $3,851.10 "," $3,851.10 "," $3,979.47 "," $4,107.84 "," $2,250.04 "," $3,637.15 "," $3,391.51 "," $2,204.21 ", N/A ," $1,755.66 "," $1,755.66 "," $4,065.05 "," $2,035.97 ", $453.60 ," $4,107.84 "
 Fac Drug Screening Propoxyphene ,CPT® 80367,0301 - LAB/CHEMISTRY,N/A,N/A, $85.00 , $55.25 , $71.40 , N/A , N/A , $68.68 , $76.50 , $71.96 , $76.50 , $76.50 , $76.50 , $72.25 , N/A , $78.48 , $80.75 , $72.25 , $79.05 , $79.05 , $80.75 , $81.60 , $69.55 , $76.50 , $72.25 , $67.15 , N/A , $68.79 , $68.79 , $80.75 , $72.94 , $67.15 , $81.60 
"Repair Flexor Tendon,Sing",CPT® 26350,N/A,N/A,N/A," $2,462.00 "," $1,600.30 "," $4,714.65 ", $732.16 , $601.86 ," $3,386.55 "," $3,457.42 "," $2,289.66 "," $2,215.80 "," $2,215.80 "," $1,969.60 "," $1,969.60 ", $601.86 ," $2,273.16 "," $2,338.90 "," $2,215.80 "," $2,215.80 "," $2,215.80 "," $2,289.66 "," $2,363.52 "," $4,337.17 "," $2,092.70 "," $3,784.00 "," $4,049.80 ", N/A ," $3,452.62 "," $3,452.62 "," $2,338.90 "," $4,058.05 ", $601.86 ," $4,714.65 "
 Fac Sigmoidoscopy Flx W/Rmvl Tumor by Hot Bx Forceps ,CPT® 45333,0360 - OR SERVICES,N/A,N/A," $1,398.00 ", $908.70 ," $1,174.32 ", $88.25 , $108.73 ," $1,129.58 "," $1,258.20 "," $1,183.55 "," $1,258.20 "," $1,258.20 "," $1,258.20 "," $1,188.30 ", $106.60 ," $1,290.77 "," $1,328.10 "," $1,188.30 "," $1,300.14 "," $1,300.14 "," $1,328.10 "," $1,342.08 "," $1,143.84 "," $1,258.20 "," $1,188.30 "," $1,104.42 ", N/A ," $1,131.40 "," $1,131.40 "," $1,328.10 "," $1,199.62 ", $88.25 ," $1,342.08 "
Perq Replacement Gtube Not Req Revj Gstrst Trc,CPT® 43762,N/A,N/A,N/A," $2,204.00 "," $1,432.60 ", $223.34 , $34.45 , $176.61 , $167.82 , N/A ," $2,049.72 "," $1,983.60 "," $1,983.60 "," $1,763.20 "," $1,763.20 ", $176.61 ," $2,034.95 "," $2,093.80 "," $1,983.60 "," $1,983.60 "," $1,983.60 "," $2,049.72 "," $2,115.84 ", $163.07 ," $1,873.40 ", $193.69 , $214.15 , N/A , $171.09 , $171.09 ," $2,093.80 ", $178.94 , $34.45 ," $2,115.84 "
 HALOPERIDOL LACTATE 5 MG/ML IJ SOLN ,HCPCS J1630,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0474-01,1 mL, $36.93 , $24.00 , $31.02 , $1.41 , $1.17 , $29.84 , $33.24 , $31.26 , $33.24 , $33.24 , $33.24 , $31.39 , $1.15 , $34.10 , $35.08 , $31.39 , $34.34 , $34.34 , $35.08 , $35.45 , $30.22 , $33.24 , $31.39 , $29.17 , N/A , $29.89 , $29.89 , $35.08 , $31.69 , $1.15 , $35.45 
 Upper Art Duplex Unilateral ,CPT® 93931,0921 - PERI VASCUL LAB,N/A,N/A, $951.00 , $618.15 , $798.84 , $121.04 , $121.35 , $768.41 , $855.90 , $805.12 , $855.90 , $855.90 , $855.90 , $808.35 , $118.97 , $878.06 , $903.45 , $808.35 , $884.43 , $884.43 , $903.45 , $912.96 , $778.11 , $855.90 , $808.35 , $751.29 , N/A , $769.64 , $769.64 , $903.45 , $816.05 , $118.97 , $912.96 
 Fac Platelet Pheresis Irradiated ,HCPCS P9036,0390 - BLOOD/STOR-PROC,N/A,N/A," $1,936.00 "," $1,258.40 "," $1,626.24 ", N/A , N/A ," $1,564.29 "," $1,742.40 "," $1,639.02 "," $1,742.40 "," $1,742.40 "," $1,742.40 "," $1,645.60 ", N/A ," $1,787.51 "," $1,839.20 "," $1,645.60 "," $1,800.48 "," $1,800.48 "," $1,839.20 "," $1,858.56 "," $1,584.04 "," $1,742.40 "," $1,645.60 "," $1,529.44 ", N/A ," $1,566.80 "," $1,566.80 "," $1,839.20 "," $1,661.28 "," $1,529.44 "," $1,858.56 "
"Biopsy of Breast, Needle Core",CPT® 19100,N/A,N/A,N/A, $944.00 , $613.60 , $213.42 , $62.91 , $58.29 , $188.01 , $178.81 , $877.92 , $849.60 , $849.60 , $755.20 , $755.20 , $58.29 , $871.60 , $896.80 , $849.60 , $849.60 , $849.60 , $877.92 , $906.24 , $235.01 , $802.40 , $362.17 , $236.34 , N/A , $191.67 , $191.67 , $896.80 , $222.29 , $58.29 , $906.24 
 Fac Ephys Eval Pacg Cvdfb Prgrmg/Reprgrmg Parameters ,CPT® 93642,0480 - CARDIOLOGY,N/A,N/A," $3,375.00 "," $2,193.75 "," $2,835.00 ", $311.88 , $544.62 ," $2,727.00 "," $3,037.50 "," $2,857.28 "," $3,037.50 "," $3,037.50 "," $3,037.50 "," $2,868.75 ", $533.94 ," $3,116.14 "," $3,206.25 "," $2,868.75 "," $3,138.75 "," $3,138.75 "," $3,206.25 "," $3,240.00 "," $2,761.43 "," $3,037.50 "," $2,868.75 "," $2,666.25 ", N/A ," $2,731.39 "," $2,731.39 "," $3,206.25 "," $2,896.09 ", $311.88 ," $3,240.00 "
Hospital Outpt Clinic Visit,HCPCS G0463,N/A,N/A,N/A, $152.00 , $98.80 , N/A , N/A , N/A , N/A , N/A , $141.36 , $136.80 , $136.80 , $121.60 , $121.60 , N/A , $140.34 , $144.40 , $136.80 , $136.80 , $136.80 , $141.36 , $145.92 , N/A , $129.20 , $121.60 , N/A , N/A , N/A , N/A , $144.40 , N/A , $121.60 , $145.92 
 Pro Diagnostic Bone Marrow Biopsies & Aspirations ,CPT® 38222,0982 - PRO FEE/OUTPT,N/A,N/A," $1,202.00 ", $781.30 , $365.65 , $73.07 , $135.37 , $262.85 , $282.49 ," $1,117.86 "," $1,081.80 "," $1,081.80 ", $961.60 , $961.60 , $135.37 ," $1,109.81 "," $1,141.90 "," $1,081.80 "," $1,081.80 "," $1,081.80 "," $1,117.86 "," $1,153.92 ", $395.53 ," $1,021.70 ", $396.26 , $393.86 , N/A , $267.98 , $267.98 ," $1,141.90 ", $310.89 , $73.07 ," $1,153.92 "
 Pro Insert Cervical Dilator ,CPT® 59200,0981 - PRO FEE/ER,N/A,N/A, $360.00 , $234.00 , $118.11 , $39.87 , $65.80 , $103.98 , $109.38 , $334.80 , $324.00 , $324.00 , $288.00 , $288.00 , $65.80 , $332.39 , $342.00 , $324.00 , $324.00 , $324.00 , $334.80 , $345.60 , $121.08 , $306.00 , $242.63 , $192.75 , N/A , $106.01 , $106.01 , $342.00 , $122.55 , $39.87 , $345.60 
 BETAMETHASONE VALERATE 0.1 % EX OINT ,HCPCS RXC637,0250 - PHARMACY,00168-0033-15,15 gram, $104.49 , $67.92 , $87.77 , N/A , N/A , $84.43 , $94.04 , $88.46 , $94.04 , $94.04 , $94.04 , $88.82 , N/A , $96.48 , $99.27 , $88.82 , $97.18 , $97.18 , $99.27 , $100.31 , $85.49 , $94.04 , $88.82 , $82.55 , N/A , $84.56 , $84.56 , $99.27 , $89.66 , $82.55 , $100.31 
 ESCITALOPRAM OXALATE 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6426-61,1 tablet, $22.51 , $14.63 , $18.91 , N/A , N/A , $18.19 , $20.26 , $19.06 , $20.26 , $20.26 , $20.26 , $19.13 , N/A , $20.78 , $21.38 , $19.13 , $20.93 , $20.93 , $21.38 , $21.61 , $18.42 , $20.26 , $19.13 , $17.78 , N/A , $18.22 , $18.22 , $21.38 , $19.32 , $17.78 , $21.61 
" Fac Cytogenetics, Dna Probe ",CPT® 88271,0310 - PATHOLOGY LAB,N/A,N/A, $262.00 , $170.30 , $220.08 , $21.85 , $20.09 , $211.70 , $235.80 , $221.81 , $235.80 , $235.80 , $235.80 , $222.70 , $19.70 , $241.90 , $248.90 , $222.70 , $243.66 , $243.66 , $248.90 , $251.52 , $214.37 , $235.80 , $222.70 , $206.98 , N/A , $212.04 , $212.04 , $248.90 , $224.82 , $19.70 , $251.52 
"Destr Malig Face,Nose,Lip <0.6 Cm",CPT® 17280,N/A,N/A,N/A, $672.00 , $436.80 , $277.07 , $83.53 , $89.26 , $248.24 , $244.32 , $624.96 , $604.80 , $604.80 , $537.60 , $537.60 , $89.26 , $620.46 , $638.40 , $604.80 , $604.80 , $604.80 , $624.96 , $645.12 , $305.11 , $571.20 , $485.27 , $318.49 , N/A , $253.08 , $253.08 , $638.40 , $293.49 , $83.53 , $645.12 
 TRIAMCINOLONE ACETONIDE 40 MG/ML IO SUSP ,HCPCS J3300,0636 - DRUGS REQUIRING DETAILED CODIN,00065-0543-01,1 mL, $993.01 , $645.46 , $834.13 , $4.36 , $4.27 , $802.35 , $893.71 , $840.68 , $893.71 , $893.71 , $893.71 , $844.06 , $4.19 , $916.85 , $943.36 , $844.06 , $923.50 , $923.50 , $943.36 , $953.29 , $812.48 , $893.71 , $844.06 , $784.48 , N/A , $803.64 , $803.64 , $943.36 , $852.10 , $4.19 , $953.29 
 Fac Assay of Sirolimus ,CPT® 80195,0301 - LAB/CHEMISTRY,N/A,N/A, $136.00 , $88.40 , $114.24 , $14.00 , $14.00 , $109.89 , $122.40 , $115.14 , $122.40 , $122.40 , $122.40 , $115.60 , $13.73 , $125.57 , $129.20 , $115.60 , $126.48 , $126.48 , $129.20 , $130.56 , $111.28 , $122.40 , $115.60 , $107.44 , N/A , $110.06 , $110.06 , $129.20 , $116.70 , $13.73 , $130.56 
Ligatn of Abdomen Artery,CPT® 37617,N/A,N/A,N/A," $8,145.00 "," $5,294.25 "," $7,761.33 "," $1,201.51 ", $804.14 ," $5,768.00 "," $5,708.97 "," $7,574.85 "," $7,330.50 "," $7,330.50 "," $6,516.00 "," $6,516.00 ", $804.14 ," $7,520.28 "," $7,737.75 "," $7,330.50 "," $7,330.50 "," $7,330.50 "," $7,574.85 "," $7,819.20 "," $7,219.35 "," $6,923.25 "," $7,170.15 "," $6,451.09 ", N/A ," $5,880.54 "," $5,880.54 "," $7,737.75 "," $6,680.29 ", $804.14 ," $7,819.20 "
 MRI Cardiac Velocity Flow Mapping ,CPT® 75565,0610 - MRI,N/A,N/A, $960.00 , $624.00 , $806.40 , $46.84 , $77.67 , $775.68 , $864.00 , $812.74 , $864.00 , $864.00 , $864.00 , $816.00 , $76.15 , $886.37 , $912.00 , $816.00 , $892.80 , $892.80 , $912.00 , $921.60 , $785.47 , $864.00 , $816.00 , $758.40 , N/A , $776.93 , $776.93 , $912.00 , $823.78 , $46.84 , $921.60 
 Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC ,MS DRG V40 (FY2023) 556,N/A,N/A,N/A," $31,817.21 "," $20,681.19 "," $26,726.46 ", N/A , N/A ," $25,708.31 "," $28,635.49 "," $26,936.45 "," $28,635.49 "," $28,635.49 "," $28,635.49 "," $27,044.63 ", N/A ," $29,376.83 "," $30,226.35 "," $27,044.63 "," $29,590.01 "," $29,590.01 "," $30,226.35 "," $30,544.52 "," $26,032.84 "," $28,635.49 "," $27,044.63 "," $25,135.60 ", N/A ," $25,749.67 "," $25,749.67 "," $30,226.35 "," $27,302.35 "," $25,135.60 "," $30,544.52 "
"Inj,Ther Agent Into Tenon's Capsule",CPT® 67515,N/A,N/A,N/A, $846.00 , $549.90 , $289.90 , $45.62 , $65.94 , $505.57 , $476.04 , $786.78 , $761.40 , $761.40 , $676.80 , $676.80 , $65.94 , $781.11 , $803.70 , $761.40 , $761.40 , $761.40 , $786.78 , $812.16 , $399.97 , $719.10 , $494.19 , $640.72 , N/A , $515.43 , $515.43 , $803.70 , $568.97 , $45.62 , $812.16 
"Lap,Sling Operation",CPT® 51992,N/A,N/A,N/A," $5,836.00 "," $3,793.40 "," $4,505.47 ", $790.37 , $786.46 ," $4,108.04 "," $3,909.36 "," $5,427.48 "," $5,252.40 "," $5,252.40 "," $4,668.80 "," $4,668.80 ", $786.46 ," $5,388.38 "," $5,544.20 "," $5,252.40 "," $5,252.40 "," $5,252.40 "," $5,427.48 "," $5,602.56 "," $4,519.27 "," $4,960.60 "," $4,510.11 "," $5,100.78 ", N/A ," $4,188.19 "," $4,188.19 "," $5,544.20 "," $4,922.61 ", $786.46 ," $5,602.56 "
 PALIPERIDONE PALMITATE ER 234 MG/1.5ML IM SUSY ,HCPCS J2426,0636 - DRUGS REQUIRING DETAILED CODIN,50458-0564-01,1.5 mL," $9,844.51 "," $6,398.93 "," $8,269.39 ", $14.50 , $13.92 ," $7,954.36 "," $8,860.06 "," $8,334.36 "," $8,860.06 "," $8,860.06 "," $8,860.06 "," $8,367.83 ", $13.65 ," $9,089.44 "," $9,352.28 "," $8,367.83 "," $9,155.39 "," $9,155.39 "," $9,352.28 "," $9,450.73 "," $8,054.78 "," $8,860.06 "," $8,367.83 "," $7,777.16 ", N/A ," $7,967.16 "," $7,967.16 "," $9,352.28 "," $8,447.57 ", $13.65 ," $9,450.73 "
Iron Dextran,HCPCS J1750,N/A,N/A,N/A, $46.00 , $29.90 , N/A , $17.52 , $16.91 , N/A , N/A , $42.78 , $41.40 , $41.40 , $36.80 , $36.80 , $16.91 , $42.47 , $43.70 , $41.40 , $41.40 , $41.40 , $42.78 , $44.16 , $20.53 , $39.10 , $22.71 , $21.56 , N/A , N/A , N/A , $43.70 , N/A , $16.91 , $44.16 
 CT Extremity Upper With Contrast ,CPT® 73201,0350 - CT SCAN,N/A,N/A," $3,361.00 "," $2,184.65 "," $2,823.24 ", $206.46 , $289.97 ," $2,715.69 "," $3,024.90 "," $2,845.42 "," $3,024.90 "," $3,024.90 "," $3,024.90 "," $2,856.85 ", $284.28 ," $3,103.21 "," $3,192.95 "," $2,856.85 "," $3,125.73 "," $3,125.73 "," $3,192.95 "," $3,226.56 "," $2,749.97 "," $3,024.90 "," $2,856.85 "," $2,655.19 ", N/A ," $2,720.06 "," $2,720.06 "," $3,192.95 "," $2,884.07 ", $206.46 ," $3,226.56 "
Drainage Scrotal Wall Abscess,CPT® 55100,N/A,N/A,N/A," $1,088.00 ", $707.20 , $740.16 , $160.07 , $30.71 , $530.69 , $546.97 ," $1,011.84 ", $979.20 , $979.20 , $870.40 , $870.40 , $30.71 ," $1,004.55 "," $1,033.60 ", $979.20 , $979.20 , $979.20 ," $1,011.84 "," $1,044.48 ", $691.67 , $924.80 , $875.98 , $802.59 , N/A , $541.04 , $541.04 ," $1,033.60 ", $648.45 , $30.71 ," $1,044.48 "
 FLUTICASONE PROPIONATE (INHAL) 250 MCG/ACT INH AEPB ,HCPCS RXC637,0250 - PHARMACY,00173-0601-02,60 each, $805.21 , $523.39 , $676.38 , N/A , N/A , $650.61 , $724.69 , $681.69 , $724.69 , $724.69 , $724.69 , $684.43 , N/A , $743.45 , $764.95 , $684.43 , $748.85 , $748.85 , $764.95 , $773.00 , $658.82 , $724.69 , $684.43 , $636.12 , N/A , $651.66 , $651.66 , $764.95 , $690.95 , $636.12 , $773.00 
Injection Aa&/Strd Femoral Nerve W/Img Gdn,CPT® 64447,N/A,N/A,N/A," $1,411.00 ", $917.15 , $262.08 , $60.98 , $69.44 , $370.27 , $349.57 ," $1,312.23 "," $1,269.90 "," $1,269.90 "," $1,128.80 "," $1,128.80 ", $69.44 ," $1,302.78 "," $1,340.45 "," $1,269.90 "," $1,269.90 "," $1,269.90 "," $1,312.23 "," $1,354.56 ", $284.46 ," $1,199.35 ", $340.76 , $403.56 , N/A , $377.50 , $377.50 ," $1,340.45 ", $404.97 , $60.98 ," $1,354.56 "
" Debridement; Bone, Skin, Subq Tissue, Muscle and/or Fascia ",CPT® 11044,0761 - TREATMENT ROOM,N/A,N/A," $4,205.00 "," $2,733.25 "," $3,532.20 ", $211.81 , $318.61 ," $3,397.64 "," $3,784.50 "," $3,559.95 "," $3,784.50 "," $3,784.50 "," $3,784.50 "," $3,574.25 ", $312.36 ," $3,882.48 "," $3,994.75 "," $3,574.25 "," $3,910.65 "," $3,910.65 "," $3,994.75 "," $4,036.80 "," $3,440.53 "," $3,784.50 "," $3,574.25 "," $3,321.95 ", N/A ," $3,403.11 "," $3,403.11 "," $3,994.75 "," $3,608.31 ", $211.81 ," $4,036.80 "
Explor Vagina/Drain Pelvic Abscess,CPT® 57010,N/A,N/A,N/A," $2,610.00 "," $1,696.50 "," $2,172.70 ", $439.79 , $536.08 ," $1,765.49 "," $1,773.05 "," $2,427.30 "," $2,349.00 "," $2,349.00 "," $2,088.00 "," $2,088.00 ", $536.08 ," $2,409.81 "," $2,479.50 "," $2,349.00 "," $2,349.00 "," $2,349.00 "," $2,427.30 "," $2,505.60 "," $2,251.20 "," $2,218.50 "," $2,329.99 "," $1,772.49 ", N/A ," $1,799.94 "," $1,799.94 "," $2,479.50 "," $2,158.90 ", $439.79 ," $2,505.60 "
" Fac Gad-Base MR Contrast Nos,1ml ",HCPCS A9579,0255 - DRUGS/RADIOLOGY,N/A,N/A, $15.00 , $9.75 , $12.60 , $1.58 , $4.89 , $12.12 , $13.50 , $12.70 , $13.50 , $13.50 , $13.50 , $12.75 , $4.79 , $13.85 , $14.25 , $12.75 , $13.95 , $13.95 , $14.25 , $14.40 , $12.27 , $13.50 , $12.75 , $11.85 , N/A , $12.14 , $12.14 , $14.25 , $12.87 , $1.58 , $14.40 
Layer Closure 12.6-20cm,12055,N/A,N/A,N/A," $1,307.00 ", $849.55 , $942.68 , $283.32 , $288.68 , $824.87 , $801.32 ," $1,215.51 "," $1,176.30 "," $1,176.30 "," $1,045.60 "," $1,045.60 ", $288.68 ," $1,206.75 "," $1,241.65 "," $1,176.30 "," $1,176.30 "," $1,176.30 "," $1,215.51 "," $1,254.72 "," $1,033.61 "," $1,110.95 "," $1,598.52 "," $1,063.66 ", N/A , $840.96 , $840.96 ," $1,241.65 ", $975.24 , $283.32 ," $1,598.52 "
 Pro Lyr Clsr S/a/T/E 12.6 Cm-20.0 Cm ,CPT® 12035,0982 - PRO FEE/OUTPT,N/A,N/A," $1,518.00 ", $986.70 , $761.06 , $227.75 , $200.71 , $653.93 , $643.73 ," $1,411.74 "," $1,366.20 "," $1,366.20 "," $1,214.40 "," $1,214.40 ", $200.71 ," $1,401.57 "," $1,442.10 "," $1,366.20 "," $1,366.20 "," $1,366.20 "," $1,411.74 "," $1,457.28 ", $835.71 ," $1,290.30 "," $1,291.66 ", $837.00 , N/A , $666.69 , $666.69 ," $1,442.10 ", $773.15 , $200.71 ," $1,457.28 "
 ROMIPLOSTIM 125 MCG SC SOLR ,HCPCS J2796,0636 - DRUGS REQUIRING DETAILED CODIN,55513-0223-01,0.25 mL," $3,506.33 "," $2,279.11 "," $2,945.32 ", $97.38 , $93.06 ," $2,833.11 "," $3,155.70 "," $2,968.46 "," $3,155.70 "," $3,155.70 "," $3,155.70 "," $2,980.38 ", $91.24 ," $3,237.39 "," $3,331.01 "," $2,980.38 "," $3,260.89 "," $3,260.89 "," $3,331.01 "," $3,366.08 "," $2,868.88 "," $3,155.70 "," $2,980.38 "," $2,770.00 ", N/A ," $2,837.67 "," $2,837.67 "," $3,331.01 "," $3,008.78 ", $91.24 ," $3,366.08 "
 Pro Immunotherapy Injections ,CPT® 95117,0982 - PRO FEE/OUTPT,N/A,N/A, $62.00 , $40.30 , $28.24 , $11.27 , $5.05 , $18.37 , $18.87 , $57.66 , $55.80 , $55.80 , $49.60 , $49.60 , $5.05 , $57.24 , $58.90 , $55.80 , $55.80 , $55.80 , $57.66 , $59.52 , $24.53 , $52.70 , $32.44 , $31.18 , N/A , $18.72 , $18.72 , $58.90 , $22.13 , $5.05 , $59.52 
 ROSUVASTATIN CALCIUM 40 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,68462-0264-30,1 tablet, $45.95 , $29.87 , $38.60 , N/A , N/A , $37.13 , $41.36 , $38.90 , $41.36 , $41.36 , $41.36 , $39.06 , N/A , $42.43 , $43.65 , $39.06 , $42.73 , $42.73 , $43.65 , $44.11 , $37.60 , $41.36 , $39.06 , $36.30 , N/A , $37.19 , $37.19 , $43.65 , $39.43 , $36.30 , $44.11 
 HYDROMORPHONE HCL 1 MG/ML IJ SOLN ,HCPCS J1170,0636 - DRUGS REQUIRING DETAILED CODIN,00409-1283-31,1 mL, $29.23 , $19.00 , $24.55 , $4.44 , $4.30 , $23.62 , $26.31 , $24.75 , $26.31 , $26.31 , $26.31 , $24.85 , $4.22 , $26.99 , $27.77 , $24.85 , $27.18 , $27.18 , $27.77 , $28.06 , $23.92 , $26.31 , $24.85 , $23.09 , N/A , $23.66 , $23.66 , $27.77 , $25.08 , $4.22 , $28.06 
" Pro Destruct Internal Hemorrhoid, Thermal ",CPT® 46930,0975 - PRO FEE/OR,N/A,N/A," $1,384.00 ", $899.60 , $953.16 , $147.02 , $143.79 , $710.05 , $733.17 ," $1,287.12 "," $1,245.60 "," $1,245.60 "," $1,107.20 "," $1,107.20 ", $143.79 ," $1,277.85 "," $1,314.80 "," $1,245.60 "," $1,245.60 "," $1,245.60 "," $1,287.12 "," $1,328.64 ", $682.46 ," $1,176.40 ", $801.04 , $850.75 , N/A , $723.90 , $723.90 ," $1,314.80 ", $757.11 , $143.79 ," $1,328.64 "
Removal Heart Sac Lesion,CPT® 33050,N/A,N/A,N/A," $6,303.00 "," $4,096.95 "," $5,906.55 ", $913.46 , $917.52 ," $4,291.11 "," $4,244.83 "," $5,861.79 "," $5,672.70 "," $5,672.70 "," $5,042.40 "," $5,042.40 ", $917.52 ," $5,819.56 "," $5,987.85 "," $5,672.70 "," $5,672.70 "," $5,672.70 "," $5,861.79 "," $6,050.88 "," $5,464.67 "," $5,357.55 "," $5,353.98 "," $4,844.48 ", N/A ," $4,374.84 "," $4,374.84 "," $5,987.85 "," $4,969.83 ", $913.46 ," $6,050.88 "
Fac Mod Sed Other Phys/Qhp Initial 15 Mins <5 Yrs,99155,N/A,N/A,N/A, $882.00 , $573.30 , $187.99 , $79.01 , $73.59 , $198.64 , $212.70 , $820.26 , $793.80 , $793.80 , $705.60 , $705.60 , $73.59 , $814.35 , $837.90 , $793.80 , $793.80 , $793.80 , $820.26 , $846.72 , $250.02 , $749.70 , $246.36 , $364.61 , N/A , $202.51 , $202.51 , $837.90 , $236.11 , $73.59 , $846.72 
Revsc Opn/Prq Fem/Pop W/Athrc/Angiop Sm Vsl,CPT® 37225,N/A,N/A,N/A," $9,424.00 "," $6,125.60 "," $3,493.69 ", $536.49 , $454.16 ," $2,676.21 "," $2,634.20 "," $8,764.32 "," $8,481.60 "," $8,481.60 "," $7,539.20 "," $7,539.20 ", $454.16 ," $8,701.18 "," $8,952.80 "," $8,481.60 "," $8,481.60 "," $8,481.60 "," $8,764.32 "," $9,047.04 "," $2,952.99 "," $8,010.40 "," $3,316.57 "," $2,930.65 ", N/A ," $2,728.43 "," $2,728.43 "," $8,952.80 "," $3,099.48 ", $454.16 ," $9,047.04 "
"Remv Resid Obstruc Prostate,>1 Yr",52630,N/A,N/A,N/A," $2,726.00 "," $1,771.90 "," $2,199.72 ", $388.54 , $768.38 ," $1,956.64 "," $1,831.29 "," $2,535.18 "," $2,453.40 "," $2,453.40 "," $2,180.80 "," $2,180.80 ", $768.38 ," $2,516.92 "," $2,589.70 "," $2,453.40 "," $2,453.40 "," $2,453.40 "," $2,535.18 "," $2,616.96 "," $2,198.07 "," $2,317.10 "," $2,073.08 "," $2,465.35 ", N/A ," $1,994.81 "," $1,994.81 "," $2,589.70 "," $2,344.61 ", $388.54 ," $2,616.96 "
"Osteopathic Manip,7-8 Body Regn",CPT® 98928,N/A,N/A,N/A, $280.00 , $182.00 , $136.63 , $57.03 , $56.46 , $135.05 , $133.09 , $260.40 , $252.00 , $252.00 , $224.00 , $224.00 , $56.46 , $258.52 , $266.00 , $252.00 , $252.00 , $252.00 , $260.40 , $268.80 , $147.82 , $238.00 , $175.37 , $227.37 , N/A , $137.69 , $137.69 , $266.00 , $160.52 , $56.46 , $268.80 
 Congenital Screen ,HCPCS S3620,0300 - LABORATORY,N/A,N/A, $231.00 , $150.15 , $194.04 , N/A , $117.30 , $186.65 , $207.90 , $195.56 , $207.90 , $207.90 , $207.90 , $196.35 , $115.00 , $213.28 , $219.45 , $196.35 , $214.83 , $214.83 , $219.45 , $221.76 , $189.00 , $207.90 , $196.35 , $182.49 , N/A , $186.95 , $186.95 , $219.45 , $198.22 , $115.00 , $221.76 
 Fac Crtj Arven Fstl Xcp Dir Arven Anast Nonautog Grf ,CPT® 36830,0360 - OR SERVICES,N/A,N/A," $2,198.00 "," $1,428.70 "," $1,846.32 ", $597.90 , $620.94 ," $1,775.98 "," $1,978.20 "," $1,860.83 "," $1,978.20 "," $1,978.20 "," $1,978.20 "," $1,868.30 ", $608.76 ," $2,029.41 "," $2,088.10 "," $1,868.30 "," $2,044.14 "," $2,044.14 "," $2,088.10 "," $2,110.08 "," $1,798.40 "," $1,978.20 "," $1,868.30 "," $1,736.42 ", N/A ," $1,778.84 "," $1,778.84 "," $2,088.10 "," $1,886.10 ", $597.90 ," $2,110.08 "
 Pro Cltx Dstl Radial Fx/Epiphysl Sep W/O Mnpj ,CPT® 25600,0981 - PRO FEE/ER,N/A,N/A," $1,329.00 ", $863.85 ," $2,022.28 ", $320.97 , $171.85 ," $1,493.35 "," $1,527.62 "," $1,235.97 "," $1,196.10 "," $1,196.10 "," $1,063.20 "," $1,063.20 ", $171.85 ," $1,227.07 "," $1,262.55 "," $1,196.10 "," $1,196.10 "," $1,196.10 "," $1,235.97 "," $1,275.84 "," $1,852.86 "," $1,129.65 "," $1,673.45 "," $1,783.02 ", N/A ," $1,522.49 "," $1,522.49 "," $1,262.55 "," $1,789.47 ", $171.85 ," $2,022.28 "
 NEOMYCIN SULFATE 500 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,39822-0310-05,1 tablet, $8.72 , $5.67 , $7.32 , N/A , N/A , $7.05 , $7.85 , $7.38 , $7.85 , $7.85 , $7.85 , $7.41 , N/A , $8.05 , $8.28 , $7.41 , $8.11 , $8.11 , $8.28 , $8.37 , $7.13 , $7.85 , $7.41 , $6.89 , N/A , $7.06 , $7.06 , $8.28 , $7.48 , $6.89 , $8.37 
" Fac Virus Inoculation, Shell Via ",CPT® 87254,0305 - LAB/HEMATOLOGY,N/A,N/A, $202.00 , $131.30 , $169.68 , $19.95 , $6.97 , $163.22 , $181.80 , $171.01 , $181.80 , $181.80 , $181.80 , $171.70 , $6.83 , $186.51 , $191.90 , $171.70 , $187.86 , $187.86 , $191.90 , $193.92 , $165.28 , $181.80 , $171.70 , $159.58 , N/A , $163.48 , $163.48 , $191.90 , $173.34 , $6.83 , $193.92 
 Fac Drug Test Def 8-14 Classes ,CPT® G0481,0301 - LAB/CHEMISTRY,N/A,N/A, $153.00 , $99.45 , $128.52 , $159.72 , $100.36 , $123.62 , $137.70 , $129.53 , $137.70 , $137.70 , $137.70 , $130.05 , $98.39 , $141.26 , $145.35 , $130.05 , $142.29 , $142.29 , $145.35 , $146.88 , $125.18 , $137.70 , $130.05 , $120.87 , N/A , $123.82 , $123.82 , $145.35 , $131.29 , $98.39 , $159.72 
 TROLAMINE SALICYLATE 10 % EX CREA ,HCPCS RXC637,0250 - PHARMACY,70000-0169-01,85 gram, $26.64 , $17.32 , $22.38 , N/A , N/A , $21.53 , $23.98 , $22.55 , $23.98 , $23.98 , $23.98 , $22.64 , N/A , $24.60 , $25.31 , $22.64 , $24.78 , $24.78 , $25.31 , $25.57 , $21.80 , $23.98 , $22.64 , $21.05 , N/A , $21.56 , $21.56 , $25.31 , $22.86 , $21.05 , $25.57 
"Knee Scope,Med+Lat Menis Repair",CPT® 29883,N/A,N/A,N/A," $6,305.00 "," $4,098.25 "," $5,098.73 ", $801.42 , $808.94 ," $4,072.60 "," $4,037.71 "," $5,863.65 "," $5,674.50 "," $5,674.50 "," $5,044.00 "," $5,044.00 ", $808.94 ," $5,821.41 "," $5,989.75 "," $5,674.50 "," $5,674.50 "," $5,674.50 "," $5,863.65 "," $6,052.80 "," $4,734.70 "," $5,359.25 "," $4,460.16 "," $4,793.33 ", N/A ," $4,152.06 "," $4,152.06 "," $5,989.75 "," $4,880.15 ", $801.42 ," $6,052.80 "
"Lyme Dis, Dna, Dir Probe",CPT® 87475,N/A,N/A,N/A, $178.00 , $115.70 , N/A , $20.45 , $20.45 , $113.46 , $135.73 , $165.54 , $160.20 , $160.20 , $142.40 , $142.40 , $20.45 , $164.35 , $169.10 , $160.20 , $160.20 , $160.20 , $165.54 , $170.88 , $133.88 , $151.30 , $131.37 , $72.72 , N/A , $105.89 , $105.89 , $169.10 , $115.71 , $20.45 , $170.88 
Sclerotherapy Fluid Collection Prq W/Img Gid,CPT® 49185,N/A,N/A,N/A," $6,546.00 "," $4,254.90 ", $728.26 , $112.83 , $788.54 , $599.12 , $591.47 ," $6,087.78 "," $5,891.40 "," $5,891.40 "," $5,236.80 "," $5,236.80 ", $788.54 ," $6,043.92 "," $6,218.70 "," $5,891.40 "," $5,891.40 "," $5,891.40 "," $6,087.78 "," $6,284.16 ", $524.83 ," $5,564.10 ", $618.38 , $701.56 , N/A , $610.81 , $610.81 ," $6,218.70 ", $638.85 , $112.83 ," $6,284.16 "
" Fac Hiv 1 Genotype, Dna/Rna, Other Regions ",CPT® 87906,0306 - LAB/BACT-MICRO,N/A,N/A, $249.00 , $161.85 , $209.16 , $131.30 , $131.30 , $201.19 , $224.10 , $210.80 , $224.10 , $224.10 , $224.10 , $211.65 , $128.73 , $229.90 , $236.55 , $211.65 , $231.57 , $231.57 , $236.55 , $239.04 , $203.73 , $224.10 , $211.65 , $196.71 , N/A , $201.52 , $201.52 , $236.55 , $213.67 , $128.73 , $239.04 
"Control Throat Bleed,Simple",CPT® 42960,N/A,N/A,N/A," $1,124.00 ", $730.60 , $995.93 , $155.79 , $76.84 , $819.97 , $843.77 ," $1,045.32 "," $1,011.60 "," $1,011.60 ", $899.20 , $899.20 , $76.84 ," $1,037.79 "," $1,067.80 "," $1,011.60 "," $1,011.60 "," $1,011.60 "," $1,045.32 "," $1,079.04 ", $714.82 , $955.40 , $920.58 , $961.37 , N/A , $835.97 , $835.97 ," $1,067.80 ", $874.33 , $76.84 ," $1,079.04 "
"Incis/Drain Thigh/Knee Abscess,Deep",27301,N/A,N/A,N/A," $3,080.00 "," $2,002.00 "," $3,080.29 ", $483.56 , $200.19 ," $2,384.48 "," $2,411.83 "," $2,864.40 "," $2,772.00 "," $2,772.00 "," $2,464.00 "," $2,464.00 ", $200.19 ," $2,843.76 "," $2,926.00 "," $2,772.00 "," $2,772.00 "," $2,772.00 "," $2,864.40 "," $2,956.80 "," $2,854.91 "," $2,618.00 "," $2,665.39 "," $2,851.17 ", N/A ," $2,431.01 "," $2,431.01 "," $2,926.00 "," $2,857.29 ", $200.19 ," $3,080.29 "
 Pro Cltx Dstl Phlngl Fx Fngr/Thmb W/O Mnpj Ea ,CPT® 26750,0981 - PRO FEE/ER,N/A,N/A, $861.00 , $559.65 ," $1,175.53 ", $187.84 , $59.10 , $887.15 , $909.28 , $800.73 , $774.90 , $774.90 , $688.80 , $688.80 , $59.10 , $794.96 , $817.95 , $774.90 , $774.90 , $774.90 , $800.73 , $826.56 ," $1,079.00 ", $731.85 , $995.51 ," $1,062.31 ", N/A , $904.46 , $904.46 , $817.95 ," $1,063.07 ", $59.10 ," $1,175.53 "
 Fac Elec Anlys Implt Ithcl/Edrl Pmp W/Repr&Ref Phys ,CPT® 62370,0360 - OR SERVICES,N/A,N/A, $967.00 , $628.55 , $812.28 , $44.01 , $101.93 , $781.34 , $870.30 , $818.66 , $870.30 , $870.30 , $870.30 , $821.95 , $99.93 , $892.83 , $918.65 , $821.95 , $899.31 , $899.31 , $918.65 , $928.32 , $791.20 , $870.30 , $821.95 , $763.93 , N/A , $782.59 , $782.59 , $918.65 , $829.78 , $44.01 , $928.32 
Medroxyprogesterone Acetate,HCPCS J1050,N/A,N/A,N/A, $1.00 , $0.65 , N/A , N/A , $0.58 , N/A , N/A , $0.93 , $0.90 , $0.90 , $0.80 , $0.80 , $0.58 , $0.92 , $0.95 , $0.90 , $0.90 , $0.90 , $0.93 , $0.96 , $0.74 , $0.85 , $0.65 , $0.67 , N/A , N/A , N/A , $0.95 , N/A , $0.58 , $0.96 
"Laminectomy,Facetectomy,Lumbar",CPT® 63012,N/A,N/A,N/A," $7,726.00 "," $5,021.90 "," $5,568.68 "," $1,088.79 "," $1,008.45 "," $6,459.42 "," $6,234.54 "," $7,185.18 "," $6,953.40 "," $6,953.40 "," $6,180.80 "," $6,180.80 "," $1,008.45 "," $7,133.42 "," $7,339.70 "," $6,953.40 "," $6,953.40 "," $6,953.40 "," $7,185.18 "," $7,416.96 "," $6,011.63 "," $6,567.10 "," $6,333.43 "," $6,777.14 ", N/A ," $6,585.46 "," $6,585.46 "," $7,339.70 "," $7,064.65 "," $1,008.45 "," $7,416.96 "
"Profes Svc,Immunother,Single/Mult Ags",CPT® 95165,N/A,N/A,N/A, $43.00 , $27.95 , $7.36 , $3.17 , $10.27 , $5.69 , $5.26 , $39.99 , $38.70 , $38.70 , $34.40 , $34.40 , $10.27 , $39.70 , $40.85 , $38.70 , $38.70 , $38.70 , $39.99 , $41.28 , $6.58 , $36.55 , $10.14 , $9.48 , N/A , $5.80 , $5.80 , $40.85 , $6.87 , $3.17 , $41.28 
 Ribs Unil W Pa Chest Min 3vw- Mh ,CPT® 71101,0972 - PRO FEE/RAD/DX,N/A,N/A, $167.00 , $108.55 , $238.79 , $41.73 , $37.57 , $171.71 , $210.74 , $155.31 , $150.30 , $150.30 , $133.60 , $133.60 , $37.57 , $154.19 , $158.65 , $150.30 , $150.30 , $150.30 , $155.31 , $160.32 , $232.19 , $141.95 , $229.20 , $192.15 , N/A , $175.06 , $175.06 , $158.65 , $202.62 , $37.57 , $238.79 
 PROTHROMBIN COMPLEX CONC HUMAN 1000 UNITS IV KIT ,HCPCS J7168,0636 - DRUGS REQUIRING DETAILED CODIN,63833-0387-02,"1,500 unit"," $13,157.90 "," $8,552.64 "," $11,052.64 ", N/A , $0.01 ," $10,631.58 "," $11,842.11 "," $11,139.48 "," $11,842.11 "," $11,842.11 "," $11,842.11 "," $11,184.22 ", $0.01 ," $12,148.69 "," $12,500.01 "," $11,184.22 "," $12,236.85 "," $12,236.85 "," $12,500.01 "," $12,631.58 "," $10,765.79 "," $11,842.11 "," $11,184.22 "," $10,394.74 ", N/A ," $10,648.69 "," $10,648.69 "," $12,500.01 "," $11,290.79 ", $0.01 ," $12,631.58 "
 Pro Egd Transoral Endoscopic Mucosal Resection ,CPT® 43254,0982 - PRO FEE/OUTPT,N/A,N/A," $2,119.00 "," $1,377.35 "," $1,660.36 ", $255.85 , $211.95 ," $1,324.72 "," $1,392.74 "," $1,970.67 "," $1,907.10 "," $1,907.10 "," $1,695.20 "," $1,695.20 ", $211.95 ," $1,956.47 "," $2,013.05 "," $1,907.10 "," $1,907.10 "," $1,907.10 "," $1,970.67 "," $2,034.24 "," $1,191.11 "," $1,801.15 "," $1,405.56 "," $1,579.92 ", N/A ," $1,350.56 "," $1,350.56 "," $2,013.05 "," $1,412.55 ", $211.95 ," $2,034.24 "
Optx Dstl Radl I-Artic Fx/Epiphysl Sep 2 Frag,25608,N/A,N/A,N/A," $3,236.00 "," $2,103.40 "," $5,041.66 ", $792.24 , $611.22 ," $3,971.14 "," $3,955.20 "," $3,009.48 "," $2,912.40 "," $2,912.40 "," $2,588.80 "," $2,588.80 ", $611.22 ," $2,987.80 "," $3,074.20 "," $2,912.40 "," $2,912.40 "," $2,912.40 "," $3,009.48 "," $3,106.56 "," $4,682.64 "," $2,750.60 "," $4,358.47 "," $4,694.37 ", N/A ," $4,048.63 "," $4,048.63 "," $3,074.20 "," $4,758.57 ", $611.22 ," $5,041.66 "
"Repair Flex Leg Tendon,Second,Ea",CPT® 27659,N/A,N/A,N/A," $4,180.00 "," $2,717.00 "," $2,904.79 ", $455.37 , $551.54 ," $2,339.82 "," $2,370.08 "," $3,887.40 "," $3,762.00 "," $3,762.00 "," $3,344.00 "," $3,344.00 ", $551.54 ," $3,859.39 "," $3,971.00 "," $3,762.00 "," $3,762.00 "," $3,762.00 "," $3,887.40 "," $4,012.80 "," $2,695.58 "," $3,553.00 "," $2,588.68 "," $2,747.67 ", N/A ," $2,385.48 "," $2,385.48 "," $3,971.00 "," $2,803.78 ", $455.37 ," $4,012.80 "
Colonoscopy W/Biopsy Single/Multiple,45380,N/A,N/A,N/A," $3,222.00 "," $2,094.30 "," $1,228.57 ", $189.88 , $603.31 ," $1,404.75 "," $1,401.29 "," $2,996.46 "," $2,899.80 "," $2,899.80 "," $2,577.60 "," $2,577.60 ", $603.31 ," $2,974.87 "," $3,060.90 "," $2,899.80 "," $2,899.80 "," $2,899.80 "," $2,996.46 "," $3,093.12 "," $1,727.67 "," $2,738.70 "," $1,379.08 "," $1,171.50 ", N/A ," $1,432.15 "," $1,432.15 "," $3,060.90 "," $1,651.84 ", $189.88 ," $3,093.12 "
 GEMCITABINE HCL 1 GM/26.3ML IV SOLN ,HCPCS J9201,0636 - DRUGS REQUIRING DETAILED CODIN,00409-0181-01,26.3 mL, $133.21 , $86.59 , $111.90 , $3.78 , $3.57 , $107.63 , $119.89 , $112.78 , $119.89 , $119.89 , $119.89 , $113.23 , $3.50 , $122.99 , $126.55 , $113.23 , $123.89 , $123.89 , $126.55 , $127.88 , $108.99 , $119.89 , $113.23 , $105.24 , N/A , $107.81 , $107.81 , $126.55 , $114.31 , $3.50 , $127.88 
 Fac Assay of Iron ,CPT® 83540,0301 - LAB/CHEMISTRY,N/A,N/A, $80.00 , $52.00 , $67.20 , $6.60 , $6.60 , $64.64 , $72.00 , $67.73 , $72.00 , $72.00 , $72.00 , $68.00 , $6.47 , $73.86 , $76.00 , $68.00 , $74.40 , $74.40 , $76.00 , $76.80 , $65.46 , $72.00 , $68.00 , $63.20 , N/A , $64.74 , $64.74 , $76.00 , $68.65 , $6.47 , $76.80 
 Complex Repair Scalp/ Arm/Leg 1.1-2.5cm ,CPT® 13120,0981 - PRO FEE/ER,N/A,N/A," $1,366.00 ", $887.90 , $748.31 , $223.03 , $131.87 , $646.85 , $634.03 ," $1,270.38 "," $1,229.40 "," $1,229.40 "," $1,092.80 "," $1,092.80 ", $131.87 ," $1,261.23 "," $1,297.70 "," $1,229.40 "," $1,229.40 "," $1,229.40 "," $1,270.38 "," $1,311.36 ", $827.01 ," $1,161.10 "," $1,261.33 ", $830.94 , N/A , $659.47 , $659.47 ," $1,297.70 ", $764.75 , $131.87 ," $1,311.36 "
"Close Bladder/Vagina Fistula,Abdom",CPT® 51900,N/A,N/A,N/A," $5,631.00 "," $3,660.15 "," $4,463.90 ", $785.30 , $810.09 ," $4,074.36 "," $3,785.33 "," $5,236.83 "," $5,067.90 "," $5,067.90 "," $4,504.80 "," $4,504.80 ", $810.09 ," $5,199.10 "," $5,349.45 "," $5,067.90 "," $5,067.90 "," $5,067.90 "," $5,236.83 "," $5,405.76 "," $4,477.89 "," $4,786.35 "," $4,292.46 "," $5,073.05 ", N/A ," $4,153.85 "," $4,153.85 "," $5,349.45 "," $4,882.25 ", $785.30 ," $5,405.76 "
 Fac Breathing Capacity Test ,CPT® 94010,0460 - PULMONARY FUNC,N/A,N/A, $383.00 , $248.95 , $321.72 , $26.12 , $42.71 , $309.46 , $344.70 , $324.25 , $344.70 , $344.70 , $344.70 , $325.55 , $41.87 , $353.62 , $363.85 , $325.55 , $356.19 , $356.19 , $363.85 , $367.68 , $313.37 , $344.70 , $325.55 , $302.57 , N/A , $309.96 , $309.96 , $363.85 , $328.65 , $26.12 , $367.68 
"Flowcytometry/Read, 2-8 Markers",CPT® 88187,N/A,N/A,N/A, $181.00 , $117.65 , $127.61 , $34.55 , $69.65 , $289.75 , $315.78 , $168.33 , $162.90 , $162.90 , $144.80 , $144.80 , $69.65 , $167.12 , $171.95 , $162.90 , $162.90 , $162.90 , $168.33 , $173.76 , $234.44 , $153.85 , $327.61 , $164.36 , N/A , $270.41 , $270.41 , $171.95 , $297.17 , $34.55 , $327.61 
Egd Transoral Endoscopic Mucosal Resection,43254,N/A,N/A,N/A," $2,119.00 "," $1,377.35 "," $1,660.36 ", $255.85 , $211.95 ," $1,324.72 "," $1,392.74 "," $1,970.67 "," $1,907.10 "," $1,907.10 "," $1,695.20 "," $1,695.20 ", $211.95 ," $1,956.47 "," $2,013.05 "," $1,907.10 "," $1,907.10 "," $1,907.10 "," $1,970.67 "," $2,034.24 "," $1,191.11 "," $1,801.15 "," $1,405.56 "," $1,579.92 ", N/A ," $1,350.56 "," $1,350.56 "," $2,013.05 "," $1,412.55 ", $211.95 ," $2,034.24 "
TREAT RADIUS FRACTURE,24655,N/A,N/A,N/A," $2,140.00 "," $1,391.00 "," $2,495.42 ", $394.82 , $230.52 ," $1,902.50 "," $1,941.67 "," $1,990.20 "," $1,926.00 "," $1,926.00 "," $1,712.00 "," $1,712.00 ", $230.52 ," $1,975.86 "," $2,033.00 "," $1,926.00 "," $1,926.00 "," $1,926.00 "," $1,990.20 "," $2,054.40 "," $2,289.74 "," $1,819.00 "," $2,133.74 "," $2,274.70 ", N/A ," $1,939.62 "," $1,939.62 "," $2,033.00 "," $2,279.74 ", $230.52 ," $2,495.42 "
Craniect Excis Skull Bone Lesn,CPT® 61500,N/A,N/A,N/A," $13,172.00 "," $8,561.80 "," $6,121.60 "," $1,196.13 "," $1,134.00 "," $7,183.97 "," $6,958.33 "," $12,249.96 "," $11,854.80 "," $11,854.80 "," $10,537.60 "," $10,537.60 "," $1,134.00 "," $12,161.71 "," $12,513.40 "," $11,854.80 "," $11,854.80 "," $11,854.80 "," $12,249.96 "," $12,645.12 "," $6,602.50 "," $11,196.20 "," $7,073.81 "," $7,503.10 ", N/A ," $7,324.15 "," $7,324.15 "," $12,513.40 "," $7,857.08 "," $1,134.00 "," $12,645.12 "
9vhpv Vacc 2/3 Dose Sched Im Use,CPT® 90651,N/A,N/A,N/A, $213.00 , $138.45 , N/A , N/A , $289.45 , N/A , N/A , $198.09 , $191.70 , $191.70 , $170.40 , $170.40 , $289.45 , $196.66 , $202.35 , $191.70 , $191.70 , $191.70 , $198.09 , $204.48 , N/A , $181.05 , $170.40 , $441.59 , N/A , N/A , N/A , $202.35 , N/A , $170.40 , $441.59 
"Shav Skin Les >21mm Face,Facial",CPT® 11313,N/A,N/A,N/A, $699.00 , $454.35 , $308.48 , $91.66 , $115.07 , $273.92 , $265.10 , $650.07 , $629.10 , $629.10 , $559.20 , $559.20 , $115.07 , $645.39 , $664.05 , $629.10 , $629.10 , $629.10 , $650.07 , $671.04 , $339.44 , $594.15 , $529.87 , $351.74 , N/A , $279.26 , $279.26 , $664.05 , $323.87 , $91.66 , $671.04 
Removal of Metatarsal,CPT® 28140,N/A,N/A,N/A," $4,073.00 "," $2,647.45 "," $2,641.93 ", $410.35 , $384.19 ," $2,150.38 "," $2,150.78 "," $3,787.89 "," $3,665.70 "," $3,665.70 "," $3,258.40 "," $3,258.40 ", $384.19 ," $3,760.60 "," $3,869.35 "," $3,665.70 "," $3,665.70 "," $3,665.70 "," $3,787.89 "," $3,910.08 "," $2,464.31 "," $3,462.05 "," $2,344.26 "," $2,550.81 ", N/A ," $2,192.34 "," $2,192.34 "," $3,869.35 "," $2,576.78 ", $384.19 ," $3,910.08 "
Refraction,92015,N/A,N/A,N/A, $62.00 , $40.30 , $20.00 , $18.93 , $10.17 , $34.59 , $33.66 , $57.66 , $55.80 , $55.80 , $49.60 , $49.60 , $10.17 , $57.24 , $58.90 , $55.80 , $55.80 , $55.80 , $57.66 , $59.52 , $58.79 , $52.70 , $56.77 , $41.01 , N/A , $35.27 , $35.27 , $58.90 , $41.95 , $10.17 , $59.52 
 Fac Dcmprn Fasct Leg Ant&/Lat&Pst Cmprt ,CPT® 27602,0360 - OR SERVICES,N/A,N/A," $4,313.00 "," $2,803.45 "," $3,622.92 ", $440.99 , $461.04 ," $3,484.90 "," $3,881.70 "," $3,651.39 "," $3,881.70 "," $3,881.70 "," $3,881.70 "," $3,666.05 ", $452.00 ," $3,982.19 "," $4,097.35 "," $3,666.05 "," $4,011.09 "," $4,011.09 "," $4,097.35 "," $4,140.48 "," $3,528.90 "," $3,881.70 "," $3,666.05 "," $3,407.27 ", N/A ," $3,490.51 "," $3,490.51 "," $4,097.35 "," $3,700.99 ", $440.99 ," $4,140.48 "
Ambulatory Bp Mntr W/Sw 24 Hr+ Scanning a/R,CPT® 93788,N/A,N/A,N/A, $128.00 , $83.20 , $30.36 , $5.04 , $18.55 , $27.71 , $31.44 , $119.04 , $115.20 , $115.20 , $102.40 , $102.40 , $18.55 , $118.18 , $121.60 , $115.20 , $115.20 , $115.20 , $119.04 , $122.88 , $29.97 , $108.80 , $30.33 , $19.15 , N/A , $28.25 , $28.25 , $121.60 , $31.31 , $5.04 , $122.88 
Egd Injection Sclerosis Esophgl/Gastric Varices,CPT® 43243,N/A,N/A,N/A," $2,660.00 "," $1,729.00 "," $1,451.45 ", $224.05 , $249.97 ," $1,200.18 "," $1,294.30 "," $2,473.80 "," $2,394.00 "," $2,394.00 "," $2,128.00 "," $2,128.00 ", $249.97 ," $2,455.98 "," $2,527.00 "," $2,394.00 "," $2,394.00 "," $2,394.00 "," $2,473.80 "," $2,553.60 "," $1,042.92 "," $2,261.00 "," $1,420.11 "," $1,383.06 ", N/A ," $1,223.59 "," $1,223.59 "," $2,527.00 "," $1,279.76 ", $224.05 ," $2,553.60 "
 Fac or Room Chg Lvl2 Base ,Custom OPTORBASELVL2,0360 - OR SERVICES,N/A,N/A," $5,234.00 "," $3,402.10 "," $4,396.56 ", N/A , N/A ," $4,229.07 "," $4,710.60 "," $4,431.10 "," $4,710.60 "," $4,710.60 "," $4,710.60 "," $4,448.90 ", N/A ," $4,832.55 "," $4,972.30 "," $4,448.90 "," $4,867.62 "," $4,867.62 "," $4,972.30 "," $5,024.64 "," $4,282.46 "," $4,710.60 "," $4,448.90 "," $4,134.86 ", N/A ," $4,235.88 "," $4,235.88 "," $4,972.30 "," $4,491.30 "," $4,134.86 "," $5,024.64 "
 Pro Arthrs Kne Lat Rls ,CPT® 29873,0982 - PRO FEE/OUTPT,N/A,N/A," $3,447.00 "," $2,240.55 "," $3,291.41 ", $516.47 , $452.38 ," $2,534.68 "," $2,544.11 "," $3,205.71 "," $3,102.30 "," $3,102.30 "," $2,757.60 "," $2,757.60 ", $452.38 ," $3,182.62 "," $3,274.65 "," $3,102.30 "," $3,102.30 "," $3,102.30 "," $3,205.71 "," $3,309.12 "," $3,043.70 "," $2,929.95 "," $2,802.76 "," $2,997.14 ", N/A ," $2,584.13 "," $2,584.13 "," $3,274.65 "," $3,037.27 ", $452.38 ," $3,309.12 "
Layer Closure 2.6-7.5cm,12032,N/A,N/A,N/A," $1,160.00 ", $754.00 , $608.50 , $183.18 , $82.48 , $532.01 , $524.46 ," $1,078.80 "," $1,044.00 "," $1,044.00 ", $928.00 , $928.00 , $82.48 ," $1,071.03 "," $1,102.00 "," $1,044.00 "," $1,044.00 "," $1,044.00 "," $1,078.80 "," $1,113.60 ", $668.28 , $986.00 ," $1,043.68 ", $685.38 , N/A , $542.39 , $542.39 ," $1,102.00 ", $628.99 , $82.48 ," $1,113.60 "
 Fac Perq Vert Agmntj Cavity Crtj Uni/Bi Cannulj Lmbr ,CPT® 22514,0361 - OR/MINOR,N/A,N/A," $29,650.00 "," $19,272.50 "," $24,906.00 ", $445.26 ," $5,745.46 "," $23,957.20 "," $26,685.00 "," $25,101.69 "," $26,685.00 "," $26,685.00 "," $26,685.00 "," $25,202.50 "," $5,632.80 "," $27,375.85 "," $28,167.50 "," $25,202.50 "," $27,574.50 "," $27,574.50 "," $28,167.50 "," $28,464.00 "," $24,259.63 "," $26,685.00 "," $25,202.50 "," $23,423.50 ", N/A ," $23,995.75 "," $23,995.75 "," $28,167.50 "," $25,442.67 ", $445.26 ," $28,464.00 "
 Pro Placement of Seton ,CPT® 46020,0982 - PRO FEE/OUTPT,N/A,N/A, $834.00 , $542.10 , $699.53 , $109.47 , $204.23 ," $1,115.57 "," $1,151.67 ", $775.62 , $750.60 , $750.60 , $667.20 , $667.20 , $204.23 , $770.03 , $792.30 , $750.60 , $750.60 , $750.60 , $775.62 , $800.64 ," $1,047.15 ", $708.90 ," $1,264.90 "," $1,330.79 ", N/A ," $1,137.33 "," $1,137.33 ", $792.30 ," $1,189.53 ", $109.47 ," $1,330.79 "
Remv Cartilage for Graft Nasal,CPT® 20912,N/A,N/A,N/A," $3,316.00 "," $2,155.40 "," $2,963.09 ", $465.23 , $293.99 ," $2,328.82 "," $2,353.04 "," $3,083.88 "," $2,984.40 "," $2,984.40 "," $2,652.80 "," $2,652.80 ", $293.99 ," $3,061.66 "," $3,150.20 "," $2,984.40 "," $2,984.40 "," $2,984.40 "," $3,083.88 "," $3,183.36 "," $2,718.36 "," $2,818.60 "," $2,577.97 "," $2,708.70 ", N/A ," $2,374.26 "," $2,374.26 "," $3,150.20 "," $2,790.60 ", $293.99 ," $3,183.36 "
 Pro Thyroid Uptake Single/Multiple Quant Measurement ,CPT® 78012,0974 - PRO FEE/NUC MED,N/A,N/A, $247.00 , $160.55 , $447.64 , $78.69 , $65.24 , $388.69 , $429.23 , $229.71 , $222.30 , $222.30 , $197.60 , $197.60 , $65.24 , $228.06 , $234.65 , $222.30 , $222.30 , $222.30 , $229.71 , $237.12 , $447.77 , $209.95 , $469.95 , $542.34 , N/A , $396.27 , $396.27 , $234.65 , $458.70 , $65.24 , $542.34 
Drug Screening Oxycodone,CPT® 80365,N/A,N/A,N/A, $79.00 , $51.35 , N/A , N/A , N/A , N/A , N/A , $73.47 , $71.10 , $71.10 , $63.20 , $63.20 , N/A , $72.94 , $75.05 , $71.10 , $71.10 , $71.10 , $73.47 , $75.84 , N/A , $67.15 , $114.69 , $67.79 , N/A , $90.04 , $90.04 , $75.05 , $98.20 , $63.20 , $114.69 
Burr Hole Evac Subdur/Extra Hematoma,CPT® 61154,N/A,N/A,N/A," $8,206.00 "," $5,333.90 "," $5,869.71 "," $1,148.28 "," $1,567.93 "," $6,863.18 "," $6,606.84 "," $7,631.58 "," $7,385.40 "," $7,385.40 "," $6,564.80 "," $6,564.80 "," $1,567.93 "," $7,576.60 "," $7,795.70 "," $7,385.40 "," $7,385.40 "," $7,385.40 "," $7,631.58 "," $7,877.76 "," $6,329.17 "," $6,975.10 "," $6,768.74 "," $7,122.09 ", N/A ," $6,997.09 "," $6,997.09 "," $7,795.70 "," $7,506.23 "," $1,148.28 "," $7,877.76 "
 CLINIMIX E/DEXTROSE (5/20) 5 % IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00338-1125-04,"2,000 mL", $534.24 , $347.26 , $448.76 , N/A , N/A , $431.67 , $480.82 , $452.29 , $480.82 , $480.82 , $480.82 , $454.10 , N/A , $493.26 , $507.53 , $454.10 , $496.84 , $496.84 , $507.53 , $512.87 , $437.12 , $480.82 , $454.10 , $422.05 , N/A , $432.36 , $432.36 , $507.53 , $458.43 , $422.05 , $512.87 
 Fac Calculus Spectroscopy ,CPT® 82365,0301 - LAB/CHEMISTRY,N/A,N/A, $160.00 , $104.00 , $134.40 , $13.16 , $13.16 , $129.28 , $144.00 , $135.46 , $144.00 , $144.00 , $144.00 , $136.00 , $12.90 , $147.73 , $152.00 , $136.00 , $148.80 , $148.80 , $152.00 , $153.60 , $130.91 , $144.00 , $136.00 , $126.40 , N/A , $129.49 , $129.49 , $152.00 , $137.30 , $12.90 , $153.60 
Brnchsc W/Ther Aspir Tracheobrncl Tree Sbsq,CPT® 31646,N/A,N/A,N/A," $1,897.00 "," $1,233.05 ", $775.96 , $134.70 , $181.42 , $543.14 , $534.49 ," $1,764.21 "," $1,707.30 "," $1,707.30 "," $1,517.60 "," $1,517.60 ", $181.42 ," $1,751.50 "," $1,802.15 "," $1,707.30 "," $1,707.30 "," $1,707.30 "," $1,764.21 "," $1,821.12 ", $749.27 ," $1,612.45 ", $745.74 , $740.28 , N/A , $553.74 , $553.74 ," $1,802.15 ", $652.14 , $134.70 ," $1,821.12 "
Assay of Androstenedione,CPT® 82157,N/A,N/A,N/A, $269.00 , $174.85 , N/A , $29.87 , $29.87 , $165.63 , $198.12 , $250.17 , $242.10 , $242.10 , $215.20 , $215.20 , $29.87 , $248.37 , $255.55 , $242.10 , $242.10 , $242.10 , $250.17 , $258.24 , $195.51 , $228.65 , $191.38 , $106.14 , N/A , $154.58 , $154.58 , $255.55 , $168.92 , $29.87 , $258.24 
 Pro Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Std ,CPT® 93931,0982 - PRO FEE/OUTPT,N/A,N/A, $375.00 , $243.75 , $788.84 , $121.04 , $121.35 , $696.53 , $917.20 , $348.75 , $337.50 , $337.50 , $300.00 , $300.00 , $121.35 , $346.24 , $356.25 , $337.50 , $337.50 , $337.50 , $348.75 , $360.00 , $552.55 , $318.75 , $489.62 , $492.29 , N/A , $710.12 , $710.12 , $356.25 , $787.17 , $121.04 , $917.20 
 DEXAMETHASONE SODIUM PHOSPHATE 0.1 % OP SOLN ,HCPCS RXC637,0250 - PHARMACY,24208-0720-02,5 mL, $332.26 , $215.97 , $279.10 , N/A , N/A , $268.47 , $299.03 , $281.29 , $299.03 , $299.03 , $299.03 , $282.42 , N/A , $306.78 , $315.65 , $282.42 , $309.00 , $309.00 , $315.65 , $318.97 , $271.86 , $299.03 , $282.42 , $262.49 , N/A , $268.90 , $268.90 , $315.65 , $285.11 , $262.49 , $318.97 
 Fac Njx Px Cntrst Kne Arthg Cntrst Enhncd CT/MRI Kne ,CPT® 27369,0361 - OR/MINOR,N/A,N/A, $335.00 , $217.75 , $281.40 , $38.54 , $113.66 , $270.68 , $301.50 , $283.61 , $301.50 , $301.50 , $301.50 , $284.75 , $111.43 , $309.31 , $318.25 , $284.75 , $311.55 , $311.55 , $318.25 , $321.60 , $274.10 , $301.50 , $284.75 , $264.65 , N/A , $271.12 , $271.12 , $318.25 , $287.46 , $38.54 , $321.60 
"Pericardiotomy,Remov Clot",CPT® 33020,N/A,N/A,N/A," $5,496.00 "," $3,572.40 "," $4,861.55 ", $749.24 ," $1,340.24 "," $3,763.29 "," $3,711.11 "," $5,111.28 "," $4,946.40 "," $4,946.40 "," $4,396.80 "," $4,396.80 "," $1,340.24 "," $5,074.46 "," $5,221.20 "," $4,946.40 "," $4,946.40 "," $4,946.40 "," $5,111.28 "," $5,276.16 "," $4,484.68 "," $4,671.60 "," $4,683.17 "," $4,227.54 ", N/A ," $3,836.72 "," $3,836.72 "," $5,221.20 "," $4,358.50 ", $749.24 ," $5,276.16 "
 Pro Remove Intrauterine Device ,CPT® 58301,0982 - PRO FEE/OUTPT,N/A,N/A, $571.00 , $371.15 , $309.85 , $62.49 , $89.76 , $276.75 , $274.64 , $531.03 , $513.90 , $513.90 , $456.80 , $456.80 , $89.76 , $527.20 , $542.45 , $513.90 , $513.90 , $513.90 , $531.03 , $548.16 , $326.54 , $485.35 , $362.17 , $277.36 , N/A , $282.15 , $282.15 , $542.45 , $338.42 , $62.49 , $548.16 
Repair Sliding Inguinal Hernia,49525,N/A,N/A,N/A," $3,730.00 "," $2,424.50 "," $3,437.14 ", $533.40 , $614.70 ," $2,688.86 "," $2,728.30 "," $3,468.90 "," $3,357.00 "," $3,357.00 "," $2,984.00 "," $2,984.00 ", $614.70 ," $3,443.91 "," $3,543.50 "," $3,357.00 "," $3,357.00 "," $3,357.00 "," $3,468.90 "," $3,580.80 "," $2,458.57 "," $3,170.50 "," $3,027.56 "," $3,176.35 ", N/A ," $2,741.32 "," $2,741.32 "," $3,543.50 "," $2,867.13 ", $533.40 ," $3,580.80 "
Excis Subcut Shldr Tumor,23076,N/A,N/A,N/A," $3,553.00 "," $2,309.45 "," $3,291.02 ", $515.17 , $184.20 ," $2,586.31 "," $2,586.00 "," $3,304.29 "," $3,197.70 "," $3,197.70 "," $2,842.40 "," $2,842.40 ", $184.20 ," $3,280.48 "," $3,375.35 "," $3,197.70 "," $3,197.70 "," $3,197.70 "," $3,304.29 "," $3,410.88 "," $3,046.23 "," $3,020.05 "," $2,859.85 "," $3,051.01 ", N/A ," $2,636.77 "," $2,636.77 "," $3,375.35 "," $3,099.15 ", $184.20 ," $3,410.88 "
 Brain MRI With Contrast ,CPT® 70552,0611 - MRI - BRAIN/HEAD/NECK,N/A,N/A," $7,156.00 "," $4,651.40 "," $6,011.04 ", $277.80 , $506.39 ," $5,782.05 "," $6,440.40 "," $6,058.27 "," $6,440.40 "," $6,440.40 "," $6,440.40 "," $6,082.60 ", $496.46 ," $6,607.13 "," $6,798.20 "," $6,082.60 "," $6,655.08 "," $6,655.08 "," $6,798.20 "," $6,869.76 "," $5,855.04 "," $6,440.40 "," $6,082.60 "," $5,653.24 ", N/A ," $5,791.35 "," $5,791.35 "," $6,798.20 "," $6,140.56 ", $277.80 ," $6,869.76 "
" Fac Compatibility Test, Antiglob ",CPT® 86922,0300 - LABORATORY,N/A,N/A, $112.00 , $72.80 , $94.08 , N/A , $43.30 , $90.50 , $100.80 , $94.82 , $100.80 , $100.80 , $100.80 , $95.20 , $42.45 , $103.41 , $106.40 , $95.20 , $104.16 , $104.16 , $106.40 , $107.52 , $91.64 , $100.80 , $95.20 , $88.48 , N/A , $90.64 , $90.64 , $106.40 , $96.11 , $42.45 , $107.52 
"X-Ray Tib + Fib, 2vw",CPT® 73590,N/A,N/A,N/A, $225.00 , $146.25 , $177.02 , $31.03 , $26.21 , $126.21 , $146.94 , $209.25 , $202.50 , $202.50 , $180.00 , $180.00 , $26.21 , $207.74 , $213.75 , $202.50 , $202.50 , $202.50 , $209.25 , $216.00 , $172.54 , $191.25 , $161.79 , $144.02 , N/A , $128.68 , $128.68 , $213.75 , $148.95 , $26.21 , $216.00 
Removal of Skin Tags,11200,N/A,N/A,N/A, $163.00 , $105.95 , $244.80 , $74.08 , $40.50 , $199.18 , $197.46 , $151.59 , $146.70 , $146.70 , $130.40 , $130.40 , $40.50 , $150.50 , $154.85 , $146.70 , $146.70 , $146.70 , $151.59 , $156.48 , $265.13 , $138.55 , $390.71 , $259.40 , N/A , $203.07 , $203.07 , $154.85 , $235.48 , $40.50 , $390.71 
 Fac Replacement Gastro-Jejunostomy Tube Percutaneous ,CPT® 49452,0750 - GASTR-INST SVS,N/A,N/A," $1,401.00 ", $910.65 ," $1,176.84 ", $129.92 , $765.20 ," $1,132.01 "," $1,260.90 "," $1,186.09 "," $1,260.90 "," $1,260.90 "," $1,260.90 "," $1,190.85 ", $750.20 ," $1,293.54 "," $1,330.95 "," $1,190.85 "," $1,302.93 "," $1,302.93 "," $1,330.95 "," $1,344.96 "," $1,146.30 "," $1,260.90 "," $1,190.85 "," $1,106.79 ", N/A ," $1,133.83 "," $1,133.83 "," $1,330.95 "," $1,202.20 ", $129.92 ," $1,344.96 "
 WARFARIN 1.25 MG TAB (COMES FROM 2.5 MG TABLET) ,HCPCS RXC637,0250 - PHARMACY,00001-0928-01,1 tablet, $3.40 , $2.21 , $2.86 , N/A , N/A , $2.75 , $3.06 , $2.88 , $3.06 , $3.06 , $3.06 , $2.89 , N/A , $3.14 , $3.23 , $2.89 , $3.16 , $3.16 , $3.23 , $3.26 , $2.78 , $3.06 , $2.89 , $2.69 , N/A , $2.75 , $2.75 , $3.23 , $2.92 , $2.69 , $3.26 
 Fac Tangential Biopsy Skin Single Lesion ,CPT® 11102,0761 - TREATMENT ROOM,N/A,N/A, $187.00 , $121.55 , $157.08 , $36.38 , $78.04 , $151.10 , $168.30 , $158.31 , $168.30 , $168.30 , $168.30 , $158.95 , $76.51 , $172.66 , $177.65 , $158.95 , $173.91 , $173.91 , $177.65 , $179.52 , $153.00 , $168.30 , $158.95 , $147.73 , N/A , $151.34 , $151.34 , $177.65 , $160.46 , $36.38 , $179.52 
Ins Pacemaker Pulse Gen Only W/Exist Mult Leads,CPT® 33221,N/A,N/A,N/A," $3,904.00 "," $2,537.60 "," $2,155.14 ", $332.38 , $404.35 ," $1,590.64 "," $1,520.38 "," $3,630.72 "," $3,513.60 "," $3,513.60 "," $3,123.20 "," $3,123.20 ", $404.35 ," $3,604.56 "," $3,708.80 "," $3,513.60 "," $3,513.60 "," $3,513.60 "," $3,630.72 "," $3,747.84 "," $1,995.45 "," $3,318.40 "," $1,908.95 "," $1,744.31 ", N/A ," $1,621.68 "," $1,621.68 "," $3,708.80 "," $1,842.25 ", $332.38 ," $3,747.84 "
 ED Fac Wedging of Cast ,CPT® 29740,0761 - TREATMENT ROOM,N/A,N/A, $418.00 , $271.70 , $351.12 , $64.41 , $15.36 , $337.74 , $376.20 , $353.88 , $376.20 , $376.20 , $376.20 , $355.30 , $15.06 , $385.94 , $397.10 , $355.30 , $388.74 , $388.74 , $397.10 , $401.28 , $342.01 , $376.20 , $355.30 , $330.22 , N/A , $338.29 , $338.29 , $397.10 , $358.69 , $15.06 , $401.28 
 Fac Iaad Ia Cryptococcus Neoformans ,CPT® 87327,0306 - LAB/BACT-MICRO,N/A,N/A, $103.00 , $66.95 , $86.52 , $13.69 , $13.69 , $83.22 , $92.70 , $87.20 , $92.70 , $92.70 , $92.70 , $87.55 , $13.42 , $95.10 , $97.85 , $87.55 , $95.79 , $95.79 , $97.85 , $98.88 , $84.27 , $92.70 , $87.55 , $81.37 , N/A , $83.36 , $83.36 , $97.85 , $88.38 , $13.42 , $98.88 
Diagnostic Computed Tomography Thorax W/Contrast,CPT® 71260,N/A,N/A,N/A," $3,215.00 "," $2,089.75 "," $1,186.64 ", $170.34 , $303.46 ," $1,092.56 "," $1,383.91 "," $2,989.95 "," $2,893.50 "," $2,893.50 "," $2,572.00 "," $2,572.00 ", $303.46 ," $2,968.41 "," $3,054.25 "," $2,893.50 "," $2,893.50 "," $2,893.50 "," $2,989.95 "," $3,086.40 "," $1,002.07 "," $2,732.75 "," $1,508.09 "," $1,275.20 ", N/A ," $1,113.88 "," $1,113.88 "," $3,054.25 "," $1,289.32 ", $170.34 ," $3,086.40 "
Emergency Department Visit Low Mdm,99283,N/A,N/A,N/A, $376.00 , $244.40 , $251.49 , $68.75 , $26.96 , $174.00 , $179.09 , $349.68 , $338.40 , $338.40 , $300.80 , $300.80 , $26.96 , $347.16 , $357.20 , $338.40 , $338.40 , $338.40 , $349.68 , $360.96 , $213.09 , $319.60 , $132.02 , $134.13 , $74.50 , $177.39 , $177.39 , $357.20 , $212.87 , $26.96 , $360.96 
Radiation Therapy Plan Interm,CPT® 77262,N/A,N/A,N/A, $720.00 , $468.00 , $603.32 , $105.78 , $126.83 , $543.97 , $553.85 , $669.60 , $648.00 , $648.00 , $576.00 , $576.00 , $126.83 , $664.78 , $684.00 , $648.00 , $648.00 , $648.00 , $669.60 , $691.20 , $602.75 , $612.00 , $608.63 , $596.44 , N/A , $554.59 , $554.59 , $684.00 , $641.92 , $105.78 , $691.20 
 HYDROCODONE-ACETAMINOPHEN 10-325 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6825-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Occupational Therapy Eval Low Complex 30 Mins,CPT® 97165,N/A,N/A,N/A, $247.00 , $160.55 , $197.34 , $100.30 , $63.91 , $169.43 , $179.72 , $229.71 , $222.30 , $222.30 , $197.60 , $197.60 , $63.91 , $228.06 , $234.65 , $222.30 , $222.30 , $222.30 , $229.71 , $237.12 , $245.52 , $209.95 , $302.90 , $204.76 , N/A , $172.73 , $172.73 , $234.65 , $192.12 , $63.91 , $302.90 
Whfo Nontorsion Joint Prefab,HCPCS L3931,N/A,N/A,N/A, $317.00 , $206.05 , N/A , $221.96 , $86.85 , N/A , N/A , $294.81 , $285.30 , $285.30 , $253.60 , $253.60 , $86.85 , $292.69 , $301.15 , $285.30 , $285.30 , $285.30 , $294.81 , $304.32 , N/A , $269.45 , $180.35 , $186.74 , N/A , N/A , N/A , $301.15 , N/A , $86.85 , $304.32 
 I 123 per 100 Uci ,HCPCS A9516,0343 - DIAGNOSTIC RADIOPHARMACEUTICALS,N/A,N/A, $198.00 , $128.70 , $166.32 , $142.47 , $72.28 , $159.98 , $178.20 , $167.63 , $178.20 , $178.20 , $178.20 , $168.30 , $70.86 , $182.81 , $188.10 , $168.30 , $184.14 , $184.14 , $188.10 , $190.08 , $162.00 , $178.20 , $168.30 , $156.42 , N/A , $160.24 , $160.24 , $188.10 , $169.90 , $70.86 , $190.08 
"Fracture Head/Neck,Closed",24650,N/A,N/A,N/A, $957.00 , $622.05 ," $1,529.32 ", $243.22 , $194.38 ," $1,155.93 "," $1,180.19 ", $890.01 , $861.30 , $861.30 , $765.60 , $765.60 , $194.38 , $883.60 , $909.15 , $861.30 , $861.30 , $861.30 , $890.01 , $918.72 ," $1,410.37 ", $813.45 ," $1,291.66 "," $1,377.14 ", N/A ," $1,178.49 "," $1,178.49 ", $909.15 ," $1,385.17 ", $194.38 ," $1,529.32 "
 Fac Cardiac Rehab Phase 3 ,Custom 9900000004,0990 - PT CONVENIENCE,N/A,N/A, $51.00 , $33.15 , $42.84 , N/A , N/A , $41.21 , $45.90 , $43.18 , $45.90 , $45.90 , $45.90 , $43.35 , N/A , $47.09 , $48.45 , $43.35 , $47.43 , $47.43 , $48.45 , $48.96 , $41.73 , $45.90 , $43.35 , $40.29 , N/A , $41.27 , $41.27 , $48.45 , $43.76 , $40.29 , $48.96 
 CLOZAPINE 100 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-7087-61,1 tablet, $5.78 , $3.76 , $4.86 , N/A , N/A , $4.67 , $5.20 , $4.89 , $5.20 , $5.20 , $5.20 , $4.91 , N/A , $5.34 , $5.49 , $4.91 , $5.38 , $5.38 , $5.49 , $5.55 , $4.73 , $5.20 , $4.91 , $4.57 , N/A , $4.68 , $4.68 , $5.49 , $4.96 , $4.57 , $5.55 
 SODIUM CHLORIDE 4 MEQ/ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,63323-0093-30,30 mL, $41.31 , $26.85 , $34.70 , N/A , N/A , $33.38 , $37.18 , $34.97 , $37.18 , $37.18 , $37.18 , $35.11 , N/A , $38.14 , $39.24 , $35.11 , $38.42 , $38.42 , $39.24 , $39.66 , $33.80 , $37.18 , $35.11 , $32.63 , N/A , $33.43 , $33.43 , $39.24 , $35.45 , $32.63 , $39.66 
Apply Short Leg Splint,29515,N/A,N/A,N/A, $350.00 , $227.50 , $298.68 , $47.11 , $31.03 , $240.63 , $243.68 , $325.50 , $315.00 , $315.00 , $280.00 , $280.00 , $31.03 , $323.16 , $332.50 , $315.00 , $315.00 , $315.00 , $325.50 , $336.00 , $277.19 , $297.50 , $265.83 , $288.50 , N/A , $245.33 , $245.33 , $332.50 , $288.36 , $31.03 , $336.00 
 Fac Evaluation of Speech Sound Production Articulate ,CPT® 92522,0444 - SPEECH PATH/EVAL,N/A,N/A, $368.00 , $239.20 , $309.12 , $110.47 , $87.90 , $297.34 , $331.20 , $311.55 , $331.20 , $331.20 , $331.20 , $312.80 , $86.18 , $339.77 , $349.60 , $312.80 , $342.24 , $342.24 , $349.60 , $353.28 , $301.10 , $331.20 , $312.80 , $290.72 , N/A , $297.82 , $297.82 , $349.60 , $315.78 , $86.18 , $353.28 
 Fac Assay of Estrone ,CPT® 82679,0301 - LAB/CHEMISTRY,N/A,N/A, $239.00 , $155.35 , $200.76 , $25.45 , $25.45 , $193.11 , $215.10 , $202.34 , $215.10 , $215.10 , $215.10 , $203.15 , $24.95 , $220.67 , $227.05 , $203.15 , $222.27 , $222.27 , $227.05 , $229.44 , $195.55 , $215.10 , $203.15 , $188.81 , N/A , $193.42 , $193.42 , $227.05 , $205.09 , $24.95 , $229.44 
Treat Phalangeal Fracture,CPT® 26765,N/A,N/A,N/A," $3,278.00 "," $2,130.70 "," $3,092.25 ", $487.69 , $262.37 ," $2,411.56 "," $2,427.02 "," $3,048.54 "," $2,950.20 "," $2,950.20 "," $2,622.40 "," $2,622.40 ", $262.37 ," $3,026.58 "," $3,114.10 "," $2,950.20 "," $2,950.20 "," $2,950.20 "," $3,048.54 "," $3,146.88 "," $2,869.55 "," $2,786.30 "," $2,667.18 "," $2,865.11 ", N/A ," $2,458.61 "," $2,458.61 "," $3,114.10 "," $2,889.74 ", $262.37 ," $3,146.88 "
Collection Capillary Blood Specimen,CPT® 36416,N/A,N/A,N/A, $35.00 , $22.75 , $10.00 , N/A , $3.09 , $11.08 , $12.63 , $32.55 , $31.50 , $31.50 , $28.00 , $28.00 , $3.09 , $32.32 , $33.25 , $31.50 , $31.50 , $31.50 , $32.55 , $33.60 , $20.88 , $29.75 , N/A , $8.11 , N/A , $11.29 , $11.29 , $33.25 , $14.77 , $3.09 , $33.60 
 Fac Occlusive Device in Vein Art ,HCPCS G0269,0360 - OR SERVICES,N/A,N/A, $366.00 , $237.90 , $307.44 , N/A , N/A , $295.73 , $329.40 , $309.86 , $329.40 , $329.40 , $329.40 , $311.10 , N/A , $337.93 , $347.70 , $311.10 , $340.38 , $340.38 , $347.70 , $351.36 , $299.46 , $329.40 , $311.10 , $289.14 , N/A , $296.20 , $296.20 , $347.70 , $314.06 , $289.14 , $351.36 
 LAYER CLOSURE Trunk 20.1-30CM ,CPT® 12036,0981 - PRO FEE/ER,N/A,N/A," $1,915.00 "," $1,244.75 ", $887.81 , $264.02 , $215.14 , $754.97 , $740.93 ," $1,780.95 "," $1,723.50 "," $1,723.50 "," $1,532.00 "," $1,532.00 ", $215.14 ," $1,768.12 "," $1,819.25 "," $1,723.50 "," $1,723.50 "," $1,723.50 "," $1,780.95 "," $1,838.40 ", $974.81 ," $1,627.75 "," $1,489.69 ", $970.85 , N/A , $769.70 , $769.70 ," $1,819.25 ", $892.60 , $215.14 ," $1,838.40 "
" Fac Tissue Culture, Lymphocyte ",CPT® 88230,0310 - PATHOLOGY LAB,N/A,N/A," $1,046.00 ", $679.90 , $878.64 , $118.82 , $69.14 , $845.17 , $941.40 , $885.54 , $941.40 , $941.40 , $941.40 , $889.10 , $67.78 , $965.77 , $993.70 , $889.10 , $972.78 , $972.78 , $993.70 ," $1,004.16 ", $855.84 , $941.40 , $889.10 , $826.34 , N/A , $846.53 , $846.53 , $993.70 , $897.57 , $67.78 ," $1,004.16 "
 Fac Echo Transthoracic ,CPT® 93304,0480 - CARDIOLOGY,N/A,N/A," $1,904.00 "," $1,237.60 "," $1,599.36 ", $152.66 , $170.29 ," $1,538.43 "," $1,713.60 "," $1,611.93 "," $1,713.60 "," $1,713.60 "," $1,713.60 "," $1,618.40 ", $166.95 ," $1,757.96 "," $1,808.80 "," $1,618.40 "," $1,770.72 "," $1,770.72 "," $1,808.80 "," $1,827.84 "," $1,557.85 "," $1,713.60 "," $1,618.40 "," $1,504.16 ", N/A ," $1,540.91 "," $1,540.91 "," $1,808.80 "," $1,633.82 ", $152.66 ," $1,827.84 "
Chmsrg Mohs Mg Tq H/N/H/F/G 1st Stag 5 Blocks,CPT® 17311,N/A,N/A,N/A," $3,261.00 "," $2,119.65 "," $1,142.77 ", $341.54 , $475.79 ," $1,033.60 "," $1,000.02 "," $3,032.73 "," $2,934.90 "," $2,934.90 "," $2,608.80 "," $2,608.80 ", $475.79 ," $3,010.88 "," $3,097.95 "," $2,934.90 "," $2,934.90 "," $2,934.90 "," $3,032.73 "," $3,130.56 "," $1,263.63 "," $2,771.85 "," $1,991.02 "," $1,321.71 ", N/A ," $1,053.77 "," $1,053.77 "," $3,097.95 "," $1,222.02 ", $341.54 ," $3,130.56 "
Rsv Vacc Pref Recombinant Adjuvanted for Im Use,CPT® 90679,N/A,N/A,N/A, $837.00 , $544.05 , N/A , N/A , N/A , N/A , N/A , $778.41 , $753.30 , $753.30 , $669.60 , $669.60 , N/A , $772.80 , $795.15 , $753.30 , $753.30 , $753.30 , $778.41 , $803.52 , N/A , $711.45 , N/A , N/A , N/A , N/A , N/A , $795.15 , N/A , $669.60 , $803.52 
"Immunoassay, Tumor Antigen, Ca 125",CPT® 86304,N/A,N/A,N/A, $237.00 , $154.05 , N/A , $21.23 , $21.23 , $117.74 , $140.86 , $220.41 , $213.30 , $213.30 , $189.60 , $189.60 , $21.23 , $218.82 , $225.15 , $213.30 , $213.30 , $213.30 , $220.41 , $227.52 , $138.95 , $201.45 , $136.23 , $75.48 , N/A , $109.88 , $109.88 , $225.15 , $120.08 , $21.23 , $227.52 
 Pro Cltx Patellar Fx W/O Mnpj ,CPT® 27520,0981 - PRO FEE/ER,N/A,N/A," $1,450.00 ", $942.50 ," $1,872.26 ", $296.68 , $195.27 ," $1,421.40 "," $1,446.93 "," $1,348.50 "," $1,305.00 "," $1,305.00 "," $1,160.00 "," $1,160.00 ", $195.27 ," $1,338.79 "," $1,377.50 "," $1,305.00 "," $1,305.00 "," $1,305.00 "," $1,348.50 "," $1,392.00 "," $1,721.73 "," $1,232.50 "," $1,589.60 "," $1,686.56 ", N/A ," $1,449.14 "," $1,449.14 "," $1,377.50 "," $1,703.25 ", $195.27 ," $1,872.26 "
 Fac Evaluation of Speech Fluency (Stutter Clutter) ,CPT® 92521,0444 - SPEECH PATH/EVAL,N/A,N/A, $510.00 , $331.50 , $428.40 , $132.59 , $105.51 , $412.08 , $459.00 , $431.77 , $459.00 , $459.00 , $459.00 , $433.50 , $103.44 , $470.88 , $484.50 , $433.50 , $474.30 , $474.30 , $484.50 , $489.60 , $417.28 , $459.00 , $433.50 , $402.90 , N/A , $412.74 , $412.74 , $484.50 , $437.63 , $103.44 , $489.60 
Amputate Metacarpal+Finger,CPT® 26910,N/A,N/A,N/A," $3,619.00 "," $2,352.35 "," $4,771.39 ", $742.52 , $461.04 ," $3,401.19 "," $3,432.13 "," $3,365.67 "," $3,257.10 "," $3,257.10 "," $2,895.20 "," $2,895.20 ", $461.04 ," $3,341.42 "," $3,438.05 "," $3,257.10 "," $3,257.10 "," $3,257.10 "," $3,365.67 "," $3,474.24 "," $4,375.01 "," $3,076.15 "," $3,773.30 "," $4,090.43 ", N/A ," $3,467.56 "," $3,467.56 "," $3,438.05 "," $4,075.60 ", $461.04 ," $4,771.39 "
" Pro Scope of Bladder and Urethra, for Diagnosis ",CPT® 52000,0982 - PRO FEE/OUTPT,N/A,N/A," $1,443.00 ", $937.95 , $433.72 , $75.96 , $144.34 , $616.56 , $575.66 ," $1,341.99 "," $1,298.70 "," $1,298.70 "," $1,154.40 "," $1,154.40 ", $144.34 ," $1,332.32 "," $1,370.85 "," $1,298.70 "," $1,298.70 "," $1,298.70 "," $1,341.99 "," $1,385.28 ", $434.80 ," $1,226.55 ", $652.97 , $504.56 , N/A , $628.59 , $628.59 ," $1,370.85 ", $738.81 , $75.96 ," $1,385.28 "
Thoracentesis Needle/Cath Pleura W/Imaging,CPT® 32555,N/A,N/A,N/A," $3,674.00 "," $2,388.10 ", $602.20 , $104.93 , $293.25 , $441.35 , $422.54 ," $3,416.82 "," $3,306.60 "," $3,306.60 "," $2,939.20 "," $2,939.20 ", $293.25 ," $3,392.20 "," $3,490.30 "," $3,306.60 "," $3,306.60 "," $3,306.60 "," $3,416.82 "," $3,527.04 ", $586.09 ," $3,122.90 ", $588.74 , $585.22 , N/A , $449.97 , $449.97 ," $3,490.30 ", $529.94 , $104.93 ," $3,527.04 "
 Pro Treatment of Thigh Fracture ,CPT® 27508,0982 - PRO FEE/OUTPT,N/A,N/A," $3,462.00 "," $2,250.30 "," $3,062.80 ", $481.59 , $614.44 ," $2,378.36 "," $2,393.52 "," $3,219.66 "," $3,115.80 "," $3,115.80 "," $2,769.60 "," $2,769.60 ", $614.44 ," $3,196.46 "," $3,288.90 "," $3,115.80 "," $3,115.80 "," $3,115.80 "," $3,219.66 "," $3,323.52 "," $2,834.72 "," $2,942.70 "," $2,636.85 "," $2,811.30 ", N/A ," $2,424.77 "," $2,424.77 "," $3,288.90 "," $2,849.98 ", $481.59 ," $3,323.52 "
Paliperidone Palmitate Inj,HCPCS J2426,N/A,N/A,N/A, $17.00 , $11.05 , N/A , $14.50 , $13.92 , N/A , N/A , $15.81 , $15.30 , $15.30 , $13.60 , $13.60 , $13.92 , $15.70 , $16.15 , $15.30 , $15.30 , $15.30 , $15.81 , $16.32 , $16.32 , $14.45 , $13.62 , $17.32 , N/A , N/A , N/A , $16.15 , N/A , $13.60 , $17.32 
Gel-Syn Injection 0.1 Mg,HCPCS J7328,N/A,N/A,N/A, $5.00 , $3.25 , N/A , $0.63 , $0.93 , N/A , N/A , $4.65 , $4.50 , $4.50 , $4.00 , $4.00 , $0.93 , $4.62 , $4.75 , $4.50 , $4.50 , $4.50 , $4.65 , $4.80 , N/A , $4.25 , $1.94 , $1.54 , N/A , N/A , N/A , $4.75 , N/A , $0.63 , $4.80 
 Fac Spec Gravity Xcpt Urine ,CPT® 84315,0301 - LAB/CHEMISTRY,N/A,N/A, $47.00 , $30.55 , $39.48 , $3.35 , $3.35 , $37.98 , $42.30 , $39.79 , $42.30 , $42.30 , $42.30 , $39.95 , $3.28 , $43.40 , $44.65 , $39.95 , $43.71 , $43.71 , $44.65 , $45.12 , $38.46 , $42.30 , $39.95 , $37.13 , N/A , $38.04 , $38.04 , $44.65 , $40.33 , $3.28 , $45.12 
 Arh Insert Subq Rythm Monit W/Prog ,CPT® 33285,0360 - OR SERVICES,N/A,N/A," $1,510.00 ", $981.50 ," $1,268.40 ", $80.00 ," $4,106.32 "," $1,220.08 "," $1,359.00 "," $1,278.37 "," $1,359.00 "," $1,359.00 "," $1,359.00 "," $1,283.50 "," $4,025.80 "," $1,394.18 "," $1,434.50 "," $1,283.50 "," $1,404.30 "," $1,404.30 "," $1,434.50 "," $1,449.60 "," $1,235.48 "," $1,359.00 "," $1,283.50 "," $1,192.90 ", N/A ," $1,222.04 "," $1,222.04 "," $1,434.50 "," $1,295.73 ", $80.00 ," $4,106.32 "
Open/Perq Placement Intravascular Stent Ea Addl,CPT® 37237,N/A,N/A,N/A," $12,640.00 "," $8,216.00 "," $1,224.80 ", $187.98 , $242.65 , $929.37 , $944.55 ," $11,755.20 "," $11,376.00 "," $11,376.00 "," $10,112.00 "," $10,112.00 ", $242.65 ," $11,670.51 "," $12,008.00 "," $11,376.00 "," $11,376.00 "," $11,376.00 "," $11,755.20 "," $12,134.40 "," $1,135.06 "," $10,744.00 "," $1,085.71 "," $1,032.45 ", N/A , $947.50 , $947.50 ," $12,008.00 "," $1,076.36 ", $187.98 ," $12,134.40 "
 BACLOFEN 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6475-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Pro CT Chest Spine W/Dye ,CPT® 72129,0972 - PRO FEE/RAD/DX,N/A,N/A, $661.00 , $429.65 ," $1,211.77 ", $173.51 , $303.06 ," $1,092.39 "," $1,389.04 ", $614.73 , $594.90 , $594.90 , $528.80 , $528.80 , $303.06 , $610.30 , $627.95 , $594.90 , $594.90 , $594.90 , $614.73 , $634.56 ," $1,017.83 ", $561.85 ," $1,511.94 "," $1,485.86 ", N/A ," $1,113.70 "," $1,113.70 ", $627.95 ," $1,289.13 ", $173.51 ," $1,511.94 "
" Fac Cytogenetics, 100-300 ",CPT® 88275,0311 - PATHOL/CYTOLOGY,N/A,N/A, $454.00 , $295.10 , $381.36 , $52.21 , $52.21 , $366.83 , $408.60 , $384.36 , $408.60 , $408.60 , $408.60 , $385.90 , $51.19 , $419.18 , $431.30 , $385.90 , $422.22 , $422.22 , $431.30 , $435.84 , $371.46 , $408.60 , $385.90 , $358.66 , N/A , $367.42 , $367.42 , $431.30 , $389.58 , $51.19 , $435.84 
"Inj., Cosyntropin, 0.25 Mg",HCPCS J0834,N/A,N/A,N/A, $369.00 , $239.85 , N/A , $28.44 , $25.28 , N/A , N/A , $343.17 , $332.10 , $332.10 , $295.20 , $295.20 , $25.28 , $340.70 , $350.55 , $332.10 , $332.10 , $332.10 , $343.17 , $354.24 , $34.19 , $313.65 , $130.40 , $40.50 , N/A , N/A , N/A , $350.55 , N/A , $25.28 , $354.24 
 Major Chest Trauma With McC ,MS DRG V40 (FY2023) 183,N/A,N/A,N/A," $22,240.52 "," $14,456.34 "," $18,682.04 ", N/A , N/A ," $17,970.34 "," $20,016.47 "," $18,828.82 "," $20,016.47 "," $20,016.47 "," $20,016.47 "," $18,904.44 ", N/A ," $20,534.67 "," $21,128.49 "," $18,904.44 "," $20,683.68 "," $20,683.68 "," $21,128.49 "," $21,350.90 "," $18,197.19 "," $20,016.47 "," $18,904.44 "," $17,570.01 ", N/A ," $17,999.25 "," $17,999.25 "," $21,128.49 "," $19,084.59 "," $17,570.01 "," $21,350.90 "
"CT Scan,Soft Tissue Neck,W/O Contrast",CPT® 70490,N/A,N/A,N/A," $2,825.00 "," $1,836.25 "," $1,068.83 ", $153.47 , $250.75 , $920.94 ," $1,170.42 "," $2,627.25 "," $2,542.50 "," $2,542.50 "," $2,260.00 "," $2,260.00 ", $250.75 ," $2,608.32 "," $2,683.75 "," $2,542.50 "," $2,542.50 "," $2,542.50 "," $2,627.25 "," $2,712.00 ", $896.11 ," $2,401.25 "," $1,276.97 "," $1,092.28 ", N/A , $938.91 , $938.91 ," $2,683.75 "," $1,086.81 ", $153.47 ," $2,712.00 "
"Excis Intrasp Lesn,Xdural,Sacral",CPT® 63268,N/A,N/A,N/A," $9,287.00 "," $6,036.55 "," $6,584.14 "," $1,274.89 "," $2,008.31 "," $7,778.27 "," $7,528.68 "," $8,636.91 "," $8,358.30 "," $8,358.30 "," $7,429.60 "," $7,429.60 "," $2,008.31 "," $8,574.69 "," $8,822.65 "," $8,358.30 "," $8,358.30 "," $8,358.30 "," $8,636.91 "," $8,915.52 "," $7,106.04 "," $7,893.95 "," $7,728.57 "," $8,047.33 ", N/A ," $7,930.03 "," $7,930.03 "," $8,822.65 "," $8,507.08 "," $1,274.89 "," $8,915.52 "
 Pro Penile Injection ,CPT® 54235,0981 - PRO FEE/ER,N/A,N/A, $500.00 , $325.00 , $321.90 , $70.23 , N/A , $235.76 , $239.61 , $465.00 , $450.00 , $450.00 , $400.00 , $400.00 , N/A , $461.65 , $475.00 , $450.00 , $450.00 , $450.00 , $465.00 , $480.00 , $302.37 , $425.00 , $381.79 , $356.52 , N/A , $240.36 , $240.36 , $475.00 , $288.08 , $70.23 , $480.00 
 Perc Drainage With Cath Placed ,CPT® 75989,0320 - DX X-RAY,N/A,N/A, $895.00 , $581.75 , $751.80 , $111.07 , $134.80 , $723.16 , $805.50 , $757.71 , $805.50 , $805.50 , $805.50 , $760.75 , $132.16 , $826.35 , $850.25 , $760.75 , $832.35 , $832.35 , $850.25 , $859.20 , $732.29 , $805.50 , $760.75 , $707.05 , N/A , $724.32 , $724.32 , $850.25 , $768.00 , $111.07 , $859.20 
 Pro Lyr Clsr F/E/E/N/L/M&/Muc 2.6 Cm-5.0 Cm ,CPT® 12052,0982 - PRO FEE/OUTPT,N/A,N/A," $1,245.00 ", $809.25 , $637.70 , $191.98 , $151.59 , $557.59 , $545.09 ," $1,157.85 "," $1,120.50 "," $1,120.50 ", $996.00 , $996.00 , $151.59 ," $1,149.51 "," $1,182.75 "," $1,120.50 "," $1,120.50 "," $1,120.50 "," $1,157.85 "," $1,195.20 ", $700.90 ," $1,058.25 "," $1,084.71 ", $716.31 , N/A , $568.47 , $568.47 ," $1,182.75 ", $659.24 , $151.59 ," $1,195.20 "
Drug/Substance Definitive Qual/Quant Nos 7/More,CPT® 80377,N/A,N/A,N/A, $266.00 , $172.90 , N/A , N/A , N/A , N/A , N/A , $247.38 , $239.40 , $239.40 , $212.80 , $212.80 , N/A , $245.60 , $252.70 , $239.40 , $239.40 , $239.40 , $247.38 , $255.36 , N/A , $226.10 , $114.69 , $67.79 , N/A , $90.04 , $90.04 , $252.70 , $98.20 , $67.79 , $255.36 
 Fac Njx Pulmonary Angio Hrt Cath W/S&I ,CPT® 93568,0481 - CARDIAC CATH LAB,N/A,N/A," $1,181.00 ", $767.65 , $992.04 , $42.66 , $151.05 , $954.25 ," $1,062.90 ", $999.83 ," $1,062.90 "," $1,062.90 "," $1,062.90 "," $1,003.85 ", $148.09 ," $1,090.42 "," $1,121.95 "," $1,003.85 "," $1,098.33 "," $1,098.33 "," $1,121.95 "," $1,133.76 ", $966.29 ," $1,062.90 "," $1,003.85 ", $932.99 , N/A , $955.78 , $955.78 ," $1,121.95 "," $1,013.42 ", $42.66 ," $1,133.76 "
"Homogenization, Tissue for Culture",CPT® 87176,N/A,N/A,N/A, $100.00 , $65.00 , N/A , $6.00 , $6.00 , $33.30 , $39.83 , $93.00 , $90.00 , $90.00 , $80.00 , $80.00 , $6.00 , $92.33 , $95.00 , $90.00 , $90.00 , $90.00 , $93.00 , $96.00 , $39.26 , $85.00 , $38.92 , $21.32 , N/A , $31.08 , $31.08 , $95.00 , $33.96 , $6.00 , $96.00 
 Pro Rmvl FB Xtrnl Eye Embedded Scjncl/Scll Nonprf8 ,CPT® 65210,0981 - PRO FEE/ER,N/A,N/A, $291.00 , $189.15 , $224.64 , $34.99 , $48.54 , $303.27 , $280.98 , $270.63 , $261.90 , $261.90 , $232.80 , $232.80 , $48.54 , $268.68 , $276.45 , $261.90 , $261.90 , $261.90 , $270.63 , $279.36 , $311.97 , $247.35 , $289.02 , $382.47 , N/A , $309.18 , $309.18 , $276.45 , $341.30 , $34.99 , $382.47 
 Fac Perq Transcath Cls Paravalvr Leak 1 Mitral Valve ,CPT® 93590,0360 - OR SERVICES,N/A,N/A," $40,494.00 "," $26,321.10 "," $34,014.96 "," $1,025.83 ", $925.65 ," $32,719.15 "," $36,444.60 "," $34,282.22 "," $36,444.60 "," $36,444.60 "," $36,444.60 "," $34,419.90 ", $907.50 ," $37,388.11 "," $38,469.30 "," $34,419.90 "," $37,659.42 "," $37,659.42 "," $38,469.30 "," $38,874.24 "," $33,132.19 "," $36,444.60 "," $34,419.90 "," $31,990.26 ", N/A ," $32,771.79 "," $32,771.79 "," $38,469.30 "," $34,747.90 ", $907.50 ," $38,874.24 "
 NECITUMUMAB 800 MG/50ML IV SOLN ,HCPCS J9295,0636 - DRUGS REQUIRING DETAILED CODIN,00002-7716-01,50 mL," $12,730.82 "," $8,275.03 "," $10,693.89 ", $5.85 , $5.85 ," $10,286.50 "," $11,457.74 "," $10,777.91 "," $11,457.74 "," $11,457.74 "," $11,457.74 "," $10,821.20 ", $5.74 ," $11,754.37 "," $12,094.28 "," $10,821.20 "," $11,839.66 "," $11,839.66 "," $12,094.28 "," $12,221.59 "," $10,416.36 "," $11,457.74 "," $10,821.20 "," $10,057.35 ", N/A ," $10,303.05 "," $10,303.05 "," $12,094.28 "," $10,924.32 ", $5.74 ," $12,221.59 "
Fx Carpal Bone W/O Manipu,CPT® 25630,N/A,N/A,N/A," $1,172.00 ", $761.80 ," $1,768.39 ", $280.46 , $206.19 ," $1,350.10 "," $1,368.18 "," $1,089.96 "," $1,054.80 "," $1,054.80 ", $937.60 , $937.60 , $206.19 ," $1,082.11 "," $1,113.40 "," $1,054.80 "," $1,054.80 "," $1,054.80 "," $1,089.96 "," $1,125.12 "," $1,632.61 ", $996.20 ," $1,500.40 "," $1,608.26 ", N/A ," $1,376.44 "," $1,376.44 "," $1,113.40 "," $1,617.81 ", $206.19 ," $1,768.39 "
Excis/Unroof Renal Cyst,CPT® 50280,N/A,N/A,N/A," $6,615.00 "," $4,299.75 "," $5,165.40 ", $909.13 ," $1,075.74 "," $4,662.84 "," $4,349.91 "," $6,151.95 "," $5,953.50 "," $5,953.50 "," $5,292.00 "," $5,292.00 "," $1,075.74 "," $6,107.63 "," $6,284.25 "," $5,953.50 "," $5,953.50 "," $5,953.50 "," $6,151.95 "," $6,350.40 "," $5,205.90 "," $5,622.75 "," $4,943.64 "," $5,841.31 ", N/A ," $4,753.82 "," $4,753.82 "," $6,284.25 "," $5,587.42 ", $909.13 ," $6,350.40 "
Esophagectomy Total Near Total W/Laps Moblj,CPT® 43286,N/A,N/A,N/A," $19,185.00 "," $12,470.25 "," $18,656.04 "," $2,890.75 "," $2,409.48 "," $14,004.22 "," $14,570.64 "," $17,842.05 "," $17,266.50 "," $17,266.50 "," $15,348.00 "," $15,348.00 "," $2,409.48 "," $17,713.51 "," $18,225.75 "," $17,266.50 "," $17,266.50 "," $17,266.50 "," $17,842.05 "," $18,417.60 "," $13,437.69 "," $16,307.25 "," $16,712.15 "," $17,618.32 ", N/A ," $14,277.46 "," $14,277.46 "," $18,225.75 "," $14,932.72 "," $2,409.48 "," $18,656.04 "
 Fac Antipsychotics Not Otherwise Specified 1-3 ,CPT® 80342,0301 - LAB/CHEMISTRY,N/A,N/A, $202.00 , $131.30 , $169.68 , N/A , N/A , $163.22 , $181.80 , $171.01 , $181.80 , $181.80 , $181.80 , $171.70 , N/A , $186.51 , $191.90 , $171.70 , $187.86 , $187.86 , $191.90 , $193.92 , $165.28 , $181.80 , $171.70 , $159.58 , N/A , $163.48 , $163.48 , $191.90 , $173.34 , $159.58 , $193.92 
 Sars-Cov-2 Covid19 W/Optic Pbb ,CPT® 87811,0306 - LAB/BACT-MICRO,N/A,N/A, $221.00 , $143.65 , $185.64 , $42.21 , $42.21 , $178.57 , $198.90 , $187.10 , $198.90 , $198.90 , $198.90 , $187.85 , $41.38 , $204.05 , $209.95 , $187.85 , $205.53 , $205.53 , $209.95 , $212.16 , $180.82 , $198.90 , $187.85 , $174.59 , N/A , $178.86 , $178.86 , $209.95 , $189.64 , $41.38 , $212.16 
 MELOXICAM 15 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60687-0199-01,1 tablet, $24.56 , $15.96 , $20.63 , N/A , N/A , $19.84 , $22.10 , $20.79 , $22.10 , $22.10 , $22.10 , $20.88 , N/A , $22.68 , $23.33 , $20.88 , $22.84 , $22.84 , $23.33 , $23.58 , $20.09 , $22.10 , $20.88 , $19.40 , N/A , $19.88 , $19.88 , $23.33 , $21.07 , $19.40 , $23.58 
 Fac Cath Placement & Njx Coronary Art Angio Img S&I ,CPT® 93454,0481 - CARDIAC CATH LAB,N/A,N/A," $5,742.00 "," $3,732.30 "," $4,823.28 ", $878.92 , $638.27 ," $4,639.54 "," $5,167.80 "," $4,861.18 "," $5,167.80 "," $5,167.80 "," $5,167.80 "," $4,880.70 ", $625.75 ," $5,301.59 "," $5,454.90 "," $4,880.70 "," $5,340.06 "," $5,340.06 "," $5,454.90 "," $5,512.32 "," $4,698.10 "," $5,167.80 "," $4,880.70 "," $4,536.18 ", N/A ," $4,647.00 "," $4,647.00 "," $5,454.90 "," $4,927.21 ", $625.75 ," $5,512.32 "
Arthrodesis Cmbn Tq 1ntrspc Each Additional,CPT® 22634,N/A,N/A,N/A," $3,437.00 "," $2,234.05 "," $2,849.67 ", $432.31 , $373.46 ," $2,372.11 "," $2,309.39 "," $3,196.41 "," $3,093.30 "," $3,093.30 "," $2,749.60 "," $2,749.60 ", $373.46 ," $3,173.38 "," $3,265.15 "," $3,093.30 "," $3,093.30 "," $3,093.30 "," $3,196.41 "," $3,299.52 "," $2,663.47 "," $2,921.45 "," $2,611.87 "," $2,733.79 ", N/A ," $2,418.40 "," $2,418.40 "," $3,265.15 "," $2,842.46 ", $373.46 ," $3,299.52 "
 RIVASTIGMINE 4.6 MG/24HR TD PT24 ,HCPCS RXC637,0250 - PHARMACY,47781-0304-03,1 patch, $83.24 , $54.11 , $69.92 , N/A , N/A , $67.26 , $74.92 , $70.47 , $74.92 , $74.92 , $74.92 , $70.75 , N/A , $76.86 , $79.08 , $70.75 , $77.41 , $77.41 , $79.08 , $79.91 , $68.11 , $74.92 , $70.75 , $65.76 , N/A , $67.37 , $67.37 , $79.08 , $71.43 , $65.76 , $79.91 
 Novavax Covid Vaccine First Dose ,CPT® 0041A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
 Treat Coccygeal Fracture ,CPT® 27200,0981 - PRO FEE/ER,N/A,N/A, $846.00 , $549.90 ," $1,170.59 ", $184.65 , $153.67 , $906.11 , $916.94 , $786.78 , $761.40 , $761.40 , $676.80 , $676.80 , $153.67 , $781.11 , $803.70 , $761.40 , $761.40 , $761.40 , $786.78 , $812.16 ," $1,071.83 ", $719.10 ," $1,004.43 "," $1,083.76 ", N/A , $923.79 , $923.79 , $803.70 ," $1,085.79 ", $153.67 ," $1,170.59 "
"Preventive Visit,New,65 & Over",99387,N/A,N/A,N/A, $513.00 , $333.45 , N/A , $158.20 , $59.72 , $273.38 , $275.44 , $477.09 , $461.70 , $461.70 , $410.40 , $410.40 , $59.72 , $473.65 , $487.35 , $461.70 , $461.70 , $461.70 , $477.09 , $492.48 , $337.65 , $436.05 , $276.04 , $271.53 , N/A , $278.72 , $278.72 , $487.35 , $334.77 , $59.72 , $492.48 
" Protoporphyrin, Erythrocyte, Zinc Beaker1 ",CPT® 84202,0301 - LAB/CHEMISTRY,N/A,N/A, $129.00 , $83.85 , $108.36 , $14.64 , $14.64 , $104.23 , $116.10 , $109.21 , $116.10 , $116.10 , $116.10 , $109.65 , $14.35 , $119.11 , $122.55 , $109.65 , $119.97 , $119.97 , $122.55 , $123.84 , $105.55 , $116.10 , $109.65 , $101.91 , N/A , $104.40 , $104.40 , $122.55 , $110.69 , $14.35 , $123.84 
Rpr Aa Hernia Recr > 10 Cm Reducible,CPT® 49617,N/A,N/A,N/A," $7,539.00 "," $4,900.35 ", N/A , $810.84 , $632.85 , N/A , N/A ," $7,011.27 "," $6,785.10 "," $6,785.10 "," $6,031.20 "," $6,031.20 ", $632.85 ," $6,960.76 "," $7,162.05 "," $6,785.10 "," $6,785.10 "," $6,785.10 "," $7,011.27 "," $7,237.44 ", N/A ," $6,408.15 "," $4,687.58 ", N/A , N/A ," $3,490.73 "," $3,490.73 "," $7,162.05 "," $3,654.49 ", $632.85 ," $7,237.44 "
Vaginal Delivery Only,59409,N/A,N/A,N/A," $3,354.00 "," $2,180.10 "," $1,869.48 ", $727.40 , $630.92 ," $1,894.25 "," $1,982.73 "," $3,119.22 "," $3,018.60 "," $3,018.60 "," $2,683.20 "," $2,683.20 ", $630.92 ," $3,096.75 "," $3,186.30 "," $3,018.60 "," $3,018.60 "," $3,018.60 "," $3,119.22 "," $3,219.84 "," $2,198.89 "," $2,850.90 "," $4,385.23 "," $1,884.92 ", N/A ," $1,931.21 "," $1,931.21 "," $3,186.30 "," $2,232.66 ", $630.92 ," $4,385.23 "
 CT Angio Abd ,CPT® 74175,0350 - CT SCAN,N/A,N/A," $4,580.00 "," $2,977.00 "," $3,847.20 ", $259.04 , $394.70 ," $3,700.64 "," $4,122.00 "," $3,877.43 "," $4,122.00 "," $4,122.00 "," $4,122.00 "," $3,893.00 ", $386.96 ," $4,228.71 "," $4,351.00 "," $3,893.00 "," $4,259.40 "," $4,259.40 "," $4,351.00 "," $4,396.80 "," $3,747.36 "," $4,122.00 "," $3,893.00 "," $3,618.20 ", N/A ," $3,706.59 "," $3,706.59 "," $4,351.00 "," $3,930.10 ", $259.04 ," $4,396.80 "
Apply- Long Arm Splint,CPT® 29105,N/A,N/A,N/A, $580.00 , $377.00 , $248.63 , $39.02 , $45.35 , $288.42 , $289.62 , $539.40 , $522.00 , $522.00 , $464.00 , $464.00 , $45.35 , $535.51 , $551.00 , $522.00 , $522.00 , $522.00 , $539.40 , $556.80 , $235.01 , $493.00 , $317.56 , $339.98 , N/A , $294.05 , $294.05 , $551.00 , $345.59 , $39.02 , $556.80 
"Virus, Not Specified",CPT® 86790,N/A,N/A,N/A, $189.00 , $122.85 , N/A , $13.14 , N/A , $32.88 , $39.34 , $175.77 , $170.10 , $170.10 , $151.20 , $151.20 , N/A , $174.50 , $179.55 , $170.10 , $170.10 , $170.10 , $175.77 , $181.44 , $86.00 , $160.65 , $84.34 , $46.70 , N/A , $30.69 , $30.69 , $179.55 , $33.54 , $13.14 , $181.44 
Colsc Flx With Directed Submucosal Njx Any Sbst,CPT® 45381,N/A,N/A,N/A," $3,248.00 "," $2,111.20 "," $1,228.57 ", $189.78 , $386.96 ," $1,159.99 "," $1,194.71 "," $3,020.64 "," $2,923.20 "," $2,923.20 "," $2,598.40 "," $2,598.40 ", $386.96 ," $2,998.88 "," $3,085.60 "," $2,923.20 "," $2,923.20 "," $2,923.20 "," $3,020.64 "," $3,118.08 ", $883.57 ," $2,760.80 "," $1,309.50 "," $1,171.50 ", N/A ," $1,182.63 "," $1,182.63 "," $3,085.60 "," $1,236.91 ", $189.78 ," $3,118.08 "
 Pro US Compl Joint R-T W/Image Documentation ,CPT® 76881,0972 - PRO FEE/RAD/DX,N/A,N/A, $279.00 , $181.35 , $332.46 , $53.33 , $85.20 , $557.36 , $642.21 , $259.47 , $251.10 , $251.10 , $223.20 , $223.20 , $85.20 , $257.60 , $265.05 , $251.10 , $251.10 , $251.10 , $259.47 , $267.84 , $368.86 , $237.15 , $704.93 , $571.60 , N/A , $568.24 , $568.24 , $265.05 , $657.73 , $53.33 , $704.93 
" Fac Artery X-Rays, Arm/Leg ",CPT® 75710,0320 - DX X-RAY,N/A,N/A," $1,252.00 ", $813.80 ," $1,051.68 ", $145.51 , $243.51 ," $1,011.62 "," $1,126.80 "," $1,059.94 "," $1,126.80 "," $1,126.80 "," $1,126.80 "," $1,064.20 ", $238.74 ," $1,155.97 "," $1,189.40 "," $1,064.20 "," $1,164.36 "," $1,164.36 "," $1,189.40 "," $1,201.92 "," $1,024.39 "," $1,126.80 "," $1,064.20 ", $989.08 , N/A ," $1,013.24 "," $1,013.24 "," $1,189.40 "," $1,074.34 ", $145.51 ," $1,201.92 "
DRAINAGE OF MOUTH LESION,41252,N/A,N/A,N/A," $1,398.00 ", $908.70 ," $1,271.99 ", $200.66 , $167.62 ," $1,014.15 "," $1,042.27 "," $1,300.14 "," $1,258.20 "," $1,258.20 "," $1,118.40 "," $1,118.40 ", $167.62 ," $1,290.77 "," $1,328.10 "," $1,258.20 "," $1,258.20 "," $1,258.20 "," $1,300.14 "," $1,342.08 ", $913.47 ," $1,188.30 "," $1,143.59 "," $1,207.78 ", N/A ," $1,033.94 "," $1,033.94 "," $1,328.10 "," $1,081.40 ", $167.62 ," $1,342.08 "
Injection 1 or 2 Musclegr,20552,N/A,N/A,N/A, $360.00 , $234.00 , $95.85 , $35.51 , $26.41 , $186.23 , $182.64 , $334.80 , $324.00 , $324.00 , $288.00 , $288.00 , $26.41 , $332.39 , $342.00 , $324.00 , $324.00 , $324.00 , $334.80 , $345.60 , $215.67 , $306.00 , $199.82 , $220.70 , N/A , $189.86 , $189.86 , $342.00 , $223.15 , $26.41 , $345.60 
"Closed Rx Scapula Fx,Manipulatn",23575,N/A,N/A,N/A," $1,904.00 "," $1,237.60 "," $2,345.66 ", $370.40 , $184.42 ," $1,805.56 "," $1,817.42 "," $1,770.72 "," $1,713.60 "," $1,713.60 "," $1,523.20 "," $1,523.20 ", $184.42 ," $1,757.96 "," $1,808.80 "," $1,713.60 "," $1,713.60 "," $1,713.60 "," $1,770.72 "," $1,827.84 "," $2,163.79 "," $1,618.40 "," $1,999.94 "," $2,138.02 ", N/A ," $1,840.79 "," $1,840.79 "," $1,808.80 "," $2,163.58 ", $184.42 ," $2,345.66 "
"Immunoassay, Non Antibody",CPT® 83516,N/A,N/A,N/A, $136.00 , $88.40 , N/A , $11.76 , $11.76 , $65.28 , $78.10 , $126.48 , $122.40 , $122.40 , $108.80 , $108.80 , $11.76 , $125.57 , $129.20 , $122.40 , $122.40 , $122.40 , $126.48 , $130.56 , $76.99 , $115.60 , $76.23 , $41.82 , N/A , $60.92 , $60.92 , $129.20 , $66.57 , $11.76 , $130.56 
 Fac Assay of Urine Vma ,CPT® 84585,0301 - LAB/CHEMISTRY,N/A,N/A, $180.00 , $117.00 , $151.20 , $15.81 , $15.81 , $145.44 , $162.00 , $152.39 , $162.00 , $162.00 , $162.00 , $153.00 , $15.50 , $166.19 , $171.00 , $153.00 , $167.40 , $167.40 , $171.00 , $172.80 , $147.28 , $162.00 , $153.00 , $142.20 , N/A , $145.67 , $145.67 , $171.00 , $154.46 , $15.50 , $172.80 
 Fac Molecular Pathology Procedure Level 6 ,CPT® 81405,0310 - PATHOLOGY LAB,N/A,N/A, $82.00 , $53.30 , $68.88 , $307.38 , $307.38 , $66.26 , $73.80 , $69.42 , $73.80 , $73.80 , $73.80 , $69.70 , $301.35 , $75.71 , $77.90 , $69.70 , $76.26 , $76.26 , $77.90 , $78.72 , $67.09 , $73.80 , $69.70 , $64.78 , N/A , $66.36 , $66.36 , $77.90 , $70.36 , $64.78 , $307.38 
"Repair Flexor Tendon,Sing",26350,N/A,N/A,N/A," $2,462.00 "," $1,600.30 "," $4,714.65 ", $732.16 , $601.86 ," $3,386.55 "," $3,457.42 "," $2,289.66 "," $2,215.80 "," $2,215.80 "," $1,969.60 "," $1,969.60 ", $601.86 ," $2,273.16 "," $2,338.90 "," $2,215.80 "," $2,215.80 "," $2,215.80 "," $2,289.66 "," $2,363.52 "," $4,337.17 "," $2,092.70 "," $3,784.00 "," $4,049.80 ", N/A ," $3,452.62 "," $3,452.62 "," $2,338.90 "," $4,058.05 ", $601.86 ," $4,714.65 "
 Fac Cltx Clavicular Fx W/Mnpj ,CPT® 23505,0361 - OR/MINOR,N/A,N/A," $3,319.00 "," $2,157.35 "," $2,787.96 ", $326.05 , $230.52 ," $2,681.75 "," $2,987.10 "," $2,809.87 "," $2,987.10 "," $2,987.10 "," $2,987.10 "," $2,821.15 ", $226.00 ," $3,064.43 "," $3,153.05 "," $2,821.15 "," $3,086.67 "," $3,086.67 "," $3,153.05 "," $3,186.24 "," $2,715.61 "," $2,987.10 "," $2,821.15 "," $2,622.01 ", N/A ," $2,686.07 "," $2,686.07 "," $3,153.05 "," $2,848.03 ", $226.00 ," $3,186.24 "
 Fac Assay of Oxalate ,CPT® 83945,0307 - LAB/UROLOGY,N/A,N/A, $128.00 , $83.20 , $107.52 , $14.74 , $14.74 , $103.42 , $115.20 , $108.36 , $115.20 , $115.20 , $115.20 , $108.80 , $14.45 , $118.18 , $121.60 , $108.80 , $119.04 , $119.04 , $121.60 , $122.88 , $104.73 , $115.20 , $108.80 , $101.12 , N/A , $103.59 , $103.59 , $121.60 , $109.84 , $14.45 , $122.88 
Puraply Am 1 Sq Cm,HCPCS Q4196,N/A,N/A,N/A, $340.00 , $221.00 , N/A , $104.33 , N/A , N/A , N/A , $316.20 , $306.00 , $306.00 , $272.00 , $272.00 , N/A , $313.92 , $323.00 , $306.00 , $306.00 , $306.00 , $316.20 , $326.40 , $140.79 , $289.00 , $209.36 , $142.16 , N/A , N/A , N/A , $323.00 , N/A , $104.33 , $326.40 
 Pro Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/O Img Gdn ,CPT® 62322,0982 - PRO FEE/OUTPT,N/A,N/A," $1,232.00 ", $800.80 , $397.54 , $76.88 , $185.09 , $472.56 , $461.97 ," $1,145.76 "," $1,108.80 "," $1,108.80 ", $985.60 , $985.60 , $185.09 ," $1,137.51 "," $1,170.40 "," $1,108.80 "," $1,108.80 "," $1,108.80 "," $1,145.76 "," $1,182.72 ", $432.18 ," $1,047.20 ", $422.91 , $524.46 , N/A , $481.78 , $481.78 ," $1,170.40 ", $516.83 , $76.88 ," $1,182.72 "
 Pelvis 1 or 2 Views ,CPT® 72170,0320 - DX X-RAY,N/A,N/A, $331.00 , $215.15 , $278.04 , $27.44 , $25.29 , $267.45 , $297.90 , $280.22 , $297.90 , $297.90 , $297.90 , $281.35 , $24.79 , $305.61 , $314.45 , $281.35 , $307.83 , $307.83 , $314.45 , $317.76 , $270.82 , $297.90 , $281.35 , $261.49 , N/A , $267.88 , $267.88 , $314.45 , $284.03 , $24.79 , $317.76 
Apply Short Arn Splint,29125,N/A,N/A,N/A, $428.00 , $278.20 , $241.35 , $38.40 , $27.51 , $190.75 , $194.03 , $398.04 , $385.20 , $385.20 , $342.40 , $342.40 , $27.51 , $395.17 , $406.60 , $385.20 , $385.20 , $385.20 , $398.04 , $410.88 , $223.62 , $363.80 , $212.30 , $229.45 , N/A , $194.47 , $194.47 , $406.60 , $228.57 , $27.51 , $410.88 
Treat Tarsal Bone Fractur,CPT® 28450,N/A,N/A,N/A," $1,439.00 ", $935.35 ," $1,193.60 ", $188.03 , $144.17 , $936.03 , $952.57 ," $1,338.27 "," $1,295.10 "," $1,295.10 "," $1,151.20 "," $1,151.20 ", $144.17 ," $1,328.63 "," $1,367.05 "," $1,295.10 "," $1,295.10 "," $1,295.10 "," $1,338.27 "," $1,381.44 "," $1,100.58 "," $1,223.15 "," $1,038.33 "," $1,108.30 ", N/A , $954.29 , $954.29 ," $1,367.05 "," $1,121.63 ", $144.17 ," $1,381.44 "
"Repair Achilles Tendon,Secondary",27654,N/A,N/A,N/A," $7,038.00 "," $4,574.70 "," $4,386.53 ", $688.37 , $845.22 ," $3,446.06 "," $3,425.52 "," $6,545.34 "," $6,334.20 "," $6,334.20 "," $5,630.40 "," $5,630.40 ", $845.22 ," $6,498.19 "," $6,686.10 "," $6,334.20 "," $6,334.20 "," $6,334.20 "," $6,545.34 "," $6,756.48 "," $4,068.90 "," $5,982.30 "," $3,746.53 "," $4,089.54 ", N/A ," $3,513.30 "," $3,513.30 "," $6,686.10 "," $4,129.36 ", $688.37 ," $6,756.48 "
So Cap Design W/O Jnts Cf,HCPCS L3671,N/A,N/A,N/A," $1,033.00 ", $671.45 , N/A , $959.23 , $664.39 , N/A , N/A , $960.69 , $929.70 , $929.70 , $826.40 , $826.40 , $664.39 , $953.77 , $981.35 , $929.70 , $929.70 , $929.70 , $960.69 , $991.68 , N/A , $878.05 , $791.48 , $807.03 , N/A , N/A , N/A , $981.35 , N/A , $664.39 , $991.68 
 Fac Hast W/Phys I&R ,CPT® 94452,0460 - PULMONARY FUNC,N/A,N/A, $557.00 , $362.05 , $467.88 , $47.71 , $45.11 , $450.06 , $501.30 , $471.56 , $501.30 , $501.30 , $501.30 , $473.45 , $44.23 , $514.28 , $529.15 , $473.45 , $518.01 , $518.01 , $529.15 , $534.72 , $455.74 , $501.30 , $473.45 , $440.03 , N/A , $450.78 , $450.78 , $529.15 , $477.96 , $44.23 , $534.72 
Automated Differential Wbc Count,CPT® 85004,N/A,N/A,N/A, $46.00 , $29.90 , N/A , $6.60 , $6.60 , $36.62 , $43.78 , $42.78 , $41.40 , $41.40 , $36.80 , $36.80 , $6.60 , $42.47 , $43.70 , $41.40 , $41.40 , $41.40 , $42.78 , $44.16 , $43.20 , $39.10 , $42.17 , $23.44 , N/A , $34.18 , $34.18 , $43.70 , $37.35 , $6.60 , $44.16 
 Fac Njx Aa&/Strd Plantar Common Digital Nerves ,CPT® 64455,0360 - OR SERVICES,N/A,N/A, $868.00 , $564.20 , $729.12 , $32.49 , $46.56 , $701.34 , $781.20 , $734.85 , $781.20 , $781.20 , $781.20 , $737.80 , $45.65 , $801.42 , $824.60 , $737.80 , $807.24 , $807.24 , $824.60 , $833.28 , $710.20 , $781.20 , $737.80 , $685.72 , N/A , $702.47 , $702.47 , $824.60 , $744.83 , $32.49 , $833.28 
Nasal/Sinus Ndsc W/Total Ethoidectomy,CPT® 31255,N/A,N/A,N/A," $3,187.00 "," $2,071.55 "," $1,745.99 ", $307.80 , $561.60 ," $1,533.29 "," $2,229.42 "," $2,963.91 "," $2,868.30 "," $2,868.30 "," $2,549.60 "," $2,549.60 ", $561.60 ," $2,942.56 "," $3,027.65 "," $2,868.30 "," $2,868.30 "," $2,868.30 "," $2,963.91 "," $3,059.52 "," $1,671.30 "," $2,708.95 "," $2,110.55 "," $1,650.12 ", N/A ," $1,563.20 "," $1,563.20 "," $3,027.65 "," $1,841.00 ", $307.80 ," $3,059.52 "
 Pro Treat Fracture Radius/Ulna ,CPT® 25605,0975 - PRO FEE/OR,N/A,N/A," $2,147.00 "," $1,395.55 "," $3,147.43 ", $496.56 , $388.30 ," $2,466.77 "," $2,502.71 "," $1,996.71 "," $1,932.30 "," $1,932.30 "," $1,717.60 "," $1,717.60 ", $388.30 ," $1,982.33 "," $2,039.65 "," $1,932.30 "," $1,932.30 "," $1,932.30 "," $1,996.71 "," $2,061.12 "," $2,912.52 "," $1,824.95 "," $2,754.59 "," $2,906.58 ", N/A ," $2,514.91 "," $2,514.91 "," $2,039.65 "," $2,955.90 ", $388.30 ," $3,147.43 "
 Fac Emblc/Thrmbc Rnl Celiac Mesentery a-Iliac Art ,CPT® 34151,0360 - OR SERVICES,N/A,N/A," $3,618.00 "," $2,351.70 "," $3,039.12 "," $1,242.47 "," $1,229.45 "," $2,923.34 "," $3,256.20 "," $3,063.00 "," $3,256.20 "," $3,256.20 "," $3,256.20 "," $3,075.30 "," $1,205.34 "," $3,340.50 "," $3,437.10 "," $3,075.30 "," $3,364.74 "," $3,364.74 "," $3,437.10 "," $3,473.28 "," $2,960.25 "," $3,256.20 "," $3,075.30 "," $2,858.22 ", N/A ," $2,928.05 "," $2,928.05 "," $3,437.10 "," $3,104.61 "," $1,205.34 "," $3,473.28 "
Esophagus Surg Procedure Unlisted,CPT® 43499,N/A,N/A,N/A, $416.00 , $270.40 , N/A , N/A , N/A , N/A , N/A , $386.88 , $374.40 , $374.40 , $332.80 , $332.80 , N/A , $384.09 , $395.20 , $374.40 , $374.40 , $374.40 , $386.88 , $399.36 , N/A , $353.60 , $332.80 , N/A , N/A , N/A , N/A , $395.20 , N/A , $332.80 , $399.36 
 Hepatolite/Tc99 Disofenin/per Study Dose ,HCPCS A9510,0343 - DIAGNOSTIC RADIOPHARMACEUTICALS,N/A,N/A, $455.00 , $295.75 , $382.20 , $52.02 , $35.52 , $367.64 , $409.50 , $385.20 , $409.50 , $409.50 , $409.50 , $386.75 , $34.82 , $420.10 , $432.25 , $386.75 , $423.15 , $423.15 , $432.25 , $436.80 , $372.28 , $409.50 , $386.75 , $359.45 , N/A , $368.23 , $368.23 , $432.25 , $390.44 , $34.82 , $436.80 
"Fix Quad/Hamstr Musc Rupt,Primary",27385,N/A,N/A,N/A," $4,171.00 "," $2,711.15 "," $3,746.99 ", $586.39 , $691.53 ," $2,772.28 "," $2,791.27 "," $3,879.03 "," $3,753.90 "," $3,753.90 "," $3,336.80 "," $3,336.80 ", $691.53 ," $3,851.08 "," $3,962.45 "," $3,753.90 "," $3,753.90 "," $3,753.90 "," $3,879.03 "," $4,004.16 "," $3,442.62 "," $3,545.35 "," $3,073.94 "," $3,274.26 ", N/A ," $2,826.38 "," $2,826.38 "," $3,962.45 "," $3,322.00 ", $586.39 ," $4,004.16 "
 Fac Egd Flexible Foreign Body Removal ,CPT® 43247,0360 - OR SERVICES,N/A,N/A," $2,438.00 "," $1,584.70 "," $2,047.92 ", $167.00 , $186.68 ," $1,969.90 "," $2,194.20 "," $2,064.01 "," $2,194.20 "," $2,194.20 "," $2,194.20 "," $2,072.30 ", $183.02 ," $2,251.01 "," $2,316.10 "," $2,072.30 "," $2,267.34 "," $2,267.34 "," $2,316.10 "," $2,340.48 "," $1,994.77 "," $2,194.20 "," $2,072.30 "," $1,926.02 ", N/A ," $1,973.07 "," $1,973.07 "," $2,316.10 "," $2,092.05 ", $167.00 ," $2,340.48 "
Qualt Assay Hemosiderin,CPT® 83070,N/A,N/A,N/A, $81.00 , $52.65 , N/A , $4.85 , $4.85 , $26.85 , $32.15 , $75.33 , $72.90 , $72.90 , $64.80 , $64.80 , $4.85 , $74.79 , $76.95 , $72.90 , $72.90 , $72.90 , $75.33 , $77.76 , $31.72 , $68.85 , $30.82 , $17.21 , N/A , $25.06 , $25.06 , $76.95 , $27.39 , $4.85 , $77.76 
Bronchoscopy W/Transbronchial Lung Bx Each Lobe,CPT® 31632,N/A,N/A,N/A, $595.00 , $386.75 , $270.25 , $46.87 , $72.43 , $191.76 , $186.98 , $553.35 , $535.50 , $535.50 , $476.00 , $476.00 , $72.43 , $549.36 , $565.25 , $535.50 , $535.50 , $535.50 , $553.35 , $571.20 , $262.23 , $505.75 , $258.69 , $258.75 , N/A , $195.50 , $195.50 , $565.25 , $230.25 , $46.87 , $571.20 
" Pro Needle Biopsy, Muscle ",CPT® 20206,0982 - PRO FEE/OUTPT,N/A,N/A, $613.00 , $398.45 , $353.73 , $55.01 , $134.06 , $292.48 , $286.69 , $570.09 , $551.70 , $551.70 , $490.40 , $490.40 , $134.06 , $565.98 , $582.35 , $551.70 , $551.70 , $551.70 , $570.09 , $588.48 , $328.65 , $521.05 , $308.64 , $344.99 , N/A , $298.19 , $298.19 , $582.35 , $350.47 , $55.01 , $588.48 
"Bone Imaging, 3 Phase",CPT® 78315,N/A,N/A,N/A," $3,304.00 "," $2,147.60 "," $1,851.24 ", $317.21 , $242.39 ," $1,706.13 "," $1,862.48 "," $3,072.72 "," $2,973.60 "," $2,973.60 "," $2,643.20 "," $2,643.20 ", $242.39 ," $3,050.58 "," $3,138.80 "," $2,973.60 "," $2,973.60 "," $2,973.60 "," $3,072.72 "," $3,171.84 "," $1,917.67 "," $2,808.40 "," $2,030.05 "," $2,330.36 ", N/A ," $1,739.42 "," $1,739.42 "," $3,138.80 "," $2,013.41 ", $242.39 ," $3,171.84 "
Repair Penis Post Injury,CPT® 54440,N/A,N/A,N/A," $3,524.00 "," $2,290.60 "," $3,084.80 ", $669.47 ," $1,089.90 "," $1,772.08 "," $1,788.34 "," $3,277.32 "," $3,171.60 "," $3,171.60 "," $2,819.20 "," $2,819.20 "," $1,089.90 "," $3,253.71 "," $3,347.80 "," $3,171.60 "," $3,171.60 "," $3,171.60 "," $3,277.32 "," $3,383.04 "," $2,881.61 "," $2,995.40 "," $2,916.94 "," $3,111.80 ", N/A ," $1,806.66 "," $1,806.66 "," $3,347.80 "," $2,165.38 ", $669.47 ," $3,383.04 "
 Pro Computerized Corneal Topography Uni/Bi ,CPT® 92025,0962 - PRO FEE/EYE,N/A,N/A, $118.00 , $76.70 , $78.32 , $35.63 , $24.40 , $66.64 , $67.92 , $109.74 , $106.20 , $106.20 , $94.40 , $94.40 , $24.40 , $108.95 , $112.10 , $106.20 , $106.20 , $106.20 , $109.74 , $113.28 , $111.99 , $100.30 , $114.55 , $80.10 , N/A , $67.93 , $67.93 , $112.10 , $80.82 , $24.40 , $114.55 
Destruction Neurolytic Agt Genicular Nerve W/Img,64624,N/A,N/A,N/A," $2,731.00 "," $1,775.15 ", $725.40 , $140.79 , $321.99 , $806.54 , N/A ," $2,539.83 "," $2,457.90 "," $2,457.90 "," $2,184.80 "," $2,184.80 ", $321.99 ," $2,521.53 "," $2,594.45 "," $2,457.90 "," $2,457.90 "," $2,457.90 "," $2,539.83 "," $2,621.76 ", $786.05 ," $2,321.35 ", $765.86 , $889.38 , N/A , $822.28 , $822.28 ," $2,594.45 ", $882.08 , $140.79 ," $2,621.76 "
Ileoscopy Thru Stoma Dx W/Collj Spec When Prfmd,CPT® 44380,N/A,N/A,N/A," $1,013.00 ", $658.45 , $346.45 , $54.25 , $133.31 , $325.80 , $332.09 , $942.09 , $911.70 , $911.70 , $810.40 , $810.40 , $133.31 , $935.30 , $962.35 , $911.70 , $911.70 , $911.70 , $942.09 , $972.48 , $248.35 , $861.05 , $362.17 , $331.07 , N/A , $332.16 , $332.16 , $962.35 , $347.39 , $54.25 , $972.48 
Echo Transesophag Image Acquisj Interp&Report,CPT® 93317,N/A,N/A,N/A," $1,505.00 ", $978.25 ," $1,893.58 ", $294.90 , N/A ," $1,150.32 "," $1,001.73 "," $1,399.65 "," $1,354.50 "," $1,354.50 "," $1,204.00 "," $1,204.00 ", N/A ," $1,389.57 "," $1,429.75 "," $1,354.50 "," $1,354.50 "," $1,354.50 "," $1,399.65 "," $1,444.80 "," $1,867.40 "," $1,279.25 ", $959.83 ," $1,758.40 ", N/A ," $1,172.77 "," $1,172.77 "," $1,429.75 "," $1,300.03 ", $294.90 ," $1,893.58 "
Exc Skin Benig >4cm Remaindr Body,11426,N/A,N/A,N/A," $1,652.00 "," $1,073.80 ", $865.20 , $256.79 , $276.88 , $745.91 , $724.34 ," $1,536.36 "," $1,486.80 "," $1,486.80 "," $1,321.60 "," $1,321.60 ", $276.88 ," $1,525.29 "," $1,569.40 "," $1,486.80 "," $1,486.80 "," $1,486.80 "," $1,536.36 "," $1,585.92 ", $953.39 ," $1,404.20 "," $1,448.66 ", $954.50 , N/A , $760.46 , $760.46 ," $1,569.40 ", $881.89 , $256.79 ," $1,585.92 "
"Cysto/Uretero/Pyeloscopy,W/Resect Tumor",CPT® 52355,N/A,N/A,N/A," $3,260.00 "," $2,119.00 "," $2,501.88 ", $439.16 ," $1,204.96 "," $2,295.05 "," $2,163.26 "," $3,031.80 "," $2,934.00 "," $2,934.00 "," $2,608.00 "," $2,608.00 "," $1,204.96 "," $3,009.96 "," $3,097.00 "," $2,934.00 "," $2,934.00 "," $2,934.00 "," $3,031.80 "," $3,129.60 "," $2,518.74 "," $2,771.00 "," $2,451.30 "," $2,878.79 ", N/A ," $2,339.83 "," $2,339.83 "," $3,097.00 "," $2,750.12 ", $439.16 ," $3,129.60 "
 Pro Oph Medical Xm&Eval Compre New Pt 1+ Vst ,CPT® 92004,0962 - PRO FEE/EYE,N/A,N/A, $445.00 , $289.25 , $208.87 , $93.23 , $45.22 , $177.44 , $177.23 , $413.85 , $400.50 , $400.50 , $356.00 , $356.00 , $45.22 , $410.87 , $422.75 , $400.50 , $400.50 , $400.50 , $413.85 , $427.20 , $271.94 , $378.25 , $298.03 , $211.32 , N/A , $180.91 , $180.91 , $422.75 , $215.19 , $45.22 , $427.20 
 Fac Replace Aortic Valve W/Byp Open Art/Venous Aprch ,CPT® 33368,0360 - OR SERVICES,N/A,N/A," $12,886.00 "," $8,375.90 "," $10,824.24 ", $662.26 , $567.15 ," $10,411.89 "," $11,597.40 "," $10,909.29 "," $11,597.40 "," $11,597.40 "," $11,597.40 "," $10,953.10 ", $556.03 ," $11,897.64 "," $12,241.70 "," $10,953.10 "," $11,983.98 "," $11,983.98 "," $12,241.70 "," $12,370.56 "," $10,543.33 "," $11,597.40 "," $10,953.10 "," $10,179.94 ", N/A ," $10,428.64 "," $10,428.64 "," $12,241.70 "," $11,057.48 ", $556.03 ," $12,370.56 "
 WARFARIN SODIUM 3 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00832-1214-01,1 tablet, $3.40 , $2.21 , $2.86 , N/A , N/A , $2.75 , $3.06 , $2.88 , $3.06 , $3.06 , $3.06 , $2.89 , N/A , $3.14 , $3.23 , $2.89 , $3.16 , $3.16 , $3.23 , $3.26 , $2.78 , $3.06 , $2.89 , $2.69 , N/A , $2.75 , $2.75 , $3.23 , $2.92 , $2.69 , $3.26 
Removal of Anal Tabs,46230,N/A,N/A,N/A," $1,800.00 "," $1,170.00 "," $1,055.93 ", $164.95 , $76.84 , $820.37 , $838.30 ," $1,674.00 "," $1,620.00 "," $1,620.00 "," $1,440.00 "," $1,440.00 ", $76.84 ," $1,661.94 "," $1,710.00 "," $1,620.00 "," $1,620.00 "," $1,620.00 "," $1,674.00 "," $1,728.00 ", $754.95 ," $1,530.00 ", $924.15 , $975.94 , N/A , $836.38 , $836.38 ," $1,710.00 ", $874.76 , $76.84 ," $1,728.00 "
"CT Angio, Pelvis, Combo, Incl Image Proc",CPT® 72191,N/A,N/A,N/A, $894.00 , $581.10 ," $1,788.15 ", $258.04 , $394.70 ," $1,448.73 "," $2,115.07 ", $831.42 , $804.60 , $804.60 , $715.20 , $715.20 , $394.70 , $825.43 , $849.30 , $804.60 , $804.60 , $804.60 , $831.42 , $858.24 ," $1,816.87 ", $759.90 ," $2,303.55 "," $1,981.87 ", N/A ," $1,477.00 "," $1,477.00 ", $849.30 ," $1,709.66 ", $258.04 ," $2,303.55 "
 Rest Gated ,CPT® 78472,0340 - NUCLEAR MEDICINE,N/A,N/A," $3,321.00 "," $2,158.65 "," $2,789.64 ", $209.10 , $242.57 ," $2,683.37 "," $2,988.90 "," $2,811.56 "," $2,988.90 "," $2,988.90 "," $2,988.90 "," $2,822.85 ", $237.81 ," $3,066.28 "," $3,154.95 "," $2,822.85 "," $3,088.53 "," $3,088.53 "," $3,154.95 "," $3,188.16 "," $2,717.24 "," $2,988.90 "," $2,822.85 "," $2,623.59 ", N/A ," $2,687.69 "," $2,687.69 "," $3,154.95 "," $2,849.75 ", $209.10 ," $3,188.16 "
Cardiac Rehab,CPT® 93797,N/A,N/A,N/A, $134.00 , $87.10 , $56.68 , $8.63 , $29.99 , $48.30 , $49.92 , $124.62 , $120.60 , $120.60 , $107.20 , $107.20 , $29.99 , $123.72 , $127.30 , $120.60 , $120.60 , $120.60 , $124.62 , $128.64 , $56.04 , $113.90 , $46.39 , $33.54 , N/A , $49.24 , $49.24 , $127.30 , $54.58 , $8.63 , $128.64 
 Fac Radiologic Exam Esophagus Double Contrast Study ,CPT® 74221,0320 - DX X-RAY,N/A,N/A, $951.00 , $618.15 , $798.84 , $110.45 , $85.64 , $768.41 , $855.90 , $805.12 , $855.90 , $855.90 , $855.90 , $808.35 , $83.96 , $878.06 , $903.45 , $808.35 , $884.43 , $884.43 , $903.45 , $912.96 , $778.11 , $855.90 , $808.35 , $751.29 , N/A , $769.64 , $769.64 , $903.45 , $816.05 , $83.96 , $912.96 
Excison Tumor Soft Tissue Thigh/Knee Subq 3+Cm,CPT® 27337,N/A,N/A,N/A," $4,431.00 "," $2,880.15 "," $2,530.97 ", $395.05 , $343.72 ," $2,002.26 "," $2,013.12 "," $4,120.83 "," $3,987.90 "," $3,987.90 "," $3,544.80 "," $3,544.80 ", $343.72 ," $4,091.14 "," $4,209.45 "," $3,987.90 "," $3,987.90 "," $3,987.90 "," $4,120.83 "," $4,253.76 "," $2,344.15 "," $3,766.35 "," $2,228.30 "," $2,359.43 ", N/A ," $2,041.33 "," $2,041.33 "," $4,209.45 "," $2,399.29 ", $343.72 ," $4,253.76 "
"Dilation/Curettage,Diagnostic",58120,N/A,N/A,N/A," $1,880.00 "," $1,222.00 "," $1,105.05 ", $223.42 , $234.44 , $891.43 , $887.78 ," $1,748.40 "," $1,692.00 "," $1,692.00 "," $1,504.00 "," $1,504.00 ", $234.44 ," $1,735.80 "," $1,786.00 "," $1,692.00 "," $1,692.00 "," $1,692.00 "," $1,748.40 "," $1,804.80 "," $1,141.04 "," $1,598.00 "," $1,166.78 ", $894.68 , N/A , $908.82 , $908.82 ," $1,786.00 "," $1,090.09 ", $223.42 ," $1,804.80 "
Supracerv Abd Hysterectomy,CPT® 58180,N/A,N/A,N/A," $5,729.00 "," $3,723.85 "," $4,509.55 ", $911.64 , $845.22 ," $3,916.47 "," $3,886.61 "," $5,327.97 "," $5,156.10 "," $5,156.10 "," $4,583.20 "," $4,583.20 ", $845.22 ," $5,289.59 "," $5,442.55 "," $5,156.10 "," $5,156.10 "," $5,156.10 "," $5,327.97 "," $5,499.84 "," $4,720.82 "," $4,869.65 "," $5,113.13 "," $3,925.38 ", N/A ," $3,992.89 "," $3,992.89 "," $5,442.55 "," $4,789.21 ", $845.22 ," $5,499.84 "
 Pro Treat Fracture Radius & Ulna ,CPT® 25565,0982 - PRO FEE/OUTPT,N/A,N/A," $2,412.00 "," $1,567.80 "," $2,866.37 ", $452.75 , $396.91 ," $2,261.48 "," $2,289.35 "," $2,243.16 "," $2,170.80 "," $2,170.80 "," $1,929.60 "," $1,929.60 ", $396.91 ," $2,227.00 "," $2,291.40 "," $2,170.80 "," $2,170.80 "," $2,170.80 "," $2,243.16 "," $2,315.52 "," $2,644.54 "," $2,050.20 "," $2,519.10 "," $2,656.81 ", N/A ," $2,305.61 "," $2,305.61 "," $2,291.40 "," $2,709.92 ", $396.91 ," $2,866.37 "
"Cystoscopy,Tx Ureteropelvc Stricture",CPT® 52342,N/A,N/A,N/A," $2,191.00 "," $1,424.15 "," $1,655.14 ", $290.80 , $372.95 ," $1,515.81 "," $1,429.41 "," $2,037.63 "," $1,971.90 "," $1,971.90 "," $1,752.80 "," $1,752.80 ", $372.95 ," $2,022.95 "," $2,081.45 "," $1,971.90 "," $1,971.90 "," $1,971.90 "," $2,037.63 "," $2,103.36 "," $1,664.45 "," $1,862.35 "," $1,618.15 "," $1,902.53 ", N/A ," $1,545.39 "," $1,545.39 "," $2,081.45 "," $1,816.37 ", $290.80 ," $2,103.36 "
Remove Uterus After Cesarean,CPT® 59525,N/A,N/A,N/A," $2,160.00 "," $1,404.00 "," $1,277.04 ", $430.55 , $435.30 ," $1,123.77 "," $1,176.28 "," $2,008.80 "," $1,944.00 "," $1,944.00 "," $1,728.00 "," $1,728.00 ", $435.30 ," $1,994.33 "," $2,052.00 "," $1,944.00 "," $1,944.00 "," $1,944.00 "," $2,008.80 "," $2,073.60 "," $2,242.63 "," $1,836.00 "," $2,608.30 "," $2,081.27 ", N/A ," $1,145.70 "," $1,145.70 "," $2,052.00 "," $1,324.53 ", $430.55 ," $2,608.30 "
"Remv Vert Body,Thor,Lat Approach",CPT® 63101,N/A,N/A,N/A," $14,973.00 "," $9,732.45 "," $10,720.84 "," $2,092.84 "," $2,109.37 "," $12,578.79 "," $12,038.21 "," $13,924.89 "," $13,475.70 "," $13,475.70 "," $11,978.40 "," $11,978.40 "," $2,109.37 "," $13,824.57 "," $14,224.35 "," $13,475.70 "," $13,475.70 "," $13,475.70 "," $13,924.89 "," $14,374.08 "," $11,597.29 "," $12,727.05 "," $12,277.93 "," $13,133.16 ", N/A ," $12,824.22 "," $12,824.22 "," $14,224.35 "," $13,757.37 "," $2,092.84 "," $14,374.08 "
 Pro Egd Percutaneous Placement Gastrostomy Tube ,CPT® 43246,0982 - PRO FEE/OUTPT,N/A,N/A," $3,393.00 "," $2,205.45 "," $1,214.72 ", $187.69 , $744.68 ," $1,008.36 "," $1,217.72 "," $3,155.49 "," $3,053.70 "," $3,053.70 "," $2,714.40 "," $2,714.40 ", $744.68 ," $3,132.76 "," $3,223.35 "," $3,053.70 "," $3,053.70 "," $3,053.70 "," $3,155.49 "," $3,257.28 ", $873.20 ," $2,884.05 "," $1,338.05 "," $1,156.34 ", N/A ," $1,028.04 "," $1,028.04 "," $3,223.35 "," $1,075.22 ", $187.69 ," $3,257.28 "
 Aac Eval Additional Thirty Minutes ,CPT® 92608,0444 - SPEECH PATH/EVAL,N/A,N/A, $223.00 , $144.95 , $187.32 , $48.38 , $39.22 , $180.18 , $200.70 , $188.79 , $200.70 , $200.70 , $200.70 , $189.55 , $38.45 , $205.90 , $211.85 , $189.55 , $207.39 , $207.39 , $211.85 , $214.08 , $182.46 , $200.70 , $189.55 , $176.17 , N/A , $180.47 , $180.47 , $211.85 , $191.36 , $38.45 , $214.08 
"X-Ray Ribs, Chest 3+ Vw",CPT® 71101,N/A,N/A,N/A, $388.00 , $252.20 , $238.79 , $41.73 , $37.57 , $171.71 , $210.74 , $360.84 , $349.20 , $349.20 , $310.40 , $310.40 , $37.57 , $358.24 , $368.60 , $349.20 , $349.20 , $349.20 , $360.84 , $372.48 , $232.19 , $329.80 , $229.20 , $192.15 , N/A , $175.06 , $175.06 , $368.60 , $202.62 , $37.57 , $372.48 
" Fac Nstill via Chest Tube Agent for Fibrinolysis, Subsequent ",CPT® 32562,0361 - OR/MINOR,N/A,N/A, $734.00 , $477.10 , $616.56 , $57.19 , $70.79 , $593.07 , $660.60 , $621.40 , $660.60 , $660.60 , $660.60 , $623.90 , $69.40 , $677.70 , $697.30 , $623.90 , $682.62 , $682.62 , $697.30 , $704.64 , $600.56 , $660.60 , $623.90 , $579.86 , N/A , $594.03 , $594.03 , $697.30 , $629.85 , $57.19 , $704.64 
Ambulatory Bp Mntr W/Sw 24 Hr+ Rec Scan Alys I&R,CPT® 93784,N/A,N/A,N/A, $821.00 , $533.65 , $286.65 , $44.66 , $71.00 , $289.63 , $311.62 , $763.53 , $738.90 , $738.90 , $656.80 , $656.80 , $71.00 , $758.03 , $779.95 , $738.90 , $738.90 , $738.90 , $763.53 , $788.16 , $283.52 , $697.85 , $292.59 , $202.30 , N/A , $295.28 , $295.28 , $779.95 , $327.33 , $44.66 , $788.16 
 VITAMIN K1 10 MG/ML IJ SOLN ,HCPCS J3430,0636 - DRUGS REQUIRING DETAILED CODIN,69097-0708-96,0.2 mL, $52.73 , $34.27 , $44.29 , $2.93 , $3.25 , $42.61 , $47.46 , $44.64 , $47.46 , $47.46 , $47.46 , $44.82 , $3.19 , $48.69 , $50.09 , $44.82 , $49.04 , $49.04 , $50.09 , $50.62 , $43.14 , $47.46 , $44.82 , $41.66 , N/A , $42.67 , $42.67 , $50.09 , $45.25 , $2.93 , $50.62 
Gastrointestinal Tract Imaging Esophagus,CPT® 91111,N/A,N/A,N/A," $4,289.00 "," $2,787.85 "," $1,974.82 ", $844.03 , $603.38 ," $1,622.73 "," $1,821.61 "," $3,988.77 "," $3,860.10 "," $3,860.10 "," $3,431.20 "," $3,431.20 ", $603.38 ," $3,960.03 "," $4,074.55 "," $3,860.10 "," $3,860.10 "," $3,860.10 "," $3,988.77 "," $4,117.44 "," $4,084.86 "," $3,645.65 "," $2,415.68 "," $2,826.03 ", N/A ," $1,654.39 "," $1,654.39 "," $4,074.55 "," $1,928.69 ", $603.38 ," $4,117.44 "
Mitralplasty W Radical Reconstr,CPT® 33427,N/A,N/A,N/A," $18,632.00 "," $12,110.80 "," $14,246.64 "," $2,198.78 "," $2,378.00 "," $10,438.78 "," $10,357.74 "," $17,327.76 "," $16,768.80 "," $16,768.80 "," $14,905.60 "," $14,905.60 "," $2,378.00 "," $17,202.93 "," $17,700.40 "," $16,768.80 "," $16,768.80 "," $16,768.80 "," $17,327.76 "," $17,886.72 "," $13,193.55 "," $15,837.20 "," $13,123.58 "," $11,718.71 ", N/A ," $10,642.46 "," $10,642.46 "," $17,700.40 "," $12,089.83 "," $2,198.78 "," $17,886.72 "
Office/OP Consltj New/Est Pt Sf Mdm 20 Minutes,99242,N/A,N/A,N/A, $326.00 , $211.90 , N/A , $74.22 , $63.23 , $151.92 , $151.47 , $303.18 , $293.40 , $293.40 , $260.80 , $260.80 , $63.23 , $301.00 , $309.70 , $293.40 , $293.40 , $293.40 , $303.18 , $312.96 , $190.00 , $277.10 , $149.27 , $150.03 , $116.50 , $154.89 , $154.89 , $309.70 , $184.40 , $63.23 , $312.96 
 TRIAMCINOLONE ACETONIDE 0.1 % EX CREA ,HCPCS RXC637,0250 - PHARMACY,67877-0251-15,15 gram, $29.98 , $19.49 , $25.18 , N/A , N/A , $24.22 , $26.98 , $25.38 , $26.98 , $26.98 , $26.98 , $25.48 , N/A , $27.68 , $28.48 , $25.48 , $27.88 , $27.88 , $28.48 , $28.78 , $24.53 , $26.98 , $25.48 , $23.68 , N/A , $24.26 , $24.26 , $28.48 , $25.73 , $23.68 , $28.78 
 Pro Remove Arm/Elbow Lesion ,CPT® 24075,0975 - PRO FEE/OR,N/A,N/A," $3,344.00 "," $2,173.60 "," $2,007.46 ", $314.81 , $80.09 ," $1,581.67 "," $1,597.42 "," $3,109.92 "," $3,009.60 "," $3,009.60 "," $2,675.20 "," $2,675.20 ", $80.09 ," $3,087.52 "," $3,176.80 "," $3,009.60 "," $3,009.60 "," $3,009.60 "," $3,109.92 "," $3,210.24 "," $1,858.16 "," $2,842.40 "," $1,762.66 "," $1,876.09 ", N/A ," $1,612.53 "," $1,612.53 "," $3,176.80 "," $1,895.29 ", $80.09 ," $3,210.24 "
Prgrmg Dev Eval Scrms Phys/Qhp in Person,CPT® 93285,N/A,N/A,N/A, $569.00 , $369.85 , $394.42 , $60.01 , $35.04 , $228.23 , $230.08 , $529.17 , $512.10 , $512.10 , $455.20 , $455.20 , $35.04 , $525.36 , $540.55 , $512.10 , $512.10 , $512.10 , $529.17 , $546.24 , $364.94 , $483.65 , $214.09 , $161.80 , N/A , $232.69 , $232.69 , $540.55 , $257.93 , $35.04 , $546.24 
"MRI, Joint of Leg W/Contrast",CPT® 73722,N/A,N/A,N/A," $4,090.00 "," $2,658.50 "," $2,285.22 ", $323.72 , $498.57 ," $1,816.15 "," $2,329.98 "," $3,803.70 "," $3,681.00 "," $3,681.00 "," $3,272.00 "," $3,272.00 ", $498.57 ," $3,776.30 "," $3,885.50 "," $3,681.00 "," $3,681.00 "," $3,681.00 "," $3,803.70 "," $3,926.40 "," $1,984.20 "," $3,476.50 "," $2,542.38 "," $3,526.32 ", N/A ," $1,851.60 "," $1,851.60 "," $3,885.50 "," $2,143.24 ", $323.72 ," $3,926.40 "
Fluorescent Antibody; Screen,CPT® 86255,N/A,N/A,N/A, $146.00 , $94.90 , N/A , $12.29 , $12.29 , $68.18 , $81.59 , $135.78 , $131.40 , $131.40 , $116.80 , $116.80 , $12.29 , $134.80 , $138.70 , $131.40 , $131.40 , $131.40 , $135.78 , $140.16 , $80.46 , $124.10 , $175.16 , $43.70 , N/A , $63.63 , $63.63 , $138.70 , $69.54 , $12.29 , $175.16 
Removal of Fallopian Tube,CPT® 58700,N/A,N/A,N/A," $4,604.00 "," $2,992.60 "," $3,760.20 ", $759.56 , $522.28 ," $3,167.84 "," $3,145.64 "," $4,281.72 "," $4,143.60 "," $4,143.60 "," $3,683.20 "," $3,683.20 ", $522.28 ," $4,250.87 "," $4,373.80 "," $4,143.60 "," $4,143.60 "," $4,143.60 "," $4,281.72 "," $4,419.84 "," $3,901.46 "," $3,913.40 "," $4,153.30 "," $3,158.26 ", N/A ," $3,229.65 "," $3,229.65 "," $4,373.80 "," $3,873.76 ", $522.28 ," $4,419.84 "
 Fac Herpes Simplex Test ,CPT® 86694,0302 - LAB/IMMUNOLOGY,N/A,N/A, $150.00 , $97.50 , $126.00 , $14.68 , $14.68 , $121.20 , $135.00 , $126.99 , $135.00 , $135.00 , $135.00 , $127.50 , $14.39 , $138.50 , $142.50 , $127.50 , $139.50 , $139.50 , $142.50 , $144.00 , $122.73 , $135.00 , $127.50 , $118.50 , N/A , $121.40 , $121.40 , $142.50 , $128.72 , $14.39 , $144.00 
Angio Aortobifemoral W Cath,CPT® 75630,N/A,N/A,N/A," $3,288.00 "," $2,137.20 ", $889.08 , $152.85 , $266.62 , $818.20 , $965.09 ," $3,057.84 "," $2,959.20 "," $2,959.20 "," $2,630.40 "," $2,630.40 ", $266.62 ," $3,035.81 "," $3,123.60 "," $2,959.20 "," $2,959.20 "," $2,959.20 "," $3,057.84 "," $3,156.48 ", $906.43 ," $2,794.80 "," $1,055.47 ", $855.80 , N/A , $834.17 , $834.17 ," $3,123.60 ", $965.58 , $152.85 ," $3,156.48 "
" Pericard Drain W Insert of Indwell Cath, Include Fluor/US, 6 Yrs + ",CPT® 33017,0981 - PRO FEE/ER,N/A,N/A," $2,037.00 "," $1,324.05 "," $1,446.32 ", $222.87 , $187.36 ," $1,028.81 ", N/A ," $1,894.41 "," $1,833.30 "," $1,833.30 "," $1,629.60 "," $1,629.60 ", $187.36 ," $1,880.76 "," $1,935.15 "," $1,833.30 "," $1,833.30 "," $1,833.30 "," $1,894.41 "," $1,955.52 "," $1,335.40 "," $1,731.45 "," $1,279.40 "," $1,188.44 ", N/A ," $1,048.88 "," $1,048.88 "," $1,935.15 "," $1,191.27 ", $187.36 ," $1,955.52 "
 AMITRIPTYLINE HCL 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,16729-0171-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Debridement, Skin, Sub-Q Tissue,Each Add 20 Sq Cm",CPT® 11045,N/A,N/A,N/A, $152.00 , $98.80 , $81.91 , $23.74 , $12.63 , $71.63 , $71.08 , $141.36 , $136.80 , $136.80 , $121.60 , $121.60 , $12.63 , $140.34 , $144.40 , $136.80 , $136.80 , $136.80 , $141.36 , $145.92 , $90.34 , $129.20 , $144.51 , $91.36 , N/A , $73.03 , $73.03 , $144.40 , $84.69 , $12.63 , $145.92 
Revise Ulnar Nerve at Wrist,CPT® 64719,N/A,N/A,N/A," $1,519.00 ", $987.35 ," $1,995.97 ", $392.48 , $549.85 ," $2,198.67 "," $2,142.58 "," $1,412.67 "," $1,367.10 "," $1,367.10 "," $1,215.20 "," $1,215.20 ", $549.85 ," $1,402.49 "," $1,443.05 "," $1,367.10 "," $1,367.10 "," $1,367.10 "," $1,412.67 "," $1,458.24 "," $2,144.33 "," $1,291.15 "," $2,119.47 "," $2,362.36 ", N/A ," $2,241.57 "," $2,241.57 "," $1,443.05 "," $2,404.68 ", $392.48 ," $2,404.68 "
"Fusion Big Toe,I-P Joint",28755,N/A,N/A,N/A," $3,399.00 "," $2,209.35 "," $2,070.12 ", $323.73 , $230.52 ," $1,623.04 "," $1,617.93 "," $3,161.07 "," $3,059.10 "," $3,059.10 "," $2,719.20 "," $2,719.20 ", $230.52 ," $3,138.30 "," $3,229.05 "," $3,059.10 "," $3,059.10 "," $3,059.10 "," $3,161.07 "," $3,263.04 "," $1,919.32 "," $2,889.15 "," $1,755.52 "," $1,936.57 ", N/A ," $1,654.70 "," $1,654.70 "," $3,229.05 "," $1,944.86 ", $230.52 ," $3,263.04 "
 Coccidiodes per Ab ,CPT® 86635,0305 - LAB/HEMATOLOGY,N/A,N/A, $143.00 , $92.95 , $120.12 , $11.70 , $8.07 , $115.54 , $128.70 , $121.06 , $128.70 , $128.70 , $128.70 , $121.55 , $7.91 , $132.03 , $135.85 , $121.55 , $132.99 , $132.99 , $135.85 , $137.28 , $117.00 , $128.70 , $121.55 , $112.97 , N/A , $115.73 , $115.73 , $135.85 , $122.71 , $7.91 , $137.28 
Proctosgmdsc Rigid W/Bx Single/Multiple,CPT® 45305,N/A,N/A,N/A," $1,203.00 ", $781.95 , $439.40 , $68.74 , $68.55 , $377.78 , $384.81 ," $1,118.79 "," $1,082.70 "," $1,082.70 ", $962.40 , $962.40 , $68.55 ," $1,110.73 "," $1,142.85 "," $1,082.70 "," $1,082.70 "," $1,082.70 "," $1,118.79 "," $1,154.88 ", $315.40 ," $1,022.55 ", $426.39 , $416.20 , N/A , $385.15 , $385.15 ," $1,142.85 ", $402.84 , $68.55 ," $1,154.88 "
" Fac Compatibility Test, Spin ",CPT® 86920,0300 - LABORATORY,N/A,N/A, $160.00 , $104.00 , $134.40 , N/A , $7.29 , $129.28 , $144.00 , $135.46 , $144.00 , $144.00 , $144.00 , $136.00 , $7.15 , $147.73 , $152.00 , $136.00 , $148.80 , $148.80 , $152.00 , $153.60 , $130.91 , $144.00 , $136.00 , $126.40 , N/A , $129.49 , $129.49 , $152.00 , $137.30 , $7.15 , $153.60 
 DEXAMETHASONE 6 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00054-8183-25,1 tablet, $9.74 , $6.33 , $8.18 , N/A , N/A , $7.87 , $8.77 , $8.25 , $8.77 , $8.77 , $8.77 , $8.28 , N/A , $8.99 , $9.25 , $8.28 , $9.06 , $9.06 , $9.25 , $9.35 , $7.97 , $8.77 , $8.28 , $7.69 , N/A , $7.88 , $7.88 , $9.25 , $8.36 , $7.69 , $9.35 
"Exc Skin Benig 1.1-2cm Face,Facial",11442,N/A,N/A,N/A, $908.00 , $590.20 , $469.34 , $141.83 , $154.85 , $396.21 , $390.89 , $844.44 , $817.20 , $817.20 , $726.40 , $726.40 , $154.85 , $838.36 , $862.60 , $817.20 , $817.20 , $817.20 , $844.44 , $871.68 , $509.92 , $771.80 , $779.64 , $508.03 , N/A , $403.95 , $403.95 , $862.60 , $468.43 , $141.83 , $871.68 
 Fac Rplcmt Compl Non-Tun Cvc W/O Subq Port/Pmp ,CPT® 36580,0761 - TREATMENT ROOM,N/A,N/A," $3,553.00 "," $2,309.45 "," $2,984.52 ", $61.68 , $315.95 ," $2,870.82 "," $3,197.70 "," $3,007.97 "," $3,197.70 "," $3,197.70 "," $3,197.70 "," $3,020.05 ", $309.75 ," $3,280.48 "," $3,375.35 "," $3,020.05 "," $3,304.29 "," $3,304.29 "," $3,375.35 "," $3,410.88 "," $2,907.06 "," $3,197.70 "," $3,020.05 "," $2,806.87 ", N/A ," $2,875.44 "," $2,875.44 "," $3,375.35 "," $3,048.83 ", $61.68 ," $3,410.88 "
 Fac Lyr Clsr F/E/E/N/L/M&/Muc 20.1 Cm-30.0 Cm ,CPT® 12056,0761 - TREATMENT ROOM,N/A,N/A," $3,138.00 "," $2,039.70 "," $2,635.92 ", $364.92 , $448.13 ," $2,535.50 "," $2,824.20 "," $2,656.63 "," $2,824.20 "," $2,824.20 "," $2,824.20 "," $2,667.30 ", $439.34 ," $2,897.32 "," $2,981.10 "," $2,667.30 "," $2,918.34 "," $2,918.34 "," $2,981.10 "," $3,012.48 "," $2,567.51 "," $2,824.20 "," $2,667.30 "," $2,479.02 ", N/A ," $2,539.58 "," $2,539.58 "," $2,981.10 "," $2,692.72 ", $364.92 ," $3,012.48 "
Immunoglobulin Light Chains Free Each,CPT® 83521,N/A,N/A,N/A, $148.00 , $96.20 , N/A , $17.62 , $17.62 , N/A , N/A , $137.64 , $133.20 , $133.20 , $118.40 , $118.40 , $17.62 , $136.65 , $140.60 , $133.20 , $133.20 , $133.20 , $137.64 , $142.08 , N/A , $125.80 , $82.38 , $50.72 , N/A , $67.70 , $67.70 , $140.60 , $74.43 , $17.62 , $142.08 
 Fac Puraply Am 1 Sq Cm ,HCPCS Q4196,0636 - DRUGS REQUIRING DETAILED CODIN,N/A,N/A, $349.00 , $226.85 , $293.16 , $104.33 , N/A , $281.99 , $314.10 , $295.46 , $314.10 , $314.10 , $314.10 , $296.65 , N/A , $322.23 , $331.55 , $296.65 , $324.57 , $324.57 , $331.55 , $335.04 , $285.55 , $314.10 , $296.65 , $275.71 , N/A , $282.45 , $282.45 , $331.55 , $299.48 , $104.33 , $335.04 
Repair Complex Addt,13133,N/A,N/A,N/A," $1,114.00 ", $724.10 , $400.49 , $119.01 , $130.42 , $358.67 , $346.07 ," $1,036.02 "," $1,002.60 "," $1,002.60 ", $891.20 , $891.20 , $130.42 ," $1,028.56 "," $1,058.30 "," $1,002.60 "," $1,002.60 "," $1,002.60 "," $1,036.02 "," $1,069.44 ", $443.31 , $946.90 , $692.22 , $459.37 , N/A , $365.66 , $365.66 ," $1,058.30 ", $424.04 , $119.01 ," $1,069.44 "
Fp Removal/Corneal,65222,N/A,N/A,N/A, $250.00 , $162.50 , $313.04 , $48.84 , $48.12 , $297.31 , $278.46 , $232.50 , $225.00 , $225.00 , $200.00 , $200.00 , $48.12 , $230.83 , $237.50 , $225.00 , $225.00 , $225.00 , $232.50 , $240.00 , $433.67 , $212.50 , $287.23 , $377.49 , N/A , $303.11 , $303.11 , $237.50 , $334.61 , $48.12 , $433.67 
 Endocrine Disorders With McC ,MS DRG V40 (FY2023) 643,N/A,N/A,N/A," $33,664.70 "," $21,882.06 "," $28,278.35 ", N/A , N/A ," $27,201.08 "," $30,298.23 "," $28,500.54 "," $30,298.23 "," $30,298.23 "," $30,298.23 "," $28,615.00 ", N/A ," $31,082.62 "," $31,981.47 "," $28,615.00 "," $31,308.17 "," $31,308.17 "," $31,981.47 "," $32,318.11 "," $27,544.46 "," $30,298.23 "," $28,615.00 "," $26,595.11 ", N/A ," $27,244.84 "," $27,244.84 "," $31,981.47 "," $28,887.68 "," $26,595.11 "," $32,318.11 "
"Program Eval Implant Device,Cardvert/Defib,Mult Lead",93284,N/A,N/A,N/A," $1,240.00 ", $806.00 , $689.20 , $105.48 , $55.43 , $487.60 , $495.15 ," $1,153.20 "," $1,116.00 "," $1,116.00 ", $992.00 , $992.00 , $55.43 ," $1,144.89 "," $1,178.00 "," $1,116.00 "," $1,116.00 "," $1,116.00 "," $1,153.20 "," $1,190.40 ", $652.28 ," $1,054.00 ", $460.29 , $323.57 , N/A , $497.12 , $497.12 ," $1,178.00 ", $551.05 , $55.43 ," $1,190.40 "
 Pro Cltx Sho Dislc W/Fx Humrl Tubrst W/Mnpj ,CPT® 23665,0981 - PRO FEE/ER,N/A,N/A," $2,159.00 "," $1,403.35 "," $2,467.60 ", $389.31 , $184.42 ," $1,901.37 "," $1,920.74 "," $2,007.87 "," $1,943.10 "," $1,943.10 "," $1,727.20 "," $1,727.20 ", $184.42 ," $1,993.40 "," $2,051.05 "," $1,943.10 "," $1,943.10 "," $1,943.10 "," $2,007.87 "," $2,072.64 "," $2,273.04 "," $1,835.15 "," $2,112.33 "," $2,250.81 ", N/A ," $1,938.47 "," $1,938.47 "," $2,051.05 "," $2,278.39 ", $184.42 ," $2,467.60 "
"Excis Foot Tumor,Subcutaneous",CPT® 28043,N/A,N/A,N/A," $2,623.00 "," $1,704.95 "," $1,611.74 ", $253.85 , $80.09 ," $1,292.68 "," $1,295.92 "," $2,439.39 "," $2,360.70 "," $2,360.70 "," $2,098.40 "," $2,098.40 ", $80.09 ," $2,421.82 "," $2,491.85 "," $2,360.70 "," $2,360.70 "," $2,360.70 "," $2,439.39 "," $2,518.08 "," $1,500.04 "," $2,229.55 "," $1,402.27 "," $1,544.63 ", N/A ," $1,317.90 "," $1,317.90 "," $2,491.85 "," $1,549.00 ", $80.09 ," $2,518.08 "
 OYSTER SHELL CALCIUM W/D 500-5 MG-MCG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-5460-72,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Perq Drainage Pleura Insert Cath W/Imaging,CPT® 32557,N/A,N/A,N/A," $5,397.00 "," $3,508.05 ", $818.57 , $142.63 , $559.75 , $599.80 , $602.46 ," $5,019.21 "," $4,857.30 "," $4,857.30 "," $4,317.60 "," $4,317.60 ", $559.75 ," $4,983.05 "," $5,127.15 "," $4,857.30 "," $4,857.30 "," $4,857.30 "," $5,019.21 "," $5,181.12 ", $795.48 ," $4,587.45 ", $870.62 , $797.92 , N/A , $611.50 , $611.50 ," $5,127.15 ", $720.18 , $142.63 ," $5,181.12 "
" Complex Repair Face,Neck, Genitalia, Hands,Feet 1.1-2.5cm ",CPT® 13131,0981 - PRO FEE/ER,N/A,N/A," $1,487.00 ", $966.55 , $776.05 , $231.89 , $176.33 , $684.64 , $667.66 ," $1,382.91 "," $1,338.30 "," $1,338.30 "," $1,189.60 "," $1,189.60 ", $176.33 ," $1,372.95 "," $1,412.65 "," $1,338.30 "," $1,338.30 "," $1,338.30 "," $1,382.91 "," $1,427.52 ", $855.05 ," $1,263.95 "," $1,330.91 ", $878.14 , N/A , $698.00 , $698.00 ," $1,412.65 ", $809.44 , $176.33 ," $1,427.52 "
Fentanyl Citrate Injeciton,HCPCS J3010,N/A,N/A,N/A, $2.00 , $1.30 , N/A , $0.86 , $1.00 , N/A , N/A , $1.86 , $1.80 , $1.80 , $1.60 , $1.60 , $1.00 , $1.85 , $1.90 , $1.80 , $1.80 , $1.80 , $1.86 , $1.92 , $0.81 , $1.70 , $0.65 , $1.16 , N/A , N/A , N/A , $1.90 , N/A , $0.65 , $1.92 
 DIVALPROEX SODIUM 500 MG PO TBEC ,HCPCS RXC637,0250 - PHARMACY,00904-6861-90,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Pro Biopsy of Toe Joint Lining ,CPT® 28054,0982 - PRO FEE/OUTPT,N/A,N/A," $2,534.00 "," $1,647.10 "," $1,457.37 ", $228.45 , $230.52 ," $1,165.23 "," $1,161.56 "," $2,356.62 "," $2,280.60 "," $2,280.60 "," $2,027.20 "," $2,027.20 ", $230.52 ," $2,339.64 "," $2,407.30 "," $2,280.60 "," $2,280.60 "," $2,280.60 "," $2,356.62 "," $2,432.64 "," $1,353.73 "," $2,153.90 "," $1,250.63 "," $1,389.89 ", N/A ," $1,187.97 "," $1,187.97 "," $2,407.30 "," $1,396.30 ", $228.45 ," $2,432.64 "
 CARFILZOMIB 30 MG IV SOLR ,HCPCS J9047,0636 - DRUGS REQUIRING DETAILED CODIN,76075-0102-01,15 mL," $4,379.89 "," $2,846.93 "," $3,679.11 ", $47.98 , $45.96 ," $3,538.95 "," $3,941.90 "," $3,708.01 "," $3,941.90 "," $3,941.90 "," $3,941.90 "," $3,722.91 ", $45.06 ," $4,043.95 "," $4,160.90 "," $3,722.91 "," $4,073.30 "," $4,073.30 "," $4,160.90 "," $4,204.69 "," $3,583.63 "," $3,941.90 "," $3,722.91 "," $3,460.11 ", N/A ," $3,544.64 "," $3,544.64 "," $4,160.90 "," $3,758.38 ", $45.06 ," $4,204.69 "
"Strapping,Ankle",CPT® 29540,N/A,N/A,N/A, $249.00 , $161.85 , $109.46 , $16.87 , $27.51 , $89.69 , $127.55 , $231.57 , $224.10 , $224.10 , $199.20 , $199.20 , $27.51 , $229.90 , $236.55 , $224.10 , $224.10 , $224.10 , $231.57 , $239.04 , $102.32 , $211.65 , $137.37 , $106.42 , N/A , $91.44 , $91.44 , $236.55 , $107.47 , $16.87 , $239.04 
 Heart Failure And Shock Without Cc/McC ,MS DRG V40 (FY2023) 293,N/A,N/A,N/A," $9,859.85 "," $6,408.90 "," $8,282.27 ", N/A , N/A ," $7,966.76 "," $8,873.87 "," $8,347.35 "," $8,873.87 "," $8,873.87 "," $8,873.87 "," $8,380.87 ", N/A ," $9,103.60 "," $9,366.86 "," $8,380.87 "," $9,169.66 "," $9,169.66 "," $9,366.86 "," $9,465.46 "," $8,067.33 "," $8,873.87 "," $8,380.87 "," $7,789.28 ", N/A ," $7,979.58 "," $7,979.58 "," $9,366.86 "," $8,460.74 "," $7,789.28 "," $9,465.46 "
 Fac Chemiluminescent Assay ,CPT® 82397,0301 - LAB/CHEMISTRY,N/A,N/A, $306.00 , $198.90 , $257.04 , $14.40 , $14.40 , $247.25 , $275.40 , $259.06 , $275.40 , $275.40 , $275.40 , $260.10 , $14.12 , $282.53 , $290.70 , $260.10 , $284.58 , $284.58 , $290.70 , $293.76 , $250.37 , $275.40 , $260.10 , $241.74 , N/A , $247.65 , $247.65 , $290.70 , $262.58 , $14.12 , $293.76 
 DEXTROSE 5 % IV SOLN ,HCPCS J7060,0636 - DRUGS REQUIRING DETAILED CODIN,00990-7922-09,"1,000 mL", $79.82 , $51.88 , $67.05 , $1.85 , $1.79 , $64.49 , $71.84 , $67.58 , $71.84 , $71.84 , $71.84 , $67.85 , $1.75 , $73.70 , $75.83 , $67.85 , $74.23 , $74.23 , $75.83 , $76.63 , $65.31 , $71.84 , $67.85 , $63.06 , N/A , $64.60 , $64.60 , $75.83 , $68.49 , $1.75 , $76.63 
" Fac Program Eval Implant Device,Pacemaker,2 Lead ",CPT® 93280,0480 - CARDIOLOGY,N/A,N/A, $377.00 , $245.05 , $316.68 , $78.83 , $50.64 , $304.62 , $339.30 , $319.17 , $339.30 , $339.30 , $339.30 , $320.45 , $49.65 , $348.08 , $358.15 , $320.45 , $350.61 , $350.61 , $358.15 , $361.92 , $308.46 , $339.30 , $320.45 , $297.83 , N/A , $305.11 , $305.11 , $358.15 , $323.50 , $49.65 , $361.92 
Open Treatment Posterior Malleolus Fracture,CPT® 27769,N/A,N/A,N/A," $6,273.00 "," $4,077.45 "," $4,436.97 ", $693.56 , $478.61 ," $3,494.63 "," $3,524.02 "," $5,833.89 "," $5,645.70 "," $5,645.70 "," $5,018.40 "," $5,018.40 ", $478.61 ," $5,791.86 "," $5,959.35 "," $5,645.70 "," $5,645.70 "," $5,645.70 "," $5,833.89 "," $6,022.08 "," $4,137.71 "," $5,332.05 "," $3,892.83 "," $4,153.59 ", N/A ," $3,562.82 "," $3,562.82 "," $5,959.35 "," $4,187.57 ", $478.61 ," $6,022.08 "
"MRI, Tmj",CPT® 70336,N/A,N/A,N/A," $3,850.00 "," $2,502.50 "," $1,926.54 ", $273.23 , $417.46 ," $1,524.33 "," $1,903.64 "," $3,580.50 "," $3,465.00 "," $3,465.00 "," $3,080.00 "," $3,080.00 ", $417.46 ," $3,554.71 "," $3,657.50 "," $3,465.00 "," $3,465.00 "," $3,465.00 "," $3,580.50 "," $3,696.00 "," $1,668.11 "," $3,272.50 "," $2,074.35 "," $2,972.40 ", N/A ," $1,554.07 "," $1,554.07 "," $3,657.50 "," $1,798.87 ", $273.23 ," $3,696.00 "
Office/OP Consltj New/Est Pt Mod Mdm 40 Minutes,CPT® 99244,N/A,N/A,N/A, $735.00 , $477.75 , N/A , $159.18 , $107.79 , $337.93 , $336.49 , $683.55 , $661.50 , $661.50 , $588.00 , $588.00 , $107.79 , $678.63 , $698.25 , $661.50 , $661.50 , $661.50 , $683.55 , $705.60 , $427.34 , $624.75 , $328.55 , $337.38 , $233.00 , $344.53 , $344.53 , $698.25 , $410.14 , $107.79 , $705.60 
 Fac Assay of Vitamin B-1 ,CPT® 84425,0301 - LAB/CHEMISTRY,N/A,N/A, $205.00 , $133.25 , $172.20 , $21.65 , $21.65 , $165.64 , $184.50 , $173.55 , $184.50 , $184.50 , $184.50 , $174.25 , $21.23 , $189.28 , $194.75 , $174.25 , $190.65 , $190.65 , $194.75 , $196.80 , $167.73 , $184.50 , $174.25 , $161.95 , N/A , $165.91 , $165.91 , $194.75 , $175.91 , $21.23 , $196.80 
 Fac Diagnostic Mammography Computer-Aided Detcj Bi ,CPT® 77066,0401 - MAMMOGRAPHY,N/A,N/A, $589.00 , $382.85 , $494.76 , $156.27 , $133.81 , $475.91 , $530.10 , $498.65 , $530.10 , $530.10 , $530.10 , $500.65 , $131.19 , $543.82 , $559.55 , $500.65 , $547.77 , $547.77 , $559.55 , $565.44 , $481.92 , $530.10 , $500.65 , $465.31 , N/A , $476.68 , $476.68 , $559.55 , $505.42 , $131.19 , $565.44 
 Immunoassay Quant Proib ,CPT® 83520,0301 - LAB/CHEMISTRY,N/A,N/A," $4,115.00 "," $2,674.75 "," $3,456.60 ", $17.62 , $17.62 ," $3,324.92 "," $3,703.50 "," $3,483.76 "," $3,703.50 "," $3,703.50 "," $3,703.50 "," $3,497.75 ", $17.27 ," $3,799.38 "," $3,909.25 "," $3,497.75 "," $3,826.95 "," $3,826.95 "," $3,909.25 "," $3,950.40 "," $3,366.89 "," $3,703.50 "," $3,497.75 "," $3,250.85 ", N/A ," $3,330.27 "," $3,330.27 "," $3,909.25 "," $3,531.08 ", $17.27 ," $3,950.40 "
Corrj Hallux Valgus W/Sesmdc W/Prox Metar Osteot,CPT® 28295,N/A,N/A,N/A," $6,863.00 "," $4,460.95 "," $3,778.58 ", $587.15 , $759.08 ," $2,544.63 "," $2,580.84 "," $6,382.59 "," $6,176.70 "," $6,176.70 "," $5,490.40 "," $5,490.40 ", $759.08 ," $6,336.61 "," $6,519.85 "," $6,176.70 "," $6,176.70 "," $6,176.70 "," $6,382.59 "," $6,588.48 "," $3,524.87 "," $5,833.55 "," $3,241.14 "," $3,151.82 ", N/A ," $2,594.28 "," $2,594.28 "," $6,519.85 "," $3,049.21 ", $587.15 ," $6,588.48 "
Assay Tyrosine,CPT® 84510,N/A,N/A,N/A, $95.00 , $61.75 , N/A , $10.84 , $10.84 , $58.87 , $70.41 , $88.35 , $85.50 , $85.50 , $76.00 , $76.00 , $10.84 , $87.71 , $90.25 , $85.50 , $85.50 , $85.50 , $88.35 , $91.20 , $70.98 , $80.75 , $68.12 , $37.71 , N/A , $54.94 , $54.94 , $90.25 , $60.04 , $10.84 , $91.20 
 Pro Inj Tendon Sheath/Ligament ,CPT® 20550,0982 - PRO FEE/OUTPT,N/A,N/A, $384.00 , $249.60 , $99.25 , $37.19 , $27.51 , $203.30 , $199.04 , $357.12 , $345.60 , $345.60 , $307.20 , $307.20 , $27.51 , $354.55 , $364.80 , $345.60 , $345.60 , $345.60 , $357.12 , $368.64 , $222.72 , $326.40 , $215.87 , $227.07 , N/A , $207.26 , $207.26 , $364.80 , $243.62 , $27.51 , $368.64 
 Fac Ephys Eval Pacg Cvdfb Lds W/Tstg of Pulse Gen ,CPT® 93641,0480 - CARDIOLOGY,N/A,N/A," $1,578.00 "," $1,025.70 "," $1,325.52 ", $580.07 , $594.19 ," $1,275.02 "," $1,420.20 "," $1,335.93 "," $1,420.20 "," $1,420.20 "," $1,420.20 "," $1,341.30 ", $582.54 ," $1,456.97 "," $1,499.10 "," $1,341.30 "," $1,467.54 "," $1,467.54 "," $1,499.10 "," $1,514.88 "," $1,291.12 "," $1,420.20 "," $1,341.30 "," $1,246.62 ", N/A ," $1,277.08 "," $1,277.08 "," $1,499.10 "," $1,354.08 ", $580.07 ," $1,514.88 "
 Fac Aspergillus Antibody ,CPT® 86606,0302 - LAB/IMMUNOLOGY,N/A,N/A, $111.00 , $72.15 , $93.24 , $15.35 , $8.07 , $89.69 , $99.90 , $93.97 , $99.90 , $99.90 , $99.90 , $94.35 , $7.91 , $102.49 , $105.45 , $94.35 , $103.23 , $103.23 , $105.45 , $106.56 , $90.82 , $99.90 , $94.35 , $87.69 , N/A , $89.83 , $89.83 , $105.45 , $95.25 , $7.91 , $106.56 
 Eeg Without Video 12-26 Hours; Intermittent ,CPT® 95709,0740 - EEG,N/A,N/A," $2,698.00 "," $1,753.70 "," $2,266.32 ", $474.81 , $396.25 ," $2,179.98 "," $2,428.20 "," $2,284.13 "," $2,428.20 "," $2,428.20 "," $2,428.20 "," $2,293.30 ", $388.48 ," $2,491.06 "," $2,563.10 "," $2,293.30 "," $2,509.14 "," $2,509.14 "," $2,563.10 "," $2,590.08 "," $2,207.50 "," $2,428.20 "," $2,293.30 "," $2,131.42 ", N/A ," $2,183.49 "," $2,183.49 "," $2,563.10 "," $2,315.15 ", $388.48 ," $2,590.08 "
 Fac Assay of Amylase ,CPT® 82150,0301 - LAB/CHEMISTRY,N/A,N/A, $92.00 , $59.80 , $77.28 , $6.61 , $6.61 , $74.34 , $82.80 , $77.89 , $82.80 , $82.80 , $82.80 , $78.20 , $6.48 , $84.94 , $87.40 , $78.20 , $85.56 , $85.56 , $87.40 , $88.32 , $75.27 , $82.80 , $78.20 , $72.68 , N/A , $74.46 , $74.46 , $87.40 , $78.95 , $6.48 , $88.32 
" Chemodenervation, Each Additional Limb; 5 or More Muscles(S) ",CPT® 64645,0360 - OR SERVICES,N/A,N/A, $196.00 , $127.40 , $164.64 , $74.73 , $60.71 , $158.37 , $176.40 , $165.93 , $176.40 , $176.40 , $176.40 , $166.60 , $59.52 , $180.97 , $186.20 , $166.60 , $182.28 , $182.28 , $186.20 , $188.16 , $160.37 , $176.40 , $166.60 , $154.84 , N/A , $158.62 , $158.62 , $186.20 , $168.19 , $59.52 , $188.16 
"Assay Troponin, Qual",CPT® 84512,N/A,N/A,N/A, $140.00 , $91.00 , N/A , $10.29 , $10.29 , $43.57 , $52.14 , $130.20 , $126.00 , $126.00 , $112.00 , $112.00 , $10.29 , $129.26 , $133.00 , $126.00 , $126.00 , $126.00 , $130.20 , $134.40 , $67.37 , $119.00 , $50.28 , $29.63 , N/A , $40.66 , $40.66 , $133.00 , $44.44 , $10.29 , $134.40 
 Bypass Graft; W/Other Than Vein; Axillary-Fem-Fem ,CPT® 35654,0360 - OR SERVICES,N/A,N/A," $5,532.00 "," $3,595.80 "," $4,646.88 "," $1,211.96 "," $1,993.09 "," $4,469.86 "," $4,978.80 "," $4,683.39 "," $4,978.80 "," $4,978.80 "," $4,978.80 "," $4,702.20 "," $1,954.01 "," $5,107.70 "," $5,255.40 "," $4,702.20 "," $5,144.76 "," $5,144.76 "," $5,255.40 "," $5,310.72 "," $4,526.28 "," $4,978.80 "," $4,702.20 "," $4,370.28 ", N/A ," $4,477.05 "," $4,477.05 "," $5,255.40 "," $4,747.01 "," $1,211.96 "," $5,310.72 "
 Pro Cltx Medial Malls Fx W/O Mnpj ,CPT® 27760,0981 - PRO FEE/ER,N/A,N/A," $1,536.00 ", $998.40 ," $1,916.98 ", $302.45 , $184.42 ," $1,467.45 "," $1,497.57 "," $1,428.48 "," $1,382.40 "," $1,382.40 "," $1,228.80 "," $1,228.80 ", $184.42 ," $1,418.19 "," $1,459.20 "," $1,382.40 "," $1,382.40 "," $1,382.40 "," $1,428.48 "," $1,474.56 "," $1,767.47 "," $1,305.60 "," $1,643.12 "," $1,745.36 ", N/A ," $1,496.08 "," $1,496.08 "," $1,459.20 "," $1,758.43 ", $184.42 ," $1,916.98 "
 Pro Opscpy Extnd Optic Nrv/Macula Drawing I&R Uni/Bi ,CPT® 92202,0962 - PRO FEE/EYE,N/A,N/A, $53.00 , $34.45 , $31.48 , $14.35 , $12.71 , $25.89 , N/A , $49.29 , $47.70 , $47.70 , $42.40 , $42.40 , $12.71 , $48.93 , $50.35 , $47.70 , $47.70 , $47.70 , $49.29 , $50.88 , $44.60 , $45.05 , $43.42 , $31.45 , N/A , $26.40 , $26.40 , $50.35 , $31.32 , $12.71 , $50.88 
 Pro Egd Balloon Dilation Esophagus <30 Mm Diam ,CPT® 43249,0982 - PRO FEE/OUTPT,N/A,N/A," $2,460.00 "," $1,599.00 ", $939.77 , $145.24 , $162.52 , $788.17 , $844.47 ," $2,287.80 "," $2,214.00 "," $2,214.00 "," $1,968.00 "," $1,968.00 ", $162.52 ," $2,271.32 "," $2,337.00 "," $2,214.00 "," $2,214.00 "," $2,214.00 "," $2,287.80 "," $2,361.60 ", $675.81 ," $2,091.00 ", $924.15 , $893.64 , N/A , $803.55 , $803.55 ," $2,337.00 ", $840.42 , $145.24 ," $2,361.60 "
 MORPHINE SULF MICROINFUSION PF 500 MG/20ML (25 MG/ML) IJ SOLN ,HCPCS J2274,0636 - DRUGS REQUIRING DETAILED CODIN,00641-6040-01,20 mL," $3,975.86 "," $2,584.31 "," $3,339.72 ", $16.01 , $17.04 ," $3,212.49 "," $3,578.27 "," $3,365.96 "," $3,578.27 "," $3,578.27 "," $3,578.27 "," $3,379.48 ", $16.71 ," $3,670.91 "," $3,777.07 "," $3,379.48 "," $3,697.55 "," $3,697.55 "," $3,777.07 "," $3,816.83 "," $3,253.05 "," $3,578.27 "," $3,379.48 "," $3,140.93 ", N/A ," $3,217.66 "," $3,217.66 "," $3,777.07 "," $3,411.69 ", $16.01 ," $3,816.83 "
 Fac Declot by Thrombolytic Agent Implant Device/Cath ,CPT® 36593,0761 - TREATMENT ROOM,N/A,N/A, $446.00 , $289.90 , $374.64 , $32.07 , $24.33 , $360.37 , $401.40 , $377.58 , $401.40 , $401.40 , $401.40 , $379.10 , $23.85 , $411.79 , $423.70 , $379.10 , $414.78 , $414.78 , $423.70 , $428.16 , $364.92 , $401.40 , $379.10 , $352.34 , N/A , $360.95 , $360.95 , $423.70 , $382.71 , $23.85 , $428.16 
 COCAINE HCL 40 MG/ML NA SOLN ,HCPCS RXC636,0636 - DRUGS REQUIRING DETAILED CODIN,64950-0362-04,4 mL," $1,510.24 ", $981.66 ," $1,268.60 ", N/A , N/A ," $1,220.27 "," $1,359.22 "," $1,278.57 "," $1,359.22 "," $1,359.22 "," $1,359.22 "," $1,283.70 ", N/A ," $1,394.40 "," $1,434.73 "," $1,283.70 "," $1,404.52 "," $1,404.52 "," $1,434.73 "," $1,449.83 "," $1,235.68 "," $1,359.22 "," $1,283.70 "," $1,193.09 ", N/A ," $1,222.24 "," $1,222.24 "," $1,434.73 "," $1,295.94 "," $1,193.09 "," $1,449.83 "
Injection Into Turbinate,CPT® 30200,N/A,N/A,N/A, $652.00 , $423.80 , $319.13 , $57.38 , $44.78 , $226.09 , $228.74 , $606.36 , $586.80 , $586.80 , $521.60 , $521.60 , $44.78 , $601.99 , $619.40 , $586.80 , $586.80 , $586.80 , $606.36 , $625.92 , $302.40 , $554.20 , $321.13 , $297.07 , N/A , $230.50 , $230.50 , $619.40 , $271.45 , $44.78 , $625.92 
 Pro Int Hrhc by Ligation 2+ Hroid W/O Img Gdn ,CPT® 46946,0982 - PRO FEE/OUTPT,N/A,N/A," $2,064.00 "," $1,341.60 "," $2,378.81 ", $367.27 , $268.05 ," $1,077.97 "," $1,110.04 "," $1,919.52 "," $1,857.60 "," $1,857.60 "," $1,651.20 "," $1,651.20 ", $268.05 ," $1,905.69 "," $1,960.80 "," $1,857.60 "," $1,857.60 "," $1,857.60 "," $1,919.52 "," $1,981.44 "," $1,699.57 "," $1,754.40 "," $1,214.95 "," $1,285.54 ", N/A ," $1,099.00 "," $1,099.00 "," $1,960.80 "," $1,149.43 ", $268.05 ," $2,378.81 "
Opscpy Extnd RTA Drawing & Scl Deprsn I&R Uni/Bi,CPT® 92201,N/A,N/A,N/A, $79.00 , $51.35 , $49.21 , $21.92 , $19.95 , $39.94 , N/A , $73.47 , $71.10 , $71.10 , $63.20 , $63.20 , $19.95 , $72.94 , $75.05 , $71.10 , $71.10 , $71.10 , $73.47 , $75.84 , $69.70 , $67.15 , $66.64 , $48.46 , N/A , $40.72 , $40.72 , $75.05 , $48.33 , $19.95 , $75.84 
"Clot Inhib Protein S,Free",CPT® 85306,N/A,N/A,N/A, $284.00 , $184.60 , N/A , $15.63 , $15.63 , $80.82 , $96.69 , $264.12 , $255.60 , $255.60 , $227.20 , $227.20 , $15.63 , $262.22 , $269.80 , $255.60 , $255.60 , $255.60 , $264.12 , $272.64 , $102.30 , $241.40 , $100.55 , $55.57 , N/A , $75.43 , $75.43 , $269.80 , $82.43 , $15.63 , $272.64 
"Remv Bladder/Nodes,Revis Tract",CPT® 51585,N/A,N/A,N/A," $14,699.00 "," $9,554.35 "," $11,377.93 "," $1,996.47 "," $2,305.21 "," $10,336.73 "," $9,585.33 "," $13,670.07 "," $13,229.10 "," $13,229.10 "," $11,759.20 "," $11,759.20 "," $2,305.21 "," $13,571.59 "," $13,964.05 "," $13,229.10 "," $13,229.10 "," $13,229.10 "," $13,670.07 "," $14,111.04 "," $11,432.61 "," $12,494.15 "," $10,854.25 "," $12,980.97 ", N/A ," $10,538.41 "," $10,538.41 "," $13,964.05 "," $12,386.38 "," $1,996.47 "," $14,111.04 "
"Adj Tiss Xfer Lid,Nos,Ear <10sqcm",14060,N/A,N/A,N/A," $4,113.00 "," $2,673.45 "," $2,129.25 ", $640.51 , $398.63 ," $1,843.34 "," $1,812.78 "," $3,825.09 "," $3,701.70 "," $3,701.70 "," $3,290.40 "," $3,290.40 ", $398.63 ," $3,797.53 "," $3,907.35 "," $3,701.70 "," $3,701.70 "," $3,701.70 "," $3,825.09 "," $3,948.48 "," $2,329.37 "," $3,496.05 "," $3,609.16 "," $2,361.62 ", N/A ," $1,879.30 "," $1,879.30 "," $3,907.35 "," $2,179.37 ", $398.63 ," $3,948.48 "
" Fac Culture Typing, Nucleic Acid Sequence, Each Isolate ",CPT® 87153,0306 - LAB/BACT-MICRO,N/A,N/A, $584.00 , $379.60 , $490.56 , $117.67 , $117.67 , $471.87 , $525.60 , $494.41 , $525.60 , $525.60 , $525.60 , $496.40 , $115.36 , $539.21 , $554.80 , $496.40 , $543.12 , $543.12 , $554.80 , $560.64 , $477.83 , $525.60 , $496.40 , $461.36 , N/A , $472.63 , $472.63 , $554.80 , $501.13 , $115.36 , $560.64 
"Full Thick Grft Nos,Ear,Lid <20sqcm",CPT® 15260,N/A,N/A,N/A," $4,599.00 "," $2,989.35 "," $2,711.23 ", $815.18 , $768.38 ," $2,353.16 "," $2,317.13 "," $4,277.07 "," $4,139.10 "," $4,139.10 "," $3,679.20 "," $3,679.20 ", $768.38 ," $4,246.26 "," $4,369.05 "," $4,139.10 "," $4,139.10 "," $4,139.10 "," $4,277.07 "," $4,415.04 "," $2,970.39 "," $3,909.15 "," $4,611.81 "," $3,019.60 ", N/A ," $2,399.07 "," $2,399.07 "," $4,369.05 "," $2,782.12 ", $768.38 ," $4,611.81 "
"Excis Tendn/Capsule Lesn,Foot",CPT® 28090,N/A,N/A,N/A," $3,132.00 "," $2,035.80 "," $1,904.44 ", $299.85 , $366.68 ," $1,519.87 "," $1,514.60 "," $2,912.76 "," $2,818.80 "," $2,818.80 "," $2,505.60 "," $2,505.60 ", $366.68 ," $2,891.78 "," $2,975.40 "," $2,818.80 "," $2,818.80 "," $2,818.80 "," $2,912.76 "," $3,006.72 "," $1,767.11 "," $2,662.20 "," $1,643.12 "," $1,801.79 ", N/A ," $1,549.53 "," $1,549.53 "," $2,975.40 "," $1,821.26 ", $299.85 ," $3,006.72 "
 Fac RBC Antibody Identification ,CPT® 86870,0300 - LABORATORY,N/A,N/A, $194.00 , $126.10 , $162.96 , N/A , $43.35 , $156.75 , $174.60 , $164.24 , $174.60 , $174.60 , $174.60 , $164.90 , $42.50 , $179.12 , $184.30 , $164.90 , $180.42 , $180.42 , $184.30 , $186.24 , $158.73 , $174.60 , $164.90 , $153.26 , N/A , $157.00 , $157.00 , $184.30 , $166.47 , $42.50 , $186.24 
Corrj Hallux Valgus W/Sesmdc W/1metar Medial Cnf,CPT® 28297,N/A,N/A,N/A," $6,280.00 "," $4,082.00 "," $3,724.37 ", $582.05 , $693.20 ," $2,853.72 "," $2,850.91 "," $5,840.40 "," $5,652.00 "," $5,652.00 "," $5,024.00 "," $5,024.00 ", $693.20 ," $5,798.32 "," $5,966.00 "," $5,652.00 "," $5,652.00 "," $5,652.00 "," $5,840.40 "," $6,028.80 "," $3,455.82 "," $5,338.00 "," $3,107.84 "," $3,500.08 ", N/A ," $2,909.40 "," $2,909.40 "," $5,966.00 "," $3,419.59 ", $582.05 ," $6,028.80 "
"Scr C/V Cyto,Thinlayer,Rescr",HCPCS G0145,N/A,N/A,N/A, $188.00 , $122.20 , N/A , $27.02 , $27.02 , $67.79 , N/A , $174.84 , $169.20 , $169.20 , $150.40 , $150.40 , $27.02 , $173.58 , $178.60 , $169.20 , $169.20 , $169.20 , $174.84 , $180.48 , $176.88 , $159.80 , $69.42 , $96.07 , N/A , $69.12 , $69.12 , $178.60 , $86.38 , $27.02 , $180.48 
"Release Exten Foot Tendon,Single",CPT® 28225,N/A,N/A,N/A," $2,662.00 "," $1,730.30 "," $1,636.18 ", $256.49 , $112.65 ," $1,273.18 "," $1,281.02 "," $2,475.66 "," $2,395.80 "," $2,395.80 "," $2,129.60 "," $2,129.60 ", $112.65 ," $2,457.82 "," $2,528.90 "," $2,395.80 "," $2,395.80 "," $2,395.80 "," $2,475.66 "," $2,555.52 "," $1,522.09 "," $2,262.70 "," $1,384.43 "," $1,533.49 ", N/A ," $1,298.02 "," $1,298.02 "," $2,528.90 "," $1,525.62 ", $112.65 ," $2,555.52 "
 PERTUZUMAB 420 MG/14ML IV SOLN ,HCPCS J9306,0636 - DRUGS REQUIRING DETAILED CODIN,50242-0145-01,14 mL," $18,631.82 "," $12,110.68 "," $15,650.73 ", $15.68 , $14.72 ," $15,054.51 "," $16,768.64 "," $15,773.70 "," $16,768.64 "," $16,768.64 "," $16,768.64 "," $15,837.05 ", $14.43 ," $17,202.76 "," $17,700.23 "," $15,837.05 "," $17,327.59 "," $17,327.59 "," $17,700.23 "," $17,886.55 "," $15,244.56 "," $16,768.64 "," $15,837.05 "," $14,719.14 ", N/A ," $15,078.73 "," $15,078.73 "," $17,700.23 "," $15,987.96 ", $14.43 ," $17,886.55 "
 Fac Smpl Rpr Supfc F/E/E/N/L/M 2.5cm/< ,CPT® 12011,0761 - TREATMENT ROOM,N/A,N/A, $428.00 , $278.20 , $359.52 , $51.31 , $66.00 , $345.82 , $385.20 , $362.34 , $385.20 , $385.20 , $385.20 , $363.80 , $64.71 , $395.17 , $406.60 , $363.80 , $398.04 , $398.04 , $406.60 , $410.88 , $350.19 , $385.20 , $363.80 , $338.12 , N/A , $346.38 , $346.38 , $406.60 , $367.27 , $51.31 , $410.88 
 Plasma Frozen W/in 24 Hr ,HCPCS P9059,0390 - BLOOD/STOR-PROC,N/A,N/A, $194.00 , $126.10 , $162.96 , N/A , N/A , $156.75 , $174.60 , $164.24 , $174.60 , $174.60 , $174.60 , $164.90 , N/A , $179.12 , $184.30 , $164.90 , $180.42 , $180.42 , $184.30 , $186.24 , $158.73 , $174.60 , $164.90 , $153.26 , N/A , $157.00 , $157.00 , $184.30 , $166.47 , $153.26 , $186.24 
 Pro Ntraoperative Sentinel Lymph Node ID W Dye Injection ,CPT® 38900,0982 - PRO FEE/OUTPT,N/A,N/A," $1,996.00 "," $1,297.40 ", $623.05 , $124.89 , $96.51 , $477.03 , $483.19 ," $1,856.28 "," $1,796.40 "," $1,796.40 "," $1,596.80 "," $1,596.80 ", $96.51 ," $1,842.91 "," $1,896.20 "," $1,796.40 "," $1,796.40 "," $1,796.40 "," $1,856.28 "," $1,916.16 ", $666.95 ," $1,696.60 ", $718.98 , $654.97 , N/A , $486.34 , $486.34 ," $1,896.20 ", $564.22 , $96.51 ," $1,916.16 "
" Pro Critical Care, First Hour ",CPT® 99291,0981 - PRO FEE/ER,N/A,N/A," $1,220.00 ", $793.00 , $433.06 , $205.74 , $270.56 , $385.76 , $385.10 ," $1,134.60 "," $1,098.00 "," $1,098.00 ", $976.00 , $976.00 , $270.56 ," $1,126.43 "," $1,159.00 "," $1,098.00 "," $1,098.00 "," $1,098.00 "," $1,134.60 "," $1,171.20 ", $551.34 ," $1,037.00 ", $480.07 , $484.31 , N/A , $393.30 , $393.30 ," $1,159.00 ", $453.59 , $205.74 ," $1,171.20 "
"Inj, Filgrastim G-CSF 1mcg",HCPCS J1442,N/A,N/A,N/A, $3.00 , $1.95 , N/A , $1.01 , $1.00 , N/A , N/A , $2.79 , $2.70 , $2.70 , $2.40 , $2.40 , $1.00 , $2.77 , $2.85 , $2.70 , $2.70 , $2.70 , $2.79 , $2.88 , $1.25 , $2.55 , $1.94 , $1.39 , N/A , N/A , N/A , $2.85 , N/A , $1.00 , $2.88 
" Fac Blood Typing, Rh (D) ",CPT® 86901,0300 - LABORATORY,N/A,N/A, $59.00 , $38.35 , $49.56 , $3.05 , $3.05 , $47.67 , $53.10 , $49.95 , $53.10 , $53.10 , $53.10 , $50.15 , $2.99 , $54.47 , $56.05 , $50.15 , $54.87 , $54.87 , $56.05 , $56.64 , $48.27 , $53.10 , $50.15 , $46.61 , N/A , $47.75 , $47.75 , $56.05 , $50.63 , $2.99 , $56.64 
 EPHEDRINE 50 MG/ML INJECTION (ANES&INPT) ,HCPCS RXA250,0250 - PHARMACY,51754-4200-04,1 mL, $94.93 , $61.70 , $79.74 , N/A , N/A , $76.70 , $85.44 , $80.37 , $85.44 , $85.44 , $85.44 , $80.69 , N/A , $87.65 , $90.18 , $80.69 , $88.28 , $88.28 , $90.18 , $91.13 , $77.67 , $85.44 , $80.69 , $74.99 , N/A , $76.83 , $76.83 , $90.18 , $81.46 , $74.99 , $91.13 
 Pro Treat Clavicle Fracture ,CPT® 23500,0981 - PRO FEE/ER,N/A,N/A, $820.00 , $533.00 ," $1,415.05 ", $225.64 , $69.88 ," $1,067.58 "," $1,092.79 ", $762.60 , $738.00 , $738.00 , $656.00 , $656.00 , $69.88 , $757.11 , $779.00 , $738.00 , $738.00 , $738.00 , $762.60 , $787.20 ," $1,301.54 ", $697.00 ," $1,197.11 "," $1,273.41 ", N/A ," $1,088.41 "," $1,088.41 ", $779.00 ," $1,279.27 ", $69.88 ," $1,415.05 "
"Explor Postop Bleed,Infec,Clot-Neck",CPT® 35800,N/A,N/A,N/A," $4,232.00 "," $2,750.80 "," $4,368.52 ", $683.60 , $468.75 ," $3,093.18 "," $3,091.73 "," $3,935.76 "," $3,808.80 "," $3,808.80 "," $3,385.60 "," $3,385.60 ", $468.75 ," $3,907.41 "," $4,020.40 "," $3,808.80 "," $3,808.80 "," $3,808.80 "," $3,935.76 "," $4,062.72 "," $3,991.91 "," $3,597.20 "," $3,876.77 "," $3,495.49 ", N/A ," $3,153.53 "," $3,153.53 "," $4,020.40 "," $3,582.42 ", $468.75 ," $4,368.52 "
 Fac Ehrlichia Antibody ,CPT® 86666,0302 - LAB/IMMUNOLOGY,N/A,N/A, $155.00 , $100.75 , $130.20 , $10.38 , $8.07 , $125.24 , $139.50 , $131.22 , $139.50 , $139.50 , $139.50 , $131.75 , $7.91 , $143.11 , $147.25 , $131.75 , $144.15 , $144.15 , $147.25 , $148.80 , $126.82 , $139.50 , $131.75 , $122.45 , N/A , $125.44 , $125.44 , $147.25 , $133.01 , $7.91 , $148.80 
 Fac Lig&Div Long Saph Vein Saphfem Junct/Interrupj ,CPT® 37700,0360 - OR SERVICES,N/A,N/A," $1,387.00 ", $901.55 ," $1,165.08 ", $224.34 , $267.62 ," $1,120.70 "," $1,248.30 "," $1,174.23 "," $1,248.30 "," $1,248.30 "," $1,248.30 "," $1,178.95 ", $262.37 ," $1,280.62 "," $1,317.65 "," $1,178.95 "," $1,289.91 "," $1,289.91 "," $1,317.65 "," $1,331.52 "," $1,134.84 "," $1,248.30 "," $1,178.95 "," $1,095.73 ", N/A ," $1,122.50 "," $1,122.50 "," $1,317.65 "," $1,190.18 ", $224.34 ," $1,331.52 "
 Fac Assay of Estriol ,CPT® 82677,0301 - LAB/CHEMISTRY,N/A,N/A, $210.00 , $136.50 , $176.40 , $24.66 , $24.66 , $169.68 , $189.00 , $177.79 , $189.00 , $189.00 , $189.00 , $178.50 , $24.18 , $193.89 , $199.50 , $178.50 , $195.30 , $195.30 , $199.50 , $201.60 , $171.82 , $189.00 , $178.50 , $165.90 , N/A , $169.95 , $169.95 , $199.50 , $180.20 , $24.18 , $201.60 
 TBO-FILGRASTIM 480 MCG/0.8ML SC SOSY ,HCPCS J1447,0636 - DRUGS REQUIRING DETAILED CODIN,63459-0912-11,0.8 mL," $1,175.81 ", $764.28 , $987.68 , $0.44 , $0.42 , $950.05 ," $1,058.23 ", $995.44 ," $1,058.23 "," $1,058.23 "," $1,058.23 ", $999.44 , $0.41 ," $1,085.63 "," $1,117.02 ", $999.44 ," $1,093.50 "," $1,093.50 "," $1,117.02 "," $1,128.78 ", $962.05 ," $1,058.23 ", $999.44 , $928.89 , N/A , $951.58 , $951.58 ," $1,117.02 "," $1,008.96 ", $0.41 ," $1,128.78 "
Sarscov2 Vacc 3mcg/0.3ml Tris-Sucrose Im Use,CPT® 91318,N/A,N/A,N/A, $173.00 , $112.45 , N/A , N/A , N/A , N/A , N/A , $160.89 , $155.70 , $155.70 , $138.40 , $138.40 , N/A , $159.73 , $164.35 , $155.70 , $155.70 , $155.70 , $160.89 , $166.08 , N/A , $147.05 , N/A , N/A , N/A , N/A , N/A , $164.35 , N/A , $138.40 , $166.08 
 GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN ,HCPCS A9577,0255 - DRUGS/RADIOLOGY,00270-5164-14,15 mL, $524.66 , $341.03 , $440.71 , $1.85 , $2.77 , $423.93 , $472.19 , $444.18 , $472.19 , $472.19 , $472.19 , $445.96 , $2.72 , $484.42 , $498.43 , $445.96 , $487.93 , $487.93 , $498.43 , $503.67 , $429.28 , $472.19 , $445.96 , $414.48 , N/A , $424.61 , $424.61 , $498.43 , $450.21 , $1.85 , $503.67 
 TETANUS IMMUNE GLOBULIN 250 UNIT/ML IM SOSY ,HCPCS J1670,0636 - DRUGS REQUIRING DETAILED CODIN,13533-0634-02,1 each," $3,885.07 "," $2,525.30 "," $3,263.46 ", $551.81 , $556.53 ," $3,139.14 "," $3,496.56 "," $3,289.10 "," $3,496.56 "," $3,496.56 "," $3,496.56 "," $3,302.31 ", $545.62 ," $3,587.09 "," $3,690.82 "," $3,302.31 "," $3,613.12 "," $3,613.12 "," $3,690.82 "," $3,729.67 "," $3,178.76 "," $3,496.56 "," $3,302.31 "," $3,069.21 ", N/A ," $3,144.19 "," $3,144.19 "," $3,690.82 "," $3,333.78 ", $545.62 ," $3,729.67 "
 Fac Complete Cbc W/Auto Diff Wbc ,CPT® 85025,0305 - LAB/HEMATOLOGY,N/A,N/A, $119.00 , $77.35 , $99.96 , $7.93 , $7.93 , $96.15 , $107.10 , $100.75 , $107.10 , $107.10 , $107.10 , $101.15 , $7.77 , $109.87 , $113.05 , $101.15 , $110.67 , $110.67 , $113.05 , $114.24 , $97.37 , $107.10 , $101.15 , $94.01 , N/A , $96.31 , $96.31 , $113.05 , $102.11 , $7.77 , $114.24 
 THEOPHYLLINE ER 100 MG PO CP24 ,HCPCS RXC637,0250 - PHARMACY,52244-0100-10,1 capsule, $19.75 , $12.84 , $16.59 , N/A , N/A , $15.96 , $17.78 , $16.72 , $17.78 , $17.78 , $17.78 , $16.79 , N/A , $18.24 , $18.76 , $16.79 , $18.37 , $18.37 , $18.76 , $18.96 , $16.16 , $17.78 , $16.79 , $15.60 , N/A , $15.98 , $15.98 , $18.76 , $16.95 , $15.60 , $18.96 
Sub Grft F/S/N/H/F/G/M/D /<100scm /<1st 25 Scm,CPT® 15275,N/A,N/A,N/A, $915.00 , $594.75 , $300.97 , $89.29 , $118.92 , $266.16 , $273.31 , $850.95 , $823.50 , $823.50 , $732.00 , $732.00 , $118.92 , $844.82 , $869.25 , $823.50 , $823.50 , $823.50 , $850.95 , $878.40 , $332.78 , $777.75 , $549.49 , $339.41 , N/A , $271.36 , $271.36 , $869.25 , $314.69 , $89.29 , $878.40 
Tissue Transglutaminase Ea Immunoglobulin Class,CPT® 86364,N/A,N/A,N/A, $136.00 , $88.40 , N/A , $11.76 , $11.76 , N/A , N/A , $126.48 , $122.40 , $122.40 , $108.80 , $108.80 , $11.76 , $125.57 , $129.20 , $122.40 , $122.40 , $122.40 , $126.48 , $130.56 , N/A , $115.60 , $54.92 , $33.86 , N/A , $45.20 , $45.20 , $129.20 , $49.69 , $11.76 , $130.56 
 Fac Dialysis Procedure ,CPT® 90999,0821 - HEMO/COMPOSITE,N/A,N/A, $651.00 , $423.15 , $546.84 , N/A , N/A , $526.01 , $585.90 , $551.14 , $585.90 , $585.90 , $585.90 , $553.35 , N/A , $601.07 , $618.45 , $553.35 , $605.43 , $605.43 , $618.45 , $624.96 , $532.65 , $585.90 , $553.35 , $514.29 , N/A , $526.85 , $526.85 , $618.45 , $558.62 , $514.29 , $624.96 
 Pro Initial Treatment of Burn(S) ,CPT® 16000,0981 - PRO FEE/ER,N/A,N/A, $277.00 , $180.05 , $143.24 , $43.12 , $29.25 , $126.05 , $122.05 , $257.61 , $249.30 , $249.30 , $221.60 , $221.60 , $29.25 , $255.75 , $263.15 , $249.30 , $249.30 , $249.30 , $257.61 , $265.92 , $157.17 , $235.45 , $242.63 , $162.35 , N/A , $128.51 , $128.51 , $263.15 , $149.03 , $29.25 , $265.92 
 Fac Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 6/> Vw ,CPT® 72084,0320 - DX X-RAY,N/A,N/A," $1,213.00 ", $788.45 ," $1,018.92 ", $97.69 , $63.30 , $980.10 ," $1,091.70 "," $1,026.93 "," $1,091.70 "," $1,091.70 "," $1,091.70 "," $1,031.05 ", $62.06 ," $1,119.96 "," $1,152.35 "," $1,031.05 "," $1,128.09 "," $1,128.09 "," $1,152.35 "," $1,164.48 ", $992.48 ," $1,091.70 "," $1,031.05 ", $958.27 , N/A , $981.68 , $981.68 ," $1,152.35 "," $1,040.88 ", $62.06 ," $1,164.48 "
Treat Interphalangeal Jnt,CPT® 26770,N/A,N/A,N/A," $1,789.00 "," $1,162.85 "," $1,609.47 ", $257.24 , $74.85 ," $1,227.08 "," $1,253.31 "," $1,663.77 "," $1,610.10 "," $1,610.10 "," $1,431.20 "," $1,431.20 ", $74.85 ," $1,651.78 "," $1,699.55 "," $1,610.10 "," $1,610.10 "," $1,610.10 "," $1,663.77 "," $1,717.44 "," $1,478.71 "," $1,520.65 "," $1,373.73 "," $1,463.84 ", N/A ," $1,251.03 "," $1,251.03 "," $1,699.55 "," $1,470.39 ", $74.85 ," $1,717.44 "
Hemoglobin Chromotography,CPT® 83021,N/A,N/A,N/A, $169.00 , $109.85 , N/A , $18.42 , $18.42 , $102.19 , $122.20 , $157.17 , $152.10 , $152.10 , $135.20 , $135.20 , $18.42 , $156.04 , $160.55 , $152.10 , $152.10 , $152.10 , $157.17 , $162.24 , $120.59 , $143.65 , $118.39 , $65.47 , N/A , $95.37 , $95.37 , $160.55 , $104.22 , $18.42 , $162.24 
" Pro Neg Press Wound Tx, > 50 Cm ",CPT® 97606,0982 - PRO FEE/OUTPT,N/A,N/A, $291.00 , $189.15 , $64.42 , $26.75 , $31.76 , $66.30 , $57.28 , $270.63 , $261.90 , $261.90 , $232.80 , $232.80 , $31.76 , $268.68 , $276.45 , $261.90 , $261.90 , $261.90 , $270.63 , $279.36 , $85.53 , $247.35 , $87.18 , $64.32 , N/A , $67.60 , $67.60 , $276.45 , $75.19 , $26.75 , $279.36 
 Fac Njx Air/Cntrst in Prtl Cavity Spx ,CPT® 49400,0761 - TREATMENT ROOM,N/A,N/A, $292.00 , $189.80 , $245.28 , $85.87 , $61.48 , $235.94 , $262.80 , $247.21 , $262.80 , $262.80 , $262.80 , $248.20 , $60.27 , $269.60 , $277.40 , $248.20 , $271.56 , $271.56 , $277.40 , $280.32 , $238.91 , $262.80 , $248.20 , $230.68 , N/A , $236.32 , $236.32 , $277.40 , $250.57 , $60.27 , $280.32 
 Gastrointestinal Hemorrhage With McC ,MS DRG V40 (FY2023) 377,N/A,N/A,N/A," $20,541.78 "," $13,352.16 "," $17,255.10 ", N/A , N/A ," $16,597.76 "," $18,487.60 "," $17,390.67 "," $18,487.60 "," $18,487.60 "," $18,487.60 "," $17,460.51 ", N/A ," $18,966.23 "," $19,514.69 "," $17,460.51 "," $19,103.86 "," $19,103.86 "," $19,514.69 "," $19,720.11 "," $16,807.28 "," $18,487.60 "," $17,460.51 "," $16,228.01 ", N/A ," $16,624.46 "," $16,624.46 "," $19,514.69 "," $17,626.90 "," $16,228.01 "," $19,720.11 "
Psychotherapy Complex Interactive,CPT® 90785,N/A,N/A,N/A, $54.00 , $35.10 , $17.32 , $13.16 , $12.68 , $34.85 , $10.70 , $50.22 , $48.60 , $48.60 , $43.20 , $43.20 , $12.68 , $49.86 , $51.30 , $48.60 , $48.60 , $48.60 , $50.22 , $51.84 , $33.12 , $45.90 , $14.19 , $53.11 , $8.50 , $35.53 , $35.53 , $51.30 , $41.42 , $8.50 , $53.11 
 Pro Repair Finger/Hand Tendon ,CPT® 26350,0982 - PRO FEE/OUTPT,N/A,N/A," $2,052.00 "," $1,333.80 "," $4,714.65 ", $732.16 , $601.86 ," $3,386.55 "," $3,457.42 "," $1,908.36 "," $1,846.80 "," $1,846.80 "," $1,641.60 "," $1,641.60 ", $601.86 ," $1,894.61 "," $1,949.40 "," $1,846.80 "," $1,846.80 "," $1,846.80 "," $1,908.36 "," $1,969.92 "," $4,337.17 "," $1,744.20 "," $3,784.00 "," $4,049.80 ", N/A ," $3,452.62 "," $3,452.62 "," $1,949.40 "," $4,058.05 ", $601.86 ," $4,714.65 "
 Fac Admn Sarscov2 Vacc 1 Dose ,CPT® 90480,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , N/A , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , N/A , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $55.30 , $67.20 
 Fac Sigmoidoscopy Flx Tndsc US Gid Ndl Aspir/Bx ,CPT® 45342,0360 - OR SERVICES,N/A,N/A," $2,393.00 "," $1,555.45 "," $2,010.12 ", $161.20 , $206.41 ," $1,933.54 "," $2,153.70 "," $2,025.91 "," $2,153.70 "," $2,153.70 "," $2,153.70 "," $2,034.05 ", $202.36 ," $2,209.46 "," $2,273.35 "," $2,034.05 "," $2,225.49 "," $2,225.49 "," $2,273.35 "," $2,297.28 "," $1,957.95 "," $2,153.70 "," $2,034.05 "," $1,890.47 ", N/A ," $1,936.65 "," $1,936.65 "," $2,273.35 "," $2,053.43 ", $161.20 ," $2,297.28 "
 Fac Aep Neurodiagnostic Interpretation and Report ,CPT® 92653,0471 - AUDIOLOGY/DX,N/A,N/A, $377.00 , $245.05 , $316.68 , $83.24 , $67.53 , $304.62 , $339.30 , $319.17 , $339.30 , $339.30 , $339.30 , $320.45 , $66.21 , $348.08 , $358.15 , $320.45 , $350.61 , $350.61 , $358.15 , $361.92 , $308.46 , $339.30 , $320.45 , $297.83 , N/A , $305.11 , $305.11 , $358.15 , $323.50 , $66.21 , $361.92 
 CHOLESTYRAMINE LIGHT 4 G PO PACK ,HCPCS RXC637,0250 - PHARMACY,68382-0529-60,1 packet, $17.22 , $11.19 , $14.46 , N/A , N/A , $13.91 , $15.50 , $14.58 , $15.50 , $15.50 , $15.50 , $14.64 , N/A , $15.90 , $16.36 , $14.64 , $16.01 , $16.01 , $16.36 , $16.53 , $14.09 , $15.50 , $14.64 , $13.60 , N/A , $13.94 , $13.94 , $16.36 , $14.78 , $13.60 , $16.53 
 PALIPERIDONE PALMITATE ER 117 MG/0.75ML IM SUSY ,HCPCS J2426,0636 - DRUGS REQUIRING DETAILED CODIN,50458-0562-01,0.75 mL," $4,922.21 "," $3,199.44 "," $4,134.66 ", $14.50 , $13.92 ," $3,977.15 "," $4,429.99 "," $4,167.14 "," $4,429.99 "," $4,429.99 "," $4,429.99 "," $4,183.88 ", $13.65 ," $4,544.68 "," $4,676.10 "," $4,183.88 "," $4,577.66 "," $4,577.66 "," $4,676.10 "," $4,725.32 "," $4,027.35 "," $4,429.99 "," $4,183.88 "," $3,888.55 ", N/A ," $3,983.54 "," $3,983.54 "," $4,676.10 "," $4,223.75 ", $13.65 ," $4,725.32 "
"Drain Ovarian Abscess,Abd Apprch",CPT® 58822,N/A,N/A,N/A," $4,343.00 "," $2,822.95 "," $3,380.00 ", $683.42 , $614.70 ," $2,845.90 "," $2,997.16 "," $4,038.99 "," $3,908.70 "," $3,908.70 "," $3,474.40 "," $3,474.40 ", $614.70 ," $4,009.89 "," $4,125.85 "," $3,908.70 "," $3,908.70 "," $3,908.70 "," $4,038.99 "," $4,169.28 "," $3,527.58 "," $3,691.55 "," $3,978.46 "," $2,850.60 ", N/A ," $2,901.42 "," $2,901.42 "," $4,125.85 "," $3,480.08 ", $614.70 ," $4,169.28 "
"Lap,Esophagogast Fundoplasty",CPT® 43280,N/A,N/A,N/A," $7,050.00 "," $4,582.50 "," $6,400.42 ", $989.92 , $935.01 ," $5,079.56 "," $5,125.75 "," $6,556.50 "," $6,345.00 "," $6,345.00 "," $5,640.00 "," $5,640.00 ", $935.01 ," $6,509.27 "," $6,697.50 "," $6,345.00 "," $6,345.00 "," $6,345.00 "," $6,556.50 "," $6,768.00 "," $4,590.49 "," $5,992.50 "," $5,707.22 "," $5,982.17 ", N/A ," $5,178.67 "," $5,178.67 "," $6,697.50 "," $5,416.34 ", $935.01 ," $6,768.00 "
 MIDAZOLAM-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN ,HCPCS J2251,0636 - DRUGS REQUIRING DETAILED CODIN,44567-0611-01,100 mL, $337.28 , $219.23 , $283.32 , $0.30 , $0.32 , $272.52 , $303.55 , $285.54 , $303.55 , $303.55 , $303.55 , $286.69 , $0.31 , $311.41 , $320.42 , $286.69 , $313.67 , $313.67 , $320.42 , $323.79 , $275.96 , $303.55 , $286.69 , $266.45 , N/A , $272.96 , $272.96 , $320.42 , $289.42 , $0.30 , $323.79 
 Fac Hla II High Resolution 1 Allele/Allele Group ,CPT® 81383,0310 - PATHOLOGY LAB,N/A,N/A, $419.00 , $272.35 , $351.96 , $111.31 , $111.31 , $338.55 , $377.10 , $354.73 , $377.10 , $377.10 , $377.10 , $356.15 , $109.13 , $386.86 , $398.05 , $356.15 , $389.67 , $389.67 , $398.05 , $402.24 , $342.83 , $377.10 , $356.15 , $331.01 , N/A , $339.10 , $339.10 , $398.05 , $359.54 , $109.13 , $402.24 
Triamcinolone a Inj Prs-Free,HCPCS J3300,N/A,N/A,N/A, $15.00 , $9.75 , N/A , $4.36 , $4.27 , N/A , N/A , $13.95 , $13.50 , $13.50 , $12.00 , $12.00 , $4.27 , $13.85 , $14.25 , $13.50 , $13.50 , $13.50 , $13.95 , $14.40 , $5.06 , $12.75 , $7.14 , $5.09 , N/A , N/A , N/A , $14.25 , N/A , $4.27 , $14.40 
 Pro CT Upper Extremity W/O Dye ,CPT® 73200,0972 - PRO FEE/RAD/DX,N/A,N/A, $563.00 , $365.95 ," $1,058.89 ", $150.37 , $242.16 , $853.40 ," $1,101.78 ", $523.59 , $506.70 , $506.70 , $450.40 , $450.40 , $242.16 , $519.82 , $534.85 , $506.70 , $506.70 , $506.70 , $523.59 , $540.48 , $983.27 , $478.55 ," $1,199.92 "," $1,164.25 ", N/A , $870.05 , $870.05 , $534.85 ," $1,007.10 ", $150.37 ," $1,199.92 "
 Other Disorders Of Nervous System Without Cc/McC ,MS DRG V40 (FY2023) 093,N/A,N/A,N/A," $30,015.44 "," $19,510.04 "," $25,212.97 ", N/A , N/A ," $24,252.48 "," $27,013.90 "," $25,411.07 "," $27,013.90 "," $27,013.90 "," $27,013.90 "," $25,513.12 ", N/A ," $27,713.26 "," $28,514.67 "," $25,513.12 "," $27,914.36 "," $27,914.36 "," $28,514.67 "," $28,814.82 "," $24,558.63 "," $27,013.90 "," $25,513.12 "," $23,712.20 ", N/A ," $24,291.50 "," $24,291.50 "," $28,514.67 "," $25,756.25 "," $23,712.20 "," $28,814.82 "
"Full Thick Grft Nos,Ear,Lid Add 20sq",CPT® 15261,N/A,N/A,N/A," $1,280.00 ", $832.00 , $433.91 , $129.04 , $368.40 , $383.44 , $374.08 ," $1,190.40 "," $1,152.00 "," $1,152.00 "," $1,024.00 "," $1,024.00 ", $368.40 ," $1,181.82 "," $1,216.00 "," $1,152.00 "," $1,152.00 "," $1,152.00 "," $1,190.40 "," $1,228.80 ", $479.39 ," $1,088.00 ", $749.31 , $487.54 , N/A , $390.93 , $390.93 ," $1,216.00 ", $453.35 , $129.04 ," $1,228.80 "
 Ilr Lmpl Loop Recorder-Reprogrammi ,CPT® 93285,0480 - CARDIOLOGY,N/A,N/A, $312.00 , $202.80 , $262.08 , $60.01 , $35.04 , $252.10 , $280.80 , $264.14 , $280.80 , $280.80 , $280.80 , $265.20 , $34.35 , $288.07 , $296.40 , $265.20 , $290.16 , $290.16 , $296.40 , $299.52 , $255.28 , $280.80 , $265.20 , $246.48 , N/A , $252.50 , $252.50 , $296.40 , $267.73 , $34.35 , $299.52 
Rpr Aa Hernia 1st > 10 Cm Reducible,CPT® 49595,N/A,N/A,N/A," $6,527.00 "," $4,242.55 ", N/A , $705.15 , $550.36 , N/A , N/A ," $6,070.11 "," $5,874.30 "," $5,874.30 "," $5,221.60 "," $5,221.60 ", $550.36 ," $6,026.38 "," $6,200.65 "," $5,874.30 "," $5,874.30 "," $5,874.30 "," $6,070.11 "," $6,265.92 ", N/A ," $5,547.95 "," $4,081.64 ", N/A , N/A ," $3,035.72 "," $3,035.72 "," $6,200.65 "," $3,178.14 ", $550.36 ," $6,265.92 "
"Closed Rx Med Malleolus Fx,Manip",27762,N/A,N/A,N/A," $3,317.00 "," $2,156.05 "," $2,693.02 ", $424.52 , $423.69 ," $2,081.98 "," $2,113.34 "," $3,084.81 "," $2,985.30 "," $2,985.30 "," $2,653.60 "," $2,653.60 ", $423.69 ," $3,062.59 "," $3,151.15 "," $2,985.30 "," $2,985.30 "," $2,985.30 "," $3,084.81 "," $3,184.32 "," $2,468.04 "," $2,819.45 "," $2,322.85 "," $2,446.54 ", N/A ," $2,122.61 "," $2,122.61 "," $3,151.15 "," $2,494.81 ", $423.69 ," $3,184.32 "
Removal of Sperm Duct(S),CPT® 55250,N/A,N/A,N/A," $1,946.00 "," $1,264.90 "," $1,016.33 ", $220.32 , $303.02 , $727.92 , $743.50 ," $1,809.78 "," $1,751.40 "," $1,751.40 "," $1,556.80 "," $1,556.80 ", $303.02 ," $1,796.74 "," $1,848.70 "," $1,751.40 "," $1,751.40 "," $1,751.40 "," $1,809.78 "," $1,868.16 ", $951.50 ," $1,654.10 "," $1,182.83 "," $1,104.13 ", N/A , $742.12 , $742.12 ," $1,848.70 ", $889.48 , $220.32 ," $1,868.16 "
Rev Upper Eyelid W Excess Skin,CPT® 15823,N/A,N/A,N/A," $2,329.00 "," $1,513.85 "," $1,787.55 ", $536.22 , $565.77 ," $1,492.01 "," $1,503.78 "," $2,165.97 "," $2,096.10 "," $2,096.10 "," $1,863.20 "," $1,863.20 ", $565.77 ," $2,150.37 "," $2,212.55 "," $2,096.10 "," $2,096.10 "," $2,096.10 "," $2,165.97 "," $2,235.84 "," $1,957.69 "," $1,979.65 "," $3,007.93 "," $1,934.59 ", N/A ," $1,521.12 "," $1,521.12 "," $2,212.55 "," $1,763.99 ", $536.22 ," $3,007.93 "
Esophagoscopy Flexible Removal Foreign Body,43215,N/A,N/A,N/A," $2,231.00 "," $1,450.15 ", $857.42 , $132.36 , $142.67 , $710.20 , $749.12 ," $2,074.83 "," $2,007.90 "," $2,007.90 "," $1,784.80 "," $1,784.80 ", $142.67 ," $2,059.88 "," $2,119.45 "," $2,007.90 "," $2,007.90 "," $2,007.90 "," $2,074.83 "," $2,141.76 ", $615.50 ," $1,896.35 ", $822.45 , $813.17 , N/A , $724.06 , $724.06 ," $2,119.45 ", $757.29 , $132.36 ," $2,141.76 "
Prednisolone Oral per 5 Mg,HCPCS J7510,N/A,N/A,N/A, $1.00 , $0.65 , N/A , $0.26 , $0.27 , N/A , N/A , $0.93 , $0.90 , $0.90 , $0.80 , $0.80 , $0.27 , $0.92 , $0.95 , $0.90 , $0.90 , $0.90 , $0.93 , $0.96 , $0.16 , $0.85 , $0.65 , $0.30 , N/A , N/A , N/A , $0.95 , N/A , $0.16 , $0.96 
" Fac US Exam Infant Hips, Dynamic ",CPT® 76885,0402 - ULTRASOUND,N/A,N/A, $784.00 , $509.60 , $658.56 , $118.83 , $86.75 , $633.47 , $705.60 , $663.73 , $705.60 , $705.60 , $705.60 , $666.40 , $85.05 , $723.87 , $744.80 , $666.40 , $729.12 , $729.12 , $744.80 , $752.64 , $641.47 , $705.60 , $666.40 , $619.36 , N/A , $634.49 , $634.49 , $744.80 , $672.75 , $85.05 , $752.64 
 CEFDINIR 300 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,65862-0177-60,1 capsule, $26.24 , $17.06 , $22.04 , N/A , N/A , $21.20 , $23.62 , $22.21 , $23.62 , $23.62 , $23.62 , $22.30 , N/A , $24.23 , $24.93 , $22.30 , $24.40 , $24.40 , $24.93 , $25.19 , $21.47 , $23.62 , $22.30 , $20.73 , N/A , $21.24 , $21.24 , $24.93 , $22.52 , $20.73 , $25.19 
 Protein Electrop Fxj&Quan Oth Flus Concentration Pro ,CPT® 84166,0971 - PRO FEE/LAB,N/A,N/A, $126.00 , $81.90 , N/A , $18.19 , $18.19 , $100.90 , $120.71 , $117.18 , $113.40 , $113.40 , $100.80 , $100.80 , $18.19 , $116.34 , $119.70 , $113.40 , $113.40 , $113.40 , $117.18 , $120.96 , $119.05 , $107.10 , $212.46 , $64.64 , N/A , $94.17 , $94.17 , $119.70 , $102.90 , $18.19 , $212.46 
 DILTIAZEM HCL ER COATED BEADS 300 MG PO CP24 ,HCPCS RXC637,0250 - PHARMACY,60687-0228-01,1 capsule, $13.77 , $8.95 , $11.57 , N/A , N/A , $11.13 , $12.39 , $11.66 , $12.39 , $12.39 , $12.39 , $11.70 , N/A , $12.71 , $13.08 , $11.70 , $12.81 , $12.81 , $13.08 , $13.22 , $11.27 , $12.39 , $11.70 , $10.88 , N/A , $11.14 , $11.14 , $13.08 , $11.82 , $10.88 , $13.22 
"Repair Anal Fistula,Rect Adv Flap",CPT® 46288,N/A,N/A,N/A," $3,466.00 "," $2,252.90 "," $3,434.67 ", $534.71 , $463.15 ," $2,619.65 "," $2,662.55 "," $3,223.38 "," $3,119.40 "," $3,119.40 "," $2,772.80 "," $2,772.80 ", $463.15 ," $3,200.16 "," $3,292.70 "," $3,119.40 "," $3,119.40 "," $3,119.40 "," $3,223.38 "," $3,327.36 "," $2,445.32 "," $2,946.10 "," $2,924.08 "," $3,111.93 ", N/A ," $2,670.76 "," $2,670.76 "," $3,292.70 "," $2,793.33 ", $463.15 ," $3,434.67 "
"Artif Insemination,Intra-Uterine",CPT® 58322,N/A,N/A,N/A, $532.00 , $345.80 , $268.50 , $54.20 , N/A , $237.67 , $237.36 , $494.76 , $478.80 , $478.80 , $425.60 , $425.60 , N/A , $491.20 , $505.40 , $478.80 , $478.80 , $478.80 , $494.76 , $510.72 , $315.19 , $452.20 , $312.21 , $239.79 , N/A , $242.31 , $242.31 , $505.40 , $290.65 , $54.20 , $510.72 
 Fac Ercp With Optical Endomicroscopy Add On ,CPT® 0397T,0750 - GASTR-INST SVS,N/A,N/A," $4,171.00 "," $2,711.15 "," $3,503.64 ", N/A , N/A ," $3,370.17 "," $3,753.90 "," $3,531.17 "," $3,753.90 "," $3,753.90 "," $3,753.90 "," $3,545.35 ", N/A ," $3,851.08 "," $3,962.45 "," $3,545.35 "," $3,879.03 "," $3,879.03 "," $3,962.45 "," $4,004.16 "," $3,412.71 "," $3,753.90 "," $3,545.35 "," $3,295.09 ", N/A ," $3,375.59 "," $3,375.59 "," $3,962.45 "," $3,579.14 "," $3,295.09 "," $4,004.16 "
 MESALAMINE ER 250 MG PO CPCR ,HCPCS RXC637,0250 - PHARMACY,54092-0189-81,1 capsule, $18.72 , $12.17 , $15.72 , N/A , N/A , $15.13 , $16.85 , $15.85 , $16.85 , $16.85 , $16.85 , $15.91 , N/A , $17.28 , $17.78 , $15.91 , $17.41 , $17.41 , $17.78 , $17.97 , $15.32 , $16.85 , $15.91 , $14.79 , N/A , $15.15 , $15.15 , $17.78 , $16.06 , $14.79 , $17.97 
Place Needle in Vein,CPT® 36000,N/A,N/A,N/A, $359.00 , $233.35 , N/A , $29.75 , $34.55 , $40.05 , $40.19 , $333.87 , $323.10 , $323.10 , $287.20 , $287.20 , $34.55 , $331.46 , $341.05 , $323.10 , $323.10 , $323.10 , $333.87 , $344.64 , $51.91 , $305.15 , N/A , $46.82 , N/A , $40.83 , $40.83 , $341.05 , $46.38 , $29.75 , $344.64 
 DENOSUMAB 60 MG/ML SC SOSY ,HCPCS J0897,0636 - DRUGS REQUIRING DETAILED CODIN,55513-0710-01,1 mL," $2,680.50 "," $1,742.33 "," $2,251.62 ", $24.67 , $23.53 ," $2,165.84 "," $2,412.45 "," $2,269.31 "," $2,412.45 "," $2,412.45 "," $2,412.45 "," $2,278.43 ", $23.07 ," $2,474.91 "," $2,546.48 "," $2,278.43 "," $2,492.87 "," $2,492.87 "," $2,546.48 "," $2,573.28 "," $2,193.19 "," $2,412.45 "," $2,278.43 "," $2,117.60 ", N/A ," $2,169.33 "," $2,169.33 "," $2,546.48 "," $2,300.14 ", $23.07 ," $2,573.28 "
 Fac Motor &/Sens 3-4 Nrv Cndj Preconf Eltrode Limb ,CPT® 95908,0922 - EMG,N/A,N/A," $1,006.00 ", $653.90 , $845.04 , $110.08 , $91.60 , $812.85 , $905.40 , $851.68 , $905.40 , $905.40 , $905.40 , $855.10 , $89.80 , $928.84 , $955.70 , $855.10 , $935.58 , $935.58 , $955.70 , $965.76 , $823.11 , $905.40 , $855.10 , $794.74 , N/A , $814.16 , $814.16 , $955.70 , $863.25 , $89.80 , $965.76 
 Fac MRI Breast W/Out&With Contrast W/Cad Unilateral ,CPT® 77048,0610 - MRI,N/A,N/A," $7,591.00 "," $4,934.15 "," $6,376.44 ", $346.43 , $313.95 ," $6,133.53 "," $6,831.90 "," $6,426.54 "," $6,831.90 "," $6,831.90 "," $6,831.90 "," $6,452.35 ", $307.79 ," $7,008.77 "," $7,211.45 "," $6,452.35 "," $7,059.63 "," $7,059.63 "," $7,211.45 "," $7,287.36 "," $6,210.96 "," $6,831.90 "," $6,452.35 "," $5,996.89 ", N/A ," $6,143.40 "," $6,143.40 "," $7,211.45 "," $6,513.84 ", $307.79 ," $7,287.36 "
" Ultrasound, Transrectal Procedure ",CPT® 76872,0402 - ULTRASOUND,N/A,N/A, $999.00 , $649.35 , $839.16 , $135.16 , $99.44 , $807.19 , $899.10 , $845.75 , $899.10 , $899.10 , $899.10 , $849.15 , $97.49 , $922.38 , $949.05 , $849.15 , $929.07 , $929.07 , $949.05 , $959.04 , $817.38 , $899.10 , $849.15 , $789.21 , N/A , $808.49 , $808.49 , $949.05 , $857.24 , $97.49 , $959.04 
 Pro Expl Pentrg Wnd Spx Xtr ,CPT® 20103,0981 - PRO FEE/ER,N/A,N/A," $2,547.00 "," $1,655.55 "," $2,087.15 ", $325.90 , $335.70 ," $1,680.45 "," $1,671.86 "," $2,368.71 "," $2,292.30 "," $2,292.30 "," $2,037.60 "," $2,037.60 ", $335.70 ," $2,351.65 "," $2,419.65 "," $2,292.30 "," $2,292.30 "," $2,292.30 "," $2,368.71 "," $2,445.12 "," $1,945.11 "," $2,164.95 "," $1,846.51 "," $1,988.52 ", N/A ," $1,713.23 "," $1,713.23 "," $2,419.65 "," $2,013.66 ", $325.90 ," $2,445.12 "
Arthrocentisis-Sm Joint,20600,N/A,N/A,N/A, $291.00 , $189.15 , $218.01 , $33.86 , $39.50 , $174.29 , $169.45 , $270.63 , $261.90 , $261.90 , $232.80 , $232.80 , $39.50 , $268.68 , $276.45 , $261.90 , $261.90 , $261.90 , $270.63 , $279.36 , $203.80 , $247.35 , $183.76 , $206.34 , N/A , $177.69 , $177.69 , $276.45 , $208.86 , $33.86 , $279.36 
"Insrt Pacing Elect,W/Attach Prev Device",CPT® 33224,N/A,N/A,N/A," $5,334.00 "," $3,467.10 "," $3,031.60 ", $467.60 , $463.35 ," $2,194.01 "," $2,109.38 "," $4,960.62 "," $4,800.60 "," $4,800.60 "," $4,267.20 "," $4,267.20 ", $463.35 ," $4,924.88 "," $5,067.30 "," $4,800.60 "," $4,800.60 "," $4,800.60 "," $4,960.62 "," $5,120.64 "," $2,811.28 "," $4,533.90 "," $2,658.26 "," $2,486.66 ", N/A ," $2,236.82 "," $2,236.82 "," $5,067.30 "," $2,541.02 ", $463.35 ," $5,120.64 "
Appl Mlt-Layer Venous Wound Compress Below Knee,CPT® 29581,N/A,N/A,N/A, $552.00 , $358.80 , $174.46 , $26.75 , $73.50 , $64.70 , $62.04 , $513.36 , $496.80 , $496.80 , $441.60 , $441.60 , $73.50 , $509.66 , $524.40 , $496.80 , $496.80 , $496.80 , $513.36 , $529.92 , $163.06 , $469.20 , $66.01 , $167.13 , N/A , $65.96 , $65.96 , $524.40 , $77.53 , $26.75 , $529.92 
Osteotomy Heel Bone,28300,N/A,N/A,N/A," $5,177.00 "," $3,365.05 "," $3,976.44 ", $623.61 , $614.70 ," $3,179.79 "," $3,182.01 "," $4,814.61 "," $4,659.30 "," $4,659.30 "," $4,141.60 "," $4,141.60 ", $614.70 ," $4,779.92 "," $4,918.15 "," $4,659.30 "," $4,659.30 "," $4,659.30 "," $4,814.61 "," $4,969.92 "," $3,700.65 "," $4,400.45 "," $3,496.77 "," $3,740.86 ", N/A ," $3,241.84 "," $3,241.84 "," $4,918.15 "," $3,810.30 ", $614.70 ," $4,969.92 "
Pro Treat Shoulder Dislocation,23660,N/A,N/A,N/A," $4,739.00 "," $3,080.35 "," $3,572.40 ", $563.22 , $845.22 ," $2,793.68 "," $2,809.44 "," $4,407.27 "," $4,265.10 "," $4,265.10 "," $3,791.20 "," $3,791.20 ", $845.22 ," $4,375.52 "," $4,502.05 "," $4,265.10 "," $4,265.10 "," $4,265.10 "," $4,407.27 "," $4,549.44 "," $3,324.27 "," $4,028.15 "," $3,100.70 "," $3,316.09 ", N/A ," $2,848.19 "," $2,848.19 "," $4,502.05 "," $3,347.64 ", $563.22 ," $4,549.44 "
"Nk Cells, Total Count",CPT® 86357,N/A,N/A,N/A, $348.00 , $226.20 , N/A , $38.48 , $38.48 , $213.44 , $255.29 , $323.64 , $313.20 , $313.20 , $278.40 , $278.40 , $38.48 , $321.31 , $330.60 , $313.20 , $313.20 , $313.20 , $323.64 , $334.08 , $251.93 , $295.80 , $246.52 , $136.81 , N/A , $199.20 , $199.20 , $330.60 , $217.68 , $38.48 , $334.08 
Antinuclear Antibodies Titer,CPT® 86039,N/A,N/A,N/A, $120.00 , $78.00 , N/A , $11.38 , $11.38 , $63.15 , $75.57 , $111.60 , $108.00 , $108.00 , $96.00 , $96.00 , $11.38 , $110.80 , $114.00 , $108.00 , $108.00 , $108.00 , $111.60 , $115.20 , $74.52 , $102.00 , $72.98 , $40.47 , N/A , $58.94 , $58.94 , $114.00 , $64.41 , $11.38 , $115.20 
Shav Skin Les 6-10mm Remaindr Body,CPT® 11306,N/A,N/A,N/A, $473.00 , $307.45 , $159.32 , $47.40 , $58.11 , $142.14 , $136.31 , $439.89 , $425.70 , $425.70 , $378.40 , $378.40 , $58.11 , $436.72 , $449.35 , $425.70 , $425.70 , $425.70 , $439.89 , $454.08 , $175.73 , $402.05 , $269.39 , $183.99 , N/A , $144.91 , $144.91 , $449.35 , $168.04 , $47.40 , $454.08 
 GENTAMICIN SULFATE 0.3 % OP SOLN ,HCPCS RXC637,0250 - PHARMACY,61314-0633-05,5 mL, $111.48 , $72.46 , $93.64 , N/A , N/A , $90.08 , $100.33 , $94.38 , $100.33 , $100.33 , $100.33 , $94.76 , N/A , $102.93 , $105.91 , $94.76 , $103.68 , $103.68 , $105.91 , $107.02 , $91.21 , $100.33 , $94.76 , $88.07 , N/A , $90.22 , $90.22 , $105.91 , $95.66 , $88.07 , $107.02 
" Fac Assay, Nephelometry Not Spec ",CPT® 83883,0301 - LAB/CHEMISTRY,N/A,N/A, $171.00 , $111.15 , $143.64 , $13.87 , $13.87 , $138.17 , $153.90 , $144.77 , $153.90 , $153.90 , $153.90 , $145.35 , $13.60 , $157.88 , $162.45 , $145.35 , $159.03 , $159.03 , $162.45 , $164.16 , $139.91 , $153.90 , $145.35 , $135.09 , N/A , $138.39 , $138.39 , $162.45 , $146.74 , $13.60 , $164.16 
Replace/Irrigate Ventric Cath,CPT® 62225,N/A,N/A,N/A," $3,384.00 "," $2,199.60 "," $2,494.13 ", $490.88 , $732.62 ," $2,847.95 "," $2,776.44 "," $3,147.12 "," $3,045.60 "," $3,045.60 "," $2,707.20 "," $2,707.20 ", $732.62 ," $3,124.45 "," $3,214.80 "," $3,045.60 "," $3,045.60 "," $3,045.60 "," $3,147.12 "," $3,248.64 "," $2,680.91 "," $2,876.40 "," $2,824.17 "," $2,949.55 ", N/A ," $2,903.52 "," $2,903.52 "," $3,214.80 "," $3,114.80 ", $490.88 ," $3,248.64 "
"Rep Tendon,Hand,Single,PR",26410,N/A,N/A,N/A," $3,183.00 "," $2,068.95 "," $3,809.13 ", $591.56 , $390.36 ," $2,681.89 "," $2,743.57 "," $2,960.19 "," $2,864.70 "," $2,864.70 "," $2,546.40 "," $2,546.40 ", $390.36 ," $2,938.86 "," $3,023.85 "," $2,864.70 "," $2,864.70 "," $2,864.70 "," $2,960.19 "," $3,055.68 "," $3,496.67 "," $2,705.55 "," $3,000.80 "," $3,216.59 ", N/A ," $2,734.22 "," $2,734.22 "," $3,023.85 "," $3,213.66 ", $390.36 ," $3,809.13 "
 CT Soft T Neck W/O&W/Contrast ,CPT® 70492,0350 - CT SCAN,N/A,N/A," $3,533.00 "," $2,296.45 "," $2,967.72 ", $227.17 , $355.58 ," $2,854.66 "," $3,179.70 "," $2,991.04 "," $3,179.70 "," $3,179.70 "," $3,179.70 "," $3,003.05 ", $348.61 ," $3,262.02 "," $3,356.35 "," $3,003.05 "," $3,285.69 "," $3,285.69 "," $3,356.35 "," $3,391.68 "," $2,890.70 "," $3,179.70 "," $3,003.05 "," $2,791.07 ", N/A ," $2,859.26 "," $2,859.26 "," $3,356.35 "," $3,031.67 ", $227.17 ," $3,391.68 "
Tracheotomy Tube Change,31502,N/A,N/A,N/A, $301.00 , $195.65 , $189.00 , $33.08 , $49.19 , $134.38 , $131.26 , $279.93 , $270.90 , $270.90 , $240.80 , $240.80 , $49.19 , $277.91 , $285.95 , $270.90 , $270.90 , $270.90 , $279.93 , $288.96 , $181.55 , $255.85 , $183.76 , $178.84 , N/A , $137.00 , $137.00 , $285.95 , $161.36 , $33.08 , $288.96 
"Lap,Surg,Colectomy, Partial, W/Anast",CPT® 44204,N/A,N/A,N/A," $10,078.00 "," $6,550.70 "," $9,169.62 "," $1,420.34 "," $1,058.86 "," $7,265.85 "," $7,328.10 "," $9,372.54 "," $9,070.20 "," $9,070.20 "," $8,062.40 "," $8,062.40 "," $1,058.86 "," $9,305.02 "," $9,574.10 "," $9,070.20 "," $9,070.20 "," $9,070.20 "," $9,372.54 "," $9,674.88 "," $6,572.77 "," $8,566.30 "," $8,135.33 "," $8,583.63 ", N/A ," $7,407.62 "," $7,407.62 "," $9,574.10 "," $7,747.58 "," $1,058.86 "," $9,674.88 "
 CLOBAZAM 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60687-0423-21,1 tablet, $16.03 , $10.42 , $13.47 , N/A , N/A , $12.95 , $14.43 , $13.57 , $14.43 , $14.43 , $14.43 , $13.63 , N/A , $14.80 , $15.23 , $13.63 , $14.91 , $14.91 , $15.23 , $15.39 , $13.12 , $14.43 , $13.63 , $12.66 , N/A , $12.97 , $12.97 , $15.23 , $13.76 , $12.66 , $15.39 
Open Rx Prox Humerus Fx,CPT® 23615,N/A,N/A,N/A," $4,807.00 "," $3,124.55 "," $5,362.96 ", $840.53 , $768.38 ," $4,266.68 "," $4,250.31 "," $4,470.51 "," $4,326.30 "," $4,326.30 "," $3,845.60 "," $3,845.60 ", $768.38 ," $4,438.30 "," $4,566.65 "," $4,326.30 "," $4,326.30 "," $4,326.30 "," $4,470.51 "," $4,614.72 "," $4,992.25 "," $4,085.95 "," $4,695.66 "," $5,029.04 ", N/A ," $4,349.94 "," $4,349.94 "," $4,566.65 "," $5,112.71 ", $768.38 ," $5,362.96 "
Blood Clot Factor XIII Test,CPT® 85291,N/A,N/A,N/A, $54.00 , $35.10 , N/A , $9.29 , $9.29 , $50.35 , $60.16 , $50.22 , $48.60 , $48.60 , $43.20 , $43.20 , $9.29 , $49.86 , $51.30 , $48.60 , $48.60 , $48.60 , $50.22 , $51.84 , $60.83 , $45.90 , $58.39 , $32.25 , N/A , $46.99 , $46.99 , $51.30 , $51.35 , $9.29 , $60.83 
Xcapsl Ctrc Rmvl Insj Io Lens Prosth W/O Ecp,66984,N/A,N/A,N/A," $5,873.00 "," $3,817.45 "," $3,349.71 ", $525.67 , $430.89 ," $5,195.80 "," $5,432.88 "," $5,461.89 "," $5,285.70 "," $5,285.70 "," $4,698.40 "," $4,698.40 ", $430.89 ," $5,422.54 "," $5,579.35 "," $5,285.70 "," $5,285.70 "," $5,285.70 "," $5,461.89 "," $5,638.08 "," $6,836.31 "," $4,992.05 "," $3,502.12 "," $4,600.11 ", N/A ," $5,297.18 "," $5,297.18 "," $5,579.35 "," $6,231.98 ", $430.89 ," $6,836.31 "
 Pro Optx Fem Fx Prox End Nck Int Fixj/Prostc Rplcmt ,CPT® 27236,0975 - PRO FEE/OR,N/A,N/A," $6,378.00 "," $4,145.70 "," $7,201.29 "," $1,125.98 "," $1,044.67 "," $5,779.29 "," $5,726.62 "," $5,931.54 "," $5,740.20 "," $5,740.20 "," $5,102.40 "," $5,102.40 "," $1,044.67 "," $5,888.81 "," $6,059.10 "," $5,740.20 "," $5,740.20 "," $5,740.20 "," $5,931.54 "," $6,122.88 "," $6,711.45 "," $5,421.30 "," $6,337.00 "," $6,792.94 ", N/A ," $5,892.06 "," $5,892.06 "," $6,059.10 "," $6,925.28 "," $1,044.67 "," $7,201.29 "
 Fac Platelets Pheresis Path Redu ,HCPCS P9073,0390 - BLOOD/STOR-PROC,N/A,N/A," $1,528.00 ", $993.20 ," $1,283.52 ", N/A , $528.28 ," $1,234.62 "," $1,375.20 "," $1,293.60 "," $1,375.20 "," $1,375.20 "," $1,375.20 "," $1,298.80 ", $517.92 ," $1,410.80 "," $1,451.60 "," $1,298.80 "," $1,421.04 "," $1,421.04 "," $1,451.60 "," $1,466.88 "," $1,250.21 "," $1,375.20 "," $1,298.80 "," $1,207.12 ", N/A ," $1,236.61 "," $1,236.61 "," $1,451.60 "," $1,311.18 ", $517.92 ," $1,466.88 "
CT Guidance Needle Placement,CPT® 77012,N/A,N/A,N/A," $1,027.00 ", $667.55 , $808.06 , $139.40 , $171.11 , $595.06 , $672.36 , $955.11 , $924.30 , $924.30 , $821.60 , $821.60 , $171.11 , $948.23 , $975.65 , $924.30 , $924.30 , $924.30 , $955.11 , $985.92 , $820.07 , $872.95 , $728.04 , $809.18 , N/A , $606.67 , $606.67 , $975.65 , $702.24 , $139.40 , $985.92 
 Pro Application of Paste Boot ,CPT® 29580,0982 - PRO FEE/OUTPT,N/A,N/A, $389.00 , $252.85 , $162.96 , $25.02 , $20.61 , $173.40 , $173.65 , $361.77 , $350.10 , $350.10 , $311.20 , $311.20 , $20.61 , $359.16 , $369.55 , $350.10 , $350.10 , $350.10 , $361.77 , $373.44 , $151.07 , $330.65 , $189.11 , $166.30 , N/A , $176.79 , $176.79 , $369.55 , $207.80 , $20.61 , $373.44 
"Open Post Rx Lumb Vert Fx,1 Lvl",CPT® 22325,N/A,N/A,N/A," $9,365.00 "," $6,087.25 "," $8,596.64 "," $1,348.29 "," $1,536.80 "," $6,838.97 "," $6,798.53 "," $8,709.45 "," $8,428.50 "," $8,428.50 "," $7,492.00 "," $7,492.00 "," $1,536.80 "," $8,646.70 "," $8,896.75 "," $8,428.50 "," $8,428.50 "," $8,428.50 "," $8,709.45 "," $8,990.40 "," $7,979.61 "," $7,960.25 "," $7,648.28 "," $7,973.22 ", N/A ," $6,972.41 "," $6,972.41 "," $8,896.75 "," $8,195.05 "," $1,348.29 "," $8,990.40 "
 MORPHINE SULFATE 10 MG/5ML PO SOLN ,HCPCS RXC637,0250 - PHARMACY,68094-0001-62,2 mL, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fx Radail Shaft Closed/Di ,CPT® 25520,0981 - PRO FEE/ER,N/A,N/A," $2,730.00 "," $1,774.50 "," $3,351.79 ", $528.07 , $485.34 ," $2,588.85 "," $2,592.77 "," $2,538.90 "," $2,457.00 "," $2,457.00 "," $2,184.00 "," $2,184.00 ", $485.34 ," $2,520.61 "," $2,593.50 "," $2,457.00 "," $2,457.00 "," $2,457.00 "," $2,538.90 "," $2,620.80 "," $3,099.50 "," $2,320.50 "," $2,858.07 "," $3,059.47 ", N/A ," $2,639.36 "," $2,639.36 "," $2,593.50 "," $3,102.20 ", $485.34 ," $3,351.79 "
 Pro Treat Knee Fracture(S) ,CPT® 27538,0982 - PRO FEE/OUTPT,N/A,N/A," $1,413.00 ", $918.45 ," $2,792.79 ", $438.31 , $307.34 ," $2,139.92 "," $2,153.40 "," $1,314.09 "," $1,271.70 "," $1,271.70 "," $1,130.40 "," $1,130.40 ", $307.34 ," $1,304.62 "," $1,342.35 "," $1,271.70 "," $1,271.70 "," $1,271.70 "," $1,314.09 "," $1,356.48 "," $2,565.24 "," $1,201.05 "," $2,369.24 "," $2,529.06 ", N/A ," $2,181.67 "," $2,181.67 "," $1,342.35 "," $2,564.24 ", $307.34 ," $2,792.79 "
 NM Sentinal Node Inj Radioactive Tracer ,CPT® 38792,0340 - NUCLEAR MEDICINE,N/A,N/A, $87.00 , $56.55 , $73.08 , $30.89 , $36.29 , $70.30 , $78.30 , $73.65 , $78.30 , $78.30 , $78.30 , $73.95 , $35.58 , $80.33 , $82.65 , $73.95 , $80.91 , $80.91 , $82.65 , $83.52 , $71.18 , $78.30 , $73.95 , $68.73 , N/A , $70.41 , $70.41 , $82.65 , $74.65 , $30.89 , $83.52 
 Pro Chng Cstost Tube Smpl ,CPT® 51705,0982 - PRO FEE/OUTPT,N/A,N/A, $598.00 , $388.70 , $277.44 , $49.05 , $89.32 , $253.25 , $237.97 , $556.14 , $538.20 , $538.20 , $478.40 , $478.40 , $89.32 , $552.13 , $568.10 , $538.20 , $538.20 , $538.20 , $556.14 , $574.08 , $278.88 , $508.30 , $269.39 , $320.52 , N/A , $258.19 , $258.19 , $568.10 , $303.46 , $49.05 , $574.08 
" Fac Smear, Special Stain ",CPT® 87207,0306 - LAB/BACT-MICRO,N/A,N/A, $117.00 , $76.05 , $98.28 , $6.11 , $6.11 , $94.54 , $105.30 , $99.05 , $105.30 , $105.30 , $105.30 , $99.45 , $5.99 , $108.03 , $111.15 , $99.45 , $108.81 , $108.81 , $111.15 , $112.32 , $95.73 , $105.30 , $99.45 , $92.43 , N/A , $94.69 , $94.69 , $111.15 , $100.40 , $5.99 , $112.32 
Percut Rx Tar-Metatar Foot Disloc,CPT® 28606,N/A,N/A,N/A," $3,140.00 "," $2,041.00 "," $2,333.70 ", $372.12 , $184.42 ," $1,913.40 "," $1,929.82 "," $2,920.20 "," $2,826.00 "," $2,826.00 "," $2,512.00 "," $2,512.00 ", $184.42 ," $2,899.16 "," $2,983.00 "," $2,826.00 "," $2,826.00 "," $2,826.00 "," $2,920.20 "," $3,014.40 "," $2,171.15 "," $2,669.00 "," $2,115.90 "," $2,304.02 ", N/A ," $1,950.74 "," $1,950.74 "," $2,983.00 "," $2,292.80 ", $184.42 ," $3,014.40 "
 Fac Irradj Bld Produx Ea Unit ,CPT® 86945,0391 - BLOOD/ADMIN,N/A,N/A, $162.00 , $105.30 , $136.08 , N/A , N/A , $130.90 , $145.80 , $137.15 , $145.80 , $145.80 , $145.80 , $137.70 , N/A , $149.57 , $153.90 , $137.70 , $150.66 , $150.66 , $153.90 , $155.52 , $132.55 , $145.80 , $137.70 , $127.98 , N/A , $131.11 , $131.11 , $153.90 , $139.01 , $127.98 , $155.52 
"Knee Scope,Lysis of Adhesns",CPT® 29884,N/A,N/A,N/A," $4,089.00 "," $2,657.85 "," $3,765.00 ", $591.75 , $888.33 ," $2,972.96 "," $2,994.86 "," $3,802.77 "," $3,680.10 "," $3,680.10 "," $3,271.20 "," $3,271.20 ", $888.33 ," $3,775.37 "," $3,884.55 "," $3,680.10 "," $3,680.10 "," $3,680.10 "," $3,802.77 "," $3,925.44 "," $3,506.92 "," $3,475.65 "," $3,305.87 "," $3,515.87 ", N/A ," $3,030.97 "," $3,030.97 "," $3,884.55 "," $3,562.46 ", $591.75 ," $3,925.44 "
 Fac Perq Breast Loc Device Placemt 1st Lesio MR Guid ,CPT® 19287,0361 - OR/MINOR,N/A,N/A," $3,132.00 "," $2,035.80 "," $2,630.88 ", $121.06 , $104.42 ," $2,530.66 "," $2,818.80 "," $2,651.55 "," $2,818.80 "," $2,818.80 "," $2,818.80 "," $2,662.20 ", $102.37 ," $2,891.78 "," $2,975.40 "," $2,662.20 "," $2,912.76 "," $2,912.76 "," $2,975.40 "," $3,006.72 "," $2,562.60 "," $2,818.80 "," $2,662.20 "," $2,474.28 ", N/A ," $2,534.73 "," $2,534.73 "," $2,975.40 "," $2,687.57 ", $102.37 ," $3,006.72 "
"Ecg Monitor/24 Hrs,Recording",CPT® 93225,N/A,N/A,N/A, $441.00 , $286.65 , $119.34 , $17.84 , $46.97 , $141.61 , $156.61 , $410.13 , $396.90 , $396.90 , $352.80 , $352.80 , $46.97 , $407.18 , $418.95 , $396.90 , $396.90 , $396.90 , $410.13 , $423.36 , $120.12 , $374.85 , $148.08 , $156.53 , N/A , $144.37 , $144.37 , $418.95 , $160.02 , $17.84 , $423.36 
"Closed Rx Dist Fibula Fx,Manip",CPT® 27788,N/A,N/A,N/A," $2,789.00 "," $1,812.85 "," $2,379.26 ", $375.59 , $230.52 ," $1,854.24 "," $1,880.56 "," $2,593.77 "," $2,510.10 "," $2,510.10 "," $2,231.20 "," $2,231.20 ", $230.52 ," $2,575.08 "," $2,649.55 "," $2,510.10 "," $2,510.10 "," $2,510.10 "," $2,593.77 "," $2,677.44 "," $2,201.70 "," $2,370.65 "," $2,065.95 "," $2,192.00 ", N/A ," $1,890.42 "," $1,890.42 "," $2,649.55 "," $2,221.92 ", $230.52 ," $2,677.44 "
 Pro Treat Thigh Fracture ,CPT® 27235,0982 - PRO FEE/OUTPT,N/A,N/A," $4,908.00 "," $3,190.20 "," $5,495.75 ", $859.35 , $796.77 ," $4,386.19 "," $4,350.98 "," $4,564.44 "," $4,417.20 "," $4,417.20 "," $3,926.40 "," $3,926.40 ", $796.77 ," $4,531.56 "," $4,662.60 "," $4,417.20 "," $4,417.20 "," $4,417.20 "," $4,564.44 "," $4,711.68 "," $5,114.46 "," $4,171.80 "," $4,809.84 "," $5,158.64 ", N/A ," $4,471.77 "," $4,471.77 "," $4,662.60 "," $5,255.92 ", $796.77 ," $5,495.75 "
 CLONIDINE HCL (ANALGESIA) 500 MCG/ML EP SOLN ,HCPCS J0735,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9723-01,10 mL, $477.81 , $310.58 , $401.36 , $21.46 , $23.35 , $386.07 , $430.03 , $404.51 , $430.03 , $430.03 , $430.03 , $406.14 , $22.89 , $441.16 , $453.92 , $406.14 , $444.36 , $444.36 , $453.92 , $458.70 , $390.94 , $430.03 , $406.14 , $377.47 , N/A , $386.69 , $386.69 , $453.92 , $410.01 , $21.46 , $458.70 
Reconstruct Radial Head,CPT® 24365,N/A,N/A,N/A," $4,393.00 "," $2,855.45 "," $3,909.43 ", $612.92 , $614.70 ," $3,079.54 "," $3,061.50 "," $4,085.49 "," $3,953.70 "," $3,953.70 "," $3,514.40 "," $3,514.40 ", $614.70 ," $4,056.06 "," $4,173.35 "," $3,953.70 "," $3,953.70 "," $3,953.70 "," $4,085.49 "," $4,217.28 "," $3,633.46 "," $3,734.05 "," $3,380.80 "," $3,628.31 ", N/A ," $3,139.62 "," $3,139.62 "," $4,173.35 "," $3,690.17 ", $612.92 ," $4,217.28 "
" Fac Muscle Test, One Limb ",CPT® 95860,0922 - EMG,N/A,N/A, $951.00 , $618.15 , $798.84 , $110.56 , $76.28 , $768.41 , $855.90 , $805.12 , $855.90 , $855.90 , $855.90 , $808.35 , $74.78 , $878.06 , $903.45 , $808.35 , $884.43 , $884.43 , $903.45 , $912.96 , $778.11 , $855.90 , $808.35 , $751.29 , N/A , $769.64 , $769.64 , $903.45 , $816.05 , $74.78 , $912.96 
 Venogram Contrast Bilat Extremity ,CPT® 75822,0320 - DX X-RAY,N/A,N/A," $1,119.00 ", $727.35 , $939.96 , $130.39 , $118.18 , $904.15 ," $1,007.10 ", $947.35 ," $1,007.10 "," $1,007.10 "," $1,007.10 ", $951.15 , $115.86 ," $1,033.17 "," $1,063.05 ", $951.15 ," $1,040.67 "," $1,040.67 "," $1,063.05 "," $1,074.24 ", $915.57 ," $1,007.10 ", $951.15 , $884.01 , N/A , $905.61 , $905.61 ," $1,063.05 ", $960.21 , $115.86 ," $1,074.24 "
" Bypass Graft, With Other Than Vein; Ilio-Mesenteric ",CPT® 35633,0360 - OR SERVICES,N/A,N/A," $2,745.00 "," $1,784.25 "," $2,305.80 "," $1,755.94 "," $1,985.37 "," $2,217.96 "," $2,470.50 "," $2,323.92 "," $2,470.50 "," $2,470.50 "," $2,470.50 "," $2,333.25 "," $1,946.44 "," $2,534.46 "," $2,607.75 "," $2,333.25 "," $2,552.85 "," $2,552.85 "," $2,607.75 "," $2,635.20 "," $2,245.96 "," $2,470.50 "," $2,333.25 "," $2,168.55 ", N/A ," $2,221.53 "," $2,221.53 "," $2,607.75 "," $2,355.48 "," $1,755.94 "," $2,635.20 "
 Pro Radiologic Exam Complete Acute Abdomen Series ,CPT® 74022,0972 - PRO FEE/RAD/DX,N/A,N/A, $198.00 , $128.70 , $282.87 , $49.14 , $46.32 , $209.33 , $260.18 , $184.14 , $178.20 , $178.20 , $158.40 , $158.40 , $46.32 , $182.81 , $188.10 , $178.20 , $178.20 , $178.20 , $184.14 , $190.08 , $274.26 , $168.30 , $283.13 , $224.79 , N/A , $213.42 , $213.42 , $188.10 , $247.04 , $46.32 , $283.13 
"Closed Rx Talus Fx,Manipulatn",28435,N/A,N/A,N/A," $1,613.00 "," $1,048.45 "," $2,020.92 ", $319.64 , $307.34 ," $1,396.56 "," $1,566.98 "," $1,500.09 "," $1,451.70 "," $1,451.70 "," $1,290.40 "," $1,290.40 ", $307.34 ," $1,489.28 "," $1,532.35 "," $1,451.70 "," $1,451.70 "," $1,451.70 "," $1,500.09 "," $1,548.48 "," $1,686.24 "," $1,371.05 "," $1,723.41 "," $1,841.35 ", N/A ," $1,423.81 "," $1,423.81 "," $1,532.35 "," $1,673.47 ", $307.34 ," $2,020.92 "
Lam Facetec/Foramot Drg Arthrd Lmbr Ea Addl Sgm,CPT® 63053,N/A,N/A,N/A," $4,363.00 "," $2,835.95 ", $889.10 , $204.87 , $188.29 , N/A , N/A ," $4,057.59 "," $3,926.70 "," $3,926.70 "," $3,490.40 "," $3,490.40 ", $188.29 ," $4,028.36 "," $4,144.85 "," $3,926.70 "," $3,926.70 "," $3,926.70 "," $4,057.59 "," $4,188.48 ", N/A ," $3,708.55 "," $1,210.10 "," $1,111.95 ", N/A , $930.79 , $930.79 ," $4,144.85 ", $997.97 , $188.29 ," $4,188.48 "
"Explor/Drain Knee,Infectn",CPT® 27310,N/A,N/A,N/A," $3,356.00 "," $2,181.40 "," $4,454.78 ", $698.89 , $629.61 ," $3,520.59 "," $3,510.34 "," $3,121.08 "," $3,020.40 "," $3,020.40 "," $2,684.80 "," $2,684.80 ", $629.61 ," $3,098.59 "," $3,188.20 "," $3,020.40 "," $3,020.40 "," $3,020.40 "," $3,121.08 "," $3,221.76 "," $4,139.94 "," $2,852.60 "," $3,876.77 "," $4,152.70 ", N/A ," $3,589.29 "," $3,589.29 "," $3,188.20 "," $4,218.68 ", $629.61 ," $4,454.78 "
 GUAIFENESIN ER 600 MG PO TB12 ,HCPCS RXC637,0250 - PHARMACY,68084-0572-01,1 tablet, $5.15 , $3.35 , $4.33 , N/A , N/A , $4.16 , $4.64 , $4.36 , $4.64 , $4.64 , $4.64 , $4.38 , N/A , $4.75 , $4.89 , $4.38 , $4.79 , $4.79 , $4.89 , $4.94 , $4.21 , $4.64 , $4.38 , $4.07 , N/A , $4.17 , $4.17 , $4.89 , $4.42 , $4.07 , $4.94 
 Pro Att/Reargmt F/C/C/M/N/Ax/G/H/F 10 Cm/< ,CPT® 14040,0982 - PRO FEE/OUTPT,N/A,N/A," $4,032.00 "," $2,620.80 "," $1,994.24 ", $599.47 , $397.57 ," $1,729.62 "," $1,705.45 "," $3,749.76 "," $3,628.80 "," $3,628.80 "," $3,225.60 "," $3,225.60 ", $397.57 ," $3,722.75 "," $3,830.40 "," $3,628.80 "," $3,628.80 "," $3,628.80 "," $3,749.76 "," $3,870.72 "," $2,184.89 "," $3,427.20 "," $3,395.07 "," $2,215.01 ", N/A ," $1,763.37 "," $1,763.37 "," $3,830.40 "," $2,044.92 ", $397.57 ," $3,870.72 "
 DIATRIZOATE MEGLUMINE 18 % UR SOLN ,HCPCS Q9958,0255 - DRUGS/RADIOLOGY,00270-1410-30,300 mL, $198.80 , $129.22 , $166.99 , $0.08 , $0.08 , $160.63 , $178.92 , $168.30 , $178.92 , $178.92 , $178.92 , $168.98 , $0.08 , $183.55 , $188.86 , $168.98 , $184.88 , $184.88 , $188.86 , $190.85 , $162.66 , $178.92 , $168.98 , $157.05 , N/A , $160.89 , $160.89 , $188.86 , $170.59 , $0.08 , $190.85 
 Fac Cellular Function Assay Stimul&Detect Biomarker ,CPT® 86352,0302 - LAB/IMMUNOLOGY,N/A,N/A," $1,182.00 ", $768.30 , $992.88 , $138.58 , $99.25 , $955.06 ," $1,063.80 "," $1,000.68 "," $1,063.80 "," $1,063.80 "," $1,063.80 "," $1,004.70 ", $97.30 ," $1,091.34 "," $1,122.90 "," $1,004.70 "," $1,099.26 "," $1,099.26 "," $1,122.90 "," $1,134.72 ", $967.11 ," $1,063.80 "," $1,004.70 ", $933.78 , N/A , $956.59 , $956.59 ," $1,122.90 "," $1,014.27 ", $97.30 ," $1,134.72 "
Control Nasal Hemorrhage,CPT® 30901,N/A,N/A,N/A, $781.00 , $507.65 , $301.30 , $53.21 , $34.36 , $216.79 , $209.25 , $726.33 , $702.90 , $702.90 , $624.80 , $624.80 , $34.36 , $721.10 , $741.95 , $702.90 , $702.90 , $702.90 , $726.33 , $749.76 , $289.39 , $663.85 , $296.15 , $286.56 , N/A , $221.02 , $221.02 , $741.95 , $260.29 , $34.36 , $749.76 
 Pro Rad Resection Tumor Soft Tiss Face/Scalp 2+Cm ,CPT® 21016,0982 - PRO FEE/OUTPT,N/A,N/A," $6,915.00 "," $4,494.75 "," $6,099.93 ", $955.17 , $859.59 ," $4,935.77 "," $4,965.12 "," $6,430.95 "," $6,223.50 "," $6,223.50 "," $5,532.00 "," $5,532.00 ", $859.59 ," $6,384.62 "," $6,569.25 "," $6,223.50 "," $6,223.50 "," $6,223.50 "," $6,430.95 "," $6,638.40 "," $5,651.61 "," $5,877.75 "," $5,487.78 "," $5,771.92 ", N/A ," $5,032.07 "," $5,032.07 "," $6,569.25 "," $5,914.46 ", $859.59 ," $6,638.40 "
"Insert Bladder Cath, Complex",51703,N/A,N/A,N/A, $680.00 , $442.00 , $412.39 , $72.47 , $143.34 , $399.54 , $371.51 , $632.40 , $612.00 , $612.00 , $544.00 , $544.00 , $143.34 , $627.84 , $646.00 , $612.00 , $612.00 , $612.00 , $632.40 , $652.80 , $413.36 , $578.00 , $419.26 , $473.02 , N/A , $407.34 , $407.34 , $646.00 , $478.77 , $72.47 , $652.80 
" Fac Detect Agent Nos, Dna, Quant ",CPT® 87799,0306 - LAB/BACT-MICRO,N/A,N/A, $422.00 , $274.30 , $354.48 , $43.70 , $43.70 , $340.98 , $379.80 , $357.27 , $379.80 , $379.80 , $379.80 , $358.70 , $42.84 , $389.63 , $400.90 , $358.70 , $392.46 , $392.46 , $400.90 , $405.12 , $345.28 , $379.80 , $358.70 , $333.38 , N/A , $341.52 , $341.52 , $400.90 , $362.12 , $42.84 , $405.12 
 Fac Enzyme Cell Activity ,CPT® 82657,0301 - LAB/CHEMISTRY,N/A,N/A, $447.00 , $290.55 , $375.48 , $22.61 , $22.61 , $361.18 , $402.30 , $378.43 , $402.30 , $402.30 , $402.30 , $379.95 , $22.17 , $412.72 , $424.65 , $379.95 , $415.71 , $415.71 , $424.65 , $429.12 , $365.74 , $402.30 , $379.95 , $353.13 , N/A , $361.76 , $361.76 , $424.65 , $383.57 , $22.17 , $429.12 
" Fac Hocm>= 400mg/Ml Iodine, 1ml ",HCPCS Q9964,0255 - DRUGS/RADIOLOGY,N/A,N/A, $186.00 , $120.90 , $156.24 , N/A , $0.30 , $150.29 , $167.40 , $157.47 , $167.40 , $167.40 , $167.40 , $158.10 , $0.29 , $171.73 , $176.70 , $158.10 , $172.98 , $172.98 , $176.70 , $178.56 , $152.19 , $167.40 , $158.10 , $146.94 , N/A , $150.53 , $150.53 , $176.70 , $159.61 , $0.29 , $178.56 
 Fac Tx Sho Area 1 Tdn ,CPT® 23405,0361 - OR/MINOR,N/A,N/A," $2,816.00 "," $1,830.40 "," $2,365.44 ", $591.33 , $461.04 ," $2,275.33 "," $2,534.40 "," $2,384.03 "," $2,534.40 "," $2,534.40 "," $2,534.40 "," $2,393.60 ", $452.00 ," $2,600.01 "," $2,675.20 "," $2,393.60 "," $2,618.88 "," $2,618.88 "," $2,675.20 "," $2,703.36 "," $2,304.05 "," $2,534.40 "," $2,393.60 "," $2,224.64 ", N/A ," $2,278.99 "," $2,278.99 "," $2,675.20 "," $2,416.41 ", $452.00 ," $2,703.36 "
" Pro Laryngoscopy,Direct ",CPT® 31525,0981 - PRO FEE/ER,N/A,N/A," $1,162.00 ", $755.30 , $859.34 , $152.06 , $303.22 , $615.92 , $602.47 ," $1,080.66 "," $1,045.80 "," $1,045.80 ", $929.60 , $929.60 , $303.22 ," $1,072.87 "," $1,103.90 "," $1,045.80 "," $1,045.80 "," $1,045.80 "," $1,080.66 "," $1,115.52 ", $821.76 , $987.70 , $849.21 , $812.19 , N/A , $627.94 , $627.94 ," $1,103.90 ", $739.55 , $152.06 ," $1,115.52 "
"Explore Eye Socket,Remv F.B.",CPT® 67413,N/A,N/A,N/A," $8,560.00 "," $5,564.00 "," $6,068.66 ", $943.50 , $698.89 ," $4,828.40 "," $4,573.14 "," $7,960.80 "," $7,704.00 "," $7,704.00 "," $6,848.00 "," $6,848.00 ", $698.89 ," $7,903.45 "," $8,132.00 "," $7,704.00 "," $7,704.00 "," $7,704.00 "," $7,960.80 "," $8,217.60 "," $8,082.73 "," $7,276.00 "," $4,740.26 "," $6,134.90 ", N/A ," $4,922.61 "," $4,922.61 "," $8,132.00 "," $5,433.93 ", $698.89 ," $8,217.60 "
 ISOSORBIDE MONONITRATE 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00228-2631-11,1 tablet, $4.37 , $2.84 , $3.67 , N/A , N/A , $3.53 , $3.93 , $3.70 , $3.93 , $3.93 , $3.93 , $3.71 , N/A , $4.03 , $4.15 , $3.71 , $4.06 , $4.06 , $4.15 , $4.20 , $3.58 , $3.93 , $3.71 , $3.45 , N/A , $3.54 , $3.54 , $4.15 , $3.75 , $3.45 , $4.20 
 Pro Smpl Rpr Supfc F/E/E/N/L/M 2.6cm-5.0cm ,CPT® 12013,0982 - PRO FEE/OUTPT,N/A,N/A, $802.00 , $521.30 , $180.71 , $53.74 , $76.93 , $169.97 , $163.73 , $745.86 , $721.80 , $721.80 , $641.60 , $641.60 , $76.93 , $740.49 , $761.90 , $721.80 , $721.80 , $721.80 , $745.86 , $769.92 , $198.93 , $681.70 , $328.27 , $200.67 , N/A , $173.28 , $173.28 , $761.90 , $200.96 , $53.74 , $769.92 
Lens Sphere Bifocal 7.12-20.,HCPCS V2202,N/A,N/A,N/A, $85.00 , $55.25 , N/A , $81.03 , N/A , N/A , N/A , $79.05 , $76.50 , $76.50 , $68.00 , $68.00 , N/A , $78.48 , $80.75 , $76.50 , $76.50 , $76.50 , $79.05 , $81.60 , N/A , $72.25 , $85.00 , $73.61 , N/A , N/A , N/A , $80.75 , N/A , $68.00 , $85.00 
 Pro Treatment of Urethra Lesion ,CPT® 53265,0982 - PRO FEE/OUTPT,N/A,N/A," $1,484.00 ", $964.60 ," $1,019.19 ", $180.35 , $107.56 , $906.93 , $851.71 ," $1,380.12 "," $1,335.60 "," $1,335.60 "," $1,187.20 "," $1,187.20 ", $107.56 ," $1,370.18 "," $1,409.80 "," $1,335.60 "," $1,335.60 "," $1,335.60 "," $1,380.12 "," $1,424.64 "," $1,019.38 "," $1,261.40 ", $966.96 ," $1,142.47 ", N/A , $924.62 , $924.62 ," $1,409.80 "," $1,086.77 ", $107.56 ," $1,424.64 "
"MR Angio, Head, Combo",CPT® 70546,N/A,N/A,N/A," $5,793.00 "," $3,765.45 "," $2,359.28 ", $337.81 , $616.29 ," $2,853.31 "," $3,661.38 "," $5,387.49 "," $5,213.70 "," $5,213.70 "," $4,634.40 "," $4,634.40 ", $616.29 ," $5,348.68 "," $5,503.35 "," $5,213.70 "," $5,213.70 "," $5,213.70 "," $5,387.49 "," $5,561.28 "," $2,013.99 "," $4,924.05 "," $3,990.76 "," $3,233.42 ", N/A ," $2,908.98 "," $2,908.98 "," $5,503.35 "," $3,367.19 ", $337.81 ," $5,561.28 "
 Pro Injection Aa&/Strd Sciatic Nerve W/Img Gdn ,CPT® 64445,0960 - PRO FEE,N/A,N/A," $1,698.00 "," $1,103.70 ", $264.94 , $69.92 , $46.08 , $404.19 , $385.85 ," $1,579.14 "," $1,528.20 "," $1,528.20 "," $1,358.40 "," $1,358.40 ", $46.08 ," $1,567.76 "," $1,613.10 "," $1,528.20 "," $1,528.20 "," $1,528.20 "," $1,579.14 "," $1,630.08 ", $287.54 ," $1,443.30 ", $378.22 , $437.51 , N/A , $412.08 , $412.08 ," $1,613.10 ", $442.06 , $46.08 ," $1,630.08 "
Physician Telephone Evaluation 11-20 Min,CPT® 99442,N/A,N/A,N/A, $114.00 , $74.10 , $134.06 , $64.08 , $21.48 , $44.31 , $44.11 , $106.02 , $102.60 , $102.60 , $91.20 , $91.20 , $21.48 , $105.26 , $108.30 , $102.60 , $102.60 , $102.60 , $106.02 , $109.44 , $122.78 , $96.90 , $54.76 , $55.96 , $29.00 , $45.17 , $45.17 , $108.30 , $52.10 , $21.48 , $134.06 
 Pro Surgical Arthroscopy Shoulder Xtnsv Dbrdmt 3+ ,CPT® 29823,0982 - PRO FEE/OUTPT,N/A,N/A," $4,156.00 "," $2,701.40 "," $3,613.81 ", $567.06 , $543.90 ," $2,996.51 "," $3,026.03 "," $3,865.08 "," $3,740.40 "," $3,740.40 "," $3,324.80 "," $3,324.80 ", $543.90 ," $3,837.23 "," $3,948.20 "," $3,740.40 "," $3,740.40 "," $3,740.40 "," $3,865.08 "," $3,989.76 "," $3,363.02 "," $3,532.60 "," $3,339.77 "," $3,549.12 ", N/A ," $3,054.98 "," $3,054.98 "," $3,948.20 "," $3,590.68 ", $543.90 ," $3,989.76 "
" Fac Detect Agent Nos, Dna, Amp ",CPT® 87798,0306 - LAB/BACT-MICRO,N/A,N/A, $315.00 , $204.75 , $264.60 , $35.79 , $35.79 , $254.52 , $283.50 , $266.68 , $283.50 , $283.50 , $283.50 , $267.75 , $35.09 , $290.84 , $299.25 , $267.75 , $292.95 , $292.95 , $299.25 , $302.40 , $257.73 , $283.50 , $267.75 , $248.85 , N/A , $254.93 , $254.93 , $299.25 , $270.30 , $35.09 , $302.40 
Cath W/Drainage 2-Way Silcne,HCPCS A4315,N/A,N/A,N/A, $60.00 , $39.00 , N/A , $35.78 , $19.81 , N/A , N/A , $55.80 , $54.00 , $54.00 , $48.00 , $48.00 , $19.81 , $55.40 , $57.00 , $54.00 , $54.00 , $54.00 , $55.80 , $57.60 , N/A , $51.00 , $31.14 , $32.51 , N/A , N/A , N/A , $57.00 , N/A , $19.81 , $57.60 
Njx Noncmpnd Sclerosant Multiple Incmptnt Veins,CPT® 36466,N/A,N/A,N/A," $10,179.00 "," $6,616.35 ", $911.30 , $139.87 , N/A , $610.54 , $619.47 ," $9,466.47 "," $9,161.10 "," $9,161.10 "," $8,143.20 "," $8,143.20 ", N/A ," $9,398.27 "," $9,670.05 "," $9,161.10 "," $9,161.10 "," $9,161.10 "," $9,466.47 "," $9,771.84 ", $847.47 ," $8,652.15 ", $797.85 , $732.87 , N/A , $622.45 , $622.45 ," $9,670.05 ", $707.10 , $139.87 ," $9,771.84 "
 NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN ,HCPCS J2710,0636 - DRUGS REQUIRING DETAILED CODIN,70121-1479-01,0.5 mL, $16.68 , $10.84 , $14.01 , N/A , $0.09 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.09 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.09 , $16.01 
 GELATIN ABSORBABLE 100 EX MISC ,HCPCS RXA250,0250 - PHARMACY,63713-0019-78,1 packet, $258.07 , $167.75 , $216.78 , N/A , N/A , $208.52 , $232.26 , $218.48 , $232.26 , $232.26 , $232.26 , $219.36 , N/A , $238.28 , $245.17 , $219.36 , $240.01 , $240.01 , $245.17 , $247.75 , $211.15 , $232.26 , $219.36 , $203.88 , N/A , $208.86 , $208.86 , $245.17 , $221.45 , $203.88 , $247.75 
Incise Finger Tendon Sheath,CPT® 26055,N/A,N/A,N/A," $3,773.00 "," $2,452.45 "," $1,794.72 ", $283.56 , $307.34 ," $1,493.87 "," $1,512.21 "," $3,508.89 "," $3,395.70 "," $3,395.70 "," $3,018.40 "," $3,018.40 ", $307.34 ," $3,483.61 "," $3,584.35 "," $3,395.70 "," $3,395.70 "," $3,395.70 "," $3,508.89 "," $3,622.08 "," $1,666.47 "," $3,207.05 "," $1,657.40 "," $1,779.74 ", N/A ," $1,523.02 "," $1,523.02 "," $3,584.35 "," $1,790.08 ", $283.56 ," $3,622.08 "
"Injection,Therap/Proph/Diagnost, IV Push, Initial Drug",CPT® 96374,N/A,N/A,N/A, $223.00 , $144.95 , $90.55 , $36.32 , $47.13 , $123.65 , $128.50 , $207.39 , $200.70 , $200.70 , $178.40 , $178.40 , $47.13 , $205.90 , $211.85 , $200.70 , $200.70 , $200.70 , $207.39 , $214.08 , $148.98 , $189.55 , $171.32 , $173.95 , N/A , $126.07 , $126.07 , $211.85 , $146.96 , $36.32 , $214.08 
Lens Sphcy Trifocal 4.0/4.25,HCPCS V2305,N/A,N/A,N/A, $90.00 , $58.50 , N/A , $90.73 , N/A , N/A , N/A , $83.70 , $81.00 , $81.00 , $72.00 , $72.00 , N/A , $83.10 , $85.50 , $81.00 , $81.00 , $81.00 , $83.70 , $86.40 , N/A , $76.50 , $90.00 , $82.43 , N/A , N/A , N/A , $85.50 , N/A , $72.00 , $90.73 
Iaad Ia Hepatitis B Surface Antigen,CPT® 87340,N/A,N/A,N/A, $97.00 , $63.05 , N/A , $10.54 , $10.54 , $58.45 , $69.92 , $90.21 , $87.30 , $87.30 , $77.60 , $77.60 , $10.54 , $89.56 , $92.15 , $87.30 , $87.30 , $87.30 , $90.21 , $93.12 , $68.98 , $82.45 , $68.12 , $37.45 , N/A , $54.55 , $54.55 , $92.15 , $59.61 , $10.54 , $93.12 
 CT Angio Chest(Noncor) W/WO Cont Pp -Mh ,CPT® 71275,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,026.00 ", $666.90 ," $1,793.54 ", $259.37 , $407.84 ," $1,452.31 "," $2,130.66 ", $954.18 , $923.40 , $923.40 , $820.80 , $820.80 , $407.84 , $947.31 , $974.70 , $923.40 , $923.40 , $923.40 , $954.18 , $984.96 ," $1,671.95 ", $872.10 ," $2,318.95 "," $1,946.82 ", N/A ," $1,480.65 "," $1,480.65 ", $974.70 ," $1,713.88 ", $259.37 ," $2,318.95 "
"Thyroidectomy=Substernal,Transcerv",CPT® 60271,N/A,N/A,N/A," $7,069.00 "," $4,594.85 "," $6,376.05 ", $992.69 ," $1,175.48 "," $5,458.76 "," $5,643.93 "," $6,574.17 "," $6,362.10 "," $6,362.10 "," $5,655.20 "," $5,655.20 "," $1,175.48 "," $6,526.81 "," $6,715.55 "," $6,362.10 "," $6,362.10 "," $6,362.10 "," $6,574.17 "," $6,786.24 "," $6,159.13 "," $6,008.65 "," $5,594.83 "," $5,247.53 ", N/A ," $5,565.27 "," $5,565.27 "," $6,715.55 "," $6,206.94 ", $992.69 ," $6,786.24 "
 Pro Fundus Phtgrphy I&R ,CPT® 92250,0962 - PRO FEE/EYE,N/A,N/A, $308.00 , $200.20 , $80.75 , $36.70 , $25.41 , $137.98 , $143.47 , $286.44 , $277.20 , $277.20 , $246.40 , $246.40 , $25.41 , $284.38 , $292.60 , $277.20 , $277.20 , $277.20 , $286.44 , $295.68 , $119.58 , $261.80 , $242.28 , $120.20 , N/A , $140.67 , $140.67 , $292.60 , $167.32 , $25.41 , $295.68 
Drug Assay Infliximab,CPT® 80230,N/A,N/A,N/A, $273.00 , $177.45 , N/A , $39.34 , $31.47 , $164.07 , N/A , $253.89 , $245.70 , $245.70 , $218.40 , $218.40 , $31.47 , $252.06 , $259.35 , $245.70 , $245.70 , $245.70 , $253.89 , $262.08 , $257.54 , $232.05 , $184.15 , $113.28 , N/A , $153.12 , $153.12 , $259.35 , $167.01 , $31.47 , $262.08 
Iaad Ia Cryptosporidium,CPT® 87328,N/A,N/A,N/A, $111.00 , $72.15 , N/A , $14.10 , $14.10 , $67.85 , $81.18 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $14.10 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $92.28 , $94.35 , $77.85 , $43.47 , N/A , $63.32 , $63.32 , $105.45 , $69.20 , $14.10 , $106.56 
 Ribs Unilateral 2 View - Mh ,CPT® 71100,0972 - PRO FEE/RAD/DX,N/A,N/A, $144.00 , $93.60 , $207.93 , $36.39 , $31.35 , $144.21 , $173.58 , $133.92 , $129.60 , $129.60 , $115.20 , $115.20 , $31.35 , $132.96 , $136.80 , $129.60 , $129.60 , $129.60 , $133.92 , $138.24 , $201.48 , $122.40 , $188.75 , $167.82 , N/A , $147.02 , $147.02 , $136.80 , $170.20 , $31.35 , $207.93 
Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/O Img Gdn,CPT® 62320,N/A,N/A,N/A," $1,090.00 ", $708.50 , $487.55 , $95.25 , $132.09 , $548.33 , $533.94 ," $1,013.70 ", $981.00 , $981.00 , $872.00 , $872.00 , $132.09 ," $1,006.40 "," $1,035.50 ", $981.00 , $981.00 , $981.00 ," $1,013.70 "," $1,046.40 ", $524.37 , $926.50 , $529.53 , $606.17 , N/A , $559.03 , $559.03 ," $1,035.50 ", $599.72 , $95.25 ," $1,046.40 "
" Fac Stool Cultr, Bacteria, Each ",CPT® 87046,0306 - LAB/BACT-MICRO,N/A,N/A, $100.00 , $65.00 , $84.00 , $9.63 , $3.36 , $80.80 , $90.00 , $84.66 , $90.00 , $90.00 , $90.00 , $85.00 , $3.29 , $92.33 , $95.00 , $85.00 , $93.00 , $93.00 , $95.00 , $96.00 , $81.82 , $90.00 , $85.00 , $79.00 , N/A , $80.93 , $80.93 , $95.00 , $85.81 , $3.29 , $96.00 
 Fac Assay of Phenobarbital ,CPT® 80184,0301 - LAB/CHEMISTRY,N/A,N/A, $107.00 , $69.55 , $89.88 , $15.61 , $15.61 , $86.46 , $96.30 , $90.59 , $96.30 , $96.30 , $96.30 , $90.95 , $15.30 , $98.79 , $101.65 , $90.95 , $99.51 , $99.51 , $101.65 , $102.72 , $87.55 , $96.30 , $90.95 , $84.53 , N/A , $86.60 , $86.60 , $101.65 , $91.82 , $15.30 , $102.72 
 COAGULATION FACTOR VIIA RECOMB 2 MG IV SOLR ,HCPCS J7189,0636 - DRUGS REQUIRING DETAILED CODIN,00169-7202-01,2 mL," $15,093.61 "," $9,810.85 "," $12,678.63 ", $2.46 , $2.40 ," $12,195.64 "," $13,584.25 "," $12,778.25 "," $13,584.25 "," $13,584.25 "," $13,584.25 "," $12,829.57 ", $2.35 ," $13,935.93 "," $14,338.93 "," $12,829.57 "," $14,037.06 "," $14,037.06 "," $14,338.93 "," $14,489.87 "," $12,349.59 "," $13,584.25 "," $12,829.57 "," $11,923.95 ", N/A ," $12,215.26 "," $12,215.26 "," $14,338.93 "," $12,951.83 ", $2.35 ," $14,489.87 "
 Pro CT Lumbar Spine W/O & W/Dye ,CPT® 72133,0972 - PRO FEE/RAD/DX,N/A,N/A, $715.00 , $464.75 ," $1,410.15 ", $202.49 , $367.83 ," $1,285.71 "," $1,654.02 ", $664.95 , $643.50 , $643.50 , $572.00 , $572.00 , $367.83 , $660.16 , $679.25 , $643.50 , $643.50 , $643.50 , $664.95 , $686.40 ," $1,187.96 ", $607.75 ," $1,802.78 "," $1,746.14 ", N/A ," $1,310.81 "," $1,310.81 ", $679.25 ," $1,517.28 ", $202.49 ," $1,802.78 "
 Pro Treatment of Ankle Fracture ,CPT® 27786,0982 - PRO FEE/OUTPT,N/A,N/A," $2,086.00 "," $1,355.90 "," $1,797.25 ", $283.29 , $184.42 ," $1,381.41 "," $1,407.46 "," $1,939.98 "," $1,877.40 "," $1,877.40 "," $1,668.80 "," $1,668.80 ", $184.42 ," $1,926.00 "," $1,981.70 "," $1,877.40 "," $1,877.40 "," $1,877.40 "," $1,939.98 "," $2,002.56 "," $1,658.34 "," $1,773.10 "," $1,543.22 "," $1,637.46 ", N/A ," $1,408.37 "," $1,408.37 "," $1,981.70 "," $1,655.31 ", $184.42 ," $2,002.56 "
 Assay of Zinc-Pbb ,CPT® 84630,0301 - LAB/CHEMISTRY,N/A,N/A, $155.00 , $100.75 , $130.20 , $11.62 , $11.62 , $125.24 , $139.50 , $131.22 , $139.50 , $139.50 , $139.50 , $131.75 , $11.39 , $143.11 , $147.25 , $131.75 , $144.15 , $144.15 , $147.25 , $148.80 , $126.82 , $139.50 , $131.75 , $122.45 , N/A , $125.44 , $125.44 , $147.25 , $133.01 , $11.39 , $148.80 
Moderna Administration Booster,CPT® 0064A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , N/A , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , N/A , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $76.25 , $128.66 , N/A , $79.82 , $79.82 , $66.50 , $92.91 , $56.00 , $128.66 
 LIDOCAINE 1% INJECTION (TRAY) ,HCPCS RXA250,0250 - PHARMACY,00001-0369-01,1 mL, $16.68 , $10.84 , $14.01 , N/A , N/A , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , N/A , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $13.18 , $16.01 
 COAGULATION FACTOR VIIA RECOMB 1 MG IV SOLR ,HCPCS J7189,0636 - DRUGS REQUIRING DETAILED CODIN,00169-7201-01,2 mL," $15,093.61 "," $9,810.85 "," $12,678.63 ", $2.46 , $2.40 ," $12,195.64 "," $13,584.25 "," $12,778.25 "," $13,584.25 "," $13,584.25 "," $13,584.25 "," $12,829.57 ", $2.35 ," $13,935.93 "," $14,338.93 "," $12,829.57 "," $14,037.06 "," $14,037.06 "," $14,338.93 "," $14,489.87 "," $12,349.59 "," $13,584.25 "," $12,829.57 "," $11,923.95 ", N/A ," $12,215.26 "," $12,215.26 "," $14,338.93 "," $12,951.83 ", $2.35 ," $14,489.87 "
 Pro Oph Medical Xm&Eval Intrm New Pt ,CPT® 92002,0962 - PRO FEE/EYE,N/A,N/A, $254.00 , $165.10 , $101.72 , $45.41 , $37.71 , $85.23 , $85.30 , $236.22 , $228.60 , $228.60 , $203.20 , $203.20 , $37.71 , $234.52 , $241.30 , $228.60 , $228.60 , $228.60 , $236.22 , $243.84 , $132.42 , $215.90 , $143.95 , $102.11 , N/A , $86.89 , $86.89 , $241.30 , $103.36 , $37.71 , $243.84 
"Bile Acids, Total",CPT® 82239,N/A,N/A,N/A, $123.00 , $79.95 , N/A , $17.46 , $17.46 , $79.99 , $95.71 , $114.39 , $110.70 , $110.70 , $98.40 , $98.40 , $17.46 , $113.57 , $116.85 , $110.70 , $110.70 , $110.70 , $114.39 , $118.08 , $114.31 , $104.55 , $111.91 , $62.09 , N/A , $74.65 , $74.65 , $116.85 , $81.58 , $17.46 , $118.08 
 Fac Sgmdsc Flx W/Dcmprn W/Plmt Dcmprn Tube ,CPT® 45337,0360 - OR SERVICES,N/A,N/A," $1,400.00 ", $910.00 ," $1,176.00 ", $108.03 , $682.55 ," $1,131.20 "," $1,260.00 "," $1,185.24 "," $1,260.00 "," $1,260.00 "," $1,260.00 "," $1,190.00 ", $669.17 ," $1,292.62 "," $1,330.00 "," $1,190.00 "," $1,302.00 "," $1,302.00 "," $1,330.00 "," $1,344.00 "," $1,145.48 "," $1,260.00 "," $1,190.00 "," $1,106.00 ", N/A ," $1,133.02 "," $1,133.02 "," $1,330.00 "," $1,201.34 ", $108.03 ," $1,344.00 "
 Pro Egd Transoral Biopsy Single/Multiple ,CPT® 43239,0982 - PRO FEE/OUTPT,N/A,N/A," $2,363.00 "," $1,535.95 ", $847.99 , $131.07 , $744.68 , $879.24 , $836.03 ," $2,197.59 "," $2,126.70 "," $2,126.70 "," $1,890.40 "," $1,890.40 ", $744.68 ," $2,181.76 "," $2,244.85 "," $2,126.70 "," $2,126.70 "," $2,126.70 "," $2,197.59 "," $2,268.48 "," $1,125.61 "," $2,008.55 ", $915.22 , $806.86 , N/A , $896.40 , $896.40 ," $2,244.85 "," $1,076.03 ", $131.07 ," $2,268.48 "
Flt3 Gene Analysis Internal Tandem Dup Variants,CPT® 81245,N/A,N/A,N/A, $705.00 , $458.25 , N/A , $168.82 , $135.39 , $688.10 , $814.87 , $655.65 , $634.50 , $634.50 , $564.00 , $564.00 , $135.39 , $650.93 , $669.75 , $634.50 , $634.50 , $634.50 , $655.65 , $676.80 ," $1,105.15 ", $599.25 , $788.30 , $486.10 , N/A , $642.18 , $642.18 , $669.75 , $701.76 , $135.39 ," $1,105.15 "
 Fac Athletic Training Eval Mod Complex ,CPT® 97170,0951 - OTHER THERAPEUTIC SERVICES - ATHLETIC TRAINING,N/A,N/A, $160.00 , $104.00 , $134.40 , N/A , N/A , $129.28 , $144.00 , $135.46 , $144.00 , $144.00 , $144.00 , $136.00 , N/A , $147.73 , $152.00 , $136.00 , $148.80 , $148.80 , $152.00 , $153.60 , $130.91 , $144.00 , $136.00 , $126.40 , N/A , $129.49 , $129.49 , $152.00 , $137.30 , $126.40 , $153.60 
 Hsv 2 G Specific Lgg Beaker1 ,CPT® 86696,0302 - LAB/IMMUNOLOGY,N/A,N/A, $178.00 , $115.70 , $149.52 , $19.74 , $19.74 , $143.82 , $160.20 , $150.69 , $160.20 , $160.20 , $160.20 , $151.30 , $19.35 , $164.35 , $169.10 , $151.30 , $165.54 , $165.54 , $169.10 , $170.88 , $145.64 , $160.20 , $151.30 , $140.62 , N/A , $144.06 , $144.06 , $169.10 , $152.74 , $19.35 , $170.88 
" Fac MRI W/O Fol W/Cont, Brst, Un ",HCPCS C8905,0614 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI-OTHER,N/A,N/A," $6,844.00 "," $4,448.60 "," $5,748.96 ", N/A , N/A ," $5,529.95 "," $6,159.60 "," $5,794.13 "," $6,159.60 "," $6,159.60 "," $6,159.60 "," $5,817.40 ", N/A ," $6,319.07 "," $6,501.80 "," $5,817.40 "," $6,364.92 "," $6,364.92 "," $6,501.80 "," $6,570.24 "," $5,599.76 "," $6,159.60 "," $5,817.40 "," $5,406.76 ", N/A ," $5,538.85 "," $5,538.85 "," $6,501.80 "," $5,872.84 "," $5,406.76 "," $6,570.24 "
 Fac Obstetric Panel ,CPT® 80081,0300 - LABORATORY,N/A,N/A, $886.00 , $575.90 , $744.24 , $76.36 , $76.36 , $715.89 , $797.40 , $750.09 , $797.40 , $797.40 , $797.40 , $753.10 , $74.86 , $818.04 , $841.70 , $753.10 , $823.98 , $823.98 , $841.70 , $850.56 , $724.93 , $797.40 , $753.10 , $699.94 , N/A , $717.04 , $717.04 , $841.70 , $760.28 , $74.86 , $850.56 
Inject Carpal Tunnel,CPT® 20526,N/A,N/A,N/A, $497.00 , $323.05 , $344.24 , $53.49 , $26.41 , $280.39 , $270.32 , $462.21 , $447.30 , $447.30 , $397.60 , $397.60 , $26.41 , $458.88 , $472.15 , $447.30 , $447.30 , $447.30 , $462.21 , $477.12 , $320.52 , $422.45 , $297.94 , $328.48 , N/A , $285.86 , $285.86 , $472.15 , $335.99 , $26.41 , $477.12 
 ZIPRASIDONE HCL 20 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-6269-08,1 capsule, $46.05 , $29.93 , $38.68 , N/A , N/A , $37.21 , $41.45 , $38.99 , $41.45 , $41.45 , $41.45 , $39.14 , N/A , $42.52 , $43.75 , $39.14 , $42.83 , $42.83 , $43.75 , $44.21 , $37.68 , $41.45 , $39.14 , $36.38 , N/A , $37.27 , $37.27 , $43.75 , $39.52 , $36.38 , $44.21 
 Pro Biopsy Arm/Elbow Soft Tissue ,CPT® 24065,0982 - PRO FEE/OUTPT,N/A,N/A," $1,293.00 ", $840.45 ," $1,008.28 ", $156.67 , $80.09 , $810.32 , $821.77 ," $1,202.49 "," $1,163.70 "," $1,163.70 "," $1,034.40 "," $1,034.40 ", $80.09 ," $1,193.83 "," $1,228.35 "," $1,163.70 "," $1,163.70 "," $1,163.70 "," $1,202.49 "," $1,241.28 ", $933.96 ," $1,099.05 ", $899.17 , $965.13 , N/A , $826.12 , $826.12 ," $1,228.35 ", $970.99 , $80.09 ," $1,241.28 "
 Pro Est Patient Visit Level 5 ,CPT® 99215,0982 - PRO FEE/OUTPT,N/A,N/A, $394.00 , $256.10 , $292.89 , $139.34 , $94.97 , $192.33 , $191.18 , $366.42 , $354.60 , $354.60 , $315.20 , $315.20 , $94.97 , $363.78 , $374.30 , $354.60 , $354.60 , $354.60 , $366.42 , $378.24 , $266.74 , $334.90 , $237.78 , $242.86 , $128.75 , $196.08 , $196.08 , $374.30 , $226.13 , $94.97 , $378.24 
" Pro X-Ray Exam of Leg, Infant ",CPT® 73592,0972 - PRO FEE/RAD/DX,N/A,N/A, $99.00 , $64.35 , $178.87 , $31.03 , $27.65 , $128.52 , $148.62 , $92.07 , $89.10 , $89.10 , $79.20 , $79.20 , $27.65 , $91.41 , $94.05 , $89.10 , $89.10 , $89.10 , $92.07 , $95.04 , $172.54 , $84.15 , $163.71 , $136.90 , N/A , $131.02 , $131.02 , $94.05 , $151.65 , $27.65 , $178.87 
Open Rx Condylar Fx Femur,CPT® 27511,N/A,N/A,N/A," $6,847.00 "," $4,450.55 "," $6,011.85 ", $938.91 ," $1,009.74 "," $4,810.45 "," $4,759.56 "," $6,367.71 "," $6,162.30 "," $6,162.30 "," $5,477.60 "," $5,477.60 "," $1,009.74 "," $6,321.84 "," $6,504.65 "," $6,162.30 "," $6,162.30 "," $6,162.30 "," $6,367.71 "," $6,573.12 "," $5,606.65 "," $5,819.95 "," $5,270.13 "," $5,653.65 ", N/A ," $4,904.32 "," $4,904.32 "," $6,504.65 "," $5,764.31 ", $938.91 ," $6,573.12 "
 Eeg Extended Monitoring > 1hr/8hrs ,CPT® 95813,0740 - EEG,N/A,N/A," $2,055.00 "," $1,335.75 "," $1,726.20 ", $421.36 , $344.42 ," $1,660.44 "," $1,849.50 "," $1,739.76 "," $1,849.50 "," $1,849.50 "," $1,849.50 "," $1,746.75 ", $337.67 ," $1,897.38 "," $1,952.25 "," $1,746.75 "," $1,911.15 "," $1,911.15 "," $1,952.25 "," $1,972.80 "," $1,681.40 "," $1,849.50 "," $1,746.75 "," $1,623.45 ", N/A ," $1,663.11 "," $1,663.11 "," $1,952.25 "," $1,763.40 ", $337.67 ," $1,972.80 "
"Knee Scope, W/Lateral Release",29873,N/A,N/A,N/A," $3,447.00 "," $2,240.55 "," $3,291.41 ", $516.47 , $452.38 ," $2,534.68 "," $2,544.11 "," $3,205.71 "," $3,102.30 "," $3,102.30 "," $2,757.60 "," $2,757.60 ", $452.38 ," $3,182.62 "," $3,274.65 "," $3,102.30 "," $3,102.30 "," $3,102.30 "," $3,205.71 "," $3,309.12 "," $3,043.70 "," $2,929.95 "," $2,802.76 "," $2,997.14 ", N/A ," $2,584.13 "," $2,584.13 "," $3,274.65 "," $3,037.27 ", $452.38 ," $3,309.12 "
 Fac Drug Screen Quantitative Mycophenolate ,CPT® 80180,0301 - LAB/CHEMISTRY,N/A,N/A, $196.00 , $127.40 , $164.64 , $18.41 , $18.41 , $158.37 , $176.40 , $165.93 , $176.40 , $176.40 , $176.40 , $166.60 , $18.05 , $180.97 , $186.20 , $166.60 , $182.28 , $182.28 , $186.20 , $188.16 , $160.37 , $176.40 , $166.60 , $154.84 , N/A , $158.62 , $158.62 , $186.20 , $168.19 , $18.05 , $188.16 
 Pro Injection Aa&/Strd Pudendal Nerve ,CPT® 64430,0982 - PRO FEE/OUTPT,N/A,N/A, $944.00 , $613.60 , $267.18 , $52.29 , $61.84 , $465.02 , $442.31 , $877.92 , $849.60 , $849.60 , $755.20 , $755.20 , $61.84 , $871.60 , $896.80 , $849.60 , $849.60 , $849.60 , $877.92 , $906.24 , $291.12 , $802.40 , $429.96 , $485.39 , N/A , $474.09 , $474.09 , $896.80 , $508.59 , $52.29 , $906.24 
Open Biopsy of Hip Joint,CPT® 27052,N/A,N/A,N/A," $3,802.00 "," $2,471.30 "," $3,526.84 ", $554.49 , $893.47 ," $2,793.39 "," $2,790.13 "," $3,535.86 "," $3,421.80 "," $3,421.80 "," $3,041.60 "," $3,041.60 ", $893.47 ," $3,510.39 "," $3,611.90 "," $3,421.80 "," $3,421.80 "," $3,421.80 "," $3,535.86 "," $3,649.92 "," $3,277.81 "," $3,231.70 "," $3,077.51 "," $3,294.82 ", N/A ," $2,847.89 "," $2,847.89 "," $3,611.90 "," $3,347.29 ", $554.49 ," $3,649.92 "
Puraply 1 Sq Cm,HCPCS Q4195,N/A,N/A,N/A, $340.00 , $221.00 , N/A , N/A , N/A , N/A , N/A , $316.20 , $306.00 , $306.00 , $272.00 , $272.00 , N/A , $313.92 , $323.00 , $306.00 , $306.00 , $306.00 , $316.20 , $326.40 , $119.41 , $289.00 , $135.69 , $92.88 , N/A , N/A , N/A , $323.00 , N/A , $92.88 , $326.40 
 OSELTAMIVIR PHOSPHATE 6 MG/ML PO SUSR ,HCPCS RXC637,0250 - PHARMACY,47781-0384-26,60 mL, $841.73 , $547.12 , $707.05 , N/A , N/A , $680.12 , $757.56 , $712.61 , $757.56 , $757.56 , $757.56 , $715.47 , N/A , $777.17 , $799.64 , $715.47 , $782.81 , $782.81 , $799.64 , $808.06 , $688.70 , $757.56 , $715.47 , $664.97 , N/A , $681.21 , $681.21 , $799.64 , $722.29 , $664.97 , $808.06 
Inj Heparin Sodium per 10 U,HCPCS J1642,N/A,N/A,N/A, $7.00 , $4.55 , N/A , $0.07 , $0.02 , N/A , N/A , $6.51 , $6.30 , $6.30 , $5.60 , $5.60 , $0.02 , $6.46 , $6.65 , $6.30 , $6.30 , $6.30 , $6.51 , $6.72 , $0.03 , $5.95 , $0.65 , $0.03 , N/A , N/A , N/A , $6.65 , N/A , $0.02 , $6.72 
 Pro Extremity Study ,CPT® 93971,0972 - PRO FEE/RAD/DX,N/A,N/A, $683.00 , $443.95 , $757.84 , $117.01 , $110.85 , $649.39 , $655.74 , $635.19 , $614.70 , $614.70 , $546.40 , $546.40 , $110.85 , $630.61 , $648.85 , $614.70 , $614.70 , $614.70 , $635.19 , $655.68 , $529.14 , $580.55 , $348.72 , $456.86 , N/A , $662.05 , $662.05 , $648.85 , $733.92 , $110.85 , $757.84 
Short-Latency Somatosens Ep Std Upr & Low Limbs,CPT® 95938,N/A,N/A,N/A," $1,631.00 "," $1,060.15 "," $1,335.17 ", $356.99 , $231.13 ," $1,085.88 "," $1,133.25 "," $1,516.83 "," $1,467.90 "," $1,467.90 "," $1,304.80 "," $1,304.80 ", $231.13 ," $1,505.90 "," $1,549.45 "," $1,467.90 "," $1,467.90 "," $1,467.90 "," $1,516.83 "," $1,565.76 "," $1,553.34 "," $1,386.35 ", $994.45 ," $1,304.32 ", N/A ," $1,107.07 "," $1,107.07 "," $1,549.45 "," $1,361.03 ", $231.13 ," $1,565.76 "
Egd Balloon Dilation Esophagus <30 Mm Diam,CPT® 43249,N/A,N/A,N/A," $2,460.00 "," $1,599.00 ", $939.77 , $145.24 , $162.52 , $788.17 , $844.47 ," $2,287.80 "," $2,214.00 "," $2,214.00 "," $1,968.00 "," $1,968.00 ", $162.52 ," $2,271.32 "," $2,337.00 "," $2,214.00 "," $2,214.00 "," $2,214.00 "," $2,287.80 "," $2,361.60 ", $675.81 ," $2,091.00 ", $924.15 , $893.64 , N/A , $803.55 , $803.55 ," $2,337.00 ", $840.42 , $145.24 ," $2,361.60 "
 Fac Evasc Rpr Dplmnt Aorto-Un-Iliac Ndgft ,CPT® 34703,0360 - OR SERVICES,N/A,N/A," $2,040.00 "," $1,326.00 "," $1,713.60 "," $1,224.74 "," $1,045.16 "," $1,648.32 "," $1,836.00 "," $1,727.06 "," $1,836.00 "," $1,836.00 "," $1,836.00 "," $1,734.00 "," $1,024.67 "," $1,883.53 "," $1,938.00 "," $1,734.00 "," $1,897.20 "," $1,897.20 "," $1,938.00 "," $1,958.40 "," $1,669.13 "," $1,836.00 "," $1,734.00 "," $1,611.60 ", N/A ," $1,650.97 "," $1,650.97 "," $1,938.00 "," $1,750.52 "," $1,024.67 "," $1,958.40 "
Removal Vaginal for.Body W Anesth,CPT® 57415,N/A,N/A,N/A, $979.00 , $636.35 , $835.50 , $169.00 , $73.68 , $652.10 , $651.22 , $910.47 , $881.10 , $881.10 , $783.20 , $783.20 , $73.68 , $903.91 , $930.05 , $881.10 , $881.10 , $881.10 , $910.47 , $939.84 , $860.95 , $832.15 , $849.21 , $660.53 , N/A , $664.82 , $664.82 , $930.05 , $797.42 , $73.68 , $939.84 
 Pro Drsng/Debride Burns Small ,CPT® 16020,0982 - PRO FEE/OUTPT,N/A,N/A, $364.00 , $236.60 , $173.81 , $52.76 , $30.25 , $148.68 , $145.73 , $338.52 , $327.60 , $327.60 , $291.20 , $291.20 , $30.25 , $336.08 , $345.80 , $327.60 , $327.60 , $327.60 , $338.52 , $349.44 , $191.27 , $309.40 , $289.02 , $192.11 , N/A , $151.58 , $151.58 , $345.80 , $175.80 , $30.25 , $349.44 
 Pro Diagnostic Bone Marrow Biopsies ,CPT® 38221,0972 - PRO FEE/RAD/DX,N/A,N/A, $480.00 , $312.00 , $340.20 , $67.98 , $234.23 , $269.17 , $270.00 , $446.40 , $432.00 , $432.00 , $384.00 , $384.00 , $234.23 , $443.18 , $456.00 , $432.00 , $432.00 , $432.00 , $446.40 , $460.80 , $359.38 , $408.00 , $387.14 , $355.09 , N/A , $274.42 , $274.42 , $456.00 , $318.38 , $67.98 , $460.80 
 Pro Inj for Sacroiliac Jt Anesth ,HCPCS G0260,0982 - PRO FEE/OUTPT,N/A,N/A," $1,862.00 "," $1,210.30 ", N/A , N/A , N/A , N/A , N/A ," $1,731.66 "," $1,675.80 "," $1,675.80 "," $1,489.60 "," $1,489.60 ", N/A ," $1,719.18 "," $1,768.90 "," $1,675.80 "," $1,675.80 "," $1,675.80 "," $1,731.66 "," $1,787.52 ", N/A ," $1,582.70 "," $1,489.60 ", N/A , N/A , N/A , N/A ," $1,768.90 ", N/A ," $1,489.60 "," $1,787.52 "
Assay Non-Endocrine Receptor,CPT® 84238,N/A,N/A,N/A, $340.00 , $221.00 , N/A , $37.30 , $37.30 , $206.92 , $247.50 , $316.20 , $306.00 , $306.00 , $272.00 , $272.00 , $37.30 , $313.92 , $323.00 , $306.00 , $306.00 , $306.00 , $316.20 , $326.40 , $244.19 , $289.00 , $240.03 , $132.58 , N/A , $193.11 , $193.11 , $323.00 , $211.02 , $37.30 , $326.40 
Indocyanine-Green Angrph W/Multiframe I&R Uni/Bi,CPT® 92240,N/A,N/A,N/A, $649.00 , $421.85 , $418.14 , $186.24 , $100.14 , $446.40 , $468.66 , $603.57 , $584.10 , $584.10 , $519.20 , $519.20 , $100.14 , $599.22 , $616.55 , $584.10 , $584.10 , $584.10 , $603.57 , $623.04 , $616.94 , $551.65 , $792.73 , $441.34 , N/A , $455.11 , $455.11 , $616.55 , $541.37 , $100.14 , $792.73 
Intranasal Biopsy,CPT® 30100,N/A,N/A,N/A, $858.00 , $557.70 , $366.56 , $65.32 , $46.08 , $262.22 , $263.55 , $797.94 , $772.20 , $772.20 , $686.40 , $686.40 , $46.08 , $792.19 , $815.10 , $772.20 , $772.20 , $772.20 , $797.94 , $823.68 , $348.99 , $729.30 , $371.09 , $345.41 , N/A , $267.33 , $267.33 , $815.10 , $314.84 , $46.08 , $823.68 
Ins Intrvas Vc Filtr W/WO Vas Acs Vsl Selxn Rs&I,CPT® 37191,N/A,N/A,N/A," $16,519.00 "," $10,737.35 "," $1,332.05 ", $205.76 ," $2,085.23 "," $1,047.65 "," $1,023.10 "," $15,362.67 "," $14,867.10 "," $14,867.10 "," $13,215.20 "," $13,215.20 "," $2,085.23 "," $15,251.99 "," $15,693.05 "," $14,867.10 "," $14,867.10 "," $14,867.10 "," $15,362.67 "," $15,858.24 "," $1,239.60 "," $14,041.15 "," $1,263.12 "," $1,118.10 ", N/A ," $1,068.09 "," $1,068.09 "," $15,693.05 "," $1,213.35 ", $205.76 ," $15,858.24 "
 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LFU IM INJ ,HCPCS 90714,0636 - DRUGS REQUIRING DETAILED CODIN,49281-0215-15,0.5 mL, $216.72 , $140.87 , $182.04 , $31.67 , $36.78 , $175.11 , $195.05 , $183.48 , $195.05 , $195.05 , $195.05 , $184.21 , $36.06 , $200.10 , $205.88 , $184.21 , $201.55 , $201.55 , $205.88 , $208.05 , $177.32 , $195.05 , $184.21 , $171.21 , N/A , $175.39 , $175.39 , $205.88 , $185.97 , $31.67 , $208.05 
 Fac Microdissection Prep Identified Target Manual ,CPT® 88381,0310 - PATHOLOGY LAB,N/A,N/A, $668.00 , $434.20 , $561.12 , $197.49 , $163.84 , $539.74 , $601.20 , $565.53 , $601.20 , $601.20 , $601.20 , $567.80 , $160.63 , $616.76 , $634.60 , $567.80 , $621.24 , $621.24 , $634.60 , $641.28 , $546.56 , $601.20 , $567.80 , $527.72 , N/A , $540.61 , $540.61 , $634.60 , $573.21 , $160.63 , $641.28 
 Pro Breast Loc Device W Stereotactic Imaging ,CPT® 19283,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,020.00 ", $663.00 , $322.08 , $95.27 , $78.20 , $285.19 , $282.91 , $948.60 , $918.00 , $918.00 , $816.00 , $816.00 , $78.20 , $941.77 , $969.00 , $918.00 , $918.00 , $918.00 , $948.60 , $979.20 , $355.25 , $867.00 , $520.64 , $360.47 , N/A , $290.75 , $290.75 , $969.00 , $337.18 , $78.20 , $979.20 
 Fac Proctosgmdsc Rigid W/Bx Single/Multiple ,CPT® 45305,0360 - OR SERVICES,N/A,N/A," $1,609.00 "," $1,045.85 "," $1,351.56 ", $68.74 , $68.55 ," $1,300.07 "," $1,448.10 "," $1,362.18 "," $1,448.10 "," $1,448.10 "," $1,448.10 "," $1,367.65 ", $67.21 ," $1,485.59 "," $1,528.55 "," $1,367.65 "," $1,496.37 "," $1,496.37 "," $1,528.55 "," $1,544.64 "," $1,316.48 "," $1,448.10 "," $1,367.65 "," $1,271.11 ", N/A ," $1,302.16 "," $1,302.16 "," $1,528.55 "," $1,380.68 ", $67.21 ," $1,544.64 "
Treatmnt Superficial Wnd,CPT® 12020,N/A,N/A,N/A," $1,121.00 ", $728.65 , $598.88 , $179.70 , $32.39 , $514.39 , $504.42 ," $1,042.53 "," $1,008.90 "," $1,008.90 ", $896.80 , $896.80 , $32.39 ," $1,035.02 "," $1,064.95 "," $1,008.90 "," $1,008.90 "," $1,008.90 "," $1,042.53 "," $1,076.16 ", $660.06 , $952.85 ," $1,004.43 ", $658.84 , N/A , $524.43 , $524.43 ," $1,064.95 ", $608.16 , $32.39 ," $1,076.16 "
 Fac Coccidioides Antibody ,CPT® 86635,0302 - LAB/IMMUNOLOGY,N/A,N/A, $143.00 , $92.95 , $120.12 , $11.70 , $8.07 , $115.54 , $128.70 , $121.06 , $128.70 , $128.70 , $128.70 , $121.55 , $7.91 , $132.03 , $135.85 , $121.55 , $132.99 , $132.99 , $135.85 , $137.28 , $117.00 , $128.70 , $121.55 , $112.97 , N/A , $115.73 , $115.73 , $135.85 , $122.71 , $7.91 , $137.28 
 Fac X-Ray Exam of Mastoids ,CPT® 70120,0320 - DX X-RAY,N/A,N/A, $343.00 , $222.95 , $288.12 , $37.96 , $32.37 , $277.14 , $308.70 , $290.38 , $308.70 , $308.70 , $308.70 , $291.55 , $31.74 , $316.69 , $325.85 , $291.55 , $318.99 , $318.99 , $325.85 , $329.28 , $280.64 , $308.70 , $291.55 , $270.97 , N/A , $277.59 , $277.59 , $325.85 , $294.33 , $31.74 , $329.28 
Lam Facetectomy&Foramot 1 Vrt Sgm Ea Addl Sgm,CPT® 63048,N/A,N/A,N/A," $1,794.00 "," $1,166.10 ", $968.03 , $188.25 , $188.29 ," $1,153.19 "," $1,097.26 "," $1,668.42 "," $1,614.60 "," $1,614.60 "," $1,435.20 "," $1,435.20 ", $188.29 ," $1,656.40 "," $1,704.30 "," $1,614.60 "," $1,614.60 "," $1,614.60 "," $1,668.42 "," $1,722.24 "," $1,053.16 "," $1,524.90 "," $1,120.39 "," $1,204.32 ", N/A ," $1,175.69 "," $1,175.69 "," $1,704.30 "," $1,261.24 ", $188.25 ," $1,722.24 "
Enterotomy Decompress Small Bowel,CPT® 44021,N/A,N/A,N/A," $5,884.00 "," $3,824.60 "," $5,784.74 ", $896.37 , $958.55 ," $4,589.50 "," $4,627.95 "," $5,472.12 "," $5,295.60 "," $5,295.60 "," $4,707.20 "," $4,707.20 ", $958.55 ," $5,432.70 "," $5,589.80 "," $5,295.60 "," $5,295.60 "," $5,295.60 "," $5,472.12 "," $5,648.64 "," $4,159.03 "," $5,001.40 "," $5,150.59 "," $5,410.87 ", N/A ," $4,679.04 "," $4,679.04 "," $5,589.80 "," $4,893.77 ", $896.37 ," $5,784.74 "
 Fac Assay of Urine Phosphorus ,CPT® 84105,0301 - LAB/CHEMISTRY,N/A,N/A, $61.00 , $39.65 , $51.24 , $5.90 , $5.90 , $49.29 , $54.90 , $51.64 , $54.90 , $54.90 , $54.90 , $51.85 , $5.78 , $56.32 , $57.95 , $51.85 , $56.73 , $56.73 , $57.95 , $58.56 , $49.91 , $54.90 , $51.85 , $48.19 , N/A , $49.37 , $49.37 , $57.95 , $52.34 , $5.78 , $58.56 
Rmvl Impltbl Dfb Plse Gen W/Repl Plse Gen 1 Lead,CPT® 33262,N/A,N/A,N/A," $3,461.00 "," $2,249.65 "," $2,230.35 ", $344.20 , $279.46 ," $1,641.83 "," $1,585.52 "," $3,218.73 "," $3,114.90 "," $3,114.90 "," $2,768.80 "," $2,768.80 ", $279.46 ," $3,195.54 "," $3,287.95 "," $3,114.90 "," $3,114.90 "," $3,114.90 "," $3,218.73 "," $3,322.56 "," $2,059.31 "," $2,941.85 "," $1,991.02 "," $1,803.17 ", N/A ," $1,673.87 "," $1,673.87 "," $3,287.95 "," $1,901.50 ", $279.46 ," $3,322.56 "
Reconstruct Radial Head,24365,N/A,N/A,N/A," $4,393.00 "," $2,855.45 "," $3,909.43 ", $612.92 , $614.70 ," $3,079.54 "," $3,061.50 "," $4,085.49 "," $3,953.70 "," $3,953.70 "," $3,514.40 "," $3,514.40 ", $614.70 ," $4,056.06 "," $4,173.35 "," $3,953.70 "," $3,953.70 "," $3,953.70 "," $4,085.49 "," $4,217.28 "," $3,633.46 "," $3,734.05 "," $3,380.80 "," $3,628.31 ", N/A ," $3,139.62 "," $3,139.62 "," $4,173.35 "," $3,690.17 ", $612.92 ," $4,217.28 "
 Fac Diagnostic Computed Tomography Thorax W/O Cntrst ,CPT® 71250,0350 - CT SCAN,N/A,N/A," $2,042.00 "," $1,327.30 "," $1,715.28 ", $135.95 , $250.57 ," $1,649.94 "," $1,837.80 "," $1,728.76 "," $1,837.80 "," $1,837.80 "," $1,837.80 "," $1,735.70 ", $245.66 ," $1,885.38 "," $1,939.90 "," $1,735.70 "," $1,899.06 "," $1,899.06 "," $1,939.90 "," $1,960.32 "," $1,670.76 "," $1,837.80 "," $1,735.70 "," $1,613.18 ", N/A ," $1,652.59 "," $1,652.59 "," $1,939.90 "," $1,752.24 ", $135.95 ," $1,960.32 "
 Pro Rpr Cplx F/C/C/M/N/Ax/G/H/F Ea 5 Cm/< ,CPT® 13133,0982 - PRO FEE/OUTPT,N/A,N/A," $1,114.00 ", $724.10 , $400.49 , $119.01 , $130.42 , $358.67 , $346.07 ," $1,036.02 "," $1,002.60 "," $1,002.60 ", $891.20 , $891.20 , $130.42 ," $1,028.56 "," $1,058.30 "," $1,002.60 "," $1,002.60 "," $1,002.60 "," $1,036.02 "," $1,069.44 ", $443.31 , $946.90 , $692.22 , $459.37 , N/A , $365.66 , $365.66 ," $1,058.30 ", $424.04 , $119.01 ," $1,069.44 "
Diagnostic Lumbar Spinal Puncture,CPT® 62270,N/A,N/A,N/A," $1,057.00 ", $687.05 , $298.01 , $58.13 , $157.45 , $435.77 , $418.02 , $983.01 , $951.30 , $951.30 , $845.60 , $845.60 , $157.45 , $975.93 ," $1,004.15 ", $951.30 , $951.30 , $951.30 , $983.01 ," $1,014.72 ", $322.97 , $898.45 , $413.90 , $464.99 , N/A , $444.28 , $444.28 ," $1,004.15 ", $476.62 , $58.13 ," $1,014.72 "
 Pro Laps Esophgl Sphnctr Agmntj Plmt Dev Crrpl ,CPT® 43284,0982 - PRO FEE/OUTPT,N/A,N/A," $4,111.00 "," $2,672.15 "," $3,891.42 ", $603.19 , N/A ," $2,940.70 "," $2,981.20 "," $3,823.23 "," $3,699.90 "," $3,699.90 "," $3,288.80 "," $3,288.80 ", N/A ," $3,795.69 "," $3,905.45 "," $3,699.90 "," $3,699.90 "," $3,699.90 "," $3,823.23 "," $3,946.56 "," $2,784.66 "," $3,494.35 "," $3,470.37 "," $3,604.77 ", N/A ," $2,998.08 "," $2,998.08 "," $3,905.45 "," $3,135.66 ", $603.19 ," $3,946.56 "
 DARATUMUMAB 400 MG/20ML IV SOLN ,HCPCS J9145,0636 - DRUGS REQUIRING DETAILED CODIN,57894-0502-20,20 mL," $7,868.28 "," $5,114.38 "," $6,609.36 ", $63.02 , $61.99 ," $6,357.57 "," $7,081.45 "," $6,661.29 "," $7,081.45 "," $7,081.45 "," $7,081.45 "," $6,688.04 ", $60.77 ," $7,264.78 "," $7,474.87 "," $6,688.04 "," $7,317.50 "," $7,317.50 "," $7,474.87 "," $7,553.55 "," $6,437.83 "," $7,081.45 "," $6,688.04 "," $6,215.94 ", N/A ," $6,367.80 "," $6,367.80 "," $7,474.87 "," $6,751.77 ", $60.77 ," $7,553.55 "
Implant Neurostim/Receiver,CPT® 63685,N/A,N/A,N/A," $2,405.00 "," $1,563.25 "," $1,742.99 ", $340.52 , $400.51 ," $2,020.96 "," $1,961.82 "," $2,236.65 "," $2,164.50 "," $2,164.50 "," $1,924.00 "," $1,924.00 ", $400.51 ," $2,220.54 "," $2,284.75 "," $2,164.50 "," $2,164.50 "," $2,164.50 "," $2,236.65 "," $2,308.80 "," $1,888.75 "," $2,044.25 "," $1,944.63 "," $2,124.75 ", N/A ," $2,060.40 "," $2,060.40 "," $2,284.75 "," $2,210.30 ", $340.52 ," $2,308.80 "
 Pro Insert Non-Tunnel Cv Cath ,CPT® 36556,0982 - PRO FEE/OUTPT,N/A,N/A," $1,860.00 "," $1,209.00 ", $514.22 , $79.62 , $322.67 , $528.55 , $516.83 ," $1,729.80 "," $1,674.00 "," $1,674.00 "," $1,488.00 "," $1,488.00 ", $322.67 ," $1,717.34 "," $1,767.00 "," $1,674.00 "," $1,674.00 "," $1,674.00 "," $1,729.80 "," $1,785.60 ", $476.45 ," $1,581.00 ", $636.91 , $489.07 , N/A , $538.87 , $538.87 ," $1,767.00 ", $612.15 , $79.62 ," $1,785.60 "
"US,Pregnant Uterus,F/U,Transabd App",CPT® 76816,N/A,N/A,N/A, $836.00 , $543.40 , $625.47 , $108.84 , $76.19 , $551.27 , $625.30 , $777.48 , $752.40 , $752.40 , $668.80 , $668.80 , $76.19 , $771.88 , $794.20 , $752.40 , $752.40 , $752.40 , $777.48 , $802.56 , $630.63 , $710.60 , $683.74 , $649.55 , N/A , $562.03 , $562.03 , $794.20 , $650.56 , $76.19 , $802.56 
Contrast Injection Perq Radiologic Eval GI Tube,CPT® 49465,N/A,N/A,N/A, $411.00 , $267.15 , $187.27 , $29.30 , $196.17 , $151.97 , $149.16 , $382.23 , $369.90 , $369.90 , $328.80 , $328.80 , $196.17 , $379.48 , $390.45 , $369.90 , $369.90 , $369.90 , $382.23 , $394.56 , $136.61 , $349.35 , $158.78 , $180.05 , N/A , $154.94 , $154.94 , $390.45 , $162.04 , $29.30 , $394.56 
" Pro Strapping,Knee ",CPT® 29530,0981 - PRO FEE/ER,N/A,N/A, $175.00 , $113.75 , $114.47 , $17.96 , $30.71 , $90.38 , $186.75 , $162.75 , $157.50 , $157.50 , $140.00 , $140.00 , $30.71 , $161.58 , $166.25 , $157.50 , $157.50 , $157.50 , $162.75 , $168.00 , $107.02 , $148.75 , $201.60 , $111.84 , N/A , $92.14 , $92.14 , $166.25 , $108.30 , $17.96 , $201.60 
Fx Cl Shouder W Man W Ane,CPT® 23655,N/A,N/A,N/A," $2,591.00 "," $1,684.15 "," $2,524.02 ", $396.16 , $212.46 ," $1,931.47 "," $1,939.57 "," $2,409.63 "," $2,331.90 "," $2,331.90 "," $2,072.80 "," $2,072.80 ", $212.46 ," $2,392.27 "," $2,461.45 "," $2,331.90 "," $2,331.90 "," $2,331.90 "," $2,409.63 "," $2,487.36 "," $2,328.36 "," $2,202.35 "," $2,131.96 "," $2,289.60 ", N/A ," $1,969.16 "," $1,969.16 "," $2,461.45 "," $2,314.46 ", $212.46 ," $2,524.02 "
 Fac Antibody Treponema Pallidum ,CPT® 86780,0302 - LAB/IMMUNOLOGY,N/A,N/A, $111.00 , $72.15 , $93.24 , $13.50 , $10.99 , $89.69 , $99.90 , $93.97 , $99.90 , $99.90 , $99.90 , $94.35 , $10.77 , $102.49 , $105.45 , $94.35 , $103.23 , $103.23 , $105.45 , $106.56 , $90.82 , $99.90 , $94.35 , $87.69 , N/A , $89.83 , $89.83 , $105.45 , $95.25 , $10.77 , $106.56 
 Path Level III 88304 Initial -Tech-Mh ,CPT® 88304,0310 - PATHOLOGY LAB,N/A,N/A, $341.00 , $221.65 , $286.44 , $41.65 , $29.95 , $275.53 , $306.90 , $288.69 , $306.90 , $306.90 , $306.90 , $289.85 , $29.36 , $314.85 , $323.95 , $289.85 , $317.13 , $317.13 , $323.95 , $327.36 , $279.01 , $306.90 , $289.85 , $269.39 , N/A , $275.97 , $275.97 , $323.95 , $292.61 , $29.36 , $327.36 
"Beta 2 Glycoprotein I Antibody,Ea",CPT® 86146,N/A,N/A,N/A, $261.00 , $169.65 , N/A , $25.96 , $8.07 , $32.88 , $39.34 , $242.73 , $234.90 , $234.90 , $208.80 , $208.80 , $8.07 , $240.98 , $247.95 , $234.90 , $234.90 , $234.90 , $242.73 , $250.56 , $169.94 , $221.85 , $167.05 , $92.28 , N/A , $30.69 , $30.69 , $247.95 , $33.54 , $8.07 , $250.56 
 CT Extremity Lower W/O Contrast ,CPT® 73700,0350 - CT SCAN,N/A,N/A," $2,640.00 "," $1,716.00 "," $2,217.60 ", $132.30 , $242.52 ," $2,133.12 "," $2,376.00 "," $2,235.02 "," $2,376.00 "," $2,376.00 "," $2,376.00 "," $2,244.00 ", $237.76 ," $2,437.51 "," $2,508.00 "," $2,244.00 "," $2,455.20 "," $2,455.20 "," $2,508.00 "," $2,534.40 "," $2,160.05 "," $2,376.00 "," $2,244.00 "," $2,085.60 ", N/A ," $2,136.55 "," $2,136.55 "," $2,508.00 "," $2,265.38 ", $132.30 ," $2,534.40 "
"I&D Mouth/Tong Intra,Submandibular",CPT® 41008,N/A,N/A,N/A," $2,465.00 "," $1,602.25 "," $1,578.33 ", $249.04 , $144.17 ," $1,314.83 "," $1,330.16 "," $2,292.45 "," $2,218.50 "," $2,218.50 "," $1,972.00 "," $1,972.00 ", $144.17 ," $2,275.93 "," $2,341.75 "," $2,218.50 "," $2,218.50 "," $2,218.50 "," $2,292.45 "," $2,366.40 "," $1,143.59 "," $2,095.25 "," $1,448.66 "," $1,548.42 ", N/A ," $1,340.48 "," $1,340.48 "," $2,341.75 "," $1,402.01 ", $144.17 ," $2,366.40 "
 Fac Molecular Pathology Interpr ,CPT® G0452,0310 - PATHOLOGY LAB,N/A,N/A, $77.00 , $50.05 , $64.68 , $49.22 , N/A , $62.22 , $69.30 , $65.19 , $69.30 , $69.30 , $69.30 , $65.45 , N/A , $71.09 , $73.15 , $65.45 , $71.61 , $71.61 , $73.15 , $73.92 , $63.00 , $69.30 , $65.45 , $60.83 , N/A , $62.32 , $62.32 , $73.15 , $66.07 , $49.22 , $73.92 
Trim Nail(S),CPT® 11719,N/A,N/A,N/A, $83.00 , $53.95 , $24.79 , $7.29 , $16.74 , $21.53 , $20.21 , $77.19 , $74.70 , $74.70 , $66.40 , $66.40 , $16.74 , $76.63 , $78.85 , $74.70 , $74.70 , $74.70 , $77.19 , $79.68 , $27.34 , $70.55 , $39.25 , $27.63 , N/A , $21.94 , $21.94 , $78.85 , $25.46 , $7.29 , $79.68 
 Pro Open Treatment Fracture Distal Tibia Only ,CPT® 27827,0975 - PRO FEE/OR,N/A,N/A," $3,512.00 "," $2,282.80 "," $6,846.58 "," $1,069.94 ", $946.73 ," $5,224.91 "," $5,223.20 "," $3,266.16 "," $3,160.80 "," $3,160.80 "," $2,809.60 "," $2,809.60 ", $946.73 ," $3,242.63 "," $3,336.40 "," $3,160.80 "," $3,160.80 "," $3,160.80 "," $3,266.16 "," $3,371.52 "," $6,349.41 "," $2,985.20 "," $5,767.88 "," $6,258.90 ", N/A ," $5,326.86 "," $5,326.86 "," $3,336.40 "," $6,260.96 ", $946.73 ," $6,846.58 "
 Fac Replace Aortic Valve Open Transaortic Approach ,CPT® 33365,0360 - OR SERVICES,N/A,N/A," $33,513.00 "," $21,783.45 "," $28,150.92 "," $1,281.15 "," $1,333.99 "," $27,078.50 "," $30,161.70 "," $28,372.11 "," $30,161.70 "," $30,161.70 "," $30,161.70 "," $28,486.05 "," $1,307.83 "," $30,942.55 "," $31,837.35 "," $28,486.05 "," $31,167.09 "," $31,167.09 "," $31,837.35 "," $32,172.48 "," $27,420.34 "," $30,161.70 "," $28,486.05 "," $26,475.27 ", N/A ," $27,122.07 "," $27,122.07 "," $31,837.35 "," $28,757.51 "," $1,281.15 "," $32,172.48 "
 LACTATED RINGERS IV SOLN ,HCPCS J7120,0258 - IV SOLUTIONS,00990-7953-09,"1,000 mL", $79.82 , $51.88 , $67.05 , $2.44 , $2.61 , $64.49 , $71.84 , $67.58 , $71.84 , $71.84 , $71.84 , $67.85 , $2.56 , $73.70 , $75.83 , $67.85 , $74.23 , $74.23 , $75.83 , $76.63 , $65.31 , $71.84 , $67.85 , $63.06 , N/A , $64.60 , $64.60 , $75.83 , $68.49 , $2.44 , $76.63 
 Fac Dbrdmt X10sv Ecsmt/Infct Skn Up 10% Bdy Surf ,CPT® 11000,0510 - CLINIC,N/A,N/A, $199.00 , $129.35 , $167.16 , $26.43 , $32.99 , $160.79 , $179.10 , N/A , $179.10 , $179.10 , $179.10 , $169.15 , $32.34 , $183.74 , $189.05 , $169.15 , $185.07 , $185.07 , $189.05 , $191.04 , $162.82 , $179.10 , $169.15 , $157.21 , N/A , $161.05 , $161.05 , $189.05 , $170.76 , $26.43 , $191.04 
"Octreotide Injection, Depot",HCPCS J2353,N/A,N/A,N/A, $317.00 , $206.05 , N/A , $212.28 , $209.76 , N/A , N/A , $294.81 , $285.30 , $285.30 , $253.60 , $253.60 , $209.76 , $292.69 , $301.15 , $285.30 , $285.30 , $285.30 , $294.81 , $304.32 , $266.64 , $269.45 , $247.17 , $289.95 , N/A , N/A , N/A , $301.15 , N/A , $209.76 , $304.32 
 Fac Egd Dilation Gastric/Duodenal Stricture ,CPT® 43245,0360 - OR SERVICES,N/A,N/A," $2,379.00 "," $1,546.35 "," $1,998.36 ", $165.31 , $174.43 ," $1,922.23 "," $2,141.10 "," $2,014.06 "," $2,141.10 "," $2,141.10 "," $2,141.10 "," $2,022.15 ", $171.01 ," $2,196.53 "," $2,260.05 "," $2,022.15 "," $2,212.47 "," $2,212.47 "," $2,260.05 "," $2,283.84 "," $1,946.50 "," $2,141.10 "," $2,022.15 "," $1,879.41 ", N/A ," $1,925.32 "," $1,925.32 "," $2,260.05 "," $2,041.42 ", $165.31 ," $2,283.84 "
 Fac Blood Volume ,CPT® 78122,0340 - NUCLEAR MEDICINE,N/A,N/A, $771.00 , $501.15 , $647.64 , $96.66 , $113.17 , $622.97 , $693.90 , $652.73 , $693.90 , $693.90 , $693.90 , $655.35 , $110.95 , $711.86 , $732.45 , $655.35 , $717.03 , $717.03 , $732.45 , $740.16 , $630.83 , $693.90 , $655.35 , $609.09 , N/A , $623.97 , $623.97 , $732.45 , $661.60 , $96.66 , $740.16 
 Incision & Drainage - Mh ,CPT® 10140,0761 - TREATMENT ROOM,N/A,N/A," $2,339.00 "," $1,520.35 "," $1,964.76 ", $113.59 , $45.35 ," $1,889.91 "," $2,105.10 "," $1,980.20 "," $2,105.10 "," $2,105.10 "," $2,105.10 "," $1,988.15 ", $44.46 ," $2,159.60 "," $2,222.05 "," $1,988.15 "," $2,175.27 "," $2,175.27 "," $2,222.05 "," $2,245.44 "," $1,913.77 "," $2,105.10 "," $1,988.15 "," $1,847.81 ", N/A ," $1,892.95 "," $1,892.95 "," $2,222.05 "," $2,007.10 ", $44.46 ," $2,245.44 "
 Fac Imfluor Std Ea Antb Dir Meth ,CPT® 88346,0302 - LAB/IMMUNOLOGY,N/A,N/A, $418.00 , $271.70 , $351.12 , $149.59 , $52.81 , $337.74 , $376.20 , $353.88 , $376.20 , $376.20 , $376.20 , $355.30 , $51.77 , $385.94 , $397.10 , $355.30 , $388.74 , $388.74 , $397.10 , $401.28 , $342.01 , $376.20 , $355.30 , $330.22 , N/A , $338.29 , $338.29 , $397.10 , $358.69 , $51.77 , $401.28 
 QUETIAPINE 12.5 MG TAB (COMES FROM 25 MG TABLET) ,HCPCS RXC637,0250 - PHARMACY,00001-0924-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Part Remv Bone,Distal Phalanx",CPT® 26236,N/A,N/A,N/A," $1,674.00 "," $1,088.10 "," $2,714.99 ", $426.37 , $307.34 ," $2,121.75 "," $2,123.66 "," $1,556.82 "," $1,506.60 "," $1,506.60 "," $1,339.20 "," $1,339.20 ", $307.34 ," $1,545.60 "," $1,590.30 "," $1,506.60 "," $1,506.60 "," $1,506.60 "," $1,556.82 "," $1,607.04 "," $2,519.51 "," $1,422.90 "," $2,333.56 "," $2,521.61 ", N/A ," $2,163.15 "," $2,163.15 "," $1,590.30 "," $2,542.45 ", $307.34 ," $2,714.99 "
Prolong outpt/office vis,G2212,N/A,N/A,N/A, $137.00 , $89.05 , $63.88 , $30.39 , $25.49 , N/A , N/A , $127.41 , $123.30 , $123.30 , $109.60 , $109.60 , $25.49 , $126.49 , $130.15 , $123.30 , $123.30 , $123.30 , $127.41 , $131.52 , $58.33 , $116.45 , $59.45 , $71.61 , N/A , $56.72 , $56.72 , $130.15 , $70.91 , $25.49 , $131.52 
 Fac Vascular Embolization or Occlusion Hemorrhage ,CPT® 37244,0360 - OR SERVICES,N/A,N/A," $14,946.00 "," $9,714.90 "," $12,554.64 ", $624.65 , $527.71 ," $12,076.37 "," $13,451.40 "," $12,653.28 "," $13,451.40 "," $13,451.40 "," $13,451.40 "," $12,704.10 ", $517.36 ," $13,799.64 "," $14,198.70 "," $12,704.10 "," $13,899.78 "," $13,899.78 "," $14,198.70 "," $14,348.16 "," $12,228.82 "," $13,451.40 "," $12,704.10 "," $11,807.34 ", N/A ," $12,095.80 "," $12,095.80 "," $14,198.70 "," $12,825.16 ", $517.36 ," $14,348.16 "
 Pro MRI Ch C-/C+ ,CPT® 71552,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,173.00 ", $762.45 ," $3,213.70 ", $462.73 , $640.25 ," $2,758.45 "," $3,508.02 "," $1,090.89 "," $1,055.70 "," $1,055.70 ", $938.40 , $938.40 , $640.25 ," $1,083.03 "," $1,114.35 "," $1,055.70 "," $1,055.70 "," $1,055.70 "," $1,090.89 "," $1,126.08 "," $2,991.65 ", $997.05 ," $3,821.27 "," $5,346.70 ", N/A ," $2,812.27 "," $2,812.27 "," $1,114.35 "," $3,255.24 ", $462.73 ," $5,346.70 "
Injection Aa&/Strd Other Peripheral Nerve/Branch,64450,N/A,N/A,N/A, $402.00 , $261.30 , $207.58 , $40.26 , $113.79 , $255.83 , $245.04 , $373.86 , $361.80 , $361.80 , $321.60 , $321.60 , $113.79 , $371.17 , $381.90 , $361.80 , $361.80 , $361.80 , $373.86 , $385.92 , $225.30 , $341.70 , $237.28 , $273.66 , N/A , $260.82 , $260.82 , $381.90 , $279.80 , $40.26 , $385.92 
 Pro Bx Soft Tiss Pelvis&Hip Area Dp Subfscal/Im ,CPT® 27041,0982 - PRO FEE/OUTPT,N/A,N/A," $6,055.00 "," $3,935.75 "," $4,303.13 ", $675.68 , $208.93 ," $3,311.81 "," $3,283.07 "," $5,631.15 "," $5,449.50 "," $5,449.50 "," $4,844.00 "," $4,844.00 ", $208.93 ," $5,590.58 "," $5,752.25 "," $5,449.50 "," $5,449.50 "," $5,449.50 "," $5,631.15 "," $5,812.80 "," $3,975.25 "," $5,146.75 "," $3,614.51 "," $3,950.00 ", N/A ," $3,376.43 "," $3,376.43 "," $5,752.25 "," $3,968.52 ", $208.93 ," $5,812.80 "
 MOXIFLOXACIN HCL 0.5 % OP SOLN ,HCPCS RXC637,0250 - PHARMACY,72266-0158-01,3 mL, $71.51 , $46.48 , $60.07 , N/A , N/A , $57.78 , $64.36 , $60.54 , $64.36 , $64.36 , $64.36 , $60.78 , N/A , $66.03 , $67.93 , $60.78 , $66.50 , $66.50 , $67.93 , $68.65 , $58.51 , $64.36 , $60.78 , $56.49 , N/A , $57.87 , $57.87 , $67.93 , $61.36 , $56.49 , $68.65 
Iadna Trichomonas Vaginalis Amplified Probe Tech,CPT® 87661,N/A,N/A,N/A, $166.00 , $107.90 , N/A , $35.79 , $35.79 , $198.56 , $235.68 , $154.38 , $149.40 , $149.40 , $132.80 , $132.80 , $35.79 , $153.27 , $157.70 , $149.40 , $149.40 , $149.40 , $154.38 , $159.36 , $234.30 , $141.10 , $168.00 , $127.26 , N/A , $185.31 , $185.31 , $157.70 , $202.50 , $35.79 , $235.68 
 Pro MRI Neck Spine W/O & W/Dye ,CPT® 72156,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,187.00 ", $771.55 ," $2,309.72 ", $329.13 , $655.99 ," $1,809.29 "," $2,972.79 "," $1,103.91 "," $1,068.30 "," $1,068.30 ", $949.60 , $949.60 , $655.99 ," $1,095.96 "," $1,127.65 "," $1,068.30 "," $1,068.30 "," $1,068.30 "," $1,103.91 "," $1,139.52 "," $1,985.57 "," $1,008.95 "," $3,239.60 "," $3,511.48 ", N/A ," $1,844.59 "," $1,844.59 "," $1,127.65 "," $2,135.13 ", $329.13 ," $3,511.48 "
 Pfizer Administration First Dose ,CPT® 0001A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
Correct Malrotation of Bowel,CPT® 44055,N/A,N/A,N/A," $10,443.00 "," $6,787.95 "," $8,822.45 "," $1,363.32 "," $1,611.98 "," $7,001.20 "," $7,073.34 "," $9,711.99 "," $9,398.70 "," $9,398.70 "," $8,354.40 "," $8,354.40 "," $1,611.98 "," $9,642.02 "," $9,920.85 "," $9,398.70 "," $9,398.70 "," $9,398.70 "," $9,711.99 "," $10,025.28 "," $6,333.16 "," $8,876.55 "," $7,881.99 "," $8,254.85 ", N/A ," $7,137.80 "," $7,137.80 "," $9,920.85 "," $7,465.38 "," $1,363.32 "," $10,025.28 "
 AZACITIDINE 100 MG IJ SUSR ,HCPCS J9025,0636 - DRUGS REQUIRING DETAILED CODIN,00781-3253-94,10 mL," $1,513.33 ", $983.66 ," $1,271.20 ", $0.41 , $0.51 ," $1,222.77 "," $1,362.00 "," $1,281.19 "," $1,362.00 "," $1,362.00 "," $1,362.00 "," $1,286.33 ", $0.50 ," $1,397.26 "," $1,437.66 "," $1,286.33 "," $1,407.40 "," $1,407.40 "," $1,437.66 "," $1,452.80 "," $1,238.21 "," $1,362.00 "," $1,286.33 "," $1,195.53 ", N/A ," $1,224.74 "," $1,224.74 "," $1,437.66 "," $1,298.59 ", $0.41 ," $1,452.80 "
 Fac Mod Sed Same Phys/Qhp Each Addl 15 Mins ,CPT® 99153,0371 - ANESTHES/RADIOLOGY,N/A,N/A, $144.00 , $93.60 , $120.96 , $10.39 , $8.53 , $116.35 , $129.60 , $121.91 , $129.60 , $129.60 , $129.60 , $122.40 , $8.36 , $132.96 , $136.80 , $122.40 , $133.92 , $133.92 , $136.80 , $138.24 , $117.82 , $129.60 , $122.40 , $113.76 , N/A , $116.54 , $116.54 , $136.80 , $123.57 , $8.36 , $138.24 
In Situ Hybridization Ea Addl Probe Stain,CPT® 88364,N/A,N/A,N/A, $352.00 , $228.80 , $492.03 , $134.42 , $76.36 , $385.01 , $442.40 , $327.36 , $316.80 , $316.80 , $281.60 , $281.60 , $76.36 , $325.00 , $334.40 , $316.80 , $316.80 , $316.80 , $327.36 , $337.92 , $915.05 , $299.20 , $657.46 , $458.85 , N/A , $359.32 , $359.32 , $334.40 , $394.88 , $76.36 , $915.05 
 VINBLASTINE SULFATE 1 MG/ML IV SOLN ,HCPCS J9360,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0278-10,10 mL, $138.67 , $90.14 , $116.48 , $4.03 , $4.07 , $112.05 , $124.80 , $117.40 , $124.80 , $124.80 , $124.80 , $117.87 , $3.99 , $128.03 , $131.74 , $117.87 , $128.96 , $128.96 , $131.74 , $133.12 , $113.46 , $124.80 , $117.87 , $109.55 , N/A , $112.23 , $112.23 , $131.74 , $118.99 , $3.99 , $133.12 
Thoracoscopy W/Thera Wedge Resexn Initial Unilat,CPT® 32666,N/A,N/A,N/A," $6,832.00 "," $4,440.80 "," $4,521.17 ", $791.37 ," $1,002.85 "," $3,293.07 "," $3,304.96 "," $6,353.76 "," $6,148.80 "," $6,148.80 "," $5,465.60 "," $5,465.60 "," $1,002.85 "," $6,307.99 "," $6,490.40 "," $6,148.80 "," $6,148.80 "," $6,148.80 "," $6,353.76 "," $6,558.72 "," $4,374.57 "," $5,807.20 "," $4,768.80 "," $4,323.58 ", N/A ," $3,357.32 "," $3,357.32 "," $6,490.40 "," $3,953.96 ", $791.37 ," $6,558.72 "
1st Hospital IP/Obs Care High Mdm 75 Minutes,CPT® 99223,N/A,N/A,N/A, $653.00 , $424.45 , $394.93 , $168.79 , $103.99 , $349.44 , $349.53 , $607.29 , $587.70 , $587.70 , $522.40 , $522.40 , $103.99 , $602.91 , $620.35 , $587.70 , $587.70 , $587.70 , $607.29 , $626.88 , $504.25 , $555.05 , $436.56 , $443.19 , $206.25 , $356.26 , $356.26 , $620.35 , $410.90 , $103.99 , $626.88 
Iaad Ia Aspergillus,CPT® 87305,N/A,N/A,N/A, $193.00 , $125.45 , N/A , $12.22 , $12.22 , $67.85 , $81.18 , $179.49 , $173.70 , $173.70 , $154.40 , $154.40 , $12.22 , $178.20 , $183.35 , $173.70 , $173.70 , $173.70 , $179.49 , $185.28 , $79.99 , $164.05 , $77.85 , $43.47 , N/A , $63.32 , $63.32 , $183.35 , $69.20 , $12.22 , $185.28 
 LURASIDONE HCL 120 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,63402-0312-30,1 tablet, $435.14 , $282.84 , $365.52 , N/A , N/A , $351.59 , $391.63 , $368.39 , $391.63 , $391.63 , $391.63 , $369.87 , N/A , $401.76 , $413.38 , $369.87 , $404.68 , $404.68 , $413.38 , $417.73 , $356.03 , $391.63 , $369.87 , $343.76 , N/A , $352.16 , $352.16 , $413.38 , $373.39 , $343.76 , $417.73 
 Pro Injection Treatment of Nerve ,CPT® 64600,0982 - PRO FEE/OUTPT,N/A,N/A," $2,753.00 "," $1,789.45 "," $1,104.48 ", $217.11 , $747.99 ," $1,205.32 "," $1,168.34 "," $2,560.29 "," $2,477.70 "," $2,477.70 "," $2,202.40 "," $2,202.40 ", $747.99 ," $2,541.84 "," $2,615.35 "," $2,477.70 "," $2,477.70 "," $2,477.70 "," $2,560.29 "," $2,642.88 "," $1,187.78 "," $2,340.05 "," $1,154.29 "," $1,318.50 ", N/A ," $1,228.83 "," $1,228.83 "," $2,615.35 "," $1,318.25 ", $217.11 ," $2,642.88 "
Ther Ivntj Cog Funcj Cntct 1st 15 Minutes,CPT® 97129,N/A,N/A,N/A, $266.00 , $172.90 , $30.24 , $22.32 , $19.24 , $52.99 , N/A , $247.38 , $239.40 , $239.40 , $212.80 , $212.80 , $19.24 , $245.60 , $252.70 , $239.40 , $239.40 , $239.40 , $247.38 , $255.36 , $58.35 , $226.10 , $66.64 , $53.70 , N/A , $54.02 , $54.02 , $252.70 , $60.00 , $19.24 , $255.36 
"Removal Foreign Body,Musc",CPT® 20520,N/A,N/A,N/A," $1,195.00 ", $776.75 , $907.27 , $141.83 , $63.53 , $711.39 , $712.53 ," $1,111.35 "," $1,075.50 "," $1,075.50 ", $956.00 , $956.00 , $63.53 ," $1,103.34 "," $1,135.25 "," $1,075.50 "," $1,075.50 "," $1,075.50 "," $1,111.35 "," $1,147.20 ", $842.13 ," $1,015.75 ", $779.64 , $849.77 , N/A , $725.26 , $725.26 ," $1,135.25 ", $852.44 , $63.53 ," $1,147.20 "
 Fac Lig/Banding Angioaccess Arven Fstl ,CPT® 37607,0360 - OR SERVICES,N/A,N/A," $5,357.00 "," $3,482.05 "," $4,499.88 ", $340.46 , $349.61 ," $4,328.46 "," $4,821.30 "," $4,535.24 "," $4,821.30 "," $4,821.30 "," $4,821.30 "," $4,553.45 ", $342.75 ," $4,946.12 "," $5,089.15 "," $4,553.45 "," $4,982.01 "," $4,982.01 "," $5,089.15 "," $5,142.72 "," $4,383.10 "," $4,821.30 "," $4,553.45 "," $4,232.03 ", N/A ," $4,335.42 "," $4,335.42 "," $5,089.15 "," $4,596.84 ", $340.46 ," $5,142.72 "
 Fac Imfluor Std Ea Antb Dir Meth ,CPT® 88346,0312 - PATHOL/HISTOL,N/A,N/A, $418.00 , $271.70 , $351.12 , $149.59 , $52.81 , $337.74 , $376.20 , $353.88 , $376.20 , $376.20 , $376.20 , $355.30 , $51.77 , $385.94 , $397.10 , $355.30 , $388.74 , $388.74 , $397.10 , $401.28 , $342.01 , $376.20 , $355.30 , $330.22 , N/A , $338.29 , $338.29 , $397.10 , $358.69 , $51.77 , $401.28 
Bx Breast W Device Addl Lesion Ultrasound Guide,CPT® 19084,N/A,N/A,N/A," $1,846.00 "," $1,199.90 ", $249.32 , $74.13 , $61.02 , $217.47 , $220.73 ," $1,716.78 "," $1,661.40 "," $1,661.40 "," $1,476.80 "," $1,476.80 ", $61.02 ," $1,704.41 "," $1,753.70 "," $1,661.40 "," $1,661.40 "," $1,661.40 "," $1,716.78 "," $1,772.16 ", $275.36 ," $1,569.10 ", $406.92 , $280.75 , N/A , $221.72 , $221.72 ," $1,753.70 ", $257.12 , $61.02 ," $1,772.16 "
"Folic Acid, RBC",CPT® 82747,N/A,N/A,N/A, $149.00 , $96.85 , N/A , $18.00 , $16.16 , $65.85 , $78.78 , $138.57 , $134.10 , $134.10 , $119.20 , $119.20 , $16.16 , $137.57 , $141.55 , $134.10 , $134.10 , $134.10 , $138.57 , $143.04 , $117.85 , $126.65 , $113.53 , $62.79 , N/A , $61.46 , $61.46 , $141.55 , $67.16 , $16.16 , $143.04 
Pro Simple Repair 7.6-12.5cm,12015,N/A,N/A,N/A, $920.00 , $598.00 , $293.11 , $87.01 , $139.20 , $268.12 , $259.48 , $855.60 , $828.00 , $828.00 , $736.00 , $736.00 , $139.20 , $849.44 , $874.00 , $828.00 , $828.00 , $828.00 , $855.60 , $883.20 , $322.89 , $782.00 , $520.95 , $325.60 , N/A , $273.35 , $273.35 , $874.00 , $317.01 , $87.01 , $883.20 
"Fungus, Antibody",CPT® 86671,N/A,N/A,N/A, $160.00 , $104.00 , N/A , $12.50 , $7.06 , $28.77 , $34.41 , $148.80 , $144.00 , $144.00 , $128.00 , $128.00 , $7.06 , $147.73 , $152.00 , $144.00 , $144.00 , $144.00 , $148.80 , $153.60 , $81.80 , $136.00 , $81.09 , $44.44 , N/A , $26.85 , $26.85 , $152.00 , $29.34 , $7.06 , $153.60 
Foot Longitud/Metatarsal Sup,HCPCS L3020,N/A,N/A,N/A, $760.00 , $494.00 , N/A , $232.08 , $93.57 , N/A , N/A , $706.80 , $684.00 , $684.00 , $608.00 , $608.00 , $93.57 , $701.71 , $722.00 , $684.00 , $684.00 , $684.00 , $706.80 , $729.60 , N/A , $646.00 , $191.38 , $195.26 , N/A , N/A , N/A , $722.00 , N/A , $93.57 , $729.60 
 CLINIMIX/DEXTROSE (4.25/10) 4.25 % IV SOLN ,HCPCS RXA258,0258 - IV SOLUTIONS,00338-1091-04,"2,000 mL", $462.32 , $300.51 , $388.35 , N/A , N/A , $373.55 , $416.09 , $391.40 , $416.09 , $416.09 , $416.09 , $392.97 , N/A , $426.86 , $439.20 , $392.97 , $429.96 , $429.96 , $439.20 , $443.83 , $378.27 , $416.09 , $392.97 , $365.23 , N/A , $374.16 , $374.16 , $439.20 , $396.72 , $365.23 , $443.83 
Radiologic Exam-Srg Spec.,CPT® 76098,N/A,N/A,N/A, $130.00 , $84.50 , $228.52 , $41.25 , $18.97 , $77.74 , $97.79 , $120.90 , $117.00 , $117.00 , $104.00 , $104.00 , $18.97 , $120.03 , $123.50 , $117.00 , $117.00 , $117.00 , $120.90 , $124.80 , $231.39 , $110.50 , $107.86 , $84.98 , N/A , $79.26 , $79.26 , $123.50 , $91.75 , $18.97 , $231.39 
 Special Teletx Port Plan ,CPT® 77321,0982 - PRO FEE/OUTPT,N/A,N/A, $544.00 , $353.60 , $522.64 , $92.48 , $110.80 , $440.75 , $469.31 , $505.92 , $489.60 , $489.60 , $435.20 , $435.20 , $110.80 , $502.28 , $516.80 , $489.60 , $489.60 , $489.60 , $505.92 , $522.24 , $529.68 , $462.40 , $514.25 , $524.38 , N/A , $449.35 , $449.35 , $516.80 , $520.14 , $92.48 , $529.68 
"Osteopathic Manip,5-6 Body Regn",CPT® 98927,N/A,N/A,N/A, $235.00 , $152.75 , $108.34 , $45.10 , $47.63 , $106.70 , $104.73 , $218.55 , $211.50 , $211.50 , $188.00 , $188.00 , $47.63 , $216.98 , $223.25 , $211.50 , $211.50 , $211.50 , $218.55 , $225.60 , $117.63 , $199.75 , $137.87 , $181.41 , N/A , $108.78 , $108.78 , $223.25 , $126.83 , $45.10 , $225.60 
Maniplatn Palar Fascial Crd Post Inj Single Cord,CPT® 26341,N/A,N/A,N/A, $234.00 , $152.10 , $479.44 , $75.11 , $76.27 , $360.26 , $359.18 , $217.62 , $210.60 , $210.60 , $187.20 , $187.20 , $76.27 , $216.05 , $222.30 , $210.60 , $210.60 , $210.60 , $217.62 , $224.64 , $440.98 , $198.90 , $392.49 , $427.51 , N/A , $367.30 , $367.30 , $222.30 , $431.69 , $75.11 , $479.44 
Layer Closure 2.6-5cm,12052,N/A,N/A,N/A," $1,245.00 ", $809.25 , $637.70 , $191.98 , $151.59 , $557.59 , $545.09 ," $1,157.85 "," $1,120.50 "," $1,120.50 ", $996.00 , $996.00 , $151.59 ," $1,149.51 "," $1,182.75 "," $1,120.50 "," $1,120.50 "," $1,120.50 "," $1,157.85 "," $1,195.20 ", $700.90 ," $1,058.25 "," $1,084.71 ", $716.31 , N/A , $568.47 , $568.47 ," $1,182.75 ", $659.24 , $151.59 ," $1,195.20 "
 Phys/Qhp Svcs OP Pulm Rehab W/O Cont Oximtry Mntr ,CPT® 94625,0948 - PULMONARY REHABILITATION,N/A,N/A, $282.00 , $183.30 , $236.88 , $16.16 , $125.77 , $227.86 , $253.80 , $238.74 , $253.80 , $253.80 , $253.80 , $239.70 , $123.30 , $260.37 , $267.90 , $239.70 , $262.26 , $262.26 , $267.90 , $270.72 , $230.73 , $253.80 , $239.70 , $222.78 , N/A , $228.22 , $228.22 , $267.90 , $241.98 , $16.16 , $270.72 
" Pro Program Eval Implant Device,Pacemaker,2 Lead ",CPT® 93280,0982 - PRO FEE/OUTPT,N/A,N/A, $774.00 , $503.10 , $517.66 , $78.83 , $50.64 , $315.12 , $321.47 , $719.82 , $696.60 , $696.60 , $619.20 , $619.20 , $50.64 , $714.63 , $735.30 , $696.60 , $696.60 , $696.60 , $719.82 , $743.04 , $482.63 , $657.90 , $299.72 , $221.10 , N/A , $321.27 , $321.27 , $735.30 , $356.13 , $50.64 , $743.04 
Remove Infusn Device/Pump,CPT® 62365,N/A,N/A,N/A," $1,951.00 "," $1,268.15 "," $1,417.21 ", $277.72 , $367.42 ," $1,640.15 "," $1,582.65 "," $1,814.43 "," $1,755.90 "," $1,755.90 "," $1,560.80 "," $1,560.80 ", $367.42 ," $1,801.36 "," $1,853.45 "," $1,755.90 "," $1,755.90 "," $1,755.90 "," $1,814.43 "," $1,872.96 "," $1,535.22 "," $1,658.35 "," $1,569.98 "," $1,729.45 ", N/A ," $1,672.15 "," $1,672.15 "," $1,853.45 "," $1,793.82 ", $277.72 ," $1,872.96 "
"Inj, Bupivacaine Liposome",HCPCS C9290,N/A,N/A,N/A, $4.00 , $2.60 , N/A , N/A , N/A , N/A , N/A , $3.72 , $3.60 , $3.60 , $3.20 , $3.20 , N/A , $3.69 , $3.80 , $3.60 , $3.60 , $3.60 , $3.72 , $3.84 , N/A , $3.40 , $3.20 , N/A , N/A , N/A , N/A , $3.80 , N/A , $3.20 , $3.84 
"Incis/Drain Thigh/Knee Abscess,Deep",CPT® 27301,N/A,N/A,N/A," $4,454.00 "," $2,895.10 "," $3,080.29 ", $483.56 , $200.19 ," $2,384.48 "," $2,411.83 "," $4,142.22 "," $4,008.60 "," $4,008.60 "," $3,563.20 "," $3,563.20 ", $200.19 ," $4,112.38 "," $4,231.30 "," $4,008.60 "," $4,008.60 "," $4,008.60 "," $4,142.22 "," $4,275.84 "," $2,854.91 "," $3,785.90 "," $2,665.39 "," $2,851.17 ", N/A ," $2,431.01 "," $2,431.01 "," $4,231.30 "," $2,857.29 ", $200.19 ," $4,275.84 "
" Pro Radiotherapy Dose Plan, Imrt ",CPT® 77301,0982 - PRO FEE/OUTPT,N/A,N/A," $2,696.00 "," $1,752.40 "," $10,198.78 "," $1,803.56 "," $1,386.70 "," $9,211.82 "," $10,279.97 "," $2,507.28 "," $2,426.40 "," $2,426.40 "," $2,156.80 "," $2,156.80 "," $1,386.70 "," $2,489.22 "," $2,561.20 "," $2,426.40 "," $2,426.40 "," $2,426.40 "," $2,507.28 "," $2,588.16 "," $10,609.11 "," $2,291.60 "," $11,267.34 "," $11,004.88 ", N/A ," $9,391.55 "," $9,391.55 "," $2,561.20 "," $10,870.90 "," $1,386.70 "," $11,267.34 "
 Fac Rp Loclzj Tum Spect 2 Area 1d Img/1 Area Img>2+D ,CPT® 78831,0409 - OTHER IMAG SVS,N/A,N/A," $3,830.00 "," $2,489.50 "," $3,217.20 ", $648.70 , $567.94 ," $3,094.64 "," $3,447.00 "," $3,242.48 "," $3,447.00 "," $3,447.00 "," $3,447.00 "," $3,255.50 ", $556.80 ," $3,536.24 "," $3,638.50 "," $3,255.50 "," $3,561.90 "," $3,561.90 "," $3,638.50 "," $3,676.80 "," $3,133.71 "," $3,447.00 "," $3,255.50 "," $3,025.70 ", N/A ," $3,099.62 "," $3,099.62 "," $3,638.50 "," $3,286.52 ", $556.80 ," $3,676.80 "
Spherocylinder Over 12.00d,HCPCS V2114,N/A,N/A,N/A, $55.00 , $35.75 , N/A , $102.05 , N/A , N/A , N/A , $51.15 , $49.50 , $49.50 , $44.00 , $44.00 , N/A , $50.78 , $52.25 , $49.50 , $49.50 , $49.50 , $51.15 , $52.80 , N/A , $46.75 , $55.00 , $92.71 , N/A , N/A , N/A , $52.25 , N/A , $44.00 , $102.05 
Revsc Opn/Prq Tib/Pero W/Angioplasty Uni Ea Vsl,CPT® 37232,N/A,N/A,N/A," $7,854.00 "," $5,105.10 "," $1,166.36 ", $179.35 , $148.88 , $877.65 , $864.20 ," $7,304.22 "," $7,068.60 "," $7,068.60 "," $6,283.20 "," $6,283.20 ", $148.88 ," $7,251.60 "," $7,461.30 "," $7,068.60 "," $7,068.60 "," $7,068.60 "," $7,304.22 "," $7,539.84 ", $969.46 ," $6,675.90 "," $1,086.49 ", $978.97 , N/A , $894.77 , $894.77 ," $7,461.30 "," $1,016.48 ", $148.88 ," $7,539.84 "
"Revise Conjunc,Buccal Membr Grft",CPT® 68325,N/A,N/A,N/A," $6,023.00 "," $3,914.95 "," $4,029.94 ", $632.84 , $922.06 ," $3,731.88 "," $3,522.80 "," $5,601.39 "," $5,420.70 "," $5,420.70 "," $4,818.40 "," $4,818.40 ", $922.06 ," $5,561.04 "," $5,721.85 "," $5,420.70 "," $5,420.70 "," $5,420.70 "," $5,601.39 "," $5,782.08 "," $5,534.61 "," $5,119.55 "," $3,657.33 "," $4,731.87 ", N/A ," $3,804.69 "," $3,804.69 "," $5,721.85 "," $4,199.87 ", $632.84 ," $5,782.08 "
"Lap,Cholecystectomy/Graph",47563,N/A,N/A,N/A," $7,409.00 "," $4,815.85 "," $4,291.24 ", $664.92 , $644.55 ," $4,426.73 "," $4,417.21 "," $6,890.37 "," $6,668.10 "," $6,668.10 "," $5,927.20 "," $5,927.20 ", $644.55 ," $6,840.73 "," $7,038.55 "," $6,668.10 "," $6,668.10 "," $6,668.10 "," $6,890.37 "," $7,112.64 "," $5,444.78 "," $6,297.65 "," $3,775.08 "," $3,957.32 ", N/A ," $4,513.10 "," $4,513.10 "," $7,038.55 "," $5,205.41 ", $644.55 ," $7,112.64 "
Replace Skull Plate/Flap,CPT® 62143,N/A,N/A,N/A," $6,740.00 "," $4,381.00 "," $4,814.26 ", $941.95 , $640.60 ," $5,637.52 "," $5,422.83 "," $6,268.20 "," $6,066.00 "," $6,066.00 "," $5,392.00 "," $5,392.00 ", $640.60 ," $6,223.04 "," $6,403.00 "," $6,066.00 "," $6,066.00 "," $6,066.00 "," $6,268.20 "," $6,470.40 "," $5,195.07 "," $5,729.00 "," $5,555.58 "," $5,823.80 ", N/A ," $5,747.52 "," $5,747.52 "," $6,403.00 "," $6,165.72 ", $640.60 ," $6,470.40 "
Admin Pneumococcal Vaccine,HCPCS G0009,N/A,N/A,N/A, $38.00 , $24.70 , N/A , N/A , N/A , $46.14 , $59.77 , $35.34 , $34.20 , $34.20 , $30.40 , $30.40 , N/A , $35.09 , $36.10 , $34.20 , $34.20 , $34.20 , $35.34 , $36.48 , N/A , $32.30 , $49.31 , $64.43 , N/A , $47.04 , $47.04 , $36.10 , $58.79 , $30.40 , $64.43 
"Injection,Therap/Proph/Diagnost, IV Push, Ea Add, New Drug",CPT® 96375,N/A,N/A,N/A, $135.00 , $87.75 , $36.72 , $15.06 , $21.95 , $49.16 , $50.34 , $125.55 , $121.50 , $121.50 , $108.00 , $108.00 , $21.95 , $124.65 , $128.25 , $121.50 , $121.50 , $121.50 , $125.55 , $129.60 , $60.86 , $114.75 , $66.91 , $67.73 , N/A , $50.12 , $50.12 , $128.25 , $58.44 , $15.06 , $129.60 
 Fac Decalcification Px ,CPT® 88311,0310 - PATHOLOGY LAB,N/A,N/A, $198.00 , $128.70 , $166.32 , $20.00 , $16.43 , $159.98 , $178.20 , $167.63 , $178.20 , $178.20 , $178.20 , $168.30 , $16.11 , $182.81 , $188.10 , $168.30 , $184.14 , $184.14 , $188.10 , $190.08 , $162.00 , $178.20 , $168.30 , $156.42 , N/A , $160.24 , $160.24 , $188.10 , $169.90 , $16.11 , $190.08 
Pfizer-Biotech Admin Peds 6m - 4y First Dose,CPT® 0081A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $56.00 , $128.02 , N/A , N/A , N/A , $66.50 , N/A , $38.92 , $128.02 
 Flo Cytometry Cell Surf Marker Techl Only Ea Addl ,CPT® 88185,0311 - PATHOL/CYTOLOGY,N/A,N/A, $373.00 , $242.45 , $313.32 , $23.32 , $23.70 , $301.38 , $335.70 , $315.78 , $335.70 , $335.70 , $335.70 , $317.05 , $23.24 , $344.39 , $354.35 , $317.05 , $346.89 , $346.89 , $354.35 , $358.08 , $305.19 , $335.70 , $317.05 , $294.67 , N/A , $301.87 , $301.87 , $354.35 , $320.07 , $23.24 , $358.08 
 Abdomen CT Scan Without/With Contrst ,CPT® 74170,0350 - CT SCAN,N/A,N/A," $4,098.00 "," $2,663.70 "," $3,442.32 ", $240.15 , $398.54 ," $3,311.18 "," $3,688.20 "," $3,469.37 "," $3,688.20 "," $3,688.20 "," $3,688.20 "," $3,483.30 ", $390.73 ," $3,783.68 "," $3,893.10 "," $3,483.30 "," $3,811.14 "," $3,811.14 "," $3,893.10 "," $3,934.08 "," $3,352.98 "," $3,688.20 "," $3,483.30 "," $3,237.42 ", N/A ," $3,316.51 "," $3,316.51 "," $3,893.10 "," $3,516.49 ", $240.15 ," $3,934.08 "
"Prostate Ca Screening, Dre",HCPCS G0102,N/A,N/A,N/A, $57.00 , $37.05 , $43.05 , $8.63 , $19.74 , $16.42 , N/A , $53.01 , $51.30 , $51.30 , $45.60 , $45.60 , $19.74 , $52.63 , $54.15 , $51.30 , $51.30 , $51.30 , $53.01 , $54.72 , $24.17 , $48.45 , $16.22 , $33.50 , N/A , $16.73 , $16.73 , $54.15 , $20.92 , $8.63 , $54.72 
 Pro Daily Hosp Mgmt Edrl/Sarach Cont Drug Admn ,CPT® 01996,0964 - PRO FEE/ANES CRNA,N/A,N/A, $575.00 , $373.75 , N/A , N/A , $18.11 , N/A , N/A , $534.75 , $517.50 , $517.50 , $460.00 , $460.00 , $18.11 , $530.90 , $546.25 , $517.50 , $517.50 , $517.50 , $534.75 , $552.00 , N/A , $488.75 , N/A , $350.52 , N/A , N/A , N/A , $546.25 , N/A , $18.11 , $552.00 
"Removal of Tonsils,<12 Y/O",CPT® 42825,N/A,N/A,N/A," $1,678.00 "," $1,090.70 "," $1,655.55 ", $261.05 , $232.33 ," $1,262.76 "," $1,305.77 "," $1,560.54 "," $1,510.20 "," $1,510.20 "," $1,342.40 "," $1,342.40 ", $232.33 ," $1,549.30 "," $1,594.10 "," $1,510.20 "," $1,510.20 "," $1,510.20 "," $1,560.54 "," $1,610.88 "," $1,164.14 "," $1,426.30 "," $1,423.68 "," $1,481.46 ", N/A ," $1,287.41 "," $1,287.41 "," $1,594.10 "," $1,346.49 ", $232.33 ," $1,655.55 "
Simple Repair 2.5cm or Le,CPT® 12011,N/A,N/A,N/A, $685.00 , $445.25 , $172.01 , $51.31 , $66.00 , $150.86 , $147.21 , $637.05 , $616.50 , $616.50 , $548.00 , $548.00 , $66.00 , $632.46 , $650.75 , $616.50 , $616.50 , $616.50 , $637.05 , $657.60 , $189.71 , $582.25 , $296.15 , $192.22 , N/A , $153.81 , $153.81 , $650.75 , $178.36 , $51.31 , $657.60 
"Shldr Arthroscop,Surg,Dis Claviculectomy",29824,N/A,N/A,N/A," $2,665.00 "," $1,732.25 "," $4,128.15 ", $647.79 , $403.88 ," $3,230.14 "," $3,267.77 "," $2,478.45 "," $2,398.50 "," $2,398.50 "," $2,132.00 "," $2,132.00 ", $403.88 ," $2,460.59 "," $2,531.75 "," $2,398.50 "," $2,398.50 "," $2,398.50 "," $2,478.45 "," $2,558.40 "," $3,835.87 "," $2,265.25 "," $3,607.38 "," $3,828.39 ", N/A ," $3,293.16 "," $3,293.16 "," $2,531.75 "," $3,870.64 ", $403.88 ," $4,128.15 "
Assay Blood Osmolality,CPT® 83930,N/A,N/A,N/A, $102.00 , $66.30 , N/A , $6.74 , $6.74 , $37.42 , $44.76 , $94.86 , $91.80 , $91.80 , $81.60 , $81.60 , $6.74 , $94.18 , $96.90 , $91.80 , $91.80 , $91.80 , $94.86 , $97.92 , $44.14 , $86.70 , $43.79 , $23.97 , N/A , $34.92 , $34.92 , $96.90 , $38.16 , $6.74 , $97.92 
Removal Shoulder Foreign Body Deep Subfascial/Im,23333,N/A,N/A,N/A," $3,712.00 "," $2,412.80 "," $2,883.66 ", $453.88 , $691.53 ," $2,502.55 "," $2,218.92 "," $3,452.16 "," $3,340.80 "," $3,340.80 "," $2,969.60 "," $2,969.60 ", $691.53 ," $3,427.29 "," $3,526.40 "," $3,340.80 "," $3,340.80 "," $3,340.80 "," $3,452.16 "," $3,563.52 "," $2,685.10 "," $3,155.20 "," $2,542.81 "," $2,662.65 ", N/A ," $2,551.38 "," $2,551.38 "," $3,526.40 "," $2,998.78 ", $453.88 ," $3,563.52 "
 EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ ,HCPCS RXC637,0250 - PHARMACY,49502-0102-02,0.3 mL, $963.17 , $626.06 , $809.06 , N/A , N/A , $778.24 , $866.85 , $815.42 , $866.85 , $866.85 , $866.85 , $818.69 , N/A , $889.29 , $915.01 , $818.69 , $895.75 , $895.75 , $915.01 , $924.64 , $788.07 , $866.85 , $818.69 , $760.90 , N/A , $779.49 , $779.49 , $915.01 , $826.50 , $760.90 , $924.64 
 Fac M/Phmtrc Alys Ish Quant/Semiq Cptr Each Multiprb ,CPT® 88374,0301 - LAB/CHEMISTRY,N/A,N/A," $1,339.00 ", $870.35 ," $1,124.76 ", $298.01 , $160.85 ," $1,081.91 "," $1,205.10 "," $1,133.60 "," $1,205.10 "," $1,205.10 "," $1,205.10 "," $1,138.15 ", $157.70 ," $1,236.30 "," $1,272.05 "," $1,138.15 "," $1,245.27 "," $1,245.27 "," $1,272.05 "," $1,285.44 "," $1,095.57 "," $1,205.10 "," $1,138.15 "," $1,057.81 ", N/A ," $1,083.65 "," $1,083.65 "," $1,272.05 "," $1,149.00 ", $157.70 ," $1,285.44 "
"Japanese Enceph Vacc, Inactivated, Im",CPT® 90738,N/A,N/A,N/A, $353.00 , $229.45 , N/A , N/A , N/A , $146.55 , $153.32 , $328.29 , $317.70 , $317.70 , $282.40 , $282.40 , N/A , $325.92 , $335.35 , $317.70 , $317.70 , $317.70 , $328.29 , $338.88 , N/A , $300.05 , $203.76 , $459.15 , N/A , $149.41 , $149.41 , $335.35 , $174.19 , $146.55 , $459.15 
 Pro Circum 28 Days or Older ,CPT® 54161,0982 - PRO FEE/OUTPT,N/A,N/A," $1,514.00 ", $984.10 , $874.86 , $188.71 , $196.32 , $630.98 , $639.26 ," $1,408.02 "," $1,362.60 "," $1,362.60 "," $1,211.20 "," $1,211.20 ", $196.32 ," $1,397.88 "," $1,438.30 "," $1,362.60 "," $1,362.60 "," $1,362.60 "," $1,408.02 "," $1,453.44 ", $819.88 ," $1,286.90 "," $1,020.48 ", $952.70 , N/A , $643.29 , $643.29 ," $1,438.30 ", $771.01 , $188.71 ," $1,453.44 "
 Pro Brncdilat Rspse Spmtry Pre&Post-Brncdilat Admn ,CPT® 94060,0982 - PRO FEE/OUTPT,N/A,N/A, $393.00 , $255.45 , $89.95 , $37.70 , $53.79 , $134.43 , $144.38 , $365.49 , $353.70 , $353.70 , $314.40 , $314.40 , $53.79 , $362.86 , $373.35 , $353.70 , $353.70 , $353.70 , $365.49 , $377.28 , $140.25 , $334.05 , $191.59 , $229.15 , N/A , $137.05 , $137.05 , $373.35 , $159.78 , $37.70 , $377.28 
 Pro Esophagogastroduodenoscopy Submucosal Injection ,CPT® 43236,0975 - PRO FEE/OR,N/A,N/A," $2,594.00 "," $1,686.10 ", $846.69 , $130.86 , $316.50 , $706.97 , $851.21 ," $2,412.42 "," $2,334.60 "," $2,334.60 "," $2,075.20 "," $2,075.20 ", $316.50 ," $2,395.04 "," $2,464.30 "," $2,334.60 "," $2,334.60 "," $2,334.60 "," $2,412.42 "," $2,490.24 ", $609.64 ," $2,204.90 ", $933.07 , $808.87 , N/A , $720.76 , $720.76 ," $2,464.30 ", $753.83 , $130.86 ," $2,490.24 "
 ISOSORBIDE DINITRATE 20 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6620-61,1 tablet, $4.40 , $2.86 , $3.70 , N/A , N/A , $3.56 , $3.96 , $3.73 , $3.96 , $3.96 , $3.96 , $3.74 , N/A , $4.06 , $4.18 , $3.74 , $4.09 , $4.09 , $4.18 , $4.22 , $3.60 , $3.96 , $3.74 , $3.48 , N/A , $3.56 , $3.56 , $4.18 , $3.78 , $3.48 , $4.22 
Rib Cartilage Graft to Face,CPT® 21230,N/A,N/A,N/A," $5,203.00 "," $3,381.95 "," $4,591.02 ", $717.47 ," $1,613.62 "," $3,692.42 "," $3,538.35 "," $4,838.79 "," $4,682.70 "," $4,682.70 "," $4,162.40 "," $4,162.40 "," $1,613.62 "," $4,803.93 "," $4,942.85 "," $4,682.70 "," $4,682.70 "," $4,682.70 "," $4,838.79 "," $4,994.88 "," $4,245.52 "," $4,422.55 "," $3,919.59 "," $4,243.56 ", N/A ," $3,764.47 "," $3,764.47 "," $4,942.85 "," $4,424.58 ", $717.47 ," $4,994.88 "
 SUCCINYLCHOLINE CHLORIDE 100 MG/5ML IV SOSY ,HCPCS RXA250,0250 - PHARMACY,70092-1086-44,1 mL, $29.45 , $19.14 , $24.74 , N/A , N/A , $23.80 , $26.51 , $24.93 , $26.51 , $26.51 , $26.51 , $25.03 , N/A , $27.19 , $27.98 , $25.03 , $27.39 , $27.39 , $27.98 , $28.27 , $24.10 , $26.51 , $25.03 , $23.27 , N/A , $23.83 , $23.83 , $27.98 , $25.27 , $23.27 , $28.27 
Esoph Balloon Distension Tst,91040,N/A,N/A,N/A," $2,252.00 "," $1,463.80 "," $1,284.26 ", $518.74 , $398.78 , $974.83 , $689.06 ," $2,094.36 "," $2,026.80 "," $2,026.80 "," $1,801.60 "," $1,801.60 ", $398.78 ," $2,079.27 "," $2,139.40 "," $2,026.80 "," $2,026.80 "," $2,026.80 "," $2,094.36 "," $2,161.92 "," $2,368.45 "," $1,914.20 ", $913.36 ," $1,699.33 ", N/A , $993.84 , $993.84 ," $2,139.40 "," $1,158.63 ", $398.78 ," $2,368.45 "
 Pro Perq Replacement Gtube Not Req Revj Gstrst Trc ,CPT® 43762,0982 - PRO FEE/OUTPT,N/A,N/A," $2,204.00 "," $1,432.60 ", $223.34 , $34.45 , $176.61 , $167.82 , N/A ," $2,049.72 "," $1,983.60 "," $1,983.60 "," $1,763.20 "," $1,763.20 ", $176.61 ," $2,034.95 "," $2,093.80 "," $1,983.60 "," $1,983.60 "," $1,983.60 "," $2,049.72 "," $2,115.84 ", $163.07 ," $1,873.40 ", $193.69 , $214.15 , N/A , $171.09 , $171.09 ," $2,093.80 ", $178.94 , $34.45 ," $2,115.84 "
Arterial Puncture,36600,N/A,N/A,N/A, $148.00 , $96.20 , $95.81 , $14.57 , $37.12 , $67.69 , $67.39 , $137.64 , $133.20 , $133.20 , $118.40 , $118.40 , $37.12 , $136.65 , $140.60 , $133.20 , $133.20 , $133.20 , $137.64 , $142.08 , $88.93 , $125.80 , $82.07 , $78.58 , N/A , $69.00 , $69.00 , $140.60 , $78.40 , $14.57 , $142.08 
Tobacco Use Cessation Intermediate 3-10 Minutes,99406,N/A,N/A,N/A, $51.00 , $33.15 , $28.60 , $11.46 , N/A , $26.24 , $26.40 , $47.43 , $45.90 , $45.90 , $40.80 , $40.80 , N/A , $47.09 , $48.45 , $45.90 , $45.90 , $45.90 , $47.43 , $48.96 , $37.52 , $43.35 , $26.25 , $26.06 , N/A , $26.75 , $26.75 , $48.45 , $32.15 , $11.46 , $48.96 
"Avulsion Nail Plate,Singl",CPT® 11730,N/A,N/A,N/A, $385.00 , $250.25 , $174.35 , $51.83 , $42.84 , $140.67 , $134.38 , $358.05 , $346.50 , $346.50 , $308.00 , $308.00 , $42.84 , $355.47 , $365.75 , $346.50 , $346.50 , $346.50 , $358.05 , $369.60 , $192.28 , $327.25 , $262.26 , $198.13 , N/A , $143.42 , $143.42 , $365.75 , $166.31 , $42.84 , $369.60 
Injection Aa&/Strd Ilioinguinal Ih Nerves,64425,N/A,N/A,N/A, $901.00 , $585.65 , $271.75 , $52.72 , $76.84 , $522.44 , $515.02 , $837.93 , $810.90 , $810.90 , $720.80 , $720.80 , $76.84 , $831.89 , $855.95 , $810.90 , $810.90 , $810.90 , $837.93 , $864.96 , $295.49 , $765.85 , $504.89 , $564.76 , N/A , $532.63 , $532.63 , $855.95 , $571.39 , $52.72 , $864.96 
 Pro Exc Tumor Soft Tissue Abdl Wall Subfascial 5+Cm ,CPT® 22901,0982 - PRO FEE/OUTPT,N/A,N/A," $4,401.00 "," $2,860.65 "," $4,009.79 ", $621.23 , $545.10 ," $3,178.19 "," $3,166.35 "," $4,092.93 "," $3,960.90 "," $3,960.90 "," $3,520.80 "," $3,520.80 ", $545.10 ," $4,063.44 "," $4,180.95 "," $3,960.90 "," $3,960.90 "," $3,960.90 "," $4,092.93 "," $4,224.96 "," $3,711.50 "," $3,740.85 "," $3,511.04 "," $3,737.64 ", N/A ," $3,240.20 "," $3,240.20 "," $4,180.95 "," $3,808.40 ", $545.10 ," $4,224.96 "
Fx Carpal Bone W/O Manipu,25630,N/A,N/A,N/A," $1,446.00 ", $939.90 ," $1,768.39 ", $280.46 , $206.19 ," $1,350.10 "," $1,368.18 "," $1,344.78 "," $1,301.40 "," $1,301.40 "," $1,156.80 "," $1,156.80 ", $206.19 ," $1,335.09 "," $1,373.70 "," $1,301.40 "," $1,301.40 "," $1,301.40 "," $1,344.78 "," $1,388.16 "," $1,632.61 "," $1,229.10 "," $1,500.40 "," $1,608.26 ", N/A ," $1,376.44 "," $1,376.44 "," $1,373.70 "," $1,617.81 ", $206.19 ," $1,768.39 "
Complex Repair 2.6-7.5cm,13101,N/A,N/A,N/A," $1,529.00 ", $993.85 , $797.06 , $238.06 , $175.19 , $693.43 , $680.66 ," $1,421.97 "," $1,376.10 "," $1,376.10 "," $1,223.20 "," $1,223.20 ", $175.19 ," $1,411.73 "," $1,452.55 "," $1,376.10 "," $1,376.10 "," $1,376.10 "," $1,421.97 "," $1,467.84 ", $882.35 ," $1,299.65 "," $1,355.89 ", $890.04 , N/A , $706.96 , $706.96 ," $1,452.55 ", $819.84 , $175.19 ," $1,467.84 "
 Fac Comprehen Metabolic Panel ,CPT® 80053,0301 - LAB/CHEMISTRY,N/A,N/A, $170.00 , $110.50 , $142.80 , $10.77 , $10.77 , $137.36 , $153.00 , $143.92 , $153.00 , $153.00 , $153.00 , $144.50 , $10.56 , $156.96 , $161.50 , $144.50 , $158.10 , $158.10 , $161.50 , $163.20 , $139.09 , $153.00 , $144.50 , $134.30 , N/A , $137.58 , $137.58 , $161.50 , $145.88 , $10.56 , $163.20 
 Fac Trpos&/Rimpltj Crtd Subcla Art ,CPT® 35695,0360 - OR SERVICES,N/A,N/A," $4,101.00 "," $2,665.65 "," $3,444.84 ", $911.06 ," $1,478.34 "," $3,313.61 "," $3,690.90 "," $3,471.91 "," $3,690.90 "," $3,690.90 "," $3,690.90 "," $3,485.85 "," $1,449.35 "," $3,786.45 "," $3,895.95 "," $3,485.85 "," $3,813.93 "," $3,813.93 "," $3,895.95 "," $3,936.96 "," $3,355.44 "," $3,690.90 "," $3,485.85 "," $3,239.79 ", N/A ," $3,318.94 "," $3,318.94 "," $3,895.95 "," $3,519.07 ", $911.06 ," $3,936.96 "
 POVIDONE-IODINE 5 % OP SOLN ,HCPCS RXC637,0250 - PHARMACY,00065-0411-30,30 mL, $99.25 , $64.51 , $83.37 , N/A , N/A , $80.19 , $89.33 , $84.03 , $89.33 , $89.33 , $89.33 , $84.36 , N/A , $91.64 , $94.29 , $84.36 , $92.30 , $92.30 , $94.29 , $95.28 , $81.21 , $89.33 , $84.36 , $78.41 , N/A , $80.32 , $80.32 , $94.29 , $85.17 , $78.41 , $95.28 
Antibody-Borelia(Lyme's),CPT® 86618,N/A,N/A,N/A, $174.00 , $113.10 , N/A , $17.37 , $17.37 , $96.37 , $115.25 , $161.82 , $156.60 , $156.60 , $139.20 , $139.20 , $17.37 , $160.65 , $165.30 , $156.60 , $156.60 , $156.60 , $161.82 , $167.04 , $113.71 , $147.90 , $111.91 , $61.74 , N/A , $89.94 , $89.94 , $165.30 , $98.28 , $17.37 , $167.04 
Inpt Telehealth Con 70/>M,HCPCS G0427,N/A,N/A,N/A, $680.00 , $442.00 , $376.12 , $181.23 , N/A , $372.74 , N/A , $632.40 , $612.00 , $612.00 , $544.00 , $544.00 , N/A , $627.84 , $646.00 , $612.00 , $612.00 , $612.00 , $632.40 , $652.80 , $558.81 , $578.00 , $377.57 , $761.47 , N/A , $380.01 , $380.01 , $646.00 , $475.01 , $181.23 , $761.47 
 Fac Scope of Sigmoid Colon Only With Biopsy ,CPT® 45331,0360 - OR SERVICES,N/A,N/A," $1,174.00 ", $763.10 , $986.16 , $68.50 , $109.66 , $948.59 ," $1,056.60 ", $993.91 ," $1,056.60 "," $1,056.60 "," $1,056.60 ", $997.90 , $107.51 ," $1,083.95 "," $1,115.30 ", $997.90 ," $1,091.82 "," $1,091.82 "," $1,115.30 "," $1,127.04 ", $960.57 ," $1,056.60 ", $997.90 , $927.46 , N/A , $950.12 , $950.12 ," $1,115.30 "," $1,007.41 ", $68.50 ," $1,127.04 "
Complex e/m visit add on,HCPCS G2211,N/A,N/A,N/A, $41.00 , $26.65 , N/A , N/A , N/A , N/A , N/A , $38.13 , $36.90 , $36.90 , $32.80 , $32.80 , N/A , $37.86 , $38.95 , $36.90 , $36.90 , $36.90 , $38.13 , $39.36 , N/A , $34.85 , N/A , $38.06 , N/A , N/A , N/A , $38.95 , N/A , $32.80 , $39.36 
Pro Cltx Kne Dislc W/O Anes,27550,N/A,N/A,N/A," $2,646.00 "," $1,719.90 "," $2,906.74 ", $457.68 , $230.52 ," $2,249.22 "," $2,237.47 "," $2,460.78 "," $2,381.40 "," $2,381.40 "," $2,116.80 "," $2,116.80 ", $230.52 ," $2,443.05 "," $2,513.70 "," $2,381.40 "," $2,381.40 "," $2,381.40 "," $2,460.78 "," $2,540.16 "," $2,767.41 "," $2,249.10 "," $2,462.01 "," $2,706.32 ", N/A ," $2,293.11 "," $2,293.11 "," $2,513.70 "," $2,695.20 ", $230.52 ," $2,906.74 "
Layer Closure 7.6-12.5cm,12034,N/A,N/A,N/A," $1,268.00 ", $824.20 , $654.87 , $196.65 , $122.93 , $564.34 , $550.50 ," $1,179.24 "," $1,141.20 "," $1,141.20 "," $1,014.40 "," $1,014.40 ", $122.93 ," $1,170.74 "," $1,204.60 "," $1,141.20 "," $1,141.20 "," $1,141.20 "," $1,179.24 "," $1,217.28 ", $719.01 ," $1,077.80 "," $1,100.77 ", $726.60 , N/A , $575.35 , $575.35 ," $1,204.60 ", $667.22 , $122.93 ," $1,217.28 "
" Fac Urinalysis, Volume Measure ",CPT® 81050,0310 - PATHOLOGY LAB,N/A,N/A, $53.00 , $34.45 , $44.52 , $3.71 , $3.71 , $42.82 , $47.70 , $44.87 , $47.70 , $47.70 , $47.70 , $45.05 , $3.64 , $48.93 , $50.35 , $45.05 , $49.29 , $49.29 , $50.35 , $50.88 , $43.36 , $47.70 , $45.05 , $41.87 , N/A , $42.89 , $42.89 , $50.35 , $45.48 , $3.64 , $50.88 
Removal Sutures/Staples Not Requiring Anesthesia,CPT® 15853,N/A,N/A,N/A, $70.00 , $45.50 , N/A , $10.94 , $8.55 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $8.55 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $60.42 , N/A , N/A , $27.12 , $27.12 , $66.50 , $31.41 , $8.55 , $67.20 
Transfer Skin Pedicle Flap,CPT® 15650,N/A,N/A,N/A," $2,422.00 "," $1,574.30 "," $1,219.55 ", $385.90 , $381.08 ," $1,048.51 "," $1,033.51 "," $2,252.46 "," $2,179.80 "," $2,179.80 "," $1,937.60 "," $1,937.60 ", $381.08 ," $2,236.23 "," $2,300.90 "," $2,179.80 "," $2,179.80 "," $2,179.80 "," $2,252.46 "," $2,325.12 "," $1,319.75 "," $2,058.70 "," $2,058.81 "," $1,334.36 ", N/A ," $1,068.97 "," $1,068.97 "," $2,300.90 "," $1,239.65 ", $381.08 ," $2,325.12 "
 Fac Assay of Proinsulin ,CPT® 84206,0301 - LAB/CHEMISTRY,N/A,N/A, $247.00 , $160.55 , $207.48 , $27.22 , $24.72 , $199.58 , $222.30 , $209.11 , $222.30 , $222.30 , $222.30 , $209.95 , $24.24 , $228.06 , $234.65 , $209.95 , $229.71 , $229.71 , $234.65 , $237.12 , $202.10 , $222.30 , $209.95 , $195.13 , N/A , $199.90 , $199.90 , $234.65 , $211.95 , $24.24 , $237.12 
Insertion Picc W/Rs&I 5 Yr/>,CPT® 36573,N/A,N/A,N/A," $1,998.00 "," $1,298.70 ", $514.35 , $80.09 , $314.22 , $345.62 , N/A ," $1,858.14 "," $1,798.20 "," $1,798.20 "," $1,598.40 "," $1,598.40 ", $314.22 ," $1,844.75 "," $1,898.10 "," $1,798.20 "," $1,798.20 "," $1,798.20 "," $1,858.14 "," $1,918.08 ", $476.57 ," $1,698.30 ", $438.90 , $425.65 , N/A , $352.36 , $352.36 ," $1,898.10 ", $400.29 , $80.09 ," $1,918.08 "
Rmvl Impltbl Dfb Pls Gen W/Rplcmt Pls Gen Mlt Ld,CPT® 33264,N/A,N/A,N/A," $3,733.00 "," $2,426.45 "," $2,411.96 ", $372.82 , $301.38 ," $1,776.71 "," $1,707.15 "," $3,471.69 "," $3,359.70 "," $3,359.70 "," $2,986.40 "," $2,986.40 ", $301.38 ," $3,446.68 "," $3,546.35 "," $3,359.70 "," $3,359.70 "," $3,359.70 "," $3,471.69 "," $3,583.68 "," $2,233.70 "," $3,173.05 "," $2,146.23 "," $1,958.75 ", N/A ," $1,811.38 "," $1,811.38 "," $3,546.35 "," $2,057.74 ", $301.38 ," $3,583.68 "
 IRBESARTAN 150 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,62332-0042-90,0.5 tablet, $7.89 , $5.13 , $6.63 , N/A , N/A , $6.38 , $7.10 , $6.68 , $7.10 , $7.10 , $7.10 , $6.71 , N/A , $7.28 , $7.50 , $6.71 , $7.34 , $7.34 , $7.50 , $7.57 , $6.46 , $7.10 , $6.71 , $6.23 , N/A , $6.39 , $6.39 , $7.50 , $6.77 , $6.23 , $7.57 
 Mpl Gene Analysis Common Variants Pbb ,CPT® 81338,0310 - PATHOLOGY LAB,N/A,N/A," $1,063.00 ", $690.95 , $892.92 , $153.34 , $122.67 , $858.90 , $956.70 , $899.94 , $956.70 , $956.70 , $956.70 , $903.55 , $120.26 , $981.47 ," $1,009.85 ", $903.55 , $988.59 , $988.59 ," $1,009.85 "," $1,020.48 ", $869.75 , $956.70 , $903.55 , $839.77 , N/A , $860.29 , $860.29 ," $1,009.85 ", $912.16 , $120.26 ," $1,020.48 "
Destroy Nerve of Eye Muscle,CPT® 67345,N/A,N/A,N/A," $2,160.00 "," $1,404.00 "," $1,311.83 ", $204.81 , $207.47 ," $1,223.03 "," $1,156.80 "," $2,008.80 "," $1,944.00 "," $1,944.00 "," $1,728.00 "," $1,728.00 ", $207.47 ," $1,994.33 "," $2,052.00 "," $1,944.00 "," $1,944.00 "," $1,944.00 "," $2,008.80 "," $2,073.60 "," $1,800.34 "," $1,836.00 "," $1,218.52 "," $1,544.53 ", N/A ," $1,246.90 "," $1,246.90 "," $2,052.00 "," $1,376.40 ", $204.81 ," $2,073.60 "
 Pro Visit to Determ Ldct Elig ,HCPCS G0296,0982 - PRO FEE/OUTPT,N/A,N/A, $177.00 , $115.05 , $124.60 , $24.98 , N/A , $99.64 , N/A , $164.61 , $159.30 , $159.30 , $141.60 , $141.60 , N/A , $163.42 , $168.15 , $159.30 , $159.30 , $159.30 , $164.61 , $169.92 , $47.78 , $150.45 , $49.11 , $56.46 , N/A , $101.59 , $101.59 , $168.15 , $126.97 , $24.98 , $169.92 
 LEVOTHYROXINE SODIUM 150 MCG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6956-61,1 tablet, $4.37 , $2.84 , $3.67 , N/A , N/A , $3.53 , $3.93 , $3.70 , $3.93 , $3.93 , $3.93 , $3.71 , N/A , $4.03 , $4.15 , $3.71 , $4.06 , $4.06 , $4.15 , $4.20 , $3.58 , $3.93 , $3.71 , $3.45 , N/A , $3.54 , $3.54 , $4.15 , $3.75 , $3.45 , $4.20 
 Pro Parathyroid Imaging W/Tomographic Spect & CT ,CPT® 78072,0974 - PRO FEE/NUC MED,N/A,N/A, $659.00 , $428.35 ," $2,358.92 ", $400.85 , $284.63 ," $2,017.38 ", $410.97 , $612.87 , $593.10 , $593.10 , $527.20 , $527.20 , $284.63 , $608.45 , $626.05 , $593.10 , $593.10 , $593.10 , $612.87 , $632.64 ," $2,461.76 ", $560.15 , $442.99 ," $2,789.30 ", N/A ," $2,056.75 "," $2,056.75 ", $626.05 ," $2,380.72 ", $284.63 ," $2,789.30 "
 Fac Angiotensin I Enzyme Test ,CPT® 82164,0301 - LAB/CHEMISTRY,N/A,N/A, $205.00 , $133.25 , $172.20 , $14.89 , $14.89 , $165.64 , $184.50 , $173.55 , $184.50 , $184.50 , $184.50 , $174.25 , $14.60 , $189.28 , $194.75 , $174.25 , $190.65 , $190.65 , $194.75 , $196.80 , $167.73 , $184.50 , $174.25 , $161.95 , N/A , $165.91 , $165.91 , $194.75 , $175.91 , $14.60 , $196.80 
 L Spine CT W/O With Contrast ,CPT® 72133,0350 - CT SCAN,N/A,N/A," $4,106.00 "," $2,668.90 "," $3,449.04 ", $202.49 , $367.83 ," $3,317.65 "," $3,695.40 "," $3,476.14 "," $3,695.40 "," $3,695.40 "," $3,695.40 "," $3,490.10 ", $360.62 ," $3,791.07 "," $3,900.70 "," $3,490.10 "," $3,818.58 "," $3,818.58 "," $3,900.70 "," $3,941.76 "," $3,359.53 "," $3,695.40 "," $3,490.10 "," $3,243.74 ", N/A ," $3,322.99 "," $3,322.99 "," $3,900.70 "," $3,523.36 ", $202.49 ," $3,941.76 "
Bacteria Culture Screen,CPT® 87081,N/A,N/A,N/A, $69.00 , $44.85 , N/A , $6.76 , $6.76 , $37.50 , $44.90 , $64.17 , $62.10 , $62.10 , $55.20 , $55.20 , $6.76 , $63.71 , $65.55 , $62.10 , $62.10 , $62.10 , $64.17 , $66.24 , $44.27 , $58.65 , $43.79 , $24.02 , N/A , $35.00 , $35.00 , $65.55 , $38.24 , $6.76 , $66.24 
 Fac Rmvl Transvns Pm Eltrd 1 Lead Sys Atr/Ventr ,CPT® 33234,0360 - OR SERVICES,N/A,N/A," $3,697.00 "," $2,403.05 "," $3,105.48 ", $446.64 ," $1,280.30 "," $2,987.18 "," $3,327.30 "," $3,129.88 "," $3,327.30 "," $3,327.30 "," $3,327.30 "," $3,142.45 "," $1,255.20 "," $3,413.44 "," $3,512.15 "," $3,142.45 "," $3,438.21 "," $3,438.21 "," $3,512.15 "," $3,549.12 "," $3,024.89 "," $3,327.30 "," $3,142.45 "," $2,920.63 ", N/A ," $2,991.98 "," $2,991.98 "," $3,512.15 "," $3,172.40 ", $446.64 ," $3,549.12 "
 Pro Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw ,CPT® 72083,0972 - PRO FEE/RAD/DX,N/A,N/A, $229.00 , $148.85 , $538.02 , $77.99 , $53.16 , $322.28 , $339.81 , $212.97 , $206.10 , $206.10 , $183.20 , $183.20 , $53.16 , $211.44 , $217.55 , $206.10 , $206.10 , $206.10 , $212.97 , $219.84 , $436.60 , $194.65 , $454.65 , $378.99 , N/A , $328.57 , $328.57 , $217.55 , $380.32 , $53.16 , $538.02 
"Removal,FB,Intraocular,Ant Chamber/Lens",65235,N/A,N/A,N/A," $4,311.00 "," $2,802.15 "," $4,518.61 ", $708.69 , $768.38 ," $4,023.43 "," $3,761.02 "," $4,009.23 "," $3,879.90 "," $3,879.90 "," $3,448.80 "," $3,448.80 ", $768.38 ," $3,980.35 "," $4,095.45 "," $3,879.90 "," $3,879.90 "," $3,879.90 "," $4,009.23 "," $4,138.56 "," $6,167.25 "," $3,664.35 "," $3,862.50 "," $5,103.14 ", N/A ," $4,101.94 "," $4,101.94 "," $4,095.45 "," $4,528.00 ", $708.69 ," $6,167.25 "
 Pro Removal Forearm Lesion Subcu ,CPT® 25075,0982 - PRO FEE/OUTPT,N/A,N/A," $3,242.00 "," $2,107.30 "," $1,930.11 ", $303.07 , $336.46 ," $1,518.48 "," $1,536.85 "," $3,015.06 "," $2,917.80 "," $2,917.80 "," $2,593.60 "," $2,593.60 ", $336.46 ," $2,993.34 "," $3,079.90 "," $2,917.80 "," $2,917.80 "," $2,917.80 "," $3,015.06 "," $3,112.32 "," $1,787.72 "," $2,755.70 "," $1,691.29 "," $1,801.91 ", N/A ," $1,548.10 "," $1,548.10 "," $3,079.90 "," $1,819.59 ", $303.07 ," $3,112.32 "
Rpr Parastomal Hernia 1st/Recr Reducible,CPT® 49621,N/A,N/A,N/A," $6,445.00 "," $4,189.25 ", N/A , $685.29 , $534.86 , N/A , N/A ," $5,993.85 "," $5,800.50 "," $5,800.50 "," $5,156.00 "," $5,156.00 ", $534.86 ," $5,950.67 "," $6,122.75 "," $5,800.50 "," $5,800.50 "," $5,800.50 "," $5,993.85 "," $6,187.20 ", N/A ," $5,478.25 "," $3,928.82 ", N/A , N/A ," $2,950.20 "," $2,950.20 "," $6,122.75 "," $3,088.61 ", $534.86 ," $6,187.20 "
 COLESEVELAM HCL 625 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,68462-0433-18,1 tablet, $20.33 , $13.21 , $17.08 , N/A , N/A , $16.43 , $18.30 , $17.21 , $18.30 , $18.30 , $18.30 , $17.28 , N/A , $18.77 , $19.31 , $17.28 , $18.91 , $18.91 , $19.31 , $19.52 , $16.63 , $18.30 , $17.28 , $16.06 , N/A , $16.45 , $16.45 , $19.31 , $17.45 , $16.06 , $19.52 
 Fac Assay of Ceruloplasmin ,CPT® 82390,0301 - LAB/CHEMISTRY,N/A,N/A, $133.00 , $86.45 , $111.72 , $10.95 , $10.95 , $107.46 , $119.70 , $112.60 , $119.70 , $119.70 , $119.70 , $113.05 , $10.74 , $122.80 , $126.35 , $113.05 , $123.69 , $123.69 , $126.35 , $127.68 , $108.82 , $119.70 , $113.05 , $105.07 , N/A , $107.64 , $107.64 , $126.35 , $114.13 , $10.74 , $127.68 
 Pro Excision Tumor Soft Tiss Face/Scalp Subq 2+Cm ,CPT® 21012,0982 - PRO FEE/OUTPT,N/A,N/A," $2,275.00 "," $1,478.75 "," $2,061.02 ", $322.84 , $278.25 ," $1,628.35 "," $1,630.47 "," $2,115.75 "," $2,047.50 "," $2,047.50 "," $1,820.00 "," $1,820.00 ", $278.25 ," $2,100.51 "," $2,161.25 "," $2,047.50 "," $2,047.50 "," $2,047.50 "," $2,115.75 "," $2,184.00 "," $1,904.92 "," $1,933.75 "," $1,787.63 "," $1,929.36 ", N/A ," $1,660.12 "," $1,660.12 "," $2,161.25 "," $1,951.25 ", $278.25 ," $2,184.00 "
"Closed Rx Metacarpal Fx,Percut",CPT® 26608,N/A,N/A,N/A," $3,152.00 "," $2,048.80 "," $2,975.31 ", $468.01 , $412.82 ," $2,289.81 "," $2,307.09 "," $2,931.36 "," $2,836.80 "," $2,836.80 "," $2,521.60 "," $2,521.60 ", $412.82 ," $2,910.24 "," $2,994.40 "," $2,836.80 "," $2,836.80 "," $2,836.80 "," $2,931.36 "," $3,025.92 "," $2,760.18 "," $2,679.20 "," $2,535.16 "," $2,718.95 ", N/A ," $2,334.49 "," $2,334.49 "," $2,994.40 "," $2,743.86 ", $412.82 ," $3,025.92 "
Incis/Drain Arm/Elbow Infect Bursa,CPT® 23931,N/A,N/A,N/A," $1,897.00 "," $1,233.05 ", $983.19 , $155.07 , $285.82 , $771.51 , $776.90 ," $1,764.21 "," $1,707.30 "," $1,707.30 "," $1,517.60 "," $1,517.60 ", $285.82 ," $1,751.50 "," $1,802.15 "," $1,707.30 "," $1,707.30 "," $1,707.30 "," $1,764.21 "," $1,821.12 ", $909.13 ," $1,612.45 ", $852.78 , $917.28 , N/A , $786.56 , $786.56 ," $1,802.15 ", $924.48 , $155.07 ," $1,821.12 "
Remote Mntr Wireless P-Art Prs Snr Up to 30 D,CPT® 93264,N/A,N/A,N/A, $413.00 , $268.45 , $220.09 , $33.82 , $40.52 , $182.07 , N/A , $384.09 , $371.70 , $371.70 , $330.40 , $330.40 , $40.52 , $381.32 , $392.35 , $371.70 , $371.70 , $371.70 , $384.09 , $396.48 , $217.66 , $351.05 , $184.80 , $214.63 , N/A , $185.62 , $185.62 , $392.35 , $205.75 , $33.82 , $396.48 
 APIXABAN 2.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00003-0893-31,1 tablet, $57.62 , $37.45 , $48.40 , N/A , N/A , $46.56 , $51.86 , $48.78 , $51.86 , $51.86 , $51.86 , $48.98 , N/A , $53.20 , $54.74 , $48.98 , $53.59 , $53.59 , $54.74 , $55.32 , $47.14 , $51.86 , $48.98 , $45.52 , N/A , $46.63 , $46.63 , $54.74 , $49.44 , $45.52 , $55.32 
 EPHEDRINE 5 MG/ML INJECTION (ANES&INPT) ,HCPCS RXA250,0250 - PHARMACY,70092-1455-46,10 mL, $302.41 , $196.57 , $254.02 , N/A , N/A , $244.35 , $272.17 , $256.02 , $272.17 , $272.17 , $272.17 , $257.05 , N/A , $279.22 , $287.29 , $257.05 , $281.24 , $281.24 , $287.29 , $290.31 , $247.43 , $272.17 , $257.05 , $238.90 , N/A , $244.74 , $244.74 , $287.29 , $259.50 , $238.90 , $290.31 
 SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,50268-0728-15,1 tablet, $3.41 , $2.22 , $2.86 , N/A , N/A , $2.76 , $3.07 , $2.89 , $3.07 , $3.07 , $3.07 , $2.90 , N/A , $3.15 , $3.24 , $2.90 , $3.17 , $3.17 , $3.24 , $3.27 , $2.79 , $3.07 , $2.90 , $2.69 , N/A , $2.76 , $2.76 , $3.24 , $2.93 , $2.69 , $3.27 
"Eye Exam, New Patient,Intermed",CPT® 92002,N/A,N/A,N/A, $254.00 , $165.10 , $101.72 , $45.41 , $37.71 , $85.23 , $85.30 , $236.22 , $228.60 , $228.60 , $203.20 , $203.20 , $37.71 , $234.52 , $241.30 , $228.60 , $228.60 , $228.60 , $236.22 , $243.84 , $132.42 , $215.90 , $143.95 , $102.11 , N/A , $86.89 , $86.89 , $241.30 , $103.36 , $37.71 , $243.84 
"Hemorrhoidectomy,External",46250,N/A,N/A,N/A," $2,999.00 "," $1,949.35 "," $1,965.02 ", $304.55 , $307.34 ," $1,492.61 "," $1,526.34 "," $2,789.07 "," $2,699.10 "," $2,699.10 "," $2,399.20 "," $2,399.20 ", $307.34 ," $2,768.98 "," $2,849.05 "," $2,699.10 "," $2,699.10 "," $2,699.10 "," $2,789.07 "," $2,879.04 "," $1,405.70 "," $2,549.15 "," $1,682.37 "," $1,780.26 ", N/A ," $1,521.74 "," $1,521.74 "," $2,849.05 "," $1,591.57 ", $304.55 ," $2,879.04 "
 VASOPRESSIN 20 UNIT/ML IV SOLN ,HCPCS J2599,0636 - DRUGS REQUIRING DETAILED CODIN,42023-0164-25,1 mL, $499.31 , $324.55 , $419.42 , N/A , N/A , $403.44 , $449.38 , $422.72 , $449.38 , $449.38 , $449.38 , $424.41 , N/A , $461.01 , $474.34 , $424.41 , $464.36 , $464.36 , $474.34 , $479.34 , $408.54 , $449.38 , $424.41 , $394.45 , N/A , $404.09 , $404.09 , $474.34 , $428.46 , $394.45 , $479.34 
"Anoscopy,Control Bleeding",CPT® 46614,N/A,N/A,N/A, $827.00 , $537.55 , $386.82 , $61.04 , $156.20 , $311.35 , $315.27 , $769.11 , $744.30 , $744.30 , $661.60 , $661.60 , $156.20 , $763.57 , $785.65 , $744.30 , $744.30 , $744.30 , $769.11 , $793.92 , $277.97 , $702.95 , $344.32 , $369.18 , N/A , $317.42 , $317.42 , $785.65 , $331.99 , $61.04 , $793.92 
"PFIZER-BIONTECH 30 mcg/0.3 mL DOSAGE, FIRST DOSE",CPT® 0051A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $76.25 , $128.66 , N/A , $79.82 , $79.82 , $66.50 , $92.91 , $38.92 , $128.66 
 Pro Exc Tumor Soft Tiss Forearm and/Wrist Subq 3+Cm ,CPT® 25071,0982 - PRO FEE/OUTPT,N/A,N/A," $3,455.00 "," $2,245.75 "," $2,570.88 ", $401.84 , $349.11 ," $2,041.20 "," $2,044.00 "," $3,213.15 "," $3,109.50 "," $3,109.50 "," $2,764.00 "," $2,764.00 ", $349.11 ," $3,190.00 "," $3,282.25 "," $3,109.50 "," $3,109.50 "," $3,109.50 "," $3,213.15 "," $3,316.80 "," $2,380.13 "," $2,936.75 "," $2,258.63 "," $2,404.23 ", N/A ," $2,081.03 "," $2,081.03 "," $3,282.25 "," $2,445.96 ", $349.11 ," $3,316.80 "
 Acute And Subacute Endocarditis Without Cc/McC ,MS DRG V40 (FY2023) 290,N/A,N/A,N/A," $48,249.96 "," $31,362.47 "," $40,529.97 ", N/A , N/A ," $38,985.97 "," $43,424.96 "," $40,848.42 "," $43,424.96 "," $43,424.96 "," $43,424.96 "," $41,012.47 ", N/A ," $44,549.19 "," $45,837.46 "," $41,012.47 "," $44,872.46 "," $44,872.46 "," $45,837.46 "," $46,319.96 "," $39,478.12 "," $43,424.96 "," $41,012.47 "," $38,117.47 ", N/A ," $39,048.69 "," $39,048.69 "," $45,837.46 "," $41,403.29 "," $38,117.47 "," $46,319.96 "
As-Aort Grf W/Card Byp F/Aortic Dissection,CPT® 33858,N/A,N/A,N/A," $24,488.00 "," $15,917.20 "," $19,743.30 "," $3,044.90 "," $2,562.74 "," $14,153.71 ", N/A ," $22,773.84 "," $22,039.20 "," $22,039.20 "," $19,590.40 "," $19,590.40 "," $2,562.74 "," $22,609.77 "," $23,263.60 "," $22,039.20 "," $22,039.20 "," $22,039.20 "," $22,773.84 "," $23,508.48 "," $18,301.56 "," $20,814.80 "," $17,641.49 "," $16,265.04 ", N/A ," $14,429.88 "," $14,429.88 "," $23,263.60 "," $16,388.78 "," $2,562.74 "," $23,508.48 "
" Fac T Cell, Absolute Count/Ratio ",CPT® 86360,0302 - LAB/IMMUNOLOGY,N/A,N/A, $435.00 , $282.75 , $365.40 , $47.92 , $47.92 , $351.48 , $391.50 , $368.27 , $391.50 , $391.50 , $391.50 , $369.75 , $46.98 , $401.64 , $413.25 , $369.75 , $404.55 , $404.55 , $413.25 , $417.60 , $355.92 , $391.50 , $369.75 , $343.65 , N/A , $352.05 , $352.05 , $413.25 , $373.27 , $46.98 , $417.60 
Iadna Human Papillomavirus Types 16 & 18 Only,CPT® 87625,N/A,N/A,N/A, $286.00 , $185.90 , N/A , $41.36 , $39.07 , $198.56 , $235.14 , $265.98 , $257.40 , $257.40 , $228.80 , $228.80 , $39.07 , $264.06 , $271.70 , $257.40 , $257.40 , $257.40 , $265.98 , $274.56 , $270.76 , $243.10 , $193.84 , $127.26 , N/A , $185.31 , $185.31 , $271.70 , $202.50 , $39.07 , $274.56 
"Repair,Inflatable Penile Prosthesis",CPT® 54408,N/A,N/A,N/A," $4,333.00 "," $2,816.45 "," $3,503.76 ", $754.50 , N/A ," $2,537.95 "," $2,559.50 "," $4,029.69 "," $3,899.70 "," $3,899.70 "," $3,466.40 "," $3,466.40 ", N/A ," $4,000.66 "," $4,116.35 "," $3,899.70 "," $3,899.70 "," $3,899.70 "," $4,029.69 "," $4,159.68 "," $3,289.20 "," $3,683.05 "," $4,078.37 "," $3,827.14 ", N/A ," $2,587.48 "," $2,587.48 "," $4,116.35 "," $3,101.24 ", $754.50 ," $4,159.68 "
Lens Sphere Trifocal 7.12-20,HCPCS V2302,N/A,N/A,N/A, $90.00 , $58.50 , N/A , $95.55 , N/A , N/A , N/A , $83.70 , $81.00 , $81.00 , $72.00 , $72.00 , N/A , $83.10 , $85.50 , $81.00 , $81.00 , $81.00 , $83.70 , $86.40 , N/A , $76.50 , $90.00 , $86.82 , N/A , N/A , N/A , $85.50 , N/A , $72.00 , $95.55 
Lens Sphcyl Bifo 7.25-12/2.2,HCPCS V2212,N/A,N/A,N/A, $85.00 , $55.25 , N/A , $90.08 , N/A , N/A , N/A , $79.05 , $76.50 , $76.50 , $68.00 , $68.00 , N/A , $78.48 , $80.75 , $76.50 , $76.50 , $76.50 , $79.05 , $81.60 , N/A , $72.25 , $85.00 , $81.84 , N/A , N/A , N/A , $80.75 , N/A , $68.00 , $90.08 
 HYDROCORTISONE SOD SUC (PF) 100 MG IJ SOLR ,HCPCS J1720,0636 - DRUGS REQUIRING DETAILED CODIN,00009-0011-04,2 mL, $119.81 , $77.88 , $100.64 , $17.86 , $18.27 , $96.81 , $107.83 , $101.43 , $107.83 , $107.83 , $107.83 , $101.84 , $17.91 , $110.62 , $113.82 , $101.84 , $111.42 , $111.42 , $113.82 , $115.02 , $98.03 , $107.83 , $101.84 , $94.65 , N/A , $96.96 , $96.96 , $113.82 , $102.81 , $17.86 , $115.02 
 Fac Tumor Immunohistochem/Manual ,CPT® 88360,0310 - PATHOLOGY LAB,N/A,N/A, $864.00 , $561.60 , $725.76 , $116.62 , $107.82 , $698.11 , $777.60 , $731.46 , $777.60 , $777.60 , $777.60 , $734.40 , $105.71 , $797.73 , $820.80 , $734.40 , $803.52 , $803.52 , $820.80 , $829.44 , $706.92 , $777.60 , $734.40 , $682.56 , N/A , $699.24 , $699.24 , $820.80 , $741.40 , $105.71 , $829.44 
Quant Diff Pulm Prfusion & Ventlaj W/WO Imaging,CPT® 78598,N/A,N/A,N/A," $2,128.00 "," $1,383.20 "," $1,625.57 ", $276.85 , $236.29 ," $1,506.45 "," $1,876.77 "," $1,979.04 "," $1,915.20 "," $1,915.20 "," $1,702.40 "," $1,702.40 ", $236.29 ," $1,964.78 "," $2,021.60 "," $1,915.20 "," $1,915.20 "," $1,915.20 "," $1,979.04 "," $2,042.88 "," $1,683.41 "," $1,808.80 "," $2,060.86 "," $2,051.95 ", N/A ," $1,535.84 "," $1,535.84 "," $2,021.60 "," $1,777.78 ", $236.29 ," $2,060.86 "
"Cabg, Arterial, Single",CPT® 33533,N/A,N/A,N/A," $18,050.00 "," $11,732.50 "," $10,926.57 "," $1,687.61 "," $1,789.31 "," $7,982.26 "," $7,891.02 "," $16,786.50 "," $16,245.00 "," $16,245.00 "," $14,440.00 "," $14,440.00 "," $1,789.31 "," $16,665.57 "," $17,147.50 "," $16,245.00 "," $16,245.00 "," $16,245.00 "," $16,786.50 "," $17,328.00 "," $10,119.44 "," $15,342.50 "," $9,996.11 "," $8,961.52 ", N/A ," $8,138.01 "," $8,138.01 "," $17,147.50 "," $9,244.78 "," $1,687.61 "," $17,328.00 "
"Pro Strapping,Hand or Finger",29280,N/A,N/A,N/A, $181.00 , $117.65 , $122.20 , $19.17 , $8.89 , $96.50 , $178.79 , $168.33 , $162.90 , $162.90 , $144.80 , $144.80 , $8.89 , $167.12 , $171.95 , $162.90 , $162.90 , $162.90 , $168.33 , $173.76 , $112.20 , $153.85 , $192.68 , $118.75 , N/A , $98.38 , $98.38 , $171.95 , $115.63 , $8.89 , $192.68 
Assay Urine Uric Acid,CPT® 84560,N/A,N/A,N/A, $68.00 , $44.20 , N/A , $5.18 , $5.18 , $26.85 , $32.15 , $63.24 , $61.20 , $61.20 , $54.40 , $54.40 , $5.18 , $62.78 , $64.60 , $61.20 , $61.20 , $61.20 , $63.24 , $65.28 , $33.92 , $57.80 , $30.82 , $17.21 , N/A , $25.06 , $25.06 , $64.60 , $27.39 , $5.18 , $65.28 
 Fac Furosemide Injection ,HCPCS J1940,0254 - DRUGS/LESS,N/A,N/A, $11.00 , $7.15 , $9.24 , $0.51 , $0.67 , $8.89 , $9.90 , $9.31 , $9.90 , $9.90 , $9.90 , $9.35 , $0.66 , $10.16 , $10.45 , $9.35 , $10.23 , $10.23 , $10.45 , $10.56 , $9.00 , $9.90 , $9.35 , $8.69 , N/A , $8.90 , $8.90 , $10.45 , $9.44 , $0.51 , $10.56 
" Fac Colorectal Scrn, Hi Risk Ind ",HCPCS G0105,0360 - OR SERVICES,N/A,N/A," $2,513.00 "," $1,633.45 "," $2,110.92 ", $174.38 , $351.69 ," $2,030.50 "," $2,261.70 "," $2,127.51 "," $2,261.70 "," $2,261.70 "," $2,261.70 "," $2,136.05 ", $344.79 ," $2,320.25 "," $2,387.35 "," $2,136.05 "," $2,337.09 "," $2,337.09 "," $2,387.35 "," $2,412.48 "," $2,056.14 "," $2,261.70 "," $2,136.05 "," $1,985.27 ", N/A ," $2,033.77 "," $2,033.77 "," $2,387.35 "," $2,156.41 ", $174.38 ," $2,412.48 "
Chmsrg Mohs Mg Tq T/a/L Ea Addl Any Stag,CPT® 17315,N/A,N/A,N/A, $397.00 , $258.05 , $160.92 , $48.24 , $61.84 , $144.79 , $139.60 , $369.21 , $357.30 , $357.30 , $317.60 , $317.60 , $61.84 , $366.55 , $377.15 , $357.30 , $357.30 , $357.30 , $369.21 , $381.12 , $177.47 , $337.45 , $276.53 , $185.62 , N/A , $147.62 , $147.62 , $377.15 , $171.18 , $48.24 , $381.12 
Intravascular US Noncoronary Rs&I Intial Vessel,CPT® 37252,N/A,N/A,N/A," $8,065.00 "," $5,242.25 ", $522.86 , $80.79 ," $1,106.24 ", $397.12 , $380.92 ," $7,500.45 "," $7,258.50 "," $7,258.50 "," $6,452.00 "," $6,452.00 "," $1,106.24 "," $7,446.41 "," $7,661.75 "," $7,258.50 "," $7,258.50 "," $7,258.50 "," $7,500.45 "," $7,742.40 ", $486.32 ," $6,855.25 ", $462.01 , $440.97 , N/A , $404.87 , $404.87 ," $7,661.75 ", $459.93 , $80.79 ," $7,742.40 "
"Noninvasv Extrem Exam,Mult,Bilat",CPT® 93923,N/A,N/A,N/A," $2,837.00 "," $1,844.05 ", $806.46 , $125.11 , $133.50 , $744.31 , $816.97 ," $2,638.41 "," $2,553.30 "," $2,553.30 "," $2,269.60 "," $2,269.60 ", $133.50 ," $2,619.40 "," $2,695.15 "," $2,553.30 "," $2,553.30 "," $2,553.30 "," $2,638.41 "," $2,723.52 ", $565.33 ," $2,411.45 ", $435.90 , $515.15 , N/A , $758.84 , $758.84 ," $2,695.15 ", $841.18 , $125.11 ," $2,723.52 "
 Pro X-Ray Exam of Collar Bone ,CPT® 73000,0972 - PRO FEE/RAD/DX,N/A,N/A, $99.00 , $64.35 , $180.79 , $31.69 , $26.56 , $131.21 , $155.62 , $92.07 , $89.10 , $89.10 , $79.20 , $79.20 , $26.56 , $91.41 , $94.05 , $89.10 , $89.10 , $89.10 , $92.07 , $95.04 , $176.32 , $84.15 , $169.49 , $140.49 , N/A , $133.76 , $133.76 , $94.05 , $154.84 , $26.56 , $180.79 
"Contact Lens Fitting,Bilat",CPT® 92310,N/A,N/A,N/A, $151.00 , $98.15 , N/A , $98.34 , $265.38 , $106.08 , $103.70 , $140.43 , $135.90 , $135.90 , $120.80 , $120.80 , $265.38 , $139.42 , $143.45 , $135.90 , $135.90 , $135.90 , $140.43 , $144.96 , $179.06 , $128.35 , $174.36 , $126.32 , N/A , $108.15 , $108.15 , $143.45 , $128.65 , $98.34 , $265.38 
 Pfizer Administration Second Dose ,CPT® 0002A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
 Pro Treat Wrist Bone Fracture ,CPT® 25630,0982 - PRO FEE/OUTPT,N/A,N/A," $1,172.00 ", $761.80 ," $1,768.39 ", $280.46 , $206.19 ," $1,350.10 "," $1,368.18 "," $1,089.96 "," $1,054.80 "," $1,054.80 ", $937.60 , $937.60 , $206.19 ," $1,082.11 "," $1,113.40 "," $1,054.80 "," $1,054.80 "," $1,054.80 "," $1,089.96 "," $1,125.12 "," $1,632.61 ", $996.20 ," $1,500.40 "," $1,608.26 ", N/A ," $1,376.44 "," $1,376.44 "," $1,113.40 "," $1,617.81 ", $206.19 ," $1,768.39 "
 TRAMADOL 25 MG TAB (COMES FROM 50 MG TABLET) ,HCPCS RXC637,0250 - PHARMACY,00001-0926-01,2 tablet, $8.96 , $5.82 , $7.53 , N/A , N/A , $7.24 , $8.06 , $7.59 , $8.06 , $8.06 , $8.06 , $7.62 , N/A , $8.27 , $8.51 , $7.62 , $8.33 , $8.33 , $8.51 , $8.60 , $7.33 , $8.06 , $7.62 , $7.08 , N/A , $7.25 , $7.25 , $8.51 , $7.69 , $7.08 , $8.60 
Assay Serum Potassium,CPT® 84132,N/A,N/A,N/A, $35.00 , $22.75 , N/A , $4.86 , $4.86 , $26.03 , $31.11 , $32.55 , $31.50 , $31.50 , $28.00 , $28.00 , $4.86 , $32.32 , $33.25 , $31.50 , $31.50 , $31.50 , $32.55 , $33.60 , $31.78 , $29.75 , $30.82 , $16.68 , N/A , $24.29 , $24.29 , $33.25 , $26.54 , $4.86 , $33.60 
 Viral Illness With McC ,MS DRG V40 (FY2023) 865,N/A,N/A,N/A," $25,080.33 "," $16,302.21 "," $21,067.48 ", N/A , N/A ," $20,264.91 "," $22,572.30 "," $21,233.01 "," $22,572.30 "," $22,572.30 "," $22,572.30 "," $21,318.28 ", N/A ," $23,156.67 "," $23,826.31 "," $21,318.28 "," $23,324.71 "," $23,324.71 "," $23,826.31 "," $24,077.12 "," $20,520.73 "," $22,572.30 "," $21,318.28 "," $19,813.46 ", N/A ," $20,297.51 "," $20,297.51 "," $23,826.31 "," $21,521.43 "," $19,813.46 "," $24,077.12 "
 Pro Treat Finger Dislocation ,CPT® 26770,0982 - PRO FEE/OUTPT,N/A,N/A," $1,789.00 "," $1,162.85 "," $1,609.47 ", $257.24 , $74.85 ," $1,227.08 "," $1,253.31 "," $1,663.77 "," $1,610.10 "," $1,610.10 "," $1,431.20 "," $1,431.20 ", $74.85 ," $1,651.78 "," $1,699.55 "," $1,610.10 "," $1,610.10 "," $1,610.10 "," $1,663.77 "," $1,717.44 "," $1,478.71 "," $1,520.65 "," $1,373.73 "," $1,463.84 ", N/A ," $1,251.03 "," $1,251.03 "," $1,699.55 "," $1,470.39 ", $74.85 ," $1,717.44 "
Cleansing Tissue/Muscle/Bone,11044,N/A,N/A,N/A," $1,859.00 "," $1,208.35 ", $710.09 , $211.81 , $318.61 , $632.19 , $613.32 ," $1,728.87 "," $1,673.10 "," $1,673.10 "," $1,487.20 "," $1,487.20 ", $318.61 ," $1,716.41 "," $1,766.05 "," $1,673.10 "," $1,673.10 "," $1,673.10 "," $1,728.87 "," $1,784.64 ", $780.34 ," $1,580.15 "," $1,231.00 ", $800.16 , N/A , $644.53 , $644.53 ," $1,766.05 ", $747.46 , $211.81 ," $1,784.64 "
 Fac Screening Digital Breast Tomosynthesis Bi ,CPT® 77063,0403 - MAMMOGRAPHY SCREENING,N/A,N/A, $124.00 , $80.60 , $104.16 , $52.04 , $42.90 , $100.19 , $111.60 , $104.98 , $111.60 , $111.60 , $111.60 , $105.40 , $42.06 , $114.49 , $117.80 , $105.40 , $115.32 , $115.32 , $117.80 , $119.04 , $101.46 , $111.60 , $105.40 , $97.96 , N/A , $100.35 , $100.35 , $117.80 , $106.40 , $42.06 , $119.04 
US Abdominal Aorta Real Time Screen Study Aaa,76706,N/A,N/A,N/A, $251.00 , $163.15 , $606.85 , $105.25 , $74.59 , $434.43 , $479.15 , $233.43 , $225.90 , $225.90 , $200.80 , $200.80 , $74.59 , $231.75 , $238.45 , $225.90 , $225.90 , $225.90 , $233.43 , $240.96 , $606.44 , $213.35 , $615.79 , $530.13 , N/A , $442.90 , $442.90 , $238.45 , $512.69 , $74.59 , $615.79 
 Pro Csto Int Urethrotomy Male ,CPT® 52275,0982 - PRO FEE/OUTPT,N/A,N/A," $3,422.00 "," $2,224.30 "," $1,331.76 ", $233.75 , $307.34 ," $1,220.96 "," $1,129.99 "," $3,182.46 "," $3,079.80 "," $3,079.80 "," $2,737.60 "," $2,737.60 ", $307.34 ," $3,159.53 "," $3,250.90 "," $3,079.80 "," $3,079.80 "," $3,079.80 "," $3,182.46 "," $3,285.12 "," $1,337.47 "," $2,908.70 "," $1,279.17 "," $1,531.88 ", N/A ," $1,244.79 "," $1,244.79 "," $3,250.90 "," $1,463.06 ", $233.75 ," $3,285.12 "
"Prolonged Serv,No Contact,1st Hr",99358,N/A,N/A,N/A, $391.00 , $254.15 , $221.34 , $88.80 , N/A , $189.51 , $188.77 , $363.63 , $351.90 , $351.90 , $312.80 , $312.80 , N/A , $361.01 , $371.45 , $351.90 , $351.90 , $351.90 , $363.63 , $375.36 , $201.62 , $332.35 , N/A , $244.37 , N/A , $193.20 , $193.20 , $371.45 , $222.82 , $88.80 , $375.36 
 Fac Other Source Albumin Quantitative Each Specimen ,CPT® 82042,0301 - LAB/CHEMISTRY,N/A,N/A, $81.00 , $52.65 , $68.04 , $7.94 , $7.18 , $65.45 , $72.90 , $68.57 , $72.90 , $72.90 , $72.90 , $68.85 , $7.04 , $74.79 , $76.95 , $68.85 , $75.33 , $75.33 , $76.95 , $77.76 , $66.27 , $72.90 , $68.85 , $63.99 , N/A , $65.55 , $65.55 , $76.95 , $69.51 , $7.04 , $77.76 
 Fac Prq Trluml Coronary Angioplasty One Art/Branch ,CPT® 92920,0481 - CARDIAC CATH LAB,N/A,N/A," $9,825.00 "," $6,386.25 "," $8,253.00 ", $474.89 , $605.17 ," $7,938.60 "," $8,842.50 "," $8,317.85 "," $8,842.50 "," $8,842.50 "," $8,842.50 "," $8,351.25 ", $593.30 ," $9,071.42 "," $9,333.75 "," $8,351.25 "," $9,137.25 "," $9,137.25 "," $9,333.75 "," $9,432.00 "," $8,038.82 "," $8,842.50 "," $8,351.25 "," $7,761.75 ", N/A ," $7,951.37 "," $7,951.37 "," $9,333.75 "," $8,430.83 ", $474.89 ," $9,432.00 "
Remv Talus/Heel Benign Bone Lesn,CPT® 28100,N/A,N/A,N/A," $4,008.00 "," $2,605.20 "," $2,582.13 ", $403.17 , $384.19 ," $2,030.21 "," $2,021.41 "," $3,727.44 "," $3,607.20 "," $3,607.20 "," $3,206.40 "," $3,206.40 ", $384.19 ," $3,700.59 "," $3,807.60 "," $3,607.20 "," $3,607.20 "," $3,607.20 "," $3,727.44 "," $3,847.68 "," $2,391.57 "," $3,406.80 "," $2,203.32 "," $2,410.13 ", N/A ," $2,069.82 "," $2,069.82 "," $3,807.60 "," $2,432.77 ", $384.19 ," $3,847.68 "
 ONABOTULINUMTOXINA 100 UNITS IJ SOLR ,HCPCS J0585,0636 - DRUGS REQUIRING DETAILED CODIN,00023-1145-01,1 each," $3,908.14 "," $2,540.29 "," $3,282.84 ", $6.52 , $6.45 ," $3,157.78 "," $3,517.33 "," $3,308.63 "," $3,517.33 "," $3,517.33 "," $3,517.33 "," $3,321.92 ", $6.32 ," $3,608.39 "," $3,712.73 "," $3,321.92 "," $3,634.57 "," $3,634.57 "," $3,712.73 "," $3,751.81 "," $3,197.64 "," $3,517.33 "," $3,321.92 "," $3,087.43 ", N/A ," $3,162.86 "," $3,162.86 "," $3,712.73 "," $3,353.57 ", $6.32 ," $3,751.81 "
 Fac Bcr/Abl1 Minor Breakpnt Qualitative/Quantitative ,CPT® 81207,0310 - PATHOLOGY LAB,N/A,N/A," $1,297.00 ", $843.05 ," $1,089.48 ", $147.74 , $147.74 ," $1,047.98 "," $1,167.30 "," $1,098.04 "," $1,167.30 "," $1,167.30 "," $1,167.30 "," $1,102.45 ", $144.84 ," $1,197.52 "," $1,232.15 "," $1,102.45 "," $1,206.21 "," $1,206.21 "," $1,232.15 "," $1,245.12 "," $1,061.21 "," $1,167.30 "," $1,102.45 "," $1,024.63 ", N/A ," $1,049.66 "," $1,049.66 "," $1,232.15 "," $1,112.96 ", $144.84 ," $1,245.12 "
Reposition Intraocular Lens W Incis,CPT® 66825,N/A,N/A,N/A," $7,385.00 "," $4,800.25 "," $5,209.36 ", $811.80 , $624.80 ," $4,291.96 "," $4,016.88 "," $6,868.05 "," $6,646.50 "," $6,646.50 "," $5,908.00 "," $5,908.00 ", $624.80 ," $6,818.57 "," $7,015.75 "," $6,646.50 "," $6,646.50 "," $6,646.50 "," $6,868.05 "," $7,089.60 "," $7,004.00 "," $6,277.25 "," $4,117.62 "," $5,460.56 ", N/A ," $4,375.71 "," $4,375.71 "," $7,015.75 "," $4,830.20 ", $624.80 ," $7,089.60 "
" Pro Ca Screen,Flexi Sigmoidscope ",HCPCS G0104,0982 - PRO FEE/OUTPT,N/A,N/A," $1,015.00 ", $659.75 , $126.46 , $53.21 , $103.39 , $117.23 , N/A , $943.95 , $913.50 , $913.50 , $812.00 , $812.00 , $103.39 , $937.15 , $964.25 , $913.50 , $913.50 , $913.50 , $943.95 , $974.40 , $165.85 , $862.75 , $124.56 , $325.47 , N/A , $119.52 , $119.52 , $964.25 , $149.41 , $53.21 , $974.40 
 PHENOBARBITAL 97.2 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00603-5168-21,1 tablet, $6.12 , $3.98 , $5.14 , N/A , N/A , $4.94 , $5.51 , $5.18 , $5.51 , $5.51 , $5.51 , $5.20 , N/A , $5.65 , $5.81 , $5.20 , $5.69 , $5.69 , $5.81 , $5.88 , $5.01 , $5.51 , $5.20 , $4.83 , N/A , $4.95 , $4.95 , $5.81 , $5.25 , $4.83 , $5.88 
Behav Assmt W/Score & Docd/Stand Instrument,CPT® 96127,N/A,N/A,N/A, $25.00 , $16.25 , $10.42 , $4.38 , $4.07 , $11.37 , $11.63 , $23.25 , $22.50 , $22.50 , $20.00 , $20.00 , $4.07 , $23.08 , $23.75 , $22.50 , $22.50 , $22.50 , $23.25 , $24.00 , $19.57 , $21.25 , $14.14 , $23.13 , N/A , $11.59 , $11.59 , $23.75 , $13.53 , $4.07 , $24.00 
"US,Retroperit, B-Scan/Real Time,Complete",CPT® 76770,N/A,N/A,N/A," $1,007.00 ", $654.55 , $620.43 , $107.56 , $119.09 , $543.01 , $702.61 , $936.51 , $906.30 , $906.30 , $805.60 , $805.60 , $119.09 , $929.76 , $956.65 , $906.30 , $906.30 , $906.30 , $936.51 , $966.72 , $623.69 , $855.95 , $764.64 , $638.53 , N/A , $553.60 , $553.60 , $956.65 , $640.80 , $107.56 , $966.72 
Treat Ankle Dislocation,CPT® 27840,N/A,N/A,N/A," $2,578.00 "," $1,675.70 "," $2,352.48 ", $375.49 , $153.67 ," $1,776.63 "," $1,824.43 "," $2,397.54 "," $2,320.20 "," $2,320.20 "," $2,062.40 "," $2,062.40 ", $153.67 ," $2,380.27 "," $2,449.10 "," $2,320.20 "," $2,320.20 "," $2,320.20 "," $2,397.54 "," $2,474.88 "," $2,156.14 "," $2,191.30 "," $2,001.72 "," $2,128.48 ", N/A ," $1,811.30 "," $1,811.30 "," $2,449.10 "," $2,128.91 ", $153.67 ," $2,474.88 "
 Pro Drainage Rectal Abscess ,CPT® 46050,0981 - PRO FEE/ER,N/A,N/A, $593.00 , $385.45 , $612.76 , $96.47 , $68.62 , $463.98 , $481.35 , $551.49 , $533.70 , $533.70 , $474.40 , $474.40 , $68.62 , $547.52 , $563.35 , $533.70 , $533.70 , $533.70 , $551.49 , $569.28 , $436.34 , $504.05 , $529.87 , $552.66 , N/A , $473.03 , $473.03 , $563.35 , $494.75 , $68.62 , $612.76 
" Fac Blood Type Antigen Donor Reagent Serum, Ea Antigen ",CPT® 86902,0300 - LABORATORY,N/A,N/A, $62.00 , $40.30 , $52.08 , $6.48 , $5.30 , $50.10 , $55.80 , $52.49 , $55.80 , $55.80 , $55.80 , $52.70 , $5.20 , $57.24 , $58.90 , $52.70 , $57.66 , $57.66 , $58.90 , $59.52 , $50.73 , $55.80 , $52.70 , $48.98 , N/A , $50.18 , $50.18 , $58.90 , $53.20 , $5.20 , $59.52 
 Fac Platelet Antibodies ,CPT® 86022,0302 - LAB/IMMUNOLOGY,N/A,N/A, $325.00 , $211.25 , $273.00 , $18.74 , $18.74 , $262.60 , $292.50 , $275.15 , $292.50 , $292.50 , $292.50 , $276.25 , $18.37 , $300.07 , $308.75 , $276.25 , $302.25 , $302.25 , $308.75 , $312.00 , $265.92 , $292.50 , $276.25 , $256.75 , N/A , $263.02 , $263.02 , $308.75 , $278.88 , $18.37 , $312.00 
 SODIUM CHLORIDE (PF) 0.9 % IJ SOLN ,HCPCS RXA250,0250 - PHARMACY,63323-0186-10,10 mL, $16.68 , $10.84 , $14.01 , N/A , N/A , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , N/A , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $13.18 , $16.01 
 EUGENOL 85 % MT SOLN ,HCPCS RXA250,0250 - PHARMACY,11917-0150-92,3.7 mL, $28.21 , $18.34 , $23.70 , N/A , N/A , $22.79 , $25.39 , $23.88 , $25.39 , $25.39 , $25.39 , $23.98 , N/A , $26.05 , $26.80 , $23.98 , $26.24 , $26.24 , $26.80 , $27.08 , $23.08 , $25.39 , $23.98 , $22.29 , N/A , $22.83 , $22.83 , $26.80 , $24.21 , $22.29 , $27.08 
Bcg Live Intravesical 1mg,HCPCS J9030,N/A,N/A,N/A, $9.00 , $5.85 , N/A , $2.95 , $2.93 , N/A , N/A , $8.37 , $8.10 , $8.10 , $7.20 , $7.20 , $2.93 , $8.31 , $8.55 , $8.10 , $8.10 , $8.10 , $8.37 , $8.64 , $3.71 , $7.65 , $5.17 , $3.99 , N/A , N/A , N/A , $8.55 , N/A , $2.93 , $8.64 
"Hypospadius Repair,1st Stage",CPT® 54304,N/A,N/A,N/A," $4,117.00 "," $2,676.05 "," $3,313.64 ", $712.82 , $759.58 ," $2,407.84 "," $2,427.29 "," $3,828.81 "," $3,705.30 "," $3,705.30 "," $3,293.60 "," $3,293.60 ", $759.58 ," $3,801.23 "," $3,911.15 "," $3,705.30 "," $3,705.30 "," $3,705.30 "," $3,828.81 "," $3,952.32 "," $3,114.72 "," $3,499.45 "," $3,866.07 "," $3,635.31 ", N/A ," $2,454.83 "," $2,454.83 "," $3,911.15 "," $2,942.22 ", $712.82 ," $3,952.32 "
 Mandible Min 4 Vw- Mh ,CPT® 70110,0972 - PRO FEE/RAD/DX,N/A,N/A, $164.00 , $106.60 , $248.01 , $42.68 , $37.90 , $180.00 , $210.60 , $152.52 , $147.60 , $147.60 , $131.20 , $131.20 , $37.90 , $151.42 , $155.80 , $147.60 , $147.60 , $147.60 , $152.52 , $157.44 , $239.53 , $139.40 , $231.13 , $191.32 , N/A , $183.52 , $183.52 , $155.80 , $212.43 , $37.90 , $248.01 
 MORPHINE 50 MG/ML PRESERVATIVE FREE INJECTION ,HCPCS J2274,0636 - DRUGS REQUIRING DETAILED CODIN,00409-1134-03,20 mL, $45.78 , $29.76 , $38.46 , $16.01 , $17.04 , $36.99 , $41.20 , $38.76 , $41.20 , $41.20 , $41.20 , $38.91 , $16.71 , $42.27 , $43.49 , $38.91 , $42.58 , $42.58 , $43.49 , $43.95 , $37.46 , $41.20 , $38.91 , $36.17 , N/A , $37.05 , $37.05 , $43.49 , $39.28 , $16.01 , $43.95 
 Sc Bx Lung Perc Ndl ,CPT® 32408,0761 - TREATMENT ROOM,N/A,N/A," $3,114.00 "," $2,024.10 "," $2,615.76 ", $145.68 , $741.88 ," $2,516.11 "," $2,802.60 "," $2,636.31 "," $2,802.60 "," $2,802.60 "," $2,802.60 "," $2,646.90 ", $727.33 ," $2,875.16 "," $2,958.30 "," $2,646.90 "," $2,896.02 "," $2,896.02 "," $2,958.30 "," $2,989.44 "," $2,547.87 "," $2,802.60 "," $2,646.90 "," $2,460.06 ", N/A ," $2,520.16 "," $2,520.16 "," $2,958.30 "," $2,672.12 ", $145.68 ," $2,989.44 "
 Fac Assay of Myoglobin ,CPT® 83874,0301 - LAB/CHEMISTRY,N/A,N/A, $174.00 , $113.10 , $146.16 , $13.18 , $13.18 , $140.59 , $156.60 , $147.31 , $156.60 , $156.60 , $156.60 , $147.90 , $12.92 , $160.65 , $165.30 , $147.90 , $161.82 , $161.82 , $165.30 , $167.04 , $142.37 , $156.60 , $147.90 , $137.46 , N/A , $140.82 , $140.82 , $165.30 , $149.31 , $12.92 , $167.04 
Interferon Alfa-2b Inj,HCPCS J9214,N/A,N/A,N/A, $64.00 , $41.60 , N/A , $33.22 , $33.22 , N/A , N/A , $59.52 , $57.60 , $57.60 , $51.20 , $51.20 , $33.22 , $59.09 , $60.80 , $57.60 , $57.60 , $57.60 , $59.52 , $61.44 , $43.89 , $54.40 , $36.98 , $45.63 , N/A , N/A , N/A , $60.80 , N/A , $33.22 , $61.44 
Iaad Ia Severe Aqt Respir Synd Coronavirus,CPT® 87426,N/A,N/A,N/A, $100.00 , $65.00 , N/A , $36.04 , $36.04 , N/A , N/A , $93.00 , $90.00 , $90.00 , $80.00 , $80.00 , $36.04 , $92.33 , $95.00 , $90.00 , $90.00 , $90.00 , $93.00 , $96.00 , N/A , $85.00 , $168.00 , $126.47 , N/A , $175.49 , $175.49 , $95.00 , $191.78 , $36.04 , $191.78 
 BUPIVACAINE HCL 0.5 % IJ SOLN ,HCPCS J0665,0636 - DRUGS REQUIRING DETAILED CODIN,00409-1163-01,50 mL, $16.70 , $10.86 , $14.03 , N/A , N/A , $13.49 , $15.03 , $14.14 , $15.03 , $15.03 , $15.03 , $14.20 , N/A , $15.42 , $15.87 , $14.20 , $15.53 , $15.53 , $15.87 , $16.03 , $13.66 , $15.03 , $14.20 , $13.19 , N/A , $13.52 , $13.52 , $15.87 , $14.33 , $13.19 , $16.03 
 Fac Computed Tomography Thorax Lw Dose Lng Ca Scr C- ,CPT® 71271,0350 - CT SCAN,N/A,N/A," $3,257.00 "," $2,117.05 "," $2,735.88 ", $140.54 , $115.93 ," $2,631.66 "," $2,931.30 "," $2,757.38 "," $2,931.30 "," $2,931.30 "," $2,931.30 "," $2,768.45 ", $113.66 ," $3,007.19 "," $3,094.15 "," $2,768.45 "," $3,029.01 "," $3,029.01 "," $3,094.15 "," $3,126.72 "," $2,664.88 "," $2,931.30 "," $2,768.45 "," $2,573.03 ", N/A ," $2,635.89 "," $2,635.89 "," $3,094.15 "," $2,794.83 ", $113.66 ," $3,126.72 "
"Repair 1 Collat Ankle Ligmnt,Primary",CPT® 27695,N/A,N/A,N/A," $4,066.00 "," $2,642.90 "," $2,957.37 ", $467.59 , $691.53 ," $2,319.87 "," $2,337.85 "," $3,781.38 "," $3,659.40 "," $3,659.40 "," $3,252.80 "," $3,252.80 ", $691.53 ," $3,754.14 "," $3,862.70 "," $3,659.40 "," $3,659.40 "," $3,659.40 "," $3,781.38 "," $3,903.36 "," $2,722.28 "," $3,456.10 "," $2,563.70 "," $2,748.44 ", N/A ," $2,365.14 "," $2,365.14 "," $3,862.70 "," $2,779.89 ", $467.59 ," $3,903.36 "
" Fac Hepatitis C, Rna, Quant ",CPT® 87522,0306 - LAB/BACT-MICRO,N/A,N/A, $396.00 , $257.40 , $332.64 , $43.70 , $43.70 , $319.97 , $356.40 , $335.25 , $356.40 , $356.40 , $356.40 , $336.60 , $42.84 , $365.63 , $376.20 , $336.60 , $368.28 , $368.28 , $376.20 , $380.16 , $324.01 , $356.40 , $336.60 , $312.84 , N/A , $320.48 , $320.48 , $376.20 , $339.81 , $42.84 , $380.16 
 KETAMINE HCL 50 MG/5ML IJ SOSY ,HCPCS RXA250,0250 - PHARMACY,69374-0982-55,5 mL, $30.83 , $20.04 , $25.90 , N/A , N/A , $24.91 , $27.75 , $26.10 , $27.75 , $27.75 , $27.75 , $26.21 , N/A , $28.47 , $29.29 , $26.21 , $28.67 , $28.67 , $29.29 , $29.60 , $25.23 , $27.75 , $26.21 , $24.36 , N/A , $24.95 , $24.95 , $29.29 , $26.46 , $24.36 , $29.60 
 Fac Pmp22 Gene Anal Duplication/Deletion Analysis ,CPT® 81324,0310 - PATHOLOGY LAB,N/A,N/A, $18.00 , $11.70 , $15.12 , $773.53 , $446.29 , $14.54 , $16.20 , $15.24 , $16.20 , $16.20 , $16.20 , $15.30 , $437.54 , $16.62 , $17.10 , $15.30 , $16.74 , $16.74 , $17.10 , $17.28 , $14.73 , $16.20 , $15.30 , $14.22 , N/A , $14.57 , $14.57 , $17.10 , $15.45 , $14.22 , $773.53 
Prealbumin,CPT® 84134,N/A,N/A,N/A, $135.00 , $87.75 , N/A , $14.88 , $7.75 , $31.60 , $37.81 , $125.55 , $121.50 , $121.50 , $108.00 , $108.00 , $7.75 , $124.65 , $128.25 , $121.50 , $121.50 , $121.50 , $125.55 , $129.60 , $97.42 , $114.75 , $95.69 , $52.90 , N/A , $29.49 , $29.49 , $128.25 , $32.22 , $7.75 , $129.60 
Cyp2d6 Gene Analysis Common Variants,CPT® 81226,N/A,N/A,N/A," $1,543.00 "," $1,002.95 ", N/A , $459.93 , N/A ," $1,872.76 "," $2,217.79 "," $1,434.99 "," $1,388.70 "," $1,388.70 "," $1,234.40 "," $1,234.40 ", N/A ," $1,424.65 "," $1,465.85 "," $1,388.70 "," $1,388.70 "," $1,388.70 "," $1,434.99 "," $1,481.28 "," $3,010.83 "," $1,311.55 "," $2,150.06 "," $1,324.32 ", N/A ," $1,747.78 "," $1,747.78 "," $1,465.85 "," $1,909.95 ", $459.93 ," $3,010.83 "
 Pro Removal of Thigh Lesion ,CPT® 27327,0975 - PRO FEE/OR,N/A,N/A," $4,268.00 "," $2,774.20 "," $1,912.82 ", $300.22 , $32.04 ," $1,507.88 "," $1,515.87 "," $3,969.24 "," $3,841.20 "," $3,841.20 "," $3,414.40 "," $3,414.40 ", $32.04 ," $3,940.64 "," $4,054.60 "," $3,841.20 "," $3,841.20 "," $3,841.20 "," $3,969.24 "," $4,097.28 "," $1,763.13 "," $3,627.80 "," $1,671.67 "," $1,778.91 ", N/A ," $1,537.31 "," $1,537.31 "," $4,054.60 "," $1,806.88 ", $32.04 ," $4,097.28 "
 Fac Immune Complex Assay ,CPT® 86332,0302 - LAB/IMMUNOLOGY,N/A,N/A, $242.00 , $157.30 , $203.28 , $24.86 , $24.86 , $195.54 , $217.80 , $204.88 , $217.80 , $217.80 , $217.80 , $205.70 , $24.37 , $223.44 , $229.90 , $205.70 , $225.06 , $225.06 , $229.90 , $232.32 , $198.00 , $217.80 , $205.70 , $191.18 , N/A , $195.85 , $195.85 , $229.90 , $207.66 , $24.37 , $232.32 
 Pro Shaving Skin Lesion 1 S/N/H/F/G Diam 0.6-1.0 Cm ,CPT® 11306,0982 - PRO FEE/OUTPT,N/A,N/A, $473.00 , $307.45 , $159.32 , $47.40 , $58.11 , $142.14 , $136.31 , $439.89 , $425.70 , $425.70 , $378.40 , $378.40 , $58.11 , $436.72 , $449.35 , $425.70 , $425.70 , $425.70 , $439.89 , $454.08 , $175.73 , $402.05 , $269.39 , $183.99 , N/A , $144.91 , $144.91 , $449.35 , $168.04 , $47.40 , $454.08 
 FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN ,HCPCS J1652,0636 - DRUGS REQUIRING DETAILED CODIN,55111-0678-02,0.5 mL, $296.40 , $192.66 , $248.98 , $1.09 , $1.09 , $239.49 , $266.76 , $250.93 , $266.76 , $266.76 , $266.76 , $251.94 , $1.07 , $273.67 , $281.58 , $251.94 , $275.65 , $275.65 , $281.58 , $284.54 , $242.51 , $266.76 , $251.94 , $234.16 , N/A , $239.88 , $239.88 , $281.58 , $254.34 , $1.07 , $284.54 
Percut Rx Tibia Shaft Fx,27756,N/A,N/A,N/A," $4,389.00 "," $2,852.85 "," $3,545.75 ", $554.33 , $768.38 ," $2,782.84 "," $2,791.04 "," $4,081.77 "," $3,950.10 "," $3,950.10 "," $3,511.20 "," $3,511.20 ", $768.38 ," $4,052.36 "," $4,169.55 "," $3,950.10 "," $3,950.10 "," $3,950.10 "," $4,081.77 "," $4,213.44 "," $3,274.31 "," $3,730.65 "," $3,079.29 "," $3,299.59 ", N/A ," $2,837.13 "," $2,837.13 "," $4,169.55 "," $3,334.64 ", $554.33 ," $4,213.44 "
Iaad Ia Histoplasm Capsulatum,CPT® 87385,N/A,N/A,N/A, $179.00 , $116.35 , N/A , $13.52 , $13.52 , $67.85 , $81.18 , $166.47 , $161.10 , $161.10 , $143.20 , $143.20 , $13.52 , $165.27 , $170.05 , $161.10 , $161.10 , $161.10 , $166.47 , $171.84 , $88.47 , $152.15 , $77.85 , $43.47 , N/A , $63.32 , $63.32 , $170.05 , $69.20 , $13.52 , $171.84 
 DARBEPOETIN ALFA 60 MCG/0.3ML IJ SOSY ,HCPCS J0882,0636 - DRUGS REQUIRING DETAILED CODIN,55513-0023-04,0.3 mL," $1,365.49 ", $887.57 ," $1,147.01 ", $3.00 , N/A ," $1,103.32 "," $1,228.94 "," $1,156.02 "," $1,228.94 "," $1,228.94 "," $1,228.94 "," $1,160.67 ", N/A ," $1,260.76 "," $1,297.22 "," $1,160.67 "," $1,269.91 "," $1,269.91 "," $1,297.22 "," $1,310.87 "," $1,117.24 "," $1,228.94 "," $1,160.67 "," $1,078.74 ", N/A ," $1,105.09 "," $1,105.09 "," $1,297.22 "," $1,171.73 ", $3.00 ," $1,310.87 "
"Removal Foreign Body,Musc",20520,N/A,N/A,N/A," $1,195.00 ", $776.75 , $907.27 , $141.83 , $63.53 , $711.39 , $712.53 ," $1,111.35 "," $1,075.50 "," $1,075.50 ", $956.00 , $956.00 , $63.53 ," $1,103.34 "," $1,135.25 "," $1,075.50 "," $1,075.50 "," $1,075.50 "," $1,111.35 "," $1,147.20 ", $842.13 ," $1,015.75 ", $779.64 , $849.77 , N/A , $725.26 , $725.26 ," $1,135.25 ", $852.44 , $63.53 ," $1,147.20 "
Spin Bone Allogrft Morselized,20930,N/A,N/A,N/A," $1,392.00 ", $904.80 , N/A , N/A , $382.01 , $584.90 , $571.27 ," $1,294.56 "," $1,252.80 "," $1,252.80 "," $1,113.60 "," $1,113.60 ", $382.01 ," $1,285.23 "," $1,322.40 "," $1,252.80 "," $1,252.80 "," $1,252.80 "," $1,294.56 "," $1,336.32 ", N/A ," $1,183.20 ", N/A , $681.93 , N/A , $596.32 , $596.32 ," $1,322.40 ", $700.88 , $382.01 ," $1,336.32 "
Labyrinthotomy,CPT® 69801,N/A,N/A,N/A," $2,863.00 "," $1,860.95 ", $584.30 , $119.01 ," $1,536.80 ", $604.72 , $613.50 ," $2,662.59 "," $2,576.70 "," $2,576.70 "," $2,290.40 "," $2,290.40 "," $1,536.80 "," $2,643.41 "," $2,719.85 "," $2,576.70 "," $2,576.70 "," $2,576.70 "," $2,662.59 "," $2,748.48 ", $635.32 ," $2,433.55 ", $670.81 , $605.62 , N/A , $616.51 , $616.51 ," $2,719.85 ", $703.94 , $119.01 ," $2,748.48 "
"Skin Graft, Harvest Cultured Tissue",CPT® 15040,N/A,N/A,N/A," $1,074.00 ", $698.10 , $387.46 , $116.16 , $214.17 , $345.83 , $337.83 , $998.82 , $966.60 , $966.60 , $859.20 , $859.20 , $214.17 , $991.62 ," $1,020.30 ", $966.60 , $966.60 , $966.60 , $998.82 ," $1,031.04 ", $428.18 , $912.90 , $677.94 , $434.83 , N/A , $352.58 , $352.58 ," $1,020.30 ", $408.87 , $116.16 ," $1,031.04 "
 SODIUM CHLORIDE 0.9 % INH NEBU ,HCPCS RXA250,0250 - PHARMACY,00487-9301-03,3 mL, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 LACTATED RINGERS BOLUS ,HCPCS RXA258,0258 - IV SOLUTIONS,00990-7953-02,250 mL, $83.14 , $54.04 , $69.84 , N/A , N/A , $67.18 , $74.83 , $70.39 , $74.83 , $74.83 , $74.83 , $70.67 , N/A , $76.76 , $78.98 , $70.67 , $77.32 , $77.32 , $78.98 , $79.81 , $68.03 , $74.83 , $70.67 , $65.68 , N/A , $67.29 , $67.29 , $78.98 , $71.34 , $65.68 , $79.81 
Adj Tiss Xfer Trunk <10sqcm,14000,N/A,N/A,N/A," $2,707.00 "," $1,759.55 "," $1,596.57 ", $480.03 , $199.64 ," $1,369.32 "," $1,352.46 "," $2,517.51 "," $2,436.30 "," $2,436.30 "," $2,165.60 "," $2,165.60 ", $199.64 ," $2,499.37 "," $2,571.65 "," $2,436.30 "," $2,436.30 "," $2,436.30 "," $2,517.51 "," $2,598.72 "," $1,741.46 "," $2,300.95 "," $2,702.86 "," $1,748.46 ", N/A ," $1,396.04 "," $1,396.04 "," $2,571.65 "," $1,618.94 ", $199.64 ," $2,702.86 "
Assay of Corticosteroids,CPT® 83491,N/A,N/A,N/A, $160.00 , $104.00 , N/A , $18.26 , $18.26 , $99.11 , $118.55 , $148.80 , $144.00 , $144.00 , $128.00 , $128.00 , $18.26 , $147.73 , $152.00 , $144.00 , $144.00 , $144.00 , $148.80 , $153.60 , $119.52 , $136.00 , $115.15 , $63.56 , N/A , $92.50 , $92.50 , $152.00 , $101.08 , $18.26 , $153.60 
 Fac Nsl Smr Eosinophils ,CPT® 89190,0305 - LAB/HEMATOLOGY,N/A,N/A, $53.00 , $34.45 , $44.52 , $5.91 , $5.91 , $42.82 , $47.70 , $44.87 , $47.70 , $47.70 , $47.70 , $45.05 , $5.79 , $48.93 , $50.35 , $45.05 , $49.29 , $49.29 , $50.35 , $50.88 , $43.36 , $47.70 , $45.05 , $41.87 , N/A , $42.89 , $42.89 , $50.35 , $45.48 , $5.79 , $50.88 
"Ca Screen,Pelvic/Breast Exam",HCPCS G0101,N/A,N/A,N/A, $173.00 , $112.45 , $129.25 , $26.16 , $33.46 , $51.11 , N/A , $160.89 , $155.70 , $155.70 , $138.40 , $138.40 , $33.46 , $159.73 , $164.35 , $155.70 , $155.70 , $155.70 , $160.89 , $166.08 , $71.97 , $147.05 , $51.90 , $103.74 , N/A , $52.10 , $52.10 , $164.35 , $65.15 , $26.16 , $166.08 
Implnt Bio Implnt for Soft Tissue Reinforcement,CPT® 15777,N/A,N/A,N/A, $937.00 , $609.05 , $672.89 , $200.31 , $161.33 , $578.82 , $518.05 , $871.41 , $843.30 , $843.30 , $749.60 , $749.60 , $161.33 , $865.13 , $890.15 , $843.30 , $843.30 , $843.30 , $871.41 , $899.52 , $740.62 , $796.45 ," $1,052.60 ", $750.17 , N/A , $590.12 , $590.12 , $890.15 , $684.34 , $161.33 ," $1,052.60 "
 Pro Fusion of Big Toe Joint ,CPT® 28755,0982 - PRO FEE/OUTPT,N/A,N/A," $3,399.00 "," $2,209.35 "," $2,070.12 ", $323.73 , $230.52 ," $1,623.04 "," $1,617.93 "," $3,161.07 "," $3,059.10 "," $3,059.10 "," $2,719.20 "," $2,719.20 ", $230.52 ," $3,138.30 "," $3,229.05 "," $3,059.10 "," $3,059.10 "," $3,059.10 "," $3,161.07 "," $3,263.04 "," $1,919.32 "," $2,889.15 "," $1,755.52 "," $1,936.57 ", N/A ," $1,654.70 "," $1,654.70 "," $3,229.05 "," $1,944.86 ", $230.52 ," $3,263.04 "
Egd Insert Guide Wire Dilator Passage Esophagus,43248,N/A,N/A,N/A," $2,084.00 "," $1,354.60 "," $1,017.71 ", $157.25 , $176.60 , $852.25 , $914.99 ," $1,938.12 "," $1,875.60 "," $1,875.60 "," $1,667.20 "," $1,667.20 ", $176.60 ," $1,924.16 "," $1,979.80 "," $1,875.60 "," $1,875.60 "," $1,875.60 "," $1,938.12 "," $2,000.64 ", $732.03 ," $1,771.40 "," $1,000.86 ", $970.45 , N/A , $868.88 , $868.88 ," $1,979.80 ", $908.74 , $157.25 ," $2,000.64 "
Moderna Admin First Dose Ages 6-11,CPT® 0091A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $56.00 , $128.02 , N/A , N/A , N/A , $66.50 , N/A , $38.92 , $128.02 
" Fac Hhcp-Svs of Csw,Ea 15 Min ",HCPCS G0155,0561 - MED SOC SERVS/VISIT,N/A,N/A, $61.00 , $39.65 , $51.24 , N/A , $17.10 , $49.29 , $54.90 , $51.64 , $54.90 , $54.90 , $54.90 , $51.85 , $16.76 , $56.32 , $57.95 , $51.85 , $56.73 , $56.73 , $57.95 , $58.56 , $49.91 , $54.90 , $51.85 , $48.19 , N/A , $49.37 , $49.37 , $57.95 , $52.34 , $16.76 , $58.56 
 AMMONIA AROMATIC INH INHA ,HCPCS RXC637,0250 - PHARMACY,46414-3333-03,1 each, $5.72 , $3.72 , $4.80 , N/A , N/A , $4.62 , $5.15 , $4.84 , $5.15 , $5.15 , $5.15 , $4.86 , N/A , $5.28 , $5.43 , $4.86 , $5.32 , $5.32 , $5.43 , $5.49 , $4.68 , $5.15 , $4.86 , $4.52 , N/A , $4.63 , $4.63 , $5.43 , $4.91 , $4.52 , $5.49 
"Remv Kidney,Radical",CPT® 50230,N/A,N/A,N/A," $8,680.00 "," $5,642.00 "," $6,884.19 "," $1,209.09 "," $1,925.14 "," $6,265.30 "," $5,814.32 "," $8,072.40 "," $7,812.00 "," $7,812.00 "," $6,944.00 "," $6,944.00 "," $1,925.14 "," $8,014.24 "," $8,246.00 "," $7,812.00 "," $7,812.00 "," $7,812.00 "," $8,072.40 "," $8,332.80 "," $6,916.72 "," $7,378.00 "," $6,595.69 "," $7,854.98 ", N/A ," $6,387.54 "," $6,387.54 "," $8,246.00 "," $7,507.62 "," $1,209.09 "," $8,332.80 "
 Fac Replace Aortic Valve Perq Femoral Artry Approach ,CPT® 33361,0360 - OR SERVICES,N/A,N/A," $27,983.00 "," $18,188.95 "," $23,505.72 "," $1,086.18 "," $1,013.84 "," $22,610.26 "," $25,184.70 "," $23,690.41 "," $25,184.70 "," $25,184.70 "," $25,184.70 "," $23,785.55 ", $993.96 ," $25,836.70 "," $26,583.85 "," $23,785.55 "," $26,024.19 "," $26,024.19 "," $26,583.85 "," $26,863.68 "," $22,895.69 "," $25,184.70 "," $23,785.55 "," $22,106.57 ", N/A ," $22,646.64 "," $22,646.64 "," $26,583.85 "," $24,012.21 ", $993.96 ," $26,863.68 "
"Cystoscopy,Intern Urethrotomy,Male",CPT® 52275,N/A,N/A,N/A," $3,422.00 "," $2,224.30 "," $1,331.76 ", $233.75 , $307.34 ," $1,220.96 "," $1,129.99 "," $3,182.46 "," $3,079.80 "," $3,079.80 "," $2,737.60 "," $2,737.60 ", $307.34 ," $3,159.53 "," $3,250.90 "," $3,079.80 "," $3,079.80 "," $3,079.80 "," $3,182.46 "," $3,285.12 "," $1,337.47 "," $2,908.70 "," $1,279.17 "," $1,531.88 ", N/A ," $1,244.79 "," $1,244.79 "," $3,250.90 "," $1,463.06 ", $233.75 ," $3,285.12 "
 Fac Tcat Ther Embolization Any Meth Rs&I ,CPT® 75894,0320 - DX X-RAY,N/A,N/A," $4,225.00 "," $2,746.25 "," $3,549.00 "," $1,058.37 "," $1,001.48 "," $3,413.80 "," $3,802.50 "," $3,576.89 "," $3,802.50 "," $3,802.50 "," $3,802.50 "," $3,591.25 ", $981.84 ," $3,900.94 "," $4,013.75 "," $3,591.25 "," $3,929.25 "," $3,929.25 "," $4,013.75 "," $4,056.00 "," $3,456.90 "," $3,802.50 "," $3,591.25 "," $3,337.75 ", N/A ," $3,419.29 "," $3,419.29 "," $4,013.75 "," $3,625.47 ", $981.84 ," $4,056.00 "
 CT Extrem Upper Without/With Contrast ,CPT® 73202,0350 - CT SCAN,N/A,N/A," $1,471.00 ", $956.15 ," $1,235.64 ", $231.52 , $355.39 ," $1,188.57 "," $1,323.90 "," $1,245.35 "," $1,323.90 "," $1,323.90 "," $1,323.90 "," $1,250.35 ", $348.42 ," $1,358.17 "," $1,397.45 "," $1,250.35 "," $1,368.03 "," $1,368.03 "," $1,397.45 "," $1,412.16 "," $1,203.57 "," $1,323.90 "," $1,250.35 "," $1,162.09 ", N/A ," $1,190.48 "," $1,190.48 "," $1,397.45 "," $1,262.27 ", $231.52 ," $1,412.16 "
"Circumcision,Othr",CPT® 54161,N/A,N/A,N/A," $1,514.00 ", $984.10 , $874.86 , $188.71 , $196.32 , $630.98 , $639.26 ," $1,408.02 "," $1,362.60 "," $1,362.60 "," $1,211.20 "," $1,211.20 ", $196.32 ," $1,397.88 "," $1,438.30 "," $1,362.60 "," $1,362.60 "," $1,362.60 "," $1,408.02 "," $1,453.44 ", $819.88 ," $1,286.90 "," $1,020.48 ", $952.70 , N/A , $643.29 , $643.29 ," $1,438.30 ", $771.01 , $188.71 ," $1,453.44 "
"PFIZER-BIONTECH 30 mcg/0.3 mL DOSAGE, 2ND DOSE",CPT® 0052A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $76.25 , $128.66 , N/A , $79.82 , $79.82 , $66.50 , $92.91 , $38.92 , $128.66 
TRANSPLANT HAND TENDON,26591,N/A,N/A,N/A," $1,521.00 ", $988.65 ," $3,089.26 ", $480.71 , $550.07 ," $2,062.61 "," $2,133.97 "," $1,414.53 "," $1,368.90 "," $1,368.90 "," $1,216.80 "," $1,216.80 ", $550.07 ," $1,404.34 "," $1,444.95 "," $1,368.90 "," $1,368.90 "," $1,368.90 "," $1,414.53 "," $1,460.16 "," $2,816.46 "," $1,292.85 "," $2,331.77 "," $2,494.50 ", N/A ," $2,102.86 "," $2,102.86 "," $1,444.95 "," $2,471.60 ", $480.71 ," $3,089.26 "
Cltx Dstl Radiour Dislc W/Mnpj - Urgent Care,25675,N/A,N/A,N/A," $2,228.00 "," $1,448.20 "," $2,507.18 ", $401.64 , $384.19 ," $1,917.99 "," $1,969.21 "," $2,072.04 "," $2,005.20 "," $2,005.20 "," $1,782.40 "," $1,782.40 ", $384.19 ," $2,057.11 "," $2,116.60 "," $2,005.20 "," $2,005.20 "," $2,005.20 "," $2,072.04 "," $2,138.88 "," $2,296.18 "," $1,893.80 "," $2,162.29 "," $2,257.06 ", N/A ," $1,955.42 "," $1,955.42 "," $2,116.60 "," $2,298.30 ", $384.19 ," $2,507.18 "
"Insert,Non-Indwelling Bladder Catheter",CPT® 51701,N/A,N/A,N/A, $385.00 , $250.25 , $137.94 , $23.95 , $87.96 , $135.20 , $125.23 , $358.05 , $346.50 , $346.50 , $308.00 , $308.00 , $87.96 , $355.47 , $365.75 , $346.50 , $346.50 , $346.50 , $358.05 , $369.60 , $137.46 , $327.25 , $142.73 , $156.13 , N/A , $137.84 , $137.84 , $365.75 , $162.00 , $23.95 , $369.60 
 Pro Removal of Foot Foreign Body ,CPT® 28192,0982 - PRO FEE/OUTPT,N/A,N/A," $3,173.00 "," $2,062.45 "," $1,930.89 ", $301.68 , $190.55 ," $1,545.60 "," $1,551.74 "," $2,950.89 "," $2,855.70 "," $2,855.70 "," $2,538.40 "," $2,538.40 ", $190.55 ," $2,929.63 "," $3,014.35 "," $2,855.70 "," $2,855.70 "," $2,855.70 "," $2,950.89 "," $3,046.08 "," $1,797.60 "," $2,697.05 "," $1,680.59 "," $1,833.96 ", N/A ," $1,575.76 "," $1,575.76 "," $3,014.35 "," $1,852.06 ", $190.55 ," $3,046.08 "
 Fac Amino Acids 1 Quan Ea Spec ,CPT® 82131,0301 - LAB/CHEMISTRY,N/A,N/A, $187.00 , $121.55 , $157.08 , $23.44 , $20.74 , $151.10 , $168.30 , $158.31 , $168.30 , $168.30 , $168.30 , $158.95 , $20.33 , $172.66 , $177.65 , $158.95 , $173.91 , $173.91 , $177.65 , $179.52 , $153.00 , $168.30 , $158.95 , $147.73 , N/A , $151.34 , $151.34 , $177.65 , $160.46 , $20.33 , $179.52 
 Pro Identify Sentinel Node ,CPT® 38792,0972 - PRO FEE/RAD/DX,N/A,N/A, $763.00 , $495.95 , $154.55 , $30.89 , $36.29 , $140.90 , $148.11 , $709.59 , $686.70 , $686.70 , $610.40 , $610.40 , $36.29 , $704.48 , $724.85 , $686.70 , $686.70 , $686.70 , $709.59 , $732.48 , $166.47 , $648.55 , $215.87 , $197.75 , N/A , $143.66 , $143.66 , $724.85 , $166.67 , $30.89 , $732.48 
 CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN ,HCPCS J0744,0636 - DRUGS REQUIRING DETAILED CODIN,25021-0114-87,200 mL, $43.15 , $28.05 , $36.25 , $2.00 , $1.37 , $34.87 , $38.84 , $36.53 , $38.84 , $38.84 , $38.84 , $36.68 , $1.34 , $39.84 , $40.99 , $36.68 , $40.13 , $40.13 , $40.99 , $41.42 , $35.31 , $38.84 , $36.68 , $34.09 , N/A , $34.92 , $34.92 , $40.99 , $37.03 , $1.34 , $41.42 
 Fac Triiodothyro9 T3 Tot ,CPT® 84480,0301 - LAB/CHEMISTRY,N/A,N/A, $160.00 , $104.00 , $134.40 , $14.46 , $14.46 , $129.28 , $144.00 , $135.46 , $144.00 , $144.00 , $144.00 , $136.00 , $14.18 , $147.73 , $152.00 , $136.00 , $148.80 , $148.80 , $152.00 , $153.60 , $130.91 , $144.00 , $136.00 , $126.40 , N/A , $129.49 , $129.49 , $152.00 , $137.30 , $14.18 , $153.60 
 Pro Prostatectomy (Turp) ,CPT® 52601,0982 - PRO FEE/OUTPT,N/A,N/A," $5,717.00 "," $3,716.05 "," $3,943.35 ", $693.12 , $828.21 ," $4,135.92 "," $3,848.30 "," $5,316.81 "," $5,145.30 "," $5,145.30 "," $4,573.60 "," $4,573.60 ", $828.21 ," $5,278.51 "," $5,431.15 "," $5,145.30 "," $5,145.30 "," $5,145.30 "," $5,316.81 "," $5,488.32 "," $3,957.68 "," $4,859.45 "," $4,358.47 "," $4,486.52 ", N/A ," $4,216.62 "," $4,216.62 "," $5,431.15 "," $4,956.02 ", $693.12 ," $5,488.32 "
"Transcran Dopp Intracran, Emboli W/Inj",CPT® 93893,N/A,N/A,N/A," $3,865.00 "," $2,512.25 "," $1,055.02 ", $161.24 , $216.22 ," $1,861.46 "," $2,016.61 "," $3,594.45 "," $3,478.50 "," $3,478.50 "," $3,092.00 "," $3,092.00 ", $216.22 ," $3,568.55 "," $3,671.75 "," $3,478.50 "," $3,478.50 "," $3,478.50 "," $3,594.45 "," $3,710.40 "," $1,634.74 "," $3,285.25 "," $1,075.55 "," $1,318.52 ", N/A ," $1,897.78 "," $1,897.78 "," $3,671.75 "," $2,103.70 ", $161.24 ," $3,710.40 "
Bone Marrow Aspiration Bone Grfg Spi Surg Only,CPT® 20939,N/A,N/A,N/A," $1,076.00 ", $699.40 , $403.00 , $63.16 , N/A , $306.57 , $314.49 ," $1,000.68 ", $968.40 , $968.40 , $860.80 , $860.80 , N/A , $993.47 ," $1,022.20 ", $968.40 , $968.40 , $968.40 ," $1,000.68 "," $1,032.96 ", $378.07 , $914.60 , $371.38 , $384.07 , N/A , $312.55 , $312.55 ," $1,022.20 ", $367.35 , $63.16 ," $1,032.96 "
"Myomectomy 1-4,W/Tot 250gms/<,Abd Apprch",CPT® 58140,N/A,N/A,N/A," $5,484.00 "," $3,564.60 "," $4,390.60 ", $888.01 , $768.38 ," $3,743.43 "," $3,723.09 "," $5,100.12 "," $4,935.60 "," $4,935.60 "," $4,387.20 "," $4,387.20 ", $768.38 ," $5,063.38 "," $5,209.80 "," $4,935.60 "," $4,935.60 "," $4,935.60 "," $5,100.12 "," $5,264.64 "," $4,587.52 "," $4,661.40 "," $4,907.96 "," $3,736.59 ", N/A ," $3,816.48 "," $3,816.48 "," $5,209.80 "," $4,577.64 ", $768.38 ," $5,264.64 "
Therapeutic Spinal Pnxr Drainage CSF W/Fluor/CT,CPT® 62329,N/A,N/A,N/A," $1,633.00 "," $1,061.45 ", $526.66 , $100.56 , $251.39 , $603.56 , N/A ," $1,518.69 "," $1,469.70 "," $1,469.70 "," $1,306.40 "," $1,306.40 ", $251.39 ," $1,507.75 "," $1,551.35 "," $1,469.70 "," $1,469.70 "," $1,469.70 "," $1,518.69 "," $1,567.68 ", $572.79 ," $1,388.05 ", $570.40 , $653.24 , N/A , $615.34 , $615.34 ," $1,551.35 ", $660.09 , $100.56 ," $1,567.68 "
"Surg Rx Missed Abortn,1st Tri",CPT® 59820,N/A,N/A,N/A," $1,724.00 "," $1,120.60 "," $1,061.25 ", $359.92 , $331.58 , $826.59 , $879.40 ," $1,603.32 "," $1,551.60 "," $1,551.60 "," $1,379.20 "," $1,379.20 ", $331.58 ," $1,591.77 "," $1,637.80 "," $1,551.60 "," $1,551.60 "," $1,551.60 "," $1,603.32 "," $1,655.04 "," $1,058.99 "," $1,465.40 "," $1,926.79 "," $1,545.07 ", N/A , $842.72 , $842.72 ," $1,637.80 ", $974.26 , $331.58 ," $1,926.79 "
 Wrist Complete Min 3vw - Mh ,CPT® 73110,0972 - PRO FEE/RAD/DX,N/A,N/A, $150.00 , $97.50 , $230.03 , $40.24 , $30.41 , $166.83 , $201.26 , $139.50 , $135.00 , $135.00 , $120.00 , $120.00 , $30.41 , $138.50 , $142.50 , $135.00 , $135.00 , $135.00 , $139.50 , $144.00 , $221.65 , $127.50 , $221.49 , $176.35 , N/A , $170.09 , $170.09 , $142.50 , $196.87 , $30.41 , $230.03 
 Fac Byp Oth/Thn Vein Aortobi-Iliac ,CPT® 35638,0360 - OR SERVICES,N/A,N/A," $2,103.00 "," $1,366.95 "," $1,766.52 "," $1,541.21 "," $1,401.62 "," $1,699.22 "," $1,892.70 "," $1,780.40 "," $1,892.70 "," $1,892.70 "," $1,892.70 "," $1,787.55 "," $1,374.14 "," $1,941.70 "," $1,997.85 "," $1,787.55 "," $1,955.79 "," $1,955.79 "," $1,997.85 "," $2,018.88 "," $1,720.67 "," $1,892.70 "," $1,787.55 "," $1,661.37 ", N/A ," $1,701.96 "," $1,701.96 "," $1,997.85 "," $1,804.58 "," $1,374.14 "," $2,018.88 "
" Fac Fluorescent Antibody, Titer ",CPT® 86256,0302 - LAB/IMMUNOLOGY,N/A,N/A, $152.00 , $98.80 , $127.68 , $12.29 , $12.29 , $122.82 , $136.80 , $128.68 , $136.80 , $136.80 , $136.80 , $129.20 , $12.05 , $140.34 , $144.40 , $129.20 , $141.36 , $141.36 , $144.40 , $145.92 , $124.37 , $136.80 , $129.20 , $120.08 , N/A , $123.01 , $123.01 , $144.40 , $130.43 , $12.05 , $145.92 
" Layer Closure Neck, Genitalia, Hands,Feet 2.5cm or Le ",CPT® 12041,0981 - PRO FEE/ER,N/A,N/A," $1,004.00 ", $652.60 , $461.96 , $139.44 , $71.45 , $427.30 , $419.98 , $933.72 , $903.60 , $903.60 , $803.20 , $803.20 , $71.45 , $926.99 , $953.80 , $903.60 , $903.60 , $903.60 , $933.72 , $963.84 , $509.89 , $853.40 , $834.94 , $528.73 , N/A , $435.64 , $435.64 , $953.80 , $505.18 , $71.45 , $963.84 
Assay Other Fluid Chlorides,CPT® 82438,N/A,N/A,N/A, $65.00 , $42.25 , N/A , $5.10 , $5.10 , $27.64 , $33.09 , $60.45 , $58.50 , $58.50 , $52.00 , $52.00 , $5.10 , $60.01 , $61.75 , $58.50 , $58.50 , $58.50 , $60.45 , $62.40 , $33.39 , $55.25 , $32.44 , $17.71 , N/A , $25.80 , $25.80 , $61.75 , $28.20 , $5.10 , $62.40 
Ambulatory Bp Mntr W/Sw 24 Hr+ Recording Only,CPT® 93786,N/A,N/A,N/A, $200.00 , $130.00 , $140.53 , $21.78 , $32.85 , $158.68 , $175.58 , $186.00 , $180.00 , $180.00 , $160.00 , $160.00 , $32.85 , $184.66 , $190.00 , $180.00 , $180.00 , $180.00 , $186.00 , $192.00 , $138.99 , $170.00 , $165.92 , $111.09 , N/A , $161.77 , $161.77 , $190.00 , $179.35 , $21.78 , $192.00 
 Myd88 Mutation Detection by Pcr Charge ,CPT® 81305,0300 - LABORATORY,N/A,N/A, $684.00 , $444.60 , $574.56 , $178.91 , $143.13 , $552.67 , $615.60 , $579.07 , $615.60 , $615.60 , $615.60 , $581.40 , $140.32 , $631.54 , $649.80 , $581.40 , $636.12 , $636.12 , $649.80 , $656.64 , $559.65 , $615.60 , $581.40 , $540.36 , N/A , $553.56 , $553.56 , $649.80 , $586.94 , $140.32 , $656.64 
 Pro Biopsy of Prostate ,CPT® 55700,0975 - PRO FEE/OR,N/A,N/A, $726.00 , $471.90 , $572.27 , $122.83 , $109.97 , $448.37 , $451.52 , $675.18 , $653.40 , $653.40 , $580.80 , $580.80 , $109.97 , $670.32 , $689.70 , $653.40 , $653.40 , $653.40 , $675.18 , $696.96 , $539.43 , $617.10 , $718.98 , $633.08 , N/A , $457.12 , $457.12 , $689.70 , $547.87 , $109.97 , $718.98 
 Fac Massage Therapy ,Custom 4200000001,0420 - PHYSICAL THERAPY,N/A,N/A, $83.00 , $53.95 , $69.72 , N/A , N/A , $67.06 , $74.70 , $70.27 , $74.70 , $74.70 , $74.70 , $70.55 , N/A , $76.63 , $78.85 , $70.55 , $77.19 , $77.19 , $78.85 , $79.68 , $67.91 , $74.70 , $70.55 , $65.57 , N/A , $67.17 , $67.17 , $78.85 , $71.22 , $65.57 , $79.68 
 VANCOMYCIN HCL IN NACL 2-0.9 GM/500ML-% IV SOLN ,HCPCS J3370,0636 - DRUGS REQUIRING DETAILED CODIN,70092-9338-07,500 mL, $303.08 , $197.00 , $254.59 , $2.46 , $2.92 , $244.89 , $272.77 , $256.59 , $272.77 , $272.77 , $272.77 , $257.62 , $2.86 , $279.83 , $287.93 , $257.62 , $281.86 , $281.86 , $287.93 , $290.96 , $247.98 , $272.77 , $257.62 , $239.43 , N/A , $245.28 , $245.28 , $287.93 , $260.07 , $2.46 , $290.96 
 Fac Whfo Nontorsion Joint Prefab ,HCPCS L3931,0274 - PROSTHETIC DEV,N/A,N/A, $310.00 , $201.50 , $260.40 , $221.96 , $86.85 , $250.48 , $279.00 , $262.45 , $279.00 , $279.00 , $279.00 , $263.50 , $85.15 , $286.22 , $294.50 , $263.50 , $288.30 , $288.30 , $294.50 , $297.60 , $253.64 , $279.00 , $263.50 , $244.90 , N/A , $250.88 , $250.88 , $294.50 , $266.01 , $85.15 , $297.60 
Radiologic Exam Chest 2 Views,CPT® 71046,N/A,N/A,N/A, $443.00 , $287.95 , $189.02 , $33.11 , $23.99 , $136.89 , $153.08 , $411.99 , $398.70 , $398.70 , $354.40 , $354.40 , $23.99 , $409.02 , $420.85 , $398.70 , $398.70 , $398.70 , $411.99 , $425.28 , $184.57 , $376.55 , $193.75 , $153.48 , N/A , $139.56 , $139.56 , $420.85 , $161.55 , $23.99 , $425.28 
 Fac Plethysmography Lung Volumes W/WO Airway Resist ,CPT® 94726,0460 - PULMONARY FUNC,N/A,N/A, $594.00 , $386.10 , $498.96 , $52.99 , $41.90 , $479.95 , $534.60 , $502.88 , $534.60 , $534.60 , $534.60 , $504.90 , $41.08 , $548.44 , $564.30 , $504.90 , $552.42 , $552.42 , $564.30 , $570.24 , $486.01 , $534.60 , $504.90 , $469.26 , N/A , $480.72 , $480.72 , $564.30 , $509.71 , $41.08 , $570.24 
Butorphanol Tartrate 1 Mg,HCPCS J0595,N/A,N/A,N/A, $13.00 , $8.45 , N/A , $5.15 , $3.61 , N/A , N/A , $12.09 , $11.70 , $11.70 , $10.40 , $10.40 , $3.61 , $12.00 , $12.35 , $11.70 , $11.70 , $11.70 , $12.09 , $12.48 , $3.93 , $11.05 , $1.95 , $3.86 , N/A , N/A , N/A , $12.35 , N/A , $1.95 , $12.48 
 Pro Urograpy Nfs Drip Tq&/Bolus Tq W/Nephrotomog ,CPT® 74415,0972 - PRO FEE/RAD/DX,N/A,N/A, $142.00 , $92.30 , $894.24 , $153.32 , $109.81 , $646.61 , $738.32 , $132.06 , $127.80 , $127.80 , $113.60 , $113.60 , $109.81 , $131.11 , $134.90 , $127.80 , $127.80 , $127.80 , $132.06 , $136.32 , $881.44 , $120.70 , $805.09 , $688.76 , N/A , $659.22 , $659.22 , $134.90 , $763.07 , $109.81 , $894.24 
 Pro Drain Neck/Chest Lesion ,CPT® 21501,0982 - PRO FEE/OUTPT,N/A,N/A," $3,031.00 "," $1,970.15 "," $2,034.89 ", $320.83 , $177.51 ," $1,549.02 "," $1,575.62 "," $2,818.83 "," $2,727.90 "," $2,727.90 "," $2,424.80 "," $2,424.80 ", $177.51 ," $2,798.52 "," $2,879.45 "," $2,727.90 "," $2,727.90 "," $2,727.90 "," $2,818.83 "," $2,909.76 "," $1,860.63 "," $2,576.35 "," $1,734.11 "," $1,827.29 ", N/A ," $1,579.24 "," $1,579.24 "," $2,879.45 "," $1,856.17 ", $177.51 ," $2,909.76 "
 Pro Biopsy of Hip Joint ,CPT® 27052,0982 - PRO FEE/OUTPT,N/A,N/A," $3,802.00 "," $2,471.30 "," $3,526.84 ", $554.49 , $893.47 ," $2,793.39 "," $2,790.13 "," $3,535.86 "," $3,421.80 "," $3,421.80 "," $3,041.60 "," $3,041.60 ", $893.47 ," $3,510.39 "," $3,611.90 "," $3,421.80 "," $3,421.80 "," $3,421.80 "," $3,535.86 "," $3,649.92 "," $3,277.81 "," $3,231.70 "," $3,077.51 "," $3,294.82 ", N/A ," $2,847.89 "," $2,847.89 "," $3,611.90 "," $3,347.29 ", $554.49 ," $3,649.92 "
Paraffin Bath Therapy,CPT® 97018,N/A,N/A,N/A, $120.00 , $78.00 , $13.06 , $5.47 , $20.29 , $24.44 , $22.33 , $111.60 , $108.00 , $108.00 , $96.00 , $96.00 , $20.29 , $110.80 , $114.00 , $108.00 , $108.00 , $108.00 , $111.60 , $115.20 , $14.16 , $102.00 , $33.45 , $21.11 , N/A , $24.92 , $24.92 , $114.00 , $27.71 , $5.47 , $115.20 
"Assay, Dipropylacetic Acid",CPT® 80164,N/A,N/A,N/A, $133.00 , $86.45 , N/A , $13.81 , $13.81 , $76.67 , $91.72 , $123.69 , $119.70 , $119.70 , $106.40 , $106.40 , $13.81 , $122.80 , $126.35 , $119.70 , $119.70 , $119.70 , $123.69 , $127.68 , $90.41 , $113.05 , $89.20 , $49.11 , N/A , $71.55 , $71.55 , $126.35 , $78.19 , $13.81 , $127.68 
Valvuloplas Tricus No Ring Insert,CPT® 33463,N/A,N/A,N/A," $25,960.00 "," $16,874.00 "," $18,040.62 "," $2,780.71 "," $2,378.00 "," $13,211.68 "," $13,069.46 "," $24,142.80 "," $23,364.00 "," $23,364.00 "," $20,768.00 "," $20,768.00 "," $2,378.00 "," $23,968.87 "," $24,662.00 "," $23,364.00 "," $23,364.00 "," $23,364.00 "," $24,142.80 "," $24,921.60 "," $16,725.69 "," $22,066.00 "," $16,570.39 "," $14,799.67 ", N/A ," $13,469.47 "," $13,469.47 "," $24,662.00 "," $15,301.31 "," $2,378.00 "," $24,921.60 "
"Stereotactic Comp Assist Proc,Spinal",CPT® 61783,N/A,N/A,N/A," $1,580.00 "," $1,027.00 "," $1,051.54 ", $204.37 , $152.12 ," $1,262.98 "," $1,196.06 "," $1,469.40 "," $1,422.00 "," $1,422.00 "," $1,264.00 "," $1,264.00 ", $152.12 ," $1,458.81 "," $1,501.00 "," $1,422.00 "," $1,422.00 "," $1,422.00 "," $1,469.40 "," $1,516.80 "," $1,139.53 "," $1,343.00 "," $1,232.79 "," $1,305.56 ", N/A ," $1,287.62 "," $1,287.62 "," $1,501.00 "," $1,381.32 ", $152.12 ," $1,516.80 "
Assay Triglycerides,CPT® 84478,N/A,N/A,N/A, $81.00 , $52.65 , N/A , $5.85 , $5.85 , $32.51 , $38.90 , $75.33 , $72.90 , $72.90 , $64.80 , $64.80 , $5.85 , $74.79 , $76.95 , $72.90 , $72.90 , $72.90 , $75.33 , $77.76 , $38.33 , $68.85 , $37.30 , $20.82 , N/A , $30.34 , $30.34 , $76.95 , $33.16 , $5.85 , $77.76 
 ASENAPINE MALEATE 10 MG SL SUBL ,HCPCS RXC637,0250 - PHARMACY,59762-2888-06,1 tablet, $111.04 , $72.18 , $93.27 , N/A , N/A , $89.72 , $99.94 , $94.01 , $99.94 , $99.94 , $99.94 , $94.38 , N/A , $102.52 , $105.49 , $94.38 , $103.27 , $103.27 , $105.49 , $106.60 , $90.85 , $99.94 , $94.38 , $87.72 , N/A , $89.86 , $89.86 , $105.49 , $95.28 , $87.72 , $106.60 
 Critical Care First 30-74 Min -Mh ,CPT® 99291,0450 - EMERGENCY SERVICES,N/A,N/A," $4,160.00 "," $2,704.00 "," $3,494.40 ", $205.74 , $270.56 ," $3,361.28 "," $3,744.00 "," $3,521.86 "," $3,744.00 "," $3,744.00 "," $3,744.00 "," $3,536.00 ", $265.25 ," $3,840.93 "," $3,952.00 "," $3,536.00 "," $3,868.80 "," $3,868.80 "," $3,952.00 "," $3,993.60 "," $3,403.71 "," $3,744.00 "," $3,536.00 "," $3,286.40 ", N/A ," $3,366.69 "," $3,366.69 "," $3,952.00 "," $3,569.70 ", $205.74 ," $3,993.60 "
Cardioversion Elective Arrhythmia External,CPT® 92960,N/A,N/A,N/A," $1,258.00 ", $817.70 , $675.35 , $104.47 , $244.76 , $670.27 , $674.00 ," $1,169.94 "," $1,132.20 "," $1,132.20 "," $1,006.40 "," $1,006.40 ", $244.76 ," $1,161.51 "," $1,195.10 "," $1,132.20 "," $1,132.20 "," $1,132.20 "," $1,169.94 "," $1,207.68 ", $666.44 ," $1,069.30 ", $627.99 , $661.06 , N/A , $683.35 , $683.35 ," $1,195.10 ", $757.50 , $104.47 ," $1,207.68 "
"Neuromusc Reeducat,1+ Areas, Ea 15 Min",CPT® 97112,N/A,N/A,N/A, $146.00 , $94.90 , $80.35 , $33.81 , $31.48 , $75.77 , $67.66 , $135.78 , $131.40 , $131.40 , $116.80 , $116.80 , $31.48 , $134.80 , $138.70 , $131.40 , $131.40 , $131.40 , $135.78 , $140.16 , $87.24 , $124.10 , $99.34 , $78.97 , N/A , $77.24 , $77.24 , $138.70 , $85.92 , $31.48 , $140.16 
"Remv Bladder,Total",CPT® 51570,N/A,N/A,N/A," $10,254.00 "," $6,665.10 "," $7,930.80 "," $1,394.32 "," $1,419.99 "," $7,238.77 "," $6,715.50 "," $9,536.22 "," $9,228.60 "," $9,228.60 "," $8,203.20 "," $8,203.20 "," $1,419.99 "," $9,467.52 "," $9,741.30 "," $9,228.60 "," $9,228.60 "," $9,228.60 "," $9,536.22 "," $9,843.84 "," $7,964.42 "," $8,715.90 "," $7,616.17 "," $9,055.96 ", N/A ," $7,380.02 "," $7,380.02 "," $9,741.30 "," $8,674.12 "," $1,394.32 "," $9,843.84 "
 OCTREOTIDE ACETATE 30 MG IM KIT ,HCPCS J2353,0636 - DRUGS REQUIRING DETAILED CODIN,00078-0825-81,1 each," $19,535.85 "," $12,698.30 "," $16,410.11 ", $212.28 , $209.76 ," $15,784.97 "," $17,582.27 "," $16,539.05 "," $17,582.27 "," $17,582.27 "," $17,582.27 "," $16,605.47 ", $205.65 ," $18,037.45 "," $18,559.06 "," $16,605.47 "," $18,168.34 "," $18,168.34 "," $18,559.06 "," $18,754.42 "," $15,984.23 "," $17,582.27 "," $16,605.47 "," $15,433.32 ", N/A ," $15,810.36 "," $15,810.36 "," $18,559.06 "," $16,763.71 ", $205.65 ," $18,754.42 "
 Fac Assay of Phosphorus ,CPT® 84100,0301 - LAB/CHEMISTRY,N/A,N/A, $62.00 , $40.30 , $52.08 , $4.83 , $4.83 , $50.10 , $55.80 , $52.49 , $55.80 , $55.80 , $55.80 , $52.70 , $4.74 , $57.24 , $58.90 , $52.70 , $57.66 , $57.66 , $58.90 , $59.52 , $50.73 , $55.80 , $52.70 , $48.98 , N/A , $50.18 , $50.18 , $58.90 , $53.20 , $4.74 , $59.52 
 Flo Cytometry Cell Surf Marker Techl Only First ,CPT® 88184,0311 - PATHOL/CYTOLOGY,N/A,N/A, $501.00 , $325.65 , $420.84 , $72.46 , $48.24 , $404.81 , $450.90 , $424.15 , $450.90 , $450.90 , $450.90 , $425.85 , $47.29 , $462.57 , $475.95 , $425.85 , $465.93 , $465.93 , $475.95 , $480.96 , $409.92 , $450.90 , $425.85 , $395.79 , N/A , $405.46 , $405.46 , $475.95 , $429.91 , $47.29 , $480.96 
 Fac X-Ray Exam of Peritoneum ,CPT® 74190,0320 - DX X-RAY,N/A,N/A, $322.00 , $209.30 , $270.48 , $75.43 , $74.16 , $260.18 , $289.80 , $272.61 , $289.80 , $289.80 , $289.80 , $273.70 , $72.71 , $297.30 , $305.90 , $273.70 , $299.46 , $299.46 , $305.90 , $309.12 , $263.46 , $289.80 , $273.70 , $254.38 , N/A , $260.59 , $260.59 , $305.90 , $276.31 , $72.71 , $309.12 
Reconstruct Prox Humeral Implant,CPT® 23470,N/A,N/A,N/A," $7,941.00 "," $5,161.65 "," $7,250.36 "," $1,132.50 "," $1,070.67 "," $5,806.79 "," $5,763.64 "," $7,385.13 "," $7,146.90 "," $7,146.90 "," $6,352.80 "," $6,352.80 "," $1,070.67 "," $7,331.93 "," $7,543.95 "," $7,146.90 "," $7,146.90 "," $7,146.90 "," $7,385.13 "," $7,623.36 "," $6,761.89 "," $6,749.85 "," $6,376.25 "," $6,815.88 ", N/A ," $5,920.09 "," $5,920.09 "," $7,543.95 "," $6,958.21 "," $1,070.67 "," $7,623.36 "
Aspirat/Injection Ganglion Cyst(S),20612,N/A,N/A,N/A, $397.00 , $258.05 , $250.97 , $39.08 , $50.15 , $203.91 , $200.35 , $369.21 , $357.30 , $357.30 , $317.60 , $317.60 , $50.15 , $366.55 , $377.15 , $357.30 , $357.30 , $357.30 , $369.21 , $381.12 , $234.59 , $337.45 , $217.66 , $243.04 , N/A , $207.89 , $207.89 , $377.15 , $244.35 , $39.08 , $381.12 
 Pro Remove Hip/Pelvis Lesion ,CPT® 27047,0982 - PRO FEE/OUTPT,N/A,N/A," $3,175.00 "," $2,063.75 "," $2,186.80 ", $341.08 , $106.76 ," $1,746.93 "," $1,746.14 "," $2,952.75 "," $2,857.50 "," $2,857.50 "," $2,540.00 "," $2,540.00 ", $106.76 ," $2,931.48 "," $3,016.25 "," $2,857.50 "," $2,857.50 "," $2,857.50 "," $2,952.75 "," $3,048.00 "," $2,019.83 "," $2,698.75 "," $1,932.14 "," $2,040.42 ", N/A ," $1,781.02 "," $1,781.02 "," $3,016.25 "," $2,093.33 ", $106.76 ," $3,048.00 "
 Pro MRI Lumbar Spine W/O Dye ,CPT® 72148,0972 - PRO FEE/RAD/DX,N/A,N/A, $878.00 , $570.70 ," $1,374.31 ", $196.06 , $417.97 ," $1,884.45 "," $1,982.74 ", $816.54 , $790.20 , $790.20 , $702.40 , $702.40 , $417.97 , $810.66 , $834.10 , $790.20 , $790.20 , $790.20 , $816.54 , $842.88 ," $2,390.10 ", $746.30 ," $2,162.95 "," $2,076.39 ", N/A ," $1,921.22 "," $1,921.22 ", $834.10 ," $2,260.27 ", $196.06 ," $2,390.10 "
 Pro Clear Outer Ear Canal ,CPT® 69200,0981 - PRO FEE/ER,N/A,N/A, $369.00 , $239.85 , $222.00 , $45.22 , $46.62 , $277.17 , $286.82 , $343.17 , $332.10 , $332.10 , $295.20 , $295.20 , $46.62 , $340.70 , $350.55 , $332.10 , $332.10 , $332.10 , $343.17 , $354.24 , $241.42 , $313.65 , $312.21 , $230.70 , N/A , $282.58 , $282.58 , $350.55 , $322.66 , $45.22 , $354.24 
 Fac Dstrj All Prmlg 1st Les ,CPT® 17000,0761 - TREATMENT ROOM,N/A,N/A, $501.00 , $325.65 , $420.84 , $53.25 , $48.35 , $404.81 , $450.90 , $424.15 , $450.90 , $450.90 , $450.90 , $425.85 , $47.40 , $462.57 , $475.95 , $425.85 , $465.93 , $465.93 , $475.95 , $480.96 , $409.92 , $450.90 , $425.85 , $395.79 , N/A , $405.46 , $405.46 , $475.95 , $429.91 , $47.40 , $480.96 
Arthrocentesis-Int. Joint,20605,N/A,N/A,N/A, $327.00 , $212.55 , $226.79 , $35.10 , $50.55 , $181.29 , $253.86 , $304.11 , $294.30 , $294.30 , $261.60 , $261.60 , $50.55 , $301.92 , $310.65 , $294.30 , $294.30 , $294.30 , $304.11 , $313.92 , $211.99 , $277.95 , $276.53 , $217.48 , N/A , $184.83 , $184.83 , $310.65 , $217.21 , $35.10 , $313.92 
 Fac Bronchoscopy W/Ther Aspir Trachbrncl Tree 1st ,CPT® 31645,0360 - OR SERVICES,N/A,N/A," $2,634.00 "," $1,712.10 "," $2,212.56 ", $139.59 , $279.26 ," $2,128.27 "," $2,370.60 "," $2,229.94 "," $2,370.60 "," $2,370.60 "," $2,370.60 "," $2,238.90 ", $273.78 ," $2,431.97 "," $2,502.30 "," $2,238.90 "," $2,449.62 "," $2,449.62 "," $2,502.30 "," $2,528.64 "," $2,155.14 "," $2,370.60 "," $2,238.90 "," $2,080.86 ", N/A ," $2,131.70 "," $2,131.70 "," $2,502.30 "," $2,260.24 ", $139.59 ," $2,528.64 "
Egd Insert Guide Wire Dilator Passage Esophagus,CPT® 43248,N/A,N/A,N/A," $2,084.00 "," $1,354.60 "," $1,017.71 ", $157.25 , $176.60 , $852.25 , $914.99 ," $1,938.12 "," $1,875.60 "," $1,875.60 "," $1,667.20 "," $1,667.20 ", $176.60 ," $1,924.16 "," $1,979.80 "," $1,875.60 "," $1,875.60 "," $1,875.60 "," $1,938.12 "," $2,000.64 ", $732.03 ," $1,771.40 "," $1,000.86 ", $970.45 , N/A , $868.88 , $868.88 ," $1,979.80 ", $908.74 , $157.25 ," $2,000.64 "
Fluorescein Angrph W/Multiframe I&R Uni/Bi,CPT® 92235,N/A,N/A,N/A, $505.00 , $328.25 , $273.04 , $135.16 , $110.62 , $192.81 , $226.40 , $469.65 , $454.50 , $454.50 , $404.00 , $404.00 , $110.62 , $466.27 , $479.75 , $454.50 , $454.50 , $454.50 , $469.65 , $484.80 , $358.70 , $429.25 , $337.57 , $182.01 , N/A , $196.57 , $196.57 , $479.75 , $233.83 , $110.62 , $484.80 
 Fac Tumor Immunohistochem/Manual ,CPT® 88360,0310 - PATHOLOGY LAB,N/A,N/A, $864.00 , $561.60 , $725.76 , $116.62 , $107.82 , $698.11 , $777.60 , $731.46 , $777.60 , $777.60 , $777.60 , $734.40 , $105.71 , $797.73 , $820.80 , $734.40 , $803.52 , $803.52 , $820.80 , $829.44 , $706.92 , $777.60 , $734.40 , $682.56 , N/A , $699.24 , $699.24 , $820.80 , $741.40 , $105.71 , $829.44 
Complex Cystometrogram,CPT® 51726,N/A,N/A,N/A," $2,892.00 "," $1,879.80 "," $1,706.77 ", $295.63 , $307.19 ," $1,270.76 "," $1,243.79 "," $2,689.56 "," $2,602.80 "," $2,602.80 "," $2,313.60 "," $2,313.60 ", $307.19 ," $2,670.18 "," $2,747.40 "," $2,602.80 "," $2,602.80 "," $2,602.80 "," $2,689.56 "," $2,776.32 "," $1,697.41 "," $2,458.20 "," $1,405.84 "," $1,630.88 ", N/A ," $1,295.55 "," $1,295.55 "," $2,747.40 "," $1,522.74 ", $295.63 ," $2,776.32 "
"Revise Wrist Joint,Carpal Instabil",25320,N/A,N/A,N/A," $5,876.00 "," $3,819.40 "," $6,011.40 ", $947.70 , $643.30 ," $4,758.23 "," $4,754.85 "," $5,464.68 "," $5,288.40 "," $5,288.40 "," $4,700.80 "," $4,700.80 ", $643.30 ," $5,425.31 "," $5,582.20 "," $5,288.40 "," $5,288.40 "," $5,288.40 "," $5,464.68 "," $5,640.96 "," $5,588.40 "," $4,994.60 "," $5,227.31 "," $5,645.67 ", N/A ," $4,851.07 "," $4,851.07 "," $5,582.20 "," $5,701.72 ", $643.30 ," $6,011.40 "
 Admin Bebtelovimab / Covid ,HCPCS M0222,0771 - VACCINE ADMINISTRATION,N/A,N/A," $1,335.00 ", $867.75 ," $1,121.40 ", N/A , $357.51 ," $1,078.68 "," $1,201.50 "," $1,130.21 "," $1,201.50 "," $1,201.50 "," $1,201.50 "," $1,134.75 ", $350.50 ," $1,232.61 "," $1,268.25 "," $1,134.75 "," $1,241.55 "," $1,241.55 "," $1,268.25 "," $1,281.60 "," $1,092.30 "," $1,201.50 "," $1,134.75 "," $1,054.65 ", N/A ," $1,080.42 "," $1,080.42 "," $1,268.25 "," $1,145.56 ", $350.50 ," $1,281.60 "
"Hamstring Recession,Prox",CPT® 27097,N/A,N/A,N/A," $4,930.00 "," $3,204.50 "," $4,160.98 ", $652.44 ," $1,067.65 "," $3,284.37 "," $3,249.72 "," $4,584.90 "," $4,437.00 "," $4,437.00 "," $3,944.00 "," $3,944.00 "," $1,067.65 "," $4,551.87 "," $4,683.50 "," $4,437.00 "," $4,437.00 "," $4,437.00 "," $4,584.90 "," $4,732.80 "," $3,864.13 "," $4,190.50 "," $3,589.54 "," $3,868.31 ", N/A ," $3,348.46 "," $3,348.46 "," $4,683.50 "," $3,935.63 ", $652.44 ," $4,732.80 "
Inject Intravitreal Pharmcologic,67028,N/A,N/A,N/A, $773.00 , $502.45 , $564.33 , $88.40 , $261.20 , $565.44 , $526.42 , $718.89 , $695.70 , $695.70 , $618.40 , $618.40 , $261.20 , $713.71 , $734.35 , $695.70 , $695.70 , $695.70 , $718.89 , $742.08 , $779.44 , $657.05 , $542.36 , $720.34 , N/A , $576.47 , $576.47 , $734.35 , $636.34 , $88.40 , $779.44 
"Tympanoplasty,Rebuild Ossicul Chain",CPT® 69632,N/A,N/A,N/A," $6,296.00 "," $4,092.40 "," $5,229.70 "," $1,057.13 ", $942.83 ," $5,186.09 "," $5,377.78 "," $5,855.28 "," $5,666.40 "," $5,666.40 "," $5,036.80 "," $5,036.80 ", $942.83 ," $5,813.10 "," $5,981.20 "," $5,666.40 "," $5,666.40 "," $5,666.40 "," $5,855.28 "," $6,044.16 "," $5,730.47 "," $5,351.60 "," $5,860.65 "," $5,205.36 ", N/A ," $5,287.29 "," $5,287.29 "," $5,981.20 "," $6,037.16 ", $942.83 ," $6,044.16 "
 AZITHROMYCIN 200 MG/5ML PO SUSR ,HCPCS RXC637,0250 - PHARMACY,42806-0149-32,15 mL, $179.15 , $116.45 , $150.49 , N/A , N/A , $144.75 , $161.24 , $151.67 , $161.24 , $161.24 , $161.24 , $152.28 , N/A , $165.41 , $170.19 , $152.28 , $166.61 , $166.61 , $170.19 , $171.98 , $146.58 , $161.24 , $152.28 , $141.53 , N/A , $144.99 , $144.99 , $170.19 , $153.73 , $141.53 , $171.98 
"Excision,Ben Tumor,Mandible,Intra-Oral",CPT® 21046,N/A,N/A,N/A," $7,135.00 "," $4,637.75 "," $6,260.48 ", $963.12 , $893.24 ," $5,481.72 "," $5,421.18 "," $6,635.55 "," $6,421.50 "," $6,421.50 "," $5,708.00 "," $5,708.00 ", $893.24 ," $6,587.75 "," $6,778.25 "," $6,421.50 "," $6,421.50 "," $6,421.50 "," $6,635.55 "," $6,849.60 "," $5,895.84 "," $6,064.75 "," $5,903.47 "," $6,404.10 ", N/A ," $5,588.68 "," $5,588.68 "," $6,778.25 "," $6,568.69 ", $893.24 ," $6,849.60 "
Open Rx Patella Fx,27524,N/A,N/A,N/A," $3,130.00 "," $2,034.50 "," $4,581.46 ", $718.25 , $655.15 ," $3,631.50 "," $3,615.12 "," $2,910.90 "," $2,817.00 "," $2,817.00 "," $2,504.00 "," $2,504.00 ", $655.15 ," $2,889.93 "," $2,973.50 "," $2,817.00 "," $2,817.00 "," $2,817.00 "," $2,910.90 "," $3,004.80 "," $4,258.35 "," $2,660.50 "," $3,994.52 "," $4,273.47 ", N/A ," $3,702.36 "," $3,702.36 "," $2,973.50 "," $4,351.61 ", $655.15 ," $4,581.46 "
"Immunology-Heterophile,Sc",CPT® 86308,N/A,N/A,N/A, $83.00 , $53.95 , N/A , $5.28 , $5.28 , $29.27 , $35.00 , $77.19 , $74.70 , $74.70 , $66.40 , $66.40 , $5.28 , $76.63 , $78.85 , $74.70 , $74.70 , $74.70 , $77.19 , $79.68 , $34.59 , $70.55 , $34.06 , $18.73 , N/A , $27.32 , $27.32 , $78.85 , $29.85 , $5.28 , $79.68 
Thoracoscopy Surg W/Pleurodesis,CPT® 32650,N/A,N/A,N/A," $8,943.00 "," $5,812.95 "," $3,488.81 ", $611.30 , $925.25 ," $2,518.17 "," $2,480.31 "," $8,316.99 "," $8,048.70 "," $8,048.70 "," $7,154.40 "," $7,154.40 ", $925.25 ," $8,257.07 "," $8,495.85 "," $8,048.70 "," $8,048.70 "," $8,048.70 "," $8,316.99 "," $8,585.28 "," $3,367.88 "," $7,601.55 "," $3,573.48 "," $3,317.85 ", N/A ," $2,567.31 "," $2,567.31 "," $8,495.85 "," $3,023.55 ", $611.30 ," $8,585.28 "
 Fac Alanine Amino (Alt) (Sgpt) ,CPT® 84460,0301 - LAB/CHEMISTRY,N/A,N/A, $63.00 , $40.95 , $52.92 , $5.41 , $5.41 , $50.90 , $56.70 , $53.34 , $56.70 , $56.70 , $56.70 , $53.55 , $5.30 , $58.17 , $59.85 , $53.55 , $58.59 , $58.59 , $59.85 , $60.48 , $51.55 , $56.70 , $53.55 , $49.77 , N/A , $50.99 , $50.99 , $59.85 , $54.06 , $5.30 , $60.48 
"Irrigat Corpus Cavern,Priapism",CPT® 54220,N/A,N/A,N/A," $1,126.00 ", $731.90 , $581.48 , $125.43 , $341.89 , $430.28 , $436.29 ," $1,047.18 "," $1,013.40 "," $1,013.40 ", $900.80 , $900.80 , $341.89 ," $1,039.64 "," $1,069.70 "," $1,013.40 "," $1,013.40 "," $1,013.40 "," $1,047.18 "," $1,080.96 ", $546.67 , $957.10 , $697.57 , $645.59 , N/A , $438.67 , $438.67 ," $1,069.70 ", $525.78 , $125.43 ," $1,080.96 "
Drug Screening Methylenedioxyamphetamines,CPT® 80359,N/A,N/A,N/A, $153.00 , $99.45 , N/A , N/A , N/A , N/A , N/A , $142.29 , $137.70 , $137.70 , $122.40 , $122.40 , N/A , $141.26 , $145.35 , $137.70 , $137.70 , $137.70 , $142.29 , $146.88 , N/A , $130.05 , $114.69 , $67.79 , N/A , $90.04 , $90.04 , $145.35 , $98.20 , $67.79 , $146.88 
 Fac Bcr/Abl1 Other Breakpnt Qualitative/Quantitative ,CPT® 81208,0310 - PATHOLOGY LAB,N/A,N/A," $1,983.00 "," $1,288.95 "," $1,665.72 ", $218.91 , $179.05 ," $1,602.26 "," $1,784.70 "," $1,678.81 "," $1,784.70 "," $1,784.70 "," $1,784.70 "," $1,685.55 ", $175.54 ," $1,830.90 "," $1,883.85 "," $1,685.55 "," $1,844.19 "," $1,844.19 "," $1,883.85 "," $1,903.68 "," $1,622.49 "," $1,784.70 "," $1,685.55 "," $1,566.57 ", N/A ," $1,604.84 "," $1,604.84 "," $1,883.85 "," $1,701.61 ", $175.54 ," $1,903.68 "
 Fac Athletic Training Eval Low Complex ,CPT® 97169,0951 - OTHER THERAPEUTIC SERVICES - ATHLETIC TRAINING,N/A,N/A, $152.00 , $98.80 , $127.68 , N/A , N/A , $122.82 , $136.80 , $128.68 , $136.80 , $136.80 , $136.80 , $129.20 , N/A , $140.34 , $144.40 , $129.20 , $141.36 , $141.36 , $144.40 , $145.92 , $124.37 , $136.80 , $129.20 , $120.08 , N/A , $123.01 , $123.01 , $144.40 , $130.43 , $120.08 , $145.92 
 DONEPEZIL HCL 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6477-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Resec Tumor Lower Leg,Deep",CPT® 27619,N/A,N/A,N/A," $3,240.00 "," $2,106.00 "," $2,828.22 ", $448.34 , $373.67 ," $2,292.10 "," $2,307.92 "," $3,013.20 "," $2,916.00 "," $2,916.00 "," $2,592.00 "," $2,592.00 ", $373.67 ," $2,991.49 "," $3,078.00 "," $2,916.00 "," $2,916.00 "," $2,916.00 "," $3,013.20 "," $3,110.40 "," $2,618.69 "," $2,754.00 "," $2,540.51 "," $2,670.87 ", N/A ," $2,336.82 "," $2,336.82 "," $3,078.00 "," $2,746.59 ", $373.67 ," $3,110.40 "
Eye Photography,CPT® 92285,N/A,N/A,N/A, $105.00 , $68.25 , $49.10 , $22.31 , $16.52 , $35.49 , $37.27 , $97.65 , $94.50 , $94.50 , $84.00 , $84.00 , $16.52 , $96.95 , $99.75 , $94.50 , $94.50 , $94.50 , $97.65 , $100.80 , $68.50 , $89.25 , $63.86 , $42.85 , N/A , $36.18 , $36.18 , $99.75 , $43.04 , $16.52 , $100.80 
 MRI Cardiac W-W/O Contrast ,CPT® 75561,0610 - MRI,N/A,N/A," $6,932.00 "," $4,505.80 "," $5,822.88 ", $375.32 , $542.12 ," $5,601.06 "," $6,238.80 "," $5,868.63 "," $6,238.80 "," $6,238.80 "," $6,238.80 "," $5,892.20 ", $531.49 ," $6,400.32 "," $6,585.40 "," $5,892.20 "," $6,446.76 "," $6,446.76 "," $6,585.40 "," $6,654.72 "," $5,671.76 "," $6,238.80 "," $5,892.20 "," $5,476.28 ", N/A ," $5,610.07 "," $5,610.07 "," $6,585.40 "," $5,948.35 ", $375.32 ," $6,654.72 "
 Inj for Si Jt Arthro/Steroid/Anes ,HCPCS G0260,0761 - TREATMENT ROOM,N/A,N/A," $1,722.00 "," $1,119.30 "," $1,446.48 ", N/A , N/A ," $1,391.38 "," $1,549.80 "," $1,457.85 "," $1,549.80 "," $1,549.80 "," $1,549.80 "," $1,463.70 ", N/A ," $1,589.92 "," $1,635.90 "," $1,463.70 "," $1,601.46 "," $1,601.46 "," $1,635.90 "," $1,653.12 "," $1,408.94 "," $1,549.80 "," $1,463.70 "," $1,360.38 ", N/A ," $1,393.61 "," $1,393.61 "," $1,635.90 "," $1,477.65 "," $1,360.38 "," $1,653.12 "
 Fac Prq Trluml Mchnl Thrmbc Vein Repeat Tx ,CPT® 37188,0761 - TREATMENT ROOM,N/A,N/A," $3,568.00 "," $2,319.20 "," $2,997.12 ", $258.04 ," $2,115.06 "," $2,882.94 "," $3,211.20 "," $3,020.67 "," $3,211.20 "," $3,211.20 "," $3,211.20 "," $3,032.80 "," $2,073.59 "," $3,294.33 "," $3,389.60 "," $3,032.80 "," $3,318.24 "," $3,318.24 "," $3,389.60 "," $3,425.28 "," $2,919.34 "," $3,211.20 "," $3,032.80 "," $2,818.72 ", N/A ," $2,887.58 "," $2,887.58 "," $3,389.60 "," $3,061.70 ", $258.04 ," $3,425.28 "
"Destr Malig Trunk,Extrem 3.1-4 Cm",CPT® 17264,N/A,N/A,N/A, $840.00 , $546.00 , $418.44 , $125.80 , $167.44 , $376.05 , $369.03 , $781.20 , $756.00 , $756.00 , $672.00 , $672.00 , $167.44 , $775.57 , $798.00 , $756.00 , $756.00 , $756.00 , $781.20 , $806.40 , $461.13 , $714.00 , $733.25 , $483.95 , N/A , $383.39 , $383.39 , $798.00 , $444.60 , $125.80 , $806.40 
 Fac Electrolyte Panel ,CPT® 80051,0301 - LAB/CHEMISTRY,N/A,N/A, $155.00 , $100.75 , $130.20 , $7.15 , $7.15 , $125.24 , $139.50 , $131.22 , $139.50 , $139.50 , $139.50 , $131.75 , $7.01 , $143.11 , $147.25 , $131.75 , $144.15 , $144.15 , $147.25 , $148.80 , $126.82 , $139.50 , $131.75 , $122.45 , N/A , $125.44 , $125.44 , $147.25 , $133.01 , $7.01 , $148.80 
Anti-Reflective Coating,HCPCS V2750,N/A,N/A,N/A, $62.00 , $40.30 , N/A , $23.33 , N/A , N/A , N/A , $57.66 , $55.80 , $55.80 , $49.60 , $49.60 , N/A , $57.24 , $58.90 , $55.80 , $55.80 , $55.80 , $57.66 , $59.52 , N/A , $52.70 , $62.00 , $21.19 , N/A , N/A , N/A , $58.90 , N/A , $21.19 , $62.00 
 Pro Chg Radiologic Exam Abdomen 3+ Views ,CPT® 74021,0972 - PRO FEE/RAD/DX,N/A,N/A, $175.00 , $113.75 , $244.47 , $42.39 , $30.59 , $174.71 , $195.23 , $162.75 , $157.50 , $157.50 , $140.00 , $140.00 , $30.59 , $161.58 , $166.25 , $157.50 , $157.50 , $157.50 , $162.75 , $168.00 , $235.98 , $148.75 , $247.47 , $195.73 , N/A , $178.12 , $178.12 , $166.25 , $206.17 , $30.59 , $247.47 
Inject Facet Joint Lumbar/Sacral,64493,N/A,N/A,N/A, $814.00 , $529.10 , $445.43 , $86.57 , $126.53 , $511.48 , $503.33 , $757.02 , $732.60 , $732.60 , $651.20 , $651.20 , $126.53 , $751.57 , $773.30 , $732.60 , $732.60 , $732.60 , $757.02 , $781.44 , $484.01 , $691.90 , $490.62 , $548.86 , N/A , $521.47 , $521.47 , $773.30 , $559.41 , $86.57 , $781.44 
US Fetal Nuchal Translucency Ea Addl Gestation,CPT® 76814,N/A,N/A,N/A, $698.00 , $453.70 , $432.33 , $74.60 , $68.31 , $390.93 , $419.53 , $649.14 , $628.20 , $628.20 , $558.40 , $558.40 , $68.31 , $644.46 , $663.10 , $628.20 , $628.20 , $628.20 , $649.14 , $670.08 , $436.37 , $593.30 , $456.47 , $452.65 , N/A , $398.56 , $398.56 , $663.10 , $461.33 , $68.31 , $670.08 
Ova and Parasites Smears,CPT® 87177,N/A,N/A,N/A, $161.00 , $104.65 , N/A , $9.08 , $9.08 , $50.35 , $60.21 , $149.73 , $144.90 , $144.90 , $128.80 , $128.80 , $9.08 , $148.65 , $152.95 , $144.90 , $144.90 , $144.90 , $149.73 , $154.56 , $59.43 , $136.85 , $58.39 , $32.28 , N/A , $46.99 , $46.99 , $152.95 , $51.35 , $9.08 , $154.56 
 SODIUM CHLORIDE 3% BOLUS ,HCPCS RXA258,0258 - IV SOLUTIONS,00264-7805-10,50 mL, $16.68 , $10.84 , $14.01 , N/A , N/A , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , N/A , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $13.18 , $16.01 
"Colposc,Cervix W/Adj Vag,W/Bx & Curretag",CPT® 57454,N/A,N/A,N/A," $1,092.00 ", $709.80 , $623.60 , $125.93 , $132.52 , $555.27 , $553.03 ," $1,015.56 ", $982.80 , $982.80 , $873.60 , $873.60 , $132.52 ," $1,008.24 "," $1,037.40 ", $982.80 , $982.80 , $982.80 ," $1,015.56 "," $1,048.32 ", $656.06 , $928.20 , $726.11 , $556.13 , N/A , $566.10 , $566.10 ," $1,037.40 ", $679.00 , $125.93 ," $1,048.32 "
 PREGABALIN 75 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-7000-61,1 capsule, $4.74 , $3.08 , $3.98 , N/A , N/A , $3.83 , $4.27 , $4.01 , $4.27 , $4.27 , $4.27 , $4.03 , N/A , $4.38 , $4.50 , $4.03 , $4.41 , $4.41 , $4.50 , $4.55 , $3.88 , $4.27 , $4.03 , $3.74 , N/A , $3.84 , $3.84 , $4.50 , $4.07 , $3.74 , $4.55 
Nfct Agent Dna/Rna Gastrointestinal Pathogen,CPT® 87505,N/A,N/A,N/A, $905.00 , $588.25 , N/A , $130.86 , $130.86 , $725.81 , $859.53 , $841.65 , $814.50 , $814.50 , $724.00 , $724.00 , $130.86 , $835.59 , $859.75 , $814.50 , $814.50 , $814.50 , $841.65 , $868.80 , $856.62 , $769.25 , $612.22 , $465.16 , N/A , $677.37 , $677.37 , $859.75 , $740.22 , $130.86 , $868.80 
 PT Aquatic Therapy ,CPT® 97113,0420 - PHYSICAL THERAPY,N/A,N/A, $146.00 , $94.90 , $122.64 , $36.73 , $39.59 , $117.97 , $131.40 , $123.60 , $131.40 , $131.40 , $131.40 , $124.10 , $38.81 , $134.80 , $138.70 , $124.10 , $135.78 , $135.78 , $138.70 , $140.16 , $119.46 , $131.40 , $124.10 , $115.34 , N/A , $118.16 , $118.16 , $138.70 , $125.28 , $36.73 , $140.16 
Spine/Lumbar Disk Surgery,C9757,N/A,N/A,N/A," $8,357.00 "," $5,432.05 ", N/A , N/A , N/A , N/A , N/A ," $7,772.01 "," $7,521.30 "," $7,521.30 "," $6,685.60 "," $6,685.60 ", N/A ," $7,716.02 "," $7,939.15 "," $7,521.30 "," $7,521.30 "," $7,521.30 "," $7,772.01 "," $8,022.72 ", N/A ," $7,103.45 "," $6,685.60 ", N/A , N/A , N/A , N/A ," $7,939.15 ", N/A ," $6,685.60 "," $8,022.72 "
 Pro Arthroscopy Biceps Tenodesis ,CPT® 29828,0982 - PRO FEE/OUTPT,N/A,N/A," $3,351.00 "," $2,178.15 "," $5,560.17 ", $870.03 , $635.43 ," $4,411.27 "," $4,435.72 "," $3,116.43 "," $3,015.90 "," $3,015.90 "," $2,680.80 "," $2,680.80 ", $635.43 ," $3,093.98 "," $3,183.45 "," $3,015.90 "," $3,015.90 "," $3,015.90 "," $3,116.43 "," $3,216.96 "," $5,178.57 "," $2,848.35 "," $4,902.61 "," $5,209.04 ", N/A ," $4,497.34 "," $4,497.34 "," $3,183.45 "," $5,285.98 ", $635.43 ," $5,560.17 "
 Pro Radex From Nose Rectum FB 1 View Chld ,CPT® 76010,0972 - PRO FEE/RAD/DX,N/A,N/A, $111.00 , $72.15 , $167.79 , $29.43 , $26.96 , $123.60 , $143.51 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $26.96 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $163.37 , $94.35 , $156.01 , $131.65 , N/A , $126.01 , $126.01 , $105.45 , $145.86 , $26.96 , $167.79 
 Fac Appl Long Arm Splnt Sho Hand ,CPT® 29105,0761 - TREATMENT ROOM,N/A,N/A, $357.00 , $232.05 , $299.88 , $39.02 , $45.35 , $288.46 , $321.30 , $302.24 , $321.30 , $321.30 , $321.30 , $303.45 , $44.46 , $329.62 , $339.15 , $303.45 , $332.01 , $332.01 , $339.15 , $342.72 , $292.10 , $321.30 , $303.45 , $282.03 , N/A , $288.92 , $288.92 , $339.15 , $306.34 , $39.02 , $342.72 
" Repair Lip, Full Thickness, Up to Half Vertical Hgt -Mh ",CPT® 40652,0761 - TREATMENT ROOM,N/A,N/A," $3,157.00 "," $2,052.05 "," $2,651.88 ", $347.44 , $539.88 ," $2,550.86 "," $2,841.30 "," $2,672.72 "," $2,841.30 "," $2,841.30 "," $2,841.30 "," $2,683.45 ", $529.29 ," $2,914.86 "," $2,999.15 "," $2,683.45 "," $2,936.01 "," $2,936.01 "," $2,999.15 "," $3,030.72 "," $2,583.06 "," $2,841.30 "," $2,683.45 "," $2,494.03 ", N/A ," $2,554.96 "," $2,554.96 "," $2,999.15 "," $2,709.02 ", $347.44 ," $3,030.72 "
 IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML INH SOLN ,HCPCS RXA250,0250 - PHARMACY,00378-9671-93,3 mL, $11.82 , $7.68 , $9.93 , N/A , N/A , $9.55 , $10.64 , $10.01 , $10.64 , $10.64 , $10.64 , $10.05 , N/A , $10.91 , $11.23 , $10.05 , $10.99 , $10.99 , $11.23 , $11.35 , $9.67 , $10.64 , $10.05 , $9.34 , N/A , $9.57 , $9.57 , $11.23 , $10.14 , $9.34 , $11.35 
"Initial Normal Newborn Care, Except Hospital or Birth Center",CPT® 99461,N/A,N/A,N/A, $343.00 , $222.95 , $125.69 , $59.74 , $78.99 , $167.12 , $174.24 , $318.99 , $308.70 , $308.70 , $274.40 , $274.40 , $78.99 , $316.69 , $325.85 , $308.70 , $308.70 , $308.70 , $318.99 , $329.28 , $165.86 , $291.55 , $139.52 , $208.55 , N/A , $170.38 , $170.38 , $325.85 , $203.84 , $59.74 , $329.28 
Afo multilig ank sup pre ots,HCPCS L1906,N/A,N/A,N/A, $172.00 , $111.80 , N/A , $131.54 , $76.50 , N/A , N/A , $159.96 , $154.80 , $154.80 , $137.60 , $137.60 , $76.50 , $158.81 , $163.40 , $154.80 , $154.80 , $154.80 , $159.96 , $165.12 , N/A , $146.20 , $121.32 , $110.67 , N/A , N/A , N/A , $163.40 , N/A , $76.50 , $165.12 
Pfizer Administration Second Dose,CPT® 0002A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $76.25 , $128.02 , N/A , $79.82 , $79.82 , $66.50 , $92.91 , $38.92 , $128.02 
"Repair Enterocele,Abd Apprch",CPT® 57270,N/A,N/A,N/A," $4,883.00 "," $3,173.95 "," $3,842.90 ", $777.46 , $691.53 ," $3,246.15 "," $3,242.17 "," $4,541.19 "," $4,394.70 "," $4,394.70 "," $3,906.40 "," $3,906.40 ", $691.53 ," $4,508.47 "," $4,638.85 "," $4,394.70 "," $4,394.70 "," $4,394.70 "," $4,541.19 "," $4,687.68 "," $4,005.03 "," $4,150.55 "," $4,258.56 "," $3,277.89 ", N/A ," $3,309.49 "," $3,309.49 "," $4,638.85 "," $3,969.51 ", $691.53 ," $4,687.68 "
 Pro Radex Elbw Arthg Rs&I ,CPT® 73085,0972 - PRO FEE/RAD/DX,N/A,N/A, $176.00 , $114.40 , $643.28 , $110.17 , $91.62 , $466.94 , $542.42 , $163.68 , $158.40 , $158.40 , $140.80 , $140.80 , $91.62 , $162.50 , $167.20 , $158.40 , $158.40 , $158.40 , $163.68 , $168.96 , $647.76 , $149.60 , $595.15 , $483.88 , N/A , $476.05 , $476.05 , $167.20 , $551.05 , $91.62 , $647.76 
 SODIUM CHLORIDE 0.45 % IV SOLN ,HCPCS RXA258,0258 - IV SOLUTIONS,00990-7985-09,"1,000 mL", $79.82 , $51.88 , $67.05 , N/A , N/A , $64.49 , $71.84 , $67.58 , $71.84 , $71.84 , $71.84 , $67.85 , N/A , $73.70 , $75.83 , $67.85 , $74.23 , $74.23 , $75.83 , $76.63 , $65.31 , $71.84 , $67.85 , $63.06 , N/A , $64.60 , $64.60 , $75.83 , $68.49 , $63.06 , $76.63 
 CYCLOSPORINE MODIFIED 25 MG PO CAPS ,HCPCS J7515,0636 - DRUGS REQUIRING DETAILED CODIN,51862-0458-47,1 capsule, $7.07 , $4.60 , $5.94 , $0.77 , $0.77 , $5.71 , $6.36 , $5.99 , $6.36 , $6.36 , $6.36 , $6.01 , $0.75 , $6.53 , $6.72 , $6.01 , $6.58 , $6.58 , $6.72 , $6.79 , $5.78 , $6.36 , $6.01 , $5.59 , N/A , $5.72 , $5.72 , $6.72 , $6.07 , $0.75 , $6.79 
"Injection,Sacroiliac Joint",27096,N/A,N/A,N/A," $1,152.00 ", $748.80 , $512.53 , $79.93 , $154.36 , $415.04 , $416.57 ," $1,071.36 "," $1,036.80 "," $1,036.80 ", $921.60 , $921.60 , $154.36 ," $1,063.64 "," $1,094.40 "," $1,036.80 "," $1,036.80 "," $1,036.80 "," $1,071.36 "," $1,105.92 ", $480.33 , $979.20 , $451.37 , $490.61 , N/A , $423.13 , $423.13 ," $1,094.40 ", $497.32 , $79.93 ," $1,105.92 "
Egd Transoral Control Bleeding Any Method,CPT® 43255,N/A,N/A,N/A," $2,873.00 "," $1,867.45 "," $1,232.14 ", $189.89 , $252.38 ," $1,024.15 "," $1,368.12 "," $2,671.89 "," $2,585.70 "," $2,585.70 "," $2,298.40 "," $2,298.40 ", $252.38 ," $2,652.64 "," $2,729.35 "," $2,585.70 "," $2,585.70 "," $2,585.70 "," $2,671.89 "," $2,758.08 ", $883.66 ," $2,442.05 "," $1,498.61 "," $1,174.10 ", N/A ," $1,044.13 "," $1,044.13 "," $2,729.35 "," $1,092.06 ", $189.89 ," $2,758.08 "
 Pro Echo Exam of Abdomen ,CPT® 76705,0972 - PRO FEE/RAD/DX,N/A,N/A, $468.00 , $304.20 , $499.55 , $86.93 , $89.08 , $506.27 , $574.33 , $435.24 , $421.20 , $421.20 , $374.40 , $374.40 , $89.08 , $432.10 , $444.60 , $421.20 , $421.20 , $421.20 , $435.24 , $449.28 , $503.30 , $397.80 , $624.04 , $515.91 , N/A , $516.14 , $516.14 , $444.60 , $597.46 , $86.93 , $624.04 
 LUBRIFRESH P.M. OP OINT ,HCPCS RXC637,0250 - PHARMACY,00023-0312-04,3.5 gram, $60.22 , $39.14 , $50.58 , N/A , N/A , $48.66 , $54.20 , $50.98 , $54.20 , $54.20 , $54.20 , $51.19 , N/A , $55.60 , $57.21 , $51.19 , $56.00 , $56.00 , $57.21 , $57.81 , $49.27 , $54.20 , $51.19 , $47.57 , N/A , $48.74 , $48.74 , $57.21 , $51.67 , $47.57 , $57.81 
Bordetella Antibody,CPT® 86615,N/A,N/A,N/A, $154.00 , $100.10 , N/A , $13.45 , $8.07 , $32.88 , $39.34 , $143.22 , $138.60 , $138.60 , $123.20 , $123.20 , $8.07 , $142.19 , $146.30 , $138.60 , $138.60 , $138.60 , $143.22 , $147.84 , $88.07 , $130.90 , $85.96 , $47.81 , N/A , $30.69 , $30.69 , $146.30 , $33.54 , $8.07 , $147.84 
 Fac Dir Rpr Arysm&Grf Insj Pop Art ,CPT® 35151,0360 - OR SERVICES,N/A,N/A," $2,744.00 "," $1,783.60 "," $2,304.96 "," $1,102.29 "," $1,340.24 "," $2,217.15 "," $2,469.60 "," $2,323.07 "," $2,469.60 "," $2,469.60 "," $2,469.60 "," $2,332.40 "," $1,313.96 "," $2,533.54 "," $2,606.80 "," $2,332.40 "," $2,551.92 "," $2,551.92 "," $2,606.80 "," $2,634.24 "," $2,245.14 "," $2,469.60 "," $2,332.40 "," $2,167.76 ", N/A ," $2,220.72 "," $2,220.72 "," $2,606.80 "," $2,354.63 "," $1,102.29 "," $2,634.24 "
 Pro Appl Cst Hand&Lwr F/Arm Gauntlet ,CPT® 29085,0982 - PRO FEE/OUTPT,N/A,N/A, $500.00 , $325.00 , $406.19 , $63.77 , $47.27 , $327.24 , $327.56 , $465.00 , $450.00 , $450.00 , $400.00 , $400.00 , $47.27 , $461.65 , $475.00 , $450.00 , $450.00 , $450.00 , $465.00 , $480.00 , $376.44 , $425.00 , $358.60 , $387.94 , N/A , $333.62 , $333.62 , $475.00 , $392.12 , $47.27 , $480.00 
 ATROPINE SULFATE 1 MG/10ML IJ SOSY ,HCPCS J0461,0636 - DRUGS REQUIRING DETAILED CODIN,00409-1630-10,5 mL, $26.15 , $17.00 , $21.97 , $0.09 , $0.10 , $21.13 , $23.54 , $22.14 , $23.54 , $23.54 , $23.54 , $22.23 , $0.10 , $24.14 , $24.84 , $22.23 , $24.32 , $24.32 , $24.84 , $25.10 , $21.40 , $23.54 , $22.23 , $20.66 , N/A , $21.16 , $21.16 , $24.84 , $22.44 , $0.09 , $25.10 
 Fac Laryngoscopy Flx/Rgd Telescopic W/Stroboscopy ,CPT® 31579,0761 - TREATMENT ROOM,N/A,N/A," $1,360.00 ", $884.00 ," $1,142.40 ", $114.65 , $151.13 ," $1,098.88 "," $1,224.00 "," $1,151.38 "," $1,224.00 "," $1,224.00 "," $1,224.00 "," $1,156.00 ", $148.17 ," $1,255.69 "," $1,292.00 "," $1,156.00 "," $1,264.80 "," $1,264.80 "," $1,292.00 "," $1,305.60 "," $1,112.75 "," $1,224.00 "," $1,156.00 "," $1,074.40 ", N/A ," $1,100.65 "," $1,100.65 "," $1,292.00 "," $1,167.02 ", $114.65 ," $1,305.60 "
CT Scan Dorsal Sp Contrast,CPT® 72129,N/A,N/A,N/A," $1,859.00 "," $1,208.35 "," $1,211.77 ", $173.51 , $303.06 ," $1,092.39 "," $1,389.04 "," $1,728.87 "," $1,673.10 "," $1,673.10 "," $1,487.20 "," $1,487.20 ", $303.06 ," $1,716.41 "," $1,766.05 "," $1,673.10 "," $1,673.10 "," $1,673.10 "," $1,728.87 "," $1,784.64 "," $1,017.83 "," $1,580.15 "," $1,511.94 "," $1,485.86 ", N/A ," $1,113.70 "," $1,113.70 "," $1,766.05 "," $1,289.13 ", $173.51 ," $1,784.64 "
Insj Prph Ctr Vad W/Subq Port Age 5 Yr/>,36571,N/A,N/A,N/A," $7,340.00 "," $4,771.00 "," $1,881.75 ", $289.78 ," $1,103.81 "," $1,395.01 "," $1,385.28 "," $6,826.20 "," $6,606.00 "," $6,606.00 "," $5,872.00 "," $5,872.00 "," $1,103.81 "," $6,777.02 "," $6,973.00 "," $6,606.00 "," $6,606.00 "," $6,606.00 "," $6,826.20 "," $7,046.40 "," $1,734.58 "," $6,239.00 "," $1,725.19 "," $1,518.35 ", N/A ," $1,422.23 "," $1,422.23 "," $6,973.00 "," $1,615.65 ", $289.78 ," $7,046.40 "
Injection Aa&/Strd Greater Occipital Nerve,64405,N/A,N/A,N/A, $503.00 , $326.95 , $249.86 , $48.34 , $45.90 , $348.30 , $335.31 , $467.79 , $452.70 , $452.70 , $402.40 , $402.40 , $45.90 , $464.42 , $477.85 , $452.70 , $452.70 , $452.70 , $467.79 , $482.88 , $272.99 , $427.55 , $335.40 , $370.40 , N/A , $355.10 , $355.10 , $477.85 , $380.94 , $45.90 , $482.88 
 SERTRALINE HCL 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6925-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Antb Legionella ,CPT® 86713,0302 - LAB/IMMUNOLOGY,N/A,N/A, $132.00 , $85.80 , $110.88 , $15.61 , $15.61 , $106.66 , $118.80 , $111.75 , $118.80 , $118.80 , $118.80 , $112.20 , $15.30 , $121.88 , $125.40 , $112.20 , $122.76 , $122.76 , $125.40 , $126.72 , $108.00 , $118.80 , $112.20 , $104.28 , N/A , $106.83 , $106.83 , $125.40 , $113.27 , $15.30 , $126.72 
"Emg,Needle,Cranial Nerve Supp Mus,Unilat",CPT® 95867,N/A,N/A,N/A, $510.00 , $331.50 , $401.89 , $105.35 , $69.38 , $299.40 , $393.20 , $474.30 , $459.00 , $459.00 , $408.00 , $408.00 , $69.38 , $470.88 , $484.50 , $459.00 , $459.00 , $459.00 , $474.30 , $489.60 , $485.23 , $433.50 , $343.65 , $384.76 , N/A , $305.24 , $305.24 , $484.50 , $375.25 , $69.38 , $489.60 
"Removal Anal Fistula,Subcutaneous",46270,N/A,N/A,N/A," $3,284.00 "," $2,134.60 "," $2,461.03 ", $383.31 , $153.67 ," $1,857.21 "," $1,907.18 "," $3,054.12 "," $2,955.60 "," $2,955.60 "," $2,627.20 "," $2,627.20 ", $153.67 ," $3,032.12 "," $3,119.80 "," $2,955.60 "," $2,955.60 "," $2,955.60 "," $3,054.12 "," $3,152.64 "," $1,752.81 "," $2,791.40 "," $2,101.63 "," $2,214.04 ", N/A ," $1,893.46 "," $1,893.46 "," $3,119.80 "," $1,980.35 ", $153.67 ," $3,152.64 "
Assay of Renin,CPT® 84244,N/A,N/A,N/A, $260.00 , $169.00 , N/A , $22.43 , $22.43 , $124.43 , $148.89 , $241.80 , $234.00 , $234.00 , $208.00 , $208.00 , $22.43 , $240.06 , $247.00 , $234.00 , $234.00 , $234.00 , $241.80 , $249.60 , $146.83 , $221.00 , $144.34 , $79.74 , N/A , $116.13 , $116.13 , $247.00 , $126.90 , $22.43 , $249.60 
 ATORVASTATIN CALCIUM 20 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6291-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 ONDANSETRON HCL 4 MG/2ML IJ SOLN ,HCPCS J2405,0636 - DRUGS REQUIRING DETAILED CODIN,00641-6078-25,1 mL, $16.68 , $10.84 , $14.01 , $0.11 , $0.09 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.09 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.09 , $16.01 
" Fac Dialysis, One Evaluation ",CPT® 90945,0803 - INPATIENT CAPD,N/A,N/A," $1,085.00 ", $705.25 , $911.40 , $83.24 , $156.60 , $876.68 , $976.50 , $918.56 , $976.50 , $976.50 , $976.50 , $922.25 , $153.53 ," $1,001.78 "," $1,030.75 ", $922.25 ," $1,009.05 "," $1,009.05 "," $1,030.75 "," $1,041.60 ", $887.75 , $976.50 , $922.25 , $857.15 , N/A , $878.09 , $878.09 ," $1,030.75 ", $931.04 , $83.24 ," $1,041.60 "
 Fac I&D Dp Absc/Hmtma Soft Tiss Nck/Thorax ,CPT® 21501,0361 - OR/MINOR,N/A,N/A," $2,829.00 "," $1,838.85 "," $2,376.36 ", $320.83 , $177.51 ," $2,285.83 "," $2,546.10 "," $2,395.03 "," $2,546.10 "," $2,546.10 "," $2,546.10 "," $2,404.65 ", $174.03 ," $2,612.02 "," $2,687.55 "," $2,404.65 "," $2,630.97 "," $2,630.97 "," $2,687.55 "," $2,715.84 "," $2,314.69 "," $2,546.10 "," $2,404.65 "," $2,234.91 ", N/A ," $2,289.51 "," $2,289.51 "," $2,687.55 "," $2,427.56 ", $174.03 ," $2,715.84 "
 Fac Assay of Lead ,CPT® 83655,0301 - LAB/CHEMISTRY,N/A,N/A, $116.00 , $75.40 , $97.44 , $12.35 , $12.35 , $93.73 , $104.40 , $98.21 , $104.40 , $104.40 , $104.40 , $98.60 , $12.11 , $107.10 , $110.20 , $98.60 , $107.88 , $107.88 , $110.20 , $111.36 , $94.91 , $104.40 , $98.60 , $91.64 , N/A , $93.88 , $93.88 , $110.20 , $99.54 , $12.11 , $111.36 
 Pro Smpl Rpr Supfc S/N/Ax/G/T 20.1cm-30.0cm ,CPT® 12006,0982 - PRO FEE/OUTPT,N/A,N/A," $1,509.00 ", $980.85 , $362.98 , $107.63 , $188.65 , $328.19 , $317.78 ," $1,403.37 "," $1,358.10 "," $1,358.10 "," $1,207.20 "," $1,207.20 ", $188.65 ," $1,393.26 "," $1,433.55 "," $1,358.10 "," $1,358.10 "," $1,358.10 "," $1,403.37 "," $1,448.64 ", $399.58 ," $1,282.65 ", $638.69 , $403.51 , N/A , $334.60 , $334.60 ," $1,433.55 ", $388.01 , $107.63 ," $1,448.64 "
Assay Ferritin,CPT® 82728,N/A,N/A,N/A, $135.00 , $87.75 , N/A , $13.90 , $13.90 , $77.08 , $92.22 , $125.55 , $121.50 , $121.50 , $108.00 , $108.00 , $13.90 , $124.65 , $128.25 , $121.50 , $121.50 , $121.50 , $125.55 , $129.60 , $91.01 , $114.75 , $89.20 , $49.43 , N/A , $71.94 , $71.94 , $128.25 , $78.61 , $13.90 , $129.60 
Ultrasonic Guidance Intraoperative,CPT® 76998,N/A,N/A,N/A," $1,005.00 ", $653.25 , $620.83 , $108.44 , $58.33 , $303.72 , $318.62 , $934.65 , $904.50 , $904.50 , $804.00 , $804.00 , $58.33 , $927.92 , $954.75 , $904.50 , $904.50 , $904.50 , $934.65 , $964.80 , $616.36 , $854.25 , $362.10 , $618.34 , N/A , $309.65 , $309.65 , $954.75 , $358.43 , $58.33 , $964.80 
 Pro Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/Img Gdn ,CPT® 62321,0982 - PRO FEE/OUTPT,N/A,N/A, $887.00 , $576.55 , $529.36 , $102.63 , $196.67 , $591.06 , $573.29 , $824.91 , $798.30 , $798.30 , $709.60 , $709.60 , $196.67 , $818.97 , $842.65 , $798.30 , $798.30 , $798.30 , $824.91 , $851.52 , $575.81 , $753.95 , $559.74 , $650.84 , N/A , $602.59 , $602.59 , $842.65 , $646.43 , $102.63 , $851.52 
 OLANZAPINE 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6377-61,1 tablet, $67.89 , $44.13 , $57.03 , N/A , N/A , $54.86 , $61.10 , $57.48 , $61.10 , $61.10 , $61.10 , $57.71 , N/A , $62.68 , $64.50 , $57.71 , $63.14 , $63.14 , $64.50 , $65.17 , $55.55 , $61.10 , $57.71 , $53.63 , N/A , $54.94 , $54.94 , $64.50 , $58.26 , $53.63 , $65.17 
Drain Pilonidal Cyst Complic,CPT® 10081,N/A,N/A,N/A," $1,278.00 ", $830.70 , $545.63 , $162.12 , $213.21 , $462.71 , $459.06 ," $1,188.54 "," $1,150.20 "," $1,150.20 "," $1,022.40 "," $1,022.40 ", $213.21 ," $1,179.98 "," $1,214.10 "," $1,150.20 "," $1,150.20 "," $1,150.20 "," $1,188.54 "," $1,226.88 ", $603.01 ," $1,086.30 ", $918.79 , $595.22 , N/A , $471.73 , $471.73 ," $1,214.10 ", $547.05 , $162.12 ," $1,226.88 "
 PHYTONADIONE 1 MG/0.5ML IJ SOLN ,HCPCS J3430,0250 - PHARMACY,76329-1240-01,0.5 mL, $152.45 , $99.09 , $128.06 , $2.93 , $3.25 , $123.18 , $137.21 , $129.06 , $137.21 , $137.21 , $137.21 , $129.58 , $3.19 , $140.76 , $144.83 , $129.58 , $141.78 , $141.78 , $144.83 , $146.35 , $124.73 , $137.21 , $129.58 , $120.44 , N/A , $123.38 , $123.38 , $144.83 , $130.82 , $2.93 , $146.35 
"Closed Rx Weight Bear Dist Tib,Manip",27825,N/A,N/A,N/A," $2,855.00 "," $1,855.75 "," $3,004.63 ", $474.54 , $435.12 ," $2,383.87 "," $2,374.71 "," $2,655.15 "," $2,569.50 "," $2,569.50 "," $2,284.00 "," $2,284.00 ", $435.12 ," $2,636.02 "," $2,712.25 "," $2,569.50 "," $2,569.50 "," $2,569.50 "," $2,655.15 "," $2,740.80 "," $2,791.58 "," $2,426.75 "," $2,619.01 "," $2,820.48 ", N/A ," $2,430.39 "," $2,430.39 "," $2,712.25 "," $2,856.59 ", $435.12 ," $3,004.63 "
 Fac Drug Screening Opiates 1 or More ,CPT® 80361,0301 - LAB/CHEMISTRY,N/A,N/A, $171.00 , $111.15 , $143.64 , N/A , N/A , $138.17 , $153.90 , $144.77 , $153.90 , $153.90 , $153.90 , $145.35 , N/A , $157.88 , $162.45 , $145.35 , $159.03 , $159.03 , $162.45 , $164.16 , $139.91 , $153.90 , $145.35 , $135.09 , N/A , $138.39 , $138.39 , $162.45 , $146.74 , $135.09 , $164.16 
" Arsenic, Blood Beaker1 ",CPT® 82175,0301 - LAB/CHEMISTRY,N/A,N/A, $205.00 , $133.25 , $172.20 , $19.35 , $19.35 , $165.64 , $184.50 , $173.55 , $184.50 , $184.50 , $184.50 , $174.25 , $18.97 , $189.28 , $194.75 , $174.25 , $190.65 , $190.65 , $194.75 , $196.80 , $167.73 , $184.50 , $174.25 , $161.95 , N/A , $165.91 , $165.91 , $194.75 , $175.91 , $18.97 , $196.80 
" Fac Trichomonas Vagin, Dir Probe ",CPT® 87660,0306 - LAB/BACT-MICRO,N/A,N/A, $118.00 , $76.70 , $99.12 , $20.45 , $20.45 , $95.34 , $106.20 , $99.90 , $106.20 , $106.20 , $106.20 , $100.30 , $20.05 , $108.95 , $112.10 , $100.30 , $109.74 , $109.74 , $112.10 , $113.28 , $96.55 , $106.20 , $100.30 , $93.22 , N/A , $95.50 , $95.50 , $112.10 , $101.26 , $20.05 , $113.28 
 Trauma 3 Activation W/O Pre-ED Notiification Lvl 1 -W/O Critical Care ,CPT® 99285,0450 - EMERGENCY SERVICES,N/A,N/A," $11,830.00 "," $7,689.50 "," $9,937.20 ", $168.76 , $44.31 ," $9,558.64 "," $10,647.00 "," $10,015.28 "," $10,647.00 "," $10,647.00 "," $10,647.00 "," $10,055.50 ", $43.44 ," $10,922.64 "," $11,238.50 "," $10,055.50 "," $11,001.90 "," $11,001.90 "," $11,238.50 "," $11,356.80 "," $9,679.31 "," $10,647.00 "," $10,055.50 "," $9,345.70 ", N/A ," $9,574.02 "," $9,574.02 "," $11,238.50 "," $10,151.32 ", $43.44 ," $11,356.80 "
Routine Ophthalmological Exa,HCPCS S0621,N/A,N/A,N/A, $436.00 , $283.40 , N/A , N/A , N/A , N/A , N/A , $405.48 , $392.40 , $392.40 , $348.80 , $348.80 , N/A , $402.56 , $414.20 , $392.40 , $392.40 , $392.40 , $405.48 , $418.56 , N/A , $370.60 , $348.80 , N/A , N/A , N/A , N/A , $414.20 , N/A , $348.80 , $418.56 
 Fac Remove Foreign Body ,CPT® 10120,0761 - TREATMENT ROOM,N/A,N/A, $572.00 , $371.80 , $480.48 , $101.48 , $42.46 , $462.18 , $514.80 , $484.26 , $514.80 , $514.80 , $514.80 , $486.20 , $41.63 , $528.13 , $543.40 , $486.20 , $531.96 , $531.96 , $543.40 , $549.12 , $468.01 , $514.80 , $486.20 , $451.88 , N/A , $462.92 , $462.92 , $543.40 , $490.83 , $41.63 , $549.12 
Thyroid Activity (Tbg) Assay,CPT® 84442,N/A,N/A,N/A, $146.00 , $94.90 , N/A , $15.08 , $15.08 , $83.65 , $100.09 , $135.78 , $131.40 , $131.40 , $116.80 , $116.80 , $15.08 , $134.80 , $138.70 , $131.40 , $131.40 , $131.40 , $135.78 , $140.16 , $98.69 , $124.10 , $97.31 , $53.60 , N/A , $78.07 , $78.07 , $138.70 , $85.31 , $15.08 , $140.16 
" Fac Interrog Eval, in Person,Cardvert/Defib ",CPT® 93289,0480 - CARDIOLOGY,N/A,N/A, $408.00 , $265.20 , $342.72 , $71.78 , $57.30 , $329.66 , $367.20 , $345.41 , $367.20 , $367.20 , $367.20 , $346.80 , $56.18 , $376.71 , $387.60 , $346.80 , $379.44 , $379.44 , $387.60 , $391.68 , $333.83 , $367.20 , $346.80 , $322.32 , N/A , $330.19 , $330.19 , $387.60 , $350.10 , $56.18 , $391.68 
Drug Assay Methotrexate,CPT® 80204,N/A,N/A,N/A, $173.00 , $112.45 , N/A , $39.34 , $39.34 , N/A , N/A , $160.89 , $155.70 , $155.70 , $138.40 , $138.40 , $39.34 , $159.73 , $164.35 , $155.70 , $155.70 , $155.70 , $160.89 , $166.08 , $257.54 , $147.05 , $184.15 , $113.28 , N/A , $151.19 , $151.19 , $164.35 , $166.24 , $39.34 , $257.54 
Suture Lrg Intest,CPT® 44604,N/A,N/A,N/A," $6,890.00 "," $4,478.50 "," $6,276.21 ", $972.00 , $976.26 ," $4,978.52 "," $5,005.10 "," $6,407.70 "," $6,201.00 "," $6,201.00 "," $5,512.00 "," $5,512.00 ", $976.26 ," $6,361.54 "," $6,545.50 "," $6,201.00 "," $6,201.00 "," $6,201.00 "," $6,407.70 "," $6,614.40 "," $4,510.46 "," $5,856.50 "," $5,566.28 "," $5,873.38 ", N/A ," $5,075.66 "," $5,075.66 "," $6,545.50 "," $5,308.60 ", $972.00 ," $6,614.40 "
 LEVETIRACETAM 500 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-7124-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Create Eardrum Opening,Gen Anesth",CPT® 69436,N/A,N/A,N/A, $650.00 , $422.50 , $758.20 , $155.15 , $218.54 , $769.66 , $796.94 , $604.50 , $585.00 , $585.00 , $520.00 , $520.00 , $218.54 , $600.15 , $617.50 , $585.00 , $585.00 , $585.00 , $604.50 , $624.00 , $818.29 , $552.50 , $868.84 , $772.85 , N/A , $784.68 , $784.68 , $617.50 , $895.96 , $155.15 , $895.96 
 CAPTOPRIL 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60687-0315-21,1 tablet, $9.48 , $6.16 , $7.96 , N/A , N/A , $7.66 , $8.53 , $8.03 , $8.53 , $8.53 , $8.53 , $8.06 , N/A , $8.75 , $9.01 , $8.06 , $8.82 , $8.82 , $9.01 , $9.10 , $7.76 , $8.53 , $8.06 , $7.49 , N/A , $7.67 , $7.67 , $9.01 , $8.13 , $7.49 , $9.10 
 Provcug- Lh ,CPT® 74455,0972 - PRO FEE/RAD/DX,N/A,N/A, $237.00 , $154.05 , $602.50 , $103.57 , $79.78 , $385.42 , $451.26 , $220.41 , $213.30 , $213.30 , $189.60 , $189.60 , $79.78 , $218.82 , $225.15 , $213.30 , $213.30 , $213.30 , $220.41 , $227.52 , $583.24 , $201.45 , $491.14 , $416.42 , N/A , $392.94 , $392.94 , $225.15 , $454.83 , $79.78 , $602.50 
 Pro 1st Hospital IP/Obs Care High Mdm 75 Minutes ,CPT® 99223,0987 - PRO FEE/HOS VIS,N/A,N/A, $653.00 , $424.45 , $394.93 , $168.79 , $103.99 , $349.44 , $349.53 , $607.29 , $587.70 , $587.70 , $522.40 , $522.40 , $103.99 , $602.91 , $620.35 , $587.70 , $587.70 , $587.70 , $607.29 , $626.88 , $504.25 , $555.05 , $436.56 , $443.19 , $206.25 , $356.26 , $356.26 , $620.35 , $410.90 , $103.99 , $626.88 
 Revasc Intravasc Lithotripsy Procedure ,HCPCS C9764,0360 - OR SERVICES,N/A,N/A," $14,147.00 "," $9,195.55 "," $11,883.48 ", N/A , N/A ," $11,430.78 "," $12,732.30 "," $11,976.85 "," $12,732.30 "," $12,732.30 "," $12,732.30 "," $12,024.95 ", N/A ," $13,061.93 "," $13,439.65 "," $12,024.95 "," $13,156.71 "," $13,156.71 "," $13,439.65 "," $13,581.12 "," $11,575.08 "," $12,732.30 "," $12,024.95 "," $11,176.13 ", N/A ," $11,449.17 "," $11,449.17 "," $13,439.65 "," $12,139.54 "," $11,176.13 "," $13,581.12 "
 ALPRAZOLAM 0.125 MG (COMES FROM THE 0.25 MG TAB) ,HCPCS RXC637,0250 - PHARMACY,00001-0323-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Remove Foreign Body,Foot",28192,N/A,N/A,N/A," $2,287.00 "," $1,486.55 "," $1,930.89 ", $301.68 , $190.55 ," $1,545.60 "," $1,551.74 "," $2,126.91 "," $2,058.30 "," $2,058.30 "," $1,829.60 "," $1,829.60 ", $190.55 ," $2,111.59 "," $2,172.65 "," $2,058.30 "," $2,058.30 "," $2,058.30 "," $2,126.91 "," $2,195.52 "," $1,797.60 "," $1,943.95 "," $1,680.59 "," $1,833.96 ", N/A ," $1,575.76 "," $1,575.76 "," $2,172.65 "," $1,852.06 ", $190.55 ," $2,195.52 "
"Assay, Dihydroxyvitamin D",CPT® 82652,N/A,N/A,N/A, $356.00 , $231.40 , N/A , $39.27 , $39.27 , $217.81 , $260.55 , $331.08 , $320.40 , $320.40 , $284.80 , $284.80 , $39.27 , $328.69 , $338.20 , $320.40 , $320.40 , $320.40 , $331.08 , $341.76 , $257.07 , $302.60 , $253.01 , $139.60 , N/A , $203.27 , $203.27 , $338.20 , $222.13 , $39.27 , $341.76 
"Fusion Big Toe,Mt-P Jt",28750,N/A,N/A,N/A," $5,538.00 "," $3,599.70 "," $3,563.76 ", $556.74 , $273.33 ," $2,894.41 "," $2,906.69 "," $5,150.34 "," $4,984.20 "," $4,984.20 "," $4,430.40 "," $4,430.40 ", $273.33 ," $5,113.24 "," $5,261.10 "," $4,984.20 "," $4,984.20 "," $4,984.20 "," $5,150.34 "," $5,316.48 "," $3,324.03 "," $4,707.30 "," $3,184.55 "," $3,400.28 ", N/A ," $2,950.89 "," $2,950.89 "," $5,261.10 "," $3,468.35 ", $273.33 ," $5,316.48 "
"Shav Skin Les <5mm Face,Facial",11310,N/A,N/A,N/A, $450.00 , $292.50 , $146.03 , $43.84 , $52.47 , $128.91 , $124.83 , $418.50 , $405.00 , $405.00 , $360.00 , $360.00 , $52.47 , $415.49 , $427.50 , $405.00 , $405.00 , $405.00 , $418.50 , $432.00 , $161.07 , $382.50 , $247.98 , $166.84 , N/A , $131.42 , $131.42 , $427.50 , $152.41 , $43.84 , $432.00 
 MEPIVACAINE HCL (PF) 1 % IJ SOLN ,HCPCS J0670,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0260-37,30 mL, $52.86 , $34.36 , $44.40 , $3.14 , $3.54 , $42.71 , $47.57 , $44.75 , $47.57 , $47.57 , $47.57 , $44.93 , $3.47 , $48.81 , $50.22 , $44.93 , $49.16 , $49.16 , $50.22 , $50.75 , $43.25 , $47.57 , $44.93 , $41.76 , N/A , $42.78 , $42.78 , $50.22 , $45.36 , $3.14 , $50.75 
 Pro Repair Rectum & Vagina ,CPT® 57250,0982 - PRO FEE/OUTPT,N/A,N/A," $4,028.00 "," $2,618.20 "," $2,917.65 ", $589.72 , $461.04 ," $2,754.11 "," $2,747.30 "," $3,746.04 "," $3,625.20 "," $3,625.20 "," $3,222.40 "," $3,222.40 ", $461.04 ," $3,719.05 "," $3,826.60 "," $3,625.20 "," $3,625.20 "," $3,625.20 "," $3,746.04 "," $3,866.88 "," $3,032.93 "," $3,423.80 "," $3,605.59 "," $2,437.43 ", N/A ," $2,807.84 "," $2,807.84 "," $3,826.60 "," $3,367.85 ", $461.04 ," $3,866.88 "
App Skn Sub Grft T/a/L Area/>100scm Adl 100scm,15274,N/A,N/A,N/A, $447.00 , $290.55 , $140.28 , $41.10 , $54.02 , $124.25 , $109.80 , $415.71 , $402.30 , $402.30 , $357.60 , $357.60 , $54.02 , $412.72 , $424.65 , $402.30 , $402.30 , $402.30 , $415.71 , $429.12 , $153.97 , $379.95 , $217.66 , $157.09 , N/A , $126.67 , $126.67 , $424.65 , $146.90 , $41.10 , $429.12 
" Pro Remove Nail Plate, Add-On ",CPT® 11732,0981 - PRO FEE/ER,N/A,N/A, $173.00 , $112.45 , $56.07 , $16.52 , $20.72 , $56.58 , $53.10 , $160.89 , $155.70 , $155.70 , $138.40 , $138.40 , $20.72 , $159.73 , $164.35 , $155.70 , $155.70 , $155.70 , $160.89 , $166.08 , $61.85 , $147.05 , $105.26 , $63.44 , N/A , $57.68 , $57.68 , $164.35 , $66.88 , $16.52 , $166.08 
Removal of Contraceptive Capsul,CPT® 11976,N/A,N/A,N/A, $550.00 , $357.50 , $294.54 , $87.33 , N/A , $259.01 , $252.64 , $511.50 , $495.00 , $495.00 , $440.00 , $440.00 , N/A , $507.82 , $522.50 , $495.00 , $495.00 , $495.00 , $511.50 , $528.00 , $324.49 , $467.50 , $506.67 , $329.26 , N/A , $264.06 , $264.06 , $522.50 , $306.21 , $87.33 , $528.00 
Insj Tunneled Ctr Vad W/Subq Port Age 5 Yr/>,CPT® 36561,N/A,N/A,N/A," $7,501.00 "," $4,875.65 "," $2,016.17 ", $311.47 ," $1,557.13 "," $1,534.48 "," $1,527.96 "," $6,975.93 "," $6,750.90 "," $6,750.90 "," $6,000.80 "," $6,000.80 "," $1,557.13 "," $6,925.67 "," $7,125.95 "," $6,750.90 "," $6,750.90 "," $6,750.90 "," $6,975.93 "," $7,200.96 "," $1,865.19 "," $6,375.85 "," $1,901.81 "," $1,665.73 ", N/A ," $1,564.42 "," $1,564.42 "," $7,125.95 "," $1,777.17 ", $311.47 ," $7,200.96 "
"Cabg, Artery-Vein, Three",CPT® 33519,N/A,N/A,N/A," $5,631.00 "," $3,660.15 "," $3,154.06 ", $485.39 , $453.61 ," $2,324.29 "," $2,297.10 "," $5,236.83 "," $5,067.90 "," $5,067.90 "," $4,504.80 "," $4,504.80 ", $453.61 ," $5,199.10 "," $5,349.45 "," $5,067.90 "," $5,067.90 "," $5,067.90 "," $5,236.83 "," $5,405.76 "," $2,927.65 "," $4,786.35 "," $2,915.16 "," $2,603.15 ", N/A ," $2,369.64 "," $2,369.64 "," $5,349.45 "," $2,691.93 ", $453.61 ," $5,405.76 "
 Fac Collagen Crosslinks ,CPT® 82523,0301 - LAB/CHEMISTRY,N/A,N/A, $254.00 , $165.10 , $213.36 , $19.05 , $14.46 , $205.23 , $228.60 , $215.04 , $228.60 , $228.60 , $228.60 , $215.90 , $14.18 , $234.52 , $241.30 , $215.90 , $236.22 , $236.22 , $241.30 , $243.84 , $207.82 , $228.60 , $215.90 , $200.66 , N/A , $205.56 , $205.56 , $241.30 , $217.96 , $14.18 , $243.84 
 Fac Egd Transoral Control Bleeding Any Method ,CPT® 43255,0360 - OR SERVICES,N/A,N/A," $2,764.00 "," $1,796.60 "," $2,321.76 ", $189.89 , $252.38 ," $2,233.31 "," $2,487.60 "," $2,340.00 "," $2,487.60 "," $2,487.60 "," $2,487.60 "," $2,349.40 ", $247.43 ," $2,552.00 "," $2,625.80 "," $2,349.40 "," $2,570.52 "," $2,570.52 "," $2,625.80 "," $2,653.44 "," $2,261.50 "," $2,487.60 "," $2,349.40 "," $2,183.56 ", N/A ," $2,236.91 "," $2,236.91 "," $2,625.80 "," $2,371.79 ", $189.89 ," $2,653.44 "
Anoscopy and Biopsy,CPT® 46606,N/A,N/A,N/A," $1,500.00 ", $975.00 , $455.52 , $70.90 , $45.35 , $362.71 , $371.27 ," $1,395.00 "," $1,350.00 "," $1,350.00 "," $1,200.00 "," $1,200.00 ", $45.35 ," $1,384.95 "," $1,425.00 "," $1,350.00 "," $1,350.00 "," $1,350.00 "," $1,395.00 "," $1,440.00 ", $327.07 ," $1,275.00 ", $410.33 , $432.19 , N/A , $369.78 , $369.78 ," $1,425.00 ", $386.76 , $45.35 ," $1,440.00 "
Lens Sphc Trifo 7.25-12/.25-,HCPCS V2311,N/A,N/A,N/A, $90.00 , $58.50 , N/A , $122.45 , N/A , N/A , N/A , $83.70 , $81.00 , $81.00 , $72.00 , $72.00 , N/A , $83.10 , $85.50 , $81.00 , $81.00 , $81.00 , $83.70 , $86.40 , N/A , $76.50 , $90.00 , $111.24 , N/A , N/A , N/A , $85.50 , N/A , $72.00 , $122.45 
Opn Fem Art Expos Dlvr Evasc Prosth Uni,CPT® 34812,N/A,N/A,N/A," $4,306.00 "," $2,798.90 "," $1,186.32 ", $182.28 , $253.14 ," $1,455.96 "," $1,442.41 "," $4,004.58 "," $3,875.40 "," $3,875.40 "," $3,444.80 "," $3,444.80 ", $253.14 ," $3,975.73 "," $4,090.70 "," $3,875.40 "," $3,875.40 "," $3,875.40 "," $4,004.58 "," $4,133.76 "," $1,099.24 "," $3,660.10 "," $1,826.88 ", $989.47 , N/A ," $1,484.36 "," $1,484.36 "," $4,090.70 "," $1,686.21 ", $182.28 ," $4,133.76 "
Assay Calcium in Urine,CPT® 82340,N/A,N/A,N/A, $68.00 , $44.20 , N/A , $6.15 , $6.15 , $34.13 , $40.81 , $63.24 , $61.20 , $61.20 , $54.40 , $54.40 , $6.15 , $62.78 , $64.60 , $61.20 , $61.20 , $61.20 , $63.24 , $65.28 , $40.26 , $57.80 , $38.92 , $21.85 , N/A , $31.85 , $31.85 , $64.60 , $34.81 , $6.15 , $65.28 
"Fracture Head/Neck,Closed",24650,N/A,N/A,N/A, $957.00 , $622.05 ," $1,529.32 ", $243.22 , $194.38 ," $1,155.93 "," $1,180.19 ", $890.01 , $861.30 , $861.30 , $765.60 , $765.60 , $194.38 , $883.60 , $909.15 , $861.30 , $861.30 , $861.30 , $890.01 , $918.72 ," $1,410.37 ", $813.45 ," $1,291.66 "," $1,377.14 ", N/A ," $1,178.49 "," $1,178.49 ", $909.15 ," $1,385.17 ", $194.38 ," $1,529.32 "
 PREGABALIN 25 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-6991-04,1 capsule, $8.14 , $5.29 , $6.84 , N/A , N/A , $6.58 , $7.33 , $6.89 , $7.33 , $7.33 , $7.33 , $6.92 , N/A , $7.52 , $7.73 , $6.92 , $7.57 , $7.57 , $7.73 , $7.81 , $6.66 , $7.33 , $6.92 , $6.43 , N/A , $6.59 , $6.59 , $7.73 , $6.98 , $6.43 , $7.81 
 Sc Bx Bone Deep ,CPT® 20225,0361 - OR/MINOR,N/A,N/A," $1,979.00 "," $1,286.35 "," $1,662.36 ", $123.85 , $284.25 ," $1,599.03 "," $1,781.10 "," $1,675.42 "," $1,781.10 "," $1,781.10 "," $1,781.10 "," $1,682.15 ", $278.68 ," $1,827.21 "," $1,880.05 "," $1,682.15 "," $1,840.47 "," $1,840.47 "," $1,880.05 "," $1,899.84 "," $1,619.22 "," $1,781.10 "," $1,682.15 "," $1,563.41 ", N/A ," $1,601.60 "," $1,601.60 "," $1,880.05 "," $1,698.18 ", $123.85 ," $1,899.84 "
 Pro Treat Fx Rad Extra-Articul ,CPT® 25607,0975 - PRO FEE/OR,N/A,N/A," $2,326.00 "," $1,511.90 "," $4,513.34 ", $710.41 , $535.03 ," $3,538.70 "," $3,537.04 "," $2,163.18 "," $2,093.40 "," $2,093.40 "," $1,860.80 "," $1,860.80 ", $535.03 ," $2,147.60 "," $2,209.70 "," $2,093.40 "," $2,093.40 "," $2,093.40 "," $2,163.18 "," $2,232.96 "," $4,189.23 "," $1,977.10 "," $3,898.18 "," $4,186.72 ", N/A ," $3,607.75 "," $3,607.75 "," $2,209.70 "," $4,240.40 ", $535.03 ," $4,513.34 "
Lens Sphcyl Bifo 7.25-12/4.2,HCPCS V2213,N/A,N/A,N/A, $85.00 , $55.25 , N/A , $94.72 , N/A , N/A , N/A , $79.05 , $76.50 , $76.50 , $68.00 , $68.00 , N/A , $78.48 , $80.75 , $76.50 , $76.50 , $76.50 , $79.05 , $81.60 , N/A , $72.25 , $85.00 , $86.06 , N/A , N/A , N/A , $80.75 , N/A , $68.00 , $94.72 
"Xpedicul Decompress Cord,Addnl Sgmt",CPT® 63057,N/A,N/A,N/A," $2,791.00 "," $1,814.15 "," $1,468.27 ", $285.40 , $278.93 ," $1,740.75 "," $1,660.40 "," $2,595.63 "," $2,511.90 "," $2,511.90 "," $2,232.80 "," $2,232.80 ", $278.93 ," $2,576.93 "," $2,651.45 "," $2,511.90 "," $2,511.90 "," $2,511.90 "," $2,595.63 "," $2,679.36 "," $1,593.82 "," $2,372.35 "," $1,693.08 "," $1,819.85 ", N/A ," $1,774.72 "," $1,774.72 "," $2,651.45 "," $1,903.83 ", $278.93 ," $2,679.36 "
"Repair Rotator Cuff,Acute",23410,N/A,N/A,N/A," $5,454.00 "," $3,545.10 "," $4,981.80 ", $780.96 , $768.38 ," $3,961.97 "," $3,945.11 "," $5,072.22 "," $4,908.60 "," $4,908.60 "," $4,363.20 "," $4,363.20 ", $768.38 ," $5,035.68 "," $5,181.30 "," $4,908.60 "," $4,908.60 "," $4,908.60 "," $5,072.22 "," $5,235.84 "," $4,634.55 "," $4,635.90 "," $4,356.68 "," $4,667.26 ", N/A ," $4,039.28 "," $4,039.28 "," $5,181.30 "," $4,747.60 ", $768.38 ," $5,235.84 "
Brnschsc Tndsc Ebus Dx/Tx Intervention Perph Les,CPT® 31654,N/A,N/A,N/A, $831.00 , $540.15 , $367.54 , $63.48 , $86.64 , $263.24 , $253.83 , $772.83 , $747.90 , $747.90 , $664.80 , $664.80 , $86.64 , $767.26 , $789.45 , $747.90 , $747.90 , $747.90 , $772.83 , $797.76 , $356.63 , $706.35 , $344.73 , $354.01 , N/A , $268.37 , $268.37 , $789.45 , $316.06 , $63.48 , $797.76 
"Dislocated Elbow,W/O Anes",24600,N/A,N/A,N/A," $2,031.00 "," $1,320.15 "," $2,087.54 ", $333.10 , $76.84 ," $1,604.04 "," $1,632.03 "," $1,888.83 "," $1,827.90 "," $1,827.90 "," $1,624.80 "," $1,624.80 ", $76.84 ," $1,875.22 "," $1,929.45 "," $1,827.90 "," $1,827.90 "," $1,827.90 "," $1,888.83 "," $1,949.76 "," $1,919.14 "," $1,726.35 "," $1,791.20 "," $1,909.64 ", N/A ," $1,635.34 "," $1,635.34 "," $1,929.45 "," $1,922.11 ", $76.84 ," $2,087.54 "
 Fac Dir Rpr Arysm/&Grf Insj Crtd Subcla Art ,CPT® 35001,0360 - OR SERVICES,N/A,N/A," $4,886.00 "," $3,175.90 "," $4,104.24 "," $1,005.50 "," $1,340.24 "," $3,947.89 "," $4,397.40 "," $4,136.49 "," $4,397.40 "," $4,397.40 "," $4,397.40 "," $4,153.10 "," $1,313.96 "," $4,511.24 "," $4,641.70 "," $4,153.10 "," $4,543.98 "," $4,543.98 "," $4,641.70 "," $4,690.56 "," $3,997.73 "," $4,397.40 "," $4,153.10 "," $3,859.94 ", N/A ," $3,954.24 "," $3,954.24 "," $4,641.70 "," $4,192.68 "," $1,005.50 "," $4,690.56 "
" Pro Electrocardiogram,Report ",CPT® 93010,0985 - PRO FEE/EKG,N/A,N/A, $102.00 , $66.30 , $51.61 , $7.96 , $9.02 , $46.31 , $46.05 , $94.86 , $91.80 , $91.80 , $81.60 , $81.60 , $9.02 , $94.18 , $96.90 , $91.80 , $91.80 , $91.80 , $94.86 , $97.92 , $86.42 , $86.70 , $42.82 , $32.14 , N/A , $47.22 , $47.22 , $96.90 , $52.33 , $7.96 , $97.92 
 Fracture Metacarpal Closed /W Manip Single - Mh ,CPT® 26605,0761 - TREATMENT ROOM,N/A,N/A," $3,229.00 "," $2,098.85 "," $2,712.36 ", $293.60 , $235.17 ," $2,609.03 "," $2,906.10 "," $2,733.67 "," $2,906.10 "," $2,906.10 "," $2,906.10 "," $2,744.65 ", $230.56 ," $2,981.34 "," $3,067.55 "," $2,744.65 "," $3,002.97 "," $3,002.97 "," $3,067.55 "," $3,099.84 "," $2,641.97 "," $2,906.10 "," $2,744.65 "," $2,550.91 ", N/A ," $2,613.23 "," $2,613.23 "," $3,067.55 "," $2,770.80 ", $230.56 ," $3,099.84 "
"Venipuncture,Over Age 3",CPT® 36410,N/A,N/A,N/A, $109.00 , $70.85 , $56.68 , $8.74 , $16.64 , $40.95 , $40.19 , $101.37 , $98.10 , $98.10 , $87.20 , $87.20 , $16.64 , $100.64 , $103.55 , $98.10 , $98.10 , $98.10 , $101.37 , $104.64 , $52.57 , $92.65 , $49.95 , $46.82 , N/A , $41.76 , $41.76 , $103.55 , $47.42 , $8.74 , $104.64 
Fx Cl Prox Humeral W Mani,23605,N/A,N/A,N/A," $2,413.00 "," $1,568.45 "," $2,634.26 ", $415.72 , $461.04 ," $2,042.21 "," $2,063.18 "," $2,244.09 "," $2,171.70 "," $2,171.70 "," $1,930.40 "," $1,930.40 ", $461.04 ," $2,227.92 "," $2,292.35 "," $2,171.70 "," $2,171.70 "," $2,171.70 "," $2,244.09 "," $2,316.48 "," $2,440.63 "," $2,051.05 "," $2,271.11 "," $2,411.56 ", N/A ," $2,082.06 "," $2,082.06 "," $2,292.35 "," $2,447.14 ", $415.72 ," $2,634.26 "
 Fac Chng Urtrost Tube/Xtrnlly Accessible Stent Ileal ,CPT® 50688,0360 - OR SERVICES,N/A,N/A," $1,871.00 "," $1,216.15 "," $1,571.64 ", $74.31 , $15.36 ," $1,511.77 "," $1,683.90 "," $1,583.99 "," $1,683.90 "," $1,683.90 "," $1,683.90 "," $1,590.35 ", $15.06 ," $1,727.49 "," $1,777.45 "," $1,590.35 "," $1,740.03 "," $1,740.03 "," $1,777.45 "," $1,796.16 "," $1,530.85 "," $1,683.90 "," $1,590.35 "," $1,478.09 ", N/A ," $1,514.20 "," $1,514.20 "," $1,777.45 "," $1,605.51 ", $15.06 ," $1,796.16 "
 Pro Layer Closure Wound 7.6-12.5 Cm ,CPT® 12034,0982 - PRO FEE/OUTPT,N/A,N/A," $1,268.00 ", $824.20 , $654.87 , $196.65 , $122.93 , $564.34 , $550.50 ," $1,179.24 "," $1,141.20 "," $1,141.20 "," $1,014.40 "," $1,014.40 ", $122.93 ," $1,170.74 "," $1,204.60 "," $1,141.20 "," $1,141.20 "," $1,141.20 "," $1,179.24 "," $1,217.28 ", $719.01 ," $1,077.80 "," $1,100.77 ", $726.60 , N/A , $575.35 , $575.35 ," $1,204.60 ", $667.22 , $122.93 ," $1,217.28 "
 METHOXY PEG-EPOETIN BETA 100 MCG/0.3ML IJ SOSY ,HCPCS J0887,0636 - DRUGS REQUIRING DETAILED CODIN,59353-0403-09,0.3 mL, $848.24 , $551.36 , $712.52 , $1.68 , N/A , $685.38 , $763.42 , $718.12 , $763.42 , $763.42 , $763.42 , $721.00 , N/A , $783.18 , $805.83 , $721.00 , $788.86 , $788.86 , $805.83 , $814.31 , $694.03 , $763.42 , $721.00 , $670.11 , N/A , $686.48 , $686.48 , $805.83 , $727.87 , $1.68 , $814.31 
"MRI, Cerv Spine Contrast",CPT® 72142,N/A,N/A,N/A," $4,869.00 "," $3,164.85 "," $1,988.49 ", $283.16 , $513.10 ," $1,542.27 "," $2,586.27 "," $4,528.17 "," $4,382.10 "," $4,382.10 "," $3,895.20 "," $3,895.20 ", $513.10 ," $4,495.55 "," $4,625.55 "," $4,382.10 "," $4,382.10 "," $4,382.10 "," $4,528.17 "," $4,674.24 "," $1,703.52 "," $4,138.65 "," $2,819.73 "," $3,015.05 ", N/A ," $1,572.36 "," $1,572.36 "," $4,625.55 "," $1,820.03 ", $283.16 ," $4,674.24 "
 Inj Proc Galactogram ,CPT® 19030,0360 - OR SERVICES,N/A,N/A, $788.00 , $512.20 , $661.92 , $73.11 , $39.09 , $636.70 , $709.20 , $667.12 , $709.20 , $709.20 , $709.20 , $669.80 , $38.32 , $727.56 , $748.60 , $669.80 , $732.84 , $732.84 , $748.60 , $756.48 , $644.74 , $709.20 , $669.80 , $622.52 , N/A , $637.73 , $637.73 , $748.60 , $676.18 , $38.32 , $756.48 
X-Ray Wrist 3+ Vw,CPT® 73110,N/A,N/A,N/A, $330.00 , $214.50 , $230.03 , $40.24 , $30.41 , $166.83 , $201.26 , $306.90 , $297.00 , $297.00 , $264.00 , $264.00 , $30.41 , $304.69 , $313.50 , $297.00 , $297.00 , $297.00 , $306.90 , $316.80 , $221.65 , $280.50 , $221.49 , $176.35 , N/A , $170.09 , $170.09 , $313.50 , $196.87 , $30.41 , $316.80 
Repair Perf Duod/Gast Ulc-Wnd/Inj,CPT® 43840,N/A,N/A,N/A," $8,817.00 "," $5,731.05 "," $8,082.23 "," $1,251.27 ", $768.38 ," $6,377.02 "," $6,428.69 "," $8,199.81 "," $7,935.30 "," $7,935.30 "," $7,053.60 "," $7,053.60 ", $768.38 ," $8,140.74 "," $8,376.15 "," $7,935.30 "," $7,935.30 "," $7,935.30 "," $8,199.81 "," $8,464.32 "," $5,790.43 "," $7,494.45 "," $7,157.67 "," $7,520.97 ", N/A ," $6,501.45 "," $6,501.45 "," $8,376.15 "," $6,799.83 ", $768.38 ," $8,464.32 "
"Program Eval Implant Device,Cardvert/Defib,2 Lead",CPT® 93283,N/A,N/A,N/A," $1,010.00 ", $656.50 , $639.21 , $97.76 , $66.57 , $443.04 , $448.84 , $939.30 , $909.00 , $909.00 , $808.00 , $808.00 , $66.57 , $932.53 , $959.50 , $909.00 , $909.00 , $909.00 , $939.30 , $969.60 , $602.81 , $858.50 , $417.47 , $297.15 , N/A , $451.68 , $451.68 , $959.50 , $500.69 , $66.57 , $969.60 
Percut Fix Prox/Neck Femur Fx,CPT® 27235,N/A,N/A,N/A," $4,908.00 "," $3,190.20 "," $5,495.75 ", $859.35 , $796.77 ," $4,386.19 "," $4,350.98 "," $4,564.44 "," $4,417.20 "," $4,417.20 "," $3,926.40 "," $3,926.40 ", $796.77 ," $4,531.56 "," $4,662.60 "," $4,417.20 "," $4,417.20 "," $4,417.20 "," $4,564.44 "," $4,711.68 "," $5,114.46 "," $4,171.80 "," $4,809.84 "," $5,158.64 ", N/A ," $4,471.77 "," $4,471.77 "," $4,662.60 "," $5,255.92 ", $796.77 ," $5,495.75 "
 Fac Chlamydia Culture ,CPT® 87110,0306 - LAB/BACT-MICRO,N/A,N/A, $180.00 , $117.00 , $151.20 , $19.99 , $19.99 , $145.44 , $162.00 , $152.39 , $162.00 , $162.00 , $162.00 , $153.00 , $19.60 , $166.19 , $171.00 , $153.00 , $167.40 , $167.40 , $171.00 , $172.80 , $147.28 , $162.00 , $153.00 , $142.20 , N/A , $145.67 , $145.67 , $171.00 , $154.46 , $19.60 , $172.80 
 Fac Emblc/Thrmbc Ax Brach Innominate Subcla Art ,CPT® 34101,0360 - OR SERVICES,N/A,N/A," $1,760.00 "," $1,144.00 "," $1,478.40 ", $534.95 , $804.14 ," $1,422.08 "," $1,584.00 "," $1,490.02 "," $1,584.00 "," $1,584.00 "," $1,584.00 "," $1,496.00 ", $788.37 ," $1,625.01 "," $1,672.00 "," $1,496.00 "," $1,636.80 "," $1,636.80 "," $1,672.00 "," $1,689.60 "," $1,440.03 "," $1,584.00 "," $1,496.00 "," $1,390.40 ", N/A ," $1,424.37 "," $1,424.37 "," $1,672.00 "," $1,510.26 ", $534.95 ," $1,689.60 "
 Pro Lyr Clsr S/a/T/E 2.5 Cm/< ,CPT® 12031,0982 - PRO FEE/OUTPT,N/A,N/A, $518.00 , $336.70 , $484.53 , $146.05 , $60.48 , $418.18 , $412.35 , $481.74 , $466.20 , $466.20 , $414.40 , $414.40 , $60.48 , $478.27 , $492.10 , $466.20 , $466.20 , $466.20 , $481.74 , $497.28 , $531.98 , $440.30 , $820.67 , $538.15 , N/A , $426.34 , $426.34 , $492.10 , $494.42 , $60.48 , $820.67 
 Pro Appendectomy ,CPT® 44950,0982 - PRO FEE/OUTPT,N/A,N/A," $5,291.00 "," $3,439.15 "," $3,828.96 ", $593.06 , $549.85 ," $3,014.59 "," $3,043.40 "," $4,920.63 "," $4,761.90 "," $4,761.90 "," $4,232.80 "," $4,232.80 ", $549.85 ," $4,885.18 "," $5,026.45 "," $4,761.90 "," $4,761.90 "," $4,761.90 "," $4,920.63 "," $5,079.36 "," $2,744.68 "," $4,497.35 "," $3,386.15 "," $3,555.69 ", N/A ," $3,073.42 "," $3,073.42 "," $5,026.45 "," $3,214.46 ", $549.85 ," $5,079.36 "
 PSEUDOEPHEDRINE HCL 30 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-5053-59,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Candida, Antibody",CPT® 86628,N/A,N/A,N/A, $134.00 , $87.10 , N/A , $12.25 , $8.07 , $32.88 , $39.34 , $124.62 , $120.60 , $120.60 , $107.20 , $107.20 , $8.07 , $123.72 , $127.30 , $120.60 , $120.60 , $120.60 , $124.62 , $128.64 , $80.19 , $113.90 , $77.85 , $43.53 , N/A , $30.69 , $30.69 , $127.30 , $33.54 , $8.07 , $128.64 
Fluphenazine Decanoate 25 Mg,HCPCS J2680,N/A,N/A,N/A, $119.00 , $77.35 , N/A , $11.17 , $9.79 , N/A , N/A , $110.67 , $107.10 , $107.10 , $95.20 , $95.20 , $9.79 , $109.87 , $113.05 , $107.10 , $107.10 , $107.10 , $110.67 , $114.24 , $15.07 , $101.15 , $29.19 , $13.71 , N/A , N/A , N/A , $113.05 , N/A , $9.79 , $114.24 
 Fac Microsomal Antibody ,CPT® 86376,0300 - LABORATORY,N/A,N/A, $146.00 , $94.90 , $122.64 , $14.84 , $14.84 , $117.97 , $131.40 , $123.60 , $131.40 , $131.40 , $131.40 , $124.10 , $14.55 , $134.80 , $138.70 , $124.10 , $135.78 , $135.78 , $138.70 , $140.16 , $119.46 , $131.40 , $124.10 , $115.34 , N/A , $118.16 , $118.16 , $138.70 , $125.28 , $14.55 , $140.16 
 Fac Egd Esophagus Balloon Dilation 30 Mm or Larger ,CPT® 43233,0360 - OR SERVICES,N/A,N/A," $2,973.00 "," $1,932.45 "," $2,497.32 ", $214.39 , $176.14 ," $2,402.18 "," $2,675.70 "," $2,516.94 "," $2,675.70 "," $2,675.70 "," $2,675.70 "," $2,527.05 ", $172.69 ," $2,744.97 "," $2,824.35 "," $2,527.05 "," $2,764.89 "," $2,764.89 "," $2,824.35 "," $2,854.08 "," $2,432.51 "," $2,675.70 "," $2,527.05 "," $2,348.67 ", N/A ," $2,406.05 "," $2,406.05 "," $2,824.35 "," $2,551.13 ", $172.69 ," $2,854.08 "
Sono Eye Biometry W Lens Calc,CPT® 76519,N/A,N/A,N/A, $565.00 , $367.25 , $378.04 , $66.49 , $72.09 , $404.02 , $453.06 , $525.45 , $508.50 , $508.50 , $452.00 , $452.00 , $72.09 , $521.66 , $536.75 , $508.50 , $508.50 , $508.50 , $525.45 , $542.40 , $372.87 , $480.25 , $496.92 , $419.21 , N/A , $411.90 , $411.90 , $536.75 , $476.79 , $66.49 , $542.40 
 Fac Colsc Flx W/Removal Lesion by Hot Bx Forceps ,CPT® 45384,0360 - OR SERVICES,N/A,N/A," $2,958.00 "," $1,922.70 "," $2,484.72 ", $213.74 , $412.82 ," $2,390.06 "," $2,662.20 "," $2,504.24 "," $2,662.20 "," $2,662.20 "," $2,662.20 "," $2,514.30 ", $404.73 ," $2,731.12 "," $2,810.10 "," $2,514.30 "," $2,750.94 "," $2,750.94 "," $2,810.10 "," $2,839.68 "," $2,420.24 "," $2,662.20 "," $2,514.30 "," $2,336.82 ", N/A ," $2,393.91 "," $2,393.91 "," $2,810.10 "," $2,538.26 ", $213.74 ," $2,839.68 "
"Conization Cervix,Loop Electrd",CPT® 57522,N/A,N/A,N/A," $1,902.00 "," $1,236.30 "," $1,208.55 ", $245.23 , $237.26 , $991.77 , $994.81 ," $1,768.86 "," $1,711.80 "," $1,711.80 "," $1,521.60 "," $1,521.60 ", $237.26 ," $1,756.12 "," $1,806.90 "," $1,711.80 "," $1,711.80 "," $1,711.80 "," $1,768.86 "," $1,825.92 "," $1,254.07 "," $1,616.70 "," $1,305.93 ", $997.33 , N/A ," $1,011.12 "," $1,011.12 "," $1,806.90 "," $1,212.79 ", $237.26 ," $1,825.92 "
 Fac Brain Canal Shunt Procedure ,CPT® 61070,0761 - TREATMENT ROOM,N/A,N/A, $273.00 , $177.45 , $229.32 , $52.97 , $107.83 , $220.58 , $245.70 , $231.12 , $245.70 , $245.70 , $245.70 , $232.05 , $105.72 , $252.06 , $259.35 , $232.05 , $253.89 , $253.89 , $259.35 , $262.08 , $223.37 , $245.70 , $232.05 , $215.67 , N/A , $220.94 , $220.94 , $259.35 , $234.26 , $52.97 , $262.08 
 EPOETIN ALFA-EPBX 2000 UNIT/ML IJ SOLN ,HCPCS Q5105,0636 - DRUGS REQUIRING DETAILED CODIN,00069-1305-10,1 mL, $64.87 , $42.17 , $54.49 , $0.77 , N/A , $52.41 , $58.38 , $54.92 , $58.38 , $58.38 , $58.38 , $55.14 , N/A , $59.89 , $61.63 , $55.14 , $60.33 , $60.33 , $61.63 , $62.28 , $53.08 , $58.38 , $55.14 , $51.25 , N/A , $52.50 , $52.50 , $61.63 , $55.66 , $0.77 , $62.28 
 PEGFILGRASTIM 6 MG/0.6ML SC SOSY ,HCPCS J2506,0636 - DRUGS REQUIRING DETAILED CODIN,55513-0190-01,0.6 mL," $18,870.90 "," $12,266.09 "," $15,851.56 ", $87.42 , $137.87 ," $15,247.69 "," $16,983.81 "," $15,976.10 "," $16,983.81 "," $16,983.81 "," $16,983.81 "," $16,040.27 ", $135.17 ," $17,423.50 "," $17,927.36 "," $16,040.27 "," $17,549.94 "," $17,549.94 "," $17,927.36 "," $18,116.06 "," $15,440.17 "," $16,983.81 "," $16,040.27 "," $14,908.01 ", N/A ," $15,272.22 "," $15,272.22 "," $17,927.36 "," $16,193.12 ", $87.42 ," $18,116.06 "
 Fac Rpsg Previously Placed Cvc Under Fluor Gdn ,CPT® 36597,0761 - TREATMENT ROOM,N/A,N/A," $4,355.00 "," $2,830.75 "," $3,658.20 ", $57.13 , $243.76 ," $3,518.84 "," $3,919.50 "," $3,686.94 "," $3,919.50 "," $3,919.50 "," $3,919.50 "," $3,701.75 ", $238.98 ," $4,020.97 "," $4,137.25 "," $3,701.75 "," $4,050.15 "," $4,050.15 "," $4,137.25 "," $4,180.80 "," $3,563.26 "," $3,919.50 "," $3,701.75 "," $3,440.45 ", N/A ," $3,524.50 "," $3,524.50 "," $4,137.25 "," $3,737.03 ", $57.13 ," $4,180.80 "
" Fac Chg Carboxyhemoglobin, Transcutaneous, per Day ",CPT® 88740,0305 - LAB/HEMATOLOGY,N/A,N/A, $32.00 , $20.80 , $26.88 , $9.56 , $5.61 , $25.86 , $28.80 , $27.09 , $28.80 , $28.80 , $28.80 , $27.20 , $5.50 , $29.55 , $30.40 , $27.20 , $29.76 , $29.76 , $30.40 , $30.72 , $26.18 , $28.80 , $27.20 , $25.28 , N/A , $25.90 , $25.90 , $30.40 , $27.46 , $5.50 , $30.72 
"Preventive Visit,Est,40-64",CPT® 99396,N/A,N/A,N/A, $386.00 , $250.90 , N/A , $121.04 , $21.85 , $207.40 , $209.11 , $358.98 , $347.40 , $347.40 , $308.80 , $308.80 , $21.85 , $356.39 , $366.70 , $347.40 , $347.40 , $347.40 , $358.98 , $370.56 , $256.61 , $328.10 , $209.28 , $206.27 , N/A , $211.45 , $211.45 , $366.70 , $253.97 , $21.85 , $370.56 
Moderna Admin Booster Adult 18+,CPT® 0094A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , N/A , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , N/A , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $76.25 , $128.02 , N/A , $79.82 , $79.82 , $66.50 , $92.91 , $56.00 , $128.02 
 Anes Injec Aa&/Strd Genicular Nrv Branches W/Img ,CPT® 64454,0960 - PRO FEE,N/A,N/A," $1,780.00 "," $1,157.00 ", $408.04 , $79.01 , $168.18 , $449.85 , N/A ," $1,655.40 "," $1,602.00 "," $1,602.00 "," $1,424.00 "," $1,424.00 ", $168.18 ," $1,643.47 "," $1,691.00 "," $1,602.00 "," $1,602.00 "," $1,602.00 "," $1,655.40 "," $1,708.80 ", $436.15 ," $1,513.00 ", $430.02 , $495.19 , N/A , $458.63 , $458.63 ," $1,691.00 ", $491.98 , $79.01 ," $1,708.80 "
"Shldr Arthroscop,Surg,Dis Claviculectomy",CPT® 29824,N/A,N/A,N/A," $2,665.00 "," $1,732.25 "," $4,128.15 ", $647.79 , $403.88 ," $3,230.14 "," $3,267.77 "," $2,478.45 "," $2,398.50 "," $2,398.50 "," $2,132.00 "," $2,132.00 ", $403.88 ," $2,460.59 "," $2,531.75 "," $2,398.50 "," $2,398.50 "," $2,398.50 "," $2,478.45 "," $2,558.40 "," $3,835.87 "," $2,265.25 "," $3,607.38 "," $3,828.39 ", N/A ," $3,293.16 "," $3,293.16 "," $2,531.75 "," $3,870.64 ", $403.88 ," $4,128.15 "
Excis Tarsal Coalition,CPT® 28116,N/A,N/A,N/A," $5,073.00 "," $3,297.45 "," $3,599.51 ", $569.86 , $461.04 ," $2,805.18 "," $2,824.01 "," $4,717.89 "," $4,565.70 "," $4,565.70 "," $4,058.40 "," $4,058.40 ", $461.04 ," $4,683.90 "," $4,819.35 "," $4,565.70 "," $4,565.70 "," $4,565.70 "," $4,717.89 "," $4,870.08 "," $3,323.37 "," $4,312.05 "," $3,061.45 "," $3,391.05 ", N/A ," $2,859.92 "," $2,859.92 "," $4,819.35 "," $3,361.44 ", $461.04 ," $4,870.08 "
 Pro Corrj Hallux Valgus W/Sesmdc W/1metar Medial Cnf ,CPT® 28297,0982 - PRO FEE/OUTPT,N/A,N/A," $6,280.00 "," $4,082.00 "," $3,724.37 ", $582.05 , $693.20 ," $2,853.72 "," $2,850.91 "," $5,840.40 "," $5,652.00 "," $5,652.00 "," $5,024.00 "," $5,024.00 ", $693.20 ," $5,798.32 "," $5,966.00 "," $5,652.00 "," $5,652.00 "," $5,652.00 "," $5,840.40 "," $6,028.80 "," $3,455.82 "," $5,338.00 "," $3,107.84 "," $3,500.08 ", N/A ," $2,909.40 "," $2,909.40 "," $5,966.00 "," $3,419.59 ", $582.05 ," $6,028.80 "
Home/Res Visit New Patient High Mdm 75 Minutes,CPT® 99345,N/A,N/A,N/A, $747.00 , $485.55 , $435.37 , $197.57 , $183.69 , $379.92 , $379.57 , $694.71 , $672.30 , $672.30 , $597.60 , $597.60 , $183.69 , $689.71 , $709.65 , $672.30 , $672.30 , $672.30 , $694.71 , $717.12 , $397.39 , $634.95 , $472.57 , $485.77 , N/A , $387.34 , $387.34 , $709.65 , $446.72 , $183.69 , $717.12 
 LEVOLEUCOVORIN CALCIUM 50 MG IV SOLR ,HCPCS J0641,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9558-01,10 mL," $1,124.36 ", $730.83 , $944.46 , N/A , $0.28 , $908.48 ," $1,011.92 ", $951.88 ," $1,011.92 "," $1,011.92 "," $1,011.92 ", $955.71 , $0.27 ," $1,038.12 "," $1,068.14 ", $955.71 ," $1,045.65 "," $1,045.65 "," $1,068.14 "," $1,079.39 ", $919.95 ," $1,011.92 ", $955.71 , $888.24 , N/A , $909.94 , $909.94 ," $1,068.14 ", $964.81 , $0.27 ," $1,079.39 "
 Fac Assay of Total Estradiol ,CPT® 82670,0302 - LAB/IMMUNOLOGY,N/A,N/A, $258.00 , $167.70 , $216.72 , $28.50 , $28.50 , $208.46 , $232.20 , $218.42 , $232.20 , $232.20 , $232.20 , $219.30 , $27.94 , $238.21 , $245.10 , $219.30 , $239.94 , $239.94 , $245.10 , $247.68 , $211.10 , $232.20 , $219.30 , $203.82 , N/A , $208.80 , $208.80 , $245.10 , $221.39 , $27.94 , $247.68 
" Fac Tissue Culture, Skin/Biopsy ",CPT® 88233,0310 - PATHOLOGY LAB,N/A,N/A, $909.00 , $590.85 , $763.56 , $143.54 , $69.14 , $734.47 , $818.10 , $769.56 , $818.10 , $818.10 , $818.10 , $772.65 , $67.78 , $839.28 , $863.55 , $772.65 , $845.37 , $845.37 , $863.55 , $872.64 , $743.74 , $818.10 , $772.65 , $718.11 , N/A , $735.65 , $735.65 , $863.55 , $780.01 , $67.78 , $872.64 
 Fac Rubeola Antibody ,CPT® 86765,0300 - LABORATORY,N/A,N/A, $134.00 , $87.10 , $112.56 , $13.14 , $13.14 , $108.27 , $120.60 , $113.44 , $120.60 , $120.60 , $120.60 , $113.90 , $12.88 , $123.72 , $127.30 , $113.90 , $124.62 , $124.62 , $127.30 , $128.64 , $109.64 , $120.60 , $113.90 , $105.86 , N/A , $108.45 , $108.45 , $127.30 , $114.99 , $12.88 , $128.64 
" Culture, Anaerobic Includes Aerobic. Beaker3 ",CPT® 87075,0306 - LAB/BACT-MICRO,N/A,N/A, $150.00 , $97.50 , $126.00 , $9.66 , $9.66 , $121.20 , $135.00 , $126.99 , $135.00 , $135.00 , $135.00 , $127.50 , $9.47 , $138.50 , $142.50 , $127.50 , $139.50 , $139.50 , $142.50 , $144.00 , $122.73 , $135.00 , $127.50 , $118.50 , N/A , $121.40 , $121.40 , $142.50 , $128.72 , $9.47 , $144.00 
 Fac Motor &/Sens 13/> Nrv Cndj Preconf Eltrode Limb ,CPT® 95913,0922 - EMG,N/A,N/A," $3,228.00 "," $2,098.20 "," $2,711.52 ", $282.07 , $237.04 ," $2,608.22 "," $2,905.20 "," $2,732.82 "," $2,905.20 "," $2,905.20 "," $2,905.20 "," $2,743.80 ", $232.39 ," $2,980.41 "," $3,066.60 "," $2,743.80 "," $3,002.04 "," $3,002.04 "," $3,066.60 "," $3,098.88 "," $2,641.15 "," $2,905.20 "," $2,743.80 "," $2,550.12 ", N/A ," $2,612.42 "," $2,612.42 "," $3,066.60 "," $2,769.95 ", $232.39 ," $3,098.88 "
 Repair of Nailbed - Mh ,CPT® 11760,0761 - TREATMENT ROOM,N/A,N/A, $798.00 , $518.70 , $670.32 , $106.67 , $42.71 , $644.78 , $718.20 , $675.59 , $718.20 , $718.20 , $718.20 , $678.30 , $41.87 , $736.79 , $758.10 , $678.30 , $742.14 , $742.14 , $758.10 , $766.08 , $652.92 , $718.20 , $678.30 , $630.42 , N/A , $645.82 , $645.82 , $758.10 , $684.76 , $41.87 , $766.08 
Closed Rx Acetabular Fx,CPT® 27220,N/A,N/A,N/A," $3,483.00 "," $2,263.95 "," $2,520.96 ", $395.57 , $384.19 ," $2,532.85 "," $2,530.47 "," $3,239.19 "," $3,134.70 "," $3,134.70 "," $2,786.40 "," $2,786.40 ", $384.19 ," $3,215.85 "," $3,308.85 "," $3,134.70 "," $3,134.70 "," $3,134.70 "," $3,239.19 "," $3,343.68 "," $2,336.08 "," $2,960.55 "," $2,792.06 "," $2,989.34 ", N/A ," $2,582.28 "," $2,582.28 "," $3,308.85 "," $3,035.08 ", $384.19 ," $3,343.68 "
" Pro Inj Dx/Ther Agnt Paravert Facet Joint, Cerv/Thorac, 2nd Level ",CPT® 64491,0982 - PRO FEE/OUTPT,N/A,N/A, $622.00 , $404.30 , $294.27 , $56.83 , $69.04 , $339.59 , $330.47 , $578.46 , $559.80 , $559.80 , $497.60 , $497.60 , $69.04 , $574.29 , $590.90 , $559.80 , $559.80 , $559.80 , $578.46 , $597.12 , $320.57 , $528.70 , $322.92 , $364.80 , N/A , $346.22 , $346.22 , $590.90 , $371.43 , $56.83 , $597.12 
Valvuloplasty Aortic Valve Open Card Byp Complex,CPT® 33391,N/A,N/A,N/A," $18,712.00 "," $12,162.80 "," $13,365.69 "," $2,058.34 "," $1,763.78 "," $9,326.05 "," $9,207.41 "," $17,402.16 "," $16,840.80 "," $16,840.80 "," $14,969.60 "," $14,969.60 "," $1,763.78 "," $17,276.79 "," $17,776.40 "," $16,840.80 "," $16,840.80 "," $16,840.80 "," $17,402.16 "," $17,963.52 "," $12,372.57 "," $15,905.20 "," $11,887.75 "," $10,892.81 ", N/A ," $9,508.01 "," $9,508.01 "," $17,776.40 "," $10,801.48 "," $1,763.78 "," $17,963.52 "
"Cystoscopy,Remv Calculus,Complic",CPT® 52315,N/A,N/A,N/A," $2,931.00 "," $1,905.15 "," $1,470.51 ", $258.60 , $378.01 ," $1,347.71 "," $1,247.48 "," $2,725.83 "," $2,637.90 "," $2,637.90 "," $2,344.80 "," $2,344.80 ", $378.01 ," $2,706.19 "," $2,784.45 "," $2,637.90 "," $2,637.90 "," $2,637.90 "," $2,725.83 "," $2,813.76 "," $1,480.04 "," $2,491.35 "," $1,411.19 "," $1,688.89 ", N/A ," $1,374.01 "," $1,374.01 "," $2,784.45 "," $1,614.93 ", $258.60 ," $2,813.76 "
 FLUVOXAMINE MALEATE 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,62559-0159-01,1 tablet, $13.21 , $8.59 , $11.10 , N/A , N/A , $10.67 , $11.89 , $11.18 , $11.89 , $11.89 , $11.89 , $11.23 , N/A , $12.20 , $12.55 , $11.23 , $12.29 , $12.29 , $12.55 , $12.68 , $10.81 , $11.89 , $11.23 , $10.44 , N/A , $10.69 , $10.69 , $12.55 , $11.34 , $10.44 , $12.68 
Psychotherapy W/Patient W/E&M Srvcs 60 Min,CPT® 90838,N/A,N/A,N/A, $445.00 , $289.25 , $138.86 , $103.04 , $133.44 , $243.62 , $247.42 , $413.85 , $400.50 , $400.50 , $356.00 , $356.00 , $133.44 , $410.87 , $422.75 , $400.50 , $400.50 , $400.50 , $413.85 , $427.20 , $264.86 , $378.25 , $322.36 , $416.09 , $136.25 , $248.37 , $248.37 , $422.75 , $289.55 , $103.04 , $427.20 
 Pro Obstetrical Care ,CPT® 59409,0981 - PRO FEE/ER,N/A,N/A," $3,354.00 "," $2,180.10 "," $1,869.48 ", $727.40 , $630.92 ," $1,894.25 "," $1,982.73 "," $3,119.22 "," $3,018.60 "," $3,018.60 "," $2,683.20 "," $2,683.20 ", $630.92 ," $3,096.75 "," $3,186.30 "," $3,018.60 "," $3,018.60 "," $3,018.60 "," $3,119.22 "," $3,219.84 "," $2,198.89 "," $2,850.90 "," $4,385.23 "," $1,884.92 ", N/A ," $1,931.21 "," $1,931.21 "," $3,186.30 "," $2,232.66 ", $630.92 ," $4,385.23 "
" Fac Sugars, Single, Qual ",CPT® 84376,0301 - LAB/CHEMISTRY,N/A,N/A, $51.00 , $33.15 , $42.84 , $5.61 , $5.61 , $41.21 , $45.90 , $43.18 , $45.90 , $45.90 , $45.90 , $43.35 , $5.50 , $47.09 , $48.45 , $43.35 , $47.43 , $47.43 , $48.45 , $48.96 , $41.73 , $45.90 , $43.35 , $40.29 , N/A , $41.27 , $41.27 , $48.45 , $43.76 , $5.50 , $48.96 
Surgical Arthroscopy Shoulder Xtnsv Dbrdmt 3+,CPT® 29823,N/A,N/A,N/A," $4,156.00 "," $2,701.40 "," $3,613.81 ", $567.06 , $543.90 ," $2,996.51 "," $3,026.03 "," $3,865.08 "," $3,740.40 "," $3,740.40 "," $3,324.80 "," $3,324.80 ", $543.90 ," $3,837.23 "," $3,948.20 "," $3,740.40 "," $3,740.40 "," $3,740.40 "," $3,865.08 "," $3,989.76 "," $3,363.02 "," $3,532.60 "," $3,339.77 "," $3,549.12 ", N/A ," $3,054.98 "," $3,054.98 "," $3,948.20 "," $3,590.68 ", $543.90 ," $3,989.76 "
 Fac Jak2 Gene Analysis P.Val617phe Variant ,CPT® 81270,0310 - PATHOLOGY LAB,N/A,N/A, $835.00 , $542.75 , $701.40 , $93.49 , $93.49 , $674.68 , $751.50 , $706.91 , $751.50 , $751.50 , $751.50 , $709.75 , $91.66 , $770.96 , $793.25 , $709.75 , $776.55 , $776.55 , $793.25 , $801.60 , $683.20 , $751.50 , $709.75 , $659.65 , N/A , $675.77 , $675.77 , $793.25 , $716.51 , $91.66 , $801.60 
 Pro Treatment of Ankle Fracture ,CPT® 28430,0982 - PRO FEE/OUTPT,N/A,N/A," $1,568.00 "," $1,019.20 "," $1,313.07 ", $207.28 , $230.52 ," $1,022.71 "," $1,034.45 "," $1,458.24 "," $1,411.20 "," $1,411.20 "," $1,254.40 "," $1,254.40 ", $230.52 ," $1,447.73 "," $1,489.60 "," $1,411.20 "," $1,411.20 "," $1,411.20 "," $1,458.24 "," $1,505.28 "," $1,212.90 "," $1,332.80 "," $1,131.10 "," $1,208.16 ", N/A ," $1,042.66 "," $1,042.66 "," $1,489.60 "," $1,225.50 ", $207.28 ," $1,505.28 "
 Pro Biopsy of Foot Joint Lining ,CPT® 28052,0982 - PRO FEE/OUTPT,N/A,N/A," $2,924.00 "," $1,900.60 "," $1,592.11 ", $249.33 , $276.59 ," $1,378.44 "," $1,386.82 "," $2,719.32 "," $2,631.60 "," $2,631.60 "," $2,339.20 "," $2,339.20 ", $276.59 ," $2,699.73 "," $2,777.80 "," $2,631.60 "," $2,631.60 "," $2,631.60 "," $2,719.32 "," $2,807.04 "," $1,628.99 "," $2,485.40 "," $1,507.53 "," $1,675.77 ", N/A ," $1,405.34 "," $1,405.34 "," $2,777.80 "," $1,651.78 ", $249.33 ," $2,807.04 "
"Hiv-1/Hiv-2, Single Assay",CPT® 86703,N/A,N/A,N/A, $123.00 , $79.95 , N/A , $13.98 , $13.98 , $77.58 , $92.80 , $114.39 , $110.70 , $110.70 , $98.40 , $98.40 , $13.98 , $113.57 , $116.85 , $110.70 , $110.70 , $110.70 , $114.39 , $118.08 , $91.54 , $104.55 , $89.20 , $49.69 , N/A , $72.40 , $72.40 , $116.85 , $79.12 , $13.98 , $118.08 
 Fac Perq Replacement Gtube Not Req Revj Gstrst Trc ,CPT® 43762,0360 - OR SERVICES,N/A,N/A, $344.00 , $223.60 , $288.96 , $34.45 , $176.61 , $277.95 , $309.60 , $291.23 , $309.60 , $309.60 , $309.60 , $292.40 , $173.15 , $317.62 , $326.80 , $292.40 , $319.92 , $319.92 , $326.80 , $330.24 , $281.46 , $309.60 , $292.40 , $271.76 , N/A , $278.40 , $278.40 , $326.80 , $295.19 , $34.45 , $330.24 
Removal Heart Lesion Intern,CPT® 33120,N/A,N/A,N/A," $22,219.00 "," $14,442.35 "," $12,192.64 "," $1,880.63 "," $2,070.95 "," $8,958.81 "," $8,862.32 "," $20,663.67 "," $19,997.10 "," $19,997.10 "," $17,775.20 "," $17,775.20 "," $2,070.95 "," $20,514.80 "," $21,108.05 "," $19,997.10 "," $19,997.10 "," $19,997.10 "," $20,663.67 "," $21,330.24 "," $11,305.99 "," $18,886.15 "," $11,227.12 "," $10,035.57 ", N/A ," $9,133.61 "," $9,133.61 "," $21,108.05 "," $10,375.79 "," $1,880.63 "," $21,330.24 "
Drug Screening Buprenorphine,CPT® 80348,N/A,N/A,N/A, $357.00 , $232.05 , N/A , N/A , N/A , N/A , N/A , $332.01 , $321.30 , $321.30 , $285.60 , $285.60 , N/A , $329.62 , $339.15 , $321.30 , $321.30 , $321.30 , $332.01 , $342.72 , N/A , $303.45 , $285.60 , N/A , N/A , N/A , N/A , $339.15 , N/A , $285.60 , $342.72 
Dynamic Cavernosometry,CPT® 54231,N/A,N/A,N/A, $773.00 , $502.45 , $508.82 , $109.67 , N/A , $374.42 , $377.29 , $718.89 , $695.70 , $695.70 , $618.40 , $618.40 , N/A , $713.71 , $734.35 , $695.70 , $695.70 , $695.70 , $718.89 , $742.08 , $478.34 , $657.05 , $601.23 , $564.31 , N/A , $381.72 , $381.72 , $734.35 , $457.52 , $109.67 , $742.08 
 NEOSTIGMINE METHYLSULFATE 5 MG/5ML IV SOSY ,HCPCS J2710,0636 - DRUGS REQUIRING DETAILED CODIN,70092-1084-44,0.5 mL, $16.68 , $10.84 , $14.01 , N/A , $0.09 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.09 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.09 , $16.01 
 Pro Abdom Paracentesis Dx/Ther W Imaging Guidance ,CPT® 49083,0982 - PRO FEE/OUTPT,N/A,N/A," $2,090.00 "," $1,358.50 ", $655.33 , $101.73 , $362.06 , $531.21 , $543.60 ," $1,943.70 "," $1,881.00 "," $1,881.00 "," $1,672.00 "," $1,672.00 ", $362.06 ," $1,929.70 "," $1,985.50 "," $1,881.00 "," $1,881.00 "," $1,881.00 "," $1,943.70 "," $2,006.40 ", $471.73 ," $1,776.50 ", $586.96 , $631.12 , N/A , $541.58 , $541.58 ," $1,985.50 ", $566.43 , $101.73 ," $2,006.40 "
 Pro Tmpst Anes ,CPT® 69436,0982 - PRO FEE/OUTPT,N/A,N/A, $650.00 , $422.50 , $758.20 , $155.15 , $218.54 , $769.66 , $796.94 , $604.50 , $585.00 , $585.00 , $520.00 , $520.00 , $218.54 , $600.15 , $617.50 , $585.00 , $585.00 , $585.00 , $604.50 , $624.00 , $818.29 , $552.50 , $868.84 , $772.85 , N/A , $784.68 , $784.68 , $617.50 , $895.96 , $155.15 , $895.96 
Drug Assay Adalimumab,CPT® 80145,N/A,N/A,N/A, $304.00 , $197.60 , N/A , $39.34 , $31.47 , $164.07 , N/A , $282.72 , $273.60 , $273.60 , $243.20 , $243.20 , $31.47 , $280.68 , $288.80 , $273.60 , $273.60 , $273.60 , $282.72 , $291.84 , $257.54 , $258.40 , $184.15 , $113.28 , N/A , $153.12 , $153.12 , $288.80 , $167.01 , $31.47 , $291.84 
Exchange Nephrostomy Catheter Prq W/Img Gid Rs&I,CPT® 50435,N/A,N/A,N/A," $3,619.00 "," $2,352.35 ", $539.58 , $94.85 , $374.42 , $502.92 , $466.00 ," $3,365.67 "," $3,257.10 "," $3,257.10 "," $2,895.20 "," $2,895.20 ", $374.42 ," $3,341.42 "," $3,438.05 "," $3,257.10 "," $3,257.10 "," $3,257.10 "," $3,365.67 "," $3,474.24 ", $540.62 ," $3,076.15 ", $518.87 , $623.02 , N/A , $512.74 , $512.74 ," $3,438.05 ", $602.65 , $94.85 ," $3,474.24 "
 Fac Assay of Urine/Urea-N ,CPT® 84540,0301 - LAB/CHEMISTRY,N/A,N/A, $63.00 , $40.95 , $52.92 , $5.67 , $5.67 , $50.90 , $56.70 , $53.34 , $56.70 , $56.70 , $56.70 , $53.55 , $5.56 , $58.17 , $59.85 , $53.55 , $58.59 , $58.59 , $59.85 , $60.48 , $51.55 , $56.70 , $53.55 , $49.77 , N/A , $50.99 , $50.99 , $59.85 , $54.06 , $5.56 , $60.48 
 CHLOROPROCAINE HCL (PF) 2 % IJ SOLN ,HCPCS J2401,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9209-10,20 mL, $131.41 , $85.42 , $110.38 , $0.04 , $0.04 , $106.18 , $118.27 , $111.25 , $118.27 , $118.27 , $118.27 , $111.70 , $0.04 , $121.33 , $124.84 , $111.70 , $122.21 , $122.21 , $124.84 , $126.15 , $107.52 , $118.27 , $111.70 , $103.81 , N/A , $106.35 , $106.35 , $124.84 , $112.76 , $0.04 , $126.15 
 Pro Hospital IP/Obs Care Same Date Mod Mdm 70 Min ,CPT® 99235,0987 - PRO FEE/HOS VIS,N/A,N/A, $531.00 , $345.15 , $329.62 , $155.20 , $193.93 , $292.56 , $291.18 , $493.83 , $477.90 , $477.90 , $424.80 , $424.80 , $193.93 , $490.27 , $504.45 , $477.90 , $477.90 , $477.90 , $493.83 , $509.76 , $495.29 , $451.35 , $362.30 , $370.50 , N/A , $298.27 , $298.27 , $504.45 , $344.01 , $155.20 , $509.76 
 Fac Assay of Urine/Uric Acid ,CPT® 84560,0301 - LAB/CHEMISTRY,N/A,N/A, $68.00 , $44.20 , $57.12 , $5.18 , $5.18 , $54.94 , $61.20 , $57.57 , $61.20 , $61.20 , $61.20 , $57.80 , $5.08 , $62.78 , $64.60 , $57.80 , $63.24 , $63.24 , $64.60 , $65.28 , $55.64 , $61.20 , $57.80 , $53.72 , N/A , $55.03 , $55.03 , $64.60 , $58.35 , $5.08 , $65.28 
Office/Outpatient New Low Mdm 30-44 Minutes,CPT® 99203,N/A,N/A,N/A, $291.00 , $189.15 , $165.80 , $79.48 , $75.25 , $131.82 , $131.48 , $270.63 , $261.90 , $261.90 , $232.80 , $232.80 , $75.25 , $268.68 , $276.45 , $261.90 , $261.90 , $261.90 , $270.63 , $279.36 , $150.96 , $247.35 , $165.77 , $165.41 , $52.50 , $134.39 , $134.39 , $276.45 , $155.01 , $52.50 , $279.36 
Non-Electronic Spirometer,HCPCS A9284,N/A,N/A,N/A, $22.00 , $14.30 , N/A , N/A , $10.43 , N/A , N/A , $20.46 , $19.80 , $19.80 , $17.60 , $17.60 , $10.43 , $20.31 , $20.90 , $19.80 , $19.80 , $19.80 , $20.46 , $21.12 , N/A , $18.70 , $17.60 , N/A , N/A , N/A , N/A , $20.90 , N/A , $10.43 , $21.12 
 SPIRONOLACTONE 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6927-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Destruc Cut/Vasc <10sq Cm,CPT® 17106,N/A,N/A,N/A," $1,517.00 ", $986.05 , $884.78 , $266.73 , $269.96 , $755.80 , $729.86 ," $1,410.81 "," $1,365.30 "," $1,365.30 "," $1,213.60 "," $1,213.60 ", $269.96 ," $1,400.65 "," $1,441.15 "," $1,365.30 "," $1,365.30 "," $1,365.30 "," $1,410.81 "," $1,456.32 ", $966.92 ," $1,289.45 "," $1,450.44 ", $973.06 , N/A , $770.55 , $770.55 ," $1,441.15 ", $893.59 , $266.73 ," $1,456.32 "
"Treat Ectopic Preg,Rmv Tube/Ovary",CPT® 59120,N/A,N/A,N/A," $3,999.00 "," $2,599.35 "," $2,210.91 ", $747.24 , $684.55 ," $1,837.78 "," $1,937.67 "," $3,719.07 "," $3,599.10 "," $3,599.10 "," $3,199.20 "," $3,199.20 ", $684.55 ," $3,692.28 "," $3,799.05 "," $3,599.10 "," $3,599.10 "," $3,599.10 "," $3,719.07 "," $3,839.04 "," $2,231.83 "," $3,399.15 "," $4,278.19 "," $3,415.57 ", N/A ," $1,873.63 "," $1,873.63 "," $3,799.05 "," $2,166.10 ", $684.55 ," $4,278.19 "
 CT Scanogram for Leg Length ,CPT® 77073,0320 - DX X-RAY,N/A,N/A, $490.00 , $318.50 , $411.60 , $44.12 , $34.41 , $395.92 , $441.00 , $414.83 , $441.00 , $441.00 , $441.00 , $416.50 , $33.74 , $452.42 , $465.50 , $416.50 , $455.70 , $455.70 , $465.50 , $470.40 , $400.92 , $441.00 , $416.50 , $387.10 , N/A , $396.56 , $396.56 , $465.50 , $420.47 , $33.74 , $470.40 
Anastomose Ureter/Renal Pelvis,CPT® 50740,N/A,N/A,N/A," $8,197.00 "," $5,328.05 "," $6,439.77 "," $1,126.05 "," $1,229.45 "," $5,843.57 "," $5,496.65 "," $7,623.21 "," $7,377.30 "," $7,377.30 "," $6,557.60 "," $6,557.60 "," $1,229.45 "," $7,568.29 "," $7,787.15 "," $7,377.30 "," $7,377.30 "," $7,377.30 "," $7,623.21 "," $7,869.12 "," $6,426.08 "," $6,967.45 "," $6,442.26 "," $7,167.57 ", N/A ," $5,957.59 "," $5,957.59 "," $7,787.15 "," $7,002.29 "," $1,126.05 "," $7,869.12 "
Ewho Rigid W/O Jnts Cf,HCPCS L3763,N/A,N/A,N/A, $859.00 , $558.35 , N/A , $796.66 , $163.06 , N/A , N/A , $798.87 , $773.10 , $773.10 , $687.20 , $687.20 , $163.06 , $793.11 , $816.05 , $773.10 , $773.10 , $773.10 , $798.87 , $824.64 , N/A , $730.15 , $646.80 , $670.26 , N/A , N/A , N/A , $816.05 , N/A , $163.06 , $824.64 
Revsc Opn/Prg Fem/Pop W/Angioplasty Uni,CPT® 37224,N/A,N/A,N/A," $13,465.00 "," $8,752.25 "," $2,579.07 ", $396.94 , $337.90 ," $1,981.88 "," $1,955.08 "," $12,522.45 "," $12,118.50 "," $12,118.50 "," $10,772.00 "," $10,772.00 ", $337.90 ," $12,432.23 "," $12,791.75 "," $12,118.50 "," $12,118.50 "," $12,118.50 "," $12,522.45 "," $12,926.40 "," $2,192.10 "," $11,445.25 "," $2,454.87 "," $2,154.85 ", N/A ," $2,020.55 "," $2,020.55 "," $12,791.75 "," $2,295.37 ", $337.90 ," $12,926.40 "
"Excision of Nail,Permanen",CPT® 11750,N/A,N/A,N/A, $813.00 , $528.45 , $330.85 , $98.28 , $111.46 , $478.76 , $468.04 , $756.09 , $731.70 , $731.70 , $650.40 , $650.40 , $111.46 , $750.64 , $772.35 , $731.70 , $731.70 , $731.70 , $756.09 , $780.48 , $362.83 , $691.05 , $918.79 , $362.76 , N/A , $488.10 , $488.10 , $772.35 , $566.03 , $98.28 , $918.79 
 BEVACIZUMAB 400 MG/16ML IV SOLN ,HCPCS J9035,0636 - DRUGS REQUIRING DETAILED CODIN,50242-0061-01,16 mL," $9,373.01 "," $6,092.46 "," $7,873.33 ", $75.05 , $72.78 ," $7,573.39 "," $8,435.71 "," $7,935.19 "," $8,435.71 "," $8,435.71 "," $8,435.71 "," $7,967.06 ", $71.35 ," $8,654.10 "," $8,904.36 "," $7,967.06 "," $8,716.90 "," $8,716.90 "," $8,904.36 "," $8,998.09 "," $7,669.00 "," $8,435.71 "," $7,967.06 "," $7,404.68 ", N/A ," $7,585.58 "," $7,585.58 "," $8,904.36 "," $8,042.98 ", $71.35 ," $8,998.09 "
 ER MD Repair Suprficl Wnd - Lh ,CPT® 12020,0981 - PRO FEE/ER,N/A,N/A," $1,121.00 ", $728.65 , $598.88 , $179.70 , $32.39 , $514.39 , $504.42 ," $1,042.53 "," $1,008.90 "," $1,008.90 ", $896.80 , $896.80 , $32.39 ," $1,035.02 "," $1,064.95 "," $1,008.90 "," $1,008.90 "," $1,008.90 "," $1,042.53 "," $1,076.16 ", $660.06 , $952.85 ," $1,004.43 ", $658.84 , N/A , $524.43 , $524.43 ," $1,064.95 ", $608.16 , $32.39 ," $1,076.16 "
Egd Ablate Tumor Polyp/Lesion W/Dilation& Wire,43270,N/A,N/A,N/A," $4,359.00 "," $2,833.35 "," $1,377.74 ", $212.56 , $184.45 ," $1,168.51 "," $1,211.94 "," $4,053.87 "," $3,923.10 "," $3,923.10 "," $3,487.20 "," $3,487.20 ", $184.45 ," $4,024.66 "," $4,141.05 "," $3,923.10 "," $3,923.10 "," $3,923.10 "," $4,053.87 "," $4,184.64 ", $989.63 ," $3,705.15 "," $1,167.45 "," $1,311.97 ", N/A ," $1,191.31 "," $1,191.31 "," $4,141.05 "," $1,245.98 ", $184.45 ," $4,184.64 "
 Fac Vascular Biopsy ,CPT® 75970,0320 - DX X-RAY,N/A,N/A," $2,680.00 "," $1,742.00 "," $2,251.20 ", $511.34 , $490.27 ," $2,165.44 "," $2,412.00 "," $2,268.89 "," $2,412.00 "," $2,412.00 "," $2,412.00 "," $2,278.00 ", $480.66 ," $2,474.44 "," $2,546.00 "," $2,278.00 "," $2,492.40 "," $2,492.40 "," $2,546.00 "," $2,572.80 "," $2,192.78 "," $2,412.00 "," $2,278.00 "," $2,117.20 ", N/A ," $2,168.92 "," $2,168.92 "," $2,546.00 "," $2,299.71 ", $480.66 ," $2,572.80 "
 C Spine CT With Contrast ,CPT® 72126,0350 - CT SCAN,N/A,N/A," $3,327.00 "," $2,162.55 "," $2,794.68 ", $172.41 , $303.06 ," $2,688.22 "," $2,994.30 "," $2,816.64 "," $2,994.30 "," $2,994.30 "," $2,994.30 "," $2,827.95 ", $297.12 ," $3,071.82 "," $3,160.65 "," $2,827.95 "," $3,094.11 "," $3,094.11 "," $3,160.65 "," $3,193.92 "," $2,722.15 "," $2,994.30 "," $2,827.95 "," $2,628.33 ", N/A ," $2,692.54 "," $2,692.54 "," $3,160.65 "," $2,854.90 ", $172.41 ," $3,193.92 "
 CARBAMAZEPINE 100 MG PO CHEW ,HCPCS RXC637,0250 - PHARMACY,00904-3854-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fracture Phalanges Closed /W Manip Each - Mh ,CPT® 26725,0761 - TREATMENT ROOM,N/A,N/A, $732.00 , $475.80 , $614.88 , $298.96 , $132.15 , $591.46 , $658.80 , $619.71 , $658.80 , $658.80 , $658.80 , $622.20 , $129.56 , $675.86 , $695.40 , $622.20 , $680.76 , $680.76 , $695.40 , $702.72 , $598.92 , $658.80 , $622.20 , $578.28 , N/A , $592.41 , $592.41 , $695.40 , $628.13 , $129.56 , $702.72 
 Pro Removal of Elbow Bursa ,CPT® 24105,0982 - PRO FEE/OUTPT,N/A,N/A," $1,330.00 ", $864.50 ," $2,218.19 ", $350.16 , $307.34 ," $1,687.87 "," $1,703.38 "," $1,236.90 "," $1,197.00 "," $1,197.00 "," $1,064.00 "," $1,064.00 ", $307.34 ," $1,227.99 "," $1,263.50 "," $1,197.00 "," $1,197.00 "," $1,197.00 "," $1,236.90 "," $1,276.80 "," $2,049.06 "," $1,130.50 "," $1,871.48 "," $2,003.84 ", N/A ," $1,720.80 "," $1,720.80 "," $1,263.50 "," $2,022.56 ", $307.34 ," $2,218.19 "
 Fac Lidocaine ,CPT® 80176,0301 - LAB/CHEMISTRY,N/A,N/A, $317.00 , $206.05 , $266.28 , $14.98 , $14.98 , $256.14 , $285.30 , $268.37 , $285.30 , $285.30 , $285.30 , $269.45 , $14.69 , $292.69 , $301.15 , $269.45 , $294.81 , $294.81 , $301.15 , $304.32 , $259.37 , $285.30 , $269.45 , $250.43 , N/A , $256.55 , $256.55 , $301.15 , $272.02 , $14.69 , $304.32 
 D5W FLUSH ,HCPCS J7060,0636 - DRUGS REQUIRING DETAILED CODIN,00990-7923-13,50 mL, $35.92 , $23.35 , $30.17 , $1.85 , $1.79 , $29.02 , $32.33 , $30.41 , $32.33 , $32.33 , $32.33 , $30.53 , $1.75 , $33.16 , $34.12 , $30.53 , $33.41 , $33.41 , $34.12 , $34.48 , $29.39 , $32.33 , $30.53 , $28.38 , N/A , $29.07 , $29.07 , $34.12 , $30.82 , $1.75 , $34.48 
Trlml Balo Angiop Open/Perq W/Img S&I 1st Vein,CPT® 37248,N/A,N/A,N/A," $9,614.00 "," $6,249.10 "," $1,786.20 ", $275.06 ," $1,752.00 "," $1,268.99 "," $1,252.37 "," $8,941.02 "," $8,652.60 "," $8,652.60 "," $7,691.20 "," $7,691.20 "," $1,752.00 "," $8,876.61 "," $9,133.30 "," $8,652.60 "," $8,652.60 "," $8,652.60 "," $8,941.02 "," $9,229.44 "," $1,654.51 "," $8,171.90 "," $1,533.50 "," $1,481.62 ", N/A ," $1,293.75 "," $1,293.75 "," $9,133.30 "," $1,469.69 ", $275.06 ," $9,229.44 "
 Pro Echo Exam of Head ,CPT® 76506,0972 - PRO FEE/RAD/DX,N/A,N/A, $355.00 , $230.75 , $655.63 , $111.97 , $91.36 , $566.82 , $663.24 , $330.15 , $319.50 , $319.50 , $284.00 , $284.00 , $91.36 , $327.77 , $337.25 , $319.50 , $319.50 , $319.50 , $330.15 , $340.80 , $647.47 , $301.75 , $726.12 , $658.03 , N/A , $577.88 , $577.88 , $337.25 , $668.91 , $91.36 , $726.12 
 CARVEDILOL 6.25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6301-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Pro Exc Face-Mm Malig+Marg 0.5 < ,CPT® 11640,0982 - PRO FEE/OUTPT,N/A,N/A, $994.00 , $646.10 , $405.52 , $121.95 , $200.70 , $341.73 , $336.34 , $924.42 , $894.60 , $894.60 , $795.20 , $795.20 , $200.70 , $917.76 , $944.30 , $894.60 , $894.60 , $894.60 , $924.42 , $954.24 , $443.61 , $844.90 , $669.02 , $439.11 , N/A , $348.39 , $348.39 , $944.30 , $404.04 , $121.95 , $954.24 
Remvl Colon & Term Ileum W/Ileocolostomy,CPT® 44160,N/A,N/A,N/A," $8,589.00 "," $5,582.85 "," $7,400.38 "," $1,146.42 "," $1,065.41 "," $5,845.84 "," $5,897.62 "," $7,987.77 "," $7,730.10 "," $7,730.10 "," $6,871.20 "," $6,871.20 "," $1,065.41 "," $7,930.22 "," $8,159.55 "," $7,730.10 "," $7,730.10 "," $7,730.10 "," $7,987.77 "," $8,245.44 "," $5,301.73 "," $7,300.65 "," $6,554.65 "," $6,902.36 ", N/A ," $5,959.91 "," $5,959.91 "," $8,159.55 "," $6,233.42 "," $1,065.41 "," $8,245.44 "
 AMANTADINE HCL 100 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00832-1015-00,1 capsule, $10.38 , $6.75 , $8.72 , N/A , N/A , $8.39 , $9.34 , $8.79 , $9.34 , $9.34 , $9.34 , $8.82 , N/A , $9.58 , $9.86 , $8.82 , $9.65 , $9.65 , $9.86 , $9.96 , $8.49 , $9.34 , $8.82 , $8.20 , N/A , $8.40 , $8.40 , $9.86 , $8.91 , $8.20 , $9.96 
 Fac Evasc Rpr Dplmnt Aorto-Bi-Iliac Ndgft Rpt ,CPT® 34706,0360 - OR SERVICES,N/A,N/A," $3,108.00 "," $2,020.20 "," $2,610.72 "," $2,019.62 "," $1,742.16 "," $2,511.26 "," $2,797.20 "," $2,631.23 "," $2,797.20 "," $2,797.20 "," $2,797.20 "," $2,641.80 "," $1,708.00 "," $2,869.62 "," $2,952.60 "," $2,641.80 "," $2,890.44 "," $2,890.44 "," $2,952.60 "," $2,983.68 "," $2,542.97 "," $2,797.20 "," $2,641.80 "," $2,455.32 ", N/A ," $2,515.30 "," $2,515.30 "," $2,952.60 "," $2,666.97 "," $1,708.00 "," $2,983.68 "
"CT Angio,Neck Combo,Incl Image Process",CPT® 70498,N/A,N/A,N/A," $4,866.00 "," $3,162.90 "," $1,769.74 ", $256.30 , $377.53 ," $1,392.40 "," $2,729.49 "," $4,525.38 "," $4,379.40 "," $4,379.40 "," $3,892.80 "," $3,892.80 ", $377.53 ," $4,492.78 "," $4,622.70 "," $4,379.40 "," $4,379.40 "," $4,379.40 "," $4,525.38 "," $4,671.36 "," $1,635.33 "," $4,136.10 "," $2,975.73 "," $1,895.67 ", N/A ," $1,419.57 "," $1,419.57 "," $4,622.70 "," $1,643.18 ", $256.30 ," $4,671.36 "
Destruct Celiac Plexus Nerve,CPT® 64680,N/A,N/A,N/A," $2,189.00 "," $1,422.85 ", $798.93 , $156.18 , $466.44 , $942.60 , $919.68 ," $2,035.77 "," $1,970.10 "," $1,970.10 "," $1,751.20 "," $1,751.20 ", $466.44 ," $2,021.10 "," $2,079.55 "," $1,970.10 "," $1,970.10 "," $1,970.10 "," $2,035.77 "," $2,101.44 ", $865.26 ," $1,860.65 ", $899.17 , $987.29 , N/A , $960.99 , $960.99 ," $2,079.55 "," $1,030.90 ", $156.18 ," $2,101.44 "
Prolong outpt/office vis,HCPCS G2212,N/A,N/A,N/A, $137.00 , $89.05 , $63.88 , $30.39 , $25.49 , N/A , N/A , $127.41 , $123.30 , $123.30 , $109.60 , $109.60 , $25.49 , $126.49 , $130.15 , $123.30 , $123.30 , $123.30 , $127.41 , $131.52 , $58.33 , $116.45 , $59.45 , $71.61 , N/A , $56.72 , $56.72 , $130.15 , $70.91 , $25.49 , $131.52 
 Pro Oph Medical Xm&Eval Compre Est Pt 1+ Vst ,CPT® 92014,0983 - PRO FEE/CLINIC,N/A,N/A, $374.00 , $243.10 , $167.47 , $75.13 , $45.43 , $141.91 , $142.07 , $347.82 , $336.60 , $336.60 , $299.20 , $299.20 , $45.43 , $345.31 , $355.30 , $336.60 , $336.60 , $336.60 , $347.82 , $359.04 , $218.04 , $317.90 , $239.24 , $169.05 , N/A , $144.67 , $144.67 , $355.30 , $172.11 , $45.43 , $359.04 
 Pro Arthrocentesis Aspir&/Inj Interm Jt/Burs W/US ,CPT® 20606,0981 - PRO FEE/ER,N/A,N/A, $464.00 , $301.60 , $319.15 , $49.66 , $62.45 , $252.02 , $260.06 , $431.52 , $417.60 , $417.60 , $371.20 , $371.20 , $62.45 , $428.41 , $440.80 , $417.60 , $417.60 , $417.60 , $431.52 , $445.44 , $301.54 , $394.40 , $273.65 , $307.57 , N/A , $256.93 , $256.93 , $440.80 , $302.01 , $49.66 , $445.44 
Exclusion L Atr Appendage Thoracoscopic Any Meth,CPT® 33269,N/A,N/A,N/A," $10,052.00 "," $6,533.80 "," $4,863.24 ", $749.14 ," $1,090.34 ", N/A , N/A ," $9,348.36 "," $9,046.80 "," $9,046.80 "," $8,041.60 "," $8,041.60 "," $1,090.34 "," $9,281.01 "," $9,549.40 "," $9,046.80 "," $9,046.80 "," $9,046.80 "," $9,348.36 "," $9,649.92 ", N/A ," $8,544.20 "," $4,305.53 "," $4,036.87 ", N/A ," $3,173.67 "," $3,173.67 "," $9,549.40 "," $3,606.05 ", $749.14 ," $9,649.92 "
 Kras Gene Analysis Rml 81275 ,CPT® 81275,0310 - PATHOLOGY LAB,N/A,N/A," $1,252.00 ", $813.80 ," $1,051.68 ", $197.12 , $161.14 ," $1,011.62 "," $1,126.80 "," $1,059.94 "," $1,126.80 "," $1,126.80 "," $1,126.80 "," $1,064.20 ", $157.98 ," $1,155.97 "," $1,189.40 "," $1,064.20 "," $1,164.36 "," $1,164.36 "," $1,189.40 "," $1,201.92 "," $1,024.39 "," $1,126.80 "," $1,064.20 ", $989.08 , N/A ," $1,013.24 "," $1,013.24 "," $1,189.40 "," $1,074.34 ", $157.98 ," $1,201.92 "
 Fac Guidance for Loclzj Target Vol for Radj Tx Dlvr ,CPT® 77387,0333 - RADIATION RX,N/A,N/A, $639.00 , $415.35 , $536.76 , N/A , N/A , $516.31 , $575.10 , $540.98 , $575.10 , $575.10 , $575.10 , $543.15 , N/A , $589.99 , $607.05 , $543.15 , $594.27 , $594.27 , $607.05 , $613.44 , $522.83 , $575.10 , $543.15 , $504.81 , N/A , $517.14 , $517.14 , $607.05 , $548.33 , $504.81 , $613.44 
Parvovirus,CPT® 86747,N/A,N/A,N/A, $150.00 , $97.50 , N/A , $15.33 , $15.33 , $85.06 , $101.76 , $139.50 , $135.00 , $135.00 , $120.00 , $120.00 , $15.33 , $138.50 , $142.50 , $135.00 , $135.00 , $135.00 , $139.50 , $144.00 , $100.36 , $127.50 , $98.93 , $54.51 , N/A , $79.38 , $79.38 , $142.50 , $86.75 , $15.33 , $144.00 
Assay of Cyclosporine,CPT® 80158,N/A,N/A,N/A, $129.00 , $83.85 , N/A , $18.41 , $18.41 , $102.15 , $122.15 , $119.97 , $116.10 , $116.10 , $103.20 , $103.20 , $18.41 , $119.11 , $122.55 , $116.10 , $116.10 , $116.10 , $119.97 , $123.84 , $120.52 , $109.65 , $118.39 , $65.44 , N/A , $95.33 , $95.33 , $122.55 , $104.18 , $18.41 , $123.84 
" Fungus Culture, Dermatophyte Beaker1 ",CPT® 87101,0306 - LAB/BACT-MICRO,N/A,N/A, $115.00 , $74.75 , $96.60 , $7.86 , $7.86 , $92.92 , $103.50 , $97.36 , $103.50 , $103.50 , $103.50 , $97.75 , $7.71 , $106.18 , $109.25 , $97.75 , $106.95 , $106.95 , $109.25 , $110.40 , $94.09 , $103.50 , $97.75 , $90.85 , N/A , $93.07 , $93.07 , $109.25 , $98.68 , $7.71 , $110.40 
 Pro Remove Foreign Body ,CPT® 10121,0981 - PRO FEE/ER,N/A,N/A," $1,048.00 ", $681.20 , $588.68 , $176.00 , $77.74 , $505.10 , $497.82 , $974.64 , $943.20 , $943.20 , $838.40 , $838.40 , $77.74 , $967.62 , $995.60 , $943.20 , $943.20 , $943.20 , $974.64 ," $1,006.08 ", $648.05 , $890.80 , $990.16 , $647.57 , N/A , $514.96 , $514.96 , $995.60 , $597.18 , $77.74 ," $1,006.08 "
"Cell Count,Misc Body Fluids",CPT® 89050,N/A,N/A,N/A, $46.00 , $29.90 , N/A , $4.81 , $4.81 , $26.46 , $32.01 , $42.78 , $41.40 , $41.40 , $36.80 , $36.80 , $4.81 , $42.47 , $43.70 , $41.40 , $41.40 , $41.40 , $42.78 , $44.16 , $31.52 , $39.10 , $30.82 , $17.12 , N/A , $24.69 , $24.69 , $43.70 , $27.13 , $4.81 , $44.16 
 Fac Blood Clot Factor XIII Test ,CPT® 85291,0305 - LAB/HEMATOLOGY,N/A,N/A, $54.00 , $35.10 , $45.36 , $9.29 , $9.29 , $43.63 , $48.60 , $45.72 , $48.60 , $48.60 , $48.60 , $45.90 , $9.11 , $49.86 , $51.30 , $45.90 , $50.22 , $50.22 , $51.30 , $51.84 , $44.18 , $48.60 , $45.90 , $42.66 , N/A , $43.70 , $43.70 , $51.30 , $46.34 , $9.11 , $51.84 
Pro Removal Hand Lesion,26116,N/A,N/A,N/A," $4,602.00 "," $2,991.30 "," $3,213.93 ", $506.16 , $286.14 ," $2,537.04 "," $2,534.12 "," $4,279.86 "," $4,141.80 "," $4,141.80 "," $3,681.60 "," $3,681.60 ", $286.14 ," $4,249.03 "," $4,371.90 "," $4,141.80 "," $4,141.80 "," $4,141.80 "," $4,279.86 "," $4,417.92 "," $2,989.89 "," $3,911.70 "," $2,784.92 "," $3,015.20 ", N/A ," $2,586.54 "," $2,586.54 "," $4,371.90 "," $3,040.13 ", $286.14 ," $4,417.92 "
 Pro Anes Dx/Ther Nerve Block/Injection Prone POS ,CPT® 01992,0964 - PRO FEE/ANES CRNA,N/A,N/A, $22.00 , $14.30 , N/A , N/A , $18.11 , N/A , N/A , $20.46 , $19.80 , $19.80 , $17.60 , $17.60 , $18.11 , $20.31 , $20.90 , $19.80 , $19.80 , $19.80 , $20.46 , $21.12 , N/A , $18.70 , N/A , N/A , N/A , N/A , N/A , $20.90 , N/A , $17.60 , $21.12 
"Fx Radial Head or Neck,Cl",CPT® 24640,N/A,N/A,N/A, $893.00 , $580.45 , $507.52 , $78.44 , $62.26 , $453.97 , $465.63 , $830.49 , $803.70 , $803.70 , $714.40 , $714.40 , $62.26 , $824.51 , $848.35 , $803.70 , $803.70 , $803.70 , $830.49 , $857.28 , $464.54 , $759.05 , $512.03 , $456.76 , N/A , $462.82 , $462.82 , $848.35 , $543.97 , $62.26 , $857.28 
Marsup Bartholin Gland Cyst,CPT® 56440,N/A,N/A,N/A," $1,411.00 ", $917.15 , $850.75 , $172.96 , $230.52 , $743.33 , $744.47 ," $1,312.23 "," $1,269.90 "," $1,269.90 "," $1,128.80 "," $1,128.80 ", $230.52 ," $1,302.78 "," $1,340.45 "," $1,269.90 "," $1,269.90 "," $1,269.90 "," $1,312.23 "," $1,354.56 ", $893.04 ," $1,199.35 ", $977.67 , $746.92 , N/A , $757.83 , $757.83 ," $1,340.45 ", $908.96 , $172.96 ," $1,354.56 "
"Fix Lid Ptosis,Levatr Resec,Extern",CPT® 67904,N/A,N/A,N/A," $6,743.00 "," $4,382.95 "," $3,656.90 ", $573.90 , $588.32 ," $3,377.56 "," $3,189.07 "," $6,270.99 "," $6,068.70 "," $6,068.70 "," $5,394.40 "," $5,394.40 ", $588.32 ," $6,225.81 "," $6,405.85 "," $6,068.70 "," $6,068.70 "," $6,068.70 "," $6,270.99 "," $6,473.28 "," $5,024.21 "," $5,731.55 "," $3,309.44 "," $4,291.25 ", N/A ," $3,443.46 "," $3,443.46 "," $6,405.85 "," $3,801.12 ", $573.90 ," $6,473.28 "
Apply- Long Arm Splint,29105,N/A,N/A,N/A, $382.00 , $248.30 , $248.63 , $39.02 , $45.35 , $288.42 , $289.62 , $355.26 , $343.80 , $343.80 , $305.60 , $305.60 , $45.35 , $352.70 , $362.90 , $343.80 , $343.80 , $343.80 , $355.26 , $366.72 , $235.01 , $324.70 , $317.56 , $339.98 , N/A , $294.05 , $294.05 , $362.90 , $345.59 , $39.02 , $366.72 
Fusion Finger Joint,26860,N/A,N/A,N/A," $1,911.00 "," $1,242.15 "," $3,869.91 ", $602.15 , $384.19 ," $2,683.79 "," $2,729.96 "," $1,777.23 "," $1,719.90 "," $1,719.90 "," $1,528.80 "," $1,528.80 ", $384.19 ," $1,764.43 "," $1,815.45 "," $1,719.90 "," $1,719.90 "," $1,719.90 "," $1,777.23 "," $1,834.56 "," $3,532.35 "," $1,624.35 "," $2,984.74 "," $3,214.26 ", N/A ," $2,736.16 "," $2,736.16 "," $1,815.45 "," $3,215.95 ", $384.19 ," $3,869.91 "
Office/Outpatient Established Mod Mdm 30-39 Min,99214,N/A,N/A,N/A, $258.00 , $167.70 , $198.24 , $94.81 , $64.80 , $135.34 , $135.69 , $239.94 , $232.20 , $232.20 , $206.40 , $206.40 , $64.80 , $238.21 , $245.10 , $232.20 , $232.20 , $232.20 , $239.94 , $247.68 , $181.36 , $219.30 , $168.77 , $172.04 , $74.50 , $137.99 , $137.99 , $245.10 , $159.15 , $64.80 , $247.68 
"RBC Sed Rate, Auto",CPT® 85652,N/A,N/A,N/A, $50.00 , $32.50 , N/A , $2.75 , $2.75 , $15.30 , $18.27 , $46.50 , $45.00 , $45.00 , $40.00 , $40.00 , $2.75 , $46.17 , $47.50 , $45.00 , $45.00 , $45.00 , $46.50 , $48.00 , $18.03 , $42.50 , $17.84 , $9.78 , N/A , $14.28 , $14.28 , $47.50 , $15.60 , $2.75 , $48.00 
 SORBITOL 70 % SOLN ,HCPCS RXA250,0250 - PHARMACY,46287-0500-30,15 mL, $10.02 , $6.51 , $8.42 , N/A , N/A , $8.10 , $9.02 , $8.48 , $9.02 , $9.02 , $9.02 , $8.52 , N/A , $9.25 , $9.52 , $8.52 , $9.32 , $9.32 , $9.52 , $9.62 , $8.20 , $9.02 , $8.52 , $7.92 , N/A , $8.11 , $8.11 , $9.52 , $8.60 , $7.92 , $9.62 
Straight Tip Urine Catheter,HCPCS A4351,N/A,N/A,N/A, $7.00 , $4.55 , N/A , $2.46 , $1.57 , N/A , N/A , $6.51 , $6.30 , $6.30 , $5.60 , $5.60 , $1.57 , $6.46 , $6.65 , $6.30 , $6.30 , $6.30 , $6.51 , $6.72 , N/A , $5.95 , $1.95 , $2.23 , N/A , N/A , N/A , $6.65 , N/A , $1.57 , $6.72 
Endoscopy Upper Small Intestine,CPT® 44360,N/A,N/A,N/A," $2,587.00 "," $1,681.55 ", $881.08 , $136.17 , $494.85 , $739.00 , $764.37 ," $2,405.91 "," $2,328.30 "," $2,328.30 "," $2,069.60 "," $2,069.60 ", $494.85 ," $2,388.58 "," $2,457.65 "," $2,328.30 "," $2,328.30 "," $2,328.30 "," $2,405.91 "," $2,483.52 ", $633.50 ," $2,198.95 ", $836.73 , $840.25 , N/A , $753.42 , $753.42 ," $2,457.65 ", $788.00 , $136.17 ," $2,483.52 "
Repair Complex Trunk 5cm,CPT® 13102,N/A,N/A,N/A, $557.00 , $362.05 , $228.24 , $67.58 , $75.77 , $202.55 , $195.28 , $518.01 , $501.30 , $501.30 , $445.60 , $445.60 , $75.77 , $514.28 , $529.15 , $501.30 , $501.30 , $501.30 , $518.01 , $534.72 , $251.34 , $473.45 , $392.49 , $258.78 , N/A , $206.50 , $206.50 , $529.15 , $239.47 , $67.58 , $534.72 
"Cytopath, C/V Auto, in Fluid",CPT® 88174,N/A,N/A,N/A, $181.00 , $117.65 , N/A , $25.88 , $25.88 , $119.66 , $180.91 , $168.33 , $162.90 , $162.90 , $144.80 , $144.80 , $25.88 , $167.12 , $171.95 , $162.90 , $162.90 , $162.90 , $168.33 , $173.76 , $169.40 , $153.85 , $139.48 , $93.39 , N/A , $111.67 , $111.67 , $171.95 , $122.72 , $25.88 , $180.91 
Excis Stoamch Malig,CPT® 43611,N/A,N/A,N/A," $8,036.00 "," $5,223.40 "," $7,268.89 "," $1,131.19 "," $1,171.51 "," $5,735.35 "," $5,780.78 "," $7,473.48 "," $7,232.40 "," $7,232.40 "," $6,428.80 "," $6,428.80 "," $1,171.51 "," $7,419.64 "," $7,634.20 "," $7,232.40 "," $7,232.40 "," $7,232.40 "," $7,473.48 "," $7,714.56 "," $5,215.85 "," $6,830.60 "," $6,435.12 "," $6,776.46 ", N/A ," $5,847.25 "," $5,847.25 "," $7,634.20 "," $6,115.62 "," $1,131.19 "," $7,714.56 "
"Destr Malig Scal,Nck,Hand 1.1-2 Cm",CPT® 17272,N/A,N/A,N/A, $737.00 , $479.05 , $388.11 , $116.85 , $122.10 , $349.15 , $342.34 , $685.41 , $663.30 , $663.30 , $589.60 , $589.60 , $122.10 , $680.47 , $700.15 , $663.30 , $663.30 , $663.30 , $685.41 , $707.52 , $427.29 , $626.45 , $679.73 , $447.92 , N/A , $355.96 , $355.96 , $700.15 , $412.79 , $116.85 , $707.52 
 VITAMIN B-6 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,77333-0940-10,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"IV Infusion, Therap/Proph/Diagnost,Concurrent Infusion",CPT® 96368,N/A,N/A,N/A, $85.00 , $55.25 , $47.23 , $19.45 , $20.32 , $45.53 , $42.16 , $79.05 , $76.50 , $76.50 , $68.00 , $68.00 , $20.32 , $78.48 , $80.75 , $76.50 , $76.50 , $76.50 , $79.05 , $81.60 , $76.34 , $72.25 , $55.75 , $78.79 , N/A , $46.42 , $46.42 , $80.75 , $54.11 , $19.45 , $81.60 
 Fac Amp Toe Iphal Jt ,CPT® 28825,0360 - OR SERVICES,N/A,N/A," $7,830.00 "," $5,089.50 "," $6,577.20 ", $165.33 , $153.67 ," $6,326.64 "," $7,047.00 "," $6,628.88 "," $7,047.00 "," $7,047.00 "," $7,047.00 "," $6,655.50 ", $150.66 ," $7,229.44 "," $7,438.50 "," $6,655.50 "," $7,281.90 "," $7,281.90 "," $7,438.50 "," $7,516.80 "," $6,406.51 "," $7,047.00 "," $6,655.50 "," $6,185.70 ", N/A ," $6,336.82 "," $6,336.82 "," $7,438.50 "," $6,718.92 ", $150.66 ," $7,516.80 "
 AZACITIDINE 100 MG IJ SUSR UNDILUTED ,HCPCS J9025,0636 - DRUGS REQUIRING DETAILED CODIN,00781-3253-94,100 mg," $1,513.33 ", $983.66 ," $1,271.20 ", $0.41 , $0.51 ," $1,222.77 "," $1,362.00 "," $1,281.19 "," $1,362.00 "," $1,362.00 "," $1,362.00 "," $1,286.33 ", $0.50 ," $1,397.26 "," $1,437.66 "," $1,286.33 "," $1,407.40 "," $1,407.40 "," $1,437.66 "," $1,452.80 "," $1,238.21 "," $1,362.00 "," $1,286.33 "," $1,195.53 ", N/A ," $1,224.74 "," $1,224.74 "," $1,437.66 "," $1,298.59 ", $0.41 ," $1,452.80 "
 Fac Esoph Balloon Distension Tst ,CPT® 91040,0750 - GASTR-INST SVS,N/A,N/A," $2,499.00 "," $1,624.35 "," $2,099.16 ", $518.74 , $398.78 ," $2,019.19 "," $2,249.10 "," $2,115.65 "," $2,249.10 "," $2,249.10 "," $2,249.10 "," $2,124.15 ", $390.96 ," $2,307.33 "," $2,374.05 "," $2,124.15 "," $2,324.07 "," $2,324.07 "," $2,374.05 "," $2,399.04 "," $2,044.68 "," $2,249.10 "," $2,124.15 "," $1,974.21 ", N/A ," $2,022.44 "," $2,022.44 "," $2,374.05 "," $2,144.39 ", $390.96 ," $2,399.04 "
Orth Dev Repair/Repl Minor P,HCPCS L4210,N/A,N/A,N/A, $74.00 , $48.10 , N/A , N/A , N/A , N/A , N/A , $68.82 , $66.60 , $66.60 , $59.20 , $59.20 , N/A , $68.32 , $70.30 , $66.60 , $66.60 , $66.60 , $68.82 , $71.04 , N/A , $62.90 , $59.20 , N/A , N/A , N/A , N/A , $70.30 , N/A , $59.20 , $71.04 
Htlv/Hiv Confirmatory Test,CPT® 86689,N/A,N/A,N/A, $169.00 , $109.85 , N/A , $19.74 , $19.74 , $109.51 , $130.96 , $157.17 , $152.10 , $152.10 , $135.20 , $135.20 , $19.74 , $156.04 , $160.55 , $152.10 , $152.10 , $152.10 , $157.17 , $162.24 , $129.20 , $143.65 , $126.50 , $70.19 , N/A , $102.20 , $102.20 , $160.55 , $111.68 , $19.74 , $162.24 
 ERTAPENEM SODIUM 1 G IJ SOLR ,HCPCS J1335,0636 - DRUGS REQUIRING DETAILED CODIN,43598-0901-58,10 mL, $616.43 , $400.68 , $517.80 , $13.59 , $15.68 , $498.08 , $554.79 , $521.87 , $554.79 , $554.79 , $554.79 , $523.97 , $15.37 , $569.15 , $585.61 , $523.97 , $573.28 , $573.28 , $585.61 , $591.77 , $504.36 , $554.79 , $523.97 , $486.98 , N/A , $498.88 , $498.88 , $585.61 , $528.96 , $13.59 , $591.77 
 Fac Rem Interrog Pm/Ldls Pm/Ids <90 D Phys/Qhp ,CPT® 93296,0480 - CARDIOLOGY,N/A,N/A, $278.00 , $180.70 , $233.52 , $21.78 , $27.22 , $224.62 , $250.20 , $235.35 , $250.20 , $250.20 , $250.20 , $236.30 , $26.69 , $256.68 , $264.10 , $236.30 , $258.54 , $258.54 , $264.10 , $266.88 , $227.46 , $250.20 , $236.30 , $219.62 , N/A , $224.99 , $224.99 , $264.10 , $238.55 , $21.78 , $266.88 
Inject Tendon Origin/Insert,20551,N/A,N/A,N/A, $342.00 , $222.30 , $99.85 , $37.19 , $26.41 , $208.42 , $205.64 , $318.06 , $307.80 , $307.80 , $273.60 , $273.60 , $26.41 , $315.77 , $324.90 , $307.80 , $307.80 , $307.80 , $318.06 , $328.32 , $224.71 , $290.70 , $223.01 , $248.94 , N/A , $212.48 , $212.48 , $324.90 , $249.74 , $26.41 , $328.32 
X-Ray Thoracic Spine+Swim 3 Vw,CPT® 72072,N/A,N/A,N/A, $353.00 , $229.45 , $221.33 , $38.71 , $36.41 , $162.84 , $198.13 , $328.29 , $317.70 , $317.70 , $282.40 , $282.40 , $36.41 , $325.92 , $335.35 , $317.70 , $317.70 , $317.70 , $328.29 , $338.88 , $214.83 , $300.05 , $215.72 , $174.94 , N/A , $166.02 , $166.02 , $335.35 , $192.17 , $36.41 , $338.88 
 Fac or Room Chg Lvl1 Base ,Custom OPTORBASELVL1,0360 - OR SERVICES,N/A,N/A," $2,183.00 "," $1,418.95 "," $1,833.72 ", N/A , N/A ," $1,763.86 "," $1,964.70 "," $1,848.13 "," $1,964.70 "," $1,964.70 "," $1,964.70 "," $1,855.55 ", N/A ," $2,015.56 "," $2,073.85 "," $1,855.55 "," $2,030.19 "," $2,030.19 "," $2,073.85 "," $2,095.68 "," $1,786.13 "," $1,964.70 "," $1,855.55 "," $1,724.57 ", N/A ," $1,766.70 "," $1,766.70 "," $2,073.85 "," $1,873.23 "," $1,724.57 "," $2,095.68 "
Pmp22 Gene Anal Duplication/Deletion Analysis,CPT® 81324,N/A,N/A,N/A," $3,434.00 "," $2,232.10 ", N/A , $773.53 , $446.29 , N/A , N/A ," $3,193.62 "," $3,090.60 "," $3,090.60 "," $2,747.20 "," $2,747.20 ", $446.29 ," $3,170.61 "," $3,262.30 "," $3,090.60 "," $3,090.60 "," $3,090.60 "," $3,193.62 "," $3,296.64 "," $5,063.74 "," $2,918.90 "," $3,615.20 "," $2,227.30 ", N/A ," $3,010.69 "," $3,010.69 "," $3,262.30 "," $3,283.70 ", $446.29 ," $5,063.74 "
 CLINDAMYCIN HCL 150 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-5959-61,1 capsule, $3.76 , $2.44 , $3.16 , N/A , N/A , $3.04 , $3.38 , $3.18 , $3.38 , $3.38 , $3.38 , $3.20 , N/A , $3.47 , $3.57 , $3.20 , $3.50 , $3.50 , $3.57 , $3.61 , $3.08 , $3.38 , $3.20 , $2.97 , N/A , $3.04 , $3.04 , $3.57 , $3.23 , $2.97 , $3.61 
 Simple Pneumonia And Pleurisy With Cc ,MS DRG V40 (FY2023) 194,N/A,N/A,N/A," $13,690.46 "," $8,898.80 "," $11,499.99 ", N/A , N/A ," $11,061.89 "," $12,321.41 "," $11,590.34 "," $12,321.41 "," $12,321.41 "," $12,321.41 "," $11,636.89 ", N/A ," $12,640.40 "," $13,005.94 "," $11,636.89 "," $12,732.13 "," $12,732.13 "," $13,005.94 "," $13,142.84 "," $11,201.53 "," $12,321.41 "," $11,636.89 "," $10,815.46 ", N/A ," $11,079.69 "," $11,079.69 "," $13,005.94 "," $11,747.78 "," $10,815.46 "," $13,142.84 "
 MRI Pelvis W/ Contrast -Mh ,CPT® 72196,0972 - PRO FEE/RAD/DX,N/A,N/A, $894.00 , $581.10 ," $1,946.77 ", $276.84 , $503.64 ," $1,955.11 "," $2,494.52 ", $831.42 , $804.60 , $804.60 , $715.20 , $715.20 , $503.64 , $825.43 , $849.30 , $804.60 , $804.60 , $804.60 , $831.42 , $858.24 ," $1,678.42 ", $759.90 ," $2,717.65 "," $3,209.78 ", N/A ," $1,993.25 "," $1,993.25 ", $849.30 ," $2,307.23 ", $276.84 ," $3,209.78 "
"Repair Enterocele,Vag Apprch",CPT® 57268,N/A,N/A,N/A," $3,194.00 "," $2,076.10 "," $2,410.20 ", $487.57 , $614.70 ," $1,969.28 "," $1,967.06 "," $2,970.42 "," $2,874.60 "," $2,874.60 "," $2,555.20 "," $2,555.20 ", $614.70 ," $2,949.02 "," $3,034.30 "," $2,874.60 "," $2,874.60 "," $2,874.60 "," $2,970.42 "," $3,066.24 "," $2,499.20 "," $2,714.90 "," $2,577.97 "," $1,981.94 ", N/A ," $2,007.71 "," $2,007.71 "," $3,034.30 "," $2,408.14 ", $487.57 ," $3,066.24 "
" Fac Virus Inoculation, Tissue ",CPT® 87252,0306 - LAB/BACT-MICRO,N/A,N/A, $241.00 , $156.65 , $202.44 , $26.59 , $26.59 , $194.73 , $216.90 , $204.03 , $216.90 , $216.90 , $216.90 , $204.85 , $26.07 , $222.52 , $228.95 , $204.85 , $224.13 , $224.13 , $228.95 , $231.36 , $197.19 , $216.90 , $204.85 , $190.39 , N/A , $195.04 , $195.04 , $228.95 , $206.80 , $26.07 , $231.36 
 Pro Cltx Fx Grt Toe Phlx/Phlg W/Mnpj ,CPT® 28495,0981 - PRO FEE/ER,N/A,N/A, $801.00 , $520.65 , $927.29 , $146.49 , $142.01 , $741.74 , $744.49 , $744.93 , $720.90 , $720.90 , $640.80 , $640.80 , $142.01 , $739.56 , $760.95 , $720.90 , $720.90 , $720.90 , $744.93 , $768.96 , $853.03 , $680.85 , $808.18 , $870.51 , N/A , $756.22 , $756.22 , $760.95 , $888.84 , $142.01 , $927.29 
Iaad Ia Rotavirus,CPT® 87425,N/A,N/A,N/A, $111.00 , $72.15 , N/A , $12.22 , $12.22 , $67.85 , $81.18 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $12.22 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $79.99 , $94.35 , $77.85 , $43.47 , N/A , $63.32 , $63.32 , $105.45 , $69.20 , $12.22 , $106.56 
 Sc Bx Liver Perc Ndl ,CPT® 47000,0761 - TREATMENT ROOM,N/A,N/A," $1,713.00 "," $1,113.45 "," $1,438.92 ", $84.16 , $123.71 ," $1,384.10 "," $1,541.70 "," $1,450.23 "," $1,541.70 "," $1,541.70 "," $1,541.70 "," $1,456.05 ", $121.28 ," $1,581.61 "," $1,627.35 "," $1,456.05 "," $1,593.09 "," $1,593.09 "," $1,627.35 "," $1,644.48 "," $1,401.58 "," $1,541.70 "," $1,456.05 "," $1,353.27 ", N/A ," $1,386.33 "," $1,386.33 "," $1,627.35 "," $1,469.93 ", $84.16 ," $1,644.48 "
B-12 Binding Capacity,CPT® 82608,N/A,N/A,N/A, $236.00 , $153.40 , N/A , $14.61 , $14.61 , $80.98 , $96.88 , $219.48 , $212.40 , $212.40 , $188.80 , $188.80 , $14.61 , $217.90 , $224.20 , $212.40 , $212.40 , $212.40 , $219.48 , $226.56 , $95.62 , $200.60 , $94.07 , $51.93 , N/A , $75.58 , $75.58 , $224.20 , $82.60 , $14.61 , $226.56 
 Pro MRI Brain W/O & W/Dye ,CPT® 70553,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,354.00 ", $880.10 ," $2,292.92 ", $327.49 , $644.90 ," $2,822.90 "," $2,971.00 "," $1,259.22 "," $1,218.60 "," $1,218.60 "," $1,083.20 "," $1,083.20 ", $644.90 ," $1,250.15 "," $1,286.30 "," $1,218.60 "," $1,218.60 "," $1,218.60 "," $1,259.22 "," $1,299.84 "," $4,060.76 "," $1,150.90 "," $3,237.68 "," $3,491.99 ", N/A ," $2,877.98 "," $2,877.98 "," $1,286.30 "," $3,385.86 ", $327.49 ," $4,060.76 "
Blood Clot Factor X Test,CPT® 85260,N/A,N/A,N/A, $265.00 , $172.25 , N/A , $18.26 , $18.26 , $101.32 , $121.17 , $246.45 , $238.50 , $238.50 , $212.00 , $212.00 , $18.26 , $244.67 , $251.75 , $238.50 , $238.50 , $238.50 , $246.45 , $254.40 , $119.52 , $225.25 , $116.77 , $64.91 , N/A , $94.56 , $94.56 , $251.75 , $103.33 , $18.26 , $254.40 
 Rt Joint Upper Ext W/O & W/Contrast ,CPT® 73223,0610 - MRI,N/A,N/A," $7,958.00 "," $5,172.70 "," $6,684.72 ", $400.04 , $633.95 ," $6,430.06 "," $7,162.20 "," $6,737.24 "," $7,162.20 "," $7,162.20 "," $7,162.20 "," $6,764.30 ", $621.52 ," $7,347.62 "," $7,560.10 "," $6,764.30 "," $7,400.94 "," $7,400.94 "," $7,560.10 "," $7,639.68 "," $6,511.24 "," $7,162.20 "," $6,764.30 "," $6,286.82 ", N/A ," $6,440.41 "," $6,440.41 "," $7,560.10 "," $6,828.76 ", $400.04 ," $7,639.68 "
" Fac Repr Forearm Tend/Musc,Flex,Prim,Ea ",CPT® 25260,0361 - OR/MINOR,N/A,N/A," $5,508.00 "," $3,580.20 "," $4,626.72 ", $612.04 , $546.22 ," $4,450.46 "," $4,957.20 "," $4,663.07 "," $4,957.20 "," $4,957.20 "," $4,957.20 "," $4,681.80 ", $535.51 ," $5,085.54 "," $5,232.60 "," $4,681.80 "," $5,122.44 "," $5,122.44 "," $5,232.60 "," $5,287.68 "," $4,506.65 "," $4,957.20 "," $4,681.80 "," $4,351.32 ", N/A ," $4,457.62 "," $4,457.62 "," $5,232.60 "," $4,726.41 ", $535.51 ," $5,287.68 "
Excision Tumor Soft Tiss Face/Scalp Subq < 2cm,CPT® 21011,N/A,N/A,N/A," $1,478.00 ", $960.70 ," $1,583.66 ", $250.41 , $260.10 ," $1,254.34 "," $1,265.20 "," $1,374.54 "," $1,330.20 "," $1,330.20 "," $1,182.40 "," $1,182.40 ", $260.10 ," $1,364.64 "," $1,404.10 "," $1,330.20 "," $1,330.20 "," $1,330.20 "," $1,374.54 "," $1,418.88 "," $1,462.62 "," $1,256.30 "," $1,382.65 "," $1,482.13 ", N/A ," $1,278.82 "," $1,278.82 "," $1,404.10 "," $1,503.06 ", $250.41 ," $1,583.66 "
Sgmdsc Flx With Endoscopic Mucosal Resection,45349,N/A,N/A,N/A," $2,493.00 "," $1,620.45 "," $1,216.80 ", $187.96 , $133.80 , N/A , N/A ," $2,318.49 "," $2,243.70 "," $2,243.70 "," $1,994.40 "," $1,994.40 ", $133.80 ," $2,301.79 "," $2,368.35 "," $2,243.70 "," $2,243.70 "," $2,243.70 "," $2,318.49 "," $2,393.28 ", $874.13 ," $2,119.05 "," $1,034.18 "," $1,160.23 ", N/A , $888.60 , $888.60 ," $2,368.35 ", $930.05 , $133.80 ," $2,393.28 "
Stereoscopic X-Ray Guidance,HCPCS G6002,N/A,N/A,N/A, $466.00 , $302.90 , $412.26 , $73.24 , $58.60 , $135.72 , N/A , $433.38 , $419.40 , $419.40 , $372.80 , $372.80 , $58.60 , $430.26 , $442.70 , $419.40 , $419.40 , $419.40 , $433.38 , $447.36 , $423.90 , $396.10 , $144.09 , $424.54 , N/A , $138.36 , $138.36 , $442.70 , $172.96 , $58.60 , $447.36 
 Skull Min 4vw- Mh ,CPT® 70260,0972 - PRO FEE/RAD/DX,N/A,N/A, $223.00 , $144.95 , $254.04 , $44.04 , $45.27 , $214.57 , $251.57 , $207.39 , $200.70 , $200.70 , $178.40 , $178.40 , $45.27 , $205.90 , $211.85 , $200.70 , $200.70 , $200.70 , $207.39 , $214.08 , $247.38 , $189.55 , $273.50 , $230.30 , N/A , $218.75 , $218.75 , $211.85 , $253.21 , $44.04 , $273.50 
 Fetal/Mat Bleed-Kleihauer ,CPT® 85460,0300 - LABORATORY,N/A,N/A, $151.00 , $98.15 , $126.84 , $7.88 , $7.88 , $122.01 , $135.90 , $127.84 , $135.90 , $135.90 , $135.90 , $128.35 , $7.73 , $139.42 , $143.45 , $128.35 , $140.43 , $140.43 , $143.45 , $144.96 , $123.55 , $135.90 , $128.35 , $119.29 , N/A , $122.20 , $122.20 , $143.45 , $129.57 , $7.73 , $144.96 
"Cmv Antibody, Igm",CPT® 86645,N/A,N/A,N/A, $159.00 , $103.35 , N/A , $17.19 , $8.07 , $32.88 , $39.34 , $147.87 , $143.10 , $143.10 , $127.20 , $127.20 , $8.07 , $146.80 , $151.05 , $143.10 , $143.10 , $143.10 , $147.87 , $152.64 , $112.51 , $135.15 , $110.29 , $61.09 , N/A , $30.69 , $30.69 , $151.05 , $33.54 , $8.07 , $152.64 
"Dressing Change,Not for Burn",CPT® 15852,N/A,N/A,N/A, $259.00 , $168.35 , $145.89 , $42.74 , $19.53 , $128.76 , $122.07 , $240.87 , $233.10 , $233.10 , $207.20 , $207.20 , $19.53 , $239.13 , $246.05 , $233.10 , $233.10 , $233.10 , $240.87 , $248.64 , $160.14 , $220.15 , $244.42 , $161.84 , N/A , $131.28 , $131.28 , $246.05 , $152.24 , $19.53 , $248.64 
Burr Hole for Biopsy,CPT® 61140,N/A,N/A,N/A," $7,526.00 "," $4,891.90 "," $5,829.36 "," $1,139.24 ", $800.73 ," $6,816.01 "," $6,555.90 "," $6,999.18 "," $6,773.40 "," $6,773.40 "," $6,020.80 "," $6,020.80 ", $800.73 ," $6,948.76 "," $7,149.70 "," $6,773.40 "," $6,773.40 "," $6,773.40 "," $6,999.18 "," $7,224.96 "," $6,296.99 "," $6,397.10 "," $6,718.79 "," $7,074.40 ", N/A ," $6,949.00 "," $6,949.00 "," $7,149.70 "," $7,454.64 ", $800.73 ," $7,454.64 "
" Fac Control Throat Bleed,Simple ",CPT® 42960,0761 - TREATMENT ROOM,N/A,N/A," $1,219.00 ", $792.35 ," $1,023.96 ", $155.79 , $76.84 , $984.95 ," $1,097.10 "," $1,032.01 "," $1,097.10 "," $1,097.10 "," $1,097.10 "," $1,036.15 ", $75.33 ," $1,125.50 "," $1,158.05 "," $1,036.15 "," $1,133.67 "," $1,133.67 "," $1,158.05 "," $1,170.24 ", $997.39 ," $1,097.10 "," $1,036.15 ", $963.01 , N/A , $986.54 , $986.54 ," $1,158.05 "," $1,046.02 ", $75.33 ," $1,170.24 "
"Eval,Oral & Pharyngeal Swallow Function",CPT® 92610,N/A,N/A,N/A, $637.00 , $414.05 , $163.68 , $69.67 , $77.36 , $163.45 , $152.12 , $592.41 , $573.30 , $573.30 , $509.60 , $509.60 , $77.36 , $588.14 , $605.15 , $573.30 , $573.30 , $573.30 , $592.41 , $611.52 , $304.82 , $541.45 , $199.70 , $277.23 , N/A , $166.64 , $166.64 , $605.15 , $194.27 , $69.67 , $611.52 
 Room Rate ,Custom 2100000001,0210 - CORONARY CARE OR (CCU),N/A,N/A," $4,915.00 "," $3,194.75 "," $4,128.60 ", N/A , N/A ," $3,971.32 "," $4,423.50 "," $4,161.04 "," $4,423.50 "," $4,423.50 "," $4,423.50 "," $4,177.75 ", N/A ," $4,538.02 "," $4,669.25 "," $4,177.75 "," $4,570.95 "," $4,570.95 "," $4,669.25 "," $4,718.40 "," $4,021.45 "," $4,423.50 "," $4,177.75 "," $3,882.85 ", N/A ," $3,977.71 "," $3,977.71 "," $4,669.25 "," $4,217.56 "," $3,882.85 "," $4,718.40 "
 Pro Lyr Clsr F/E/E/N/L/M&/Muc 7.6 Cm-12.5 Cm ,CPT® 12054,0982 - PRO FEE/OUTPT,N/A,N/A," $1,652.00 "," $1,073.80 ", $691.80 , $208.93 , $210.26 , $622.08 , $609.78 ," $1,536.36 "," $1,486.80 "," $1,486.80 "," $1,321.60 "," $1,321.60 ", $210.26 ," $1,525.29 "," $1,569.40 "," $1,486.80 "," $1,486.80 "," $1,486.80 "," $1,536.36 "," $1,585.92 ", $758.54 ," $1,404.20 "," $1,218.52 ", $778.84 , N/A , $634.21 , $634.21 ," $1,569.40 ", $735.47 , $208.93 ," $1,585.92 "
 FLUOROURACIL 1 GM/20ML IV SOLN ,HCPCS J9190,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0117-20,20 mL, $36.99 , $24.04 , $31.07 , $1.87 , $2.57 , $29.89 , $33.29 , $31.32 , $33.29 , $33.29 , $33.29 , $31.44 , $2.52 , $34.15 , $35.14 , $31.44 , $34.40 , $34.40 , $35.14 , $35.51 , $30.27 , $33.29 , $31.44 , $29.22 , N/A , $29.94 , $29.94 , $35.14 , $31.74 , $1.87 , $35.51 
Spin Bone Allogrft Structural,CPT® 20931,N/A,N/A,N/A, $754.00 , $490.10 , $633.04 , $98.41 , $157.05 , $531.95 , $516.98 , $701.22 , $678.60 , $678.60 , $603.20 , $603.20 , $157.05 , $696.17 , $716.30 , $678.60 , $678.60 , $678.60 , $701.22 , $723.84 , $592.47 , $640.90 , $588.74 , $609.41 , N/A , $542.33 , $542.33 , $716.30 , $637.43 , $98.41 , $723.84 
" Fac Thyroid Met Imaging, Body ",CPT® 78018,0340 - NUCLEAR MEDICINE,N/A,N/A," $2,788.00 "," $1,812.20 "," $2,341.92 ", $285.41 , $263.53 ," $2,252.70 "," $2,509.20 "," $2,360.32 "," $2,509.20 "," $2,509.20 "," $2,509.20 "," $2,369.80 ", $258.36 ," $2,574.16 "," $2,648.60 "," $2,369.80 "," $2,592.84 "," $2,592.84 "," $2,648.60 "," $2,676.48 "," $2,281.14 "," $2,509.20 "," $2,369.80 "," $2,202.52 ", N/A ," $2,256.33 "," $2,256.33 "," $2,648.60 "," $2,392.38 ", $258.36 ," $2,676.48 "
 TBO-FILGRASTIM 300 MCG/0.5ML SC SOSY ,HCPCS J1447,0636 - DRUGS REQUIRING DETAILED CODIN,63459-0910-11,0.5 mL, $734.67 , $477.54 , $617.12 , $0.44 , $0.42 , $593.61 , $661.20 , $621.97 , $661.20 , $661.20 , $661.20 , $624.47 , $0.41 , $678.32 , $697.94 , $624.47 , $683.24 , $683.24 , $697.94 , $705.28 , $601.11 , $661.20 , $624.47 , $580.39 , N/A , $594.57 , $594.57 , $697.94 , $630.42 , $0.41 , $705.28 
"Capsulotomy Mt-P Jt,Foot,Each",CPT® 28270,N/A,N/A,N/A," $3,273.00 "," $2,127.45 "," $2,068.24 ", $324.80 , $548.76 ," $1,645.97 "," $1,644.43 "," $3,043.89 "," $2,945.70 "," $2,945.70 "," $2,618.40 "," $2,618.40 ", $548.76 ," $3,021.96 "," $3,109.35 "," $2,945.70 "," $2,945.70 "," $2,945.70 "," $3,043.89 "," $3,142.08 "," $1,926.07 "," $2,782.05 "," $1,780.50 "," $1,961.47 ", N/A ," $1,678.08 "," $1,678.08 "," $3,109.35 "," $1,972.36 ", $324.80 ," $3,142.08 "
 Fac Fine Needle Aspiration Bx W/CT Gdn 1st Lesion ,CPT® 10009,0361 - OR/MINOR,N/A,N/A," $5,301.00 "," $3,445.65 "," $4,452.84 ", $104.81 , $371.64 ," $4,283.21 "," $4,770.90 "," $4,487.83 "," $4,770.90 "," $4,770.90 "," $4,770.90 "," $4,505.85 ", $364.35 ," $4,894.41 "," $5,035.95 "," $4,505.85 "," $4,929.93 "," $4,929.93 "," $5,035.95 "," $5,088.96 "," $4,337.28 "," $4,770.90 "," $4,505.85 "," $4,187.79 ", N/A ," $4,290.10 "," $4,290.10 "," $5,035.95 "," $4,548.79 ", $104.81 ," $5,088.96 "
Assay Ceruloplasmin,CPT® 82390,N/A,N/A,N/A, $133.00 , $86.45 , N/A , $10.95 , $10.95 , $60.79 , $72.67 , $123.69 , $119.70 , $119.70 , $106.40 , $106.40 , $10.95 , $122.80 , $126.35 , $119.70 , $119.70 , $119.70 , $123.69 , $127.68 , $71.71 , $113.05 , $69.74 , $38.94 , N/A , $56.73 , $56.73 , $126.35 , $61.99 , $10.95 , $127.68 
Pro Cltx Sternum Fx,21820,N/A,N/A,N/A, $648.00 , $421.20 , $902.40 , $144.84 , $139.46 , $701.61 , $719.90 , $602.64 , $583.20 , $583.20 , $518.40 , $518.40 , $139.46 , $598.30 , $615.60 , $583.20 , $583.20 , $583.20 , $602.64 , $622.08 , $834.95 , $550.80 , $788.56 , $828.92 , N/A , $715.30 , $715.30 , $615.60 , $840.73 , $139.46 , $902.40 
 Mm Dm Rt Diag Post Procedure Images Wwo Cad-C ,CPT® 77065,0401 - MAMMOGRAPHY,N/A,N/A, $461.00 , $299.65 , $387.24 , $123.77 , $105.44 , $372.49 , $414.90 , $390.28 , $414.90 , $414.90 , $414.90 , $391.85 , $103.37 , $425.64 , $437.95 , $391.85 , $428.73 , $428.73 , $437.95 , $442.56 , $377.19 , $414.90 , $391.85 , $364.19 , N/A , $373.09 , $373.09 , $437.95 , $395.58 , $103.37 , $442.56 
"Anoscopy,Ablate Lesion",CPT® 46615,N/A,N/A,N/A, $621.00 , $403.65 , $560.50 , $86.09 , $211.99 , $441.56 , $448.25 , $577.53 , $558.90 , $558.90 , $496.80 , $496.80 , $211.99 , $573.37 , $589.95 , $558.90 , $558.90 , $558.90 , $577.53 , $596.16 , $400.77 , $527.85 , $495.97 , $522.69 , N/A , $450.17 , $450.17 , $589.95 , $470.84 , $86.09 , $596.16 
" Closed Rx Mt-Phal Toe Disloc,Anesth - Urgent Care ",CPT® 28635,0761 - TREATMENT ROOM,N/A,N/A," $1,007.00 ", $654.55 , $845.88 , $130.34 , $107.56 , $813.66 , $906.30 , $852.53 , $906.30 , $906.30 , $906.30 , $855.95 , $105.45 , $929.76 , $956.65 , $855.95 , $936.51 , $936.51 , $956.65 , $966.72 , $823.93 , $906.30 , $855.95 , $795.53 , N/A , $814.97 , $814.97 , $956.65 , $864.11 , $105.45 , $966.72 
" Pro Bone Imaging, Whole Body ",CPT® 78306,0974 - PRO FEE/NUC MED,N/A,N/A," $2,028.00 "," $1,318.20 "," $1,585.95 ", $270.63 , $214.25 ," $1,239.14 "," $1,341.60 "," $1,886.04 "," $1,825.20 "," $1,825.20 "," $1,622.40 "," $1,622.40 ", $214.25 ," $1,872.45 "," $1,926.60 "," $1,825.20 "," $1,825.20 "," $1,825.20 "," $1,886.04 "," $1,946.88 "," $1,657.16 "," $1,723.80 "," $1,461.87 "," $2,042.81 ", N/A ," $1,263.31 "," $1,263.31 "," $1,926.60 "," $1,462.30 ", $214.25 ," $2,042.81 "
"Laryngoscopy,Dirct,OP,Biopsy",CPT® 31535,N/A,N/A,N/A," $1,100.00 ", $715.00 ," $1,014.59 ", $179.67 , $175.39 , $732.37 , $717.76 ," $1,023.00 ", $990.00 , $990.00 , $880.00 , $880.00 , $175.39 ," $1,015.63 "," $1,045.00 ", $990.00 , $990.00 , $990.00 ," $1,023.00 "," $1,056.00 ", $972.32 , $935.00 ," $1,011.56 ", $962.10 , N/A , $746.66 , $746.66 ," $1,045.00 ", $879.35 , $175.39 ," $1,056.00 "
 Fac Hepatitis C Ab Test ,CPT® 86803,0302 - LAB/IMMUNOLOGY,N/A,N/A, $173.00 , $112.45 , $145.32 , $14.56 , $14.56 , $139.78 , $155.70 , $146.46 , $155.70 , $155.70 , $155.70 , $147.05 , $14.27 , $159.73 , $164.35 , $147.05 , $160.89 , $160.89 , $164.35 , $166.08 , $141.55 , $155.70 , $147.05 , $136.67 , N/A , $140.01 , $140.01 , $164.35 , $148.45 , $14.27 , $166.08 
Closed Rx Inter/Subtroch Femur Fx,27238,N/A,N/A,N/A," $3,389.00 "," $2,202.85 "," $2,867.28 ", $451.16 , $461.04 ," $2,218.00 "," $2,228.81 "," $3,151.77 "," $3,050.10 "," $3,050.10 "," $2,711.20 "," $2,711.20 ", $461.04 ," $3,129.06 "," $3,219.55 "," $3,050.10 "," $3,050.10 "," $3,050.10 "," $3,151.77 "," $3,253.44 "," $2,652.56 "," $2,880.65 "," $2,456.66 "," $2,621.53 ", N/A ," $2,261.28 "," $2,261.28 "," $3,219.55 "," $2,657.80 ", $451.16 ," $3,253.44 "
Psychotherapy W/Patient 45 Minutes,90834,N/A,N/A,N/A, $141.00 , $91.65 , $118.65 , $87.92 , $77.18 , $189.56 , $168.47 , $131.13 , $126.90 , $126.90 , $112.80 , $112.80 , $77.18 , $130.19 , $133.95 , $126.90 , $126.90 , $126.90 , $131.13 , $135.36 , $226.17 , $119.85 , $218.96 , $320.51 , $167.50 , $193.26 , $193.26 , $133.95 , $225.28 , $77.18 , $320.51 
"Dil Urethra,Female,Initial",CPT® 53660,N/A,N/A,N/A, $498.00 , $323.70 , $223.45 , $39.41 , $20.61 , $203.68 , $191.07 , $463.14 , $448.20 , $448.20 , $398.40 , $398.40 , $20.61 , $459.80 , $473.10 , $448.20 , $448.20 , $448.20 , $463.14 , $478.08 , $224.59 , $423.30 , $215.87 , $256.75 , N/A , $207.66 , $207.66 , $473.10 , $244.07 , $20.61 , $478.08 
 Renogram W/ Flow/Function ,CPT® 78707,0340 - NUCLEAR MEDICINE,N/A,N/A," $1,904.00 "," $1,237.60 "," $1,599.36 ", $214.65 , $224.82 ," $1,538.43 "," $1,713.60 "," $1,611.93 "," $1,713.60 "," $1,713.60 "," $1,713.60 "," $1,618.40 ", $220.41 ," $1,757.96 "," $1,808.80 "," $1,618.40 "," $1,770.72 "," $1,770.72 "," $1,808.80 "," $1,827.84 "," $1,557.85 "," $1,713.60 "," $1,618.40 "," $1,504.16 ", N/A ," $1,540.91 "," $1,540.91 "," $1,808.80 "," $1,633.82 ", $214.65 ," $1,827.84 "
Fac Mod Sed Other Phys/Qhp Each Addl 15 Mins,99157,N/A,N/A,N/A, $582.00 , $378.30 , $142.51 , $59.83 , $45.63 , $123.23 , $126.41 , $541.26 , $523.80 , $523.80 , $465.60 , $465.60 , $45.63 , $537.36 , $552.90 , $523.80 , $523.80 , $523.80 , $541.26 , $558.72 , $190.57 , $494.70 , $184.77 , $216.69 , N/A , $125.64 , $125.64 , $552.90 , $146.45 , $45.63 , $558.72 
Simple Repair 7.6-12.5cm,12004,N/A,N/A,N/A, $848.00 , $551.20 , $227.60 , $67.81 , $89.32 , $199.60 , $193.84 , $788.64 , $763.20 , $763.20 , $678.40 , $678.40 , $89.32 , $782.96 , $805.60 , $763.20 , $763.20 , $763.20 , $788.64 , $814.08 , $250.63 , $720.80 , $388.93 , $254.00 , N/A , $203.50 , $203.50 , $805.60 , $235.99 , $67.81 , $814.08 
 Fac Assay of Magnesium ,CPT® 83735,0301 - LAB/CHEMISTRY,N/A,N/A, $80.00 , $52.00 , $67.20 , $6.83 , $6.83 , $64.64 , $72.00 , $67.73 , $72.00 , $72.00 , $72.00 , $68.00 , $6.70 , $73.86 , $76.00 , $68.00 , $74.40 , $74.40 , $76.00 , $76.80 , $65.46 , $72.00 , $68.00 , $63.20 , N/A , $64.74 , $64.74 , $76.00 , $68.65 , $6.70 , $76.80 
"Remove FB,Intranasal",30300,N/A,N/A,N/A, $522.00 , $339.30 , $688.10 , $121.29 , $64.81 , $481.74 , $495.34 , $485.46 , $469.80 , $469.80 , $417.60 , $417.60 , $64.81 , $481.96 , $495.90 , $469.80 , $469.80 , $469.80 , $485.46 , $501.12 , $637.33 , $443.70 , $695.78 , $541.12 , N/A , $491.14 , $491.14 , $495.90 , $578.42 , $64.81 , $695.78 
 Fac Image-Guide Fluid Collxn Drainage Cath Visc Perq ,CPT® 49405,0361 - OR/MINOR,N/A,N/A," $5,262.00 "," $3,420.30 "," $4,420.08 ", $185.07 , $162.82 ," $4,251.70 "," $4,735.80 "," $4,454.81 "," $4,735.80 "," $4,735.80 "," $4,735.80 "," $4,472.70 ", $159.63 ," $4,858.40 "," $4,998.90 "," $4,472.70 "," $4,893.66 "," $4,893.66 "," $4,998.90 "," $5,051.52 "," $4,305.37 "," $4,735.80 "," $4,472.70 "," $4,156.98 ", N/A ," $4,258.54 "," $4,258.54 "," $4,998.90 "," $4,515.32 ", $159.63 ," $5,051.52 "
Removal Subcutaneous Cardiac Rhythm Monitor,CPT® 33286,N/A,N/A,N/A," $1,225.00 ", $796.25 , $510.51 , $78.86 , $102.59 , $347.21 , N/A ," $1,139.25 "," $1,102.50 "," $1,102.50 ", $980.00 , $980.00 , $102.59 ," $1,131.04 "," $1,163.75 "," $1,102.50 "," $1,102.50 "," $1,102.50 "," $1,139.25 "," $1,176.00 ", $473.58 ," $1,041.25 ", $453.12 , $420.79 , N/A , $353.98 , $353.98 ," $1,163.75 ", $402.13 , $78.86 ," $1,176.00 "
 Pro Esophagoscopy Flex Transoral Lesion Ablation ,CPT® 43229,0982 - PRO FEE/OUTPT,N/A,N/A," $1,313.00 ", $853.45 ," $1,204.32 ", $186.05 , $156.39 , $990.75 ," $1,027.50 "," $1,221.09 "," $1,181.70 "," $1,181.70 "," $1,050.40 "," $1,050.40 ", $156.39 ," $1,212.29 "," $1,247.35 "," $1,181.70 "," $1,181.70 "," $1,181.70 "," $1,221.09 "," $1,260.48 ", $866.13 ," $1,116.05 "," $1,025.30 "," $1,148.50 ", N/A ," $1,010.08 "," $1,010.08 "," $1,247.35 "," $1,056.44 ", $156.39 ," $1,260.48 "
Assay for Tobramycin,CPT® 80200,N/A,N/A,N/A, $136.00 , $88.40 , N/A , $16.45 , $16.45 , $91.22 , $109.10 , $126.48 , $122.40 , $122.40 , $108.80 , $108.80 , $16.45 , $125.57 , $129.20 , $122.40 , $122.40 , $122.40 , $126.48 , $130.56 , $107.70 , $115.60 , $105.42 , $58.48 , N/A , $85.13 , $85.13 , $129.20 , $93.03 , $16.45 , $130.56 
Repair Nonunion Radius and Ulna,CPT® 25415,N/A,N/A,N/A," $6,480.00 "," $4,212.00 "," $5,870.54 ", $918.50 , $804.14 ," $4,661.35 "," $4,617.26 "," $6,026.40 "," $5,832.00 "," $5,832.00 "," $5,184.00 "," $5,184.00 ", $804.14 ," $5,982.98 "," $6,156.00 "," $5,832.00 "," $5,832.00 "," $5,832.00 "," $6,026.40 "," $6,220.80 "," $5,463.48 "," $5,508.00 "," $5,105.99 "," $5,481.87 ", N/A ," $4,752.30 "," $4,752.30 "," $6,156.00 "," $5,585.65 ", $804.14 ," $6,220.80 "
 Fac Nfct Agent Dna/Rna Gastrointestinal Pathogen ,CPT® 87505,0306 - LAB/BACT-MICRO,N/A,N/A, $905.00 , $588.25 , $760.20 , $130.86 , $130.86 , $731.24 , $814.50 , $766.17 , $814.50 , $814.50 , $814.50 , $769.25 , $128.29 , $835.59 , $859.75 , $769.25 , $841.65 , $841.65 , $859.75 , $868.80 , $740.47 , $814.50 , $769.25 , $714.95 , N/A , $732.42 , $732.42 , $859.75 , $776.58 , $128.29 , $868.80 
Trurl Dstrj Prst8 Tiss Rf Wv Thermotherapy,CPT® 53854,N/A,N/A,N/A," $12,663.00 "," $8,230.95 "," $2,064.02 ", $365.04 , N/A ," $1,723.74 ", N/A ," $11,776.59 "," $11,396.70 "," $11,396.70 "," $10,130.40 "," $10,130.40 ", N/A ," $11,691.75 "," $12,029.85 "," $11,396.70 "," $11,396.70 "," $11,396.70 "," $11,776.59 "," $12,156.48 "," $2,061.64 "," $10,763.55 "," $2,004.39 "," $2,310.41 ", N/A ," $1,757.37 "," $1,757.37 "," $12,029.85 "," $2,065.54 ", $365.04 ," $12,156.48 "
Clear Outer Ear Canal,69200,N/A,N/A,N/A, $369.00 , $239.85 , $222.00 , $45.22 , $46.62 , $277.17 , $286.82 , $343.17 , $332.10 , $332.10 , $295.20 , $295.20 , $46.62 , $340.70 , $350.55 , $332.10 , $332.10 , $332.10 , $343.17 , $354.24 , $241.42 , $313.65 , $312.21 , $230.70 , N/A , $282.58 , $282.58 , $350.55 , $322.66 , $45.22 , $354.24 
" Pro Lap, Repair Paraesophageal Hernia, Incl Fundoplasty W/O Mesh ",CPT® 43281,0982 - PRO FEE/OUTPT,N/A,N/A," $10,192.00 "," $6,624.80 "," $9,099.87 "," $1,405.68 "," $1,292.22 "," $7,254.46 "," $7,295.52 "," $9,478.56 "," $9,172.80 "," $9,172.80 "," $8,153.60 "," $8,153.60 "," $1,292.22 "," $9,410.27 "," $9,682.40 "," $9,172.80 "," $9,172.80 "," $9,172.80 "," $9,478.56 "," $9,784.32 "," $6,537.25 "," $8,663.20 "," $8,131.76 "," $8,532.66 ", N/A ," $7,396.00 "," $7,396.00 "," $9,682.40 "," $7,735.44 "," $1,292.22 "," $9,784.32 "
Exploration of Hip Joint,CPT® 27033,N/A,N/A,N/A," $6,433.00 "," $4,181.45 "," $5,880.88 ", $920.13 , $893.47 ," $4,685.39 "," $4,651.42 "," $5,982.69 "," $5,789.70 "," $5,789.70 "," $5,146.40 "," $5,146.40 ", $893.47 ," $5,939.59 "," $6,111.35 "," $5,789.70 "," $5,789.70 "," $5,789.70 "," $5,982.69 "," $6,175.68 "," $5,480.89 "," $5,468.05 "," $5,145.24 "," $5,509.04 ", N/A ," $4,776.80 "," $4,776.80 "," $6,111.35 "," $5,614.44 ", $893.47 ," $6,175.68 "
 Fac Unlis Px Int ,CPT® 44799,0360 - OR SERVICES,N/A,N/A," $1,938.00 "," $1,259.70 "," $1,627.92 ", N/A , N/A ," $1,565.90 "," $1,744.20 "," $1,640.71 "," $1,744.20 "," $1,744.20 "," $1,744.20 "," $1,647.30 ", N/A ," $1,789.36 "," $1,841.10 "," $1,647.30 "," $1,802.34 "," $1,802.34 "," $1,841.10 "," $1,860.48 "," $1,585.67 "," $1,744.20 "," $1,647.30 "," $1,531.02 ", N/A ," $1,568.42 "," $1,568.42 "," $1,841.10 "," $1,663.00 "," $1,531.02 "," $1,860.48 "
Online Digital E/M Svc Est Pt <7 D 5-10 Minutes,CPT® 99421,N/A,N/A,N/A, $49.00 , $31.85 , $26.12 , $12.47 , $11.93 , $22.17 , N/A , $45.57 , $44.10 , $44.10 , $39.20 , $39.20 , $11.93 , $45.24 , $46.55 , $44.10 , $44.10 , $44.10 , $45.57 , $47.04 , $23.23 , $41.65 , $28.39 , $28.50 , N/A , $22.60 , $22.60 , $46.55 , $25.96 , $11.93 , $47.04 
 Pro Liver and Spleen Imaging ,CPT® 78215,0974 - PRO FEE/NUC MED,N/A,N/A, $149.00 , $96.85 ," $1,051.08 ", $180.78 , $140.80 , $953.25 ," $1,041.73 ", $138.57 , $134.10 , $134.10 , $119.20 , $119.20 , $140.80 , $137.57 , $141.55 , $134.10 , $134.10 , $134.10 , $138.57 , $143.04 ," $1,082.87 ", $126.65 ," $1,138.29 "," $1,306.45 ", N/A , $971.85 , $971.85 , $141.55 ," $1,124.95 ", $119.20 ," $1,306.45 "
Intro Needle/Intracath Extremity Artery,CPT® 36140,N/A,N/A,N/A," $3,190.00 "," $2,073.50 ", $525.14 , $80.72 , $72.41 , $442.25 , $435.61 ," $2,966.70 "," $2,871.00 "," $2,871.00 "," $2,552.00 "," $2,552.00 ", $72.41 ," $2,945.33 "," $3,030.50 "," $2,871.00 "," $2,871.00 "," $2,871.00 "," $2,966.70 "," $3,062.40 ", $485.84 ," $2,711.50 ", $545.92 , $438.77 , N/A , $450.88 , $450.88 ," $3,030.50 ", $512.22 , $72.41 ," $3,062.40 "
 CLINDAMYCIN PHOSPHATE 300 MG/2ML IJ SOLN ,HCPCS J0736,0636 - DRUGS REQUIRING DETAILED CODIN,00009-0870-26,2 mL, $16.68 , $10.84 , $14.01 , N/A , N/A , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , N/A , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $13.18 , $16.01 
Leuprolide Acetate /3.75 Mg,HCPCS J1950,N/A,N/A,N/A," $1,368.00 ", $889.20 , N/A ," $1,574.39 "," $1,510.51 ", N/A , N/A ," $1,272.24 "," $1,231.20 "," $1,231.20 "," $1,094.40 "," $1,094.40 "," $1,510.51 "," $1,263.07 "," $1,299.60 "," $1,231.20 "," $1,231.20 "," $1,231.20 "," $1,272.24 "," $1,313.28 "," $1,699.72 "," $1,162.80 "," $1,283.23 "," $2,070.05 ", N/A , N/A , N/A ," $1,299.60 ", N/A ," $1,094.40 "," $2,070.05 "
Insertion Epicardial Electrode Open,CPT® 33202,N/A,N/A,N/A," $8,379.00 "," $5,446.35 "," $4,524.59 ", $700.93 , $937.08 ," $3,307.06 "," $3,289.19 "," $7,792.47 "," $7,541.10 "," $7,541.10 "," $6,703.20 "," $6,703.20 ", $937.08 ," $7,736.33 "," $7,960.05 "," $7,541.10 "," $7,541.10 "," $7,541.10 "," $7,792.47 "," $8,043.84 "," $4,187.22 "," $7,122.15 "," $4,155.09 "," $3,721.00 ", N/A ," $3,371.59 "," $3,371.59 "," $7,960.05 "," $3,830.11 ", $700.93 ," $8,043.84 "
 PHOSPHA 250 NEUTRAL 155-852-130 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,64980-0104-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Rubella Antibody ,CPT® 86762,0302 - LAB/IMMUNOLOGY,N/A,N/A, $133.00 , $86.45 , $111.72 , $14.68 , $14.68 , $107.46 , $119.70 , $112.60 , $119.70 , $119.70 , $119.70 , $113.05 , $14.39 , $122.80 , $126.35 , $113.05 , $123.69 , $123.69 , $126.35 , $127.68 , $108.82 , $119.70 , $113.05 , $105.07 , N/A , $107.64 , $107.64 , $126.35 , $114.13 , $14.39 , $127.68 
 Pro Treatment of Tibia Fracture ,CPT® 27758,0982 - PRO FEE/OUTPT,N/A,N/A," $5,212.00 "," $3,387.80 "," $5,440.05 ", $851.77 , $775.54 ," $4,302.26 "," $4,276.45 "," $4,847.16 "," $4,690.80 "," $4,690.80 "," $4,169.60 "," $4,169.60 ", $775.54 ," $4,812.24 "," $4,951.40 "," $4,690.80 "," $4,690.80 "," $4,690.80 "," $4,847.16 "," $5,003.52 "," $5,056.37 "," $4,430.20 "," $4,725.99 "," $5,063.13 ", N/A ," $4,386.20 "," $4,386.20 "," $4,951.40 "," $5,155.35 ", $775.54 ," $5,440.05 "
 VENLAFAXINE HCL 75 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,57237-0175-01,1 tablet, $11.23 , $7.30 , $9.43 , N/A , N/A , $9.07 , $10.11 , $9.51 , $10.11 , $10.11 , $10.11 , $9.55 , N/A , $10.37 , $10.67 , $9.55 , $10.44 , $10.44 , $10.67 , $10.78 , $9.19 , $10.11 , $9.55 , $8.87 , N/A , $9.09 , $9.09 , $10.67 , $9.64 , $8.87 , $10.78 
"Manual Ther Tech,1+Regions,Ea 15 Min",CPT® 97140,N/A,N/A,N/A, $145.00 , $94.25 , $63.60 , $27.12 , $27.60 , $67.77 , $60.79 , $134.85 , $130.50 , $130.50 , $116.00 , $116.00 , $27.60 , $133.88 , $137.75 , $130.50 , $130.50 , $130.50 , $134.85 , $139.20 , $69.02 , $123.25 , $89.21 , $63.42 , N/A , $69.10 , $69.10 , $137.75 , $76.86 , $27.12 , $139.20 
"Open Skull,Decompres,W/Duraplasty",CPT® 61322,N/A,N/A,N/A," $15,145.00 "," $9,844.25 "," $10,830.87 "," $2,114.50 "," $1,745.13 "," $12,810.24 "," $12,224.27 "," $14,084.85 "," $13,630.50 "," $13,630.50 "," $12,116.00 "," $12,116.00 "," $1,745.13 "," $13,983.38 "," $14,387.75 "," $13,630.50 "," $13,630.50 "," $13,630.50 "," $14,084.85 "," $14,539.20 "," $11,690.65 "," $12,873.25 "," $12,579.44 "," $13,220.66 ", N/A ," $13,060.20 "," $13,060.20 "," $14,387.75 "," $14,010.52 "," $1,745.13 "," $14,539.20 "
 CHLOROPROCAINE HCL (PF) 3 % IJ SOLN ,HCPCS J2401,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9210-10,20 mL, $137.98 , $89.69 , $115.90 , $0.04 , $0.04 , $111.49 , $124.18 , $116.81 , $124.18 , $124.18 , $124.18 , $117.28 , $0.04 , $127.40 , $131.08 , $117.28 , $128.32 , $128.32 , $131.08 , $132.46 , $112.90 , $124.18 , $117.28 , $109.00 , N/A , $111.67 , $111.67 , $131.08 , $118.40 , $0.04 , $132.46 
 I 131 Dose-Wb per Mci ,HCPCS A9528,0343 - DIAGNOSTIC RADIOPHARMACEUTICALS,N/A,N/A, $334.00 , $217.10 , $280.56 , N/A , $32.95 , $269.87 , $300.60 , $282.76 , $300.60 , $300.60 , $300.60 , $283.90 , $32.30 , $308.38 , $317.30 , $283.90 , $310.62 , $310.62 , $317.30 , $320.64 , $273.28 , $300.60 , $283.90 , $263.86 , N/A , $270.31 , $270.31 , $317.30 , $286.61 , $32.30 , $320.64 
 IFOSFAMIDE 1 GM/20ML IV SOLN ,HCPCS J9208,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9531-01,20 mL, $108.06 , $70.24 , $90.77 , $25.89 , $26.91 , $87.31 , $97.25 , $91.48 , $97.25 , $97.25 , $97.25 , $91.85 , $26.38 , $99.77 , $102.66 , $91.85 , $100.50 , $100.50 , $102.66 , $103.74 , $88.41 , $97.25 , $91.85 , $85.37 , N/A , $87.45 , $87.45 , $102.66 , $92.73 , $25.89 , $103.74 
"Excis Synov Wrist,Extens Tendon",CPT® 25118,N/A,N/A,N/A," $2,919.00 "," $1,897.35 "," $2,358.72 ", $371.98 , $416.39 ," $1,836.15 "," $1,841.28 "," $2,714.67 "," $2,627.10 "," $2,627.10 "," $2,335.20 "," $2,335.20 ", $416.39 ," $2,695.11 "," $2,773.05 "," $2,627.10 "," $2,627.10 "," $2,627.10 "," $2,714.67 "," $2,802.24 "," $2,185.85 "," $2,481.15 "," $2,021.34 "," $2,182.05 ", N/A ," $1,871.98 "," $1,871.98 "," $2,773.05 "," $2,200.23 ", $371.98 ," $2,802.24 "
 TRYPAN BLUE 0.06 % IO SOSY ,HCPCS RXA250,0250 - PHARMACY,68803-0612-10,0.5 mL, $470.34 , $305.72 , $395.09 , N/A , N/A , $380.03 , $423.31 , $398.19 , $423.31 , $423.31 , $423.31 , $399.79 , N/A , $434.26 , $446.82 , $399.79 , $437.42 , $437.42 , $446.82 , $451.53 , $384.83 , $423.31 , $399.79 , $371.57 , N/A , $380.65 , $380.65 , $446.82 , $403.60 , $371.57 , $451.53 
 Fac Automated Platelet Count ,CPT® 85049,0305 - LAB/HEMATOLOGY,N/A,N/A, $51.00 , $33.15 , $42.84 , $4.57 , $4.57 , $41.21 , $45.90 , $43.18 , $45.90 , $45.90 , $45.90 , $43.35 , $4.48 , $47.09 , $48.45 , $43.35 , $47.43 , $47.43 , $48.45 , $48.96 , $41.73 , $45.90 , $43.35 , $40.29 , N/A , $41.27 , $41.27 , $48.45 , $43.76 , $4.48 , $48.96 
 Fac Njx Px Antegrde Nfrosgrm &/Urtrgrm New Access ,CPT® 50430,0761 - TREATMENT ROOM,N/A,N/A," $1,243.00 ", $807.95 ," $1,044.12 ", $145.85 , $413.62 ," $1,004.34 "," $1,118.70 "," $1,052.32 "," $1,118.70 "," $1,118.70 "," $1,118.70 "," $1,056.55 ", $405.51 ," $1,147.66 "," $1,180.85 "," $1,056.55 "," $1,155.99 "," $1,155.99 "," $1,180.85 "," $1,193.28 "," $1,017.02 "," $1,118.70 "," $1,056.55 ", $981.97 , N/A ," $1,005.96 "," $1,005.96 "," $1,180.85 "," $1,066.62 ", $145.85 ," $1,193.28 "
"Puncture Abscesss,Cyst,He",CPT® 10160,N/A,N/A,N/A, $490.00 , $318.50 , $307.12 , $92.99 , $30.77 , $262.79 , $257.92 , $455.70 , $441.00 , $441.00 , $392.00 , $392.00 , $30.77 , $452.42 , $465.50 , $441.00 , $441.00 , $441.00 , $455.70 , $470.40 , $335.46 , $416.50 , $510.24 , $335.24 , N/A , $267.91 , $267.91 , $465.50 , $310.70 , $30.77 , $510.24 
 Other Kidney And Urinary Tract Diagnoses With Cc ,MS DRG V40 (FY2023) 699,N/A,N/A,N/A," $13,187.23 "," $8,571.70 "," $11,077.27 ", N/A , N/A ," $10,655.28 "," $11,868.51 "," $11,164.31 "," $11,868.51 "," $11,868.51 "," $11,868.51 "," $11,209.15 ", N/A ," $12,175.77 "," $12,527.87 "," $11,209.15 "," $12,264.12 "," $12,264.12 "," $12,527.87 "," $12,659.74 "," $10,789.79 "," $11,868.51 "," $11,209.15 "," $10,417.91 ", N/A ," $10,672.43 "," $10,672.43 "," $12,527.87 "," $11,315.96 "," $10,417.91 "," $12,659.74 "
 LORATADINE-PSEUDOEPHEDRINE ER 5-120 MG PO TB12 ,HCPCS RXC637,0250 - PHARMACY,45802-0122-60,1 tablet, $5.78 , $3.76 , $4.86 , N/A , N/A , $4.67 , $5.20 , $4.89 , $5.20 , $5.20 , $5.20 , $4.91 , N/A , $5.34 , $5.49 , $4.91 , $5.38 , $5.38 , $5.49 , $5.55 , $4.73 , $5.20 , $4.91 , $4.57 , N/A , $4.68 , $4.68 , $5.49 , $4.96 , $4.57 , $5.55 
App Skn Sub Grft T/a/L Area/<100scm Ea Adl 25scm,CPT® 15272,N/A,N/A,N/A, $160.00 , $104.00 , $54.57 , $15.78 , $21.08 , $47.60 , $45.05 , $148.80 , $144.00 , $144.00 , $128.00 , $128.00 , $21.08 , $147.73 , $152.00 , $144.00 , $144.00 , $144.00 , $148.80 , $153.60 , $59.43 , $136.00 , $89.20 , $61.56 , N/A , $48.53 , $48.53 , $152.00 , $56.28 , $15.78 , $153.60 
X-Ray Exam of Finger(S),CPT® 73140,N/A,N/A,N/A, $231.00 , $150.15 , $210.66 , $37.22 , $23.98 , $146.89 , $179.94 , $214.83 , $207.90 , $207.90 , $184.80 , $184.80 , $23.98 , $213.28 , $219.45 , $207.90 , $207.90 , $207.90 , $214.83 , $221.76 , $204.23 , $196.35 , $198.38 , $161.69 , N/A , $149.76 , $149.76 , $219.45 , $173.35 , $23.98 , $221.76 
 ROPINIROLE HCL 0.25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6373-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Revise Fem Part Oftotal Hip,27138,N/A,N/A,N/A," $10,107.00 "," $6,569.55 "," $9,150.12 "," $1,427.88 "," $1,251.82 "," $7,397.03 "," $7,312.86 "," $9,399.51 "," $9,096.30 "," $9,096.30 "," $8,085.60 "," $8,085.60 "," $1,251.82 "," $9,331.79 "," $9,601.65 "," $9,096.30 "," $9,096.30 "," $9,096.30 "," $9,399.51 "," $9,702.72 "," $8,543.88 "," $8,590.95 "," $8,101.43 "," $8,692.39 ", N/A ," $7,541.36 "," $7,541.36 "," $9,601.65 "," $8,863.76 "," $1,251.82 "," $9,702.72 "
 HEPARIN (PORCINE) IN NACL 1000-0.9 UT/500ML-% IV SOLN ,HCPCS J1644,0636 - DRUGS REQUIRING DETAILED CODIN,00409-7620-03,500 mL, $33.39 , $21.70 , $28.05 , $0.27 , $0.27 , $26.98 , $30.05 , $28.27 , $30.05 , $30.05 , $30.05 , $28.38 , $0.26 , $30.83 , $31.72 , $28.38 , $31.05 , $31.05 , $31.72 , $32.05 , $27.32 , $30.05 , $28.38 , $26.38 , N/A , $27.02 , $27.02 , $31.72 , $28.65 , $0.26 , $32.05 
Mast Prtl,19301,N/A,N/A,N/A," $2,533.00 "," $1,646.45 "," $2,067.03 ", $612.83 , $305.59 ," $1,752.29 "," $1,701.51 "," $2,355.69 "," $2,279.70 "," $2,279.70 "," $2,026.40 "," $2,026.40 ", $305.59 ," $2,338.72 "," $2,406.35 "," $2,279.70 "," $2,279.70 "," $2,279.70 "," $2,355.69 "," $2,431.68 "," $2,255.88 "," $2,153.05 "," $3,436.11 "," $2,213.34 ", N/A ," $1,786.48 "," $1,786.48 "," $2,406.35 "," $2,071.72 ", $305.59 ," $3,436.11 "
Cov-19 amp prb hgh thruput,HCPCS U0003,N/A,N/A,N/A, $221.00 , $143.65 , N/A , $76.50 , $76.50 , N/A , N/A , $205.53 , $198.90 , $198.90 , $176.80 , $176.80 , $76.50 , $204.05 , $209.95 , $198.90 , $198.90 , $198.90 , $205.53 , $212.16 , $500.79 , $187.85 , $142.80 , $293.70 , N/A , $423.86 , $423.86 , $209.95 , $463.18 , $76.50 , $500.79 
Clear Outer Ear Canal,CPT® 69200,N/A,N/A,N/A, $711.00 , $462.15 , $222.00 , $45.22 , $46.62 , $277.17 , $286.82 , $661.23 , $639.90 , $639.90 , $568.80 , $568.80 , $46.62 , $656.47 , $675.45 , $639.90 , $639.90 , $639.90 , $661.23 , $682.56 , $241.42 , $604.35 , $312.21 , $230.70 , N/A , $282.58 , $282.58 , $675.45 , $322.66 , $45.22 , $682.56 
 Pro Follow-Up Surgery of Eye ,CPT® 66250,0982 - PRO FEE/OUTPT,N/A,N/A," $6,873.00 "," $4,467.45 "," $3,422.77 ", $537.39 , $620.01 ," $3,153.41 "," $2,988.49 "," $6,391.89 "," $6,185.70 "," $6,185.70 "," $5,498.40 "," $5,498.40 ", $620.01 ," $6,345.84 "," $6,529.35 "," $6,185.70 "," $6,185.70 "," $6,185.70 "," $6,391.89 "," $6,598.08 "," $4,701.06 "," $5,842.05 "," $3,102.49 "," $4,008.02 ", N/A ," $3,214.94 "," $3,214.94 "," $6,529.35 "," $3,548.88 ", $537.39 ," $6,598.08 "
Sgmdsc Flx Rmvl Tum Polyp/Oth Les Snare Tq,CPT® 45338,N/A,N/A,N/A," $2,391.00 "," $1,554.15 ", $736.26 , $113.74 , $150.61 , $669.17 , $687.26 ," $2,223.63 "," $2,151.90 "," $2,151.90 "," $1,912.80 "," $1,912.80 ", $150.61 ," $2,207.61 "," $2,271.45 "," $2,151.90 "," $2,151.90 "," $2,151.90 "," $2,223.63 "," $2,295.36 ", $528.04 ," $2,032.35 ", $752.88 , $700.61 , N/A , $682.23 , $682.23 ," $2,271.45 ", $713.53 , $113.74 ," $2,295.36 "
 Fac Brca2 Gene Analysis Full Dup/Del Analysis ,CPT® 81167,0310 - PATHOLOGY LAB,N/A,N/A, $6.00 , $3.90 , $5.04 , $288.54 , $230.83 , $4.85 , $5.40 , $5.08 , $5.40 , $5.40 , $5.40 , $5.10 , $226.30 , $5.54 , $5.70 , $5.10 , $5.58 , $5.58 , $5.70 , $5.76 , $4.91 , $5.40 , $5.10 , $4.74 , N/A , $4.86 , $4.86 , $5.70 , $5.15 , $4.74 , $288.54 
 Fac Revsc Opn/Prq Iliac Art W/Stnt Plmt & Angioplsty ,CPT® 37221,0360 - OR SERVICES,N/A,N/A," $21,804.00 "," $14,172.60 "," $18,315.36 ", $440.14 , $374.92 ," $17,617.63 "," $19,623.60 "," $18,459.27 "," $19,623.60 "," $19,623.60 "," $19,623.60 "," $18,533.40 ", $367.57 ," $20,131.63 "," $20,713.80 "," $18,533.40 "," $20,277.72 "," $20,277.72 "," $20,713.80 "," $20,931.84 "," $17,840.03 "," $19,623.60 "," $18,533.40 "," $17,225.16 ", N/A ," $17,645.98 "," $17,645.98 "," $20,713.80 "," $18,710.01 ", $367.57 ," $20,931.84 "
"Fx Humeral,Closed W/O Man",24560,N/A,N/A,N/A," $1,189.00 ", $772.85 ," $1,833.33 ", $291.21 , $184.42 ," $1,380.07 "," $1,410.71 "," $1,105.77 "," $1,070.10 "," $1,070.10 ", $951.20 , $951.20 , $184.42 ," $1,097.80 "," $1,129.55 "," $1,070.10 "," $1,070.10 "," $1,070.10 "," $1,105.77 "," $1,141.44 "," $1,695.22 "," $1,010.65 "," $1,548.57 "," $1,649.44 ", N/A ," $1,407.00 "," $1,407.00 "," $1,129.55 "," $1,653.71 ", $184.42 ," $1,833.33 "
 TRANEXAMIC ACID 1000 MG/10ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,81284-0611-10,10 mL, $33.91 , $22.04 , $28.48 , N/A , N/A , $27.40 , $30.52 , $28.71 , $30.52 , $30.52 , $30.52 , $28.82 , N/A , $31.31 , $32.21 , $28.82 , $31.54 , $31.54 , $32.21 , $32.55 , $27.75 , $30.52 , $28.82 , $26.79 , N/A , $27.44 , $27.44 , $32.21 , $29.10 , $26.79 , $32.55 
" Layer Closure Neck, Genitalia, Hands,Feet 20.1-30cm ",CPT® 12046,0981 - PRO FEE/ER,N/A,N/A," $2,056.00 "," $1,336.40 ", $995.01 , $295.31 , $292.55 , $840.68 , $902.38 ," $1,912.08 "," $1,850.40 "," $1,850.40 "," $1,644.80 "," $1,644.80 ", $292.55 ," $1,898.30 "," $1,953.20 "," $1,850.40 "," $1,850.40 "," $1,850.40 "," $1,912.08 "," $1,973.76 "," $1,085.71 "," $1,747.60 "," $1,809.04 "," $1,062.50 ", N/A , $857.08 , $857.08 ," $1,953.20 ", $993.92 , $292.55 ," $1,973.76 "
Drug Screening Gabapentin Non-Blood,CPT® 80355,N/A,N/A,N/A, $207.00 , $134.55 , N/A , N/A , N/A , N/A , N/A , $192.51 , $186.30 , $186.30 , $165.60 , $165.60 , N/A , $191.12 , $196.65 , $186.30 , $186.30 , $186.30 , $192.51 , $198.72 , N/A , $175.95 , $114.69 , $67.79 , N/A , $90.04 , $90.04 , $196.65 , $98.20 , $67.79 , $198.72 
 Pulmonary Embolism With McC Or Acute Cor Pulmonale ,MS DRG V40 (FY2023) 175,N/A,N/A,N/A," $25,236.05 "," $16,403.43 "," $21,198.28 ", N/A , N/A ," $20,390.73 "," $22,712.45 "," $21,364.84 "," $22,712.45 "," $22,712.45 "," $22,712.45 "," $21,450.64 ", N/A ," $23,300.44 "," $23,974.25 "," $21,450.64 "," $23,469.53 "," $23,469.53 "," $23,974.25 "," $24,226.61 "," $20,648.14 "," $22,712.45 "," $21,450.64 "," $19,936.48 ", N/A ," $20,423.54 "," $20,423.54 "," $23,974.25 "," $21,655.05 "," $19,936.48 "," $24,226.61 "
"Explor Penet Wound,Extrem",20103,N/A,N/A,N/A," $3,902.00 "," $2,536.30 "," $2,087.15 ", $325.90 , $335.70 ," $1,680.45 "," $1,671.86 "," $3,628.86 "," $3,511.80 "," $3,511.80 "," $3,121.60 "," $3,121.60 ", $335.70 ," $3,602.72 "," $3,706.90 "," $3,511.80 "," $3,511.80 "," $3,511.80 "," $3,628.86 "," $3,745.92 "," $1,945.11 "," $3,316.70 "," $1,846.51 "," $1,988.52 ", N/A ," $1,713.23 "," $1,713.23 "," $3,706.90 "," $2,013.66 ", $325.90 ," $3,745.92 "
 OSELTAMIVIR PHOSPHATE 75 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,68180-0677-11,1 capsule, $79.41 , $51.62 , $66.70 , N/A , N/A , $64.16 , $71.47 , $67.23 , $71.47 , $71.47 , $71.47 , $67.50 , N/A , $73.32 , $75.44 , $67.50 , $73.85 , $73.85 , $75.44 , $76.23 , $64.97 , $71.47 , $67.50 , $62.73 , N/A , $64.27 , $64.27 , $75.44 , $68.14 , $62.73 , $76.23 
 Pro Treat Fracture Radius & Ulna ,CPT® 25560,0982 - PRO FEE/OUTPT,N/A,N/A," $1,798.00 "," $1,168.70 "," $1,610.31 ", $255.85 , $202.15 ," $1,207.93 "," $1,232.28 "," $1,672.14 "," $1,618.20 "," $1,618.20 "," $1,438.40 "," $1,438.40 ", $202.15 ," $1,660.09 "," $1,708.10 "," $1,618.20 "," $1,618.20 "," $1,618.20 "," $1,672.14 "," $1,726.08 "," $1,481.60 "," $1,528.30 "," $1,352.32 "," $1,443.52 ", N/A ," $1,231.51 "," $1,231.51 "," $1,708.10 "," $1,447.45 ", $202.15 ," $1,726.08 "
" Fac X-Ray Guide, GI Dilation ",CPT® 74360,0320 - DX X-RAY,N/A,N/A, $733.00 , $476.45 , $615.72 , $155.79 , $151.14 , $592.26 , $659.70 , $620.56 , $659.70 , $659.70 , $659.70 , $623.05 , $148.18 , $676.78 , $696.35 , $623.05 , $681.69 , $681.69 , $696.35 , $703.68 , $599.74 , $659.70 , $623.05 , $579.07 , N/A , $593.22 , $593.22 , $696.35 , $628.99 , $148.18 , $703.68 
 Fac Enteroscopy > 2nd Prtn Conv Gstrst Tube ,CPT® 44373,0360 - OR SERVICES,N/A,N/A," $2,601.00 "," $1,690.65 "," $2,184.84 ", $180.72 , $191.75 ," $2,101.61 "," $2,340.90 "," $2,202.01 "," $2,340.90 "," $2,340.90 "," $2,340.90 "," $2,210.85 ", $187.99 ," $2,401.50 "," $2,470.95 "," $2,210.85 "," $2,418.93 "," $2,418.93 "," $2,470.95 "," $2,496.96 "," $2,128.14 "," $2,340.90 "," $2,210.85 "," $2,054.79 ", N/A ," $2,104.99 "," $2,104.99 "," $2,470.95 "," $2,231.92 ", $180.72 ," $2,496.96 "
" Fac Scr C/V Cyto,Thinlayer,Rescr ",HCPCS G0145,0311 - PATHOL/CYTOLOGY,N/A,N/A, $188.00 , $122.20 , $157.92 , $27.02 , $27.02 , $151.90 , $169.20 , $159.16 , $169.20 , $169.20 , $169.20 , $159.80 , $26.49 , $173.58 , $178.60 , $159.80 , $174.84 , $174.84 , $178.60 , $180.48 , $153.82 , $169.20 , $159.80 , $148.52 , N/A , $152.15 , $152.15 , $178.60 , $161.32 , $26.49 , $180.48 
 Pro Myocardial Perfusion Planar Multiple Studies ,CPT® 78454,0974 - PRO FEE/NUC MED,N/A,N/A, $460.00 , $299.00 ," $2,321.16 ", $398.86 , $159.47 ," $2,146.32 "," $2,337.20 ", $427.80 , $414.00 , $414.00 , $368.00 , $368.00 , $159.47 , $424.72 , $437.00 , $414.00 , $414.00 , $414.00 , $427.80 , $441.60 ," $2,400.33 ", $391.00 ," $2,548.15 "," $2,940.62 ", N/A ," $2,188.20 "," $2,188.20 ", $437.00 ," $2,532.86 ", $159.47 ," $2,940.62 "
 Fac Assay of Procalcitonin ,CPT® 84145,0301 - LAB/CHEMISTRY,N/A,N/A, $242.00 , $157.30 , $203.28 , $27.76 , $27.76 , $195.54 , $217.80 , $204.88 , $217.80 , $217.80 , $217.80 , $205.70 , $27.22 , $223.44 , $229.90 , $205.70 , $225.06 , $225.06 , $229.90 , $232.32 , $198.00 , $217.80 , $205.70 , $191.18 , N/A , $195.85 , $195.85 , $229.90 , $207.66 , $27.22 , $232.32 
 ACETAMINOPHEN 325 MG RE SUPP ,HCPCS RXC637,0250 - PHARMACY,51672-2116-02,1 suppository, $4.12 , $2.68 , $3.46 , N/A , N/A , $3.33 , $3.71 , $3.49 , $3.71 , $3.71 , $3.71 , $3.50 , N/A , $3.80 , $3.91 , $3.50 , $3.83 , $3.83 , $3.91 , $3.96 , $3.37 , $3.71 , $3.50 , $3.25 , N/A , $3.33 , $3.33 , $3.91 , $3.54 , $3.25 , $3.96 
 Fac Histoplasma ,CPT® 86698,0305 - LAB/HEMATOLOGY,N/A,N/A, $140.00 , $91.00 , $117.60 , $14.07 , $14.07 , $113.12 , $126.00 , $118.52 , $126.00 , $126.00 , $126.00 , $119.00 , $13.79 , $129.26 , $133.00 , $119.00 , $130.20 , $130.20 , $133.00 , $134.40 , $114.55 , $126.00 , $119.00 , $110.60 , N/A , $113.30 , $113.30 , $133.00 , $120.13 , $13.79 , $134.40 
 GLIMEPIRIDE 1 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,68084-0788-25,1 tablet, $5.18 , $3.37 , $4.35 , N/A , N/A , $4.19 , $4.66 , $4.39 , $4.66 , $4.66 , $4.66 , $4.40 , N/A , $4.78 , $4.92 , $4.40 , $4.82 , $4.82 , $4.92 , $4.97 , $4.24 , $4.66 , $4.40 , $4.09 , N/A , $4.19 , $4.19 , $4.92 , $4.44 , $4.09 , $4.97 
 FLECAINIDE ACETATE 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,50268-0320-15,1 tablet, $20.82 , $13.53 , $17.49 , N/A , N/A , $16.82 , $18.74 , $17.63 , $18.74 , $18.74 , $18.74 , $17.70 , N/A , $19.22 , $19.78 , $17.70 , $19.36 , $19.36 , $19.78 , $19.99 , $17.03 , $18.74 , $17.70 , $16.45 , N/A , $16.85 , $16.85 , $19.78 , $17.87 , $16.45 , $19.99 
 VANCOMYCIN HCL 750 MG IV SOLR ,HCPCS J3371,0636 - DRUGS REQUIRING DETAILED CODIN,00409-6531-02,15 mL, $60.63 , $39.41 , $50.93 , $6.43 , $6.66 , $48.99 , $54.57 , $51.33 , $54.57 , $54.57 , $54.57 , $51.54 , $6.53 , $55.98 , $57.60 , $51.54 , $56.39 , $56.39 , $57.60 , $58.20 , $49.61 , $54.57 , $51.54 , $47.90 , N/A , $49.07 , $49.07 , $57.60 , $52.03 , $6.43 , $58.20 
Layer Closure 7.6-12.5cm,CPT® 12044,N/A,N/A,N/A," $1,440.00 ", $936.00 , $680.71 , $204.36 , $138.28 , $588.98 , $571.43 ," $1,339.20 "," $1,296.00 "," $1,296.00 "," $1,152.00 "," $1,152.00 ", $138.28 ," $1,329.55 "," $1,368.00 "," $1,296.00 "," $1,296.00 "," $1,296.00 "," $1,339.20 "," $1,382.40 ", $745.42 ," $1,224.00 "," $1,141.80 ", $753.29 , N/A , $600.46 , $600.46 ," $1,368.00 ", $696.35 , $138.28 ," $1,382.40 "
 Pro Appl Short Leg Cst Belw Kne-Toe ,CPT® 29405,0981 - PRO FEE/ER,N/A,N/A, $353.00 , $229.45 , $353.21 , $55.88 , $70.65 , $291.95 , $292.92 , $328.29 , $317.70 , $317.70 , $282.40 , $282.40 , $70.65 , $325.92 , $335.35 , $317.70 , $317.70 , $317.70 , $328.29 , $338.88 , $330.82 , $300.05 , $319.35 , $344.75 , N/A , $297.65 , $297.65 , $335.35 , $349.86 , $55.88 , $353.21 
Ligat/Div/Excise Varicose Veins,CPT® 37785,N/A,N/A,N/A," $2,544.00 "," $1,653.60 "," $1,517.30 ", $233.50 , $76.84 ," $1,142.78 "," $1,148.15 "," $2,365.92 "," $2,289.60 "," $2,289.60 "," $2,035.20 "," $2,035.20 ", $76.84 ," $2,348.88 "," $2,416.80 "," $2,289.60 "," $2,289.60 "," $2,289.60 "," $2,365.92 "," $2,442.24 "," $1,405.07 "," $2,162.40 "," $1,436.17 "," $1,262.87 ", N/A ," $1,165.07 "," $1,165.07 "," $2,416.80 "," $1,323.51 ", $76.84 ," $2,442.24 "
Hospital IP/Obs Care Same Date Sf/Low Mdm 45 Min,CPT® 99234,N/A,N/A,N/A, $407.00 , $264.55 , $258.55 , $95.38 , $141.73 , $231.15 , $231.50 , $378.51 , $366.30 , $366.30 , $325.60 , $325.60 , $141.73 , $375.78 , $386.65 , $366.30 , $366.30 , $366.30 , $378.51 , $390.72 , $387.82 , $345.95 , $289.54 , $290.69 , N/A , $235.65 , $235.65 , $386.65 , $271.78 , $95.38 , $390.72 
Wrist Cock-Up Non-Molded,HCPCS L3908,N/A,N/A,N/A, $105.00 , $68.25 , N/A , $78.05 , $50.84 , N/A , N/A , $97.65 , $94.50 , $94.50 , $84.00 , $84.00 , $50.84 , $96.95 , $99.75 , $94.50 , $94.50 , $94.50 , $97.65 , $100.80 , N/A , $89.25 , $59.04 , $65.67 , N/A , N/A , N/A , $99.75 , N/A , $50.84 , $100.80 
Lens Sphc Trifo 7.25-12/2.25,HCPCS V2312,N/A,N/A,N/A, $90.00 , $58.50 , N/A , $112.24 , N/A , N/A , N/A , $83.70 , $81.00 , $81.00 , $72.00 , $72.00 , N/A , $83.10 , $85.50 , $81.00 , $81.00 , $81.00 , $83.70 , $86.40 , N/A , $76.50 , $90.00 , $101.98 , N/A , N/A , N/A , $85.50 , N/A , $72.00 , $112.24 
 RIVASTIGMINE TARTRATE 1.5 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,65862-0648-60,1 capsule, $23.95 , $15.57 , $20.12 , N/A , N/A , $19.35 , $21.56 , $20.28 , $21.56 , $21.56 , $21.56 , $20.36 , N/A , $22.11 , $22.75 , $20.36 , $22.27 , $22.27 , $22.75 , $22.99 , $19.60 , $21.56 , $20.36 , $18.92 , N/A , $19.38 , $19.38 , $22.75 , $20.55 , $18.92 , $22.99 
 Fac Egd Transoral Endoscopic Mucosal Resection ,CPT® 43254,0360 - OR SERVICES,N/A,N/A," $3,598.00 "," $2,338.70 "," $3,022.32 ", $255.85 , $211.95 ," $2,907.18 "," $3,238.20 "," $3,046.07 "," $3,238.20 "," $3,238.20 "," $3,238.20 "," $3,058.30 ", $207.79 ," $3,322.03 "," $3,418.10 "," $3,058.30 "," $3,346.14 "," $3,346.14 "," $3,418.10 "," $3,454.08 "," $2,943.88 "," $3,238.20 "," $3,058.30 "," $2,842.42 ", N/A ," $2,911.86 "," $2,911.86 "," $3,418.10 "," $3,087.44 ", $207.79 ," $3,454.08 "
" Removal Embedded Foreign Body, Eyelid - Mh ",CPT® 67938,0761 - TREATMENT ROOM,N/A,N/A," $1,125.00 ", $731.25 , $945.00 , $114.79 , $66.00 , $909.00 ," $1,012.50 ", $952.43 ," $1,012.50 "," $1,012.50 "," $1,012.50 ", $956.25 , $64.71 ," $1,038.71 "," $1,068.75 ", $956.25 ," $1,046.25 "," $1,046.25 "," $1,068.75 "," $1,080.00 ", $920.48 ," $1,012.50 ", $956.25 , $888.75 , N/A , $910.46 , $910.46 ," $1,068.75 ", $965.36 , $64.71 ," $1,080.00 "
 Pro Rpr Lac 2.5 Cm/< Floor Mouth&/Ant 2-3rd Tongue ,CPT® 41250,0982 - PRO FEE/OUTPT,N/A,N/A," $1,127.00 ", $732.55 , $929.57 , $146.64 , $61.48 , $746.18 , $778.43 ," $1,048.11 "," $1,014.30 "," $1,014.30 ", $901.60 , $901.60 , $61.48 ," $1,040.56 "," $1,070.65 "," $1,014.30 "," $1,014.30 "," $1,014.30 "," $1,048.11 "," $1,081.92 ", $673.07 , $957.95 , $852.78 , $890.69 , N/A , $760.74 , $760.74 ," $1,070.65 ", $795.64 , $61.48 ," $1,081.92 "
R & L Hrt Cath W/Njx L Ventriculog Img S&I,CPT® 93453,N/A,N/A,N/A," $7,324.00 "," $4,760.60 "," $7,417.67 "," $1,112.69 "," $1,213.92 "," $6,092.28 "," $6,523.49 "," $6,811.32 "," $6,591.60 "," $6,591.60 "," $5,859.20 "," $5,859.20 "," $1,213.92 "," $6,762.25 "," $6,957.80 "," $6,591.60 "," $6,591.60 "," $6,591.60 "," $6,811.32 "," $7,031.04 "," $6,974.88 "," $6,225.40 "," $6,197.84 "," $6,328.26 ", N/A ," $6,211.15 "," $6,211.15 "," $6,957.80 "," $6,885.13 "," $1,112.69 "," $7,417.67 "
"Emg,Needle,Thor Paraspin Mus,Exc T1/T12",CPT® 95869,N/A,N/A,N/A, $462.00 , $300.30 , $368.18 , $94.22 , $48.07 , $259.77 , $296.34 , $429.66 , $415.80 , $415.80 , $369.60 , $369.60 , $48.07 , $426.56 , $438.90 , $415.80 , $415.80 , $415.80 , $429.66 , $443.52 , $440.86 , $392.70 , $259.51 , $354.16 , N/A , $264.84 , $264.84 , $438.90 , $325.59 , $48.07 , $443.52 
 Vaccine Admin of Influenza ,HCPCS G0008,0771 - VACCINE ADMINISTRATION,N/A,N/A, $38.00 , $24.70 , $31.92 , N/A , N/A , $30.70 , $34.20 , $32.17 , $34.20 , $34.20 , $34.20 , $32.30 , N/A , $35.09 , $36.10 , $32.30 , $35.34 , $35.34 , $36.10 , $36.48 , $31.09 , $34.20 , $32.30 , $30.02 , N/A , $30.75 , $30.75 , $36.10 , $32.61 , $30.02 , $36.48 
" Fac Oth Resp Proc, Group ",HCPCS G0239,0419 - OTHER RESPIRATORY SERVICES,N/A,N/A, $174.00 , $113.10 , $146.16 , $12.26 , N/A , $140.59 , $156.60 , $147.31 , $156.60 , $156.60 , $156.60 , $147.90 , N/A , $160.65 , $165.30 , $147.90 , $161.82 , $161.82 , $165.30 , $167.04 , $142.37 , $156.60 , $147.90 , $137.46 , N/A , $140.82 , $140.82 , $165.30 , $149.31 , $12.26 , $167.04 
Rev Upper Eyelid W Excess Skin,15823,N/A,N/A,N/A," $2,329.00 "," $1,513.85 "," $1,787.55 ", $536.22 , $565.77 ," $1,492.01 "," $1,503.78 "," $2,165.97 "," $2,096.10 "," $2,096.10 "," $1,863.20 "," $1,863.20 ", $565.77 ," $2,150.37 "," $2,212.55 "," $2,096.10 "," $2,096.10 "," $2,096.10 "," $2,165.97 "," $2,235.84 "," $1,957.69 "," $1,979.65 "," $3,007.93 "," $1,934.59 ", N/A ," $1,521.12 "," $1,521.12 "," $2,212.55 "," $1,763.99 ", $536.22 ," $3,007.93 "
 SODIUM ACETATE 2 MEQ/ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00409-7299-73,20 mL, $19.73 , $12.82 , $16.57 , N/A , N/A , $15.94 , $17.76 , $16.70 , $17.76 , $17.76 , $17.76 , $16.77 , N/A , $18.22 , $18.74 , $16.77 , $18.35 , $18.35 , $18.74 , $18.94 , $16.14 , $17.76 , $16.77 , $15.59 , N/A , $15.97 , $15.97 , $18.74 , $16.93 , $15.59 , $18.94 
 USTEKINUMAB 130 MG/26ML IV SOLN ,HCPCS J3358,0636 - DRUGS REQUIRING DETAILED CODIN,57894-0054-27,26 mL," $11,885.25 "," $7,725.41 "," $9,983.61 ", $12.84 , $12.50 ," $9,603.28 "," $10,696.73 "," $10,062.05 "," $10,696.73 "," $10,696.73 "," $10,696.73 "," $10,102.46 ", $12.25 ," $10,973.65 "," $11,290.99 "," $10,102.46 "," $11,053.28 "," $11,053.28 "," $11,290.99 "," $11,409.84 "," $9,724.51 "," $10,696.73 "," $10,102.46 "," $9,389.35 ", N/A ," $9,618.73 "," $9,618.73 "," $11,290.99 "," $10,198.73 ", $12.25 ," $11,409.84 "
 Fac Colonoscopy Stoma Dx Including Collj Spec Spx ,CPT® 44388,0360 - OR SERVICES,N/A,N/A," $2,097.00 "," $1,363.05 "," $1,761.48 ", $146.74 , $272.24 ," $1,694.38 "," $1,887.30 "," $1,775.32 "," $1,887.30 "," $1,887.30 "," $1,887.30 "," $1,782.45 ", $266.90 ," $1,936.16 "," $1,992.15 "," $1,782.45 "," $1,950.21 "," $1,950.21 "," $1,992.15 "," $2,013.12 "," $1,715.77 "," $1,887.30 "," $1,782.45 "," $1,656.63 ", N/A ," $1,697.10 "," $1,697.10 "," $1,992.15 "," $1,799.44 ", $146.74 ," $2,013.12 "
 Fac Chg Hbb Duplication/Deletion Variants ,CPT® 81363,0300 - LABORATORY,N/A,N/A, $960.00 , $624.00 , $806.40 , $206.45 , $165.16 , $775.68 , $864.00 , $812.74 , $864.00 , $864.00 , $864.00 , $816.00 , $161.92 , $886.37 , $912.00 , $816.00 , $892.80 , $892.80 , $912.00 , $921.60 , $785.47 , $864.00 , $816.00 , $758.40 , N/A , $776.93 , $776.93 , $912.00 , $823.78 , $161.92 , $921.60 
 Fac Exc Infct Grf Xtr ,CPT® 35903,0360 - OR SERVICES,N/A,N/A," $4,028.00 "," $2,618.20 "," $3,383.52 ", $510.67 , $538.96 ," $3,254.62 "," $3,625.20 "," $3,410.10 "," $3,625.20 "," $3,625.20 "," $3,625.20 "," $3,423.80 ", $528.39 ," $3,719.05 "," $3,826.60 "," $3,423.80 "," $3,746.04 "," $3,746.04 "," $3,826.60 "," $3,866.88 "," $3,295.71 "," $3,625.20 "," $3,423.80 "," $3,182.12 ", N/A ," $3,259.86 "," $3,259.86 "," $3,826.60 "," $3,456.43 ", $510.67 ," $3,866.88 "
 Fac Drug Test Prsmv Read Direct Optical Obs PR Date ,CPT® 80305,0301 - LAB/CHEMISTRY,N/A,N/A, $56.00 , $36.40 , $47.04 , $12.85 , $12.85 , $45.25 , $50.40 , $47.41 , $50.40 , $50.40 , $50.40 , $47.60 , $12.60 , $51.70 , $53.20 , $47.60 , $52.08 , $52.08 , $53.20 , $53.76 , $45.82 , $50.40 , $47.60 , $44.24 , N/A , $45.32 , $45.32 , $53.20 , $48.05 , $12.60 , $53.76 
Layer Closure 30+Cm,12037,N/A,N/A,N/A," $1,866.00 "," $1,212.90 "," $1,027.96 ", $306.27 , $258.15 , $892.94 , $855.00 ," $1,735.38 "," $1,679.40 "," $1,679.40 "," $1,492.80 "," $1,492.80 ", $258.15 ," $1,722.88 "," $1,772.70 "," $1,679.40 "," $1,679.40 "," $1,679.40 "," $1,735.38 "," $1,791.36 "," $1,129.34 "," $1,586.10 "," $1,719.84 "," $1,133.19 ", N/A , $910.36 , $910.36 ," $1,772.70 "," $1,055.71 ", $258.15 ," $1,791.36 "
 Depo-Medrol 40mg/Ml 1ml Vial ,HCPCS J1030,0250 - PHARMACY,N/A,N/A, $25.00 , $16.25 , $21.00 , $7.76 , $8.24 , $20.20 , $22.50 , $21.17 , $22.50 , $22.50 , $22.50 , $21.25 , $8.08 , $23.08 , $23.75 , $21.25 , $23.25 , $23.25 , $23.75 , $24.00 , $20.46 , $22.50 , $21.25 , $19.75 , N/A , $20.23 , $20.23 , $23.75 , $21.45 , $7.76 , $24.00 
Methylprednisolone Injection,HCPCS J2930,N/A,N/A,N/A, $17.00 , $11.05 , N/A , $5.84 , $6.07 , N/A , N/A , $15.81 , $15.30 , $15.30 , $13.60 , $13.60 , $6.07 , $15.70 , $16.15 , $15.30 , $15.30 , $15.30 , $15.81 , $16.32 , $7.09 , $14.45 , $5.19 , $7.48 , N/A , N/A , N/A , $16.15 , N/A , $5.19 , $16.32 
Incision Flex Toe Tendon,28232,N/A,N/A,N/A," $2,630.00 "," $1,709.50 "," $1,495.26 ", $234.58 , $92.19 ," $1,198.78 "," $1,205.65 "," $2,445.90 "," $2,367.00 "," $2,367.00 "," $2,104.00 "," $2,104.00 ", $92.19 ," $2,428.28 "," $2,498.50 "," $2,367.00 "," $2,367.00 "," $2,367.00 "," $2,445.90 "," $2,524.80 "," $1,391.15 "," $2,235.50 "," $1,305.93 "," $1,427.25 ", N/A ," $1,222.18 "," $1,222.18 "," $2,498.50 "," $1,436.49 ", $92.19 ," $2,524.80 "
Imhistochem/Cytchm Ea Multiplex Antibody Slide,CPT® 88344,N/A,N/A,N/A, $490.00 , $318.50 , $607.13 , $165.40 , $92.01 , $463.97 , $533.14 , $455.70 , $441.00 , $441.00 , $392.00 , $392.00 , $92.01 , $452.42 , $465.50 , $441.00 , $441.00 , $441.00 , $455.70 , $470.40 ," $1,128.92 ", $416.50 , $809.30 , $606.79 , N/A , $433.01 , $433.01 , $465.50 , $475.86 , $92.01 ," $1,128.92 "
Repr Thoracoabdom Aa W Graft,CPT® 33877,N/A,N/A,N/A," $30,541.00 "," $19,851.65 "," $20,919.93 "," $3,216.80 "," $2,106.32 "," $15,568.07 "," $15,446.13 "," $28,403.13 "," $27,486.90 "," $27,486.90 "," $24,432.80 "," $24,432.80 "," $2,106.32 "," $28,198.51 "," $29,013.95 "," $27,486.90 "," $27,486.90 "," $27,486.90 "," $28,403.13 "," $29,319.36 "," $19,337.40 "," $25,959.85 "," $19,576.54 "," $17,315.63 ", N/A ," $15,871.84 "," $15,871.84 "," $29,013.95 "," $18,030.40 "," $2,106.32 "," $29,319.36 "
 CLONAZEPAM 0.125 MG TAB (COMES FROM 0.5 MG TABLET) ,HCPCS RXC637,0250 - PHARMACY,00001-0917-01,2 tablet, $7.70 , $5.01 , $6.47 , N/A , N/A , $6.22 , $6.93 , $6.52 , $6.93 , $6.93 , $6.93 , $6.55 , N/A , $7.11 , $7.32 , $6.55 , $7.16 , $7.16 , $7.32 , $7.39 , $6.30 , $6.93 , $6.55 , $6.08 , N/A , $6.23 , $6.23 , $7.32 , $6.61 , $6.08 , $7.39 
Ezderm,HCPCS Q4136,N/A,N/A,N/A, $2.00 , $1.30 , N/A , N/A , N/A , N/A , N/A , $1.86 , $1.80 , $1.80 , $1.60 , $1.60 , N/A , $1.85 , $1.90 , $1.80 , $1.80 , $1.80 , $1.86 , $1.92 , N/A , $1.70 , $1.60 , N/A , N/A , N/A , N/A , $1.90 , N/A , $1.60 , $1.92 
 Pro Remove Bone Fixation Device ,CPT® 20694,0975 - PRO FEE/OR,N/A,N/A," $2,810.00 "," $1,826.50 "," $2,077.73 ", $327.71 , $361.03 ," $1,632.54 "," $1,636.37 "," $2,613.30 "," $2,529.00 "," $2,529.00 "," $2,248.00 "," $2,248.00 ", $361.03 ," $2,594.47 "," $2,669.50 "," $2,529.00 "," $2,529.00 "," $2,529.00 "," $2,613.30 "," $2,697.60 "," $1,927.04 "," $2,388.50 "," $1,798.34 "," $1,936.80 ", N/A ," $1,664.40 "," $1,664.40 "," $2,669.50 "," $1,956.25 ", $327.71 ," $2,697.60 "
 Pro Knee Arthroscopy/Surgery ,CPT® 29880,0975 - PRO FEE/OR,N/A,N/A," $4,171.00 "," $2,711.15 "," $3,426.35 ", $537.81 , $595.32 ," $2,716.58 "," $2,722.07 "," $3,879.03 "," $3,753.90 "," $3,753.90 "," $3,336.80 "," $3,336.80 ", $595.32 ," $3,851.08 "," $3,962.45 "," $3,753.90 "," $3,753.90 "," $3,753.90 "," $3,879.03 "," $4,004.16 "," $3,187.06 "," $3,545.35 "," $3,004.36 "," $3,207.23 ", N/A ," $2,769.58 "," $2,769.58 "," $3,962.45 "," $3,255.23 ", $537.81 ," $4,004.16 "
"Vag Deliv+Postpartum Care,Prev C-Sec",CPT® 59614,N/A,N/A,N/A," $3,956.00 "," $2,571.40 "," $3,046.83 "," $1,029.07 ", $744.70 ," $2,637.10 "," $2,763.82 "," $3,679.08 "," $3,560.40 "," $3,560.40 "," $3,164.80 "," $3,164.80 ", $744.70 ," $3,652.57 "," $3,758.20 "," $3,560.40 "," $3,560.40 "," $3,560.40 "," $3,679.08 "," $3,797.76 "," $3,106.40 "," $3,362.60 "," $6,124.69 "," $2,623.13 ", N/A ," $2,688.56 "," $2,688.56 "," $3,758.20 "," $3,108.23 ", $744.70 ," $6,124.69 "
 ALPHA1-PROTEINASE INHIBITOR 1000 MG/50ML IV SOLN ,HCPCS J0257,0636 - DRUGS REQUIRING DETAILED CODIN,00944-2884-01,0.05 mL, $35.00 , $22.75 , $29.40 , $5.42 , $5.25 , $28.28 , $31.50 , $29.63 , $31.50 , $31.50 , $31.50 , $29.75 , $5.15 , $32.32 , $33.25 , $29.75 , $32.55 , $32.55 , $33.25 , $33.60 , $28.64 , $31.50 , $29.75 , $27.65 , N/A , $28.33 , $28.33 , $33.25 , $30.03 , $5.15 , $33.60 
 Pro CT Scan for Therapy Guide ,CPT® 77014,0982 - PRO FEE/OUTPT,N/A,N/A, $465.00 , $302.25 , $680.28 , $118.91 , $138.72 , $556.72 , $643.82 , $432.45 , $418.50 , $418.50 , $372.00 , $372.00 , $138.72 , $429.33 , $441.75 , $418.50 , $418.50 , $418.50 , $432.45 , $446.40 , $685.24 , $395.25 , $704.93 , $780.58 , N/A , $567.59 , $567.59 , $441.75 , $657.01 , $118.91 , $780.58 
 Pro Inj for Sacroiliac Jt Anesth ,HCPCS G0260,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,862.00 "," $1,210.30 ", N/A , N/A , N/A , N/A , N/A ," $1,731.66 "," $1,675.80 "," $1,675.80 "," $1,489.60 "," $1,489.60 ", N/A ," $1,719.18 "," $1,768.90 "," $1,675.80 "," $1,675.80 "," $1,675.80 "," $1,731.66 "," $1,787.52 ", N/A ," $1,582.70 "," $1,489.60 ", N/A , N/A , N/A , N/A ," $1,768.90 ", N/A ," $1,489.60 "," $1,787.52 "
 Pro Path Consltj Surg Cytologic Xm Ea Sit ,CPT® 88334,0971 - PRO FEE/LAB,N/A,N/A, $133.00 , $86.45 , $202.39 , $55.88 , $39.32 , $266.19 , $300.46 , $123.69 , $119.70 , $119.70 , $106.40 , $106.40 , $39.32 , $122.80 , $126.35 , $119.70 , $119.70 , $119.70 , $123.69 , $127.68 , $368.32 , $113.05 , $313.02 , $195.12 , N/A , $248.43 , $248.43 , $126.35 , $273.01 , $39.32 , $368.32 
" Pro Program Eval Implant Device,Cardvert/Defib,2 Lead ",CPT® 93283,0982 - PRO FEE/OUTPT,N/A,N/A," $1,020.00 ", $663.00 , $639.21 , $97.76 , $66.57 , $443.04 , $448.84 , $948.60 , $918.00 , $918.00 , $816.00 , $816.00 , $66.57 , $941.77 , $969.00 , $918.00 , $918.00 , $918.00 , $948.60 , $979.20 , $602.81 , $867.00 , $417.47 , $297.15 , N/A , $451.68 , $451.68 , $969.00 , $500.69 , $66.57 , $979.20 
"Revision of Eyelid,< 1/4 Lid Margin",CPT® 67961,N/A,N/A,N/A," $5,319.00 "," $3,457.35 "," $2,788.18 ", $438.06 ," $1,144.74 "," $2,573.53 "," $2,429.00 "," $4,946.67 "," $4,787.10 "," $4,787.10 "," $4,255.20 "," $4,255.20 "," $1,144.74 "," $4,911.03 "," $5,053.05 "," $4,787.10 "," $4,787.10 "," $4,787.10 "," $4,946.67 "," $5,106.24 "," $3,829.81 "," $4,521.15 "," $2,517.31 "," $3,270.26 ", N/A ," $2,623.74 "," $2,623.74 "," $5,053.05 "," $2,896.26 ", $438.06 ," $5,106.24 "
 Fac Aep Threshold Estimation Mlt Frequencies I&R ,CPT® 92652,0470 - AUDIOLOGY,N/A,N/A, $377.00 , $245.05 , $316.68 , $111.82 , $91.96 , $304.62 , $339.30 , $319.17 , $339.30 , $339.30 , $339.30 , $320.45 , $90.16 , $348.08 , $358.15 , $320.45 , $350.61 , $350.61 , $358.15 , $361.92 , $308.46 , $339.30 , $320.45 , $297.83 , N/A , $305.11 , $305.11 , $358.15 , $323.50 , $90.16 , $361.92 
 Pro Wound Closure by Adhesive ,HCPCS G0168,0981 - PRO FEE/ER,N/A,N/A, $144.00 , $93.60 , $32.95 , $13.67 , N/A , $51.11 , N/A , $133.92 , $129.60 , $129.60 , $115.20 , $115.20 , N/A , $132.96 , $136.80 , $129.60 , $129.60 , $129.60 , $133.92 , $138.24 , $51.92 , $122.40 , $51.90 , $98.90 , N/A , $52.10 , $52.10 , $136.80 , $65.15 , $13.67 , $138.24 
 Pro Fine Needle Aspiration Bx W/MR Gdn Ea Addl ,CPT® 10012,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,000.00 ", $650.00 , N/A , N/A , $223.87 , $752.01 , N/A , $930.00 , $900.00 , $900.00 , $800.00 , $800.00 , $223.87 , $923.30 , $950.00 , $900.00 , $900.00 , $900.00 , $930.00 , $960.00 , N/A , $850.00 , $982.65 , $918.60 , N/A , $766.68 , $766.68 , $950.00 , $889.75 , $223.87 , $982.65 
"Antepartum Care Only, >7 Visits",CPT® 59426,N/A,N/A,N/A," $3,720.00 "," $2,418.00 "," $2,140.89 ", $722.47 , $517.24 ," $1,464.28 "," $1,530.82 "," $3,459.60 "," $3,348.00 "," $3,348.00 "," $2,976.00 "," $2,976.00 ", $517.24 ," $3,434.68 "," $3,534.00 "," $3,348.00 "," $3,348.00 "," $3,348.00 "," $3,459.60 "," $3,571.20 "," $2,184.94 "," $3,162.00 "," $3,380.80 "," $2,713.00 ", N/A ," $1,492.85 "," $1,492.85 "," $3,534.00 "," $1,725.90 ", $517.24 ," $3,571.20 "
 AMIODARONE HCL 200 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6993-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Closed Rx Bimalleolar Fx,Manip",27810,N/A,N/A,N/A," $2,544.00 "," $1,653.60 "," $2,621.26 ", $415.07 , $394.39 ," $2,044.66 "," $2,077.68 "," $2,365.92 "," $2,289.60 "," $2,289.60 "," $2,035.20 "," $2,035.20 ", $394.39 ," $2,348.88 "," $2,416.80 "," $2,289.60 "," $2,289.60 "," $2,289.60 "," $2,365.92 "," $2,442.24 "," $2,420.62 "," $2,162.40 "," $2,287.17 "," $2,409.72 ", N/A ," $2,084.56 "," $2,084.56 "," $2,416.80 "," $2,450.12 ", $394.39 ," $2,621.26 "
Secondary Closure-Surg Wn,CPT® 13160,N/A,N/A,N/A," $3,043.00 "," $1,977.95 "," $2,534.63 ", $755.62 , $190.55 ," $2,192.28 "," $2,140.14 "," $2,829.99 "," $2,738.70 "," $2,738.70 "," $2,434.40 "," $2,434.40 ", $190.55 ," $2,809.60 "," $2,890.85 "," $2,738.70 "," $2,738.70 "," $2,738.70 "," $2,829.99 "," $2,921.28 "," $2,777.60 "," $2,586.55 "," $4,294.24 "," $2,769.01 ", N/A ," $2,235.05 "," $2,235.05 "," $2,890.85 "," $2,591.92 ", $190.55 ," $4,294.24 "
 Fac Assay of Erythropoietin ,CPT® 82668,0301 - LAB/CHEMISTRY,N/A,N/A, $234.00 , $152.10 , $196.56 , $19.17 , $19.17 , $189.07 , $210.60 , $198.10 , $210.60 , $210.60 , $210.60 , $198.90 , $18.79 , $216.05 , $222.30 , $198.90 , $217.62 , $217.62 , $222.30 , $224.64 , $191.46 , $210.60 , $198.90 , $184.86 , N/A , $189.38 , $189.38 , $222.30 , $200.80 , $18.79 , $224.64 
Islet Cell Antibody,CPT® 86341,N/A,N/A,N/A, $172.00 , $111.80 , N/A , $24.04 , $19.62 , $79.99 , $95.71 , $159.96 , $154.80 , $154.80 , $137.60 , $137.60 , $19.62 , $158.81 , $163.40 , $154.80 , $154.80 , $154.80 , $159.96 , $165.12 , $157.38 , $146.20 , $129.75 , $71.75 , N/A , $74.65 , $74.65 , $163.40 , $81.58 , $19.62 , $165.12 
 Pro Treatment of Ankle Fracture ,CPT® 27822,0975 - PRO FEE/OR,N/A,N/A," $3,239.00 "," $2,105.35 "," $5,376.22 ", $838.56 , $738.92 ," $4,063.25 "," $4,063.58 "," $3,012.27 "," $2,915.10 "," $2,915.10 "," $2,591.20 "," $2,591.20 ", $738.92 ," $2,990.57 "," $3,077.05 "," $2,915.10 "," $2,915.10 "," $2,915.10 "," $3,012.27 "," $3,109.44 "," $4,979.47 "," $2,753.15 "," $4,481.57 "," $4,894.21 ", N/A ," $4,142.53 "," $4,142.53 "," $3,077.05 "," $4,868.93 ", $738.92 ," $5,376.22 "
 Pro Appl Long Arm Splnt Sho Hand ,CPT® 29105,0982 - PRO FEE/OUTPT,N/A,N/A, $580.00 , $377.00 , $248.63 , $39.02 , $45.35 , $288.42 , $289.62 , $539.40 , $522.00 , $522.00 , $464.00 , $464.00 , $45.35 , $535.51 , $551.00 , $522.00 , $522.00 , $522.00 , $539.40 , $556.80 , $235.01 , $493.00 , $317.56 , $339.98 , N/A , $294.05 , $294.05 , $551.00 , $345.59 , $39.02 , $556.80 
" Pro Excision of Nail Fold, Toe ",CPT® 11765,0981 - PRO FEE/ER,N/A,N/A, $485.00 , $315.25 , $298.86 , $89.88 , $111.12 , $259.63 , $252.76 , $451.05 , $436.50 , $436.50 , $388.00 , $388.00 , $111.12 , $447.80 , $460.75 , $436.50 , $436.50 , $436.50 , $451.05 , $465.60 , $329.62 , $412.25 , $494.19 , $334.41 , N/A , $264.69 , $264.69 , $460.75 , $306.96 , $89.88 , $494.19 
 Fac Cytogenetics&Molec Cytogenetics I&R ,CPT® 88291,0310 - PATHOLOGY LAB,N/A,N/A, $455.00 , $295.75 , $382.20 , $31.99 , $5.77 , $367.64 , $409.50 , $385.20 , $409.50 , $409.50 , $409.50 , $386.75 , $5.66 , $420.10 , $432.25 , $386.75 , $423.15 , $423.15 , $432.25 , $436.80 , $372.28 , $409.50 , $386.75 , $359.45 , N/A , $368.23 , $368.23 , $432.25 , $390.44 , $5.66 , $436.80 
Insertion Subq Cardiac Rhythm Monitor W/Prgrmg,CPT® 33285,N/A,N/A,N/A," $1,710.00 "," $1,111.50 ", $517.27 , $80.00 ," $4,106.32 ", $353.88 , N/A ," $1,590.30 "," $1,539.00 "," $1,539.00 "," $1,368.00 "," $1,368.00 "," $4,106.32 "," $1,578.84 "," $1,624.50 "," $1,539.00 "," $1,539.00 "," $1,539.00 "," $1,590.30 "," $1,641.60 ", $479.86 ," $1,453.50 ", $460.23 , $428.73 , N/A , $360.79 , $360.79 ," $1,624.50 ", $409.84 , $80.00 ," $4,106.32 "
Computerized Ophthalmic Imaging Retina,92134,N/A,N/A,N/A, $135.00 , $87.75 , $88.31 , $39.74 , $32.72 , $79.44 , $81.53 , $125.55 , $121.50 , $121.50 , $108.00 , $108.00 , $32.72 , $124.65 , $128.25 , $121.50 , $121.50 , $121.50 , $125.55 , $129.60 , $125.08 , $114.75 , $137.87 , $87.83 , N/A , $81.00 , $81.00 , $128.25 , $96.35 , $32.72 , $137.87 
"Hypospad Repair,1 Stage,Dist,Plasty",CPT® 54324,N/A,N/A,N/A," $5,312.00 "," $3,452.80 "," $4,283.02 ", $920.78 ," $1,619.11 "," $3,111.99 "," $3,132.17 "," $4,940.16 "," $4,780.80 "," $4,780.80 "," $4,249.60 "," $4,249.60 "," $1,619.11 "," $4,904.57 "," $5,046.40 "," $4,780.80 "," $4,780.80 "," $4,780.80 "," $4,940.16 "," $5,099.52 "," $4,024.95 "," $4,515.20 "," $4,988.24 "," $4,691.22 ", N/A ," $3,172.72 "," $3,172.72 "," $5,046.40 "," $3,802.69 ", $920.78 ," $5,099.52 "
 Pro Appl Short Leg Cst Belw Kne-Toe ,CPT® 29405,0982 - PRO FEE/OUTPT,N/A,N/A, $685.00 , $445.25 , $353.21 , $55.88 , $70.65 , $291.95 , $292.92 , $637.05 , $616.50 , $616.50 , $548.00 , $548.00 , $70.65 , $632.46 , $650.75 , $616.50 , $616.50 , $616.50 , $637.05 , $657.60 , $330.82 , $582.25 , $319.35 , $344.75 , N/A , $297.65 , $297.65 , $650.75 , $349.86 , $55.88 , $657.60 
Culture Fungi-Identif,CPT® 87106,N/A,N/A,N/A, $114.00 , $74.10 , N/A , $10.53 , $10.53 , $58.41 , $69.87 , $106.02 , $102.60 , $102.60 , $91.20 , $91.20 , $10.53 , $105.26 , $108.30 , $102.60 , $102.60 , $102.60 , $106.02 , $109.44 , $68.91 , $96.90 , $68.12 , $37.42 , N/A , $54.51 , $54.51 , $108.30 , $59.57 , $10.53 , $109.44 
 LEVOTHYROXINE SODIUM 112 MCG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6954-61,1 tablet, $4.19 , $2.72 , $3.52 , N/A , N/A , $3.39 , $3.77 , $3.55 , $3.77 , $3.77 , $3.77 , $3.56 , N/A , $3.87 , $3.98 , $3.56 , $3.90 , $3.90 , $3.98 , $4.02 , $3.43 , $3.77 , $3.56 , $3.31 , N/A , $3.39 , $3.39 , $3.98 , $3.60 , $3.31 , $4.02 
"Drain Appendiceal Abscess, Open",CPT® 44900,N/A,N/A,N/A," $5,013.00 "," $3,258.45 "," $4,679.29 ", $724.03 , $461.04 ," $3,635.45 "," $3,685.91 "," $4,662.09 "," $4,511.70 "," $4,511.70 "," $4,010.40 "," $4,010.40 ", $461.04 ," $4,628.50 "," $4,762.35 "," $4,511.70 "," $4,511.70 "," $4,511.70 "," $4,662.09 "," $4,812.48 "," $3,348.93 "," $4,261.05 "," $4,096.21 "," $4,286.39 ", N/A ," $3,706.38 "," $3,706.38 "," $4,762.35 "," $3,876.48 ", $461.04 ," $4,812.48 "
 Pro Lyr Clsr F/E/E/N/L/M&/Muc 5.1 Cm-7.5 Cm ,CPT® 12053,0981 - PRO FEE/ER,N/A,N/A," $1,445.00 ", $939.25 , $685.07 , $206.62 , $153.67 , $595.05 , $580.29 ," $1,343.85 "," $1,300.50 "," $1,300.50 "," $1,156.00 "," $1,156.00 ", $153.67 ," $1,334.17 "," $1,372.75 "," $1,300.50 "," $1,300.50 "," $1,300.50 "," $1,343.85 "," $1,387.20 ", $753.04 ," $1,228.25 "," $1,156.07 ", $765.21 , N/A , $606.66 , $606.66 ," $1,372.75 ", $703.53 , $153.67 ," $1,387.20 "
 Aspiration of Lumbar Disk ,CPT® 62267,0361 - OR/MINOR,N/A,N/A," $1,411.00 ", $917.15 ," $1,185.24 ", $148.22 , $228.35 ," $1,140.09 "," $1,269.90 "," $1,194.55 "," $1,269.90 "," $1,269.90 "," $1,269.90 "," $1,199.35 ", $223.87 ," $1,302.78 "," $1,340.45 "," $1,199.35 "," $1,312.23 "," $1,312.23 "," $1,340.45 "," $1,354.56 "," $1,154.48 "," $1,269.90 "," $1,199.35 "," $1,114.69 ", N/A ," $1,141.92 "," $1,141.92 "," $1,340.45 "," $1,210.78 ", $148.22 ," $1,354.56 "
 Fac Assay of Procainamide ,CPT® 80192,0301 - LAB/CHEMISTRY,N/A,N/A, $166.00 , $107.90 , $139.44 , $17.09 , $17.09 , $134.13 , $149.40 , $140.54 , $149.40 , $149.40 , $149.40 , $141.10 , $16.75 , $153.27 , $157.70 , $141.10 , $154.38 , $154.38 , $157.70 , $159.36 , $135.82 , $149.40 , $141.10 , $131.14 , N/A , $134.34 , $134.34 , $157.70 , $142.44 , $16.75 , $159.36 
 HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML PO SOLN ,HCPCS RXC637,0250 - PHARMACY,60687-0417-71,5 mL, $8.43 , $5.48 , $7.08 , N/A , N/A , $6.81 , $7.59 , $7.14 , $7.59 , $7.59 , $7.59 , $7.17 , N/A , $7.78 , $8.01 , $7.17 , $7.84 , $7.84 , $8.01 , $8.09 , $6.90 , $7.59 , $7.17 , $6.66 , N/A , $6.82 , $6.82 , $8.01 , $7.23 , $6.66 , $8.09 
Nasal/Sinus Ndsc Tot W/Frnt Sins Expl Tiss Rmvl,CPT® 31253,N/A,N/A,N/A," $3,380.00 "," $2,197.00 "," $2,695.37 ", $475.70 , $387.83 ," $1,795.65 "," $1,818.01 "," $3,143.40 "," $3,042.00 "," $3,042.00 "," $2,704.00 "," $2,704.00 ", $387.83 ," $3,120.75 "," $3,211.00 "," $3,042.00 "," $3,042.00 "," $3,042.00 "," $3,143.40 "," $3,244.80 "," $2,583.92 "," $2,873.00 "," $2,642.31 "," $2,551.46 ", N/A ," $1,830.68 "," $1,830.68 "," $3,211.00 "," $2,156.01 ", $387.83 ," $3,244.80 "
 Fac Foot Arch Supp Longitud/Meta ,HCPCS L3060,0274 - PROSTHETIC DEV,N/A,N/A, $121.00 , $78.65 , $101.64 , $86.28 , $60.29 , $97.77 , $108.90 , $102.44 , $108.90 , $108.90 , $108.90 , $102.85 , $59.11 , $111.72 , $114.95 , $102.85 , $112.53 , $112.53 , $114.95 , $116.16 , $99.00 , $108.90 , $102.85 , $95.59 , N/A , $97.93 , $97.93 , $114.95 , $103.83 , $59.11 , $116.16 
"Resect Diaphram,Simple Repair",CPT® 39560,N/A,N/A,N/A," $4,450.00 "," $2,892.50 "," $3,235.85 ", $743.29 , $816.72 ," $2,793.10 "," $2,823.31 "," $4,138.50 "," $4,005.00 "," $4,005.00 "," $3,560.00 "," $3,560.00 ", $816.72 ," $4,108.69 "," $4,227.50 "," $4,005.00 "," $4,005.00 "," $4,005.00 "," $4,138.50 "," $4,272.00 "," $4,407.24 "," $3,782.50 "," $4,188.98 "," $3,659.28 ", N/A ," $2,847.60 "," $2,847.60 "," $4,227.50 "," $3,300.63 ", $743.29 ," $4,407.24 "
 Fac Glucose Tolerance Test (Gtt) ,CPT® 82951,0301 - LAB/CHEMISTRY,N/A,N/A, $128.00 , $83.20 , $107.52 , $13.13 , $13.13 , $103.42 , $115.20 , $108.36 , $115.20 , $115.20 , $115.20 , $108.80 , $12.87 , $118.18 , $121.60 , $108.80 , $119.04 , $119.04 , $121.60 , $122.88 , $104.73 , $115.20 , $108.80 , $101.12 , N/A , $103.59 , $103.59 , $121.60 , $109.84 , $12.87 , $122.88 
Elec Alys Implt Npgt Phys/Qhp W/O Programming,CPT® 95970,N/A,N/A,N/A, $286.00 , $185.90 , $67.41 , $17.79 , $18.88 , $77.19 , $81.00 , $265.98 , $257.40 , $257.40 , $228.80 , $228.80 , $18.88 , $264.06 , $271.70 , $257.40 , $257.40 , $257.40 , $265.98 , $274.56 , $79.88 , $243.10 , $70.96 , $91.25 , N/A , $78.70 , $78.70 , $271.70 , $96.74 , $17.79 , $274.56 
Euflexxa Inj per Dose,HCPCS J7323,N/A,N/A,N/A, $605.00 , $393.25 , N/A , $134.05 , $132.17 , N/A , N/A , $562.65 , $544.50 , $544.50 , $484.00 , $484.00 , $132.17 , $558.60 , $574.75 , $544.50 , $544.50 , $544.50 , $562.65 , $580.80 , $167.91 , $514.25 , $288.69 , $170.68 , N/A , N/A , N/A , $574.75 , N/A , $132.17 , $580.80 
Open Rx Prox/Shaft Fibula Fx,CPT® 27784,N/A,N/A,N/A," $4,718.00 "," $3,066.70 "," $4,319.12 ", $678.86 , $614.70 ," $3,457.33 "," $3,447.77 "," $4,387.74 "," $4,246.20 "," $4,246.20 "," $3,774.40 "," $3,774.40 ", $614.70 ," $4,356.13 "," $4,482.10 "," $4,246.20 "," $4,246.20 "," $4,246.20 "," $4,387.74 "," $4,529.28 "," $4,008.58 "," $4,010.30 "," $3,805.41 "," $4,051.11 ", N/A ," $3,524.79 "," $3,524.79 "," $4,482.10 "," $4,142.88 ", $614.70 ," $4,529.28 "
Simple Repair 2.6-7.5cm,12002,N/A,N/A,N/A, $685.00 , $445.25 , $183.91 , $54.60 , $67.36 , $160.40 , $155.64 , $637.05 , $616.50 , $616.50 , $548.00 , $548.00 , $67.36 , $632.46 , $650.75 , $616.50 , $616.50 , $616.50 , $637.05 , $657.60 , $201.24 , $582.25 , $312.21 , $204.29 , N/A , $163.53 , $163.53 , $650.75 , $189.63 , $54.60 , $657.60 
 Pro Cltx Mtcarphlngl Dislc 1 W/Mnpj W/O Anes ,CPT® 26700,0981 - PRO FEE/ER,N/A,N/A, $912.00 , $592.80 ," $1,924.98 ", $306.67 , $96.29 ," $1,453.63 "," $1,482.73 ", $848.16 , $820.80 , $820.80 , $729.60 , $729.60 , $96.29 , $842.05 , $866.40 , $820.80 , $820.80 , $820.80 , $848.16 , $875.52 ," $1,764.46 ", $775.20 ," $1,627.07 "," $1,738.39 ", N/A ," $1,481.99 "," $1,481.99 ", $866.40 ," $1,741.85 ", $96.29 ," $1,924.98 "
Nephrectomy,CPT® 50546,N/A,N/A,N/A," $8,349.00 "," $5,426.85 "," $6,480.37 "," $1,138.66 "," $1,127.05 "," $5,874.29 "," $5,462.35 "," $7,764.57 "," $7,514.10 "," $7,514.10 "," $6,679.20 "," $6,679.20 "," $1,127.05 "," $7,708.63 "," $7,931.55 "," $7,514.10 "," $7,514.10 "," $7,514.10 "," $7,764.57 "," $8,015.04 "," $6,506.11 "," $7,096.65 "," $6,199.62 "," $7,372.88 ", N/A ," $5,988.91 "," $5,988.91 "," $7,931.55 "," $7,039.08 "," $1,127.05 "," $8,015.04 "
"FB Removal,Conreal",65220,N/A,N/A,N/A, $537.00 , $349.05 , $250.45 , $39.41 , $47.02 , $236.97 , $219.45 , $499.41 , $483.30 , $483.30 , $429.60 , $429.60 , $47.02 , $495.81 , $510.15 , $483.30 , $483.30 , $483.30 , $499.41 , $515.52 , $347.54 , $456.45 , $226.58 , $300.51 , N/A , $241.60 , $241.60 , $510.15 , $266.70 , $39.41 , $515.52 
"Ecg/Review,Interpret Only",CPT® 93272,N/A,N/A,N/A, $278.00 , $180.70 , $156.46 , $23.78 , $27.46 , $139.79 , $137.96 , $258.54 , $250.20 , $250.20 , $222.40 , $222.40 , $27.46 , $256.68 , $264.10 , $250.20 , $250.20 , $250.20 , $258.54 , $266.88 , $154.73 , $236.30 , $126.67 , $153.78 , N/A , $142.52 , $142.52 , $264.10 , $157.98 , $23.78 , $266.88 
"Echo,Eye,Corneal Pachymetry",CPT® 76514,N/A,N/A,N/A, $108.00 , $70.20 , $63.34 , $10.97 , $12.21 , $72.76 , $78.59 , $100.44 , $97.20 , $97.20 , $86.40 , $86.40 , $12.21 , $99.72 , $102.60 , $97.20 , $97.20 , $97.20 , $100.44 , $103.68 , $63.09 , $91.80 , $86.67 , $85.92 , N/A , $74.17 , $74.17 , $102.60 , $85.85 , $10.97 , $103.68 
Office/Outpatient Established High Mdm 40-54 Min,99215,N/A,N/A,N/A, $394.00 , $256.10 , $292.89 , $139.34 , $94.97 , $192.33 , $191.18 , $366.42 , $354.60 , $354.60 , $315.20 , $315.20 , $94.97 , $363.78 , $374.30 , $354.60 , $354.60 , $354.60 , $366.42 , $378.24 , $266.74 , $334.90 , $237.78 , $242.86 , $128.75 , $196.08 , $196.08 , $374.30 , $226.13 , $94.97 , $378.24 
 Fac Microdissection Prep Identified Target Manual ,CPT® 88381,0310 - PATHOLOGY LAB,N/A,N/A, $668.00 , $434.20 , $561.12 , $197.49 , $163.84 , $539.74 , $601.20 , $565.53 , $601.20 , $601.20 , $601.20 , $567.80 , $160.63 , $616.76 , $634.60 , $567.80 , $621.24 , $621.24 , $634.60 , $641.28 , $546.56 , $601.20 , $567.80 , $527.72 , N/A , $540.61 , $540.61 , $634.60 , $573.21 , $160.63 , $641.28 
Ear and Throat Examination,92502,N/A,N/A,N/A, $722.00 , $469.30 , $219.41 , $92.69 , $124.66 , $216.27 , $219.90 , $671.46 , $649.80 , $649.80 , $577.60 , $577.60 , $124.66 , $666.62 , $685.90 , $649.80 , $649.80 , $649.80 , $671.46 , $693.12 , $404.50 , $613.70 , $289.92 , $364.84 , N/A , $220.49 , $220.49 , $685.90 , $257.07 , $92.69 , $693.12 
"Knee Scope,Diagnostic",CPT® 29870,N/A,N/A,N/A," $3,994.00 "," $2,596.10 "," $2,492.04 ", $391.10 , $460.10 ," $1,993.38 "," $1,995.27 "," $3,714.42 "," $3,594.60 "," $3,594.60 "," $3,195.20 "," $3,195.20 ", $460.10 ," $3,687.66 "," $3,794.30 "," $3,594.60 "," $3,594.60 "," $3,594.60 "," $3,714.42 "," $3,834.24 "," $2,310.35 "," $3,394.90 "," $2,199.75 "," $2,330.47 ", N/A ," $2,032.27 "," $2,032.27 "," $3,794.30 "," $2,388.64 ", $391.10 ," $3,834.24 "
 Fac Hfo W/O Joints Cf ,HCPCS L3913,0274 - PROSTHETIC DEV,N/A,N/A, $406.00 , $263.90 , $341.04 , $288.30 , $78.13 , $328.05 , $365.40 , $343.72 , $365.40 , $365.40 , $365.40 , $345.10 , $76.60 , $374.86 , $385.70 , $345.10 , $377.58 , $377.58 , $385.70 , $389.76 , $332.19 , $365.40 , $345.10 , $320.74 , N/A , $328.58 , $328.58 , $385.70 , $348.39 , $76.60 , $389.76 
 Fac Continuous Inhalation Treatment Ea Addl Hr ,CPT® 94645,0410 - RESPIRATORY SVC,N/A,N/A, $236.00 , $153.40 , $198.24 , $15.22 , $10.97 , $190.69 , $212.40 , $199.80 , $212.40 , $212.40 , $212.40 , $200.60 , $10.75 , $217.90 , $224.20 , $200.60 , $219.48 , $219.48 , $224.20 , $226.56 , $193.10 , $212.40 , $200.60 , $186.44 , N/A , $190.99 , $190.99 , $224.20 , $202.51 , $10.75 , $226.56 
"Closure of Gastrostomy,Surgical",CPT® 43870,N/A,N/A,N/A," $4,489.00 "," $2,917.85 "," $4,254.06 ", $659.19 , $922.06 ," $3,355.46 "," $3,395.25 "," $4,174.77 "," $4,040.10 "," $4,040.10 "," $3,591.20 "," $3,591.20 ", $922.06 ," $4,144.69 "," $4,264.55 "," $4,040.10 "," $4,040.10 "," $4,040.10 "," $4,174.77 "," $4,309.44 "," $3,048.82 "," $3,815.65 "," $3,769.73 "," $3,949.47 ", N/A ," $3,420.93 "," $3,420.93 "," $4,264.55 "," $3,577.92 ", $659.19 ," $4,309.44 "
 Fac Oasis Wound Matrix Skin Sub ,HCPCS Q4102,0636 - DRUGS REQUIRING DETAILED CODIN,N/A,N/A, $17.00 , $11.05 , $14.28 , $13.09 , N/A , $13.74 , $15.30 , $14.39 , $15.30 , $15.30 , $15.30 , $14.45 , N/A , $15.70 , $16.15 , $14.45 , $15.81 , $15.81 , $16.15 , $16.32 , $13.91 , $15.30 , $14.45 , $13.43 , N/A , $13.76 , $13.76 , $16.15 , $14.59 , $13.09 , $16.32 
"Cystoscopy,Dir Vis Int Urethrotomy",CPT® 52276,N/A,N/A,N/A," $1,851.00 "," $1,203.15 "," $1,416.28 ", $248.83 , $307.34 ," $1,297.98 "," $1,207.60 "," $1,721.43 "," $1,665.90 "," $1,665.90 "," $1,480.80 "," $1,480.80 ", $307.34 ," $1,709.03 "," $1,758.45 "," $1,665.90 "," $1,665.90 "," $1,665.90 "," $1,721.43 "," $1,776.96 "," $1,424.95 "," $1,573.35 "," $1,368.38 "," $1,628.44 ", N/A ," $1,323.31 "," $1,323.31 "," $1,758.45 "," $1,555.36 ", $248.83 ," $1,776.96 "
 Critical Care First 30-74 Min -Mh ,CPT® 99291,0450 - EMERGENCY SERVICES,N/A,N/A," $7,701.00 "," $5,005.65 "," $6,468.84 ", $205.74 , $270.56 ," $6,222.41 "," $6,930.90 "," $6,519.67 "," $6,930.90 "," $6,930.90 "," $6,930.90 "," $6,545.85 ", $265.25 ," $7,110.33 "," $7,315.95 "," $6,545.85 "," $7,161.93 "," $7,161.93 "," $7,315.95 "," $7,392.96 "," $6,300.96 "," $6,930.90 "," $6,545.85 "," $6,083.79 ", N/A ," $6,232.42 "," $6,232.42 "," $7,315.95 "," $6,608.23 ", $205.74 ," $7,392.96 "
 Specimen Fat Stain ,CPT® 89125,0300 - LABORATORY,N/A,N/A, $75.00 , $48.75 , $63.00 , $6.00 , $6.00 , $60.60 , $67.50 , $63.50 , $67.50 , $67.50 , $67.50 , $63.75 , $5.88 , $69.25 , $71.25 , $63.75 , $69.75 , $69.75 , $71.25 , $72.00 , $61.37 , $67.50 , $63.75 , $59.25 , N/A , $60.70 , $60.70 , $71.25 , $64.36 , $5.88 , $72.00 
 Fac Intravascular US Noncoronary Rs&I Intial Vessel ,CPT® 37252,0360 - OR SERVICES,N/A,N/A," $1,625.00 "," $1,056.25 "," $1,365.00 ", $80.79 ," $1,106.24 "," $1,313.00 "," $1,462.50 "," $1,375.73 "," $1,462.50 "," $1,462.50 "," $1,462.50 "," $1,381.25 "," $1,084.55 "," $1,500.36 "," $1,543.75 "," $1,381.25 "," $1,511.25 "," $1,511.25 "," $1,543.75 "," $1,560.00 "," $1,329.58 "," $1,462.50 "," $1,381.25 "," $1,283.75 ", N/A ," $1,315.11 "," $1,315.11 "," $1,543.75 "," $1,394.41 ", $80.79 ," $1,560.00 "
Chorionic Gonadotropin/1000u,HCPCS J0725,N/A,N/A,N/A, $36.00 , $23.40 , N/A , $23.54 , $23.34 , N/A , N/A , $33.48 , $32.40 , $32.40 , $28.80 , $28.80 , $23.34 , $33.24 , $34.20 , $32.40 , $32.40 , $32.40 , $33.48 , $34.56 , $32.05 , $30.60 , $24.00 , $30.62 , N/A , N/A , N/A , $34.20 , N/A , $23.34 , $34.56 
" Acute Myocardial Infarction, Discharged Alive With McC ",MS DRG V40 (FY2023) 280,N/A,N/A,N/A," $31,844.77 "," $20,699.10 "," $26,749.61 ", N/A , N/A ," $25,730.57 "," $28,660.29 "," $26,959.78 "," $28,660.29 "," $28,660.29 "," $28,660.29 "," $27,068.05 ", N/A ," $29,402.28 "," $30,252.53 "," $27,068.05 "," $29,615.64 "," $29,615.64 "," $30,252.53 "," $30,570.98 "," $26,055.39 "," $28,660.29 "," $27,068.05 "," $25,157.37 ", N/A ," $25,771.97 "," $25,771.97 "," $30,252.53 "," $27,326.00 "," $25,157.37 "," $30,570.98 "
Myocardial Spect Single Study at Rest or Stress,CPT® 78451,N/A,N/A,N/A," $3,881.00 "," $2,522.65 "," $1,823.87 ", $310.94 , $190.06 ," $1,680.22 "," $1,863.35 "," $3,609.33 "," $3,492.90 "," $3,492.90 "," $3,104.80 "," $3,104.80 ", $190.06 ," $3,583.33 "," $3,686.95 "," $3,492.90 "," $3,492.90 "," $3,492.90 "," $3,609.33 "," $3,725.76 "," $1,888.50 "," $3,298.85 "," $2,039.68 "," $2,293.53 ", N/A ," $1,713.00 "," $1,713.00 "," $3,686.95 "," $1,982.84 ", $190.06 ," $3,725.76 "
 TOPIRAMATE 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,68382-0139-14,1 tablet, $26.20 , $17.03 , $22.01 , N/A , N/A , $21.17 , $23.58 , $22.18 , $23.58 , $23.58 , $23.58 , $22.27 , N/A , $24.19 , $24.89 , $22.27 , $24.37 , $24.37 , $24.89 , $25.15 , $21.44 , $23.58 , $22.27 , $20.70 , N/A , $21.20 , $21.20 , $24.89 , $22.48 , $20.70 , $25.15 
 Pro Computerized Ophthalmic Imaging Anterior Segment ,CPT® 92132,0962 - PRO FEE/EYE,N/A,N/A, $104.00 , $67.60 , $67.84 , $30.95 , $26.60 , $61.08 , $63.82 , $96.72 , $93.60 , $93.60 , $83.20 , $83.20 , $26.60 , $96.02 , $98.80 , $93.60 , $93.60 , $93.60 , $96.72 , $99.84 , $96.09 , $88.40 , $108.47 , $65.89 , N/A , $62.26 , $62.26 , $98.80 , $74.08 , $26.60 , $108.47 
Electrical Stimulation,CPT® 97032,N/A,N/A,N/A, $110.00 , $71.50 , $34.32 , $14.33 , $23.97 , $43.36 , $38.52 , $102.30 , $99.00 , $99.00 , $88.00 , $88.00 , $23.97 , $101.56 , $104.50 , $99.00 , $99.00 , $99.00 , $102.30 , $105.60 , $37.24 , $93.50 , $56.77 , $38.11 , N/A , $44.21 , $44.21 , $104.50 , $49.18 , $14.33 , $105.60 
 Pro Molecular Pathology Interpr ,HCPCS G0452,0971 - PRO FEE/LAB,N/A,N/A, $77.00 , $50.05 , $174.05 , $49.22 , N/A , $34.85 , N/A , $71.61 , $69.30 , $69.30 , $61.60 , $61.60 , N/A , $71.09 , $73.15 , $69.30 , $69.30 , $69.30 , $71.61 , $73.92 , $316.70 , $65.45 , $35.68 , $70.71 , N/A , $35.53 , $35.53 , $73.15 , $44.41 , $34.85 , $316.70 
 CALCIUM POLYCARBOPHIL 625 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00536-4306-11,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Pro Cltx Sho Dislc W/Surg/Antmcl Nck Fx W/Mnpj,23675,N/A,N/A,N/A," $2,914.00 "," $1,894.10 "," $3,078.60 ", $484.34 , $245.89 ," $2,419.08 "," $2,413.79 "," $2,710.02 "," $2,622.60 "," $2,622.60 "," $2,331.20 "," $2,331.20 ", $245.89 ," $2,690.50 "," $2,768.30 "," $2,622.60 "," $2,622.60 "," $2,622.60 "," $2,710.02 "," $2,797.44 "," $2,846.83 "," $2,476.90 "," $2,658.26 "," $2,834.01 ", N/A ," $2,466.29 "," $2,466.29 "," $2,768.30 "," $2,898.76 ", $245.89 ," $3,078.60 "
 Fac Office/Outpatient New Moderate Mdm 45-59 Minutes ,CPT® 99204,0510 - CLINIC,N/A,N/A, $500.00 , $325.00 , $420.00 , $128.82 , $107.66 , $404.00 , $450.00 , N/A , $450.00 , $450.00 , $450.00 , $425.00 , $105.55 , $461.65 , $475.00 , $425.00 , $465.00 , $465.00 , $475.00 , $480.00 , $409.10 , $450.00 , $425.00 , $395.00 , N/A , $404.65 , $404.65 , $475.00 , $429.05 , $105.55 , $480.00 
 Fac Natriuretic Peptide ,CPT® 83880,0301 - LAB/CHEMISTRY,N/A,N/A, $302.00 , $196.30 , $253.68 , $40.05 , $40.05 , $244.02 , $271.80 , $255.67 , $271.80 , $271.80 , $271.80 , $256.70 , $39.26 , $278.84 , $286.90 , $256.70 , $280.86 , $280.86 , $286.90 , $289.92 , $247.10 , $271.80 , $256.70 , $238.58 , N/A , $244.41 , $244.41 , $286.90 , $259.15 , $39.26 , $289.92 
Colonoscopy Stoma Dx Including Collj Spec Spx,CPT® 44388,N/A,N/A,N/A," $2,729.00 "," $1,773.85 "," $2,013.64 ", $146.74 , $272.24 , $791.86 , $808.81 ," $2,537.97 "," $2,456.10 "," $2,456.10 "," $2,183.20 "," $2,183.20 ", $272.24 ," $2,519.69 "," $2,592.55 "," $2,456.10 "," $2,456.10 "," $2,456.10 "," $2,537.97 "," $2,619.84 ", $681.67 ," $2,319.65 ", $888.46 , $902.79 , N/A , $807.31 , $807.31 ," $2,592.55 ", $844.36 , $146.74 ," $2,619.84 "
 Fac Radex Hips Bilateral With Pelvis 3-4 Views ,CPT® 73522,0320 - DX X-RAY,N/A,N/A, $479.00 , $311.35 , $402.36 , $52.93 , $38.29 , $387.03 , $431.10 , $405.52 , $431.10 , $431.10 , $431.10 , $407.15 , $37.54 , $442.26 , $455.05 , $407.15 , $445.47 , $445.47 , $455.05 , $459.84 , $391.92 , $431.10 , $407.15 , $378.41 , N/A , $387.65 , $387.65 , $455.05 , $411.03 , $37.54 , $459.84 
 SODIUM BICARBONATE 650 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,77333-0831-10,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Removal Ureter,Bladder Cuff",CPT® 50650,N/A,N/A,N/A," $7,209.00 "," $4,685.85 "," $5,606.54 ", $983.70 ," $1,229.45 "," $5,062.58 "," $4,711.71 "," $6,704.37 "," $6,488.10 "," $6,488.10 "," $5,767.20 "," $5,767.20 "," $1,229.45 "," $6,656.07 "," $6,848.55 "," $6,488.10 "," $6,488.10 "," $6,488.10 "," $6,704.37 "," $6,920.64 "," $5,617.13 "," $6,127.65 "," $5,341.49 "," $6,367.21 ", N/A ," $5,161.36 "," $5,161.36 "," $6,848.55 "," $6,066.41 ", $983.70 ," $6,920.64 "
"Debride Mastoid Cavity,Simple",CPT® 69220,N/A,N/A,N/A, $796.00 , $517.40 , $238.90 , $49.04 , $44.47 , $298.13 , $307.04 , $740.28 , $716.40 , $716.40 , $636.80 , $636.80 , $44.47 , $734.95 , $756.20 , $716.40 , $716.40 , $716.40 , $740.28 , $764.16 , $261.18 , $676.60 , $333.62 , $249.86 , N/A , $303.94 , $303.94 , $756.20 , $347.05 , $44.47 , $764.16 
Pro Remove Limb Nerve Lesion,64782,N/A,N/A,N/A," $4,541.00 "," $2,951.65 "," $2,246.76 ", $439.08 , $230.52 ," $2,502.07 "," $2,432.00 "," $4,223.13 "," $4,086.90 "," $4,086.90 "," $3,632.80 "," $3,632.80 ", $230.52 ," $4,192.71 "," $4,313.95 "," $4,086.90 "," $4,086.90 "," $4,086.90 "," $4,223.13 "," $4,359.36 "," $2,433.72 "," $3,859.85 "," $2,385.29 "," $2,725.50 ", N/A ," $2,550.89 "," $2,550.89 "," $4,313.95 "," $2,736.50 ", $230.52 ," $4,359.36 "
"Strapping,Wrist or Elbow",29260,N/A,N/A,N/A, $352.00 , $228.80 , $120.06 , $18.51 , $15.54 , $94.80 , $184.95 , $327.36 , $316.80 , $316.80 , $281.60 , $281.60 , $15.54 , $325.00 , $334.40 , $316.80 , $316.80 , $316.80 , $327.36 , $337.92 , $112.20 , $299.20 , $199.82 , $114.64 , N/A , $96.65 , $96.65 , $334.40 , $113.60 , $15.54 , $337.92 
 Pro Revise/Replace Knee Joint ,CPT® 27486,0975 - PRO FEE/OR,N/A,N/A," $7,898.00 "," $5,133.70 "," $8,454.10 "," $1,321.56 "," $1,016.23 "," $6,796.02 "," $6,731.66 "," $7,345.14 "," $7,108.20 "," $7,108.20 "," $6,318.40 "," $6,318.40 "," $1,016.23 "," $7,292.22 "," $7,503.10 "," $7,108.20 "," $7,108.20 "," $7,108.20 "," $7,345.14 "," $7,582.08 "," $7,887.71 "," $6,713.30 "," $7,452.04 "," $7,996.34 ", N/A ," $6,928.63 "," $6,928.63 "," $7,503.10 "," $8,143.61 "," $1,016.23 "," $8,454.10 "
Motor &/Sens 7-8 Nrv Cndj Preconf Eltrode Limb,CPT® 95910,N/A,N/A,N/A," $1,016.00 ", $660.40 , $876.05 , $172.89 , $144.37 , $628.54 ," $1,502.27 ", $944.88 , $914.40 , $914.40 , $812.80 , $812.80 , $144.37 , $938.07 , $965.20 , $914.40 , $914.40 , $914.40 , $944.88 , $975.36 , $817.12 , $863.60 , $548.42 , $755.56 , N/A , $640.80 , $640.80 , $965.20 , $787.79 , $144.37 ," $1,502.27 "
 CEFTRIAXONE SODIUM 250 MG IJ SOLR ,HCPCS J0696,0636 - DRUGS REQUIRING DETAILED CODIN,00409-7337-01,2.5 mL, $16.68 , $10.84 , $14.01 , $0.58 , $0.54 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.53 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.53 , $16.01 
 Pro Exc Tumor Soft Tiss Back/Flank Subfascial 5+Cm ,CPT® 21933,0982 - PRO FEE/OUTPT,N/A,N/A," $4,898.00 "," $3,183.70 "," $4,435.41 ", $690.51 , $610.14 ," $3,538.64 "," $3,518.47 "," $4,555.14 "," $4,408.20 "," $4,408.20 "," $3,918.40 "," $3,918.40 ", $610.14 ," $4,522.32 "," $4,653.10 "," $4,408.20 "," $4,408.20 "," $4,408.20 "," $4,555.14 "," $4,702.08 "," $4,111.98 "," $4,163.30 "," $3,905.32 "," $4,146.38 ", N/A ," $3,607.68 "," $3,607.68 "," $4,653.10 "," $4,240.30 ", $610.14 ," $4,702.08 "
" Pro X-Ray Exam of Arm, Infant ",CPT® 73092,0972 - PRO FEE/RAD/DX,N/A,N/A, $99.00 , $64.35 , $178.87 , $31.03 , $27.29 , $128.52 , $173.15 , $92.07 , $89.10 , $89.10 , $79.20 , $79.20 , $27.29 , $91.41 , $94.05 , $89.10 , $89.10 , $89.10 , $92.07 , $95.04 , $172.54 , $84.15 , $190.68 , $136.90 , N/A , $131.02 , $131.02 , $94.05 , $151.65 , $27.29 , $190.68 
"Cystoscopy,Ureteral Meatotomy",CPT® 52290,N/A,N/A,N/A," $1,704.00 "," $1,107.60 "," $1,306.11 ", $229.62 , $307.34 ," $1,197.60 "," $1,112.71 "," $1,584.72 "," $1,533.60 "," $1,533.60 "," $1,363.20 "," $1,363.20 ", $307.34 ," $1,573.30 "," $1,618.80 "," $1,533.60 "," $1,533.60 "," $1,533.60 "," $1,584.72 "," $1,635.84 "," $1,314.89 "," $1,448.40 "," $1,259.55 "," $1,504.98 ", N/A ," $1,220.97 "," $1,220.97 "," $1,618.80 "," $1,435.06 ", $229.62 ," $1,635.84 "
"Cystourethroscopy,Ureteral Biopsy",CPT® 52007,N/A,N/A,N/A," $3,314.00 "," $2,154.10 ", $887.05 , $156.35 , $213.05 , $811.66 , $756.28 ," $3,082.02 "," $2,982.60 "," $2,982.60 "," $2,651.20 "," $2,651.20 ", $213.05 ," $3,059.82 "," $3,148.30 "," $2,982.60 "," $2,982.60 "," $2,982.60 "," $3,082.02 "," $3,181.44 ", $892.93 ," $2,816.90 ", $856.35 ," $1,018.75 ", N/A , $827.50 , $827.50 ," $3,148.30 ", $972.61 , $156.35 ," $3,181.44 "
Open Fixatn Mid Humerus Fracture,CPT® 24515,N/A,N/A,N/A," $5,172.00 "," $3,361.80 "," $5,355.87 ", $839.01 , $691.53 ," $4,225.72 "," $4,207.15 "," $4,809.96 "," $4,654.80 "," $4,654.80 "," $4,137.60 "," $4,137.60 ", $691.53 ," $4,775.31 "," $4,913.40 "," $4,654.80 "," $4,654.80 "," $4,654.80 "," $4,809.96 "," $4,965.12 "," $4,977.00 "," $4,396.20 "," $4,643.92 "," $4,981.32 ", N/A ," $4,308.17 "," $4,308.17 "," $4,913.40 "," $5,063.65 ", $691.53 ," $5,355.87 "
 Lac Repair Face Complex 2.6-7.5cm - Mh ,CPT® 13132,0761 - TREATMENT ROOM,N/A,N/A," $2,062.00 "," $1,340.30 "," $1,732.08 ", $290.72 , $268.64 ," $1,666.10 "," $1,855.80 "," $1,745.69 "," $1,855.80 "," $1,855.80 "," $1,855.80 "," $1,752.70 ", $263.37 ," $1,903.84 "," $1,958.90 "," $1,752.70 "," $1,917.66 "," $1,917.66 "," $1,958.90 "," $1,979.52 "," $1,687.13 "," $1,855.80 "," $1,752.70 "," $1,628.98 ", N/A ," $1,668.78 "," $1,668.78 "," $1,958.90 "," $1,769.40 ", $263.37 ," $1,979.52 "
"Bone Biopsy,Trocar/Needle Deep",CPT® 20225,N/A,N/A,N/A," $3,586.00 "," $2,330.90 ", $801.65 , $123.85 , $284.25 , $539.04 , $532.57 ," $3,334.98 "," $3,227.40 "," $3,227.40 "," $2,868.80 "," $2,868.80 ", $284.25 ," $3,310.95 "," $3,406.70 "," $3,227.40 "," $3,227.40 "," $3,227.40 "," $3,334.98 "," $3,442.56 ", $748.72 ," $3,048.10 ", $578.04 , $628.00 , N/A , $549.56 , $549.56 ," $3,406.70 ", $645.94 , $123.85 ," $3,442.56 "
"Repair Shldr Capsul,Ant,Bone Block",CPT® 23460,N/A,N/A,N/A," $7,207.00 "," $4,684.55 "," $6,594.45 "," $1,031.53 "," $1,229.45 "," $5,255.91 "," $5,202.40 "," $6,702.51 "," $6,486.30 "," $6,486.30 "," $5,765.60 "," $5,765.60 "," $1,229.45 "," $6,654.22 "," $6,846.65 "," $6,486.30 "," $6,486.30 "," $6,486.30 "," $6,702.51 "," $6,918.72 "," $6,138.26 "," $6,125.95 "," $5,755.39 "," $6,180.43 ", N/A ," $5,358.46 "," $5,358.46 "," $6,846.65 "," $6,298.08 "," $1,031.53 "," $6,918.72 "
Osteotomy Ulna,CPT® 25360,N/A,N/A,N/A," $4,438.00 "," $2,884.70 "," $4,008.16 ", $629.77 , $614.70 ," $3,150.20 "," $3,141.03 "," $4,127.34 "," $3,994.20 "," $3,994.20 "," $3,550.40 "," $3,550.40 ", $614.70 ," $4,097.61 "," $4,216.10 "," $3,994.20 "," $3,994.20 "," $3,994.20 "," $4,127.34 "," $4,260.48 "," $3,713.85 "," $3,772.30 "," $3,462.87 "," $3,726.50 ", N/A ," $3,211.67 "," $3,211.67 "," $4,216.10 "," $3,774.85 ", $614.70 ," $4,260.48 "
Exc Skin Malig >4cm Remaindr Body,11626,N/A,N/A,N/A," $2,096.00 "," $1,362.40 ", $925.79 , $275.85 , $457.12 , $801.49 , $778.13 ," $1,949.28 "," $1,886.40 "," $1,886.40 "," $1,676.80 "," $1,676.80 ", $457.12 ," $1,935.24 "," $1,991.20 "," $1,886.40 "," $1,886.40 "," $1,886.40 "," $1,949.28 "," $2,012.16 "," $1,014.19 "," $1,781.60 "," $1,559.27 "," $1,020.08 ", N/A , $817.13 , $817.13 ," $1,991.20 ", $947.60 , $275.85 ," $2,012.16 "
 THYROID 30 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00456-0458-01,1 tablet, $5.66 , $3.68 , $4.75 , N/A , N/A , $4.57 , $5.09 , $4.79 , $5.09 , $5.09 , $5.09 , $4.81 , N/A , $5.23 , $5.38 , $4.81 , $5.26 , $5.26 , $5.38 , $5.43 , $4.63 , $5.09 , $4.81 , $4.47 , N/A , $4.58 , $4.58 , $5.38 , $4.86 , $4.47 , $5.43 
 Fac Assay of Ferritin ,CPT® 82728,0301 - LAB/CHEMISTRY,N/A,N/A, $135.00 , $87.75 , $113.40 , $13.90 , $13.90 , $109.08 , $121.50 , $114.29 , $121.50 , $121.50 , $121.50 , $114.75 , $13.63 , $124.65 , $128.25 , $114.75 , $125.55 , $125.55 , $128.25 , $129.60 , $110.46 , $121.50 , $114.75 , $106.65 , N/A , $109.26 , $109.26 , $128.25 , $115.84 , $13.63 , $129.60 
 Wound Trtmnt W/Packing ,CPT® 12021,0981 - PRO FEE/ER,N/A,N/A, $794.00 , $516.10 , $449.31 , $134.92 , $40.65 , $376.90 , $386.02 , $738.42 , $714.60 , $714.60 , $635.20 , $635.20 , $40.65 , $733.10 , $754.30 , $714.60 , $714.60 , $714.60 , $738.42 , $762.24 , $490.29 , $674.90 , $768.93 , $482.58 , N/A , $384.26 , $384.26 , $754.30 , $445.62 , $40.65 , $768.93 
Nonphysician Telephone Assessment 11-20 Min,CPT® 98967,N/A,N/A,N/A, $105.00 , $68.25 , $51.41 , $21.77 , N/A , $57.00 , $56.29 , $97.65 , $94.50 , $94.50 , $84.00 , $84.00 , N/A , $96.95 , $99.75 , $94.50 , $94.50 , $94.50 , $97.65 , $100.80 , $45.82 , $89.25 , $74.00 , $96.39 , N/A , $58.12 , $58.12 , $99.75 , $67.76 , $21.77 , $100.80 
Tap Block Unilateral by Injection(S),64486,N/A,N/A,N/A, $814.00 , $529.10 , $276.80 , $53.31 , $97.79 , $356.51 , $350.87 , $757.02 , $732.60 , $732.60 , $651.20 , $651.20 , $97.79 , $751.57 , $773.30 , $732.60 , $732.60 , $732.60 , $757.02 , $781.44 , $300.42 , $691.90 , $289.64 , $361.04 , N/A , $363.47 , $363.47 , $773.30 , $389.92 , $53.31 , $781.44 
" Fac Hospice, Inpatient Hospital ",CPT® Q5005,0656 - HOSPICE/IP NON-RESPITE,N/A,N/A," $1,085.00 ", $705.25 , $911.40 , N/A , N/A , $876.68 , $976.50 , $918.56 , $976.50 , $976.50 , $976.50 , $922.25 , N/A ," $1,001.78 "," $1,030.75 ", $922.25 ," $1,009.05 "," $1,009.05 "," $1,030.75 "," $1,041.60 ", $887.75 , $976.50 , $922.25 , $857.15 , N/A , $878.09 , $878.09 ," $1,030.75 ", $931.04 , $857.15 ," $1,041.60 "
Albuterol Unit Dose,HCPCS J7613,N/A,N/A,N/A, $8.00 , $5.20 , N/A , $0.03 , $0.04 , N/A , N/A , $7.44 , $7.20 , $7.20 , $6.40 , $6.40 , $0.04 , $7.39 , $7.60 , $7.20 , $7.20 , $7.20 , $7.44 , $7.68 , $0.05 , $6.80 , $0.65 , $0.05 , N/A , N/A , N/A , $7.60 , N/A , $0.03 , $7.68 
 Pro Remove Sacrum Pressure Sore ,CPT® 15931,0982 - PRO FEE/OUTPT,N/A,N/A," $2,696.00 "," $1,752.40 "," $2,206.77 ", $660.56 , $366.32 ," $1,848.82 "," $1,798.75 "," $2,507.28 "," $2,426.40 "," $2,426.40 "," $2,156.80 "," $2,156.80 ", $366.32 ," $2,489.22 "," $2,561.20 "," $2,426.40 "," $2,426.40 "," $2,426.40 "," $2,507.28 "," $2,588.16 "," $2,422.83 "," $2,291.60 "," $3,623.43 "," $2,350.78 ", N/A ," $1,884.90 "," $1,884.90 "," $2,561.20 "," $2,185.86 ", $366.32 ," $3,623.43 "
 Esophagogastroduodenoscopy W/Plac of Stent(Incl Dilation) ,CPT® 43266,0360 - OR SERVICES,N/A,N/A," $2,841.00 "," $1,846.65 "," $2,386.44 ", $205.06 , $175.28 ," $2,295.53 "," $2,556.90 "," $2,405.19 "," $2,556.90 "," $2,556.90 "," $2,556.90 "," $2,414.85 ", $171.84 ," $2,623.10 "," $2,698.95 "," $2,414.85 "," $2,642.13 "," $2,642.13 "," $2,698.95 "," $2,727.36 "," $2,324.51 "," $2,556.90 "," $2,414.85 "," $2,244.39 ", N/A ," $2,299.22 "," $2,299.22 "," $2,698.95 "," $2,437.86 ", $171.84 ," $2,727.36 "
Fac Rmvl Embedded FB Vestibule Mouth Smpl,40804,N/A,N/A,N/A, $602.00 , $391.30 , $695.89 , $109.50 , $30.71 , $639.41 , $673.81 , $559.86 , $541.80 , $541.80 , $481.60 , $481.60 , $30.71 , $555.83 , $571.90 , $541.80 , $541.80 , $541.80 , $559.86 , $577.92 , $506.97 , $511.70 , $733.25 , $657.96 , N/A , $651.89 , $651.89 , $571.90 , $681.79 , $30.71 , $733.25 
Inj Proc Shoulder Arthrography/CT/MRI,CPT® 23350,N/A,N/A,N/A," $1,024.00 ", $665.60 , $309.34 , $48.12 , $41.91 , $252.34 , $243.88 , $952.32 , $921.60 , $921.60 , $819.20 , $819.20 , $41.91 , $945.46 , $972.80 , $921.60 , $921.60 , $921.60 , $952.32 , $983.04 , $289.12 , $870.40 , $264.04 , $299.23 , N/A , $257.26 , $257.26 , $972.80 , $302.38 , $41.91 , $983.04 
 GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN ,HCPCS RXC637,0250 - PHARMACY,00121-1775-00,5 mL, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
" Fac Strep B, Dna, Amp Probe ",CPT® 87653,0306 - LAB/BACT-MICRO,N/A,N/A, $324.00 , $210.60 , $272.16 , $35.79 , $35.79 , $261.79 , $291.60 , $274.30 , $291.60 , $291.60 , $291.60 , $275.40 , $35.09 , $299.15 , $307.80 , $275.40 , $301.32 , $301.32 , $307.80 , $311.04 , $265.10 , $291.60 , $275.40 , $255.96 , N/A , $262.21 , $262.21 , $307.80 , $278.02 , $35.09 , $311.04 
Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm,97607,N/A,N/A,N/A, $422.00 , $274.30 , $49.32 , $20.51 , $31.76 , $99.25 , N/A , $392.46 , $379.80 , $379.80 , $337.60 , $337.60 , $31.76 , $389.63 , $400.90 , $379.80 , $379.80 , $379.80 , $392.46 , $405.12 , $65.81 , $358.70 , $65.63 , $95.09 , N/A , $101.19 , $101.19 , $400.90 , $112.54 , $20.51 , $405.12 
 Other Disorders Of Nervous System With Cc ,MS DRG V40 (FY2023) 092,N/A,N/A,N/A," $12,368.70 "," $8,039.66 "," $10,389.71 ", N/A , N/A ," $9,993.91 "," $11,131.83 "," $10,471.34 "," $11,131.83 "," $11,131.83 "," $11,131.83 "," $10,513.40 ", N/A ," $11,420.02 "," $11,750.27 "," $10,513.40 "," $11,502.89 "," $11,502.89 "," $11,750.27 "," $11,873.95 "," $10,120.07 "," $11,131.83 "," $10,513.40 "," $9,771.27 ", N/A ," $10,009.99 "," $10,009.99 "," $11,750.27 "," $10,613.58 "," $9,771.27 "," $11,873.95 "
"Surg Diagnostic Exam, Anorectal",45990,N/A,N/A,N/A, $705.00 , $458.25 , $635.31 , $98.63 , $89.21 , $510.76 , $514.87 , $655.65 , $634.50 , $634.50 , $564.00 , $564.00 , $89.21 , $650.93 , $669.75 , $634.50 , $634.50 , $634.50 , $655.65 , $676.80 , $456.24 , $599.25 , $565.55 , $605.04 , N/A , $520.72 , $520.72 , $669.75 , $544.61 , $89.21 , $676.80 
"Resec Tumor Lower Leg,Subcut",CPT® 27618,N/A,N/A,N/A," $2,968.00 "," $1,929.20 "," $1,868.04 ", $293.01 , $213.54 ," $1,484.08 "," $1,479.61 "," $2,760.24 "," $2,671.20 "," $2,671.20 "," $2,374.40 "," $2,374.40 ", $213.54 ," $2,740.35 "," $2,819.60 "," $2,671.20 "," $2,671.20 "," $2,671.20 "," $2,760.24 "," $2,849.28 "," $1,724.44 "," $2,522.80 "," $1,627.07 "," $1,761.99 ", N/A ," $1,513.04 "," $1,513.04 "," $2,819.60 "," $1,778.36 ", $213.54 ," $2,849.28 "
" Pro N Block Inj, Hypogas Plxs ",CPT® 64517,0982 - PRO FEE/OUTPT,N/A,N/A," $1,273.00 ", $827.45 , $626.91 , $122.10 , $185.43 , $691.69 , $668.67 ," $1,183.89 "," $1,145.70 "," $1,145.70 "," $1,018.40 "," $1,018.40 ", $185.43 ," $1,175.36 "," $1,209.35 "," $1,145.70 "," $1,145.70 "," $1,145.70 "," $1,183.89 "," $1,222.08 ", $678.02 ," $1,082.05 ", $651.18 , $764.35 , N/A , $705.18 , $705.18 ," $1,209.35 ", $756.51 , $122.10 ," $1,222.08 "
 Pro Hospital IP/Obs Care Same Date Sf/Low Mdm 45 Min ,CPT® 99234,0987 - PRO FEE/HOS VIS,N/A,N/A, $407.00 , $264.55 , $258.55 , $95.38 , $141.73 , $231.15 , $231.50 , $378.51 , $366.30 , $366.30 , $325.60 , $325.60 , $141.73 , $375.78 , $386.65 , $366.30 , $366.30 , $366.30 , $378.51 , $390.72 , $387.82 , $345.95 , $289.54 , $290.69 , N/A , $235.65 , $235.65 , $386.65 , $271.78 , $95.38 , $390.72 
 LIDOCAINE-EPINEPHRINE 1 %-1:200000 IJ SOLN ,HCPCS RXA250,0250 - PHARMACY,63323-0487-01,10 mL, $52.35 , $34.03 , $43.97 , N/A , N/A , $42.30 , $47.12 , $44.32 , $47.12 , $47.12 , $47.12 , $44.50 , N/A , $48.33 , $49.73 , $44.50 , $48.69 , $48.69 , $49.73 , $50.26 , $42.83 , $47.12 , $44.50 , $41.36 , N/A , $42.37 , $42.37 , $49.73 , $44.92 , $41.36 , $50.26 
Simple Repair 5.1-7.5cm,12014,N/A,N/A,N/A, $597.00 , $388.05 , $232.08 , $69.01 , $92.31 , $214.79 , $208.07 , $555.21 , $537.30 , $537.30 , $477.60 , $477.60 , $92.31 , $551.21 , $567.15 , $537.30 , $537.30 , $537.30 , $555.21 , $573.12 , $255.61 , $507.45 , $417.47 , $258.60 , N/A , $218.98 , $218.98 , $567.15 , $253.95 , $69.01 , $573.12 
X-Ray Foot 3+ Vw,CPT® 73630,N/A,N/A,N/A, $234.00 , $152.10 , $194.13 , $33.68 , $29.84 , $137.07 , $167.96 , $217.62 , $210.60 , $210.60 , $187.20 , $187.20 , $29.84 , $216.05 , $222.30 , $210.60 , $210.60 , $210.60 , $217.62 , $224.64 , $187.73 , $198.90 , $184.90 , $147.71 , N/A , $139.74 , $139.74 , $222.30 , $161.74 , $29.84 , $224.64 
 Fac Insj of Subq Implantable Defibrillator Electrode ,CPT® 33271,0360 - OR SERVICES,N/A,N/A," $4,673.00 "," $3,037.45 "," $3,925.32 ", $413.85 , $384.40 ," $3,775.78 "," $4,205.70 "," $3,956.16 "," $4,205.70 "," $4,205.70 "," $4,205.70 "," $3,972.05 ", $376.86 ," $4,314.58 "," $4,439.35 "," $3,972.05 "," $4,345.89 "," $4,345.89 "," $4,439.35 "," $4,486.08 "," $3,823.45 "," $4,205.70 "," $3,972.05 "," $3,691.67 ", N/A ," $3,781.86 "," $3,781.86 "," $4,439.35 "," $4,009.90 ", $376.86 ," $4,486.08 "
Layer Closure 2.5cm or Le,CPT® 12051,N/A,N/A,N/A," $1,095.00 ", $711.75 , $541.38 , $162.92 , $106.23 , $469.05 , $460.11 ," $1,018.35 ", $985.50 , $985.50 , $876.00 , $876.00 , $106.23 ," $1,011.01 "," $1,040.25 ", $985.50 , $985.50 , $985.50 ," $1,018.35 "," $1,051.20 ", $593.04 , $930.75 , $917.01 , $602.22 , N/A , $478.20 , $478.20 ," $1,040.25 ", $554.57 , $106.23 ," $1,051.20 "
 Pro Application of Long Leg Cast ,CPT® 29345,0982 - PRO FEE/OUTPT,N/A,N/A, $899.00 , $584.35 , $597.74 , $94.01 , $111.25 , $488.19 , $488.55 , $836.07 , $809.10 , $809.10 , $719.20 , $719.20 , $111.25 , $830.05 , $854.05 , $809.10 , $809.10 , $809.10 , $836.07 , $863.04 , $558.12 , $764.15 , $538.79 , $575.51 , N/A , $497.71 , $497.71 , $854.05 , $584.99 , $94.01 , $863.04 
 Braf Gene Analysis V600e Vrint ,CPT® 81210,0310 - PATHOLOGY LAB,N/A,N/A," $1,101.00 ", $715.65 , $924.84 , $178.91 , $146.27 , $889.61 , $990.90 , $932.11 , $990.90 , $990.90 , $990.90 , $935.85 , $143.40 ," $1,016.55 "," $1,045.95 ", $935.85 ," $1,023.93 "," $1,023.93 "," $1,045.95 "," $1,056.96 ", $900.84 , $990.90 , $935.85 , $869.79 , N/A , $891.04 , $891.04 ," $1,045.95 ", $944.77 , $143.40 ," $1,056.96 "
Excis Tongue Lesn,CPT® 41110,N/A,N/A,N/A, $935.00 , $607.75 , $803.53 , $126.26 , $62.67 , $638.73 , $664.75 , $869.55 , $841.50 , $841.50 , $748.00 , $748.00 , $62.67 , $863.29 , $888.25 , $841.50 , $841.50 , $841.50 , $869.55 , $897.60 , $573.47 , $794.75 , $726.11 , $752.70 , N/A , $651.19 , $651.19 , $888.25 , $681.08 , $62.67 , $897.60 
" Pro Total Disc Arthroplasty, Cervical, Single ",CPT® 22856,0975 - PRO FEE/OR,N/A,N/A," $11,033.00 "," $7,171.45 "," $9,507.42 "," $1,481.65 "," $1,425.60 "," $7,694.81 "," $7,822.79 "," $10,260.69 "," $9,929.70 "," $9,929.70 "," $8,826.40 "," $8,826.40 "," $1,425.60 "," $10,186.77 "," $10,481.35 "," $9,929.70 "," $9,929.70 "," $9,929.70 "," $10,260.69 "," $10,591.68 "," $8,863.31 "," $9,378.05 "," $8,836.47 "," $9,023.67 ", N/A ," $7,844.95 "," $7,844.95 "," $10,481.35 "," $9,220.60 "," $1,425.60 "," $10,591.68 "
Office/Outpatient Established Sf Mdm 10-19 Min,99212,N/A,N/A,N/A, $119.00 , $77.35 , $72.24 , $34.37 , $29.87 , $44.01 , $43.22 , $110.67 , $107.10 , $107.10 , $95.20 , $95.20 , $29.87 , $109.87 , $113.05 , $107.10 , $107.10 , $107.10 , $110.67 , $114.24 , $65.53 , $101.15 , $54.01 , $55.40 , $64.00 , $44.87 , $44.87 , $113.05 , $51.74 , $29.87 , $114.24 
Who W/Nontorsion Jnt(S) Cf,HCPCS L3905,N/A,N/A,N/A," $1,511.00 ", $982.15 , N/A ," $1,055.71 ", $463.28 , N/A , N/A ," $1,405.23 "," $1,359.90 "," $1,359.90 "," $1,208.80 "," $1,208.80 ", $463.28 ," $1,395.11 "," $1,435.45 "," $1,359.90 "," $1,359.90 "," $1,359.90 "," $1,405.23 "," $1,450.56 ", N/A ," $1,284.35 ", $871.27 , $888.21 , N/A , N/A , N/A ," $1,435.45 ", N/A , $463.28 ," $1,450.56 "
Adj Tiss Xfer Trunk 10.1-30,CPT® 14001,N/A,N/A,N/A," $4,196.00 "," $2,727.40 "," $2,066.42 ", $619.33 , $329.01 ," $1,779.65 "," $1,751.98 "," $3,902.28 "," $3,776.40 "," $3,776.40 "," $3,356.80 "," $3,356.80 ", $329.01 ," $3,874.17 "," $3,986.20 "," $3,776.40 "," $3,776.40 "," $3,776.40 "," $3,902.28 "," $4,028.16 "," $2,257.71 "," $3,566.60 "," $3,502.12 "," $2,284.00 ", N/A ," $1,814.37 "," $1,814.37 "," $3,986.20 "," $2,104.04 ", $329.01 ," $4,028.16 "
 OLANZAPINE 5 MG PO TBDP ,HCPCS RXC637,0250 - PHARMACY,60505-3275-00,1 tablet, $73.33 , $47.66 , $61.60 , N/A , N/A , $59.25 , $66.00 , $62.08 , $66.00 , $66.00 , $66.00 , $62.33 , N/A , $67.71 , $69.66 , $62.33 , $68.20 , $68.20 , $69.66 , $70.40 , $60.00 , $66.00 , $62.33 , $57.93 , N/A , $59.35 , $59.35 , $69.66 , $62.92 , $57.93 , $70.40 
Musc Myoq/Fscq Flap Head&Neck W/Named Vasc Pedcl,CPT® 15733,N/A,N/A,N/A," $7,879.00 "," $5,121.35 "," $3,288.28 ", $981.98 , $821.78 ," $2,708.67 "," $2,728.17 "," $7,327.47 "," $7,091.10 "," $7,091.10 "," $6,303.20 "," $6,303.20 ", $821.78 ," $7,274.68 "," $7,485.05 "," $7,091.10 "," $7,091.10 "," $7,091.10 "," $7,327.47 "," $7,563.84 "," $3,616.81 "," $6,697.15 "," $5,462.32 "," $3,685.87 ", N/A ," $2,761.52 "," $2,761.52 "," $7,485.05 "," $3,202.43 ", $821.78 ," $7,563.84 "
Blood Clot Factor II Test,CPT® 85210,N/A,N/A,N/A, $120.00 , $78.00 , N/A , $13.24 , $8.07 , $32.88 , $39.34 , $111.60 , $108.00 , $108.00 , $96.00 , $96.00 , $8.07 , $110.80 , $114.00 , $108.00 , $108.00 , $108.00 , $111.60 , $115.20 , $86.67 , $102.00 , $84.34 , $47.08 , N/A , $30.69 , $30.69 , $114.00 , $33.54 , $8.07 , $115.20 
 Pro Control Nasal Hemorrhage ,CPT® 30906,0981 - PRO FEE/ER,N/A,N/A," $1,138.00 ", $739.70 , $727.95 , $126.25 , $301.31 , $501.10 , $487.02 ," $1,058.34 "," $1,024.20 "," $1,024.20 ", $910.40 , $910.40 , $301.31 ," $1,050.72 "," $1,081.10 "," $1,024.20 "," $1,024.20 "," $1,024.20 "," $1,058.34 "," $1,092.48 ", $700.97 , $967.30 , $688.65 , $689.87 , N/A , $510.88 , $510.88 ," $1,081.10 ", $601.68 , $126.25 ," $1,092.48 "
 Pro Cltx Prox Tibfib Jt Dislc W/O Anes ,CPT® 27830,0981 - PRO FEE/ER,N/A,N/A," $1,894.00 "," $1,231.10 "," $2,228.01 ", $351.99 , $230.52 ," $1,693.54 "," $1,719.93 "," $1,761.42 "," $1,704.60 "," $1,704.60 "," $1,515.20 "," $1,515.20 ", $230.52 ," $1,748.73 "," $1,799.30 "," $1,704.60 "," $1,704.60 "," $1,704.60 "," $1,761.42 "," $1,818.24 "," $2,053.76 "," $1,609.90 "," $1,891.11 "," $2,023.56 ", N/A ," $1,726.59 "," $1,726.59 "," $1,799.30 "," $2,029.35 ", $230.52 ," $2,228.01 "
 EPOETIN ALFA-EPBX 10000 UNIT/ML IJ SOLN ,HCPCS Q5105,0636 - DRUGS REQUIRING DETAILED CODIN,00069-1308-10,1 mL, $324.32 , $210.81 , $272.43 , $0.77 , N/A , $262.05 , $291.89 , $274.57 , $291.89 , $291.89 , $291.89 , $275.67 , N/A , $299.44 , $308.10 , $275.67 , $301.62 , $301.62 , $308.10 , $311.35 , $265.36 , $291.89 , $275.67 , $256.21 , N/A , $262.47 , $262.47 , $308.10 , $278.30 , $0.77 , $311.35 
 Fac Cath Plmt L Hrt/Arts/Grfts Wnjx & Angio Img S&I ,CPT® 93459,0481 - CARDIAC CATH LAB,N/A,N/A," $14,530.00 "," $9,444.50 "," $12,205.20 "," $1,084.73 ", $850.21 ," $11,740.24 "," $13,077.00 "," $12,301.10 "," $13,077.00 "," $13,077.00 "," $13,077.00 "," $12,350.50 ", $833.54 ," $13,415.55 "," $13,803.50 "," $12,350.50 "," $13,512.90 "," $13,512.90 "," $13,803.50 "," $13,948.80 "," $11,888.45 "," $13,077.00 "," $12,350.50 "," $11,478.70 ", N/A ," $11,759.13 "," $11,759.13 "," $13,803.50 "," $12,468.19 ", $833.54 ," $13,948.80 "
Bx Synovium Metatarso-Phal Jt,28052,N/A,N/A,N/A," $2,924.00 "," $1,900.60 "," $1,592.11 ", $249.33 , $276.59 ," $1,378.44 "," $1,386.82 "," $2,719.32 "," $2,631.60 "," $2,631.60 "," $2,339.20 "," $2,339.20 ", $276.59 ," $2,699.73 "," $2,777.80 "," $2,631.60 "," $2,631.60 "," $2,631.60 "," $2,719.32 "," $2,807.04 "," $1,628.99 "," $2,485.40 "," $1,507.53 "," $1,675.77 ", N/A ," $1,405.34 "," $1,405.34 "," $2,777.80 "," $1,651.78 ", $249.33 ," $2,807.04 "
 CARFILZOMIB 10 MG IV SOLR ,HCPCS J9047,0636 - DRUGS REQUIRING DETAILED CODIN,76075-0103-01,5 mL," $1,459.97 ", $948.98 ," $1,226.37 ", $47.98 , $45.96 ," $1,179.66 "," $1,313.97 "," $1,236.01 "," $1,313.97 "," $1,313.97 "," $1,313.97 "," $1,240.97 ", $45.06 ," $1,347.99 "," $1,386.97 "," $1,240.97 "," $1,357.77 "," $1,357.77 "," $1,386.97 "," $1,401.57 "," $1,194.55 "," $1,313.97 "," $1,240.97 "," $1,153.38 ", N/A ," $1,181.55 "," $1,181.55 "," $1,386.97 "," $1,252.80 ", $45.06 ," $1,401.57 "
Apply-Shoudler to Hand,CPT® 29065,N/A,N/A,N/A, $638.00 , $414.70 , $411.13 , $64.54 , $78.67 , $331.65 , $332.74 , $593.34 , $574.20 , $574.20 , $510.40 , $510.40 , $78.67 , $589.07 , $606.10 , $574.20 , $574.20 , $574.20 , $593.34 , $612.48 , $381.08 , $542.30 , $365.73 , $390.75 , N/A , $338.12 , $338.12 , $606.10 , $397.43 , $64.54 , $612.48 
Exc Skin Malig 3.1-4cm Remaindr Body,CPT® 11624,N/A,N/A,N/A," $1,694.00 "," $1,101.10 ", $758.13 , $226.87 , $390.36 , $655.26 , $637.05 ," $1,575.42 "," $1,524.60 "," $1,524.60 "," $1,355.20 "," $1,355.20 ", $390.36 ," $1,564.07 "," $1,609.30 "," $1,524.60 "," $1,524.60 "," $1,524.60 "," $1,575.42 "," $1,626.24 ", $830.47 ," $1,439.90 "," $1,273.82 ", $838.92 , N/A , $668.04 , $668.04 ," $1,609.30 ", $774.73 , $226.87 ," $1,626.24 "
Complex Repair 1.1-2.5cm,CPT® 13120,N/A,N/A,N/A," $1,366.00 ", $887.90 , $748.31 , $223.03 , $131.87 , $646.85 , $634.03 ," $1,270.38 "," $1,229.40 "," $1,229.40 "," $1,092.80 "," $1,092.80 ", $131.87 ," $1,261.23 "," $1,297.70 "," $1,229.40 "," $1,229.40 "," $1,229.40 "," $1,270.38 "," $1,311.36 ", $827.01 ," $1,161.10 "," $1,261.33 ", $830.94 , N/A , $659.47 , $659.47 ," $1,297.70 ", $764.75 , $131.87 ," $1,311.36 "
X-Ray Ribs 2 Vw Unilat,CPT® 71100,N/A,N/A,N/A, $479.00 , $311.35 , $207.93 , $36.39 , $31.35 , $144.21 , $173.58 , $445.47 , $431.10 , $431.10 , $383.20 , $383.20 , $31.35 , $442.26 , $455.05 , $431.10 , $431.10 , $431.10 , $445.47 , $459.84 , $201.48 , $407.15 , $188.75 , $167.82 , N/A , $147.02 , $147.02 , $455.05 , $170.20 , $31.35 , $459.84 
 ASCORBIC ACID 500 MG PO TABS ,HCPCS RXA250,0250 - PHARMACY,00904-0523-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Rmvl Prm Ipr Cannula/Cath ,CPT® 49422,0361 - OR/MINOR,N/A,N/A," $2,789.00 "," $1,812.85 "," $2,342.76 ", $201.99 , $667.22 ," $2,253.51 "," $2,510.10 "," $2,361.17 "," $2,510.10 "," $2,510.10 "," $2,510.10 "," $2,370.65 ", $654.14 ," $2,575.08 "," $2,649.55 "," $2,370.65 "," $2,593.77 "," $2,593.77 "," $2,649.55 "," $2,677.44 "," $2,281.96 "," $2,510.10 "," $2,370.65 "," $2,203.31 ", N/A ," $2,257.14 "," $2,257.14 "," $2,649.55 "," $2,393.24 ", $201.99 ," $2,677.44 "
Layer Closure 20.1-30cm,12046,N/A,N/A,N/A," $2,056.00 "," $1,336.40 ", $995.01 , $295.31 , $292.55 , $840.68 , $902.38 ," $1,912.08 "," $1,850.40 "," $1,850.40 "," $1,644.80 "," $1,644.80 ", $292.55 ," $1,898.30 "," $1,953.20 "," $1,850.40 "," $1,850.40 "," $1,850.40 "," $1,912.08 "," $1,973.76 "," $1,085.71 "," $1,747.60 "," $1,809.04 "," $1,062.50 ", N/A , $857.08 , $857.08 ," $1,953.20 ", $993.92 , $292.55 ," $1,973.76 "
 Ercp Pancreatic Only ,CPT® 74329,0320 - DX X-RAY,N/A,N/A, $733.00 , $476.45 , $615.72 , $152.83 , $159.34 , $592.26 , $659.70 , $620.56 , $659.70 , $659.70 , $659.70 , $623.05 , $156.22 , $676.78 , $696.35 , $623.05 , $681.69 , $681.69 , $696.35 , $703.68 , $599.74 , $659.70 , $623.05 , $579.07 , N/A , $593.22 , $593.22 , $696.35 , $628.99 , $152.83 , $703.68 
 Pro Cltx Metatarsophlngl Jt Dislc W/O Anes ,CPT® 28630,0981 - PRO FEE/ER,N/A,N/A, $837.00 , $544.05 , $677.30 , $106.32 , $134.96 , $532.98 , $535.04 , $778.41 , $753.30 , $753.30 , $669.60 , $669.60 , $134.96 , $772.80 , $795.15 , $753.30 , $753.30 , $753.30 , $778.41 , $803.52 , $627.12 , $711.45 , $583.39 , $633.25 , N/A , $543.38 , $543.38 , $795.15 , $638.64 , $106.32 , $803.52 
 Pelvic US ,CPT® 76856,0402 - ULTRASOUND,N/A,N/A, $580.00 , $377.00 , $487.20 , $104.51 , $99.44 , $468.64 , $522.00 , $491.03 , $522.00 , $522.00 , $522.00 , $493.00 , $97.49 , $535.51 , $551.00 , $493.00 , $539.40 , $539.40 , $551.00 , $556.80 , $474.56 , $522.00 , $493.00 , $458.20 , N/A , $469.39 , $469.39 , $551.00 , $497.70 , $97.49 , $556.80 
Egd Flex Removal Lesion(S) by Hot Biopsy Forceps,43250,N/A,N/A,N/A," $2,545.00 "," $1,654.25 "," $1,032.98 ", $159.86 , $295.67 , $862.02 , $916.97 ," $2,366.85 "," $2,290.50 "," $2,290.50 "," $2,036.00 "," $2,036.00 ", $295.67 ," $2,349.80 "," $2,417.75 "," $2,290.50 "," $2,290.50 "," $2,290.50 "," $2,366.85 "," $2,443.20 ", $744.02 ," $2,163.25 "," $1,008.00 ", $984.49 , N/A , $878.84 , $878.84 ," $2,417.75 ", $919.17 , $159.86 ," $2,443.20 "
 Pro Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas ,CPT® 78014,0974 - PRO FEE/NUC MED,N/A,N/A, $206.00 , $133.90 ," $1,274.32 ", $218.24 , $190.86 ," $1,183.50 "," $1,255.61 ", $191.58 , $185.40 , $185.40 , $164.80 , $164.80 , $190.86 , $190.20 , $195.70 , $185.40 , $185.40 , $185.40 , $191.58 , $197.76 ," $1,322.17 ", $175.10 ," $1,373.27 "," $1,623.69 ", N/A ," $1,206.60 "," $1,206.60 ", $195.70 ," $1,396.65 ", $164.80 ," $1,623.69 "
"Destruc Flat Warts, Up to 14 Lesions",17110,N/A,N/A,N/A, $342.00 , $222.30 , $157.95 , $65.34 , $26.07 , $189.80 , $190.02 , $318.06 , $307.80 , $307.80 , $273.60 , $273.60 , $26.07 , $315.77 , $324.90 , $307.80 , $307.80 , $307.80 , $318.06 , $328.32 , $233.71 , $290.70 , $374.65 , $246.56 , N/A , $193.50 , $193.50 , $324.90 , $224.41 , $26.07 , $374.65 
 Pro CT Scan for Needle Biopsy ,CPT® 77012,0972 - PRO FEE/RAD/DX,N/A,N/A, $782.00 , $508.30 , $808.06 , $139.40 , $171.11 , $595.06 , $672.36 , $727.26 , $703.80 , $703.80 , $625.60 , $625.60 , $171.11 , $722.02 , $742.90 , $703.80 , $703.80 , $703.80 , $727.26 , $750.72 , $820.07 , $664.70 , $728.04 , $809.18 , N/A , $606.67 , $606.67 , $742.90 , $702.24 , $139.40 , $820.07 
" Fac Genotype, Dna, Hepatitis C ",CPT® 87902,0300 - LABORATORY,N/A,N/A," $2,376.00 "," $1,544.40 "," $1,995.84 ", $262.60 , $262.60 ," $1,919.81 "," $2,138.40 "," $2,011.52 "," $2,138.40 "," $2,138.40 "," $2,138.40 "," $2,019.60 ", $257.45 ," $2,193.76 "," $2,257.20 "," $2,019.60 "," $2,209.68 "," $2,209.68 "," $2,257.20 "," $2,280.96 "," $1,944.04 "," $2,138.40 "," $2,019.60 "," $1,877.04 ", N/A ," $1,922.90 "," $1,922.90 "," $2,257.20 "," $2,038.85 ", $257.45 ," $2,280.96 "
Glucagon Hydrochloride/1 Mg,HCPCS J1610,N/A,N/A,N/A, $338.00 , $219.70 , N/A , $199.08 , $194.07 , N/A , N/A , $314.34 , $304.20 , $304.20 , $270.40 , $270.40 , $194.07 , $312.08 , $321.10 , $304.20 , $304.20 , $304.20 , $314.34 , $324.48 , $230.69 , $287.30 , $225.12 , $222.11 , N/A , N/A , N/A , $321.10 , N/A , $194.07 , $324.48 
 Pro Injection Sclerosant Multiple Incmptnt Veins ,CPT® 36471,0982 - PRO FEE/OUTPT,N/A,N/A," $1,211.00 ", $787.15 , $447.20 , $69.44 , $76.21 , $431.60 , $432.80 ," $1,126.23 "," $1,089.90 "," $1,089.90 ", $968.80 , $968.80 , $76.21 ," $1,118.12 "," $1,150.45 "," $1,089.90 "," $1,089.90 "," $1,089.90 "," $1,126.23 "," $1,162.56 ", $414.20 ," $1,029.35 ", $542.36 , $372.68 , N/A , $440.02 , $440.02 ," $1,150.45 ", $499.87 , $69.44 ," $1,162.56 "
 Fac Intensity Modulated Radiation Tx Dlvr Complex ,CPT® 77386,0333 - RADIATION RX,N/A,N/A," $4,455.00 "," $2,895.75 "," $3,742.20 ", N/A , N/A ," $3,599.64 "," $4,009.50 "," $3,771.60 "," $4,009.50 "," $4,009.50 "," $4,009.50 "," $3,786.75 ", N/A ," $4,113.30 "," $4,232.25 "," $3,786.75 "," $4,143.15 "," $4,143.15 "," $4,232.25 "," $4,276.80 "," $3,645.08 "," $4,009.50 "," $3,786.75 "," $3,519.45 ", N/A ," $3,605.43 "," $3,605.43 "," $4,232.25 "," $3,822.84 "," $3,519.45 "," $4,276.80 "
Computerized Ophthalmic Imaging Anterior Segment,92132,N/A,N/A,N/A, $104.00 , $67.60 , $67.84 , $30.95 , $26.60 , $61.08 , $63.82 , $96.72 , $93.60 , $93.60 , $83.20 , $83.20 , $26.60 , $96.02 , $98.80 , $93.60 , $93.60 , $93.60 , $96.72 , $99.84 , $96.09 , $88.40 , $108.47 , $65.89 , N/A , $62.26 , $62.26 , $98.80 , $74.08 , $26.60 , $108.47 
 ARIPIPRAZOLE ER 400 MG IM SRER ,HCPCS J0401,0636 - DRUGS REQUIRING DETAILED CODIN,59148-0019-71,2 mL," $7,995.40 "," $5,197.01 "," $6,716.14 ", $6.85 , $6.55 ," $6,460.28 "," $7,195.86 "," $6,768.91 "," $7,195.86 "," $7,195.86 "," $7,195.86 "," $6,796.09 ", $6.42 ," $7,382.15 "," $7,595.63 "," $6,796.09 "," $7,435.72 "," $7,435.72 "," $7,595.63 "," $7,675.58 "," $6,541.84 "," $7,195.86 "," $6,796.09 "," $6,316.37 ", N/A ," $6,470.68 "," $6,470.68 "," $7,595.63 "," $6,860.85 ", $6.42 ," $7,675.58 "
"Renal Flow/Funct Image,Pharm Rx",CPT® 78708,N/A,N/A,N/A," $1,762.00 "," $1,145.30 ", $980.55 , $171.08 , $177.99 , $854.01 , $912.30 ," $1,638.66 "," $1,585.80 "," $1,585.80 "," $1,409.60 "," $1,409.60 ", $177.99 ," $1,626.85 "," $1,673.90 "," $1,585.80 "," $1,585.80 "," $1,585.80 "," $1,638.66 "," $1,691.52 ", $978.69 ," $1,497.70 ", $991.91 ," $1,176.95 ", N/A , $870.68 , $870.68 ," $1,673.90 "," $1,007.81 ", $171.08 ," $1,691.52 "
 LIDOCAINE-PHENYLEPHRINE 1-1.5 % IO SOLN ,HCPCS RXA250,0250 - PHARMACY,71384-0650-01,1 mL, $114.04 , $74.13 , $95.79 , N/A , N/A , $92.14 , $102.64 , $96.55 , $102.64 , $102.64 , $102.64 , $96.93 , N/A , $105.29 , $108.34 , $96.93 , $106.06 , $106.06 , $108.34 , $109.48 , $93.31 , $102.64 , $96.93 , $90.09 , N/A , $92.29 , $92.29 , $108.34 , $97.86 , $90.09 , $109.48 
 CYCLOPENTOLATE HCL 1 % OP SOLN ,HCPCS RXA250,0250 - PHARMACY,61314-0396-01,2 mL, $86.30 , $56.10 , $72.49 , N/A , N/A , $69.73 , $77.67 , $73.06 , $77.67 , $77.67 , $77.67 , $73.36 , N/A , $79.68 , $81.99 , $73.36 , $80.26 , $80.26 , $81.99 , $82.85 , $70.61 , $77.67 , $73.36 , $68.18 , N/A , $69.84 , $69.84 , $81.99 , $74.05 , $68.18 , $82.85 
"Lt Compres Band <3""/Yd",HCPCS A6448,N/A,N/A,N/A, $9.00 , $5.85 , N/A , $1.56 , $0.49 , N/A , N/A , $8.37 , $8.10 , $8.10 , $7.20 , $7.20 , $0.49 , $8.31 , $8.55 , $8.10 , $8.10 , $8.10 , $8.37 , $8.64 , N/A , $7.65 , $1.30 , $1.42 , N/A , N/A , N/A , $8.55 , N/A , $0.49 , $8.64 
Prothrombin Time,CPT® 85610,N/A,N/A,N/A, $69.00 , $44.85 , N/A , $4.38 , $4.38 , $22.24 , $26.58 , $64.17 , $62.10 , $62.10 , $55.20 , $55.20 , $4.38 , $63.71 , $65.55 , $62.10 , $62.10 , $62.10 , $64.17 , $66.24 , $28.65 , $58.65 , $25.95 , $14.22 , N/A , $20.76 , $20.76 , $65.55 , $22.68 , $4.38 , $66.24 
" Pro US Exam Infant Hips, Dynamic ",CPT® 76885,0972 - PRO FEE/RAD/DX,N/A,N/A, $512.00 , $332.80 , $651.22 , $118.83 , $86.75 , $694.32 , $791.98 , $476.16 , $460.80 , $460.80 , $409.60 , $409.60 , $86.75 , $472.73 , $486.40 , $460.80 , $460.80 , $460.80 , $476.16 , $491.52 , $793.20 , $435.20 , $860.94 , $814.38 , N/A , $707.87 , $707.87 , $486.40 , $819.35 , $86.75 , $860.94 
 SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN ,HCPCS J3030,0250 - PHARMACY,55150-0173-01,0.5 mL, $67.81 , $44.08 , $56.96 , N/A , $52.93 , $54.79 , $61.03 , $57.41 , $61.03 , $61.03 , $61.03 , $57.64 , $51.89 , $62.61 , $64.42 , $57.64 , $63.06 , $63.06 , $64.42 , $65.10 , $55.48 , $61.03 , $57.64 , $53.57 , N/A , $54.88 , $54.88 , $64.42 , $58.19 , $51.89 , $65.10 
 Fac Wound Trtmnt W/Packing ,CPT® 12021,0761 - TREATMENT ROOM,N/A,N/A, $661.00 , $429.65 , $555.24 , $134.92 , $40.65 , $534.09 , $594.90 , $559.60 , $594.90 , $594.90 , $594.90 , $561.85 , $39.85 , $610.30 , $627.95 , $561.85 , $614.73 , $614.73 , $627.95 , $634.56 , $540.83 , $594.90 , $561.85 , $522.19 , N/A , $534.95 , $534.95 , $627.95 , $567.20 , $39.85 , $634.56 
Drainage Rectal Abscess,CPT® 46050,N/A,N/A,N/A," $1,319.00 ", $857.35 , $612.76 , $96.47 , $68.62 , $463.98 , $481.35 ," $1,226.67 "," $1,187.10 "," $1,187.10 "," $1,055.20 "," $1,055.20 ", $68.62 ," $1,217.83 "," $1,253.05 "," $1,187.10 "," $1,187.10 "," $1,187.10 "," $1,226.67 "," $1,266.24 ", $436.34 ," $1,121.15 ", $529.87 , $552.66 , N/A , $473.03 , $473.03 ," $1,253.05 ", $494.75 , $68.62 ," $1,266.24 "
 Pro Smpl Rpr Supfc S/N/Ax/G/T 7.6cm-12.5cm ,CPT® 12004,0981 - PRO FEE/ER,N/A,N/A, $807.00 , $524.55 , $227.60 , $67.81 , $89.32 , $199.60 , $193.84 , $750.51 , $726.30 , $726.30 , $645.60 , $645.60 , $89.32 , $745.10 , $766.65 , $726.30 , $726.30 , $726.30 , $750.51 , $774.72 , $250.63 , $685.95 , $388.93 , $254.00 , N/A , $203.50 , $203.50 , $766.65 , $235.99 , $67.81 , $774.72 
 FLUTICASONE-SALMETEROL 250-50 MCG/ACT INH AEPB ,HCPCS RXC637,0250 - PHARMACY,00173-0696-04,14 each, $446.16 , $290.00 , $374.77 , N/A , N/A , $360.50 , $401.54 , $377.72 , $401.54 , $401.54 , $401.54 , $379.24 , N/A , $411.94 , $423.85 , $379.24 , $414.93 , $414.93 , $423.85 , $428.31 , $365.05 , $401.54 , $379.24 , $352.47 , N/A , $361.08 , $361.08 , $423.85 , $382.85 , $352.47 , $428.31 
 Trauma 3 Activation W/O Pre-ED Notiification Lvl 1 -W/O Critical Care ,CPT® 99285,0450 - EMERGENCY SERVICES,N/A,N/A," $4,953.00 "," $3,219.45 "," $4,160.52 ", $168.76 , $44.31 ," $4,002.02 "," $4,457.70 "," $4,193.21 "," $4,457.70 "," $4,457.70 "," $4,457.70 "," $4,210.05 ", $43.44 ," $4,573.10 "," $4,705.35 "," $4,210.05 "," $4,606.29 "," $4,606.29 "," $4,705.35 "," $4,754.88 "," $4,052.54 "," $4,457.70 "," $4,210.05 "," $3,912.87 ", N/A ," $4,008.46 "," $4,008.46 "," $4,705.35 "," $4,250.17 ", $43.44 ," $4,754.88 "
 PROTHROMBIN COMPLEX CONCENTRATE (KCENTRA) SYRINGE ,HCPCS J7168,0636 - DRUGS REQUIRING DETAILED CODIN,00001-0885-01,500 unit," $4,385.97 "," $2,850.88 "," $3,684.21 ", N/A , $0.01 ," $3,543.86 "," $3,947.37 "," $3,713.16 "," $3,947.37 "," $3,947.37 "," $3,947.37 "," $3,728.07 ", $0.01 ," $4,049.57 "," $4,166.67 "," $3,728.07 "," $4,078.95 "," $4,078.95 "," $4,166.67 "," $4,210.53 "," $3,588.60 "," $3,947.37 "," $3,728.07 "," $3,464.92 ", N/A ," $3,549.57 "," $3,549.57 "," $4,166.67 "," $3,763.60 ", $0.01 ," $4,210.53 "
Treatmnt Superficial Wnd,12020,N/A,N/A,N/A," $1,121.00 ", $728.65 , $598.88 , $179.70 , $32.39 , $514.39 , $504.42 ," $1,042.53 "," $1,008.90 "," $1,008.90 ", $896.80 , $896.80 , $32.39 ," $1,035.02 "," $1,064.95 "," $1,008.90 "," $1,008.90 "," $1,008.90 "," $1,042.53 "," $1,076.16 ", $660.06 , $952.85 ," $1,004.43 ", $658.84 , N/A , $524.43 , $524.43 ," $1,064.95 ", $608.16 , $32.39 ," $1,076.16 "
 Fac or Room Charge Plastics ,N/A,0360 - OR SERVICES,N/A,N/A, $55.00 , $35.75 , $46.20 , N/A , N/A , $44.44 , $49.50 , $46.56 , $49.50 , $49.50 , $49.50 , $46.75 , N/A , $50.78 , $52.25 , $46.75 , $51.15 , $51.15 , $52.25 , $52.80 , $45.00 , $49.50 , $46.75 , $43.45 , N/A , $44.51 , $44.51 , $52.25 , $47.20 , $43.45 , $52.80 
Hemoglobin,CPT® 85018,N/A,N/A,N/A, $38.00 , $24.70 , N/A , $2.42 , $2.42 , $13.43 , $16.05 , $35.34 , $34.20 , $34.20 , $30.40 , $30.40 , $2.42 , $35.09 , $36.10 , $34.20 , $34.20 , $34.20 , $35.34 , $36.48 , $15.83 , $32.30 , $16.22 , $8.59 , N/A , $12.53 , $12.53 , $36.10 , $13.70 , $2.42 , $36.48 
 FLUORESCEIN SODIUM 1 MG OP STRP ,HCPCS RXA250,0250 - PHARMACY,17238-0900-11,1 strip, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
" Fac Chromosome Analysis, 20-25 ",CPT® 88264,0310 - PATHOLOGY LAB,N/A,N/A," $2,410.00 "," $1,566.50 "," $2,024.40 ", $147.50 , $147.50 ," $1,947.28 "," $2,169.00 "," $2,040.31 "," $2,169.00 "," $2,169.00 "," $2,169.00 "," $2,048.50 ", $144.61 ," $2,225.15 "," $2,289.50 "," $2,048.50 "," $2,241.30 "," $2,241.30 "," $2,289.50 "," $2,313.60 "," $1,971.86 "," $2,169.00 "," $2,048.50 "," $1,903.90 ", N/A ," $1,950.41 "," $1,950.41 "," $2,289.50 "," $2,068.02 ", $144.61 ," $2,313.60 "
 DOXYCYCLINE MONOHYDRATE 25 MG/5ML PO SUSR ,HCPCS RXC637,0250 - PHARMACY,68180-0657-01,10 mL, $19.53 , $12.69 , $16.41 , N/A , N/A , $15.78 , $17.58 , $16.53 , $17.58 , $17.58 , $17.58 , $16.60 , N/A , $18.03 , $18.55 , $16.60 , $18.16 , $18.16 , $18.55 , $18.75 , $15.98 , $17.58 , $16.60 , $15.43 , N/A , $15.81 , $15.81 , $18.55 , $16.76 , $15.43 , $18.75 
Office/Outpatient New Sf Mdm 15-29 Minutes,99202,N/A,N/A,N/A, $191.00 , $124.15 , $97.59 , $46.48 , $50.34 , $86.35 , $86.61 , $177.63 , $171.90 , $171.90 , $152.80 , $152.80 , $50.34 , $176.35 , $181.45 , $171.90 , $171.90 , $171.90 , $177.63 , $183.36 , $89.09 , $162.35 , $108.02 , $109.92 , $42.00 , $88.04 , $88.04 , $181.45 , $101.55 , $42.00 , $183.36 
 Pro X-Ray Exam of Jaw ,CPT® 70100,0972 - PRO FEE/RAD/DX,N/A,N/A, $118.00 , $76.70 , $216.92 , $37.96 , $29.85 , $155.77 , $183.82 , $109.74 , $106.20 , $106.20 , $94.40 , $94.40 , $29.85 , $108.95 , $112.10 , $106.20 , $106.20 , $106.20 , $109.74 , $113.28 , $210.48 , $100.30 , $202.23 , $165.69 , N/A , $158.81 , $158.81 , $112.10 , $183.80 , $29.85 , $216.92 
Moderna Administration Second Dose,CPT® 0012A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $76.25 , $128.02 , N/A , $79.82 , $79.82 , $66.50 , $92.91 , $38.92 , $128.02 
 Pro Nipple Exploration ,CPT® 19110,0982 - PRO FEE/OUTPT,N/A,N/A," $1,187.00 ", $771.55 ," $1,110.47 ", $331.23 , $312.04 , $919.74 , $909.39 ," $1,103.91 "," $1,068.30 "," $1,068.30 ", $949.60 , $949.60 , $312.04 ," $1,095.96 "," $1,127.65 "," $1,068.30 "," $1,068.30 "," $1,068.30 "," $1,103.91 "," $1,139.52 "," $1,212.16 "," $1,008.95 "," $1,826.88 "," $1,174.09 ", N/A , $937.68 , $937.68 ," $1,127.65 "," $1,087.40 ", $312.04 ," $1,826.88 "
 Pro Conization of Cervix ,CPT® 57520,0982 - PRO FEE/OUTPT,N/A,N/A," $1,931.00 "," $1,255.15 "," $1,405.10 ", $285.27 , $276.68 ," $1,116.88 "," $1,114.54 "," $1,795.83 "," $1,737.90 "," $1,737.90 "," $1,544.80 "," $1,544.80 ", $276.68 ," $1,782.89 "," $1,834.45 "," $1,737.90 "," $1,737.90 "," $1,737.90 "," $1,795.83 "," $1,853.76 "," $1,450.34 "," $1,641.35 "," $1,461.15 "," $1,127.53 ", N/A ," $1,138.66 "," $1,138.66 "," $1,834.45 "," $1,365.76 ", $276.68 ," $1,853.76 "
 MINOCYCLINE HCL 50 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00591-5694-60,1 capsule, $8.73 , $5.67 , $7.33 , N/A , N/A , $7.05 , $7.86 , $7.39 , $7.86 , $7.86 , $7.86 , $7.42 , N/A , $8.06 , $8.29 , $7.42 , $8.12 , $8.12 , $8.29 , $8.38 , $7.14 , $7.86 , $7.42 , $6.90 , N/A , $7.07 , $7.07 , $8.29 , $7.49 , $6.90 , $8.38 
Wound Trtmnt W/Packing,CPT® 12021,N/A,N/A,N/A, $652.00 , $423.80 , $449.31 , $134.92 , $40.65 , $376.90 , $386.02 , $606.36 , $586.80 , $586.80 , $521.60 , $521.60 , $40.65 , $601.99 , $619.40 , $586.80 , $586.80 , $586.80 , $606.36 , $625.92 , $490.29 , $554.20 , $768.93 , $482.58 , N/A , $384.26 , $384.26 , $619.40 , $445.62 , $40.65 , $768.93 
 Fac Spin/Brain Pump Refil & Main ,CPT® 95991,0940 - OTHER RX SVS,N/A,N/A, $551.00 , $358.15 , $462.84 , $38.21 , $82.71 , $445.21 , $495.90 , $466.48 , $495.90 , $495.90 , $495.90 , $468.35 , $81.09 , $508.74 , $523.45 , $468.35 , $512.43 , $512.43 , $523.45 , $528.96 , $450.83 , $495.90 , $468.35 , $435.29 , N/A , $445.92 , $445.92 , $523.45 , $472.81 , $38.21 , $528.96 
 GUAIFENESIN 100 MG/5ML PO LIQD ,HCPCS RXC637,0250 - PHARMACY,00121-1488-00,10 mL, $7.45 , $4.84 , $6.26 , N/A , N/A , $6.02 , $6.71 , $6.31 , $6.71 , $6.71 , $6.71 , $6.33 , N/A , $6.88 , $7.08 , $6.33 , $6.93 , $6.93 , $7.08 , $7.15 , $6.10 , $6.71 , $6.33 , $5.89 , N/A , $6.03 , $6.03 , $7.08 , $6.39 , $5.89 , $7.15 
Excision of Umbilicus,CPT® 49250,N/A,N/A,N/A," $3,819.00 "," $2,482.35 "," $3,565.84 ", $554.67 , $736.76 ," $2,751.12 "," $2,791.30 "," $3,551.67 "," $3,437.10 "," $3,437.10 "," $3,055.20 "," $3,055.20 ", $736.76 ," $3,526.08 "," $3,628.05 "," $3,437.10 "," $3,437.10 "," $3,437.10 "," $3,551.67 "," $3,666.24 "," $2,535.11 "," $3,246.15 "," $3,095.35 "," $3,267.80 ", N/A ," $2,804.80 "," $2,804.80 "," $3,628.05 "," $2,933.51 ", $554.67 ," $3,666.24 "
Tgsap So/Hematolymphoid Neo/Do 51/<Dna/Dna&Rna,CPT® 81455,N/A,N/A,N/A," $13,236.00 "," $8,603.40 ", N/A ," $2,977.99 "," $2,977.99 ", N/A , N/A ," $12,309.48 "," $11,912.40 "," $11,912.40 "," $10,588.80 "," $10,588.80 "," $2,977.99 "," $12,220.80 "," $12,574.20 "," $11,912.40 "," $11,912.40 "," $11,912.40 "," $12,309.48 "," $12,706.56 "," $19,494.82 "," $11,250.60 "," $13,918.02 "," $8,574.87 ", N/A ," $11,590.81 "," $11,590.81 "," $12,574.20 "," $12,641.87 "," $2,977.99 "," $19,494.82 "
 INFLIXIMAB-AXXQ 100 MG IV SOLR ,HCPCS Q5121,0636 - DRUGS REQUIRING DETAILED CODIN,55513-0670-01,10 mL," $1,470.16 ", $955.60 ," $1,234.93 ", $28.90 , $34.17 ," $1,187.89 "," $1,323.14 "," $1,244.64 "," $1,323.14 "," $1,323.14 "," $1,323.14 "," $1,249.64 ", $33.50 ," $1,357.40 "," $1,396.65 "," $1,249.64 "," $1,367.25 "," $1,367.25 "," $1,396.65 "," $1,411.35 "," $1,202.88 "," $1,323.14 "," $1,249.64 "," $1,161.43 ", N/A ," $1,189.80 "," $1,189.80 "," $1,396.65 "," $1,261.54 ", $28.90 ," $1,411.35 "
 Fac Drug Screening Methylphenidate ,CPT® 80360,0301 - LAB/CHEMISTRY,N/A,N/A, $189.00 , $122.85 , $158.76 , N/A , N/A , $152.71 , $170.10 , $160.01 , $170.10 , $170.10 , $170.10 , $160.65 , N/A , $174.50 , $179.55 , $160.65 , $175.77 , $175.77 , $179.55 , $181.44 , $154.64 , $170.10 , $160.65 , $149.31 , N/A , $152.96 , $152.96 , $179.55 , $162.18 , $149.31 , $181.44 
Egd Removal Tumor Polyp/Other Lesion Snare Tech,CPT® 43251,N/A,N/A,N/A," $2,620.00 "," $1,703.00 "," $1,201.33 ", $185.58 , $203.13 , $998.36 ," $1,059.33 "," $2,436.60 "," $2,358.00 "," $2,358.00 "," $2,096.00 "," $2,096.00 ", $203.13 ," $2,419.05 "," $2,489.00 "," $2,358.00 "," $2,358.00 "," $2,358.00 "," $2,436.60 "," $2,515.20 ", $862.97 ," $2,227.00 "," $1,161.43 "," $1,145.55 ", N/A ," $1,017.84 "," $1,017.84 "," $2,489.00 "," $1,064.54 ", $185.58 ," $2,515.20 "
Part Remv Othr Tarsal/Metatarsal,28122,N/A,N/A,N/A," $4,071.00 "," $2,646.15 "," $2,709.20 ", $424.70 , $384.19 ," $2,165.95 "," $2,162.58 "," $3,786.03 "," $3,663.90 "," $3,663.90 "," $3,256.80 "," $3,256.80 ", $384.19 ," $3,758.75 "," $3,867.45 "," $3,663.90 "," $3,663.90 "," $3,663.90 "," $3,786.03 "," $3,908.16 "," $2,515.35 "," $3,460.35 "," $2,346.04 "," $2,575.48 ", N/A ," $2,208.21 "," $2,208.21 "," $3,867.45 "," $2,595.42 ", $384.19 ," $3,908.16 "
 ACETYLCYSTEINE 200 MG/ML IV SOLN ,HCPCS J0132,0636 - DRUGS REQUIRING DETAILED CODIN,55150-0259-30,30 mL," $1,797.96 "," $1,168.67 "," $1,510.29 ", $0.80 , $1.01 ," $1,452.75 "," $1,618.16 "," $1,522.15 "," $1,618.16 "," $1,618.16 "," $1,618.16 "," $1,528.27 ", $0.99 ," $1,660.06 "," $1,708.06 "," $1,528.27 "," $1,672.10 "," $1,672.10 "," $1,708.06 "," $1,726.04 "," $1,471.09 "," $1,618.16 "," $1,528.27 "," $1,420.39 ", N/A ," $1,455.09 "," $1,455.09 "," $1,708.06 "," $1,542.83 ", $0.80 ," $1,726.04 "
 Fac Tx Tarsal B1 Fx Xcp Talus&Calcn W/Mnpj ,CPT® 28455,0761 - TREATMENT ROOM,N/A,N/A," $2,482.00 "," $1,613.30 "," $2,084.88 ", $257.53 , $153.67 ," $2,005.46 "," $2,233.80 "," $2,101.26 "," $2,233.80 "," $2,233.80 "," $2,233.80 "," $2,109.70 ", $150.66 ," $2,291.63 "," $2,357.90 "," $2,109.70 "," $2,308.26 "," $2,308.26 "," $2,357.90 "," $2,382.72 "," $2,030.77 "," $2,233.80 "," $2,109.70 "," $1,960.78 ", N/A ," $2,008.68 "," $2,008.68 "," $2,357.90 "," $2,129.80 ", $150.66 ," $2,382.72 "
"Destruc Benign/Premal,First Lesion",17000,N/A,N/A,N/A, $337.00 , $219.05 , $130.35 , $53.25 , $48.35 , $144.21 , $151.73 , $313.41 , $303.30 , $303.30 , $269.60 , $269.60 , $48.35 , $311.15 , $320.15 , $303.30 , $303.30 , $303.30 , $313.41 , $323.52 , $191.09 , $286.45 , $299.72 , $185.66 , N/A , $147.02 , $147.02 , $320.15 , $170.50 , $48.35 , $323.52 
Radex Hips Bilateral With Pelvis Minimum 5 Views,CPT® 73523,N/A,N/A,N/A, $414.00 , $269.10 , $418.81 , $60.96 , $44.46 , $269.48 , $284.34 , $385.02 , $372.60 , $372.60 , $331.20 , $331.20 , $44.46 , $382.25 , $393.30 , $372.60 , $372.60 , $372.60 , $385.02 , $397.44 , $338.15 , $351.90 , $356.81 , $285.55 , N/A , $274.75 , $274.75 , $393.30 , $318.01 , $44.46 , $418.81 
"Spine Fixation,Post,Harrington",CPT® 22840,N/A,N/A,N/A," $5,274.00 "," $3,428.10 "," $4,367.87 ", $679.00 , $480.44 ," $3,639.58 "," $3,546.81 "," $4,904.82 "," $4,746.60 "," $4,746.60 "," $4,219.20 "," $4,219.20 ", $480.44 ," $4,869.48 "," $5,010.30 "," $4,746.60 "," $4,746.60 "," $4,746.60 "," $4,904.82 "," $5,063.04 "," $4,085.35 "," $4,482.90 "," $4,015.93 "," $4,197.74 ", N/A ," $3,710.60 "," $3,710.60 "," $5,010.30 "," $4,361.27 ", $480.44 ," $5,063.04 "
Bone Imaging (Spect),CPT® 78320,N/A,N/A,N/A, $714.00 , $464.10 , N/A , N/A , N/A , N/A ," $1,208.97 ", $664.02 , $642.60 , $642.60 , $571.20 , $571.20 , N/A , $659.24 , $678.30 , $642.60 , $642.60 , $642.60 , $664.02 , $685.44 , N/A , $606.90 , N/A , N/A , N/A , N/A , N/A , $678.30 , N/A , $571.20 ," $1,208.97 "
Fundal Photography,92250,N/A,N/A,N/A, $308.00 , $200.20 , $80.75 , $36.70 , $25.41 , $137.98 , $143.47 , $286.44 , $277.20 , $277.20 , $246.40 , $246.40 , $25.41 , $284.38 , $292.60 , $277.20 , $277.20 , $277.20 , $286.44 , $295.68 , $119.58 , $261.80 , $242.28 , $120.20 , N/A , $140.67 , $140.67 , $292.60 , $167.32 , $25.41 , $295.68 
"Tympanoplas/Mastoidec,Rad,Rebld Ossi",CPT® 69646,N/A,N/A,N/A," $9,992.00 "," $6,494.80 "," $7,578.75 "," $1,531.48 "," $1,844.16 "," $7,432.78 "," $7,656.91 "," $9,292.56 "," $8,992.80 "," $8,992.80 "," $7,993.60 "," $7,993.60 "," $1,844.16 "," $9,225.61 "," $9,492.40 "," $8,992.80 "," $8,992.80 "," $8,992.80 "," $9,292.56 "," $9,592.32 "," $8,247.61 "," $8,493.20 "," $8,344.07 "," $7,472.76 ", N/A ," $7,577.80 "," $7,577.80 "," $9,492.40 "," $8,652.53 "," $1,531.48 "," $9,592.32 "
 Fac Cc E/M Critically Ill/Injured Ea 30 Min ,CPT® 99292,0510 - CLINIC,N/A,N/A," $1,295.00 ", $841.75 ," $1,087.80 ", $103.14 , $121.38 ," $1,046.36 "," $1,165.50 ", N/A ," $1,165.50 "," $1,165.50 "," $1,165.50 "," $1,100.75 ", $119.00 ," $1,195.67 "," $1,230.25 "," $1,100.75 "," $1,204.35 "," $1,204.35 "," $1,230.25 "," $1,243.20 "," $1,059.57 "," $1,165.50 "," $1,100.75 "," $1,023.05 ", N/A ," $1,048.04 "," $1,048.04 "," $1,230.25 "," $1,111.24 ", $103.14 ," $1,243.20 "
Excise Breast Cyst,CPT® 19120,N/A,N/A,N/A," $3,216.00 "," $2,090.40 "," $1,309.41 ", $390.34 , $312.04 ," $1,110.98 "," $1,084.83 "," $2,990.88 "," $2,894.40 "," $2,894.40 "," $2,572.80 "," $2,572.80 ", $312.04 ," $2,969.33 "," $3,055.20 "," $2,894.40 "," $2,894.40 "," $2,894.40 "," $2,990.88 "," $3,087.36 "," $1,429.95 "," $2,733.60 "," $2,185.48 "," $1,408.87 ", N/A ," $1,132.66 "," $1,132.66 "," $3,055.20 "," $1,313.51 ", $312.04 ," $3,087.36 "
 Fac Chg Radiologic Exam Chest Single View ,CPT® 71045,0324 - DX X-RAY/CHEST,N/A,N/A, $226.00 , $146.90 , $189.84 , $25.48 , $15.52 , $182.61 , $203.40 , $191.33 , $203.40 , $203.40 , $203.40 , $192.10 , $15.22 , $208.67 , $214.70 , $192.10 , $210.18 , $210.18 , $214.70 , $216.96 , $184.91 , $203.40 , $192.10 , $178.54 , N/A , $182.90 , $182.90 , $214.70 , $193.93 , $15.22 , $216.96 
" Fac Chromosome Analysis, 5 ",CPT® 88261,0310 - PATHOLOGY LAB,N/A,N/A," $1,740.00 "," $1,131.00 "," $1,461.60 ", $269.63 , $245.32 ," $1,405.92 "," $1,566.00 "," $1,473.08 "," $1,566.00 "," $1,566.00 "," $1,566.00 "," $1,479.00 ", $240.51 ," $1,606.54 "," $1,653.00 "," $1,479.00 "," $1,618.20 "," $1,618.20 "," $1,653.00 "," $1,670.40 "," $1,423.67 "," $1,566.00 "," $1,479.00 "," $1,374.60 ", N/A ," $1,408.18 "," $1,408.18 "," $1,653.00 "," $1,493.09 ", $240.51 ," $1,670.40 "
Emergency Department Visit High Mdm,CPT® 99285,N/A,N/A,N/A, $894.00 , $581.10 , $618.57 , $168.76 , $44.31 , $489.08 , $501.00 , $831.42 , $804.60 , $804.60 , $715.20 , $715.20 , $44.31 , $825.43 , $849.30 , $804.60 , $804.60 , $804.60 , $831.42 , $858.24 , $526.01 , $759.90 , $369.80 , $374.75 , $182.00 , $498.62 , $498.62 , $849.30 , $598.36 , $44.31 , $858.24 
 SUMATRIPTAN SUCCINATE 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,65862-0147-36,1 tablet, $129.15 , $83.95 , $108.49 , N/A , N/A , $104.35 , $116.24 , $109.34 , $116.24 , $116.24 , $116.24 , $109.78 , N/A , $119.24 , $122.69 , $109.78 , $120.11 , $120.11 , $122.69 , $123.98 , $105.67 , $116.24 , $109.78 , $102.03 , N/A , $104.52 , $104.52 , $122.69 , $110.82 , $102.03 , $123.98 
"Stereotactic Comp Assist Proc,Cranial,Intradural",CPT® 61781,N/A,N/A,N/A," $1,580.00 "," $1,027.00 "," $1,051.65 ", $205.11 , $248.63 ," $1,269.80 "," $1,194.23 "," $1,469.40 "," $1,422.00 "," $1,422.00 "," $1,264.00 "," $1,264.00 ", $248.63 ," $1,458.81 "," $1,501.00 "," $1,422.00 "," $1,422.00 "," $1,422.00 "," $1,469.40 "," $1,516.80 "," $1,142.11 "," $1,343.00 "," $1,231.00 "," $1,310.93 ", N/A ," $1,294.58 "," $1,294.58 "," $1,501.00 "," $1,388.78 ", $205.11 ," $1,516.80 "
 Fac Fluorescent Nonnfct Agt Antb Scr Ea Antb ,CPT® 86255,0302 - LAB/IMMUNOLOGY,N/A,N/A, $146.00 , $94.90 , $122.64 , $12.29 , $12.29 , $117.97 , $131.40 , $123.60 , $131.40 , $131.40 , $131.40 , $124.10 , $12.05 , $134.80 , $138.70 , $124.10 , $135.78 , $135.78 , $138.70 , $140.16 , $119.46 , $131.40 , $124.10 , $115.34 , N/A , $118.16 , $118.16 , $138.70 , $125.28 , $12.05 , $140.16 
 Fac Ablatj Bone Tumor Cryo Perq W/Img Gdn When Prfmd ,CPT® 20983,0361 - OR/MINOR,N/A,N/A," $14,042.00 "," $9,127.30 "," $11,795.28 ", $325.41 ," $5,479.02 "," $11,345.94 "," $12,637.80 "," $11,887.96 "," $12,637.80 "," $12,637.80 "," $12,637.80 "," $11,935.70 "," $5,371.59 "," $12,964.98 "," $13,339.90 "," $11,935.70 "," $13,059.06 "," $13,059.06 "," $13,339.90 "," $13,480.32 "," $11,489.16 "," $12,637.80 "," $11,935.70 "," $11,093.18 ", N/A ," $11,364.19 "," $11,364.19 "," $13,339.90 "," $12,049.44 ", $325.41 ," $13,480.32 "
 HYOSCYAMINE SULFATE ER 0.375 MG PO TB12 ,HCPCS RXC637,0250 - PHARMACY,51525-0115-01,1 tablet, $5.08 , $3.30 , $4.27 , N/A , N/A , $4.10 , $4.57 , $4.30 , $4.57 , $4.57 , $4.57 , $4.32 , N/A , $4.69 , $4.83 , $4.32 , $4.72 , $4.72 , $4.83 , $4.88 , $4.16 , $4.57 , $4.32 , $4.01 , N/A , $4.11 , $4.11 , $4.83 , $4.36 , $4.01 , $4.88 
Removal of Knee Prosthesis,CPT® 27488,N/A,N/A,N/A," $7,899.00 "," $5,134.35 "," $7,239.96 "," $1,133.19 ", $893.47 ," $5,799.03 "," $5,754.58 "," $7,346.07 "," $7,109.10 "," $7,109.10 "," $6,319.20 "," $6,319.20 ", $893.47 ," $7,293.15 "," $7,504.05 "," $7,109.10 "," $7,109.10 "," $7,109.10 "," $7,346.07 "," $7,583.04 "," $6,747.49 "," $6,714.15 "," $6,367.32 "," $6,826.25 ", N/A ," $5,912.18 "," $5,912.18 "," $7,504.05 "," $6,948.91 ", $893.47 ," $7,583.04 "
 TERBUTALINE SULFATE 1 MG/ML IJ SOLN ,HCPCS J3105,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9746-10,1 mL, $24.66 , $16.03 , $20.71 , $2.34 , $1.35 , $19.93 , $22.19 , $20.88 , $22.19 , $22.19 , $22.19 , $20.96 , $1.32 , $22.77 , $23.43 , $20.96 , $22.93 , $22.93 , $23.43 , $23.67 , $20.18 , $22.19 , $20.96 , $19.48 , N/A , $19.96 , $19.96 , $23.43 , $21.16 , $1.32 , $23.67 
 Fac Antb Severe Aqt Respir Synd Sars-Cov-2 Covid-19 ,CPT® 86769,0301 - LAB/CHEMISTRY,N/A,N/A, $163.00 , $105.95 , $136.92 , $42.97 , $42.97 , $131.70 , $146.70 , $138.00 , $146.70 , $146.70 , $146.70 , $138.55 , $42.13 , $150.50 , $154.85 , $138.55 , $151.59 , $151.59 , $154.85 , $156.48 , $133.37 , $146.70 , $138.55 , $128.77 , N/A , $131.92 , $131.92 , $154.85 , $139.87 , $42.13 , $156.48 
 Fac US Urine Capacity Measure ,CPT® 51798,0761 - TREATMENT ROOM,N/A,N/A, $173.00 , $112.45 , $145.32 , $10.29 , $13.26 , $139.78 , $155.70 , $146.46 , $155.70 , $155.70 , $155.70 , $147.05 , $13.00 , $159.73 , $164.35 , $147.05 , $160.89 , $160.89 , $164.35 , $166.08 , $141.55 , $155.70 , $147.05 , $136.67 , N/A , $140.01 , $140.01 , $164.35 , $148.45 , $10.29 , $166.08 
Non-Rad Contrast Materialnoc,HCPCS A9698,N/A,N/A,N/A, $322.00 , $209.30 , N/A , N/A , N/A , N/A , N/A , $299.46 , $289.80 , $289.80 , $257.60 , $257.60 , N/A , $297.30 , $305.90 , $289.80 , $289.80 , $289.80 , $299.46 , $309.12 , N/A , $273.70 , $257.60 , N/A , N/A , N/A , N/A , $305.90 , N/A , $257.60 , $309.12 
" Pro Excision, Breast Lesion ",CPT® 19125,0982 - PRO FEE/OUTPT,N/A,N/A," $3,858.00 "," $2,507.70 "," $1,447.92 ", $430.51 , $347.51 ," $1,232.96 "," $1,203.57 "," $3,587.94 "," $3,472.20 "," $3,472.20 "," $3,086.40 "," $3,086.40 ", $347.51 ," $3,562.09 "," $3,665.10 "," $3,472.20 "," $3,472.20 "," $3,472.20 "," $3,587.94 "," $3,703.68 "," $1,579.49 "," $3,279.30 "," $2,426.33 "," $1,559.65 ", N/A ," $1,257.02 "," $1,257.02 "," $3,665.10 "," $1,457.72 ", $347.51 ," $3,703.68 "
 INDOMETHACIN 25 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,50268-0430-15,1 capsule, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Repair Scalp/Arm/Leg Addt,13122,N/A,N/A,N/A, $764.00 , $496.60 , $261.73 , $78.10 , $88.09 , $233.43 , $225.70 , $710.52 , $687.60 , $687.60 , $611.20 , $611.20 , $88.09 , $705.40 , $725.80 , $687.60 , $687.60 , $687.60 , $710.52 , $733.44 , $289.90 , $649.40 , $453.15 , $298.73 , N/A , $237.98 , $237.98 , $725.80 , $275.96 , $78.10 , $733.44 
 CEFAZOLIN IN SODIUM CHLORIDE 3-0.9 GM/100ML-% IV SOLN ,HCPCS J0690,0636 - DRUGS REQUIRING DETAILED CODIN,70092-1623-03,100 mL, $133.56 , $86.81 , $112.19 , $0.89 , $0.79 , $107.92 , $120.20 , $113.07 , $120.20 , $120.20 , $120.20 , $113.53 , $0.77 , $123.32 , $126.88 , $113.53 , $124.21 , $124.21 , $126.88 , $128.22 , $109.28 , $120.20 , $113.53 , $105.51 , N/A , $108.09 , $108.09 , $126.88 , $114.61 , $0.77 , $128.22 
 LOXAPINE SUCCINATE 25 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00591-0371-01,1 capsule, $9.89 , $6.43 , $8.31 , N/A , N/A , $7.99 , $8.90 , $8.37 , $8.90 , $8.90 , $8.90 , $8.41 , N/A , $9.13 , $9.40 , $8.41 , $9.20 , $9.20 , $9.40 , $9.49 , $8.09 , $8.90 , $8.41 , $7.81 , N/A , $8.00 , $8.00 , $9.40 , $8.49 , $7.81 , $9.49 
 Fac Assay of Tacrolimus ,CPT® 80197,0300 - LABORATORY,N/A,N/A, $160.00 , $104.00 , $134.40 , $14.00 , $14.00 , $129.28 , $144.00 , $135.46 , $144.00 , $144.00 , $144.00 , $136.00 , $13.73 , $147.73 , $152.00 , $136.00 , $148.80 , $148.80 , $152.00 , $153.60 , $130.91 , $144.00 , $136.00 , $126.40 , N/A , $129.49 , $129.49 , $152.00 , $137.30 , $13.73 , $153.60 
 Pta-Tibial-Peroneal Add'l W/Atherectomy ,CPT® 37233,0360 - OR SERVICES,N/A,N/A," $9,219.00 "," $5,992.35 "," $7,743.96 ", $291.66 , $244.76 ," $7,448.95 "," $8,297.10 "," $7,804.81 "," $8,297.10 "," $8,297.10 "," $8,297.10 "," $7,836.15 ", $239.96 ," $8,511.90 "," $8,758.05 "," $7,836.15 "," $8,573.67 "," $8,573.67 "," $8,758.05 "," $8,850.24 "," $7,542.99 "," $8,297.10 "," $7,836.15 "," $7,283.01 ", N/A ," $7,460.94 "," $7,460.94 "," $8,758.05 "," $7,910.82 ", $239.96 ," $8,850.24 "
Lens Spher Single Plano 4.00,HCPCS V2100,N/A,N/A,N/A, $55.00 , $35.75 , N/A , $54.17 , N/A , N/A , N/A , $51.15 , $49.50 , $49.50 , $44.00 , $44.00 , N/A , $50.78 , $52.25 , $49.50 , $49.50 , $49.50 , $51.15 , $52.80 , N/A , $46.75 , $55.00 , $49.23 , N/A , N/A , N/A , $52.25 , N/A , $44.00 , $55.00 
"Fix Collat Lig,MC-P Jt,Graft",CPT® 26541,N/A,N/A,N/A," $3,965.00 "," $2,577.25 "," $5,217.03 ", $811.14 , $691.53 ," $3,808.11 "," $3,836.86 "," $3,687.45 "," $3,568.50 "," $3,568.50 "," $3,172.00 "," $3,172.00 ", $691.53 ," $3,660.88 "," $3,766.75 "," $3,568.50 "," $3,568.50 "," $3,568.50 "," $3,687.45 "," $3,806.40 "," $4,803.58 "," $3,370.25 "," $4,205.04 "," $4,535.70 ", N/A ," $3,882.41 "," $3,882.41 "," $3,766.75 "," $4,563.21 ", $691.53 ," $5,217.03 "
" Pro Nosebleed, Simple ",CPT® 30901,0982 - PRO FEE/OUTPT,N/A,N/A, $781.00 , $507.65 , $301.30 , $53.21 , $34.36 , $216.79 , $209.25 , $726.33 , $702.90 , $702.90 , $624.80 , $624.80 , $34.36 , $721.10 , $741.95 , $702.90 , $702.90 , $702.90 , $726.33 , $749.76 , $289.39 , $663.85 , $296.15 , $286.56 , N/A , $221.02 , $221.02 , $741.95 , $260.29 , $34.36 , $749.76 
 Astra Zeneca Covid Vaccine 1st Dose ,CPT® 0021A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , N/A , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , N/A , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $55.30 , $67.20 
 MICAFUNGIN SODIUM 50 MG IV SOLR ,HCPCS J2247,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0728-10,5 mL, $576.36 , $374.63 , $484.14 , $0.30 , $0.38 , $465.70 , $518.72 , $487.95 , $518.72 , $518.72 , $518.72 , $489.91 , $0.37 , $532.15 , $547.54 , $489.91 , $536.01 , $536.01 , $547.54 , $553.31 , $471.58 , $518.72 , $489.91 , $455.32 , N/A , $466.45 , $466.45 , $547.54 , $494.57 , $0.30 , $553.31 
Assay Calcium,CPT® 82330,N/A,N/A,N/A, $166.00 , $107.90 , N/A , $13.95 , $13.95 , $77.33 , $92.52 , $154.38 , $149.40 , $149.40 , $132.80 , $132.80 , $13.95 , $153.27 , $157.70 , $149.40 , $149.40 , $149.40 , $154.38 , $159.36 , $91.34 , $141.10 , $89.20 , $49.58 , N/A , $72.17 , $72.17 , $157.70 , $78.86 , $13.95 , $159.36 
 Fac Harvest Uxtr Vein 1 Sgm Lxtr/Cab Px ,CPT® 35500,0360 - OR SERVICES,N/A,N/A," $1,034.00 ", $672.10 , $868.56 , $280.47 , $334.72 , $835.47 , $930.60 , $875.38 , $930.60 , $930.60 , $930.60 , $878.90 , $328.16 , $954.69 , $982.30 , $878.90 , $961.62 , $961.62 , $982.30 , $992.64 , $846.02 , $930.60 , $878.90 , $816.86 , N/A , $836.82 , $836.82 , $982.30 , $887.28 , $280.47 , $992.64 
"Lap,Hernia Repair Proc,Unlist",CPT® 49659,N/A,N/A,N/A," $2,768.00 "," $1,799.20 ", N/A , N/A , $767.54 , N/A , N/A ," $2,574.24 "," $2,491.20 "," $2,491.20 "," $2,214.40 "," $2,214.40 ", $767.54 ," $2,555.69 "," $2,629.60 "," $2,491.20 "," $2,491.20 "," $2,491.20 "," $2,574.24 "," $2,657.28 ", N/A ," $2,352.80 "," $2,214.40 ", N/A , N/A , N/A , N/A ," $2,629.60 ", N/A , $767.54 ," $2,657.28 "
" Fac Vein X-Ray, Trunk ",CPT® 75825,0320 - DX X-RAY,N/A,N/A," $1,063.00 ", $690.95 , $892.92 , $110.98 , $218.52 , $858.90 , $956.70 , $899.94 , $956.70 , $956.70 , $956.70 , $903.55 , $214.24 , $981.47 ," $1,009.85 ", $903.55 , $988.59 , $988.59 ," $1,009.85 "," $1,020.48 ", $869.75 , $956.70 , $903.55 , $839.77 , N/A , $860.29 , $860.29 ," $1,009.85 ", $912.16 , $110.98 ," $1,020.48 "
Assay for Nickel,CPT® 83885,N/A,N/A,N/A, $142.00 , $92.30 , N/A , $25.00 , $25.00 , $138.61 , $165.83 , $132.06 , $127.80 , $127.80 , $113.60 , $113.60 , $25.00 , $131.11 , $134.90 , $127.80 , $127.80 , $127.80 , $132.06 , $136.32 , $163.66 , $120.70 , $160.56 , $88.87 , N/A , $129.36 , $129.36 , $134.90 , $141.36 , $25.00 , $165.83 
 Path Level IV 88305 Initial -Tech-Mh ,CPT® 88305,0310 - PATHOLOGY LAB,N/A,N/A, $298.00 , $193.70 , $250.32 , $70.47 , $66.83 , $240.78 , $268.20 , $252.29 , $268.20 , $268.20 , $268.20 , $253.30 , $65.52 , $275.14 , $283.10 , $253.30 , $277.14 , $277.14 , $283.10 , $286.08 , $243.82 , $268.20 , $253.30 , $235.42 , N/A , $241.17 , $241.17 , $283.10 , $255.71 , $65.52 , $286.08 
"Fx Humeral,Closed W/O Man",CPT® 24560,N/A,N/A,N/A," $1,189.00 ", $772.85 ," $1,833.33 ", $291.21 , $184.42 ," $1,380.07 "," $1,410.71 "," $1,105.77 "," $1,070.10 "," $1,070.10 ", $951.20 , $951.20 , $184.42 ," $1,097.80 "," $1,129.55 "," $1,070.10 "," $1,070.10 "," $1,070.10 "," $1,105.77 "," $1,141.44 "," $1,695.22 "," $1,010.65 "," $1,548.57 "," $1,649.44 ", N/A ," $1,407.00 "," $1,407.00 "," $1,129.55 "," $1,653.71 ", $184.42 ," $1,833.33 "
 Fac Mnt Subs Tx for Change Dx ,HCPCS G0270,0942 - EDUC/TRAINING,N/A,N/A, $60.00 , $39.00 , $50.40 , $27.15 , N/A , $48.48 , $54.00 , $50.80 , $54.00 , $54.00 , $54.00 , $51.00 , N/A , $55.40 , $57.00 , $51.00 , $55.80 , $55.80 , $57.00 , $57.60 , $49.09 , $54.00 , $51.00 , $47.40 , N/A , $48.56 , $48.56 , $57.00 , $51.49 , $27.15 , $57.60 
 CALCIUM GLUCONATE 10 % IV SOLN ,HCPCS J0612,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0360-19,10 mL, $61.75 , $40.14 , $51.87 , N/A , $0.05 , $49.89 , $55.58 , $52.28 , $55.58 , $55.58 , $55.58 , $52.49 , $0.05 , $57.01 , $58.66 , $52.49 , $57.43 , $57.43 , $58.66 , $59.28 , $50.52 , $55.58 , $52.49 , $48.78 , N/A , $49.97 , $49.97 , $58.66 , $52.99 , $0.05 , $59.28 
 SODIUM HYPOCHLORITE 0.5 % EX SOLN ,HCPCS RXC637,0250 - PHARMACY,39328-0062-50,473 mL, $70.47 , $45.81 , $59.19 , N/A , N/A , $56.94 , $63.42 , $59.66 , $63.42 , $63.42 , $63.42 , $59.90 , N/A , $65.06 , $66.95 , $59.90 , $65.54 , $65.54 , $66.95 , $67.65 , $57.66 , $63.42 , $59.90 , $55.67 , N/A , $57.03 , $57.03 , $66.95 , $60.47 , $55.67 , $67.65 
Spin Bone Autogrft Local,CPT® 20936,N/A,N/A,N/A," $1,281.00 ", $832.65 , N/A , N/A , $464.89 , $614.93 , $595.80 ," $1,191.33 "," $1,152.90 "," $1,152.90 "," $1,024.80 "," $1,024.80 ", $464.89 ," $1,182.75 "," $1,216.95 "," $1,152.90 "," $1,152.90 "," $1,152.90 "," $1,191.33 "," $1,229.76 ", N/A ," $1,088.85 ", N/A , $721.19 , N/A , $626.92 , $626.92 ," $1,216.95 ", $736.86 , $464.89 ," $1,229.76 "
 Pro X-Ray Eye for Foreign Body ,CPT® 70030,0972 - PRO FEE/RAD/DX,N/A,N/A, $112.00 , $72.80 , $182.93 , $32.05 , $27.07 , $130.30 , $153.94 , $104.16 , $100.80 , $100.80 , $89.60 , $89.60 , $27.07 , $103.41 , $106.40 , $100.80 , $100.80 , $100.80 , $104.16 , $107.52 , $176.55 , $95.20 , $169.49 , $140.54 , N/A , $132.84 , $132.84 , $106.40 , $153.75 , $27.07 , $182.93 
 Fac Drug Test Def 1-7 Classes ,CPT® G0480,0301 - LAB/CHEMISTRY,N/A,N/A, $270.00 , $175.50 , $226.80 , $116.72 , $65.23 , $218.16 , $243.00 , $228.58 , $243.00 , $243.00 , $243.00 , $229.50 , $63.95 , $249.29 , $256.50 , $229.50 , $251.10 , $251.10 , $256.50 , $259.20 , $220.91 , $243.00 , $229.50 , $213.30 , N/A , $218.51 , $218.51 , $256.50 , $231.69 , $63.95 , $259.20 
 Pro Treat Hip Dislocation ,CPT® 27265,0982 - PRO FEE/OUTPT,N/A,N/A," $2,643.00 "," $1,717.95 "," $2,514.92 ", $401.80 , $336.07 ," $1,923.46 "," $1,959.11 "," $2,457.99 "," $2,378.70 "," $2,378.70 "," $2,114.40 "," $2,114.40 ", $336.07 ," $2,440.28 "," $2,510.85 "," $2,378.70 "," $2,378.70 "," $2,378.70 "," $2,457.99 "," $2,537.28 "," $2,304.80 "," $2,246.55 "," $2,151.58 "," $2,290.13 ", N/A ," $1,960.98 "," $1,960.98 "," $2,510.85 "," $2,304.84 ", $336.07 ," $2,537.28 "
 BEVACIZUMAB-BVZR 100 MG/4ML IV SOLN ,HCPCS Q5118,0636 - DRUGS REQUIRING DETAILED CODIN,00069-0315-01,4 mL," $1,803.59 "," $1,172.33 "," $1,515.02 ", $28.75 , $34.36 ," $1,457.30 "," $1,623.23 "," $1,526.92 "," $1,623.23 "," $1,623.23 "," $1,623.23 "," $1,533.05 ", $33.69 ," $1,665.25 "," $1,713.41 "," $1,533.05 "," $1,677.34 "," $1,677.34 "," $1,713.41 "," $1,731.45 "," $1,475.70 "," $1,623.23 "," $1,533.05 "," $1,424.84 ", N/A ," $1,459.65 "," $1,459.65 "," $1,713.41 "," $1,547.66 ", $28.75 ," $1,731.45 "
Closed Rx Knee Disloc+Anesth,CPT® 27552,N/A,N/A,N/A," $4,187.00 "," $2,721.55 "," $3,876.67 ", $607.68 , $307.34 ," $3,016.21 "," $3,016.32 "," $3,893.91 "," $3,768.30 "," $3,768.30 "," $3,349.60 "," $3,349.60 ", $307.34 ," $3,865.86 "," $3,977.65 "," $3,768.30 "," $3,768.30 "," $3,768.30 "," $3,893.91 "," $4,019.52 "," $3,593.51 "," $3,558.95 "," $3,329.06 "," $3,545.90 ", N/A ," $3,075.06 "," $3,075.06 "," $3,977.65 "," $3,614.29 ", $307.34 ," $4,019.52 "
 FLUOXETINE HCL 20 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-5785-61,1 capsule, $12.76 , $8.29 , $10.72 , N/A , N/A , $10.31 , $11.48 , $10.80 , $11.48 , $11.48 , $11.48 , $10.85 , N/A , $11.78 , $12.12 , $10.85 , $11.87 , $11.87 , $12.12 , $12.25 , $10.44 , $11.48 , $10.85 , $10.08 , N/A , $10.33 , $10.33 , $12.12 , $10.95 , $10.08 , $12.25 
"Knee Scope,Aid Ant Cruciate Repair",CPT® 29888,N/A,N/A,N/A," $6,537.00 "," $4,249.05 "," $5,922.48 ", $925.28 , $869.33 ," $4,755.46 "," $4,743.68 "," $6,079.41 "," $5,883.30 "," $5,883.30 "," $5,229.60 "," $5,229.60 ", $869.33 ," $6,035.61 "," $6,210.15 "," $5,883.30 "," $5,883.30 "," $5,883.30 "," $6,079.41 "," $6,275.52 "," $6,519.97 "," $5,556.45 "," $5,245.15 "," $5,597.70 ", N/A ," $4,848.25 "," $4,848.25 "," $6,210.15 "," $5,698.42 ", $869.33 ," $6,519.97 "
"Eeg,W/Awake & Drowsy Record",CPT® 95816,N/A,N/A,N/A," $1,629.00 "," $1,058.85 "," $1,405.35 ", $375.76 , $161.81 ," $1,142.48 "," $1,412.06 "," $1,514.97 "," $1,466.10 "," $1,466.10 "," $1,303.20 "," $1,303.20 ", $161.81 ," $1,504.06 "," $1,547.55 "," $1,466.10 "," $1,466.10 "," $1,466.10 "," $1,514.97 "," $1,563.84 "," $1,627.77 "," $1,384.65 "," $1,238.76 "," $1,375.42 ", N/A ," $1,164.77 "," $1,164.77 "," $1,547.55 "," $1,431.93 ", $161.81 ," $1,627.77 "
 VERAPAMIL HCL ER 180 MG PO TBCR ,HCPCS RXC637,0250 - PHARMACY,68462-0293-01,1 tablet, $7.40 , $4.81 , $6.22 , N/A , N/A , $5.98 , $6.66 , $6.26 , $6.66 , $6.66 , $6.66 , $6.29 , N/A , $6.83 , $7.03 , $6.29 , $6.88 , $6.88 , $7.03 , $7.10 , $6.05 , $6.66 , $6.29 , $5.85 , N/A , $5.99 , $5.99 , $7.03 , $6.35 , $5.85 , $7.10 
 VALPROATE SODIUM 100 MG/ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00143-9785-10,5 mL, $106.57 , $69.27 , $89.52 , N/A , N/A , $86.11 , $95.91 , $90.22 , $95.91 , $95.91 , $95.91 , $90.58 , N/A , $98.40 , $101.24 , $90.58 , $99.11 , $99.11 , $101.24 , $102.31 , $87.20 , $95.91 , $90.58 , $84.19 , N/A , $86.25 , $86.25 , $101.24 , $91.45 , $84.19 , $102.31 
 TETRAHYDROZOLINE HCL 0.05 % OP SOLN ,HCPCS RXC637,0250 - PHARMACY,00536-1217-94,15 mL, $9.79 , $6.36 , $8.22 , N/A , N/A , $7.91 , $8.81 , $8.29 , $8.81 , $8.81 , $8.81 , $8.32 , N/A , $9.04 , $9.30 , $8.32 , $9.10 , $9.10 , $9.30 , $9.40 , $8.01 , $8.81 , $8.32 , $7.73 , N/A , $7.92 , $7.92 , $9.30 , $8.40 , $7.73 , $9.40 
"Reimplant Ureter,Single Ureter",CPT® 50780,N/A,N/A,N/A," $7,656.00 "," $4,976.40 "," $5,963.44 "," $1,047.67 "," $1,630.34 "," $5,404.09 "," $5,026.10 "," $7,120.08 "," $6,890.40 "," $6,890.40 "," $6,124.80 "," $6,124.80 "," $1,630.34 "," $7,068.78 "," $7,273.20 "," $6,890.40 "," $6,890.40 "," $6,890.40 "," $7,120.08 "," $7,349.76 "," $5,978.39 "," $6,507.60 "," $5,725.06 "," $6,761.26 ", N/A ," $5,509.54 "," $5,509.54 "," $7,273.20 "," $6,475.66 "," $1,047.67 "," $7,349.76 "
 Fac Assay of Urine/Uric Acid ,CPT® 84560,0301 - LAB/CHEMISTRY,N/A,N/A, $68.00 , $44.20 , $57.12 , $5.18 , $5.18 , $54.94 , $61.20 , $57.57 , $61.20 , $61.20 , $61.20 , $57.80 , $5.08 , $62.78 , $64.60 , $57.80 , $63.24 , $63.24 , $64.60 , $65.28 , $55.64 , $61.20 , $57.80 , $53.72 , N/A , $55.03 , $55.03 , $64.60 , $58.35 , $5.08 , $65.28 
Metoclopramide Hcl Injection,HCPCS J2765,N/A,N/A,N/A, $11.00 , $7.15 , N/A , $1.26 , $1.12 , N/A , N/A , $10.23 , $9.90 , $9.90 , $8.80 , $8.80 , $1.12 , $10.16 , $10.45 , $9.90 , $9.90 , $9.90 , $10.23 , $10.56 , $1.46 , $9.35 , $0.65 , $1.49 , N/A , N/A , N/A , $10.45 , N/A , $0.65 , $10.56 
Revis/Repair OP Wound Anter Sgmt,CPT® 66250,N/A,N/A,N/A," $6,873.00 "," $4,467.45 "," $3,422.77 ", $537.39 , $620.01 ," $3,153.41 "," $2,988.49 "," $6,391.89 "," $6,185.70 "," $6,185.70 "," $5,498.40 "," $5,498.40 ", $620.01 ," $6,345.84 "," $6,529.35 "," $6,185.70 "," $6,185.70 "," $6,185.70 "," $6,391.89 "," $6,598.08 "," $4,701.06 "," $5,842.05 "," $3,102.49 "," $4,008.02 ", N/A ," $3,214.94 "," $3,214.94 "," $6,529.35 "," $3,548.88 ", $537.39 ," $6,598.08 "
" Pro Shoulder Scope, Bone Shaving ",CPT® 29826,0975 - PRO FEE/OR,N/A,N/A," $3,910.00 "," $2,541.50 "," $1,032.59 ", $160.23 , $582.25 , $850.38 , $834.76 ," $3,636.30 "," $3,519.00 "," $3,519.00 "," $3,128.00 "," $3,128.00 ", $582.25 ," $3,610.10 "," $3,714.50 "," $3,519.00 "," $3,519.00 "," $3,519.00 "," $3,636.30 "," $3,753.60 "," $1,910.28 "," $3,323.50 ", $925.93 , $996.64 , N/A , $866.98 , $866.98 ," $3,714.50 "," $1,019.01 ", $160.23 ," $3,753.60 "
 Fac Brnchsc W/Brncl Alveolar Lavage ,CPT® 31624,0360 - OR SERVICES,N/A,N/A," $2,245.00 "," $1,459.25 "," $1,885.80 ", $127.44 , $308.45 ," $1,813.96 "," $2,020.50 "," $1,900.62 "," $2,020.50 "," $2,020.50 "," $2,020.50 "," $1,908.25 ", $302.40 ," $2,072.81 "," $2,132.75 "," $1,908.25 "," $2,087.85 "," $2,087.85 "," $2,132.75 "," $2,155.20 "," $1,836.86 "," $2,020.50 "," $1,908.25 "," $1,773.55 ", N/A ," $1,816.88 "," $1,816.88 "," $2,132.75 "," $1,926.43 ", $127.44 ," $2,155.20 "
 Pro Diagnostic Lumbar Spinal Puncture ,CPT® 62270,0981 - PRO FEE/ER,N/A,N/A, $656.00 , $426.40 , $298.01 , $58.13 , $157.45 , $435.77 , $418.02 , $610.08 , $590.40 , $590.40 , $524.80 , $524.80 , $157.45 , $605.68 , $623.20 , $590.40 , $590.40 , $590.40 , $610.08 , $629.76 , $322.97 , $557.60 , $413.90 , $464.99 , N/A , $444.28 , $444.28 , $623.20 , $476.62 , $58.13 , $629.76 
 METHADONE HCL 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00406-5755-62,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN ,HCPCS J1956,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9722-24,50 mL, $36.99 , $24.04 , $31.07 , $0.94 , $0.99 , $29.89 , $33.29 , $31.32 , $33.29 , $33.29 , $33.29 , $31.44 , $0.97 , $34.15 , $35.14 , $31.44 , $34.40 , $34.40 , $35.14 , $35.51 , $30.27 , $33.29 , $31.44 , $29.22 , N/A , $29.94 , $29.94 , $35.14 , $31.74 , $0.94 , $35.51 
 Fac Culture Aerobic Identify ,CPT® 87077,0306 - LAB/BACT-MICRO,N/A,N/A, $108.00 , $70.20 , $90.72 , $8.24 , $8.24 , $87.26 , $97.20 , $91.43 , $97.20 , $97.20 , $97.20 , $91.80 , $8.08 , $99.72 , $102.60 , $91.80 , $100.44 , $100.44 , $102.60 , $103.68 , $88.37 , $97.20 , $91.80 , $85.32 , N/A , $87.40 , $87.40 , $102.60 , $92.67 , $8.08 , $103.68 
 ALPROSTADIL 500 MCG/ML IJ SOLN ,HCPCS J0270,0636 - DRUGS REQUIRING DETAILED CODIN,00009-3169-06,1 mL, $819.78 , $532.86 , $688.62 , N/A , $0.68 , $662.38 , $737.80 , $694.03 , $737.80 , $737.80 , $737.80 , $696.81 , $0.67 , $756.90 , $778.79 , $696.81 , $762.40 , $762.40 , $778.79 , $786.99 , $670.74 , $737.80 , $696.81 , $647.63 , N/A , $663.45 , $663.45 , $778.79 , $703.45 , $0.67 , $786.99 
Excis Rectal Lesion,CPT® 45160,N/A,N/A,N/A," $6,601.00 "," $4,290.65 "," $6,113.12 ", $946.72 ," $1,059.93 "," $4,800.41 "," $4,859.47 "," $6,138.93 "," $5,940.90 "," $5,940.90 "," $5,280.80 "," $5,280.80 "," $1,059.93 "," $6,094.70 "," $6,270.95 "," $5,940.90 "," $5,940.90 "," $5,940.90 "," $6,138.93 "," $6,336.96 "," $4,376.59 "," $5,610.85 "," $5,403.93 "," $5,661.36 ", N/A ," $4,894.07 "," $4,894.07 "," $6,270.95 "," $5,118.69 ", $946.72 ," $6,336.96 "
 Fac Dmd Duplication/Deletion Analysis ,CPT® 81161,0310 - PATHOLOGY LAB,N/A,N/A, $6.00 , $3.90 , $5.04 , $284.58 , $142.81 , $4.85 , $5.40 , $5.08 , $5.40 , $5.40 , $5.40 , $5.10 , $140.01 , $5.54 , $5.70 , $5.10 , $5.58 , $5.58 , $5.70 , $5.76 , $4.91 , $5.40 , $5.10 , $4.74 , N/A , $4.86 , $4.86 , $5.70 , $5.15 , $4.74 , $284.58 
"Bartonella, Antibody",CPT® 86611,N/A,N/A,N/A, $153.00 , $99.45 , N/A , $10.38 , $8.07 , $32.88 , $39.34 , $142.29 , $137.70 , $137.70 , $122.40 , $122.40 , $8.07 , $141.26 , $145.35 , $137.70 , $137.70 , $137.70 , $142.29 , $146.88 , $67.97 , $130.05 , $66.50 , $36.89 , N/A , $30.69 , $30.69 , $145.35 , $33.54 , $8.07 , $146.88 
Static or Dynami Afo Pre Ots,HCPCS L4397,N/A,N/A,N/A, $77.00 , $50.05 , N/A , $196.30 , $63.24 , N/A , N/A , $71.61 , $69.30 , $69.30 , $61.60 , $61.60 , $63.24 , $71.09 , $73.15 , $69.30 , $69.30 , $69.30 , $71.61 , $73.92 , N/A , $65.45 , $326.96 , $165.15 , N/A , N/A , N/A , $73.15 , N/A , $61.60 , $326.96 
Computerized Ophthalmic Imaging Optic Nerve,CPT® 92133,N/A,N/A,N/A, $209.00 , $135.85 , $80.01 , $36.05 , $32.72 , $77.59 , $79.73 , $194.37 , $188.10 , $188.10 , $167.20 , $167.20 , $32.72 , $192.97 , $198.55 , $188.10 , $188.10 , $188.10 , $194.37 , $200.64 , $113.35 , $177.65 , $134.82 , $79.52 , N/A , $79.10 , $79.10 , $198.55 , $94.10 , $32.72 , $200.64 
Fac Rpr Blvsl Dir Uxtr,35206,N/A,N/A,N/A," $6,104.00 "," $3,967.60 "," $4,591.67 ", $712.87 , $775.02 ," $3,351.92 "," $3,360.86 "," $5,676.72 "," $5,493.60 "," $5,493.60 "," $4,883.20 "," $4,883.20 ", $775.02 ," $5,635.82 "," $5,798.80 "," $5,493.60 "," $5,493.60 "," $5,493.60 "," $5,676.72 "," $5,859.84 "," $4,235.78 "," $5,188.40 "," $4,230.02 "," $3,773.56 ", N/A ," $3,417.32 "," $3,417.32 "," $5,798.80 "," $3,882.07 ", $712.87 ," $5,859.84 "
 Pro Egd Partial/Compl Esophagogastric Fundoplasty ,CPT® 43210,0982 - PRO FEE/OUTPT,N/A,N/A," $2,821.00 "," $1,833.65 "," $2,594.67 ", $400.08 , N/A ," $2,070.77 "," $2,058.56 "," $2,623.53 "," $2,538.90 "," $2,538.90 "," $2,256.80 "," $2,256.80 ", N/A ," $2,604.63 "," $2,679.95 "," $2,538.90 "," $2,538.90 "," $2,538.90 "," $2,623.53 "," $2,708.16 "," $1,866.13 "," $2,397.85 "," $2,249.61 "," $2,479.40 ", N/A ," $2,111.17 "," $2,111.17 "," $2,679.95 "," $2,208.04 ", $400.08 ," $2,708.16 "
 Fac Psychotherapy W/Patient W/E&M Srvcs 30 Min ,CPT® 90833,0914 - PSYCH/INDIV RX,N/A,N/A, $136.00 , $88.40 , $114.24 , $61.36 , $79.97 , $109.89 , $122.40 , $115.14 , $122.40 , $122.40 , $122.40 , $115.60 , $78.40 , $125.57 , $129.20 , $115.60 , $126.48 , $126.48 , $129.20 , $130.56 , $111.28 , $122.40 , $115.60 , $107.44 , N/A , $110.06 , $110.06 , $129.20 , $116.70 , $61.36 , $130.56 
"Shldr Arthroscop,Lyse Adhesns",29825,N/A,N/A,N/A," $2,799.00 "," $1,819.35 "," $3,583.19 ", $561.48 , $420.46 ," $2,801.78 "," $2,823.75 "," $2,603.07 "," $2,519.10 "," $2,519.10 "," $2,239.20 "," $2,239.20 ", $420.46 ," $2,584.32 "," $2,659.05 "," $2,519.10 "," $2,519.10 "," $2,519.10 "," $2,603.07 "," $2,687.04 "," $3,335.66 "," $2,379.15 "," $3,116.76 "," $3,307.21 ", N/A ," $2,856.45 "," $2,856.45 "," $2,659.05 "," $3,357.35 ", $420.46 ," $3,583.19 "
 Fac Assay of Corticosteroids ,CPT® 83491,0301 - LAB/CHEMISTRY,N/A,N/A, $160.00 , $104.00 , $134.40 , $18.26 , $18.26 , $129.28 , $144.00 , $135.46 , $144.00 , $144.00 , $144.00 , $136.00 , $17.90 , $147.73 , $152.00 , $136.00 , $148.80 , $148.80 , $152.00 , $153.60 , $130.91 , $144.00 , $136.00 , $126.40 , N/A , $129.49 , $129.49 , $152.00 , $137.30 , $17.90 , $153.60 
"Exc Skin Malig 3.1-4cm Trunk,Arm,Leg",CPT® 11604,N/A,N/A,N/A," $1,490.00 ", $968.50 , $679.52 , $203.78 , $369.39 , $587.14 , $572.25 ," $1,385.70 "," $1,341.00 "," $1,341.00 "," $1,192.00 "," $1,192.00 ", $369.39 ," $1,375.72 "," $1,415.50 "," $1,341.00 "," $1,341.00 "," $1,341.00 "," $1,385.70 "," $1,430.40 ", $745.34 ," $1,266.50 "," $1,141.80 ", $752.81 , N/A , $598.60 , $598.60 ," $1,415.50 ", $694.18 , $203.78 ," $1,430.40 "
"Lysis/Excis,Penile Postcircum Adhesions",CPT® 54162,N/A,N/A,N/A," $1,300.00 ", $845.00 , $888.68 , $191.99 , $88.56 , $638.16 , $647.54 ," $1,209.00 "," $1,170.00 "," $1,170.00 "," $1,040.00 "," $1,040.00 ", $88.56 ," $1,200.29 "," $1,235.00 "," $1,170.00 "," $1,170.00 "," $1,170.00 "," $1,209.00 "," $1,248.00 ", $831.41 ," $1,105.00 "," $1,032.97 ", $966.24 , N/A , $650.61 , $650.61 ," $1,235.00 ", $779.78 , $88.56 ," $1,248.00 "
 CYCLOPHOSPHAMIDE 2 GM/10ML IV SOLN ,HCPCS J9070,0636 - DRUGS REQUIRING DETAILED CODIN,50742-0521-10,10 mL," $9,030.62 "," $5,869.90 "," $7,585.72 ", $17.43 , $22.57 ," $7,296.74 "," $8,127.56 "," $7,645.32 "," $8,127.56 "," $8,127.56 "," $8,127.56 "," $7,676.03 ", $22.13 ," $8,337.97 "," $8,579.09 "," $7,676.03 "," $8,398.48 "," $8,398.48 "," $8,579.09 "," $8,669.40 "," $7,388.85 "," $8,127.56 "," $7,676.03 "," $7,134.19 ", N/A ," $7,308.48 "," $7,308.48 "," $8,579.09 "," $7,749.18 ", $17.43 ," $8,669.40 "
 Pro Gonioscopy Spx ,CPT® 92020,0962 - PRO FEE/EYE,N/A,N/A, $89.00 , $57.85 , $44.44 , $20.12 , $13.72 , $37.30 , $37.81 , $82.77 , $80.10 , $80.10 , $71.20 , $71.20 , $13.72 , $82.17 , $84.55 , $80.10 , $80.10 , $80.10 , $82.77 , $85.44 , $62.96 , $75.65 , $63.86 , $45.13 , N/A , $38.02 , $38.02 , $84.55 , $45.22 , $13.72 , $85.44 
 Fac Perq Breast Loc Device Placemt Each Les US Image ,CPT® 19286,0361 - OR/MINOR,N/A,N/A," $1,032.00 ", $670.80 , $866.88 , $40.65 , $32.53 , $833.86 , $928.80 , $873.69 , $928.80 , $928.80 , $928.80 , $877.20 , $31.89 , $952.85 , $980.40 , $877.20 , $959.76 , $959.76 , $980.40 , $990.72 , $844.38 , $928.80 , $877.20 , $815.28 , N/A , $835.20 , $835.20 , $980.40 , $885.56 , $31.89 , $990.72 
 SILVER NITRATE-POT NITRATE 75-25 % EX MISC ,HCPCS RXA250,0250 - PHARMACY,12870-0001-01,1 stick, $4.66 , $3.03 , $3.91 , N/A , N/A , $3.77 , $4.19 , $3.95 , $4.19 , $4.19 , $4.19 , $3.96 , N/A , $4.30 , $4.43 , $3.96 , $4.33 , $4.33 , $4.43 , $4.47 , $3.81 , $4.19 , $3.96 , $3.68 , N/A , $3.77 , $3.77 , $4.43 , $4.00 , $3.68 , $4.47 
 PHENAZOPYRIDINE HCL 100 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,75826-0114-10,1 tablet, $4.94 , $3.21 , $4.15 , N/A , N/A , $3.99 , $4.45 , $4.18 , $4.45 , $4.45 , $4.45 , $4.20 , N/A , $4.56 , $4.69 , $4.20 , $4.59 , $4.59 , $4.69 , $4.74 , $4.04 , $4.45 , $4.20 , $3.90 , N/A , $4.00 , $4.00 , $4.69 , $4.24 , $3.90 , $4.74 
"Epstein-Barr Antibody,Nuclear",CPT® 86664,N/A,N/A,N/A, $141.00 , $91.65 , N/A , $15.60 , $15.60 , $86.56 , $103.53 , $131.13 , $126.90 , $126.90 , $112.80 , $112.80 , $15.60 , $130.19 , $133.95 , $126.90 , $126.90 , $126.90 , $131.13 , $135.36 , $102.09 , $119.85 , $100.55 , $55.45 , N/A , $80.78 , $80.78 , $133.95 , $88.28 , $15.60 , $135.36 
Tcat Insj/Rpl Perm Leadless Pacemaker Rv W/Img,CPT® 33274,N/A,N/A,N/A," $5,676.00 "," $3,689.40 "," $2,861.82 ", $441.08 , N/A ," $1,947.04 ", N/A ," $5,278.68 "," $5,108.40 "," $5,108.40 "," $4,540.80 "," $4,540.80 ", N/A ," $5,240.65 "," $5,392.20 "," $5,108.40 "," $5,108.40 "," $5,108.40 "," $5,278.68 "," $5,448.96 "," $2,656.99 "," $4,824.60 "," $2,519.71 "," $2,366.12 ", N/A ," $1,985.03 "," $1,985.03 "," $5,392.20 "," $2,254.99 ", $441.08 ," $5,448.96 "
"Fetal Biophys Prof,W/O Nst",CPT® 76819,N/A,N/A,N/A, $933.00 , $606.45 , $475.19 , $83.42 , $89.42 , $426.09 , $474.00 , $867.69 , $839.70 , $839.70 , $746.40 , $746.40 , $89.42 , $861.44 , $886.35 , $839.70 , $839.70 , $839.70 , $867.69 , $895.68 , $479.00 , $793.05 , $518.11 , $503.86 , N/A , $434.40 , $434.40 , $886.35 , $502.84 , $83.42 , $895.68 
"Dt Immunization, Im <7yo",CPT® 90702,N/A,N/A,N/A, $78.00 , $50.70 , N/A , N/A , $15.30 , $45.22 , $47.29 , $72.54 , $70.20 , $70.20 , $62.40 , $62.40 , $15.30 , $72.02 , $74.10 , $70.20 , $70.20 , $70.20 , $72.54 , $74.88 , N/A , $66.30 , $62.85 , $103.53 , N/A , $46.10 , $46.10 , $74.10 , $53.74 , $15.30 , $103.53 
 Fac Myelograpy 2/More Regions Rs&I ,CPT® 72270,0320 - DX X-RAY,N/A,N/A," $1,716.00 "," $1,115.40 "," $1,441.44 ", $162.75 , $211.06 ," $1,386.53 "," $1,544.40 "," $1,452.77 "," $1,544.40 "," $1,544.40 "," $1,544.40 "," $1,458.60 ", $206.92 ," $1,584.38 "," $1,630.20 "," $1,458.60 "," $1,595.88 "," $1,595.88 "," $1,630.20 "," $1,647.36 "," $1,404.03 "," $1,544.40 "," $1,458.60 "," $1,355.64 ", N/A ," $1,388.76 "," $1,388.76 "," $1,630.20 "," $1,472.50 ", $162.75 ," $1,647.36 "
"Adj Tiss Xfer Lid,Nos,Ear 10.1-30",CPT® 14061,N/A,N/A,N/A," $5,594.00 "," $3,636.10 "," $2,618.85 ", $787.10 , $533.82 ," $2,277.64 "," $2,232.69 "," $5,202.42 "," $5,034.60 "," $5,034.60 "," $4,475.20 "," $4,475.20 ", $533.82 ," $5,164.94 "," $5,314.30 "," $5,034.60 "," $5,034.60 "," $5,034.60 "," $5,202.42 "," $5,370.24 "," $2,868.79 "," $4,754.90 "," $4,442.32 "," $2,918.08 ", N/A ," $2,322.08 "," $2,322.08 "," $5,314.30 "," $2,692.83 ", $533.82 ," $5,370.24 "
Ndsc Eval Intstinal Pouch W/Bx Single/Multiple,CPT® 44386,N/A,N/A,N/A," $2,755.00 "," $1,790.75 ", $545.68 , $84.77 , $40.17 , $606.60 , $622.85 ," $2,562.15 "," $2,479.50 "," $2,479.50 "," $2,204.00 "," $2,204.00 ", $40.17 ," $2,543.69 "," $2,617.25 "," $2,479.50 "," $2,479.50 "," $2,479.50 "," $2,562.15 "," $2,644.80 ", $390.64 ," $2,341.75 ", $683.30 , $516.96 , N/A , $618.44 , $618.44 ," $2,617.25 ", $646.83 , $40.17 ," $2,644.80 "
 PROCAINAMIDE HCL 500 MG/ML IJ SOLN ,HCPCS J2690,0636 - DRUGS REQUIRING DETAILED CODIN,14789-0900-02,2 mL," $3,698.55 "," $2,404.06 "," $3,106.78 ", $314.15 , $167.66 ," $2,988.43 "," $3,328.70 "," $3,131.19 "," $3,328.70 "," $3,328.70 "," $3,328.70 "," $3,143.77 ", $164.37 ," $3,414.87 "," $3,513.62 "," $3,143.77 "," $3,439.65 "," $3,439.65 "," $3,513.62 "," $3,550.61 "," $3,026.15 "," $3,328.70 "," $3,143.77 "," $2,921.85 ", N/A ," $2,993.24 "," $2,993.24 "," $3,513.62 "," $3,173.73 ", $164.37 ," $3,550.61 "
 TRIAMCINOLONE ACETONIDE 0.5 % EX CREA ,HCPCS RXC637,0250 - PHARMACY,67877-0318-15,15 gram, $58.26 , $37.87 , $48.94 , N/A , N/A , $47.07 , $52.43 , $49.32 , $52.43 , $52.43 , $52.43 , $49.52 , N/A , $53.79 , $55.35 , $49.52 , $54.18 , $54.18 , $55.35 , $55.93 , $47.67 , $52.43 , $49.52 , $46.03 , N/A , $47.15 , $47.15 , $55.35 , $49.99 , $46.03 , $55.93 
Insj Ant Sgm Drg Dev Trab Mw W/O Res&Ctrc Rmvl1+,0671T,N/A,N/A,N/A," $7,994.00 "," $5,196.10 ", N/A , N/A , N/A , N/A , N/A ," $7,434.42 "," $7,194.60 "," $7,194.60 "," $6,395.20 "," $6,395.20 ", N/A ," $7,380.86 "," $7,594.30 "," $7,194.60 "," $7,194.60 "," $7,194.60 "," $7,434.42 "," $7,674.24 ", N/A ," $6,794.90 "," $1,869.34 "," $6,991.24 ", N/A ," $1,828.70 "," $1,828.70 "," $7,594.30 "," $2,128.64 "," $1,828.70 "," $7,674.24 "
 Closed Tx Patellar Disloc W/O Anes -Mh ,CPT® 27560,0761 - TREATMENT ROOM,N/A,N/A," $1,706.00 "," $1,108.90 "," $1,433.04 ", $334.64 , $268.05 ," $1,378.45 "," $1,535.40 "," $1,444.30 "," $1,535.40 "," $1,535.40 "," $1,535.40 "," $1,450.10 ", $262.79 ," $1,575.15 "," $1,620.70 "," $1,450.10 "," $1,586.58 "," $1,586.58 "," $1,620.70 "," $1,637.76 "," $1,395.85 "," $1,535.40 "," $1,450.10 "," $1,347.74 ", N/A ," $1,380.67 "," $1,380.67 "," $1,620.70 "," $1,463.92 ", $262.79 ," $1,637.76 "
 NALOXONE HCL 2 MG/2ML IJ SOSY ,HCPCS J2310,0636 - DRUGS REQUIRING DETAILED CODIN,76329-3369-01,1 mL, $101.72 , $66.12 , $85.44 , $9.64 , $10.51 , $82.19 , $91.55 , $86.12 , $91.55 , $91.55 , $91.55 , $86.46 , $10.30 , $93.92 , $96.63 , $86.46 , $94.60 , $94.60 , $96.63 , $97.65 , $83.23 , $91.55 , $86.46 , $80.36 , N/A , $82.32 , $82.32 , $96.63 , $87.29 , $9.64 , $97.65 
 KERR INSTA-CHAR IN SORBITOL 25 GM/120ML PO SUSP ,HCPCS RXA250,0250 - PHARMACY,66689-0203-04,120 mL, $152.26 , $98.97 , $127.90 , N/A , N/A , $123.03 , $137.03 , $128.90 , $137.03 , $137.03 , $137.03 , $129.42 , N/A , $140.58 , $144.65 , $129.42 , $141.60 , $141.60 , $144.65 , $146.17 , $124.58 , $137.03 , $129.42 , $120.29 , N/A , $123.22 , $123.22 , $144.65 , $130.65 , $120.29 , $146.17 
Ko Single Upright Custom Fit,HCPCS L1843,N/A,N/A,N/A," $1,190.00 ", $773.50 , N/A ," $1,049.58 ", $427.85 , N/A , N/A ," $1,106.70 "," $1,071.00 "," $1,071.00 ", $952.00 , $952.00 , $427.85 ," $1,098.73 "," $1,130.50 "," $1,071.00 "," $1,071.00 "," $1,071.00 "," $1,106.70 "," $1,142.40 ", N/A ," $1,011.50 ", $866.08 , $883.04 , N/A , N/A , N/A ," $1,130.50 ", N/A , $427.85 ," $1,142.40 "
 Other Kidney And Urinary Tract Diagnoses Without Cc/McC ,MS DRG V40 (FY2023) 700,N/A,N/A,N/A," $12,033.56 "," $7,821.81 "," $10,108.19 ", N/A , N/A ," $9,723.12 "," $10,830.20 "," $10,187.61 "," $10,830.20 "," $10,830.20 "," $10,830.20 "," $10,228.53 ", N/A ," $11,110.59 "," $11,431.88 "," $10,228.53 "," $11,191.21 "," $11,191.21 "," $11,431.88 "," $11,552.22 "," $9,845.86 "," $10,830.20 "," $10,228.53 "," $9,506.51 ", N/A ," $9,738.76 "," $9,738.76 "," $11,431.88 "," $10,326.00 "," $9,506.51 "," $11,552.22 "
"Thoracotomy,Major",CPT® 32160,N/A,N/A,N/A," $6,941.00 "," $4,511.65 "," $4,155.30 ", $730.65 ," $1,004.81 "," $2,982.90 "," $2,929.64 "," $6,455.13 "," $6,246.90 "," $6,246.90 "," $5,552.80 "," $5,552.80 "," $1,004.81 "," $6,408.63 "," $6,593.95 "," $6,246.90 "," $6,246.90 "," $6,246.90 "," $6,455.13 "," $6,663.36 "," $4,014.68 "," $5,899.85 "," $4,222.88 "," $3,946.86 ", N/A ," $3,041.11 "," $3,041.11 "," $6,593.95 "," $3,581.53 ", $730.65 ," $6,663.36 "
 Fac Drug Screening Sedative Hypnotics ,CPT® 80368,0301 - LAB/CHEMISTRY,N/A,N/A, $224.00 , $145.60 , $188.16 , N/A , N/A , $180.99 , $201.60 , $189.64 , $201.60 , $201.60 , $201.60 , $190.40 , N/A , $206.82 , $212.80 , $190.40 , $208.32 , $208.32 , $212.80 , $215.04 , $183.28 , $201.60 , $190.40 , $176.96 , N/A , $181.28 , $181.28 , $212.80 , $192.21 , $176.96 , $215.04 
"Rmv Knee Synovium,Ant/Post",CPT® 27334,N/A,N/A,N/A," $4,481.00 "," $2,912.65 "," $4,180.74 ", $656.57 , $922.06 ," $3,295.78 "," $3,289.46 "," $4,167.33 "," $4,032.90 "," $4,032.90 "," $3,584.80 "," $3,584.80 ", $922.06 ," $4,137.31 "," $4,256.95 "," $4,032.90 "," $4,032.90 "," $4,032.90 "," $4,167.33 "," $4,301.76 "," $3,883.06 "," $3,808.85 "," $3,632.35 "," $3,886.96 ", N/A ," $3,360.08 "," $3,360.08 "," $4,256.95 "," $3,949.31 ", $656.57 ," $4,301.76 "
 SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00703-9514-03,10 mL, $77.31 , $50.25 , $64.94 , N/A , N/A , $62.47 , $69.58 , $65.45 , $69.58 , $69.58 , $69.58 , $65.71 , N/A , $71.38 , $73.44 , $65.71 , $71.90 , $71.90 , $73.44 , $74.22 , $63.26 , $69.58 , $65.71 , $61.07 , N/A , $62.57 , $62.57 , $73.44 , $66.34 , $61.07 , $74.22 
Platelet Count,CPT® 85049,N/A,N/A,N/A, $51.00 , $33.15 , N/A , $4.57 , $4.57 , $25.32 , $30.29 , $47.43 , $45.90 , $45.90 , $40.80 , $40.80 , $4.57 , $47.09 , $48.45 , $45.90 , $45.90 , $45.90 , $47.43 , $48.96 , $29.91 , $43.35 , $29.19 , $16.24 , N/A , $23.63 , $23.63 , $48.45 , $25.82 , $4.57 , $48.96 
 ATORVASTATIN CALCIUM 80 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6293-04,1 tablet, $9.98 , $6.49 , $8.38 , N/A , N/A , $8.06 , $8.98 , $8.45 , $8.98 , $8.98 , $8.98 , $8.48 , N/A , $9.21 , $9.48 , $8.48 , $9.28 , $9.28 , $9.48 , $9.58 , $8.17 , $8.98 , $8.48 , $7.88 , N/A , $8.08 , $8.08 , $9.48 , $8.56 , $7.88 , $9.58 
 Fac Drug Tst Prsmv Instrmnt Chem Analyzers PR Date ,CPT® 80307,0301 - LAB/CHEMISTRY,N/A,N/A, $541.00 , $351.65 , $454.44 , $63.38 , $63.38 , $437.13 , $486.90 , $458.01 , $486.90 , $486.90 , $486.90 , $459.85 , $62.14 , $499.51 , $513.95 , $459.85 , $503.13 , $503.13 , $513.95 , $519.36 , $442.65 , $486.90 , $459.85 , $427.39 , N/A , $437.83 , $437.83 , $513.95 , $464.23 , $62.14 , $519.36 
I&D Deep Absc/Hematoma Neck/Chest,CPT® 21501,N/A,N/A,N/A," $3,031.00 "," $1,970.15 "," $2,034.89 ", $320.83 , $177.51 ," $1,549.02 "," $1,575.62 "," $2,818.83 "," $2,727.90 "," $2,727.90 "," $2,424.80 "," $2,424.80 ", $177.51 ," $2,798.52 "," $2,879.45 "," $2,727.90 "," $2,727.90 "," $2,727.90 "," $2,818.83 "," $2,909.76 "," $1,860.63 "," $2,576.35 "," $1,734.11 "," $1,827.29 ", N/A ," $1,579.24 "," $1,579.24 "," $2,879.45 "," $1,856.17 ", $177.51 ," $2,909.76 "
 Fac Assay of Glucagon ,CPT® 82943,0301 - LAB/CHEMISTRY,N/A,N/A, $119.00 , $77.35 , $99.96 , $14.58 , $13.70 , $96.15 , $107.10 , $100.75 , $107.10 , $107.10 , $107.10 , $101.15 , $13.43 , $109.87 , $113.05 , $101.15 , $110.67 , $110.67 , $113.05 , $114.24 , $97.37 , $107.10 , $101.15 , $94.01 , N/A , $96.31 , $96.31 , $113.05 , $102.11 , $13.43 , $114.24 
 Fac Antidepressants Not Otherwise Specified ,CPT® 80338,0301 - LAB/CHEMISTRY,N/A,N/A, $69.00 , $44.85 , $57.96 , N/A , N/A , $55.75 , $62.10 , $58.42 , $62.10 , $62.10 , $62.10 , $58.65 , N/A , $63.71 , $65.55 , $58.65 , $64.17 , $64.17 , $65.55 , $66.24 , $56.46 , $62.10 , $58.65 , $54.51 , N/A , $55.84 , $55.84 , $65.55 , $59.21 , $54.51 , $66.24 
 Pro Arthrs Sho Surg W/Lss&Rescj Ads +-Mnpj ,CPT® 29825,0982 - PRO FEE/OUTPT,N/A,N/A," $2,799.00 "," $1,819.35 "," $3,583.19 ", $561.48 , $420.46 ," $2,801.78 "," $2,823.75 "," $2,603.07 "," $2,519.10 "," $2,519.10 "," $2,239.20 "," $2,239.20 ", $420.46 ," $2,584.32 "," $2,659.05 "," $2,519.10 "," $2,519.10 "," $2,519.10 "," $2,603.07 "," $2,687.04 "," $3,335.66 "," $2,379.15 "," $3,116.76 "," $3,307.21 ", N/A ," $2,856.45 "," $2,856.45 "," $2,659.05 "," $3,357.35 ", $420.46 ," $3,583.19 "
"Shav Skin Les 6-10mm Face,Facial",CPT® 11311,N/A,N/A,N/A, $502.00 , $326.30 , $200.87 , $60.34 , $74.81 , $180.78 , $174.29 , $466.86 , $451.80 , $451.80 , $401.60 , $401.60 , $74.81 , $463.50 , $476.90 , $451.80 , $451.80 , $451.80 , $466.86 , $481.92 , $222.33 , $426.70 , $346.11 , $230.29 , N/A , $184.31 , $184.31 , $476.90 , $213.76 , $60.34 , $481.92 
"MR Angio, Head",CPT® 70544,N/A,N/A,N/A," $6,152.00 "," $3,998.80 "," $1,543.08 ", $220.97 , $403.88 ," $1,863.94 "," $2,422.82 "," $5,721.36 "," $5,536.80 "," $5,536.80 "," $4,921.60 "," $4,921.60 ", $403.88 ," $5,680.14 "," $5,844.40 "," $5,536.80 "," $5,536.80 "," $5,536.80 "," $5,721.36 "," $5,905.92 "," $1,319.59 "," $5,229.20 "," $2,640.60 "," $2,189.99 ", N/A ," $1,900.31 "," $1,900.31 "," $5,844.40 "," $2,199.64 ", $220.97 ," $5,905.92 "
Incision of Tongue Fold,CPT® 41010,N/A,N/A,N/A, $893.00 , $580.45 , $680.55 , $107.20 , $97.17 , $527.24 , $553.52 , $830.49 , $803.70 , $803.70 , $714.40 , $714.40 , $97.17 , $824.51 , $848.35 , $803.70 , $803.70 , $803.70 , $830.49 , $857.28 , $482.28 , $759.05 , $603.01 , $619.44 , N/A , $537.52 , $537.52 , $848.35 , $562.20 , $97.17 , $857.28 
" Pro CT Angiography, Head ",CPT® 70496,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,043.00 ", $677.95 ," $1,769.74 ", $256.30 , $377.53 ," $1,399.18 "," $2,641.86 ", $969.99 , $938.70 , $938.70 , $834.40 , $834.40 , $377.53 , $963.00 , $990.85 , $938.70 , $938.70 , $938.70 , $969.99 ," $1,001.28 "," $1,637.22 ", $886.55 ," $2,877.51 "," $1,900.26 ", N/A ," $1,426.47 "," $1,426.47 ", $990.85 ," $1,651.18 ", $256.30 ," $2,877.51 "
 Fac Htlv/Hiv Confirmatory Test ,CPT® 86689,0300 - LABORATORY,N/A,N/A, $260.00 , $169.00 , $218.40 , $19.74 , $19.74 , $210.08 , $234.00 , $220.12 , $234.00 , $234.00 , $234.00 , $221.00 , $19.35 , $240.06 , $247.00 , $221.00 , $241.80 , $241.80 , $247.00 , $249.60 , $212.73 , $234.00 , $221.00 , $205.40 , N/A , $210.42 , $210.42 , $247.00 , $223.11 , $19.35 , $249.60 
 Fac Radiation Treatment Aid(S) ,CPT® 77332,0333 - RADIATION RX,N/A,N/A, $635.00 , $412.75 , $533.40 , $37.56 , $76.07 , $513.08 , $571.50 , $537.59 , $571.50 , $571.50 , $571.50 , $539.75 , $74.58 , $586.30 , $603.25 , $539.75 , $590.55 , $590.55 , $603.25 , $609.60 , $519.56 , $571.50 , $539.75 , $501.65 , N/A , $513.91 , $513.91 , $603.25 , $544.89 , $37.56 , $609.60 
"Dest,Nerve,Facial",64612,N/A,N/A,N/A, $731.00 , $475.15 , $572.10 , $112.30 , $185.45 , $639.64 , $644.20 , $679.83 , $657.90 , $657.90 , $584.80 , $584.80 , $185.45 , $674.93 , $694.45 , $657.90 , $657.90 , $657.90 , $679.83 , $701.76 , $614.83 , $621.35 , $654.75 , $689.66 , N/A , $652.12 , $652.12 , $694.45 , $699.57 , $112.30 , $701.76 
"Hepatitis C Virus, Genotype Anal Dna/Rna",CPT® 87902,N/A,N/A,N/A," $1,381.00 ", $897.65 , N/A , $262.60 , $262.60 ," $1,456.57 "," $1,742.30 "," $1,284.33 "," $1,242.90 "," $1,242.90 "," $1,104.80 "," $1,104.80 ", $262.60 ," $1,275.08 "," $1,311.95 "," $1,242.90 "," $1,242.90 "," $1,242.90 "," $1,284.33 "," $1,325.76 "," $1,719.05 "," $1,173.85 "," $1,686.72 ", $933.50 , N/A ," $1,359.36 "," $1,359.36 "," $1,311.95 "," $1,485.48 ", $262.60 ," $1,742.30 "
"Adj Tiss Xfer Any Area,30.1-60 Sqcm",CPT® 14301,N/A,N/A,N/A," $6,087.00 "," $3,956.55 "," $2,761.89 ", $827.38 , $871.80 ," $2,409.59 "," $2,360.03 "," $5,660.91 "," $5,478.30 "," $5,478.30 "," $4,869.60 "," $4,869.60 ", $871.80 ," $5,620.13 "," $5,782.65 "," $5,478.30 "," $5,478.30 "," $5,478.30 "," $5,660.91 "," $5,843.52 "," $3,027.48 "," $5,173.95 "," $4,717.07 "," $3,071.62 ", N/A ," $2,456.60 "," $2,456.60 "," $5,782.65 "," $2,848.82 ", $827.38 ," $5,843.52 "
 Fac Lvr&Spleen Img Static Only ,CPT® 78215,0340 - NUCLEAR MEDICINE,N/A,N/A," $1,738.00 "," $1,129.70 "," $1,459.92 ", $180.78 , $140.80 ," $1,404.30 "," $1,564.20 "," $1,471.39 "," $1,564.20 "," $1,564.20 "," $1,564.20 "," $1,477.30 ", $138.04 ," $1,604.70 "," $1,651.10 "," $1,477.30 "," $1,616.34 "," $1,616.34 "," $1,651.10 "," $1,668.48 "," $1,422.03 "," $1,564.20 "," $1,477.30 "," $1,373.02 ", N/A ," $1,406.56 "," $1,406.56 "," $1,651.10 "," $1,491.38 ", $138.04 ," $1,668.48 "
"Apply Bone Uniplane,Ext Fix Dev",20690,N/A,N/A,N/A," $3,849.00 "," $2,501.85 "," $3,613.81 ", $565.91 , $479.56 ," $2,868.20 "," $2,830.07 "," $3,579.57 "," $3,464.10 "," $3,464.10 "," $3,079.20 "," $3,079.20 ", $479.56 ," $3,553.78 "," $3,656.55 "," $3,464.10 "," $3,464.10 "," $3,464.10 "," $3,579.57 "," $3,695.04 "," $3,363.02 "," $3,271.65 "," $3,123.90 "," $3,380.26 ", N/A ," $2,924.17 "," $2,924.17 "," $3,656.55 "," $3,436.94 ", $479.56 ," $3,695.04 "
 KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN ,HCPCS RXA258,0258 - IV SOLUTIONS,00990-7902-09,"1,000 mL", $106.42 , $69.17 , $89.39 , N/A , N/A , $85.99 , $95.78 , $90.10 , $95.78 , $95.78 , $95.78 , $90.46 , N/A , $98.26 , $101.10 , $90.46 , $98.97 , $98.97 , $101.10 , $102.16 , $87.07 , $95.78 , $90.46 , $84.07 , N/A , $86.13 , $86.13 , $101.10 , $91.32 , $84.07 , $102.16 
 Temporomandibular Joint Bil- Mh ,CPT® 70330,0972 - PRO FEE/RAD/DX,N/A,N/A, $159.00 , $103.35 , $302.70 , $52.18 , $45.11 , $221.55 , $257.85 , $147.87 , $143.10 , $143.10 , $127.20 , $127.20 , $45.11 , $146.80 , $151.05 , $143.10 , $143.10 , $143.10 , $147.87 , $152.64 , $294.02 , $135.15 , $283.13 , $237.78 , N/A , $225.87 , $225.87 , $151.05 , $261.44 , $45.11 , $302.70 
Prq Plmt Biliary Drg Cath W/Img Gid Rs&I Int-Ext,CPT® 47534,N/A,N/A,N/A," $10,311.00 "," $6,702.15 "," $2,261.22 ", $349.97 ," $1,304.35 "," $1,966.00 "," $1,822.91 "," $9,589.23 "," $9,279.90 "," $9,279.90 "," $8,248.80 "," $8,248.80 "," $1,304.35 "," $9,520.15 "," $9,795.45 "," $9,279.90 "," $9,279.90 "," $9,279.90 "," $9,589.23 "," $9,898.56 "," $1,634.15 "," $8,764.35 "," $1,911.99 "," $2,185.02 ", N/A ," $2,004.36 "," $2,004.36 "," $9,795.45 "," $2,096.36 ", $349.97 ," $9,898.56 "
Lymphatics & Lymph Glands Imaging,CPT® 78195,N/A,N/A,N/A," $5,427.00 "," $3,527.55 "," $1,895.56 ", $323.97 , $197.50 ," $1,750.88 "," $1,907.86 "," $5,047.11 "," $4,884.30 "," $4,884.30 "," $4,341.60 "," $4,341.60 ", $197.50 ," $5,010.75 "," $5,155.65 "," $4,884.30 "," $4,884.30 "," $4,884.30 "," $5,047.11 "," $5,209.92 "," $1,963.62 "," $4,612.95 "," $2,082.05 "," $2,395.94 ", N/A ," $1,785.05 "," $1,785.05 "," $5,155.65 "," $2,066.22 ", $197.50 ," $5,209.92 "
 LISINOPRIL 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6797-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Echo Transesophag R-T 2d W/Prb Img Acquisj I&R ,CPT® 93312,0483 - CARDIOLOGY – ECHOCARDIOLOGY,N/A,N/A," $2,495.00 "," $1,621.75 "," $2,095.80 ", $233.60 , $391.89 ," $2,015.96 "," $2,245.50 "," $2,112.27 "," $2,245.50 "," $2,245.50 "," $2,245.50 "," $2,120.75 ", $384.21 ," $2,303.63 "," $2,370.25 "," $2,120.75 "," $2,320.35 "," $2,320.35 "," $2,370.25 "," $2,395.20 "," $2,041.41 "," $2,245.50 "," $2,120.75 "," $1,971.05 ", N/A ," $2,019.20 "," $2,019.20 "," $2,370.25 "," $2,140.96 ", $233.60 ," $2,395.20 "
Intracardiac Electrophysiologic 3d Mapping,CPT® 93613,N/A,N/A,N/A," $3,836.00 "," $2,493.40 "," $1,733.10 ", $266.15 , $582.69 ," $2,112.13 "," $2,068.82 "," $3,567.48 "," $3,452.40 "," $3,452.40 "," $3,068.80 "," $3,068.80 ", $582.69 ," $3,541.78 "," $3,644.20 "," $3,452.40 "," $3,452.40 "," $3,452.40 "," $3,567.48 "," $3,682.56 "," $1,716.23 "," $3,260.60 "," $2,012.42 "," $1,861.47 ", N/A ," $2,153.34 "," $2,153.34 "," $3,644.20 "," $2,386.99 ", $266.15 ," $3,682.56 "
Excise Ext. Hemorrhoid,46320,N/A,N/A,N/A, $870.00 , $565.50 , $692.64 , $107.89 , $165.14 , $525.60 , $539.21 , $809.10 , $783.00 , $783.00 , $696.00 , $696.00 , $165.14 , $803.27 , $826.50 , $783.00 , $783.00 , $783.00 , $809.10 , $835.20 , $493.49 , $739.50 , $594.09 , $627.81 , N/A , $535.85 , $535.85 , $826.50 , $560.45 , $107.89 , $835.20 
 Pro X-Ray Exam of Humerus ,CPT® 73060,0972 - PRO FEE/RAD/DX,N/A,N/A, $136.00 , $88.40 , $178.87 , $31.69 , $27.66 , $126.21 , $155.69 , $126.48 , $122.40 , $122.40 , $108.80 , $108.80 , $27.66 , $125.57 , $129.20 , $122.40 , $122.40 , $122.40 , $126.48 , $130.56 , $176.32 , $115.60 , $169.49 , $145.84 , N/A , $128.68 , $128.68 , $129.20 , $148.95 , $27.66 , $178.87 
 Fac Insertion Picc W/O Img Gdn 5 Yr/> ,CPT® 36569,0761 - TREATMENT ROOM,N/A,N/A," $2,378.00 "," $1,545.70 "," $1,997.52 ", $87.87 , $94.88 ," $1,921.42 "," $2,140.20 "," $2,013.21 "," $2,140.20 "," $2,140.20 "," $2,140.20 "," $2,021.30 ", $93.02 ," $2,195.61 "," $2,259.10 "," $2,021.30 "," $2,211.54 "," $2,211.54 "," $2,259.10 "," $2,282.88 "," $1,945.68 "," $2,140.20 "," $2,021.30 "," $1,878.62 ", N/A ," $1,924.52 "," $1,924.52 "," $2,259.10 "," $2,040.56 ", $87.87 ," $2,282.88 "
 Pro Smpl Rpr Supfc F/E/E/N/L/M 2.5cm/< ,CPT® 12011,0982 - PRO FEE/OUTPT,N/A,N/A, $685.00 , $445.25 , $172.01 , $51.31 , $66.00 , $150.86 , $147.21 , $637.05 , $616.50 , $616.50 , $548.00 , $548.00 , $66.00 , $632.46 , $650.75 , $616.50 , $616.50 , $616.50 , $637.05 , $657.60 , $189.71 , $582.25 , $296.15 , $192.22 , N/A , $153.81 , $153.81 , $650.75 , $178.36 , $51.31 , $657.60 
Acetone Assay,CPT® 82010,N/A,N/A,N/A, $124.00 , $80.60 , N/A , $8.33 , $8.33 , $46.24 , $55.29 , $115.32 , $111.60 , $111.60 , $99.20 , $99.20 , $8.33 , $114.49 , $117.80 , $111.60 , $111.60 , $111.60 , $115.32 , $119.04 , $54.55 , $105.40 , $53.52 , $29.57 , N/A , $43.15 , $43.15 , $117.80 , $47.15 , $8.33 , $119.04 
"Fix Ectropion,Extensive",CPT® 67917,N/A,N/A,N/A," $2,129.00 "," $1,383.85 "," $2,801.70 ", $440.14 , $475.41 ," $2,593.20 "," $2,535.54 "," $1,979.97 "," $1,916.10 "," $1,916.10 "," $1,703.20 "," $1,703.20 ", $475.41 ," $1,965.71 "," $2,022.55 "," $1,916.10 "," $1,916.10 "," $1,916.10 "," $1,979.97 "," $2,043.84 "," $3,846.57 "," $1,809.65 "," $2,627.93 "," $3,289.59 ", N/A ," $2,643.80 "," $2,643.80 "," $2,022.55 "," $2,918.41 ", $440.14 ," $3,846.57 "
 Pro Radex Mastoids Compl Minimum 3 Views PR Side ,CPT® 70130,0972 - PRO FEE/RAD/DX,N/A,N/A, $100.00 , $65.00 , $355.54 , $61.66 , $50.25 , $259.57 , $314.65 , $93.00 , $90.00 , $90.00 , $80.00 , $80.00 , $50.25 , $92.33 , $95.00 , $90.00 , $90.00 , $90.00 , $93.00 , $96.00 , $346.06 , $85.00 , $342.84 , $273.28 , N/A , $264.64 , $264.64 , $95.00 , $306.33 , $50.25 , $355.54 
US Compl Joint R-T W/Image Documentation,CPT® 76881,N/A,N/A,N/A, $839.00 , $545.35 , $332.46 , $53.33 , $85.20 , $557.36 , $642.21 , $780.27 , $755.10 , $755.10 , $671.20 , $671.20 , $85.20 , $774.65 , $797.05 , $755.10 , $755.10 , $755.10 , $780.27 , $805.44 , $368.86 , $713.15 , $704.93 , $571.60 , N/A , $568.24 , $568.24 , $797.05 , $657.73 , $53.33 , $805.44 
Endovasc Taa Repr Incl Subcl,CPT® 33880,N/A,N/A,N/A," $13,173.00 "," $8,562.45 "," $10,369.06 "," $1,596.65 "," $2,378.00 "," $7,764.98 "," $7,716.99 "," $12,250.89 "," $11,855.70 "," $11,855.70 "," $10,538.40 "," $10,538.40 "," $2,378.00 "," $12,162.63 "," $12,514.35 "," $11,855.70 "," $11,855.70 "," $11,855.70 "," $12,250.89 "," $12,646.08 "," $9,603.40 "," $11,197.05 "," $9,744.56 "," $8,618.80 ", N/A ," $7,916.49 "," $7,916.49 "," $12,514.35 "," $8,993.13 "," $1,596.65 "," $12,646.08 "
 Fac Paring/Cutting B9 Hyprkeratotic Les 2-4 < ,CPT® 11056,0761 - TREATMENT ROOM,N/A,N/A, $134.00 , $87.10 , $112.56 , $21.33 , $36.84 , $108.27 , $120.60 , $113.44 , $120.60 , $120.60 , $120.60 , $113.90 , $36.12 , $123.72 , $127.30 , $113.90 , $124.62 , $124.62 , $127.30 , $128.64 , $109.64 , $120.60 , $113.90 , $105.86 , N/A , $108.45 , $108.45 , $127.30 , $114.99 , $21.33 , $128.64 
 Ot Neuromuscular Re-ED 15 Min ,CPT® 97112,0420 - PHYSICAL THERAPY,N/A,N/A, $146.00 , $94.90 , $122.64 , $33.81 , $31.48 , $117.97 , $131.40 , $123.60 , $131.40 , $131.40 , $131.40 , $124.10 , $30.86 , $134.80 , $138.70 , $124.10 , $135.78 , $135.78 , $138.70 , $140.16 , $119.46 , $131.40 , $124.10 , $115.34 , N/A , $118.16 , $118.16 , $138.70 , $125.28 , $30.86 , $140.16 
Amputation Finger/Thumb,26951,N/A,N/A,N/A," $2,889.00 "," $1,877.85 "," $4,394.59 ", $685.79 , $230.52 ," $3,103.57 "," $3,158.66 "," $2,686.77 "," $2,600.10 "," $2,600.10 "," $2,311.20 "," $2,311.20 ", $230.52 ," $2,667.41 "," $2,744.55 "," $2,600.10 "," $2,600.10 "," $2,600.10 "," $2,686.77 "," $2,773.44 "," $4,014.84 "," $2,455.65 "," $3,461.08 "," $3,699.99 ", N/A ," $3,164.13 "," $3,164.13 "," $2,744.55 "," $3,718.97 ", $230.52 ," $4,394.59 "
Assay Serotonin,CPT® 84260,N/A,N/A,N/A, $279.00 , $181.35 , N/A , $31.60 , $31.60 , $175.28 , $209.63 , $259.47 , $251.10 , $251.10 , $223.20 , $223.20 , $31.60 , $257.60 , $265.05 , $251.10 , $251.10 , $251.10 , $259.47 , $267.84 , $206.86 , $237.15 , $202.73 , $112.34 , N/A , $163.58 , $163.58 , $265.05 , $178.76 , $31.60 , $267.84 
 Fac Hfo W/Joint(S) Cf ,HCPCS L3921,0274 - PROSTHETIC DEV,N/A,N/A, $357.00 , $232.05 , $299.88 , $341.97 , $236.85 , $288.46 , $321.30 , $302.24 , $321.30 , $321.30 , $321.30 , $303.45 , $232.21 , $329.62 , $339.15 , $303.45 , $332.01 , $332.01 , $339.15 , $342.72 , $292.10 , $321.30 , $303.45 , $282.03 , N/A , $288.92 , $288.92 , $339.15 , $306.34 , $232.21 , $342.72 
 Fac Iaad Ia Cryptococcus Neoformans ,CPT® 87327,0306 - LAB/BACT-MICRO,N/A,N/A, $103.00 , $66.95 , $86.52 , $13.69 , $13.69 , $83.22 , $92.70 , $87.20 , $92.70 , $92.70 , $92.70 , $87.55 , $13.42 , $95.10 , $97.85 , $87.55 , $95.79 , $95.79 , $97.85 , $98.88 , $84.27 , $92.70 , $87.55 , $81.37 , N/A , $83.36 , $83.36 , $97.85 , $88.38 , $13.42 , $98.88 
" Pro US Exam, Pelvic, Limited ",CPT® 76857,0972 - PRO FEE/RAD/DX,N/A,N/A, $173.00 , $112.45 , $270.40 , $48.14 , $62.84 , $225.99 , $504.45 , $160.89 , $155.70 , $155.70 , $138.40 , $138.40 , $62.84 , $159.73 , $164.35 , $155.70 , $155.70 , $155.70 , $160.89 , $166.08 , $265.60 , $147.05 , $550.85 , $272.09 , N/A , $230.40 , $230.40 , $164.35 , $266.71 , $48.14 , $550.85 
 Fac Trauma 3 Eval W/ Pre-ED Notification W/Critical Care ,HCPCS G0390,0683 - TRAUMA LEVEL III,N/A,N/A," $1,225.00 ", $796.25 ," $1,029.00 ", N/A , N/A , $989.80 ," $1,102.50 "," $1,037.09 "," $1,102.50 "," $1,102.50 "," $1,102.50 "," $1,041.25 ", N/A ," $1,131.04 "," $1,163.75 "," $1,041.25 "," $1,139.25 "," $1,139.25 "," $1,163.75 "," $1,176.00 "," $1,002.30 "," $1,102.50 "," $1,041.25 ", $967.75 , N/A , $991.39 , $991.39 ," $1,163.75 "," $1,051.17 ", $967.75 ," $1,176.00 "
"Fx Closed, Humeral",24530,N/A,N/A,N/A," $2,510.00 "," $1,631.50 "," $2,179.65 ", $345.51 , $245.89 ," $1,654.51 "," $1,676.86 "," $2,334.30 "," $2,259.00 "," $2,259.00 "," $2,008.00 "," $2,008.00 ", $245.89 ," $2,317.48 "," $2,384.50 "," $2,259.00 "," $2,259.00 "," $2,259.00 "," $2,334.30 "," $2,409.60 "," $2,006.52 "," $2,133.50 "," $1,841.15 "," $1,967.73 ", N/A ," $1,686.79 "," $1,686.79 "," $2,384.50 "," $1,982.57 ", $245.89 ," $2,409.60 "
 DRONABINOL 2.5 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,42858-0867-06,1 capsule, $8.53 , $5.54 , $7.17 , N/A , N/A , $6.89 , $7.68 , $7.22 , $7.68 , $7.68 , $7.68 , $7.25 , N/A , $7.88 , $8.10 , $7.25 , $7.93 , $7.93 , $8.10 , $8.19 , $6.98 , $7.68 , $7.25 , $6.74 , N/A , $6.90 , $6.90 , $8.10 , $7.32 , $6.74 , $8.19 
" Fac Office/Outpt Visit, New Levl I ",CPT® 99201,0510 - CLINIC,N/A,N/A, $166.00 , $107.90 , $139.44 , N/A , N/A , $134.13 , $149.40 , N/A , $149.40 , $149.40 , $149.40 , $141.10 , N/A , $153.27 , $157.70 , $141.10 , $154.38 , $154.38 , $157.70 , $159.36 , $135.82 , $149.40 , $141.10 , $131.14 , N/A , $134.34 , $134.34 , $157.70 , $142.44 , $131.14 , $159.36 
 RIVAROXABAN 15 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,50458-0578-10,1 tablet, $111.46 , $72.45 , $93.63 , N/A , N/A , $90.06 , $100.31 , $94.36 , $100.31 , $100.31 , $100.31 , $94.74 , N/A , $102.91 , $105.89 , $94.74 , $103.66 , $103.66 , $105.89 , $107.00 , $91.20 , $100.31 , $94.74 , $88.05 , N/A , $90.20 , $90.20 , $105.89 , $95.64 , $88.05 , $107.00 
Complex Repair 2.6-7.5cm,13121,N/A,N/A,N/A," $1,861.00 "," $1,209.65 ", $826.64 , $247.45 , $218.65 , $731.79 , $713.39 ," $1,730.73 "," $1,674.90 "," $1,674.90 "," $1,488.80 "," $1,488.80 ", $218.65 ," $1,718.26 "," $1,767.95 "," $1,674.90 "," $1,674.90 "," $1,674.90 "," $1,730.73 "," $1,786.56 ", $912.10 ," $1,581.85 "," $1,421.90 ", $938.47 , N/A , $746.06 , $746.06 ," $1,767.95 ", $865.20 , $218.65 ," $1,786.56 "
 Fac Automated Leukocyte Count ,CPT® 85048,0305 - LAB/HEMATOLOGY,N/A,N/A, $51.00 , $33.15 , $42.84 , $2.59 , $2.59 , $41.21 , $45.90 , $43.18 , $45.90 , $45.90 , $45.90 , $43.35 , $2.54 , $47.09 , $48.45 , $43.35 , $47.43 , $47.43 , $48.45 , $48.96 , $41.73 , $45.90 , $43.35 , $40.29 , N/A , $41.27 , $41.27 , $48.45 , $43.76 , $2.54 , $48.96 
"Inc/Drain Retropharyng Abscess,Oral",CPT® 42720,N/A,N/A,N/A," $3,014.00 "," $1,959.10 "," $2,372.83 ", $370.93 , $153.67 ," $1,886.99 "," $1,927.38 "," $2,803.02 "," $2,712.60 "," $2,712.60 "," $2,411.20 "," $2,411.20 ", $153.67 ," $2,782.83 "," $2,863.30 "," $2,712.60 "," $2,712.60 "," $2,712.60 "," $2,803.02 "," $2,893.44 "," $1,692.88 "," $2,561.90 "," $2,105.20 "," $2,220.89 ", N/A ," $1,923.81 "," $1,923.81 "," $2,863.30 "," $2,012.12 ", $153.67 ," $2,893.44 "
Dilation Nasolacrimal Duct,CPT® 68801,N/A,N/A,N/A, $398.00 , $258.70 , $484.45 , $77.05 , $44.63 , $607.38 , $577.04 , $370.14 , $358.20 , $358.20 , $318.40 , $318.40 , $44.63 , $367.47 , $378.10 , $358.20 , $358.20 , $358.20 , $370.14 , $382.08 , $663.69 , $338.30 , $594.09 , $566.45 , N/A , $619.24 , $619.24 , $378.10 , $683.56 , $44.63 , $683.56 
 Sc Puncture Asp Cyst ,CPT® 19000,0761 - TREATMENT ROOM,N/A,N/A, $490.00 , $318.50 , $411.60 , $40.41 , $37.38 , $395.92 , $441.00 , $414.83 , $441.00 , $441.00 , $441.00 , $416.50 , $36.65 , $452.42 , $465.50 , $416.50 , $455.70 , $455.70 , $465.50 , $470.40 , $400.92 , $441.00 , $416.50 , $387.10 , N/A , $396.56 , $396.56 , $465.50 , $420.47 , $36.65 , $470.40 
"Hypospad Repair,1 Stage,Distal",CPT® 54322,N/A,N/A,N/A," $4,282.00 "," $2,783.30 "," $3,459.95 ", $744.33 , $791.36 ," $2,508.11 "," $2,526.89 "," $3,982.26 "," $3,853.80 "," $3,853.80 "," $3,425.60 "," $3,425.60 ", $791.36 ," $3,953.57 "," $4,067.90 "," $3,853.80 "," $3,853.80 "," $3,853.80 "," $3,982.26 "," $4,110.72 "," $3,250.91 "," $3,639.70 "," $4,024.85 "," $3,781.82 ", N/A ," $2,557.05 "," $2,557.05 "," $4,067.90 "," $3,064.78 ", $744.33 ," $4,110.72 "
IV Dop Vel&/or Press C/Flo Rsrv Meas 1st Vsl,CPT® 93571,N/A,N/A,N/A," $5,898.00 "," $3,833.70 "," $1,623.64 ", $253.68 , $269.51 ," $1,485.28 "," $1,377.86 "," $5,485.14 "," $5,308.20 "," $5,308.20 "," $4,718.40 "," $4,718.40 ", $269.51 ," $5,445.62 "," $5,603.10 "," $5,308.20 "," $5,308.20 "," $5,308.20 "," $5,485.14 "," $5,662.08 "," $1,597.90 "," $5,013.30 "," $1,309.50 "," $1,634.01 ", N/A ," $1,514.26 "," $1,514.26 "," $5,603.10 "," $1,678.58 ", $253.68 ," $5,662.08 "
 ARIPIPRAZOLE ER 300 MG IM SRER ,HCPCS J0401,0636 - DRUGS REQUIRING DETAILED CODIN,59148-0018-71,1.5 mL," $5,996.53 "," $3,897.74 "," $5,037.09 ", $6.85 , $6.55 ," $4,845.20 "," $5,396.88 "," $5,076.66 "," $5,396.88 "," $5,396.88 "," $5,396.88 "," $5,097.05 ", $6.42 ," $5,536.60 "," $5,696.70 "," $5,097.05 "," $5,576.77 "," $5,576.77 "," $5,696.70 "," $5,756.67 "," $4,906.36 "," $5,396.88 "," $5,097.05 "," $4,737.26 ", N/A ," $4,852.99 "," $4,852.99 "," $5,696.70 "," $5,145.62 ", $6.42 ," $5,756.67 "
"Bx/Excis Spin Tum,Indur,Xmed,Thor",CPT® 63281,N/A,N/A,N/A," $13,680.00 "," $8,892.00 "," $9,569.82 "," $1,869.88 "," $2,378.00 "," $11,286.57 "," $10,790.78 "," $12,722.40 "," $12,312.00 "," $12,312.00 "," $10,944.00 "," $10,944.00 "," $2,378.00 "," $12,630.74 "," $12,996.00 "," $12,312.00 "," $12,312.00 "," $12,312.00 "," $12,722.40 "," $13,132.80 "," $10,341.77 "," $11,628.00 "," $11,095.09 "," $11,681.18 ", N/A ," $11,506.79 "," $11,506.79 "," $12,996.00 "," $12,344.07 "," $1,869.88 "," $13,132.80 "
"Rotovirus Vaccine, Human Attenuated, 2 Dose, Oral",CPT® 90681,N/A,N/A,N/A, $228.00 , $148.20 , N/A , N/A , $15.30 , $166.82 , $173.93 , $212.04 , $205.20 , $205.20 , $182.40 , $182.40 , $15.30 , $210.51 , $216.60 , $205.20 , $205.20 , $205.20 , $212.04 , $218.88 , N/A , $193.80 , $231.13 , $214.94 , N/A , $170.08 , $170.08 , $216.60 , $198.27 , $15.30 , $231.13 
 Fac Perq Vertebroplasty Uni/Bi Injection Lumbosacral ,CPT® 22511,0361 - OR/MINOR,N/A,N/A," $11,758.00 "," $7,642.70 "," $9,876.72 ", $385.27 ," $1,356.60 "," $9,500.46 "," $10,582.20 "," $9,954.32 "," $10,582.20 "," $10,582.20 "," $10,582.20 "," $9,994.30 "," $1,330.00 "," $10,856.16 "," $11,170.10 "," $9,994.30 "," $10,934.94 "," $10,934.94 "," $11,170.10 "," $11,287.68 "," $9,620.40 "," $10,582.20 "," $9,994.30 "," $9,288.82 ", N/A ," $9,515.75 "," $9,515.75 "," $11,170.10 "," $10,089.54 ", $385.27 ," $11,287.68 "
"Removal Spleen, Total",CPT® 38100,N/A,N/A,N/A," $8,439.00 "," $5,485.35 "," $5,259.00 "," $1,059.40 ", $922.06 ," $4,001.67 "," $4,089.43 "," $7,848.27 "," $7,595.10 "," $7,595.10 "," $6,751.20 "," $6,751.20 ", $922.06 ," $7,791.73 "," $8,017.05 "," $7,595.10 "," $7,595.10 "," $7,595.10 "," $7,848.27 "," $8,101.44 "," $5,633.34 "," $7,173.15 "," $6,067.60 "," $5,521.93 ", N/A ," $4,079.74 "," $4,079.74 "," $8,017.05 "," $4,733.05 ", $922.06 ," $8,101.44 "
 Fac Assay of Urine Sodium ,CPT® 84300,0301 - LAB/CHEMISTRY,N/A,N/A, $71.00 , $46.15 , $59.64 , $5.16 , $5.16 , $57.37 , $63.90 , $60.11 , $63.90 , $63.90 , $63.90 , $60.35 , $5.06 , $65.55 , $67.45 , $60.35 , $66.03 , $66.03 , $67.45 , $68.16 , $58.09 , $63.90 , $60.35 , $56.09 , N/A , $57.46 , $57.46 , $67.45 , $60.93 , $5.06 , $68.16 
" Fac Eeg, Coma or Sleep Only ",CPT® 95822,0740 - EEG,N/A,N/A," $1,586.00 "," $1,030.90 "," $1,332.24 ", $408.27 , $161.34 ," $1,281.49 "," $1,427.40 "," $1,342.71 "," $1,427.40 "," $1,427.40 "," $1,427.40 "," $1,348.10 ", $158.18 ," $1,464.35 "," $1,506.70 "," $1,348.10 "," $1,474.98 "," $1,474.98 "," $1,506.70 "," $1,522.56 "," $1,297.67 "," $1,427.40 "," $1,348.10 "," $1,252.94 ", N/A ," $1,283.55 "," $1,283.55 "," $1,506.70 "," $1,360.95 ", $158.18 ," $1,522.56 "
 Fac Anes Complicated Airway Care Tech ,Custom 1000699,0370 - ANESTHESIA,N/A,N/A," $1,164.00 ", $756.60 , $977.76 , N/A , N/A , $940.51 ," $1,047.60 ", $985.44 ," $1,047.60 "," $1,047.60 "," $1,047.60 ", $989.40 , N/A ," $1,074.72 "," $1,105.80 ", $989.40 ," $1,082.52 "," $1,082.52 "," $1,105.80 "," $1,117.44 ", $952.38 ," $1,047.60 ", $989.40 , $919.56 , N/A , $942.03 , $942.03 ," $1,105.80 ", $998.83 , $919.56 ," $1,117.44 "
 EPINEPHRINE HCL (NASAL) 0.1 % NA SOLN ,HCPCS RXA250,0250 - PHARMACY,42023-0103-01,30 mL," $1,544.61 "," $1,004.00 "," $1,297.47 ", N/A , N/A ," $1,248.04 "," $1,390.15 "," $1,307.67 "," $1,390.15 "," $1,390.15 "," $1,390.15 "," $1,312.92 ", N/A ," $1,426.14 "," $1,467.38 "," $1,312.92 "," $1,436.49 "," $1,436.49 "," $1,467.38 "," $1,482.83 "," $1,263.80 "," $1,390.15 "," $1,312.92 "," $1,220.24 ", N/A ," $1,250.05 "," $1,250.05 "," $1,467.38 "," $1,325.43 "," $1,220.24 "," $1,482.83 "
Insert Gastrostomy Tube Percutaneous,CPT® 49440,N/A,N/A,N/A," $7,350.00 "," $4,777.50 "," $1,244.75 ", $193.16 , $852.22 ," $1,084.85 "," $1,091.47 "," $6,835.50 "," $6,615.00 "," $6,615.00 "," $5,880.00 "," $5,880.00 ", $852.22 ," $6,786.26 "," $6,982.50 "," $6,615.00 "," $6,615.00 "," $6,615.00 "," $6,835.50 "," $7,056.00 ", $898.40 ," $6,247.50 "," $1,182.83 "," $1,204.66 ", N/A ," $1,106.02 "," $1,106.02 "," $6,982.50 "," $1,156.78 ", $193.16 ," $7,056.00 "
 Pro Hospital IP/Obs Care Same Date High Mdm 85 Min ,CPT® 99236,0987 - PRO FEE/HOS VIS,N/A,N/A, $675.00 , $438.75 , $422.12 , $203.44 , $233.79 , $376.83 , $376.09 , $627.75 , $607.50 , $607.50 , $540.00 , $540.00 , $233.79 , $623.23 , $641.25 , $607.50 , $607.50 , $607.50 , $627.75 , $648.00 , $635.81 , $573.75 , $468.07 , $478.40 , $285.00 , $384.18 , $384.18 , $641.25 , $443.09 , $203.44 , $648.00 
 DOCETAXEL 20 MG/ML IV CONC ,HCPCS J9171,0636 - DRUGS REQUIRING DETAILED CODIN,16729-0267-63,1 mL, $502.09 , $326.36 , $421.76 , $0.96 , $0.59 , $405.69 , $451.88 , $425.07 , $451.88 , $451.88 , $451.88 , $426.78 , $0.58 , $463.58 , $476.99 , $426.78 , $466.94 , $466.94 , $476.99 , $482.01 , $410.81 , $451.88 , $426.78 , $396.65 , N/A , $406.34 , $406.34 , $476.99 , $430.84 , $0.58 , $482.01 
 HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML INJECTION (INPT) ,HCPCS 90744,0636 - DRUGS REQUIRING DETAILED CODIN,58160-0820-52,0.5 mL, $167.88 , $109.12 , $141.02 , $30.50 , $40.00 , $135.65 , $151.09 , $142.13 , $151.09 , $151.09 , $151.09 , $142.70 , $39.22 , $155.00 , $159.49 , $142.70 , $156.13 , $156.13 , $159.49 , $161.16 , $137.36 , $151.09 , $142.70 , $132.63 , N/A , $135.87 , $135.87 , $159.49 , $144.06 , $30.50 , $161.16 
 Dislocation Finger /W Manip W/O Anes - Mh ,CPT® 26770,0761 - TREATMENT ROOM,N/A,N/A," $1,888.00 "," $1,227.20 "," $1,585.92 ", $257.24 , $74.85 ," $1,525.50 "," $1,699.20 "," $1,598.38 "," $1,699.20 "," $1,699.20 "," $1,699.20 "," $1,604.80 ", $73.38 ," $1,743.19 "," $1,793.60 "," $1,604.80 "," $1,755.84 "," $1,755.84 "," $1,793.60 "," $1,812.48 "," $1,544.76 "," $1,699.20 "," $1,604.80 "," $1,491.52 ", N/A ," $1,527.96 "," $1,527.96 "," $1,793.60 "," $1,620.09 ", $73.38 ," $1,812.48 "
"Cystoscopy,Steroid Inj,Stricture",CPT® 52283,N/A,N/A,N/A," $2,024.00 "," $1,315.60 "," $1,078.70 ", $189.85 , $169.04 , $988.38 , $917.60 ," $1,882.32 "," $1,821.60 "," $1,821.60 "," $1,619.20 "," $1,619.20 ", $169.04 ," $1,868.76 "," $1,922.80 "," $1,821.60 "," $1,821.60 "," $1,821.60 "," $1,882.32 "," $1,943.04 "," $1,087.37 "," $1,720.40 "," $1,040.11 "," $1,240.96 ", N/A ," $1,007.67 "," $1,007.67 "," $1,922.80 "," $1,184.37 ", $169.04 ," $1,943.04 "
" Fac Phenotype, Infect Agent Drug ",CPT® 87900,0306 - LAB/BACT-MICRO,N/A,N/A," $1,203.00 ", $781.95 ," $1,010.52 ", $132.96 , $132.96 , $972.02 ," $1,082.70 "," $1,018.46 "," $1,082.70 "," $1,082.70 "," $1,082.70 "," $1,022.55 ", $130.35 ," $1,110.73 "," $1,142.85 "," $1,022.55 "," $1,118.79 "," $1,118.79 "," $1,142.85 "," $1,154.88 ", $984.29 ," $1,082.70 "," $1,022.55 ", $950.37 , N/A , $973.59 , $973.59 ," $1,142.85 "," $1,032.29 ", $130.35 ," $1,154.88 "
Curette/Treat Cornea,CPT® 65435,N/A,N/A,N/A, $741.00 , $481.65 , $424.19 , $66.71 , $60.28 , $393.25 , $371.43 , $689.13 , $666.90 , $666.90 , $592.80 , $592.80 , $60.28 , $684.17 , $703.95 , $666.90 , $666.90 , $666.90 , $689.13 , $711.36 , $581.81 , $629.85 , $385.36 , $502.95 , N/A , $400.93 , $400.93 , $703.95 , $442.58 , $60.28 , $711.36 
Alginate Drsg >16 <=48 Sq In,HCPCS A6197,N/A,N/A,N/A, $37.00 , $24.05 , N/A , $22.31 , $15.88 , N/A , N/A , $34.41 , $33.30 , $33.30 , $29.60 , $29.60 , $15.88 , $34.16 , $35.15 , $33.30 , $33.30 , $33.30 , $34.41 , $35.52 , N/A , $31.45 , $19.46 , $20.26 , N/A , N/A , N/A , $35.15 , N/A , $15.88 , $35.52 
 Fac Protein E-Phoresis/Urine/CSF ,CPT® 84166,0301 - LAB/CHEMISTRY,N/A,N/A, $166.00 , $107.90 , $139.44 , $18.19 , $18.19 , $134.13 , $149.40 , $140.54 , $149.40 , $149.40 , $149.40 , $141.10 , $17.83 , $153.27 , $157.70 , $141.10 , $154.38 , $154.38 , $157.70 , $159.36 , $135.82 , $149.40 , $141.10 , $131.14 , N/A , $134.34 , $134.34 , $157.70 , $142.44 , $17.83 , $159.36 
"Removal of Epididymis,Unilat",CPT® 54860,N/A,N/A,N/A," $2,324.00 "," $1,510.60 "," $1,861.86 ", $401.82 , $461.04 ," $1,343.92 "," $1,361.23 "," $2,161.32 "," $2,091.60 "," $2,091.60 "," $1,859.20 "," $1,859.20 ", $461.04 ," $2,145.75 "," $2,207.80 "," $2,091.60 "," $2,091.60 "," $2,091.60 "," $2,161.32 "," $2,231.04 "," $1,748.17 "," $1,975.40 "," $2,169.42 "," $2,032.39 ", N/A ," $1,370.14 "," $1,370.14 "," $2,207.80 "," $1,642.17 ", $401.82 ," $2,231.04 "
 MIDODRINE HCL 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6818-61,1 tablet, $5.34 , $3.47 , $4.49 , N/A , N/A , $4.31 , $4.81 , $4.52 , $4.81 , $4.81 , $4.81 , $4.54 , N/A , $4.93 , $5.07 , $4.54 , $4.97 , $4.97 , $5.07 , $5.13 , $4.37 , $4.81 , $4.54 , $4.22 , N/A , $4.32 , $4.32 , $5.07 , $4.58 , $4.22 , $5.13 
 Fac Microslide Consultation ,CPT® 88323,0310 - PATHOLOGY LAB,N/A,N/A, $564.00 , $366.60 , $473.76 , $113.71 , $112.79 , $455.71 , $507.60 , $477.48 , $507.60 , $507.60 , $507.60 , $479.40 , $110.58 , $520.74 , $535.80 , $479.40 , $524.52 , $524.52 , $535.80 , $541.44 , $461.46 , $507.60 , $479.40 , $445.56 , N/A , $456.45 , $456.45 , $535.80 , $483.97 , $110.58 , $541.44 
 Orbit/Face/Neck MRI W/O & W/Contrast ,CPT® 70543,0610 - MRI,N/A,N/A," $9,470.00 "," $6,155.50 "," $7,954.80 ", $349.15 , $633.95 ," $7,651.76 "," $8,523.00 "," $8,017.30 "," $8,523.00 "," $8,523.00 "," $8,523.00 "," $8,049.50 ", $621.52 ," $8,743.65 "," $8,996.50 "," $8,049.50 "," $8,807.10 "," $8,807.10 "," $8,996.50 "," $9,091.20 "," $7,748.35 "," $8,523.00 "," $8,049.50 "," $7,481.30 ", N/A ," $7,664.07 "," $7,664.07 "," $8,996.50 "," $8,126.21 ", $349.15 ," $9,091.20 "
Explore & Treat Metacarpo-Phal Jt,CPT® 26075,N/A,N/A,N/A," $2,140.00 "," $1,391.00 "," $2,082.93 ", $329.48 , $230.52 ," $1,607.86 "," $1,584.12 "," $1,990.20 "," $1,926.00 "," $1,926.00 "," $1,712.00 "," $1,712.00 ", $230.52 ," $1,975.86 "," $2,033.00 "," $1,926.00 "," $1,926.00 "," $1,926.00 "," $1,990.20 "," $2,054.40 "," $1,929.93 "," $1,819.00 "," $1,737.68 "," $1,904.81 ", N/A ," $1,639.24 "," $1,639.24 "," $2,033.00 "," $1,926.67 ", $230.52 ," $2,082.93 "
Control Nasal Hemorrhage,30901,N/A,N/A,N/A, $526.00 , $341.90 , $301.30 , $53.21 , $34.36 , $216.79 , $209.25 , $489.18 , $473.40 , $473.40 , $420.80 , $420.80 , $34.36 , $485.66 , $499.70 , $473.40 , $473.40 , $473.40 , $489.18 , $504.96 , $289.39 , $447.10 , $296.15 , $286.56 , N/A , $221.02 , $221.02 , $499.70 , $260.29 , $34.36 , $504.96 
Removal of Larynx Lesion,CPT® 31300,N/A,N/A,N/A," $6,829.00 "," $4,438.85 "," $6,894.14 "," $1,214.88 ", $922.06 ," $4,819.48 "," $4,798.42 "," $6,350.97 "," $6,146.10 "," $6,146.10 "," $5,463.20 "," $5,463.20 ", $922.06 ," $6,305.22 "," $6,487.55 "," $6,146.10 "," $6,146.10 "," $6,146.10 "," $6,350.97 "," $6,555.84 "," $6,682.37 "," $5,804.65 "," $6,747.33 "," $6,584.98 ", N/A ," $4,913.51 "," $4,913.51 "," $6,487.55 "," $5,786.71 ", $922.06 ," $6,894.14 "
 Pro Sigmoidoscopy Flx W/Rmvl Tumor by Hot Bx Forceps ,CPT® 45333,0982 - PRO FEE/OUTPT,N/A,N/A," $2,388.00 "," $1,552.20 ", $570.96 , $88.25 , $108.73 , $522.44 , $537.65 ," $2,220.84 "," $2,149.20 "," $2,149.20 "," $1,910.40 "," $1,910.40 ", $108.73 ," $2,204.84 "," $2,268.60 "," $2,149.20 "," $2,149.20 "," $2,149.20 "," $2,220.84 "," $2,292.48 ", $409.84 ," $2,029.80 ", $590.53 , $541.98 , N/A , $532.63 , $532.63 ," $2,268.60 ", $557.08 , $88.25 ," $2,292.48 "
 Fac Q Fever Antibody ,CPT® 86638,0302 - LAB/IMMUNOLOGY,N/A,N/A, $90.00 , $58.50 , $75.60 , $12.36 , $8.07 , $72.72 , $81.00 , $76.19 , $81.00 , $81.00 , $81.00 , $76.50 , $7.91 , $83.10 , $85.50 , $76.50 , $83.70 , $83.70 , $85.50 , $86.40 , $73.64 , $81.00 , $76.50 , $71.10 , N/A , $72.84 , $72.84 , $85.50 , $77.23 , $7.91 , $86.40 
Fluor Gid Ctr Vad Plmt Rplcmt/Rmvl,CPT® 77001,N/A,N/A,N/A," $1,054.00 ", $685.10 , $580.29 , $98.73 , $67.21 , $334.35 , $627.13 , $980.22 , $948.60 , $948.60 , $843.20 , $843.20 , $67.21 , $973.16 ," $1,001.30 ", $948.60 , $948.60 , $948.60 , $980.22 ," $1,011.84 ", $564.90 , $895.90 , $685.67 , $424.63 , N/A , $340.88 , $340.88 ," $1,001.30 ", $394.59 , $67.21 ," $1,011.84 "
Drug Assay Lacosamide,CPT® 80235,N/A,N/A,N/A, $276.00 , $179.40 , N/A , $27.65 , $22.12 , $115.33 , N/A , $256.68 , $248.40 , $248.40 , $220.80 , $220.80 , $22.12 , $254.83 , $262.20 , $248.40 , $248.40 , $248.40 , $256.68 , $264.96 , $181.02 , $234.60 , $129.23 , $79.62 , N/A , $107.63 , $107.63 , $262.20 , $117.39 , $22.12 , $264.96 
 Foot Ap Lateral - Mh ,CPT® 73620,0972 - PRO FEE/RAD/DX,N/A,N/A, $99.00 , $64.35 , $158.11 , $27.74 , $25.48 , $121.74 , $146.85 , $92.07 , $89.10 , $89.10 , $79.20 , $79.20 , $25.48 , $91.41 , $94.05 , $89.10 , $89.10 , $89.10 , $92.07 , $95.04 , $155.58 , $84.15 , $161.79 , $131.49 , N/A , $124.12 , $124.12 , $94.05 , $143.67 , $25.48 , $161.79 
Adrenalin Epinephrine Inject,HCPCS J0171,N/A,N/A,N/A, $40.00 , $26.00 , N/A , $0.74 , $0.75 , N/A , N/A , $37.20 , $36.00 , $36.00 , $32.00 , $32.00 , $0.75 , $36.93 , $38.00 , $36.00 , $36.00 , $36.00 , $37.20 , $38.40 , $1.04 , $34.00 , $0.65 , $0.95 , N/A , N/A , N/A , $38.00 , N/A , $0.65 , $38.40 
CT Scan of Abdomen Combo,CPT® 74170,N/A,N/A,N/A," $4,612.00 "," $2,997.80 "," $1,658.44 ", $240.15 , $398.54 ," $1,249.53 "," $1,636.68 "," $4,289.16 "," $4,150.80 "," $4,150.80 "," $3,689.60 "," $3,689.60 ", $398.54 ," $4,258.26 "," $4,381.40 "," $4,150.80 "," $4,150.80 "," $4,150.80 "," $4,289.16 "," $4,427.52 "," $1,574.88 "," $3,920.20 "," $1,843.22 "," $1,703.97 ", N/A ," $1,273.91 "," $1,273.91 "," $4,381.40 "," $1,474.57 ", $240.15 ," $4,427.52 "
 Fac Aersl Inhlj Pentamidine F/PCP Tx/Proph ,CPT® 94642,0410 - RESPIRATORY SVC,N/A,N/A, $186.00 , $120.90 , $156.24 , $17.53 , $124.77 , $150.29 , $167.40 , $157.47 , $167.40 , $167.40 , $167.40 , $158.10 , $122.32 , $171.73 , $176.70 , $158.10 , $172.98 , $172.98 , $176.70 , $178.56 , $152.19 , $167.40 , $158.10 , $146.94 , N/A , $150.53 , $150.53 , $176.70 , $159.61 , $17.53 , $178.56 
DXA Bone Density Study 1+ Sits Appendicular Skel,CPT® 77081,N/A,N/A,N/A, $613.00 , $398.45 , $173.71 , $30.77 , $28.10 , $134.07 , $147.30 , $570.09 , $551.70 , $551.70 , $490.40 , $490.40 , $28.10 , $565.98 , $582.35 , $551.70 , $551.70 , $551.70 , $570.09 , $588.48 , $173.00 , $521.05 , $161.79 , $210.82 , N/A , $136.69 , $136.69 , $582.35 , $158.22 , $28.10 , $588.48 
 SITAGLIPTIN PHOSPHATE 100 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00006-0277-31,1 tablet, $112.44 , $73.09 , $94.45 , N/A , N/A , $90.85 , $101.20 , $95.19 , $101.20 , $101.20 , $101.20 , $95.57 , N/A , $103.82 , $106.82 , $95.57 , $104.57 , $104.57 , $106.82 , $107.94 , $92.00 , $101.20 , $95.57 , $88.83 , N/A , $91.00 , $91.00 , $106.82 , $96.48 , $88.83 , $107.94 
 Pro Egd Removal Tumor Polyp/Other Lesion Snare Tech ,CPT® 43251,0982 - PRO FEE/OUTPT,N/A,N/A," $2,620.00 "," $1,703.00 "," $1,201.33 ", $185.58 , $203.13 , $998.36 ," $1,059.33 "," $2,436.60 "," $2,358.00 "," $2,358.00 "," $2,096.00 "," $2,096.00 ", $203.13 ," $2,419.05 "," $2,489.00 "," $2,358.00 "," $2,358.00 "," $2,358.00 "," $2,436.60 "," $2,515.20 ", $862.97 ," $2,227.00 "," $1,161.43 "," $1,145.55 ", N/A ," $1,017.84 "," $1,017.84 "," $2,489.00 "," $1,064.54 ", $185.58 ," $2,515.20 "
Nasal/Sinus Ndsc Surg W/Dilation Frnt&Sphn Sinus,CPT® 31298,N/A,N/A,N/A," $21,046.00 "," $13,679.90 "," $1,377.36 ", $243.71 ," $3,079.85 ", $915.95 , $928.06 ," $19,572.78 "," $18,941.40 "," $18,941.40 "," $16,836.80 "," $16,836.80 "," $3,079.85 "," $19,431.77 "," $19,993.70 "," $18,941.40 "," $18,941.40 "," $18,941.40 "," $19,572.78 "," $20,204.16 "," $1,319.54 "," $17,889.10 "," $1,354.03 "," $1,302.48 ", N/A , $933.82 , $933.82 ," $19,993.70 "," $1,099.77 ", $243.71 ," $20,204.16 "
 Pro Apply Finger Splint ,CPT® 29130,0982 - PRO FEE/OUTPT,N/A,N/A, $268.00 , $174.20 , $175.70 , $27.56 , $10.31 , $137.91 , $137.01 , $249.24 , $241.20 , $241.20 , $214.40 , $214.40 , $10.31 , $247.44 , $254.60 , $241.20 , $241.20 , $241.20 , $249.24 , $257.28 , $162.22 , $227.80 , $149.86 , $165.82 , N/A , $140.61 , $140.61 , $254.60 , $165.26 , $10.31 , $257.28 
 Fac Egd US Guided Transmural Injxn/Fiducial Marker ,CPT® 43253,0360 - OR SERVICES,N/A,N/A," $3,356.00 "," $2,181.40 "," $2,819.04 ", $248.93 , $204.37 ," $2,711.65 "," $3,020.40 "," $2,841.19 "," $3,020.40 "," $3,020.40 "," $3,020.40 "," $2,852.60 ", $200.36 ," $3,098.59 "," $3,188.20 "," $2,852.60 "," $3,121.08 "," $3,121.08 "," $3,188.20 "," $3,221.76 "," $2,745.88 "," $3,020.40 "," $2,852.60 "," $2,651.24 ", N/A ," $2,716.01 "," $2,716.01 "," $3,188.20 "," $2,879.78 ", $200.36 ," $3,221.76 "
 NICOTINE POLACRILEX 2 MG MT GUM ,HCPCS RXC637,0250 - PHARMACY,00536-3029-23,12 each, $17.39 , $11.30 , $14.61 , N/A , N/A , $14.05 , $15.65 , $14.72 , $15.65 , $15.65 , $15.65 , $14.78 , N/A , $16.06 , $16.52 , $14.78 , $16.17 , $16.17 , $16.52 , $16.69 , $14.23 , $15.65 , $14.78 , $13.74 , N/A , $14.07 , $14.07 , $16.52 , $14.92 , $13.74 , $16.69 
 Pro Rp Loclzj Tum Spect CT 2area/Sep Acquisj Img ,CPT® 78832,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,626.00 "," $1,056.90 "," $4,919.73 ", $831.35 , $739.48 ," $4,379.54 ", N/A ," $1,512.18 "," $1,463.40 "," $1,463.40 "," $1,300.80 "," $1,300.80 ", $739.48 ," $1,501.29 "," $1,544.70 "," $1,463.40 "," $1,463.40 "," $1,463.40 "," $1,512.18 "," $1,560.96 "," $5,121.34 "," $1,382.10 "," $4,861.11 "," $6,081.99 ", N/A ," $4,464.99 "," $4,464.99 "," $1,544.70 "," $5,174.48 ", $739.48 ," $6,081.99 "
 METHYLPREDNISOLONE ACETATE 80 MG/ML IJ SUSP ,HCPCS J1040,0636 - DRUGS REQUIRING DETAILED CODIN,00009-3475-03,1 mL, $121.59 , $79.03 , $102.14 , $12.15 , $13.01 , $98.24 , $109.43 , $102.94 , $109.43 , $109.43 , $109.43 , $103.35 , $12.75 , $112.26 , $115.51 , $103.35 , $113.08 , $113.08 , $115.51 , $116.73 , $99.48 , $109.43 , $103.35 , $96.06 , N/A , $98.40 , $98.40 , $115.51 , $104.34 , $12.15 , $116.73 
 Fac Cov-19 Amp Prb Hgh Thruput ,HCPCS U0003,0306 - LAB/BACT-MICRO,N/A,N/A, $221.00 , $143.65 , $185.64 , $76.50 , $76.50 , $178.57 , $198.90 , $187.10 , $198.90 , $198.90 , $198.90 , $187.85 , $75.00 , $204.05 , $209.95 , $187.85 , $205.53 , $205.53 , $209.95 , $212.16 , $180.82 , $198.90 , $187.85 , $174.59 , N/A , $178.86 , $178.86 , $209.95 , $189.64 , $75.00 , $212.16 
Developmental Tst Admin Phys/Qhp Ea Addl 30 Min,CPT® 96113,N/A,N/A,N/A, $255.00 , $165.75 , $130.92 , $55.19 , $69.49 , $121.35 , N/A , $237.15 , $229.50 , $229.50 , $204.00 , $204.00 , $69.49 , $235.44 , $242.25 , $229.50 , $229.50 , $229.50 , $237.15 , $244.80 , $234.55 , $216.75 , $167.61 , $220.87 , N/A , $123.72 , $123.72 , $242.25 , $144.23 , $55.19 , $244.80 
 Fac Peri-Px Dev Eval Pm/Ldls Pm Phys/Qhp in Person ,CPT® 93286,0480 - CARDIOLOGY,N/A,N/A, $306.00 , $198.90 , $257.04 , $45.39 , $25.87 , $247.25 , $275.40 , $259.06 , $275.40 , $275.40 , $275.40 , $260.10 , $25.36 , $282.53 , $290.70 , $260.10 , $284.58 , $284.58 , $290.70 , $293.76 , $250.37 , $275.40 , $260.10 , $241.74 , N/A , $247.65 , $247.65 , $290.70 , $262.58 , $25.36 , $293.76 
 Fac Washed Red Blood Cells Unit ,HCPCS P9022,0390 - BLOOD/STOR-PROC,N/A,N/A, $670.00 , $435.50 , $562.80 , N/A , N/A , $541.36 , $603.00 , $567.22 , $603.00 , $603.00 , $603.00 , $569.50 , N/A , $618.61 , $636.50 , $569.50 , $623.10 , $623.10 , $636.50 , $643.20 , $548.19 , $603.00 , $569.50 , $529.30 , N/A , $542.23 , $542.23 , $636.50 , $574.93 , $529.30 , $643.20 
 Pro Arthrocnts Aspir&/Njx Sm Jt/Bursa ,CPT® 20600,0982 - PRO FEE/OUTPT,N/A,N/A, $360.00 , $234.00 , $218.01 , $33.86 , $39.50 , $174.29 , $169.45 , $334.80 , $324.00 , $324.00 , $288.00 , $288.00 , $39.50 , $332.39 , $342.00 , $324.00 , $324.00 , $324.00 , $334.80 , $345.60 , $203.80 , $306.00 , $183.76 , $206.34 , N/A , $177.69 , $177.69 , $342.00 , $208.86 , $33.86 , $345.60 
 ROTAVIRUS VAC LIVE PENTAVALENT PO SOLN ,HCPCS RXA250,0250 - PHARMACY,00006-4047-41,2 mL, $590.77 , $384.00 , $496.25 , N/A , N/A , $477.34 , $531.69 , $500.15 , $531.69 , $531.69 , $531.69 , $502.15 , N/A , $545.46 , $561.23 , $502.15 , $549.42 , $549.42 , $561.23 , $567.14 , $483.37 , $531.69 , $502.15 , $466.71 , N/A , $478.11 , $478.11 , $561.23 , $506.94 , $466.71 , $567.14 
Layer Closure 2.5cm or Le,12031,N/A,N/A,N/A, $981.00 , $637.65 , $484.53 , $146.05 , $60.48 , $418.18 , $412.35 , $912.33 , $882.90 , $882.90 , $784.80 , $784.80 , $60.48 , $905.76 , $931.95 , $882.90 , $882.90 , $882.90 , $912.33 , $941.76 , $531.98 , $833.85 , $820.67 , $538.15 , N/A , $426.34 , $426.34 , $931.95 , $494.42 , $60.48 , $941.76 
 Fac Imcytchm Tiss Immunoproxidase Ea Antb ,CPT® 88342,0310 - PATHOLOGY LAB,N/A,N/A, $430.00 , $279.50 , $361.20 , $98.62 , $54.62 , $347.44 , $387.00 , $364.04 , $387.00 , $387.00 , $387.00 , $365.50 , $53.55 , $397.02 , $408.50 , $365.50 , $399.90 , $399.90 , $408.50 , $412.80 , $351.83 , $387.00 , $365.50 , $339.70 , N/A , $348.00 , $348.00 , $408.50 , $368.98 , $53.55 , $412.80 
Polysomnography W/Cpap,95811,N/A,N/A,N/A," $6,369.00 "," $4,139.85 "," $2,325.90 ", $622.13 ," $1,159.73 "," $2,077.89 "," $2,300.90 "," $5,923.17 "," $5,732.10 "," $5,732.10 "," $5,095.20 "," $5,095.20 "," $1,159.73 "," $5,880.50 "," $6,050.55 "," $5,732.10 "," $5,732.10 "," $5,732.10 "," $5,923.17 "," $6,114.24 "," $2,763.52 "," $5,413.65 "," $2,018.31 "," $2,480.88 ", N/A ," $2,118.44 "," $2,118.44 "," $6,050.55 "," $2,604.38 ", $622.13 ," $6,114.24 "
Open Rx Dist Tib/Fib Jt Disrupt,CPT® 27829,N/A,N/A,N/A," $3,591.00 "," $2,334.15 "," $4,358.71 ", $680.77 , $390.51 ," $3,306.79 "," $3,316.74 "," $3,339.63 "," $3,231.90 "," $3,231.90 "," $2,872.80 "," $2,872.80 ", $390.51 ," $3,315.57 "," $3,411.45 "," $3,231.90 "," $3,231.90 "," $3,231.90 "," $3,339.63 "," $3,447.36 "," $4,042.74 "," $3,052.35 "," $3,655.55 "," $3,972.04 ", N/A ," $3,371.32 "," $3,371.32 "," $3,411.45 "," $3,962.48 ", $390.51 ," $4,358.71 "
 Fac Spec Stains Histochem Staining Frozen Sctj ,CPT® 88314,0312 - PATHOL/HISTOL,N/A,N/A, $280.00 , $182.00 , $235.20 , $89.00 , $39.85 , $226.24 , $252.00 , $237.05 , $252.00 , $252.00 , $252.00 , $238.00 , $39.07 , $258.52 , $266.00 , $238.00 , $260.40 , $260.40 , $266.00 , $268.80 , $229.10 , $252.00 , $238.00 , $221.20 , N/A , $226.60 , $226.60 , $266.00 , $240.27 , $39.07 , $268.80 
 Fac Ndsc Eval Intstinal Pouch Dx W/Collj Spec Spx ,CPT® 44385,0360 - OR SERVICES,N/A,N/A," $1,071.00 ", $696.15 , $899.64 , $69.04 , $200.83 , $865.37 , $963.90 , $906.71 , $963.90 , $963.90 , $963.90 , $910.35 , $196.89 , $988.85 ," $1,017.45 ", $910.35 , $996.03 , $996.03 ," $1,017.45 "," $1,028.16 ", $876.29 , $963.90 , $910.35 , $846.09 , N/A , $866.76 , $866.76 ," $1,017.45 ", $919.03 , $69.04 ," $1,028.16 "
" Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC ",MS DRG V40 (FY2023) 896,N/A,N/A,N/A," $27,404.97 "," $17,813.23 "," $23,020.17 ", N/A , N/A ," $22,143.22 "," $24,664.47 "," $23,201.05 "," $24,664.47 "," $24,664.47 "," $24,664.47 "," $23,294.22 ", N/A ," $25,303.01 "," $26,034.72 "," $23,294.22 "," $25,486.62 "," $25,486.62 "," $26,034.72 "," $26,308.77 "," $22,422.75 "," $24,664.47 "," $23,294.22 "," $21,649.93 ", N/A ," $22,178.84 "," $22,178.84 "," $26,034.72 "," $23,516.20 "," $21,649.93 "," $26,308.77 "
Online Digital E/M Svc Est Pt <7 D 21+ Minutes,CPT® 99423,N/A,N/A,N/A, $131.00 , $85.15 , $82.93 , $39.14 , $38.33 , $72.11 , N/A , $121.83 , $117.90 , $117.90 , $104.80 , $104.80 , $38.33 , $120.95 , $124.45 , $117.90 , $117.90 , $117.90 , $121.83 , $125.76 , $74.68 , $111.35 , $88.91 , $92.45 , N/A , $73.52 , $73.52 , $124.45 , $84.40 , $38.33 , $125.76 
 Pro Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 2/3 Vw ,CPT® 72082,0972 - PRO FEE/RAD/DX,N/A,N/A, $192.00 , $124.80 , $478.87 , $69.17 , $48.93 , $296.57 , $312.80 , $178.56 , $172.80 , $172.80 , $153.60 , $153.60 , $48.93 , $177.27 , $182.40 , $172.80 , $172.80 , $172.80 , $178.56 , $184.32 , $385.25 , $163.20 , $404.77 , $314.23 , N/A , $302.36 , $302.36 , $182.40 , $349.97 , $48.93 , $478.87 
"Chemother,Cns,W/Lumbar Puncture",CPT® 96450,N/A,N/A,N/A, $872.00 , $566.80 , $256.94 , $74.10 , $201.46 , $231.12 , $177.45 , $810.96 , $784.80 , $784.80 , $697.60 , $697.60 , $201.46 , $805.12 , $828.40 , $784.80 , $784.80 , $784.80 , $810.96 , $837.12 , $235.33 , $741.20 , $233.15 , $313.82 , N/A , $235.63 , $235.63 , $828.40 , $278.37 , $74.10 , $837.12 
Cytopathology Cerv/Vag,CPT® 88141,N/A,N/A,N/A, $192.00 , $124.80 , $79.51 , $22.56 , $22.43 , $128.25 , $144.51 , $178.56 , $172.80 , $172.80 , $153.60 , $153.60 , $22.43 , $177.27 , $182.40 , $172.80 , $172.80 , $172.80 , $178.56 , $184.32 , $140.29 , $163.20 , $150.83 , $112.96 , N/A , $119.69 , $119.69 , $182.40 , $131.53 , $22.43 , $184.32 
Open Rx Uni Tib Plat Fx,CPT® 27535,N/A,N/A,N/A," $4,983.00 "," $3,238.95 "," $5,422.43 ", $846.80 , $708.49 ," $4,329.13 "," $4,286.16 "," $4,634.19 "," $4,484.70 "," $4,484.70 "," $3,986.40 "," $3,986.40 ", $708.49 ," $4,600.80 "," $4,733.85 "," $4,484.70 "," $4,484.70 "," $4,484.70 "," $4,634.19 "," $4,783.68 "," $5,055.76 "," $4,235.55 "," $4,743.83 "," $5,087.91 ", N/A ," $4,413.60 "," $4,413.60 "," $4,733.85 "," $5,187.56 ", $708.49 ," $5,422.43 "
"Destr, Benign Lesions, 15 or More",17111,N/A,N/A,N/A, $708.00 , $460.20 , $193.25 , $79.93 , $55.78 , $233.67 , $232.11 , $658.44 , $637.20 , $637.20 , $566.40 , $566.40 , $55.78 , $653.70 , $672.60 , $637.20 , $637.20 , $637.20 , $658.44 , $679.68 , $287.04 , $601.80 , $458.50 , $302.36 , N/A , $238.23 , $238.23 , $672.60 , $276.29 , $55.78 , $679.68 
 Fac Splt Agrft T/a/L 1st 100 Cm/</1% Bdy Inft/Chld ,CPT® 15100,0360 - OR SERVICES,N/A,N/A," $4,611.00 "," $2,997.15 "," $3,873.24 ", $677.39 , $522.35 ," $3,725.69 "," $4,149.90 "," $3,903.67 "," $4,149.90 "," $4,149.90 "," $4,149.90 "," $3,919.35 ", $512.11 ," $4,257.34 "," $4,380.45 "," $3,919.35 "," $4,288.23 "," $4,288.23 "," $4,380.45 "," $4,426.56 "," $3,772.72 "," $4,149.90 "," $3,919.35 "," $3,642.69 ", N/A ," $3,731.68 "," $3,731.68 "," $4,380.45 "," $3,956.70 ", $512.11 ," $4,426.56 "
 Fac Right Heart Cath O2 Saturation & Cardiac Output ,CPT® 93451,0481 - CARDIAC CATH LAB,N/A,N/A," $6,353.00 "," $4,129.45 "," $5,336.52 ", $847.69 , $840.89 ," $5,133.22 "," $5,717.70 "," $5,378.45 "," $5,717.70 "," $5,717.70 "," $5,717.70 "," $5,400.05 ", $824.40 ," $5,865.72 "," $6,035.35 "," $5,400.05 "," $5,908.29 "," $5,908.29 "," $6,035.35 "," $6,098.88 "," $5,198.02 "," $5,717.70 "," $5,400.05 "," $5,018.87 ", N/A ," $5,141.48 "," $5,141.48 "," $6,035.35 "," $5,451.51 ", $824.40 ," $6,098.88 "
 Septal Reductn Tx; Perc Transcath ,CPT® 93583,0480 - CARDIOLOGY,N/A,N/A," $17,150.00 "," $11,147.50 "," $14,406.00 ", $666.10 , $554.96 ," $13,857.20 "," $15,435.00 "," $14,519.19 "," $15,435.00 "," $15,435.00 "," $15,435.00 "," $14,577.50 ", $544.08 ," $15,834.60 "," $16,292.50 "," $14,577.50 "," $15,949.50 "," $15,949.50 "," $16,292.50 "," $16,464.00 "," $14,032.13 "," $15,435.00 "," $14,577.50 "," $13,548.50 ", N/A ," $13,879.50 "," $13,879.50 "," $16,292.50 "," $14,716.42 ", $544.08 ," $16,464.00 "
 Fac Iadna Babesia Microti Amplified Probe Technique ,CPT® 87469,0306 - LAB/BACT-MICRO,N/A,N/A, $53.00 , $34.45 , $44.52 , $35.79 , $35.79 , $42.82 , $47.70 , $44.87 , $47.70 , $47.70 , $47.70 , $45.05 , $35.09 , $48.93 , $50.35 , $45.05 , $49.29 , $49.29 , $50.35 , $50.88 , $43.36 , $47.70 , $45.05 , $41.87 , N/A , $42.89 , $42.89 , $50.35 , $45.48 , $35.09 , $50.88 
"Resect Small Intest,Each Addnl",CPT® 44121,N/A,N/A,N/A," $1,570.00 "," $1,020.50 "," $1,418.37 ", $219.16 , $452.24 ," $1,139.42 "," $1,136.03 "," $1,460.10 "," $1,413.00 "," $1,413.00 "," $1,256.00 "," $1,256.00 ", $452.24 ," $1,449.58 "," $1,491.50 "," $1,413.00 "," $1,413.00 "," $1,413.00 "," $1,460.10 "," $1,507.20 "," $1,022.13 "," $1,334.50 "," $1,264.90 "," $1,339.81 ", N/A ," $1,161.65 "," $1,161.65 "," $1,491.50 "," $1,214.98 ", $219.16 ," $1,507.20 "
Hba1/Hba2 Gene Analysis Dup/Del Variants,CPT® 81269,N/A,N/A,N/A," $1,166.00 ", $757.90 , N/A , $206.45 , $165.16 , $841.47 , N/A ," $1,084.38 "," $1,049.40 "," $1,049.40 ", $932.80 , $932.80 , $165.16 ," $1,076.57 "," $1,107.70 "," $1,049.40 "," $1,049.40 "," $1,049.40 "," $1,084.38 "," $1,119.36 "," $1,351.47 ", $991.10 , $964.38 , $594.45 , N/A , $785.31 , $785.31 ," $1,107.70 ", $858.18 , $165.16 ," $1,351.47 "
" Fac Protein, Western Blot Test ",CPT® 84182,0301 - LAB/CHEMISTRY,N/A,N/A, $322.00 , $209.30 , $270.48 , $29.79 , $24.98 , $260.18 , $289.80 , $272.61 , $289.80 , $289.80 , $289.80 , $273.70 , $24.49 , $297.30 , $305.90 , $273.70 , $299.46 , $299.46 , $305.90 , $309.12 , $263.46 , $289.80 , $273.70 , $254.38 , N/A , $260.59 , $260.59 , $305.90 , $276.31 , $24.49 , $309.12 
" Fac Platelets, Hla-M, L/R, Unit ",HCPCS P9052,0390 - BLOOD/STOR-PROC,N/A,N/A," $1,589.00 "," $1,032.85 "," $1,334.76 ", N/A , N/A ," $1,283.91 "," $1,430.10 "," $1,345.25 "," $1,430.10 "," $1,430.10 "," $1,430.10 "," $1,350.65 ", N/A ," $1,467.12 "," $1,509.55 "," $1,350.65 "," $1,477.77 "," $1,477.77 "," $1,509.55 "," $1,525.44 "," $1,300.12 "," $1,430.10 "," $1,350.65 "," $1,255.31 ", N/A ," $1,285.98 "," $1,285.98 "," $1,509.55 "," $1,363.52 "," $1,255.31 "," $1,525.44 "
 RITUXIMAB-PVVR 100 MG/10ML IV SOLN ,HCPCS Q5119,0636 - DRUGS REQUIRING DETAILED CODIN,00069-0238-01,10 mL," $2,107.62 "," $1,369.95 "," $1,770.40 ", $28.06 , $33.33 ," $1,702.96 "," $1,896.86 "," $1,784.31 "," $1,896.86 "," $1,896.86 "," $1,896.86 "," $1,791.48 ", $32.68 ," $1,945.97 "," $2,002.24 "," $1,791.48 "," $1,960.09 "," $1,960.09 "," $2,002.24 "," $2,023.32 "," $1,724.45 "," $1,896.86 "," $1,791.48 "," $1,665.02 ", N/A ," $1,705.70 "," $1,705.70 "," $2,002.24 "," $1,808.55 ", $28.06 ," $2,023.32 "
Biopsy Palate/Uvula,CPT® 42100,N/A,N/A,N/A," $1,030.00 ", $669.50 , $676.00 , $106.75 , $70.99 , $533.17 , $547.45 , $957.90 , $927.00 , $927.00 , $824.00 , $824.00 , $70.99 , $951.00 , $978.50 , $927.00 , $927.00 , $927.00 , $957.90 , $988.80 , $477.45 , $875.50 , $597.66 , $627.46 , N/A , $543.58 , $543.58 , $978.50 , $568.53 , $70.99 , $988.80 
 MIDAZOLAM HCL 5 MG/ML INJECTION (INPT) ,HCPCS J2250,0636 - DRUGS REQUIRING DETAILED CODIN,00409-2308-49,0.6 mL, $16.68 , $10.84 , $14.01 , $0.14 , $0.17 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.17 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.14 , $16.01 
"Immunoassay, Tumor Antigen, Ca 15-3",CPT® 86300,N/A,N/A,N/A, $237.00 , $154.05 , N/A , $21.23 , $21.23 , $117.74 , $140.86 , $220.41 , $213.30 , $213.30 , $189.60 , $189.60 , $21.23 , $218.82 , $225.15 , $213.30 , $213.30 , $213.30 , $220.41 , $227.52 , $138.95 , $201.45 , $136.23 , $75.48 , N/A , $109.88 , $109.88 , $225.15 , $120.08 , $21.23 , $227.52 
Spherocylindr 4.00d/2.12-4d,HCPCS V2104,N/A,N/A,N/A, $55.00 , $35.75 , N/A , $47.01 , N/A , N/A , N/A , $51.15 , $49.50 , $49.50 , $44.00 , $44.00 , N/A , $50.78 , $52.25 , $49.50 , $49.50 , $49.50 , $51.15 , $52.80 , N/A , $46.75 , $55.00 , $42.71 , N/A , N/A , N/A , $52.25 , N/A , $42.71 , $55.00 
 Pro MRI Joint Upr Extr W/O&W/Dye ,CPT® 73223,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,118.00 ", $726.70 ," $2,824.22 ", $400.04 , $633.95 ," $2,231.93 "," $2,844.80 "," $1,039.74 "," $1,006.20 "," $1,006.20 ", $894.40 , $894.40 , $633.95 ," $1,032.25 "," $1,062.10 "," $1,006.20 "," $1,006.20 "," $1,006.20 "," $1,039.74 "," $1,073.28 "," $2,446.75 ", $950.30 ," $3,102.85 "," $4,345.63 ", N/A ," $2,275.48 "," $2,275.48 "," $1,062.10 "," $2,633.91 ", $400.04 ," $4,345.63 "
 Pre Hemodialysis Assesment ,CPT® 93985,0921 - PERI VASCUL LAB,N/A,N/A, $803.00 , $521.95 , $674.52 , $242.17 , $209.24 , $648.82 , $722.70 , $679.82 , $722.70 , $722.70 , $722.70 , $682.55 , $205.14 , $741.41 , $762.85 , $682.55 , $746.79 , $746.79 , $762.85 , $770.88 , $657.01 , $722.70 , $682.55 , $634.37 , N/A , $649.87 , $649.87 , $762.85 , $689.05 , $205.14 , $770.88 
Drug Tst Prsmv Read Instrmnt Asstd Dir Opt Obs,CPT® 80306,N/A,N/A,N/A, $150.00 , $97.50 , N/A , $17.48 , $17.48 , $112.12 , N/A , $139.50 , $135.00 , $135.00 , $120.00 , $120.00 , $17.48 , $138.50 , $142.50 , $135.00 , $135.00 , $135.00 , $139.50 , $144.00 , $114.45 , $127.50 , $82.38 , $52.75 , N/A , $104.64 , $104.64 , $142.50 , $114.35 , $17.48 , $144.00 
 Pro Remove Mesh From Abd Wall ,CPT® 11008,0975 - PRO FEE/OR,N/A,N/A," $1,717.00 "," $1,116.05 ", $839.60 , $247.58 , $258.21 , $741.30 , $709.97 ," $1,596.81 "," $1,545.30 "," $1,545.30 "," $1,373.60 "," $1,373.60 ", $258.21 ," $1,585.31 "," $1,631.15 "," $1,545.30 "," $1,545.30 "," $1,545.30 "," $1,596.81 "," $1,648.32 ", $922.00 ," $1,459.45 "," $1,439.74 ", $932.31 , N/A , $755.77 , $755.77 ," $1,631.15 ", $876.44 , $247.58 ," $1,648.32 "
 Fac External Radiation Dosimetry ,CPT® 77399,0333 - RADIATION RX,N/A,N/A," $1,038.00 ", $674.70 , $871.92 , N/A , N/A , $838.70 , $934.20 , $878.77 , $934.20 , $934.20 , $934.20 , $882.30 , N/A , $958.39 , $986.10 , $882.30 , $965.34 , $965.34 , $986.10 , $996.48 , $849.29 , $934.20 , $882.30 , $820.02 , N/A , $840.05 , $840.05 , $986.10 , $890.71 , $820.02 , $996.48 
 Pro Office/OP Consltj New/Est Pt Sf Mdm 20 Minutes ,CPT® 99242,0988 - PRO FEE/CONSULT,N/A,N/A, $326.00 , $211.90 , N/A , $74.22 , $63.23 , $151.92 , $151.47 , $303.18 , $293.40 , $293.40 , $260.80 , $260.80 , $63.23 , $301.00 , $309.70 , $293.40 , $293.40 , $293.40 , $303.18 , $312.96 , $190.00 , $277.10 , $149.27 , $150.03 , $116.50 , $154.89 , $154.89 , $309.70 , $184.40 , $63.23 , $312.96 
"Removal Anal Fistula,Subcutaneous",CPT® 46270,N/A,N/A,N/A," $3,284.00 "," $2,134.60 "," $2,461.03 ", $383.31 , $153.67 ," $1,857.21 "," $1,907.18 "," $3,054.12 "," $2,955.60 "," $2,955.60 "," $2,627.20 "," $2,627.20 ", $153.67 ," $3,032.12 "," $3,119.80 "," $2,955.60 "," $2,955.60 "," $2,955.60 "," $3,054.12 "," $3,152.64 "," $1,752.81 "," $2,791.40 "," $2,101.63 "," $2,214.04 ", N/A ," $1,893.46 "," $1,893.46 "," $3,119.80 "," $1,980.35 ", $153.67 ," $3,152.64 "
Njx Supravalv Aortog Hrt Cath W/S&I,CPT® 93567,N/A,N/A,N/A," $1,999.00 "," $1,299.35 ", $304.92 , $33.93 , $139.28 , $280.21 , $266.68 ," $1,859.07 "," $1,799.10 "," $1,799.10 "," $1,599.20 "," $1,599.20 ", $139.28 ," $1,845.68 "," $1,899.05 "," $1,799.10 "," $1,799.10 "," $1,799.10 "," $1,859.07 "," $1,919.04 ", $300.86 ," $1,699.15 ", $251.55 , $301.69 , N/A , $285.68 , $285.68 ," $1,899.05 ", $316.67 , $33.93 ," $1,919.04 "
 GADOXETATE DISODIUM 0.25 MOL/L IV SOLN ,HCPCS A9581,0255 - DRUGS/RADIOLOGY,50419-0320-05,10 mL, $875.07 , $568.80 , $735.06 , $15.02 , $13.77 , $707.06 , $787.56 , $740.83 , $787.56 , $787.56 , $787.56 , $743.81 , $13.50 , $807.95 , $831.32 , $743.81 , $813.82 , $813.82 , $831.32 , $840.07 , $715.98 , $787.56 , $743.81 , $691.31 , N/A , $708.19 , $708.19 , $831.32 , $750.90 , $13.50 , $840.07 
 Cellulitis Without McC ,MS DRG V40 (FY2023) 603,N/A,N/A,N/A," $15,986.04 "," $10,390.93 "," $13,428.27 ", N/A , N/A ," $12,916.72 "," $14,387.44 "," $13,533.78 "," $14,387.44 "," $14,387.44 "," $14,387.44 "," $13,588.13 ", N/A ," $14,759.91 "," $15,186.74 "," $13,588.13 "," $14,867.02 "," $14,867.02 "," $15,186.74 "," $15,346.60 "," $13,079.78 "," $14,387.44 "," $13,588.13 "," $12,628.97 ", N/A ," $12,937.50 "," $12,937.50 "," $15,186.74 "," $13,717.62 "," $12,628.97 "," $15,346.60 "
 Desflurane per 30 Minutes ,Custom 3700000006,0370 - ANESTHESIA,N/A,N/A, $123.00 , $79.95 , $103.32 , N/A , N/A , $99.38 , $110.70 , $104.13 , $110.70 , $110.70 , $110.70 , $104.55 , N/A , $113.57 , $116.85 , $104.55 , $114.39 , $114.39 , $116.85 , $118.08 , $100.64 , $110.70 , $104.55 , $97.17 , N/A , $99.54 , $99.54 , $116.85 , $105.55 , $97.17 , $118.08 
" Pro Medicare Annual Wellness Visit, Initial ",HCPCS G0438,0982 - PRO FEE/OUTPT,N/A,N/A, $276.00 , $179.40 , $402.88 , $161.76 , N/A , $315.97 , $372.56 , $256.68 , $248.40 , $248.40 , $220.80 , $220.80 , N/A , $254.83 , $262.20 , $248.40 , $248.40 , $248.40 , $256.68 , $264.96 , $449.07 , $234.60 , $323.08 , $365.15 , N/A , $322.13 , $322.13 , $262.20 , $402.66 , $161.76 , $449.07 
 Pro Amp F/Arm Thru Rds&U Re-Amp ,CPT® 25909,0982 - PRO FEE/OUTPT,N/A,N/A," $5,760.00 "," $3,744.00 "," $4,176.38 ", $654.81 , $614.70 ," $3,297.63 "," $3,278.26 "," $5,356.80 "," $5,184.00 "," $5,184.00 "," $4,608.00 "," $4,608.00 ", $614.70 ," $5,318.21 "," $5,472.00 "," $5,184.00 "," $5,184.00 "," $5,184.00 "," $5,356.80 "," $5,529.60 "," $3,879.08 "," $4,896.00 "," $3,621.65 "," $3,883.74 ", N/A ," $3,361.98 "," $3,361.98 "," $5,472.00 "," $3,951.51 ", $614.70 ," $5,529.60 "
" Fac Whfo, Rigid W/O Joints ",HCPCS L3808,0274 - PROSTHETIC DEV,N/A,N/A, $590.00 , $383.50 , $495.60 , $379.23 , $171.87 , $476.72 , $531.00 , $499.49 , $531.00 , $531.00 , $531.00 , $501.50 , $168.50 , $544.75 , $560.50 , $501.50 , $548.70 , $548.70 , $560.50 , $566.40 , $482.74 , $531.00 , $501.50 , $466.10 , N/A , $477.49 , $477.49 , $560.50 , $506.28 , $168.50 , $566.40 
Endovasc Taa Repr W/O Subcl,CPT® 33881,N/A,N/A,N/A," $13,852.00 "," $9,003.80 "," $8,892.59 "," $1,368.98 "," $1,369.87 "," $6,669.93 "," $6,626.99 "," $12,882.36 "," $12,466.80 "," $12,466.80 "," $11,081.60 "," $11,081.60 "," $1,369.87 "," $12,789.55 "," $13,159.40 "," $12,466.80 "," $12,466.80 "," $12,466.80 "," $12,882.36 "," $13,297.92 "," $8,226.73 "," $11,774.20 "," $8,365.48 "," $7,403.93 ", N/A ," $6,800.07 "," $6,800.07 "," $13,159.40 "," $7,724.87 "," $1,368.98 "," $13,297.92 "
 Fac Assay of Magnesium ,CPT® 83735,0301 - LAB/CHEMISTRY,N/A,N/A, $80.00 , $52.00 , $67.20 , $6.83 , $6.83 , $64.64 , $72.00 , $67.73 , $72.00 , $72.00 , $72.00 , $68.00 , $6.70 , $73.86 , $76.00 , $68.00 , $74.40 , $74.40 , $76.00 , $76.80 , $65.46 , $72.00 , $68.00 , $63.20 , N/A , $64.74 , $64.74 , $76.00 , $68.65 , $6.70 , $76.80 
 LIDOCAINE HCL 4 % MT SOLN ,HCPCS RXA250,0250 - PHARMACY,76329-6300-05,4 mL, $169.40 , $110.11 , $142.30 , N/A , N/A , $136.88 , $152.46 , $143.41 , $152.46 , $152.46 , $152.46 , $143.99 , N/A , $156.41 , $160.93 , $143.99 , $157.54 , $157.54 , $160.93 , $162.62 , $138.60 , $152.46 , $143.99 , $133.83 , N/A , $137.10 , $137.10 , $160.93 , $145.36 , $133.83 , $162.62 
Revise/Replace Cranial Nerve Stim Electrode/Connect Pulse Gen,CPT® 64569,N/A,N/A,N/A," $4,995.00 "," $3,246.75 "," $3,593.51 ", $703.12 , $435.11 ," $4,265.70 "," $4,086.07 "," $4,645.35 "," $4,495.50 "," $4,495.50 "," $3,996.00 "," $3,996.00 ", $435.11 ," $4,611.88 "," $4,745.25 "," $4,495.50 "," $4,495.50 "," $4,495.50 "," $4,645.35 "," $4,795.20 "," $3,845.46 "," $4,245.75 "," $4,137.24 "," $4,368.56 ", N/A ," $4,348.93 "," $4,348.93 "," $4,745.25 "," $4,665.38 ", $435.11 ," $4,795.20 "
Excis Spermatocele,CPT® 54840,N/A,N/A,N/A," $1,765.00 "," $1,147.25 "," $1,433.97 ", $309.07 , $461.04 ," $1,029.99 "," $1,044.92 "," $1,641.45 "," $1,588.50 "," $1,588.50 "," $1,412.00 "," $1,412.00 ", $461.04 ," $1,629.62 "," $1,676.75 "," $1,588.50 "," $1,588.50 "," $1,588.50 "," $1,641.45 "," $1,694.40 "," $1,344.97 "," $1,500.25 "," $1,664.53 "," $1,558.14 ", N/A ," $1,050.09 "," $1,050.09 "," $1,676.75 "," $1,258.58 ", $309.07 ," $1,694.40 "
 NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,72485-0305-01,2 mL, $100.17 , $65.11 , $84.14 , N/A , N/A , $80.94 , $90.15 , $84.80 , $90.15 , $90.15 , $90.15 , $85.14 , N/A , $92.49 , $95.16 , $85.14 , $93.16 , $93.16 , $95.16 , $96.16 , $81.96 , $90.15 , $85.14 , $79.13 , N/A , $81.07 , $81.07 , $95.16 , $85.96 , $79.13 , $96.16 
Excis Supratent Brain Abscess,CPT® 61514,N/A,N/A,N/A," $12,250.00 "," $7,962.50 "," $8,727.47 "," $1,706.70 "," $1,921.01 "," $10,288.32 "," $9,822.64 "," $11,392.50 "," $11,025.00 "," $11,025.00 "," $9,800.00 "," $9,800.00 "," $1,921.01 "," $11,310.43 "," $11,637.50 "," $11,025.00 "," $11,025.00 "," $11,025.00 "," $11,392.50 "," $11,760.00 "," $9,420.26 "," $10,412.50 "," $10,101.37 "," $10,602.26 ", N/A ," $10,489.07 "," $10,489.07 "," $11,637.50 "," $11,252.27 "," $1,706.70 "," $11,760.00 "
 Fac Natriuretic Peptide ,CPT® 83880,0301 - LAB/CHEMISTRY,N/A,N/A, $302.00 , $196.30 , $253.68 , $40.05 , $40.05 , $244.02 , $271.80 , $255.67 , $271.80 , $271.80 , $271.80 , $256.70 , $39.26 , $278.84 , $286.90 , $256.70 , $280.86 , $280.86 , $286.90 , $289.92 , $247.10 , $271.80 , $256.70 , $238.58 , N/A , $244.41 , $244.41 , $286.90 , $259.15 , $39.26 , $289.92 
 Fac Tmvi W/Prosthetic Valve Percutaneous Approach ,CPT® 0483T,0360 - OR SERVICES,N/A,N/A," $18,003.00 "," $11,701.95 "," $15,122.52 "," $1,302.82 ", N/A ," $14,546.42 "," $16,202.70 "," $15,241.34 "," $16,202.70 "," $16,202.70 "," $16,202.70 "," $15,302.55 ", N/A ," $16,622.17 "," $17,102.85 "," $15,302.55 "," $16,742.79 "," $16,742.79 "," $17,102.85 "," $17,282.88 "," $14,730.05 "," $16,202.70 "," $15,302.55 "," $14,222.37 ", N/A ," $14,569.83 "," $14,569.83 "," $17,102.85 "," $15,448.37 "," $1,302.82 "," $17,282.88 "
 Pro Exc H-F-Nk-Sp B9+Marg 0.6-1 ,CPT® 11421,0981 - PRO FEE/ER,N/A,N/A, $596.00 , $387.40 , $351.80 , $105.96 , $93.30 , $301.07 , $297.24 , $554.28 , $536.40 , $536.40 , $476.80 , $476.80 , $93.30 , $550.29 , $566.20 , $536.40 , $536.40 , $536.40 , $554.28 , $572.16 , $385.15 , $506.60 , $590.53 , $385.78 , N/A , $306.95 , $306.95 , $566.20 , $355.95 , $93.30 , $590.53 
Triamcinolone Acetonide Inj,HCPCS J3301,N/A,N/A,N/A, $13.00 , $8.45 , N/A , $1.03 , $1.14 , N/A , N/A , $12.09 , $11.70 , $11.70 , $10.40 , $10.40 , $1.14 , $12.00 , $12.35 , $11.70 , $11.70 , $11.70 , $12.09 , $12.48 , $1.60 , $11.05 , $3.24 , $1.42 , N/A , N/A , N/A , $12.35 , N/A , $1.03 , $12.48 
 Fac Enterovirus Antibody ,CPT® 86658,0302 - LAB/IMMUNOLOGY,N/A,N/A, $116.00 , $75.40 , $97.44 , $13.29 , $8.07 , $93.73 , $104.40 , $98.21 , $104.40 , $104.40 , $104.40 , $98.60 , $7.91 , $107.10 , $110.20 , $98.60 , $107.88 , $107.88 , $110.20 , $111.36 , $94.91 , $104.40 , $98.60 , $91.64 , N/A , $93.88 , $93.88 , $110.20 , $99.54 , $7.91 , $111.36 
" Fac Immunoassay, Nonantibody ",CPT® 83516,0302 - LAB/IMMUNOLOGY,N/A,N/A, $136.00 , $88.40 , $114.24 , $11.76 , $11.76 , $109.89 , $122.40 , $115.14 , $122.40 , $122.40 , $122.40 , $115.60 , $11.53 , $125.57 , $129.20 , $115.60 , $126.48 , $126.48 , $129.20 , $130.56 , $111.28 , $122.40 , $115.60 , $107.44 , N/A , $110.06 , $110.06 , $129.20 , $116.70 , $11.53 , $130.56 
Closed Tx Nasal Bone Fx W/Mnpj W/Stabilization,CPT® 21320,N/A,N/A,N/A," $1,700.00 "," $1,105.00 ", $581.30 , $90.62 , $249.08 , $657.68 , $661.73 ," $1,581.00 "," $1,530.00 "," $1,530.00 "," $1,360.00 "," $1,360.00 ", $249.08 ," $1,569.61 "," $1,615.00 "," $1,530.00 "," $1,530.00 "," $1,530.00 "," $1,581.00 "," $1,632.00 ", $762.04 ," $1,445.00 ", $724.33 , $766.18 , N/A , $670.52 , $670.52 ," $1,615.00 ", $788.10 , $90.62 ," $1,632.00 "
 Fac Assay of Metanephrines ,CPT® 83835,0301 - LAB/CHEMISTRY,N/A,N/A, $238.00 , $154.70 , $199.92 , $17.28 , $17.28 , $192.30 , $214.20 , $201.49 , $214.20 , $214.20 , $214.20 , $202.30 , $16.94 , $219.75 , $226.10 , $202.30 , $221.34 , $221.34 , $226.10 , $228.48 , $194.73 , $214.20 , $202.30 , $188.02 , N/A , $192.61 , $192.61 , $226.10 , $204.23 , $16.94 , $228.48 
 Fac Delivery/Birthing Room Resuscitation ,CPT® 99465,0722 - DELIVERY ROOM,N/A,N/A, $758.00 , $492.70 , $636.72 , $138.15 , $95.27 , $612.46 , $682.20 , $641.72 , $682.20 , $682.20 , $682.20 , $644.30 , $93.40 , $699.86 , $720.10 , $644.30 , $704.94 , $704.94 , $720.10 , $727.68 , $620.20 , $682.20 , $644.30 , $598.82 , N/A , $613.45 , $613.45 , $720.10 , $650.44 , $93.40 , $727.68 
 Fac Byp W/Vein Fempop ,CPT® 35556,0360 - OR SERVICES,N/A,N/A," $5,842.00 "," $3,797.30 "," $4,907.28 "," $1,239.58 "," $1,340.24 "," $4,720.34 "," $5,257.80 "," $4,945.84 "," $5,257.80 "," $5,257.80 "," $5,257.80 "," $4,965.70 "," $1,313.96 "," $5,393.92 "," $5,549.90 "," $4,965.70 "," $5,433.06 "," $5,433.06 "," $5,549.90 "," $5,608.32 "," $4,779.92 "," $5,257.80 "," $4,965.70 "," $4,615.18 ", N/A ," $4,727.93 "," $4,727.93 "," $5,549.90 "," $5,013.02 "," $1,239.58 "," $5,608.32 "
 Perc Transluminal Coronary Lithotripsy ,CPT® 0715T,0360 - OR SERVICES,N/A,N/A," $10,400.00 "," $6,760.00 "," $8,736.00 ", N/A , N/A ," $8,403.20 "," $9,360.00 "," $8,804.64 "," $9,360.00 "," $9,360.00 "," $9,360.00 "," $8,840.00 ", N/A ," $9,602.32 "," $9,880.00 "," $8,840.00 "," $9,672.00 "," $9,672.00 "," $9,880.00 "," $9,984.00 "," $8,509.28 "," $9,360.00 "," $8,840.00 "," $8,216.00 ", N/A ," $8,416.72 "," $8,416.72 "," $9,880.00 "," $8,924.24 "," $8,216.00 "," $9,984.00 "
Echo R-T 2d W/Probe Placement Only,CPT® 93313,N/A,N/A,N/A," $1,051.00 ", $683.15 , $70.40 , $10.84 , $69.06 , $122.97 , $227.51 , $977.43 , $945.90 , $945.90 , $840.80 , $840.80 , $69.06 , $970.39 , $998.45 , $945.90 , $945.90 , $945.90 , $977.43 ," $1,008.96 ", $69.62 , $893.35 , $215.87 , $69.22 , N/A , $125.36 , $125.36 , $998.45 , $138.96 , $10.84 ," $1,008.96 "
"Part Remv Bladder,Reimplnt Ureter",CPT® 51565,N/A,N/A,N/A," $8,983.00 "," $5,838.95 "," $6,963.08 "," $1,223.11 "," $1,229.45 "," $6,351.06 "," $5,892.26 "," $8,354.19 "," $8,084.70 "," $8,084.70 "," $7,186.40 "," $7,186.40 "," $1,229.45 "," $8,294.00 "," $8,533.85 "," $8,084.70 "," $8,084.70 "," $8,084.70 "," $8,354.19 "," $8,623.68 "," $6,990.84 "," $7,635.55 "," $6,684.89 "," $7,932.95 ", N/A ," $6,474.98 "," $6,474.98 "," $8,533.85 "," $7,610.40 "," $1,223.11 "," $8,623.68 "
 BENZOCAINE 20 % MT GEL ,HCPCS RXC637,0250 - PHARMACY,60640-8800-01,1 each, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Replace Aortic Valve Open Axillry Artry Approach ,CPT® 33363,0360 - OR SERVICES,N/A,N/A," $30,395.00 "," $19,756.75 "," $25,531.80 "," $1,226.04 "," $1,148.29 "," $24,559.16 "," $27,355.50 "," $25,732.41 "," $27,355.50 "," $27,355.50 "," $27,355.50 "," $25,835.75 "," $1,125.77 "," $28,063.70 "," $28,875.25 "," $25,835.75 "," $28,267.35 "," $28,267.35 "," $28,875.25 "," $29,179.20 "," $24,869.19 "," $27,355.50 "," $25,835.75 "," $24,012.05 ", N/A ," $24,598.67 "," $24,598.67 "," $28,875.25 "," $26,081.95 "," $1,125.77 "," $29,179.20 "
" Fac Immunoassay, Ria ",CPT® 83520,0301 - LAB/CHEMISTRY,N/A,N/A, $227.00 , $147.55 , $190.68 , $17.62 , $17.62 , $183.42 , $204.30 , $192.18 , $204.30 , $204.30 , $204.30 , $192.95 , $17.27 , $209.59 , $215.65 , $192.95 , $211.11 , $211.11 , $215.65 , $217.92 , $185.73 , $204.30 , $192.95 , $179.33 , N/A , $183.71 , $183.71 , $215.65 , $194.79 , $17.27 , $217.92 
" Fac Alpha-Fetoprotein, Serum ",CPT® 82105,0301 - LAB/CHEMISTRY,N/A,N/A, $190.00 , $123.50 , $159.60 , $17.11 , $17.11 , $153.52 , $171.00 , $160.85 , $171.00 , $171.00 , $171.00 , $161.50 , $16.77 , $175.43 , $180.50 , $161.50 , $176.70 , $176.70 , $180.50 , $182.40 , $155.46 , $171.00 , $161.50 , $150.10 , N/A , $153.77 , $153.77 , $180.50 , $163.04 , $16.77 , $182.40 
 Fac Scalp Cooling Placment Mntr & Removal of Device ,CPT® 0663T,0280 - ONCOLOGY,N/A,N/A, $202.00 , $131.30 , $169.68 , N/A , N/A , $163.22 , $181.80 , $171.01 , $181.80 , $181.80 , $181.80 , $171.70 , N/A , $186.51 , $191.90 , $171.70 , $187.86 , $187.86 , $191.90 , $193.92 , $165.28 , $181.80 , $171.70 , $159.58 , N/A , $163.48 , $163.48 , $191.90 , $173.34 , $159.58 , $193.92 
"MRI W/Cont, Breast, Uni",HCPCS C8903,N/A,N/A,N/A, $36.00 , $23.40 , N/A , N/A , N/A , N/A , N/A , $33.48 , $32.40 , $32.40 , $28.80 , $28.80 , N/A , $33.24 , $34.20 , $32.40 , $32.40 , $32.40 , $33.48 , $34.56 , N/A , $30.60 , $28.80 , N/A , N/A , N/A , N/A , $34.20 , N/A , $28.80 , $34.56 
 Fac Needle Emg Ea Extremity W/Paraspinl Area Limited ,CPT® 95885,0922 - EMG,N/A,N/A, $198.00 , $128.70 , $166.32 , $61.13 , $43.69 , $159.98 , $178.20 , $167.63 , $178.20 , $178.20 , $178.20 , $168.30 , $42.83 , $182.81 , $188.10 , $168.30 , $184.14 , $184.14 , $188.10 , $190.08 , $162.00 , $178.20 , $168.30 , $156.42 , N/A , $160.24 , $160.24 , $188.10 , $169.90 , $42.83 , $190.08 
Endomyocardial Biopsy,CPT® 93505,N/A,N/A,N/A," $16,993.00 "," $11,045.45 "," $4,157.79 ", $624.92 , $471.35 ," $4,084.75 "," $4,332.52 "," $15,803.49 "," $15,293.70 "," $15,293.70 "," $13,594.40 "," $13,594.40 ", $471.35 ," $15,689.64 "," $16,143.35 "," $15,293.70 "," $15,293.70 "," $15,293.70 "," $15,803.49 "," $16,313.28 "," $4,016.37 "," $14,444.05 "," $4,108.70 "," $4,134.43 ", N/A ," $4,164.45 "," $4,164.45 "," $16,143.35 "," $4,616.33 ", $471.35 ," $16,313.28 "
 Pro Thoracentesis Needle/Cath Pleura W/O Imaging ,CPT® 32554,0975 - PRO FEE/OR,N/A,N/A," $3,519.00 "," $2,287.35 ", $486.39 , $84.12 , $196.83 , $347.08 , $337.80 ," $3,272.67 "," $3,167.10 "," $3,167.10 "," $2,815.20 "," $2,815.20 ", $196.83 ," $3,249.09 "," $3,343.05 "," $3,167.10 "," $3,167.10 "," $3,167.10 "," $3,272.67 "," $3,378.24 ", $471.39 ," $2,991.15 ", $470.99 , $466.30 , N/A , $353.86 , $353.86 ," $3,343.05 ", $416.75 , $84.12 ," $3,378.24 "
"Destruc Benign/Premal,First Lesion",CPT® 17000,N/A,N/A,N/A, $337.00 , $219.05 , $130.35 , $53.25 , $48.35 , $144.21 , $151.73 , $313.41 , $303.30 , $303.30 , $269.60 , $269.60 , $48.35 , $311.15 , $320.15 , $303.30 , $303.30 , $303.30 , $313.41 , $323.52 , $191.09 , $286.45 , $299.72 , $185.66 , N/A , $147.02 , $147.02 , $320.15 , $170.50 , $48.35 , $323.52 
 Fac Laps Surg Esopg/Gstr Fundoplasty ,CPT® 43280,0360 - OR SERVICES,N/A,N/A," $3,584.00 "," $2,329.60 "," $3,010.56 ", $989.92 , $935.01 ," $2,895.87 "," $3,225.60 "," $3,034.21 "," $3,225.60 "," $3,225.60 "," $3,225.60 "," $3,046.40 ", $916.68 ," $3,309.11 "," $3,404.80 "," $3,046.40 "," $3,333.12 "," $3,333.12 "," $3,404.80 "," $3,440.64 "," $2,932.43 "," $3,225.60 "," $3,046.40 "," $2,831.36 ", N/A ," $2,900.53 "," $2,900.53 "," $3,404.80 "," $3,075.43 ", $916.68 ," $3,440.64 "
 CT Angio Neck ,CPT® 70498,0350 - CT SCAN,N/A,N/A," $3,823.00 "," $2,484.95 "," $3,211.32 ", $256.30 , $377.53 ," $3,088.98 "," $3,440.70 "," $3,236.55 "," $3,440.70 "," $3,440.70 "," $3,440.70 "," $3,249.55 ", $370.13 ," $3,529.78 "," $3,631.85 "," $3,249.55 "," $3,555.39 "," $3,555.39 "," $3,631.85 "," $3,670.08 "," $3,127.98 "," $3,440.70 "," $3,249.55 "," $3,020.17 ", N/A ," $3,093.95 "," $3,093.95 "," $3,631.85 "," $3,280.52 ", $256.30 ," $3,670.08 "
"Renal Endoscopy,Treatment",CPT® 50557,N/A,N/A,N/A," $2,927.00 "," $1,902.55 "," $1,852.36 ", $325.38 , $169.04 ," $1,700.75 "," $1,573.15 "," $2,722.11 "," $2,634.30 "," $2,634.30 "," $2,341.60 "," $2,341.60 ", $169.04 ," $2,702.50 "," $2,780.65 "," $2,634.30 "," $2,634.30 "," $2,634.30 "," $2,722.11 "," $2,809.92 "," $1,863.93 "," $2,487.95 "," $1,782.28 "," $2,130.37 ", N/A ," $1,733.94 "," $1,733.94 "," $2,780.65 "," $2,037.98 ", $169.04 ," $2,809.92 "
Repair Non/Malunion Tarsal Bone(S),CPT® 28320,N/A,N/A,N/A," $4,135.00 "," $2,687.75 "," $3,744.26 ", $588.31 , $446.29 ," $2,967.18 "," $2,977.44 "," $3,845.55 "," $3,721.50 "," $3,721.50 "," $3,308.00 "," $3,308.00 ", $446.29 ," $3,817.85 "," $3,928.25 "," $3,721.50 "," $3,721.50 "," $3,721.50 "," $3,845.55 "," $3,969.60 "," $3,518.55 "," $3,514.75 "," $3,261.27 "," $3,521.47 ", N/A ," $3,025.08 "," $3,025.08 "," $3,928.25 "," $3,555.54 ", $446.29 ," $3,969.60 "
"Burn Dressing,Sm,W/O Anes",CPT® 16020,N/A,N/A,N/A, $364.00 , $236.60 , $173.81 , $52.76 , $30.25 , $148.68 , $145.73 , $338.52 , $327.60 , $327.60 , $291.20 , $291.20 , $30.25 , $336.08 , $345.80 , $327.60 , $327.60 , $327.60 , $338.52 , $349.44 , $191.27 , $309.40 , $289.02 , $192.11 , N/A , $151.58 , $151.58 , $345.80 , $175.80 , $30.25 , $349.44 
Egd Percutaneous Placement Gastrostomy Tube,CPT® 43246,N/A,N/A,N/A," $3,393.00 "," $2,205.45 "," $1,214.72 ", $187.69 , $744.68 ," $1,008.36 "," $1,217.72 "," $3,155.49 "," $3,053.70 "," $3,053.70 "," $2,714.40 "," $2,714.40 ", $744.68 ," $3,132.76 "," $3,223.35 "," $3,053.70 "," $3,053.70 "," $3,053.70 "," $3,155.49 "," $3,257.28 ", $873.20 ," $2,884.05 "," $1,338.05 "," $1,156.34 ", N/A ," $1,028.04 "," $1,028.04 "," $3,223.35 "," $1,075.22 ", $187.69 ," $3,257.28 "
 Fac Trauma 2 Activation W/ Pre-ED Notficiation- Level II- W/O Critical Care ,Custom 1000566,0682 - TRAUMA LEVEL II,N/A,N/A," $5,108.00 "," $3,320.20 "," $4,290.72 ", N/A , N/A ," $4,127.26 "," $4,597.20 "," $4,324.43 "," $4,597.20 "," $4,597.20 "," $4,597.20 "," $4,341.80 ", N/A ," $4,716.22 "," $4,852.60 "," $4,341.80 "," $4,750.44 "," $4,750.44 "," $4,852.60 "," $4,903.68 "," $4,179.37 "," $4,597.20 "," $4,341.80 "," $4,035.32 ", N/A ," $4,133.90 "," $4,133.90 "," $4,852.60 "," $4,383.17 "," $4,035.32 "," $4,903.68 "
Revis Vent Musc for Ihss,CPT® 33416,N/A,N/A,N/A," $26,357.00 "," $17,132.05 "," $11,809.01 "," $1,824.20 "," $2,378.00 "," $8,679.47 "," $8,625.05 "," $24,512.01 "," $23,721.30 "," $23,721.30 "," $21,085.60 "," $21,085.60 "," $2,378.00 "," $24,335.42 "," $25,039.15 "," $23,721.30 "," $23,721.30 "," $23,721.30 "," $24,512.01 "," $25,302.72 "," $10,933.65 "," $22,403.45 "," $10,922.04 "," $9,717.39 ", N/A ," $8,848.82 "," $8,848.82 "," $25,039.15 "," $10,052.26 "," $1,824.20 "," $25,302.72 "
 Fac Bcr/Abl1 Major Breakpnt Qualitative/Quantitative ,CPT® 81206,0310 - PATHOLOGY LAB,N/A,N/A," $1,514.00 ", $984.10 ," $1,271.76 ", $167.24 , $167.24 ," $1,223.31 "," $1,362.60 "," $1,281.75 "," $1,362.60 "," $1,362.60 "," $1,362.60 "," $1,286.90 ", $163.96 ," $1,397.88 "," $1,438.30 "," $1,286.90 "," $1,408.02 "," $1,408.02 "," $1,438.30 "," $1,453.44 "," $1,238.75 "," $1,362.60 "," $1,286.90 "," $1,196.06 ", N/A ," $1,225.28 "," $1,225.28 "," $1,438.30 "," $1,299.16 ", $163.96 ," $1,453.44 "
Closed Tx Distal Phalangeal Fx W/O Manip Ea -Mh,26755,N/A,N/A,N/A," $1,497.00 ", $973.05 ," $1,701.51 ", $269.64 , $63.53 ," $1,312.50 "," $1,334.43 "," $1,392.21 "," $1,347.30 "," $1,347.30 "," $1,197.60 "," $1,197.60 ", $63.53 ," $1,382.18 "," $1,422.15 "," $1,347.30 "," $1,347.30 "," $1,347.30 "," $1,392.21 "," $1,437.12 "," $1,574.04 "," $1,272.45 "," $1,464.72 "," $1,562.15 ", N/A ," $1,338.12 "," $1,338.12 "," $1,422.15 "," $1,572.76 ", $63.53 ," $1,701.51 "
 DOXYCYCLINE HYCLATE 50 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00143-3141-50,1 capsule, $11.58 , $7.53 , $9.73 , N/A , N/A , $9.36 , $10.42 , $9.80 , $10.42 , $10.42 , $10.42 , $9.84 , N/A , $10.69 , $11.00 , $9.84 , $10.77 , $10.77 , $11.00 , $11.12 , $9.47 , $10.42 , $9.84 , $9.15 , N/A , $9.37 , $9.37 , $11.00 , $9.94 , $9.15 , $11.12 
"Full Thick Excis Lip,Recon W Flap",CPT® 40525,N/A,N/A,N/A," $3,485.00 "," $2,265.25 "," $3,389.49 ", $530.41 , $493.08 ," $2,640.18 "," $2,718.97 "," $3,241.05 "," $3,136.50 "," $3,136.50 "," $2,788.00 "," $2,788.00 ", $493.08 ," $3,217.70 "," $3,310.75 "," $3,136.50 "," $3,136.50 "," $3,136.50 "," $3,241.05 "," $3,345.60 "," $2,424.95 "," $2,962.25 "," $2,984.74 "," $3,130.52 ", N/A ," $2,691.69 "," $2,691.69 "," $3,310.75 "," $2,815.22 ", $493.08 ," $3,389.49 "
 Pro Insert Temp Bladder Cath ,CPT® 51702,0982 - PRO FEE/OUTPT,N/A,N/A, $664.00 , $431.60 , $137.37 , $23.85 , $112.85 , $147.13 , $137.78 , $617.52 , $597.60 , $597.60 , $531.20 , $531.20 , $112.85 , $613.07 , $630.80 , $597.60 , $597.60 , $597.60 , $617.52 , $637.44 , $136.89 , $564.40 , $157.00 , $158.32 , N/A , $150.00 , $150.00 , $630.80 , $176.30 , $23.85 , $637.44 
 TRANEXAMIC ACID 1000 MG/10ML IV SOLN FOR NEBULIZATION ,HCPCS RXA250,0250 - PHARMACY,61990-0611-02,5 mL, $64.09 , $41.66 , $53.84 , N/A , N/A , $51.78 , $57.68 , $54.26 , $57.68 , $57.68 , $57.68 , $54.48 , N/A , $59.17 , $60.89 , $54.48 , $59.60 , $59.60 , $60.89 , $61.53 , $52.44 , $57.68 , $54.48 , $50.63 , N/A , $51.87 , $51.87 , $60.89 , $55.00 , $50.63 , $61.53 
"Cystourethroscopy,Ureter Catheter",52005,N/A,N/A,N/A," $1,045.00 ", $679.25 , $713.00 , $125.24 , $199.19 , $652.08 , $607.23 , $971.85 , $940.50 , $940.50 , $836.00 , $836.00 , $199.19 , $964.85 , $992.75 , $940.50 , $940.50 , $940.50 , $971.85 ," $1,003.20 ", $716.14 , $888.25 , $688.65 , $819.38 , N/A , $664.80 , $664.80 , $992.75 , $781.39 , $125.24 ," $1,003.20 "
Assay of Manganese,CPT® 83785,N/A,N/A,N/A, $209.00 , $135.85 , N/A , $27.18 , $27.18 , $139.15 , $166.42 , $194.37 , $188.10 , $188.10 , $167.20 , $167.20 , $27.18 , $192.97 , $198.55 , $188.10 , $188.10 , $188.10 , $194.37 , $200.64 , $177.95 , $177.65 , $160.56 , $89.20 , N/A , $129.86 , $129.86 , $198.55 , $141.91 , $27.18 , $200.64 
"Darbepoetin Alfa, Non-Esrd",HCPCS J0881,N/A,N/A,N/A, $22.00 , $14.30 , N/A , $3.00 , $3.18 , N/A , N/A , $20.46 , $19.80 , $19.80 , $17.60 , $17.60 , $3.18 , $20.31 , $20.90 , $19.80 , $19.80 , $19.80 , $20.46 , $21.12 , $4.16 , $18.70 , $6.49 , $4.43 , N/A , N/A , N/A , $20.90 , N/A , $3.00 , $21.12 
Tangential Biopsy Skin Ea Sep/Additional Lesion,CPT® 11103,N/A,N/A,N/A, $201.00 , $130.65 , $70.48 , $20.80 , $42.10 , $58.71 , N/A , $186.93 , $180.90 , $180.90 , $160.80 , $160.80 , $42.10 , $185.58 , $190.95 , $180.90 , $180.90 , $180.90 , $186.93 , $192.96 , $77.73 , $170.85 , $113.72 , $80.59 , N/A , $59.85 , $59.85 , $190.95 , $69.41 , $20.80 , $192.96 
 Fac Blood Clot Factor VIII Test ,CPT® 85245,0305 - LAB/HEMATOLOGY,N/A,N/A, $236.00 , $153.40 , $198.24 , $23.40 , $23.40 , $190.69 , $212.40 , $199.80 , $212.40 , $212.40 , $212.40 , $200.60 , $22.94 , $217.90 , $224.20 , $200.60 , $219.48 , $219.48 , $224.20 , $226.56 , $193.10 , $212.40 , $200.60 , $186.44 , N/A , $190.99 , $190.99 , $224.20 , $202.51 , $22.94 , $226.56 
"Thoracotomy,Major,Explore",CPT® 32100,N/A,N/A,N/A," $6,404.00 "," $4,162.60 "," $4,210.90 ", $736.46 ," $1,230.24 "," $3,057.33 "," $3,011.89 "," $5,955.72 "," $5,763.60 "," $5,763.60 "," $5,123.20 "," $5,123.20 "," $1,230.24 "," $5,912.81 "," $6,083.80 "," $5,763.60 "," $5,763.60 "," $5,763.60 "," $5,955.72 "," $6,147.84 "," $4,056.56 "," $5,443.40 "," $4,367.39 "," $4,020.14 ", N/A ," $3,116.98 "," $3,116.98 "," $6,083.80 "," $3,670.91 ", $736.46 ," $6,147.84 "
" Mra With Contrast, Abdominal ",HCPCS C8900,0616 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA-LOWER EXTREMITIES,N/A,N/A," $4,438.00 "," $2,884.70 "," $3,727.92 ", N/A , N/A ," $3,585.90 "," $3,994.20 "," $3,757.21 "," $3,994.20 "," $3,994.20 "," $3,994.20 "," $3,772.30 ", N/A ," $4,097.61 "," $4,216.10 "," $3,772.30 "," $4,127.34 "," $4,127.34 "," $4,216.10 "," $4,260.48 "," $3,631.17 "," $3,994.20 "," $3,772.30 "," $3,506.02 ", N/A ," $3,591.67 "," $3,591.67 "," $4,216.10 "," $3,808.25 "," $3,506.02 "," $4,260.48 "
 LIDOCAINE 4 % EX PTCH ,HCPCS RXC637,0250 - PHARMACY,00536-1202-15,1 patch, $7.73 , $5.02 , $6.49 , N/A , N/A , $6.25 , $6.96 , $6.54 , $6.96 , $6.96 , $6.96 , $6.57 , N/A , $7.14 , $7.34 , $6.57 , $7.19 , $7.19 , $7.34 , $7.42 , $6.32 , $6.96 , $6.57 , $6.11 , N/A , $6.26 , $6.26 , $7.34 , $6.63 , $6.11 , $7.42 
 Pro US Ndl Plmt Img S&I ,CPT® 76942,0981 - PRO FEE/ER,N/A,N/A, $394.00 , $256.10 , $326.54 , $57.19 , $98.27 , $290.60 ," $1,078.86 ", $366.42 , $354.60 , $354.60 , $315.20 , $315.20 , $98.27 , $363.78 , $374.30 , $354.60 , $354.60 , $354.60 , $366.42 , $378.24 , $319.64 , $334.90 ," $1,180.66 ", $336.85 , N/A , $296.28 , $296.28 , $374.30 , $342.94 , $57.19 ," $1,180.66 "
Perq Replacement Gtube Not Req Revj Gstrst Trc,43762,N/A,N/A,N/A," $2,204.00 "," $1,432.60 ", $223.34 , $34.45 , $176.61 , $167.82 , N/A ," $2,049.72 "," $1,983.60 "," $1,983.60 "," $1,763.20 "," $1,763.20 ", $176.61 ," $2,034.95 "," $2,093.80 "," $1,983.60 "," $1,983.60 "," $1,983.60 "," $2,049.72 "," $2,115.84 ", $163.07 ," $1,873.40 ", $193.69 , $214.15 , N/A , $171.09 , $171.09 ," $2,093.80 ", $178.94 , $34.45 ," $2,115.84 "
Open Rx Gr Tuberosity Fx,CPT® 23630,N/A,N/A,N/A," $5,129.00 "," $3,333.85 "," $4,741.69 ", $745.41 , $537.90 ," $3,770.48 "," $3,765.38 "," $4,769.97 "," $4,616.10 "," $4,616.10 "," $4,103.20 "," $4,103.20 ", $537.90 ," $4,735.61 "," $4,872.55 "," $4,616.10 "," $4,616.10 "," $4,616.10 "," $4,769.97 "," $4,923.84 "," $4,415.33 "," $4,359.65 "," $4,158.65 "," $4,437.44 ", N/A ," $3,844.05 "," $3,844.05 "," $4,872.55 "," $4,518.13 ", $537.90 ," $4,923.84 "
 Pro Wound Closure by Adhesive ,CPT® G0168,0982 - PRO FEE/OUTPT,N/A,N/A, $399.00 , $259.35 , $32.95 , $13.67 , N/A , $51.11 , N/A , $371.07 , $359.10 , $359.10 , $319.20 , $319.20 , N/A , $368.40 , $379.05 , $359.10 , $359.10 , $359.10 , $371.07 , $383.04 , $51.92 , $339.15 , $51.90 , $98.90 , N/A , $52.10 , $52.10 , $379.05 , $65.15 , $13.67 , $383.04 
 CT Guided Aspir &/or Inj Major Jt ,CPT® 20610,0761 - TREATMENT ROOM,N/A,N/A, $599.00 , $389.35 , $503.16 , $42.73 , $65.94 , $483.99 , $539.10 , $507.11 , $539.10 , $539.10 , $539.10 , $509.15 , $64.65 , $553.06 , $569.05 , $509.15 , $557.07 , $557.07 , $569.05 , $575.04 , $490.10 , $539.10 , $509.15 , $473.21 , N/A , $484.77 , $484.77 , $569.05 , $514.00 , $42.73 , $575.04 
Blood Clot Factor V Test,CPT® 85220,N/A,N/A,N/A, $254.00 , $165.10 , N/A , $18.00 , $18.00 , $99.82 , $119.45 , $236.22 , $228.60 , $228.60 , $203.20 , $203.20 , $18.00 , $234.52 , $241.30 , $228.60 , $228.60 , $228.60 , $236.22 , $243.84 , $117.85 , $215.90 , $115.15 , $64.00 , N/A , $93.16 , $93.16 , $241.30 , $101.80 , $18.00 , $243.84 
Remv Pilonidal Lesion Complic,CPT® 11772,N/A,N/A,N/A," $3,963.00 "," $2,575.95 "," $1,846.64 ", $548.02 , $432.26 ," $1,557.59 "," $1,531.58 "," $3,685.59 "," $3,566.70 "," $3,566.70 "," $3,170.40 "," $3,170.40 ", $432.26 ," $3,659.04 "," $3,764.85 "," $3,566.70 "," $3,566.70 "," $3,566.70 "," $3,685.59 "," $3,804.48 "," $2,033.11 "," $3,368.55 "," $3,070.37 "," $1,979.40 ", N/A ," $1,587.98 "," $1,587.98 "," $3,764.85 "," $1,841.52 ", $432.26 ," $3,804.48 "
Occlude Fallopian Tube by Device,CPT® 58615,N/A,N/A,N/A," $1,516.00 ", $985.40 ," $1,204.00 ", $243.07 , $225.45 , $992.16 , $993.98 ," $1,409.88 "," $1,364.40 "," $1,364.40 "," $1,212.80 "," $1,212.80 ", $225.45 ," $1,399.72 "," $1,440.20 "," $1,364.40 "," $1,364.40 "," $1,364.40 "," $1,409.88 "," $1,455.36 "," $1,252.76 "," $1,288.60 "," $1,305.93 ", $994.16 , N/A ," $1,011.52 "," $1,011.52 "," $1,440.20 "," $1,213.25 ", $225.45 ," $1,455.36 "
Tcat Impl Wrls P-Art Prs Snr L-T Hemodyn Mntr,CPT® 33289,N/A,N/A,N/A," $2,714.00 "," $1,764.10 "," $1,960.66 ", $301.84 , N/A ," $1,304.28 ", N/A ," $2,524.02 "," $2,442.60 "," $2,442.60 "," $2,171.20 "," $2,171.20 ", N/A ," $2,505.84 "," $2,578.30 "," $2,442.60 "," $2,442.60 "," $2,442.60 "," $2,524.02 "," $2,605.44 "," $1,806.53 "," $2,306.90 "," $1,734.30 "," $1,581.97 ", N/A ," $1,329.73 "," $1,329.73 "," $2,578.30 "," $1,510.57 ", $301.84 ," $2,605.44 "
Tobacco Use Cessation Intermediate 3-10 Minutes,CPT® 99406,N/A,N/A,N/A, $51.00 , $33.15 , $28.60 , $11.46 , N/A , $26.24 , $26.40 , $47.43 , $45.90 , $45.90 , $40.80 , $40.80 , N/A , $47.09 , $48.45 , $45.90 , $45.90 , $45.90 , $47.43 , $48.96 , $37.52 , $43.35 , $26.25 , $26.06 , N/A , $26.75 , $26.75 , $48.45 , $32.15 , $11.46 , $48.96 
"Smear, Complex Stain, for Ova/ Para",CPT® 87209,N/A,N/A,N/A, $167.00 , $108.55 , N/A , $18.34 , $18.34 , $101.69 , $121.66 , $155.31 , $150.30 , $150.30 , $133.60 , $133.60 , $18.34 , $154.19 , $158.65 , $150.30 , $150.30 , $150.30 , $155.31 , $160.32 , $120.06 , $141.95 , $118.39 , $65.17 , N/A , $94.90 , $94.90 , $158.65 , $103.71 , $18.34 , $160.32 
" Fac Artery X-Rays, Lung ",CPT® 75746,0320 - DX X-RAY,N/A,N/A," $1,308.00 ", $850.20 ," $1,098.72 ", $132.44 , $234.27 ," $1,056.86 "," $1,177.20 "," $1,107.35 "," $1,177.20 "," $1,177.20 "," $1,177.20 "," $1,111.80 ", $229.68 ," $1,207.68 "," $1,242.60 "," $1,111.80 "," $1,216.44 "," $1,216.44 "," $1,242.60 "," $1,255.68 "," $1,070.21 "," $1,177.20 "," $1,111.80 "," $1,033.32 ", N/A ," $1,058.56 "," $1,058.56 "," $1,242.60 "," $1,122.39 ", $132.44 ," $1,255.68 "
Inj Magnesium Sulfate,HCPCS J3475,N/A,N/A,N/A, $5.00 , $3.25 , N/A , $0.95 , $0.81 , N/A , N/A , $4.65 , $4.50 , $4.50 , $4.00 , $4.00 , $0.81 , $4.62 , $4.75 , $4.50 , $4.50 , $4.50 , $4.65 , $4.80 , $1.12 , $4.25 , $0.65 , $0.99 , N/A , N/A , N/A , $4.75 , N/A , $0.65 , $4.80 
 Astra Zeneca Covid Vaccine 2nd Dose ,CPT® 0022A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , N/A , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , N/A , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $55.30 , $67.20 
Sono Fetal Heart F/U,CPT® 76826,N/A,N/A,N/A," $1,047.00 ", $680.55 , $903.76 , $155.21 , $86.83 , $788.74 , $691.74 , $973.71 , $942.30 , $942.30 , $837.60 , $837.60 , $86.83 , $966.70 , $994.65 , $942.30 , $942.30 , $942.30 , $973.71 ," $1,005.12 ", $913.48 , $889.95 , $756.93 , $925.82 , N/A , $804.13 , $804.13 , $994.65 , $930.79 , $86.83 ," $1,005.12 "
Fx Cl Clavicular W Manipu,23505,N/A,N/A,N/A," $1,827.00 "," $1,187.55 "," $2,069.73 ", $326.05 , $230.52 ," $1,600.02 "," $1,616.31 "," $1,699.11 "," $1,644.30 "," $1,644.30 "," $1,461.60 "," $1,461.60 ", $230.52 ," $1,686.87 "," $1,735.65 "," $1,644.30 "," $1,644.30 "," $1,644.30 "," $1,699.11 "," $1,753.92 "," $1,905.10 "," $1,552.95 "," $1,776.93 "," $1,889.14 ", N/A ," $1,631.24 "," $1,631.24 "," $1,735.65 "," $1,917.27 ", $230.52 ," $2,069.73 "
 Loopogram/Nephrostogram ,CPT® 74425,0320 - DX X-RAY,N/A,N/A," $1,569.00 "," $1,019.85 "," $1,317.96 ", $135.51 , $70.00 ," $1,267.75 "," $1,412.10 "," $1,328.32 "," $1,412.10 "," $1,412.10 "," $1,412.10 "," $1,333.65 ", $68.63 ," $1,448.66 "," $1,490.55 "," $1,333.65 "," $1,459.17 "," $1,459.17 "," $1,490.55 "," $1,506.24 "," $1,283.76 "," $1,412.10 "," $1,333.65 "," $1,239.51 ", N/A ," $1,269.79 "," $1,269.79 "," $1,490.55 "," $1,346.36 ", $68.63 ," $1,506.24 "
Fine Needle Aspiration Bx W/O Img Gdn 1st Lesion,CPT® 10021,N/A,N/A,N/A, $556.00 , $361.40 , $175.24 , $52.22 , $77.05 , $190.96 , $184.90 , $517.08 , $500.40 , $500.40 , $444.80 , $444.80 , $77.05 , $513.35 , $528.20 , $500.40 , $500.40 , $500.40 , $517.08 , $533.76 , $183.62 , $472.60 , $371.09 , $242.14 , N/A , $194.69 , $194.69 , $528.20 , $225.77 , $52.22 , $533.76 
Induced Abortn by D&C,CPT® 59840,N/A,N/A,N/A," $1,069.00 ", $694.85 , $608.79 , $205.75 , $355.34 , $482.58 , $508.96 , $994.17 , $962.10 , $962.10 , $855.20 , $855.20 , $355.34 , $987.01 ," $1,015.55 ", $962.10 , $962.10 , $962.10 , $994.17 ," $1,026.24 ", $609.08 , $908.65 ," $1,113.26 ", $898.62 , N/A , $491.99 , $491.99 ," $1,015.55 ", $568.78 , $205.75 ," $1,113.26 "
 Fac Mlh1 Gene Analysis Promoter Methylation Analysis ,CPT® 81288,0310 - PATHOLOGY LAB,N/A,N/A, $360.00 , $234.00 , $302.40 , $196.17 , $162.83 , $290.88 , $324.00 , $304.78 , $324.00 , $324.00 , $324.00 , $306.00 , $159.64 , $332.39 , $342.00 , $306.00 , $334.80 , $334.80 , $342.00 , $345.60 , $294.55 , $324.00 , $306.00 , $284.40 , N/A , $291.35 , $291.35 , $342.00 , $308.92 , $159.64 , $345.60 
 Fac Byp Oth/Thn Vein Fem-Ant Tibl Pst Tibl/Proneal ,CPT® 35666,0360 - OR SERVICES,N/A,N/A," $3,733.00 "," $2,426.45 "," $3,135.72 "," $1,151.45 ", $693.97 ," $3,016.26 "," $3,359.70 "," $3,160.36 "," $3,359.70 "," $3,359.70 "," $3,359.70 "," $3,173.05 ", $680.36 ," $3,446.68 "," $3,546.35 "," $3,173.05 "," $3,471.69 "," $3,471.69 "," $3,546.35 "," $3,583.68 "," $3,054.34 "," $3,359.70 "," $3,173.05 "," $2,949.07 ", N/A ," $3,021.12 "," $3,021.12 "," $3,546.35 "," $3,203.29 ", $680.36 ," $3,583.68 "
 Fac Assay of Histamine ,CPT® 83088,0301 - LAB/CHEMISTRY,N/A,N/A, $396.00 , $257.40 , $332.64 , $30.12 , $30.12 , $319.97 , $356.40 , $335.25 , $356.40 , $356.40 , $356.40 , $336.60 , $29.53 , $365.63 , $376.20 , $336.60 , $368.28 , $368.28 , $376.20 , $380.16 , $324.01 , $356.40 , $336.60 , $312.84 , N/A , $320.48 , $320.48 , $376.20 , $339.81 , $29.53 , $380.16 
"Zoster Vacc, Live, Sub-Q",CPT® 90736,N/A,N/A,N/A, $327.00 , $212.55 , N/A , N/A , $187.68 , $355.47 , $370.73 , $304.11 , $294.30 , $294.30 , $261.60 , $261.60 , $187.68 , $301.92 , $310.65 , $294.30 , $294.30 , $294.30 , $304.11 , $313.92 , N/A , $277.95 , $492.67 , $359.90 , N/A , $362.41 , $362.41 , $310.65 , $422.48 , $187.68 , $492.67 
" Fac Microbe Susceptible, Enzyme ",CPT® 87185,0306 - LAB/BACT-MICRO,N/A,N/A, $72.00 , $46.80 , $60.48 , $4.85 , $4.85 , $58.18 , $64.80 , $60.96 , $64.80 , $64.80 , $64.80 , $61.20 , $4.75 , $66.48 , $68.40 , $61.20 , $66.96 , $66.96 , $68.40 , $69.12 , $58.91 , $64.80 , $61.20 , $56.88 , N/A , $58.27 , $58.27 , $68.40 , $61.78 , $4.75 , $69.12 
"Destruct Internal Hemorrhoid, Thermal",46930,N/A,N/A,N/A," $1,384.00 ", $899.60 , $953.16 , $147.02 , $143.79 , $710.05 , $733.17 ," $1,287.12 "," $1,245.60 "," $1,245.60 "," $1,107.20 "," $1,107.20 ", $143.79 ," $1,277.85 "," $1,314.80 "," $1,245.60 "," $1,245.60 "," $1,245.60 "," $1,287.12 "," $1,328.64 ", $682.46 ," $1,176.40 ", $801.04 , $850.75 , N/A , $723.90 , $723.90 ," $1,314.80 ", $757.11 , $143.79 ," $1,328.64 "
Incisional Biopsy Skin Ea Sep/Additional Lesion,CPT® 11107,N/A,N/A,N/A, $295.00 , $191.75 , $99.21 , $29.27 , $56.85 , $82.76 , N/A , $274.35 , $265.50 , $265.50 , $236.00 , $236.00 , $56.85 , $272.37 , $280.25 , $265.50 , $265.50 , $265.50 , $274.35 , $283.20 , $109.90 , $250.75 , $161.70 , $113.62 , N/A , $84.38 , $84.38 , $280.25 , $97.84 , $29.27 , $283.20 
 Fac Sgmdsc Flx Dired Sbmcsl Njx Any Sbst ,CPT® 45335,0360 - OR SERVICES,N/A,N/A," $1,099.00 ", $714.35 , $923.16 , $63.40 , $158.58 , $887.99 , $989.10 , $930.41 , $989.10 , $989.10 , $989.10 , $934.15 , $155.47 ," $1,014.71 "," $1,044.05 ", $934.15 ," $1,022.07 "," $1,022.07 "," $1,044.05 "," $1,055.04 ", $899.20 , $989.10 , $934.15 , $868.21 , N/A , $889.42 , $889.42 ," $1,044.05 ", $943.05 , $63.40 ," $1,055.04 "
Explor Interphalangeal Jt,CPT® 28024,N/A,N/A,N/A," $3,035.00 "," $1,972.75 "," $1,888.71 ", $298.27 , $199.78 ," $1,506.70 "," $1,497.20 "," $2,822.55 "," $2,731.50 "," $2,731.50 "," $2,428.00 "," $2,428.00 ", $199.78 ," $2,802.22 "," $2,883.25 "," $2,731.50 "," $2,731.50 "," $2,731.50 "," $2,822.55 "," $2,913.60 "," $1,749.63 "," $2,579.75 "," $1,618.15 "," $1,779.51 ", N/A ," $1,536.10 "," $1,536.10 "," $2,883.25 "," $1,805.46 ", $199.78 ," $2,913.60 "
 Pro Office/Outpatient Established Mod Mdm 30-39 Min ,CPT® 99214,0982 - PRO FEE/OUTPT,N/A,N/A, $293.00 , $190.45 , $198.24 , $94.81 , $64.80 , $135.34 , $135.69 , $272.49 , $263.70 , $263.70 , $234.40 , $234.40 , $64.80 , $270.53 , $278.35 , $263.70 , $263.70 , $263.70 , $272.49 , $281.28 , $181.36 , $249.05 , $168.77 , $172.04 , $74.50 , $137.99 , $137.99 , $278.35 , $159.15 , $64.80 , $281.28 
"Repr Bl Ves Direct,Abd",CPT® 35221,N/A,N/A,N/A," $8,961.00 "," $5,824.65 "," $8,613.28 "," $1,329.76 "," $1,337.08 "," $6,256.79 "," $6,187.55 "," $8,333.73 "," $8,064.90 "," $8,064.90 "," $7,168.80 "," $7,168.80 "," $1,337.08 "," $8,273.69 "," $8,512.95 "," $8,064.90 "," $8,064.90 "," $8,064.90 "," $8,333.73 "," $8,602.56 "," $7,935.55 "," $7,616.85 "," $7,792.79 "," $7,019.06 ", N/A ," $6,378.87 "," $6,378.87 "," $8,512.95 "," $7,246.40 "," $1,329.76 "," $8,613.28 "
Egd Dilation Gastric/Duodenal Stricture,CPT® 43245,N/A,N/A,N/A," $2,546.00 "," $1,654.90 "," $1,069.77 ", $165.31 , $174.43 , $889.63 , $911.65 ," $2,367.78 "," $2,291.40 "," $2,291.40 "," $2,036.80 "," $2,036.80 ", $174.43 ," $2,350.72 "," $2,418.70 "," $2,291.40 "," $2,291.40 "," $2,291.40 "," $2,367.78 "," $2,444.16 ", $770.53 ," $2,164.10 "," $1,000.86 "," $1,018.00 ", N/A , $906.99 , $906.99 ," $2,418.70 ", $948.60 , $165.31 ," $2,444.16 "
"Fusion Foot Bones,Subtalar",28725,N/A,N/A,N/A," $7,522.00 "," $4,889.30 "," $4,754.69 ", $745.14 , $768.38 ," $3,781.83 "," $3,762.66 "," $6,995.46 "," $6,769.80 "," $6,769.80 "," $6,017.60 "," $6,017.60 ", $768.38 ," $6,945.06 "," $7,145.90 "," $6,769.80 "," $6,769.80 "," $6,769.80 "," $6,995.46 "," $7,221.12 "," $4,420.81 "," $6,393.70 "," $4,122.97 "," $4,473.55 ", N/A ," $3,855.61 "," $3,855.61 "," $7,145.90 "," $4,531.72 ", $745.14 ," $7,221.12 "
 Cardiac Arrhythmia And Conduction Disorders With Cc ,MS DRG V40 (FY2023) 309,N/A,N/A,N/A," $22,916.04 "," $14,895.43 "," $19,249.47 ", N/A , N/A ," $18,516.16 "," $20,624.44 "," $19,400.72 "," $20,624.44 "," $20,624.44 "," $20,624.44 "," $19,478.63 ", N/A ," $21,158.38 "," $21,770.24 "," $19,478.63 "," $21,311.92 "," $21,311.92 "," $21,770.24 "," $21,999.40 "," $18,749.90 "," $20,624.44 "," $19,478.63 "," $18,103.67 ", N/A ," $18,545.95 "," $18,545.95 "," $21,770.24 "," $19,664.25 "," $18,103.67 "," $21,999.40 "
" Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC ",MS DRG V40 (FY2023) 640,N/A,N/A,N/A," $27,526.45 "," $17,892.19 "," $23,122.22 ", N/A , N/A ," $22,241.37 "," $24,773.81 "," $23,303.89 "," $24,773.81 "," $24,773.81 "," $24,773.81 "," $23,397.48 ", N/A ," $25,415.17 "," $26,150.13 "," $23,397.48 "," $25,599.60 "," $25,599.60 "," $26,150.13 "," $26,425.39 "," $22,522.14 "," $24,773.81 "," $23,397.48 "," $21,745.90 ", N/A ," $22,277.16 "," $22,277.16 "," $26,150.13 "," $23,620.45 "," $21,745.90 "," $26,425.39 "
 Fac Plmt Urtrl Stent Prq Pre-Existing Nfros Tract ,CPT® 50693,0761 - TREATMENT ROOM,N/A,N/A," $11,632.00 "," $7,560.80 "," $9,770.88 ", $193.21 , $839.21 ," $9,398.66 "," $10,468.80 "," $9,847.65 "," $10,468.80 "," $10,468.80 "," $10,468.80 "," $9,887.20 ", $822.75 ," $10,739.83 "," $11,050.40 "," $9,887.20 "," $10,817.76 "," $10,817.76 "," $11,050.40 "," $11,166.72 "," $9,517.30 "," $10,468.80 "," $9,887.20 "," $9,189.28 ", N/A ," $9,413.78 "," $9,413.78 "," $11,050.40 "," $9,981.42 ", $193.21 ," $11,166.72 "
 HYDROXYZINE HCL 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6618-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Thyr Stimulating Horm ,CPT® 84443,0301 - LAB/CHEMISTRY,N/A,N/A, $168.00 , $109.20 , $141.12 , $17.14 , $17.14 , $135.74 , $151.20 , $142.23 , $151.20 , $151.20 , $151.20 , $142.80 , $16.80 , $155.11 , $159.60 , $142.80 , $156.24 , $156.24 , $159.60 , $161.28 , $137.46 , $151.20 , $142.80 , $132.72 , N/A , $135.96 , $135.96 , $159.60 , $144.16 , $16.80 , $161.28 
Abd-Vaginal Vesical Neck Suspensn,CPT® 51845,N/A,N/A,N/A," $4,046.00 "," $2,629.90 "," $3,164.46 ", $556.61 , $803.35 ," $2,865.94 "," $2,685.08 "," $3,762.78 "," $3,641.40 "," $3,641.40 "," $3,236.80 "," $3,236.80 ", $803.35 ," $3,735.67 "," $3,843.70 "," $3,641.40 "," $3,641.40 "," $3,641.40 "," $3,762.78 "," $3,884.16 "," $3,171.60 "," $3,439.10 "," $3,057.89 "," $3,589.98 ", N/A ," $2,921.86 "," $2,921.86 "," $3,843.70 "," $3,434.23 ", $556.61 ," $3,884.16 "
Insj/Rplcmt Temp Transvns 1chmbr Eltrd/Pm Cath,CPT® 33210,N/A,N/A,N/A," $1,996.00 "," $1,297.40 ", $955.44 , $146.85 , $177.64 , $763.43 , $739.51 ," $1,856.28 "," $1,796.40 "," $1,796.40 "," $1,596.80 "," $1,596.80 ", $177.64 ," $1,842.91 "," $1,896.20 "," $1,796.40 "," $1,796.40 "," $1,796.40 "," $1,856.28 "," $1,916.16 ", $885.68 ," $1,696.60 ", $933.07 , $793.57 , N/A , $778.33 , $778.33 ," $1,896.20 ", $884.19 , $146.85 ," $1,916.16 "
"Knee Scope,Med/Lat Menisectomy",29881,N/A,N/A,N/A," $4,242.00 "," $2,757.30 "," $3,302.59 ", $518.48 , $554.63 ," $2,617.29 "," $2,621.37 "," $3,945.06 "," $3,817.80 "," $3,817.80 "," $3,393.60 "," $3,393.60 ", $554.63 ," $3,916.64 "," $4,029.90 "," $3,817.80 "," $3,817.80 "," $3,817.80 "," $3,945.06 "," $4,072.32 "," $3,585.30 "," $3,605.70 "," $2,891.97 "," $3,087.83 ", N/A ," $2,668.36 "," $2,668.36 "," $4,029.90 "," $3,136.28 ", $518.48 ," $4,072.32 "
 PROPOFOL INFUSION 10 MG/ML (ANES) ,HCPCS J2704,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0269-65,100 mL, $184.93 , $120.20 , $155.34 , $0.10 , $0.14 , $149.42 , $166.44 , $156.56 , $166.44 , $166.44 , $166.44 , $157.19 , $0.14 , $170.75 , $175.68 , $157.19 , $171.98 , $171.98 , $175.68 , $177.53 , $151.31 , $166.44 , $157.19 , $146.09 , N/A , $149.66 , $149.66 , $175.68 , $158.69 , $0.10 , $177.53 
 Fac Anosc Bx 1/Mlt ,CPT® 46606,0360 - OR SERVICES,N/A,N/A," $3,907.00 "," $2,539.55 "," $3,281.88 ", $70.90 , $45.35 ," $3,156.86 "," $3,516.30 "," $3,307.67 "," $3,516.30 "," $3,516.30 "," $3,516.30 "," $3,320.95 ", $44.46 ," $3,607.33 "," $3,711.65 "," $3,320.95 "," $3,633.51 "," $3,633.51 "," $3,711.65 "," $3,750.72 "," $3,196.71 "," $3,516.30 "," $3,320.95 "," $3,086.53 ", N/A ," $3,161.94 "," $3,161.94 "," $3,711.65 "," $3,352.60 ", $44.46 ," $3,750.72 "
 CETIRIZINE HCL 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6717-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Assay for Lithium,CPT® 80178,N/A,N/A,N/A, $80.00 , $52.00 , N/A , $6.74 , $6.74 , $37.42 , $44.76 , $74.40 , $72.00 , $72.00 , $64.00 , $64.00 , $6.74 , $73.86 , $76.00 , $72.00 , $72.00 , $72.00 , $74.40 , $76.80 , $44.14 , $68.00 , $43.79 , $23.97 , N/A , $34.92 , $34.92 , $76.00 , $38.16 , $6.74 , $76.80 
Ins Pacemaker Pulse Gen Only W/Exist Dual Leads,CPT® 33213,N/A,N/A,N/A," $4,115.00 "," $2,674.75 "," $2,007.07 ", $309.91 , $569.99 ," $1,484.28 "," $1,458.73 "," $3,826.95 "," $3,703.50 "," $3,703.50 "," $3,292.00 "," $3,292.00 ", $569.99 ," $3,799.38 "," $3,909.25 "," $3,703.50 "," $3,703.50 "," $3,703.50 "," $3,826.95 "," $3,950.40 "," $1,848.87 "," $3,497.75 "," $1,830.45 "," $1,623.01 ", N/A ," $1,513.24 "," $1,513.24 "," $3,909.25 "," $1,719.04 ", $309.91 ," $3,950.40 "
 Fac Rfl/Main Portable Pmp ,CPT® 96521,0260 - IV THERAPY,N/A,N/A, $931.00 , $605.15 , $782.04 , $122.61 , $124.73 , $752.25 , $837.90 , $788.18 , $837.90 , $837.90 , $837.90 , $791.35 , $122.28 , $859.59 , $884.45 , $791.35 , $865.83 , $865.83 , $884.45 , $893.76 , $761.74 , $837.90 , $791.35 , $735.49 , N/A , $753.46 , $753.46 , $884.45 , $798.89 , $122.28 , $893.76 
Open Rx Radial Shaft Fx,25515,N/A,N/A,N/A," $3,334.00 "," $2,167.10 "," $4,092.14 ", $643.00 , $614.70 ," $3,224.60 "," $3,220.84 "," $3,100.62 "," $3,000.60 "," $3,000.60 "," $2,667.20 "," $2,667.20 ", $614.70 ," $3,078.28 "," $3,167.30 "," $3,000.60 "," $3,000.60 "," $3,000.60 "," $3,100.62 "," $3,200.64 "," $3,797.55 "," $2,833.90 "," $3,550.29 "," $3,809.50 ", N/A ," $3,287.51 "," $3,287.51 "," $3,167.30 "," $3,864.00 ", $614.70 ," $4,092.14 "
"Chemodenerv Eccrine Glands, Non-Axillary",CPT® 64653,N/A,N/A,N/A, $879.00 , $571.35 , $248.14 , $48.13 , $59.97 , $290.20 , $275.87 , $817.47 , $791.10 , $791.10 , $703.20 , $703.20 , $59.97 , $811.58 , $835.05 , $791.10 , $791.10 , $791.10 , $817.47 , $843.84 , $266.33 , $747.15 , $280.10 , $310.57 , N/A , $295.86 , $295.86 , $835.05 , $317.38 , $48.13 , $843.84 
 Chronic Obstructive Pulmonary Disease Without Cc/McC ,MS DRG V40 (FY2023) 192,N/A,N/A,N/A," $9,072.34 "," $5,897.02 "," $7,620.77 ", N/A , N/A ," $7,330.45 "," $8,165.11 "," $7,680.64 "," $8,165.11 "," $8,165.11 "," $8,165.11 "," $7,711.49 ", N/A ," $8,376.49 "," $8,618.72 "," $7,711.49 "," $8,437.28 "," $8,437.28 "," $8,618.72 "," $8,709.45 "," $7,422.99 "," $8,165.11 "," $7,711.49 "," $7,167.15 ", N/A ," $7,342.24 "," $7,342.24 "," $8,618.72 "," $7,784.97 "," $7,167.15 "," $8,709.45 "
 Lt Galactogram Mammary Single Duct ,CPT® 77053,0320 - DX X-RAY,N/A,N/A, $799.00 , $519.35 , $671.16 , $52.50 , $68.06 , $645.59 , $719.10 , $676.43 , $719.10 , $719.10 , $719.10 , $679.15 , $66.73 , $737.72 , $759.05 , $679.15 , $743.07 , $743.07 , $759.05 , $767.04 , $653.74 , $719.10 , $679.15 , $631.21 , N/A , $646.63 , $646.63 , $759.05 , $685.62 , $52.50 , $767.04 
"Stereotactic Comp Assist Proc,Cranial,Extradural",CPT® 61782,N/A,N/A,N/A," $1,580.00 "," $1,027.00 ", $842.04 , $164.17 , $138.09 , $979.21 , $988.67 ," $1,469.40 "," $1,422.00 "," $1,422.00 "," $1,264.00 "," $1,264.00 ", $138.09 ," $1,458.81 "," $1,501.00 "," $1,422.00 "," $1,422.00 "," $1,422.00 "," $1,469.40 "," $1,516.80 ", $906.51 ," $1,343.00 "," $1,006.21 "," $1,027.59 ", N/A , $998.32 , $998.32 ," $1,501.00 "," $1,070.96 ", $138.09 ," $1,516.80 "
Inj Proc for Myelography and/or CT,62284,N/A,N/A,N/A," $1,070.00 ", $695.50 , $415.53 , $80.47 , $294.76 , $485.54 , $459.96 , $995.10 , $963.00 , $963.00 , $856.00 , $856.00 , $294.76 , $987.93 ," $1,016.50 ", $963.00 , $963.00 , $963.00 , $995.10 ," $1,027.20 ", $452.28 , $909.50 , $447.80 , $524.70 , N/A , $495.02 , $495.02 ," $1,016.50 ", $531.03 , $80.47 ," $1,027.20 "
 Fac Trauma 3 Activation W/ Pre-ED Notficiation- Level II- W/O Critical Care ,N/A,0683 - TRAUMA LEVEL III,N/A,N/A," $3,064.00 "," $1,991.60 "," $2,573.76 ", N/A , N/A ," $2,475.71 "," $2,757.60 "," $2,593.98 "," $2,757.60 "," $2,757.60 "," $2,757.60 "," $2,604.40 ", N/A ," $2,828.99 "," $2,910.80 "," $2,604.40 "," $2,849.52 "," $2,849.52 "," $2,910.80 "," $2,941.44 "," $2,506.96 "," $2,757.60 "," $2,604.40 "," $2,420.56 ", N/A ," $2,479.70 "," $2,479.70 "," $2,910.80 "," $2,629.22 "," $2,420.56 "," $2,941.44 "
1st Hospital IP/Obs Care Sf/Low Mdm 40 Minutes,CPT® 99221,N/A,N/A,N/A, $324.00 , $210.60 , $197.44 , $79.64 , $82.46 , $174.68 , $174.13 , $301.32 , $291.60 , $291.60 , $259.20 , $259.20 , $82.46 , $299.15 , $307.80 , $291.60 , $291.60 , $291.60 , $301.32 , $311.04 , $251.10 , $275.40 , $219.03 , $219.35 , $40.00 , $178.09 , $178.09 , $307.80 , $205.40 , $40.00 , $311.04 
Ecmo/Ecls Insj of Prph Cannula 6 Yrs&Older Open,CPT® 33954,N/A,N/A,N/A," $2,863.00 "," $1,860.95 "," $2,772.25 ", $425.79 , $524.47 ," $1,883.09 "," $2,077.49 "," $2,662.59 "," $2,576.70 "," $2,576.70 "," $2,290.40 "," $2,290.40 ", $524.47 ," $2,643.41 "," $2,719.85 "," $2,576.70 "," $2,576.70 "," $2,576.70 "," $2,662.59 "," $2,748.48 "," $2,565.61 "," $2,433.55 "," $2,466.40 "," $2,291.94 ", N/A ," $1,919.83 "," $1,919.83 "," $2,719.85 "," $2,180.92 ", $425.79 ," $2,772.25 "
 AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00093-2275-34,1 tablet, $25.96 , $16.87 , $21.81 , N/A , N/A , $20.98 , $23.36 , $21.98 , $23.36 , $23.36 , $23.36 , $22.07 , N/A , $23.97 , $24.66 , $22.07 , $24.14 , $24.14 , $24.66 , $24.92 , $21.24 , $23.36 , $22.07 , $20.51 , N/A , $21.01 , $21.01 , $24.66 , $22.28 , $20.51 , $24.92 
Haloperidol Decanoate Inj,HCPCS J1631,N/A,N/A,N/A, $39.00 , $25.35 , N/A , $8.50 , $7.80 , N/A , N/A , $36.27 , $35.10 , $35.10 , $31.20 , $31.20 , $7.80 , $36.01 , $37.05 , $35.10 , $35.10 , $35.10 , $36.27 , $37.44 , $15.00 , $33.15 , $36.33 , $10.90 , N/A , N/A , N/A , $37.05 , N/A , $7.80 , $37.44 
"Cysto/Uretero/Pyeloscopy, Dx",CPT® 52351,N/A,N/A,N/A," $2,491.00 "," $1,619.15 "," $1,620.98 ", $284.82 , $319.64 ," $1,485.02 "," $1,405.94 "," $2,316.63 "," $2,241.90 "," $2,241.90 "," $1,992.80 "," $1,992.80 ", $319.64 ," $2,299.94 "," $2,366.45 "," $2,241.90 "," $2,241.90 "," $2,241.90 "," $2,316.63 "," $2,391.36 "," $1,630.11 "," $2,117.35 "," $1,591.39 "," $1,864.92 ", N/A ," $1,513.99 "," $1,513.99 "," $2,366.45 "," $1,779.48 ", $284.82 ," $2,391.36 "
 Pro Cltx Metar Fx W/O Mnpj ,CPT® 28470,0981 - PRO FEE/ER,N/A,N/A, $971.00 , $631.15 ," $1,281.15 ", $202.14 , $155.34 , $994.98 ," $1,021.36 ", $903.03 , $873.90 , $873.90 , $776.80 , $776.80 , $155.34 , $896.52 , $922.45 , $873.90 , $873.90 , $873.90 , $903.03 , $932.16 ," $1,181.08 ", $825.35 ," $1,115.04 "," $1,181.65 ", N/A ," $1,014.40 "," $1,014.40 ", $922.45 ," $1,192.29 ", $155.34 ," $1,281.15 "
"MRI, Cerv Spine",CPT® 72141,N/A,N/A,N/A," $5,381.00 "," $3,497.65 "," $1,372.00 ", $195.41 , $423.92 ," $1,910.49 "," $2,009.89 "," $5,004.33 "," $4,842.90 "," $4,842.90 "," $4,304.80 "," $4,304.80 ", $423.92 ," $4,968.28 "," $5,111.95 "," $4,842.90 "," $4,842.90 "," $4,842.90 "," $5,004.33 "," $5,165.76 "," $2,401.56 "," $4,573.85 "," $2,191.84 "," $2,076.39 ", N/A ," $1,947.76 "," $1,947.76 "," $5,111.95 "," $2,291.47 ", $195.41 ," $5,165.76 "
 Pro Radiologic Exam Swallow Function Contrast Study ,CPT® 74230,0972 - PRO FEE/RAD/DX,N/A,N/A, $328.00 , $213.20 , $737.06 , $125.26 , $81.46 , $609.02 , $484.52 , $305.04 , $295.20 , $295.20 , $262.40 , $262.40 , $81.46 , $302.84 , $311.60 , $295.20 , $295.20 , $295.20 , $305.04 , $314.88 , $736.12 , $278.80 , $527.74 , $653.26 , N/A , $620.91 , $620.91 , $311.60 , $718.71 , $81.46 , $737.06 
"Urine Culture, Colony Count",CPT® 87086,N/A,N/A,N/A, $113.00 , $73.45 , N/A , $8.23 , $8.23 , $45.69 , $54.65 , $105.09 , $101.70 , $101.70 , $90.40 , $90.40 , $8.23 , $104.33 , $107.35 , $101.70 , $101.70 , $101.70 , $105.09 , $108.48 , $53.89 , $96.05 , $53.52 , $29.25 , N/A , $42.64 , $42.64 , $107.35 , $46.60 , $8.23 , $108.48 
Treat Phalangeal Shft Frc,26720,N/A,N/A,N/A, $841.00 , $546.65 ," $1,172.86 ", $187.01 , $74.22 , $886.14 , $907.35 , $782.13 , $756.90 , $756.90 , $672.80 , $672.80 , $74.22 , $776.50 , $798.95 , $756.90 , $756.90 , $756.90 , $782.13 , $807.36 ," $1,075.93 ", $714.85 , $995.51 ," $1,060.64 ", N/A , $903.43 , $903.43 , $798.95 ," $1,061.84 ", $74.22 ," $1,172.86 "
"Remv Hydrocele,Sperm Cord,Unilat",55500,N/A,N/A,N/A," $2,919.00 "," $1,897.35 "," $1,738.25 ", $374.28 , $401.40 ," $1,261.41 "," $1,292.60 "," $2,714.67 "," $2,627.10 "," $2,627.10 "," $2,335.20 "," $2,335.20 ", $401.40 ," $2,695.11 "," $2,773.05 "," $2,627.10 "," $2,627.10 "," $2,627.10 "," $2,714.67 "," $2,802.24 "," $1,626.46 "," $2,481.15 "," $2,083.79 "," $1,891.21 ", N/A ," $1,286.02 "," $1,286.02 "," $2,773.05 "," $1,541.37 ", $374.28 ," $2,802.24 "
 Humerus Min 2 Views ,CPT® 73060,0320 - DX X-RAY,N/A,N/A, $296.00 , $192.40 , $248.64 , $31.69 , $27.66 , $239.17 , $266.40 , $250.59 , $266.40 , $266.40 , $266.40 , $251.60 , $27.12 , $273.30 , $281.20 , $251.60 , $275.28 , $275.28 , $281.20 , $284.16 , $242.19 , $266.40 , $251.60 , $233.84 , N/A , $239.55 , $239.55 , $281.20 , $254.00 , $27.12 , $284.16 
 Fac Assay of Gastrin ,CPT® 82941,0301 - LAB/CHEMISTRY,N/A,N/A, $174.00 , $113.10 , $146.16 , $17.98 , $17.98 , $140.59 , $156.60 , $147.31 , $156.60 , $156.60 , $156.60 , $147.90 , $17.63 , $160.65 , $165.30 , $147.90 , $161.82 , $161.82 , $165.30 , $167.04 , $142.37 , $156.60 , $147.90 , $137.46 , N/A , $140.82 , $140.82 , $165.30 , $149.31 , $17.63 , $167.04 
 Pro Apply Short Leg Splint ,CPT® 29515,0982 - PRO FEE/OUTPT,N/A,N/A, $473.00 , $307.45 , $298.68 , $47.11 , $31.03 , $240.63 , $243.68 , $439.89 , $425.70 , $425.70 , $378.40 , $378.40 , $31.03 , $436.72 , $449.35 , $425.70 , $425.70 , $425.70 , $439.89 , $454.08 , $277.19 , $402.05 , $265.83 , $288.50 , N/A , $245.33 , $245.33 , $449.35 , $288.36 , $31.03 , $454.08 
Microsomal Antibody,CPT® 86376,N/A,N/A,N/A, $146.00 , $94.90 , N/A , $14.84 , $14.84 , $82.31 , $98.41 , $135.78 , $131.40 , $131.40 , $116.80 , $116.80 , $14.84 , $134.80 , $138.70 , $131.40 , $131.40 , $131.40 , $135.78 , $140.16 , $97.15 , $124.10 , $95.69 , $52.75 , N/A , $76.82 , $76.82 , $138.70 , $83.95 , $14.84 , $140.16 
 KCL IN DEXTROSE-NACL 20-5-0.9 MEQ/L-%-% IV SOLN ,HCPCS RXA258,0258 - IV SOLUTIONS,00990-7107-09,"1,000 mL", $119.72 , $77.82 , $100.56 , N/A , N/A , $96.73 , $107.75 , $101.35 , $107.75 , $107.75 , $107.75 , $101.76 , N/A , $110.54 , $113.73 , $101.76 , $111.34 , $111.34 , $113.73 , $114.93 , $97.95 , $107.75 , $101.76 , $94.58 , N/A , $96.89 , $96.89 , $113.73 , $102.73 , $94.58 , $114.93 
Exc Skin Benig 1.1-2cm Remaindr Body,CPT® 11422,N/A,N/A,N/A, $702.00 , $456.30 , $435.54 , $131.06 , $143.41 , $370.23 , $364.50 , $652.86 , $631.80 , $631.80 , $561.60 , $561.60 , $143.41 , $648.16 , $666.90 , $631.80 , $631.80 , $631.80 , $652.86 , $673.92 , $475.45 , $596.70 , $726.11 , $478.34 , N/A , $377.45 , $377.45 , $666.90 , $437.72 , $131.06 , $726.11 
Elec Anlys Implt Ithcl/Edrl Pmp W/Repr&Ref Phys,CPT® 62370,N/A,N/A,N/A, $896.00 , $582.40 , $226.62 , $44.01 , $101.93 , $262.25 , $253.52 , $833.28 , $806.40 , $806.40 , $716.80 , $716.80 , $101.93 , $827.28 , $851.20 , $806.40 , $806.40 , $806.40 , $833.28 , $860.16 , $139.93 , $761.60 , $246.20 , $282.22 , N/A , $267.37 , $267.37 , $851.20 , $286.80 , $44.01 , $860.16 
" Fac Hocm 200-249mg/Ml Iodine,1ml ",HCPCS Q9960,0255 - DRUGS/RADIOLOGY,N/A,N/A, $2.00 , $1.30 , $1.68 , N/A , $0.28 , $1.62 , $1.80 , $1.69 , $1.80 , $1.80 , $1.80 , $1.70 , $0.27 , $1.85 , $1.90 , $1.70 , $1.86 , $1.86 , $1.90 , $1.92 , $1.64 , $1.80 , $1.70 , $1.58 , N/A , $1.62 , $1.62 , $1.90 , $1.72 , $0.27 , $1.92 
"Open Rx Shldr Disloc,Gr Tub Fx",CPT® 23670,N/A,N/A,N/A," $5,096.00 "," $3,312.40 "," $5,285.48 ", $828.89 , $845.22 ," $4,231.05 "," $4,213.90 "," $4,739.28 "," $4,586.40 "," $4,586.40 "," $4,076.80 "," $4,076.80 ", $845.22 ," $4,705.14 "," $4,841.20 "," $4,586.40 "," $4,586.40 "," $4,586.40 "," $4,739.28 "," $4,892.16 "," $4,923.49 "," $4,331.60 "," $4,656.41 "," $4,971.19 ", N/A ," $4,313.60 "," $4,313.60 "," $4,841.20 "," $5,070.01 ", $828.89 ," $5,285.48 "
Erythropoietin,CPT® 82668,N/A,N/A,N/A, $234.00 , $152.10 , N/A , $19.17 , $19.17 , $106.35 , $127.22 , $217.62 , $210.60 , $210.60 , $187.20 , $187.20 , $19.17 , $216.05 , $222.30 , $210.60 , $210.60 , $210.60 , $217.62 , $224.64 , $125.47 , $198.90 , $123.26 , $68.14 , N/A , $99.25 , $99.25 , $222.30 , $108.46 , $19.17 , $224.64 
Eye Exam & Treatment,CPT® 92014,N/A,N/A,N/A, $374.00 , $243.10 , $167.47 , $75.13 , $45.43 , $141.91 , $142.07 , $347.82 , $336.60 , $336.60 , $299.20 , $299.20 , $45.43 , $345.31 , $355.30 , $336.60 , $336.60 , $336.60 , $347.82 , $359.04 , $218.04 , $317.90 , $239.24 , $169.05 , N/A , $144.67 , $144.67 , $355.30 , $172.11 , $45.43 , $359.04 
 Fac Cltx Prox Fibula/Shft Fx W/Mnpj ,CPT® 27781,0761 - TREATMENT ROOM,N/A,N/A," $3,987.00 "," $2,591.55 "," $3,349.08 ", $393.47 , $307.34 ," $3,221.50 "," $3,588.30 "," $3,375.39 "," $3,588.30 "," $3,588.30 "," $3,588.30 "," $3,388.95 ", $301.31 ," $3,681.20 "," $3,787.65 "," $3,388.95 "," $3,707.91 "," $3,707.91 "," $3,787.65 "," $3,827.52 "," $3,262.16 "," $3,588.30 "," $3,388.95 "," $3,149.73 ", N/A ," $3,226.68 "," $3,226.68 "," $3,787.65 "," $3,421.24 ", $301.31 ," $3,827.52 "
Lens Sphcy Trifocal 4.25-7/.,HCPCS V2307,N/A,N/A,N/A, $90.00 , $58.50 , N/A , $88.94 , N/A , N/A , N/A , $83.70 , $81.00 , $81.00 , $72.00 , $72.00 , N/A , $83.10 , $85.50 , $81.00 , $81.00 , $81.00 , $83.70 , $86.40 , N/A , $76.50 , $90.00 , $80.81 , N/A , N/A , N/A , $85.50 , N/A , $72.00 , $90.00 
 Pro X-Ray Exam of Facial Bones ,CPT® 70140,0972 - PRO FEE/RAD/DX,N/A,N/A, $124.00 , $80.60 , $181.13 , $31.74 , $28.06 , $140.60 , $159.35 , $115.32 , $111.60 , $111.60 , $99.20 , $99.20 , $28.06 , $114.49 , $117.80 , $111.60 , $111.60 , $111.60 , $115.32 , $119.04 , $176.67 , $105.40 , $175.27 , $149.63 , N/A , $143.34 , $143.34 , $117.80 , $165.93 , $28.06 , $181.13 
Implant Neurostim/Receiver,63685,N/A,N/A,N/A," $2,405.00 "," $1,563.25 "," $1,742.99 ", $340.52 , $400.51 ," $2,020.96 "," $1,961.82 "," $2,236.65 "," $2,164.50 "," $2,164.50 "," $1,924.00 "," $1,924.00 ", $400.51 ," $2,220.54 "," $2,284.75 "," $2,164.50 "," $2,164.50 "," $2,164.50 "," $2,236.65 "," $2,308.80 "," $1,888.75 "," $2,044.25 "," $1,944.63 "," $2,124.75 ", N/A ," $2,060.40 "," $2,060.40 "," $2,284.75 "," $2,210.30 ", $340.52 ," $2,308.80 "
 Fac Colonoscopy Stoma Control Bleeding ,CPT® 44391,0360 - OR SERVICES,N/A,N/A," $3,092.00 "," $2,009.80 "," $2,597.28 ", $218.21 , $362.61 ," $2,498.34 "," $2,782.80 "," $2,617.69 "," $2,782.80 "," $2,782.80 "," $2,782.80 "," $2,628.20 ", $355.50 ," $2,854.84 "," $2,937.40 "," $2,628.20 "," $2,875.56 "," $2,875.56 "," $2,937.40 "," $2,968.32 "," $2,529.87 "," $2,782.80 "," $2,628.20 "," $2,442.68 ", N/A ," $2,502.36 "," $2,502.36 "," $2,937.40 "," $2,653.25 ", $218.21 ," $2,968.32 "
 Fac Level 1 Delivery ,Custom 7200000001,0720 - DELIVROOM/LABOR,N/A,N/A," $3,803.00 "," $2,471.95 "," $3,194.52 ", N/A , N/A ," $3,072.82 "," $3,422.70 "," $3,219.62 "," $3,422.70 "," $3,422.70 "," $3,422.70 "," $3,232.55 ", N/A ," $3,511.31 "," $3,612.85 "," $3,232.55 "," $3,536.79 "," $3,536.79 "," $3,612.85 "," $3,650.88 "," $3,111.61 "," $3,422.70 "," $3,232.55 "," $3,004.37 ", N/A ," $3,077.77 "," $3,077.77 "," $3,612.85 "," $3,263.35 "," $3,004.37 "," $3,650.88 "
 Pro Tx Tarsal B1 Fx Xcp Talus&Calcn W/Mnpj ,CPT® 28455,0982 - PRO FEE/OUTPT,N/A,N/A," $2,167.00 "," $1,408.55 "," $1,619.28 ", $257.53 , $153.67 ," $1,267.45 "," $1,157.12 "," $2,015.31 "," $1,950.30 "," $1,950.30 "," $1,733.60 "," $1,733.60 ", $153.67 ," $2,000.79 "," $2,058.65 "," $1,950.30 "," $1,950.30 "," $1,950.30 "," $2,015.31 "," $2,080.32 "," $1,492.56 "," $1,841.95 "," $1,261.33 "," $1,503.87 ", N/A ," $1,292.18 "," $1,292.18 "," $2,058.65 "," $1,518.76 ", $153.67 ," $2,080.32 "
Corpora Caver-Spongiosa Shunt,CPT® 54430,N/A,N/A,N/A," $3,514.00 "," $2,284.10 "," $2,833.82 ", $610.28 , $907.22 ," $2,055.97 "," $2,075.88 "," $3,268.02 "," $3,162.60 "," $3,162.60 "," $2,811.20 "," $2,811.20 ", $907.22 ," $3,244.48 "," $3,338.30 "," $3,162.60 "," $3,162.60 "," $3,162.60 "," $3,268.02 "," $3,373.44 "," $2,661.74 "," $2,986.90 "," $3,307.65 "," $3,104.06 ", N/A ," $2,096.09 "," $2,096.09 "," $3,338.30 "," $2,512.29 ", $610.28 ," $3,373.44 "
Gonadotropin (Lh),CPT® 83002,N/A,N/A,N/A, $172.00 , $111.80 , N/A , $18.89 , $18.89 , $104.77 , $125.35 , $159.96 , $154.80 , $154.80 , $137.60 , $137.60 , $18.89 , $158.81 , $163.40 , $154.80 , $154.80 , $154.80 , $159.96 , $165.12 , $123.66 , $146.20 , $121.64 , $67.14 , N/A , $97.78 , $97.78 , $163.40 , $106.85 , $18.89 , $165.12 
 Injection Anes Greater Occipital Area ,CPT® 64405,0761 - TREATMENT ROOM,N/A,N/A, $610.00 , $396.50 , $512.40 , $48.34 , $45.90 , $492.88 , $549.00 , $516.43 , $549.00 , $549.00 , $549.00 , $518.50 , $45.00 , $563.21 , $579.50 , $518.50 , $567.30 , $567.30 , $579.50 , $585.60 , $499.10 , $549.00 , $518.50 , $481.90 , N/A , $493.67 , $493.67 , $579.50 , $523.44 , $45.00 , $585.60 
Ambulatory Bp Mntr W/Sw 24 Hr+ Review W/I&R,CPT® 93790,N/A,N/A,N/A, $292.00 , $189.80 , $115.83 , $17.84 , $19.59 , $103.24 , $104.61 , $271.56 , $262.80 , $262.80 , $233.60 , $233.60 , $19.59 , $269.60 , $277.40 , $262.80 , $262.80 , $262.80 , $271.56 , $280.32 , $114.50 , $248.20 , $96.34 , $72.06 , N/A , $105.26 , $105.26 , $277.40 , $116.67 , $17.84 , $280.32 
"Hemorrhoidectomy,External",CPT® 46250,N/A,N/A,N/A," $2,999.00 "," $1,949.35 "," $1,965.02 ", $304.55 , $307.34 ," $1,492.61 "," $1,526.34 "," $2,789.07 "," $2,699.10 "," $2,699.10 "," $2,399.20 "," $2,399.20 ", $307.34 ," $2,768.98 "," $2,849.05 "," $2,699.10 "," $2,699.10 "," $2,699.10 "," $2,789.07 "," $2,879.04 "," $1,405.70 "," $2,549.15 "," $1,682.37 "," $1,780.26 ", N/A ," $1,521.74 "," $1,521.74 "," $2,849.05 "," $1,591.57 ", $304.55 ," $2,879.04 "
"Macroscopic Exam, Parasite",CPT® 87169,N/A,N/A,N/A, $62.00 , $40.30 , N/A , $4.40 , $4.40 , $24.15 , $28.90 , $57.66 , $55.80 , $55.80 , $49.60 , $49.60 , $4.40 , $57.24 , $58.90 , $55.80 , $55.80 , $55.80 , $57.66 , $59.52 , $28.78 , $52.70 , $27.57 , $15.48 , N/A , $22.54 , $22.54 , $58.90 , $24.63 , $4.40 , $59.52 
 Fac Chemodenervation 1 Extremity 5 or More Muscles ,CPT® 64644,0360 - OR SERVICES,N/A,N/A, $996.00 , $647.40 , $836.64 , $107.42 , $86.61 , $804.77 , $896.40 , $843.21 , $896.40 , $896.40 , $896.40 , $846.60 , $84.91 , $919.61 , $946.20 , $846.60 , $926.28 , $926.28 , $946.20 , $956.16 , $814.93 , $896.40 , $846.60 , $786.84 , N/A , $806.06 , $806.06 , $946.20 , $854.67 , $84.91 , $956.16 
 Fac Assay of Urine Phosphorus ,CPT® 84105,0301 - LAB/CHEMISTRY,N/A,N/A, $61.00 , $39.65 , $51.24 , $5.90 , $5.90 , $49.29 , $54.90 , $51.64 , $54.90 , $54.90 , $54.90 , $51.85 , $5.78 , $56.32 , $57.95 , $51.85 , $56.73 , $56.73 , $57.95 , $58.56 , $49.91 , $54.90 , $51.85 , $48.19 , N/A , $49.37 , $49.37 , $57.95 , $52.34 , $5.78 , $58.56 
 Simulation - Simple ,CPT® 77280,0333 - RADIATION RX,N/A,N/A," $2,898.00 "," $1,883.70 "," $2,434.32 ", $265.10 , $174.36 ," $2,341.58 "," $2,608.20 "," $2,453.45 "," $2,608.20 "," $2,608.20 "," $2,608.20 "," $2,463.30 ", $170.94 ," $2,675.72 "," $2,753.10 "," $2,463.30 "," $2,695.14 "," $2,695.14 "," $2,753.10 "," $2,782.08 "," $2,371.14 "," $2,608.20 "," $2,463.30 "," $2,289.42 ", N/A ," $2,345.35 "," $2,345.35 "," $2,753.10 "," $2,486.77 ", $170.94 ," $2,782.08 "
" Fac Enterovirus, Dna, Amp Probe ",CPT® 87498,0306 - LAB/BACT-MICRO,N/A,N/A, $302.00 , $196.30 , $253.68 , $35.79 , $35.79 , $244.02 , $271.80 , $255.67 , $271.80 , $271.80 , $271.80 , $256.70 , $35.09 , $278.84 , $286.90 , $256.70 , $280.86 , $280.86 , $286.90 , $289.92 , $247.10 , $271.80 , $256.70 , $238.58 , N/A , $244.41 , $244.41 , $286.90 , $259.15 , $35.09 , $289.92 
 Pro Prolong Outpt/Office Vis ,HCPCS G2212,0982 - PRO FEE/OUTPT,N/A,N/A, $137.00 , $89.05 , $63.88 , $30.39 , $25.49 , N/A , N/A , $127.41 , $123.30 , $123.30 , $109.60 , $109.60 , $25.49 , $126.49 , $130.15 , $123.30 , $123.30 , $123.30 , $127.41 , $131.52 , $58.33 , $116.45 , $59.45 , $71.61 , N/A , $56.72 , $56.72 , $130.15 , $70.91 , $25.49 , $131.52 
" Removal of Foreign Body, Foot Subcu - Mh ",CPT® 28190,0761 - TREATMENT ROOM,N/A,N/A," $1,043.00 ", $677.95 , $876.12 , $128.35 , $42.71 , $842.74 , $938.70 , $883.00 , $938.70 , $938.70 , $938.70 , $886.55 , $41.87 , $963.00 , $990.85 , $886.55 , $969.99 , $969.99 , $990.85 ," $1,001.28 ", $853.38 , $938.70 , $886.55 , $823.97 , N/A , $844.10 , $844.10 , $990.85 , $895.00 , $41.87 ," $1,001.28 "
 BEVACIZUMAB-AWWB 100 MG/4ML IV SOLN ,HCPCS Q5107,0636 - DRUGS REQUIRING DETAILED CODIN,55513-0206-01,4 mL," $2,051.56 "," $1,333.51 "," $1,723.31 ", $28.97 , $32.33 ," $1,657.66 "," $1,846.40 "," $1,736.85 "," $1,846.40 "," $1,846.40 "," $1,846.40 "," $1,743.83 ", $31.70 ," $1,894.21 "," $1,948.98 "," $1,743.83 "," $1,907.95 "," $1,907.95 "," $1,948.98 "," $1,969.50 "," $1,678.59 "," $1,846.40 "," $1,743.83 "," $1,620.73 ", N/A ," $1,660.33 "," $1,660.33 "," $1,948.98 "," $1,760.44 ", $28.97 ," $1,969.50 "
 Rmvl Foreign Body Foot ,CPT® 28193,0761 - TREATMENT ROOM,N/A,N/A," $2,614.00 "," $1,699.10 "," $2,195.76 ", $356.58 , $214.44 ," $2,112.11 "," $2,352.60 "," $2,213.01 "," $2,352.60 "," $2,352.60 "," $2,352.60 "," $2,221.90 ", $210.24 ," $2,413.51 "," $2,483.30 "," $2,221.90 "," $2,431.02 "," $2,431.02 "," $2,483.30 "," $2,509.44 "," $2,138.77 "," $2,352.60 "," $2,221.90 "," $2,065.06 ", N/A ," $2,115.51 "," $2,115.51 "," $2,483.30 "," $2,243.07 ", $210.24 ," $2,509.44 "
 WARFARIN SODIUM 6 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00832-1217-01,1 tablet, $4.56 , $2.96 , $3.83 , N/A , N/A , $3.68 , $4.10 , $3.86 , $4.10 , $4.10 , $4.10 , $3.88 , N/A , $4.21 , $4.33 , $3.88 , $4.24 , $4.24 , $4.33 , $4.38 , $3.73 , $4.10 , $3.88 , $3.60 , N/A , $3.69 , $3.69 , $4.33 , $3.91 , $3.60 , $4.38 
 Pacemaker Single Lead Reprogrammin ,CPT® 93279,0480 - CARDIOLOGY,N/A,N/A, $325.00 , $211.25 , $273.00 , $67.13 , $42.62 , $262.60 , $292.50 , $275.15 , $292.50 , $292.50 , $292.50 , $276.25 , $41.78 , $300.07 , $308.75 , $276.25 , $302.25 , $302.25 , $308.75 , $312.00 , $265.92 , $292.50 , $276.25 , $256.75 , N/A , $263.02 , $263.02 , $308.75 , $278.88 , $41.78 , $312.00 
 ROSUVASTATIN CALCIUM 20 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,68462-0263-90,1 tablet, $45.95 , $29.87 , $38.60 , N/A , N/A , $37.13 , $41.36 , $38.90 , $41.36 , $41.36 , $41.36 , $39.06 , N/A , $42.43 , $43.65 , $39.06 , $42.73 , $42.73 , $43.65 , $44.11 , $37.60 , $41.36 , $39.06 , $36.30 , N/A , $37.19 , $37.19 , $43.65 , $39.43 , $36.30 , $44.11 
Thoracoscopy W/Segmentectomy,CPT® 32669,N/A,N/A,N/A," $8,065.00 "," $5,242.25 "," $6,943.93 "," $1,212.74 "," $1,541.22 "," $5,081.72 "," $4,958.61 "," $7,500.45 "," $7,258.50 "," $7,258.50 "," $6,452.00 "," $6,452.00 "," $1,541.22 "," $7,446.41 "," $7,661.75 "," $7,258.50 "," $7,258.50 "," $7,258.50 "," $7,500.45 "," $7,742.40 "," $6,727.41 "," $6,855.25 "," $7,170.15 "," $6,659.59 ", N/A ," $5,180.87 "," $5,180.87 "," $7,661.75 "," $6,101.57 "," $1,212.74 "," $7,742.40 "
 Pro Neurp&/Trpos UR Nrv Elbw ,CPT® 64718,0975 - PRO FEE/OR,N/A,N/A," $3,886.00 "," $2,525.90 "," $2,935.92 ", $578.30 , $486.60 ," $3,246.74 "," $3,188.24 "," $3,613.98 "," $3,497.40 "," $3,497.40 "," $3,108.80 "," $3,108.80 ", $486.60 ," $3,587.94 "," $3,691.70 "," $3,497.40 "," $3,497.40 "," $3,497.40 "," $3,613.98 "," $3,730.56 "," $3,158.37 "," $3,303.10 "," $3,161.36 "," $3,490.52 ", N/A ," $3,310.09 "," $3,310.09 "," $3,691.70 "," $3,550.93 ", $486.60 ," $3,730.56 "
Visit to Determ Ldct Elig,HCPCS G0296,N/A,N/A,N/A, $177.00 , $115.05 , $124.60 , $24.98 , N/A , $99.64 , N/A , $164.61 , $159.30 , $159.30 , $141.60 , $141.60 , N/A , $163.42 , $168.15 , $159.30 , $159.30 , $159.30 , $164.61 , $169.92 , $47.78 , $150.45 , $49.11 , $56.46 , N/A , $101.59 , $101.59 , $168.15 , $126.97 , $24.98 , $169.92 
 Fac Endoscopic Papilla Cannulation Bile/Pancreatic ,CPT® 43273,0360 - OR SERVICES,N/A,N/A," $1,443.00 ", $937.95 ," $1,212.12 ", $112.32 , $121.40 ," $1,165.94 "," $1,298.70 "," $1,221.64 "," $1,298.70 "," $1,298.70 "," $1,298.70 "," $1,226.55 ", $119.02 ," $1,332.32 "," $1,370.85 "," $1,226.55 "," $1,341.99 "," $1,341.99 "," $1,370.85 "," $1,385.28 "," $1,180.66 "," $1,298.70 "," $1,226.55 "," $1,139.97 ", N/A ," $1,167.82 "," $1,167.82 "," $1,370.85 "," $1,238.24 ", $112.32 ," $1,385.28 "
 Fac Perq Dilation Xst Trc New Access Renal Coltj Sys ,CPT® 50437,0361 - OR/MINOR,N/A,N/A," $7,651.00 "," $4,973.15 "," $6,426.84 ", $236.77 , $203.29 ," $6,182.01 "," $6,885.90 "," $6,477.34 "," $6,885.90 "," $6,885.90 "," $6,885.90 "," $6,503.35 ", $199.30 ," $7,064.17 "," $7,268.45 "," $6,503.35 "," $7,115.43 "," $7,115.43 "," $7,268.45 "," $7,344.96 "," $6,260.05 "," $6,885.90 "," $6,503.35 "," $6,044.29 ", N/A ," $6,191.95 "," $6,191.95 "," $7,268.45 "," $6,565.32 ", $199.30 ," $7,344.96 "
Prolong home eval add 15m,HCPCS G0318,N/A,N/A,N/A, $104.00 , $67.60 , N/A , $29.07 , $23.72 , N/A , N/A , $96.72 , $93.60 , $93.60 , $83.20 , $83.20 , $23.72 , $96.02 , $98.80 , $93.60 , $93.60 , $93.60 , $96.72 , $99.84 , N/A , $88.40 , $56.86 , N/A , N/A , $49.06 , $49.06 , $98.80 , $61.32 , $23.72 , $99.84 
Urine Bact Cult ID,CPT® 87088,N/A,N/A,N/A, $88.00 , $57.20 , N/A , $8.25 , $8.25 , $45.82 , $54.80 , $81.84 , $79.20 , $79.20 , $70.40 , $70.40 , $8.25 , $81.25 , $83.60 , $79.20 , $79.20 , $79.20 , $81.84 , $84.48 , $54.02 , $74.80 , $53.52 , $29.34 , N/A , $42.76 , $42.76 , $83.60 , $46.72 , $8.25 , $84.48 
 Fac Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq ,CPT® 45385,0360 - OR SERVICES,N/A,N/A," $3,374.00 "," $2,193.10 "," $2,834.16 ", $240.44 , $476.76 ," $2,726.19 "," $3,036.60 "," $2,856.43 "," $3,036.60 "," $3,036.60 "," $3,036.60 "," $2,867.90 ", $467.41 ," $3,115.21 "," $3,205.30 "," $2,867.90 "," $3,137.82 "," $3,137.82 "," $3,205.30 "," $3,239.04 "," $2,760.61 "," $3,036.60 "," $2,867.90 "," $2,665.46 ", N/A ," $2,730.58 "," $2,730.58 "," $3,205.30 "," $2,895.23 ", $240.44 ," $3,239.04 "
Surgery to Stop Tib/Fib Growth,CPT® 27477,N/A,N/A,N/A," $5,183.00 "," $3,368.95 "," $4,460.56 ", $699.03 , $845.22 ," $3,533.84 "," $3,507.53 "," $4,820.19 "," $4,664.70 "," $4,664.70 "," $4,146.40 "," $4,146.40 ", $845.22 ," $4,785.46 "," $4,923.85 "," $4,664.70 "," $4,664.70 "," $4,664.70 "," $4,820.19 "," $4,975.68 "," $4,146.15 "," $4,405.55 "," $3,874.99 "," $4,160.68 ", N/A ," $3,602.79 "," $3,602.79 "," $4,923.85 "," $4,234.55 ", $699.03 ," $4,975.68 "
 CEFEPIME HCL 2 G IV SOLR ,HCPCS J0692,0636 - DRUGS REQUIRING DETAILED CODIN,44567-0241-10,10 mL, $60.41 , $39.27 , $50.74 , $1.25 , $1.32 , $48.81 , $54.37 , $51.14 , $54.37 , $54.37 , $54.37 , $51.35 , $1.29 , $55.78 , $57.39 , $51.35 , $56.18 , $56.18 , $57.39 , $57.99 , $49.43 , $54.37 , $51.35 , $47.72 , N/A , $48.89 , $48.89 , $57.39 , $51.84 , $1.25 , $57.99 
Appl Mlt-Layer Venous Wound Compress Below Knee,29581,N/A,N/A,N/A, $552.00 , $358.80 , $174.46 , $26.75 , $73.50 , $64.70 , $62.04 , $513.36 , $496.80 , $496.80 , $441.60 , $441.60 , $73.50 , $509.66 , $524.40 , $496.80 , $496.80 , $496.80 , $513.36 , $529.92 , $163.06 , $469.20 , $66.01 , $167.13 , N/A , $65.96 , $65.96 , $524.40 , $77.53 , $26.75 , $529.92 
Evaluation of Speech Sound Production Articulate,CPT® 92522,N/A,N/A,N/A, $383.00 , $248.95 , $261.82 , $110.47 , $87.90 , $207.21 , $211.84 , $356.19 , $344.70 , $344.70 , $306.40 , $306.40 , $87.90 , $353.62 , $363.85 , $344.70 , $344.70 , $344.70 , $356.19 , $367.68 , $334.91 , $325.55 , $334.20 , $348.67 , N/A , $211.26 , $211.26 , $363.85 , $246.27 , $87.90 , $367.68 
"Explor Postop Bleed,Infec,Clot-Abd",CPT® 35840,N/A,N/A,N/A," $7,073.00 "," $4,597.45 "," $7,129.53 "," $1,109.49 ", $590.81 ," $5,082.89 "," $5,057.38 "," $6,577.89 "," $6,365.70 "," $6,365.70 "," $5,658.40 "," $5,658.40 ", $590.81 ," $6,530.50 "," $6,719.35 "," $6,365.70 "," $6,365.70 "," $6,365.70 "," $6,577.89 "," $6,790.08 "," $6,553.63 "," $6,012.05 "," $6,353.05 "," $5,762.89 ", N/A ," $5,182.06 "," $5,182.06 "," $6,719.35 "," $5,886.81 ", $590.81 ," $7,129.53 "
 NORTRIPTYLINE HCL 50 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,50268-0605-15,1 capsule, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
" Fac Candida, Dna, Dir Probe ",CPT® 87480,0306 - LAB/BACT-MICRO,N/A,N/A, $118.00 , $76.70 , $99.12 , $20.45 , $20.45 , $95.34 , $106.20 , $99.90 , $106.20 , $106.20 , $106.20 , $100.30 , $20.05 , $108.95 , $112.10 , $100.30 , $109.74 , $109.74 , $112.10 , $113.28 , $96.55 , $106.20 , $100.30 , $93.22 , N/A , $95.50 , $95.50 , $112.10 , $101.26 , $20.05 , $113.28 
Subsequent Intensive Care Infant < 1500 Grams,CPT® 99478,N/A,N/A,N/A, $877.00 , $570.05 , $273.76 , $129.95 , $196.88 , $373.87 , $378.26 , $815.61 , $789.30 , $789.30 , $701.60 , $701.60 , $196.88 , $809.73 , $833.15 , $789.30 , $789.30 , $789.30 , $815.61 , $841.92 , $344.49 , $745.45 , $303.04 , $454.19 , N/A , $381.17 , $381.17 , $833.15 , $456.08 , $129.95 , $841.92 
"Subsequent Observation Care,Level III",CPT® 99226,N/A,N/A,N/A, $278.00 , $180.70 , $202.69 , N/A , N/A , $181.48 , $179.73 , $258.54 , $250.20 , $250.20 , $222.40 , $222.40 , N/A , $256.68 , $264.10 , $250.20 , $250.20 , $250.20 , $258.54 , $266.88 , $306.18 , $236.30 , N/A , $230.31 , N/A , N/A , N/A , $264.10 , N/A , $179.73 , $306.18 
 CARVEDILOL 3.125 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6300-61,1 tablet, $10.80 , $7.02 , $9.07 , N/A , N/A , $8.73 , $9.72 , $9.14 , $9.72 , $9.72 , $9.72 , $9.18 , N/A , $9.97 , $10.26 , $9.18 , $10.04 , $10.04 , $10.26 , $10.37 , $8.84 , $9.72 , $9.18 , $8.53 , N/A , $8.74 , $8.74 , $10.26 , $9.27 , $8.53 , $10.37 
 CLONIDINE HCL 0.1 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60687-0113-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 BUPRENORPHINE HCL-NALOXONE HCL 4-1 MG SL FILM ,HCPCS RXA250,0250 - PHARMACY,47781-0356-03,1 Film, $45.16 , $29.35 , $37.93 , N/A , N/A , $36.49 , $40.64 , $38.23 , $40.64 , $40.64 , $40.64 , $38.39 , N/A , $41.70 , $42.90 , $38.39 , $42.00 , $42.00 , $42.90 , $43.35 , $36.95 , $40.64 , $38.39 , $35.68 , N/A , $36.55 , $36.55 , $42.90 , $38.75 , $35.68 , $43.35 
 Pro Cltx Articular Fx Invg Mtcarphlngl/Iphal Jt W/O ,CPT® 26740,0981 - PRO FEE/ER,N/A,N/A, $914.00 , $594.10 ," $1,375.21 ", $218.73 , $126.34 ," $1,034.45 "," $1,051.56 ", $850.02 , $822.60 , $822.60 , $731.20 , $731.20 , $126.34 , $843.90 , $868.30 , $822.60 , $822.60 , $822.60 , $850.02 , $877.44 ," $1,266.41 ", $776.90 ," $1,150.72 "," $1,238.55 ", N/A ," $1,054.63 "," $1,054.63 ", $868.30 ," $1,239.57 ", $126.34 ," $1,375.21 "
 POVIDONE-IODINE 10 % EX OINT ,HCPCS RXC637,0250 - PHARMACY,00536-1271-80,28.4 gram, $9.20 , $5.98 , $7.73 , N/A , N/A , $7.43 , $8.28 , $7.79 , $8.28 , $8.28 , $8.28 , $7.82 , N/A , $8.49 , $8.74 , $7.82 , $8.56 , $8.56 , $8.74 , $8.83 , $7.53 , $8.28 , $7.82 , $7.27 , N/A , $7.45 , $7.45 , $8.74 , $7.89 , $7.27 , $8.83 
"Fix Entropion,Excis Tarsal Wedge",67923,N/A,N/A,N/A," $5,624.00 "," $3,655.60 "," $2,640.04 ", $414.85 , $461.04 ," $2,439.53 "," $2,491.22 "," $5,230.32 "," $5,061.60 "," $5,061.60 "," $4,499.20 "," $4,499.20 ", $461.04 ," $5,192.64 "," $5,342.80 "," $5,061.60 "," $5,061.60 "," $5,061.60 "," $5,230.32 "," $5,399.04 "," $3,624.90 "," $4,780.40 "," $2,581.54 "," $3,097.33 ", N/A ," $2,487.13 "," $2,487.13 "," $5,342.80 "," $2,745.46 ", $414.85 ," $5,399.04 "
" Fac Instill via Chest Tube Agent for Fibrinolysis, 1st Day ",CPT® 32561,0361 - OR/MINOR,N/A,N/A, $831.00 , $540.15 , $698.04 , $64.02 , $79.62 , $671.45 , $747.90 , $703.52 , $747.90 , $747.90 , $747.90 , $706.35 , $78.06 , $767.26 , $789.45 , $706.35 , $772.83 , $772.83 , $789.45 , $797.76 , $679.92 , $747.90 , $706.35 , $656.49 , N/A , $672.53 , $672.53 , $789.45 , $713.08 , $64.02 , $797.76 
"Burn Dressing,Lg,W/O Anes",CPT® 16030,N/A,N/A,N/A, $859.00 , $558.35 , $413.47 , $123.20 , $81.33 , $359.30 , $352.65 , $798.87 , $773.10 , $773.10 , $687.20 , $687.20 , $81.33 , $793.11 , $816.05 , $773.10 , $773.10 , $773.10 , $798.87 , $824.64 , $452.84 , $730.15 , $706.49 , $468.44 , N/A , $366.31 , $366.31 , $816.05 , $424.78 , $81.33 , $824.64 
 Fac Fine Needle Aspiration Bx W/US Gdn 1st Lesion ,CPT® 10005,0361 - OR/MINOR,N/A,N/A," $1,475.00 ", $958.75 ," $1,239.00 ", $70.37 , $100.23 ," $1,191.80 "," $1,327.50 "," $1,248.74 "," $1,327.50 "," $1,327.50 "," $1,327.50 "," $1,253.75 ", $98.26 ," $1,361.87 "," $1,401.25 "," $1,253.75 "," $1,371.75 "," $1,371.75 "," $1,401.25 "," $1,416.00 "," $1,206.85 "," $1,327.50 "," $1,253.75 "," $1,165.25 ", N/A ," $1,193.72 "," $1,193.72 "," $1,401.25 "," $1,265.70 ", $70.37 ," $1,416.00 "
 ZOSTER VAC RECOMB ADJUVANTED 50 MCG/0.5ML IM SUSR ,HCPCS 90750,0636 - DRUGS REQUIRING DETAILED CODIN,58160-0823-11,1 each," $1,130.56 ", $734.86 , $949.67 , N/A , $190.30 , $913.49 ," $1,017.50 ", $957.13 ," $1,017.50 "," $1,017.50 "," $1,017.50 ", $960.98 , $186.57 ," $1,043.85 "," $1,074.03 ", $960.98 ," $1,051.42 "," $1,051.42 "," $1,074.03 "," $1,085.34 ", $925.02 ," $1,017.50 ", $960.98 , $893.14 , N/A , $914.96 , $914.96 ," $1,074.03 ", $970.13 , $186.57 ," $1,085.34 "
"Removal External Ear,Partial",69110,N/A,N/A,N/A," $2,613.00 "," $1,698.45 "," $1,572.50 ", $319.31 , $219.95 ," $1,552.61 "," $1,616.18 "," $2,430.09 "," $2,351.70 "," $2,351.70 "," $2,090.40 "," $2,090.40 ", $219.95 ," $2,412.58 "," $2,482.35 "," $2,351.70 "," $2,351.70 "," $2,351.70 "," $2,430.09 "," $2,508.48 "," $1,708.71 "," $2,221.05 "," $1,764.44 "," $1,576.67 ", N/A ," $1,582.90 "," $1,582.90 "," $2,482.35 "," $1,807.42 ", $219.95 ," $2,508.48 "
"Assay, Gammaglobulin Ige",CPT® 82785,N/A,N/A,N/A, $152.00 , $98.80 , N/A , $16.79 , $16.79 , $93.17 , $111.47 , $141.36 , $136.80 , $136.80 , $121.60 , $121.60 , $16.79 , $140.34 , $144.40 , $136.80 , $136.80 , $136.80 , $141.36 , $145.92 , $109.91 , $129.20 , $108.66 , $59.68 , N/A , $86.95 , $86.95 , $144.40 , $95.02 , $16.79 , $145.92 
"Lap,Inguinal Hernia Repr,Initial",CPT® 49650,N/A,N/A,N/A," $3,308.00 "," $2,150.20 "," $2,598.83 ", $403.57 , $359.94 ," $2,009.15 "," $2,048.92 "," $3,076.44 "," $2,977.20 "," $2,977.20 "," $2,646.40 "," $2,646.40 ", $359.94 ," $3,054.28 "," $3,142.60 "," $2,977.20 "," $2,977.20 "," $2,977.20 "," $3,076.44 "," $3,175.68 "," $1,855.34 "," $2,811.80 "," $2,272.90 "," $2,383.24 ", N/A ," $2,048.35 "," $2,048.35 "," $3,142.60 "," $2,142.36 ", $359.94 ," $3,175.68 "
X-Ray Elbow 2 Vw,CPT® 73070,N/A,N/A,N/A, $275.00 , $178.75 , $163.79 , $28.73 , $26.19 , $129.44 , $152.06 , $255.75 , $247.50 , $247.50 , $220.00 , $220.00 , $26.19 , $253.91 , $261.25 , $247.50 , $247.50 , $247.50 , $255.75 , $264.00 , $159.36 , $233.75 , $167.57 , $136.80 , N/A , $131.97 , $131.97 , $261.25 , $152.74 , $26.19 , $264.00 
Inj Triamcinolone Ace Xr 1mg,HCPCS J3304,N/A,N/A,N/A, $33.00 , $21.45 , N/A , $17.45 , $17.29 , N/A , N/A , $30.69 , $29.70 , $29.70 , $26.40 , $26.40 , $17.29 , $30.47 , $31.35 , $29.70 , $29.70 , $29.70 , $30.69 , $31.68 , $23.40 , $28.05 , $32.31 , $22.08 , N/A , N/A , N/A , $31.35 , N/A , $17.29 , $32.31 
 DARBEPOETIN ALFA 25 MCG/0.42ML IJ SOSY ,HCPCS J0882,0636 - DRUGS REQUIRING DETAILED CODIN,55513-0057-04,0.42 mL, $568.96 , $369.82 , $477.93 , $3.00 , N/A , $459.72 , $512.06 , $481.68 , $512.06 , $512.06 , $512.06 , $483.62 , N/A , $525.32 , $540.51 , $483.62 , $529.13 , $529.13 , $540.51 , $546.20 , $465.52 , $512.06 , $483.62 , $449.48 , N/A , $460.46 , $460.46 , $540.51 , $488.22 , $3.00 , $546.20 
Inject for Retrograde Urethocysto,CPT® 51610,N/A,N/A,N/A, $756.00 , $491.40 , $346.61 , $61.24 , $25.41 , $316.81 , $294.68 , $703.08 , $680.40 , $680.40 , $604.80 , $604.80 , $25.41 , $698.01 , $718.20 , $680.40 , $680.40 , $680.40 , $703.08 , $725.76 , $346.52 , $642.60 , $333.62 , $395.24 , N/A , $322.99 , $322.99 , $718.20 , $379.64 , $25.41 , $725.76 
" Pro Skin Splt Grft, Trnk/Arm/Leg ",CPT® 15100,0975 - PRO FEE/OR,N/A,N/A," $4,851.00 "," $3,153.15 "," $2,265.05 ", $677.39 , $522.35 ," $1,945.58 "," $1,908.03 "," $4,511.43 "," $4,365.90 "," $4,365.90 "," $3,880.80 "," $3,880.80 ", $522.35 ," $4,478.93 "," $4,608.45 "," $4,365.90 "," $4,365.90 "," $4,365.90 "," $4,511.43 "," $4,656.96 "," $2,476.68 "," $4,123.35 "," $3,830.39 "," $2,471.69 ", N/A ," $1,983.54 "," $1,983.54 "," $4,608.45 "," $2,300.24 ", $522.35 ," $4,656.96 "
 Pro Treat Shoulder Dislocation ,CPT® 23650,0981 - PRO FEE/ER,N/A,N/A," $2,008.00 "," $1,305.20 "," $1,823.71 ", $292.70 , $192.43 ," $1,386.81 "," $1,412.59 "," $1,867.44 "," $1,807.20 "," $1,807.20 "," $1,606.40 "," $1,606.40 ", $192.43 ," $1,853.99 "," $1,907.60 "," $1,807.20 "," $1,807.20 "," $1,807.20 "," $1,867.44 "," $1,927.68 "," $1,671.17 "," $1,706.80 "," $1,548.57 "," $1,654.68 ", N/A ," $1,413.87 "," $1,413.87 "," $1,907.60 "," $1,661.81 ", $192.43 ," $1,927.68 "
 Pro MRI Lower Extremity W/O Dye ,CPT® 73718,0972 - PRO FEE/RAD/DX,N/A,N/A, $705.00 , $458.25 ," $1,613.64 ", $230.21 , $411.48 ," $1,734.14 "," $2,190.09 ", $655.65 , $634.50 , $634.50 , $564.00 , $564.00 , $411.48 , $650.93 , $669.75 , $634.50 , $634.50 , $634.50 , $655.65 , $676.80 ," $1,390.99 ", $599.25 ," $2,390.22 "," $2,835.74 ", N/A ," $1,767.98 "," $1,767.98 ", $669.75 ," $2,046.46 ", $230.21 ," $2,835.74 "
 Pro CT Neck Spine W/Dye ,CPT® 72126,0972 - PRO FEE/RAD/DX,N/A,N/A, $687.00 , $446.55 ," $1,202.67 ", $172.41 , $303.06 ," $1,092.39 "," $1,383.77 ", $638.91 , $618.30 , $618.30 , $549.60 , $549.60 , $303.06 , $634.31 , $652.65 , $618.30 , $618.30 , $618.30 , $638.91 , $659.52 ," $1,012.21 ", $583.95 ," $1,506.16 "," $1,478.94 ", N/A ," $1,113.70 "," $1,113.70 ", $652.65 ," $1,289.13 ", $172.41 ," $1,506.16 "
 MORPHINE SULF MICROINFUSION PF 200 MG/20ML (10 MG/ML) IJ SOLN ,HCPCS J2274,0636 - DRUGS REQUIRING DETAILED CODIN,00641-6039-01,20 mL," $1,282.17 ", $833.41 ," $1,077.02 ", $16.01 , $17.04 ," $1,035.99 "," $1,153.95 "," $1,085.49 "," $1,153.95 "," $1,153.95 "," $1,153.95 "," $1,089.84 ", $16.71 ," $1,183.83 "," $1,218.06 "," $1,089.84 "," $1,192.42 "," $1,192.42 "," $1,218.06 "," $1,230.88 "," $1,049.07 "," $1,153.95 "," $1,089.84 "," $1,012.91 ", N/A ," $1,037.66 "," $1,037.66 "," $1,218.06 "," $1,100.23 ", $16.01 ," $1,230.88 "
 NEOMYCIN-BACITRACIN ZN-POLYMYX 5-400-10000 OP OINT ,HCPCS RXC637,0250 - PHARMACY,24208-0780-55,3.5 gram, $292.54 , $190.15 , $245.73 , N/A , N/A , $236.37 , $263.29 , $247.66 , $263.29 , $263.29 , $263.29 , $248.66 , N/A , $270.10 , $277.91 , $248.66 , $272.06 , $272.06 , $277.91 , $280.84 , $239.36 , $263.29 , $248.66 , $231.11 , N/A , $236.75 , $236.75 , $277.91 , $251.03 , $231.11 , $280.84 
 Fac Assay of Urine Potassium ,CPT® 84133,0301 - LAB/CHEMISTRY,N/A,N/A, $55.00 , $35.75 , $46.20 , $4.82 , $4.82 , $44.44 , $49.50 , $46.56 , $49.50 , $49.50 , $49.50 , $46.75 , $4.73 , $50.78 , $52.25 , $46.75 , $51.15 , $51.15 , $52.25 , $52.80 , $45.00 , $49.50 , $46.75 , $43.45 , N/A , $44.51 , $44.51 , $52.25 , $47.20 , $4.73 , $52.80 
 Pro US Pelvic Nonob Real-Time Img Complete ,CPT® 76856,0972 - PRO FEE/RAD/DX,N/A,N/A, $309.00 , $200.85 , $604.71 , $104.51 , $99.44 , $525.68 , $660.93 , $287.37 , $278.10 , $278.10 , $247.20 , $247.20 , $99.44 , $285.30 , $293.55 , $278.10 , $278.10 , $278.10 , $287.37 , $296.64 , $608.05 , $262.65 , $718.41 , $620.29 , N/A , $535.94 , $535.94 , $293.55 , $620.37 , $99.44 , $718.41 
 Pro Insert Pessary/Other Device ,CPT® 57160,0982 - PRO FEE/OUTPT,N/A,N/A, $460.00 , $299.00 , $213.95 , $43.44 , $15.36 , $191.41 , $190.18 , $427.80 , $414.00 , $414.00 , $368.00 , $368.00 , $15.36 , $424.72 , $437.00 , $414.00 , $414.00 , $414.00 , $427.80 , $441.60 , $228.25 , $391.00 , $249.77 , $192.55 , N/A , $195.15 , $195.15 , $437.00 , $234.06 , $15.36 , $441.60 
 Pro Fixation of Shoulder ,CPT® 23700,0982 - PRO FEE/OUTPT,N/A,N/A," $1,288.00 ", $837.20 ," $1,194.77 ", $187.52 , $142.01 , $946.55 , $942.80 ," $1,197.84 "," $1,159.20 "," $1,159.20 "," $1,030.40 "," $1,030.40 ", $142.01 ," $1,189.21 "," $1,223.60 "," $1,159.20 "," $1,159.20 "," $1,159.20 "," $1,197.84 "," $1,236.48 "," $1,107.03 "," $1,094.80 "," $1,038.33 "," $1,116.76 ", N/A , $965.02 , $965.02 ," $1,223.60 "," $1,134.26 ", $142.01 ," $1,236.48 "
 Chest Pain ,MS DRG V40 (FY2023) 313,N/A,N/A,N/A," $11,457.94 "," $7,447.66 "," $9,624.67 ", N/A , N/A ," $9,258.02 "," $10,312.15 "," $9,700.29 "," $10,312.15 "," $10,312.15 "," $10,312.15 "," $9,739.25 ", N/A ," $10,579.12 "," $10,885.04 "," $9,739.25 "," $10,655.88 "," $10,655.88 "," $10,885.04 "," $10,999.62 "," $9,374.89 "," $10,312.15 "," $9,739.25 "," $9,051.77 ", N/A ," $9,272.91 "," $9,272.91 "," $10,885.04 "," $9,832.06 "," $9,051.77 "," $10,999.62 "
Reconstr Total Shoulder Implant,CPT® 23472,N/A,N/A,N/A," $5,844.00 "," $3,798.60 "," $8,726.19 "," $1,362.37 "," $1,327.39 "," $7,041.56 "," $6,985.49 "," $5,434.92 "," $5,259.60 "," $5,259.60 "," $4,675.20 "," $4,675.20 "," $1,327.39 "," $5,395.77 "," $5,551.80 "," $5,259.60 "," $5,259.60 "," $5,259.60 "," $5,434.92 "," $5,610.24 "," $8,144.18 "," $4,967.40 "," $7,732.13 "," $8,275.48 ", N/A ," $7,178.95 "," $7,178.95 "," $5,551.80 "," $8,437.82 "," $1,327.39 "," $8,726.19 "
 MITOMYCIN 0.4 MG/ML EYE DROPS ,HCPCS J7315,0636 - DRUGS REQUIRING DETAILED CODIN,00001-0227-01,1 mL, $667.60 , $433.94 , $560.78 , N/A , N/A , $539.42 , $600.84 , $565.19 , $600.84 , $600.84 , $600.84 , $567.46 , N/A , $616.40 , $634.22 , $567.46 , $620.87 , $620.87 , $634.22 , $640.90 , $546.23 , $600.84 , $567.46 , $527.40 , N/A , $540.29 , $540.29 , $634.22 , $572.87 , $527.40 , $640.90 
"Excise Excess Skin Tissue,Leg",CPT® 15833,N/A,N/A,N/A," $5,359.00 "," $3,483.35 "," $2,786.95 ", $835.82 , $401.40 ," $2,371.76 "," $2,328.90 "," $4,983.87 "," $4,823.10 "," $4,823.10 "," $4,287.20 "," $4,287.20 ", $401.40 ," $4,947.96 "," $5,091.05 "," $4,823.10 "," $4,823.10 "," $4,823.10 "," $4,983.87 "," $5,144.64 "," $3,050.69 "," $4,555.15 "," $4,674.25 "," $3,031.78 ", N/A ," $2,418.04 "," $2,418.04 "," $5,091.05 "," $2,804.12 ", $401.40 ," $5,144.64 "
Removal Drug Implant Device,11982,N/A,N/A,N/A, $576.00 , $374.40 , $232.87 , $69.06 , $93.57 , $272.59 , $254.08 , $535.68 , $518.40 , $518.40 , $460.80 , $460.80 , $93.57 , $531.82 , $547.20 , $518.40 , $518.40 , $518.40 , $535.68 , $552.96 , $258.07 , $489.60 , $504.89 , $345.36 , N/A , $277.91 , $277.91 , $547.20 , $322.29 , $69.06 , $552.96 
 Fac Chg Radiologic Exam Chest 3 Views ,CPT® 71047,0324 - DX X-RAY/CHEST,N/A,N/A, $373.00 , $242.45 , $313.32 , $41.73 , $30.77 , $301.38 , $335.70 , $315.78 , $335.70 , $335.70 , $335.70 , $317.05 , $30.17 , $344.39 , $354.35 , $317.05 , $346.89 , $346.89 , $354.35 , $358.08 , $305.19 , $335.70 , $317.05 , $294.67 , N/A , $301.87 , $301.87 , $354.35 , $320.07 , $30.17 , $358.08 
"Hsv, Dna, Amp Probe",CPT® 87529,N/A,N/A,N/A, $324.00 , $210.60 , N/A , $35.79 , $35.79 , $198.56 , $237.51 , $301.32 , $291.60 , $291.60 , $259.20 , $259.20 , $35.79 , $299.15 , $307.80 , $291.60 , $291.60 , $291.60 , $301.32 , $311.04 , $234.30 , $275.40 , $230.30 , $127.26 , N/A , $185.31 , $185.31 , $307.80 , $202.50 , $35.79 , $311.04 
Part Remv Talus or Calcaneus,CPT® 28120,N/A,N/A,N/A," $4,464.00 "," $2,901.60 "," $3,061.44 ", $479.04 , $384.19 ," $2,434.25 "," $2,436.06 "," $4,151.52 "," $4,017.60 "," $4,017.60 "," $3,571.20 "," $3,571.20 ", $384.19 ," $4,121.61 "," $4,240.80 "," $4,017.60 "," $4,017.60 "," $4,017.60 "," $4,151.52 "," $4,285.44 "," $2,844.60 "," $3,794.40 "," $2,661.82 "," $2,885.84 ", N/A ," $2,481.75 "," $2,481.75 "," $4,240.80 "," $2,916.93 ", $384.19 ," $4,285.44 "
Incisional Biopsy Skin Single Lesion,11106,N/A,N/A,N/A, $600.00 , $390.00 , $182.51 , $53.95 , $118.70 , $154.51 , N/A , $558.00 , $540.00 , $540.00 , $480.00 , $480.00 , $118.70 , $553.98 , $570.00 , $540.00 , $540.00 , $540.00 , $558.00 , $576.00 , $203.73 , $510.00 , $296.75 , $211.83 , N/A , $157.53 , $157.53 , $570.00 , $182.68 , $53.95 , $576.00 
 Fac Transtelephonic Rhythm Strip Pacemaker Eval ,CPT® 93293,0732 - TELEMETRY,N/A,N/A, $182.00 , $118.30 , $152.88 , $44.76 , $49.26 , $147.06 , $163.80 , $154.08 , $163.80 , $163.80 , $163.80 , $154.70 , $48.29 , $168.04 , $172.90 , $154.70 , $169.26 , $169.26 , $172.90 , $174.72 , $148.91 , $163.80 , $154.70 , $143.78 , N/A , $147.29 , $147.29 , $172.90 , $156.17 , $44.76 , $174.72 
 LEUPROLIDE ACETATE (3 MONTH) 11.25 MG IM KIT ,HCPCS J1950,0636 - DRUGS REQUIRING DETAILED CODIN,00074-3663-03,1 each," $14,410.52 "," $9,366.84 "," $12,104.84 "," $1,574.39 "," $1,510.51 "," $11,643.70 "," $12,969.47 "," $12,199.95 "," $12,969.47 "," $12,969.47 "," $12,969.47 "," $12,248.94 "," $1,480.89 "," $13,305.23 "," $13,689.99 "," $12,248.94 "," $13,401.78 "," $13,401.78 "," $13,689.99 "," $13,834.10 "," $11,790.69 "," $12,969.47 "," $12,248.94 "," $11,384.31 ", N/A ," $11,662.43 "," $11,662.43 "," $13,689.99 "," $12,365.67 "," $1,480.89 "," $13,834.10 "
"Hysteroscopy,Dx,Sep Proc",58555,N/A,N/A,N/A," $2,046.00 "," $1,329.90 ", $703.35 , $143.00 , $165.56 , $773.00 , $770.48 ," $1,902.78 "," $1,841.40 "," $1,841.40 "," $1,636.80 "," $1,636.80 ", $165.56 ," $1,889.07 "," $1,943.70 "," $1,841.40 "," $1,841.40 "," $1,841.40 "," $1,902.78 "," $1,964.16 ", $743.43 ," $1,739.10 "," $1,013.35 ", $631.69 , N/A , $788.08 , $788.08 ," $1,943.70 ", $945.25 , $143.00 ," $1,964.16 "
" Bypass Graft, W/Vein; Brachial-Ulnar or -Radial ",CPT® 35523,0360 - OR SERVICES,N/A,N/A," $11,274.00 "," $7,328.10 "," $9,470.16 "," $1,129.16 ", $967.18 ," $9,109.39 "," $10,146.60 "," $9,544.57 "," $10,146.60 "," $10,146.60 "," $10,146.60 "," $9,582.90 ", $948.22 ," $10,409.28 "," $10,710.30 "," $9,582.90 "," $10,484.82 "," $10,484.82 "," $10,710.30 "," $10,823.04 "," $9,224.39 "," $10,146.60 "," $9,582.90 "," $8,906.46 ", N/A ," $9,124.05 "," $9,124.05 "," $10,710.30 "," $9,674.22 ", $948.22 ," $10,823.04 "
Layer Closure 2.6-7.5cm,CPT® 12032,N/A,N/A,N/A," $1,160.00 ", $754.00 , $608.50 , $183.18 , $82.48 , $532.01 , $524.46 ," $1,078.80 "," $1,044.00 "," $1,044.00 ", $928.00 , $928.00 , $82.48 ," $1,071.03 "," $1,102.00 "," $1,044.00 "," $1,044.00 "," $1,044.00 "," $1,078.80 "," $1,113.60 ", $668.28 , $986.00 ," $1,043.68 ", $685.38 , N/A , $542.39 , $542.39 ," $1,102.00 ", $628.99 , $82.48 ," $1,113.60 "
Cast Sup Shrt Leg Plaster,HCPCS Q4037,N/A,N/A,N/A, $40.00 , $26.00 , N/A , $19.91 , $12.91 , N/A , N/A , $37.20 , $36.00 , $36.00 , $32.00 , $32.00 , $12.91 , $36.93 , $38.00 , $36.00 , $36.00 , $36.00 , $37.20 , $38.40 , N/A , $34.00 , $84.99 , $18.10 , N/A , N/A , N/A , $38.00 , N/A , $12.91 , $84.99 
" IR Perc Implant Neurostim Electrode, Sacral Nerve Inc Guidance ",CPT® 64561,0360 - OR SERVICES,N/A,N/A," $19,023.00 "," $12,364.95 "," $15,979.32 ", $288.45 , $788.34 ," $15,370.58 "," $17,120.70 "," $16,104.87 "," $17,120.70 "," $17,120.70 "," $17,120.70 "," $16,169.55 ", $772.88 ," $17,563.94 "," $18,071.85 "," $16,169.55 "," $17,691.39 "," $17,691.39 "," $18,071.85 "," $18,262.08 "," $15,564.62 "," $17,120.70 "," $16,169.55 "," $15,028.17 ", N/A ," $15,395.31 "," $15,395.31 "," $18,071.85 "," $16,323.64 ", $288.45 ," $18,262.08 "
 Nasal Bones Min 3vw- Mh ,CPT® 70160,0972 - PRO FEE/RAD/DX,N/A,N/A, $111.00 , $72.15 , $214.95 , $37.62 , $30.01 , $153.99 , $178.47 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $30.01 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $208.47 , $94.35 , $196.46 , $165.59 , N/A , $156.99 , $156.99 , $105.45 , $181.71 , $30.01 , $214.95 
Exc Mediastinal Cyst,CPT® 39200,N/A,N/A,N/A," $5,011.00 "," $3,257.15 "," $3,454.53 ", $788.87 ," $1,229.45 "," $3,077.91 "," $3,126.61 "," $4,660.23 "," $4,509.90 "," $4,509.90 "," $4,008.80 "," $4,008.80 "," $1,229.45 "," $4,626.66 "," $4,760.45 "," $4,509.90 "," $4,509.90 "," $4,509.90 "," $4,660.23 "," $4,810.56 "," $4,726.77 "," $4,259.35 "," $4,670.68 "," $3,980.50 ", N/A ," $3,137.96 "," $3,137.96 "," $4,760.45 "," $3,637.20 ", $788.87 ," $4,810.56 "
 Pro Cltx Med Ankle Fx W/Mnpj ,CPT® 27762,0982 - PRO FEE/OUTPT,N/A,N/A," $1,416.00 ", $920.40 ," $2,693.02 ", $424.52 , $423.69 ," $2,081.98 "," $2,113.34 "," $1,316.88 "," $1,274.40 "," $1,274.40 "," $1,132.80 "," $1,132.80 ", $423.69 ," $1,307.39 "," $1,345.20 "," $1,274.40 "," $1,274.40 "," $1,274.40 "," $1,316.88 "," $1,359.36 "," $2,468.04 "," $1,203.60 "," $2,322.85 "," $2,446.54 ", N/A ," $2,122.61 "," $2,122.61 "," $1,345.20 "," $2,494.81 ", $423.69 ," $2,693.02 "
 Fac Bx Anrct Wall Anal Appr ,CPT® 45100,0360 - OR SERVICES,N/A,N/A," $4,208.00 "," $2,735.20 "," $3,534.72 ", $288.87 , $230.52 ," $3,400.06 "," $3,787.20 "," $3,562.49 "," $3,787.20 "," $3,787.20 "," $3,787.20 "," $3,576.80 ", $226.00 ," $3,885.25 "," $3,997.60 "," $3,576.80 "," $3,913.44 "," $3,913.44 "," $3,997.60 "," $4,039.68 "," $3,442.99 "," $3,787.20 "," $3,576.80 "," $3,324.32 ", N/A ," $3,405.53 "," $3,405.53 "," $3,997.60 "," $3,610.88 ", $226.00 ," $4,039.68 "
 Fac Blood Clot Inhibitor Test ,CPT® 85303,0305 - LAB/HEMATOLOGY,N/A,N/A, $272.00 , $176.80 , $228.48 , $14.12 , $14.12 , $219.78 , $244.80 , $230.28 , $244.80 , $244.80 , $244.80 , $231.20 , $13.84 , $251.14 , $258.40 , $231.20 , $252.96 , $252.96 , $258.40 , $261.12 , $222.55 , $244.80 , $231.20 , $214.88 , N/A , $220.13 , $220.13 , $258.40 , $233.40 , $13.84 , $261.12 
Arthrocentisis-Sm Joint,20600,N/A,N/A,N/A, $360.00 , $234.00 , $218.01 , $33.86 , $39.50 , $174.29 , $169.45 , $334.80 , $324.00 , $324.00 , $288.00 , $288.00 , $39.50 , $332.39 , $342.00 , $324.00 , $324.00 , $324.00 , $334.80 , $345.60 , $203.80 , $306.00 , $183.76 , $206.34 , N/A , $177.69 , $177.69 , $342.00 , $208.86 , $33.86 , $345.60 
 Fac Sigmoidoscopy Flx With With Band Ligation(S) ,CPT® 45350,0360 - OR SERVICES,N/A,N/A," $1,516.00 ", $985.40 ," $1,273.44 ", $95.27 , $133.80 ," $1,224.93 "," $1,364.40 "," $1,283.45 "," $1,364.40 "," $1,364.40 "," $1,364.40 "," $1,288.60 ", $131.18 ," $1,399.72 "," $1,440.20 "," $1,288.60 "," $1,409.88 "," $1,409.88 "," $1,440.20 "," $1,455.36 "," $1,240.39 "," $1,364.40 "," $1,288.60 "," $1,197.64 ", N/A ," $1,226.90 "," $1,226.90 "," $1,440.20 "," $1,300.88 ", $95.27 ," $1,455.36 "
"Legion Pneumo Ag, Dfa",CPT® 87278,N/A,N/A,N/A, $115.00 , $74.75 , N/A , $15.91 , $15.91 , $67.85 , $81.18 , $106.95 , $103.50 , $103.50 , $92.00 , $92.00 , $15.91 , $106.18 , $109.25 , $103.50 , $103.50 , $103.50 , $106.95 , $110.40 , $104.16 , $97.75 , $77.85 , $45.82 , N/A , $63.32 , $63.32 , $109.25 , $69.20 , $15.91 , $110.40 
Diagnostic Bone Marrow Biopsies & Aspirations,38222,N/A,N/A,N/A," $1,202.00 ", $781.30 , $365.65 , $73.07 , $135.37 , $262.85 , $282.49 ," $1,117.86 "," $1,081.80 "," $1,081.80 ", $961.60 , $961.60 , $135.37 ," $1,109.81 "," $1,141.90 "," $1,081.80 "," $1,081.80 "," $1,081.80 "," $1,117.86 "," $1,153.92 ", $395.53 ," $1,021.70 ", $396.26 , $393.86 , N/A , $267.98 , $267.98 ," $1,141.90 ", $310.89 , $73.07 ," $1,153.92 "
" Fac Detect Agent Nos, Dna, Amp ",CPT® 87798,0306 - LAB/BACT-MICRO,N/A,N/A, $315.00 , $204.75 , $264.60 , $35.79 , $35.79 , $254.52 , $283.50 , $266.68 , $283.50 , $283.50 , $283.50 , $267.75 , $35.09 , $290.84 , $299.25 , $267.75 , $292.95 , $292.95 , $299.25 , $302.40 , $257.73 , $283.50 , $267.75 , $248.85 , N/A , $254.93 , $254.93 , $299.25 , $270.30 , $35.09 , $302.40 
Remove Foreign Body Simple,10120,N/A,N/A,N/A, $579.00 , $376.35 , $336.16 , $101.48 , $42.46 , $283.24 , $279.57 , $538.47 , $521.10 , $521.10 , $463.20 , $463.20 , $42.46 , $534.59 , $550.05 , $521.10 , $521.10 , $521.10 , $538.47 , $555.84 , $369.08 , $492.15 , $553.06 , $366.67 , N/A , $288.77 , $288.77 , $550.05 , $334.86 , $42.46 , $555.84 
 Fac Assay of Urine Phosphorus ,CPT® 84105,0301 - LAB/CHEMISTRY,N/A,N/A, $61.00 , $39.65 , $51.24 , $5.90 , $5.90 , $49.29 , $54.90 , $51.64 , $54.90 , $54.90 , $54.90 , $51.85 , $5.78 , $56.32 , $57.95 , $51.85 , $56.73 , $56.73 , $57.95 , $58.56 , $49.91 , $54.90 , $51.85 , $48.19 , N/A , $49.37 , $49.37 , $57.95 , $52.34 , $5.78 , $58.56 
 Pro Diagnostic Anoscopy ,CPT® 46600,0982 - PRO FEE/OUTPT,N/A,N/A, $586.00 , $380.90 , $248.37 , $39.14 , $31.62 , $195.21 , $200.98 , $544.98 , $527.40 , $527.40 , $468.80 , $468.80 , $31.62 , $541.05 , $556.70 , $527.40 , $527.40 , $527.40 , $544.98 , $562.56 , $176.09 , $498.10 , $219.44 , $235.21 , N/A , $199.01 , $199.01 , $556.70 , $208.15 , $31.62 , $562.56 
"Destr Malig Trunk,Extrem 1.1-2 Cm",CPT® 17262,N/A,N/A,N/A, $675.00 , $438.75 , $352.89 , $106.56 , $123.93 , $318.30 , $311.97 , $627.75 , $607.50 , $607.50 , $540.00 , $540.00 , $123.93 , $623.23 , $641.25 , $607.50 , $607.50 , $607.50 , $627.75 , $648.00 , $388.42 , $573.75 , $619.07 , $408.00 , N/A , $324.51 , $324.51 , $641.25 , $376.32 , $106.56 , $648.00 
 Pro Incisional Biopsy Skin Ea Sep/Additional Lesion ,CPT® 11107,0982 - PRO FEE/OUTPT,N/A,N/A, $295.00 , $191.75 , $99.21 , $29.27 , $56.85 , $82.76 , N/A , $274.35 , $265.50 , $265.50 , $236.00 , $236.00 , $56.85 , $272.37 , $280.25 , $265.50 , $265.50 , $265.50 , $274.35 , $283.20 , $109.90 , $250.75 , $161.70 , $113.62 , N/A , $84.38 , $84.38 , $280.25 , $97.84 , $29.27 , $283.20 
Immunoglobulin Assay,CPT® 86023,N/A,N/A,N/A, $109.00 , $70.85 , N/A , $12.71 , $12.71 , $70.47 , $84.29 , $101.37 , $98.10 , $98.10 , $87.20 , $87.20 , $12.71 , $100.64 , $103.55 , $98.10 , $98.10 , $98.10 , $101.37 , $104.64 , $83.20 , $92.65 , $81.09 , $45.17 , N/A , $65.77 , $65.77 , $103.55 , $71.87 , $12.71 , $104.64 
 Fac Assay of Total Thyroxine ,CPT® 84436,0301 - LAB/CHEMISTRY,N/A,N/A, $78.00 , $50.70 , $65.52 , $7.01 , $7.01 , $63.02 , $70.20 , $66.03 , $70.20 , $70.20 , $70.20 , $66.30 , $6.87 , $72.02 , $74.10 , $66.30 , $72.54 , $72.54 , $74.10 , $74.88 , $63.82 , $70.20 , $66.30 , $61.62 , N/A , $63.13 , $63.13 , $74.10 , $66.93 , $6.87 , $74.88 
 Fac Img-Guide Fluid Collxn Drainag Cath Periton Perq ,CPT® 49406,0361 - OR/MINOR,N/A,N/A," $6,345.00 "," $4,124.25 "," $5,329.80 ", $185.07 , $244.64 ," $5,126.76 "," $5,710.50 "," $5,371.68 "," $5,710.50 "," $5,710.50 "," $5,710.50 "," $5,393.25 ", $239.84 ," $5,858.34 "," $6,027.75 "," $5,393.25 "," $5,900.85 "," $5,900.85 "," $6,027.75 "," $6,091.20 "," $5,191.48 "," $5,710.50 "," $5,393.25 "," $5,012.55 ", N/A ," $5,135.01 "," $5,135.01 "," $6,027.75 "," $5,444.64 ", $185.07 ," $6,091.20 "
"Hiv 1,Phenoty Analy Dna/Rna,Ea Addl Drug",CPT® 87904,N/A,N/A,N/A, $241.00 , $156.65 , N/A , $26.59 , $26.59 , $147.50 , $176.41 , $224.13 , $216.90 , $216.90 , $192.80 , $192.80 , $26.59 , $222.52 , $228.95 , $216.90 , $216.90 , $216.90 , $224.13 , $231.36 , $174.08 , $204.85 , $170.29 , $94.51 , N/A , $137.66 , $137.66 , $228.95 , $150.44 , $26.59 , $231.36 
 Fac Intro Cath R Hrt/Main P-Art ,CPT® 36013,0360 - OR SERVICES,N/A,N/A," $2,437.00 "," $1,584.05 "," $2,047.08 ", $116.74 , $778.17 ," $1,969.10 "," $2,193.30 "," $2,063.16 "," $2,193.30 "," $2,193.30 "," $2,193.30 "," $2,071.45 ", $762.91 ," $2,250.08 "," $2,315.15 "," $2,071.45 "," $2,266.41 "," $2,266.41 "," $2,315.15 "," $2,339.52 "," $1,993.95 "," $2,193.30 "," $2,071.45 "," $1,925.23 ", N/A ," $1,972.26 "," $1,972.26 "," $2,315.15 "," $2,091.19 ", $116.74 ," $2,339.52 "
 CISPLATIN 100 MG/100ML IV SOLN ,HCPCS J9060,0636 - DRUGS REQUIRING DETAILED CODIN,16729-0288-38,100 mL, $106.10 , $68.97 , $89.12 , $3.23 , $1.72 , $85.73 , $95.49 , $89.82 , $95.49 , $95.49 , $95.49 , $90.19 , $1.69 , $97.96 , $100.80 , $90.19 , $98.67 , $98.67 , $100.80 , $101.86 , $86.81 , $95.49 , $90.19 , $83.82 , N/A , $85.87 , $85.87 , $100.80 , $91.04 , $1.69 , $101.86 
Drug Screen Quant Alcohols Biomarkers 1 or 2,CPT® 80321,N/A,N/A,N/A, $270.00 , $175.50 , N/A , N/A , N/A , N/A , N/A , $251.10 , $243.00 , $243.00 , $216.00 , $216.00 , N/A , $249.29 , $256.50 , $243.00 , $243.00 , $243.00 , $251.10 , $259.20 , N/A , $229.50 , $216.00 , N/A , N/A , N/A , N/A , $256.50 , N/A , $216.00 , $259.20 
 INDOCYANINE GREEN 25 MG IV SOLR ,HCPCS RXA250,0250 - PHARMACY,70100-0424-02,2.5 mg, $87.22 , $56.69 , $73.26 , N/A , N/A , $70.47 , $78.50 , $73.84 , $78.50 , $78.50 , $78.50 , $74.14 , N/A , $80.53 , $82.86 , $74.14 , $81.11 , $81.11 , $82.86 , $83.73 , $71.36 , $78.50 , $74.14 , $68.90 , N/A , $70.59 , $70.59 , $82.86 , $74.84 , $68.90 , $83.73 
 Fac Insj Eltrd Car Ven Sys Attch Pm/Cvdfb Pls Gen ,CPT® 33224,0360 - OR SERVICES,N/A,N/A," $6,353.00 "," $4,129.45 "," $5,336.52 ", $467.60 , $463.35 ," $5,133.22 "," $5,717.70 "," $5,378.45 "," $5,717.70 "," $5,717.70 "," $5,717.70 "," $5,400.05 ", $454.26 ," $5,865.72 "," $6,035.35 "," $5,400.05 "," $5,908.29 "," $5,908.29 "," $6,035.35 "," $6,098.88 "," $5,198.02 "," $5,717.70 "," $5,400.05 "," $5,018.87 ", N/A ," $5,141.48 "," $5,141.48 "," $6,035.35 "," $5,451.51 ", $454.26 ," $6,098.88 "
"Doppler Echo Heart,Complete",CPT® 93320,N/A,N/A,N/A," $2,211.00 "," $1,437.15 ", $326.24 , $49.80 , $128.64 , $296.10 , $249.85 ," $2,056.23 "," $1,989.90 "," $1,989.90 "," $1,768.80 "," $1,768.80 ", $128.64 ," $2,041.42 "," $2,100.45 "," $1,989.90 "," $1,989.90 "," $1,989.90 "," $2,056.23 "," $2,122.56 ", $328.91 ," $1,879.35 ", $235.50 , $326.37 , N/A , $301.88 , $301.88 ," $2,100.45 ", $334.63 , $49.80 ," $2,122.56 "
Laps Supracrv Hyst 250 G/< Rmvl Tube/Ovary,CPT® 58542,N/A,N/A,N/A," $5,767.00 "," $3,748.55 "," $3,924.75 ", $792.97 , $734.86 ," $3,741.30 "," $3,919.53 "," $5,363.31 "," $5,190.30 "," $5,190.30 "," $4,613.60 "," $4,613.60 ", $734.86 ," $5,324.67 "," $5,478.65 "," $5,190.30 "," $5,190.30 "," $5,190.30 "," $5,363.31 "," $5,536.32 "," $4,100.40 "," $4,901.95 "," $5,157.73 "," $3,338.83 ", N/A ," $3,814.30 "," $3,814.30 "," $5,478.65 "," $4,575.03 ", $734.86 ," $5,536.32 "
 Pro Bx/Exc Lymph Node Opn Supfc ,CPT® 38500,0982 - PRO FEE/OUTPT,N/A,N/A," $3,098.00 "," $2,013.70 "," $1,178.95 ", $238.19 , $322.82 , $882.52 , $911.96 ," $2,881.14 "," $2,788.20 "," $2,788.20 "," $2,478.40 "," $2,478.40 ", $322.82 ," $2,860.38 "," $2,943.10 "," $2,788.20 "," $2,788.20 "," $2,788.20 "," $2,881.14 "," $2,974.08 "," $1,259.29 "," $2,633.30 "," $1,348.75 "," $1,222.60 ", N/A , $899.74 , $899.74 ," $2,943.10 "," $1,043.82 ", $238.19 ," $2,974.08 "
 Pro Escharotomy 1st Inc ,CPT® 16035,0982 - PRO FEE/OUTPT,N/A,N/A, $986.00 , $640.90 , $609.18 , $183.73 , $53.35 , $532.41 , $521.12 , $916.98 , $887.40 , $887.40 , $788.80 , $788.80 , $53.35 , $910.37 , $936.70 , $887.40 , $887.40 , $887.40 , $916.98 , $946.56 , $673.12 , $838.10 ," $1,047.25 ", $681.87 , N/A , $542.80 , $542.80 , $936.70 , $629.45 , $53.35 ," $1,047.25 "
"Nasal Scope,Bx/Rmv Polyp/Debrid",CPT® 31237,N/A,N/A,N/A," $1,866.00 "," $1,212.90 ", $747.55 , $152.66 , $256.58 , $617.63 , $681.39 ," $1,735.38 "," $1,679.40 "," $1,679.40 "," $1,492.80 "," $1,492.80 ", $256.58 ," $1,722.88 "," $1,772.70 "," $1,679.40 "," $1,679.40 "," $1,679.40 "," $1,735.38 "," $1,791.36 ", $822.65 ," $1,586.10 ", $959.83 , $811.93 , N/A , $629.68 , $629.68 ," $1,772.70 ", $741.57 , $152.66 ," $1,791.36 "
 Initial 1st Degree Burn Local Treatment ,CPT® 16000,0761 - TREATMENT ROOM,N/A,N/A, $161.00 , $104.65 , $135.24 , $43.12 , $29.25 , $130.09 , $144.90 , $136.30 , $144.90 , $144.90 , $144.90 , $136.85 , $28.68 , $148.65 , $152.95 , $136.85 , $149.73 , $149.73 , $152.95 , $154.56 , $131.73 , $144.90 , $136.85 , $127.19 , N/A , $130.30 , $130.30 , $152.95 , $138.15 , $28.68 , $154.56 
 Sacro/Iliac Joints 3 or More Views ,CPT® 72202,0320 - DX X-RAY,N/A,N/A, $345.00 , $224.25 , $289.80 , $38.71 , $33.12 , $278.76 , $310.50 , $292.08 , $310.50 , $310.50 , $310.50 , $293.25 , $32.47 , $318.54 , $327.75 , $293.25 , $320.85 , $320.85 , $327.75 , $331.20 , $282.28 , $310.50 , $293.25 , $272.55 , N/A , $279.21 , $279.21 , $327.75 , $296.04 , $32.47 , $331.20 
 Fac Enzyme Cell Activity ,CPT® 82657,0301 - LAB/CHEMISTRY,N/A,N/A, $447.00 , $290.55 , $375.48 , $22.61 , $22.61 , $361.18 , $402.30 , $378.43 , $402.30 , $402.30 , $402.30 , $379.95 , $22.17 , $412.72 , $424.65 , $379.95 , $415.71 , $415.71 , $424.65 , $429.12 , $365.74 , $402.30 , $379.95 , $353.13 , N/A , $361.76 , $361.76 , $424.65 , $383.57 , $22.17 , $429.12 
Chemodenervation 1 Extremity Ea Addl 1-4 Muscle,CPT® 64643,N/A,N/A,N/A, $587.00 , $381.55 , $339.14 , $65.24 , $53.05 , $398.94 , $387.78 , $545.91 , $528.30 , $528.30 , $469.60 , $469.60 , $53.05 , $541.98 , $557.65 , $528.30 , $528.30 , $528.30 , $545.91 , $563.52 , $367.47 , $498.95 , $371.38 , $420.75 , N/A , $406.72 , $406.72 , $557.65 , $436.31 , $53.05 , $563.52 
Actin Smooth Muscle Antibody Each,CPT® 86015,N/A,N/A,N/A, $136.00 , $88.40 , N/A , $12.29 , $11.76 , N/A , N/A , $126.48 , $122.40 , $122.40 , $108.80 , $108.80 , $11.76 , $125.57 , $129.20 , $122.40 , $122.40 , $122.40 , $126.48 , $130.56 , N/A , $115.60 , $58.15 , $33.86 , N/A , $45.20 , $45.20 , $129.20 , $49.69 , $11.76 , $130.56 
 Fac Radiology Port Film(S) ,CPT® 77417,0333 - RADIATION RX,N/A,N/A, $253.00 , $164.45 , $212.52 , $13.24 , $21.94 , $204.42 , $227.70 , $214.19 , $227.70 , $227.70 , $227.70 , $215.05 , $21.51 , $233.59 , $240.35 , $215.05 , $235.29 , $235.29 , $240.35 , $242.88 , $207.00 , $227.70 , $215.05 , $199.87 , N/A , $204.75 , $204.75 , $240.35 , $217.10 , $13.24 , $242.88 
X-Ray Ankle 2 Vw,CPT® 73600,N/A,N/A,N/A, $210.00 , $136.50 , $180.79 , $32.02 , $26.20 , $128.52 , $153.87 , $195.30 , $189.00 , $189.00 , $168.00 , $168.00 , $26.20 , $193.89 , $199.50 , $189.00 , $189.00 , $189.00 , $195.30 , $201.60 , $178.21 , $178.50 , $169.49 , $149.43 , N/A , $131.02 , $131.02 , $199.50 , $151.65 , $26.20 , $201.60 
 SODIUM POLYSTYRENE SULFONATE 15 GM/60ML PO SUSP ,HCPCS RXC637,0250 - PHARMACY,46287-0006-60,60 mL, $155.96 , $101.37 , $131.01 , N/A , N/A , $126.02 , $140.36 , $132.04 , $140.36 , $140.36 , $140.36 , $132.57 , N/A , $144.00 , $148.16 , $132.57 , $145.04 , $145.04 , $148.16 , $149.72 , $127.61 , $140.36 , $132.57 , $123.21 , N/A , $126.22 , $126.22 , $148.16 , $133.83 , $123.21 , $149.72 
 US OB Transvaginal- Mh ,CPT® 76817,0972 - PRO FEE/RAD/DX,N/A,N/A, $351.00 , $228.15 , $529.77 , $91.81 , $86.65 , $468.25 , $540.46 , $326.43 , $315.90 , $315.90 , $280.80 , $280.80 , $86.65 , $324.08 , $333.45 , $315.90 , $315.90 , $315.90 , $326.43 , $336.96 , $533.38 , $298.35 , $589.37 , $546.42 , N/A , $477.38 , $477.38 , $333.45 , $552.57 , $86.65 , $589.37 
 Transfor Epidural L/S Single Lvl-CT ,CPT® 64483,0761 - TREATMENT ROOM,N/A,N/A," $1,478.00 ", $960.70 ," $1,241.52 ", $106.70 , $205.84 ," $1,194.22 "," $1,330.20 "," $1,251.27 "," $1,330.20 "," $1,330.20 "," $1,330.20 "," $1,256.30 ", $201.80 ," $1,364.64 "," $1,404.10 "," $1,256.30 "," $1,374.54 "," $1,374.54 "," $1,404.10 "," $1,418.88 "," $1,209.30 "," $1,330.20 "," $1,256.30 "," $1,167.62 ", N/A ," $1,196.15 "," $1,196.15 "," $1,404.10 "," $1,268.27 ", $106.70 ," $1,418.88 "
Fine Needle Aspiration Bx W/O Img Gdn Ea Addl,CPT® 10004,N/A,N/A,N/A, $229.00 , $148.85 , $136.75 , $40.34 , $40.98 , $110.98 , N/A , $212.97 , $206.10 , $206.10 , $183.20 , $183.20 , $40.98 , $211.44 , $217.55 , $206.10 , $206.10 , $206.10 , $212.97 , $219.84 , $142.47 , $194.65 , $223.89 , $151.87 , N/A , $113.14 , $113.14 , $217.55 , $131.20 , $40.34 , $223.89 
Repair of Anal Fistula W/Fibrin Glue,CPT® 46706,N/A,N/A,N/A," $1,068.00 ", $694.20 ," $1,076.86 ", $167.69 , $132.06 , $825.52 , $824.83 , $993.24 , $961.20 , $961.20 , $854.40 , $854.40 , $132.06 , $986.08 ," $1,014.60 ", $961.20 , $961.20 , $961.20 , $993.24 ," $1,025.28 ", $766.02 , $907.80 , $906.30 , $980.36 , N/A , $841.63 , $841.63 ," $1,014.60 ", $880.26 , $132.06 ," $1,076.86 "
Urinary Leg or Abdomen Bag,HCPCS A4358,N/A,N/A,N/A, $15.00 , $9.75 , N/A , $9.00 , N/A , N/A , N/A , $13.95 , $13.50 , $13.50 , $12.00 , $12.00 , N/A , $13.85 , $14.25 , $13.50 , $13.50 , $13.50 , $13.95 , $14.40 , N/A , $12.75 , $7.79 , $8.17 , N/A , N/A , N/A , $14.25 , N/A , $7.79 , $14.40 
Nasopharyngoscopy,CPT® 92511,N/A,N/A,N/A, $535.00 , $347.75 , $86.86 , $36.95 , $91.35 , $108.54 , $111.57 , $497.55 , $481.50 , $481.50 , $428.00 , $428.00 , $91.35 , $493.97 , $508.25 , $481.50 , $481.50 , $481.50 , $497.55 , $513.60 , $160.07 , $454.75 , $146.99 , $142.85 , N/A , $110.67 , $110.67 , $508.25 , $129.01 , $36.95 , $513.60 
 Pro Drain Blood From Under Nail ,CPT® 11740,0981 - PRO FEE/ER,N/A,N/A, $187.00 , $121.55 , $101.46 , $30.96 , $37.00 , $89.90 , $88.22 , $173.91 , $168.30 , $168.30 , $149.60 , $149.60 , $37.00 , $172.66 , $177.65 , $168.30 , $168.30 , $168.30 , $173.91 , $179.52 , $110.68 , $158.95 , $173.05 , $117.10 , N/A , $91.66 , $91.66 , $177.65 , $106.30 , $30.96 , $179.52 
Laryngoscopy Flexible Diagnostic,31575,N/A,N/A,N/A, $427.00 , $277.55 , $364.67 , $65.21 , $98.45 , $294.56 , $382.52 , $397.11 , $384.30 , $384.30 , $341.60 , $341.60 , $98.45 , $394.25 , $405.65 , $384.30 , $384.30 , $384.30 , $397.11 , $409.92 , $347.16 , $362.95 , $406.77 , $341.75 , N/A , $300.30 , $300.30 , $405.65 , $353.68 , $65.21 , $409.92 
 Pro Lyr Clsr S/a/T/E > 30.0 Cm ,CPT® 12037,0982 - PRO FEE/OUTPT,N/A,N/A," $1,866.00 "," $1,212.90 "," $1,027.96 ", $306.27 , $258.15 , $892.94 , $855.00 ," $1,735.38 "," $1,679.40 "," $1,679.40 "," $1,492.80 "," $1,492.80 ", $258.15 ," $1,722.88 "," $1,772.70 "," $1,679.40 "," $1,679.40 "," $1,679.40 "," $1,735.38 "," $1,791.36 "," $1,129.34 "," $1,586.10 "," $1,719.84 "," $1,133.19 ", N/A , $910.36 , $910.36 ," $1,772.70 "," $1,055.71 ", $258.15 ," $1,791.36 "
Spherocylinder 4.00d/>6.00d,HCPCS V2106,N/A,N/A,N/A, $55.00 , $35.75 , N/A , $61.93 , N/A , N/A , N/A , $51.15 , $49.50 , $49.50 , $44.00 , $44.00 , N/A , $50.78 , $52.25 , $49.50 , $49.50 , $49.50 , $51.15 , $52.80 , N/A , $46.75 , $55.00 , $56.27 , N/A , N/A , N/A , $52.25 , N/A , $44.00 , $61.93 
"Pro Lap,Vag Hyst,Uterus 250gms/<,Salp-Ooph",CPT® 58552,N/A,N/A,N/A," $5,883.00 "," $3,823.95 "," $4,609.25 ", $933.94 , $868.75 ," $4,012.25 "," $3,980.92 "," $5,471.19 "," $5,294.70 "," $5,294.70 "," $4,706.40 "," $4,706.40 ", $868.75 ," $5,431.77 "," $5,588.85 "," $5,294.70 "," $5,294.70 "," $5,294.70 "," $5,471.19 "," $5,647.68 "," $4,834.48 "," $5,000.55 "," $5,239.80 "," $4,021.65 ", N/A ," $4,090.54 "," $4,090.54 "," $5,588.85 "," $4,906.35 ", $868.75 ," $5,647.68 "
"Inject Nerv Blck,Celiac Plexus",CPT® 64530,N/A,N/A,N/A," $1,403.00 ", $911.95 , $468.05 , $90.93 , $158.01 , $517.86 , $512.95 ," $1,304.79 "," $1,262.70 "," $1,262.70 "," $1,122.40 "," $1,122.40 ", $158.01 ," $1,295.39 "," $1,332.85 "," $1,262.70 "," $1,262.70 "," $1,262.70 "," $1,304.79 "," $1,346.88 ", $504.95 ," $1,192.55 ", $499.54 , $551.57 , N/A , $527.97 , $527.97 ," $1,332.85 ", $566.37 , $90.93 ," $1,346.88 "
"Visual Field Exam,Intermed",92082,N/A,N/A,N/A, $180.00 , $117.00 , $100.55 , $45.89 , $55.95 , $84.09 , $114.50 , $167.40 , $162.00 , $162.00 , $144.00 , $144.00 , $55.95 , $166.19 , $171.00 , $162.00 , $162.00 , $162.00 , $167.40 , $172.80 , $144.52 , $153.00 , $150.03 , $101.72 , N/A , $85.74 , $85.74 , $171.00 , $101.97 , $45.89 , $172.80 
 Fac Drug Test Def 15-21 Classes ,CPT® G0482,0301 - LAB/CHEMISTRY,N/A,N/A, $298.00 , $193.70 , $250.32 , $202.71 , $135.46 , $240.78 , $268.20 , $252.29 , $268.20 , $268.20 , $268.20 , $253.30 , $132.80 , $275.14 , $283.10 , $253.30 , $277.14 , $277.14 , $283.10 , $286.08 , $243.82 , $268.20 , $253.30 , $235.42 , N/A , $241.17 , $241.17 , $283.10 , $255.71 , $132.80 , $286.08 
Pericardiocentesis W/Img Guidance When Performed,CPT® 33016,N/A,N/A,N/A," $1,967.00 "," $1,278.55 "," $1,379.95 ", $212.20 , $179.74 , $989.07 , N/A ," $1,829.31 "," $1,770.30 "," $1,770.30 "," $1,573.60 "," $1,573.60 ", $179.74 ," $1,816.13 "," $1,868.65 "," $1,770.30 "," $1,770.30 "," $1,770.30 "," $1,829.31 "," $1,888.32 "," $1,280.92 "," $1,671.95 "," $1,218.98 "," $1,140.34 ", N/A ," $1,008.36 "," $1,008.36 "," $1,868.65 "," $1,145.24 ", $179.74 ," $1,888.32 "
 Pro X-Ray Bile Ducts/Pancreas ,CPT® 74300,0972 - PRO FEE/RAD/DX,N/A,N/A, $222.00 , $144.30 , $352.29 , $61.72 , $74.22 , $252.22 , $257.70 , $206.46 , $199.80 , $199.80 , $177.60 , $177.60 , $74.22 , $204.97 , $210.90 , $199.80 , $199.80 , $199.80 , $206.46 , $213.12 , $352.70 , $188.70 , $286.98 , $332.32 , N/A , $257.14 , $257.14 , $210.90 , $297.64 , $61.72 , $352.70 
Prolong inpt eval add15 m,HCPCS G0316,N/A,N/A,N/A, $162.00 , $105.30 , N/A , $29.73 , $24.23 , N/A , N/A , $150.66 , $145.80 , $145.80 , $129.60 , $129.60 , $24.23 , $149.57 , $153.90 , $145.80 , $145.80 , $145.80 , $150.66 , $155.52 , N/A , $137.70 , $58.15 , N/A , N/A , $50.15 , $50.15 , $153.90 , $62.69 , $24.23 , $155.52 
" Pro Scope Bladder, Simple Removal Stone, Stent ",CPT® 52310,0982 - PRO FEE/OUTPT,N/A,N/A," $1,809.00 "," $1,175.85 ", $811.61 , $142.63 , $249.02 , $741.48 , $689.79 ," $1,682.37 "," $1,628.10 "," $1,628.10 "," $1,447.20 "," $1,447.20 ", $249.02 ," $1,670.25 "," $1,718.55 "," $1,628.10 "," $1,628.10 "," $1,628.10 "," $1,682.37 "," $1,736.64 ", $815.26 ," $1,537.65 ", $783.20 , $931.02 , N/A , $755.96 , $755.96 ," $1,718.55 ", $888.49 , $142.63 ," $1,736.64 "
" Fac Cytomeg, Dna, Amp Probe ",CPT® 87496,0306 - LAB/BACT-MICRO,N/A,N/A, $324.00 , $210.60 , $272.16 , $35.79 , $35.79 , $261.79 , $291.60 , $274.30 , $291.60 , $291.60 , $291.60 , $275.40 , $35.09 , $299.15 , $307.80 , $275.40 , $301.32 , $301.32 , $307.80 , $311.04 , $265.10 , $291.60 , $275.40 , $255.96 , N/A , $262.21 , $262.21 , $307.80 , $278.02 , $35.09 , $311.04 
 Pro Psychotherapy W/Patient W/E&M Srvcs 30 Min ,CPT® 90833,0961 - PRO FEE/PSYCH,N/A,N/A, $247.00 , $160.55 , $82.93 , $61.36 , $79.97 , $147.18 , $94.10 , $229.71 , $222.30 , $222.30 , $197.60 , $197.60 , $79.97 , $228.06 , $234.65 , $222.30 , $222.30 , $222.30 , $229.71 , $237.12 , $158.13 , $209.95 , $122.66 , $249.57 , $68.25 , $150.05 , $150.05 , $234.65 , $174.94 , $61.36 , $249.57 
" Pro Inj Dx/Ther Agnt Paravert Facet Joint, Lumbar/Sac, 2nd Level ",CPT® 64494,0972 - PRO FEE/RAD/DX,N/A,N/A, $536.00 , $348.40 , $253.08 , $49.11 , $62.02 , $292.30 , $282.07 , $498.48 , $482.40 , $482.40 , $428.80 , $428.80 , $62.02 , $494.89 , $509.20 , $482.40 , $482.40 , $482.40 , $498.48 , $514.56 , $276.51 , $455.60 , $274.75 , $313.65 , N/A , $298.00 , $298.00 , $509.20 , $319.69 , $49.11 , $514.56 
" Fac Assay, Bld/Serum Cholesterol ",CPT® 82465,0301 - LAB/CHEMISTRY,N/A,N/A, $53.00 , $34.45 , $44.52 , $4.44 , $4.44 , $42.82 , $47.70 , $44.87 , $47.70 , $47.70 , $47.70 , $45.05 , $4.35 , $48.93 , $50.35 , $45.05 , $49.29 , $49.29 , $50.35 , $50.88 , $43.36 , $47.70 , $45.05 , $41.87 , N/A , $42.89 , $42.89 , $50.35 , $45.48 , $4.35 , $50.88 
 Pro Core Needle Bx Lung/Mediastinum Perq W/Img ,CPT® 32408,0982 - PRO FEE/OUTPT,N/A,N/A," $1,508.00 ", $980.20 , $836.11 , $145.68 , $741.88 , N/A , N/A ," $1,402.44 "," $1,357.20 "," $1,357.20 "," $1,206.40 "," $1,206.40 ", $741.88 ," $1,392.34 "," $1,432.60 "," $1,357.20 "," $1,357.20 "," $1,357.20 "," $1,402.44 "," $1,447.68 ", $810.69 ," $1,281.80 ", $794.29 , $805.24 , N/A , $555.56 , $555.56 ," $1,432.60 ", $655.58 , $145.68 ," $1,447.68 "
 CT Lumb/Sacr Inj Third Plus Level ,CPT® 64495,0360 - OR SERVICES,N/A,N/A, $790.00 , $513.50 , $663.60 , $49.77 , $62.93 , $638.32 , $711.00 , $668.81 , $711.00 , $711.00 , $711.00 , $671.50 , $61.70 , $729.41 , $750.50 , $671.50 , $734.70 , $734.70 , $750.50 , $758.40 , $646.38 , $711.00 , $671.50 , $624.10 , N/A , $639.35 , $639.35 , $750.50 , $677.90 , $49.77 , $758.40 
Thoracic Aorta Graft,CPT® 33875,N/A,N/A,N/A," $22,441.00 "," $14,586.65 "," $15,838.23 "," $2,461.21 "," $2,378.00 "," $11,728.84 "," $11,635.46 "," $20,870.13 "," $20,196.90 "," $20,196.90 "," $17,952.80 "," $17,952.80 "," $2,378.00 "," $20,719.78 "," $21,318.95 "," $20,196.90 "," $20,196.90 "," $20,196.90 "," $20,870.13 "," $21,543.36 "," $14,707.10 "," $19,074.85 "," $14,741.72 "," $13,153.66 ", N/A ," $11,957.69 "," $11,957.69 "," $21,318.95 "," $13,583.93 "," $2,378.00 "," $21,543.36 "
Amputation Finger/Thumb+Flaps,26952,N/A,N/A,N/A," $2,858.00 "," $1,857.70 "," $4,299.17 ", $669.14 , $336.65 ," $3,062.08 "," $3,105.60 "," $2,657.94 "," $2,572.20 "," $2,572.20 "," $2,286.40 "," $2,286.40 ", $336.65 ," $2,638.79 "," $2,715.10 "," $2,572.20 "," $2,572.20 "," $2,572.20 "," $2,657.94 "," $2,743.68 "," $3,934.94 "," $2,429.30 "," $3,405.78 "," $3,654.94 ", N/A ," $3,121.83 "," $3,121.83 "," $2,715.10 "," $3,669.26 ", $336.65 ," $4,299.17 "
Treat Fibula Fracture,CPT® 27780,N/A,N/A,N/A," $2,004.00 "," $1,302.60 "," $1,775.74 ", $281.00 , $190.55 ," $1,342.07 "," $1,370.57 "," $1,863.72 "," $1,803.60 "," $1,803.60 "," $1,603.20 "," $1,603.20 ", $190.55 ," $1,850.29 "," $1,903.80 "," $1,803.60 "," $1,803.60 "," $1,803.60 "," $1,863.72 "," $1,923.84 "," $1,634.23 "," $1,703.40 "," $1,503.97 "," $1,596.71 ", N/A ," $1,368.26 "," $1,368.26 "," $1,903.80 "," $1,608.19 ", $190.55 ," $1,923.84 "
" Fac Culture, Bacteria, Other ",CPT® 87070,0306 - LAB/BACT-MICRO,N/A,N/A, $116.00 , $75.40 , $97.44 , $8.79 , $8.79 , $93.73 , $104.40 , $98.21 , $104.40 , $104.40 , $104.40 , $98.60 , $8.62 , $107.10 , $110.20 , $98.60 , $107.88 , $107.88 , $110.20 , $111.36 , $94.91 , $104.40 , $98.60 , $91.64 , N/A , $93.88 , $93.88 , $110.20 , $99.54 , $8.62 , $111.36 
 Fac Diagnostic Computed Tomography Thorax W/Contrast ,CPT® 71260,0352 - CT SCAN/BODY,N/A,N/A," $2,760.00 "," $1,794.00 "," $2,318.40 ", $170.34 , $303.46 ," $2,230.08 "," $2,484.00 "," $2,336.62 "," $2,484.00 "," $2,484.00 "," $2,484.00 "," $2,346.00 ", $297.51 ," $2,548.31 "," $2,622.00 "," $2,346.00 "," $2,566.80 "," $2,566.80 "," $2,622.00 "," $2,649.60 "," $2,258.23 "," $2,484.00 "," $2,346.00 "," $2,180.40 ", N/A ," $2,233.67 "," $2,233.67 "," $2,622.00 "," $2,368.36 ", $170.34 ," $2,649.60 "
"Fusion Big Toe,I-P Jt+Tendn Xfer",CPT® 28760,N/A,N/A,N/A," $4,851.00 "," $3,153.15 "," $3,514.68 ", $548.21 , $384.19 ," $2,845.01 "," $2,795.46 "," $4,511.43 "," $4,365.90 "," $4,365.90 "," $3,880.80 "," $3,880.80 ", $384.19 ," $4,478.93 "," $4,608.45 "," $4,365.90 "," $4,365.90 "," $4,365.90 "," $4,511.43 "," $4,656.96 "," $3,269.61 "," $4,123.35 "," $3,038.26 "," $3,390.27 ", N/A ," $2,900.52 "," $2,900.52 "," $4,608.45 "," $3,409.14 ", $384.19 ," $4,656.96 "
"Lap,Splenectomy",CPT® 38120,N/A,N/A,N/A," $5,489.00 "," $3,567.85 "," $4,835.60 ", $976.13 ," $1,345.87 "," $3,656.44 "," $3,747.88 "," $5,104.77 "," $4,940.10 "," $4,940.10 "," $4,391.20 "," $4,391.20 "," $1,345.87 "," $5,067.99 "," $5,214.55 "," $4,940.10 "," $4,940.10 "," $4,940.10 "," $5,104.77 "," $5,269.44 "," $5,171.00 "," $4,665.65 "," $5,557.36 "," $5,040.99 ", N/A ," $3,727.79 "," $3,727.79 "," $5,214.55 "," $4,324.72 ", $976.13 ," $5,557.36 "
"Lat Explor Eye Sock,Remv Lesn",CPT® 67420,N/A,N/A,N/A," $15,447.00 "," $10,040.55 "," $10,878.21 "," $1,697.27 "," $1,205.52 "," $9,138.61 "," $8,593.31 "," $14,365.71 "," $13,902.30 "," $13,902.30 "," $12,357.60 "," $12,357.60 "," $1,205.52 "," $14,262.22 "," $14,674.65 "," $13,902.30 "," $13,902.30 "," $13,902.30 "," $14,365.71 "," $14,829.12 "," $14,640.81 "," $13,129.95 "," $8,931.02 "," $11,568.65 ", N/A ," $9,316.92 "," $9,316.92 "," $14,674.65 "," $10,284.65 "," $1,205.52 "," $14,829.12 "
 Fac Ko W Adj Flex/Ext Rotat Mold ,HCPCS L1846,0274 - PROSTHETIC DEV,N/A,N/A," $1,439.00 ", $935.35 ," $1,208.76 "," $1,368.64 ", $891.92 ," $1,162.71 "," $1,295.10 "," $1,218.26 "," $1,295.10 "," $1,295.10 "," $1,295.10 "," $1,223.15 ", $874.43 ," $1,328.63 "," $1,367.05 "," $1,223.15 "," $1,338.27 "," $1,338.27 "," $1,367.05 "," $1,381.44 "," $1,177.39 "," $1,295.10 "," $1,223.15 "," $1,136.81 ", N/A ," $1,164.58 "," $1,164.58 "," $1,367.05 "," $1,234.81 ", $874.43 ," $1,381.44 "
Removal of Sperm Duct(S),55250,N/A,N/A,N/A," $1,946.00 "," $1,264.90 "," $1,016.33 ", $220.32 , $303.02 , $727.92 , $743.50 ," $1,809.78 "," $1,751.40 "," $1,751.40 "," $1,556.80 "," $1,556.80 ", $303.02 ," $1,796.74 "," $1,848.70 "," $1,751.40 "," $1,751.40 "," $1,751.40 "," $1,809.78 "," $1,868.16 ", $951.50 ," $1,654.10 "," $1,182.83 "," $1,104.13 ", N/A , $742.12 , $742.12 ," $1,848.70 ", $889.48 , $220.32 ," $1,868.16 "
 VANCOMYCIN HCL 1.5 G IV SOLR ,HCPCS J3371,0636 - DRUGS REQUIRING DETAILED CODIN,00409-3515-01,30 mL, $150.12 , $97.58 , $126.10 , $6.43 , $6.66 , $121.30 , $135.11 , $127.09 , $135.11 , $135.11 , $135.11 , $127.60 , $6.53 , $138.61 , $142.61 , $127.60 , $139.61 , $139.61 , $142.61 , $144.12 , $122.83 , $135.11 , $127.60 , $118.59 , N/A , $121.49 , $121.49 , $142.61 , $128.82 , $6.43 , $144.12 
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess,CPT® 97602,N/A,N/A,N/A, $169.00 , $109.85 , N/A , N/A , N/A , $83.86 , $74.55 , $157.17 , $152.10 , $152.10 , $135.20 , $135.20 , N/A , $156.04 , $160.55 , $152.10 , $152.10 , $152.10 , $157.17 , $162.24 , N/A , $143.65 , N/A , $86.13 , N/A , $85.49 , $85.49 , $160.55 , $95.09 , $74.55 , $162.24 
"Cysto/Ureteroscopy,Tx Ureter Strict",CPT® 52344,N/A,N/A,N/A," $2,650.00 "," $1,722.50 "," $1,979.61 ", $346.93 , $524.15 ," $1,813.30 "," $1,728.44 "," $2,464.50 "," $2,385.00 "," $2,385.00 "," $2,120.00 "," $2,120.00 ", $524.15 ," $2,446.75 "," $2,517.50 "," $2,385.00 "," $2,385.00 "," $2,385.00 "," $2,464.50 "," $2,544.00 "," $1,988.84 "," $2,252.50 "," $1,957.12 "," $2,276.55 ", N/A ," $1,848.68 "," $1,848.68 "," $2,517.50 "," $2,172.87 ", $346.93 ," $2,544.00 "
 Fac Thyr Stimulating Horm ,CPT® 84443,0301 - LAB/CHEMISTRY,N/A,N/A, $168.00 , $109.20 , $141.12 , $17.14 , $17.14 , $135.74 , $151.20 , $142.23 , $151.20 , $151.20 , $151.20 , $142.80 , $16.80 , $155.11 , $159.60 , $142.80 , $156.24 , $156.24 , $159.60 , $161.28 , $137.46 , $151.20 , $142.80 , $132.72 , N/A , $135.96 , $135.96 , $159.60 , $144.16 , $16.80 , $161.28 
Car Seat/Bed Test Inft Thru 12 Mo 60 Min,CPT® 94780,N/A,N/A,N/A, $215.00 , $139.75 , $54.94 , $22.94 , $39.68 , $56.16 , $52.41 , $199.95 , $193.50 , $193.50 , $172.00 , $172.00 , $39.68 , $198.51 , $204.25 , $193.50 , $193.50 , $193.50 , $199.95 , $206.40 , $71.91 , $182.75 , $68.93 , $90.94 , N/A , $57.25 , $57.25 , $204.25 , $66.75 , $22.94 , $206.40 
 Fac Echo Transthoracic ,CPT® 93350,0483 - CARDIOLOGY – ECHOCARDIOLOGY,N/A,N/A," $2,183.00 "," $1,418.95 "," $1,833.72 ", $183.12 , $145.53 ," $1,763.86 "," $1,964.70 "," $1,848.13 "," $1,964.70 "," $1,964.70 "," $1,964.70 "," $1,855.55 ", $142.68 ," $2,015.56 "," $2,073.85 "," $1,855.55 "," $2,030.19 "," $2,030.19 "," $2,073.85 "," $2,095.68 "," $1,786.13 "," $1,964.70 "," $1,855.55 "," $1,724.57 ", N/A ," $1,766.70 "," $1,766.70 "," $2,073.85 "," $1,873.23 ", $142.68 ," $2,095.68 "
Myoglobin,CPT® 83874,N/A,N/A,N/A, $174.00 , $113.10 , N/A , $13.18 , $13.18 , $73.09 , $87.39 , $161.82 , $156.60 , $156.60 , $139.20 , $139.20 , $13.18 , $160.65 , $165.30 , $156.60 , $156.60 , $156.60 , $161.82 , $167.04 , $86.27 , $147.90 , $84.34 , $46.85 , N/A , $68.21 , $68.21 , $165.30 , $74.54 , $13.18 , $167.04 
 Pro Clsd Tx Nursemaid Elbow/Manip ,CPT® 24640,0982 - PRO FEE/OUTPT,N/A,N/A, $893.00 , $580.45 , $507.52 , $78.44 , $62.26 , $453.97 , $465.63 , $830.49 , $803.70 , $803.70 , $714.40 , $714.40 , $62.26 , $824.51 , $848.35 , $803.70 , $803.70 , $803.70 , $830.49 , $857.28 , $464.54 , $759.05 , $512.03 , $456.76 , N/A , $462.82 , $462.82 , $848.35 , $543.97 , $62.26 , $857.28 
"Hemorrhoidectomy,Int/Ext,Simple",46255,N/A,N/A,N/A," $3,324.00 "," $2,160.60 "," $2,188.36 ", $338.94 , $398.66 ," $1,677.63 "," $1,711.67 "," $3,091.32 "," $2,991.60 "," $2,991.60 "," $2,659.20 "," $2,659.20 ", $398.66 ," $3,069.05 "," $3,157.80 "," $2,991.60 "," $2,991.60 "," $2,991.60 "," $3,091.32 "," $3,191.04 "," $1,566.77 "," $2,825.40 "," $1,887.54 "," $1,993.47 ", N/A ," $1,710.36 "," $1,710.36 "," $3,157.80 "," $1,788.84 ", $338.94 ," $3,191.04 "
 Pro Treat Hip Dislocation ,CPT® 27266,0975 - PRO FEE/OR,N/A,N/A," $2,568.00 "," $1,669.20 "," $3,570.13 ", $559.59 , $549.47 ," $2,800.32 "," $2,792.35 "," $2,388.24 "," $2,311.20 "," $2,311.20 "," $2,054.40 "," $2,054.40 ", $549.47 ," $2,371.03 "," $2,439.60 "," $2,311.20 "," $2,311.20 "," $2,311.20 "," $2,388.24 "," $2,465.28 "," $3,311.68 "," $2,182.80 "," $3,082.86 "," $3,299.05 ", N/A ," $2,854.97 "," $2,854.97 "," $2,439.60 "," $3,355.60 ", $549.47 ," $3,570.13 "
 Fac Fungus Antibody ,CPT® 86671,0300 - LABORATORY,N/A,N/A, $160.00 , $104.00 , $134.40 , $12.50 , $7.06 , $129.28 , $144.00 , $135.46 , $144.00 , $144.00 , $144.00 , $136.00 , $6.92 , $147.73 , $152.00 , $136.00 , $148.80 , $148.80 , $152.00 , $153.60 , $130.91 , $144.00 , $136.00 , $126.40 , N/A , $129.49 , $129.49 , $152.00 , $137.30 , $6.92 , $153.60 
 Fac Plate Pheres Leukoredu Irrad ,HCPCS P9037,0390 - BLOOD/STOR-PROC,N/A,N/A," $1,803.00 "," $1,171.95 "," $1,514.52 ", N/A , N/A ," $1,456.82 "," $1,622.70 "," $1,526.42 "," $1,622.70 "," $1,622.70 "," $1,622.70 "," $1,532.55 ", N/A ," $1,664.71 "," $1,712.85 "," $1,532.55 "," $1,676.79 "," $1,676.79 "," $1,712.85 "," $1,730.88 "," $1,475.21 "," $1,622.70 "," $1,532.55 "," $1,424.37 ", N/A ," $1,459.17 "," $1,459.17 "," $1,712.85 "," $1,547.15 "," $1,424.37 "," $1,730.88 "
"Arthro, Loose Body + Chondro",G0289,N/A,N/A,N/A, $111.00 , $72.15 , $187.94 , $79.26 , $84.92 , $159.72 , N/A , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $84.92 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $477.19 , $94.35 , $166.08 , $490.96 , N/A , $162.83 , $162.83 , $105.45 , $203.55 , $79.26 , $490.96 
 PROPRANOLOL HCL ER 60 MG PO CP24 ,HCPCS RXC637,0250 - PHARMACY,60687-0215-01,1 capsule, $11.21 , $7.29 , $9.42 , N/A , N/A , $9.06 , $10.09 , $9.49 , $10.09 , $10.09 , $10.09 , $9.53 , N/A , $10.35 , $10.65 , $9.53 , $10.43 , $10.43 , $10.65 , $10.76 , $9.17 , $10.09 , $9.53 , $8.86 , N/A , $9.07 , $9.07 , $10.65 , $9.62 , $8.86 , $10.76 
Episiotomy/Vaginal Repr by Othr MD,CPT® 59300,N/A,N/A,N/A," $1,079.00 ", $701.35 , $392.37 , $133.15 , $170.42 , $344.87 , $362.44 ," $1,003.47 ", $971.10 , $971.10 , $863.20 , $863.20 , $170.42 , $996.24 ," $1,025.05 ", $971.10 , $971.10 , $971.10 ," $1,003.47 "," $1,035.84 ", $399.37 , $917.15 , $799.26 , $640.69 , N/A , $351.59 , $351.59 ," $1,025.05 ", $406.48 , $133.15 ," $1,035.84 "
 Fac Chg Hba1/Hba2 Gene Analysis Dup/Del Variants ,CPT® 81269,0300 - LABORATORY,N/A,N/A," $1,166.00 ", $757.90 , $979.44 , $206.45 , $165.16 , $942.13 ," $1,049.40 ", $987.14 ," $1,049.40 "," $1,049.40 "," $1,049.40 ", $991.10 , $161.92 ," $1,076.57 "," $1,107.70 ", $991.10 ," $1,084.38 "," $1,084.38 "," $1,107.70 "," $1,119.36 ", $954.02 ," $1,049.40 ", $991.10 , $921.14 , N/A , $943.64 , $943.64 ," $1,107.70 "," $1,000.54 ", $161.92 ," $1,119.36 "
 DOFETILIDE 500 MCG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-6683-08,1 capsule, $32.47 , $21.11 , $27.27 , N/A , N/A , $26.24 , $29.22 , $27.49 , $29.22 , $29.22 , $29.22 , $27.60 , N/A , $29.98 , $30.85 , $27.60 , $30.20 , $30.20 , $30.85 , $31.17 , $26.57 , $29.22 , $27.60 , $25.65 , N/A , $26.28 , $26.28 , $30.85 , $27.86 , $25.65 , $31.17 
Drain External Ear Lesion,69005,N/A,N/A,N/A," $1,762.00 "," $1,145.30 ", $758.50 , $155.08 , $72.58 , $755.35 , $776.05 ," $1,638.66 "," $1,585.80 "," $1,585.80 "," $1,409.60 "," $1,409.60 ", $72.58 ," $1,626.85 "," $1,673.90 "," $1,585.80 "," $1,585.80 "," $1,585.80 "," $1,638.66 "," $1,691.52 ", $816.81 ," $1,497.70 ", $847.43 , $757.85 , N/A , $770.09 , $770.09 ," $1,673.90 ", $879.31 , $72.58 ," $1,691.52 "
 Pro Injection Aa&/Strd Axillary Nerve W/Img Gdn ,CPT® 64417,0964 - PRO FEE/ANES CRNA,N/A,N/A," $1,698.00 "," $1,103.70 ", $302.22 , $61.03 , $46.08 , $396.12 , $376.64 ," $1,579.14 "," $1,528.20 "," $1,528.20 "," $1,358.40 "," $1,358.40 ", $46.08 ," $1,567.76 "," $1,613.10 "," $1,528.20 "," $1,528.20 "," $1,528.20 "," $1,579.14 "," $1,630.08 ", $326.16 ," $1,443.30 ", $369.30 , $426.36 , N/A , $403.84 , $403.84 ," $1,613.10 ", $433.22 , $46.08 ," $1,630.08 "
Complex Repair 2.6-7.5cm,CPT® 13121,N/A,N/A,N/A," $1,861.00 "," $1,209.65 ", $826.64 , $247.45 , $218.65 , $731.79 , $713.39 ," $1,730.73 "," $1,674.90 "," $1,674.90 "," $1,488.80 "," $1,488.80 ", $218.65 ," $1,718.26 "," $1,767.95 "," $1,674.90 "," $1,674.90 "," $1,674.90 "," $1,730.73 "," $1,786.56 ", $912.10 ," $1,581.85 "," $1,421.90 ", $938.47 , N/A , $746.06 , $746.06 ," $1,767.95 ", $865.20 , $218.65 ," $1,786.56 "
Iadna S. Aureus Methicillin Resistant Amp Prb Tq,CPT® 87641,N/A,N/A,N/A, $139.00 , $90.35 , N/A , $35.79 , $35.79 , $198.56 , $237.51 , $129.27 , $125.10 , $125.10 , $111.20 , $111.20 , $35.79 , $128.34 , $132.05 , $125.10 , $125.10 , $125.10 , $129.27 , $133.44 , $234.30 , $118.15 , $230.30 , $127.26 , N/A , $185.31 , $185.31 , $132.05 , $202.50 , $35.79 , $237.51 
Remove Perm Cannula/Catheter,49422,N/A,N/A,N/A," $1,823.00 "," $1,184.95 "," $1,307.74 ", $201.99 , $667.22 ," $1,790.30 "," $1,818.74 "," $1,695.39 "," $1,640.70 "," $1,640.70 "," $1,458.40 "," $1,458.40 ", $667.22 ," $1,683.18 "," $1,731.85 "," $1,640.70 "," $1,640.70 "," $1,640.70 "," $1,695.39 "," $1,750.08 ", $940.30 ," $1,549.55 "," $2,019.56 "," $2,109.74 ", N/A ," $1,825.23 "," $1,825.23 "," $1,731.85 "," $1,908.99 ", $201.99 ," $2,109.74 "
 MAGNESIUM SULFATE 4 GM/100ML IV SOLN ,HCPCS J3475,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0106-00,100 mL, $48.81 , $31.73 , $41.00 , $0.95 , $0.81 , $39.44 , $43.93 , $41.32 , $43.93 , $43.93 , $43.93 , $41.49 , $0.79 , $45.07 , $46.37 , $41.49 , $45.39 , $45.39 , $46.37 , $46.86 , $39.94 , $43.93 , $41.49 , $38.56 , N/A , $39.50 , $39.50 , $46.37 , $41.88 , $0.79 , $46.86 
 Pro Drainage of Scrotum Abscess ,CPT® 55100,0982 - PRO FEE/OUTPT,N/A,N/A," $1,088.00 ", $707.20 , $740.16 , $160.07 , $30.71 , $530.69 , $546.97 ," $1,011.84 ", $979.20 , $979.20 , $870.40 , $870.40 , $30.71 ," $1,004.55 "," $1,033.60 ", $979.20 , $979.20 , $979.20 ," $1,011.84 "," $1,044.48 ", $691.67 , $924.80 , $875.98 , $802.59 , N/A , $541.04 , $541.04 ," $1,033.60 ", $648.45 , $30.71 ," $1,044.48 "
Diab Manage Trn per Indiv,G0108,N/A,N/A,N/A, $210.00 , $136.50 , $128.40 , $53.88 , N/A , $97.34 , N/A , $195.30 , $189.00 , $189.00 , $168.00 , $168.00 , N/A , $193.89 , $199.50 , $189.00 , $189.00 , $189.00 , $195.30 , $201.60 , $169.46 , $178.50 , $99.26 , $203.23 , N/A , $99.24 , $99.24 , $199.50 , $124.04 , $53.88 , $203.23 
 Voiding Urethrocystography ,CPT® 74455,0320 - DX X-RAY,N/A,N/A," $1,022.00 ", $664.30 , $858.48 , $103.57 , $79.78 , $825.78 , $919.80 , $865.23 , $919.80 , $919.80 , $919.80 , $868.70 , $78.22 , $943.61 , $970.90 , $868.70 , $950.46 , $950.46 , $970.90 , $981.12 , $836.20 , $919.80 , $868.70 , $807.38 , N/A , $827.10 , $827.10 , $970.90 , $876.98 , $78.22 , $981.12 
Synvisc or Synvisc-One,HCPCS J7325,N/A,N/A,N/A, $40.00 , $26.00 , N/A , $9.81 , $9.99 , N/A , N/A , $37.20 , $36.00 , $36.00 , $32.00 , $32.00 , $9.99 , $36.93 , $38.00 , $36.00 , $36.00 , $36.00 , $37.20 , $38.40 , $14.16 , $34.00 , $22.71 , $13.22 , N/A , N/A , N/A , $38.00 , N/A , $9.81 , $38.40 
"Myelin Basic Protein,CSF",CPT® 83873,N/A,N/A,N/A, $191.00 , $124.15 , N/A , $17.54 , $17.54 , $97.33 , $116.45 , $177.63 , $171.90 , $171.90 , $152.80 , $152.80 , $17.54 , $176.35 , $181.45 , $171.90 , $171.90 , $171.90 , $177.63 , $183.36 , $114.85 , $162.35 , $113.53 , $62.38 , N/A , $90.83 , $90.83 , $181.45 , $99.26 , $17.54 , $183.36 
 Fac Inpatient Behavioral Therapy ,CPT® 90899,0900 - PSYCH TREATMENT,N/A,N/A, $353.00 , $229.45 , $296.52 , N/A , $77.18 , $285.22 , $317.70 , $298.85 , $317.70 , $317.70 , $317.70 , $300.05 , $75.67 , $325.92 , $335.35 , $300.05 , $328.29 , $328.29 , $335.35 , $338.88 , $288.82 , $317.70 , $300.05 , $278.87 , N/A , $285.68 , $285.68 , $335.35 , $302.91 , $75.67 , $338.88 
 Pro Spec Stains Histochem Staining Frozen Sctj ,CPT® 88314,0971 - PRO FEE/LAB,N/A,N/A, $151.00 , $98.15 , $351.46 , $89.00 , $39.85 , $295.85 , $369.57 , $140.43 , $135.90 , $135.90 , $120.80 , $120.80 , $39.85 , $139.42 , $143.45 , $135.90 , $135.90 , $135.90 , $140.43 , $144.96 , $641.75 , $128.35 , $386.00 , $296.05 , N/A , $276.11 , $276.11 , $143.45 , $303.44 , $39.85 , $641.75 
 TOCILIZUMAB 200 MG/10ML IV SOLN ,HCPCS J3262,0636 - DRUGS REQUIRING DETAILED CODIN,50242-0136-01,10 mL," $3,904.47 "," $2,537.91 "," $3,279.75 ", $6.03 , $6.11 ," $3,154.81 "," $3,514.02 "," $3,305.52 "," $3,514.02 "," $3,514.02 "," $3,514.02 "," $3,318.80 ", $5.99 ," $3,605.00 "," $3,709.25 "," $3,318.80 "," $3,631.16 "," $3,631.16 "," $3,709.25 "," $3,748.29 "," $3,194.64 "," $3,514.02 "," $3,318.80 "," $3,084.53 ", N/A ," $3,159.89 "," $3,159.89 "," $3,709.25 "," $3,350.43 ", $5.99 ," $3,748.29 "
"Developmental Test, Lim",CPT® 96110,N/A,N/A,N/A, $44.00 , $28.60 , N/A , $10.29 , $94.93 , $20.73 , $20.26 , $40.92 , $39.60 , $39.60 , $35.20 , $35.20 , $94.93 , $40.63 , $41.80 , $39.60 , $39.60 , $39.60 , $40.92 , $42.24 , $41.59 , $37.40 , $27.37 , $37.79 , N/A , $21.14 , $21.14 , $41.80 , $24.64 , $10.29 , $94.93 
 Pro Repair/Graft Radius or Ulna ,CPT® 25405,0975 - PRO FEE/OR,N/A,N/A," $7,185.00 "," $4,670.25 "," $6,304.35 ", $985.61 , $998.92 ," $4,987.85 "," $4,950.73 "," $6,682.05 "," $6,466.50 "," $6,466.50 "," $5,748.00 "," $5,748.00 ", $998.92 ," $6,633.91 "," $6,825.75 "," $6,466.50 "," $6,466.50 "," $6,466.50 "," $6,682.05 "," $6,897.60 "," $5,866.43 "," $6,107.25 "," $5,459.24 "," $5,902.65 ", N/A ," $5,085.17 "," $5,085.17 "," $6,825.75 "," $5,976.89 ", $985.61 ," $6,897.60 "
Pro Clsd Tx Acromioclavicular Disloc WO Manip - Lh,23540,N/A,N/A,N/A, $662.00 , $430.30 ," $1,462.70 ", $233.67 , $133.38 ," $1,100.47 "," $1,119.50 ", $615.66 , $595.80 , $595.80 , $529.60 , $529.60 , $133.38 , $611.22 , $628.90 , $595.80 , $595.80 , $595.80 , $615.66 , $635.52 ," $1,338.90 ", $562.70 ," $1,225.65 "," $1,309.10 ", N/A ," $1,121.94 "," $1,121.94 ", $628.90 ," $1,318.69 ", $133.38 ," $1,462.70 "
Ventilation Assist & Mgmt Inpatient Ea Sbsq Day,CPT® 94003,N/A,N/A,N/A," $1,400.00 ", $910.00 , $149.35 , $62.01 , $52.26 , $149.19 , $149.82 ," $1,302.00 "," $1,260.00 "," $1,260.00 "," $1,120.00 "," $1,120.00 ", $52.26 ," $1,292.62 "," $1,330.00 "," $1,260.00 "," $1,260.00 "," $1,260.00 "," $1,302.00 "," $1,344.00 ", $198.31 ," $1,190.00 ", $197.67 , $252.05 , N/A , $152.10 , $152.10 ," $1,330.00 ", $177.31 , $52.26 ," $1,344.00 "
"Prostate Specific Antigen,Free",CPT® 84154,N/A,N/A,N/A, $171.00 , $111.15 , N/A , $18.76 , $18.76 , $104.06 , $124.52 , $159.03 , $153.90 , $153.90 , $136.80 , $136.80 , $18.76 , $157.88 , $162.45 , $153.90 , $153.90 , $153.90 , $159.03 , $164.16 , $122.79 , $145.35 , $120.02 , $66.70 , N/A , $97.12 , $97.12 , $162.45 , $106.13 , $18.76 , $164.16 
"Hep B Core Ab Test, Total",CPT® 86704,N/A,N/A,N/A, $126.00 , $81.90 , N/A , $12.29 , $12.29 , $68.18 , $81.59 , $117.18 , $113.40 , $113.40 , $100.80 , $100.80 , $12.29 , $116.34 , $119.70 , $113.40 , $113.40 , $113.40 , $117.18 , $120.96 , $80.46 , $107.10 , $79.47 , $43.70 , N/A , $63.63 , $63.63 , $119.70 , $69.54 , $12.29 , $120.96 
Treat Metacarpal Fracture,CPT® 26605,N/A,N/A,N/A," $2,114.00 "," $1,374.10 "," $1,855.17 ", $293.60 , $235.17 ," $1,410.06 "," $1,432.50 "," $1,966.02 "," $1,902.60 "," $1,902.60 "," $1,691.20 "," $1,691.20 ", $235.17 ," $1,951.86 "," $2,008.30 "," $1,902.60 "," $1,902.60 "," $1,902.60 "," $1,966.02 "," $2,029.44 "," $1,703.17 "," $1,796.90 "," $1,571.76 "," $1,675.41 ", N/A ," $1,437.57 "," $1,437.57 "," $2,008.30 "," $1,689.69 ", $235.17 ," $2,029.44 "
 Fac Automated Leukocyte Count ,CPT® 85048,0305 - LAB/HEMATOLOGY,N/A,N/A, $51.00 , $33.15 , $42.84 , $2.59 , $2.59 , $41.21 , $45.90 , $43.18 , $45.90 , $45.90 , $45.90 , $43.35 , $2.54 , $47.09 , $48.45 , $43.35 , $47.43 , $47.43 , $48.45 , $48.96 , $41.73 , $45.90 , $43.35 , $40.29 , N/A , $41.27 , $41.27 , $48.45 , $43.76 , $2.54 , $48.96 
Hearing Aid Check Binaural,CPT® 92593,N/A,N/A,N/A, $143.00 , $92.95 , N/A , N/A , $24.97 , $76.23 , $79.75 , $132.99 , $128.70 , $128.70 , $114.40 , $114.40 , $24.97 , $132.03 , $135.85 , $128.70 , $128.70 , $128.70 , $132.99 , $137.28 , N/A , $121.55 , $106.44 , $133.10 , N/A , $77.72 , $77.72 , $135.85 , $90.59 , $24.97 , $137.28 
Incision of Urethral Meatus,CPT® 53020,N/A,N/A,N/A, $676.00 , $439.40 , $520.15 , $91.48 , $67.13 , $475.88 , $442.85 , $628.68 , $608.40 , $608.40 , $540.80 , $540.80 , $67.13 , $624.15 , $642.20 , $608.40 , $608.40 , $608.40 , $628.68 , $648.96 , $522.85 , $574.60 , $501.32 , $597.61 , N/A , $485.16 , $485.16 , $642.20 , $570.24 , $67.13 , $648.96 
 Fac Mgmt Gene Promoter Methylation Analysis ,CPT® 81287,0300 - LABORATORY,N/A,N/A, $198.00 , $128.70 , $166.32 , $127.13 , $84.75 , $159.98 , $178.20 , $167.63 , $178.20 , $178.20 , $178.20 , $168.30 , $83.09 , $182.81 , $188.10 , $168.30 , $184.14 , $184.14 , $188.10 , $190.08 , $162.00 , $178.20 , $168.30 , $156.42 , N/A , $160.24 , $160.24 , $188.10 , $169.90 , $83.09 , $190.08 
Excision Tumor Soft Tiss Face/Scalp Subq 2+Cm,CPT® 21012,N/A,N/A,N/A," $2,275.00 "," $1,478.75 "," $2,061.02 ", $322.84 , $278.25 ," $1,628.35 "," $1,630.47 "," $2,115.75 "," $2,047.50 "," $2,047.50 "," $1,820.00 "," $1,820.00 ", $278.25 ," $2,100.51 "," $2,161.25 "," $2,047.50 "," $2,047.50 "," $2,047.50 "," $2,115.75 "," $2,184.00 "," $1,904.92 "," $1,933.75 "," $1,787.63 "," $1,929.36 ", N/A ," $1,660.12 "," $1,660.12 "," $2,161.25 "," $1,951.25 ", $278.25 ," $2,184.00 "
 Fac 85347 ,CPT® 85347,0305 - LAB/HEMATOLOGY,N/A,N/A, $97.00 , $63.05 , $81.48 , $4.37 , $4.37 , $78.38 , $87.30 , $82.12 , $87.30 , $87.30 , $87.30 , $82.45 , $4.28 , $89.56 , $92.15 , $82.45 , $90.21 , $90.21 , $92.15 , $93.12 , $79.37 , $87.30 , $82.45 , $76.63 , N/A , $78.50 , $78.50 , $92.15 , $83.24 , $4.28 , $93.12 
"Insert,Temp Indwelling Blad Cath,Simple",51702,N/A,N/A,N/A, $239.00 , $155.35 , $137.37 , $23.85 , $112.85 , $147.13 , $137.78 , $222.27 , $215.10 , $215.10 , $191.20 , $191.20 , $112.85 , $220.67 , $227.05 , $215.10 , $215.10 , $215.10 , $222.27 , $229.44 , $136.89 , $203.15 , $157.00 , $158.32 , N/A , $150.00 , $150.00 , $227.05 , $176.30 , $23.85 , $229.44 
 CT Angio Head ,CPT® 70496,0350 - CT SCAN,N/A,N/A," $4,009.00 "," $2,605.85 "," $3,367.56 ", $256.30 , $377.53 ," $3,239.27 "," $3,608.10 "," $3,394.02 "," $3,608.10 "," $3,608.10 "," $3,608.10 "," $3,407.65 ", $370.13 ," $3,701.51 "," $3,808.55 "," $3,407.65 "," $3,728.37 "," $3,728.37 "," $3,808.55 "," $3,848.64 "," $3,280.16 "," $3,608.10 "," $3,407.65 "," $3,167.11 ", N/A ," $3,244.48 "," $3,244.48 "," $3,808.55 "," $3,440.12 ", $256.30 ," $3,848.64 "
"Repair Bladder Wound/Inj,Complic",CPT® 51865,N/A,N/A,N/A," $6,193.00 "," $4,025.45 "," $4,842.59 ", $850.11 , $874.22 ," $4,369.54 "," $4,083.61 "," $5,759.49 "," $5,573.70 "," $5,573.70 "," $4,954.40 "," $4,954.40 ", $874.22 ," $5,718.00 "," $5,883.35 "," $5,573.70 "," $5,573.70 "," $5,573.70 "," $5,759.49 "," $5,945.28 "," $4,856.05 "," $5,264.05 "," $4,659.98 "," $5,461.35 ", N/A ," $4,454.80 "," $4,454.80 "," $5,883.35 "," $5,235.96 ", $850.11 ," $5,945.28 "
Lam Facetec/Foramot Drg Arthrd Lumbar 1 Vrt Sgm,CPT® 63052,N/A,N/A,N/A," $5,637.00 "," $3,664.05 "," $1,186.12 ", $230.84 ," $1,072.37 ", N/A , N/A ," $5,242.41 "," $5,073.30 "," $5,073.30 "," $4,509.60 "," $4,509.60 "," $1,072.37 "," $5,204.64 "," $5,355.15 "," $5,073.30 "," $5,073.30 "," $5,073.30 "," $5,242.41 "," $5,411.52 ", N/A ," $4,791.45 "," $1,366.47 "," $1,483.65 ", N/A ," $1,241.74 "," $1,241.74 "," $5,355.15 "," $1,331.38 ", $230.84 ," $5,411.52 "
 LEUPROLIDE ACETATE (3 MONTH) 22.5 MG SC KIT ,HCPCS J9217,0636 - DRUGS REQUIRING DETAILED CODIN,62935-0223-05,1 each," $3,984.32 "," $2,589.81 "," $3,346.83 ", $169.18 , $192.10 ," $3,219.33 "," $3,585.89 "," $3,373.13 "," $3,585.89 "," $3,585.89 "," $3,585.89 "," $3,386.67 ", $188.33 ," $3,678.72 "," $3,785.10 "," $3,386.67 "," $3,705.42 "," $3,705.42 "," $3,785.10 "," $3,824.95 "," $3,259.97 "," $3,585.89 "," $3,386.67 "," $3,147.61 ", N/A ," $3,224.51 "," $3,224.51 "," $3,785.10 "," $3,418.94 ", $169.18 ," $3,824.95 "
 If Study Initial Proibd ,CPT® 88346,0310 - PATHOLOGY LAB,N/A,N/A, $418.00 , $271.70 , $351.12 , $149.59 , $52.81 , $337.74 , $376.20 , $353.88 , $376.20 , $376.20 , $376.20 , $355.30 , $51.77 , $385.94 , $397.10 , $355.30 , $388.74 , $388.74 , $397.10 , $401.28 , $342.01 , $376.20 , $355.30 , $330.22 , N/A , $338.29 , $338.29 , $397.10 , $358.69 , $51.77 , $401.28 
 Fac Candida Antibody ,CPT® 86628,0302 - LAB/IMMUNOLOGY,N/A,N/A, $134.00 , $87.10 , $112.56 , $12.25 , $8.07 , $108.27 , $120.60 , $113.44 , $120.60 , $120.60 , $120.60 , $113.90 , $7.91 , $123.72 , $127.30 , $113.90 , $124.62 , $124.62 , $127.30 , $128.64 , $109.64 , $120.60 , $113.90 , $105.86 , N/A , $108.45 , $108.45 , $127.30 , $114.99 , $7.91 , $128.64 
" Pro Bone Imaging, 3 Phase ",CPT® 78315,0974 - PRO FEE/NUC MED,N/A,N/A," $2,319.00 "," $1,507.35 "," $1,851.24 ", $317.21 , $242.39 ," $1,706.13 "," $1,862.48 "," $2,156.67 "," $2,087.10 "," $2,087.10 "," $1,855.20 "," $1,855.20 ", $242.39 ," $2,141.13 "," $2,203.05 "," $2,087.10 "," $2,087.10 "," $2,087.10 "," $2,156.67 "," $2,226.24 "," $1,917.67 "," $1,971.15 "," $2,030.05 "," $2,330.36 ", N/A ," $1,739.42 "," $1,739.42 "," $2,203.05 "," $2,013.41 ", $242.39 ," $2,330.36 "
" Fac Flowcytometry/ Tc, 1 Marker ",CPT® 88184,0311 - PATHOL/CYTOLOGY,N/A,N/A, $501.00 , $325.65 , $420.84 , $72.46 , $48.24 , $404.81 , $450.90 , $424.15 , $450.90 , $450.90 , $450.90 , $425.85 , $47.29 , $462.57 , $475.95 , $425.85 , $465.93 , $465.93 , $475.95 , $480.96 , $409.92 , $450.90 , $425.85 , $395.79 , N/A , $405.46 , $405.46 , $475.95 , $429.91 , $47.29 , $480.96 
 Pro Sgmdsc Flx With Endoscopic Mucosal Resection ,CPT® 45349,0982 - PRO FEE/OUTPT,N/A,N/A," $2,493.00 "," $1,620.45 "," $1,216.80 ", $187.96 , $133.80 , N/A , N/A ," $2,318.49 "," $2,243.70 "," $2,243.70 "," $1,994.40 "," $1,994.40 ", $133.80 ," $2,301.79 "," $2,368.35 "," $2,243.70 "," $2,243.70 "," $2,243.70 "," $2,318.49 "," $2,393.28 ", $874.13 ," $2,119.05 "," $1,034.18 "," $1,160.23 ", N/A , $888.60 , $888.60 ," $2,368.35 ", $930.05 , $133.80 ," $2,393.28 "
Assay 17-(17-Ks)Ketosteroids,CPT® 83586,N/A,N/A,N/A, $132.00 , $85.80 , N/A , $13.06 , $13.06 , $72.47 , $86.66 , $122.76 , $118.80 , $118.80 , $105.60 , $105.60 , $13.06 , $121.88 , $125.40 , $118.80 , $118.80 , $118.80 , $122.76 , $126.72 , $85.47 , $112.20 , $84.34 , $46.40 , N/A , $67.63 , $67.63 , $125.40 , $73.90 , $13.06 , $126.72 
 Fac Urine Albumin Quantitative ,CPT® 82043,0301 - LAB/CHEMISTRY,N/A,N/A, $140.00 , $91.00 , $117.60 , $5.90 , $5.90 , $113.12 , $126.00 , $118.52 , $126.00 , $126.00 , $126.00 , $119.00 , $5.78 , $129.26 , $133.00 , $119.00 , $130.20 , $130.20 , $133.00 , $134.40 , $114.55 , $126.00 , $119.00 , $110.60 , N/A , $113.30 , $113.30 , $133.00 , $120.13 , $5.78 , $134.40 
Apply Rigid Leg Cast,CPT® 29445,N/A,N/A,N/A, $917.00 , $596.05 , $610.74 , $94.45 , $147.47 , $512.77 , $511.45 , $852.81 , $825.30 , $825.30 , $733.60 , $733.60 , $147.47 , $846.67 , $871.15 , $825.30 , $825.30 , $825.30 , $852.81 , $880.32 , $573.55 , $779.45 , $558.41 , $597.86 , N/A , $522.78 , $522.78 , $871.15 , $614.44 , $94.45 , $880.32 
 Fac Cltx Dstl Xtnsr Tdn Insj +-Prq Pinning ,CPT® 26432,0361 - OR/MINOR,N/A,N/A," $5,863.00 "," $3,810.95 "," $4,924.92 ", $536.34 , $414.43 ," $4,737.30 "," $5,276.70 "," $4,963.62 "," $5,276.70 "," $5,276.70 "," $5,276.70 "," $4,983.55 ", $406.30 ," $5,413.31 "," $5,569.85 "," $4,983.55 "," $5,452.59 "," $5,452.59 "," $5,569.85 "," $5,628.48 "," $4,797.11 "," $5,276.70 "," $4,983.55 "," $4,631.77 ", N/A ," $4,744.93 "," $4,744.93 "," $5,569.85 "," $5,031.04 ", $406.30 ," $5,628.48 "
 Fac Sc Std Antmcrb Agt Disk Meth PR Plate ,CPT® 87184,0306 - LAB/BACT-MICRO,N/A,N/A, $79.00 , $51.35 , $66.36 , $7.63 , $7.63 , $63.83 , $71.10 , $66.88 , $71.10 , $71.10 , $71.10 , $67.15 , $7.48 , $72.94 , $75.05 , $67.15 , $73.47 , $73.47 , $75.05 , $75.84 , $64.64 , $71.10 , $67.15 , $62.41 , N/A , $63.93 , $63.93 , $75.05 , $67.79 , $7.48 , $75.84 
Bcr/Abl1 Major Breakpnt Qualitative/Quantitative,CPT® 81206,N/A,N/A,N/A," $1,118.00 ", $726.70 , N/A , $167.24 , $167.24 , $927.65 ," $1,098.55 "," $1,039.74 "," $1,006.20 "," $1,006.20 ", $894.40 , $894.40 , $167.24 ," $1,032.25 "," $1,062.10 "," $1,006.20 "," $1,006.20 "," $1,006.20 "," $1,039.74 "," $1,073.28 "," $1,094.80 ", $950.30 , $781.84 , $594.51 , N/A , $865.74 , $865.74 ," $1,062.10 ", $946.07 , $167.24 ," $1,098.55 "
Needle Insertion W/O Injection 3 or More Muscles,CPT® 20561,N/A,N/A,N/A, $65.00 , $42.25 , $141.12 , $22.06 , N/A , $118.47 , N/A , $60.45 , $58.50 , $58.50 , $52.00 , $52.00 , N/A , $60.01 , $61.75 , $58.50 , $58.50 , $58.50 , $60.45 , $62.40 , $136.79 , $55.25 , $117.28 , $143.65 , N/A , $120.78 , $120.78 , $61.75 , $141.97 , $22.06 , $143.65 
" Pro Cytopath, C/V, Interpret ",CPT® 88141,0971 - PRO FEE/LAB,N/A,N/A, $192.00 , $124.80 , $79.51 , $22.56 , $22.43 , $128.25 , $144.51 , $178.56 , $172.80 , $172.80 , $153.60 , $153.60 , $22.43 , $177.27 , $182.40 , $172.80 , $172.80 , $172.80 , $178.56 , $184.32 , $140.29 , $163.20 , $150.83 , $112.96 , N/A , $119.69 , $119.69 , $182.40 , $131.53 , $22.43 , $184.32 
Psychological Tst Eval Svc Phys/Qhp Ea Addl Hour,CPT® 96131,N/A,N/A,N/A, $538.00 , $349.70 , $186.12 , $76.71 , $103.31 , $175.49 , N/A , $500.34 , $484.20 , $484.20 , $430.40 , $430.40 , $103.31 , $496.74 , $511.10 , $484.20 , $484.20 , $484.20 , $500.34 , $516.48 , $352.27 , $457.30 , $228.19 , $320.28 , N/A , $178.91 , $178.91 , $511.10 , $208.59 , $76.71 , $516.48 
Cast Sup Gauntlet Fiberglass,HCPCS Q4014,N/A,N/A,N/A, $150.00 , $97.50 , N/A , $32.21 , $20.84 , N/A , N/A , $139.50 , $135.00 , $135.00 , $120.00 , $120.00 , $20.84 , $138.50 , $142.50 , $135.00 , $135.00 , $135.00 , $139.50 , $144.00 , N/A , $127.50 , $83.04 , $29.26 , N/A , N/A , N/A , $142.50 , N/A , $20.84 , $144.00 
Bevacizumab Injection,HCPCS C9257,N/A,N/A,N/A, $69.00 , $44.85 , N/A , N/A , N/A , N/A , N/A , $64.17 , $62.10 , $62.10 , $55.20 , $55.20 , N/A , $63.71 , $65.55 , $62.10 , $62.10 , $62.10 , $64.17 , $66.24 , N/A , $58.65 , $55.20 , N/A , N/A , N/A , N/A , $65.55 , N/A , $55.20 , $66.24 
"Dna Antibody, Natv/2 Strand",CPT® 86225,N/A,N/A,N/A, $176.00 , $114.40 , N/A , $14.01 , $14.01 , $77.71 , $92.95 , $163.68 , $158.40 , $158.40 , $140.80 , $140.80 , $14.01 , $162.50 , $167.20 , $158.40 , $158.40 , $158.40 , $163.68 , $168.96 , $91.75 , $149.60 , $89.20 , $49.84 , N/A , $72.52 , $72.52 , $167.20 , $79.25 , $14.01 , $168.96 
 AMIODARONE HCL IN DEXTROSE 360-4.14 MG/200ML-% IV SOLN ,HCPCS J0283,0636 - DRUGS REQUIRING DETAILED CODIN,43066-0360-20,200 mL, $284.59 , $184.98 , $239.06 , N/A , $0.07 , $229.95 , $256.13 , $240.93 , $256.13 , $256.13 , $256.13 , $241.90 , $0.07 , $262.76 , $270.36 , $241.90 , $264.67 , $264.67 , $270.36 , $273.21 , $232.85 , $256.13 , $241.90 , $224.83 , N/A , $230.32 , $230.32 , $270.36 , $244.21 , $0.07 , $273.21 
 Fac Brucella Antibody ,CPT® 86622,0302 - LAB/IMMUNOLOGY,N/A,N/A, $119.00 , $77.35 , $99.96 , $9.11 , $8.07 , $96.15 , $107.10 , $100.75 , $107.10 , $107.10 , $107.10 , $101.15 , $7.91 , $109.87 , $113.05 , $101.15 , $110.67 , $110.67 , $113.05 , $114.24 , $97.37 , $107.10 , $101.15 , $94.01 , N/A , $96.31 , $96.31 , $113.05 , $102.11 , $7.91 , $114.24 
 Fac Scalp Cooling 1st Measurement & Cap Calibration ,CPT® 0662T,0280 - ONCOLOGY,N/A,N/A," $2,406.00 "," $1,563.90 "," $2,021.04 ", N/A , N/A ," $1,944.05 "," $2,165.40 "," $2,036.92 "," $2,165.40 "," $2,165.40 "," $2,165.40 "," $2,045.10 ", N/A ," $2,221.46 "," $2,285.70 "," $2,045.10 "," $2,237.58 "," $2,237.58 "," $2,285.70 "," $2,309.76 "," $1,968.59 "," $2,165.40 "," $2,045.10 "," $1,900.74 ", N/A ," $1,947.18 "," $1,947.18 "," $2,285.70 "," $2,064.59 "," $1,900.74 "," $2,309.76 "
Open Rx Ankle Dislocatn+Fixatn,CPT® 27848,N/A,N/A,N/A," $5,403.00 "," $3,511.95 "," $4,818.00 ", $749.85 , $691.53 ," $3,934.38 "," $3,885.61 "," $5,024.79 "," $4,862.70 "," $4,862.70 "," $4,322.40 "," $4,322.40 ", $691.53 ," $4,988.59 "," $5,132.85 "," $4,862.70 "," $4,862.70 "," $4,862.70 "," $5,024.79 "," $5,186.88 "," $4,517.77 "," $4,592.55 "," $4,292.46 "," $4,563.58 ", N/A ," $4,011.14 "," $4,011.14 "," $5,132.85 "," $4,714.53 ", $691.53 ," $5,186.88 "
"Closed Rx Tibia Shaft Fx,Manipulatn",CPT® 27752,N/A,N/A,N/A," $2,050.00 "," $1,332.50 "," $3,010.67 ", $474.05 , $502.11 ," $2,384.99 "," $2,399.89 "," $1,906.50 "," $1,845.00 "," $1,845.00 "," $1,640.00 "," $1,640.00 ", $502.11 ," $1,892.77 "," $1,947.50 "," $1,845.00 "," $1,845.00 "," $1,845.00 "," $1,906.50 "," $1,968.00 "," $2,794.53 "," $1,742.50 "," $2,643.98 "," $2,805.41 ", N/A ," $2,431.52 "," $2,431.52 "," $1,947.50 "," $2,857.92 ", $474.05 ," $3,010.67 "
 Fac Iaad Ia Hepatitis B Surface Antigen ,CPT® 87340,0306 - LAB/BACT-MICRO,N/A,N/A, $97.00 , $63.05 , $81.48 , $10.54 , $10.54 , $78.38 , $87.30 , $82.12 , $87.30 , $87.30 , $87.30 , $82.45 , $10.33 , $89.56 , $92.15 , $82.45 , $90.21 , $90.21 , $92.15 , $93.12 , $79.37 , $87.30 , $82.45 , $76.63 , N/A , $78.50 , $78.50 , $92.15 , $83.24 , $10.33 , $93.12 
 Abdomen 2 Views With Single View Chest ,CPT® 74022,0320 - DX X-RAY,N/A,N/A, $414.00 , $269.10 , $347.76 , $49.14 , $46.32 , $334.51 , $372.60 , $350.49 , $372.60 , $372.60 , $372.60 , $351.90 , $45.41 , $382.25 , $393.30 , $351.90 , $385.02 , $385.02 , $393.30 , $397.44 , $338.73 , $372.60 , $351.90 , $327.06 , N/A , $335.05 , $335.05 , $393.30 , $355.25 , $45.41 , $397.44 
"I&D Finger Abscess,Compli",26011,N/A,N/A,N/A," $1,072.00 ", $696.80 ," $1,138.61 ", $178.74 , $161.97 , $890.56 , $896.50 , $996.96 , $964.80 , $964.80 , $857.60 , $857.60 , $161.97 , $989.78 ," $1,018.40 ", $964.80 , $964.80 , $964.80 , $996.96 ," $1,029.12 "," $1,057.07 ", $911.20 , $983.02 ," $1,060.93 ", N/A , $907.94 , $907.94 ," $1,018.40 "," $1,067.16 ", $161.97 ," $1,138.61 "
 Incision & Drainage Vulva/Perineal Abscess - Mh ,CPT® 56405,0761 - TREATMENT ROOM,N/A,N/A, $996.00 , $647.40 , $836.64 , $122.85 , $122.21 , $804.77 , $896.40 , $843.21 , $896.40 , $896.40 , $896.40 , $846.60 , $119.81 , $919.61 , $946.20 , $846.60 , $926.28 , $926.28 , $946.20 , $956.16 , $814.93 , $896.40 , $846.60 , $786.84 , N/A , $806.06 , $806.06 , $946.20 , $854.67 , $119.81 , $956.16 
"Semen Analysis,Complete",CPT® 89320,N/A,N/A,N/A, $262.00 , $170.30 , N/A , $12.56 , $12.56 , $67.48 , $81.59 , $243.66 , $235.80 , $235.80 , $209.60 , $209.60 , $12.56 , $241.90 , $248.90 , $235.80 , $235.80 , $235.80 , $243.66 , $251.52 , $71.93 , $222.70 , $79.47 , $43.61 , N/A , $62.98 , $62.98 , $248.90 , $69.21 , $12.56 , $251.52 
 Fac Immunodiffusion Nes ,CPT® 86329,0302 - LAB/IMMUNOLOGY,N/A,N/A, $121.00 , $78.65 , $101.64 , $14.33 , $14.33 , $97.77 , $108.90 , $102.44 , $108.90 , $108.90 , $108.90 , $102.85 , $14.05 , $111.72 , $114.95 , $102.85 , $112.53 , $112.53 , $114.95 , $116.16 , $99.00 , $108.90 , $102.85 , $95.59 , N/A , $97.93 , $97.93 , $114.95 , $103.83 , $14.05 , $116.16 
 CITALOPRAM HYDROBROMIDE 10 MG/5ML PO SOLN ,HCPCS RXC637,0250 - PHARMACY,31722-0564-24,5 mL, $12.59 , $8.18 , $10.58 , N/A , N/A , $10.17 , $11.33 , $10.66 , $11.33 , $11.33 , $11.33 , $10.70 , N/A , $11.62 , $11.96 , $10.70 , $11.71 , $11.71 , $11.96 , $12.09 , $10.30 , $11.33 , $10.70 , $9.95 , N/A , $10.19 , $10.19 , $11.96 , $10.80 , $9.95 , $12.09 
" Fac Detect Agent Nos, Dna, Amp ",CPT® 87798,0306 - LAB/BACT-MICRO,N/A,N/A, $315.00 , $204.75 , $264.60 , $35.79 , $35.79 , $254.52 , $283.50 , $266.68 , $283.50 , $283.50 , $283.50 , $267.75 , $35.09 , $290.84 , $299.25 , $267.75 , $292.95 , $292.95 , $299.25 , $302.40 , $257.73 , $283.50 , $267.75 , $248.85 , N/A , $254.93 , $254.93 , $299.25 , $270.30 , $35.09 , $302.40 
"Mccd,Phys Coor-Care Ovrsght",HCPCS G9008,N/A,N/A,N/A, $116.00 , $75.40 , N/A , N/A , N/A , N/A , N/A , $107.88 , $104.40 , $104.40 , $92.80 , $92.80 , N/A , $107.10 , $110.20 , $104.40 , $104.40 , $104.40 , $107.88 , $111.36 , N/A , $98.60 , $92.80 , N/A , N/A , N/A , N/A , $110.20 , N/A , $92.80 , $111.36 
"Repair Lip,Full Thick,Vermilion",40650,N/A,N/A,N/A," $1,809.00 "," $1,175.85 "," $1,903.27 ", $300.79 , $539.88 ," $1,433.05 "," $1,493.94 "," $1,682.37 "," $1,628.10 "," $1,628.10 "," $1,447.20 "," $1,447.20 ", $539.88 ," $1,670.25 "," $1,718.55 "," $1,628.10 "," $1,628.10 "," $1,628.10 "," $1,682.37 "," $1,736.64 "," $1,350.46 "," $1,537.65 "," $1,637.77 "," $1,713.95 ", N/A ," $1,461.01 "," $1,461.01 "," $1,718.55 "," $1,528.04 ", $300.79 ," $1,903.27 "
"Repr,Dural/CSF Leak,Not Req Laminectomy",CPT® 63707,N/A,N/A,N/A," $5,961.00 "," $3,874.65 "," $4,393.64 ", $861.43 , $767.52 ," $5,000.27 "," $4,827.81 "," $5,543.73 "," $5,364.90 "," $5,364.90 "," $4,768.80 "," $4,768.80 ", $767.52 ," $5,503.79 "," $5,662.95 "," $5,364.90 "," $5,364.90 "," $5,364.90 "," $5,543.73 "," $5,722.56 "," $4,736.69 "," $5,066.85 "," $4,872.28 "," $5,275.07 ", N/A ," $5,097.84 "," $5,097.84 "," $5,662.95 "," $5,468.78 ", $767.52 ," $5,722.56 "
" Fac Cytogenetics, Dna Probe ",CPT® 88271,0310 - PATHOLOGY LAB,N/A,N/A, $262.00 , $170.30 , $220.08 , $21.85 , $20.09 , $211.70 , $235.80 , $221.81 , $235.80 , $235.80 , $235.80 , $222.70 , $19.70 , $241.90 , $248.90 , $222.70 , $243.66 , $243.66 , $248.90 , $251.52 , $214.37 , $235.80 , $222.70 , $206.98 , N/A , $212.04 , $212.04 , $248.90 , $224.82 , $19.70 , $251.52 
 Fac Viscer and Infrarenal Abdom Aorta 3 Prosthesis ,CPT® 34847,0360 - OR SERVICES,N/A,N/A," $5,308.00 "," $3,450.20 "," $4,458.72 "," $3,511.27 ", N/A ," $4,288.86 "," $4,777.20 "," $4,493.75 "," $4,777.20 "," $4,777.20 "," $4,777.20 "," $4,511.80 ", N/A ," $4,900.88 "," $5,042.60 "," $4,511.80 "," $4,936.44 "," $4,936.44 "," $5,042.60 "," $5,095.68 "," $4,343.01 "," $4,777.20 "," $4,511.80 "," $4,193.32 ", N/A ," $4,295.76 "," $4,295.76 "," $5,042.60 "," $4,554.79 "," $3,511.27 "," $5,095.68 "
 Pro Radiation Therapy Dose Plan ,CPT® 77300,0982 - PRO FEE/OUTPT,N/A,N/A, $209.00 , $135.85 , $364.47 , $64.66 , $68.96 , $301.73 , $344.98 , $194.37 , $188.10 , $188.10 , $167.20 , $167.20 , $68.96 , $192.97 , $198.55 , $188.10 , $188.10 , $188.10 , $194.37 , $200.64 , $371.86 , $177.65 , $377.50 , $372.66 , N/A , $307.61 , $307.61 , $198.55 , $356.08 , $64.66 , $377.50 
 Pro Cltx Mtcrpl Fx 1 W/O Mnpj Ea B1 ,CPT® 26600,0981 - PRO FEE/ER,N/A,N/A," $1,243.00 ", $807.95 ," $1,787.76 ", $284.00 , $155.34 ," $1,331.76 "," $1,361.00 "," $1,155.99 "," $1,118.70 "," $1,118.70 ", $994.40 , $994.40 , $155.34 ," $1,147.66 "," $1,180.85 "," $1,118.70 "," $1,118.70 "," $1,118.70 "," $1,155.99 "," $1,193.28 "," $1,640.20 "," $1,056.55 "," $1,491.48 "," $1,590.09 ", N/A ," $1,357.74 "," $1,357.74 "," $1,180.85 "," $1,595.82 ", $155.34 ," $1,787.76 "
X-Ray Knee 4+ View,CPT® 73564,N/A,N/A,N/A, $347.00 , $225.55 , $260.88 , $45.91 , $36.94 , $186.86 , $233.42 , $322.71 , $312.30 , $312.30 , $277.60 , $277.60 , $36.94 , $320.39 , $329.65 , $312.30 , $312.30 , $312.30 , $322.71 , $333.12 , $252.37 , $294.95 , $258.09 , $200.05 , N/A , $190.51 , $190.51 , $329.65 , $220.49 , $36.94 , $333.12 
 Fac Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw ,CPT® 72083,0320 - DX X-RAY,N/A,N/A, $921.00 , $598.65 , $773.64 , $77.99 , $53.16 , $744.17 , $828.90 , $779.72 , $828.90 , $828.90 , $828.90 , $782.85 , $52.12 , $850.36 , $874.95 , $782.85 , $856.53 , $856.53 , $874.95 , $884.16 , $753.56 , $828.90 , $782.85 , $727.59 , N/A , $745.37 , $745.37 , $874.95 , $790.31 , $52.12 , $884.16 
 Avulsion Nail Plate Each Addtl ,CPT® 11732,0761 - TREATMENT ROOM,N/A,N/A, $159.00 , $103.35 , $133.56 , $16.52 , $20.72 , $128.47 , $143.10 , $134.61 , $143.10 , $143.10 , $143.10 , $135.15 , $20.31 , $146.80 , $151.05 , $135.15 , $147.87 , $147.87 , $151.05 , $152.64 , $130.09 , $143.10 , $135.15 , $125.61 , N/A , $128.68 , $128.68 , $151.05 , $136.44 , $16.52 , $152.64 
" Fac Immunoassay,Infectious Agent ",CPT® 86317,0302 - LAB/IMMUNOLOGY,N/A,N/A, $138.00 , $89.70 , $115.92 , $15.29 , $15.29 , $111.50 , $124.20 , $116.83 , $124.20 , $124.20 , $124.20 , $117.30 , $14.99 , $127.42 , $131.10 , $117.30 , $128.34 , $128.34 , $131.10 , $132.48 , $112.91 , $124.20 , $117.30 , $109.02 , N/A , $111.68 , $111.68 , $131.10 , $118.42 , $14.99 , $132.48 
Cast Sup Lng Leg Splnt Fbrgl,HCPCS Q4042,N/A,N/A,N/A, $66.00 , $42.90 , N/A , $41.39 , $25.27 , N/A , N/A , $61.38 , $59.40 , $59.40 , $52.80 , $52.80 , $25.27 , $60.94 , $62.70 , $59.40 , $59.40 , $59.40 , $61.38 , $63.36 , N/A , $56.10 , $103.15 , $37.60 , N/A , N/A , N/A , $62.70 , N/A , $25.27 , $103.15 
"Fix Infrapatella Tendon,Primary",CPT® 27380,N/A,N/A,N/A," $3,251.00 "," $2,113.15 "," $3,839.55 ", $600.63 , $691.53 ," $2,858.84 "," $2,871.16 "," $3,023.43 "," $2,925.90 "," $2,925.90 "," $2,600.80 "," $2,600.80 ", $691.53 ," $3,001.65 "," $3,088.45 "," $2,925.90 "," $2,925.90 "," $2,925.90 "," $3,023.43 "," $3,120.96 "," $3,533.07 "," $2,763.35 "," $3,164.93 "," $3,375.56 ", N/A ," $2,914.62 "," $2,914.62 "," $3,088.45 "," $3,425.72 ", $600.63 ," $3,839.55 "
"Chlamydia, Igm, Antibody",CPT® 86632,N/A,N/A,N/A, $111.00 , $72.15 , N/A , $12.93 , $8.07 , $32.88 , $39.34 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $8.07 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $84.67 , $94.35 , $82.71 , $45.99 , N/A , $30.69 , $30.69 , $105.45 , $33.54 , $8.07 , $106.56 
"Muscle Test, Two Limbs",CPT® 95861,N/A,N/A,N/A," $1,134.00 ", $737.10 , $611.08 , $158.19 , $111.74 , $552.17 , $596.70 ," $1,054.62 "," $1,020.60 "," $1,020.60 ", $907.20 , $907.20 , $111.74 ," $1,047.02 "," $1,077.30 "," $1,020.60 "," $1,020.60 "," $1,020.60 "," $1,054.62 "," $1,088.64 ", $746.98 , $963.90 , $520.04 , $661.72 , N/A , $562.94 , $562.94 ," $1,077.30 ", $692.09 , $111.74 ," $1,088.64 "
"Open Rx Carpal Bone Fx,Each Bone",25645,N/A,N/A,N/A," $3,729.00 "," $2,423.85 "," $3,495.05 ", $548.91 , $481.11 ," $2,743.96 "," $2,730.76 "," $3,467.97 "," $3,356.10 "," $3,356.10 "," $2,983.20 "," $2,983.20 ", $481.11 ," $3,442.99 "," $3,542.55 "," $3,356.10 "," $3,356.10 "," $3,356.10 "," $3,467.97 "," $3,579.84 "," $3,244.12 "," $3,169.65 "," $3,015.07 "," $3,231.19 ", N/A ," $2,797.51 "," $2,797.51 "," $3,542.55 "," $3,288.05 ", $481.11 ," $3,579.84 "
"Cardiac Stress Tst,Dr Superv Only",CPT® 93016,N/A,N/A,N/A, $237.00 , $154.05 , $136.44 , $20.92 , $23.72 , $122.08 , $122.23 , $220.41 , $213.30 , $213.30 , $189.60 , $189.60 , $23.72 , $218.82 , $225.15 , $213.30 , $213.30 , $213.30 , $220.41 , $227.52 , $134.97 , $201.45 , $112.40 , $134.17 , N/A , $124.46 , $124.46 , $225.15 , $137.96 , $20.92 , $227.52 
Interstitial Dev Plmt Radiation Therapy 1/Mlt,CPT® 49411,N/A,N/A,N/A," $4,150.00 "," $2,697.50 "," $1,130.94 ", $177.00 , $430.67 , $963.73 , $951.44 ," $3,859.50 "," $3,735.00 "," $3,735.00 "," $3,320.00 "," $3,320.00 ", $430.67 ," $3,831.70 "," $3,942.50 "," $3,735.00 "," $3,735.00 "," $3,735.00 "," $3,859.50 "," $3,984.00 ", $815.26 ," $3,527.50 "," $1,025.84 "," $1,077.05 ", N/A , $982.53 , $982.53 ," $3,942.50 "," $1,027.62 ", $177.00 ," $3,984.00 "
 POVIDONE-IODINE 10 % EX SOLN ,HCPCS RXC637,0250 - PHARMACY,00904-1103-09,236 mL, $21.83 , $14.19 , $18.34 , N/A , N/A , $17.64 , $19.65 , $18.48 , $19.65 , $19.65 , $19.65 , $18.56 , N/A , $20.16 , $20.74 , $18.56 , $20.30 , $20.30 , $20.74 , $20.96 , $17.86 , $19.65 , $18.56 , $17.25 , N/A , $17.67 , $17.67 , $20.74 , $18.73 , $17.25 , $20.96 
 PERFLUTREN PROTEIN A MICROSPH IV SUSP ,HCPCS Q9956,0255 - DRUGS/RADIOLOGY,00407-2707-03,3 mL, $865.46 , $562.55 , $726.99 , $43.57 , $33.43 , $699.29 , $778.91 , $732.70 , $778.91 , $778.91 , $778.91 , $735.64 , $32.77 , $799.08 , $822.19 , $735.64 , $804.88 , $804.88 , $822.19 , $830.84 , $708.12 , $778.91 , $735.64 , $683.71 , N/A , $700.42 , $700.42 , $822.19 , $742.65 , $32.77 , $830.84 
Walker Folding Wheeled W/O S,HCPCS E0143,N/A,N/A,N/A, $137.00 , $89.05 , N/A , $77.45 , $43.71 , N/A , N/A , $127.41 , $123.30 , $123.30 , $109.60 , $109.60 , $43.71 , $126.49 , $130.15 , $123.30 , $123.30 , $123.30 , $127.41 , $131.52 , N/A , $116.45 , N/A , $91.56 , N/A , N/A , N/A , $130.15 , N/A , $43.71 , $131.52 
Injection Aa&/Strd Intercostal Nrv Single Lvl,64420,N/A,N/A,N/A, $501.00 , $325.65 , $291.72 , $56.48 , $46.08 , $379.80 , $375.69 , $465.93 , $450.90 , $450.90 , $400.80 , $400.80 , $46.08 , $462.57 , $475.95 , $450.90 , $450.90 , $450.90 , $465.93 , $480.96 , $316.65 , $425.85 , $367.52 , $406.08 , N/A , $387.20 , $387.20 , $475.95 , $415.37 , $46.08 , $480.96 
Treat Metatarsal Fracture,28470,N/A,N/A,N/A," $1,411.00 ", $917.15 ," $1,281.15 ", $202.14 , $155.34 , $994.98 ," $1,021.36 "," $1,312.23 "," $1,269.90 "," $1,269.90 "," $1,128.80 "," $1,128.80 ", $155.34 ," $1,302.78 "," $1,340.45 "," $1,269.90 "," $1,269.90 "," $1,269.90 "," $1,312.23 "," $1,354.56 "," $1,181.08 "," $1,199.35 "," $1,115.04 "," $1,181.65 ", N/A ," $1,014.40 "," $1,014.40 "," $1,340.45 "," $1,192.29 ", $155.34 ," $1,354.56 "
Thoracotomy W/Dx Wedge Resexn &Antom Lung Resexn,CPT® 32507,N/A,N/A,N/A," $1,185.00 ", $770.25 , $802.47 , $139.75 , $119.74 , $591.70 , $605.83 ," $1,102.05 "," $1,066.50 "," $1,066.50 ", $948.00 , $948.00 , $119.74 ," $1,094.11 "," $1,125.75 "," $1,066.50 "," $1,066.50 "," $1,066.50 "," $1,102.05 "," $1,137.60 ", $778.71 ," $1,007.25 ", $879.54 , $772.44 , N/A , $603.24 , $603.24 ," $1,125.75 ", $710.44 , $119.74 ," $1,137.60 "
" Fac B Cells, Total Count ",CPT® 86355,0302 - LAB/IMMUNOLOGY,N/A,N/A, $348.00 , $226.20 , $292.32 , $38.48 , $38.48 , $281.18 , $313.20 , $294.62 , $313.20 , $313.20 , $313.20 , $295.80 , $37.73 , $321.31 , $330.60 , $295.80 , $323.64 , $323.64 , $330.60 , $334.08 , $284.73 , $313.20 , $295.80 , $274.92 , N/A , $281.64 , $281.64 , $330.60 , $298.62 , $37.73 , $334.08 
 BRENTUXIMAB VEDOTIN 50 MG IV SOLR ,HCPCS J9042,0636 - DRUGS REQUIRING DETAILED CODIN,51144-0050-01,10 mL," $31,984.72 "," $20,790.07 "," $26,867.16 ", $226.40 , $218.08 ," $25,843.65 "," $28,786.25 "," $27,078.26 "," $28,786.25 "," $28,786.25 "," $28,786.25 "," $27,187.01 ", $213.80 ," $29,531.49 "," $30,385.48 "," $27,187.01 "," $29,745.79 "," $29,745.79 "," $30,385.48 "," $30,705.33 "," $26,169.90 "," $28,786.25 "," $27,187.01 "," $25,267.93 ", N/A ," $25,885.23 "," $25,885.23 "," $30,385.48 "," $27,446.09 ", $213.80 ," $30,705.33 "
"Dil Uret Stric,Male,Init,Filiform",CPT® 53620,N/A,N/A,N/A, $951.00 , $618.15 , $469.09 , $82.35 , $39.88 , $428.35 , $397.78 , $884.43 , $855.90 , $855.90 , $760.80 , $760.80 , $39.88 , $878.06 , $903.45 , $855.90 , $855.90 , $855.90 , $884.43 , $912.96 , $470.97 , $808.35 , $449.58 , $536.41 , N/A , $436.71 , $436.71 , $903.45 , $513.26 , $39.88 , $912.96 
 POLY-VI-SOL PO SOLN ,HCPCS RXC637,0250 - PHARMACY,00001-0778-01,1 mL, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Extended Holter 48hrs – 7 Days ,CPT® 93242,0731 - HOLTER MONT,N/A,N/A," $1,210.00 ", $786.50 ," $1,016.40 ", $11.60 , $11.62 , $977.68 ," $1,089.00 "," $1,024.39 "," $1,089.00 "," $1,089.00 "," $1,089.00 "," $1,028.50 ", $11.39 ," $1,117.19 "," $1,149.50 "," $1,028.50 "," $1,125.30 "," $1,125.30 "," $1,149.50 "," $1,161.60 ", $990.02 ," $1,089.00 "," $1,028.50 ", $955.90 , N/A , $979.25 , $979.25 ," $1,149.50 "," $1,038.30 ", $11.39 ," $1,161.60 "
Cciiv4 Vaccine Antibiotic Free 0.5 Ml Dos Im Use,CPT® 90756,N/A,N/A,N/A, $50.00 , $32.50 , N/A , $31.19 , $46.49 , $46.07 , N/A , $46.50 , $45.00 , $45.00 , $40.00 , $40.00 , $46.49 , $46.17 , $47.50 , $45.00 , $45.00 , $45.00 , $46.50 , $48.00 , $36.01 , $42.50 , $90.87 , $44.28 , N/A , $46.98 , $46.98 , $47.50 , $54.74 , $31.19 , $90.87 
Ranitidine Hydrochloride Inj,HCPCS J2780,N/A,N/A,N/A, $7.00 , $4.55 , N/A , N/A , $6.24 , N/A , N/A , $6.51 , $6.30 , $6.30 , $5.60 , $5.60 , $6.24 , $6.46 , $6.65 , $6.30 , $6.30 , $6.30 , $6.51 , $6.72 , N/A , $5.95 , $1.95 , $10.08 , N/A , N/A , N/A , $6.65 , N/A , $1.95 , $10.08 
Home/Res Visit Est Patient Low Mdm 30 Minutes,CPT® 99348,N/A,N/A,N/A, $216.00 , $140.40 , $166.66 , $74.72 , $64.77 , $144.60 , $146.00 , $200.88 , $194.40 , $194.40 , $172.80 , $172.80 , $64.77 , $199.43 , $205.20 , $194.40 , $194.40 , $194.40 , $200.88 , $207.36 , $152.12 , $183.60 , $181.53 , $184.12 , $206.00 , $147.42 , $147.42 , $205.20 , $170.05 , $64.77 , $207.36 
Xfer Single Superfici Low Leg Tendon,CPT® 27690,N/A,N/A,N/A," $5,060.00 "," $3,289.00 "," $3,946.54 ", $615.65 , $614.70 ," $3,068.92 "," $3,075.05 "," $4,705.80 "," $4,554.00 "," $4,554.00 "," $4,048.00 "," $4,048.00 ", $614.70 ," $4,671.90 "," $4,807.00 "," $4,554.00 "," $4,554.00 "," $4,554.00 "," $4,705.80 "," $4,857.60 "," $3,673.96 "," $4,301.00 "," $3,361.18 "," $3,670.07 ", N/A ," $3,128.80 "," $3,128.80 "," $4,807.00 "," $3,677.45 ", $614.70 ," $4,857.60 "
 FLUOXETINE HCL 10 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-5784-61,1 capsule, $12.43 , $8.08 , $10.44 , N/A , N/A , $10.04 , $11.19 , $10.52 , $11.19 , $11.19 , $11.19 , $10.57 , N/A , $11.48 , $11.81 , $10.57 , $11.56 , $11.56 , $11.81 , $11.93 , $10.17 , $11.19 , $10.57 , $9.82 , N/A , $10.06 , $10.06 , $11.81 , $10.67 , $9.82 , $11.93 
 Fac Level 3 Delivery ,Custom 7200000003,0720 - DELIVROOM/LABOR,N/A,N/A," $4,812.00 "," $3,127.80 "," $4,042.08 ", N/A , N/A ," $3,888.10 "," $4,330.80 "," $4,073.84 "," $4,330.80 "," $4,330.80 "," $4,330.80 "," $4,090.20 ", N/A ," $4,442.92 "," $4,571.40 "," $4,090.20 "," $4,475.16 "," $4,475.16 "," $4,571.40 "," $4,619.52 "," $3,937.18 "," $4,330.80 "," $4,090.20 "," $3,801.48 ", N/A ," $3,894.35 "," $3,894.35 "," $4,571.40 "," $4,129.18 "," $3,801.48 "," $4,619.52 "
Rickettsia,CPT® 86757,N/A,N/A,N/A, $175.00 , $113.75 , N/A , $19.74 , $19.74 , $109.51 , $130.96 , $162.75 , $157.50 , $157.50 , $140.00 , $140.00 , $19.74 , $161.58 , $166.25 , $157.50 , $157.50 , $157.50 , $162.75 , $168.00 , $129.20 , $148.75 , $126.50 , $70.19 , N/A , $102.20 , $102.20 , $166.25 , $111.68 , $19.74 , $168.00 
Insertion Picc W/O Img Gdn 5 Yr/>,CPT® 36569,N/A,N/A,N/A," $1,559.00 "," $1,013.35 ", $570.51 , $87.87 , $94.88 , $405.39 , $393.52 ," $1,449.87 "," $1,403.10 "," $1,403.10 "," $1,247.20 "," $1,247.20 ", $94.88 ," $1,439.42 "," $1,481.05 "," $1,403.10 "," $1,403.10 "," $1,403.10 "," $1,449.87 "," $1,496.64 ", $529.38 ," $1,325.15 ", $478.13 , $430.78 , N/A , $413.31 , $413.31 ," $1,481.05 ", $469.51 , $87.87 ," $1,496.64 "
 MRI Lower Joint W/WO Contrast- Lh ,CPT® 73723,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,115.00 ", $724.75 ," $2,815.05 ", $398.73 , $634.32 ," $2,242.08 "," $2,844.80 "," $1,036.95 "," $1,003.50 "," $1,003.50 ", $892.00 , $892.00 , $634.32 ," $1,029.48 "," $1,059.25 "," $1,003.50 "," $1,003.50 "," $1,003.50 "," $1,036.95 "," $1,070.40 "," $2,439.19 ", $947.75 ," $3,100.93 "," $4,339.10 ", N/A ," $2,285.83 "," $2,285.83 "," $1,059.25 "," $2,645.90 ", $398.73 ," $4,339.10 "
Ko Elastic W/Joints Pre Ots,HCPCS L1812,N/A,N/A,N/A, $119.00 , $77.35 , N/A , $86.88 , $64.86 , N/A , N/A , $110.67 , $107.10 , $107.10 , $95.20 , $95.20 , $64.86 , $109.87 , $113.05 , $107.10 , $107.10 , $107.10 , $110.67 , $114.24 , N/A , $101.15 , $147.97 , $101.31 , N/A , N/A , N/A , $113.05 , N/A , $64.86 , $147.97 
 Lumbar Spine 2 or 3 Views- Mh ,CPT® 72100,0972 - PRO FEE/RAD/DX,N/A,N/A, $136.00 , $88.40 , $224.98 , $39.34 , $37.65 , $165.53 , $191.35 , $126.48 , $122.40 , $122.40 , $108.80 , $108.80 , $37.65 , $125.57 , $129.20 , $122.40 , $122.40 , $122.40 , $126.48 , $130.56 , $218.44 , $115.60 , $209.94 , $176.76 , N/A , $168.76 , $168.76 , $129.20 , $195.34 , $37.65 , $224.98 
"Blood Lipoprotein,Ldl Cholest",CPT® 83721,N/A,N/A,N/A, $151.00 , $98.15 , N/A , $10.71 , $10.71 , $54.00 , $64.55 , $140.43 , $135.90 , $135.90 , $120.80 , $120.80 , $10.71 , $139.42 , $143.45 , $135.90 , $135.90 , $135.90 , $140.43 , $144.96 , $70.11 , $128.35 , $63.25 , $34.60 , N/A , $50.40 , $50.40 , $143.45 , $55.08 , $10.71 , $144.96 
"Herpes Simplex Type 2 Ag, Dfa",CPT® 87273,N/A,N/A,N/A, $113.00 , $73.45 , N/A , $12.22 , $12.22 , $67.85 , $81.18 , $105.09 , $101.70 , $101.70 , $90.40 , $90.40 , $12.22 , $104.33 , $107.35 , $101.70 , $101.70 , $101.70 , $105.09 , $108.48 , $79.99 , $96.05 , $77.85 , $43.47 , N/A , $63.32 , $63.32 , $107.35 , $69.20 , $12.22 , $108.48 
 Fac Removal Implantable Defib Pulse Generator Only ,CPT® 33241,0360 - OR SERVICES,N/A,N/A," $4,082.00 "," $2,653.30 "," $3,428.88 ", $199.70 , $222.93 ," $3,298.26 "," $3,673.80 "," $3,455.82 "," $3,673.80 "," $3,673.80 "," $3,673.80 "," $3,469.70 ", $218.56 ," $3,768.91 "," $3,877.90 "," $3,469.70 "," $3,796.26 "," $3,796.26 "," $3,877.90 "," $3,918.72 "," $3,339.89 "," $3,673.80 "," $3,469.70 "," $3,224.78 ", N/A ," $3,303.56 "," $3,303.56 "," $3,877.90 "," $3,502.76 ", $199.70 ," $3,918.72 "
 Sleep Stdy-Unatend-Sleep Stg ,CPT® 95800,0920 - OTHER DX SVS,N/A,N/A," $1,524.00 ", $990.60 ," $1,280.16 ", $146.28 , $158.21 ," $1,231.39 "," $1,371.60 "," $1,290.22 "," $1,371.60 "," $1,371.60 "," $1,371.60 "," $1,295.40 ", $155.11 ," $1,407.11 "," $1,447.80 "," $1,295.40 "," $1,417.32 "," $1,417.32 "," $1,447.80 "," $1,463.04 "," $1,246.94 "," $1,371.60 "," $1,295.40 "," $1,203.96 ", N/A ," $1,233.37 "," $1,233.37 "," $1,447.80 "," $1,307.74 ", $146.28 ," $1,463.04 "
Drug Assay Posaconazole,CPT® 80187,N/A,N/A,N/A, $167.00 , $108.55 , N/A , $27.65 , $22.12 , $115.33 , N/A , $155.31 , $150.30 , $150.30 , $133.60 , $133.60 , $22.12 , $154.19 , $158.65 , $150.30 , $150.30 , $150.30 , $155.31 , $160.32 , $181.02 , $141.95 , $129.23 , $79.62 , N/A , $107.63 , $107.63 , $158.65 , $117.39 , $22.12 , $181.02 
 Fac Cath Plmt L Hrt & Arts W/Njx & Angio Img S&I ,CPT® 93458,0481 - CARDIAC CATH LAB,N/A,N/A," $13,869.00 "," $9,014.85 "," $11,649.96 "," $1,009.01 ", $769.71 ," $11,206.15 "," $12,482.10 "," $11,741.50 "," $12,482.10 "," $12,482.10 "," $12,482.10 "," $11,788.65 ", $754.62 ," $12,805.25 "," $13,175.55 "," $11,788.65 "," $12,898.17 "," $12,898.17 "," $13,175.55 "," $13,314.24 "," $11,347.62 "," $12,482.10 "," $11,788.65 "," $10,956.51 ", N/A ," $11,224.18 "," $11,224.18 "," $13,175.55 "," $11,900.99 ", $754.62 ," $13,314.24 "
TREAT FRACTURE ULNAR STYLOID,25690,N/A,N/A,N/A," $2,574.00 "," $1,673.10 "," $3,026.47 ", $477.04 , $338.07 ," $2,313.15 "," $2,320.26 "," $2,393.82 "," $2,316.60 "," $2,316.60 "," $2,059.20 "," $2,059.20 ", $338.07 ," $2,376.57 "," $2,445.30 "," $2,316.60 "," $2,316.60 "," $2,316.60 "," $2,393.82 "," $2,471.04 "," $2,793.44 "," $2,187.90 "," $2,558.35 "," $2,734.50 ", N/A ," $2,358.28 "," $2,358.28 "," $2,445.30 "," $2,771.82 ", $338.07 ," $3,026.47 "
Thoracoscopy Surg Ctrl Trauma Bleed,CPT® 32654,N/A,N/A,N/A," $6,619.00 "," $4,302.35 "," $6,104.14 "," $1,072.90 ", $859.11 ," $4,358.82 "," $4,356.78 "," $6,155.67 "," $5,957.10 "," $5,957.10 "," $5,295.20 "," $5,295.20 ", $859.11 ," $6,111.32 "," $6,288.05 "," $5,957.10 "," $5,957.10 "," $5,957.10 "," $6,155.67 "," $6,354.24 "," $5,880.86 "," $5,626.15 "," $6,288.83 "," $5,785.68 ", N/A ," $4,443.87 "," $4,443.87 "," $6,288.05 "," $5,233.59 ", $859.11 ," $6,354.24 "
 SACUBITRIL-VALSARTAN 24-26 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00078-0659-20,1 tablet, $68.63 , $44.61 , $57.65 , N/A , N/A , $55.45 , $61.77 , $58.10 , $61.77 , $61.77 , $61.77 , $58.34 , N/A , $63.37 , $65.20 , $58.34 , $63.83 , $63.83 , $65.20 , $65.88 , $56.15 , $61.77 , $58.34 , $54.22 , N/A , $55.54 , $55.54 , $65.20 , $58.89 , $54.22 , $65.88 
Insj Tunneled Cvc W/O Subq Port/Pmp Age 5 Yr/>,36558,N/A,N/A,N/A," $6,181.00 "," $4,017.65 "," $1,579.50 ", $244.84 ," $1,026.74 "," $1,210.08 "," $1,203.51 "," $5,748.33 "," $5,562.90 "," $5,562.90 "," $4,944.80 "," $4,944.80 "," $1,026.74 "," $5,706.92 "," $5,871.95 "," $5,562.90 "," $5,562.90 "," $5,562.90 "," $5,748.33 "," $5,933.76 "," $1,461.34 "," $5,253.85 "," $1,484.34 "," $1,306.67 ", N/A ," $1,233.69 "," $1,233.69 "," $5,871.95 "," $1,401.46 ", $244.84 ," $5,933.76 "
Exc Tumor Soft Tiss Forearm and/Wrist Subq 3+Cm,25071,N/A,N/A,N/A," $3,455.00 "," $2,245.75 "," $2,570.88 ", $401.84 , $349.11 ," $2,041.20 "," $2,044.00 "," $3,213.15 "," $3,109.50 "," $3,109.50 "," $2,764.00 "," $2,764.00 ", $349.11 ," $3,190.00 "," $3,282.25 "," $3,109.50 "," $3,109.50 "," $3,109.50 "," $3,213.15 "," $3,316.80 "," $2,380.13 "," $2,936.75 "," $2,258.63 "," $2,404.23 ", N/A ," $2,081.03 "," $2,081.03 "," $3,282.25 "," $2,445.96 ", $349.11 ," $3,316.80 "
Pro Removal of Finger Tendon,26180,N/A,N/A,N/A," $3,183.00 "," $2,068.95 "," $2,769.65 ", $436.80 , $76.84 ," $2,136.32 "," $2,138.48 "," $2,960.19 "," $2,864.70 "," $2,864.70 "," $2,546.40 "," $2,546.40 ", $76.84 ," $2,938.86 "," $3,023.85 "," $2,864.70 "," $2,864.70 "," $2,864.70 "," $2,960.19 "," $3,055.68 "," $2,573.26 "," $2,705.55 "," $2,346.04 "," $2,545.45 ", N/A ," $2,178.01 "," $2,178.01 "," $3,023.85 "," $2,559.92 ", $76.84 ," $3,055.68 "
Abduct Restrainer Canvas&Web,HCPCS L3660,N/A,N/A,N/A, $142.00 , $92.30 , N/A , $110.01 , $71.64 , N/A , N/A , $132.06 , $127.80 , $127.80 , $113.60 , $113.60 , $71.64 , $131.11 , $134.90 , $127.80 , $127.80 , $127.80 , $132.06 , $136.32 , N/A , $120.70 , $101.85 , $92.55 , N/A , N/A , N/A , $134.90 , N/A , $71.64 , $136.32 
 BETHANECHOL CHLORIDE 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00832-0512-01,1 tablet, $13.72 , $8.92 , $11.52 , N/A , N/A , $11.09 , $12.35 , $11.62 , $12.35 , $12.35 , $12.35 , $11.66 , N/A , $12.67 , $13.03 , $11.66 , $12.76 , $12.76 , $13.03 , $13.17 , $11.23 , $12.35 , $11.66 , $10.84 , N/A , $11.10 , $11.10 , $13.03 , $11.77 , $10.84 , $13.17 
"Chemother, IV Infuse, Each Sequ Infus",CPT® 96417,N/A,N/A,N/A, $377.00 , $245.05 , $223.13 , $62.53 , $68.94 , $175.06 , $159.11 , $350.61 , $339.30 , $339.30 , $301.60 , $301.60 , $68.94 , $348.08 , $358.15 , $339.30 , $339.30 , $339.30 , $350.61 , $361.92 , $212.51 , $320.45 , $211.87 , $263.17 , N/A , $178.47 , $178.47 , $358.15 , $210.86 , $62.53 , $361.92 
 MEASLES-MUMPS-RUBELLA-VARICELL SC SUSR ,HCPCS 90710,0636 - DRUGS REQUIRING DETAILED CODIN,00006-4171-00,0.5 mL," $1,662.18 "," $1,080.42 "," $1,396.23 ", N/A , $198.95 ," $1,343.04 "," $1,495.96 "," $1,407.20 "," $1,495.96 "," $1,495.96 "," $1,495.96 "," $1,412.85 ", $195.05 ," $1,534.69 "," $1,579.07 "," $1,412.85 "," $1,545.83 "," $1,545.83 "," $1,579.07 "," $1,595.69 "," $1,360.00 "," $1,495.96 "," $1,412.85 "," $1,313.12 ", N/A ," $1,345.20 "," $1,345.20 "," $1,579.07 "," $1,426.32 ", $195.05 ," $1,595.69 "
Nursing Facility Dschrg Mgmt 30 Min/< Tot Time,CPT® 99315,N/A,N/A,N/A, $202.00 , $131.30 , $144.25 , $79.53 , $55.70 , $126.13 , $126.68 , $187.86 , $181.80 , $181.80 , $161.60 , $161.60 , $55.70 , $186.51 , $191.90 , $181.80 , $181.80 , $181.80 , $187.86 , $193.92 , $183.65 , $171.70 , $157.52 , $154.85 , N/A , $128.59 , $128.59 , $191.90 , $148.29 , $55.70 , $193.92 
Bronchoscopy W/Cptr-Asst Image-Guided Navigation,CPT® 31627,N/A,N/A,N/A," $7,647.00 "," $4,970.55 ", $525.95 , $91.00 , $987.21 , $377.97 , $362.14 ," $7,111.71 "," $6,882.30 "," $6,882.30 "," $6,117.60 "," $6,117.60 ", $987.21 ," $7,060.48 "," $7,264.65 "," $6,882.30 "," $6,882.30 "," $6,882.30 "," $7,111.71 "," $7,341.12 ", $510.34 ," $6,499.95 ", $501.32 , $505.68 , N/A , $385.35 , $385.35 ," $7,264.65 ", $453.84 , $91.00 ," $7,341.12 "
 Fac Rcptr Assay Non-Endoc Spec Rcptr ,CPT® 84238,0300 - LABORATORY,N/A,N/A, $340.00 , $221.00 , $285.60 , $37.30 , $37.30 , $274.72 , $306.00 , $287.84 , $306.00 , $306.00 , $306.00 , $289.00 , $36.57 , $313.92 , $323.00 , $289.00 , $316.20 , $316.20 , $323.00 , $326.40 , $278.19 , $306.00 , $289.00 , $268.60 , N/A , $275.16 , $275.16 , $323.00 , $291.75 , $36.57 , $326.40 
"Tracheostomy,Emerg Proc.",CPT® 31603,N/A,N/A,N/A," $1,969.00 "," $1,279.85 "," $1,702.35 ", $298.46 , $206.02 , $851.51 , $826.46 ," $1,831.17 "," $1,772.10 "," $1,772.10 "," $1,575.20 "," $1,575.20 ", $206.02 ," $1,817.98 "," $1,870.55 "," $1,772.10 "," $1,772.10 "," $1,772.10 "," $1,831.17 "," $1,890.24 "," $1,642.91 "," $1,673.65 "," $1,177.48 "," $1,625.23 ", N/A , $868.12 , $868.12 ," $1,870.55 "," $1,022.39 ", $206.02 ," $1,890.24 "
 Fac Cessation Thrombolytic Ther W/Catheter Removal ,CPT® 37214,0360 - OR SERVICES,N/A,N/A," $9,301.00 "," $6,045.65 "," $7,812.84 ", $111.75 , $168.01 ," $7,515.21 "," $8,370.90 "," $7,874.23 "," $8,370.90 "," $8,370.90 "," $8,370.90 "," $7,905.85 ", $164.72 ," $8,587.61 "," $8,835.95 "," $7,905.85 "," $8,649.93 "," $8,649.93 "," $8,835.95 "," $8,928.96 "," $7,610.08 "," $8,370.90 "," $7,905.85 "," $7,347.79 ", N/A ," $7,527.30 "," $7,527.30 "," $8,835.95 "," $7,981.19 ", $111.75 ," $8,928.96 "
Singl Visn Sphere 7.12-20.00,HCPCS V2102,N/A,N/A,N/A, $55.00 , $35.75 , N/A , $90.00 , N/A , N/A , N/A , $51.15 , $49.50 , $49.50 , $44.00 , $44.00 , N/A , $50.78 , $52.25 , $49.50 , $49.50 , $49.50 , $51.15 , $52.80 , N/A , $46.75 , $55.00 , $81.77 , N/A , N/A , N/A , $52.25 , N/A , $44.00 , $90.00 
"Incise Post Synechiae,Eye",CPT® 65875,N/A,N/A,N/A," $5,665.00 "," $3,682.25 "," $3,917.81 ", $614.57 , $614.70 ," $3,562.54 "," $3,333.22 "," $5,268.45 "," $5,098.50 "," $5,098.50 "," $4,532.00 "," $4,532.00 ", $614.70 ," $5,230.49 "," $5,381.75 "," $5,098.50 "," $5,098.50 "," $5,098.50 "," $5,268.45 "," $5,438.40 "," $5,375.39 "," $4,815.25 "," $3,423.62 "," $4,532.87 ", N/A ," $3,632.05 "," $3,632.05 "," $5,381.75 "," $4,009.32 ", $614.57 ," $5,438.40 "
Dilate Esophagus,CPT® 43450,N/A,N/A,N/A," $1,073.00 ", $697.45 , $487.96 , $75.97 , $229.55 , $420.30 , $435.90 , $997.89 , $965.70 , $965.70 , $858.40 , $858.40 , $229.55 , $990.70 ," $1,019.35 ", $965.70 , $965.70 , $965.70 , $997.89 ," $1,030.08 ", $349.39 , $912.05 , $478.13 , $463.22 , N/A , $428.50 , $428.50 ," $1,019.35 ", $448.19 , $75.97 ," $1,030.08 "
" Fac Nk Cells, Total Count ",CPT® 86357,0302 - LAB/IMMUNOLOGY,N/A,N/A, $348.00 , $226.20 , $292.32 , $38.48 , $38.48 , $281.18 , $313.20 , $294.62 , $313.20 , $313.20 , $313.20 , $295.80 , $37.73 , $321.31 , $330.60 , $295.80 , $323.64 , $323.64 , $330.60 , $334.08 , $284.73 , $313.20 , $295.80 , $274.92 , N/A , $281.64 , $281.64 , $330.60 , $298.62 , $37.73 , $334.08 
 Choletec/Tc Mebrofenin per Study Dose ,HCPCS A9537,0343 - DIAGNOSTIC RADIOPHARMACEUTICALS,N/A,N/A, $193.00 , $125.45 , $162.12 , $60.93 , $51.46 , $155.94 , $173.70 , $163.39 , $173.70 , $173.70 , $173.70 , $164.05 , $50.45 , $178.20 , $183.35 , $164.05 , $179.49 , $179.49 , $183.35 , $185.28 , $157.91 , $173.70 , $164.05 , $152.47 , N/A , $156.19 , $156.19 , $183.35 , $165.61 , $50.45 , $185.28 
"Osteotomy Prox Phalanx,1st Toe",CPT® 28310,N/A,N/A,N/A," $3,589.00 "," $2,332.85 "," $2,235.03 ", $350.42 , $184.42 ," $1,765.56 "," $1,744.94 "," $3,337.77 "," $3,230.10 "," $3,230.10 "," $2,871.20 "," $2,871.20 ", $184.42 ," $3,313.72 "," $3,409.55 "," $3,230.10 "," $3,230.10 "," $3,230.10 "," $3,337.77 "," $3,445.44 "," $2,075.33 "," $3,050.65 "," $1,887.54 "," $2,092.97 ", N/A ," $1,800.01 "," $1,800.01 "," $3,409.55 "," $2,115.66 ", $184.42 ," $3,445.44 "
 Fac Islet Cell Antibody ,CPT® 86341,0302 - LAB/IMMUNOLOGY,N/A,N/A, $172.00 , $111.80 , $144.48 , $24.04 , $19.62 , $138.98 , $154.80 , $145.62 , $154.80 , $154.80 , $154.80 , $146.20 , $19.24 , $158.81 , $163.40 , $146.20 , $159.96 , $159.96 , $163.40 , $165.12 , $140.73 , $154.80 , $146.20 , $135.88 , N/A , $139.20 , $139.20 , $163.40 , $147.59 , $19.24 , $165.12 
 CLINDAMYCIN 600 MG IV SOLN (INPT) ,HCPCS J0736,0636 - DRUGS REQUIRING DETAILED CODIN,00338-3612-24,50 mL, $65.76 , $42.74 , $55.24 , N/A , N/A , $53.13 , $59.18 , $55.67 , $59.18 , $59.18 , $59.18 , $55.90 , N/A , $60.72 , $62.47 , $55.90 , $61.16 , $61.16 , $62.47 , $63.13 , $53.80 , $59.18 , $55.90 , $51.95 , N/A , $53.22 , $53.22 , $62.47 , $56.43 , $51.95 , $63.13 
 Pro Treat Fx Radial 3+ Frag ,CPT® 25609,0975 - PRO FEE/OR,N/A,N/A," $3,803.00 "," $2,471.95 "," $6,398.99 "," $1,004.45 ", $779.80 ," $5,048.32 "," $5,020.87 "," $3,536.79 "," $3,422.70 "," $3,422.70 "," $3,042.40 "," $3,042.40 ", $779.80 ," $3,511.31 "," $3,612.85 "," $3,422.70 "," $3,422.70 "," $3,422.70 "," $3,536.79 "," $3,650.88 "," $5,947.48 "," $3,232.55 "," $5,535.95 "," $5,968.91 ", N/A ," $5,146.82 "," $5,146.82 "," $3,612.85 "," $6,049.35 ", $779.80 ," $6,398.99 "
 POLATUZUMAB VEDOTIN-PIIQ 140 MG IV SOLR ,HCPCS J9309,0636 - DRUGS REQUIRING DETAILED CODIN,50242-0105-01,7 mL," $48,662.29 "," $31,630.49 "," $40,876.32 ", $123.68 , $120.47 ," $39,319.13 "," $43,796.06 "," $41,197.49 "," $43,796.06 "," $43,796.06 "," $43,796.06 "," $41,362.95 ", $118.11 ," $44,929.89 "," $46,229.18 "," $41,362.95 "," $45,255.93 "," $45,255.93 "," $46,229.18 "," $46,715.80 "," $39,815.49 "," $43,796.06 "," $41,362.95 "," $38,443.21 ", N/A ," $39,382.39 "," $39,382.39 "," $46,229.18 "," $41,757.11 ", $118.11 ," $46,715.80 "
Dstr Nrolytc Agnt Parverteb Fct Addl Lmbr/Sacral,64636,N/A,N/A,N/A, $528.00 , $343.20 , $292.60 , $56.72 , $145.70 , $338.44 , $317.36 , $491.04 , $475.20 , $475.20 , $422.40 , $422.40 , $145.70 , $487.50 , $501.60 , $475.20 , $475.20 , $475.20 , $491.04 , $506.88 , $319.39 , $448.80 , $306.86 , $361.90 , N/A , $345.04 , $345.04 , $501.60 , $370.15 , $56.72 , $506.88 
Angio Extermity Bilat,CPT® 75716,N/A,N/A,N/A," $2,154.00 "," $1,400.10 ", $915.82 , $158.15 , $276.91 , $887.22 ," $1,126.57 "," $2,003.22 "," $1,938.60 "," $1,938.60 "," $1,723.20 "," $1,723.20 ", $276.91 ," $1,988.79 "," $2,046.30 "," $1,938.60 "," $1,938.60 "," $1,938.60 "," $2,003.22 "," $2,067.84 ", $933.02 ," $1,830.90 "," $1,236.52 ", $982.10 , N/A , $904.53 , $904.53 ," $2,046.30 "," $1,047.01 ", $158.15 ," $2,067.84 "
 Fac Amb Ift 911 Loaded Mileage Als ,HCPCS A0425,0540 - AMBULANCE,N/A,N/A, $41.00 , $26.65 , $34.44 , N/A , $7.08 , $33.13 , $36.90 , $34.71 , $36.90 , $36.90 , $36.90 , $34.85 , $6.94 , $37.86 , $38.95 , $34.85 , $38.13 , $38.13 , $38.95 , $39.36 , $33.55 , $36.90 , $34.85 , $32.39 , N/A , $33.18 , $33.18 , $38.95 , $35.18 , $6.94 , $39.36 
 Pro Cltx Patellar Dislc W/O Anes ,CPT® 27560,0981 - PRO FEE/ER,N/A,N/A," $1,854.00 "," $1,205.10 "," $2,081.63 ", $334.64 , $268.05 ," $1,598.33 "," $1,645.91 "," $1,724.22 "," $1,668.60 "," $1,668.60 "," $1,483.20 "," $1,483.20 ", $268.05 ," $1,711.80 "," $1,761.30 "," $1,668.60 "," $1,668.60 "," $1,668.60 "," $1,724.22 "," $1,779.84 "," $1,966.99 "," $1,575.90 "," $1,809.04 "," $1,917.68 ", N/A ," $1,629.51 "," $1,629.51 "," $1,761.30 "," $1,915.26 ", $268.05 ," $2,081.63 "
 NM Thyroid Uptake and Imaging Single or Mult ,CPT® 78014,0340 - NUCLEAR MEDICINE,N/A,N/A," $2,218.00 "," $1,441.70 "," $1,863.12 ", $218.24 , $190.86 ," $1,792.14 "," $1,996.20 "," $1,877.76 "," $1,996.20 "," $1,996.20 "," $1,996.20 "," $1,885.30 ", $187.12 ," $2,047.88 "," $2,107.10 "," $1,885.30 "," $2,062.74 "," $2,062.74 "," $2,107.10 "," $2,129.28 "," $1,814.77 "," $1,996.20 "," $1,885.30 "," $1,752.22 ", N/A ," $1,795.03 "," $1,795.03 "," $2,107.10 "," $1,903.27 ", $187.12 ," $2,129.28 "
Angio Ea Addnl Selectv Vessel,CPT® 75774,N/A,N/A,N/A, $664.00 , $431.60 , $548.97 , $95.32 , $171.58 , $415.73 , $530.59 , $617.52 , $597.60 , $597.60 , $531.20 , $531.20 , $171.58 , $613.07 , $630.80 , $597.60 , $597.60 , $597.60 , $617.52 , $637.44 , $571.37 , $564.40 , $581.66 , $437.05 , N/A , $423.84 , $423.84 , $630.80 , $490.62 , $95.32 , $637.44 
 Kidney And Urinary Tract Infections Without McC ,MS DRG V40 (FY2023) 690,N/A,N/A,N/A," $22,426.19 "," $14,577.02 "," $18,838.00 ", N/A , N/A ," $18,120.36 "," $20,183.57 "," $18,986.01 "," $20,183.57 "," $20,183.57 "," $20,183.57 "," $19,062.26 ", N/A ," $20,706.10 "," $21,304.88 "," $19,062.26 "," $20,856.36 "," $20,856.36 "," $21,304.88 "," $21,529.14 "," $18,349.11 "," $20,183.57 "," $19,062.26 "," $17,716.69 ", N/A ," $18,149.52 "," $18,149.52 "," $21,304.88 "," $19,243.91 "," $17,716.69 "," $21,529.14 "
 METRONIDAZOLE 500 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60687-0550-01,1 tablet, $4.73 , $3.07 , $3.97 , N/A , N/A , $3.82 , $4.26 , $4.00 , $4.26 , $4.26 , $4.26 , $4.02 , N/A , $4.37 , $4.49 , $4.02 , $4.40 , $4.40 , $4.49 , $4.54 , $3.87 , $4.26 , $4.02 , $3.74 , N/A , $3.83 , $3.83 , $4.49 , $4.06 , $3.74 , $4.54 
 Von Willebrand Factor Antigen Beaker1 ,CPT® 85246,0305 - LAB/HEMATOLOGY,N/A,N/A, $348.00 , $226.20 , $292.32 , $23.40 , $23.40 , $281.18 , $313.20 , $294.62 , $313.20 , $313.20 , $313.20 , $295.80 , $22.94 , $321.31 , $330.60 , $295.80 , $323.64 , $323.64 , $330.60 , $334.08 , $284.73 , $313.20 , $295.80 , $274.92 , N/A , $281.64 , $281.64 , $330.60 , $298.62 , $22.94 , $334.08 
Home/Res Visit Est Patient Mod Mdm 40 Minutes,99349,N/A,N/A,N/A, $328.00 , $213.20 , $256.54 , $124.28 , $100.42 , $221.05 , $221.63 , $305.04 , $295.20 , $295.20 , $262.40 , $262.40 , $100.42 , $302.84 , $311.60 , $295.20 , $295.20 , $295.20 , $305.04 , $314.88 , $233.75 , $278.80 , $275.29 , $281.82 , $192.00 , $225.37 , $225.37 , $311.60 , $259.93 , $100.42 , $314.88 
Interferon Beta-1a Inj,HCPCS J1826,N/A,N/A,N/A," $2,986.00 "," $1,940.90 ", N/A , N/A , $768.32 , N/A , N/A ," $2,776.98 "," $2,687.40 "," $2,687.40 "," $2,388.80 "," $2,388.80 ", $768.32 ," $2,756.97 "," $2,836.70 "," $2,687.40 "," $2,687.40 "," $2,687.40 "," $2,776.98 "," $2,866.56 ", N/A ," $2,538.10 "," $1,129.47 "," $2,454.56 ", N/A , N/A , N/A ," $2,836.70 ", N/A , $768.32 ," $2,866.56 "
"Spinal Fusion,Ant,Ea Adnl Level",CPT® 22585,N/A,N/A,N/A," $2,326.00 "," $1,511.90 "," $1,882.40 ", $292.44 , $452.26 ," $1,576.80 "," $1,553.01 "," $2,163.18 "," $2,093.40 "," $2,093.40 "," $1,860.80 "," $1,860.80 ", $452.26 ," $2,147.60 "," $2,209.70 "," $2,093.40 "," $2,093.40 "," $2,093.40 "," $2,163.18 "," $2,232.96 "," $1,763.07 "," $1,977.10 "," $1,762.66 "," $1,818.53 ", N/A ," $1,607.57 "," $1,607.57 "," $2,209.70 "," $1,889.45 ", $292.44 ," $2,232.96 "
 Fac X-Ray Exam of Tear Duct ,CPT® 70170,0320 - DX X-RAY,N/A,N/A," $1,954.00 "," $1,270.10 "," $1,641.36 ", $53.50 , $52.95 ," $1,578.83 "," $1,758.60 "," $1,654.26 "," $1,758.60 "," $1,758.60 "," $1,758.60 "," $1,660.90 ", $51.91 ," $1,804.13 "," $1,856.30 "," $1,660.90 "," $1,817.22 "," $1,817.22 "," $1,856.30 "," $1,875.84 "," $1,598.76 "," $1,758.60 "," $1,660.90 "," $1,543.66 ", N/A ," $1,581.37 "," $1,581.37 "," $1,856.30 "," $1,676.73 ", $51.91 ," $1,875.84 "
"MRI, Lumbar Spine Contrast",CPT® 72149,N/A,N/A,N/A," $3,734.00 "," $2,427.10 "," $1,952.02 ", $278.24 , $506.39 ," $1,521.95 "," $2,499.38 "," $3,472.62 "," $3,360.60 "," $3,360.60 "," $2,987.20 "," $2,987.20 ", $506.39 ," $3,447.60 "," $3,547.30 "," $3,360.60 "," $3,360.60 "," $3,360.60 "," $3,472.62 "," $3,584.64 "," $1,677.11 "," $3,173.90 "," $2,725.35 "," $2,973.82 ", N/A ," $1,551.65 "," $1,551.65 "," $3,547.30 "," $1,796.06 ", $278.24 ," $3,584.64 "
"Fix Lid Ptosis,Front Musc,Fas Slng",CPT® 67902,N/A,N/A,N/A," $6,489.00 "," $4,217.85 "," $4,474.47 ", $701.22 , $907.22 ," $4,091.44 "," $3,858.61 "," $6,034.77 "," $5,840.10 "," $5,840.10 "," $5,191.20 "," $5,191.20 ", $907.22 ," $5,991.29 "," $6,164.55 "," $5,840.10 "," $5,840.10 "," $5,840.10 "," $6,034.77 "," $6,229.44 "," $6,136.65 "," $5,515.65 "," $4,010.58 "," $5,186.41 ", N/A ," $4,171.27 "," $4,171.27 "," $6,164.55 "," $4,604.55 ", $701.22 ," $6,229.44 "
 WHITE PETROLATUM EX OINT ,HCPCS RXC637,0250 - PHARMACY,N/A,N/A, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Lap,Abdomen,Drain Lymphocele",CPT® 49323,N/A,N/A,N/A," $3,891.00 "," $2,529.15 "," $3,807.05 ", $593.10 , $602.08 ," $3,018.79 "," $3,088.46 "," $3,618.63 "," $3,501.90 "," $3,501.90 "," $3,112.80 "," $3,112.80 ", $602.08 ," $3,592.56 "," $3,696.45 "," $3,501.90 "," $3,501.90 "," $3,501.90 "," $3,618.63 "," $3,735.36 "," $2,724.73 "," $3,307.35 "," $3,428.97 "," $3,574.74 ", N/A ," $3,077.69 "," $3,077.69 "," $3,696.45 "," $3,218.96 ", $593.10 ," $3,807.05 "
 Fac Mononuclear Cell Antigen Quantitative Nos Ea ,CPT® 86356,0302 - LAB/IMMUNOLOGY,N/A,N/A, $247.00 , $160.55 , $207.48 , $27.32 , $27.32 , $199.58 , $222.30 , $209.11 , $222.30 , $222.30 , $222.30 , $209.95 , $26.78 , $228.06 , $234.65 , $209.95 , $229.71 , $229.71 , $234.65 , $237.12 , $202.10 , $222.30 , $209.95 , $195.13 , N/A , $199.90 , $199.90 , $234.65 , $211.95 , $26.78 , $237.12 
Tap Block Bilateral by Injection(S),CPT® 64488,N/A,N/A,N/A, $999.00 , $649.35 , $343.46 , $66.45 , $120.54 , $445.01 , $440.53 , $929.07 , $899.10 , $899.10 , $799.20 , $799.20 , $120.54 , $922.38 , $949.05 , $899.10 , $899.10 , $899.10 , $929.07 , $959.04 , $373.35 , $849.15 , $358.94 , $431.53 , N/A , $453.69 , $453.69 , $949.05 , $486.70 , $66.45 , $959.04 
 Fac Transferase (Ast) (Sgot) ,CPT® 84450,0301 - LAB/CHEMISTRY,N/A,N/A, $71.00 , $46.15 , $59.64 , $5.28 , $5.28 , $57.37 , $63.90 , $60.11 , $63.90 , $63.90 , $63.90 , $60.35 , $5.18 , $65.55 , $67.45 , $60.35 , $66.03 , $66.03 , $67.45 , $68.16 , $58.09 , $63.90 , $60.35 , $56.09 , N/A , $57.46 , $57.46 , $67.45 , $60.93 , $5.18 , $68.16 
 Wrist Min 3 Views ,CPT® 73110,0320 - DX X-RAY,N/A,N/A, $380.00 , $247.00 , $319.20 , $40.24 , $30.41 , $307.04 , $342.00 , $321.71 , $342.00 , $342.00 , $342.00 , $323.00 , $29.81 , $350.85 , $361.00 , $323.00 , $353.40 , $353.40 , $361.00 , $364.80 , $310.92 , $342.00 , $323.00 , $300.20 , N/A , $307.53 , $307.53 , $361.00 , $326.08 , $29.81 , $364.80 
"Remove FB,Intranasal",30300,N/A,N/A,N/A, $814.00 , $529.10 , $688.10 , $121.29 , $64.81 , $481.74 , $495.34 , $757.02 , $732.60 , $732.60 , $651.20 , $651.20 , $64.81 , $751.57 , $773.30 , $732.60 , $732.60 , $732.60 , $757.02 , $781.44 , $637.33 , $691.90 , $695.78 , $541.12 , N/A , $491.14 , $491.14 , $773.30 , $578.42 , $64.81 , $781.44 
Njx Px Cntrst Kne Arthg Cntrst Enhncd CT/MRI Kne,CPT® 27369,N/A,N/A,N/A, $452.00 , $293.80 , $243.43 , $38.54 , $113.66 , $185.17 , N/A , $420.36 , $406.80 , $406.80 , $361.60 , $361.60 , $113.66 , $417.33 , $429.40 , $406.80 , $406.80 , $406.80 , $420.36 , $433.92 , $227.54 , $384.20 , $213.23 , $235.47 , N/A , $188.78 , $188.78 , $429.40 , $221.87 , $38.54 , $433.92 
 Pro Situ Hybridization Ea Prb ,CPT® 88365,0971 - PRO FEE/LAB,N/A,N/A, $632.00 , $410.80 , $640.10 , $177.52 , $61.82 , $622.27 , $815.31 , $587.76 , $568.80 , $568.80 , $505.60 , $505.60 , $61.82 , $583.53 , $600.40 , $568.80 , $568.80 , $568.80 , $587.76 , $606.72 ," $1,175.66 ", $537.20 , $851.47 , $624.49 , N/A , $580.74 , $580.74 , $600.40 , $638.21 , $61.82 ," $1,175.66 "
Insert Intrauterine Device,CPT® 58300,N/A,N/A,N/A, $588.00 , $382.20 , N/A , $108.57 , $89.76 , $213.25 , $207.47 , $546.84 , $529.20 , $529.20 , $470.40 , $470.40 , $89.76 , $542.90 , $558.60 , $529.20 , $529.20 , $529.20 , $546.84 , $564.48 , $256.00 , $499.80 , $265.83 , $220.53 , N/A , $217.41 , $217.41 , $558.60 , $260.79 , $89.76 , $564.48 
 Fac Laps W/Insertion Perm Intraperitoneal Catheter ,CPT® 49324,0360 - OR SERVICES,N/A,N/A," $2,485.00 "," $1,615.25 "," $2,087.40 ", $356.88 , $290.58 ," $2,007.88 "," $2,236.50 "," $2,103.80 "," $2,236.50 "," $2,236.50 "," $2,236.50 "," $2,112.25 ", $284.88 ," $2,294.40 "," $2,360.75 "," $2,112.25 "," $2,311.05 "," $2,311.05 "," $2,360.75 "," $2,385.60 "," $2,033.23 "," $2,236.50 "," $2,112.25 "," $1,963.15 ", N/A ," $2,011.11 "," $2,011.11 "," $2,360.75 "," $2,132.38 ", $284.88 ," $2,385.60 "
 Pro Control Nasal Hemorrhage Anterior Complex ,CPT® 30903,0981 - PRO FEE/ER,N/A,N/A, $736.00 , $478.40 , $411.13 , $72.80 , $61.84 , $302.11 , $295.94 , $684.48 , $662.40 , $662.40 , $588.80 , $588.80 , $61.84 , $679.55 , $699.20 , $662.40 , $662.40 , $662.40 , $684.48 , $706.56 , $397.68 , $625.60 , $419.26 , $398.37 , N/A , $308.01 , $308.01 , $699.20 , $362.73 , $61.84 , $706.56 
 Feeding Tube Place W/Fluoro and Images ,CPT® 74340,0320 - DX X-RAY,N/A,N/A, $610.00 , $396.50 , $512.40 , $133.30 , $130.29 , $492.88 , $549.00 , $516.43 , $549.00 , $549.00 , $549.00 , $518.50 , $127.74 , $563.21 , $579.50 , $518.50 , $567.30 , $567.30 , $579.50 , $585.60 , $499.10 , $549.00 , $518.50 , $481.90 , N/A , $493.67 , $493.67 , $579.50 , $523.44 , $127.74 , $585.60 
Transcran Doppler Intracran Art,CPT® 93886,N/A,N/A,N/A," $2,269.00 "," $1,474.85 "," $1,713.01 ", $265.47 , $210.86 ," $1,544.94 "," $2,127.68 "," $2,110.17 "," $2,042.10 "," $2,042.10 "," $1,815.20 "," $1,815.20 ", $210.86 ," $2,094.97 "," $2,155.55 "," $2,042.10 "," $2,042.10 "," $2,042.10 "," $2,110.17 "," $2,178.24 "," $1,196.51 "," $1,928.65 "," $1,134.35 "," $1,035.45 ", N/A ," $1,575.09 "," $1,575.09 "," $2,155.55 "," $1,746.00 ", $210.86 ," $2,178.24 "
 Fac Work Hardening/Conditioning 1st 2 Hr ,CPT® 97545,0951 - OTHER THERAPEUTIC SERVICES - ATHLETIC TRAINING,N/A,N/A, $565.00 , $367.25 , $474.60 , N/A , N/A , $456.52 , $508.50 , $478.33 , $508.50 , $508.50 , $508.50 , $480.25 , N/A , $521.66 , $536.75 , $480.25 , $525.45 , $525.45 , $536.75 , $542.40 , $462.28 , $508.50 , $480.25 , $446.35 , N/A , $457.25 , $457.25 , $536.75 , $484.83 , $446.35 , $542.40 
" Fac Culture, Bacteria, Other ",CPT® 87070,0306 - LAB/BACT-MICRO,N/A,N/A, $116.00 , $75.40 , $97.44 , $8.79 , $8.79 , $93.73 , $104.40 , $98.21 , $104.40 , $104.40 , $104.40 , $98.60 , $8.62 , $107.10 , $110.20 , $98.60 , $107.88 , $107.88 , $110.20 , $111.36 , $94.91 , $104.40 , $98.60 , $91.64 , N/A , $93.88 , $93.88 , $110.20 , $99.54 , $8.62 , $111.36 
Probe Nasolacrimal Duct,CPT® 68810,N/A,N/A,N/A," $1,599.00 "," $1,039.35 ", $783.90 , $123.82 , $83.68 ," $1,060.23 "," $1,004.44 "," $1,487.07 "," $1,439.10 "," $1,439.10 "," $1,279.20 "," $1,279.20 ", $83.68 ," $1,476.36 "," $1,519.05 "," $1,439.10 "," $1,439.10 "," $1,439.10 "," $1,487.07 "," $1,535.04 "," $1,077.49 "," $1,359.15 "," $1,038.33 ", $923.29 , N/A ," $1,080.91 "," $1,080.91 "," $1,519.05 "," $1,193.18 ", $83.68 ," $1,535.04 "
Exc Tumor Soft Tissue Foot/Toe Subfasc 1.5+Cm,CPT® 28041,N/A,N/A,N/A," $3,588.00 "," $2,332.20 "," $2,777.13 ", $435.62 , $375.50 ," $2,249.23 "," $2,266.68 "," $3,336.84 "," $3,229.20 "," $3,229.20 "," $2,870.40 "," $2,870.40 ", $375.50 ," $3,312.80 "," $3,408.60 "," $3,229.20 "," $3,229.20 "," $3,229.20 "," $3,336.84 "," $3,444.48 "," $2,583.50 "," $3,049.80 "," $2,456.66 "," $2,657.64 ", N/A ," $2,293.12 "," $2,293.12 "," $3,408.60 "," $2,695.23 ", $375.50 ," $3,444.48 "
 VILAZODONE HCL 40 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00456-1140-30,1 tablet, $68.00 , $44.20 , $57.12 , N/A , N/A , $54.94 , $61.20 , $57.57 , $61.20 , $61.20 , $61.20 , $57.80 , N/A , $62.78 , $64.60 , $57.80 , $63.24 , $63.24 , $64.60 , $65.28 , $55.64 , $61.20 , $57.80 , $53.72 , N/A , $55.03 , $55.03 , $64.60 , $58.35 , $53.72 , $65.28 
Eeg During Surgery,CPT® 95955,N/A,N/A,N/A," $1,124.00 ", $730.60 , $755.40 , $189.45 , $117.20 , $681.01 , $812.86 ," $1,045.32 "," $1,011.60 "," $1,011.60 ", $899.20 , $899.20 , $117.20 ," $1,037.79 "," $1,067.80 "," $1,011.60 "," $1,011.60 "," $1,011.60 "," $1,045.32 "," $1,079.04 ", $937.03 , $955.40 , $712.64 , $812.53 , N/A , $694.29 , $694.29 ," $1,067.80 ", $853.54 , $117.20 ," $1,079.04 "
 PROCHLORPERAZINE MALEATE 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,50268-0685-15,1 tablet, $9.12 , $5.93 , $7.66 , N/A , N/A , $7.37 , $8.21 , $7.72 , $8.21 , $8.21 , $8.21 , $7.75 , N/A , $8.42 , $8.66 , $7.75 , $8.48 , $8.48 , $8.66 , $8.76 , $7.46 , $8.21 , $7.75 , $7.20 , N/A , $7.38 , $7.38 , $8.66 , $7.83 , $7.20 , $8.76 
"Amputation Foot,Transmetatarsal",CPT® 28805,N/A,N/A,N/A," $5,026.00 "," $3,266.90 "," $4,360.85 ", $677.03 , $537.90 ," $3,579.67 "," $3,592.06 "," $4,674.18 "," $4,523.40 "," $4,523.40 "," $4,020.80 "," $4,020.80 ", $537.90 ," $4,640.51 "," $4,774.70 "," $4,523.40 "," $4,523.40 "," $4,523.40 "," $4,674.18 "," $4,824.96 "," $4,063.23 "," $4,272.10 "," $3,958.84 "," $4,200.30 ", N/A ," $3,649.51 "," $3,649.51 "," $4,774.70 "," $4,289.47 ", $537.90 ," $4,824.96 "
 Pro Reconstruct Head of Radius ,CPT® 24365,0975 - PRO FEE/OR,N/A,N/A," $4,393.00 "," $2,855.45 "," $3,909.43 ", $612.92 , $614.70 ," $3,079.54 "," $3,061.50 "," $4,085.49 "," $3,953.70 "," $3,953.70 "," $3,514.40 "," $3,514.40 ", $614.70 ," $4,056.06 "," $4,173.35 "," $3,953.70 "," $3,953.70 "," $3,953.70 "," $4,085.49 "," $4,217.28 "," $3,633.46 "," $3,734.05 "," $3,380.80 "," $3,628.31 ", N/A ," $3,139.62 "," $3,139.62 "," $4,173.35 "," $3,690.17 ", $612.92 ," $4,217.28 "
 Fac Hgb/Rbcs Ftl F&Mat Hemrrg Rosette ,CPT® 85461,0305 - LAB/HEMATOLOGY,N/A,N/A, $109.00 , $70.85 , $91.56 , $9.55 , $9.21 , $88.07 , $98.10 , $92.28 , $98.10 , $98.10 , $98.10 , $92.65 , $9.03 , $100.64 , $103.55 , $92.65 , $101.37 , $101.37 , $103.55 , $104.64 , $89.18 , $98.10 , $92.65 , $86.11 , N/A , $88.21 , $88.21 , $103.55 , $93.53 , $9.03 , $104.64 
"Assay, Aminolevulinic Acid",CPT® 82135,N/A,N/A,N/A, $150.00 , $97.50 , N/A , $16.78 , $16.78 , $93.08 , $111.36 , $139.50 , $135.00 , $135.00 , $120.00 , $120.00 , $16.78 , $138.50 , $142.50 , $135.00 , $135.00 , $135.00 , $139.50 , $144.00 , $109.84 , $127.50 , $107.04 , $59.65 , N/A , $86.87 , $86.87 , $142.50 , $94.93 , $16.78 , $144.00 
Family Psychotherapy W/O Patient Present 50 Mins,CPT® 90846,N/A,N/A,N/A, $415.00 , $269.75 , $127.89 , $94.88 , $120.80 , $229.22 , $178.96 , $385.95 , $373.50 , $373.50 , $332.00 , $332.00 , $120.80 , $383.17 , $394.25 , $373.50 , $373.50 , $373.50 , $385.95 , $398.40 , $244.70 , $352.75 , $233.15 , $387.85 , $122.00 , $233.69 , $233.69 , $394.25 , $272.45 , $94.88 , $398.40 
"Ehrlichia, Antibody",CPT® 86666,N/A,N/A,N/A, $155.00 , $100.75 , N/A , $10.38 , $8.07 , $32.88 , $39.34 , $144.15 , $139.50 , $139.50 , $124.00 , $124.00 , $8.07 , $143.11 , $147.25 , $139.50 , $139.50 , $139.50 , $144.15 , $148.80 , $67.97 , $131.75 , $66.50 , $36.89 , N/A , $30.69 , $30.69 , $147.25 , $33.54 , $8.07 , $148.80 
" Fac Tcd, Emboli Detect W/Inj ",CPT® 93893,0921 - PERI VASCUL LAB,N/A,N/A," $1,025.00 ", $666.25 , $861.00 , $161.24 , $216.22 , $828.20 , $922.50 , $867.77 , $922.50 , $922.50 , $922.50 , $871.25 , $211.98 , $946.38 , $973.75 , $871.25 , $953.25 , $953.25 , $973.75 , $984.00 , $838.66 , $922.50 , $871.25 , $809.75 , N/A , $829.53 , $829.53 , $973.75 , $879.55 , $161.24 , $984.00 
" Fac Iliac Art Angio,Cardiac Cath ",HCPCS G0278,0481 - CARDIAC CATH LAB,N/A,N/A," $4,988.00 "," $3,242.20 "," $4,189.92 ", $12.25 , $12.31 ," $4,030.30 "," $4,489.20 "," $4,222.84 "," $4,489.20 "," $4,489.20 "," $4,489.20 "," $4,239.80 ", $12.07 ," $4,605.42 "," $4,738.60 "," $4,239.80 "," $4,638.84 "," $4,638.84 "," $4,738.60 "," $4,788.48 "," $4,081.18 "," $4,489.20 "," $4,239.80 "," $3,940.52 ", N/A ," $4,036.79 "," $4,036.79 "," $4,738.60 "," $4,280.20 ", $12.07 ," $4,788.48 "
Prq Trluml Coronry Tot Occlus Revasc Mi One Vsl,CPT® 92941,N/A,N/A,N/A," $5,575.00 "," $3,623.75 "," $3,864.38 ", $593.80 , $508.22 ," $3,621.23 "," $3,647.46 "," $5,184.75 "," $5,017.50 "," $5,017.50 "," $4,460.00 "," $4,460.00 ", $508.22 ," $5,147.40 "," $5,296.25 "," $5,017.50 "," $5,017.50 "," $5,017.50 "," $5,184.75 "," $5,352.00 "," $3,578.07 "," $4,738.75 "," $2,017.29 "," $3,809.46 ", N/A ," $3,691.89 "," $3,691.89 "," $5,296.25 "," $4,092.48 ", $508.22 ," $5,352.00 "
 FERUMOXYTOL 510 MG/17ML IV SOLN ,HCPCS Q0138,0636 - DRUGS REQUIRING DETAILED CODIN,00781-3154-01,17 mL," $5,580.80 "," $3,627.52 "," $4,687.87 ", $0.51 , $0.57 ," $4,509.29 "," $5,022.72 "," $4,724.71 "," $5,022.72 "," $5,022.72 "," $5,022.72 "," $4,743.68 ", $0.56 ," $5,152.75 "," $5,301.76 "," $4,743.68 "," $5,190.14 "," $5,190.14 "," $5,301.76 "," $5,357.57 "," $4,566.21 "," $5,022.72 "," $4,743.68 "," $4,408.83 ", N/A ," $4,516.54 "," $4,516.54 "," $5,301.76 "," $4,788.88 ", $0.51 ," $5,357.57 "
"Decortication,Pulmonary,Total",CPT® 32220,N/A,N/A,N/A," $11,016.00 "," $7,160.40 "," $8,303.17 "," $1,454.39 "," $1,455.24 "," $5,985.87 "," $5,884.98 "," $10,244.88 "," $9,914.40 "," $9,914.40 "," $8,812.80 "," $8,812.80 "," $1,455.24 "," $10,171.07 "," $10,465.20 "," $9,914.40 "," $9,914.40 "," $9,914.40 "," $10,244.88 "," $10,575.36 "," $8,010.04 "," $9,363.60 "," $8,502.85 "," $7,868.30 ", N/A ," $6,102.66 "," $6,102.66 "," $10,465.20 "," $7,187.17 "," $1,454.39 "," $10,575.36 "
 FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR ,HCPCS J1453,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9384-01,5 mL, $400.68 , $260.44 , $336.57 , $0.14 , $0.19 , $323.75 , $360.61 , $339.22 , $360.61 , $360.61 , $360.61 , $340.58 , $0.19 , $369.95 , $380.65 , $340.58 , $372.63 , $372.63 , $380.65 , $384.65 , $327.84 , $360.61 , $340.58 , $316.54 , N/A , $324.27 , $324.27 , $380.65 , $343.82 , $0.14 , $384.65 
"Electrocardiogram,Report",93010,N/A,N/A,N/A, $102.00 , $66.30 , $51.61 , $7.96 , $9.02 , $46.31 , $46.05 , $94.86 , $91.80 , $91.80 , $81.60 , $81.60 , $9.02 , $94.18 , $96.90 , $91.80 , $91.80 , $91.80 , $94.86 , $97.92 , $86.42 , $86.70 , $42.82 , $32.14 , N/A , $47.22 , $47.22 , $96.90 , $52.33 , $7.96 , $97.92 
Removal Superficial Implant,20670,N/A,N/A,N/A," $2,609.00 "," $1,695.85 ", $884.65 , $139.34 , $54.21 , $713.22 , $723.32 ," $2,426.37 "," $2,348.10 "," $2,348.10 "," $2,087.20 "," $2,087.20 ", $54.21 ," $2,408.89 "," $2,478.55 "," $2,348.10 "," $2,348.10 "," $2,348.10 "," $2,426.37 "," $2,504.64 ", $826.94 ," $2,217.65 ", $792.12 , $845.36 , N/A , $727.14 , $727.14 ," $2,478.55 ", $854.63 , $54.21 ," $2,504.64 "
Pro Tx of Thigh Fx - Lh,27240,N/A,N/A,N/A," $8,544.00 "," $5,553.60 "," $5,807.95 ", $906.37 , $824.74 ," $4,618.26 "," $4,602.97 "," $7,945.92 "," $7,689.60 "," $7,689.60 "," $6,835.20 "," $6,835.20 ", $824.74 ," $7,888.68 "," $8,116.80 "," $7,689.60 "," $7,689.60 "," $7,689.60 "," $7,945.92 "," $8,202.24 "," $5,407.50 "," $7,262.40 "," $5,088.15 "," $5,444.46 ", N/A ," $4,708.37 "," $4,708.37 "," $8,116.80 "," $5,534.00 ", $824.74 ," $8,202.24 "
Excise Mullerian Duct Cyst,CPT® 55680,N/A,N/A,N/A," $1,903.00 "," $1,236.95 "," $1,544.37 ", $333.29 ," $1,229.45 "," $1,140.78 "," $1,125.98 "," $1,769.79 "," $1,712.70 "," $1,712.70 "," $1,522.40 "," $1,522.40 "," $1,229.45 "," $1,757.04 "," $1,807.85 "," $1,712.70 "," $1,712.70 "," $1,712.70 "," $1,769.79 "," $1,826.88 "," $1,447.91 "," $1,617.55 "," $1,791.20 "," $1,680.16 ", N/A ," $1,163.04 "," $1,163.04 "," $1,807.85 "," $1,393.98 ", $333.29 ," $1,826.88 "
Shoe Lifts Elevation Heel /I,HCPCS L3334,N/A,N/A,N/A, $88.00 , $57.20 , N/A , $44.60 , $48.34 , N/A , N/A , $81.84 , $79.20 , $79.20 , $70.40 , $70.40 , $48.34 , $81.25 , $83.60 , $79.20 , $79.20 , $79.20 , $81.84 , $84.48 , N/A , $74.80 , $36.98 , $37.53 , N/A , N/A , N/A , $83.60 , N/A , $36.98 , $84.48 
 Incision/Drainage of Pilonidal Cyst Simple - Mh ,CPT® 10080,0761 - TREATMENT ROOM,N/A,N/A, $389.00 , $252.85 , $326.76 , $100.38 , $61.55 , $314.31 , $350.10 , $329.33 , $350.10 , $350.10 , $350.10 , $330.65 , $60.34 , $359.16 , $369.55 , $330.65 , $361.77 , $361.77 , $369.55 , $373.44 , $318.28 , $350.10 , $330.65 , $307.31 , N/A , $314.82 , $314.82 , $369.55 , $333.80 , $60.34 , $373.44 
IV Inj to Test Blood Flow in Flap/Graft,CPT® 15860,N/A,N/A,N/A, $489.00 , $317.85 , $334.73 , $99.22 , $13.87 , $301.60 , $291.89 , $454.77 , $440.10 , $440.10 , $391.20 , $391.20 , $13.87 , $451.49 , $464.55 , $440.10 , $440.10 , $440.10 , $454.77 , $469.44 , $367.56 , $415.65 , $588.74 , $373.56 , N/A , $307.49 , $307.49 , $464.55 , $356.58 , $13.87 , $588.74 
"Exc Skin Malig <5mm Trunk,Arm,Leg",CPT® 11600,N/A,N/A,N/A, $885.00 , $575.25 , $391.95 , $117.50 , $92.19 , $326.56 , $319.86 , $823.05 , $796.50 , $796.50 , $708.00 , $708.00 , $92.19 , $817.12 , $840.75 , $796.50 , $796.50 , $796.50 , $823.05 , $849.60 , $429.85 , $752.25 , $636.91 , $419.71 , N/A , $332.94 , $332.94 , $840.75 , $386.10 , $92.19 , $849.60 
Mitralplasty W Cp Bypass,CPT® 33425,N/A,N/A,N/A," $22,993.00 "," $14,945.45 "," $15,915.64 "," $2,454.87 "," $2,378.00 "," $11,659.07 "," $11,600.95 "," $21,383.49 "," $20,693.70 "," $20,693.70 "," $18,394.40 "," $18,394.40 "," $2,378.00 "," $21,229.44 "," $21,843.35 "," $20,693.70 "," $20,693.70 "," $20,693.70 "," $21,383.49 "," $22,073.28 "," $14,749.38 "," $19,544.05 "," $14,695.34 "," $13,103.25 ", N/A ," $11,886.56 "," $11,886.56 "," $21,843.35 "," $13,503.13 "," $2,378.00 "," $22,073.28 "
Opscpy Extnd Optic Nrv/Macula Drawing I&R Uni/Bi,92202,N/A,N/A,N/A, $53.00 , $34.45 , $31.48 , $14.35 , $12.71 , $25.89 , N/A , $49.29 , $47.70 , $47.70 , $42.40 , $42.40 , $12.71 , $48.93 , $50.35 , $47.70 , $47.70 , $47.70 , $49.29 , $50.88 , $44.60 , $45.05 , $43.42 , $31.45 , N/A , $26.40 , $26.40 , $50.35 , $31.32 , $12.71 , $50.88 
 Fac Lyr Clsr S/a/T/E 2.6 Cm-7.5 Cm ,CPT® 12032,0761 - TREATMENT ROOM,N/A,N/A, $919.00 , $597.35 , $771.96 , $183.18 , $82.48 , $742.55 , $827.10 , $778.03 , $827.10 , $827.10 , $827.10 , $781.15 , $80.86 , $848.51 , $873.05 , $781.15 , $854.67 , $854.67 , $873.05 , $882.24 , $751.93 , $827.10 , $781.15 , $726.01 , N/A , $743.75 , $743.75 , $873.05 , $788.59 , $80.86 , $882.24 
 Pro US Abdominal Aorta Real Time Screen Study Aaa ,CPT® 76706,0972 - PRO FEE/RAD/DX,N/A,N/A, $209.00 , $135.85 , $606.85 , $105.25 , $74.59 , $434.43 , $479.15 , $194.37 , $188.10 , $188.10 , $167.20 , $167.20 , $74.59 , $192.97 , $198.55 , $188.10 , $188.10 , $188.10 , $194.37 , $200.64 , $606.44 , $177.65 , $615.79 , $530.13 , N/A , $442.90 , $442.90 , $198.55 , $512.69 , $74.59 , $615.79 
 Fac Ercp W/Pressure Measurement Sphincter of Oddi ,CPT® 43263,0360 - OR SERVICES,N/A,N/A," $4,459.00 "," $2,898.35 "," $3,745.56 ", $338.22 , $604.84 ," $3,602.87 "," $4,013.10 "," $3,774.99 "," $4,013.10 "," $4,013.10 "," $4,013.10 "," $3,790.15 ", $592.98 ," $4,116.99 "," $4,236.05 "," $3,790.15 "," $4,146.87 "," $4,146.87 "," $4,236.05 "," $4,280.64 "," $3,648.35 "," $4,013.10 "," $3,790.15 "," $3,522.61 ", N/A ," $3,608.67 "," $3,608.67 "," $4,236.05 "," $3,826.27 ", $338.22 ," $4,280.64 "
Gadoxetate Disodium Inj,HCPCS A9581,N/A,N/A,N/A, $44.00 , $28.60 , N/A , $15.02 , $13.77 , N/A , N/A , $40.92 , $39.60 , $39.60 , $35.20 , $35.20 , $13.77 , $40.63 , $41.80 , $39.60 , $39.60 , $39.60 , $40.92 , $42.24 , $19.11 , $37.40 , $25.30 , $19.27 , N/A , N/A , N/A , $41.80 , N/A , $13.77 , $42.24 
 BLEOMYCIN SULFATE 30 UNITS IJ SOLR ,HCPCS J9040,0636 - DRUGS REQUIRING DETAILED CODIN,61703-0323-22,5 mL, $137.64 , $89.47 , $115.62 , $25.02 , $25.76 , $111.21 , $123.88 , $116.53 , $123.88 , $123.88 , $123.88 , $116.99 , $25.25 , $127.08 , $130.76 , $116.99 , $128.01 , $128.01 , $130.76 , $132.13 , $112.62 , $123.88 , $116.99 , $108.74 , N/A , $111.39 , $111.39 , $130.76 , $118.11 , $25.02 , $132.13 
 Fac Cryoglobulin Qual/Semi-Quan ,CPT® 82595,0301 - LAB/CHEMISTRY,N/A,N/A, $95.00 , $61.75 , $79.80 , $6.60 , $6.60 , $76.76 , $85.50 , $80.43 , $85.50 , $85.50 , $85.50 , $80.75 , $6.47 , $87.71 , $90.25 , $80.75 , $88.35 , $88.35 , $90.25 , $91.20 , $77.73 , $85.50 , $80.75 , $75.05 , N/A , $76.88 , $76.88 , $90.25 , $81.52 , $6.47 , $91.20 
Tap Block Unilateral by Injection(S),CPT® 64486,N/A,N/A,N/A, $814.00 , $529.10 , $276.80 , $53.31 , $97.79 , $356.51 , $350.87 , $757.02 , $732.60 , $732.60 , $651.20 , $651.20 , $97.79 , $751.57 , $773.30 , $732.60 , $732.60 , $732.60 , $757.02 , $781.44 , $300.42 , $691.90 , $289.64 , $361.04 , N/A , $363.47 , $363.47 , $773.30 , $389.92 , $53.31 , $781.44 
"Incision,Hemorrhoid",CPT® 46083,N/A,N/A,N/A," $1,180.00 ", $767.00 , $672.56 , $104.60 , $84.21 , $505.76 , $520.72 ," $1,097.40 "," $1,062.00 "," $1,062.00 ", $944.00 , $944.00 , $84.21 ," $1,089.49 "," $1,121.00 "," $1,062.00 "," $1,062.00 "," $1,062.00 "," $1,097.40 "," $1,132.80 ", $478.52 ," $1,003.00 ", $570.90 , $608.17 , N/A , $515.63 , $515.63 ," $1,121.00 ", $539.29 , $84.21 ," $1,132.80 "
Dis site tele svcs rhc/fqhc,HCPCS G2025,N/A,N/A,N/A, $331.00 , $215.15 , N/A , $95.51 , N/A , N/A , N/A , $307.83 , $297.90 , $297.90 , $264.80 , $264.80 , N/A , $305.61 , $314.45 , $297.90 , $297.90 , $297.90 , $307.83 , $317.76 , $551.27 , $281.35 , $187.39 , $197.34 , N/A , $94.80 , $94.80 , $314.45 , $118.51 , $94.80 , $551.27 
"Excision,Torus Mandibularis",CPT® 21031,N/A,N/A,N/A," $2,104.00 "," $1,367.60 "," $1,695.27 ", $265.19 , $488.42 ," $1,450.45 "," $1,441.69 "," $1,956.72 "," $1,893.60 "," $1,893.60 "," $1,683.20 "," $1,683.20 ", $488.42 ," $1,942.62 "," $1,998.80 "," $1,893.60 "," $1,893.60 "," $1,893.60 "," $1,956.72 "," $2,019.84 "," $1,590.00 "," $1,788.40 "," $1,568.19 "," $1,705.33 ", N/A ," $1,478.74 "," $1,478.74 "," $1,998.80 "," $1,738.04 ", $265.19 ," $2,019.84 "
Assay for Hva,CPT® 83150,N/A,N/A,N/A, $159.00 , $103.35 , N/A , $22.86 , $19.37 , $78.95 , $94.43 , $147.87 , $143.10 , $143.10 , $127.20 , $127.20 , $19.37 , $146.80 , $151.05 , $143.10 , $143.10 , $143.10 , $147.87 , $152.64 , $149.64 , $135.15 , $126.50 , $70.16 , N/A , $73.68 , $73.68 , $151.05 , $80.52 , $19.37 , $152.64 
 Pro Bl Draw < 3 Yrs Other Vein ,CPT® 36406,0964 - PRO FEE/ANES CRNA,N/A,N/A, $143.00 , $92.95 , $55.97 , $8.63 , $26.81 , $43.35 , $41.66 , $132.99 , $128.70 , $128.70 , $114.40 , $114.40 , $26.81 , $132.03 , $135.85 , $128.70 , $128.70 , $128.70 , $132.99 , $137.28 , $50.00 , $121.55 , $51.74 , $44.41 , N/A , $44.20 , $44.20 , $135.85 , $50.22 , $8.63 , $137.28 
Remove Skull Plate/Flap,CPT® 62142,N/A,N/A,N/A," $9,324.00 "," $6,060.60 "," $4,131.56 ", $808.44 , $533.82 ," $4,792.54 "," $4,625.30 "," $8,671.32 "," $8,391.60 "," $8,391.60 "," $7,459.20 "," $7,459.20 ", $533.82 ," $8,608.85 "," $8,857.80 "," $8,391.60 "," $8,391.60 "," $8,391.60 "," $8,671.32 "," $8,951.04 "," $4,433.42 "," $7,925.40 "," $4,725.99 "," $4,988.04 ", N/A ," $4,886.04 "," $4,886.04 "," $8,857.80 "," $5,241.58 ", $533.82 ," $8,951.04 "
 Immunofixj Electrophoresis Serum Pro ,CPT® 86334,0971 - PRO FEE/LAB,N/A,N/A, $131.00 , $85.15 , N/A , $22.79 , $22.79 , $126.43 , $151.19 , $121.83 , $117.90 , $117.90 , $104.80 , $104.80 , $22.79 , $120.95 , $124.45 , $117.90 , $117.90 , $117.90 , $121.83 , $125.76 , $149.17 , $111.35 , $240.03 , $81.03 , N/A , $117.99 , $117.99 , $124.45 , $128.94 , $22.79 , $240.03 
" Pro Debride Skin, Subcut Tussue/Muscle ",CPT® 11043,0982 - PRO FEE/OUTPT,N/A,N/A, $530.00 , $344.50 , $487.15 , $145.28 , $233.20 , $424.55 , $413.55 , $492.90 , $477.00 , $477.00 , $424.00 , $424.00 , $233.20 , $489.35 , $503.50 , $477.00 , $477.00 , $477.00 , $492.90 , $508.80 , $537.67 , $450.50 , $827.81 , $543.19 , N/A , $432.84 , $432.84 , $503.50 , $501.95 , $145.28 , $827.81 
"Explore/Treat Interphalangeal Jt,Ea",26080,N/A,N/A,N/A," $2,077.00 "," $1,350.05 "," $2,459.93 ", $387.68 , $230.52 ," $1,877.43 "," $1,888.59 "," $1,931.61 "," $1,869.30 "," $1,869.30 "," $1,661.60 "," $1,661.60 ", $230.52 ," $1,917.69 "," $1,973.15 "," $1,869.30 "," $1,869.30 "," $1,869.30 "," $1,931.61 "," $1,993.92 "," $2,276.48 "," $1,765.45 "," $2,071.30 "," $2,236.33 ", N/A ," $1,914.07 "," $1,914.07 "," $1,973.15 "," $2,249.72 ", $230.52 ," $2,459.93 "
Transvrs a-Arch Grf W/Card Byp Prfd Hypothermia,CPT® 33871,N/A,N/A,N/A," $18,623.00 "," $12,104.95 "," $18,936.97 "," $2,920.10 "," $2,461.44 "," $13,599.64 ", N/A ," $17,319.39 "," $16,760.70 "," $16,760.70 "," $14,898.40 "," $14,898.40 "," $2,461.44 "," $17,194.62 "," $17,691.85 "," $16,760.70 "," $16,760.70 "," $16,760.70 "," $17,319.39 "," $17,878.08 "," $17,567.30 "," $15,829.55 "," $16,918.28 "," $15,622.75 ", N/A ," $13,864.99 "," $13,864.99 "," $17,691.85 "," $15,747.21 "," $2,461.44 "," $18,936.97 "
Rad Resection Tumor Soft Tiss Face/Scalp 2+Cm,CPT® 21016,N/A,N/A,N/A," $6,915.00 "," $4,494.75 "," $6,099.93 ", $955.17 , $859.59 ," $4,935.77 "," $4,965.12 "," $6,430.95 "," $6,223.50 "," $6,223.50 "," $5,532.00 "," $5,532.00 ", $859.59 ," $6,384.62 "," $6,569.25 "," $6,223.50 "," $6,223.50 "," $6,223.50 "," $6,430.95 "," $6,638.40 "," $5,651.61 "," $5,877.75 "," $5,487.78 "," $5,771.92 ", N/A ," $5,032.07 "," $5,032.07 "," $6,569.25 "," $5,914.46 ", $859.59 ," $6,638.40 "
"Frenulotomy,Penis",CPT® 54164,N/A,N/A,N/A," $1,065.00 ", $692.25 , $861.13 , $186.21 , $88.56 , $618.76 , $632.66 , $990.45 , $958.50 , $958.50 , $852.00 , $852.00 , $88.56 , $983.31 ," $1,011.75 ", $958.50 , $958.50 , $958.50 , $990.45 ," $1,022.40 ", $802.60 , $905.25 ," $1,008.00 ", $940.09 , N/A , $630.83 , $630.83 ," $1,011.75 ", $756.11 , $88.56 ," $1,022.40 "
" Fac Nk Cells, Total Count ",CPT® 86357,0302 - LAB/IMMUNOLOGY,N/A,N/A, $348.00 , $226.20 , $292.32 , $38.48 , $38.48 , $281.18 , $313.20 , $294.62 , $313.20 , $313.20 , $313.20 , $295.80 , $37.73 , $321.31 , $330.60 , $295.80 , $323.64 , $323.64 , $330.60 , $334.08 , $284.73 , $313.20 , $295.80 , $274.92 , N/A , $281.64 , $281.64 , $330.60 , $298.62 , $37.73 , $334.08 
 Fac Rmvl Tun Cvc W/O Subq Port/Pmp ,CPT® 36589,0761 - TREATMENT ROOM,N/A,N/A," $2,063.00 "," $1,340.95 "," $1,732.92 ", $129.12 , $231.82 ," $1,666.90 "," $1,856.70 "," $1,746.54 "," $1,856.70 "," $1,856.70 "," $1,856.70 "," $1,753.55 ", $227.27 ," $1,904.77 "," $1,959.85 "," $1,753.55 "," $1,918.59 "," $1,918.59 "," $1,959.85 "," $1,980.48 "," $1,687.95 "," $1,856.70 "," $1,753.55 "," $1,629.77 ", N/A ," $1,669.59 "," $1,669.59 "," $1,959.85 "," $1,770.26 ", $129.12 ," $1,980.48 "
 Sulfur Colloid per Dose Up to 20 Mci ,HCPCS A9541,0343 - DIAGNOSTIC RADIOPHARMACEUTICALS,N/A,N/A, $660.00 , $429.00 , $554.40 , $728.11 , $43.41 , $533.28 , $594.00 , $558.76 , $594.00 , $594.00 , $594.00 , $561.00 , $42.56 , $609.38 , $627.00 , $561.00 , $613.80 , $613.80 , $627.00 , $633.60 , $540.01 , $594.00 , $561.00 , $521.40 , N/A , $534.14 , $534.14 , $627.00 , $566.35 , $42.56 , $728.11 
 DICLOFENAC SODIUM 50 MG PO TBEC ,HCPCS RXC637,0250 - PHARMACY,61442-0102-60,1 tablet, $4.66 , $3.03 , $3.91 , N/A , N/A , $3.77 , $4.19 , $3.95 , $4.19 , $4.19 , $4.19 , $3.96 , N/A , $4.30 , $4.43 , $3.96 , $4.33 , $4.33 , $4.43 , $4.47 , $3.81 , $4.19 , $3.96 , $3.68 , N/A , $3.77 , $3.77 , $4.43 , $4.00 , $3.68 , $4.47 
 Fac Vascular Embolize/Occlude Organ Tumor Infarct ,CPT® 37243,0360 - OR SERVICES,N/A,N/A," $31,984.00 "," $20,789.60 "," $26,866.56 ", $529.47 , $452.35 ," $25,843.07 "," $28,785.60 "," $27,077.65 "," $28,785.60 "," $28,785.60 "," $28,785.60 "," $27,186.40 ", $443.48 ," $29,530.83 "," $30,384.80 "," $27,186.40 "," $29,745.12 "," $29,745.12 "," $30,384.80 "," $30,704.64 "," $26,169.31 "," $28,785.60 "," $27,186.40 "," $25,267.36 ", N/A ," $25,884.65 "," $25,884.65 "," $30,384.80 "," $27,445.47 ", $443.48 ," $30,704.64 "
 Pro Shaving Skin Les 1 Trunk/Arm/Leg Diam 0.5cm/< ,CPT® 11300,0982 - PRO FEE/OUTPT,N/A,N/A, $382.00 , $248.30 , $109.62 , $32.66 , $50.40 , $96.10 , $92.59 , $355.26 , $343.80 , $343.80 , $305.60 , $305.60 , $50.40 , $352.70 , $362.90 , $343.80 , $343.80 , $343.80 , $355.26 , $366.72 , $120.13 , $324.70 , $183.76 , $124.39 , N/A , $97.98 , $97.98 , $362.90 , $113.63 , $32.66 , $366.72 
"Freeing Bowel Adhesion,Enterolysis",CPT® 44005,N/A,N/A,N/A," $7,142.00 "," $4,642.30 "," $6,495.71 "," $1,004.78 "," $1,383.09 "," $5,139.24 "," $5,181.72 "," $6,642.06 "," $6,427.80 "," $6,427.80 "," $5,713.60 "," $5,713.60 "," $1,383.09 "," $6,594.21 "," $6,784.90 "," $6,427.80 "," $6,427.80 "," $6,427.80 "," $6,642.06 "," $6,856.32 "," $4,655.17 "," $6,070.70 "," $5,766.10 "," $6,066.94 ", N/A ," $5,239.51 "," $5,239.51 "," $6,784.90 "," $5,479.98 "," $1,004.78 "," $6,856.32 "
 Path/Fzn Sec Ea Addl Specimen -Tech -Mh ,CPT® 88332,0310 - PATHOLOGY LAB,N/A,N/A, $234.00 , $152.10 , $196.56 , $54.10 , $38.03 , $189.07 , $210.60 , $198.10 , $210.60 , $210.60 , $210.60 , $198.90 , $37.28 , $216.05 , $222.30 , $198.90 , $217.62 , $217.62 , $222.30 , $224.64 , $191.46 , $210.60 , $198.90 , $184.86 , N/A , $189.38 , $189.38 , $222.30 , $200.80 , $37.28 , $224.64 
 Ankle Ap Lateral - Mh ,CPT® 73600,0972 - PRO FEE/RAD/DX,N/A,N/A, $99.00 , $64.35 , $180.79 , $32.02 , $26.20 , $128.52 , $153.87 , $92.07 , $89.10 , $89.10 , $79.20 , $79.20 , $26.20 , $91.41 , $94.05 , $89.10 , $89.10 , $89.10 , $92.07 , $95.04 , $178.21 , $84.15 , $169.49 , $149.43 , N/A , $131.02 , $131.02 , $94.05 , $151.65 , $26.20 , $180.79 
 Pro CT Angio Abd&Plvis Cntrst Mtrl W/WO Cntrst Imges ,CPT® 74174,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,239.00 ", $805.35 ," $2,729.79 ", $389.73 , $439.35 ," $1,853.19 "," $2,633.37 "," $1,152.27 "," $1,115.10 "," $1,115.10 ", $991.20 , $991.20 , $439.35 ," $1,143.97 "," $1,177.05 "," $1,115.10 "," $1,115.10 "," $1,115.10 "," $1,152.27 "," $1,189.44 "," $2,264.47 "," $1,053.15 "," $2,869.80 "," $2,516.94 ", N/A ," $1,889.35 "," $1,889.35 "," $1,177.05 "," $2,186.95 ", $389.73 ," $2,869.80 "
 T Spine MRI With Contrast ,CPT® 72147,0612 - MRI - SPINE,N/A,N/A," $5,847.00 "," $3,800.55 "," $4,911.48 ", $280.87 , $513.47 ," $4,724.38 "," $5,262.30 "," $4,950.07 "," $5,262.30 "," $5,262.30 "," $5,262.30 "," $4,969.95 ", $503.40 ," $5,398.54 "," $5,554.65 "," $4,969.95 "," $5,437.71 "," $5,437.71 "," $5,554.65 "," $5,613.12 "," $4,784.02 "," $5,262.30 "," $4,969.95 "," $4,619.13 ", N/A ," $4,731.98 "," $4,731.98 "," $5,554.65 "," $5,017.31 ", $280.87 ," $5,613.12 "
"Incis/Drain Thigh/Knee Abscess,Deep",27301,N/A,N/A,N/A," $4,454.00 "," $2,895.10 "," $3,080.29 ", $483.56 , $200.19 ," $2,384.48 "," $2,411.83 "," $4,142.22 "," $4,008.60 "," $4,008.60 "," $3,563.20 "," $3,563.20 ", $200.19 ," $4,112.38 "," $4,231.30 "," $4,008.60 "," $4,008.60 "," $4,008.60 "," $4,142.22 "," $4,275.84 "," $2,854.91 "," $3,785.90 "," $2,665.39 "," $2,851.17 ", N/A ," $2,431.01 "," $2,431.01 "," $4,231.30 "," $2,857.29 ", $200.19 ," $4,275.84 "
"Removal of Tonsils,12+ Y/O",CPT® 42826,N/A,N/A,N/A," $1,811.00 "," $1,177.15 "," $1,574.30 ", $248.15 , $224.35 ," $1,211.14 "," $1,250.93 "," $1,684.23 "," $1,629.90 "," $1,629.90 "," $1,448.80 "," $1,448.80 ", $224.35 ," $1,672.10 "," $1,720.45 "," $1,629.90 "," $1,629.90 "," $1,629.90 "," $1,684.23 "," $1,738.56 "," $1,109.60 "," $1,539.35 "," $1,363.03 "," $1,421.93 ", N/A ," $1,234.77 "," $1,234.77 "," $1,720.45 "," $1,291.44 ", $224.35 ," $1,738.56 "
Simple Repair 12.6-20cm,CPT® 12016,N/A,N/A,N/A," $1,205.00 ", $783.25 , $401.06 , $118.20 , $180.97 , $362.55 , $349.59 ," $1,120.65 "," $1,084.50 "," $1,084.50 ", $964.00 , $964.00 , $180.97 ," $1,112.58 "," $1,144.75 "," $1,084.50 "," $1,084.50 "," $1,084.50 "," $1,120.65 "," $1,156.80 ", $439.48 ," $1,024.25 ", $702.92 , $442.73 , N/A , $369.62 , $369.62 ," $1,144.75 ", $428.65 , $118.20 ," $1,156.80 "
Cciiv4 Vaccine Preservative Free 0.5 Ml Im Use,CPT® 90674,N/A,N/A,N/A, $50.00 , $32.50 , N/A , $32.93 , $48.23 , N/A , N/A , $46.50 , $45.00 , $45.00 , $40.00 , $40.00 , $48.23 , $46.17 , $47.50 , $45.00 , $45.00 , $45.00 , $46.50 , $48.00 , $38.00 , $42.50 , $95.92 , $46.73 , N/A , $60.90 , $60.90 , $47.50 , $70.76 , $32.93 , $95.92 
 Fac Tracht Tube Chng Prior Estbm Fstl Trc ,CPT® 31502,0761 - TREATMENT ROOM,N/A,N/A, $144.00 , $93.60 , $120.96 , $33.08 , $49.19 , $116.35 , $129.60 , $121.91 , $129.60 , $129.60 , $129.60 , $122.40 , $48.23 , $132.96 , $136.80 , $122.40 , $133.92 , $133.92 , $136.80 , $138.24 , $117.82 , $129.60 , $122.40 , $113.76 , N/A , $116.54 , $116.54 , $136.80 , $123.57 , $33.08 , $138.24 
"Assay Protein,Total,Serum",CPT® 84155,N/A,N/A,N/A, $41.00 , $26.65 , N/A , $3.74 , $3.74 , $20.74 , $24.81 , $38.13 , $36.90 , $36.90 , $32.80 , $32.80 , $3.74 , $37.86 , $38.95 , $36.90 , $36.90 , $36.90 , $38.13 , $39.36 , $24.51 , $34.85 , $24.33 , $13.30 , N/A , $19.36 , $19.36 , $38.95 , $21.16 , $3.74 , $39.36 
" Fac Incision Subcut Toe Tendon,>1 ",CPT® 28011,0761 - TREATMENT ROOM,N/A,N/A," $2,300.00 "," $1,495.00 "," $1,932.00 ", $271.81 , $115.24 ," $1,858.40 "," $2,070.00 "," $1,947.18 "," $2,070.00 "," $2,070.00 "," $2,070.00 "," $1,955.00 ", $112.98 ," $2,123.59 "," $2,185.00 "," $1,955.00 "," $2,139.00 "," $2,139.00 "," $2,185.00 "," $2,208.00 "," $1,881.86 "," $2,070.00 "," $1,955.00 "," $1,817.00 ", N/A ," $1,861.39 "," $1,861.39 "," $2,185.00 "," $1,973.63 ", $112.98 ," $2,208.00 "
 G2066 Ilr-Lmpl Loop Recorder-Remote Analysis ,CPT® 93271,0480 - CARDIOLOGY,N/A,N/A, $331.00 , $215.15 , $278.04 , $143.28 , $221.82 , $267.45 , $297.90 , $280.22 , $297.90 , $297.90 , $297.90 , $281.35 , $217.47 , $305.61 , $314.45 , $281.35 , $307.83 , $307.83 , $314.45 , $317.76 , $270.82 , $297.90 , $281.35 , $261.49 , N/A , $267.88 , $267.88 , $314.45 , $284.03 , $143.28 , $317.76 
Ear Microscopy Examination,92504,N/A,N/A,N/A, $79.00 , $51.35 , $21.46 , $9.28 , $24.58 , $21.39 , $21.61 , $73.47 , $71.10 , $71.10 , $63.20 , $63.20 , $24.58 , $72.94 , $75.05 , $71.10 , $71.10 , $71.10 , $73.47 , $75.84 , $40.25 , $67.15 , $28.38 , $36.21 , N/A , $21.81 , $21.81 , $75.05 , $25.43 , $9.28 , $75.84 
 Pro Repair Bladder Defect ,CPT® 57288,0982 - PRO FEE/OUTPT,N/A,N/A," $5,271.00 "," $3,426.15 "," $3,521.70 ", $712.23 , $675.48 ," $2,923.16 "," $2,884.37 "," $4,902.03 "," $4,743.90 "," $4,743.90 "," $4,216.80 "," $4,216.80 ", $675.48 ," $4,866.71 "," $5,007.45 "," $4,743.90 "," $4,743.90 "," $4,743.90 "," $4,902.03 "," $5,060.16 "," $3,667.10 "," $4,480.35 "," $3,746.53 "," $2,957.02 ", N/A ," $2,980.20 "," $2,980.20 "," $5,007.45 "," $3,574.56 ", $675.48 ," $5,060.16 "
 POLYETHYLENE GLYCOL 400 LIQD ,HCPCS RXC637,0250 - PHARMACY,62991-2914-01,"4,000 mL"," $4,314.98 "," $2,804.74 "," $3,624.58 ", N/A , N/A ," $3,486.50 "," $3,883.48 "," $3,653.06 "," $3,883.48 "," $3,883.48 "," $3,883.48 "," $3,667.73 ", N/A ," $3,984.02 "," $4,099.23 "," $3,667.73 "," $4,012.93 "," $4,012.93 "," $4,099.23 "," $4,142.38 "," $3,530.52 "," $3,883.48 "," $3,667.73 "," $3,408.83 ", N/A ," $3,492.11 "," $3,492.11 "," $4,099.23 "," $3,702.68 "," $3,408.83 "," $4,142.38 "
 Pro Fine Needle Aspiration Bx W/O Img Gdn 1st Lesion ,CPT® 10021,0982 - PRO FEE/OUTPT,N/A,N/A, $556.00 , $361.40 , $175.24 , $52.22 , $77.05 , $190.96 , $184.90 , $517.08 , $500.40 , $500.40 , $444.80 , $444.80 , $77.05 , $513.35 , $528.20 , $500.40 , $500.40 , $500.40 , $517.08 , $533.76 , $183.62 , $472.60 , $371.09 , $242.14 , N/A , $194.69 , $194.69 , $528.20 , $225.77 , $52.22 , $533.76 
 Echo 3d Img&Pst-Pxessing Tee/Tte Cgen Car Anoml ,CPT® 93319,0483 - CARDIOLOGY – ECHOCARDIOLOGY,N/A,N/A, $118.00 , $76.70 , $99.12 , $23.30 , N/A , $95.34 , $106.20 , $99.90 , $106.20 , $106.20 , $106.20 , $100.30 , N/A , $108.95 , $112.10 , $100.30 , $109.74 , $109.74 , $112.10 , $113.28 , $96.55 , $106.20 , $100.30 , $93.22 , N/A , $95.50 , $95.50 , $112.10 , $101.26 , $23.30 , $113.28 
 Pt Whirlpool ,CPT® 97022,0430 - OCCUPATION THER,N/A,N/A, $124.00 , $80.60 , $104.16 , $16.82 , $27.61 , $100.19 , $111.60 , $104.98 , $111.60 , $111.60 , $111.60 , $105.40 , $27.07 , $114.49 , $117.80 , $105.40 , $115.32 , $115.32 , $117.80 , $119.04 , $101.46 , $111.60 , $105.40 , $97.96 , N/A , $100.35 , $100.35 , $117.80 , $106.40 , $16.82 , $119.04 
 Fac Epstein-Barr Antibody ,CPT® 86664,0302 - LAB/IMMUNOLOGY,N/A,N/A, $141.00 , $91.65 , $118.44 , $15.60 , $15.60 , $113.93 , $126.90 , $119.37 , $126.90 , $126.90 , $126.90 , $119.85 , $15.29 , $130.19 , $133.95 , $119.85 , $131.13 , $131.13 , $133.95 , $135.36 , $115.37 , $126.90 , $119.85 , $111.39 , N/A , $114.11 , $114.11 , $133.95 , $120.99 , $15.29 , $135.36 
 Pro Lyr Clsr S/a/T/E > 30.0 Cm ,CPT® 12037,0981 - PRO FEE/ER,N/A,N/A," $1,866.00 "," $1,212.90 "," $1,027.96 ", $306.27 , $258.15 , $892.94 , $855.00 ," $1,735.38 "," $1,679.40 "," $1,679.40 "," $1,492.80 "," $1,492.80 ", $258.15 ," $1,722.88 "," $1,772.70 "," $1,679.40 "," $1,679.40 "," $1,679.40 "," $1,735.38 "," $1,791.36 "," $1,129.34 "," $1,586.10 "," $1,719.84 "," $1,133.19 ", N/A , $910.36 , $910.36 ," $1,772.70 "," $1,055.71 ", $258.15 ," $1,791.36 "
" Pro Injection,Therap/Proph/Diagnost, Im or Subcut ",CPT® 96372,0982 - PRO FEE/OUTPT,N/A,N/A, $91.00 , $59.15 , $33.14 , $13.86 , $3.38 , $55.65 , $58.19 , $84.63 , $81.90 , $81.90 , $72.80 , $72.80 , $3.38 , $84.02 , $86.45 , $81.90 , $81.90 , $81.90 , $84.63 , $87.36 , $51.48 , $77.35 , $77.04 , $77.48 , N/A , $56.74 , $56.74 , $86.45 , $66.15 , $3.38 , $87.36 
Mod Sed Same Phys/Qhp Initial 15 Mins 5/> Yrs,99152,N/A,N/A,N/A, $160.00 , $104.00 , $28.01 , $11.70 , $40.63 , $26.51 , $27.37 , $148.80 , $144.00 , $144.00 , $128.00 , $128.00 , $40.63 , $147.73 , $152.00 , $144.00 , $144.00 , $144.00 , $148.80 , $153.60 , $37.64 , $136.00 , $37.36 , $46.92 , N/A , $27.03 , $27.03 , $152.00 , $31.50 , $11.70 , $153.60 
Explore Lacrimal Canaliculi,CPT® 68840,N/A,N/A,N/A," $1,189.00 ", $772.85 , $718.64 , $113.66 , $65.12 , $658.15 , $627.52 ," $1,105.77 "," $1,070.10 "," $1,070.10 ", $951.20 , $951.20 , $65.12 ," $1,097.80 "," $1,129.55 "," $1,070.10 "," $1,070.10 "," $1,070.10 "," $1,105.77 "," $1,141.44 ", $985.95 ," $1,010.65 ", $649.40 , $838.03 , N/A , $671.00 , $671.00 ," $1,129.55 ", $740.69 , $65.12 ," $1,141.44 "
 GLYBURIDE 2.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,23155-0057-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Xenon per 10 Mci ,HCPCS A9558,0343 - DIAGNOSTIC RADIOPHARMACEUTICALS,N/A,N/A, $78.00 , $50.70 , $65.52 , N/A , $31.79 , $63.02 , $70.20 , $66.03 , $70.20 , $70.20 , $70.20 , $66.30 , $31.17 , $72.02 , $74.10 , $66.30 , $72.54 , $72.54 , $74.10 , $74.88 , $63.82 , $70.20 , $66.30 , $61.62 , N/A , $63.13 , $63.13 , $74.10 , $66.93 , $31.17 , $74.88 
 CT Cardiac Struct&Morph W/Contrast ,CPT® 75572,0350 - CT SCAN,N/A,N/A," $3,443.00 "," $2,237.95 "," $2,892.12 ", $231.22 , $118.91 ," $2,781.94 "," $3,098.70 "," $2,914.84 "," $3,098.70 "," $3,098.70 "," $3,098.70 "," $2,926.55 ", $116.58 ," $3,178.92 "," $3,270.85 "," $2,926.55 "," $3,201.99 "," $3,201.99 "," $3,270.85 "," $3,305.28 "," $2,817.06 "," $3,098.70 "," $2,926.55 "," $2,719.97 ", N/A ," $2,786.42 "," $2,786.42 "," $3,270.85 "," $2,954.44 ", $116.58 ," $3,305.28 "
"Resec Toe at I-P Jt,Single,Ea",CPT® 28160,N/A,N/A,N/A," $2,809.00 "," $1,825.85 "," $1,659.45 ", $259.18 , $183.20 ," $1,331.23 "," $1,327.41 "," $2,612.37 "," $2,528.10 "," $2,528.10 "," $2,247.20 "," $2,247.20 ", $183.20 ," $2,593.55 "," $2,668.55 "," $2,528.10 "," $2,528.10 "," $2,528.10 "," $2,612.37 "," $2,696.64 "," $1,539.39 "," $2,387.65 "," $1,436.17 "," $1,573.94 ", N/A ," $1,357.21 "," $1,357.21 "," $2,668.55 "," $1,595.17 ", $183.20 ," $2,696.64 "
 BUPROPION HCL 100 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6636-61,1 tablet, $10.10 , $6.57 , $8.48 , N/A , N/A , $8.16 , $9.09 , $8.55 , $9.09 , $9.09 , $9.09 , $8.59 , N/A , $9.33 , $9.60 , $8.59 , $9.39 , $9.39 , $9.60 , $9.70 , $8.26 , $9.09 , $8.59 , $7.98 , N/A , $8.17 , $8.17 , $9.60 , $8.67 , $7.98 , $9.70 
"Nasal/Sinus Scopy,Rmv Concha Bull",CPT® 31240,N/A,N/A,N/A, $915.00 , $594.75 , $854.16 , $151.69 , $239.88 , $615.00 , $606.19 , $850.95 , $823.50 , $823.50 , $732.00 , $732.00 , $239.88 , $844.82 , $869.25 , $823.50 , $823.50 , $823.50 , $850.95 , $878.40 , $819.16 , $777.75 , $854.57 , $808.37 , N/A , $627.01 , $627.01 , $869.25 , $738.44 , $151.69 , $878.40 
" Other Injury, Poisoning And Toxic Effect Diagnoses With McC ",MS DRG V40 (FY2023) 922,N/A,N/A,N/A," $36,109.63 "," $23,471.26 "," $30,332.09 ", N/A , N/A ," $29,176.58 "," $32,498.67 "," $30,570.41 "," $32,498.67 "," $32,498.67 "," $32,498.67 "," $30,693.19 ", N/A ," $33,340.02 "," $34,304.15 "," $30,693.19 "," $33,581.96 "," $33,581.96 "," $34,304.15 "," $34,665.24 "," $29,544.90 "," $32,498.67 "," $30,693.19 "," $28,526.61 ", N/A ," $29,223.52 "," $29,223.52 "," $34,304.15 "," $30,985.67 "," $28,526.61 "," $34,665.24 "
 Pro Wedging Cst Xcp Clubfoot Csts ,CPT® 29740,0981 - PRO FEE/ER,N/A,N/A, $519.00 , $337.35 , $413.47 , $64.41 , $15.36 , $339.04 , $316.55 , $482.67 , $467.10 , $467.10 , $415.20 , $415.20 , $15.36 , $479.19 , $493.05 , $467.10 , $467.10 , $467.10 , $482.67 , $498.24 , $385.84 , $441.15 , $347.89 , $398.97 , N/A , $345.65 , $345.65 , $493.05 , $406.28 , $15.36 , $498.24 
" Pro US Exam, Abdom, Complete ",CPT® 76700,0972 - PRO FEE/RAD/DX,N/A,N/A, $492.00 , $319.80 , $670.36 , $115.56 , $122.89 , $617.33 , $743.41 , $457.56 , $442.80 , $442.80 , $393.60 , $393.60 , $122.89 , $454.26 , $467.40 , $442.80 , $442.80 , $442.80 , $457.56 , $472.32 , $675.38 , $418.20 , $810.86 , $690.50 , N/A , $629.38 , $629.38 , $467.40 , $728.53 , $115.56 , $810.86 
 MORPHINE SULFATE ER 60 MG PO TBCR ,HCPCS RXC637,0250 - PHARMACY,00904-6559-61,1 tablet, $17.42 , $11.32 , $14.63 , N/A , N/A , $14.08 , $15.68 , $14.75 , $15.68 , $15.68 , $15.68 , $14.81 , N/A , $16.08 , $16.55 , $14.81 , $16.20 , $16.20 , $16.55 , $16.72 , $14.25 , $15.68 , $14.81 , $13.76 , N/A , $14.10 , $14.10 , $16.55 , $14.95 , $13.76 , $16.72 
Lyme Disease Antibody,CPT® 86617,N/A,N/A,N/A, $186.00 , $120.90 , N/A , $15.80 , $15.80 , $87.64 , $104.87 , $172.98 , $167.40 , $167.40 , $148.80 , $148.80 , $15.80 , $171.73 , $176.70 , $167.40 , $167.40 , $167.40 , $172.98 , $178.56 , $103.43 , $158.10 , $102.18 , $56.18 , N/A , $81.79 , $81.79 , $176.70 , $89.38 , $15.80 , $178.56 
Injection 1 or 2 Musclegr,CPT® 20552,N/A,N/A,N/A, $360.00 , $234.00 , $95.85 , $35.51 , $26.41 , $186.23 , $182.64 , $334.80 , $324.00 , $324.00 , $288.00 , $288.00 , $26.41 , $332.39 , $342.00 , $324.00 , $324.00 , $324.00 , $334.80 , $345.60 , $215.67 , $306.00 , $199.82 , $220.70 , N/A , $189.86 , $189.86 , $342.00 , $223.15 , $26.41 , $345.60 
 Pro Removal of Foreign Body ,CPT® 27372,0982 - PRO FEE/OUTPT,N/A,N/A," $3,994.00 "," $2,596.10 "," $2,450.96 ", $382.69 , $160.13 ," $1,950.30 "," $1,950.16 "," $3,714.42 "," $3,594.60 "," $3,594.60 "," $3,195.20 "," $3,195.20 ", $160.13 ," $3,687.66 "," $3,794.30 "," $3,594.60 "," $3,594.60 "," $3,594.60 "," $3,714.42 "," $3,834.24 "," $2,267.38 "," $3,394.90 "," $2,151.58 "," $2,264.21 ", N/A ," $1,988.36 "," $1,988.36 "," $3,794.30 "," $2,337.00 ", $160.13 ," $3,834.24 "
 MISOPROSTOL 50 MCG TAB (COMES FROM 100 MCG TABLET) ,HCPCS RXC637,0250 - PHARMACY,00001-0072-01,1 tablet, $5.04 , $3.28 , $4.23 , N/A , N/A , $4.07 , $4.54 , $4.27 , $4.54 , $4.54 , $4.54 , $4.28 , N/A , $4.65 , $4.79 , $4.28 , $4.69 , $4.69 , $4.79 , $4.84 , $4.12 , $4.54 , $4.28 , $3.98 , N/A , $4.08 , $4.08 , $4.79 , $4.32 , $3.98 , $4.84 
 Fac Immunodiffusion Ouchterlony ,CPT® 86331,0302 - LAB/IMMUNOLOGY,N/A,N/A, $139.00 , $90.35 , $116.76 , $12.22 , $12.22 , $112.31 , $125.10 , $117.68 , $125.10 , $125.10 , $125.10 , $118.15 , $11.98 , $128.34 , $132.05 , $118.15 , $129.27 , $129.27 , $132.05 , $133.44 , $113.73 , $125.10 , $118.15 , $109.81 , N/A , $112.49 , $112.49 , $132.05 , $119.28 , $11.98 , $133.44 
"Cabg, Artery-Vein, Two",CPT® 33518,N/A,N/A,N/A," $3,885.00 "," $2,525.25 "," $2,383.75 ", $367.19 , $363.85 ," $1,757.44 "," $1,737.33 "," $3,613.05 "," $3,496.50 "," $3,496.50 "," $3,108.00 "," $3,108.00 ", $363.85 ," $3,587.02 "," $3,690.75 "," $3,496.50 "," $3,496.50 "," $3,496.50 "," $3,613.05 "," $3,729.60 "," $2,212.77 "," $3,302.25 "," $2,205.10 "," $1,968.13 ", N/A ," $1,791.72 "," $1,791.72 "," $3,690.75 "," $2,035.42 ", $363.85 ," $3,729.60 "
Repair/Graft Achilles Tendon,CPT® 27652,N/A,N/A,N/A," $4,738.00 "," $3,079.70 "," $4,085.77 ", $641.31 , $787.71 ," $3,348.20 "," $3,305.18 "," $4,406.34 "," $4,264.20 "," $4,264.20 "," $3,790.40 "," $3,790.40 ", $787.71 ," $4,374.60 "," $4,501.10 "," $4,264.20 "," $4,264.20 "," $4,264.20 "," $4,406.34 "," $4,548.48 "," $3,815.26 "," $4,027.30 "," $3,614.51 "," $3,922.23 ", N/A ," $3,413.53 "," $3,413.53 "," $4,501.10 "," $4,012.11 ", $641.31 ," $4,548.48 "
Physical Therapy Re-Eval Est Plan Care 20 Mins,CPT® 97164,N/A,N/A,N/A, $208.00 , $135.20 , $135.06 , $69.08 , $67.74 , $118.51 , $112.64 , $193.44 , $187.20 , $187.20 , $166.40 , $166.40 , $67.74 , $192.05 , $197.60 , $187.20 , $187.20 , $187.20 , $193.44 , $199.68 , $172.57 , $176.80 , $210.01 , $128.34 , N/A , $120.82 , $120.82 , $197.60 , $134.38 , $67.74 , $210.01 
 METHOTREXATE SODIUM 50 MG/2ML IJ SOLN ,HCPCS J9250,0636 - DRUGS REQUIRING DETAILED CODIN,61703-0350-38,2 mL, $44.81 , $29.13 , $37.64 , $0.28 , $0.26 , $36.21 , $40.33 , $37.94 , $40.33 , $40.33 , $40.33 , $38.09 , $0.25 , $41.37 , $42.57 , $38.09 , $41.67 , $41.67 , $42.57 , $43.02 , $36.66 , $40.33 , $38.09 , $35.40 , N/A , $36.26 , $36.26 , $42.57 , $38.45 , $0.25 , $43.02 
 ATENOLOL 12.5 MG TAB (COMES FROM 25 MG TABLET) ,HCPCS RXC637,0250 - PHARMACY,00001-0038-01,1 tablet, $4.11 , $2.67 , $3.45 , N/A , N/A , $3.32 , $3.70 , $3.48 , $3.70 , $3.70 , $3.70 , $3.49 , N/A , $3.79 , $3.90 , $3.49 , $3.82 , $3.82 , $3.90 , $3.95 , $3.36 , $3.70 , $3.49 , $3.25 , N/A , $3.33 , $3.33 , $3.90 , $3.53 , $3.25 , $3.95 
 Fac Hemoglobin Electrophoresis ,CPT® 83020,0301 - LAB/CHEMISTRY,N/A,N/A, $126.00 , $81.90 , $105.84 , $13.13 , $6.32 , $101.81 , $113.40 , $106.67 , $113.40 , $113.40 , $113.40 , $107.10 , $6.20 , $116.34 , $119.70 , $107.10 , $117.18 , $117.18 , $119.70 , $120.96 , $103.09 , $113.40 , $107.10 , $99.54 , N/A , $101.97 , $101.97 , $119.70 , $108.12 , $6.20 , $120.96 
"Instill via Chest Tube Agent for Fibrinolysis, Subsequent",CPT® 32562,N/A,N/A,N/A, $467.00 , $303.55 , $326.89 , $57.19 , $70.79 , $239.38 , $234.27 , $434.31 , $420.30 , $420.30 , $373.60 , $373.60 , $70.79 , $431.18 , $443.65 , $420.30 , $420.30 , $420.30 , $434.31 , $448.32 , $318.33 , $396.95 , $335.40 , $316.28 , N/A , $244.05 , $244.05 , $443.65 , $287.41 , $57.19 , $448.32 
Assay of Total Estradiol,CPT® 82670,N/A,N/A,N/A, $258.00 , $167.70 , N/A , $28.50 , $28.50 , $158.07 , $189.10 , $239.94 , $232.20 , $232.20 , $206.40 , $206.40 , $28.50 , $238.21 , $245.10 , $232.20 , $232.20 , $232.20 , $239.94 , $247.68 , $186.56 , $219.30 , $183.27 , $101.30 , N/A , $147.52 , $147.52 , $245.10 , $161.20 , $28.50 , $247.68 
 Transient Ischemia Without Thrombolytic ,MS DRG V40 (FY2023) 069,N/A,N/A,N/A," $23,346.69 "," $15,175.35 "," $19,611.22 ", N/A , N/A ," $18,864.13 "," $21,012.02 "," $19,765.31 "," $21,012.02 "," $21,012.02 "," $21,012.02 "," $19,844.69 ", N/A ," $21,556.00 "," $22,179.36 "," $19,844.69 "," $21,712.42 "," $21,712.42 "," $22,179.36 "," $22,412.82 "," $19,102.26 "," $21,012.02 "," $19,844.69 "," $18,443.89 ", N/A ," $18,894.48 "," $18,894.48 "," $22,179.36 "," $20,033.79 "," $18,443.89 "," $22,412.82 "
Excis Cornea Lesn,CPT® 65400,N/A,N/A,N/A," $6,219.00 "," $4,042.35 "," $3,710.46 ", $583.06 , $461.04 ," $3,412.52 "," $3,191.03 "," $5,783.67 "," $5,597.10 "," $5,597.10 "," $4,975.20 "," $4,975.20 ", $461.04 ," $5,742.00 "," $5,908.05 "," $5,597.10 "," $5,597.10 "," $5,597.10 "," $5,783.67 "," $5,970.24 "," $5,092.95 "," $5,286.15 "," $3,277.33 "," $4,338.27 ", N/A ," $3,479.10 "," $3,479.10 "," $5,908.05 "," $3,840.48 ", $461.04 ," $5,970.24 "
"Partial Removal, Clavicle",23120,N/A,N/A,N/A," $3,847.00 "," $2,500.55 "," $3,590.15 ", $564.07 , $537.90 ," $2,815.43 "," $2,826.91 "," $3,577.71 "," $3,462.30 "," $3,462.30 "," $3,077.60 "," $3,077.60 ", $537.90 ," $3,551.94 "," $3,654.65 "," $3,462.30 "," $3,462.30 "," $3,462.30 "," $3,577.71 "," $3,693.12 "," $3,332.28 "," $3,269.95 "," $3,116.76 "," $3,327.06 ", N/A ," $2,870.37 "," $2,870.37 "," $3,654.65 "," $3,373.70 ", $537.90 ," $3,693.12 "
 Fac Platelet Pheres Leukoreduced ,HCPCS P9035,0390 - BLOOD/STOR-PROC,N/A,N/A," $1,463.00 ", $950.95 ," $1,228.92 ", N/A , N/A ," $1,182.10 "," $1,316.70 "," $1,238.58 "," $1,316.70 "," $1,316.70 "," $1,316.70 "," $1,243.55 ", N/A ," $1,350.79 "," $1,389.85 "," $1,243.55 "," $1,360.59 "," $1,360.59 "," $1,389.85 "," $1,404.48 "," $1,197.03 "," $1,316.70 "," $1,243.55 "," $1,155.77 ", N/A ," $1,184.01 "," $1,184.01 "," $1,389.85 "," $1,255.40 "," $1,155.77 "," $1,404.48 "
"Fix Lid Ptosis,Levatr Resec,Intern",CPT® 67903,N/A,N/A,N/A," $5,425.00 "," $3,526.25 "," $2,953.93 ", $463.37 , $907.22 ," $2,733.42 "," $2,585.66 "," $5,045.25 "," $4,882.50 "," $4,882.50 "," $4,340.00 "," $4,340.00 ", $907.22 ," $5,008.90 "," $5,153.75 "," $4,882.50 "," $4,882.50 "," $4,882.50 "," $5,045.25 "," $5,208.00 "," $4,058.93 "," $4,611.25 "," $2,685.02 "," $3,473.06 ", N/A ," $2,786.75 "," $2,786.75 "," $5,153.75 "," $3,076.21 ", $463.37 ," $5,208.00 "
TREAT LOWER LEG JOINT,27842,N/A,N/A,N/A," $3,003.00 "," $1,951.95 "," $3,047.14 ", $473.72 , $153.67 ," $2,397.06 "," $2,397.90 "," $2,792.79 "," $2,702.70 "," $2,702.70 "," $2,402.40 "," $2,402.40 ", $153.67 ," $2,772.67 "," $2,852.85 "," $2,702.70 "," $2,702.70 "," $2,702.70 "," $2,792.79 "," $2,882.88 "," $2,818.09 "," $2,552.55 "," $2,640.41 "," $2,813.33 ", N/A ," $2,443.83 "," $2,443.83 "," $2,852.85 "," $2,872.37 ", $153.67 ," $3,047.14 "
 OXYMETAZOLINE HCL 0.05 % NA SOLN ,HCPCS RXC637,0250 - PHARMACY,00904-7006-35,15 mL, $12.26 , $7.97 , $10.30 , N/A , N/A , $9.91 , $11.03 , $10.38 , $11.03 , $11.03 , $11.03 , $10.42 , N/A , $11.32 , $11.65 , $10.42 , $11.40 , $11.40 , $11.65 , $11.77 , $10.03 , $11.03 , $10.42 , $9.69 , N/A , $9.92 , $9.92 , $11.65 , $10.52 , $9.69 , $11.77 
Orchiopexy Inguinal or Scrotal Approach,CPT® 54640,N/A,N/A,N/A," $3,558.00 "," $2,312.70 "," $1,910.64 ", $410.82 , $768.38 ," $1,534.70 "," $1,565.04 "," $3,308.94 "," $3,202.20 "," $3,202.20 "," $2,846.40 "," $2,846.40 ", $768.38 ," $3,285.10 "," $3,380.10 "," $3,202.20 "," $3,202.20 "," $3,202.20 "," $3,308.94 "," $3,415.68 "," $1,797.30 "," $3,024.30 "," $2,503.04 "," $2,311.86 ", N/A ," $1,564.65 "," $1,564.65 "," $3,380.10 "," $1,875.32 ", $410.82 ," $3,415.68 "
Incisional Biopsy Skin Ea Sep/Additional Lesion,11107,N/A,N/A,N/A, $295.00 , $191.75 , $99.21 , $29.27 , $56.85 , $82.76 , N/A , $274.35 , $265.50 , $265.50 , $236.00 , $236.00 , $56.85 , $272.37 , $280.25 , $265.50 , $265.50 , $265.50 , $274.35 , $283.20 , $109.90 , $250.75 , $161.70 , $113.62 , N/A , $84.38 , $84.38 , $280.25 , $97.84 , $29.27 , $283.20 
Perq Dstl Radial Fx/Epiphysl Sep,CPT® 25606,N/A,N/A,N/A," $4,248.00 "," $2,761.20 "," $4,083.11 ", $642.81 , $530.72 ," $3,188.66 "," $3,190.39 "," $3,950.64 "," $3,823.20 "," $3,823.20 "," $3,398.40 "," $3,398.40 ", $530.72 ," $3,922.18 "," $4,035.60 "," $3,823.20 "," $3,823.20 "," $3,823.20 "," $3,950.64 "," $4,078.08 "," $3,783.27 "," $3,610.80 "," $3,514.61 "," $3,771.96 ", N/A ," $3,250.87 "," $3,250.87 "," $4,035.60 "," $3,820.94 ", $530.72 ," $4,083.11 "
Tissue Culture-Amniotic F,CPT® 88235,N/A,N/A,N/A," $1,461.00 ", $949.65 , N/A , $153.31 , $69.14 , $278.89 ," $1,252.46 "," $1,358.73 "," $1,314.90 "," $1,314.90 "," $1,168.80 "," $1,168.80 ", $69.14 ," $1,348.94 "," $1,387.95 "," $1,314.90 "," $1,314.90 "," $1,314.90 "," $1,358.73 "," $1,402.56 "," $1,003.59 "," $1,241.85 ", $965.00 , $643.61 , N/A , $260.28 , $260.28 ," $1,387.95 ", $286.03 , $69.14 ," $1,402.56 "
Apply Short Leg Splint,CPT® 29515,N/A,N/A,N/A, $473.00 , $307.45 , $298.68 , $47.11 , $31.03 , $240.63 , $243.68 , $439.89 , $425.70 , $425.70 , $378.40 , $378.40 , $31.03 , $436.72 , $449.35 , $425.70 , $425.70 , $425.70 , $439.89 , $454.08 , $277.19 , $402.05 , $265.83 , $288.50 , N/A , $245.33 , $245.33 , $449.35 , $288.36 , $31.03 , $454.08 
 Fac M/Phmtrc Alys Ish Quant/Semiq Mnl Each Multiprb ,CPT® 88377,0310 - PATHOLOGY LAB,N/A,N/A," $1,385.00 ", $900.25 ," $1,163.40 ", $389.56 , $168.73 ," $1,119.08 "," $1,246.50 "," $1,172.54 "," $1,246.50 "," $1,246.50 "," $1,246.50 "," $1,177.25 ", $165.42 ," $1,278.77 "," $1,315.75 "," $1,177.25 "," $1,288.05 "," $1,288.05 "," $1,315.75 "," $1,329.60 "," $1,133.21 "," $1,246.50 "," $1,177.25 "," $1,094.15 ", N/A ," $1,120.88 "," $1,120.88 "," $1,315.75 "," $1,188.47 ", $165.42 ," $1,329.60 "
"Intraoperative Cyto Path Consult, Add Sites",CPT® 88334,N/A,N/A,N/A, $132.00 , $85.80 , $202.39 , $55.88 , $39.32 , $266.19 , $300.46 , $122.76 , $118.80 , $118.80 , $105.60 , $105.60 , $39.32 , $121.88 , $125.40 , $118.80 , $118.80 , $118.80 , $122.76 , $126.72 , $368.32 , $112.20 , $313.02 , $195.12 , N/A , $248.43 , $248.43 , $125.40 , $273.01 , $39.32 , $368.32 
 Fac Assay of Thyroid Activity ,CPT® 84442,0301 - LAB/CHEMISTRY,N/A,N/A, $146.00 , $94.90 , $122.64 , $15.08 , $15.08 , $117.97 , $131.40 , $123.60 , $131.40 , $131.40 , $131.40 , $124.10 , $14.78 , $134.80 , $138.70 , $124.10 , $135.78 , $135.78 , $138.70 , $140.16 , $119.46 , $131.40 , $124.10 , $115.34 , N/A , $118.16 , $118.16 , $138.70 , $125.28 , $14.78 , $140.16 
Thoracentesis Needle/Cath Pleura W/O Imaging,32554,N/A,N/A,N/A, $872.00 , $566.80 , $486.39 , $84.12 , $196.83 , $347.08 , $337.80 , $810.96 , $784.80 , $784.80 , $697.60 , $697.60 , $196.83 , $805.12 , $828.40 , $784.80 , $784.80 , $784.80 , $810.96 , $837.12 , $471.39 , $741.20 , $470.99 , $466.30 , N/A , $353.86 , $353.86 , $828.40 , $416.75 , $84.12 , $837.12 
 ISOSULFAN BLUE 1 % SC SOLN ,HCPCS RXA250,0250 - PHARMACY,67457-0220-05,5 mL," $3,119.36 "," $2,027.58 "," $2,620.26 ", N/A , N/A ," $2,520.44 "," $2,807.42 "," $2,640.85 "," $2,807.42 "," $2,807.42 "," $2,807.42 "," $2,651.46 ", N/A ," $2,880.11 "," $2,963.39 "," $2,651.46 "," $2,901.00 "," $2,901.00 "," $2,963.39 "," $2,994.59 "," $2,552.26 "," $2,807.42 "," $2,651.46 "," $2,464.29 ", N/A ," $2,524.50 "," $2,524.50 "," $2,963.39 "," $2,676.72 "," $2,464.29 "," $2,994.59 "
 Fac Assay of for Hva ,CPT® 83150,0301 - LAB/CHEMISTRY,N/A,N/A, $159.00 , $103.35 , $133.56 , $22.86 , $19.37 , $128.47 , $143.10 , $134.61 , $143.10 , $143.10 , $143.10 , $135.15 , $18.99 , $146.80 , $151.05 , $135.15 , $147.87 , $147.87 , $151.05 , $152.64 , $130.09 , $143.10 , $135.15 , $125.61 , N/A , $128.68 , $128.68 , $151.05 , $136.44 , $18.99 , $152.64 
Remove Extern Bone Fix Dev W Anesth,20694,N/A,N/A,N/A," $2,810.00 "," $1,826.50 "," $2,077.73 ", $327.71 , $361.03 ," $1,632.54 "," $1,636.37 "," $2,613.30 "," $2,529.00 "," $2,529.00 "," $2,248.00 "," $2,248.00 ", $361.03 ," $2,594.47 "," $2,669.50 "," $2,529.00 "," $2,529.00 "," $2,529.00 "," $2,613.30 "," $2,697.60 "," $1,927.04 "," $2,388.50 "," $1,798.34 "," $1,936.80 ", N/A ," $1,664.40 "," $1,664.40 "," $2,669.50 "," $1,956.25 ", $327.71 ," $2,697.60 "
 MESALAMINE 400 MG PO CPDR ,HCPCS RXC637,0250 - PHARMACY,60687-0556-32,1 capsule, $31.44 , $20.44 , $26.41 , N/A , N/A , $25.40 , $28.30 , $26.62 , $28.30 , $28.30 , $28.30 , $26.72 , N/A , $29.03 , $29.87 , $26.72 , $29.24 , $29.24 , $29.87 , $30.18 , $25.72 , $28.30 , $26.72 , $24.84 , N/A , $25.44 , $25.44 , $29.87 , $26.98 , $24.84 , $30.18 
 Fac Injection Sclerosant Single Incmptnt Vein ,CPT® 36470,0360 - OR SERVICES,N/A,N/A, $499.00 , $324.35 , $419.16 , $35.00 , $50.81 , $403.19 , $449.10 , $422.45 , $449.10 , $449.10 , $449.10 , $424.15 , $49.81 , $460.73 , $474.05 , $424.15 , $464.07 , $464.07 , $474.05 , $479.04 , $408.28 , $449.10 , $424.15 , $394.21 , N/A , $403.84 , $403.84 , $474.05 , $428.19 , $35.00 , $479.04 
" Pro Laparoscope Proc, Intestine ",CPT® 44238,0982 - PRO FEE/OUTPT,N/A,N/A, $421.00 , $273.65 , N/A , N/A , N/A , N/A , N/A , $391.53 , $378.90 , $378.90 , $336.80 , $336.80 , N/A , $388.71 , $399.95 , $378.90 , $378.90 , $378.90 , $391.53 , $404.16 , N/A , $357.85 , $336.80 , N/A , N/A , N/A , N/A , $399.95 , N/A , $336.80 , $404.16 
Change of Ureterostomy Tube,CPT® 50688,N/A,N/A,N/A, $542.00 , $352.30 , $419.58 , $74.31 , $15.36 , $393.03 , $370.19 , $504.06 , $487.80 , $487.80 , $433.60 , $433.60 , $15.36 , $500.43 , $514.90 , $487.80 , $487.80 , $487.80 , $504.06 , $520.32 , $419.90 , $460.70 , $419.26 , $488.04 , N/A , $400.70 , $400.70 , $514.90 , $470.94 , $15.36 , $520.32 
"Inject Trigger Points, > 3",20553,N/A,N/A,N/A, $358.00 , $232.70 , $108.92 , $40.47 , $26.41 , $210.81 , $207.99 , $332.94 , $322.20 , $322.20 , $286.40 , $286.40 , $26.41 , $330.54 , $340.10 , $322.20 , $322.20 , $322.20 , $332.94 , $343.68 , $244.53 , $304.30 , $224.79 , $250.96 , N/A , $214.93 , $214.93 , $340.10 , $252.63 , $26.41 , $343.68 
 Fac Athletic Training Eval High Complex ,CPT® 97171,0951 - OTHER THERAPEUTIC SERVICES - ATHLETIC TRAINING,N/A,N/A, $160.00 , $104.00 , $134.40 , N/A , N/A , $129.28 , $144.00 , $135.46 , $144.00 , $144.00 , $144.00 , $136.00 , N/A , $147.73 , $152.00 , $136.00 , $148.80 , $148.80 , $152.00 , $153.60 , $130.91 , $144.00 , $136.00 , $126.40 , N/A , $129.49 , $129.49 , $152.00 , $137.30 , $126.40 , $153.60 
 Fac Evasc Rpr Dta Exp Coverage W/O Art Origin ,CPT® 33881,0360 - OR SERVICES,N/A,N/A," $22,070.00 "," $14,345.50 "," $18,538.80 "," $1,368.98 "," $1,369.87 "," $17,832.56 "," $19,863.00 "," $18,684.46 "," $19,863.00 "," $19,863.00 "," $19,863.00 "," $18,759.50 "," $1,343.01 "," $20,377.23 "," $20,966.50 "," $18,759.50 "," $20,525.10 "," $20,525.10 "," $20,966.50 "," $21,187.20 "," $18,057.67 "," $19,863.00 "," $18,759.50 "," $17,435.30 ", N/A ," $17,861.25 "," $17,861.25 "," $20,966.50 "," $18,938.27 "," $1,343.01 "," $21,187.20 "
 Fac Removal of Spinal Lamina ,CPT® 63045,0360 - OR SERVICES,N/A,N/A," $18,774.00 "," $12,203.10 "," $15,770.16 "," $1,168.79 "," $1,072.37 "," $15,169.39 "," $16,896.60 "," $15,894.07 "," $16,896.60 "," $16,896.60 "," $16,896.60 "," $15,957.90 "," $1,051.34 "," $17,334.03 "," $17,835.30 "," $15,957.90 "," $17,459.82 "," $17,459.82 "," $17,835.30 "," $18,023.04 "," $15,360.89 "," $16,896.60 "," $15,957.90 "," $14,831.46 ", N/A ," $15,193.80 "," $15,193.80 "," $17,835.30 "," $16,109.97 "," $1,051.34 "," $18,023.04 "
 Fac Introduction Catheter Aorta ,CPT® 36200,0360 - OR SERVICES,N/A,N/A," $1,662.00 "," $1,080.30 "," $1,396.08 ", $124.81 , $616.57 ," $1,342.90 "," $1,495.80 "," $1,407.05 "," $1,495.80 "," $1,495.80 "," $1,495.80 "," $1,412.70 ", $604.48 ," $1,534.52 "," $1,578.90 "," $1,412.70 "," $1,545.66 "," $1,545.66 "," $1,578.90 "," $1,595.52 "," $1,359.85 "," $1,495.80 "," $1,412.70 "," $1,312.98 ", N/A ," $1,345.06 "," $1,345.06 "," $1,578.90 "," $1,426.16 ", $124.81 ," $1,595.52 "
 LIDOCAINE 5 % EX PTCH ,HCPCS RXC637,0250 - PHARMACY,00591-3525-30,1 patch, $48.09 , $31.26 , $40.40 , N/A , N/A , $38.86 , $43.28 , $40.71 , $43.28 , $43.28 , $43.28 , $40.88 , N/A , $44.40 , $45.69 , $40.88 , $44.72 , $44.72 , $45.69 , $46.17 , $39.35 , $43.28 , $40.88 , $37.99 , N/A , $38.92 , $38.92 , $45.69 , $41.27 , $37.99 , $46.17 
 Fac Assay of Urine Sodium ,CPT® 84300,0301 - LAB/CHEMISTRY,N/A,N/A, $71.00 , $46.15 , $59.64 , $5.16 , $5.16 , $57.37 , $63.90 , $60.11 , $63.90 , $63.90 , $63.90 , $60.35 , $5.06 , $65.55 , $67.45 , $60.35 , $66.03 , $66.03 , $67.45 , $68.16 , $58.09 , $63.90 , $60.35 , $56.09 , N/A , $57.46 , $57.46 , $67.45 , $60.93 , $5.06 , $68.16 
"Conization Cervix,Knife/Laser",57520,N/A,N/A,N/A," $1,931.00 "," $1,255.15 "," $1,405.10 ", $285.27 , $276.68 ," $1,116.88 "," $1,114.54 "," $1,795.83 "," $1,737.90 "," $1,737.90 "," $1,544.80 "," $1,544.80 ", $276.68 ," $1,782.89 "," $1,834.45 "," $1,737.90 "," $1,737.90 "," $1,737.90 "," $1,795.83 "," $1,853.76 "," $1,450.34 "," $1,641.35 "," $1,461.15 "," $1,127.53 ", N/A ," $1,138.66 "," $1,138.66 "," $1,834.45 "," $1,365.76 ", $276.68 ," $1,853.76 "
 Fac Injection Aa&/Strd Intercostal Nrv Ea Addl Lvl ,CPT® 64421,0761 - TREATMENT ROOM,N/A,N/A, $479.00 , $311.35 , $402.36 , $23.62 , $46.08 , $387.03 , $431.10 , $405.52 , $431.10 , $431.10 , $431.10 , $407.15 , $45.18 , $442.26 , $455.05 , $407.15 , $445.47 , $445.47 , $455.05 , $459.84 , $391.92 , $431.10 , $407.15 , $378.41 , N/A , $387.65 , $387.65 , $455.05 , $411.03 , $23.62 , $459.84 
Excision Bn-Lesion.5cm Le,11400,N/A,N/A,N/A, $486.00 , $315.90 , $269.31 , $81.33 , $48.12 , $218.95 , $215.53 , $451.98 , $437.40 , $437.40 , $388.80 , $388.80 , $48.12 , $448.72 , $461.70 , $437.40 , $437.40 , $437.40 , $451.98 , $466.56 , $293.40 , $413.10 , $426.39 , $284.49 , N/A , $223.23 , $223.23 , $461.70 , $258.85 , $48.12 , $466.56 
 Fac Glucose Other Fluid ,CPT® 82945,0301 - LAB/CHEMISTRY,N/A,N/A, $118.00 , $76.70 , $99.12 , $4.01 , $4.01 , $95.34 , $106.20 , $99.90 , $106.20 , $106.20 , $106.20 , $100.30 , $3.93 , $108.95 , $112.10 , $100.30 , $109.74 , $109.74 , $112.10 , $113.28 , $96.55 , $106.20 , $100.30 , $93.22 , N/A , $95.50 , $95.50 , $112.10 , $101.26 , $3.93 , $113.28 
 Pro Cystouretero W/Lithotripsy ,CPT® 52353,0982 - PRO FEE/OUTPT,N/A,N/A," $3,899.00 "," $2,534.35 "," $2,100.25 ", $368.50 , $431.86 ," $1,924.93 "," $2,675.07 "," $3,626.07 "," $3,509.10 "," $3,509.10 "," $3,119.20 "," $3,119.20 ", $431.86 ," $3,599.95 "," $3,704.05 "," $3,509.10 "," $3,509.10 "," $3,509.10 "," $3,626.07 "," $3,743.04 "," $2,112.54 "," $3,314.15 "," $2,060.59 "," $2,413.34 ", N/A ," $1,962.49 "," $1,962.49 "," $3,704.05 "," $2,306.64 ", $368.50 ," $3,743.04 "
" Pro Inj W/Fluor, Eval Cv Device ",CPT® 36598,0972 - PRO FEE/RAD/DX,N/A,N/A, $467.00 , $303.55 , $222.63 , $34.22 , $161.63 , $163.03 , $156.73 , $434.31 , $420.30 , $420.30 , $373.60 , $373.60 , $161.63 , $431.18 , $443.65 , $420.30 , $420.30 , $420.30 , $434.31 , $448.32 , $205.30 , $396.95 , $190.89 , $185.09 , N/A , $166.21 , $166.21 , $443.65 , $188.81 , $34.22 , $448.32 
Psycl/Nrpsycl Tst Tech 2+ Tst 1st 30 Min,CPT® 96138,N/A,N/A,N/A, $156.00 , $101.40 , $79.27 , $32.95 , $43.43 , $77.90 , N/A , $145.08 , $140.40 , $140.40 , $124.80 , $124.80 , $43.43 , $144.03 , $148.20 , $140.40 , $140.40 , $140.40 , $145.08 , $149.76 , $156.10 , $132.60 , $101.98 , $143.08 , $53.53 , $79.41 , $79.41 , $148.20 , $92.59 , $32.95 , $156.10 
" Fac Detect Agnt Mult, Dna, Ampli ",CPT® 87801,0306 - LAB/BACT-MICRO,N/A,N/A, $648.00 , $421.20 , $544.32 , $71.60 , $49.97 , $523.58 , $583.20 , $548.60 , $583.20 , $583.20 , $583.20 , $550.80 , $48.99 , $598.30 , $615.60 , $550.80 , $602.64 , $602.64 , $615.60 , $622.08 , $530.19 , $583.20 , $550.80 , $511.92 , N/A , $524.43 , $524.43 , $615.60 , $556.05 , $48.99 , $622.08 
 Fac Rmvl of Subq Implantable Defibrillator Electrode ,CPT® 33272,0360 - OR SERVICES,N/A,N/A," $4,096.00 "," $2,662.40 "," $3,440.64 ", $319.67 , $318.69 ," $3,309.57 "," $3,686.40 "," $3,467.67 "," $3,686.40 "," $3,686.40 "," $3,686.40 "," $3,481.60 ", $312.44 ," $3,781.84 "," $3,891.20 "," $3,481.60 "," $3,809.28 "," $3,809.28 "," $3,891.20 "," $3,932.16 "," $3,351.35 "," $3,686.40 "," $3,481.60 "," $3,235.84 ", N/A ," $3,314.89 "," $3,314.89 "," $3,891.20 "," $3,514.78 ", $312.44 ," $3,932.16 "
"Revise Knee Joint Replace,1 Part",27486,N/A,N/A,N/A," $9,320.00 "," $6,058.00 "," $8,454.10 "," $1,321.56 "," $1,016.23 "," $6,796.02 "," $6,731.66 "," $8,667.60 "," $8,388.00 "," $8,388.00 "," $7,456.00 "," $7,456.00 "," $1,016.23 "," $8,605.16 "," $8,854.00 "," $8,388.00 "," $8,388.00 "," $8,388.00 "," $8,667.60 "," $8,947.20 "," $7,887.71 "," $7,922.00 "," $7,452.04 "," $7,996.34 ", N/A ," $6,928.63 "," $6,928.63 "," $8,854.00 "," $8,143.61 "," $1,016.23 "," $8,947.20 "
"Esrd Services, per Month, 20+ Yr Old, 2-3 Visits",CPT® 90961,N/A,N/A,N/A, $951.00 , $618.15 , $685.90 , $286.44 , $230.14 , $531.86 , $537.46 , $884.43 , $855.90 , $855.90 , $760.80 , $760.80 , $230.14 , $878.06 , $903.45 , $855.90 , $855.90 , $855.90 , $884.43 , $912.96 , $905.31 , $808.35 , $707.57 , $902.47 , N/A , $542.25 , $542.25 , $903.45 , $632.16 , $230.14 , $912.96 
 Major Gastrointestinal Disorders And Peritoneal Infections With Cc ,MS DRG V40 (FY2023) 372,N/A,N/A,N/A," $4,737.75 "," $3,079.54 "," $3,979.71 ", N/A , N/A ," $3,828.10 "," $4,263.98 "," $4,010.98 "," $4,263.98 "," $4,263.98 "," $4,263.98 "," $4,027.09 ", N/A ," $4,374.36 "," $4,500.86 "," $4,027.09 "," $4,406.11 "," $4,406.11 "," $4,500.86 "," $4,548.24 "," $3,876.43 "," $4,263.98 "," $4,027.09 "," $3,742.82 ", N/A ," $3,834.26 "," $3,834.26 "," $4,500.86 "," $4,065.46 "," $3,742.82 "," $4,548.24 "
RBC Antibody Identification,CPT® 86870,N/A,N/A,N/A, $194.00 , $126.10 , N/A , N/A , $43.35 , $123.66 , $141.52 , $180.42 , $174.60 , $174.60 , $155.20 , $155.20 , $43.35 , $179.12 , $184.30 , $174.60 , $174.60 , $174.60 , $180.42 , $186.24 , N/A , $164.90 , $142.72 , $128.49 , N/A , $115.41 , $115.41 , $184.30 , $126.12 , $43.35 , $186.24 
 Brain Ultra Sound ,CPT® 76506,0402 - ULTRASOUND,N/A,N/A, $617.00 , $401.05 , $518.28 , $111.97 , $91.36 , $498.54 , $555.30 , $522.35 , $555.30 , $555.30 , $555.30 , $524.45 , $89.57 , $569.68 , $586.15 , $524.45 , $573.81 , $573.81 , $586.15 , $592.32 , $504.83 , $555.30 , $524.45 , $487.43 , N/A , $499.34 , $499.34 , $586.15 , $529.45 , $89.57 , $592.32 
" Fac Debridement, Skin, Sub-Q Tissue,Muscle,Each Add 20 Sq Cm ",CPT® 11046,0761 - TREATMENT ROOM,N/A,N/A, $306.00 , $198.90 , $257.04 , $50.80 , $27.29 , $247.25 , $275.40 , $259.06 , $275.40 , $275.40 , $275.40 , $260.10 , $26.75 , $282.53 , $290.70 , $260.10 , $284.58 , $284.58 , $290.70 , $293.76 , $250.37 , $275.40 , $260.10 , $241.74 , N/A , $247.65 , $247.65 , $290.70 , $262.58 , $26.75 , $293.76 
Compre Ep Eval Abltj 3d Mapg Tx Vt,CPT® 93654,N/A,N/A,N/A," $9,436.00 "," $6,133.40 "," $6,535.23 ", $920.46 ," $1,236.93 "," $6,014.76 "," $5,917.34 "," $8,775.48 "," $8,492.40 "," $8,492.40 "," $7,548.80 "," $7,548.80 "," $1,236.93 "," $8,712.26 "," $8,964.20 "," $8,492.40 "," $8,492.40 "," $8,492.40 "," $8,775.48 "," $9,058.56 "," $6,475.78 "," $8,020.60 "," $5,757.17 "," $5,399.89 ", N/A ," $6,132.11 "," $6,132.11 "," $8,964.20 "," $6,797.50 ", $920.46 ," $9,058.56 "
 Plcmnt Distal Extprosth(S) Delayed Endovasc Rep Desc Thoracic Aorta ,CPT® 33886,0360 - OR SERVICES,N/A,N/A," $13,755.00 "," $8,940.75 "," $11,554.20 ", $859.12 , $871.69 ," $11,114.04 "," $12,379.50 "," $11,644.98 "," $12,379.50 "," $12,379.50 "," $12,379.50 "," $11,691.75 ", $854.60 ," $12,699.99 "," $13,067.25 "," $11,691.75 "," $12,792.15 "," $12,792.15 "," $13,067.25 "," $13,204.80 "," $11,254.34 "," $12,379.50 "," $11,691.75 "," $10,866.45 ", N/A ," $11,131.92 "," $11,131.92 "," $13,067.25 "," $11,803.17 ", $854.60 ," $13,204.80 "
Diffusing Capacity,CPT® 94729,N/A,N/A,N/A, $451.00 , $293.15 , $135.19 , $55.39 , $41.69 , $120.11 , $140.31 , $419.43 , $405.90 , $405.90 , $360.80 , $360.80 , $41.69 , $416.41 , $428.45 , $405.90 , $405.90 , $405.90 , $419.43 , $432.96 , $179.54 , $383.35 , $186.52 , $205.98 , N/A , $122.45 , $122.45 , $428.45 , $142.75 , $41.69 , $432.96 
" Pro Hysteroscopy, Dx, Sep Proc ",CPT® 58555,0982 - PRO FEE/OUTPT,N/A,N/A," $2,046.00 "," $1,329.90 ", $703.35 , $143.00 , $165.56 , $773.00 , $770.48 ," $1,902.78 "," $1,841.40 "," $1,841.40 "," $1,636.80 "," $1,636.80 ", $165.56 ," $1,889.07 "," $1,943.70 "," $1,841.40 "," $1,841.40 "," $1,841.40 "," $1,902.78 "," $1,964.16 ", $743.43 ," $1,739.10 "," $1,013.35 ", $631.69 , N/A , $788.08 , $788.08 ," $1,943.70 ", $945.25 , $143.00 ," $1,964.16 "
Fibrinolytic Plasminogen,CPT® 85420,N/A,N/A,N/A, $119.00 , $77.35 , N/A , $6.66 , $6.66 , $36.96 , $44.22 , $110.67 , $107.10 , $107.10 , $95.20 , $95.20 , $6.66 , $109.87 , $113.05 , $107.10 , $107.10 , $107.10 , $110.67 , $114.24 , $43.60 , $101.15 , $42.17 , $23.67 , N/A , $34.49 , $34.49 , $113.05 , $37.69 , $6.66 , $114.24 
 Fac Byp Fem-Ant Tibl Pst Tibl Proneal Art/Oth Dstl ,CPT® 35566,0360 - OR SERVICES,N/A,N/A," $6,575.00 "," $4,273.75 "," $5,523.00 "," $1,475.82 "," $1,340.24 "," $5,312.60 "," $5,917.50 "," $5,566.40 "," $5,917.50 "," $5,917.50 "," $5,917.50 "," $5,588.75 "," $1,313.96 "," $6,070.70 "," $6,246.25 "," $5,588.75 "," $6,114.75 "," $6,114.75 "," $6,246.25 "," $6,312.00 "," $5,379.67 "," $5,917.50 "," $5,588.75 "," $5,194.25 ", N/A ," $5,321.15 "," $5,321.15 "," $6,246.25 "," $5,642.01 "," $1,313.96 "," $6,312.00 "
" Pro Peri-Proc Prog Eval Implant Device,Cardvert/Defib ",CPT® 93287,0982 - PRO FEE/OUTPT,N/A,N/A, $278.00 , $180.70 , $348.99 , $52.88 , $34.25 , $195.33 , $195.39 , $258.54 , $250.20 , $250.20 , $222.40 , $222.40 , $34.25 , $256.68 , $264.10 , $250.20 , $250.20 , $250.20 , $258.54 , $266.88 , $324.20 , $236.30 , $181.97 , $144.09 , N/A , $199.14 , $199.14 , $264.10 , $220.75 , $34.25 , $348.99 
 CALCITONIN (SALMON) 200 UNIT/ACT NA SOLN ,HCPCS RXC637,0250 - PHARMACY,49884-0161-11,3.7 mL, $608.93 , $395.80 , $511.50 , N/A , N/A , $492.02 , $548.04 , $515.52 , $548.04 , $548.04 , $548.04 , $517.59 , N/A , $562.23 , $578.48 , $517.59 , $566.30 , $566.30 , $578.48 , $584.57 , $498.23 , $548.04 , $517.59 , $481.05 , N/A , $492.81 , $492.81 , $578.48 , $522.52 , $481.05 , $584.57 
 Pro Cltx Mtcarphlngl Dislc 1 W/Mnpj W/O Anes ,CPT® 26700,0982 - PRO FEE/OUTPT,N/A,N/A, $912.00 , $592.80 ," $1,924.98 ", $306.67 , $96.29 ," $1,453.63 "," $1,482.73 ", $848.16 , $820.80 , $820.80 , $729.60 , $729.60 , $96.29 , $842.05 , $866.40 , $820.80 , $820.80 , $820.80 , $848.16 , $875.52 ," $1,764.46 ", $775.20 ," $1,627.07 "," $1,738.39 ", N/A ," $1,481.99 "," $1,481.99 ", $866.40 ," $1,741.85 ", $96.29 ," $1,924.98 "
 METFORMIN HCL 500 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-7162-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Oligoclonal Immunoglobulin,CPT® 83916,N/A,N/A,N/A, $193.00 , $125.45 , N/A , $27.94 , $27.92 , $113.79 , $136.08 , $179.49 , $173.70 , $173.70 , $154.40 , $154.40 , $27.92 , $178.20 , $183.35 , $173.70 , $173.70 , $173.70 , $179.49 , $185.28 , $182.89 , $164.05 , $131.37 , $80.44 , N/A , $106.20 , $106.20 , $183.35 , $116.05 , $27.92 , $185.28 
Compre Electrophysiologic Arrhythmia Induction,CPT® 93620,N/A,N/A,N/A," $6,476.00 "," $4,209.40 "," $5,946.20 ", $921.07 , N/A ," $4,641.48 "," $4,570.09 "," $6,022.68 "," $5,828.40 "," $5,828.40 "," $5,180.80 "," $5,180.80 ", N/A ," $5,979.29 "," $6,152.20 "," $5,828.40 "," $5,828.40 "," $5,828.40 "," $6,022.68 "," $6,216.96 "," $5,873.35 "," $5,504.60 "," $4,431.62 "," $5,668.24 ", N/A ," $4,732.04 "," $4,732.04 "," $6,152.20 "," $5,245.53 ", $921.07 ," $6,216.96 "
X-Ray Jaw 4+ Vw,CPT® 70110,N/A,N/A,N/A, $561.00 , $364.65 , $248.01 , $42.68 , $37.90 , $180.00 , $210.60 , $521.73 , $504.90 , $504.90 , $448.80 , $448.80 , $37.90 , $517.97 , $532.95 , $504.90 , $504.90 , $504.90 , $521.73 , $538.56 , $239.53 , $476.85 , $231.13 , $191.32 , N/A , $183.52 , $183.52 , $532.95 , $212.43 , $37.90 , $538.56 
" Fac Cytogenetics, Dna Probe ",CPT® 88271,0310 - PATHOLOGY LAB,N/A,N/A, $262.00 , $170.30 , $220.08 , $21.85 , $20.09 , $211.70 , $235.80 , $221.81 , $235.80 , $235.80 , $235.80 , $222.70 , $19.70 , $241.90 , $248.90 , $222.70 , $243.66 , $243.66 , $248.90 , $251.52 , $214.37 , $235.80 , $222.70 , $206.98 , N/A , $212.04 , $212.04 , $248.90 , $224.82 , $19.70 , $251.52 
Lens Sphc Trifocal 4.25-7/2.,HCPCS V2308,N/A,N/A,N/A, $90.00 , $58.50 , N/A , $97.02 , N/A , N/A , N/A , $83.70 , $81.00 , $81.00 , $72.00 , $72.00 , N/A , $83.10 , $85.50 , $81.00 , $81.00 , $81.00 , $83.70 , $86.40 , N/A , $76.50 , $90.00 , $88.15 , N/A , N/A , N/A , $85.50 , N/A , $72.00 , $97.02 
"Tomosynthesis, Mammo Diagnostic",HCPCS G0279,N/A,N/A,N/A, $265.00 , $172.25 , $217.43 , $52.04 , $105.44 , $102.62 , N/A , $246.45 , $238.50 , $238.50 , $212.00 , $212.00 , $105.44 , $244.67 , $251.75 , $238.50 , $238.50 , $238.50 , $246.45 , $254.40 , $301.25 , $225.25 , $102.09 , $299.38 , N/A , $104.62 , $104.62 , $251.75 , $130.79 , $52.04 , $301.25 
 LIDOCAINE-PRILOCAINE 2.5-2.5 % EX KIT ,HCPCS RXC637,0250 - PHARMACY,00168-0357-56,1 each, $254.69 , $165.55 , $213.94 , N/A , N/A , $205.79 , $229.22 , $215.62 , $229.22 , $229.22 , $229.22 , $216.49 , N/A , $235.16 , $241.96 , $216.49 , $236.86 , $236.86 , $241.96 , $244.50 , $208.39 , $229.22 , $216.49 , $201.21 , N/A , $206.12 , $206.12 , $241.96 , $218.55 , $201.21 , $244.50 
"Echography,Transvaginal",CPT® 76830,N/A,N/A,N/A, $917.00 , $596.05 , $684.11 , $118.64 , $99.44 , $585.23 , $399.82 , $852.81 , $825.30 , $825.30 , $733.60 , $733.60 , $99.44 , $846.67 , $871.15 , $825.30 , $825.30 , $825.30 , $852.81 , $880.32 , $687.13 , $779.45 , $431.43 , $687.46 , N/A , $596.65 , $596.65 , $871.15 , $690.62 , $99.44 , $880.32 
 Fac Fetal Congenital Abnor Assay Two Proteins ,CPT® 81508,0310 - PATHOLOGY LAB,N/A,N/A, $390.00 , $253.50 , $327.60 , $55.39 , $55.39 , $315.12 , $351.00 , $330.17 , $351.00 , $351.00 , $351.00 , $331.50 , $54.30 , $360.09 , $370.50 , $331.50 , $362.70 , $362.70 , $370.50 , $374.40 , $319.10 , $351.00 , $331.50 , $308.10 , N/A , $315.63 , $315.63 , $370.50 , $334.66 , $54.30 , $374.40 
Injection Aa&/Strd Trigeminal Nerve Each Branch,64400,N/A,N/A,N/A, $530.00 , $344.50 , $237.17 , $46.38 , $95.27 , $389.08 , $370.43 , $492.90 , $477.00 , $477.00 , $424.00 , $424.00 , $95.27 , $489.35 , $503.50 , $477.00 , $477.00 , $477.00 , $492.90 , $508.80 , $254.96 , $450.50 , $367.52 , $417.54 , N/A , $396.67 , $396.67 , $503.50 , $425.54 , $46.38 , $508.80 
"Cystourethroscopy,Fulgur 2-5cm Lesn",CPT® 52235,N/A,N/A,N/A," $1,935.00 "," $1,257.75 "," $1,544.39 ", $271.60 , $294.09 ," $1,414.72 "," $1,312.81 "," $1,799.55 "," $1,741.50 "," $1,741.50 "," $1,548.00 "," $1,548.00 ", $294.09 ," $1,786.59 "," $1,838.25 "," $1,741.50 "," $1,741.50 "," $1,741.50 "," $1,799.55 "," $1,857.60 "," $1,553.70 "," $1,644.75 "," $1,486.13 "," $1,776.87 ", N/A ," $1,442.32 "," $1,442.32 "," $1,838.25 "," $1,695.24 ", $271.60 ," $1,857.60 "
Sarscov2 Vaccine 50 Mcg/0.5 Ml for Im Use,CPT® 91322,N/A,N/A,N/A, $173.00 , $112.45 , N/A , N/A , N/A , N/A , N/A , $160.89 , $155.70 , $155.70 , $138.40 , $138.40 , N/A , $159.73 , $164.35 , $155.70 , $155.70 , $155.70 , $160.89 , $166.08 , N/A , $147.05 , N/A , N/A , N/A , N/A , N/A , $164.35 , N/A , $138.40 , $166.08 
"Fusion Foot Bone,Midtarsal,1 Jt",28740,N/A,N/A,N/A," $5,694.00 "," $3,701.10 "," $3,797.24 ", $594.52 , $307.34 ," $3,046.33 "," $3,041.70 "," $5,295.42 "," $5,124.60 "," $5,124.60 "," $4,555.20 "," $4,555.20 ", $307.34 ," $5,257.27 "," $5,409.30 "," $5,124.60 "," $5,124.60 "," $5,124.60 "," $5,295.42 "," $5,466.24 "," $3,532.53 "," $4,839.90 "," $3,327.28 "," $3,605.31 ", N/A ," $3,105.77 "," $3,105.77 "," $5,409.30 "," $3,650.39 ", $307.34 ," $5,466.24 "
"Knee Scope,Single Menisectomy",CPT® 29880,N/A,N/A,N/A," $4,171.00 "," $2,711.15 "," $3,426.35 ", $537.81 , $595.32 ," $2,716.58 "," $2,722.07 "," $3,879.03 "," $3,753.90 "," $3,753.90 "," $3,336.80 "," $3,336.80 ", $595.32 ," $3,851.08 "," $3,962.45 "," $3,753.90 "," $3,753.90 "," $3,753.90 "," $3,879.03 "," $4,004.16 "," $3,187.06 "," $3,545.35 "," $3,004.36 "," $3,207.23 ", N/A ," $2,769.58 "," $2,769.58 "," $3,962.45 "," $3,255.23 ", $537.81 ," $4,004.16 "
Tobramycin Sulfate Injection,HCPCS J3260,N/A,N/A,N/A, $26.00 , $16.90 , N/A , $2.70 , $2.77 , N/A , N/A , $24.18 , $23.40 , $23.40 , $20.80 , $20.80 , $2.77 , $24.01 , $24.70 , $23.40 , $23.40 , $23.40 , $24.18 , $24.96 , $5.27 , $22.10 , $4.54 , $3.39 , N/A , N/A , N/A , $24.70 , N/A , $2.70 , $24.96 
Ceftriaxone Sodium Injection,HCPCS J0696,N/A,N/A,N/A, $30.00 , $19.50 , N/A , $0.58 , $0.54 , N/A , N/A , $27.90 , $27.00 , $27.00 , $24.00 , $24.00 , $0.54 , $27.70 , $28.50 , $27.00 , $27.00 , $27.00 , $27.90 , $28.80 , $0.73 , $25.50 , $1.30 , $0.65 , N/A , N/A , N/A , $28.50 , N/A , $0.54 , $28.80 
 Fac Heparin Neutralization ,CPT® 85525,0305 - LAB/HEMATOLOGY,N/A,N/A, $154.00 , $100.10 , $129.36 , $12.08 , $12.08 , $124.43 , $138.60 , $130.38 , $138.60 , $138.60 , $138.60 , $130.90 , $11.84 , $142.19 , $146.30 , $130.90 , $143.22 , $143.22 , $146.30 , $147.84 , $126.00 , $138.60 , $130.90 , $121.66 , N/A , $124.63 , $124.63 , $146.30 , $132.15 , $11.84 , $147.84 
 IRON SUCROSE 20 MG/ML IV SOLN ,HCPCS J1756,0636 - DRUGS REQUIRING DETAILED CODIN,00517-2340-10,5 mL, $377.39 , $245.30 , $317.01 , $0.21 , $0.22 , $304.93 , $339.65 , $319.50 , $339.65 , $339.65 , $339.65 , $320.78 , $0.22 , $348.44 , $358.52 , $320.78 , $350.97 , $350.97 , $358.52 , $362.29 , $308.78 , $339.65 , $320.78 , $298.14 , N/A , $305.42 , $305.42 , $358.52 , $323.84 , $0.21 , $362.29 
Repair of Ruptured Uterus,CPT® 59350,N/A,N/A,N/A," $1,784.00 "," $1,159.60 ", $738.09 , $249.65 , $614.70 , $651.27 , $681.72 ," $1,659.12 "," $1,605.60 "," $1,605.60 "," $1,427.20 "," $1,427.20 ", $614.70 ," $1,647.17 "," $1,694.80 "," $1,605.60 "," $1,605.60 "," $1,605.60 "," $1,659.12 "," $1,712.64 ", $753.79 ," $1,516.40 "," $1,511.10 "," $1,205.61 ", N/A , $663.98 , $663.98 ," $1,694.80 ", $767.61 , $249.65 ," $1,712.64 "
 Pro Anes Emergency Intubation ,CPT® 31500,0982 - PRO FEE/OUTPT,N/A,N/A, $770.00 , $500.50 , $758.54 , $132.66 , $155.78 , $421.83 , $406.96 , $716.10 , $693.00 , $693.00 , $616.00 , $616.00 , $155.78 , $710.94 , $731.50 , $693.00 , $693.00 , $693.00 , $716.10 , $739.20 , $734.78 , $654.50 , $576.25 , $726.12 , N/A , $430.06 , $430.06 , $731.50 , $506.49 , $132.66 , $758.54 
Rmvl Transvns Pm Eltrd Dual Lead Sys,CPT® 33235,N/A,N/A,N/A," $6,913.00 "," $4,493.45 "," $3,799.06 ", $587.39 , $948.38 ," $2,757.52 "," $2,669.19 "," $6,429.09 "," $6,221.70 "," $6,221.70 "," $5,530.40 "," $5,530.40 ", $948.38 ," $6,382.77 "," $6,567.35 "," $6,221.70 "," $6,221.70 "," $6,221.70 "," $6,429.09 "," $6,636.48 "," $3,512.11 "," $5,876.05 "," $3,352.26 "," $3,090.59 ", N/A ," $2,811.32 "," $2,811.32 "," $6,567.35 "," $3,193.66 ", $587.39 ," $6,636.48 "
 BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL FILM ,HCPCS RXC637,0250 - PHARMACY,47781-0355-03,1 Film, $25.21 , $16.39 , $21.18 , N/A , N/A , $20.37 , $22.69 , $21.34 , $22.69 , $22.69 , $22.69 , $21.43 , N/A , $23.28 , $23.95 , $21.43 , $23.45 , $23.45 , $23.95 , $24.20 , $20.63 , $22.69 , $21.43 , $19.92 , N/A , $20.40 , $20.40 , $23.95 , $21.63 , $19.92 , $24.20 
Removal of Rectal Marker,CPT® 46030,N/A,N/A,N/A, $884.00 , $574.60 , $527.54 , $82.11 , $30.71 , $428.02 , $442.61 , $822.12 , $795.60 , $795.60 , $707.20 , $707.20 , $30.71 , $816.20 , $839.80 , $795.60 , $795.60 , $795.60 , $822.12 , $848.64 , $393.33 , $751.40 , $487.05 , $511.42 , N/A , $436.37 , $436.37 , $839.80 , $456.41 , $30.71 , $848.64 
 Bone Marrow Needle Biopsy ,CPT® 38221,0761 - TREATMENT ROOM,N/A,N/A," $1,389.00 ", $902.85 ," $1,166.76 ", $67.98 , $234.23 ," $1,122.31 "," $1,250.10 "," $1,175.93 "," $1,250.10 "," $1,250.10 "," $1,250.10 "," $1,180.65 ", $229.64 ," $1,282.46 "," $1,319.55 "," $1,180.65 "," $1,291.77 "," $1,291.77 "," $1,319.55 "," $1,333.44 "," $1,136.48 "," $1,250.10 "," $1,180.65 "," $1,097.31 ", N/A ," $1,124.12 "," $1,124.12 "," $1,319.55 "," $1,191.90 ", $67.98 ," $1,333.44 "
" Pro Critical Care, Add'l 30 Min ",CPT® 99292,0982 - PRO FEE/OUTPT,N/A,N/A, $616.00 , $400.40 , $217.33 , $103.14 , $121.38 , $192.94 , $193.49 , $572.88 , $554.40 , $554.40 , $492.80 , $492.80 , $121.38 , $568.75 , $585.20 , $554.40 , $554.40 , $554.40 , $572.88 , $591.36 , $276.66 , $523.60 , $241.53 , $242.43 , N/A , $196.71 , $196.71 , $585.20 , $226.88 , $103.14 , $591.36 
 Fac Assay of C-Peptide ,CPT® 84681,0301 - LAB/CHEMISTRY,N/A,N/A, $226.00 , $146.90 , $189.84 , $21.23 , $7.24 , $182.61 , $203.40 , $191.33 , $203.40 , $203.40 , $203.40 , $192.10 , $7.10 , $208.67 , $214.70 , $192.10 , $210.18 , $210.18 , $214.70 , $216.96 , $184.91 , $203.40 , $192.10 , $178.54 , N/A , $182.90 , $182.90 , $214.70 , $193.93 , $7.10 , $216.96 
"Drain Abscess/Hematoma,Nasal Septum",30020,N/A,N/A,N/A, $686.00 , $445.90 , $663.61 , $118.56 , $38.38 , $455.16 , $457.05 , $637.98 , $617.40 , $617.40 , $548.80 , $548.80 , $38.38 , $633.38 , $651.70 , $617.40 , $617.40 , $617.40 , $637.98 , $658.56 , $626.93 , $583.10 , $642.26 , $598.33 , N/A , $464.04 , $464.04 , $651.70 , $546.49 , $38.38 , $663.61 
 Pro Treat Fracture of Ulna ,CPT® 25545,0982 - PRO FEE/OUTPT,N/A,N/A," $2,420.00 "," $1,573.00 "," $3,823.82 ", $601.46 , $614.70 ," $3,002.80 "," $3,000.32 "," $2,250.60 "," $2,178.00 "," $2,178.00 "," $1,936.00 "," $1,936.00 ", $614.70 ," $2,234.39 "," $2,299.00 "," $2,178.00 "," $2,178.00 "," $2,178.00 "," $2,250.60 "," $2,323.20 "," $3,546.08 "," $2,057.00 "," $3,305.87 "," $3,546.50 ", N/A ," $3,061.39 "," $3,061.39 "," $2,299.00 "," $3,598.22 ", $601.46 ," $3,823.82 "
Debride Assoc Fx/Disloc Skin/Muscle,11011,N/A,N/A,N/A," $3,260.00 "," $2,119.00 ", $929.12 , $276.29 , $407.24 , $805.58 , $781.43 ," $3,031.80 "," $2,934.00 "," $2,934.00 "," $2,608.00 "," $2,608.00 ", $407.24 ," $3,009.96 "," $3,097.00 "," $2,934.00 "," $2,934.00 "," $2,934.00 "," $3,031.80 "," $3,129.60 "," $1,025.13 "," $2,771.00 "," $1,577.11 "," $1,035.45 ", N/A , $821.30 , $821.30 ," $3,097.00 ", $952.43 , $276.29 ," $3,129.60 "
 MITOMYCIN 5 MG IV SOLR ,HCPCS J9280,0636 - DRUGS REQUIRING DETAILED CODIN,16729-0115-05,10 mL, $667.60 , $433.94 , $560.78 , $80.60 , $45.36 , $539.42 , $600.84 , $565.19 , $600.84 , $600.84 , $600.84 , $567.46 , $44.47 , $616.40 , $634.22 , $567.46 , $620.87 , $620.87 , $634.22 , $640.90 , $546.23 , $600.84 , $567.46 , $527.40 , N/A , $540.29 , $540.29 , $634.22 , $572.87 , $44.47 , $640.90 
Treat Ankle Fracture,27760,N/A,N/A,N/A," $2,203.00 "," $1,431.95 "," $1,916.98 ", $302.45 , $184.42 ," $1,467.45 "," $1,497.57 "," $2,048.79 "," $1,982.70 "," $1,982.70 "," $1,762.40 "," $1,762.40 ", $184.42 ," $2,034.03 "," $2,092.85 "," $1,982.70 "," $1,982.70 "," $1,982.70 "," $2,048.79 "," $2,114.88 "," $1,767.47 "," $1,872.55 "," $1,643.12 "," $1,745.36 ", N/A ," $1,496.08 "," $1,496.08 "," $2,092.85 "," $1,758.43 ", $184.42 ," $2,114.88 "
"Explor Penet Wound,Extrem",CPT® 20103,N/A,N/A,N/A," $3,902.00 "," $2,536.30 "," $2,087.15 ", $325.90 , $335.70 ," $1,680.45 "," $1,671.86 "," $3,628.86 "," $3,511.80 "," $3,511.80 "," $3,121.60 "," $3,121.60 ", $335.70 ," $3,602.72 "," $3,706.90 "," $3,511.80 "," $3,511.80 "," $3,511.80 "," $3,628.86 "," $3,745.92 "," $1,945.11 "," $3,316.70 "," $1,846.51 "," $1,988.52 ", N/A ," $1,713.23 "," $1,713.23 "," $3,706.90 "," $2,013.66 ", $325.90 ," $3,745.92 "
 Fac Neuro CSF Detcj Prion Prtn Quakg Conf Conv Qual ,CPT® 0035U,0301 - LAB/CHEMISTRY,N/A,N/A, $324.00 , $210.60 , $272.16 , $551.81 , N/A , $261.79 , $291.60 , $274.30 , $291.60 , $291.60 , $291.60 , $275.40 , N/A , $299.15 , $307.80 , $275.40 , $301.32 , $301.32 , $307.80 , $311.04 , $265.10 , $291.60 , $275.40 , $255.96 , N/A , $262.21 , $262.21 , $307.80 , $278.02 , $255.96 , $551.81 
"Lap,Cholecystectomy/Graph",CPT® 47563,N/A,N/A,N/A," $7,409.00 "," $4,815.85 "," $4,291.24 ", $664.92 , $644.55 ," $4,426.73 "," $4,417.21 "," $6,890.37 "," $6,668.10 "," $6,668.10 "," $5,927.20 "," $5,927.20 ", $644.55 ," $6,840.73 "," $7,038.55 "," $6,668.10 "," $6,668.10 "," $6,668.10 "," $6,890.37 "," $7,112.64 "," $5,444.78 "," $6,297.65 "," $3,775.08 "," $3,957.32 ", N/A ," $4,513.10 "," $4,513.10 "," $7,038.55 "," $5,205.41 ", $644.55 ," $7,112.64 "
X-Ray Lumbar Spine Flex/Exten,CPT® 72120,N/A,N/A,N/A, $399.00 , $259.35 , $230.67 , $40.00 , $47.05 , $190.24 , $226.41 , $371.07 , $359.10 , $359.10 , $319.20 , $319.20 , $47.05 , $368.40 , $379.05 , $359.10 , $359.10 , $359.10 , $371.07 , $383.04 , $224.11 , $339.15 , $248.46 , $205.40 , N/A , $193.95 , $193.95 , $379.05 , $224.50 , $40.00 , $383.04 
 Fac Mthfr Gene Analysis Common Variants ,CPT® 81291,0310 - PATHOLOGY LAB,N/A,N/A, $674.00 , $438.10 , $566.16 , $66.65 , N/A , $544.59 , $606.60 , $570.61 , $606.60 , $606.60 , $606.60 , $572.90 , N/A , $622.30 , $640.30 , $572.90 , $626.82 , $626.82 , $640.30 , $647.04 , $551.47 , $606.60 , $572.90 , $532.46 , N/A , $545.47 , $545.47 , $640.30 , $578.36 , $66.65 , $647.04 
Botulinum Toxin a per Unit,HCPCS J0585,N/A,N/A,N/A, $14.00 , $9.10 , N/A , $6.52 , $6.45 , N/A , N/A , $13.02 , $12.60 , $12.60 , $11.20 , $11.20 , $6.45 , $12.93 , $13.30 , $12.60 , $12.60 , $12.60 , $13.02 , $13.44 , $7.90 , $11.90 , $10.38 , $8.12 , N/A , N/A , N/A , $13.30 , N/A , $6.45 , $13.44 
 Fac Therapeutic Procd Strg Endur ,HCPCS G0237,0419 - OTHER RESPIRATORY SERVICES,N/A,N/A, $167.00 , $108.55 , $140.28 , $10.29 , N/A , $134.94 , $150.30 , $141.38 , $150.30 , $150.30 , $150.30 , $141.95 , N/A , $154.19 , $158.65 , $141.95 , $155.31 , $155.31 , $158.65 , $160.32 , $136.64 , $150.30 , $141.95 , $131.93 , N/A , $135.15 , $135.15 , $158.65 , $143.30 , $10.29 , $160.32 
Sewho Cap Design W/Jnt(S) Cf,HCPCS L3971,N/A,N/A,N/A," $2,160.00 "," $1,404.00 ", N/A ," $2,004.52 "," $1,388.39 ", N/A , N/A ," $2,008.80 "," $1,944.00 "," $1,944.00 "," $1,728.00 "," $1,728.00 "," $1,388.39 "," $1,994.33 "," $2,052.00 "," $1,944.00 "," $1,944.00 "," $1,944.00 "," $2,008.80 "," $2,073.60 ", N/A ," $1,836.00 "," $1,654.31 "," $1,686.49 ", N/A , N/A , N/A ," $2,052.00 ", N/A ," $1,388.39 "," $2,073.60 "
Xcapsl Ctrc Rmvl Insj Io Lens Prosth Cplx WO Ecp,66982,N/A,N/A,N/A," $6,377.00 "," $4,145.05 "," $4,590.24 ", $719.58 , $590.85 ," $4,503.46 "," $4,211.34 "," $5,930.61 "," $5,739.30 "," $5,739.30 "," $5,101.60 "," $5,101.60 ", $590.85 ," $5,887.88 "," $6,058.15 "," $5,739.30 "," $5,739.30 "," $5,739.30 "," $5,930.61 "," $6,121.92 "," $6,310.51 "," $5,420.45 "," $4,344.20 "," $5,713.83 ", N/A ," $4,591.33 "," $4,591.33 "," $6,058.15 "," $5,068.22 ", $590.85 ," $6,310.51 "
Thyroglobulin,CPT® 84432,N/A,N/A,N/A, $181.00 , $117.65 , N/A , $16.38 , $16.38 , $90.89 , $108.71 , $168.33 , $162.90 , $162.90 , $144.80 , $144.80 , $16.38 , $167.12 , $171.95 , $162.90 , $162.90 , $162.90 , $168.33 , $173.76 , $107.24 , $153.85 , $105.42 , $58.24 , N/A , $84.82 , $84.82 , $171.95 , $92.69 , $16.38 , $173.76 
 ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5ML PO SUSR ,HCPCS RXC637,0250 - PHARMACY,24338-0132-13,100 mL," $2,319.30 "," $1,507.55 "," $1,948.21 ", N/A , N/A ," $1,873.99 "," $2,087.37 "," $1,963.52 "," $2,087.37 "," $2,087.37 "," $2,087.37 "," $1,971.41 ", N/A ," $2,141.41 "," $2,203.34 "," $1,971.41 "," $2,156.95 "," $2,156.95 "," $2,203.34 "," $2,226.53 "," $1,897.65 "," $2,087.37 "," $1,971.41 "," $1,832.25 ", N/A ," $1,877.01 "," $1,877.01 "," $2,203.34 "," $1,990.19 "," $1,832.25 "," $2,226.53 "
 Pelvis CT Scan Without Contrast ,CPT® 72192,0350 - CT SCAN,N/A,N/A," $1,852.00 "," $1,203.80 "," $1,555.68 ", $135.96 , $239.47 ," $1,496.42 "," $1,666.80 "," $1,567.90 "," $1,666.80 "," $1,666.80 "," $1,666.80 "," $1,574.20 ", $234.77 ," $1,709.95 "," $1,759.40 "," $1,574.20 "," $1,722.36 "," $1,722.36 "," $1,759.40 "," $1,777.92 "," $1,515.31 "," $1,666.80 "," $1,574.20 "," $1,463.08 ", N/A ," $1,498.82 "," $1,498.82 "," $1,759.40 "," $1,589.20 ", $135.96 ," $1,777.92 "
"Special Stains,Each",CPT® 88312,N/A,N/A,N/A, $606.00 , $393.90 , $401.60 , $110.50 , $28.78 , $386.48 , $447.47 , $563.58 , $545.40 , $545.40 , $484.80 , $484.80 , $28.78 , $559.52 , $575.70 , $545.40 , $545.40 , $545.40 , $563.58 , $581.76 , $715.40 , $515.10 , $465.47 , $338.00 , N/A , $360.69 , $360.69 , $575.70 , $396.39 , $28.78 , $715.40 
 POTASSIUM CHLORIDE 10 MEQ/100ML IV SOLN ,HCPCS J3480,0636 - DRUGS REQUIRING DETAILED CODIN,00990-7074-26,100 mL, $29.80 , $19.37 , $25.03 , $0.10 , $0.14 , $24.08 , $26.82 , $25.23 , $26.82 , $26.82 , $26.82 , $25.33 , $0.14 , $27.51 , $28.31 , $25.33 , $27.71 , $27.71 , $28.31 , $28.61 , $24.38 , $26.82 , $25.33 , $23.54 , N/A , $24.12 , $24.12 , $28.31 , $25.57 , $0.10 , $28.61 
 IPRATROPIUM BROMIDE HFA 17 MCG/ACT INH AERS ,HCPCS RXC637,0250 - PHARMACY,00597-0087-17,12.9 gram," $1,347.56 ", $875.91 ," $1,131.95 ", N/A , N/A ," $1,088.83 "," $1,212.80 "," $1,140.84 "," $1,212.80 "," $1,212.80 "," $1,212.80 "," $1,145.43 ", N/A ," $1,244.20 "," $1,280.18 "," $1,145.43 "," $1,253.23 "," $1,253.23 "," $1,280.18 "," $1,293.66 "," $1,102.57 "," $1,212.80 "," $1,145.43 "," $1,064.57 ", N/A ," $1,090.58 "," $1,090.58 "," $1,280.18 "," $1,156.34 "," $1,064.57 "," $1,293.66 "
 Pro Injection Aa&/Strd Greater Occipital Nerve ,CPT® 64405,0982 - PRO FEE/OUTPT,N/A,N/A, $503.00 , $326.95 , $249.86 , $48.34 , $45.90 , $348.30 , $335.31 , $467.79 , $452.70 , $452.70 , $402.40 , $402.40 , $45.90 , $464.42 , $477.85 , $452.70 , $452.70 , $452.70 , $467.79 , $482.88 , $272.99 , $427.55 , $335.40 , $370.40 , N/A , $355.10 , $355.10 , $477.85 , $380.94 , $45.90 , $482.88 
Bronchoscopy Needle Bx Trachea Main Stem&/Bron,CPT® 31629,N/A,N/A,N/A," $3,473.00 "," $2,257.45 "," $1,020.57 ", $177.09 , $412.40 , $797.89 , $778.97 ," $3,229.89 "," $3,125.70 "," $3,125.70 "," $2,778.40 "," $2,778.40 ", $412.40 ," $3,206.62 "," $3,299.35 "," $3,125.70 "," $3,125.70 "," $3,125.70 "," $3,229.89 "," $3,334.08 ", $989.09 ," $2,952.05 "," $1,082.93 ", $978.93 , N/A , $813.46 , $813.46 ," $3,299.35 ", $958.02 , $177.09 ," $3,334.08 "
" Pro Preventive Visit, Est, Age 40-64 ",CPT® 99396,0982 - PRO FEE/OUTPT,N/A,N/A, $386.00 , $250.90 , N/A , $121.04 , $21.85 , $207.40 , $209.11 , $358.98 , $347.40 , $347.40 , $308.80 , $308.80 , $21.85 , $356.39 , $366.70 , $347.40 , $347.40 , $347.40 , $358.98 , $370.56 , $256.61 , $328.10 , $209.28 , $206.27 , N/A , $211.45 , $211.45 , $366.70 , $253.97 , $21.85 , $370.56 
Inj Retacrit Non-Esrd Use,HCPCS Q5106,N/A,N/A,N/A, $40.00 , $26.00 , N/A , $7.65 , $8.68 , N/A , N/A , $37.20 , $36.00 , $36.00 , $32.00 , $32.00 , $8.68 , $36.93 , $38.00 , $36.00 , $36.00 , $36.00 , $37.20 , $38.40 , $11.22 , $34.00 , $15.51 , $11.39 , N/A , N/A , N/A , $38.00 , N/A , $7.65 , $38.40 
 Orbits CT Without/With Contrast ,CPT® 70482,0350 - CT SCAN,N/A,N/A," $4,646.00 "," $3,019.90 "," $3,902.64 ", $215.63 , $355.58 ," $3,753.97 "," $4,181.40 "," $3,933.30 "," $4,181.40 "," $4,181.40 "," $4,181.40 "," $3,949.10 ", $348.61 ," $4,289.65 "," $4,413.70 "," $3,949.10 "," $4,320.78 "," $4,320.78 "," $4,413.70 "," $4,460.16 "," $3,801.36 "," $4,181.40 "," $3,949.10 "," $3,670.34 ", N/A ," $3,760.01 "," $3,760.01 "," $4,413.70 "," $3,986.73 ", $215.63 ," $4,460.16 "
CT Neck Tissue Combo,CPT® 70492,N/A,N/A,N/A," $4,500.00 "," $2,925.00 "," $1,584.66 ", $227.17 , $355.58 ," $1,322.70 "," $1,686.11 "," $4,185.00 "," $4,050.00 "," $4,050.00 "," $3,600.00 "," $3,600.00 ", $355.58 ," $4,154.85 "," $4,275.00 "," $4,050.00 "," $4,050.00 "," $4,050.00 "," $4,185.00 "," $4,320.00 "," $1,341.31 "," $3,825.00 "," $1,837.44 "," $1,590.16 ", N/A ," $1,348.52 "," $1,348.52 "," $4,275.00 "," $1,560.92 ", $227.17 ," $4,320.00 "
 ATENOLOL 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,51079-0684-20,1 tablet, $4.59 , $2.98 , $3.86 , N/A , N/A , $3.71 , $4.13 , $3.89 , $4.13 , $4.13 , $4.13 , $3.90 , N/A , $4.24 , $4.36 , $3.90 , $4.27 , $4.27 , $4.36 , $4.41 , $3.76 , $4.13 , $3.90 , $3.63 , N/A , $3.71 , $3.71 , $4.36 , $3.94 , $3.63 , $4.41 
Colostomy,CPT® 44320,N/A,N/A,N/A," $7,852.00 "," $5,103.80 "," $7,171.39 "," $1,111.27 "," $1,176.66 "," $5,661.85 "," $5,727.89 "," $7,302.36 "," $7,066.80 "," $7,066.80 "," $6,281.60 "," $6,281.60 "," $1,176.66 "," $7,249.75 "," $7,459.40 "," $7,066.80 "," $7,066.80 "," $7,066.80 "," $7,302.36 "," $7,537.92 "," $5,139.40 "," $6,674.20 "," $6,363.76 "," $6,690.63 ", N/A ," $5,772.32 "," $5,772.32 "," $7,459.40 "," $6,037.25 "," $1,111.27 "," $7,537.92 "
 Pro Active Wound Care/20 Cm or < ,CPT® 97597,0981 - PRO FEE/ER,N/A,N/A, $242.00 , $157.30 , $82.90 , $34.49 , $43.20 , $54.44 , $46.92 , $225.06 , $217.80 , $217.80 , $193.60 , $193.60 , $43.20 , $223.44 , $229.90 , $217.80 , $217.80 , $217.80 , $225.06 , $232.32 , $109.43 , $205.70 , $69.95 , $54.53 , N/A , $55.50 , $55.50 , $229.90 , $61.73 , $34.49 , $232.32 
" Fac Virus Inoculation, Tissue ",CPT® 87252,0306 - LAB/BACT-MICRO,N/A,N/A, $241.00 , $156.65 , $202.44 , $26.59 , $26.59 , $194.73 , $216.90 , $204.03 , $216.90 , $216.90 , $216.90 , $204.85 , $26.07 , $222.52 , $228.95 , $204.85 , $224.13 , $224.13 , $228.95 , $231.36 , $197.19 , $216.90 , $204.85 , $190.39 , N/A , $195.04 , $195.04 , $228.95 , $206.80 , $26.07 , $231.36 
 LIDOCAINE HCL (PF) 1 % IJ SOLN ,HCPCS RXA250,0250 - PHARMACY,63323-0492-27,2 mL, $16.68 , $10.84 , $14.01 , N/A , N/A , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , N/A , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $13.18 , $16.01 
"Blood,Occult,Fecal Hgb,Feces,1-3 Simult",CPT® 82274,N/A,N/A,N/A, $147.00 , $95.55 , N/A , $16.24 , $16.24 , $90.01 , $107.63 , $136.71 , $132.30 , $132.30 , $117.60 , $117.60 , $16.24 , $135.73 , $139.65 , $132.30 , $132.30 , $132.30 , $136.71 , $141.12 , $106.30 , $124.95 , $103.80 , $57.56 , N/A , $84.00 , $84.00 , $139.65 , $91.80 , $16.24 , $141.12 
Dstr Nrolytc Agnt Parverteb Fct Addl Crvcl/Thora,64634,N/A,N/A,N/A," $1,589.00 "," $1,032.85 ", $332.07 , $64.33 , $161.82 , $384.95 , $361.04 ," $1,477.77 "," $1,430.10 "," $1,430.10 "," $1,271.20 "," $1,271.20 ", $161.82 ," $1,467.12 "," $1,509.55 "," $1,430.10 "," $1,430.10 "," $1,430.10 "," $1,477.77 "," $1,525.44 ", $362.83 ," $1,350.65 ", $349.68 , $413.79 , N/A , $392.46 , $392.46 ," $1,509.55 ", $421.03 , $64.33 ," $1,525.44 "
 Fac Collagen Crosslinks ,CPT® 82523,0301 - LAB/CHEMISTRY,N/A,N/A, $254.00 , $165.10 , $213.36 , $19.05 , $14.46 , $205.23 , $228.60 , $215.04 , $228.60 , $228.60 , $228.60 , $215.90 , $14.18 , $234.52 , $241.30 , $215.90 , $236.22 , $236.22 , $241.30 , $243.84 , $207.82 , $228.60 , $215.90 , $200.66 , N/A , $205.56 , $205.56 , $241.30 , $217.96 , $14.18 , $243.84 
 CT Coronary Calcium Scoring ,CPT® 75571,0350 - CT SCAN,N/A,N/A, $99.00 , $64.35 , $83.16 , $101.37 , $72.73 , $79.99 , $89.10 , $83.81 , $89.10 , $89.10 , $89.10 , $84.15 , $71.30 , $91.41 , $94.05 , $84.15 , $92.07 , $92.07 , $94.05 , $95.04 , $81.00 , $89.10 , $84.15 , $78.21 , N/A , $80.12 , $80.12 , $94.05 , $84.95 , $71.30 , $101.37 
 NICOTINE 21 MG/24HR TD PT24 ,HCPCS RXC637,0250 - PHARMACY,00536-5896-88,1 patch, $11.01 , $7.16 , $9.25 , N/A , N/A , $8.90 , $9.91 , $9.32 , $9.91 , $9.91 , $9.91 , $9.36 , N/A , $10.17 , $10.46 , $9.36 , $10.24 , $10.24 , $10.46 , $10.57 , $9.01 , $9.91 , $9.36 , $8.70 , N/A , $8.91 , $8.91 , $10.46 , $9.45 , $8.70 , $10.57 
 Image-Guided Catheter Fluid Collection Drainage ED Pro ,CPT® 10030,0981 - PRO FEE/ER,N/A,N/A," $1,274.00 ", $828.10 , $436.46 , $129.07 , $117.73 , $439.51 , $425.90 ," $1,184.82 "," $1,146.60 "," $1,146.60 "," $1,019.20 "," $1,019.20 ", $117.73 ," $1,176.28 "," $1,210.30 "," $1,146.60 "," $1,146.60 "," $1,146.60 "," $1,184.82 "," $1,223.04 ", $481.77 ," $1,082.90 ", $707.22 , $492.62 , N/A , $448.08 , $448.08 ," $1,210.30 ", $519.65 , $117.73 ," $1,223.04 "
 DOXEPIN HCL 25 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,51079-0437-20,1 capsule, $4.34 , $2.82 , $3.65 , N/A , N/A , $3.51 , $3.91 , $3.67 , $3.91 , $3.91 , $3.91 , $3.69 , N/A , $4.01 , $4.12 , $3.69 , $4.04 , $4.04 , $4.12 , $4.17 , $3.55 , $3.91 , $3.69 , $3.43 , N/A , $3.51 , $3.51 , $4.12 , $3.72 , $3.43 , $4.17 
 Fac Cyp2d6 Gene Analysis Common Variants ,CPT® 81226,0300 - LABORATORY,N/A,N/A," $1,543.00 "," $1,002.95 "," $1,296.12 ", $459.93 , N/A ," $1,246.74 "," $1,388.70 "," $1,306.30 "," $1,388.70 "," $1,388.70 "," $1,388.70 "," $1,311.55 ", N/A ," $1,424.65 "," $1,465.85 "," $1,311.55 "," $1,434.99 "," $1,434.99 "," $1,465.85 "," $1,481.28 "," $1,262.48 "," $1,388.70 "," $1,311.55 "," $1,218.97 ", N/A ," $1,248.75 "," $1,248.75 "," $1,465.85 "," $1,324.05 ", $459.93 ," $1,481.28 "
Mod Sed Same Phys/Qhp Each Addl 15 Mins,99153,N/A,N/A,N/A, $103.00 , $66.95 , $23.95 , $10.39 , $8.53 , $22.93 , $23.60 , $95.79 , $92.70 , $92.70 , $82.40 , $82.40 , $8.53 , $95.10 , $97.85 , $92.70 , $92.70 , $92.70 , $95.79 , $98.88 , $31.53 , $87.55 , $33.32 , $40.46 , N/A , $23.38 , $23.38 , $97.85 , $27.25 , $8.53 , $98.88 
 DARBEPOETIN ALFA 150 MCG/0.3ML IJ SOSY ,HCPCS J0882,0636 - DRUGS REQUIRING DETAILED CODIN,55513-0027-01,0.3 mL," $3,413.71 "," $2,218.91 "," $2,867.52 ", $3.00 , N/A ," $2,758.28 "," $3,072.34 "," $2,890.05 "," $3,072.34 "," $3,072.34 "," $3,072.34 "," $2,901.65 ", N/A ," $3,151.88 "," $3,243.02 "," $2,901.65 "," $3,174.75 "," $3,174.75 "," $3,243.02 "," $3,277.16 "," $2,793.10 "," $3,072.34 "," $2,901.65 "," $2,696.83 ", N/A ," $2,762.72 "," $2,762.72 "," $3,243.02 "," $2,929.30 ", $3.00 ," $3,277.16 "
Fluoroscopy Up to 1 Hour Physician/Qhp Time,CPT® 76000,N/A,N/A,N/A, $535.00 , $347.75 , $239.02 , $42.11 , $59.59 , $222.68 , $273.12 , $497.55 , $481.50 , $481.50 , $428.00 , $428.00 , $59.59 , $493.97 , $508.25 , $481.50 , $481.50 , $481.50 , $497.55 , $513.60 , $232.48 , $454.75 , $300.46 , $239.65 , N/A , $227.02 , $227.02 , $508.25 , $262.79 , $42.11 , $513.60 
 FENTANYL 12 MCG/HR TD PT72 ,HCPCS RXC637,0250 - PHARMACY,00378-9119-98,1 patch, $104.29 , $67.79 , $87.60 , N/A , N/A , $84.27 , $93.86 , $88.29 , $93.86 , $93.86 , $93.86 , $88.65 , N/A , $96.29 , $99.08 , $88.65 , $96.99 , $96.99 , $99.08 , $100.12 , $85.33 , $93.86 , $88.65 , $82.39 , N/A , $84.40 , $84.40 , $99.08 , $89.49 , $82.39 , $100.12 
"Corneal Transplant,Penetrat,Aphakia",CPT® 65750,N/A,N/A,N/A," $11,278.00 "," $7,330.70 "," $7,809.56 "," $1,220.30 "," $1,443.34 "," $6,987.81 "," $6,486.53 "," $10,488.54 "," $10,150.20 "," $10,150.20 "," $9,022.40 "," $9,022.40 "," $1,443.34 "," $10,412.98 "," $10,714.10 "," $10,150.20 "," $10,150.20 "," $10,150.20 "," $10,488.54 "," $10,826.88 "," $10,669.35 "," $9,586.30 "," $6,654.56 "," $8,861.33 ", N/A ," $7,124.16 "," $7,124.16 "," $10,714.10 "," $7,864.14 "," $1,220.30 "," $10,826.88 "
Biopsy Liver Needle Percutaneous,CPT® 47000,N/A,N/A,N/A, $857.00 , $557.05 , $541.52 , $84.16 , $123.71 , $503.68 , $503.57 , $797.01 , $771.30 , $771.30 , $685.60 , $685.60 , $123.71 , $791.27 , $814.15 , $771.30 , $771.30 , $771.30 , $797.01 , $822.72 , $391.05 , $728.45 , $544.14 , $522.04 , N/A , $513.51 , $513.51 , $814.15 , $537.07 , $84.16 , $822.72 
Exc Sacr Press Ulc W Pri Suture,CPT® 15931,N/A,N/A,N/A," $2,696.00 "," $1,752.40 "," $2,206.77 ", $660.56 , $366.32 ," $1,848.82 "," $1,798.75 "," $2,507.28 "," $2,426.40 "," $2,426.40 "," $2,156.80 "," $2,156.80 ", $366.32 ," $2,489.22 "," $2,561.20 "," $2,426.40 "," $2,426.40 "," $2,426.40 "," $2,507.28 "," $2,588.16 "," $2,422.83 "," $2,291.60 "," $3,623.43 "," $2,350.78 ", N/A ," $1,884.90 "," $1,884.90 "," $2,561.20 "," $2,185.86 ", $366.32 ," $3,623.43 "
 Pro Egd Transoral Control Bleeding Any Method ,CPT® 43255,0975 - PRO FEE/OR,N/A,N/A," $2,873.00 "," $1,867.45 "," $1,232.14 ", $189.89 , $252.38 ," $1,024.15 "," $1,368.12 "," $2,671.89 "," $2,585.70 "," $2,585.70 "," $2,298.40 "," $2,298.40 ", $252.38 ," $2,652.64 "," $2,729.35 "," $2,585.70 "," $2,585.70 "," $2,585.70 "," $2,671.89 "," $2,758.08 ", $883.66 ," $2,442.05 "," $1,498.61 "," $1,174.10 ", N/A ," $1,044.13 "," $1,044.13 "," $2,729.35 "," $1,092.06 ", $189.89 ," $2,758.08 "
"Release Palm Contract,Open,Partial",CPT® 26045,N/A,N/A,N/A," $3,067.00 "," $1,993.55 "," $2,902.64 ", $456.71 ," $1,069.75 "," $2,250.23 "," $2,256.25 "," $2,852.31 "," $2,760.30 "," $2,760.30 "," $2,453.60 "," $2,453.60 "," $1,069.75 "," $2,831.76 "," $2,913.65 "," $2,760.30 "," $2,760.30 "," $2,760.30 "," $2,852.31 "," $2,944.32 "," $2,693.53 "," $2,606.95 "," $2,483.42 "," $2,663.66 ", N/A ," $2,294.14 "," $2,294.14 "," $2,913.65 "," $2,696.42 ", $456.71 ," $2,944.32 "
Kit Gene Analysis Targeted Sequence Analysis,CPT® 81272,N/A,N/A,N/A, $354.00 , $230.10 , N/A , $336.10 , $198.97 ," $1,013.75 ", N/A , $329.22 , $318.60 , $318.60 , $283.20 , $283.20 , $198.97 , $326.85 , $336.30 , $318.60 , $318.60 , $318.60 , $329.22 , $339.84 ," $2,200.21 ", $300.90 ," $1,570.14 ", $967.77 , N/A , $946.10 , $946.10 , $336.30 ," $1,033.88 ", $198.97 ," $2,200.21 "
" Pro Debride Nail, 1-5 ",CPT® 11720,0981 - PRO FEE/ER,N/A,N/A, $125.00 , $81.25 , $46.82 , $13.79 , $19.04 , $41.04 , $39.04 , $116.25 , $112.50 , $112.50 , $100.00 , $100.00 , $19.04 , $115.41 , $118.75 , $112.50 , $112.50 , $112.50 , $116.25 , $120.00 , $51.62 , $106.25 , $76.71 , $52.68 , N/A , $41.84 , $41.84 , $118.75 , $48.53 , $13.79 , $120.00 
"Skyla, 13.5 Mg",HCPCS J7301,N/A,N/A,N/A," $1,136.00 ", $738.40 , N/A , N/A , $935.70 , N/A , N/A ," $1,056.48 "," $1,022.40 "," $1,022.40 ", $908.80 , $908.80 , $935.70 ," $1,048.87 "," $1,079.20 "," $1,022.40 "," $1,022.40 "," $1,022.40 "," $1,056.48 "," $1,090.56 ", N/A , $965.60 , $908.80 ," $1,173.44 ", N/A , N/A , N/A ," $1,079.20 ", N/A , $908.80 ," $1,173.44 "
 Fac Assay of Urine Chloride ,CPT® 82436,0301 - LAB/CHEMISTRY,N/A,N/A, $62.00 , $40.30 , $52.08 , $5.87 , $5.87 , $50.10 , $55.80 , $52.49 , $55.80 , $55.80 , $55.80 , $52.70 , $5.75 , $57.24 , $58.90 , $52.70 , $57.66 , $57.66 , $58.90 , $59.52 , $50.73 , $55.80 , $52.70 , $48.98 , N/A , $50.18 , $50.18 , $58.90 , $53.20 , $5.75 , $59.52 
 Fac Cstb Gene Analysis Full Gene Sequence ,CPT® 81189,0310 - PATHOLOGY LAB,N/A,N/A, $6.00 , $3.90 , $5.04 , $280.33 , $224.26 , $4.85 , $5.40 , $5.08 , $5.40 , $5.40 , $5.40 , $5.10 , $219.86 , $5.54 , $5.70 , $5.10 , $5.58 , $5.58 , $5.70 , $5.76 , $4.91 , $5.40 , $5.10 , $4.74 , N/A , $4.86 , $4.86 , $5.70 , $5.15 , $4.74 , $280.33 
" Fac Occult Blood, Other Sources ",CPT® 82271,0301 - LAB/CHEMISTRY,N/A,N/A, $46.00 , $29.90 , $38.64 , $5.43 , $4.21 , $37.17 , $41.40 , $38.94 , $41.40 , $41.40 , $41.40 , $39.10 , $4.13 , $42.47 , $43.70 , $39.10 , $42.78 , $42.78 , $43.70 , $44.16 , $37.64 , $41.40 , $39.10 , $36.34 , N/A , $37.23 , $37.23 , $43.70 , $39.47 , $4.13 , $44.16 
 Tmj's ,CPT® 70336,0611 - MRI - BRAIN/HEAD/NECK,N/A,N/A," $5,584.00 "," $3,629.60 "," $4,690.56 ", $273.23 , $417.46 ," $4,511.87 "," $5,025.60 "," $4,727.41 "," $5,025.60 "," $5,025.60 "," $5,025.60 "," $4,746.40 ", $409.27 ," $5,155.71 "," $5,304.80 "," $4,746.40 "," $5,193.12 "," $5,193.12 "," $5,304.80 "," $5,360.64 "," $4,568.83 "," $5,025.60 "," $4,746.40 "," $4,411.36 ", N/A ," $4,519.13 "," $4,519.13 "," $5,304.80 "," $4,791.63 ", $273.23 ," $5,360.64 "
Sub Grft F/S/N/H/F/G/M/D />100scm 1st 100scm,15277,N/A,N/A,N/A," $2,293.00 "," $1,490.45 ", $706.66 , $209.45 , $229.39 , $615.40 , $572.66 ," $2,132.49 "," $2,063.70 "," $2,063.70 "," $1,834.40 "," $1,834.40 ", $229.39 ," $2,117.13 "," $2,178.35 "," $2,063.70 "," $2,063.70 "," $2,063.70 "," $2,132.49 "," $2,201.28 ", $777.03 ," $1,949.05 "," $1,141.80 ", $794.80 , N/A , $627.41 , $627.41 ," $2,178.35 ", $727.58 , $209.45 ," $2,201.28 "
"Repair of Rectum,Prolapse Mucosa",CPT® 45505,N/A,N/A,N/A," $3,896.00 "," $2,532.40 "," $3,697.53 ", $575.61 , $614.70 ," $2,825.07 "," $2,882.81 "," $3,623.28 "," $3,506.40 "," $3,506.40 "," $3,116.80 "," $3,116.80 ", $614.70 ," $3,597.18 "," $3,701.20 "," $3,506.40 "," $3,506.40 "," $3,506.40 "," $3,623.28 "," $3,740.16 "," $2,636.99 "," $3,311.60 "," $3,173.85 "," $3,356.35 ", N/A ," $2,880.19 "," $2,880.19 "," $3,701.20 "," $3,012.37 ", $575.61 ," $3,740.16 "
 Pelvis MRI With Contrast ,CPT® 72196,0612 - MRI - SPINE,N/A,N/A," $6,006.00 "," $3,903.90 "," $5,045.04 ", $276.84 , $503.64 ," $4,852.85 "," $5,405.40 "," $5,084.68 "," $5,405.40 "," $5,405.40 "," $5,405.40 "," $5,105.10 ", $493.76 ," $5,545.34 "," $5,705.70 "," $5,105.10 "," $5,585.58 "," $5,585.58 "," $5,705.70 "," $5,765.76 "," $4,914.11 "," $5,405.40 "," $5,105.10 "," $4,744.74 ", N/A ," $4,860.66 "," $4,860.66 "," $5,705.70 "," $5,153.75 ", $276.84 ," $5,765.76 "
Abdom Paracentesis Dx/Ther W/O Imaging Guidance,CPT® 49082,N/A,N/A,N/A," $1,172.00 ", $761.80 , $446.29 , $68.89 , $188.97 , $361.06 , $352.03 ," $1,089.96 "," $1,054.80 "," $1,054.80 ", $937.60 , $937.60 , $188.97 ," $1,082.11 "," $1,113.40 "," $1,054.80 "," $1,054.80 "," $1,054.80 "," $1,089.96 "," $1,125.12 ", $319.40 , $996.20 , $380.01 , $425.52 , N/A , $368.10 , $368.10 ," $1,113.40 ", $385.00 , $68.89 ," $1,125.12 "
Iiv3 Vacc Presrv Free 0.25 Ml Dosage Im Use,CPT® 90655,N/A,N/A,N/A, $44.00 , $28.60 , N/A , N/A , $15.30 , $33.52 , $50.35 , $40.92 , $39.60 , $39.60 , $35.20 , $35.20 , $15.30 , $40.63 , $41.80 , $39.60 , $39.60 , $39.60 , $40.92 , $42.24 , N/A , $37.40 , $48.66 , $24.38 , N/A , $34.17 , $34.17 , $41.80 , $39.83 , $15.30 , $50.35 
 Pet Imaging W/CT Ltd Area ,CPT® 78814,0404 - PET POSITIVE EMISSION TOMOGRAP,N/A,N/A," $8,429.00 "," $5,478.85 "," $7,080.36 "," $1,544.06 ", N/A ," $6,810.63 "," $7,586.10 "," $7,135.99 "," $7,586.10 "," $7,586.10 "," $7,586.10 "," $7,164.65 ", N/A ," $7,782.50 "," $8,007.55 "," $7,164.65 "," $7,838.97 "," $7,838.97 "," $8,007.55 "," $8,091.84 "," $6,896.61 "," $7,586.10 "," $7,164.65 "," $6,658.91 ", N/A ," $6,821.59 "," $6,821.59 "," $8,007.55 "," $7,232.92 "," $1,544.06 "," $8,091.84 "
 Fac Injection Sclerosant Multiple Incmptnt Veins ,CPT® 36471,0361 - OR/MINOR,N/A,N/A, $321.00 , $208.65 , $269.64 , $69.44 , $76.21 , $259.37 , $288.90 , $271.76 , $288.90 , $288.90 , $288.90 , $272.85 , $74.72 , $296.38 , $304.95 , $272.85 , $298.53 , $298.53 , $304.95 , $308.16 , $262.64 , $288.90 , $272.85 , $253.59 , N/A , $259.79 , $259.79 , $304.95 , $275.45 , $69.44 , $308.16 
"Enterovirus, Antibody",CPT® 86658,N/A,N/A,N/A, $116.00 , $75.40 , N/A , $13.29 , $8.07 , $32.88 , $39.34 , $107.88 , $104.40 , $104.40 , $92.80 , $92.80 , $8.07 , $107.10 , $110.20 , $104.40 , $104.40 , $104.40 , $107.88 , $111.36 , $87.00 , $98.60 , $85.96 , $47.23 , N/A , $30.69 , $30.69 , $110.20 , $33.54 , $8.07 , $111.36 
Pro Smpl Rpr Supfc S/N/Ax/G/T > 30.0cm,12007,N/A,N/A,N/A," $1,347.00 ", $875.55 , $453.83 , $133.90 , $230.92 , $407.52 , $398.76 ," $1,252.71 "," $1,212.30 "," $1,212.30 "," $1,077.60 "," $1,077.60 ", $230.92 ," $1,243.69 "," $1,279.65 "," $1,212.30 "," $1,212.30 "," $1,212.30 "," $1,252.71 "," $1,293.12 ", $497.61 ," $1,144.95 ", $801.04 , $504.22 , N/A , $415.47 , $415.47 ," $1,279.65 ", $481.80 , $133.90 ," $1,293.12 "
 BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RE SUPP ,HCPCS RXC637,0250 - PHARMACY,00574-7040-12,1 suppository, $171.85 , $111.70 , $144.35 , N/A , N/A , $138.85 , $154.67 , $145.49 , $154.67 , $154.67 , $154.67 , $146.07 , N/A , $158.67 , $163.26 , $146.07 , $159.82 , $159.82 , $163.26 , $164.98 , $140.61 , $154.67 , $146.07 , $135.76 , N/A , $139.08 , $139.08 , $163.26 , $147.46 , $135.76 , $164.98 
Removal Tunneled Cv Cath,CPT® 36589,N/A,N/A,N/A," $1,063.00 ", $690.95 , $835.71 , $129.12 , $231.82 , $600.86 , $603.93 , $988.59 , $956.70 , $956.70 , $850.40 , $850.40 , $231.82 , $981.47 ," $1,009.85 ", $956.70 , $956.70 , $956.70 , $988.59 ," $1,020.48 ", $775.29 , $903.55 , $747.52 , $680.36 , N/A , $612.58 , $612.58 ," $1,009.85 ", $695.91 , $129.12 ," $1,020.48 "
Repair/Graft Flex Foot Tendon,CPT® 28202,N/A,N/A,N/A," $4,169.00 "," $2,709.85 "," $2,656.94 ", $418.34 , $614.70 ," $2,090.85 "," $2,076.38 "," $3,877.17 "," $3,752.10 "," $3,752.10 "," $3,335.20 "," $3,335.20 ", $614.70 ," $3,849.24 "," $3,960.55 "," $3,752.10 "," $3,752.10 "," $3,752.10 "," $3,877.17 "," $4,002.24 "," $2,479.61 "," $3,543.65 "," $2,244.35 "," $2,512.32 ", N/A ," $2,131.65 "," $2,131.65 "," $3,960.55 "," $2,505.44 ", $418.34 ," $4,002.24 "
Fp Removal/Corneal,65222,N/A,N/A,N/A, $250.00 , $162.50 , $313.04 , $48.84 , $48.12 , $297.31 , $278.46 , $232.50 , $225.00 , $225.00 , $200.00 , $200.00 , $48.12 , $230.83 , $237.50 , $225.00 , $225.00 , $225.00 , $232.50 , $240.00 , $433.67 , $212.50 , $287.23 , $377.49 , N/A , $303.11 , $303.11 , $237.50 , $334.61 , $48.12 , $433.67 
"Microsurg Techniques,Req Oper Microscope",CPT® 69990,N/A,N/A,N/A," $2,617.00 "," $1,701.05 ", $933.70 , $189.19 , $187.56 ," $1,018.07 ", $992.09 ," $2,433.81 "," $2,355.30 "," $2,355.30 "," $2,093.60 "," $2,093.60 ", $187.56 ," $2,416.28 "," $2,486.15 "," $2,355.30 "," $2,355.30 "," $2,355.30 "," $2,433.81 "," $2,512.32 "," $1,031.85 "," $2,224.45 "," $1,136.45 ", $996.96 , N/A ," $1,037.94 "," $1,037.94 "," $2,486.15 "," $1,185.14 ", $187.56 ," $2,512.32 "
 IR Pericardial Drainage W Indwelling Drain Fluoro or US Guidance Inc ,CPT® 33017,0360 - OR SERVICES,N/A,N/A," $2,008.00 "," $1,305.20 "," $1,686.72 ", $222.87 , $187.36 ," $1,622.46 "," $1,807.20 "," $1,699.97 "," $1,807.20 "," $1,807.20 "," $1,807.20 "," $1,706.80 ", $183.69 ," $1,853.99 "," $1,907.60 "," $1,706.80 "," $1,867.44 "," $1,867.44 "," $1,907.60 "," $1,927.68 "," $1,642.95 "," $1,807.20 "," $1,706.80 "," $1,586.32 ", N/A ," $1,625.07 "," $1,625.07 "," $1,907.60 "," $1,723.06 ", $183.69 ," $1,927.68 "
 MELATONIN 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,80681-0040-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 MIDAZOLAM HCL 5 MG/5 ML INJECTION (INPT) ,HCPCS J2250,0636 - DRUGS REQUIRING DETAILED CODIN,00409-2305-05,5 mL, $16.68 , $10.84 , $14.01 , $0.14 , $0.17 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.17 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.14 , $16.01 
Hereditary Colon Ca Genomic Seq Analys 7 Genes,CPT® 81435,N/A,N/A,N/A," $3,167.00 "," $2,058.55 ", N/A , $596.60 , $596.60 , N/A , N/A ," $2,945.31 "," $2,850.30 "," $2,850.30 "," $2,533.60 "," $2,533.60 ", $596.60 ," $2,924.09 "," $3,008.65 "," $2,850.30 "," $2,850.30 "," $2,850.30 "," $2,945.31 "," $3,040.32 "," $3,905.51 "," $2,691.95 "," $2,788.13 "," $2,120.81 ", N/A ," $2,322.05 "," $2,322.05 "," $3,008.65 "," $2,532.62 ", $596.60 ," $3,905.51 "
"Excis Bowel Lesion(S),Mult Enterotomies",CPT® 44111,N/A,N/A,N/A," $6,384.00 "," $4,149.60 "," $5,865.67 ", $915.37 ," $1,075.74 "," $4,626.33 "," $4,680.53 "," $5,937.12 "," $5,745.60 "," $5,745.60 "," $5,107.20 "," $5,107.20 "," $1,075.74 "," $5,894.35 "," $6,064.80 "," $5,745.60 "," $5,745.60 "," $5,745.60 "," $5,937.12 "," $6,128.64 "," $4,209.85 "," $5,426.40 "," $5,205.90 "," $5,479.54 ", N/A ," $4,716.60 "," $4,716.60 "," $6,064.80 "," $4,933.05 ", $915.37 ," $6,128.64 "
 Cellulitis With McC ,MS DRG V40 (FY2023) 602,N/A,N/A,N/A," $22,432.72 "," $14,581.27 "," $18,843.48 ", N/A , N/A ," $18,125.64 "," $20,189.45 "," $18,991.54 "," $20,189.45 "," $20,189.45 "," $20,189.45 "," $19,067.81 ", N/A ," $20,712.13 "," $21,311.08 "," $19,067.81 "," $20,862.43 "," $20,862.43 "," $21,311.08 "," $21,535.41 "," $18,354.45 "," $20,189.45 "," $19,067.81 "," $17,721.85 ", N/A ," $18,154.80 "," $18,154.80 "," $21,311.08 "," $19,249.52 "," $17,721.85 "," $21,535.41 "
 SODIUM THIOSULFATE 250 MG/ML IV SOLN ,HCPCS J0208,0636 - DRUGS REQUIRING DETAILED CODIN,60267-0705-50,50 mL, $549.65 , $357.27 , $461.71 , N/A , $0.78 , $444.12 , $494.69 , $465.33 , $494.69 , $494.69 , $494.69 , $467.20 , $0.76 , $507.49 , $522.17 , $467.20 , $511.17 , $511.17 , $522.17 , $527.66 , $449.72 , $494.69 , $467.20 , $434.22 , N/A , $444.83 , $444.83 , $522.17 , $471.65 , $0.76 , $527.66 
 Fac Assay of Magnesium ,CPT® 83735,0301 - LAB/CHEMISTRY,N/A,N/A, $80.00 , $52.00 , $67.20 , $6.83 , $6.83 , $64.64 , $72.00 , $67.73 , $72.00 , $72.00 , $72.00 , $68.00 , $6.70 , $73.86 , $76.00 , $68.00 , $74.40 , $74.40 , $76.00 , $76.80 , $65.46 , $72.00 , $68.00 , $63.20 , N/A , $64.74 , $64.74 , $76.00 , $68.65 , $6.70 , $76.80 
Excision Subling Salivary Cyst,CPT® 42408,N/A,N/A,N/A," $2,951.00 "," $1,918.15 "," $2,172.37 ", $340.75 , $134.71 ," $1,573.62 "," $1,620.63 "," $2,744.43 "," $2,655.90 "," $2,655.90 "," $2,360.80 "," $2,360.80 ", $134.71 ," $2,724.66 "," $2,803.45 "," $2,655.90 "," $2,655.90 "," $2,655.90 "," $2,744.43 "," $2,832.96 "," $1,558.22 "," $2,508.35 "," $1,768.01 "," $2,016.65 ", N/A ," $1,604.32 "," $1,604.32 "," $2,803.45 "," $1,677.95 ", $134.71 ," $2,832.96 "
 Pro Remove Spine Infusion Device ,CPT® 62365,0982 - PRO FEE/OUTPT,N/A,N/A," $1,951.00 "," $1,268.15 "," $1,417.21 ", $277.72 , $367.42 ," $1,640.15 "," $1,582.65 "," $1,814.43 "," $1,755.90 "," $1,755.90 "," $1,560.80 "," $1,560.80 ", $367.42 ," $1,801.36 "," $1,853.45 "," $1,755.90 "," $1,755.90 "," $1,755.90 "," $1,814.43 "," $1,872.96 "," $1,535.22 "," $1,658.35 "," $1,569.98 "," $1,729.45 ", N/A ," $1,672.15 "," $1,672.15 "," $1,853.45 "," $1,793.82 ", $277.72 ," $1,872.96 "
Bowel to Bowel Anastomosis,CPT® 44130,N/A,N/A,N/A," $8,527.00 "," $5,542.55 "," $7,833.48 "," $1,212.53 "," $1,282.02 "," $6,177.12 "," $6,232.73 "," $7,930.11 "," $7,674.30 "," $7,674.30 "," $6,821.60 "," $6,821.60 "," $1,282.02 "," $7,872.98 "," $8,100.65 "," $7,674.30 "," $7,674.30 "," $7,674.30 "," $7,930.11 "," $8,185.92 "," $5,613.04 "," $7,247.95 "," $6,931.09 "," $7,290.01 ", N/A ," $6,297.65 "," $6,297.65 "," $8,100.65 "," $6,586.68 "," $1,212.53 "," $8,185.92 "
"Wrist Arthroscop,Clean/Drain",CPT® 29843,N/A,N/A,N/A," $3,341.00 "," $2,171.65 "," $2,968.16 ", $466.72 , $500.35 ," $2,338.63 "," $2,334.74 "," $3,107.13 "," $3,006.90 "," $3,006.90 "," $2,672.80 "," $2,672.80 ", $500.35 ," $3,084.75 "," $3,173.95 "," $3,006.90 "," $3,006.90 "," $3,006.90 "," $3,107.13 "," $3,207.36 "," $2,759.40 "," $2,839.85 "," $2,574.40 "," $2,758.22 ", N/A ," $2,384.26 "," $2,384.26 "," $3,173.95 "," $2,802.35 ", $466.72 ," $3,207.36 "
X-Ray Sacroiliac Jts 3+ Vw,CPT® 72202,N/A,N/A,N/A, $453.00 , $294.45 , $221.33 , $38.71 , $33.12 , $154.14 , $183.89 , $421.29 , $407.70 , $407.70 , $362.40 , $362.40 , $33.12 , $418.25 , $430.35 , $407.70 , $407.70 , $407.70 , $421.29 , $434.88 , $214.83 , $385.05 , $202.23 , $165.75 , N/A , $157.14 , $157.14 , $430.35 , $181.90 , $33.12 , $434.88 
 Pro Prgrmg Dev Eval 1 Lead Pm/Ldls Pm 1 Car Chmbr IP ,CPT® 93279,0982 - PRO FEE/OUTPT,N/A,N/A, $654.00 , $425.10 , $438.49 , $67.13 , $42.62 , $269.26 , $278.80 , $608.22 , $588.60 , $588.60 , $523.20 , $523.20 , $42.62 , $603.84 , $621.30 , $588.60 , $588.60 , $588.60 , $608.22 , $627.84 , $408.55 , $555.90 , $260.47 , $187.91 , N/A , $274.52 , $274.52 , $621.30 , $304.30 , $42.62 , $627.84 
Iadna Dna/Rna Rsv Amplified Probe Technique,CPT® 87634,N/A,N/A,N/A, $138.00 , $89.70 , N/A , $71.60 , $70.72 , $360.28 , N/A , $128.34 , $124.20 , $124.20 , $110.40 , $110.40 , $70.72 , $127.42 , $131.10 , $124.20 , $124.20 , $124.20 , $128.34 , $132.48 , $468.74 , $117.30 , $334.38 , $254.52 , N/A , $336.24 , $336.24 , $131.10 , $367.44 , $70.72 , $468.74 
 Ankle Disarticulation Cl ,CPT® 27889,0360 - OR SERVICES,N/A,N/A," $9,130.00 "," $5,934.50 "," $7,669.20 ", $589.92 , $768.38 ," $7,377.04 "," $8,217.00 "," $7,729.46 "," $8,217.00 "," $8,217.00 "," $8,217.00 "," $7,760.50 ", $753.31 ," $8,429.73 "," $8,673.50 "," $7,760.50 "," $8,490.90 "," $8,490.90 "," $8,673.50 "," $8,764.80 "," $7,470.17 "," $8,217.00 "," $7,760.50 "," $7,212.70 ", N/A ," $7,388.91 "," $7,388.91 "," $8,673.50 "," $7,834.45 ", $589.92 ," $8,764.80 "
Preputial Stretching,54450,N/A,N/A,N/A, $386.00 , $250.90 , $250.75 , $54.02 , $26.24 , $184.37 , $185.20 , $358.98 , $347.40 , $347.40 , $308.80 , $308.80 , $26.24 , $356.39 , $366.70 , $347.40 , $347.40 , $347.40 , $358.98 , $370.56 , $236.84 , $328.10 , $294.37 , $279.62 , N/A , $187.97 , $187.97 , $366.70 , $225.28 , $26.24 , $370.56 
 LEVETIRACETAM 500 MG/5ML IV SOLN ,HCPCS J1953,0636 - DRUGS REQUIRING DETAILED CODIN,00409-1886-02,5 mL, $23.97 , $15.58 , $20.13 , $0.07 , $0.09 , $19.37 , $21.57 , $20.29 , $21.57 , $21.57 , $21.57 , $20.37 , $0.09 , $22.13 , $22.77 , $20.37 , $22.29 , $22.29 , $22.77 , $23.01 , $19.61 , $21.57 , $20.37 , $18.94 , N/A , $19.40 , $19.40 , $22.77 , $20.57 , $0.07 , $23.01 
 SODIUM HYPOCHLORITE 0.0125 % EX SOLN ,HCPCS RXA250,0250 - PHARMACY,00436-0669-16,473 mL, $58.32 , $37.91 , $48.99 , N/A , N/A , $47.12 , $52.49 , $49.37 , $52.49 , $52.49 , $52.49 , $49.57 , N/A , $53.85 , $55.40 , $49.57 , $54.24 , $54.24 , $55.40 , $55.99 , $47.72 , $52.49 , $49.57 , $46.07 , N/A , $47.20 , $47.20 , $55.40 , $50.04 , $46.07 , $55.99 
 PEGFILGRASTIM-BMEZ 6 MG/0.6ML SC SOSY ,HCPCS Q5120,0636 - DRUGS REQUIRING DETAILED CODIN,61314-0866-01,0.6 mL," $11,542.30 "," $7,502.50 "," $9,695.53 ", $30.65 , $91.74 ," $9,326.18 "," $10,388.07 "," $9,771.71 "," $10,388.07 "," $10,388.07 "," $10,388.07 "," $9,810.96 ", $89.94 ," $10,657.01 "," $10,965.19 "," $9,810.96 "," $10,734.34 "," $10,734.34 "," $10,965.19 "," $11,080.61 "," $9,443.91 "," $10,388.07 "," $9,810.96 "," $9,118.42 ", N/A ," $9,341.18 "," $9,341.18 "," $10,965.19 "," $9,904.45 ", $30.65 ," $11,080.61 "
 MODAFINIL 100 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,62332-0385-30,1 tablet, $113.36 , $73.68 , $95.22 , N/A , N/A , $91.59 , $102.02 , $95.97 , $102.02 , $102.02 , $102.02 , $96.36 , N/A , $104.67 , $107.69 , $96.36 , $105.42 , $105.42 , $107.69 , $108.83 , $92.75 , $102.02 , $96.36 , $89.55 , N/A , $91.74 , $91.74 , $107.69 , $97.27 , $89.55 , $108.83 
Assay Vasopressin,CPT® 84588,N/A,N/A,N/A, $314.00 , $204.10 , N/A , $34.62 , $34.62 , $192.04 , $229.73 , $292.02 , $282.60 , $282.60 , $251.20 , $251.20 , $34.62 , $289.92 , $298.30 , $282.60 , $282.60 , $282.60 , $292.02 , $301.44 , $226.62 , $266.90 , $222.19 , $123.06 , N/A , $179.22 , $179.22 , $298.30 , $195.85 , $34.62 , $301.44 
"Strapping,Wrist or Elbow",CPT® 29260,N/A,N/A,N/A, $352.00 , $228.80 , $120.06 , $18.51 , $15.54 , $94.80 , $184.95 , $327.36 , $316.80 , $316.80 , $281.60 , $281.60 , $15.54 , $325.00 , $334.40 , $316.80 , $316.80 , $316.80 , $327.36 , $337.92 , $112.20 , $299.20 , $199.82 , $114.64 , N/A , $96.65 , $96.65 , $334.40 , $113.60 , $15.54 , $337.92 
 QUETIAPINE FUMARATE 100 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60687-0349-01,1 tablet, $33.28 , $21.63 , $27.96 , N/A , N/A , $26.89 , $29.95 , $28.17 , $29.95 , $29.95 , $29.95 , $28.29 , N/A , $30.73 , $31.62 , $28.29 , $30.95 , $30.95 , $31.62 , $31.95 , $27.23 , $29.95 , $28.29 , $26.29 , N/A , $26.93 , $26.93 , $31.62 , $28.56 , $26.29 , $31.95 
 Fac Intro Cath Dialysis Circuit W/Tcat Plmt IV Stent ,CPT® 36903,0360 - OR SERVICES,N/A,N/A," $26,615.00 "," $17,299.75 "," $22,356.60 ", $290.61 ," $4,411.40 "," $21,504.92 "," $23,953.50 "," $22,532.26 "," $23,953.50 "," $23,953.50 "," $23,953.50 "," $22,622.75 "," $4,324.90 "," $24,573.63 "," $25,284.25 "," $22,622.75 "," $24,751.95 "," $24,751.95 "," $25,284.25 "," $25,550.40 "," $21,776.39 "," $23,953.50 "," $22,622.75 "," $21,025.85 ", N/A ," $21,539.52 "," $21,539.52 "," $25,284.25 "," $22,838.33 ", $290.61 ," $25,550.40 "
Laser Surgery of Eye,CPT® 65855,N/A,N/A,N/A," $2,886.00 "," $1,875.90 "," $1,264.38 ", $198.46 , $274.40 ," $1,684.50 "," $2,123.40 "," $2,683.98 "," $2,597.40 "," $2,597.40 "," $2,308.80 "," $2,308.80 ", $274.40 ," $2,664.64 "," $2,741.70 "," $2,597.40 "," $2,597.40 "," $2,597.40 "," $2,683.98 "," $2,770.56 "," $1,738.87 "," $2,453.10 "," $1,628.85 "," $1,494.94 ", N/A ," $1,717.36 "," $1,717.36 "," $2,741.70 "," $1,895.73 ", $198.46 ," $2,770.56 "
"Trim Hyperkeratotic Skin Lesion,2-4",11056,N/A,N/A,N/A, $244.00 , $158.60 , $72.42 , $21.33 , $36.84 , $63.57 , $60.59 , $226.92 , $219.60 , $219.60 , $195.20 , $195.20 , $36.84 , $225.29 , $231.80 , $219.60 , $219.60 , $219.60 , $226.92 , $234.24 , $79.89 , $207.40 , $117.75 , $81.61 , N/A , $64.81 , $64.81 , $231.80 , $75.17 , $21.33 , $234.24 
 Extended Holter 7-15 Days ,CPT® 93246,0731 - HOLTER MONT,N/A,N/A," $1,210.00 ", $786.50 ," $1,016.40 ", $11.60 , $11.62 , $977.68 ," $1,089.00 "," $1,024.39 "," $1,089.00 "," $1,089.00 "," $1,089.00 "," $1,028.50 ", $11.39 ," $1,117.19 "," $1,149.50 "," $1,028.50 "," $1,125.30 "," $1,125.30 "," $1,149.50 "," $1,161.60 ", $990.02 ," $1,089.00 "," $1,028.50 ", $955.90 , N/A , $979.25 , $979.25 ," $1,149.50 "," $1,038.30 ", $11.39 ," $1,161.60 "
 Pro Csto Calibration Dilat Urtl Strix/Stenosis ,CPT® 52281,0982 - PRO FEE/OUTPT,N/A,N/A," $1,957.00 "," $1,272.05 ", $815.93 , $143.40 , $186.38 , $746.11 , $695.66 ," $1,820.01 "," $1,761.30 "," $1,761.30 "," $1,565.60 "," $1,565.60 ", $186.38 ," $1,806.90 "," $1,859.15 "," $1,761.30 "," $1,761.30 "," $1,761.30 "," $1,820.01 "," $1,878.72 ", $819.61 ," $1,663.45 ", $788.56 , $936.15 , N/A , $760.67 , $760.67 ," $1,859.15 ", $894.06 , $143.40 ," $1,878.72 "
"Virus ID;Centrif Enh Tech,W/Immunofluor",CPT® 87254,N/A,N/A,N/A, $202.00 , $131.30 , N/A , $19.95 , $6.97 , $110.68 , $132.34 , $187.86 , $181.80 , $181.80 , $161.60 , $161.60 , $6.97 , $186.51 , $191.90 , $181.80 , $181.80 , $181.80 , $187.86 , $193.92 , $130.61 , $171.70 , $128.13 , $70.93 , N/A , $103.29 , $103.29 , $191.90 , $112.87 , $6.97 , $193.92 
"Shav Skin Les 6-10mm Trunk,Arm,Leg",CPT® 11301,N/A,N/A,N/A, $468.00 , $304.20 , $164.46 , $49.27 , $62.13 , $146.28 , $142.05 , $435.24 , $421.20 , $421.20 , $374.40 , $374.40 , $62.13 , $432.10 , $444.60 , $421.20 , $421.20 , $421.20 , $435.24 , $449.28 , $181.38 , $397.80 , $281.88 , $187.83 , N/A , $149.14 , $149.14 , $444.60 , $172.94 , $49.27 , $449.28 
 Fac Bx Breast W Device Addl Lesion Ultrasound Guide ,CPT® 19084,0361 - OR/MINOR,N/A,N/A," $4,017.00 "," $2,611.05 "," $3,374.28 ", $74.13 , $61.02 ," $3,245.74 "," $3,615.30 "," $3,400.79 "," $3,615.30 "," $3,615.30 "," $3,615.30 "," $3,414.45 ", $59.82 ," $3,708.90 "," $3,816.15 "," $3,414.45 "," $3,735.81 "," $3,735.81 "," $3,816.15 "," $3,856.32 "," $3,286.71 "," $3,615.30 "," $3,414.45 "," $3,173.43 ", N/A ," $3,250.96 "," $3,250.96 "," $3,816.15 "," $3,446.99 ", $59.82 ," $3,856.32 "
RBC Leukocytes Reduced,HCPCS P9016,N/A,N/A,N/A, $446.00 , $289.90 , N/A , N/A , $458.48 , N/A , N/A , $414.78 , $401.40 , $401.40 , $356.80 , $356.80 , $458.48 , $411.79 , $423.70 , $401.40 , $401.40 , $401.40 , $414.78 , $428.16 , N/A , $379.10 , $356.80 , N/A , N/A , N/A , N/A , $423.70 , N/A , $356.80 , $458.48 
Injection Aa&/Strd Sciatic Nrv Cont Nfs Cath Img,CPT® 64446,N/A,N/A,N/A," $2,216.00 "," $1,440.40 ", $292.97 , $73.50 , $84.16 , $447.66 , $421.14 ," $2,060.88 "," $1,994.40 "," $1,994.40 "," $1,772.80 "," $1,772.80 ", $84.16 ," $2,046.03 "," $2,105.20 "," $1,994.40 "," $1,994.40 "," $1,994.40 "," $2,060.88 "," $2,127.36 ", $317.99 ," $1,883.60 ", $412.12 , $480.21 , N/A , $456.39 , $456.39 ," $2,105.20 ", $489.59 , $73.50 ," $2,127.36 "
 Collection of Blood From Cvad -ED ,CPT® 36591,0761 - TREATMENT ROOM,N/A,N/A, $161.00 , $104.65 , $135.24 , $26.05 , $15.87 , $130.09 , $144.90 , $136.30 , $144.90 , $144.90 , $144.90 , $136.85 , $15.56 , $148.65 , $152.95 , $136.85 , $149.73 , $149.73 , $152.95 , $154.56 , $131.73 , $144.90 , $136.85 , $127.19 , N/A , $130.30 , $130.30 , $152.95 , $138.15 , $15.56 , $154.56 
 Pro Open Treatment Metatarsal Fracture Each ,CPT® 28485,0975 - PRO FEE/OR,N/A,N/A," $3,207.00 "," $2,084.55 "," $3,485.63 ", $546.26 , $384.19 ," $2,574.42 "," $2,574.82 "," $2,982.51 "," $2,886.30 "," $2,886.30 "," $2,565.60 "," $2,565.60 ", $384.19 ," $2,961.02 "," $3,046.65 "," $2,886.30 "," $2,886.30 "," $2,886.30 "," $2,982.51 "," $3,078.72 "," $3,222.61 "," $2,725.95 "," $2,804.55 "," $3,151.82 ", N/A ," $2,624.65 "," $2,624.65 "," $3,046.65 "," $3,084.91 ", $384.19 ," $3,485.63 "
Remov/Foreign Body/Ear,CPT® 67938,N/A,N/A,N/A," $1,052.00 ", $683.80 , $725.34 , $114.79 , $66.00 , $652.93 , $615.59 , $978.36 , $946.80 , $946.80 , $841.60 , $841.60 , $66.00 , $971.31 , $999.40 , $946.80 , $946.80 , $946.80 , $978.36 ," $1,009.92 ", $992.25 , $894.20 , $635.13 , $841.40 , N/A , $665.67 , $665.67 , $999.40 , $734.83 , $66.00 ," $1,009.92 "
Mast Modf Rad W/Ax Lymph Nod W/WO Pect/Alis Min,CPT® 19307,N/A,N/A,N/A," $6,301.00 "," $4,095.65 "," $3,694.44 "," $1,094.48 ", $842.85 ," $3,213.09 "," $3,125.50 "," $5,859.93 "," $5,670.90 "," $5,670.90 "," $5,040.80 "," $5,040.80 ", $842.85 ," $5,817.71 "," $5,985.95 "," $5,670.90 "," $5,670.90 "," $5,670.90 "," $5,859.93 "," $6,048.96 "," $4,052.16 "," $5,355.85 "," $6,310.23 "," $4,063.28 ", N/A ," $3,275.78 "," $3,275.78 "," $5,985.95 "," $3,798.81 ", $842.85 ," $6,310.23 "
"Open Rx a-C Jt Disloc,Fascial Grft",23552,N/A,N/A,N/A," $4,508.00 "," $2,930.20 "," $3,995.62 ", $621.15 , $768.38 ," $3,146.73 "," $3,159.48 "," $4,192.44 "," $4,057.20 "," $4,057.20 "," $3,606.40 "," $3,606.40 ", $768.38 ," $4,162.24 "," $4,282.60 "," $4,057.20 "," $4,057.20 "," $4,057.20 "," $4,192.44 "," $4,327.68 "," $3,712.64 "," $3,831.80 "," $3,486.06 "," $3,721.44 ", N/A ," $3,208.13 "," $3,208.13 "," $4,282.60 "," $3,770.70 ", $621.15 ," $4,327.68 "
Hallux Rigidus W/Cheilectomy 1st Mp Jt W/Implt,CPT® 28291,N/A,N/A,N/A," $4,816.00 "," $3,130.40 "," $3,043.11 ", $471.52 , $590.92 ," $2,278.68 "," $2,293.33 "," $4,478.88 "," $4,334.40 "," $4,334.40 "," $3,852.80 "," $3,852.80 ", $590.92 ," $4,446.61 "," $4,575.20 "," $4,334.40 "," $4,334.40 "," $4,334.40 "," $4,478.88 "," $4,623.36 "," $2,841.95 "," $4,093.60 "," $2,565.91 "," $2,800.70 ", N/A ," $2,323.14 "," $2,323.14 "," $4,575.20 "," $2,730.53 ", $471.52 ," $4,623.36 "
Psychotherapy W/Patient W/E&M Srvcs 60 Min,90838,N/A,N/A,N/A, $237.00 , $154.05 , $138.86 , $103.04 , $133.44 , $243.62 , $247.42 , $220.41 , $213.30 , $213.30 , $189.60 , $189.60 , $133.44 , $218.82 , $225.15 , $213.30 , $213.30 , $213.30 , $220.41 , $227.52 , $264.86 , $201.45 , $322.36 , $416.09 , $136.25 , $248.37 , $248.37 , $225.15 , $289.55 , $103.04 , $416.09 
 Pro Repair/Graft of Thigh ,CPT® 27472,0975 - PRO FEE/OR,N/A,N/A," $8,680.00 "," $5,642.00 "," $7,623.79 "," $1,193.44 "," $1,306.26 "," $6,107.01 "," $6,049.44 "," $8,072.40 "," $7,812.00 "," $7,812.00 "," $6,944.00 "," $6,944.00 "," $1,306.26 "," $8,014.24 "," $8,246.00 "," $7,812.00 "," $7,812.00 "," $7,812.00 "," $8,072.40 "," $8,332.80 "," $7,105.67 "," $7,378.00 "," $6,695.59 "," $7,167.78 ", N/A ," $6,226.17 "," $6,226.17 "," $8,246.00 "," $7,317.95 "," $1,193.44 "," $8,332.80 "
Ins/Rplcmnt Perm Subq Impltbl Dfb W/Subq Eltrd,CPT® 33270,N/A,N/A,N/A," $5,546.00 "," $3,604.90 "," $3,350.88 ", $517.28 , $485.96 ," $2,638.25 "," $2,546.66 "," $5,157.78 "," $4,991.40 "," $4,991.40 "," $4,436.80 "," $4,436.80 ", $485.96 ," $5,120.62 "," $5,268.70 "," $4,991.40 "," $4,991.40 "," $4,991.40 "," $5,157.78 "," $5,324.16 "," $3,101.62 "," $4,714.10 "," $2,953.28 "," $2,752.02 ", N/A ," $2,689.72 "," $2,689.72 "," $5,268.70 "," $3,055.52 ", $485.96 ," $5,324.16 "
 Pro Removal of Wrist Bone ,CPT® 25210,0982 - PRO FEE/OUTPT,N/A,N/A," $1,302.00 ", $846.30 ," $3,029.13 ", $477.30 , $461.04 ," $2,346.85 "," $2,352.01 "," $1,210.86 "," $1,171.80 "," $1,171.80 "," $1,041.60 "," $1,041.60 ", $461.04 ," $1,202.14 "," $1,236.90 "," $1,171.80 "," $1,171.80 "," $1,171.80 "," $1,210.86 "," $1,249.92 "," $2,811.10 "," $1,106.70 "," $2,585.11 "," $2,792.89 ", N/A ," $2,392.64 "," $2,392.64 "," $1,236.90 "," $2,812.21 ", $461.04 ," $3,029.13 "
Dermagraft Skin Sub,HCPCS Q4106,N/A,N/A,N/A, $84.00 , $54.60 , N/A , $35.17 , $36.13 , N/A , N/A , $78.12 , $75.60 , $75.60 , $67.20 , $67.20 , $36.13 , $77.56 , $79.80 , $75.60 , $75.60 , $75.60 , $78.12 , $80.64 , $41.56 , $71.40 , $77.85 , $33.30 , N/A , N/A , N/A , $79.80 , N/A , $33.30 , $80.64 
 Pro Treatment Toe Fracture ,CPT® 28515,0982 - PRO FEE/OUTPT,N/A,N/A," $1,059.00 ", $688.35 , $888.42 , $141.25 , $76.84 , $702.96 , $708.81 , $984.87 , $953.10 , $953.10 , $847.20 , $847.20 , $76.84 , $977.77 ," $1,006.05 ", $953.10 , $953.10 , $953.10 , $984.87 ," $1,016.64 ", $817.30 , $900.15 , $768.93 , $830.94 , N/A , $716.67 , $716.67 ," $1,006.05 ", $842.36 , $76.84 ," $1,016.64 "
 BORTEZOMIB 3.5 MG IJ SOLR ,HCPCS J9046,0636 - DRUGS REQUIRING DETAILED CODIN,55150-0337-01,3.5 mg, $220.53 , $143.34 , $185.25 , $49.52 , $11.18 , $178.19 , $198.48 , $186.70 , $198.48 , $198.48 , $198.48 , $187.45 , $10.96 , $203.62 , $209.50 , $187.45 , $205.09 , $205.09 , $209.50 , $211.71 , $180.44 , $198.48 , $187.45 , $174.22 , N/A , $178.47 , $178.47 , $209.50 , $189.24 , $10.96 , $211.71 
"Split Grft,Head,Fac,Hand,Feet <100cm",CPT® 15120,N/A,N/A,N/A," $4,851.00 "," $3,153.15 "," $2,194.60 ", $656.83 , $799.78 ," $1,903.99 "," $1,858.32 "," $4,511.43 "," $4,365.90 "," $4,365.90 "," $3,880.80 "," $3,880.80 ", $799.78 ," $4,478.93 "," $4,608.45 "," $4,365.90 "," $4,365.90 "," $4,365.90 "," $4,511.43 "," $4,656.96 "," $2,407.55 "," $4,123.35 "," $3,717.99 "," $2,420.90 ", N/A ," $1,941.14 "," $1,941.14 "," $4,608.45 "," $2,251.05 ", $656.83 ," $4,656.96 "
 Xr Cervical Spine 3 Views or Less ,CPT® 72040,0320 - DX X-RAY,N/A,N/A, $345.00 , $224.25 , $289.80 , $39.02 , $35.77 , $278.76 , $310.50 , $292.08 , $310.50 , $310.50 , $310.50 , $293.25 , $35.07 , $318.54 , $327.75 , $293.25 , $320.85 , $320.85 , $327.75 , $331.20 , $282.28 , $310.50 , $293.25 , $272.55 , N/A , $279.21 , $279.21 , $327.75 , $296.04 , $35.07 , $331.20 
Fusion Finger Joint,CPT® 26860,N/A,N/A,N/A," $1,911.00 "," $1,242.15 "," $3,869.91 ", $602.15 , $384.19 ," $2,683.79 "," $2,729.96 "," $1,777.23 "," $1,719.90 "," $1,719.90 "," $1,528.80 "," $1,528.80 ", $384.19 ," $1,764.43 "," $1,815.45 "," $1,719.90 "," $1,719.90 "," $1,719.90 "," $1,777.23 "," $1,834.56 "," $3,532.35 "," $1,624.35 "," $2,984.74 "," $3,214.26 ", N/A ," $2,736.16 "," $2,736.16 "," $1,815.45 "," $3,215.95 ", $384.19 ," $3,869.91 "
"Burn Dressing,Lg,W/O Anes",16030,N/A,N/A,N/A, $859.00 , $558.35 , $413.47 , $123.20 , $81.33 , $359.30 , $352.65 , $798.87 , $773.10 , $773.10 , $687.20 , $687.20 , $81.33 , $793.11 , $816.05 , $773.10 , $773.10 , $773.10 , $798.87 , $824.64 , $452.84 , $730.15 , $706.49 , $468.44 , N/A , $366.31 , $366.31 , $816.05 , $424.78 , $81.33 , $824.64 
 Fac Vitamin B-12 ,CPT® 82607,0301 - LAB/CHEMISTRY,N/A,N/A, $165.00 , $107.25 , $138.60 , $15.38 , $15.38 , $133.32 , $148.50 , $139.69 , $148.50 , $148.50 , $148.50 , $140.25 , $15.08 , $152.34 , $156.75 , $140.25 , $153.45 , $153.45 , $156.75 , $158.40 , $135.00 , $148.50 , $140.25 , $130.35 , N/A , $133.53 , $133.53 , $156.75 , $141.59 , $15.08 , $158.40 
X-Ray Lumbar Spine 6+ Vw,CPT® 72114,N/A,N/A,N/A, $587.00 , $381.55 , $350.67 , $60.93 , $66.50 , $294.27 , $340.30 , $545.91 , $528.30 , $528.30 , $469.60 , $469.60 , $66.50 , $541.98 , $557.65 , $528.30 , $528.30 , $528.30 , $545.91 , $563.52 , $341.82 , $498.95 , $373.65 , $310.70 , N/A , $300.01 , $300.01 , $557.65 , $347.27 , $60.93 , $563.52 
Replacement of Mitral Valve,CPT® 33430,N/A,N/A,N/A," $19,214.00 "," $12,489.10 "," $16,339.18 "," $2,523.19 "," $2,378.00 "," $11,946.98 "," $11,815.29 "," $17,869.02 "," $17,292.60 "," $17,292.60 "," $15,371.20 "," $15,371.20 "," $2,378.00 "," $17,740.29 "," $18,253.30 "," $17,292.60 "," $17,292.60 "," $17,292.60 "," $17,869.02 "," $18,445.44 "," $15,135.29 "," $16,331.90 "," $14,970.08 "," $13,404.98 ", N/A ," $12,180.08 "," $12,180.08 "," $18,253.30 "," $13,836.59 "," $2,378.00 "," $18,445.44 "
 Fac Apligraf Skin Sub ,HCPCS Q4101,0636 - DRUGS REQUIRING DETAILED CODIN,N/A,N/A, $99.00 , $64.35 , $83.16 , $31.03 , $31.79 , $79.99 , $89.10 , $83.81 , $89.10 , $89.10 , $89.10 , $84.15 , $31.17 , $91.41 , $94.05 , $84.15 , $92.07 , $92.07 , $94.05 , $95.04 , $81.00 , $89.10 , $84.15 , $78.21 , N/A , $80.12 , $80.12 , $94.05 , $84.95 , $31.03 , $95.04 
 SODIUM HYPOCHLORITE 0.25 % EX SOLN ,HCPCS RXC637,0250 - PHARMACY,39328-0063-25,473 mL, $70.47 , $45.81 , $59.19 , N/A , N/A , $56.94 , $63.42 , $59.66 , $63.42 , $63.42 , $63.42 , $59.90 , N/A , $65.06 , $66.95 , $59.90 , $65.54 , $65.54 , $66.95 , $67.65 , $57.66 , $63.42 , $59.90 , $55.67 , N/A , $57.03 , $57.03 , $66.95 , $60.47 , $55.67 , $67.65 
 Polysom Stage4 or>Attend <6yr ,CPT® 95782,0920 - OTHER DX SVS,N/A,N/A," $6,877.00 "," $4,470.05 "," $5,776.68 ", $929.80 ," $1,251.81 "," $5,556.62 "," $6,189.30 "," $5,822.07 "," $6,189.30 "," $6,189.30 "," $6,189.30 "," $5,845.45 "," $1,227.26 "," $6,349.53 "," $6,533.15 "," $5,845.45 "," $6,395.61 "," $6,395.61 "," $6,533.15 "," $6,601.92 "," $5,626.76 "," $6,189.30 "," $5,845.45 "," $5,432.83 ", N/A ," $5,565.56 "," $5,565.56 "," $6,533.15 "," $5,901.15 ", $929.80 ," $6,601.92 "
Treat Talus Fracture,28430,N/A,N/A,N/A," $1,568.00 "," $1,019.20 "," $1,313.07 ", $207.28 , $230.52 ," $1,022.71 "," $1,034.45 "," $1,458.24 "," $1,411.20 "," $1,411.20 "," $1,254.40 "," $1,254.40 ", $230.52 ," $1,447.73 "," $1,489.60 "," $1,411.20 "," $1,411.20 "," $1,411.20 "," $1,458.24 "," $1,505.28 "," $1,212.90 "," $1,332.80 "," $1,131.10 "," $1,208.16 ", N/A ," $1,042.66 "," $1,042.66 "," $1,489.60 "," $1,225.50 ", $207.28 ," $1,505.28 "
 Pro Exc/Curtg B1 Cst/B9 Tum Rds/U ,CPT® 25120,0982 - PRO FEE/OUTPT,N/A,N/A," $3,022.00 "," $1,964.30 "," $3,082.37 ", $485.00 , $284.00 ," $2,391.55 "," $2,397.77 "," $2,810.46 "," $2,719.80 "," $2,719.80 "," $2,417.60 "," $2,417.60 ", $284.00 ," $2,790.21 "," $2,870.90 "," $2,719.80 "," $2,719.80 "," $2,719.80 "," $2,810.46 "," $2,901.12 "," $2,859.61 "," $2,568.70 "," $2,638.63 "," $2,840.56 ", N/A ," $2,438.22 "," $2,438.22 "," $2,870.90 "," $2,865.76 ", $284.00 ," $3,082.37 "
 Pro X-Ray Exam of Pelvis ,CPT® 72190,0972 - PRO FEE/RAD/DX,N/A,N/A, $111.00 , $72.15 , $238.55 , $41.70 , $38.00 , $181.69 , $229.84 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $38.00 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $230.13 , $94.35 , $254.24 , $191.00 , N/A , $185.23 , $185.23 , $105.45 , $214.42 , $38.00 , $254.24 
Sono Abdomen Limited,CPT® 76705,N/A,N/A,N/A, $754.00 , $490.10 , $499.55 , $86.93 , $89.08 , $506.27 , $574.33 , $701.22 , $678.60 , $678.60 , $603.20 , $603.20 , $89.08 , $696.17 , $716.30 , $678.60 , $678.60 , $678.60 , $701.22 , $723.84 , $503.30 , $640.90 , $624.04 , $515.91 , N/A , $516.14 , $516.14 , $716.30 , $597.46 , $86.93 , $723.84 
 Pro MRI Orbit Face&Nck C+ Matrl ,CPT® 70542,0972 - PRO FEE/RAD/DX,N/A,N/A, $973.00 , $632.45 ," $1,942.22 ", $276.76 , $497.69 ," $1,915.00 "," $2,420.12 ", $904.89 , $875.70 , $875.70 , $778.40 , $778.40 , $497.69 , $898.37 , $924.35 , $875.70 , $875.70 , $875.70 , $904.89 , $934.08 ," $1,675.27 ", $827.05 ," $2,640.60 "," $2,969.18 ", N/A ," $1,952.36 "," $1,952.36 ", $924.35 ," $2,259.89 ", $276.76 ," $2,969.18 "
Ko Elas W/ Condyle Pads & Jo,HCPCS L1820,N/A,N/A,N/A, $223.00 , $144.95 , N/A , $166.24 , $75.59 , N/A , N/A , $207.39 , $200.70 , $200.70 , $178.40 , $178.40 , $75.59 , $205.90 , $211.85 , $200.70 , $200.70 , $200.70 , $207.39 , $214.08 , N/A , $189.55 , $131.05 , $139.87 , N/A , N/A , N/A , $211.85 , N/A , $75.59 , $214.08 
 ETOMIDATE 2 MG/ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00143-9507-10,20 mL, $41.41 , $26.92 , $34.78 , N/A , N/A , $33.46 , $37.27 , $35.06 , $37.27 , $37.27 , $37.27 , $35.20 , N/A , $38.23 , $39.34 , $35.20 , $38.51 , $38.51 , $39.34 , $39.75 , $33.88 , $37.27 , $35.20 , $32.71 , N/A , $33.51 , $33.51 , $39.34 , $35.53 , $32.71 , $39.75 
Treat Phalangeal Fracture,26750,N/A,N/A,N/A, $861.00 , $559.65 ," $1,175.53 ", $187.84 , $59.10 , $887.15 , $909.28 , $800.73 , $774.90 , $774.90 , $688.80 , $688.80 , $59.10 , $794.96 , $817.95 , $774.90 , $774.90 , $774.90 , $800.73 , $826.56 ," $1,079.00 ", $731.85 , $995.51 ," $1,062.31 ", N/A , $904.46 , $904.46 , $817.95 ," $1,063.07 ", $59.10 ," $1,175.53 "
Lens Sphcy Bifocal 4.25-7/Ov,HCPCS V2210,N/A,N/A,N/A, $85.00 , $55.25 , N/A , $88.40 , N/A , N/A , N/A , $79.05 , $76.50 , $76.50 , $68.00 , $68.00 , N/A , $78.48 , $80.75 , $76.50 , $76.50 , $76.50 , $79.05 , $81.60 , N/A , $72.25 , $85.00 , $80.31 , N/A , N/A , N/A , $80.75 , N/A , $68.00 , $88.40 
Assay of Parathormone,CPT® 83970,N/A,N/A,N/A, $293.00 , $190.45 , N/A , $42.11 , $42.11 , $233.52 , $279.36 , $272.49 , $263.70 , $263.70 , $234.40 , $234.40 , $42.11 , $270.53 , $278.35 , $263.70 , $263.70 , $263.70 , $272.49 , $281.28 , $275.64 , $249.05 , $270.85 , $149.67 , N/A , $217.94 , $217.94 , $278.35 , $238.16 , $42.11 , $281.28 
" Fac Virus Inoculation, Tissue ",CPT® 87252,0306 - LAB/BACT-MICRO,N/A,N/A, $241.00 , $156.65 , $202.44 , $26.59 , $26.59 , $194.73 , $216.90 , $204.03 , $216.90 , $216.90 , $216.90 , $204.85 , $26.07 , $222.52 , $228.95 , $204.85 , $224.13 , $224.13 , $228.95 , $231.36 , $197.19 , $216.90 , $204.85 , $190.39 , N/A , $195.04 , $195.04 , $228.95 , $206.80 , $26.07 , $231.36 
Repair Biceps Long Tendon,CPT® 23430,N/A,N/A,N/A," $2,607.00 "," $1,694.55 "," $4,536.16 ", $711.01 , $537.90 ," $3,600.06 "," $3,601.50 "," $2,424.51 "," $2,346.30 "," $2,346.30 "," $2,085.60 "," $2,085.60 ", $537.90 ," $2,407.04 "," $2,476.65 "," $2,346.30 "," $2,346.30 "," $2,346.30 "," $2,424.51 "," $2,502.72 "," $4,217.37 "," $2,215.95 "," $3,974.89 "," $4,235.40 ", N/A ," $3,670.30 "," $3,670.30 "," $2,476.65 "," $4,313.89 ", $537.90 ," $4,536.16 "
 AMPICILLIN SODIUM 250 MG IJ SOLR UNDILUTED ,HCPCS J0290,0636 - DRUGS REQUIRING DETAILED CODIN,00781-3402-95,250 mg, $21.51 , $13.98 , $18.07 , $0.80 , $0.94 , $17.38 , $19.36 , $18.21 , $19.36 , $19.36 , $19.36 , $18.28 , $0.92 , $19.86 , $20.43 , $18.28 , $20.00 , $20.00 , $20.43 , $20.65 , $17.60 , $19.36 , $18.28 , $16.99 , N/A , $17.41 , $17.41 , $20.43 , $18.46 , $0.80 , $20.65 
Excision Tumor Soft Tissue Shoulder Subq 3+Cm,23071,N/A,N/A,N/A," $3,297.00 "," $2,143.05 "," $2,536.63 ", $395.70 , $342.80 ," $2,010.77 "," $2,011.47 "," $3,066.21 "," $2,967.30 "," $2,967.30 "," $2,637.60 "," $2,637.60 ", $342.80 ," $3,044.12 "," $3,132.15 "," $2,967.30 "," $2,967.30 "," $2,967.30 "," $3,066.21 "," $3,165.12 "," $2,350.06 "," $2,802.45 "," $2,226.51 "," $2,366.34 ", N/A ," $2,050.01 "," $2,050.01 "," $3,132.15 "," $2,409.50 ", $342.80 ," $3,165.12 "
 BUMETANIDE 2 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,69238-1491-01,1 tablet, $15.25 , $9.91 , $12.81 , N/A , N/A , $12.32 , $13.73 , $12.91 , $13.73 , $13.73 , $13.73 , $12.96 , N/A , $14.08 , $14.49 , $12.96 , $14.18 , $14.18 , $14.49 , $14.64 , $12.48 , $13.73 , $12.96 , $12.05 , N/A , $12.34 , $12.34 , $14.49 , $13.09 , $12.05 , $14.64 
 DACARBAZINE 200 MG IV SOLR ,HCPCS J9130,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0128-20,20 mL, $73.98 , $48.09 , $62.14 , $4.13 , $4.32 , $59.78 , $66.58 , $62.63 , $66.58 , $66.58 , $66.58 , $62.88 , $4.24 , $68.31 , $70.28 , $62.88 , $68.80 , $68.80 , $70.28 , $71.02 , $60.53 , $66.58 , $62.88 , $58.44 , N/A , $59.87 , $59.87 , $70.28 , $63.48 , $4.13 , $71.02 
 Fac Acylcarnitines Quan Ea Spec ,CPT® 82017,0301 - LAB/CHEMISTRY,N/A,N/A, $197.00 , $128.05 , $165.48 , $17.21 , $17.21 , $159.18 , $177.30 , $166.78 , $177.30 , $177.30 , $177.30 , $167.45 , $16.87 , $181.89 , $187.15 , $167.45 , $183.21 , $183.21 , $187.15 , $189.12 , $161.19 , $177.30 , $167.45 , $155.63 , N/A , $159.43 , $159.43 , $187.15 , $169.05 , $16.87 , $189.12 
Assay Vitamin-K,CPT® 84597,N/A,N/A,N/A, $197.00 , $128.05 , N/A , $13.99 , $13.99 , $77.58 , $92.80 , $183.21 , $177.30 , $177.30 , $157.60 , $157.60 , $13.99 , $181.89 , $187.15 , $177.30 , $177.30 , $177.30 , $183.21 , $189.12 , $91.61 , $167.45 , $89.20 , $49.75 , N/A , $72.40 , $72.40 , $187.15 , $79.12 , $13.99 , $189.12 
 Fac Endoluminal Coronary Ivus Oct I&R Addl Vessel ,CPT® 92979,0402 - ULTRASOUND,N/A,N/A, $643.00 , $417.95 , $540.12 , $163.70 , $163.58 , $519.54 , $578.70 , $544.36 , $578.70 , $578.70 , $578.70 , $546.55 , $160.37 , $593.68 , $610.85 , $546.55 , $597.99 , $597.99 , $610.85 , $617.28 , $526.10 , $578.70 , $546.55 , $507.97 , N/A , $520.38 , $520.38 , $610.85 , $551.76 , $160.37 , $617.28 
 DIPHENHYDRAMINE HCL 12.5 MG/5ML PO ELIX ,HCPCS RXC637,0250 - PHARMACY,00121-0978-00,5 mL, $23.38 , $15.20 , $19.64 , N/A , N/A , $18.89 , $21.04 , $19.79 , $21.04 , $21.04 , $21.04 , $19.87 , N/A , $21.59 , $22.21 , $19.87 , $21.74 , $21.74 , $22.21 , $22.44 , $19.13 , $21.04 , $19.87 , $18.47 , N/A , $18.92 , $18.92 , $22.21 , $20.06 , $18.47 , $22.44 
Open Rx Fingr Articular Fx,26746,N/A,N/A,N/A," $1,978.00 "," $1,285.70 "," $4,544.15 ", $713.02 , $381.08 ," $3,573.09 "," $3,558.02 "," $1,839.54 "," $1,780.20 "," $1,780.20 "," $1,582.40 "," $1,582.40 ", $381.08 ," $1,826.29 "," $1,879.10 "," $1,780.20 "," $1,780.20 "," $1,780.20 "," $1,839.54 "," $1,898.88 "," $4,226.05 "," $1,681.30 "," $3,916.02 "," $4,238.02 ", N/A ," $3,642.81 "," $3,642.81 "," $1,879.10 "," $4,281.58 ", $381.08 ," $4,544.15 "
 Pro Cmbnd Anterpost Colporraphy W/Cysto ,CPT® 57260,0982 - PRO FEE/OUTPT,N/A,N/A," $4,964.00 "," $3,226.60 "," $3,680.35 ", $744.02 , $768.38 ," $3,395.95 "," $3,378.00 "," $4,616.52 "," $4,467.60 "," $4,467.60 "," $3,971.20 "," $3,971.20 ", $768.38 ," $4,583.26 "," $4,715.80 "," $4,467.60 "," $4,467.60 "," $4,467.60 "," $4,616.52 "," $4,765.44 "," $3,841.26 "," $4,219.40 "," $4,435.18 "," $3,123.34 ", N/A ," $3,462.21 "," $3,462.21 "," $4,715.80 "," $4,152.72 ", $744.02 ," $4,765.44 "
 Pro CT Abdomen W/O Dye ,CPT® 74150,0972 - PRO FEE/RAD/DX,N/A,N/A, $670.00 , $435.50 , $974.05 , $139.75 , $242.66 , $713.75 , $936.69 , $623.10 , $603.00 , $603.00 , $536.00 , $536.00 , $242.66 , $618.61 , $636.50 , $603.00 , $603.00 , $603.00 , $623.10 , $643.20 , $815.95 , $569.50 ," $1,018.88 ", $972.21 , N/A , $727.68 , $727.68 , $636.50 , $842.32 , $139.75 ," $1,018.88 "
Revision of Eyelid,CPT® 67880,N/A,N/A,N/A," $4,244.00 "," $2,758.60 "," $2,260.83 ", $355.44 , $178.69 ," $2,082.78 "," $1,967.75 "," $3,946.92 "," $3,819.60 "," $3,819.60 "," $3,395.20 "," $3,395.20 ", $178.69 ," $3,918.49 "," $4,031.80 "," $3,819.60 "," $3,819.60 "," $3,819.60 "," $3,946.92 "," $4,074.24 "," $3,104.12 "," $3,607.40 "," $2,035.62 "," $2,646.97 ", N/A ," $2,123.42 "," $2,123.42 "," $4,031.80 "," $2,343.99 ", $178.69 ," $4,074.24 "
" Fac Nuclear Rx, Intra-Arterial ",CPT® 79445,0340 - NUCLEAR MEDICINE,N/A,N/A, $536.00 , $348.40 , $450.24 , $160.02 , $203.80 , $433.09 , $482.40 , $453.78 , $482.40 , $482.40 , $482.40 , $455.60 , $199.80 , $494.89 , $509.20 , $455.60 , $498.48 , $498.48 , $509.20 , $514.56 , $438.56 , $482.40 , $455.60 , $423.44 , N/A , $433.78 , $433.78 , $509.20 , $459.94 , $160.02 , $514.56 
 Fac Nitric Oxide Inhaled per Hour ,Custom 2500000001,0220 - SPECIAL CHARGES,N/A,N/A, $643.00 , $417.95 , $540.12 , N/A , N/A , $519.54 , $578.70 , $544.36 , $578.70 , $578.70 , $578.70 , $546.55 , N/A , $593.68 , $610.85 , $546.55 , $597.99 , $597.99 , $610.85 , $617.28 , $526.10 , $578.70 , $546.55 , $507.97 , N/A , $520.38 , $520.38 , $610.85 , $551.76 , $507.97 , $617.28 
 Hand Min 3 Views ,CPT® 73130,0320 - DX X-RAY,N/A,N/A, $335.00 , $217.75 , $281.40 , $36.30 , $29.84 , $270.68 , $301.50 , $283.61 , $301.50 , $301.50 , $301.50 , $284.75 , $29.25 , $309.31 , $318.25 , $284.75 , $311.55 , $311.55 , $318.25 , $321.60 , $274.10 , $301.50 , $284.75 , $264.65 , N/A , $271.12 , $271.12 , $318.25 , $287.46 , $29.25 , $321.60 
 Pro US Pg Uter R-T Img Lmtd 1+ Fetuses ,CPT® 76815,0972 - PRO FEE/RAD/DX,N/A,N/A, $266.00 , $172.90 , $462.43 , $80.48 , $87.65 , $405.52 , $478.15 , $247.38 , $239.40 , $239.40 , $212.80 , $212.80 , $87.65 , $245.60 , $252.70 , $239.40 , $239.40 , $239.40 , $247.38 , $255.36 , $466.34 , $226.10 , $520.03 , $475.70 , N/A , $413.43 , $413.43 , $252.70 , $478.57 , $80.48 , $520.03 
Reduce Testis Torsion,CPT® 54600,N/A,N/A,N/A," $2,491.00 "," $1,619.15 "," $2,010.66 ", $433.54 , $401.40 ," $1,453.99 "," $1,471.13 "," $2,316.63 "," $2,241.90 "," $2,241.90 "," $1,992.80 "," $1,992.80 ", $401.40 ," $2,299.94 "," $2,366.45 "," $2,241.90 "," $2,241.90 "," $2,241.90 "," $2,316.63 "," $2,391.36 "," $1,887.65 "," $2,117.35 "," $2,340.69 "," $2,199.79 ", N/A ," $1,482.36 "," $1,482.36 "," $2,366.45 "," $1,776.72 ", $401.40 ," $2,391.36 "
Moderna Admin Peds 6m - 5y Third Dose,CPT® 0113A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $56.00 , $128.02 , N/A , N/A , N/A , $66.50 , N/A , $38.92 , $128.02 
 Pro Exc Cyst/Aberrant Breast Tissue Open 1/> Les ,CPT® 19120,0982 - PRO FEE/OUTPT,N/A,N/A," $3,216.00 "," $2,090.40 "," $1,309.41 ", $390.34 , $312.04 ," $1,110.98 "," $1,084.83 "," $2,990.88 "," $2,894.40 "," $2,894.40 "," $2,572.80 "," $2,572.80 ", $312.04 ," $2,969.33 "," $3,055.20 "," $2,894.40 "," $2,894.40 "," $2,894.40 "," $2,990.88 "," $3,087.36 "," $1,429.95 "," $2,733.60 "," $2,185.48 "," $1,408.87 ", N/A ," $1,132.66 "," $1,132.66 "," $3,055.20 "," $1,313.51 ", $312.04 ," $3,087.36 "
Iaad Ia Respiratory Synctial Virus,CPT® 87420,N/A,N/A,N/A, $111.00 , $72.15 , N/A , $14.19 , $14.19 , $67.85 , $81.18 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $14.19 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $92.88 , $94.35 , $77.85 , $43.47 , N/A , $63.32 , $63.32 , $105.45 , $69.20 , $14.19 , $106.56 
"Wrist Arthroscop,Release Xvers Lig",CPT® 29848,N/A,N/A,N/A," $3,269.00 "," $2,124.85 "," $3,129.75 ", $493.19 , $426.81 ," $2,464.43 "," $2,466.23 "," $3,040.17 "," $2,942.10 "," $2,942.10 "," $2,615.20 "," $2,615.20 ", $426.81 ," $3,018.27 "," $3,105.55 "," $2,942.10 "," $2,942.10 "," $2,942.10 "," $3,040.17 "," $3,138.24 "," $2,907.21 "," $2,778.65 "," $2,711.78 "," $2,927.67 ", N/A ," $2,512.52 "," $2,512.52 "," $3,105.55 "," $2,953.09 ", $426.81 ," $3,138.24 "
X-Ray Urethrocystogram,CPT® 74450,N/A,N/A,N/A, $893.00 , $580.45 , $430.82 , $75.59 , $74.28 , $348.75 , $360.37 , $830.49 , $803.70 , $803.70 , $714.40 , $714.40 , $74.28 , $824.51 , $848.35 , $803.70 , $803.70 , $803.70 , $830.49 , $857.28 , $426.74 , $759.05 , $402.54 ," $1,238.28 ", N/A , $355.56 , $355.56 , $848.35 , $411.56 , $74.28 ," $1,238.28 "
 Fac Interrog Dev Eval Scrms Phys/Qhp in Person ,CPT® 93291,0480 - CARDIOLOGY,N/A,N/A, $266.00 , $172.90 , $223.44 , $49.12 , $39.27 , $214.93 , $239.40 , $225.20 , $239.40 , $239.40 , $239.40 , $226.10 , $38.50 , $245.60 , $252.70 , $226.10 , $247.38 , $247.38 , $252.70 , $255.36 , $217.64 , $239.40 , $226.10 , $210.14 , N/A , $215.27 , $215.27 , $252.70 , $228.25 , $38.50 , $255.36 
Repair Tympanic Membrane,CPT® 69610,N/A,N/A,N/A," $2,250.00 "," $1,462.50 "," $1,357.15 ", $276.82 , $48.28 ," $1,399.32 "," $1,427.07 "," $2,092.50 "," $2,025.00 "," $2,025.00 "," $1,800.00 "," $1,800.00 ", $48.28 ," $2,077.43 "," $2,137.50 "," $2,025.00 "," $2,025.00 "," $2,025.00 "," $2,092.50 "," $2,160.00 "," $1,477.52 "," $1,912.50 "," $1,557.49 "," $1,402.90 ", N/A ," $1,426.62 "," $1,426.62 "," $2,137.50 "," $1,628.96 ", $48.28 ," $2,160.00 "
"Closed Rx Radial Shaft Fx,Manipulatn",CPT® 25505,N/A,N/A,N/A," $3,310.00 "," $2,151.50 "," $2,830.49 ", $449.44 , $307.34 ," $2,214.08 "," $2,235.49 "," $3,078.30 "," $2,979.00 "," $2,979.00 "," $2,648.00 "," $2,648.00 ", $307.34 ," $3,056.12 "," $3,144.50 "," $2,979.00 "," $2,979.00 "," $2,979.00 "," $3,078.30 "," $3,177.60 "," $2,620.32 "," $2,813.50 "," $2,458.44 "," $2,598.41 ", N/A ," $2,257.28 "," $2,257.28 "," $3,144.50 "," $2,653.10 ", $307.34 ," $3,177.60 "
"Bx/Remv,Lymph Node,Deep Cerv",38510,N/A,N/A,N/A," $5,210.00 "," $3,386.50 "," $1,947.85 ", $395.28 , $512.47 ," $1,473.28 "," $1,516.59 "," $4,845.30 "," $4,689.00 "," $4,689.00 "," $4,168.00 "," $4,168.00 ", $512.47 ," $4,810.39 "," $4,949.50 "," $4,689.00 "," $4,689.00 "," $4,689.00 "," $4,845.30 "," $5,001.60 "," $2,076.31 "," $4,428.50 "," $2,231.86 "," $2,025.57 ", N/A ," $1,502.03 "," $1,502.03 "," $4,949.50 "," $1,742.55 ", $395.28 ," $5,001.60 "
 Pro Removal Hand Lesion Subcut ,CPT® 26115,0982 - PRO FEE/OUTPT,N/A,N/A," $3,545.00 "," $2,304.25 "," $2,032.75 ", $321.14 , $112.10 ," $1,602.76 "," $1,606.38 "," $3,296.85 "," $3,190.50 "," $3,190.50 "," $2,836.00 "," $2,836.00 ", $112.10 ," $3,273.10 "," $3,367.75 "," $3,190.50 "," $3,190.50 "," $3,190.50 "," $3,296.85 "," $3,403.20 "," $1,888.95 "," $3,013.25 "," $1,764.44 "," $1,905.46 ", N/A ," $1,634.04 "," $1,634.04 "," $3,367.75 "," $1,920.58 ", $112.10 ," $3,403.20 "
Iaadiadoo Hiv1 Antigen W/Hiv1 & Hiv2 Antibodies,CPT® 87806,N/A,N/A,N/A, $231.00 , $150.15 , N/A , $33.43 , $26.81 , $136.24 , $161.33 , $214.83 , $207.90 , $207.90 , $184.80 , $184.80 , $26.81 , $213.28 , $219.45 , $207.90 , $207.90 , $207.90 , $214.83 , $221.76 , $218.81 , $196.35 , $156.69 , $96.25 , N/A , $127.15 , $127.15 , $219.45 , $138.94 , $26.81 , $221.76 
 EPOETIN ALFA-EPBX 3000 UNIT/ML IJ SOLN ,HCPCS Q5105,0636 - DRUGS REQUIRING DETAILED CODIN,00069-1306-10,1 mL, $97.30 , $63.25 , $81.73 , $0.77 , N/A , $78.62 , $87.57 , $82.37 , $87.57 , $87.57 , $87.57 , $82.71 , N/A , $89.84 , $92.44 , $82.71 , $90.49 , $90.49 , $92.44 , $93.41 , $79.61 , $87.57 , $82.71 , $76.87 , N/A , $78.74 , $78.74 , $92.44 , $83.49 , $0.77 , $93.41 
 PHENOBARBITAL 16.2 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,63739-0192-10,1 tablet, $3.55 , $2.31 , $2.98 , N/A , N/A , $2.87 , $3.20 , $3.01 , $3.20 , $3.20 , $3.20 , $3.02 , N/A , $3.28 , $3.37 , $3.02 , $3.30 , $3.30 , $3.37 , $3.41 , $2.90 , $3.20 , $3.02 , $2.80 , N/A , $2.87 , $2.87 , $3.37 , $3.05 , $2.80 , $3.41 
 Fac Bld Typing Ag Scr Unit Pt Serum Scr ,CPT® 86904,0300 - LABORATORY,N/A,N/A, $68.00 , $44.20 , $57.12 , $16.67 , $13.20 , $54.94 , $61.20 , $57.57 , $61.20 , $61.20 , $61.20 , $57.80 , $12.94 , $62.78 , $64.60 , $57.80 , $63.24 , $63.24 , $64.60 , $65.28 , $55.64 , $61.20 , $57.80 , $53.72 , N/A , $55.03 , $55.03 , $64.60 , $58.35 , $12.94 , $65.28 
Iadna Sarscov2 & Inf a&B & Rsv Mult Amp Probe Tq,CPT® 87637,N/A,N/A,N/A, $553.00 , $359.45 , N/A , $145.48 , $145.48 , N/A , N/A , $514.29 , $497.70 , $497.70 , $442.40 , $442.40 , $145.48 , $510.58 , $525.35 , $497.70 , $497.70 , $497.70 , $514.29 , $530.88 , N/A , $470.05 , $680.07 , $445.22 , N/A , $553.40 , $553.40 , $525.35 , $604.75 , $145.48 , $680.07 
 Fac Physical Performance Test ,CPT® 97750,0430 - OCCUPATION THER,N/A,N/A, $208.00 , $135.20 , $174.72 , $33.72 , $25.05 , $168.06 , $187.20 , $176.09 , $187.20 , $187.20 , $187.20 , $176.80 , $24.56 , $192.05 , $197.60 , $176.80 , $193.44 , $193.44 , $197.60 , $199.68 , $170.19 , $187.20 , $176.80 , $164.32 , N/A , $168.33 , $168.33 , $197.60 , $178.48 , $24.56 , $199.68 
 Diabetes With Cc ,MS DRG V40 (FY2023) 638,N/A,N/A,N/A," $17,479.27 "," $11,361.53 "," $14,682.59 ", N/A , N/A ," $14,123.25 "," $15,731.34 "," $14,797.95 "," $15,731.34 "," $15,731.34 "," $15,731.34 "," $14,857.38 ", N/A ," $16,138.61 "," $16,605.31 "," $14,857.38 "," $16,255.72 "," $16,255.72 "," $16,605.31 "," $16,780.10 "," $14,301.54 "," $15,731.34 "," $14,857.38 "," $13,808.62 ", N/A ," $14,145.97 "," $14,145.97 "," $16,605.31 "," $14,998.96 "," $13,808.62 "," $16,780.10 "
"Closed Rx Mid Humerus Fx,Manipulatn",24505,N/A,N/A,N/A," $2,578.00 "," $1,675.70 "," $2,790.13 ", $440.14 , $384.19 ," $2,171.23 "," $2,194.08 "," $2,397.54 "," $2,320.20 "," $2,320.20 "," $2,062.40 "," $2,062.40 ", $384.19 ," $2,380.27 "," $2,449.10 "," $2,320.20 "," $2,320.20 "," $2,320.20 "," $2,397.54 "," $2,474.88 "," $2,578.50 "," $2,191.30 "," $2,415.62 "," $2,549.14 ", N/A ," $2,213.60 "," $2,213.60 "," $2,449.10 "," $2,601.78 ", $384.19 ," $2,790.13 "
 Hiv Ermh ,CPT® 86703,0302 - LAB/IMMUNOLOGY,N/A,N/A, $123.00 , $79.95 , $103.32 , $13.98 , $13.98 , $99.38 , $110.70 , $104.13 , $110.70 , $110.70 , $110.70 , $104.55 , $13.71 , $113.57 , $116.85 , $104.55 , $114.39 , $114.39 , $116.85 , $118.08 , $100.64 , $110.70 , $104.55 , $97.17 , N/A , $99.54 , $99.54 , $116.85 , $105.55 , $13.71 , $118.08 
"Hysteroscopy,W/Endometrial Ablation",58563,N/A,N/A,N/A," $7,123.00 "," $4,629.95 "," $1,145.00 ", $232.15 ," $1,306.81 "," $1,393.41 "," $1,387.53 "," $6,624.39 "," $6,410.70 "," $6,410.70 "," $5,698.40 "," $5,698.40 "," $1,306.81 "," $6,576.67 "," $6,766.85 "," $6,410.70 "," $6,410.70 "," $6,410.70 "," $6,624.39 "," $6,838.08 "," $1,207.19 "," $6,054.55 "," $1,826.88 "," $1,025.91 ", N/A ," $1,420.60 "," $1,420.60 "," $6,766.85 "," $1,703.93 ", $232.15 ," $6,838.08 "
 Veeg 2-12 Hours Unmonitored ,CPT® 95711,0740 - EEG,N/A,N/A," $1,731.00 "," $1,125.15 "," $1,454.04 ", $132.99 , $206.53 ," $1,398.65 "," $1,557.90 "," $1,465.46 "," $1,557.90 "," $1,557.90 "," $1,557.90 "," $1,471.35 ", $202.48 ," $1,598.23 "," $1,644.45 "," $1,471.35 "," $1,609.83 "," $1,609.83 "," $1,644.45 "," $1,661.76 "," $1,416.30 "," $1,557.90 "," $1,471.35 "," $1,367.49 ", N/A ," $1,400.90 "," $1,400.90 "," $1,644.45 "," $1,485.37 ", $132.99 ," $1,661.76 "
 GLYBURIDE 1.25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,23155-0056-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Pro Treat Thigh Fracture ,CPT® 27245,0975 - PRO FEE/OR,N/A,N/A," $8,324.00 "," $5,410.60 "," $7,400.45 "," $1,157.06 "," $1,107.65 "," $5,945.99 "," $5,888.38 "," $7,741.32 "," $7,491.60 "," $7,491.60 "," $6,659.20 "," $6,659.20 "," $1,107.65 "," $7,685.55 "," $7,907.80 "," $7,491.60 "," $7,491.60 "," $7,491.60 "," $7,741.32 "," $7,991.04 "," $6,899.58 "," $7,075.40 "," $6,515.40 "," $6,990.58 ", N/A ," $6,062.00 "," $6,062.00 "," $7,907.80 "," $7,125.01 "," $1,107.65 "," $7,991.04 "
 Fac Conv Ext Bil Drg Cath to Int-Ext Bil Drg Cath ,CPT® 47535,0361 - OR/MINOR,N/A,N/A," $6,083.00 "," $3,953.95 "," $5,109.72 ", $185.53 , $874.33 ," $4,915.06 "," $5,474.70 "," $5,149.87 "," $5,474.70 "," $5,474.70 "," $5,474.70 "," $5,170.55 ", $857.19 ," $5,616.43 "," $5,778.85 "," $5,170.55 "," $5,657.19 "," $5,657.19 "," $5,778.85 "," $5,839.68 "," $4,977.11 "," $5,474.70 "," $5,170.55 "," $4,805.57 ", N/A ," $4,922.97 "," $4,922.97 "," $5,778.85 "," $5,219.82 ", $185.53 ," $5,839.68 "
Anastomsis of Ureter,CPT® 50760,N/A,N/A,N/A," $7,537.00 "," $4,899.05 "," $6,069.36 "," $1,064.03 "," $1,229.45 "," $5,485.11 "," $5,120.12 "," $7,009.41 "," $6,783.30 "," $6,783.30 "," $6,029.60 "," $6,029.60 "," $1,229.45 "," $6,958.91 "," $7,160.15 "," $6,783.30 "," $6,783.30 "," $6,783.30 "," $7,009.41 "," $7,235.52 "," $6,082.37 "," $6,406.45 "," $5,864.22 "," $6,828.03 ", N/A ," $5,592.13 "," $5,592.13 "," $7,160.15 "," $6,572.75 "," $1,064.03 "," $7,235.52 "
Echo Transesophag R-T 2d W/Prb Img Acquisj I&R,CPT® 93312,N/A,N/A,N/A," $2,030.00 "," $1,319.50 "," $1,526.92 ", $233.60 , $391.89 ," $1,649.91 "," $1,708.69 "," $1,887.90 "," $1,827.00 "," $1,827.00 "," $1,624.00 "," $1,624.00 ", $391.89 ," $1,874.30 "," $1,928.50 "," $1,827.00 "," $1,827.00 "," $1,827.00 "," $1,887.90 "," $1,948.80 "," $1,528.98 "," $1,725.50 "," $1,603.87 "," $1,486.71 ", N/A ," $1,682.11 "," $1,682.11 "," $1,928.50 "," $1,864.61 ", $233.60 ," $1,948.80 "
 Foot 2 Views ,CPT® 73620,0320 - DX X-RAY,N/A,N/A, $262.00 , $170.30 , $220.08 , $27.74 , $25.48 , $211.70 , $235.80 , $221.81 , $235.80 , $235.80 , $235.80 , $222.70 , $24.98 , $241.90 , $248.90 , $222.70 , $243.66 , $243.66 , $248.90 , $251.52 , $214.37 , $235.80 , $222.70 , $206.98 , N/A , $212.04 , $212.04 , $248.90 , $224.82 , $24.98 , $251.52 
"Incis/Drain Arm,Deep Absc/Hematoma",CPT® 23930,N/A,N/A,N/A," $2,276.00 "," $1,479.40 "," $1,305.01 ", $203.88 , $266.76 ," $1,030.60 "," $1,039.43 "," $2,116.68 "," $2,048.40 "," $2,048.40 "," $1,820.80 "," $1,820.80 ", $266.76 ," $2,101.43 "," $2,162.20 "," $2,048.40 "," $2,048.40 "," $2,048.40 "," $2,116.68 "," $2,184.96 "," $1,215.91 "," $1,934.60 "," $1,150.72 "," $1,229.44 ", N/A ," $1,050.71 "," $1,050.71 "," $2,162.20 "," $1,234.97 ", $203.88 ," $2,184.96 "
Pro Arthrs Elbw Surg Synvct Compl,29836,N/A,N/A,N/A," $3,728.00 "," $2,423.20 "," $3,574.61 ", $561.03 , $630.68 ," $2,782.10 "," $2,772.14 "," $3,467.04 "," $3,355.20 "," $3,355.20 "," $2,982.40 "," $2,982.40 ", $630.68 ," $3,442.06 "," $3,541.60 "," $3,355.20 "," $3,355.20 "," $3,355.20 "," $3,467.04 "," $3,578.88 "," $3,312.52 "," $3,168.80 "," $3,059.67 "," $3,310.25 ", N/A ," $2,836.38 "," $2,836.38 "," $3,541.60 "," $3,333.77 ", $561.03 ," $3,578.88 "
 CEFDINIR 125 MG/5ML PO SUSR ,HCPCS RXC637,0250 - PHARMACY,68180-0722-05,100 mL, $415.06 , $269.79 , $348.65 , N/A , N/A , $335.37 , $373.55 , $351.39 , $373.55 , $373.55 , $373.55 , $352.80 , N/A , $383.22 , $394.31 , $352.80 , $386.01 , $386.01 , $394.31 , $398.46 , $339.60 , $373.55 , $352.80 , $327.90 , N/A , $335.91 , $335.91 , $394.31 , $356.16 , $327.90 , $398.46 
Nuclear Antigen Antibody,CPT® 86235,N/A,N/A,N/A, $167.00 , $108.55 , N/A , $18.29 , $18.29 , $101.48 , $121.36 , $155.31 , $150.30 , $150.30 , $133.60 , $133.60 , $18.29 , $154.19 , $158.65 , $150.30 , $150.30 , $150.30 , $155.31 , $160.32 , $119.72 , $141.95 , $116.77 , $65.03 , N/A , $94.71 , $94.71 , $158.65 , $103.50 , $18.29 , $160.32 
 Fac Revsc Opn/Prq Tib/Pero W/Angioplasty Uni Ea Vsl ,CPT® 37232,0360 - OR SERVICES,N/A,N/A," $7,558.00 "," $4,912.70 "," $6,348.72 ", $179.35 , $148.88 ," $6,106.86 "," $6,802.20 "," $6,398.60 "," $6,802.20 "," $6,802.20 "," $6,802.20 "," $6,424.30 ", $145.96 ," $6,978.30 "," $7,180.10 "," $6,424.30 "," $7,028.94 "," $7,028.94 "," $7,180.10 "," $7,255.68 "," $6,183.96 "," $6,802.20 "," $6,424.30 "," $5,970.82 ", N/A ," $6,116.69 "," $6,116.69 "," $7,180.10 "," $6,485.52 ", $145.96 ," $7,255.68 "
 TROSPIUM CHLORIDE ER 60 MG PO CP24 ,HCPCS RXC637,0250 - PHARMACY,70010-0027-03,1 capsule, $55.30 , $35.95 , $46.45 , N/A , N/A , $44.68 , $49.77 , $46.82 , $49.77 , $49.77 , $49.77 , $47.01 , N/A , $51.06 , $52.54 , $47.01 , $51.43 , $51.43 , $52.54 , $53.09 , $45.25 , $49.77 , $47.01 , $43.69 , N/A , $44.75 , $44.75 , $52.54 , $47.45 , $43.69 , $53.09 
Arthrocentesis Aspir&/Inj Interm Jt/Burs W/US,20606,N/A,N/A,N/A, $464.00 , $301.60 , $319.15 , $49.66 , $62.45 , $252.02 , $260.06 , $431.52 , $417.60 , $417.60 , $371.20 , $371.20 , $62.45 , $428.41 , $440.80 , $417.60 , $417.60 , $417.60 , $431.52 , $445.44 , $301.54 , $394.40 , $273.65 , $307.57 , N/A , $256.93 , $256.93 , $440.80 , $302.01 , $49.66 , $445.44 
Antidepressants Serotonergic Class 1 or 2,CPT® 80332,N/A,N/A,N/A, $338.00 , $219.70 , N/A , N/A , N/A , N/A , N/A , $314.34 , $304.20 , $304.20 , $270.40 , $270.40 , N/A , $312.08 , $321.10 , $304.20 , $304.20 , $304.20 , $314.34 , $324.48 , N/A , $287.30 , $114.69 , $67.79 , N/A , $90.04 , $90.04 , $321.10 , $98.20 , $67.79 , $324.48 
" Fac Artery X-Rays, Spine ",CPT® 75705,0320 - DX X-RAY,N/A,N/A," $2,303.00 "," $1,496.95 "," $1,934.52 ", $237.74 , $295.08 ," $1,860.82 "," $2,072.70 "," $1,949.72 "," $2,072.70 "," $2,072.70 "," $2,072.70 "," $1,957.55 ", $289.29 ," $2,126.36 "," $2,187.85 "," $1,957.55 "," $2,141.79 "," $2,141.79 "," $2,187.85 "," $2,210.88 "," $1,884.31 "," $2,072.70 "," $1,957.55 "," $1,819.37 ", N/A ," $1,863.82 "," $1,863.82 "," $2,187.85 "," $1,976.20 ", $237.74 ," $2,210.88 "
 Major Chest Trauma With Cc ,MS DRG V40 (FY2023) 184,N/A,N/A,N/A," $24,335.84 "," $15,818.30 "," $20,442.11 ", N/A , N/A ," $19,663.36 "," $21,902.26 "," $20,602.72 "," $21,902.26 "," $21,902.26 "," $21,902.26 "," $20,685.46 ", N/A ," $22,469.28 "," $23,119.05 "," $20,685.46 "," $22,632.33 "," $22,632.33 "," $23,119.05 "," $23,362.41 "," $19,911.58 "," $21,902.26 "," $20,685.46 "," $19,225.31 ", N/A ," $19,695.00 "," $19,695.00 "," $23,119.05 "," $20,882.58 "," $19,225.31 "," $23,362.41 "
"Injection,Therap/Proph/Diagnost, Intra-Arterial",CPT® 96373,N/A,N/A,N/A, $82.00 , $53.30 , $41.76 , $17.81 , $16.10 , $43.18 , $45.21 , $76.26 , $73.80 , $73.80 , $65.60 , $65.60 , $16.10 , $75.71 , $77.90 , $73.80 , $73.80 , $73.80 , $76.26 , $78.72 , $66.39 , $69.70 , $59.81 , $72.14 , N/A , $44.02 , $44.02 , $77.90 , $51.32 , $16.10 , $78.72 
 CLONAZEPAM 0.25 MG TAB (COMES FROM 0.5 MG TABLET) ,HCPCS RXC637,0250 - PHARMACY,00001-0053-01,1 tablet, $4.10 , $2.67 , $3.44 , N/A , N/A , $3.31 , $3.69 , $3.47 , $3.69 , $3.69 , $3.69 , $3.49 , N/A , $3.79 , $3.90 , $3.49 , $3.81 , $3.81 , $3.90 , $3.94 , $3.35 , $3.69 , $3.49 , $3.24 , N/A , $3.32 , $3.32 , $3.90 , $3.52 , $3.24 , $3.94 
Injection 1 or 2 Musclegr,20552,N/A,N/A,N/A, $360.00 , $234.00 , $95.85 , $35.51 , $26.41 , $186.23 , $182.64 , $334.80 , $324.00 , $324.00 , $288.00 , $288.00 , $26.41 , $332.39 , $342.00 , $324.00 , $324.00 , $324.00 , $334.80 , $345.60 , $215.67 , $306.00 , $199.82 , $220.70 , N/A , $189.86 , $189.86 , $342.00 , $223.15 , $26.41 , $345.60 
Lymphocyte Transformation,CPT® 86353,N/A,N/A,N/A, $196.00 , $127.40 , N/A , $50.01 , $50.01 , $277.38 , $331.78 , $182.28 , $176.40 , $176.40 , $156.80 , $156.80 , $50.01 , $180.97 , $186.20 , $176.40 , $176.40 , $176.40 , $182.28 , $188.16 , $327.38 , $166.60 , $321.12 , $177.78 , N/A , $258.87 , $258.87 , $186.20 , $282.89 , $50.01 , $331.78 
 Fac Assay of Serotonin ,CPT® 84260,0301 - LAB/CHEMISTRY,N/A,N/A, $279.00 , $181.35 , $234.36 , $31.60 , $31.60 , $225.43 , $251.10 , $236.20 , $251.10 , $251.10 , $251.10 , $237.15 , $30.98 , $257.60 , $265.05 , $237.15 , $259.47 , $259.47 , $265.05 , $267.84 , $228.28 , $251.10 , $237.15 , $220.41 , N/A , $225.79 , $225.79 , $265.05 , $239.41 , $30.98 , $267.84 
 Pro Layer Closure Wound 2.6cm - 7.5cm ,CPT® 12042,0982 - PRO FEE/OUTPT,N/A,N/A," $1,172.00 ", $761.80 , $627.61 , $188.46 , $103.08 , $547.43 , $537.01 ," $1,089.96 "," $1,054.80 "," $1,054.80 ", $937.60 , $937.60 , $103.08 ," $1,082.11 "," $1,113.40 "," $1,054.80 "," $1,054.80 "," $1,054.80 "," $1,089.96 "," $1,125.12 ", $689.37 , $996.20 ," $1,066.87 ", $703.69 , N/A , $558.12 , $558.12 ," $1,113.40 ", $647.23 , $103.08 ," $1,125.12 "
 ED US Abdominal Aorta Real Time Screen Study Aaa ,CPT® 76706,0402 - ULTRASOUND,N/A,N/A, $559.00 , $363.35 , $469.56 , $105.25 , $74.59 , $451.67 , $503.10 , $473.25 , $503.10 , $503.10 , $503.10 , $475.15 , $73.13 , $516.12 , $531.05 , $475.15 , $519.87 , $519.87 , $531.05 , $536.64 , $457.37 , $503.10 , $475.15 , $441.61 , N/A , $452.40 , $452.40 , $531.05 , $479.68 , $73.13 , $536.64 
 ER MD DRN Outr Ear Cnl Ls - Lh ,CPT® 69020,0981 - PRO FEE/ER,N/A,N/A, $697.00 , $453.05 , $686.75 , $140.65 , $30.71 , $684.27 , $713.79 , $648.21 , $627.30 , $627.30 , $557.60 , $557.60 , $30.71 , $643.54 , $662.15 , $627.30 , $627.30 , $627.30 , $648.21 , $669.12 , $743.03 , $592.45 , $777.85 , $687.84 , N/A , $697.62 , $697.62 , $662.15 , $796.57 , $30.71 , $796.57 
Excision Tumor Soft Tissue Pelvis&Hip Subq 3+Cm,27043,N/A,N/A,N/A," $3,115.00 "," $2,024.75 "," $2,818.73 ", $440.04 , $385.10 ," $2,248.05 "," $2,253.94 "," $2,896.95 "," $2,803.50 "," $2,803.50 "," $2,492.00 "," $2,492.00 ", $385.10 ," $2,876.08 "," $2,959.25 "," $2,803.50 "," $2,803.50 "," $2,803.50 "," $2,896.95 "," $2,990.40 "," $2,609.95 "," $2,647.75 "," $2,497.69 "," $2,638.75 ", N/A ," $2,291.91 "," $2,291.91 "," $2,959.25 "," $2,693.81 ", $385.10 ," $2,990.40 "
 LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN ,HCPCS J1956,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9720-24,150 mL, $38.53 , $25.04 , $32.37 , $0.94 , $0.99 , $31.13 , $34.68 , $32.62 , $34.68 , $34.68 , $34.68 , $32.75 , $0.97 , $35.57 , $36.60 , $32.75 , $35.83 , $35.83 , $36.60 , $36.99 , $31.53 , $34.68 , $32.75 , $30.44 , N/A , $31.18 , $31.18 , $36.60 , $33.06 , $0.94 , $36.99 
 Cytogenetics All Panel Fish ,CPT® 88275,0310 - PATHOLOGY LAB,N/A,N/A, $456.00 , $296.40 , $383.04 , $52.21 , $52.21 , $368.45 , $410.40 , $386.05 , $410.40 , $410.40 , $410.40 , $387.60 , $51.19 , $421.02 , $433.20 , $387.60 , $424.08 , $424.08 , $433.20 , $437.76 , $373.10 , $410.40 , $387.60 , $360.24 , N/A , $369.04 , $369.04 , $433.20 , $391.29 , $51.19 , $437.76 
"Nasal Scopy,Sphenoidotomy",CPT® 31287,N/A,N/A,N/A," $1,341.00 ", $871.65 ," $1,085.77 ", $192.08 , $635.98 , $889.08 , $872.75 ," $1,247.13 "," $1,206.90 "," $1,206.90 "," $1,072.80 "," $1,072.80 ", $635.98 ," $1,238.15 "," $1,273.95 "," $1,206.90 "," $1,206.90 "," $1,206.90 "," $1,247.13 "," $1,287.36 "," $1,037.84 "," $1,139.85 "," $1,229.22 "," $1,027.22 ", N/A , $906.43 , $906.43 ," $1,273.95 "," $1,067.51 ", $192.08 ," $1,287.36 "
"Lt Compres Band >=5""/Yd",HCPCS A6450,N/A,N/A,N/A, $11.00 , $7.15 , N/A , $2.38 , $0.73 , N/A , N/A , $10.23 , $9.90 , $9.90 , $8.80 , $8.80 , $0.73 , $10.16 , $10.45 , $9.90 , $9.90 , $9.90 , $10.23 , $10.56 , N/A , $9.35 , $3.88 , $2.16 , N/A , N/A , N/A , $10.45 , N/A , $0.73 , $10.56 
 TACROLIMUS 1 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-7097-61,1 capsule, $8.43 , $5.48 , $7.08 , N/A , N/A , $6.81 , $7.59 , $7.14 , $7.59 , $7.59 , $7.59 , $7.17 , N/A , $7.78 , $8.01 , $7.17 , $7.84 , $7.84 , $8.01 , $8.09 , $6.90 , $7.59 , $7.17 , $6.66 , N/A , $6.82 , $6.82 , $8.01 , $7.23 , $6.66 , $8.09 
Corticorelin Ovine Triflutal,HCPCS J0795,N/A,N/A,N/A, $34.00 , $22.10 , N/A , N/A , $9.86 , N/A , N/A , $31.62 , $30.60 , $30.60 , $27.20 , $27.20 , $9.86 , $31.39 , $32.30 , $30.60 , $30.60 , $30.60 , $31.62 , $32.64 , $12.57 , $28.90 , $11.03 , $14.28 , N/A , N/A , N/A , $32.30 , N/A , $9.86 , $32.64 
 PROCAINAMIDE HCL 100 MG/ML IJ SOLN ,HCPCS J2690,0636 - DRUGS REQUIRING DETAILED CODIN,00409-1902-01,10 mL, $540.51 , $351.33 , $454.03 , $314.15 , $167.66 , $436.73 , $486.46 , $457.60 , $486.46 , $486.46 , $486.46 , $459.43 , $164.37 , $499.05 , $513.48 , $459.43 , $502.67 , $502.67 , $513.48 , $518.89 , $442.25 , $486.46 , $459.43 , $427.00 , N/A , $437.43 , $437.43 , $513.48 , $463.81 , $164.37 , $518.89 
 Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC ,MS DRG V40 (FY2023) 989,N/A,N/A,N/A," $40,441.97 "," $26,287.28 "," $33,971.25 ", N/A , N/A ," $32,677.11 "," $36,397.77 "," $34,238.17 "," $36,397.77 "," $36,397.77 "," $36,397.77 "," $34,375.67 ", N/A ," $37,340.07 "," $38,419.87 "," $34,375.67 "," $37,611.03 "," $37,611.03 "," $38,419.87 "," $38,824.29 "," $33,089.62 "," $36,397.77 "," $34,375.67 "," $31,949.16 ", N/A ," $32,729.69 "," $32,729.69 "," $38,419.87 "," $34,703.25 "," $31,949.16 "," $38,824.29 "
 ATENOLOL 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,51079-0759-20,1 tablet, $4.11 , $2.67 , $3.45 , N/A , N/A , $3.32 , $3.70 , $3.48 , $3.70 , $3.70 , $3.70 , $3.49 , N/A , $3.79 , $3.90 , $3.49 , $3.82 , $3.82 , $3.90 , $3.95 , $3.36 , $3.70 , $3.49 , $3.25 , N/A , $3.33 , $3.33 , $3.90 , $3.53 , $3.25 , $3.95 
Iaad Ia Clostridium Difficile Toxin,CPT® 87324,N/A,N/A,N/A, $116.00 , $75.40 , N/A , $12.22 , $12.22 , $67.85 , $81.18 , $107.88 , $104.40 , $104.40 , $92.80 , $92.80 , $12.22 , $107.10 , $110.20 , $104.40 , $104.40 , $104.40 , $107.88 , $111.36 , $79.99 , $98.60 , $77.85 , $43.47 , N/A , $63.32 , $63.32 , $110.20 , $69.20 , $12.22 , $111.36 
"Fitting of Glasses,Monofocal",CPT® 92340,N/A,N/A,N/A, $54.00 , $35.10 , N/A , $33.69 , $22.96 , $33.32 , $33.03 , $50.22 , $48.60 , $48.60 , $43.20 , $43.20 , $22.96 , $49.86 , $51.30 , $48.60 , $48.60 , $48.60 , $50.22 , $51.84 , N/A , $45.90 , $55.75 , $39.48 , N/A , $33.98 , $33.98 , $51.30 , $40.41 , $22.96 , $55.75 
" Repair Avm Fistula, Lower Ext ",CPT® 35190,0360 - OR SERVICES,N/A,N/A," $8,331.00 "," $5,415.15 "," $6,998.04 ", $687.62 ," $1,073.41 "," $6,731.45 "," $7,497.90 "," $7,053.02 "," $7,497.90 "," $7,497.90 "," $7,497.90 "," $7,081.35 "," $1,052.36 "," $7,692.01 "," $7,914.45 "," $7,081.35 "," $7,747.83 "," $7,747.83 "," $7,914.45 "," $7,997.76 "," $6,816.42 "," $7,497.90 "," $7,081.35 "," $6,581.49 ", N/A ," $6,742.28 "," $6,742.28 "," $7,914.45 "," $7,148.83 ", $687.62 ," $7,997.76 "
 Fac Drug Screening Methadone ,CPT® 80358,0301 - LAB/CHEMISTRY,N/A,N/A, $166.00 , $107.90 , $139.44 , N/A , N/A , $134.13 , $149.40 , $140.54 , $149.40 , $149.40 , $149.40 , $141.10 , N/A , $153.27 , $157.70 , $141.10 , $154.38 , $154.38 , $157.70 , $159.36 , $135.82 , $149.40 , $141.10 , $131.14 , N/A , $134.34 , $134.34 , $157.70 , $142.44 , $131.14 , $159.36 
Cord Blood Harvesting,HCPCS S2140,N/A,N/A,N/A, $371.00 , $241.15 , N/A , N/A , N/A , N/A , N/A , $345.03 , $333.90 , $333.90 , $296.80 , $296.80 , N/A , $342.54 , $352.45 , $333.90 , $333.90 , $333.90 , $345.03 , $356.16 , N/A , $315.35 , $296.80 , N/A , N/A , N/A , N/A , $352.45 , N/A , $296.80 , $356.16 
 Fac Ft Insert Ucb Berkeley Shell ,HCPCS L3000,0274 - PROSTHETIC DEV,N/A,N/A, $372.00 , $241.80 , $312.48 , $367.46 , $126.91 , $300.58 , $334.80 , $314.94 , $334.80 , $334.80 , $334.80 , $316.20 , $124.42 , $343.47 , $353.40 , $316.20 , $345.96 , $345.96 , $353.40 , $357.12 , $304.37 , $334.80 , $316.20 , $293.88 , N/A , $301.06 , $301.06 , $353.40 , $319.21 , $124.42 , $367.46 
 Pro Exc Tumor Soft Tissue Upper Arm/Elbow Subq 3+Cm ,CPT® 24071,0982 - PRO FEE/OUTPT,N/A,N/A," $3,058.00 "," $1,987.70 "," $2,452.97 ", $382.32 , $332.95 ," $1,943.39 "," $1,947.61 "," $2,843.94 "," $2,752.20 "," $2,752.20 "," $2,446.40 "," $2,446.40 ", $332.95 ," $2,823.45 "," $2,905.10 "," $2,752.20 "," $2,752.20 "," $2,752.20 "," $2,843.94 "," $2,935.68 "," $2,274.55 "," $2,599.30 "," $2,155.15 "," $2,292.22 ", N/A ," $1,981.30 "," $1,981.30 "," $2,905.10 "," $2,328.72 ", $332.95 ," $2,935.68 "
"Cabg, Vein, Single",CPT® 33510,N/A,N/A,N/A," $18,050.00 "," $11,732.50 "," $11,291.80 "," $1,743.57 "," $1,769.61 "," $8,253.69 "," $8,211.72 "," $16,786.50 "," $16,245.00 "," $16,245.00 "," $14,440.00 "," $14,440.00 "," $1,769.61 "," $16,665.57 "," $17,147.50 "," $16,245.00 "," $16,245.00 "," $16,245.00 "," $16,786.50 "," $17,328.00 "," $10,457.14 "," $15,342.50 "," $10,399.31 "," $9,266.12 ", N/A ," $8,414.73 "," $8,414.73 "," $17,147.50 "," $9,559.14 "," $1,743.57 "," $17,328.00 "
"Repair Rotator Cuff,Acute",CPT® 23410,N/A,N/A,N/A," $5,454.00 "," $3,545.10 "," $4,981.80 ", $780.96 , $768.38 ," $3,961.97 "," $3,945.11 "," $5,072.22 "," $4,908.60 "," $4,908.60 "," $4,363.20 "," $4,363.20 ", $768.38 ," $5,035.68 "," $5,181.30 "," $4,908.60 "," $4,908.60 "," $4,908.60 "," $5,072.22 "," $5,235.84 "," $4,634.55 "," $4,635.90 "," $4,356.68 "," $4,667.26 ", N/A ," $4,039.28 "," $4,039.28 "," $5,181.30 "," $4,747.60 ", $768.38 ," $5,235.84 "
Simple Repair 5.1-7.5cm,CPT® 12014,N/A,N/A,N/A, $861.00 , $559.65 , $232.08 , $69.01 , $92.31 , $214.79 , $208.07 , $800.73 , $774.90 , $774.90 , $688.80 , $688.80 , $92.31 , $794.96 , $817.95 , $774.90 , $774.90 , $774.90 , $800.73 , $826.56 , $255.61 , $731.85 , $417.47 , $258.60 , N/A , $218.98 , $218.98 , $817.95 , $253.95 , $69.01 , $826.56 
 Fac Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/Img Gdn ,CPT® 62321,0761 - TREATMENT ROOM,N/A,N/A," $1,832.00 "," $1,190.80 "," $1,538.88 ", $102.63 , $196.67 ," $1,480.26 "," $1,648.80 "," $1,550.97 "," $1,648.80 "," $1,648.80 "," $1,648.80 "," $1,557.20 ", $192.81 ," $1,691.49 "," $1,740.40 "," $1,557.20 "," $1,703.76 "," $1,703.76 "," $1,740.40 "," $1,758.72 "," $1,498.94 "," $1,648.80 "," $1,557.20 "," $1,447.28 ", N/A ," $1,482.64 "," $1,482.64 "," $1,740.40 "," $1,572.04 ", $102.63 ," $1,758.72 "
Exc Skin & Subq Tissue Abd Panniculectomy,CPT® 15830,N/A,N/A,N/A," $5,336.00 "," $3,468.40 "," $3,701.44 "," $1,107.08 ", $888.05 ," $3,186.51 "," $3,097.35 "," $4,962.48 "," $4,802.40 "," $4,802.40 "," $4,268.80 "," $4,268.80 ", $888.05 ," $4,926.73 "," $5,069.20 "," $4,802.40 "," $4,802.40 "," $4,802.40 "," $4,962.48 "," $5,122.56 "," $4,062.72 "," $4,535.60 "," $6,229.95 "," $4,067.23 ", N/A ," $3,248.68 "," $3,248.68 "," $5,069.20 "," $3,767.38 ", $888.05 ," $6,229.95 "
 Fac Unlis Px Hemic/Lymphatic Sys ,CPT® 38999,0360 - OR SERVICES,N/A,N/A," $3,201.00 "," $2,080.65 "," $2,688.84 ", N/A , N/A ," $2,586.41 "," $2,880.90 "," $2,709.97 "," $2,880.90 "," $2,880.90 "," $2,880.90 "," $2,720.85 ", N/A ," $2,955.48 "," $3,040.95 "," $2,720.85 "," $2,976.93 "," $2,976.93 "," $3,040.95 "," $3,072.96 "," $2,619.06 "," $2,880.90 "," $2,720.85 "," $2,528.79 ", N/A ," $2,590.57 "," $2,590.57 "," $3,040.95 "," $2,746.78 "," $2,528.79 "," $3,072.96 "
 CT Maxillofacial/Sinuses/W/O & W/Contrast ,CPT® 70488,0350 - CT SCAN,N/A,N/A," $2,804.00 "," $1,822.60 "," $2,355.36 ", $189.03 , $354.06 ," $2,265.63 "," $2,523.60 "," $2,373.87 "," $2,523.60 "," $2,523.60 "," $2,523.60 "," $2,383.40 ", $347.12 ," $2,588.93 "," $2,663.80 "," $2,383.40 "," $2,607.72 "," $2,607.72 "," $2,663.80 "," $2,691.84 "," $2,294.23 "," $2,523.60 "," $2,383.40 "," $2,215.16 ", N/A ," $2,269.28 "," $2,269.28 "," $2,663.80 "," $2,406.11 ", $189.03 ," $2,691.84 "
 Pro Drainage Rectal Abscess ,CPT® 46050,0982 - PRO FEE/OUTPT,N/A,N/A," $1,319.00 ", $857.35 , $612.76 , $96.47 , $68.62 , $463.98 , $481.35 ," $1,226.67 "," $1,187.10 "," $1,187.10 "," $1,055.20 "," $1,055.20 ", $68.62 ," $1,217.83 "," $1,253.05 "," $1,187.10 "," $1,187.10 "," $1,187.10 "," $1,226.67 "," $1,266.24 ", $436.34 ," $1,121.15 ", $529.87 , $552.66 , N/A , $473.03 , $473.03 ," $1,253.05 ", $494.75 , $68.62 ," $1,266.24 "
Complex Repair 2.6-7.5cm,13132,N/A,N/A,N/A," $2,287.00 "," $1,486.55 ", $971.79 , $290.72 , $268.64 , $861.57 , $839.43 ," $2,126.91 "," $2,058.30 "," $2,058.30 "," $1,829.60 "," $1,829.60 ", $268.64 ," $2,111.59 "," $2,172.65 "," $2,058.30 "," $2,058.30 "," $2,058.30 "," $2,126.91 "," $2,195.52 "," $1,069.42 "," $1,943.95 "," $1,671.67 "," $1,104.41 ", N/A , $878.38 , $878.38 ," $2,172.65 "," $1,018.64 ", $268.64 ," $2,195.52 "
 Fac Chg Tpmt Gene Analaysis Common Variants ,CPT® 81335,0310 - PATHOLOGY LAB,N/A,N/A, $784.00 , $509.60 , $658.56 , $178.31 , $142.64 , $633.47 , $705.60 , $663.73 , $705.60 , $705.60 , $705.60 , $666.40 , $139.84 , $723.87 , $744.80 , $666.40 , $729.12 , $729.12 , $744.80 , $752.64 , $641.47 , $705.60 , $666.40 , $619.36 , N/A , $634.49 , $634.49 , $744.80 , $672.75 , $139.84 , $752.64 
Remov FB/Eye/Ext Eye/Embe,CPT® 65210,N/A,N/A,N/A, $519.00 , $337.35 , $224.64 , $34.99 , $48.54 , $303.27 , $280.98 , $482.67 , $467.10 , $467.10 , $415.20 , $415.20 , $48.54 , $479.19 , $493.05 , $467.10 , $467.10 , $467.10 , $482.67 , $498.24 , $311.97 , $441.15 , $289.02 , $382.47 , N/A , $309.18 , $309.18 , $493.05 , $341.30 , $34.99 , $498.24 
"Exc Skin Benig 3.1-4cm Trunk,Arm,Leg",11404,N/A,N/A,N/A," $1,117.00 ", $726.05 , $522.78 , $157.18 , $175.90 , $439.00 , $431.68 ," $1,038.81 "," $1,005.30 "," $1,005.30 ", $893.60 , $893.60 , $175.90 ," $1,031.33 "," $1,061.15 "," $1,005.30 "," $1,005.30 "," $1,005.30 "," $1,038.81 "," $1,072.32 ", $569.24 , $949.45 , $863.49 , $563.64 , N/A , $447.56 , $447.56 ," $1,061.15 ", $519.02 , $157.18 ," $1,072.32 "
Advance Care Planning First 30 Mins,CPT® 99497,N/A,N/A,N/A, $192.00 , $124.80 , $148.24 , $73.62 , $64.54 , N/A , N/A , $178.56 , $172.80 , $172.80 , $153.60 , $153.60 , $64.54 , $177.27 , $182.40 , $172.80 , $172.80 , $172.80 , $178.56 , $184.32 , $142.10 , $163.20 , $166.61 , $173.58 , N/A , $127.97 , $127.97 , $182.40 , $147.60 , $64.54 , $184.32 
Cast Sup Sht Arm Ped Plaster,HCPCS Q4011,N/A,N/A,N/A, $15.00 , $9.75 , N/A , $5.23 , $3.39 , N/A , N/A , $13.95 , $13.50 , $13.50 , $12.00 , $12.00 , $3.39 , $13.85 , $14.25 , $13.50 , $13.50 , $13.50 , $13.95 , $14.40 , N/A , $12.75 , $20.76 , $4.75 , N/A , N/A , N/A , $14.25 , N/A , $3.39 , $20.76 
 Fac App Skn Sub Grft T/a/L Area/>100scm Adl 100scm ,CPT® 15274,0761 - TREATMENT ROOM,N/A,N/A, $764.00 , $496.60 , $641.76 , $41.10 , $54.02 , $617.31 , $687.60 , $646.80 , $687.60 , $687.60 , $687.60 , $649.40 , $52.96 , $705.40 , $725.80 , $649.40 , $710.52 , $710.52 , $725.80 , $733.44 , $625.10 , $687.60 , $649.40 , $603.56 , N/A , $618.31 , $618.31 , $725.80 , $655.59 , $41.10 , $733.44 
"Fusion Foot Bones,Pantalar",CPT® 28705,N/A,N/A,N/A," $10,444.00 "," $6,788.60 "," $7,462.33 "," $1,164.22 ", $614.70 ," $6,123.35 "," $6,189.69 "," $9,712.92 "," $9,399.60 "," $9,399.60 "," $8,355.20 "," $8,355.20 ", $614.70 ," $9,642.95 "," $9,921.80 "," $9,399.60 "," $9,399.60 "," $9,399.60 "," $9,712.92 "," $10,026.24 "," $6,924.47 "," $8,877.40 "," $6,815.12 "," $7,176.77 ", N/A ," $6,242.83 "," $6,242.83 "," $9,921.80 "," $7,337.51 ", $614.70 ," $10,026.24 "
Assay Citrate,CPT® 82507,N/A,N/A,N/A, $250.00 , $162.50 , N/A , $28.36 , $28.36 , $157.32 , $188.18 , $232.50 , $225.00 , $225.00 , $200.00 , $200.00 , $28.36 , $230.83 , $237.50 , $225.00 , $225.00 , $225.00 , $232.50 , $240.00 , $185.63 , $212.50 , $181.65 , $100.83 , N/A , $146.82 , $146.82 , $237.50 , $160.44 , $28.36 , $240.00 
 Fac Radiologic Small Intestine Follow-Through Study ,CPT® 74248,0320 - DX X-RAY,N/A,N/A," $1,272.00 ", $826.80 ," $1,068.48 ", $82.53 , $65.14 ," $1,027.78 "," $1,144.80 "," $1,076.88 "," $1,144.80 "," $1,144.80 "," $1,144.80 "," $1,081.20 ", $63.86 ," $1,174.44 "," $1,208.40 "," $1,081.20 "," $1,182.96 "," $1,182.96 "," $1,208.40 "," $1,221.12 "," $1,040.75 "," $1,144.80 "," $1,081.20 "," $1,004.88 ", N/A ," $1,029.43 "," $1,029.43 "," $1,208.40 "," $1,091.50 ", $63.86 ," $1,221.12 "
"Cystourethroscopy,Fulgur <0.5cm Lesn",52224,N/A,N/A,N/A," $2,813.00 "," $1,828.45 "," $1,090.26 ", $190.95 , $155.03 ," $1,000.80 ", $923.92 ," $2,616.09 "," $2,531.70 "," $2,531.70 "," $2,250.40 "," $2,250.40 ", $155.03 ," $2,597.24 "," $2,672.35 "," $2,531.70 "," $2,531.70 "," $2,531.70 "," $2,616.09 "," $2,700.48 "," $1,099.24 "," $2,391.05 "," $1,047.25 "," $1,253.67 ", N/A ," $1,020.32 "," $1,020.32 "," $2,672.35 "," $1,199.24 ", $155.03 ," $2,700.48 "
 Fac Drug Screening Opiates 1 or More ,CPT® 80361,0301 - LAB/CHEMISTRY,N/A,N/A, $171.00 , $111.15 , $143.64 , N/A , N/A , $138.17 , $153.90 , $144.77 , $153.90 , $153.90 , $153.90 , $145.35 , N/A , $157.88 , $162.45 , $145.35 , $159.03 , $159.03 , $162.45 , $164.16 , $139.91 , $153.90 , $145.35 , $135.09 , N/A , $138.39 , $138.39 , $162.45 , $146.74 , $135.09 , $164.16 
 FULVESTRANT 250 MG/5ML IM SOSY ,HCPCS J9393,0636 - DRUGS REQUIRING DETAILED CODIN,16729-0436-30,5 mL," $2,128.47 "," $1,383.51 "," $1,787.91 ", $21.62 , $15.75 ," $1,719.80 "," $1,915.62 "," $1,801.96 "," $1,915.62 "," $1,915.62 "," $1,915.62 "," $1,809.20 ", $15.44 ," $1,965.22 "," $2,022.05 "," $1,809.20 "," $1,979.48 "," $1,979.48 "," $2,022.05 "," $2,043.33 "," $1,741.51 "," $1,915.62 "," $1,809.20 "," $1,681.49 ", N/A ," $1,722.57 "," $1,722.57 "," $2,022.05 "," $1,826.44 ", $15.44 ," $2,043.33 "
 SITAGLIPTIN PHOSPHATE 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00006-0112-31,1 tablet, $112.44 , $73.09 , $94.45 , N/A , N/A , $90.85 , $101.20 , $95.19 , $101.20 , $101.20 , $101.20 , $95.57 , N/A , $103.82 , $106.82 , $95.57 , $104.57 , $104.57 , $106.82 , $107.94 , $92.00 , $101.20 , $95.57 , $88.83 , N/A , $91.00 , $91.00 , $106.82 , $96.48 , $88.83 , $107.94 
 BLEOMYCIN SULFATE 15 UNITS IJ SOLR ,HCPCS J9040,0636 - DRUGS REQUIRING DETAILED CODIN,61703-0332-18,5 mL, $148.37 , $96.44 , $124.63 , $25.02 , $25.76 , $119.88 , $133.53 , $125.61 , $133.53 , $133.53 , $133.53 , $126.11 , $25.25 , $136.99 , $140.95 , $126.11 , $137.98 , $137.98 , $140.95 , $142.44 , $121.40 , $133.53 , $126.11 , $117.21 , N/A , $120.08 , $120.08 , $140.95 , $127.32 , $25.02 , $142.44 
"MRI, Joint Upper Extrem W/Contrast",CPT® 73222,N/A,N/A,N/A," $3,907.00 "," $2,539.55 "," $2,280.60 ", $323.39 , $498.05 ," $1,799.91 "," $2,299.19 "," $3,633.51 "," $3,516.30 "," $3,516.30 "," $3,125.60 "," $3,125.60 ", $498.05 ," $3,607.33 "," $3,711.65 "," $3,516.30 "," $3,516.30 "," $3,516.30 "," $3,633.51 "," $3,750.72 "," $1,980.41 "," $3,320.95 "," $2,505.78 "," $3,503.53 ", N/A ," $1,835.03 "," $1,835.03 "," $3,711.65 "," $2,124.09 ", $323.39 ," $3,750.72 "
"Phlebotomy,Theraputic",CPT® 99195,N/A,N/A,N/A, $398.00 , $258.70 , $231.74 , $93.91 , $6.75 , $218.69 , $228.73 , $370.14 , $358.20 , $358.20 , $318.40 , $318.40 , $6.75 , $367.47 , $378.10 , $358.20 , $358.20 , $358.20 , $370.14 , $382.08 , $318.84 , $338.30 , $306.14 , $380.04 , N/A , $222.97 , $222.97 , $378.10 , $259.94 , $6.75 , $382.08 
"Specimen Handling,Pt->Lab",CPT® 99001,N/A,N/A,N/A, $45.00 , $29.25 , N/A , N/A , $4.00 , $17.08 , $16.65 , $41.85 , $40.50 , $40.50 , $36.00 , $36.00 , $4.00 , $41.55 , $42.75 , $40.50 , $40.50 , $40.50 , $41.85 , $43.20 , N/A , $38.25 , N/A , $16.77 , N/A , $17.41 , $17.41 , $42.75 , $20.31 , $4.00 , $43.20 
"Eye Exam, New Patient,Comprehesv",CPT® 92004,N/A,N/A,N/A, $445.00 , $289.25 , $208.87 , $93.23 , $45.22 , $177.44 , $177.23 , $413.85 , $400.50 , $400.50 , $356.00 , $356.00 , $45.22 , $410.87 , $422.75 , $400.50 , $400.50 , $400.50 , $413.85 , $427.20 , $271.94 , $378.25 , $298.03 , $211.32 , N/A , $180.91 , $180.91 , $422.75 , $215.19 , $45.22 , $427.20 
"Vein Bypass Graft,Aorto-Mesen",CPT® 35531,N/A,N/A,N/A," $13,171.00 "," $8,561.15 "," $11,186.11 "," $1,724.53 "," $1,993.16 "," $8,756.97 "," $8,742.62 "," $12,249.03 "," $11,853.90 "," $11,853.90 "," $10,536.80 "," $10,536.80 "," $1,993.16 "," $12,160.78 "," $12,512.45 "," $11,853.90 "," $11,853.90 "," $11,853.90 "," $12,249.03 "," $12,644.16 "," $10,328.57 "," $11,195.35 "," $11,054.06 "," $9,762.01 ", N/A ," $8,927.84 "," $8,927.84 "," $12,512.45 "," $10,142.02 "," $1,724.53 "," $12,644.16 "
Sleep Std Vntj Respir Ecg/Hrt Rate&O2 Sat Unattn,CPT® 95806,N/A,N/A,N/A," $1,406.00 ", $913.90 , $336.45 , $90.26 , $166.30 , $371.72 , $412.51 ," $1,307.58 "," $1,265.40 "," $1,265.40 "," $1,124.80 "," $1,124.80 ", $166.30 ," $1,298.16 "," $1,335.70 "," $1,265.40 "," $1,265.40 "," $1,265.40 "," $1,307.58 "," $1,349.76 ", $434.12 ," $1,195.10 ", $546.39 , $644.70 , N/A , $378.97 , $378.97 ," $1,335.70 ", $441.82 , $90.26 ," $1,349.76 "
 Fac Skn Tst Candida ,CPT® 86485,0305 - LAB/HEMATOLOGY,N/A,N/A, $59.00 , $38.35 , $49.56 , $10.84 , $9.61 , $47.67 , $53.10 , $49.95 , $53.10 , $53.10 , $53.10 , $50.15 , $9.42 , $54.47 , $56.05 , $50.15 , $54.87 , $54.87 , $56.05 , $56.64 , $48.27 , $53.10 , $50.15 , $46.61 , N/A , $47.75 , $47.75 , $56.05 , $50.63 , $9.42 , $56.64 
" Pro Remove External Ear, Partial ",CPT® 69110,0982 - PRO FEE/OUTPT,N/A,N/A," $2,613.00 "," $1,698.45 "," $1,572.50 ", $319.31 , $219.95 ," $1,552.61 "," $1,616.18 "," $2,430.09 "," $2,351.70 "," $2,351.70 "," $2,090.40 "," $2,090.40 ", $219.95 ," $2,412.58 "," $2,482.35 "," $2,351.70 "," $2,351.70 "," $2,351.70 "," $2,430.09 "," $2,508.48 "," $1,708.71 "," $2,221.05 "," $1,764.44 "," $1,576.67 ", N/A ," $1,582.90 "," $1,582.90 "," $2,482.35 "," $1,807.42 ", $219.95 ," $2,508.48 "
 Fac Injection of Joint of Lower Back Into Pelvis ,CPT® 27096,0360 - OR SERVICES,N/A,N/A," $1,010.00 ", $656.50 , $848.40 , $79.93 , $154.36 , $816.08 , $909.00 , $855.07 , $909.00 , $909.00 , $909.00 , $858.50 , $151.33 , $932.53 , $959.50 , $858.50 , $939.30 , $939.30 , $959.50 , $969.60 , $826.38 , $909.00 , $858.50 , $797.90 , N/A , $817.39 , $817.39 , $959.50 , $866.68 , $79.93 , $969.60 
"Fx Radial,Closed,W/O Mani",CPT® 25600,N/A,N/A,N/A," $2,106.00 "," $1,368.90 "," $2,022.28 ", $320.97 , $171.85 ," $1,493.35 "," $1,527.62 "," $1,958.58 "," $1,895.40 "," $1,895.40 "," $1,684.80 "," $1,684.80 ", $171.85 ," $1,944.47 "," $2,000.70 "," $1,895.40 "," $1,895.40 "," $1,895.40 "," $1,958.58 "," $2,021.76 "," $1,852.86 "," $1,790.10 "," $1,673.45 "," $1,783.02 ", N/A ," $1,522.49 "," $1,522.49 "," $2,000.70 "," $1,789.47 ", $171.85 ," $2,022.28 "
 SACITUZUMAB GOVITECAN-HZIY 180 MG IV SOLR ,HCPCS J9317,0636 - DRUGS REQUIRING DETAILED CODIN,55135-0132-01,18 mL," $6,895.72 "," $4,482.22 "," $5,792.40 ", $33.99 , $33.23 ," $5,571.74 "," $6,206.15 "," $5,837.92 "," $6,206.15 "," $6,206.15 "," $6,206.15 "," $5,861.36 ", $32.58 ," $6,366.82 "," $6,550.93 "," $5,861.36 "," $6,413.02 "," $6,413.02 "," $6,550.93 "," $6,619.89 "," $5,642.08 "," $6,206.15 "," $5,861.36 "," $5,447.62 ", N/A ," $5,580.71 "," $5,580.71 "," $6,550.93 "," $5,917.22 ", $32.58 ," $6,619.89 "
"Blood Smear,Micro Exam,Manual Diff Wbc",CPT® 85007,N/A,N/A,N/A, $31.00 , $20.15 , N/A , $3.88 , $3.88 , $19.46 , $23.29 , $28.83 , $27.90 , $27.90 , $24.80 , $24.80 , $3.88 , $28.62 , $29.45 , $27.90 , $27.90 , $27.90 , $28.83 , $29.76 , $25.37 , $26.35 , $22.71 , $12.45 , N/A , $18.16 , $18.16 , $29.45 , $19.84 , $3.88 , $29.76 
Layer Clousre 2.6-7.5cm,12042,N/A,N/A,N/A," $1,172.00 ", $761.80 , $627.61 , $188.46 , $103.08 , $547.43 , $537.01 ," $1,089.96 "," $1,054.80 "," $1,054.80 ", $937.60 , $937.60 , $103.08 ," $1,082.11 "," $1,113.40 "," $1,054.80 "," $1,054.80 "," $1,054.80 "," $1,089.96 "," $1,125.12 ", $689.37 , $996.20 ," $1,066.87 ", $703.69 , N/A , $558.12 , $558.12 ," $1,113.40 ", $647.23 , $103.08 ," $1,125.12 "
" Fac Nk Cells, Total Count ",CPT® 86357,0302 - LAB/IMMUNOLOGY,N/A,N/A, $348.00 , $226.20 , $292.32 , $38.48 , $38.48 , $281.18 , $313.20 , $294.62 , $313.20 , $313.20 , $313.20 , $295.80 , $37.73 , $321.31 , $330.60 , $295.80 , $323.64 , $323.64 , $330.60 , $334.08 , $284.73 , $313.20 , $295.80 , $274.92 , N/A , $281.64 , $281.64 , $330.60 , $298.62 , $37.73 , $334.08 
 Fac Esophagogastroduodenoscopy Transoral Diagnostic ,CPT® 43235,0360 - OR SERVICES,N/A,N/A," $1,892.00 "," $1,229.80 "," $1,589.28 ", $116.11 , $398.41 ," $1,528.74 "," $1,702.80 "," $1,601.77 "," $1,702.80 "," $1,702.80 "," $1,702.80 "," $1,608.20 ", $390.60 ," $1,746.88 "," $1,797.40 "," $1,608.20 "," $1,759.56 "," $1,759.56 "," $1,797.40 "," $1,816.32 "," $1,548.03 "," $1,702.80 "," $1,608.20 "," $1,494.68 ", N/A ," $1,531.20 "," $1,531.20 "," $1,797.40 "," $1,623.53 ", $116.11 ," $1,816.32 "
Ko W Adj Flex/Ext Rotat Mold,HCPCS L1846,N/A,N/A,N/A," $1,474.00 ", $958.10 , N/A ," $1,368.64 ", $891.92 , N/A , N/A ," $1,370.82 "," $1,326.60 "," $1,326.60 "," $1,179.20 "," $1,179.20 ", $891.92 ," $1,360.94 "," $1,400.30 "," $1,326.60 "," $1,326.60 "," $1,326.60 "," $1,370.82 "," $1,415.04 ", N/A ," $1,252.90 "," $1,128.83 "," $1,151.49 ", N/A , N/A , N/A ," $1,400.30 ", N/A , $891.92 ," $1,415.04 "
"Shldr Arthroscop,Surg,W/Removal,Loose/FB",CPT® 29819,N/A,N/A,N/A," $3,859.00 "," $2,508.35 "," $3,581.76 ", $561.48 , $500.35 ," $2,829.38 "," $2,827.06 "," $3,588.87 "," $3,473.10 "," $3,473.10 "," $3,087.20 "," $3,087.20 ", $500.35 ," $3,563.01 "," $3,666.05 "," $3,473.10 "," $3,473.10 "," $3,473.10 "," $3,588.87 "," $3,704.64 "," $3,336.26 "," $3,280.15 "," $3,118.54 "," $3,323.78 ", N/A ," $2,884.59 "," $2,884.59 "," $3,666.05 "," $3,390.41 ", $500.35 ," $3,704.64 "
 Fac Esophagoscopy Flex Balloon Dilat <30 Mm Diam ,CPT® 43220,0360 - OR SERVICES,N/A,N/A," $1,710.00 "," $1,111.50 "," $1,436.40 ", $111.47 , $996.11 ," $1,381.68 "," $1,539.00 "," $1,447.69 "," $1,539.00 "," $1,539.00 "," $1,539.00 "," $1,453.50 ", $976.58 ," $1,578.84 "," $1,624.50 "," $1,453.50 "," $1,590.30 "," $1,590.30 "," $1,624.50 "," $1,641.60 "," $1,399.12 "," $1,539.00 "," $1,453.50 "," $1,350.90 ", N/A ," $1,383.90 "," $1,383.90 "," $1,624.50 "," $1,467.35 ", $111.47 ," $1,641.60 "
 Fac Dialyis Circuit Vasc Emboli Occls Evasc Img S&I ,CPT® 36909,0360 - OR SERVICES,N/A,N/A," $15,057.00 "," $9,787.05 "," $12,647.88 ", $185.25 ," $1,544.79 "," $12,166.06 "," $13,551.30 "," $12,747.26 "," $13,551.30 "," $13,551.30 "," $13,551.30 "," $12,798.45 "," $1,514.50 "," $13,902.13 "," $14,304.15 "," $12,798.45 "," $14,003.01 "," $14,003.01 "," $14,304.15 "," $14,454.72 "," $12,319.64 "," $13,551.30 "," $12,798.45 "," $11,895.03 ", N/A ," $12,185.63 "," $12,185.63 "," $14,304.15 "," $12,920.41 ", $185.25 ," $14,454.72 "
"Cystourethroscopy,Ureter Catheter",52005,N/A,N/A,N/A, $924.00 , $600.60 , $713.00 , $125.24 , $199.19 , $652.08 , $607.23 , $859.32 , $831.60 , $831.60 , $739.20 , $739.20 , $199.19 , $853.13 , $877.80 , $831.60 , $831.60 , $831.60 , $859.32 , $887.04 , $716.14 , $785.40 , $688.65 , $819.38 , N/A , $664.80 , $664.80 , $877.80 , $781.39 , $125.24 , $887.04 
Ntrprof Phone/Ntrnet/Ehr Assmt&Mgmt 21-30 Min,CPT® 99448,N/A,N/A,N/A, $245.00 , $159.25 , $103.86 , $52.15 , $42.95 , N/A , N/A , $227.85 , $220.50 , $220.50 , $196.00 , $196.00 , $42.95 , $226.21 , $232.75 , $220.50 , $220.50 , $220.50 , $227.85 , $235.20 , $96.43 , $208.25 , $119.54 , $118.28 , N/A , $86.84 , $86.84 , $232.75 , $100.15 , $42.95 , $235.20 
 Traumatic Stupor And Coma >1 Hour With McC ,MS DRG V40 (FY2023) 082,N/A,N/A,N/A," $19,871.41 "," $12,916.42 "," $16,691.98 ", N/A , N/A ," $16,056.10 "," $17,884.27 "," $16,823.14 "," $17,884.27 "," $17,884.27 "," $17,884.27 "," $16,890.70 ", N/A ," $18,347.27 "," $18,877.84 "," $16,890.70 "," $18,480.41 "," $18,480.41 "," $18,877.84 "," $19,076.55 "," $16,258.79 "," $17,884.27 "," $16,890.70 "," $15,698.41 ", N/A ," $16,081.93 "," $16,081.93 "," $18,877.84 "," $17,051.66 "," $15,698.41 "," $19,076.55 "
Clean Out Mastoid Cavity,CPT® 69222,N/A,N/A,N/A, $607.00 , $394.55 , $651.20 , $133.07 , $102.90 , $657.44 , $686.61 , $564.51 , $546.30 , $546.30 , $485.60 , $485.60 , $102.90 , $560.44 , $576.65 , $546.30 , $546.30 , $546.30 , $564.51 , $582.72 , $702.53 , $515.95 , $747.52 , $660.36 , N/A , $670.26 , $670.26 , $576.65 , $765.33 , $102.90 , $765.33 
Remvl Perm Pm Pls Gen W/Repl Plse Gen Mult Lead,CPT® 33229,N/A,N/A,N/A," $3,423.00 "," $2,224.95 "," $2,238.54 ", $345.70 , $279.17 ," $1,639.27 "," $1,575.16 "," $3,183.39 "," $3,080.70 "," $3,080.70 "," $2,738.40 "," $2,738.40 ", $279.17 ," $3,160.46 "," $3,251.85 "," $3,080.70 "," $3,080.70 "," $3,080.70 "," $3,183.39 "," $3,286.08 "," $2,066.91 "," $2,909.55 "," $1,980.31 "," $1,813.62 ", N/A ," $1,671.26 "," $1,671.26 "," $3,251.85 "," $1,898.53 ", $279.17 ," $3,286.08 "
Neuromuscular Junction Test,CPT® 95937,N/A,N/A,N/A, $479.00 , $311.35 , $395.88 , $103.46 , $61.92 , $264.18 , $269.65 , $445.47 , $431.10 , $431.10 , $383.20 , $383.20 , $61.92 , $442.26 , $455.05 , $431.10 , $431.10 , $431.10 , $445.47 , $459.84 , $451.67 , $407.15 , $236.20 , $311.00 , N/A , $269.34 , $269.34 , $455.05 , $331.10 , $61.92 , $459.84 
 Fac in Situ Hybridization Ea Multiplex Probe Stain ,CPT® 88366,0310 - PATHOLOGY LAB,N/A,N/A, $836.00 , $543.40 , $702.24 , $274.14 , $117.74 , $675.49 , $752.40 , $707.76 , $752.40 , $752.40 , $752.40 , $710.60 , $115.43 , $771.88 , $794.20 , $710.60 , $777.48 , $777.48 , $794.20 , $802.56 , $684.02 , $752.40 , $710.60 , $660.44 , N/A , $676.57 , $676.57 , $794.20 , $717.37 , $115.43 , $802.56 
Eye Photography,92285,N/A,N/A,N/A, $105.00 , $68.25 , $49.10 , $22.31 , $16.52 , $35.49 , $37.27 , $97.65 , $94.50 , $94.50 , $84.00 , $84.00 , $16.52 , $96.95 , $99.75 , $94.50 , $94.50 , $94.50 , $97.65 , $100.80 , $68.50 , $89.25 , $63.86 , $42.85 , N/A , $36.18 , $36.18 , $99.75 , $43.04 , $16.52 , $100.80 
 Fac Revsc Opn/Prq Iliac Art W/Stnt & Angiop Ipsilatl ,CPT® 37223,0360 - OR SERVICES,N/A,N/A," $12,163.00 "," $7,905.95 "," $10,216.92 ", $188.40 , $158.19 ," $9,827.70 "," $10,946.70 "," $10,297.20 "," $10,946.70 "," $10,946.70 "," $10,946.70 "," $10,338.55 ", $155.09 ," $11,230.10 "," $11,554.85 "," $10,338.55 "," $11,311.59 "," $11,311.59 "," $11,554.85 "," $11,676.48 "," $9,951.77 "," $10,946.70 "," $10,338.55 "," $9,608.77 ", N/A ," $9,843.52 "," $9,843.52 "," $11,554.85 "," $10,437.07 ", $155.09 ," $11,676.48 "
 TPN - CALCIUM GLUC 0.465 MEQ/ML ,HCPCS RXA250,0250 - PHARMACY,63323-0360-59,50 mL, $166.44 , $108.19 , $139.81 , N/A , N/A , $134.48 , $149.80 , $140.91 , $149.80 , $149.80 , $149.80 , $141.47 , N/A , $153.67 , $158.12 , $141.47 , $154.79 , $154.79 , $158.12 , $159.78 , $136.18 , $149.80 , $141.47 , $131.49 , N/A , $134.70 , $134.70 , $158.12 , $142.82 , $131.49 , $159.78 
Sono Pelvis Limited,76857,N/A,N/A,N/A, $170.00 , $110.50 , $270.40 , $48.14 , $62.84 , $225.99 , $504.45 , $158.10 , $153.00 , $153.00 , $136.00 , $136.00 , $62.84 , $156.96 , $161.50 , $153.00 , $153.00 , $153.00 , $158.10 , $163.20 , $265.60 , $144.50 , $550.85 , $272.09 , N/A , $230.40 , $230.40 , $161.50 , $266.71 , $48.14 , $550.85 
"Lap,Tubal Block by Device",CPT® 58671,N/A,N/A,N/A," $3,301.00 "," $2,145.65 "," $1,756.35 ", $356.00 , $330.50 ," $1,483.20 "," $1,489.30 "," $3,069.93 "," $2,970.90 "," $2,970.90 "," $2,640.80 "," $2,640.80 ", $330.50 ," $3,047.81 "," $3,135.95 "," $2,970.90 "," $2,970.90 "," $2,970.90 "," $3,069.93 "," $3,168.96 "," $1,834.25 "," $2,805.85 "," $1,957.12 "," $1,486.79 ", N/A ," $1,512.14 "," $1,512.14 "," $3,135.95 "," $1,813.73 ", $330.50 ," $3,168.96 "
"Decompress Thigh/Knee,1 Compartmt",CPT® 27496,N/A,N/A,N/A," $3,512.00 "," $2,282.80 "," $3,353.74 ", $527.35 , $401.66 ," $2,620.01 "," $2,619.18 "," $3,266.16 "," $3,160.80 "," $3,160.80 "," $2,809.60 "," $2,809.60 ", $401.66 ," $3,242.63 "," $3,336.40 "," $3,160.80 "," $3,160.80 "," $3,160.80 "," $3,266.16 "," $3,371.52 "," $3,110.65 "," $2,985.20 "," $2,888.40 "," $3,095.22 ", N/A ," $2,671.14 "," $2,671.14 "," $3,336.40 "," $3,139.54 ", $401.66 ," $3,371.52 "
"Assay Protein,Total,Urine",CPT® 84156,N/A,N/A,N/A, $68.00 , $44.20 , N/A , $3.74 , $3.74 , $20.74 , $24.81 , $63.24 , $61.20 , $61.20 , $54.40 , $54.40 , $3.74 , $62.78 , $64.60 , $61.20 , $61.20 , $61.20 , $63.24 , $65.28 , $24.51 , $57.80 , $24.33 , $13.30 , N/A , $19.36 , $19.36 , $64.60 , $21.16 , $3.74 , $65.28 
" Pro Prev Visit, New, Age 65& Over ",CPT® 99387,0982 - PRO FEE/OUTPT,N/A,N/A, $513.00 , $333.45 , N/A , $158.20 , $59.72 , $273.38 , $275.44 , $477.09 , $461.70 , $461.70 , $410.40 , $410.40 , $59.72 , $473.65 , $487.35 , $461.70 , $461.70 , $461.70 , $477.09 , $492.48 , $337.65 , $436.05 , $276.04 , $271.53 , N/A , $278.72 , $278.72 , $487.35 , $334.77 , $59.72 , $492.48 
 METOPROLOL TARTRATE 12.5 MG TAB (COMES FROM 25 MG TABLET) ,HCPCS RXC637,0250 - PHARMACY,00001-0006-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Pro Exc Tr-Ext Mlg+Marg 0.5 < Cm ,CPT® 11600,0982 - PRO FEE/OUTPT,N/A,N/A, $885.00 , $575.25 , $391.95 , $117.50 , $92.19 , $326.56 , $319.86 , $823.05 , $796.50 , $796.50 , $708.00 , $708.00 , $92.19 , $817.12 , $840.75 , $796.50 , $796.50 , $796.50 , $823.05 , $849.60 , $429.85 , $752.25 , $636.91 , $419.71 , N/A , $332.94 , $332.94 , $840.75 , $386.10 , $92.19 , $849.60 
Manual Prep&Insj I-Artic Drug Delivery Device,CPT® 20704,N/A,N/A,N/A," $1,024.00 ", $665.60 , $902.59 , $136.89 , $112.49 , $691.40 , N/A , $952.32 , $921.60 , $921.60 , $819.20 , $819.20 , $112.49 , $945.46 , $972.80 , $921.60 , $921.60 , $921.60 , $952.32 , $983.04 , $811.63 , $870.40 , $774.75 , $829.45 , N/A , $704.89 , $704.89 , $972.80 , $828.60 , $112.49 , $983.04 
"Bacteria Identification, Aerobic Isolate",CPT® 87077,N/A,N/A,N/A, $108.00 , $70.20 , N/A , $8.24 , $8.24 , $45.73 , $54.70 , $100.44 , $97.20 , $97.20 , $86.40 , $86.40 , $8.24 , $99.72 , $102.60 , $97.20 , $97.20 , $97.20 , $100.44 , $103.68 , $53.95 , $91.80 , $53.52 , $29.28 , N/A , $42.68 , $42.68 , $102.60 , $46.64 , $8.24 , $103.68 
Drain Pilonidal Cyst Simpl,10080,N/A,N/A,N/A, $582.00 , $378.30 , $335.61 , $100.38 , $61.55 , $282.06 , $278.01 , $541.26 , $523.80 , $523.80 , $465.60 , $465.60 , $61.55 , $537.36 , $552.90 , $523.80 , $523.80 , $523.80 , $541.26 , $558.72 , $367.33 , $494.70 , $553.06 , $359.71 , N/A , $287.57 , $287.57 , $552.90 , $333.47 , $61.55 , $558.72 
 DIVALPROEX SODIUM 125 MG PO CSDR ,HCPCS RXC637,0250 - PHARMACY,00904-6615-61,1 capsule, $5.51 , $3.58 , $4.63 , N/A , N/A , $4.45 , $4.96 , $4.66 , $4.96 , $4.96 , $4.96 , $4.68 , N/A , $5.09 , $5.23 , $4.68 , $5.12 , $5.12 , $5.23 , $5.29 , $4.51 , $4.96 , $4.68 , $4.35 , N/A , $4.46 , $4.46 , $5.23 , $4.73 , $4.35 , $5.29 
Remv Benign Femur Lesion,CPT® 27355,N/A,N/A,N/A," $3,843.00 "," $2,497.95 "," $3,714.04 ", $582.52 , $614.70 ," $2,906.38 "," $2,896.82 "," $3,573.99 "," $3,458.70 "," $3,458.70 "," $3,074.40 "," $3,074.40 ", $614.70 ," $3,548.24 "," $3,650.85 "," $3,458.70 "," $3,458.70 "," $3,458.70 "," $3,573.99 "," $3,689.28 "," $3,437.68 "," $3,266.55 "," $3,198.83 "," $3,432.46 ", N/A ," $2,963.10 "," $2,963.10 "," $3,650.85 "," $3,482.69 ", $582.52 ," $3,714.04 "
Mechanical Traction Therapy,CPT® 97012,N/A,N/A,N/A, $89.00 , $57.85 , $33.53 , $14.33 , $26.30 , $36.24 , $32.39 , $82.77 , $80.10 , $80.10 , $71.20 , $71.20 , $26.30 , $82.17 , $84.55 , $80.10 , $80.10 , $80.10 , $82.77 , $85.44 , $37.24 , $75.65 , $47.64 , $36.40 , N/A , $36.94 , $36.94 , $84.55 , $41.08 , $14.33 , $85.44 
"Lap,Surg,Colectomy,W/Anast,W/Colostomy",CPT® 44208,N/A,N/A,N/A," $12,626.00 "," $8,206.90 "," $11,826.30 "," $1,831.32 "," $1,655.54 "," $9,431.94 "," $9,525.36 "," $11,742.18 "," $11,363.40 "," $11,363.40 "," $10,100.80 "," $10,100.80 "," $1,655.54 "," $11,657.59 "," $11,994.70 "," $11,363.40 "," $11,363.40 "," $11,363.40 "," $11,742.18 "," $12,120.96 "," $8,495.72 "," $10,732.10 "," $10,547.39 "," $11,148.92 ", N/A ," $9,615.96 "," $9,615.96 "," $11,994.70 "," $10,057.30 "," $1,655.54 "," $12,120.96 "
 Pro Rmvl Impacted Cerumen Spx 1/Bth Ears ,CPT® 69210,0982 - PRO FEE/OUTPT,N/A,N/A, $289.00 , $187.85 , $154.15 , $31.15 , $14.13 , $157.99 , $157.57 , $268.77 , $260.10 , $260.10 , $231.20 , $231.20 , $14.13 , $266.83 , $274.55 , $260.10 , $260.10 , $260.10 , $268.77 , $277.44 , $170.16 , $245.65 , $171.27 , $161.15 , N/A , $161.08 , $161.08 , $274.55 , $183.90 , $14.13 , $277.44 
 Fac Pregnenolone ,CPT® 84140,0301 - LAB/CHEMISTRY,N/A,N/A, $193.00 , $125.45 , $162.12 , $21.08 , $21.08 , $155.94 , $173.70 , $163.39 , $173.70 , $173.70 , $173.70 , $164.05 , $20.67 , $178.20 , $183.35 , $164.05 , $179.49 , $179.49 , $183.35 , $185.28 , $157.91 , $173.70 , $164.05 , $152.47 , N/A , $156.19 , $156.19 , $183.35 , $165.61 , $20.67 , $185.28 
 Pro Insert Intrauterine Device ,CPT® 58300,0982 - PRO FEE/OUTPT,N/A,N/A, $588.00 , $382.20 , N/A , $108.57 , $89.76 , $213.25 , $207.47 , $546.84 , $529.20 , $529.20 , $470.40 , $470.40 , $89.76 , $542.90 , $558.60 , $529.20 , $529.20 , $529.20 , $546.84 , $564.48 , $256.00 , $499.80 , $265.83 , $220.53 , N/A , $217.41 , $217.41 , $558.60 , $260.79 , $89.76 , $564.48 
Closed Treatment Pst Malleolus Fracture W Mnpj,CPT® 27768,N/A,N/A,N/A," $2,758.00 "," $1,792.70 "," $2,753.86 ", $434.79 , $276.98 ," $2,121.82 "," $2,131.82 "," $2,564.94 "," $2,482.20 "," $2,482.20 "," $2,206.40 "," $2,206.40 ", $276.98 ," $2,546.46 "," $2,620.10 "," $2,482.20 "," $2,482.20 "," $2,482.20 "," $2,564.94 "," $2,647.68 "," $2,545.18 "," $2,344.30 "," $2,347.83 "," $2,508.80 ", N/A ," $2,163.22 "," $2,163.22 "," $2,620.10 "," $2,542.56 ", $276.98 ," $2,753.86 "
Apply Short Leg Cast,29405,N/A,N/A,N/A, $353.00 , $229.45 , $353.21 , $55.88 , $70.65 , $291.95 , $292.92 , $328.29 , $317.70 , $317.70 , $282.40 , $282.40 , $70.65 , $325.92 , $335.35 , $317.70 , $317.70 , $317.70 , $328.29 , $338.88 , $330.82 , $300.05 , $319.35 , $344.75 , N/A , $297.65 , $297.65 , $335.35 , $349.86 , $55.88 , $353.21 
 BUPIVACAINE 0.75% INJECTION FOR EYE MEDS ,HCPCS J0665,0636 - DRUGS REQUIRING DETAILED CODIN,55150-0172-30,30 mL, $32.52 , $21.14 , $27.32 , N/A , N/A , $26.28 , $29.27 , $27.53 , $29.27 , $29.27 , $29.27 , $27.64 , N/A , $30.03 , $30.89 , $27.64 , $30.24 , $30.24 , $30.89 , $31.22 , $26.61 , $29.27 , $27.64 , $25.69 , N/A , $26.32 , $26.32 , $30.89 , $27.91 , $25.69 , $31.22 
 CT Guided Muscle Biopsy ,CPT® 20206,0361 - OR/MINOR,N/A,N/A," $1,557.00 "," $1,012.05 "," $1,307.88 ", $55.01 , $134.06 ," $1,258.06 "," $1,401.30 "," $1,318.16 "," $1,401.30 "," $1,401.30 "," $1,401.30 "," $1,323.45 ", $131.43 ," $1,437.58 "," $1,479.15 "," $1,323.45 "," $1,448.01 "," $1,448.01 "," $1,479.15 "," $1,494.72 "," $1,273.94 "," $1,401.30 "," $1,323.45 "," $1,230.03 ", N/A ," $1,260.08 "," $1,260.08 "," $1,479.15 "," $1,336.06 ", $55.01 ," $1,494.72 "
 Pfizer Pediatric Vaccine Administration - Third Dose ,CPT® 0073A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
" Fac Artery X-Ray, Each Vessel ",CPT® 75774,0320 - DX X-RAY,N/A,N/A, $931.00 , $605.15 , $782.04 , $95.32 , $171.58 , $752.25 , $837.90 , $788.18 , $837.90 , $837.90 , $837.90 , $791.35 , $168.22 , $859.59 , $884.45 , $791.35 , $865.83 , $865.83 , $884.45 , $893.76 , $761.74 , $837.90 , $791.35 , $735.49 , N/A , $753.46 , $753.46 , $884.45 , $798.89 , $95.32 , $893.76 
 Lt Upper Extremity With Contrast ,CPT® 73219,0610 - MRI,N/A,N/A," $7,574.00 "," $4,923.10 "," $6,362.16 ", $342.65 , $498.05 ," $6,119.79 "," $6,816.60 "," $6,412.15 "," $6,816.60 "," $6,816.60 "," $6,816.60 "," $6,437.90 ", $488.28 ," $6,993.07 "," $7,195.30 "," $6,437.90 "," $7,043.82 "," $7,043.82 "," $7,195.30 "," $7,271.04 "," $6,197.05 "," $6,816.60 "," $6,437.90 "," $5,983.46 ", N/A ," $6,129.64 "," $6,129.64 "," $7,195.30 "," $6,499.25 ", $342.65 ," $7,271.04 "
 Cardiac Rehab Outpt W Continuous Monitor-Mh ,CPT® 93798,0943 - CARDIAC REHAB,N/A,N/A, $293.00 , $190.45 , $246.12 , $13.18 , $47.37 , $236.74 , $263.70 , $248.05 , $263.70 , $263.70 , $263.70 , $249.05 , $46.44 , $270.53 , $278.35 , $249.05 , $272.49 , $272.49 , $278.35 , $281.28 , $239.73 , $263.70 , $249.05 , $231.47 , N/A , $237.12 , $237.12 , $278.35 , $251.42 , $13.18 , $281.28 
Excision of Epiphyseal Bar,CPT® 20150,N/A,N/A,N/A," $6,054.00 "," $3,935.10 "," $6,053.84 ", $947.16 ," $1,115.73 "," $4,493.22 "," $4,815.05 "," $5,630.22 "," $5,448.60 "," $5,448.60 "," $4,843.20 "," $4,843.20 "," $1,115.73 "," $5,589.66 "," $5,751.30 "," $5,448.60 "," $5,448.60 "," $5,448.60 "," $5,630.22 "," $5,811.84 "," $5,642.15 "," $5,145.90 "," $5,329.00 "," $5,721.04 ", N/A ," $4,580.90 "," $4,580.90 "," $5,751.30 "," $5,384.18 ", $947.16 ," $6,053.84 "
 Fac Metabolic Panel Total Ca ,CPT® 80048,0301 - LAB/CHEMISTRY,N/A,N/A, $138.00 , $89.70 , $115.92 , $8.63 , $8.63 , $111.50 , $124.20 , $116.83 , $124.20 , $124.20 , $124.20 , $117.30 , $8.46 , $127.42 , $131.10 , $117.30 , $128.34 , $128.34 , $131.10 , $132.48 , $112.91 , $124.20 , $117.30 , $109.02 , N/A , $111.68 , $111.68 , $131.10 , $118.42 , $8.46 , $132.48 
 Fac Drug Test Def 1-7 Classes ,CPT® G0480,0302 - LAB/IMMUNOLOGY,N/A,N/A, $270.00 , $175.50 , $226.80 , $116.72 , $65.23 , $218.16 , $243.00 , $228.58 , $243.00 , $243.00 , $243.00 , $229.50 , $63.95 , $249.29 , $256.50 , $229.50 , $251.10 , $251.10 , $256.50 , $259.20 , $220.91 , $243.00 , $229.50 , $213.30 , N/A , $218.51 , $218.51 , $256.50 , $231.69 , $63.95 , $259.20 
 Fac Perc D-E Cor Revasc Chro Sin ,HCPCS C9607,0481 - CARDIAC CATH LAB,N/A,N/A," $15,529.00 "," $10,093.85 "," $13,044.36 ", N/A , N/A ," $12,547.43 "," $13,976.10 "," $13,146.85 "," $13,976.10 "," $13,976.10 "," $13,976.10 "," $13,199.65 ", N/A ," $14,337.93 "," $14,752.55 "," $13,199.65 "," $14,441.97 "," $14,441.97 "," $14,752.55 "," $14,907.84 "," $12,705.83 "," $13,976.10 "," $13,199.65 "," $12,267.91 ", N/A ," $12,567.62 "," $12,567.62 "," $14,752.55 "," $13,325.43 "," $12,267.91 "," $14,907.84 "
Remove Foreign Body Complic,10121,N/A,N/A,N/A," $1,048.00 ", $681.20 , $588.68 , $176.00 , $77.74 , $505.10 , $497.82 , $974.64 , $943.20 , $943.20 , $838.40 , $838.40 , $77.74 , $967.62 , $995.60 , $943.20 , $943.20 , $943.20 , $974.64 ," $1,006.08 ", $648.05 , $890.80 , $990.16 , $647.57 , N/A , $514.96 , $514.96 , $995.60 , $597.18 , $77.74 ," $1,006.08 "
 FLUCONAZOLE 100 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6500-61,1 tablet, $49.88 , $32.42 , $41.90 , N/A , N/A , $40.30 , $44.89 , $42.23 , $44.89 , $44.89 , $44.89 , $42.40 , N/A , $46.05 , $47.39 , $42.40 , $46.39 , $46.39 , $47.39 , $47.88 , $40.81 , $44.89 , $42.40 , $39.41 , N/A , $40.37 , $40.37 , $47.39 , $42.80 , $39.41 , $47.88 
 VERAPAMIL HCL 80 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,23155-0026-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Lyme Disease Antibody ,CPT® 86618,0302 - LAB/IMMUNOLOGY,N/A,N/A, $174.00 , $113.10 , $146.16 , $17.37 , $17.37 , $140.59 , $156.60 , $147.31 , $156.60 , $156.60 , $156.60 , $147.90 , $17.03 , $160.65 , $165.30 , $147.90 , $161.82 , $161.82 , $165.30 , $167.04 , $142.37 , $156.60 , $147.90 , $137.46 , N/A , $140.82 , $140.82 , $165.30 , $149.31 , $17.03 , $167.04 
"Drain Retroperitoneal Abscess,Open",CPT® 49060,N/A,N/A,N/A," $7,732.00 "," $5,025.80 "," $6,561.17 "," $1,014.34 "," $1,075.86 "," $5,175.10 "," $5,217.59 "," $7,190.76 "," $6,958.80 "," $6,958.80 "," $6,185.60 "," $6,185.60 "," $1,075.86 "," $7,138.96 "," $7,345.40 "," $6,958.80 "," $6,958.80 "," $6,958.80 "," $7,190.76 "," $7,422.72 "," $4,699.80 "," $6,572.20 "," $5,789.29 "," $6,114.37 ", N/A ," $5,276.08 "," $5,276.08 "," $7,345.40 "," $5,518.21 "," $1,014.34 "," $7,422.72 "
 Fac Iadna Sars-Cov-2 Covid-19 Amplified Probe Tq ,CPT® 87635,0306 - LAB/BACT-MICRO,N/A,N/A, $221.00 , $143.65 , $185.64 , $52.34 , $52.34 , $178.57 , $198.90 , $187.10 , $198.90 , $198.90 , $198.90 , $187.85 , $51.31 , $204.05 , $209.95 , $187.85 , $205.53 , $205.53 , $209.95 , $212.16 , $180.82 , $198.90 , $187.85 , $174.59 , N/A , $178.86 , $178.86 , $209.95 , $189.64 , $51.31 , $212.16 
 Fac Open Tx Metacarpal Fracture Single Ea Bone ,CPT® 26615,0761 - TREATMENT ROOM,N/A,N/A," $5,402.00 "," $3,511.30 "," $4,537.68 ", $555.54 , $461.04 ," $4,364.82 "," $4,861.80 "," $4,573.33 "," $4,861.80 "," $4,861.80 "," $4,861.80 "," $4,591.70 ", $452.00 ," $4,987.67 "," $5,131.90 "," $4,591.70 "," $5,023.86 "," $5,023.86 "," $5,131.90 "," $5,185.92 "," $4,419.92 "," $4,861.80 "," $4,591.70 "," $4,267.58 ", N/A ," $4,371.84 "," $4,371.84 "," $5,131.90 "," $4,635.46 ", $452.00 ," $5,185.92 "
Excis Primary Ganglion Wrist,CPT® 25111,N/A,N/A,N/A," $2,285.00 "," $1,485.25 "," $2,001.29 ", $316.34 , $267.34 ," $1,540.41 "," $1,553.48 "," $2,125.05 "," $2,056.50 "," $2,056.50 "," $1,828.00 "," $1,828.00 ", $267.34 ," $2,109.74 "," $2,170.75 "," $2,056.50 "," $2,056.50 "," $2,056.50 "," $2,125.05 "," $2,193.60 "," $1,852.25 "," $1,942.25 "," $1,705.57 "," $1,833.43 ", N/A ," $1,570.47 "," $1,570.47 "," $2,170.75 "," $1,845.85 ", $267.34 ," $2,193.60 "
Needle Insertion W/O Injection 1 or 2 Muscles,20560,N/A,N/A,N/A, $146.00 , $94.90 , $94.51 , $14.78 , N/A , $78.65 , N/A , $135.78 , $131.40 , $131.40 , $116.80 , $116.80 , N/A , $134.80 , $138.70 , $131.40 , $131.40 , $131.40 , $135.78 , $140.16 , $90.69 , $124.10 , $78.19 , $95.51 , N/A , $80.18 , $80.18 , $138.70 , $94.26 , $14.78 , $140.16 
Venogram Extrem Bilat,CPT® 75822,N/A,N/A,N/A, $985.00 , $640.25 , $756.09 , $130.39 , $118.18 , $653.80 , $830.60 , $916.05 , $886.50 , $886.50 , $788.00 , $788.00 , $118.18 , $909.45 , $935.75 , $886.50 , $886.50 , $886.50 , $916.05 , $945.60 , $776.98 , $837.25 , $905.24 , $684.71 , N/A , $666.56 , $666.56 , $935.75 , $771.56 , $118.18 , $945.60 
"Med Nutr Ther, 1st, Indiv, Ea 15 Min",CPT® 97802,N/A,N/A,N/A, $136.00 , $88.40 , $75.82 , $32.22 , N/A , $73.03 , $73.92 , $126.48 , $122.40 , $122.40 , $108.80 , $108.80 , N/A , $125.57 , $129.20 , $122.40 , $122.40 , $122.40 , $126.48 , $130.56 , $100.67 , $115.60 , $97.32 , $124.09 , N/A , $74.46 , $74.46 , $129.20 , $86.80 , $32.22 , $130.56 
 Elbow Min 3vw - Mh ,CPT® 73080,0972 - PRO FEE/RAD/DX,N/A,N/A, $140.00 , $91.00 , $182.82 , $32.04 , $31.97 , $148.21 , $178.47 , $130.20 , $126.00 , $126.00 , $112.00 , $112.00 , $31.97 , $129.26 , $133.00 , $126.00 , $126.00 , $126.00 , $130.20 , $134.40 , $176.44 , $119.00 , $196.46 , $158.47 , N/A , $151.10 , $151.10 , $133.00 , $174.91 , $31.97 , $196.46 
Chmsrg Mohs Mg Tq H/N/H/F/G Ea Addl Stag,CPT® 17312,N/A,N/A,N/A," $1,982.00 "," $1,288.30 ", $607.78 , $181.90 , $313.52 , $550.47 , $531.02 ," $1,843.26 "," $1,783.80 "," $1,783.80 "," $1,585.60 "," $1,585.60 ", $313.52 ," $1,829.98 "," $1,882.90 "," $1,783.80 "," $1,783.80 "," $1,783.80 "," $1,843.26 "," $1,902.72 ", $671.18 ," $1,684.70 "," $1,056.17 ", $704.38 , N/A , $561.20 , $561.20 ," $1,882.90 ", $650.80 , $181.90 ," $1,902.72 "
 Fac Endovasc Viscer Aorta Repair Fenest 1 Endograft ,CPT® 34841,0360 - OR SERVICES,N/A,N/A," $4,295.00 "," $2,791.75 "," $3,607.80 "," $1,493.72 ", N/A ," $3,470.36 "," $3,865.50 "," $3,636.15 "," $3,865.50 "," $3,865.50 "," $3,865.50 "," $3,650.75 ", N/A ," $3,965.57 "," $4,080.25 "," $3,650.75 "," $3,994.35 "," $3,994.35 "," $4,080.25 "," $4,123.20 "," $3,514.17 "," $3,865.50 "," $3,650.75 "," $3,393.05 ", N/A ," $3,475.94 "," $3,475.94 "," $4,080.25 "," $3,685.54 "," $1,493.72 "," $4,123.20 "
Ankle Control Orthosi Prefab,HCPCS L4350,N/A,N/A,N/A, $158.00 , $102.70 , N/A , $113.18 , $67.90 , N/A , N/A , $146.94 , $142.20 , $142.20 , $126.40 , $126.40 , $67.90 , $145.88 , $150.10 , $142.20 , $142.20 , $142.20 , $146.94 , $151.68 , N/A , $134.30 , $90.18 , $95.23 , N/A , N/A , N/A , $150.10 , N/A , $67.90 , $151.68 
" Fac N Block Inj, Celiac Pelus ",CPT® 64530,0761 - TREATMENT ROOM,N/A,N/A," $1,360.00 ", $884.00 ," $1,142.40 ", $90.93 , $158.01 ," $1,098.88 "," $1,224.00 "," $1,151.38 "," $1,224.00 "," $1,224.00 "," $1,224.00 "," $1,156.00 ", $154.91 ," $1,255.69 "," $1,292.00 "," $1,156.00 "," $1,264.80 "," $1,264.80 "," $1,292.00 "," $1,305.60 "," $1,112.75 "," $1,224.00 "," $1,156.00 "," $1,074.40 ", N/A ," $1,100.65 "," $1,100.65 "," $1,292.00 "," $1,167.02 ", $90.93 ," $1,305.60 "
"Incis/Drain Scrotum/Testis,Epididym",54700,N/A,N/A,N/A," $1,169.00 ", $759.85 , $943.06 , $203.19 , $46.08 , $685.19 , $696.57 ," $1,087.17 "," $1,052.10 "," $1,052.10 ", $935.20 , $935.20 , $46.08 ," $1,079.34 "," $1,110.55 "," $1,052.10 "," $1,052.10 "," $1,052.10 "," $1,087.17 "," $1,122.24 ", $885.89 , $993.65 ," $1,115.04 "," $1,029.40 ", N/A , $698.56 , $698.56 ," $1,110.55 ", $837.26 , $46.08 ," $1,122.24 "
" Teletherapy Isodose Plan, Complex ",CPT® 77307,0982 - PRO FEE/OUTPT,N/A,N/A, $932.00 , $605.80 ," $1,587.40 ", $281.92 , $222.42 ," $1,349.17 "," $1,472.49 ", $866.76 , $838.80 , $838.80 , $745.60 , $745.60 , $222.42 , $860.52 , $885.40 , $838.80 , $838.80 , $838.80 , $866.76 , $894.72 ," $1,614.36 ", $792.20 ," $1,638.27 "," $1,626.24 ", N/A ," $1,375.49 "," $1,375.49 ", $885.40 ," $1,592.17 ", $222.42 ," $1,638.27 "
 FLUTICASONE PROPIONATE (INHAL) 50 MCG/ACT INH AEPB ,HCPCS RXA250,0250 - PHARMACY,00173-0600-02,60 each, $570.28 , $370.68 , $479.04 , N/A , N/A , $460.79 , $513.25 , $482.80 , $513.25 , $513.25 , $513.25 , $484.74 , N/A , $526.54 , $541.77 , $484.74 , $530.36 , $530.36 , $541.77 , $547.47 , $466.60 , $513.25 , $484.74 , $450.52 , N/A , $461.53 , $461.53 , $541.77 , $489.36 , $450.52 , $547.47 
" Hand, 2 Views ",CPT® 73120,0320 - DX X-RAY,N/A,N/A, $282.00 , $183.30 , $236.88 , $30.70 , $25.85 , $227.86 , $253.80 , $238.74 , $253.80 , $253.80 , $253.80 , $239.70 , $25.34 , $260.37 , $267.90 , $239.70 , $262.26 , $262.26 , $267.90 , $270.72 , $230.73 , $253.80 , $239.70 , $222.78 , N/A , $228.22 , $228.22 , $267.90 , $241.98 , $25.34 , $270.72 
Assay Organic Acids Quantitative,CPT® 83918,N/A,N/A,N/A, $187.00 , $121.55 , N/A , $24.07 , $22.84 , $93.08 , $111.36 , $173.91 , $168.30 , $168.30 , $149.60 , $149.60 , $22.84 , $172.66 , $177.65 , $168.30 , $168.30 , $168.30 , $173.91 , $179.52 , $157.58 , $158.95 , $107.04 , $69.31 , N/A , $86.87 , $86.87 , $177.65 , $94.93 , $22.84 , $179.52 
"Vag Hyst,Rev Vag/Urethr,Fix Enteroce",58270,N/A,N/A,N/A," $5,266.00 "," $3,422.90 "," $4,225.55 ", $854.14 , $802.87 ," $3,588.29 "," $3,575.10 "," $4,897.38 "," $4,739.40 "," $4,739.40 "," $4,212.80 "," $4,212.80 ", $802.87 ," $4,862.10 "," $5,002.70 "," $4,739.40 "," $4,739.40 "," $4,739.40 "," $4,897.38 "," $5,055.36 "," $4,407.76 "," $4,476.10 "," $4,702.79 "," $3,597.61 ", N/A ," $3,658.30 "," $3,658.30 "," $5,002.70 "," $4,387.91 ", $802.87 ," $5,055.36 "
 Pro Prgrmg Dev Eval Scrms Phys/Qhp in Person ,CPT® 93285,0982 - PRO FEE/OUTPT,N/A,N/A, $574.00 , $373.10 , $394.42 , $60.01 , $35.04 , $228.23 , $230.08 , $533.82 , $516.60 , $516.60 , $459.20 , $459.20 , $35.04 , $529.97 , $545.30 , $516.60 , $516.60 , $516.60 , $533.82 , $551.04 , $364.94 , $487.90 , $214.09 , $161.80 , N/A , $232.69 , $232.69 , $545.30 , $257.93 , $35.04 , $551.04 
 AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR ,HCPCS J0295,0636 - DRUGS REQUIRING DETAILED CODIN,55150-0117-20,8 mL, $75.00 , $48.75 , $63.00 , $1.93 , $2.33 , $60.60 , $67.50 , $63.50 , $67.50 , $67.50 , $67.50 , $63.75 , $2.28 , $69.25 , $71.25 , $63.75 , $69.75 , $69.75 , $71.25 , $72.00 , $61.37 , $67.50 , $63.75 , $59.25 , N/A , $60.70 , $60.70 , $71.25 , $64.36 , $1.93 , $72.00 
"Decortication,Pulmonary,Partial",CPT® 32225,N/A,N/A,N/A," $7,459.00 "," $4,848.35 "," $5,189.43 ", $907.95 , $614.70 ," $3,752.57 "," $3,687.89 "," $6,936.87 "," $6,713.10 "," $6,713.10 "," $5,967.20 "," $5,967.20 ", $614.70 ," $6,886.89 "," $7,086.05 "," $6,713.10 "," $6,713.10 "," $6,713.10 "," $6,936.87 "," $7,160.64 "," $5,003.88 "," $6,340.15 "," $5,325.43 "," $4,941.17 ", N/A ," $3,825.80 "," $3,825.80 "," $7,086.05 "," $4,505.70 ", $614.70 ," $7,160.64 "
"Part Remv Bone Metatarsal Head,Ea",28288,N/A,N/A,N/A," $4,045.00 "," $2,629.25 "," $2,687.04 ", $421.68 , $272.17 ," $2,107.60 "," $2,111.56 "," $3,761.85 "," $3,640.50 "," $3,640.50 "," $3,236.00 "," $3,236.00 ", $272.17 ," $3,734.75 "," $3,842.75 "," $3,640.50 "," $3,640.50 "," $3,640.50 "," $3,761.85 "," $3,883.20 "," $2,494.68 "," $3,438.25 "," $2,292.52 "," $2,515.65 ", N/A ," $2,148.72 "," $2,148.72 "," $3,842.75 "," $2,525.50 ", $272.17 ," $3,883.20 "
" Fac Lyme Dis, Dna, Amp Probe ",CPT® 87476,0306 - LAB/BACT-MICRO,N/A,N/A, $387.00 , $251.55 , $325.08 , $35.79 , $35.79 , $312.70 , $348.30 , $327.63 , $348.30 , $348.30 , $348.30 , $328.95 , $35.09 , $357.32 , $367.65 , $328.95 , $359.91 , $359.91 , $367.65 , $371.52 , $316.64 , $348.30 , $328.95 , $305.73 , N/A , $313.20 , $313.20 , $367.65 , $332.08 , $35.09 , $371.52 
"Hemorrhoidectomy,Int/Ext,Simple",CPT® 46255,N/A,N/A,N/A," $3,324.00 "," $2,160.60 "," $2,188.36 ", $338.94 , $398.66 ," $1,677.63 "," $1,711.67 "," $3,091.32 "," $2,991.60 "," $2,991.60 "," $2,659.20 "," $2,659.20 ", $398.66 ," $3,069.05 "," $3,157.80 "," $2,991.60 "," $2,991.60 "," $2,991.60 "," $3,091.32 "," $3,191.04 "," $1,566.77 "," $2,825.40 "," $1,887.54 "," $1,993.47 ", N/A ," $1,710.36 "," $1,710.36 "," $3,157.80 "," $1,788.84 ", $338.94 ," $3,191.04 "
Sewho Cap Design W/O Jnts Cf,HCPCS L3961,N/A,N/A,N/A," $1,926.00 "," $1,251.90 ", N/A ," $1,788.62 "," $1,238.85 ", N/A , N/A ," $1,791.18 "," $1,733.40 "," $1,733.40 "," $1,540.80 "," $1,540.80 "," $1,238.85 "," $1,778.28 "," $1,829.70 "," $1,733.40 "," $1,733.40 "," $1,733.40 "," $1,791.18 "," $1,848.96 ", N/A ," $1,637.10 "," $1,476.56 "," $1,504.85 ", N/A , N/A , N/A ," $1,829.70 ", N/A ," $1,238.85 "," $1,848.96 "
Trlml Balo Angiop Open/Perq Img S&I 1st Art,CPT® 37246,N/A,N/A,N/A," $12,555.00 "," $8,160.75 "," $2,057.64 ", $316.71 ," $2,532.15 "," $1,475.45 "," $1,457.88 "," $11,676.15 "," $11,299.50 "," $11,299.50 "," $10,044.00 "," $10,044.00 "," $2,532.15 "," $11,592.03 "," $11,927.25 "," $11,299.50 "," $11,299.50 "," $11,299.50 "," $11,676.15 "," $12,052.80 "," $1,902.99 "," $10,671.75 "," $1,798.27 "," $1,724.74 ", N/A ," $1,504.24 "," $1,504.24 "," $11,927.25 "," $1,708.81 ", $316.71 ," $12,052.80 "
"Removal of Epididymis,Bilat",CPT® 54861,N/A,N/A,N/A," $3,108.00 "," $2,020.20 "," $2,523.71 ", $543.47 , $614.70 ," $1,817.33 "," $1,835.17 "," $2,890.44 "," $2,797.20 "," $2,797.20 "," $2,486.40 "," $2,486.40 ", $614.70 ," $2,869.62 "," $2,952.60 "," $2,797.20 "," $2,797.20 "," $2,797.20 "," $2,890.44 "," $2,983.68 "," $2,366.07 "," $2,641.80 "," $2,922.30 "," $2,744.98 ", N/A ," $1,852.79 "," $1,852.79 "," $2,952.60 "," $2,220.67 ", $543.47 ," $2,983.68 "
 Trg Gene Rearragement Analysis ,CPT® 81342,0310 - PATHOLOGY LAB,N/A,N/A," $1,753.00 "," $1,139.45 "," $1,472.52 ", $205.53 , $205.53 ," $1,416.42 "," $1,577.70 "," $1,484.09 "," $1,577.70 "," $1,577.70 "," $1,577.70 "," $1,490.05 ", $201.50 ," $1,618.54 "," $1,665.35 "," $1,490.05 "," $1,630.29 "," $1,630.29 "," $1,665.35 "," $1,682.88 "," $1,434.30 "," $1,577.70 "," $1,490.05 "," $1,384.87 ", N/A ," $1,418.70 "," $1,418.70 "," $1,665.35 "," $1,504.25 ", $201.50 ," $1,682.88 "
"Drain Abscess/Hematoma,Nasal Septum",CPT® 30020,N/A,N/A,N/A," $1,601.00 "," $1,040.65 ", $663.61 , $118.56 , $38.38 , $455.16 , $457.05 ," $1,488.93 "," $1,440.90 "," $1,440.90 "," $1,280.80 "," $1,280.80 ", $38.38 ," $1,478.20 "," $1,520.95 "," $1,440.90 "," $1,440.90 "," $1,440.90 "," $1,488.93 "," $1,536.96 ", $626.93 ," $1,360.85 ", $642.26 , $598.33 , N/A , $464.04 , $464.04 ," $1,520.95 ", $546.49 , $38.38 ," $1,536.96 "
Percut Rx IP Jt Dislocation,CPT® 26776,N/A,N/A,N/A," $3,069.00 "," $1,994.85 "," $2,785.51 ", $438.15 , $96.07 ," $2,129.26 "," $2,141.88 "," $2,854.17 "," $2,762.10 "," $2,762.10 "," $2,455.20 "," $2,455.20 ", $96.07 ," $2,833.61 "," $2,915.55 "," $2,762.10 "," $2,762.10 "," $2,762.10 "," $2,854.17 "," $2,946.24 "," $2,578.14 "," $2,608.65 "," $2,351.40 "," $2,534.66 ", N/A ," $2,170.80 "," $2,170.80 "," $2,915.55 "," $2,551.46 ", $96.07 ," $2,946.24 "
 Fac Mycoplasma Antibody ,CPT® 86738,0302 - LAB/IMMUNOLOGY,N/A,N/A, $128.00 , $83.20 , $107.52 , $13.50 , $13.50 , $103.42 , $115.20 , $108.36 , $115.20 , $115.20 , $115.20 , $108.80 , $13.24 , $118.18 , $121.60 , $108.80 , $119.04 , $119.04 , $121.60 , $122.88 , $104.73 , $115.20 , $108.80 , $101.12 , N/A , $103.59 , $103.59 , $121.60 , $109.84 , $13.24 , $122.88 
 Critical Care Ea Add'l 30 Min -Mh ,CPT® 99292,0450 - EMERGENCY SERVICES,N/A,N/A," $1,320.00 ", $858.00 ," $1,108.80 ", $103.14 , $121.38 ," $1,066.56 "," $1,188.00 "," $1,117.51 "," $1,188.00 "," $1,188.00 "," $1,188.00 "," $1,122.00 ", $119.00 ," $1,218.76 "," $1,254.00 "," $1,122.00 "," $1,227.60 "," $1,227.60 "," $1,254.00 "," $1,267.20 "," $1,080.02 "," $1,188.00 "," $1,122.00 "," $1,042.80 ", N/A ," $1,068.28 "," $1,068.28 "," $1,254.00 "," $1,132.69 ", $103.14 ," $1,267.20 "
Osteotomy Heel Bone,CPT® 28300,N/A,N/A,N/A," $5,177.00 "," $3,365.05 "," $3,976.44 ", $623.61 , $614.70 ," $3,179.79 "," $3,182.01 "," $4,814.61 "," $4,659.30 "," $4,659.30 "," $4,141.60 "," $4,141.60 ", $614.70 ," $4,779.92 "," $4,918.15 "," $4,659.30 "," $4,659.30 "," $4,659.30 "," $4,814.61 "," $4,969.92 "," $3,700.65 "," $4,400.45 "," $3,496.77 "," $3,740.86 ", N/A ," $3,241.84 "," $3,241.84 "," $4,918.15 "," $3,810.30 ", $614.70 ," $4,969.92 "
 US Abdo Lmtd W/Retroperi Renal (Renal/A0- Mh ,CPT® 76775,0972 - PRO FEE/RAD/DX,N/A,N/A, $353.00 , $229.45 , $327.35 , $58.03 , $88.69 , $276.72 , $576.01 , $328.29 , $317.70 , $317.70 , $282.40 , $282.40 , $88.69 , $325.92 , $335.35 , $317.70 , $317.70 , $317.70 , $328.29 , $338.88 , $324.22 , $300.05 , $627.89 , $326.12 , N/A , $282.12 , $282.12 , $335.35 , $326.56 , $58.03 , $627.89 
 Pro Non-Routine Bl Draw > 3 Yrs ,CPT® 36410,0964 - PRO FEE/ANES CRNA,N/A,N/A, $143.00 , $92.95 , $56.68 , $8.74 , $16.64 , $40.95 , $40.19 , $132.99 , $128.70 , $128.70 , $114.40 , $114.40 , $16.64 , $132.03 , $135.85 , $128.70 , $128.70 , $128.70 , $132.99 , $137.28 , $52.57 , $121.55 , $49.95 , $46.82 , N/A , $41.76 , $41.76 , $135.85 , $47.42 , $8.74 , $137.28 
"Inject Trigem Nerv,1st Branch",64600,N/A,N/A,N/A," $2,753.00 "," $1,789.45 "," $1,104.48 ", $217.11 , $747.99 ," $1,205.32 "," $1,168.34 "," $2,560.29 "," $2,477.70 "," $2,477.70 "," $2,202.40 "," $2,202.40 ", $747.99 ," $2,541.84 "," $2,615.35 "," $2,477.70 "," $2,477.70 "," $2,477.70 "," $2,560.29 "," $2,642.88 "," $1,187.78 "," $2,340.05 "," $1,154.29 "," $1,318.50 ", N/A ," $1,228.83 "," $1,228.83 "," $2,615.35 "," $1,318.25 ", $217.11 ," $2,642.88 "
Prq Trluml Coronry Chrnic Occlus Revasc Addl Vsl,CPT® 92944,N/A,N/A,N/A," $2,230.00 "," $1,449.50 ", N/A , N/A , N/A , N/A , N/A ," $2,073.90 "," $2,007.00 "," $2,007.00 "," $1,784.00 "," $1,784.00 ", N/A ," $2,058.96 "," $2,118.50 "," $2,007.00 "," $2,007.00 "," $2,007.00 "," $2,073.90 "," $2,140.80 ", N/A ," $1,895.50 ", N/A , N/A , N/A , N/A , N/A ," $2,118.50 ", N/A ," $1,784.00 "," $2,140.80 "
Who W Nontor Jnt(S) Prefab,HCPCS L3915,N/A,N/A,N/A, $610.00 , $396.50 , N/A , $565.90 , $391.96 , N/A , N/A , $567.30 , $549.00 , $549.00 , $488.00 , $488.00 , $391.96 , $563.21 , $579.50 , $549.00 , $549.00 , $549.00 , $567.30 , $585.60 , N/A , $518.50 , $467.10 , $476.11 , N/A , N/A , N/A , $579.50 , N/A , $391.96 , $585.60 
 Fac in-Situ Vein Byp Fempop ,CPT® 35583,0360 - OR SERVICES,N/A,N/A," $5,791.00 "," $3,764.15 "," $4,864.44 "," $1,281.77 "," $1,054.33 "," $4,679.13 "," $5,211.90 "," $4,902.66 "," $5,211.90 "," $5,211.90 "," $5,211.90 "," $4,922.35 "," $1,033.66 "," $5,346.83 "," $5,501.45 "," $4,922.35 "," $5,385.63 "," $5,385.63 "," $5,501.45 "," $5,559.36 "," $4,738.20 "," $5,211.90 "," $4,922.35 "," $4,574.89 ", N/A ," $4,686.66 "," $4,686.66 "," $5,501.45 "," $4,969.26 "," $1,033.66 "," $5,559.36 "
 Fac Assay of Body Fluid Acidity ,CPT® 83986,0301 - LAB/CHEMISTRY,N/A,N/A, $61.00 , $39.65 , $51.24 , $3.65 , $3.65 , $49.29 , $54.90 , $51.64 , $54.90 , $54.90 , $54.90 , $51.85 , $3.58 , $56.32 , $57.95 , $51.85 , $56.73 , $56.73 , $57.95 , $58.56 , $49.91 , $54.90 , $51.85 , $48.19 , N/A , $49.37 , $49.37 , $57.95 , $52.34 , $3.58 , $58.56 
Dilation Rectal Stricture W Anest,CPT® 45910,N/A,N/A,N/A," $1,299.00 ", $844.35 ," $1,180.79 ", $183.62 , $133.31 , $928.53 , $952.03 ," $1,208.07 "," $1,169.10 "," $1,169.10 "," $1,039.20 "," $1,039.20 ", $133.31 ," $1,199.37 "," $1,234.05 "," $1,169.10 "," $1,169.10 "," $1,169.10 "," $1,208.07 "," $1,247.04 ", $840.60 ," $1,104.15 "," $1,045.46 "," $1,098.70 ", N/A , $946.64 , $946.64 ," $1,234.05 ", $990.08 , $133.31 ," $1,247.04 "
 GABAPENTIN 600 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6823-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 INFLIXIMAB-DYYB 100 MG IV SOLR ,HCPCS Q5103,0636 - DRUGS REQUIRING DETAILED CODIN,00069-0809-01,10 mL," $2,782.37 "," $1,808.54 "," $2,337.19 ", $18.80 , $25.30 ," $2,248.15 "," $2,504.13 "," $2,355.55 "," $2,504.13 "," $2,504.13 "," $2,504.13 "," $2,365.01 ", $24.80 ," $2,568.96 "," $2,643.25 "," $2,365.01 "," $2,587.60 "," $2,587.60 "," $2,643.25 "," $2,671.08 "," $2,276.54 "," $2,504.13 "," $2,365.01 "," $2,198.07 ", N/A ," $2,251.77 "," $2,251.77 "," $2,643.25 "," $2,387.55 ", $18.80 ," $2,671.08 "
 Pro Wedge Excise Skin Nail ,CPT® 11765,0982 - PRO FEE/OUTPT,N/A,N/A, $485.00 , $315.25 , $298.86 , $89.88 , $111.12 , $259.63 , $252.76 , $451.05 , $436.50 , $436.50 , $388.00 , $388.00 , $111.12 , $447.80 , $460.75 , $436.50 , $436.50 , $436.50 , $451.05 , $465.60 , $329.62 , $412.25 , $494.19 , $334.41 , N/A , $264.69 , $264.69 , $460.75 , $306.96 , $89.88 , $494.19 
 In Situ Hybridization per Spec Add'l Pro ,CPT® 88364,0971 - PRO FEE/LAB,N/A,N/A, $352.00 , $228.80 , $492.03 , $134.42 , $76.36 , $385.01 , $442.40 , $327.36 , $316.80 , $316.80 , $281.60 , $281.60 , $76.36 , $325.00 , $334.40 , $316.80 , $316.80 , $316.80 , $327.36 , $337.92 , $915.05 , $299.20 , $657.46 , $458.85 , N/A , $359.32 , $359.32 , $334.40 , $394.88 , $76.36 , $915.05 
Active Wound Care > 20 Cm,97598,N/A,N/A,N/A, $209.00 , $135.85 , $56.54 , $23.51 , $55.15 , $26.06 , $22.25 , $194.37 , $188.10 , $188.10 , $167.20 , $167.20 , $55.15 , $192.97 , $198.55 , $188.10 , $188.10 , $188.10 , $194.37 , $200.64 , $75.48 , $177.65 , $33.45 , $25.64 , N/A , $26.57 , $26.57 , $198.55 , $29.54 , $22.25 , $200.64 
Iaadiadoo Influenza,CPT® 87804,N/A,N/A,N/A, $114.00 , $74.10 , N/A , $16.88 , $16.65 , $67.85 , $81.18 , $106.02 , $102.60 , $102.60 , $91.20 , $91.20 , $16.65 , $105.26 , $108.30 , $102.60 , $102.60 , $102.60 , $106.02 , $109.44 , $110.51 , $96.90 , $77.85 , $48.51 , N/A , $63.32 , $63.32 , $108.30 , $69.20 , $16.65 , $110.51 
 Fac Molecular Pathology Interpr ,CPT® G0452,0310 - PATHOLOGY LAB,N/A,N/A, $77.00 , $50.05 , $64.68 , $49.22 , N/A , $62.22 , $69.30 , $65.19 , $69.30 , $69.30 , $69.30 , $65.45 , N/A , $71.09 , $73.15 , $65.45 , $71.61 , $71.61 , $73.15 , $73.92 , $63.00 , $69.30 , $65.45 , $60.83 , N/A , $62.32 , $62.32 , $73.15 , $66.07 , $49.22 , $73.92 
"Preventive Visit,New,40-64",99386,N/A,N/A,N/A, $478.00 , $310.70 , N/A , $145.76 , $62.71 , $254.52 , $256.24 , $444.54 , $430.20 , $430.20 , $382.40 , $382.40 , $62.71 , $441.34 , $454.10 , $430.20 , $430.20 , $430.20 , $444.54 , $458.88 , $314.18 , $406.30 , $256.54 , $253.45 , $183.25 , $259.48 , $259.48 , $454.10 , $311.66 , $62.71 , $458.88 
Exc Skin Malig 3.1-4cm Remaindr Body,11624,N/A,N/A,N/A," $1,694.00 "," $1,101.10 ", $758.13 , $226.87 , $390.36 , $655.26 , $637.05 ," $1,575.42 "," $1,524.60 "," $1,524.60 "," $1,355.20 "," $1,355.20 ", $390.36 ," $1,564.07 "," $1,609.30 "," $1,524.60 "," $1,524.60 "," $1,524.60 "," $1,575.42 "," $1,626.24 ", $830.47 ," $1,439.90 "," $1,273.82 ", $838.92 , N/A , $668.04 , $668.04 ," $1,609.30 ", $774.73 , $226.87 ," $1,626.24 "
"Lap, Surg Colostomy",CPT® 44188,N/A,N/A,N/A," $8,045.00 "," $5,229.25 "," $7,302.23 "," $1,130.68 ", $922.91 ," $5,794.86 "," $5,895.40 "," $7,481.85 "," $7,240.50 "," $7,240.50 "," $6,436.00 "," $6,436.00 ", $922.91 ," $7,427.95 "," $7,642.75 "," $7,240.50 "," $7,240.50 "," $7,240.50 "," $7,481.85 "," $7,723.20 "," $5,251.09 "," $6,838.25 "," $6,531.46 "," $6,864.25 ", N/A ," $5,907.93 "," $5,907.93 "," $7,642.75 "," $6,179.07 ", $922.91 ," $7,723.20 "
Thoracentesis Needle/Cath Pleura W/Imaging,32555,N/A,N/A,N/A," $3,674.00 "," $2,388.10 ", $602.20 , $104.93 , $293.25 , $441.35 , $422.54 ," $3,416.82 "," $3,306.60 "," $3,306.60 "," $2,939.20 "," $2,939.20 ", $293.25 ," $3,392.20 "," $3,490.30 "," $3,306.60 "," $3,306.60 "," $3,306.60 "," $3,416.82 "," $3,527.04 ", $586.09 ," $3,122.90 ", $588.74 , $585.22 , N/A , $449.97 , $449.97 ," $3,490.30 ", $529.94 , $104.93 ," $3,527.04 "
Injection Aa&/Strd Femoral Nerve W/Img Gdn,64447,N/A,N/A,N/A, $751.00 , $488.15 , $262.08 , $60.98 , $69.44 , $370.27 , $349.57 , $698.43 , $675.90 , $675.90 , $600.80 , $600.80 , $69.44 , $693.40 , $713.45 , $675.90 , $675.90 , $675.90 , $698.43 , $720.96 , $284.46 , $638.35 , $340.76 , $403.56 , N/A , $377.50 , $377.50 , $713.45 , $404.97 , $60.98 , $720.96 
Comm Svcs by Rhc/FQHC 5 Min,HCPCS G0071,N/A,N/A,N/A, $37.00 , $24.05 , N/A , $23.02 , N/A , N/A , N/A , $34.41 , $33.30 , $33.30 , $29.60 , $29.60 , N/A , $34.16 , $35.15 , $33.30 , $33.30 , $33.30 , $34.41 , $35.52 , $42.70 , $31.45 , $45.23 , $25.04 , N/A , $41.53 , $41.53 , $35.15 , $51.90 , $23.02 , $51.90 
 Pro Treat Humerus Fracture ,CPT® 24560,0982 - PRO FEE/OUTPT,N/A,N/A," $1,189.00 ", $772.85 ," $1,833.33 ", $291.21 , $184.42 ," $1,380.07 "," $1,410.71 "," $1,105.77 "," $1,070.10 "," $1,070.10 ", $951.20 , $951.20 , $184.42 ," $1,097.80 "," $1,129.55 "," $1,070.10 "," $1,070.10 "," $1,070.10 "," $1,105.77 "," $1,141.44 "," $1,695.22 "," $1,010.65 "," $1,548.57 "," $1,649.44 ", N/A ," $1,407.00 "," $1,407.00 "," $1,129.55 "," $1,653.71 ", $184.42 ," $1,833.33 "
"Repair Urethra Inj,Penile,Prostatc",CPT® 53515,N/A,N/A,N/A," $5,542.00 "," $3,602.30 "," $4,308.71 ", $757.77 ," $1,229.45 "," $3,891.46 "," $3,621.50 "," $5,154.06 "," $4,987.80 "," $4,987.80 "," $4,433.60 "," $4,433.60 "," $1,229.45 "," $5,116.93 "," $5,264.90 "," $4,987.80 "," $4,987.80 "," $4,987.80 "," $5,154.06 "," $5,320.32 "," $4,323.80 "," $4,710.70 "," $4,098.00 "," $4,894.84 ", N/A ," $3,967.39 "," $3,967.39 "," $5,264.90 "," $4,663.08 ", $757.77 ," $5,320.32 "
"Place Amniotic Membrane Ocular Surface Wound Healing, Sutured",CPT® 65779,N/A,N/A,N/A," $11,331.00 "," $7,365.15 ", $914.68 , $141.67 , $210.61 ," $1,607.30 "," $1,498.73 "," $10,537.83 "," $10,197.90 "," $10,197.90 "," $9,064.80 "," $9,064.80 ", $210.61 ," $10,461.91 "," $10,764.45 "," $10,197.90 "," $10,197.90 "," $10,197.90 "," $10,537.83 "," $10,877.76 "," $1,260.58 "," $9,631.35 "," $1,541.43 "," $1,095.41 ", N/A ," $1,638.66 "," $1,638.66 "," $10,764.45 "," $1,808.86 ", $141.67 ," $10,877.76 "
"Cystoscopy,Dil Urethral Stricture",CPT® 52281,N/A,N/A,N/A," $1,957.00 "," $1,272.05 ", $815.93 , $143.40 , $186.38 , $746.11 , $695.66 ," $1,820.01 "," $1,761.30 "," $1,761.30 "," $1,565.60 "," $1,565.60 ", $186.38 ," $1,806.90 "," $1,859.15 "," $1,761.30 "," $1,761.30 "," $1,761.30 "," $1,820.01 "," $1,878.72 ", $819.61 ," $1,663.45 ", $788.56 , $936.15 , N/A , $760.67 , $760.67 ," $1,859.15 ", $894.06 , $143.40 ," $1,878.72 "
"Remv Lens Material,Aspiratn",66840,N/A,N/A,N/A," $6,162.00 "," $4,005.30 "," $4,265.76 ", $669.14 , $547.80 ," $3,942.90 "," $3,733.31 "," $5,730.66 "," $5,545.80 "," $5,545.80 "," $4,929.60 "," $4,929.60 ", $547.80 ," $5,689.37 "," $5,853.90 "," $5,545.80 "," $5,545.80 "," $5,545.80 "," $5,730.66 "," $5,915.52 "," $5,863.97 "," $5,237.70 "," $3,878.56 "," $5,009.24 ", N/A ," $4,019.83 "," $4,019.83 "," $5,853.90 "," $4,437.37 ", $547.80 ," $5,915.52 "
" Fac Hla Typing, a, B, or C ",CPT® 86812,0302 - LAB/IMMUNOLOGY,N/A,N/A, $267.00 , $173.55 , $224.28 , $26.33 , $26.33 , $215.74 , $240.30 , $226.04 , $240.30 , $240.30 , $240.30 , $226.95 , $25.81 , $246.52 , $253.65 , $226.95 , $248.31 , $248.31 , $253.65 , $256.32 , $218.46 , $240.30 , $226.95 , $210.93 , N/A , $216.08 , $216.08 , $253.65 , $229.11 , $25.81 , $256.32 
 Pro Arthrs Kne Infctj Lvg&Drg ,CPT® 29871,0975 - PRO FEE/OR,N/A,N/A," $3,514.00 "," $2,284.10 "," $3,138.79 ", $493.81 , $604.11 ," $2,483.32 "," $2,481.44 "," $3,268.02 "," $3,162.60 "," $3,162.60 "," $2,811.20 "," $2,811.20 ", $604.11 ," $3,244.48 "," $3,338.30 "," $3,162.60 "," $3,162.60 "," $3,162.60 "," $3,268.02 "," $3,373.44 "," $2,916.25 "," $2,986.90 "," $2,736.75 "," $2,931.30 ", N/A ," $2,531.78 "," $2,531.78 "," $3,338.30 "," $2,975.72 ", $493.81 ," $3,373.44 "
" Fac Fungi Identification, Mold ",CPT® 87107,0306 - LAB/BACT-MICRO,N/A,N/A, $150.00 , $97.50 , $126.00 , $10.53 , $10.53 , $121.20 , $135.00 , $126.99 , $135.00 , $135.00 , $135.00 , $127.50 , $10.32 , $138.50 , $142.50 , $127.50 , $139.50 , $139.50 , $142.50 , $144.00 , $122.73 , $135.00 , $127.50 , $118.50 , N/A , $121.40 , $121.40 , $142.50 , $128.72 , $10.32 , $144.00 
 LABETALOL 5 MG/ML INJECTION (INPT) ,HCPCS J1920,0636 - DRUGS REQUIRING DETAILED CODIN,00409-2339-34,4 mL, $56.00 , $36.40 , $47.04 , N/A , N/A , $45.25 , $50.40 , $47.41 , $50.40 , $50.40 , $50.40 , $47.60 , N/A , $51.70 , $53.20 , $47.60 , $52.08 , $52.08 , $53.20 , $53.76 , $45.82 , $50.40 , $47.60 , $44.24 , N/A , $45.32 , $45.32 , $53.20 , $48.05 , $44.24 , $53.76 
 Pro Injection Aa&/Strd Sciatic Nerve W/Img Gdn ,CPT® 64445,0982 - PRO FEE/OUTPT,N/A,N/A," $1,653.00 "," $1,074.45 ", $264.94 , $69.92 , $46.08 , $404.19 , $385.85 ," $1,537.29 "," $1,487.70 "," $1,487.70 "," $1,322.40 "," $1,322.40 ", $46.08 ," $1,526.21 "," $1,570.35 "," $1,487.70 "," $1,487.70 "," $1,487.70 "," $1,537.29 "," $1,586.88 ", $287.54 ," $1,405.05 ", $378.22 , $437.51 , N/A , $412.08 , $412.08 ," $1,570.35 ", $442.06 , $46.08 ," $1,586.88 "
 Fac Abltj 1/> Lvr Tum Prq Rf ,CPT® 47382,0361 - OR/MINOR,N/A,N/A," $8,338.00 "," $5,419.70 "," $7,003.92 ", $700.74 , $661.99 ," $6,737.10 "," $7,504.20 "," $7,058.95 "," $7,504.20 "," $7,504.20 "," $7,504.20 "," $7,087.30 ", $649.01 ," $7,698.48 "," $7,921.10 "," $7,087.30 "," $7,754.34 "," $7,754.34 "," $7,921.10 "," $8,004.48 "," $6,822.15 "," $7,504.20 "," $7,087.30 "," $6,587.02 ", N/A ," $6,747.94 "," $6,747.94 "," $7,921.10 "," $7,154.84 ", $649.01 ," $8,004.48 "
Cath Plmt R Hrt & Arts W/Njx & Angio Img S&I,CPT® 93456,N/A,N/A,N/A," $7,565.00 "," $4,917.25 "," $7,285.92 "," $1,093.15 ", $798.55 ," $5,991.28 "," $6,421.72 "," $7,035.45 "," $6,808.50 "," $6,808.50 "," $6,052.00 "," $6,052.00 ", $798.55 ," $6,984.76 "," $7,186.75 "," $6,808.50 "," $6,808.50 "," $6,808.50 "," $7,035.45 "," $7,262.40 "," $6,862.51 "," $6,430.25 "," $6,099.71 "," $6,257.02 ", N/A ," $6,108.18 "," $6,108.18 "," $7,186.75 "," $6,770.99 ", $798.55 ," $7,285.92 "
 LIDOCAINE HCL 1 % IJ SOLN ,HCPCS RXA250,0250 - PHARMACY,63323-0485-27,20 mL, $20.86 , $13.56 , $17.52 , N/A , N/A , $16.85 , $18.77 , $17.66 , $18.77 , $18.77 , $18.77 , $17.73 , N/A , $19.26 , $19.82 , $17.73 , $19.40 , $19.40 , $19.82 , $20.03 , $17.07 , $18.77 , $17.73 , $16.48 , N/A , $16.88 , $16.88 , $19.82 , $17.90 , $16.48 , $20.03 
 Fac Imfluor Std Ea Antb Dir Meth ,CPT® 88346,0310 - PATHOLOGY LAB,N/A,N/A, $418.00 , $271.70 , $351.12 , $149.59 , $52.81 , $337.74 , $376.20 , $353.88 , $376.20 , $376.20 , $376.20 , $355.30 , $51.77 , $385.94 , $397.10 , $355.30 , $388.74 , $388.74 , $397.10 , $401.28 , $342.01 , $376.20 , $355.30 , $330.22 , N/A , $338.29 , $338.29 , $397.10 , $358.69 , $51.77 , $401.28 
"Replantation Digit Distal, Complt",CPT® 20822,N/A,N/A,N/A," $11,995.00 "," $7,796.75 "," $10,658.18 "," $1,665.20 "," $1,753.00 "," $8,713.03 "," $8,730.50 "," $11,155.35 "," $10,795.50 "," $10,795.50 "," $9,596.00 "," $9,596.00 "," $1,753.00 "," $11,074.98 "," $11,395.25 "," $10,795.50 "," $10,795.50 "," $10,795.50 "," $11,155.35 "," $11,515.20 "," $9,937.08 "," $10,195.75 "," $9,658.92 "," $10,061.24 ", N/A ," $8,883.04 "," $8,883.04 "," $11,395.25 "," $10,440.74 "," $1,665.20 "," $11,515.20 "
"Vag Hyst,Rev Vag/Urethr,Fix Enteroce",CPT® 58270,N/A,N/A,N/A," $5,266.00 "," $3,422.90 "," $4,225.55 ", $854.14 , $802.87 ," $3,588.29 "," $3,575.10 "," $4,897.38 "," $4,739.40 "," $4,739.40 "," $4,212.80 "," $4,212.80 ", $802.87 ," $4,862.10 "," $5,002.70 "," $4,739.40 "," $4,739.40 "," $4,739.40 "," $4,897.38 "," $5,055.36 "," $4,407.76 "," $4,476.10 "," $4,702.79 "," $3,597.61 ", N/A ," $3,658.30 "," $3,658.30 "," $5,002.70 "," $4,387.91 ", $802.87 ," $5,055.36 "
 LACOSAMIDE 200 MG/20ML IV SOLN ,HCPCS C9254,0636 - DRUGS REQUIRING DETAILED CODIN,00131-1810-67,5 mL, $142.55 , $92.66 , $119.74 , N/A , N/A , $115.18 , $128.30 , $120.68 , $128.30 , $128.30 , $128.30 , $121.17 , N/A , $131.62 , $135.42 , $121.17 , $132.57 , $132.57 , $135.42 , $136.85 , $116.63 , $128.30 , $121.17 , $112.61 , N/A , $115.37 , $115.37 , $135.42 , $122.32 , $112.61 , $136.85 
 FLUOROURACIL 500 MG/10ML IV SOLN ,HCPCS J9190,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0117-10,10 mL, $18.50 , $12.03 , $15.54 , $1.87 , $2.57 , $14.95 , $16.65 , $15.66 , $16.65 , $16.65 , $16.65 , $15.73 , $2.52 , $17.08 , $17.58 , $15.73 , $17.21 , $17.21 , $17.58 , $17.76 , $15.14 , $16.65 , $15.73 , $14.62 , N/A , $14.97 , $14.97 , $17.58 , $15.87 , $1.87 , $17.76 
Shav Skin Les 6-10mm Remaindr Body,11306,N/A,N/A,N/A, $473.00 , $307.45 , $159.32 , $47.40 , $58.11 , $142.14 , $136.31 , $439.89 , $425.70 , $425.70 , $378.40 , $378.40 , $58.11 , $436.72 , $449.35 , $425.70 , $425.70 , $425.70 , $439.89 , $454.08 , $175.73 , $402.05 , $269.39 , $183.99 , N/A , $144.91 , $144.91 , $449.35 , $168.04 , $47.40 , $454.08 
 Fac Eval Speech Sound Product Language Comprehension ,CPT® 92523,0444 - SPEECH PATH/EVAL,N/A,N/A, $749.00 , $486.85 , $629.16 , $227.40 , $181.48 , $605.19 , $674.10 , $634.10 , $674.10 , $674.10 , $674.10 , $636.65 , $177.92 , $691.55 , $711.55 , $636.65 , $696.57 , $696.57 , $711.55 , $719.04 , $612.83 , $674.10 , $636.65 , $591.71 , N/A , $606.17 , $606.17 , $711.55 , $642.72 , $177.92 , $719.04 
Relocation of Skin Pocket for Pacemaker,CPT® 33222,N/A,N/A,N/A," $3,631.00 "," $2,360.15 "," $2,056.28 ", $318.91 , $394.70 ," $1,489.50 "," $1,458.22 "," $3,376.83 "," $3,267.90 "," $3,267.90 "," $2,904.80 "," $2,904.80 ", $394.70 ," $3,352.50 "," $3,449.45 "," $3,267.90 "," $3,267.90 "," $3,267.90 "," $3,376.83 "," $3,485.76 "," $1,891.81 "," $3,086.35 "," $1,828.67 "," $1,641.40 ", N/A ," $1,518.57 "," $1,518.57 "," $3,449.45 "," $1,725.10 ", $318.91 ," $3,485.76 "
Insrt Aort Balloon Assist Fem Art,CPT® 33970,N/A,N/A,N/A," $3,846.00 "," $2,499.90 "," $2,063.62 ", $317.76 , $602.11 ," $1,515.07 "," $1,487.99 "," $3,576.78 "," $3,461.40 "," $3,461.40 "," $3,076.80 "," $3,076.80 ", $602.11 ," $3,551.01 "," $3,653.70 "," $3,461.40 "," $3,461.40 "," $3,461.40 "," $3,576.78 "," $3,692.16 "," $1,903.41 "," $3,269.10 "," $1,885.76 "," $1,703.18 ", N/A ," $1,544.63 "," $1,544.63 "," $3,653.70 "," $1,754.71 ", $317.76 ," $3,692.16 "
Sugars Single Qualitative,CPT® 84376,N/A,N/A,N/A, $51.00 , $33.15 , N/A , $5.61 , $5.61 , $31.10 , $37.22 , $47.43 , $45.90 , $45.90 , $40.80 , $40.80 , $5.61 , $47.09 , $48.45 , $45.90 , $45.90 , $45.90 , $47.43 , $48.96 , $36.72 , $43.35 , $35.68 , $19.94 , N/A , $29.02 , $29.02 , $48.45 , $31.72 , $5.61 , $48.96 
 Fac M/Phmtrc Alys Ish Quant/Semiq Mnl Each Multiprb ,CPT® 88377,0310 - PATHOLOGY LAB,N/A,N/A," $1,385.00 ", $900.25 ," $1,163.40 ", $389.56 , $168.73 ," $1,119.08 "," $1,246.50 "," $1,172.54 "," $1,246.50 "," $1,246.50 "," $1,246.50 "," $1,177.25 ", $165.42 ," $1,278.77 "," $1,315.75 "," $1,177.25 "," $1,288.05 "," $1,288.05 "," $1,315.75 "," $1,329.60 "," $1,133.21 "," $1,246.50 "," $1,177.25 "," $1,094.15 ", N/A ," $1,120.88 "," $1,120.88 "," $1,315.75 "," $1,188.47 ", $165.42 ," $1,329.60 "
Cont Gluc Monitoring Patient Provided Equiptment,CPT® 95249,N/A,N/A,N/A, $335.00 , $217.75 , $133.20 , $58.88 , $43.32 , $113.18 , $119.80 , $311.55 , $301.50 , $301.50 , $268.00 , $268.00 , $43.32 , $309.31 , $318.25 , $301.50 , $301.50 , $301.50 , $311.55 , $321.60 , $171.70 , $284.75 , $183.76 , $205.36 , N/A , $115.39 , $115.39 , $318.25 , $134.53 , $43.32 , $321.60 
 Abdomen MRI W/O & With Contrast ,CPT® 74183,0610 - MRI,N/A,N/A," $6,700.00 "," $4,355.00 "," $5,628.00 ", $348.90 , $639.53 ," $5,413.60 "," $6,030.00 "," $5,672.22 "," $6,030.00 "," $6,030.00 "," $6,030.00 "," $5,695.00 ", $626.99 ," $6,186.11 "," $6,365.00 "," $5,695.00 "," $6,231.00 "," $6,231.00 "," $6,365.00 "," $6,432.00 "," $5,481.94 "," $6,030.00 "," $5,695.00 "," $5,293.00 ", N/A ," $5,422.31 "," $5,422.31 "," $6,365.00 "," $5,749.27 ", $348.90 ," $6,432.00 "
"Cystoscopy,Remv Calculus,Simple",52310,N/A,N/A,N/A," $1,809.00 "," $1,175.85 ", $811.61 , $142.63 , $249.02 , $741.48 , $689.79 ," $1,682.37 "," $1,628.10 "," $1,628.10 "," $1,447.20 "," $1,447.20 ", $249.02 ," $1,670.25 "," $1,718.55 "," $1,628.10 "," $1,628.10 "," $1,628.10 "," $1,682.37 "," $1,736.64 ", $815.26 ," $1,537.65 ", $783.20 , $931.02 , N/A , $755.96 , $755.96 ," $1,718.55 ", $888.49 , $142.63 ," $1,736.64 "
Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level,CPT® 64483,N/A,N/A,N/A," $1,016.00 ", $660.40 , $550.37 , $106.70 , $205.84 , $636.12 , $622.08 , $944.88 , $914.40 , $914.40 , $812.80 , $812.80 , $205.84 , $938.07 , $965.20 , $914.40 , $914.40 , $914.40 , $944.88 , $975.36 , $598.03 , $863.60 , $604.80 , $680.05 , N/A , $648.53 , $648.53 , $965.20 , $695.74 , $106.70 , $975.36 
"Bx Low Leg Soft Tissue,Superficial",CPT® 27613,N/A,N/A,N/A," $1,701.00 "," $1,105.65 ", $989.11 , $154.86 , $42.71 , $787.57 , $806.39 ," $1,581.93 "," $1,530.90 "," $1,530.90 "," $1,360.80 "," $1,360.80 ", $42.71 ," $1,570.53 "," $1,615.95 "," $1,530.90 "," $1,530.90 "," $1,530.90 "," $1,581.93 "," $1,632.96 ", $914.01 ," $1,445.85 ", $879.54 , $943.20 , N/A , $802.93 , $802.93 ," $1,615.95 ", $943.73 , $42.71 ," $1,632.96 "
 CEFAZOLIN SODIUM 2 GM/20ML IV SOSY ,HCPCS J0690,0636 - DRUGS REQUIRING DETAILED CODIN,00001-0808-01,20 mL, $16.68 , $10.84 , $14.01 , $0.89 , $0.79 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.77 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.77 , $16.01 
Remv Toe Benign Bone Lesn,CPT® 28108,N/A,N/A,N/A," $2,890.00 "," $1,878.50 "," $1,788.48 ", $280.82 , $276.59 ," $1,429.67 "," $1,414.41 "," $2,687.70 "," $2,601.00 "," $2,601.00 "," $2,312.00 "," $2,312.00 ", $276.59 ," $2,668.34 "," $2,745.50 "," $2,601.00 "," $2,601.00 "," $2,601.00 "," $2,687.70 "," $2,774.40 "," $1,657.31 "," $2,456.50 "," $1,528.94 "," $1,695.02 ", N/A ," $1,457.57 "," $1,457.57 "," $2,745.50 "," $1,713.17 ", $276.59 ," $2,774.40 "
Reconstruction of Pylorus,CPT® 43800,N/A,N/A,N/A," $6,176.00 "," $4,014.40 "," $5,536.90 ", $855.67 ," $1,152.57 "," $4,362.95 "," $4,405.18 "," $5,743.68 "," $5,558.40 "," $5,558.40 "," $4,940.80 "," $4,940.80 "," $1,152.57 "," $5,702.30 "," $5,867.20 "," $5,558.40 "," $5,558.40 "," $5,558.40 "," $5,743.68 "," $5,928.96 "," $3,968.06 "," $5,249.60 "," $4,906.18 "," $5,143.63 ", N/A ," $4,448.08 "," $4,448.08 "," $5,867.20 "," $4,652.22 ", $855.67 ," $5,928.96 "
 Fac Assay of Cyclosporine ,CPT® 80158,0301 - LAB/CHEMISTRY,N/A,N/A, $207.00 , $134.55 , $173.88 , $18.41 , $18.41 , $167.26 , $186.30 , $175.25 , $186.30 , $186.30 , $186.30 , $175.95 , $18.05 , $191.12 , $196.65 , $175.95 , $192.51 , $192.51 , $196.65 , $198.72 , $169.37 , $186.30 , $175.95 , $163.53 , N/A , $167.53 , $167.53 , $196.65 , $177.63 , $18.05 , $198.72 
Treat Phalangeal Shft Frc,26720,N/A,N/A,N/A," $1,300.00 ", $845.00 ," $1,172.86 ", $187.01 , $74.22 , $886.14 , $907.35 ," $1,209.00 "," $1,170.00 "," $1,170.00 "," $1,040.00 "," $1,040.00 ", $74.22 ," $1,200.29 "," $1,235.00 "," $1,170.00 "," $1,170.00 "," $1,170.00 "," $1,209.00 "," $1,248.00 "," $1,075.93 "," $1,105.00 ", $995.51 ," $1,060.64 ", N/A , $903.43 , $903.43 ," $1,235.00 "," $1,061.84 ", $74.22 ," $1,248.00 "
 Fac Blood Ph ,CPT® 82800,0301 - LAB/CHEMISTRY,N/A,N/A, $90.00 , $58.50 , $75.60 , $11.22 , $11.22 , $72.72 , $81.00 , $76.19 , $81.00 , $81.00 , $81.00 , $76.50 , $11.00 , $83.10 , $85.50 , $76.50 , $83.70 , $83.70 , $85.50 , $86.40 , $73.64 , $81.00 , $76.50 , $71.10 , N/A , $72.84 , $72.84 , $85.50 , $77.23 , $11.00 , $86.40 
"Repair Detach Retina,Scleral Buckle",CPT® 67107,N/A,N/A,N/A," $10,359.00 "," $6,733.35 "," $6,910.87 "," $1,082.69 "," $1,512.06 "," $6,880.56 "," $6,471.15 "," $9,633.87 "," $9,323.10 "," $9,323.10 "," $8,287.20 "," $8,287.20 "," $1,512.06 "," $9,564.46 "," $9,841.05 "," $9,323.10 "," $9,323.10 "," $9,323.10 "," $9,633.87 "," $9,944.64 "," $9,501.82 "," $8,805.15 "," $6,700.94 "," $8,139.16 ", N/A ," $7,014.81 "," $7,014.81 "," $9,841.05 "," $7,743.42 "," $1,082.69 "," $9,944.64 "
"Burn,Initial Treatment",16000,N/A,N/A,N/A, $161.00 , $104.65 , $143.24 , $43.12 , $29.25 , $126.05 , $122.05 , $149.73 , $144.90 , $144.90 , $128.80 , $128.80 , $29.25 , $148.65 , $152.95 , $144.90 , $144.90 , $144.90 , $149.73 , $154.56 , $157.17 , $136.85 , $242.63 , $162.35 , N/A , $128.51 , $128.51 , $152.95 , $149.03 , $29.25 , $242.63 
 METOPROLOL TARTRATE 5 MG/5ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00409-1778-05,1 mL, $16.68 , $10.84 , $14.01 , N/A , N/A , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , N/A , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $13.18 , $16.01 
 Pro Egd Ablate Tumor Polyp/Lesion W/Dilation& Wire ,CPT® 43270,0982 - PRO FEE/OUTPT,N/A,N/A," $4,359.00 "," $2,833.35 "," $1,377.74 ", $212.56 , $184.45 ," $1,168.51 "," $1,211.94 "," $4,053.87 "," $3,923.10 "," $3,923.10 "," $3,487.20 "," $3,487.20 ", $184.45 ," $4,024.66 "," $4,141.05 "," $3,923.10 "," $3,923.10 "," $3,923.10 "," $4,053.87 "," $4,184.64 ", $989.63 ," $3,705.15 "," $1,167.45 "," $1,311.97 ", N/A ," $1,191.31 "," $1,191.31 "," $4,141.05 "," $1,245.98 ", $184.45 ," $4,184.64 "
 Microdissection Prep Identified Target Mnl ,CPT® 88381,0310 - PATHOLOGY LAB,N/A,N/A, $668.00 , $434.20 , $561.12 , $197.49 , $163.84 , $539.74 , $601.20 , $565.53 , $601.20 , $601.20 , $601.20 , $567.80 , $160.63 , $616.76 , $634.60 , $567.80 , $621.24 , $621.24 , $634.60 , $641.28 , $546.56 , $601.20 , $567.80 , $527.72 , N/A , $540.61 , $540.61 , $634.60 , $573.21 , $160.63 , $641.28 
Abdom Paracentesis Dx/Ther W Imaging Guidance,49083,N/A,N/A,N/A, $956.00 , $621.40 , $655.33 , $101.73 , $362.06 , $531.21 , $543.60 , $889.08 , $860.40 , $860.40 , $764.80 , $764.80 , $362.06 , $882.67 , $908.20 , $860.40 , $860.40 , $860.40 , $889.08 , $917.76 , $471.73 , $812.60 , $586.96 , $631.12 , N/A , $541.58 , $541.58 , $908.20 , $566.43 , $101.73 , $917.76 
" Pro US Exam, Spinal Canal ",CPT® 76800,0972 - PRO FEE/RAD/DX,N/A,N/A, $592.00 , $384.80 , $817.97 , $152.11 , $120.18 , $663.89 , $691.42 , $550.56 , $532.80 , $532.80 , $473.60 , $473.60 , $120.18 , $546.59 , $562.40 , $532.80 , $532.80 , $532.80 , $550.56 , $568.32 , $782.25 , $503.20 , $755.01 , $808.65 , N/A , $676.84 , $676.84 , $562.40 , $783.46 , $120.18 , $817.97 
"Remov Sesamoid Bone,1st Toe",28315,N/A,N/A,N/A," $3,212.00 "," $2,087.80 "," $2,025.21 ", $317.59 , $206.19 ," $1,607.33 "," $1,594.49 "," $2,987.16 "," $2,890.80 "," $2,890.80 "," $2,569.60 "," $2,569.60 ", $206.19 ," $2,965.64 "," $3,051.40 "," $2,890.80 "," $2,890.80 "," $2,890.80 "," $2,987.16 "," $3,083.52 "," $1,883.23 "," $2,730.20 "," $1,726.97 "," $1,912.14 ", N/A ," $1,638.69 "," $1,638.69 "," $3,051.40 "," $1,926.04 ", $206.19 ," $3,083.52 "
 Fac RBC Sickle Cell Test ,CPT® 85660,0305 - LAB/HEMATOLOGY,N/A,N/A, $66.00 , $42.90 , $55.44 , $5.62 , $5.62 , $53.33 , $59.40 , $55.88 , $59.40 , $59.40 , $59.40 , $56.10 , $5.51 , $60.94 , $62.70 , $56.10 , $61.38 , $61.38 , $62.70 , $63.36 , $54.00 , $59.40 , $56.10 , $52.14 , N/A , $53.41 , $53.41 , $62.70 , $56.63 , $5.51 , $63.36 
Tenotomy Elbow Lateral/Medial Debride Open,24358,N/A,N/A,N/A," $3,464.00 "," $2,251.60 "," $3,246.69 ", $510.18 , $366.18 ," $2,520.37 "," $2,521.78 "," $3,221.52 "," $3,117.60 "," $3,117.60 "," $2,771.20 "," $2,771.20 ", $366.18 ," $3,198.31 "," $3,290.80 "," $3,117.60 "," $3,117.60 "," $3,117.60 "," $3,221.52 "," $3,325.44 "," $3,005.26 "," $2,944.40 "," $2,777.79 "," $2,984.45 ", N/A ," $2,569.55 "," $2,569.55 "," $3,290.80 "," $3,020.14 ", $366.18 ," $3,325.44 "
 GLYCINE 1.5 % IR SOLN ,HCPCS RXA258,0258 - IV SOLUTIONS,00990-7974-08,"3,000 mL", $77.06 , $50.09 , $64.73 , N/A , N/A , $62.26 , $69.35 , $65.24 , $69.35 , $69.35 , $69.35 , $65.50 , N/A , $71.15 , $73.21 , $65.50 , $71.67 , $71.67 , $73.21 , $73.98 , $63.05 , $69.35 , $65.50 , $60.88 , N/A , $62.36 , $62.36 , $73.21 , $66.13 , $60.88 , $73.98 
"Epstein-Barr Antibody,Early",CPT® 86663,N/A,N/A,N/A, $155.00 , $100.75 , N/A , $13.38 , $13.38 , $74.26 , $88.77 , $144.15 , $139.50 , $139.50 , $124.00 , $124.00 , $13.38 , $143.11 , $147.25 , $139.50 , $139.50 , $139.50 , $144.15 , $148.80 , $87.61 , $131.75 , $85.96 , $47.58 , N/A , $69.30 , $69.30 , $147.25 , $75.73 , $13.38 , $148.80 
Drug Delivery System >=50 Ml,HCPCS A4305,N/A,N/A,N/A, $86.00 , $55.90 , N/A , N/A , $11.57 , N/A , N/A , $79.98 , $77.40 , $77.40 , $68.80 , $68.80 , $11.57 , $79.40 , $81.70 , $77.40 , $77.40 , $77.40 , $79.98 , $82.56 , N/A , $73.10 , $16.87 , $9.81 , N/A , N/A , N/A , $81.70 , N/A , $9.81 , $82.56 
Drug Assay Amiodarone,CPT® 80151,N/A,N/A,N/A, $152.00 , $98.80 , N/A , $19.01 , $15.21 , N/A , N/A , $141.36 , $136.80 , $136.80 , $121.60 , $121.60 , $15.21 , $140.34 , $144.40 , $136.80 , $136.80 , $136.80 , $141.36 , $145.92 , $124.46 , $129.20 , $88.85 , $54.75 , N/A , $74.00 , $74.00 , $144.40 , $80.71 , $15.21 , $145.92 
"Lap,Adrenalectomy",CPT® 60650,N/A,N/A,N/A," $8,495.00 "," $5,521.75 "," $7,108.53 "," $1,103.17 "," $1,535.71 "," $6,129.70 "," $6,289.00 "," $7,900.35 "," $7,645.50 "," $7,645.50 "," $6,796.00 "," $6,796.00 "," $1,535.71 "," $7,843.43 "," $8,070.25 "," $7,645.50 "," $7,645.50 "," $7,645.50 "," $7,900.35 "," $8,155.20 "," $6,922.45 "," $7,220.75 "," $6,238.87 "," $5,946.84 ", N/A ," $6,249.30 "," $6,249.30 "," $8,070.25 "," $6,969.84 "," $1,103.17 "," $8,155.20 "
" Pro Fusion of Finger Jnt, Add-On ",CPT® 26861,0982 - PRO FEE/OUTPT,N/A,N/A, $712.00 , $462.80 , $611.91 , $94.71 , $186.84 , $499.38 , $488.06 , $662.16 , $640.80 , $640.80 , $569.60 , $569.60 , $186.84 , $657.39 , $676.40 , $640.80 , $640.80 , $640.80 , $662.16 , $683.52 , $573.91 , $605.20 , $540.57 , $587.19 , N/A , $509.12 , $509.12 , $676.40 , $598.41 , $94.71 , $683.52 
"Rout OB Care,C-Sec,Prev C-Sec",CPT® 59618,N/A,N/A,N/A," $8,462.00 "," $5,500.30 "," $7,216.56 "," $2,441.48 "," $1,407.14 "," $5,427.24 "," $5,732.06 "," $7,869.66 "," $7,615.80 "," $7,615.80 "," $6,769.60 "," $6,769.60 "," $1,407.14 "," $7,812.96 "," $8,038.90 "," $7,615.80 "," $7,615.80 "," $7,615.80 "," $7,869.66 "," $8,123.52 "," $7,294.97 "," $7,192.70 "," $12,632.96 "," $5,422.11 ", N/A ," $5,533.13 "," $5,533.13 "," $8,038.90 "," $6,396.85 "," $1,407.14 "," $12,632.96 "
"Excise Lesn Neck/Chest,Deep",CPT® 21556,N/A,N/A,N/A," $3,479.00 "," $2,261.35 "," $3,232.78 ", $505.10 , $358.52 ," $2,553.41 "," $2,574.55 "," $3,235.47 "," $3,131.10 "," $3,131.10 "," $2,783.20 "," $2,783.20 ", $358.52 ," $3,212.16 "," $3,305.05 "," $3,131.10 "," $3,131.10 "," $3,131.10 "," $3,235.47 "," $3,339.84 "," $2,984.35 "," $2,957.15 "," $2,842.01 "," $2,986.72 ", N/A ," $2,603.22 "," $2,603.22 "," $3,305.05 "," $3,059.73 ", $358.52 ," $3,339.84 "
 APIXABAN 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00003-0894-31,1 tablet, $57.62 , $37.45 , $48.40 , N/A , N/A , $46.56 , $51.86 , $48.78 , $51.86 , $51.86 , $51.86 , $48.98 , N/A , $53.20 , $54.74 , $48.98 , $53.59 , $53.59 , $54.74 , $55.32 , $47.14 , $51.86 , $48.98 , $45.52 , N/A , $46.63 , $46.63 , $54.74 , $49.44 , $45.52 , $55.32 
 Fac US Breast Uni Real Time With Image Limited ,CPT® 76642,0402 - ULTRASOUND,N/A,N/A, $518.00 , $336.70 , $435.12 , $84.14 , $69.75 , $418.54 , $466.20 , $438.54 , $466.20 , $466.20 , $466.20 , $440.30 , $68.38 , $478.27 , $492.10 , $440.30 , $481.74 , $481.74 , $492.10 , $497.28 , $423.83 , $466.20 , $440.30 , $409.22 , N/A , $419.22 , $419.22 , $492.10 , $444.50 , $68.38 , $497.28 
Nasal/Sinus Ndsc Surg W/Dilation Maxillary Sinus,CPT® 31295,N/A,N/A,N/A," $11,734.00 "," $7,627.10 ", $850.77 , $150.53 , $127.09 , $637.83 , $630.42 ," $10,912.62 "," $10,560.60 "," $10,560.60 "," $9,387.20 "," $9,387.20 ", $127.09 ," $10,834.00 "," $11,147.30 "," $10,560.60 "," $10,560.60 "," $10,560.60 "," $10,912.62 "," $11,264.64 ", $815.29 ," $9,973.90 ", $888.46 , $804.28 , N/A , $650.27 , $650.27 ," $11,147.30 ", $765.84 , $127.09 ," $11,264.64 "
Elec Alys Implt Npgt Cplx Sp/Pn Prgrmg,CPT® 95972,N/A,N/A,N/A, $498.00 , $323.70 , $145.88 , $38.59 , $56.46 , $134.00 , $263.49 , $463.14 , $448.20 , $448.20 , $398.40 , $398.40 , $56.46 , $459.80 , $473.10 , $448.20 , $448.20 , $448.20 , $463.14 , $478.08 , $174.37 , $423.30 , $231.13 , $156.58 , N/A , $136.61 , $136.61 , $473.10 , $167.96 , $38.59 , $478.08 
 Fac Drug Screen Quantitative Gabapentin ,CPT® 80171,0301 - LAB/CHEMISTRY,N/A,N/A, $157.00 , $102.05 , $131.88 , $22.10 , $14.77 , $126.86 , $141.30 , $132.92 , $141.30 , $141.30 , $141.30 , $133.45 , $14.48 , $144.96 , $149.15 , $133.45 , $146.01 , $146.01 , $149.15 , $150.72 , $128.46 , $141.30 , $133.45 , $124.03 , N/A , $127.06 , $127.06 , $149.15 , $134.72 , $14.48 , $150.72 
 Fac Chrmsm Cnt 15-20 Cll 2karyotyp Banding ,CPT® 88262,0310 - PATHOLOGY LAB,N/A,N/A," $2,289.00 "," $1,487.85 "," $1,922.76 ", $128.00 , $128.00 ," $1,849.51 "," $2,060.10 "," $1,937.87 "," $2,060.10 "," $2,060.10 "," $2,060.10 "," $1,945.65 ", $125.49 ," $2,113.43 "," $2,174.55 "," $1,945.65 "," $2,128.77 "," $2,128.77 "," $2,174.55 "," $2,197.44 "," $1,872.86 "," $2,060.10 "," $1,945.65 "," $1,808.31 ", N/A ," $1,852.49 "," $1,852.49 "," $2,174.55 "," $1,964.19 ", $125.49 ," $2,197.44 "
 Fac Mass Spectrometry Quant ,CPT® 83789,0301 - LAB/CHEMISTRY,N/A,N/A, $174.00 , $113.10 , $146.16 , $24.59 , $24.59 , $140.59 , $156.60 , $147.31 , $156.60 , $156.60 , $156.60 , $147.90 , $24.11 , $160.65 , $165.30 , $147.90 , $161.82 , $161.82 , $165.30 , $167.04 , $142.37 , $156.60 , $147.90 , $137.46 , N/A , $140.82 , $140.82 , $165.30 , $149.31 , $24.11 , $167.04 
 Pro Intravitreal Njx Pharmacologic Agt Spx ,CPT® 67028,0975 - PRO FEE/OR,N/A,N/A, $773.00 , $502.45 , $564.33 , $88.40 , $261.20 , $565.44 , $526.42 , $718.89 , $695.70 , $695.70 , $618.40 , $618.40 , $261.20 , $713.71 , $734.35 , $695.70 , $695.70 , $695.70 , $718.89 , $742.08 , $779.44 , $657.05 , $542.36 , $720.34 , N/A , $576.47 , $576.47 , $734.35 , $636.34 , $88.40 , $779.44 
Treat Interphalangeal Jnt,28660,N/A,N/A,N/A, $613.00 , $398.45 , $565.96 , $89.32 , $69.38 , $431.41 , $434.98 , $570.09 , $551.70 , $551.70 , $490.40 , $490.40 , $69.38 , $565.98 , $582.35 , $551.70 , $551.70 , $551.70 , $570.09 , $588.48 , $522.51 , $521.05 , $476.35 , $510.98 , N/A , $439.83 , $439.83 , $582.35 , $516.96 , $69.38 , $588.48 
" Fac Assay, Carbamazepine, Free ",CPT® 80157,0301 - LAB/CHEMISTRY,N/A,N/A, $121.00 , $78.65 , $101.64 , $13.52 , $13.52 , $97.77 , $108.90 , $102.44 , $108.90 , $108.90 , $108.90 , $102.85 , $13.25 , $111.72 , $114.95 , $102.85 , $112.53 , $112.53 , $114.95 , $116.16 , $99.00 , $108.90 , $102.85 , $95.59 , N/A , $97.93 , $97.93 , $114.95 , $103.83 , $13.25 , $116.16 
 AZATHIOPRINE 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,68084-0229-01,1 tablet, $4.35 , $2.83 , $3.65 , N/A , N/A , $3.51 , $3.92 , $3.68 , $3.92 , $3.92 , $3.92 , $3.70 , N/A , $4.02 , $4.13 , $3.70 , $4.05 , $4.05 , $4.13 , $4.18 , $3.56 , $3.92 , $3.70 , $3.44 , N/A , $3.52 , $3.52 , $4.13 , $3.73 , $3.44 , $4.18 
Transcatheter Transapical Replacemt Aortic Valve,CPT® 33366,N/A,N/A,N/A," $18,050.00 "," $11,732.50 "," $9,165.13 "," $1,411.29 "," $1,418.27 "," $8,246.48 "," $8,278.52 "," $16,786.50 "," $16,245.00 "," $16,245.00 "," $14,440.00 "," $14,440.00 "," $1,418.27 "," $16,665.57 "," $17,147.50 "," $16,245.00 "," $16,245.00 "," $16,245.00 "," $16,786.50 "," $17,328.00 "," $8,485.32 "," $15,342.50 "," $8,159.72 "," $9,231.80 ", N/A ," $8,407.39 "," $8,407.39 "," $17,147.50 "," $9,550.80 "," $1,411.29 "," $17,328.00 "
 PHENAZOPYRIDINE HCL 200 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,42192-0802-01,1 tablet, $20.55 , $13.36 , $17.26 , N/A , N/A , $16.60 , $18.50 , $17.40 , $18.50 , $18.50 , $18.50 , $17.47 , N/A , $18.97 , $19.52 , $17.47 , $19.11 , $19.11 , $19.52 , $19.73 , $16.81 , $18.50 , $17.47 , $16.23 , N/A , $16.63 , $16.63 , $19.52 , $17.63 , $16.23 , $19.73 
 Fac Balloon Dilat Ureteral Stricture W/Img Gid Rs&I ,CPT® 50706,0360 - OR SERVICES,N/A,N/A," $5,548.00 "," $3,606.20 "," $4,660.32 ", $170.93 , $606.49 ," $4,482.78 "," $4,993.20 "," $4,696.94 "," $4,993.20 "," $4,993.20 "," $4,993.20 "," $4,715.80 ", $594.60 ," $5,122.47 "," $5,270.60 "," $4,715.80 "," $5,159.64 "," $5,159.64 "," $5,270.60 "," $5,326.08 "," $4,539.37 "," $4,993.20 "," $4,715.80 "," $4,382.92 ", N/A ," $4,490.00 "," $4,490.00 "," $5,270.60 "," $4,760.74 ", $170.93 ," $5,326.08 "
Remove Pelvis Lymph Nodes,CPT® 38770,N/A,N/A,N/A," $4,518.00 "," $2,936.70 "," $3,766.20 ", $762.72 , $765.08 ," $2,845.34 "," $2,881.50 "," $4,201.74 "," $4,066.20 "," $4,066.20 "," $3,614.40 "," $3,614.40 ", $765.08 ," $4,171.47 "," $4,292.10 "," $4,066.20 "," $4,066.20 "," $4,066.20 "," $4,201.74 "," $4,337.28 "," $4,042.98 "," $3,840.30 "," $4,174.71 "," $3,989.81 ", N/A ," $2,900.85 "," $2,900.85 "," $4,292.10 "," $3,365.37 ", $762.72 ," $4,337.28 "
 Fac Amino Acids Mlt Qual Ea Spec ,CPT® 82128,0301 - LAB/CHEMISTRY,N/A,N/A, $119.00 , $77.35 , $99.96 , $14.15 , $14.15 , $96.15 , $107.10 , $100.75 , $107.10 , $107.10 , $107.10 , $101.15 , $13.87 , $109.87 , $113.05 , $101.15 , $110.67 , $110.67 , $113.05 , $114.24 , $97.37 , $107.10 , $101.15 , $94.01 , N/A , $96.31 , $96.31 , $113.05 , $102.11 , $13.87 , $114.24 
Assay Urine Urea-N,CPT® 84540,N/A,N/A,N/A, $63.00 , $40.95 , N/A , $5.67 , $5.67 , $26.85 , $32.15 , $58.59 , $56.70 , $56.70 , $50.40 , $50.40 , $5.67 , $58.17 , $59.85 , $56.70 , $56.70 , $56.70 , $58.59 , $60.48 , $37.13 , $53.55 , $30.82 , $17.21 , N/A , $25.06 , $25.06 , $59.85 , $27.39 , $5.67 , $60.48 
"Lap,Vag Hyst,Uterus >250gms",CPT® 58553,N/A,N/A,N/A," $6,763.00 "," $4,395.95 "," $5,261.30 "," $1,063.90 "," $1,019.42 "," $4,610.61 "," $4,600.20 "," $6,289.59 "," $6,086.70 "," $6,086.70 "," $5,410.40 "," $5,410.40 "," $1,019.42 "," $6,244.28 "," $6,424.85 "," $6,086.70 "," $6,086.70 "," $6,086.70 "," $6,289.59 "," $6,492.48 "," $5,526.23 "," $5,748.55 "," $6,056.90 "," $4,603.20 ", N/A ," $4,700.57 "," $4,700.57 "," $6,424.85 "," $5,638.05 "," $1,019.42 "," $6,492.48 "
 Fac Slctv Cath Carotid/Innom Art Angio Xtrcranl Art ,CPT® 36222,0360 - OR SERVICES,N/A,N/A," $7,090.00 "," $4,608.50 "," $5,955.60 ", $255.61 , $456.30 ," $5,728.72 "," $6,381.00 "," $6,002.39 "," $6,381.00 "," $6,381.00 "," $6,381.00 "," $6,026.50 ", $447.35 ," $6,546.20 "," $6,735.50 "," $6,026.50 "," $6,593.70 "," $6,593.70 "," $6,735.50 "," $6,806.40 "," $5,801.04 "," $6,381.00 "," $6,026.50 "," $5,601.10 ", N/A ," $5,737.94 "," $5,737.94 "," $6,735.50 "," $6,083.93 ", $255.61 ," $6,806.40 "
" Pro Med Nutrition, Indiv, Subseq ",CPT® 97803,0982 - PRO FEE/OUTPT,N/A,N/A, $113.00 , $73.45 , $64.46 , $27.15 , N/A , $61.35 , $62.99 , $105.09 , $101.70 , $101.70 , $90.40 , $90.40 , N/A , $104.33 , $107.35 , $101.70 , $101.70 , $101.70 , $105.09 , $108.48 , $85.60 , $96.05 , $83.12 , $104.94 , N/A , $62.56 , $62.56 , $107.35 , $72.92 , $27.15 , $108.48 
"Amputation Toe,Mt-P Jt",CPT® 28820,N/A,N/A,N/A," $3,837.00 "," $2,494.05 "," $1,097.20 ", $170.21 , $184.42 ," $1,941.50 "," $1,962.17 "," $3,568.41 "," $3,453.30 "," $3,453.30 "," $3,069.60 "," $3,069.60 ", $184.42 ," $3,542.70 "," $3,645.15 "," $3,453.30 "," $3,453.30 "," $3,453.30 "," $3,568.41 "," $3,683.52 "," $1,030.80 "," $3,261.45 "," $2,146.23 "," $2,289.48 ", N/A ," $1,979.38 "," $1,979.38 "," $3,645.15 "," $2,326.47 ", $170.21 ," $3,683.52 "
"Laryngoscopy,Indirect",31505,N/A,N/A,N/A, $278.00 , $180.70 , $265.36 , $47.56 , $48.28 , $188.55 , $189.85 , $258.54 , $250.20 , $250.20 , $222.40 , $222.40 , $48.28 , $256.68 , $264.10 , $250.20 , $250.20 , $250.20 , $258.54 , $266.88 , $252.04 , $236.30 , $265.83 , $249.84 , N/A , $192.23 , $192.23 , $264.10 , $226.41 , $47.56 , $266.88 
App Skn Sub Grft T/a/L Area/<100scm Ea Adl 25scm,15272,N/A,N/A,N/A, $160.00 , $104.00 , $54.57 , $15.78 , $21.08 , $47.60 , $45.05 , $148.80 , $144.00 , $144.00 , $128.00 , $128.00 , $21.08 , $147.73 , $152.00 , $144.00 , $144.00 , $144.00 , $148.80 , $153.60 , $59.43 , $136.00 , $89.20 , $61.56 , N/A , $48.53 , $48.53 , $152.00 , $56.28 , $15.78 , $153.60 
" Fac Mra W/O Cont, Lwr Ext ",HCPCS C8913,0616 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA-LOWER EXTREMITIES,N/A,N/A," $1,908.00 "," $1,240.20 "," $1,602.72 ", N/A , N/A ," $1,541.66 "," $1,717.20 "," $1,615.31 "," $1,717.20 "," $1,717.20 "," $1,717.20 "," $1,621.80 ", N/A ," $1,761.66 "," $1,812.60 "," $1,621.80 "," $1,774.44 "," $1,774.44 "," $1,812.60 "," $1,831.68 "," $1,561.13 "," $1,717.20 "," $1,621.80 "," $1,507.32 ", N/A ," $1,544.14 "," $1,544.14 "," $1,812.60 "," $1,637.25 "," $1,507.32 "," $1,831.68 "
 Fac Chloride Oth Src ,CPT® 82438,0301 - LAB/CHEMISTRY,N/A,N/A, $65.00 , $42.25 , $54.60 , $5.10 , $5.10 , $52.52 , $58.50 , $55.03 , $58.50 , $58.50 , $58.50 , $55.25 , $5.00 , $60.01 , $61.75 , $55.25 , $60.45 , $60.45 , $61.75 , $62.40 , $53.18 , $58.50 , $55.25 , $51.35 , N/A , $52.60 , $52.60 , $61.75 , $55.78 , $5.00 , $62.40 
 Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC ,MS DRG V40 (FY2023) 066,N/A,N/A,N/A," $29,533.92 "," $19,197.05 "," $24,808.49 ", N/A , N/A ," $23,863.41 "," $26,580.53 "," $25,003.42 "," $26,580.53 "," $26,580.53 "," $26,580.53 "," $25,103.83 ", N/A ," $27,268.67 "," $28,057.22 "," $25,103.83 "," $27,466.55 "," $27,466.55 "," $28,057.22 "," $28,352.56 "," $24,164.65 "," $26,580.53 "," $25,103.83 "," $23,331.80 ", N/A ," $23,901.80 "," $23,901.80 "," $28,057.22 "," $25,343.06 "," $23,331.80 "," $28,352.56 "
Iiv4 Vacc Prsrv Free 0.25 Ml Dos for Im Use,CPT® 90685,N/A,N/A,N/A, $32.00 , $20.80 , N/A , N/A , $15.30 , $52.23 , $53.43 , $29.76 , $28.80 , $28.80 , $25.60 , $25.60 , $15.30 , $29.55 , $30.40 , $28.80 , $28.80 , $28.80 , $29.76 , $30.72 , $27.47 , $27.20 , $25.60 , $37.43 , N/A , N/A , N/A , $30.40 , N/A , $15.30 , $53.43 
 Transperineal Plmt Biodegrad Matrl 1/Mlt Njx ,CPT® 55874,0761 - TREATMENT ROOM,N/A,N/A," $5,897.00 "," $3,833.05 "," $4,953.48 ", $157.24 , N/A ," $4,764.78 "," $5,307.30 "," $4,992.40 "," $5,307.30 "," $5,307.30 "," $5,307.30 "," $5,012.45 ", N/A ," $5,444.70 "," $5,602.15 "," $5,012.45 "," $5,484.21 "," $5,484.21 "," $5,602.15 "," $5,661.12 "," $4,824.93 "," $5,307.30 "," $5,012.45 "," $4,658.63 ", N/A ," $4,772.44 "," $4,772.44 "," $5,602.15 "," $5,060.22 ", $157.24 ," $5,661.12 "
Drug Screen Analgesics Non-Opioid 1 or 2,CPT® 80329,N/A,N/A,N/A, $65.00 , $42.25 , N/A , N/A , N/A , N/A , N/A , $60.45 , $58.50 , $58.50 , $52.00 , $52.00 , N/A , $60.01 , $61.75 , $58.50 , $58.50 , $58.50 , $60.45 , $62.40 , N/A , $55.25 , $114.69 , $67.79 , N/A , $90.04 , $90.04 , $61.75 , $98.20 , $52.00 , $114.69 
Surgical Cleansing of Skin,11000,N/A,N/A,N/A, $287.00 , $186.55 , $90.07 , $26.43 , $32.99 , $79.59 , $75.61 , $266.91 , $258.30 , $258.30 , $229.60 , $229.60 , $32.99 , $264.99 , $272.65 , $258.30 , $258.30 , $258.30 , $266.91 , $275.52 , $99.34 , $243.95 , $148.08 , $101.80 , N/A , $81.14 , $81.14 , $272.65 , $94.10 , $26.43 , $275.52 
" Fac Mirena, 52 Mg ",HCPCS J7298,0636 - DRUGS REQUIRING DETAILED CODIN,N/A,N/A," $1,202.00 ", $781.30 ," $1,009.68 ", N/A ," $1,123.73 ", $971.22 ," $1,081.80 "," $1,017.61 "," $1,081.80 "," $1,081.80 "," $1,081.80 "," $1,021.70 "," $1,101.70 "," $1,109.81 "," $1,141.90 "," $1,021.70 "," $1,117.86 "," $1,117.86 "," $1,141.90 "," $1,153.92 ", $983.48 ," $1,081.80 "," $1,021.70 ", $949.58 , N/A , $972.78 , $972.78 ," $1,141.90 "," $1,031.44 ", $949.58 ," $1,153.92 "
Glycated Hemoglobin Test,CPT® 83036,N/A,N/A,N/A, $103.00 , $66.95 , N/A , $9.90 , $9.90 , $54.91 , $65.67 , $95.79 , $92.70 , $92.70 , $82.40 , $82.40 , $9.90 , $95.10 , $97.85 , $92.70 , $92.70 , $92.70 , $95.79 , $98.88 , $64.84 , $87.55 , $63.25 , $35.21 , N/A , $51.25 , $51.25 , $97.85 , $56.01 , $9.90 , $98.88 
"Revision Cervix W Preg,Vag Apprch",CPT® 59320,N/A,N/A,N/A," $1,834.00 "," $1,192.10 ", $403.80 , $136.44 , $137.05 , $353.08 , $371.63 ," $1,705.62 "," $1,650.60 "," $1,650.60 "," $1,467.20 "," $1,467.20 ", $137.05 ," $1,693.33 "," $1,742.30 "," $1,650.60 "," $1,650.60 "," $1,650.60 "," $1,705.62 "," $1,760.64 ", $410.38 ," $1,558.90 ", $818.89 , $657.78 , N/A , $359.98 , $359.98 ," $1,742.30 ", $416.17 , $136.44 ," $1,760.64 "
"Hepatitis Panel,Acute",CPT® 80074,N/A,N/A,N/A, $434.00 , $282.10 , N/A , $48.58 , $48.58 , $269.53 , $322.33 , $403.62 , $390.60 , $390.60 , $347.20 , $347.20 , $48.58 , $400.71 , $412.30 , $390.60 , $390.60 , $390.60 , $403.62 , $416.64 , $318.04 , $368.90 , $319.50 , $172.72 , N/A , $251.54 , $251.54 , $412.30 , $274.88 , $48.58 , $416.64 
 Fac Enterovirus Antibody ,CPT® 86658,0302 - LAB/IMMUNOLOGY,N/A,N/A, $116.00 , $75.40 , $97.44 , $13.29 , $8.07 , $93.73 , $104.40 , $98.21 , $104.40 , $104.40 , $104.40 , $98.60 , $7.91 , $107.10 , $110.20 , $98.60 , $107.88 , $107.88 , $110.20 , $111.36 , $94.91 , $104.40 , $98.60 , $91.64 , N/A , $93.88 , $93.88 , $110.20 , $99.54 , $7.91 , $111.36 
 Fac Ko Adj Jnt POS Rigid Support ,HCPCS L1832,0274 - PROSTHETIC DEV,N/A,N/A, $823.00 , $534.95 , $691.32 , $805.72 , $486.59 , $664.98 , $740.70 , $696.75 , $740.70 , $740.70 , $740.70 , $699.55 , $477.05 , $759.88 , $781.85 , $699.55 , $765.39 , $765.39 , $781.85 , $790.08 , $673.38 , $740.70 , $699.55 , $650.17 , N/A , $666.05 , $666.05 , $781.85 , $706.22 , $477.05 , $805.72 
Excis/Curet Benign Tumr Clav/Scapula,CPT® 23140,N/A,N/A,N/A," $3,369.00 "," $2,189.85 "," $3,392.48 ", $532.96 , $376.66 ," $2,535.76 "," $2,552.47 "," $3,133.17 "," $3,032.10 "," $3,032.10 "," $2,695.20 "," $2,695.20 ", $376.66 ," $3,110.60 "," $3,200.55 "," $3,032.10 "," $3,032.10 "," $3,032.10 "," $3,133.17 "," $3,234.24 "," $3,149.46 "," $2,863.65 "," $2,818.82 "," $3,029.68 ", N/A ," $2,585.23 "," $2,585.23 "," $3,200.55 "," $3,038.56 ", $376.66 ," $3,392.48 "
Wound Closure by Adhesive,G0168,N/A,N/A,N/A, $144.00 , $93.60 , $32.95 , $13.67 , N/A , $51.11 , N/A , $133.92 , $129.60 , $129.60 , $115.20 , $115.20 , N/A , $132.96 , $136.80 , $129.60 , $129.60 , $129.60 , $133.92 , $138.24 , $51.92 , $122.40 , $51.90 , $98.90 , N/A , $52.10 , $52.10 , $136.80 , $65.15 , $13.67 , $138.24 
 Fac Thrombolysis Venous Infusion W/Imaging Init Tx ,CPT® 37212,0761 - TREATMENT ROOM,N/A,N/A," $7,436.00 "," $4,833.40 "," $6,246.24 ", $309.71 , $408.82 ," $6,008.29 "," $6,692.40 "," $6,295.32 "," $6,692.40 "," $6,692.40 "," $6,692.40 "," $6,320.60 ", $400.80 ," $6,865.66 "," $7,064.20 "," $6,320.60 "," $6,915.48 "," $6,915.48 "," $7,064.20 "," $7,138.56 "," $6,084.14 "," $6,692.40 "," $6,320.60 "," $5,874.44 ", N/A ," $6,017.95 "," $6,017.95 "," $7,064.20 "," $6,380.83 ", $309.71 ," $7,138.56 "
 Pro Drainage of Gland Abscess ,CPT® 56420,0981 - PRO FEE/ER,N/A,N/A, $690.00 , $448.50 , $529.30 , $107.00 , $49.34 , $372.48 , $373.89 , $641.70 , $621.00 , $621.00 , $552.00 , $552.00 , $49.34 , $637.08 , $655.50 , $621.00 , $621.00 , $621.00 , $641.70 , $662.40 , $537.13 , $586.50 , $490.62 , $372.95 , N/A , $379.75 , $379.75 , $655.50 , $455.49 , $49.34 , $662.40 
Psychotherapy W/Patient 30 Minutes,CPT® 90832,N/A,N/A,N/A, $257.00 , $167.05 , $90.07 , $66.42 , $58.10 , $143.28 , $112.18 , $239.01 , $231.30 , $231.30 , $205.60 , $205.60 , $58.10 , $237.29 , $244.15 , $231.30 , $231.30 , $231.30 , $239.01 , $246.72 , $171.81 , $218.45 , $145.98 , $240.60 , $84.00 , $146.08 , $146.08 , $244.15 , $170.30 , $58.10 , $246.72 
 Fac Perq Transcath Cls Paravalvr Leak Each Occls Dev ,CPT® 93592,0360 - OR SERVICES,N/A,N/A," $14,362.00 "," $9,335.30 "," $12,064.08 ", $373.22 , $338.26 ," $11,604.50 "," $12,925.80 "," $12,158.87 "," $12,925.80 "," $12,925.80 "," $12,925.80 "," $12,207.70 ", $331.63 ," $13,260.43 "," $13,643.90 "," $12,207.70 "," $13,356.66 "," $13,356.66 "," $13,643.90 "," $13,787.52 "," $11,750.99 "," $12,925.80 "," $12,207.70 "," $11,345.98 ", N/A ," $11,623.17 "," $11,623.17 "," $13,643.90 "," $12,324.03 ", $331.63 ," $13,787.52 "
 Admin Pfizer Booster 10mcg/0.2ml ,CPT® 0074A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
"Valrubicin, 200 Mg",HCPCS J9357,N/A,N/A,N/A," $2,376.00 "," $1,544.40 ", N/A ," $1,419.64 "," $1,471.38 ", N/A , N/A ," $2,209.68 "," $2,138.40 "," $2,138.40 "," $1,900.80 "," $1,900.80 "," $1,471.38 "," $2,193.76 "," $2,257.20 "," $2,138.40 "," $2,138.40 "," $2,138.40 "," $2,209.68 "," $2,280.96 "," $1,797.15 "," $2,019.60 "," $1,981.28 "," $1,799.72 ", N/A , N/A , N/A ," $2,257.20 ", N/A ," $1,419.64 "," $2,280.96 "
 Inj Sclerosant; Spider Veins Lim/Trnk ,CPT® 36468,0360 - OR SERVICES,N/A,N/A, $504.00 , $327.60 , $423.36 , N/A , N/A , $407.23 , $453.60 , $426.69 , $453.60 , $453.60 , $453.60 , $428.40 , N/A , $465.34 , $478.80 , $428.40 , $468.72 , $468.72 , $478.80 , $483.84 , $412.37 , $453.60 , $428.40 , $398.16 , N/A , $407.89 , $407.89 , $478.80 , $432.48 , $398.16 , $483.84 
Lysis of Labial Lesion(S),CPT® 56441,N/A,N/A,N/A, $937.00 , $609.05 , $737.05 , $149.58 , $49.79 , $568.45 , $564.88 , $871.41 , $843.30 , $843.30 , $749.60 , $749.60 , $49.79 , $865.13 , $890.15 , $843.30 , $843.30 , $843.30 , $871.41 , $899.52 , $755.50 , $796.45 , $735.03 , $573.12 , N/A , $579.54 , $579.54 , $890.15 , $695.12 , $49.79 , $899.52 
"CT Angio,Head Combo,Incl Image Process",CPT® 70496,N/A,N/A,N/A," $5,052.00 "," $3,283.80 "," $1,769.74 ", $256.30 , $377.53 ," $1,399.18 "," $2,641.86 "," $4,698.36 "," $4,546.80 "," $4,546.80 "," $4,041.60 "," $4,041.60 ", $377.53 ," $4,664.51 "," $4,799.40 "," $4,546.80 "," $4,546.80 "," $4,546.80 "," $4,698.36 "," $4,849.92 "," $1,637.22 "," $4,294.20 "," $2,877.51 "," $1,900.26 ", N/A ," $1,426.47 "," $1,426.47 "," $4,799.40 "," $1,651.18 ", $256.30 ," $4,849.92 "
 KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN ,HCPCS J1885,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0162-01,0.5 mL, $16.68 , $10.84 , $14.01 , $0.56 , $0.60 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.59 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.56 , $16.01 
Thoracoscopy Surg Tot Pulm Decort,CPT® 32652,N/A,N/A,N/A," $9,692.00 "," $6,299.80 "," $8,603.44 "," $1,503.83 "," $1,316.55 "," $6,272.86 "," $6,128.18 "," $9,013.56 "," $8,722.80 "," $8,722.80 "," $7,753.60 "," $7,753.60 "," $1,316.55 "," $8,948.62 "," $9,207.40 "," $8,722.80 "," $8,722.80 "," $8,722.80 "," $9,013.56 "," $9,304.32 "," $8,325.00 "," $8,238.20 "," $8,856.09 "," $8,231.97 ", N/A ," $6,395.25 "," $6,395.25 "," $9,207.40 "," $7,531.75 "," $1,316.55 "," $9,304.32 "
Open Rx Radial Shaft Fx,CPT® 25515,N/A,N/A,N/A," $3,334.00 "," $2,167.10 "," $4,092.14 ", $643.00 , $614.70 ," $3,224.60 "," $3,220.84 "," $3,100.62 "," $3,000.60 "," $3,000.60 "," $2,667.20 "," $2,667.20 ", $614.70 ," $3,078.28 "," $3,167.30 "," $3,000.60 "," $3,000.60 "," $3,000.60 "," $3,100.62 "," $3,200.64 "," $3,797.55 "," $2,833.90 "," $3,550.29 "," $3,809.50 ", N/A ," $3,287.51 "," $3,287.51 "," $3,167.30 "," $3,864.00 ", $614.70 ," $4,092.14 "
 Fac Hopd Covid-19 Spec Collect ,HCPCS C9803,0300 - LABORATORY,N/A,N/A, $32.00 , $20.80 , $26.88 , N/A , $23.29 , $25.86 , $28.80 , $27.09 , $28.80 , $28.80 , $28.80 , $27.20 , $22.83 , $29.55 , $30.40 , $27.20 , $29.76 , $29.76 , $30.40 , $30.72 , $26.18 , $28.80 , $27.20 , $25.28 , N/A , $25.90 , $25.90 , $30.40 , $27.46 , $22.83 , $30.72 
Inject Second Level Lumbar/Sacral,64494,N/A,N/A,N/A, $536.00 , $348.40 , $253.08 , $49.11 , $62.02 , $292.30 , $282.07 , $498.48 , $482.40 , $482.40 , $428.80 , $428.80 , $62.02 , $494.89 , $509.20 , $482.40 , $482.40 , $482.40 , $498.48 , $514.56 , $276.51 , $455.60 , $274.75 , $313.65 , N/A , $298.00 , $298.00 , $509.20 , $319.69 , $49.11 , $514.56 
 Fac Perq Vertebroplasty Uni/Bi Injx Cervicothoracic ,CPT® 22510,0361 - OR/MINOR,N/A,N/A," $11,916.00 "," $7,745.40 "," $10,009.44 ", $410.21 ," $1,369.73 "," $9,628.13 "," $10,724.40 "," $10,088.09 "," $10,724.40 "," $10,724.40 "," $10,724.40 "," $10,128.60 "," $1,342.87 "," $11,002.04 "," $11,320.20 "," $10,128.60 "," $11,081.88 "," $11,081.88 "," $11,320.20 "," $11,439.36 "," $9,749.67 "," $10,724.40 "," $10,128.60 "," $9,413.64 ", N/A ," $9,643.62 "," $9,643.62 "," $11,320.20 "," $10,225.12 ", $410.21 ," $11,439.36 "
 Ot Orthotics (Splint) Mgmt/15 Min -Outpt -Mh ,CPT® 97760,0430 - OCCUPATION THER,N/A,N/A, $159.00 , $103.35 , $133.56 , $48.26 , $27.95 , $128.47 , $143.10 , $134.61 , $143.10 , $143.10 , $143.10 , $135.15 , $27.40 , $146.80 , $151.05 , $135.15 , $147.87 , $147.87 , $151.05 , $152.64 , $130.09 , $143.10 , $135.15 , $125.61 , N/A , $128.68 , $128.68 , $151.05 , $136.44 , $27.40 , $152.64 
 Pro CT Upper Extremity W/Dye ,CPT® 73201,0972 - PRO FEE/RAD/DX,N/A,N/A, $653.00 , $424.45 ," $1,442.21 ", $206.46 , $289.97 ," $1,060.46 "," $1,351.78 ", $607.29 , $587.70 , $587.70 , $522.40 , $522.40 , $289.97 , $602.91 , $620.35 , $587.70 , $587.70 , $587.70 , $607.29 , $626.88 ," $1,224.35 ", $555.05 ," $1,473.42 "," $1,443.95 ", N/A ," $1,081.15 "," $1,081.15 ", $620.35 ," $1,251.44 ", $206.46 ," $1,473.42 "
"Bx/Excis Spinal Tumor,Xdural,Lumb",CPT® 63277,N/A,N/A,N/A," $11,074.00 "," $7,198.10 "," $7,227.43 "," $1,413.93 "," $2,378.00 "," $8,424.24 "," $8,097.58 "," $10,298.82 "," $9,966.60 "," $9,966.60 "," $8,859.20 "," $8,859.20 "," $2,378.00 "," $10,224.62 "," $10,520.30 "," $9,966.60 "," $9,966.60 "," $9,966.60 "," $10,298.82 "," $10,631.04 "," $7,813.12 "," $9,412.90 "," $8,251.30 "," $8,796.52 ", N/A ," $8,588.61 "," $8,588.61 "," $10,520.30 "," $9,213.54 "," $1,413.93 "," $10,631.04 "
Vip Assay,CPT® 84586,N/A,N/A,N/A, $313.00 , $203.45 , N/A , $36.04 , $17.70 , $72.13 , $86.25 , $291.09 , $281.70 , $281.70 , $250.40 , $250.40 , $17.70 , $288.99 , $297.35 , $281.70 , $281.70 , $281.70 , $291.09 , $300.48 , $235.91 , $266.05 , $231.92 , $128.11 , N/A , $67.32 , $67.32 , $297.35 , $73.56 , $17.70 , $300.48 
 Room Rate ,Custom 2140000001,0214 - POST CCU,N/A,N/A," $4,915.00 "," $3,194.75 "," $4,128.60 ", N/A , N/A ," $3,971.32 "," $4,423.50 "," $4,161.04 "," $4,423.50 "," $4,423.50 "," $4,423.50 "," $4,177.75 ", N/A ," $4,538.02 "," $4,669.25 "," $4,177.75 "," $4,570.95 "," $4,570.95 "," $4,669.25 "," $4,718.40 "," $4,021.45 "," $4,423.50 "," $4,177.75 "," $3,882.85 ", N/A ," $3,977.71 "," $3,977.71 "," $4,669.25 "," $4,217.56 "," $3,882.85 "," $4,718.40 "
 Pro Treat Kneecap Fracture ,CPT® 27524,0982 - PRO FEE/OUTPT,N/A,N/A," $3,130.00 "," $2,034.50 "," $4,581.46 ", $718.25 , $655.15 ," $3,631.50 "," $3,615.12 "," $2,910.90 "," $2,817.00 "," $2,817.00 "," $2,504.00 "," $2,504.00 ", $655.15 ," $2,889.93 "," $2,973.50 "," $2,817.00 "," $2,817.00 "," $2,817.00 "," $2,910.90 "," $3,004.80 "," $4,258.35 "," $2,660.50 "," $3,994.52 "," $4,273.47 ", N/A ," $3,702.36 "," $3,702.36 "," $2,973.50 "," $4,351.61 ", $655.15 ," $4,581.46 "
" Fac Assay of Phenytoin, Total ",CPT® 80185,0301 - LAB/CHEMISTRY,N/A,N/A, $133.00 , $86.45 , $111.72 , $13.52 , $13.52 , $107.46 , $119.70 , $112.60 , $119.70 , $119.70 , $119.70 , $113.05 , $13.25 , $122.80 , $126.35 , $113.05 , $123.69 , $123.69 , $126.35 , $127.68 , $108.82 , $119.70 , $113.05 , $105.07 , N/A , $107.64 , $107.64 , $126.35 , $114.13 , $13.25 , $127.68 
"Retrobulbar Inject,Alcohol",CPT® 67505,N/A,N/A,N/A, $800.00 , $520.00 , $445.19 , $69.78 , $153.67 , $461.53 , $436.54 , $744.00 , $720.00 , $720.00 , $640.00 , $640.00 , $153.67 , $738.64 , $760.00 , $720.00 , $720.00 , $720.00 , $744.00 , $768.00 , $612.59 , $680.00 , $454.94 , $575.24 , N/A , $470.54 , $470.54 , $760.00 , $519.41 , $69.78 , $768.00 
Laps Esophgl Sphnctr Agmntj Plmt Dev Crrpl,43284,N/A,N/A,N/A," $4,111.00 "," $2,672.15 "," $3,891.42 ", $603.19 , N/A ," $2,940.70 "," $2,981.20 "," $3,823.23 "," $3,699.90 "," $3,699.90 "," $3,288.80 "," $3,288.80 ", N/A ," $3,795.69 "," $3,905.45 "," $3,699.90 "," $3,699.90 "," $3,699.90 "," $3,823.23 "," $3,946.56 "," $2,784.66 "," $3,494.35 "," $3,470.37 "," $3,604.77 ", N/A ," $2,998.08 "," $2,998.08 "," $3,905.45 "," $3,135.66 ", $603.19 ," $3,946.56 "
Remvl Perm Pm Plse Gen W/Repl Plse Gen Sngl Lead,CPT® 33227,N/A,N/A,N/A," $3,152.00 "," $2,048.80 "," $2,025.79 ", $313.04 , $257.25 ," $1,495.28 "," $1,453.53 "," $2,931.36 "," $2,836.80 "," $2,836.80 "," $2,521.60 "," $2,521.60 ", $257.25 ," $2,910.24 "," $2,994.40 "," $2,836.80 "," $2,836.80 "," $2,836.80 "," $2,931.36 "," $3,025.92 "," $1,867.59 "," $2,679.20 "," $1,825.10 "," $1,636.89 ", N/A ," $1,524.45 "," $1,524.45 "," $2,994.40 "," $1,731.78 ", $257.25 ," $3,025.92 "
 Pro Insert Non-Tunnel Cv Cath ,CPT® 36556,0960 - PRO FEE,N/A,N/A," $1,470.00 ", $955.50 , $514.22 , $79.62 , $322.67 , $528.55 , $516.83 ," $1,367.10 "," $1,323.00 "," $1,323.00 "," $1,176.00 "," $1,176.00 ", $322.67 ," $1,357.25 "," $1,396.50 "," $1,323.00 "," $1,323.00 "," $1,323.00 "," $1,367.10 "," $1,411.20 ", $476.45 ," $1,249.50 ", $636.91 , $489.07 , N/A , $538.87 , $538.87 ," $1,396.50 ", $612.15 , $79.62 ," $1,411.20 "
 FISH OIL 1000 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,77333-0308-10,1 capsule, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Doppler Echo Heart,Limited,F/U",CPT® 93321,N/A,N/A,N/A," $1,085.00 ", $705.25 , $161.53 , $24.66 , $47.42 , $147.86 , $132.33 ," $1,009.05 ", $976.50 , $976.50 , $868.00 , $868.00 , $47.42 ," $1,001.78 "," $1,030.75 ", $976.50 , $976.50 , $976.50 ," $1,009.05 "," $1,041.60 ", $163.98 , $922.25 , $124.88 , $164.23 , N/A , $150.74 , $150.74 ," $1,030.75 ", $167.12 , $24.66 ," $1,041.60 "
 Pro Njx Anes Sphenopalatine Ganglion ,CPT® 64505,0982 - PRO FEE/OUTPT,N/A,N/A, $753.00 , $489.45 , $493.38 , $96.56 , $76.84 , $484.32 , $470.40 , $700.29 , $677.70 , $677.70 , $602.40 , $602.40 , $76.84 , $695.24 , $715.35 , $677.70 , $677.70 , $677.70 , $700.29 , $722.88 , $520.28 , $640.05 , $456.72 , $535.18 , N/A , $493.77 , $493.77 , $715.35 , $529.70 , $76.84 , $722.88 
 METHOCARBAMOL 500 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60687-0559-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Blood Folic Acid Serum,CPT® 82746,N/A,N/A,N/A, $148.00 , $96.20 , N/A , $14.99 , $14.99 , $83.19 , $99.50 , $137.64 , $133.20 , $133.20 , $118.40 , $118.40 , $14.99 , $136.65 , $140.60 , $133.20 , $133.20 , $133.20 , $137.64 , $142.08 , $98.16 , $125.80 , $95.69 , $53.31 , N/A , $77.64 , $77.64 , $140.60 , $84.84 , $14.99 , $142.08 
 Pro Treatment of Ankle Fracture ,CPT® 27816,0982 - PRO FEE/OUTPT,N/A,N/A," $2,108.00 "," $1,370.20 "," $1,828.13 ", $288.74 , $384.19 ," $1,389.63 "," $1,401.19 "," $1,960.44 "," $1,897.20 "," $1,897.20 "," $1,686.40 "," $1,686.40 ", $384.19 ," $1,946.32 "," $2,002.60 "," $1,897.20 "," $1,897.20 "," $1,897.20 "," $1,960.44 "," $2,023.68 "," $1,683.83 "," $1,791.80 "," $1,534.30 "," $1,655.10 ", N/A ," $1,416.74 "," $1,416.74 "," $2,002.60 "," $1,665.18 ", $288.74 ," $2,023.68 "
 PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN ,HCPCS J2560,0636 - DRUGS REQUIRING DETAILED CODIN,42494-0416-25,0.77 mL, $490.23 , $318.65 , $411.79 , $40.17 , $46.78 , $396.11 , $441.21 , $415.03 , $441.21 , $441.21 , $441.21 , $416.70 , $45.86 , $452.63 , $465.72 , $416.70 , $455.91 , $455.91 , $465.72 , $470.62 , $401.11 , $441.21 , $416.70 , $387.28 , N/A , $396.74 , $396.74 , $465.72 , $420.67 , $40.17 , $470.62 
 Fac Insert Cervical Dilator ,CPT® 59200,0761 - TREATMENT ROOM,N/A,N/A, $194.00 , $126.10 , $162.96 , $39.87 , $65.80 , $156.75 , $174.60 , $164.24 , $174.60 , $174.60 , $174.60 , $164.90 , $64.51 , $179.12 , $184.30 , $164.90 , $180.42 , $180.42 , $184.30 , $186.24 , $158.73 , $174.60 , $164.90 , $153.26 , N/A , $157.00 , $157.00 , $184.30 , $166.47 , $39.87 , $186.24 
 Nasal Bones Min 3 Views Complete ,CPT® 70160,0320 - DX X-RAY,N/A,N/A, $373.00 , $242.45 , $313.32 , $37.62 , $30.01 , $301.38 , $335.70 , $315.78 , $335.70 , $335.70 , $335.70 , $317.05 , $29.42 , $344.39 , $354.35 , $317.05 , $346.89 , $346.89 , $354.35 , $358.08 , $305.19 , $335.70 , $317.05 , $294.67 , N/A , $301.87 , $301.87 , $354.35 , $320.07 , $29.42 , $358.08 
 Repair Blood Vessel With Vein Graft; Intra-Abdominal ,CPT® 35251,0360 - OR SERVICES,N/A,N/A," $9,069.00 "," $5,894.85 "," $7,617.96 "," $1,575.33 "," $2,183.17 "," $7,327.75 "," $8,162.10 "," $7,677.82 "," $8,162.10 "," $8,162.10 "," $8,162.10 "," $7,708.65 "," $2,140.36 "," $8,373.41 "," $8,615.55 "," $7,708.65 "," $8,434.17 "," $8,434.17 "," $8,615.55 "," $8,706.24 "," $7,420.26 "," $8,162.10 "," $7,708.65 "," $7,164.51 ", N/A ," $7,339.54 "," $7,339.54 "," $8,615.55 "," $7,782.11 "," $1,575.33 "," $8,706.24 "
 Pro Radex Hips Bilateral With Pelvis Minimum 5 Views ,CPT® 73523,0972 - PRO FEE/RAD/DX,N/A,N/A, $192.00 , $124.80 , $418.81 , $60.96 , $44.46 , $269.48 , $284.34 , $178.56 , $172.80 , $172.80 , $153.60 , $153.60 , $44.46 , $177.27 , $182.40 , $172.80 , $172.80 , $172.80 , $178.56 , $184.32 , $338.15 , $163.20 , $356.81 , $285.55 , N/A , $274.75 , $274.75 , $182.40 , $318.01 , $44.46 , $418.81 
CT Neck Tissue Contrast,CPT® 70491,N/A,N/A,N/A," $3,545.00 "," $2,304.25 "," $1,319.01 ", $188.89 , $297.22 ," $1,122.44 "," $1,411.23 "," $3,296.85 "," $3,190.50 "," $3,190.50 "," $2,836.00 "," $2,836.00 ", $297.22 ," $3,273.10 "," $3,367.75 "," $3,190.50 "," $3,190.50 "," $3,190.50 "," $3,296.85 "," $3,403.20 "," $1,110.14 "," $3,013.25 "," $1,538.91 "," $1,318.77 ", N/A ," $1,144.34 "," $1,144.34 "," $3,367.75 "," $1,324.60 ", $188.89 ," $3,403.20 "
" Amplified Probe Technique, Each Organism Beaker1 ",CPT® 87798,0306 - LAB/BACT-MICRO,N/A,N/A, $53.00 , $34.45 , $44.52 , $35.79 , $35.79 , $42.82 , $47.70 , $44.87 , $47.70 , $47.70 , $47.70 , $45.05 , $35.09 , $48.93 , $50.35 , $45.05 , $49.29 , $49.29 , $50.35 , $50.88 , $43.36 , $47.70 , $45.05 , $41.87 , N/A , $42.89 , $42.89 , $50.35 , $45.48 , $35.09 , $50.88 
Crystal Identify-Microsco,CPT® 89060,N/A,N/A,N/A, $93.00 , $60.45 , N/A , $7.48 , $7.48 , $40.07 , $48.39 , $86.49 , $83.70 , $83.70 , $74.40 , $74.40 , $7.48 , $85.87 , $88.35 , $83.70 , $83.70 , $83.70 , $86.49 , $89.28 , $48.94 , $79.05 , $141.10 , $25.93 , N/A , $37.40 , $37.40 , $88.35 , $41.10 , $7.48 , $141.10 
 LEUPROLIDE ACETATE (6 MONTH) 45 MG SC KIT ,HCPCS J9217,0636 - DRUGS REQUIRING DETAILED CODIN,62935-0453-45,1 each," $7,968.64 "," $5,179.62 "," $6,693.66 ", $169.18 , $192.10 ," $6,438.66 "," $7,171.78 "," $6,746.25 "," $7,171.78 "," $7,171.78 "," $7,171.78 "," $6,773.34 ", $188.33 ," $7,357.45 "," $7,570.21 "," $6,773.34 "," $7,410.84 "," $7,410.84 "," $7,570.21 "," $7,649.89 "," $6,519.94 "," $7,171.78 "," $6,773.34 "," $6,295.23 ", N/A ," $6,449.02 "," $6,449.02 "," $7,570.21 "," $6,837.89 ", $169.18 ," $7,649.89 "
Removal Vaginal for.Body W Anesth,57415,N/A,N/A,N/A, $979.00 , $636.35 , $835.50 , $169.00 , $73.68 , $652.10 , $651.22 , $910.47 , $881.10 , $881.10 , $783.20 , $783.20 , $73.68 , $903.91 , $930.05 , $881.10 , $881.10 , $881.10 , $910.47 , $939.84 , $860.95 , $832.15 , $849.21 , $660.53 , N/A , $664.82 , $664.82 , $930.05 , $797.42 , $73.68 , $939.84 
 Pro CT Abdomen W/O & W/Dye ,CPT® 74170,0972 - PRO FEE/RAD/DX,N/A,N/A, $788.00 , $512.20 ," $1,658.44 ", $240.15 , $398.54 ," $1,249.53 "," $1,636.68 ", $732.84 , $709.20 , $709.20 , $630.40 , $630.40 , $398.54 , $727.56 , $748.60 , $709.20 , $709.20 , $709.20 , $732.84 , $756.48 ," $1,574.88 ", $669.80 ," $1,843.22 "," $1,703.97 ", N/A ," $1,273.91 "," $1,273.91 ", $748.60 ," $1,474.57 ", $240.15 ," $1,843.22 "
 DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,16729-0239-93,2 mL, $117.68 , $76.49 , $98.85 , N/A , N/A , $95.09 , $105.91 , $99.63 , $105.91 , $105.91 , $105.91 , $100.03 , N/A , $108.65 , $111.80 , $100.03 , $109.44 , $109.44 , $111.80 , $112.97 , $96.29 , $105.91 , $100.03 , $92.97 , N/A , $95.24 , $95.24 , $111.80 , $100.98 , $92.97 , $112.97 
"Removal of Hip Prosthesis,Complex",CPT® 27091,N/A,N/A,N/A," $14,630.00 "," $9,509.50 "," $9,580.48 "," $1,496.63 ", $669.43 ," $7,714.60 "," $7,629.72 "," $13,605.90 "," $13,167.00 "," $13,167.00 "," $11,704.00 "," $11,704.00 ", $669.43 ," $13,507.88 "," $13,898.50 "," $13,167.00 "," $13,167.00 "," $13,167.00 "," $13,605.90 "," $14,044.80 "," $8,932.91 "," $12,435.50 "," $8,451.11 "," $9,065.43 ", N/A ," $7,865.12 "," $7,865.12 "," $13,898.50 "," $9,244.32 ", $669.43 ," $14,044.80 "
" Fac Exam,Synovial Fluid Crystals ",CPT® 89060,0300 - LABORATORY,N/A,N/A, $93.00 , $60.45 , $78.12 , $7.48 , $7.48 , $75.14 , $83.70 , $78.73 , $83.70 , $83.70 , $83.70 , $79.05 , $7.33 , $85.87 , $88.35 , $79.05 , $86.49 , $86.49 , $88.35 , $89.28 , $76.09 , $83.70 , $79.05 , $73.47 , N/A , $75.26 , $75.26 , $88.35 , $79.80 , $7.33 , $89.28 
 SODIUM CHLORIDE 3 % INH NEBU ,HCPCS RXA250,0250 - PHARMACY,00378-6997-89,16 mL, $8.22 , $5.34 , $6.90 , N/A , N/A , $6.64 , $7.40 , $6.96 , $7.40 , $7.40 , $7.40 , $6.99 , N/A , $7.59 , $7.81 , $6.99 , $7.64 , $7.64 , $7.81 , $7.89 , $6.73 , $7.40 , $6.99 , $6.49 , N/A , $6.65 , $6.65 , $7.81 , $7.05 , $6.49 , $7.89 
"Rep Tendon,Hand,Single,PR",CPT® 26410,N/A,N/A,N/A," $3,183.00 "," $2,068.95 "," $3,809.13 ", $591.56 , $390.36 ," $2,681.89 "," $2,743.57 "," $2,960.19 "," $2,864.70 "," $2,864.70 "," $2,546.40 "," $2,546.40 ", $390.36 ," $2,938.86 "," $3,023.85 "," $2,864.70 "," $2,864.70 "," $2,864.70 "," $2,960.19 "," $3,055.68 "," $3,496.67 "," $2,705.55 "," $3,000.80 "," $3,216.59 ", N/A ," $2,734.22 "," $2,734.22 "," $3,023.85 "," $3,213.66 ", $390.36 ," $3,809.13 "
 Pro Dup-Scan Xtrc Art Uni/Lmtd Std ,CPT® 93882,0972 - PRO FEE/RAD/DX,N/A,N/A, $281.00 , $182.65 , $790.86 , $121.03 , $131.93 , $690.82 , $980.78 , $261.33 , $252.90 , $252.90 , $224.80 , $224.80 , $131.93 , $259.45 , $266.95 , $252.90 , $252.90 , $252.90 , $261.33 , $269.76 , $555.95 , $238.85 , $524.09 , $491.94 , N/A , $704.30 , $704.30 , $266.95 , $780.73 , $121.03 , $980.78 
 Fac Plmt Bile Duct Stent Prq New Access W/Sep Cath ,CPT® 47540,0361 - OR/MINOR,N/A,N/A," $18,562.00 "," $12,065.30 "," $15,592.08 ", $414.93 ," $4,051.34 "," $14,998.10 "," $16,705.80 "," $15,714.59 "," $16,705.80 "," $16,705.80 "," $16,705.80 "," $15,777.70 "," $3,971.90 "," $17,138.29 "," $17,633.90 "," $15,777.70 "," $17,262.66 "," $17,262.66 "," $17,633.90 "," $17,819.52 "," $15,187.43 "," $16,705.80 "," $15,777.70 "," $14,663.98 ", N/A ," $15,022.23 "," $15,022.23 "," $17,633.90 "," $15,928.05 ", $414.93 ," $17,819.52 "
 Events Monitor- Mh ,CPT® 93270,0731 - HOLTER MONT,N/A,N/A, $426.00 , $276.90 , $357.84 , $7.99 , $46.97 , $344.21 , $383.40 , $360.65 , $383.40 , $383.40 , $383.40 , $362.10 , $46.05 , $393.33 , $404.70 , $362.10 , $396.18 , $396.18 , $404.70 , $408.96 , $348.55 , $383.40 , $362.10 , $336.54 , N/A , $344.76 , $344.76 , $404.70 , $365.55 , $7.99 , $408.96 
 Pro I&D Cplx Po Wnd Infctj ,CPT® 10180,0981 - PRO FEE/ER,N/A,N/A," $1,100.00 ", $715.00 , $560.69 , $168.12 , $111.13 , $482.45 , $474.37 ," $1,023.00 ", $990.00 , $990.00 , $880.00 , $880.00 , $111.13 ," $1,015.63 "," $1,045.00 ", $990.00 , $990.00 , $990.00 ," $1,023.00 "," $1,056.00 ", $615.17 , $935.00 , $954.47 , $613.85 , N/A , $491.86 , $491.86 ," $1,045.00 ", $570.41 , $111.13 ," $1,056.00 "
" Fac Inj Octafluoropropane Mic,Ml ",HCPCS Q9956,0255 - DRUGS/RADIOLOGY,N/A,N/A, $97.00 , $63.05 , $81.48 , $43.57 , $33.43 , $78.38 , $87.30 , $82.12 , $87.30 , $87.30 , $87.30 , $82.45 , $32.77 , $89.56 , $92.15 , $82.45 , $90.21 , $90.21 , $92.15 , $93.12 , $79.37 , $87.30 , $82.45 , $76.63 , N/A , $78.50 , $78.50 , $92.15 , $83.24 , $32.77 , $93.12 
 Fac Gg Ig Subclasses Ea ,CPT® 82787,0301 - LAB/CHEMISTRY,N/A,N/A, $174.00 , $113.10 , $146.16 , $8.18 , $5.82 , $140.59 , $156.60 , $147.31 , $156.60 , $156.60 , $156.60 , $147.90 , $5.71 , $160.65 , $165.30 , $147.90 , $161.82 , $161.82 , $165.30 , $167.04 , $142.37 , $156.60 , $147.90 , $137.46 , N/A , $140.82 , $140.82 , $165.30 , $149.31 , $5.71 , $167.04 
 Fac Assay of Arsenic ,CPT® 82175,0301 - LAB/CHEMISTRY,N/A,N/A, $205.00 , $133.25 , $172.20 , $19.35 , $19.35 , $165.64 , $184.50 , $173.55 , $184.50 , $184.50 , $184.50 , $174.25 , $18.97 , $189.28 , $194.75 , $174.25 , $190.65 , $190.65 , $194.75 , $196.80 , $167.73 , $184.50 , $174.25 , $161.95 , N/A , $165.91 , $165.91 , $194.75 , $175.91 , $18.97 , $196.80 
 Fac Vascular Embolization or Occlusion Arterial Rs&I ,CPT® 37242,0360 - OR SERVICES,N/A,N/A," $27,291.00 "," $17,739.15 "," $22,924.44 ", $439.19 ," $2,378.00 "," $22,051.13 "," $24,561.90 "," $23,104.56 "," $24,561.90 "," $24,561.90 "," $24,561.90 "," $23,197.35 "," $2,331.37 "," $25,197.78 "," $25,926.45 "," $23,197.35 "," $25,380.63 "," $25,380.63 "," $25,926.45 "," $26,199.36 "," $22,329.50 "," $24,561.90 "," $23,197.35 "," $21,559.89 ", N/A ," $22,086.61 "," $22,086.61 "," $25,926.45 "," $23,418.41 ", $439.19 ," $26,199.36 "
Heparin Assay,CPT® 85520,N/A,N/A,N/A, $230.00 , $149.50 , N/A , $13.35 , $13.35 , $63.20 , $75.62 , $213.90 , $207.00 , $207.00 , $184.00 , $184.00 , $13.35 , $212.36 , $218.50 , $207.00 , $207.00 , $207.00 , $213.90 , $220.80 , $87.40 , $195.50 , $85.96 , $47.46 , N/A , $58.98 , $58.98 , $218.50 , $64.45 , $13.35 , $220.80 
Nfct Ds Bct Vaginosis&Vaginitis Dna Vag Flu Alg,CPT® 81514,N/A,N/A,N/A, $648.00 , $421.20 , N/A , $268.25 , $214.60 , N/A , N/A , $602.64 , $583.20 , $583.20 , $518.40 , $518.40 , $214.60 , $598.30 , $615.60 , $583.20 , $583.20 , $583.20 , $602.64 , $622.08 ," $1,756.04 ", $550.80 ," $1,253.53 ", $772.40 , N/A ," $1,044.07 "," $1,044.07 ", $615.60 ," $1,138.75 ", $214.60 ," $1,756.04 "
 Fac Amp Leg Thru Tibfib Re-Amp ,CPT® 27886,0360 - OR SERVICES,N/A,N/A," $3,442.00 "," $2,237.30 "," $2,891.28 ", $601.71 , $589.51 ," $2,781.14 "," $3,097.80 "," $2,914.00 "," $3,097.80 "," $3,097.80 "," $3,097.80 "," $2,925.70 ", $577.95 ," $3,178.00 "," $3,269.90 "," $2,925.70 "," $3,201.06 "," $3,201.06 "," $3,269.90 "," $3,304.32 "," $2,816.24 "," $3,097.80 "," $2,925.70 "," $2,719.18 ", N/A ," $2,785.61 "," $2,785.61 "," $3,269.90 "," $2,953.58 ", $577.95 ," $3,304.32 "
 Pro I&D Leg/Ankle Infct Bursa ,CPT® 27604,0982 - PRO FEE/OUTPT,N/A,N/A," $2,705.00 "," $1,758.25 "," $1,980.55 ", $310.29 , $46.08 ," $1,666.41 "," $1,646.97 "," $2,515.65 "," $2,434.50 "," $2,434.50 "," $2,164.00 "," $2,164.00 ", $46.08 ," $2,497.53 "," $2,569.75 "," $2,434.50 "," $2,434.50 "," $2,434.50 "," $2,515.65 "," $2,596.80 "," $1,882.87 "," $2,299.25 "," $1,809.04 "," $1,935.02 ", N/A ," $1,698.92 "," $1,698.92 "," $2,569.75 "," $1,996.84 ", $46.08 ," $2,596.80 "
"Inj, lanreotide, (cipla) 1mg",HCPCS J1932,N/A,N/A,N/A, $83.00 , $53.95 , N/A , $52.41 , $61.70 , N/A , N/A , $77.19 , $74.70 , $74.70 , $66.40 , $66.40 , $61.70 , $76.63 , $78.85 , $74.70 , $74.70 , $74.70 , $77.19 , $79.68 , N/A , $70.55 , $115.02 , $79.40 , N/A , N/A , N/A , $78.85 , N/A , $52.41 , $115.02 
 RAMUCIRUMAB 100 MG/10ML IV SOLN ,HCPCS J9308,0636 - DRUGS REQUIRING DETAILED CODIN,00002-7669-01,10 mL," $4,077.14 "," $2,650.14 "," $3,424.80 ", $70.25 , $68.20 ," $3,294.33 "," $3,669.43 "," $3,451.71 "," $3,669.43 "," $3,669.43 "," $3,669.43 "," $3,465.57 ", $66.86 ," $3,764.42 "," $3,873.28 "," $3,465.57 "," $3,791.74 "," $3,791.74 "," $3,873.28 "," $3,914.05 "," $3,335.92 "," $3,669.43 "," $3,465.57 "," $3,220.94 ", N/A ," $3,299.63 "," $3,299.63 "," $3,873.28 "," $3,498.59 ", $66.86 ," $3,914.05 "
Ntrprof Phone/Ntrnet/Ehr Assmt&Mgmt 5-10 Min,CPT® 99446,N/A,N/A,N/A, $83.00 , $53.95 , $34.82 , $17.13 , $14.22 , N/A , N/A , $77.19 , $74.70 , $74.70 , $66.40 , $66.40 , $14.22 , $76.63 , $78.85 , $74.70 , $74.70 , $74.70 , $77.19 , $79.68 , $33.39 , $70.55 , $39.60 , $39.68 , N/A , $30.07 , $30.07 , $78.85 , $34.67 , $14.22 , $79.68 
 Pro Post-Cataract Laser Surgery ,CPT® 66821,0975 - PRO FEE/OR,N/A,N/A," $1,563.00 "," $1,015.95 "," $1,923.81 ", $302.19 , $262.06 ," $1,757.76 "," $1,658.57 "," $1,453.59 "," $1,406.70 "," $1,406.70 "," $1,250.40 "," $1,250.40 ", $262.06 ," $1,443.12 "," $1,484.85 "," $1,406.70 "," $1,406.70 "," $1,406.70 "," $1,453.59 "," $1,500.48 "," $2,644.27 "," $1,328.55 "," $1,705.57 "," $2,236.74 ", N/A ," $1,792.06 "," $1,792.06 "," $1,484.85 "," $1,978.18 ", $262.06 ," $2,644.27 "
 Pro Exc Face-Mm Mlg+Marg > 4 Cm ,CPT® 11646,0982 - PRO FEE/OUTPT,N/A,N/A," $2,592.00 "," $1,684.80 "," $1,240.69 ", $369.64 , $684.49 ," $1,081.06 "," $1,046.74 "," $2,410.56 "," $2,332.80 "," $2,332.80 "," $2,073.60 "," $2,073.60 ", $684.49 ," $2,393.19 "," $2,462.40 "," $2,332.80 "," $2,332.80 "," $2,332.80 "," $2,410.56 "," $2,488.32 "," $1,362.75 "," $2,203.20 "," $2,094.49 "," $1,374.50 ", N/A ," $1,102.15 "," $1,102.15 "," $2,462.40 "," $1,278.11 ", $369.64 ," $2,488.32 "
 Pfizer Vac Admin 6 Mo-5 Yrs 2nd Dose ,CPT® 0082A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
Pro Arthscpy Ankle Debrid-Lh,29897,N/A,N/A,N/A," $4,396.00 "," $2,857.40 "," $3,025.75 ", $479.04 , $420.46 ," $2,464.06 "," $2,489.09 "," $4,088.28 "," $3,956.40 "," $3,956.40 "," $3,516.80 "," $3,516.80 ", $420.46 ," $4,058.83 "," $4,176.20 "," $3,956.40 "," $3,956.40 "," $3,956.40 "," $4,088.28 "," $4,220.16 "," $2,828.82 "," $3,736.60 "," $2,734.97 "," $2,887.93 ", N/A ," $2,512.14 "," $2,512.14 "," $4,176.20 "," $2,952.65 ", $420.46 ," $4,220.16 "
Wound Closure by Adhesive,HCPCS G0168,N/A,N/A,N/A, $330.00 , $214.50 , $32.95 , $13.67 , N/A , $51.11 , N/A , $306.90 , $297.00 , $297.00 , $264.00 , $264.00 , N/A , $304.69 , $313.50 , $297.00 , $297.00 , $297.00 , $306.90 , $316.80 , $51.92 , $280.50 , $51.90 , $98.90 , N/A , $52.10 , $52.10 , $313.50 , $65.15 , $13.67 , $316.80 
"Resec Toe at I-P Jt,Single,Ea",28160,N/A,N/A,N/A," $2,809.00 "," $1,825.85 "," $1,659.45 ", $259.18 , $183.20 ," $1,331.23 "," $1,327.41 "," $2,612.37 "," $2,528.10 "," $2,528.10 "," $2,247.20 "," $2,247.20 ", $183.20 ," $2,593.55 "," $2,668.55 "," $2,528.10 "," $2,528.10 "," $2,528.10 "," $2,612.37 "," $2,696.64 "," $1,539.39 "," $2,387.65 "," $1,436.17 "," $1,573.94 ", N/A ," $1,357.21 "," $1,357.21 "," $2,668.55 "," $1,595.17 ", $183.20 ," $2,696.64 "
 Degenerative Nervous System Disorders Without McC ,MS DRG V40 (FY2023) 057,N/A,N/A,N/A," $9,912.83 "," $6,443.34 "," $8,326.78 ", N/A , N/A ," $8,009.57 "," $8,921.55 "," $8,392.20 "," $8,921.55 "," $8,921.55 "," $8,921.55 "," $8,425.91 ", N/A ," $9,152.52 "," $9,417.19 "," $8,425.91 "," $9,218.93 "," $9,218.93 "," $9,417.19 "," $9,516.32 "," $8,110.68 "," $8,921.55 "," $8,425.91 "," $7,831.14 ", N/A ," $8,022.45 "," $8,022.45 "," $9,417.19 "," $8,506.20 "," $7,831.14 "," $9,516.32 "
Drain Skin Abscess Complic,CPT® 10061,N/A,N/A,N/A, $834.00 , $542.10 , $590.92 , $177.26 , $93.30 , $490.97 , $481.05 , $775.62 , $750.60 , $750.60 , $667.20 , $667.20 , $93.30 , $770.03 , $792.30 , $750.60 , $750.60 , $750.60 , $775.62 , $800.64 , $644.00 , $708.90 , $950.91 , $632.67 , N/A , $500.54 , $500.54 , $792.30 , $580.46 , $93.30 , $950.91 
 Fac Radex Hips Bilateral With Pelvis Minimum 5 Views ,CPT® 73523,0320 - DX X-RAY,N/A,N/A, $583.00 , $378.95 , $489.72 , $60.96 , $44.46 , $471.06 , $524.70 , $493.57 , $524.70 , $524.70 , $524.70 , $495.55 , $43.59 , $538.28 , $553.85 , $495.55 , $542.19 , $542.19 , $553.85 , $559.68 , $477.01 , $524.70 , $495.55 , $460.57 , N/A , $471.82 , $471.82 , $553.85 , $500.27 , $43.59 , $559.68 
 Fac Telethx Isodose Pln Cplx W/Basic Dosimetry ,CPT® 77307,0333 - RADIATION RX,N/A,N/A," $2,047.00 "," $1,330.55 "," $1,719.48 ", $281.92 , $222.42 ," $1,653.98 "," $1,842.30 "," $1,732.99 "," $1,842.30 "," $1,842.30 "," $1,842.30 "," $1,739.95 ", $218.06 ," $1,890.00 "," $1,944.65 "," $1,739.95 "," $1,903.71 "," $1,903.71 "," $1,944.65 "," $1,965.12 "," $1,674.86 "," $1,842.30 "," $1,739.95 "," $1,617.13 ", N/A ," $1,656.64 "," $1,656.64 "," $1,944.65 "," $1,756.53 ", $218.06 ," $1,965.12 "
"Lap,Partial Nephrectomy",CPT® 50543,N/A,N/A,N/A," $10,158.00 "," $6,602.70 "," $8,042.81 "," $1,412.64 "," $1,276.52 "," $7,279.47 "," $6,770.71 "," $9,446.94 "," $9,142.20 "," $9,142.20 "," $8,126.40 "," $8,126.40 "," $1,276.52 "," $9,378.88 "," $9,650.10 "," $9,142.20 "," $9,142.20 "," $9,142.20 "," $9,446.94 "," $9,751.68 "," $8,074.31 "," $8,634.30 "," $7,671.48 "," $9,150.20 ", N/A ," $7,421.50 "," $7,421.50 "," $9,650.10 "," $8,722.90 "," $1,276.52 "," $9,751.68 "
 PILOCARPINE HCL 1 % OP SOLN ,HCPCS RXC637,0250 - PHARMACY,61314-0203-15,15 mL, $506.32 , $329.11 , $425.31 , N/A , N/A , $409.11 , $455.69 , $428.65 , $455.69 , $455.69 , $455.69 , $430.37 , N/A , $467.49 , $481.00 , $430.37 , $470.88 , $470.88 , $481.00 , $486.07 , $414.27 , $455.69 , $430.37 , $399.99 , N/A , $409.76 , $409.76 , $481.00 , $434.47 , $399.99 , $486.07 
 Fac Diagnostic Lumbar Spinal Puncture W/Fluor or CT ,CPT® 62328,0320 - DX X-RAY,N/A,N/A," $1,580.00 "," $1,027.00 "," $1,327.20 ", $82.55 , $204.50 ," $1,276.64 "," $1,422.00 "," $1,337.63 "," $1,422.00 "," $1,422.00 "," $1,422.00 "," $1,343.00 ", $200.49 ," $1,458.81 "," $1,501.00 "," $1,343.00 "," $1,469.40 "," $1,469.40 "," $1,501.00 "," $1,516.80 "," $1,292.76 "," $1,422.00 "," $1,343.00 "," $1,248.20 ", N/A ," $1,278.69 "," $1,278.69 "," $1,501.00 "," $1,355.80 ", $82.55 ," $1,516.80 "
"Colposcopy,Cervix W/Adj Vagina,W/Bx",CPT® 57455,N/A,N/A,N/A," $1,009.00 ", $655.85 , $507.40 , $102.68 , $130.01 , $452.63 , $449.05 , $938.37 , $908.10 , $908.10 , $807.20 , $807.20 , $130.01 , $931.61 , $958.55 , $908.10 , $908.10 , $908.10 , $938.37 , $968.64 , $534.15 , $857.65 , $590.53 , $452.58 , N/A , $461.46 , $461.46 , $958.55 , $553.51 , $102.68 , $968.64 
 Fac Insj Implntbl Defib Pulse Gen W/1 Existing Ld ,CPT® 33240,0360 - OR SERVICES,N/A,N/A," $5,654.00 "," $3,675.10 "," $4,749.36 ", $337.07 , $458.25 ," $4,568.43 "," $5,088.60 "," $4,786.68 "," $5,088.60 "," $5,088.60 "," $5,088.60 "," $4,805.90 ", $449.26 ," $5,220.34 "," $5,371.30 "," $4,805.90 "," $5,258.22 "," $5,258.22 "," $5,371.30 "," $5,427.84 "," $4,626.10 "," $5,088.60 "," $4,805.90 "," $4,466.66 ", N/A ," $4,575.78 "," $4,575.78 "," $5,371.30 "," $4,851.70 ", $337.07 ," $5,427.84 "
 Path Level V 88307 Initial -Tech-Mh ,CPT® 88307,0310 - PATHOLOGY LAB,N/A,N/A," $1,571.00 "," $1,021.15 "," $1,319.64 ", $284.70 , $115.67 ," $1,269.37 "," $1,413.90 "," $1,330.01 "," $1,413.90 "," $1,413.90 "," $1,413.90 "," $1,335.35 ", $113.40 ," $1,450.50 "," $1,492.45 "," $1,335.35 "," $1,461.03 "," $1,461.03 "," $1,492.45 "," $1,508.16 "," $1,285.39 "," $1,413.90 "," $1,335.35 "," $1,241.09 ", N/A ," $1,271.41 "," $1,271.41 "," $1,492.45 "," $1,348.08 ", $113.40 ," $1,508.16 "
"Closed Rx Bimalleolar Fx,Manip",27810,N/A,N/A,N/A," $3,115.00 "," $2,024.75 "," $2,621.26 ", $415.07 , $394.39 ," $2,044.66 "," $2,077.68 "," $2,896.95 "," $2,803.50 "," $2,803.50 "," $2,492.00 "," $2,492.00 ", $394.39 ," $2,876.08 "," $2,959.25 "," $2,803.50 "," $2,803.50 "," $2,803.50 "," $2,896.95 "," $2,990.40 "," $2,420.62 "," $2,647.75 "," $2,287.17 "," $2,409.72 ", N/A ," $2,084.56 "," $2,084.56 "," $2,959.25 "," $2,450.12 ", $394.39 ," $2,990.40 "
Insertion Picc W/O Img Gdn 5 Yr/>,36569,N/A,N/A,N/A," $1,559.00 "," $1,013.35 ", $570.51 , $87.87 , $94.88 , $405.39 , $393.52 ," $1,449.87 "," $1,403.10 "," $1,403.10 "," $1,247.20 "," $1,247.20 ", $94.88 ," $1,439.42 "," $1,481.05 "," $1,403.10 "," $1,403.10 "," $1,403.10 "," $1,449.87 "," $1,496.64 ", $529.38 ," $1,325.15 ", $478.13 , $430.78 , N/A , $413.31 , $413.31 ," $1,481.05 ", $469.51 , $87.87 ," $1,496.64 "
Scratch Resistant Coating,HCPCS V2760,N/A,N/A,N/A, $24.00 , $15.60 , N/A , $19.25 , N/A , N/A , N/A , $22.32 , $21.60 , $21.60 , $19.20 , $19.20 , N/A , $22.16 , $22.80 , $21.60 , $21.60 , $21.60 , $22.32 , $23.04 , N/A , $20.40 , $24.00 , $17.49 , N/A , N/A , N/A , $22.80 , N/A , $17.49 , $24.00 
 PILOCARPINE HCL 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00574-0792-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Lens Sphcy Bifocal 4.00d/Ove,HCPCS V2206,N/A,N/A,N/A, $85.00 , $55.25 , N/A , $84.14 , N/A , N/A , N/A , $79.05 , $76.50 , $76.50 , $68.00 , $68.00 , N/A , $78.48 , $80.75 , $76.50 , $76.50 , $76.50 , $79.05 , $81.60 , N/A , $72.25 , $85.00 , $76.45 , N/A , N/A , N/A , $80.75 , N/A , $68.00 , $85.00 
 C Spine MRI With Contrast ,CPT® 72142,0612 - MRI - SPINE,N/A,N/A," $5,712.00 "," $3,712.80 "," $4,798.08 ", $283.16 , $513.10 ," $4,615.30 "," $5,140.80 "," $4,835.78 "," $5,140.80 "," $5,140.80 "," $5,140.80 "," $4,855.20 ", $503.04 ," $5,273.89 "," $5,426.40 "," $4,855.20 "," $5,312.16 "," $5,312.16 "," $5,426.40 "," $5,483.52 "," $4,673.56 "," $5,140.80 "," $4,855.20 "," $4,512.48 ", N/A ," $4,622.72 "," $4,622.72 "," $5,426.40 "," $4,901.47 ", $283.16 ," $5,483.52 "
 MYCOPHENOLATE SODIUM 360 MG PO TBEC ,HCPCS J7518,0636 - DRUGS REQUIRING DETAILED CODIN,60505-2966-07,2 tablet, $93.89 , $61.03 , $78.87 , $0.68 , $0.79 , $75.86 , $84.50 , $79.49 , $84.50 , $84.50 , $84.50 , $79.81 , $0.77 , $86.69 , $89.20 , $79.81 , $87.32 , $87.32 , $89.20 , $90.13 , $76.82 , $84.50 , $79.81 , $74.17 , N/A , $75.99 , $75.99 , $89.20 , $80.57 , $0.68 , $90.13 
 Fac Bx Breast W Device 1st Lesion Magnetic Res Guide ,CPT® 19085,0361 - OR/MINOR,N/A,N/A," $9,137.00 "," $5,939.05 "," $7,675.08 ", $172.52 , $146.68 ," $7,382.70 "," $8,223.30 "," $7,735.38 "," $8,223.30 "," $8,223.30 "," $8,223.30 "," $7,766.45 ", $143.80 ," $8,436.19 "," $8,680.15 "," $7,766.45 "," $8,497.41 "," $8,497.41 "," $8,680.15 "," $8,771.52 "," $7,475.89 "," $8,223.30 "," $7,766.45 "," $7,218.23 ", N/A ," $7,394.57 "," $7,394.57 "," $8,680.15 "," $7,840.46 ", $143.80 ," $8,771.52 "
 Fac Tap Block Bilateral by Injection(S) ,CPT® 64488,0360 - OR SERVICES,N/A,N/A," $1,210.00 ", $786.50 ," $1,016.40 ", $66.45 , $120.54 , $977.68 ," $1,089.00 "," $1,024.39 "," $1,089.00 "," $1,089.00 "," $1,089.00 "," $1,028.50 ", $118.18 ," $1,117.19 "," $1,149.50 "," $1,028.50 "," $1,125.30 "," $1,125.30 "," $1,149.50 "," $1,161.60 ", $990.02 ," $1,089.00 "," $1,028.50 ", $955.90 , N/A , $979.25 , $979.25 ," $1,149.50 "," $1,038.30 ", $66.45 ," $1,161.60 "
 Pro I & D of Pilonidal Cyst Simple ,CPT® 10080,0982 - PRO FEE/OUTPT,N/A,N/A, $795.00 , $516.75 , $335.61 , $100.38 , $61.55 , $282.06 , $278.01 , $739.35 , $715.50 , $715.50 , $636.00 , $636.00 , $61.55 , $734.02 , $755.25 , $715.50 , $715.50 , $715.50 , $739.35 , $763.20 , $367.33 , $675.75 , $553.06 , $359.71 , N/A , $287.57 , $287.57 , $755.25 , $333.47 , $61.55 , $763.20 
X-Ray Lumbar Spine 2/3 Vw,CPT® 72100,N/A,N/A,N/A, $314.00 , $204.10 , $224.98 , $39.34 , $37.65 , $165.53 , $191.35 , $292.02 , $282.60 , $282.60 , $251.20 , $251.20 , $37.65 , $289.92 , $298.30 , $282.60 , $282.60 , $282.60 , $292.02 , $301.44 , $218.44 , $266.90 , $209.94 , $176.76 , N/A , $168.76 , $168.76 , $298.30 , $195.34 , $37.65 , $301.44 
"Lap,Orchiectomy",CPT® 54690,N/A,N/A,N/A," $3,609.00 "," $2,345.85 "," $2,905.02 ", $624.94 , $699.30 ," $2,112.10 "," $2,369.15 "," $3,356.37 "," $3,248.10 "," $3,248.10 "," $2,887.20 "," $2,887.20 ", $699.30 ," $3,332.19 "," $3,428.55 "," $3,248.10 "," $3,248.10 "," $3,248.10 "," $3,356.37 "," $3,464.64 "," $2,729.72 "," $3,067.65 "," $3,901.75 "," $3,186.82 ", N/A ," $2,153.32 "," $2,153.32 "," $3,428.55 "," $2,580.85 ", $624.94 ," $3,901.75 "
 Pro Sgmdsc Flx Rmvl Tum Polyp/Oth Les Snare Tq ,CPT® 45338,0982 - PRO FEE/OUTPT,N/A,N/A," $2,391.00 "," $1,554.15 ", $736.26 , $113.74 , $150.61 , $669.17 , $687.26 ," $2,223.63 "," $2,151.90 "," $2,151.90 "," $1,912.80 "," $1,912.80 ", $150.61 ," $2,207.61 "," $2,271.45 "," $2,151.90 "," $2,151.90 "," $2,151.90 "," $2,223.63 "," $2,295.36 ", $528.04 ," $2,032.35 ", $752.88 , $700.61 , N/A , $682.23 , $682.23 ," $2,271.45 ", $713.53 , $113.74 ," $2,295.36 "
Complex Cystometrogram Voiding Pressure Studies,CPT® 51728,N/A,N/A,N/A," $2,171.00 "," $1,411.15 "," $2,074.26 ", $358.26 , $248.26 ," $1,516.31 "," $1,484.79 "," $2,019.03 "," $1,953.90 "," $1,953.90 "," $1,736.80 "," $1,736.80 ", $248.26 ," $2,004.48 "," $2,062.45 "," $1,953.90 "," $1,953.90 "," $1,953.90 "," $2,019.03 "," $2,084.16 "," $2,063.13 "," $1,845.35 "," $1,673.45 "," $1,956.16 ", N/A ," $1,545.90 "," $1,545.90 "," $2,062.45 "," $1,816.97 ", $248.26 ," $2,084.16 "
Repair of Nasal Septum,CPT® 30520,N/A,N/A,N/A," $3,788.00 "," $2,462.20 "," $3,759.35 ", $661.97 , $780.73 ," $2,375.22 "," $2,399.86 "," $3,522.84 "," $3,409.20 "," $3,409.20 "," $3,030.40 "," $3,030.40 ", $780.73 ," $3,497.46 "," $3,598.60 "," $3,409.20 "," $3,409.20 "," $3,409.20 "," $3,522.84 "," $3,636.48 "," $3,555.08 "," $3,219.80 "," $3,373.67 "," $3,127.66 ", N/A ," $2,421.57 "," $2,421.57 "," $3,598.60 "," $2,851.92 ", $661.97 ," $3,759.35 "
 Fac R& L Hrt Cath W/Injec Hrt Art/Grft& L Vent I ,CPT® 93461,0481 - CARDIAC CATH LAB,N/A,N/A," $17,250.00 "," $11,212.50 "," $14,490.00 "," $1,328.32 "," $1,042.25 "," $13,938.00 "," $15,525.00 "," $14,603.85 "," $15,525.00 "," $15,525.00 "," $15,525.00 "," $14,662.50 "," $1,021.81 "," $15,926.93 "," $16,387.50 "," $14,662.50 "," $16,042.50 "," $16,042.50 "," $16,387.50 "," $16,560.00 "," $14,113.95 "," $15,525.00 "," $14,662.50 "," $13,627.50 ", N/A ," $13,960.43 "," $13,960.43 "," $16,387.50 "," $14,802.23 "," $1,021.81 "," $16,560.00 "
"Closed Rx I-P Jt,Toe Disloc,Anesth",CPT® 28665,N/A,N/A,N/A," $1,029.00 ", $668.85 , $784.88 , $121.60 , $76.84 , $645.54 , $647.99 , $956.97 , $926.10 , $926.10 , $823.20 , $823.20 , $76.84 , $950.08 , $977.55 , $926.10 , $926.10 , $926.10 , $956.97 , $987.84 , $727.09 , $874.65 , $706.49 , $768.68 , N/A , $658.13 , $658.13 , $977.55 , $773.53 , $76.84 , $987.84 
"Injection,Therap/Proph/Diagnost, Im or Subcut",CPT® 96372,N/A,N/A,N/A, $90.00 , $58.50 , $33.14 , $13.86 , $3.38 , $55.65 , $58.19 , $83.70 , $81.00 , $81.00 , $72.00 , $72.00 , $3.38 , $83.10 , $85.50 , $81.00 , $81.00 , $81.00 , $83.70 , $86.40 , $51.48 , $76.50 , $77.04 , $77.48 , N/A , $56.74 , $56.74 , $85.50 , $66.15 , $3.38 , $86.40 
 Pro Exc Tumor Soft Tissue Shoulder Subfascial 5+Cm ,CPT® 23073,0982 - PRO FEE/OUTPT,N/A,N/A," $5,457.00 "," $3,547.05 "," $4,200.56 ", $655.86 , $568.22 ," $3,326.76 "," $3,305.98 "," $5,075.01 "," $4,911.30 "," $4,911.30 "," $4,365.60 "," $4,365.60 ", $568.22 ," $5,038.45 "," $5,184.15 "," $4,911.30 "," $4,911.30 "," $4,911.30 "," $5,075.01 "," $5,238.72 "," $3,901.55 "," $4,638.45 "," $3,660.90 "," $3,917.76 ", N/A ," $3,391.67 "," $3,391.67 "," $5,184.15 "," $3,986.41 ", $568.22 ," $5,238.72 "
"Remove Spinal Neurostim Electrode Perc Array, Incl Fluoro",CPT® 63661,N/A,N/A,N/A," $2,715.00 "," $1,764.75 "," $1,585.17 ", $309.25 , $463.01 ," $1,789.69 "," $1,740.60 "," $2,524.95 "," $2,443.50 "," $2,443.50 "," $2,172.00 "," $2,172.00 ", $463.01 ," $2,506.76 "," $2,579.25 "," $2,443.50 "," $2,443.50 "," $2,443.50 "," $2,524.95 "," $2,606.40 "," $1,708.40 "," $2,307.75 "," $1,714.49 "," $1,919.56 ", N/A ," $1,824.61 "," $1,824.61 "," $2,579.25 "," $1,957.35 ", $309.25 ," $2,606.40 "
 NEOMYCIN-POLYMYXIN-HC OP SUSP ,HCPCS RXC637,0250 - PHARMACY,61314-0641-75,7.5 mL, $874.56 , $568.46 , $734.63 , N/A , N/A , $706.64 , $787.10 , $740.40 , $787.10 , $787.10 , $787.10 , $743.38 , N/A , $807.48 , $830.83 , $743.38 , $813.34 , $813.34 , $830.83 , $839.58 , $715.56 , $787.10 , $743.38 , $690.90 , N/A , $707.78 , $707.78 , $830.83 , $750.46 , $690.90 , $839.58 
Plmt Nephroureteral Cath Prq New Access Rs&I,CPT® 50433,N/A,N/A,N/A," $7,468.00 "," $4,854.20 "," $1,374.42 ", $241.17 , $901.77 ," $1,353.06 "," $1,193.89 "," $6,945.24 "," $6,721.20 "," $6,721.20 "," $5,974.40 "," $5,974.40 ", $901.77 ," $6,895.20 "," $7,094.60 "," $6,721.20 "," $6,721.20 "," $6,721.20 "," $6,945.24 "," $7,169.28 "," $1,385.34 "," $6,347.80 "," $1,318.49 "," $1,599.66 ", N/A ," $1,379.46 "," $1,379.46 "," $7,094.60 "," $1,621.36 ", $241.17 ," $7,169.28 "
Needle Emg Nonextremty Mscles W/Nerve Conduction,CPT® 95887,N/A,N/A,N/A, $904.00 , $587.60 , $320.38 , $82.44 , $61.15 , $261.12 , $242.56 , $840.72 , $813.60 , $813.60 , $723.20 , $723.20 , $61.15 , $834.66 , $858.80 , $813.60 , $813.60 , $813.60 , $840.72 , $867.84 , $382.74 , $768.40 , $212.88 , $307.36 , N/A , $266.21 , $266.21 , $858.80 , $327.28 , $61.15 , $867.84 
 Fac Max Brthing Cap Mxml Vol Vntj ,CPT® 94200,0460 - PULMONARY FUNC,N/A,N/A, $313.00 , $203.45 , $262.92 , $14.10 , $18.14 , $252.90 , $281.70 , $264.99 , $281.70 , $281.70 , $281.70 , $266.05 , $17.78 , $288.99 , $297.35 , $266.05 , $291.09 , $291.09 , $297.35 , $300.48 , $256.10 , $281.70 , $266.05 , $247.27 , N/A , $253.31 , $253.31 , $297.35 , $268.59 , $14.10 , $300.48 
Glutathione Assay,CPT® 82978,N/A,N/A,N/A, $112.00 , $72.80 , N/A , $15.76 , $15.76 , $80.65 , $96.50 , $104.16 , $100.80 , $100.80 , $89.60 , $89.60 , $15.76 , $103.41 , $106.40 , $100.80 , $100.80 , $100.80 , $104.16 , $107.52 , $103.16 , $95.20 , $94.07 , $51.69 , N/A , $75.27 , $75.27 , $106.40 , $82.26 , $15.76 , $107.52 
Iaad Ia Hepatitis B Surface Ag Neutralization,CPT® 87341,N/A,N/A,N/A, $108.00 , $70.20 , N/A , $10.54 , $10.54 , $58.45 , $69.92 , $100.44 , $97.20 , $97.20 , $86.40 , $86.40 , $10.54 , $99.72 , $102.60 , $97.20 , $97.20 , $97.20 , $100.44 , $103.68 , $68.98 , $91.80 , $68.12 , $37.45 , N/A , $54.55 , $54.55 , $102.60 , $59.61 , $10.54 , $103.68 
 Pro Cltx Metar Fx W/O Mnpj ,CPT® 28470,0982 - PRO FEE/OUTPT,N/A,N/A," $1,411.00 ", $917.15 ," $1,281.15 ", $202.14 , $155.34 , $994.98 ," $1,021.36 "," $1,312.23 "," $1,269.90 "," $1,269.90 "," $1,128.80 "," $1,128.80 ", $155.34 ," $1,302.78 "," $1,340.45 "," $1,269.90 "," $1,269.90 "," $1,269.90 "," $1,312.23 "," $1,354.56 "," $1,181.08 "," $1,199.35 "," $1,115.04 "," $1,181.65 ", N/A ," $1,014.40 "," $1,014.40 "," $1,340.45 "," $1,192.29 ", $155.34 ," $1,354.56 "
"Repair Urethra Injury,Penile",CPT® 53505,N/A,N/A,N/A," $3,387.00 "," $2,201.55 "," $2,637.30 ", $464.60 , $549.85 ," $2,376.16 "," $2,218.68 "," $3,149.91 "," $3,048.30 "," $3,048.30 "," $2,709.60 "," $2,709.60 ", $549.85 ," $3,127.22 "," $3,217.65 "," $3,048.30 "," $3,048.30 "," $3,048.30 "," $3,149.91 "," $3,251.52 "," $2,644.85 "," $2,878.95 "," $2,511.96 "," $2,991.81 ", N/A ," $2,422.52 "," $2,422.52 "," $3,217.65 "," $2,847.33 ", $464.60 ," $3,251.52 "
 SERTRALINE HCL 100 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6926-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Renal Failure With McC ,MS DRG V40 (FY2023) 682,N/A,N/A,N/A," $9,937.90 "," $6,459.64 "," $8,347.84 ", N/A , N/A ," $8,029.82 "," $8,944.11 "," $8,413.43 "," $8,944.11 "," $8,944.11 "," $8,944.11 "," $8,447.22 ", N/A ," $9,175.66 "," $9,441.01 "," $8,447.22 "," $9,242.25 "," $9,242.25 "," $9,441.01 "," $9,540.38 "," $8,131.19 "," $8,944.11 "," $8,447.22 "," $7,850.94 ", N/A ," $8,042.74 "," $8,042.74 "," $9,441.01 "," $8,527.71 "," $7,850.94 "," $9,540.38 "
Treat Interphalangeal Jnt,26770,N/A,N/A,N/A," $1,507.00 ", $979.55 ," $1,609.47 ", $257.24 , $74.85 ," $1,227.08 "," $1,253.31 "," $1,401.51 "," $1,356.30 "," $1,356.30 "," $1,205.60 "," $1,205.60 ", $74.85 ," $1,391.41 "," $1,431.65 "," $1,356.30 "," $1,356.30 "," $1,356.30 "," $1,401.51 "," $1,446.72 "," $1,478.71 "," $1,280.95 "," $1,373.73 "," $1,463.84 ", N/A ," $1,251.03 "," $1,251.03 "," $1,431.65 "," $1,470.39 ", $74.85 ," $1,609.47 "
"Exc Skin Malig 3.1-4cm Face,Facial",CPT® 11644,N/A,N/A,N/A," $1,990.00 "," $1,293.50 ", $899.54 , $268.82 , $596.38 , $778.04 , $757.93 ," $1,850.70 "," $1,791.00 "," $1,791.00 "," $1,592.00 "," $1,592.00 ", $596.38 ," $1,837.37 "," $1,890.50 "," $1,791.00 "," $1,791.00 "," $1,791.00 "," $1,850.70 "," $1,910.40 ", $986.37 ," $1,691.50 "," $1,514.67 ", $995.32 , N/A , $793.23 , $793.23 ," $1,890.50 ", $919.88 , $268.82 ," $1,910.40 "
Cysto/Uretero/Pyeloscopy W/Lithotripsy,52353,N/A,N/A,N/A," $3,899.00 "," $2,534.35 "," $2,100.25 ", $368.50 , $431.86 ," $1,924.93 "," $2,675.07 "," $3,626.07 "," $3,509.10 "," $3,509.10 "," $3,119.20 "," $3,119.20 ", $431.86 ," $3,599.95 "," $3,704.05 "," $3,509.10 "," $3,509.10 "," $3,509.10 "," $3,626.07 "," $3,743.04 "," $2,112.54 "," $3,314.15 "," $2,060.59 "," $2,413.34 ", N/A ," $1,962.49 "," $1,962.49 "," $3,704.05 "," $2,306.64 ", $368.50 ," $3,743.04 "
 Pro CT Lumbar Spine W/Dye ,CPT® 72132,0972 - PRO FEE/RAD/DX,N/A,N/A, $687.00 , $446.55 ," $1,202.67 ", $172.75 , $302.34 ," $1,089.02 "," $1,385.53 ", $638.91 , $618.30 , $618.30 , $549.60 , $549.60 , $302.34 , $634.31 , $652.65 , $618.30 , $618.30 , $618.30 , $638.91 , $659.52 ," $1,012.21 ", $583.95 ," $1,508.09 "," $1,478.94 ", N/A ," $1,110.26 "," $1,110.26 ", $652.65 ," $1,285.14 ", $172.75 ," $1,508.09 "
Exc Skin Benig >4cm Remaindr Body,CPT® 11426,N/A,N/A,N/A," $1,652.00 "," $1,073.80 ", $865.20 , $256.79 , $276.88 , $745.91 , $724.34 ," $1,536.36 "," $1,486.80 "," $1,486.80 "," $1,321.60 "," $1,321.60 ", $276.88 ," $1,525.29 "," $1,569.40 "," $1,486.80 "," $1,486.80 "," $1,486.80 "," $1,536.36 "," $1,585.92 ", $953.39 ," $1,404.20 "," $1,448.66 ", $954.50 , N/A , $760.46 , $760.46 ," $1,569.40 ", $881.89 , $256.79 ," $1,585.92 "
"Incise Inner Eye Adhesns,Incisn",CPT® 65865,N/A,N/A,N/A," $4,274.00 "," $2,778.10 "," $2,956.01 ", $463.62 , $768.38 ," $2,674.27 "," $2,462.59 "," $3,974.82 "," $3,846.60 "," $3,846.60 "," $3,419.20 "," $3,419.20 ", $768.38 ," $3,946.18 "," $4,060.30 "," $3,846.60 "," $3,846.60 "," $3,846.60 "," $3,974.82 "," $4,103.04 "," $4,047.93 "," $3,632.90 "," $2,497.69 "," $3,400.92 ", N/A ," $2,726.45 "," $2,726.45 "," $4,060.30 "," $3,009.65 ", $463.62 ," $4,103.04 "
 RANOLAZINE ER 500 MG PO TB12 ,HCPCS RXC637,0250 - PHARMACY,70756-0703-60,1 tablet, $33.00 , $21.45 , $27.72 , N/A , N/A , $26.66 , $29.70 , $27.94 , $29.70 , $29.70 , $29.70 , $28.05 , N/A , $30.47 , $31.35 , $28.05 , $30.69 , $30.69 , $31.35 , $31.68 , $27.00 , $29.70 , $28.05 , $26.07 , N/A , $26.71 , $26.71 , $31.35 , $28.32 , $26.07 , $31.68 
 Admin Moderna Bivalent Booster 6 - 11 Yrs ,CPT® 0144A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
Radiologic Exam Small Int Single Contrast Study,CPT® 74250,N/A,N/A,N/A," $1,488.00 ", $967.20 , $713.86 , $122.45 , $77.22 , $491.78 , $578.71 ," $1,383.84 "," $1,339.20 "," $1,339.20 "," $1,190.40 "," $1,190.40 ", $77.22 ," $1,373.87 "," $1,413.60 "," $1,339.20 "," $1,339.20 "," $1,339.20 "," $1,383.84 "," $1,428.48 ", $696.07 ," $1,264.80 ", $631.74 , $522.08 , N/A , $501.37 , $501.37 ," $1,413.60 ", $580.35 , $77.22 ," $1,428.48 "
"Visual Field Exam,Intermed",CPT® 92082,N/A,N/A,N/A, $180.00 , $117.00 , $100.55 , $45.89 , $55.95 , $84.09 , $114.50 , $167.40 , $162.00 , $162.00 , $144.00 , $144.00 , $55.95 , $166.19 , $171.00 , $162.00 , $162.00 , $162.00 , $167.40 , $172.80 , $144.52 , $153.00 , $150.03 , $101.72 , N/A , $85.74 , $85.74 , $171.00 , $101.97 , $45.89 , $172.80 
Drug Assay Leflunomide,CPT® 80193,N/A,N/A,N/A, $152.00 , $98.80 , N/A , $39.34 , $39.34 , N/A , N/A , $141.36 , $136.80 , $136.80 , $121.60 , $121.60 , $39.34 , $140.34 , $144.40 , $136.80 , $136.80 , $136.80 , $141.36 , $145.92 , $257.54 , $129.20 , $184.15 , $113.28 , N/A , $151.19 , $151.19 , $144.40 , $166.24 , $39.34 , $257.54 
Insert Pelvic Fixation Device,CPT® 22848,N/A,N/A,N/A," $2,369.00 "," $1,539.85 "," $2,085.92 ", $324.23 , $520.55 ," $1,729.17 "," $1,679.27 "," $2,203.17 "," $2,132.10 "," $2,132.10 "," $1,895.20 "," $1,895.20 ", $520.55 ," $2,187.30 "," $2,250.55 "," $2,132.10 "," $2,132.10 "," $2,132.10 "," $2,203.17 "," $2,274.24 "," $1,952.65 "," $2,013.65 "," $1,880.40 "," $2,005.92 ", N/A ," $1,762.90 "," $1,762.90 "," $2,250.55 "," $2,072.06 ", $324.23 ," $2,274.24 "
 Fac Cytogenetics&Molec Cytogenetics I&R ,CPT® 88291,0310 - PATHOLOGY LAB,N/A,N/A, $455.00 , $295.75 , $382.20 , $31.99 , $5.77 , $367.64 , $409.50 , $385.20 , $409.50 , $409.50 , $409.50 , $386.75 , $5.66 , $420.10 , $432.25 , $386.75 , $423.15 , $423.15 , $432.25 , $436.80 , $372.28 , $409.50 , $386.75 , $359.45 , N/A , $368.23 , $368.23 , $432.25 , $390.44 , $5.66 , $436.80 
"Full Thick Grft Scalp,Arm,Leg <20sqc",CPT® 15220,N/A,N/A,N/A," $3,769.00 "," $2,449.85 "," $1,947.04 ", $584.80 , $461.04 ," $1,678.82 "," $1,653.62 "," $3,505.17 "," $3,392.10 "," $3,392.10 "," $3,015.20 "," $3,015.20 ", $461.04 ," $3,479.92 "," $3,580.55 "," $3,392.10 "," $3,392.10 "," $3,392.10 "," $3,505.17 "," $3,618.24 "," $2,134.83 "," $3,203.65 "," $3,300.52 "," $2,150.62 ", N/A ," $1,711.58 "," $1,711.58 "," $3,580.55 "," $1,984.86 ", $461.04 ," $3,618.24 "
 Pro Anterior Colporraphy Rpr Cystocele W/Cysto ,CPT® 57240,0982 - PRO FEE/OUTPT,N/A,N/A," $4,005.00 "," $2,603.25 "," $2,907.05 ", $588.09 , $537.90 ," $2,738.88 "," $2,708.47 "," $3,724.65 "," $3,604.50 "," $3,604.50 "," $3,204.00 "," $3,204.00 ", $537.90 ," $3,697.82 "," $3,804.75 "," $3,604.50 "," $3,604.50 "," $3,604.50 "," $3,724.65 "," $3,844.80 "," $3,022.85 "," $3,404.25 "," $3,532.45 "," $2,428.96 ", N/A ," $2,792.33 "," $2,792.33 "," $3,804.75 "," $3,349.24 ", $537.90 ," $3,844.80 "
Remov FB/Eye/Ext Eye/Embe,65210,N/A,N/A,N/A, $291.00 , $189.15 , $224.64 , $34.99 , $48.54 , $303.27 , $280.98 , $270.63 , $261.90 , $261.90 , $232.80 , $232.80 , $48.54 , $268.68 , $276.45 , $261.90 , $261.90 , $261.90 , $270.63 , $279.36 , $311.97 , $247.35 , $289.02 , $382.47 , N/A , $309.18 , $309.18 , $276.45 , $341.30 , $34.99 , $382.47 
" Pro PR Program Eval Implant Device,Pacemaker,Mult Lead ",CPT® 93281,0982 - PRO FEE/OUTPT,N/A,N/A, $910.00 , $591.50 , $548.41 , $83.77 , $59.19 , $369.43 , $375.61 , $846.30 , $819.00 , $819.00 , $728.00 , $728.00 , $59.19 , $840.20 , $864.50 , $819.00 , $819.00 , $819.00 , $846.30 , $873.60 , $515.08 , $773.50 , $349.68 , $240.25 , N/A , $376.65 , $376.65 , $864.50 , $417.52 , $59.19 , $873.60 
 Fac Assay of Metanephrines ,CPT® 83835,0301 - LAB/CHEMISTRY,N/A,N/A, $238.00 , $154.70 , $199.92 , $17.28 , $17.28 , $192.30 , $214.20 , $201.49 , $214.20 , $214.20 , $214.20 , $202.30 , $16.94 , $219.75 , $226.10 , $202.30 , $221.34 , $221.34 , $226.10 , $228.48 , $194.73 , $214.20 , $202.30 , $188.02 , N/A , $192.61 , $192.61 , $226.10 , $204.23 , $16.94 , $228.48 
 Fac Antb Hiv-2 ,CPT® 86702,0302 - LAB/IMMUNOLOGY,N/A,N/A, $133.00 , $86.45 , $111.72 , $13.79 , $13.79 , $107.46 , $119.70 , $112.60 , $119.70 , $119.70 , $119.70 , $113.05 , $13.52 , $122.80 , $126.35 , $113.05 , $123.69 , $123.69 , $126.35 , $127.68 , $108.82 , $119.70 , $113.05 , $105.07 , N/A , $107.64 , $107.64 , $126.35 , $114.13 , $13.52 , $127.68 
 Fac Rmvl & Rplcmt Intly Dwelling Ureteral Stent Prq ,CPT® 50382,0360 - OR SERVICES,N/A,N/A," $4,131.00 "," $2,685.15 "," $3,470.04 ", $238.66 ," $1,308.77 "," $3,337.85 "," $3,717.90 "," $3,497.30 "," $3,717.90 "," $3,717.90 "," $3,717.90 "," $3,511.35 "," $1,283.11 "," $3,814.15 "," $3,924.45 "," $3,511.35 "," $3,841.83 "," $3,841.83 "," $3,924.45 "," $3,965.76 "," $3,379.98 "," $3,717.90 "," $3,511.35 "," $3,263.49 ", N/A ," $3,343.22 "," $3,343.22 "," $3,924.45 "," $3,544.81 ", $238.66 ," $3,965.76 "
Rad Resec Soft Tiss Tumr Lower Leg,CPT® 27615,N/A,N/A,N/A," $6,748.00 "," $4,386.20 "," $6,168.18 ", $963.16 ," $1,331.03 "," $4,912.70 "," $4,897.54 "," $6,275.64 "," $6,073.20 "," $6,073.20 "," $5,398.40 "," $5,398.40 "," $1,331.03 "," $6,230.43 "," $6,410.60 "," $6,073.20 "," $6,073.20 "," $6,073.20 "," $6,275.64 "," $6,478.08 "," $5,726.81 "," $5,735.80 "," $5,425.34 "," $5,806.13 ", N/A ," $5,008.56 "," $5,008.56 "," $6,410.60 "," $5,886.82 ", $963.16 ," $6,478.08 "
"Needle Biopsy, Lymph Node(S)",CPT® 38505,N/A,N/A,N/A," $1,747.00 "," $1,135.55 ", $407.80 , $82.42 , $208.20 , $255.70 , $261.73 ," $1,624.71 "," $1,572.30 "," $1,572.30 "," $1,397.60 "," $1,397.60 ", $208.20 ," $1,613.01 "," $1,659.65 "," $1,572.30 "," $1,572.30 "," $1,572.30 "," $1,624.71 "," $1,677.12 ", $353.66 ," $1,484.95 ", $378.22 , $355.24 , N/A , $260.70 , $260.70 ," $1,659.65 ", $302.44 , $82.42 ," $1,677.12 "
Drainage Nasal Abscess ED Fac,30000,N/A,N/A,N/A, $686.00 , $445.90 , $657.40 , $117.58 , $30.71 , $451.13 , $453.39 , $637.98 , $617.40 , $617.40 , $548.80 , $548.80 , $30.71 , $633.38 , $651.70 , $617.40 , $617.40 , $617.40 , $637.98 , $658.56 , $623.33 , $583.10 , $640.48 , $597.16 , N/A , $459.93 , $459.93 , $651.70 , $541.65 , $30.71 , $658.56 
 Pro Mra Nck C-/C+ ,CPT® 70549,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,045.00 ", $679.25 ," $2,476.25 ", $354.34 , $616.14 ," $2,865.15 "," $3,669.14 ", $971.85 , $940.50 , $940.50 , $836.00 , $836.00 , $616.14 , $964.85 , $992.75 , $940.50 , $940.50 , $940.50 , $971.85 ," $1,003.20 "," $2,113.64 ", $888.25 ," $3,996.54 "," $3,361.29 ", N/A ," $2,921.06 "," $2,921.06 ", $992.75 ," $3,381.19 ", $354.34 ," $3,996.54 "
"Remove Foreign Body,Foot",CPT® 28192,N/A,N/A,N/A," $3,173.00 "," $2,062.45 "," $1,930.89 ", $301.68 , $190.55 ," $1,545.60 "," $1,551.74 "," $2,950.89 "," $2,855.70 "," $2,855.70 "," $2,538.40 "," $2,538.40 ", $190.55 ," $2,929.63 "," $3,014.35 "," $2,855.70 "," $2,855.70 "," $2,855.70 "," $2,950.89 "," $3,046.08 "," $1,797.60 "," $2,697.05 "," $1,680.59 "," $1,833.96 ", N/A ," $1,575.76 "," $1,575.76 "," $3,014.35 "," $1,852.06 ", $190.55 ," $3,046.08 "
 HALOPERIDOL 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6782-61,1 tablet, $4.67 , $3.04 , $3.92 , N/A , N/A , $3.77 , $4.20 , $3.95 , $4.20 , $4.20 , $4.20 , $3.97 , N/A , $4.31 , $4.44 , $3.97 , $4.34 , $4.34 , $4.44 , $4.48 , $3.82 , $4.20 , $3.97 , $3.69 , N/A , $3.78 , $3.78 , $4.44 , $4.01 , $3.69 , $4.48 
Injection Aa&/Strd Intercostal Nrv Ea Addl Lvl,64421,N/A,N/A,N/A," $2,512.00 "," $1,632.80 ", $123.14 , $23.62 , $46.08 , $514.45 , $512.66 ," $2,336.16 "," $2,260.80 "," $2,260.80 "," $2,009.60 "," $2,009.60 ", $46.08 ," $2,319.33 "," $2,386.40 "," $2,260.80 "," $2,260.80 "," $2,260.80 "," $2,336.16 "," $2,411.52 ", $133.67 ," $2,135.20 ", $503.11 , $557.55 , N/A , $524.49 , $524.49 ," $2,386.40 ", $562.66 , $23.62 ," $2,411.52 "
 Fac Tmvi W/Prosthetic Valve Transthoracic Exposure ,CPT® 0484T,0360 - OR SERVICES,N/A,N/A," $24,063.00 "," $15,640.95 "," $20,212.92 "," $1,554.16 ", N/A ," $19,442.90 "," $21,656.70 "," $20,371.74 "," $21,656.70 "," $21,656.70 "," $21,656.70 "," $20,453.55 ", N/A ," $22,217.37 "," $22,859.85 "," $20,453.55 "," $22,378.59 "," $22,378.59 "," $22,859.85 "," $23,100.48 "," $19,688.35 "," $21,656.70 "," $20,453.55 "," $19,009.77 ", N/A ," $19,474.19 "," $19,474.19 "," $22,859.85 "," $20,648.46 "," $1,554.16 "," $23,100.48 "
Excis Epididymis Local Lesion,CPT® 54830,N/A,N/A,N/A," $2,044.00 "," $1,328.60 "," $1,656.19 ", $357.41 , $247.42 ," $1,195.58 "," $1,215.64 "," $1,900.92 "," $1,839.60 "," $1,839.60 "," $1,635.20 "," $1,635.20 ", $247.42 ," $1,887.23 "," $1,941.80 "," $1,839.60 "," $1,839.60 "," $1,839.60 "," $1,900.92 "," $1,962.24 "," $1,552.65 "," $1,737.40 "," $1,939.28 "," $1,805.83 ", N/A ," $1,218.91 "," $1,218.91 "," $1,941.80 "," $1,460.93 ", $247.42 ," $1,962.24 "
Drainage Rectal Abscess,46050,N/A,N/A,N/A, $593.00 , $385.45 , $612.76 , $96.47 , $68.62 , $463.98 , $481.35 , $551.49 , $533.70 , $533.70 , $474.40 , $474.40 , $68.62 , $547.52 , $563.35 , $533.70 , $533.70 , $533.70 , $551.49 , $569.28 , $436.34 , $504.05 , $529.87 , $552.66 , N/A , $473.03 , $473.03 , $563.35 , $494.75 , $68.62 , $612.76 
" Fac Organic Acid, Single, Quant ",CPT® 83921,0301 - LAB/CHEMISTRY,N/A,N/A, $215.00 , $139.75 , $180.60 , $21.63 , $21.63 , $173.72 , $193.50 , $182.02 , $193.50 , $193.50 , $193.50 , $182.75 , $21.21 , $198.51 , $204.25 , $182.75 , $199.95 , $199.95 , $204.25 , $206.40 , $175.91 , $193.50 , $182.75 , $169.85 , N/A , $174.00 , $174.00 , $204.25 , $184.49 , $21.21 , $206.40 
"Explore/Treat Interphalangeal Jt,Ea",CPT® 26080,N/A,N/A,N/A," $2,077.00 "," $1,350.05 "," $2,459.93 ", $387.68 , $230.52 ," $1,877.43 "," $1,888.59 "," $1,931.61 "," $1,869.30 "," $1,869.30 "," $1,661.60 "," $1,661.60 ", $230.52 ," $1,917.69 "," $1,973.15 "," $1,869.30 "," $1,869.30 "," $1,869.30 "," $1,931.61 "," $1,993.92 "," $2,276.48 "," $1,765.45 "," $2,071.30 "," $2,236.33 ", N/A ," $1,914.07 "," $1,914.07 "," $1,973.15 "," $2,249.72 ", $230.52 ," $2,459.93 "
Repair Brow Ptosis,CPT® 67900,N/A,N/A,N/A," $5,902.00 "," $3,836.30 "," $3,102.45 ", $486.88 ," $1,126.80 "," $2,875.43 "," $2,703.84 "," $5,488.86 "," $5,311.80 "," $5,311.80 "," $4,721.60 "," $4,721.60 "," $1,126.80 "," $5,449.32 "," $5,606.90 "," $5,311.80 "," $5,311.80 "," $5,311.80 "," $5,488.86 "," $5,665.92 "," $4,264.99 "," $5,016.70 "," $2,799.20 "," $3,646.28 ", N/A ," $2,931.53 "," $2,931.53 "," $5,606.90 "," $3,236.02 ", $486.88 ," $5,665.92 "
 Fac Hemodialysis Access by Joining Artery and Vein ,CPT® 36821,0360 - OR SERVICES,N/A,N/A," $10,516.00 "," $6,835.40 "," $8,833.44 ", $593.19 , $922.06 ," $8,496.93 "," $9,464.40 "," $8,902.85 "," $9,464.40 "," $9,464.40 "," $9,464.40 "," $8,938.60 ", $903.98 ," $9,709.42 "," $9,990.20 "," $8,938.60 "," $9,779.88 "," $9,779.88 "," $9,990.20 "," $10,095.36 "," $8,604.19 "," $9,464.40 "," $8,938.60 "," $8,307.64 ", N/A ," $8,510.60 "," $8,510.60 "," $9,990.20 "," $9,023.78 ", $593.19 ," $10,095.36 "
 Fac Insj 1 Transvns Eltrd Perm Pacemaker/Impltbl Dfb ,CPT® 33216,0360 - OR SERVICES,N/A,N/A," $4,049.00 "," $2,631.85 "," $3,401.16 ", $344.42 , $401.40 ," $3,271.59 "," $3,644.10 "," $3,427.88 "," $3,644.10 "," $3,644.10 "," $3,644.10 "," $3,441.65 ", $393.53 ," $3,738.44 "," $3,846.55 "," $3,441.65 "," $3,765.57 "," $3,765.57 "," $3,846.55 "," $3,887.04 "," $3,312.89 "," $3,644.10 "," $3,441.65 "," $3,198.71 ", N/A ," $3,276.86 "," $3,276.86 "," $3,846.55 "," $3,474.45 ", $344.42 ," $3,887.04 "
 Intraoperative Ultrasound ,CPT® 76998,0402 - ULTRASOUND,N/A,N/A, $751.00 , $488.15 , $630.84 , $108.44 , $58.33 , $606.81 , $675.90 , $635.80 , $675.90 , $675.90 , $675.90 , $638.35 , $57.19 , $693.40 , $713.45 , $638.35 , $698.43 , $698.43 , $713.45 , $720.96 , $614.47 , $675.90 , $638.35 , $593.29 , N/A , $607.78 , $607.78 , $713.45 , $644.43 , $57.19 , $720.96 
Elec Alys Implt Cplx Cn Npgt Prgrmg,CPT® 95977,N/A,N/A,N/A, $279.00 , $181.35 , $189.66 , $50.05 , $42.96 , $160.04 , N/A , $259.47 , $251.10 , $251.10 , $223.20 , $223.20 , $42.96 , $257.60 , $265.05 , $251.10 , $251.10 , $251.10 , $259.47 , $267.84 , $224.85 , $237.15 , $155.49 , $200.72 , N/A , $163.17 , $163.17 , $265.05 , $200.58 , $42.96 , $267.84 
 CILOSTAZOL 100 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60505-2522-01,1 tablet, $9.38 , $6.10 , $7.88 , N/A , N/A , $7.58 , $8.44 , $7.94 , $8.44 , $8.44 , $8.44 , $7.97 , N/A , $8.66 , $8.91 , $7.97 , $8.72 , $8.72 , $8.91 , $9.00 , $7.67 , $8.44 , $7.97 , $7.41 , N/A , $7.59 , $7.59 , $8.91 , $8.05 , $7.41 , $9.00 
 Critical Care First 30-74 Min -Mh ,CPT® 99291,0450 - EMERGENCY SERVICES,N/A,N/A," $5,560.00 "," $3,614.00 "," $4,670.40 ", $205.74 , $270.56 ," $4,492.48 "," $5,004.00 "," $4,707.10 "," $5,004.00 "," $5,004.00 "," $5,004.00 "," $4,726.00 ", $265.25 ," $5,133.55 "," $5,282.00 "," $4,726.00 "," $5,170.80 "," $5,170.80 "," $5,282.00 "," $5,337.60 "," $4,549.19 "," $5,004.00 "," $4,726.00 "," $4,392.40 ", N/A ," $4,499.71 "," $4,499.71 "," $5,282.00 "," $4,771.04 ", $205.74 ," $5,337.60 "
 Pro Office/OP Consltj New/Est Pt High Mdm 55 Minutes ,CPT® 99245,0988 - PRO FEE/CONSULT,N/A,N/A, $917.00 , $596.05 , N/A , $207.53 , $108.89 , $419.36 , $417.44 , $852.81 , $825.30 , $825.30 , $733.60 , $733.60 , $108.89 , $846.67 , $871.15 , $825.30 , $825.30 , $825.30 , $852.81 , $880.32 , $528.96 , $779.45 , $408.06 , $417.70 , $275.00 , $427.54 , $427.54 , $871.15 , $509.00 , $108.89 , $880.32 
Assay Urine Sodium,CPT® 84300,N/A,N/A,N/A, $71.00 , $46.15 , N/A , $5.16 , $5.16 , $27.53 , $32.93 , $66.03 , $63.90 , $63.90 , $56.80 , $56.80 , $5.16 , $65.55 , $67.45 , $63.90 , $63.90 , $63.90 , $66.03 , $68.16 , $33.79 , $60.35 , $32.44 , $17.62 , N/A , $25.69 , $25.69 , $67.45 , $28.07 , $5.16 , $68.16 
 Pro Biopsy of Salivary Gland ,CPT® 42400,0972 - PRO FEE/RAD/DX,N/A,N/A, $538.00 , $349.70 , $325.52 , $51.14 , $76.84 , $266.57 , $273.46 , $500.34 , $484.20 , $484.20 , $430.40 , $430.40 , $76.84 , $496.74 , $511.10 , $484.20 , $484.20 , $484.20 , $500.34 , $516.48 , $233.28 , $457.30 , $296.15 , $313.85 , N/A , $271.77 , $271.77 , $511.10 , $284.25 , $51.14 , $516.48 
" Fac Replantation Thumb Distal,Complete ",CPT® 20827,0360 - OR SERVICES,N/A,N/A," $11,374.00 "," $7,393.10 "," $9,554.16 "," $1,709.40 ", $776.76 ," $9,190.19 "," $10,236.60 "," $9,629.23 "," $10,236.60 "," $10,236.60 "," $10,236.60 "," $9,667.90 ", $761.53 ," $10,501.61 "," $10,805.30 "," $9,667.90 "," $10,577.82 "," $10,577.82 "," $10,805.30 "," $10,919.04 "," $9,306.21 "," $10,236.60 "," $9,667.90 "," $8,985.46 ", N/A ," $9,204.98 "," $9,204.98 "," $10,805.30 "," $9,760.03 ", $761.53 ," $10,919.04 "
Cmbnd Anterpost Colporraphy W/Cysto W/Ntrcl Rpr,CPT® 57265,N/A,N/A,N/A," $5,452.00 "," $3,543.80 "," $4,114.75 ", $831.40 , $845.22 ," $3,717.40 "," $3,698.95 "," $5,070.36 "," $4,906.80 "," $4,906.80 "," $4,361.60 "," $4,361.60 ", $845.22 ," $5,033.83 "," $5,179.40 "," $4,906.80 "," $4,906.80 "," $4,906.80 "," $5,070.36 "," $5,233.92 "," $4,299.54 "," $4,634.20 "," $4,856.22 "," $3,506.39 ", N/A ," $3,789.93 "," $3,789.93 "," $5,179.40 "," $4,545.79 ", $831.40 ," $5,233.92 "
 CABAZITAXEL 60 MG/1.5 ML IV SOLN DILUTED TO 10 MG/ML ,HCPCS J9043,0636 - DRUGS REQUIRING DETAILED CODIN,00001-0987-01,6 mL," $34,953.73 "," $22,719.92 "," $29,361.13 ", $210.15 , $203.57 ," $28,242.61 "," $31,458.36 "," $29,591.83 "," $31,458.36 "," $31,458.36 "," $31,458.36 "," $29,710.67 ", $199.58 ," $32,272.78 "," $33,206.04 "," $29,710.67 "," $32,506.97 "," $32,506.97 "," $33,206.04 "," $33,555.58 "," $28,599.14 "," $31,458.36 "," $29,710.67 "," $27,613.45 ", N/A ," $28,288.05 "," $28,288.05 "," $33,206.04 "," $29,993.80 ", $199.58 ," $33,555.58 "
 METHYLPHENIDATE HCL 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,16729-0479-01,1 tablet, $5.20 , $3.38 , $4.37 , N/A , N/A , $4.20 , $4.68 , $4.40 , $4.68 , $4.68 , $4.68 , $4.42 , N/A , $4.80 , $4.94 , $4.42 , $4.84 , $4.84 , $4.94 , $4.99 , $4.25 , $4.68 , $4.42 , $4.11 , N/A , $4.21 , $4.21 , $4.94 , $4.46 , $4.11 , $4.99 
Bcr/Abl1 Other Breakpnt Qualitative/Quantitative,CPT® 81208,N/A,N/A,N/A," $1,983.00 "," $1,288.95 ", N/A , $218.91 , $179.05 , $909.98 ," $1,077.63 "," $1,844.19 "," $1,784.70 "," $1,784.70 "," $1,586.40 "," $1,586.40 ", $179.05 ," $1,830.90 "," $1,883.85 "," $1,784.70 "," $1,784.70 "," $1,784.70 "," $1,844.19 "," $1,903.68 "," $1,433.07 "," $1,685.55 "," $1,022.53 ", $630.34 , N/A , $849.25 , $849.25 ," $1,883.85 ", $928.05 , $179.05 ," $1,903.68 "
" Fac Immunotherapy, One Injection ",CPT® 95115,0940 - OTHER RX SVS,N/A,N/A, $130.00 , $84.50 , $109.20 , $9.63 , $3.80 , $105.04 , $117.00 , $110.06 , $117.00 , $117.00 , $117.00 , $110.50 , $3.73 , $120.03 , $123.50 , $110.50 , $120.90 , $120.90 , $123.50 , $124.80 , $106.37 , $117.00 , $110.50 , $102.70 , N/A , $105.21 , $105.21 , $123.50 , $111.55 , $3.73 , $124.80 
X-Ray Thor-Lumb Sp 2 Vw,CPT® 72080,N/A,N/A,N/A, $354.00 , $230.10 , $196.50 , $34.08 , $34.04 , $158.08 , $193.11 , $329.22 , $318.60 , $318.60 , $283.20 , $283.20 , $34.04 , $326.85 , $336.30 , $318.60 , $318.60 , $318.60 , $329.22 , $339.84 , $190.08 , $300.90 , $213.79 , $169.59 , N/A , $161.17 , $161.17 , $336.30 , $186.54 , $34.04 , $339.84 
Revise/Remove Neurostim/Receiver,63688,N/A,N/A,N/A," $2,457.00 "," $1,597.05 "," $1,790.20 ", $351.09 , $400.51 ," $2,042.54 "," $1,979.16 "," $2,285.01 "," $2,211.30 "," $2,211.30 "," $1,965.60 "," $1,965.60 ", $400.51 ," $2,268.55 "," $2,334.15 "," $2,211.30 "," $2,211.30 "," $2,211.30 "," $2,285.01 "," $2,358.72 "," $1,935.77 "," $2,088.45 "," $1,967.82 "," $2,176.52 ", N/A ," $2,082.39 "," $2,082.39 "," $2,334.15 "," $2,233.92 ", $351.09 ," $2,358.72 "
Exploratory of Abdomen,CPT® 49000,N/A,N/A,N/A," $5,043.00 "," $3,277.95 "," $4,594.46 ", $712.07 ," $1,026.83 "," $3,623.45 "," $3,664.28 "," $4,689.99 "," $4,538.70 "," $4,538.70 "," $4,034.40 "," $4,034.40 "," $1,026.83 "," $4,656.20 "," $4,790.85 "," $4,538.70 "," $4,538.70 "," $4,538.70 "," $4,689.99 "," $4,841.28 "," $3,290.34 "," $4,286.55 "," $4,067.67 "," $4,279.31 ", N/A ," $3,694.14 "," $3,694.14 "," $4,790.85 "," $3,863.66 ", $712.07 ," $4,841.28 "
 Fac Inc Lngl Frenum Frexomy ,CPT® 41010,0761 - TREATMENT ROOM,N/A,N/A, $619.00 , $402.35 , $519.96 , $107.20 , $97.17 , $500.15 , $557.10 , $524.05 , $557.10 , $557.10 , $557.10 , $526.15 , $95.26 , $571.52 , $588.05 , $526.15 , $575.67 , $575.67 , $588.05 , $594.24 , $506.47 , $557.10 , $526.15 , $489.01 , N/A , $500.96 , $500.96 , $588.05 , $531.16 , $95.26 , $594.24 
Fluorouracil Injection,HCPCS J9190,N/A,N/A,N/A, $9.00 , $5.85 , N/A , $1.87 , $2.57 , N/A , N/A , $8.37 , $8.10 , $8.10 , $7.20 , $7.20 , $2.57 , $8.31 , $8.55 , $8.10 , $8.10 , $8.10 , $8.37 , $8.64 , $2.03 , $7.65 , $3.24 , $3.31 , N/A , N/A , N/A , $8.55 , N/A , $1.87 , $8.64 
"Electro-Uroflowmetry, First",CPT® 51741,N/A,N/A,N/A, $774.00 , $503.10 , $74.98 , $13.42 , $75.77 , $76.68 , $73.40 , $719.82 , $696.60 , $696.60 , $619.20 , $619.20 , $75.77 , $714.63 , $735.30 , $696.60 , $696.60 , $696.60 , $719.82 , $743.04 , $75.32 , $657.90 , $82.07 , $95.93 , N/A , $78.18 , $78.18 , $735.30 , $91.86 , $13.42 , $743.04 
Ko Adj Jnt POS Rigid Support,HCPCS L1832,N/A,N/A,N/A, $831.00 , $540.15 , N/A , $805.72 , $486.59 , N/A , N/A , $772.83 , $747.90 , $747.90 , $664.80 , $664.80 , $486.59 , $767.26 , $789.45 , $747.90 , $747.90 , $747.90 , $772.83 , $797.76 , N/A , $706.35 , $614.37 , $677.88 , N/A , N/A , N/A , $789.45 , N/A , $486.59 , $805.72 
 Fac Continuous Inhalation Treatment 1st Hr ,CPT® 94644,0410 - RESPIRATORY SVC,N/A,N/A, $711.00 , $462.15 , $597.24 , $58.23 , $28.76 , $574.49 , $639.90 , $601.93 , $639.90 , $639.90 , $639.90 , $604.35 , $28.20 , $656.47 , $675.45 , $604.35 , $661.23 , $661.23 , $675.45 , $682.56 , $581.74 , $639.90 , $604.35 , $561.69 , N/A , $575.41 , $575.41 , $675.45 , $610.11 , $28.20 , $682.56 
Inj Aripiprazole Ext Rel 1mg,HCPCS J0401,N/A,N/A,N/A, $11.00 , $7.15 , N/A , $6.85 , $6.55 , N/A , N/A , $10.23 , $9.90 , $9.90 , $8.80 , $8.80 , $6.55 , $10.16 , $10.45 , $9.90 , $9.90 , $9.90 , $10.23 , $10.56 , $7.70 , $9.35 , $12.28 , $8.36 , N/A , N/A , N/A , $10.45 , N/A , $6.55 , $12.28 
Removal of Ovarian Cyst(S),CPT® 58925,N/A,N/A,N/A," $4,403.00 "," $2,861.95 "," $3,609.80 ", $728.79 , $691.53 ," $3,026.43 "," $3,001.39 "," $4,094.79 "," $3,962.70 "," $3,962.70 "," $3,522.40 "," $3,522.40 ", $691.53 ," $4,065.29 "," $4,182.85 "," $3,962.70 "," $3,962.70 "," $3,962.70 "," $4,094.79 "," $4,226.88 "," $3,750.81 "," $3,742.55 "," $3,957.05 "," $3,031.94 ", N/A ," $3,085.48 "," $3,085.48 "," $4,182.85 "," $3,700.85 ", $691.53 ," $4,226.88 "
 Lt Lower Ext MRI Without Contrast ,CPT® 73718,0610 - MRI,N/A,N/A," $4,517.00 "," $2,936.05 "," $3,794.28 ", $230.21 , $411.48 ," $3,649.74 "," $4,065.30 "," $3,824.09 "," $4,065.30 "," $4,065.30 "," $4,065.30 "," $3,839.45 ", $403.41 ," $4,170.55 "," $4,291.15 "," $3,839.45 "," $4,200.81 "," $4,200.81 "," $4,291.15 "," $4,336.32 "," $3,695.81 "," $4,065.30 "," $3,839.45 "," $3,568.43 ", N/A ," $3,655.61 "," $3,655.61 "," $4,291.15 "," $3,876.04 ", $230.21 ," $4,336.32 "
Bumetanide 0.5 Mg,HCPCS S0171,N/A,N/A,N/A, $3.00 , $1.95 , N/A , N/A , N/A , N/A , N/A , $2.79 , $2.70 , $2.70 , $2.40 , $2.40 , N/A , $2.77 , $2.85 , $2.70 , $2.70 , $2.70 , $2.79 , $2.88 , N/A , $2.55 , $1.95 , $0.87 , N/A , N/A , N/A , $2.85 , N/A , $0.87 , $2.88 
 Novavax Covid Vaccine Second Dose ,CPT® 0042A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
" Protein, CSF Beaker1 ",CPT® 84157,0301 - LAB/CHEMISTRY,N/A,N/A, $82.00 , $53.30 , $68.88 , $4.08 , $4.08 , $66.26 , $73.80 , $69.42 , $73.80 , $73.80 , $73.80 , $69.70 , $4.00 , $75.71 , $77.90 , $69.70 , $76.26 , $76.26 , $77.90 , $78.72 , $67.09 , $73.80 , $69.70 , $64.78 , N/A , $66.36 , $66.36 , $77.90 , $70.36 , $4.00 , $78.72 
 Fac Rp Loclzj Tum Spect 1 Area Single Day Imaging ,CPT® 78803,0340 - NUCLEAR MEDICINE,N/A,N/A," $2,955.00 "," $1,920.75 "," $2,482.20 ", $349.18 , $314.32 ," $2,387.64 "," $2,659.50 "," $2,501.70 "," $2,659.50 "," $2,659.50 "," $2,659.50 "," $2,511.75 ", $308.16 ," $2,728.35 "," $2,807.25 "," $2,511.75 "," $2,748.15 "," $2,748.15 "," $2,807.25 "," $2,836.80 "," $2,417.78 "," $2,659.50 "," $2,511.75 "," $2,334.45 ", N/A ," $2,391.48 "," $2,391.48 "," $2,807.25 "," $2,535.69 ", $308.16 ," $2,836.80 "
 HYDROMORPHONE HCL 2 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,42858-0301-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Arthrodesis Si Jt Opn W/Obtaining B1 Grf Instrmj,CPT® 27280,N/A,N/A,N/A," $8,372.00 "," $5,441.80 "," $7,996.63 "," $1,248.99 ", $922.06 ," $4,963.74 "," $4,984.62 "," $7,785.96 "," $7,534.80 "," $7,534.80 "," $6,697.60 "," $6,697.60 ", $922.06 ," $7,729.87 "," $7,953.40 "," $7,534.80 "," $7,534.80 "," $7,534.80 "," $7,785.96 "," $8,037.12 "," $7,448.18 "," $7,116.20 "," $5,521.68 "," $7,541.24 ", N/A ," $5,060.60 "," $5,060.60 "," $7,953.40 "," $5,948.01 ", $922.06 ," $8,037.12 "
 Pro Cltx Fx Grt Toe Phlx/Phlg W/O Mnpj ,CPT® 28490,0981 - PRO FEE/ER,N/A,N/A, $559.00 , $363.35 , $772.46 , $123.06 , $85.41 , $611.90 , $626.73 , $519.87 , $503.10 , $503.10 , $447.20 , $447.20 , $85.41 , $516.12 , $531.05 , $503.10 , $503.10 , $503.10 , $519.87 , $536.64 , $710.88 , $475.15 , $681.51 , $728.10 , N/A , $623.83 , $623.83 , $531.05 , $733.23 , $85.41 , $772.46 
 CT Cerv/Thor Inj Third Plus Level ,CPT® 64492,0761 - TREATMENT ROOM,N/A,N/A, $823.00 , $534.95 , $691.32 , $57.81 , $69.96 , $664.98 , $740.70 , $696.75 , $740.70 , $740.70 , $740.70 , $699.55 , $68.59 , $759.88 , $781.85 , $699.55 , $765.39 , $765.39 , $781.85 , $790.08 , $673.38 , $740.70 , $699.55 , $650.17 , N/A , $666.05 , $666.05 , $781.85 , $706.22 , $57.81 , $790.08 
"Incision,Hemorrhoid",46083,N/A,N/A,N/A," $1,180.00 ", $767.00 , $672.56 , $104.60 , $84.21 , $505.76 , $520.72 ," $1,097.40 "," $1,062.00 "," $1,062.00 ", $944.00 , $944.00 , $84.21 ," $1,089.49 "," $1,121.00 "," $1,062.00 "," $1,062.00 "," $1,062.00 "," $1,097.40 "," $1,132.80 ", $478.52 ," $1,003.00 ", $570.90 , $608.17 , N/A , $515.63 , $515.63 ," $1,121.00 ", $539.29 , $84.21 ," $1,132.80 "
 Fac Assay of 5-Hiaa ,CPT® 83497,0301 - LAB/CHEMISTRY,N/A,N/A, $154.00 , $100.10 , $129.36 , $13.16 , $13.16 , $124.43 , $138.60 , $130.38 , $138.60 , $138.60 , $138.60 , $130.90 , $12.90 , $142.19 , $146.30 , $130.90 , $143.22 , $143.22 , $146.30 , $147.84 , $126.00 , $138.60 , $130.90 , $121.66 , N/A , $124.63 , $124.63 , $146.30 , $132.15 , $12.90 , $147.84 
 OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN ,HCPCS J2354,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0376-01,0.75 mL, $45.96 , $29.87 , $38.61 , $1.34 , $1.45 , $37.14 , $41.36 , $38.91 , $41.36 , $41.36 , $41.36 , $39.07 , $1.42 , $42.43 , $43.66 , $39.07 , $42.74 , $42.74 , $43.66 , $44.12 , $37.60 , $41.36 , $39.07 , $36.31 , N/A , $37.20 , $37.20 , $43.66 , $39.44 , $1.34 , $44.12 
Manipulatn Knee Jt+Anesthesia,27570,N/A,N/A,N/A, $816.00 , $530.40 , $931.58 , $147.22 , $151.20 , $726.41 , $730.37 , $758.88 , $734.40 , $734.40 , $652.80 , $652.80 , $151.20 , $753.41 , $775.20 , $734.40 , $734.40 , $734.40 , $758.88 , $783.36 , $859.06 , $693.60 , $802.83 , $858.23 , N/A , $740.58 , $740.58 , $775.20 , $870.45 , $147.22 , $931.58 
Office/OP Consltj New/Est Pt High Mdm 55 Minutes,CPT® 99245,N/A,N/A,N/A, $917.00 , $596.05 , N/A , $207.53 , $108.89 , $419.36 , $417.44 , $852.81 , $825.30 , $825.30 , $733.60 , $733.60 , $108.89 , $846.67 , $871.15 , $825.30 , $825.30 , $825.30 , $852.81 , $880.32 , $528.96 , $779.45 , $408.06 , $417.70 , $275.00 , $427.54 , $427.54 , $871.15 , $509.00 , $108.89 , $880.32 
 Fac in Situ Hybridization Ea Multiplex Probe Stain ,CPT® 88366,0310 - PATHOLOGY LAB,N/A,N/A, $836.00 , $543.40 , $702.24 , $274.14 , $117.74 , $675.49 , $752.40 , $707.76 , $752.40 , $752.40 , $752.40 , $710.60 , $115.43 , $771.88 , $794.20 , $710.60 , $777.48 , $777.48 , $794.20 , $802.56 , $684.02 , $752.40 , $710.60 , $660.44 , N/A , $676.57 , $676.57 , $794.20 , $717.37 , $115.43 , $802.56 
 Pro Njx Px Cntrst Kne Arthg Cntrst Enhncd CT/MRI Kne ,CPT® 27369,0972 - PRO FEE/RAD/DX,N/A,N/A, $452.00 , $293.80 , $243.43 , $38.54 , $113.66 , $185.17 , N/A , $420.36 , $406.80 , $406.80 , $361.60 , $361.60 , $113.66 , $417.33 , $429.40 , $406.80 , $406.80 , $406.80 , $420.36 , $433.92 , $227.54 , $384.20 , $213.23 , $235.47 , N/A , $188.78 , $188.78 , $429.40 , $221.87 , $38.54 , $433.92 
Open Rx Uni Tib Plat Fx,27535,N/A,N/A,N/A," $4,983.00 "," $3,238.95 "," $5,422.43 ", $846.80 , $708.49 ," $4,329.13 "," $4,286.16 "," $4,634.19 "," $4,484.70 "," $4,484.70 "," $3,986.40 "," $3,986.40 ", $708.49 ," $4,600.80 "," $4,733.85 "," $4,484.70 "," $4,484.70 "," $4,484.70 "," $4,634.19 "," $4,783.68 "," $5,055.76 "," $4,235.55 "," $4,743.83 "," $5,087.91 ", N/A ," $4,413.60 "," $4,413.60 "," $4,733.85 "," $5,187.56 ", $708.49 ," $5,422.43 "
Drug Test Def 8-14 Classes,HCPCS G0481,N/A,N/A,N/A, $235.00 , $152.75 , N/A , $159.72 , $100.36 , $232.46 , N/A , $218.55 , $211.50 , $211.50 , $188.00 , $188.00 , $100.36 , $216.98 , $223.25 , $211.50 , $211.50 , $211.50 , $218.55 , $225.60 ," $1,045.59 ", $199.75 , $298.53 , $459.90 , N/A , $237.00 , $237.00 , $223.25 , $296.25 , $100.36 ," $1,045.59 "
"Duplex Scan Extracranial,Limited",CPT® 93882,N/A,N/A,N/A," $2,100.00 "," $1,365.00 ", $790.86 , $121.03 , $131.93 , $690.82 , $980.78 ," $1,953.00 "," $1,890.00 "," $1,890.00 "," $1,680.00 "," $1,680.00 ", $131.93 ," $1,938.93 "," $1,995.00 "," $1,890.00 "," $1,890.00 "," $1,890.00 "," $1,953.00 "," $2,016.00 ", $555.95 ," $1,785.00 ", $524.09 , $491.94 , N/A , $704.30 , $704.30 ," $1,995.00 ", $780.73 , $121.03 ," $2,016.00 "
 Fac Gases Bld O2 Saturation Only Dir Meas ,CPT® 82810,0301 - LAB/CHEMISTRY,N/A,N/A, $102.00 , $66.30 , $85.68 , $9.97 , $9.97 , $82.42 , $91.80 , $86.35 , $91.80 , $91.80 , $91.80 , $86.70 , $9.77 , $94.18 , $96.90 , $86.70 , $94.86 , $94.86 , $96.90 , $97.92 , $83.46 , $91.80 , $86.70 , $80.58 , N/A , $82.55 , $82.55 , $96.90 , $87.53 , $9.77 , $97.92 
 Pro Explore/Treat Finger Joint ,CPT® 26080,0982 - PRO FEE/OUTPT,N/A,N/A," $2,077.00 "," $1,350.05 "," $2,459.93 ", $387.68 , $230.52 ," $1,877.43 "," $1,888.59 "," $1,931.61 "," $1,869.30 "," $1,869.30 "," $1,661.60 "," $1,661.60 ", $230.52 ," $1,917.69 "," $1,973.15 "," $1,869.30 "," $1,869.30 "," $1,869.30 "," $1,931.61 "," $1,993.92 "," $2,276.48 "," $1,765.45 "," $2,071.30 "," $2,236.33 ", N/A ," $1,914.07 "," $1,914.07 "," $1,973.15 "," $2,249.72 ", $230.52 ," $2,459.93 "
 CEFAZOLIN SODIUM 3 G IV SOLR ,HCPCS J0690,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9140-01,15 mL, $54.10 , $35.17 , $45.44 , $0.89 , $0.79 , $43.71 , $48.69 , $45.80 , $48.69 , $48.69 , $48.69 , $45.99 , $0.77 , $49.95 , $51.40 , $45.99 , $50.31 , $50.31 , $51.40 , $51.94 , $44.26 , $48.69 , $45.99 , $42.74 , N/A , $43.78 , $43.78 , $51.40 , $46.42 , $0.77 , $51.94 
Fine Needle Aspiration Bx W/US Gdn Ea Addl,CPT® 10006,N/A,N/A,N/A, $331.00 , $215.15 , $163.27 , $48.12 , $47.61 , $128.25 , N/A , $307.83 , $297.90 , $297.90 , $264.80 , $264.80 , $47.61 , $305.61 , $314.45 , $297.90 , $297.90 , $297.90 , $307.83 , $317.76 , $170.30 , $281.35 , $262.99 , $176.27 , N/A , $130.75 , $130.75 , $314.45 , $151.61 , $47.61 , $317.76 
 Pro Appl Cst Sho Hand Long Arm ,CPT® 29065,0982 - PRO FEE/OUTPT,N/A,N/A, $638.00 , $414.70 , $411.13 , $64.54 , $78.67 , $331.65 , $332.74 , $593.34 , $574.20 , $574.20 , $510.40 , $510.40 , $78.67 , $589.07 , $606.10 , $574.20 , $574.20 , $574.20 , $593.34 , $612.48 , $381.08 , $542.30 , $365.73 , $390.75 , N/A , $338.12 , $338.12 , $606.10 , $397.43 , $64.54 , $612.48 
 PENICILLIN G BENZATHINE 600000 UNIT/ML IM SUSY ,HCPCS J0561,0636 - DRUGS REQUIRING DETAILED CODIN,60793-0700-10,1 mL, $897.11 , $583.12 , $753.57 , $20.57 , $18.96 , $724.86 , $807.40 , $759.49 , $807.40 , $807.40 , $807.40 , $762.54 , $18.59 , $828.30 , $852.25 , $762.54 , $834.31 , $834.31 , $852.25 , $861.23 , $734.02 , $807.40 , $762.54 , $708.72 , N/A , $726.03 , $726.03 , $852.25 , $769.81 , $18.59 , $861.23 
Incis Achilles Tendon+Gen Anesth,CPT® 27606,N/A,N/A,N/A," $2,201.00 "," $1,430.65 "," $1,672.19 ", $259.46 , $169.04 ," $1,385.34 "," $1,381.21 "," $2,046.93 "," $1,980.90 "," $1,980.90 "," $1,760.80 "," $1,760.80 ", $169.04 ," $2,032.18 "," $2,090.95 "," $1,980.90 "," $1,980.90 "," $1,980.90 "," $2,046.93 "," $2,112.96 "," $1,562.47 "," $1,870.85 "," $1,518.24 "," $1,606.72 ", N/A ," $1,412.37 "," $1,412.37 "," $2,090.95 "," $1,660.04 ", $169.04 ," $2,112.96 "
 Lower Art.Duplex - Unilateral ,CPT® 93926,0921 - PERI VASCUL LAB,N/A,N/A," $1,038.00 ", $674.70 , $871.92 , $125.31 , $148.70 , $838.70 , $934.20 , $878.77 , $934.20 , $934.20 , $934.20 , $882.30 , $145.78 , $958.39 , $986.10 , $882.30 , $965.34 , $965.34 , $986.10 , $996.48 , $849.29 , $934.20 , $882.30 , $820.02 , N/A , $840.05 , $840.05 , $986.10 , $890.71 , $125.31 , $996.48 
 Pro Treatment of Fibula Fracture ,CPT® 27780,0982 - PRO FEE/OUTPT,N/A,N/A," $2,004.00 "," $1,302.60 "," $1,775.74 ", $281.00 , $190.55 ," $1,342.07 "," $1,370.57 "," $1,863.72 "," $1,803.60 "," $1,803.60 "," $1,603.20 "," $1,603.20 ", $190.55 ," $1,850.29 "," $1,903.80 "," $1,803.60 "," $1,803.60 "," $1,803.60 "," $1,863.72 "," $1,923.84 "," $1,634.23 "," $1,703.40 "," $1,503.97 "," $1,596.71 ", N/A ," $1,368.26 "," $1,368.26 "," $1,903.80 "," $1,608.19 ", $190.55 ," $1,923.84 "
Colsc Flx W/Removal Lesion by Hot Bx Forceps,45384,N/A,N/A,N/A," $3,451.00 "," $2,243.15 "," $1,385.61 ", $213.74 , $412.82 ," $1,575.38 "," $1,571.71 "," $3,209.43 "," $3,105.90 "," $3,105.90 "," $2,760.80 "," $2,760.80 ", $412.82 ," $3,186.31 "," $3,278.45 "," $3,105.90 "," $3,105.90 "," $3,105.90 "," $3,209.43 "," $3,312.96 "," $1,937.09 "," $2,933.35 "," $1,439.74 "," $1,320.64 ", N/A ," $1,606.11 "," $1,606.11 "," $3,278.45 "," $1,852.49 ", $213.74 ," $3,312.96 "
Xfer Single Deep Low Leg Tendon,CPT® 27691,N/A,N/A,N/A," $7,149.00 "," $4,646.85 "," $4,556.83 ", $713.24 , $614.70 ," $3,639.99 "," $3,640.74 "," $6,648.57 "," $6,434.10 "," $6,434.10 "," $5,719.20 "," $5,719.20 ", $614.70 ," $6,600.67 "," $6,791.55 "," $6,434.10 "," $6,434.10 "," $6,434.10 "," $6,648.57 "," $6,863.04 "," $4,238.59 "," $6,076.65 "," $4,003.44 "," $4,278.89 ", N/A ," $3,711.01 "," $3,711.01 "," $6,791.55 "," $4,361.75 ", $614.70 ," $6,863.04 "
Prgrmg Dev Eval Implantable Subq Lead Dfb System,CPT® 93260,N/A,N/A,N/A, $516.00 , $335.40 , $491.21 , $75.56 , $52.28 , $355.70 , $379.47 , $479.88 , $464.40 , $464.40 , $412.80 , $412.80 , $52.28 , $476.42 , $490.20 , $464.40 , $464.40 , $464.40 , $479.88 , $495.36 , $466.88 , $438.60 , $406.92 , $392.05 , N/A , $362.64 , $362.64 , $490.20 , $401.99 , $52.28 , $495.36 
 Fac Angiotensin I Enzyme Test ,CPT® 82164,0301 - LAB/CHEMISTRY,N/A,N/A, $205.00 , $133.25 , $172.20 , $14.89 , $14.89 , $165.64 , $184.50 , $173.55 , $184.50 , $184.50 , $184.50 , $174.25 , $14.60 , $189.28 , $194.75 , $174.25 , $190.65 , $190.65 , $194.75 , $196.80 , $167.73 , $184.50 , $174.25 , $161.95 , N/A , $165.91 , $165.91 , $194.75 , $175.91 , $14.60 , $196.80 
 Fac Assay of Zinc ,CPT® 84630,0301 - LAB/CHEMISTRY,N/A,N/A, $155.00 , $100.75 , $130.20 , $11.62 , $11.62 , $125.24 , $139.50 , $131.22 , $139.50 , $139.50 , $139.50 , $131.75 , $11.39 , $143.11 , $147.25 , $131.75 , $144.15 , $144.15 , $147.25 , $148.80 , $126.82 , $139.50 , $131.75 , $122.45 , N/A , $125.44 , $125.44 , $147.25 , $133.01 , $11.39 , $148.80 
 Pro Abdom Paracentesis Dx/Ther W/O Imaging Guidance ,CPT® 49082,0982 - PRO FEE/OUTPT,N/A,N/A," $1,172.00 ", $761.80 , $446.29 , $68.89 , $188.97 , $361.06 , $352.03 ," $1,089.96 "," $1,054.80 "," $1,054.80 ", $937.60 , $937.60 , $188.97 ," $1,082.11 "," $1,113.40 "," $1,054.80 "," $1,054.80 "," $1,054.80 "," $1,089.96 "," $1,125.12 ", $319.40 , $996.20 , $380.01 , $425.52 , N/A , $368.10 , $368.10 ," $1,113.40 ", $385.00 , $68.89 ," $1,125.12 "
Removal Peritoneal Foreign Body From Cavity,CPT® 49402,N/A,N/A,N/A," $5,582.00 "," $3,628.30 "," $5,089.05 ", $789.14 , $626.07 ," $4,021.43 "," $4,062.21 "," $5,191.26 "," $5,023.80 "," $5,023.80 "," $4,465.60 "," $4,465.60 ", $626.07 ," $5,153.86 "," $5,302.90 "," $5,023.80 "," $5,023.80 "," $5,023.80 "," $5,191.26 "," $5,358.72 "," $3,653.68 "," $4,744.70 "," $4,513.68 "," $4,751.26 ", N/A ," $4,099.89 "," $4,099.89 "," $5,302.90 "," $4,288.04 ", $626.07 ," $5,358.72 "
 Fac Microdissection Prep Identified Target Manual ,CPT® 88381,0310 - PATHOLOGY LAB,N/A,N/A, $668.00 , $434.20 , $561.12 , $197.49 , $163.84 , $539.74 , $601.20 , $565.53 , $601.20 , $601.20 , $601.20 , $567.80 , $160.63 , $616.76 , $634.60 , $567.80 , $621.24 , $621.24 , $634.60 , $641.28 , $546.56 , $601.20 , $567.80 , $527.72 , N/A , $540.61 , $540.61 , $634.60 , $573.21 , $160.63 , $641.28 
Insj 1 Transvns Eltrd Perm Pacemaker/Impltbl Dfb,CPT® 33216,N/A,N/A,N/A," $4,049.00 "," $2,631.85 "," $2,223.07 ", $344.42 , $401.40 ," $1,634.46 "," $1,577.06 "," $3,765.57 "," $3,644.10 "," $3,644.10 "," $3,239.20 "," $3,239.20 ", $401.40 ," $3,738.44 "," $3,846.55 "," $3,644.10 "," $3,644.10 "," $3,644.10 "," $3,765.57 "," $3,887.04 "," $2,053.93 "," $3,441.65 "," $1,976.74 "," $1,795.59 ", N/A ," $1,666.35 "," $1,666.35 "," $3,846.55 "," $1,892.97 ", $344.42 ," $3,887.04 "
 TRIHEXYPHENIDYL HCL 2 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00591-5335-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 CADEXOMER IODINE 0.9 % EX GEL ,HCPCS RXA250,0250 - PHARMACY,40565-0122-49,40 gram, $439.31 , $285.55 , $369.02 , N/A , N/A , $354.96 , $395.38 , $371.92 , $395.38 , $395.38 , $395.38 , $373.41 , N/A , $405.61 , $417.34 , $373.41 , $408.56 , $408.56 , $417.34 , $421.74 , $359.44 , $395.38 , $373.41 , $347.05 , N/A , $355.53 , $355.53 , $417.34 , $376.97 , $347.05 , $421.74 
Medication Admin & Hemodynamic Measurment,CPT® 93463,N/A,N/A,N/A," $2,420.00 "," $1,573.00 ", $611.65 , $93.96 , $114.22 , $543.52 , $573.87 ," $2,250.60 "," $2,178.00 "," $2,178.00 "," $1,936.00 "," $1,936.00 ", $114.22 ," $2,234.39 "," $2,299.00 "," $2,178.00 "," $2,178.00 "," $2,178.00 "," $2,250.60 "," $2,323.20 ", $601.47 ," $2,057.00 ", $554.84 , $592.94 , N/A , $554.13 , $554.13 ," $2,299.00 ", $614.27 , $93.96 ," $2,323.20 "
 Smear - Gram Stain Direct. Beaker1 ,CPT® 87205,0306 - LAB/BACT-MICRO,N/A,N/A, $80.00 , $52.00 , $67.20 , $4.36 , $4.36 , $64.64 , $72.00 , $67.73 , $72.00 , $72.00 , $72.00 , $68.00 , $4.27 , $73.86 , $76.00 , $68.00 , $74.40 , $74.40 , $76.00 , $76.80 , $65.46 , $72.00 , $68.00 , $63.20 , N/A , $64.74 , $64.74 , $76.00 , $68.65 , $4.27 , $76.80 
Brief Check in by MD/Qhp,HCPCS G2012,N/A,N/A,N/A, $40.00 , $26.00 , $25.45 , $12.14 , $11.22 , N/A , N/A , $37.20 , $36.00 , $36.00 , $32.00 , $32.00 , $11.22 , $36.93 , $38.00 , $36.00 , $36.00 , $36.00 , $37.20 , $38.40 , $23.86 , $34.00 , $23.91 , $28.50 , N/A , $23.20 , $23.20 , $38.00 , $29.01 , $11.22 , $38.40 
 IV Startcapped/Not Used ,CPT® 36000,0761 - TREATMENT ROOM,N/A,N/A, $44.00 , $28.60 , $36.96 , $29.75 , $34.55 , $35.55 , $39.60 , $37.25 , $39.60 , $39.60 , $39.60 , $37.40 , $33.87 , $40.63 , $41.80 , $37.40 , $40.92 , $40.92 , $41.80 , $42.24 , $36.00 , $39.60 , $37.40 , $34.76 , N/A , $35.61 , $35.61 , $41.80 , $37.76 , $29.75 , $42.24 
 Fac Assay of Vancomycin ,CPT® 80202,0301 - LAB/CHEMISTRY,N/A,N/A, $136.00 , $88.40 , $114.24 , $13.81 , $13.81 , $109.89 , $122.40 , $115.14 , $122.40 , $122.40 , $122.40 , $115.60 , $13.54 , $125.57 , $129.20 , $115.60 , $126.48 , $126.48 , $129.20 , $130.56 , $111.28 , $122.40 , $115.60 , $107.44 , N/A , $110.06 , $110.06 , $129.20 , $116.70 , $13.54 , $130.56 
 TIROFIBAN HCL IN NACL 12.5-0.9 MG/250ML-% IV SOLN ,HCPCS J3246,0636 - DRUGS REQUIRING DETAILED CODIN,25208-0002-02,250 mL," $1,473.00 ", $957.45 ," $1,237.32 ", N/A , $9.50 ," $1,190.18 "," $1,325.70 "," $1,247.04 "," $1,325.70 "," $1,325.70 "," $1,325.70 "," $1,252.05 ", $9.31 ," $1,360.02 "," $1,399.35 "," $1,252.05 "," $1,369.89 "," $1,369.89 "," $1,399.35 "," $1,414.08 "," $1,205.21 "," $1,325.70 "," $1,252.05 "," $1,163.67 ", N/A ," $1,192.10 "," $1,192.10 "," $1,399.35 "," $1,263.98 ", $9.31 ," $1,414.08 "
Treat Talus Fracture,CPT® 28430,N/A,N/A,N/A," $1,568.00 "," $1,019.20 "," $1,313.07 ", $207.28 , $230.52 ," $1,022.71 "," $1,034.45 "," $1,458.24 "," $1,411.20 "," $1,411.20 "," $1,254.40 "," $1,254.40 ", $230.52 ," $1,447.73 "," $1,489.60 "," $1,411.20 "," $1,411.20 "," $1,411.20 "," $1,458.24 "," $1,505.28 "," $1,212.90 "," $1,332.80 "," $1,131.10 "," $1,208.16 ", N/A ," $1,042.66 "," $1,042.66 "," $1,489.60 "," $1,225.50 ", $207.28 ," $1,505.28 "
Complex Repair 1.1-2.5cm,13151,N/A,N/A,N/A," $1,815.00 "," $1,179.75 ", $891.21 , $266.54 , $211.00 , $786.73 , $767.55 ," $1,687.95 "," $1,633.50 "," $1,633.50 "," $1,452.00 "," $1,452.00 ", $211.00 ," $1,675.79 "," $1,724.25 "," $1,633.50 "," $1,633.50 "," $1,633.50 "," $1,687.95 "," $1,742.40 ", $981.32 ," $1,542.75 "," $1,528.94 "," $1,006.77 ", N/A , $802.09 , $802.09 ," $1,724.25 ", $930.16 , $211.00 ," $1,742.40 "
"Open Post Rx Cerv Vert Fx,1 Lvl",CPT® 22326,N/A,N/A,N/A," $9,648.00 "," $6,271.20 "," $8,761.29 "," $1,372.79 "," $1,536.80 "," $7,102.70 "," $6,984.58 "," $8,972.64 "," $8,683.20 "," $8,683.20 "," $7,718.40 "," $7,718.40 "," $1,536.80 "," $8,908.00 "," $9,165.60 "," $8,683.20 "," $8,683.20 "," $8,683.20 "," $8,972.64 "," $9,262.08 "," $8,135.86 "," $8,200.80 "," $7,890.92 "," $8,189.86 ", N/A ," $7,241.29 "," $7,241.29 "," $9,165.60 "," $8,511.08 "," $1,372.79 "," $9,262.08 "
IP/Obs Consltj New/Est Pt High Mdm 80 Minutes,CPT® 99255,N/A,N/A,N/A, $759.00 , $493.35 , N/A , $183.09 , $107.79 , $440.07 , $451.08 , $705.87 , $683.10 , $683.10 , $607.20 , $607.20 , $107.79 , $700.78 , $721.05 , $683.10 , $683.10 , $683.10 , $705.87 , $728.64 , $558.93 , $645.15 , $439.56 , $441.51 , $238.75 , $448.66 , $448.66 , $721.05 , $534.11 , $107.79 , $728.64 
Assay for Collagen Cross Links,CPT® 82523,N/A,N/A,N/A, $254.00 , $165.10 , N/A , $19.05 , $14.46 , $58.95 , $70.55 , $236.22 , $228.60 , $228.60 , $203.20 , $203.20 , $14.46 , $234.52 , $241.30 , $228.60 , $228.60 , $228.60 , $236.22 , $243.84 , $124.73 , $215.90 , $123.26 , $67.76 , N/A , $55.02 , $55.02 , $241.30 , $60.12 , $14.46 , $243.84 
 Fac Assay of Prealbumin ,CPT® 84134,0301 - LAB/CHEMISTRY,N/A,N/A, $135.00 , $87.75 , $113.40 , $14.88 , $7.75 , $109.08 , $121.50 , $114.29 , $121.50 , $121.50 , $121.50 , $114.75 , $7.60 , $124.65 , $128.25 , $114.75 , $125.55 , $125.55 , $128.25 , $129.60 , $110.46 , $121.50 , $114.75 , $106.65 , N/A , $109.26 , $109.26 , $128.25 , $115.84 , $7.60 , $129.60 
Digital Breast Tomosynthesis Unilateral,CPT® 77061,N/A,N/A,N/A," $1,082.00 ", $703.30 , N/A , N/A , $313.95 , $781.28 , $843.93 ," $1,006.26 ", $973.80 , $973.80 , $865.60 , $865.60 , $313.95 , $999.01 ," $1,027.90 ", $973.80 , $973.80 , $973.80 ," $1,006.26 "," $1,038.72 ", N/A , $919.70 , $721.30 , $717.67 , N/A , $796.53 , $796.53 ," $1,027.90 ", $921.99 , $313.95 ," $1,038.72 "
"Inject Diskogram,Lumbar,Ea Level",CPT® 62290,N/A,N/A,N/A," $2,393.00 "," $1,555.45 ", $794.92 , $151.94 , $183.16 , $968.91 , $947.88 ," $2,225.49 "," $2,153.70 "," $2,153.70 "," $1,914.40 "," $1,914.40 ", $183.16 ," $2,209.46 "," $2,273.35 "," $2,153.70 "," $2,153.70 "," $2,153.70 "," $2,225.49 "," $2,297.28 ", $879.36 ," $2,034.05 ", $924.15 ," $1,027.28 ", N/A , $987.81 , $987.81 ," $2,273.35 "," $1,059.71 ", $151.94 ," $2,297.28 "
 Immunofl Study Ea Add Ab Stain Pro ,CPT® 88350,0971 - PRO FEE/LAB,N/A,N/A, $45.00 , $29.25 , $421.28 , $114.53 , $57.02 , $287.31 , $328.28 , $41.85 , $40.50 , $40.50 , $36.00 , $36.00 , $57.02 , $41.55 , $42.75 , $40.50 , $40.50 , $40.50 , $41.85 , $43.20 , $700.71 , $38.25 , $560.53 , $252.47 , N/A , $268.14 , $268.14 , $42.75 , $294.67 , $36.00 , $700.71 
 Fac Iaad Ia Giardia ,CPT® 87329,0306 - LAB/BACT-MICRO,N/A,N/A, $111.00 , $72.15 , $93.24 , $12.22 , $12.22 , $89.69 , $99.90 , $93.97 , $99.90 , $99.90 , $99.90 , $94.35 , $11.98 , $102.49 , $105.45 , $94.35 , $103.23 , $103.23 , $105.45 , $106.56 , $90.82 , $99.90 , $94.35 , $87.69 , N/A , $89.83 , $89.83 , $105.45 , $95.25 , $11.98 , $106.56 
" Fac Hepatitis B, Dna, Quant ",CPT® 87517,0306 - LAB/BACT-MICRO,N/A,N/A, $396.00 , $257.40 , $332.64 , $43.70 , $43.70 , $319.97 , $356.40 , $335.25 , $356.40 , $356.40 , $356.40 , $336.60 , $42.84 , $365.63 , $376.20 , $336.60 , $368.28 , $368.28 , $376.20 , $380.16 , $324.01 , $356.40 , $336.60 , $312.84 , N/A , $320.48 , $320.48 , $376.20 , $339.81 , $42.84 , $380.16 
Iiv4 Vacc Split Virus 0.25 Ml Dos for Im Use,CPT® 90687,N/A,N/A,N/A, $32.00 , $20.80 , N/A , $10.44 , $15.30 , $20.26 , $20.73 , $29.76 , $28.80 , $28.80 , $25.60 , $25.60 , $15.30 , $29.55 , $30.40 , $28.80 , $28.80 , $28.80 , $29.76 , $30.72 , $12.45 , $27.20 , $30.29 , $29.72 , N/A , $20.65 , $20.65 , $30.40 , $24.09 , $10.44 , $30.72 
 Fac Convert Nephrostomy Cath to Nephrourtrl Cath Prq ,CPT® 50434,0361 - OR/MINOR,N/A,N/A," $6,374.00 "," $4,143.10 "," $5,354.16 ", $181.24 , $713.68 ," $5,150.19 "," $5,736.60 "," $5,396.23 "," $5,736.60 "," $5,736.60 "," $5,736.60 "," $5,417.90 ", $699.69 ," $5,885.11 "," $6,055.30 "," $5,417.90 "," $5,927.82 "," $5,927.82 "," $6,055.30 "," $6,119.04 "," $5,215.21 "," $5,736.60 "," $5,417.90 "," $5,035.46 ", N/A ," $5,158.48 "," $5,158.48 "," $6,055.30 "," $5,469.53 ", $181.24 ," $6,119.04 "
 Pfizer First Dose Tris-Sucrose Formulation ,CPT® 0051A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
Apply Short Leg Cast,29425,N/A,N/A,N/A, $636.00 , $413.40 , $330.72 , $52.05 , $72.09 , $277.32 , $277.13 , $591.48 , $572.40 , $572.40 , $508.80 , $508.80 , $72.09 , $587.22 , $604.20 , $572.40 , $572.40 , $572.40 , $591.48 , $610.56 , $311.12 , $540.60 , $301.51 , $326.81 , N/A , $282.72 , $282.72 , $604.20 , $332.30 , $52.05 , $610.56 
"Fix Entropion,Extensive",67924,N/A,N/A,N/A," $5,969.00 "," $3,879.85 "," $2,801.83 ", $440.25 , $614.67 ," $2,594.02 "," $2,397.47 "," $5,551.17 "," $5,372.10 "," $5,372.10 "," $4,775.20 "," $4,775.20 ", $614.67 ," $5,511.18 "," $5,670.55 "," $5,372.10 "," $5,372.10 "," $5,372.10 "," $5,551.17 "," $5,730.24 "," $3,848.52 "," $5,073.65 "," $2,488.77 "," $3,293.77 ", N/A ," $2,644.63 "," $2,644.63 "," $5,670.55 "," $2,919.31 ", $440.25 ," $5,730.24 "
Remove Intrauterine Device,58301,N/A,N/A,N/A, $571.00 , $371.15 , $309.85 , $62.49 , $89.76 , $276.75 , $274.64 , $531.03 , $513.90 , $513.90 , $456.80 , $456.80 , $89.76 , $527.20 , $542.45 , $513.90 , $513.90 , $513.90 , $531.03 , $548.16 , $326.54 , $485.35 , $362.17 , $277.36 , N/A , $282.15 , $282.15 , $542.45 , $338.42 , $62.49 , $548.16 
Njx Aa&/Strd Tfrml Epi Cervical/Thoracic Ea Addl,CPT® 64480,N/A,N/A,N/A, $834.00 , $542.10 , $303.16 , $58.87 , $200.42 , $354.71 , $349.10 , $775.62 , $750.60 , $750.60 , $667.20 , $667.20 , $200.42 , $770.03 , $792.30 , $750.60 , $750.60 , $750.60 , $775.62 , $800.64 , $332.04 , $708.90 , $346.11 , $379.46 , N/A , $361.63 , $361.63 , $792.30 , $387.93 , $58.87 , $800.64 
"Lap,Dx Surgical Abd W/Biopsy",49321,N/A,N/A,N/A," $3,508.00 "," $2,280.20 "," $2,070.64 ", $321.57 , $373.69 ," $1,625.05 "," $1,656.01 "," $3,262.44 "," $3,157.20 "," $3,157.20 "," $2,806.40 "," $2,806.40 ", $373.69 ," $3,238.94 "," $3,332.60 "," $3,157.20 "," $3,157.20 "," $3,157.20 "," $3,262.44 "," $3,367.68 "," $1,484.93 "," $2,981.80 "," $1,839.37 "," $1,929.04 ", N/A ," $1,656.76 "," $1,656.76 "," $3,332.60 "," $1,732.81 ", $321.57 ," $3,367.68 "
 Fac Unsched Dialysis Esrd Pt Hos ,HCPCS G0257,0801 - INPATIENT HEMODIALYSIS,N/A,N/A," $2,240.00 "," $1,456.00 "," $1,881.60 ", N/A , N/A ," $1,809.92 "," $2,016.00 "," $1,896.38 "," $2,016.00 "," $2,016.00 "," $2,016.00 "," $1,904.00 ", N/A ," $2,068.19 "," $2,128.00 "," $1,904.00 "," $2,083.20 "," $2,083.20 "," $2,128.00 "," $2,150.40 "," $1,832.77 "," $2,016.00 "," $1,904.00 "," $1,769.60 ", N/A ," $1,812.83 "," $1,812.83 "," $2,128.00 "," $1,922.14 "," $1,769.60 "," $2,150.40 "
"Puncture Abscesss,Cyst,He",10160,N/A,N/A,N/A, $490.00 , $318.50 , $307.12 , $92.99 , $30.77 , $262.79 , $257.92 , $455.70 , $441.00 , $441.00 , $392.00 , $392.00 , $30.77 , $452.42 , $465.50 , $441.00 , $441.00 , $441.00 , $455.70 , $470.40 , $335.46 , $416.50 , $510.24 , $335.24 , N/A , $267.91 , $267.91 , $465.50 , $310.70 , $30.77 , $510.24 
Smn1 Gene Analysis Dosage/Delet Alys W/Smn2 Alys,CPT® 81329,N/A,N/A,N/A, $633.00 , $411.45 , N/A , $139.74 , $111.79 , $569.57 , N/A , $588.69 , $569.70 , $569.70 , $506.40 , $506.40 , $111.79 , $584.45 , $601.35 , $569.70 , $569.70 , $569.70 , $588.69 , $607.68 , $914.78 , $538.05 , $652.61 , $402.37 , N/A , $531.56 , $531.56 , $601.35 , $580.88 , $111.79 , $914.78 
Injection for Bladder X-Ray,CPT® 51600,N/A,N/A,N/A," $1,292.00 ", $839.80 , $238.51 , $41.68 , $179.05 , $217.99 , $200.92 ," $1,201.56 "," $1,162.80 "," $1,162.80 "," $1,033.60 "," $1,033.60 ", $179.05 ," $1,192.90 "," $1,227.40 "," $1,162.80 "," $1,162.80 "," $1,162.80 "," $1,201.56 "," $1,240.32 ", $239.73 ," $1,098.20 ", $226.58 , $274.27 , N/A , $222.24 , $222.24 ," $1,227.40 ", $261.20 , $41.68 ," $1,240.32 "
 Otitis Media And Uri Without McC ,MS DRG V40 (FY2023) 153,N/A,N/A,N/A," $10,693.50 "," $6,950.78 "," $8,982.54 ", N/A , N/A ," $8,640.35 "," $9,624.15 "," $9,053.12 "," $9,624.15 "," $9,624.15 "," $9,624.15 "," $9,089.48 ", N/A ," $9,873.31 "," $10,158.83 "," $9,089.48 "," $9,944.96 "," $9,944.96 "," $10,158.83 "," $10,265.76 "," $8,749.42 "," $9,624.15 "," $9,089.48 "," $8,447.87 ", N/A ," $8,654.25 "," $8,654.25 "," $10,158.83 "," $9,176.09 "," $8,447.87 "," $10,265.76 "
 Fac Affinity1 Square Cm ,HCPCS Q4159,0636 - DRUGS REQUIRING DETAILED CODIN,N/A,N/A, $837.00 , $544.05 , $703.08 , $428.95 , N/A , $676.30 , $753.30 , $708.60 , $753.30 , $753.30 , $753.30 , $711.45 , N/A , $772.80 , $795.15 , $711.45 , $778.41 , $778.41 , $795.15 , $803.52 , $684.83 , $753.30 , $711.45 , $661.23 , N/A , $677.38 , $677.38 , $795.15 , $718.23 , $428.95 , $803.52 
"US,Pregnant Uterus,Transvaginal",CPT® 76817,N/A,N/A,N/A, $823.00 , $534.95 , $529.77 , $91.81 , $86.65 , $468.25 , $540.46 , $765.39 , $740.70 , $740.70 , $658.40 , $658.40 , $86.65 , $759.88 , $781.85 , $740.70 , $740.70 , $740.70 , $765.39 , $790.08 , $533.38 , $699.55 , $589.37 , $546.42 , N/A , $477.38 , $477.38 , $781.85 , $552.57 , $86.65 , $790.08 
"Closed Rx Weight Bear Dist Tib,Manip",27825,N/A,N/A,N/A," $2,855.00 "," $1,855.75 "," $3,004.63 ", $474.54 , $435.12 ," $2,383.87 "," $2,374.71 "," $2,655.15 "," $2,569.50 "," $2,569.50 "," $2,284.00 "," $2,284.00 ", $435.12 ," $2,636.02 "," $2,712.25 "," $2,569.50 "," $2,569.50 "," $2,569.50 "," $2,655.15 "," $2,740.80 "," $2,791.58 "," $2,426.75 "," $2,619.01 "," $2,820.48 ", N/A ," $2,430.39 "," $2,430.39 "," $2,712.25 "," $2,856.59 ", $435.12 ," $3,004.63 "
 Pro Rmvl FB Musc/Tdn Shth Smpl ,CPT® 20520,0982 - PRO FEE/OUTPT,N/A,N/A," $1,195.00 ", $776.75 , $907.27 , $141.83 , $63.53 , $711.39 , $712.53 ," $1,111.35 "," $1,075.50 "," $1,075.50 ", $956.00 , $956.00 , $63.53 ," $1,103.34 "," $1,135.25 "," $1,075.50 "," $1,075.50 "," $1,075.50 "," $1,111.35 "," $1,147.20 ", $842.13 ," $1,015.75 ", $779.64 , $849.77 , N/A , $725.26 , $725.26 ," $1,135.25 ", $852.44 , $63.53 ," $1,147.20 "
"Discission,2nd Cataract,Laser",CPT® 66821,N/A,N/A,N/A," $1,563.00 "," $1,015.95 "," $1,923.81 ", $302.19 , $262.06 ," $1,757.76 "," $1,658.57 "," $1,453.59 "," $1,406.70 "," $1,406.70 "," $1,250.40 "," $1,250.40 ", $262.06 ," $1,443.12 "," $1,484.85 "," $1,406.70 "," $1,406.70 "," $1,406.70 "," $1,453.59 "," $1,500.48 "," $2,644.27 "," $1,328.55 "," $1,705.57 "," $2,236.74 ", N/A ," $1,792.06 "," $1,792.06 "," $1,484.85 "," $1,978.18 ", $262.06 ," $2,644.27 "
" Pro Treat Finger Fracture, Each ",CPT® 26740,0982 - PRO FEE/OUTPT,N/A,N/A," $1,456.00 ", $946.40 ," $1,375.21 ", $218.73 , $126.34 ," $1,034.45 "," $1,051.56 "," $1,354.08 "," $1,310.40 "," $1,310.40 "," $1,164.80 "," $1,164.80 ", $126.34 ," $1,344.32 "," $1,383.20 "," $1,310.40 "," $1,310.40 "," $1,310.40 "," $1,354.08 "," $1,397.76 "," $1,266.41 "," $1,237.60 "," $1,150.72 "," $1,238.55 ", N/A ," $1,054.63 "," $1,054.63 "," $1,383.20 "," $1,239.57 ", $126.34 ," $1,397.76 "
Hyalgan Supartz Visco-3 Dose,HCPCS J7321,N/A,N/A,N/A, $315.00 , $204.75 , N/A , $74.95 , $80.25 , N/A , N/A , $292.95 , $283.50 , $283.50 , $252.00 , $252.00 , $80.25 , $290.84 , $299.25 , $283.50 , $283.50 , $283.50 , $292.95 , $302.40 , $94.95 , $267.75 , $171.27 , $100.36 , N/A , N/A , N/A , $299.25 , N/A , $74.95 , $302.40 
 BACLOFEN 40 MG/20ML IT SOLN ,HCPCS J0475,0636 - DRUGS REQUIRING DETAILED CODIN,70121-2503-01,20 mL," $5,826.14 "," $3,786.99 "," $4,893.96 ", $186.14 , $189.64 ," $4,707.52 "," $5,243.53 "," $4,932.41 "," $5,243.53 "," $5,243.53 "," $5,243.53 "," $4,952.22 ", $185.92 ," $5,379.28 "," $5,534.83 "," $4,952.22 "," $5,418.31 "," $5,418.31 "," $5,534.83 "," $5,593.09 "," $4,766.95 "," $5,243.53 "," $4,952.22 "," $4,602.65 ", N/A ," $4,715.10 "," $4,715.10 "," $5,534.83 "," $4,999.41 ", $185.92 ," $5,593.09 "
 LANSOPRAZOLE 30 MG PO TBDD ,HCPCS RXC637,0250 - PHARMACY,43598-0561-78,1 tablet, $81.03 , $52.67 , $68.07 , N/A , N/A , $65.47 , $72.93 , $68.60 , $72.93 , $72.93 , $72.93 , $68.88 , N/A , $74.81 , $76.98 , $68.88 , $75.36 , $75.36 , $76.98 , $77.79 , $66.30 , $72.93 , $68.88 , $64.01 , N/A , $65.58 , $65.58 , $76.98 , $69.53 , $64.01 , $77.79 
 Fac Fibrin Dgradj Produxs D-Dimer Qual/Semiquan ,CPT® 85378,0305 - LAB/HEMATOLOGY,N/A,N/A, $131.00 , $85.15 , $110.04 , $9.91 , $9.90 , $105.85 , $117.90 , $110.90 , $117.90 , $117.90 , $117.90 , $111.35 , $9.71 , $120.95 , $124.45 , $111.35 , $121.83 , $121.83 , $124.45 , $125.76 , $107.18 , $117.90 , $111.35 , $103.49 , N/A , $106.02 , $106.02 , $124.45 , $112.41 , $9.71 , $125.76 
 Pro I&D Absc Smpl/1 ,CPT® 10060,0981 - PRO FEE/ER,N/A,N/A, $464.00 , $301.60 , $340.58 , $102.58 , $41.23 , $265.18 , $259.37 , $431.52 , $417.60 , $417.60 , $371.20 , $371.20 , $41.23 , $428.41 , $440.80 , $417.60 , $417.60 , $417.60 , $431.52 , $445.44 , $366.26 , $394.40 , $512.03 , $344.96 , N/A , $270.35 , $270.35 , $440.80 , $313.53 , $41.23 , $512.03 
Simple Repair 12.6-20cm,CPT® 12005,N/A,N/A,N/A, $896.00 , $582.40 , $295.26 , $87.55 , $142.50 , $269.43 , $261.25 , $833.28 , $806.40 , $806.40 , $716.80 , $716.80 , $142.50 , $827.28 , $851.20 , $806.40 , $806.40 , $806.40 , $833.28 , $860.16 , $326.46 , $761.60 , $524.51 , $329.30 , N/A , $274.68 , $274.68 , $851.20 , $318.54 , $87.55 , $860.16 
 ACETYLCHOLINE CHLORIDE 20 MG IO SOLR ,HCPCS RXA250,0250 - PHARMACY,24208-0539-20,2 mL, $748.09 , $486.26 , $628.40 , N/A , N/A , $604.46 , $673.28 , $633.33 , $673.28 , $673.28 , $673.28 , $635.88 , N/A , $690.71 , $710.69 , $635.88 , $695.72 , $695.72 , $710.69 , $718.17 , $612.09 , $673.28 , $635.88 , $590.99 , N/A , $605.43 , $605.43 , $710.69 , $641.94 , $590.99 , $718.17 
Admin Influenza Virus Vac,HCPCS G0008,N/A,N/A,N/A, $38.00 , $24.70 , N/A , N/A , N/A , $46.14 , $59.77 , $35.34 , $34.20 , $34.20 , $30.40 , $30.40 , N/A , $35.09 , $36.10 , $34.20 , $34.20 , $34.20 , $35.34 , $36.48 , N/A , $32.30 , $49.31 , $64.43 , N/A , $47.04 , $47.04 , $36.10 , $58.79 , $30.40 , $64.43 
 Thoracentesis Needle/Cath Pleura W/Imaging ED ,CPT® 32555,0981 - PRO FEE/ER,N/A,N/A," $1,489.00 ", $967.85 , $602.20 , $104.93 , $293.25 , $441.35 , $422.54 ," $1,384.77 "," $1,340.10 "," $1,340.10 "," $1,191.20 "," $1,191.20 ", $293.25 ," $1,374.79 "," $1,414.55 "," $1,340.10 "," $1,340.10 "," $1,340.10 "," $1,384.77 "," $1,429.44 ", $586.09 ," $1,265.65 ", $588.74 , $585.22 , N/A , $449.97 , $449.97 ," $1,414.55 ", $529.94 , $104.93 ," $1,429.44 "
Escharotomy,16035,N/A,N/A,N/A, $986.00 , $640.90 , $609.18 , $183.73 , $53.35 , $532.41 , $521.12 , $916.98 , $887.40 , $887.40 , $788.80 , $788.80 , $53.35 , $910.37 , $936.70 , $887.40 , $887.40 , $887.40 , $916.98 , $946.56 , $673.12 , $838.10 ," $1,047.25 ", $681.87 , N/A , $542.80 , $542.80 , $936.70 , $629.45 , $53.35 ," $1,047.25 "
 Nuc Kidney Flow and Function W/O Rx Mag3- Mh ,CPT® 78707,0974 - PRO FEE/NUC MED,N/A,N/A, $321.00 , $208.65 ," $1,244.91 ", $214.65 , $224.82 ," $1,143.47 "," $1,231.93 ", $298.53 , $288.90 , $288.90 , $256.80 , $256.80 , $224.82 , $296.38 , $304.95 , $288.90 , $288.90 , $288.90 , $298.53 , $308.16 ," $1,281.60 ", $272.85 ," $1,342.45 "," $1,563.45 ", N/A ," $1,165.78 "," $1,165.78 ", $304.95 ," $1,349.42 ", $214.65 ," $1,563.45 "
"Tympanoplasty,Rebld Ossic Chain+Pros",CPT® 69633,N/A,N/A,N/A," $6,182.00 "," $4,018.30 "," $5,066.45 "," $1,025.69 ", $907.99 ," $5,022.74 "," $5,205.09 "," $5,749.26 "," $5,563.80 "," $5,563.80 "," $4,945.60 "," $4,945.60 ", $907.99 ," $5,707.84 "," $5,872.90 "," $5,563.80 "," $5,563.80 "," $5,563.80 "," $5,749.26 "," $5,934.72 "," $5,554.29 "," $5,254.70 "," $5,673.32 "," $5,044.67 ", N/A ," $5,120.74 "," $5,120.74 "," $5,872.90 "," $5,847.00 ", $907.99 ," $5,934.72 "
 Fac Molecular Pathology Procedure Level 1 ,CPT® 81400,0310 - PATHOLOGY LAB,N/A,N/A, $1.00 , $0.65 , $0.84 , $65.24 , $65.24 , $0.81 , $0.90 , $0.85 , $0.90 , $0.90 , $0.90 , $0.85 , $63.96 , $0.92 , $0.95 , $0.85 , $0.93 , $0.93 , $0.95 , $0.96 , $0.82 , $0.90 , $0.85 , $0.79 , N/A , $0.81 , $0.81 , $0.95 , $0.86 , $0.79 , $65.24 
 Rmv Skin Tags Ea Addl ,CPT® 11201,0761 - TREATMENT ROOM,N/A,N/A, $119.00 , $77.35 , $99.96 , $15.71 , $15.36 , $96.15 , $107.10 , $100.75 , $107.10 , $107.10 , $107.10 , $101.15 , $15.06 , $109.87 , $113.05 , $101.15 , $110.67 , $110.67 , $113.05 , $114.24 , $97.37 , $107.10 , $101.15 , $94.01 , N/A , $96.31 , $96.31 , $113.05 , $102.11 , $15.06 , $114.24 
 Fac Antidepressants Tricyclic Other Cyclicals 1 or 2 ,CPT® 80335,0301 - LAB/CHEMISTRY,N/A,N/A, $156.00 , $101.40 , $131.04 , N/A , N/A , $126.05 , $140.40 , $132.07 , $140.40 , $140.40 , $140.40 , $132.60 , N/A , $144.03 , $148.20 , $132.60 , $145.08 , $145.08 , $148.20 , $149.76 , $127.64 , $140.40 , $132.60 , $123.24 , N/A , $126.25 , $126.25 , $148.20 , $133.86 , $123.24 , $149.76 
 TRASTUZUMAB 150 MG IV SOLR ,HCPCS J9355,0636 - DRUGS REQUIRING DETAILED CODIN,50242-0132-01,150 mg," $4,582.24 "," $2,978.46 "," $3,849.08 ", $82.70 , $84.39 ," $3,702.45 "," $4,124.02 "," $3,879.32 "," $4,124.02 "," $4,124.02 "," $4,124.02 "," $3,894.90 ", $82.74 ," $4,230.78 "," $4,353.13 "," $3,894.90 "," $4,261.48 "," $4,261.48 "," $4,353.13 "," $4,398.95 "," $3,749.19 "," $4,124.02 "," $3,894.90 "," $3,619.97 ", N/A ," $3,708.41 "," $3,708.41 "," $4,353.13 "," $3,932.02 ", $82.70 ," $4,398.95 "
"Reimplant Ureter,Duplicated Ureter",CPT® 50782,N/A,N/A,N/A," $7,739.00 "," $5,030.35 "," $5,807.50 "," $1,020.50 "," $1,333.42 "," $5,491.98 "," $5,395.74 "," $7,197.27 "," $6,965.10 "," $6,965.10 "," $6,191.20 "," $6,191.20 "," $1,333.42 "," $7,145.42 "," $7,352.05 "," $6,965.10 "," $6,965.10 "," $6,965.10 "," $7,197.27 "," $7,429.44 "," $5,829.81 "," $6,578.15 "," $6,320.94 "," $6,613.51 ", N/A ," $5,599.13 "," $5,599.13 "," $7,352.05 "," $6,580.96 "," $1,020.50 "," $7,429.44 "
 PHENYLEPHRINE HCL 1 % NA SOLN ,HCPCS RXC637,0250 - PHARMACY,00225-0810-47,15 mL, $22.58 , $14.68 , $18.97 , N/A , N/A , $18.24 , $20.32 , $19.12 , $20.32 , $20.32 , $20.32 , $19.19 , N/A , $20.85 , $21.45 , $19.19 , $21.00 , $21.00 , $21.45 , $21.68 , $18.47 , $20.32 , $19.19 , $17.84 , N/A , $18.27 , $18.27 , $21.45 , $19.38 , $17.84 , $21.68 
 CALCIUM CARBONATE ANTACID 500 MG PO CHEW ,HCPCS RXC637,0250 - PHARMACY,66553-0004-01,1 tablet, $0.42 , $0.27 , $0.35 , N/A , N/A , $0.34 , $0.38 , $0.36 , $0.38 , $0.38 , $0.38 , $0.36 , N/A , $0.39 , $0.40 , $0.36 , $0.39 , $0.39 , $0.40 , $0.40 , $0.34 , $0.38 , $0.36 , $0.33 , N/A , $0.34 , $0.34 , $0.40 , $0.36 , $0.33 , $0.40 
" Fac Hfo Nontorsion Joint, Prefab ",HCPCS L3929,0274 - PROSTHETIC DEV,N/A,N/A, $105.00 , $68.25 , $88.20 , $97.24 , $81.60 , $84.84 , $94.50 , $88.89 , $94.50 , $94.50 , $94.50 , $89.25 , $80.00 , $96.95 , $99.75 , $89.25 , $97.65 , $97.65 , $99.75 , $100.80 , $85.91 , $94.50 , $89.25 , $82.95 , N/A , $84.98 , $84.98 , $99.75 , $90.10 , $80.00 , $100.80 
 Fac Assay of Interleukin-6 (Il-6) ,CPT® 83529,0301 - LAB/CHEMISTRY,N/A,N/A, $111.00 , $72.15 , $93.24 , $17.62 , $17.62 , $89.69 , $99.90 , $93.97 , $99.90 , $99.90 , $99.90 , $94.35 , $17.27 , $102.49 , $105.45 , $94.35 , $103.23 , $103.23 , $105.45 , $106.56 , $90.82 , $99.90 , $94.35 , $87.69 , N/A , $89.83 , $89.83 , $105.45 , $95.25 , $17.27 , $106.56 
"MRI, Lower Extrem",CPT® 73718,N/A,N/A,N/A," $4,920.00 "," $3,198.00 "," $1,613.64 ", $230.21 , $411.48 ," $1,734.14 "," $2,190.09 "," $4,575.60 "," $4,428.00 "," $4,428.00 "," $3,936.00 "," $3,936.00 ", $411.48 ," $4,542.64 "," $4,674.00 "," $4,428.00 "," $4,428.00 "," $4,428.00 "," $4,575.60 "," $4,723.20 "," $1,390.99 "," $4,182.00 "," $2,390.22 "," $2,835.74 ", N/A ," $1,767.98 "," $1,767.98 "," $4,674.00 "," $2,046.46 ", $230.21 ," $4,723.20 "
X-Ray Shoulder 1 Vw,CPT® 73020,N/A,N/A,N/A, $232.00 , $150.80 , $120.18 , $21.17 , $22.57 , $109.13 , $125.76 , $215.76 , $208.80 , $208.80 , $185.60 , $185.60 , $22.57 , $214.21 , $220.40 , $208.80 , $208.80 , $208.80 , $215.76 , $222.72 , $117.82 , $197.20 , $138.68 , $115.33 , N/A , $111.26 , $111.26 , $220.40 , $128.79 , $21.17 , $222.72 
 Pro Biopsy Bone Open Superficial ,CPT® 20240,0982 - PRO FEE/OUTPT,N/A,N/A," $1,469.00 ", $954.85 , $868.34 , $134.08 , $153.67 ," $1,050.49 "," $1,072.56 "," $1,366.17 "," $1,322.10 "," $1,322.10 "," $1,175.20 "," $1,175.20 ", $153.67 ," $1,356.33 "," $1,395.55 "," $1,322.10 "," $1,322.10 "," $1,322.10 "," $1,366.17 "," $1,410.24 ", $815.67 ," $1,248.65 "," $1,177.48 ", $876.05 , N/A ," $1,070.98 "," $1,070.98 "," $1,395.55 "," $1,258.77 ", $134.08 ," $1,410.24 "
 Prothrombin Time Beaker1 ,CPT® 85610,0305 - LAB/HEMATOLOGY,N/A,N/A, $69.00 , $44.85 , $57.96 , $4.38 , $4.38 , $55.75 , $62.10 , $58.42 , $62.10 , $62.10 , $62.10 , $58.65 , $4.29 , $63.71 , $65.55 , $58.65 , $64.17 , $64.17 , $65.55 , $66.24 , $56.46 , $62.10 , $58.65 , $54.51 , N/A , $55.84 , $55.84 , $65.55 , $59.21 , $4.29 , $66.24 
 Pro Diagnostic Mammography Computer-Aided Detcj Uni ,CPT® 77065,0972 - PRO FEE/RAD/DX,N/A,N/A, $191.00 , $124.15 , $713.86 , $123.77 , $105.44 , $614.06 , $683.70 , $177.63 , $171.90 , $171.90 , $152.80 , $152.80 , $105.44 , $176.35 , $181.45 , $171.90 , $171.90 , $171.90 , $177.63 , $183.36 , $711.14 , $162.35 , $721.30 , $731.08 , N/A , $626.04 , $626.04 , $181.45 , $724.65 , $105.44 , $731.08 
"Repair,Inflatable Sphincter Device",CPT® 53449,N/A,N/A,N/A," $4,261.00 "," $2,769.65 "," $3,327.01 ", $586.43 , $502.07 ," $2,989.17 "," $2,790.31 "," $3,962.73 "," $3,834.90 "," $3,834.90 "," $3,408.80 "," $3,408.80 ", $502.07 ," $3,934.18 "," $4,047.95 "," $3,834.90 "," $3,834.90 "," $3,834.90 "," $3,962.73 "," $4,090.56 "," $3,336.86 "," $3,621.85 "," $3,159.58 "," $3,763.13 ", N/A ," $3,047.49 "," $3,047.49 "," $4,047.95 "," $3,581.91 ", $502.07 ," $4,090.56 "
" Pro Treat Finger Fracture, Each ",CPT® 26742,0975 - PRO FEE/OR,N/A,N/A, $764.00 , $496.60 ," $2,083.84 ", $329.17 , $168.45 ," $1,595.87 "," $1,612.46 ", $710.52 , $687.60 , $687.60 , $611.20 , $611.20 , $168.45 , $705.40 , $725.80 , $687.60 , $687.60 , $687.60 , $710.52 , $733.44 ," $1,930.83 ", $649.40 ," $1,771.58 "," $1,911.72 ", N/A ," $1,627.01 "," $1,627.01 ", $725.80 ," $1,912.32 ", $168.45 ," $2,083.84 "
 CLONIDINE HCL 0.2 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60687-0124-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Esophagoscopy Flex Transoral Lesion Ablation,43229,N/A,N/A,N/A," $1,313.00 ", $853.45 ," $1,204.32 ", $186.05 , $156.39 , $990.75 ," $1,027.50 "," $1,221.09 "," $1,181.70 "," $1,181.70 "," $1,050.40 "," $1,050.40 ", $156.39 ," $1,212.29 "," $1,247.35 "," $1,181.70 "," $1,181.70 "," $1,181.70 "," $1,221.09 "," $1,260.48 ", $866.13 ," $1,116.05 "," $1,025.30 "," $1,148.50 ", N/A ," $1,010.08 "," $1,010.08 "," $1,247.35 "," $1,056.44 ", $156.39 ," $1,260.48 "
T Cell Absolute Count/Ratio,CPT® 86360,N/A,N/A,N/A, $321.00 , $208.65 , N/A , $47.92 , $47.92 , $265.83 , $317.99 , $298.53 , $288.90 , $288.90 , $256.80 , $256.80 , $47.92 , $296.38 , $304.95 , $288.90 , $288.90 , $288.90 , $298.53 , $308.16 , $313.70 , $272.85 , $308.15 , $170.38 , N/A , $248.09 , $248.09 , $304.95 , $271.11 , $47.92 , $317.99 
 Pro Duplex Scan Artl Infl&Ven O/F Hemo Compl Bi Std ,CPT® 93985,0982 - PRO FEE/OUTPT,N/A,N/A, $534.00 , $347.10 ," $1,588.47 ", $242.17 , $209.24 ," $1,393.80 ", N/A , $496.62 , $480.60 , $480.60 , $427.20 , $427.20 , $209.24 , $493.04 , $507.30 , $480.60 , $480.60 , $480.60 , $496.62 , $512.64 ," $1,143.39 ", $453.90 , $751.19 , $998.05 , N/A ," $1,420.99 "," $1,420.99 ", $507.30 ," $1,575.93 ", $209.24 ," $1,588.47 "
 Fac Fluorescent Nonnfct Agt Antb Scr Ea Antb ,CPT® 86255,0302 - LAB/IMMUNOLOGY,N/A,N/A, $146.00 , $94.90 , $122.64 , $12.29 , $12.29 , $117.97 , $131.40 , $123.60 , $131.40 , $131.40 , $131.40 , $124.10 , $12.05 , $134.80 , $138.70 , $124.10 , $135.78 , $135.78 , $138.70 , $140.16 , $119.46 , $131.40 , $124.10 , $115.34 , N/A , $118.16 , $118.16 , $138.70 , $125.28 , $12.05 , $140.16 
 DIAZEPAM 10 MG RE GEL ,HCPCS RXC637,0250 - PHARMACY,00187-0658-20,1 each," $2,162.11 "," $1,405.37 "," $1,816.17 ", N/A , N/A ," $1,746.98 "," $1,945.90 "," $1,830.44 "," $1,945.90 "," $1,945.90 "," $1,945.90 "," $1,837.79 ", N/A ," $1,996.28 "," $2,054.00 "," $1,837.79 "," $2,010.76 "," $2,010.76 "," $2,054.00 "," $2,075.63 "," $1,769.04 "," $1,945.90 "," $1,837.79 "," $1,708.07 ", N/A ," $1,749.80 "," $1,749.80 "," $2,054.00 "," $1,855.31 "," $1,708.07 "," $2,075.63 "
 TOPOTECAN HCL 4 MG/4ML IV SOLN ,HCPCS J9351,0636 - DRUGS REQUIRING DETAILED CODIN,00409-0302-01,4 mL, $427.08 , $277.60 , $358.75 , $0.51 , $1.20 , $345.08 , $384.37 , $361.57 , $384.37 , $384.37 , $384.37 , $363.02 , $1.18 , $394.32 , $405.73 , $363.02 , $397.18 , $397.18 , $405.73 , $410.00 , $349.44 , $384.37 , $363.02 , $337.39 , N/A , $345.64 , $345.64 , $405.73 , $366.48 , $0.51 , $410.00 
Dexamethasone Intra Implant,HCPCS J7312,N/A,N/A,N/A, $602.00 , $391.30 , N/A , $208.77 , $203.97 , N/A , N/A , $559.86 , $541.80 , $541.80 , $481.60 , $481.60 , $203.97 , $555.83 , $571.90 , $541.80 , $541.80 , $541.80 , $559.86 , $577.92 , $260.09 , $511.70 , $373.68 , $260.89 , N/A , N/A , N/A , $571.90 , N/A , $203.97 , $577.92 
Insj Stablj Dev W/Dcmprn Lumbar Second Level,CPT® 22868,N/A,N/A,N/A," $2,401.00 "," $1,560.65 "," $1,391.98 ", $217.17 , N/A ," $1,119.62 "," $1,080.58 "," $2,232.93 "," $2,160.90 "," $2,160.90 "," $1,920.80 "," $1,920.80 ", N/A ," $2,216.84 "," $2,280.95 "," $2,160.90 "," $2,160.90 "," $2,160.90 "," $2,232.93 "," $2,304.96 "," $1,307.09 "," $2,040.85 "," $1,290.06 "," $1,319.64 ", N/A ," $1,141.46 "," $1,141.46 "," $2,280.95 "," $1,341.61 ", $217.17 ," $2,304.96 "
Partial Hip Replacement,CPT® 27125,N/A,N/A,N/A," $6,482.00 "," $4,213.30 "," $6,828.51 "," $1,068.50 ", $988.14 ," $5,473.78 "," $5,420.06 "," $6,028.26 "," $5,833.80 "," $5,833.80 "," $5,185.60 "," $5,185.60 ", $988.14 ," $5,984.83 "," $6,157.90 "," $5,833.80 "," $5,833.80 "," $5,833.80 "," $6,028.26 "," $6,222.72 "," $6,364.24 "," $5,509.70 "," $5,998.02 "," $6,437.47 ", N/A ," $5,580.59 "," $5,580.59 "," $6,157.90 "," $6,559.18 ", $988.14 ," $6,828.51 "
X-Ray Skull 4+ Views,CPT® 70260,N/A,N/A,N/A, $658.00 , $427.70 , $254.04 , $44.04 , $45.27 , $214.57 , $251.57 , $611.94 , $592.20 , $592.20 , $526.40 , $526.40 , $45.27 , $607.53 , $625.10 , $592.20 , $592.20 , $592.20 , $611.94 , $631.68 , $247.38 , $559.30 , $273.50 , $230.30 , N/A , $218.75 , $218.75 , $625.10 , $253.21 , $44.04 , $631.68 
Fusion/Graft Intercarpal,CPT® 25825,N/A,N/A,N/A," $5,021.00 "," $3,263.65 "," $4,887.55 ", $765.59 , $922.06 ," $3,646.62 "," $3,644.47 "," $4,669.53 "," $4,518.90 "," $4,518.90 "," $4,016.80 "," $4,016.80 ", $922.06 ," $4,635.89 "," $4,769.95 "," $4,518.90 "," $4,518.90 "," $4,518.90 "," $4,669.53 "," $4,820.16 "," $4,508.07 "," $4,267.85 "," $4,003.44 "," $4,342.65 ", N/A ," $3,717.77 "," $3,717.77 "," $4,769.95 "," $4,369.72 ", $765.59 ," $4,887.55 "
 Fac Colsc Flx W/Ndsc US Xm Rctm Et Al Lmtd&Adj Strux ,CPT® 45391,0360 - OR SERVICES,N/A,N/A," $3,426.00 "," $2,226.90 "," $2,877.84 ", $244.39 , $254.47 ," $2,768.21 "," $3,083.40 "," $2,900.45 "," $3,083.40 "," $3,083.40 "," $3,083.40 "," $2,912.10 ", $249.48 ," $3,163.23 "," $3,254.70 "," $2,912.10 "," $3,186.18 "," $3,186.18 "," $3,254.70 "," $3,288.96 "," $2,803.15 "," $3,083.40 "," $2,912.10 "," $2,706.54 ", N/A ," $2,772.66 "," $2,772.66 "," $3,254.70 "," $2,939.85 ", $244.39 ," $3,288.96 "
"Exc Skin Benig 2.1-3cm Trunk,Arm,Leg",11403,N/A,N/A,N/A, $846.00 , $549.90 , $475.69 , $143.37 , $154.53 , $399.76 , $393.99 , $786.78 , $761.40 , $761.40 , $676.80 , $676.80 , $154.53 , $781.11 , $803.70 , $761.40 , $761.40 , $761.40 , $786.78 , $812.16 , $518.92 , $719.10 , $784.99 , $515.24 , N/A , $407.56 , $407.56 , $803.70 , $472.63 , $143.37 , $812.16 
 DAPSONE 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,70954-0135-10,1 tablet, $12.67 , $8.24 , $10.64 , N/A , N/A , $10.24 , $11.40 , $10.73 , $11.40 , $11.40 , $11.40 , $10.77 , N/A , $11.70 , $12.04 , $10.77 , $11.78 , $11.78 , $12.04 , $12.16 , $10.37 , $11.40 , $10.77 , $10.01 , N/A , $10.25 , $10.25 , $12.04 , $10.87 , $10.01 , $12.16 
 Pro Fetal Non-Stress Test ,CPT® 59025,0982 - PRO FEE/OUTPT,N/A,N/A, $295.00 , $191.75 , $134.01 , $46.00 , $50.89 , $111.46 , $119.70 , $274.35 , $265.50 , $265.50 , $236.00 , $236.00 , $50.89 , $272.37 , $280.25 , $265.50 , $265.50 , $265.50 , $274.35 , $283.20 , $137.25 , $250.75 , $258.69 , $211.43 , N/A , $113.63 , $113.63 , $280.25 , $131.36 , $46.00 , $283.20 
 Laceration Repair Face Simple 7.6-12.5 Cm - Mh ,CPT® 12015,0761 - TREATMENT ROOM,N/A,N/A, $262.00 , $170.30 , $220.08 , $87.01 , $139.20 , $211.70 , $235.80 , $221.81 , $235.80 , $235.80 , $235.80 , $222.70 , $136.47 , $241.90 , $248.90 , $222.70 , $243.66 , $243.66 , $248.90 , $251.52 , $214.37 , $235.80 , $222.70 , $206.98 , N/A , $212.04 , $212.04 , $248.90 , $224.82 , $87.01 , $251.52 
Arthrocentesis-Major Jnt,CPT® 20610,N/A,N/A,N/A, $467.00 , $303.55 , $274.69 , $42.73 , $65.94 , $223.70 , $219.57 , $434.31 , $420.30 , $420.30 , $373.60 , $373.60 , $65.94 , $431.18 , $443.65 , $420.30 , $420.30 , $420.30 , $434.31 , $448.32 , $257.37 , $396.95 , $240.85 , $264.61 , N/A , $228.06 , $228.06 , $443.65 , $268.04 , $42.73 , $448.32 
Catheterize for Urine Spec,HCPCS P9612,N/A,N/A,N/A, $22.00 , $14.30 , N/A , $8.74 , N/A , $3.91 , N/A , $20.46 , $19.80 , $19.80 , $17.60 , $17.60 , N/A , $20.31 , $20.90 , $19.80 , $19.80 , $19.80 , $20.46 , $21.12 , $9.48 , $18.70 , $42.82 , $8.81 , N/A , N/A , N/A , $20.90 , N/A , $3.91 , $42.82 
" Fac Genotype, Dna, Hepatitis C ",CPT® 87902,0300 - LABORATORY,N/A,N/A," $2,376.00 "," $1,544.40 "," $1,995.84 ", $262.60 , $262.60 ," $1,919.81 "," $2,138.40 "," $2,011.52 "," $2,138.40 "," $2,138.40 "," $2,138.40 "," $2,019.60 ", $257.45 ," $2,193.76 "," $2,257.20 "," $2,019.60 "," $2,209.68 "," $2,209.68 "," $2,257.20 "," $2,280.96 "," $1,944.04 "," $2,138.40 "," $2,019.60 "," $1,877.04 ", N/A ," $1,922.90 "," $1,922.90 "," $2,257.20 "," $2,038.85 ", $257.45 ," $2,280.96 "
 Pro Appl Long Leg Splnt Thi Ankle/Toes ,CPT® 29505,0981 - PRO FEE/ER,N/A,N/A, $331.00 , $215.15 , $310.83 , $49.45 , $46.08 , $241.34 , $244.33 , $307.83 , $297.90 , $297.90 , $264.80 , $264.80 , $46.08 , $305.61 , $314.45 , $297.90 , $297.90 , $297.90 , $307.83 , $317.76 , $289.85 , $281.35 , $267.61 , $292.25 , N/A , $246.04 , $246.04 , $314.45 , $289.17 , $46.08 , $317.76 
 Pro Inject Epidural Patch ,CPT® 62273,0960 - PRO FEE,N/A,N/A," $1,782.00 "," $1,158.30 ", $559.10 , $108.56 , $122.93 , $643.03 , $619.00 ," $1,657.26 "," $1,603.80 "," $1,603.80 "," $1,425.60 "," $1,425.60 ", $122.93 ," $1,645.32 "," $1,692.90 "," $1,603.80 "," $1,603.80 "," $1,603.80 "," $1,657.26 "," $1,710.72 ", $604.41 ," $1,514.70 ", $603.01 , $686.89 , N/A , $655.58 , $655.58 ," $1,692.90 ", $703.28 , $108.56 ," $1,710.72 "
 Pro Remove Foreign Body From Eye ,CPT® 65220,0981 - PRO FEE/ER,N/A,N/A, $339.00 , $220.35 , $250.45 , $39.41 , $47.02 , $236.97 , $219.45 , $315.27 , $305.10 , $305.10 , $271.20 , $271.20 , $47.02 , $313.00 , $322.05 , $305.10 , $305.10 , $305.10 , $315.27 , $325.44 , $347.54 , $288.15 , $226.58 , $300.51 , N/A , $241.60 , $241.60 , $322.05 , $266.70 , $39.41 , $347.54 
Removal of Ovary/Tube(S),CPT® 58720,N/A,N/A,N/A," $4,820.00 "," $3,133.00 "," $3,567.20 ", $722.32 , $648.95 ," $2,976.52 "," $2,936.91 "," $4,482.60 "," $4,338.00 "," $4,338.00 "," $3,856.00 "," $3,856.00 ", $648.95 ," $4,450.31 "," $4,579.00 "," $4,338.00 "," $4,338.00 "," $4,338.00 "," $4,482.60 "," $4,627.20 "," $3,704.36 "," $4,097.00 "," $3,869.64 "," $2,987.91 ", N/A ," $3,034.61 "," $3,034.61 "," $4,579.00 "," $3,639.81 ", $648.95 ," $4,627.20 "
 PT Wheelchair Mgt/Training ,CPT® 97542,0420 - PHYSICAL THERAPY,N/A,N/A, $163.00 , $105.95 , $136.92 , $31.80 , $19.32 , $131.70 , $146.70 , $138.00 , $146.70 , $146.70 , $146.70 , $138.55 , $18.94 , $150.50 , $154.85 , $138.55 , $151.59 , $151.59 , $154.85 , $156.48 , $133.37 , $146.70 , $138.55 , $128.77 , N/A , $131.92 , $131.92 , $154.85 , $139.87 , $18.94 , $156.48 
 Fac Mchnl Rmvl Pricath Obstr Cv Dev via Ven Access ,CPT® 36595,0360 - OR SERVICES,N/A,N/A," $3,934.00 "," $2,557.10 "," $3,304.56 ", $170.68 , $851.72 ," $3,178.67 "," $3,540.60 "," $3,330.52 "," $3,540.60 "," $3,540.60 "," $3,540.60 "," $3,343.90 ", $835.02 ," $3,632.26 "," $3,737.30 "," $3,343.90 "," $3,658.62 "," $3,658.62 "," $3,737.30 "," $3,776.64 "," $3,218.80 "," $3,540.60 "," $3,343.90 "," $3,107.86 ", N/A ," $3,183.79 "," $3,183.79 "," $3,737.30 "," $3,375.77 ", $170.68 ," $3,776.64 "
Antibody-Chlamydia,CPT® 86631,N/A,N/A,N/A, $99.00 , $64.35 , N/A , $12.06 , $8.07 , $32.88 , $39.34 , $92.07 , $89.10 , $89.10 , $79.20 , $79.20 , $8.07 , $91.41 , $94.05 , $89.10 , $89.10 , $89.10 , $92.07 , $95.04 , $78.92 , $84.15 , $77.85 , $42.88 , N/A , $30.69 , $30.69 , $94.05 , $33.54 , $8.07 , $95.04 
Assay of Interleukin-6 (Il-6),CPT® 83529,N/A,N/A,N/A, $149.00 , $96.85 , N/A , $17.62 , $17.62 , N/A , N/A , $138.57 , $134.10 , $134.10 , $119.20 , $119.20 , $17.62 , $137.57 , $141.55 , $134.10 , $134.10 , $134.10 , $138.57 , $143.04 , N/A , $126.65 , $82.38 , $50.72 , N/A , $67.70 , $67.70 , $141.55 , $74.43 , $17.62 , $143.04 
Imm Admn Sarscov2 Ad26 5x1010vp/0.5 Ml 1 Dose,CPT® 0031A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $76.25 , $128.02 , N/A , $79.82 , $79.82 , $66.50 , $92.91 , $38.92 , $128.02 
 Fac Evasc Rpr Dplmnt Aorto-Aortic Ndgft ,CPT® 34701,0360 - OR SERVICES,N/A,N/A," $1,916.00 "," $1,245.40 "," $1,609.44 "," $1,104.37 ", $934.31 ," $1,548.13 "," $1,724.40 "," $1,622.09 "," $1,724.40 "," $1,724.40 "," $1,724.40 "," $1,628.60 ", $915.99 ," $1,769.04 "," $1,820.20 "," $1,628.60 "," $1,781.88 "," $1,781.88 "," $1,820.20 "," $1,839.36 "," $1,567.67 "," $1,724.40 "," $1,628.60 "," $1,513.64 ", N/A ," $1,550.62 "," $1,550.62 "," $1,820.20 "," $1,644.12 ", $915.99 ," $1,839.36 "
Complex Repair 2.6-7.5cm,CPT® 13101,N/A,N/A,N/A," $1,529.00 ", $993.85 , $797.06 , $238.06 , $175.19 , $693.43 , $680.66 ," $1,421.97 "," $1,376.10 "," $1,376.10 "," $1,223.20 "," $1,223.20 ", $175.19 ," $1,411.73 "," $1,452.55 "," $1,376.10 "," $1,376.10 "," $1,376.10 "," $1,421.97 "," $1,467.84 ", $882.35 ," $1,299.65 "," $1,355.89 ", $890.04 , N/A , $706.96 , $706.96 ," $1,452.55 ", $819.84 , $175.19 ," $1,467.84 "
"Ligmt Revision,Knee,Intra-Artic",CPT® 27428,N/A,N/A,N/A," $7,329.00 "," $4,763.85 "," $6,762.41 "," $1,059.46 "," $1,106.50 "," $5,375.05 "," $5,335.54 "," $6,815.97 "," $6,596.10 "," $6,596.10 "," $5,863.20 "," $5,863.20 "," $1,106.50 "," $6,766.87 "," $6,962.55 "," $6,596.10 "," $6,596.10 "," $6,596.10 "," $6,815.97 "," $7,035.84 "," $6,289.94 "," $6,229.65 "," $5,899.90 "," $6,339.45 ", N/A ," $5,479.93 "," $5,479.93 "," $6,962.55 "," $6,440.89 "," $1,059.46 "," $7,035.84 "
Gel-One,HCPCS J7326,N/A,N/A,N/A," $1,678.00 "," $1,090.70 ", N/A , $527.06 , $532.92 , N/A , N/A ," $1,560.54 "," $1,510.20 "," $1,510.20 "," $1,342.40 "," $1,342.40 ", $532.92 ," $1,549.30 "," $1,594.10 "," $1,510.20 "," $1,510.20 "," $1,510.20 "," $1,560.54 "," $1,610.88 ", N/A ," $1,426.30 "," $1,156.72 ", $641.87 , N/A , N/A , N/A ," $1,594.10 ", N/A , $527.06 ," $1,610.88 "
Integra Drt or Omnigraft,HCPCS Q4105,N/A,N/A,N/A, $82.00 , $53.30 , N/A , $26.54 , N/A , N/A , N/A , $76.26 , $73.80 , $73.80 , $65.60 , $65.60 , N/A , $75.71 , $77.90 , $73.80 , $73.80 , $73.80 , $76.26 , $78.72 , N/A , $69.70 , $25.95 , $77.65 , N/A , N/A , N/A , $77.90 , N/A , $25.95 , $78.72 
 Pelvis Min 3 View ,CPT® 72190,0320 - DX X-RAY,N/A,N/A, $395.00 , $256.75 , $331.80 , $41.70 , $38.00 , $319.16 , $355.50 , $334.41 , $355.50 , $355.50 , $355.50 , $335.75 , $37.25 , $364.70 , $375.25 , $335.75 , $367.35 , $367.35 , $375.25 , $379.20 , $323.19 , $355.50 , $335.75 , $312.05 , N/A , $319.67 , $319.67 , $375.25 , $338.95 , $37.25 , $379.20 
Urine Flow Measurement,CPT® 51736,N/A,N/A,N/A, $149.00 , $96.85 , $72.51 , $12.98 , $46.19 , $74.97 , $70.28 , $138.57 , $134.10 , $134.10 , $119.20 , $119.20 , $46.19 , $137.57 , $141.55 , $134.10 , $134.10 , $134.10 , $138.57 , $143.04 , $72.86 , $126.65 , $80.28 , $93.74 , N/A , $76.44 , $76.44 , $141.55 , $89.86 , $12.98 , $143.04 
X-Ray Thoracic Spine 2 Vw,CPT® 72070,N/A,N/A,N/A, $307.00 , $199.55 , $185.02 , $32.42 , $32.08 , $148.61 , $178.84 , $285.51 , $276.30 , $276.30 , $245.60 , $245.60 , $32.08 , $283.45 , $291.65 , $276.30 , $276.30 , $276.30 , $285.51 , $294.72 , $178.67 , $260.95 , $196.46 , $171.36 , N/A , $151.51 , $151.51 , $291.65 , $175.38 , $32.08 , $294.72 
 Clavicle ,CPT® 73000,0320 - DX X-RAY,N/A,N/A, $282.00 , $183.30 , $236.88 , $31.69 , $26.56 , $227.86 , $253.80 , $238.74 , $253.80 , $253.80 , $253.80 , $239.70 , $26.04 , $260.37 , $267.90 , $239.70 , $262.26 , $262.26 , $267.90 , $270.72 , $230.73 , $253.80 , $239.70 , $222.78 , N/A , $228.22 , $228.22 , $267.90 , $241.98 , $26.04 , $270.72 
Repair Vagina/Perineum,CPT® 57210,N/A,N/A,N/A," $2,244.00 "," $1,458.60 "," $1,875.05 ", $378.32 , $508.11 ," $1,498.78 "," $1,492.71 "," $2,086.92 "," $2,019.60 "," $2,019.60 "," $1,795.20 "," $1,795.20 ", $508.11 ," $2,071.89 "," $2,131.80 "," $2,019.60 "," $2,019.60 "," $2,019.60 "," $2,086.92 "," $2,154.24 "," $1,938.19 "," $1,907.40 "," $1,955.33 "," $1,505.27 ", N/A ," $1,528.03 "," $1,528.03 "," $2,131.80 "," $1,832.79 ", $378.32 ," $2,154.24 "
 Pro Excison Tumor Soft Tissue Thigh/Knee Subq 3+Cm ,CPT® 27337,0982 - PRO FEE/OUTPT,N/A,N/A," $4,431.00 "," $2,880.15 "," $2,530.97 ", $395.05 , $343.72 ," $2,002.26 "," $2,013.12 "," $4,120.83 "," $3,987.90 "," $3,987.90 "," $3,544.80 "," $3,544.80 ", $343.72 ," $4,091.14 "," $4,209.45 "," $3,987.90 "," $3,987.90 "," $3,987.90 "," $4,120.83 "," $4,253.76 "," $2,344.15 "," $3,766.35 "," $2,228.30 "," $2,359.43 ", N/A ," $2,041.33 "," $2,041.33 "," $4,209.45 "," $2,399.29 ", $343.72 ," $4,253.76 "
 Pro US Breast Uni Real Time With Image Limited ,CPT® 76642,0972 - PRO FEE/RAD/DX,N/A,N/A, $229.00 , $148.85 , $481.69 , $84.14 , $69.75 , $423.05 , $463.07 , $212.97 , $206.10 , $206.10 , $183.20 , $183.20 , $69.75 , $211.44 , $217.55 , $206.10 , $206.10 , $206.10 , $212.97 , $219.84 , $485.48 , $194.65 , $491.10 , $495.72 , N/A , $431.31 , $431.31 , $217.55 , $499.25 , $69.75 , $499.25 
"Exc Skin Benig 1.1-2cm Trunk,Arm,Leg",CPT® 11402,N/A,N/A,N/A, $661.00 , $429.65 , $371.55 , $111.62 , $134.16 , $310.37 , $305.45 , $614.73 , $594.90 , $594.90 , $528.80 , $528.80 , $134.16 , $610.30 , $627.95 , $594.90 , $594.90 , $594.90 , $614.73 , $634.56 , $405.71 , $561.85 , $608.37 , $400.75 , N/A , $316.43 , $316.43 , $627.95 , $366.95 , $111.62 , $634.56 
Treat Phalangeal Fracture,26750,N/A,N/A,N/A," $1,206.00 ", $783.90 ," $1,175.53 ", $187.84 , $59.10 , $887.15 , $909.28 ," $1,121.58 "," $1,085.40 "," $1,085.40 ", $964.80 , $964.80 , $59.10 ," $1,113.50 "," $1,145.70 "," $1,085.40 "," $1,085.40 "," $1,085.40 "," $1,121.58 "," $1,157.76 "," $1,079.00 "," $1,025.10 ", $995.51 ," $1,062.31 ", N/A , $904.46 , $904.46 ," $1,145.70 "," $1,063.07 ", $59.10 ," $1,175.53 "
 Pro Implant Neuroelectrodes ,CPT® 63650,0982 - PRO FEE/OUTPT,N/A,N/A," $8,360.00 "," $5,434.00 "," $2,045.78 ", $397.89 , $366.89 ," $2,322.82 "," $2,361.96 "," $7,774.80 "," $7,524.00 "," $7,524.00 "," $6,688.00 "," $6,688.00 ", $366.89 ," $7,718.79 "," $7,942.00 "," $7,524.00 "," $7,524.00 "," $7,524.00 "," $7,774.80 "," $8,025.60 "," $2,220.52 "," $7,106.00 "," $2,301.44 "," $2,487.64 ", N/A ," $2,368.14 "," $2,368.14 "," $7,942.00 "," $2,540.46 ", $366.89 ," $8,025.60 "
"Odontoid Fx,W/O Graft,Open",CPT® 22318,N/A,N/A,N/A," $10,521.00 "," $6,838.65 "," $9,450.09 "," $1,482.72 "," $2,212.34 "," $7,741.41 "," $7,612.08 "," $9,784.53 "," $9,468.90 "," $9,468.90 "," $8,416.80 "," $8,416.80 "," $2,212.34 "," $9,714.04 "," $9,994.95 "," $9,468.90 "," $9,468.90 "," $9,468.90 "," $9,784.53 "," $10,100.16 "," $8,776.42 "," $8,942.85 "," $8,661.63 "," $8,867.80 ", N/A ," $7,892.46 "," $7,892.46 "," $9,994.95 "," $9,276.44 "," $1,482.72 "," $10,100.16 "
Atria Abltj &Rcnstj W Other Px Extensive W/O Byp,CPT® 33258,N/A,N/A,N/A," $6,183.00 "," $4,018.95 "," $3,817.26 ", $591.67 , $496.75 ," $2,807.51 "," $2,804.14 "," $5,750.19 "," $5,564.70 "," $5,564.70 "," $4,946.40 "," $4,946.40 ", $496.75 ," $5,708.76 "," $5,873.85 "," $5,564.70 "," $5,564.70 "," $5,564.70 "," $5,750.19 "," $5,935.68 "," $3,530.95 "," $5,255.55 "," $3,539.58 "," $3,156.72 ", N/A ," $2,862.30 "," $2,862.30 "," $5,873.85 "," $3,251.57 ", $496.75 ," $5,935.68 "
 Pro Removal of Finger Lesion ,CPT® 26210,0982 - PRO FEE/OUTPT,N/A,N/A," $3,002.00 "," $1,951.30 "," $2,756.59 ", $435.10 , $384.19 ," $2,127.80 "," $2,131.42 "," $2,791.86 "," $2,701.80 "," $2,701.80 "," $2,401.60 "," $2,401.60 ", $384.19 ," $2,771.75 "," $2,851.90 "," $2,701.80 "," $2,701.80 "," $2,701.80 "," $2,791.86 "," $2,881.92 "," $2,555.66 "," $2,551.70 "," $2,340.69 "," $2,530.43 ", N/A ," $2,169.32 "," $2,169.32 "," $2,851.90 "," $2,549.73 ", $384.19 ," $2,881.92 "
" Pro PR Program Eval Implant Device,Cardvert/Defib,Mult Lead ",CPT® 93284,0982 - PRO FEE/OUTPT,N/A,N/A," $1,252.00 ", $813.80 , $689.20 , $105.48 , $55.43 , $487.60 , $495.15 ," $1,164.36 "," $1,126.80 "," $1,126.80 "," $1,001.60 "," $1,001.60 ", $55.43 ," $1,155.97 "," $1,189.40 "," $1,126.80 "," $1,126.80 "," $1,126.80 "," $1,164.36 "," $1,201.92 ", $652.28 ," $1,064.20 ", $460.29 , $323.57 , N/A , $497.12 , $497.12 ," $1,189.40 ", $551.05 , $55.43 ," $1,201.92 "
" Pro FB Removal,Conreal Without Slit Lamp ",CPT® 65220,0982 - PRO FEE/OUTPT,N/A,N/A, $537.00 , $349.05 , $250.45 , $39.41 , $47.02 , $236.97 , $219.45 , $499.41 , $483.30 , $483.30 , $429.60 , $429.60 , $47.02 , $495.81 , $510.15 , $483.30 , $483.30 , $483.30 , $499.41 , $515.52 , $347.54 , $456.45 , $226.58 , $300.51 , N/A , $241.60 , $241.60 , $510.15 , $266.70 , $39.41 , $515.52 
 Fac Level 2 Delivery ,Custom 150324,0720 - DELIVROOM/LABOR,N/A,N/A," $4,374.00 "," $2,843.10 "," $3,674.16 ", N/A , N/A ," $3,534.19 "," $3,936.60 "," $3,703.03 "," $3,936.60 "," $3,936.60 "," $3,936.60 "," $3,717.90 ", N/A ," $4,038.51 "," $4,155.30 "," $3,717.90 "," $4,067.82 "," $4,067.82 "," $4,155.30 "," $4,199.04 "," $3,578.81 "," $3,936.60 "," $3,717.90 "," $3,455.46 ", N/A ," $3,539.88 "," $3,539.88 "," $4,155.30 "," $3,753.33 "," $3,455.46 "," $4,199.04 "
 Pro MR Breast W/WO Contrast Bilateral ,CPT® 77049,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,309.00 ", $850.85 ," $2,059.46 ", $353.78 , $320.77 ," $1,797.77 ", N/A ," $1,217.37 "," $1,178.10 "," $1,178.10 "," $1,047.20 "," $1,047.20 ", $320.77 ," $1,208.60 "," $1,243.55 "," $1,178.10 "," $1,178.10 "," $1,178.10 "," $1,217.37 "," $1,256.64 "," $2,145.79 "," $1,112.65 "," $2,064.15 "," $5,151.59 ", N/A ," $1,832.84 "," $1,832.84 "," $1,243.55 "," $2,121.56 ", $320.77 ," $5,151.59 "
Repair Complex Addt,CPT® 13153,N/A,N/A,N/A," $1,423.00 ", $924.95 , $433.74 , $129.18 , $143.36 , $387.36 , $372.44 ," $1,323.39 "," $1,280.70 "," $1,280.70 "," $1,138.40 "," $1,138.40 ", $143.36 ," $1,313.86 "," $1,351.85 "," $1,280.70 "," $1,280.70 "," $1,280.70 "," $1,323.39 "," $1,366.08 ", $478.39 ," $1,209.55 ", $745.74 , $493.49 , N/A , $394.92 , $394.92 ," $1,351.85 ", $457.97 , $129.18 ," $1,366.08 "
Shav Skin Les <5mm Remaindr Body,CPT® 11305,N/A,N/A,N/A, $411.00 , $267.15 , $123.52 , $36.29 , $46.39 , $107.98 , $103.20 , $382.23 , $369.90 , $369.90 , $328.80 , $328.80 , $46.39 , $379.48 , $390.45 , $369.90 , $369.90 , $369.90 , $382.23 , $394.56 , $135.45 , $349.35 , $201.60 , $138.82 , N/A , $110.08 , $110.08 , $390.45 , $127.66 , $36.29 , $394.56 
 Critical Care First 30-74 Min -Mh ,CPT® 99291,0450 - EMERGENCY SERVICES,N/A,N/A," $12,373.00 "," $8,042.45 "," $10,393.32 ", $205.74 , $270.56 ," $9,997.38 "," $11,135.70 "," $10,474.98 "," $11,135.70 "," $11,135.70 "," $11,135.70 "," $10,517.05 ", $265.25 ," $11,423.99 "," $11,754.35 "," $10,517.05 "," $11,506.89 "," $11,506.89 "," $11,754.35 "," $11,878.08 "," $10,123.59 "," $11,135.70 "," $10,517.05 "," $9,774.67 ", N/A ," $10,013.47 "," $10,013.47 "," $11,754.35 "," $10,617.27 ", $205.74 ," $11,878.08 "
 Fac RBC Leukocytes Reduced ,HCPCS P9016,0390 - BLOOD/STOR-PROC,N/A,N/A, $446.00 , $289.90 , $374.64 , N/A , $458.48 , $360.37 , $401.40 , $377.58 , $401.40 , $401.40 , $401.40 , $379.10 , $449.49 , $411.79 , $423.70 , $379.10 , $414.78 , $414.78 , $423.70 , $428.16 , $364.92 , $401.40 , $379.10 , $352.34 , N/A , $360.95 , $360.95 , $423.70 , $382.71 , $352.34 , $458.48 
Remov/Foreign Body/Ear,67938,N/A,N/A,N/A," $1,052.00 ", $683.80 , $725.34 , $114.79 , $66.00 , $652.93 , $615.59 , $978.36 , $946.80 , $946.80 , $841.60 , $841.60 , $66.00 , $971.31 , $999.40 , $946.80 , $946.80 , $946.80 , $978.36 ," $1,009.92 ", $992.25 , $894.20 , $635.13 , $841.40 , N/A , $665.67 , $665.67 , $999.40 , $734.83 , $66.00 ," $1,009.92 "
Multifocal Electroretinography W/I&R,CPT® 92274,N/A,N/A,N/A, $418.00 , $271.70 , $188.78 , $87.63 , $72.46 , $148.11 , N/A , $388.74 , $376.20 , $376.20 , $334.40 , $334.40 , $72.46 , $385.94 , $397.10 , $376.20 , $376.20 , $376.20 , $388.74 , $401.28 , $272.60 , $355.30 , $267.56 , $190.43 , N/A , $151.01 , $151.01 , $397.10 , $179.63 , $72.46 , $401.28 
 Fac Glycoprotein Antibody ,CPT® 86146,0302 - LAB/IMMUNOLOGY,N/A,N/A, $261.00 , $169.65 , $219.24 , $25.96 , $8.07 , $210.89 , $234.90 , $220.96 , $234.90 , $234.90 , $234.90 , $221.85 , $7.91 , $240.98 , $247.95 , $221.85 , $242.73 , $242.73 , $247.95 , $250.56 , $213.55 , $234.90 , $221.85 , $206.19 , N/A , $211.23 , $211.23 , $247.95 , $223.96 , $7.91 , $250.56 
Dimethyl Sulfoxide 50% 50 Ml,HCPCS J1212,N/A,N/A,N/A, $962.00 , $625.30 , N/A , $696.17 , $651.47 , N/A , N/A , $894.66 , $865.80 , $865.80 , $769.60 , $769.60 , $651.47 , $888.21 , $913.90 , $865.80 , $865.80 , $865.80 , $894.66 , $923.52 , $828.27 , $817.70 , $164.13 , $830.05 , N/A , N/A , N/A , $913.90 , N/A , $164.13 , $923.52 
 Fac Esophagoscopy Intra/Transmural Needle Aspirat/Bx ,CPT® 43232,0360 - OR SERVICES,N/A,N/A," $2,690.00 "," $1,748.50 "," $2,259.60 ", $187.98 , $494.52 ," $2,173.52 "," $2,421.00 "," $2,277.35 "," $2,421.00 "," $2,421.00 "," $2,421.00 "," $2,286.50 ", $484.82 ," $2,483.68 "," $2,555.50 "," $2,286.50 "," $2,501.70 "," $2,501.70 "," $2,555.50 "," $2,582.40 "," $2,200.96 "," $2,421.00 "," $2,286.50 "," $2,125.10 ", N/A ," $2,177.02 "," $2,177.02 "," $2,555.50 "," $2,308.29 ", $187.98 ," $2,582.40 "
 Pro Colonoscopy Stoma Dx Including Collj Spec Spx ,CPT® 44388,0982 - PRO FEE/OUTPT,N/A,N/A," $2,729.00 "," $1,773.85 "," $2,013.64 ", $146.74 , $272.24 , $791.86 , $808.81 ," $2,537.97 "," $2,456.10 "," $2,456.10 "," $2,183.20 "," $2,183.20 ", $272.24 ," $2,519.69 "," $2,592.55 "," $2,456.10 "," $2,456.10 "," $2,456.10 "," $2,537.97 "," $2,619.84 ", $681.67 ," $2,319.65 ", $888.46 , $902.79 , N/A , $807.31 , $807.31 ," $2,592.55 ", $844.36 , $146.74 ," $2,619.84 "
"Cath, Vein Umbilical Newborn",CPT® 36510,N/A,N/A,N/A, $657.00 , $427.05 , $335.27 , $51.68 , $150.54 , $251.47 , $253.54 , $611.01 , $591.30 , $591.30 , $525.60 , $525.60 , $150.54 , $606.61 , $624.15 , $591.30 , $591.30 , $591.30 , $611.01 , $630.72 , $307.81 , $558.45 , $319.35 , $272.58 , N/A , $256.38 , $256.38 , $624.15 , $291.24 , $51.68 , $630.72 
Part Removal Colon W Coloproctostomy,CPT® 44145,N/A,N/A,N/A," $10,868.00 "," $7,064.20 "," $9,851.79 "," $1,526.49 "," $1,383.11 "," $7,828.74 "," $7,881.46 "," $10,107.24 "," $9,781.20 "," $9,781.20 "," $8,694.40 "," $8,694.40 "," $1,383.11 "," $10,034.42 "," $10,324.60 "," $9,781.20 "," $9,781.20 "," $9,781.20 "," $10,107.24 "," $10,433.28 "," $7,066.35 "," $9,237.80 "," $8,752.62 "," $9,242.35 ", N/A ," $7,981.50 "," $7,981.50 "," $10,324.60 "," $8,347.80 "," $1,383.11 "," $10,433.28 "
CT Scan Lumbar Sp Contrast,CPT® 72132,N/A,N/A,N/A," $3,938.00 "," $2,559.70 "," $1,202.67 ", $172.75 , $302.34 ," $1,089.02 "," $1,385.53 "," $3,662.34 "," $3,544.20 "," $3,544.20 "," $3,150.40 "," $3,150.40 ", $302.34 ," $3,635.96 "," $3,741.10 "," $3,544.20 "," $3,544.20 "," $3,544.20 "," $3,662.34 "," $3,780.48 "," $1,012.21 "," $3,347.30 "," $1,508.09 "," $1,478.94 ", N/A ," $1,110.26 "," $1,110.26 "," $3,741.10 "," $1,285.14 ", $172.75 ," $3,780.48 "
 METHACHOLINE 25 MG/ML SYRINGE FOR INHALATION ,HCPCS RXA250,0250 - PHARMACY,N/A,N/A, $72.13 , $46.88 , $60.59 , N/A , N/A , $58.28 , $64.92 , $61.07 , $64.92 , $64.92 , $64.92 , $61.31 , N/A , $66.60 , $68.52 , $61.31 , $67.08 , $67.08 , $68.52 , $69.24 , $59.02 , $64.92 , $61.31 , $56.98 , N/A , $58.37 , $58.37 , $68.52 , $61.89 , $56.98 , $69.24 
Afo Plastic Molded W/Ankle J,HCPCS L1970,N/A,N/A,N/A," $1,157.00 ", $752.05 , N/A , $809.61 , $376.44 , N/A , N/A ," $1,076.01 "," $1,041.30 "," $1,041.30 ", $925.60 , $925.60 , $376.44 ," $1,068.26 "," $1,099.15 "," $1,041.30 "," $1,041.30 "," $1,041.30 "," $1,076.01 "," $1,110.72 ", N/A , $983.45 , $718.82 , $681.16 , N/A , N/A , N/A ," $1,099.15 ", N/A , $376.44 ," $1,110.72 "
 Pro Shvg Skn Les 1 Les T/a/L Diam 0.6-1.0 Cm ,CPT® 11301,0982 - PRO FEE/OUTPT,N/A,N/A, $468.00 , $304.20 , $164.46 , $49.27 , $62.13 , $146.28 , $142.05 , $435.24 , $421.20 , $421.20 , $374.40 , $374.40 , $62.13 , $432.10 , $444.60 , $421.20 , $421.20 , $421.20 , $435.24 , $449.28 , $181.38 , $397.80 , $281.88 , $187.83 , N/A , $149.14 , $149.14 , $444.60 , $172.94 , $49.27 , $449.28 
 Fac Assay of Free Thyroxine ,CPT® 84439,0301 - LAB/CHEMISTRY,N/A,N/A, $106.00 , $68.90 , $89.04 , $9.20 , $9.20 , $85.65 , $95.40 , $89.74 , $95.40 , $95.40 , $95.40 , $90.10 , $9.02 , $97.87 , $100.70 , $90.10 , $98.58 , $98.58 , $100.70 , $101.76 , $86.73 , $95.40 , $90.10 , $83.74 , N/A , $85.79 , $85.79 , $100.70 , $90.96 , $9.02 , $101.76 
 Pro Debride Skin/Tissue ,CPT® 11042,0981 - PRO FEE/ER,N/A,N/A, $502.00 , $326.30 , $192.85 , $57.23 , $63.58 , $169.46 , $164.75 , $466.86 , $451.80 , $451.80 , $401.60 , $401.60 , $63.58 , $463.50 , $476.90 , $451.80 , $451.80 , $451.80 , $466.86 , $481.92 , $211.84 , $426.70 , $326.48 , $218.43 , N/A , $172.76 , $172.76 , $476.90 , $200.35 , $57.23 , $481.92 
 CETUXIMAB 200 MG/100ML IV SOLN ,HCPCS J9055,0636 - DRUGS REQUIRING DETAILED CODIN,66733-0958-23,100 mL," $4,500.89 "," $2,925.58 "," $3,780.75 ", $73.52 , $71.76 ," $3,636.72 "," $4,050.80 "," $3,810.45 "," $4,050.80 "," $4,050.80 "," $4,050.80 "," $3,825.76 ", $70.35 ," $4,155.67 "," $4,275.85 "," $3,825.76 "," $4,185.83 "," $4,185.83 "," $4,275.85 "," $4,320.85 "," $3,682.63 "," $4,050.80 "," $3,825.76 "," $3,555.70 ", N/A ," $3,642.57 "," $3,642.57 "," $4,275.85 "," $3,862.21 ", $70.35 ," $4,320.85 "
"Blood Smear,MD Report",CPT® 85060,N/A,N/A,N/A, $135.00 , $87.75 , $85.66 , $23.22 , $21.94 , $101.35 , $115.11 , $125.55 , $121.50 , $121.50 , $108.00 , $108.00 , $21.94 , $124.65 , $128.25 , $121.50 , $121.50 , $121.50 , $125.55 , $129.60 , $155.91 , $114.75 , $115.15 , $72.60 , N/A , $94.59 , $94.59 , $128.25 , $103.37 , $21.94 , $155.91 
 Fac Actin Smooth Muscle Antibody Each ,CPT® 86015,0300 - LABORATORY,N/A,N/A, $136.00 , $88.40 , $114.24 , $12.29 , $11.76 , $109.89 , $122.40 , $115.14 , $122.40 , $122.40 , $122.40 , $115.60 , $11.53 , $125.57 , $129.20 , $115.60 , $126.48 , $126.48 , $129.20 , $130.56 , $111.28 , $122.40 , $115.60 , $107.44 , N/A , $110.06 , $110.06 , $129.20 , $116.70 , $11.53 , $130.56 
Injection Sclerosant Multiple Incmptnt Veins,36471,N/A,N/A,N/A," $1,211.00 ", $787.15 , $447.20 , $69.44 , $76.21 , $431.60 , $432.80 ," $1,126.23 "," $1,089.90 "," $1,089.90 ", $968.80 , $968.80 , $76.21 ," $1,118.12 "," $1,150.45 "," $1,089.90 "," $1,089.90 "," $1,089.90 "," $1,126.23 "," $1,162.56 ", $414.20 ," $1,029.35 ", $542.36 , $372.68 , N/A , $440.02 , $440.02 ," $1,150.45 ", $499.87 , $69.44 ," $1,162.56 "
Iaad Ia Hiv-1 Ag W/Hiv-1 & Hiv-2 Antbdy Single,CPT® 87389,N/A,N/A,N/A, $90.00 , $58.50 , N/A , $24.56 , $24.56 , $136.24 , $163.01 , $83.70 , $81.00 , $81.00 , $72.00 , $72.00 , $24.56 , $83.10 , $85.50 , $81.00 , $81.00 , $81.00 , $83.70 , $86.40 , $160.79 , $76.50 , $157.32 , $87.32 , N/A , $127.15 , $127.15 , $85.50 , $138.94 , $24.56 , $163.01 
Revision of Bladder/Urethra,CPT® 51800,N/A,N/A,N/A," $7,750.00 "," $5,037.50 "," $5,612.81 ", $986.45 ," $1,135.96 "," $5,104.68 "," $4,748.87 "," $7,207.50 "," $6,975.00 "," $6,975.00 "," $6,200.00 "," $6,200.00 "," $1,135.96 "," $7,155.58 "," $7,362.50 "," $6,975.00 "," $6,975.00 "," $6,975.00 "," $7,207.50 "," $7,440.00 "," $5,648.09 "," $6,587.50 "," $5,387.87 "," $6,399.87 ", N/A ," $5,204.28 "," $5,204.28 "," $7,362.50 "," $6,116.88 ", $986.45 ," $7,440.00 "
Corrj Hallux Valgus W/Sesmdc W/Rescj Prox Phal,CPT® 28292,N/A,N/A,N/A," $5,263.00 "," $3,420.95 "," $2,985.06 ", $469.55 , $496.45 ," $2,967.90 "," $2,954.42 "," $4,894.59 "," $4,736.70 "," $4,736.70 "," $4,210.40 "," $4,210.40 ", $496.45 ," $4,859.33 "," $4,999.85 "," $4,736.70 "," $4,736.70 "," $4,736.70 "," $4,894.59 "," $5,052.48 "," $2,773.20 "," $4,473.55 "," $3,198.83 "," $2,852.89 ", N/A ," $3,025.81 "," $3,025.81 "," $4,999.85 "," $3,556.39 ", $469.55 ," $5,052.48 "
Interrog Dev Eval Pm/Ldls Pm Phys/Qhp in Person,CPT® 93288,N/A,N/A,N/A, $508.00 , $330.20 , $367.84 , $55.79 , $32.77 , $198.96 , $206.62 , $472.44 , $457.20 , $457.20 , $406.40 , $406.40 , $32.77 , $469.04 , $482.60 , $457.20 , $457.20 , $457.20 , $472.44 , $487.68 , $337.97 , $431.80 , $192.68 , $145.29 , N/A , $202.84 , $202.84 , $482.60 , $224.84 , $32.77 , $487.68 
Instll Rx Agnt Into Rnal Tub,CPT® 50391,N/A,N/A,N/A, $858.00 , $557.70 , $527.28 , $92.25 , $124.05 , $485.92 , $447.43 , $797.94 , $772.20 , $772.20 , $686.40 , $686.40 , $124.05 , $792.19 , $815.10 , $772.20 , $772.20 , $772.20 , $797.94 , $823.68 , $531.33 , $729.30 , $508.46 , $605.12 , N/A , $495.40 , $495.40 , $815.10 , $582.26 , $92.25 , $823.68 
 Fac Icar Catheter Ablation Atrioventr Node Function ,CPT® 93650,0481 - CARDIAC CATH LAB,N/A,N/A," $6,233.00 "," $4,051.45 "," $5,235.72 ", $532.37 , $584.47 ," $5,036.26 "," $5,609.70 "," $5,276.86 "," $5,609.70 "," $5,609.70 "," $5,609.70 "," $5,298.05 ", $573.01 ," $5,754.93 "," $5,921.35 "," $5,298.05 "," $5,796.69 "," $5,796.69 "," $5,921.35 "," $5,983.68 "," $5,099.84 "," $5,609.70 "," $5,298.05 "," $4,924.07 ", N/A ," $5,044.37 "," $5,044.37 "," $5,921.35 "," $5,348.54 ", $532.37 ," $5,983.68 "
 Spinal Disorders And Injuries With Cc/McC ,MS DRG V40 (FY2023) 052,N/A,N/A,N/A," $21,367.69 "," $13,889.00 "," $17,948.86 ", N/A , N/A ," $17,265.09 "," $19,230.92 "," $18,089.89 "," $19,230.92 "," $19,230.92 "," $19,230.92 "," $18,162.54 ", N/A ," $19,728.79 "," $20,299.31 "," $18,162.54 "," $19,871.95 "," $19,871.95 "," $20,299.31 "," $20,512.98 "," $17,483.04 "," $19,230.92 "," $18,162.54 "," $16,880.48 ", N/A ," $17,292.87 "," $17,292.87 "," $20,299.31 "," $18,335.61 "," $16,880.48 "," $20,512.98 "
 Pro Nj/Asp Intermediate Joint/Bursa ,CPT® 20605,0982 - PRO FEE/OUTPT,N/A,N/A, $382.00 , $248.30 , $226.79 , $35.10 , $50.55 , $181.29 , $253.86 , $355.26 , $343.80 , $343.80 , $305.60 , $305.60 , $50.55 , $352.70 , $362.90 , $343.80 , $343.80 , $343.80 , $355.26 , $366.72 , $211.99 , $324.70 , $276.53 , $217.48 , N/A , $184.83 , $184.83 , $362.90 , $217.21 , $35.10 , $366.72 
 Fac Assay of Triglycerides ,CPT® 84478,0301 - LAB/CHEMISTRY,N/A,N/A, $81.00 , $52.65 , $68.04 , $5.85 , $5.85 , $65.45 , $72.90 , $68.57 , $72.90 , $72.90 , $72.90 , $68.85 , $5.74 , $74.79 , $76.95 , $68.85 , $75.33 , $75.33 , $76.95 , $77.76 , $66.27 , $72.90 , $68.85 , $63.99 , N/A , $65.55 , $65.55 , $76.95 , $69.51 , $5.74 , $77.76 
"Amino Acids, Single Quantitation",CPT® 82131,N/A,N/A,N/A, $187.00 , $121.55 , N/A , $23.44 , $20.74 , $95.42 , $114.13 , $173.91 , $168.30 , $168.30 , $149.60 , $149.60 , $20.74 , $172.66 , $177.65 , $168.30 , $168.30 , $168.30 , $173.91 , $179.52 , $153.44 , $158.95 , $110.29 , $67.49 , N/A , $89.05 , $89.05 , $177.65 , $97.31 , $20.74 , $179.52 
Rmv Aortic Balloon Device,CPT® 33968,N/A,N/A,N/A, $965.00 , $627.25 , $196.43 , $30.54 , $42.36 , $144.09 , $141.47 , $897.45 , $868.50 , $868.50 , $772.00 , $772.00 , $42.36 , $890.98 , $916.75 , $868.50 , $868.50 , $868.50 , $897.45 , $926.40 , $183.48 , $820.25 , $178.41 , $163.42 , N/A , $146.90 , $146.90 , $916.75 , $166.88 , $30.54 , $926.40 
 Fac Cltx Intercondylar Spi&/Tubrst Fx Kne +-Mnpj ,CPT® 27538,0761 - TREATMENT ROOM,N/A,N/A, $775.00 , $503.75 , $651.00 , $438.31 , $307.34 , $626.20 , $697.50 , $656.12 , $697.50 , $697.50 , $697.50 , $658.75 , $301.31 , $715.56 , $736.25 , $658.75 , $720.75 , $720.75 , $736.25 , $744.00 , $634.11 , $697.50 , $658.75 , $612.25 , N/A , $627.21 , $627.21 , $736.25 , $665.03 , $301.31 , $744.00 
Stapedectomy,CPT® 69660,N/A,N/A,N/A," $5,424.00 "," $3,525.60 "," $4,443.45 ", $900.32 , $819.61 ," $4,468.79 "," $4,599.05 "," $5,044.32 "," $4,881.60 "," $4,881.60 "," $4,339.20 "," $4,339.20 ", $819.61 ," $5,007.98 "," $5,152.80 "," $4,881.60 "," $4,881.60 "," $4,881.60 "," $5,044.32 "," $5,207.04 "," $4,872.61 "," $4,610.40 "," $5,015.00 "," $4,473.32 ", N/A ," $4,555.99 "," $4,555.99 "," $5,152.80 "," $5,202.14 ", $819.61 ," $5,207.04 "
 Isoflurane per 30 Minutes ,Custom 3700000007,0370 - ANESTHESIA,N/A,N/A, $8.00 , $5.20 , $6.72 , N/A , N/A , $6.46 , $7.20 , $6.77 , $7.20 , $7.20 , $7.20 , $6.80 , N/A , $7.39 , $7.60 , $6.80 , $7.44 , $7.44 , $7.60 , $7.68 , $6.55 , $7.20 , $6.80 , $6.32 , N/A , $6.47 , $6.47 , $7.60 , $6.86 , $6.32 , $7.68 
 ATENOLOL 100 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,51079-0685-20,1 tablet, $7.67 , $4.99 , $6.44 , N/A , N/A , $6.20 , $6.90 , $6.49 , $6.90 , $6.90 , $6.90 , $6.52 , N/A , $7.08 , $7.29 , $6.52 , $7.13 , $7.13 , $7.29 , $7.36 , $6.28 , $6.90 , $6.52 , $6.06 , N/A , $6.21 , $6.21 , $7.29 , $6.58 , $6.06 , $7.36 
 Pro Screening Digital Breast Tomosynthesis Bi ,CPT® 77063,0972 - PRO FEE/RAD/DX,N/A,N/A, $184.00 , $119.60 , $217.43 , $52.04 , $42.90 , $268.72 , $289.82 , $171.12 , $165.60 , $165.60 , $147.20 , $147.20 , $42.90 , $169.89 , $174.80 , $165.60 , $165.60 , $165.60 , $171.12 , $176.64 , $301.25 , $156.40 , $303.10 , $299.38 , N/A , $273.97 , $273.97 , $174.80 , $317.13 , $42.90 , $317.13 
 Pro Exc Tr-Ext Mlg+Marg 2.1-3 Cm ,CPT® 11603,0982 - PRO FEE/OUTPT,N/A,N/A," $1,190.00 ", $773.50 , $618.19 , $185.66 , $250.91 , $533.33 , $520.40 ," $1,106.70 "," $1,071.00 "," $1,071.00 ", $952.00 , $952.00 , $250.91 ," $1,098.73 "," $1,130.50 "," $1,071.00 "," $1,071.00 "," $1,071.00 "," $1,106.70 "," $1,142.40 ", $677.73 ," $1,011.50 "," $1,034.76 ", $686.47 , N/A , $543.74 , $543.74 ," $1,130.50 ", $630.55 , $185.66 ," $1,142.40 "
Total Hip Arthroplasty,27130,N/A,N/A,N/A," $8,944.00 "," $5,813.60 "," $7,729.22 "," $1,207.86 "," $1,274.03 "," $6,553.93 "," $6,887.98 "," $8,317.92 "," $8,049.60 "," $8,049.60 "," $7,155.20 "," $7,155.20 "," $1,274.03 "," $8,258.00 "," $8,496.80 "," $8,049.60 "," $8,049.60 "," $8,049.60 "," $8,317.92 "," $8,586.24 "," $8,507.46 "," $7,602.40 "," $7,626.87 "," $7,706.23 ", N/A ," $6,681.80 "," $6,681.80 "," $8,496.80 "," $7,853.49 "," $1,207.86 "," $8,586.24 "
" Pro Contrst X-Ray, Urinary Tract ",CPT® 74400,0972 - PRO FEE/RAD/DX,N/A,N/A, $142.00 , $92.30 , $782.71 , $134.16 , $93.19 , $519.70 , $603.39 , $132.06 , $127.80 , $127.80 , $113.60 , $113.60 , $93.19 , $131.11 , $134.90 , $127.80 , $127.80 , $127.80 , $132.06 , $136.32 , $751.48 , $120.70 , $656.78 , $554.46 , N/A , $529.85 , $529.85 , $134.90 , $613.31 , $93.19 , $782.71 
 Epidural Inj of Blood or Clot Patch ,CPT® 62273,0761 - TREATMENT ROOM,N/A,N/A," $1,098.00 ", $713.70 , $922.32 , $108.56 , $122.93 , $887.18 , $988.20 , $929.57 , $988.20 , $988.20 , $988.20 , $933.30 , $120.52 ," $1,013.78 "," $1,043.10 ", $933.30 ," $1,021.14 "," $1,021.14 "," $1,043.10 "," $1,054.08 ", $898.38 , $988.20 , $933.30 , $867.42 , N/A , $888.61 , $888.61 ," $1,043.10 ", $942.19 , $108.56 ," $1,054.08 "
Sbsq Nursing Facility Care High Mdm 45 Minutes,CPT® 99310,N/A,N/A,N/A, $361.00 , $234.65 , $267.58 , $149.41 , $85.51 , $233.84 , $234.23 , $335.73 , $324.90 , $324.90 , $288.80 , $288.80 , $85.51 , $333.31 , $342.95 , $324.90 , $324.90 , $324.90 , $335.73 , $346.56 , $340.94 , $306.85 , $291.79 , $288.78 , $153.00 , $238.40 , $238.40 , $342.95 , $274.96 , $85.51 , $346.56 
 VENLAFAXINE HCL 37.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,57237-0173-01,1 tablet, $10.28 , $6.68 , $8.64 , N/A , N/A , $8.31 , $9.25 , $8.70 , $9.25 , $9.25 , $9.25 , $8.74 , N/A , $9.49 , $9.77 , $8.74 , $9.56 , $9.56 , $9.77 , $9.87 , $8.41 , $9.25 , $8.74 , $8.12 , N/A , $8.32 , $8.32 , $9.77 , $8.82 , $8.12 , $9.87 
Rubella,CPT® 86762,N/A,N/A,N/A, $133.00 , $86.45 , N/A , $14.68 , $14.68 , $81.40 , $97.43 , $123.69 , $119.70 , $119.70 , $106.40 , $106.40 , $14.68 , $122.80 , $126.35 , $119.70 , $119.70 , $119.70 , $123.69 , $127.68 , $96.09 , $113.05 , $94.07 , $52.19 , N/A , $75.97 , $75.97 , $126.35 , $83.02 , $14.68 , $127.68 
Cytopathology-Study Ext.,CPT® 88162,N/A,N/A,N/A, $711.00 , $462.15 , $404.82 , $116.89 , $55.03 , $397.22 , $439.82 , $661.23 , $639.90 , $639.90 , $568.80 , $568.80 , $55.03 , $656.47 , $675.45 , $639.90 , $639.90 , $639.90 , $661.23 , $682.56 , $661.98 , $604.35 , $458.98 , $336.44 , N/A , $370.71 , $370.71 , $675.45 , $407.40 , $55.03 , $682.56 
Spherocylindr 7.25d/4.25-6d,HCPCS V2113,N/A,N/A,N/A, $55.00 , $35.75 , N/A , $86.13 , N/A , N/A , N/A , $51.15 , $49.50 , $49.50 , $44.00 , $44.00 , N/A , $50.78 , $52.25 , $49.50 , $49.50 , $49.50 , $51.15 , $52.80 , N/A , $46.75 , $55.00 , $78.25 , N/A , N/A , N/A , $52.25 , N/A , $44.00 , $86.13 
 BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6938-06,1 tablet, $11.14 , $7.24 , $9.36 , N/A , N/A , $9.00 , $10.03 , $9.43 , $10.03 , $10.03 , $10.03 , $9.47 , N/A , $10.29 , $10.58 , $9.47 , $10.36 , $10.36 , $10.58 , $10.69 , $9.11 , $10.03 , $9.47 , $8.80 , N/A , $9.02 , $9.02 , $10.58 , $9.56 , $8.80 , $10.69 
 Fac Perc D-E Cor Revasc T Cabg S ,HCPCS C9604,0481 - CARDIAC CATH LAB,N/A,N/A," $15,529.00 "," $10,093.85 "," $13,044.36 ", N/A , N/A ," $12,547.43 "," $13,976.10 "," $13,146.85 "," $13,976.10 "," $13,976.10 "," $13,976.10 "," $13,199.65 ", N/A ," $14,337.93 "," $14,752.55 "," $13,199.65 "," $14,441.97 "," $14,441.97 "," $14,752.55 "," $14,907.84 "," $12,705.83 "," $13,976.10 "," $13,199.65 "," $12,267.91 ", N/A ," $12,567.62 "," $12,567.62 "," $14,752.55 "," $13,325.43 "," $12,267.91 "," $14,907.84 "
 TAFASITAMAB-CXIX 200 MG IV SOLR ,HCPCS J9349,0636 - DRUGS REQUIRING DETAILED CODIN,73535-0208-01,5 mL," $3,847.84 "," $2,501.10 "," $3,232.19 ", $13.57 , $13.41 ," $3,109.05 "," $3,463.06 "," $3,257.58 "," $3,463.06 "," $3,463.06 "," $3,463.06 "," $3,270.66 ", $13.15 ," $3,552.71 "," $3,655.45 "," $3,270.66 "," $3,578.49 "," $3,578.49 "," $3,655.45 "," $3,693.93 "," $3,148.30 "," $3,463.06 "," $3,270.66 "," $3,039.79 ", N/A ," $3,114.06 "," $3,114.06 "," $3,655.45 "," $3,301.83 ", $13.15 ," $3,693.93 "
"Incise Post Synechiae,Eye",65875,N/A,N/A,N/A," $5,665.00 "," $3,682.25 "," $3,917.81 ", $614.57 , $614.70 ," $3,562.54 "," $3,333.22 "," $5,268.45 "," $5,098.50 "," $5,098.50 "," $4,532.00 "," $4,532.00 ", $614.70 ," $5,230.49 "," $5,381.75 "," $5,098.50 "," $5,098.50 "," $5,098.50 "," $5,268.45 "," $5,438.40 "," $5,375.39 "," $4,815.25 "," $3,423.62 "," $4,532.87 ", N/A ," $3,632.05 "," $3,632.05 "," $5,381.75 "," $4,009.32 ", $614.57 ," $5,438.40 "
Anterior Colporraphy Rpr Cystocele W/Cysto,57240,N/A,N/A,N/A," $4,005.00 "," $2,603.25 "," $2,907.05 ", $588.09 , $537.90 ," $2,738.88 "," $2,708.47 "," $3,724.65 "," $3,604.50 "," $3,604.50 "," $3,204.00 "," $3,204.00 ", $537.90 ," $3,697.82 "," $3,804.75 "," $3,604.50 "," $3,604.50 "," $3,604.50 "," $3,724.65 "," $3,844.80 "," $3,022.85 "," $3,404.25 "," $3,532.45 "," $2,428.96 ", N/A ," $2,792.33 "," $2,792.33 "," $3,804.75 "," $3,349.24 ", $537.90 ," $3,844.80 "
"Repair Paraesophageal Hiatal Hernia,Thoracotomy, WO Mesh",CPT® 43334,N/A,N/A,N/A," $8,416.00 "," $5,470.40 "," $7,299.96 "," $1,124.64 ", $914.84 ," $5,904.71 "," $5,925.28 "," $7,826.88 "," $7,574.40 "," $7,574.40 "," $6,732.80 "," $6,732.80 ", $914.84 ," $7,770.49 "," $7,995.20 "," $7,574.40 "," $7,574.40 "," $7,574.40 "," $7,826.88 "," $8,079.36 "," $5,276.81 "," $7,153.60 "," $6,609.96 "," $6,901.89 ", N/A ," $6,019.93 "," $6,019.93 "," $7,995.20 "," $6,296.19 ", $914.84 ," $8,079.36 "
 Ot Massage 15 Min ,CPT® 97124,0420 - PHYSICAL THERAPY,N/A,N/A, $79.00 , $51.35 , $66.36 , $29.94 , $25.07 , $63.83 , $71.10 , $66.88 , $71.10 , $71.10 , $71.10 , $67.15 , $24.58 , $72.94 , $75.05 , $67.15 , $73.47 , $73.47 , $75.05 , $75.84 , $64.64 , $71.10 , $67.15 , $62.41 , N/A , $63.93 , $63.93 , $75.05 , $67.79 , $24.58 , $75.84 
 LAMOTRIGINE 100 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-7008-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Insj Implntbl Defib Pulse Gen W/Exist Dual Leads ,CPT® 33230,0360 - OR SERVICES,N/A,N/A," $5,694.00 "," $3,701.10 "," $4,782.96 ", $353.84 , $434.82 ," $4,600.75 "," $5,124.60 "," $4,820.54 "," $5,124.60 "," $5,124.60 "," $5,124.60 "," $4,839.90 ", $426.29 ," $5,257.27 "," $5,409.30 "," $4,839.90 "," $5,295.42 "," $5,295.42 "," $5,409.30 "," $5,466.24 "," $4,658.83 "," $5,124.60 "," $4,839.90 "," $4,498.26 ", N/A ," $4,608.15 "," $4,608.15 "," $5,409.30 "," $4,886.02 ", $353.84 ," $5,466.24 "
"Drain Mouth Absc/Cyst/Hematoma,Simpl",CPT® 40800,N/A,N/A,N/A," $1,448.00 ", $941.20 , $740.22 , $115.73 , $30.71 , $643.19 , $665.31 ," $1,346.64 "," $1,303.20 "," $1,303.20 "," $1,158.40 "," $1,158.40 ", $30.71 ," $1,336.94 "," $1,375.60 "," $1,303.20 "," $1,303.20 "," $1,303.20 "," $1,346.64 "," $1,390.08 ", $540.50 ," $1,230.80 ", $726.11 , $759.67 , N/A , $655.74 , $655.74 ," $1,375.60 ", $685.83 , $30.71 ," $1,390.08 "
 CT Lw Dose Whole Body ,CPT® 76497,0352 - CT SCAN/BODY,N/A,N/A," $2,523.00 "," $1,639.95 "," $2,119.32 ", N/A , N/A ," $2,038.58 "," $2,270.70 "," $2,135.97 "," $2,270.70 "," $2,270.70 "," $2,270.70 "," $2,144.55 ", N/A ," $2,329.49 "," $2,396.85 "," $2,144.55 "," $2,346.39 "," $2,346.39 "," $2,396.85 "," $2,422.08 "," $2,064.32 "," $2,270.70 "," $2,144.55 "," $1,993.17 ", N/A ," $2,041.86 "," $2,041.86 "," $2,396.85 "," $2,164.99 "," $1,993.17 "," $2,422.08 "
 HYDROMORPHONE 6 MG/30 ML PCA ,HCPCS RXA250,0250 - PHARMACY,70092-9112-49,30 mL, $169.98 , $110.49 , $142.78 , N/A , N/A , $137.34 , $152.98 , $143.91 , $152.98 , $152.98 , $152.98 , $144.48 , N/A , $156.94 , $161.48 , $144.48 , $158.08 , $158.08 , $161.48 , $163.18 , $139.08 , $152.98 , $144.48 , $134.28 , N/A , $137.56 , $137.56 , $161.48 , $145.86 , $134.28 , $163.18 
"Apply Bone Uniplane,Ext Fix Dev",CPT® 20690,N/A,N/A,N/A," $3,849.00 "," $2,501.85 "," $3,613.81 ", $565.91 , $479.56 ," $2,868.20 "," $2,830.07 "," $3,579.57 "," $3,464.10 "," $3,464.10 "," $3,079.20 "," $3,079.20 ", $479.56 ," $3,553.78 "," $3,656.55 "," $3,464.10 "," $3,464.10 "," $3,464.10 "," $3,579.57 "," $3,695.04 "," $3,363.02 "," $3,271.65 "," $3,123.90 "," $3,380.26 ", N/A ," $2,924.17 "," $2,924.17 "," $3,656.55 "," $3,436.94 ", $479.56 ," $3,695.04 "
 TEMAZEPAM 15 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00228-2076-10,1 capsule, $3.78 , $2.46 , $3.18 , N/A , N/A , $3.05 , $3.40 , $3.20 , $3.40 , $3.40 , $3.40 , $3.21 , N/A , $3.49 , $3.59 , $3.21 , $3.52 , $3.52 , $3.59 , $3.63 , $3.09 , $3.40 , $3.21 , $2.99 , N/A , $3.06 , $3.06 , $3.59 , $3.24 , $2.99 , $3.63 
Insert/Place Flow Direct Cath,CPT® 93503,N/A,N/A,N/A," $3,044.00 "," $1,978.60 ", $545.16 , $84.22 , $213.83 , $707.19 , $710.34 ," $2,830.92 "," $2,739.60 "," $2,739.60 "," $2,435.20 "," $2,435.20 ", $213.83 ," $2,810.53 "," $2,891.80 "," $2,739.60 "," $2,739.60 "," $2,739.60 "," $2,830.92 "," $2,922.24 ", $502.52 ," $2,587.40 ", $674.38 , $625.44 , N/A , $720.98 , $720.98 ," $2,891.80 ", $799.22 , $84.22 ," $2,922.24 "
"Fix Entropion,Excis Tarsal Wedge",CPT® 67923,N/A,N/A,N/A," $5,624.00 "," $3,655.60 "," $2,640.04 ", $414.85 , $461.04 ," $2,439.53 "," $2,491.22 "," $5,230.32 "," $5,061.60 "," $5,061.60 "," $4,499.20 "," $4,499.20 ", $461.04 ," $5,192.64 "," $5,342.80 "," $5,061.60 "," $5,061.60 "," $5,061.60 "," $5,230.32 "," $5,399.04 "," $3,624.90 "," $4,780.40 "," $2,581.54 "," $3,097.33 ", N/A ," $2,487.13 "," $2,487.13 "," $5,342.80 "," $2,745.46 ", $414.85 ," $5,399.04 "
 Fac Incision of Eyelid Fold ,CPT® 67715,0761 - TREATMENT ROOM,N/A,N/A," $1,000.00 ", $650.00 , $840.00 , $103.64 , $151.20 , $808.00 , $900.00 , $846.60 , $900.00 , $900.00 , $900.00 , $850.00 , $148.24 , $923.30 , $950.00 , $850.00 , $930.00 , $930.00 , $950.00 , $960.00 , $818.20 , $900.00 , $850.00 , $790.00 , N/A , $809.30 , $809.30 , $950.00 , $858.10 , $103.64 , $960.00 
 Pro Debride Abdom Wall ,CPT® 11005,0982 - PRO FEE/OUTPT,N/A,N/A," $4,078.00 "," $2,650.70 "," $2,386.66 ", $703.47 , $690.32 ," $2,109.90 "," $2,020.69 "," $3,792.54 "," $3,670.20 "," $3,670.20 "," $3,262.40 "," $3,262.40 ", $690.32 ," $3,765.22 "," $3,874.10 "," $3,670.20 "," $3,670.20 "," $3,670.20 "," $3,792.54 "," $3,914.88 "," $2,626.79 "," $3,466.30 "," $4,098.00 "," $2,653.72 ", N/A ," $2,151.06 "," $2,151.06 "," $3,874.10 "," $2,494.51 ", $690.32 ," $4,098.00 "
"Ankle Scope,Aid Repair Fx,Bone Defct",29892,N/A,N/A,N/A," $5,544.00 "," $3,603.60 "," $3,941.67 ", $621.39 , $613.65 ," $3,098.15 "," $2,949.53 "," $5,155.92 "," $4,989.60 "," $4,989.60 "," $4,435.20 "," $4,435.20 ", $613.65 ," $5,118.78 "," $5,266.80 "," $4,989.60 "," $4,989.60 "," $4,989.60 "," $5,155.92 "," $5,322.24 "," $3,698.72 "," $4,712.40 "," $3,270.19 "," $3,856.93 ", N/A ," $3,158.60 "," $3,158.60 "," $5,266.80 "," $3,712.47 ", $613.65 ," $5,322.24 "
Control Nasal Hemorrhage,30905,N/A,N/A,N/A, $943.00 , $612.95 , $562.01 , $99.47 , $223.20 , $380.68 , $372.34 , $876.99 , $848.70 , $848.70 , $754.40 , $754.40 , $223.20 , $870.67 , $895.85 , $848.70 , $848.70 , $848.70 , $876.99 , $905.28 , $541.66 , $801.55 , $529.87 , $535.02 , N/A , $388.11 , $388.11 , $895.85 , $457.08 , $99.47 , $905.28 
Treat Ankle Fracture,27816,N/A,N/A,N/A," $2,108.00 "," $1,370.20 "," $1,828.13 ", $288.74 , $384.19 ," $1,389.63 "," $1,401.19 "," $1,960.44 "," $1,897.20 "," $1,897.20 "," $1,686.40 "," $1,686.40 ", $384.19 ," $1,946.32 "," $2,002.60 "," $1,897.20 "," $1,897.20 "," $1,897.20 "," $1,960.44 "," $2,023.68 "," $1,683.83 "," $1,791.80 "," $1,534.30 "," $1,655.10 ", N/A ," $1,416.74 "," $1,416.74 "," $2,002.60 "," $1,665.18 ", $288.74 ," $2,023.68 "
"Removal of Hydrocele,Tunica,Unilat",55040,N/A,N/A,N/A," $3,208.00 "," $2,085.20 "," $1,504.47 ", $324.04 , $333.51 ," $1,083.03 "," $1,102.68 "," $2,983.44 "," $2,887.20 "," $2,887.20 "," $2,566.40 "," $2,566.40 ", $333.51 ," $2,961.95 "," $3,047.60 "," $2,887.20 "," $2,887.20 "," $2,887.20 "," $2,983.44 "," $3,079.68 "," $1,410.36 "," $2,726.80 "," $1,764.44 "," $1,634.50 ", N/A ," $1,104.16 "," $1,104.16 "," $3,047.60 "," $1,323.40 ", $324.04 ," $3,079.68 "
 CT Angio Pelvis ,CPT® 72191,0350 - CT SCAN,N/A,N/A," $4,291.00 "," $2,789.15 "," $3,604.44 ", $258.04 , $394.70 ," $3,467.13 "," $3,861.90 "," $3,632.76 "," $3,861.90 "," $3,861.90 "," $3,861.90 "," $3,647.35 ", $386.96 ," $3,961.88 "," $4,076.45 "," $3,647.35 "," $3,990.63 "," $3,990.63 "," $4,076.45 "," $4,119.36 "," $3,510.90 "," $3,861.90 "," $3,647.35 "," $3,389.89 ", N/A ," $3,472.71 "," $3,472.71 "," $4,076.45 "," $3,682.11 ", $258.04 ," $4,119.36 "
 NORTRIPTYLINE HCL 25 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,60687-0293-01,1 capsule, $4.54 , $2.95 , $3.81 , N/A , N/A , $3.67 , $4.09 , $3.84 , $4.09 , $4.09 , $4.09 , $3.86 , N/A , $4.19 , $4.31 , $3.86 , $4.22 , $4.22 , $4.31 , $4.36 , $3.71 , $4.09 , $3.86 , $3.59 , N/A , $3.67 , $3.67 , $4.31 , $3.90 , $3.59 , $4.36 
 Fac Carcinoembryonic Antigen ,CPT® 82378,0301 - LAB/CHEMISTRY,N/A,N/A, $203.00 , $131.95 , $170.52 , $19.34 , $19.34 , $164.02 , $182.70 , $171.86 , $182.70 , $182.70 , $182.70 , $172.55 , $18.96 , $187.43 , $192.85 , $172.55 , $188.79 , $188.79 , $192.85 , $194.88 , $166.09 , $182.70 , $172.55 , $160.37 , N/A , $164.29 , $164.29 , $192.85 , $174.19 , $18.96 , $194.88 
 DOXORUBICIN HCL 2 MG/ML IV SOLN ,HCPCS J9000,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9084-01,5 mL, $35.00 , $22.75 , $29.40 , $2.55 , $2.51 , $28.28 , $31.50 , $29.63 , $31.50 , $31.50 , $31.50 , $29.75 , $2.46 , $32.32 , $33.25 , $29.75 , $32.55 , $32.55 , $33.25 , $33.60 , $28.64 , $31.50 , $29.75 , $27.65 , N/A , $28.33 , $28.33 , $33.25 , $30.03 , $2.46 , $33.60 
 DILTIAZEM 1 MG/ML INFUSION PREMIX ,HCPCS RXA250,0250 - PHARMACY,70092-1575-36,125 mL, $134.85 , $87.65 , $113.27 , N/A , N/A , $108.96 , $121.37 , $114.16 , $121.37 , $121.37 , $121.37 , $114.62 , N/A , $124.51 , $128.11 , $114.62 , $125.41 , $125.41 , $128.11 , $129.46 , $110.33 , $121.37 , $114.62 , $106.53 , N/A , $109.13 , $109.13 , $128.11 , $115.71 , $106.53 , $129.46 
 GLUCAGON 1 MG INJECTION (INPT) ,HCPCS J1610,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0593-03,1 mL," $1,366.31 ", $888.10 ," $1,147.70 ", $199.08 , $194.07 ," $1,103.98 "," $1,229.68 "," $1,156.72 "," $1,229.68 "," $1,229.68 "," $1,229.68 "," $1,161.36 ", $190.26 ," $1,261.51 "," $1,297.99 "," $1,161.36 "," $1,270.67 "," $1,270.67 "," $1,297.99 "," $1,311.66 "," $1,117.91 "," $1,229.68 "," $1,161.36 "," $1,079.38 ", N/A ," $1,105.75 "," $1,105.75 "," $1,297.99 "," $1,172.43 ", $190.26 ," $1,311.66 "
Removal Impacted Cerumen Irrigation/Lvg Unilat,69209,N/A,N/A,N/A, $111.00 , $72.15 , $72.25 , $14.88 , $9.93 , $59.81 , $59.38 , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $9.93 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $77.94 , $94.35 , $81.74 , $68.74 , N/A , $60.98 , $60.98 , $105.45 , $69.62 , $9.93 , $106.56 
 Fac Ablation Renal Tumor Unilateral Perq Cryotherapy ,CPT® 50593,0361 - OR/MINOR,N/A,N/A," $13,825.00 "," $8,986.25 "," $11,613.00 ", $435.80 ," $2,378.14 "," $11,170.60 "," $12,442.50 "," $11,704.25 "," $12,442.50 "," $12,442.50 "," $12,442.50 "," $11,751.25 "," $2,331.51 "," $12,764.62 "," $13,133.75 "," $11,751.25 "," $12,857.25 "," $12,857.25 "," $13,133.75 "," $13,272.00 "," $11,311.62 "," $12,442.50 "," $11,751.25 "," $10,921.75 ", N/A ," $11,188.57 "," $11,188.57 "," $13,133.75 "," $11,863.23 ", $435.80 ," $13,272.00 "
 PROCHLORPERAZINE MALEATE 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,50268-0684-15,1 tablet, $8.28 , $5.38 , $6.96 , N/A , N/A , $6.69 , $7.45 , $7.01 , $7.45 , $7.45 , $7.45 , $7.04 , N/A , $7.64 , $7.87 , $7.04 , $7.70 , $7.70 , $7.87 , $7.95 , $6.77 , $7.45 , $7.04 , $6.54 , N/A , $6.70 , $6.70 , $7.87 , $7.11 , $6.54 , $7.95 
"Heart Pacing, Mapping",CPT® 93631,N/A,N/A,N/A," $3,905.00 "," $2,538.25 "," $11,961.37 "," $1,870.58 ", $659.02 ," $2,870.64 "," $2,900.38 "," $3,631.65 "," $3,514.50 "," $3,514.50 "," $3,124.00 "," $3,124.00 ", $659.02 ," $3,605.49 "," $3,709.75 "," $3,514.50 "," $3,514.50 "," $3,514.50 "," $3,631.65 "," $3,748.80 "," $11,755.43 "," $3,319.25 "," $2,825.96 "," $10,993.49 ", N/A ," $2,926.64 "," $2,926.64 "," $3,709.75 "," $3,244.23 ", $659.02 ," $11,961.37 "
Sono Abd Retroperitnl Ltd,CPT® 76775,N/A,N/A,N/A, $850.00 , $552.50 , $327.35 , $58.03 , $88.69 , $276.72 , $576.01 , $790.50 , $765.00 , $765.00 , $680.00 , $680.00 , $88.69 , $784.81 , $807.50 , $765.00 , $765.00 , $765.00 , $790.50 , $816.00 , $324.22 , $722.50 , $627.89 , $326.12 , N/A , $282.12 , $282.12 , $807.50 , $326.56 , $58.03 , $816.00 
" Fac Drug Assay Carbamazepine -10,11-Epoxide ",CPT® 80161,0301 - LAB/CHEMISTRY,N/A,N/A, $191.00 , $124.15 , $160.44 , $19.01 , $15.21 , $154.33 , $171.90 , $161.70 , $171.90 , $171.90 , $171.90 , $162.35 , $14.91 , $176.35 , $181.45 , $162.35 , $177.63 , $177.63 , $181.45 , $183.36 , $156.28 , $171.90 , $162.35 , $150.89 , N/A , $154.58 , $154.58 , $181.45 , $163.90 , $14.91 , $183.36 
"Thyroid Lobectomy,Unilat",60220,N/A,N/A,N/A," $5,736.00 "," $3,728.40 "," $4,289.16 ", $669.53 , $674.26 ," $3,649.89 "," $3,798.50 "," $5,334.48 "," $5,162.40 "," $5,162.40 "," $4,588.80 "," $4,588.80 ", $674.26 ," $5,296.05 "," $5,449.20 "," $5,162.40 "," $5,162.40 "," $5,162.40 "," $5,334.48 "," $5,506.56 "," $4,138.84 "," $4,875.60 "," $3,764.38 "," $3,510.37 ", N/A ," $3,721.11 "," $3,721.11 "," $5,449.20 "," $4,150.13 ", $669.53 ," $5,506.56 "
"Destruc Benign/Premal,15+ Lesions",17004,N/A,N/A,N/A, $814.00 , $529.10 , $231.63 , $95.50 , $178.52 , $272.16 , $348.41 , $757.02 , $732.60 , $732.60 , $651.20 , $651.20 , $178.52 , $751.57 , $773.30 , $732.60 , $732.60 , $732.60 , $757.02 , $781.44 , $346.58 , $691.90 , $692.22 , $348.55 , N/A , $277.47 , $277.47 , $773.30 , $321.77 , $95.50 , $781.44 
 AMITRIPTYLINE HCL 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60687-0433-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Fix Non/Malunion Tibia+Autograft,CPT® 27724,N/A,N/A,N/A," $8,693.00 "," $5,650.45 "," $7,556.25 "," $1,180.99 "," $1,132.42 "," $6,118.12 "," $6,054.65 "," $8,084.49 "," $7,823.70 "," $7,823.70 "," $6,954.40 "," $6,954.40 "," $1,132.42 "," $8,026.25 "," $8,258.35 "," $7,823.70 "," $7,823.70 "," $7,823.70 "," $8,084.49 "," $8,345.28 "," $7,055.05 "," $7,389.05 "," $6,704.51 "," $7,178.62 ", N/A ," $6,237.49 "," $6,237.49 "," $8,258.35 "," $7,331.28 "," $1,132.42 "," $8,345.28 "
 Pro Office/Outpatient New Sf Mdm 15-29 Minutes ,CPT® 99202,0982 - PRO FEE/OUTPT,N/A,N/A, $191.00 , $124.15 , $97.59 , $46.48 , $50.34 , $86.35 , $86.61 , $177.63 , $171.90 , $171.90 , $152.80 , $152.80 , $50.34 , $176.35 , $181.45 , $171.90 , $171.90 , $171.90 , $177.63 , $183.36 , $89.09 , $162.35 , $108.02 , $109.92 , $42.00 , $88.04 , $88.04 , $181.45 , $101.55 , $42.00 , $183.36 
 Fac Assay of Nucleotidase ,CPT® 83915,0301 - LAB/CHEMISTRY,N/A,N/A, $187.00 , $121.55 , $157.08 , $11.37 , $11.37 , $151.10 , $168.30 , $158.31 , $168.30 , $168.30 , $168.30 , $158.95 , $11.15 , $172.66 , $177.65 , $158.95 , $173.91 , $173.91 , $177.65 , $179.52 , $153.00 , $168.30 , $158.95 , $147.73 , N/A , $151.34 , $151.34 , $177.65 , $160.46 , $11.15 , $179.52 
 Fac Antb Helminth Nes ,CPT® 86682,0302 - LAB/IMMUNOLOGY,N/A,N/A, $205.00 , $133.25 , $172.20 , $13.27 , $8.07 , $165.64 , $184.50 , $173.55 , $184.50 , $184.50 , $184.50 , $174.25 , $7.91 , $189.28 , $194.75 , $174.25 , $190.65 , $190.65 , $194.75 , $196.80 , $167.73 , $184.50 , $174.25 , $161.95 , N/A , $165.91 , $165.91 , $194.75 , $175.91 , $7.91 , $196.80 
 Fac Iadna Mycobacteria Tuberculosis Amp Prb ,CPT® 87556,0306 - LAB/BACT-MICRO,N/A,N/A, $785.00 , $510.25 , $659.40 , $42.51 , $42.51 , $634.28 , $706.50 , $664.58 , $706.50 , $706.50 , $706.50 , $667.25 , $41.68 , $724.79 , $745.75 , $667.25 , $730.05 , $730.05 , $745.75 , $753.60 , $642.29 , $706.50 , $667.25 , $620.15 , N/A , $635.30 , $635.30 , $745.75 , $673.61 , $41.68 , $753.60 
Wedge Exc. of Skin of Nai,CPT® 11765,N/A,N/A,N/A, $485.00 , $315.25 , $298.86 , $89.88 , $111.12 , $259.63 , $252.76 , $451.05 , $436.50 , $436.50 , $388.00 , $388.00 , $111.12 , $447.80 , $460.75 , $436.50 , $436.50 , $436.50 , $451.05 , $465.60 , $329.62 , $412.25 , $494.19 , $334.41 , N/A , $264.69 , $264.69 , $460.75 , $306.96 , $89.88 , $494.19 
Diphenhydramine Hcl Injectio,HCPCS J1200,N/A,N/A,N/A, $8.00 , $5.20 , N/A , $1.08 , $1.18 , N/A , N/A , $7.44 , $7.20 , $7.20 , $6.40 , $6.40 , $1.18 , $7.39 , $7.60 , $7.20 , $7.20 , $7.20 , $7.44 , $7.68 , $1.24 , $6.80 , $1.30 , $1.64 , N/A , N/A , N/A , $7.60 , N/A , $1.08 , $7.68 
"Ear/Pulse Oximetry,Oxygen",CPT® 94760,N/A,N/A,N/A, $127.00 , $82.55 , $4.94 , $2.08 , $7.12 , $6.70 , $7.29 , $118.11 , $114.30 , $114.30 , $101.60 , $101.60 , $7.12 , $117.26 , $120.65 , $114.30 , $114.30 , $114.30 , $118.11 , $121.92 , $6.57 , $107.95 , $10.14 , $9.82 , N/A , $6.83 , $6.83 , $120.65 , $7.97 , $2.08 , $121.92 
 Head MR Angio W/O and With Contrast ,CPT® 70546,0615 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA-HEAD AND NECK,N/A,N/A," $7,524.00 "," $4,890.60 "," $6,320.16 ", $337.81 , $616.29 ," $6,079.39 "," $6,771.60 "," $6,369.82 "," $6,771.60 "," $6,771.60 "," $6,771.60 "," $6,395.40 ", $604.21 ," $6,946.91 "," $7,147.80 "," $6,395.40 "," $6,997.32 "," $6,997.32 "," $7,147.80 "," $7,223.04 "," $6,156.14 "," $6,771.60 "," $6,395.40 "," $5,943.96 ", N/A ," $6,089.17 "," $6,089.17 "," $7,147.80 "," $6,456.34 ", $337.81 ," $7,223.04 "
 Pro Exc Tdn Finger Flexor or Extensor Ea ,CPT® 26180,0982 - PRO FEE/OUTPT,N/A,N/A," $3,183.00 "," $2,068.95 "," $2,769.65 ", $436.80 , $76.84 ," $2,136.32 "," $2,138.48 "," $2,960.19 "," $2,864.70 "," $2,864.70 "," $2,546.40 "," $2,546.40 ", $76.84 ," $2,938.86 "," $3,023.85 "," $2,864.70 "," $2,864.70 "," $2,864.70 "," $2,960.19 "," $3,055.68 "," $2,573.26 "," $2,705.55 "," $2,346.04 "," $2,545.45 ", N/A ," $2,178.01 "," $2,178.01 "," $3,023.85 "," $2,559.92 ", $76.84 ," $3,055.68 "
 ANTIHEMOPHILIC FACTOR-VWF 500-1200 UNITS IV SOLR ,HCPCS J7187,0636 - DRUGS REQUIRING DETAILED CODIN,63833-0616-02,3 VWF, $35.00 , $22.75 , $29.40 , $1.38 , $1.38 , $28.28 , $31.50 , $29.63 , $31.50 , $31.50 , $31.50 , $29.75 , $1.35 , $32.32 , $33.25 , $29.75 , $32.55 , $32.55 , $33.25 , $33.60 , $28.64 , $31.50 , $29.75 , $27.65 , N/A , $28.33 , $28.33 , $33.25 , $30.03 , $1.35 , $33.60 
Tprnl Plmt Ndl/Caths Into Prst8 Radj Insj,CPT® 55875,N/A,N/A,N/A," $4,159.00 "," $2,703.35 "," $3,456.33 ", $748.61 , $613.12 ," $2,448.66 "," $2,468.82 "," $3,867.87 "," $3,743.10 "," $3,743.10 "," $3,327.20 "," $3,327.20 ", $613.12 ," $3,840.00 "," $3,951.05 "," $3,743.10 "," $3,743.10 "," $3,743.10 "," $3,867.87 "," $3,992.64 "," $3,228.10 "," $3,535.15 "," $3,933.86 "," $3,709.85 ", N/A ," $2,496.44 "," $2,496.44 "," $3,951.05 "," $2,992.10 ", $613.12 ," $3,992.64 "
 Fac Cytogenetics&Molec Cytogenetics I&R ,CPT® 88291,0310 - PATHOLOGY LAB,N/A,N/A, $455.00 , $295.75 , $382.20 , $31.99 , $5.77 , $367.64 , $409.50 , $385.20 , $409.50 , $409.50 , $409.50 , $386.75 , $5.66 , $420.10 , $432.25 , $386.75 , $423.15 , $423.15 , $432.25 , $436.80 , $372.28 , $409.50 , $386.75 , $359.45 , N/A , $368.23 , $368.23 , $432.25 , $390.44 , $5.66 , $436.80 
 Pro MRI Chest W/Dye ,CPT® 71551,0972 - PRO FEE/RAD/DX,N/A,N/A, $846.00 , $549.90 ," $2,724.05 ", $385.74 , $503.27 ," $2,176.13 "," $2,753.87 ", $786.78 , $761.40 , $761.40 , $676.80 , $676.80 , $503.27 , $781.11 , $803.70 , $761.40 , $761.40 , $761.40 , $786.78 , $812.16 ," $2,357.70 ", $719.10 ," $3,004.63 "," $4,219.84 ", N/A ," $2,218.59 "," $2,218.59 ", $803.70 ," $2,568.05 ", $385.74 ," $4,219.84 "
Fx Closed Clavicular,23500,N/A,N/A,N/A, $820.00 , $533.00 ," $1,415.05 ", $225.64 , $69.88 ," $1,067.58 "," $1,092.79 ", $762.60 , $738.00 , $738.00 , $656.00 , $656.00 , $69.88 , $757.11 , $779.00 , $738.00 , $738.00 , $738.00 , $762.60 , $787.20 ," $1,301.54 ", $697.00 ," $1,197.11 "," $1,273.41 ", N/A ," $1,088.41 "," $1,088.41 ", $779.00 ," $1,279.27 ", $69.88 ," $1,415.05 "
"Fix Entropion,Extensive",CPT® 67924,N/A,N/A,N/A," $5,969.00 "," $3,879.85 "," $2,801.83 ", $440.25 , $614.67 ," $2,594.02 "," $2,397.47 "," $5,551.17 "," $5,372.10 "," $5,372.10 "," $4,775.20 "," $4,775.20 ", $614.67 ," $5,511.18 "," $5,670.55 "," $5,372.10 "," $5,372.10 "," $5,372.10 "," $5,551.17 "," $5,730.24 "," $3,848.52 "," $5,073.65 "," $2,488.77 "," $3,293.77 ", N/A ," $2,644.63 "," $2,644.63 "," $5,670.55 "," $2,919.31 ", $440.25 ," $5,730.24 "
Repair Scalp/Arm/Leg Addt,CPT® 13122,N/A,N/A,N/A, $764.00 , $496.60 , $261.73 , $78.10 , $88.09 , $233.43 , $225.70 , $710.52 , $687.60 , $687.60 , $611.20 , $611.20 , $88.09 , $705.40 , $725.80 , $687.60 , $687.60 , $687.60 , $710.52 , $733.44 , $289.90 , $649.40 , $453.15 , $298.73 , N/A , $237.98 , $237.98 , $725.80 , $275.96 , $78.10 , $733.44 
 Fac Chg Idh1 Common Variants ,CPT® 81120,0310 - PATHOLOGY LAB,N/A,N/A, $915.00 , $594.75 , $768.60 , $197.12 , $157.69 , $739.32 , $823.50 , $774.64 , $823.50 , $823.50 , $823.50 , $777.75 , $154.60 , $844.82 , $869.25 , $777.75 , $850.95 , $850.95 , $869.25 , $878.40 , $748.65 , $823.50 , $777.75 , $722.85 , N/A , $740.51 , $740.51 , $869.25 , $785.16 , $154.60 , $878.40 
 Pro DXA Bone Density Study Axial Skeleton ,CPT® 77085,0975 - PRO FEE/OR,N/A,N/A, $149.00 , $96.85 , $286.40 , $50.98 , $44.25 , $268.40 , $290.56 , $138.57 , $134.10 , $134.10 , $119.20 , $119.20 , $44.25 , $137.57 , $141.55 , $134.10 , $134.10 , $134.10 , $138.57 , $143.04 , $289.10 , $126.65 , $297.34 , $424.33 , N/A , $273.63 , $273.63 , $141.55 , $316.75 , $44.25 , $424.33 
" Pro Hemorrhoidectomy,Int/Ext,Simple ",CPT® 46255,0982 - PRO FEE/OUTPT,N/A,N/A," $3,324.00 "," $2,160.60 "," $2,188.36 ", $338.94 , $398.66 ," $1,677.63 "," $1,711.67 "," $3,091.32 "," $2,991.60 "," $2,991.60 "," $2,659.20 "," $2,659.20 ", $398.66 ," $3,069.05 "," $3,157.80 "," $2,991.60 "," $2,991.60 "," $2,991.60 "," $3,091.32 "," $3,191.04 "," $1,566.77 "," $2,825.40 "," $1,887.54 "," $1,993.47 ", N/A ," $1,710.36 "," $1,710.36 "," $3,157.80 "," $1,788.84 ", $338.94 ," $3,191.04 "
" Pro Dress/Debrid P-Thick Burn, M ",CPT® 16025,0982 - PRO FEE/OUTPT,N/A,N/A, $402.00 , $261.30 , $353.80 , $104.77 , $43.96 , $304.75 , $296.43 , $373.86 , $361.80 , $361.80 , $321.60 , $321.60 , $43.96 , $371.17 , $381.90 , $361.80 , $361.80 , $361.80 , $373.86 , $385.92 , $384.92 , $341.70 , $592.31 , $389.98 , N/A , $310.69 , $310.69 , $381.90 , $360.30 , $43.96 , $592.31 
 AMPICILLIN SODIUM 500 MG IJ SOLR ,HCPCS J0290,0636 - DRUGS REQUIRING DETAILED CODIN,00781-3407-95,0.5 mL, $22.64 , $14.72 , $19.02 , $0.80 , $0.94 , $18.29 , $20.38 , $19.17 , $20.38 , $20.38 , $20.38 , $19.24 , $0.92 , $20.90 , $21.51 , $19.24 , $21.06 , $21.06 , $21.51 , $21.73 , $18.52 , $20.38 , $19.24 , $17.89 , N/A , $18.32 , $18.32 , $21.51 , $19.43 , $0.80 , $21.73 
Fx Cl Prox Humeral W/O MA,23600,N/A,N/A,N/A," $1,196.00 ", $777.40 ," $1,967.03 ", $311.94 , $245.89 ," $1,478.02 "," $1,510.03 "," $1,112.28 "," $1,076.40 "," $1,076.40 ", $956.80 , $956.80 , $245.89 ," $1,104.27 "," $1,136.20 "," $1,076.40 "," $1,076.40 "," $1,076.40 "," $1,112.28 "," $1,148.16 "," $1,808.38 "," $1,016.60 "," $1,657.40 "," $1,760.08 ", N/A ," $1,506.86 "," $1,506.86 "," $1,136.20 "," $1,771.09 ", $245.89 ," $1,967.03 "
 HALOPERIDOL DECANOATE 50 MG/ML IM SOLN ,HCPCS J1631,0636 - DRUGS REQUIRING DETAILED CODIN,70069-0381-01,1 mL, $137.03 , $89.07 , $115.11 , $8.50 , $7.80 , $110.72 , $123.33 , $116.01 , $123.33 , $123.33 , $123.33 , $116.48 , $7.65 , $126.52 , $130.18 , $116.48 , $127.44 , $127.44 , $130.18 , $131.55 , $112.12 , $123.33 , $116.48 , $108.25 , N/A , $110.90 , $110.90 , $130.18 , $117.59 , $7.65 , $131.55 
 Carotid Duplex - Limited ,CPT® 93882,0921 - PERI VASCUL LAB,N/A,N/A, $836.00 , $543.40 , $702.24 , $121.03 , $131.93 , $675.49 , $752.40 , $707.76 , $752.40 , $752.40 , $752.40 , $710.60 , $129.34 , $771.88 , $794.20 , $710.60 , $777.48 , $777.48 , $794.20 , $802.56 , $684.02 , $752.40 , $710.60 , $660.44 , N/A , $676.57 , $676.57 , $794.20 , $717.37 , $121.03 , $802.56 
 Pro Cltx Calcaneal Fx W/O Mnpj ,CPT® 28400,0981 - PRO FEE/ER,N/A,N/A," $1,019.00 ", $662.35 ," $1,427.86 ", $226.27 , $230.52 ," $1,105.57 "," $1,134.26 ", $947.67 , $917.10 , $917.10 , $815.20 , $815.20 , $230.52 , $940.84 , $968.05 , $917.10 , $917.10 , $917.10 , $947.67 , $978.24 ," $1,314.98 ", $866.15 ," $1,238.14 "," $1,313.86 ", N/A ," $1,127.14 "," $1,127.14 ", $968.05 ," $1,324.78 ", $226.27 ," $1,427.86 "
Dstr Nrolytc Agnt Parverteb Fct Addl Crvcl/Thora,CPT® 64634,N/A,N/A,N/A, $606.00 , $393.90 , $332.07 , $64.33 , $161.82 , $384.95 , $361.04 , $563.58 , $545.40 , $545.40 , $484.80 , $484.80 , $161.82 , $559.52 , $575.70 , $545.40 , $545.40 , $545.40 , $563.58 , $581.76 , $362.83 , $515.10 , $349.68 , $413.79 , N/A , $392.46 , $392.46 , $575.70 , $421.03 , $64.33 , $581.76 
 ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% INH NEBU ,HCPCS RXA250,0250 - PHARMACY,00487-9501-01,3 mL, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Drug Screen Quantitative Zonisamide ,CPT® 80203,0301 - LAB/CHEMISTRY,N/A,N/A, $260.00 , $169.00 , $218.40 , $13.52 , $13.52 , $210.08 , $234.00 , $220.12 , $234.00 , $234.00 , $234.00 , $221.00 , $13.25 , $240.06 , $247.00 , $221.00 , $241.80 , $241.80 , $247.00 , $249.60 , $212.73 , $234.00 , $221.00 , $205.40 , N/A , $210.42 , $210.42 , $247.00 , $223.11 , $13.25 , $249.60 
 Pro Cytopathology Cerv/Vag ,CPT® 88141,0971 - PRO FEE/LAB,N/A,N/A, $192.00 , $124.80 , $79.51 , $22.56 , $22.43 , $128.25 , $144.51 , $178.56 , $172.80 , $172.80 , $153.60 , $153.60 , $22.43 , $177.27 , $182.40 , $172.80 , $172.80 , $172.80 , $178.56 , $184.32 , $140.29 , $163.20 , $150.83 , $112.96 , N/A , $119.69 , $119.69 , $182.40 , $131.53 , $22.43 , $184.32 
"Knee Scope,Full Synovect",CPT® 29876,N/A,N/A,N/A," $4,129.00 "," $2,683.85 "," $3,974.17 ", $622.54 , $562.99 ," $3,175.92 "," $3,161.93 "," $3,839.97 "," $3,716.10 "," $3,716.10 "," $3,303.20 "," $3,303.20 ", $562.99 ," $3,812.31 "," $3,922.55 "," $3,716.10 "," $3,716.10 "," $3,716.10 "," $3,839.97 "," $3,963.84 "," $3,697.88 "," $3,509.65 "," $3,491.41 "," $3,737.52 ", N/A ," $3,237.88 "," $3,237.88 "," $3,922.55 "," $3,805.67 ", $562.99 ," $3,974.17 "
Gauze > 48 in No W/Sal W/O B,HCPCS A6224,N/A,N/A,N/A, $11.00 , $7.15 , N/A , $4.89 , $2.62 , N/A , N/A , $10.23 , $9.90 , $9.90 , $8.80 , $8.80 , $2.62 , $10.16 , $10.45 , $9.90 , $9.90 , $9.90 , $10.23 , $10.56 , N/A , $9.35 , $4.54 , $4.45 , N/A , N/A , N/A , $10.45 , N/A , $2.62 , $10.56 
 Pro Diagnostic Bone Marrow Biopsies ,CPT® 38221,0982 - PRO FEE/OUTPT,N/A,N/A," $1,202.00 ", $781.30 , $340.20 , $67.98 , $234.23 , $269.17 , $270.00 ," $1,117.86 "," $1,081.80 "," $1,081.80 ", $961.60 , $961.60 , $234.23 ," $1,109.81 "," $1,141.90 "," $1,081.80 "," $1,081.80 "," $1,081.80 "," $1,117.86 "," $1,153.92 ", $359.38 ," $1,021.70 ", $387.14 , $355.09 , N/A , $274.42 , $274.42 ," $1,141.90 ", $318.38 , $67.98 ," $1,153.92 "
 Bone Scan Ltd W/Three Phase ,CPT® 78315,0341 - NUC MED/DX PROCEDURES,N/A,N/A," $2,949.00 "," $1,916.85 "," $2,477.16 ", $317.21 , $242.39 ," $2,382.79 "," $2,654.10 "," $2,496.62 "," $2,654.10 "," $2,654.10 "," $2,654.10 "," $2,506.65 ", $237.64 ," $2,722.81 "," $2,801.55 "," $2,506.65 "," $2,742.57 "," $2,742.57 "," $2,801.55 "," $2,831.04 "," $2,412.87 "," $2,654.10 "," $2,506.65 "," $2,329.71 ", N/A ," $2,386.63 "," $2,386.63 "," $2,801.55 "," $2,530.54 ", $237.64 ," $2,831.04 "
 L Spine MRI With Contrast ,CPT® 72149,0612 - MRI - SPINE,N/A,N/A," $5,783.00 "," $3,758.95 "," $4,857.72 ", $278.24 , $506.39 ," $4,672.66 "," $5,204.70 "," $4,895.89 "," $5,204.70 "," $5,204.70 "," $5,204.70 "," $4,915.55 ", $496.46 ," $5,339.44 "," $5,493.85 "," $4,915.55 "," $5,378.19 "," $5,378.19 "," $5,493.85 "," $5,551.68 "," $4,731.65 "," $5,204.70 "," $4,915.55 "," $4,568.57 ", N/A ," $4,680.18 "," $4,680.18 "," $5,493.85 "," $4,962.39 ", $278.24 ," $5,551.68 "
"US,Head/Neck Tissues,B-Scan/Real Time",CPT® 76536,N/A,N/A,N/A, $927.00 , $602.55 , $637.19 , $109.87 , $87.55 , $555.80 , $647.71 , $862.11 , $834.30 , $834.30 , $741.60 , $741.60 , $87.55 , $855.90 , $880.65 , $834.30 , $834.30 , $834.30 , $862.11 , $889.92 , $644.21 , $787.95 , $706.86 , $655.97 , N/A , $566.64 , $566.64 , $880.65 , $655.90 , $87.55 , $889.92 
Probe Nasolac Duct W Gen Anesth,CPT® 68811,N/A,N/A,N/A," $1,406.00 ", $913.90 , $827.39 , $130.29 , $267.78 ," $1,168.50 "," $1,106.74 "," $1,307.58 "," $1,265.40 "," $1,265.40 "," $1,124.80 "," $1,124.80 ", $267.78 ," $1,298.16 "," $1,335.70 "," $1,265.40 "," $1,265.40 "," $1,265.40 "," $1,307.58 "," $1,349.76 "," $1,137.45 "," $1,195.10 "," $1,147.15 ", $978.81 , N/A ," $1,191.30 "," $1,191.30 "," $1,335.70 "," $1,315.04 ", $130.29 ," $1,349.76 "
 Pro Treat Metacarpal Fracture ,CPT® 26600,0982 - PRO FEE/OUTPT,N/A,N/A," $1,917.00 "," $1,246.05 "," $1,787.76 ", $284.00 , $155.34 ," $1,331.76 "," $1,361.00 "," $1,782.81 "," $1,725.30 "," $1,725.30 "," $1,533.60 "," $1,533.60 ", $155.34 ," $1,769.97 "," $1,821.15 "," $1,725.30 "," $1,725.30 "," $1,725.30 "," $1,782.81 "," $1,840.32 "," $1,640.20 "," $1,629.45 "," $1,491.48 "," $1,590.09 ", N/A ," $1,357.74 "," $1,357.74 "," $1,821.15 "," $1,595.82 ", $155.34 ," $1,840.32 "
" Pro Strapping,Hand or Finger ",CPT® 29280,0981 - PRO FEE/ER,N/A,N/A, $181.00 , $117.65 , $122.20 , $19.17 , $8.89 , $96.50 , $178.79 , $168.33 , $162.90 , $162.90 , $144.80 , $144.80 , $8.89 , $167.12 , $171.95 , $162.90 , $162.90 , $162.90 , $168.33 , $173.76 , $112.20 , $153.85 , $192.68 , $118.75 , N/A , $98.38 , $98.38 , $171.95 , $115.63 , $8.89 , $192.68 
" Pro Repair Rotator Cuff, Chronic ",CPT® 23412,0975 - PRO FEE/OR,N/A,N/A," $4,677.00 "," $3,040.05 "," $5,174.20 ", $810.67 , $754.88 ," $4,110.06 "," $4,090.88 "," $4,349.61 "," $4,209.30 "," $4,209.30 "," $3,741.60 "," $3,741.60 ", $754.88 ," $4,318.27 "," $4,443.15 "," $4,209.30 "," $4,209.30 "," $4,209.30 "," $4,349.61 "," $4,489.92 "," $4,813.76 "," $3,975.45 "," $4,519.03 "," $4,843.14 ", N/A ," $4,190.25 "," $4,190.25 "," $4,443.15 "," $4,925.04 ", $754.88 ," $5,174.20 "
Injection Aa&/Strd Nerves Nrvtg Si Joint W/Img,64451,N/A,N/A,N/A, $815.00 , $529.75 , $404.72 , $78.68 , $166.49 , $436.58 , N/A , $757.95 , $733.50 , $733.50 , $652.00 , $652.00 , $166.49 , $752.49 , $774.25 , $733.50 , $733.50 , $733.50 , $757.95 , $782.40 , $421.43 , $692.75 , $428.24 , $480.34 , N/A , $445.09 , $445.09 , $774.25 , $477.46 , $78.68 , $782.40 
 Meckels Imag1ng ,CPT® 78290,0340 - NUCLEAR MEDICINE,N/A,N/A," $2,956.00 "," $1,921.40 "," $2,483.04 ", $301.84 , $156.54 ," $2,388.45 "," $2,660.40 "," $2,502.55 "," $2,660.40 "," $2,660.40 "," $2,660.40 "," $2,512.60 ", $153.47 ," $2,729.27 "," $2,808.20 "," $2,512.60 "," $2,749.08 "," $2,749.08 "," $2,808.20 "," $2,837.76 "," $2,418.60 "," $2,660.40 "," $2,512.60 "," $2,335.24 ", N/A ," $2,392.29 "," $2,392.29 "," $2,808.20 "," $2,536.54 ", $153.47 ," $2,837.76 "
 MAGNESIUM SULFATE 50 % IJ SOLN ,HCPCS J3475,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0064-03,2 mL, $16.68 , $10.84 , $14.01 , $0.95 , $0.81 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.79 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.79 , $16.01 
 Fac Biopsy of Prostate ,CPT® 55700,0361 - OR/MINOR,N/A,N/A," $2,110.00 "," $1,371.50 "," $1,772.40 ", $122.83 , $109.97 ," $1,704.88 "," $1,899.00 "," $1,786.33 "," $1,899.00 "," $1,899.00 "," $1,899.00 "," $1,793.50 ", $107.81 ," $1,948.16 "," $2,004.50 "," $1,793.50 "," $1,962.30 "," $1,962.30 "," $2,004.50 "," $2,025.60 "," $1,726.40 "," $1,899.00 "," $1,793.50 "," $1,666.90 ", N/A ," $1,707.62 "," $1,707.62 "," $2,004.50 "," $1,810.59 ", $107.81 ," $2,025.60 "
Hepatitis Be Ab Test,CPT® 86707,N/A,N/A,N/A, $126.00 , $81.90 , N/A , $11.80 , $11.80 , $65.48 , $78.29 , $117.18 , $113.40 , $113.40 , $100.80 , $100.80 , $11.80 , $116.34 , $119.70 , $113.40 , $113.40 , $113.40 , $117.18 , $120.96 , $77.26 , $107.10 , $76.23 , $41.94 , N/A , $61.11 , $61.11 , $119.70 , $66.78 , $11.80 , $120.96 
"Prolonged Serv,No Contact,1st Hr",CPT® 99358,N/A,N/A,N/A, $391.00 , $254.15 , $221.34 , $88.80 , N/A , $189.51 , $188.77 , $363.63 , $351.90 , $351.90 , $312.80 , $312.80 , N/A , $361.01 , $371.45 , $351.90 , $351.90 , $351.90 , $363.63 , $375.36 , $201.62 , $332.35 , N/A , $244.37 , N/A , $193.20 , $193.20 , $371.45 , $222.82 , $88.80 , $375.36 
Injection Aa&/Strd Brach Plex Cont Nfs Cath Img,CPT® 64416,N/A,N/A,N/A," $1,210.00 ", $786.50 , $317.98 , $75.23 , $83.45 , $445.70 , $421.14 ," $1,125.30 "," $1,089.00 "," $1,089.00 ", $968.00 , $968.00 , $83.45 ," $1,117.19 "," $1,149.50 "," $1,089.00 "," $1,089.00 "," $1,089.00 "," $1,125.30 "," $1,161.60 ", $346.26 ," $1,028.50 ", $410.33 , $480.21 , N/A , $454.40 , $454.40 ," $1,149.50 ", $487.47 , $75.23 ," $1,161.60 "
Hospital IP/Obs Discharge Day Mgmt 30 Min/<,CPT® 99238,N/A,N/A,N/A, $284.00 , $184.60 , $143.56 , $78.65 , $51.64 , $125.27 , $125.75 , $264.12 , $255.60 , $255.60 , $227.20 , $227.20 , $51.64 , $262.22 , $269.80 , $255.60 , $255.60 , $255.60 , $264.12 , $272.64 , $181.90 , $241.40 , $156.02 , $160.16 , $97.00 , $127.71 , $127.71 , $269.80 , $147.30 , $51.64 , $272.64 
"Esrd Services, per Month, 20+ Yr Old, 1 Visit",CPT® 90962,N/A,N/A,N/A, $777.00 , $505.05 , $470.90 , $197.04 , $183.86 , $410.43 , $416.13 , $722.61 , $699.30 , $699.30 , $621.60 , $621.60 , $183.86 , $717.40 , $738.15 , $699.30 , $699.30 , $699.30 , $722.61 , $745.92 , $619.82 , $660.45 , $548.42 , $697.88 , N/A , $418.44 , $418.44 , $738.15 , $487.82 , $183.86 , $745.92 
 Meconium Drug Screen Qualitative ,HCPCS G0481,0301 - LAB/CHEMISTRY,N/A,N/A, $235.00 , $152.75 , $197.40 , $159.72 , $100.36 , $189.88 , $211.50 , $198.95 , $211.50 , $211.50 , $211.50 , $199.75 , $98.39 , $216.98 , $223.25 , $199.75 , $218.55 , $218.55 , $223.25 , $225.60 , $192.28 , $211.50 , $199.75 , $185.65 , N/A , $190.19 , $190.19 , $223.25 , $201.65 , $98.39 , $225.60 
 Pro Amputation of Finger/Thumb ,CPT® 26952,0982 - PRO FEE/OUTPT,N/A,N/A," $4,286.00 "," $2,785.90 "," $4,299.17 ", $669.14 , $336.65 ," $3,062.08 "," $3,105.60 "," $3,985.98 "," $3,857.40 "," $3,857.40 "," $3,428.80 "," $3,428.80 ", $336.65 ," $3,957.26 "," $4,071.70 "," $3,857.40 "," $3,857.40 "," $3,857.40 "," $3,985.98 "," $4,114.56 "," $3,934.94 "," $3,643.10 "," $3,405.78 "," $3,654.94 ", N/A ," $3,121.83 "," $3,121.83 "," $4,071.70 "," $3,669.26 ", $336.65 ," $4,299.17 "
" Fluorescent Antibody, Screen-Pbb ",CPT® 86255,0302 - LAB/IMMUNOLOGY,N/A,N/A, $146.00 , $94.90 , $122.64 , $12.29 , $12.29 , $117.97 , $131.40 , $123.60 , $131.40 , $131.40 , $131.40 , $124.10 , $12.05 , $134.80 , $138.70 , $124.10 , $135.78 , $135.78 , $138.70 , $140.16 , $119.46 , $131.40 , $124.10 , $115.34 , N/A , $118.16 , $118.16 , $138.70 , $125.28 , $12.05 , $140.16 
 TRACE MINERALS CU-MN-SE-ZN 300-55-60-3000 MCG/ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00517-9305-25,1 mL, $144.74 , $94.08 , $121.58 , N/A , N/A , $116.95 , $130.27 , $122.54 , $130.27 , $130.27 , $130.27 , $123.03 , N/A , $133.64 , $137.50 , $123.03 , $134.61 , $134.61 , $137.50 , $138.95 , $118.43 , $130.27 , $123.03 , $114.34 , N/A , $117.14 , $117.14 , $137.50 , $124.20 , $114.34 , $138.95 
 Pro Treat Fracture of Ulna ,CPT® 25535,0982 - PRO FEE/OUTPT,N/A,N/A," $2,575.00 "," $1,673.75 "," $2,828.09 ", $446.23 , $307.34 ," $2,178.51 "," $2,197.64 "," $2,394.75 "," $2,317.50 "," $2,317.50 "," $2,060.00 "," $2,060.00 ", $307.34 ," $2,377.50 "," $2,446.25 "," $2,317.50 "," $2,317.50 "," $2,317.50 "," $2,394.75 "," $2,472.00 "," $2,617.19 "," $2,188.75 "," $2,417.41 "," $2,567.19 ", N/A ," $2,221.01 "," $2,221.01 "," $2,446.25 "," $2,610.49 ", $307.34 ," $2,828.09 "
 Fac Flt3 Gene Analysis Internal Tandem Dup Variants ,CPT® 81245,0300 - LABORATORY,N/A,N/A, $705.00 , $458.25 , $592.20 , $168.82 , $135.39 , $569.64 , $634.50 , $596.85 , $634.50 , $634.50 , $634.50 , $599.25 , $132.74 , $650.93 , $669.75 , $599.25 , $655.65 , $655.65 , $669.75 , $676.80 , $576.83 , $634.50 , $599.25 , $556.95 , N/A , $570.56 , $570.56 , $669.75 , $604.96 , $132.74 , $676.80 
"Coron Art, Bypass/Reop >1 Mon Orig",CPT® 33530,N/A,N/A,N/A," $4,943.00 "," $3,212.95 "," $3,044.60 ", $468.68 ," $1,057.93 "," $2,244.88 "," $2,216.31 "," $4,596.99 "," $4,448.70 "," $4,448.70 "," $3,954.40 "," $3,954.40 "," $1,057.93 "," $4,563.87 "," $4,695.85 "," $4,448.70 "," $4,448.70 "," $4,448.70 "," $4,596.99 "," $4,745.28 "," $2,825.33 "," $4,201.55 "," $2,813.47 "," $2,513.55 ", N/A ," $2,288.68 "," $2,288.68 "," $4,695.85 "," $2,599.93 ", $468.68 ," $4,745.28 "
Hospital IP/Obs Care Same Date Mod Mdm 70 Min,CPT® 99235,N/A,N/A,N/A, $531.00 , $345.15 , $329.62 , $155.20 , $193.93 , $292.56 , $291.18 , $493.83 , $477.90 , $477.90 , $424.80 , $424.80 , $193.93 , $490.27 , $504.45 , $477.90 , $477.90 , $477.90 , $493.83 , $509.76 , $495.29 , $451.35 , $362.30 , $370.50 , N/A , $298.27 , $298.27 , $504.45 , $344.01 , $155.20 , $509.76 
 Fac Thrombolysis Arterial Infusion Icra Rs&I Init Tx ,CPT® 37211,0761 - TREATMENT ROOM,N/A,N/A," $8,997.00 "," $5,848.05 "," $7,557.48 ", $351.92 , $272.54 ," $7,269.58 "," $8,097.30 "," $7,616.86 "," $8,097.30 "," $8,097.30 "," $8,097.30 "," $7,647.45 ", $267.20 ," $8,306.93 "," $8,547.15 "," $7,647.45 "," $8,367.21 "," $8,367.21 "," $8,547.15 "," $8,637.12 "," $7,361.35 "," $8,097.30 "," $7,647.45 "," $7,107.63 ", N/A ," $7,281.27 "," $7,281.27 "," $8,547.15 "," $7,720.33 ", $267.20 ," $8,637.12 "
" Fac Fluorescent Antibody, Titer ",CPT® 86256,0302 - LAB/IMMUNOLOGY,N/A,N/A, $152.00 , $98.80 , $127.68 , $12.29 , $12.29 , $122.82 , $136.80 , $128.68 , $136.80 , $136.80 , $136.80 , $129.20 , $12.05 , $140.34 , $144.40 , $129.20 , $141.36 , $141.36 , $144.40 , $145.92 , $124.37 , $136.80 , $129.20 , $120.08 , N/A , $123.01 , $123.01 , $144.40 , $130.43 , $12.05 , $145.92 
"Culture,Spec, Bacteria,Quant,Aerobic",CPT® 87071,N/A,N/A,N/A, $132.00 , $85.80 , N/A , $10.09 , $6.72 , $53.43 , $63.85 , $122.76 , $118.80 , $118.80 , $105.60 , $105.60 , $6.72 , $121.88 , $125.40 , $118.80 , $118.80 , $118.80 , $122.76 , $126.72 , $66.04 , $112.20 , $61.63 , $34.25 , N/A , $49.86 , $49.86 , $125.40 , $54.48 , $6.72 , $126.72 
"Biopsy of Breast, Incisional",CPT® 19101,N/A,N/A,N/A," $2,251.00 "," $1,463.15 ", $703.90 , $208.99 , $274.21 , $596.28 , $581.14 ," $2,093.43 "," $2,025.90 "," $2,025.90 "," $1,800.80 "," $1,800.80 ", $274.21 ," $2,078.35 "," $2,138.45 "," $2,025.90 "," $2,025.90 "," $2,025.90 "," $2,093.43 "," $2,160.96 ", $769.07 ," $1,913.35 "," $1,170.35 ", $755.64 , N/A , $607.92 , $607.92 ," $2,138.45 ", $704.98 , $208.99 ," $2,160.96 "
 BISOPROLOL FUMARATE 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,52817-0270-30,1 tablet, $11.58 , $7.53 , $9.73 , N/A , N/A , $9.36 , $10.42 , $9.80 , $10.42 , $10.42 , $10.42 , $9.84 , N/A , $10.69 , $11.00 , $9.84 , $10.77 , $10.77 , $11.00 , $11.12 , $9.47 , $10.42 , $9.84 , $9.15 , N/A , $9.37 , $9.37 , $11.00 , $9.94 , $9.15 , $11.12 
Rmvl1/Dual Chmbr Impltbl Dfb Eltrd Transvns Xtrj,CPT® 33244,N/A,N/A,N/A," $9,480.00 "," $6,162.00 "," $5,155.67 ", $795.89 , $840.15 ," $3,708.80 "," $3,578.83 "," $8,816.40 "," $8,532.00 "," $8,532.00 "," $7,584.00 "," $7,584.00 ", $840.15 ," $8,752.88 "," $9,006.00 "," $8,532.00 "," $8,532.00 "," $8,532.00 "," $8,816.40 "," $9,100.80 "," $4,764.20 "," $8,058.00 "," $4,497.63 "," $4,161.66 ", N/A ," $3,781.17 "," $3,781.17 "," $9,006.00 "," $4,295.41 ", $795.89 ," $9,100.80 "
Excison Tumor Soft Tissue Thigh/Knee Subq 3+Cm,27337,N/A,N/A,N/A," $4,431.00 "," $2,880.15 "," $2,530.97 ", $395.05 , $343.72 ," $2,002.26 "," $2,013.12 "," $4,120.83 "," $3,987.90 "," $3,987.90 "," $3,544.80 "," $3,544.80 ", $343.72 ," $4,091.14 "," $4,209.45 "," $3,987.90 "," $3,987.90 "," $3,987.90 "," $4,120.83 "," $4,253.76 "," $2,344.15 "," $3,766.35 "," $2,228.30 "," $2,359.43 ", N/A ," $2,041.33 "," $2,041.33 "," $4,209.45 "," $2,399.29 ", $343.72 ," $4,253.76 "
 CITALOPRAM HYDROBROMIDE 20 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6085-61,1 tablet, $13.84 , $9.00 , $11.63 , N/A , N/A , $11.18 , $12.46 , $11.72 , $12.46 , $12.46 , $12.46 , $11.76 , N/A , $12.78 , $13.15 , $11.76 , $12.87 , $12.87 , $13.15 , $13.29 , $11.32 , $12.46 , $11.76 , $10.93 , N/A , $11.20 , $11.20 , $13.15 , $11.88 , $10.93 , $13.29 
 Sotrovimab Covid Infusion ,HCPCS M0247,0771 - VACCINE ADMINISTRATION,N/A,N/A," $1,335.00 ", $867.75 ," $1,121.40 ", N/A , $459.00 ," $1,078.68 "," $1,201.50 "," $1,130.21 "," $1,201.50 "," $1,201.50 "," $1,201.50 "," $1,134.75 ", $450.00 ," $1,232.61 "," $1,268.25 "," $1,134.75 "," $1,241.55 "," $1,241.55 "," $1,268.25 "," $1,281.60 "," $1,092.30 "," $1,201.50 "," $1,134.75 "," $1,054.65 ", N/A ," $1,080.42 "," $1,080.42 "," $1,268.25 "," $1,145.56 ", $450.00 ," $1,281.60 "
Inj Multihance,HCPCS A9577,N/A,N/A,N/A, $14.00 , $9.10 , N/A , $1.85 , $2.77 , N/A , N/A , $13.02 , $12.60 , $12.60 , $11.20 , $11.20 , $2.77 , $12.93 , $13.30 , $12.60 , $12.60 , $12.60 , $13.02 , $13.44 , $2.44 , $11.90 , $4.54 , $2.48 , N/A , N/A , N/A , $13.30 , N/A , $1.85 , $13.44 
 Fac Perq Device Placemt Breast Loc Ea Les W Guidnce ,CPT® 19282,0361 - OR/MINOR,N/A,N/A," $1,089.00 ", $707.85 , $914.76 , $47.80 , $37.70 , $879.91 , $980.10 , $921.95 , $980.10 , $980.10 , $980.10 , $925.65 , $36.96 ," $1,005.47 "," $1,034.55 ", $925.65 ," $1,012.77 "," $1,012.77 "," $1,034.55 "," $1,045.44 ", $891.02 , $980.10 , $925.65 , $860.31 , N/A , $881.33 , $881.33 ," $1,034.55 ", $934.47 , $36.96 ," $1,045.44 "
 QUETIAPINE FUMARATE 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6639-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Sacrum/Coccyx Min 2 Views ,CPT® 72220,0320 - DX X-RAY,N/A,N/A, $296.00 , $192.40 , $248.64 , $32.04 , $27.66 , $239.17 , $266.40 , $250.59 , $266.40 , $266.40 , $266.40 , $251.60 , $27.12 , $273.30 , $281.20 , $251.60 , $275.28 , $275.28 , $281.20 , $284.16 , $242.19 , $266.40 , $251.60 , $233.84 , N/A , $239.55 , $239.55 , $281.20 , $254.00 , $27.12 , $284.16 
 Pro Mod Sed Other Phys/Qhp Initial 15 Mins 5/> Yrs ,CPT® 99156,0981 - PRO FEE/ER,N/A,N/A, $296.00 , $192.40 , $172.75 , $72.45 , $60.13 , $162.41 , $165.47 , $275.28 , $266.40 , $266.40 , $236.80 , $236.80 , $60.13 , $273.30 , $281.20 , $266.40 , $266.40 , $266.40 , $275.28 , $284.16 , $230.14 , $251.60 , $226.17 , $283.65 , N/A , $165.58 , $165.58 , $281.20 , $193.03 , $60.13 , $284.16 
 Chest MRI W/O and With Contrast ,CPT® 71552,0610 - MRI,N/A,N/A," $10,910.00 "," $7,091.50 "," $9,164.40 ", $462.73 , $640.25 ," $8,815.28 "," $9,819.00 "," $9,236.41 "," $9,819.00 "," $9,819.00 "," $9,819.00 "," $9,273.50 ", $627.70 ," $10,073.20 "," $10,364.50 "," $9,273.50 "," $10,146.30 "," $10,146.30 "," $10,364.50 "," $10,473.60 "," $8,926.56 "," $9,819.00 "," $9,273.50 "," $8,618.90 ", N/A ," $8,829.46 "," $8,829.46 "," $10,364.50 "," $9,361.87 ", $462.73 ," $10,473.60 "
 Pro Echo Exam of Abdomen ,CPT® 76705,0981 - PRO FEE/ER,N/A,N/A, $556.00 , $361.40 , $499.55 , $86.93 , $89.08 , $506.27 , $574.33 , $517.08 , $500.40 , $500.40 , $444.80 , $444.80 , $89.08 , $513.35 , $528.20 , $500.40 , $500.40 , $500.40 , $517.08 , $533.76 , $503.30 , $472.60 , $624.04 , $515.91 , N/A , $516.14 , $516.14 , $528.20 , $597.46 , $86.93 , $624.04 
Closure of Vagina,57120,N/A,N/A,N/A," $3,066.00 "," $1,992.90 "," $2,520.75 ", $509.81 , $989.73 ," $2,075.29 "," $2,077.48 "," $2,851.38 "," $2,759.40 "," $2,759.40 "," $2,452.80 "," $2,452.80 ", $989.73 ," $2,830.84 "," $2,912.70 "," $2,759.40 "," $2,759.40 "," $2,759.40 "," $2,851.38 "," $2,943.36 "," $2,618.03 "," $2,606.10 "," $2,726.05 "," $2,083.52 ", N/A ," $2,115.78 "," $2,115.78 "," $2,912.70 "," $2,537.75 ", $509.81 ," $2,943.36 "
 Pro Lyr Clsr F/E/E/N/L/M&/Muc 20.1 Cm-30.0 Cm ,CPT® 12056,0981 - PRO FEE/ER,N/A,N/A," $2,535.00 "," $1,647.75 "," $1,217.88 ", $364.92 , $448.13 , $952.97 ," $1,010.78 "," $2,357.55 "," $2,281.50 "," $2,281.50 "," $2,028.00 "," $2,028.00 ", $448.13 ," $2,340.57 "," $2,408.25 "," $2,281.50 "," $2,281.50 "," $2,281.50 "," $2,357.55 "," $2,433.60 "," $1,338.76 "," $2,154.75 "," $2,001.72 "," $1,341.54 ", N/A , $971.56 , $971.56 ," $2,408.25 "," $1,126.68 ", $364.92 ," $2,433.60 "
"Fix Entropion,Thermocaut",CPT® 67922,N/A,N/A,N/A," $2,816.00 "," $1,830.40 "," $1,222.26 ", $193.18 , $76.84 ," $1,115.45 "," $1,328.35 "," $2,618.88 "," $2,534.40 "," $2,534.40 "," $2,252.80 "," $2,252.80 ", $76.84 ," $2,600.01 "," $2,675.20 "," $2,534.40 "," $2,534.40 "," $2,534.40 "," $2,618.88 "," $2,703.36 "," $1,668.35 "," $2,393.60 "," $1,364.81 "," $1,422.07 ", N/A ," $1,137.22 "," $1,137.22 "," $2,675.20 "," $1,255.31 ", $76.84 ," $2,703.36 "
 Fac Placement Xtn Prosth for Endovascular Rpr ,CPT® 34709,0360 - OR SERVICES,N/A,N/A, $493.00 , $320.45 , $414.12 , $285.71 , $243.75 , $398.34 , $443.70 , $417.37 , $443.70 , $443.70 , $443.70 , $419.05 , $238.97 , $455.19 , $468.35 , $419.05 , $458.49 , $458.49 , $468.35 , $473.28 , $403.37 , $443.70 , $419.05 , $389.47 , N/A , $398.98 , $398.98 , $468.35 , $423.04 , $238.97 , $473.28 
 Fac Myelography via Lumbar Injection Rs&I Cervical ,CPT® 62302,0361 - OR/MINOR,N/A,N/A," $1,907.00 "," $1,239.55 "," $1,601.88 ", $114.71 , $192.64 ," $1,540.86 "," $1,716.30 "," $1,614.47 "," $1,716.30 "," $1,716.30 "," $1,716.30 "," $1,620.95 ", $188.86 ," $1,760.73 "," $1,811.65 "," $1,620.95 "," $1,773.51 "," $1,773.51 "," $1,811.65 "," $1,830.72 "," $1,560.31 "," $1,716.30 "," $1,620.95 "," $1,506.53 ", N/A ," $1,543.34 "," $1,543.34 "," $1,811.65 "," $1,636.40 ", $114.71 ," $1,830.72 "
Online Digital E/M Svc Est Pt <7 D 21+ Minutes,99423,N/A,N/A,N/A, $131.00 , $85.15 , $82.93 , $39.14 , $38.33 , $72.11 , N/A , $121.83 , $117.90 , $117.90 , $104.80 , $104.80 , $38.33 , $120.95 , $124.45 , $117.90 , $117.90 , $117.90 , $121.83 , $125.76 , $74.68 , $111.35 , $88.91 , $92.45 , N/A , $73.52 , $73.52 , $124.45 , $84.40 , $38.33 , $125.76 
Xers Tst Brncspsm Pre&Post Spmtry&Pls Ox W/Ecg,CPT® 94617,N/A,N/A,N/A, $574.00 , $373.10 , $205.18 , $85.92 , $75.54 , $198.37 , $209.86 , $533.82 , $516.60 , $516.60 , $459.20 , $459.20 , $75.54 , $529.97 , $545.30 , $516.60 , $516.60 , $516.60 , $533.82 , $551.04 , $284.89 , $487.90 , $262.51 , $359.73 , N/A , $202.24 , $202.24 , $545.30 , $235.77 , $75.54 , $551.04 
 Pro Abdom Paracentesis Dx/Ther W Imaging Guidance ,CPT® 49083,0972 - PRO FEE/RAD/DX,N/A,N/A," $2,090.00 "," $1,358.50 ", $655.33 , $101.73 , $362.06 , $531.21 , $543.60 ," $1,943.70 "," $1,881.00 "," $1,881.00 "," $1,672.00 "," $1,672.00 ", $362.06 ," $1,929.70 "," $1,985.50 "," $1,881.00 "," $1,881.00 "," $1,881.00 "," $1,943.70 "," $2,006.40 ", $471.73 ," $1,776.50 ", $586.96 , $631.12 , N/A , $541.58 , $541.58 ," $1,985.50 ", $566.43 , $101.73 ," $2,006.40 "
 Finger(S) Min 2 Views ,CPT® 73140,0320 - DX X-RAY,N/A,N/A, $365.00 , $237.25 , $306.60 , $37.22 , $23.98 , $294.92 , $328.50 , $309.01 , $328.50 , $328.50 , $328.50 , $310.25 , $23.51 , $337.00 , $346.75 , $310.25 , $339.45 , $339.45 , $346.75 , $350.40 , $298.64 , $328.50 , $310.25 , $288.35 , N/A , $295.39 , $295.39 , $346.75 , $313.21 , $23.51 , $350.40 
Diagnostic Bone Marrow Aspirations,38220,N/A,N/A,N/A," $1,087.00 ", $706.55 , $326.35 , $65.55 , $305.29 , $218.73 , $217.42 ," $1,010.91 ", $978.30 , $978.30 , $869.60 , $869.60 , $305.29 ," $1,003.63 "," $1,032.65 ", $978.30 , $978.30 , $978.30 ," $1,010.91 "," $1,043.52 ", $348.86 , $923.95 , $314.00 , $340.85 , N/A , $223.00 , $223.00 ," $1,032.65 ", $258.71 , $65.55 ," $1,043.52 "
 Fac Revsc Opn/Prq Tib/Pero W/Stnt/Angiop Sm Vsl ,CPT® 37230,0360 - OR SERVICES,N/A,N/A," $24,474.00 "," $15,908.10 "," $20,558.16 ", $620.78 , $516.28 ," $19,774.99 "," $22,026.60 "," $20,719.69 "," $22,026.60 "," $22,026.60 "," $22,026.60 "," $20,802.90 ", $506.16 ," $22,596.84 "," $23,250.30 "," $20,802.90 "," $22,760.82 "," $22,760.82 "," $23,250.30 "," $23,495.04 "," $20,024.63 "," $22,026.60 "," $20,802.90 "," $19,334.46 ", N/A ," $19,806.81 "," $19,806.81 "," $23,250.30 "," $21,001.14 ", $506.16 ," $23,495.04 "
Remove Intrauterine Device,CPT® 58301,N/A,N/A,N/A, $571.00 , $371.15 , $309.85 , $62.49 , $89.76 , $276.75 , $274.64 , $531.03 , $513.90 , $513.90 , $456.80 , $456.80 , $89.76 , $527.20 , $542.45 , $513.90 , $513.90 , $513.90 , $531.03 , $548.16 , $326.54 , $485.35 , $362.17 , $277.36 , N/A , $282.15 , $282.15 , $542.45 , $338.42 , $62.49 , $548.16 
"Closed Rx Tarsal Fx,Manip,Each",CPT® 28455,N/A,N/A,N/A," $2,167.00 "," $1,408.55 "," $1,619.28 ", $257.53 , $153.67 ," $1,267.45 "," $1,157.12 "," $2,015.31 "," $1,950.30 "," $1,950.30 "," $1,733.60 "," $1,733.60 ", $153.67 ," $2,000.79 "," $2,058.65 "," $1,950.30 "," $1,950.30 "," $1,950.30 "," $2,015.31 "," $2,080.32 "," $1,492.56 "," $1,841.95 "," $1,261.33 "," $1,503.87 ", N/A ," $1,292.18 "," $1,292.18 "," $2,058.65 "," $1,518.76 ", $153.67 ," $2,080.32 "
 Pro Mod Sedat Endo Service >5yrs ,HCPCS G0500,0982 - PRO FEE/OUTPT,N/A,N/A, $155.00 , $100.75 , $11.93 , $4.99 , N/A , $9.73 , N/A , $144.15 , $139.50 , $139.50 , $124.00 , $124.00 , N/A , $143.11 , $147.25 , $139.50 , $139.50 , $139.50 , $144.15 , $148.80 , $15.86 , $131.75 , $10.34 , $20.23 , N/A , $9.92 , $9.92 , $147.25 , $12.40 , $4.99 , $148.80 
Insert Cervical Dilator,CPT® 59200,N/A,N/A,N/A, $505.00 , $328.25 , $118.11 , $39.87 , $65.80 , $103.98 , $109.38 , $469.65 , $454.50 , $454.50 , $404.00 , $404.00 , $65.80 , $466.27 , $479.75 , $454.50 , $454.50 , $454.50 , $469.65 , $484.80 , $121.08 , $429.25 , $242.63 , $192.75 , N/A , $106.01 , $106.01 , $479.75 , $122.55 , $39.87 , $484.80 
 Moderna Administration Second Dose ,CPT® 0012A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
Treat Hip Dislocation,27265,N/A,N/A,N/A," $2,643.00 "," $1,717.95 "," $2,514.92 ", $401.80 , $336.07 ," $1,923.46 "," $1,959.11 "," $2,457.99 "," $2,378.70 "," $2,378.70 "," $2,114.40 "," $2,114.40 ", $336.07 ," $2,440.28 "," $2,510.85 "," $2,378.70 "," $2,378.70 "," $2,378.70 "," $2,457.99 "," $2,537.28 "," $2,304.80 "," $2,246.55 "," $2,151.58 "," $2,290.13 ", N/A ," $1,960.98 "," $1,960.98 "," $2,510.85 "," $2,304.84 ", $336.07 ," $2,537.28 "
 WARFARIN SODIUM 2 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00832-1212-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
" Fac Assay, Serum Cholinesterase ",CPT® 82480,0301 - LAB/CHEMISTRY,N/A,N/A, $100.00 , $65.00 , $84.00 , $8.03 , $8.03 , $80.80 , $90.00 , $84.66 , $90.00 , $90.00 , $90.00 , $85.00 , $7.87 , $92.33 , $95.00 , $85.00 , $93.00 , $93.00 , $95.00 , $96.00 , $81.82 , $90.00 , $85.00 , $79.00 , N/A , $80.93 , $80.93 , $95.00 , $85.81 , $7.87 , $96.00 
 Pro Sp Bone Agrft Local Add-On ,CPT® 20936,0982 - PRO FEE/OUTPT,N/A,N/A," $1,281.00 ", $832.65 , N/A , N/A , $464.89 , $614.93 , $595.80 ," $1,191.33 "," $1,152.90 "," $1,152.90 "," $1,024.80 "," $1,024.80 ", $464.89 ," $1,182.75 "," $1,216.95 "," $1,152.90 "," $1,152.90 "," $1,152.90 "," $1,191.33 "," $1,229.76 ", N/A ," $1,088.85 ", N/A , $721.19 , N/A , $626.92 , $626.92 ," $1,216.95 ", $736.86 , $464.89 ," $1,229.76 "
NOVAVAX 5 mcg/0.5mL DOSAGE; SECOND DOSE,CPT® 0042A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $76.25 , $128.02 , N/A , $82.60 , $82.60 , $66.50 , $96.14 , $38.92 , $128.02 
Pro Tenotomy Elbow Lateral/Medial Percutaneous,24357,N/A,N/A,N/A," $3,600.00 "," $2,340.00 "," $2,613.59 ", $409.40 , $311.91 ," $2,087.61 "," $2,128.22 "," $3,348.00 "," $3,240.00 "," $3,240.00 "," $2,880.00 "," $2,880.00 ", $311.91 ," $3,323.88 "," $3,420.00 "," $3,240.00 "," $3,240.00 "," $3,240.00 "," $3,348.00 "," $3,456.00 "," $2,416.76 "," $3,060.00 "," $2,342.48 "," $2,416.45 ", N/A ," $2,128.34 "," $2,128.34 "," $3,420.00 "," $2,501.57 ", $311.91 ," $3,456.00 "
Laparoscopy Tot Hysterectomy > 250 G W Tube/Ovary,CPT® 58573,N/A,N/A,N/A," $7,901.00 "," $5,135.65 "," $5,722.00 "," $1,156.55 ", $918.77 ," $5,306.63 "," $5,387.03 "," $7,347.93 "," $7,110.90 "," $7,110.90 "," $6,320.80 "," $6,320.80 ", $918.77 ," $7,294.99 "," $7,505.95 "," $7,110.90 "," $7,110.90 "," $7,110.90 "," $7,347.93 "," $7,584.96 "," $5,975.62 "," $6,715.85 "," $7,088.09 "," $4,926.94 ", N/A ," $5,410.16 "," $5,410.16 "," $7,505.95 "," $6,489.16 ", $918.77 ," $7,584.96 "
 DEXTROSE-NACL 5-0.45 % IV SOLN ,HCPCS RXA258,0258 - IV SOLUTIONS,00990-7926-09,"1,000 mL", $79.82 , $51.88 , $67.05 , N/A , N/A , $64.49 , $71.84 , $67.58 , $71.84 , $71.84 , $71.84 , $67.85 , N/A , $73.70 , $75.83 , $67.85 , $74.23 , $74.23 , $75.83 , $76.63 , $65.31 , $71.84 , $67.85 , $63.06 , N/A , $64.60 , $64.60 , $75.83 , $68.49 , $63.06 , $76.63 
" Resection; Sm Bowel, Single Anastomsis ",CPT® 44120,0360 - OR SERVICES,N/A,N/A," $11,740.00 "," $7,631.00 "," $9,861.60 "," $1,122.97 "," $1,490.95 "," $9,485.92 "," $10,566.00 "," $9,939.08 "," $10,566.00 "," $10,566.00 "," $10,566.00 "," $9,979.00 "," $1,461.72 "," $10,839.54 "," $11,153.00 "," $9,979.00 "," $10,918.20 "," $10,918.20 "," $11,153.00 "," $11,270.40 "," $9,605.67 "," $10,566.00 "," $9,979.00 "," $9,274.60 ", N/A ," $9,501.18 "," $9,501.18 "," $11,153.00 "," $10,074.09 "," $1,122.97 "," $11,270.40 "
Aortic Hemiarch Graft W/Isol & Ctrl Arch Vessels,CPT® 33866,N/A,N/A,N/A," $6,713.00 "," $4,363.45 "," $5,341.77 ", $822.75 , $792.45 ," $4,097.47 ", N/A ," $6,243.09 "," $6,041.70 "," $6,041.70 "," $5,370.40 "," $5,370.40 ", $792.45 ," $6,198.11 "," $6,377.35 "," $6,041.70 "," $6,041.70 "," $6,041.70 "," $6,243.09 "," $6,444.48 "," $4,965.80 "," $5,706.05 "," $4,779.98 "," $4,967.99 ", N/A ," $4,177.42 "," $4,177.42 "," $6,377.35 "," $4,745.54 ", $792.45 ," $6,444.48 "
 Pro Arthrs Kne Synvct Major 2/> Cmprts ,CPT® 29876,0982 - PRO FEE/OUTPT,N/A,N/A," $4,129.00 "," $2,683.85 "," $3,974.17 ", $622.54 , $562.99 ," $3,175.92 "," $3,161.93 "," $3,839.97 "," $3,716.10 "," $3,716.10 "," $3,303.20 "," $3,303.20 ", $562.99 ," $3,812.31 "," $3,922.55 "," $3,716.10 "," $3,716.10 "," $3,716.10 "," $3,839.97 "," $3,963.84 "," $3,697.88 "," $3,509.65 "," $3,491.41 "," $3,737.52 ", N/A ," $3,237.88 "," $3,237.88 "," $3,922.55 "," $3,805.67 ", $562.99 ," $3,974.17 "
 Fac Fine Needle Aspiration Bx W/CT Gdn Ea Addl ,CPT® 10010,0361 - OR/MINOR,N/A,N/A," $3,191.00 "," $2,074.15 "," $2,680.44 ", $68.29 , $223.87 ," $2,578.33 "," $2,871.90 "," $2,701.50 "," $2,871.90 "," $2,871.90 "," $2,871.90 "," $2,712.35 ", $219.48 ," $2,946.25 "," $3,031.45 "," $2,712.35 "," $2,967.63 "," $2,967.63 "," $3,031.45 "," $3,063.36 "," $2,610.88 "," $2,871.90 "," $2,712.35 "," $2,520.89 ", N/A ," $2,582.48 "," $2,582.48 "," $3,031.45 "," $2,738.20 ", $68.29 ," $3,063.36 "
 CHLORDIAZEPOXIDE HCL 5 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00555-0158-02,1 capsule, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Cytogenetics Mole Rep Int,CPT® 88291,N/A,N/A,N/A, $455.00 , $295.75 , $117.55 , $31.99 , $5.77 , $127.51 , $140.52 , $423.15 , $409.50 , $409.50 , $364.00 , $364.00 , $5.77 , $420.10 , $432.25 , $409.50 , $409.50 , $409.50 , $423.15 , $436.80 , $213.87 , $386.75 , $145.97 , $115.94 , N/A , $119.00 , $119.00 , $432.25 , $130.77 , $5.77 , $436.80 
 Fac Assay of Beta-2 Protein ,CPT® 82232,0301 - LAB/CHEMISTRY,N/A,N/A, $225.00 , $146.25 , $189.00 , $16.50 , $16.50 , $181.80 , $202.50 , $190.49 , $202.50 , $202.50 , $202.50 , $191.25 , $16.18 , $207.74 , $213.75 , $191.25 , $209.25 , $209.25 , $213.75 , $216.00 , $184.10 , $202.50 , $191.25 , $177.75 , N/A , $182.09 , $182.09 , $213.75 , $193.07 , $16.18 , $216.00 
 Pro Insert Emergency Airway ,CPT® 31500,0982 - PRO FEE/OUTPT,N/A,N/A," $1,361.00 ", $884.65 , $758.54 , $132.66 , $155.78 , $421.83 , $406.96 ," $1,265.73 "," $1,224.90 "," $1,224.90 "," $1,088.80 "," $1,088.80 ", $155.78 ," $1,256.61 "," $1,292.95 "," $1,224.90 "," $1,224.90 "," $1,224.90 "," $1,265.73 "," $1,306.56 ", $734.78 ," $1,156.85 ", $576.25 , $726.12 , N/A , $430.06 , $430.06 ," $1,292.95 ", $506.49 , $132.66 ," $1,306.56 "
Ablation Renal Tumor Unilateral Perq Cryotherapy,CPT® 50593,N/A,N/A,N/A," $9,490.00 "," $6,168.50 "," $2,480.84 ", $435.80 ," $2,378.14 "," $2,390.65 "," $2,218.74 "," $8,825.70 "," $8,541.00 "," $8,541.00 "," $7,592.00 "," $7,592.00 "," $2,378.14 "," $8,762.12 "," $9,015.50 "," $8,541.00 "," $8,541.00 "," $8,541.00 "," $8,825.70 "," $9,110.40 "," $2,496.33 "," $8,066.50 "," $2,515.53 "," $2,861.27 ", N/A ," $2,437.30 "," $2,437.30 "," $9,015.50 "," $2,864.70 ", $435.80 ," $9,110.40 "
Exc Tumor Soft Tissue Abdominal Wall Subq 3+Cm,CPT® 22903,N/A,N/A,N/A," $2,894.00 "," $1,881.10 "," $2,648.88 ", $412.17 , $361.86 ," $2,100.05 "," $2,088.99 "," $2,691.42 "," $2,604.60 "," $2,604.60 "," $2,315.20 "," $2,315.20 ", $361.86 ," $2,672.03 "," $2,749.30 "," $2,604.60 "," $2,604.60 "," $2,604.60 "," $2,691.42 "," $2,778.24 "," $2,454.49 "," $2,459.90 "," $2,306.79 "," $2,466.08 ", N/A ," $2,141.03 "," $2,141.03 "," $2,749.30 "," $2,516.46 ", $361.86 ," $2,778.24 "
" Fac OB US, Follow-Up, per Fetus ",CPT® 76816,0402 - ULTRASOUND,N/A,N/A, $514.00 , $334.10 , $431.76 , $108.84 , $76.19 , $415.31 , $462.60 , $435.15 , $462.60 , $462.60 , $462.60 , $436.90 , $74.70 , $474.58 , $488.30 , $436.90 , $478.02 , $478.02 , $488.30 , $493.44 , $420.55 , $462.60 , $436.90 , $406.06 , N/A , $415.98 , $415.98 , $488.30 , $441.06 , $74.70 , $493.44 
Computerized Corneal Topography Uni/Bi,CPT® 92025,N/A,N/A,N/A, $118.00 , $76.70 , $78.32 , $35.63 , $24.40 , $66.64 , $67.92 , $109.74 , $106.20 , $106.20 , $94.40 , $94.40 , $24.40 , $108.95 , $112.10 , $106.20 , $106.20 , $106.20 , $109.74 , $113.28 , $111.99 , $100.30 , $114.55 , $80.10 , N/A , $67.93 , $67.93 , $112.10 , $80.82 , $24.40 , $114.55 
 PALIPERIDONE PALMITATE ER 819 MG/2.63ML IM SUSY ,HCPCS J2427,0636 - DRUGS REQUIRING DETAILED CODIN,50458-0609-01,2.63 mL," $29,533.63 "," $19,196.86 "," $24,808.25 ", N/A , N/A ," $23,863.17 "," $26,580.27 "," $25,003.17 "," $26,580.27 "," $26,580.27 "," $26,580.27 "," $25,103.59 ", N/A ," $27,268.40 "," $28,056.95 "," $25,103.59 "," $27,466.28 "," $27,466.28 "," $28,056.95 "," $28,352.28 "," $24,164.42 "," $26,580.27 "," $25,103.59 "," $23,331.57 ", N/A ," $23,901.57 "," $23,901.57 "," $28,056.95 "," $25,342.81 "," $23,331.57 "," $28,352.28 "
 Pet Imaging W/CT Skull to Mid-Thigh ,CPT® 78815,0404 - PET POSITIVE EMISSION TOMOGRAP,N/A,N/A," $8,592.00 "," $5,584.80 "," $7,217.28 "," $1,555.08 "," $2,303.38 "," $6,942.34 "," $7,732.80 "," $7,273.99 "," $7,732.80 "," $7,732.80 "," $7,732.80 "," $7,303.20 "," $2,258.22 "," $7,932.99 "," $8,162.40 "," $7,303.20 "," $7,990.56 "," $7,990.56 "," $8,162.40 "," $8,248.32 "," $7,029.97 "," $7,732.80 "," $7,303.20 "," $6,787.68 ", N/A ," $6,953.51 "," $6,953.51 "," $8,162.40 "," $7,372.80 "," $1,555.08 "," $8,248.32 "
 Pro Emergency Department Visit Moderate Mdm ,CPT® 99284,0981 - PRO FEE/ER,N/A,N/A, $633.00 , $411.45 , $426.57 , $116.35 , $31.98 , $331.78 , $340.64 , $588.69 , $569.70 , $569.70 , $506.40 , $506.40 , $31.98 , $584.45 , $601.35 , $569.70 , $569.70 , $569.70 , $588.69 , $607.68 , $362.22 , $538.05 , $252.79 , $254.40 , $117.00 , $338.26 , $338.26 , $601.35 , $405.90 , $31.98 , $607.68 
 Fac Colonoscopy Flexible With Band Ligation(S) ,CPT® 45398,0360 - OR SERVICES,N/A,N/A," $2,988.00 "," $1,942.20 "," $2,509.92 ", $220.75 , $265.41 ," $2,414.30 "," $2,689.20 "," $2,529.64 "," $2,689.20 "," $2,689.20 "," $2,689.20 "," $2,539.80 ", $260.21 ," $2,758.82 "," $2,838.60 "," $2,539.80 "," $2,778.84 "," $2,778.84 "," $2,838.60 "," $2,868.48 "," $2,444.78 "," $2,689.20 "," $2,539.80 "," $2,360.52 ", N/A ," $2,418.19 "," $2,418.19 "," $2,838.60 "," $2,564.00 ", $220.75 ," $2,868.48 "
Optx Dstl Radl X-Artic Fx/Epiphysl Sep,25607,N/A,N/A,N/A," $2,326.00 "," $1,511.90 "," $4,513.34 ", $710.41 , $535.03 ," $3,538.70 "," $3,537.04 "," $2,163.18 "," $2,093.40 "," $2,093.40 "," $1,860.80 "," $1,860.80 ", $535.03 ," $2,147.60 "," $2,209.70 "," $2,093.40 "," $2,093.40 "," $2,093.40 "," $2,163.18 "," $2,232.96 "," $4,189.23 "," $1,977.10 "," $3,898.18 "," $4,186.72 ", N/A ," $3,607.75 "," $3,607.75 "," $2,209.70 "," $4,240.40 ", $535.03 ," $4,513.34 "
Excis Tongue Fold,CPT® 41115,N/A,N/A,N/A," $1,726.00 "," $1,121.90 ", $904.54 , $142.08 , $106.76 , $704.41 , $734.88 ," $1,605.18 "," $1,553.40 "," $1,553.40 "," $1,380.80 "," $1,380.80 ", $106.76 ," $1,593.62 "," $1,639.70 "," $1,553.40 "," $1,553.40 "," $1,553.40 "," $1,605.18 "," $1,656.96 ", $643.26 ," $1,467.10 ", $801.04 , $828.16 , N/A , $718.15 , $718.15 ," $1,639.70 ", $751.10 , $106.76 ," $1,656.96 "
Sono Fetal Heart Doppler,CPT® 76827,N/A,N/A,N/A, $807.00 , $524.55 , $401.82 , $68.97 , $66.58 , $366.72 , $316.42 , $750.51 , $726.30 , $726.30 , $645.60 , $645.60 , $66.58 , $745.10 , $766.65 , $726.30 , $726.30 , $726.30 , $750.51 , $774.72 , $407.83 , $685.95 , $342.84 , $424.94 , N/A , $373.88 , $373.88 , $766.65 , $432.79 , $66.58 , $774.72 
"US,Preg Uter,Fetal & Mat, 2-3 Trim,Addl",CPT® 76810,N/A,N/A,N/A, $686.00 , $445.90 , $502.16 , $87.61 , $94.79 , $455.17 , $510.59 , $637.98 , $617.40 , $617.40 , $548.80 , $548.80 , $94.79 , $633.38 , $651.70 , $617.40 , $617.40 , $617.40 , $637.98 , $658.56 , $507.82 , $583.10 , $556.63 , $525.49 , N/A , $464.05 , $464.05 , $651.70 , $537.13 , $87.61 , $658.56 
 Fac Insertion Indwelling Tunneled Pleural Catheter ,CPT® 32550,0361 - OR/MINOR,N/A,N/A," $9,705.00 "," $6,308.25 "," $8,152.20 ", $191.92 , $945.07 ," $7,841.64 "," $8,734.50 "," $8,216.25 "," $8,734.50 "," $8,734.50 "," $8,734.50 "," $8,249.25 ", $926.54 ," $8,960.63 "," $9,219.75 "," $8,249.25 "," $9,025.65 "," $9,025.65 "," $9,219.75 "," $9,316.80 "," $7,940.63 "," $8,734.50 "," $8,249.25 "," $7,666.95 ", N/A ," $7,854.26 "," $7,854.26 "," $9,219.75 "," $8,327.86 ", $191.92 ," $9,316.80 "
" Pro OB US >/= 14 Wks, Addl Fetus ",CPT® 76810,0972 - PRO FEE/RAD/DX,N/A,N/A, $338.00 , $219.70 , $502.16 , $87.61 , $94.79 , $455.17 , $510.59 , $314.34 , $304.20 , $304.20 , $270.40 , $270.40 , $94.79 , $312.08 , $321.10 , $304.20 , $304.20 , $304.20 , $314.34 , $324.48 , $507.82 , $287.30 , $556.63 , $525.49 , N/A , $464.05 , $464.05 , $321.10 , $537.13 , $87.61 , $556.63 
"Osteotomy 1st Metatarsal,Base/Shaft",CPT® 28306,N/A,N/A,N/A," $4,199.00 "," $2,729.35 "," $2,482.22 ", $391.20 , $357.66 ," $1,978.40 "," $1,978.03 "," $3,905.07 "," $3,779.10 "," $3,779.10 "," $3,359.20 "," $3,359.20 ", $357.66 ," $3,876.94 "," $3,989.05 "," $3,779.10 "," $3,779.10 "," $3,779.10 "," $3,905.07 "," $4,031.04 "," $2,288.05 "," $3,569.15 "," $2,160.50 "," $2,348.64 ", N/A ," $2,017.01 "," $2,017.01 "," $3,989.05 "," $2,370.71 ", $357.66 ," $4,031.04 "
 Pro Egd Deliver Thermal Energy Sphnctr/Cardia Gerd ,CPT® 43257,0982 - PRO FEE/OUTPT,N/A,N/A," $1,168.00 ", $759.20 ," $1,422.14 ", $218.70 , $274.68 ," $1,136.95 "," $1,570.98 "," $1,086.24 "," $1,051.20 "," $1,051.20 ", $934.40 , $934.40 , $274.68 ," $1,078.41 "," $1,109.60 "," $1,051.20 "," $1,051.20 "," $1,051.20 "," $1,086.24 "," $1,121.28 "," $1,019.34 ", $992.80 ," $1,719.84 "," $1,350.90 ", N/A ," $1,159.13 "," $1,159.13 "," $1,109.60 "," $1,212.32 ", $218.70 ," $1,719.84 "
 Fac Fluorescent Nonnfct Agt Antb Scr Ea Antb ,CPT® 86255,0302 - LAB/IMMUNOLOGY,N/A,N/A, $146.00 , $94.90 , $122.64 , $12.29 , $12.29 , $117.97 , $131.40 , $123.60 , $131.40 , $131.40 , $131.40 , $124.10 , $12.05 , $134.80 , $138.70 , $124.10 , $135.78 , $135.78 , $138.70 , $140.16 , $119.46 , $131.40 , $124.10 , $115.34 , N/A , $118.16 , $118.16 , $138.70 , $125.28 , $12.05 , $140.16 
 Pro Treat Elbow Fracture ,CPT® 24635,0982 - PRO FEE/OUTPT,N/A,N/A," $4,545.00 "," $2,954.25 "," $4,122.50 ", $648.58 , $845.22 ," $3,240.63 "," $3,237.34 "," $4,226.85 "," $4,090.50 "," $4,090.50 "," $3,636.00 "," $3,636.00 ", $845.22 ," $4,196.40 "," $4,317.75 "," $4,090.50 "," $4,090.50 "," $4,090.50 "," $4,226.85 "," $4,363.20 "," $3,831.11 "," $3,863.25 "," $3,568.13 "," $3,836.91 ", N/A ," $3,303.86 "," $3,303.86 "," $4,317.75 "," $3,883.21 ", $648.58 ," $4,363.20 "
Third and Any Addl Level Cerv/Thor,CPT® 64492,N/A,N/A,N/A, $622.00 , $404.30 , $297.65 , $57.81 , $69.96 , $343.48 , $334.14 , $578.46 , $559.80 , $559.80 , $497.60 , $497.60 , $69.96 , $574.29 , $590.90 , $559.80 , $559.80 , $559.80 , $578.46 , $597.12 , $326.05 , $528.70 , $326.48 , $369.05 , N/A , $350.19 , $350.19 , $590.90 , $375.68 , $57.81 , $597.12 
"C-Sec Only,Prev C-Sec",CPT® 59620,N/A,N/A,N/A," $4,263.00 "," $2,770.95 "," $2,492.64 ", $841.27 , $833.15 ," $2,195.20 "," $2,298.62 "," $3,964.59 "," $3,836.70 "," $3,836.70 "," $3,410.40 "," $3,410.40 ", $833.15 ," $3,936.03 "," $4,049.85 "," $3,836.70 "," $3,836.70 "," $3,836.70 "," $3,964.59 "," $4,092.48 "," $2,541.39 "," $3,623.55 "," $5,097.07 "," $2,181.59 ", N/A ," $2,238.03 "," $2,238.03 "," $4,049.85 "," $2,587.37 ", $833.15 ," $5,097.07 "
Bilirubin Total Transcutaneous,CPT® 88720,N/A,N/A,N/A, $119.00 , $77.35 , N/A , $5.12 , $3.57 , $28.11 , $43.30 , $110.67 , $107.10 , $107.10 , $95.20 , $95.20 , $3.57 , $109.87 , $113.05 , $107.10 , $107.10 , $107.10 , $110.67 , $114.24 , $33.52 , $101.15 , $32.44 , $21.91 , N/A , $26.23 , $26.23 , $113.05 , $28.82 , $3.57 , $114.24 
Open Rx Navicular Fx,CPT® 25628,N/A,N/A,N/A," $4,834.00 "," $3,142.10 "," $4,404.01 ", $690.80 , $481.11 ," $3,471.47 "," $3,451.11 "," $4,495.62 "," $4,350.60 "," $4,350.60 "," $3,867.20 "," $3,867.20 ", $481.11 ," $4,463.23 "," $4,592.30 "," $4,350.60 "," $4,350.60 "," $4,350.60 "," $4,495.62 "," $4,640.64 "," $4,095.77 "," $4,108.90 "," $3,798.27 "," $4,108.61 ", N/A ," $3,539.21 "," $3,539.21 "," $4,592.30 "," $4,159.83 ", $481.11 ," $4,640.64 "
 Pro Colonoscopy Ca Scrn Not Hi Rsk Ind ,HCPCS G0121,0982 - PRO FEE/OUTPT,N/A,N/A," $1,932.00 "," $1,255.80 "," $2,171.85 ", $174.48 , $351.69 , $373.81 , N/A ," $1,796.76 "," $1,738.80 "," $1,738.80 "," $1,545.60 "," $1,545.60 ", $351.69 ," $1,783.82 "," $1,835.40 "," $1,738.80 "," $1,738.80 "," $1,738.80 "," $1,796.76 "," $1,854.72 ", $813.49 ," $1,642.20 ", $420.39 ," $1,074.52 ", N/A , $381.10 , $381.10 ," $1,835.40 ", $476.38 , $174.48 ," $2,171.85 "
 FERROUS SULFATE 325 (65 FE) MG PO TBEC ,HCPCS RXC637,0250 - PHARMACY,69367-0166-20,1 tablet, $4.22 , $2.74 , $3.54 , N/A , N/A , $3.41 , $3.80 , $3.57 , $3.80 , $3.80 , $3.80 , $3.59 , N/A , $3.90 , $4.01 , $3.59 , $3.92 , $3.92 , $4.01 , $4.05 , $3.45 , $3.80 , $3.59 , $3.33 , N/A , $3.42 , $3.42 , $4.01 , $3.62 , $3.33 , $4.05 
 HEPATITIS B IMMUNE GLOBULIN 110 UNIT/0.5ML IM SOSY ,HCPCS 90371,0636 - DRUGS REQUIRING DETAILED CODIN,13533-0636-03,0.5 mL, $545.23 , $354.40 , $457.99 , $139.47 , $140.35 , $440.55 , $490.71 , $461.59 , $490.71 , $490.71 , $490.71 , $463.45 , $137.60 , $503.41 , $517.97 , $463.45 , $507.06 , $507.06 , $517.97 , $523.42 , $446.11 , $490.71 , $463.45 , $430.73 , N/A , $441.25 , $441.25 , $517.97 , $467.86 , $137.60 , $523.42 
 Fac Enteroscopy > 2nd Prtn W/Rmvl Lesion Snare ,CPT® 44364,0360 - OR SERVICES,N/A,N/A," $2,825.00 "," $1,836.25 "," $2,373.00 ", $193.73 , $398.63 ," $2,282.60 "," $2,542.50 "," $2,391.65 "," $2,542.50 "," $2,542.50 "," $2,542.50 "," $2,401.25 ", $390.81 ," $2,608.32 "," $2,683.75 "," $2,401.25 "," $2,627.25 "," $2,627.25 "," $2,683.75 "," $2,712.00 "," $2,311.42 "," $2,542.50 "," $2,401.25 "," $2,231.75 ", N/A ," $2,286.27 "," $2,286.27 "," $2,683.75 "," $2,424.13 ", $193.73 ," $2,712.00 "
"Rep Tendon Finger,W/O Gra",26418,N/A,N/A,N/A," $2,087.00 "," $1,356.55 "," $3,954.41 ", $615.23 , $426.00 ," $2,746.72 "," $2,822.57 "," $1,940.91 "," $1,878.30 "," $1,878.30 "," $1,669.60 "," $1,669.60 ", $426.00 ," $1,926.93 "," $1,982.65 "," $1,878.30 "," $1,878.30 "," $1,878.30 "," $1,940.91 "," $2,003.52 "," $3,614.06 "," $1,773.95 "," $3,084.65 "," $3,289.40 ", N/A ," $2,800.31 "," $2,800.31 "," $1,982.65 "," $3,291.34 ", $426.00 ," $3,954.41 "
"Cardiac Stress Tst,Complete",CPT® 93015,N/A,N/A,N/A, $887.00 , $576.55 , $445.38 , $69.37 , $93.74 , $411.77 , $447.31 , $824.91 , $798.30 , $798.30 , $709.60 , $709.60 , $93.74 , $818.97 , $842.65 , $798.30 , $798.30 , $798.30 , $824.91 , $851.52 , $434.18 , $753.95 , $417.47 , $426.88 , N/A , $419.81 , $419.81 , $842.65 , $465.35 , $69.37 , $851.52 
Fo Nontorsion Joint Cf,HCPCS L3935,N/A,N/A,N/A, $252.00 , $163.80 , N/A , $235.17 , $80.67 , N/A , N/A , $234.36 , $226.80 , $226.80 , $201.60 , $201.60 , $80.67 , $232.67 , $239.40 , $226.80 , $226.80 , $226.80 , $234.36 , $241.92 , N/A , $214.20 , $193.98 , $197.86 , N/A , N/A , N/A , $239.40 , N/A , $80.67 , $241.92 
 Pro Screening Mammography Bi 2-View Breast Inc Cad ,CPT® 77067,0972 - PRO FEE/RAD/DX,N/A,N/A, $178.00 , $115.70 , $726.51 , $126.63 , $108.04 , $629.01 , $696.92 , $165.54 , $160.20 , $160.20 , $142.40 , $142.40 , $108.04 , $164.35 , $169.10 , $160.20 , $160.20 , $160.20 , $165.54 , $170.88 , $727.53 , $151.30 , $738.57 , $745.21 , N/A , $641.28 , $641.28 , $169.10 , $742.30 , $108.04 , $745.21 
Layer Closure 30+Cm,12037,N/A,N/A,N/A," $1,866.00 "," $1,212.90 "," $1,027.96 ", $306.27 , $258.15 , $892.94 , $855.00 ," $1,735.38 "," $1,679.40 "," $1,679.40 "," $1,492.80 "," $1,492.80 ", $258.15 ," $1,722.88 "," $1,772.70 "," $1,679.40 "," $1,679.40 "," $1,679.40 "," $1,735.38 "," $1,791.36 "," $1,129.34 "," $1,586.10 "," $1,719.84 "," $1,133.19 ", N/A , $910.36 , $910.36 ," $1,772.70 "," $1,055.71 ", $258.15 ," $1,791.36 "
 Fac Bfb Trainj Any Modality ,CPT® 90901,0420 - PHYSICAL THERAPY,N/A,N/A, $62.00 , $40.30 , $52.08 , $18.88 , $49.89 , $50.10 , $55.80 , $52.49 , $55.80 , $55.80 , $55.80 , $52.70 , $48.91 , $57.24 , $58.90 , $52.70 , $57.66 , $57.66 , $58.90 , $59.52 , $50.73 , $55.80 , $52.70 , $48.98 , N/A , $50.18 , $50.18 , $58.90 , $53.20 , $18.88 , $59.52 
Excis/Dest Intranas Lesion; Int App,CPT® 30117,N/A,N/A,N/A," $5,348.00 "," $3,476.20 "," $1,833.04 ", $325.53 , $26.70 ," $1,299.68 "," $1,307.56 "," $4,973.64 "," $4,813.20 "," $4,813.20 "," $4,278.40 "," $4,278.40 ", $26.70 ," $4,937.81 "," $5,080.60 "," $4,813.20 "," $4,813.20 "," $4,813.20 "," $4,973.64 "," $5,134.08 "," $1,762.76 "," $4,545.80 "," $1,835.80 "," $1,716.82 ", N/A ," $1,325.03 "," $1,325.03 "," $5,080.60 "," $1,560.51 ", $26.70 ," $5,134.08 "
 FERROUS GLUCONATE 324 (37.5 FE) MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,20555-0019-00,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Pro Smpl Rpr Supfc S/N/Ax/G/T 2.6cm-7.5cm ,CPT® 12002,0981 - PRO FEE/ER,N/A,N/A, $574.00 , $373.10 , $183.91 , $54.60 , $67.36 , $160.40 , $155.64 , $533.82 , $516.60 , $516.60 , $459.20 , $459.20 , $67.36 , $529.97 , $545.30 , $516.60 , $516.60 , $516.60 , $533.82 , $551.04 , $201.24 , $487.90 , $312.21 , $204.29 , N/A , $163.53 , $163.53 , $545.30 , $189.63 , $54.60 , $551.04 
Thoracoscopy W/Dx Bx of Lung Nodules Unilatrl,CPT® 32608,N/A,N/A,N/A," $2,103.00 "," $1,366.95 "," $1,950.06 ", $340.70 , $290.49 ," $1,430.97 "," $1,452.92 "," $1,955.79 "," $1,892.70 "," $1,892.70 "," $1,682.40 "," $1,682.40 ", $290.49 ," $1,941.70 "," $1,997.85 "," $1,892.70 "," $1,892.70 "," $1,892.70 "," $1,955.79 "," $2,018.88 "," $1,891.08 "," $1,787.55 "," $2,103.41 "," $1,875.49 ", N/A ," $1,458.89 "," $1,458.89 "," $1,997.85 "," $1,718.16 ", $290.49 ," $2,103.41 "
"Fix Lid Ptosis,Levatr Resec,Extern",67904,N/A,N/A,N/A," $6,743.00 "," $4,382.95 "," $3,656.90 ", $573.90 , $588.32 ," $3,377.56 "," $3,189.07 "," $6,270.99 "," $6,068.70 "," $6,068.70 "," $5,394.40 "," $5,394.40 ", $588.32 ," $6,225.81 "," $6,405.85 "," $6,068.70 "," $6,068.70 "," $6,068.70 "," $6,270.99 "," $6,473.28 "," $5,024.21 "," $5,731.55 "," $3,309.44 "," $4,291.25 ", N/A ," $3,443.46 "," $3,443.46 "," $6,405.85 "," $3,801.12 ", $573.90 ," $6,473.28 "
 Pro Att/Reargmt Trnk Dfct 10 Cm/< ,CPT® 14000,0982 - PRO FEE/OUTPT,N/A,N/A," $2,707.00 "," $1,759.55 "," $1,596.57 ", $480.03 , $199.64 ," $1,369.32 "," $1,352.46 "," $2,517.51 "," $2,436.30 "," $2,436.30 "," $2,165.60 "," $2,165.60 ", $199.64 ," $2,499.37 "," $2,571.65 "," $2,436.30 "," $2,436.30 "," $2,436.30 "," $2,517.51 "," $2,598.72 "," $1,741.46 "," $2,300.95 "," $2,702.86 "," $1,748.46 ", N/A ," $1,396.04 "," $1,396.04 "," $2,571.65 "," $1,618.94 ", $199.64 ," $2,702.86 "
 Pro Exc H-F-Nk-Sp B9+Marg 0.6-1 ,CPT® 11421,0975 - PRO FEE/OR,N/A,N/A, $141.00 , $91.65 , $351.80 , $105.96 , $93.30 , $301.07 , $297.24 , $131.13 , $126.90 , $126.90 , $112.80 , $112.80 , $93.30 , $130.19 , $133.95 , $126.90 , $126.90 , $126.90 , $131.13 , $135.36 , $385.15 , $119.85 , $590.53 , $385.78 , N/A , $306.95 , $306.95 , $133.95 , $355.95 , $93.30 , $590.53 
Injection Aa&/Strd Sciatic Nerve W/Img Gdn,64445,N/A,N/A,N/A," $1,653.00 "," $1,074.45 ", $264.94 , $69.92 , $46.08 , $404.19 , $385.85 ," $1,537.29 "," $1,487.70 "," $1,487.70 "," $1,322.40 "," $1,322.40 ", $46.08 ," $1,526.21 "," $1,570.35 "," $1,487.70 "," $1,487.70 "," $1,487.70 "," $1,537.29 "," $1,586.88 ", $287.54 ," $1,405.05 ", $378.22 , $437.51 , N/A , $412.08 , $412.08 ," $1,570.35 ", $442.06 , $46.08 ," $1,586.88 "
Lens Sphcy Bifo 7.25-12/.25-,HCPCS V2211,N/A,N/A,N/A, $85.00 , $55.25 , N/A , $86.06 , N/A , N/A , N/A , $79.05 , $76.50 , $76.50 , $68.00 , $68.00 , N/A , $78.48 , $80.75 , $76.50 , $76.50 , $76.50 , $79.05 , $81.60 , N/A , $72.25 , $85.00 , $78.18 , N/A , N/A , N/A , $80.75 , N/A , $68.00 , $86.06 
 TRAZODONE HCL 100 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6869-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 FOLIC ACID 5 MG/ML IJ SOLN ,HCPCS RXA250,0250 - PHARMACY,63323-0184-10,1 mL, $30.32 , $19.71 , $25.47 , N/A , N/A , $24.50 , $27.29 , $25.67 , $27.29 , $27.29 , $27.29 , $25.77 , N/A , $27.99 , $28.80 , $25.77 , $28.20 , $28.20 , $28.80 , $29.11 , $24.81 , $27.29 , $25.77 , $23.95 , N/A , $24.54 , $24.54 , $28.80 , $26.02 , $23.95 , $29.11 
IV Dop Vel&/or Press C/Flo Rsrv Meas Addl Vsl,CPT® 93572,N/A,N/A,N/A," $1,239.00 ", $805.35 , N/A , N/A , $166.76 , $884.36 , $832.86 ," $1,152.27 "," $1,115.10 "," $1,115.10 ", $991.20 , $991.20 , $166.76 ," $1,143.97 "," $1,177.05 "," $1,115.10 "," $1,115.10 "," $1,115.10 "," $1,152.27 "," $1,189.44 ", N/A ," $1,053.15 ", $790.34 ," $1,093.31 ", N/A , $901.62 , $901.62 ," $1,177.05 ", $999.47 , $166.76 ," $1,189.44 "
"Rabies Vaccine, Im",CPT® 90675,N/A,N/A,N/A, $517.00 , $336.05 , N/A , $336.59 , $280.73 , $509.81 , $581.26 , $480.81 , $465.30 , $465.30 , $413.60 , $413.60 , $280.73 , $477.35 , $491.15 , $465.30 , $465.30 , $465.30 , $480.81 , $496.32 , $424.59 , $439.45 , $567.68 , $572.63 , N/A , $519.76 , $519.76 , $491.15 , $605.94 , $280.73 , $605.94 
 Fac Chemo IV Infus Each Addl Seq ,CPT® 96417,0335 - CHEMOTHERP-IV,N/A,N/A, $377.00 , $245.05 , $316.68 , $62.53 , $68.94 , $304.62 , $339.30 , $319.17 , $339.30 , $339.30 , $339.30 , $320.45 , $67.59 , $348.08 , $358.15 , $320.45 , $350.61 , $350.61 , $358.15 , $361.92 , $308.46 , $339.30 , $320.45 , $297.83 , N/A , $305.11 , $305.11 , $358.15 , $323.50 , $62.53 , $361.92 
Esophagoscopy Rig Transoral Removal Foreign Body,CPT® 43194,N/A,N/A,N/A," $1,320.00 ", $858.00 ," $1,166.49 ", $181.14 , $123.56 , $765.22 , $812.33 ," $1,227.60 "," $1,188.00 "," $1,188.00 "," $1,056.00 "," $1,056.00 ", $123.56 ," $1,218.76 "," $1,254.00 "," $1,188.00 "," $1,188.00 "," $1,188.00 "," $1,227.60 "," $1,267.20 ", $831.86 ," $1,122.00 "," $1,016.41 "," $1,090.27 ", N/A , $780.15 , $780.15 ," $1,254.00 ", $815.95 , $123.56 ," $1,267.20 "
"Biopsy of Prostate,Needle/Punch",55700,N/A,N/A,N/A, $726.00 , $471.90 , $572.27 , $122.83 , $109.97 , $448.37 , $451.52 , $675.18 , $653.40 , $653.40 , $580.80 , $580.80 , $109.97 , $670.32 , $689.70 , $653.40 , $653.40 , $653.40 , $675.18 , $696.96 , $539.43 , $617.10 , $718.98 , $633.08 , N/A , $457.12 , $457.12 , $689.70 , $547.87 , $109.97 , $718.98 
Reinforce Hip Bones,CPT® 27187,N/A,N/A,N/A," $6,566.00 "," $4,267.90 "," $6,034.73 ", $943.98 ," $1,536.80 "," $4,784.82 "," $4,749.79 "," $6,106.38 "," $5,909.40 "," $5,909.40 "," $5,252.80 "," $5,252.80 "," $1,536.80 "," $6,062.39 "," $6,237.70 "," $5,909.40 "," $5,909.40 "," $5,909.40 "," $6,106.38 "," $6,303.36 "," $5,609.73 "," $5,581.10 "," $5,252.28 "," $5,630.83 ", N/A ," $4,878.18 "," $4,878.18 "," $6,237.70 "," $5,733.59 ", $943.98 ," $6,303.36 "
 Pro Blepharp Upr Eyelid W/Excsv Skn W8ing Down Lid ,CPT® 15823,0975 - PRO FEE/OR,N/A,N/A," $2,329.00 "," $1,513.85 "," $1,787.55 ", $536.22 , $565.77 ," $1,492.01 "," $1,503.78 "," $2,165.97 "," $2,096.10 "," $2,096.10 "," $1,863.20 "," $1,863.20 ", $565.77 ," $2,150.37 "," $2,212.55 "," $2,096.10 "," $2,096.10 "," $2,096.10 "," $2,165.97 "," $2,235.84 "," $1,957.69 "," $1,979.65 "," $3,007.93 "," $1,934.59 ", N/A ," $1,521.12 "," $1,521.12 "," $2,212.55 "," $1,763.99 ", $536.22 ," $3,007.93 "
Removal Prepatella Bursa,27340,N/A,N/A,N/A," $1,563.00 "," $1,015.95 "," $2,302.37 ", $362.46 , $307.34 ," $1,790.25 "," $1,800.84 "," $1,453.59 "," $1,406.70 "," $1,406.70 "," $1,250.40 "," $1,250.40 ", $307.34 ," $1,443.12 "," $1,484.85 "," $1,406.70 "," $1,406.70 "," $1,406.70 "," $1,453.59 "," $1,500.48 "," $2,129.87 "," $1,328.55 "," $1,982.10 "," $2,116.27 ", N/A ," $1,825.18 "," $1,825.18 "," $1,484.85 "," $2,145.24 ", $307.34 ," $2,302.37 "
Pfizer-Biotech Admin Peds 6m - 4y Third Dose,CPT® 0083A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $56.00 , $128.02 , N/A , N/A , N/A , $66.50 , N/A , $38.92 , $128.02 
Remove Renal Tube W/Fluoro,CPT® 50389,N/A,N/A,N/A," $2,485.00 "," $1,615.25 ", $288.48 , $50.70 , $432.29 , $269.48 , $249.57 ," $2,311.05 "," $2,236.50 "," $2,236.50 "," $1,988.00 "," $1,988.00 ", $432.29 ," $2,294.40 "," $2,360.75 "," $2,236.50 "," $2,236.50 "," $2,236.50 "," $2,311.05 "," $2,385.60 ", $291.89 ," $2,112.25 ", $283.67 , $335.41 , N/A , $274.75 , $274.75 ," $2,360.75 ", $322.93 , $50.70 ," $2,385.60 "
 LAYER CLOSURE Trunk 7.6-12.5CM ,CPT® 12034,0981 - PRO FEE/ER,N/A,N/A," $1,268.00 ", $824.20 , $654.87 , $196.65 , $122.93 , $564.34 , $550.50 ," $1,179.24 "," $1,141.20 "," $1,141.20 "," $1,014.40 "," $1,014.40 ", $122.93 ," $1,170.74 "," $1,204.60 "," $1,141.20 "," $1,141.20 "," $1,141.20 "," $1,179.24 "," $1,217.28 ", $719.01 ," $1,077.80 "," $1,100.77 ", $726.60 , N/A , $575.35 , $575.35 ," $1,204.60 ", $667.22 , $122.93 ," $1,217.28 "
Corpora-Glans Fistulizatn,CPT® 54435,N/A,N/A,N/A," $2,291.00 "," $1,489.15 "," $1,839.72 ", $397.41 , $506.74 ," $1,338.04 "," $1,355.35 "," $2,130.63 "," $2,061.90 "," $2,061.90 "," $1,832.80 "," $1,832.80 ", $506.74 ," $2,115.28 "," $2,176.45 "," $2,061.90 "," $2,061.90 "," $2,061.90 "," $2,130.63 "," $2,199.36 "," $1,728.70 "," $1,947.35 "," $2,156.93 "," $2,022.69 ", N/A ," $1,364.15 "," $1,364.15 "," $2,176.45 "," $1,635.02 ", $397.41 ," $2,199.36 "
 Fac Galactose-1-Phosphate Uridyl Trase Quan ,CPT® 82775,0301 - LAB/CHEMISTRY,N/A,N/A, $194.00 , $126.10 , $162.96 , $21.49 , $21.49 , $156.75 , $174.60 , $164.24 , $174.60 , $174.60 , $174.60 , $164.90 , $21.07 , $179.12 , $184.30 , $164.90 , $180.42 , $180.42 , $184.30 , $186.24 , $158.73 , $174.60 , $164.90 , $153.26 , N/A , $157.00 , $157.00 , $184.30 , $166.47 , $21.07 , $186.24 
" Acute Myocardial Infarction, Discharged Alive Without Cc/McC ",MS DRG V40 (FY2023) 282,N/A,N/A,N/A," $11,729.66 "," $7,624.28 "," $9,852.91 ", N/A , N/A ," $9,477.57 "," $10,556.69 "," $9,930.33 "," $10,556.69 "," $10,556.69 "," $10,556.69 "," $9,970.21 ", N/A ," $10,830.00 "," $11,143.18 "," $9,970.21 "," $10,908.58 "," $10,908.58 "," $11,143.18 "," $11,260.47 "," $9,597.21 "," $10,556.69 "," $9,970.21 "," $9,266.43 ", N/A ," $9,492.81 "," $9,492.81 "," $11,143.18 "," $10,065.22 "," $9,266.43 "," $11,260.47 "
 OB US Detailed Add Fetus ,CPT® 76812,0402 - ULTRASOUND,N/A,N/A," $1,862.00 "," $1,210.30 "," $1,564.08 ", $190.57 , $131.67 ," $1,504.50 "," $1,675.80 "," $1,576.37 "," $1,675.80 "," $1,675.80 "," $1,675.80 "," $1,582.70 ", $129.09 ," $1,719.18 "," $1,768.90 "," $1,582.70 "," $1,731.66 "," $1,731.66 "," $1,768.90 "," $1,787.52 "," $1,523.49 "," $1,675.80 "," $1,582.70 "," $1,470.98 ", N/A ," $1,506.92 "," $1,506.92 "," $1,768.90 "," $1,597.78 ", $129.09 ," $1,787.52 "
 CT Maxillofacial/Sinuses W/Contrast ,CPT® 70487,0350 - CT SCAN,N/A,N/A," $2,281.00 "," $1,482.65 "," $1,916.04 ", $155.41 , $292.65 ," $1,843.05 "," $2,052.90 "," $1,931.09 "," $2,052.90 "," $2,052.90 "," $2,052.90 "," $1,938.85 ", $286.91 ," $2,106.05 "," $2,166.95 "," $1,938.85 "," $2,121.33 "," $2,121.33 "," $2,166.95 "," $2,189.76 "," $1,866.31 "," $2,052.90 "," $1,938.85 "," $1,801.99 ", N/A ," $1,846.01 "," $1,846.01 "," $2,166.95 "," $1,957.33 ", $155.41 ," $2,189.76 "
X-Ray Cerv Spine 2 Vw,CPT® 72040,N/A,N/A,N/A, $302.00 , $196.30 , $223.07 , $39.02 , $35.77 , $157.08 , $228.16 , $280.86 , $271.80 , $271.80 , $241.60 , $241.60 , $35.77 , $278.84 , $286.90 , $271.80 , $271.80 , $271.80 , $280.86 , $289.92 , $216.55 , $256.70 , $208.01 , $167.82 , N/A , $160.15 , $160.15 , $286.90 , $185.37 , $35.77 , $289.92 
" Fac 2d Tee W/Contrast, Int/Rept ",HCPCS C8925,0480 - CARDIOLOGY,N/A,N/A," $2,495.00 "," $1,621.75 "," $2,095.80 ", N/A , N/A ," $2,015.96 "," $2,245.50 "," $2,112.27 "," $2,245.50 "," $2,245.50 "," $2,245.50 "," $2,120.75 ", N/A ," $2,303.63 "," $2,370.25 "," $2,120.75 "," $2,320.35 "," $2,320.35 "," $2,370.25 "," $2,395.20 "," $2,041.41 "," $2,245.50 "," $2,120.75 "," $1,971.05 ", N/A ," $2,019.20 "," $2,019.20 "," $2,370.25 "," $2,140.96 "," $1,971.05 "," $2,395.20 "
 Isovue 300 per Ml ,HCPCS Q9967,0636 - DRUGS REQUIRING DETAILED CODIN,N/A,N/A, $2.00 , $1.30 , $1.68 , $0.13 , $0.17 , $1.62 , $1.80 , $1.69 , $1.80 , $1.80 , $1.80 , $1.70 , $0.17 , $1.85 , $1.90 , $1.70 , $1.86 , $1.86 , $1.90 , $1.92 , $1.64 , $1.80 , $1.70 , $1.58 , N/A , $1.62 , $1.62 , $1.90 , $1.72 , $0.13 , $1.92 
Hymenotomy Simple Incision,CPT® 56442,N/A,N/A,N/A, $320.00 , $208.00 , $219.45 , $45.17 , $37.87 , $195.48 , $196.29 , $297.60 , $288.00 , $288.00 , $256.00 , $256.00 , $37.87 , $295.46 , $304.00 , $288.00 , $288.00 , $288.00 , $297.60 , $307.20 , $229.56 , $272.00 , $256.91 , $197.47 , N/A , $199.28 , $199.28 , $304.00 , $239.04 , $37.87 , $307.20 
Plmt Nephrostomy Cath Prq New Access Rs&I,CPT® 50432,N/A,N/A,N/A," $5,506.00 "," $3,578.90 "," $1,108.95 ", $194.48 , $670.07 ," $1,095.90 ", $957.55 ," $5,120.58 "," $4,955.40 "," $4,955.40 "," $4,404.80 "," $4,404.80 ", $670.07 ," $5,083.69 "," $5,230.70 "," $4,955.40 "," $4,955.40 "," $4,955.40 "," $5,120.58 "," $5,285.76 "," $1,116.03 "," $4,680.10 "," $1,062.61 "," $1,283.39 ", N/A ," $1,117.28 "," $1,117.28 "," $5,230.70 "," $1,313.19 ", $194.48 ," $5,285.76 "
 Fac Paring/Cutting B9 Hyprkeratotic Les 1 Les ,CPT® 11055,0761 - TREATMENT ROOM,N/A,N/A, $134.00 , $87.10 , $112.56 , $15.16 , $26.33 , $108.27 , $120.60 , $113.44 , $120.60 , $120.60 , $120.60 , $113.90 , $25.81 , $123.72 , $127.30 , $113.90 , $124.62 , $124.62 , $127.30 , $128.64 , $109.64 , $120.60 , $113.90 , $105.86 , N/A , $108.45 , $108.45 , $127.30 , $114.99 , $15.16 , $128.64 
 Pro App Skn Sub Grft T/a/L Area/<100scm Ea Adl 25scm ,CPT® 15272,0982 - PRO FEE/OUTPT,N/A,N/A, $160.00 , $104.00 , $54.57 , $15.78 , $21.08 , $47.60 , $45.05 , $148.80 , $144.00 , $144.00 , $128.00 , $128.00 , $21.08 , $147.73 , $152.00 , $144.00 , $144.00 , $144.00 , $148.80 , $153.60 , $59.43 , $136.00 , $89.20 , $61.56 , N/A , $48.53 , $48.53 , $152.00 , $56.28 , $15.78 , $153.60 
Remv Bone for Graft Minor,CPT® 20900,N/A,N/A,N/A," $1,971.00 "," $1,281.15 "," $1,097.20 ", $171.29 , $202.22 , $920.66 ," $1,013.35 "," $1,833.03 "," $1,773.90 "," $1,773.90 "," $1,576.80 "," $1,576.80 ", $202.22 ," $1,819.82 "," $1,872.45 "," $1,773.90 "," $1,773.90 "," $1,773.90 "," $1,833.03 "," $1,892.16 "," $1,028.93 "," $1,675.35 "," $1,118.61 "," $1,075.00 ", N/A , $938.62 , $938.62 ," $1,872.45 "," $1,103.19 ", $171.29 ," $1,892.16 "
" Fac Immunoassay,Infectious Agent ",CPT® 86317,0302 - LAB/IMMUNOLOGY,N/A,N/A, $138.00 , $89.70 , $115.92 , $15.29 , $15.29 , $111.50 , $124.20 , $116.83 , $124.20 , $124.20 , $124.20 , $117.30 , $14.99 , $127.42 , $131.10 , $117.30 , $128.34 , $128.34 , $131.10 , $132.48 , $112.91 , $124.20 , $117.30 , $109.02 , N/A , $111.68 , $111.68 , $131.10 , $118.42 , $14.99 , $132.48 
 Fac Tcat Bx ,CPT® 37200,0761 - TREATMENT ROOM,N/A,N/A," $10,052.00 "," $6,533.80 "," $8,443.68 ", $202.98 , $231.08 ," $8,122.02 "," $9,046.80 "," $8,510.02 "," $9,046.80 "," $9,046.80 "," $9,046.80 "," $8,544.20 ", $226.55 ," $9,281.01 "," $9,549.40 "," $8,544.20 "," $9,348.36 "," $9,348.36 "," $9,549.40 "," $9,649.92 "," $8,224.55 "," $9,046.80 "," $8,544.20 "," $7,941.08 ", N/A ," $8,135.08 "," $8,135.08 "," $9,549.40 "," $8,625.62 ", $202.98 ," $9,649.92 "
" Fac West Nile Virus, Antibody ",CPT® 86789,0300 - LABORATORY,N/A,N/A, $29.00 , $18.85 , $24.36 , $14.68 , $14.68 , $23.43 , $26.10 , $24.55 , $26.10 , $26.10 , $26.10 , $24.65 , $14.39 , $26.78 , $27.55 , $24.65 , $26.97 , $26.97 , $27.55 , $27.84 , $23.73 , $26.10 , $24.65 , $22.91 , N/A , $23.47 , $23.47 , $27.55 , $24.88 , $14.39 , $27.84 
 Pro Repair Biceps Tendon ,CPT® 23430,0982 - PRO FEE/OUTPT,N/A,N/A," $2,607.00 "," $1,694.55 "," $4,536.16 ", $711.01 , $537.90 ," $3,600.06 "," $3,601.50 "," $2,424.51 "," $2,346.30 "," $2,346.30 "," $2,085.60 "," $2,085.60 ", $537.90 ," $2,407.04 "," $2,476.65 "," $2,346.30 "," $2,346.30 "," $2,346.30 "," $2,424.51 "," $2,502.72 "," $4,217.37 "," $2,215.95 "," $3,974.89 "," $4,235.40 ", N/A ," $3,670.30 "," $3,670.30 "," $2,476.65 "," $4,313.89 ", $537.90 ," $4,536.16 "
 DEXTROSE 250 MG/ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00409-1775-10,10 mL, $86.66 , $56.33 , $72.79 , N/A , N/A , $70.02 , $77.99 , $73.37 , $77.99 , $77.99 , $77.99 , $73.66 , N/A , $80.01 , $82.33 , $73.66 , $80.59 , $80.59 , $82.33 , $83.19 , $70.91 , $77.99 , $73.66 , $68.46 , N/A , $70.13 , $70.13 , $82.33 , $74.36 , $68.46 , $83.19 
Ntrprof Phone/Ntrnet/Ehr Referral Svc 30 Min,CPT® 99452,N/A,N/A,N/A, $140.00 , $91.00 , $72.91 , $32.51 , $29.19 , $76.22 , N/A , $130.20 , $126.00 , $126.00 , $112.00 , $112.00 , $29.19 , $129.26 , $133.00 , $126.00 , $126.00 , $126.00 , $130.20 , $134.40 , $66.16 , $119.00 , $73.22 , $80.44 , N/A , $77.70 , $77.70 , $133.00 , $90.58 , $29.19 , $134.40 
 CLONIDINE HCL (ANALGESIA) 100 MCG/ML EP SOLN ,HCPCS J0735,0636 - DRUGS REQUIRING DETAILED CODIN,67457-0218-10,10 mL, $129.38 , $84.10 , $108.68 , $21.46 , $23.35 , $104.54 , $116.44 , $109.53 , $116.44 , $116.44 , $116.44 , $109.97 , $22.89 , $119.46 , $122.91 , $109.97 , $120.32 , $120.32 , $122.91 , $124.20 , $105.86 , $116.44 , $109.97 , $102.21 , N/A , $104.71 , $104.71 , $122.91 , $111.02 , $21.46 , $124.20 
 BENZOCAINE-MENTHOL MG LOZG (INPT) ,HCPCS RXC637,0250 - PHARMACY,63824-0732-16,16 lozenge, $15.05 , $9.78 , $12.64 , N/A , N/A , $12.16 , $13.55 , $12.74 , $13.55 , $13.55 , $13.55 , $12.79 , N/A , $13.90 , $14.30 , $12.79 , $14.00 , $14.00 , $14.30 , $14.45 , $12.31 , $13.55 , $12.79 , $11.89 , N/A , $12.18 , $12.18 , $14.30 , $12.91 , $11.89 , $14.45 
 Fac Sigmoidoscopy Flx W/Rmvl Foreign Body ,CPT® 45332,0360 - OR SERVICES,N/A,N/A," $1,545.00 "," $1,004.25 "," $1,297.80 ", $99.12 , $114.34 ," $1,248.36 "," $1,390.50 "," $1,308.00 "," $1,390.50 "," $1,390.50 "," $1,390.50 "," $1,313.25 ", $112.10 ," $1,426.50 "," $1,467.75 "," $1,313.25 "," $1,436.85 "," $1,436.85 "," $1,467.75 "," $1,483.20 "," $1,264.12 "," $1,390.50 "," $1,313.25 "," $1,220.55 ", N/A ," $1,250.37 "," $1,250.37 "," $1,467.75 "," $1,325.76 ", $99.12 ," $1,483.20 "
X-Ray Hand 2 Vw,CPT® 73120,N/A,N/A,N/A, $268.00 , $174.20 , $175.10 , $30.70 , $25.85 , $123.44 , $146.85 , $249.24 , $241.20 , $241.20 , $214.40 , $214.40 , $25.85 , $247.44 , $254.60 , $241.20 , $241.20 , $241.20 , $249.24 , $257.28 , $170.65 , $227.80 , $161.79 , $142.25 , N/A , $125.85 , $125.85 , $254.60 , $145.67 , $25.85 , $257.28 
"Exc Skin Benig 1.1-2cm Face,Facial",CPT® 11442,N/A,N/A,N/A, $908.00 , $590.20 , $469.34 , $141.83 , $154.85 , $396.21 , $390.89 , $844.44 , $817.20 , $817.20 , $726.40 , $726.40 , $154.85 , $838.36 , $862.60 , $817.20 , $817.20 , $817.20 , $844.44 , $871.68 , $509.92 , $771.80 , $779.64 , $508.03 , N/A , $403.95 , $403.95 , $862.60 , $468.43 , $141.83 , $871.68 
 Moderna Admin Booster ,CPT® 0064A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , N/A , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , N/A , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $55.30 , $67.20 
Excision Submaxillary Gland,CPT® 42440,N/A,N/A,N/A," $2,756.00 "," $1,791.40 "," $2,557.10 ", $401.94 , $417.99 ," $1,982.65 "," $2,032.48 "," $2,563.08 "," $2,480.40 "," $2,480.40 "," $2,204.80 "," $2,204.80 ", $417.99 ," $2,544.61 "," $2,618.20 "," $2,480.40 "," $2,480.40 "," $2,480.40 "," $2,563.08 "," $2,645.76 "," $1,810.84 "," $2,342.60 "," $2,221.16 "," $2,325.54 ", N/A ," $2,021.33 "," $2,021.33 "," $2,618.20 "," $2,114.10 ", $401.94 ," $2,645.76 "
 Iodine L-131 ,HCPCS A9524,0343 - DIAGNOSTIC RADIOPHARMACEUTICALS,N/A,N/A, $222.00 , $144.30 , $186.48 , N/A , $48.22 , $179.38 , $199.80 , $187.95 , $199.80 , $199.80 , $199.80 , $188.70 , $47.27 , $204.97 , $210.90 , $188.70 , $206.46 , $206.46 , $210.90 , $213.12 , $181.64 , $199.80 , $188.70 , $175.38 , N/A , $179.66 , $179.66 , $210.90 , $190.50 , $47.27 , $213.12 
 Wound Incision Subcut Toe Tendon ,CPT® 28010,0761 - TREATMENT ROOM,N/A,N/A," $1,029.00 ", $668.85 , $864.36 , $202.90 , $76.84 , $831.43 , $926.10 , $871.15 , $926.10 , $926.10 , $926.10 , $874.65 , $75.33 , $950.08 , $977.55 , $874.65 , $956.97 , $956.97 , $977.55 , $987.84 , $841.93 , $926.10 , $874.65 , $812.91 , N/A , $832.77 , $832.77 , $977.55 , $882.98 , $75.33 , $987.84 
 Amputation; at Knee ,CPT® 27598,0360 - OR SERVICES,N/A,N/A," $12,200.00 "," $7,930.00 "," $10,248.00 ", $644.48 , $922.06 ," $9,857.60 "," $10,980.00 "," $10,328.52 "," $10,980.00 "," $10,980.00 "," $10,980.00 "," $10,370.00 ", $903.98 ," $11,264.26 "," $11,590.00 "," $10,370.00 "," $11,346.00 "," $11,346.00 "," $11,590.00 "," $11,712.00 "," $9,982.04 "," $10,980.00 "," $10,370.00 "," $9,638.00 ", N/A ," $9,873.46 "," $9,873.46 "," $11,590.00 "," $10,468.82 ", $644.48 ," $11,712.00 "
 ROMIPLOSTIM 250 MCG SC SOLR ,HCPCS J2796,0636 - DRUGS REQUIRING DETAILED CODIN,55513-0221-01,0.5 mL," $7,012.55 "," $4,558.16 "," $5,890.54 ", $97.38 , $93.06 ," $5,666.14 "," $6,311.30 "," $5,936.82 "," $6,311.30 "," $6,311.30 "," $6,311.30 "," $5,960.67 ", $91.24 ," $6,474.69 "," $6,661.92 "," $5,960.67 "," $6,521.67 "," $6,521.67 "," $6,661.92 "," $6,732.05 "," $5,737.67 "," $6,311.30 "," $5,960.67 "," $5,539.91 ", N/A ," $5,675.26 "," $5,675.26 "," $6,661.92 "," $6,017.47 ", $91.24 ," $6,732.05 "
 Rt Breast Biopsy Specimen Film ,CPT® 76098,0320 - DX X-RAY,N/A,N/A, $116.00 , $75.40 , $97.44 , $41.25 , $18.97 , $93.73 , $104.40 , $98.21 , $104.40 , $104.40 , $104.40 , $98.60 , $18.60 , $107.10 , $110.20 , $98.60 , $107.88 , $107.88 , $110.20 , $111.36 , $94.91 , $104.40 , $98.60 , $91.64 , N/A , $93.88 , $93.88 , $110.20 , $99.54 , $18.60 , $111.36 
Insj/Rplcmt Breast Implant Sep Day Mastectomy,CPT® 19342,N/A,N/A,N/A," $7,159.00 "," $4,653.35 "," $2,420.12 ", $725.13 , $793.96 ," $2,514.20 "," $2,466.18 "," $6,657.87 "," $6,443.10 "," $6,443.10 "," $5,727.20 "," $5,727.20 ", $793.96 ," $6,609.90 "," $6,801.05 "," $6,443.10 "," $6,443.10 "," $6,443.10 "," $6,657.87 "," $6,872.64 "," $2,654.64 "," $6,085.15 "," $4,948.99 "," $3,214.03 ", N/A ," $2,563.26 "," $2,563.26 "," $6,801.05 "," $2,972.52 ", $725.13 ," $6,872.64 "
 Fac Sewho Cap Design W/O Jnts Cf ,HCPCS L3961,0274 - PROSTHETIC DEV,N/A,N/A," $1,880.00 "," $1,222.00 "," $1,579.20 "," $1,788.62 "," $1,238.85 "," $1,519.04 "," $1,692.00 "," $1,591.61 "," $1,692.00 "," $1,692.00 "," $1,692.00 "," $1,598.00 "," $1,214.56 "," $1,735.80 "," $1,786.00 "," $1,598.00 "," $1,748.40 "," $1,748.40 "," $1,786.00 "," $1,804.80 "," $1,538.22 "," $1,692.00 "," $1,598.00 "," $1,485.20 ", N/A ," $1,521.48 "," $1,521.48 "," $1,786.00 "," $1,613.23 "," $1,214.56 "," $1,804.80 "
 Pro Removal of Pilonidal Lesion ,CPT® 11772,0982 - PRO FEE/OUTPT,N/A,N/A," $3,963.00 "," $2,575.95 "," $1,846.64 ", $548.02 , $432.26 ," $1,557.59 "," $1,531.58 "," $3,685.59 "," $3,566.70 "," $3,566.70 "," $3,170.40 "," $3,170.40 ", $432.26 ," $3,659.04 "," $3,764.85 "," $3,566.70 "," $3,566.70 "," $3,566.70 "," $3,685.59 "," $3,804.48 "," $2,033.11 "," $3,368.55 "," $3,070.37 "," $1,979.40 ", N/A ," $1,587.98 "," $1,587.98 "," $3,764.85 "," $1,841.52 ", $432.26 ," $3,804.48 "
Cast Sup Shrt Leg Ped Plster,HCPCS Q4039,N/A,N/A,N/A, $71.00 , $46.15 , N/A , $10.00 , $6.46 , N/A , N/A , $66.03 , $63.90 , $63.90 , $56.80 , $56.80 , $6.46 , $65.55 , $67.45 , $63.90 , $63.90 , $63.90 , $66.03 , $68.16 , N/A , $60.35 , $42.17 , $9.08 , N/A , N/A , N/A , $67.45 , N/A , $6.46 , $68.16 
 FLUOROURACIL 5 GM/100ML IV SOLN ,HCPCS J9190,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0117-61,100 mL, $158.22 , $102.84 , $132.90 , $1.87 , $2.57 , $127.84 , $142.40 , $133.95 , $142.40 , $142.40 , $142.40 , $134.49 , $2.52 , $146.08 , $150.31 , $134.49 , $147.14 , $147.14 , $150.31 , $151.89 , $129.46 , $142.40 , $134.49 , $124.99 , N/A , $128.05 , $128.05 , $150.31 , $135.77 , $1.87 , $151.89 
"Typhoid Vaccine, Im",CPT® 90691,N/A,N/A,N/A, $186.00 , $120.90 , N/A , N/A , $84.53 , $174.62 , $208.25 , $172.98 , $167.40 , $167.40 , $148.80 , $148.80 , $84.53 , $171.73 , $176.70 , $167.40 , $167.40 , $167.40 , $172.98 , $178.56 , N/A , $158.10 , $203.76 , $131.92 , N/A , $178.03 , $178.03 , $176.70 , $207.54 , $84.53 , $208.25 
 IV Push Ea Add'l Same Drug -ED -Mh ,CPT® 96376,0260 - IV THERAPY,N/A,N/A, $204.00 , $132.60 , $171.36 , N/A , $24.64 , $164.83 , $183.60 , $172.71 , $183.60 , $183.60 , $183.60 , $173.40 , $24.16 , $188.35 , $193.80 , $173.40 , $189.72 , $189.72 , $193.80 , $195.84 , $166.91 , $183.60 , $173.40 , $161.16 , N/A , $165.10 , $165.10 , $193.80 , $175.05 , $24.16 , $195.84 
 CLONIDINE 0.1 MG/24HR TD PTWK ,HCPCS RXC637,0250 - PHARMACY,00378-0871-99,1 patch, $170.15 , $110.60 , $142.93 , N/A , N/A , $137.48 , $153.14 , $144.05 , $153.14 , $153.14 , $153.14 , $144.63 , N/A , $157.10 , $161.64 , $144.63 , $158.24 , $158.24 , $161.64 , $163.34 , $139.22 , $153.14 , $144.63 , $134.42 , N/A , $137.70 , $137.70 , $161.64 , $146.01 , $134.42 , $163.34 
Perq Dstl Radial Fx/Epiphysl Sep,25606,N/A,N/A,N/A," $4,248.00 "," $2,761.20 "," $4,083.11 ", $642.81 , $530.72 ," $3,188.66 "," $3,190.39 "," $3,950.64 "," $3,823.20 "," $3,823.20 "," $3,398.40 "," $3,398.40 ", $530.72 ," $3,922.18 "," $4,035.60 "," $3,823.20 "," $3,823.20 "," $3,823.20 "," $3,950.64 "," $4,078.08 "," $3,783.27 "," $3,610.80 "," $3,514.61 "," $3,771.96 ", N/A ," $3,250.87 "," $3,250.87 "," $4,035.60 "," $3,820.94 ", $530.72 ," $4,083.11 "
Exc Sacr Press Ulc W Pri Suture,15931,N/A,N/A,N/A," $2,696.00 "," $1,752.40 "," $2,206.77 ", $660.56 , $366.32 ," $1,848.82 "," $1,798.75 "," $2,507.28 "," $2,426.40 "," $2,426.40 "," $2,156.80 "," $2,156.80 ", $366.32 ," $2,489.22 "," $2,561.20 "," $2,426.40 "," $2,426.40 "," $2,426.40 "," $2,507.28 "," $2,588.16 "," $2,422.83 "," $2,291.60 "," $3,623.43 "," $2,350.78 ", N/A ," $1,884.90 "," $1,884.90 "," $2,561.20 "," $2,185.86 ", $366.32 ," $3,623.43 "
 Fac Fo Nontorsion Joint Cf ,HCPCS L3935,0274 - PROSTHETIC DEV,N/A,N/A, $246.00 , $159.90 , $206.64 , $235.17 , $80.67 , $198.77 , $221.40 , $208.26 , $221.40 , $221.40 , $221.40 , $209.10 , $79.09 , $227.13 , $233.70 , $209.10 , $228.78 , $228.78 , $233.70 , $236.16 , $201.28 , $221.40 , $209.10 , $194.34 , N/A , $199.09 , $199.09 , $233.70 , $211.09 , $79.09 , $236.16 
Tangential Biopsy Skin Ea Sep/Additional Lesion,11103,N/A,N/A,N/A, $201.00 , $130.65 , $70.48 , $20.80 , $42.10 , $58.71 , N/A , $186.93 , $180.90 , $180.90 , $160.80 , $160.80 , $42.10 , $185.58 , $190.95 , $180.90 , $180.90 , $180.90 , $186.93 , $192.96 , $77.73 , $170.85 , $113.72 , $80.59 , N/A , $59.85 , $59.85 , $190.95 , $69.41 , $20.80 , $192.96 
Paravaginal Defect Repair Vaginal Approach,CPT® 57285,N/A,N/A,N/A," $4,164.00 "," $2,706.60 "," $3,283.90 ", $663.38 , $478.13 ," $2,742.44 "," $2,730.71 "," $3,872.52 "," $3,747.60 "," $3,747.60 "," $3,331.20 "," $3,331.20 ", $478.13 ," $3,844.62 "," $3,955.80 "," $3,747.60 "," $3,747.60 "," $3,747.60 "," $3,872.52 "," $3,997.44 "," $3,424.48 "," $3,539.40 "," $3,575.26 "," $2,763.61 ", N/A ," $2,795.95 "," $2,795.95 "," $3,955.80 "," $3,353.56 ", $478.13 ," $3,997.44 "
"Dilation/Curettage,Diagnostic",CPT® 58120,N/A,N/A,N/A," $1,880.00 "," $1,222.00 "," $1,105.05 ", $223.42 , $234.44 , $891.43 , $887.78 ," $1,748.40 "," $1,692.00 "," $1,692.00 "," $1,504.00 "," $1,504.00 ", $234.44 ," $1,735.80 "," $1,786.00 "," $1,692.00 "," $1,692.00 "," $1,692.00 "," $1,748.40 "," $1,804.80 "," $1,141.04 "," $1,598.00 "," $1,166.78 ", $894.68 , N/A , $908.82 , $908.82 ," $1,786.00 "," $1,090.09 ", $223.42 ," $1,804.80 "
Initial Nursing Facility Care Mod Mdm 35 Minutes,CPT® 99305,N/A,N/A,N/A, $343.00 , $222.95 , $257.31 , $129.74 , $75.26 , $225.96 , $229.10 , $318.99 , $308.70 , $308.70 , $274.40 , $274.40 , $75.26 , $316.69 , $325.85 , $308.70 , $308.70 , $308.70 , $318.99 , $329.28 , $326.99 , $291.55 , $286.54 , $277.27 , $123.00 , $230.37 , $230.37 , $325.85 , $265.69 , $75.26 , $329.28 
" Pro Layr Clos Wnd Face,Facial <2.5cm ",CPT® 12051,0982 - PRO FEE/OUTPT,N/A,N/A, $804.00 , $522.60 , $541.38 , $162.92 , $106.23 , $469.05 , $460.11 , $747.72 , $723.60 , $723.60 , $643.20 , $643.20 , $106.23 , $742.33 , $763.80 , $723.60 , $723.60 , $723.60 , $747.72 , $771.84 , $593.04 , $683.40 , $917.01 , $602.22 , N/A , $478.20 , $478.20 , $763.80 , $554.57 , $106.23 , $917.01 
Arthrocentesis Aspir&/Inj Interm Jt/Burs W/US,CPT® 20606,N/A,N/A,N/A, $538.00 , $349.70 , $319.15 , $49.66 , $62.45 , $252.02 , $260.06 , $500.34 , $484.20 , $484.20 , $430.40 , $430.40 , $62.45 , $496.74 , $511.10 , $484.20 , $484.20 , $484.20 , $500.34 , $516.48 , $301.54 , $457.30 , $273.65 , $307.57 , N/A , $256.93 , $256.93 , $511.10 , $302.01 , $49.66 , $516.48 
Surg Excision of Anal Lesion(S),46922,N/A,N/A,N/A," $1,756.00 "," $1,141.40 ", $837.92 , $131.22 , $76.84 , $642.36 , $659.57 ," $1,633.08 "," $1,580.40 "," $1,580.40 "," $1,404.80 "," $1,404.80 ", $76.84 ," $1,621.31 "," $1,668.20 "," $1,580.40 "," $1,580.40 "," $1,580.40 "," $1,633.08 "," $1,685.76 ", $595.23 ," $1,492.60 ", $726.11 , $765.51 , N/A , $654.89 , $654.89 ," $1,668.20 ", $684.95 , $76.84 ," $1,685.76 "
 Moderna Administration First Dose ,CPT® 0011A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
 Pro Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 6/> Vw ,CPT® 72084,0972 - PRO FEE/RAD/DX,N/A,N/A, $199.00 , $129.35 , $674.24 , $97.69 , $63.30 , $383.66 , $404.29 , $185.07 , $179.10 , $179.10 , $159.20 , $159.20 , $63.30 , $183.74 , $189.05 , $179.10 , $179.10 , $179.10 , $185.07 , $191.04 , $537.68 , $169.15 , $571.67 , $441.00 , N/A , $391.15 , $391.15 , $189.05 , $452.77 , $63.30 , $674.24 
"Resec Head of Phalanx,Toe",CPT® 28153,N/A,N/A,N/A," $2,772.00 "," $1,801.80 "," $1,642.23 ", $256.97 , $105.64 ," $1,303.01 "," $1,311.08 "," $2,577.96 "," $2,494.80 "," $2,494.80 "," $2,217.60 "," $2,217.60 ", $105.64 ," $2,559.39 "," $2,633.40 "," $2,494.80 "," $2,494.80 "," $2,494.80 "," $2,577.96 "," $2,661.12 "," $1,522.57 "," $2,356.20 "," $1,418.33 "," $1,556.07 ", N/A ," $1,328.43 "," $1,328.43 "," $2,633.40 "," $1,561.36 ", $105.64 ," $2,661.12 "
 Pro Circumcision W/Regionl Block ,CPT® 54150,0982 - PRO FEE/OUTPT,N/A,N/A, $830.00 , $539.50 , $426.81 , $91.37 , $61.84 , $313.26 , $316.20 , $771.90 , $747.00 , $747.00 , $664.00 , $664.00 , $61.84 , $766.34 , $788.50 , $747.00 , $747.00 , $747.00 , $771.90 , $796.80 , $401.58 , $705.50 , $508.46 , $470.51 , N/A , $319.36 , $319.36 , $788.50 , $382.78 , $61.84 , $796.80 
 Fac Blood Clot Factor X Test ,CPT® 85260,0305 - LAB/HEMATOLOGY,N/A,N/A, $265.00 , $172.25 , $222.60 , $18.26 , $18.26 , $214.12 , $238.50 , $224.35 , $238.50 , $238.50 , $238.50 , $225.25 , $17.90 , $244.67 , $251.75 , $225.25 , $246.45 , $246.45 , $251.75 , $254.40 , $216.82 , $238.50 , $225.25 , $209.35 , N/A , $214.46 , $214.46 , $251.75 , $227.40 , $17.90 , $254.40 
"Dil Urethra,Female,Subsequent",CPT® 53661,N/A,N/A,N/A, $491.00 , $319.15 , $216.03 , $38.45 , $19.25 , $196.94 , $184.88 , $456.63 , $441.90 , $441.90 , $392.80 , $392.80 , $19.25 , $453.34 , $466.45 , $441.90 , $441.90 , $441.90 , $456.63 , $471.36 , $217.20 , $417.35 , $208.74 , $250.37 , N/A , $200.78 , $200.78 , $466.45 , $235.99 , $19.25 , $471.36 
" Fac Piflu F-18, Dia 1 Millicurie ",HCPCS A9595,0343 - DIAGNOSTIC RADIOPHARMACEUTICALS,N/A,N/A," $1,642.00 "," $1,067.30 "," $1,379.28 ", N/A , $867.00 ," $1,326.74 "," $1,477.80 "," $1,390.12 "," $1,477.80 "," $1,477.80 "," $1,477.80 "," $1,395.70 ", $850.00 ," $1,516.06 "," $1,559.90 "," $1,395.70 "," $1,527.06 "," $1,527.06 "," $1,559.90 "," $1,576.32 "," $1,343.48 "," $1,477.80 "," $1,395.70 "," $1,297.18 ", N/A ," $1,328.87 "," $1,328.87 "," $1,559.90 "," $1,409.00 ", $850.00 ," $1,576.32 "
 Pro Doppler Flow Testing ,CPT® 93990,0972 - PRO FEE/RAD/DX,N/A,N/A, $331.00 , $215.15 , $821.15 , $125.08 , $140.15 , $861.26 ," $1,170.07 ", $307.83 , $297.90 , $297.90 , $264.80 , $264.80 , $140.15 , $305.61 , $314.45 , $297.90 , $297.90 , $297.90 , $307.83 , $317.76 , $655.71 , $281.35 , $625.46 , $600.83 , N/A , $878.06 , $878.06 , $314.45 , $973.35 , $125.08 ," $1,170.07 "
Revise Fem Part Oftotal Hip,CPT® 27138,N/A,N/A,N/A," $10,107.00 "," $6,569.55 "," $9,150.12 "," $1,427.88 "," $1,251.82 "," $7,397.03 "," $7,312.86 "," $9,399.51 "," $9,096.30 "," $9,096.30 "," $8,085.60 "," $8,085.60 "," $1,251.82 "," $9,331.79 "," $9,601.65 "," $9,096.30 "," $9,096.30 "," $9,096.30 "," $9,399.51 "," $9,702.72 "," $8,543.88 "," $8,590.95 "," $8,101.43 "," $8,692.39 ", N/A ," $7,541.36 "," $7,541.36 "," $9,601.65 "," $8,863.76 "," $1,251.82 "," $9,702.72 "
 Fac Igh@ Variable Region Somatic Mutation Analysis ,CPT® 81263,0310 - PATHOLOGY LAB,N/A,N/A," $2,545.00 "," $1,654.25 "," $2,137.80 ", $300.41 , $300.41 ," $2,056.36 "," $2,290.50 "," $2,154.60 "," $2,290.50 "," $2,290.50 "," $2,290.50 "," $2,163.25 ", $294.52 ," $2,349.80 "," $2,417.75 "," $2,163.25 "," $2,366.85 "," $2,366.85 "," $2,417.75 "," $2,443.20 "," $2,082.32 "," $2,290.50 "," $2,163.25 "," $2,010.55 ", N/A ," $2,059.67 "," $2,059.67 "," $2,417.75 "," $2,183.86 ", $294.52 ," $2,443.20 "
 Fac Brnchsc Ebus Guided Sampl 1/2 Node Station/Strux ,CPT® 31652,0360 - OR SERVICES,N/A,N/A," $3,365.00 "," $2,187.25 "," $2,826.60 ", $209.61 , $718.85 ," $2,718.92 "," $3,028.50 "," $2,848.81 "," $3,028.50 "," $3,028.50 "," $3,028.50 "," $2,860.25 ", $704.75 ," $3,106.90 "," $3,196.75 "," $2,860.25 "," $3,129.45 "," $3,129.45 "," $3,196.75 "," $3,230.40 "," $2,753.24 "," $3,028.50 "," $2,860.25 "," $2,658.35 ", N/A ," $2,723.29 "," $2,723.29 "," $3,196.75 "," $2,887.51 ", $209.61 ," $3,230.40 "
Assay of Arsenic,CPT® 82175,N/A,N/A,N/A, $205.00 , $133.25 , N/A , $19.35 , $19.35 , $107.34 , $128.40 , $190.65 , $184.50 , $184.50 , $164.00 , $164.00 , $19.35 , $189.28 , $194.75 , $184.50 , $184.50 , $184.50 , $190.65 , $196.80 , $126.67 , $174.25 , $124.88 , $68.78 , N/A , $100.18 , $100.18 , $194.75 , $109.48 , $19.35 , $196.80 
Simple Repair 12.6-20cm,12016,N/A,N/A,N/A," $1,205.00 ", $783.25 , $401.06 , $118.20 , $180.97 , $362.55 , $349.59 ," $1,120.65 "," $1,084.50 "," $1,084.50 ", $964.00 , $964.00 , $180.97 ," $1,112.58 "," $1,144.75 "," $1,084.50 "," $1,084.50 "," $1,084.50 "," $1,120.65 "," $1,156.80 ", $439.48 ," $1,024.25 ", $702.92 , $442.73 , N/A , $369.62 , $369.62 ," $1,144.75 ", $428.65 , $118.20 ," $1,156.80 "
Removal of Heel Spur,28119,N/A,N/A,N/A," $3,308.00 "," $2,150.20 "," $2,257.00 ", $353.25 , $384.19 ," $1,779.50 "," $1,771.98 "," $3,076.44 "," $2,977.20 "," $2,977.20 "," $2,646.40 "," $2,646.40 ", $384.19 ," $3,054.28 "," $3,142.60 "," $2,977.20 "," $2,977.20 "," $2,977.20 "," $3,076.44 "," $3,175.68 "," $2,084.07 "," $2,811.80 "," $1,917.87 "," $2,110.43 ", N/A ," $1,814.22 "," $1,814.22 "," $3,142.60 "," $2,132.34 ", $353.25 ," $3,175.68 "
 Pro Tangential Biopsy Skin Ea Sep/Additional Lesion ,CPT® 11103,0982 - PRO FEE/OUTPT,N/A,N/A, $201.00 , $130.65 , $70.48 , $20.80 , $42.10 , $58.71 , N/A , $186.93 , $180.90 , $180.90 , $160.80 , $160.80 , $42.10 , $185.58 , $190.95 , $180.90 , $180.90 , $180.90 , $186.93 , $192.96 , $77.73 , $170.85 , $113.72 , $80.59 , N/A , $59.85 , $59.85 , $190.95 , $69.41 , $20.80 , $192.96 
Treat Calcaneal Fracture,28400,N/A,N/A,N/A," $1,019.00 ", $662.35 ," $1,427.86 ", $226.27 , $230.52 ," $1,105.57 "," $1,134.26 ", $947.67 , $917.10 , $917.10 , $815.20 , $815.20 , $230.52 , $940.84 , $968.05 , $917.10 , $917.10 , $917.10 , $947.67 , $978.24 ," $1,314.98 ", $866.15 ," $1,238.14 "," $1,313.86 ", N/A ," $1,127.14 "," $1,127.14 ", $968.05 ," $1,324.78 ", $226.27 ," $1,427.86 "
 Fac Aspa Gene Analysis Common Variants ,CPT® 81200,0310 - PATHOLOGY LAB,N/A,N/A, $1.00 , $0.65 , $0.84 , $48.20 , $48.20 , $0.81 , $0.90 , $0.85 , $0.90 , $0.90 , $0.90 , $0.85 , $47.25 , $0.92 , $0.95 , $0.85 , $0.93 , $0.93 , $0.95 , $0.96 , $0.82 , $0.90 , $0.85 , $0.79 , N/A , $0.81 , $0.81 , $0.95 , $0.86 , $0.79 , $48.20 
 Pro Fetal Biophys Profil W/O Nst ,CPT® 76819,0972 - PRO FEE/RAD/DX,N/A,N/A, $361.00 , $234.65 , $475.19 , $83.42 , $89.42 , $426.09 , $474.00 , $335.73 , $324.90 , $324.90 , $288.80 , $288.80 , $89.42 , $333.31 , $342.95 , $324.90 , $324.90 , $324.90 , $335.73 , $346.56 , $479.00 , $306.85 , $518.11 , $503.86 , N/A , $434.40 , $434.40 , $342.95 , $502.84 , $83.42 , $518.11 
Iadna Streptococcus Grp Amp Prb,CPT® 87651,N/A,N/A,N/A, $140.00 , $91.00 , N/A , $35.79 , $35.79 , $198.56 , $237.51 , $130.20 , $126.00 , $126.00 , $112.00 , $112.00 , $35.79 , $129.26 , $133.00 , $126.00 , $126.00 , $126.00 , $130.20 , $134.40 , $234.30 , $119.00 , $230.30 , $127.26 , N/A , $185.31 , $185.31 , $133.00 , $202.50 , $35.79 , $237.51 
 Fac Rmvl Impltbl Dfb Plse Gen W/Rplcmt Plse Gen 2 Ld ,CPT® 33263,0360 - OR SERVICES,N/A,N/A," $9,774.00 "," $6,353.10 "," $8,210.16 ", $357.36 , $290.41 ," $7,897.39 "," $8,796.60 "," $8,274.67 "," $8,796.60 "," $8,796.60 "," $8,796.60 "," $8,307.90 ", $284.72 ," $9,024.33 "," $9,285.30 "," $8,307.90 "," $9,089.82 "," $9,089.82 "," $9,285.30 "," $9,383.04 "," $7,997.09 "," $8,796.60 "," $8,307.90 "," $7,721.46 ", N/A ," $7,910.10 "," $7,910.10 "," $9,285.30 "," $8,387.07 ", $284.72 ," $9,383.04 "
Fx Cl Tuberosity W/O Mani,23620,N/A,N/A,N/A," $1,873.00 "," $1,217.45 "," $1,620.39 ", $256.76 , $122.93 ," $1,235.51 "," $1,257.69 "," $1,741.89 "," $1,685.70 "," $1,685.70 "," $1,498.40 "," $1,498.40 ", $122.93 ," $1,729.34 "," $1,779.35 "," $1,685.70 "," $1,685.70 "," $1,685.70 "," $1,741.89 "," $1,798.08 "," $1,489.07 "," $1,592.05 "," $1,380.87 "," $1,464.61 ", N/A ," $1,259.62 "," $1,259.62 "," $1,779.35 "," $1,480.49 ", $122.93 ," $1,798.08 "
Online Digital E/M Svc Est Pt <7 D 11-20 Minutes,CPT® 99422,N/A,N/A,N/A, $77.00 , $50.05 , $51.58 , $24.61 , $23.72 , $45.29 , N/A , $71.61 , $69.30 , $69.30 , $61.60 , $61.60 , $23.72 , $71.09 , $73.15 , $69.30 , $69.30 , $69.30 , $71.61 , $73.92 , $47.07 , $65.45 , $56.03 , $58.07 , N/A , $46.18 , $46.18 , $73.15 , $53.00 , $23.72 , $73.92 
Complex Repair 1.1-2.5cm,13131,N/A,N/A,N/A," $1,487.00 ", $966.55 , $776.05 , $231.89 , $176.33 , $684.64 , $667.66 ," $1,382.91 "," $1,338.30 "," $1,338.30 "," $1,189.60 "," $1,189.60 ", $176.33 ," $1,372.95 "," $1,412.65 "," $1,338.30 "," $1,338.30 "," $1,338.30 "," $1,382.91 "," $1,427.52 ", $855.05 ," $1,263.95 "," $1,330.91 ", $878.14 , N/A , $698.00 , $698.00 ," $1,412.65 ", $809.44 , $176.33 ," $1,427.52 "
Ext Ecg > 48hr to 21 Day Review and Interpretatn,CPT® 0298T,N/A,N/A,N/A, $358.00 , $232.70 , N/A , N/A , N/A , N/A , N/A , $332.94 , $322.20 , $322.20 , $286.40 , $286.40 , N/A , $330.54 , $340.10 , $322.20 , $322.20 , $322.20 , $332.94 , $343.68 , N/A , $304.30 , N/A , N/A , N/A , N/A , N/A , $340.10 , N/A , $286.40 , $343.68 
"Injection, Fulvestrant",HCPCS J9395,N/A,N/A,N/A, $213.00 , $138.45 , N/A , $9.66 , $12.91 , N/A , N/A , $198.09 , $191.70 , $191.70 , $170.40 , $170.40 , $12.91 , $196.66 , $202.35 , $191.70 , $191.70 , $191.70 , $198.09 , $204.48 , $35.88 , $181.05 , $168.68 , $15.48 , N/A , N/A , N/A , $202.35 , N/A , $9.66 , $204.48 
Fx Cl Prox Humeral W Mani,CPT® 23605,N/A,N/A,N/A," $1,672.00 "," $1,086.80 "," $2,634.26 ", $415.72 , $461.04 ," $2,042.21 "," $2,063.18 "," $1,554.96 "," $1,504.80 "," $1,504.80 "," $1,337.60 "," $1,337.60 ", $461.04 ," $1,543.76 "," $1,588.40 "," $1,504.80 "," $1,504.80 "," $1,504.80 "," $1,554.96 "," $1,605.12 "," $2,440.63 "," $1,421.20 "," $2,271.11 "," $2,411.56 ", N/A ," $2,082.06 "," $2,082.06 "," $1,588.40 "," $2,447.14 ", $415.72 ," $2,634.26 "
Imm Admn Sarscov2 Vaccine Single Dose,CPT® 90480,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , N/A , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , N/A , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , N/A , N/A , N/A , N/A , N/A , $66.50 , N/A , $56.00 , $67.20 
Closed Rx Dist Fem Epiphysis,CPT® 27516,N/A,N/A,N/A," $3,214.00 "," $2,089.10 "," $2,981.10 ", $470.48 , $461.04 ," $2,298.16 "," $2,307.36 "," $2,989.02 "," $2,892.60 "," $2,892.60 "," $2,571.20 "," $2,571.20 ", $461.04 ," $2,967.49 "," $3,053.30 "," $2,892.60 "," $2,892.60 "," $2,892.60 "," $2,989.02 "," $3,085.44 "," $2,754.34 "," $2,731.90 "," $2,540.51 "," $2,718.77 ", N/A ," $2,343.01 "," $2,343.01 "," $3,053.30 "," $2,753.86 ", $461.04 ," $3,085.44 "
"Revise Eyelashes,Forceps",67820,N/A,N/A,N/A, $356.00 , $231.40 , $136.89 , $21.46 , $24.58 , $302.85 , $286.04 , $331.08 , $320.40 , $320.40 , $284.80 , $284.80 , $24.58 , $328.69 , $338.20 , $320.40 , $320.40 , $320.40 , $331.08 , $341.76 , $191.25 , $302.60 , $294.37 , $308.28 , N/A , $308.77 , $308.77 , $338.20 , $340.84 , $21.46 , $341.76 
 AMPICILLIN SODIUM 2 G IJ SOLR ,HCPCS J0290,0636 - DRUGS REQUIRING DETAILED CODIN,00781-3408-95,16 mL, $86.06 , $55.94 , $72.29 , $0.80 , $0.94 , $69.54 , $77.45 , $72.86 , $77.45 , $77.45 , $77.45 , $73.15 , $0.92 , $79.46 , $81.76 , $73.15 , $80.04 , $80.04 , $81.76 , $82.62 , $70.41 , $77.45 , $73.15 , $67.99 , N/A , $69.65 , $69.65 , $81.76 , $73.85 , $0.80 , $82.62 
"US,Preg Uter,Fet & Mat,+ Detl Fet Exm",CPT® 76811,N/A,N/A,N/A," $1,767.00 "," $1,148.55 ", $989.13 , $174.57 , $190.41 , $876.31 , $987.19 ," $1,643.31 "," $1,590.30 "," $1,590.30 "," $1,413.60 "," $1,413.60 ", $190.41 ," $1,631.47 "," $1,678.65 "," $1,590.30 "," $1,590.30 "," $1,590.30 "," $1,643.31 "," $1,696.32 ", $982.99 ," $1,501.95 "," $1,072.81 "," $1,025.68 ", N/A , $893.41 , $893.41 ," $1,678.65 "," $1,034.14 ", $174.57 ," $1,696.32 "
Removal Urachal Cyst,CPT® 51500,N/A,N/A,N/A," $4,563.00 "," $2,965.95 "," $3,459.32 ", $608.94 ," $1,267.84 "," $3,111.67 "," $2,902.72 "," $4,243.59 "," $4,106.70 "," $4,106.70 "," $3,650.40 "," $3,650.40 "," $1,267.84 "," $4,213.02 "," $4,334.85 "," $4,106.70 "," $4,106.70 "," $4,106.70 "," $4,243.59 "," $4,380.48 "," $3,467.39 "," $3,878.55 "," $3,286.25 "," $3,919.13 ", N/A ," $3,172.38 "," $3,172.38 "," $4,334.85 "," $3,728.68 ", $608.94 ," $4,380.48 "
 Fac Scope of Sigmoid Colon Only for Diagnosis ,CPT® 45330,0360 - OR SERVICES,N/A,N/A, $996.00 , $647.40 , $836.64 , $53.33 , $68.55 , $804.77 , $896.40 , $843.21 , $896.40 , $896.40 , $896.40 , $846.60 , $67.21 , $919.61 , $946.20 , $846.60 , $926.28 , $926.28 , $946.20 , $956.16 , $814.93 , $896.40 , $846.60 , $786.84 , N/A , $806.06 , $806.06 , $946.20 , $854.67 , $53.33 , $956.16 
 DESVENLAFAXINE SUCCINATE ER 50 MG PO TB24 ,HCPCS RXC637,0250 - PHARMACY,70436-0012-04,1 tablet, $56.57 , $36.77 , $47.52 , N/A , N/A , $45.71 , $50.91 , $47.89 , $50.91 , $50.91 , $50.91 , $48.08 , N/A , $52.23 , $53.74 , $48.08 , $52.61 , $52.61 , $53.74 , $54.31 , $46.29 , $50.91 , $48.08 , $44.69 , N/A , $45.78 , $45.78 , $53.74 , $48.54 , $44.69 , $54.31 
 Pro Strpg Elbw/Wrst ,CPT® 29260,0982 - PRO FEE/OUTPT,N/A,N/A, $352.00 , $228.80 , $120.06 , $18.51 , $15.54 , $94.80 , $184.95 , $327.36 , $316.80 , $316.80 , $281.60 , $281.60 , $15.54 , $325.00 , $334.40 , $316.80 , $316.80 , $316.80 , $327.36 , $337.92 , $112.20 , $299.20 , $199.82 , $114.64 , N/A , $96.65 , $96.65 , $334.40 , $113.60 , $15.54 , $337.92 
"Repair Lip,>1/2 Vert Height",CPT® 40654,N/A,N/A,N/A," $3,899.00 "," $2,534.35 "," $2,610.14 ", $411.10 , $539.88 ," $2,037.70 "," $2,097.65 "," $3,626.07 "," $3,509.10 "," $3,509.10 "," $3,119.20 "," $3,119.20 ", $539.88 ," $3,599.95 "," $3,704.05 "," $3,509.10 "," $3,509.10 "," $3,509.10 "," $3,626.07 "," $3,743.04 "," $1,858.88 "," $3,314.15 "," $2,301.44 "," $2,431.85 ", N/A ," $2,077.46 "," $2,077.46 "," $3,704.05 "," $2,172.81 ", $411.10 ," $3,743.04 "
Thromboplas Time Partial,CPT® 85730,N/A,N/A,N/A, $94.00 , $61.10 , N/A , $6.13 , $6.13 , $33.97 , $40.62 , $87.42 , $84.60 , $84.60 , $75.20 , $75.20 , $6.13 , $86.79 , $89.30 , $84.60 , $84.60 , $84.60 , $87.42 , $90.24 , $40.13 , $79.90 , $38.92 , $21.79 , N/A , $31.70 , $31.70 , $89.30 , $34.64 , $6.13 , $90.24 
Jak2 Targeted Sequence Analysis,CPT® 81279,N/A,N/A,N/A," $1,097.00 ", $713.05 , N/A , $188.90 , $151.12 , N/A , N/A ," $1,020.21 ", $987.30 , $987.30 , $877.60 , $877.60 , $151.12 ," $1,012.86 "," $1,042.15 ", $987.30 , $987.30 , $987.30 ," $1,020.21 "," $1,053.12 "," $1,236.62 ", $932.45 , $883.61 , $543.93 , N/A , $735.24 , $735.24 ," $1,042.15 ", $801.92 , $151.12 ," $1,236.62 "
"Lap, Esophagomyotomy W Fundoplasty",CPT® 43279,N/A,N/A,N/A," $10,354.00 "," $6,730.10 "," $7,603.70 "," $1,173.96 "," $1,122.18 "," $6,075.42 "," $6,106.56 "," $9,629.22 "," $9,318.60 "," $9,318.60 "," $8,283.20 "," $8,283.20 "," $1,122.18 "," $9,559.85 "," $9,836.30 "," $9,318.60 "," $9,318.60 "," $9,318.60 "," $9,629.22 "," $9,939.84 "," $5,463.13 "," $8,800.90 "," $6,806.20 "," $7,125.06 ", N/A ," $6,193.97 "," $6,193.97 "," $9,836.30 "," $6,478.23 "," $1,122.18 "," $9,939.84 "
 Fac Bfb Traing W/Emg &/Manometry 1st 15 Min Cntct ,CPT® 90912,0917 - PSYCH/BIOFEED,N/A,N/A, $152.00 , $98.80 , $127.68 , $42.05 , $63.61 , $122.82 , $136.80 , $128.68 , $136.80 , $136.80 , $136.80 , $129.20 , $62.36 , $140.34 , $144.40 , $129.20 , $141.36 , $141.36 , $144.40 , $145.92 , $124.37 , $136.80 , $129.20 , $120.08 , N/A , $123.01 , $123.01 , $144.40 , $130.43 , $42.05 , $145.92 
IP/Obs Consltj New/Est Pt Sf Mdm 35 Minutes,CPT® 99252,N/A,N/A,N/A, $326.00 , $211.90 , N/A , $70.01 , $63.23 , $164.58 , $164.07 , $303.18 , $293.40 , $293.40 , $260.80 , $260.80 , $63.23 , $301.00 , $309.70 , $293.40 , $293.40 , $293.40 , $303.18 , $312.96 , $207.96 , $277.10 , $160.52 , $164.02 , $87.75 , $167.79 , $167.79 , $309.70 , $199.74 , $63.23 , $312.96 
Endoven Abltj Incmptnt Vein Xtr Rf 2nd+ Veins,CPT® 36476,N/A,N/A,N/A," $2,861.00 "," $1,859.65 ", $786.63 , $120.99 , $230.12 , $583.88 , $737.89 ," $2,660.73 "," $2,574.90 "," $2,574.90 "," $2,288.80 "," $2,288.80 ", $230.12 ," $2,641.56 "," $2,717.95 "," $2,574.90 "," $2,574.90 "," $2,574.90 "," $2,660.73 "," $2,746.56 ", $727.86 ," $2,431.85 ", $929.50 , $655.15 , N/A , $595.26 , $595.26 ," $2,717.95 ", $676.24 , $120.99 ," $2,746.56 "
 PRAMIPEXOLE DIHYDROCHLORIDE 0.25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6704-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Amb Ift 911 Base Rate Bls Non-Emergent ,HCPCS A0428,0540 - AMBULANCE,N/A,N/A, $994.00 , $646.10 , $834.96 , N/A , $215.30 , $803.15 , $894.60 , $841.52 , $894.60 , $894.60 , $894.60 , $844.90 , $211.08 , $917.76 , $944.30 , $844.90 , $924.42 , $924.42 , $944.30 , $954.24 , $813.29 , $894.60 , $844.90 , $785.26 , N/A , $804.44 , $804.44 , $944.30 , $852.95 , $211.08 , $954.24 
Laps Total Hysterectomy 250 G/< W Tube/Ovary,58571,N/A,N/A,N/A," $6,179.00 "," $4,016.35 "," $4,274.80 ", $864.79 , $718.13 ," $4,110.90 "," $4,210.54 "," $5,746.47 "," $5,561.10 "," $5,561.10 "," $4,943.20 "," $4,943.20 ", $718.13 ," $5,705.07 "," $5,870.05 "," $5,561.10 "," $5,561.10 "," $5,561.10 "," $5,746.47 "," $5,931.84 "," $4,449.41 "," $5,252.15 "," $5,539.52 "," $3,629.53 ", N/A ," $4,191.11 "," $4,191.11 "," $5,870.05 "," $5,026.98 ", $718.13 ," $5,931.84 "
Pvb Thoracic Single Injection Site W/Img Gid,CPT® 64461,N/A,N/A,N/A, $978.00 , $635.70 , $388.39 , $75.14 , $119.15 , $489.05 , $464.02 , $909.54 , $880.20 , $880.20 , $782.40 , $782.40 , $119.15 , $902.99 , $929.10 , $880.20 , $880.20 , $880.20 , $909.54 , $938.88 , $414.88 , $831.30 , $410.47 , $521.75 , N/A , $498.59 , $498.59 , $929.10 , $534.86 , $75.14 , $938.88 
 Fac Egd Ablate Tumor Polyp/Lesion W/Dilation& Wire ,CPT® 43270,0360 - OR SERVICES,N/A,N/A," $3,048.00 "," $1,981.20 "," $2,560.32 ", $212.56 , $184.45 ," $2,462.78 "," $2,743.20 "," $2,580.44 "," $2,743.20 "," $2,743.20 "," $2,743.20 "," $2,590.80 ", $180.83 ," $2,814.22 "," $2,895.60 "," $2,590.80 "," $2,834.64 "," $2,834.64 "," $2,895.60 "," $2,926.08 "," $2,493.87 "," $2,743.20 "," $2,590.80 "," $2,407.92 ", N/A ," $2,466.75 "," $2,466.75 "," $2,895.60 "," $2,615.49 ", $180.83 ," $2,926.08 "
 Pro Removal of Arm Foreign Body ,CPT® 24200,0982 - PRO FEE/OUTPT,N/A,N/A," $1,355.00 ", $880.75 , $867.10 , $133.90 , $65.65 , $676.19 , $678.21 ," $1,260.15 "," $1,219.50 "," $1,219.50 "," $1,084.00 "," $1,084.00 ", $65.65 ," $1,251.07 "," $1,287.25 "," $1,219.50 "," $1,219.50 "," $1,219.50 "," $1,260.15 "," $1,300.80 ", $803.92 ," $1,151.75 ", $743.95 , $802.46 , N/A , $689.38 , $689.38 ," $1,287.25 ", $810.26 , $65.65 ," $1,300.80 "
"Chromosome Anal-Ct15,2kar",CPT® 88262,N/A,N/A,N/A," $2,289.00 "," $1,487.85 ", N/A , $128.00 , $128.00 , $697.92 ," $1,059.18 "," $2,128.77 "," $2,060.10 "," $2,060.10 "," $1,831.20 "," $1,831.20 ", $128.00 ," $2,113.43 "," $2,174.55 "," $2,060.10 "," $2,060.10 "," $2,060.10 "," $2,128.77 "," $2,197.44 ", $837.92 ," $1,945.65 ", $817.41 , $544.74 , N/A , $651.34 , $651.34 ," $2,174.55 ", $715.80 , $128.00 ," $2,197.44 "
 Grp Psyctx Pbb ,CPT® 90853,0915 - PSYCH/GROUP RX,N/A,N/A, $40.00 , $26.00 , $33.60 , $23.24 , $28.56 , $32.32 , $36.00 , $33.86 , $36.00 , $36.00 , $36.00 , $34.00 , $28.00 , $36.93 , $38.00 , $34.00 , $37.20 , $37.20 , $38.00 , $38.40 , $32.73 , $36.00 , $34.00 , $31.60 , N/A , $32.37 , $32.37 , $38.00 , $34.32 , $23.24 , $38.40 
Aldolase,CPT® 82085,N/A,N/A,N/A, $120.00 , $78.00 , N/A , $9.90 , $9.90 , $54.91 , $65.67 , $111.60 , $108.00 , $108.00 , $96.00 , $96.00 , $9.90 , $110.80 , $114.00 , $108.00 , $108.00 , $108.00 , $111.60 , $115.20 , $64.84 , $102.00 , $63.25 , $35.21 , N/A , $51.25 , $51.25 , $114.00 , $56.01 , $9.90 , $115.20 
 ACETAMINOPHEN 10 MG/ML IV SOLN ,HCPCS J0134,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0434-00,100 mL, $73.98 , $48.09 , $62.14 , $0.07 , $0.14 , $59.78 , $66.58 , $62.63 , $66.58 , $66.58 , $66.58 , $62.88 , $0.14 , $68.31 , $70.28 , $62.88 , $68.80 , $68.80 , $70.28 , $71.02 , $60.53 , $66.58 , $62.88 , $58.44 , N/A , $59.87 , $59.87 , $70.28 , $63.48 , $0.07 , $71.02 
" Pro Treat Finger Fracture, Each ",CPT® 26727,0982 - PRO FEE/OUTPT,N/A,N/A," $2,052.00 "," $1,333.80 "," $2,930.72 ", $461.65 , $176.16 ," $2,255.38 "," $2,267.82 "," $1,908.36 "," $1,846.80 "," $1,846.80 "," $1,641.60 "," $1,641.60 ", $176.16 ," $1,894.61 "," $1,949.40 "," $1,846.80 "," $1,846.80 "," $1,846.80 "," $1,908.36 "," $1,969.92 "," $2,718.42 "," $1,744.20 "," $2,490.55 "," $2,682.13 ", N/A ," $2,299.38 "," $2,299.38 "," $1,949.40 "," $2,702.59 ", $176.16 ," $2,930.72 "
" Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC ",MS DRG V40 (FY2023) 641,N/A,N/A,N/A," $21,476.97 "," $13,960.03 "," $18,040.65 ", N/A , N/A ," $17,353.39 "," $19,329.27 "," $18,182.40 "," $19,329.27 "," $19,329.27 "," $19,329.27 "," $18,255.42 ", N/A ," $19,829.69 "," $20,403.12 "," $18,255.42 "," $19,973.58 "," $19,973.58 "," $20,403.12 "," $20,617.89 "," $17,572.46 "," $19,329.27 "," $18,255.42 "," $16,966.81 ", N/A ," $17,381.31 "," $17,381.31 "," $20,403.12 "," $18,429.39 "," $16,966.81 "," $20,617.89 "
"Strapping,Ankle",29540,N/A,N/A,N/A, $186.00 , $120.90 , $109.46 , $16.87 , $27.51 , $89.69 , $127.55 , $172.98 , $167.40 , $167.40 , $148.80 , $148.80 , $27.51 , $171.73 , $176.70 , $167.40 , $167.40 , $167.40 , $172.98 , $178.56 , $102.32 , $158.10 , $137.37 , $106.42 , N/A , $91.44 , $91.44 , $176.70 , $107.47 , $16.87 , $178.56 
 Fac Hast W/Phys I&R W/Suppl O2 Titrj ,CPT® 94453,0460 - PULMONARY FUNC,N/A,N/A, $656.00 , $426.40 , $551.04 , $64.83 , $64.19 , $530.05 , $590.40 , $555.37 , $590.40 , $590.40 , $590.40 , $557.60 , $62.93 , $605.68 , $623.20 , $557.60 , $610.08 , $610.08 , $623.20 , $629.76 , $536.74 , $590.40 , $557.60 , $518.24 , N/A , $530.90 , $530.90 , $623.20 , $562.91 , $62.93 , $629.76 
"Destruct,Vaginal Lesion(S),Simple",CPT® 57061,N/A,N/A,N/A," $1,109.00 ", $720.85 , $548.65 , $111.68 , $43.94 , $400.88 , $403.28 ," $1,031.37 ", $998.10 , $998.10 , $887.20 , $887.20 , $43.94 ," $1,023.94 "," $1,053.55 ", $998.10 , $998.10 , $998.10 ," $1,031.37 "," $1,064.64 ", $557.51 , $942.65 , $528.08 , $403.93 , N/A , $408.71 , $408.71 ," $1,053.55 ", $490.21 , $43.94 ," $1,064.64 "
 Pro Treat Shoulder Dislocation ,CPT® 23650,0982 - PRO FEE/OUTPT,N/A,N/A," $2,030.00 "," $1,319.50 "," $1,823.71 ", $292.70 , $192.43 ," $1,386.81 "," $1,412.59 "," $1,887.90 "," $1,827.00 "," $1,827.00 "," $1,624.00 "," $1,624.00 ", $192.43 ," $1,874.30 "," $1,928.50 "," $1,827.00 "," $1,827.00 "," $1,827.00 "," $1,887.90 "," $1,948.80 "," $1,671.17 "," $1,725.50 "," $1,548.57 "," $1,654.68 ", N/A ," $1,413.87 "," $1,413.87 "," $1,928.50 "," $1,661.81 ", $192.43 ," $1,948.80 "
 BUPRENORPHINE HCL 2 MG SL SUBL ,HCPCS RXC637,0250 - PHARMACY,00054-0176-13,1 tablet, $21.27 , $13.83 , $17.87 , N/A , N/A , $17.19 , $19.14 , $18.01 , $19.14 , $19.14 , $19.14 , $18.08 , N/A , $19.64 , $20.21 , $18.08 , $19.78 , $19.78 , $20.21 , $20.42 , $17.40 , $19.14 , $18.08 , $16.80 , N/A , $17.21 , $17.21 , $20.21 , $18.25 , $16.80 , $20.42 
"Repair Collat Ligamt/Capsule,Knee",CPT® 27405,N/A,N/A,N/A," $4,335.00 "," $2,817.75 "," $4,128.54 ", $646.44 , $971.77 ," $3,258.11 "," $3,258.07 "," $4,031.55 "," $3,901.50 "," $3,901.50 "," $3,468.00 "," $3,468.00 ", $971.77 ," $4,002.51 "," $4,118.25 "," $3,901.50 "," $3,901.50 "," $3,901.50 "," $4,031.55 "," $4,161.60 "," $3,833.04 "," $3,684.75 "," $3,596.67 "," $3,835.77 ", N/A ," $3,321.68 "," $3,321.68 "," $4,118.25 "," $3,904.14 ", $646.44 ," $4,161.60 "
Incise Finger Tendon Sheath,26055,N/A,N/A,N/A," $3,773.00 "," $2,452.45 "," $1,794.72 ", $283.56 , $307.34 ," $1,493.87 "," $1,512.21 "," $3,508.89 "," $3,395.70 "," $3,395.70 "," $3,018.40 "," $3,018.40 ", $307.34 ," $3,483.61 "," $3,584.35 "," $3,395.70 "," $3,395.70 "," $3,395.70 "," $3,508.89 "," $3,622.08 "," $1,666.47 "," $3,207.05 "," $1,657.40 "," $1,779.74 ", N/A ," $1,523.02 "," $1,523.02 "," $3,584.35 "," $1,790.08 ", $283.56 ," $3,622.08 "
Excis Primary Ganglion Wrist,25111,N/A,N/A,N/A," $2,285.00 "," $1,485.25 "," $2,001.29 ", $316.34 , $267.34 ," $1,540.41 "," $1,553.48 "," $2,125.05 "," $2,056.50 "," $2,056.50 "," $1,828.00 "," $1,828.00 ", $267.34 ," $2,109.74 "," $2,170.75 "," $2,056.50 "," $2,056.50 "," $2,056.50 "," $2,125.05 "," $2,193.60 "," $1,852.25 "," $1,942.25 "," $1,705.57 "," $1,833.43 ", N/A ," $1,570.47 "," $1,570.47 "," $2,170.75 "," $1,845.85 ", $267.34 ," $2,193.60 "
Drug Screen Quantitative Gabapentin,CPT® 80171,N/A,N/A,N/A, $157.00 , $102.05 , N/A , $22.10 , $14.77 , $75.01 , $89.06 , $146.01 , $141.30 , $141.30 , $125.60 , $125.60 , $14.77 , $144.96 , $149.15 , $141.30 , $141.30 , $141.30 , $146.01 , $150.72 , $144.70 , $133.45 , $103.38 , $63.64 , N/A , $70.00 , $70.00 , $149.15 , $76.49 , $14.77 , $150.72 
 DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IJ SOLN ,HCPCS J1100,0636 - DRUGS REQUIRING DETAILED CODIN,00641-0367-25,0.2 mL, $16.68 , $10.84 , $14.01 , $0.12 , $0.13 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.13 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.12 , $16.01 
"Closed Rx Radial Shaft Fx,Manipulatn",25505,N/A,N/A,N/A," $2,600.00 "," $1,690.00 "," $2,830.49 ", $449.44 , $307.34 ," $2,214.08 "," $2,235.49 "," $2,418.00 "," $2,340.00 "," $2,340.00 "," $2,080.00 "," $2,080.00 ", $307.34 ," $2,400.58 "," $2,470.00 "," $2,340.00 "," $2,340.00 "," $2,340.00 "," $2,418.00 "," $2,496.00 "," $2,620.32 "," $2,210.00 "," $2,458.44 "," $2,598.41 ", N/A ," $2,257.28 "," $2,257.28 "," $2,470.00 "," $2,653.10 ", $307.34 ," $2,830.49 "
 Fac Njx/Nfs Nulyt Sbst Edrl Lmbr Sac ,CPT® 62282,0761 - TREATMENT ROOM,N/A,N/A," $2,523.00 "," $1,639.95 "," $2,119.32 ", $137.22 , $211.74 ," $2,038.58 "," $2,270.70 "," $2,135.97 "," $2,270.70 "," $2,270.70 "," $2,270.70 "," $2,144.55 ", $207.59 ," $2,329.49 "," $2,396.85 "," $2,144.55 "," $2,346.39 "," $2,346.39 "," $2,396.85 "," $2,422.08 "," $2,064.32 "," $2,270.70 "," $2,144.55 "," $1,993.17 ", N/A ," $2,041.86 "," $2,041.86 "," $2,396.85 "," $2,164.99 ", $137.22 ," $2,422.08 "
Colsc Flx W/Removal Lesion by Hot Bx Forceps,CPT® 45384,N/A,N/A,N/A," $3,451.00 "," $2,243.15 "," $1,385.61 ", $213.74 , $412.82 ," $1,575.38 "," $1,571.71 "," $3,209.43 "," $3,105.90 "," $3,105.90 "," $2,760.80 "," $2,760.80 ", $412.82 ," $3,186.31 "," $3,278.45 "," $3,105.90 "," $3,105.90 "," $3,105.90 "," $3,209.43 "," $3,312.96 "," $1,937.09 "," $2,933.35 "," $1,439.74 "," $1,320.64 ", N/A ," $1,606.11 "," $1,606.11 "," $3,278.45 "," $1,852.49 ", $213.74 ," $3,312.96 "
 Pro Breast Biopsy Stereotactic W Imaging ,CPT® 19081,0972 - PRO FEE/RAD/DX,N/A,N/A," $2,555.00 "," $1,660.75 ", $530.50 , $156.49 , $133.59 , $468.96 , $483.12 ," $2,376.15 "," $2,299.50 "," $2,299.50 "," $2,044.00 "," $2,044.00 ", $133.59 ," $2,359.03 "," $2,427.25 "," $2,299.50 "," $2,299.50 "," $2,299.50 "," $2,376.15 "," $2,452.80 ", $584.71 ," $2,171.75 ", $856.49 , $595.58 , N/A , $478.11 , $478.11 ," $2,427.25 ", $554.44 , $133.59 ," $2,452.80 "
"Exc Parotd,Lat Lobe,Dissect 5th Nerv",CPT® 42415,N/A,N/A,N/A," $7,364.00 "," $4,786.60 "," $6,492.85 "," $1,016.94 "," $1,235.75 "," $5,075.42 "," $5,168.96 "," $6,848.52 "," $6,627.60 "," $6,627.60 "," $5,891.20 "," $5,891.20 "," $1,235.75 "," $6,799.18 "," $6,995.80 "," $6,627.60 "," $6,627.60 "," $6,627.60 "," $6,848.52 "," $7,069.44 "," $4,606.06 "," $6,259.40 "," $5,650.13 "," $5,945.65 ", N/A ," $5,174.45 "," $5,174.45 "," $6,995.80 "," $5,411.91 "," $1,016.94 "," $7,069.44 "
Family Psychotherapy W/Patient Present 50 Mins,90847,N/A,N/A,N/A, $166.00 , $107.90 , $133.00 , $98.99 , $96.92 , $237.38 , $211.12 , $154.38 , $149.40 , $149.40 , $132.80 , $132.80 , $96.92 , $153.27 , $157.70 , $149.40 , $149.40 , $149.40 , $154.38 , $159.36 , $253.64 , $141.10 , $274.72 , $404.45 , $160.00 , $242.02 , $242.02 , $157.70 , $282.14 , $96.92 , $404.45 
 Fac Orth Dev Repair/Repl Minor P ,HCPCS L4210,0274 - PROSTHETIC DEV,N/A,N/A, $72.00 , $46.80 , $60.48 , N/A , N/A , $58.18 , $64.80 , $60.96 , $64.80 , $64.80 , $64.80 , $61.20 , N/A , $66.48 , $68.40 , $61.20 , $66.96 , $66.96 , $68.40 , $69.12 , $58.91 , $64.80 , $61.20 , $56.88 , N/A , $58.27 , $58.27 , $68.40 , $61.78 , $56.88 , $69.12 
 LIDOCAINE 4 % EX CREA ,HCPCS RXC637,0250 - PHARMACY,00496-0882-06,5 gram, $43.15 , $28.05 , $36.25 , N/A , N/A , $34.87 , $38.84 , $36.53 , $38.84 , $38.84 , $38.84 , $36.68 , N/A , $39.84 , $40.99 , $36.68 , $40.13 , $40.13 , $40.99 , $41.42 , $35.31 , $38.84 , $36.68 , $34.09 , N/A , $34.92 , $34.92 , $40.99 , $37.03 , $34.09 , $41.42 
 Pro Deep Muscle Biopsy ,CPT® 20205,0982 - PRO FEE/OUTPT,N/A,N/A," $1,139.00 ", $740.35 , $904.67 , $141.15 , $153.67 , $740.12 , $731.81 ," $1,059.27 "," $1,025.10 "," $1,025.10 ", $911.20 , $911.20 , $153.67 ," $1,051.64 "," $1,082.05 "," $1,025.10 "," $1,025.10 "," $1,025.10 "," $1,059.27 "," $1,093.44 ", $843.69 , $968.15 , $817.10 , $863.72 , N/A , $754.56 , $754.56 ," $1,082.05 ", $886.88 , $141.15 ," $1,093.44 "
 Fac Removal Biliary Drg Catheter Req Fluor Gid Rs&I ,CPT® 47537,0361 - OR/MINOR,N/A,N/A," $1,660.00 "," $1,079.00 "," $1,394.40 ", $91.61 , $319.09 ," $1,341.28 "," $1,494.00 "," $1,405.36 "," $1,494.00 "," $1,494.00 "," $1,494.00 "," $1,411.00 ", $312.83 ," $1,532.68 "," $1,577.00 "," $1,411.00 "," $1,543.80 "," $1,543.80 "," $1,577.00 "," $1,593.60 "," $1,358.21 "," $1,494.00 "," $1,411.00 "," $1,311.40 ", N/A ," $1,343.44 "," $1,343.44 "," $1,577.00 "," $1,424.45 ", $91.61 ," $1,593.60 "
 Fac Radex Hips Bilateral With Pelvis 2 Views ,CPT® 73521,0320 - DX X-RAY,N/A,N/A, $371.00 , $241.15 , $311.64 , $40.66 , $31.33 , $299.77 , $333.90 , $314.09 , $333.90 , $333.90 , $333.90 , $315.35 , $30.72 , $342.54 , $352.45 , $315.35 , $345.03 , $345.03 , $352.45 , $356.16 , $303.55 , $333.90 , $315.35 , $293.09 , N/A , $300.25 , $300.25 , $352.45 , $318.36 , $30.72 , $356.16 
 Fac Short-Latency Somatosens Ep Std Upr & Low Limbs ,CPT® 95938,0922 - EMG,N/A,N/A," $1,480.00 ", $962.00 ," $1,243.20 ", $356.99 , $231.13 ," $1,195.84 "," $1,332.00 "," $1,252.97 "," $1,332.00 "," $1,332.00 "," $1,332.00 "," $1,258.00 ", $226.60 ," $1,366.48 "," $1,406.00 "," $1,258.00 "," $1,376.40 "," $1,376.40 "," $1,406.00 "," $1,420.80 "," $1,210.94 "," $1,332.00 "," $1,258.00 "," $1,169.20 ", N/A ," $1,197.76 "," $1,197.76 "," $1,406.00 "," $1,269.99 ", $226.60 ," $1,420.80 "
 Evacuation of Subungual Hematoma - Mh ,CPT® 11740,0761 - TREATMENT ROOM,N/A,N/A, $98.00 , $63.70 , $82.32 , $30.96 , $37.00 , $79.18 , $88.20 , $82.97 , $88.20 , $88.20 , $88.20 , $83.30 , $36.27 , $90.48 , $93.10 , $83.30 , $91.14 , $91.14 , $93.10 , $94.08 , $80.18 , $88.20 , $83.30 , $77.42 , N/A , $79.31 , $79.31 , $93.10 , $84.09 , $30.96 , $94.08 
"Osteotomy,Post,Ea Addn Sgmt",CPT® 22216,N/A,N/A,N/A," $2,541.00 "," $1,651.65 "," $2,100.35 ", $326.37 , $740.61 ," $1,743.08 "," $1,699.09 "," $2,363.13 "," $2,286.90 "," $2,286.90 "," $2,032.80 "," $2,032.80 ", $740.61 ," $2,346.11 "," $2,413.95 "," $2,286.90 "," $2,286.90 "," $2,286.90 "," $2,363.13 "," $2,439.36 "," $1,966.75 "," $2,159.85 "," $1,912.52 "," $2,020.28 ", N/A ," $1,777.09 "," $1,777.09 "," $2,413.95 "," $2,088.69 ", $326.37 ," $2,439.36 "
"MRI, Pelvis, Combo",CPT® 72197,N/A,N/A,N/A," $8,374.00 "," $5,443.10 "," $2,446.08 ", $347.59 , $639.90 ," $2,408.12 "," $3,045.38 "," $7,787.82 "," $7,536.60 "," $7,536.60 "," $6,699.20 "," $6,699.20 ", $639.90 ," $7,731.71 "," $7,955.30 "," $7,536.60 "," $7,536.60 "," $7,536.60 "," $7,787.82 "," $8,039.04 "," $2,110.15 "," $7,117.90 "," $3,316.64 "," $3,933.75 ", N/A ," $2,455.11 "," $2,455.11 "," $7,955.30 "," $2,841.83 ", $347.59 ," $8,039.04 "
Amputation Finger/Thumb,26951,N/A,N/A,N/A," $4,285.00 "," $2,785.25 "," $4,394.59 ", $685.79 , $230.52 ," $3,103.57 "," $3,158.66 "," $3,985.05 "," $3,856.50 "," $3,856.50 "," $3,428.00 "," $3,428.00 ", $230.52 ," $3,956.34 "," $4,070.75 "," $3,856.50 "," $3,856.50 "," $3,856.50 "," $3,985.05 "," $4,113.60 "," $4,014.84 "," $3,642.25 "," $3,461.08 "," $3,699.99 ", N/A ," $3,164.13 "," $3,164.13 "," $4,070.75 "," $3,718.97 ", $230.52 ," $4,394.59 "
"Burn Dressing,MD,W/O Anes",16025,N/A,N/A,N/A, $402.00 , $261.30 , $353.80 , $104.77 , $43.96 , $304.75 , $296.43 , $373.86 , $361.80 , $361.80 , $321.60 , $321.60 , $43.96 , $371.17 , $381.90 , $361.80 , $361.80 , $361.80 , $373.86 , $385.92 , $384.92 , $341.70 , $592.31 , $389.98 , N/A , $310.69 , $310.69 , $381.90 , $360.30 , $43.96 , $592.31 
 Evaluation for Use and/or Fitting of Voice Prosthetic Device ,CPT® 92597,0440 - SPEECH PATHOL,N/A,N/A, $319.00 , $207.35 , $267.96 , $71.57 , $81.33 , $257.75 , $287.10 , $270.07 , $287.10 , $287.10 , $287.10 , $271.15 , $79.74 , $294.53 , $303.05 , $271.15 , $296.67 , $296.67 , $303.05 , $306.24 , $261.01 , $287.10 , $271.15 , $252.01 , N/A , $258.17 , $258.17 , $303.05 , $273.73 , $71.57 , $306.24 
Assay of Procalcitonin,CPT® 84145,N/A,N/A,N/A, $242.00 , $157.30 , N/A , $27.76 , $27.76 , $151.54 , $181.28 , $225.06 , $217.80 , $217.80 , $193.60 , $193.60 , $27.76 , $223.44 , $229.90 , $217.80 , $217.80 , $217.80 , $225.06 , $232.32 , $181.75 , $205.70 , $175.16 , $97.16 , N/A , $141.43 , $141.43 , $229.90 , $154.55 , $27.76 , $232.32 
 Fac Chemodenervation of Trunk Muscle 1-5 Muscles ,CPT® 64646,0360 - OR SERVICES,N/A,N/A," $3,006.00 "," $1,953.90 "," $2,525.04 ", $105.62 , $85.80 ," $2,428.85 "," $2,705.40 "," $2,544.88 "," $2,705.40 "," $2,705.40 "," $2,705.40 "," $2,555.10 ", $84.12 ," $2,775.44 "," $2,855.70 "," $2,555.10 "," $2,795.58 "," $2,795.58 "," $2,855.70 "," $2,885.76 "," $2,459.51 "," $2,705.40 "," $2,555.10 "," $2,374.74 ", N/A ," $2,432.76 "," $2,432.76 "," $2,855.70 "," $2,579.45 ", $84.12 ," $2,885.76 "
Iadna-Dna/Rna GI Pthgn Multiplex Probe Tq 6-11,CPT® 87506,N/A,N/A,N/A," $1,405.00 ", $913.25 , N/A , $268.25 , $237.60 ," $1,207.54 "," $1,430.00 "," $1,306.65 "," $1,264.50 "," $1,264.50 "," $1,124.00 "," $1,124.00 ", $237.60 ," $1,297.24 "," $1,334.75 "," $1,264.50 "," $1,264.50 "," $1,264.50 "," $1,306.65 "," $1,348.80 "," $1,756.04 "," $1,194.25 "," $1,253.53 ", $773.87 , N/A ," $1,126.95 "," $1,126.95 "," $1,334.75 "," $1,231.51 ", $237.60 ," $1,756.04 "
"Part Remv Bone,Prox/Mid Phalanx",CPT® 26235,N/A,N/A,N/A," $3,260.00 "," $2,119.00 "," $3,021.07 ", $475.91 , $307.34 ," $2,373.35 "," $2,366.87 "," $3,031.80 "," $2,934.00 "," $2,934.00 "," $2,608.00 "," $2,608.00 ", $307.34 ," $3,009.96 "," $3,097.00 "," $2,934.00 "," $2,934.00 "," $2,934.00 "," $3,031.80 "," $3,129.60 "," $2,810.20 "," $2,771.00 "," $2,599.38 "," $2,819.83 ", N/A ," $2,419.65 "," $2,419.65 "," $3,097.00 "," $2,843.96 ", $307.34 ," $3,129.60 "
Chemodenervation 1 Extremity Ea Addl 5/< Muscles,CPT® 64645,N/A,N/A,N/A, $754.00 , $490.10 , $389.22 , $74.73 , $60.71 , $453.66 , $443.83 , $701.22 , $678.60 , $678.60 , $603.20 , $603.20 , $60.71 , $696.17 , $716.30 , $678.60 , $678.60 , $678.60 , $701.22 , $723.84 , $420.03 , $640.90 , $431.80 , $480.83 , N/A , $462.51 , $462.51 , $716.30 , $496.17 , $60.71 , $723.84 
"Smear,Flourescent,F/B/C",CPT® 87206,N/A,N/A,N/A, $88.00 , $57.20 , N/A , $5.50 , $5.50 , $30.47 , $36.38 , $81.84 , $79.20 , $79.20 , $70.40 , $70.40 , $5.50 , $81.25 , $83.60 , $79.20 , $79.20 , $79.20 , $81.84 , $84.48 , $35.99 , $74.80 , $35.68 , $19.53 , N/A , $28.44 , $28.44 , $83.60 , $31.08 , $5.50 , $84.48 
 Fac Assay Alkaline Phosphatases ,CPT® 84080,0301 - LAB/CHEMISTRY,N/A,N/A, $158.00 , $102.70 , $132.72 , $15.08 , $15.08 , $127.66 , $142.20 , $133.76 , $142.20 , $142.20 , $142.20 , $134.30 , $14.78 , $145.88 , $150.10 , $134.30 , $146.94 , $146.94 , $150.10 , $151.68 , $129.28 , $142.20 , $134.30 , $124.82 , N/A , $127.87 , $127.87 , $150.10 , $135.58 , $14.78 , $151.68 
 Pro Chg Radiologic Exam Abdomen 1 View ,CPT® 74018,0972 - PRO FEE/RAD/DX,N/A,N/A, $96.00 , $62.40 , $169.65 , $29.43 , $21.43 , $122.30 , $136.70 , $89.28 , $86.40 , $86.40 , $76.80 , $76.80 , $21.43 , $88.64 , $91.20 , $86.40 , $86.40 , $86.40 , $89.28 , $92.16 , $163.37 , $81.60 , $172.65 , $137.06 , N/A , $124.69 , $124.69 , $91.20 , $144.32 , $21.43 , $172.65 
" Fac Organic Acid, Single, Quant ",CPT® 83921,0301 - LAB/CHEMISTRY,N/A,N/A, $151.00 , $98.15 , $126.84 , $21.63 , $21.63 , $122.01 , $135.90 , $127.84 , $135.90 , $135.90 , $135.90 , $128.35 , $21.21 , $139.42 , $143.45 , $128.35 , $140.43 , $140.43 , $143.45 , $144.96 , $123.55 , $135.90 , $128.35 , $119.29 , N/A , $122.20 , $122.20 , $143.45 , $129.57 , $21.21 , $144.96 
 Pro Explore/Treat Elbow Joint ,CPT® 24101,0982 - PRO FEE/OUTPT,N/A,N/A," $2,816.00 "," $1,830.40 "," $3,093.94 ", $486.69 , $528.51 ," $2,410.49 "," $2,409.98 "," $2,618.88 "," $2,534.40 "," $2,534.40 "," $2,252.80 "," $2,252.80 ", $528.51 ," $2,600.01 "," $2,675.20 "," $2,534.40 "," $2,534.40 "," $2,534.40 "," $2,618.88 "," $2,703.36 "," $2,868.41 "," $2,393.60 "," $2,654.69 "," $2,844.73 ", N/A ," $2,457.52 "," $2,457.52 "," $2,675.20 "," $2,888.45 ", $486.69 ," $3,093.94 "
 C Spine MRI Without Contrast ,CPT® 72141,0612 - MRI - SPINE,N/A,N/A," $4,508.00 "," $2,930.20 "," $3,786.72 ", $195.41 , $423.92 ," $3,642.46 "," $4,057.20 "," $3,816.47 "," $4,057.20 "," $4,057.20 "," $4,057.20 "," $3,831.80 ", $415.61 ," $4,162.24 "," $4,282.60 "," $3,831.80 "," $4,192.44 "," $4,192.44 "," $4,282.60 "," $4,327.68 "," $3,688.45 "," $4,057.20 "," $3,831.80 "," $3,561.32 ", N/A ," $3,648.32 "," $3,648.32 "," $4,282.60 "," $3,868.31 ", $195.41 ," $4,327.68 "
Drug Screening Methadone,CPT® 80358,N/A,N/A,N/A, $166.00 , $107.90 , N/A , N/A , N/A , N/A , N/A , $154.38 , $149.40 , $149.40 , $132.80 , $132.80 , N/A , $153.27 , $157.70 , $149.40 , $149.40 , $149.40 , $154.38 , $159.36 , N/A , $141.10 , $114.69 , $67.79 , N/A , $90.04 , $90.04 , $157.70 , $98.20 , $67.79 , $159.36 
Image-Guided Catheter Fluid Collection Drainage,CPT® 10030,N/A,N/A,N/A," $2,836.00 "," $1,843.40 ", $436.46 , $129.07 , $117.73 , $439.51 , $425.90 ," $2,637.48 "," $2,552.40 "," $2,552.40 "," $2,268.80 "," $2,268.80 ", $117.73 ," $2,618.48 "," $2,694.20 "," $2,552.40 "," $2,552.40 "," $2,552.40 "," $2,637.48 "," $2,722.56 ", $481.77 ," $2,410.60 ", $707.22 , $492.62 , N/A , $448.08 , $448.08 ," $2,694.20 ", $519.65 , $117.73 ," $2,722.56 "
"Bx,Penis (Separate Procedure)",CPT® 54100,N/A,N/A,N/A, $629.00 , $408.85 , $534.72 , $116.44 , $46.08 , $402.31 , $414.80 , $584.97 , $566.10 , $566.10 , $503.20 , $503.20 , $46.08 , $580.76 , $597.55 , $566.10 , $566.10 , $566.10 , $584.97 , $603.84 , $505.53 , $534.65 , $667.24 , $604.16 , N/A , $410.16 , $410.16 , $597.55 , $491.60 , $46.08 , $667.24 
 Pro Excision Tumor Soft Tissue Back/Flank Subq 3+Cm ,CPT® 21931,0975 - PRO FEE/OR,N/A,N/A," $3,337.00 "," $2,169.05 "," $2,826.59 ", $440.04 , $385.71 ," $2,249.43 "," $2,252.29 "," $3,103.41 "," $3,003.30 "," $3,003.30 "," $2,669.60 "," $2,669.60 ", $385.71 ," $3,081.05 "," $3,170.15 "," $3,003.30 "," $3,003.30 "," $3,003.30 "," $3,103.41 "," $3,203.52 "," $2,619.84 "," $2,836.45 "," $2,495.91 "," $2,642.86 ", N/A ," $2,293.32 "," $2,293.32 "," $3,170.15 "," $2,695.47 ", $385.71 ," $3,203.52 "
Treat Great Toe Fracture,CPT® 28495,N/A,N/A,N/A," $1,193.00 ", $775.45 , $927.29 , $146.49 , $142.01 , $741.74 , $744.49 ," $1,109.49 "," $1,073.70 "," $1,073.70 ", $954.40 , $954.40 , $142.01 ," $1,101.50 "," $1,133.35 "," $1,073.70 "," $1,073.70 "," $1,073.70 "," $1,109.49 "," $1,145.28 ", $853.03 ," $1,014.05 ", $808.18 , $870.51 , N/A , $756.22 , $756.22 ," $1,133.35 ", $888.84 , $142.01 ," $1,145.28 "
"Laser Surgery, Anal Lesion(S)",CPT® 46917,N/A,N/A,N/A," $3,101.00 "," $2,015.65 ", $779.48 , $123.35 , $46.08 , $633.45 , $651.09 ," $2,883.93 "," $2,790.90 "," $2,790.90 "," $2,480.80 "," $2,480.80 ", $46.08 ," $2,863.15 "," $2,945.95 "," $2,790.90 "," $2,790.90 "," $2,790.90 "," $2,883.93 "," $2,976.96 ", $558.12 ," $2,635.85 ", $717.19 , $764.21 , N/A , $645.82 , $645.82 ," $2,945.95 ", $675.44 , $46.08 ," $2,976.96 "
C-Reactive Protein,CPT® 86140,N/A,N/A,N/A, $82.00 , $53.30 , N/A , $5.28 , $5.28 , $29.27 , $35.00 , $76.26 , $73.80 , $73.80 , $65.60 , $65.60 , $5.28 , $75.71 , $77.90 , $73.80 , $73.80 , $73.80 , $76.26 , $78.72 , $34.59 , $69.70 , $34.06 , $18.77 , N/A , $27.32 , $27.32 , $77.90 , $29.85 , $5.28 , $78.72 
Chemical Cauterization of Granulation Tissue,17250,N/A,N/A,N/A, $239.00 , $155.35 , $118.49 , $35.56 , $24.75 , $100.85 , $98.94 , $222.27 , $215.10 , $215.10 , $191.20 , $191.20 , $24.75 , $220.67 , $227.05 , $215.10 , $215.10 , $215.10 , $222.27 , $229.44 , $128.31 , $203.15 , $196.25 , $130.88 , N/A , $102.81 , $102.81 , $227.05 , $119.25 , $24.75 , $229.44 
 Pro Remove Wrist Tendon Lesion ,CPT® 25111,0975 - PRO FEE/OR,N/A,N/A," $2,285.00 "," $1,485.25 "," $2,001.29 ", $316.34 , $267.34 ," $1,540.41 "," $1,553.48 "," $2,125.05 "," $2,056.50 "," $2,056.50 "," $1,828.00 "," $1,828.00 ", $267.34 ," $2,109.74 "," $2,170.75 "," $2,056.50 "," $2,056.50 "," $2,056.50 "," $2,125.05 "," $2,193.60 "," $1,852.25 "," $1,942.25 "," $1,705.57 "," $1,833.43 ", N/A ," $1,570.47 "," $1,570.47 "," $2,170.75 "," $1,845.85 ", $267.34 ," $2,193.60 "
Subconjunctival Injectn,CPT® 68200,N/A,N/A,N/A, $372.00 , $241.80 , $210.34 , $32.80 , $30.11 , $196.50 , $185.05 , $345.96 , $334.80 , $334.80 , $297.60 , $297.60 , $30.11 , $343.47 , $353.40 , $334.80 , $334.80 , $334.80 , $345.96 , $357.12 , $289.44 , $316.20 , $190.89 , $251.44 , N/A , $200.34 , $200.34 , $353.40 , $221.16 , $30.11 , $357.12 
"Debridement-Skin,Tiss,Mus",11043,N/A,N/A,N/A, $530.00 , $344.50 , $487.15 , $145.28 , $233.20 , $424.55 , $413.55 , $492.90 , $477.00 , $477.00 , $424.00 , $424.00 , $233.20 , $489.35 , $503.50 , $477.00 , $477.00 , $477.00 , $492.90 , $508.80 , $537.67 , $450.50 , $827.81 , $543.19 , N/A , $432.84 , $432.84 , $503.50 , $501.95 , $145.28 , $827.81 
"Echo Heart, Full Stress/Rest",CPT® 93350,N/A,N/A,N/A," $3,426.00 "," $2,226.90 "," $1,199.71 ", $183.12 , $145.53 ," $1,296.62 "," $1,123.81 "," $3,186.18 "," $3,083.40 "," $3,083.40 "," $2,740.80 "," $2,740.80 ", $145.53 ," $3,163.23 "," $3,254.70 "," $3,083.40 "," $3,083.40 "," $3,083.40 "," $3,186.18 "," $3,288.96 "," $1,190.70 "," $2,912.10 "," $1,050.81 "," $1,244.16 ", N/A ," $1,321.92 "," $1,321.92 "," $3,254.70 "," $1,465.37 ", $145.53 ," $3,288.96 "
 HEPARIN SODIUM (PORCINE) PF 5000 UNIT/0.5ML INJECTION (INPT) ,HCPCS J1644,0636 - DRUGS REQUIRING DETAILED CODIN,00409-1316-32,0.5 mL, $25.49 , $16.57 , $21.41 , $0.27 , $0.27 , $20.60 , $22.94 , $21.58 , $22.94 , $22.94 , $22.94 , $21.67 , $0.26 , $23.53 , $24.22 , $21.67 , $23.71 , $23.71 , $24.22 , $24.47 , $20.86 , $22.94 , $21.67 , $20.14 , N/A , $20.63 , $20.63 , $24.22 , $21.87 , $0.26 , $24.47 
Simple Repair 7.6-12.5cm,12004,N/A,N/A,N/A, $807.00 , $524.55 , $227.60 , $67.81 , $89.32 , $199.60 , $193.84 , $750.51 , $726.30 , $726.30 , $645.60 , $645.60 , $89.32 , $745.10 , $766.65 , $726.30 , $726.30 , $726.30 , $750.51 , $774.72 , $250.63 , $685.95 , $388.93 , $254.00 , N/A , $203.50 , $203.50 , $766.65 , $235.99 , $67.81 , $774.72 
 Pro US Trvg ,CPT® 76830,0972 - PRO FEE/RAD/DX,N/A,N/A, $329.00 , $213.85 , $684.11 , $118.64 , $99.44 , $585.23 , $399.82 , $305.97 , $296.10 , $296.10 , $263.20 , $263.20 , $99.44 , $303.77 , $312.55 , $296.10 , $296.10 , $296.10 , $305.97 , $315.84 , $687.13 , $279.65 , $431.43 , $687.46 , N/A , $596.65 , $596.65 , $312.55 , $690.62 , $99.44 , $690.62 
Vaginal Delivery Only,CPT® 59409,N/A,N/A,N/A," $3,354.00 "," $2,180.10 "," $1,869.48 ", $727.40 , $630.92 ," $1,894.25 "," $1,982.73 "," $3,119.22 "," $3,018.60 "," $3,018.60 "," $2,683.20 "," $2,683.20 ", $630.92 ," $3,096.75 "," $3,186.30 "," $3,018.60 "," $3,018.60 "," $3,018.60 "," $3,119.22 "," $3,219.84 "," $2,198.89 "," $2,850.90 "," $4,385.23 "," $1,884.92 ", N/A ," $1,931.21 "," $1,931.21 "," $3,186.30 "," $2,232.66 ", $630.92 ," $4,385.23 "
"Lap, Surg Close Enterostomy Resect Anast",CPT® 44227,N/A,N/A,N/A," $11,076.00 "," $7,199.40 "," $9,895.28 "," $1,530.70 "," $1,306.12 "," $7,868.27 "," $7,929.98 "," $10,300.68 "," $9,968.40 "," $9,968.40 "," $8,860.80 "," $8,860.80 "," $1,306.12 "," $10,226.47 "," $10,522.20 "," $9,968.40 "," $9,968.40 "," $9,968.40 "," $10,300.68 "," $10,632.96 "," $7,101.65 "," $9,414.60 "," $8,818.63 "," $9,269.31 ", N/A ," $8,021.80 "," $8,021.80 "," $10,522.20 "," $8,389.94 "," $1,306.12 "," $10,632.96 "
 Fac Chemiluminescent Assay ,CPT® 82397,0300 - LABORATORY,N/A,N/A, $306.00 , $198.90 , $257.04 , $14.40 , $14.40 , $247.25 , $275.40 , $259.06 , $275.40 , $275.40 , $275.40 , $260.10 , $14.12 , $282.53 , $290.70 , $260.10 , $284.58 , $284.58 , $290.70 , $293.76 , $250.37 , $275.40 , $260.10 , $241.74 , N/A , $247.65 , $247.65 , $290.70 , $262.58 , $14.12 , $293.76 
Open Rx Bimalleolar Fx,27814,N/A,N/A,N/A," $4,253.00 "," $2,764.45 "," $4,659.14 ", $730.07 , $675.04 ," $3,732.38 "," $3,721.69 "," $3,955.29 "," $3,827.70 "," $3,827.70 "," $3,402.40 "," $3,402.40 ", $675.04 ," $3,926.79 "," $4,040.35 "," $3,827.70 "," $3,827.70 "," $3,827.70 "," $3,955.29 "," $4,082.88 "," $4,338.92 "," $3,615.05 "," $4,106.92 "," $4,386.62 ", N/A ," $3,805.20 "," $3,805.20 "," $4,040.35 "," $4,472.48 ", $675.04 ," $4,659.14 "
 BUTORPHANOL TARTRATE 1 MG/ML IJ SOLN ,HCPCS J0595,0636 - DRUGS REQUIRING DETAILED CODIN,00409-1623-01,1 mL, $37.80 , $24.57 , $31.75 , $5.15 , $3.61 , $30.54 , $34.02 , $32.00 , $34.02 , $34.02 , $34.02 , $32.13 , $3.54 , $34.90 , $35.91 , $32.13 , $35.15 , $35.15 , $35.91 , $36.29 , $30.93 , $34.02 , $32.13 , $29.86 , N/A , $30.59 , $30.59 , $35.91 , $32.44 , $3.54 , $36.29 
"Cytomeg, Dna, Quant",CPT® 87497,N/A,N/A,N/A, $433.00 , $281.45 , N/A , $43.70 , $43.70 , $242.34 , $289.89 , $402.69 , $389.70 , $389.70 , $346.40 , $346.40 , $43.70 , $399.79 , $411.35 , $389.70 , $389.70 , $389.70 , $402.69 , $415.68 , $286.05 , $368.05 , $280.58 , $155.31 , N/A , $226.17 , $226.17 , $411.35 , $247.15 , $43.70 , $415.68 
"Remv Kidney Stone,Staghorn",CPT® 50075,N/A,N/A,N/A," $10,149.00 "," $6,596.85 "," $7,861.98 "," $1,380.78 "," $1,383.11 "," $7,137.50 "," $6,622.69 "," $9,438.57 "," $9,134.10 "," $9,134.10 "," $8,119.20 "," $8,119.20 "," $1,383.11 "," $9,370.57 "," $9,641.55 "," $9,134.10 "," $9,134.10 "," $9,134.10 "," $9,438.57 "," $9,743.04 "," $7,897.58 "," $8,626.65 "," $7,498.42 "," $8,962.90 ", N/A ," $7,276.77 "," $7,276.77 "," $9,641.55 "," $8,552.78 "," $1,380.78 "," $9,743.04 "
"Removal of Lung,Lobectomy",CPT® 32480,N/A,N/A,N/A," $10,480.00 "," $6,812.00 "," $7,674.53 "," $1,340.24 "," $2,065.41 "," $5,580.91 "," $5,464.28 "," $9,746.40 "," $9,432.00 "," $9,432.00 "," $8,384.00 "," $8,384.00 "," $2,065.41 "," $9,676.18 "," $9,956.00 "," $9,432.00 "," $9,432.00 "," $9,432.00 "," $9,746.40 "," $10,060.80 "," $7,421.18 "," $8,908.00 "," $7,903.40 "," $7,326.16 ", N/A ," $5,689.81 "," $5,689.81 "," $9,956.00 "," $6,700.95 "," $1,340.24 "," $10,060.80 "
" Pro Strapping,Wrist or Elbow ",CPT® 29260,0981 - PRO FEE/ER,N/A,N/A, $186.00 , $120.90 , $120.06 , $18.51 , $15.54 , $94.80 , $184.95 , $172.98 , $167.40 , $167.40 , $148.80 , $148.80 , $15.54 , $171.73 , $176.70 , $167.40 , $167.40 , $167.40 , $172.98 , $178.56 , $112.20 , $158.10 , $199.82 , $114.64 , N/A , $96.65 , $96.65 , $176.70 , $113.60 , $15.54 , $199.82 
 Fac Revsc Opn/Prq Tib/Pero W/Angioplasty Uni ,CPT® 37228,0360 - OR SERVICES,N/A,N/A," $15,684.00 "," $10,194.60 "," $13,174.56 ", $484.20 , $412.40 ," $12,672.67 "," $14,115.60 "," $13,278.07 "," $14,115.60 "," $14,115.60 "," $14,115.60 "," $13,331.40 ", $404.31 ," $14,481.04 "," $14,899.80 "," $13,331.40 "," $14,586.12 "," $14,586.12 "," $14,899.80 "," $15,056.64 "," $12,832.65 "," $14,115.60 "," $13,331.40 "," $12,390.36 ", N/A ," $12,693.06 "," $12,693.06 "," $14,899.80 "," $13,458.44 ", $404.31 ," $15,056.64 "
 Retroperitoneal US Limited ,CPT® 76775,0402 - ULTRASOUND,N/A,N/A, $527.00 , $342.55 , $442.68 , $58.03 , $88.69 , $425.82 , $474.30 , $446.16 , $474.30 , $474.30 , $474.30 , $447.95 , $86.95 , $486.58 , $500.65 , $447.95 , $490.11 , $490.11 , $500.65 , $505.92 , $431.19 , $474.30 , $447.95 , $416.33 , N/A , $426.50 , $426.50 , $500.65 , $452.22 , $58.03 , $505.92 
"Renal Scope,Remv FB/Stone",CPT® 50580,N/A,N/A,N/A," $4,237.00 "," $2,754.05 "," $3,251.97 ", $570.46 , $107.56 ," $2,984.62 "," $2,759.91 "," $3,940.41 "," $3,813.30 "," $3,813.30 "," $3,389.60 "," $3,389.60 ", $107.56 ," $3,912.02 "," $4,025.15 "," $3,813.30 "," $3,813.30 "," $3,813.30 "," $3,940.41 "," $4,067.52 "," $3,276.50 "," $3,601.45 "," $3,125.68 "," $3,741.17 ", N/A ," $3,042.86 "," $3,042.86 "," $4,025.15 "," $3,576.46 ", $107.56 ," $4,067.52 "
 Fac Cltng Factor XI Pta ,CPT® 85270,0305 - LAB/HEMATOLOGY,N/A,N/A, $279.00 , $181.35 , $234.36 , $18.26 , $18.26 , $225.43 , $251.10 , $236.20 , $251.10 , $251.10 , $251.10 , $237.15 , $17.90 , $257.60 , $265.05 , $237.15 , $259.47 , $259.47 , $265.05 , $267.84 , $228.28 , $251.10 , $237.15 , $220.41 , N/A , $225.79 , $225.79 , $265.05 , $239.41 , $17.90 , $267.84 
 IBUPROFEN 400 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-5853-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Hep a Antibody Total,CPT® 86708,N/A,N/A,N/A, $117.00 , $76.05 , N/A , $12.64 , $12.64 , $70.10 , $83.85 , $108.81 , $105.30 , $105.30 , $93.60 , $93.60 , $12.64 , $108.03 , $111.15 , $105.30 , $105.30 , $105.30 , $108.81 , $112.32 , $82.73 , $99.45 , $81.09 , $44.91 , N/A , $65.42 , $65.42 , $111.15 , $71.49 , $12.64 , $112.32 
Hla Class I Typing High Resolution One Locus Ea,CPT® 81380,N/A,N/A,N/A, $778.00 , $505.70 , N/A , $180.80 , $180.80 ," $1,002.81 "," $1,187.57 ", $723.54 , $700.20 , $700.20 , $622.40 , $622.40 , $180.80 , $718.33 , $739.10 , $700.20 , $700.20 , $700.20 , $723.54 , $746.88 ," $1,183.54 ", $661.30 , $844.84 , $642.70 , N/A , $935.89 , $935.89 , $739.10 ," $1,022.73 ", $180.80 ," $1,187.57 "
"Drain Ovarian Cyst(S),Abd Apprch",CPT® 58805,N/A,N/A,N/A," $2,418.00 "," $1,571.70 "," $2,034.50 ", $411.71 , $614.70 ," $1,644.79 "," $1,644.94 "," $2,248.74 "," $2,176.20 "," $2,176.20 "," $1,934.40 "," $1,934.40 ", $614.70 ," $2,232.54 "," $2,297.10 "," $2,176.20 "," $2,176.20 "," $2,176.20 "," $2,248.74 "," $2,321.28 "," $2,108.49 "," $2,055.30 "," $2,158.72 "," $1,649.64 ", N/A ," $1,676.89 "," $1,676.89 "," $2,297.10 "," $2,011.32 ", $411.71 ," $2,321.28 "
"Biopsy Vulva/Perineum,One Lesn",56605,N/A,N/A,N/A, $498.00 , $323.70 , $276.15 , $56.07 , $75.29 , $247.42 , $244.27 , $463.14 , $448.20 , $448.20 , $398.40 , $398.40 , $75.29 , $459.80 , $473.10 , $448.20 , $448.20 , $448.20 , $463.14 , $478.08 , $291.64 , $423.30 , $321.13 , $247.71 , N/A , $252.25 , $252.25 , $473.10 , $302.56 , $56.07 , $478.08 
 IPILIMUMAB 200 MG/40ML IV SOLN ,HCPCS J9228,0636 - DRUGS REQUIRING DETAILED CODIN,00003-2328-22,40 mL," $98,384.80 "," $63,950.12 "," $82,643.23 ", $171.29 , $169.09 ," $79,494.92 "," $88,546.32 "," $83,292.57 "," $88,546.32 "," $88,546.32 "," $88,546.32 "," $83,627.08 ", $165.77 ," $90,838.69 "," $93,465.56 "," $83,627.08 "," $91,497.86 "," $91,497.86 "," $93,465.56 "," $94,449.41 "," $80,498.44 "," $88,546.32 "," $83,627.08 "," $77,723.99 ", N/A ," $79,622.82 "," $79,622.82 "," $93,465.56 "," $84,424.00 ", $165.77 ," $94,449.41 "
 Fac Aldolase ,CPT® 82085,0301 - LAB/CHEMISTRY,N/A,N/A, $120.00 , $78.00 , $100.80 , $9.90 , $9.90 , $96.96 , $108.00 , $101.59 , $108.00 , $108.00 , $108.00 , $102.00 , $9.71 , $110.80 , $114.00 , $102.00 , $111.60 , $111.60 , $114.00 , $115.20 , $98.18 , $108.00 , $102.00 , $94.80 , N/A , $97.12 , $97.12 , $114.00 , $102.97 , $9.71 , $115.20 
"Cardiac Stress Tst,Interp/Rept Only",93018,N/A,N/A,N/A, $237.00 , $154.05 , $91.46 , $13.76 , $16.17 , $79.74 , $81.22 , $220.41 , $213.30 , $213.30 , $189.60 , $189.60 , $16.17 , $218.82 , $225.15 , $213.30 , $213.30 , $213.30 , $220.41 , $227.52 , $90.47 , $201.45 , $74.93 , $89.87 , N/A , $81.30 , $81.30 , $225.15 , $90.12 , $13.76 , $227.52 
 CEFTAROLINE FOSAMIL 600 MG IV SOLR ,HCPCS J0712,0636 - DRUGS REQUIRING DETAILED CODIN,00456-0600-10,20 mL," $1,439.50 ", $935.68 ," $1,209.18 ", $3.97 , $3.86 ," $1,163.12 "," $1,295.55 "," $1,218.68 "," $1,295.55 "," $1,295.55 "," $1,295.55 "," $1,223.58 ", $3.78 ," $1,329.09 "," $1,367.53 "," $1,223.58 "," $1,338.74 "," $1,338.74 "," $1,367.53 "," $1,381.92 "," $1,177.80 "," $1,295.55 "," $1,223.58 "," $1,137.21 ", N/A ," $1,164.99 "," $1,164.99 "," $1,367.53 "," $1,235.23 ", $3.78 ," $1,381.92 "
"Hysteroscopy,Rmv FB",CPT® 58562,N/A,N/A,N/A," $2,832.00 "," $1,840.80 "," $1,031.85 ", $209.13 , $178.29 ," $1,181.14 "," $1,173.06 "," $2,633.76 "," $2,548.80 "," $2,548.80 "," $2,265.60 "," $2,265.60 ", $178.29 ," $2,614.79 "," $2,690.40 "," $2,548.80 "," $2,548.80 "," $2,548.80 "," $2,633.76 "," $2,718.72 "," $1,086.80 "," $2,407.20 "," $1,545.00 ", $924.84 , N/A ," $1,204.18 "," $1,204.18 "," $2,690.40 "," $1,444.34 ", $178.29 ," $2,718.72 "
Incision Exten Foot/Toe Tendon,CPT® 28234,N/A,N/A,N/A," $2,762.00 "," $1,795.30 "," $1,658.02 ", $261.45 , $61.48 ," $1,302.61 "," $1,309.07 "," $2,568.66 "," $2,485.80 "," $2,485.80 "," $2,209.60 "," $2,209.60 ", $61.48 ," $2,550.15 "," $2,623.90 "," $2,485.80 "," $2,485.80 "," $2,485.80 "," $2,568.66 "," $2,651.52 "," $1,535.95 "," $2,347.70 "," $1,418.33 "," $1,541.89 ", N/A ," $1,328.03 "," $1,328.03 "," $2,623.90 "," $1,560.92 ", $61.48 ," $2,651.52 "
Layer Closure 12.6-20cm,12045,N/A,N/A,N/A," $1,528.00 ", $993.20 , $860.68 , $260.68 , $184.42 , $744.08 , $725.79 ," $1,421.04 "," $1,375.20 "," $1,375.20 "," $1,222.40 "," $1,222.40 ", $184.42 ," $1,410.80 "," $1,451.60 "," $1,375.20 "," $1,375.20 "," $1,375.20 "," $1,421.04 "," $1,466.88 ", $936.61 ," $1,298.80 "," $1,448.66 ", $942.06 , N/A , $758.60 , $758.60 ," $1,451.60 ", $879.73 , $184.42 ," $1,466.88 "
 Fac Antb Helminth Nes ,CPT® 86682,0302 - LAB/IMMUNOLOGY,N/A,N/A, $205.00 , $133.25 , $172.20 , $13.27 , $8.07 , $165.64 , $184.50 , $173.55 , $184.50 , $184.50 , $184.50 , $174.25 , $7.91 , $189.28 , $194.75 , $174.25 , $190.65 , $190.65 , $194.75 , $196.80 , $167.73 , $184.50 , $174.25 , $161.95 , N/A , $165.91 , $165.91 , $194.75 , $175.91 , $7.91 , $196.80 
Transurethral Elec-Surg Prostatectom,52601,N/A,N/A,N/A," $5,717.00 "," $3,716.05 "," $3,943.35 ", $693.12 , $828.21 ," $4,135.92 "," $3,848.30 "," $5,316.81 "," $5,145.30 "," $5,145.30 "," $4,573.60 "," $4,573.60 ", $828.21 ," $5,278.51 "," $5,431.15 "," $5,145.30 "," $5,145.30 "," $5,145.30 "," $5,316.81 "," $5,488.32 "," $3,957.68 "," $4,859.45 "," $4,358.47 "," $4,486.52 ", N/A ," $4,216.62 "," $4,216.62 "," $5,431.15 "," $4,956.02 ", $693.12 ," $5,488.32 "
 Pro Rmvl FB Foot Comp ,CPT® 28193,0981 - PRO FEE/ER,N/A,N/A," $2,814.00 "," $1,829.10 "," $2,279.29 ", $356.58 , $214.44 ," $1,826.54 "," $1,823.32 "," $2,617.02 "," $2,532.60 "," $2,532.60 "," $2,251.20 "," $2,251.20 ", $214.44 ," $2,598.17 "," $2,673.30 "," $2,532.60 "," $2,532.60 "," $2,532.60 "," $2,617.02 "," $2,701.44 "," $2,124.63 "," $2,391.90 "," $1,971.39 "," $2,164.89 ", N/A ," $1,862.17 "," $1,862.17 "," $2,673.30 "," $2,188.72 ", $214.44 ," $2,701.44 "
X-Ray Sinuses 3+ Vw,CPT® 70220,N/A,N/A,N/A, $546.00 , $354.90 , $213.61 , $37.05 , $37.18 , $176.62 , $207.11 , $507.78 , $491.40 , $491.40 , $436.80 , $436.80 , $37.18 , $504.12 , $518.70 , $491.40 , $491.40 , $491.40 , $507.78 , $524.16 , $207.15 , $464.10 , $227.27 , $189.55 , N/A , $180.07 , $180.07 , $518.70 , $208.42 , $37.05 , $524.16 
"Proastatectomy,",CPT® 55821,N/A,N/A,N/A," $4,789.00 "," $3,112.85 "," $3,861.76 ", $798.61 ," $1,229.45 "," $2,804.00 "," $2,826.65 "," $4,453.77 "," $4,310.10 "," $4,310.10 "," $3,831.20 "," $3,831.20 "," $1,229.45 "," $4,421.68 "," $4,549.55 "," $4,310.10 "," $4,310.10 "," $4,310.10 "," $4,453.77 "," $4,597.44 "," $3,631.83 "," $4,070.65 "," $4,504.76 "," $4,229.23 ", N/A ," $2,858.71 "," $2,858.71 "," $4,549.55 "," $3,426.33 ", $798.61 ," $4,597.44 "
 PREGABALIN 50 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-6992-61,1 capsule, $4.65 , $3.02 , $3.91 , N/A , N/A , $3.76 , $4.19 , $3.94 , $4.19 , $4.19 , $4.19 , $3.95 , N/A , $4.29 , $4.42 , $3.95 , $4.32 , $4.32 , $4.42 , $4.46 , $3.80 , $4.19 , $3.95 , $3.67 , N/A , $3.76 , $3.76 , $4.42 , $3.99 , $3.67 , $4.46 
Psyl/Nrpsycl Tst Phys/Qhp 2+ Tst 1st 30 Min,CPT® 96136,N/A,N/A,N/A, $207.00 , $134.55 , $55.27 , $23.16 , $54.03 , $51.67 , N/A , $192.51 , $186.30 , $186.30 , $165.60 , $165.60 , $54.03 , $191.12 , $196.65 , $186.30 , $186.30 , $186.30 , $192.51 , $198.72 , $103.74 , $175.95 , $69.67 , $94.03 , $65.93 , $52.68 , $52.68 , $196.65 , $61.41 , $23.16 , $198.72 
"Insert Vert Fix Dev,Ant,4-7 Sgmts",CPT® 22846,N/A,N/A,N/A," $5,224.00 "," $3,395.60 "," $4,331.15 ", $673.86 ," $1,077.43 "," $3,623.66 "," $3,535.29 "," $4,858.32 "," $4,701.60 "," $4,701.60 "," $4,179.20 "," $4,179.20 "," $1,077.43 "," $4,823.32 "," $4,962.80 "," $4,701.60 "," $4,701.60 "," $4,701.60 "," $4,858.32 "," $5,015.04 "," $4,049.61 "," $4,440.40 "," $4,024.85 "," $4,160.80 ", N/A ," $3,694.36 "," $3,694.36 "," $4,962.80 "," $4,342.19 ", $673.86 ," $5,015.04 "
 FENTANYL 25 MCG/HR TD PT72 ,HCPCS RXC637,0250 - PHARMACY,60505-7081-02,1 patch, $109.25 , $71.01 , $91.77 , N/A , N/A , $88.27 , $98.33 , $92.49 , $98.33 , $98.33 , $98.33 , $92.86 , N/A , $100.87 , $103.79 , $92.86 , $101.60 , $101.60 , $103.79 , $104.88 , $89.39 , $98.33 , $92.86 , $86.31 , N/A , $88.42 , $88.42 , $103.79 , $93.75 , $86.31 , $104.88 
Office/Outpatient Est Pt May Not Req Phys/Qhp,CPT® 99211,N/A,N/A,N/A, $92.00 , $59.80 , $18.08 , $8.63 , $16.58 , $16.02 , $15.74 , $85.56 , $82.80 , $82.80 , $73.60 , $73.60 , $16.58 , $84.94 , $87.40 , $82.80 , $82.80 , $82.80 , $85.56 , $88.32 , $16.50 , $78.20 , $19.50 , $20.26 , N/A , $16.33 , $16.33 , $87.40 , $18.83 , $8.63 , $88.32 
 ACETAMINOPHEN 500 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6730-61,1 tablet, $0.42 , $0.27 , $0.35 , N/A , N/A , $0.34 , $0.38 , $0.36 , $0.38 , $0.38 , $0.38 , $0.36 , N/A , $0.39 , $0.40 , $0.36 , $0.39 , $0.39 , $0.40 , $0.40 , $0.34 , $0.38 , $0.36 , $0.33 , N/A , $0.34 , $0.34 , $0.40 , $0.36 , $0.33 , $0.40 
 Pro Diagnostic Anoscopy ,CPT® 46600,0981 - PRO FEE/ER,N/A,N/A, $264.00 , $171.60 , $248.37 , $39.14 , $31.62 , $195.21 , $200.98 , $245.52 , $237.60 , $237.60 , $211.20 , $211.20 , $31.62 , $243.75 , $250.80 , $237.60 , $237.60 , $237.60 , $245.52 , $253.44 , $176.09 , $224.40 , $219.44 , $235.21 , N/A , $199.01 , $199.01 , $250.80 , $208.15 , $31.62 , $253.44 
Biopsy of Nerve,CPT® 64795,N/A,N/A,N/A," $1,268.00 ", $824.20 , $898.61 , $177.41 , $130.84 ," $1,043.71 "," $1,017.01 "," $1,179.24 "," $1,141.20 "," $1,141.20 "," $1,014.40 "," $1,014.40 ", $130.84 ," $1,170.74 "," $1,204.60 "," $1,141.20 "," $1,141.20 "," $1,141.20 "," $1,179.24 "," $1,217.28 ", $971.05 ," $1,077.80 "," $1,029.41 "," $1,116.45 ", N/A ," $1,064.08 "," $1,064.08 "," $1,204.60 "," $1,141.50 ", $130.84 ," $1,217.28 "
" Needle Placemnt-Aspir,Bx,Inj ",CPT® 76942,0402 - ULTRASOUND,N/A,N/A," $1,028.00 ", $668.20 , $863.52 , $57.19 , $98.27 , $830.62 , $925.20 , $870.30 , $925.20 , $925.20 , $925.20 , $873.80 , $96.34 , $949.15 , $976.60 , $873.80 , $956.04 , $956.04 , $976.60 , $986.88 , $841.11 , $925.20 , $873.80 , $812.12 , N/A , $831.96 , $831.96 , $976.60 , $882.13 , $57.19 , $986.88 
 Canalith Repositioning Outpt ,CPT® 95992,0420 - PHYSICAL THERAPY,N/A,N/A, $347.00 , $225.55 , $291.48 , $35.56 , $75.25 , $280.38 , $312.30 , $293.77 , $312.30 , $312.30 , $312.30 , $294.95 , $73.77 , $320.39 , $329.65 , $294.95 , $322.71 , $322.71 , $329.65 , $333.12 , $283.92 , $312.30 , $294.95 , $274.13 , N/A , $280.83 , $280.83 , $329.65 , $297.76 , $35.56 , $333.12 
 Pro Remove Eyelid Foreign Body ,CPT® 67938,0982 - PRO FEE/OUTPT,N/A,N/A," $1,052.00 ", $683.80 , $725.34 , $114.79 , $66.00 , $652.93 , $615.59 , $978.36 , $946.80 , $946.80 , $841.60 , $841.60 , $66.00 , $971.31 , $999.40 , $946.80 , $946.80 , $946.80 , $978.36 ," $1,009.92 ", $992.25 , $894.20 , $635.13 , $841.40 , N/A , $665.67 , $665.67 , $999.40 , $734.83 , $66.00 ," $1,009.92 "
 Pro Mra Abd C+-Matrl ,CPT® 74185,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,023.00 ", $664.95 ," $2,426.06 ", $346.46 , $464.63 ," $1,917.43 "," $2,466.98 ", $951.39 , $920.70 , $920.70 , $818.40 , $818.40 , $464.63 , $944.54 , $971.85 , $920.70 , $920.70 , $920.70 , $951.39 , $982.08 ," $2,092.90 ", $869.55 ," $2,686.83 "," $2,697.08 ", N/A ," $1,954.85 "," $1,954.85 ", $971.85 ," $2,262.77 ", $346.46 ," $2,697.08 "
 Image-Guided Catheter Fluid Collection Drainage ED Fac ,CPT® 10030,0361 - OR/MINOR,N/A,N/A," $2,185.00 "," $1,420.25 "," $1,835.40 ", $129.07 , $117.73 ," $1,765.48 "," $1,966.50 "," $1,849.82 "," $1,966.50 "," $1,966.50 "," $1,966.50 "," $1,857.25 ", $115.42 ," $2,017.41 "," $2,075.75 "," $1,857.25 "," $2,032.05 "," $2,032.05 "," $2,075.75 "," $2,097.60 "," $1,787.77 "," $1,966.50 "," $1,857.25 "," $1,726.15 ", N/A ," $1,768.32 "," $1,768.32 "," $2,075.75 "," $1,874.95 ", $115.42 ," $2,097.60 "
 OXCARBAZEPINE 300 MG/5ML PO SUSP ,HCPCS RXA250,0250 - PHARMACY,65162-0649-78,250 mL," $1,402.37 ", $911.54 ," $1,177.99 ", N/A , N/A ," $1,133.11 "," $1,262.13 "," $1,187.25 "," $1,262.13 "," $1,262.13 "," $1,262.13 "," $1,192.01 ", N/A ," $1,294.81 "," $1,332.25 "," $1,192.01 "," $1,304.20 "," $1,304.20 "," $1,332.25 "," $1,346.28 "," $1,147.42 "," $1,262.13 "," $1,192.01 "," $1,107.87 ", N/A ," $1,134.94 "," $1,134.94 "," $1,332.25 "," $1,203.37 "," $1,107.87 "," $1,346.28 "
Thoracentesis Needle/Cath Pleura W/Imaging,32555,N/A,N/A,N/A," $1,489.00 ", $967.85 , $602.20 , $104.93 , $293.25 , $441.35 , $422.54 ," $1,384.77 "," $1,340.10 "," $1,340.10 "," $1,191.20 "," $1,191.20 ", $293.25 ," $1,374.79 "," $1,414.55 "," $1,340.10 "," $1,340.10 "," $1,340.10 "," $1,384.77 "," $1,429.44 ", $586.09 ," $1,265.65 ", $588.74 , $585.22 , N/A , $449.97 , $449.97 ," $1,414.55 ", $529.94 , $104.93 ," $1,429.44 "
 Fac Esophagoscopy Flexible Guide Wire Dilation ,CPT® 43226,0360 - OR SERVICES,N/A,N/A," $1,783.00 "," $1,158.95 "," $1,497.72 ", $122.27 , $336.65 ," $1,440.66 "," $1,604.70 "," $1,509.49 "," $1,604.70 "," $1,604.70 "," $1,604.70 "," $1,515.55 ", $330.05 ," $1,646.24 "," $1,693.85 "," $1,515.55 "," $1,658.19 "," $1,658.19 "," $1,693.85 "," $1,711.68 "," $1,458.85 "," $1,604.70 "," $1,515.55 "," $1,408.57 ", N/A ," $1,442.98 "," $1,442.98 "," $1,693.85 "," $1,529.99 ", $122.27 ," $1,711.68 "
 OCRELIZUMAB 300 MG/10ML IV SOLN ,HCPCS J2350,0636 - DRUGS REQUIRING DETAILED CODIN,50242-0150-01,10 mL," $55,206.13 "," $35,883.98 "," $46,373.15 ", $62.65 , $60.84 ," $44,606.55 "," $49,685.52 "," $46,737.51 "," $49,685.52 "," $49,685.52 "," $49,685.52 "," $46,925.21 ", $59.65 ," $50,971.82 "," $52,445.82 "," $46,925.21 "," $51,341.70 "," $51,341.70 "," $52,445.82 "," $52,997.88 "," $45,169.66 "," $49,685.52 "," $46,925.21 "," $43,612.84 ", N/A ," $44,678.32 "," $44,678.32 "," $52,445.82 "," $47,372.38 ", $59.65 ," $52,997.88 "
 Path/Fzn Sec Ea Addl Specimen -Mh ,CPT® 88332,0971 - PRO FEE/LAB,N/A,N/A, $225.00 , $146.25 , $194.51 , $54.10 , $38.03 , $181.43 , $200.39 , $209.25 , $202.50 , $202.50 , $180.00 , $180.00 , $38.03 , $207.74 , $213.75 , $202.50 , $202.50 , $202.50 , $209.25 , $216.00 , $351.76 , $191.25 , $207.60 , $185.85 , N/A , $169.32 , $169.32 , $213.75 , $186.07 , $38.03 , $351.76 
Remove Impacted Cerumen,CPT® 69210,N/A,N/A,N/A, $289.00 , $187.85 , $154.15 , $31.15 , $14.13 , $157.99 , $157.57 , $268.77 , $260.10 , $260.10 , $231.20 , $231.20 , $14.13 , $266.83 , $274.55 , $260.10 , $260.10 , $260.10 , $268.77 , $277.44 , $170.16 , $245.65 , $171.27 , $161.15 , N/A , $161.08 , $161.08 , $274.55 , $183.90 , $14.13 , $277.44 
"Fx Scaphoid,Closed W/O MA",CPT® 25622,N/A,N/A,N/A," $1,996.00 "," $1,297.40 "," $1,769.63 ", $281.15 , $206.19 ," $1,331.19 "," $1,359.46 "," $1,856.28 "," $1,796.40 "," $1,796.40 "," $1,596.80 "," $1,596.80 ", $206.19 ," $1,842.91 "," $1,896.20 "," $1,796.40 "," $1,796.40 "," $1,796.40 "," $1,856.28 "," $1,916.16 "," $1,628.51 "," $1,696.60 "," $1,491.48 "," $1,596.88 ", N/A ," $1,357.16 "," $1,357.16 "," $1,896.20 "," $1,595.16 ", $206.19 ," $1,916.16 "
Debridement of Nails 1-6,11720,N/A,N/A,N/A, $125.00 , $81.25 , $46.82 , $13.79 , $19.04 , $41.04 , $39.04 , $116.25 , $112.50 , $112.50 , $100.00 , $100.00 , $19.04 , $115.41 , $118.75 , $112.50 , $112.50 , $112.50 , $116.25 , $120.00 , $51.62 , $106.25 , $76.71 , $52.68 , N/A , $41.84 , $41.84 , $118.75 , $48.53 , $13.79 , $120.00 
"Bx Arm/Elbow Soft Tissue,Superficial",24065,N/A,N/A,N/A," $1,293.00 ", $840.45 ," $1,008.28 ", $156.67 , $80.09 , $810.32 , $821.77 ," $1,202.49 "," $1,163.70 "," $1,163.70 "," $1,034.40 "," $1,034.40 ", $80.09 ," $1,193.83 "," $1,228.35 "," $1,163.70 "," $1,163.70 "," $1,163.70 "," $1,202.49 "," $1,241.28 ", $933.96 ," $1,099.05 ", $899.17 , $965.13 , N/A , $826.12 , $826.12 ," $1,228.35 ", $970.99 , $80.09 ," $1,241.28 "
"Revision Spinal Neurostim Electrode Perc Array, Incl Fluoro",63663,N/A,N/A,N/A," $5,751.00 "," $3,738.15 "," $2,205.42 ", $429.55 , $673.61 ," $2,528.06 "," $2,520.03 "," $5,348.43 "," $5,175.90 "," $5,175.90 "," $4,600.80 "," $4,600.80 ", $673.61 ," $5,309.90 "," $5,463.45 "," $5,175.90 "," $5,175.90 "," $5,175.90 "," $5,348.43 "," $5,520.96 "," $2,396.22 "," $4,888.35 "," $2,485.20 "," $2,696.90 ", N/A ," $2,577.39 "," $2,577.39 "," $5,463.45 "," $2,764.92 ", $429.55 ," $5,520.96 "
 Pro Chemodervate Facial/Trigem/Cerv Musc Migraine ,CPT® 64615,0982 - PRO FEE/OUTPT,N/A,N/A, $931.00 , $605.15 , $566.59 , $109.75 , $96.09 , $667.63 , $665.87 , $865.83 , $837.90 , $837.90 , $744.80 , $744.80 , $96.09 , $859.59 , $884.45 , $837.90 , $837.90 , $837.90 , $865.83 , $893.76 , $612.53 , $791.35 , $679.73 , $697.98 , N/A , $680.65 , $680.65 , $884.45 , $730.18 , $96.09 , $893.76 
CT Scan Head Contrast,CPT® 70460,N/A,N/A,N/A," $2,845.00 "," $1,849.25 "," $1,056.16 ", $151.13 , $251.09 , $772.52 ," $1,142.80 "," $2,645.85 "," $2,560.50 "," $2,560.50 "," $2,276.00 "," $2,276.00 ", $251.09 ," $2,626.79 "," $2,702.75 "," $2,560.50 "," $2,560.50 "," $2,560.50 "," $2,645.85 "," $2,731.20 ", $886.83 ," $2,418.25 "," $1,242.30 "," $1,058.68 ", N/A , $787.59 , $787.59 ," $2,702.75 ", $911.64 , $151.13 ," $2,731.20 "
 Fac Perq Breast Loc Device Placemt Add Lesio MR Guid ,CPT® 19288,0361 - OR/MINOR,N/A,N/A," $1,583.00 "," $1,028.95 "," $1,329.72 ", $60.87 , $48.72 ," $1,279.06 "," $1,424.70 "," $1,340.17 "," $1,424.70 "," $1,424.70 "," $1,424.70 "," $1,345.55 ", $47.76 ," $1,461.58 "," $1,503.85 "," $1,345.55 "," $1,472.19 "," $1,472.19 "," $1,503.85 "," $1,519.68 "," $1,295.21 "," $1,424.70 "," $1,345.55 "," $1,250.57 ", N/A ," $1,281.12 "," $1,281.12 "," $1,503.85 "," $1,358.37 ", $47.76 ," $1,519.68 "
"Exc Skin Benig 0.6-1cm Face,Facial",CPT® 11441,N/A,N/A,N/A, $682.00 , $443.30 , $426.39 , $128.83 , $116.82 , $358.23 , $354.74 , $634.26 , $613.80 , $613.80 , $545.60 , $545.60 , $116.82 , $629.69 , $647.90 , $613.80 , $613.80 , $613.80 , $634.26 , $654.72 , $462.54 , $579.70 , $704.71 , $461.95 , N/A , $365.22 , $365.22 , $647.90 , $423.54 , $116.82 , $704.71 
" Fac Cortisol, Free ",CPT® 82530,0301 - LAB/CHEMISTRY,N/A,N/A, $314.00 , $204.10 , $263.76 , $17.04 , $17.04 , $253.71 , $282.60 , $265.83 , $282.60 , $282.60 , $282.60 , $266.90 , $16.71 , $289.92 , $298.30 , $266.90 , $292.02 , $292.02 , $298.30 , $301.44 , $256.91 , $282.60 , $266.90 , $248.06 , N/A , $254.12 , $254.12 , $298.30 , $269.44 , $16.71 , $301.44 
 Fac Exchng Absc/Cst Drg Cath Rad Gid Spx ,CPT® 49423,0761 - TREATMENT ROOM,N/A,N/A," $3,425.00 "," $2,226.25 "," $2,877.00 ", $67.09 , $765.94 ," $2,767.40 "," $3,082.50 "," $2,899.61 "," $3,082.50 "," $3,082.50 "," $3,082.50 "," $2,911.25 ", $750.92 ," $3,162.30 "," $3,253.75 "," $2,911.25 "," $3,185.25 "," $3,185.25 "," $3,253.75 "," $3,288.00 "," $2,802.34 "," $3,082.50 "," $2,911.25 "," $2,705.75 ", N/A ," $2,771.85 "," $2,771.85 "," $3,253.75 "," $2,938.99 ", $67.09 ," $3,288.00 "
Open Rx Scapula Fracture,CPT® 23585,N/A,N/A,N/A," $6,743.00 "," $4,382.95 "," $5,931.25 ", $926.69 , $845.22 ," $4,727.32 "," $4,708.10 "," $6,270.99 "," $6,068.70 "," $6,068.70 "," $5,394.40 "," $5,394.40 ", $845.22 ," $6,225.81 "," $6,405.85 "," $6,068.70 "," $6,068.70 "," $6,068.70 "," $6,270.99 "," $6,473.28 "," $5,508.43 "," $5,731.55 "," $5,204.11 "," $5,568.15 ", N/A ," $4,819.56 "," $4,819.56 "," $6,405.85 "," $5,664.68 ", $845.22 ," $6,473.28 "
 Fac Ins Intrvas Vc Filtr W/WO Vas Acs Vsl Selxn Rs&I ,CPT® 37191,0761 - TREATMENT ROOM,N/A,N/A," $20,535.00 "," $13,347.75 "," $17,249.40 ", $205.76 ," $2,085.23 "," $16,592.28 "," $18,481.50 "," $17,384.93 "," $18,481.50 "," $18,481.50 "," $18,481.50 "," $17,454.75 "," $2,044.34 "," $18,959.97 "," $19,508.25 "," $17,454.75 "," $19,097.55 "," $19,097.55 "," $19,508.25 "," $19,713.60 "," $16,801.74 "," $18,481.50 "," $17,454.75 "," $16,222.65 ", N/A ," $16,618.98 "," $16,618.98 "," $19,508.25 "," $17,621.08 ", $205.76 ," $19,713.60 "
"Curette/Treat Cornea,Apply Chelate",CPT® 65436,N/A,N/A,N/A," $3,464.00 "," $2,251.60 "," $2,272.14 ", $357.13 , $61.48 ," $2,102.68 "," $1,981.89 "," $3,221.52 "," $3,117.60 "," $3,117.60 "," $2,771.20 "," $2,771.20 ", $61.48 ," $3,198.31 "," $3,290.80 "," $3,117.60 "," $3,117.60 "," $3,117.60 "," $3,221.52 "," $3,325.44 "," $3,119.73 "," $2,944.40 "," $2,049.89 "," $2,672.16 ", N/A ," $2,143.70 "," $2,143.70 "," $3,290.80 "," $2,366.38 ", $61.48 ," $3,325.44 "
 Closed Tx Bimalleoar Ankle Fx W/ Manip -Mh ,CPT® 27810,0761 - TREATMENT ROOM,N/A,N/A," $3,899.00 "," $2,534.35 "," $3,275.16 ", $415.07 , $394.39 ," $3,150.39 "," $3,509.10 "," $3,300.89 "," $3,509.10 "," $3,509.10 "," $3,509.10 "," $3,314.15 ", $386.66 ," $3,599.95 "," $3,704.05 "," $3,314.15 "," $3,626.07 "," $3,626.07 "," $3,704.05 "," $3,743.04 "," $3,190.16 "," $3,509.10 "," $3,314.15 "," $3,080.21 ", N/A ," $3,155.46 "," $3,155.46 "," $3,704.05 "," $3,345.73 ", $386.66 ," $3,743.04 "
 ESCITALOPRAM OXALATE 20 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6427-61,1 tablet, $23.49 , $15.27 , $19.73 , N/A , N/A , $18.98 , $21.14 , $19.89 , $21.14 , $21.14 , $21.14 , $19.97 , N/A , $21.69 , $22.32 , $19.97 , $21.85 , $21.85 , $22.32 , $22.55 , $19.22 , $21.14 , $19.97 , $18.56 , N/A , $19.01 , $19.01 , $22.32 , $20.16 , $18.56 , $22.55 
 DIGOXIN 0.25 MG/ML IJ SOLN ,HCPCS J1160,0636 - DRUGS REQUIRING DETAILED CODIN,00641-1410-35,2 mL, $33.91 , $22.04 , $28.48 , $11.03 , $8.28 , $27.40 , $30.52 , $28.71 , $30.52 , $30.52 , $30.52 , $28.82 , $8.12 , $31.31 , $32.21 , $28.82 , $31.54 , $31.54 , $32.21 , $32.55 , $27.75 , $30.52 , $28.82 , $26.79 , N/A , $27.44 , $27.44 , $32.21 , $29.10 , $8.12 , $32.55 
"Complement, Total (Ch50)",CPT® 86162,N/A,N/A,N/A, $256.00 , $166.40 , N/A , $20.73 , $20.73 , $107.05 , $128.01 , $238.08 , $230.40 , $230.40 , $204.80 , $204.80 , $20.73 , $236.36 , $243.20 , $230.40 , $230.40 , $230.40 , $238.08 , $245.76 , $135.68 , $217.60 , $132.99 , $73.69 , N/A , $99.91 , $99.91 , $243.20 , $109.18 , $20.73 , $245.76 
 Fac Bx Breast W Device 1st Lesion Ultrasound Guide ,CPT® 19083,0361 - OR/MINOR,N/A,N/A," $5,704.00 "," $3,707.60 "," $4,791.36 ", $147.29 , $125.44 ," $4,608.83 "," $5,133.60 "," $4,829.01 "," $5,133.60 "," $5,133.60 "," $5,133.60 "," $4,848.40 ", $122.98 ," $5,266.50 "," $5,418.80 "," $4,848.40 "," $5,304.72 "," $5,304.72 "," $5,418.80 "," $5,475.84 "," $4,667.01 "," $5,133.60 "," $4,848.40 "," $4,506.16 ", N/A ," $4,616.25 "," $4,616.25 "," $5,418.80 "," $4,894.60 ", $122.98 ," $5,475.84 "
Psycl/Nrpsycl Tst Tech 2+ Tst Ea Addl 30 Min,CPT® 96139,N/A,N/A,N/A, $164.00 , $106.60 , $80.83 , $33.94 , $43.43 , $77.90 , N/A , $152.52 , $147.60 , $147.60 , $131.20 , $131.20 , $43.43 , $151.42 , $155.80 , $147.60 , $147.60 , $147.60 , $152.52 , $157.44 , $156.10 , $139.40 , $105.01 , $143.08 , $53.53 , $79.41 , $79.41 , $155.80 , $92.59 , $33.94 , $157.44 
Chemodenervation Anal Sphincter,CPT® 46505,N/A,N/A,N/A," $2,072.00 "," $1,346.80 "," $1,553.57 ", $240.67 , $193.46 ," $1,135.37 "," $1,179.05 "," $1,926.96 "," $1,864.80 "," $1,864.80 "," $1,657.60 "," $1,657.60 ", $193.46 ," $1,913.08 "," $1,968.40 "," $1,864.80 "," $1,864.80 "," $1,864.80 "," $1,926.96 "," $1,989.12 "," $1,104.90 "," $1,761.20 "," $1,298.80 "," $1,356.86 ", N/A ," $1,157.52 "," $1,157.52 "," $1,968.40 "," $1,210.65 ", $193.46 ," $1,989.12 "
" Fac Whfo,No Joint, Prefabricated ",HCPCS L3807,0274 - PROSTHETIC DEV,N/A,N/A, $376.00 , $244.40 , $315.84 , $266.19 , $145.69 , $303.81 , $338.40 , $318.32 , $338.40 , $338.40 , $338.40 , $319.60 , $142.83 , $347.16 , $357.20 , $319.60 , $349.68 , $349.68 , $357.20 , $360.96 , $307.64 , $338.40 , $319.60 , $297.04 , N/A , $304.30 , $304.30 , $357.20 , $322.65 , $142.83 , $360.96 
X-Ray Retrograde Pyelogram,CPT® 74420,N/A,N/A,N/A," $2,558.00 "," $1,662.70 ", $435.12 , $76.09 , $120.86 , $567.25 , $597.15 ," $2,378.94 "," $2,302.20 "," $2,302.20 "," $2,046.40 "," $2,046.40 ", $120.86 ," $2,361.80 "," $2,430.10 "," $2,302.20 "," $2,302.20 "," $2,302.20 "," $2,378.94 "," $2,455.68 ", $424.05 ," $2,174.30 ", $668.34 ," $2,360.61 ", N/A , $578.31 , $578.31 ," $2,430.10 ", $669.40 , $76.09 ," $2,455.68 "
Cath W/Drainage 2-Way Latex,HCPCS A4314,N/A,N/A,N/A, $42.00 , $27.30 , N/A , $34.29 , $18.42 , N/A , N/A , $39.06 , $37.80 , $37.80 , $33.60 , $33.60 , $18.42 , $38.78 , $39.90 , $37.80 , $37.80 , $37.80 , $39.06 , $40.32 , N/A , $35.70 , $29.84 , $31.16 , N/A , N/A , N/A , $39.90 , N/A , $18.42 , $40.32 
"Dil Urethra Stric,Male,Gen Anesth",CPT® 53605,N/A,N/A,N/A, $441.00 , $286.65 , $343.56 , $60.54 , $137.47 , $316.90 , $291.70 , $410.13 , $396.90 , $396.90 , $352.80 , $352.80 , $137.47 , $407.18 , $418.95 , $396.90 , $396.90 , $396.90 , $410.13 , $423.36 , $347.78 , $374.85 , $330.05 , $397.11 , N/A , $323.09 , $323.09 , $418.95 , $379.74 , $60.54 , $423.36 
Excis Urethral Polyp(S),CPT® 53260,N/A,N/A,N/A," $1,403.00 ", $911.95 , $980.78 , $173.22 , $76.84 , $878.54 , $826.62 ," $1,304.79 "," $1,262.70 "," $1,262.70 "," $1,122.40 "," $1,122.40 ", $76.84 ," $1,295.39 "," $1,332.85 "," $1,262.70 "," $1,262.70 "," $1,262.70 "," $1,304.79 "," $1,346.88 ", $980.81 ," $1,192.55 ", $941.99 ," $1,102.29 ", N/A , $895.68 , $895.68 ," $1,332.85 "," $1,052.74 ", $76.84 ," $1,346.88 "
Biopsy Bone Open Deep,CPT® 20245,N/A,N/A,N/A," $4,143.00 "," $2,692.95 "," $2,091.25 ", $323.65 , $284.00 ," $2,980.23 "," $3,005.59 "," $3,852.99 "," $3,728.70 "," $3,728.70 "," $3,314.40 "," $3,314.40 ", $284.00 ," $3,825.23 "," $3,935.85 "," $3,728.70 "," $3,728.70 "," $3,728.70 "," $3,852.99 "," $3,977.28 "," $1,952.95 "," $3,521.55 "," $3,313.01 "," $2,013.43 ", N/A ," $3,038.38 "," $3,038.38 "," $3,935.85 "," $3,571.18 ", $284.00 ," $3,977.28 "
Rplcmt Compl Tun Ctr Vad W/Subq Port,CPT® 36582,N/A,N/A,N/A," $7,018.00 "," $4,561.70 "," $1,734.85 ", $268.28 ," $1,170.87 "," $1,325.35 "," $1,318.83 "," $6,526.74 "," $6,316.20 "," $6,316.20 "," $5,614.40 "," $5,614.40 "," $1,170.87 "," $6,479.72 "," $6,667.10 "," $6,316.20 "," $6,316.20 "," $6,316.20 "," $6,526.74 "," $6,737.28 "," $1,606.31 "," $5,965.30 "," $1,634.20 "," $1,429.21 ", N/A ," $1,351.21 "," $1,351.21 "," $6,667.10 "," $1,534.97 ", $268.28 ," $6,737.28 "
" Fac Tissue Culture, Placenta ",CPT® 88235,0300 - LABORATORY,N/A,N/A," $1,461.00 ", $949.65 ," $1,227.24 ", $153.31 , $69.14 ," $1,180.49 "," $1,314.90 "," $1,236.88 "," $1,314.90 "," $1,314.90 "," $1,314.90 "," $1,241.85 ", $67.78 ," $1,348.94 "," $1,387.95 "," $1,241.85 "," $1,358.73 "," $1,358.73 "," $1,387.95 "," $1,402.56 "," $1,195.39 "," $1,314.90 "," $1,241.85 "," $1,154.19 ", N/A ," $1,182.39 "," $1,182.39 "," $1,387.95 "," $1,253.68 ", $67.78 ," $1,402.56 "
 Fac Iadna Trichomonas Vaginalis Amplified Probe Tech ,CPT® 87661,0306 - LAB/BACT-MICRO,N/A,N/A, $324.00 , $210.60 , $272.16 , $35.79 , $35.79 , $261.79 , $291.60 , $274.30 , $291.60 , $291.60 , $291.60 , $275.40 , $35.09 , $299.15 , $307.80 , $275.40 , $301.32 , $301.32 , $307.80 , $311.04 , $265.10 , $291.60 , $275.40 , $255.96 , N/A , $262.21 , $262.21 , $307.80 , $278.02 , $35.09 , $311.04 
Open Big Toe Fx,CPT® 28505,N/A,N/A,N/A," $4,469.00 "," $2,904.85 "," $3,079.57 ", $479.38 , $230.52 ," $2,473.79 "," $2,437.68 "," $4,156.17 "," $4,022.10 "," $4,022.10 "," $3,575.20 "," $3,575.20 ", $230.52 ," $4,126.23 "," $4,245.55 "," $4,022.10 "," $4,022.10 "," $4,022.10 "," $4,156.17 "," $4,290.24 "," $2,849.00 "," $3,798.65 "," $2,654.69 "," $2,904.02 ", N/A ," $2,522.06 "," $2,522.06 "," $4,245.55 "," $2,964.32 ", $230.52 ," $4,290.24 "
Assay of Ammonia,CPT® 82140,N/A,N/A,N/A, $135.00 , $87.75 , N/A , $14.86 , $14.86 , $82.44 , $98.62 , $125.55 , $121.50 , $121.50 , $108.00 , $108.00 , $14.86 , $124.65 , $128.25 , $121.50 , $121.50 , $121.50 , $125.55 , $129.60 , $97.29 , $114.75 , $95.69 , $52.84 , N/A , $76.94 , $76.94 , $128.25 , $84.08 , $14.86 , $129.60 
 Fac Rmvl FB Musc/Tdn Shth Smpl ,CPT® 20520,0761 - TREATMENT ROOM,N/A,N/A," $1,341.00 ", $871.65 ," $1,126.44 ", $141.83 , $63.53 ," $1,083.53 "," $1,206.90 "," $1,135.29 "," $1,206.90 "," $1,206.90 "," $1,206.90 "," $1,139.85 ", $62.28 ," $1,238.15 "," $1,273.95 "," $1,139.85 "," $1,247.13 "," $1,247.13 "," $1,273.95 "," $1,287.36 "," $1,097.21 "," $1,206.90 "," $1,139.85 "," $1,059.39 ", N/A ," $1,085.27 "," $1,085.27 "," $1,273.95 "," $1,150.71 ", $62.28 ," $1,287.36 "
 VITAMIN B-12 100 MCG PO TABS ,HCPCS RXC637,0250 - PHARMACY,50268-0852-15,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Pro Telheath Inpt Consult 25min ,HCPCS G0407,0987 - PRO FEE/HOS VIS,N/A,N/A, $211.00 , $137.15 , $135.42 , $70.03 , N/A , $133.69 , N/A , $196.23 , $189.90 , $189.90 , $168.80 , $168.80 , N/A , $194.82 , $200.45 , $189.90 , $189.90 , $189.90 , $196.23 , $202.56 , $200.61 , $179.35 , $133.64 , $273.40 , N/A , $136.30 , $136.30 , $200.45 , $170.39 , $70.03 , $273.40 
Open Rx Radial Head/Neck Fx,CPT® 24665,N/A,N/A,N/A," $4,156.00 "," $2,701.40 "," $4,025.97 ", $631.74 , $537.90 ," $3,140.39 "," $3,139.37 "," $3,865.08 "," $3,740.40 "," $3,740.40 "," $3,324.80 "," $3,324.80 ", $537.90 ," $3,837.23 "," $3,948.20 "," $3,740.40 "," $3,740.40 "," $3,740.40 "," $3,865.08 "," $3,989.76 "," $3,742.35 "," $3,532.60 "," $3,459.30 "," $3,726.14 ", N/A ," $3,201.66 "," $3,201.66 "," $3,948.20 "," $3,763.09 ", $537.90 ," $4,025.97 "
Dstr Nrolytc Agnt Parverteb Fct Addl Lmbr/Sacral,CPT® 64636,N/A,N/A,N/A, $528.00 , $343.20 , $292.60 , $56.72 , $145.70 , $338.44 , $317.36 , $491.04 , $475.20 , $475.20 , $422.40 , $422.40 , $145.70 , $487.50 , $501.60 , $475.20 , $475.20 , $475.20 , $491.04 , $506.88 , $319.39 , $448.80 , $306.86 , $361.90 , N/A , $345.04 , $345.04 , $501.60 , $370.15 , $56.72 , $506.88 
Infec agen detec ampli probe,HCPCS U0005,N/A,N/A,N/A, $93.00 , $60.45 , N/A , $25.50 , $25.50 , N/A , N/A , $86.49 , $83.70 , $83.70 , $74.40 , $74.40 , $25.50 , $85.87 , $88.35 , $83.70 , $83.70 , $83.70 , $86.49 , $89.28 , $166.93 , $79.05 , $47.82 , $73.43 , N/A , $31.77 , $31.77 , $88.35 , $31.77 , $25.50 , $166.93 
Sigmoidoscopy Flx W/Rmvl Foreign Body,CPT® 45332,N/A,N/A,N/A," $1,904.00 "," $1,237.60 ", $642.20 , $99.12 , $114.34 , $524.11 , $540.95 ," $1,770.72 "," $1,713.60 "," $1,713.60 "," $1,523.20 "," $1,523.20 ", $114.34 ," $1,757.96 "," $1,808.80 "," $1,713.60 "," $1,713.60 "," $1,713.60 "," $1,770.72 "," $1,827.84 ", $459.64 ," $1,618.40 ", $595.88 , $608.41 , N/A , $534.33 , $534.33 ," $1,808.80 ", $558.86 , $99.12 ," $1,827.84 "
Debride Assoc Fx/Disloc Skin/Subq,11010,N/A,N/A,N/A," $1,592.00 "," $1,034.80 ", $871.93 , $261.22 , $345.88 , $760.78 , $739.10 ," $1,480.56 "," $1,432.80 "," $1,432.80 "," $1,273.60 "," $1,273.60 ", $345.88 ," $1,469.89 "," $1,512.40 "," $1,432.80 "," $1,432.80 "," $1,432.80 "," $1,480.56 "," $1,528.32 ", $953.65 ," $1,353.20 "," $1,482.56 ", $983.21 , N/A , $775.62 , $775.62 ," $1,512.40 ", $899.45 , $261.22 ," $1,528.32 "
 NITROGLYCERIN 2 % TD OINT ,HCPCS RXC637,0250 - PHARMACY,00281-0326-08,1 gram, $14.16 , $9.20 , $11.89 , N/A , N/A , $11.44 , $12.74 , $11.99 , $12.74 , $12.74 , $12.74 , $12.04 , N/A , $13.07 , $13.45 , $12.04 , $13.17 , $13.17 , $13.45 , $13.59 , $11.59 , $12.74 , $12.04 , $11.19 , N/A , $11.46 , $11.46 , $13.45 , $12.15 , $11.19 , $13.59 
"Repair Flex Tendon,Zone 2,Pri Hand",26356,N/A,N/A,N/A," $3,585.00 "," $2,330.25 "," $4,885.86 ", $768.43 , $738.54 ," $5,216.15 "," $5,292.11 "," $3,334.05 "," $3,226.50 "," $3,226.50 "," $2,868.00 "," $2,868.00 ", $738.54 ," $3,310.03 "," $3,405.75 "," $3,226.50 "," $3,226.50 "," $3,226.50 "," $3,334.05 "," $3,441.60 "," $4,550.07 "," $3,047.25 "," $5,798.21 "," $4,542.61 ", N/A ," $5,317.93 "," $5,317.93 "," $3,405.75 "," $6,250.45 ", $738.54 ," $6,250.45 "
"Excis Tumor,Soft Tiss Forearm/Wrist,Subq",25075,N/A,N/A,N/A," $3,242.00 "," $2,107.30 "," $1,930.11 ", $303.07 , $336.46 ," $1,518.48 "," $1,536.85 "," $3,015.06 "," $2,917.80 "," $2,917.80 "," $2,593.60 "," $2,593.60 ", $336.46 ," $2,993.34 "," $3,079.90 "," $2,917.80 "," $2,917.80 "," $2,917.80 "," $3,015.06 "," $3,112.32 "," $1,787.72 "," $2,755.70 "," $1,691.29 "," $1,801.91 ", N/A ," $1,548.10 "," $1,548.10 "," $3,079.90 "," $1,819.59 ", $303.07 ," $3,112.32 "
"Closed Rx Hum Supracondylr Fx,Manipu",24535,N/A,N/A,N/A," $3,148.00 "," $2,046.20 "," $3,493.49 ", $552.11 , $533.82 ," $2,721.20 "," $2,743.97 "," $2,927.64 "," $2,833.20 "," $2,833.20 "," $2,518.40 "," $2,518.40 ", $533.82 ," $2,906.55 "," $2,990.60 "," $2,833.20 "," $2,833.20 "," $2,833.20 "," $2,927.64 "," $3,022.08 "," $3,252.44 "," $2,675.80 "," $3,022.20 "," $3,233.03 ", N/A ," $2,774.30 "," $2,774.30 "," $2,990.60 "," $3,260.78 ", $533.82 ," $3,493.49 "
Exc Tumor Soft Tiss Forearm and/Wrist Subq 3+Cm,CPT® 25071,N/A,N/A,N/A," $3,455.00 "," $2,245.75 "," $2,570.88 ", $401.84 , $349.11 ," $2,041.20 "," $2,044.00 "," $3,213.15 "," $3,109.50 "," $3,109.50 "," $2,764.00 "," $2,764.00 ", $349.11 ," $3,190.00 "," $3,282.25 "," $3,109.50 "," $3,109.50 "," $3,109.50 "," $3,213.15 "," $3,316.80 "," $2,380.13 "," $2,936.75 "," $2,258.63 "," $2,404.23 ", N/A ," $2,081.03 "," $2,081.03 "," $3,282.25 "," $2,445.96 ", $349.11 ," $3,316.80 "
"Part Remv Bladder,Complicated",CPT® 51555,N/A,N/A,N/A," $8,789.00 "," $5,712.85 "," $6,799.26 "," $1,193.46 "," $1,229.45 "," $6,193.00 "," $5,770.33 "," $8,173.77 "," $7,910.10 "," $7,910.10 "," $7,031.20 "," $7,031.20 "," $1,229.45 "," $8,114.88 "," $8,349.55 "," $7,910.10 "," $7,910.10 "," $7,910.10 "," $8,173.77 "," $8,437.44 "," $6,831.31 "," $7,470.65 "," $6,567.14 "," $7,751.66 ", N/A ," $6,313.84 "," $6,313.84 "," $8,349.55 "," $7,421.01 "," $1,193.46 "," $8,437.44 "
 Fac Harvest Fempop Vein 1 Sgm Vasc Rcnstj Px ,CPT® 35572,0360 - OR SERVICES,N/A,N/A, $533.00 , $346.45 , $447.72 , $304.42 , $339.21 , $430.66 , $479.70 , $451.24 , $479.70 , $479.70 , $479.70 , $453.05 , $332.56 , $492.12 , $506.35 , $453.05 , $495.69 , $495.69 , $506.35 , $511.68 , $436.10 , $479.70 , $453.05 , $421.07 , N/A , $431.36 , $431.36 , $506.35 , $457.37 , $304.42 , $511.68 
 DIGOXIN IMMUNE FAB 40 MG IV SOLR ,HCPCS J1162,0636 - DRUGS REQUIRING DETAILED CODIN,50633-0120-11,4 mL," $13,522.50 "," $8,789.63 "," $11,358.90 "," $4,685.44 "," $4,688.96 "," $10,926.18 "," $12,170.25 "," $11,448.15 "," $12,170.25 "," $12,170.25 "," $12,170.25 "," $11,494.13 "," $4,597.02 "," $12,485.32 "," $12,846.38 "," $11,494.13 "," $12,575.93 "," $12,575.93 "," $12,846.38 "," $12,981.60 "," $11,064.11 "," $12,170.25 "," $11,494.13 "," $10,682.78 ", N/A ," $10,943.76 "," $10,943.76 "," $12,846.38 "," $11,603.66 "," $4,597.02 "," $12,981.60 "
"Lens, >= 1.66 P/>=1.80 G",HCPCS V2783,N/A,N/A,N/A, $65.00 , $42.25 , N/A , $85.09 , N/A , N/A , N/A , $60.45 , $58.50 , $58.50 , $52.00 , $52.00 , N/A , $60.01 , $61.75 , $58.50 , $58.50 , $58.50 , $60.45 , $62.40 , N/A , $55.25 , $65.00 , $77.31 , N/A , N/A , N/A , $61.75 , N/A , $52.00 , $85.09 
 Pro Cltx Acromclav Dislc W/O Mnpj ,CPT® 23540,0982 - PRO FEE/OUTPT,N/A,N/A, $695.00 , $451.75 ," $1,462.70 ", $233.67 , $133.38 ," $1,100.47 "," $1,119.50 ", $646.35 , $625.50 , $625.50 , $556.00 , $556.00 , $133.38 , $641.69 , $660.25 , $625.50 , $625.50 , $625.50 , $646.35 , $667.20 ," $1,338.90 ", $590.75 ," $1,225.65 "," $1,309.10 ", N/A ," $1,121.94 "," $1,121.94 ", $660.25 ," $1,318.69 ", $133.38 ," $1,462.70 "
 CEPHALEXIN 250 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,60687-0152-01,1 capsule, $3.67 , $2.39 , $3.08 , N/A , N/A , $2.97 , $3.30 , $3.11 , $3.30 , $3.30 , $3.30 , $3.12 , N/A , $3.39 , $3.49 , $3.12 , $3.41 , $3.41 , $3.49 , $3.52 , $3.00 , $3.30 , $3.12 , $2.90 , N/A , $2.97 , $2.97 , $3.49 , $3.15 , $2.90 , $3.52 
Removal Gallbladder,CPT® 47600,N/A,N/A,N/A," $6,947.00 "," $4,515.55 "," $6,374.81 ", $987.55 ," $1,233.02 "," $5,010.62 "," $5,067.82 "," $6,460.71 "," $6,252.30 "," $6,252.30 "," $5,557.60 "," $5,557.60 "," $1,233.02 "," $6,414.17 "," $6,599.65 "," $6,252.30 "," $6,252.30 "," $6,252.30 "," $6,460.71 "," $6,669.12 "," $4,566.35 "," $5,904.95 "," $5,637.64 "," $5,911.85 ", N/A ," $5,108.39 "," $5,108.39 "," $6,599.65 "," $5,342.83 ", $987.55 ," $6,669.12 "
 Pro Open Treatment Fracture Distal Tibia & Fibula ,CPT® 27828,0982 - PRO FEE/OUTPT,N/A,N/A," $8,581.00 "," $5,577.65 "," $8,100.24 "," $1,262.57 "," $1,210.57 "," $6,257.89 "," $6,220.19 "," $7,980.33 "," $7,722.90 "," $7,722.90 "," $6,864.80 "," $6,864.80 "," $1,210.57 "," $7,922.84 "," $8,151.95 "," $7,722.90 "," $7,722.90 "," $7,722.90 "," $7,980.33 "," $8,237.76 "," $7,515.49 "," $7,293.85 "," $6,874.00 "," $7,468.19 ", N/A ," $6,379.99 "," $6,379.99 "," $8,151.95 "," $7,498.76 "," $1,210.57 "," $8,237.76 "
Office/Outpatient New High Mdm 60-74 Minutes,CPT® 99205,N/A,N/A,N/A, $652.00 , $423.80 , $366.66 , $174.91 , $136.97 , $290.52 , $289.74 , $606.36 , $586.80 , $586.80 , $521.60 , $521.60 , $136.97 , $601.99 , $619.40 , $586.80 , $586.80 , $586.80 , $606.36 , $625.92 , $334.52 , $554.20 , $363.05 , $366.53 , $109.75 , $296.18 , $296.18 , $619.40 , $341.61 , $109.75 , $625.92 
"Stereotactic Brain Bx,Aspir,Exc",CPT® 61750,N/A,N/A,N/A," $9,003.00 "," $5,851.95 "," $6,439.26 "," $1,256.81 "," $1,173.61 "," $7,573.61 "," $7,254.92 "," $8,372.79 "," $8,102.70 "," $8,102.70 "," $7,202.40 "," $7,202.40 "," $1,173.61 "," $8,312.47 "," $8,552.85 "," $8,102.70 "," $8,102.70 "," $8,102.70 "," $8,372.79 "," $8,642.88 "," $6,946.29 "," $7,652.55 "," $7,453.82 "," $7,869.31 ", N/A ," $7,721.39 "," $7,721.39 "," $8,552.85 "," $8,283.23 "," $1,173.61 "," $8,642.88 "
" Fac Detect Agent Nos, Dna, Quant ",CPT® 87799,0306 - LAB/BACT-MICRO,N/A,N/A, $422.00 , $274.30 , $354.48 , $43.70 , $43.70 , $340.98 , $379.80 , $357.27 , $379.80 , $379.80 , $379.80 , $358.70 , $42.84 , $389.63 , $400.90 , $358.70 , $392.46 , $392.46 , $400.90 , $405.12 , $345.28 , $379.80 , $358.70 , $333.38 , N/A , $341.52 , $341.52 , $400.90 , $362.12 , $42.84 , $405.12 
Mast Gynecomastia,19300,N/A,N/A,N/A," $3,111.00 "," $2,022.15 "," $1,372.89 ", $410.11 , $397.21 ," $1,113.74 "," $1,088.11 "," $2,893.23 "," $2,799.90 "," $2,799.90 "," $2,488.80 "," $2,488.80 ", $397.21 ," $2,872.39 "," $2,955.45 "," $2,799.90 "," $2,799.90 "," $2,799.90 "," $2,893.23 "," $2,986.56 "," $1,482.91 "," $2,644.35 "," $2,187.26 "," $1,423.88 ", N/A ," $1,135.47 "," $1,135.47 "," $2,955.45 "," $1,316.75 ", $397.21 ," $2,986.56 "
 Pro Dup-Scan Xtrc Art Compl Bi Std ,CPT® 93880,0972 - PRO FEE/RAD/DX,N/A,N/A, $293.00 , $190.45 ," $1,216.41 ", $187.12 , $169.41 ," $1,087.59 "," $1,368.20 ", $272.49 , $263.70 , $263.70 , $234.40 , $234.40 , $169.41 , $270.53 , $278.35 , $263.70 , $263.70 , $263.70 , $272.49 , $281.28 , $858.22 , $249.05 , $727.85 , $771.42 , N/A ," $1,108.82 "," $1,108.82 ", $278.35 ," $1,229.13 ", $169.41 ," $1,368.20 "
Renal Endoscopy,CPT® 50551,N/A,N/A,N/A," $2,515.00 "," $1,634.75 "," $1,578.61 ", $277.33 , $138.28 ," $1,445.92 "," $1,341.33 "," $2,338.95 "," $2,263.50 "," $2,263.50 "," $2,012.00 "," $2,012.00 ", $138.28 ," $2,322.10 "," $2,389.25 "," $2,263.50 "," $2,263.50 "," $2,263.50 "," $2,338.95 "," $2,414.40 "," $1,587.46 "," $2,137.75 "," $1,518.24 "," $1,813.61 ", N/A ," $1,474.13 "," $1,474.13 "," $2,389.25 "," $1,732.62 ", $138.28 ," $2,414.40 "
 FENTANYL CITRATE-NACL 2-0.9 MG/100ML-% IV SOLN ,HCPCS J3010,0636 - DRUGS REQUIRING DETAILED CODIN,70092-1094-36,100 mL, $277.32 , $180.26 , $232.95 , $0.86 , $1.00 , $224.07 , $249.59 , $234.78 , $249.59 , $249.59 , $249.59 , $235.72 , $0.98 , $256.05 , $263.45 , $235.72 , $257.91 , $257.91 , $263.45 , $266.23 , $226.90 , $249.59 , $235.72 , $219.08 , N/A , $224.44 , $224.44 , $263.45 , $237.97 , $0.86 , $266.23 
"Preventive Visit,Est,12-17",CPT® 99394,N/A,N/A,N/A, $344.00 , $223.60 , N/A , $111.40 , $62.20 , $185.45 , $186.86 , $319.92 , $309.60 , $309.60 , $275.20 , $275.20 , $62.20 , $317.62 , $326.80 , $309.60 , $309.60 , $309.60 , $319.92 , $330.24 , $229.57 , $292.40 , $186.78 , $185.13 , N/A , $189.06 , $189.06 , $326.80 , $227.07 , $62.20 , $330.24 
" Fac Eeg, Cerebral Death Only ",CPT® 95824,0740 - EEG,N/A,N/A," $1,586.00 "," $1,030.90 "," $1,332.24 ", N/A , $107.56 ," $1,281.49 "," $1,427.40 "," $1,342.71 "," $1,427.40 "," $1,427.40 "," $1,427.40 "," $1,348.10 ", $105.45 ," $1,464.35 "," $1,506.70 "," $1,348.10 "," $1,474.98 "," $1,474.98 "," $1,506.70 "," $1,522.56 "," $1,297.67 "," $1,427.40 "," $1,348.10 "," $1,252.94 ", N/A ," $1,283.55 "," $1,283.55 "," $1,506.70 "," $1,360.95 ", $105.45 ," $1,522.56 "
 Fac Supslctv Cath 2nd+Ord Renal&Accessory Artery/S&I ,CPT® 36253,0360 - OR SERVICES,N/A,N/A," $6,881.00 "," $4,472.65 "," $5,780.04 ", $331.60 ," $1,748.55 "," $5,559.85 "," $6,192.90 "," $5,825.45 "," $6,192.90 "," $6,192.90 "," $6,192.90 "," $5,848.85 "," $1,714.26 "," $6,353.23 "," $6,536.95 "," $5,848.85 "," $6,399.33 "," $6,399.33 "," $6,536.95 "," $6,605.76 "," $5,630.03 "," $6,192.90 "," $5,848.85 "," $5,435.99 ", N/A ," $5,568.79 "," $5,568.79 "," $6,536.95 "," $5,904.59 ", $331.60 ," $6,605.76 "
 Venous Duplex Scan/Dvt-Bilateral ,CPT® 93970,0921 - PERI VASCUL LAB,N/A,N/A," $1,267.00 ", $823.55 ," $1,064.28 ", $184.54 , $172.43 ," $1,023.74 "," $1,140.30 "," $1,072.64 "," $1,140.30 "," $1,140.30 "," $1,140.30 "," $1,076.95 ", $169.05 ," $1,169.82 "," $1,203.65 "," $1,076.95 "," $1,178.31 "," $1,178.31 "," $1,203.65 "," $1,216.32 "," $1,036.66 "," $1,140.30 "," $1,076.95 "," $1,000.93 ", N/A ," $1,025.38 "," $1,025.38 "," $1,203.65 "," $1,087.21 ", $169.05 ," $1,216.32 "
 Flo Cytometry Cell Surf Marker Techl Only Ea Addl ,CPT® 88185,0311 - PATHOL/CYTOLOGY,N/A,N/A, $373.00 , $242.45 , $313.32 , $23.32 , $23.70 , $301.38 , $335.70 , $315.78 , $335.70 , $335.70 , $335.70 , $317.05 , $23.24 , $344.39 , $354.35 , $317.05 , $346.89 , $346.89 , $354.35 , $358.08 , $305.19 , $335.70 , $317.05 , $294.67 , N/A , $301.87 , $301.87 , $354.35 , $320.07 , $23.24 , $358.08 
Assay of Ggt,CPT® 82977,N/A,N/A,N/A, $80.00 , $52.00 , N/A , $7.34 , $7.34 , $40.74 , $48.74 , $74.40 , $72.00 , $72.00 , $64.00 , $64.00 , $7.34 , $73.86 , $76.00 , $72.00 , $72.00 , $72.00 , $74.40 , $76.80 , $48.08 , $68.00 , $47.03 , $26.11 , N/A , $38.02 , $38.02 , $76.00 , $41.55 , $7.34 , $76.80 
"Electron Microscopy,Diagn",CPT® 88348,N/A,N/A,N/A," $2,247.00 "," $1,460.55 "," $1,616.35 ", $463.41 , $141.98 , $836.06 ," $3,298.35 "," $2,089.71 "," $2,022.30 "," $2,022.30 "," $1,797.60 "," $1,797.60 ", $141.98 ," $2,074.66 "," $2,134.65 "," $2,022.30 "," $2,022.30 "," $2,022.30 "," $2,089.71 "," $2,157.12 "," $2,728.38 "," $1,909.95 "," $3,457.77 "," $1,202.11 ", N/A , $780.26 , $780.26 ," $2,134.65 ", $857.47 , $141.98 ," $3,457.77 "
Eeg Phys/Qhp Ea Incr>12hr<26hr After 24hr W/Veeg,CPT® 95720,N/A,N/A,N/A," $3,967.00 "," $2,578.55 ", $750.08 , $198.08 , $166.88 , $454.76 , N/A ," $3,689.31 "," $3,570.30 "," $3,570.30 "," $3,173.60 "," $3,173.60 ", $166.88 ," $3,662.73 "," $3,768.65 "," $3,570.30 "," $3,570.30 "," $3,570.30 "," $3,689.31 "," $3,808.32 ", $881.90 ," $3,371.95 ", $608.83 , $785.57 , N/A , $463.63 , $463.63 ," $3,768.65 ", $539.59 , $166.88 ," $3,808.32 "
 ACETAMINOPHEN 120 MG RE SUPP ,HCPCS RXC637,0250 - PHARMACY,45802-0732-30,1 suppository, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Ileoscopy Thru Stoma Dx W/Collj Spec When Prfmd ,CPT® 44380,0360 - OR SERVICES,N/A,N/A, $982.00 , $638.30 , $824.88 , $54.25 , $133.31 , $793.46 , $883.80 , $831.36 , $883.80 , $883.80 , $883.80 , $834.70 , $130.70 , $906.68 , $932.90 , $834.70 , $913.26 , $913.26 , $932.90 , $942.72 , $803.47 , $883.80 , $834.70 , $775.78 , N/A , $794.73 , $794.73 , $932.90 , $842.65 , $54.25 , $942.72 
 BACLOFEN 20 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6476-61,1 tablet, $5.58 , $3.63 , $4.69 , N/A , N/A , $4.51 , $5.02 , $4.72 , $5.02 , $5.02 , $5.02 , $4.74 , N/A , $5.15 , $5.30 , $4.74 , $5.19 , $5.19 , $5.30 , $5.36 , $4.57 , $5.02 , $4.74 , $4.41 , N/A , $4.52 , $4.52 , $5.30 , $4.79 , $4.41 , $5.36 
 BUSPIRONE HCL 15 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6899-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Assay of Zinc ,CPT® 84630,0301 - LAB/CHEMISTRY,N/A,N/A, $155.00 , $100.75 , $130.20 , $11.62 , $11.62 , $125.24 , $139.50 , $131.22 , $139.50 , $139.50 , $139.50 , $131.75 , $11.39 , $143.11 , $147.25 , $131.75 , $144.15 , $144.15 , $147.25 , $148.80 , $126.82 , $139.50 , $131.75 , $122.45 , N/A , $125.44 , $125.44 , $147.25 , $133.01 , $11.39 , $148.80 
Injection Aa&/Strd Genicular Nrv Branches W/Img,64454,N/A,N/A,N/A," $1,869.00 "," $1,214.85 ", $408.04 , $79.01 , $168.18 , $449.85 , N/A ," $1,738.17 "," $1,682.10 "," $1,682.10 "," $1,495.20 "," $1,495.20 ", $168.18 ," $1,725.65 "," $1,775.55 "," $1,682.10 "," $1,682.10 "," $1,682.10 "," $1,738.17 "," $1,794.24 ", $436.15 ," $1,588.65 ", $430.02 , $495.19 , N/A , $458.63 , $458.63 ," $1,775.55 ", $491.98 , $79.01 ," $1,794.24 "
 Pro Laparo Hernia Repair Initial ,CPT® 49650,0982 - PRO FEE/OUTPT,N/A,N/A," $3,308.00 "," $2,150.20 "," $2,598.83 ", $403.57 , $359.94 ," $2,009.15 "," $2,048.92 "," $3,076.44 "," $2,977.20 "," $2,977.20 "," $2,646.40 "," $2,646.40 ", $359.94 ," $3,054.28 "," $3,142.60 "," $2,977.20 "," $2,977.20 "," $2,977.20 "," $3,076.44 "," $3,175.68 "," $1,855.34 "," $2,811.80 "," $2,272.90 "," $2,383.24 ", N/A ," $2,048.35 "," $2,048.35 "," $3,142.60 "," $2,142.36 ", $359.94 ," $3,175.68 "
 Fac in Situ Hybridization Ea Multiplex Probe Stain ,CPT® 88366,0310 - PATHOLOGY LAB,N/A,N/A, $836.00 , $543.40 , $702.24 , $274.14 , $117.74 , $675.49 , $752.40 , $707.76 , $752.40 , $752.40 , $752.40 , $710.60 , $115.43 , $771.88 , $794.20 , $710.60 , $777.48 , $777.48 , $794.20 , $802.56 , $684.02 , $752.40 , $710.60 , $660.44 , N/A , $676.57 , $676.57 , $794.20 , $717.37 , $115.43 , $802.56 
Colonoscopy Flx W/Endoscopic Mucosal Resection,CPT® 45390,N/A,N/A,N/A," $2,139.00 "," $1,390.35 "," $2,040.42 ", $314.66 , $265.41 , N/A , N/A ," $1,989.27 "," $1,925.10 "," $1,925.10 "," $1,711.20 "," $1,711.20 ", $265.41 ," $1,974.94 "," $2,032.05 "," $1,925.10 "," $1,925.10 "," $1,925.10 "," $1,989.27 "," $2,053.44 "," $1,466.15 "," $1,818.15 "," $1,730.74 "," $1,945.15 ", N/A ," $1,490.41 "," $1,490.41 "," $2,032.05 "," $1,559.96 ", $265.41 ," $2,053.44 "
Remv Pilonidal Lesion Extens,11771,N/A,N/A,N/A," $3,137.00 "," $2,039.05 "," $1,420.35 ", $422.83 , $449.32 ," $1,170.22 "," $1,141.19 "," $2,917.41 "," $2,823.30 "," $2,823.30 "," $2,509.60 "," $2,509.60 ", $449.32 ," $2,896.39 "," $2,980.15 "," $2,823.30 "," $2,823.30 "," $2,823.30 "," $2,917.41 "," $3,011.52 "," $1,534.83 "," $2,666.45 "," $2,296.09 "," $1,490.58 ", N/A ," $1,193.05 "," $1,193.05 "," $2,980.15 "," $1,383.53 ", $422.83 ," $3,011.52 "
 DECITABINE 50 MG IV SOLR ,HCPCS J0893,0636 - DRUGS REQUIRING DETAILED CODIN,72205-0031-01,10 mL," $4,780.46 "," $3,107.30 "," $4,015.59 ", $2.28 , $1.92 ," $3,862.61 "," $4,302.41 "," $4,047.14 "," $4,302.41 "," $4,302.41 "," $4,302.41 "," $4,063.39 ", $1.88 ," $4,413.80 "," $4,541.44 "," $4,063.39 "," $4,445.83 "," $4,445.83 "," $4,541.44 "," $4,589.24 "," $3,911.37 "," $4,302.41 "," $4,063.39 "," $3,776.56 ", N/A ," $3,868.83 "," $3,868.83 "," $4,541.44 "," $4,102.11 ", $1.88 ," $4,589.24 "
 DULOXETINE HCL 30 MG PO CPEP ,HCPCS RXC637,0250 - PHARMACY,57237-0018-90,1 capsule, $40.34 , $26.22 , $33.89 , N/A , N/A , $32.59 , $36.31 , $34.15 , $36.31 , $36.31 , $36.31 , $34.29 , N/A , $37.25 , $38.32 , $34.29 , $37.52 , $37.52 , $38.32 , $38.73 , $33.01 , $36.31 , $34.29 , $31.87 , N/A , $32.65 , $32.65 , $38.32 , $34.62 , $31.87 , $38.73 
Egd Flex Removal Lesion(S) by Hot Biopsy Forceps,CPT® 43250,N/A,N/A,N/A," $2,545.00 "," $1,654.25 "," $1,032.98 ", $159.86 , $295.67 , $862.02 , $916.97 ," $2,366.85 "," $2,290.50 "," $2,290.50 "," $2,036.00 "," $2,036.00 ", $295.67 ," $2,349.80 "," $2,417.75 "," $2,290.50 "," $2,290.50 "," $2,290.50 "," $2,366.85 "," $2,443.20 ", $744.02 ," $2,163.25 "," $1,008.00 ", $984.49 , N/A , $878.84 , $878.84 ," $2,417.75 ", $919.17 , $159.86 ," $2,443.20 "
"Insert Bladder Cath, Complex",CPT® 51703,N/A,N/A,N/A, $923.00 , $599.95 , $412.39 , $72.47 , $143.34 , $399.54 , $371.51 , $858.39 , $830.70 , $830.70 , $738.40 , $738.40 , $143.34 , $852.21 , $876.85 , $830.70 , $830.70 , $830.70 , $858.39 , $886.08 , $413.36 , $784.55 , $419.26 , $473.02 , N/A , $407.34 , $407.34 , $876.85 , $478.77 , $72.47 , $886.08 
 Pro Removal Shoulder Foreign Body Deep Subfascial/Im ,CPT® 23333,0975 - PRO FEE/OR,N/A,N/A," $3,712.00 "," $2,412.80 "," $2,883.66 ", $453.88 , $691.53 ," $2,502.55 "," $2,218.92 "," $3,452.16 "," $3,340.80 "," $3,340.80 "," $2,969.60 "," $2,969.60 ", $691.53 ," $3,427.29 "," $3,526.40 "," $3,340.80 "," $3,340.80 "," $3,340.80 "," $3,452.16 "," $3,563.52 "," $2,685.10 "," $3,155.20 "," $2,542.81 "," $2,662.65 ", N/A ," $2,551.38 "," $2,551.38 "," $3,526.40 "," $2,998.78 ", $453.88 ," $3,563.52 "
"Lt Compres Band >=3"" <5""/Yd",HCPCS A6449,N/A,N/A,N/A, $8.00 , $5.20 , N/A , $2.38 , $0.62 , N/A , N/A , $7.44 , $7.20 , $7.20 , $6.40 , $6.40 , $0.62 , $7.39 , $7.60 , $7.20 , $7.20 , $7.20 , $7.44 , $7.68 , N/A , $6.80 , $1.95 , $2.16 , N/A , N/A , N/A , $7.60 , N/A , $0.62 , $7.68 
"Amputation Metatarsal+Toe,Single",28810,N/A,N/A,N/A," $3,343.00 "," $2,172.95 "," $2,591.23 ", $403.35 , $384.19 ," $2,103.13 "," $2,129.13 "," $3,108.99 "," $3,008.70 "," $3,008.70 "," $2,674.40 "," $2,674.40 ", $384.19 ," $3,086.59 "," $3,175.85 "," $3,008.70 "," $3,008.70 "," $3,008.70 "," $3,108.99 "," $3,209.28 "," $2,408.99 "," $2,841.55 "," $2,344.26 "," $2,463.28 ", N/A ," $2,144.16 "," $2,144.16 "," $3,175.85 "," $2,520.16 ", $384.19 ," $3,209.28 "
 Pro Diagnostic Lumbar Spinal Puncture ,CPT® 62270,0964 - PRO FEE/ANES CRNA,N/A,N/A," $1,057.00 ", $687.05 , $298.01 , $58.13 , $157.45 , $435.77 , $418.02 , $983.01 , $951.30 , $951.30 , $845.60 , $845.60 , $157.45 , $975.93 ," $1,004.15 ", $951.30 , $951.30 , $951.30 , $983.01 ," $1,014.72 ", $322.97 , $898.45 , $413.90 , $464.99 , N/A , $444.28 , $444.28 ," $1,004.15 ", $476.62 , $58.13 ," $1,014.72 "
Extensive Retinopathy 1+ Sess Preterm Infant,CPT® 67229,N/A,N/A,N/A," $10,374.00 "," $6,743.10 "," $7,125.89 "," $1,116.16 "," $1,108.10 "," $6,604.66 "," $6,036.33 "," $9,647.82 "," $9,336.60 "," $9,336.60 "," $8,299.20 "," $8,299.20 "," $1,108.10 "," $9,578.31 "," $9,855.30 "," $9,336.60 "," $9,336.60 "," $9,336.60 "," $9,647.82 "," $9,959.04 "," $9,800.40 "," $8,817.90 "," $6,124.69 "," $8,379.98 ", N/A ," $6,733.53 "," $6,733.53 "," $9,855.30 "," $7,432.94 "," $1,108.10 "," $9,959.04 "
Monovisc Inj per Dose,HCPCS J7327,N/A,N/A,N/A," $1,982.00 "," $1,288.30 ", N/A , $706.61 , $733.72 , N/A , N/A ," $1,843.26 "," $1,783.80 "," $1,783.80 "," $1,585.60 "," $1,585.60 ", $733.72 ," $1,829.98 "," $1,882.90 "," $1,783.80 "," $1,783.80 "," $1,783.80 "," $1,843.26 "," $1,902.72 "," $1,027.75 "," $1,684.70 "," $1,358.23 ", $987.04 , N/A , N/A , N/A ," $1,882.90 ", N/A , $706.61 ," $1,902.72 "
Gastrocnemius Recession,CPT® 27687,N/A,N/A,N/A," $3,850.00 "," $2,502.50 "," $2,795.59 ", $438.64 , $461.04 ," $2,219.07 "," $2,225.15 "," $3,580.50 "," $3,465.00 "," $3,465.00 "," $3,080.00 "," $3,080.00 ", $461.04 ," $3,554.71 "," $3,657.50 "," $3,465.00 "," $3,465.00 "," $3,465.00 "," $3,580.50 "," $3,696.00 "," $2,598.02 "," $3,272.50 "," $2,437.03 "," $2,612.71 ", N/A ," $2,262.37 "," $2,262.37 "," $3,657.50 "," $2,659.10 ", $438.64 ," $3,696.00 "
 Pro Vis Fld Xm Uni/Bi I&R Lmtd Xm ,CPT® 92081,0962 - PRO FEE/EYE,N/A,N/A, $145.00 , $94.25 , $71.51 , $32.59 , $43.72 , $59.07 , $72.67 , $134.85 , $130.50 , $130.50 , $116.00 , $116.00 , $43.72 , $133.88 , $137.75 , $130.50 , $130.50 , $130.50 , $134.85 , $139.20 , $102.32 , $123.25 , $104.41 , $72.54 , N/A , $60.23 , $60.23 , $137.75 , $71.64 , $32.59 , $139.20 
 Pro Treat Radius Fracture ,CPT® 24650,0982 - PRO FEE/OUTPT,N/A,N/A, $957.00 , $622.05 ," $1,529.32 ", $243.22 , $194.38 ," $1,155.93 "," $1,180.19 ", $890.01 , $861.30 , $861.30 , $765.60 , $765.60 , $194.38 , $883.60 , $909.15 , $861.30 , $861.30 , $861.30 , $890.01 , $918.72 ," $1,410.37 ", $813.45 ," $1,291.66 "," $1,377.14 ", N/A ," $1,178.49 "," $1,178.49 ", $909.15 ," $1,385.17 ", $194.38 ," $1,529.32 "
 Pro App Skn Sub Grft T/a/L Area/<100scm /<1st 25 Scm ,CPT® 15271,0982 - PRO FEE/OUTPT,N/A,N/A, $858.00 , $557.70 , $266.19 , $78.87 , $111.11 , $232.17 , $227.23 , $797.94 , $772.20 , $772.20 , $686.40 , $686.40 , $111.11 , $792.19 , $815.10 , $772.20 , $772.20 , $772.20 , $797.94 , $823.68 , $292.36 , $729.30 , $454.94 , $295.22 , N/A , $236.70 , $236.70 , $815.10 , $274.49 , $78.87 , $823.68 
 PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR ,HCPCS J2543,0636 - DRUGS REQUIRING DETAILED CODIN,00781-3114-95,20 mL, $120.13 , $78.08 , $100.91 , $1.39 , $1.55 , $97.07 , $108.12 , $101.70 , $108.12 , $108.12 , $108.12 , $102.11 , $1.52 , $110.92 , $114.12 , $102.11 , $111.72 , $111.72 , $114.12 , $115.32 , $98.29 , $108.12 , $102.11 , $94.90 , N/A , $97.22 , $97.22 , $114.12 , $103.08 , $1.39 , $115.32 
 Pro Revise Hip Joint Replacement ,CPT® 27137,0975 - PRO FEE/OR,N/A,N/A," $4,094.00 "," $2,661.10 "," $8,805.29 "," $1,374.83 "," $1,251.82 "," $7,118.56 "," $7,035.55 "," $3,807.42 "," $3,684.60 "," $3,684.60 "," $3,275.20 "," $3,275.20 "," $1,251.82 "," $3,779.99 "," $3,889.30 "," $3,684.60 "," $3,684.60 "," $3,684.60 "," $3,807.42 "," $3,930.24 "," $8,223.42 "," $3,479.90 "," $7,792.79 "," $8,363.90 ", N/A ," $7,257.45 "," $7,257.45 "," $3,889.30 "," $8,530.08 "," $1,251.82 "," $8,805.29 "
Phys/Qhp Svcs OP Pulm Rehab WO Cont Oximtry Mntr,CPT® 94625,N/A,N/A,N/A, $274.00 , $178.10 , $42.07 , $16.16 , $125.77 , N/A , N/A , $254.82 , $246.60 , $246.60 , $219.20 , $219.20 , $125.77 , $252.98 , $260.30 , $246.60 , $246.60 , $246.60 , $254.82 , $263.04 , N/A , $232.90 , $50.48 , $71.21 , N/A , $38.29 , $38.29 , $260.30 , $44.57 , $16.16 , $263.04 
Gastric Emptying Study,CPT® 78264,N/A,N/A,N/A," $3,218.00 "," $2,091.70 "," $1,767.26 ", $302.36 , $203.93 ," $1,423.12 "," $1,544.44 "," $2,992.74 "," $2,896.20 "," $2,896.20 "," $2,574.40 "," $2,574.40 ", $203.93 ," $2,971.18 "," $3,057.10 "," $2,896.20 "," $2,896.20 "," $2,896.20 "," $2,992.74 "," $3,089.28 "," $1,837.73 "," $2,735.30 "," $1,681.43 "," $2,260.44 ", N/A ," $1,450.89 "," $1,450.89 "," $3,057.10 "," $1,679.43 ", $203.93 ," $3,089.28 "
 ASPIRIN 81 MG PO CHEW ,HCPCS RXC637,0250 - PHARMACY,66553-0002-01,1 tablet, $0.42 , $0.27 , $0.35 , N/A , N/A , $0.34 , $0.38 , $0.36 , $0.38 , $0.38 , $0.38 , $0.36 , N/A , $0.39 , $0.40 , $0.36 , $0.39 , $0.39 , $0.40 , $0.40 , $0.34 , $0.38 , $0.36 , $0.33 , N/A , $0.34 , $0.34 , $0.40 , $0.36 , $0.33 , $0.40 
Acupunct W/O Elec Stimul 15 Min,CPT® 97810,N/A,N/A,N/A, $215.00 , $139.75 , $60.60 , $30.04 , N/A , $68.75 , $67.72 , $199.95 , $193.50 , $193.50 , $172.00 , $172.00 , N/A , $198.51 , $204.25 , $193.50 , $193.50 , $193.50 , $199.95 , $206.40 , $169.52 , $182.75 , $89.21 , $116.12 , N/A , $70.09 , $70.09 , $204.25 , $81.71 , $30.04 , $206.40 
Gastrointestinal Tract Imaging Esophagus,91111,N/A,N/A,N/A," $4,289.00 "," $2,787.85 "," $1,974.82 ", $844.03 , $603.38 ," $1,622.73 "," $1,821.61 "," $3,988.77 "," $3,860.10 "," $3,860.10 "," $3,431.20 "," $3,431.20 ", $603.38 ," $3,960.03 "," $4,074.55 "," $3,860.10 "," $3,860.10 "," $3,860.10 "," $3,988.77 "," $4,117.44 "," $4,084.86 "," $3,645.65 "," $2,415.68 "," $2,826.03 ", N/A ," $1,654.39 "," $1,654.39 "," $4,074.55 "," $1,928.69 ", $603.38 ," $4,117.44 "
Arthrodesis Ant Interbody Inc Discectomy C Blw C2 Each Addl,CPT® 22552,N/A,N/A,N/A," $2,739.00 "," $1,780.35 "," $2,269.74 ", $352.98 , $281.02 ," $1,901.01 "," $1,834.89 "," $2,547.27 "," $2,465.10 "," $2,465.10 "," $2,191.20 "," $2,191.20 ", $281.02 ," $2,528.92 "," $2,602.05 "," $2,465.10 "," $2,465.10 "," $2,465.10 "," $2,547.27 "," $2,629.44 "," $2,121.25 "," $2,328.15 "," $2,074.87 "," $2,182.41 ", N/A ," $1,938.10 "," $1,938.10 "," $2,602.05 "," $2,277.96 ", $281.02 ," $2,629.44 "
 Fac Specimen Concentration ,CPT® 87015,0306 - LAB/BACT-MICRO,N/A,N/A, $89.00 , $57.85 , $74.76 , $6.81 , $5.18 , $71.91 , $80.10 , $75.35 , $80.10 , $80.10 , $80.10 , $75.65 , $5.08 , $82.17 , $84.55 , $75.65 , $82.77 , $82.77 , $84.55 , $85.44 , $72.82 , $80.10 , $75.65 , $70.31 , N/A , $72.03 , $72.03 , $84.55 , $76.37 , $5.08 , $85.44 
RBC Antibody Screen,CPT® 86850,N/A,N/A,N/A, $110.00 , $71.50 , N/A , $9.97 , $5.31 , $69.65 , $80.40 , $102.30 , $99.00 , $99.00 , $88.00 , $88.00 , $5.31 , $101.56 , $104.50 , $99.00 , $99.00 , $99.00 , $102.30 , $105.60 , $65.24 , $93.50 , $81.09 , $28.69 , N/A , $65.00 , $65.00 , $104.50 , $71.03 , $5.31 , $105.60 
"Blood Typing, Abo",CPT® 86900,N/A,N/A,N/A, $59.00 , $38.35 , N/A , $3.05 , $3.05 , $15.50 , $18.56 , $54.87 , $53.10 , $53.10 , $47.20 , $47.20 , $3.05 , $54.47 , $56.05 , $53.10 , $53.10 , $53.10 , $54.87 , $56.64 , $19.96 , $50.15 , $19.46 , $10.84 , N/A , $14.47 , $14.47 , $56.05 , $15.82 , $3.05 , $56.64 
 BUPIVACAINE LIPOSOME 1.3 % IJ SUSP ,HCPCS C9290,0636 - DRUGS REQUIRING DETAILED CODIN,65250-0266-09,20 mL," $2,250.98 "," $1,463.14 "," $1,890.82 ", N/A , N/A ," $1,818.79 "," $2,025.88 "," $1,905.68 "," $2,025.88 "," $2,025.88 "," $2,025.88 "," $1,913.33 ", N/A ," $2,078.33 "," $2,138.43 "," $1,913.33 "," $2,093.41 "," $2,093.41 "," $2,138.43 "," $2,160.94 "," $1,841.75 "," $2,025.88 "," $1,913.33 "," $1,778.27 ", N/A ," $1,821.72 "," $1,821.72 "," $2,138.43 "," $1,931.57 "," $1,778.27 "," $2,160.94 "
 ERIBULIN MESYLATE 1 MG/2ML IV SOLN ,HCPCS J9179,0636 - DRUGS REQUIRING DETAILED CODIN,62856-0389-01,2 mL," $4,022.35 "," $2,614.53 "," $3,378.77 ", $131.36 , $129.46 ," $3,250.06 "," $3,620.12 "," $3,405.32 "," $3,620.12 "," $3,620.12 "," $3,620.12 "," $3,419.00 ", $126.92 ," $3,713.84 "," $3,821.23 "," $3,419.00 "," $3,740.79 "," $3,740.79 "," $3,821.23 "," $3,861.46 "," $3,291.09 "," $3,620.12 "," $3,419.00 "," $3,177.66 ", N/A ," $3,255.29 "," $3,255.29 "," $3,821.23 "," $3,451.58 ", $126.92 ," $3,861.46 "
F5 Coagulation Factor V Anal Leiden Variant,CPT® 81241,N/A,N/A,N/A, $628.00 , $408.20 , N/A , $74.84 , $68.03 , $345.73 , $409.42 , $584.04 , $565.20 , $565.20 , $502.40 , $502.40 , $68.03 , $579.83 , $596.60 , $565.20 , $565.20 , $565.20 , $584.04 , $602.88 , $489.91 , $533.80 , $350.54 , $221.57 , N/A , $322.66 , $322.66 , $596.60 , $352.60 , $68.03 , $602.88 
Covid-19 lab test non-cdc,HCPCS U0002,N/A,N/A,N/A, $221.00 , $143.65 , N/A , $52.34 , $52.34 , N/A , N/A , $205.53 , $198.90 , $198.90 , $176.80 , $176.80 , $52.34 , $204.05 , $209.95 , $198.90 , $198.90 , $198.90 , $205.53 , $212.16 , N/A , $187.85 , $97.57 , $150.70 , N/A , $217.47 , $217.47 , $209.95 , $237.65 , $52.34 , $237.65 
Excis Vaginal Cyst/Tumor,CPT® 57135,N/A,N/A,N/A," $2,021.00 "," $1,313.65 ", $891.30 , $180.85 , $213.54 , $703.80 , $702.15 ," $1,879.53 "," $1,818.90 "," $1,818.90 "," $1,616.80 "," $1,616.80 ", $213.54 ," $1,865.99 "," $1,919.95 "," $1,818.90 "," $1,818.90 "," $1,818.90 "," $1,879.53 "," $1,940.16 ", $919.17 ," $1,717.85 ", $920.58 , $710.30 , N/A , $717.53 , $717.53 ," $1,919.95 ", $860.63 , $180.85 ," $1,940.16 "
 Progrmg Dev Eval Scrms Phys/Qhp Remote ,CPT® 0650T,0360 - OR SERVICES,N/A,N/A, $324.00 , $210.60 , $272.16 , N/A , N/A , $261.79 , $291.60 , $274.30 , $291.60 , $291.60 , $291.60 , $275.40 , N/A , $299.15 , $307.80 , $275.40 , $301.32 , $301.32 , $307.80 , $311.04 , $265.10 , $291.60 , $275.40 , $255.96 , N/A , $262.21 , $262.21 , $307.80 , $278.02 , $255.96 , $311.04 
 Pro Partial Removal of Toe ,CPT® 28124,0982 - PRO FEE/OUTPT,N/A,N/A," $3,174.00 "," $2,063.10 "," $2,071.49 ", $325.03 , $230.52 ," $1,630.93 "," $1,622.56 "," $2,951.82 "," $2,856.60 "," $2,856.60 "," $2,539.20 "," $2,539.20 ", $230.52 ," $2,930.55 "," $3,015.30 "," $2,856.60 "," $2,856.60 "," $2,856.60 "," $2,951.82 "," $3,047.04 "," $1,921.13 "," $2,697.90 "," $1,751.95 "," $1,945.21 ", N/A ," $1,662.75 "," $1,662.75 "," $3,015.30 "," $1,954.34 ", $230.52 ," $3,047.04 "
 Fac Perq Thrmbc/Nfs Dialysis Circuit Img Dx Angrph ,CPT® 36904,0360 - OR SERVICES,N/A,N/A," $15,523.00 "," $10,089.95 "," $13,039.32 ", $341.56 ," $2,095.49 "," $12,542.58 "," $13,970.70 "," $13,141.77 "," $13,970.70 "," $13,970.70 "," $13,970.70 "," $13,194.55 "," $2,054.40 "," $14,332.39 "," $14,746.85 "," $13,194.55 "," $14,436.39 "," $14,436.39 "," $14,746.85 "," $14,902.08 "," $12,700.92 "," $13,970.70 "," $13,194.55 "," $12,263.17 ", N/A ," $12,562.76 "," $12,562.76 "," $14,746.85 "," $13,320.29 ", $341.56 ," $14,902.08 "
Autochondrocyte Implant Knee,CPT® 27412,N/A,N/A,N/A," $10,035.00 "," $6,522.75 "," $9,917.83 "," $1,550.16 "," $1,416.96 "," $7,989.07 "," $7,888.25 "," $9,332.55 "," $9,031.50 "," $9,031.50 "," $8,028.00 "," $8,028.00 "," $1,416.96 "," $9,265.32 "," $9,533.25 "," $9,031.50 "," $9,031.50 "," $9,031.50 "," $9,332.55 "," $9,633.60 "," $9,249.64 "," $8,529.75 "," $8,734.78 "," $9,386.23 ", N/A ," $8,144.96 "," $8,144.96 "," $9,533.25 "," $9,573.21 "," $1,416.96 "," $9,917.83 "
"Destruction,Lesion(S),Vulva,Simple",CPT® 56501,N/A,N/A,N/A, $706.00 , $458.90 , $636.10 , $129.57 , $116.65 , $468.60 , $469.60 , $656.58 , $635.40 , $635.40 , $564.80 , $564.80 , $116.65 , $651.85 , $670.70 , $635.40 , $635.40 , $635.40 , $656.58 , $677.76 , $645.71 , $600.10 , $617.29 , $473.72 , N/A , $477.74 , $477.74 , $670.70 , $573.02 , $116.65 , $677.76 
 Fac Roprtj Crtd Teaec > 1 Mo After Original Opration ,CPT® 35390,0360 - OR SERVICES,N/A,N/A, $158.00 , $102.70 , $132.72 , $140.73 , $669.44 , $127.66 , $142.20 , $133.76 , $142.20 , $142.20 , $142.20 , $134.30 , $656.31 , $145.88 , $150.10 , $134.30 , $146.94 , $146.94 , $150.10 , $151.68 , $129.28 , $142.20 , $134.30 , $124.82 , N/A , $127.87 , $127.87 , $150.10 , $135.58 , $124.82 , $669.44 
 Fac Acylcarnitines Quan Ea Spec ,CPT® 82017,0301 - LAB/CHEMISTRY,N/A,N/A, $197.00 , $128.05 , $165.48 , $17.21 , $17.21 , $159.18 , $177.30 , $166.78 , $177.30 , $177.30 , $177.30 , $167.45 , $16.87 , $181.89 , $187.15 , $167.45 , $183.21 , $183.21 , $187.15 , $189.12 , $161.19 , $177.30 , $167.45 , $155.63 , N/A , $159.43 , $159.43 , $187.15 , $169.05 , $16.87 , $189.12 
"Incision Eardrum,Aspir",CPT® 69420,N/A,N/A,N/A," $1,126.00 ", $731.90 , $570.15 , $117.08 , $165.21 , $580.28 , $603.67 ," $1,047.18 "," $1,013.40 "," $1,013.40 ", $900.80 , $900.80 , $165.21 ," $1,039.64 "," $1,069.70 "," $1,013.40 "," $1,013.40 "," $1,013.40 "," $1,047.18 "," $1,080.96 ", $618.46 , $957.10 , $658.32 , $582.35 , N/A , $591.59 , $591.59 ," $1,069.70 ", $675.50 , $117.08 ," $1,080.96 "
 Pro CT Head/Brain W/Dye ,CPT® 70460,0972 - PRO FEE/RAD/DX,N/A,N/A, $610.00 , $396.50 ," $1,056.16 ", $151.13 , $251.09 , $772.52 ," $1,142.80 ", $567.30 , $549.00 , $549.00 , $488.00 , $488.00 , $251.09 , $563.21 , $579.50 , $549.00 , $549.00 , $549.00 , $567.30 , $585.60 , $886.83 , $518.50 ," $1,242.30 "," $1,058.68 ", N/A , $787.59 , $787.59 , $579.50 , $911.64 , $151.13 ," $1,242.30 "
Inject Third and Any Level Lumbar/Sacral,CPT® 64495,N/A,N/A,N/A, $536.00 , $348.40 , $256.46 , $49.77 , $62.93 , $296.18 , $287.57 , $498.48 , $482.40 , $482.40 , $428.80 , $428.80 , $62.93 , $494.89 , $509.20 , $482.40 , $482.40 , $482.40 , $498.48 , $514.56 , $280.21 , $455.60 , $278.31 , $317.90 , N/A , $301.95 , $301.95 , $509.20 , $323.93 , $49.77 , $514.56 
 Pro Arthrs Ankle Exc Ostchndrl Dfct W/Drlg Dfct ,CPT® 29891,0982 - PRO FEE/OUTPT,N/A,N/A," $6,931.00 "," $4,505.15 "," $4,111.25 ", $643.64 , $641.55 ," $3,301.98 "," $3,289.26 "," $6,445.83 "," $6,237.90 "," $6,237.90 "," $5,544.80 "," $5,544.80 ", $641.55 ," $6,399.39 "," $6,584.45 "," $6,237.90 "," $6,237.90 "," $6,237.90 "," $6,445.83 "," $6,653.76 "," $3,821.95 "," $5,891.35 "," $3,616.30 "," $3,862.17 ", N/A ," $3,366.41 "," $3,366.41 "," $6,584.45 "," $3,956.71 ", $641.55 ," $6,653.76 "
Optx Dstl Radl I-Artic Fx/Epiphysl Sep 3 Frag,25609,N/A,N/A,N/A," $4,563.00 "," $2,965.95 "," $6,398.99 "," $1,004.45 ", $779.80 ," $5,048.32 "," $5,020.87 "," $4,243.59 "," $4,106.70 "," $4,106.70 "," $3,650.40 "," $3,650.40 ", $779.80 ," $4,213.02 "," $4,334.85 "," $4,106.70 "," $4,106.70 "," $4,106.70 "," $4,243.59 "," $4,380.48 "," $5,947.48 "," $3,878.55 "," $5,535.95 "," $5,968.91 ", N/A ," $5,146.82 "," $5,146.82 "," $4,334.85 "," $6,049.35 ", $779.80 ," $6,398.99 "
 Pro Treat Dislocation/Fracture ,CPT® 23670,0982 - PRO FEE/OUTPT,N/A,N/A," $5,096.00 "," $3,312.40 "," $5,285.48 ", $828.89 , $845.22 ," $4,231.05 "," $4,213.90 "," $4,739.28 "," $4,586.40 "," $4,586.40 "," $4,076.80 "," $4,076.80 ", $845.22 ," $4,705.14 "," $4,841.20 "," $4,586.40 "," $4,586.40 "," $4,586.40 "," $4,739.28 "," $4,892.16 "," $4,923.49 "," $4,331.60 "," $4,656.41 "," $4,971.19 ", N/A ," $4,313.60 "," $4,313.60 "," $4,841.20 "," $5,070.01 ", $828.89 ," $5,285.48 "
Psychotherapy W/Patient 30 Minutes,90832,N/A,N/A,N/A, $107.00 , $69.55 , $90.07 , $66.42 , $58.10 , $143.28 , $112.18 , $99.51 , $96.30 , $96.30 , $85.60 , $85.60 , $58.10 , $98.79 , $101.65 , $96.30 , $96.30 , $96.30 , $99.51 , $102.72 , $171.81 , $90.95 , $145.98 , $240.60 , $84.00 , $146.08 , $146.08 , $101.65 , $170.30 , $58.10 , $240.60 
"US,Infant Hips,Limited/Static",CPT® 76886,N/A,N/A,N/A, $918.00 , $596.70 , $573.62 , $99.80 , $77.44 , $509.20 , $560.30 , $853.74 , $826.20 , $826.20 , $734.40 , $734.40 , $77.44 , $847.59 , $872.10 , $826.20 , $826.20 , $826.20 , $853.74 , $881.28 , $580.89 , $780.30 , $608.63 , $593.97 , N/A , $519.14 , $519.14 , $872.10 , $600.90 , $77.44 , $881.28 
 OXALIPLATIN 100 MG/20ML IV SOLN ,HCPCS J9263,0636 - DRUGS REQUIRING DETAILED CODIN,71288-0101-20,20 mL, $123.29 , $80.14 , $103.56 , $0.07 , $0.08 , $99.62 , $110.96 , $104.38 , $110.96 , $110.96 , $110.96 , $104.80 , $0.08 , $113.83 , $117.13 , $104.80 , $114.66 , $114.66 , $117.13 , $118.36 , $100.88 , $110.96 , $104.80 , $97.40 , N/A , $99.78 , $99.78 , $117.13 , $105.80 , $0.07 , $118.36 
" Pro Revision Spinal Neurostim Electrode Perc Array, Incl Fluoro ",CPT® 63663,0982 - PRO FEE/OUTPT,N/A,N/A," $5,751.00 "," $3,738.15 "," $2,205.42 ", $429.55 , $673.61 ," $2,528.06 "," $2,520.03 "," $5,348.43 "," $5,175.90 "," $5,175.90 "," $4,600.80 "," $4,600.80 ", $673.61 ," $5,309.90 "," $5,463.45 "," $5,175.90 "," $5,175.90 "," $5,175.90 "," $5,348.43 "," $5,520.96 "," $2,396.22 "," $4,888.35 "," $2,485.20 "," $2,696.90 ", N/A ," $2,577.39 "," $2,577.39 "," $5,463.45 "," $2,764.92 ", $429.55 ," $5,520.96 "
 DILTIAZEM HCL ER COATED BEADS 120 MG PO CP24 ,HCPCS RXC637,0250 - PHARMACY,60687-0195-01,1 capsule, $4.97 , $3.23 , $4.17 , N/A , N/A , $4.02 , $4.47 , $4.21 , $4.47 , $4.47 , $4.47 , $4.22 , N/A , $4.59 , $4.72 , $4.22 , $4.62 , $4.62 , $4.72 , $4.77 , $4.07 , $4.47 , $4.22 , $3.93 , N/A , $4.02 , $4.02 , $4.72 , $4.26 , $3.93 , $4.77 
Insert Intra-Aortic Balloon Asst Device,CPT® 33967,N/A,N/A,N/A," $2,826.00 "," $1,836.90 "," $1,511.58 ", $232.33 , $250.47 ," $1,107.25 "," $1,081.31 "," $2,628.18 "," $2,543.40 "," $2,543.40 "," $2,260.80 "," $2,260.80 ", $250.47 ," $2,609.25 "," $2,684.70 "," $2,543.40 "," $2,543.40 "," $2,543.40 "," $2,628.18 "," $2,712.96 "," $1,401.60 "," $2,402.10 "," $1,366.59 "," $1,248.27 ", N/A ," $1,128.86 "," $1,128.86 "," $2,684.70 "," $1,282.38 ", $232.33 ," $2,712.96 "
 Pro Exc Tr-Ext B9+Marg 2.1-3 Cm ,CPT® 11403,0982 - PRO FEE/OUTPT,N/A,N/A, $846.00 , $549.90 , $475.69 , $143.37 , $154.53 , $399.76 , $393.99 , $786.78 , $761.40 , $761.40 , $676.80 , $676.80 , $154.53 , $781.11 , $803.70 , $761.40 , $761.40 , $761.40 , $786.78 , $812.16 , $518.92 , $719.10 , $784.99 , $515.24 , N/A , $407.56 , $407.56 , $803.70 , $472.63 , $143.37 , $812.16 
" Pro Radiologic Examination, Chest, 2 Views ",CPT® 71046,0972 - PRO FEE/RAD/DX,N/A,N/A, $144.00 , $93.60 , $189.02 , $33.11 , $23.99 , $136.89 , $153.08 , $133.92 , $129.60 , $129.60 , $115.20 , $115.20 , $23.99 , $132.96 , $136.80 , $129.60 , $129.60 , $129.60 , $133.92 , $138.24 , $184.57 , $122.40 , $193.75 , $153.48 , N/A , $139.56 , $139.56 , $136.80 , $161.55 , $23.99 , $193.75 
 Fac Assay of Pyruvate ,CPT® 84210,0301 - LAB/CHEMISTRY,N/A,N/A, $132.00 , $85.80 , $110.88 , $14.77 , $14.77 , $106.66 , $118.80 , $111.75 , $118.80 , $118.80 , $118.80 , $112.20 , $14.48 , $121.88 , $125.40 , $112.20 , $122.76 , $122.76 , $125.40 , $126.72 , $108.00 , $118.80 , $112.20 , $104.28 , N/A , $106.83 , $106.83 , $125.40 , $113.27 , $14.48 , $126.72 
Critical Care E&M L2,CPT® 99292,N/A,N/A,N/A, $616.00 , $400.40 , $217.33 , $103.14 , $121.38 , $192.94 , $193.49 , $572.88 , $554.40 , $554.40 , $492.80 , $492.80 , $121.38 , $568.75 , $585.20 , $554.40 , $554.40 , $554.40 , $572.88 , $591.36 , $276.66 , $523.60 , $241.53 , $242.43 , N/A , $196.71 , $196.71 , $585.20 , $226.88 , $103.14 , $591.36 
 MEPERIDINE HCL 50 MG/ML IJ SOLN ,HCPCS J2175,0636 - DRUGS REQUIRING DETAILED CODIN,00641-6053-25,1 mL, $29.70 , $19.31 , $24.95 , $7.46 , $9.78 , $24.00 , $26.73 , $25.14 , $26.73 , $26.73 , $26.73 , $25.25 , $9.59 , $27.42 , $28.22 , $25.25 , $27.62 , $27.62 , $28.22 , $28.51 , $24.30 , $26.73 , $25.25 , $23.46 , N/A , $24.04 , $24.04 , $28.22 , $25.49 , $7.46 , $28.51 
Exc Tumor Soft Tiss Back/Flank Subfascial 5+Cm,21933,N/A,N/A,N/A," $4,898.00 "," $3,183.70 "," $4,435.41 ", $690.51 , $610.14 ," $3,538.64 "," $3,518.47 "," $4,555.14 "," $4,408.20 "," $4,408.20 "," $3,918.40 "," $3,918.40 ", $610.14 ," $4,522.32 "," $4,653.10 "," $4,408.20 "," $4,408.20 "," $4,408.20 "," $4,555.14 "," $4,702.08 "," $4,111.98 "," $4,163.30 "," $3,905.32 "," $4,146.38 ", N/A ," $3,607.68 "," $3,607.68 "," $4,653.10 "," $4,240.30 ", $610.14 ," $4,702.08 "
 Fac Radex Hip Unilateral With Pelvis Minimum 4 Views ,CPT® 73503,0320 - DX X-RAY,N/A,N/A, $543.00 , $352.95 , $456.12 , $58.48 , $40.49 , $438.74 , $488.70 , $459.70 , $488.70 , $488.70 , $488.70 , $461.55 , $39.70 , $501.35 , $515.85 , $461.55 , $504.99 , $504.99 , $515.85 , $521.28 , $444.28 , $488.70 , $461.55 , $428.97 , N/A , $439.45 , $439.45 , $515.85 , $465.95 , $39.70 , $521.28 
"Prevent Counsel,Indiv,15 Min",CPT® 99401,N/A,N/A,N/A, $118.00 , $76.70 , N/A , $37.71 , $30.60 , $52.05 , $52.47 , $109.74 , $106.20 , $106.20 , $94.40 , $94.40 , $30.60 , $108.95 , $112.10 , $106.20 , $106.20 , $106.20 , $109.74 , $113.28 , $65.17 , $100.30 , $52.51 , $52.59 , N/A , $53.07 , $53.07 , $112.10 , $63.74 , $30.60 , $113.28 
 DROPERIDOL 2.5 MG/ML IJ SOLN ,HCPCS J1790,0636 - DRUGS REQUIRING DETAILED CODIN,00517-9702-25,2 mL, $55.17 , $35.86 , $46.34 , N/A , $2.18 , $44.58 , $49.65 , $46.71 , $49.65 , $49.65 , $49.65 , $46.89 , $2.14 , $50.94 , $52.41 , $46.89 , $51.31 , $51.31 , $52.41 , $52.96 , $45.14 , $49.65 , $46.89 , $43.58 , N/A , $44.65 , $44.65 , $52.41 , $47.34 , $2.14 , $52.96 
Foot Press Off Load Supp Dev,HCPCS A9283,N/A,N/A,N/A, $54.00 , $35.10 , N/A , N/A , N/A , N/A , N/A , $50.22 , $48.60 , $48.60 , $43.20 , $43.20 , N/A , $49.86 , $51.30 , $48.60 , $48.60 , $48.60 , $50.22 , $51.84 , N/A , $45.90 , $43.20 , N/A , N/A , N/A , N/A , $51.30 , N/A , $43.20 , $51.84 
Excision of Facial Bone(S),CPT® 21026,N/A,N/A,N/A," $4,135.00 "," $2,687.75 "," $2,660.71 ", $416.10 , $943.25 ," $2,443.54 "," $2,457.57 "," $3,845.55 "," $3,721.50 "," $3,721.50 "," $3,308.00 "," $3,308.00 ", $943.25 ," $3,817.85 "," $3,928.25 "," $3,721.50 "," $3,721.50 "," $3,721.50 "," $3,845.55 "," $3,969.60 "," $2,511.61 "," $3,514.75 "," $2,683.23 "," $2,867.01 ", N/A ," $2,491.23 "," $2,491.23 "," $3,928.25 "," $2,928.07 ", $416.10 ," $3,969.60 "
 Fac Transcatheter Dlvr Enhncd Fixation Devices Rs&I ,CPT® 34712,0360 - OR SERVICES,N/A,N/A," $1,392.00 ", $904.80 ," $1,169.28 ", $588.66 , $525.12 ," $1,124.74 "," $1,252.80 "," $1,178.47 "," $1,252.80 "," $1,252.80 "," $1,252.80 "," $1,183.20 ", $514.82 ," $1,285.23 "," $1,322.40 "," $1,183.20 "," $1,294.56 "," $1,294.56 "," $1,322.40 "," $1,336.32 "," $1,138.93 "," $1,252.80 "," $1,183.20 "," $1,099.68 ", N/A ," $1,126.55 "," $1,126.55 "," $1,322.40 "," $1,194.48 ", $514.82 ," $1,336.32 "
 ANTIHEMOPHILIC FACTOR-VWF 250-600 UNITS IV SOLR ,HCPCS J7187,0636 - DRUGS REQUIRING DETAILED CODIN,63833-0615-02,3 VWF, $35.00 , $22.75 , $29.40 , $1.38 , $1.38 , $28.28 , $31.50 , $29.63 , $31.50 , $31.50 , $31.50 , $29.75 , $1.35 , $32.32 , $33.25 , $29.75 , $32.55 , $32.55 , $33.25 , $33.60 , $28.64 , $31.50 , $29.75 , $27.65 , N/A , $28.33 , $28.33 , $33.25 , $30.03 , $1.35 , $33.60 
 Fac Molecular Pathology Interpr ,CPT® G0452,0310 - PATHOLOGY LAB,N/A,N/A, $77.00 , $50.05 , $64.68 , $49.22 , N/A , $62.22 , $69.30 , $65.19 , $69.30 , $69.30 , $69.30 , $65.45 , N/A , $71.09 , $73.15 , $65.45 , $71.61 , $71.61 , $73.15 , $73.92 , $63.00 , $69.30 , $65.45 , $60.83 , N/A , $62.32 , $62.32 , $73.15 , $66.07 , $49.22 , $73.92 
Nfct Ds Bct/Vir Respir Dna/Rna 22 Trgt Sarscov2,CPT® 0202U,N/A,N/A,N/A," $1,542.00 "," $1,002.30 ", N/A , $425.12 , N/A , N/A , N/A ," $1,434.06 "," $1,387.80 "," $1,387.80 "," $1,233.60 "," $1,233.60 ", N/A ," $1,423.73 "," $1,464.90 "," $1,387.80 "," $1,387.80 "," $1,387.80 "," $1,434.06 "," $1,480.32 ", N/A ," $1,310.70 ", $794.78 ," $1,168.69 ", N/A , $875.43 , $875.43 ," $1,464.90 "," $1,019.01 ", $425.12 ," $1,480.32 "
Doppler Fetal Mid Cerebral Artery,CPT® 76821,N/A,N/A,N/A, $862.00 , $560.30 , $505.30 , $87.89 , $88.87 , $445.84 , $501.53 , $801.66 , $775.80 , $775.80 , $689.60 , $689.60 , $88.87 , $795.88 , $818.90 , $775.80 , $775.80 , $775.80 , $801.66 , $827.52 , $509.03 , $732.70 , $548.92 , $523.02 , N/A , $454.54 , $454.54 , $818.90 , $526.16 , $87.89 , $827.52 
 Fac Egd Flex Removal Lesion(S) by Hot Biopsy Forceps ,CPT® 43250,0360 - OR SERVICES,N/A,N/A," $2,290.00 "," $1,488.50 "," $1,923.60 ", $159.86 , $295.67 ," $1,850.32 "," $2,061.00 "," $1,938.71 "," $2,061.00 "," $2,061.00 "," $2,061.00 "," $1,946.50 ", $289.87 ," $2,114.36 "," $2,175.50 "," $1,946.50 "," $2,129.70 "," $2,129.70 "," $2,175.50 "," $2,198.40 "," $1,873.68 "," $2,061.00 "," $1,946.50 "," $1,809.10 ", N/A ," $1,853.30 "," $1,853.30 "," $2,175.50 "," $1,965.05 ", $159.86 ," $2,198.40 "
 Fac Removal Impacted Cerumen Irrigation/Lvg Unilat ,CPT® 69209,0761 - TREATMENT ROOM,N/A,N/A, $147.00 , $95.55 , $123.48 , $14.88 , $9.93 , $118.78 , $132.30 , $124.45 , $132.30 , $132.30 , $132.30 , $124.95 , $9.74 , $135.73 , $139.65 , $124.95 , $136.71 , $136.71 , $139.65 , $141.12 , $120.28 , $132.30 , $124.95 , $116.13 , N/A , $118.97 , $118.97 , $139.65 , $126.14 , $9.74 , $141.12 
 Pro Fluoroscopic Guidance Needle Placement Add On ,CPT® 77002,0972 - PRO FEE/RAD/DX,N/A,N/A, $629.00 , $408.85 , $659.69 , $114.76 , $61.30 , $439.87 , $414.49 , $584.97 , $566.10 , $566.10 , $503.20 , $503.20 , $61.30 , $580.76 , $597.55 , $566.10 , $566.10 , $566.10 , $584.97 , $603.84 , $642.09 , $534.65 , $452.62 , $476.71 , N/A , $448.45 , $448.45 , $597.55 , $519.08 , $61.30 , $659.69 
 Fac Amino Acids 1 Quan Ea Spec ,CPT® 82131,0301 - LAB/CHEMISTRY,N/A,N/A, $187.00 , $121.55 , $157.08 , $23.44 , $20.74 , $151.10 , $168.30 , $158.31 , $168.30 , $168.30 , $168.30 , $158.95 , $20.33 , $172.66 , $177.65 , $158.95 , $173.91 , $173.91 , $177.65 , $179.52 , $153.00 , $168.30 , $158.95 , $147.73 , N/A , $151.34 , $151.34 , $177.65 , $160.46 , $20.33 , $179.52 
Heparin Neutralizatn,CPT® 85525,N/A,N/A,N/A, $154.00 , $100.10 , N/A , $12.08 , $12.08 , $67.02 , $80.15 , $143.22 , $138.60 , $138.60 , $123.20 , $123.20 , $12.08 , $142.19 , $146.30 , $138.60 , $138.60 , $138.60 , $143.22 , $147.84 , $79.06 , $130.90 , $77.85 , $42.94 , N/A , $62.55 , $62.55 , $146.30 , $68.35 , $12.08 , $147.84 
 Pro Treat Elbow Fracture ,CPT® 24586,0982 - PRO FEE/OUTPT,N/A,N/A," $4,283.00 "," $2,783.95 "," $6,584.63 "," $1,029.82 ", $934.20 ," $5,225.54 "," $5,173.18 "," $3,983.19 "," $3,854.70 "," $3,854.70 "," $3,426.40 "," $3,426.40 ", $934.20 ," $3,954.49 "," $4,068.85 "," $3,854.70 "," $3,854.70 "," $3,854.70 "," $3,983.19 "," $4,111.68 "," $6,134.89 "," $3,640.55 "," $5,717.93 "," $6,164.46 ", N/A ," $5,327.49 "," $5,327.49 "," $4,068.85 "," $6,261.69 ", $934.20 ," $6,584.63 "
Trlml Balo Angiop Open/Perq W/Img S&I Addl Vein,CPT® 37249,N/A,N/A,N/A," $3,821.00 "," $2,483.65 ", $862.42 , $132.82 , $750.06 , $622.20 , $610.47 ," $3,553.53 "," $3,438.90 "," $3,438.90 "," $3,056.80 "," $3,056.80 ", $750.06 ," $3,527.93 "," $3,629.95 "," $3,438.90 "," $3,438.90 "," $3,438.90 "," $3,553.53 "," $3,668.16 ", $798.79 ," $3,247.85 ", $751.65 , $722.21 , N/A , $634.35 , $634.35 ," $3,629.95 ", $720.62 , $132.82 ," $3,668.16 "
"Reconstruc Eyelid,<2/3,One Stage",CPT® 67971,N/A,N/A,N/A," $6,438.00 "," $4,184.70 "," $4,420.13 ", $693.11 , $768.38 ," $4,098.07 "," $3,866.49 "," $5,987.34 "," $5,794.20 "," $5,794.20 "," $5,150.40 "," $5,150.40 ", $768.38 ," $5,944.21 "," $6,116.10 "," $5,794.20 "," $5,794.20 "," $5,794.20 "," $5,987.34 "," $6,180.48 "," $6,074.64 "," $5,472.30 "," $4,019.50 "," $5,195.20 ", N/A ," $4,178.03 "," $4,178.03 "," $6,116.10 "," $4,611.99 ", $693.11 ," $6,180.48 "
 Pro I & D of Vulva/Perineum ,CPT® 56405,0982 - PRO FEE/OUTPT,N/A,N/A, $741.00 , $481.65 , $606.40 , $122.85 , $122.21 , $442.68 , $446.19 , $689.13 , $666.90 , $666.90 , $592.80 , $592.80 , $122.21 , $684.17 , $703.95 , $666.90 , $666.90 , $666.90 , $689.13 , $711.36 , $616.66 , $629.85 , $585.17 , $446.08 , N/A , $451.32 , $451.32 , $703.95 , $541.33 , $122.21 , $711.36 
 ZIPRASIDONE HCL 40 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-6270-08,1 capsule, $46.05 , $29.93 , $38.68 , N/A , N/A , $37.21 , $41.45 , $38.99 , $41.45 , $41.45 , $41.45 , $39.14 , N/A , $42.52 , $43.75 , $39.14 , $42.83 , $42.83 , $43.75 , $44.21 , $37.68 , $41.45 , $39.14 , $36.38 , N/A , $37.27 , $37.27 , $43.75 , $39.52 , $36.38 , $44.21 
Fix Simpl Depress Skull Fx,CPT® 62000,N/A,N/A,N/A," $6,596.00 "," $4,287.40 "," $4,755.30 ", $930.51 ," $1,152.58 "," $5,575.43 "," $5,342.26 "," $6,134.28 "," $5,936.40 "," $5,936.40 "," $5,276.80 "," $5,276.80 "," $1,152.58 "," $6,090.09 "," $6,266.20 "," $5,936.40 "," $5,936.40 "," $5,936.40 "," $6,134.28 "," $6,332.16 "," $5,128.63 "," $5,606.60 "," $5,478.86 "," $5,769.39 ", N/A ," $5,684.21 "," $5,684.21 "," $6,266.20 "," $6,097.82 ", $930.51 ," $6,332.16 "
 PALIPERIDONE PALMITATE ER 546 MG/1.75ML IM SUSY ,HCPCS J2427,0636 - DRUGS REQUIRING DETAILED CODIN,50458-0608-01,1.75 mL," $19,689.54 "," $12,798.20 "," $16,539.21 ", N/A , N/A ," $15,909.15 "," $17,720.59 "," $16,669.16 "," $17,720.59 "," $17,720.59 "," $17,720.59 "," $16,736.11 ", N/A ," $18,179.35 "," $18,705.06 "," $16,736.11 "," $18,311.27 "," $18,311.27 "," $18,705.06 "," $18,901.96 "," $16,109.98 "," $17,720.59 "," $16,736.11 "," $15,554.74 ", N/A ," $15,934.74 "," $15,934.74 "," $18,705.06 "," $16,895.59 "," $15,554.74 "," $18,901.96 "
Revise/Repair Finger/Toe Nerve,CPT® 64702,N/A,N/A,N/A," $3,318.00 "," $2,156.70 "," $2,505.10 ", $495.28 , $261.50 ," $2,754.32 "," $2,701.82 "," $3,085.74 "," $2,986.20 "," $2,986.20 "," $2,654.40 "," $2,654.40 ", $261.50 ," $3,063.51 "," $3,152.10 "," $2,986.20 "," $2,986.20 "," $2,986.20 "," $3,085.74 "," $3,185.28 "," $2,698.65 "," $2,820.30 "," $2,663.61 "," $2,969.82 ", N/A ," $2,808.06 "," $2,808.06 "," $3,152.10 "," $3,012.39 ", $261.50 ," $3,185.28 "
Colonoscopy Ca Scrn Not Hi Rsk Ind,HCPCS G0121,N/A,N/A,N/A," $1,932.00 "," $1,255.80 "," $2,171.85 ", $174.48 , $351.69 , $373.81 , N/A ," $1,796.76 "," $1,738.80 "," $1,738.80 "," $1,545.60 "," $1,545.60 ", $351.69 ," $1,783.82 "," $1,835.40 "," $1,738.80 "," $1,738.80 "," $1,738.80 "," $1,796.76 "," $1,854.72 ", $813.49 ," $1,642.20 ", $420.39 ," $1,074.52 ", N/A , $381.10 , $381.10 ," $1,835.40 ", $476.38 , $174.48 ," $2,171.85 "
"Drain Abscess,Peritonsill",CPT® 42700,N/A,N/A,N/A," $1,316.00 ", $855.40 , $833.04 , $131.69 , $124.27 , $655.65 , $682.92 ," $1,223.88 "," $1,184.40 "," $1,184.40 "," $1,052.80 "," $1,052.80 ", $124.27 ," $1,215.06 "," $1,250.20 "," $1,184.40 "," $1,184.40 "," $1,184.40 "," $1,223.88 "," $1,263.36 ", $591.70 ," $1,118.60 ", $745.74 , $772.76 , N/A , $668.44 , $668.44 ," $1,250.20 ", $699.12 , $124.27 ," $1,263.36 "
 EPOETIN ALFA-EPBX 20000 UNIT/ML IJ SOLN ,HCPCS Q5105,0636 - DRUGS REQUIRING DETAILED CODIN,00069-1311-01,1 mL, $648.64 , $421.62 , $544.86 , $0.77 , N/A , $524.10 , $583.78 , $549.14 , $583.78 , $583.78 , $583.78 , $551.34 , N/A , $598.89 , $616.21 , $551.34 , $603.24 , $603.24 , $616.21 , $622.69 , $530.72 , $583.78 , $551.34 , $512.43 , N/A , $524.94 , $524.94 , $616.21 , $556.60 , $0.77 , $622.69 
" Pro Application, Long Leg Splint ",CPT® 29505,0982 - PRO FEE/OUTPT,N/A,N/A, $570.00 , $370.50 , $310.83 , $49.45 , $46.08 , $241.34 , $244.33 , $530.10 , $513.00 , $513.00 , $456.00 , $456.00 , $46.08 , $526.28 , $541.50 , $513.00 , $513.00 , $513.00 , $530.10 , $547.20 , $289.85 , $484.50 , $267.61 , $292.25 , N/A , $246.04 , $246.04 , $541.50 , $289.17 , $46.08 , $547.20 
 Pro Injection Aa&/Strd Intercostal Nrv Single Lvl ,CPT® 64420,0981 - PRO FEE/ER,N/A,N/A, $501.00 , $325.65 , $291.72 , $56.48 , $46.08 , $379.80 , $375.69 , $465.93 , $450.90 , $450.90 , $400.80 , $400.80 , $46.08 , $462.57 , $475.95 , $450.90 , $450.90 , $450.90 , $465.93 , $480.96 , $316.65 , $425.85 , $367.52 , $406.08 , N/A , $387.20 , $387.20 , $475.95 , $415.37 , $46.08 , $480.96 
"Biopsy of Prostate,Needle,Transperineal",CPT® 55706,N/A,N/A,N/A," $2,045.00 "," $1,329.25 "," $1,669.44 ", $359.95 , $304.68 ," $1,197.68 "," $1,199.29 "," $1,901.85 "," $1,840.50 "," $1,840.50 "," $1,636.00 "," $1,636.00 ", $304.68 ," $1,888.15 "," $1,942.75 "," $1,840.50 "," $1,840.50 "," $1,840.50 "," $1,901.85 "," $1,963.20 "," $1,562.25 "," $1,738.25 "," $1,896.46 "," $1,806.67 ", N/A ," $1,221.04 "," $1,221.04 "," $1,942.75 "," $1,463.48 ", $304.68 ," $1,963.20 "
Change of Cystostomy Tube,CPT® 51705,N/A,N/A,N/A, $598.00 , $388.70 , $277.44 , $49.05 , $89.32 , $253.25 , $237.97 , $556.14 , $538.20 , $538.20 , $478.40 , $478.40 , $89.32 , $552.13 , $568.10 , $538.20 , $538.20 , $538.20 , $556.14 , $574.08 , $278.88 , $508.30 , $269.39 , $320.52 , N/A , $258.19 , $258.19 , $568.10 , $303.46 , $49.05 , $574.08 
 Fac Cltx Tars Jt Dislc W/O Anes ,CPT® 28600,0761 - TREATMENT ROOM,N/A,N/A," $2,003.00 "," $1,301.95 "," $1,682.52 ", $183.30 , $107.56 ," $1,618.42 "," $1,802.70 "," $1,695.74 "," $1,802.70 "," $1,802.70 "," $1,802.70 "," $1,702.55 ", $105.45 ," $1,849.37 "," $1,902.85 "," $1,702.55 "," $1,862.79 "," $1,862.79 "," $1,902.85 "," $1,922.88 "," $1,638.85 "," $1,802.70 "," $1,702.55 "," $1,582.37 ", N/A ," $1,621.03 "," $1,621.03 "," $1,902.85 "," $1,718.77 ", $105.45 ," $1,922.88 "
 WARFARIN 0.5 MG TAB (COMES FROM 1 MG TABLET) ,HCPCS RXC637,0250 - PHARMACY,00001-0927-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Mediastinoscopy, Cerv Approach",CPT® 39000,N/A,N/A,N/A," $2,877.00 "," $1,870.05 "," $2,024.09 ", $449.12 , $614.70 ," $1,749.20 "," $1,808.12 "," $2,675.61 "," $2,589.30 "," $2,589.30 "," $2,301.60 "," $2,301.60 ", $614.70 ," $2,656.33 "," $2,733.15 "," $2,589.30 "," $2,589.30 "," $2,589.30 "," $2,675.61 "," $2,761.92 "," $2,735.87 "," $2,445.45 "," $2,681.45 "," $2,286.26 ", N/A ," $1,783.33 "," $1,783.33 "," $2,733.15 "," $2,067.06 ", $449.12 ," $2,761.92 "
 Pro Apply Short Leg Cast ,CPT® 29405,0982 - PRO FEE/OUTPT,N/A,N/A, $685.00 , $445.25 , $353.21 , $55.88 , $70.65 , $291.95 , $292.92 , $637.05 , $616.50 , $616.50 , $548.00 , $548.00 , $70.65 , $632.46 , $650.75 , $616.50 , $616.50 , $616.50 , $637.05 , $657.60 , $330.82 , $582.25 , $319.35 , $344.75 , N/A , $297.65 , $297.65 , $650.75 , $349.86 , $55.88 , $657.60 
"Neg Press Wound Tx, > 50 Cm",CPT® 97606,N/A,N/A,N/A, $291.00 , $189.15 , $64.42 , $26.75 , $31.76 , $66.30 , $57.28 , $270.63 , $261.90 , $261.90 , $232.80 , $232.80 , $31.76 , $268.68 , $276.45 , $261.90 , $261.90 , $261.90 , $270.63 , $279.36 , $85.53 , $247.35 , $87.18 , $64.32 , N/A , $67.60 , $67.60 , $276.45 , $75.19 , $26.75 , $279.36 
 Fac Njx Supravalv Aortog Hrt Cath W/S&I ,CPT® 93567,0481 - CARDIAC CATH LAB,N/A,N/A, $563.00 , $365.95 , $472.92 , $33.93 , $139.28 , $454.90 , $506.70 , $476.64 , $506.70 , $506.70 , $506.70 , $478.55 , $136.55 , $519.82 , $534.85 , $478.55 , $523.59 , $523.59 , $534.85 , $540.48 , $460.65 , $506.70 , $478.55 , $444.77 , N/A , $455.64 , $455.64 , $534.85 , $483.11 , $33.93 , $540.48 
Fine Needle Evaluation,CPT® 88172,N/A,N/A,N/A, $147.00 , $95.55 , $195.25 , $54.94 , $48.00 , $227.11 , $252.06 , $136.71 , $132.30 , $132.30 , $117.60 , $117.60 , $48.00 , $135.73 , $139.65 , $132.30 , $132.30 , $132.30 , $136.71 , $141.12 , $357.50 , $124.95 , $261.12 , $201.46 , N/A , $211.95 , $211.95 , $139.65 , $232.93 , $48.00 , $357.50 
Transcervical Uterine Fibroid Abltj W/US Gdn Rf,CPT® 0404T,N/A,N/A,N/A," $2,692.00 "," $1,749.80 ", N/A , N/A , N/A , N/A , N/A ," $2,503.56 "," $2,422.80 "," $2,422.80 "," $2,153.60 "," $2,153.60 ", N/A ," $2,485.52 "," $2,557.40 "," $2,422.80 "," $2,422.80 "," $2,422.80 "," $2,503.56 "," $2,584.32 ", N/A ," $2,288.20 "," $1,139.83 "," $2,495.15 ", N/A ," $1,207.51 "," $1,207.51 "," $2,557.40 "," $1,405.57 "," $1,139.83 "," $2,584.32 "
Open Rx Prox Ulna Fracture,CPT® 24685,N/A,N/A,N/A," $3,825.00 "," $2,486.25 "," $3,995.68 ", $627.48 , $614.70 ," $3,150.32 "," $3,155.45 "," $3,557.25 "," $3,442.50 "," $3,442.50 "," $3,060.00 "," $3,060.00 ", $614.70 ," $3,531.62 "," $3,633.75 "," $3,442.50 "," $3,442.50 "," $3,442.50 "," $3,557.25 "," $3,672.00 "," $3,718.00 "," $3,251.25 "," $3,478.92 "," $3,726.44 ", N/A ," $3,211.79 "," $3,211.79 "," $3,633.75 "," $3,774.99 ", $614.70 ," $3,995.68 "
 Fac Assay of Calcitonin ,CPT® 82308,0301 - LAB/CHEMISTRY,N/A,N/A, $286.00 , $185.90 , $240.24 , $27.33 , $27.33 , $231.09 , $257.40 , $242.13 , $257.40 , $257.40 , $257.40 , $243.10 , $26.79 , $264.06 , $271.70 , $243.10 , $265.98 , $265.98 , $271.70 , $274.56 , $234.01 , $257.40 , $243.10 , $225.94 , N/A , $231.46 , $231.46 , $271.70 , $245.42 , $26.79 , $274.56 
 Fac Assay of Tyrosine ,CPT® 84510,0301 - LAB/CHEMISTRY,N/A,N/A, $95.00 , $61.75 , $79.80 , $10.84 , $10.84 , $76.76 , $85.50 , $80.43 , $85.50 , $85.50 , $85.50 , $80.75 , $10.63 , $87.71 , $90.25 , $80.75 , $88.35 , $88.35 , $90.25 , $91.20 , $77.73 , $85.50 , $80.75 , $75.05 , N/A , $76.88 , $76.88 , $90.25 , $81.52 , $10.63 , $91.20 
"Split Grft,Trunk,Arm,Leg <100sqcm",15100,N/A,N/A,N/A," $4,851.00 "," $3,153.15 "," $2,265.05 ", $677.39 , $522.35 ," $1,945.58 "," $1,908.03 "," $4,511.43 "," $4,365.90 "," $4,365.90 "," $3,880.80 "," $3,880.80 ", $522.35 ," $4,478.93 "," $4,608.45 "," $4,365.90 "," $4,365.90 "," $4,365.90 "," $4,511.43 "," $4,656.96 "," $2,476.68 "," $4,123.35 "," $3,830.39 "," $2,471.69 ", N/A ," $1,983.54 "," $1,983.54 "," $4,608.45 "," $2,300.24 ", $522.35 ," $4,656.96 "
 PAROXETINE HCL 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-5676-61,1 tablet, $14.46 , $9.40 , $12.15 , N/A , N/A , $11.68 , $13.01 , $12.24 , $13.01 , $13.01 , $13.01 , $12.29 , N/A , $13.35 , $13.74 , $12.29 , $13.45 , $13.45 , $13.74 , $13.88 , $11.83 , $13.01 , $12.29 , $11.42 , N/A , $11.70 , $11.70 , $13.74 , $12.41 , $11.42 , $13.88 
Levalbuterol Unit Dose,HCPCS J7614,N/A,N/A,N/A, $9.00 , $5.85 , N/A , $0.04 , $0.05 , N/A , N/A , $8.37 , $8.10 , $8.10 , $7.20 , $7.20 , $0.05 , $8.31 , $8.55 , $8.10 , $8.10 , $8.10 , $8.37 , $8.64 , $0.08 , $7.65 , $0.65 , $0.07 , N/A , N/A , N/A , $8.55 , N/A , $0.04 , $8.64 
 Pro Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs ,CPT® 78472,0974 - PRO FEE/NUC MED,N/A,N/A, $855.00 , $555.75 ," $1,226.24 ", $209.10 , $242.57 ," $1,131.79 "," $1,233.82 ", $795.15 , $769.50 , $769.50 , $684.00 , $684.00 , $242.57 , $789.42 , $812.25 , $769.50 , $769.50 , $769.50 , $795.15 , $820.80 ," $1,262.97 ", $726.75 ," $1,350.16 "," $1,540.70 ", N/A ," $1,153.88 "," $1,153.88 ", $812.25 ," $1,335.64 ", $209.10 ," $1,540.70 "
"Subtot Remv Vitreous,Mech Virectomy",CPT® 67010,N/A,N/A,N/A," $4,852.00 "," $3,153.80 "," $3,343.15 ", $526.48 , $438.64 ," $3,071.73 "," $2,865.64 "," $4,512.36 "," $4,366.80 "," $4,366.80 "," $3,881.60 "," $3,881.60 ", $438.64 ," $4,479.85 "," $4,609.40 "," $4,366.80 "," $4,366.80 "," $4,366.80 "," $4,512.36 "," $4,657.92 "," $4,577.05 "," $4,124.20 "," $2,945.49 "," $3,901.60 ", N/A ," $3,131.66 "," $3,131.66 "," $4,609.40 "," $3,456.94 ", $438.64 ," $4,657.92 "
Layer Closure 2.5cm or Le,12051,N/A,N/A,N/A, $804.00 , $522.60 , $541.38 , $162.92 , $106.23 , $469.05 , $460.11 , $747.72 , $723.60 , $723.60 , $643.20 , $643.20 , $106.23 , $742.33 , $763.80 , $723.60 , $723.60 , $723.60 , $747.72 , $771.84 , $593.04 , $683.40 , $917.01 , $602.22 , N/A , $478.20 , $478.20 , $763.80 , $554.57 , $106.23 , $917.01 
Closed Tx Interphalanx Jt Disloc W/ Manip W/ Anes -Mh,26775,N/A,N/A,N/A," $2,366.00 "," $1,537.90 "," $2,190.89 ", $348.94 , $96.07 ," $1,665.79 "," $1,696.44 "," $2,200.38 "," $2,129.40 "," $2,129.40 "," $1,892.80 "," $1,892.80 ", $96.07 ," $2,184.53 "," $2,247.70 "," $2,129.40 "," $2,129.40 "," $2,129.40 "," $2,200.38 "," $2,271.36 "," $2,017.00 "," $2,011.10 "," $1,860.78 "," $1,975.65 ", N/A ," $1,698.29 "," $1,698.29 "," $2,247.70 "," $1,996.10 ", $96.07 ," $2,271.36 "
 WITCH HAZEL-GLYCERIN EX PADS ,HCPCS RXC637,0250 - PHARMACY,50289-3250-01,1 Pad, $16.85 , $10.95 , $14.15 , N/A , N/A , $13.61 , $15.17 , $14.27 , $15.17 , $15.17 , $15.17 , $14.32 , N/A , $15.56 , $16.01 , $14.32 , $15.67 , $15.67 , $16.01 , $16.18 , $13.79 , $15.17 , $14.32 , $13.31 , N/A , $13.64 , $13.64 , $16.01 , $14.46 , $13.31 , $16.18 
" Fac Smear, Complex Stain ",CPT® 87209,0306 - LAB/BACT-MICRO,N/A,N/A, $167.00 , $108.55 , $140.28 , $18.34 , $18.34 , $134.94 , $150.30 , $141.38 , $150.30 , $150.30 , $150.30 , $141.95 , $17.98 , $154.19 , $158.65 , $141.95 , $155.31 , $155.31 , $158.65 , $160.32 , $136.64 , $150.30 , $141.95 , $131.93 , N/A , $135.15 , $135.15 , $158.65 , $143.30 , $17.98 , $160.32 
Revsc Opn/Prq Fem/Pop W/Stnt/Angiop Sm Vsl,CPT® 37226,N/A,N/A,N/A," $40,544.00 "," $26,353.60 "," $3,009.44 ", $463.08 , $384.61 ," $2,322.60 "," $2,212.08 "," $37,705.92 "," $36,489.60 "," $36,489.60 "," $32,435.20 "," $32,435.20 ", $384.61 ," $37,434.28 "," $38,516.80 "," $36,489.60 "," $36,489.60 "," $36,489.60 "," $37,705.92 "," $38,922.24 "," $2,568.61 "," $34,462.40 "," $2,717.13 "," $2,527.44 ", N/A ," $2,367.92 "," $2,367.92 "," $38,516.80 "," $2,689.97 ", $384.61 ," $38,922.24 "
"Renal Scope,Endopyelotomy",CPT® 50575,N/A,N/A,N/A," $4,980.00 "," $3,237.00 "," $3,824.10 ", $670.42 , $820.06 ," $3,506.23 "," $3,241.30 "," $4,631.40 "," $4,482.00 "," $4,482.00 "," $3,984.00 "," $3,984.00 ", $820.06 ," $4,598.03 "," $4,731.00 "," $4,482.00 "," $4,482.00 "," $4,482.00 "," $4,631.40 "," $4,780.80 "," $3,850.42 "," $4,233.00 "," $3,673.39 "," $4,396.28 ", N/A ," $3,574.65 "," $3,574.65 "," $4,731.00 "," $4,201.49 ", $670.42 ," $4,780.80 "
 Fac Dehydroepiandrosterone ,CPT® 82626,0301 - LAB/CHEMISTRY,N/A,N/A, $245.00 , $159.25 , $205.80 , $25.78 , $25.78 , $197.96 , $220.50 , $207.42 , $220.50 , $220.50 , $220.50 , $208.25 , $25.27 , $226.21 , $232.75 , $208.25 , $227.85 , $227.85 , $232.75 , $235.20 , $200.46 , $220.50 , $208.25 , $193.55 , N/A , $198.28 , $198.28 , $232.75 , $210.23 , $25.27 , $235.20 
"Excise Lesion,Back or Flank",21930,N/A,N/A,N/A," $3,153.00 "," $2,049.45 "," $2,206.04 ", $345.13 , $398.01 ," $1,751.41 "," $1,765.94 "," $2,932.29 "," $2,837.70 "," $2,837.70 "," $2,522.40 "," $2,522.40 ", $398.01 ," $2,911.16 "," $2,995.35 "," $2,837.70 "," $2,837.70 "," $2,837.70 "," $2,932.29 "," $3,026.88 "," $2,045.63 "," $2,680.05 "," $1,951.77 "," $2,069.50 ", N/A ," $1,785.59 "," $1,785.59 "," $2,995.35 "," $2,098.72 ", $345.13 ," $3,026.88 "
Exc Skin Benig <5mm Remaindr Body,CPT® 11420,N/A,N/A,N/A, $491.00 , $319.15 , $266.56 , $79.82 , $70.33 , $222.80 , $220.55 , $456.63 , $441.90 , $441.90 , $392.80 , $392.80 , $70.33 , $453.34 , $466.45 , $441.90 , $441.90 , $441.90 , $456.63 , $471.36 , $290.68 , $417.35 , $435.31 , $287.24 , N/A , $227.15 , $227.15 , $466.45 , $263.42 , $70.33 , $471.36 
Chemodervate Facial/Trigem/Cerv Musc Migraine,64615,N/A,N/A,N/A, $931.00 , $605.15 , $566.59 , $109.75 , $96.09 , $667.63 , $665.87 , $865.83 , $837.90 , $837.90 , $744.80 , $744.80 , $96.09 , $859.59 , $884.45 , $837.90 , $837.90 , $837.90 , $865.83 , $893.76 , $612.53 , $791.35 , $679.73 , $697.98 , N/A , $680.65 , $680.65 , $884.45 , $730.18 , $96.09 , $893.76 
"Excis Tumor,Soft Tiss Up Arm/Elbow,Subq",24075,N/A,N/A,N/A," $3,344.00 "," $2,173.60 "," $2,007.46 ", $314.81 , $80.09 ," $1,581.67 "," $1,597.42 "," $3,109.92 "," $3,009.60 "," $3,009.60 "," $2,675.20 "," $2,675.20 ", $80.09 ," $3,087.52 "," $3,176.80 "," $3,009.60 "," $3,009.60 "," $3,009.60 "," $3,109.92 "," $3,210.24 "," $1,858.16 "," $2,842.40 "," $1,762.66 "," $1,876.09 ", N/A ," $1,612.53 "," $1,612.53 "," $3,176.80 "," $1,895.29 ", $80.09 ," $3,210.24 "
 Pro Apply Long Leg Splint ,CPT® 29505,0982 - PRO FEE/OUTPT,N/A,N/A, $570.00 , $370.50 , $310.83 , $49.45 , $46.08 , $241.34 , $244.33 , $530.10 , $513.00 , $513.00 , $456.00 , $456.00 , $46.08 , $526.28 , $541.50 , $513.00 , $513.00 , $513.00 , $530.10 , $547.20 , $289.85 , $484.50 , $267.61 , $292.25 , N/A , $246.04 , $246.04 , $541.50 , $289.17 , $46.08 , $547.20 
Thoracoscopy Resexn Thymus Uni/Bilateral,CPT® 32673,N/A,N/A,N/A," $9,956.00 "," $6,471.40 "," $6,291.65 "," $1,098.98 ", $922.08 ," $4,605.06 "," $4,440.60 "," $9,259.08 "," $8,960.40 "," $8,960.40 "," $7,964.80 "," $7,964.80 ", $922.08 ," $9,192.37 "," $9,458.20 "," $8,960.40 "," $8,960.40 "," $8,960.40 "," $9,259.08 "," $9,557.76 "," $6,093.23 "," $8,462.60 "," $6,388.73 "," $6,042.63 ", N/A ," $4,694.91 "," $4,694.91 "," $9,458.20 "," $5,529.24 ", $922.08 ," $9,557.76 "
Telhealth Inpt Consult 15min,HCPCS G0406,N/A,N/A,N/A, $114.00 , $74.10 , $72.94 , $39.50 , N/A , $72.09 , N/A , $106.02 , $102.60 , $102.60 , $91.20 , $91.20 , N/A , $105.26 , $108.30 , $102.60 , $102.60 , $102.60 , $106.02 , $109.44 , $107.46 , $96.90 , $72.66 , $146.41 , N/A , $73.50 , $73.50 , $108.30 , $91.85 , $39.50 , $146.41 
Excis Urethral Prolapse,CPT® 53275,N/A,N/A,N/A," $1,830.00 "," $1,189.50 "," $1,424.56 ", $250.73 , $184.42 ," $1,285.46 "," $1,198.15 "," $1,701.90 "," $1,647.00 "," $1,647.00 "," $1,464.00 "," $1,464.00 ", $184.42 ," $1,689.64 "," $1,738.50 "," $1,647.00 "," $1,647.00 "," $1,647.00 "," $1,701.90 "," $1,756.80 "," $1,425.81 "," $1,555.50 "," $1,357.67 "," $1,614.80 ", N/A ," $1,310.54 "," $1,310.54 "," $1,738.50 "," $1,540.33 ", $184.42 ," $1,756.80 "
 KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN ,HCPCS J1885,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0161-01,1 mL, $23.12 , $15.03 , $19.42 , $0.56 , $0.60 , $18.68 , $20.81 , $19.57 , $20.81 , $20.81 , $20.81 , $19.65 , $0.59 , $21.35 , $21.96 , $19.65 , $21.50 , $21.50 , $21.96 , $22.20 , $18.92 , $20.81 , $19.65 , $18.26 , N/A , $18.71 , $18.71 , $21.96 , $19.84 , $0.56 , $22.20 
 Ot Neg Pressure Wound Therapy Non/Dme >50 Sq Cm ,CPT® 97608,0761 - TREATMENT ROOM,N/A,N/A, $472.00 , $306.80 , $396.48 , $23.23 , $31.76 , $381.38 , $424.80 , $399.60 , $424.80 , $424.80 , $424.80 , $401.20 , $31.14 , $435.80 , $448.40 , $401.20 , $438.96 , $438.96 , $448.40 , $453.12 , $386.19 , $424.80 , $401.20 , $372.88 , N/A , $381.99 , $381.99 , $448.40 , $405.02 , $23.23 , $453.12 
Debride Assoc Fx/Disloc Skin/Subq,11010,N/A,N/A,N/A," $1,392.00 ", $904.80 , $871.93 , $261.22 , $345.88 , $760.78 , $739.10 ," $1,294.56 "," $1,252.80 "," $1,252.80 "," $1,113.60 "," $1,113.60 ", $345.88 ," $1,285.23 "," $1,322.40 "," $1,252.80 "," $1,252.80 "," $1,252.80 "," $1,294.56 "," $1,336.32 ", $953.65 ," $1,183.20 "," $1,482.56 ", $983.21 , N/A , $775.62 , $775.62 ," $1,322.40 ", $899.45 , $261.22 ," $1,482.56 "
"PPPS, initial visit",HCPCS G0438,N/A,N/A,N/A, $276.00 , $179.40 , $402.88 , $161.76 , N/A , $315.97 , $372.56 , $256.68 , $248.40 , $248.40 , $220.80 , $220.80 , N/A , $254.83 , $262.20 , $248.40 , $248.40 , $248.40 , $256.68 , $264.96 , $449.07 , $234.60 , $323.08 , $365.15 , N/A , $322.13 , $322.13 , $262.20 , $402.66 , $161.76 , $449.07 
Layer Closure 7.6-12.5cm,12044,N/A,N/A,N/A," $1,440.00 ", $936.00 , $680.71 , $204.36 , $138.28 , $588.98 , $571.43 ," $1,339.20 "," $1,296.00 "," $1,296.00 "," $1,152.00 "," $1,152.00 ", $138.28 ," $1,329.55 "," $1,368.00 "," $1,296.00 "," $1,296.00 "," $1,296.00 "," $1,339.20 "," $1,382.40 ", $745.42 ," $1,224.00 "," $1,141.80 ", $753.29 , N/A , $600.46 , $600.46 ," $1,368.00 ", $696.35 , $138.28 ," $1,382.40 "
Pelvic Examination W Anesth,CPT® 57410,N/A,N/A,N/A, $734.00 , $477.10 , $494.30 , $100.19 , $97.25 , $439.23 , $436.23 , $682.62 , $660.60 , $660.60 , $587.20 , $587.20 , $97.25 , $677.70 , $697.30 , $660.60 , $660.60 , $660.60 , $682.62 , $704.64 , $518.63 , $623.90 , $572.68 , $441.63 , N/A , $447.80 , $447.80 , $697.30 , $537.11 , $97.25 , $704.64 
Explore/Treat Wrist Joint,CPT® 25101,N/A,N/A,N/A," $2,948.00 "," $1,916.20 "," $2,492.43 ", $392.23 , $614.70 ," $1,942.95 "," $1,955.13 "," $2,741.64 "," $2,653.20 "," $2,653.20 "," $2,358.40 "," $2,358.40 ", $614.70 ," $2,721.89 "," $2,800.60 "," $2,653.20 "," $2,653.20 "," $2,653.20 "," $2,741.64 "," $2,830.08 "," $2,309.50 "," $2,505.80 "," $2,149.80 "," $2,306.46 ", N/A ," $1,980.86 "," $1,980.86 "," $2,800.60 "," $2,328.22 ", $392.23 ," $2,830.08 "
 ATOVAQUONE 750 MG/5ML PO SUSP ,HCPCS RXC637,0250 - PHARMACY,50268-0086-11,5 mL, $212.16 , $137.90 , $178.21 , N/A , N/A , $171.43 , $190.94 , $179.61 , $190.94 , $190.94 , $190.94 , $180.34 , N/A , $195.89 , $201.55 , $180.34 , $197.31 , $197.31 , $201.55 , $203.67 , $173.59 , $190.94 , $180.34 , $167.61 , N/A , $171.70 , $171.70 , $201.55 , $182.05 , $167.61 , $203.67 
 Fac Byp Oth/Thn Vein Ilioiliac ,CPT® 35663,0360 - OR SERVICES,N/A,N/A," $4,357.00 "," $2,832.05 "," $3,659.88 "," $1,080.87 "," $1,340.24 "," $3,520.46 "," $3,921.30 "," $3,688.64 "," $3,921.30 "," $3,921.30 "," $3,921.30 "," $3,703.45 "," $1,313.96 "," $4,022.82 "," $4,139.15 "," $3,703.45 "," $4,052.01 "," $4,052.01 "," $4,139.15 "," $4,182.72 "," $3,564.90 "," $3,921.30 "," $3,703.45 "," $3,442.03 ", N/A ," $3,526.12 "," $3,526.12 "," $4,139.15 "," $3,738.74 "," $1,080.87 "," $4,182.72 "
 Pro Office/Outpatient Established High Mdm 40-54 Min ,CPT® 99215,0982 - PRO FEE/OUTPT,N/A,N/A, $394.00 , $256.10 , $292.89 , $139.34 , $94.97 , $192.33 , $191.18 , $366.42 , $354.60 , $354.60 , $315.20 , $315.20 , $94.97 , $363.78 , $374.30 , $354.60 , $354.60 , $354.60 , $366.42 , $378.24 , $266.74 , $334.90 , $237.78 , $242.86 , $128.75 , $196.08 , $196.08 , $374.30 , $226.13 , $94.97 , $378.24 
"Cystoscopy,Guide,Percut Nephros",CPT® 52334,N/A,N/A,N/A," $1,787.00 "," $1,161.55 ", $979.05 , $172.49 ," $1,050.11 "," $1,257.09 "," $1,167.99 "," $1,661.91 "," $1,608.30 "," $1,608.30 "," $1,429.60 "," $1,429.60 "," $1,050.11 "," $1,649.94 "," $1,697.65 "," $1,608.30 "," $1,608.30 "," $1,608.30 "," $1,661.91 "," $1,715.52 ", $987.34 ," $1,518.95 "," $1,323.78 "," $1,577.82 ", N/A ," $1,281.62 "," $1,281.62 "," $1,697.65 "," $1,506.37 ", $172.49 ," $1,715.52 "
Assay Urine Sulfate,CPT® 84392,N/A,N/A,N/A, $46.00 , $29.90 , N/A , $5.60 , $5.60 , $26.85 , $32.15 , $42.78 , $41.40 , $41.40 , $36.80 , $36.80 , $5.60 , $42.47 , $43.70 , $41.40 , $41.40 , $41.40 , $42.78 , $44.16 , $36.66 , $39.10 , $30.82 , $17.21 , N/A , $25.06 , $25.06 , $43.70 , $27.39 , $5.60 , $44.16 
Cystatin C,CPT® 82610,N/A,N/A,N/A, $242.00 , $157.30 , N/A , $18.89 , $18.87 , $76.91 , $92.03 , $225.06 , $217.80 , $217.80 , $193.60 , $193.60 , $18.87 , $223.44 , $229.90 , $217.80 , $217.80 , $217.80 , $225.06 , $232.32 , $123.66 , $205.70 , $89.20 , $54.39 , N/A , $71.78 , $71.78 , $229.90 , $78.44 , $18.87 , $232.32 
Part Remv Othr Tarsal/Metatarsal,CPT® 28122,N/A,N/A,N/A," $4,071.00 "," $2,646.15 "," $2,709.20 ", $424.70 , $384.19 ," $2,165.95 "," $2,162.58 "," $3,786.03 "," $3,663.90 "," $3,663.90 "," $3,256.80 "," $3,256.80 ", $384.19 ," $3,758.75 "," $3,867.45 "," $3,663.90 "," $3,663.90 "," $3,663.90 "," $3,786.03 "," $3,908.16 "," $2,515.35 "," $3,460.35 "," $2,346.04 "," $2,575.48 ", N/A ," $2,208.21 "," $2,208.21 "," $3,867.45 "," $2,595.42 ", $384.19 ," $3,908.16 "
Percutaneous Transluminal Coronary Lithotripsy,CPT® 0715T,N/A,N/A,N/A," $3,900.00 "," $2,535.00 ", N/A , N/A , N/A , N/A , N/A ," $3,627.00 "," $3,510.00 "," $3,510.00 "," $3,120.00 "," $3,120.00 ", N/A ," $3,600.87 "," $3,705.00 "," $3,510.00 "," $3,510.00 "," $3,510.00 "," $3,627.00 "," $3,744.00 ", N/A ," $3,315.00 "," $3,120.00 ", N/A , N/A , N/A , N/A ," $3,705.00 ", N/A ," $3,120.00 "," $3,744.00 "
 ALPRAZOLAM 1 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,65862-0678-01,1 tablet, $5.94 , $3.86 , $4.99 , N/A , N/A , $4.80 , $5.35 , $5.03 , $5.35 , $5.35 , $5.35 , $5.05 , N/A , $5.48 , $5.64 , $5.05 , $5.52 , $5.52 , $5.64 , $5.70 , $4.86 , $5.35 , $5.05 , $4.69 , N/A , $4.81 , $4.81 , $5.64 , $5.10 , $4.69 , $5.70 
"Locm 300-399mg/Ml Iodine,1ml",HCPCS Q9967,N/A,N/A,N/A, $5.00 , $3.25 , N/A , $0.13 , $0.17 , N/A , N/A , $4.65 , $4.50 , $4.50 , $4.00 , $4.00 , $0.17 , $4.62 , $4.75 , $4.50 , $4.50 , $4.50 , $4.65 , $4.80 , $0.16 , $4.25 , $0.65 , $0.16 , N/A , N/A , N/A , $4.75 , N/A , $0.13 , $4.80 
 INSULIN REGULAR HUMAN 100 UNIT/ML IJ SOLN ,HCPCS J1815,0636 - DRUGS REQUIRING DETAILED CODIN,00002-8215-17,3 mL, $274.98 , $178.74 , $230.98 , N/A , $0.92 , $222.18 , $247.48 , $232.80 , $247.48 , $247.48 , $247.48 , $233.73 , $0.90 , $253.89 , $261.23 , $233.73 , $255.73 , $255.73 , $261.23 , $263.98 , $224.99 , $247.48 , $233.73 , $217.23 , N/A , $222.54 , $222.54 , $261.23 , $235.96 , $0.90 , $263.98 
"Fix Unstable Patella,Exten Realign",CPT® 27422,N/A,N/A,N/A," $4,519.00 "," $2,937.35 "," $4,523.87 ", $708.01 , $645.95 ," $3,577.83 "," $3,570.68 "," $4,202.67 "," $4,067.10 "," $4,067.10 "," $3,615.20 "," $3,615.20 ", $645.95 ," $4,172.39 "," $4,293.05 "," $4,067.10 "," $4,067.10 "," $4,067.10 "," $4,202.67 "," $4,338.24 "," $4,209.72 "," $3,841.15 "," $3,942.78 "," $4,218.42 ", N/A ," $3,647.64 "," $3,647.64 "," $4,293.05 "," $4,287.28 ", $645.95 ," $4,523.87 "
 WARFARIN SODIUM 4 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00832-1215-01,1 tablet, $3.40 , $2.21 , $2.86 , N/A , N/A , $2.75 , $3.06 , $2.88 , $3.06 , $3.06 , $3.06 , $2.89 , N/A , $3.14 , $3.23 , $2.89 , $3.16 , $3.16 , $3.23 , $3.26 , $2.78 , $3.06 , $2.89 , $2.69 , N/A , $2.75 , $2.75 , $3.23 , $2.92 , $2.69 , $3.26 
 DIPHENHYDRAMINE HCL 50 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-2056-61,1 capsule, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Fats/Lipids, Feces, Quantitative",CPT® 82710,N/A,N/A,N/A, $186.00 , $120.90 , N/A , $17.14 , $17.14 , $95.09 , $113.73 , $172.98 , $167.40 , $167.40 , $148.80 , $148.80 , $17.14 , $171.73 , $176.70 , $167.40 , $167.40 , $167.40 , $172.98 , $178.56 , $112.18 , $158.10 , $110.29 , $60.94 , N/A , $88.74 , $88.74 , $176.70 , $96.97 , $17.14 , $178.56 
 Fac Prq Trluml Coronary Angioplasty Addl Branch ,CPT® 92921,0481 - CARDIAC CATH LAB,N/A,N/A," $7,024.00 "," $4,565.60 "," $5,900.16 ", N/A , $161.36 ," $5,675.39 "," $6,321.60 "," $5,946.52 "," $6,321.60 "," $6,321.60 "," $6,321.60 "," $5,970.40 ", $158.20 ," $6,485.26 "," $6,672.80 "," $5,970.40 "," $6,532.32 "," $6,532.32 "," $6,672.80 "," $6,743.04 "," $5,747.04 "," $6,321.60 "," $5,970.40 "," $5,548.96 ", N/A ," $5,684.52 "," $5,684.52 "," $6,672.80 "," $6,027.29 ", $158.20 ," $6,743.04 "
 Fac Tobacco Use Cessation Intermediate 3-10 Minutes ,CPT® 99406,0942 - EDUC/TRAINING,N/A,N/A, $30.00 , $19.50 , $25.20 , $11.46 , N/A , $24.24 , $27.00 , $25.40 , $27.00 , $27.00 , $27.00 , $25.50 , N/A , $27.70 , $28.50 , $25.50 , $27.90 , $27.90 , $28.50 , $28.80 , $24.55 , $27.00 , $25.50 , $23.70 , N/A , $24.28 , $24.28 , $28.50 , $25.74 , $11.46 , $28.80 
 ANTIHEM FACT (BDD-RFVIIIFC) 500 UNITS IV SOLR ,HCPCS J7205,0636 - DRUGS REQUIRING DETAILED CODIN,71104-0802-01,1 each, $35.00 , $22.75 , $29.40 , $2.21 , $2.22 , $28.28 , $31.50 , $29.63 , $31.50 , $31.50 , $31.50 , $29.75 , $2.18 , $32.32 , $33.25 , $29.75 , $32.55 , $32.55 , $33.25 , $33.60 , $28.64 , $31.50 , $29.75 , $27.65 , N/A , $28.33 , $28.33 , $33.25 , $30.03 , $2.18 , $33.60 
 NITROGLYCERIN 0.2 MG/HR TD PT24 ,HCPCS RXC637,0250 - PHARMACY,00378-9104-93,1 patch, $9.78 , $6.36 , $8.22 , N/A , N/A , $7.90 , $8.80 , $8.28 , $8.80 , $8.80 , $8.80 , $8.31 , N/A , $9.03 , $9.29 , $8.31 , $9.10 , $9.10 , $9.29 , $9.39 , $8.00 , $8.80 , $8.31 , $7.73 , N/A , $7.91 , $7.91 , $9.29 , $8.39 , $7.73 , $9.39 
 Fac Drs&/Dbrdmt Prtl-Thkns Brns 1st/Sbsq Medium ,CPT® 16025,0761 - TREATMENT ROOM,N/A,N/A, $793.00 , $515.45 , $666.12 , $104.77 , $43.96 , $640.74 , $713.70 , $671.35 , $713.70 , $713.70 , $713.70 , $674.05 , $43.10 , $732.18 , $753.35 , $674.05 , $737.49 , $737.49 , $753.35 , $761.28 , $648.83 , $713.70 , $674.05 , $626.47 , N/A , $641.77 , $641.77 , $753.35 , $680.47 , $43.10 , $761.28 
 Fac Exc Face-Mm B9+Marg 0.5 < Cm ,CPT® 11440,0761 - TREATMENT ROOM,N/A,N/A," $1,136.00 ", $738.40 , $954.24 , $103.49 , $82.89 , $917.89 ," $1,022.40 ", $961.74 ," $1,022.40 "," $1,022.40 "," $1,022.40 ", $965.60 , $81.26 ," $1,048.87 "," $1,079.20 ", $965.60 ," $1,056.48 "," $1,056.48 "," $1,079.20 "," $1,090.56 ", $929.48 ," $1,022.40 ", $965.60 , $897.44 , N/A , $919.36 , $919.36 ," $1,079.20 ", $974.80 , $81.26 ," $1,090.56 "
 IPRATROPIUM BROMIDE 0.03 % NA SOLN ,HCPCS RXC637,0250 - PHARMACY,00054-0045-44,30 mL, $573.59 , $372.83 , $481.82 , N/A , N/A , $463.46 , $516.23 , $485.60 , $516.23 , $516.23 , $516.23 , $487.55 , N/A , $529.60 , $544.91 , $487.55 , $533.44 , $533.44 , $544.91 , $550.65 , $469.31 , $516.23 , $487.55 , $453.14 , N/A , $464.21 , $464.21 , $544.91 , $492.20 , $453.14 , $550.65 
 Pro Control Nasal Hemorrhage Anterior Simple ,CPT® 30901,0981 - PRO FEE/ER,N/A,N/A, $526.00 , $341.90 , $301.30 , $53.21 , $34.36 , $216.79 , $209.25 , $489.18 , $473.40 , $473.40 , $420.80 , $420.80 , $34.36 , $485.66 , $499.70 , $473.40 , $473.40 , $473.40 , $489.18 , $504.96 , $289.39 , $447.10 , $296.15 , $286.56 , N/A , $221.02 , $221.02 , $499.70 , $260.29 , $34.36 , $504.96 
Xfer Addnl Lower Leg Tendon,CPT® 27692,N/A,N/A,N/A," $1,006.00 ", $653.90 , $608.66 , $94.17 , $223.16 , $504.84 , $506.62 , $935.58 , $905.40 , $905.40 , $804.80 , $804.80 , $223.16 , $928.84 , $955.70 , $905.40 , $905.40 , $905.40 , $935.58 , $965.76 , $575.54 , $855.10 , $560.20 , $596.60 , N/A , $514.70 , $514.70 , $955.70 , $604.94 , $94.17 , $965.76 
"Explore Undesc Testis,Abdominal",CPT® 54560,N/A,N/A,N/A," $3,768.00 "," $2,449.20 "," $3,047.62 ", $656.28 , $768.38 ," $2,225.25 "," $2,223.99 "," $3,504.24 "," $3,391.20 "," $3,391.20 "," $3,014.40 "," $3,014.40 ", $768.38 ," $3,478.99 "," $3,579.60 "," $3,391.20 "," $3,391.20 "," $3,391.20 "," $3,504.24 "," $3,617.28 "," $2,862.83 "," $3,202.80 "," $3,543.15 "," $3,327.52 ", N/A ," $2,268.67 "," $2,268.67 "," $3,579.60 "," $2,719.13 ", $656.28 ," $3,617.28 "
"Fx Scaphoid,Closed W/O MA",25622,N/A,N/A,N/A," $1,335.00 ", $867.75 ," $1,769.63 ", $281.15 , $206.19 ," $1,331.19 "," $1,359.46 "," $1,241.55 "," $1,201.50 "," $1,201.50 "," $1,068.00 "," $1,068.00 ", $206.19 ," $1,232.61 "," $1,268.25 "," $1,201.50 "," $1,201.50 "," $1,201.50 "," $1,241.55 "," $1,281.60 "," $1,628.51 "," $1,134.75 "," $1,491.48 "," $1,596.88 ", N/A ," $1,357.16 "," $1,357.16 "," $1,268.25 "," $1,595.16 ", $206.19 ," $1,769.63 "
Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn,CPT® 62323,N/A,N/A,N/A, $821.00 , $533.65 , $490.00 , $95.03 , $290.12 , $540.47 , $529.00 , $763.53 , $738.90 , $738.90 , $656.80 , $656.80 , $290.12 , $758.03 , $779.95 , $738.90 , $738.90 , $738.90 , $763.53 , $788.16 , $530.64 , $697.85 , $518.87 , $600.56 , N/A , $551.01 , $551.01 , $779.95 , $591.10 , $95.03 , $788.16 
 Mdp-Tc Medronate per Study Dose ,HCPCS A9503,0343 - DIAGNOSTIC RADIOPHARMACEUTICALS,N/A,N/A, $142.00 , $92.30 , $119.28 , $95.18 , $19.57 , $114.74 , $127.80 , $120.22 , $127.80 , $127.80 , $127.80 , $120.70 , $19.19 , $131.11 , $134.90 , $120.70 , $132.06 , $132.06 , $134.90 , $136.32 , $116.18 , $127.80 , $120.70 , $112.18 , N/A , $114.92 , $114.92 , $134.90 , $121.85 , $19.19 , $136.32 
Physical Therapy Evaluation High Complex 45 Mins,CPT® 97163,N/A,N/A,N/A, $402.00 , $261.30 , $196.04 , $100.30 , $67.74 , $174.75 , $166.54 , $373.86 , $361.80 , $361.80 , $321.60 , $321.60 , $67.74 , $371.17 , $381.90 , $361.80 , $361.80 , $361.80 , $373.86 , $385.92 , $253.17 , $341.70 , $302.90 , $189.75 , N/A , $178.16 , $178.16 , $381.90 , $198.16 , $67.74 , $385.92 
Psychotherapy for Crisis Each Addl 30 Minutes,CPT® 90840,N/A,N/A,N/A, $258.00 , $167.70 , $82.61 , $61.58 , $57.77 , $141.90 , $145.17 , $239.94 , $232.20 , $232.20 , $206.40 , $206.40 , $57.77 , $238.21 , $245.10 , $232.20 , $232.20 , $232.20 , $239.94 , $247.68 , $151.40 , $219.30 , $186.79 , $240.60 , $8.50 , $144.66 , $144.66 , $245.10 , $168.67 , $8.50 , $247.68 
Fx Ulnar Shaft W/O Manipu,CPT® 25530,N/A,N/A,N/A," $1,720.00 "," $1,118.00 "," $1,510.80 ", $240.36 , $154.82 ," $1,143.45 "," $1,163.91 "," $1,599.60 "," $1,548.00 "," $1,548.00 "," $1,376.00 "," $1,376.00 ", $154.82 ," $1,588.08 "," $1,634.00 "," $1,548.00 "," $1,548.00 "," $1,548.00 "," $1,599.60 "," $1,651.20 "," $1,395.00 "," $1,462.00 "," $1,273.82 "," $1,362.13 ", N/A ," $1,165.76 "," $1,165.76 "," $1,634.00 "," $1,370.18 ", $154.82 ," $1,651.20 "
Biopsy of Ext Auditory Canal,CPT® 69105,N/A,N/A,N/A, $862.00 , $560.30 , $296.15 , $61.22 , $46.08 , $305.01 , $313.77 , $801.66 , $775.80 , $775.80 , $689.60 , $689.60 , $46.08 , $795.88 , $818.90 , $775.80 , $775.80 , $775.80 , $801.66 , $827.52 , $320.78 , $732.70 , $342.54 , $307.65 , N/A , $310.96 , $310.96 , $818.90 , $355.06 , $46.08 , $827.52 
 DULOXETINE HCL 20 MG PO CPEP ,HCPCS RXC637,0250 - PHARMACY,57237-0017-60,1 capsule, $35.95 , $23.37 , $30.20 , N/A , N/A , $29.05 , $32.36 , $30.44 , $32.36 , $32.36 , $32.36 , $30.56 , N/A , $33.19 , $34.15 , $30.56 , $33.43 , $33.43 , $34.15 , $34.51 , $29.41 , $32.36 , $30.56 , $28.40 , N/A , $29.09 , $29.09 , $34.15 , $30.85 , $28.40 , $34.51 
 SUFENTANIL CITRATE 50 MCG/ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00409-3382-21,1 mL, $80.37 , $52.24 , $67.51 , N/A , N/A , $64.94 , $72.33 , $68.04 , $72.33 , $72.33 , $72.33 , $68.31 , N/A , $74.21 , $76.35 , $68.31 , $74.74 , $74.74 , $76.35 , $77.16 , $65.76 , $72.33 , $68.31 , $63.49 , N/A , $65.04 , $65.04 , $76.35 , $68.97 , $63.49 , $77.16 
Excision Tumor Soft Tissue Pelvis&Hip Subq 3+Cm,CPT® 27043,N/A,N/A,N/A," $3,115.00 "," $2,024.75 "," $2,818.73 ", $440.04 , $385.10 ," $2,248.05 "," $2,253.94 "," $2,896.95 "," $2,803.50 "," $2,803.50 "," $2,492.00 "," $2,492.00 ", $385.10 ," $2,876.08 "," $2,959.25 "," $2,803.50 "," $2,803.50 "," $2,803.50 "," $2,896.95 "," $2,990.40 "," $2,609.95 "," $2,647.75 "," $2,497.69 "," $2,638.75 ", N/A ," $2,291.91 "," $2,291.91 "," $2,959.25 "," $2,693.81 ", $385.10 ," $2,990.40 "
 Pro Avuls Nail Plate Simple ,CPT® 11730,0982 - PRO FEE/OUTPT,N/A,N/A, $385.00 , $250.25 , $174.35 , $51.83 , $42.84 , $140.67 , $134.38 , $358.05 , $346.50 , $346.50 , $308.00 , $308.00 , $42.84 , $355.47 , $365.75 , $346.50 , $346.50 , $346.50 , $358.05 , $369.60 , $192.28 , $327.25 , $262.26 , $198.13 , N/A , $143.42 , $143.42 , $365.75 , $166.31 , $42.84 , $369.60 
 ENOXAPARIN SODIUM 150 MG/ML IJ SOSY ,HCPCS J1650,0636 - DRUGS REQUIRING DETAILED CODIN,71288-0411-83,1 mL, $138.70 , $90.16 , $116.51 , $0.69 , $0.83 , $112.07 , $124.83 , $117.42 , $124.83 , $124.83 , $124.83 , $117.90 , $0.81 , $128.06 , $131.77 , $117.90 , $128.99 , $128.99 , $131.77 , $133.15 , $113.48 , $124.83 , $117.90 , $109.57 , N/A , $112.25 , $112.25 , $131.77 , $119.02 , $0.69 , $133.15 
 Fac Molecular Pathology Procedure Level 8 ,CPT® 81407,0310 - PATHOLOGY LAB,N/A,N/A, $230.00 , $149.50 , $193.20 , $863.20 , $863.20 , $185.84 , $207.00 , $194.72 , $207.00 , $207.00 , $207.00 , $195.50 , $846.27 , $212.36 , $218.50 , $195.50 , $213.90 , $213.90 , $218.50 , $220.80 , $188.19 , $207.00 , $195.50 , $181.70 , N/A , $186.14 , $186.14 , $218.50 , $197.36 , $181.70 , $863.20 
" Lap, Surgical, Enterolysis (Sep Proc) ",CPT® 44180,0360 - OR SERVICES,N/A,N/A," $10,192.00 "," $6,624.80 "," $8,561.28 ", $847.84 , $725.16 ," $8,235.14 "," $9,172.80 "," $8,628.55 "," $9,172.80 "," $9,172.80 "," $9,172.80 "," $8,663.20 ", $710.94 ," $9,410.27 "," $9,682.40 "," $8,663.20 "," $9,478.56 "," $9,478.56 "," $9,682.40 "," $9,784.32 "," $8,339.09 "," $9,172.80 "," $8,663.20 "," $8,051.68 ", N/A ," $8,248.39 "," $8,248.39 "," $9,682.40 "," $8,745.76 ", $710.94 ," $9,784.32 "
Diab Manage Trn Ind/Group,HCPCS G0109,N/A,N/A,N/A, $61.00 , $39.65 , $36.65 , $15.32 , N/A , $26.36 , N/A , $56.73 , $54.90 , $54.90 , $48.80 , $48.80 , N/A , $56.32 , $57.95 , $54.90 , $54.90 , $54.90 , $56.73 , $58.56 , $47.63 , $51.85 , $26.60 , $55.28 , N/A , $26.87 , $26.87 , $57.95 , $33.58 , $15.32 , $58.56 
 US Thoracentesis for Aspiration Only ,CPT® 32555,0761 - TREATMENT ROOM,N/A,N/A," $2,233.00 "," $1,451.45 "," $1,875.72 ", $104.93 , $293.25 ," $1,804.26 "," $2,009.70 "," $1,890.46 "," $2,009.70 "," $2,009.70 "," $2,009.70 "," $1,898.05 ", $287.50 ," $2,061.73 "," $2,121.35 "," $1,898.05 "," $2,076.69 "," $2,076.69 "," $2,121.35 "," $2,143.68 "," $1,827.04 "," $2,009.70 "," $1,898.05 "," $1,764.07 ", N/A ," $1,807.17 "," $1,807.17 "," $2,121.35 "," $1,916.14 ", $104.93 ," $2,143.68 "
Fx Cl Shouder W Man W Ane,23655,N/A,N/A,N/A," $2,591.00 "," $1,684.15 "," $2,524.02 ", $396.16 , $212.46 ," $1,931.47 "," $1,939.57 "," $2,409.63 "," $2,331.90 "," $2,331.90 "," $2,072.80 "," $2,072.80 ", $212.46 ," $2,392.27 "," $2,461.45 "," $2,331.90 "," $2,331.90 "," $2,331.90 "," $2,409.63 "," $2,487.36 "," $2,328.36 "," $2,202.35 "," $2,131.96 "," $2,289.60 ", N/A ," $1,969.16 "," $1,969.16 "," $2,461.45 "," $2,314.46 ", $212.46 ," $2,524.02 "
Open Rx Monteggia Fx/Disloc Elbow,CPT® 24635,N/A,N/A,N/A," $4,545.00 "," $2,954.25 "," $4,122.50 ", $648.58 , $845.22 ," $3,240.63 "," $3,237.34 "," $4,226.85 "," $4,090.50 "," $4,090.50 "," $3,636.00 "," $3,636.00 ", $845.22 ," $4,196.40 "," $4,317.75 "," $4,090.50 "," $4,090.50 "," $4,090.50 "," $4,226.85 "," $4,363.20 "," $3,831.11 "," $3,863.25 "," $3,568.13 "," $3,836.91 ", N/A ," $3,303.86 "," $3,303.86 "," $4,317.75 "," $3,883.21 ", $648.58 ," $4,363.20 "
Removal of Skin Tags,CPT® 11200,N/A,N/A,N/A, $337.00 , $219.05 , $244.80 , $74.08 , $40.50 , $199.18 , $197.46 , $313.41 , $303.30 , $303.30 , $269.60 , $269.60 , $40.50 , $311.15 , $320.15 , $303.30 , $303.30 , $303.30 , $313.41 , $323.52 , $265.13 , $286.45 , $390.71 , $259.40 , N/A , $203.07 , $203.07 , $320.15 , $235.48 , $40.50 , $390.71 
 Pro Tangential Biopsy Skin Single Lesion ,CPT® 11102,0982 - PRO FEE/OUTPT,N/A,N/A, $244.00 , $158.60 , $121.11 , $36.38 , $78.04 , $101.29 , N/A , $226.92 , $219.60 , $219.60 , $195.20 , $195.20 , $78.04 , $225.29 , $231.80 , $219.60 , $219.60 , $219.60 , $226.92 , $234.24 , $134.04 , $207.40 , $199.02 , $138.93 , N/A , $103.26 , $103.26 , $231.80 , $119.75 , $36.38 , $234.24 
Collect Blood From Catheter Venous Nos,CPT® 36592,N/A,N/A,N/A, $181.00 , $117.65 , $284.60 , $28.35 , $19.66 , $109.96 , $117.93 , $168.33 , $162.90 , $162.90 , $144.80 , $144.80 , $19.66 , $167.12 , $171.95 , $162.90 , $162.90 , $162.90 , $168.33 , $173.76 , $169.66 , $153.85 , $144.51 , $132.99 , N/A , $112.10 , $112.10 , $171.95 , $127.34 , $19.66 , $284.60 
"Inject Nerv Block, Hypogas Plexus",64517,N/A,N/A,N/A," $1,273.00 ", $827.45 , $626.91 , $122.10 , $185.43 , $691.69 , $668.67 ," $1,183.89 "," $1,145.70 "," $1,145.70 "," $1,018.40 "," $1,018.40 ", $185.43 ," $1,175.36 "," $1,209.35 "," $1,145.70 "," $1,145.70 "," $1,145.70 "," $1,183.89 "," $1,222.08 ", $678.02 ," $1,082.05 ", $651.18 , $764.35 , N/A , $705.18 , $705.18 ," $1,209.35 ", $756.51 , $122.10 ," $1,222.08 "
Open Rx Monteggia Fx/Disloc Elbow,24635,N/A,N/A,N/A," $4,545.00 "," $2,954.25 "," $4,122.50 ", $648.58 , $845.22 ," $3,240.63 "," $3,237.34 "," $4,226.85 "," $4,090.50 "," $4,090.50 "," $3,636.00 "," $3,636.00 ", $845.22 ," $4,196.40 "," $4,317.75 "," $4,090.50 "," $4,090.50 "," $4,090.50 "," $4,226.85 "," $4,363.20 "," $3,831.11 "," $3,863.25 "," $3,568.13 "," $3,836.91 ", N/A ," $3,303.86 "," $3,303.86 "," $4,317.75 "," $3,883.21 ", $648.58 ," $4,363.20 "
X-Ray Ankle 3+ Vw,CPT® 73610,N/A,N/A,N/A, $238.00 , $154.70 , $207.35 , $36.30 , $30.19 , $148.21 , $178.47 , $221.34 , $214.20 , $214.20 , $190.40 , $190.40 , $30.19 , $219.75 , $226.10 , $214.20 , $214.20 , $214.20 , $221.34 , $228.48 , $200.91 , $202.30 , $196.46 , $158.47 , N/A , $151.10 , $151.10 , $226.10 , $174.91 , $30.19 , $228.48 
 Fac Compre Electrophysiol Xm W/Left Ventr Pacng/Rec ,CPT® 93622,0481 - CARDIAC CATH LAB,N/A,N/A," $2,368.00 "," $1,539.20 "," $1,989.12 ", $510.18 ," $2,378.00 "," $1,913.34 "," $2,131.20 "," $2,004.75 "," $2,131.20 "," $2,131.20 "," $2,131.20 "," $2,012.80 "," $2,331.37 "," $2,186.37 "," $2,249.60 "," $2,012.80 "," $2,202.24 "," $2,202.24 "," $2,249.60 "," $2,273.28 "," $1,937.50 "," $2,131.20 "," $2,012.80 "," $1,870.72 ", N/A ," $1,916.42 "," $1,916.42 "," $2,249.60 "," $2,031.98 ", $510.18 ," $2,378.00 "
 Fac Total Cortisol ,CPT® 82533,0301 - LAB/CHEMISTRY,N/A,N/A, $202.00 , $131.30 , $169.68 , $16.63 , $16.63 , $163.22 , $181.80 , $171.01 , $181.80 , $181.80 , $181.80 , $171.70 , $16.30 , $186.51 , $191.90 , $171.70 , $187.86 , $187.86 , $191.90 , $193.92 , $165.28 , $181.80 , $171.70 , $159.58 , N/A , $163.48 , $163.48 , $191.90 , $173.34 , $16.30 , $193.92 
Cryocautery of Cervix,CPT® 57511,N/A,N/A,N/A, $927.00 , $602.55 , $701.00 , $142.02 , $69.95 , $538.37 , $542.75 , $862.11 , $834.30 , $834.30 , $741.60 , $741.60 , $69.95 , $855.90 , $880.65 , $834.30 , $834.30 , $834.30 , $862.11 , $889.92 , $717.51 , $787.95 , $711.84 , $541.15 , N/A , $548.87 , $548.87 , $880.65 , $658.34 , $69.95 , $889.92 
 SODIUM TETRADECYL SULFATE 1 % IV SOLN ,HCPCS RXA250,0250 - PHARMACY,67457-0162-02,2 mL, $481.60 , $313.04 , $404.54 , N/A , N/A , $389.13 , $433.44 , $407.72 , $433.44 , $433.44 , $433.44 , $409.36 , N/A , $444.66 , $457.52 , $409.36 , $447.89 , $447.89 , $457.52 , $462.34 , $394.05 , $433.44 , $409.36 , $380.46 , N/A , $389.76 , $389.76 , $457.52 , $413.26 , $380.46 , $462.34 
 Fac Tcat Impl Wrls P-Art Prs Snr L-T Hemodyn Mntr ,CPT® 33289,0481 - CARDIAC CATH LAB,N/A,N/A," $12,521.00 "," $8,138.65 "," $10,517.64 ", $301.84 , N/A ," $10,116.97 "," $11,268.90 "," $10,600.28 "," $11,268.90 "," $11,268.90 "," $11,268.90 "," $10,642.85 ", N/A ," $11,560.64 "," $11,894.95 "," $10,642.85 "," $11,644.53 "," $11,644.53 "," $11,894.95 "," $12,020.16 "," $10,244.68 "," $11,268.90 "," $10,642.85 "," $9,891.59 ", N/A ," $10,133.25 "," $10,133.25 "," $11,894.95 "," $10,744.27 ", $301.84 ," $12,020.16 "
 Pro CT Chest Spine W/O & W/Dye ,CPT® 72130,0972 - PRO FEE/RAD/DX,N/A,N/A, $715.00 , $464.75 ," $1,418.55 ", $203.81 , $368.56 ," $1,288.10 "," $1,662.77 ", $664.95 , $643.50 , $643.50 , $572.00 , $572.00 , $368.56 , $660.16 , $679.25 , $643.50 , $643.50 , $643.50 , $664.95 , $686.40 ," $1,193.58 ", $607.75 ," $1,812.41 "," $1,763.63 ", N/A ," $1,313.24 "," $1,313.24 ", $679.25 ," $1,520.08 ", $203.81 ," $1,812.41 "
 DEXAMETHASONE 4 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00054-8175-25,1 tablet, $6.19 , $4.02 , $5.20 , N/A , N/A , $5.00 , $5.57 , $5.24 , $5.57 , $5.57 , $5.57 , $5.26 , N/A , $5.72 , $5.88 , $5.26 , $5.76 , $5.76 , $5.88 , $5.94 , $5.06 , $5.57 , $5.26 , $4.89 , N/A , $5.01 , $5.01 , $5.88 , $5.31 , $4.89 , $5.94 
Open Rx Heel Fracture,CPT® 28415,N/A,N/A,N/A," $7,802.00 "," $5,071.30 "," $6,905.28 "," $1,077.63 ", $768.38 ," $5,373.70 "," $5,361.49 "," $7,255.86 "," $7,021.80 "," $7,021.80 "," $6,241.60 "," $6,241.60 ", $768.38 ," $7,203.59 "," $7,411.90 "," $7,021.80 "," $7,021.80 "," $7,021.80 "," $7,255.86 "," $7,489.92 "," $6,402.20 "," $6,631.70 "," $5,901.68 "," $6,413.87 ", N/A ," $5,478.55 "," $5,478.55 "," $7,411.90 "," $6,439.24 ", $768.38 ," $7,489.92 "
Lens Sphc Trifo 7.25-12/4.25,HCPCS V2313,N/A,N/A,N/A, $90.00 , $58.50 , N/A , $122.52 , N/A , N/A , N/A , $83.70 , $81.00 , $81.00 , $72.00 , $72.00 , N/A , $83.10 , $85.50 , $81.00 , $81.00 , $81.00 , $83.70 , $86.40 , N/A , $76.50 , $90.00 , $111.32 , N/A , N/A , N/A , $85.50 , N/A , $72.00 , $122.52 
 Fac Microdissection Prep Identified Target Manual ,CPT® 88381,0310 - PATHOLOGY LAB,N/A,N/A, $668.00 , $434.20 , $561.12 , $197.49 , $163.84 , $539.74 , $601.20 , $565.53 , $601.20 , $601.20 , $601.20 , $567.80 , $160.63 , $616.76 , $634.60 , $567.80 , $621.24 , $621.24 , $634.60 , $641.28 , $546.56 , $601.20 , $567.80 , $527.72 , N/A , $540.61 , $540.61 , $634.60 , $573.21 , $160.63 , $641.28 
 PREDNISONE 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00054-0019-20,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Peng Benzathine/Procaine Inj,HCPCS J0558,N/A,N/A,N/A, $27.00 , $17.55 , N/A , $15.98 , $14.71 , N/A , N/A , $25.11 , $24.30 , $24.30 , $21.60 , $21.60 , $14.71 , $24.93 , $25.65 , $24.30 , $24.30 , $24.30 , $25.11 , $25.92 , $15.65 , $22.95 , $7.14 , $17.17 , N/A , N/A , N/A , $25.65 , N/A , $7.14 , $25.92 
"Adj Tiss Xfer Head,Fac,Hand <10sqcm",14040,N/A,N/A,N/A," $4,032.00 "," $2,620.80 "," $1,994.24 ", $599.47 , $397.57 ," $1,729.62 "," $1,705.45 "," $3,749.76 "," $3,628.80 "," $3,628.80 "," $3,225.60 "," $3,225.60 ", $397.57 ," $3,722.75 "," $3,830.40 "," $3,628.80 "," $3,628.80 "," $3,628.80 "," $3,749.76 "," $3,870.72 "," $2,184.89 "," $3,427.20 "," $3,395.07 "," $2,215.01 ", N/A ," $1,763.37 "," $1,763.37 "," $3,830.40 "," $2,044.92 ", $397.57 ," $3,870.72 "
Cardiopulmonary Resuscita,92950,N/A,N/A,N/A," $1,990.00 "," $1,293.50 "," $1,136.20 ", $175.23 , $189.13 ," $1,020.88 "," $1,025.94 "," $1,850.70 "," $1,791.00 "," $1,791.00 "," $1,592.00 "," $1,592.00 ", $189.13 ," $1,837.37 "," $1,890.50 "," $1,791.00 "," $1,791.00 "," $1,791.00 "," $1,850.70 "," $1,910.40 "," $1,120.89 "," $1,691.50 ", $961.61 ," $1,114.88 ", N/A ," $1,040.80 "," $1,040.80 "," $1,890.50 "," $1,153.73 ", $175.23 ," $1,910.40 "
 Pro Rpr Cplx S/a/L 2.6 Cm-7.5 Cm ,CPT® 13121,0982 - PRO FEE/OUTPT,N/A,N/A," $1,861.00 "," $1,209.65 ", $826.64 , $247.45 , $218.65 , $731.79 , $713.39 ," $1,730.73 "," $1,674.90 "," $1,674.90 "," $1,488.80 "," $1,488.80 ", $218.65 ," $1,718.26 "," $1,767.95 "," $1,674.90 "," $1,674.90 "," $1,674.90 "," $1,730.73 "," $1,786.56 ", $912.10 ," $1,581.85 "," $1,421.90 ", $938.47 , N/A , $746.06 , $746.06 ," $1,767.95 ", $865.20 , $218.65 ," $1,786.56 "
Drain Vulva Abscess,56405,N/A,N/A,N/A, $741.00 , $481.65 , $606.40 , $122.85 , $122.21 , $442.68 , $446.19 , $689.13 , $666.90 , $666.90 , $592.80 , $592.80 , $122.21 , $684.17 , $703.95 , $666.90 , $666.90 , $666.90 , $689.13 , $711.36 , $616.66 , $629.85 , $585.17 , $446.08 , N/A , $451.32 , $451.32 , $703.95 , $541.33 , $122.21 , $711.36 
 Pro Diagnostic Computed Tomography Thorax W/Contrast ,CPT® 71260,0972 - PRO FEE/RAD/DX,N/A,N/A, $699.00 , $454.35 ," $1,186.64 ", $170.34 , $303.46 ," $1,092.56 "," $1,383.91 ", $650.07 , $629.10 , $629.10 , $559.20 , $559.20 , $303.46 , $645.39 , $664.05 , $629.10 , $629.10 , $629.10 , $650.07 , $671.04 ," $1,002.07 ", $594.15 ," $1,508.09 "," $1,275.20 ", N/A ," $1,113.88 "," $1,113.88 ", $664.05 ," $1,289.32 ", $170.34 ," $1,508.09 "
Occupational Ther Re-Eval Est Plan Care 30 Mins,CPT® 97168,N/A,N/A,N/A, $181.00 , $117.65 , $135.72 , $68.75 , $63.91 , $111.96 , $122.34 , $168.33 , $162.90 , $162.90 , $144.80 , $144.80 , $63.91 , $167.12 , $171.95 , $162.90 , $162.90 , $162.90 , $168.33 , $173.76 , $164.92 , $153.85 , $209.00 , $139.39 , N/A , $114.15 , $114.15 , $171.95 , $126.95 , $63.91 , $209.00 
Pro Ampu Arm Thru Rad/Uln Re,25909,N/A,N/A,N/A," $5,760.00 "," $3,744.00 "," $4,176.38 ", $654.81 , $614.70 ," $3,297.63 "," $3,278.26 "," $5,356.80 "," $5,184.00 "," $5,184.00 "," $4,608.00 "," $4,608.00 ", $614.70 ," $5,318.21 "," $5,472.00 "," $5,184.00 "," $5,184.00 "," $5,184.00 "," $5,356.80 "," $5,529.60 "," $3,879.08 "," $4,896.00 "," $3,621.65 "," $3,883.74 ", N/A ," $3,361.98 "," $3,361.98 "," $5,472.00 "," $3,951.51 ", $614.70 ," $5,529.60 "
Ultrasound Therapy,CPT® 97035,N/A,N/A,N/A, $99.00 , $64.35 , $33.34 , $14.26 , $19.80 , $28.95 , $25.48 , $92.07 , $89.10 , $89.10 , $79.20 , $79.20 , $19.80 , $91.41 , $94.05 , $89.10 , $89.10 , $89.10 , $92.07 , $95.04 , $36.18 , $84.15 , $37.51 , $32.82 , N/A , $29.52 , $29.52 , $94.05 , $32.83 , $14.26 , $95.04 
 Scrotal US ,CPT® 76870,0402 - ULTRASOUND,N/A,N/A, $627.00 , $407.55 , $526.68 , $99.83 , $95.93 , $506.62 , $564.30 , $530.82 , $564.30 , $564.30 , $564.30 , $532.95 , $94.05 , $578.91 , $595.65 , $532.95 , $583.11 , $583.11 , $595.65 , $601.92 , $513.01 , $564.30 , $532.95 , $495.33 , N/A , $507.43 , $507.43 , $595.65 , $538.03 , $94.05 , $601.92 
Thoracoscopy Surg Lobectomy,CPT® 32663,N/A,N/A,N/A," $14,318.00 "," $9,306.70 "," $7,234.48 "," $1,263.13 "," $2,192.42 "," $5,291.81 "," $5,163.70 "," $13,315.74 "," $12,886.20 "," $12,886.20 "," $11,454.40 "," $11,454.40 "," $2,192.42 "," $13,219.81 "," $13,602.10 "," $12,886.20 "," $12,886.20 "," $12,886.20 "," $13,315.74 "," $13,745.28 "," $7,011.16 "," $12,170.30 "," $7,468.09 "," $6,937.77 ", N/A ," $5,395.06 "," $5,395.06 "," $13,602.10 "," $6,353.83 "," $1,263.13 "," $13,745.28 "
 Fac Dna Antibody ,CPT® 86225,0302 - LAB/IMMUNOLOGY,N/A,N/A, $176.00 , $114.40 , $147.84 , $14.01 , $14.01 , $142.21 , $158.40 , $149.00 , $158.40 , $158.40 , $158.40 , $149.60 , $13.74 , $162.50 , $167.20 , $149.60 , $163.68 , $163.68 , $167.20 , $168.96 , $144.00 , $158.40 , $149.60 , $139.04 , N/A , $142.44 , $142.44 , $167.20 , $151.03 , $13.74 , $168.96 
"Wearable Mobile Cv Telemetry, Phys Review/Interp W/Report",CPT® 93228,N/A,N/A,N/A, $270.00 , $175.50 , $159.38 , $24.58 , $20.16 , $142.81 , $142.02 , $251.10 , $243.00 , $243.00 , $216.00 , $216.00 , $20.16 , $249.29 , $256.50 , $243.00 , $243.00 , $243.00 , $251.10 , $259.20 , $158.11 , $229.50 , $132.02 , $156.65 , N/A , $145.60 , $145.60 , $256.50 , $161.40 , $20.16 , $259.20 
"Dtap/Hepb/Ipv Vaccine,Im",CPT® 90723,N/A,N/A,N/A, $208.00 , $135.20 , N/A , N/A , $15.30 , $162.92 , $170.10 , $193.44 , $187.20 , $187.20 , $166.40 , $166.40 , $15.30 , $192.05 , $197.60 , $187.20 , $187.20 , $187.20 , $193.44 , $199.68 , N/A , $176.80 , $226.06 , $147.95 , N/A , $166.10 , $166.10 , $197.60 , $193.63 , $15.30 , $226.06 
Assay Urine Osmolality,CPT® 83935,N/A,N/A,N/A, $108.00 , $70.20 , N/A , $6.96 , $6.96 , $38.59 , $46.13 , $100.44 , $97.20 , $97.20 , $86.40 , $86.40 , $6.96 , $99.72 , $102.60 , $97.20 , $97.20 , $97.20 , $100.44 , $103.68 , $45.54 , $91.80 , $45.41 , $24.73 , N/A , $36.01 , $36.01 , $102.60 , $39.35 , $6.96 , $103.68 
 ONDANSETRON HCL 8 MG PO TABS ,HCPCS RXA250,0250 - PHARMACY,00904-6552-61,1 tablet, $4.86 , $3.16 , $4.08 , N/A , N/A , $3.93 , $4.37 , $4.11 , $4.37 , $4.37 , $4.37 , $4.13 , N/A , $4.49 , $4.62 , $4.13 , $4.52 , $4.52 , $4.62 , $4.67 , $3.98 , $4.37 , $4.13 , $3.84 , N/A , $3.93 , $3.93 , $4.62 , $4.17 , $3.84 , $4.67 
 Fac Dlyd Placement Xtn Prosth for Evasc Rpr 1st Vsl ,CPT® 34710,0360 - OR SERVICES,N/A,N/A," $1,678.00 "," $1,090.70 "," $1,409.52 ", $710.25 , $608.27 ," $1,355.82 "," $1,510.20 "," $1,420.59 "," $1,510.20 "," $1,510.20 "," $1,510.20 "," $1,426.30 ", $596.34 ," $1,549.30 "," $1,594.10 "," $1,426.30 "," $1,560.54 "," $1,560.54 "," $1,594.10 "," $1,610.88 "," $1,372.94 "," $1,510.20 "," $1,426.30 "," $1,325.62 ", N/A ," $1,358.01 "," $1,358.01 "," $1,594.10 "," $1,439.89 ", $596.34 ," $1,610.88 "
Nursing Facility Dschrg Mgmt 30 Min+ Tot Time,CPT® 99316,N/A,N/A,N/A, $300.00 , $195.00 , $207.54 , $127.77 , $73.52 , $181.67 , $182.13 , $279.00 , $270.00 , $270.00 , $240.00 , $240.00 , $73.52 , $276.99 , $285.00 , $270.00 , $270.00 , $270.00 , $279.00 , $288.00 , $264.76 , $255.00 , $225.78 , $225.00 , N/A , $185.22 , $185.22 , $285.00 , $213.62 , $73.52 , $288.00 
 Fac Prq Aspir Spi Cord Cst/Syrinx ,CPT® 62268,0360 - OR SERVICES,N/A,N/A," $2,414.00 "," $1,569.10 "," $2,027.76 ", $245.21 , $38.12 ," $1,950.51 "," $2,172.60 "," $2,043.69 "," $2,172.60 "," $2,172.60 "," $2,172.60 "," $2,051.90 ", $37.37 ," $2,228.85 "," $2,293.30 "," $2,051.90 "," $2,245.02 "," $2,245.02 "," $2,293.30 "," $2,317.44 "," $1,975.13 "," $2,172.60 "," $2,051.90 "," $1,907.06 ", N/A ," $1,953.65 "," $1,953.65 "," $2,293.30 "," $2,071.45 ", $37.37 ," $2,317.44 "
 DEXAMETHASONE 9 % IO SUSP ,HCPCS RXA250,0250 - PHARMACY,71879-0001-01,0.5 mL," $3,667.73 "," $2,384.02 "," $3,080.89 ", N/A , N/A ," $2,963.53 "," $3,300.96 "," $3,105.10 "," $3,300.96 "," $3,300.96 "," $3,300.96 "," $3,117.57 ", N/A ," $3,386.42 "," $3,484.34 "," $3,117.57 "," $3,410.99 "," $3,410.99 "," $3,484.34 "," $3,521.02 "," $3,000.94 "," $3,300.96 "," $3,117.57 "," $2,897.51 ", N/A ," $2,968.29 "," $2,968.29 "," $3,484.34 "," $3,147.28 "," $2,897.51 "," $3,521.02 "
"Repr Vaginal Prolapse,Sacrosp Lig",CPT® 57282,N/A,N/A,N/A," $4,220.00 "," $2,743.00 "," $3,285.25 ", $664.41 , $691.53 ," $2,042.46 "," $2,038.63 "," $3,924.60 "," $3,798.00 "," $3,798.00 "," $3,376.00 "," $3,376.00 ", $691.53 ," $3,896.33 "," $4,009.00 "," $3,798.00 "," $3,798.00 "," $3,798.00 "," $3,924.60 "," $4,051.20 "," $3,425.37 "," $3,587.00 "," $2,665.39 "," $2,057.21 ", N/A ," $2,082.31 "," $2,082.31 "," $4,009.00 "," $2,497.61 ", $664.41 ," $4,051.20 "
 Fac Nuclear Antigen Antibody ,CPT® 86235,0300 - LABORATORY,N/A,N/A, $167.00 , $108.55 , $140.28 , $18.29 , $18.29 , $134.94 , $150.30 , $141.38 , $150.30 , $150.30 , $150.30 , $141.95 , $17.93 , $154.19 , $158.65 , $141.95 , $155.31 , $155.31 , $158.65 , $160.32 , $136.64 , $150.30 , $141.95 , $131.93 , N/A , $135.15 , $135.15 , $158.65 , $143.30 , $17.93 , $160.32 
"Exc Skin Malig 0.6-1cm Face,Facial",11641,N/A,N/A,N/A," $1,253.00 ", $814.45 , $497.90 , $149.52 , $258.41 , $426.82 , $418.95 ," $1,165.29 "," $1,127.70 "," $1,127.70 "," $1,002.40 "," $1,002.40 ", $258.41 ," $1,156.89 "," $1,190.35 "," $1,127.70 "," $1,127.70 "," $1,127.70 "," $1,165.29 "," $1,202.88 ", $544.62 ," $1,065.05 ", $833.16 , $547.51 , N/A , $435.16 , $435.16 ," $1,190.35 ", $504.63 , $149.52 ," $1,202.88 "
Rpr Aa Hernia Recr 3-10 Cm Reducible,CPT® 49615,N/A,N/A,N/A," $5,653.00 "," $3,674.45 ", N/A , $585.11 , $456.66 , N/A , N/A ," $5,257.29 "," $5,087.70 "," $5,087.70 "," $4,522.40 "," $4,522.40 ", $456.66 ," $5,219.41 "," $5,370.35 "," $5,087.70 "," $5,087.70 "," $5,087.70 "," $5,257.29 "," $5,426.88 ", N/A ," $4,805.05 "," $3,388.63 ", N/A , N/A ," $2,518.92 "," $2,518.92 "," $5,370.35 "," $2,637.09 ", $456.66 ," $5,426.88 "
 Fac Pten Gene Analysis Full Sequence Analysis ,CPT® 81321,0310 - PATHOLOGY LAB,N/A,N/A, $14.00 , $9.10 , $11.76 , $612.00 , $490.17 , $11.31 , $12.60 , $11.85 , $12.60 , $12.60 , $12.60 , $11.90 , $480.56 , $12.93 , $13.30 , $11.90 , $13.02 , $13.02 , $13.30 , $13.44 , $11.45 , $12.60 , $11.90 , $11.06 , N/A , $11.33 , $11.33 , $13.30 , $12.01 , $11.06 , $612.00 
 Pro Chg Radiologic Exam Chest 4+ Views ,CPT® 71048,0972 - PRO FEE/RAD/DX,N/A,N/A, $137.00 , $89.05 , $261.93 , $45.74 , $33.05 , $188.36 , $210.93 , $127.41 , $123.30 , $123.30 , $109.60 , $109.60 , $33.05 , $126.49 , $130.15 , $123.30 , $123.30 , $123.30 , $127.41 , $131.52 , $251.51 , $116.45 , $266.65 , $211.48 , N/A , $192.04 , $192.04 , $130.15 , $222.29 , $33.05 , $266.65 
Biopsy of Rectum,CPT® 45100,N/A,N/A,N/A," $2,165.00 "," $1,407.25 "," $1,844.44 ", $288.87 , $230.52 ," $1,426.85 "," $1,467.67 "," $2,013.45 "," $1,948.50 "," $1,948.50 "," $1,732.00 "," $1,732.00 ", $230.52 ," $1,998.94 "," $2,056.75 "," $1,948.50 "," $1,948.50 "," $1,948.50 "," $2,013.45 "," $2,078.40 "," $1,314.61 "," $1,840.25 "," $1,612.79 "," $1,697.26 ", N/A ," $1,454.69 "," $1,454.69 "," $2,056.75 "," $1,521.45 ", $230.52 ," $2,078.40 "
 Fac Immunization Admin ,CPT® 90471,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , $19.78 , N/A , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , N/A , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $19.78 , $67.20 
"Revise Conjunc,Fix Cul-De-Sac=Buccal",CPT® 68328,N/A,N/A,N/A," $6,473.00 "," $4,207.45 "," $4,328.09 ", $679.34 ," $1,074.67 "," $4,006.38 "," $3,787.58 "," $6,019.89 "," $5,825.70 "," $5,825.70 "," $5,178.40 "," $5,178.40 "," $1,074.67 "," $5,976.52 "," $6,149.35 "," $5,825.70 "," $5,825.70 "," $5,825.70 "," $6,019.89 "," $6,214.08 "," $5,951.79 "," $5,502.05 "," $3,935.65 "," $5,086.14 ", N/A ," $4,084.56 "," $4,084.56 "," $6,149.35 "," $4,508.83 ", $679.34 ," $6,214.08 "
" Fac Assay of Folic Acid, RBC ",CPT® 82747,0301 - LAB/CHEMISTRY,N/A,N/A, $149.00 , $96.85 , $125.16 , $18.00 , $16.16 , $120.39 , $134.10 , $126.14 , $134.10 , $134.10 , $134.10 , $126.65 , $15.84 , $137.57 , $141.55 , $126.65 , $138.57 , $138.57 , $141.55 , $143.04 , $121.91 , $134.10 , $126.65 , $117.71 , N/A , $120.59 , $120.59 , $141.55 , $127.86 , $15.84 , $143.04 
 Fac Gluc Bld Rgnt Strip ,CPT® 82948,0301 - LAB/CHEMISTRY,N/A,N/A, $56.00 , $36.40 , $47.04 , $5.14 , $4.40 , $45.25 , $50.40 , $47.41 , $50.40 , $50.40 , $50.40 , $47.60 , $4.31 , $51.70 , $53.20 , $47.60 , $52.08 , $52.08 , $53.20 , $53.76 , $45.82 , $50.40 , $47.60 , $44.24 , N/A , $45.32 , $45.32 , $53.20 , $48.05 , $4.31 , $53.76 
 LISINOPRIL 2.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,68180-0512-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 FERROUS SULFATE 300 (60 FE) MG/5ML PO SOLN ,HCPCS RXC637,0250 - PHARMACY,39328-0157-05,5 mL, $18.96 , $12.32 , $15.93 , N/A , N/A , $15.32 , $17.06 , $16.05 , $17.06 , $17.06 , $17.06 , $16.12 , N/A , $17.51 , $18.01 , $16.12 , $17.63 , $17.63 , $18.01 , $18.20 , $15.51 , $17.06 , $16.12 , $14.98 , N/A , $15.34 , $15.34 , $18.01 , $16.27 , $14.98 , $18.20 
"Sodium,Other Source",CPT® 84302,N/A,N/A,N/A, $57.00 , $37.05 , N/A , $4.96 , $4.96 , $27.53 , $32.93 , $53.01 , $51.30 , $51.30 , $45.60 , $45.60 , $4.96 , $52.63 , $54.15 , $51.30 , $51.30 , $51.30 , $53.01 , $54.72 , $32.45 , $48.45 , $32.44 , $17.62 , N/A , $25.69 , $25.69 , $54.15 , $28.07 , $4.96 , $54.72 
Sono Head,CPT® 76506,N/A,N/A,N/A, $922.00 , $599.30 , $655.63 , $111.97 , $91.36 , $566.82 , $663.24 , $857.46 , $829.80 , $829.80 , $737.60 , $737.60 , $91.36 , $851.28 , $875.90 , $829.80 , $829.80 , $829.80 , $857.46 , $885.12 , $647.47 , $783.70 , $726.12 , $658.03 , N/A , $577.88 , $577.88 , $875.90 , $668.91 , $91.36 , $885.12 
 Fac US Breast Uni Real Time With Image Complete ,CPT® 76641,0402 - ULTRASOUND,N/A,N/A, $733.00 , $476.45 , $615.72 , $102.29 , $84.87 , $592.26 , $659.70 , $620.56 , $659.70 , $659.70 , $659.70 , $623.05 , $83.21 , $676.78 , $696.35 , $623.05 , $681.69 , $681.69 , $696.35 , $703.68 , $599.74 , $659.70 , $623.05 , $579.07 , N/A , $593.22 , $593.22 , $696.35 , $628.99 , $83.21 , $703.68 
 LEUPROLIDE ACETATE 7.5 MG SC KIT ,HCPCS J9217,0636 - DRUGS REQUIRING DETAILED CODIN,62935-0753-75,1 each," $1,328.12 ", $863.28 ," $1,115.62 ", $169.18 , $192.10 ," $1,073.12 "," $1,195.31 "," $1,124.39 "," $1,195.31 "," $1,195.31 "," $1,195.31 "," $1,128.90 ", $188.33 ," $1,226.25 "," $1,261.71 "," $1,128.90 "," $1,235.15 "," $1,235.15 "," $1,261.71 "," $1,275.00 "," $1,086.67 "," $1,195.31 "," $1,128.90 "," $1,049.21 ", N/A ," $1,074.85 "," $1,074.85 "," $1,261.71 "," $1,139.66 ", $169.18 ," $1,275.00 "
 Fac Tcat Mitral Valve Repair Initial Prosthesis ,CPT® 33418,0360 - OR SERVICES,N/A,N/A," $26,923.00 "," $17,499.95 "," $22,615.32 "," $1,622.81 "," $1,371.00 "," $21,753.78 "," $24,230.70 "," $22,793.01 "," $24,230.70 "," $24,230.70 "," $24,230.70 "," $22,884.55 "," $1,344.12 "," $24,858.01 "," $25,576.85 "," $22,884.55 "," $25,038.39 "," $25,038.39 "," $25,576.85 "," $25,846.08 "," $22,028.40 "," $24,230.70 "," $22,884.55 "," $21,269.17 ", N/A ," $21,788.78 "," $21,788.78 "," $25,576.85 "," $23,102.63 "," $1,344.12 "," $25,846.08 "
 PAMIDRONATE DISODIUM 30 MG/10ML IV SOLN ,HCPCS J2430,0636 - DRUGS REQUIRING DETAILED CODIN,61703-0324-18,10 mL, $41.22 , $26.79 , $34.62 , $10.53 , $10.78 , $33.31 , $37.10 , $34.90 , $37.10 , $37.10 , $37.10 , $35.04 , $10.57 , $38.06 , $39.16 , $35.04 , $38.33 , $38.33 , $39.16 , $39.57 , $33.73 , $37.10 , $35.04 , $32.56 , N/A , $33.36 , $33.36 , $39.16 , $35.37 , $10.53 , $39.57 
Drain Skin Abscess Simple,CPT® 10060,N/A,N/A,N/A, $464.00 , $301.60 , $340.58 , $102.58 , $41.23 , $265.18 , $259.37 , $431.52 , $417.60 , $417.60 , $371.20 , $371.20 , $41.23 , $428.41 , $440.80 , $417.60 , $417.60 , $417.60 , $431.52 , $445.44 , $366.26 , $394.40 , $512.03 , $344.96 , N/A , $270.35 , $270.35 , $440.80 , $313.53 , $41.23 , $512.03 
" Fac Vein X-Ray, Arm/Leg ",CPT® 75820,0320 - DX X-RAY,N/A,N/A," $1,062.00 ", $690.30 , $892.08 , $107.21 , $77.42 , $858.10 , $955.80 , $899.09 , $955.80 , $955.80 , $955.80 , $902.70 , $75.90 , $980.54 ," $1,008.90 ", $902.70 , $987.66 , $987.66 ," $1,008.90 "," $1,019.52 ", $868.93 , $955.80 , $902.70 , $838.98 , N/A , $859.48 , $859.48 ," $1,008.90 ", $911.30 , $75.90 ," $1,019.52 "
 Fac Slctv Cath Plmt Ven Sys 2nd Order/> Slctv Branch ,CPT® 36012,0360 - OR SERVICES,N/A,N/A," $1,673.00 "," $1,087.45 "," $1,405.32 ", $159.48 , $857.08 ," $1,351.78 "," $1,505.70 "," $1,416.36 "," $1,505.70 "," $1,505.70 "," $1,505.70 "," $1,422.05 ", $840.27 ," $1,544.68 "," $1,589.35 "," $1,422.05 "," $1,555.89 "," $1,555.89 "," $1,589.35 "," $1,606.08 "," $1,368.85 "," $1,505.70 "," $1,422.05 "," $1,321.67 ", N/A ," $1,353.96 "," $1,353.96 "," $1,589.35 "," $1,435.60 ", $159.48 ," $1,606.08 "
 Pro Removal Tunneled Cv Cath ,CPT® 36589,0982 - PRO FEE/OUTPT,N/A,N/A," $1,063.00 ", $690.95 , $835.71 , $129.12 , $231.82 , $600.86 , $603.93 , $988.59 , $956.70 , $956.70 , $850.40 , $850.40 , $231.82 , $981.47 ," $1,009.85 ", $956.70 , $956.70 , $956.70 , $988.59 ," $1,020.48 ", $775.29 , $903.55 , $747.52 , $680.36 , N/A , $612.58 , $612.58 ," $1,009.85 ", $695.91 , $129.12 ," $1,020.48 "
 Fac Carcinoembryonic Antigen ,CPT® 82378,0301 - LAB/CHEMISTRY,N/A,N/A, $203.00 , $131.95 , $170.52 , $19.34 , $19.34 , $164.02 , $182.70 , $171.86 , $182.70 , $182.70 , $182.70 , $172.55 , $18.96 , $187.43 , $192.85 , $172.55 , $188.79 , $188.79 , $192.85 , $194.88 , $166.09 , $182.70 , $172.55 , $160.37 , N/A , $164.29 , $164.29 , $192.85 , $174.19 , $18.96 , $194.88 
 Pro Cardioversion Elective Arrhythmia External ,CPT® 92960,0982 - PRO FEE/OUTPT,N/A,N/A," $1,258.00 ", $817.70 , $675.35 , $104.47 , $244.76 , $670.27 , $674.00 ," $1,169.94 "," $1,132.20 "," $1,132.20 "," $1,006.40 "," $1,006.40 ", $244.76 ," $1,161.51 "," $1,195.10 "," $1,132.20 "," $1,132.20 "," $1,132.20 "," $1,169.94 "," $1,207.68 ", $666.44 ," $1,069.30 ", $627.99 , $661.06 , N/A , $683.35 , $683.35 ," $1,195.10 ", $757.50 , $104.47 ," $1,207.68 "
 Pro Amputation of Finger/Thumb ,CPT® 26951,0975 - PRO FEE/OR,N/A,N/A," $4,285.00 "," $2,785.25 "," $4,394.59 ", $685.79 , $230.52 ," $3,103.57 "," $3,158.66 "," $3,985.05 "," $3,856.50 "," $3,856.50 "," $3,428.00 "," $3,428.00 ", $230.52 ," $3,956.34 "," $4,070.75 "," $3,856.50 "," $3,856.50 "," $3,856.50 "," $3,985.05 "," $4,113.60 "," $4,014.84 "," $3,642.25 "," $3,461.08 "," $3,699.99 ", N/A ," $3,164.13 "," $3,164.13 "," $4,070.75 "," $3,718.97 ", $230.52 ," $4,394.59 "
 NM Biliary With Gb Funtion W/Quant Measure ,CPT® 78227,0340 - NUCLEAR MEDICINE,N/A,N/A," $3,867.00 "," $2,513.55 "," $3,248.28 ", $399.41 , $351.35 ," $3,124.54 "," $3,480.30 "," $3,273.80 "," $3,480.30 "," $3,480.30 "," $3,480.30 "," $3,286.95 ", $344.46 ," $3,570.40 "," $3,673.65 "," $3,286.95 "," $3,596.31 "," $3,596.31 "," $3,673.65 "," $3,712.32 "," $3,163.98 "," $3,480.30 "," $3,286.95 "," $3,054.93 ", N/A ," $3,129.56 "," $3,129.56 "," $3,673.65 "," $3,318.27 ", $344.46 ," $3,712.32 "
 INDAPAMIDE 1.25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,62559-0510-01,1 tablet, $7.30 , $4.75 , $6.13 , N/A , N/A , $5.90 , $6.57 , $6.18 , $6.57 , $6.57 , $6.57 , $6.21 , N/A , $6.74 , $6.94 , $6.21 , $6.79 , $6.79 , $6.94 , $7.01 , $5.97 , $6.57 , $6.21 , $5.77 , N/A , $5.91 , $5.91 , $6.94 , $6.26 , $5.77 , $7.01 
 RITUXIMAB 500 MG/50ML IV SOLN ,HCPCS J9312,0636 - DRUGS REQUIRING DETAILED CODIN,50242-0053-06,50 mL," $13,812.37 "," $8,978.04 "," $11,602.39 ", $82.66 , $83.39 ," $11,160.39 "," $12,431.13 "," $11,693.55 "," $12,431.13 "," $12,431.13 "," $12,431.13 "," $11,740.51 ", $81.75 ," $12,752.96 "," $13,121.75 "," $11,740.51 "," $12,845.50 "," $12,845.50 "," $13,121.75 "," $13,259.88 "," $11,301.28 "," $12,431.13 "," $11,740.51 "," $10,911.77 ", N/A ," $11,178.35 "," $11,178.35 "," $13,121.75 "," $11,852.39 ", $81.75 ," $13,259.88 "
 Pro MRI Spi Canal&Cnts Crv C+ Matrl ,CPT® 72142,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,948.00 "," $1,266.20 "," $1,988.49 ", $283.16 , $513.10 ," $1,542.27 "," $2,586.27 "," $1,811.64 "," $1,753.20 "," $1,753.20 "," $1,558.40 "," $1,558.40 ", $513.10 ," $1,798.59 "," $1,850.60 "," $1,753.20 "," $1,753.20 "," $1,753.20 "," $1,811.64 "," $1,870.08 "," $1,703.52 "," $1,655.80 "," $2,819.73 "," $3,015.05 ", N/A ," $1,572.36 "," $1,572.36 "," $1,850.60 "," $1,820.03 ", $283.16 ," $3,015.05 "
"Immunology-Flourescent,Ti",CPT® 86256,N/A,N/A,N/A, $152.00 , $98.80 , N/A , $12.29 , $12.29 , $68.18 , $81.59 , $141.36 , $136.80 , $136.80 , $121.60 , $121.60 , $12.29 , $140.34 , $144.40 , $136.80 , $136.80 , $136.80 , $141.36 , $145.92 , $80.46 , $129.20 , $170.29 , $43.70 , N/A , $63.63 , $63.63 , $144.40 , $69.54 , $12.29 , $170.29 
 Fac Trimming Nondystrophic Nails Any Number ,CPT® 11719,0761 - TREATMENT ROOM,N/A,N/A, $79.00 , $51.35 , $66.36 , $7.29 , $16.74 , $63.83 , $71.10 , $66.88 , $71.10 , $71.10 , $71.10 , $67.15 , $16.41 , $72.94 , $75.05 , $67.15 , $73.47 , $73.47 , $75.05 , $75.84 , $64.64 , $71.10 , $67.15 , $62.41 , N/A , $63.93 , $63.93 , $75.05 , $67.79 , $7.29 , $75.84 
"Excis Tumor,Soft Tiss Forearm/Wrist,Subq",CPT® 25075,N/A,N/A,N/A," $3,242.00 "," $2,107.30 "," $1,930.11 ", $303.07 , $336.46 ," $1,518.48 "," $1,536.85 "," $3,015.06 "," $2,917.80 "," $2,917.80 "," $2,593.60 "," $2,593.60 ", $336.46 ," $2,993.34 "," $3,079.90 "," $2,917.80 "," $2,917.80 "," $2,917.80 "," $3,015.06 "," $3,112.32 "," $1,787.72 "," $2,755.70 "," $1,691.29 "," $1,801.91 ", N/A ," $1,548.10 "," $1,548.10 "," $3,079.90 "," $1,819.59 ", $303.07 ," $3,112.32 "
 HYALURONIDASE BOVINE 150 UNIT/ML IJ SOLN ,HCPCS J3470,0636 - DRUGS REQUIRING DETAILED CODIN,00548-9090-10,1 mL, $343.97 , $223.58 , $288.93 , N/A , $21.62 , $277.93 , $309.57 , $291.21 , $309.57 , $309.57 , $309.57 , $292.37 , $21.20 , $317.59 , $326.77 , $292.37 , $319.89 , $319.89 , $326.77 , $330.21 , $281.44 , $309.57 , $292.37 , $271.74 , N/A , $278.37 , $278.37 , $326.77 , $295.16 , $21.20 , $330.21 
 DIAZEPAM 2.5 MG RE GEL ,HCPCS RXA250,0250 - PHARMACY,68682-0650-20,1 each," $1,576.51 "," $1,024.73 "," $1,324.27 ", N/A , N/A ," $1,273.82 "," $1,418.86 "," $1,334.67 "," $1,418.86 "," $1,418.86 "," $1,418.86 "," $1,340.03 ", N/A ," $1,455.59 "," $1,497.68 "," $1,340.03 "," $1,466.15 "," $1,466.15 "," $1,497.68 "," $1,513.45 "," $1,289.90 "," $1,418.86 "," $1,340.03 "," $1,245.44 ", N/A ," $1,275.87 "," $1,275.87 "," $1,497.68 "," $1,352.80 "," $1,245.44 "," $1,513.45 "
"Insert,Temp Indwelling Blad Cath,Simple",51702,N/A,N/A,N/A, $664.00 , $431.60 , $137.37 , $23.85 , $112.85 , $147.13 , $137.78 , $617.52 , $597.60 , $597.60 , $531.20 , $531.20 , $112.85 , $613.07 , $630.80 , $597.60 , $597.60 , $597.60 , $617.52 , $637.44 , $136.89 , $564.40 , $157.00 , $158.32 , N/A , $150.00 , $150.00 , $630.80 , $176.30 , $23.85 , $637.44 
 Fac Assay of Ammonia ,CPT® 82140,0301 - LAB/CHEMISTRY,N/A,N/A, $135.00 , $87.75 , $113.40 , $14.86 , $14.86 , $109.08 , $121.50 , $114.29 , $121.50 , $121.50 , $121.50 , $114.75 , $14.57 , $124.65 , $128.25 , $114.75 , $125.55 , $125.55 , $128.25 , $129.60 , $110.46 , $121.50 , $114.75 , $106.65 , N/A , $109.26 , $109.26 , $128.25 , $115.84 , $14.57 , $129.60 
Breast Reduction,CPT® 19318,N/A,N/A,N/A," $6,637.00 "," $4,314.05 "," $3,465.48 "," $1,036.83 ", $982.43 ," $3,831.12 "," $3,821.70 "," $6,172.41 "," $5,973.30 "," $5,973.30 "," $5,309.60 "," $5,309.60 ", $982.43 ," $6,127.94 "," $6,305.15 "," $5,973.30 "," $5,973.30 "," $5,973.30 "," $6,172.41 "," $6,371.52 "," $4,711.83 "," $5,641.45 "," $5,908.82 "," $3,829.37 ", N/A ," $3,905.87 "," $3,905.87 "," $6,305.15 "," $4,505.03 ", $982.43 ," $6,371.52 "
Pinworm Exam,CPT® 87172,N/A,N/A,N/A, $62.00 , $40.30 , N/A , $4.36 , $4.36 , $24.15 , $28.90 , $57.66 , $55.80 , $55.80 , $49.60 , $49.60 , $4.36 , $57.24 , $58.90 , $55.80 , $55.80 , $55.80 , $57.66 , $59.52 , $28.51 , $52.70 , $27.57 , $15.45 , N/A , $22.54 , $22.54 , $58.90 , $24.63 , $4.36 , $59.52 
Testosterone,CPT® 84402,N/A,N/A,N/A, $226.00 , $146.90 , N/A , $25.98 , $25.98 , $144.05 , $172.31 , $210.18 , $203.40 , $203.40 , $180.80 , $180.80 , $25.98 , $208.67 , $214.70 , $203.40 , $203.40 , $203.40 , $210.18 , $216.96 , $170.07 , $192.10 , $167.05 , $92.37 , N/A , $134.44 , $134.44 , $214.70 , $146.92 , $25.98 , $216.96 
 Fac Wrist Cock-Up Non-Molded ,HCPCS L3908,0274 - PROSTHETIC DEV,N/A,N/A, $98.00 , $63.70 , $82.32 , $78.05 , $50.84 , $79.18 , $88.20 , $82.97 , $88.20 , $88.20 , $88.20 , $83.30 , $49.84 , $90.48 , $93.10 , $83.30 , $91.14 , $91.14 , $93.10 , $94.08 , $80.18 , $88.20 , $83.30 , $77.42 , N/A , $79.31 , $79.31 , $93.10 , $84.09 , $49.84 , $94.08 
 Pro Cltx Dstl Rdl Fx/Epiphysl Sep W/Mnpj ,CPT® 25605,0981 - PRO FEE/ER,N/A,N/A," $2,674.00 "," $1,738.10 "," $3,147.43 ", $496.56 , $388.30 ," $2,466.77 "," $2,502.71 "," $2,486.82 "," $2,406.60 "," $2,406.60 "," $2,139.20 "," $2,139.20 ", $388.30 ," $2,468.90 "," $2,540.30 "," $2,406.60 "," $2,406.60 "," $2,406.60 "," $2,486.82 "," $2,567.04 "," $2,912.52 "," $2,272.90 "," $2,754.59 "," $2,906.58 ", N/A ," $2,514.91 "," $2,514.91 "," $2,540.30 "," $2,955.90 ", $388.30 ," $3,147.43 "
 Fac Evasc Rpr Dplmnt Aorto-Un-Iliac Ndgft Rpt ,CPT® 34704,0360 - OR SERVICES,N/A,N/A," $3,092.00 "," $2,009.80 "," $2,597.28 "," $2,036.59 "," $1,742.33 "," $2,498.34 "," $2,782.80 "," $2,617.69 "," $2,782.80 "," $2,782.80 "," $2,782.80 "," $2,628.20 "," $1,708.17 "," $2,854.84 "," $2,937.40 "," $2,628.20 "," $2,875.56 "," $2,875.56 "," $2,937.40 "," $2,968.32 "," $2,529.87 "," $2,782.80 "," $2,628.20 "," $2,442.68 ", N/A ," $2,502.36 "," $2,502.36 "," $2,937.40 "," $2,653.25 "," $1,708.17 "," $2,968.32 "
 Fac Slctv Cath Plmt L/R P-Art ,CPT® 36014,0360 - OR SERVICES,N/A,N/A," $4,290.00 "," $2,788.50 "," $3,603.60 ", $140.03 , $806.45 ," $3,466.32 "," $3,861.00 "," $3,631.91 "," $3,861.00 "," $3,861.00 "," $3,861.00 "," $3,646.50 ", $790.64 ," $3,960.96 "," $4,075.50 "," $3,646.50 "," $3,989.70 "," $3,989.70 "," $4,075.50 "," $4,118.40 "," $3,510.08 "," $3,861.00 "," $3,646.50 "," $3,389.10 ", N/A ," $3,471.90 "," $3,471.90 "," $4,075.50 "," $3,681.25 ", $140.03 ," $4,118.40 "
Transj Care Mgmt High Mdm F2f 7 Cal D Discharge,CPT® 99496,N/A,N/A,N/A, $603.00 , $391.95 , $373.50 , $185.93 , N/A , $277.02 , $349.83 , $560.79 , $542.70 , $542.70 , $482.40 , $482.40 , N/A , $556.75 , $572.85 , $542.70 , $542.70 , $542.70 , $560.79 , $578.88 , $358.44 , $512.55 , $435.81 , $351.21 , N/A , $282.42 , $282.42 , $572.85 , $325.72 , $185.93 , $578.88 
"Alpha-1-Antitrypsin, Total",CPT® 82103,N/A,N/A,N/A, $153.00 , $99.45 , N/A , $13.71 , $13.71 , $76.04 , $90.94 , $142.29 , $137.70 , $137.70 , $122.40 , $122.40 , $13.71 , $141.26 , $145.35 , $137.70 , $137.70 , $137.70 , $142.29 , $146.88 , $89.74 , $130.05 , $87.58 , $48.72 , N/A , $70.97 , $70.97 , $145.35 , $77.55 , $13.71 , $146.88 
"Repair Ing Hernia,5+Y/O,Reducibl",CPT® 49505,N/A,N/A,N/A," $3,355.00 "," $2,180.75 "," $3,134.37 ", $486.32 , $438.54 ," $2,443.03 "," $2,485.13 "," $3,120.15 "," $3,019.50 "," $3,019.50 "," $2,684.00 "," $2,684.00 ", $438.54 ," $3,097.67 "," $3,187.25 "," $3,019.50 "," $3,019.50 "," $3,019.50 "," $3,120.15 "," $3,220.80 "," $2,239.61 "," $2,851.75 "," $2,756.38 "," $2,889.05 ", N/A ," $2,490.70 "," $2,490.70 "," $3,187.25 "," $2,605.01 ", $438.54 ," $3,220.80 "
" Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC ",MS DRG V40 (FY2023) 897,N/A,N/A,N/A," $9,899.54 "," $6,434.70 "," $8,315.61 ", N/A , N/A ," $7,998.83 "," $8,909.59 "," $8,380.95 "," $8,909.59 "," $8,909.59 "," $8,909.59 "," $8,414.61 ", N/A ," $9,140.25 "," $9,404.56 "," $8,414.61 "," $9,206.57 "," $9,206.57 "," $9,404.56 "," $9,503.56 "," $8,099.80 "," $8,909.59 "," $8,414.61 "," $7,820.64 ", N/A ," $8,011.70 "," $8,011.70 "," $9,404.56 "," $8,494.80 "," $7,820.64 "," $9,503.56 "
CT Scan of Pelvis Contrast,CPT® 72193,N/A,N/A,N/A," $3,860.00 "," $2,509.00 "," $1,581.44 ", $228.79 , $287.44 ," $1,075.69 "," $1,390.35 "," $3,589.80 "," $3,474.00 "," $3,474.00 "," $3,088.00 "," $3,088.00 ", $287.44 ," $3,563.94 "," $3,667.00 "," $3,474.00 "," $3,474.00 "," $3,474.00 "," $3,589.80 "," $3,705.60 "," $1,375.00 "," $3,281.00 "," $1,573.58 "," $1,464.57 ", N/A ," $1,096.68 "," $1,096.68 "," $3,667.00 "," $1,269.43 ", $228.79 ," $3,705.60 "
" Pro Dress/Debrid P-Thick Burn, L ",CPT® 16030,0981 - PRO FEE/ER,N/A,N/A, $859.00 , $558.35 , $413.47 , $123.20 , $81.33 , $359.30 , $352.65 , $798.87 , $773.10 , $773.10 , $687.20 , $687.20 , $81.33 , $793.11 , $816.05 , $773.10 , $773.10 , $773.10 , $798.87 , $824.64 , $452.84 , $730.15 , $706.49 , $468.44 , N/A , $366.31 , $366.31 , $816.05 , $424.78 , $81.33 , $824.64 
"Laminectomy,>2 Sgmt,Cervical",CPT® 63015,N/A,N/A,N/A," $9,558.00 "," $6,212.70 "," $6,826.04 "," $1,335.01 "," $1,536.80 "," $8,024.58 "," $7,708.86 "," $8,888.94 "," $8,602.20 "," $8,602.20 "," $7,646.40 "," $7,646.40 "," $1,536.80 "," $8,824.90 "," $9,080.10 "," $8,602.20 "," $8,602.20 "," $8,602.20 "," $8,888.94 "," $9,175.68 "," $7,379.48 "," $8,124.30 "," $7,883.78 "," $8,342.56 ", N/A ," $8,181.16 "," $8,181.16 "," $9,080.10 "," $8,776.48 "," $1,335.01 "," $9,175.68 "
Open Rx Humeral Condylar Fx,CPT® 24579,N/A,N/A,N/A," $4,342.00 "," $2,822.30 "," $5,071.56 ", $796.59 , $614.70 ," $4,027.52 "," $4,012.85 "," $4,038.06 "," $3,907.80 "," $3,907.80 "," $3,473.60 "," $3,473.60 ", $614.70 ," $4,008.97 "," $4,124.90 "," $3,907.80 "," $3,907.80 "," $3,907.80 "," $4,038.06 "," $4,168.32 "," $4,715.18 "," $3,690.70 "," $4,429.83 "," $4,754.49 ", N/A ," $4,106.11 "," $4,106.11 "," $4,124.90 "," $4,826.14 ", $614.70 ," $5,071.56 "
Pt-Focused Hlth Risk Assmt Score Doc Stnd Instrm,CPT® 96160,N/A,N/A,N/A, $29.00 , $18.85 , $6.79 , $2.63 , $4.55 , $9.73 , $8.55 , $26.97 , $26.10 , $26.10 , $23.20 , $23.20 , $4.55 , $26.78 , $27.55 , $26.10 , $26.10 , $26.10 , $26.97 , $27.84 , $8.31 , $24.65 , $8.08 , $14.66 , N/A , $9.92 , $9.92 , $27.55 , $11.56 , $2.63 , $27.84 
Trim Nail(S),HCPCS G0127,N/A,N/A,N/A, $37.00 , $24.05 , $36.45 , $7.29 , N/A , $14.48 , N/A , $34.41 , $33.30 , $33.30 , $29.60 , $29.60 , N/A , $34.16 , $35.15 , $33.30 , $33.30 , $33.30 , $34.41 , $35.52 , $27.34 , $31.45 , $14.27 , $27.63 , N/A , $14.76 , $14.76 , $35.15 , $18.45 , $7.29 , $36.45 
Treat Tibial Fracture,27530,N/A,N/A,N/A," $1,266.00 ", $822.90 ," $1,803.82 ", $285.61 , $164.92 ," $1,350.84 "," $1,377.36 "," $1,177.38 "," $1,139.40 "," $1,139.40 "," $1,012.80 "," $1,012.80 ", $164.92 ," $1,168.90 "," $1,202.70 "," $1,139.40 "," $1,139.40 "," $1,139.40 "," $1,177.38 "," $1,215.36 "," $1,654.54 "," $1,076.10 "," $1,511.10 "," $1,607.37 ", N/A ," $1,377.20 "," $1,377.20 "," $1,202.70 "," $1,618.70 ", $164.92 ," $1,803.82 "
 CLOBETASOL PROPIONATE 0.05 % EX OINT ,HCPCS RXC637,0250 - PHARMACY,51672-1259-02,30 gram," $1,334.26 ", $867.27 ," $1,120.78 ", N/A , N/A ," $1,078.08 "," $1,200.83 "," $1,129.58 "," $1,200.83 "," $1,200.83 "," $1,200.83 "," $1,134.12 ", N/A ," $1,231.92 "," $1,267.55 "," $1,134.12 "," $1,240.86 "," $1,240.86 "," $1,267.55 "," $1,280.89 "," $1,091.69 "," $1,200.83 "," $1,134.12 "," $1,054.07 ", N/A ," $1,079.82 "," $1,079.82 "," $1,267.55 "," $1,144.93 "," $1,054.07 "," $1,280.89 "
Explore Elbow Joint,24101,N/A,N/A,N/A," $2,816.00 "," $1,830.40 "," $3,093.94 ", $486.69 , $528.51 ," $2,410.49 "," $2,409.98 "," $2,618.88 "," $2,534.40 "," $2,534.40 "," $2,252.80 "," $2,252.80 ", $528.51 ," $2,600.01 "," $2,675.20 "," $2,534.40 "," $2,534.40 "," $2,534.40 "," $2,618.88 "," $2,703.36 "," $2,868.41 "," $2,393.60 "," $2,654.69 "," $2,844.73 ", N/A ," $2,457.52 "," $2,457.52 "," $2,675.20 "," $2,888.45 ", $486.69 ," $3,093.94 "
 Pro Drg Xtrnl Ear Absc/Hmtma Comp ,CPT® 69005,0982 - PRO FEE/OUTPT,N/A,N/A," $1,762.00 "," $1,145.30 ", $758.50 , $155.08 , $72.58 , $755.35 , $776.05 ," $1,638.66 "," $1,585.80 "," $1,585.80 "," $1,409.60 "," $1,409.60 ", $72.58 ," $1,626.85 "," $1,673.90 "," $1,585.80 "," $1,585.80 "," $1,585.80 "," $1,638.66 "," $1,691.52 ", $816.81 ," $1,497.70 ", $847.43 , $757.85 , N/A , $770.09 , $770.09 ," $1,673.90 ", $879.31 , $72.58 ," $1,691.52 "
"Suture Eyelid Wound,Full Thick",CPT® 67935,N/A,N/A,N/A," $5,430.00 "," $3,529.50 "," $2,701.79 ", $422.61 , $635.13 ," $2,503.51 "," $2,353.00 "," $5,049.90 "," $4,887.00 "," $4,887.00 "," $4,344.00 "," $4,344.00 ", $635.13 ," $5,013.52 "," $5,158.50 "," $4,887.00 "," $4,887.00 "," $4,887.00 "," $5,049.90 "," $5,212.80 "," $3,712.01 "," $4,615.50 "," $2,447.74 "," $3,165.52 ", N/A ," $2,552.36 "," $2,552.36 "," $5,158.50 "," $2,817.46 ", $422.61 ," $5,212.80 "
 Fac Injection Aa&/Strd Trigeminal Nerve Each Branch ,CPT® 64400,0761 - TREATMENT ROOM,N/A,N/A, $841.00 , $546.65 , $706.44 , $46.38 , $95.27 , $679.53 , $756.90 , $711.99 , $756.90 , $756.90 , $756.90 , $714.85 , $93.40 , $776.50 , $798.95 , $714.85 , $782.13 , $782.13 , $798.95 , $807.36 , $688.11 , $756.90 , $714.85 , $664.39 , N/A , $680.62 , $680.62 , $798.95 , $721.66 , $46.38 , $807.36 
 SILVER SULFADIAZINE 1 % EX CREA ,HCPCS RXC637,0250 - PHARMACY,67877-0124-50,50 gram, $77.57 , $50.42 , $65.16 , N/A , N/A , $62.68 , $69.81 , $65.67 , $69.81 , $69.81 , $69.81 , $65.93 , N/A , $71.62 , $73.69 , $65.93 , $72.14 , $72.14 , $73.69 , $74.47 , $63.47 , $69.81 , $65.93 , $61.28 , N/A , $62.78 , $62.78 , $73.69 , $66.56 , $61.28 , $74.47 
"Preventive Visit,New,40-64",99386,N/A,N/A,N/A, $478.00 , $310.70 , N/A , $145.76 , $62.71 , $254.52 , $256.24 , $444.54 , $430.20 , $430.20 , $382.40 , $382.40 , $62.71 , $441.34 , $454.10 , $430.20 , $430.20 , $430.20 , $444.54 , $458.88 , $314.18 , $406.30 , $256.54 , $253.45 , $183.25 , $259.48 , $259.48 , $454.10 , $311.66 , $62.71 , $458.88 
Gerd Tst W/ Mucos Ph Electrod,CPT® 91035,N/A,N/A,N/A," $2,092.00 "," $1,359.80 "," $1,124.71 ", $455.01 , $409.86 ," $1,451.02 "," $1,181.73 "," $1,945.56 "," $1,882.80 "," $1,882.80 "," $1,673.60 "," $1,673.60 ", $409.86 ," $1,931.54 "," $1,987.40 "," $1,882.80 "," $1,882.80 "," $1,882.80 "," $1,945.56 "," $2,008.32 "," $2,177.10 "," $1,778.20 "," $1,566.19 "," $1,825.51 ", N/A ," $1,479.33 "," $1,479.33 "," $1,987.40 "," $1,740.40 ", $409.86 ," $2,177.10 "
"Open Rx Femur,Distal End",27514,N/A,N/A,N/A," $4,027.00 "," $2,617.55 "," $5,836.03 ", $911.01 ," $1,092.81 "," $4,669.43 "," $4,618.72 "," $3,745.11 "," $3,624.30 "," $3,624.30 "," $3,221.60 "," $3,221.60 "," $1,092.81 "," $3,718.13 "," $3,825.65 "," $3,624.30 "," $3,624.30 "," $3,624.30 "," $3,745.11 "," $3,865.92 "," $5,439.74 "," $3,422.95 "," $5,113.13 "," $5,484.79 ", N/A ," $4,760.54 "," $4,760.54 "," $3,825.65 "," $5,595.32 ", $911.01 ," $5,836.03 "
Hallus-Valgus Nght Dynamic S,HCPCS L3100,N/A,N/A,N/A, $26.00 , $16.90 , N/A , $50.60 , $25.91 , N/A , N/A , $24.18 , $23.40 , $23.40 , $20.80 , $20.80 , $25.91 , $24.01 , $24.70 , $23.40 , $23.40 , $23.40 , $24.18 , $24.96 , N/A , $22.10 , $41.52 , $42.57 , N/A , N/A , N/A , $24.70 , N/A , $20.80 , $50.60 
"Muscle-Skin Flap,Trunk",CPT® 15734,N/A,N/A,N/A," $11,288.00 "," $7,337.20 "," $4,717.87 "," $1,403.56 "," $1,289.81 "," $3,577.75 "," $3,494.36 "," $10,497.84 "," $10,159.20 "," $10,159.20 "," $9,030.40 "," $9,030.40 "," $1,289.81 "," $10,422.21 "," $10,723.60 "," $10,159.20 "," $10,159.20 "," $10,159.20 "," $10,497.84 "," $10,836.48 "," $5,178.15 "," $9,594.80 "," $7,036.35 "," $5,207.52 ", N/A ," $3,647.55 "," $3,647.55 "," $10,723.60 "," $4,229.94 "," $1,289.81 "," $10,836.48 "
 Cervical Spine 2 or 3 Views- Mh ,CPT® 72040,0972 - PRO FEE/RAD/DX,N/A,N/A, $136.00 , $88.40 , $223.07 , $39.02 , $35.77 , $157.08 , $228.16 , $126.48 , $122.40 , $122.40 , $108.80 , $108.80 , $35.77 , $125.57 , $129.20 , $122.40 , $122.40 , $122.40 , $126.48 , $130.56 , $216.55 , $115.60 , $208.01 , $167.82 , N/A , $160.15 , $160.15 , $129.20 , $185.37 , $35.77 , $228.16 
"Helminth, Antibody",CPT® 86682,N/A,N/A,N/A, $205.00 , $133.25 , N/A , $13.27 , $8.07 , $32.88 , $39.34 , $190.65 , $184.50 , $184.50 , $164.00 , $164.00 , $8.07 , $189.28 , $194.75 , $184.50 , $184.50 , $184.50 , $190.65 , $196.80 , $86.87 , $174.25 , $85.96 , $47.17 , N/A , $30.69 , $30.69 , $194.75 , $33.54 , $8.07 , $196.80 
 ED Fac Inject Tendon/Lig/Gangl ,CPT® 20550,0761 - TREATMENT ROOM,N/A,N/A, $656.00 , $426.40 , $551.04 , $37.19 , $27.51 , $530.05 , $590.40 , $555.37 , $590.40 , $590.40 , $590.40 , $557.60 , $26.97 , $605.68 , $623.20 , $557.60 , $610.08 , $610.08 , $623.20 , $629.76 , $536.74 , $590.40 , $557.60 , $518.24 , N/A , $530.90 , $530.90 , $623.20 , $562.91 , $26.97 , $629.76 
Intro Catheter Superior/Inferior Vena Cava,CPT® 36010,N/A,N/A,N/A," $3,432.00 "," $2,230.80 ", $645.58 , $99.17 , $498.06 , $531.60 , $519.75 ," $3,191.76 "," $3,088.80 "," $3,088.80 "," $2,745.60 "," $2,745.60 ", $498.06 ," $3,168.77 "," $3,260.40 "," $3,088.80 "," $3,088.80 "," $3,088.80 "," $3,191.76 "," $3,294.72 ", $600.84 ," $2,917.20 ", $640.48 , $538.05 , N/A , $541.96 , $541.96 ," $3,260.40 ", $615.67 , $99.17 ," $3,294.72 "
Ctr Motr Ep Std Transcrnl Motr Stim Upr&Low Limb,CPT® 95939,N/A,N/A,N/A," $2,475.00 "," $1,608.75 "," $2,022.36 ", $536.38 , $361.94 ," $1,602.28 "," $1,731.70 "," $2,301.75 "," $2,227.50 "," $2,227.50 "," $1,980.00 "," $1,980.00 ", $361.94 ," $2,285.17 "," $2,351.25 "," $2,227.50 "," $2,227.50 "," $2,227.50 "," $2,301.75 "," $2,376.00 "," $2,357.73 "," $2,103.75 "," $1,519.56 "," $1,918.85 ", N/A ," $1,633.55 "," $1,633.55 "," $2,351.25 "," $2,008.28 ", $361.94 ," $2,376.00 "
Ranibizumab Injection,HCPCS J2778,N/A,N/A,N/A," $1,224.00 ", $795.60 , N/A , $241.31 , $252.60 , N/A , N/A ," $1,138.32 "," $1,101.60 "," $1,101.60 ", $979.20 , $979.20 , $252.60 ," $1,130.12 "," $1,162.80 "," $1,101.60 "," $1,101.60 "," $1,101.60 "," $1,138.32 "," $1,175.04 ", $399.01 ," $1,040.40 ", $759.04 , $336.97 , N/A , N/A , N/A ," $1,162.80 ", N/A , $241.31 ," $1,175.04 "
" Direct Repair; Aneur, Pseudo; W or W/O Patch Graft, Abd Aorta ",CPT® 35081,0360 - OR SERVICES,N/A,N/A," $6,577.00 "," $4,275.05 "," $5,524.68 "," $1,538.03 "," $1,708.25 "," $5,314.22 "," $5,919.30 "," $5,568.09 "," $5,919.30 "," $5,919.30 "," $5,919.30 "," $5,590.45 "," $1,674.75 "," $6,072.54 "," $6,248.15 "," $5,590.45 "," $6,116.61 "," $6,116.61 "," $6,248.15 "," $6,313.92 "," $5,381.30 "," $5,919.30 "," $5,590.45 "," $5,195.83 ", N/A ," $5,322.77 "," $5,322.77 "," $6,248.15 "," $5,643.72 "," $1,538.03 "," $6,313.92 "
 NM Thyroid Imaging Scan ,CPT® 78013,0340 - NUCLEAR MEDICINE,N/A,N/A," $1,869.00 "," $1,214.85 "," $1,569.96 ", $174.66 , $164.86 ," $1,510.15 "," $1,682.10 "," $1,582.30 "," $1,682.10 "," $1,682.10 "," $1,682.10 "," $1,588.65 ", $161.63 ," $1,725.65 "," $1,775.55 "," $1,588.65 "," $1,738.17 "," $1,738.17 "," $1,775.55 "," $1,794.24 "," $1,529.22 "," $1,682.10 "," $1,588.65 "," $1,476.51 ", N/A ," $1,512.58 "," $1,512.58 "," $1,775.55 "," $1,603.79 ", $161.63 ," $1,794.24 "
 NM Thyroid Uptake Single or Multiple ,CPT® 78012,0340 - NUCLEAR MEDICINE,N/A,N/A, $731.00 , $475.15 , $614.04 , $78.69 , $65.24 , $590.65 , $657.90 , $618.86 , $657.90 , $657.90 , $657.90 , $621.35 , $63.96 , $674.93 , $694.45 , $621.35 , $679.83 , $679.83 , $694.45 , $701.76 , $598.10 , $657.90 , $621.35 , $577.49 , N/A , $591.60 , $591.60 , $694.45 , $627.27 , $63.96 , $701.76 
"I&D Finger Abscess,Simple",CPT® 26010,N/A,N/A,N/A, $817.00 , $531.05 , $867.23 , $136.36 , $30.71 , $664.95 , $677.89 , $759.81 , $735.30 , $735.30 , $653.60 , $653.60 , $30.71 , $754.34 , $776.15 , $735.30 , $735.30 , $735.30 , $759.81 , $784.32 , $800.12 , $694.45 , $742.17 , $793.35 , N/A , $677.92 , $677.92 , $776.15 , $796.82 , $30.71 , $867.23 
"Destruct,Anal Lesn(S),Simple,Chem",CPT® 46900,N/A,N/A,N/A," $1,625.00 "," $1,056.25 ", $842.53 , $132.21 , $27.51 , $657.84 , $677.95 ," $1,511.25 "," $1,462.50 "," $1,462.50 "," $1,300.00 "," $1,300.00 ", $27.51 ," $1,500.36 "," $1,543.75 "," $1,462.50 "," $1,462.50 "," $1,462.50 "," $1,511.25 "," $1,560.00 ", $598.53 ," $1,381.25 ", $742.17 , $783.26 , N/A , $670.68 , $670.68 ," $1,543.75 ", $701.46 , $27.51 ," $1,560.00 "
Reconstr Nose+Maj Septal Repair,CPT® 30420,N/A,N/A,N/A," $8,138.00 "," $5,289.70 "," $8,083.87 "," $1,419.73 "," $1,383.11 "," $5,223.35 "," $5,224.33 "," $7,568.34 "," $7,324.20 "," $7,324.20 "," $6,510.40 "," $6,510.40 "," $1,383.11 "," $7,513.82 "," $7,731.10 "," $7,324.20 "," $7,324.20 "," $7,324.20 "," $7,568.34 "," $7,812.48 "," $7,676.66 "," $6,917.30 "," $7,362.83 "," $6,873.29 ", N/A ," $5,325.27 "," $5,325.27 "," $7,731.10 "," $6,271.64 "," $1,383.11 "," $8,083.87 "
 Pro Cltx Prox Fibula/Shft Fx W/O Mnpj ,CPT® 27780,0981 - PRO FEE/ER,N/A,N/A," $1,353.00 ", $879.45 ," $1,775.74 ", $281.00 , $190.55 ," $1,342.07 "," $1,370.57 "," $1,258.29 "," $1,217.70 "," $1,217.70 "," $1,082.40 "," $1,082.40 ", $190.55 ," $1,249.22 "," $1,285.35 "," $1,217.70 "," $1,217.70 "," $1,217.70 "," $1,258.29 "," $1,298.88 "," $1,634.23 "," $1,150.05 "," $1,503.97 "," $1,596.71 ", N/A ," $1,368.26 "," $1,368.26 "," $1,285.35 "," $1,608.19 ", $190.55 ," $1,775.74 "
Assay Biotinidase,CPT® 82261,N/A,N/A,N/A, $133.00 , $86.45 , N/A , $17.21 , $17.21 , $81.53 , $97.54 , $123.69 , $119.70 , $119.70 , $106.40 , $106.40 , $17.21 , $122.80 , $126.35 , $119.70 , $119.70 , $119.70 , $123.69 , $127.68 , $112.64 , $113.05 , $110.29 , $61.18 , N/A , $76.09 , $76.09 , $126.35 , $83.15 , $17.21 , $127.68 
"Cauter Turbinate Mucosa,Intramural",CPT® 30802,N/A,N/A,N/A," $1,535.00 ", $997.75 ," $1,132.00 ", $198.84 , $52.83 , $724.09 , $733.77 ," $1,427.55 "," $1,381.50 "," $1,381.50 "," $1,228.00 "," $1,228.00 ", $52.83 ," $1,417.27 "," $1,458.25 "," $1,381.50 "," $1,381.50 "," $1,381.50 "," $1,427.55 "," $1,473.60 "," $1,074.19 "," $1,304.75 "," $1,031.19 ", $954.09 , N/A , $738.22 , $738.22 ," $1,458.25 ", $869.42 , $52.83 ," $1,473.60 "
 Cytology - Body Fluid Smear - Mh ,CPT® 88112,0310 - PATHOLOGY LAB,N/A,N/A, $546.00 , $354.90 , $458.64 , $65.87 , $118.37 , $441.17 , $491.40 , $462.24 , $491.40 , $491.40 , $491.40 , $464.10 , $116.05 , $504.12 , $518.70 , $464.10 , $507.78 , $507.78 , $518.70 , $524.16 , $446.74 , $491.40 , $464.10 , $431.34 , N/A , $441.88 , $441.88 , $518.70 , $468.52 , $65.87 , $524.16 
 LACOSAMIDE 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00131-2477-60,1 tablet, $76.43 , $49.68 , $64.20 , N/A , N/A , $61.76 , $68.79 , $64.71 , $68.79 , $68.79 , $68.79 , $64.97 , N/A , $70.57 , $72.61 , $64.97 , $71.08 , $71.08 , $72.61 , $73.37 , $62.54 , $68.79 , $64.97 , $60.38 , N/A , $61.85 , $61.85 , $72.61 , $65.58 , $60.38 , $73.37 
"Assay, Total Thyroxine",CPT® 84436,N/A,N/A,N/A, $78.00 , $50.70 , N/A , $7.01 , $7.01 , $38.87 , $46.48 , $72.54 , $70.20 , $70.20 , $62.40 , $62.40 , $7.01 , $72.02 , $74.10 , $70.20 , $70.20 , $70.20 , $72.54 , $74.88 , $45.87 , $66.30 , $45.41 , $24.91 , N/A , $36.28 , $36.28 , $74.10 , $39.64 , $7.01 , $74.88 
"Amputate Thigh,Re-Amputatn",CPT® 27596,N/A,N/A,N/A," $4,843.00 "," $3,147.95 "," $4,259.26 ", $662.11 , $647.94 ," $3,472.70 "," $3,519.32 "," $4,503.99 "," $4,358.70 "," $4,358.70 "," $3,874.40 "," $3,874.40 ", $647.94 ," $4,471.54 "," $4,600.85 "," $4,358.70 "," $4,358.70 "," $4,358.70 "," $4,503.99 "," $4,649.28 "," $3,953.98 "," $4,116.55 "," $3,910.67 "," $4,045.98 ", N/A ," $3,540.45 "," $3,540.45 "," $4,600.85 "," $4,161.29 ", $647.94 ," $4,649.28 "
 Fac Chemotherapy Admn IV Infusion Tq Ea Hr ,CPT® 96415,0335 - CHEMOTHERP-IV,N/A,N/A, $151.00 , $98.15 , $126.84 , $27.47 , $30.74 , $122.01 , $135.90 , $127.84 , $135.90 , $135.90 , $135.90 , $128.35 , $30.14 , $139.42 , $143.45 , $128.35 , $140.43 , $140.43 , $143.45 , $144.96 , $123.55 , $135.90 , $128.35 , $119.29 , N/A , $122.20 , $122.20 , $143.45 , $129.57 , $27.47 , $144.96 
Ligate/Strip Long Saph Vein Belw Sep-Fem Junc,CPT® 37722,N/A,N/A,N/A," $3,303.00 "," $2,146.95 "," $2,736.37 ", $419.89 , $420.22 ," $2,063.69 "," $2,089.01 "," $3,071.79 "," $2,972.70 "," $2,972.70 "," $2,642.40 "," $2,642.40 ", $420.22 ," $3,049.66 "," $3,137.85 "," $2,972.70 "," $2,972.70 "," $2,972.70 "," $3,071.79 "," $3,170.88 "," $2,541.39 "," $2,807.55 "," $2,626.14 "," $2,282.82 ", N/A ," $2,103.96 "," $2,103.96 "," $3,137.85 "," $2,390.10 ", $419.89 ," $3,170.88 "
Compre Ep Eval Abltj 3d Mapg Tx Svt,CPT® 93653,N/A,N/A,N/A," $7,071.00 "," $4,596.15 "," $4,886.18 ", $763.79 , $926.90 ," $4,522.35 "," $4,434.21 "," $6,576.03 "," $6,363.90 "," $6,363.90 "," $5,656.80 "," $5,656.80 ", $926.90 ," $6,528.65 "," $6,717.45 "," $6,363.90 "," $6,363.90 "," $6,363.90 "," $6,576.03 "," $6,788.16 "," $4,839.17 "," $6,010.35 "," $4,313.87 "," $4,030.72 ", N/A ," $4,610.59 "," $4,610.59 "," $6,717.45 "," $5,110.88 ", $763.79 ," $6,788.16 "
Rpr Parastomal Hrna 1st/Recr Ncrc8/Strangulated,CPT® 49622,N/A,N/A,N/A," $7,767.00 "," $5,048.55 ", N/A , $845.91 , $660.23 , N/A , N/A ," $7,223.31 "," $6,990.30 "," $6,990.30 "," $6,213.60 "," $6,213.60 ", $660.23 ," $7,171.27 "," $7,378.65 "," $6,990.30 "," $6,990.30 "," $6,990.30 "," $7,223.31 "," $7,456.32 ", N/A ," $6,601.95 "," $4,847.50 ", N/A , N/A ," $3,641.73 "," $3,641.73 "," $7,378.65 "," $3,812.58 ", $660.23 ," $7,456.32 "
 Fac Elec Stim Other Than Wound ,HCPCS G0283,0422 - PHYS THERP/HOUR,N/A,N/A, $109.00 , $70.85 , $91.56 , $11.91 , $23.97 , $88.07 , $98.10 , $92.28 , $98.10 , $98.10 , $98.10 , $92.65 , $23.50 , $100.64 , $103.55 , $92.65 , $101.37 , $101.37 , $103.55 , $104.64 , $89.18 , $98.10 , $92.65 , $86.11 , N/A , $88.21 , $88.21 , $103.55 , $93.53 , $11.91 , $104.64 
 Fac Drug Screen Quant Amphetamines 3 or 4 ,CPT® 80325,0301 - LAB/CHEMISTRY,N/A,N/A, $216.00 , $140.40 , $181.44 , N/A , N/A , $174.53 , $194.40 , $182.87 , $194.40 , $194.40 , $194.40 , $183.60 , N/A , $199.43 , $205.20 , $183.60 , $200.88 , $200.88 , $205.20 , $207.36 , $176.73 , $194.40 , $183.60 , $170.64 , N/A , $174.81 , $174.81 , $205.20 , $185.35 , $170.64 , $207.36 
 FLUTICASONE-SALMETEROL 500-50 MCG/ACT INH AEPB ,HCPCS RXC637,0250 - PHARMACY,00173-0697-04,14 each, $727.14 , $472.64 , $610.80 , N/A , N/A , $587.53 , $654.43 , $615.60 , $654.43 , $654.43 , $654.43 , $618.07 , N/A , $671.37 , $690.78 , $618.07 , $676.24 , $676.24 , $690.78 , $698.05 , $594.95 , $654.43 , $618.07 , $574.44 , N/A , $588.47 , $588.47 , $690.78 , $623.96 , $574.44 , $698.05 
 Pro Pro Prolng E/M Svc Before&/After Dir Pt Care 1st Hr ,CPT® 99358,0982 - PRO FEE/OUTPT,N/A,N/A, $391.00 , $254.15 , $221.34 , $88.80 , N/A , $189.51 , $188.77 , $363.63 , $351.90 , $351.90 , $312.80 , $312.80 , N/A , $361.01 , $371.45 , $351.90 , $351.90 , $351.90 , $363.63 , $375.36 , $201.62 , $332.35 , N/A , $244.37 , N/A , $193.20 , $193.20 , $371.45 , $222.82 , $88.80 , $375.36 
 NIFEDIPINE ER 60 MG PO TB24 ,HCPCS RXC637,0250 - PHARMACY,50742-0621-01,1 tablet, $12.76 , $8.29 , $10.72 , N/A , N/A , $10.31 , $11.48 , $10.80 , $11.48 , $11.48 , $11.48 , $10.85 , N/A , $11.78 , $12.12 , $10.85 , $11.87 , $11.87 , $12.12 , $12.25 , $10.44 , $11.48 , $10.85 , $10.08 , N/A , $10.33 , $10.33 , $12.12 , $10.95 , $10.08 , $12.25 
 Pro Partial Amputation of Toe ,CPT® 28825,0982 - PRO FEE/OUTPT,N/A,N/A," $3,679.00 "," $2,391.35 "," $1,067.04 ", $165.33 , $153.67 ," $1,823.42 "," $1,834.23 "," $3,421.47 "," $3,311.10 "," $3,311.10 "," $2,943.20 "," $2,943.20 ", $153.67 ," $3,396.82 "," $3,495.05 "," $3,311.10 "," $3,311.10 "," $3,311.10 "," $3,421.47 "," $3,531.84 "," $1,000.61 "," $3,127.15 "," $2,003.50 "," $2,152.14 ", N/A ," $1,859.00 "," $1,859.00 "," $3,495.05 "," $2,185.00 ", $153.67 ," $3,531.84 "
"Eo Withjoint, Prefabricated",HCPCS L3760,N/A,N/A,N/A, $714.00 , $464.10 , N/A , $532.41 , $360.47 , N/A , N/A , $664.02 , $642.60 , $642.60 , $571.20 , $571.20 , $360.47 , $659.24 , $678.30 , $642.60 , $642.60 , $642.60 , $664.02 , $685.44 , N/A , $606.90 , $439.20 , $447.93 , N/A , N/A , N/A , $678.30 , N/A , $360.47 , $685.44 
Diagnostic Lumbar Spinal Puncture,62270,N/A,N/A,N/A, $656.00 , $426.40 , $298.01 , $58.13 , $157.45 , $435.77 , $418.02 , $610.08 , $590.40 , $590.40 , $524.80 , $524.80 , $157.45 , $605.68 , $623.20 , $590.40 , $590.40 , $590.40 , $610.08 , $629.76 , $322.97 , $557.60 , $413.90 , $464.99 , N/A , $444.28 , $444.28 , $623.20 , $476.62 , $58.13 , $629.76 
 LUSPATERCEPT-AAMT 25 MG SC SOLR ,HCPCS J0896,0636 - DRUGS REQUIRING DETAILED CODIN,59572-0711-01,0.5 mL," $11,172.90 "," $7,262.39 "," $9,385.24 ", $39.96 , $39.24 ," $9,027.70 "," $10,055.61 "," $9,458.98 "," $10,055.61 "," $10,055.61 "," $10,055.61 "," $9,496.97 ", $38.47 ," $10,315.94 "," $10,614.26 "," $9,496.97 "," $10,390.80 "," $10,390.80 "," $10,614.26 "," $10,725.98 "," $9,141.67 "," $10,055.61 "," $9,496.97 "," $8,826.59 ", N/A ," $9,042.23 "," $9,042.23 "," $10,614.26 "," $9,587.47 ", $38.47 ," $10,725.98 "
"Biopsy Tongue,Anter 2/3",CPT® 41100,N/A,N/A,N/A, $974.00 , $633.10 , $662.61 , $104.01 , $46.08 , $523.60 , $538.20 , $905.82 , $876.60 , $876.60 , $779.20 , $779.20 , $46.08 , $899.29 , $925.30 , $876.60 , $876.60 , $876.60 , $905.82 , $935.04 , $473.91 , $827.90 , $586.96 , $613.77 , N/A , $533.82 , $533.82 , $925.30 , $558.33 , $46.08 , $935.04 
Simple Repair 2.6-5cm,CPT® 12013,N/A,N/A,N/A, $802.00 , $521.30 , $180.71 , $53.74 , $76.93 , $169.97 , $163.73 , $745.86 , $721.80 , $721.80 , $641.60 , $641.60 , $76.93 , $740.49 , $761.90 , $721.80 , $721.80 , $721.80 , $745.86 , $769.92 , $198.93 , $681.70 , $328.27 , $200.67 , N/A , $173.28 , $173.28 , $761.90 , $200.96 , $53.74 , $769.92 
"Immuniz Admin,Intranasal/Oral,Each Addl",CPT® 90474,N/A,N/A,N/A, $47.00 , $30.55 , $30.35 , $11.54 , N/A , $28.51 , $29.13 , $43.71 , $42.30 , $42.30 , $37.60 , $37.60 , N/A , $43.40 , $44.65 , $42.30 , $42.30 , $42.30 , $43.71 , $45.12 , $44.86 , $39.95 , $37.51 , $39.95 , N/A , $29.07 , $29.07 , $44.65 , $34.44 , $11.54 , $45.12 
Remot Image Submit by Pt,HCPCS G2010,N/A,N/A,N/A, $35.00 , $22.75 , $18.77 , $8.96 , $9.42 , N/A , N/A , $32.55 , $31.50 , $31.50 , $28.00 , $28.00 , $9.42 , $32.32 , $33.25 , $31.50 , $31.50 , $31.50 , $32.55 , $33.60 , $52.65 , $29.75 , $17.45 , $20.26 , N/A , $16.66 , $16.66 , $33.25 , $20.82 , $8.96 , $52.65 
" Fac Eo Withjoint, Prefabricated ",HCPCS L3760,0274 - PROSTHETIC DEV,N/A,N/A, $697.00 , $453.05 , $585.48 , $532.41 , $360.47 , $563.18 , $627.30 , $590.08 , $627.30 , $627.30 , $627.30 , $592.45 , $353.40 , $643.54 , $662.15 , $592.45 , $648.21 , $648.21 , $662.15 , $669.12 , $570.29 , $627.30 , $592.45 , $550.63 , N/A , $564.08 , $564.08 , $662.15 , $598.10 , $353.40 , $669.12 
Biopsy of External Ear,CPT® 69100,N/A,N/A,N/A, $761.00 , $494.65 , $219.75 , $44.85 , $46.08 , $233.80 , $236.91 , $707.73 , $684.90 , $684.90 , $608.80 , $608.80 , $46.08 , $702.63 , $722.95 , $684.90 , $684.90 , $684.90 , $707.73 , $730.56 , $242.51 , $646.85 , $258.69 , $240.38 , N/A , $238.37 , $238.37 , $722.95 , $272.18 , $44.85 , $730.56 
Spectrophotometry,CPT® 84311,N/A,N/A,N/A, $199.00 , $129.35 , N/A , $8.26 , $8.26 , $39.58 , $47.32 , $185.07 , $179.10 , $179.10 , $159.20 , $159.20 , $8.26 , $183.74 , $189.05 , $179.10 , $179.10 , $179.10 , $185.07 , $191.04 , $54.09 , $169.15 , $45.41 , $25.35 , N/A , $36.94 , $36.94 , $189.05 , $40.36 , $8.26 , $191.04 
 Pro Radiologic Exam Esophagus Single Contrast Study ,CPT® 74220,0972 - PRO FEE/RAD/DX,N/A,N/A, $414.00 , $269.10 , $569.62 , $98.12 , $72.27 , $420.62 , $487.52 , $385.02 , $372.60 , $372.60 , $331.20 , $331.20 , $72.27 , $382.25 , $393.30 , $372.60 , $372.60 , $372.60 , $385.02 , $397.44 , $558.02 , $351.90 , $531.59 , $446.77 , N/A , $428.82 , $428.82 , $393.30 , $496.36 , $72.27 , $569.62 
"Bx Arm/Elbow Soft Tissue,Superficial",CPT® 24065,N/A,N/A,N/A," $1,293.00 ", $840.45 ," $1,008.28 ", $156.67 , $80.09 , $810.32 , $821.77 ," $1,202.49 "," $1,163.70 "," $1,163.70 "," $1,034.40 "," $1,034.40 ", $80.09 ," $1,193.83 "," $1,228.35 "," $1,163.70 "," $1,163.70 "," $1,163.70 "," $1,202.49 "," $1,241.28 ", $933.96 ," $1,099.05 ", $899.17 , $965.13 , N/A , $826.12 , $826.12 ," $1,228.35 ", $970.99 , $80.09 ," $1,241.28 "
"Remove Tonsils/Adenoids,<12 Y/O",CPT® 42820,N/A,N/A,N/A," $2,004.00 "," $1,302.60 "," $1,792.25 ", $281.97 , $260.05 ," $1,397.68 "," $1,436.21 "," $1,863.72 "," $1,803.60 "," $1,803.60 "," $1,603.20 "," $1,603.20 ", $260.05 ," $1,850.29 "," $1,903.80 "," $1,803.60 "," $1,803.60 "," $1,803.60 "," $1,863.72 "," $1,923.84 "," $1,267.83 "," $1,703.40 "," $1,566.41 "," $1,637.56 ", N/A ," $1,424.95 "," $1,424.95 "," $1,903.80 "," $1,490.34 ", $260.05 ," $1,923.84 "
 Pro CT Lumbar Spine W/O Dye ,CPT® 72131,0972 - PRO FEE/RAD/DX,N/A,N/A, $563.00 , $365.95 , $919.73 , $131.98 , $250.57 , $853.40 ," $1,105.05 ", $523.59 , $506.70 , $506.70 , $450.40 , $450.40 , $250.57 , $519.82 , $534.85 , $506.70 , $506.70 , $506.70 , $523.59 , $540.48 , $772.34 , $478.55 ," $1,203.78 "," $1,166.51 ", N/A , $870.05 , $870.05 , $534.85 ," $1,007.10 ", $131.98 ," $1,203.78 "
 Fac Free Assay (Ft-3) ,CPT® 84481,0301 - LAB/CHEMISTRY,N/A,N/A, $219.00 , $142.35 , $183.96 , $17.28 , $16.40 , $176.95 , $197.10 , $185.41 , $197.10 , $197.10 , $197.10 , $186.15 , $16.08 , $202.20 , $208.05 , $186.15 , $203.67 , $203.67 , $208.05 , $210.24 , $179.19 , $197.10 , $186.15 , $173.01 , N/A , $177.24 , $177.24 , $208.05 , $187.92 , $16.08 , $210.24 
 DEXAMETHASONE 0.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00054-8179-25,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Parvovirus Antibody ,CPT® 86747,0302 - LAB/IMMUNOLOGY,N/A,N/A, $150.00 , $97.50 , $126.00 , $15.33 , $15.33 , $121.20 , $135.00 , $126.99 , $135.00 , $135.00 , $135.00 , $127.50 , $15.03 , $138.50 , $142.50 , $127.50 , $139.50 , $139.50 , $142.50 , $144.00 , $122.73 , $135.00 , $127.50 , $118.50 , N/A , $121.40 , $121.40 , $142.50 , $128.72 , $15.03 , $144.00 
 Pro Insert Non-Tunnel Cv Cath ,CPT® 36556,0981 - PRO FEE/ER,N/A,N/A, $874.00 , $568.10 , $514.22 , $79.62 , $322.67 , $528.55 , $516.83 , $812.82 , $786.60 , $786.60 , $699.20 , $699.20 , $322.67 , $806.96 , $830.30 , $786.60 , $786.60 , $786.60 , $812.82 , $839.04 , $476.45 , $742.90 , $636.91 , $489.07 , N/A , $538.87 , $538.87 , $830.30 , $612.15 , $79.62 , $839.04 
 DILTIAZEM HCL ER COATED BEADS 180 MG PO CP24 ,HCPCS RXC637,0250 - PHARMACY,60687-0206-01,1 capsule, $4.97 , $3.23 , $4.17 , N/A , N/A , $4.02 , $4.47 , $4.21 , $4.47 , $4.47 , $4.47 , $4.22 , N/A , $4.59 , $4.72 , $4.22 , $4.62 , $4.62 , $4.72 , $4.77 , $4.07 , $4.47 , $4.22 , $3.93 , N/A , $4.02 , $4.02 , $4.72 , $4.26 , $3.93 , $4.77 
" Pro Excision, Addl Breast Lesion ",CPT® 19126,0982 - PRO FEE/OUTPT,N/A,N/A," $1,692.00 "," $1,099.80 ", $493.20 , $145.21 , $142.31 , $434.60 , $413.75 ," $1,573.56 "," $1,522.80 "," $1,522.80 "," $1,353.60 "," $1,353.60 ", $142.31 ," $1,562.22 "," $1,607.40 "," $1,522.80 "," $1,522.80 "," $1,522.80 "," $1,573.56 "," $1,624.32 ", $541.98 ," $1,438.20 ", $842.08 , $543.99 , N/A , $443.08 , $443.08 ," $1,607.40 ", $513.82 , $142.31 ," $1,624.32 "
 QUETIAPINE FUMARATE 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6638-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Adj Tiss Xfer Scalp,Extrem <10sqcm",CPT® 14020,N/A,N/A,N/A," $3,209.00 "," $2,085.85 "," $1,804.62 ", $543.35 , $371.14 ," $1,551.36 "," $1,532.17 "," $2,984.37 "," $2,888.10 "," $2,888.10 "," $2,567.20 "," $2,567.20 ", $371.14 ," $2,962.87 "," $3,048.55 "," $2,888.10 "," $2,888.10 "," $2,888.10 "," $2,984.37 "," $3,080.64 "," $1,971.71 "," $2,727.65 "," $3,054.32 "," $1,986.10 ", N/A ," $1,581.63 "," $1,581.63 "," $3,048.55 "," $1,834.16 ", $371.14 ," $3,080.64 "
 KCL IN NACL 20-0.45 MEQ/L-% IV SOLN (INPT) ,HCPCS RXA258,0258 - IV SOLUTIONS,00990-9257-39,"1,000 mL", $106.42 , $69.17 , $89.39 , N/A , N/A , $85.99 , $95.78 , $90.10 , $95.78 , $95.78 , $95.78 , $90.46 , N/A , $98.26 , $101.10 , $90.46 , $98.97 , $98.97 , $101.10 , $102.16 , $87.07 , $95.78 , $90.46 , $84.07 , N/A , $86.13 , $86.13 , $101.10 , $91.32 , $84.07 , $102.16 
"Duplex Large Vessel(S),Limited",CPT® 93979,N/A,N/A,N/A," $1,089.00 ", $707.85 , $744.32 , $114.80 , $121.27 , $645.26 , $915.51 ," $1,012.77 ", $980.10 , $980.10 , $871.20 , $871.20 , $121.27 ," $1,005.47 "," $1,034.55 ", $980.10 , $980.10 , $980.10 ," $1,012.77 "," $1,045.44 ", $521.73 , $925.65 , $488.61 , $458.14 , N/A , $657.85 , $657.85 ," $1,034.55 ", $729.24 , $114.80 ," $1,045.44 "
 Room Rate ,Custom 2060000001,0206 - POST ICU,N/A,N/A," $4,468.00 "," $2,904.20 "," $3,753.12 ", N/A , N/A ," $3,610.14 "," $4,021.20 "," $3,782.61 "," $4,021.20 "," $4,021.20 "," $4,021.20 "," $3,797.80 ", N/A ," $4,125.30 "," $4,244.60 "," $3,797.80 "," $4,155.24 "," $4,155.24 "," $4,244.60 "," $4,289.28 "," $3,655.72 "," $4,021.20 "," $3,797.80 "," $3,529.72 ", N/A ," $3,615.95 "," $3,615.95 "," $4,244.60 "," $3,833.99 "," $3,529.72 "," $4,289.28 "
Shoe Heel Pad & Depress For,HCPCS L3480,N/A,N/A,N/A, $79.00 , $51.35 , N/A , $72.88 , $32.27 , N/A , N/A , $73.47 , $71.10 , $71.10 , $63.20 , $63.20 , $32.27 , $72.94 , $75.05 , $71.10 , $71.10 , $71.10 , $73.47 , $75.84 , N/A , $67.15 , $60.33 , $61.32 , N/A , N/A , N/A , $75.05 , N/A , $32.27 , $75.84 
 Fac Drug Assay Flecainide ,CPT® 80181,0301 - LAB/CHEMISTRY,N/A,N/A, $149.00 , $96.85 , $125.16 , $19.01 , $15.21 , $120.39 , $134.10 , $126.14 , $134.10 , $134.10 , $134.10 , $126.65 , $14.91 , $137.57 , $141.55 , $126.65 , $138.57 , $138.57 , $141.55 , $143.04 , $121.91 , $134.10 , $126.65 , $117.71 , N/A , $120.59 , $120.59 , $141.55 , $127.86 , $14.91 , $143.04 
 Pro MRI Ch C-Matrl ,CPT® 71550,0972 - PRO FEE/RAD/DX,N/A,N/A," $4,056.00 "," $2,636.40 "," $2,022.79 ", $294.32 , $417.06 ," $1,970.26 "," $2,480.04 "," $3,772.08 "," $3,650.40 "," $3,650.40 "," $3,244.80 "," $3,244.80 ", $417.06 ," $3,744.90 "," $3,853.20 "," $3,650.40 "," $3,650.40 "," $3,650.40 "," $3,772.08 "," $3,893.76 "," $2,140.63 "," $3,447.60 "," $2,704.16 "," $3,832.37 ", N/A ," $2,008.70 "," $2,008.70 "," $3,853.20 "," $2,325.12 ", $294.32 ," $3,893.76 "
 Fac Prolact +6 H2mf per Ml ,Custom 2200000001,0220 - SPECIAL CHARGES,N/A,N/A, $32.00 , $20.80 , $26.88 , N/A , N/A , $25.86 , $28.80 , $27.09 , $28.80 , $28.80 , $28.80 , $27.20 , N/A , $29.55 , $30.40 , $27.20 , $29.76 , $29.76 , $30.40 , $30.72 , $26.18 , $28.80 , $27.20 , $25.28 , N/A , $25.90 , $25.90 , $30.40 , $27.46 , $25.28 , $30.72 
X-Ray Shoulder 2+ Vw,CPT® 73030,N/A,N/A,N/A, $375.00 , $243.75 , $194.24 , $34.02 , $28.56 , $136.45 , $163.02 , $348.75 , $337.50 , $337.50 , $300.00 , $300.00 , $28.56 , $346.24 , $356.25 , $337.50 , $337.50 , $337.50 , $348.75 , $360.00 , $187.84 , $318.75 , $181.05 , $147.76 , N/A , $139.11 , $139.11 , $356.25 , $161.02 , $28.56 , $360.00 
 Pro Amputation Toe & Metatarsal ,CPT® 28810,0982 - PRO FEE/OUTPT,N/A,N/A," $3,343.00 "," $2,172.95 "," $2,591.23 ", $403.35 , $384.19 ," $2,103.13 "," $2,129.13 "," $3,108.99 "," $3,008.70 "," $3,008.70 "," $2,674.40 "," $2,674.40 ", $384.19 ," $3,086.59 "," $3,175.85 "," $3,008.70 "," $3,008.70 "," $3,008.70 "," $3,108.99 "," $3,209.28 "," $2,408.99 "," $2,841.55 "," $2,344.26 "," $2,463.28 ", N/A ," $2,144.16 "," $2,144.16 "," $3,175.85 "," $2,520.16 ", $384.19 ," $3,209.28 "
Pro Excis/Curet Benig Bone Les Rad/Ulna,25120,N/A,N/A,N/A," $2,934.00 "," $1,907.10 "," $3,082.37 ", $485.00 , $284.00 ," $2,391.55 "," $2,397.77 "," $2,728.62 "," $2,640.60 "," $2,640.60 "," $2,347.20 "," $2,347.20 ", $284.00 ," $2,708.96 "," $2,787.30 "," $2,640.60 "," $2,640.60 "," $2,640.60 "," $2,728.62 "," $2,816.64 "," $2,859.61 "," $2,493.90 "," $2,638.63 "," $2,840.56 ", N/A ," $2,438.22 "," $2,438.22 "," $2,787.30 "," $2,865.76 ", $284.00 ," $3,082.37 "
 Fac Lyr Clsr N/H/F/Xtrnl Gent 2.5 Cm/< ,CPT® 12041,0761 - TREATMENT ROOM,N/A,N/A, $343.00 , $222.95 , $288.12 , $139.44 , $71.45 , $277.14 , $308.70 , $290.38 , $308.70 , $308.70 , $308.70 , $291.55 , $70.05 , $316.69 , $325.85 , $291.55 , $318.99 , $318.99 , $325.85 , $329.28 , $280.64 , $308.70 , $291.55 , $270.97 , N/A , $277.59 , $277.59 , $325.85 , $294.33 , $70.05 , $329.28 
 Pro Dilation of Rectal Narrowing ,CPT® 45910,0982 - PRO FEE/OUTPT,N/A,N/A," $1,299.00 ", $844.35 ," $1,180.79 ", $183.62 , $133.31 , $928.53 , $952.03 ," $1,208.07 "," $1,169.10 "," $1,169.10 "," $1,039.20 "," $1,039.20 ", $133.31 ," $1,199.37 "," $1,234.05 "," $1,169.10 "," $1,169.10 "," $1,169.10 "," $1,208.07 "," $1,247.04 ", $840.60 ," $1,104.15 "," $1,045.46 "," $1,098.70 ", N/A , $946.64 , $946.64 ," $1,234.05 ", $990.08 , $133.31 ," $1,247.04 "
"Assay Glucose, Body Fluid",CPT® 82945,N/A,N/A,N/A, $118.00 , $76.70 , N/A , $4.01 , $4.01 , $22.20 , $26.53 , $109.74 , $106.20 , $106.20 , $94.40 , $94.40 , $4.01 , $108.95 , $112.10 , $106.20 , $106.20 , $106.20 , $109.74 , $113.28 , $26.24 , $100.30 , $25.95 , $14.22 , N/A , $20.72 , $20.72 , $112.10 , $22.64 , $4.01 , $113.28 
Multiple Sleep Latency Test,CPT® 95805,N/A,N/A,N/A," $3,090.00 "," $2,008.50 "," $1,525.89 ", $408.91 , $393.44 , $923.89 , $963.86 ," $2,873.70 "," $2,781.00 "," $2,781.00 "," $2,472.00 "," $2,472.00 ", $393.44 ," $2,853.00 "," $2,935.50 "," $2,781.00 "," $2,781.00 "," $2,781.00 "," $2,873.70 "," $2,966.40 "," $1,803.97 "," $2,626.50 "," $1,279.31 "," $1,628.12 ", N/A , $941.92 , $941.92 ," $2,935.50 "," $1,098.08 ", $393.44 ," $2,966.40 "
Pvb Thoracic Second & Addl Inj Site W/Img Gid,CPT® 64462,N/A,N/A,N/A, $517.00 , $336.05 , $243.41 , $46.99 , $67.32 , $307.17 , $291.09 , $480.81 , $465.30 , $465.30 , $413.60 , $413.60 , $67.32 , $477.35 , $491.15 , $465.30 , $465.30 , $465.30 , $480.81 , $496.32 , $264.20 , $439.45 , $255.88 , $323.88 , N/A , $313.16 , $313.16 , $491.15 , $335.95 , $46.99 , $496.32 
"Excis Bowel Lesion(S),Single Enterotomy",CPT® 44110,N/A,N/A,N/A," $5,540.00 "," $3,601.00 "," $5,095.81 ", $790.07 , $922.06 ," $4,008.70 "," $4,040.43 "," $5,152.20 "," $4,986.00 "," $4,986.00 "," $4,432.00 "," $4,432.00 ", $922.06 ," $5,115.08 "," $5,263.00 "," $4,986.00 "," $4,986.00 "," $4,986.00 "," $5,152.20 "," $5,318.40 "," $3,654.28 "," $4,709.00 "," $4,490.49 "," $4,734.92 ", N/A ," $4,086.91 "," $4,086.91 "," $5,263.00 "," $4,274.49 ", $790.07 ," $5,318.40 "
 Colon/Barium Enema Adult W/WO Kub Sa ,CPT® 74270,0320 - DX X-RAY,N/A,N/A," $1,702.00 "," $1,106.30 "," $1,429.68 ", $154.05 , $106.23 ," $1,375.22 "," $1,531.80 "," $1,440.91 "," $1,531.80 "," $1,531.80 "," $1,531.80 "," $1,446.70 ", $104.15 ," $1,571.46 "," $1,616.90 "," $1,446.70 "," $1,582.86 "," $1,582.86 "," $1,616.90 "," $1,633.92 "," $1,392.58 "," $1,531.80 "," $1,446.70 "," $1,344.58 ", N/A ," $1,377.43 "," $1,377.43 "," $1,616.90 "," $1,460.49 ", $104.15 ," $1,633.92 "
"Adj Tiss Xfer Any Area,Ea Add 30.0 Sqcm",CPT® 14302,N/A,N/A,N/A," $1,405.00 ", $913.25 , $678.74 , $202.09 , $191.54 , $603.43 , $576.43 ," $1,306.65 "," $1,264.50 "," $1,264.50 "," $1,124.00 "," $1,124.00 ", $191.54 ," $1,297.24 "," $1,334.75 "," $1,264.50 "," $1,264.50 "," $1,264.50 "," $1,306.65 "," $1,348.80 ", $748.24 ," $1,194.25 "," $1,156.07 ", $766.05 , N/A , $615.20 , $615.20 ," $1,334.75 ", $713.42 , $191.54 ," $1,348.80 "
Perq Replacement Gtube Req Revj Gstrst Trc,43763,N/A,N/A,N/A," $4,101.00 "," $2,665.65 ", $511.81 , $81.55 , $261.98 , $371.96 , N/A ," $3,813.93 "," $3,690.90 "," $3,690.90 "," $3,280.80 "," $3,280.80 ", $261.98 ," $3,786.45 "," $3,895.95 "," $3,690.90 "," $3,690.90 "," $3,690.90 "," $3,813.93 "," $3,936.96 ", $364.60 ," $3,485.85 ", $460.23 , $476.79 , N/A , $379.23 , $379.23 ," $3,895.95 ", $396.62 , $81.55 ," $3,936.96 "
 Digestive Malignancy With Cc ,MS DRG V40 (FY2023) 375,N/A,N/A,N/A," $43,788.63 "," $28,462.61 "," $36,782.45 ", N/A , N/A ," $35,381.21 "," $39,409.77 "," $37,071.45 "," $39,409.77 "," $39,409.77 "," $39,409.77 "," $37,220.34 ", N/A ," $40,430.04 "," $41,599.20 "," $37,220.34 "," $40,723.43 "," $40,723.43 "," $41,599.20 "," $42,037.08 "," $35,827.86 "," $39,409.77 "," $37,220.34 "," $34,593.02 ", N/A ," $35,438.14 "," $35,438.14 "," $41,599.20 "," $37,575.02 "," $34,593.02 "," $42,037.08 "
Cyclic Cirullinated Peptide Antibody,CPT® 86200,N/A,N/A,N/A, $209.00 , $135.85 , N/A , $13.21 , $13.21 , $73.26 , $87.64 , $194.37 , $188.10 , $188.10 , $167.20 , $167.20 , $13.21 , $192.97 , $198.55 , $188.10 , $188.10 , $188.10 , $194.37 , $200.64 , $86.47 , $177.65 , $84.34 , $46.93 , N/A , $68.37 , $68.37 , $198.55 , $74.71 , $13.21 , $200.64 
"Apply Cast,Finger-Elbow",29075,N/A,N/A,N/A, $339.00 , $220.35 , $373.23 , $59.32 , $54.80 , $299.54 , $303.79 , $315.27 , $305.10 , $305.10 , $271.20 , $271.20 , $54.80 , $313.00 , $322.05 , $305.10 , $305.10 , $305.10 , $315.27 , $325.44 , $349.50 , $288.15 , $333.62 , $357.56 , N/A , $305.39 , $305.39 , $322.05 , $358.95 , $54.80 , $373.23 
 Fac Trlml Balo Angiop Open/Perq Img S&I Ea Addl Art ,CPT® 37247,0360 - OR SERVICES,N/A,N/A," $6,710.00 "," $4,361.50 "," $5,636.40 ", $154.95 ," $1,023.33 "," $5,421.68 "," $6,039.00 "," $5,680.69 "," $6,039.00 "," $6,039.00 "," $6,039.00 "," $5,703.50 "," $1,003.26 "," $6,195.34 "," $6,374.50 "," $5,703.50 "," $6,240.30 "," $6,240.30 "," $6,374.50 "," $6,441.60 "," $5,490.12 "," $6,039.00 "," $5,703.50 "," $5,300.90 ", N/A ," $5,430.40 "," $5,430.40 "," $6,374.50 "," $5,757.85 ", $154.95 ," $6,441.60 "
"Ureterolithotomy,Upper 1/3",CPT® 50610,N/A,N/A,N/A," $6,586.00 "," $4,280.90 "," $5,103.41 ", $897.27 ," $1,229.45 "," $4,628.19 "," $4,300.19 "," $6,124.98 "," $5,927.40 "," $5,927.40 "," $5,268.80 "," $5,268.80 "," $1,229.45 "," $6,080.85 "," $6,256.70 "," $5,927.40 "," $5,927.40 "," $5,927.40 "," $6,124.98 "," $6,322.56 "," $5,125.81 "," $5,598.10 "," $4,866.93 "," $5,815.84 ", N/A ," $4,718.49 "," $4,718.49 "," $6,256.70 "," $5,545.94 ", $897.27 ," $6,322.56 "
Surgical Path Level 4,CPT® 88305,N/A,N/A,N/A, $557.00 , $362.05 , $254.78 , $70.47 , $66.83 , $290.81 , $323.57 , $518.01 , $501.30 , $501.30 , $445.60 , $445.60 , $66.83 , $514.28 , $529.15 , $501.30 , $501.30 , $501.30 , $518.01 , $534.72 , $457.06 , $473.45 , $334.10 , $239.59 , N/A , $271.40 , $271.40 , $529.15 , $298.26 , $66.83 , $534.72 
 Other Factors Influencing Health Status ,MS DRG V40 (FY2023) 951,N/A,N/A,N/A," $16,996.52 "," $11,047.74 "," $14,277.08 ", N/A , N/A ," $13,733.19 "," $15,296.87 "," $14,389.25 "," $15,296.87 "," $15,296.87 "," $15,296.87 "," $14,447.04 ", N/A ," $15,692.89 "," $16,146.69 "," $14,447.04 "," $15,806.76 "," $15,806.76 "," $16,146.69 "," $16,316.66 "," $13,906.55 "," $15,296.87 "," $14,447.04 "," $13,427.25 ", N/A ," $13,755.28 "," $13,755.28 "," $16,146.69 "," $14,584.71 "," $13,427.25 "," $16,316.66 "
"Repr Bl Ves Direct,Chest W Bypass",CPT® 35211,N/A,N/A,N/A," $8,332.00 "," $5,415.80 "," $8,176.94 "," $1,255.27 "," $2,378.00 "," $5,909.39 "," $5,865.60 "," $7,748.76 "," $7,498.80 "," $7,498.80 "," $6,665.60 "," $6,665.60 "," $2,378.00 "," $7,692.94 "," $7,915.40 "," $7,498.80 "," $7,498.80 "," $7,498.80 "," $7,748.76 "," $7,998.72 "," $7,552.51 "," $7,082.20 "," $7,421.71 "," $6,646.68 ", N/A ," $6,024.70 "," $6,024.70 "," $7,915.40 "," $6,844.06 "," $1,255.27 "," $8,176.94 "
Perq Prcrd Drg 6yr+ W/O Congenital Car Anomaly,33017,N/A,N/A,N/A," $2,037.00 "," $1,324.05 "," $1,446.32 ", $222.87 , $187.36 ," $1,028.81 ", N/A ," $1,894.41 "," $1,833.30 "," $1,833.30 "," $1,629.60 "," $1,629.60 ", $187.36 ," $1,880.76 "," $1,935.15 "," $1,833.30 "," $1,833.30 "," $1,833.30 "," $1,894.41 "," $1,955.52 "," $1,335.40 "," $1,731.45 "," $1,279.40 "," $1,188.44 ", N/A ," $1,048.88 "," $1,048.88 "," $1,935.15 "," $1,191.27 ", $187.36 ," $1,955.52 "
Ligation of Hemorrhoid(S),CPT® 46221,N/A,N/A,N/A," $1,138.00 ", $739.70 ," $1,206.14 ", $185.85 , $46.08 , $914.44 , $947.04 ," $1,058.34 "," $1,024.20 "," $1,024.20 ", $910.40 , $910.40 , $46.08 ," $1,050.72 "," $1,081.10 "," $1,024.20 "," $1,024.20 "," $1,024.20 "," $1,058.34 "," $1,092.48 ", $861.85 , $967.30 ," $1,038.33 "," $1,090.74 ", N/A , $932.28 , $932.28 ," $1,081.10 ", $975.06 , $46.08 ," $1,206.14 "
"Open Rx Tibia Shaft Fx,Screws",27758,N/A,N/A,N/A," $5,212.00 "," $3,387.80 "," $5,440.05 ", $851.77 , $775.54 ," $4,302.26 "," $4,276.45 "," $4,847.16 "," $4,690.80 "," $4,690.80 "," $4,169.60 "," $4,169.60 ", $775.54 ," $4,812.24 "," $4,951.40 "," $4,690.80 "," $4,690.80 "," $4,690.80 "," $4,847.16 "," $5,003.52 "," $5,056.37 "," $4,430.20 "," $4,725.99 "," $5,063.13 ", N/A ," $4,386.20 "," $4,386.20 "," $4,951.40 "," $5,155.35 ", $775.54 ," $5,440.05 "
 VITAMIN D3 25 MCG (1000 UT) PO TABS ,HCPCS RXC637,0250 - PHARMACY,20555-0033-00,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Removal & Replace,Inflatable Sphincter",CPT® 53447,N/A,N/A,N/A," $5,634.00 "," $3,662.10 "," $4,371.84 ", $768.71 ," $1,102.51 "," $3,953.29 "," $3,684.11 "," $5,239.62 "," $5,070.60 "," $5,070.60 "," $4,507.20 "," $4,507.20 "," $1,102.51 "," $5,201.87 "," $5,352.30 "," $5,070.60 "," $5,070.60 "," $5,070.60 "," $5,239.62 "," $5,408.64 "," $4,389.15 "," $4,788.90 "," $4,171.14 "," $4,975.94 ", N/A ," $4,030.43 "," $4,030.43 "," $5,352.30 "," $4,737.20 ", $768.71 ," $5,408.64 "
 Excis Tr-Ext B9+Marg > 4.0 Cm ,CPT® 11406,0761 - TREATMENT ROOM,N/A,N/A," $1,538.00 ", $999.70 ," $1,291.92 ", $234.46 , $381.08 ," $1,242.70 "," $1,384.20 "," $1,302.07 "," $1,384.20 "," $1,384.20 "," $1,384.20 "," $1,307.30 ", $373.61 ," $1,420.04 "," $1,461.10 "," $1,307.30 "," $1,430.34 "," $1,430.34 "," $1,461.10 "," $1,476.48 "," $1,258.39 "," $1,384.20 "," $1,307.30 "," $1,215.02 ", N/A ," $1,244.70 "," $1,244.70 "," $1,461.10 "," $1,319.76 ", $234.46 ," $1,476.48 "
 Lap; Revision IP Cath ,CPT® 49325,0360 - OR SERVICES,N/A,N/A," $2,576.00 "," $1,674.40 "," $2,163.84 ", $380.60 , $469.13 ," $2,081.41 "," $2,318.40 "," $2,180.84 "," $2,318.40 "," $2,318.40 "," $2,318.40 "," $2,189.60 ", $459.93 ," $2,378.42 "," $2,447.20 "," $2,189.60 "," $2,395.68 "," $2,395.68 "," $2,447.20 "," $2,472.96 "," $2,107.68 "," $2,318.40 "," $2,189.60 "," $2,035.04 ", N/A ," $2,084.76 "," $2,084.76 "," $2,447.20 "," $2,210.47 ", $380.60 ," $2,472.96 "
" Fac Nuclear Rx, IV Admin ",CPT® 79101,0342 - NUC MED/RX PROCEDURES,N/A,N/A, $536.00 , $348.40 , $450.24 , $145.24 , $163.56 , $433.09 , $482.40 , $453.78 , $482.40 , $482.40 , $482.40 , $455.60 , $160.35 , $494.89 , $509.20 , $455.60 , $498.48 , $498.48 , $509.20 , $514.56 , $438.56 , $482.40 , $455.60 , $423.44 , N/A , $433.78 , $433.78 , $509.20 , $459.94 , $145.24 , $514.56 
"Reinsert Bi/Triceps Tendon,Distal",CPT® 24342,N/A,N/A,N/A," $2,943.00 "," $1,912.95 "," $4,720.56 ", $739.12 , $922.06 ," $3,742.14 "," $3,726.16 "," $2,736.99 "," $2,648.70 "," $2,648.70 "," $2,354.40 "," $2,354.40 ", $922.06 ," $2,717.27 "," $2,795.85 "," $2,648.70 "," $2,648.70 "," $2,648.70 "," $2,736.99 "," $2,825.28 "," $4,392.97 "," $2,501.55 "," $4,114.05 "," $4,412.90 ", N/A ," $3,815.16 "," $3,815.16 "," $2,795.85 "," $4,484.16 ", $739.12 ," $4,720.56 "
 Videofluoroscopic Swallow Study ,CPT® 74230,0320 - DX X-RAY,N/A,N/A," $1,392.00 ", $904.80 ," $1,169.28 ", $125.26 , $81.46 ," $1,124.74 "," $1,252.80 "," $1,178.47 "," $1,252.80 "," $1,252.80 "," $1,252.80 "," $1,183.20 ", $79.86 ," $1,285.23 "," $1,322.40 "," $1,183.20 "," $1,294.56 "," $1,294.56 "," $1,322.40 "," $1,336.32 "," $1,138.93 "," $1,252.80 "," $1,183.20 "," $1,099.68 ", N/A ," $1,126.55 "," $1,126.55 "," $1,322.40 "," $1,194.48 ", $79.86 ," $1,336.32 "
 Closed Tx Interphalanx Jt Disloc W/ Manip W/ Anes -Mh ,CPT® 26775,0761 - TREATMENT ROOM,N/A,N/A," $3,350.00 "," $2,177.50 "," $2,814.00 ", $348.94 , $96.07 ," $2,706.80 "," $3,015.00 "," $2,836.11 "," $3,015.00 "," $3,015.00 "," $3,015.00 "," $2,847.50 ", $94.19 ," $3,093.06 "," $3,182.50 "," $2,847.50 "," $3,115.50 "," $3,115.50 "," $3,182.50 "," $3,216.00 "," $2,740.97 "," $3,015.00 "," $2,847.50 "," $2,646.50 ", N/A ," $2,711.16 "," $2,711.16 "," $3,182.50 "," $2,874.64 ", $94.19 ," $3,216.00 "
 Fac Molecular Pathology Interpr ,CPT® G0452,0310 - PATHOLOGY LAB,N/A,N/A, $77.00 , $50.05 , $64.68 , $49.22 , N/A , $62.22 , $69.30 , $65.19 , $69.30 , $69.30 , $69.30 , $65.45 , N/A , $71.09 , $73.15 , $65.45 , $71.61 , $71.61 , $73.15 , $73.92 , $63.00 , $69.30 , $65.45 , $60.83 , N/A , $62.32 , $62.32 , $73.15 , $66.07 , $49.22 , $73.92 
Incontinence Supply,HCPCS A4335,N/A,N/A,N/A, $6.00 , $3.90 , N/A , N/A , N/A , N/A , N/A , $5.58 , $5.40 , $5.40 , $4.80 , $4.80 , N/A , $5.54 , $5.70 , $5.40 , $5.40 , $5.40 , $5.58 , $5.76 , N/A , $5.10 , $4.80 , N/A , N/A , N/A , N/A , $5.70 , N/A , $4.80 , $5.76 
Spine/Lumbar Disk Surgery,HCPCS C9757,N/A,N/A,N/A," $8,357.00 "," $5,432.05 ", N/A , N/A , N/A , N/A , N/A ," $7,772.01 "," $7,521.30 "," $7,521.30 "," $6,685.60 "," $6,685.60 ", N/A ," $7,716.02 "," $7,939.15 "," $7,521.30 "," $7,521.30 "," $7,521.30 "," $7,772.01 "," $8,022.72 ", N/A ," $7,103.45 "," $6,685.60 ", N/A , N/A , N/A , N/A ," $7,939.15 ", N/A ," $6,685.60 "," $8,022.72 "
Bilirubin Total,CPT® 82247,N/A,N/A,N/A, $45.00 , $29.25 , N/A , $5.12 , $5.12 , $28.39 , $33.97 , $41.85 , $40.50 , $40.50 , $36.00 , $36.00 , $5.12 , $41.55 , $42.75 , $40.50 , $40.50 , $40.50 , $41.85 , $43.20 , $33.52 , $38.25 , $32.44 , $18.18 , N/A , $26.50 , $26.50 , $42.75 , $28.96 , $5.12 , $43.20 
 Pro Removal of Sesamoid Bone ,CPT® 28315,0982 - PRO FEE/OUTPT,N/A,N/A," $3,212.00 "," $2,087.80 "," $2,025.21 ", $317.59 , $206.19 ," $1,607.33 "," $1,594.49 "," $2,987.16 "," $2,890.80 "," $2,890.80 "," $2,569.60 "," $2,569.60 ", $206.19 ," $2,965.64 "," $3,051.40 "," $2,890.80 "," $2,890.80 "," $2,890.80 "," $2,987.16 "," $3,083.52 "," $1,883.23 "," $2,730.20 "," $1,726.97 "," $1,912.14 ", N/A ," $1,638.69 "," $1,638.69 "," $3,051.40 "," $1,926.04 ", $206.19 ," $3,083.52 "
" Fac Chylmd Trach, Dna, Amp Probe ",CPT® 87491,0306 - LAB/BACT-MICRO,N/A,N/A, $317.00 , $206.05 , $266.28 , $35.79 , $35.79 , $256.14 , $285.30 , $268.37 , $285.30 , $285.30 , $285.30 , $269.45 , $35.09 , $292.69 , $301.15 , $269.45 , $294.81 , $294.81 , $301.15 , $304.32 , $259.37 , $285.30 , $269.45 , $250.43 , N/A , $256.55 , $256.55 , $301.15 , $272.02 , $35.09 , $304.32 
Atria Ablate & Rcnstj W Other Procedure Limited,CPT® 33257,N/A,N/A,N/A," $5,486.00 "," $3,565.90 "," $3,420.63 ", $530.44 , $440.17 ," $2,491.32 "," $2,492.44 "," $5,101.98 "," $4,937.40 "," $4,937.40 "," $4,388.80 "," $4,388.80 ", $440.17 ," $5,065.22 "," $5,211.70 "," $4,937.40 "," $4,937.40 "," $4,937.40 "," $5,101.98 "," $5,266.56 "," $3,166.21 "," $4,663.10 "," $3,145.30 "," $2,805.45 ", N/A ," $2,539.93 "," $2,539.93 "," $5,211.70 "," $2,885.37 ", $440.17 ," $5,266.56 "
Removal of Heel Bone,CPT® 28118,N/A,N/A,N/A," $3,917.00 "," $2,546.05 "," $2,591.10 ", $405.98 , $384.19 ," $2,022.75 "," $2,022.53 "," $3,642.81 "," $3,525.30 "," $3,525.30 "," $3,133.60 "," $3,133.60 ", $384.19 ," $3,616.57 "," $3,721.15 "," $3,525.30 "," $3,525.30 "," $3,525.30 "," $3,642.81 "," $3,760.32 "," $2,401.10 "," $3,329.45 "," $2,201.53 "," $2,408.64 ", N/A ," $2,062.22 "," $2,062.22 "," $3,721.15 "," $2,423.86 ", $384.19 ," $3,760.32 "
Molecular Pathology Procedure Level 2,CPT® 81401,N/A,N/A,N/A, $968.00 , $629.20 , N/A , $139.74 , $139.74 , N/A , N/A , $900.24 , $871.20 , $871.20 , $774.40 , $774.40 , $139.74 , $893.75 , $919.60 , $871.20 , $871.20 , $871.20 , $900.24 , $929.28 , $914.78 , $822.80 , $652.61 , $402.37 , N/A , $543.89 , $543.89 , $919.60 , $593.21 , $139.74 , $929.28 
Lens Sphcyl Bifocal 4.00d/.1,HCPCS V2203,N/A,N/A,N/A, $85.00 , $55.25 , N/A , $62.83 , N/A , N/A , N/A , $79.05 , $76.50 , $76.50 , $68.00 , $68.00 , N/A , $78.48 , $80.75 , $76.50 , $76.50 , $76.50 , $79.05 , $81.60 , N/A , $72.25 , $85.00 , $57.08 , N/A , N/A , N/A , $80.75 , N/A , $57.08 , $85.00 
Intraabdominal Pressure Test,CPT® 51797,N/A,N/A,N/A," $1,654.00 "," $1,075.10 "," $1,108.60 ", $189.42 , $142.44 , $540.18 , $527.65 ," $1,538.22 "," $1,488.60 "," $1,488.60 "," $1,323.20 "," $1,323.20 ", $142.44 ," $1,527.14 "," $1,571.30 "," $1,488.60 "," $1,488.60 "," $1,488.60 "," $1,538.22 "," $1,587.84 "," $1,041.63 "," $1,405.90 ", $595.88 , $696.61 , N/A , $550.72 , $550.72 ," $1,571.30 ", $647.29 , $142.44 ," $1,587.84 "
 Fac Sigmoidoscopy Flx Control Bleeding ,CPT® 45334,0360 - OR SERVICES,N/A,N/A," $1,738.00 "," $1,129.70 "," $1,459.92 ", $111.58 , $218.09 ," $1,404.30 "," $1,564.20 "," $1,471.39 "," $1,564.20 "," $1,564.20 "," $1,564.20 "," $1,477.30 ", $213.81 ," $1,604.70 "," $1,651.10 "," $1,477.30 "," $1,616.34 "," $1,616.34 "," $1,651.10 "," $1,668.48 "," $1,422.03 "," $1,564.20 "," $1,477.30 "," $1,373.02 ", N/A ," $1,406.56 "," $1,406.56 "," $1,651.10 "," $1,491.38 ", $111.58 ," $1,668.48 "
 Fac Plmt Prox Xtn Prosth Evasc Rpr Dta Ea Prox Xtn ,CPT® 33884,0360 - OR SERVICES,N/A,N/A," $3,259.00 "," $2,118.35 "," $2,737.56 ", $347.39 , $315.47 ," $2,633.27 "," $2,933.10 "," $2,759.07 "," $2,933.10 "," $2,933.10 "," $2,933.10 "," $2,770.15 ", $309.28 ," $3,009.03 "," $3,096.05 "," $2,770.15 "," $3,030.87 "," $3,030.87 "," $3,096.05 "," $3,128.64 "," $2,666.51 "," $2,933.10 "," $2,770.15 "," $2,574.61 ", N/A ," $2,637.51 "," $2,637.51 "," $3,096.05 "," $2,796.55 ", $309.28 ," $3,128.64 "
"Vag Hyst,Rmv Tube/Ovary",CPT® 58262,N/A,N/A,N/A," $5,501.00 "," $3,575.65 "," $4,373.00 ", $884.24 , $837.40 ," $3,754.99 "," $3,742.93 "," $5,115.93 "," $4,950.90 "," $4,950.90 "," $4,400.80 "," $4,400.80 ", $837.40 ," $5,079.07 "," $5,225.95 "," $4,950.90 "," $4,950.90 "," $4,950.90 "," $5,115.93 "," $5,280.96 "," $4,572.31 "," $4,675.85 "," $4,924.02 "," $3,756.36 ", N/A ," $3,828.25 "," $3,828.25 "," $5,225.95 "," $4,591.77 ", $837.40 ," $5,280.96 "
 Fac Assay of Insulin ,CPT® 83525,0301 - LAB/CHEMISTRY,N/A,N/A, $172.00 , $111.80 , $144.48 , $11.66 , $11.66 , $138.98 , $154.80 , $145.62 , $154.80 , $154.80 , $154.80 , $146.20 , $11.43 , $158.81 , $163.40 , $146.20 , $159.96 , $159.96 , $163.40 , $165.12 , $140.73 , $154.80 , $146.20 , $135.88 , N/A , $139.20 , $139.20 , $163.40 , $147.59 , $11.43 , $165.12 
Removal Colon/Ileostomy,CPT® 44150,N/A,N/A,N/A," $12,645.00 "," $8,219.25 "," $11,098.75 "," $1,717.14 "," $1,690.46 "," $8,835.67 "," $8,950.02 "," $11,759.85 "," $11,380.50 "," $11,380.50 "," $10,116.00 "," $10,116.00 "," $1,690.46 "," $11,675.13 "," $12,012.75 "," $11,380.50 "," $11,380.50 "," $11,380.50 "," $11,759.85 "," $12,139.20 "," $7,988.14 "," $10,748.25 "," $9,931.88 "," $10,442.11 ", N/A ," $9,008.07 "," $9,008.07 "," $12,012.75 "," $9,421.48 "," $1,690.46 "," $12,139.20 "
"Brucella, Antibody",CPT® 86622,N/A,N/A,N/A, $119.00 , $77.35 , N/A , $9.11 , $8.07 , $32.88 , $39.34 , $110.67 , $107.10 , $107.10 , $95.20 , $95.20 , $8.07 , $109.87 , $113.05 , $107.10 , $107.10 , $107.10 , $110.67 , $114.24 , $59.63 , $101.15 , $58.39 , $32.40 , N/A , $30.69 , $30.69 , $113.05 , $33.54 , $8.07 , $114.24 
 Fac Cltx Carpl Scphd Navclr Fx W/O Mnpj ,CPT® 25622,0761 - TREATMENT ROOM,N/A,N/A," $3,058.00 "," $1,987.70 "," $2,568.72 ", $281.15 , $206.19 ," $2,470.86 "," $2,752.20 "," $2,588.90 "," $2,752.20 "," $2,752.20 "," $2,752.20 "," $2,599.30 ", $202.15 ," $2,823.45 "," $2,905.10 "," $2,599.30 "," $2,843.94 "," $2,843.94 "," $2,905.10 "," $2,935.68 "," $2,502.06 "," $2,752.20 "," $2,599.30 "," $2,415.82 ", N/A ," $2,474.84 "," $2,474.84 "," $2,905.10 "," $2,624.07 ", $202.15 ," $2,935.68 "
"Lap, Radical Nephrectomy",CPT® 50545,N/A,N/A,N/A," $9,140.00 "," $5,941.00 "," $7,198.83 "," $1,263.57 "," $1,491.91 "," $6,556.56 "," $6,091.50 "," $8,500.20 "," $8,226.00 "," $8,226.00 "," $7,312.00 "," $7,312.00 "," $1,491.91 "," $8,438.96 "," $8,683.00 "," $8,226.00 "," $8,226.00 "," $8,226.00 "," $8,500.20 "," $8,774.40 "," $7,236.53 "," $7,769.00 "," $6,907.90 "," $8,233.57 ", N/A ," $6,684.50 "," $6,684.50 "," $8,683.00 "," $7,856.67 "," $1,263.57 "," $8,774.40 "
Ear Microscopy Examination,CPT® 92504,N/A,N/A,N/A, $79.00 , $51.35 , $21.46 , $9.28 , $24.58 , $21.39 , $21.61 , $73.47 , $71.10 , $71.10 , $63.20 , $63.20 , $24.58 , $72.94 , $75.05 , $71.10 , $71.10 , $71.10 , $73.47 , $75.84 , $40.25 , $67.15 , $28.38 , $36.21 , N/A , $21.81 , $21.81 , $75.05 , $25.43 , $9.28 , $75.84 
Physician Online Evaluation & Management Service,CPT® 99444,N/A,N/A,N/A, $48.00 , $31.20 , N/A , N/A , N/A , N/A , $57.24 , $44.64 , $43.20 , $43.20 , $38.40 , $38.40 , N/A , $44.32 , $45.60 , $43.20 , $43.20 , $43.20 , $44.64 , $46.08 , N/A , $40.80 , N/A , N/A , N/A , N/A , N/A , $45.60 , N/A , $38.40 , $57.24 
 Fac App Skn Sub Grft T/a/L Area/<100scm /<1st 25 Scm ,CPT® 15271,0761 - TREATMENT ROOM,N/A,N/A," $2,372.00 "," $1,541.80 "," $1,992.48 ", $78.87 , $111.11 ," $1,916.58 "," $2,134.80 "," $2,008.14 "," $2,134.80 "," $2,134.80 "," $2,134.80 "," $2,016.20 ", $108.93 ," $2,190.07 "," $2,253.40 "," $2,016.20 "," $2,205.96 "," $2,205.96 "," $2,253.40 "," $2,277.12 "," $1,940.77 "," $2,134.80 "," $2,016.20 "," $1,873.88 ", N/A ," $1,919.66 "," $1,919.66 "," $2,253.40 "," $2,035.41 ", $78.87 ," $2,277.12 "
 Fac Alanine Amino (Alt) (Sgpt) ,CPT® 84460,0301 - LAB/CHEMISTRY,N/A,N/A, $63.00 , $40.95 , $52.92 , $5.41 , $5.41 , $50.90 , $56.70 , $53.34 , $56.70 , $56.70 , $56.70 , $53.55 , $5.30 , $58.17 , $59.85 , $53.55 , $58.59 , $58.59 , $59.85 , $60.48 , $51.55 , $56.70 , $53.55 , $49.77 , N/A , $50.99 , $50.99 , $59.85 , $54.06 , $5.30 , $60.48 
"Ophthal Biometry,Intraoc Lens Pow Calc",CPT® 92136,N/A,N/A,N/A, $282.00 , $183.30 , $108.52 , $46.46 , $75.68 , $157.42 , $164.65 , $262.26 , $253.80 , $253.80 , $225.60 , $225.60 , $75.68 , $260.37 , $267.90 , $253.80 , $253.80 , $253.80 , $262.26 , $270.72 , $167.21 , $239.70 , $277.76 , $165.78 , N/A , $160.48 , $160.48 , $267.90 , $190.91 , $46.46 , $277.76 
 MOI-STIR MT SOLN ,HCPCS RXC637,0250 - PHARMACY,55299-0601-04,120 mL, $52.40 , $34.06 , $44.02 , N/A , N/A , $42.34 , $47.16 , $44.36 , $47.16 , $47.16 , $47.16 , $44.54 , N/A , $48.38 , $49.78 , $44.54 , $48.73 , $48.73 , $49.78 , $50.30 , $42.87 , $47.16 , $44.54 , $41.40 , N/A , $42.41 , $42.41 , $49.78 , $44.96 , $41.40 , $50.30 
Esophagogastroduodenoscopy Submucosal Injection,43236,N/A,N/A,N/A," $2,594.00 "," $1,686.10 ", $846.69 , $130.86 , $316.50 , $706.97 , $851.21 ," $2,412.42 "," $2,334.60 "," $2,334.60 "," $2,075.20 "," $2,075.20 ", $316.50 ," $2,395.04 "," $2,464.30 "," $2,334.60 "," $2,334.60 "," $2,334.60 "," $2,412.42 "," $2,490.24 ", $609.64 ," $2,204.90 ", $933.07 , $808.87 , N/A , $720.76 , $720.76 ," $2,464.30 ", $753.83 , $130.86 ," $2,490.24 "
"Excis Intrasp Lesn,Xdural,Thoracic",CPT® 63266,N/A,N/A,N/A," $11,117.00 "," $7,226.05 "," $7,921.47 "," $1,545.41 "," $1,659.43 "," $9,295.15 "," $8,911.01 "," $10,338.81 "," $10,005.30 "," $10,005.30 "," $8,893.60 "," $8,893.60 "," $1,659.43 "," $10,264.33 "," $10,561.15 "," $10,005.30 "," $10,005.30 "," $10,005.30 "," $10,338.81 "," $10,672.32 "," $8,562.28 "," $9,449.45 "," $9,132.62 "," $9,653.48 ", N/A ," $9,476.51 "," $9,476.51 "," $10,561.15 "," $10,166.05 "," $1,545.41 "," $10,672.32 "
"Electrocardiogram,12 Lead",CPT® 93000,N/A,N/A,N/A, $223.00 , $144.95 , $88.34 , $13.97 , $19.58 , $115.08 , $102.13 , $207.39 , $200.70 , $200.70 , $178.40 , $178.40 , $19.58 , $205.90 , $211.85 , $200.70 , $200.70 , $200.70 , $207.39 , $214.08 , $89.45 , $189.55 , $96.34 , $63.28 , N/A , $117.32 , $117.32 , $211.85 , $143.25 , $13.97 , $214.08 
Obtaining Screen Pap Smear,HCPCS Q0091,N/A,N/A,N/A, $150.00 , $97.50 , $88.90 , $17.93 , N/A , N/A , N/A , $139.50 , $135.00 , $135.00 , $120.00 , $120.00 , N/A , $138.50 , $142.50 , $135.00 , $135.00 , $135.00 , $139.50 , $144.00 , $119.72 , $127.50 , $36.33 , $41.27 , N/A , N/A , N/A , $142.50 , N/A , $17.93 , $144.00 
 Fac Unlis Maternity Care&Dlvr ,CPT® 59899,0361 - OR/MINOR,N/A,N/A, $345.00 , $224.25 , $289.80 , N/A , N/A , $278.76 , $310.50 , $292.08 , $310.50 , $310.50 , $310.50 , $293.25 , N/A , $318.54 , $327.75 , $293.25 , $320.85 , $320.85 , $327.75 , $331.20 , $282.28 , $310.50 , $293.25 , $272.55 , N/A , $279.21 , $279.21 , $327.75 , $296.04 , $272.55 , $331.20 
CT Guidance Radiation Therapy Flds Placement,CPT® 77014,N/A,N/A,N/A," $1,901.00 "," $1,235.65 ", $680.28 , $118.91 , $138.72 , $556.72 , $643.82 ," $1,767.93 "," $1,710.90 "," $1,710.90 "," $1,520.80 "," $1,520.80 ", $138.72 ," $1,755.19 "," $1,805.95 "," $1,710.90 "," $1,710.90 "," $1,710.90 "," $1,767.93 "," $1,824.96 ", $685.24 ," $1,615.85 ", $704.93 , $780.58 , N/A , $567.59 , $567.59 ," $1,805.95 ", $657.01 , $118.91 ," $1,824.96 "
 Fac T3 Reverse ,CPT® 84482,0301 - LAB/CHEMISTRY,N/A,N/A, $210.00 , $136.50 , $176.40 , $16.08 , $10.68 , $169.68 , $189.00 , $177.79 , $189.00 , $189.00 , $189.00 , $178.50 , $10.47 , $193.89 , $199.50 , $178.50 , $195.30 , $195.30 , $199.50 , $201.60 , $171.82 , $189.00 , $178.50 , $165.90 , N/A , $169.95 , $169.95 , $199.50 , $180.20 , $10.47 , $201.60 
TREAT HIP DISLOCATION,27256,N/A,N/A,N/A," $1,950.00 "," $1,267.50 "," $1,423.18 ", $224.70 , $268.05 ," $1,137.30 "," $1,132.37 "," $1,813.50 "," $1,755.00 "," $1,755.00 "," $1,560.00 "," $1,560.00 ", $268.05 ," $1,800.44 "," $1,852.50 "," $1,755.00 "," $1,755.00 "," $1,755.00 "," $1,813.50 "," $1,872.00 "," $1,316.55 "," $1,657.50 "," $1,250.63 "," $1,336.09 ", N/A ," $1,159.49 "," $1,159.49 "," $1,852.50 "," $1,362.81 ", $224.70 ," $1,872.00 "
 VITAMIN D3 10 MCG (400 UNIT) PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-5823-60,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Radex Hips Bilateral With Pelvis 3-4 Views,CPT® 73522,N/A,N/A,N/A, $382.00 , $248.30 , $366.03 , $52.93 , $38.29 , $232.10 , $245.04 , $355.26 , $343.80 , $343.80 , $305.60 , $305.60 , $38.29 , $352.70 , $362.90 , $343.80 , $343.80 , $343.80 , $355.26 , $366.72 , $294.60 , $324.70 , $308.86 , $245.99 , N/A , $236.63 , $236.63 , $362.90 , $273.90 , $38.29 , $366.72 
"Prostate Specific Antigen,Total",CPT® 84153,N/A,N/A,N/A, $177.00 , $115.05 , N/A , $18.76 , $18.76 , $104.06 , $124.52 , $164.61 , $159.30 , $159.30 , $141.60 , $141.60 , $18.76 , $163.42 , $168.15 , $159.30 , $159.30 , $159.30 , $164.61 , $169.92 , $122.79 , $150.45 , $120.02 , $66.70 , N/A , $97.12 , $97.12 , $168.15 , $106.13 , $18.76 , $169.92 
Removal Shoulder Foreign Body Deep Subfascial/Im,CPT® 23333,N/A,N/A,N/A," $3,712.00 "," $2,412.80 "," $2,883.66 ", $453.88 , $691.53 ," $2,502.55 "," $2,218.92 "," $3,452.16 "," $3,340.80 "," $3,340.80 "," $2,969.60 "," $2,969.60 ", $691.53 ," $3,427.29 "," $3,526.40 "," $3,340.80 "," $3,340.80 "," $3,340.80 "," $3,452.16 "," $3,563.52 "," $2,685.10 "," $3,155.20 "," $2,542.81 "," $2,662.65 ", N/A ," $2,551.38 "," $2,551.38 "," $3,526.40 "," $2,998.78 ", $453.88 ," $3,563.52 "
"Amputation Toe,I-P Jt",28825,N/A,N/A,N/A," $3,679.00 "," $2,391.35 "," $1,067.04 ", $165.33 , $153.67 ," $1,823.42 "," $1,834.23 "," $3,421.47 "," $3,311.10 "," $3,311.10 "," $2,943.20 "," $2,943.20 ", $153.67 ," $3,396.82 "," $3,495.05 "," $3,311.10 "," $3,311.10 "," $3,311.10 "," $3,421.47 "," $3,531.84 "," $1,000.61 "," $3,127.15 "," $2,003.50 "," $2,152.14 ", N/A ," $1,859.00 "," $1,859.00 "," $3,495.05 "," $2,185.00 ", $153.67 ," $3,531.84 "
 RABIES IMMUNE GLOBULIN 300 UNIT/ML IJ SOLN ,HCPCS 90375,0636 - DRUGS REQUIRING DETAILED CODIN,13533-0318-01,1 mL," $2,000.89 "," $1,300.58 "," $1,680.75 ", $290.37 , $150.22 ," $1,616.72 "," $1,800.80 "," $1,693.95 "," $1,800.80 "," $1,800.80 "," $1,800.80 "," $1,700.76 ", $147.27 ," $1,847.42 "," $1,900.85 "," $1,700.76 "," $1,860.83 "," $1,860.83 "," $1,900.85 "," $1,920.85 "," $1,637.13 "," $1,800.80 "," $1,700.76 "," $1,580.70 ", N/A ," $1,619.32 "," $1,619.32 "," $1,900.85 "," $1,716.96 ", $147.27 ," $1,920.85 "
"Lap,Prostatectomy,Radical,W/Nerve Spare",CPT® 55866,N/A,N/A,N/A," $8,703.00 "," $5,656.95 "," $6,355.67 "," $1,135.10 "," $1,517.93 "," $5,573.43 "," $5,607.41 "," $8,093.79 "," $7,832.70 "," $7,832.70 "," $6,962.40 "," $6,962.40 "," $1,517.93 "," $8,035.48 "," $8,267.85 "," $7,832.70 "," $7,832.70 "," $7,832.70 "," $8,093.79 "," $8,354.88 "," $5,979.13 "," $7,397.55 "," $8,941.73 "," $6,993.52 ", N/A ," $5,682.18 "," $5,682.18 "," $8,267.85 "," $6,810.42 "," $1,135.10 "," $8,941.73 "
"Muscle Test, 4 Limbs",CPT® 95864,N/A,N/A,N/A," $1,494.00 ", $971.10 , $891.56 , $229.90 , $163.63 , $776.77 , $834.55 ," $1,389.42 "," $1,344.60 "," $1,344.60 "," $1,195.20 "," $1,195.20 ", $163.63 ," $1,379.41 "," $1,419.30 "," $1,344.60 "," $1,344.60 "," $1,344.60 "," $1,389.42 "," $1,434.24 "," $1,086.25 "," $1,269.90 ", $728.86 , $945.21 , N/A , $791.93 , $791.93 ," $1,419.30 ", $973.60 , $163.63 ," $1,434.24 "
"Rotavirus Vaccine, Oral",CPT® 90680,N/A,N/A,N/A, $229.00 , $148.85 , N/A , N/A , $15.30 , $166.82 , $173.93 , $212.97 , $206.10 , $206.10 , $183.20 , $183.20 , $15.30 , $211.44 , $217.55 , $206.10 , $206.10 , $206.10 , $212.97 , $219.84 , N/A , $194.65 , $231.13 , $153.11 , N/A , $170.08 , $170.08 , $217.55 , $198.27 , $15.30 , $231.13 
 Pro Computed Tomography Thorax Lw Dose Lng Ca Scr C- ,CPT® 71271,0982 - PRO FEE/OUTPT,N/A,N/A, $517.00 , $336.05 , $975.59 , $140.54 , $115.93 , N/A , N/A , $480.81 , $465.30 , $465.30 , $413.60 , $413.60 , $115.93 , $477.35 , $491.15 , $465.30 , $465.30 , $465.30 , $480.81 , $496.32 , $818.47 , $439.45 , $819.14 ," $1,006.07 ", N/A , $684.12 , $684.12 , $491.15 , $792.15 , $115.93 ," $1,006.07 "
 LITHIUM CARBONATE 300 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00054-8527-25,1 capsule, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Repr Vaginal Prolapse,Uterosacral",CPT® 57283,N/A,N/A,N/A," $4,498.00 "," $2,923.70 "," $3,303.30 ", $668.40 , $601.09 ," $2,806.06 "," $2,799.89 "," $4,183.14 "," $4,048.20 "," $4,048.20 "," $3,598.40 "," $3,598.40 ", $601.09 ," $4,153.00 "," $4,273.10 "," $4,048.20 "," $4,048.20 "," $4,048.20 "," $4,183.14 "," $4,318.08 "," $3,443.81 "," $3,823.30 "," $3,676.96 "," $2,815.30 ", N/A ," $2,860.81 "," $2,860.81 "," $4,273.10 "," $3,431.37 ", $601.09 ," $4,318.08 "
"Nasal/Sinus Scopy,W/Control Nasal Hem",CPT® 31238,N/A,N/A,N/A," $1,849.00 "," $1,201.85 ", $899.99 , $159.58 , $301.25 , $646.92 , $737.47 ," $1,719.57 "," $1,664.10 "," $1,664.10 "," $1,479.20 "," $1,479.20 ", $301.25 ," $1,707.18 "," $1,756.55 "," $1,664.10 "," $1,664.10 "," $1,664.10 "," $1,719.57 "," $1,775.04 ", $861.77 ," $1,571.65 "," $1,040.11 ", $850.29 , N/A , $659.55 , $659.55 ," $1,756.55 ", $776.76 , $159.58 ," $1,775.04 "
 Fac Semen Analysis Strict Morphologic Criteria ,CPT® 89322,0300 - LABORATORY,N/A,N/A, $299.00 , $194.35 , $251.16 , $15.81 , $15.81 , $241.59 , $269.10 , $253.13 , $269.10 , $269.10 , $269.10 , $254.15 , $15.50 , $276.07 , $284.05 , $254.15 , $278.07 , $278.07 , $284.05 , $287.04 , $244.64 , $269.10 , $254.15 , $236.21 , N/A , $241.98 , $241.98 , $284.05 , $256.57 , $15.50 , $287.04 
 BACTERIOSTATIC WATER(BENZ ALC) IJ SOLN ,HCPCS RXA250,0250 - PHARMACY,00409-3977-03,30 mL, $16.68 , $10.84 , $14.01 , N/A , N/A , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , N/A , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $13.18 , $16.01 
 NITROGLYCERIN 0.3 MG SL SUBL ,HCPCS RXC637,0250 - PHARMACY,59762-4921-01,100 tablet, $241.95 , $157.27 , $203.24 , N/A , N/A , $195.50 , $217.76 , $204.83 , $217.76 , $217.76 , $217.76 , $205.66 , N/A , $223.39 , $229.85 , $205.66 , $225.01 , $225.01 , $229.85 , $232.27 , $197.96 , $217.76 , $205.66 , $191.14 , N/A , $195.81 , $195.81 , $229.85 , $207.62 , $191.14 , $232.27 
"Sigmoidoscopy,Diagnostic",CPT® 45330,N/A,N/A,N/A," $1,000.00 ", $650.00 , $342.49 , $53.33 , $68.55 , $303.35 , $313.33 , $930.00 , $900.00 , $900.00 , $800.00 , $800.00 , $68.55 , $923.30 , $950.00 , $900.00 , $900.00 , $900.00 , $930.00 , $960.00 , $243.98 , $850.00 , $342.54 , $325.47 , N/A , $309.28 , $309.28 , $950.00 , $323.46 , $53.33 , $960.00 
 PREDNISONE 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60687-0122-01,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Eye Exam & Treatment,92014,N/A,N/A,N/A, $374.00 , $243.10 , $167.47 , $75.13 , $45.43 , $141.91 , $142.07 , $347.82 , $336.60 , $336.60 , $299.20 , $299.20 , $45.43 , $345.31 , $355.30 , $336.60 , $336.60 , $336.60 , $347.82 , $359.04 , $218.04 , $317.90 , $239.24 , $169.05 , N/A , $144.67 , $144.67 , $355.30 , $172.11 , $45.43 , $359.04 
 Fac Amikacin ,CPT® 80150,0301 - LAB/CHEMISTRY,N/A,N/A, $71.00 , $46.15 , $59.64 , $15.38 , $15.38 , $57.37 , $63.90 , $60.11 , $63.90 , $63.90 , $63.90 , $60.35 , $15.08 , $65.55 , $67.45 , $60.35 , $66.03 , $66.03 , $67.45 , $68.16 , $58.09 , $63.90 , $60.35 , $56.09 , N/A , $57.46 , $57.46 , $67.45 , $60.93 , $15.08 , $68.16 
 Pro Arthrocentesis Aspir&/Inj Major Jt/Bursa W/US ,CPT® 20611,0981 - PRO FEE/ER,N/A,N/A, $525.00 , $341.25 , $362.70 , $56.61 , $71.34 , $294.38 , $303.91 , $488.25 , $472.50 , $472.50 , $420.00 , $420.00 , $71.34 , $484.73 , $498.75 , $472.50 , $472.50 , $472.50 , $488.25 , $504.00 , $341.67 , $446.25 , $316.30 , $351.78 , N/A , $300.12 , $300.12 , $498.75 , $352.75 , $56.61 , $504.00 
 IODINE STRONG 5 % PO SOLN ,HCPCS RXA250,0250 - PHARMACY,48433-0230-15,1 mL, $14.20 , $9.23 , $11.93 , N/A , N/A , $11.47 , $12.78 , $12.02 , $12.78 , $12.78 , $12.78 , $12.07 , N/A , $13.11 , $13.49 , $12.07 , $13.21 , $13.21 , $13.49 , $13.63 , $11.62 , $12.78 , $12.07 , $11.22 , N/A , $11.49 , $11.49 , $13.49 , $12.19 , $11.22 , $13.63 
 Rev Graft W/Nonauto Graft; Femoral Anastomosis ,CPT® 35883,0360 - OR SERVICES,N/A,N/A," $3,156.00 "," $2,051.40 "," $2,651.04 "," $1,064.22 "," $1,040.94 "," $2,550.05 "," $2,840.40 "," $2,671.87 "," $2,840.40 "," $2,840.40 "," $2,840.40 "," $2,682.60 "," $1,020.53 "," $2,913.93 "," $2,998.20 "," $2,682.60 "," $2,935.08 "," $2,935.08 "," $2,998.20 "," $3,029.76 "," $2,582.24 "," $2,840.40 "," $2,682.60 "," $2,493.24 ", N/A ," $2,554.15 "," $2,554.15 "," $2,998.20 "," $2,708.16 "," $1,020.53 "," $3,029.76 "
Albuterol Concentrated Form,HCPCS J7611,N/A,N/A,N/A, $9.00 , $5.85 , N/A , $0.13 , $0.18 , N/A , N/A , $8.37 , $8.10 , $8.10 , $7.20 , $7.20 , $0.18 , $8.31 , $8.55 , $8.10 , $8.10 , $8.10 , $8.37 , $8.64 , $0.34 , $7.65 , $0.65 , $0.35 , N/A , N/A , N/A , $8.55 , N/A , $0.13 , $8.64 
Screening Digital Breast Tomosynthesis Bi,CPT® 77063,N/A,N/A,N/A, $308.00 , $200.20 , $217.43 , $52.04 , $42.90 , $268.72 , $289.82 , $286.44 , $277.20 , $277.20 , $246.40 , $246.40 , $42.90 , $284.38 , $292.60 , $277.20 , $277.20 , $277.20 , $286.44 , $295.68 , $301.25 , $261.80 , $303.10 , $299.38 , N/A , $273.97 , $273.97 , $292.60 , $317.13 , $42.90 , $317.13 
 Gastrointestinal Obstruction With Cc ,MS DRG V40 (FY2023) 389,N/A,N/A,N/A," $15,741.16 "," $10,231.75 "," $13,222.57 ", N/A , N/A ," $12,718.86 "," $14,167.04 "," $13,326.47 "," $14,167.04 "," $14,167.04 "," $14,167.04 "," $13,379.99 ", N/A ," $14,533.81 "," $14,954.10 "," $13,379.99 "," $14,639.28 "," $14,639.28 "," $14,954.10 "," $15,111.51 "," $12,879.42 "," $14,167.04 "," $13,379.99 "," $12,435.52 ", N/A ," $12,739.32 "," $12,739.32 "," $14,954.10 "," $13,507.49 "," $12,435.52 "," $15,111.51 "
"Excis Varicocel,Abd Aprch+Fix Hernia",CPT® 55540,N/A,N/A,N/A," $2,897.00 "," $1,883.05 "," $2,403.63 ", $515.68 , $614.70 ," $1,733.85 "," $1,739.64 "," $2,694.21 "," $2,607.30 "," $2,607.30 "," $2,317.60 "," $2,317.60 ", $614.70 ," $2,674.80 "," $2,752.15 "," $2,607.30 "," $2,607.30 "," $2,607.30 "," $2,694.21 "," $2,781.12 "," $2,241.60 "," $2,462.45 "," $2,852.72 "," $2,558.42 ", N/A ," $1,767.68 "," $1,767.68 "," $2,752.15 "," $2,118.66 ", $515.68 ," $2,852.72 "
Ionm Remote/Nearby/>1 Patient in or per Hour,CPT® 95941,N/A,N/A,N/A, $987.00 , $641.55 , N/A , N/A , $99.59 , N/A , N/A , $917.91 , $888.30 , $888.30 , $789.60 , $789.60 , $99.59 , $911.30 , $937.65 , $888.30 , $888.30 , $888.30 , $917.91 , $947.52 , N/A , $838.95 , $789.60 , N/A , N/A , N/A , N/A , $937.65 , N/A , $99.59 , $947.52 
"Remv Kidney,W/Rib Resection",CPT® 50220,N/A,N/A,N/A," $7,217.00 "," $4,691.05 "," $5,646.90 ", $991.61 ," $1,530.21 "," $5,090.30 "," $4,739.82 "," $6,711.81 "," $6,495.30 "," $6,495.30 "," $5,773.60 "," $5,773.60 "," $1,530.21 "," $6,663.46 "," $6,856.15 "," $6,495.30 "," $6,495.30 "," $6,495.30 "," $6,711.81 "," $6,928.32 "," $5,649.69 "," $6,134.45 "," $5,407.50 "," $6,373.03 ", N/A ," $5,189.62 "," $5,189.62 "," $6,856.15 "," $6,099.66 ", $991.61 ," $6,928.32 "
 ACYCLOVIR SODIUM 50 MG/ML IV SOLN ,HCPCS J0133,0636 - DRUGS REQUIRING DETAILED CODIN,55150-0154-10,10 mL, $82.19 , $53.42 , $69.04 , $0.05 , $0.05 , $66.41 , $73.97 , $69.58 , $73.97 , $73.97 , $73.97 , $69.86 , $0.05 , $75.89 , $78.08 , $69.86 , $76.44 , $76.44 , $78.08 , $78.90 , $67.25 , $73.97 , $69.86 , $64.93 , N/A , $66.52 , $66.52 , $78.08 , $70.53 , $0.05 , $78.90 
Injection Enzyme Palmar Fascial Cord,CPT® 20527,N/A,N/A,N/A, $313.00 , $203.45 , $394.42 , $61.91 , $58.38 , $321.09 , $289.81 , $291.09 , $281.70 , $281.70 , $250.40 , $250.40 , $58.38 , $288.99 , $297.35 , $281.70 , $281.70 , $281.70 , $291.09 , $300.48 , $367.40 , $266.05 , $317.56 , $377.76 , N/A , $327.35 , $327.35 , $297.35 , $384.77 , $58.38 , $394.42 
 Fac Rmvl Impltable Contraceptive Capsls ,CPT® 11976,0361 - OR/MINOR,N/A,N/A, $429.00 , $278.85 , $360.36 , $87.33 , N/A , $346.63 , $386.10 , $363.19 , $386.10 , $386.10 , $386.10 , $364.65 , N/A , $396.10 , $407.55 , $364.65 , $398.97 , $398.97 , $407.55 , $411.84 , $351.01 , $386.10 , $364.65 , $338.91 , N/A , $347.19 , $347.19 , $407.55 , $368.12 , $87.33 , $411.84 
Lens Sphcy Trifocal 4.0/2.25,HCPCS V2304,N/A,N/A,N/A, $90.00 , $58.50 , N/A , $81.21 , N/A , N/A , N/A , $83.70 , $81.00 , $81.00 , $72.00 , $72.00 , N/A , $83.10 , $85.50 , $81.00 , $81.00 , $81.00 , $83.70 , $86.40 , N/A , $76.50 , $90.00 , $73.79 , N/A , N/A , N/A , $85.50 , N/A , $72.00 , $90.00 
"Knee Scope,Clean/Drain",CPT® 29871,N/A,N/A,N/A," $3,549.00 "," $2,306.85 "," $3,138.79 ", $493.81 , $604.11 ," $2,483.32 "," $2,481.44 "," $3,300.57 "," $3,194.10 "," $3,194.10 "," $2,839.20 "," $2,839.20 ", $604.11 ," $3,276.79 "," $3,371.55 "," $3,194.10 "," $3,194.10 "," $3,194.10 "," $3,300.57 "," $3,407.04 "," $2,916.25 "," $3,016.65 "," $2,736.75 "," $2,931.30 ", N/A ," $2,531.78 "," $2,531.78 "," $3,371.55 "," $2,975.72 ", $493.81 ," $3,407.04 "
Grafting of Autologous Fat by Lipo Ea Addl 50 Cc,CPT® 15772,N/A,N/A,N/A," $1,486.00 ", $965.90 , $464.64 , $139.13 , $140.96 , $376.34 , N/A ," $1,381.98 "," $1,337.40 "," $1,337.40 "," $1,188.80 "," $1,188.80 ", $140.96 ," $1,372.02 "," $1,411.70 "," $1,337.40 "," $1,337.40 "," $1,337.40 "," $1,381.98 "," $1,426.56 ", $481.51 ," $1,263.10 ", $781.85 , $488.16 , N/A , $383.68 , $383.68 ," $1,411.70 ", $445.26 , $139.13 ," $1,426.56 "
"Rep Tendon, Central Slip",26426,N/A,N/A,N/A," $2,898.00 "," $1,883.70 "," $3,093.61 ", $487.06 , $480.44 ," $2,409.70 "," $2,410.15 "," $2,695.14 "," $2,608.20 "," $2,608.20 "," $2,318.40 "," $2,318.40 ", $480.44 ," $2,675.72 "," $2,753.10 "," $2,608.20 "," $2,608.20 "," $2,608.20 "," $2,695.14 "," $2,782.08 "," $2,870.76 "," $2,463.30 "," $2,651.12 "," $2,859.63 ", N/A ," $2,456.71 "," $2,456.71 "," $2,753.10 "," $2,887.52 ", $480.44 ," $3,093.61 "
"Insert Cannula,Vein-Vein",CPT® 36800,N/A,N/A,N/A," $1,817.00 "," $1,181.05 ", $746.01 , $114.39 , $148.04 , $536.47 , $711.48 ," $1,689.81 "," $1,635.30 "," $1,635.30 "," $1,453.60 "," $1,453.60 ", $148.04 ," $1,677.64 "," $1,726.15 "," $1,635.30 "," $1,635.30 "," $1,635.30 "," $1,689.81 "," $1,744.32 ", $689.35 ," $1,544.45 ", $881.33 , $606.90 , N/A , $546.94 , $546.94 ," $1,726.15 ", $621.33 , $114.39 ," $1,744.32 "
 Fac Collj Capillary Bld Spec ,CPT® 36416,0300 - LABORATORY,N/A,N/A, $35.00 , $22.75 , $29.40 , N/A , $3.09 , $28.28 , $31.50 , $29.63 , $31.50 , $31.50 , $31.50 , $29.75 , $3.03 , $32.32 , $33.25 , $29.75 , $32.55 , $32.55 , $33.25 , $33.60 , $28.64 , $31.50 , $29.75 , $27.65 , N/A , $28.33 , $28.33 , $33.25 , $30.03 , $3.03 , $33.60 
Egd Flexible Foreign Body Removal,43247,N/A,N/A,N/A," $2,315.00 "," $1,504.75 "," $1,081.54 ", $167.00 , $186.68 , $894.33 , $972.62 ," $2,152.95 "," $2,083.50 "," $2,083.50 "," $1,852.00 "," $1,852.00 ", $186.68 ," $2,137.44 "," $2,199.25 "," $2,083.50 "," $2,083.50 "," $2,083.50 "," $2,152.95 "," $2,222.40 ", $777.60 ," $1,967.75 "," $1,066.87 "," $1,032.34 ", N/A , $911.79 , $911.79 ," $2,199.25 ", $953.64 , $167.00 ," $2,222.40 "
"Lap,Tubal Cautery",CPT® 58670,N/A,N/A,N/A," $2,349.00 "," $1,526.85 "," $1,759.60 ", $356.00 , $330.69 ," $1,484.06 "," $1,487.92 "," $2,184.57 "," $2,114.10 "," $2,114.10 "," $1,879.20 "," $1,879.20 ", $330.69 ," $2,168.83 "," $2,231.55 "," $2,114.10 "," $2,114.10 "," $2,114.10 "," $2,184.57 "," $2,255.04 "," $1,834.25 "," $1,996.65 "," $1,957.12 "," $1,488.80 ", N/A ," $1,513.02 "," $1,513.02 "," $2,231.55 "," $1,814.79 ", $330.69 ," $2,255.04 "
 VENELEX EX OINT ,HCPCS RXC637,0250 - PHARMACY,58980-0780-21,60 gram, $407.46 , $264.85 , $342.27 , N/A , N/A , $329.23 , $366.71 , $344.96 , $366.71 , $366.71 , $366.71 , $346.34 , N/A , $376.21 , $387.09 , $346.34 , $378.94 , $378.94 , $387.09 , $391.16 , $333.38 , $366.71 , $346.34 , $321.89 , N/A , $329.76 , $329.76 , $387.09 , $349.64 , $321.89 , $391.16 
 VANCOMYCIN HCL 1 G IV SOLR ,HCPCS J3371,0636 - DRUGS REQUIRING DETAILED CODIN,72611-0765-10,20 mL, $36.93 , $24.00 , $31.02 , $6.43 , $6.66 , $29.84 , $33.24 , $31.26 , $33.24 , $33.24 , $33.24 , $31.39 , $6.53 , $34.10 , $35.08 , $31.39 , $34.34 , $34.34 , $35.08 , $35.45 , $30.22 , $33.24 , $31.39 , $29.17 , N/A , $29.89 , $29.89 , $35.08 , $31.69 , $6.43 , $35.45 
 LEVONORGESTREL 1.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,68180-0852-11,1 tablet, $187.81 , $122.08 , $157.76 , N/A , N/A , $151.75 , $169.03 , $159.00 , $169.03 , $169.03 , $169.03 , $159.64 , N/A , $173.40 , $178.42 , $159.64 , $174.66 , $174.66 , $178.42 , $180.30 , $153.67 , $169.03 , $159.64 , $148.37 , N/A , $151.99 , $151.99 , $178.42 , $161.16 , $148.37 , $180.30 
 MEGESTROL ACETATE 20 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00555-0606-02,1 tablet, $5.35 , $3.48 , $4.49 , N/A , N/A , $4.32 , $4.82 , $4.53 , $4.82 , $4.82 , $4.82 , $4.55 , N/A , $4.94 , $5.08 , $4.55 , $4.98 , $4.98 , $5.08 , $5.14 , $4.38 , $4.82 , $4.55 , $4.23 , N/A , $4.33 , $4.33 , $5.08 , $4.59 , $4.23 , $5.14 
 Pro Trim Nail(S) ,CPT® 11719,0982 - PRO FEE/OUTPT,N/A,N/A, $83.00 , $53.95 , $24.79 , $7.29 , $16.74 , $21.53 , $20.21 , $77.19 , $74.70 , $74.70 , $66.40 , $66.40 , $16.74 , $76.63 , $78.85 , $74.70 , $74.70 , $74.70 , $77.19 , $79.68 , $27.34 , $70.55 , $39.25 , $27.63 , N/A , $21.94 , $21.94 , $78.85 , $25.46 , $7.29 , $79.68 
 Fac Dstr Nrolytc Agnt Parverteb Fct Addl Crvcl/Thora ,CPT® 64634,0360 - OR SERVICES,N/A,N/A, $608.00 , $395.20 , $510.72 , $64.33 , $161.82 , $491.26 , $547.20 , $514.73 , $547.20 , $547.20 , $547.20 , $516.80 , $158.65 , $561.37 , $577.60 , $516.80 , $565.44 , $565.44 , $577.60 , $583.68 , $497.47 , $547.20 , $516.80 , $480.32 , N/A , $492.05 , $492.05 , $577.60 , $521.72 , $64.33 , $583.68 
 OB Limited 1 or More Fetuses US ,CPT® 76815,0402 - ULTRASOUND,N/A,N/A, $442.00 , $287.30 , $371.28 , $80.48 , $87.65 , $357.14 , $397.80 , $374.20 , $397.80 , $397.80 , $397.80 , $375.70 , $85.93 , $408.10 , $419.90 , $375.70 , $411.06 , $411.06 , $419.90 , $424.32 , $361.64 , $397.80 , $375.70 , $349.18 , N/A , $357.71 , $357.71 , $419.90 , $379.28 , $80.48 , $424.32 
"Exc Skin Malig 1.1-2cm Face,Facial",CPT® 11642,N/A,N/A,N/A," $1,514.00 ", $984.10 , $582.11 , $174.71 , $228.52 , $502.44 , $491.79 ," $1,408.02 "," $1,362.60 "," $1,362.60 "," $1,211.20 "," $1,211.20 ", $228.52 ," $1,397.88 "," $1,438.30 "," $1,362.60 "," $1,362.60 "," $1,362.60 "," $1,408.02 "," $1,453.44 ", $637.97 ," $1,286.90 ", $977.67 , $643.58 , N/A , $512.24 , $512.24 ," $1,438.30 ", $594.04 , $174.71 ," $1,453.44 "
Cytopath C/V Auto Fluid Redo,CPT® 88175,N/A,N/A,N/A, $244.00 , $158.60 , N/A , $27.14 , $27.14 , $147.59 , $225.75 , $226.92 , $219.60 , $219.60 , $195.20 , $195.20 , $27.14 , $225.29 , $231.80 , $219.60 , $219.60 , $219.60 , $226.92 , $234.24 , $177.68 , $207.40 , $173.54 , $115.79 , N/A , $137.74 , $137.74 , $231.80 , $151.37 , $27.14 , $234.24 
"Preventive Visit,Est,18-39",CPT® 99395,N/A,N/A,N/A, $356.00 , $231.40 , N/A , $113.89 , $62.20 , $190.81 , $192.22 , $331.08 , $320.40 , $320.40 , $284.80 , $284.80 , $62.20 , $328.69 , $338.20 , $320.40 , $320.40 , $320.40 , $331.08 , $341.76 , $236.26 , $302.60 , $192.03 , $190.54 , N/A , $194.54 , $194.54 , $338.20 , $233.67 , $62.20 , $341.76 
 Pro Rmvl FB Foot Subq ,CPT® 28190,0981 - PRO FEE/ER,N/A,N/A, $961.00 , $624.65 , $821.41 , $128.35 , $42.71 , $660.87 , $659.35 , $893.73 , $864.90 , $864.90 , $768.80 , $768.80 , $42.71 , $887.29 , $912.95 , $864.90 , $864.90 , $864.90 , $893.73 , $922.56 , $767.83 , $816.85 , $713.63 , $787.33 , N/A , $673.77 , $673.77 , $912.95 , $791.93 , $42.71 , $922.56 
Genetic Testing for Severe Inherited Conditions,CPT® 81443,N/A,N/A,N/A," $11,164.00 "," $7,256.60 ", N/A ," $2,497.53 ", N/A ," $10,179.77 ", N/A ," $10,382.52 "," $10,047.60 "," $10,047.60 "," $8,931.20 "," $8,931.20 ", N/A ," $10,307.72 "," $10,605.80 "," $10,047.60 "," $10,047.60 "," $10,047.60 "," $10,382.52 "," $10,717.44 "," $16,349.58 "," $9,489.40 "," $11,672.66 "," $7,191.42 ", N/A ," $9,500.41 "," $9,500.41 "," $10,605.80 "," $10,381.89 "," $2,497.53 "," $16,349.58 "
 FLUMAZENIL 0.5 MG/5ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00143-9784-10,5 mL, $41.74 , $27.13 , $35.06 , N/A , N/A , $33.73 , $37.57 , $35.34 , $37.57 , $37.57 , $37.57 , $35.48 , N/A , $38.54 , $39.65 , $35.48 , $38.82 , $38.82 , $39.65 , $40.07 , $34.15 , $37.57 , $35.48 , $32.97 , N/A , $33.78 , $33.78 , $39.65 , $35.82 , $32.97 , $40.07 
" Aftercare, Musculoskeletal System And Connective Tissue With McC ",MS DRG V40 (FY2023) 559,N/A,N/A,N/A," $10,736.43 "," $6,978.68 "," $9,018.60 ", N/A , N/A ," $8,675.04 "," $9,662.79 "," $9,089.46 "," $9,662.79 "," $9,662.79 "," $9,662.79 "," $9,125.97 ", N/A ," $9,912.95 "," $10,199.61 "," $9,125.97 "," $9,984.88 "," $9,984.88 "," $10,199.61 "," $10,306.97 "," $8,784.55 "," $9,662.79 "," $9,125.97 "," $8,481.78 ", N/A ," $8,688.99 "," $8,688.99 "," $10,199.61 "," $9,212.93 "," $8,481.78 "," $10,306.97 "
" Fac Blood Serology, Qualitative ",CPT® 86592,0302 - LAB/IMMUNOLOGY,N/A,N/A, $59.00 , $38.35 , $49.56 , $4.36 , $4.36 , $47.67 , $53.10 , $49.95 , $53.10 , $53.10 , $53.10 , $50.15 , $4.27 , $54.47 , $56.05 , $50.15 , $54.87 , $54.87 , $56.05 , $56.64 , $48.27 , $53.10 , $50.15 , $46.61 , N/A , $47.75 , $47.75 , $56.05 , $50.63 , $4.27 , $56.64 
"Adj Tiss Xfer Scalp,Extrem 10.1-30",CPT® 14021,N/A,N/A,N/A," $4,360.00 "," $2,834.00 "," $2,261.44 ", $679.65 , $640.60 ," $1,962.55 "," $1,932.02 "," $4,054.80 "," $3,924.00 "," $3,924.00 "," $3,488.00 "," $3,488.00 ", $640.60 ," $4,025.59 "," $4,142.00 "," $3,924.00 "," $3,924.00 "," $3,924.00 "," $4,054.80 "," $4,185.60 "," $2,475.57 "," $3,706.00 "," $3,850.01 "," $2,514.00 ", N/A ," $2,000.85 "," $2,000.85 "," $4,142.00 "," $2,320.31 ", $640.60 ," $4,185.60 "
"Ureter Endoscopy,W Ureteral Cath",CPT® 50972,N/A,N/A,N/A," $2,499.00 "," $1,624.35 "," $1,920.27 ", $337.01 , $210.32 ," $1,759.49 "," $1,627.72 "," $2,324.07 "," $2,249.10 "," $2,249.10 "," $1,999.20 "," $1,999.20 ", $210.32 ," $2,307.33 "," $2,374.05 "," $2,249.10 "," $2,249.10 "," $2,249.10 "," $2,324.07 "," $2,399.04 "," $1,929.17 "," $2,124.15 "," $1,844.72 "," $2,206.47 ", N/A ," $1,793.82 "," $1,793.82 "," $2,374.05 "," $2,108.36 ", $210.32 ," $2,399.04 "
"Laparoscopy,Surg,Colpopexy",CPT® 57425,N/A,N/A,N/A," $5,782.00 "," $3,758.30 "," $4,594.10 ", $927.61 , $902.02 ," $3,952.99 "," $3,932.72 "," $5,377.26 "," $5,203.80 "," $5,203.80 "," $4,625.60 "," $4,625.60 ", $902.02 ," $5,338.52 "," $5,492.90 "," $5,203.80 "," $5,203.80 "," $5,203.80 "," $5,377.26 "," $5,550.72 "," $4,804.17 "," $4,914.70 "," $5,154.16 "," $3,976.90 ", N/A ," $4,030.11 "," $4,030.11 "," $5,492.90 "," $4,833.87 ", $902.02 ," $5,550.72 "
 BACLOFEN 10 MG/20ML IT SOLN ,HCPCS J0475,0636 - DRUGS REQUIRING DETAILED CODIN,70121-2501-01,20 mL," $1,456.62 ", $946.80 ," $1,223.56 ", $186.14 , $189.64 ," $1,176.95 "," $1,310.96 "," $1,233.17 "," $1,310.96 "," $1,310.96 "," $1,310.96 "," $1,238.13 ", $185.92 ," $1,344.90 "," $1,383.79 "," $1,238.13 "," $1,354.66 "," $1,354.66 "," $1,383.79 "," $1,398.36 "," $1,191.81 "," $1,310.96 "," $1,238.13 "," $1,150.73 ", N/A ," $1,178.84 "," $1,178.84 "," $1,383.79 "," $1,249.93 ", $185.92 ," $1,398.36 "
Transcatheter Biopsy,CPT® 37200,N/A,N/A,N/A," $1,363.00 ", $885.95 ," $1,315.67 ", $202.98 , $231.08 , $980.75 , $958.62 ," $1,267.59 "," $1,226.70 "," $1,226.70 "," $1,090.40 "," $1,090.40 ", $231.08 ," $1,258.46 "," $1,294.85 "," $1,226.70 "," $1,226.70 "," $1,226.70 "," $1,267.59 "," $1,308.48 "," $1,226.98 "," $1,158.55 "," $1,163.21 "," $1,105.86 ", N/A , $999.89 , $999.89 ," $1,294.85 "," $1,135.87 ", $202.98 ," $1,315.67 "
 CT Limited Sinus Without Contrast ,CPT® 70486,0350 - CT SCAN,N/A,N/A," $1,981.00 "," $1,287.65 "," $1,664.04 ", $131.06 , $247.43 ," $1,600.65 "," $1,782.90 "," $1,677.11 "," $1,782.90 "," $1,782.90 "," $1,782.90 "," $1,683.85 ", $242.58 ," $1,829.06 "," $1,881.95 "," $1,683.85 "," $1,842.33 "," $1,842.33 "," $1,881.95 "," $1,901.76 "," $1,620.85 "," $1,782.90 "," $1,683.85 "," $1,564.99 ", N/A ," $1,603.22 "," $1,603.22 "," $1,881.95 "," $1,699.90 ", $131.06 ," $1,901.76 "
 Reposition Gastric Feeding Tube Into Duoden ,CPT® 43761,0360 - OR SERVICES,N/A,N/A," $1,071.00 ", $696.15 , $899.64 , $97.25 , $114.19 , $865.37 , $963.90 , $906.71 , $963.90 , $963.90 , $963.90 , $910.35 , $111.95 , $988.85 ," $1,017.45 ", $910.35 , $996.03 , $996.03 ," $1,017.45 "," $1,028.16 ", $876.29 , $963.90 , $910.35 , $846.09 , N/A , $866.76 , $866.76 ," $1,017.45 ", $919.03 , $97.25 ," $1,028.16 "
 ENALAPRILAT 1.25 MG/ML IV INJ ,HCPCS RXA250,0250 - PHARMACY,00143-9787-10,1 mL, $32.73 , $21.27 , $27.49 , N/A , N/A , $26.45 , $29.46 , $27.71 , $29.46 , $29.46 , $29.46 , $27.82 , N/A , $30.22 , $31.09 , $27.82 , $30.44 , $30.44 , $31.09 , $31.42 , $26.78 , $29.46 , $27.82 , $25.86 , N/A , $26.49 , $26.49 , $31.09 , $28.09 , $25.86 , $31.42 
Fix Non/Malunion Femur Below Neck,CPT® 27470,N/A,N/A,N/A," $7,752.00 "," $5,038.80 "," $7,124.20 "," $1,115.76 "," $1,035.39 "," $5,676.79 "," $5,635.05 "," $7,209.36 "," $6,976.80 "," $6,976.80 "," $6,201.60 "," $6,201.60 "," $1,035.39 "," $7,157.42 "," $7,364.40 "," $6,976.80 "," $6,976.80 "," $6,976.80 "," $7,209.36 "," $7,441.92 "," $6,631.31 "," $6,589.20 "," $6,233.52 "," $6,683.19 ", N/A ," $5,787.56 "," $5,787.56 "," $7,364.40 "," $6,802.42 "," $1,035.39 "," $7,441.92 "
Removal Intact Breast Implant,CPT® 19328,N/A,N/A,N/A," $3,268.00 "," $2,124.20 "," $1,762.08 ", $528.27 , $427.06 ," $1,346.50 "," $1,325.26 "," $3,039.24 "," $2,941.20 "," $2,941.20 "," $2,614.40 "," $2,614.40 ", $427.06 ," $3,017.34 "," $3,104.60 "," $2,941.20 "," $2,941.20 "," $2,941.20 "," $3,039.24 "," $3,137.28 "," $1,930.87 "," $2,777.80 "," $2,658.26 "," $1,725.00 ", N/A ," $1,372.77 "," $1,372.77 "," $3,104.60 "," $1,591.97 ", $427.06 ," $3,137.28 "
"Excis Conjunc Lesn,>1 Cm",CPT® 68115,N/A,N/A,N/A," $3,078.00 "," $2,000.70 "," $1,123.33 ", $176.65 , $109.97 ," $1,043.19 ", $970.32 ," $2,862.54 "," $2,770.20 "," $2,770.20 "," $2,462.40 "," $2,462.40 ", $109.97 ," $2,841.92 "," $2,924.10 "," $2,770.20 "," $2,770.20 "," $2,770.20 "," $2,862.54 "," $2,954.88 "," $1,541.86 "," $2,616.30 ", $995.51 ," $1,323.12 ", N/A ," $1,063.55 "," $1,063.55 "," $2,924.10 "," $1,174.02 ", $109.97 ," $2,954.88 "
 Sialogram ,CPT® 70390,0320 - DX X-RAY,N/A,N/A, $608.00 , $395.20 , $510.72 , $116.57 , $90.84 , $491.26 , $547.20 , $514.73 , $547.20 , $547.20 , $547.20 , $516.80 , $89.06 , $561.37 , $577.60 , $516.80 , $565.44 , $565.44 , $577.60 , $583.68 , $497.47 , $547.20 , $516.80 , $480.32 , N/A , $492.05 , $492.05 , $577.60 , $521.72 , $89.06 , $583.68 
 Fac Ercp Destruction/Lithotripsy Calculi Any Method ,CPT® 43265,0360 - OR SERVICES,N/A,N/A," $5,589.00 "," $3,632.85 "," $4,694.76 ", $409.42 , $471.21 ," $4,515.91 "," $5,030.10 "," $4,731.65 "," $5,030.10 "," $5,030.10 "," $5,030.10 "," $4,750.65 ", $461.97 ," $5,160.32 "," $5,309.55 "," $4,750.65 "," $5,197.77 "," $5,197.77 "," $5,309.55 "," $5,365.44 "," $4,572.92 "," $5,030.10 "," $4,750.65 "," $4,415.31 ", N/A ," $4,523.18 "," $4,523.18 "," $5,309.55 "," $4,795.92 ", $409.42 ," $5,365.44 "
Remove Eyelid Lesn (Not Chalazion),67840,N/A,N/A,N/A," $2,601.00 "," $1,690.65 ", $967.33 , $152.02 , $78.75 , $897.04 , $841.30 ," $2,418.93 "," $2,340.90 "," $2,340.90 "," $2,080.80 "," $2,080.80 ", $78.75 ," $2,401.50 "," $2,470.95 "," $2,340.90 "," $2,340.90 "," $2,340.90 "," $2,418.93 "," $2,496.96 "," $1,326.31 "," $2,210.85 ", $867.06 ," $1,135.98 ", N/A , $914.53 , $914.53 ," $2,470.95 "," $1,009.55 ", $78.75 ," $2,496.96 "
Colonoscopy Ca Scrn Not Hi Rsk Ind,G0121,N/A,N/A,N/A," $1,932.00 "," $1,255.80 "," $2,171.85 ", $174.48 , $351.69 , $373.81 , N/A ," $1,796.76 "," $1,738.80 "," $1,738.80 "," $1,545.60 "," $1,545.60 ", $351.69 ," $1,783.82 "," $1,835.40 "," $1,738.80 "," $1,738.80 "," $1,738.80 "," $1,796.76 "," $1,854.72 ", $813.49 ," $1,642.20 ", $420.39 ," $1,074.52 ", N/A , $381.10 , $381.10 ," $1,835.40 ", $476.38 , $174.48 ," $2,171.85 "
 Pro Online Digital E/M Svc Est Pt <7 D 21+ Minutes ,CPT® 99423,0982 - PRO FEE/OUTPT,N/A,N/A, $131.00 , $85.15 , $82.93 , $39.14 , $38.33 , $72.11 , N/A , $121.83 , $117.90 , $117.90 , $104.80 , $104.80 , $38.33 , $120.95 , $124.45 , $117.90 , $117.90 , $117.90 , $121.83 , $125.76 , $74.68 , $111.35 , $88.91 , $92.45 , N/A , $73.52 , $73.52 , $124.45 , $84.40 , $38.33 , $125.76 
 Pro Exc Chalazion 1 ,CPT® 67800,0982 - PRO FEE/OUTPT,N/A,N/A, $968.00 , $629.20 , $629.59 , $98.86 , $67.40 , $584.99 , $551.22 , $900.24 , $871.20 , $871.20 , $774.40 , $774.40 , $67.40 , $893.75 , $919.60 , $871.20 , $871.20 , $871.20 , $900.24 , $929.28 , $869.30 , $822.80 , $569.12 , $744.29 , N/A , $596.41 , $596.41 , $919.60 , $658.35 , $67.40 , $929.28 
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas,CPT® 78014,N/A,N/A,N/A," $2,424.00 "," $1,575.60 "," $1,274.32 ", $218.24 , $190.86 ," $1,183.50 "," $1,255.61 "," $2,254.32 "," $2,181.60 "," $2,181.60 "," $1,939.20 "," $1,939.20 ", $190.86 ," $2,238.08 "," $2,302.80 "," $2,181.60 "," $2,181.60 "," $2,181.60 "," $2,254.32 "," $2,327.04 "," $1,322.17 "," $2,060.40 "," $1,373.27 "," $1,623.69 ", N/A ," $1,206.60 "," $1,206.60 "," $2,302.80 "," $1,396.65 ", $190.86 ," $2,327.04 "
 Cytopath Concentration Smrs&Interpj ,CPT® 88108,0310 - PATHOLOGY LAB,N/A,N/A, $260.00 , $169.00 , $218.40 , $65.00 , $38.28 , $210.08 , $234.00 , $220.12 , $234.00 , $234.00 , $234.00 , $221.00 , $37.53 , $240.06 , $247.00 , $221.00 , $241.80 , $241.80 , $247.00 , $249.60 , $212.73 , $234.00 , $221.00 , $205.40 , N/A , $210.42 , $210.42 , $247.00 , $223.11 , $37.53 , $249.60 
"Remv Vert Body,Cerv,One Sgmt",CPT® 63081,N/A,N/A,N/A," $11,538.00 "," $7,499.70 "," $8,176.74 "," $1,596.75 "," $1,515.75 "," $9,554.43 "," $9,215.33 "," $10,730.34 "," $10,384.20 "," $10,384.20 "," $9,230.40 "," $9,230.40 "," $1,515.75 "," $10,653.04 "," $10,961.10 "," $10,384.20 "," $10,384.20 "," $10,384.20 "," $10,730.34 "," $11,076.48 "," $8,844.45 "," $9,807.30 "," $9,380.61 "," $10,018.34 ", N/A ," $9,740.86 "," $9,740.86 "," $10,961.10 "," $10,449.63 "," $1,515.75 "," $11,076.48 "
Iaadiadoo Respiratory Synctial Virus,CPT® 87807,N/A,N/A,N/A, $120.00 , $78.00 , N/A , $13.36 , $13.36 , $67.85 , $81.18 , $111.60 , $108.00 , $108.00 , $96.00 , $96.00 , $13.36 , $110.80 , $114.00 , $108.00 , $108.00 , $108.00 , $111.60 , $115.20 , $87.47 , $102.00 , $77.85 , $43.47 , N/A , $63.32 , $63.32 , $114.00 , $69.20 , $13.36 , $115.20 
 ACYCLOVIR 200 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-5789-61,1 capsule, $7.86 , $5.11 , $6.60 , N/A , N/A , $6.35 , $7.07 , $6.65 , $7.07 , $7.07 , $7.07 , $6.68 , N/A , $7.26 , $7.47 , $6.68 , $7.31 , $7.31 , $7.47 , $7.55 , $6.43 , $7.07 , $6.68 , $6.21 , N/A , $6.36 , $6.36 , $7.47 , $6.74 , $6.21 , $7.55 
 Fac Rickettsia Antibody ,CPT® 86757,0302 - LAB/IMMUNOLOGY,N/A,N/A, $175.00 , $113.75 , $147.00 , $19.74 , $19.74 , $141.40 , $157.50 , $148.16 , $157.50 , $157.50 , $157.50 , $148.75 , $19.35 , $161.58 , $166.25 , $148.75 , $162.75 , $162.75 , $166.25 , $168.00 , $143.19 , $157.50 , $148.75 , $138.25 , N/A , $141.63 , $141.63 , $166.25 , $150.17 , $19.35 , $168.00 
 Closed Rx Navic/Lunate Fx/Disloc ,CPT® 25680,0761 - TREATMENT ROOM,N/A,N/A," $4,760.00 "," $3,094.00 "," $3,998.40 ", $513.71 , $384.19 ," $3,846.08 "," $4,284.00 "," $4,029.82 "," $4,284.00 "," $4,284.00 "," $4,284.00 "," $4,046.00 ", $376.66 ," $4,394.91 "," $4,522.00 "," $4,046.00 "," $4,426.80 "," $4,426.80 "," $4,522.00 "," $4,569.60 "," $3,894.63 "," $4,284.00 "," $4,046.00 "," $3,760.40 ", N/A ," $3,852.27 "," $3,852.27 "," $4,522.00 "," $4,084.56 ", $376.66 ," $4,569.60 "
 Fac Tc99m Tetrofosmin ,HCPCS A9502,0343 - DIAGNOSTIC RADIOPHARMACEUTICALS,N/A,N/A, $142.00 , $92.30 , $119.28 , N/A , $139.54 , $114.74 , $127.80 , $120.22 , $127.80 , $127.80 , $127.80 , $120.70 , $136.80 , $131.11 , $134.90 , $120.70 , $132.06 , $132.06 , $134.90 , $136.32 , $116.18 , $127.80 , $120.70 , $112.18 , N/A , $114.92 , $114.92 , $134.90 , $121.85 , $112.18 , $139.54 
"Lap, Incisional Hernia Repair,Incarcerated",CPT® 49655,N/A,N/A,N/A," $8,000.00 "," $5,200.00 "," $6,164.08 ", N/A , N/A ," $4,843.58 "," $4,674.14 "," $7,440.00 "," $7,200.00 "," $7,200.00 "," $6,400.00 "," $6,400.00 ", N/A ," $7,386.40 "," $7,600.00 "," $7,200.00 "," $7,200.00 "," $7,200.00 "," $7,440.00 "," $7,680.00 "," $4,412.91 "," $6,800.00 ", N/A ," $5,714.10 ", N/A , N/A , N/A ," $7,600.00 ", N/A ," $4,412.91 "," $7,680.00 "
 Pro Exc Tr-Ext B9+Marg 3.1-4 Cm ,CPT® 11404,0982 - PRO FEE/OUTPT,N/A,N/A," $1,117.00 ", $726.05 , $522.78 , $157.18 , $175.90 , $439.00 , $431.68 ," $1,038.81 "," $1,005.30 "," $1,005.30 ", $893.60 , $893.60 , $175.90 ," $1,031.33 "," $1,061.15 "," $1,005.30 "," $1,005.30 "," $1,005.30 "," $1,038.81 "," $1,072.32 ", $569.24 , $949.45 , $863.49 , $563.64 , N/A , $447.56 , $447.56 ," $1,061.15 ", $519.02 , $157.18 ," $1,072.32 "
Blood Ph,CPT® 82800,N/A,N/A,N/A, $90.00 , $58.50 , N/A , $11.22 , $11.22 , $47.85 , $57.25 , $83.70 , $81.00 , $81.00 , $72.00 , $72.00 , $11.22 , $83.10 , $85.50 , $81.00 , $81.00 , $81.00 , $83.70 , $86.40 , $73.45 , $76.50 , $55.14 , $32.31 , N/A , $44.66 , $44.66 , $85.50 , $48.80 , $11.22 , $86.40 
 Ankle Min 3vw Bil- Mh ,CPT® 73610,0972 - PRO FEE/RAD/DX,N/A,N/A, $105.00 , $68.25 , $207.35 , $36.30 , $30.19 , $148.21 , $178.47 , $97.65 , $94.50 , $94.50 , $84.00 , $84.00 , $30.19 , $96.95 , $99.75 , $94.50 , $94.50 , $94.50 , $97.65 , $100.80 , $200.91 , $89.25 , $196.46 , $158.47 , N/A , $151.10 , $151.10 , $99.75 , $174.91 , $30.19 , $207.35 
"Fix Ectropion,Excis Tarsal Wedge",CPT® 67916,N/A,N/A,N/A," $5,573.00 "," $3,622.45 "," $2,639.26 ", $414.53 , $461.04 ," $2,437.92 "," $2,299.11 "," $5,182.89 "," $5,015.70 "," $5,015.70 "," $4,458.40 "," $4,458.40 ", $461.04 ," $5,145.55 "," $5,294.35 "," $5,015.70 "," $5,015.70 "," $5,015.70 "," $5,182.89 "," $5,350.08 "," $3,620.91 "," $4,737.05 "," $2,378.16 "," $3,095.06 ", N/A ," $2,485.49 "," $2,485.49 "," $5,294.35 "," $2,743.63 ", $414.53 ," $5,350.08 "
 SODIUM BICARBONATE 4.2 % IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00409-5534-14,10 mL, $102.43 , $66.58 , $86.04 , N/A , N/A , $82.76 , $92.19 , $86.72 , $92.19 , $92.19 , $92.19 , $87.07 , N/A , $94.57 , $97.31 , $87.07 , $95.26 , $95.26 , $97.31 , $98.33 , $83.81 , $92.19 , $87.07 , $80.92 , N/A , $82.90 , $82.90 , $97.31 , $87.90 , $80.92 , $98.33 
 Pro Cltx Prox Tibfib Jt Dislc Req Anes ,CPT® 27831,0981 - PRO FEE/ER,N/A,N/A," $2,264.00 "," $1,471.60 "," $2,519.27 ", $396.76 , $167.35 ," $1,928.06 "," $1,932.28 "," $2,105.52 "," $2,037.60 "," $2,037.60 "," $1,811.20 "," $1,811.20 ", $167.35 ," $2,090.35 "," $2,150.80 "," $2,037.60 "," $2,037.60 "," $2,037.60 "," $2,105.52 "," $2,173.44 "," $2,323.30 "," $1,924.40 "," $2,126.60 "," $2,280.72 ", N/A ," $1,965.68 "," $1,965.68 "," $2,150.80 "," $2,310.39 ", $167.35 ," $2,519.27 "
Muramidase,CPT® 85549,N/A,N/A,N/A, $176.00 , $114.40 , N/A , $19.13 , $19.13 , $106.10 , $126.92 , $163.68 , $158.40 , $158.40 , $140.80 , $140.80 , $19.13 , $162.50 , $167.20 , $158.40 , $158.40 , $158.40 , $163.68 , $168.96 , $125.20 , $149.60 , $123.26 , $67.99 , N/A , $99.02 , $99.02 , $167.20 , $108.20 , $19.13 , $168.96 
"Remv Gallbladder,Explor Common Duct",CPT® 47610,N/A,N/A,N/A," $7,883.00 "," $5,123.95 "," $7,462.00 "," $1,152.24 "," $1,028.19 "," $5,887.89 "," $5,937.13 "," $7,331.19 "," $7,094.70 "," $7,094.70 "," $6,306.40 "," $6,306.40 "," $1,028.19 "," $7,278.37 "," $7,488.85 "," $7,094.70 "," $7,094.70 "," $7,094.70 "," $7,331.19 "," $7,567.68 "," $5,342.04 "," $6,700.55 "," $6,611.74 "," $6,936.75 ", N/A ," $6,002.78 "," $6,002.78 "," $7,488.85 "," $6,278.26 "," $1,028.19 "," $7,567.68 "
 Fac Glycosylated Hemoglobin Test ,CPT® 83036,0301 - LAB/CHEMISTRY,N/A,N/A, $103.00 , $66.95 , $86.52 , $9.90 , $9.90 , $83.22 , $92.70 , $87.20 , $92.70 , $92.70 , $92.70 , $87.55 , $9.71 , $95.10 , $97.85 , $87.55 , $95.79 , $95.79 , $97.85 , $98.88 , $84.27 , $92.70 , $87.55 , $81.37 , N/A , $83.36 , $83.36 , $97.85 , $88.38 , $9.71 , $98.88 
Incision of Eyelid,CPT® 67710,N/A,N/A,N/A," $2,271.00 "," $1,476.15 ", $600.54 , $94.88 , $151.20 , $549.71 , $523.96 ," $2,112.03 "," $2,043.90 "," $2,043.90 "," $1,816.80 "," $1,816.80 ", $151.20 ," $2,096.81 "," $2,157.45 "," $2,043.90 "," $2,043.90 "," $2,043.90 "," $2,112.03 "," $2,180.16 ", $826.37 ," $1,930.35 ", $542.36 , $700.78 , N/A , $560.44 , $560.44 ," $2,157.45 ", $618.65 , $94.88 ," $2,180.16 "
 Brain Ltd Static W/Flow Less Than 3 Views ,CPT® 78601,0340 - NUCLEAR MEDICINE,N/A,N/A," $2,004.00 "," $1,302.60 "," $1,683.36 ", $198.88 , $160.57 ," $1,619.23 "," $1,803.60 "," $1,696.59 "," $1,803.60 "," $1,803.60 "," $1,803.60 "," $1,703.40 ", $157.42 ," $1,850.29 "," $1,903.80 "," $1,703.40 "," $1,863.72 "," $1,863.72 "," $1,903.80 "," $1,923.84 "," $1,639.67 "," $1,803.60 "," $1,703.40 "," $1,583.16 ", N/A ," $1,621.84 "," $1,621.84 "," $1,903.80 "," $1,719.63 ", $157.42 ," $1,923.84 "
"Repair Ing Hernia,Full/Preterm Inf,Reduc",CPT® 49495,N/A,N/A,N/A," $2,716.00 "," $1,765.40 "," $2,447.12 ", $380.32 , $585.77 ," $1,817.57 "," $1,875.36 "," $2,525.88 "," $2,444.40 "," $2,444.40 "," $2,172.80 "," $2,172.80 ", $585.77 ," $2,507.68 "," $2,580.20 "," $2,444.40 "," $2,444.40 "," $2,444.40 "," $2,525.88 "," $2,607.36 "," $1,754.02 "," $2,308.60 "," $2,085.57 "," $2,274.04 ", N/A ," $1,853.03 "," $1,853.03 "," $2,580.20 "," $1,938.06 ", $380.32 ," $2,607.36 "
"Culture,Blood,Bacterial,Aerobic",CPT® 87040,N/A,N/A,N/A, $130.00 , $84.50 , N/A , $10.53 , $10.53 , $58.41 , $69.87 , $120.90 , $117.00 , $117.00 , $104.00 , $104.00 , $10.53 , $120.03 , $123.50 , $117.00 , $117.00 , $117.00 , $120.90 , $124.80 , $68.91 , $110.50 , $68.12 , $37.42 , N/A , $54.51 , $54.51 , $123.50 , $59.57 , $10.53 , $124.80 
 OXYCODONE HCL 5 MG/5ML PO SOLN ,HCPCS RXC637,0250 - PHARMACY,64950-0354-55,5 mL, $36.37 , $23.64 , $30.55 , N/A , N/A , $29.39 , $32.73 , $30.79 , $32.73 , $32.73 , $32.73 , $30.91 , N/A , $33.58 , $34.55 , $30.91 , $33.82 , $33.82 , $34.55 , $34.92 , $29.76 , $32.73 , $30.91 , $28.73 , N/A , $29.43 , $29.43 , $34.55 , $31.21 , $28.73 , $34.92 
Rmvl Noninfct Mesh/Prosth Aa/Parastomal Hrna Rpr,CPT® 49623,N/A,N/A,N/A," $1,990.00 "," $1,293.50 ", N/A , $182.19 , $142.20 , N/A , N/A ," $1,850.70 "," $1,791.00 "," $1,791.00 "," $1,592.00 "," $1,592.00 ", $142.20 ," $1,837.37 "," $1,890.50 "," $1,791.00 "," $1,791.00 "," $1,791.00 "," $1,850.70 "," $1,910.40 ", N/A ," $1,691.50 "," $1,044.84 ", N/A , N/A , $784.34 , $784.34 ," $1,890.50 ", $821.13 , $142.20 ," $1,910.40 "
 Fac Thrmbc Artl/Ven Grf Xcp Hemo Grf/Fstl W/Revj Grf ,CPT® 35876,0360 - OR SERVICES,N/A,N/A," $3,131.00 "," $2,035.15 "," $2,630.04 ", $841.03 ," $1,059.93 "," $2,529.85 "," $2,817.90 "," $2,650.70 "," $2,817.90 "," $2,817.90 "," $2,817.90 "," $2,661.35 "," $1,039.15 "," $2,890.85 "," $2,974.45 "," $2,661.35 "," $2,911.83 "," $2,911.83 "," $2,974.45 "," $3,005.76 "," $2,561.78 "," $2,817.90 "," $2,661.35 "," $2,473.49 ", N/A ," $2,533.92 "," $2,533.92 "," $2,974.45 "," $2,686.71 ", $841.03 ," $3,005.76 "
 LACTATED RINGERS IV SOLN (PVC-FREE) ,HCPCS J7120,0258 - IV SOLUTIONS,00264-7750-20,250 mL, $69.84 , $45.40 , $58.67 , $2.44 , $2.61 , $56.43 , $62.86 , $59.13 , $62.86 , $62.86 , $62.86 , $59.36 , $2.56 , $64.48 , $66.35 , $59.36 , $64.95 , $64.95 , $66.35 , $67.05 , $57.14 , $62.86 , $59.36 , $55.17 , N/A , $56.52 , $56.52 , $66.35 , $59.93 , $2.44 , $67.05 
Buprenorphine Xr Over 100 Mg,HCPCS Q9992,N/A,N/A,N/A," $2,553.00 "," $1,659.45 ", N/A ," $1,924.10 "," $1,862.35 ", N/A , N/A ," $2,374.29 "," $2,297.70 "," $2,297.70 "," $2,042.40 "," $2,042.40 "," $1,862.35 "," $2,357.18 "," $2,425.35 "," $2,297.70 "," $2,297.70 "," $2,297.70 "," $2,374.29 "," $2,450.88 "," $2,361.65 "," $2,170.05 "," $3,481.52 "," $2,402.20 ", N/A , N/A , N/A ," $2,425.35 ", N/A ," $1,862.35 "," $3,481.52 "
 Ttvi/Rplcmt Prstc Vlv Perq W/R Hrt Cath&Angrph ,CPT® 0646T,0360 - OR SERVICES,N/A,N/A," $18,003.00 "," $11,701.95 "," $15,122.52 ", N/A , N/A ," $14,546.42 "," $16,202.70 "," $15,241.34 "," $16,202.70 "," $16,202.70 "," $16,202.70 "," $15,302.55 ", N/A ," $16,622.17 "," $17,102.85 "," $15,302.55 "," $16,742.79 "," $16,742.79 "," $17,102.85 "," $17,282.88 "," $14,730.05 "," $16,202.70 "," $15,302.55 "," $14,222.37 ", N/A ," $14,569.83 "," $14,569.83 "," $17,102.85 "," $15,448.37 "," $14,222.37 "," $17,282.88 "
"Hepatitis, Delta Agent",CPT® 86692,N/A,N/A,N/A, $191.00 , $124.15 , N/A , $17.50 , $17.50 , $97.08 , $116.15 , $177.63 , $171.90 , $171.90 , $152.80 , $152.80 , $17.50 , $176.35 , $181.45 , $171.90 , $171.90 , $171.90 , $177.63 , $183.36 , $114.58 , $162.35 , $111.91 , $62.24 , N/A , $90.60 , $90.60 , $181.45 , $99.00 , $17.50 , $183.36 
 Inj Proc Hip Arthro W/O Anes ,CPT® 27093,0761 - TREATMENT ROOM,N/A,N/A, $683.00 , $443.95 , $573.72 , $65.17 , $67.21 , $551.86 , $614.70 , $578.23 , $614.70 , $614.70 , $614.70 , $580.55 , $65.89 , $630.61 , $648.85 , $580.55 , $635.19 , $635.19 , $648.85 , $655.68 , $558.83 , $614.70 , $580.55 , $539.57 , N/A , $552.75 , $552.75 , $648.85 , $586.08 , $65.17 , $655.68 
"Gastro/Jejuno Tube, Std",HCPCS B4087,N/A,N/A,N/A, $73.00 , $47.45 , N/A , $34.78 , $38.34 , N/A , N/A , $67.89 , $65.70 , $65.70 , $58.40 , $58.40 , $38.34 , $67.40 , $69.35 , $65.70 , $65.70 , $65.70 , $67.89 , $70.08 , N/A , $62.05 , $45.41 , $143.49 , N/A , N/A , N/A , $69.35 , N/A , $34.78 , $143.49 
" Fac Assay of Psa, Total ",CPT® 84153,0301 - LAB/CHEMISTRY,N/A,N/A, $177.00 , $115.05 , $148.68 , $18.76 , $18.76 , $143.02 , $159.30 , $149.85 , $159.30 , $159.30 , $159.30 , $150.45 , $18.39 , $163.42 , $168.15 , $150.45 , $164.61 , $164.61 , $168.15 , $169.92 , $144.82 , $159.30 , $150.45 , $139.83 , N/A , $143.25 , $143.25 , $168.15 , $151.88 , $18.39 , $169.92 
Hospital IP/Obs Care Same Date Sf/Low Mdm 45 Min,99234,N/A,N/A,N/A, $407.00 , $264.55 , $258.55 , $95.38 , $141.73 , $231.15 , $231.50 , $378.51 , $366.30 , $366.30 , $325.60 , $325.60 , $141.73 , $375.78 , $386.65 , $366.30 , $366.30 , $366.30 , $378.51 , $390.72 , $387.82 , $345.95 , $289.54 , $290.69 , N/A , $235.65 , $235.65 , $386.65 , $271.78 , $95.38 , $390.72 
Biopsy of Skin Lesion,CPT® 11100,N/A,N/A,N/A, $384.00 , $249.60 , N/A , N/A , N/A , $132.80 , $129.40 , $357.12 , $345.60 , $345.60 , $307.20 , $307.20 , N/A , $354.55 , $364.80 , $345.60 , $345.60 , $345.60 , $357.12 , $368.64 , N/A , $326.40 , N/A , N/A , N/A , N/A , N/A , $364.80 , N/A , $129.40 , $368.64 
 VITAMIN B-12 500 MCG PO TABS ,HCPCS RXC637,0250 - PHARMACY,77333-0937-10,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Pro Removal of Kneecap Bursa ,CPT® 27340,0982 - PRO FEE/OUTPT,N/A,N/A," $1,563.00 "," $1,015.95 "," $2,302.37 ", $362.46 , $307.34 ," $1,790.25 "," $1,800.84 "," $1,453.59 "," $1,406.70 "," $1,406.70 "," $1,250.40 "," $1,250.40 ", $307.34 ," $1,443.12 "," $1,484.85 "," $1,406.70 "," $1,406.70 "," $1,406.70 "," $1,453.59 "," $1,500.48 "," $2,129.87 "," $1,328.55 "," $1,982.10 "," $2,116.27 ", N/A ," $1,825.18 "," $1,825.18 "," $1,484.85 "," $2,145.24 ", $307.34 ," $2,302.37 "
"Excis Intrasp Lesn,Xdural,Cervical",CPT® 63265,N/A,N/A,N/A," $10,936.00 "," $7,108.40 "," $7,682.27 "," $1,501.70 "," $1,402.10 "," $9,015.70 "," $8,659.97 "," $10,170.48 "," $9,842.40 "," $9,842.40 "," $8,748.80 "," $8,748.80 "," $1,402.10 "," $10,097.21 "," $10,389.20 "," $9,842.40 "," $9,842.40 "," $9,842.40 "," $10,170.48 "," $10,498.56 "," $8,296.68 "," $9,295.60 "," $8,870.37 "," $9,373.05 ", N/A ," $9,191.61 "," $9,191.61 "," $10,389.20 "," $9,860.44 "," $1,402.10 "," $10,498.56 "
 VANCOMYCIN HCL 1250 MG/250ML IV SOLN ,HCPCS J3372,0636 - DRUGS REQUIRING DETAILED CODIN,70594-0057-02,300 mL, $140.24 , $91.16 , $117.80 , $6.71 , $6.69 , $113.31 , $126.22 , $118.73 , $126.22 , $126.22 , $126.22 , $119.20 , $6.56 , $129.48 , $133.23 , $119.20 , $130.42 , $130.42 , $133.23 , $134.63 , $114.74 , $126.22 , $119.20 , $110.79 , N/A , $113.50 , $113.50 , $133.23 , $120.34 , $6.56 , $134.63 
 MEROPENEM 500 MG IV SOLR ,HCPCS J2185,0636 - DRUGS REQUIRING DETAILED CODIN,70594-0075-02,10 mL, $18.50 , $12.03 , $15.54 , $0.53 , $0.63 , $14.95 , $16.65 , $15.66 , $16.65 , $16.65 , $16.65 , $15.73 , $0.62 , $17.08 , $17.58 , $15.73 , $17.21 , $17.21 , $17.58 , $17.76 , $15.14 , $16.65 , $15.73 , $14.62 , N/A , $14.97 , $14.97 , $17.58 , $15.87 , $0.53 , $17.76 
Fx Radial Shaft Closed,25500,N/A,N/A,N/A," $1,781.00 "," $1,157.65 "," $1,601.34 ", $254.45 , $170.42 ," $1,203.90 "," $1,222.94 "," $1,656.33 "," $1,602.90 "," $1,602.90 "," $1,424.80 "," $1,424.80 ", $170.42 ," $1,644.40 "," $1,691.95 "," $1,602.90 "," $1,602.90 "," $1,602.90 "," $1,656.33 "," $1,709.76 "," $1,473.82 "," $1,513.85 "," $1,338.05 "," $1,436.19 ", N/A ," $1,227.40 "," $1,227.40 "," $1,691.95 "," $1,442.63 ", $170.42 ," $1,709.76 "
 Pro Punch Biopsy Skin Single Lesion ,CPT® 11104,0982 - PRO FEE/OUTPT,N/A,N/A, $491.00 , $319.15 , $150.65 , $44.88 , $98.18 , $127.17 , N/A , $456.63 , $441.90 , $441.90 , $392.80 , $392.80 , $98.18 , $453.34 , $466.45 , $441.90 , $441.90 , $441.90 , $456.63 , $471.36 , $167.40 , $417.35 , $247.00 , $174.53 , N/A , $129.65 , $129.65 , $466.45 , $150.35 , $44.88 , $471.36 
Exc Skin Benig 2.1-3cm Remaindr Body,CPT® 11423,N/A,N/A,N/A," $1,032.00 ", $670.80 , $498.95 , $150.64 , $167.14 , $428.81 , $422.17 , $959.76 , $928.80 , $928.80 , $825.60 , $825.60 , $167.14 , $952.85 , $980.40 , $928.80 , $928.80 , $928.80 , $959.76 , $990.72 , $545.40 , $877.20 , $840.29 , $546.89 , N/A , $437.17 , $437.17 , $980.40 , $506.99 , $150.64 , $990.72 
 APREPITANT 125 MG PO CAPS ,HCPCS J8501,0636 - DRUGS REQUIRING DETAILED CODIN,00781-2323-68,1 capsule," $1,635.52 "," $1,063.09 "," $1,373.84 ", $3.18 , $3.30 ," $1,321.50 "," $1,471.97 "," $1,384.63 "," $1,471.97 "," $1,471.97 "," $1,471.97 "," $1,390.19 ", $3.24 ," $1,510.08 "," $1,553.74 "," $1,390.19 "," $1,521.03 "," $1,521.03 "," $1,553.74 "," $1,570.10 "," $1,338.18 "," $1,471.97 "," $1,390.19 "," $1,292.06 ", N/A ," $1,323.63 "," $1,323.63 "," $1,553.74 "," $1,403.44 ", $3.18 ," $1,570.10 "
 Fac Trauma 4 Activation W/ Pre-ED Notification- Level II W/ Critical Care ,HCPCS G0390,0684 - TRAUMA LEVEL IV,N/A,N/A," $1,533.00 ", $996.45 ," $1,287.72 ", N/A , N/A ," $1,238.66 "," $1,379.70 "," $1,297.84 "," $1,379.70 "," $1,379.70 "," $1,379.70 "," $1,303.05 ", N/A ," $1,415.42 "," $1,456.35 "," $1,303.05 "," $1,425.69 "," $1,425.69 "," $1,456.35 "," $1,471.68 "," $1,254.30 "," $1,379.70 "," $1,303.05 "," $1,211.07 ", N/A ," $1,240.66 "," $1,240.66 "," $1,456.35 "," $1,315.47 "," $1,211.07 "," $1,471.68 "
External Ecg Rec>48hr<7d Review & Interpretation,CPT® 93244,N/A,N/A,N/A, $358.00 , $232.70 , $154.05 , $23.08 , $19.22 , N/A , N/A , $332.94 , $322.20 , $322.20 , $286.40 , $286.40 , $19.22 , $330.54 , $340.10 , $322.20 , $322.20 , $322.20 , $332.94 , $343.68 , $152.38 , $304.30 , $122.61 , $153.60 , N/A , $128.28 , $128.28 , $340.10 , $142.34 , $19.22 , $343.68 
Osteotomy Metatarsal (Not 1st),28308,N/A,N/A,N/A," $3,731.00 "," $2,425.15 "," $2,379.91 ", $374.12 , $284.13 ," $1,848.67 "," $1,839.97 "," $3,469.83 "," $3,357.90 "," $3,357.90 "," $2,984.80 "," $2,984.80 ", $284.13 ," $3,444.83 "," $3,544.45 "," $3,357.90 "," $3,357.90 "," $3,357.90 "," $3,469.83 "," $3,581.76 "," $2,202.24 "," $3,171.35 "," $1,996.37 "," $2,208.03 ", N/A ," $1,884.75 "," $1,884.75 "," $3,544.45 "," $2,215.25 ", $284.13 ," $3,581.76 "
Casirivi and imdevi infusion,HCPCS M0243,N/A,N/A,N/A," $1,335.00 ", $867.75 , N/A , N/A , $459.00 , N/A , N/A ," $1,241.55 "," $1,201.50 "," $1,201.50 "," $1,068.00 "," $1,068.00 ", $459.00 ," $1,232.61 "," $1,268.25 "," $1,201.50 "," $1,201.50 "," $1,201.50 "," $1,241.55 "," $1,281.60 ", N/A ," $1,134.75 ", $858.10 ," $1,699.91 ", N/A , N/A , N/A ," $1,268.25 ", N/A , $459.00 ," $1,699.91 "
"Close Tear Duct Opening by Plug,Ea",CPT® 68761,N/A,N/A,N/A, $637.00 , $414.05 , $727.87 , $114.29 , $97.37 , $673.05 , $636.84 , $592.41 , $573.30 , $573.30 , $509.60 , $509.60 , $97.37 , $588.14 , $605.15 , $573.30 , $573.30 , $573.30 , $592.41 , $611.52 , $998.63 , $541.45 , $654.75 , $859.42 , N/A , $686.18 , $686.18 , $605.15 , $757.46 , $97.37 , $998.63 
 DOXORUBICIN HCL 50 MG IV SOLR ,HCPCS J9000,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9277-01,3 mL, $773.41 , $502.72 , $649.66 , $2.55 , $2.51 , $624.92 , $696.07 , $654.77 , $696.07 , $696.07 , $696.07 , $657.40 , $2.46 , $714.09 , $734.74 , $657.40 , $719.27 , $719.27 , $734.74 , $742.47 , $632.80 , $696.07 , $657.40 , $610.99 , N/A , $625.92 , $625.92 , $734.74 , $663.66 , $2.46 , $742.47 
" Fac Cytopath Smear, Other Source ",CPT® 88161,0310 - PATHOLOGY LAB,N/A,N/A, $224.00 , $145.60 , $188.16 , $75.40 , $32.88 , $180.99 , $201.60 , $189.64 , $201.60 , $201.60 , $201.60 , $190.40 , $32.24 , $206.82 , $212.80 , $190.40 , $208.32 , $208.32 , $212.80 , $215.04 , $183.28 , $201.60 , $190.40 , $176.96 , N/A , $181.28 , $181.28 , $212.80 , $192.21 , $32.24 , $215.04 
 NICOTINE POLACRILEX 2 MG MT LOZG ,HCPCS RXC637,0250 - PHARMACY,45802-0344-05,1 lozenge, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
" Pro OB US < 14 Wks, Single Fetus ",CPT® 76801,0972 - PRO FEE/RAD/DX,N/A,N/A, $362.00 , $235.30 , $670.60 , $116.85 , $118.45 , $595.71 , $671.89 , $336.66 , $325.80 , $325.80 , $289.60 , $289.60 , $118.45 , $334.23 , $343.90 , $325.80 , $325.80 , $325.80 , $336.66 , $347.52 , $675.55 , $307.70 , $729.97 , $695.54 , N/A , $607.33 , $607.33 , $343.90 , $702.99 , $116.85 , $729.97 
Drug Screening Fentanyl,CPT® 80354,N/A,N/A,N/A, $167.00 , $108.55 , N/A , N/A , N/A , N/A , N/A , $155.31 , $150.30 , $150.30 , $133.60 , $133.60 , N/A , $154.19 , $158.65 , $150.30 , $150.30 , $150.30 , $155.31 , $160.32 , N/A , $141.95 , $114.69 , $67.79 , N/A , $90.04 , $90.04 , $158.65 , $98.20 , $67.79 , $160.32 
 GENTAMICIN 2 MG/ML IV IN SALINE SYR ,HCPCS RXA250,0250 - PHARMACY,00001-0063-01,5 mL, $16.68 , $10.84 , $14.01 , N/A , N/A , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , N/A , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $13.18 , $16.01 
Treat Metatarsal Fracture,CPT® 28470,N/A,N/A,N/A," $1,411.00 ", $917.15 ," $1,281.15 ", $202.14 , $155.34 , $994.98 ," $1,021.36 "," $1,312.23 "," $1,269.90 "," $1,269.90 "," $1,128.80 "," $1,128.80 ", $155.34 ," $1,302.78 "," $1,340.45 "," $1,269.90 "," $1,269.90 "," $1,269.90 "," $1,312.23 "," $1,354.56 "," $1,181.08 "," $1,199.35 "," $1,115.04 "," $1,181.65 ", N/A ," $1,014.40 "," $1,014.40 "," $1,340.45 "," $1,192.29 ", $155.34 ," $1,354.56 "
 Fac Cytopath C/V Auto Fluid Redo ,CPT® 88175,0310 - PATHOLOGY LAB,N/A,N/A, $244.00 , $158.60 , $204.96 , $27.14 , $27.14 , $197.15 , $219.60 , $206.57 , $219.60 , $219.60 , $219.60 , $207.40 , $26.61 , $225.29 , $231.80 , $207.40 , $226.92 , $226.92 , $231.80 , $234.24 , $199.64 , $219.60 , $207.40 , $192.76 , N/A , $197.47 , $197.47 , $231.80 , $209.38 , $26.61 , $234.24 
Endomet Biopsy Done W/Colposcopy,CPT® 58110,N/A,N/A,N/A, $288.00 , $187.20 , $188.30 , $37.77 , $45.15 , $166.74 , $165.83 , $267.84 , $259.20 , $259.20 , $230.40 , $230.40 , $45.15 , $265.91 , $273.60 , $259.20 , $259.20 , $259.20 , $267.84 , $276.48 , $198.93 , $244.80 , $217.66 , $168.16 , N/A , $169.99 , $169.99 , $273.60 , $203.89 , $37.77 , $276.48 
"Repair,Incomplete Circumcision",CPT® 54163,N/A,N/A,N/A," $1,201.00 ", $780.65 , $968.34 , $210.06 , $88.56 , $700.35 , $713.22 ," $1,116.93 "," $1,080.90 "," $1,080.90 ", $960.80 , $960.80 , $88.56 ," $1,108.88 "," $1,140.95 "," $1,080.90 "," $1,080.90 "," $1,080.90 "," $1,116.93 "," $1,152.96 ", $907.82 ," $1,020.85 "," $1,134.66 "," $1,061.32 ", N/A , $714.01 , $714.01 ," $1,140.95 ", $855.80 , $88.56 ," $1,152.96 "
"Neg Press Wound Tx, > 50 Cm",97606,N/A,N/A,N/A, $291.00 , $189.15 , $64.42 , $26.75 , $31.76 , $66.30 , $57.28 , $270.63 , $261.90 , $261.90 , $232.80 , $232.80 , $31.76 , $268.68 , $276.45 , $261.90 , $261.90 , $261.90 , $270.63 , $279.36 , $85.53 , $247.35 , $87.18 , $64.32 , N/A , $67.60 , $67.60 , $276.45 , $75.19 , $26.75 , $279.36 
 Pro Removal of Fallopian Tube ,CPT® 58700,0982 - PRO FEE/OUTPT,N/A,N/A," $4,604.00 "," $2,992.60 "," $3,760.20 ", $759.56 , $522.28 ," $3,167.84 "," $3,145.64 "," $4,281.72 "," $4,143.60 "," $4,143.60 "," $3,683.20 "," $3,683.20 ", $522.28 ," $4,250.87 "," $4,373.80 "," $4,143.60 "," $4,143.60 "," $4,143.60 "," $4,281.72 "," $4,419.84 "," $3,901.46 "," $3,913.40 "," $4,153.30 "," $3,158.26 ", N/A ," $3,229.65 "," $3,229.65 "," $4,373.80 "," $3,873.76 ", $522.28 ," $4,419.84 "
 Fac Antipsychotics Not Otherwise Specified 1-3 ,CPT® 80342,0301 - LAB/CHEMISTRY,N/A,N/A, $202.00 , $131.30 , $169.68 , N/A , N/A , $163.22 , $181.80 , $171.01 , $181.80 , $181.80 , $181.80 , $171.70 , N/A , $186.51 , $191.90 , $171.70 , $187.86 , $187.86 , $191.90 , $193.92 , $165.28 , $181.80 , $171.70 , $159.58 , N/A , $163.48 , $163.48 , $191.90 , $173.34 , $159.58 , $193.92 
"Cult Spec, Anaerb W/Addn Methods",CPT® 87076,N/A,N/A,N/A, $115.00 , $74.75 , N/A , $8.24 , $8.24 , $45.73 , $54.70 , $106.95 , $103.50 , $103.50 , $92.00 , $92.00 , $8.24 , $106.18 , $109.25 , $103.50 , $103.50 , $103.50 , $106.95 , $110.40 , $53.95 , $97.75 , $53.52 , $29.28 , N/A , $42.68 , $42.68 , $109.25 , $46.64 , $8.24 , $110.40 
 Fac RBC Leukoreduced Irradiated ,HCPCS P9040,0390 - BLOOD/STOR-PROC,N/A,N/A, $658.00 , $427.70 , $552.72 , N/A , N/A , $531.66 , $592.20 , $557.06 , $592.20 , $592.20 , $592.20 , $559.30 , N/A , $607.53 , $625.10 , $559.30 , $611.94 , $611.94 , $625.10 , $631.68 , $538.38 , $592.20 , $559.30 , $519.82 , N/A , $532.52 , $532.52 , $625.10 , $564.63 , $519.82 , $631.68 
 Pro Treat Fracture Ulnar Styloid ,CPT® 25652,0982 - PRO FEE/OUTPT,N/A,N/A," $4,143.00 "," $2,692.95 "," $3,814.79 ", $599.48 , $442.86 ," $3,000.99 "," $2,990.79 "," $3,852.99 "," $3,728.70 "," $3,728.70 "," $3,314.40 "," $3,314.40 ", $442.86 ," $3,825.23 "," $3,935.85 "," $3,728.70 "," $3,728.70 "," $3,728.70 "," $3,852.99 "," $3,977.28 "," $3,539.64 "," $3,521.55 "," $3,291.60 "," $3,549.30 ", N/A ," $3,059.54 "," $3,059.54 "," $3,935.85 "," $3,596.05 ", $442.86 ," $3,977.28 "
 MEGESTROL ACETATE 40 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-7236-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Cns Dna/Rna Amp Probe Multiple Subtypes 12-25,CPT® 87483,N/A,N/A,N/A," $3,562.00 "," $2,315.30 ", N/A , $425.12 , $425.12 ," $3,212.05 ", N/A ," $3,312.66 "," $3,205.80 "," $3,205.80 "," $2,849.60 "," $2,849.60 ", $425.12 ," $3,288.79 "," $3,383.90 "," $3,205.80 "," $3,205.80 "," $3,205.80 "," $3,312.66 "," $3,419.52 "," $2,782.93 "," $3,027.70 "," $1,986.90 "," $1,511.23 ", N/A ," $2,997.69 "," $2,997.69 "," $3,383.90 "," $3,275.82 ", $425.12 ," $3,419.52 "
Thyroid Uptake Single/Multiple Quant Measurement,CPT® 78012,N/A,N/A,N/A, $978.00 , $635.70 , $447.64 , $78.69 , $65.24 , $388.69 , $429.23 , $909.54 , $880.20 , $880.20 , $782.40 , $782.40 , $65.24 , $902.99 , $929.10 , $880.20 , $880.20 , $880.20 , $909.54 , $938.88 , $447.77 , $831.30 , $469.95 , $542.34 , N/A , $396.27 , $396.27 , $929.10 , $458.70 , $65.24 , $938.88 
Excis Subcut Shldr Tumor,CPT® 23076,N/A,N/A,N/A," $3,553.00 "," $2,309.45 "," $3,291.02 ", $515.17 , $184.20 ," $2,586.31 "," $2,586.00 "," $3,304.29 "," $3,197.70 "," $3,197.70 "," $2,842.40 "," $2,842.40 ", $184.20 ," $3,280.48 "," $3,375.35 "," $3,197.70 "," $3,197.70 "," $3,197.70 "," $3,304.29 "," $3,410.88 "," $3,046.23 "," $3,020.05 "," $2,859.85 "," $3,051.01 ", N/A ," $2,636.77 "," $2,636.77 "," $3,375.35 "," $3,099.15 ", $184.20 ," $3,410.88 "
 Pro Office/Outpatient Est Pt May Not Req Phys/Qhp ,CPT® 99211,0982 - PRO FEE/OUTPT,N/A,N/A, $92.00 , $59.80 , $18.08 , $8.63 , $16.58 , $16.02 , $15.74 , $85.56 , $82.80 , $82.80 , $73.60 , $73.60 , $16.58 , $84.94 , $87.40 , $82.80 , $82.80 , $82.80 , $85.56 , $88.32 , $16.50 , $78.20 , $19.50 , $20.26 , N/A , $16.33 , $16.33 , $87.40 , $18.83 , $8.63 , $88.32 
Manual Prep and Insertion Deep Drug Delivery Dev,CPT® 20700,N/A,N/A,N/A, $676.00 , $439.40 , $509.28 , $79.08 , $65.01 , $399.30 , N/A , $628.68 , $608.40 , $608.40 , $540.80 , $540.80 , $65.01 , $624.15 , $642.20 , $608.40 , $608.40 , $608.40 , $628.68 , $648.96 , $466.29 , $574.60 , $446.01 , $479.35 , N/A , $407.09 , $407.09 , $642.20 , $478.52 , $65.01 , $648.96 
"Suct Assis Lipectomy,Trunk",CPT® 15877,N/A,N/A,N/A," $2,418.00 "," $1,571.70 ", N/A , N/A , N/A , N/A , N/A ," $2,248.74 "," $2,176.20 "," $2,176.20 "," $1,934.40 "," $1,934.40 ", N/A ," $2,232.54 "," $2,297.10 "," $2,176.20 "," $2,176.20 "," $2,176.20 "," $2,248.74 "," $2,321.28 ", N/A ," $2,055.30 "," $1,934.40 ", N/A , N/A , N/A , N/A ," $2,297.10 ", N/A ," $1,934.40 "," $2,321.28 "
 Fac Teaec +-Patch Grf Dp Profunda Fem ,CPT® 35372,0360 - OR SERVICES,N/A,N/A," $4,226.00 "," $2,746.90 "," $3,549.84 ", $868.70 , $804.68 ," $3,414.61 "," $3,803.40 "," $3,577.73 "," $3,803.40 "," $3,803.40 "," $3,803.40 "," $3,592.10 ", $788.90 ," $3,901.87 "," $4,014.70 "," $3,592.10 "," $3,930.18 "," $3,930.18 "," $4,014.70 "," $4,056.96 "," $3,457.71 "," $3,803.40 "," $3,592.10 "," $3,338.54 ", N/A ," $3,420.10 "," $3,420.10 "," $4,014.70 "," $3,626.33 ", $788.90 ," $4,056.96 "
 PHENOL 89 % EX SWAB ,HCPCS RXA250,0250 - PHARMACY,00884-6297-30,1 Swab, $28.04 , $18.23 , $23.55 , N/A , N/A , $22.66 , $25.24 , $23.74 , $25.24 , $25.24 , $25.24 , $23.83 , N/A , $25.89 , $26.64 , $23.83 , $26.08 , $26.08 , $26.64 , $26.92 , $22.94 , $25.24 , $23.83 , $22.15 , N/A , $22.69 , $22.69 , $26.64 , $24.06 , $22.15 , $26.92 
 Fac Assay of Ammonia ,CPT® 82140,0301 - LAB/CHEMISTRY,N/A,N/A, $135.00 , $87.75 , $113.40 , $14.86 , $14.86 , $109.08 , $121.50 , $114.29 , $121.50 , $121.50 , $121.50 , $114.75 , $14.57 , $124.65 , $128.25 , $114.75 , $125.55 , $125.55 , $128.25 , $129.60 , $110.46 , $121.50 , $114.75 , $106.65 , N/A , $109.26 , $109.26 , $128.25 , $115.84 , $14.57 , $129.60 
 Fac Cltx Scapular Fx W/O Mnpj ,CPT® 23570,0361 - OR/MINOR,N/A,N/A," $1,088.00 ", $707.20 , $913.92 , $239.36 , $101.63 , $879.10 , $979.20 , $921.10 , $979.20 , $979.20 , $979.20 , $924.80 , $99.64 ," $1,004.55 "," $1,033.60 ", $924.80 ," $1,011.84 "," $1,011.84 "," $1,033.60 "," $1,044.48 ", $890.20 , $979.20 , $924.80 , $859.52 , N/A , $880.52 , $880.52 ," $1,033.60 ", $933.61 , $99.64 ," $1,044.48 "
"Cystourethroscopy,Biopsy",CPT® 52204,N/A,N/A,N/A," $1,447.00 ", $940.55 , $758.54 , $133.17 , $232.99 , $695.08 , $646.50 ," $1,345.71 "," $1,302.30 "," $1,302.30 "," $1,157.60 "," $1,157.60 ", $232.99 ," $1,336.02 "," $1,374.65 "," $1,302.30 "," $1,302.30 "," $1,302.30 "," $1,345.71 "," $1,389.12 ", $761.89 ," $1,229.95 ", $731.47 , $871.32 , N/A , $708.64 , $708.64 ," $1,374.65 ", $832.90 , $133.17 ," $1,389.12 "
Inj Enoxaparin Sodium,HCPCS J1650,N/A,N/A,N/A, $23.00 , $14.95 , N/A , $0.69 , $0.83 , N/A , N/A , $21.39 , $20.70 , $20.70 , $18.40 , $18.40 , $0.83 , $21.24 , $21.85 , $20.70 , $20.70 , $20.70 , $21.39 , $22.08 , $0.99 , $19.55 , $6.49 , $1.10 , N/A , N/A , N/A , $21.85 , N/A , $0.69 , $22.08 
" Ivl W/Stent + Pta; Tib, Peroneal ",HCPCS C9773,0360 - OR SERVICES,N/A,N/A," $23,839.00 "," $15,495.35 "," $20,024.76 ", N/A , N/A ," $19,261.91 "," $21,455.10 "," $20,182.10 "," $21,455.10 "," $21,455.10 "," $21,455.10 "," $20,263.15 ", N/A ," $22,010.55 "," $22,647.05 "," $20,263.15 "," $22,170.27 "," $22,170.27 "," $22,647.05 "," $22,885.44 "," $19,505.07 "," $21,455.10 "," $20,263.15 "," $18,832.81 ", N/A ," $19,292.90 "," $19,292.90 "," $22,647.05 "," $20,456.25 "," $18,832.81 "," $22,885.44 "
Prq Trluml Coronry Stent/Ath/Angio One Art/Brnch,CPT® 92933,N/A,N/A,N/A," $5,565.00 "," $3,617.25 "," $3,855.61 ", $592.67 , $507.25 ," $3,613.46 "," $3,640.53 "," $5,175.45 "," $5,008.50 "," $5,008.50 "," $4,452.00 "," $4,452.00 ", $507.25 ," $5,138.16 "," $5,286.75 "," $5,008.50 "," $5,008.50 "," $5,008.50 "," $5,175.45 "," $5,342.40 "," $3,573.17 "," $4,730.25 "," $2,013.24 "," $3,802.19 ", N/A ," $3,683.96 "," $3,683.96 "," $5,286.75 "," $4,083.71 ", $507.25 ," $5,342.40 "
 Pro Drg Fngr Absc Smpl ,CPT® 26010,0982 - PRO FEE/OUTPT,N/A,N/A, $817.00 , $531.05 , $867.23 , $136.36 , $30.71 , $664.95 , $677.89 , $759.81 , $735.30 , $735.30 , $653.60 , $653.60 , $30.71 , $754.34 , $776.15 , $735.30 , $735.30 , $735.30 , $759.81 , $784.32 , $800.12 , $694.45 , $742.17 , $793.35 , N/A , $677.92 , $677.92 , $776.15 , $796.82 , $30.71 , $867.23 
Removal Perq Left Hrt Vad Artl/Artl&Ven Sep Insj,CPT® 33992,N/A,N/A,N/A," $1,156.00 ", $751.40 ," $1,099.61 ", $168.38 , $156.77 , $910.29 , $868.58 ," $1,075.08 "," $1,040.40 "," $1,040.40 ", $924.80 , $924.80 , $156.77 ," $1,067.33 "," $1,098.20 "," $1,040.40 "," $1,040.40 "," $1,040.40 "," $1,075.08 "," $1,109.76 "," $1,017.01 ", $982.60 ," $1,097.20 ", $961.29 , N/A , $928.05 , $928.05 ," $1,098.20 "," $1,054.28 ", $156.77 ," $1,109.76 "
"Biopsy of Penis,Deep Struct",CPT® 54105,N/A,N/A,N/A," $1,452.00 ", $943.80 , $941.79 , $203.43 , $92.19 , $683.83 , $688.79 ," $1,350.36 "," $1,306.80 "," $1,306.80 "," $1,161.60 "," $1,161.60 ", $92.19 ," $1,340.63 "," $1,379.40 "," $1,306.80 "," $1,306.80 "," $1,306.80 "," $1,350.36 "," $1,393.92 ", $885.62 ," $1,234.20 "," $1,097.20 "," $1,032.60 ", N/A , $697.16 , $697.16 ," $1,379.40 ", $835.61 , $92.19 ," $1,393.92 "
" Fac Coombs Test, Indirect, Titer ",CPT® 86886,0300 - LABORATORY,N/A,N/A, $115.00 , $74.75 , $96.60 , $5.28 , $5.28 , $92.92 , $103.50 , $97.36 , $103.50 , $103.50 , $103.50 , $97.75 , $5.18 , $106.18 , $109.25 , $97.75 , $106.95 , $106.95 , $109.25 , $110.40 , $94.09 , $103.50 , $97.75 , $90.85 , N/A , $93.07 , $93.07 , $109.25 , $98.68 , $5.18 , $110.40 
 PYRIDOXINE HCL 100 MG/ML IJ SOLN ,HCPCS J3415,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0180-01,1 mL, $117.50 , $76.38 , $98.70 , $16.22 , $12.95 , $94.94 , $105.75 , $99.48 , $105.75 , $105.75 , $105.75 , $99.88 , $12.70 , $108.49 , $111.63 , $99.88 , $109.28 , $109.28 , $111.63 , $112.80 , $96.14 , $105.75 , $99.88 , $92.83 , N/A , $95.09 , $95.09 , $111.63 , $100.83 , $12.70 , $112.80 
 Fac Egd Intrmural US Needle Aspirate/Biopsy Esophags ,CPT® 43238,0360 - OR SERVICES,N/A,N/A," $3,152.00 "," $2,048.80 "," $2,647.68 ", $220.15 , $272.47 ," $2,546.82 "," $2,836.80 "," $2,668.48 "," $2,836.80 "," $2,836.80 "," $2,836.80 "," $2,679.20 ", $267.13 ," $2,910.24 "," $2,994.40 "," $2,679.20 "," $2,931.36 "," $2,931.36 "," $2,994.40 "," $3,025.92 "," $2,578.97 "," $2,836.80 "," $2,679.20 "," $2,490.08 ", N/A ," $2,550.91 "," $2,550.91 "," $2,994.40 "," $2,704.73 ", $220.15 ," $3,025.92 "
Mast Prtl,CPT® 19301,N/A,N/A,N/A," $2,533.00 "," $1,646.45 "," $2,067.03 ", $612.83 , $305.59 ," $1,752.29 "," $1,701.51 "," $2,355.69 "," $2,279.70 "," $2,279.70 "," $2,026.40 "," $2,026.40 ", $305.59 ," $2,338.72 "," $2,406.35 "," $2,279.70 "," $2,279.70 "," $2,279.70 "," $2,355.69 "," $2,431.68 "," $2,255.88 "," $2,153.05 "," $3,436.11 "," $2,213.34 ", N/A ," $1,786.48 "," $1,786.48 "," $2,406.35 "," $2,071.72 ", $305.59 ," $3,436.11 "
 EPOETIN ALFA-EPBX 40000 UNIT/ML IJ SOLN ,HCPCS Q5105,0636 - DRUGS REQUIRING DETAILED CODIN,00069-1309-01,1 mL," $1,297.27 ", $843.23 ," $1,089.71 ", $0.77 , N/A ," $1,048.19 "," $1,167.54 "," $1,098.27 "," $1,167.54 "," $1,167.54 "," $1,167.54 "," $1,102.68 ", N/A ," $1,197.77 "," $1,232.41 "," $1,102.68 "," $1,206.46 "," $1,206.46 "," $1,232.41 "," $1,245.38 "," $1,061.43 "," $1,167.54 "," $1,102.68 "," $1,024.84 ", N/A ," $1,049.88 "," $1,049.88 "," $1,232.41 "," $1,113.19 ", $0.77 ," $1,245.38 "
"Specimen Handling,Dr Off->Lab",CPT® 99000,N/A,N/A,N/A, $46.00 , $29.90 , N/A , N/A , $3.81 , $13.97 , $14.33 , $42.78 , $41.40 , $41.40 , $36.80 , $36.80 , $3.81 , $42.47 , $43.70 , $41.40 , $41.40 , $41.40 , $42.78 , $44.16 , $48.81 , $39.10 , N/A , $15.77 , N/A , $14.25 , $14.25 , $43.70 , $16.62 , $3.81 , $48.81 
 Fac Assay of Ascorbic Acid ,CPT® 82180,0301 - LAB/CHEMISTRY,N/A,N/A, $134.00 , $87.10 , $112.56 , $10.09 , $10.09 , $108.27 , $120.60 , $113.44 , $120.60 , $120.60 , $120.60 , $113.90 , $9.89 , $123.72 , $127.30 , $113.90 , $124.62 , $124.62 , $127.30 , $128.64 , $109.64 , $120.60 , $113.90 , $105.86 , N/A , $108.45 , $108.45 , $127.30 , $114.99 , $9.89 , $128.64 
Incis Deep Fingr/Hand Bone Lesn,CPT® 26034,N/A,N/A,N/A," $3,548.00 "," $2,306.20 "," $3,391.18 ", $532.35 , $276.59 ," $2,591.03 "," $2,601.22 "," $3,299.64 "," $3,193.20 "," $3,193.20 "," $2,838.40 "," $2,838.40 ", $276.59 ," $3,275.87 "," $3,370.60 "," $3,193.20 "," $3,193.20 "," $3,193.20 "," $3,299.64 "," $3,406.08 "," $3,137.10 "," $3,015.80 "," $2,859.85 "," $3,094.98 ", N/A ," $2,641.58 "," $2,641.58 "," $3,370.60 "," $3,104.81 ", $276.59 ," $3,406.08 "
"FB Removal,Conreal",CPT® 65220,N/A,N/A,N/A, $537.00 , $349.05 , $250.45 , $39.41 , $47.02 , $236.97 , $219.45 , $499.41 , $483.30 , $483.30 , $429.60 , $429.60 , $47.02 , $495.81 , $510.15 , $483.30 , $483.30 , $483.30 , $499.41 , $515.52 , $347.54 , $456.45 , $226.58 , $300.51 , N/A , $241.60 , $241.60 , $510.15 , $266.70 , $39.41 , $515.52 
 Fac Ablate L/R Atrial Fibril W/Isolated Pulm Vein ,CPT® 93657,0481 - CARDIAC CATH LAB,N/A,N/A," $5,696.00 "," $3,702.40 "," $4,784.64 ", $280.41 , $309.17 ," $4,602.37 "," $5,126.40 "," $4,822.23 "," $5,126.40 "," $5,126.40 "," $5,126.40 "," $4,841.60 ", $303.11 ," $5,259.12 "," $5,411.20 "," $4,841.60 "," $5,297.28 "," $5,297.28 "," $5,411.20 "," $5,468.16 "," $4,660.47 "," $5,126.40 "," $4,841.60 "," $4,499.84 ", N/A ," $4,609.77 "," $4,609.77 "," $5,411.20 "," $4,887.74 ", $280.41 ," $5,468.16 "
 Fac Lactate (Ld) (Ldh) Enzyme ,CPT® 83615,0301 - LAB/CHEMISTRY,N/A,N/A, $78.00 , $50.70 , $65.52 , $6.16 , $6.16 , $63.02 , $70.20 , $66.03 , $70.20 , $70.20 , $70.20 , $66.30 , $6.04 , $72.02 , $74.10 , $66.30 , $72.54 , $72.54 , $74.10 , $74.88 , $63.82 , $70.20 , $66.30 , $61.62 , N/A , $63.13 , $63.13 , $74.10 , $66.93 , $6.04 , $74.88 
 Fac Drug Screening Benzodiazepines 1-12 ,CPT® 80346,0301 - LAB/CHEMISTRY,N/A,N/A, $156.00 , $101.40 , $131.04 , N/A , N/A , $126.05 , $140.40 , $132.07 , $140.40 , $140.40 , $140.40 , $132.60 , N/A , $144.03 , $148.20 , $132.60 , $145.08 , $145.08 , $148.20 , $149.76 , $127.64 , $140.40 , $132.60 , $123.24 , N/A , $126.25 , $126.25 , $148.20 , $133.86 , $123.24 , $149.76 
Team Conference Face-to-Face Nonphysician,CPT® 99366,N/A,N/A,N/A, $99.00 , $64.35 , N/A , $40.27 , N/A , $72.61 , $72.51 , $92.07 , $89.10 , $89.10 , $79.20 , $79.20 , N/A , $91.41 , $94.05 , $89.10 , $89.10 , $89.10 , $92.07 , $95.04 , $75.57 , $84.15 , N/A , $92.45 , N/A , $74.03 , $74.03 , $94.05 , $85.36 , $40.27 , $95.04 
Assay for Procainamide,CPT® 80192,N/A,N/A,N/A, $166.00 , $107.90 , N/A , $17.09 , $17.09 , $94.79 , $113.38 , $154.38 , $149.40 , $149.40 , $132.80 , $132.80 , $17.09 , $153.27 , $157.70 , $149.40 , $149.40 , $149.40 , $154.38 , $159.36 , $111.84 , $141.10 , $110.29 , $60.74 , N/A , $88.46 , $88.46 , $157.70 , $96.67 , $17.09 , $159.36 
Exc Tumor Soft Tissue Abdl Wall Subfascial 5+Cm,CPT® 22901,N/A,N/A,N/A," $4,401.00 "," $2,860.65 "," $4,009.79 ", $621.23 , $545.10 ," $3,178.19 "," $3,166.35 "," $4,092.93 "," $3,960.90 "," $3,960.90 "," $3,520.80 "," $3,520.80 ", $545.10 ," $4,063.44 "," $4,180.95 "," $3,960.90 "," $3,960.90 "," $3,960.90 "," $4,092.93 "," $4,224.96 "," $3,711.50 "," $3,740.85 "," $3,511.04 "," $3,737.64 ", N/A ," $3,240.20 "," $3,240.20 "," $4,180.95 "," $3,808.40 ", $545.10 ," $4,224.96 "
"Removal of FB,Pharynx",CPT® 42809,N/A,N/A,N/A," $1,197.00 ", $778.05 , $774.61 , $121.29 , $46.62 , $640.06 , $659.95 ," $1,113.21 "," $1,077.30 "," $1,077.30 ", $957.60 , $957.60 , $46.62 ," $1,105.19 "," $1,137.15 "," $1,077.30 "," $1,077.30 "," $1,077.30 "," $1,113.21 "," $1,149.12 ", $548.59 ," $1,017.45 ", $722.55 , $692.65 , N/A , $652.55 , $652.55 ," $1,137.15 ", $682.48 , $46.62 ," $1,149.12 "
X-Ray Heel,CPT® 73650,N/A,N/A,N/A, $207.00 , $134.55 , $161.88 , $28.08 , $25.85 , $126.81 , $152.13 , $192.51 , $186.30 , $186.30 , $165.60 , $165.60 , $25.85 , $191.12 , $196.65 , $186.30 , $186.30 , $186.30 , $192.51 , $198.72 , $157.47 , $175.95 , $167.57 , $136.90 , N/A , $129.28 , $129.28 , $196.65 , $149.66 , $25.85 , $198.72 
 BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL FILM ,HCPCS RXC637,0250 - PHARMACY,47781-0357-03,1 Film, $45.16 , $29.35 , $37.93 , N/A , N/A , $36.49 , $40.64 , $38.23 , $40.64 , $40.64 , $40.64 , $38.39 , N/A , $41.70 , $42.90 , $38.39 , $42.00 , $42.00 , $42.90 , $43.35 , $36.95 , $40.64 , $38.39 , $35.68 , N/A , $36.55 , $36.55 , $42.90 , $38.75 , $35.68 , $43.35 
"Probe Nasolac Duct,Insert Tube/Stent",CPT® 68815,N/A,N/A,N/A," $3,539.00 "," $2,300.35 "," $1,363.64 ", $214.58 , $448.42 ," $1,457.18 "," $1,372.78 "," $3,291.27 "," $3,185.10 "," $3,185.10 "," $2,831.20 "," $2,831.20 ", $448.42 ," $3,267.56 "," $3,362.05 "," $3,185.10 "," $3,185.10 "," $3,185.10 "," $3,291.27 "," $3,397.44 "," $1,872.46 "," $3,008.15 "," $1,420.11 "," $1,594.11 ", N/A ," $1,485.61 "," $1,485.61 "," $3,362.05 "," $1,639.90 ", $214.58 ," $3,397.44 "
Colonoscopy Flexible With Decompression,CPT® 45393,N/A,N/A,N/A," $2,263.00 "," $1,470.95 "," $1,541.87 ", $237.46 , $265.41 , N/A , N/A ," $2,104.59 "," $2,036.70 "," $2,036.70 "," $1,810.40 "," $1,810.40 ", $265.41 ," $2,089.43 "," $2,149.85 "," $2,036.70 "," $2,036.70 "," $2,036.70 "," $2,104.59 "," $2,172.48 "," $1,108.62 "," $1,923.55 "," $1,311.38 "," $1,467.36 ", N/A ," $1,126.96 "," $1,126.96 "," $2,149.85 "," $1,179.56 ", $237.46 ," $2,172.48 "
Replace Aortic Valve Perq Femoral Artry Approach,CPT® 33361,N/A,N/A,N/A," $13,392.00 "," $8,704.80 "," $7,055.43 "," $1,086.18 "," $1,013.84 "," $5,796.75 "," $5,615.58 "," $12,454.56 "," $12,052.80 "," $12,052.80 "," $10,713.60 "," $10,713.60 "," $1,013.84 "," $12,364.83 "," $12,722.40 "," $12,052.80 "," $12,052.80 "," $12,052.80 "," $12,454.56 "," $12,856.32 "," $6,536.58 "," $11,383.20 "," $7,091.65 "," $6,513.28 ", N/A ," $5,909.85 "," $5,909.85 "," $12,722.40 "," $6,713.60 "," $1,013.84 "," $12,856.32 "
 Pro MRI Brain W/O Dye ,CPT® 70551,0972 - PRO FEE/RAD/DX,N/A,N/A, $873.00 , $567.45 ," $1,403.99 ", $200.99 , $418.18 ," $2,157.44 "," $2,269.88 ", $811.89 , $785.70 , $785.70 , $698.40 , $698.40 , $418.18 , $806.04 , $829.35 , $785.70 , $785.70 , $785.70 , $811.89 , $838.08 ," $2,474.12 ", $742.05 ," $2,474.96 "," $2,135.03 ", N/A ," $2,199.54 "," $2,199.54 ", $829.35 ," $2,587.69 ", $200.99 ," $2,587.69 "
 Fac Dbrdmt Nail Any Meth 6/> ,CPT® 11721,0761 - TREATMENT ROOM,N/A,N/A, $108.00 , $70.20 , $90.72 , $23.04 , $33.71 , $87.26 , $97.20 , $91.43 , $97.20 , $97.20 , $97.20 , $91.80 , $33.05 , $99.72 , $102.60 , $91.80 , $100.44 , $100.44 , $102.60 , $103.68 , $88.37 , $97.20 , $91.80 , $85.32 , N/A , $87.40 , $87.40 , $102.60 , $92.67 , $23.04 , $103.68 
 Fac Cath Plmt & Njx Coronary Art/Grft Angio Img S&I ,CPT® 93455,0481 - CARDIAC CATH LAB,N/A,N/A," $6,578.00 "," $4,275.70 "," $5,525.52 ", $978.61 , $744.66 ," $5,315.02 "," $5,920.20 "," $5,568.93 "," $5,920.20 "," $5,920.20 "," $5,920.20 "," $5,591.30 ", $730.06 ," $6,073.47 "," $6,249.10 "," $5,591.30 "," $6,117.54 "," $6,117.54 "," $6,249.10 "," $6,314.88 "," $5,382.12 "," $5,920.20 "," $5,591.30 "," $5,196.62 ", N/A ," $5,323.58 "," $5,323.58 "," $6,249.10 "," $5,644.58 ", $730.06 ," $6,314.88 "
"Knee Scope, Autograft Impant",CPT® 29866,N/A,N/A,N/A," $6,912.00 "," $4,492.80 "," $6,370.00 ", $998.03 , $894.47 ," $5,069.03 "," $5,031.99 "," $6,428.16 "," $6,220.80 "," $6,220.80 "," $5,529.60 "," $5,529.60 ", $894.47 ," $6,381.85 "," $6,566.40 "," $6,220.80 "," $6,220.80 "," $6,220.80 "," $6,428.16 "," $6,635.52 "," $5,925.73 "," $5,875.20 "," $5,562.71 "," $5,967.24 ", N/A ," $5,167.94 "," $5,167.94 "," $6,566.40 "," $6,074.16 ", $894.47 ," $6,635.52 "
"Repair Recurr Inguin Hern,Reducibl",49520,N/A,N/A,N/A," $4,096.00 "," $2,662.40 "," $3,788.14 ", $587.08 , $536.30 ," $2,964.45 "," $3,003.90 "," $3,809.28 "," $3,686.40 "," $3,686.40 "," $3,276.80 "," $3,276.80 ", $536.30 ," $3,781.84 "," $3,891.20 "," $3,686.40 "," $3,686.40 "," $3,686.40 "," $3,809.28 "," $3,932.16 "," $2,706.64 "," $3,481.60 "," $3,337.98 "," $3,500.59 ", N/A ," $3,022.29 "," $3,022.29 "," $3,891.20 "," $3,161.00 ", $536.30 ," $3,932.16 "
Mediastinoscopy Includes Mediastinal Mass Biopsy,CPT® 39401,N/A,N/A,N/A," $4,591.00 "," $2,984.15 "," $1,219.24 ", $278.77 , $246.33 ," $1,097.57 "," $1,079.98 "," $4,269.63 "," $4,131.90 "," $4,131.90 "," $3,672.80 "," $3,672.80 ", $246.33 ," $4,238.87 "," $4,361.45 "," $4,131.90 "," $4,131.90 "," $4,131.90 "," $4,269.63 "," $4,407.36 "," $1,664.50 "," $3,902.35 "," $1,609.91 "," $1,413.25 ", N/A ," $1,118.99 "," $1,118.99 "," $4,361.45 "," $1,297.00 ", $246.33 ," $4,407.36 "
Cryoablate Renal Mass Open Incl Intraop U/S,CPT® 50250,N/A,N/A,N/A," $8,487.00 "," $5,516.55 "," $6,574.44 "," $1,155.05 ", $989.35 ," $5,952.29 "," $5,543.24 "," $7,892.91 "," $7,638.30 "," $7,638.30 "," $6,789.60 "," $6,789.60 ", $989.35 ," $7,836.05 "," $8,062.65 "," $7,638.30 "," $7,638.30 "," $7,638.30 "," $7,892.91 "," $8,147.52 "," $6,601.38 "," $7,213.95 "," $6,279.91 "," $7,481.58 ", N/A ," $6,068.42 "," $6,068.42 "," $8,062.65 "," $7,132.56 ", $989.35 ," $8,147.52 "
Arthrocentesis-Major Jnt,20610,N/A,N/A,N/A, $467.00 , $303.55 , $274.69 , $42.73 , $65.94 , $223.70 , $219.57 , $434.31 , $420.30 , $420.30 , $373.60 , $373.60 , $65.94 , $431.18 , $443.65 , $420.30 , $420.30 , $420.30 , $434.31 , $448.32 , $257.37 , $396.95 , $240.85 , $264.61 , N/A , $228.06 , $228.06 , $443.65 , $268.04 , $42.73 , $448.32 
Infectious Agent Dna/Rna Influenza Ea Type,CPT® 87501,N/A,N/A,N/A, $363.00 , $235.95 , N/A , $52.34 , $52.34 , $290.31 , $347.29 , $337.59 , $326.70 , $326.70 , $290.40 , $290.40 , $52.34 , $335.16 , $344.85 , $326.70 , $326.70 , $326.70 , $337.59 , $348.48 , $342.61 , $308.55 , $335.72 , $186.06 , N/A , $270.94 , $270.94 , $344.85 , $296.08 , $52.34 , $348.48 
 MILRINONE LACTATE 10 MG/10ML IV SOLN ,HCPCS J2260,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9710-10,10 mL, $38.53 , $25.04 , $32.37 , $1.91 , $2.16 , $31.13 , $34.68 , $32.62 , $34.68 , $34.68 , $34.68 , $32.75 , $2.12 , $35.57 , $36.60 , $32.75 , $35.83 , $35.83 , $36.60 , $36.99 , $31.53 , $34.68 , $32.75 , $30.44 , N/A , $31.18 , $31.18 , $36.60 , $33.06 , $1.91 , $36.99 
 DIVALPROEX SODIUM 250 MG PO TBEC ,HCPCS RXC637,0250 - PHARMACY,00904-6860-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Hospital IP/Obs Discharge Day Mgmt > 30 Min,CPT® 99239,N/A,N/A,N/A, $421.00 , $273.65 , $210.48 , $111.29 , $106.65 , $185.68 , $185.45 , $391.53 , $378.90 , $378.90 , $336.80 , $336.80 , $106.65 , $388.71 , $399.95 , $378.90 , $378.90 , $378.90 , $391.53 , $404.16 , $268.26 , $357.85 , $231.03 , $236.64 , $133.00 , $189.30 , $189.30 , $399.95 , $218.32 , $106.65 , $404.16 
Egd Intraluminal Tube/Catheter Insertion,CPT® 43241,N/A,N/A,N/A," $1,304.00 ", $847.60 , $871.07 , $134.31 , $144.86 , $729.28 , $758.71 ," $1,212.72 "," $1,173.60 "," $1,173.60 "," $1,043.20 "," $1,043.20 ", $144.86 ," $1,203.98 "," $1,238.80 "," $1,173.60 "," $1,173.60 "," $1,173.60 "," $1,212.72 "," $1,251.84 ", $625.31 ," $1,108.40 ", $831.37 , $828.28 , N/A , $743.51 , $743.51 ," $1,238.80 ", $777.62 , $134.31 ," $1,251.84 "
 Pro Tobacco Use Cessation Intermediate 3-10 Minutes ,CPT® 99406,0982 - PRO FEE/OUTPT,N/A,N/A, $51.00 , $33.15 , $28.60 , $11.46 , N/A , $26.24 , $26.40 , $47.43 , $45.90 , $45.90 , $40.80 , $40.80 , N/A , $47.09 , $48.45 , $45.90 , $45.90 , $45.90 , $47.43 , $48.96 , $37.52 , $43.35 , $26.25 , $26.06 , N/A , $26.75 , $26.75 , $48.45 , $32.15 , $11.46 , $48.96 
 Fac Office/Outpatient New Sf Mdm 15-29 Minutes ,CPT® 99202,0510 - CLINIC,N/A,N/A, $185.00 , $120.25 , $155.40 , $46.48 , $50.34 , $149.48 , $166.50 , N/A , $166.50 , $166.50 , $166.50 , $157.25 , $49.35 , $170.81 , $175.75 , $157.25 , $172.05 , $172.05 , $175.75 , $177.60 , $151.37 , $166.50 , $157.25 , $146.15 , N/A , $149.72 , $149.72 , $175.75 , $158.75 , $46.48 , $177.60 
Insert Testicular Prosthesis,CPT® 54660,N/A,N/A,N/A," $1,964.00 "," $1,276.60 "," $1,593.02 ", $344.25 , $275.40 ," $1,145.88 "," $1,163.05 "," $1,826.52 "," $1,767.60 "," $1,767.60 "," $1,571.20 "," $1,571.20 ", $275.40 ," $1,813.36 "," $1,865.80 "," $1,767.60 "," $1,767.60 "," $1,767.60 "," $1,826.52 "," $1,885.44 "," $1,493.22 "," $1,669.40 "," $1,850.07 "," $1,733.91 ", N/A ," $1,168.24 "," $1,168.24 "," $1,865.80 "," $1,400.20 ", $275.40 ," $1,885.44 "
 Pro Perq Replacement Gtube Not Req Revj Gstrst Trc ,CPT® 43762,0981 - PRO FEE/ER,N/A,N/A, $357.00 , $232.05 , $223.34 , $34.45 , $176.61 , $167.82 , N/A , $332.01 , $321.30 , $321.30 , $285.60 , $285.60 , $176.61 , $329.62 , $339.15 , $321.30 , $321.30 , $321.30 , $332.01 , $342.72 , $163.07 , $303.45 , $193.69 , $214.15 , N/A , $171.09 , $171.09 , $339.15 , $178.94 , $34.45 , $342.72 
 ACETIC ACID 0.25 % IR SOLN ,HCPCS RXA250,0250 - PHARMACY,00990-6143-09,"1,000 mL", $30.83 , $20.04 , $25.90 , N/A , N/A , $24.91 , $27.75 , $26.10 , $27.75 , $27.75 , $27.75 , $26.21 , N/A , $28.47 , $29.29 , $26.21 , $28.67 , $28.67 , $29.29 , $29.60 , $25.23 , $27.75 , $26.21 , $24.36 , N/A , $24.95 , $24.95 , $29.29 , $26.46 , $24.36 , $29.60 
 Pro Remove Foreign Body From Eye ,CPT® 65205,0982 - PRO FEE/OUTPT,N/A,N/A, $421.00 , $273.65 , $180.70 , $28.20 , $35.23 , $251.30 , $232.46 , $391.53 , $378.90 , $378.90 , $336.80 , $336.80 , $35.23 , $388.71 , $399.95 , $378.90 , $378.90 , $378.90 , $391.53 , $404.16 , $248.64 , $357.85 , $239.06 , $319.55 , N/A , $256.20 , $256.20 , $399.95 , $282.82 , $28.20 , $404.16 
Thrombolysis Venous Infusion W/Imaging Init Tx,CPT® 37212,N/A,N/A,N/A," $2,217.00 "," $1,441.05 "," $2,006.23 ", $309.71 , $408.82 ," $1,528.29 "," $1,511.36 "," $2,061.81 "," $1,995.30 "," $1,995.30 "," $1,773.60 "," $1,773.60 ", $408.82 ," $2,046.96 "," $2,106.15 "," $1,995.30 "," $1,995.30 "," $1,995.30 "," $2,061.81 "," $2,128.32 "," $1,860.53 "," $1,884.45 "," $1,882.19 "," $1,666.75 ", N/A ," $1,558.12 "," $1,558.12 "," $2,106.15 "," $1,770.02 ", $309.71 ," $2,128.32 "
 Pro Rmv Foreign Body Ear ,CPT® 69200,0982 - PRO FEE/OUTPT,N/A,N/A, $711.00 , $462.15 , $222.00 , $45.22 , $46.62 , $277.17 , $286.82 , $661.23 , $639.90 , $639.90 , $568.80 , $568.80 , $46.62 , $656.47 , $675.45 , $639.90 , $639.90 , $639.90 , $661.23 , $682.56 , $241.42 , $604.35 , $312.21 , $230.70 , N/A , $282.58 , $282.58 , $675.45 , $322.66 , $45.22 , $682.56 
 Pro Inj Tendon Sheath/Ligament ,CPT® 20550,0981 - PRO FEE/ER,N/A,N/A, $384.00 , $249.60 , $99.25 , $37.19 , $27.51 , $203.30 , $199.04 , $357.12 , $345.60 , $345.60 , $307.20 , $307.20 , $27.51 , $354.55 , $364.80 , $345.60 , $345.60 , $345.60 , $357.12 , $368.64 , $222.72 , $326.40 , $215.87 , $227.07 , N/A , $207.26 , $207.26 , $364.80 , $243.62 , $27.51 , $368.64 
Drug Screen Quant Dipropylacetic Acid Free,CPT® 80165,N/A,N/A,N/A, $122.00 , $79.30 , N/A , $13.81 , $13.81 , $76.67 , $90.78 , $113.46 , $109.80 , $109.80 , $97.60 , $97.60 , $13.81 , $112.64 , $115.90 , $109.80 , $109.80 , $109.80 , $113.46 , $117.12 , $90.41 , $103.70 , $64.61 , $49.11 , N/A , $71.55 , $71.55 , $115.90 , $78.19 , $13.81 , $117.12 
 SODIUM CHLORIDE BACTERIOSTATIC 0.9 % IJ SOLN ,HCPCS RXA250,0250 - PHARMACY,00409-1966-07,30 mL, $16.68 , $10.84 , $14.01 , N/A , N/A , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , N/A , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $13.18 , $16.01 
 Pro Esophgl Funcj G-Esop Rflx Impd Eltrd Plmt ,CPT® 91037,0982 - PRO FEE/OUTPT,N/A,N/A, $794.00 , $516.10 , $404.14 , $166.18 , $132.55 , $358.37 , $387.96 , $738.42 , $714.60 , $714.60 , $635.20 , $635.20 , $132.55 , $733.10 , $754.30 , $714.60 , $714.60 , $714.60 , $738.42 , $762.24 , $755.60 , $674.90 , $513.95 , $612.40 , N/A , $365.36 , $365.36 , $754.30 , $425.94 , $132.55 , $762.24 
Percut Rx Tibia Shaft Fx,CPT® 27756,N/A,N/A,N/A," $4,389.00 "," $2,852.85 "," $3,545.75 ", $554.33 , $768.38 ," $2,782.84 "," $2,791.04 "," $4,081.77 "," $3,950.10 "," $3,950.10 "," $3,511.20 "," $3,511.20 ", $768.38 ," $4,052.36 "," $4,169.55 "," $3,950.10 "," $3,950.10 "," $3,950.10 "," $4,081.77 "," $4,213.44 "," $3,274.31 "," $3,730.65 "," $3,079.29 "," $3,299.59 ", N/A ," $2,837.13 "," $2,837.13 "," $4,169.55 "," $3,334.64 ", $554.33 ," $4,213.44 "
 Fac Intensity Modulated Radiation Tx Dlvr Simple ,CPT® 77385,0333 - RADIATION RX,N/A,N/A," $4,534.00 "," $2,947.10 "," $3,808.56 ", N/A , N/A ," $3,663.47 "," $4,080.60 "," $3,838.48 "," $4,080.60 "," $4,080.60 "," $4,080.60 "," $3,853.90 ", N/A ," $4,186.24 "," $4,307.30 "," $3,853.90 "," $4,216.62 "," $4,216.62 "," $4,307.30 "," $4,352.64 "," $3,709.72 "," $4,080.60 "," $3,853.90 "," $3,581.86 ", N/A ," $3,669.37 "," $3,669.37 "," $4,307.30 "," $3,890.63 "," $3,581.86 "," $4,352.64 "
Treat Great Toe Fracture,CPT® 28490,N/A,N/A,N/A, $959.00 , $623.35 , $772.46 , $123.06 , $85.41 , $611.90 , $626.73 , $891.87 , $863.10 , $863.10 , $767.20 , $767.20 , $85.41 , $885.44 , $911.05 , $863.10 , $863.10 , $863.10 , $891.87 , $920.64 , $710.88 , $815.15 , $681.51 , $728.10 , N/A , $623.83 , $623.83 , $911.05 , $733.23 , $85.41 , $920.64 
 Sinuses Min 3 Views Complete ,CPT® 70220,0320 - DX X-RAY,N/A,N/A, $382.00 , $248.30 , $320.88 , $37.05 , $37.18 , $308.66 , $343.80 , $323.40 , $343.80 , $343.80 , $343.80 , $324.70 , $36.45 , $352.70 , $362.90 , $324.70 , $355.26 , $355.26 , $362.90 , $366.72 , $312.55 , $343.80 , $324.70 , $301.78 , N/A , $309.15 , $309.15 , $362.90 , $327.79 , $36.45 , $366.72 
 Fac Dbrdmt W/Rmvl Fm Fx&/Dislc Skn&Subq Tiss ,CPT® 11010,0761 - TREATMENT ROOM,N/A,N/A," $1,953.00 "," $1,269.45 "," $1,640.52 ", $261.22 , $345.88 ," $1,578.02 "," $1,757.70 "," $1,653.41 "," $1,757.70 "," $1,757.70 "," $1,757.70 "," $1,660.05 ", $339.10 ," $1,803.20 "," $1,855.35 "," $1,660.05 "," $1,816.29 "," $1,816.29 "," $1,855.35 "," $1,874.88 "," $1,597.94 "," $1,757.70 "," $1,660.05 "," $1,542.87 ", N/A ," $1,580.56 "," $1,580.56 "," $1,855.35 "," $1,675.87 ", $261.22 ," $1,874.88 "
Endomysial Antibody Each Immunoglobulin Class,CPT® 86231,N/A,N/A,N/A, $155.00 , $100.75 , N/A , $12.33 , $12.29 , N/A , N/A , $144.15 , $139.50 , $139.50 , $124.00 , $124.00 , $12.29 , $143.11 , $147.25 , $139.50 , $139.50 , $139.50 , $144.15 , $148.80 , N/A , $131.75 , $58.15 , $35.51 , N/A , $47.39 , $47.39 , $147.25 , $52.11 , $12.29 , $148.80 
 Pro Treat Kneecap Fracture ,CPT® 27520,0982 - PRO FEE/OUTPT,N/A,N/A," $1,913.00 "," $1,243.45 "," $1,872.26 ", $296.68 , $195.27 ," $1,421.40 "," $1,446.93 "," $1,779.09 "," $1,721.70 "," $1,721.70 "," $1,530.40 "," $1,530.40 ", $195.27 ," $1,766.27 "," $1,817.35 "," $1,721.70 "," $1,721.70 "," $1,721.70 "," $1,779.09 "," $1,836.48 "," $1,721.73 "," $1,626.05 "," $1,589.60 "," $1,686.56 ", N/A ," $1,449.14 "," $1,449.14 "," $1,817.35 "," $1,703.25 ", $195.27 ," $1,872.26 "
 METHACHOLINE 5 MG/ML SYRINGE FOR INHALATION ,HCPCS RXA250,0250 - PHARMACY,00000-1098-02,3 mL, $72.13 , $46.88 , $60.59 , N/A , N/A , $58.28 , $64.92 , $61.07 , $64.92 , $64.92 , $64.92 , $61.31 , N/A , $66.60 , $68.52 , $61.31 , $67.08 , $67.08 , $68.52 , $69.24 , $59.02 , $64.92 , $61.31 , $56.98 , N/A , $58.37 , $58.37 , $68.52 , $61.89 , $56.98 , $69.24 
Incision Flex Toe Tendon,CPT® 28232,N/A,N/A,N/A," $2,630.00 "," $1,709.50 "," $1,495.26 ", $234.58 , $92.19 ," $1,198.78 "," $1,205.65 "," $2,445.90 "," $2,367.00 "," $2,367.00 "," $2,104.00 "," $2,104.00 ", $92.19 ," $2,428.28 "," $2,498.50 "," $2,367.00 "," $2,367.00 "," $2,367.00 "," $2,445.90 "," $2,524.80 "," $1,391.15 "," $2,235.50 "," $1,305.93 "," $1,427.25 ", N/A ," $1,222.18 "," $1,222.18 "," $2,498.50 "," $1,436.49 ", $92.19 ," $2,524.80 "
 Pro Cltx Intercondylar Spi&/Tubrst Fx Kne +-Mnpj ,CPT® 27538,0981 - PRO FEE/ER,N/A,N/A," $2,318.00 "," $1,506.70 "," $2,792.79 ", $438.31 , $307.34 ," $2,139.92 "," $2,153.40 "," $2,155.74 "," $2,086.20 "," $2,086.20 "," $1,854.40 "," $1,854.40 ", $307.34 ," $2,140.21 "," $2,202.10 "," $2,086.20 "," $2,086.20 "," $2,086.20 "," $2,155.74 "," $2,225.28 "," $2,565.24 "," $1,970.30 "," $2,369.24 "," $2,529.06 ", N/A ," $2,181.67 "," $2,181.67 "," $2,202.10 "," $2,564.24 ", $307.34 ," $2,792.79 "
Assay C-Peptide,CPT® 84681,N/A,N/A,N/A, $226.00 , $146.90 , N/A , $21.23 , $7.24 , $29.52 , $35.31 , $210.18 , $203.40 , $203.40 , $180.80 , $180.80 , $7.24 , $208.67 , $214.70 , $203.40 , $203.40 , $203.40 , $210.18 , $216.96 , $138.95 , $192.10 , $136.23 , $75.48 , N/A , $27.55 , $27.55 , $214.70 , $30.10 , $7.24 , $216.96 
"Knee Scope, Allograft Impant",CPT® 29867,N/A,N/A,N/A," $8,377.00 "," $5,445.05 "," $7,719.99 "," $1,208.41 "," $1,103.18 "," $6,181.32 "," $6,118.83 "," $7,790.61 "," $7,539.30 "," $7,539.30 "," $6,701.60 "," $6,701.60 "," $1,103.18 "," $7,734.48 "," $7,958.15 "," $7,539.30 "," $7,539.30 "," $7,539.30 "," $7,790.61 "," $8,041.92 "," $7,193.59 "," $7,120.45 "," $6,766.96 "," $7,267.87 ", N/A ," $6,301.93 "," $6,301.93 "," $7,958.15 "," $7,407.02 "," $1,103.18 "," $8,041.92 "
 GADOTERIDOL 279.3 MG/ML IV SOLN ,HCPCS A9579,0255 - DRUGS/RADIOLOGY,00270-1111-04,5 mL, $182.75 , $118.79 , $153.51 , $1.58 , $4.89 , $147.66 , $164.48 , $154.72 , $164.48 , $164.48 , $164.48 , $155.34 , $4.79 , $168.73 , $173.61 , $155.34 , $169.96 , $169.96 , $173.61 , $175.44 , $149.53 , $164.48 , $155.34 , $144.37 , N/A , $147.90 , $147.90 , $173.61 , $156.82 , $1.58 , $175.44 
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 2/3 Vw,CPT® 72082,N/A,N/A,N/A, $553.00 , $359.45 , $478.87 , $69.17 , $48.93 , $296.57 , $312.80 , $514.29 , $497.70 , $497.70 , $442.40 , $442.40 , $48.93 , $510.58 , $525.35 , $497.70 , $497.70 , $497.70 , $514.29 , $530.88 , $385.25 , $470.05 , $404.77 , $314.23 , N/A , $302.36 , $302.36 , $525.35 , $349.97 , $48.93 , $530.88 
Iadna Ehrlichia Chaffeensis Amplified Probe Tq,CPT® 87484,N/A,N/A,N/A, $53.00 , $34.45 , N/A , $35.79 , $35.79 , N/A , N/A , $49.29 , $47.70 , $47.70 , $42.40 , $42.40 , $35.79 , $48.93 , $50.35 , $47.70 , $47.70 , $47.70 , $49.29 , $50.88 , N/A , $45.05 , $168.00 , N/A , N/A , $137.55 , $137.55 , $50.35 , $151.24 , $35.79 , $168.00 
Sumatriptan Succinate / 6 Mg,HCPCS J3030,N/A,N/A,N/A, $149.00 , $96.85 , N/A , N/A , $52.93 , N/A , N/A , $138.57 , $134.10 , $134.10 , $119.20 , $119.20 , $52.93 , $137.57 , $141.55 , $134.10 , $134.10 , $134.10 , $138.57 , $143.04 , N/A , $126.65 , $103.80 , $32.60 , N/A , N/A , N/A , $141.55 , N/A , $32.60 , $143.04 
 POTASSIUM PHOSPHATES 15 MMOLE/5ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,65219-0052-29,5 mL, $147.82 , $96.08 , $124.17 , N/A , N/A , $119.44 , $133.04 , $125.14 , $133.04 , $133.04 , $133.04 , $125.65 , N/A , $136.48 , $140.43 , $125.65 , $137.47 , $137.47 , $140.43 , $141.91 , $120.95 , $133.04 , $125.65 , $116.78 , N/A , $119.63 , $119.63 , $140.43 , $126.84 , $116.78 , $141.91 
"Peri-Proc Prog Eval Implant Device,Cardvert/Defib",93287,N/A,N/A,N/A, $347.00 , $225.55 , $348.99 , $52.88 , $34.25 , $195.33 , $195.39 , $322.71 , $312.30 , $312.30 , $277.60 , $277.60 , $34.25 , $320.39 , $329.65 , $312.30 , $312.30 , $312.30 , $322.71 , $333.12 , $324.20 , $294.95 , $181.97 , $144.09 , N/A , $199.14 , $199.14 , $329.65 , $220.75 , $34.25 , $348.99 
Drain Peri-Bladder Abscess,CPT® 51080,N/A,N/A,N/A," $2,852.00 "," $1,853.80 "," $2,221.46 ", $392.21 , $768.38 ," $1,997.43 "," $1,869.26 "," $2,652.36 "," $2,566.80 "," $2,566.80 "," $2,281.60 "," $2,281.60 ", $768.38 ," $2,633.25 "," $2,709.40 "," $2,566.80 "," $2,566.80 "," $2,566.80 "," $2,652.36 "," $2,737.92 "," $2,227.48 "," $2,424.20 "," $2,115.90 "," $2,518.04 ", N/A ," $2,036.40 "," $2,036.40 "," $2,709.40 "," $2,393.50 ", $392.21 ," $2,737.92 "
"Stereotactic Radiosurgery, Spinal, Single Lesion",CPT® 63620,N/A,N/A,N/A," $7,162.00 "," $4,655.30 "," $5,138.54 "," $1,007.10 ", $668.75 ," $6,022.15 "," $5,746.33 "," $6,660.66 "," $6,445.80 "," $6,445.80 "," $5,729.60 "," $5,729.60 ", $668.75 ," $6,612.67 "," $6,803.90 "," $6,445.80 "," $6,445.80 "," $6,445.80 "," $6,660.66 "," $6,875.52 "," $5,545.97 "," $6,087.70 "," $5,873.14 "," $6,263.04 ", N/A ," $6,139.65 "," $6,139.65 "," $6,803.90 "," $6,586.41 ", $668.75 ," $6,875.52 "
 Fac Assay of Thyroglobulin ,CPT® 84432,0301 - LAB/CHEMISTRY,N/A,N/A, $181.00 , $117.65 , $152.04 , $16.38 , $16.38 , $146.25 , $162.90 , $153.23 , $162.90 , $162.90 , $162.90 , $153.85 , $16.06 , $167.12 , $171.95 , $153.85 , $168.33 , $168.33 , $171.95 , $173.76 , $148.09 , $162.90 , $153.85 , $142.99 , N/A , $146.48 , $146.48 , $171.95 , $155.32 , $16.06 , $173.76 
Insj Intraperitoneal Catheter W/Img Guid,CPT® 49418,N/A,N/A,N/A," $10,735.00 "," $6,977.75 "," $1,233.12 ", $190.80 , $168.01 ," $1,063.67 "," $1,079.38 "," $9,983.55 "," $9,661.50 "," $9,661.50 "," $8,588.00 "," $8,588.00 ", $168.01 ," $9,911.63 "," $10,198.25 "," $9,661.50 "," $9,661.50 "," $9,661.50 "," $9,983.55 "," $10,305.60 ", $890.50 ," $9,124.75 "," $1,182.83 "," $1,184.78 ", N/A ," $1,084.42 "," $1,084.42 "," $10,198.25 "," $1,134.18 ", $168.01 ," $10,305.60 "
 Fac Ambulatory Bp Mntr W/Sw 24 Hr+ Scanning a/R ,CPT® 93788,0480 - CARDIOLOGY,N/A,N/A, $368.00 , $239.20 , $309.12 , $5.04 , $18.55 , $297.34 , $331.20 , $311.55 , $331.20 , $331.20 , $331.20 , $312.80 , $18.19 , $339.77 , $349.60 , $312.80 , $342.24 , $342.24 , $349.60 , $353.28 , $301.10 , $331.20 , $312.80 , $290.72 , N/A , $297.82 , $297.82 , $349.60 , $315.78 , $5.04 , $353.28 
"Shav Skin Les 6-10mm Face,Facial",11311,N/A,N/A,N/A, $502.00 , $326.30 , $200.87 , $60.34 , $74.81 , $180.78 , $174.29 , $466.86 , $451.80 , $451.80 , $401.60 , $401.60 , $74.81 , $463.50 , $476.90 , $451.80 , $451.80 , $451.80 , $466.86 , $481.92 , $222.33 , $426.70 , $346.11 , $230.29 , N/A , $184.31 , $184.31 , $476.90 , $213.76 , $60.34 , $481.92 
 GLUCOSE 4 G CHEW TABS (INPT) ,HCPCS RXC637,0250 - PHARMACY,56151-1610-11,1 tablet, $10.23 , $6.65 , $8.59 , N/A , N/A , $8.27 , $9.21 , $8.66 , $9.21 , $9.21 , $9.21 , $8.70 , N/A , $9.45 , $9.72 , $8.70 , $9.51 , $9.51 , $9.72 , $9.82 , $8.37 , $9.21 , $8.70 , $8.08 , N/A , $8.28 , $8.28 , $9.72 , $8.78 , $8.08 , $9.82 
"Colposcopy,Entire Vagina,W/Biopsy(S)",CPT® 57421,N/A,N/A,N/A, $937.00 , $609.05 , $566.50 , $114.42 , $216.39 , $506.03 , $497.61 , $871.41 , $843.30 , $843.30 , $749.60 , $749.60 , $216.39 , $865.13 , $890.15 , $843.30 , $843.30 , $843.30 , $871.41 , $899.52 , $594.66 , $796.45 , $654.75 , $505.42 , N/A , $515.90 , $515.90 , $890.15 , $618.80 , $114.42 , $899.52 
 Fac Vc Tot Spx ,CPT® 94150,0460 - PULMONARY FUNC,N/A,N/A, $279.00 , $181.35 , $234.36 , $23.98 , $19.53 , $225.43 , $251.10 , $236.20 , $251.10 , $251.10 , $251.10 , $237.15 , $19.15 , $257.60 , $265.05 , $237.15 , $259.47 , $259.47 , $265.05 , $267.84 , $228.28 , $251.10 , $237.15 , $220.41 , N/A , $225.79 , $225.79 , $265.05 , $239.41 , $19.15 , $267.84 
 Fac Amp Foot Transmetar ,CPT® 28805,0360 - OR SERVICES,N/A,N/A," $10,638.00 "," $6,914.70 "," $8,935.92 ", $677.03 , $537.90 ," $8,595.50 "," $9,574.20 "," $9,006.13 "," $9,574.20 "," $9,574.20 "," $9,574.20 "," $9,042.30 ", $527.35 ," $9,822.07 "," $10,106.10 "," $9,042.30 "," $9,893.34 "," $9,893.34 "," $10,106.10 "," $10,212.48 "," $8,704.01 "," $9,574.20 "," $9,042.30 "," $8,404.02 ", N/A ," $8,609.33 "," $8,609.33 "," $10,106.10 "," $9,128.47 ", $527.35 ," $10,212.48 "
 OB Greater or Equal to 14 Weeks Each Gestat ,CPT® 76810,0402 - ULTRASOUND,N/A,N/A, $350.00 , $227.50 , $294.00 , $87.61 , $94.79 , $282.80 , $315.00 , $296.31 , $315.00 , $315.00 , $315.00 , $297.50 , $92.93 , $323.16 , $332.50 , $297.50 , $325.50 , $325.50 , $332.50 , $336.00 , $286.37 , $315.00 , $297.50 , $276.50 , N/A , $283.26 , $283.26 , $332.50 , $300.34 , $87.61 , $336.00 
 KCL IN DEXTROSE-NACL 30-5-0.45 MEQ/L-%-% IV SOLN ,HCPCS RXA258,0258 - IV SOLUTIONS,00990-7903-09,"1,000 mL", $119.72 , $77.82 , $100.56 , N/A , N/A , $96.73 , $107.75 , $101.35 , $107.75 , $107.75 , $107.75 , $101.76 , N/A , $110.54 , $113.73 , $101.76 , $111.34 , $111.34 , $113.73 , $114.93 , $97.95 , $107.75 , $101.76 , $94.58 , N/A , $96.89 , $96.89 , $113.73 , $102.73 , $94.58 , $114.93 
Insertion Central Vencath,36556,N/A,N/A,N/A, $874.00 , $568.10 , $514.22 , $79.62 , $322.67 , $528.55 , $516.83 , $812.82 , $786.60 , $786.60 , $699.20 , $699.20 , $322.67 , $806.96 , $830.30 , $786.60 , $786.60 , $786.60 , $812.82 , $839.04 , $476.45 , $742.90 , $636.91 , $489.07 , N/A , $538.87 , $538.87 , $830.30 , $612.15 , $79.62 , $839.04 
 Fac Drug Screen Quantitative Caffeine ,CPT® 80155,0301 - LAB/CHEMISTRY,N/A,N/A, $159.00 , $103.35 , $133.56 , $39.34 , $15.75 , $128.47 , $143.10 , $134.61 , $143.10 , $143.10 , $143.10 , $135.15 , $15.44 , $146.80 , $151.05 , $135.15 , $147.87 , $147.87 , $151.05 , $152.64 , $130.09 , $143.10 , $135.15 , $125.61 , N/A , $128.68 , $128.68 , $151.05 , $136.44 , $15.44 , $152.64 
Imp Spinal Canal Cath,CPT® 62350,N/A,N/A,N/A," $2,650.00 "," $1,722.50 "," $1,921.14 ", $375.49 , $340.77 ," $2,219.22 "," $2,165.23 "," $2,464.50 "," $2,385.00 "," $2,385.00 "," $2,120.00 "," $2,120.00 ", $340.77 ," $2,446.75 "," $2,517.50 "," $2,385.00 "," $2,385.00 "," $2,385.00 "," $2,464.50 "," $2,544.00 "," $2,081.59 "," $2,252.50 "," $2,146.23 "," $2,348.31 ", N/A ," $2,262.52 "," $2,262.52 "," $2,517.50 "," $2,427.14 ", $340.77 ," $2,544.00 "
" Fac Immunoassay, Ria ",CPT® 83520,0301 - LAB/CHEMISTRY,N/A,N/A, $227.00 , $147.55 , $190.68 , $17.62 , $17.62 , $183.42 , $204.30 , $192.18 , $204.30 , $204.30 , $204.30 , $192.95 , $17.27 , $209.59 , $215.65 , $192.95 , $211.11 , $211.11 , $215.65 , $217.92 , $185.73 , $204.30 , $192.95 , $179.33 , N/A , $183.71 , $183.71 , $215.65 , $194.79 , $17.27 , $217.92 
Open Harvest Upper Extremity Art 1 Segment Cab,CPT® 35600,N/A,N/A,N/A," $3,083.00 "," $2,003.95 "," $1,080.95 ", $165.93 ," $1,789.31 "," $1,093.71 "," $1,084.61 "," $2,867.19 "," $2,774.70 "," $2,774.70 "," $2,466.40 "," $2,466.40 "," $1,789.31 "," $2,846.53 "," $2,928.85 "," $2,774.70 "," $2,774.70 "," $2,774.70 "," $2,867.19 "," $2,959.68 "," $1,377.80 "," $2,620.55 "," $1,377.30 "," $1,222.56 ", N/A ," $1,115.05 "," $1,115.05 "," $2,928.85 "," $1,266.71 ", $165.93 ," $2,959.68 "
 Fac Prq Cholecstost ,CPT® 47490,0750 - GASTR-INST SVS,N/A,N/A," $10,116.00 "," $6,575.40 "," $8,497.44 ", $320.90 , $457.32 ," $8,173.73 "," $9,104.40 "," $8,564.21 "," $9,104.40 "," $9,104.40 "," $9,104.40 "," $8,598.60 ", $448.35 ," $9,340.10 "," $9,610.20 "," $8,598.60 "," $9,407.88 "," $9,407.88 "," $9,610.20 "," $9,711.36 "," $8,276.91 "," $9,104.40 "," $8,598.60 "," $7,991.64 ", N/A ," $8,186.88 "," $8,186.88 "," $9,610.20 "," $8,680.54 ", $320.90 ," $9,711.36 "
 Fac Foot Longitud/Metatarsal Sup ,HCPCS L3020,0274 - PROSTHETIC DEV,N/A,N/A, $721.00 , $468.65 , $605.64 , $232.08 , $93.57 , $582.57 , $648.90 , $610.40 , $648.90 , $648.90 , $648.90 , $612.85 , $91.74 , $665.70 , $684.95 , $612.85 , $670.53 , $670.53 , $684.95 , $692.16 , $589.92 , $648.90 , $612.85 , $569.59 , N/A , $583.51 , $583.51 , $684.95 , $618.69 , $91.74 , $692.16 
"Yellow Fever Immunizatn,Live,Subcut",CPT® 90717,N/A,N/A,N/A, $259.00 , $168.35 , N/A , N/A , $88.22 , $188.65 , $218.17 , $240.87 , $233.10 , $233.10 , $207.20 , $207.20 , $88.22 , $239.13 , $246.05 , $233.10 , $233.10 , $233.10 , $240.87 , $248.64 , N/A , $220.15 , $212.88 , $242.65 , N/A , $192.33 , $192.33 , $246.05 , $224.20 , $88.22 , $248.64 
 Fac Trg@ Gene Rearrangement Analysis ,CPT® 81342,0310 - PATHOLOGY LAB,N/A,N/A," $1,753.00 "," $1,139.45 "," $1,472.52 ", $205.53 , $205.53 ," $1,416.42 "," $1,577.70 "," $1,484.09 "," $1,577.70 "," $1,577.70 "," $1,577.70 "," $1,490.05 ", $201.50 ," $1,618.54 "," $1,665.35 "," $1,490.05 "," $1,630.29 "," $1,630.29 "," $1,665.35 "," $1,682.88 "," $1,434.30 "," $1,577.70 "," $1,490.05 "," $1,384.87 ", N/A ," $1,418.70 "," $1,418.70 "," $1,665.35 "," $1,504.25 ", $201.50 ," $1,682.88 "
 RIFAXIMIN 550 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,65649-0303-03,1 tablet, $324.63 , $211.01 , $272.69 , N/A , N/A , $262.30 , $292.17 , $274.83 , $292.17 , $292.17 , $292.17 , $275.94 , N/A , $299.73 , $308.40 , $275.94 , $301.91 , $301.91 , $308.40 , $311.64 , $265.61 , $292.17 , $275.94 , $256.46 , N/A , $262.72 , $262.72 , $308.40 , $278.57 , $256.46 , $311.64 
Exc Tumor Soft Tissue Thigh/Knee Subfasc 5+Cm,27339,N/A,N/A,N/A," $5,818.00 "," $3,781.70 "," $4,545.32 ", $707.82 , $618.82 ," $3,616.46 "," $3,590.82 "," $5,410.74 "," $5,236.20 "," $5,236.20 "," $4,654.40 "," $4,654.40 ", $618.82 ," $5,371.76 "," $5,527.10 "," $5,236.20 "," $5,236.20 "," $5,236.20 "," $5,410.74 "," $5,585.28 "," $4,210.08 "," $4,945.30 "," $3,978.46 "," $4,247.73 ", N/A ," $3,687.03 "," $3,687.03 "," $5,527.10 "," $4,333.59 ", $618.82 ," $5,585.28 "
 Fac Aep Hearing Status Deter Broadband Stimuli I&R ,CPT® 92651,0470 - AUDIOLOGY,N/A,N/A, $297.00 , $193.05 , $249.48 , $83.93 , $70.43 , $239.98 , $267.30 , $251.44 , $267.30 , $267.30 , $267.30 , $252.45 , $69.05 , $274.22 , $282.15 , $252.45 , $276.21 , $276.21 , $282.15 , $285.12 , $243.01 , $267.30 , $252.45 , $234.63 , N/A , $240.36 , $240.36 , $282.15 , $254.86 , $69.05 , $285.12 
 Fac Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 2/3 Vw ,CPT® 72082,0320 - DX X-RAY,N/A,N/A, $671.00 , $436.15 , $563.64 , $69.17 , $48.93 , $542.17 , $603.90 , $568.07 , $603.90 , $603.90 , $603.90 , $570.35 , $47.97 , $619.53 , $637.45 , $570.35 , $624.03 , $624.03 , $637.45 , $644.16 , $549.01 , $603.90 , $570.35 , $530.09 , N/A , $543.04 , $543.04 , $637.45 , $575.79 , $47.97 , $644.16 
"Inj., Tildrakizumab, 1 Mg",HCPCS J3245,N/A,N/A,N/A, $345.00 , $224.25 , N/A , $146.14 , $140.59 , N/A , N/A , $320.85 , $310.50 , $310.50 , $276.00 , $276.00 , $140.59 , $318.54 , $327.75 , $310.50 , $310.50 , $310.50 , $320.85 , $331.20 , $175.98 , $293.25 , $262.34 , $181.62 , N/A , N/A , N/A , $327.75 , N/A , $140.59 , $331.20 
" Pro Rep Smpl Wnd Face, Eyelids,Nose,Ears,Lips 2.5cm or Less ",CPT® 12011,0982 - PRO FEE/OUTPT,N/A,N/A, $685.00 , $445.25 , $172.01 , $51.31 , $66.00 , $150.86 , $147.21 , $637.05 , $616.50 , $616.50 , $548.00 , $548.00 , $66.00 , $632.46 , $650.75 , $616.50 , $616.50 , $616.50 , $637.05 , $657.60 , $189.71 , $582.25 , $296.15 , $192.22 , N/A , $153.81 , $153.81 , $650.75 , $178.36 , $51.31 , $657.60 
Assay Magnesium,CPT® 83735,N/A,N/A,N/A, $80.00 , $52.00 , N/A , $6.83 , $6.83 , $37.88 , $45.34 , $74.40 , $72.00 , $72.00 , $64.00 , $64.00 , $6.83 , $73.86 , $76.00 , $72.00 , $72.00 , $72.00 , $74.40 , $76.80 , $44.74 , $68.00 , $43.79 , $24.29 , N/A , $35.35 , $35.35 , $76.00 , $38.63 , $6.83 , $76.80 
 PENICILLIN V POTASSIUM 250 MG/5ML PO SOLR ,HCPCS RXA250,0250 - PHARMACY,00093-4127-73,100 mL, $57.54 , $37.40 , $48.33 , N/A , N/A , $46.49 , $51.79 , $48.71 , $51.79 , $51.79 , $51.79 , $48.91 , N/A , $53.13 , $54.66 , $48.91 , $53.51 , $53.51 , $54.66 , $55.24 , $47.08 , $51.79 , $48.91 , $45.46 , N/A , $46.57 , $46.57 , $54.66 , $49.38 , $45.46 , $55.24 
 IPRATROPIUM BROMIDE 0.02 % INH SOLN ,HCPCS RXC637,0250 - PHARMACY,00487-9801-01,2.5 mL, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
" Fac Immuniz Admin, Thru Age 18, Any Route,W Counsel, 1st Vaccine/Toxoid ",CPT® 90460,0771 - VACCINE ADMINISTRATION,N/A,N/A, $94.00 , $61.10 , $78.96 , $21.97 , N/A , $75.95 , $84.60 , $79.58 , $84.60 , $84.60 , $84.60 , $79.90 , N/A , $86.79 , $89.30 , $79.90 , $87.42 , $87.42 , $89.30 , $90.24 , $76.91 , $84.60 , $79.90 , $74.26 , N/A , $76.07 , $76.07 , $89.30 , $80.66 , $21.97 , $90.24 
Flt3 Gene Anlys Tyrosine Kinase Domain Variants,CPT® 81246,N/A,N/A,N/A, $626.00 , $406.90 , N/A , $84.66 , $84.66 , N/A , N/A , $582.18 , $563.40 , $563.40 , $500.80 , $500.80 , $84.66 , $577.99 , $594.70 , $563.40 , $563.40 , $563.40 , $582.18 , $600.96 , $554.21 , $532.10 , $395.77 , $243.77 , N/A , $329.51 , $329.51 , $594.70 , $359.39 , $84.66 , $600.96 
 Fac Bcr/Abl1 Major Breakpnt Qualitative/Quantitative ,CPT® 81206,0310 - PATHOLOGY LAB,N/A,N/A," $1,514.00 ", $984.10 ," $1,271.76 ", $167.24 , $167.24 ," $1,223.31 "," $1,362.60 "," $1,281.75 "," $1,362.60 "," $1,362.60 "," $1,362.60 "," $1,286.90 ", $163.96 ," $1,397.88 "," $1,438.30 "," $1,286.90 "," $1,408.02 "," $1,408.02 "," $1,438.30 "," $1,453.44 "," $1,238.75 "," $1,362.60 "," $1,286.90 "," $1,196.06 ", N/A ," $1,225.28 "," $1,225.28 "," $1,438.30 "," $1,299.16 ", $163.96 ," $1,453.44 "
 POLIDOCANOL 0.5 % IV SOLN ,HCPCS RXA250,0250 - PHARMACY,67850-0140-05,2 mL, $121.44 , $78.94 , $102.01 , N/A , N/A , $98.12 , $109.30 , $102.81 , $109.30 , $109.30 , $109.30 , $103.22 , N/A , $112.13 , $115.37 , $103.22 , $112.94 , $112.94 , $115.37 , $116.58 , $99.36 , $109.30 , $103.22 , $95.94 , N/A , $98.28 , $98.28 , $115.37 , $104.21 , $95.94 , $116.58 
"CT Scan,Abdomen and Pelvis,W Contrast",CPT® 74177,N/A,N/A,N/A," $5,321.00 "," $3,458.65 "," $2,205.84 ", $313.11 , $252.11 ," $1,484.35 "," $1,762.67 "," $4,948.53 "," $4,788.90 "," $4,788.90 "," $4,256.80 "," $4,256.80 ", $252.11 ," $4,912.88 "," $5,054.95 "," $4,788.90 "," $4,788.90 "," $4,788.90 "," $4,948.53 "," $5,108.16 "," $1,837.67 "," $4,522.85 "," $1,979.97 "," $2,023.91 ", N/A ," $1,513.31 "," $1,513.31 "," $5,054.95 "," $1,751.68 ", $252.11 ," $5,108.16 "
 CARBIDOPA-LEVODOPA 10-100 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,62756-0517-88,1 tablet, $3.65 , $2.37 , $3.07 , N/A , N/A , $2.95 , $3.29 , $3.09 , $3.29 , $3.29 , $3.29 , $3.10 , N/A , $3.37 , $3.47 , $3.10 , $3.39 , $3.39 , $3.47 , $3.50 , $2.99 , $3.29 , $3.10 , $2.88 , N/A , $2.95 , $2.95 , $3.47 , $3.13 , $2.88 , $3.50 
 FENTANYL 75 MCG/HR TD PT72 ,HCPCS RXC637,0250 - PHARMACY,60505-7083-02,1 patch, $304.65 , $198.02 , $255.91 , N/A , N/A , $246.16 , $274.19 , $257.92 , $274.19 , $274.19 , $274.19 , $258.95 , N/A , $281.28 , $289.42 , $258.95 , $283.32 , $283.32 , $289.42 , $292.46 , $249.26 , $274.19 , $258.95 , $240.67 , N/A , $246.55 , $246.55 , $289.42 , $261.42 , $240.67 , $292.46 
 AZTREONAM 2 G IJ SOLR ,HCPCS J0457,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0402-20,20 mL, $451.91 , $293.74 , $379.60 , N/A , N/A , $365.14 , $406.72 , $382.59 , $406.72 , $406.72 , $406.72 , $384.12 , N/A , $417.25 , $429.31 , $384.12 , $420.28 , $420.28 , $429.31 , $433.83 , $369.75 , $406.72 , $384.12 , $357.01 , N/A , $365.73 , $365.73 , $429.31 , $387.78 , $357.01 , $433.83 
 Pro Explore/Treat Wrist Joint ,CPT® 25040,0982 - PRO FEE/OUTPT,N/A,N/A," $3,724.00 "," $2,420.60 "," $3,425.24 ", $537.67 , $614.70 ," $2,711.40 "," $2,701.18 "," $3,463.32 "," $3,351.60 "," $3,351.60 "," $2,979.20 "," $2,979.20 ", $614.70 ," $3,438.37 "," $3,537.80 "," $3,351.60 "," $3,351.60 "," $3,351.60 "," $3,463.32 "," $3,575.04 "," $3,186.76 "," $3,165.40 "," $2,972.25 "," $3,209.20 ", N/A ," $2,764.30 "," $2,764.30 "," $3,537.80 "," $3,249.04 ", $537.67 ," $3,575.04 "
" Fac Infectious Agent Dna/Rna Influenza >2 Types, Ea Add ",CPT® 87503,0306 - LAB/BACT-MICRO,N/A,N/A, $209.00 , $135.85 , $175.56 , $29.80 , $28.83 , $168.87 , $188.10 , $176.94 , $188.10 , $188.10 , $188.10 , $177.65 , $28.26 , $192.97 , $198.55 , $177.65 , $194.37 , $194.37 , $198.55 , $200.64 , $171.00 , $188.10 , $177.65 , $165.11 , N/A , $169.14 , $169.14 , $198.55 , $179.34 , $28.26 , $200.64 
Insj Tunneled Ctr Vad W/Subq Port Age 5 Yr/>,36561,N/A,N/A,N/A," $7,501.00 "," $4,875.65 "," $2,016.17 ", $311.47 ," $1,557.13 "," $1,534.48 "," $1,527.96 "," $6,975.93 "," $6,750.90 "," $6,750.90 "," $6,000.80 "," $6,000.80 "," $1,557.13 "," $6,925.67 "," $7,125.95 "," $6,750.90 "," $6,750.90 "," $6,750.90 "," $6,975.93 "," $7,200.96 "," $1,865.19 "," $6,375.85 "," $1,901.81 "," $1,665.73 ", N/A ," $1,564.42 "," $1,564.42 "," $7,125.95 "," $1,777.17 ", $311.47 ," $7,200.96 "
" Pro Partial Removal, Finger Bone ",CPT® 26236,0975 - PRO FEE/OR,N/A,N/A," $1,674.00 "," $1,088.10 "," $2,714.99 ", $426.37 , $307.34 ," $2,121.75 "," $2,123.66 "," $1,556.82 "," $1,506.60 "," $1,506.60 "," $1,339.20 "," $1,339.20 ", $307.34 ," $1,545.60 "," $1,590.30 "," $1,506.60 "," $1,506.60 "," $1,506.60 "," $1,556.82 "," $1,607.04 "," $2,519.51 "," $1,422.90 "," $2,333.56 "," $2,521.61 ", N/A ," $2,163.15 "," $2,163.15 "," $1,590.30 "," $2,542.45 ", $307.34 ," $2,714.99 "
 Fac Cor Ffr Derived Cta Data Prep & Transmis ,CPT® 0502T,0350 - CT SCAN,N/A,N/A, $121.00 , $78.65 , $101.64 , N/A , N/A , $97.77 , $108.90 , $102.44 , $108.90 , $108.90 , $108.90 , $102.85 , N/A , $111.72 , $114.95 , $102.85 , $112.53 , $112.53 , $114.95 , $116.16 , $99.00 , $108.90 , $102.85 , $95.59 , N/A , $97.93 , $97.93 , $114.95 , $103.83 , $95.59 , $116.16 
X-Ray Sterno-Clavicluar Jt,CPT® 71130,N/A,N/A,N/A, $392.00 , $254.80 , $234.44 , $40.66 , $35.69 , $170.62 , $198.13 , $364.56 , $352.80 , $352.80 , $313.60 , $313.60 , $35.69 , $361.93 , $372.40 , $352.80 , $352.80 , $352.80 , $364.56 , $376.32 , $227.90 , $333.20 , $217.64 , $182.12 , N/A , $173.95 , $173.95 , $372.40 , $201.34 , $35.69 , $376.32 
" Pro CT Scan,Abdomen and Pelvis,Combo ",CPT® 74178,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,132.00 ", $735.80 ," $2,470.93 ", $350.88 , $319.24 ," $1,680.49 "," $2,072.72 "," $1,052.76 "," $1,018.80 "," $1,018.80 ", $905.60 , $905.60 , $319.24 ," $1,045.18 "," $1,075.40 "," $1,018.80 "," $1,018.80 "," $1,018.80 "," $1,052.76 "," $1,086.72 "," $2,062.13 ", $962.20 ," $2,318.95 "," $2,291.05 ", N/A ," $1,713.28 "," $1,713.28 "," $1,075.40 "," $1,983.16 ", $319.24 ," $2,470.93 "
 Fac Arthrocentesis Aspir&/Inj Interm Jt/Burs W/US ,CPT® 20606,0761 - TREATMENT ROOM,N/A,N/A," $1,971.00 "," $1,281.15 "," $1,655.64 ", $49.66 , $62.45 ," $1,592.57 "," $1,773.90 "," $1,668.65 "," $1,773.90 "," $1,773.90 "," $1,773.90 "," $1,675.35 ", $61.23 ," $1,819.82 "," $1,872.45 "," $1,675.35 "," $1,833.03 "," $1,833.03 "," $1,872.45 "," $1,892.16 "," $1,612.67 "," $1,773.90 "," $1,675.35 "," $1,557.09 ", N/A ," $1,595.13 "," $1,595.13 "," $1,872.45 "," $1,691.32 ", $49.66 ," $1,892.16 "
Abscess or Hematoma Ear,CPT® 69000,N/A,N/A,N/A," $1,057.00 ", $687.05 , $587.55 , $120.89 , $30.71 , $571.83 , $595.04 , $983.01 , $951.30 , $951.30 , $845.60 , $845.60 , $30.71 , $975.93 ," $1,004.15 ", $951.30 , $951.30 , $951.30 , $983.01 ," $1,014.72 ", $631.71 , $898.45 , $649.40 , $582.65 , N/A , $582.99 , $582.99 ," $1,004.15 ", $665.66 , $30.71 ," $1,014.72 "
 Fac Prolact +4 H2mf per Ml ,Custom 2200000004,0220 - SPECIAL CHARGES,N/A,N/A, $32.00 , $20.80 , $26.88 , N/A , N/A , $25.86 , $28.80 , $27.09 , $28.80 , $28.80 , $28.80 , $27.20 , N/A , $29.55 , $30.40 , $27.20 , $29.76 , $29.76 , $30.40 , $30.72 , $26.18 , $28.80 , $27.20 , $25.28 , N/A , $25.90 , $25.90 , $30.40 , $27.46 , $25.28 , $30.72 
 METHADONE HCL 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6530-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 C Spine CT Without Contrast ,CPT® 72125,0350 - CT SCAN,N/A,N/A," $2,271.00 "," $1,476.15 "," $1,907.64 ", $132.63 , $250.57 ," $1,834.97 "," $2,043.90 "," $1,922.63 "," $2,043.90 "," $2,043.90 "," $2,043.90 "," $1,930.35 ", $245.66 ," $2,096.81 "," $2,157.45 "," $1,930.35 "," $2,112.03 "," $2,112.03 "," $2,157.45 "," $2,180.16 "," $1,858.13 "," $2,043.90 "," $1,930.35 "," $1,794.09 ", N/A ," $1,837.92 "," $1,837.92 "," $2,157.45 "," $1,948.75 ", $132.63 ," $2,180.16 "
 Fac Esophagoscopy Flexible Removal Foreign Body ,CPT® 43215,0360 - OR SERVICES,N/A,N/A," $1,933.00 "," $1,256.45 "," $1,623.72 ", $132.36 , $142.67 ," $1,561.86 "," $1,739.70 "," $1,636.48 "," $1,739.70 "," $1,739.70 "," $1,739.70 "," $1,643.05 ", $139.87 ," $1,784.74 "," $1,836.35 "," $1,643.05 "," $1,797.69 "," $1,797.69 "," $1,836.35 "," $1,855.68 "," $1,581.58 "," $1,739.70 "," $1,643.05 "," $1,527.07 ", N/A ," $1,564.38 "," $1,564.38 "," $1,836.35 "," $1,658.71 ", $132.36 ," $1,855.68 "
"Closed Rx Trauma Hip Disloc,Anesth",27252,N/A,N/A,N/A," $2,787.00 "," $1,811.55 "," $4,583.22 ", $714.45 , $532.53 ," $3,661.56 "," $3,638.25 "," $2,591.91 "," $2,508.30 "," $2,508.30 "," $2,229.60 "," $2,229.60 ", $532.53 ," $2,573.24 "," $2,647.65 "," $2,508.30 "," $2,508.30 "," $2,508.30 "," $2,591.91 "," $2,675.52 "," $4,261.18 "," $2,368.95 "," $4,021.28 "," $4,294.62 ", N/A ," $3,733.01 "," $3,733.01 "," $2,647.65 "," $4,387.60 ", $532.53 ," $4,583.22 "
 Pro Repair Superficicial Wound ,CPT® 12001,0982 - PRO FEE/OUTPT,N/A,N/A, $567.00 , $368.55 , $140.22 , $41.72 , $52.39 , $121.02 , $117.45 , $527.31 , $510.30 , $510.30 , $453.60 , $453.60 , $52.39 , $523.51 , $538.65 , $510.30 , $510.30 , $510.30 , $527.31 , $544.32 , $152.67 , $481.95 , $235.50 , $154.59 , N/A , $123.38 , $123.38 , $538.65 , $143.07 , $41.72 , $544.32 
 Fac Ko W/Adj Jt Rot Cntrl Molded ,HCPCS L1844,0274 - PROSTHETIC DEV,N/A,N/A," $1,873.00 "," $1,217.45 "," $1,573.32 "," $1,781.33 ", $617.24 ," $1,513.38 "," $1,685.70 "," $1,585.68 "," $1,685.70 "," $1,685.70 "," $1,685.70 "," $1,592.05 ", $605.14 ," $1,729.34 "," $1,779.35 "," $1,592.05 "," $1,741.89 "," $1,741.89 "," $1,779.35 "," $1,798.08 "," $1,532.49 "," $1,685.70 "," $1,592.05 "," $1,479.67 ", N/A ," $1,515.82 "," $1,515.82 "," $1,779.35 "," $1,607.22 ", $605.14 ," $1,798.08 "
"Pro Lap,Vag Hyst,Uterus 250gms/<,Salp-Ooph",58552,N/A,N/A,N/A," $5,883.00 "," $3,823.95 "," $4,609.25 ", $933.94 , $868.75 ," $4,012.25 "," $3,980.92 "," $5,471.19 "," $5,294.70 "," $5,294.70 "," $4,706.40 "," $4,706.40 ", $868.75 ," $5,431.77 "," $5,588.85 "," $5,294.70 "," $5,294.70 "," $5,294.70 "," $5,471.19 "," $5,647.68 "," $4,834.48 "," $5,000.55 "," $5,239.80 "," $4,021.65 ", N/A ," $4,090.54 "," $4,090.54 "," $5,588.85 "," $4,906.35 ", $868.75 ," $5,647.68 "
 LURASIDONE HCL 20 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,63402-0302-30,1 tablet, $291.51 , $189.48 , $244.87 , N/A , N/A , $235.54 , $262.36 , $246.79 , $262.36 , $262.36 , $262.36 , $247.78 , N/A , $269.15 , $276.93 , $247.78 , $271.10 , $271.10 , $276.93 , $279.85 , $238.51 , $262.36 , $247.78 , $230.29 , N/A , $235.92 , $235.92 , $276.93 , $250.14 , $230.29 , $279.85 
 Fac Optime Anes Mac Tech ,Custom OPTANESMAC,0370 - ANESTHESIA,N/A,N/A, $239.00 , $155.35 , $200.76 , N/A , N/A , $193.11 , $215.10 , $202.34 , $215.10 , $215.10 , $215.10 , $203.15 , N/A , $220.67 , $227.05 , $203.15 , $222.27 , $222.27 , $227.05 , $229.44 , $195.55 , $215.10 , $203.15 , $188.81 , N/A , $193.42 , $193.42 , $227.05 , $205.09 , $188.81 , $229.44 
 Fac Assay of Cpk in Blood ,CPT® 82552,0301 - LAB/CHEMISTRY,N/A,N/A, $204.00 , $132.60 , $171.36 , $13.66 , $13.66 , $164.83 , $183.60 , $172.71 , $183.60 , $183.60 , $183.60 , $173.40 , $13.39 , $188.35 , $193.80 , $173.40 , $189.72 , $189.72 , $193.80 , $195.84 , $166.91 , $183.60 , $173.40 , $161.16 , N/A , $165.10 , $165.10 , $193.80 , $175.05 , $13.39 , $195.84 
 Ra Test Qual ,CPT® 86430,0302 - LAB/IMMUNOLOGY,N/A,N/A, $58.00 , $37.70 , $48.72 , $6.26 , $6.26 , $46.86 , $52.20 , $49.10 , $52.20 , $52.20 , $52.20 , $49.30 , $6.14 , $53.55 , $55.10 , $49.30 , $53.94 , $53.94 , $55.10 , $55.68 , $47.46 , $52.20 , $49.30 , $45.82 , N/A , $46.94 , $46.94 , $55.10 , $49.77 , $6.14 , $55.68 
Remove Perm Cannula/Catheter,CPT® 49422,N/A,N/A,N/A," $2,427.00 "," $1,577.55 "," $1,307.74 ", $201.99 , $667.22 ," $1,790.30 "," $1,818.74 "," $2,257.11 "," $2,184.30 "," $2,184.30 "," $1,941.60 "," $1,941.60 ", $667.22 ," $2,240.85 "," $2,305.65 "," $2,184.30 "," $2,184.30 "," $2,184.30 "," $2,257.11 "," $2,329.92 ", $940.30 ," $2,062.95 "," $2,019.56 "," $2,109.74 ", N/A ," $1,825.23 "," $1,825.23 "," $2,305.65 "," $1,908.99 ", $201.99 ," $2,329.92 "
Treat Tibial Shaft Fractr,27750,N/A,N/A,N/A," $2,288.00 "," $1,487.20 "," $2,003.43 ", $317.27 , $156.40 ," $1,532.38 "," $1,554.50 "," $2,127.84 "," $2,059.20 "," $2,059.20 "," $1,830.40 "," $1,830.40 ", $156.40 ," $2,112.51 "," $2,173.60 "," $2,059.20 "," $2,059.20 "," $2,059.20 "," $2,127.84 "," $2,196.48 "," $1,847.67 "," $1,944.80 "," $1,707.35 "," $1,815.91 ", N/A ," $1,562.28 "," $1,562.28 "," $2,173.60 "," $1,836.23 ", $156.40 ," $2,196.48 "
 ATORVASTATIN CALCIUM 40 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6292-61,1 tablet, $3.55 , $2.31 , $2.98 , N/A , N/A , $2.87 , $3.20 , $3.01 , $3.20 , $3.20 , $3.20 , $3.02 , N/A , $3.28 , $3.37 , $3.02 , $3.30 , $3.30 , $3.37 , $3.41 , $2.90 , $3.20 , $3.02 , $2.80 , N/A , $2.87 , $2.87 , $3.37 , $3.05 , $2.80 , $3.41 
Egd Partial/Compl Esophagogastric Fundoplasty,43210,N/A,N/A,N/A," $2,821.00 "," $1,833.65 "," $2,594.67 ", $400.08 , N/A ," $2,070.77 "," $2,058.56 "," $2,623.53 "," $2,538.90 "," $2,538.90 "," $2,256.80 "," $2,256.80 ", N/A ," $2,604.63 "," $2,679.95 "," $2,538.90 "," $2,538.90 "," $2,538.90 "," $2,623.53 "," $2,708.16 "," $1,866.13 "," $2,397.85 "," $2,249.61 "," $2,479.40 ", N/A ," $2,111.17 "," $2,111.17 "," $2,679.95 "," $2,208.04 ", $400.08 ," $2,708.16 "
Fac Surgical Path Level 4,CPT® 88305,N/A,N/A,N/A, $557.00 , $362.05 , N/A , N/A , N/A , N/A , N/A , $518.01 , $501.30 , $501.30 , $445.60 , $445.60 , N/A , $514.28 , $529.15 , $501.30 , $501.30 , $501.30 , $518.01 , $534.72 , N/A , $473.45 , N/A , N/A , N/A , N/A , N/A , $529.15 , N/A , $445.60 , $534.72 
 TOPIRAMATE 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,68084-0342-01,1 tablet, $10.79 , $7.01 , $9.06 , N/A , N/A , $8.72 , $9.71 , $9.13 , $9.71 , $9.71 , $9.71 , $9.17 , N/A , $9.96 , $10.25 , $9.17 , $10.03 , $10.03 , $10.25 , $10.36 , $8.83 , $9.71 , $9.17 , $8.52 , N/A , $8.73 , $8.73 , $10.25 , $9.26 , $8.52 , $10.36 
Layer Closure 5.1-7.5cm,12053,N/A,N/A,N/A," $1,445.00 ", $939.25 , $685.07 , $206.62 , $153.67 , $595.05 , $580.29 ," $1,343.85 "," $1,300.50 "," $1,300.50 "," $1,156.00 "," $1,156.00 ", $153.67 ," $1,334.17 "," $1,372.75 "," $1,300.50 "," $1,300.50 "," $1,300.50 "," $1,343.85 "," $1,387.20 ", $753.04 ," $1,228.25 "," $1,156.07 ", $765.21 , N/A , $606.66 , $606.66 ," $1,372.75 ", $703.53 , $153.67 ," $1,387.20 "
"Initial Hosp Neonate 28 Day or Less, Critically Ill",CPT® 99468,N/A,N/A,N/A," $5,392.00 "," $3,504.80 "," $2,444.99 ", $871.87 , $517.82 ," $2,431.11 "," $2,555.49 "," $5,014.56 "," $4,852.80 "," $4,852.80 "," $4,313.60 "," $4,313.60 ", $517.82 ," $4,978.43 "," $5,122.40 "," $4,852.80 "," $4,852.80 "," $4,852.80 "," $5,014.56 "," $5,176.32 "," $2,313.14 "," $4,583.20 "," $2,059.79 "," $3,051.00 ", N/A ," $2,478.55 "," $2,478.55 "," $5,122.40 "," $2,965.59 ", $517.82 ," $5,176.32 "
Reduction Rectal Prolapse W Anesthe,45900,N/A,N/A,N/A," $1,427.00 ", $927.55 ," $1,276.21 ", $198.18 , $133.31 , $963.93 , $986.90 ," $1,327.11 "," $1,284.30 "," $1,284.30 "," $1,141.60 "," $1,141.60 ", $133.31 ," $1,317.55 "," $1,355.65 "," $1,284.30 "," $1,284.30 "," $1,284.30 "," $1,327.11 "," $1,369.92 ", $913.47 ," $1,212.95 "," $1,088.28 "," $1,173.80 ", N/A , $982.74 , $982.74 ," $1,355.65 "," $1,027.85 ", $133.31 ," $1,369.92 "
"Transect Othr Spinal N,Xtradural",CPT® 64772,N/A,N/A,N/A," $3,826.00 "," $2,486.90 "," $2,732.13 ", $532.99 , $614.70 ," $3,114.11 "," $3,071.22 "," $3,558.18 "," $3,443.40 "," $3,443.40 "," $3,060.80 "," $3,060.80 ", $614.70 ," $3,532.55 "," $3,634.70 "," $3,443.40 "," $3,443.40 "," $3,443.40 "," $3,558.18 "," $3,672.96 "," $2,952.67 "," $3,252.10 "," $3,070.37 "," $3,313.67 ", N/A ," $3,174.87 "," $3,174.87 "," $3,634.70 "," $3,405.89 ", $532.99 ," $3,672.96 "
 Pro Amp Toe Metatarsophlngl Jt ,CPT® 28820,0982 - PRO FEE/OUTPT,N/A,N/A," $3,837.00 "," $2,494.05 "," $1,097.20 ", $170.21 , $184.42 ," $1,941.50 "," $1,962.17 "," $3,568.41 "," $3,453.30 "," $3,453.30 "," $3,069.60 "," $3,069.60 ", $184.42 ," $3,542.70 "," $3,645.15 "," $3,453.30 "," $3,453.30 "," $3,453.30 "," $3,568.41 "," $3,683.52 "," $1,030.80 "," $3,261.45 "," $2,146.23 "," $2,289.48 ", N/A ," $1,979.38 "," $1,979.38 "," $3,645.15 "," $2,326.47 ", $170.21 ," $3,683.52 "
Sling Oper Stres Incontinence,57288,N/A,N/A,N/A," $5,271.00 "," $3,426.15 "," $3,521.70 ", $712.23 , $675.48 ," $2,923.16 "," $2,884.37 "," $4,902.03 "," $4,743.90 "," $4,743.90 "," $4,216.80 "," $4,216.80 ", $675.48 ," $4,866.71 "," $5,007.45 "," $4,743.90 "," $4,743.90 "," $4,743.90 "," $4,902.03 "," $5,060.16 "," $3,667.10 "," $4,480.35 "," $3,746.53 "," $2,957.02 ", N/A ," $2,980.20 "," $2,980.20 "," $5,007.45 "," $3,574.56 ", $675.48 ," $5,060.16 "
 Fac Esophagogastroduodenoscopy US Scope W/Adj Strxrs ,CPT® 43237,0360 - OR SERVICES,N/A,N/A," $2,706.00 "," $1,758.90 "," $2,273.04 ", $185.69 , $219.61 ," $2,186.45 "," $2,435.40 "," $2,290.90 "," $2,435.40 "," $2,435.40 "," $2,435.40 "," $2,300.10 ", $215.30 ," $2,498.45 "," $2,570.70 "," $2,300.10 "," $2,516.58 "," $2,516.58 "," $2,570.70 "," $2,597.76 "," $2,214.05 "," $2,435.40 "," $2,300.10 "," $2,137.74 ", N/A ," $2,189.97 "," $2,189.97 "," $2,570.70 "," $2,322.02 ", $185.69 ," $2,597.76 "
"Med Nutr Ther, Group, Ea 30 Min",CPT® 97804,N/A,N/A,N/A, $37.00 , $24.05 , $35.88 , $15.32 , N/A , $34.13 , $34.80 , $34.41 , $33.30 , $33.30 , $29.60 , $29.60 , N/A , $34.16 , $35.15 , $33.30 , $33.30 , $33.30 , $34.41 , $35.52 , $47.63 , $31.45 , $45.62 , $57.94 , N/A , $34.80 , $34.80 , $35.15 , $40.55 , $15.32 , $57.94 
Mod Sedat Endo Service >5yrs,G0500,N/A,N/A,N/A, $155.00 , $100.75 , $11.93 , $4.99 , N/A , $9.73 , N/A , $144.15 , $139.50 , $139.50 , $124.00 , $124.00 , N/A , $143.11 , $147.25 , $139.50 , $139.50 , $139.50 , $144.15 , $148.80 , $15.86 , $131.75 , $10.34 , $20.23 , N/A , $9.92 , $9.92 , $147.25 , $12.40 , $4.99 , $148.80 
 Fac Renal Function Panel ,CPT® 80069,0301 - LAB/CHEMISTRY,N/A,N/A, $153.00 , $99.45 , $128.52 , $8.85 , $8.85 , $123.62 , $137.70 , $129.53 , $137.70 , $137.70 , $137.70 , $130.05 , $8.68 , $141.26 , $145.35 , $130.05 , $142.29 , $142.29 , $145.35 , $146.88 , $125.18 , $137.70 , $130.05 , $120.87 , N/A , $123.82 , $123.82 , $145.35 , $131.29 , $8.68 , $146.88 
Mod Sed Other Phys/Qhp Initial 15 Mins 5/> Yrs,CPT® 99156,N/A,N/A,N/A, $293.00 , $190.45 , $172.75 , $72.45 , $60.13 , $162.41 , $165.47 , $272.49 , $263.70 , $263.70 , $234.40 , $234.40 , $60.13 , $270.53 , $278.35 , $263.70 , $263.70 , $263.70 , $272.49 , $281.28 , $230.14 , $249.05 , $226.17 , $283.65 , N/A , $165.58 , $165.58 , $278.35 , $193.03 , $60.13 , $283.65 
" Lumbar Spine,Min 4 Views ",CPT® 72110,0320 - DX X-RAY,N/A,N/A, $484.00 , $314.60 , $406.56 , $50.58 , $51.88 , $391.07 , $435.60 , $409.75 , $435.60 , $435.60 , $435.60 , $411.40 , $50.86 , $446.88 , $459.80 , $411.40 , $450.12 , $450.12 , $459.80 , $464.64 , $396.01 , $435.60 , $411.40 , $382.36 , N/A , $391.70 , $391.70 , $459.80 , $415.32 , $50.58 , $464.64 
 Pro Protein E-Phoresis ,CPT® 84165,0971 - PRO FEE/LAB,N/A,N/A, $132.00 , $85.80 , N/A , $10.95 , $10.95 , $60.74 , $72.67 , $122.76 , $118.80 , $118.80 , $105.60 , $105.60 , $10.95 , $121.88 , $125.40 , $118.80 , $118.80 , $118.80 , $122.76 , $126.72 , $71.71 , $112.20 , $165.43 , $38.94 , N/A , $56.69 , $56.69 , $125.40 , $61.95 , $10.95 , $165.43 
Exc Skin Benig <5mm Remaindr Body,11420,N/A,N/A,N/A, $491.00 , $319.15 , $266.56 , $79.82 , $70.33 , $222.80 , $220.55 , $456.63 , $441.90 , $441.90 , $392.80 , $392.80 , $70.33 , $453.34 , $466.45 , $441.90 , $441.90 , $441.90 , $456.63 , $471.36 , $290.68 , $417.35 , $435.31 , $287.24 , N/A , $227.15 , $227.15 , $466.45 , $263.42 , $70.33 , $471.36 
"Excis Mouth Mucosa/Sub,Complx Repr",CPT® 40814,N/A,N/A,N/A," $2,514.00 "," $1,634.10 "," $1,765.73 ", $276.84 , $111.57 ," $1,490.20 "," $1,525.65 "," $2,338.02 "," $2,262.60 "," $2,262.60 "," $2,011.20 "," $2,011.20 ", $111.57 ," $2,321.18 "," $2,388.30 "," $2,262.60 "," $2,262.60 "," $2,262.60 "," $2,338.02 "," $2,413.44 "," $1,282.29 "," $2,136.90 "," $1,662.75 "," $1,750.94 ", N/A ," $1,519.27 "," $1,519.27 "," $2,388.30 "," $1,589.00 ", $111.57 ," $2,413.44 "
 Fac Cyp2c19 Gene Analysis Common Variants ,CPT® 81225,0300 - LABORATORY,N/A,N/A, $808.00 , $525.20 , $678.72 , $297.19 , N/A , $652.86 , $727.20 , $684.05 , $727.20 , $727.20 , $727.20 , $686.80 , N/A , $746.03 , $767.60 , $686.80 , $751.44 , $751.44 , $767.60 , $775.68 , $661.11 , $727.20 , $686.80 , $638.32 , N/A , $653.91 , $653.91 , $767.60 , $693.34 , $297.19 , $775.68 
Hydrocolld Drg > 48 in W/O B,HCPCS A6236,N/A,N/A,N/A, $40.00 , $26.00 , N/A , $36.96 , $20.15 , N/A , N/A , $37.20 , $36.00 , $36.00 , $32.00 , $32.00 , $20.15 , $36.93 , $38.00 , $36.00 , $36.00 , $36.00 , $37.20 , $38.40 , N/A , $34.00 , $31.79 , $33.58 , N/A , N/A , N/A , $38.00 , N/A , $20.15 , $38.40 
Pro Lyr Clsr N/H/F/Xtrnl Gent > 30.0 Cm,12047,N/A,N/A,N/A," $2,292.00 "," $1,489.80 "," $1,103.67 ", $327.50 , $279.47 ," $1,027.93 "," $1,001.77 "," $2,131.56 "," $2,062.80 "," $2,062.80 "," $1,833.60 "," $1,833.60 ", $279.47 ," $2,116.20 "," $2,177.40 "," $2,062.80 "," $2,062.80 "," $2,062.80 "," $2,131.56 "," $2,200.32 "," $1,205.95 "," $1,948.20 "," $2,008.86 "," $1,184.56 ", N/A ," $1,047.99 "," $1,047.99 "," $2,177.40 "," $1,215.31 ", $279.47 ," $2,200.32 "
 Alk-Eml4 Gene Fusion by Fish Rml 88377 ,CPT® 88377,0310 - PATHOLOGY LAB,N/A,N/A," $1,385.00 ", $900.25 ," $1,163.40 ", $389.56 , $168.73 ," $1,119.08 "," $1,246.50 "," $1,172.54 "," $1,246.50 "," $1,246.50 "," $1,246.50 "," $1,177.25 ", $165.42 ," $1,278.77 "," $1,315.75 "," $1,177.25 "," $1,288.05 "," $1,288.05 "," $1,315.75 "," $1,329.60 "," $1,133.21 "," $1,246.50 "," $1,177.25 "," $1,094.15 ", N/A ," $1,120.88 "," $1,120.88 "," $1,315.75 "," $1,188.47 ", $165.42 ," $1,329.60 "
Paravaginal Defect Repair Laparoscopic Approach,CPT® 57423,N/A,N/A,N/A," $5,625.00 "," $3,656.25 "," $4,383.85 ", $885.58 , $659.90 ," $3,724.90 "," $3,718.47 "," $5,231.25 "," $5,062.50 "," $5,062.50 "," $4,500.00 "," $4,500.00 ", $659.90 ," $5,193.56 "," $5,343.75 "," $5,062.50 "," $5,062.50 "," $5,062.50 "," $5,231.25 "," $5,400.00 "," $4,580.88 "," $4,781.25 "," $4,890.12 "," $3,737.70 ", N/A ," $3,797.58 "," $3,797.58 "," $5,343.75 "," $4,554.97 ", $659.90 ," $5,400.00 "
 METHYLPREDNISOLONE SODIUM SUCC 40 MG INJECTION (INPT) ,HCPCS J2920,0636 - DRUGS REQUIRING DETAILED CODIN,00009-0039-28,1 mL, $37.27 , $24.23 , $31.31 , $4.32 , $4.21 , $30.11 , $33.54 , $31.55 , $33.54 , $33.54 , $33.54 , $31.68 , $4.13 , $34.41 , $35.41 , $31.68 , $34.66 , $34.66 , $35.41 , $35.78 , $30.49 , $33.54 , $31.68 , $29.44 , N/A , $30.16 , $30.16 , $35.41 , $31.98 , $4.13 , $35.78 
Suspensn Uterus,CPT® 58400,N/A,N/A,N/A," $3,799.00 "," $2,469.35 "," $2,211.25 ", $446.45 , $568.07 ," $1,791.06 "," $1,785.05 "," $3,533.07 "," $3,419.10 "," $3,419.10 "," $3,039.20 "," $3,039.20 ", $568.07 ," $3,507.62 "," $3,609.05 "," $3,419.10 "," $3,419.10 "," $3,419.10 "," $3,533.07 "," $3,647.04 "," $2,288.40 "," $3,229.15 "," $2,333.56 "," $1,808.65 ", N/A ," $1,826.01 "," $1,826.01 "," $3,609.05 "," $2,190.19 ", $446.45 ," $3,647.04 "
"Excis Tendon Sheath Lesion, Hand/Finger",CPT® 26160,N/A,N/A,N/A," $3,855.00 "," $2,505.75 "," $1,944.61 ", $307.22 , $319.22 ," $1,605.88 "," $1,621.13 "," $3,585.15 "," $3,469.50 "," $3,469.50 "," $3,084.00 "," $3,084.00 ", $319.22 ," $3,559.32 "," $3,662.25 "," $3,469.50 "," $3,469.50 "," $3,469.50 "," $3,585.15 "," $3,700.80 "," $1,806.58 "," $3,276.75 "," $1,778.71 "," $1,915.12 ", N/A ," $1,637.21 "," $1,637.21 "," $3,662.25 "," $1,924.31 ", $307.22 ," $3,700.80 "
"Adj Tiss Xfer Head,Fac,Hand <10sqcm",CPT® 14040,N/A,N/A,N/A," $4,032.00 "," $2,620.80 "," $1,994.24 ", $599.47 , $397.57 ," $1,729.62 "," $1,705.45 "," $3,749.76 "," $3,628.80 "," $3,628.80 "," $3,225.60 "," $3,225.60 ", $397.57 ," $3,722.75 "," $3,830.40 "," $3,628.80 "," $3,628.80 "," $3,628.80 "," $3,749.76 "," $3,870.72 "," $2,184.89 "," $3,427.20 "," $3,395.07 "," $2,215.01 ", N/A ," $1,763.37 "," $1,763.37 "," $3,830.40 "," $2,044.92 ", $397.57 ," $3,870.72 "
"Closed Rx Trauma Hip Disloc,Anesth",CPT® 27252,N/A,N/A,N/A," $2,787.00 "," $1,811.55 "," $4,583.22 ", $714.45 , $532.53 ," $3,661.56 "," $3,638.25 "," $2,591.91 "," $2,508.30 "," $2,508.30 "," $2,229.60 "," $2,229.60 ", $532.53 ," $2,573.24 "," $2,647.65 "," $2,508.30 "," $2,508.30 "," $2,508.30 "," $2,591.91 "," $2,675.52 "," $4,261.18 "," $2,368.95 "," $4,021.28 "," $4,294.62 ", N/A ," $3,733.01 "," $3,733.01 "," $2,647.65 "," $4,387.60 ", $532.53 ," $4,583.22 "
Transtelephonic Rhythm Strip Pacemaker Eval,CPT® 93293,N/A,N/A,N/A, $688.00 , $447.20 , $299.91 , $44.76 , $49.26 , $286.07 , $296.78 , $639.84 , $619.20 , $619.20 , $550.40 , $550.40 , $49.26 , $635.23 , $653.60 , $619.20 , $619.20 , $619.20 , $639.84 , $660.48 , $311.25 , $584.80 , $278.31 , $201.37 , N/A , $291.66 , $291.66 , $653.60 , $323.30 , $44.76 , $660.48 
 LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN ,HCPCS RXA250,0250 - PHARMACY,00409-3182-01,20 mL, $20.55 , $13.36 , $17.26 , N/A , N/A , $16.60 , $18.50 , $17.40 , $18.50 , $18.50 , $18.50 , $17.47 , N/A , $18.97 , $19.52 , $17.47 , $19.11 , $19.11 , $19.52 , $19.73 , $16.81 , $18.50 , $17.47 , $16.23 , N/A , $16.63 , $16.63 , $19.52 , $17.63 , $16.23 , $19.73 
"Fix Ectropion,Suture",CPT® 67914,N/A,N/A,N/A," $4,466.00 "," $2,902.90 "," $2,013.31 ", $317.20 , $142.01 ," $1,850.81 "," $1,535.77 "," $4,153.38 "," $4,019.40 "," $4,019.40 "," $3,572.80 "," $3,572.80 ", $142.01 ," $4,123.46 "," $4,242.70 "," $4,019.40 "," $4,019.40 "," $4,019.40 "," $4,153.38 "," $4,287.36 "," $2,762.60 "," $3,796.10 "," $1,591.39 "," $2,352.61 ", N/A ," $1,886.92 "," $1,886.92 "," $4,242.70 "," $2,082.93 ", $142.01 ," $4,287.36 "
"Arthrodesis Ant Interbody Inc Discectomy, Cervical Below C2",CPT® 22551,N/A,N/A,N/A," $11,469.00 "," $7,454.85 "," $9,883.19 "," $1,543.42 "," $1,205.54 "," $8,156.71 "," $8,031.40 "," $10,666.17 "," $10,322.10 "," $10,322.10 "," $9,175.20 "," $9,175.20 "," $1,205.54 "," $10,589.33 "," $10,895.55 "," $10,322.10 "," $10,322.10 "," $10,322.10 "," $10,666.17 "," $11,010.24 "," $9,216.13 "," $9,748.65 "," $9,089.81 "," $9,390.58 ", N/A ," $8,315.86 "," $8,315.86 "," $10,895.55 "," $9,774.11 "," $1,205.54 "," $11,010.24 "
 Pro Echo Guide for Amniocentesis ,CPT® 76946,0972 - PRO FEE/RAD/DX,N/A,N/A, $531.00 , $345.15 , $181.42 , $32.40 , $39.54 , $157.66 , $169.50 , $493.83 , $477.90 , $477.90 , $424.80 , $424.80 , $39.54 , $490.27 , $504.45 , $477.90 , $477.90 , $477.90 , $493.83 , $509.76 , $180.74 , $451.35 , $184.90 , $182.10 , N/A , $160.74 , $160.74 , $504.45 , $186.06 , $32.40 , $509.76 
Promethazine Hcl Injection,HCPCS J2550,N/A,N/A,N/A, $13.00 , $8.45 , N/A , $3.21 , $3.28 , N/A , N/A , $12.09 , $11.70 , $11.70 , $10.40 , $10.40 , $3.28 , $12.00 , $12.35 , $11.70 , $11.70 , $11.70 , $12.09 , $12.48 , $2.95 , $11.05 , $3.24 , $4.12 , N/A , N/A , N/A , $12.35 , N/A , $2.95 , $12.48 
"Lap, Surg Jejunostomy",44186,N/A,N/A,N/A," $4,256.00 "," $2,766.40 "," $3,890.45 ", $602.20 , $509.16 ," $3,064.39 "," $3,105.27 "," $3,958.08 "," $3,830.40 "," $3,830.40 "," $3,404.80 "," $3,404.80 ", $509.16 ," $3,929.56 "," $4,043.20 "," $3,830.40 "," $3,830.40 "," $3,830.40 "," $3,958.08 "," $4,085.76 "," $2,786.57 "," $3,617.60 "," $3,453.95 "," $3,605.06 ", N/A ," $3,124.18 "," $3,124.18 "," $4,043.20 "," $3,267.54 ", $509.16 ," $4,085.76 "
Carcinoembryonic Antigen,CPT® 82378,N/A,N/A,N/A, $203.00 , $131.95 , N/A , $19.34 , $19.34 , $107.30 , $128.40 , $188.79 , $182.70 , $182.70 , $162.40 , $162.40 , $19.34 , $187.43 , $192.85 , $182.70 , $182.70 , $182.70 , $188.79 , $194.88 , $126.60 , $172.55 , $124.88 , $68.76 , N/A , $100.14 , $100.14 , $192.85 , $109.43 , $19.34 , $194.88 
 Pro Antegrade Urography Radiological Supvj & Interpj ,CPT® 74425,0972 - PRO FEE/RAD/DX,N/A,N/A, $144.00 , $93.60 , $788.57 , $135.51 , $70.00 , $315.84 , $333.30 , $133.92 , $129.60 , $129.60 , $115.20 , $115.20 , $70.00 , $132.96 , $136.80 , $129.60 , $129.60 , $129.60 , $133.92 , $138.24 , $768.61 , $122.40 , $364.02 ," $1,345.97 ", N/A , $322.00 , $322.00 , $136.80 , $372.73 , $70.00 ," $1,345.97 "
 Fac Human Epididymis Protein 4 (He4) ,CPT® 86305,0302 - LAB/IMMUNOLOGY,N/A,N/A, $281.00 , $182.65 , $236.04 , $21.23 , $21.23 , $227.05 , $252.90 , $237.89 , $252.90 , $252.90 , $252.90 , $238.85 , $20.81 , $259.45 , $266.95 , $238.85 , $261.33 , $261.33 , $266.95 , $269.76 , $229.91 , $252.90 , $238.85 , $221.99 , N/A , $227.41 , $227.41 , $266.95 , $241.13 , $20.81 , $269.76 
Hfo Without Joints Pre Ots,HCPCS L3924,N/A,N/A,N/A, $102.00 , $66.30 , N/A , $102.84 , $28.32 , N/A , N/A , $94.86 , $91.80 , $91.80 , $81.60 , $81.60 , $28.32 , $94.18 , $96.90 , $91.80 , $91.80 , $91.80 , $94.86 , $97.92 , N/A , $86.70 , $173.82 , $86.51 , N/A , N/A , N/A , $96.90 , N/A , $28.32 , $173.82 
 Bone Survey Infant -Mh ,CPT® 77076,0972 - PRO FEE/RAD/DX,N/A,N/A, $433.00 , $281.45 , $606.68 , $105.96 , $59.64 , $454.00 , $563.86 , $402.69 , $389.70 , $389.70 , $346.40 , $346.40 , $59.64 , $399.79 , $411.35 , $389.70 , $389.70 , $389.70 , $402.69 , $415.68 , $587.42 , $368.05 , $612.48 , $485.18 , N/A , $462.85 , $462.85 , $411.35 , $535.76 , $59.64 , $612.48 
 Fac Prq Plmt Biliary Drg Cath W/Img Gid Rs&I Externl ,CPT® 47533,0361 - OR/MINOR,N/A,N/A," $12,620.00 "," $8,203.00 "," $10,600.80 ", $250.05 ," $1,058.43 "," $10,196.96 "," $11,358.00 "," $10,684.09 "," $11,358.00 "," $11,358.00 "," $11,358.00 "," $10,727.00 "," $1,037.68 "," $11,652.05 "," $11,989.00 "," $10,727.00 "," $11,736.60 "," $11,736.60 "," $11,989.00 "," $12,115.20 "," $10,325.68 "," $11,358.00 "," $10,727.00 "," $9,969.80 ", N/A ," $10,213.37 "," $10,213.37 "," $11,989.00 "," $10,829.22 ", $250.05 ," $12,115.20 "
"Removal Adenoids,Primary,12+ Y/O",CPT® 42831,N/A,N/A,N/A," $1,552.00 "," $1,008.80 "," $1,423.63 ", $224.93 , $277.57 ," $1,077.78 "," $1,119.32 "," $1,443.36 "," $1,396.80 "," $1,396.80 "," $1,241.60 "," $1,241.60 ", $277.57 ," $1,432.96 "," $1,474.40 "," $1,396.80 "," $1,396.80 "," $1,396.80 "," $1,443.36 "," $1,489.92 "," $1,000.42 "," $1,319.20 "," $1,220.30 "," $1,266.48 ", N/A ," $1,098.80 "," $1,098.80 "," $1,474.40 "," $1,149.23 ", $224.93 ," $1,489.92 "
 Sat Biopsy Prostate 1-20 Spec ,HCPCS G0416,0314 - PATHOL/BIOPSY,N/A,N/A, $500.00 , $325.00 , $420.00 , $356.03 , N/A , $404.00 , $450.00 , $423.30 , $450.00 , $450.00 , $450.00 , $425.00 , N/A , $461.65 , $475.00 , $425.00 , $465.00 , $465.00 , $475.00 , $480.00 , $409.10 , $450.00 , $425.00 , $395.00 , N/A , $404.65 , $404.65 , $475.00 , $429.05 , $356.03 , $480.00 
 Vaginal Panel Qnt Rt Amplification ,CPT® 81514,0300 - LABORATORY,N/A,N/A, $648.00 , $421.20 , $544.32 , $268.25 , $214.60 , $523.58 , $583.20 , $548.60 , $583.20 , $583.20 , $583.20 , $550.80 , $210.39 , $598.30 , $615.60 , $550.80 , $602.64 , $602.64 , $615.60 , $622.08 , $530.19 , $583.20 , $550.80 , $511.92 , N/A , $524.43 , $524.43 , $615.60 , $556.05 , $210.39 , $622.08 
 Pro Optx Aqt Sho Dislc ,CPT® 23660,0975 - PRO FEE/OR,N/A,N/A," $4,739.00 "," $3,080.35 "," $3,572.40 ", $563.22 , $845.22 ," $2,793.68 "," $2,809.44 "," $4,407.27 "," $4,265.10 "," $4,265.10 "," $3,791.20 "," $3,791.20 ", $845.22 ," $4,375.52 "," $4,502.05 "," $4,265.10 "," $4,265.10 "," $4,265.10 "," $4,407.27 "," $4,549.44 "," $3,324.27 "," $4,028.15 "," $3,100.70 "," $3,316.09 ", N/A ," $2,848.19 "," $2,848.19 "," $4,502.05 "," $3,347.64 ", $563.22 ," $4,549.44 "
"Shldr Arthroscop,Part Acromioplas",CPT® 29826,N/A,N/A,N/A," $3,910.00 "," $2,541.50 "," $1,032.59 ", $160.23 , $582.25 , $850.38 , $834.76 ," $3,636.30 "," $3,519.00 "," $3,519.00 "," $3,128.00 "," $3,128.00 ", $582.25 ," $3,610.10 "," $3,714.50 "," $3,519.00 "," $3,519.00 "," $3,519.00 "," $3,636.30 "," $3,753.60 "," $1,910.28 "," $3,323.50 ", $925.93 , $996.64 , N/A , $866.98 , $866.98 ," $3,714.50 "," $1,019.01 ", $160.23 ," $3,753.60 "
"Repair Flex Tendon,Zone 2,Pri Hand",CPT® 26356,N/A,N/A,N/A," $3,585.00 "," $2,330.25 "," $4,885.86 ", $768.43 , $738.54 ," $5,216.15 "," $5,292.11 "," $3,334.05 "," $3,226.50 "," $3,226.50 "," $2,868.00 "," $2,868.00 ", $738.54 ," $3,310.03 "," $3,405.75 "," $3,226.50 "," $3,226.50 "," $3,226.50 "," $3,334.05 "," $3,441.60 "," $4,550.07 "," $3,047.25 "," $5,798.21 "," $4,542.61 ", N/A ," $5,317.93 "," $5,317.93 "," $3,405.75 "," $6,250.45 ", $738.54 ," $6,250.45 "
"Revise Conjunc,Fix Cul-De-Sac+Grft",CPT® 68326,N/A,N/A,N/A," $5,908.00 "," $3,840.20 "," $3,955.19 ", $621.31 , $922.06 ," $3,654.25 "," $3,457.69 "," $5,494.44 "," $5,317.20 "," $5,317.20 "," $4,726.40 "," $4,726.40 ", $922.06 ," $5,454.86 "," $5,612.60 "," $5,317.20 "," $5,317.20 "," $5,317.20 "," $5,494.44 "," $5,671.68 "," $5,431.71 "," $5,021.80 "," $3,591.32 "," $4,642.08 ", N/A ," $3,725.55 "," $3,725.55 "," $5,612.60 "," $4,112.52 ", $621.31 ," $5,671.68 "
 Fac Stab Phlebt Varicose Veins 1 Xtr 10-20 Stab Incs ,CPT® 37765,0360 - OR SERVICES,N/A,N/A," $4,404.00 "," $2,862.60 "," $3,699.36 ", $246.37 , $460.89 ," $3,558.43 "," $3,963.60 "," $3,728.43 "," $3,963.60 "," $3,963.60 "," $3,963.60 "," $3,743.40 ", $451.85 ," $4,066.21 "," $4,183.80 "," $3,743.40 "," $4,095.72 "," $4,095.72 "," $4,183.80 "," $4,227.84 "," $3,603.35 "," $3,963.60 "," $3,743.40 "," $3,479.16 ", N/A ," $3,564.16 "," $3,564.16 "," $4,183.80 "," $3,779.07 ", $246.37 ," $4,227.84 "
Iiv4 Vacc Split Virus 0.5 Ml Dos for Im Use,CPT® 90688,N/A,N/A,N/A, $32.00 , $20.80 , N/A , $20.89 , $36.19 , $36.63 , $37.48 , $29.76 , $28.80 , $28.80 , $25.60 , $25.60 , $36.19 , $29.55 , $30.40 , $28.80 , $28.80 , $28.80 , $29.76 , $30.72 , $24.92 , $27.20 , $60.58 , $30.08 , N/A , $37.35 , $37.35 , $30.40 , $43.53 , $20.89 , $60.58 
Ko W/Adj Jt Rot Cntrl Molded,HCPCS L1844,N/A,N/A,N/A," $1,918.00 "," $1,246.70 ", N/A ," $1,781.33 ", $617.24 , N/A , N/A ," $1,783.74 "," $1,726.20 "," $1,726.20 "," $1,534.40 "," $1,534.40 ", $617.24 ," $1,770.89 "," $1,822.10 "," $1,726.20 "," $1,726.20 "," $1,726.20 "," $1,783.74 "," $1,841.28 ", N/A ," $1,630.30 "," $1,606.96 "," $1,498.70 ", N/A , N/A , N/A ," $1,822.10 ", N/A , $617.24 ," $1,841.28 "
 Pro Injection Aa&/Strd Genicular Nrv Branches W/Img ,CPT® 64454,0982 - PRO FEE/OUTPT,N/A,N/A," $1,869.00 "," $1,214.85 ", $408.04 , $79.01 , $168.18 , $449.85 , N/A ," $1,738.17 "," $1,682.10 "," $1,682.10 "," $1,495.20 "," $1,495.20 ", $168.18 ," $1,725.65 "," $1,775.55 "," $1,682.10 "," $1,682.10 "," $1,682.10 "," $1,738.17 "," $1,794.24 ", $436.15 ," $1,588.65 ", $430.02 , $495.19 , N/A , $458.63 , $458.63 ," $1,775.55 ", $491.98 , $79.01 ," $1,794.24 "
 ARMODAFINIL 50 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,65862-0805-30,3 tablet, $111.95 , $72.77 , $94.04 , N/A , N/A , $90.46 , $100.76 , $94.78 , $100.76 , $100.76 , $100.76 , $95.16 , N/A , $103.36 , $106.35 , $95.16 , $104.11 , $104.11 , $106.35 , $107.47 , $91.60 , $100.76 , $95.16 , $88.44 , N/A , $90.60 , $90.60 , $106.35 , $96.06 , $88.44 , $107.47 
 Knee Complete Min 4vw - Mh ,CPT® 73564,0972 - PRO FEE/RAD/DX,N/A,N/A, $132.00 , $85.80 , $260.88 , $45.91 , $36.94 , $186.86 , $233.42 , $122.76 , $118.80 , $118.80 , $105.60 , $105.60 , $36.94 , $121.88 , $125.40 , $118.80 , $118.80 , $118.80 , $122.76 , $126.72 , $252.37 , $112.20 , $258.09 , $200.05 , N/A , $190.51 , $190.51 , $125.40 , $220.49 , $36.94 , $260.88 
 MORPHINE 0.5 MG/ML PEDIATRIC ORAL SYRINGE ,HCPCS J2275,0636 - DRUGS REQUIRING DETAILED CODIN,00001-0199-01,1 mL, $16.68 , $10.84 , $14.01 , N/A , N/A , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , N/A , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $13.18 , $16.01 
Pneuma/Vac Walk Boot Pre Ots,HCPCS L4361,N/A,N/A,N/A, $297.00 , $193.05 , N/A , $302.85 , $156.15 , N/A , N/A , $276.21 , $267.30 , $267.30 , $237.60 , $237.60 , $156.15 , $274.22 , $282.15 , $267.30 , $267.30 , $267.30 , $276.21 , $285.12 , N/A , $252.45 , $566.04 , $254.80 , N/A , N/A , N/A , $282.15 , N/A , $156.15 , $566.04 
 Fac Antidepressants Serotonergic Class 1 or 2 ,CPT® 80332,0301 - LAB/CHEMISTRY,N/A,N/A, $338.00 , $219.70 , $283.92 , N/A , N/A , $273.10 , $304.20 , $286.15 , $304.20 , $304.20 , $304.20 , $287.30 , N/A , $312.08 , $321.10 , $287.30 , $314.34 , $314.34 , $321.10 , $324.48 , $276.55 , $304.20 , $287.30 , $267.02 , N/A , $273.54 , $273.54 , $321.10 , $290.04 , $267.02 , $324.48 
Diab Manage Trn per Indiv,HCPCS G0108,N/A,N/A,N/A, $210.00 , $136.50 , $128.40 , $53.88 , N/A , $97.34 , N/A , $195.30 , $189.00 , $189.00 , $168.00 , $168.00 , N/A , $193.89 , $199.50 , $189.00 , $189.00 , $189.00 , $195.30 , $201.60 , $169.46 , $178.50 , $99.26 , $203.23 , N/A , $99.24 , $99.24 , $199.50 , $124.04 , $53.88 , $203.23 
" Cholinesterase, RBC Beaker1 ",CPT® 82482,0301 - LAB/CHEMISTRY,N/A,N/A, $119.00 , $77.35 , $99.96 , $10.01 , $10.01 , $96.15 , $107.10 , $100.75 , $107.10 , $107.10 , $107.10 , $101.15 , $9.81 , $109.87 , $113.05 , $101.15 , $110.67 , $110.67 , $113.05 , $114.24 , $97.37 , $107.10 , $101.15 , $94.01 , N/A , $96.31 , $96.31 , $113.05 , $102.11 , $9.81 , $114.24 
"Incise Bladder,+Ureter Cath",CPT® 51045,N/A,N/A,N/A," $3,374.00 "," $2,193.10 "," $2,713.77 ", $473.75 , $768.38 ," $2,378.73 "," $2,237.39 "," $3,137.82 "," $3,036.60 "," $3,036.60 "," $2,699.20 "," $2,699.20 ", $768.38 ," $3,115.21 "," $3,205.30 "," $3,036.60 "," $3,036.60 "," $3,036.60 "," $3,137.82 "," $3,239.04 "," $2,696.61 "," $2,867.90 "," $2,558.35 "," $2,973.10 ", N/A ," $2,425.14 "," $2,425.14 "," $3,205.30 "," $2,850.41 ", $473.75 ," $3,239.04 "
"Excis Conjunc Lesn,=<1 Cm",CPT® 68110,N/A,N/A,N/A," $2,184.00 "," $1,419.60 ", $908.96 , $143.24 , $93.05 , $840.25 , $798.27 ," $2,031.12 "," $1,965.60 "," $1,965.60 "," $1,747.20 "," $1,747.20 ", $93.05 ," $2,016.49 "," $2,074.80 "," $1,965.60 "," $1,965.60 "," $1,965.60 "," $2,031.12 "," $2,096.64 "," $1,249.67 "," $1,856.40 ", $827.81 ," $1,069.63 ", N/A , $856.64 , $856.64 ," $2,074.80 ", $945.61 , $93.05 ," $2,096.64 "
 Ot Paraffin Bath ,CPT® 97018,0430 - OCCUPATION THER,N/A,N/A, $120.00 , $78.00 , $100.80 , $5.47 , $20.29 , $96.96 , $108.00 , $101.59 , $108.00 , $108.00 , $108.00 , $102.00 , $19.89 , $110.80 , $114.00 , $102.00 , $111.60 , $111.60 , $114.00 , $115.20 , $98.18 , $108.00 , $102.00 , $94.80 , N/A , $97.12 , $97.12 , $114.00 , $102.97 , $5.47 , $115.20 
 Pro Radex Spi Thrc Minimum 4 Views ,CPT® 72074,0972 - PRO FEE/RAD/DX,N/A,N/A, $189.00 , $122.85 , $251.78 , $43.67 , $42.55 , $184.85 , $234.92 , $175.77 , $170.10 , $170.10 , $151.20 , $151.20 , $42.55 , $174.50 , $179.55 , $170.10 , $170.10 , $170.10 , $175.77 , $181.44 , $245.20 , $160.65 , $258.09 , $196.46 , N/A , $188.45 , $188.45 , $179.55 , $218.14 , $42.55 , $258.09 
 Insertion Picc W/Rs&I 5 Yr/> ED Pro ,CPT® 36573,0981 - PRO FEE/ER,N/A,N/A, $750.00 , $487.50 , $514.35 , $80.09 , $314.22 , $345.62 , N/A , $697.50 , $675.00 , $675.00 , $600.00 , $600.00 , $314.22 , $692.48 , $712.50 , $675.00 , $675.00 , $675.00 , $697.50 , $720.00 , $476.57 , $637.50 , $438.90 , $425.65 , N/A , $352.36 , $352.36 , $712.50 , $400.29 , $80.09 , $720.00 
"Revise Knee Joint Replace,All Parts",27487,N/A,N/A,N/A," $9,790.00 "," $6,363.50 "," $10,532.47 "," $1,644.52 "," $1,190.41 "," $8,494.01 "," $8,398.75 "," $9,104.70 "," $8,811.00 "," $8,811.00 "," $7,832.00 "," $7,832.00 "," $1,190.41 "," $9,039.11 "," $9,300.50 "," $8,811.00 "," $8,811.00 "," $8,811.00 "," $9,104.70 "," $9,398.40 "," $9,832.71 "," $8,321.50 "," $9,303.89 "," $9,988.20 ", N/A ," $8,659.75 "," $8,659.75 "," $9,300.50 "," $10,178.27 "," $1,190.41 "," $10,532.47 "
 Pro Bone Length Studies ,CPT® 77073,0972 - PRO FEE/RAD/DX,N/A,N/A, $307.00 , $199.55 , $254.39 , $44.12 , $34.41 , $172.01 , $201.49 , $285.51 , $276.30 , $276.30 , $245.60 , $245.60 , $34.41 , $283.45 , $291.65 , $276.30 , $276.30 , $276.30 , $285.51 , $294.72 , $247.78 , $260.95 , $223.42 , $181.39 , N/A , $175.36 , $175.36 , $291.65 , $203.00 , $34.41 , $294.72 
Bx Synovium Interphalang Jt,28054,N/A,N/A,N/A," $2,534.00 "," $1,647.10 "," $1,457.37 ", $228.45 , $230.52 ," $1,165.23 "," $1,161.56 "," $2,356.62 "," $2,280.60 "," $2,280.60 "," $2,027.20 "," $2,027.20 ", $230.52 ," $2,339.64 "," $2,407.30 "," $2,280.60 "," $2,280.60 "," $2,280.60 "," $2,356.62 "," $2,432.64 "," $1,353.73 "," $2,153.90 "," $1,250.63 "," $1,389.89 ", N/A ," $1,187.97 "," $1,187.97 "," $2,407.30 "," $1,396.30 ", $228.45 ," $2,432.64 "
Placement Ntrstl Device Rad Gid Prostate 1/>,CPT® 55876,N/A,N/A,N/A, $742.00 , $482.30 , $449.88 , $97.32 , $121.11 , $323.15 , $325.44 , $690.06 , $667.80 , $667.80 , $593.60 , $593.60 , $121.11 , $685.09 , $704.90 , $667.80 , $667.80 , $667.80 , $690.06 , $712.32 , $419.52 , $630.70 , $519.16 , $489.28 , N/A , $329.45 , $329.45 , $704.90 , $394.85 , $97.32 , $712.32 
Q Fever Antibody,CPT® 86638,N/A,N/A,N/A, $90.00 , $58.50 , N/A , $12.36 , $8.07 , $32.88 , $39.34 , $83.70 , $81.00 , $81.00 , $72.00 , $72.00 , $8.07 , $83.10 , $85.50 , $81.00 , $81.00 , $81.00 , $83.70 , $86.40 , $80.93 , $76.50 , $79.47 , $43.97 , N/A , $30.69 , $30.69 , $85.50 , $33.54 , $8.07 , $86.40 
Surgical Arthroscopy Shoulder Xtnsv Dbrdmt 3+,29823,N/A,N/A,N/A," $4,156.00 "," $2,701.40 "," $3,613.81 ", $567.06 , $543.90 ," $2,996.51 "," $3,026.03 "," $3,865.08 "," $3,740.40 "," $3,740.40 "," $3,324.80 "," $3,324.80 ", $543.90 ," $3,837.23 "," $3,948.20 "," $3,740.40 "," $3,740.40 "," $3,740.40 "," $3,865.08 "," $3,989.76 "," $3,363.02 "," $3,532.60 "," $3,339.77 "," $3,549.12 ", N/A ," $3,054.98 "," $3,054.98 "," $3,948.20 "," $3,590.68 ", $543.90 ," $3,989.76 "
"Fasciotomy,Iliotibial,Open",27305,N/A,N/A,N/A," $3,369.00 "," $2,189.85 "," $2,955.16 ", $465.14 , $461.04 ," $2,323.35 "," $2,329.29 "," $3,133.17 "," $3,032.10 "," $3,032.10 "," $2,695.20 "," $2,695.20 ", $461.04 ," $3,110.60 "," $3,200.55 "," $3,032.10 "," $3,032.10 "," $3,032.10 "," $3,133.17 "," $3,234.24 "," $2,737.46 "," $2,863.65 "," $2,569.05 "," $2,729.02 ", N/A ," $2,368.68 "," $2,368.68 "," $3,200.55 "," $2,784.04 ", $461.04 ," $3,234.24 "
 PANTOPRAZOLE SODIUM 20 MG PO TBEC ,HCPCS RXC637,0250 - PHARMACY,60687-0585-01,1 tablet, $19.53 , $12.69 , $16.41 , N/A , N/A , $15.78 , $17.58 , $16.53 , $17.58 , $17.58 , $17.58 , $16.60 , N/A , $18.03 , $18.55 , $16.60 , $18.16 , $18.16 , $18.55 , $18.75 , $15.98 , $17.58 , $16.60 , $15.43 , N/A , $15.81 , $15.81 , $18.55 , $16.76 , $15.43 , $18.75 
Preputial Stretching,CPT® 54450,N/A,N/A,N/A, $386.00 , $250.90 , $250.75 , $54.02 , $26.24 , $184.37 , $185.20 , $358.98 , $347.40 , $347.40 , $308.80 , $308.80 , $26.24 , $356.39 , $366.70 , $347.40 , $347.40 , $347.40 , $358.98 , $370.56 , $236.84 , $328.10 , $294.37 , $279.62 , N/A , $187.97 , $187.97 , $366.70 , $225.28 , $26.24 , $370.56 
 Fac Drug Test Def 22+ Classes ,HCPCS G0483,0301 - LAB/CHEMISTRY,N/A,N/A, $711.00 , $462.15 , $597.24 , $251.86 , $175.62 , $574.49 , $639.90 , $601.93 , $639.90 , $639.90 , $639.90 , $604.35 , $172.18 , $656.47 , $675.45 , $604.35 , $661.23 , $661.23 , $675.45 , $682.56 , $581.74 , $639.90 , $604.35 , $561.69 , N/A , $575.41 , $575.41 , $675.45 , $610.11 , $172.18 , $682.56 
 Fac Hep B Surface Antibody ,CPT® 86706,0302 - LAB/IMMUNOLOGY,N/A,N/A, $111.00 , $72.15 , $93.24 , $10.95 , $10.95 , $89.69 , $99.90 , $93.97 , $99.90 , $99.90 , $99.90 , $94.35 , $10.74 , $102.49 , $105.45 , $94.35 , $103.23 , $103.23 , $105.45 , $106.56 , $90.82 , $99.90 , $94.35 , $87.69 , N/A , $89.83 , $89.83 , $105.45 , $95.25 , $10.74 , $106.56 
 MUPIROCIN 2 % EX OINT ,HCPCS RXC637,0250 - PHARMACY,51672-1312-00,22 gram, $128.39 , $83.45 , $107.85 , N/A , N/A , $103.74 , $115.55 , $108.69 , $115.55 , $115.55 , $115.55 , $109.13 , N/A , $118.54 , $121.97 , $109.13 , $119.40 , $119.40 , $121.97 , $123.25 , $105.05 , $115.55 , $109.13 , $101.43 , N/A , $103.91 , $103.91 , $121.97 , $110.17 , $101.43 , $123.25 
"Closed Rx Elbow Dislocatn,Anesthesia",CPT® 24605,N/A,N/A,N/A," $3,485.00 "," $2,265.25 "," $2,947.30 ", $463.23 , $252.67 ," $2,263.13 "," $2,273.77 "," $3,241.05 "," $3,136.50 "," $3,136.50 "," $2,788.00 "," $2,788.00 ", $252.67 ," $3,217.70 "," $3,310.75 "," $3,136.50 "," $3,136.50 "," $3,136.50 "," $3,241.05 "," $3,345.60 "," $2,726.01 "," $2,962.25 "," $2,503.04 "," $2,679.27 ", N/A ," $2,307.29 "," $2,307.29 "," $3,310.75 "," $2,711.89 ", $252.67 ," $3,345.60 "
"Inject Diskogram,Lumbar,Ea Level",62290,N/A,N/A,N/A," $2,393.00 "," $1,555.45 ", $794.92 , $151.94 , $183.16 , $968.91 , $947.88 ," $2,225.49 "," $2,153.70 "," $2,153.70 "," $1,914.40 "," $1,914.40 ", $183.16 ," $2,209.46 "," $2,273.35 "," $2,153.70 "," $2,153.70 "," $2,153.70 "," $2,225.49 "," $2,297.28 ", $879.36 ," $2,034.05 ", $924.15 ," $1,027.28 ", N/A , $987.81 , $987.81 ," $2,273.35 "," $1,059.71 ", $151.94 ," $2,297.28 "
 Fac Appl Mlt-Layer Venous Wound Compress Below Knee ,CPT® 29581,0510 - CLINIC,N/A,N/A, $552.00 , $358.80 , $463.68 , $26.75 , $73.50 , $446.02 , $496.80 , N/A , $496.80 , $496.80 , $496.80 , $469.20 , $72.06 , $509.66 , $524.40 , $469.20 , $513.36 , $513.36 , $524.40 , $529.92 , $451.65 , $496.80 , $469.20 , $436.08 , N/A , $446.73 , $446.73 , $524.40 , $473.67 , $26.75 , $529.92 
Xcapsl Ctrc Rmvl Insj Io Lens Prosth Insj 1+,CPT® 66991,N/A,N/A,N/A," $7,064.00 "," $4,591.60 "," $4,206.54 ", $659.93 , $430.89 , N/A , N/A ," $6,569.52 "," $6,357.60 "," $6,357.60 "," $5,651.20 "," $5,651.20 ", $430.89 ," $6,522.19 "," $6,710.80 "," $6,357.60 "," $6,357.60 "," $6,357.60 "," $6,569.52 "," $6,781.44 ", N/A ," $6,004.40 "," $3,564.55 "," $4,978.77 ", N/A ," $3,590.35 "," $3,590.35 "," $6,710.80 "," $3,964.34 ", $430.89 ," $6,781.44 "
Ecmo/Ecls Initiation Veno-Arterial,CPT® 33947,N/A,N/A,N/A," $4,349.00 "," $2,826.85 "," $2,009.02 ", $309.60 , $408.32 ," $1,477.84 "," $1,489.48 "," $4,044.57 "," $3,914.10 "," $3,914.10 "," $3,479.20 "," $3,479.20 ", $408.32 ," $4,015.43 "," $4,131.55 "," $3,914.10 "," $3,914.10 "," $3,914.10 "," $4,044.57 "," $4,175.04 "," $1,863.70 "," $3,696.65 "," $1,778.72 "," $1,655.95 ", N/A ," $1,506.67 "," $1,506.67 "," $4,131.55 "," $1,711.56 ", $309.60 ," $4,175.04 "
 Simple Repair 21.1-30cm ,CPT® 12017,0981 - PRO FEE/ER,N/A,N/A," $1,403.00 ", $911.95 , $471.41 , $141.05 , $247.42 , $417.96 , $400.18 ," $1,304.79 "," $1,262.70 "," $1,262.70 "," $1,122.40 "," $1,122.40 ", $247.42 ," $1,295.39 "," $1,332.85 "," $1,262.70 "," $1,262.70 "," $1,262.70 "," $1,304.79 "," $1,346.88 ", $519.15 ," $1,192.55 ", $806.40 , $526.37 , N/A , $426.12 , $426.12 ," $1,332.85 ", $494.15 , $141.05 ," $1,346.88 "
" Fac IV Infusion, Hydration, Ea Add Hour ",CPT® 96361,0260 - IV THERAPY,N/A,N/A, $129.00 , $83.85 , $108.36 , $12.41 , $16.39 , $104.23 , $116.10 , $109.21 , $116.10 , $116.10 , $116.10 , $109.65 , $16.07 , $119.11 , $122.55 , $109.65 , $119.97 , $119.97 , $122.55 , $123.84 , $105.55 , $116.10 , $109.65 , $101.91 , N/A , $104.40 , $104.40 , $122.55 , $110.69 , $12.41 , $123.84 
"Removal Penis,Partial",CPT® 54120,N/A,N/A,N/A," $3,469.00 "," $2,254.85 "," $2,803.22 ", $603.62 , $647.16 ," $2,029.06 "," $2,047.33 "," $3,226.17 "," $3,122.10 "," $3,122.10 "," $2,775.20 "," $2,775.20 ", $647.16 ," $3,202.93 "," $3,295.55 "," $3,122.10 "," $3,122.10 "," $3,122.10 "," $3,226.17 "," $3,330.24 "," $2,626.69 "," $2,948.65 "," $3,263.05 "," $3,063.57 ", N/A ," $2,068.65 "," $2,068.65 "," $3,295.55 "," $2,479.41 ", $603.62 ," $3,330.24 "
 Pelvis CT Scan With Contrast ,CPT® 72193,0350 - CT SCAN,N/A,N/A," $3,434.00 "," $2,232.10 "," $2,884.56 ", $228.79 , $287.44 ," $2,774.67 "," $3,090.60 "," $2,907.22 "," $3,090.60 "," $3,090.60 "," $3,090.60 "," $2,918.90 ", $281.80 ," $3,170.61 "," $3,262.30 "," $2,918.90 "," $3,193.62 "," $3,193.62 "," $3,262.30 "," $3,296.64 "," $2,809.70 "," $3,090.60 "," $2,918.90 "," $2,712.86 ", N/A ," $2,779.14 "," $2,779.14 "," $3,262.30 "," $2,946.72 ", $228.79 ," $3,296.64 "
 Pro Insert Non-Tunnel Cv Cath ,CPT® 36556,0982 - PRO FEE/OUTPT,N/A,N/A," $1,860.00 "," $1,209.00 ", $514.22 , $79.62 , $322.67 , $528.55 , $516.83 ," $1,729.80 "," $1,674.00 "," $1,674.00 "," $1,488.00 "," $1,488.00 ", $322.67 ," $1,717.34 "," $1,767.00 "," $1,674.00 "," $1,674.00 "," $1,674.00 "," $1,729.80 "," $1,785.60 ", $476.45 ," $1,581.00 ", $636.91 , $489.07 , N/A , $538.87 , $538.87 ," $1,767.00 ", $612.15 , $79.62 ," $1,785.60 "
 Pro Remove Skin Tags Add-On ,CPT® 11201,0982 - PRO FEE/OUTPT,N/A,N/A, $149.00 , $96.85 , $52.16 , $15.71 , $15.36 , $45.31 , $43.98 , $138.57 , $134.10 , $134.10 , $119.20 , $119.20 , $15.36 , $137.57 , $141.55 , $134.10 , $134.10 , $134.10 , $138.57 , $143.04 , $57.50 , $126.65 , $87.42 , $59.64 , N/A , $46.20 , $46.20 , $141.55 , $53.57 , $15.36 , $143.04 
 Reticyte/Hgb Concentrate ,CPT® 85046,0305 - LAB/HEMATOLOGY,N/A,N/A, $48.00 , $31.20 , $40.32 , $5.68 , $5.68 , $38.78 , $43.20 , $40.64 , $43.20 , $43.20 , $43.20 , $40.80 , $5.57 , $44.32 , $45.60 , $40.80 , $44.64 , $44.64 , $45.60 , $46.08 , $39.27 , $43.20 , $40.80 , $37.92 , N/A , $38.85 , $38.85 , $45.60 , $41.19 , $5.57 , $46.08 
 Fac Teaec W/Graft Popliteal Art ,CPT® 35303,0360 - OR SERVICES,N/A,N/A," $2,534.00 "," $1,647.10 "," $2,128.56 "," $1,101.10 "," $1,018.09 "," $2,047.47 "," $2,280.60 "," $2,145.28 "," $2,280.60 "," $2,280.60 "," $2,280.60 "," $2,153.90 ", $998.13 ," $2,339.64 "," $2,407.30 "," $2,153.90 "," $2,356.62 "," $2,356.62 "," $2,407.30 "," $2,432.64 "," $2,073.32 "," $2,280.60 "," $2,153.90 "," $2,001.86 ", N/A ," $2,050.77 "," $2,050.77 "," $2,407.30 "," $2,174.43 ", $998.13 ," $2,432.64 "
Corneal Smear,CPT® 65430,N/A,N/A,N/A," $1,061.00 ", $689.65 , $624.07 , $97.64 , $24.62 , $585.55 , $549.65 , $986.73 , $954.90 , $954.90 , $848.80 , $848.80 , $24.62 , $979.62 ," $1,007.95 ", $954.90 , $954.90 , $954.90 , $986.73 ," $1,018.56 ", $858.66 , $901.85 , $565.55 , $744.94 , N/A , $596.97 , $596.97 ," $1,007.95 ", $658.98 , $24.62 ," $1,018.56 "
Prq Trluml Mchnl Thrmbc Vein Repeat Tx,CPT® 37188,N/A,N/A,N/A," $11,464.00 "," $7,451.60 "," $1,659.06 ", $258.04 ," $2,115.06 "," $1,285.13 "," $1,253.16 "," $10,661.52 "," $10,317.60 "," $10,317.60 "," $9,171.20 "," $9,171.20 "," $2,115.06 "," $10,584.71 "," $10,890.80 "," $10,317.60 "," $10,317.60 "," $10,317.60 "," $10,661.52 "," $11,005.44 "," $1,537.18 "," $9,744.40 "," $1,534.30 "," $1,385.92 ", N/A ," $1,310.20 "," $1,310.20 "," $10,890.80 "," $1,488.38 ", $258.04 ," $11,005.44 "
 IMMUNE GLOBULIN 10% (GAMMAGARD) IJ SOLN (INPT) ,HCPCS RXC636,0636 - DRUGS REQUIRING DETAILED CODIN,00944-2700-04,50 mL," $2,373.57 "," $1,542.82 "," $1,993.80 ", N/A , N/A ," $1,917.84 "," $2,136.21 "," $2,009.46 "," $2,136.21 "," $2,136.21 "," $2,136.21 "," $2,017.53 ", N/A ," $2,191.52 "," $2,254.89 "," $2,017.53 "," $2,207.42 "," $2,207.42 "," $2,254.89 "," $2,278.63 "," $1,942.05 "," $2,136.21 "," $2,017.53 "," $1,875.12 ", N/A ," $1,920.93 "," $1,920.93 "," $2,254.89 "," $2,036.76 "," $1,875.12 "," $2,278.63 "
 Fac Cftr Gene Analysis Full Gene Sequence ,CPT® 81223,0310 - PATHOLOGY LAB,N/A,N/A," $1,188.00 ", $772.20 , $997.92 , $508.98 , $508.98 , $959.90 ," $1,069.20 "," $1,005.76 "," $1,069.20 "," $1,069.20 "," $1,069.20 "," $1,009.80 ", $499.00 ," $1,096.88 "," $1,128.60 "," $1,009.80 "," $1,104.84 "," $1,104.84 "," $1,128.60 "," $1,140.48 ", $972.02 ," $1,069.20 "," $1,009.80 ", $938.52 , N/A , $961.45 , $961.45 ," $1,128.60 "," $1,019.42 ", $499.00 ," $1,140.48 "
 Ssa 60 Antibody Beaker1 ,CPT® 86235,0302 - LAB/IMMUNOLOGY,N/A,N/A, $167.00 , $108.55 , $140.28 , $18.29 , $18.29 , $134.94 , $150.30 , $141.38 , $150.30 , $150.30 , $150.30 , $141.95 , $17.93 , $154.19 , $158.65 , $141.95 , $155.31 , $155.31 , $158.65 , $160.32 , $136.64 , $150.30 , $141.95 , $131.93 , N/A , $135.15 , $135.15 , $158.65 , $143.30 , $17.93 , $160.32 
Topical Fluoride Varnish,HCPCS D1206,N/A,N/A,N/A, $95.00 , $61.75 , N/A , N/A , N/A , N/A , N/A , $88.35 , $85.50 , $85.50 , $76.00 , $76.00 , N/A , $87.71 , $90.25 , $85.50 , $85.50 , $85.50 , $88.35 , $91.20 , N/A , $80.75 , $42.82 , $86.65 , N/A , N/A , N/A , $90.25 , N/A , $42.82 , $91.20 
Ertapenem Injection,HCPCS J1335,N/A,N/A,N/A, $134.00 , $87.10 , N/A , $13.59 , $15.68 , N/A , N/A , $124.62 , $120.60 , $120.60 , $107.20 , $107.20 , $15.68 , $123.72 , $127.30 , $120.60 , $120.60 , $120.60 , $124.62 , $128.64 , $36.57 , $113.90 , $60.33 , $19.87 , N/A , N/A , N/A , $127.30 , N/A , $13.59 , $128.64 
" Pro Drain/Inject, Joint/Bursa ",CPT® 20610,0982 - PRO FEE/OUTPT,N/A,N/A, $467.00 , $303.55 , $274.69 , $42.73 , $65.94 , $223.70 , $219.57 , $434.31 , $420.30 , $420.30 , $373.60 , $373.60 , $65.94 , $431.18 , $443.65 , $420.30 , $420.30 , $420.30 , $434.31 , $448.32 , $257.37 , $396.95 , $240.85 , $264.61 , N/A , $228.06 , $228.06 , $443.65 , $268.04 , $42.73 , $448.32 
 Coronavirus Ag Ia Pbb ,CPT® 87426,0306 - LAB/BACT-MICRO,N/A,N/A, $100.00 , $65.00 , $84.00 , $36.04 , $36.04 , $80.80 , $90.00 , $84.66 , $90.00 , $90.00 , $90.00 , $85.00 , $35.33 , $92.33 , $95.00 , $85.00 , $93.00 , $93.00 , $95.00 , $96.00 , $81.82 , $90.00 , $85.00 , $79.00 , N/A , $80.93 , $80.93 , $95.00 , $85.81 , $35.33 , $96.00 
Open Rx Lat Malleolus Fx,27792,N/A,N/A,N/A," $3,584.00 "," $2,329.60 "," $3,947.78 ", $618.62 , $614.70 ," $3,155.71 "," $3,161.84 "," $3,333.12 "," $3,225.60 "," $3,225.60 "," $2,867.20 "," $2,867.20 ", $614.70 ," $3,309.11 "," $3,404.80 "," $3,225.60 "," $3,225.60 "," $3,225.60 "," $3,333.12 "," $3,440.64 "," $3,669.86 "," $3,046.40 "," $3,486.06 "," $3,704.75 ", N/A ," $3,217.28 "," $3,217.28 "," $3,404.80 "," $3,781.44 ", $614.70 ," $3,947.78 "
Fusion Radioulnar Jnt/Ulna Resec,CPT® 25830,N/A,N/A,N/A," $6,279.00 "," $4,081.35 "," $6,405.69 ", $981.83 , $804.08 ," $4,585.82 "," $4,624.45 "," $5,839.47 "," $5,651.10 "," $5,651.10 "," $5,023.20 "," $5,023.20 ", $804.08 ," $5,797.40 "," $5,965.05 "," $5,651.10 "," $5,651.10 "," $5,651.10 "," $5,839.47 "," $6,027.84 "," $5,809.73 "," $5,337.15 "," $5,089.94 "," $5,430.28 ", N/A ," $4,675.30 "," $4,675.30 "," $5,965.05 "," $5,495.14 ", $804.08 ," $6,405.69 "
 Fac Spec Coll SNF/Lab Covid-19 ,HCPCS G2024,0300 - LABORATORY,N/A,N/A, $32.00 , $20.80 , $26.88 , $25.97 , N/A , $25.86 , $28.80 , $27.09 , $28.80 , $28.80 , $28.80 , $27.20 , N/A , $29.55 , $30.40 , $27.20 , $29.76 , $29.76 , $30.40 , $30.72 , $26.18 , $28.80 , $27.20 , $25.28 , N/A , $25.90 , $25.90 , $30.40 , $27.46 , $25.28 , $30.72 
"Flowcytometry/Tech Component, Add-On",CPT® 88185,N/A,N/A,N/A, $375.00 , $243.75 , $77.18 , $23.32 , $23.70 , $223.11 , $245.18 , $348.75 , $337.50 , $337.50 , $300.00 , $300.00 , $23.70 , $346.24 , $356.25 , $337.50 , $337.50 , $337.50 , $348.75 , $360.00 , $144.83 , $318.75 , $257.87 , $103.65 , N/A , $208.22 , $208.22 , $356.25 , $228.82 , $23.32 , $360.00 
 CHLORTHALIDONE 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6900-61,1 tablet, $13.46 , $8.75 , $11.31 , N/A , N/A , $10.88 , $12.11 , $11.40 , $12.11 , $12.11 , $12.11 , $11.44 , N/A , $12.43 , $12.79 , $11.44 , $12.52 , $12.52 , $12.79 , $12.92 , $11.01 , $12.11 , $11.44 , $10.63 , N/A , $10.89 , $10.89 , $12.79 , $11.55 , $10.63 , $12.92 
 ONDANSETRON 8 MG PO TBDP ,HCPCS RXA250,0250 - PHARMACY,65862-0391-10,1 tablet, $190.75 , $123.99 , $160.23 , N/A , N/A , $154.13 , $171.68 , $161.49 , $171.68 , $171.68 , $171.68 , $162.14 , N/A , $176.12 , $181.21 , $162.14 , $177.40 , $177.40 , $181.21 , $183.12 , $156.07 , $171.68 , $162.14 , $150.69 , N/A , $154.37 , $154.37 , $181.21 , $163.68 , $150.69 , $183.12 
 Fac Transcortin ,CPT® 84449,0301 - LAB/CHEMISTRY,N/A,N/A, $150.00 , $97.50 , $126.00 , $18.36 , $18.36 , $121.20 , $135.00 , $126.99 , $135.00 , $135.00 , $135.00 , $127.50 , $18.00 , $138.50 , $142.50 , $127.50 , $139.50 , $139.50 , $142.50 , $144.00 , $122.73 , $135.00 , $127.50 , $118.50 , N/A , $121.40 , $121.40 , $142.50 , $128.72 , $18.00 , $144.00 
Colonoscopy Stoma Dx Including Collj Spec Spx,44388,N/A,N/A,N/A," $2,729.00 "," $1,773.85 "," $2,013.64 ", $146.74 , $272.24 , $791.86 , $808.81 ," $2,537.97 "," $2,456.10 "," $2,456.10 "," $2,183.20 "," $2,183.20 ", $272.24 ," $2,519.69 "," $2,592.55 "," $2,456.10 "," $2,456.10 "," $2,456.10 "," $2,537.97 "," $2,619.84 ", $681.67 ," $2,319.65 ", $888.46 , $902.79 , N/A , $807.31 , $807.31 ," $2,592.55 ", $844.36 , $146.74 ," $2,619.84 "
"Arthrodesis,Ankle,Open",CPT® 27870,N/A,N/A,N/A," $8,183.00 "," $5,318.95 "," $6,159.86 ", $961.57 ," $1,075.74 "," $4,998.95 "," $4,982.21 "," $7,610.19 "," $7,364.70 "," $7,364.70 "," $6,546.40 "," $6,546.40 "," $1,075.74 "," $7,555.36 "," $7,773.85 "," $7,364.70 "," $7,364.70 "," $7,364.70 "," $7,610.19 "," $7,855.68 "," $5,745.61 "," $6,955.55 "," $5,494.92 "," $5,877.09 ", N/A ," $5,096.49 "," $5,096.49 "," $7,773.85 "," $5,990.20 ", $961.57 ," $7,855.68 "
Manipulatn Shldr Jt W Anesthesia,CPT® 23700,N/A,N/A,N/A," $1,288.00 ", $837.20 ," $1,194.77 ", $187.52 , $142.01 , $946.55 , $942.80 ," $1,197.84 "," $1,159.20 "," $1,159.20 "," $1,030.40 "," $1,030.40 ", $142.01 ," $1,189.21 "," $1,223.60 "," $1,159.20 "," $1,159.20 "," $1,159.20 "," $1,197.84 "," $1,236.48 "," $1,107.03 "," $1,094.80 "," $1,038.33 "," $1,116.76 ", N/A , $965.02 , $965.02 ," $1,223.60 "," $1,134.26 ", $142.01 ," $1,236.48 "
Punc/Aspir Breast Cyst,CPT® 19000,N/A,N/A,N/A, $563.00 , $365.95 , $136.68 , $40.41 , $37.38 , $120.05 , $114.08 , $523.59 , $506.70 , $506.70 , $450.40 , $450.40 , $37.38 , $519.82 , $534.85 , $506.70 , $506.70 , $506.70 , $523.59 , $540.48 , $151.14 , $478.55 , $224.79 , $153.32 , N/A , $122.40 , $122.40 , $534.85 , $141.95 , $37.38 , $540.48 
 Fac Iaadiadoo Hiv1 Antigen W/Hiv1 & Hiv2 Antibodies ,CPT® 87806,0306 - LAB/BACT-MICRO,N/A,N/A, $231.00 , $150.15 , $194.04 , $33.43 , $26.81 , $186.65 , $207.90 , $195.56 , $207.90 , $207.90 , $207.90 , $196.35 , $26.28 , $213.28 , $219.45 , $196.35 , $214.83 , $214.83 , $219.45 , $221.76 , $189.00 , $207.90 , $196.35 , $182.49 , N/A , $186.95 , $186.95 , $219.45 , $198.22 , $26.28 , $221.76 
"Burn Dressing,Sm,W/O Anes",16020,N/A,N/A,N/A, $364.00 , $236.60 , $173.81 , $52.76 , $30.25 , $148.68 , $145.73 , $338.52 , $327.60 , $327.60 , $291.20 , $291.20 , $30.25 , $336.08 , $345.80 , $327.60 , $327.60 , $327.60 , $338.52 , $349.44 , $191.27 , $309.40 , $289.02 , $192.11 , N/A , $151.58 , $151.58 , $345.80 , $175.80 , $30.25 , $349.44 
TREAT HUMERUS FRACTURE,24577,N/A,N/A,N/A," $2,650.00 "," $1,722.50 "," $3,127.48 ", $492.98 , $307.34 ," $2,418.00 "," $2,423.31 "," $2,464.50 "," $2,385.00 "," $2,385.00 "," $2,120.00 "," $2,120.00 ", $307.34 ," $2,446.75 "," $2,517.50 "," $2,385.00 "," $2,385.00 "," $2,385.00 "," $2,464.50 "," $2,544.00 "," $2,891.25 "," $2,252.50 "," $2,668.96 "," $2,858.61 ", N/A ," $2,465.17 "," $2,465.17 "," $2,517.50 "," $2,897.46 ", $307.34 ," $3,127.48 "
Redo Excis Lumbar Disk,CPT® 63042,N/A,N/A,N/A," $8,517.00 "," $5,536.05 "," $6,093.52 "," $1,190.94 "," $1,122.09 "," $7,070.37 "," $6,830.26 "," $7,920.81 "," $7,665.30 "," $7,665.30 "," $6,813.60 "," $6,813.60 "," $1,122.09 "," $7,863.75 "," $8,091.15 "," $7,665.30 "," $7,665.30 "," $7,665.30 "," $7,920.81 "," $8,176.32 "," $6,592.08 "," $7,239.45 "," $6,906.11 "," $7,449.98 ", N/A ," $7,208.33 "," $7,208.33 "," $8,091.15 "," $7,732.86 "," $1,122.09 "," $8,176.32 "
 Pro US Chest- Lh ,CPT® 76604,0972 - PRO FEE/RAD/DX,N/A,N/A, $263.00 , $170.95 , $329.38 , $55.74 , $82.61 , $423.02 , $465.39 , $244.59 , $236.70 , $236.70 , $210.40 , $210.40 , $82.61 , $242.83 , $249.85 , $236.70 , $236.70 , $236.70 , $244.59 , $252.48 , $369.55 , $223.55 , $508.48 , $501.74 , N/A , $431.28 , $431.28 , $249.85 , $499.21 , $55.74 , $508.48 
 FLEET ENEMA 7-19 GM/118ML RE ENEM ,HCPCS RXC637,0250 - PHARMACY,00132-0201-40,1 enema, $9.57 , $6.22 , $8.04 , N/A , N/A , $7.73 , $8.61 , $8.10 , $8.61 , $8.61 , $8.61 , $8.13 , N/A , $8.84 , $9.09 , $8.13 , $8.90 , $8.90 , $9.09 , $9.19 , $7.83 , $8.61 , $8.13 , $7.56 , N/A , $7.75 , $7.75 , $9.09 , $8.21 , $7.56 , $9.19 
 EPINEPHRINE (ANAPHYLAXIS) 1 MG/ML IJ SOLN ,HCPCS J0171,0636 - DRUGS REQUIRING DETAILED CODIN,42023-0159-25,0.3 mL, $27.67 , $17.99 , $23.24 , $0.74 , $0.75 , $22.36 , $24.90 , $23.43 , $24.90 , $24.90 , $24.90 , $23.52 , $0.74 , $25.55 , $26.29 , $23.52 , $25.73 , $25.73 , $26.29 , $26.56 , $22.64 , $24.90 , $23.52 , $21.86 , N/A , $22.39 , $22.39 , $26.29 , $23.74 , $0.74 , $26.56 
 Fac Plmt Nephroureteral Cath Prq New Access Rs&I ,CPT® 50433,0750 - GASTR-INST SVS,N/A,N/A," $4,659.00 "," $3,028.35 "," $3,913.56 ", $241.17 , $901.77 ," $3,764.47 "," $4,193.10 "," $3,944.31 "," $4,193.10 "," $4,193.10 "," $4,193.10 "," $3,960.15 ", $884.09 ," $4,301.65 "," $4,426.05 "," $3,960.15 "," $4,332.87 "," $4,332.87 "," $4,426.05 "," $4,472.64 "," $3,811.99 "," $4,193.10 "," $3,960.15 "," $3,680.61 ", N/A ," $3,770.53 "," $3,770.53 "," $4,426.05 "," $3,997.89 ", $241.17 ," $4,472.64 "
 Fac Rtrvl Intrvas Vc Filtr W/WO Acs Vsl Selxn Rs&I ,CPT® 37193,0361 - OR/MINOR,N/A,N/A," $8,268.00 "," $5,374.20 "," $6,945.12 ", $321.61 ," $1,330.85 "," $6,680.54 "," $7,441.20 "," $6,999.69 "," $7,441.20 "," $7,441.20 "," $7,441.20 "," $7,027.80 "," $1,304.75 "," $7,633.84 "," $7,854.60 "," $7,027.80 "," $7,689.24 "," $7,689.24 "," $7,854.60 "," $7,937.28 "," $6,764.88 "," $7,441.20 "," $7,027.80 "," $6,531.72 ", N/A ," $6,691.29 "," $6,691.29 "," $7,854.60 "," $7,094.77 ", $321.61 ," $7,937.28 "
Myocardial Spect Multiple Studies,CPT® 78452,N/A,N/A,N/A," $5,287.00 "," $3,436.55 "," $2,536.80 ", $430.43 , $323.37 ," $2,327.23 "," $2,593.36 "," $4,916.91 "," $4,758.30 "," $4,758.30 "," $4,229.60 "," $4,229.60 ", $323.37 ," $4,881.49 "," $5,022.65 "," $4,758.30 "," $4,758.30 "," $4,758.30 "," $4,916.91 "," $5,075.52 "," $2,630.24 "," $4,493.95 "," $2,842.84 "," $3,192.61 ", N/A ," $2,372.64 "," $2,372.64 "," $5,022.65 "," $2,746.39 ", $323.37 ," $5,075.52 "
 ISOSORBIDE MONONITRATE ER 60 MG PO TB24 ,HCPCS RXC637,0250 - PHARMACY,00904-6450-61,1 tablet, $10.41 , $6.77 , $8.74 , N/A , N/A , $8.41 , $9.37 , $8.81 , $9.37 , $9.37 , $9.37 , $8.85 , N/A , $9.61 , $9.89 , $8.85 , $9.68 , $9.68 , $9.89 , $9.99 , $8.52 , $9.37 , $8.85 , $8.22 , N/A , $8.42 , $8.42 , $9.89 , $8.93 , $8.22 , $9.99 
 NOREPINEPHRINE-SODIUM CHLORIDE 16-0.9 MG/250ML-% IV SOLN ,HCPCS RXA250,0250 - PHARMACY,69374-0315-25,250 mL, $141.27 , $91.83 , $118.67 , N/A , N/A , $114.15 , $127.14 , $119.60 , $127.14 , $127.14 , $127.14 , $120.08 , N/A , $130.43 , $134.21 , $120.08 , $131.38 , $131.38 , $134.21 , $135.62 , $115.59 , $127.14 , $120.08 , $111.60 , N/A , $114.33 , $114.33 , $134.21 , $121.22 , $111.60 , $135.62 
" Pro Inj Dx/Ther Agnt Paravert Facet Joint, Lumbar/Sac, 1st Level ",CPT® 64493,0982 - PRO FEE/OUTPT,N/A,N/A, $814.00 , $529.10 , $445.43 , $86.57 , $126.53 , $511.48 , $503.33 , $757.02 , $732.60 , $732.60 , $651.20 , $651.20 , $126.53 , $751.57 , $773.30 , $732.60 , $732.60 , $732.60 , $757.02 , $781.44 , $484.01 , $691.90 , $490.62 , $548.86 , N/A , $521.47 , $521.47 , $773.30 , $559.41 , $86.57 , $781.44 
 Pro Partial Removal of Foot Bone ,CPT® 28288,0982 - PRO FEE/OUTPT,N/A,N/A," $4,045.00 "," $2,629.25 "," $2,687.04 ", $421.68 , $272.17 ," $2,107.60 "," $2,111.56 "," $3,761.85 "," $3,640.50 "," $3,640.50 "," $3,236.00 "," $3,236.00 ", $272.17 ," $3,734.75 "," $3,842.75 "," $3,640.50 "," $3,640.50 "," $3,640.50 "," $3,761.85 "," $3,883.20 "," $2,494.68 "," $3,438.25 "," $2,292.52 "," $2,515.65 ", N/A ," $2,148.72 "," $2,148.72 "," $3,842.75 "," $2,525.50 ", $272.17 ," $3,883.20 "
 Fac Assay of Amylase ,CPT® 82150,0301 - LAB/CHEMISTRY,N/A,N/A, $92.00 , $59.80 , $77.28 , $6.61 , $6.61 , $74.34 , $82.80 , $77.89 , $82.80 , $82.80 , $82.80 , $78.20 , $6.48 , $84.94 , $87.40 , $78.20 , $85.56 , $85.56 , $87.40 , $88.32 , $75.27 , $82.80 , $78.20 , $72.68 , N/A , $74.46 , $74.46 , $87.40 , $78.95 , $6.48 , $88.32 
 Pro Mra Head C-/C+ ,CPT® 70546,0972 - PRO FEE/RAD/DX,N/A,N/A, $858.00 , $557.70 ," $2,359.28 ", $337.81 , $616.29 ," $2,853.31 "," $3,661.38 ", $797.94 , $772.20 , $772.20 , $686.40 , $686.40 , $616.29 , $792.19 , $815.10 , $772.20 , $772.20 , $772.20 , $797.94 , $823.68 ," $2,013.99 ", $729.30 ," $3,990.76 "," $3,233.42 ", N/A ," $2,908.98 "," $2,908.98 ", $815.10 ," $3,367.19 ", $337.81 ," $3,990.76 "
"Cabg, Vein, Three",CPT® 33512,N/A,N/A,N/A," $20,961.00 "," $13,624.65 "," $14,132.04 "," $2,181.21 "," $2,334.06 "," $10,311.09 "," $10,239.47 "," $19,493.73 "," $18,864.90 "," $18,864.90 "," $16,768.80 "," $16,768.80 "," $2,334.06 "," $19,353.29 "," $19,912.95 "," $18,864.90 "," $18,864.90 "," $18,864.90 "," $19,493.73 "," $20,122.56 "," $13,083.51 "," $17,816.85 "," $12,973.71 "," $11,568.92 ", N/A ," $10,512.28 "," $10,512.28 "," $19,912.95 "," $11,941.95 "," $2,181.21 "," $20,122.56 "
 Fac Slctv Cathj 2nd Order Abdl Pel/Lxtr Art Brnch ,CPT® 36246,0761 - TREATMENT ROOM,N/A,N/A," $3,571.00 "," $2,321.15 "," $2,999.64 ", $227.83 , $593.68 ," $2,885.37 "," $3,213.90 "," $3,023.21 "," $3,213.90 "," $3,213.90 "," $3,213.90 "," $3,035.35 ", $582.04 ," $3,297.10 "," $3,392.45 "," $3,035.35 "," $3,321.03 "," $3,321.03 "," $3,392.45 "," $3,428.16 "," $2,921.79 "," $3,213.90 "," $3,035.35 "," $2,821.09 ", N/A ," $2,890.01 "," $2,890.01 "," $3,392.45 "," $3,064.28 ", $227.83 ," $3,428.16 "
 Fac Infrared Therapy ,CPT® 97026,0430 - OCCUPATION THER,N/A,N/A, $130.00 , $84.50 , $109.20 , $6.45 , $19.20 , $105.04 , $117.00 , $110.06 , $117.00 , $117.00 , $117.00 , $110.50 , $18.82 , $120.03 , $123.50 , $110.50 , $120.90 , $120.90 , $123.50 , $124.80 , $106.37 , $117.00 , $110.50 , $102.70 , N/A , $105.21 , $105.21 , $123.50 , $111.55 , $6.45 , $124.80 
 Pro X-Ray Exam of Shoulder ,CPT® 73020,0972 - PRO FEE/RAD/DX,N/A,N/A, $93.00 , $60.45 , $120.18 , $21.17 , $22.57 , $109.13 , $125.76 , $86.49 , $83.70 , $83.70 , $74.40 , $74.40 , $22.57 , $85.87 , $88.35 , $83.70 , $83.70 , $83.70 , $86.49 , $89.28 , $117.82 , $79.05 , $138.68 , $115.33 , N/A , $111.26 , $111.26 , $88.35 , $128.79 , $21.17 , $138.68 
Dilation Nasolacrimal Duct,68801,N/A,N/A,N/A, $398.00 , $258.70 , $484.45 , $77.05 , $44.63 , $607.38 , $577.04 , $370.14 , $358.20 , $358.20 , $318.40 , $318.40 , $44.63 , $367.47 , $378.10 , $358.20 , $358.20 , $358.20 , $370.14 , $382.08 , $663.69 , $338.30 , $594.09 , $566.45 , N/A , $619.24 , $619.24 , $378.10 , $683.56 , $44.63 , $683.56 
 MEDROXYPROGESTERONE ACETATE 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,60687-0105-21,1 tablet, $8.61 , $5.60 , $7.23 , N/A , N/A , $6.96 , $7.75 , $7.29 , $7.75 , $7.75 , $7.75 , $7.32 , N/A , $7.95 , $8.18 , $7.32 , $8.01 , $8.01 , $8.18 , $8.27 , $7.04 , $7.75 , $7.32 , $6.80 , N/A , $6.97 , $6.97 , $8.18 , $7.39 , $6.80 , $8.27 
 Pro Wound Closure by Adhesive ,HCPCS G0168,0982 - PRO FEE/OUTPT,N/A,N/A, $399.00 , $259.35 , $32.95 , $13.67 , N/A , $51.11 , N/A , $371.07 , $359.10 , $359.10 , $319.20 , $319.20 , N/A , $368.40 , $379.05 , $359.10 , $359.10 , $359.10 , $371.07 , $383.04 , $51.92 , $339.15 , $51.90 , $98.90 , N/A , $52.10 , $52.10 , $379.05 , $65.15 , $13.67 , $383.04 
Assay of Prostaglandin,CPT® 84150,N/A,N/A,N/A, $299.00 , $194.35 , N/A , $42.61 , $34.64 , $141.18 , $168.92 , $278.07 , $269.10 , $269.10 , $239.20 , $239.20 , $34.64 , $276.07 , $284.05 , $269.10 , $269.10 , $269.10 , $278.07 , $287.04 , $278.91 , $254.15 , $163.81 , $122.68 , N/A , $131.76 , $131.76 , $284.05 , $143.99 , $34.64 , $287.04 
"Closed Rx Metacarpal Fx,Open",CPT® 26615,N/A,N/A,N/A," $2,386.00 "," $1,550.90 "," $3,532.95 ", $555.54 , $461.04 ," $2,775.50 "," $2,780.71 "," $2,218.98 "," $2,147.40 "," $2,147.40 "," $1,908.80 "," $1,908.80 ", $461.04 ," $2,202.99 "," $2,266.70 "," $2,147.40 "," $2,147.40 "," $2,147.40 "," $2,218.98 "," $2,290.56 "," $3,283.35 "," $2,028.10 "," $3,056.10 "," $3,289.76 ", N/A ," $2,829.65 "," $2,829.65 "," $2,266.70 "," $3,325.85 ", $461.04 ," $3,532.95 "
Surg Excision of Anal Lesion(S),CPT® 46922,N/A,N/A,N/A," $1,756.00 "," $1,141.40 ", $837.92 , $131.22 , $76.84 , $642.36 , $659.57 ," $1,633.08 "," $1,580.40 "," $1,580.40 "," $1,404.80 "," $1,404.80 ", $76.84 ," $1,621.31 "," $1,668.20 "," $1,580.40 "," $1,580.40 "," $1,580.40 "," $1,633.08 "," $1,685.76 ", $595.23 ," $1,492.60 ", $726.11 , $765.51 , N/A , $654.89 , $654.89 ," $1,668.20 ", $684.95 , $76.84 ," $1,685.76 "
"Stereotactic Radiosurgery, Cranial,Complex,Ea Add",CPT® 61799,N/A,N/A,N/A," $4,286.00 "," $2,785.90 "," $1,351.22 ", $263.06 , $254.67 ," $1,639.00 "," $1,533.29 "," $3,985.98 "," $3,857.40 "," $3,857.40 "," $3,428.80 "," $3,428.80 ", $254.67 ," $3,957.26 "," $4,071.70 "," $3,857.40 "," $3,857.40 "," $3,857.40 "," $3,985.98 "," $4,114.56 "," $1,464.35 "," $3,643.10 "," $1,578.90 "," $1,685.52 ", N/A ," $1,670.98 "," $1,670.98 "," $4,071.70 "," $1,792.59 ", $254.67 ," $4,114.56 "
" Exploration; Post OP Hemorrhage, Thrombosis or Infection; Neck ",CPT® 35800,0360 - OR SERVICES,N/A,N/A," $4,830.00 "," $3,139.50 "," $4,057.20 ", $683.60 , $468.75 ," $3,902.64 "," $4,347.00 "," $4,089.08 "," $4,347.00 "," $4,347.00 "," $4,347.00 "," $4,105.50 ", $459.56 ," $4,459.54 "," $4,588.50 "," $4,105.50 "," $4,491.90 "," $4,491.90 "," $4,588.50 "," $4,636.80 "," $3,951.91 "," $4,347.00 "," $4,105.50 "," $3,815.70 ", N/A ," $3,908.92 "," $3,908.92 "," $4,588.50 "," $4,144.62 ", $459.56 ," $4,636.80 "
 Fac Carotene ,CPT® 82380,0301 - LAB/CHEMISTRY,N/A,N/A, $80.00 , $52.00 , $67.20 , $9.40 , $9.40 , $64.64 , $72.00 , $67.73 , $72.00 , $72.00 , $72.00 , $68.00 , $9.22 , $73.86 , $76.00 , $68.00 , $74.40 , $74.40 , $76.00 , $76.80 , $65.46 , $72.00 , $68.00 , $63.20 , N/A , $64.74 , $64.74 , $76.00 , $68.65 , $9.22 , $76.80 
 Fac Slctv Cathj 2nd Order Abdl Pel/Lxtr Art Brnch ,CPT® 36246,0360 - OR SERVICES,N/A,N/A," $3,571.00 "," $2,321.15 "," $2,999.64 ", $227.83 , $593.68 ," $2,885.37 "," $3,213.90 "," $3,023.21 "," $3,213.90 "," $3,213.90 "," $3,213.90 "," $3,035.35 ", $582.04 ," $3,297.10 "," $3,392.45 "," $3,035.35 "," $3,321.03 "," $3,321.03 "," $3,392.45 "," $3,428.16 "," $2,921.79 "," $3,213.90 "," $3,035.35 "," $2,821.09 ", N/A ," $2,890.01 "," $2,890.01 "," $3,392.45 "," $3,064.28 ", $227.83 ," $3,428.16 "
 MELOXICAM 7.5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,50268-0525-15,1 tablet, $15.92 , $10.35 , $13.37 , N/A , N/A , $12.86 , $14.33 , $13.48 , $14.33 , $14.33 , $14.33 , $13.53 , N/A , $14.70 , $15.12 , $13.53 , $14.81 , $14.81 , $15.12 , $15.28 , $13.03 , $14.33 , $13.53 , $12.58 , N/A , $12.88 , $12.88 , $15.12 , $13.66 , $12.58 , $15.28 
 Fac Prq Trluml Coronary Stent W/Angio Addl Art/Brnch ,CPT® 92929,0481 - CARDIAC CATH LAB,N/A,N/A," $3,450.00 "," $2,242.50 "," $2,898.00 ", N/A , $226.64 ," $2,787.60 "," $3,105.00 "," $2,920.77 "," $3,105.00 "," $3,105.00 "," $3,105.00 "," $2,932.50 ", $222.20 ," $3,185.39 "," $3,277.50 "," $2,932.50 "," $3,208.50 "," $3,208.50 "," $3,277.50 "," $3,312.00 "," $2,822.79 "," $3,105.00 "," $2,932.50 "," $2,725.50 ", N/A ," $2,792.09 "," $2,792.09 "," $3,277.50 "," $2,960.45 ", $222.20 ," $3,312.00 "
 Fac Trauma 4 Activation W/ Pre-ED Notficiation- Level II- W/O Critical Care ,Custom 1000810,0684 - TRAUMA LEVEL IV,N/A,N/A," $1,533.00 ", $996.45 ," $1,287.72 ", N/A , N/A ," $1,238.66 "," $1,379.70 "," $1,297.84 "," $1,379.70 "," $1,379.70 "," $1,379.70 "," $1,303.05 ", N/A ," $1,415.42 "," $1,456.35 "," $1,303.05 "," $1,425.69 "," $1,425.69 "," $1,456.35 "," $1,471.68 "," $1,254.30 "," $1,379.70 "," $1,303.05 "," $1,211.07 ", N/A ," $1,240.66 "," $1,240.66 "," $1,456.35 "," $1,315.47 "," $1,211.07 "," $1,471.68 "
 Fac Injection Treatment of Nerve ,CPT® 64680,0360 - OR SERVICES,N/A,N/A," $2,199.00 "," $1,429.35 "," $1,847.16 ", $156.18 , $466.44 ," $1,776.79 "," $1,979.10 "," $1,861.67 "," $1,979.10 "," $1,979.10 "," $1,979.10 "," $1,869.15 ", $457.29 ," $2,030.34 "," $2,089.05 "," $1,869.15 "," $2,045.07 "," $2,045.07 "," $2,089.05 "," $2,111.04 "," $1,799.22 "," $1,979.10 "," $1,869.15 "," $1,737.21 ", N/A ," $1,779.65 "," $1,779.65 "," $2,089.05 "," $1,886.96 ", $156.18 ," $2,111.04 "
"Removal External Ear,Partial",CPT® 69110,N/A,N/A,N/A," $2,613.00 "," $1,698.45 "," $1,572.50 ", $319.31 , $219.95 ," $1,552.61 "," $1,616.18 "," $2,430.09 "," $2,351.70 "," $2,351.70 "," $2,090.40 "," $2,090.40 ", $219.95 ," $2,412.58 "," $2,482.35 "," $2,351.70 "," $2,351.70 "," $2,351.70 "," $2,430.09 "," $2,508.48 "," $1,708.71 "," $2,221.05 "," $1,764.44 "," $1,576.67 ", N/A ," $1,582.90 "," $1,582.90 "," $2,482.35 "," $1,807.42 ", $219.95 ," $2,508.48 "
 Pro Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level ,CPT® 64483,0982 - PRO FEE/OUTPT,N/A,N/A," $1,016.00 ", $660.40 , $550.37 , $106.70 , $205.84 , $636.12 , $622.08 , $944.88 , $914.40 , $914.40 , $812.80 , $812.80 , $205.84 , $938.07 , $965.20 , $914.40 , $914.40 , $914.40 , $944.88 , $975.36 , $598.03 , $863.60 , $604.80 , $680.05 , N/A , $648.53 , $648.53 , $965.20 , $695.74 , $106.70 , $975.36 
"Apply Bone Multiplan,Ext Fix Dev",CPT® 20692,N/A,N/A,N/A," $7,317.00 "," $4,756.05 "," $6,818.18 "," $1,070.43 ", $897.14 ," $5,414.82 "," $5,379.01 "," $6,804.81 "," $6,585.30 "," $6,585.30 "," $5,853.60 "," $5,853.60 ", $897.14 ," $6,755.79 "," $6,951.15 "," $6,585.30 "," $6,585.30 "," $6,585.30 "," $6,804.81 "," $7,024.32 "," $6,339.95 "," $6,219.45 "," $5,919.52 "," $6,390.69 ", N/A ," $5,520.47 "," $5,520.47 "," $6,951.15 "," $6,488.51 ", $897.14 ," $7,024.32 "
" Pro Program Eval Implant Device,Cardvert/Defib,1 Lead ",CPT® 93282,0982 - PRO FEE/OUTPT,N/A,N/A, $842.00 , $547.30 , $522.99 , $79.84 , $54.59 , $344.32 , $346.75 , $783.06 , $757.80 , $757.80 , $673.60 , $673.60 , $54.59 , $777.42 , $799.90 , $757.80 , $757.80 , $757.80 , $783.06 , $808.32 , $489.96 , $715.70 , $324.70 , $232.24 , N/A , $351.04 , $351.04 , $799.90 , $389.12 , $54.59 , $808.32 
Antinuclear Antibodies,CPT® 86038,N/A,N/A,N/A, $104.00 , $67.60 , N/A , $12.33 , $12.33 , $58.95 , $70.55 , $96.72 , $93.60 , $93.60 , $83.20 , $83.20 , $12.33 , $96.02 , $98.80 , $93.60 , $93.60 , $93.60 , $96.72 , $99.84 , $80.73 , $88.40 , $79.47 , $43.82 , N/A , $55.02 , $55.02 , $98.80 , $60.12 , $12.33 , $99.84 
Sperm Washing for Artif Insem,CPT® 58323,N/A,N/A,N/A, $374.00 , $243.10 , $56.50 , $11.34 , N/A , $50.13 , $50.06 , $347.82 , $336.60 , $336.60 , $299.20 , $299.20 , N/A , $345.31 , $355.30 , $336.60 , $336.60 , $336.60 , $347.82 , $359.04 , $66.61 , $317.90 , $66.01 , $50.32 , N/A , $51.11 , $51.11 , $355.30 , $61.28 , $11.34 , $359.04 
 Pro Insertion Picc W/O Img Gdn 5 Yr/> ,CPT® 36569,0960 - PRO FEE,N/A,N/A," $1,617.00 "," $1,051.05 ", $570.51 , $87.87 , $94.88 , $405.39 , $393.52 ," $1,503.81 "," $1,455.30 "," $1,455.30 "," $1,293.60 "," $1,293.60 ", $94.88 ," $1,492.98 "," $1,536.15 "," $1,455.30 "," $1,455.30 "," $1,455.30 "," $1,503.81 "," $1,552.32 ", $529.38 ," $1,374.45 ", $478.13 , $430.78 , N/A , $413.31 , $413.31 ," $1,536.15 ", $469.51 , $87.87 ," $1,552.32 "
"Hep B Vaccine, Adol, Im",CPT® 90743,N/A,N/A,N/A, $151.00 , $98.15 , N/A , $75.33 , $40.00 , $53.01 , $73.99 , $140.43 , $135.90 , $135.90 , $120.80 , $120.80 , $40.00 , $139.42 , $143.45 , $135.90 , $135.90 , $135.90 , $140.43 , $144.96 , N/A , $128.35 , $71.97 , $117.84 , N/A , $54.04 , $54.04 , $143.45 , $63.00 , $40.00 , $144.96 
 Fac Occupational Therapy Eval High Complex ,CPT® 97167,0434 - OCCUP THERP/EVAL,N/A,N/A, $417.00 , $271.05 , $350.28 , $100.30 , $63.91 , $336.94 , $375.30 , $353.03 , $375.30 , $375.30 , $375.30 , $354.45 , $62.66 , $385.02 , $396.15 , $354.45 , $387.81 , $387.81 , $396.15 , $400.32 , $341.19 , $375.30 , $354.45 , $329.43 , N/A , $337.48 , $337.48 , $396.15 , $357.83 , $62.66 , $400.32 
 Fac Peripheral Vascular Rehab ,CPT® 93668,0480 - CARDIOLOGY,N/A,N/A, $159.00 , $103.35 , $133.56 , $13.90 , N/A , $128.47 , $143.10 , $134.61 , $143.10 , $143.10 , $143.10 , $135.15 , N/A , $146.80 , $151.05 , $135.15 , $147.87 , $147.87 , $151.05 , $152.64 , $130.09 , $143.10 , $135.15 , $125.61 , N/A , $128.68 , $128.68 , $151.05 , $136.44 , $13.90 , $152.64 
 Fac Radiation Physics Consult ,CPT® 77336,0333 - RADIATION RX,N/A,N/A," $1,483.00 ", $963.95 ," $1,245.72 ", $82.96 , $110.62 ," $1,198.26 "," $1,334.70 "," $1,255.51 "," $1,334.70 "," $1,334.70 "," $1,334.70 "," $1,260.55 ", $108.45 ," $1,369.25 "," $1,408.85 "," $1,260.55 "," $1,379.19 "," $1,379.19 "," $1,408.85 "," $1,423.68 "," $1,213.39 "," $1,334.70 "," $1,260.55 "," $1,171.57 ", N/A ," $1,200.19 "," $1,200.19 "," $1,408.85 "," $1,272.56 ", $82.96 ," $1,423.68 "
 Orbits for Detection of F.B. in Eyes ,CPT® 70030,0320 - DX X-RAY,N/A,N/A, $312.00 , $202.80 , $262.08 , $32.05 , $27.07 , $252.10 , $280.80 , $264.14 , $280.80 , $280.80 , $280.80 , $265.20 , $26.54 , $288.07 , $296.40 , $265.20 , $290.16 , $290.16 , $296.40 , $299.52 , $255.28 , $280.80 , $265.20 , $246.48 , N/A , $252.50 , $252.50 , $296.40 , $267.73 , $26.54 , $299.52 
 Injection Sacro Jnt Arthr ,CPT® 27096,0981 - PRO FEE/ER,N/A,N/A, $653.00 , $424.45 , $512.53 , $79.93 , $154.36 , $415.04 , $416.57 , $607.29 , $587.70 , $587.70 , $522.40 , $522.40 , $154.36 , $602.91 , $620.35 , $587.70 , $587.70 , $587.70 , $607.29 , $626.88 , $480.33 , $555.05 , $451.37 , $490.61 , N/A , $423.13 , $423.13 , $620.35 , $497.32 , $79.93 , $626.88 
 Pro Treatment of Tibia Fracture ,CPT® 27759,0982 - PRO FEE/OUTPT,N/A,N/A," $3,746.00 "," $2,434.90 "," $6,032.59 ", $944.03 , $879.19 ," $4,820.61 "," $4,781.45 "," $3,483.78 "," $3,371.40 "," $3,371.40 "," $2,996.80 "," $2,996.80 ", $879.19 ," $3,458.68 "," $3,558.70 "," $3,371.40 "," $3,371.40 "," $3,371.40 "," $3,483.78 "," $3,596.16 "," $5,622.20 "," $3,184.10 "," $5,287.97 "," $5,671.47 ", N/A ," $4,914.67 "," $4,914.67 "," $3,558.70 "," $5,776.48 ", $879.19 ," $6,032.59 "
"Eye Exam, New Patient,Comprehesv",92004,N/A,N/A,N/A, $445.00 , $289.25 , $208.87 , $93.23 , $45.22 , $177.44 , $177.23 , $413.85 , $400.50 , $400.50 , $356.00 , $356.00 , $45.22 , $410.87 , $422.75 , $400.50 , $400.50 , $400.50 , $413.85 , $427.20 , $271.94 , $378.25 , $298.03 , $211.32 , N/A , $180.91 , $180.91 , $422.75 , $215.19 , $45.22 , $427.20 
 Fac Chorionic Gonadotropin Test ,CPT® 84702,0301 - LAB/CHEMISTRY,N/A,N/A, $176.00 , $114.40 , $147.84 , $15.35 , $15.35 , $142.21 , $158.40 , $149.00 , $158.40 , $158.40 , $158.40 , $149.60 , $15.05 , $162.50 , $167.20 , $149.60 , $163.68 , $163.68 , $167.20 , $168.96 , $144.00 , $158.40 , $149.60 , $139.04 , N/A , $142.44 , $142.44 , $167.20 , $151.03 , $15.05 , $168.96 
Cryosurg Ablation of Prostate,CPT® 55873,N/A,N/A,N/A," $39,064.00 "," $25,391.60 "," $3,384.00 ", $728.90 , $850.35 ," $2,462.90 "," $2,476.15 "," $36,329.52 "," $35,157.60 "," $35,157.60 "," $31,251.20 "," $31,251.20 ", $850.35 ," $36,067.79 "," $37,110.80 "," $35,157.60 "," $35,157.60 "," $35,157.60 "," $36,329.52 "," $37,501.44 "," $3,177.49 "," $33,204.40 "," $3,948.13 "," $3,700.74 ", N/A ," $2,510.96 "," $2,510.96 "," $37,110.80 "," $3,009.52 ", $728.90 ," $37,501.44 "
 Pro Chng Cstost Tube Smpl ,CPT® 51705,0981 - PRO FEE/ER,N/A,N/A, $431.00 , $280.15 , $277.44 , $49.05 , $89.32 , $253.25 , $237.97 , $400.83 , $387.90 , $387.90 , $344.80 , $344.80 , $89.32 , $397.94 , $409.45 , $387.90 , $387.90 , $387.90 , $400.83 , $413.76 , $278.88 , $366.35 , $269.39 , $320.52 , N/A , $258.19 , $258.19 , $409.45 , $303.46 , $49.05 , $413.76 
 Treat Femoral Fracture Fac ,CPT® 27232,0360 - OR SERVICES,N/A,N/A," $4,885.00 "," $3,175.25 "," $4,103.40 ", $684.77 , $768.38 ," $3,947.08 "," $4,396.50 "," $4,135.64 "," $4,396.50 "," $4,396.50 "," $4,396.50 "," $4,152.25 ", $753.31 ," $4,510.32 "," $4,640.75 "," $4,152.25 "," $4,543.05 "," $4,543.05 "," $4,640.75 "," $4,689.60 "," $3,996.91 "," $4,396.50 "," $4,152.25 "," $3,859.15 ", N/A ," $3,953.43 "," $3,953.43 "," $4,640.75 "," $4,191.82 ", $684.77 ," $4,689.60 "
 Inj Intercostal Nerve Single ,CPT® 64420,0761 - TREATMENT ROOM,N/A,N/A," $1,213.00 ", $788.45 ," $1,018.92 ", $56.48 , $46.08 , $980.10 ," $1,091.70 "," $1,026.93 "," $1,091.70 "," $1,091.70 "," $1,091.70 "," $1,031.05 ", $45.18 ," $1,119.96 "," $1,152.35 "," $1,031.05 "," $1,128.09 "," $1,128.09 "," $1,152.35 "," $1,164.48 ", $992.48 ," $1,091.70 "," $1,031.05 ", $958.27 , N/A , $981.68 , $981.68 ," $1,152.35 "," $1,040.88 ", $45.18 ," $1,164.48 "
 Fac Insrt/Redo Spine N Generator ,CPT® 63685,0360 - OR SERVICES,N/A,N/A," $6,389.00 "," $4,152.85 "," $5,366.76 ", $340.52 , $400.51 ," $5,162.31 "," $5,750.10 "," $5,408.93 "," $5,750.10 "," $5,750.10 "," $5,750.10 "," $5,430.65 ", $392.66 ," $5,898.96 "," $6,069.55 "," $5,430.65 "," $5,941.77 "," $5,941.77 "," $6,069.55 "," $6,133.44 "," $5,227.48 "," $5,750.10 "," $5,430.65 "," $5,047.31 ", N/A ," $5,170.62 "," $5,170.62 "," $6,069.55 "," $5,482.40 ", $340.52 ," $6,133.44 "
Chemodervate Facial/Trigem/Cerv Musc Migraine,CPT® 64615,N/A,N/A,N/A, $931.00 , $605.15 , $566.59 , $109.75 , $96.09 , $667.63 , $665.87 , $865.83 , $837.90 , $837.90 , $744.80 , $744.80 , $96.09 , $859.59 , $884.45 , $837.90 , $837.90 , $837.90 , $865.83 , $893.76 , $612.53 , $791.35 , $679.73 , $697.98 , N/A , $680.65 , $680.65 , $884.45 , $730.18 , $96.09 , $893.76 
"Preventive Visit,Est,40-64",99396,N/A,N/A,N/A, $386.00 , $250.90 , N/A , $121.04 , $21.85 , $207.40 , $209.11 , $358.98 , $347.40 , $347.40 , $308.80 , $308.80 , $21.85 , $356.39 , $366.70 , $347.40 , $347.40 , $347.40 , $358.98 , $370.56 , $256.61 , $328.10 , $209.28 , $206.27 , N/A , $211.45 , $211.45 , $366.70 , $253.97 , $21.85 , $370.56 
 Pro Exc Tr-Ext B9+Marg 1.1-2 Cm ,CPT® 11402,0982 - PRO FEE/OUTPT,N/A,N/A, $661.00 , $429.65 , $371.55 , $111.62 , $134.16 , $310.37 , $305.45 , $614.73 , $594.90 , $594.90 , $528.80 , $528.80 , $134.16 , $610.30 , $627.95 , $594.90 , $594.90 , $594.90 , $614.73 , $634.56 , $405.71 , $561.85 , $608.37 , $400.75 , N/A , $316.43 , $316.43 , $627.95 , $366.95 , $111.62 , $634.56 
Metacarpohalangeal Disloc,CPT® 26700,N/A,N/A,N/A, $912.00 , $592.80 ," $1,924.98 ", $306.67 , $96.29 ," $1,453.63 "," $1,482.73 ", $848.16 , $820.80 , $820.80 , $729.60 , $729.60 , $96.29 , $842.05 , $866.40 , $820.80 , $820.80 , $820.80 , $848.16 , $875.52 ," $1,764.46 ", $775.20 ," $1,627.07 "," $1,738.39 ", N/A ," $1,481.99 "," $1,481.99 ", $866.40 ," $1,741.85 ", $96.29 ," $1,924.98 "
 CT Extremity Lower W/Contrast ,CPT® 73701,0350 - CT SCAN,N/A,N/A," $3,273.00 "," $2,127.45 "," $2,749.32 ", $170.34 , $292.14 ," $2,644.58 "," $2,945.70 "," $2,770.92 "," $2,945.70 "," $2,945.70 "," $2,945.70 "," $2,782.05 ", $286.41 ," $3,021.96 "," $3,109.35 "," $2,782.05 "," $3,043.89 "," $3,043.89 "," $3,109.35 "," $3,142.08 "," $2,677.97 "," $2,945.70 "," $2,782.05 "," $2,585.67 ", N/A ," $2,648.84 "," $2,648.84 "," $3,109.35 "," $2,808.56 ", $170.34 ," $3,142.08 "
Iridotomy/Iridectomy by Laser,CPT® 66761,N/A,N/A,N/A," $2,518.00 "," $1,636.70 "," $1,457.17 ", $228.35 , $360.39 ," $1,335.82 "," $2,002.32 "," $2,341.74 "," $2,266.20 "," $2,266.20 "," $2,014.40 "," $2,014.40 ", $360.39 ," $2,324.87 "," $2,392.10 "," $2,266.20 "," $2,266.20 "," $2,266.20 "," $2,341.74 "," $2,417.28 "," $1,998.33 "," $2,140.30 "," $1,288.09 "," $1,696.80 ", N/A ," $1,361.88 "," $1,361.88 "," $2,392.10 "," $1,503.35 ", $228.35 ," $2,417.28 "
 MEMANTINE HCL 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00591-3875-44,1 tablet, $31.36 , $20.38 , $26.34 , N/A , N/A , $25.34 , $28.22 , $26.55 , $28.22 , $28.22 , $28.22 , $26.66 , N/A , $28.95 , $29.79 , $26.66 , $29.16 , $29.16 , $29.79 , $30.11 , $25.66 , $28.22 , $26.66 , $24.77 , N/A , $25.38 , $25.38 , $29.79 , $26.91 , $24.77 , $30.11 
Calprotectin Fecal,CPT® 83993,N/A,N/A,N/A, $169.00 , $109.85 , N/A , $20.02 , $20.02 , $111.04 , $132.83 , $157.17 , $152.10 , $152.10 , $135.20 , $135.20 , $20.02 , $156.04 , $160.55 , $152.10 , $152.10 , $152.10 , $157.17 , $162.24 , $131.07 , $143.65 , $128.13 , $71.19 , N/A , $103.63 , $103.63 , $160.55 , $113.25 , $20.02 , $162.24 
 BELIMUMAB 120 MG IV SOLR ,HCPCS J0490,0636 - DRUGS REQUIRING DETAILED CODIN,49401-0101-01,1.5 mL," $1,802.71 "," $1,171.76 "," $1,514.28 ", $51.95 , $51.21 ," $1,456.59 "," $1,622.44 "," $1,526.17 "," $1,622.44 "," $1,622.44 "," $1,622.44 "," $1,532.30 ", $50.21 ," $1,664.44 "," $1,712.57 "," $1,532.30 "," $1,676.52 "," $1,676.52 "," $1,712.57 "," $1,730.60 "," $1,474.98 "," $1,622.44 "," $1,532.30 "," $1,424.14 ", N/A ," $1,458.93 "," $1,458.93 "," $1,712.57 "," $1,546.91 ", $50.21 ," $1,730.60 "
Wound Closure by Adhesive,G0168,N/A,N/A,N/A, $399.00 , $259.35 , $32.95 , $13.67 , N/A , $51.11 , N/A , $371.07 , $359.10 , $359.10 , $319.20 , $319.20 , N/A , $368.40 , $379.05 , $359.10 , $359.10 , $359.10 , $371.07 , $383.04 , $51.92 , $339.15 , $51.90 , $98.90 , N/A , $52.10 , $52.10 , $379.05 , $65.15 , $13.67 , $383.04 
 Pro Diagnostic Computed Tomography Thorax W/O Cntrst ,CPT® 71250,0972 - PRO FEE/RAD/DX,N/A,N/A, $653.00 , $424.45 , $943.67 , $135.95 , $250.57 , $858.63 ," $1,106.95 ", $607.29 , $587.70 , $587.70 , $522.40 , $522.40 , $250.57 , $602.91 , $620.35 , $587.70 , $587.70 , $587.70 , $607.29 , $626.88 , $792.11 , $555.05 ," $1,205.70 "," $1,056.69 ", N/A , $875.39 , $875.39 , $620.35 ," $1,013.28 ", $135.95 ," $1,205.70 "
"Remv Bladder/Nodes,Ileal Conduit",CPT® 51595,N/A,N/A,N/A," $15,232.00 "," $9,900.80 "," $11,774.39 "," $2,065.89 "," $2,378.00 "," $10,716.74 "," $9,939.15 "," $14,165.76 "," $13,708.80 "," $13,708.80 "," $12,185.60 "," $12,185.60 "," $2,378.00 "," $14,063.71 "," $14,470.40 "," $13,708.80 "," $13,708.80 "," $13,708.80 "," $14,165.76 "," $14,622.72 "," $11,834.91 "," $12,947.20 "," $11,264.58 "," $13,452.12 ", N/A ," $10,925.84 "," $10,925.84 "," $14,470.40 "," $12,841.75 "," $2,065.89 "," $14,622.72 "
Revise Median N/Carpal Tunnel Surg,64721,N/A,N/A,N/A," $2,658.00 "," $1,727.70 "," $2,135.38 ", $420.71 , $355.74 ," $2,342.38 "," $2,296.44 "," $2,471.94 "," $2,392.20 "," $2,392.20 "," $2,126.40 "," $2,126.40 ", $355.74 ," $2,454.13 "," $2,525.10 "," $2,392.20 "," $2,392.20 "," $2,392.20 "," $2,471.94 "," $2,551.68 "," $2,295.69 "," $2,259.30 "," $2,272.90 "," $2,518.27 ", N/A ," $2,388.09 "," $2,388.09 "," $2,525.10 "," $2,561.83 ", $355.74 ," $2,561.83 "
"Colposcopy,Cervix W/Adj Vag,W/Loop Coniz",CPT® 57461,N/A,N/A,N/A," $2,061.00 "," $1,339.65 ", $856.90 , $172.91 , $300.40 , $767.60 , $760.98 ," $1,916.73 "," $1,854.90 "," $1,854.90 "," $1,648.80 "," $1,648.80 ", $300.40 ," $1,902.92 "," $1,957.95 "," $1,854.90 "," $1,854.90 "," $1,854.90 "," $1,916.73 "," $1,978.56 ", $903.59 ," $1,751.85 "," $1,004.43 ", $766.56 , N/A , $782.58 , $782.58 ," $1,957.95 ", $938.65 , $172.91 ," $1,978.56 "
" Fac Subcut Infusion, Therap/Proph/Diagnost,Ea Add Hour ",CPT® 96370,0260 - IV THERAPY,N/A,N/A, $212.00 , $137.80 , $178.08 , $15.20 , $12.13 , $171.30 , $190.80 , $179.48 , $190.80 , $190.80 , $190.80 , $180.20 , $11.89 , $195.74 , $201.40 , $180.20 , $197.16 , $197.16 , $201.40 , $203.52 , $173.46 , $190.80 , $180.20 , $167.48 , N/A , $171.57 , $171.57 , $201.40 , $181.92 , $11.89 , $203.52 
Continuous Glucose Monitoring Analysis I&R,CPT® 95251,N/A,N/A,N/A, $222.00 , $144.30 , $81.02 , $33.82 , $23.82 , $96.95 , $96.74 , $206.46 , $199.80 , $199.80 , $177.60 , $177.60 , $23.82 , $204.97 , $210.90 , $199.80 , $199.80 , $199.80 , $206.46 , $213.12 , $107.60 , $188.70 , $126.71 , $136.74 , N/A , $98.84 , $98.84 , $210.90 , $115.23 , $23.82 , $213.12 
 PANTOPRAZOLE SODIUM 40 MG PO TBEC ,HCPCS RXC637,0250 - PHARMACY,00904-6474-61,1 tablet, $20.99 , $13.64 , $17.63 , N/A , N/A , $16.96 , $18.89 , $17.77 , $18.89 , $18.89 , $18.89 , $17.84 , N/A , $19.38 , $19.94 , $17.84 , $19.52 , $19.52 , $19.94 , $20.15 , $17.17 , $18.89 , $17.84 , $16.58 , N/A , $16.99 , $16.99 , $19.94 , $18.01 , $16.58 , $20.15 
"Repr Forearm Ext Tend Sheath,Graft",CPT® 25275,N/A,N/A,N/A," $4,318.00 "," $2,806.70 "," $4,112.75 ", $646.02 , $617.39 ," $3,231.12 "," $3,237.94 "," $4,015.74 "," $3,886.20 "," $3,886.20 "," $3,454.40 "," $3,454.40 ", $617.39 ," $3,986.81 "," $4,102.10 "," $3,886.20 "," $3,886.20 "," $3,886.20 "," $4,015.74 "," $4,145.28 "," $3,818.88 "," $3,670.30 "," $3,575.26 "," $3,836.37 ", N/A ," $3,294.17 "," $3,294.17 "," $4,102.10 "," $3,871.82 ", $617.39 ," $4,145.28 "
Lens Trifocal Add Over 3.25d,HCPCS V2320,N/A,N/A,N/A, $7.00 , $4.55 , N/A , $81.40 , N/A , N/A , N/A , $6.51 , $6.30 , $6.30 , $5.60 , $5.60 , N/A , $6.46 , $6.65 , $6.30 , $6.30 , $6.30 , $6.51 , $6.72 , N/A , $5.95 , $7.00 , $73.95 , N/A , N/A , N/A , $6.65 , N/A , $5.60 , $81.40 
 VALPROATE SODIUM 250 MG/5ML PO SOLN ,HCPCS RXC637,0250 - PHARMACY,00121-4675-00,5 mL, $5.42 , $3.52 , $4.55 , N/A , N/A , $4.38 , $4.88 , $4.59 , $4.88 , $4.88 , $4.88 , $4.61 , N/A , $5.00 , $5.15 , $4.61 , $5.04 , $5.04 , $5.15 , $5.20 , $4.43 , $4.88 , $4.61 , $4.28 , N/A , $4.39 , $4.39 , $5.15 , $4.65 , $4.28 , $5.20 
"Closed Rx Rad/Ulna Shaft Fx,Manip",25565,N/A,N/A,N/A," $2,412.00 "," $1,567.80 "," $2,866.37 ", $452.75 , $396.91 ," $2,261.48 "," $2,289.35 "," $2,243.16 "," $2,170.80 "," $2,170.80 "," $1,929.60 "," $1,929.60 ", $396.91 ," $2,227.00 "," $2,291.40 "," $2,170.80 "," $2,170.80 "," $2,170.80 "," $2,243.16 "," $2,315.52 "," $2,644.54 "," $2,050.20 "," $2,519.10 "," $2,656.81 ", N/A ," $2,305.61 "," $2,305.61 "," $2,291.40 "," $2,709.92 ", $396.91 ," $2,866.37 "
Duplex Up Extrem Art Bilat,CPT® 93930,N/A,N/A,N/A," $1,629.00 "," $1,058.85 "," $1,243.84 ", $191.49 , $168.91 ," $1,126.68 "," $1,368.99 "," $1,514.97 "," $1,466.10 "," $1,466.10 "," $1,303.20 "," $1,303.20 ", $168.91 ," $1,504.06 "," $1,547.55 "," $1,466.10 "," $1,466.10 "," $1,466.10 "," $1,514.97 "," $1,563.84 ", $882.57 ," $1,384.65 ", $730.89 , $791.88 , N/A ," $1,148.67 "," $1,148.67 "," $1,547.55 "," $1,273.31 ", $168.91 ," $1,563.84 "
 USTEKINUMAB 90 MG/ML SC SOSY ,HCPCS J3357,0636 - DRUGS REQUIRING DETAILED CODIN,57894-0061-03,1 mL," $77,968.26 "," $50,679.37 "," $65,493.34 ", $150.60 , $158.10 ," $62,998.35 "," $70,171.43 "," $66,007.93 "," $70,171.43 "," $70,171.43 "," $70,171.43 "," $66,273.02 ", $155.00 ," $71,988.09 "," $74,069.85 "," $66,273.02 "," $72,510.48 "," $72,510.48 "," $74,069.85 "," $74,849.53 "," $63,793.63 "," $70,171.43 "," $66,273.02 "," $61,594.93 ", N/A ," $63,099.71 "," $63,099.71 "," $74,069.85 "," $66,904.56 ", $150.60 ," $74,849.53 "
"Initial Normal Newborn Care, Hospital or Birth Center",CPT® 99460,N/A,N/A,N/A, $381.00 , $247.65 , $190.72 , $90.66 , $110.60 , $262.66 , $245.45 , $354.33 , $342.90 , $342.90 , $304.80 , $304.80 , $110.60 , $351.78 , $361.95 , $342.90 , $342.90 , $342.90 , $354.33 , $365.76 , $241.35 , $323.85 , $195.78 , $317.64 , N/A , $267.78 , $267.78 , $361.95 , $320.40 , $90.66 , $365.76 
 BUDESONIDE 3 MG PO CPEP ,HCPCS RXC637,0250 - PHARMACY,65162-0778-10,2 capsule, $255.37 , $165.99 , $214.51 , N/A , N/A , $206.34 , $229.83 , $216.20 , $229.83 , $229.83 , $229.83 , $217.06 , N/A , $235.78 , $242.60 , $217.06 , $237.49 , $237.49 , $242.60 , $245.16 , $208.94 , $229.83 , $217.06 , $201.74 , N/A , $206.67 , $206.67 , $242.60 , $219.13 , $201.74 , $245.16 
 VANCOMYCIN HCL 500 MG IV SOLR ,HCPCS J3371,0636 - DRUGS REQUIRING DETAILED CODIN,72611-0761-10,10 mL, $18.50 , $12.03 , $15.54 , $6.43 , $6.66 , $14.95 , $16.65 , $15.66 , $16.65 , $16.65 , $16.65 , $15.73 , $6.53 , $17.08 , $17.58 , $15.73 , $17.21 , $17.21 , $17.58 , $17.76 , $15.14 , $16.65 , $15.73 , $14.62 , N/A , $14.97 , $14.97 , $17.58 , $15.87 , $6.43 , $17.76 
Exc Tumor Soft Tiss Face&Scalp Subfascial 2+Cm,CPT® 21014,N/A,N/A,N/A," $2,365.00 "," $1,537.25 "," $3,175.64 ", $498.51 , $430.04 ," $2,513.17 "," $2,516.55 "," $2,199.45 "," $2,128.50 "," $2,128.50 "," $1,892.00 "," $1,892.00 ", $430.04 ," $2,183.60 "," $2,246.75 "," $2,128.50 "," $2,128.50 "," $2,128.50 "," $2,199.45 "," $2,270.40 "," $2,945.30 "," $2,010.25 "," $2,761.73 "," $2,979.63 ", N/A ," $2,562.21 "," $2,562.21 "," $2,246.75 "," $3,011.50 ", $430.04 ," $3,175.64 "
 SULFASALAZINE 500 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,59762-5000-05,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 ALBUMIN HUMAN 5 % IV SOLN ,HCPCS P9041,0636 - DRUGS REQUIRING DETAILED CODIN,00944-0495-05,250 mL, $357.02 , $232.06 , $299.90 , $10.83 , $9.74 , $288.47 , $321.32 , $302.25 , $321.32 , $321.32 , $321.32 , $303.47 , $9.55 , $329.64 , $339.17 , $303.47 , $332.03 , $332.03 , $339.17 , $342.74 , $292.11 , $321.32 , $303.47 , $282.05 , N/A , $288.94 , $288.94 , $339.17 , $306.36 , $9.55 , $342.74 
X-Ray Skull <4 Views,CPT® 70250,N/A,N/A,N/A, $522.00 , $339.30 , $201.84 , $35.33 , $34.64 , $169.77 , $198.27 , $485.46 , $469.80 , $469.80 , $417.60 , $417.60 , $34.64 , $481.96 , $495.90 , $469.80 , $469.80 , $469.80 , $485.46 , $501.12 , $195.41 , $443.70 , $217.64 , $184.09 , N/A , $173.09 , $173.09 , $495.90 , $200.36 , $34.64 , $501.12 
Compre Audiomtry Threshold Eval Sp Recognij,CPT® 92557,N/A,N/A,N/A, $499.00 , $324.35 , $75.07 , $31.47 , $40.51 , $72.51 , $72.63 , $464.07 , $449.10 , $449.10 , $399.20 , $399.20 , $40.51 , $460.73 , $474.05 , $449.10 , $449.10 , $449.10 , $464.07 , $479.04 , $96.52 , $424.15 , $95.29 , $124.98 , N/A , $73.92 , $73.92 , $474.05 , $86.18 , $31.47 , $479.04 
 Pro Control Nasal Hemorrhage Posterior W/Packs or Cautery ,CPT® 30905,0981 - PRO FEE/ER,N/A,N/A, $943.00 , $612.95 , $562.01 , $99.47 , $223.20 , $380.68 , $372.34 , $876.99 , $848.70 , $848.70 , $754.40 , $754.40 , $223.20 , $870.67 , $895.85 , $848.70 , $848.70 , $848.70 , $876.99 , $905.28 , $541.66 , $801.55 , $529.87 , $535.02 , N/A , $388.11 , $388.11 , $895.85 , $457.08 , $99.47 , $905.28 
Cast Hand Lower Fore Arm,CPT® 29085,N/A,N/A,N/A, $536.00 , $348.40 , $406.19 , $63.77 , $47.27 , $327.24 , $327.56 , $498.48 , $482.40 , $482.40 , $428.80 , $428.80 , $47.27 , $494.89 , $509.20 , $482.40 , $482.40 , $482.40 , $498.48 , $514.56 , $376.44 , $455.60 , $358.60 , $387.94 , N/A , $333.62 , $333.62 , $509.20 , $392.12 , $47.27 , $514.56 
 Fac Intro Cath Dialysis Circuit Dx Angrph Fluor S&I ,CPT® 36901,0360 - OR SERVICES,N/A,N/A," $5,226.00 "," $3,396.90 "," $4,389.84 ", $155.83 , $449.75 ," $4,222.61 "," $4,703.40 "," $4,424.33 "," $4,703.40 "," $4,703.40 "," $4,703.40 "," $4,442.10 ", $440.93 ," $4,825.17 "," $4,964.70 "," $4,442.10 "," $4,860.18 "," $4,860.18 "," $4,964.70 "," $5,016.96 "," $4,275.91 "," $4,703.40 "," $4,442.10 "," $4,128.54 ", N/A ," $4,229.40 "," $4,229.40 "," $4,964.70 "," $4,484.43 ", $155.83 ," $5,016.96 "
 C Reactive Protein Quant ,CPT® 86140,0302 - LAB/IMMUNOLOGY,N/A,N/A, $82.00 , $53.30 , $68.88 , $5.28 , $5.28 , $66.26 , $73.80 , $69.42 , $73.80 , $73.80 , $73.80 , $69.70 , $5.18 , $75.71 , $77.90 , $69.70 , $76.26 , $76.26 , $77.90 , $78.72 , $67.09 , $73.80 , $69.70 , $64.78 , N/A , $66.36 , $66.36 , $77.90 , $70.36 , $5.18 , $78.72 
 Fac Imhistochem/Cytchm Ea Multiplex Antibody Slide ,CPT® 88344,0310 - PATHOLOGY LAB,N/A,N/A, $490.00 , $318.50 , $411.60 , $165.40 , $92.01 , $395.92 , $441.00 , $414.83 , $441.00 , $441.00 , $441.00 , $416.50 , $90.21 , $452.42 , $465.50 , $416.50 , $455.70 , $455.70 , $465.50 , $470.40 , $400.92 , $441.00 , $416.50 , $387.10 , N/A , $396.56 , $396.56 , $465.50 , $420.47 , $90.21 , $470.40 
 NALBUPHINE HCL 10 MG/ML IJ SOLN ,HCPCS J2300,0636 - DRUGS REQUIRING DETAILED CODIN,00409-1463-01,1 mL, $24.99 , $16.24 , $20.99 , $2.77 , $2.92 , $20.19 , $22.49 , $21.16 , $22.49 , $22.49 , $22.49 , $21.24 , $2.86 , $23.07 , $23.74 , $21.24 , $23.24 , $23.24 , $23.74 , $23.99 , $20.45 , $22.49 , $21.24 , $19.74 , N/A , $20.22 , $20.22 , $23.74 , $21.44 , $2.77 , $23.99 
 ACETIC ACID 1% SOLUTION ,HCPCS RXA250,0250 - PHARMACY,N/A,N/A, $12.33 , $8.01 , $10.36 , N/A , N/A , $9.96 , $11.10 , $10.44 , $11.10 , $11.10 , $11.10 , $10.48 , N/A , $11.38 , $11.71 , $10.48 , $11.47 , $11.47 , $11.71 , $11.84 , $10.09 , $11.10 , $10.48 , $9.74 , N/A , $9.98 , $9.98 , $11.71 , $10.58 , $9.74 , $11.84 
 Fac Assay of Urine/Urea-N ,CPT® 84540,0301 - LAB/CHEMISTRY,N/A,N/A, $63.00 , $40.95 , $52.92 , $5.67 , $5.67 , $50.90 , $56.70 , $53.34 , $56.70 , $56.70 , $56.70 , $53.55 , $5.56 , $58.17 , $59.85 , $53.55 , $58.59 , $58.59 , $59.85 , $60.48 , $51.55 , $56.70 , $53.55 , $49.77 , N/A , $50.99 , $50.99 , $59.85 , $54.06 , $5.56 , $60.48 
Incision of Foot/Toe Fascia,CPT® 28008,N/A,N/A,N/A," $2,884.00 "," $1,874.60 "," $1,833.20 ", $287.22 , $153.67 ," $1,449.07 "," $1,435.73 "," $2,682.12 "," $2,595.60 "," $2,595.60 "," $2,307.20 "," $2,307.20 ", $153.67 ," $2,662.80 "," $2,739.80 "," $2,595.60 "," $2,595.60 "," $2,595.60 "," $2,682.12 "," $2,768.64 "," $1,706.91 "," $2,451.40 "," $1,552.14 "," $1,725.11 ", N/A ," $1,477.34 "," $1,477.34 "," $2,739.80 "," $1,736.38 ", $153.67 ," $2,768.64 "
Partial Removal of Rib,CPT® 21600,N/A,N/A,N/A," $3,773.00 "," $2,452.45 "," $3,388.00 ", $534.72 , $384.19 ," $2,686.11 "," $2,730.81 "," $3,508.89 "," $3,395.70 "," $3,395.70 "," $3,018.40 "," $3,018.40 ", $384.19 ," $3,483.61 "," $3,584.35 "," $3,395.70 "," $3,395.70 "," $3,395.70 "," $3,508.89 "," $3,622.08 "," $3,127.58 "," $3,207.05 "," $3,020.42 "," $3,127.99 ", N/A ," $2,738.53 "," $2,738.53 "," $3,584.35 "," $3,218.75 ", $384.19 ," $3,622.08 "
Palatophayngoplasty,CPT® 42145,N/A,N/A,N/A," $4,923.00 "," $3,199.95 "," $4,252.50 ", $665.96 , $619.85 ," $3,396.62 "," $3,504.78 "," $4,578.39 "," $4,430.70 "," $4,430.70 "," $3,938.40 "," $3,938.40 ", $619.85 ," $4,545.41 "," $4,676.85 "," $4,430.70 "," $4,430.70 "," $4,430.70 "," $4,578.39 "," $4,726.08 "," $3,046.55 "," $4,184.55 "," $3,823.25 "," $3,982.98 ", N/A ," $3,462.89 "," $3,462.89 "," $4,676.85 "," $3,621.83 ", $619.85 ," $4,726.08 "
"Repair Lip,Full Thick,Vermilion",CPT® 40650,N/A,N/A,N/A," $2,295.00 "," $1,491.75 "," $1,903.27 ", $300.79 , $539.88 ," $1,433.05 "," $1,493.94 "," $2,134.35 "," $2,065.50 "," $2,065.50 "," $1,836.00 "," $1,836.00 ", $539.88 ," $2,118.97 "," $2,180.25 "," $2,065.50 "," $2,065.50 "," $2,065.50 "," $2,134.35 "," $2,203.20 "," $1,350.46 "," $1,950.75 "," $1,637.77 "," $1,713.95 ", N/A ," $1,461.01 "," $1,461.01 "," $2,180.25 "," $1,528.04 ", $300.79 ," $2,203.20 "
 Fac Swing Bed ,Custom 1200000001,0120 - ROOM-BOARD/SEMI,N/A,N/A, $746.00 , $484.90 , $626.64 , N/A , N/A , $602.77 , $671.40 , $631.56 , $671.40 , $671.40 , $671.40 , $634.10 , N/A , $688.78 , $708.70 , $634.10 , $693.78 , $693.78 , $708.70 , $716.16 , $610.38 , $671.40 , $634.10 , $589.34 , N/A , $603.74 , $603.74 , $708.70 , $640.14 , $589.34 , $716.16 
 Drainage Nasal Abscess ED Fac ,CPT® 30000,0761 - TREATMENT ROOM,N/A,N/A," $1,167.00 ", $758.55 , $980.28 , $117.58 , $30.71 , $942.94 ," $1,050.30 ", $987.98 ," $1,050.30 "," $1,050.30 "," $1,050.30 ", $991.95 , $30.11 ," $1,077.49 "," $1,108.65 ", $991.95 ," $1,085.31 "," $1,085.31 "," $1,108.65 "," $1,120.32 ", $954.84 ," $1,050.30 ", $991.95 , $921.93 , N/A , $944.45 , $944.45 ," $1,108.65 "," $1,001.40 ", $30.11 ," $1,120.32 "
"MRI, Cerv Spine Combo",CPT® 72156,N/A,N/A,N/A," $7,744.00 "," $5,033.60 "," $2,309.72 ", $329.13 , $655.99 ," $1,809.29 "," $2,972.79 "," $7,201.92 "," $6,969.60 "," $6,969.60 "," $6,195.20 "," $6,195.20 ", $655.99 ," $7,150.04 "," $7,356.80 "," $6,969.60 "," $6,969.60 "," $6,969.60 "," $7,201.92 "," $7,434.24 "," $1,985.57 "," $6,582.40 "," $3,239.60 "," $3,511.48 ", N/A ," $1,844.59 "," $1,844.59 "," $7,356.80 "," $2,135.13 ", $329.13 ," $7,434.24 "
 Fac Dehydroepiandrosterone ,CPT® 82627,0301 - LAB/CHEMISTRY,N/A,N/A, $222.00 , $144.30 , $186.48 , $22.67 , $22.67 , $179.38 , $199.80 , $187.95 , $199.80 , $199.80 , $199.80 , $188.70 , $22.23 , $204.97 , $210.90 , $188.70 , $206.46 , $206.46 , $210.90 , $213.12 , $181.64 , $199.80 , $188.70 , $175.38 , N/A , $179.66 , $179.66 , $210.90 , $190.50 , $22.23 , $213.12 
 Fac Slctv Cath Vertebral Art Angio Vertebral Artery ,CPT® 36226,0360 - OR SERVICES,N/A,N/A," $18,463.00 "," $12,000.95 "," $15,508.92 ", $324.55 ," $1,703.87 "," $14,918.10 "," $16,616.70 "," $15,630.78 "," $16,616.70 "," $16,616.70 "," $16,616.70 "," $15,693.55 "," $1,670.46 "," $17,046.89 "," $17,539.85 "," $15,693.55 "," $17,170.59 "," $17,170.59 "," $17,539.85 "," $17,724.48 "," $15,106.43 "," $16,616.70 "," $15,693.55 "," $14,585.77 ", N/A ," $14,942.11 "," $14,942.11 "," $17,539.85 "," $15,843.10 ", $324.55 ," $17,724.48 "
Layer Closure 20.0-30cm,CPT® 12056,N/A,N/A,N/A," $2,349.00 "," $1,526.85 "," $1,217.88 ", $364.92 , $448.13 , $952.97 ," $1,010.78 "," $2,184.57 "," $2,114.10 "," $2,114.10 "," $1,879.20 "," $1,879.20 ", $448.13 ," $2,168.83 "," $2,231.55 "," $2,114.10 "," $2,114.10 "," $2,114.10 "," $2,184.57 "," $2,255.04 "," $1,338.76 "," $1,996.65 "," $2,001.72 "," $1,341.54 ", N/A , $971.56 , $971.56 ," $2,231.55 "," $1,126.68 ", $364.92 ," $2,255.04 "
"Destr Malig Scal,Nck,Hand 3.1-4 Cm",CPT® 17274,N/A,N/A,N/A, $935.00 , $607.75 , $537.68 , $161.82 , $206.41 , $481.60 , $471.78 , $869.55 , $841.50 , $841.50 , $748.00 , $748.00 , $206.41 , $863.29 , $888.25 , $841.50 , $841.50 , $841.50 , $869.55 , $897.60 , $591.78 , $794.75 , $936.63 , $619.87 , N/A , $490.99 , $490.99 , $888.25 , $569.40 , $161.82 , $936.63 
Nasal/Sinus Ndsc Total With Sphenoidotomy,CPT® 31257,N/A,N/A,N/A," $2,475.00 "," $1,608.75 "," $2,403.27 ", $424.08 , $345.53 ," $1,599.16 "," $1,619.61 "," $2,301.75 "," $2,227.50 "," $2,227.50 "," $1,980.00 "," $1,980.00 ", $345.53 ," $2,285.17 "," $2,351.25 "," $2,227.50 "," $2,227.50 "," $2,227.50 "," $2,301.75 "," $2,376.00 "," $2,304.09 "," $2,103.75 "," $2,354.45 "," $2,273.02 ", N/A ," $1,630.37 "," $1,630.37 "," $2,351.25 "," $1,920.10 ", $345.53 ," $2,403.27 "
Total Abdom Hysterectomy,58150,N/A,N/A,N/A," $5,971.00 "," $3,881.15 "," $4,754.80 ", $963.96 , $887.97 ," $4,111.31 "," $4,050.89 "," $5,553.03 "," $5,373.90 "," $5,373.90 "," $4,776.80 "," $4,776.80 ", $887.97 ," $5,513.02 "," $5,672.45 "," $5,373.90 "," $5,373.90 "," $5,373.90 "," $5,553.03 "," $5,732.16 "," $4,972.38 "," $5,075.35 "," $5,332.57 "," $4,130.51 ", N/A ," $4,191.52 "," $4,191.52 "," $5,672.45 "," $5,027.46 ", $887.97 ," $5,732.16 "
 Pro Excision of Anal Lesion(S) ,CPT® 46922,0982 - PRO FEE/OUTPT,N/A,N/A," $1,756.00 "," $1,141.40 ", $837.92 , $131.22 , $76.84 , $642.36 , $659.57 ," $1,633.08 "," $1,580.40 "," $1,580.40 "," $1,404.80 "," $1,404.80 ", $76.84 ," $1,621.31 "," $1,668.20 "," $1,580.40 "," $1,580.40 "," $1,580.40 "," $1,633.08 "," $1,685.76 ", $595.23 ," $1,492.60 ", $726.11 , $765.51 , N/A , $654.89 , $654.89 ," $1,668.20 ", $684.95 , $76.84 ," $1,685.76 "
 POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN ,HCPCS J3480,0636 - DRUGS REQUIRING DETAILED CODIN,00409-6651-06,10 mL, $22.35 , $14.53 , $18.77 , $0.10 , $0.14 , $18.06 , $20.12 , $18.92 , $20.12 , $20.12 , $20.12 , $19.00 , $0.14 , $20.64 , $21.23 , $19.00 , $20.79 , $20.79 , $21.23 , $21.46 , $18.29 , $20.12 , $19.00 , $17.66 , N/A , $18.09 , $18.09 , $21.23 , $19.18 , $0.10 , $21.46 
 Fac Chrmsm Cnt 15-20 Cll 2karyotyp Banding ,CPT® 88262,0310 - PATHOLOGY LAB,N/A,N/A," $2,289.00 "," $1,487.85 "," $1,922.76 ", $128.00 , $128.00 ," $1,849.51 "," $2,060.10 "," $1,937.87 "," $2,060.10 "," $2,060.10 "," $2,060.10 "," $1,945.65 ", $125.49 ," $2,113.43 "," $2,174.55 "," $1,945.65 "," $2,128.77 "," $2,128.77 "," $2,174.55 "," $2,197.44 "," $1,872.86 "," $2,060.10 "," $1,945.65 "," $1,808.31 ", N/A ," $1,852.49 "," $1,852.49 "," $2,174.55 "," $1,964.19 ", $125.49 ," $2,197.44 "
Egd Balloon Dilation Esophagus <30 Mm Diam,43249,N/A,N/A,N/A," $2,460.00 "," $1,599.00 ", $939.77 , $145.24 , $162.52 , $788.17 , $844.47 ," $2,287.80 "," $2,214.00 "," $2,214.00 "," $1,968.00 "," $1,968.00 ", $162.52 ," $2,271.32 "," $2,337.00 "," $2,214.00 "," $2,214.00 "," $2,214.00 "," $2,287.80 "," $2,361.60 ", $675.81 ," $2,091.00 ", $924.15 , $893.64 , N/A , $803.55 , $803.55 ," $2,337.00 ", $840.42 , $145.24 ," $2,361.60 "
"Partial Excision Thyroid,Unilat",CPT® 60210,N/A,N/A,N/A," $5,182.00 "," $3,368.30 "," $4,278.63 ", $666.63 , $858.25 ," $3,646.44 "," $3,790.38 "," $4,819.26 "," $4,663.80 "," $4,663.80 "," $4,145.60 "," $4,145.60 ", $858.25 ," $4,784.54 "," $4,922.90 "," $4,663.80 "," $4,663.80 "," $4,663.80 "," $4,819.26 "," $4,974.72 "," $4,134.74 "," $4,404.70 "," $3,766.16 "," $3,506.69 ", N/A ," $3,717.59 "," $3,717.59 "," $4,922.90 "," $4,146.24 ", $666.63 ," $4,974.72 "
 Fac CT Abdomen W/O Dye ,CPT® 74150,0350 - CT SCAN,N/A,N/A," $1,830.00 "," $1,189.50 "," $1,537.20 ", $139.75 , $242.66 ," $1,478.64 "," $1,647.00 "," $1,549.28 "," $1,647.00 "," $1,647.00 "," $1,647.00 "," $1,555.50 ", $237.90 ," $1,689.64 "," $1,738.50 "," $1,555.50 "," $1,701.90 "," $1,701.90 "," $1,738.50 "," $1,756.80 "," $1,497.31 "," $1,647.00 "," $1,555.50 "," $1,445.70 ", N/A ," $1,481.02 "," $1,481.02 "," $1,738.50 "," $1,570.32 ", $139.75 ," $1,756.80 "
"MRI, Abdomen (MRI)",CPT® 74181,N/A,N/A,N/A," $5,392.00 "," $3,504.80 "," $1,409.80 ", $201.61 , $416.70 ," $1,583.40 "," $1,987.60 "," $5,014.56 "," $4,852.80 "," $4,852.80 "," $4,313.60 "," $4,313.60 ", $416.70 ," $4,978.43 "," $5,122.40 "," $4,852.80 "," $4,852.80 "," $4,852.80 "," $5,014.56 "," $5,176.32 "," $1,211.46 "," $4,583.20 "," $2,164.87 "," $2,609.32 ", N/A ," $1,614.30 "," $1,614.30 "," $5,122.40 "," $1,868.58 ", $201.61 ," $5,176.32 "
Layer Closure 12.6-20cm,12035,N/A,N/A,N/A," $1,518.00 ", $986.70 , $761.06 , $227.75 , $200.71 , $653.93 , $643.73 ," $1,411.74 "," $1,366.20 "," $1,366.20 "," $1,214.40 "," $1,214.40 ", $200.71 ," $1,401.57 "," $1,442.10 "," $1,366.20 "," $1,366.20 "," $1,366.20 "," $1,411.74 "," $1,457.28 ", $835.71 ," $1,290.30 "," $1,291.66 ", $837.00 , N/A , $666.69 , $666.69 ," $1,442.10 ", $773.15 , $200.71 ," $1,457.28 "
" Pro Pet Image W/CT, Skull-Thigh ",CPT® 78815,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,043.00 ", $677.95 ," $10,746.75 "," $1,555.08 "," $2,303.38 "," $4,838.11 "," $4,986.72 ", $969.99 , $938.70 , $938.70 , $834.40 , $834.40 ," $2,303.38 ", $963.00 , $990.85 , $938.70 , $938.70 , $938.70 , $969.99 ," $1,001.28 "," $8,636.92 ", $886.55 ," $5,570.11 "," $5,827.23 ", N/A ," $4,932.51 "," $4,932.51 ", $990.85 ," $5,709.45 ", $834.40 ," $10,746.75 "
Plethysmography Lung Volumes W/WO Airway Resist,CPT® 94726,N/A,N/A,N/A, $464.00 , $301.60 , $125.62 , $52.99 , $41.90 , $116.47 , $135.63 , $431.52 , $417.60 , $417.60 , $371.20 , $371.20 , $41.90 , $428.41 , $440.80 , $417.60 , $417.60 , $417.60 , $431.52 , $445.44 , $164.71 , $394.40 , $181.46 , $207.76 , N/A , $118.75 , $118.75 , $440.80 , $138.43 , $41.90 , $445.44 
 Injection Aa&/Strd Brachial Plex ,CPT® 64415,0360 - OR SERVICES,N/A,N/A," $1,931.00 "," $1,255.15 "," $1,622.04 ", $67.27 , $76.84 ," $1,560.25 "," $1,737.90 "," $1,634.78 "," $1,737.90 "," $1,737.90 "," $1,737.90 "," $1,641.35 ", $75.33 ," $1,782.89 "," $1,834.45 "," $1,641.35 "," $1,795.83 "," $1,795.83 "," $1,834.45 "," $1,853.76 "," $1,579.94 "," $1,737.90 "," $1,641.35 "," $1,525.49 ", N/A ," $1,562.76 "," $1,562.76 "," $1,834.45 "," $1,656.99 ", $67.27 ," $1,853.76 "
Assay Lipase,CPT® 83690,N/A,N/A,N/A, $101.00 , $65.65 , N/A , $7.03 , $7.03 , $38.99 , $46.62 , $93.93 , $90.90 , $90.90 , $80.80 , $80.80 , $7.03 , $93.25 , $95.95 , $90.90 , $90.90 , $90.90 , $93.93 , $96.96 , $46.01 , $85.85 , $45.41 , $24.99 , N/A , $36.39 , $36.39 , $95.95 , $39.77 , $7.03 , $96.96 
Rplcmt Oi Implt Skull Mag Tc Attachment Esp>=100,CPT® 69730,N/A,N/A,N/A," $6,060.00 "," $3,939.00 ", N/A , $662.49 , $517.07 , N/A , N/A ," $5,635.80 "," $5,454.00 "," $5,454.00 "," $4,848.00 "," $4,848.00 ", $517.07 ," $5,595.20 "," $5,757.00 "," $5,454.00 "," $5,454.00 "," $5,454.00 "," $5,635.80 "," $5,817.60 ", N/A ," $5,151.00 "," $3,667.61 ", N/A , N/A ," $2,866.17 "," $2,866.17 "," $5,757.00 "," $3,274.61 ", $517.07 ," $5,817.60 "
"Hysteroscopy,W/Endo Bx",CPT® 58558,N/A,N/A,N/A," $2,752.00 "," $1,788.80 "," $1,075.35 ", $218.28 , $181.31 ," $1,086.05 "," $1,080.64 "," $2,559.36 "," $2,476.80 "," $2,476.80 "," $2,201.60 "," $2,201.60 ", $181.31 ," $2,540.92 "," $2,614.40 "," $2,476.80 "," $2,476.80 "," $2,476.80 "," $2,559.36 "," $2,641.92 "," $1,132.05 "," $2,339.20 "," $1,421.90 ", $962.97 , N/A ," $1,107.24 "," $1,107.24 "," $2,614.40 "," $1,328.05 ", $181.31 ," $2,641.92 "
 OFLOXACIN 0.3 % OP SOLN ,HCPCS RXC637,0250 - PHARMACY,64980-0515-05,5 mL, $361.38 , $234.90 , $303.56 , N/A , N/A , $292.00 , $325.24 , $305.94 , $325.24 , $325.24 , $325.24 , $307.17 , N/A , $333.66 , $343.31 , $307.17 , $336.08 , $336.08 , $343.31 , $346.92 , $295.68 , $325.24 , $307.17 , $285.49 , N/A , $292.46 , $292.46 , $343.31 , $310.10 , $285.49 , $346.92 
 DESIPRAMINE HCL 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,23155-0579-01,1 tablet, $9.37 , $6.09 , $7.87 , N/A , N/A , $7.57 , $8.43 , $7.93 , $8.43 , $8.43 , $8.43 , $7.96 , N/A , $8.65 , $8.90 , $7.96 , $8.71 , $8.71 , $8.90 , $9.00 , $7.67 , $8.43 , $7.96 , $7.40 , N/A , $7.58 , $7.58 , $8.90 , $8.04 , $7.40 , $9.00 
Special Radiation Treatment,CPT® 77470,N/A,N/A,N/A," $4,177.00 "," $2,715.05 ", $763.16 , $137.14 , $219.71 , $745.25 , $786.79 ," $3,884.61 "," $3,759.30 "," $3,759.30 "," $3,341.60 "," $3,341.60 ", $219.71 ," $3,856.62 "," $3,968.15 "," $3,759.30 "," $3,759.30 "," $3,759.30 "," $3,884.61 "," $4,009.92 ", $747.73 ," $3,550.45 ", $857.09 , $763.43 , N/A , $759.78 , $759.78 ," $3,968.15 ", $879.47 , $137.14 ," $4,009.92 "
"Unlisted Laparoscopy Proc,Intestine",CPT® 44238,N/A,N/A,N/A, $421.00 , $273.65 , N/A , N/A , N/A , N/A , N/A , $391.53 , $378.90 , $378.90 , $336.80 , $336.80 , N/A , $388.71 , $399.95 , $378.90 , $378.90 , $378.90 , $391.53 , $404.16 , N/A , $357.85 , $336.80 , N/A , N/A , N/A , N/A , $399.95 , N/A , $336.80 , $404.16 
 Fac Blood Gases W/O2 Saturation ,CPT® 82805,0301 - LAB/CHEMISTRY,N/A,N/A, $262.00 , $170.30 , $220.08 , $80.35 , $39.39 , $211.70 , $235.80 , $221.81 , $235.80 , $235.80 , $235.80 , $222.70 , $38.62 , $241.90 , $248.90 , $222.70 , $243.66 , $243.66 , $248.90 , $251.52 , $214.37 , $235.80 , $222.70 , $206.98 , N/A , $212.04 , $212.04 , $248.90 , $224.82 , $38.62 , $251.52 
Control Nasal Hemorrhage,CPT® 30905,N/A,N/A,N/A," $2,007.00 "," $1,304.55 ", $562.01 , $99.47 , $223.20 , $380.68 , $372.34 ," $1,866.51 "," $1,806.30 "," $1,806.30 "," $1,605.60 "," $1,605.60 ", $223.20 ," $1,853.06 "," $1,906.65 "," $1,806.30 "," $1,806.30 "," $1,806.30 "," $1,866.51 "," $1,926.72 ", $541.66 ," $1,705.95 ", $529.87 , $535.02 , N/A , $388.11 , $388.11 ," $1,906.65 ", $457.08 , $99.47 ," $1,926.72 "
 Fac Drug Screen Analgesics Non-Opioid 1 or 2 ,CPT® 80329,0301 - LAB/CHEMISTRY,N/A,N/A, $65.00 , $42.25 , $54.60 , N/A , N/A , $52.52 , $58.50 , $55.03 , $58.50 , $58.50 , $58.50 , $55.25 , N/A , $60.01 , $61.75 , $55.25 , $60.45 , $60.45 , $61.75 , $62.40 , $53.18 , $58.50 , $55.25 , $51.35 , N/A , $52.60 , $52.60 , $61.75 , $55.78 , $51.35 , $62.40 
Psychological Tst Eval Svc Phys/Qhp First Hour,CPT® 96130,N/A,N/A,N/A, $762.00 , $495.30 , $253.66 , $107.63 , $135.58 , $230.24 , N/A , $708.66 , $685.80 , $685.80 , $609.60 , $609.60 , $135.58 , $703.55 , $723.90 , $685.80 , $685.80 , $685.80 , $708.66 , $731.52 , $468.74 , $647.70 , $324.10 , $419.96 , N/A , $234.73 , $234.73 , $723.90 , $273.64 , $107.63 , $731.52 
 Pro Perq Replacement Gtube Req Revj Gstrst Trc ,CPT® 43763,0982 - PRO FEE/OUTPT,N/A,N/A," $4,101.00 "," $2,665.65 ", $511.81 , $81.55 , $261.98 , $371.96 , N/A ," $3,813.93 "," $3,690.90 "," $3,690.90 "," $3,280.80 "," $3,280.80 ", $261.98 ," $3,786.45 "," $3,895.95 "," $3,690.90 "," $3,690.90 "," $3,690.90 "," $3,813.93 "," $3,936.96 ", $364.60 ," $3,485.85 ", $460.23 , $476.79 , N/A , $379.23 , $379.23 ," $3,895.95 ", $396.62 , $81.55 ," $3,936.96 "
 Pro Anes Cervical Spine & Cord ,CPT® 00600,0964 - PRO FEE/ANES CRNA,N/A,N/A, $22.00 , $14.30 , N/A , N/A , $18.11 , N/A , N/A , $20.46 , $19.80 , $19.80 , $17.60 , $17.60 , $18.11 , $20.31 , $20.90 , $19.80 , $19.80 , $19.80 , $20.46 , $21.12 , N/A , $18.70 , N/A , N/A , N/A , N/A , N/A , $20.90 , N/A , $17.60 , $21.12 
 INFLIXIMAB 100 MG IV SOLR ,HCPCS J1745,0636 - DRUGS REQUIRING DETAILED CODIN,57894-0160-01,10 mL," $1,396.65 ", $907.82 ," $1,173.19 ", $33.57 , $35.56 ," $1,128.49 "," $1,256.99 "," $1,182.40 "," $1,256.99 "," $1,256.99 "," $1,256.99 "," $1,187.15 ", $34.86 ," $1,289.53 "," $1,326.82 "," $1,187.15 "," $1,298.88 "," $1,298.88 "," $1,326.82 "," $1,340.78 "," $1,142.74 "," $1,256.99 "," $1,187.15 "," $1,103.35 ", N/A ," $1,130.31 "," $1,130.31 "," $1,326.82 "," $1,198.47 ", $33.57 ," $1,340.78 "
"CT Scan,Pelvis,W/O Contrast",CPT® 72192,N/A,N/A,N/A," $2,250.00 "," $1,462.50 ", $946.05 , $135.96 , $239.47 , $697.73 , $918.19 ," $2,092.50 "," $2,025.00 "," $2,025.00 "," $1,800.00 "," $1,800.00 ", $239.47 ," $2,077.43 "," $2,137.50 "," $2,025.00 "," $2,025.00 "," $2,025.00 "," $2,092.50 "," $2,160.00 ", $794.11 ," $1,912.50 ", $997.69 , $947.47 , N/A , $711.35 , $711.35 ," $2,137.50 ", $823.40 , $135.96 ," $2,160.00 "
"Epoetin Alfa, Non-Esrd",HCPCS J0885,N/A,N/A,N/A, $36.00 , $23.40 , N/A , $7.02 , $8.42 , N/A , N/A , $33.48 , $32.40 , $32.40 , $28.80 , $28.80 , $8.42 , $33.24 , $34.20 , $32.40 , $32.40 , $32.40 , $33.48 , $34.56 , $10.69 , $30.60 , $19.46 , $11.73 , N/A , N/A , N/A , $34.20 , N/A , $7.02 , $34.56 
 Fac Arven Anast Opn F/Arm Vein Trpos ,CPT® 36820,0360 - OR SERVICES,N/A,N/A," $10,467.00 "," $6,803.55 "," $8,792.28 ", $649.70 , $590.45 ," $8,457.34 "," $9,420.30 "," $8,861.36 "," $9,420.30 "," $9,420.30 "," $9,420.30 "," $8,896.95 ", $578.87 ," $9,664.18 "," $9,943.65 "," $8,896.95 "," $9,734.31 "," $9,734.31 "," $9,943.65 "," $10,048.32 "," $8,564.10 "," $9,420.30 "," $8,896.95 "," $8,268.93 ", N/A ," $8,470.94 "," $8,470.94 "," $9,943.65 "," $8,981.73 ", $578.87 ," $10,048.32 "
 Fac Slctv Cathj Ea 1st Ord Thrc/Brch/Cphlc Brnch ,CPT® 36215,0360 - OR SERVICES,N/A,N/A," $1,719.00 "," $1,117.35 "," $1,443.96 ", $198.04 ," $1,090.69 "," $1,388.95 "," $1,547.10 "," $1,455.31 "," $1,547.10 "," $1,547.10 "," $1,547.10 "," $1,461.15 "," $1,069.30 "," $1,587.15 "," $1,633.05 "," $1,461.15 "," $1,598.67 "," $1,598.67 "," $1,633.05 "," $1,650.24 "," $1,406.49 "," $1,547.10 "," $1,461.15 "," $1,358.01 ", N/A ," $1,391.19 "," $1,391.19 "," $1,633.05 "," $1,475.07 ", $198.04 ," $1,650.24 "
 PHENOBARBITAL 64.8 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00603-5167-21,1 tablet, $4.34 , $2.82 , $3.65 , N/A , N/A , $3.51 , $3.91 , $3.67 , $3.91 , $3.91 , $3.91 , $3.69 , N/A , $4.01 , $4.12 , $3.69 , $4.04 , $4.04 , $4.12 , $4.17 , $3.55 , $3.91 , $3.69 , $3.43 , N/A , $3.51 , $3.51 , $4.12 , $3.72 , $3.43 , $4.17 
Fx Closed Clavicular,23500,N/A,N/A,N/A, $820.00 , $533.00 ," $1,415.05 ", $225.64 , $69.88 ," $1,067.58 "," $1,092.79 ", $762.60 , $738.00 , $738.00 , $656.00 , $656.00 , $69.88 , $757.11 , $779.00 , $738.00 , $738.00 , $738.00 , $762.60 , $787.20 ," $1,301.54 ", $697.00 ," $1,197.11 "," $1,273.41 ", N/A ," $1,088.41 "," $1,088.41 ", $779.00 ," $1,279.27 ", $69.88 ," $1,415.05 "
Explore/Drain Elbow for Infect,CPT® 24000,N/A,N/A,N/A," $1,801.00 "," $1,170.65 "," $2,897.57 ", $460.48 , $768.38 ," $2,299.68 "," $2,295.86 "," $1,674.93 "," $1,620.90 "," $1,620.90 "," $1,440.80 "," $1,440.80 ", $768.38 ," $1,662.86 "," $1,710.95 "," $1,620.90 "," $1,620.90 "," $1,620.90 "," $1,674.93 "," $1,728.96 "," $2,714.69 "," $1,530.85 "," $2,529.80 "," $2,716.57 ", N/A ," $2,344.56 "," $2,344.56 "," $1,710.95 "," $2,755.69 ", $460.48 ," $2,897.57 "
 CLOBETASOL PROPIONATE 0.05 % EX SOLN ,HCPCS RXC637,0250 - PHARMACY,68462-0532-28,25 mL, $529.87 , $344.42 , $445.09 , N/A , N/A , $428.13 , $476.88 , $448.59 , $476.88 , $476.88 , $476.88 , $450.39 , N/A , $489.23 , $503.38 , $450.39 , $492.78 , $492.78 , $503.38 , $508.68 , $433.54 , $476.88 , $450.39 , $418.60 , N/A , $428.82 , $428.82 , $503.38 , $454.68 , $418.60 , $508.68 
Hpv Combo Assay Ca Screen,HCPCS G0476,N/A,N/A,N/A, $248.00 , $161.20 , N/A , $35.79 , N/A , $118.25 , N/A , $230.64 , $223.20 , $223.20 , $198.40 , $198.40 , N/A , $228.98 , $235.60 , $223.20 , $223.20 , $223.20 , $230.64 , $238.08 , $234.30 , $210.80 , $67.20 , $127.26 , N/A , $120.56 , $120.56 , $235.60 , $150.68 , $35.79 , $238.08 
"Immunohistochemistry, Tumor",CPT® 88361,N/A,N/A,N/A, $920.00 , $598.00 , $431.16 , $116.79 , $135.03 , $672.08 , $715.54 , $855.60 , $828.00 , $828.00 , $736.00 , $736.00 , $135.03 , $849.44 , $874.00 , $828.00 , $828.00 , $828.00 , $855.60 , $883.20 , $791.18 , $782.00 , $746.05 , $505.34 , N/A , $627.23 , $627.23 , $874.00 , $689.30 , $116.79 , $883.20 
Percut Fix Thumb Fx/Disloc,CPT® 26650,N/A,N/A,N/A," $4,035.00 "," $2,622.75 "," $2,976.42 ", $469.74 , $384.19 ," $2,302.85 "," $2,309.74 "," $3,752.55 "," $3,631.50 "," $3,631.50 "," $3,228.00 "," $3,228.00 ", $384.19 ," $3,725.52 "," $3,833.25 "," $3,631.50 "," $3,631.50 "," $3,631.50 "," $3,752.55 "," $3,873.60 "," $2,763.13 "," $3,429.75 "," $2,538.72 "," $2,723.84 ", N/A ," $2,347.79 "," $2,347.79 "," $3,833.25 "," $2,759.47 ", $384.19 ," $3,873.60 "
 Pro Repair Radius or Ulna ,CPT® 25400,0982 - PRO FEE/OUTPT,N/A,N/A," $3,142.00 "," $2,042.30 "," $4,887.61 ", $766.88 , $603.45 ," $3,871.95 "," $3,842.85 "," $2,922.06 "," $2,827.80 "," $2,827.80 "," $2,513.60 "," $2,513.60 ", $603.45 ," $2,901.01 "," $2,984.90 "," $2,827.80 "," $2,827.80 "," $2,827.80 "," $2,922.06 "," $3,016.32 "," $4,550.49 "," $2,670.70 "," $4,237.15 "," $4,578.54 ", N/A ," $3,947.50 "," $3,947.50 "," $2,984.90 "," $4,639.72 ", $603.45 ," $4,887.61 "
Mod Sed Same Phys/Qhp Each Addl 15 Mins,CPT® 99153,N/A,N/A,N/A, $83.00 , $53.95 , $23.95 , $10.39 , $8.53 , $22.93 , $23.60 , $77.19 , $74.70 , $74.70 , $66.40 , $66.40 , $8.53 , $76.63 , $78.85 , $74.70 , $74.70 , $74.70 , $77.19 , $79.68 , $31.53 , $70.55 , $33.32 , $40.46 , N/A , $23.38 , $23.38 , $78.85 , $27.25 , $8.53 , $79.68 
Office/Outpatient Established Mod Mdm 30-39 Min,99214,N/A,N/A,N/A, $293.00 , $190.45 , $198.24 , $94.81 , $64.80 , $135.34 , $135.69 , $272.49 , $263.70 , $263.70 , $234.40 , $234.40 , $64.80 , $270.53 , $278.35 , $263.70 , $263.70 , $263.70 , $272.49 , $281.28 , $181.36 , $249.05 , $168.77 , $172.04 , $74.50 , $137.99 , $137.99 , $278.35 , $159.15 , $64.80 , $281.28 
Lens Sphc Trifocal 4.25-7/4.,HCPCS V2309,N/A,N/A,N/A, $90.00 , $58.50 , N/A , $101.53 , N/A , N/A , N/A , $83.70 , $81.00 , $81.00 , $72.00 , $72.00 , N/A , $83.10 , $85.50 , $81.00 , $81.00 , $81.00 , $83.70 , $86.40 , N/A , $76.50 , $90.00 , $92.24 , N/A , N/A , N/A , $85.50 , N/A , $72.00 , $101.53 
Treat Calcaneal Fracture,CPT® 28400,N/A,N/A,N/A," $1,673.00 "," $1,087.45 "," $1,427.86 ", $226.27 , $230.52 ," $1,105.57 "," $1,134.26 "," $1,555.89 "," $1,505.70 "," $1,505.70 "," $1,338.40 "," $1,338.40 ", $230.52 ," $1,544.68 "," $1,589.35 "," $1,505.70 "," $1,505.70 "," $1,505.70 "," $1,555.89 "," $1,606.08 "," $1,314.98 "," $1,422.05 "," $1,238.14 "," $1,313.86 ", N/A ," $1,127.14 "," $1,127.14 "," $1,589.35 "," $1,324.78 ", $226.27 ," $1,606.08 "
 Pro Quant Diff Pulm Prfusion & Ventlaj W/WO Imaging ,CPT® 78598,0972 - PRO FEE/RAD/DX,N/A,N/A," $2,128.00 "," $1,383.20 "," $1,625.57 ", $276.85 , $236.29 ," $1,506.45 "," $1,876.77 "," $1,979.04 "," $1,915.20 "," $1,915.20 "," $1,702.40 "," $1,702.40 ", $236.29 ," $1,964.78 "," $2,021.60 "," $1,915.20 "," $1,915.20 "," $1,915.20 "," $1,979.04 "," $2,042.88 "," $1,683.41 "," $1,808.80 "," $2,060.86 "," $2,051.95 ", N/A ," $1,535.84 "," $1,535.84 "," $2,021.60 "," $1,777.78 ", $236.29 ," $2,060.86 "
"Removal of Hydrocele,Tunica,Unilat",CPT® 55040,N/A,N/A,N/A," $3,208.00 "," $2,085.20 "," $1,504.47 ", $324.04 , $333.51 ," $1,083.03 "," $1,102.68 "," $2,983.44 "," $2,887.20 "," $2,887.20 "," $2,566.40 "," $2,566.40 ", $333.51 ," $2,961.95 "," $3,047.60 "," $2,887.20 "," $2,887.20 "," $2,887.20 "," $2,983.44 "," $3,079.68 "," $1,410.36 "," $2,726.80 "," $1,764.44 "," $1,634.50 ", N/A ," $1,104.16 "," $1,104.16 "," $3,047.60 "," $1,323.40 ", $324.04 ," $3,079.68 "
"Meas,Post-Void Res,US,Non-Imaging",51798,N/A,N/A,N/A, $123.00 , $79.95 , $56.81 , $10.29 , $13.26 , $89.64 , $90.20 , $114.39 , $110.70 , $110.70 , $98.40 , $98.40 , $13.26 , $113.57 , $116.85 , $110.70 , $110.70 , $110.70 , $114.39 , $118.08 , $55.26 , $104.55 , $103.48 , $95.62 , N/A , $91.40 , $91.40 , $116.85 , $107.40 , $10.29 , $118.08 
Thyrotropin Injection,HCPCS J3240,N/A,N/A,N/A," $2,991.00 "," $1,944.15 ", N/A ," $2,041.52 "," $1,965.27 ", N/A , N/A ," $2,781.63 "," $2,691.90 "," $2,691.90 "," $2,392.80 "," $2,392.80 "," $1,965.27 "," $2,761.59 "," $2,841.45 "," $2,691.90 "," $2,691.90 "," $2,691.90 "," $2,781.63 "," $2,871.36 "," $2,393.53 "," $2,542.35 "," $2,005.94 "," $2,512.43 ", N/A , N/A , N/A ," $2,841.45 ", N/A ," $1,965.27 "," $2,871.36 "
"Myomectomy 5/>,Tot>250 Gms,Abd Apprch",CPT® 58146,N/A,N/A,N/A," $6,679.00 "," $4,341.35 "," $5,437.80 "," $1,098.75 "," $1,021.79 "," $4,689.63 "," $4,679.55 "," $6,211.47 "," $6,011.10 "," $6,011.10 "," $5,343.20 "," $5,343.20 "," $1,021.79 "," $6,166.72 "," $6,345.05 "," $6,011.10 "," $6,011.10 "," $6,011.10 "," $6,211.47 "," $6,411.84 "," $5,698.46 "," $5,677.15 "," $6,160.37 "," $4,693.10 ", N/A ," $4,781.13 "," $4,781.13 "," $6,345.05 "," $5,734.67 "," $1,021.79 "," $6,411.84 "
Immune Complex Assay,CPT® 86332,N/A,N/A,N/A, $242.00 , $157.30 , N/A , $24.86 , $24.86 , $137.90 , $164.93 , $225.06 , $217.80 , $217.80 , $193.60 , $193.60 , $24.86 , $223.44 , $229.90 , $217.80 , $217.80 , $217.80 , $225.06 , $232.32 , $162.72 , $205.70 , $158.94 , $88.37 , N/A , $128.70 , $128.70 , $229.90 , $140.64 , $24.86 , $232.32 
 GEMCITABINE HCL 2 GM/52.6ML IV SOLN ,HCPCS J9201,0636 - DRUGS REQUIRING DETAILED CODIN,00409-0182-01,52.6 mL, $266.41 , $173.17 , $223.78 , $3.78 , $3.57 , $215.26 , $239.77 , $225.54 , $239.77 , $239.77 , $239.77 , $226.45 , $3.50 , $245.98 , $253.09 , $226.45 , $247.76 , $247.76 , $253.09 , $255.75 , $217.98 , $239.77 , $226.45 , $210.46 , N/A , $215.61 , $215.61 , $253.09 , $228.61 , $3.50 , $255.75 
"Arthro, Loose Body + Chondro",HCPCS G0289,N/A,N/A,N/A, $111.00 , $72.15 , $187.94 , $79.26 , $84.92 , $159.72 , N/A , $103.23 , $99.90 , $99.90 , $88.80 , $88.80 , $84.92 , $102.49 , $105.45 , $99.90 , $99.90 , $99.90 , $103.23 , $106.56 , $477.19 , $94.35 , $166.08 , $490.96 , N/A , $162.83 , $162.83 , $105.45 , $203.55 , $79.26 , $490.96 
"Fx Ulnar,Closed,W/O Manip",24670,N/A,N/A,N/A," $1,130.00 ", $734.50 ," $1,666.60 ", $264.23 , $194.38 ," $1,264.93 "," $1,285.98 "," $1,050.90 "," $1,017.00 "," $1,017.00 ", $904.00 , $904.00 , $194.38 ," $1,043.33 "," $1,073.50 "," $1,017.00 "," $1,017.00 "," $1,017.00 "," $1,050.90 "," $1,084.80 "," $1,534.20 ", $960.50 ," $1,411.19 "," $1,501.55 ", N/A ," $1,289.61 "," $1,289.61 "," $1,073.50 "," $1,515.75 ", $194.38 ," $1,666.60 "
Needle Emg Guidance for Chemodenervation,CPT® 95874,N/A,N/A,N/A, $208.00 , $135.20 , $298.03 , $76.28 , $24.87 , $229.81 , $254.79 , $193.44 , $187.20 , $187.20 , $166.40 , $166.40 , $24.87 , $192.05 , $197.60 , $187.20 , $187.20 , $187.20 , $193.44 , $199.68 , $359.19 , $176.80 , $224.03 , $284.38 , N/A , $234.29 , $234.29 , $197.60 , $288.04 , $24.87 , $359.19 
 Fac Removal of Spinal Lamina ,CPT® 63047,0360 - OR SERVICES,N/A,N/A," $16,828.00 "," $10,938.20 "," $14,135.52 "," $1,014.94 ", $936.64 ," $13,597.02 "," $15,145.20 "," $14,246.58 "," $15,145.20 "," $15,145.20 "," $15,145.20 "," $14,303.80 ", $918.27 ," $15,537.29 "," $15,986.60 "," $14,303.80 "," $15,650.04 "," $15,650.04 "," $15,986.60 "," $16,154.88 "," $13,768.67 "," $15,145.20 "," $14,303.80 "," $13,294.12 ", N/A ," $13,618.90 "," $13,618.90 "," $15,986.60 "," $14,440.11 ", $918.27 ," $16,154.88 "
 Pro Arthrs Ankle Tibtlr&Fibltlr Surg Dbrdmt Lmtd ,CPT® 29897,0982 - PRO FEE/OUTPT,N/A,N/A," $5,544.00 "," $3,603.60 "," $3,025.75 ", $479.04 , $420.46 ," $2,464.06 "," $2,489.09 "," $5,155.92 "," $4,989.60 "," $4,989.60 "," $4,435.20 "," $4,435.20 ", $420.46 ," $5,118.78 "," $5,266.80 "," $4,989.60 "," $4,989.60 "," $4,989.60 "," $5,155.92 "," $5,322.24 "," $2,828.82 "," $4,712.40 "," $2,734.97 "," $2,887.93 ", N/A ," $2,512.14 "," $2,512.14 "," $5,266.80 "," $2,952.65 ", $420.46 ," $5,322.24 "
 Fac Evasc Rpr Dplmnt Ilio-Iliac Ndgft ,CPT® 34707,0360 - OR SERVICES,N/A,N/A," $1,612.00 "," $1,047.80 "," $1,354.08 "," $1,041.07 ", $870.84 ," $1,302.50 "," $1,450.80 "," $1,364.72 "," $1,450.80 "," $1,450.80 "," $1,450.80 "," $1,370.20 ", $853.76 ," $1,488.36 "," $1,531.40 "," $1,370.20 "," $1,499.16 "," $1,499.16 "," $1,531.40 "," $1,547.52 "," $1,318.94 "," $1,450.80 "," $1,370.20 "," $1,273.48 ", N/A ," $1,304.59 "," $1,304.59 "," $1,531.40 "," $1,383.26 ", $853.76 ," $1,547.52 "
 Repair Lac Floor of Mouth/Anterior Tongue <=2.5cm -Mh ,CPT® 41250,0761 - TREATMENT ROOM,N/A,N/A," $1,373.00 ", $892.45 ," $1,153.32 ", $146.64 , $61.48 ," $1,109.38 "," $1,235.70 "," $1,162.38 "," $1,235.70 "," $1,235.70 "," $1,235.70 "," $1,167.05 ", $60.27 ," $1,267.69 "," $1,304.35 "," $1,167.05 "," $1,276.89 "," $1,276.89 "," $1,304.35 "," $1,318.08 "," $1,123.39 "," $1,235.70 "," $1,167.05 "," $1,084.67 ", N/A ," $1,111.17 "," $1,111.17 "," $1,304.35 "," $1,178.17 ", $60.27 ," $1,318.08 "
 Fac Imcytchm Tiss Immunoproxidase Ea Antb ,CPT® 88342,0310 - PATHOLOGY LAB,N/A,N/A, $430.00 , $279.50 , $361.20 , $98.62 , $54.62 , $347.44 , $387.00 , $364.04 , $387.00 , $387.00 , $387.00 , $365.50 , $53.55 , $397.02 , $408.50 , $365.50 , $399.90 , $399.90 , $408.50 , $412.80 , $351.83 , $387.00 , $365.50 , $339.70 , N/A , $348.00 , $348.00 , $408.50 , $368.98 , $53.55 , $412.80 
 Pro Windowing of Cast ,CPT® 29730,0981 - PRO FEE/ER,N/A,N/A, $348.00 , $226.20 , $267.80 , $42.00 , $22.62 , $215.54 , $216.71 , $323.64 , $313.20 , $313.20 , $278.40 , $278.40 , $22.62 , $321.31 , $330.60 , $313.20 , $313.20 , $313.20 , $323.64 , $334.08 , $247.00 , $295.80 , $237.28 , $253.23 , N/A , $219.75 , $219.75 , $330.60 , $258.29 , $22.62 , $334.08 
"Inject Corpora Cavern,Pharm Agnt",54235,N/A,N/A,N/A, $500.00 , $325.00 , $321.90 , $70.23 , N/A , $235.76 , $239.61 , $465.00 , $450.00 , $450.00 , $400.00 , $400.00 , N/A , $461.65 , $475.00 , $450.00 , $450.00 , $450.00 , $465.00 , $480.00 , $302.37 , $425.00 , $381.79 , $356.52 , N/A , $240.36 , $240.36 , $475.00 , $288.08 , $70.23 , $480.00 
Surgical Path Level 2,CPT® 88302,N/A,N/A,N/A, $351.00 , $228.15 , $111.48 , $31.97 , $20.63 , $126.33 , $140.21 , $326.43 , $315.90 , $315.90 , $280.80 , $280.80 , $20.63 , $324.08 , $333.45 , $315.90 , $315.90 , $315.90 , $326.43 , $336.96 , $200.65 , $298.35 , $147.59 , $106.48 , N/A , $117.90 , $117.90 , $333.45 , $129.56 , $20.63 , $336.96 
 VILAZODONE HCL 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00456-1110-30,1 tablet, $68.00 , $44.20 , $57.12 , N/A , N/A , $54.94 , $61.20 , $57.57 , $61.20 , $61.20 , $61.20 , $57.80 , N/A , $62.78 , $64.60 , $57.80 , $63.24 , $63.24 , $64.60 , $65.28 , $55.64 , $61.20 , $57.80 , $53.72 , N/A , $55.03 , $55.03 , $64.60 , $58.35 , $53.72 , $65.28 
 GELATIN ABSORBABLE 12-7 MM EX MISC ,HCPCS RXA250,0250 - PHARMACY,00009-0315-08,1 packet, $53.25 , $34.61 , $44.73 , N/A , N/A , $43.03 , $47.93 , $45.08 , $47.93 , $47.93 , $47.93 , $45.26 , N/A , $49.17 , $50.59 , $45.26 , $49.52 , $49.52 , $50.59 , $51.12 , $43.57 , $47.93 , $45.26 , $42.07 , N/A , $43.10 , $43.10 , $50.59 , $45.69 , $42.07 , $51.12 
Sex Hormone Globulin (Shbg),CPT® 84270,N/A,N/A,N/A, $210.00 , $136.50 , N/A , $22.16 , $22.16 , $122.98 , $147.07 , $195.30 , $189.00 , $189.00 , $168.00 , $168.00 , $22.16 , $193.89 , $199.50 , $189.00 , $189.00 , $189.00 , $195.30 , $201.60 , $145.10 , $178.50 , $142.72 , $78.80 , N/A , $114.77 , $114.77 , $199.50 , $125.42 , $22.16 , $201.60 
" Angiography, Internal Mammary ",CPT® 75756,0320 - DX X-RAY,N/A,N/A," $1,697.00 "," $1,103.05 "," $1,425.48 ", $157.39 , $250.42 ," $1,371.18 "," $1,527.30 "," $1,436.68 "," $1,527.30 "," $1,527.30 "," $1,527.30 "," $1,442.45 ", $245.51 ," $1,566.84 "," $1,612.15 "," $1,442.45 "," $1,578.21 "," $1,578.21 "," $1,612.15 "," $1,629.12 "," $1,388.49 "," $1,527.30 "," $1,442.45 "," $1,340.63 ", N/A ," $1,373.38 "," $1,373.38 "," $1,612.15 "," $1,456.20 ", $157.39 ," $1,629.12 "
"Hfo Nontorsion Joint, Prefab",HCPCS L3929,N/A,N/A,N/A, $106.00 , $68.90 , N/A , $97.24 , $81.60 , N/A , N/A , $98.58 , $95.40 , $95.40 , $84.80 , $84.80 , $81.60 , $97.87 , $100.70 , $95.40 , $95.40 , $95.40 , $98.58 , $101.76 , N/A , $90.10 , $77.20 , $81.80 , N/A , N/A , N/A , $100.70 , N/A , $77.20 , $101.76 
Assay/17-Hydroxypregnenolone,CPT® 84143,N/A,N/A,N/A, $162.00 , $105.30 , N/A , $23.27 , $23.27 , $129.08 , $154.45 , $150.66 , $145.80 , $145.80 , $129.60 , $129.60 , $23.27 , $149.57 , $153.90 , $145.80 , $145.80 , $145.80 , $150.66 , $155.52 , $152.31 , $137.70 , $149.21 , $82.71 , N/A , $120.47 , $120.47 , $153.90 , $131.65 , $23.27 , $155.52 
" Pro Treat Finger Fracture, Each ",CPT® 26720,0982 - PRO FEE/OUTPT,N/A,N/A," $1,300.00 ", $845.00 ," $1,172.86 ", $187.01 , $74.22 , $886.14 , $907.35 ," $1,209.00 "," $1,170.00 "," $1,170.00 "," $1,040.00 "," $1,040.00 ", $74.22 ," $1,200.29 "," $1,235.00 "," $1,170.00 "," $1,170.00 "," $1,170.00 "," $1,209.00 "," $1,248.00 "," $1,075.93 "," $1,105.00 ", $995.51 ," $1,060.64 ", N/A , $903.43 , $903.43 ," $1,235.00 "," $1,061.84 ", $74.22 ," $1,248.00 "
"Fx Ulnar,Closed,W/O Manip",CPT® 24670,N/A,N/A,N/A," $1,004.00 ", $652.60 ," $1,666.60 ", $264.23 , $194.38 ," $1,264.93 "," $1,285.98 ", $933.72 , $903.60 , $903.60 , $803.20 , $803.20 , $194.38 , $926.99 , $953.80 , $903.60 , $903.60 , $903.60 , $933.72 , $963.84 ," $1,534.20 ", $853.40 ," $1,411.19 "," $1,501.55 ", N/A ," $1,289.61 "," $1,289.61 ", $953.80 ," $1,515.75 ", $194.38 ," $1,666.60 "
 Pro Cltx Fx Phlx/Phlg Oth/Thn Grt Toe W/O Mnpj ,CPT® 28510,0981 - PRO FEE/ER,N/A,N/A, $558.00 , $362.70 , $743.67 , $118.80 , $61.48 , $587.40 , $600.10 , $518.94 , $502.20 , $502.20 , $446.40 , $446.40 , $61.48 , $515.20 , $530.10 , $502.20 , $502.20 , $502.20 , $518.94 , $535.68 , $688.46 , $474.30 , $651.18 , $699.92 , N/A , $598.86 , $598.86 , $530.10 , $703.87 , $61.48 , $743.67 
Arthrocentesis Aspir&/Inj Major Jt/Bursa W/US,CPT® 20611,N/A,N/A,N/A, $696.00 , $452.40 , $362.70 , $56.61 , $71.34 , $294.38 , $303.91 , $647.28 , $626.40 , $626.40 , $556.80 , $556.80 , $71.34 , $642.62 , $661.20 , $626.40 , $626.40 , $626.40 , $647.28 , $668.16 , $341.67 , $591.60 , $316.30 , $351.78 , N/A , $300.12 , $300.12 , $661.20 , $352.75 , $56.61 , $668.16 
Rp Loclzj Tum Spect W/CT 1 Area/Acquisj 1day Img,CPT® 78830,N/A,N/A,N/A," $4,150.00 "," $2,697.50 "," $2,596.60 ", $439.62 , $393.09 ," $2,328.90 ", N/A ," $3,859.50 "," $3,735.00 "," $3,735.00 "," $3,320.00 "," $3,320.00 ", $393.09 ," $3,831.70 "," $3,942.50 "," $3,735.00 "," $3,735.00 "," $3,735.00 "," $3,859.50 "," $3,984.00 "," $2,727.94 "," $3,527.50 "," $2,568.68 "," $3,233.31 ", N/A ," $2,374.34 "," $2,374.34 "," $3,942.50 "," $2,751.63 ", $393.09 ," $3,984.00 "
 Fac Assay Acid Phosphatase ,CPT® 84060,0301 - LAB/CHEMISTRY,N/A,N/A, $68.00 , $44.20 , $57.12 , $7.79 , $7.79 , $54.94 , $61.20 , $57.57 , $61.20 , $61.20 , $61.20 , $57.80 , $7.64 , $62.78 , $64.60 , $57.80 , $63.24 , $63.24 , $64.60 , $65.28 , $55.64 , $61.20 , $57.80 , $53.72 , N/A , $55.03 , $55.03 , $64.60 , $58.35 , $7.64 , $65.28 
"Fx Radial & Ulnar,Closed",25560,N/A,N/A,N/A," $1,239.00 ", $805.35 ," $1,610.31 ", $255.85 , $202.15 ," $1,207.93 "," $1,232.28 "," $1,152.27 "," $1,115.10 "," $1,115.10 ", $991.20 , $991.20 , $202.15 ," $1,143.97 "," $1,177.05 "," $1,115.10 "," $1,115.10 "," $1,115.10 "," $1,152.27 "," $1,189.44 "," $1,481.60 "," $1,053.15 "," $1,352.32 "," $1,443.52 ", N/A ," $1,231.51 "," $1,231.51 "," $1,177.05 "," $1,447.45 ", $202.15 ," $1,610.31 "
 PALONOSETRON HCL 0.25 MG/5ML IV SOLN ,HCPCS J2469,0636 - DRUGS REQUIRING DETAILED CODIN,00781-3312-75,5 mL, $832.48 , $541.11 , $699.28 , $1.02 , $1.33 , $672.64 , $749.23 , $704.78 , $749.23 , $749.23 , $749.23 , $707.61 , $1.30 , $768.63 , $790.86 , $707.61 , $774.21 , $774.21 , $790.86 , $799.18 , $681.14 , $749.23 , $707.61 , $657.66 , N/A , $673.73 , $673.73 , $790.86 , $714.35 , $1.02 , $799.18 
Pfizer-Biontech Admin Biv Booster 5 Yrs to 11 Yrs,CPT® 0154A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $56.00 , $128.02 , N/A , N/A , N/A , $66.50 , N/A , $38.92 , $128.02 
"Knee Scope,Med or Lat Menis Repair",CPT® 29882,N/A,N/A,N/A," $5,144.00 "," $3,343.60 "," $4,191.01 ", $657.29 , $600.95 ," $3,377.99 "," $3,369.07 "," $4,783.92 "," $4,629.60 "," $4,629.60 "," $4,115.20 "," $4,115.20 ", $600.95 ," $4,749.46 "," $4,886.80 "," $4,629.60 "," $4,629.60 "," $4,629.60 "," $4,783.92 "," $4,938.24 "," $3,909.75 "," $4,372.40 "," $3,721.56 "," $3,975.62 ", N/A ," $3,443.90 "," $3,443.90 "," $4,886.80 "," $4,047.80 ", $600.95 ," $4,938.24 "
Chemical Cauterization of Granulation Tissue,CPT® 17250,N/A,N/A,N/A, $339.00 , $220.35 , $118.49 , $35.56 , $24.75 , $100.85 , $98.94 , $315.27 , $305.10 , $305.10 , $271.20 , $271.20 , $24.75 , $313.00 , $322.05 , $305.10 , $305.10 , $305.10 , $315.27 , $325.44 , $128.31 , $288.15 , $196.25 , $130.88 , N/A , $102.81 , $102.81 , $322.05 , $119.25 , $24.75 , $325.44 
Chromosome Anal-Addt Kary,CPT® 88280,N/A,N/A,N/A, $240.00 , $156.00 , N/A , $34.14 , $34.14 , $140.52 , $213.38 , $223.20 , $216.00 , $216.00 , $192.00 , $192.00 , $34.14 , $221.59 , $228.00 , $216.00 , $216.00 , $216.00 , $223.20 , $230.40 , $223.49 , $204.00 , $163.81 , $118.48 , N/A , $131.14 , $131.14 , $228.00 , $144.11 , $34.14 , $230.40 
 Fac Fine Needle Aspiration Bx W/US Gdn Ea Addl ,CPT® 10006,0361 - OR/MINOR,N/A,N/A, $994.00 , $646.10 , $834.96 , $48.12 , $47.61 , $803.15 , $894.60 , $841.52 , $894.60 , $894.60 , $894.60 , $844.90 , $46.68 , $917.76 , $944.30 , $844.90 , $924.42 , $924.42 , $944.30 , $954.24 , $813.29 , $894.60 , $844.90 , $785.26 , N/A , $804.44 , $804.44 , $944.30 , $852.95 , $46.68 , $954.24 
"Total Disc Arthroplasty, Cervical, Single",CPT® 22856,N/A,N/A,N/A," $11,033.00 "," $7,171.45 "," $9,507.42 "," $1,481.65 "," $1,425.60 "," $7,694.81 "," $7,822.79 "," $10,260.69 "," $9,929.70 "," $9,929.70 "," $8,826.40 "," $8,826.40 "," $1,425.60 "," $10,186.77 "," $10,481.35 "," $9,929.70 "," $9,929.70 "," $9,929.70 "," $10,260.69 "," $10,591.68 "," $8,863.31 "," $9,378.05 "," $8,836.47 "," $9,023.67 ", N/A ," $7,844.95 "," $7,844.95 "," $10,481.35 "," $9,220.60 "," $1,425.60 "," $10,591.68 "
Diagnostic Bone Marrow Aspirations,CPT® 38220,N/A,N/A,N/A," $1,087.00 ", $706.55 , $326.35 , $65.55 , $305.29 , $218.73 , $217.42 ," $1,010.91 ", $978.30 , $978.30 , $869.60 , $869.60 , $305.29 ," $1,003.63 "," $1,032.65 ", $978.30 , $978.30 , $978.30 ," $1,010.91 "," $1,043.52 ", $348.86 , $923.95 , $314.00 , $340.85 , N/A , $223.00 , $223.00 ," $1,032.65 ", $258.71 , $65.55 ," $1,043.52 "
 M/Phmtrc Alys Ish Quant/Semiq Mnl Each Multiprb Pro ,CPT® 88377,0971 - PRO FEE/LAB,N/A,N/A, $287.00 , $186.55 ," $1,442.41 ", $389.56 , $168.73 , $850.80 , $976.01 , $266.91 , $258.30 , $258.30 , $229.60 , $229.60 , $168.73 , $264.99 , $272.65 , $258.30 , $258.30 , $258.30 , $266.91 , $275.52 ," $2,683.91 ", $243.95 ," $1,907.75 "," $1,419.29 ", N/A , $794.02 , $794.02 , $272.65 , $872.60 , $168.73 ," $2,683.91 "
 OMALIZUMAB 150 MG/ML SC SOSY ,HCPCS J2357,0636 - DRUGS REQUIRING DETAILED CODIN,50242-0215-01,1 mL," $3,841.72 "," $2,497.12 "," $3,227.04 ", $40.17 , $38.96 ," $3,104.11 "," $3,457.55 "," $3,252.40 "," $3,457.55 "," $3,457.55 "," $3,457.55 "," $3,265.46 ", $38.20 ," $3,547.06 "," $3,649.63 "," $3,265.46 "," $3,572.80 "," $3,572.80 "," $3,649.63 "," $3,688.05 "," $3,143.30 "," $3,457.55 "," $3,265.46 "," $3,034.96 ", N/A ," $3,109.10 "," $3,109.10 "," $3,649.63 "," $3,296.58 ", $38.20 ," $3,688.05 "
Colonoscopy Flx W/Removal of Foreign Body(S),CPT® 45379,N/A,N/A,N/A," $3,450.00 "," $2,242.50 "," $1,463.54 ", $225.60 , $599.30 ," $1,285.13 "," $1,318.68 "," $3,208.50 "," $3,105.00 "," $3,105.00 "," $2,760.00 "," $2,760.00 ", $599.30 ," $3,185.39 "," $3,277.50 "," $3,105.00 "," $3,105.00 "," $3,105.00 "," $3,208.50 "," $3,312.00 "," $1,049.61 "," $2,932.50 "," $1,446.88 "," $1,390.72 ", N/A ," $1,310.20 "," $1,310.20 "," $3,277.50 "," $1,370.34 ", $225.60 ," $3,312.00 "
"Hiv-1, Dna, Quant",CPT® 87536,N/A,N/A,N/A, $435.00 , $282.75 , N/A , $86.80 , $86.80 , $481.43 , $575.85 , $404.55 , $391.50 , $391.50 , $348.00 , $348.00 , $86.80 , $401.64 , $413.25 , $391.50 , $391.50 , $391.50 , $404.55 , $417.60 , $568.23 , $369.75 , $557.91 , $308.56 , N/A , $449.30 , $449.30 , $413.25 , $490.99 , $86.80 , $575.85 
 Fac Drug Screening Methadone ,CPT® 80358,0301 - LAB/CHEMISTRY,N/A,N/A, $166.00 , $107.90 , $139.44 , N/A , N/A , $134.13 , $149.40 , $140.54 , $149.40 , $149.40 , $149.40 , $141.10 , N/A , $153.27 , $157.70 , $141.10 , $154.38 , $154.38 , $157.70 , $159.36 , $135.82 , $149.40 , $141.10 , $131.14 , N/A , $134.34 , $134.34 , $157.70 , $142.44 , $131.14 , $159.36 
 Pro Destroy Premlg Lesions 15+ ,CPT® 17004,0982 - PRO FEE/OUTPT,N/A,N/A, $814.00 , $529.10 , $231.63 , $95.50 , $178.52 , $272.16 , $348.41 , $757.02 , $732.60 , $732.60 , $651.20 , $651.20 , $178.52 , $751.57 , $773.30 , $732.60 , $732.60 , $732.60 , $757.02 , $781.44 , $346.58 , $691.90 , $692.22 , $348.55 , N/A , $277.47 , $277.47 , $773.30 , $321.77 , $95.50 , $781.44 
" Fac Immunoassay, Tumor, Ca 125 ",CPT® 86304,0302 - LAB/IMMUNOLOGY,N/A,N/A, $237.00 , $154.05 , $199.08 , $21.23 , $21.23 , $191.50 , $213.30 , $200.64 , $213.30 , $213.30 , $213.30 , $201.45 , $20.81 , $218.82 , $225.15 , $201.45 , $220.41 , $220.41 , $225.15 , $227.52 , $193.91 , $213.30 , $201.45 , $187.23 , N/A , $191.80 , $191.80 , $225.15 , $203.37 , $20.81 , $227.52 
 Fac Trauma 2 Activation W/ Pre-ED Notification- Level I W/Critical Care ,HCPCS G0390,0682 - TRAUMA LEVEL II,N/A,N/A," $9,824.00 "," $6,385.60 "," $8,252.16 ", N/A , N/A ," $7,937.79 "," $8,841.60 "," $8,317.00 "," $8,841.60 "," $8,841.60 "," $8,841.60 "," $8,350.40 ", N/A ," $9,070.50 "," $9,332.80 "," $8,350.40 "," $9,136.32 "," $9,136.32 "," $9,332.80 "," $9,431.04 "," $8,038.00 "," $8,841.60 "," $8,350.40 "," $7,760.96 ", N/A ," $7,950.56 "," $7,950.56 "," $9,332.80 "," $8,429.97 "," $7,760.96 "," $9,431.04 "
"Dislocated Elbow,W/O Anes",CPT® 24600,N/A,N/A,N/A," $2,031.00 "," $1,320.15 "," $2,087.54 ", $333.10 , $76.84 ," $1,604.04 "," $1,632.03 "," $1,888.83 "," $1,827.90 "," $1,827.90 "," $1,624.80 "," $1,624.80 ", $76.84 ," $1,875.22 "," $1,929.45 "," $1,827.90 "," $1,827.90 "," $1,827.90 "," $1,888.83 "," $1,949.76 "," $1,919.14 "," $1,726.35 "," $1,791.20 "," $1,909.64 ", N/A ," $1,635.34 "," $1,635.34 "," $1,929.45 "," $1,922.11 ", $76.84 ," $2,087.54 "
 Fac Rmvl Transvns Pm Eltrd Dual Lead Sys ,CPT® 33235,0360 - OR SERVICES,N/A,N/A," $5,120.00 "," $3,328.00 "," $4,300.80 ", $587.39 , $948.38 ," $4,136.96 "," $4,608.00 "," $4,334.59 "," $4,608.00 "," $4,608.00 "," $4,608.00 "," $4,352.00 ", $929.78 ," $4,727.30 "," $4,864.00 "," $4,352.00 "," $4,761.60 "," $4,761.60 "," $4,864.00 "," $4,915.20 "," $4,189.18 "," $4,608.00 "," $4,352.00 "," $4,044.80 ", N/A ," $4,143.62 "," $4,143.62 "," $4,864.00 "," $4,393.47 ", $587.39 ," $4,915.20 "
 LACTULOSE 10 GM/15ML PO SOLN ,HCPCS RXC637,0250 - PHARMACY,00121-1154-00,15 mL, $12.87 , $8.37 , $10.81 , N/A , N/A , $10.40 , $11.58 , $10.90 , $11.58 , $11.58 , $11.58 , $10.94 , N/A , $11.88 , $12.23 , $10.94 , $11.97 , $11.97 , $12.23 , $12.36 , $10.53 , $11.58 , $10.94 , $10.17 , N/A , $10.42 , $10.42 , $12.23 , $11.04 , $10.17 , $12.36 
Drain Hand Tendon Sheath,CPT® 26020,N/A,N/A,N/A," $1,703.00 "," $1,106.95 "," $3,415.62 ", $536.98 , $338.07 ," $2,087.05 "," $2,101.50 "," $1,583.79 "," $1,532.70 "," $1,532.70 "," $1,362.40 "," $1,362.40 ", $338.07 ," $1,572.38 "," $1,617.85 "," $1,532.70 "," $1,532.70 "," $1,532.70 "," $1,583.79 "," $1,634.88 "," $3,167.90 "," $1,447.55 "," $2,308.58 "," $2,477.46 ", N/A ," $2,127.78 "," $2,127.78 "," $1,617.85 "," $2,500.91 ", $338.07 ," $3,415.62 "
"Irrigat Corpus Cavern,Priapism",54220,N/A,N/A,N/A," $1,126.00 ", $731.90 , $581.48 , $125.43 , $341.89 , $430.28 , $436.29 ," $1,047.18 "," $1,013.40 "," $1,013.40 ", $900.80 , $900.80 , $341.89 ," $1,039.64 "," $1,069.70 "," $1,013.40 "," $1,013.40 "," $1,013.40 "," $1,047.18 "," $1,080.96 ", $546.67 , $957.10 , $697.57 , $645.59 , N/A , $438.67 , $438.67 ," $1,069.70 ", $525.78 , $125.43 ," $1,080.96 "
Health Behavior Ivntj Indiv F2f 1st 30 Min,CPT® 96158,N/A,N/A,N/A, $214.00 , $139.10 , $149.29 , $57.12 , $64.77 , $133.96 , N/A , $199.02 , $192.60 , $192.60 , $171.20 , $171.20 , $64.77 , $197.59 , $203.30 , $192.60 , $192.60 , $192.60 , $199.02 , $205.44 , $181.31 , $181.90 , $170.63 , $232.32 , N/A , $136.57 , $136.57 , $203.30 , $158.94 , $57.12 , $232.32 
 DOPAMINE IN D5W 1.6-5 MG/ML-% IV SOLN ,HCPCS J1265,0636 - DRUGS REQUIRING DETAILED CODIN,00338-1007-02,250 mL, $87.33 , $56.76 , $73.36 , $0.71 , $0.68 , $70.56 , $78.60 , $73.93 , $78.60 , $78.60 , $78.60 , $74.23 , $0.67 , $80.63 , $82.96 , $74.23 , $81.22 , $81.22 , $82.96 , $83.84 , $71.45 , $78.60 , $74.23 , $68.99 , N/A , $70.68 , $70.68 , $82.96 , $74.94 , $0.67 , $83.84 
 CEMIPLIMAB-RWLC 350 MG/7ML IV SOLN ,HCPCS J9119,0636 - DRUGS REQUIRING DETAILED CODIN,61755-0008-01,7 mL," $29,396.90 "," $19,107.99 "," $24,693.40 ", $27.46 , $27.77 ," $23,752.70 "," $26,457.21 "," $24,887.42 "," $26,457.21 "," $26,457.21 "," $26,457.21 "," $24,987.37 ", $27.23 ," $27,142.16 "," $27,927.06 "," $24,987.37 "," $27,339.12 "," $27,339.12 "," $27,927.06 "," $28,221.02 "," $24,052.54 "," $26,457.21 "," $24,987.37 "," $23,223.55 ", N/A ," $23,790.91 "," $23,790.91 "," $27,927.06 "," $25,225.48 ", $27.23 ," $28,221.02 "
"Stereotactic Radiosurgery, Cranial,Simple,Ea Add",CPT® 61797,N/A,N/A,N/A," $1,944.00 "," $1,263.60 ", $978.48 , $190.21 , $147.40 ," $1,186.96 "," $1,109.36 "," $1,807.92 "," $1,749.60 "," $1,749.60 "," $1,555.20 "," $1,555.20 ", $147.40 ," $1,794.90 "," $1,846.80 "," $1,749.60 "," $1,749.60 "," $1,749.60 "," $1,807.92 "," $1,866.24 "," $1,063.35 "," $1,652.40 "," $1,143.59 "," $1,222.50 ", N/A ," $1,210.12 "," $1,210.12 "," $1,846.80 "," $1,298.17 ", $147.40 ," $1,866.24 "
 Pro Cta Lxtr C-/C+ Post-Pxessing ,CPT® 73706,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,029.00 ", $668.85 ," $1,812.93 ", $262.47 , $354.97 ," $1,671.84 "," $2,134.00 ", $956.97 , $926.10 , $926.10 , $823.20 , $823.20 , $354.97 , $950.08 , $977.55 , $926.10 , $926.10 , $926.10 , $956.97 , $987.84 ," $1,950.90 ", $874.65 ," $2,328.58 "," $2,304.48 ", N/A ," $1,704.47 "," $1,704.47 ", $977.55 ," $1,972.93 ", $262.47 ," $2,328.58 "
"Lap, Surg Mobil Splenic Fl Dur Ptl Colectomy",CPT® 44213,N/A,N/A,N/A," $1,327.00 ", $862.55 ," $1,110.72 ", $171.16 , $166.63 , $893.57 , $891.90 ," $1,234.11 "," $1,194.30 "," $1,194.30 "," $1,061.60 "," $1,061.60 ", $166.63 ," $1,225.22 "," $1,260.65 "," $1,194.30 "," $1,194.30 "," $1,194.30 "," $1,234.11 "," $1,273.92 ", $798.15 ," $1,127.95 ", $991.94 ," $1,051.75 ", N/A , $911.01 , $911.01 ," $1,260.65 ", $952.82 , $166.63 ," $1,273.92 "
" Fac Rheumatoid Factor, Quant ",CPT® 86431,0302 - LAB/IMMUNOLOGY,N/A,N/A, $87.00 , $56.55 , $73.08 , $5.78 , $5.78 , $70.30 , $78.30 , $73.65 , $78.30 , $78.30 , $78.30 , $73.95 , $5.67 , $80.33 , $82.65 , $73.95 , $80.91 , $80.91 , $82.65 , $83.52 , $71.18 , $78.30 , $73.95 , $68.73 , N/A , $70.41 , $70.41 , $82.65 , $74.65 , $5.67 , $83.52 
 FLUOCINONIDE 0.05 % EX GEL ,HCPCS RXA250,0250 - PHARMACY,51672-1279-01,15 gram, $305.98 , $198.89 , $257.02 , N/A , N/A , $247.23 , $275.38 , $259.04 , $275.38 , $275.38 , $275.38 , $260.08 , N/A , $282.51 , $290.68 , $260.08 , $284.56 , $284.56 , $290.68 , $293.74 , $250.35 , $275.38 , $260.08 , $241.72 , N/A , $247.63 , $247.63 , $290.68 , $262.56 , $241.72 , $293.74 
 Pro Cystouretero & or Pyeloscope ,CPT® 52351,0982 - PRO FEE/OUTPT,N/A,N/A," $2,491.00 "," $1,619.15 "," $1,620.98 ", $284.82 , $319.64 ," $1,485.02 "," $1,405.94 "," $2,316.63 "," $2,241.90 "," $2,241.90 "," $1,992.80 "," $1,992.80 ", $319.64 ," $2,299.94 "," $2,366.45 "," $2,241.90 "," $2,241.90 "," $2,241.90 "," $2,316.63 "," $2,391.36 "," $1,630.11 "," $2,117.35 "," $1,591.39 "," $1,864.92 ", N/A ," $1,513.99 "," $1,513.99 "," $2,366.45 "," $1,779.48 ", $284.82 ," $2,391.36 "
 Hand 2vw - Mh ,CPT® 73120,0972 - PRO FEE/RAD/DX,N/A,N/A, $99.00 , $64.35 , $175.10 , $30.70 , $25.85 , $123.44 , $146.85 , $92.07 , $89.10 , $89.10 , $79.20 , $79.20 , $25.85 , $91.41 , $94.05 , $89.10 , $89.10 , $89.10 , $92.07 , $95.04 , $170.65 , $84.15 , $161.79 , $142.25 , N/A , $125.85 , $125.85 , $94.05 , $145.67 , $25.85 , $175.10 
 Pro Treatment of Fibula Fracture ,CPT® 27784,0982 - PRO FEE/OUTPT,N/A,N/A," $4,718.00 "," $3,066.70 "," $4,319.12 ", $678.86 , $614.70 ," $3,457.33 "," $3,447.77 "," $4,387.74 "," $4,246.20 "," $4,246.20 "," $3,774.40 "," $3,774.40 ", $614.70 ," $4,356.13 "," $4,482.10 "," $4,246.20 "," $4,246.20 "," $4,246.20 "," $4,387.74 "," $4,529.28 "," $4,008.58 "," $4,010.30 "," $3,805.41 "," $4,051.11 ", N/A ," $3,524.79 "," $3,524.79 "," $4,482.10 "," $4,142.88 ", $614.70 ," $4,529.28 "
Fx Cl Shouder Disl W Mani,CPT® 23650,N/A,N/A,N/A," $2,030.00 "," $1,319.50 "," $1,823.71 ", $292.70 , $192.43 ," $1,386.81 "," $1,412.59 "," $1,887.90 "," $1,827.00 "," $1,827.00 "," $1,624.00 "," $1,624.00 ", $192.43 ," $1,874.30 "," $1,928.50 "," $1,827.00 "," $1,827.00 "," $1,827.00 "," $1,887.90 "," $1,948.80 "," $1,671.17 "," $1,725.50 "," $1,548.57 "," $1,654.68 ", N/A ," $1,413.87 "," $1,413.87 "," $1,928.50 "," $1,661.81 ", $192.43 ," $1,948.80 "
Breast Prosthesis Silicone/E,HCPCS L8030,N/A,N/A,N/A, $443.00 , $287.95 , N/A , $409.65 , $220.15 , N/A , N/A , $411.99 , $398.70 , $398.70 , $354.40 , $354.40 , $220.15 , $409.02 , $420.85 , $398.70 , $398.70 , $398.70 , $411.99 , $425.28 , N/A , $376.55 , $339.95 , $344.66 , N/A , N/A , N/A , $420.85 , N/A , $220.15 , $425.28 
 RALOXIFENE HCL 60 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,50268-0694-15,1 tablet, $36.62 , $23.80 , $30.76 , N/A , N/A , $29.59 , $32.96 , $31.00 , $32.96 , $32.96 , $32.96 , $31.13 , N/A , $33.81 , $34.79 , $31.13 , $34.06 , $34.06 , $34.79 , $35.16 , $29.96 , $32.96 , $31.13 , $28.93 , N/A , $29.64 , $29.64 , $34.79 , $31.42 , $28.93 , $35.16 
"Fix Ectropion,Extensive",67917,N/A,N/A,N/A," $2,129.00 "," $1,383.85 "," $2,801.70 ", $440.14 , $475.41 ," $2,593.20 "," $2,535.54 "," $1,979.97 "," $1,916.10 "," $1,916.10 "," $1,703.20 "," $1,703.20 ", $475.41 ," $1,965.71 "," $2,022.55 "," $1,916.10 "," $1,916.10 "," $1,916.10 "," $1,979.97 "," $2,043.84 "," $3,846.57 "," $1,809.65 "," $2,627.93 "," $3,289.59 ", N/A ," $2,643.80 "," $2,643.80 "," $2,022.55 "," $2,918.41 ", $440.14 ," $3,846.57 "
 Knee 1 or 2 Views ,CPT® 73560,0320 - DX X-RAY,N/A,N/A, $326.00 , $211.90 , $273.84 , $33.66 , $27.82 , $263.41 , $293.40 , $275.99 , $293.40 , $293.40 , $293.40 , $277.10 , $27.27 , $301.00 , $309.70 , $277.10 , $303.18 , $303.18 , $309.70 , $312.96 , $266.73 , $293.40 , $277.10 , $257.54 , N/A , $263.83 , $263.83 , $309.70 , $279.74 , $27.27 , $312.96 
App Skn Sub Grft T/a/L Area/<100scm /<1st 25 Scm,CPT® 15271,N/A,N/A,N/A, $858.00 , $557.70 , $266.19 , $78.87 , $111.11 , $232.17 , $227.23 , $797.94 , $772.20 , $772.20 , $686.40 , $686.40 , $111.11 , $792.19 , $815.10 , $772.20 , $772.20 , $772.20 , $797.94 , $823.68 , $292.36 , $729.30 , $454.94 , $295.22 , N/A , $236.70 , $236.70 , $815.10 , $274.49 , $78.87 , $823.68 
 Pro Radiologic Exam Colon Single Contrast Study ,CPT® 74270,0972 - PRO FEE/RAD/DX,N/A,N/A, $426.00 , $276.90 , $898.65 , $154.05 , $106.23 , $712.84 , $840.67 , $396.18 , $383.40 , $383.40 , $340.80 , $340.80 , $106.23 , $393.33 , $404.70 , $383.40 , $383.40 , $383.40 , $396.18 , $408.96 , $882.02 , $362.10 , $916.80 , $759.03 , N/A , $726.75 , $726.75 , $404.70 , $841.24 , $106.23 , $916.80 
"Suture Esophagus Wound,Thor Apprch",CPT® 43415,N/A,N/A,N/A," $16,126.00 "," $10,481.90 "," $15,030.21 "," $2,337.82 "," $2,378.00 "," $12,094.70 "," $12,223.22 "," $14,997.18 "," $14,513.40 "," $14,513.40 "," $12,900.80 "," $12,900.80 "," $2,378.00 "," $14,889.14 "," $15,319.70 "," $14,513.40 "," $14,513.40 "," $14,513.40 "," $14,997.18 "," $15,480.96 "," $10,822.65 "," $13,707.10 "," $13,680.20 "," $14,283.51 ", N/A ," $12,330.69 "," $12,330.69 "," $15,319.70 "," $12,896.59 "," $2,337.82 "," $15,480.96 "
Assay Urine Potassium,CPT® 84133,N/A,N/A,N/A, $55.00 , $35.75 , N/A , $4.82 , $4.82 , $24.32 , $29.09 , $51.15 , $49.50 , $49.50 , $44.00 , $44.00 , $4.82 , $50.78 , $52.25 , $49.50 , $49.50 , $49.50 , $51.15 , $52.80 , $31.58 , $46.75 , $27.57 , $15.62 , N/A , $22.70 , $22.70 , $52.25 , $24.80 , $4.82 , $52.80 
"Echo Heart Xthoracic,Complete",CPT® 93307,N/A,N/A,N/A, $930.00 , $604.50 , $882.64 , $134.57 , $164.14 , $699.93 , $641.30 , $864.90 , $837.00 , $837.00 , $744.00 , $744.00 , $164.14 , $858.67 , $883.50 , $837.00 , $837.00 , $837.00 , $864.90 , $892.80 , $885.50 , $790.50 , $599.45 , $853.69 , N/A , $713.59 , $713.59 , $883.50 , $791.01 , $134.57 , $892.80 
 Respiratory Infections And Inflammations Without Cc/McC ,MS DRG V40 (FY2023) 179,N/A,N/A,N/A," $17,613.25 "," $11,448.61 "," $14,795.13 ", N/A , N/A ," $14,231.51 "," $15,851.93 "," $14,911.38 "," $15,851.93 "," $15,851.93 "," $15,851.93 "," $14,971.26 ", N/A ," $16,262.31 "," $16,732.59 "," $14,971.26 "," $16,380.32 "," $16,380.32 "," $16,732.59 "," $16,908.72 "," $14,411.16 "," $15,851.93 "," $14,971.26 "," $13,914.47 ", N/A ," $14,254.40 "," $14,254.40 "," $16,732.59 "," $15,113.93 "," $13,914.47 "," $16,908.72 "
" Fac Deoxyribonuclease, Antibody ",CPT® 86215,0302 - LAB/IMMUNOLOGY,N/A,N/A, $169.00 , $109.85 , $141.96 , $13.52 , $13.52 , $136.55 , $152.10 , $143.08 , $152.10 , $152.10 , $152.10 , $143.65 , $13.25 , $156.04 , $160.55 , $143.65 , $157.17 , $157.17 , $160.55 , $162.24 , $138.28 , $152.10 , $143.65 , $133.51 , N/A , $136.77 , $136.77 , $160.55 , $145.02 , $13.25 , $162.24 
 Pro CT Chest Spine W/O Dye ,CPT® 72128,0972 - PRO FEE/RAD/DX,N/A,N/A, $563.00 , $365.95 , $921.97 , $132.63 , $250.57 , $858.48 ," $1,110.31 ", $523.59 , $506.70 , $506.70 , $450.40 , $450.40 , $250.57 , $519.82 , $534.85 , $506.70 , $506.70 , $506.70 , $523.59 , $540.48 , $774.23 , $478.55 ," $1,207.63 "," $1,171.10 ", N/A , $875.23 , $875.23 , $534.85 ," $1,013.10 ", $132.63 ," $1,207.63 "
"Echo Xthoracic,Cong Anom,Complete",CPT® 93303,N/A,N/A,N/A," $4,636.00 "," $3,013.40 "," $1,423.70 ", $216.88 , $305.51 ," $1,276.97 "," $1,108.19 "," $4,311.48 "," $4,172.40 "," $4,172.40 "," $3,708.80 "," $3,708.80 ", $305.51 ," $4,280.42 "," $4,404.20 "," $4,172.40 "," $4,172.40 "," $4,172.40 "," $4,311.48 "," $4,450.56 "," $1,437.37 "," $3,940.60 "," $1,036.54 "," $1,444.74 ", N/A ," $1,301.88 "," $1,301.88 "," $4,404.20 "," $1,443.16 ", $216.88 ," $4,450.56 "
Remove Armpit Lymph Nodes Superfic,CPT® 38740,N/A,N/A,N/A," $6,655.00 "," $4,325.75 "," $3,222.75 ", $651.34 , $384.19 ," $2,405.97 "," $2,473.19 "," $6,189.15 "," $5,989.50 "," $5,989.50 "," $5,324.00 "," $5,324.00 ", $384.19 ," $6,144.56 "," $6,322.25 "," $5,989.50 "," $5,989.50 "," $5,989.50 "," $6,189.15 "," $6,388.80 "," $3,438.41 "," $5,656.75 "," $3,662.68 "," $3,329.79 ", N/A ," $2,452.91 "," $2,452.91 "," $6,322.25 "," $2,845.69 ", $384.19 ," $6,388.80 "
 CARBAMAZEPINE ER 100 MG PO CP12 ,HCPCS RXC637,0250 - PHARMACY,60505-2805-07,1 capsule, $10.09 , $6.56 , $8.48 , N/A , N/A , $8.15 , $9.08 , $8.54 , $9.08 , $9.08 , $9.08 , $8.58 , N/A , $9.32 , $9.59 , $8.58 , $9.38 , $9.38 , $9.59 , $9.69 , $8.26 , $9.08 , $8.58 , $7.97 , N/A , $8.17 , $8.17 , $9.59 , $8.66 , $7.97 , $9.69 
"I&D Finger Abscess,Compli",CPT® 26011,N/A,N/A,N/A," $2,938.00 "," $1,909.70 "," $1,138.61 ", $178.74 , $161.97 , $890.56 , $896.50 ," $2,732.34 "," $2,644.20 "," $2,644.20 "," $2,350.40 "," $2,350.40 ", $161.97 ," $2,712.66 "," $2,791.10 "," $2,644.20 "," $2,644.20 "," $2,644.20 "," $2,732.34 "," $2,820.48 "," $1,057.07 "," $2,497.30 ", $983.02 ," $1,060.93 ", N/A , $907.94 , $907.94 ," $2,791.10 "," $1,067.16 ", $161.97 ," $2,820.48 "
Compre Ep Eval Abltj Atr Fib Pulm Vein Isolation,CPT® 93656,N/A,N/A,N/A," $9,438.00 "," $6,134.70 "," $6,555.25 ", $866.04 , $824.90 ," $6,041.51 "," $5,919.39 "," $8,777.34 "," $8,494.20 "," $8,494.20 "," $7,550.40 "," $7,550.40 ", $824.90 ," $8,714.11 "," $8,966.10 "," $8,494.20 "," $8,494.20 "," $8,494.20 "," $8,777.34 "," $9,060.48 "," $6,497.64 "," $8,022.30 "," $5,758.96 "," $5,414.80 ", N/A ," $6,159.39 "," $6,159.39 "," $8,966.10 "," $6,827.75 ", $824.90 ," $9,060.48 "
 Fac Hospital Observation per Hr ,HCPCS G0378,0762 - OBSERVATION,N/A,N/A, $101.00 , $65.65 , $84.84 , N/A , N/A , $81.61 , $90.90 , $85.51 , $90.90 , $90.90 , $90.90 , $85.85 , N/A , $93.25 , $95.95 , $85.85 , $93.93 , $93.93 , $95.95 , $96.96 , $82.64 , $90.90 , $85.85 , $79.79 , N/A , $81.74 , $81.74 , $95.95 , $86.67 , $79.79 , $96.96 
 Pro Cltx Iphal Jt Dislc W/O Anes ,CPT® 28660,0982 - PRO FEE/OUTPT,N/A,N/A, $758.00 , $492.70 , $565.96 , $89.32 , $69.38 , $431.41 , $434.98 , $704.94 , $682.20 , $682.20 , $606.40 , $606.40 , $69.38 , $699.86 , $720.10 , $682.20 , $682.20 , $682.20 , $704.94 , $727.68 , $522.51 , $644.30 , $476.35 , $510.98 , N/A , $439.83 , $439.83 , $720.10 , $516.96 , $69.38 , $727.68 
Tube Thoracostomy Includes Water Seal,32551,N/A,N/A,N/A," $1,763.00 "," $1,145.95 ", $828.52 , $143.99 , $198.32 , $651.04 , $647.17 ," $1,639.59 "," $1,586.70 "," $1,586.70 "," $1,410.40 "," $1,410.40 ", $198.32 ," $1,627.78 "," $1,674.85 "," $1,586.70 "," $1,586.70 "," $1,586.70 "," $1,639.59 "," $1,692.48 ", $800.35 ," $1,498.55 ", $933.07 , $796.75 , N/A , $663.74 , $663.74 ," $1,674.85 ", $781.70 , $143.99 ," $1,692.48 "
 SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML PO SUSP ,HCPCS RXC637,0250 - PHARMACY,00121-0853-40,10 mL, $30.67 , $19.94 , $25.76 , N/A , N/A , $24.78 , $27.60 , $25.97 , $27.60 , $27.60 , $27.60 , $26.07 , N/A , $28.32 , $29.14 , $26.07 , $28.52 , $28.52 , $29.14 , $29.44 , $25.09 , $27.60 , $26.07 , $24.23 , N/A , $24.82 , $24.82 , $29.14 , $26.32 , $24.23 , $29.44 
 ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN ,HCPCS J0153,0636 - DRUGS REQUIRING DETAILED CODIN,67457-0857-30,2 mL, $80.14 , $52.09 , $67.32 , $0.55 , $0.53 , $64.75 , $72.13 , $67.85 , $72.13 , $72.13 , $72.13 , $68.12 , $0.52 , $73.99 , $76.13 , $68.12 , $74.53 , $74.53 , $76.13 , $76.93 , $65.57 , $72.13 , $68.12 , $63.31 , N/A , $64.86 , $64.86 , $76.13 , $68.77 , $0.52 , $76.93 
 Pro Rmvl/Bivalv Gauntlet Boot/Bdy Cst ,CPT® 29700,0981 - PRO FEE/ER,N/A,N/A, $264.00 , $171.60 , $198.45 , $30.97 , $22.66 , $160.94 , $161.75 , $245.52 , $237.60 , $237.60 , $211.20 , $211.20 , $22.66 , $243.75 , $250.80 , $237.60 , $237.60 , $237.60 , $245.52 , $253.44 , $185.48 , $224.40 , $178.41 , $193.88 , N/A , $164.08 , $164.08 , $250.80 , $192.87 , $22.66 , $253.44 
 Holter Monitor Recording Hook Up- Mh ,CPT® 93225,0731 - HOLTER MONT,N/A,N/A, $573.00 , $372.45 , $481.32 , $17.84 , $46.97 , $462.98 , $515.70 , $485.10 , $515.70 , $515.70 , $515.70 , $487.05 , $46.05 , $529.05 , $544.35 , $487.05 , $532.89 , $532.89 , $544.35 , $550.08 , $468.83 , $515.70 , $487.05 , $452.67 , N/A , $463.73 , $463.73 , $544.35 , $491.69 , $17.84 , $550.08 
 ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP ,HCPCS RXC637,0250 - PHARMACY,00121-1761-30,30 mL, $19.42 , $12.62 , $16.31 , N/A , N/A , $15.69 , $17.48 , $16.44 , $17.48 , $17.48 , $17.48 , $16.51 , N/A , $17.93 , $18.45 , $16.51 , $18.06 , $18.06 , $18.45 , $18.64 , $15.89 , $17.48 , $16.51 , $15.34 , N/A , $15.72 , $15.72 , $18.45 , $16.66 , $15.34 , $18.64 
"Stereotactic Radiosurgery, Spinal, Ea Add Lesion",CPT® 63621,N/A,N/A,N/A," $1,626.00 "," $1,056.90 "," $1,125.07 ", $219.11 , $211.81 ," $1,363.20 "," $1,275.01 "," $1,512.18 "," $1,463.40 "," $1,463.40 "," $1,300.80 "," $1,300.80 ", $211.81 ," $1,501.29 "," $1,544.70 "," $1,463.40 "," $1,463.40 "," $1,463.40 "," $1,512.18 "," $1,560.96 "," $1,219.46 "," $1,382.10 "," $1,311.29 "," $1,407.12 ", N/A ," $1,389.79 "," $1,389.79 "," $1,544.70 "," $1,490.92 ", $211.81 ," $1,560.96 "
 Pfizer Covid Vaccine Peds 5-11 Yrs 2nd Dose ,CPT® 0072A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
 Pro Drg Xtrnl Ear Absc/Hmtma Smpl ,CPT® 69000,0982 - PRO FEE/OUTPT,N/A,N/A," $1,057.00 ", $687.05 , $587.55 , $120.89 , $30.71 , $571.83 , $595.04 , $983.01 , $951.30 , $951.30 , $845.60 , $845.60 , $30.71 , $975.93 ," $1,004.15 ", $951.30 , $951.30 , $951.30 , $983.01 ," $1,014.72 ", $631.71 , $898.45 , $649.40 , $582.65 , N/A , $582.99 , $582.99 ," $1,004.15 ", $665.66 , $30.71 ," $1,014.72 "
" Fac Medical Nutrition, Indiv, In ",CPT® 97802,0942 - EDUC/TRAINING,N/A,N/A, $60.00 , $39.00 , $50.40 , $32.22 , N/A , $48.48 , $54.00 , $50.80 , $54.00 , $54.00 , $54.00 , $51.00 , N/A , $55.40 , $57.00 , $51.00 , $55.80 , $55.80 , $57.00 , $57.60 , $49.09 , $54.00 , $51.00 , $47.40 , N/A , $48.56 , $48.56 , $57.00 , $51.49 , $32.22 , $57.60 
Img-Guide Fluid Collxn Drainag Cath Periton Perq,49406,N/A,N/A,N/A," $2,390.00 "," $1,553.50 "," $1,198.54 ", $185.07 , $244.64 ," $1,041.92 "," $1,072.96 "," $2,222.70 "," $2,151.00 "," $2,151.00 "," $1,912.00 "," $1,912.00 ", $244.64 ," $2,206.69 "," $2,270.50 "," $2,151.00 "," $2,151.00 "," $2,151.00 "," $2,222.70 "," $2,294.40 ", $867.06 ," $2,031.50 "," $1,009.30 "," $1,155.04 ", N/A ," $1,062.26 "," $1,062.26 "," $2,270.50 "," $1,111.01 ", $185.07 ," $2,294.40 "
"Injection-Tendon,Ligament",20550,N/A,N/A,N/A, $384.00 , $249.60 , $99.25 , $37.19 , $27.51 , $203.30 , $199.04 , $357.12 , $345.60 , $345.60 , $307.20 , $307.20 , $27.51 , $354.55 , $364.80 , $345.60 , $345.60 , $345.60 , $357.12 , $368.64 , $222.72 , $326.40 , $215.87 , $227.07 , N/A , $207.26 , $207.26 , $364.80 , $243.62 , $27.51 , $368.64 
Path Consult-Sng. Frozen,CPT® 88331,N/A,N/A,N/A, $712.00 , $462.80 , $367.00 , $100.89 , $81.44 , $411.90 , $457.84 , $662.16 , $640.80 , $640.80 , $569.60 , $569.60 , $81.44 , $657.39 , $676.40 , $640.80 , $640.80 , $640.80 , $662.16 , $683.52 , $669.99 , $605.20 , $475.20 , $341.22 , N/A , $384.41 , $384.41 , $676.40 , $422.45 , $81.44 , $683.52 
Incise Tear Duct Opening,CPT® 68440,N/A,N/A,N/A, $945.00 , $614.25 , $612.24 , $96.82 , $30.71 , $560.87 , $533.65 , $878.85 , $850.50 , $850.50 , $756.00 , $756.00 , $30.71 , $872.52 , $897.75 , $850.50 , $850.50 , $850.50 , $878.85 , $907.20 , $839.50 , $803.25 , $553.06 , $714.04 , N/A , $571.81 , $571.81 , $897.75 , $631.20 , $30.71 , $907.20 
"Whfo, Rigid W/O Joints",HCPCS L3808,N/A,N/A,N/A, $397.00 , $258.05 , N/A , $379.23 , $171.87 , N/A , N/A , $369.21 , $357.30 , $357.30 , $317.60 , $317.60 , $171.87 , $366.55 , $377.15 , $357.30 , $357.30 , $357.30 , $369.21 , $381.12 , N/A , $337.45 , $327.62 , $319.04 , N/A , N/A , N/A , $377.15 , N/A , $171.87 , $381.12 
 Fac Prtx Srm Antb ID Diffial RBC Absrpj ,CPT® 86978,0300 - LABORATORY,N/A,N/A, $204.00 , $132.60 , $171.36 , N/A , N/A , $164.83 , $183.60 , $172.71 , $183.60 , $183.60 , $183.60 , $173.40 , N/A , $188.35 , $193.80 , $173.40 , $189.72 , $189.72 , $193.80 , $195.84 , $166.91 , $183.60 , $173.40 , $161.16 , N/A , $165.10 , $165.10 , $193.80 , $175.05 , $161.16 , $195.84 
 Pro Rmvl/Bivalv Full Arm/Full Leg Cst ,CPT® 29705,0981 - PRO FEE/ER,N/A,N/A, $364.00 , $236.60 , $271.51 , $42.35 , $25.41 , $227.88 , $224.32 , $338.52 , $327.60 , $327.60 , $291.20 , $291.20 , $25.41 , $336.08 , $345.80 , $327.60 , $327.60 , $327.60 , $338.52 , $349.44 , $257.01 , $309.40 , $246.20 , $267.11 , N/A , $232.33 , $232.33 , $345.80 , $273.07 , $25.41 , $349.44 
 Fac Emergency Level III ,CPT® 99283,0450 - EMERGENCY SERVICES,N/A,N/A, $883.00 , $573.95 , $741.72 , $68.75 , $26.96 , $713.46 , $794.70 , $747.55 , $794.70 , $794.70 , $794.70 , $750.55 , $26.43 , $815.27 , $838.85 , $750.55 , $821.19 , $821.19 , $838.85 , $847.68 , $722.47 , $794.70 , $750.55 , $697.57 , N/A , $714.61 , $714.61 , $838.85 , $757.70 , $26.43 , $847.68 
 Fac Assay of Lead ,CPT® 83655,0301 - LAB/CHEMISTRY,N/A,N/A, $116.00 , $75.40 , $97.44 , $12.35 , $12.35 , $93.73 , $104.40 , $98.21 , $104.40 , $104.40 , $104.40 , $98.60 , $12.11 , $107.10 , $110.20 , $98.60 , $107.88 , $107.88 , $110.20 , $111.36 , $94.91 , $104.40 , $98.60 , $91.64 , N/A , $93.88 , $93.88 , $110.20 , $99.54 , $12.11 , $111.36 
"Laryngoscopy,Indirect With Biopsy",CPT® 31510,N/A,N/A,N/A, $171.00 , $111.15 , $649.81 , $115.92 , $61.48 , $468.06 , $458.65 , $159.03 , $153.90 , $153.90 , $136.80 , $136.80 , $61.48 , $157.88 , $162.45 , $153.90 , $153.90 , $153.90 , $159.03 , $164.16 , $623.83 , $145.35 , $647.62 , $615.05 , N/A , $477.19 , $477.19 , $162.45 , $562.00 , $61.48 , $649.81 
 Fac Blood Clot Inhibitor Test ,CPT® 85306,0305 - LAB/HEMATOLOGY,N/A,N/A, $284.00 , $184.60 , $238.56 , $15.63 , $15.63 , $229.47 , $255.60 , $240.43 , $255.60 , $255.60 , $255.60 , $241.40 , $15.32 , $262.22 , $269.80 , $241.40 , $264.12 , $264.12 , $269.80 , $272.64 , $232.37 , $255.60 , $241.40 , $224.36 , N/A , $229.84 , $229.84 , $269.80 , $243.70 , $15.32 , $272.64 
"Ref/Main,Imp Pump,Drug Del,Cns, Phys",CPT® 95991,N/A,N/A,N/A, $525.00 , $341.25 , $144.40 , $38.21 , $82.71 , $128.01 , $135.15 , $488.25 , $472.50 , $472.50 , $420.00 , $420.00 , $82.71 , $484.73 , $498.75 , $472.50 , $472.50 , $472.50 , $488.25 , $504.00 , $171.20 , $446.25 , $117.59 , $150.08 , N/A , $130.51 , $130.51 , $498.75 , $160.43 , $38.21 , $504.00 
 Critical Care First 30-74 Min -Mh ,CPT® 99291,0450 - EMERGENCY SERVICES,N/A,N/A," $5,677.00 "," $3,690.05 "," $4,768.68 ", $205.74 , $270.56 ," $4,587.02 "," $5,109.30 "," $4,806.15 "," $5,109.30 "," $5,109.30 "," $5,109.30 "," $4,825.45 ", $265.25 ," $5,241.57 "," $5,393.15 "," $4,825.45 "," $5,279.61 "," $5,279.61 "," $5,393.15 "," $5,449.92 "," $4,644.92 "," $5,109.30 "," $4,825.45 "," $4,484.83 ", N/A ," $4,594.40 "," $4,594.40 "," $5,393.15 "," $4,871.43 ", $205.74 ," $5,449.92 "
"Rep Tendon,Hand,Single,PR",26410,N/A,N/A,N/A," $2,283.00 "," $1,483.95 "," $3,809.13 ", $591.56 , $390.36 ," $2,681.89 "," $2,743.57 "," $2,123.19 "," $2,054.70 "," $2,054.70 "," $1,826.40 "," $1,826.40 ", $390.36 ," $2,107.89 "," $2,168.85 "," $2,054.70 "," $2,054.70 "," $2,054.70 "," $2,123.19 "," $2,191.68 "," $3,496.67 "," $1,940.55 "," $3,000.80 "," $3,216.59 ", N/A ," $2,734.22 "," $2,734.22 "," $2,168.85 "," $3,213.66 ", $390.36 ," $3,809.13 "
 Moderna Pediatric Vaccine Admin Age 6-11 - Second Dose ,CPT® 0092A,0771 - VACCINE ADMINISTRATION,N/A,N/A, $70.00 , $45.50 , $58.80 , N/A , $38.92 , $56.56 , $63.00 , $59.26 , $63.00 , $63.00 , $63.00 , $59.50 , $38.16 , $64.63 , $66.50 , $59.50 , $65.10 , $65.10 , $66.50 , $67.20 , $57.27 , $63.00 , $59.50 , $55.30 , N/A , $56.65 , $56.65 , $66.50 , $60.07 , $38.16 , $67.20 
 Fac Insert Gastrostomy Tube Percutaneous ,CPT® 49440,0360 - OR SERVICES,N/A,N/A," $2,480.00 "," $1,612.00 "," $2,083.20 ", $193.16 , $852.22 ," $2,003.84 "," $2,232.00 "," $2,099.57 "," $2,232.00 "," $2,232.00 "," $2,232.00 "," $2,108.00 ", $835.51 ," $2,289.78 "," $2,356.00 "," $2,108.00 "," $2,306.40 "," $2,306.40 "," $2,356.00 "," $2,380.80 "," $2,029.14 "," $2,232.00 "," $2,108.00 "," $1,959.20 ", N/A ," $2,007.06 "," $2,007.06 "," $2,356.00 "," $2,128.09 ", $193.16 ," $2,380.80 "
Orthopedic Shoe Modifica Nos,HCPCS L3649,N/A,N/A,N/A, $20.00 , $13.00 , N/A , N/A , N/A , N/A , N/A , $18.60 , $18.00 , $18.00 , $16.00 , $16.00 , N/A , $18.47 , $19.00 , $18.00 , $18.00 , $18.00 , $18.60 , $19.20 , N/A , $17.00 , $16.00 , N/A , N/A , N/A , N/A , $19.00 , N/A , $16.00 , $19.20 
" Fac Phenotype, Dna Hiv W/Clt Add ",CPT® 87904,0306 - LAB/BACT-MICRO,N/A,N/A, $241.00 , $156.65 , $202.44 , $26.59 , $26.59 , $194.73 , $216.90 , $204.03 , $216.90 , $216.90 , $216.90 , $204.85 , $26.07 , $222.52 , $228.95 , $204.85 , $224.13 , $224.13 , $228.95 , $231.36 , $197.19 , $216.90 , $204.85 , $190.39 , N/A , $195.04 , $195.04 , $228.95 , $206.80 , $26.07 , $231.36 
 C T or L Spine Single View- Mh ,CPT® 72020,0972 - PRO FEE/RAD/DX,N/A,N/A, $93.00 , $60.45 , $137.29 , $24.13 , $22.94 , $103.05 , $124.00 , $86.49 , $83.70 , $83.70 , $74.40 , $74.40 , $22.94 , $85.87 , $88.35 , $83.70 , $83.70 , $83.70 , $86.49 , $89.28 , $134.89 , $79.05 , $136.75 , $111.74 , N/A , $105.06 , $105.06 , $88.35 , $121.62 , $22.94 , $137.29 
"Rad Excis Wrist Synov/Tendon,Flexor",25115,N/A,N/A,N/A," $6,303.00 "," $4,096.95 "," $4,619.16 ", $726.54 , $691.53 ," $3,655.14 "," $3,641.07 "," $5,861.79 "," $5,672.70 "," $5,672.70 "," $5,042.40 "," $5,042.40 ", $691.53 ," $5,819.56 "," $5,987.85 "," $5,672.70 "," $5,672.70 "," $5,672.70 "," $5,861.79 "," $6,050.88 "," $4,299.45 "," $5,357.55 "," $4,005.22 "," $4,338.12 ", N/A ," $3,726.46 "," $3,726.46 "," $5,987.85 "," $4,379.93 ", $691.53 ," $6,050.88 "
Cystourethroscopy W/Irrig & Evac Clots,CPT® 52001,N/A,N/A,N/A," $1,976.00 "," $1,284.40 "," $1,538.76 ", $270.28 , $133.30 ," $1,409.60 "," $1,306.55 "," $1,837.68 "," $1,778.40 "," $1,778.40 "," $1,580.80 "," $1,580.80 ", $133.30 ," $1,824.44 "," $1,877.20 "," $1,778.40 "," $1,778.40 "," $1,778.40 "," $1,837.68 "," $1,896.96 "," $1,548.08 "," $1,679.60 "," $1,478.99 "," $1,768.24 ", N/A ," $1,437.10 "," $1,437.10 "," $1,877.20 "," $1,689.12 ", $133.30 ," $1,896.96 "
Replace Aortic Valve Open Axillry Artry Approach,CPT® 33363,N/A,N/A,N/A," $18,307.00 "," $11,899.55 "," $7,967.44 "," $1,226.04 "," $1,148.29 "," $6,651.39 "," $6,360.31 "," $17,025.51 "," $16,476.30 "," $16,476.30 "," $14,645.60 "," $14,645.60 "," $1,148.29 "," $16,902.85 "," $17,391.65 "," $16,476.30 "," $16,476.30 "," $16,476.30 "," $17,025.51 "," $17,574.72 "," $7,380.76 "," $15,560.95 "," $8,033.64 "," $7,364.54 ", N/A ," $6,781.17 "," $6,781.17 "," $17,391.65 "," $7,703.40 "," $1,148.29 "," $17,574.72 "
 ESTRADIOL 1 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00555-0886-02,1 tablet, $3.50 , $2.28 , $2.94 , N/A , N/A , $2.83 , $3.15 , $2.96 , $3.15 , $3.15 , $3.15 , $2.98 , N/A , $3.23 , $3.33 , $2.98 , $3.26 , $3.26 , $3.33 , $3.36 , $2.86 , $3.15 , $2.98 , $2.77 , N/A , $2.83 , $2.83 , $3.33 , $3.00 , $2.77 , $3.36 
Antibody John Cunningham Virus,CPT® 86711,N/A,N/A,N/A, $131.00 , $85.15 , N/A , $17.23 , $16.11 , $81.40 , $97.43 , $121.83 , $117.90 , $117.90 , $104.80 , $104.80 , $16.11 , $120.95 , $124.45 , $117.90 , $117.90 , $117.90 , $121.83 , $125.76 , $112.78 , $111.35 , $94.07 , $52.19 , N/A , $75.97 , $75.97 , $124.45 , $83.02 , $16.11 , $125.76 
 Pro Diagnostic Bone Marrow Aspirations ,CPT® 38220,0982 - PRO FEE/OUTPT,N/A,N/A," $1,087.00 ", $706.55 , $326.35 , $65.55 , $305.29 , $218.73 , $217.42 ," $1,010.91 ", $978.30 , $978.30 , $869.60 , $869.60 , $305.29 ," $1,003.63 "," $1,032.65 ", $978.30 , $978.30 , $978.30 ," $1,010.91 "," $1,043.52 ", $348.86 , $923.95 , $314.00 , $340.85 , N/A , $223.00 , $223.00 ," $1,032.65 ", $258.71 , $65.55 ," $1,043.52 "
Surgical Path Level 4,88305,N/A,N/A,N/A, $298.00 , $193.70 , $254.78 , $70.47 , $66.83 , $290.81 , $323.57 , $277.14 , $268.20 , $268.20 , $238.40 , $238.40 , $66.83 , $275.14 , $283.10 , $268.20 , $268.20 , $268.20 , $277.14 , $286.08 , $457.06 , $253.30 , $334.10 , $239.59 , N/A , $271.40 , $271.40 , $283.10 , $298.26 , $66.83 , $457.06 
Home/Res Visit Est Patient Low Mdm 30 Minutes,99348,N/A,N/A,N/A, $216.00 , $140.40 , $166.66 , $74.72 , $64.77 , $144.60 , $146.00 , $200.88 , $194.40 , $194.40 , $172.80 , $172.80 , $64.77 , $199.43 , $205.20 , $194.40 , $194.40 , $194.40 , $200.88 , $207.36 , $152.12 , $183.60 , $181.53 , $184.12 , $206.00 , $147.42 , $147.42 , $205.20 , $170.05 , $64.77 , $207.36 
 Pro Partial Removal of Toe ,CPT® 28160,0982 - PRO FEE/OUTPT,N/A,N/A," $2,809.00 "," $1,825.85 "," $1,659.45 ", $259.18 , $183.20 ," $1,331.23 "," $1,327.41 "," $2,612.37 "," $2,528.10 "," $2,528.10 "," $2,247.20 "," $2,247.20 ", $183.20 ," $2,593.55 "," $2,668.55 "," $2,528.10 "," $2,528.10 "," $2,528.10 "," $2,612.37 "," $2,696.64 "," $1,539.39 "," $2,387.65 "," $1,436.17 "," $1,573.94 ", N/A ," $1,357.21 "," $1,357.21 "," $2,668.55 "," $1,595.17 ", $183.20 ," $2,696.64 "
Chorionic Gonadotropin Test,CPT® 84702,N/A,N/A,N/A, $176.00 , $114.40 , N/A , $15.35 , $15.35 , $85.18 , $101.90 , $163.68 , $158.40 , $158.40 , $140.80 , $140.80 , $15.35 , $162.50 , $167.20 , $158.40 , $158.40 , $158.40 , $163.68 , $168.96 , $100.49 , $149.60 , $98.93 , $54.49 , N/A , $79.50 , $79.50 , $167.20 , $86.88 , $15.35 , $168.96 
Office/Outpatient Established Low Mdm 20-29 Min,99213,N/A,N/A,N/A, $197.00 , $128.05 , $134.27 , $64.08 , $41.21 , $87.92 , $87.90 , $183.21 , $177.30 , $177.30 , $157.60 , $157.60 , $41.21 , $181.89 , $187.15 , $177.30 , $177.30 , $177.30 , $183.21 , $189.12 , $122.57 , $167.45 , $109.52 , $112.10 , $64.00 , $89.64 , $89.64 , $187.15 , $103.40 , $41.21 , $189.12 
Partial Removal of Tibia,CPT® 27640,N/A,N/A,N/A," $5,589.00 "," $3,632.85 "," $5,070.85 ", $792.95 , $768.38 ," $4,044.81 "," $4,016.70 "," $5,197.77 "," $5,030.10 "," $5,030.10 "," $4,471.20 "," $4,471.20 ", $768.38 ," $5,160.32 "," $5,309.55 "," $5,030.10 "," $5,030.10 "," $5,030.10 "," $5,197.77 "," $5,365.44 "," $4,713.85 "," $4,750.65 "," $4,428.05 "," $4,748.05 ", N/A ," $4,123.72 "," $4,123.72 "," $5,309.55 "," $4,846.85 ", $768.38 ," $5,365.44 "
Open Rx Ulna Shaft Fx,25545,N/A,N/A,N/A," $2,420.00 "," $1,573.00 "," $3,823.82 ", $601.46 , $614.70 ," $3,002.80 "," $3,000.32 "," $2,250.60 "," $2,178.00 "," $2,178.00 "," $1,936.00 "," $1,936.00 ", $614.70 ," $2,234.39 "," $2,299.00 "," $2,178.00 "," $2,178.00 "," $2,178.00 "," $2,250.60 "," $2,323.20 "," $3,546.08 "," $2,057.00 "," $3,305.87 "," $3,546.50 ", N/A ," $3,061.39 "," $3,061.39 "," $2,299.00 "," $3,598.22 ", $601.46 ," $3,823.82 "
 IODIXANOL 320 MG/ML IV SOLN ,HCPCS Q9967,0255 - DRUGS/RADIOLOGY,00407-2223-16,50 mL, $326.71 , $212.36 , $274.44 , $0.13 , $0.17 , $263.98 , $294.04 , $276.59 , $294.04 , $294.04 , $294.04 , $277.70 , $0.17 , $301.65 , $310.37 , $277.70 , $303.84 , $303.84 , $310.37 , $313.64 , $267.31 , $294.04 , $277.70 , $258.10 , N/A , $264.41 , $264.41 , $310.37 , $280.35 , $0.13 , $313.64 
Dilation of Cervical Canal,CPT® 57800,N/A,N/A,N/A, $397.00 , $258.05 , $222.50 , $45.32 , $42.71 , $199.24 , $197.59 , $369.21 , $357.30 , $357.30 , $317.60 , $317.60 , $42.71 , $366.55 , $377.15 , $357.30 , $357.30 , $357.30 , $369.21 , $381.12 , $234.99 , $337.45 , $258.69 , $200.59 , N/A , $203.12 , $203.12 , $377.15 , $243.63 , $42.71 , $381.12 
 PRALIDOXIME CHLORIDE 1 G IV SOLR ,HCPCS RXA250,0250 - PHARMACY,60977-0141-01,1 gram, $534.44 , $347.39 , $448.93 , N/A , N/A , $431.83 , $481.00 , $452.46 , $481.00 , $481.00 , $481.00 , $454.27 , N/A , $493.45 , $507.72 , $454.27 , $497.03 , $497.03 , $507.72 , $513.06 , $437.28 , $481.00 , $454.27 , $422.21 , N/A , $432.52 , $432.52 , $507.72 , $458.60 , $422.21 , $513.06 
 Fac Pvb Thoracic Second & Addl Inj Site W/Img Gid ,CPT® 64462,0361 - OR/MINOR,N/A,N/A," $1,159.00 ", $753.35 , $973.56 , $46.99 , $67.32 , $936.47 ," $1,043.10 ", $981.21 ," $1,043.10 "," $1,043.10 "," $1,043.10 ", $985.15 , $66.00 ," $1,070.10 "," $1,101.05 ", $985.15 ," $1,077.87 "," $1,077.87 "," $1,101.05 "," $1,112.64 ", $948.29 ," $1,043.10 ", $985.15 , $915.61 , N/A , $937.98 , $937.98 ," $1,101.05 ", $994.54 , $46.99 ," $1,112.64 "
"Repair Achilles Tendon,Primary",27650,N/A,N/A,N/A," $4,457.00 "," $2,897.05 "," $4,053.47 ", $634.54 , $588.80 ," $3,200.62 "," $3,230.07 "," $4,145.01 "," $4,011.30 "," $4,011.30 "," $3,565.60 "," $3,565.60 ", $588.80 ," $4,115.15 "," $4,234.15 "," $4,011.30 "," $4,011.30 "," $4,011.30 "," $4,145.01 "," $4,278.72 "," $3,765.19 "," $3,788.45 "," $3,543.15 "," $3,785.55 ", N/A ," $3,263.07 "," $3,263.07 "," $4,234.15 "," $3,835.26 ", $588.80 ," $4,278.72 "
 CT Abd Pelvis W/O & W/Contrast ,CPT® 74178,0350 - CT SCAN,N/A,N/A," $5,308.00 "," $3,450.20 "," $4,458.72 ", $350.88 , $319.24 ," $4,288.86 "," $4,777.20 "," $4,493.75 "," $4,777.20 "," $4,777.20 "," $4,777.20 "," $4,511.80 ", $312.98 ," $4,900.88 "," $5,042.60 "," $4,511.80 "," $4,936.44 "," $4,936.44 "," $5,042.60 "," $5,095.68 "," $4,343.01 "," $4,777.20 "," $4,511.80 "," $4,193.32 ", N/A ," $4,295.76 "," $4,295.76 "," $5,042.60 "," $4,554.79 ", $312.98 ," $5,095.68 "
 Pro Smpl Rpr Supfc F/E/E/N/L/M 5.1cm-7.5cm ,CPT® 12014,0982 - PRO FEE/OUTPT,N/A,N/A, $597.00 , $388.05 , $232.08 , $69.01 , $92.31 , $214.79 , $208.07 , $555.21 , $537.30 , $537.30 , $477.60 , $477.60 , $92.31 , $551.21 , $567.15 , $537.30 , $537.30 , $537.30 , $555.21 , $573.12 , $255.61 , $507.45 , $417.47 , $258.60 , N/A , $218.98 , $218.98 , $567.15 , $253.95 , $69.01 , $573.12 
 XR CHEST 2 View ,CPT® 71046,0324 - DX X-RAY/CHEST,N/A,N/A, $299.00 , $194.35 , $251.16 , $33.11 , $23.99 , $241.59 , $269.10 , $253.13 , $269.10 , $269.10 , $269.10 , $254.15 , $23.52 , $276.07 , $284.05 , $254.15 , $278.07 , $278.07 , $284.05 , $287.04 , $244.64 , $269.10 , $254.15 , $236.21 , N/A , $241.98 , $241.98 , $284.05 , $256.57 , $23.52 , $287.04 
"Inject Corpora Cavern,Pharm Agnt",CPT® 54235,N/A,N/A,N/A, $500.00 , $325.00 , $321.90 , $70.23 , N/A , $235.76 , $239.61 , $465.00 , $450.00 , $450.00 , $400.00 , $400.00 , N/A , $461.65 , $475.00 , $450.00 , $450.00 , $450.00 , $465.00 , $480.00 , $302.37 , $425.00 , $381.79 , $356.52 , N/A , $240.36 , $240.36 , $475.00 , $288.08 , $70.23 , $480.00 
Chorionic Gonadotropin Assay,CPT® 84703,N/A,N/A,N/A, $120.00 , $78.00 , N/A , $7.67 , $7.67 , $42.53 , $50.87 , $111.60 , $108.00 , $108.00 , $96.00 , $96.00 , $7.67 , $110.80 , $114.00 , $108.00 , $108.00 , $108.00 , $111.60 , $115.20 , $50.21 , $102.00 , $48.66 , $27.28 , N/A , $39.69 , $39.69 , $114.00 , $43.38 , $7.67 , $115.20 
"Radiation Therapy,Dosimetry Plan",CPT® 77300,N/A,N/A,N/A, $649.00 , $421.85 , $364.47 , $64.66 , $68.96 , $301.73 , $344.98 , $603.57 , $584.10 , $584.10 , $519.20 , $519.20 , $68.96 , $599.22 , $616.55 , $584.10 , $584.10 , $584.10 , $603.57 , $623.04 , $371.86 , $551.65 , $377.50 , $372.66 , N/A , $307.61 , $307.61 , $616.55 , $356.08 , $64.66 , $623.04 
Chromosome Analysis,CPT® 88264,N/A,N/A,N/A," $2,410.00 "," $1,566.50 ", N/A , $147.50 , $147.50 , $697.92 ," $1,059.18 "," $2,241.30 "," $2,169.00 "," $2,169.00 "," $1,928.00 "," $1,928.00 ", $147.50 ," $2,225.15 "," $2,289.50 "," $2,169.00 "," $2,169.00 "," $2,169.00 "," $2,241.30 "," $2,313.60 ", $965.59 ," $2,048.50 ", $817.41 , $544.74 , N/A , $651.34 , $651.34 ," $2,289.50 ", $715.80 , $147.50 ," $2,313.60 "
 Pro Parathyr Img ,CPT® 78070,0974 - PRO FEE/NUC MED,N/A,N/A, $270.00 , $175.50 ," $1,566.35 ", $268.56 , $99.64 ," $1,475.60 "," $1,593.51 ", $251.10 , $243.00 , $243.00 , $216.00 , $216.00 , $99.64 , $249.29 , $256.50 , $243.00 , $243.00 , $243.00 , $251.10 , $259.20 ," $1,633.84 ", $229.50 ," $1,737.29 "," $2,020.72 ", N/A ," $1,504.39 "," $1,504.39 ", $256.50 ," $1,741.34 ", $99.64 ," $2,020.72 "
 Fac Rp Loclzj Tum Spect CT 2area 1d Img/1 AR Img>2+D ,CPT® 78832,0409 - OTHER IMAG SVS,N/A,N/A," $4,540.00 "," $2,951.00 "," $3,813.60 ", $831.35 , $739.48 ," $3,668.32 "," $4,086.00 "," $3,843.56 "," $4,086.00 "," $4,086.00 "," $4,086.00 "," $3,859.00 ", $724.98 ," $4,191.78 "," $4,313.00 "," $3,859.00 "," $4,222.20 "," $4,222.20 "," $4,313.00 "," $4,358.40 "," $3,714.63 "," $4,086.00 "," $3,859.00 "," $3,586.60 ", N/A ," $3,674.22 "," $3,674.22 "," $4,313.00 "," $3,895.77 ", $724.98 ," $4,358.40 "
"Ankle Scope,Part Synovectomy",CPT® 29895,N/A,N/A,N/A," $4,965.00 "," $3,227.25 "," $2,883.79 ", $447.54 , $420.46 ," $2,357.67 "," $2,335.61 "," $4,617.45 "," $4,468.50 "," $4,468.50 "," $3,972.00 "," $3,972.00 ", $420.46 ," $4,584.18 "," $4,716.75 "," $4,468.50 "," $4,468.50 "," $4,468.50 "," $4,617.45 "," $4,766.40 "," $2,678.65 "," $4,220.25 "," $2,561.92 "," $2,718.06 ", N/A ," $2,403.68 "," $2,403.68 "," $4,716.75 "," $2,825.19 ", $420.46 ," $4,766.40 "
 METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN ,HCPCS J2765,0636 - DRUGS REQUIRING DETAILED CODIN,23155-0240-41,2 mL, $16.68 , $10.84 , $14.01 , $1.26 , $1.12 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $1.10 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $1.10 , $16.01 
Assay Cadmium,CPT® 82300,N/A,N/A,N/A, $262.00 , $170.30 , N/A , $24.11 , $24.11 , $130.92 , $156.61 , $243.66 , $235.80 , $235.80 , $209.60 , $209.60 , $24.11 , $241.90 , $248.90 , $235.80 , $235.80 , $235.80 , $243.66 , $251.52 , $157.85 , $222.70 , $150.83 , $83.94 , N/A , $122.18 , $122.18 , $248.90 , $133.52 , $24.11 , $251.52 
 Inj Proc for Ileal Conduit ,CPT® 50690,0761 - TREATMENT ROOM,N/A,N/A, $199.00 , $129.35 , $167.16 , $67.01 , $21.50 , $160.79 , $179.10 , $168.47 , $179.10 , $179.10 , $179.10 , $169.15 , $21.08 , $183.74 , $189.05 , $169.15 , $185.07 , $185.07 , $189.05 , $191.04 , $162.82 , $179.10 , $169.15 , $157.21 , N/A , $161.05 , $161.05 , $189.05 , $170.76 , $21.08 , $191.04 
" Fac Alpha-1-Antitrypsin, Pheno ",CPT® 82104,0301 - LAB/CHEMISTRY,N/A,N/A, $214.00 , $139.10 , $179.76 , $14.75 , $14.75 , $172.91 , $192.60 , $181.17 , $192.60 , $192.60 , $192.60 , $181.90 , $14.46 , $197.59 , $203.30 , $181.90 , $199.02 , $199.02 , $203.30 , $205.44 , $175.09 , $192.60 , $181.90 , $169.06 , N/A , $173.19 , $173.19 , $203.30 , $183.63 , $14.46 , $205.44 
 Pro Repair Radius & Ulna ,CPT® 25415,0982 - PRO FEE/OUTPT,N/A,N/A," $6,480.00 "," $4,212.00 "," $5,870.54 ", $918.50 , $804.14 ," $4,661.35 "," $4,617.26 "," $6,026.40 "," $5,832.00 "," $5,832.00 "," $5,184.00 "," $5,184.00 ", $804.14 ," $5,982.98 "," $6,156.00 "," $5,832.00 "," $5,832.00 "," $5,832.00 "," $6,026.40 "," $6,220.80 "," $5,463.48 "," $5,508.00 "," $5,105.99 "," $5,481.87 ", N/A ," $4,752.30 "," $4,752.30 "," $6,156.00 "," $5,585.65 ", $804.14 ," $6,220.80 "
 Pro Radex Hip Unilateral With Pelvis Minimum 4 Views ,CPT® 73503,0972 - PRO FEE/RAD/DX,N/A,N/A, $180.00 , $117.00 , $402.29 , $58.48 , $40.49 , $245.48 , $259.09 , $167.40 , $162.00 , $162.00 , $144.00 , $144.00 , $40.49 , $166.19 , $171.00 , $162.00 , $162.00 , $162.00 , $167.40 , $172.80 , $322.62 , $153.00 , $341.47 , $260.18 , N/A , $250.28 , $250.28 , $171.00 , $289.69 , $40.49 , $402.29 
Incontinence Treatment Systm,HCPCS E0740,N/A,N/A,N/A, $69.00 , $44.85 , N/A , $70.93 , $253.98 , N/A , N/A , $64.17 , $62.10 , $62.10 , $55.20 , $55.20 , $253.98 , $63.71 , $65.55 , $62.10 , $62.10 , $62.10 , $64.17 , $66.24 , N/A , $58.65 , N/A , $524.37 , N/A , N/A , N/A , $65.55 , N/A , $55.20 , $524.37 
"Biopsy of Breast, Incisional",19101,N/A,N/A,N/A," $2,251.00 "," $1,463.15 ", $703.90 , $208.99 , $274.21 , $596.28 , $581.14 ," $2,093.43 "," $2,025.90 "," $2,025.90 "," $1,800.80 "," $1,800.80 ", $274.21 ," $2,078.35 "," $2,138.45 "," $2,025.90 "," $2,025.90 "," $2,025.90 "," $2,093.43 "," $2,160.96 ", $769.07 ," $1,913.35 "," $1,170.35 ", $755.64 , N/A , $607.92 , $607.92 ," $2,138.45 ", $704.98 , $208.99 ," $2,160.96 "
 Abdomen MRI With Contrast ,CPT® 74182,0610 - MRI,N/A,N/A," $6,492.00 "," $4,219.80 "," $5,453.28 ", $311.87 , $503.64 ," $5,245.54 "," $5,842.80 "," $5,496.13 "," $5,842.80 "," $5,842.80 "," $5,842.80 "," $5,518.20 ", $493.76 ," $5,994.06 "," $6,167.40 "," $5,518.20 "," $6,037.56 "," $6,037.56 "," $6,167.40 "," $6,232.32 "," $5,311.75 "," $5,842.80 "," $5,518.20 "," $5,128.68 ", N/A ," $5,253.98 "," $5,253.98 "," $6,167.40 "," $5,570.79 ", $311.87 ," $6,232.32 "
Replace Aortic Valve Openfemoral Artery Approach,CPT® 33362,N/A,N/A,N/A," $17,681.00 "," $11,492.65 "," $7,686.38 "," $1,184.18 "," $1,109.01 "," $6,328.06 "," $6,142.77 "," $16,443.33 "," $15,912.90 "," $15,912.90 "," $14,144.80 "," $14,144.80 "," $1,109.01 "," $16,324.87 "," $16,796.95 "," $15,912.90 "," $15,912.90 "," $15,912.90 "," $16,443.33 "," $16,973.76 "," $7,119.42 "," $15,028.85 "," $7,758.89 "," $7,107.01 ", N/A ," $6,451.54 "," $6,451.54 "," $16,796.95 "," $7,328.94 "," $1,109.01 "," $16,973.76 "
 Fac Molec Cytg Chrmoml Ish 10-30 Cll ,CPT® 88273,0310 - PATHOLOGY LAB,N/A,N/A, $249.00 , $161.85 , $209.16 , $35.51 , $35.51 , $201.19 , $224.10 , $210.80 , $224.10 , $224.10 , $224.10 , $211.65 , $34.81 , $229.90 , $236.55 , $211.65 , $231.57 , $231.57 , $236.55 , $239.04 , $203.73 , $224.10 , $211.65 , $196.71 , N/A , $201.52 , $201.52 , $236.55 , $213.67 , $34.81 , $239.04 
Im/Repl Cartd Sinus Baroreflx Activ Dev Tot Syst,CPT® 0266T,N/A,N/A,N/A," $5,283.00 "," $3,433.95 ", N/A , N/A , N/A , N/A , N/A ," $4,913.19 "," $4,754.70 "," $4,754.70 "," $4,226.40 "," $4,226.40 ", N/A ," $4,877.79 "," $5,018.85 "," $4,754.70 "," $4,754.70 "," $4,754.70 "," $4,913.19 "," $5,071.68 ", N/A ," $4,490.55 ", $966.01 , $590.86 , N/A , $944.91 , $944.91 ," $5,018.85 "," $1,099.89 ", $590.86 ," $5,071.68 "
Open Skull Evac Sub/Extradur Blood,CPT® 61312,N/A,N/A,N/A," $13,337.00 "," $8,669.05 "," $9,402.69 "," $1,835.92 "," $1,729.79 "," $11,211.30 "," $10,692.78 "," $12,403.41 "," $12,003.30 "," $12,003.30 "," $10,669.60 "," $10,669.60 "," $1,729.79 "," $12,314.05 "," $12,670.15 "," $12,003.30 "," $12,003.30 "," $12,003.30 "," $12,403.41 "," $12,803.52 "," $10,174.69 "," $11,336.45 "," $11,009.46 "," $11,577.66 ", N/A ," $11,430.05 "," $11,430.05 "," $12,670.15 "," $12,261.75 "," $1,729.79 "," $12,803.52 "
Anoscopy Dx W/HRA &Chem Agnts Enhancement,CPT® 46601,N/A,N/A,N/A, $948.00 , $616.20 , $580.78 , $88.56 , $109.63 , N/A , N/A , $881.64 , $853.20 , $853.20 , $758.40 , $758.40 , $109.63 , $875.29 , $900.60 , $853.20 , $853.20 , $853.20 , $881.64 , $910.08 , $416.91 , $805.80 , $490.44 , $546.70 , N/A , $423.80 , $423.80 , $900.60 , $443.58 , $88.56 , $910.08 
"Remove Hip/Pelvis Tumor,Subcut",CPT® 27047,N/A,N/A,N/A," $3,175.00 "," $2,063.75 "," $2,186.80 ", $341.08 , $106.76 ," $1,746.93 "," $1,746.14 "," $2,952.75 "," $2,857.50 "," $2,857.50 "," $2,540.00 "," $2,540.00 ", $106.76 ," $2,931.48 "," $3,016.25 "," $2,857.50 "," $2,857.50 "," $2,857.50 "," $2,952.75 "," $3,048.00 "," $2,019.83 "," $2,698.75 "," $1,932.14 "," $2,040.42 ", N/A ," $1,781.02 "," $1,781.02 "," $3,016.25 "," $2,093.33 ", $106.76 ," $3,048.00 "
"Renal Endoscopy,Remv FB/Stone",CPT® 50561,N/A,N/A,N/A," $3,318.00 "," $2,156.70 "," $2,114.28 ", $370.72 , $107.56 ," $1,932.40 "," $1,792.99 "," $3,085.74 "," $2,986.20 "," $2,986.20 "," $2,654.40 "," $2,654.40 ", $107.56 ," $3,063.51 "," $3,152.10 "," $2,986.20 "," $2,986.20 "," $2,986.20 "," $3,085.74 "," $3,185.28 "," $2,127.28 "," $2,820.30 "," $2,032.05 "," $2,427.86 ", N/A ," $1,970.10 "," $1,970.10 "," $3,152.10 "," $2,315.57 ", $107.56 ," $3,185.28 "
 Fac Amb 911 Base Rate Als Emergent ,HCPCS A0427,0540 - AMBULANCE,N/A,N/A," $1,869.00 "," $1,214.85 "," $1,569.96 ", N/A , $409.08 ," $1,510.15 "," $1,682.10 "," $1,582.30 "," $1,682.10 "," $1,682.10 "," $1,682.10 "," $1,588.65 ", $401.06 ," $1,725.65 "," $1,775.55 "," $1,588.65 "," $1,738.17 "," $1,738.17 "," $1,775.55 "," $1,794.24 "," $1,529.22 "," $1,682.10 "," $1,588.65 "," $1,476.51 ", N/A ," $1,512.58 "," $1,512.58 "," $1,775.55 "," $1,603.79 ", $401.06 ," $1,794.24 "
 Fac Slctv Cathj 3rd+ Ord Slctv Thrc/Brch/Cphlc Brnch ,CPT® 36217,0360 - OR SERVICES,N/A,N/A," $2,445.00 "," $1,589.25 "," $2,053.80 ", $297.95 ," $2,117.53 "," $1,975.56 "," $2,200.50 "," $2,069.94 "," $2,200.50 "," $2,200.50 "," $2,200.50 "," $2,078.25 "," $2,076.01 "," $2,257.47 "," $2,322.75 "," $2,078.25 "," $2,273.85 "," $2,273.85 "," $2,322.75 "," $2,347.20 "," $2,000.50 "," $2,200.50 "," $2,078.25 "," $1,931.55 ", N/A ," $1,978.74 "," $1,978.74 "," $2,322.75 "," $2,098.05 ", $297.95 ," $2,347.20 "
Lipoprotein-Associated Phospholipase A2,CPT® 83698,N/A,N/A,N/A, $330.00 , $214.50 , N/A , $47.24 , $47.11 , $192.04 , $229.73 , $306.90 , $297.00 , $297.00 , $264.00 , $264.00 , $47.11 , $304.69 , $313.50 , $297.00 , $297.00 , $297.00 , $306.90 , $316.80 , $309.22 , $280.50 , $222.19 , $136.01 , N/A , $179.22 , $179.22 , $313.50 , $195.85 , $47.11 , $316.80 
Repair Complex Trunk 5cm,13102,N/A,N/A,N/A, $557.00 , $362.05 , $228.24 , $67.58 , $75.77 , $202.55 , $195.28 , $518.01 , $501.30 , $501.30 , $445.60 , $445.60 , $75.77 , $514.28 , $529.15 , $501.30 , $501.30 , $501.30 , $518.01 , $534.72 , $251.34 , $473.45 , $392.49 , $258.78 , N/A , $206.50 , $206.50 , $529.15 , $239.47 , $67.58 , $534.72 
"Prevent Counsel,Indiv,30 Min",CPT® 99402,N/A,N/A,N/A, $211.00 , $137.15 , N/A , $61.46 , $19.35 , $106.41 , $108.41 , $196.23 , $189.90 , $189.90 , $168.80 , $168.80 , $19.35 , $194.82 , $200.45 , $189.90 , $189.90 , $189.90 , $196.23 , $202.56 , $132.58 , $179.35 , $108.77 , $106.74 , N/A , $108.49 , $108.49 , $200.45 , $130.29 , $19.35 , $202.56 
 St Swallow and/or Feeding Trmt 31-45 Min -Mh ,CPT® 92526,0441 - SPEECH PATH/VISIT,N/A,N/A, $373.00 , $242.45 , $313.32 , $84.52 , $66.75 , $301.38 , $335.70 , $315.78 , $335.70 , $335.70 , $335.70 , $317.05 , $65.44 , $344.39 , $354.35 , $317.05 , $346.89 , $346.89 , $354.35 , $358.08 , $305.19 , $335.70 , $317.05 , $294.67 , N/A , $301.87 , $301.87 , $354.35 , $320.07 , $65.44 , $358.08 
 FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN ,HCPCS Q2009,0636 - DRUGS REQUIRING DETAILED CODIN,00069-6001-21,10 mL, $712.08 , $462.85 , $598.15 , N/A , $1.44 , $575.36 , $640.87 , $602.85 , $640.87 , $640.87 , $640.87 , $605.27 , $1.41 , $657.46 , $676.48 , $605.27 , $662.23 , $662.23 , $676.48 , $683.60 , $582.62 , $640.87 , $605.27 , $562.54 , N/A , $576.29 , $576.29 , $676.48 , $611.04 , $1.41 , $683.60 
 Fac Multiple Sleep Latency Test ,CPT® 95805,0740 - EEG,N/A,N/A," $2,516.00 "," $1,635.40 "," $2,113.44 ", $408.91 , $393.44 ," $2,032.93 "," $2,264.40 "," $2,130.05 "," $2,264.40 "," $2,264.40 "," $2,264.40 "," $2,138.60 ", $385.73 ," $2,323.02 "," $2,390.20 "," $2,138.60 "," $2,339.88 "," $2,339.88 "," $2,390.20 "," $2,415.36 "," $2,058.59 "," $2,264.40 "," $2,138.60 "," $1,987.64 ", N/A ," $2,036.20 "," $2,036.20 "," $2,390.20 "," $2,158.98 ", $385.73 ," $2,415.36 "
 Fac Myelography via Lumbar Injection Rs&I 2+ Regions ,CPT® 62305,0361 - OR/MINOR,N/A,N/A," $2,399.00 "," $1,559.35 "," $2,015.16 ", $117.77 , $207.22 ," $1,938.39 "," $2,159.10 "," $2,030.99 "," $2,159.10 "," $2,159.10 "," $2,159.10 "," $2,039.15 ", $203.16 ," $2,215.00 "," $2,279.05 "," $2,039.15 "," $2,231.07 "," $2,231.07 "," $2,279.05 "," $2,303.04 "," $1,962.86 "," $2,159.10 "," $2,039.15 "," $1,895.21 ", N/A ," $1,941.51 "," $1,941.51 "," $2,279.05 "," $2,058.58 ", $117.77 ," $2,303.04 "
 Fac Radiologic Examination Femur Minimum 2 Views ,CPT® 73552,0320 - DX X-RAY,N/A,N/A, $331.00 , $215.15 , $278.04 , $35.01 , $25.42 , $267.45 , $297.90 , $280.22 , $297.90 , $297.90 , $297.90 , $281.35 , $24.92 , $305.61 , $314.45 , $281.35 , $307.83 , $307.83 , $314.45 , $317.76 , $270.82 , $297.90 , $281.35 , $261.49 , N/A , $267.88 , $267.88 , $314.45 , $284.03 , $24.92 , $317.76 
 PHYTONADIONE 2.5 MG (1/2 OF 5 MG TAB) ,HCPCS RXC637,0250 - PHARMACY,00001-0769-01,1 tablet, $362.22 , $235.44 , $304.26 , N/A , N/A , $292.67 , $326.00 , $306.66 , $326.00 , $326.00 , $326.00 , $307.89 , N/A , $334.44 , $344.11 , $307.89 , $336.86 , $336.86 , $344.11 , $347.73 , $296.37 , $326.00 , $307.89 , $286.15 , N/A , $293.14 , $293.14 , $344.11 , $310.82 , $286.15 , $347.73 
 Fractures Of Hip And Pelvis With McC ,MS DRG V40 (FY2023) 535,N/A,N/A,N/A," $23,302.81 "," $15,146.83 "," $19,574.36 ", N/A , N/A ," $18,828.67 "," $20,972.53 "," $19,728.16 "," $20,972.53 "," $20,972.53 "," $20,972.53 "," $19,807.39 ", N/A ," $21,515.48 "," $22,137.67 "," $19,807.39 "," $21,671.61 "," $21,671.61 "," $22,137.67 "," $22,370.70 "," $19,066.36 "," $20,972.53 "," $19,807.39 "," $18,409.22 ", N/A ," $18,858.96 "," $18,858.96 "," $22,137.67 "," $19,996.14 "," $18,409.22 "," $22,370.70 "
 Fac Pltlt Aggregation Ea Agt ,CPT® 85576,0305 - LAB/HEMATOLOGY,N/A,N/A, $224.00 , $145.60 , $188.16 , $25.41 , $25.41 , $180.99 , $201.60 , $189.64 , $201.60 , $201.60 , $201.60 , $190.40 , $24.91 , $206.82 , $212.80 , $190.40 , $208.32 , $208.32 , $212.80 , $215.04 , $183.28 , $201.60 , $190.40 , $176.96 , N/A , $181.28 , $181.28 , $212.80 , $192.21 , $24.91 , $215.04 
"Knee Scope,Lysis of Adhesns",29884,N/A,N/A,N/A," $4,089.00 "," $2,657.85 "," $3,765.00 ", $591.75 , $888.33 ," $2,972.96 "," $2,994.86 "," $3,802.77 "," $3,680.10 "," $3,680.10 "," $3,271.20 "," $3,271.20 ", $888.33 ," $3,775.37 "," $3,884.55 "," $3,680.10 "," $3,680.10 "," $3,680.10 "," $3,802.77 "," $3,925.44 "," $3,506.92 "," $3,475.65 "," $3,305.87 "," $3,515.87 ", N/A ," $3,030.97 "," $3,030.97 "," $3,884.55 "," $3,562.46 ", $591.75 ," $3,925.44 "
"Open Fix Inter/Subtroch Fx,Implnt",CPT® 27245,N/A,N/A,N/A," $5,558.00 "," $3,612.70 "," $7,400.45 "," $1,157.06 "," $1,107.65 "," $5,945.99 "," $5,888.38 "," $5,168.94 "," $5,002.20 "," $5,002.20 "," $4,446.40 "," $4,446.40 "," $1,107.65 "," $5,131.70 "," $5,280.10 "," $5,002.20 "," $5,002.20 "," $5,002.20 "," $5,168.94 "," $5,335.68 "," $6,899.58 "," $4,724.30 "," $6,515.40 "," $6,990.58 ", N/A ," $6,062.00 "," $6,062.00 "," $5,280.10 "," $7,125.01 "," $1,107.65 "," $7,400.45 "
 MOXIFLOXACIN HCL-BSS 1 MG/ML IZ SOLN ,HCPCS RXA250,0250 - PHARMACY,71449-0096-42,1 mL, $246.57 , $160.27 , $207.12 , N/A , N/A , $199.23 , $221.91 , $208.75 , $221.91 , $221.91 , $221.91 , $209.58 , N/A , $227.66 , $234.24 , $209.58 , $229.31 , $229.31 , $234.24 , $236.71 , $201.74 , $221.91 , $209.58 , $194.79 , N/A , $199.55 , $199.55 , $234.24 , $211.58 , $194.79 , $236.71 
Internal Eye Photo,CPT® 92286,N/A,N/A,N/A, $343.00 , $222.95 , $85.14 , $38.34 , $103.49 , $67.40 , $64.45 , $318.99 , $308.70 , $308.70 , $274.40 , $274.40 , $103.49 , $316.69 , $325.85 , $308.70 , $308.70 , $308.70 , $318.99 , $329.28 , $119.58 , $291.55 , $115.56 , $81.00 , N/A , $68.71 , $68.71 , $325.85 , $81.73 , $38.34 , $329.28 
 VENLAFAXINE HCL 25 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,68084-0896-25,1 tablet, $10.62 , $6.90 , $8.92 , N/A , N/A , $8.58 , $9.56 , $8.99 , $9.56 , $9.56 , $9.56 , $9.03 , N/A , $9.81 , $10.09 , $9.03 , $9.88 , $9.88 , $10.09 , $10.20 , $8.69 , $9.56 , $9.03 , $8.39 , N/A , $8.59 , $8.59 , $10.09 , $9.11 , $8.39 , $10.20 
 Fac Spectrophotometry ,CPT® 84311,0302 - LAB/IMMUNOLOGY,N/A,N/A, $199.00 , $129.35 , $167.16 , $8.26 , $8.26 , $160.79 , $179.10 , $168.47 , $179.10 , $179.10 , $179.10 , $169.15 , $8.10 , $183.74 , $189.05 , $169.15 , $185.07 , $185.07 , $189.05 , $191.04 , $162.82 , $179.10 , $169.15 , $157.21 , N/A , $161.05 , $161.05 , $189.05 , $170.76 , $8.10 , $191.04 
"Psa, Total Screening",HCPCS G0103,N/A,N/A,N/A, $172.00 , $111.80 , N/A , $19.70 , $19.70 , $47.31 , N/A , $159.96 , $154.80 , $154.80 , $137.60 , $137.60 , $19.70 , $158.81 , $163.40 , $154.80 , $154.80 , $154.80 , $159.96 , $165.12 , $128.94 , $146.20 , $48.01 , $66.70 , N/A , $48.24 , $48.24 , $163.40 , $60.28 , $19.70 , $165.12 
 Wrist 2 Views ,CPT® 73100,0320 - DX X-RAY,N/A,N/A, $322.00 , $209.30 , $270.48 , $33.33 , $28.13 , $260.18 , $289.80 , $272.61 , $289.80 , $289.80 , $289.80 , $273.70 , $27.58 , $297.30 , $305.90 , $273.70 , $299.46 , $299.46 , $305.90 , $309.12 , $263.46 , $289.80 , $273.70 , $254.38 , N/A , $260.59 , $260.59 , $305.90 , $276.31 , $27.58 , $309.12 
 Fac Diffusing Capacity ,CPT® 94729,0460 - PULMONARY FUNC,N/A,N/A, $623.00 , $404.95 , $523.32 , $55.39 , $41.69 , $503.38 , $560.70 , $527.43 , $560.70 , $560.70 , $560.70 , $529.55 , $40.87 , $575.22 , $591.85 , $529.55 , $579.39 , $579.39 , $591.85 , $598.08 , $509.74 , $560.70 , $529.55 , $492.17 , N/A , $504.19 , $504.19 , $591.85 , $534.60 , $40.87 , $598.08 
 Fac Needle Insertion W/O Injection 3 or More Muscles ,CPT® 20561,0761 - TREATMENT ROOM,N/A,N/A, $62.00 , $40.30 , $52.08 , $22.06 , N/A , $50.10 , $55.80 , $52.49 , $55.80 , $55.80 , $55.80 , $52.70 , N/A , $57.24 , $58.90 , $52.70 , $57.66 , $57.66 , $58.90 , $59.52 , $50.73 , $55.80 , $52.70 , $48.98 , N/A , $50.18 , $50.18 , $58.90 , $53.20 , $22.06 , $59.52 
 Fac Tc99m Pyrophosphate ,HCPCS A9538,0343 - DIAGNOSTIC RADIOPHARMACEUTICALS,N/A,N/A, $142.00 , $92.30 , $119.28 , $27.99 , $20.16 , $114.74 , $127.80 , $120.22 , $127.80 , $127.80 , $127.80 , $120.70 , $19.76 , $131.11 , $134.90 , $120.70 , $132.06 , $132.06 , $134.90 , $136.32 , $116.18 , $127.80 , $120.70 , $112.18 , N/A , $114.92 , $114.92 , $134.90 , $121.85 , $19.76 , $136.32 
 Fac Rmvl Fecal Impaction/FB Spx Under Anes ,CPT® 45915,0360 - OR SERVICES,N/A,N/A," $3,267.00 "," $2,123.55 "," $2,744.28 ", $218.03 , $130.70 ," $2,639.74 "," $2,940.30 "," $2,765.84 "," $2,940.30 "," $2,940.30 "," $2,940.30 "," $2,776.95 ", $128.14 ," $3,016.42 "," $3,103.65 "," $2,776.95 "," $3,038.31 "," $3,038.31 "," $3,103.65 "," $3,136.32 "," $2,673.06 "," $2,940.30 "," $2,776.95 "," $2,580.93 ", N/A ," $2,643.98 "," $2,643.98 "," $3,103.65 "," $2,803.41 ", $128.14 ," $3,136.32 "
"Ankle Scope,Extens Debridemnt",CPT® 29898,N/A,N/A,N/A," $3,868.00 "," $2,514.20 "," $3,451.44 ", $540.06 , $630.68 ," $2,760.38 "," $2,745.92 "," $3,597.24 "," $3,481.20 "," $3,481.20 "," $3,094.40 "," $3,094.40 ", $630.68 ," $3,571.32 "," $3,674.60 "," $3,481.20 "," $3,481.20 "," $3,481.20 "," $3,597.24 "," $3,713.28 "," $3,201.28 "," $3,287.80 "," $3,009.72 "," $3,245.43 ", N/A ," $2,814.24 "," $2,814.24 "," $3,674.60 "," $3,307.74 ", $540.06 ," $3,713.28 "
 PROMETHAZINE HCL 25 MG RE SUPP ,HCPCS RXC637,0250 - PHARMACY,00713-0526-12,1 suppository, $90.95 , $59.12 , $76.40 , N/A , N/A , $73.49 , $81.86 , $77.00 , $81.86 , $81.86 , $81.86 , $77.31 , N/A , $83.97 , $86.40 , $77.31 , $84.58 , $84.58 , $86.40 , $87.31 , $74.42 , $81.86 , $77.31 , $71.85 , N/A , $73.61 , $73.61 , $86.40 , $78.04 , $71.85 , $87.31 
" Alcohol, Drug Abuse Or Dependence, Left Ama ",MS DRG V40 (FY2023) 894,N/A,N/A,N/A," $8,191.92 "," $5,324.75 "," $6,881.21 ", N/A , N/A ," $6,619.07 "," $7,372.73 "," $6,935.28 "," $7,372.73 "," $7,372.73 "," $7,372.73 "," $6,963.13 ", N/A ," $7,563.60 "," $7,782.32 "," $6,963.13 "," $7,618.49 "," $7,618.49 "," $7,782.32 "," $7,864.24 "," $6,702.63 "," $7,372.73 "," $6,963.13 "," $6,471.62 ", N/A ," $6,629.72 "," $6,629.72 "," $7,782.32 "," $7,029.49 "," $6,471.62 "," $7,864.24 "
 Simple Pneumonia And Pleurisy Without Cc/McC ,MS DRG V40 (FY2023) 195,N/A,N/A,N/A," $13,546.55 "," $8,805.26 "," $11,379.10 ", N/A , N/A ," $10,945.61 "," $12,191.90 "," $11,468.51 "," $12,191.90 "," $12,191.90 "," $12,191.90 "," $11,514.57 ", N/A ," $12,507.53 "," $12,869.22 "," $11,514.57 "," $12,598.29 "," $12,598.29 "," $12,869.22 "," $13,004.69 "," $11,083.79 "," $12,191.90 "," $11,514.57 "," $10,701.77 ", N/A ," $10,963.22 "," $10,963.22 "," $12,869.22 "," $11,624.29 "," $10,701.77 "," $13,004.69 "
"Fx Radial & Ulnar,Closed",25560,N/A,N/A,N/A," $1,798.00 "," $1,168.70 "," $1,610.31 ", $255.85 , $202.15 ," $1,207.93 "," $1,232.28 "," $1,672.14 "," $1,618.20 "," $1,618.20 "," $1,438.40 "," $1,438.40 ", $202.15 ," $1,660.09 "," $1,708.10 "," $1,618.20 "," $1,618.20 "," $1,618.20 "," $1,672.14 "," $1,726.08 "," $1,481.60 "," $1,528.30 "," $1,352.32 "," $1,443.52 ", N/A ," $1,231.51 "," $1,231.51 "," $1,708.10 "," $1,447.45 ", $202.15 ," $1,726.08 "
 HYDROCORTISONE 1 % EX OINT ,HCPCS RXC637,0250 - PHARMACY,45802-0276-03,28 gram, $20.57 , $13.37 , $17.28 , N/A , N/A , $16.62 , $18.51 , $17.41 , $18.51 , $18.51 , $18.51 , $17.48 , N/A , $18.99 , $19.54 , $17.48 , $19.13 , $19.13 , $19.54 , $19.75 , $16.83 , $18.51 , $17.48 , $16.25 , N/A , $16.65 , $16.65 , $19.54 , $17.65 , $16.25 , $19.75 
 Pro Egd Insert Guide Wire Dilator Passage Esophagus ,CPT® 43248,0982 - PRO FEE/OUTPT,N/A,N/A," $2,084.00 "," $1,354.60 "," $1,017.71 ", $157.25 , $176.60 , $852.25 , $914.99 ," $1,938.12 "," $1,875.60 "," $1,875.60 "," $1,667.20 "," $1,667.20 ", $176.60 ," $1,924.16 "," $1,979.80 "," $1,875.60 "," $1,875.60 "," $1,875.60 "," $1,938.12 "," $2,000.64 ", $732.03 ," $1,771.40 "," $1,000.86 ", $970.45 , N/A , $868.88 , $868.88 ," $1,979.80 ", $908.74 , $157.25 ," $2,000.64 "
" Fac Thromboplastin Time, Partial ",CPT® 85732,0305 - LAB/HEMATOLOGY,N/A,N/A, $118.00 , $76.70 , $99.12 , $6.60 , $6.60 , $95.34 , $106.20 , $99.90 , $106.20 , $106.20 , $106.20 , $100.30 , $6.47 , $108.95 , $112.10 , $100.30 , $109.74 , $109.74 , $112.10 , $113.28 , $96.55 , $106.20 , $100.30 , $93.22 , N/A , $95.50 , $95.50 , $112.10 , $101.26 , $6.47 , $113.28 
Thoracentesis Needle/Cath Pleura W/O Imaging,32554,N/A,N/A,N/A," $3,519.00 "," $2,287.35 ", $486.39 , $84.12 , $196.83 , $347.08 , $337.80 ," $3,272.67 "," $3,167.10 "," $3,167.10 "," $2,815.20 "," $2,815.20 ", $196.83 ," $3,249.09 "," $3,343.05 "," $3,167.10 "," $3,167.10 "," $3,167.10 "," $3,272.67 "," $3,378.24 ", $471.39 ," $2,991.15 ", $470.99 , $466.30 , N/A , $353.86 , $353.86 ," $3,343.05 ", $416.75 , $84.12 ," $3,378.24 "
Drug Assay Itraconzaole,CPT® 80189,N/A,N/A,N/A, $438.00 , $284.70 , N/A , $27.65 , $27.65 , N/A , N/A , $407.34 , $394.20 , $394.20 , $350.40 , $350.40 , $27.65 , $404.41 , $416.10 , $394.20 , $394.20 , $394.20 , $407.34 , $420.48 , $181.02 , $372.30 , $129.23 , $79.62 , N/A , $106.27 , $106.27 , $416.10 , $116.84 , $27.65 , $420.48 
 Fac Drug Tst Prsmv Instrmnt Chem Analyzers PR Date ,CPT® 80307,0301 - LAB/CHEMISTRY,N/A,N/A, $98.00 , $63.70 , $82.32 , $63.38 , $63.38 , $79.18 , $88.20 , $82.97 , $88.20 , $88.20 , $88.20 , $83.30 , $62.14 , $90.48 , $93.10 , $83.30 , $91.14 , $91.14 , $93.10 , $94.08 , $80.18 , $88.20 , $83.30 , $77.42 , N/A , $79.31 , $79.31 , $93.10 , $84.09 , $62.14 , $94.08 
" Fac Artery X-Rays, Arms/Legs ",CPT® 75716,0320 - DX X-RAY,N/A,N/A," $1,193.00 ", $775.45 ," $1,002.12 ", $158.15 , $276.91 , $963.94 ," $1,073.70 "," $1,009.99 "," $1,073.70 "," $1,073.70 "," $1,073.70 "," $1,014.05 ", $271.48 ," $1,101.50 "," $1,133.35 "," $1,014.05 "," $1,109.49 "," $1,109.49 "," $1,133.35 "," $1,145.28 ", $976.11 ," $1,073.70 "," $1,014.05 ", $942.47 , N/A , $965.49 , $965.49 ," $1,133.35 "," $1,023.71 ", $158.15 ," $1,145.28 "
 Fac Obstructive Material Removal From GI Tube ,CPT® 49460,0750 - GASTR-INST SVS,N/A,N/A, $654.00 , $425.10 , $549.36 , $46.96 , $625.80 , $528.43 , $588.60 , $553.68 , $588.60 , $588.60 , $588.60 , $555.90 , $613.53 , $603.84 , $621.30 , $555.90 , $608.22 , $608.22 , $621.30 , $627.84 , $535.10 , $588.60 , $555.90 , $516.66 , N/A , $529.28 , $529.28 , $621.30 , $561.20 , $46.96 , $627.84 
Immunoassay Infectious Ag,CPT® 86317,N/A,N/A,N/A, $138.00 , $89.70 , N/A , $15.29 , $15.29 , $84.81 , $101.47 , $128.34 , $124.20 , $124.20 , $110.40 , $110.40 , $15.29 , $127.42 , $131.10 , $124.20 , $124.20 , $124.20 , $128.34 , $132.48 , $100.09 , $117.30 , $98.93 , $54.33 , N/A , $79.15 , $79.15 , $131.10 , $86.50 , $15.29 , $132.48 
Exc Tumor Soft Tissue Abdominal Wall Subq 3+Cm,22903,N/A,N/A,N/A," $2,894.00 "," $1,881.10 "," $2,648.88 ", $412.17 , $361.86 ," $2,100.05 "," $2,088.99 "," $2,691.42 "," $2,604.60 "," $2,604.60 "," $2,315.20 "," $2,315.20 ", $361.86 ," $2,672.03 "," $2,749.30 "," $2,604.60 "," $2,604.60 "," $2,604.60 "," $2,691.42 "," $2,778.24 "," $2,454.49 "," $2,459.90 "," $2,306.79 "," $2,466.08 ", N/A ," $2,141.03 "," $2,141.03 "," $2,749.30 "," $2,516.46 ", $361.86 ," $2,778.24 "
 ATEZOLIZUMAB 1200 MG/20ML IV SOLN ,HCPCS J9022,0636 - DRUGS REQUIRING DETAILED CODIN,50242-0917-01,20 mL," $30,424.10 "," $19,775.67 "," $25,556.24 ", $84.33 , $82.68 ," $24,582.67 "," $27,381.69 "," $25,757.04 "," $27,381.69 "," $27,381.69 "," $27,381.69 "," $25,860.49 ", $81.06 ," $28,090.57 "," $28,902.90 "," $25,860.49 "," $28,294.41 "," $28,294.41 "," $28,902.90 "," $29,207.14 "," $24,893.00 "," $27,381.69 "," $25,860.49 "," $24,035.04 ", N/A ," $24,622.22 "," $24,622.22 "," $28,902.90 "," $26,106.92 ", $81.06 ," $29,207.14 "
"Exc Skin Benig 3.1-4cm Face,Facial",CPT® 11444,N/A,N/A,N/A," $1,358.00 ", $882.70 , $723.93 , $216.51 , $338.07 , $620.10 , $603.18 ," $1,262.94 "," $1,222.20 "," $1,222.20 "," $1,086.40 "," $1,086.40 ", $338.07 ," $1,253.84 "," $1,290.10 "," $1,222.20 "," $1,222.20 "," $1,222.20 "," $1,262.94 "," $1,303.68 ", $790.64 ," $1,154.30 "," $1,204.24 ", $791.21 , N/A , $632.21 , $632.21 ," $1,290.10 ", $733.14 , $216.51 ," $1,303.68 "
Drainage of Gums Cyst,41800,N/A,N/A,N/A, $731.00 , $475.15 , $949.52 , $149.06 , $30.71 , $713.43 , $755.10 , $679.83 , $657.90 , $657.90 , $584.80 , $584.80 , $30.71 , $674.93 , $694.45 , $657.90 , $657.90 , $657.90 , $679.83 , $701.76 , $697.11 , $621.35 , $824.24 , $871.64 , N/A , $727.36 , $727.36 , $694.45 , $760.72 , $30.71 , $949.52 
Pro Mntr Ntrstl Flu Press Dev Cmprt Synd,20950,N/A,N/A,N/A, $558.00 , $362.70 , $530.40 , $83.05 , $190.55 , $439.01 , $444.26 , $518.94 , $502.20 , $502.20 , $446.40 , $446.40 , $190.55 , $515.20 , $530.10 , $502.20 , $502.20 , $502.20 , $518.94 , $535.68 , $494.55 , $474.30 , $488.83 , $517.30 , N/A , $447.57 , $447.57 , $530.10 , $526.07 , $83.05 , $535.68 
"Lumbar Spine Fusion,Anter Apprch",22558,N/A,N/A,N/A," $10,107.00 "," $6,569.55 "," $9,007.51 "," $1,403.90 "," $1,324.58 "," $7,391.14 "," $7,300.82 "," $9,399.51 "," $9,096.30 "," $9,096.30 "," $8,085.60 "," $8,085.60 "," $1,324.58 "," $9,331.79 "," $9,601.65 "," $9,096.30 "," $9,096.30 "," $9,096.30 "," $9,399.51 "," $9,702.72 "," $8,402.03 "," $8,590.95 "," $8,162.09 "," $8,574.83 ", N/A ," $7,535.35 "," $7,535.35 "," $9,601.65 "," $8,856.71 "," $1,324.58 "," $9,702.72 "
"Destruc Eyelid Lesn, <1 Cm",CPT® 67850,N/A,N/A,N/A," $2,011.00 "," $1,307.15 ", $801.97 , $127.00 , $53.59 , $765.24 , $711.35 ," $1,870.23 "," $1,809.90 "," $1,809.90 "," $1,608.80 "," $1,608.80 ", $53.59 ," $1,856.76 "," $1,910.45 "," $1,809.90 "," $1,809.90 "," $1,809.90 "," $1,870.23 "," $1,930.56 "," $1,105.34 "," $1,709.35 ", $729.68 , $968.19 , N/A , $780.17 , $780.17 ," $1,910.45 ", $861.20 , $53.59 ," $1,930.56 "
"Urinalysis, Auto, W/O Scope",CPT® 81003,N/A,N/A,N/A, $46.00 , $29.90 , N/A , $2.30 , $2.30 , $12.72 , $15.21 , $42.78 , $41.40 , $41.40 , $36.80 , $36.80 , $2.30 , $42.47 , $43.70 , $41.40 , $41.40 , $41.40 , $42.78 , $44.16 , $15.02 , $39.10 , $14.60 , $8.12 , N/A , $11.87 , $11.87 , $43.70 , $12.97 , $2.30 , $44.16 
Drug Assay Acetaminophen,CPT® 80143,N/A,N/A,N/A, $156.00 , $101.40 , N/A , $19.01 , $15.21 , N/A , N/A , $145.08 , $140.40 , $140.40 , $124.80 , $124.80 , $15.21 , $144.03 , $148.20 , $140.40 , $140.40 , $140.40 , $145.08 , $149.76 , $124.46 , $132.60 , $88.85 , $54.75 , N/A , $74.00 , $74.00 , $148.20 , $80.71 , $15.21 , $149.76 
"Lap,Pelvic Lymphadenectomy",CPT® 38571,N/A,N/A,N/A," $12,518.00 "," $8,136.70 "," $3,114.80 ", $629.83 , $764.45 ," $2,828.57 "," $2,832.51 "," $11,641.74 "," $11,266.20 "," $11,266.20 "," $10,014.40 "," $10,014.40 ", $764.45 ," $11,557.87 "," $11,892.10 "," $11,266.20 "," $11,266.20 "," $11,266.20 "," $11,641.74 "," $12,017.28 "," $3,348.90 "," $10,640.30 "," $4,069.45 "," $3,315.66 ", N/A ," $2,883.76 "," $2,883.76 "," $11,892.10 "," $3,345.54 ", $629.83 ," $12,017.28 "
 NM Parathyroid Planar and Spect Imaging ,CPT® 78071,0341 - NUC MED/DX PROCEDURES,N/A,N/A," $3,197.00 "," $2,078.05 "," $2,685.48 ", $321.01 , $284.63 ," $2,583.18 "," $2,877.30 "," $2,706.58 "," $2,877.30 "," $2,877.30 "," $2,877.30 "," $2,717.45 ", $279.05 ," $2,951.79 "," $3,037.15 "," $2,717.45 "," $2,973.21 "," $2,973.21 "," $3,037.15 "," $3,069.12 "," $2,615.79 "," $2,877.30 "," $2,717.45 "," $2,525.63 ", N/A ," $2,587.33 "," $2,587.33 "," $3,037.15 "," $2,743.35 ", $279.05 ," $3,069.12 "
 Pro CT Lower Extremity W/O Dye ,CPT® 73700,0972 - PRO FEE/RAD/DX,N/A,N/A, $563.00 , $365.95 , $919.73 , $132.30 , $242.52 , $853.40 ," $1,105.30 ", $523.59 , $506.70 , $506.70 , $450.40 , $450.40 , $242.52 , $519.82 , $534.85 , $506.70 , $506.70 , $506.70 , $523.59 , $540.48 , $772.34 , $478.55 ," $1,203.78 "," $1,166.51 ", N/A , $870.05 , $870.05 , $534.85 ," $1,007.10 ", $132.30 ," $1,203.78 "
"Plasty Knee,Med or Lat Compartmt",27446,N/A,N/A,N/A," $6,460.00 "," $4,199.00 "," $6,951.82 "," $1,081.92 ", $982.32 ," $5,602.81 "," $5,284.92 "," $6,007.80 "," $5,814.00 "," $5,814.00 "," $5,168.00 "," $5,168.00 ", $982.32 ," $5,964.52 "," $6,137.00 "," $5,814.00 "," $5,814.00 "," $5,814.00 "," $6,007.80 "," $6,201.60 "," $6,486.20 "," $5,491.00 "," $5,849.95 "," $6,586.66 ", N/A ," $5,712.14 "," $5,712.14 "," $6,137.00 "," $6,713.78 ", $982.32 ," $6,951.82 "
"Fusion MC-P Joint,Single",CPT® 26516,N/A,N/A,N/A," $4,328.00 "," $2,813.20 "," $4,672.53 ", $726.29 , $430.29 ," $3,329.55 "," $3,369.58 "," $4,025.04 "," $3,895.20 "," $3,895.20 "," $3,462.40 "," $3,462.40 ", $430.29 ," $3,996.04 "," $4,111.60 "," $3,895.20 "," $3,895.20 "," $3,895.20 "," $4,025.04 "," $4,154.88 "," $4,286.55 "," $3,678.80 "," $3,693.01 "," $3,977.34 ", N/A ," $3,394.52 "," $3,394.52 "," $4,111.60 "," $3,989.76 ", $430.29 ," $4,672.53 "
 Critical Care First 30-74 Min -Mh ,CPT® 99291,0450 - EMERGENCY SERVICES,N/A,N/A," $2,641.00 "," $1,716.65 "," $2,218.44 ", $205.74 , $270.56 ," $2,133.93 "," $2,376.90 "," $2,235.87 "," $2,376.90 "," $2,376.90 "," $2,376.90 "," $2,244.85 ", $265.25 ," $2,438.44 "," $2,508.95 "," $2,244.85 "," $2,456.13 "," $2,456.13 "," $2,508.95 "," $2,535.36 "," $2,160.87 "," $2,376.90 "," $2,244.85 "," $2,086.39 ", N/A ," $2,137.36 "," $2,137.36 "," $2,508.95 "," $2,266.24 ", $205.74 ," $2,535.36 "
"Bypass Graft Othr,Carot-Subcl",CPT® 35606,N/A,N/A,N/A," $7,232.00 "," $4,700.80 "," $6,768.78 "," $1,045.20 "," $1,340.24 "," $5,109.40 "," $5,097.93 "," $6,725.76 "," $6,508.80 "," $6,508.80 "," $5,785.60 "," $5,785.60 "," $1,340.24 "," $6,677.31 "," $6,870.40 "," $6,508.80 "," $6,508.80 "," $6,508.80 "," $6,725.76 "," $6,942.72 "," $6,256.29 "," $6,147.20 "," $6,452.96 "," $5,635.64 ", N/A ," $5,209.10 "," $5,209.10 "," $6,870.40 "," $5,917.54 "," $1,045.20 "," $6,942.72 "
 Fac Intro Needle/Intracath Extremity Artery ,CPT® 36140,0360 - OR SERVICES,N/A,N/A," $1,432.00 ", $930.80 ," $1,202.88 ", $80.72 , $72.41 ," $1,157.06 "," $1,288.80 "," $1,212.33 "," $1,288.80 "," $1,288.80 "," $1,288.80 "," $1,217.20 ", $70.99 ," $1,322.17 "," $1,360.40 "," $1,217.20 "," $1,331.76 "," $1,331.76 "," $1,360.40 "," $1,374.72 "," $1,171.66 "," $1,288.80 "," $1,217.20 "," $1,131.28 ", N/A ," $1,158.92 "," $1,158.92 "," $1,360.40 "," $1,228.80 ", $70.99 ," $1,374.72 "
" Fac Egfr Gene Analysis, Common Variants ",CPT® 81235,0310 - PATHOLOGY LAB,N/A,N/A," $2,091.00 "," $1,359.15 "," $1,756.44 ", $331.07 , $269.29 ," $1,689.53 "," $1,881.90 "," $1,770.24 "," $1,881.90 "," $1,881.90 "," $1,881.90 "," $1,777.35 ", $264.01 ," $1,930.62 "," $1,986.45 "," $1,777.35 "," $1,944.63 "," $1,944.63 "," $1,986.45 "," $2,007.36 "," $1,710.86 "," $1,881.90 "," $1,777.35 "," $1,651.89 ", N/A ," $1,692.25 "," $1,692.25 "," $1,986.45 "," $1,794.29 ", $264.01 ," $2,007.36 "
Tube Thoracostomy Includes Water Seal,32551,N/A,N/A,N/A," $1,454.00 ", $945.10 , $828.52 , $143.99 , $198.32 , $651.04 , $647.17 ," $1,352.22 "," $1,308.60 "," $1,308.60 "," $1,163.20 "," $1,163.20 ", $198.32 ," $1,342.48 "," $1,381.30 "," $1,308.60 "," $1,308.60 "," $1,308.60 "," $1,352.22 "," $1,395.84 ", $800.35 ," $1,235.90 ", $933.07 , $796.75 , N/A , $663.74 , $663.74 ," $1,381.30 ", $781.70 , $143.99 ," $1,395.84 "
 Fac Injection Treatment of Nerve ,CPT® 64640,0360 - OR SERVICES,N/A,N/A," $1,244.00 ", $808.60 ," $1,044.96 ", $114.17 , $160.13 ," $1,005.15 "," $1,119.60 "," $1,053.17 "," $1,119.60 "," $1,119.60 "," $1,119.60 "," $1,057.40 ", $156.99 ," $1,148.59 "," $1,181.80 "," $1,057.40 "," $1,156.92 "," $1,156.92 "," $1,181.80 "," $1,194.24 "," $1,017.84 "," $1,119.60 "," $1,057.40 ", $982.76 , N/A ," $1,006.77 "," $1,006.77 "," $1,181.80 "," $1,067.48 ", $114.17 ," $1,194.24 "
Allergy Patch Tests,CPT® 95044,N/A,N/A,N/A, $59.00 , $38.35 , $12.14 , $4.70 , $3.76 , $10.02 , $9.91 , $54.87 , $53.10 , $53.10 , $47.20 , $47.20 , $3.76 , $54.47 , $56.05 , $53.10 , $53.10 , $53.10 , $54.87 , $56.64 , $16.28 , $50.15 , $17.23 , $16.88 , N/A , $10.21 , $10.21 , $56.05 , $12.06 , $3.76 , $56.64 
Aflibercept Injection,HCPCS J0178,N/A,N/A,N/A," $3,670.00 "," $2,385.50 ", N/A , $893.18 , $916.30 , N/A , N/A ," $3,413.10 "," $3,303.00 "," $3,303.00 "," $2,936.00 "," $2,936.00 ", $916.30 ," $3,388.51 "," $3,486.50 "," $3,303.00 "," $3,303.00 "," $3,303.00 "," $3,413.10 "," $3,523.20 "," $1,191.33 "," $3,119.50 "," $1,869.70 "," $1,177.51 ", N/A , N/A , N/A ," $3,486.50 ", N/A , $893.18 ," $3,523.20 "
"Liletta, 52 Mg",HCPCS J7297,N/A,N/A,N/A," $1,069.00 ", $694.85 , N/A , N/A , $862.00 , N/A , N/A , $994.17 , $962.10 , $962.10 , $855.20 , $855.20 , $862.00 , $987.01 ," $1,015.55 ", $962.10 , $962.10 , $962.10 , $994.17 ," $1,026.24 ", N/A , $908.65 , $855.20 ," $1,135.07 ", N/A , N/A , N/A ," $1,015.55 ", N/A , $855.20 ," $1,135.07 "
"Exc Skin Malig 0.6-1cm Face,Facial",CPT® 11641,N/A,N/A,N/A," $1,253.00 ", $814.45 , $497.90 , $149.52 , $258.41 , $426.82 , $418.95 ," $1,165.29 "," $1,127.70 "," $1,127.70 "," $1,002.40 "," $1,002.40 ", $258.41 ," $1,156.89 "," $1,190.35 "," $1,127.70 "," $1,127.70 "," $1,127.70 "," $1,165.29 "," $1,202.88 ", $544.62 ," $1,065.05 ", $833.16 , $547.51 , N/A , $435.16 , $435.16 ," $1,190.35 ", $504.63 , $149.52 ," $1,202.88 "
Critical Care E&M L2,99292,N/A,N/A,N/A, $616.00 , $400.40 , $217.33 , $103.14 , $121.38 , $192.94 , $193.49 , $572.88 , $554.40 , $554.40 , $492.80 , $492.80 , $121.38 , $568.75 , $585.20 , $554.40 , $554.40 , $554.40 , $572.88 , $591.36 , $276.66 , $523.60 , $241.53 , $242.43 , N/A , $196.71 , $196.71 , $585.20 , $226.88 , $103.14 , $591.36 
Physical Therapy Treatment,CPT® 97039,N/A,N/A,N/A, $124.00 , $80.60 , N/A , N/A , $33.59 , $25.81 , N/A , $115.32 , $111.60 , $111.60 , $99.20 , $99.20 , $33.59 , $114.49 , $117.80 , $111.60 , $111.60 , $111.60 , $115.32 , $119.04 , N/A , $105.40 , $39.38 , N/A , N/A , $26.31 , $26.31 , $117.80 , $29.28 , $25.81 , $119.04 
"Thoracotomy,Cyst Removal",CPT® 32140,N/A,N/A,N/A," $8,763.00 "," $5,695.95 "," $5,146.65 ", $900.02 ," $1,728.87 "," $3,762.05 "," $3,671.16 "," $8,149.59 "," $7,886.70 "," $7,886.70 "," $7,010.40 "," $7,010.40 "," $1,728.87 "," $8,090.88 "," $8,324.85 "," $7,886.70 "," $7,886.70 "," $7,886.70 "," $8,149.59 "," $8,412.48 "," $4,980.91 "," $7,448.55 "," $5,300.45 "," $4,921.65 ", N/A ," $3,835.45 "," $3,835.45 "," $8,324.85 "," $4,517.05 ", $900.02 ," $8,412.48 "
" Fac Assay Test for Blood, Fecal ",CPT® 82274,0301 - LAB/CHEMISTRY,N/A,N/A, $147.00 , $95.55 , $123.48 , $16.24 , $16.24 , $118.78 , $132.30 , $124.45 , $132.30 , $132.30 , $132.30 , $124.95 , $15.92 , $135.73 , $139.65 , $124.95 , $136.71 , $136.71 , $139.65 , $141.12 , $120.28 , $132.30 , $124.95 , $116.13 , N/A , $118.97 , $118.97 , $139.65 , $126.14 , $15.92 , $141.12 
 Oximeter Continuous-Daily ,CPT® 94762,0460 - PULMONARY FUNC,N/A,N/A, $359.00 , $233.35 , $301.56 , $24.74 , $42.59 , $290.07 , $323.10 , $303.93 , $323.10 , $323.10 , $323.10 , $305.15 , $41.75 , $331.46 , $341.05 , $305.15 , $333.87 , $333.87 , $341.05 , $344.64 , $293.73 , $323.10 , $305.15 , $283.61 , N/A , $290.54 , $290.54 , $341.05 , $308.06 , $24.74 , $344.64 
 Fac Calr Gene Analysis Common Variants in Exon 9 ,CPT® 81219,0310 - PATHOLOGY LAB,N/A,N/A, $679.00 , $441.35 , $570.36 , $124.06 , $100.04 , $548.63 , $611.10 , $574.84 , $611.10 , $611.10 , $611.10 , $577.15 , $98.08 , $626.92 , $645.05 , $577.15 , $631.47 , $631.47 , $645.05 , $651.84 , $555.56 , $611.10 , $577.15 , $536.41 , N/A , $549.51 , $549.51 , $645.05 , $582.65 , $98.08 , $651.84 
 MESNA 100 MG/ML IV SOLN ,HCPCS J9209,0636 - DRUGS REQUIRING DETAILED CODIN,00338-1305-01,10 mL, $73.51 , $47.78 , $61.75 , $1.70 , $1.82 , $59.40 , $66.16 , $62.23 , $66.16 , $66.16 , $66.16 , $62.48 , $1.78 , $67.87 , $69.83 , $62.48 , $68.36 , $68.36 , $69.83 , $70.57 , $60.15 , $66.16 , $62.48 , $58.07 , N/A , $59.49 , $59.49 , $69.83 , $63.08 , $1.70 , $70.57 
Uv Lens/Es,HCPCS V2755,N/A,N/A,N/A, $7.00 , $4.55 , N/A , $19.52 , N/A , N/A , N/A , $6.51 , $6.30 , $6.30 , $5.60 , $5.60 , N/A , $6.46 , $6.65 , $6.30 , $6.30 , $6.30 , $6.51 , $6.72 , N/A , $5.95 , $7.00 , $17.75 , N/A , N/A , N/A , $6.65 , N/A , $5.60 , $19.52 
Heavy Metal Quantiative Each Nes,CPT® 83018,N/A,N/A,N/A, $224.00 , $145.60 , N/A , $22.40 , $22.40 , $124.26 , $148.65 , $208.32 , $201.60 , $201.60 , $179.20 , $179.20 , $22.40 , $206.82 , $212.80 , $201.60 , $201.60 , $201.60 , $208.32 , $215.04 , $146.63 , $190.40 , $144.34 , $79.65 , N/A , $115.97 , $115.97 , $212.80 , $126.73 , $22.40 , $215.04 
" Fac Organic Acids, Total, Quant ",CPT® 83918,0301 - LAB/CHEMISTRY,N/A,N/A, $187.00 , $121.55 , $157.08 , $24.07 , $22.84 , $151.10 , $168.30 , $158.31 , $168.30 , $168.30 , $168.30 , $158.95 , $22.39 , $172.66 , $177.65 , $158.95 , $173.91 , $173.91 , $177.65 , $179.52 , $153.00 , $168.30 , $158.95 , $147.73 , N/A , $151.34 , $151.34 , $177.65 , $160.46 , $22.39 , $179.52 
 BACITRACIN-POLYMYXIN B 500-10000 UNIT/GM EX OINT TUBE ,HCPCS RXC637,0250 - PHARMACY,70000-0070-01,28 gram, $48.76 , $31.69 , $40.96 , N/A , N/A , $39.40 , $43.88 , $41.28 , $43.88 , $43.88 , $43.88 , $41.45 , N/A , $45.02 , $46.32 , $41.45 , $45.35 , $45.35 , $46.32 , $46.81 , $39.90 , $43.88 , $41.45 , $38.52 , N/A , $39.46 , $39.46 , $46.32 , $41.84 , $38.52 , $46.81 
 ED Fac Cltx UR Shft Fx W/O Mnpj ,CPT® 25530,0361 - OR/MINOR,N/A,N/A," $3,216.00 "," $2,090.40 "," $2,701.44 ", $240.36 , $154.82 ," $2,598.53 "," $2,894.40 "," $2,722.67 "," $2,894.40 "," $2,894.40 "," $2,894.40 "," $2,733.60 ", $151.78 ," $2,969.33 "," $3,055.20 "," $2,733.60 "," $2,990.88 "," $2,990.88 "," $3,055.20 "," $3,087.36 "," $2,631.33 "," $2,894.40 "," $2,733.60 "," $2,540.64 ", N/A ," $2,602.71 "," $2,602.71 "," $3,055.20 "," $2,759.65 ", $151.78 ," $3,087.36 "
Adj Tiss Xfer Trunk <10sqcm,CPT® 14000,N/A,N/A,N/A," $2,707.00 "," $1,759.55 "," $1,596.57 ", $480.03 , $199.64 ," $1,369.32 "," $1,352.46 "," $2,517.51 "," $2,436.30 "," $2,436.30 "," $2,165.60 "," $2,165.60 ", $199.64 ," $2,499.37 "," $2,571.65 "," $2,436.30 "," $2,436.30 "," $2,436.30 "," $2,517.51 "," $2,598.72 "," $1,741.46 "," $2,300.95 "," $2,702.86 "," $1,748.46 ", N/A ," $1,396.04 "," $1,396.04 "," $2,571.65 "," $1,618.94 ", $199.64 ," $2,702.86 "
Layer Closure 12.6-20cm,CPT® 12045,N/A,N/A,N/A," $1,528.00 ", $993.20 , $860.68 , $260.68 , $184.42 , $744.08 , $725.79 ," $1,421.04 "," $1,375.20 "," $1,375.20 "," $1,222.40 "," $1,222.40 ", $184.42 ," $1,410.80 "," $1,451.60 "," $1,375.20 "," $1,375.20 "," $1,375.20 "," $1,421.04 "," $1,466.88 ", $936.61 ," $1,298.80 "," $1,448.66 ", $942.06 , N/A , $758.60 , $758.60 ," $1,451.60 ", $879.73 , $184.42 ," $1,466.88 "
Exc Tumor Soft Tissue Abdl Wall Subfascial 5+Cm,22901,N/A,N/A,N/A," $4,401.00 "," $2,860.65 "," $4,009.79 ", $621.23 , $545.10 ," $3,178.19 "," $3,166.35 "," $4,092.93 "," $3,960.90 "," $3,960.90 "," $3,520.80 "," $3,520.80 ", $545.10 ," $4,063.44 "," $4,180.95 "," $3,960.90 "," $3,960.90 "," $3,960.90 "," $4,092.93 "," $4,224.96 "," $3,711.50 "," $3,740.85 "," $3,511.04 "," $3,737.64 ", N/A ," $3,240.20 "," $3,240.20 "," $4,180.95 "," $3,808.40 ", $545.10 ," $4,224.96 "
"Laryngoscopy,Direct,Scope,Inj Cords",CPT® 31571,N/A,N/A,N/A," $1,380.00 ", $897.00 ," $1,336.65 ", $236.40 , $348.69 , $963.66 , $941.44 ," $1,283.40 "," $1,242.00 "," $1,242.00 "," $1,104.00 "," $1,104.00 ", $348.69 ," $1,274.15 "," $1,311.00 "," $1,242.00 "," $1,242.00 "," $1,242.00 "," $1,283.40 "," $1,324.80 "," $1,278.21 "," $1,173.00 "," $1,327.34 "," $1,263.79 ", N/A , $982.47 , $982.47 ," $1,311.00 "," $1,157.05 ", $236.40 ," $1,336.65 "
"Repair Recurr Inguin Hern,Reducibl",CPT® 49520,N/A,N/A,N/A," $4,096.00 "," $2,662.40 "," $3,788.14 ", $587.08 , $536.30 ," $2,964.45 "," $3,003.90 "," $3,809.28 "," $3,686.40 "," $3,686.40 "," $3,276.80 "," $3,276.80 ", $536.30 ," $3,781.84 "," $3,891.20 "," $3,686.40 "," $3,686.40 "," $3,686.40 "," $3,809.28 "," $3,932.16 "," $2,706.64 "," $3,481.60 "," $3,337.98 "," $3,500.59 ", N/A ," $3,022.29 "," $3,022.29 "," $3,891.20 "," $3,161.00 ", $536.30 ," $3,932.16 "
"Closed Rx Ulna Shaft Fx,Manipulatn",25535,N/A,N/A,N/A," $2,575.00 "," $1,673.75 "," $2,828.09 ", $446.23 , $307.34 ," $2,178.51 "," $2,197.64 "," $2,394.75 "," $2,317.50 "," $2,317.50 "," $2,060.00 "," $2,060.00 ", $307.34 ," $2,377.50 "," $2,446.25 "," $2,317.50 "," $2,317.50 "," $2,317.50 "," $2,394.75 "," $2,472.00 "," $2,617.19 "," $2,188.75 "," $2,417.41 "," $2,567.19 ", N/A ," $2,221.01 "," $2,221.01 "," $2,446.25 "," $2,610.49 ", $307.34 ," $2,828.09 "
 ASCORBIC ACID 25000 MG/50ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,67157-0101-50,50 mL," $1,667.95 "," $1,084.17 "," $1,401.08 ", N/A , N/A ," $1,347.70 "," $1,501.16 "," $1,412.09 "," $1,501.16 "," $1,501.16 "," $1,501.16 "," $1,417.76 ", N/A ," $1,540.02 "," $1,584.55 "," $1,417.76 "," $1,551.19 "," $1,551.19 "," $1,584.55 "," $1,601.23 "," $1,364.72 "," $1,501.16 "," $1,417.76 "," $1,317.68 ", N/A ," $1,349.87 "," $1,349.87 "," $1,584.55 "," $1,431.27 "," $1,317.68 "," $1,601.23 "
Repair Complex Addt,13133,N/A,N/A,N/A," $1,114.00 ", $724.10 , $400.49 , $119.01 , $130.42 , $358.67 , $346.07 ," $1,036.02 "," $1,002.60 "," $1,002.60 ", $891.20 , $891.20 , $130.42 ," $1,028.56 "," $1,058.30 "," $1,002.60 "," $1,002.60 "," $1,002.60 "," $1,036.02 "," $1,069.44 ", $443.31 , $946.90 , $692.22 , $459.37 , N/A , $365.66 , $365.66 ," $1,058.30 ", $424.04 , $119.01 ," $1,069.44 "
 Fac Assay of Blood Lipoprotein ,CPT® 83721,0301 - LAB/CHEMISTRY,N/A,N/A, $151.00 , $98.15 , $126.84 , $10.71 , $10.71 , $122.01 , $135.90 , $127.84 , $135.90 , $135.90 , $135.90 , $128.35 , $10.50 , $139.42 , $143.45 , $128.35 , $140.43 , $140.43 , $143.45 , $144.96 , $123.55 , $135.90 , $128.35 , $119.29 , N/A , $122.20 , $122.20 , $143.45 , $129.57 , $10.50 , $144.96 
 GABAPENTIN 300 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-6666-61,1 capsule, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Inject Trigem Nerv,1st Branch",CPT® 64600,N/A,N/A,N/A," $2,753.00 "," $1,789.45 "," $1,104.48 ", $217.11 , $747.99 ," $1,205.32 "," $1,168.34 "," $2,560.29 "," $2,477.70 "," $2,477.70 "," $2,202.40 "," $2,202.40 ", $747.99 ," $2,541.84 "," $2,615.35 "," $2,477.70 "," $2,477.70 "," $2,477.70 "," $2,560.29 "," $2,642.88 "," $1,187.78 "," $2,340.05 "," $1,154.29 "," $1,318.50 ", N/A ," $1,228.83 "," $1,228.83 "," $2,615.35 "," $1,318.25 ", $217.11 ," $2,642.88 "
 Pro Sec Clsr Surg Wnd/Dehsn X10sv/Comp ,CPT® 13160,0982 - PRO FEE/OUTPT,N/A,N/A," $3,043.00 "," $1,977.95 "," $2,534.63 ", $755.62 , $190.55 ," $2,192.28 "," $2,140.14 "," $2,829.99 "," $2,738.70 "," $2,738.70 "," $2,434.40 "," $2,434.40 ", $190.55 ," $2,809.60 "," $2,890.85 "," $2,738.70 "," $2,738.70 "," $2,738.70 "," $2,829.99 "," $2,921.28 "," $2,777.60 "," $2,586.55 "," $4,294.24 "," $2,769.01 ", N/A ," $2,235.05 "," $2,235.05 "," $2,890.85 "," $2,591.92 ", $190.55 ," $4,294.24 "
 METHYLPREDNISOLONE SODIUM SUCC 125 MG INJECTION (INPT) ,HCPCS J2930,0636 - DRUGS REQUIRING DETAILED CODIN,00009-0047-22,2 mL, $60.02 , $39.01 , $50.42 , $5.84 , $6.07 , $48.50 , $54.02 , $50.81 , $54.02 , $54.02 , $54.02 , $51.02 , $5.95 , $55.42 , $57.02 , $51.02 , $55.82 , $55.82 , $57.02 , $57.62 , $49.11 , $54.02 , $51.02 , $47.42 , N/A , $48.57 , $48.57 , $57.02 , $51.50 , $5.84 , $57.62 
Plastazote Sandal Each,HCPCS L3265,N/A,N/A,N/A, $51.00 , $33.15 , N/A , N/A , N/A , N/A , N/A , $47.43 , $45.90 , $45.90 , $40.80 , $40.80 , N/A , $47.09 , $48.45 , $45.90 , $45.90 , $45.90 , $47.43 , $48.96 , N/A , $43.35 , $25.95 , $13.97 , N/A , N/A , N/A , $48.45 , N/A , $13.97 , $48.96 
Repair Testis Injury,CPT® 54670,N/A,N/A,N/A," $2,228.00 "," $1,448.20 "," $1,819.37 ", $392.76 , $461.04 ," $1,301.18 "," $1,318.34 "," $2,072.04 "," $2,005.20 "," $2,005.20 "," $1,782.40 "," $1,782.40 ", $461.04 ," $2,057.11 "," $2,116.60 "," $2,005.20 "," $2,005.20 "," $2,005.20 "," $2,072.04 "," $2,138.88 "," $1,703.31 "," $1,893.80 "," $2,098.06 "," $1,967.61 ", N/A ," $1,326.56 "," $1,326.56 "," $2,116.60 "," $1,589.97 ", $392.76 ," $2,138.88 "
Inject Rx Other Periph Nerve,CPT® 64640,N/A,N/A,N/A," $1,489.00 ", $967.85 , $587.34 , $114.17 , $160.13 , $520.91 , $518.16 ," $1,384.77 "," $1,340.10 "," $1,340.10 "," $1,191.20 "," $1,191.20 ", $160.13 ," $1,374.79 "," $1,414.55 "," $1,340.10 "," $1,340.10 "," $1,340.10 "," $1,384.77 "," $1,429.44 ", $635.03 ," $1,265.65 ", $503.11 , $565.00 , N/A , $531.08 , $531.08 ," $1,414.55 ", $569.71 , $114.17 ," $1,429.44 "
"Cabg, Vein, Four",CPT® 33513,N/A,N/A,N/A," $29,127.00 "," $18,932.55 "," $14,462.44 "," $2,229.66 "," $2,378.00 "," $10,606.89 "," $10,529.10 "," $27,088.11 "," $26,214.30 "," $26,214.30 "," $23,301.60 "," $23,301.60 "," $2,378.00 "," $26,892.96 "," $27,670.65 "," $26,214.30 "," $26,214.30 "," $26,214.30 "," $27,088.11 "," $27,961.92 "," $13,421.82 "," $24,757.95 "," $13,344.80 "," $11,898.68 ", N/A ," $10,813.85 "," $10,813.85 "," $27,670.65 "," $12,284.52 "," $2,229.66 "," $27,961.92 "
Sub Grft F/S/N/H/F/G/M/D />100scm Adl 100scm,CPT® 15278,N/A,N/A,N/A, $434.00 , $282.10 , $176.73 , $51.73 , $63.67 , $156.27 , $137.50 , $403.62 , $390.60 , $390.60 , $347.20 , $347.20 , $63.67 , $400.71 , $412.30 , $390.60 , $390.60 , $390.60 , $403.62 , $416.64 , $193.69 , $368.90 , $274.75 , $198.27 , N/A , $159.32 , $159.32 , $412.30 , $184.77 , $51.73 , $416.64 
Closed Treatment Pst Malleolus Fracture W/O Mnpj,CPT® 27767,N/A,N/A,N/A," $1,851.00 "," $1,203.15 "," $1,807.39 ", $286.69 , $181.08 ," $1,368.19 "," $1,396.13 "," $1,721.43 "," $1,665.90 "," $1,665.90 "," $1,480.80 "," $1,480.80 ", $181.08 ," $1,709.03 "," $1,758.45 "," $1,665.90 "," $1,665.90 "," $1,665.90 "," $1,721.43 "," $1,776.96 "," $1,666.41 "," $1,573.35 "," $1,528.94 "," $1,625.54 ", N/A ," $1,394.88 "," $1,394.88 "," $1,758.45 "," $1,639.47 ", $181.08 ," $1,807.39 "
 Fac Immunofluorescence per Spec Add Singl Antb Stain ,CPT® 88350,0310 - PATHOLOGY LAB,N/A,N/A, $292.00 , $189.80 , $245.28 , $114.53 , $57.02 , $235.94 , $262.80 , $247.21 , $262.80 , $262.80 , $262.80 , $248.20 , $55.90 , $269.60 , $277.40 , $248.20 , $271.56 , $271.56 , $277.40 , $280.32 , $238.91 , $262.80 , $248.20 , $230.68 , N/A , $236.32 , $236.32 , $277.40 , $250.57 , $55.90 , $280.32 
 Fac Prim Prq Trluml Mchnl Thrmbc N-Cor N-Icra 1st ,CPT® 37184,0761 - TREATMENT ROOM,N/A,N/A," $3,055.00 "," $1,985.75 "," $2,566.20 ", $391.68 ," $2,378.00 "," $2,468.44 "," $2,749.50 "," $2,586.36 "," $2,749.50 "," $2,749.50 "," $2,749.50 "," $2,596.75 "," $2,331.37 "," $2,820.68 "," $2,902.25 "," $2,596.75 "," $2,841.15 "," $2,841.15 "," $2,902.25 "," $2,932.80 "," $2,499.60 "," $2,749.50 "," $2,596.75 "," $2,413.45 ", N/A ," $2,472.41 "," $2,472.41 "," $2,902.25 "," $2,621.50 ", $391.68 ," $2,932.80 "
"Work Hardening/Condn,0-2 Hr",CPT® 97545,N/A,N/A,N/A, $565.00 , $367.25 , N/A , N/A , N/A , $297.99 , $265.06 , $525.45 , $508.50 , $508.50 , $452.00 , $452.00 , N/A , $521.66 , $536.75 , $508.50 , $508.50 , $508.50 , $525.45 , $542.40 , N/A , $480.25 , $396.36 , $332.76 , N/A , $303.80 , $303.80 , $536.75 , $337.90 , $265.06 , $542.40 
 NICARDIPINE HCL 2.5 MG/ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00517-0735-10,10 mL, $189.50 , $123.18 , $159.18 , N/A , N/A , $153.12 , $170.55 , $160.43 , $170.55 , $170.55 , $170.55 , $161.08 , N/A , $174.97 , $180.03 , $161.08 , $176.24 , $176.24 , $180.03 , $181.92 , $155.05 , $170.55 , $161.08 , $149.71 , N/A , $153.36 , $153.36 , $180.03 , $162.61 , $149.71 , $181.92 
 Pro Vis Fld Xm Uni/Bi I&R Intrm Xm ,CPT® 92082,0962 - PRO FEE/EYE,N/A,N/A, $180.00 , $117.00 , $100.55 , $45.89 , $55.95 , $84.09 , $114.50 , $167.40 , $162.00 , $162.00 , $144.00 , $144.00 , $55.95 , $166.19 , $171.00 , $162.00 , $162.00 , $162.00 , $167.40 , $172.80 , $144.52 , $153.00 , $150.03 , $101.72 , N/A , $85.74 , $85.74 , $171.00 , $101.97 , $45.89 , $172.80 
Chemodenerv Eccrine Glands Both Axillae,CPT® 64650,N/A,N/A,N/A, $376.00 , $244.40 , $196.25 , $38.30 , $51.86 , $230.04 , $218.70 , $349.68 , $338.40 , $338.40 , $300.80 , $300.80 , $51.86 , $347.16 , $357.20 , $338.40 , $338.40 , $338.40 , $349.68 , $360.96 , $212.98 , $319.60 , $215.87 , $248.09 , N/A , $234.53 , $234.53 , $357.20 , $251.61 , $38.30 , $360.96 
"Instill via Chest Tube Agent for Fibrinolysis, 1st Day",CPT® 32561,N/A,N/A,N/A, $772.00 , $501.80 , $369.09 , $64.02 , $79.62 , $266.34 , $262.64 , $717.96 , $694.80 , $694.80 , $617.60 , $617.60 , $79.62 , $712.79 , $733.40 , $694.80 , $694.80 , $694.80 , $717.96 , $741.12 , $356.96 , $656.20 , $374.65 , $354.12 , N/A , $271.54 , $271.54 , $733.40 , $319.79 , $64.02 , $741.12 
Hla I Typing High Resolution 1 Allele/Allele Grp,CPT® 81381,N/A,N/A,N/A," $1,198.00 ", $778.70 , N/A , $173.30 , $105.28 , $535.10 , $633.69 ," $1,114.14 "," $1,078.20 "," $1,078.20 ", $958.40 , $958.40 , $105.28 ," $1,106.11 "," $1,138.10 "," $1,078.20 "," $1,078.20 "," $1,078.20 "," $1,114.14 "," $1,150.08 "," $1,134.46 "," $1,018.30 ", $809.30 , $499.00 , N/A , $499.39 , $499.39 ," $1,138.10 ", $545.73 , $105.28 ," $1,150.08 "
Drain Rectal Abscess,46040,N/A,N/A,N/A," $2,569.00 "," $1,669.85 "," $2,598.90 ", $404.09 , $192.43 ," $1,960.97 "," $2,012.51 "," $2,389.17 "," $2,312.10 "," $2,312.10 "," $2,055.20 "," $2,055.20 ", $192.43 ," $2,371.96 "," $2,440.55 "," $2,312.10 "," $2,312.10 "," $2,312.10 "," $2,389.17 "," $2,466.24 "," $1,851.25 "," $2,183.65 "," $2,217.59 "," $2,340.82 ", N/A ," $1,999.23 "," $1,999.23 "," $2,440.55 "," $2,090.98 ", $192.43 ," $2,598.90 "
 Fac Sbrt Delivery ,CPT® 77373,0333 - RADIATION RX,N/A,N/A," $14,318.00 "," $9,306.70 "," $12,027.12 ", $982.34 ," $1,319.28 "," $11,568.94 "," $12,886.20 "," $12,121.62 "," $12,886.20 "," $12,886.20 "," $12,886.20 "," $12,170.30 "," $1,293.41 "," $13,219.81 "," $13,602.10 "," $12,170.30 "," $13,315.74 "," $13,315.74 "," $13,602.10 "," $13,745.28 "," $11,714.99 "," $12,886.20 "," $12,170.30 "," $11,311.22 ", N/A ," $11,587.56 "," $11,587.56 "," $13,602.10 "," $12,286.28 ", $982.34 ," $13,745.28 "
"Remv Hydrocele,Sperm Cord,Unilat",CPT® 55500,N/A,N/A,N/A," $2,919.00 "," $1,897.35 "," $1,738.25 ", $374.28 , $401.40 ," $1,261.41 "," $1,292.60 "," $2,714.67 "," $2,627.10 "," $2,627.10 "," $2,335.20 "," $2,335.20 ", $401.40 ," $2,695.11 "," $2,773.05 "," $2,627.10 "," $2,627.10 "," $2,627.10 "," $2,714.67 "," $2,802.24 "," $1,626.46 "," $2,481.15 "," $2,083.79 "," $1,891.21 ", N/A ," $1,286.02 "," $1,286.02 "," $2,773.05 "," $1,541.37 ", $374.28 ," $2,802.24 "
Chemical Pleurodesis for Persistent Pneumothorax,CPT® 32560,N/A,N/A,N/A," $1,707.00 "," $1,109.55 ", $410.55 , $70.83 , $347.85 , $298.34 , $291.18 ," $1,587.51 "," $1,536.30 "," $1,536.30 "," $1,365.60 "," $1,365.60 ", $347.85 ," $1,576.07 "," $1,621.65 "," $1,536.30 "," $1,536.30 "," $1,536.30 "," $1,587.51 "," $1,638.72 ", $397.79 ," $1,450.95 ", $415.69 , $396.04 , N/A , $304.16 , $304.16 ," $1,621.65 ", $358.22 , $70.83 ," $1,638.72 "
 Fac Drug Screening Cocaine ,CPT® 80353,0301 - LAB/CHEMISTRY,N/A,N/A, $191.00 , $124.15 , $160.44 , N/A , N/A , $154.33 , $171.90 , $161.70 , $171.90 , $171.90 , $171.90 , $162.35 , N/A , $176.35 , $181.45 , $162.35 , $177.63 , $177.63 , $181.45 , $183.36 , $156.28 , $171.90 , $162.35 , $150.89 , N/A , $154.58 , $154.58 , $181.45 , $163.90 , $150.89 , $183.36 
Temporal Artery Ligatn or Bx,CPT® 37609,N/A,N/A,N/A," $1,952.00 "," $1,268.80 "," $1,228.76 ", $191.29 , $190.55 , $893.52 , $904.87 ," $1,815.36 "," $1,756.80 "," $1,756.80 "," $1,561.60 "," $1,561.60 ", $190.55 ," $1,802.28 "," $1,854.40 "," $1,756.80 "," $1,756.80 "," $1,756.80 "," $1,815.36 "," $1,873.92 "," $1,133.39 "," $1,659.20 "," $1,131.10 "," $1,009.19 ", N/A , $910.96 , $910.96 ," $1,854.40 "," $1,034.85 ", $190.55 ," $1,873.92 "
Sigmoidoscopy Flx With With Band Ligation(S),CPT® 45350,N/A,N/A,N/A," $2,150.00 "," $1,397.50 ", $616.46 , $95.27 , $133.80 , N/A , N/A ," $1,999.50 "," $1,935.00 "," $1,935.00 "," $1,720.00 "," $1,720.00 ", $133.80 ," $1,985.10 "," $2,042.50 "," $1,935.00 "," $1,935.00 "," $1,935.00 "," $1,999.50 "," $2,064.00 ", $441.60 ," $1,827.50 ", $525.98 , $585.87 , N/A , $448.91 , $448.91 ," $2,042.50 ", $469.85 , $95.27 ," $2,064.00 "
"US,Preg Uter,Fetal & Mat, 2-3 Trimest",CPT® 76805,N/A,N/A,N/A," $1,044.00 ", $678.60 , $770.82 , $134.36 , $138.63 , $682.02 , $782.28 , $970.92 , $939.60 , $939.60 , $835.20 , $835.20 , $138.63 , $963.93 , $991.80 , $939.60 , $939.60 , $939.60 , $970.92 ," $1,002.24 ", $777.27 , $887.40 , $853.24 , $800.96 , N/A , $695.32 , $695.32 , $991.80 , $804.85 , $134.36 ," $1,002.24 "
Mult Punc Anter Cornea,CPT® 65600,N/A,N/A,N/A," $3,868.00 "," $2,514.20 "," $2,089.10 ", $329.03 , $461.04 ," $1,949.41 "," $1,827.21 "," $3,597.24 "," $3,481.20 "," $3,481.20 "," $3,094.40 "," $3,094.40 ", $461.04 ," $3,571.32 "," $3,674.60 "," $3,481.20 "," $3,481.20 "," $3,481.20 "," $3,597.24 "," $3,713.28 "," $2,870.74 "," $3,287.80 "," $1,878.62 "," $2,473.82 ", N/A ," $1,987.44 "," $1,987.44 "," $3,674.60 "," $2,193.88 ", $329.03 ," $3,713.28 "
 Fac Specimen Collect Covid-19 ,HCPCS G2023,0300 - LABORATORY,N/A,N/A, $32.00 , $20.80 , $26.88 , $23.93 , N/A , $25.86 , $28.80 , $27.09 , $28.80 , $28.80 , $28.80 , $27.20 , N/A , $29.55 , $30.40 , $27.20 , $29.76 , $29.76 , $30.40 , $30.72 , $26.18 , $28.80 , $27.20 , $25.28 , N/A , $25.90 , $25.90 , $30.40 , $27.46 , $23.93 , $30.72 
 CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN ,HCPCS RXA250,0250 - PHARMACY,43598-0917-58,1 mL," $1,966.34 "," $1,278.12 "," $1,651.73 ", N/A , N/A ," $1,588.80 "," $1,769.71 "," $1,664.70 "," $1,769.71 "," $1,769.71 "," $1,769.71 "," $1,671.39 ", N/A ," $1,815.52 "," $1,868.02 "," $1,671.39 "," $1,828.70 "," $1,828.70 "," $1,868.02 "," $1,887.69 "," $1,608.86 "," $1,769.71 "," $1,671.39 "," $1,553.41 ", N/A ," $1,591.36 "," $1,591.36 "," $1,868.02 "," $1,687.32 "," $1,553.41 "," $1,887.69 "
"US,Pregnant Uterus,Limited, 1/> Fetuses",76815,N/A,N/A,N/A, $263.00 , $170.95 , $462.43 , $80.48 , $87.65 , $405.52 , $478.15 , $244.59 , $236.70 , $236.70 , $210.40 , $210.40 , $87.65 , $242.83 , $249.85 , $236.70 , $236.70 , $236.70 , $244.59 , $252.48 , $466.34 , $223.55 , $520.03 , $475.70 , N/A , $413.43 , $413.43 , $249.85 , $478.57 , $80.48 , $520.03 
"Quantitative Assay, Drug",CPT® 80299,N/A,N/A,N/A, $146.00 , $94.90 , N/A , $19.01 , $19.01 , $77.49 , $92.71 , $135.78 , $131.40 , $131.40 , $116.80 , $116.80 , $19.01 , $134.80 , $138.70 , $131.40 , $131.40 , $131.40 , $135.78 , $140.16 , $124.46 , $124.10 , $89.20 , $54.75 , N/A , $72.32 , $72.32 , $138.70 , $79.03 , $19.01 , $140.16 
"Trim Hyperkeratotic Skin Lesion, One",11055,N/A,N/A,N/A, $162.00 , $105.30 , $51.44 , $15.16 , $26.33 , $45.02 , $42.27 , $150.66 , $145.80 , $145.80 , $129.60 , $129.60 , $26.33 , $149.57 , $153.90 , $145.80 , $145.80 , $145.80 , $150.66 , $155.52 , $56.75 , $137.70 , $82.07 , $57.83 , N/A , $45.91 , $45.91 , $153.90 , $53.23 , $15.16 , $155.52 
"Cystourethroscopy,Fulguratn",CPT® 52214,N/A,N/A,N/A," $4,647.00 "," $3,020.55 ", $943.63 , $164.94 , $155.03 , $863.18 , $796.57 ," $4,321.71 "," $4,182.30 "," $4,182.30 "," $3,717.60 "," $3,717.60 ", $155.03 ," $4,290.58 "," $4,414.65 "," $4,182.30 "," $4,182.30 "," $4,182.30 "," $4,321.71 "," $4,461.12 ", $951.06 ," $3,949.95 ", $902.74 ," $1,083.33 ", N/A , $880.02 , $880.02 ," $4,414.65 "," $1,034.33 ", $155.03 ," $4,461.12 "
 Pro MRI Lumbar Spine W/O & W/Dye ,CPT® 72158,0972 - PRO FEE/RAD/DX,N/A,N/A," $1,358.00 ", $882.70 ," $2,302.86 ", $328.48 , $645.20 ," $2,762.80 "," $2,908.15 "," $1,262.94 "," $1,222.20 "," $1,222.20 "," $1,086.40 "," $1,086.40 ", $645.20 ," $1,253.84 "," $1,290.10 "," $1,222.20 "," $1,222.20 "," $1,222.20 "," $1,262.94 "," $1,303.68 "," $4,069.10 "," $1,154.30 "," $3,170.26 "," $3,505.04 ", N/A ," $2,816.70 "," $2,816.70 "," $1,290.10 "," $3,313.79 ", $328.48 ," $4,069.10 "
 Pro Online Digital E/M Svc Est Pt <7 D 5-10 Minutes ,CPT® 99421,0982 - PRO FEE/OUTPT,N/A,N/A, $49.00 , $31.85 , $26.12 , $12.47 , $11.93 , $22.17 , N/A , $45.57 , $44.10 , $44.10 , $39.20 , $39.20 , $11.93 , $45.24 , $46.55 , $44.10 , $44.10 , $44.10 , $45.57 , $47.04 , $23.23 , $41.65 , $28.39 , $28.50 , N/A , $22.60 , $22.60 , $46.55 , $25.96 , $11.93 , $47.04 
 HYDROMORPHONE HCL 0.2 MG/ML IJ SOLN ,HCPCS RXC636,0636 - DRUGS REQUIRING DETAILED CODIN,76045-0121-01,1 mL, $33.73 , $21.92 , $28.33 , N/A , N/A , $27.25 , $30.36 , $28.56 , $30.36 , $30.36 , $30.36 , $28.67 , N/A , $31.14 , $32.04 , $28.67 , $31.37 , $31.37 , $32.04 , $32.38 , $27.60 , $30.36 , $28.67 , $26.65 , N/A , $27.30 , $27.30 , $32.04 , $28.94 , $26.65 , $32.38 
In Gemcitabine Hcl Nos 200mg,HCPCS J9201,N/A,N/A,N/A, $9.00 , $5.85 , N/A , $3.78 , $3.57 , N/A , N/A , $8.37 , $8.10 , $8.10 , $7.20 , $7.20 , $3.57 , $8.31 , $8.55 , $8.10 , $8.10 , $8.10 , $8.37 , $8.64 , $5.17 , $7.65 , $20.76 , $5.16 , N/A , N/A , N/A , $8.55 , N/A , $3.57 , $20.76 
" Culture, Aerobic - Routine . Beaker1 ",CPT® 87070,0306 - LAB/BACT-MICRO,N/A,N/A, $116.00 , $75.40 , $97.44 , $8.79 , $8.79 , $93.73 , $104.40 , $98.21 , $104.40 , $104.40 , $104.40 , $98.60 , $8.62 , $107.10 , $110.20 , $98.60 , $107.88 , $107.88 , $110.20 , $111.36 , $94.91 , $104.40 , $98.60 , $91.64 , N/A , $93.88 , $93.88 , $110.20 , $99.54 , $8.62 , $111.36 
 AGALSIDASE BETA 5 MG IV SOLR ,HCPCS J0180,0636 - DRUGS REQUIRING DETAILED CODIN,58468-0041-01,1 mL," $3,039.60 "," $1,975.74 "," $2,553.26 ", $219.69 , $212.49 ," $2,456.00 "," $2,735.64 "," $2,573.33 "," $2,735.64 "," $2,735.64 "," $2,735.64 "," $2,583.66 ", $208.32 ," $2,806.46 "," $2,887.62 "," $2,583.66 "," $2,826.83 "," $2,826.83 "," $2,887.62 "," $2,918.02 "," $2,487.00 "," $2,735.64 "," $2,583.66 "," $2,401.28 ", N/A ," $2,459.95 "," $2,459.95 "," $2,887.62 "," $2,608.28 ", $208.32 ," $2,918.02 "
"Explor/Remv Stone,Renal Pelvis",CPT® 50130,N/A,N/A,N/A," $7,195.00 "," $4,676.75 "," $5,581.99 ", $980.97 ," $1,075.74 "," $5,056.13 "," $4,697.64 "," $6,691.35 "," $6,475.50 "," $6,475.50 "," $5,756.00 "," $5,756.00 "," $1,075.74 "," $6,643.14 "," $6,835.25 "," $6,475.50 "," $6,475.50 "," $6,475.50 "," $6,691.35 "," $6,907.20 "," $5,601.20 "," $6,115.75 "," $5,318.29 "," $6,353.94 ", N/A ," $5,154.78 "," $5,154.78 "," $6,835.25 "," $6,058.72 ", $980.97 ," $6,907.20 "
 DOXAZOSIN MESYLATE 2 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-5523-61,1 tablet, $4.99 , $3.24 , $4.19 , N/A , N/A , $4.03 , $4.49 , $4.22 , $4.49 , $4.49 , $4.49 , $4.24 , N/A , $4.61 , $4.74 , $4.24 , $4.64 , $4.64 , $4.74 , $4.79 , $4.08 , $4.49 , $4.24 , $3.94 , N/A , $4.04 , $4.04 , $4.74 , $4.28 , $3.94 , $4.79 
 Fac Electric Stimulation Therapy ,CPT® 97014,0420 - PHYSICAL THERAPY,N/A,N/A, $78.00 , $50.70 , $65.52 , $12.24 , N/A , $63.02 , $70.20 , $66.03 , $70.20 , $70.20 , $70.20 , $66.30 , N/A , $72.02 , $74.10 , $66.30 , $72.54 , $72.54 , $74.10 , $74.88 , $63.82 , $70.20 , $66.30 , $61.62 , N/A , $63.13 , $63.13 , $74.10 , $66.93 , $12.24 , $74.88 
 Fac Evasc Rpr Dplmnt Aorto-Aortic Ndgft Rpt ,CPT® 34702,0360 - OR SERVICES,N/A,N/A," $2,953.00 "," $1,919.45 "," $2,480.52 "," $1,642.74 "," $1,397.67 "," $2,386.02 "," $2,657.70 "," $2,500.01 "," $2,657.70 "," $2,657.70 "," $2,657.70 "," $2,510.05 "," $1,370.26 "," $2,726.50 "," $2,805.35 "," $2,510.05 "," $2,746.29 "," $2,746.29 "," $2,805.35 "," $2,834.88 "," $2,416.14 "," $2,657.70 "," $2,510.05 "," $2,332.87 ", N/A ," $2,389.86 "," $2,389.86 "," $2,805.35 "," $2,533.97 "," $1,370.26 "," $2,834.88 "
Incis/Drain Arm/Elbow Infect Bursa,23931,N/A,N/A,N/A, $878.00 , $570.70 , $983.19 , $155.07 , $285.82 , $771.51 , $776.90 , $816.54 , $790.20 , $790.20 , $702.40 , $702.40 , $285.82 , $810.66 , $834.10 , $790.20 , $790.20 , $790.20 , $816.54 , $842.88 , $909.13 , $746.30 , $852.78 , $917.28 , N/A , $786.56 , $786.56 , $834.10 , $924.48 , $155.07 , $983.19 
 Cranial And Peripheral Nerve Disorders Without McC ,MS DRG V40 (FY2023) 074,N/A,N/A,N/A," $55,906.74 "," $36,339.38 "," $46,961.66 ", N/A , N/A ," $45,172.65 "," $50,316.07 "," $47,330.65 "," $50,316.07 "," $50,316.07 "," $50,316.07 "," $47,520.73 ", N/A ," $51,618.69 "," $53,111.40 "," $47,520.73 "," $51,993.27 "," $51,993.27 "," $53,111.40 "," $53,670.47 "," $45,742.89 "," $50,316.07 "," $47,520.73 "," $44,166.32 ", N/A ," $45,245.32 "," $45,245.32 "," $53,111.40 "," $47,973.57 "," $44,166.32 "," $53,670.47 "
 Fac Work Hardening Add-On ,CPT® 97546,0951 - OTHER THERAPEUTIC SERVICES - ATHLETIC TRAINING,N/A,N/A, $265.00 , $172.25 , $222.60 , N/A , N/A , $214.12 , $238.50 , $224.35 , $238.50 , $238.50 , $238.50 , $225.25 , N/A , $244.67 , $251.75 , $225.25 , $246.45 , $246.45 , $251.75 , $254.40 , $216.82 , $238.50 , $225.25 , $209.35 , N/A , $214.46 , $214.46 , $251.75 , $227.40 , $209.35 , $254.40 
 Fac Tcat Prm Occlusion/Embolization Prq Non-Cns ,CPT® 61626,0360 - OR SERVICES,N/A,N/A," $6,899.00 "," $4,484.35 "," $5,795.16 ", $820.03 , $843.81 ," $5,574.39 "," $6,209.10 "," $5,840.69 "," $6,209.10 "," $6,209.10 "," $6,209.10 "," $5,864.15 ", $827.26 ," $6,369.85 "," $6,554.05 "," $5,864.15 "," $6,416.07 "," $6,416.07 "," $6,554.05 "," $6,623.04 "," $5,644.76 "," $6,209.10 "," $5,864.15 "," $5,450.21 ", N/A ," $5,583.36 "," $5,583.36 "," $6,554.05 "," $5,920.03 ", $820.03 ," $6,623.04 "
Variable Concentration Mask,HCPCS A4620,N/A,N/A,N/A, $2.00 , $1.30 , N/A , $0.87 , $1.05 , N/A , N/A , $1.86 , $1.80 , $1.80 , $1.60 , $1.60 , $1.05 , $1.85 , $1.90 , $1.80 , $1.80 , $1.80 , $1.86 , $1.92 , N/A , $1.70 , $0.65 , $0.78 , N/A , N/A , N/A , $1.90 , N/A , $0.65 , $1.92 
Cannula Nasal,HCPCS A4615,N/A,N/A,N/A, $8.00 , $5.20 , N/A , $0.99 , $0.77 , N/A , N/A , $7.44 , $7.20 , $7.20 , $6.40 , $6.40 , $0.77 , $7.39 , $7.60 , $7.20 , $7.20 , $7.20 , $7.44 , $7.68 , N/A , $6.80 , $0.65 , $0.90 , N/A , N/A , N/A , $7.60 , N/A , $0.65 , $7.68 
"Debridement-Skin,Tiss,Mus",CPT® 11043,N/A,N/A,N/A," $1,073.00 ", $697.45 , $487.15 , $145.28 , $233.20 , $424.55 , $413.55 , $997.89 , $965.70 , $965.70 , $858.40 , $858.40 , $233.20 , $990.70 ," $1,019.35 ", $965.70 , $965.70 , $965.70 , $997.89 ," $1,030.08 ", $537.67 , $912.05 , $827.81 , $543.19 , N/A , $432.84 , $432.84 ," $1,019.35 ", $501.95 , $145.28 ," $1,030.08 "
Blood Clot Factor IX Test,CPT® 85250,N/A,N/A,N/A, $325.00 , $211.25 , N/A , $19.42 , $19.42 , $107.72 , $128.85 , $302.25 , $292.50 , $292.50 , $260.00 , $260.00 , $19.42 , $300.07 , $308.75 , $292.50 , $292.50 , $292.50 , $302.25 , $312.00 , $127.13 , $276.25 , $124.88 , $69.05 , N/A , $100.53 , $100.53 , $308.75 , $109.86 , $19.42 , $312.00 
" Fac Detect Agent Nos, Dna, Amp ",CPT® 87798,0306 - LAB/BACT-MICRO,N/A,N/A, $315.00 , $204.75 , $264.60 , $35.79 , $35.79 , $254.52 , $283.50 , $266.68 , $283.50 , $283.50 , $283.50 , $267.75 , $35.09 , $290.84 , $299.25 , $267.75 , $292.95 , $292.95 , $299.25 , $302.40 , $257.73 , $283.50 , $267.75 , $248.85 , N/A , $254.93 , $254.93 , $299.25 , $270.30 , $35.09 , $302.40 
 TROPICAMIDE 1 % OP SOLN ,HCPCS RXA250,0250 - PHARMACY,61314-0355-01,3 mL, $71.93 , $46.75 , $60.42 , N/A , N/A , $58.12 , $64.74 , $60.90 , $64.74 , $64.74 , $64.74 , $61.14 , N/A , $66.41 , $68.33 , $61.14 , $66.89 , $66.89 , $68.33 , $69.05 , $58.85 , $64.74 , $61.14 , $56.82 , N/A , $58.21 , $58.21 , $68.33 , $61.72 , $56.82 , $69.05 
 GEMCITABINE HCL 1 G IV SOLR ,HCPCS J9196,0636 - DRUGS REQUIRING DETAILED CODIN,71288-0114-50,26.32 mL, $135.08 , $87.80 , $113.47 , N/A , $3.93 , $109.14 , $121.57 , $114.36 , $121.57 , $121.57 , $121.57 , $114.82 , $3.85 , $124.72 , $128.33 , $114.82 , $125.62 , $125.62 , $128.33 , $129.68 , $110.52 , $121.57 , $114.82 , $106.71 , N/A , $109.32 , $109.32 , $128.33 , $115.91 , $3.85 , $129.68 
" Fac 2d Transtho W/Contr, Stress ",HCPCS C8928,0483 - CARDIOLOGY – ECHOCARDIOLOGY,N/A,N/A," $2,390.00 "," $1,553.50 "," $2,007.60 ", N/A , N/A ," $1,931.12 "," $2,151.00 "," $2,023.37 "," $2,151.00 "," $2,151.00 "," $2,151.00 "," $2,031.50 ", N/A ," $2,206.69 "," $2,270.50 "," $2,031.50 "," $2,222.70 "," $2,222.70 "," $2,270.50 "," $2,294.40 "," $1,955.50 "," $2,151.00 "," $2,031.50 "," $1,888.10 ", N/A ," $1,934.23 "," $1,934.23 "," $2,270.50 "," $2,050.86 "," $1,888.10 "," $2,294.40 "
Tissue Culture-Bone Marrw,CPT® 88237,N/A,N/A,N/A," $1,445.00 ", $939.25 , N/A , $146.63 , $69.14 , $278.89 ," $1,073.09 "," $1,343.85 "," $1,300.50 "," $1,300.50 "," $1,156.00 "," $1,156.00 ", $69.14 ," $1,334.17 "," $1,372.75 "," $1,300.50 "," $1,300.50 "," $1,300.50 "," $1,343.85 "," $1,387.20 ", $959.85 ," $1,228.25 ", $827.14 , $551.99 , N/A , $260.28 , $260.28 ," $1,372.75 ", $286.03 , $69.14 ," $1,387.20 "
 Fac Heparin Neutralization ,CPT® 85525,0305 - LAB/HEMATOLOGY,N/A,N/A, $154.00 , $100.10 , $129.36 , $12.08 , $12.08 , $124.43 , $138.60 , $130.38 , $138.60 , $138.60 , $138.60 , $130.90 , $11.84 , $142.19 , $146.30 , $130.90 , $143.22 , $143.22 , $146.30 , $147.84 , $126.00 , $138.60 , $130.90 , $121.66 , N/A , $124.63 , $124.63 , $146.30 , $132.15 , $11.84 , $147.84 
 OLANZAPINE 10 MG IM SOLR ,HCPCS J2359,0250 - PHARMACY,55150-0308-01,2 mL, $218.48 , $142.01 , $183.52 , N/A , N/A , $176.53 , $196.63 , $184.97 , $196.63 , $196.63 , $196.63 , $185.71 , N/A , $201.72 , $207.56 , $185.71 , $203.19 , $203.19 , $207.56 , $209.74 , $178.76 , $196.63 , $185.71 , $172.60 , N/A , $176.82 , $176.82 , $207.56 , $187.48 , $172.60 , $209.74 
X-Ray Cerv Spine 7 Vw,CPT® 72052,N/A,N/A,N/A, $527.00 , $342.55 , $350.67 , $61.26 , $62.79 , $265.81 , $372.87 , $490.11 , $474.30 , $474.30 , $421.60 , $421.60 , $62.79 , $486.58 , $500.65 , $474.30 , $474.30 , $474.30 , $490.11 , $505.92 , $341.82 , $447.95 , $362.10 , $282.37 , N/A , $270.99 , $270.99 , $500.65 , $313.70 , $61.26 , $505.92 
 Pro Surgical Arthroscopy Shoulder Lmtd Dbrdmt 1/2 ,CPT® 29822,0975 - PRO FEE/OR,N/A,N/A," $2,772.00 "," $1,801.80 "," $3,304.02 ", $518.48 , $420.46 ," $2,747.80 "," $2,772.74 "," $2,577.96 "," $2,494.80 "," $2,494.80 "," $2,217.60 "," $2,217.60 ", $420.46 ," $2,559.39 "," $2,633.40 "," $2,494.80 "," $2,494.80 "," $2,494.80 "," $2,577.96 "," $2,661.12 "," $3,071.96 "," $2,356.20 "," $3,061.45 "," $3,256.81 ", N/A ," $2,801.42 "," $2,801.42 "," $2,633.40 "," $3,292.65 ", $420.46 ," $3,304.02 "
 Fac Iadna Mycoplasma Genitalium Amplified Probe Tech ,CPT® 87563,0306 - LAB/BACT-MICRO,N/A,N/A, $314.00 , $204.10 , $263.76 , $35.79 , $28.63 , $253.71 , $282.60 , $265.83 , $282.60 , $282.60 , $282.60 , $266.90 , $28.07 , $289.92 , $298.30 , $266.90 , $292.02 , $292.02 , $298.30 , $301.44 , $256.91 , $282.60 , $266.90 , $248.06 , N/A , $254.12 , $254.12 , $298.30 , $269.44 , $28.07 , $301.44 
" Pro Laparoscopy, Appendectomy ",CPT® 44970,0983 - PRO FEE/CLINIC,N/A,N/A," $5,469.00 "," $3,554.85 "," $3,603.80 ", $559.02 , $505.80 ," $2,823.58 "," $2,862.61 "," $5,086.17 "," $4,922.10 "," $4,922.10 "," $4,375.20 "," $4,375.20 ", $505.80 ," $5,049.53 "," $5,195.55 "," $4,922.10 "," $4,922.10 "," $4,922.10 "," $5,086.17 "," $5,250.24 "," $2,577.70 "," $4,648.65 "," $3,179.20 "," $3,336.46 ", N/A ," $2,878.67 "," $2,878.67 "," $5,195.55 "," $3,010.78 ", $505.80 ," $5,250.24 "
 Fac Drug Screen Quantitative Clozapine ,CPT® 80159,0301 - LAB/CHEMISTRY,N/A,N/A, $176.00 , $114.40 , $147.84 , $20.55 , $20.55 , $142.21 , $158.40 , $149.00 , $158.40 , $158.40 , $158.40 , $149.60 , $20.15 , $162.50 , $167.20 , $149.60 , $163.68 , $163.68 , $167.20 , $168.96 , $144.00 , $158.40 , $149.60 , $139.04 , N/A , $142.44 , $142.44 , $167.20 , $151.03 , $20.15 , $168.96 
Non-Pneum Walk Boot Prefab,HCPCS L4386,N/A,N/A,N/A, $264.00 , $171.60 , N/A , $185.47 , $131.51 , N/A , N/A , $245.52 , $237.60 , $237.60 , $211.20 , $211.20 , $131.51 , $243.75 , $250.80 , $237.60 , $237.60 , $237.60 , $245.52 , $253.44 , N/A , $224.40 , $153.11 , $156.03 , N/A , N/A , N/A , $250.80 , N/A , $131.51 , $253.44 
 Pelvis CT Scan Without/With Contrast ,CPT® 72194,0350 - CT SCAN,N/A,N/A," $3,948.00 "," $2,566.20 "," $3,316.32 ", $231.85 , $366.31 ," $3,189.98 "," $3,553.20 "," $3,342.38 "," $3,553.20 "," $3,553.20 "," $3,553.20 "," $3,355.80 ", $359.13 ," $3,645.19 "," $3,750.60 "," $3,355.80 "," $3,671.64 "," $3,671.64 "," $3,750.60 "," $3,790.08 "," $3,230.25 "," $3,553.20 "," $3,355.80 "," $3,118.92 ", N/A ," $3,195.12 "," $3,195.12 "," $3,750.60 "," $3,387.78 ", $231.85 ," $3,790.08 "
 PHYTONADIONE 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,69238-1051-03,1 tablet, $344.11 , $223.67 , $289.05 , N/A , N/A , $278.04 , $309.70 , $291.32 , $309.70 , $309.70 , $309.70 , $292.49 , N/A , $317.72 , $326.90 , $292.49 , $320.02 , $320.02 , $326.90 , $330.35 , $281.55 , $309.70 , $292.49 , $271.85 , N/A , $278.49 , $278.49 , $326.90 , $295.28 , $271.85 , $330.35 
 Pro Release Palm Contracture ,CPT® 26121,0975 - PRO FEE/OR,N/A,N/A," $1,993.00 "," $1,295.45 "," $3,675.36 ", $577.80 , $768.40 ," $2,871.39 "," $2,868.14 "," $1,853.49 "," $1,793.70 "," $1,793.70 "," $1,594.40 "," $1,594.40 ", $768.40 ," $1,840.14 "," $1,893.35 "," $1,793.70 "," $1,793.70 "," $1,793.70 "," $1,853.49 "," $1,913.28 "," $3,414.48 "," $1,694.05 "," $3,154.23 "," $3,411.54 ", N/A ," $2,927.41 "," $2,927.41 "," $1,893.35 "," $3,440.75 ", $577.80 ," $3,675.36 "
Arthrogram of Shoulder,CPT® 73040,N/A,N/A,N/A," $1,330.00 ", $864.50 , $752.32 , $129.87 , $101.89 , $476.41 , $566.20 ," $1,236.90 "," $1,197.00 "," $1,197.00 "," $1,064.00 "," $1,064.00 ", $101.89 ," $1,227.99 "," $1,263.50 "," $1,197.00 "," $1,197.00 "," $1,197.00 "," $1,236.90 "," $1,276.80 ", $723.06 ," $1,130.50 ", $618.26 , $511.89 , N/A , $485.71 , $485.71 ," $1,263.50 ", $562.21 , $101.89 ," $1,276.80 "
Removal of Omentum,CPT® 49255,N/A,N/A,N/A," $5,166.00 "," $3,357.90 "," $4,760.28 ", $740.69 , $736.76 ," $3,721.69 "," $3,779.65 "," $4,804.38 "," $4,649.40 "," $4,649.40 "," $4,132.80 "," $4,132.80 ", $736.76 ," $4,769.77 "," $4,907.70 "," $4,649.40 "," $4,649.40 "," $4,649.40 "," $4,804.38 "," $4,959.36 "," $3,406.31 "," $4,391.10 "," $4,192.55 "," $4,419.18 ", N/A ," $3,794.32 "," $3,794.32 "," $4,907.70 "," $3,968.44 ", $736.76 ," $4,959.36 "
"Enterocystoplasty,W/Bowel Anastomosis",CPT® 51960,N/A,N/A,N/A," $9,652.00 "," $6,273.80 "," $7,479.60 "," $1,313.64 "," $1,386.62 "," $6,791.30 "," $6,326.71 "," $8,976.36 "," $8,686.80 "," $8,686.80 "," $7,721.60 "," $7,721.60 "," $1,386.62 "," $8,911.69 "," $9,169.40 "," $8,686.80 "," $8,686.80 "," $8,686.80 "," $8,976.36 "," $9,265.92 "," $7,510.02 "," $8,204.20 "," $7,179.07 "," $8,524.18 ", N/A ," $6,923.81 "," $6,923.81 "," $9,169.40 "," $8,137.94 "," $1,313.64 "," $9,265.92 "
Evac. Subungual Hematoma,CPT® 11740,N/A,N/A,N/A, $187.00 , $121.55 , $101.46 , $30.96 , $37.00 , $89.90 , $88.22 , $173.91 , $168.30 , $168.30 , $149.60 , $149.60 , $37.00 , $172.66 , $177.65 , $168.30 , $168.30 , $168.30 , $173.91 , $179.52 , $110.68 , $158.95 , $173.05 , $117.10 , N/A , $91.66 , $91.66 , $177.65 , $106.30 , $30.96 , $179.52 
"Knee Scope,Single Menisectomy",29880,N/A,N/A,N/A," $4,171.00 "," $2,711.15 "," $3,426.35 ", $537.81 , $595.32 ," $2,716.58 "," $2,722.07 "," $3,879.03 "," $3,753.90 "," $3,753.90 "," $3,336.80 "," $3,336.80 ", $595.32 ," $3,851.08 "," $3,962.45 "," $3,753.90 "," $3,753.90 "," $3,753.90 "," $3,879.03 "," $4,004.16 "," $3,187.06 "," $3,545.35 "," $3,004.36 "," $3,207.23 ", N/A ," $2,769.58 "," $2,769.58 "," $3,962.45 "," $3,255.23 ", $537.81 ," $4,004.16 "
 Pro Xcapsl Ctrc Rmvl Insj Io Lens Prosth Cplx WO Ecp ,CPT® 66982,0975 - PRO FEE/OR,N/A,N/A," $6,377.00 "," $4,145.05 "," $4,590.24 ", $719.58 , $590.85 ," $4,503.46 "," $4,211.34 "," $5,930.61 "," $5,739.30 "," $5,739.30 "," $5,101.60 "," $5,101.60 ", $590.85 ," $5,887.88 "," $6,058.15 "," $5,739.30 "," $5,739.30 "," $5,739.30 "," $5,930.61 "," $6,121.92 "," $6,310.51 "," $5,420.45 "," $4,344.20 "," $5,713.83 ", N/A ," $4,591.33 "," $4,591.33 "," $6,058.15 "," $5,068.22 ", $590.85 ," $6,310.51 "
 Pro Diagnostic Mammography Computer-Aided Detcj Bi ,CPT® 77066,0972 - PRO FEE/RAD/DX,N/A,N/A, $235.00 , $152.75 , $901.96 , $156.27 , $133.81 , $779.21 , $864.47 , $218.55 , $211.50 , $211.50 , $188.00 , $188.00 , $133.81 , $216.98 , $223.25 , $211.50 , $211.50 , $211.50 , $218.55 , $225.60 , $900.41 , $199.75 , $909.30 , $924.37 , N/A , $794.41 , $794.41 , $223.25 , $919.55 , $133.81 , $924.37 
Removal of Indwelling Tunneled Pleural Catheter With Cuff,CPT® 32552,N/A,N/A,N/A," $1,026.00 ", $666.90 , $850.20 , $148.82 , $151.27 , $612.07 , $619.59 , $954.18 , $923.40 , $923.40 , $820.80 , $820.80 , $151.27 , $947.31 , $974.70 , $923.40 , $923.40 , $923.40 , $954.18 , $984.96 , $825.52 , $872.10 , $890.25 , $810.70 , N/A , $624.01 , $624.01 , $974.70 , $734.91 , $148.82 , $984.96 
Total Hip Arthroplasty,CPT® 27130,N/A,N/A,N/A," $8,944.00 "," $5,813.60 "," $7,729.22 "," $1,207.86 "," $1,274.03 "," $6,553.93 "," $6,887.98 "," $8,317.92 "," $8,049.60 "," $8,049.60 "," $7,155.20 "," $7,155.20 "," $1,274.03 "," $8,258.00 "," $8,496.80 "," $8,049.60 "," $8,049.60 "," $8,049.60 "," $8,317.92 "," $8,586.24 "," $8,507.46 "," $7,602.40 "," $7,626.87 "," $7,706.23 ", N/A ," $6,681.80 "," $6,681.80 "," $8,496.80 "," $7,853.49 "," $1,207.86 "," $8,586.24 "
"Anoscopy,Diagnostic",CPT® 46600,N/A,N/A,N/A, $586.00 , $380.90 , $248.37 , $39.14 , $31.62 , $195.21 , $200.98 , $544.98 , $527.40 , $527.40 , $468.80 , $468.80 , $31.62 , $541.05 , $556.70 , $527.40 , $527.40 , $527.40 , $544.98 , $562.56 , $176.09 , $498.10 , $219.44 , $235.21 , N/A , $199.01 , $199.01 , $556.70 , $208.15 , $31.62 , $562.56 
Wheelchair Mngement Training,CPT® 97542,N/A,N/A,N/A, $163.00 , $105.95 , $62.32 , $31.80 , $19.32 , $69.44 , $61.53 , $151.59 , $146.70 , $146.70 , $130.40 , $130.40 , $19.32 , $150.50 , $154.85 , $146.70 , $146.70 , $146.70 , $151.59 , $156.48 , $81.20 , $138.55 , $90.22 , $75.74 , N/A , $70.80 , $70.80 , $154.85 , $78.74 , $19.32 , $156.48 
"Thrombin Time, Plasma",CPT® 85670,N/A,N/A,N/A, $115.00 , $74.75 , N/A , $5.89 , N/A , $32.64 , $39.04 , $106.95 , $103.50 , $103.50 , $92.00 , $92.00 , N/A , $106.18 , $109.25 , $103.50 , $103.50 , $103.50 , $106.95 , $110.40 , $38.53 , $97.75 , $37.30 , $20.91 , N/A , $30.46 , $30.46 , $109.25 , $33.28 , $5.89 , $110.40 
 Folic Acid Beaker1 ,CPT® 82746,0301 - LAB/CHEMISTRY,N/A,N/A, $148.00 , $96.20 , $124.32 , $14.99 , $14.99 , $119.58 , $133.20 , $125.30 , $133.20 , $133.20 , $133.20 , $125.80 , $14.70 , $136.65 , $140.60 , $125.80 , $137.64 , $137.64 , $140.60 , $142.08 , $121.09 , $133.20 , $125.80 , $116.92 , N/A , $119.78 , $119.78 , $140.60 , $127.00 , $14.70 , $142.08 
Stab Phlebotomy Veins-Extrem 20+,CPT® 37766,N/A,N/A,N/A," $4,779.00 "," $3,106.35 "," $1,954.55 ", $301.84 , $561.28 ," $2,379.97 "," $2,397.35 "," $4,444.47 "," $4,301.10 "," $4,301.10 "," $3,823.20 "," $3,823.20 ", $561.28 ," $4,412.45 "," $4,540.05 "," $4,301.10 "," $4,301.10 "," $4,301.10 "," $4,444.47 "," $4,587.84 "," $1,804.91 "," $4,062.15 "," $3,004.36 "," $2,662.27 ", N/A ," $2,426.41 "," $2,426.41 "," $4,540.05 "," $2,756.40 ", $301.84 ," $4,587.84 "
 IR Inj Non-Compounded Sclerosant Multi Vein Inc Guidance ,CPT® 36466,0360 - OR SERVICES,N/A,N/A," $2,835.00 "," $1,842.75 "," $2,381.40 ", $139.87 , N/A ," $2,290.68 "," $2,551.50 "," $2,400.11 "," $2,551.50 "," $2,551.50 "," $2,551.50 "," $2,409.75 ", N/A ," $2,617.56 "," $2,693.25 "," $2,409.75 "," $2,636.55 "," $2,636.55 "," $2,693.25 "," $2,721.60 "," $2,319.60 "," $2,551.50 "," $2,409.75 "," $2,239.65 ", N/A ," $2,294.37 "," $2,294.37 "," $2,693.25 "," $2,432.71 ", $139.87 ," $2,721.60 "
 Fac Drug Screen Quant Alcohols Biomarkers 1 or 2 ,CPT® 80321,0301 - LAB/CHEMISTRY,N/A,N/A, $270.00 , $175.50 , $226.80 , N/A , N/A , $218.16 , $243.00 , $228.58 , $243.00 , $243.00 , $243.00 , $229.50 , N/A , $249.29 , $256.50 , $229.50 , $251.10 , $251.10 , $256.50 , $259.20 , $220.91 , $243.00 , $229.50 , $213.30 , N/A , $218.51 , $218.51 , $256.50 , $231.69 , $213.30 , $259.20 
 Pro Ftl Biophysical Profile Non-Strs Tstg ,CPT® 76818,0972 - PRO FEE/RAD/DX,N/A,N/A, $432.00 , $280.80 , $651.05 , $115.42 , $106.98 , $581.96 , $653.05 , $401.76 , $388.80 , $388.80 , $345.60 , $345.60 , $106.98 , $398.87 , $410.40 , $388.80 , $388.80 , $388.80 , $401.76 , $414.72 , $648.62 , $367.20 , $712.64 , $691.01 , N/A , $593.31 , $593.31 , $410.40 , $686.77 , $106.98 , $712.64 
 DONEPEZIL HCL 10 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6478-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Cabg, Artery-Vein, Four",CPT® 33521,N/A,N/A,N/A," $7,457.00 "," $4,847.05 "," $3,781.96 ", $582.12 , $517.82 ," $2,787.73 "," $2,758.12 "," $6,935.01 "," $6,711.30 "," $6,711.30 "," $5,965.60 "," $5,965.60 ", $517.82 ," $6,885.05 "," $7,084.15 "," $6,711.30 "," $6,711.30 "," $6,711.30 "," $6,935.01 "," $7,158.72 "," $3,512.11 "," $6,338.45 "," $3,503.90 "," $3,120.50 ", N/A ," $2,842.13 "," $2,842.13 "," $7,084.15 "," $3,228.66 ", $517.82 ," $7,158.72 "
 BACITRA-NEOMYCIN-POLYMYXIN-HC 1 % OP OINT ,HCPCS RXC637,0250 - PHARMACY,24208-0785-55,3.5 gram, $334.16 , $217.20 , $280.69 , N/A , N/A , $270.00 , $300.74 , $282.90 , $300.74 , $300.74 , $300.74 , $284.04 , N/A , $308.53 , $317.45 , $284.04 , $310.77 , $310.77 , $317.45 , $320.79 , $273.41 , $300.74 , $284.04 , $263.99 , N/A , $270.44 , $270.44 , $317.45 , $286.74 , $263.99 , $320.79 
"Open Rx Tibia Shaft Fx,Screws",CPT® 27758,N/A,N/A,N/A," $5,212.00 "," $3,387.80 "," $5,440.05 ", $851.77 , $775.54 ," $4,302.26 "," $4,276.45 "," $4,847.16 "," $4,690.80 "," $4,690.80 "," $4,169.60 "," $4,169.60 ", $775.54 ," $4,812.24 "," $4,951.40 "," $4,690.80 "," $4,690.80 "," $4,690.80 "," $4,847.16 "," $5,003.52 "," $5,056.37 "," $4,430.20 "," $4,725.99 "," $5,063.13 ", N/A ," $4,386.20 "," $4,386.20 "," $4,951.40 "," $5,155.35 ", $775.54 ," $5,440.05 "
 Fac Assay of Parathormone ,CPT® 83970,0301 - LAB/CHEMISTRY,N/A,N/A, $381.00 , $247.65 , $320.04 , $42.11 , $42.11 , $307.85 , $342.90 , $322.55 , $342.90 , $342.90 , $342.90 , $323.85 , $41.28 , $351.78 , $361.95 , $323.85 , $354.33 , $354.33 , $361.95 , $365.76 , $311.73 , $342.90 , $323.85 , $300.99 , N/A , $308.34 , $308.34 , $361.95 , $326.94 , $41.28 , $365.76 
 Fac Esophagoscopy Flexible Transnasal Diagnostic ,CPT® 43197,0360 - OR SERVICES,N/A,N/A, $936.00 , $608.40 , $786.24 , $77.37 , $138.90 , $756.29 , $842.40 , $792.42 , $842.40 , $842.40 , $842.40 , $795.60 , $136.18 , $864.21 , $889.20 , $795.60 , $870.48 , $870.48 , $889.20 , $898.56 , $765.84 , $842.40 , $795.60 , $739.44 , N/A , $757.50 , $757.50 , $889.20 , $803.18 , $77.37 , $898.56 
 Fac Njx Ilesn > 7 ,CPT® 11901,0360 - OR SERVICES,N/A,N/A, $290.00 , $188.50 , $243.60 , $43.95 , $20.32 , $234.32 , $261.00 , $245.51 , $261.00 , $261.00 , $261.00 , $246.50 , $19.92 , $267.76 , $275.50 , $246.50 , $269.70 , $269.70 , $275.50 , $278.40 , $237.28 , $261.00 , $246.50 , $229.10 , N/A , $234.70 , $234.70 , $275.50 , $248.85 , $19.92 , $278.40 
Eo W/O Joints Cf,HCPCS L3702,N/A,N/A,N/A, $438.00 , $284.70 , N/A , $307.41 , $132.15 , N/A , N/A , $407.34 , $394.20 , $394.20 , $350.40 , $350.40 , $132.15 , $404.41 , $416.10 , $394.20 , $394.20 , $394.20 , $407.34 , $420.48 , N/A , $372.30 , $253.66 , $258.63 , N/A , N/A , N/A , $416.10 , N/A , $132.15 , $420.48 
 VORICONAZOLE 200 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-7024-04,1 tablet, $142.80 , $92.82 , $119.95 , N/A , N/A , $115.38 , $128.52 , $120.89 , $128.52 , $128.52 , $128.52 , $121.38 , N/A , $131.85 , $135.66 , $121.38 , $132.80 , $132.80 , $135.66 , $137.09 , $116.84 , $128.52 , $121.38 , $112.81 , N/A , $115.57 , $115.57 , $135.66 , $122.54 , $112.81 , $137.09 
 PROPARACAINE HCL 0.5 % OP SOLN ,HCPCS RXA250,0250 - PHARMACY,61314-0016-01,15 mL, $225.39 , $146.50 , $189.33 , N/A , N/A , $182.12 , $202.85 , $190.82 , $202.85 , $202.85 , $202.85 , $191.58 , N/A , $208.10 , $214.12 , $191.58 , $209.61 , $209.61 , $214.12 , $216.37 , $184.41 , $202.85 , $191.58 , $178.06 , N/A , $182.41 , $182.41 , $214.12 , $193.41 , $178.06 , $216.37 
"Exc Skin Benig >4cm Trunk,Arm,Leg",11406,N/A,N/A,N/A," $1,487.00 ", $966.55 , $784.82 , $234.46 , $381.08 , $667.03 , $648.45 ," $1,382.91 "," $1,338.30 "," $1,338.30 "," $1,189.60 "," $1,189.60 ", $381.08 ," $1,372.95 "," $1,412.65 "," $1,338.30 "," $1,338.30 "," $1,338.30 "," $1,382.91 "," $1,427.52 ", $857.06 ," $1,263.95 "," $1,302.37 ", $852.08 , N/A , $680.04 , $680.04 ," $1,412.65 ", $788.62 , $234.46 ," $1,427.52 "
 Pro Remove Foreign Body From Eye ,CPT® 65220,0982 - PRO FEE/OUTPT,N/A,N/A, $537.00 , $349.05 , $250.45 , $39.41 , $47.02 , $236.97 , $219.45 , $499.41 , $483.30 , $483.30 , $429.60 , $429.60 , $47.02 , $495.81 , $510.15 , $483.30 , $483.30 , $483.30 , $499.41 , $515.52 , $347.54 , $456.45 , $226.58 , $300.51 , N/A , $241.60 , $241.60 , $510.15 , $266.70 , $39.41 , $515.52 
 Fac Sleep Std Vntj Respir Ecg/Hrt Rate&O2 Sat Unattn ,CPT® 95806,0920 - OTHER DX SVS,N/A,N/A, $849.00 , $551.85 , $713.16 , $90.26 , $166.30 , $685.99 , $764.10 , $718.76 , $764.10 , $764.10 , $764.10 , $721.65 , $163.04 , $783.88 , $806.55 , $721.65 , $789.57 , $789.57 , $806.55 , $815.04 , $694.65 , $764.10 , $721.65 , $670.71 , N/A , $687.10 , $687.10 , $806.55 , $728.53 , $90.26 , $815.04 
"Electrocardiogram, Tracing",CPT® 93005,N/A,N/A,N/A, $121.00 , $78.65 , $36.66 , $6.02 , $16.74 , $59.02 , $56.08 , $112.53 , $108.90 , $108.90 , $96.80 , $96.80 , $16.74 , $111.72 , $114.95 , $108.90 , $108.90 , $108.90 , $112.53 , $116.16 , $38.38 , $102.85 , $53.52 , $31.14 , N/A , $60.17 , $60.17 , $114.95 , $73.47 , $6.02 , $116.16 
"Avulsion Nail Plate,Singl",11730,N/A,N/A,N/A, $385.00 , $250.25 , $174.35 , $51.83 , $42.84 , $140.67 , $134.38 , $358.05 , $346.50 , $346.50 , $308.00 , $308.00 , $42.84 , $355.47 , $365.75 , $346.50 , $346.50 , $346.50 , $358.05 , $369.60 , $192.28 , $327.25 , $262.26 , $198.13 , N/A , $143.42 , $143.42 , $365.75 , $166.31 , $42.84 , $369.60 
Mast Gynecomastia,CPT® 19300,N/A,N/A,N/A," $3,111.00 "," $2,022.15 "," $1,372.89 ", $410.11 , $397.21 ," $1,113.74 "," $1,088.11 "," $2,893.23 "," $2,799.90 "," $2,799.90 "," $2,488.80 "," $2,488.80 ", $397.21 ," $2,872.39 "," $2,955.45 "," $2,799.90 "," $2,799.90 "," $2,799.90 "," $2,893.23 "," $2,986.56 "," $1,482.91 "," $2,644.35 "," $2,187.26 "," $1,423.88 ", N/A ," $1,135.47 "," $1,135.47 "," $2,955.45 "," $1,316.75 ", $397.21 ," $2,986.56 "
"Destruct by Neuro Agent, Plantar Digital Nerve",CPT® 64632,N/A,N/A,N/A, $574.00 , $373.10 , $331.76 , $64.94 , $77.08 , $387.66 , $373.99 , $533.82 , $516.60 , $516.60 , $459.20 , $459.20 , $77.08 , $529.97 , $545.30 , $516.60 , $516.60 , $516.60 , $533.82 , $551.04 , $358.24 , $487.90 , $362.17 , $419.89 , N/A , $395.22 , $395.22 , $545.30 , $423.98 , $64.94 , $551.04 
 FLEET PEDIATRIC 3.5-9.5 GM/59ML RE ENEM ,HCPCS RXC637,0250 - PHARMACY,00132-0202-20,1 enema, $11.19 , $7.27 , $9.40 , N/A , N/A , $9.04 , $10.07 , $9.47 , $10.07 , $10.07 , $10.07 , $9.51 , N/A , $10.33 , $10.63 , $9.51 , $10.41 , $10.41 , $10.63 , $10.74 , $9.16 , $10.07 , $9.51 , $8.84 , N/A , $9.06 , $9.06 , $10.63 , $9.60 , $8.84 , $10.74 
 Pro Clsd Tx Distal Radial Fx W Manip ,CPT® 25605,0982 - PRO FEE/OUTPT,N/A,N/A," $2,147.00 "," $1,395.55 "," $3,147.43 ", $496.56 , $388.30 ," $2,466.77 "," $2,502.71 "," $1,996.71 "," $1,932.30 "," $1,932.30 "," $1,717.60 "," $1,717.60 ", $388.30 ," $1,982.33 "," $2,039.65 "," $1,932.30 "," $1,932.30 "," $1,932.30 "," $1,996.71 "," $2,061.12 "," $2,912.52 "," $1,824.95 "," $2,754.59 "," $2,906.58 ", N/A ," $2,514.91 "," $2,514.91 "," $2,039.65 "," $2,955.90 ", $388.30 ," $3,147.43 "
 Fac Assay of Renin ,CPT® 84244,0301 - LAB/CHEMISTRY,N/A,N/A, $260.00 , $169.00 , $218.40 , $22.43 , $22.43 , $210.08 , $234.00 , $220.12 , $234.00 , $234.00 , $234.00 , $221.00 , $21.99 , $240.06 , $247.00 , $221.00 , $241.80 , $241.80 , $247.00 , $249.60 , $212.73 , $234.00 , $221.00 , $205.40 , N/A , $210.42 , $210.42 , $247.00 , $223.11 , $21.99 , $249.60 
 ACAMPROSATE CALCIUM 333 MG PO TBEC ,HCPCS RXC637,0250 - PHARMACY,60687-0121-25,2 tablet, $27.87 , $18.12 , $23.41 , N/A , N/A , $22.52 , $25.08 , $23.59 , $25.08 , $25.08 , $25.08 , $23.69 , N/A , $25.73 , $26.48 , $23.69 , $25.92 , $25.92 , $26.48 , $26.76 , $22.80 , $25.08 , $23.69 , $22.02 , N/A , $22.56 , $22.56 , $26.48 , $23.92 , $22.02 , $26.76 
" Fac Ext Ecg Record Contin 48 Hr, Scan Analysis W Report ",CPT® 93226,0731 - HOLTER MONT,N/A,N/A, $818.00 , $531.70 , $687.12 , $35.24 , $82.91 , $660.94 , $736.20 , $692.52 , $736.20 , $736.20 , $736.20 , $695.30 , $81.28 , $755.26 , $777.10 , $695.30 , $760.74 , $760.74 , $777.10 , $785.28 , $669.29 , $736.20 , $695.30 , $646.22 , N/A , $662.01 , $662.01 , $777.10 , $701.93 , $35.24 , $785.28 
Igh@ Variable Region Somatic Mutation Analysis,CPT® 81263,N/A,N/A,N/A," $2,545.00 "," $1,654.25 ", N/A , $300.41 , $300.41 ," $1,666.27 "," $1,973.24 "," $2,366.85 "," $2,290.50 "," $2,290.50 "," $2,036.00 "," $2,036.00 ", $300.41 ," $2,349.80 "," $2,417.75 "," $2,290.50 "," $2,290.50 "," $2,290.50 "," $2,366.85 "," $2,443.20 "," $1,966.58 "," $2,163.25 "," $1,403.76 "," $1,067.89 ", N/A ," $1,555.07 "," $1,555.07 "," $2,417.75 "," $1,699.35 ", $300.41 ," $2,443.20 "
Thoractomy W/Dx Bx Lung Nodule/Mass Unilateral,CPT® 32097,N/A,N/A,N/A," $6,455.00 "," $4,195.75 "," $4,160.30 ", $728.36 , $618.85 ," $3,042.34 "," $2,997.14 "," $6,003.15 "," $5,809.50 "," $5,809.50 "," $5,164.00 "," $5,164.00 ", $618.85 ," $5,959.90 "," $6,132.25 "," $5,809.50 "," $5,809.50 "," $5,809.50 "," $6,003.15 "," $6,196.80 "," $4,023.86 "," $5,486.75 "," $4,329.92 "," $3,990.90 ", N/A ," $3,101.70 "," $3,101.70 "," $6,132.25 "," $3,652.90 ", $618.85 ," $6,196.80 "
Repair Nonunion Radius or Ulna,CPT® 25400,N/A,N/A,N/A," $3,142.00 "," $2,042.30 "," $4,887.61 ", $766.88 , $603.45 ," $3,871.95 "," $3,842.85 "," $2,922.06 "," $2,827.80 "," $2,827.80 "," $2,513.60 "," $2,513.60 ", $603.45 ," $2,901.01 "," $2,984.90 "," $2,827.80 "," $2,827.80 "," $2,827.80 "," $2,922.06 "," $3,016.32 "," $4,550.49 "," $2,670.70 "," $4,237.15 "," $4,578.54 ", N/A ," $3,947.50 "," $3,947.50 "," $2,984.90 "," $4,639.72 ", $603.45 ," $4,887.61 "
 Fac Sigmoidoscopy Flx Tndsc Balo Dilat ,CPT® 45340,0360 - OR SERVICES,N/A,N/A," $1,229.00 ", $798.85 ," $1,032.36 ", $74.05 , $270.89 , $993.03 ," $1,106.10 "," $1,040.47 "," $1,106.10 "," $1,106.10 "," $1,106.10 "," $1,044.65 ", $265.58 ," $1,134.74 "," $1,167.55 "," $1,044.65 "," $1,142.97 "," $1,142.97 "," $1,167.55 "," $1,179.84 "," $1,005.57 "," $1,106.10 "," $1,044.65 ", $970.91 , N/A , $994.63 , $994.63 ," $1,167.55 "," $1,054.60 ", $74.05 ," $1,179.84 "
" Pro Scope Bladder, Removal of Tumors, Medium ",CPT® 52235,0982 - PRO FEE/OUTPT,N/A,N/A," $1,935.00 "," $1,257.75 "," $1,544.39 ", $271.60 , $294.09 ," $1,414.72 "," $1,312.81 "," $1,799.55 "," $1,741.50 "," $1,741.50 "," $1,548.00 "," $1,548.00 ", $294.09 ," $1,786.59 "," $1,838.25 "," $1,741.50 "," $1,741.50 "," $1,741.50 "," $1,799.55 "," $1,857.60 "," $1,553.70 "," $1,644.75 "," $1,486.13 "," $1,776.87 ", N/A ," $1,442.32 "," $1,442.32 "," $1,838.25 "," $1,695.24 ", $271.60 ," $1,857.60 "
"Exc Skin Malig >4cm Trunk,Arm,Leg",11606,N/A,N/A,N/A," $1,933.00 "," $1,256.45 "," $1,003.41 ", $298.77 , $439.58 , $869.82 , $842.77 ," $1,797.69 "," $1,739.70 "," $1,739.70 "," $1,546.40 "," $1,546.40 ", $439.58 ," $1,784.74 "," $1,836.35 "," $1,739.70 "," $1,739.70 "," $1,739.70 "," $1,797.69 "," $1,855.68 "," $1,100.70 "," $1,643.05 "," $1,689.51 "," $1,111.40 ", N/A , $886.79 , $886.79 ," $1,836.35 "," $1,028.36 ", $298.77 ," $1,855.68 "
" Pro Insert Bladder Cath, Complex ",CPT® 51703,0981 - PRO FEE/ER,N/A,N/A, $680.00 , $442.00 , $412.39 , $72.47 , $143.34 , $399.54 , $371.51 , $632.40 , $612.00 , $612.00 , $544.00 , $544.00 , $143.34 , $627.84 , $646.00 , $612.00 , $612.00 , $612.00 , $632.40 , $652.80 , $413.36 , $578.00 , $419.26 , $473.02 , N/A , $407.34 , $407.34 , $646.00 , $478.77 , $72.47 , $652.80 
" Fac Herpes Simplex 2, Ag, If ",CPT® 87273,0305 - LAB/HEMATOLOGY,N/A,N/A, $192.00 , $124.80 , $161.28 , $12.22 , $12.22 , $155.14 , $172.80 , $162.55 , $172.80 , $172.80 , $172.80 , $163.20 , $11.98 , $177.27 , $182.40 , $163.20 , $178.56 , $178.56 , $182.40 , $184.32 , $157.09 , $172.80 , $163.20 , $151.68 , N/A , $155.39 , $155.39 , $182.40 , $164.76 , $11.98 , $184.32 
 Nras Gene Analysis Rml 81311 ,CPT® 81311,0310 - PATHOLOGY LAB,N/A,N/A," $1,230.00 ", $799.50 ," $1,033.20 ", $301.71 , $178.60 , $993.84 ," $1,107.00 "," $1,041.32 "," $1,107.00 "," $1,107.00 "," $1,107.00 "," $1,045.50 ", $175.10 ," $1,135.66 "," $1,168.50 "," $1,045.50 "," $1,143.90 "," $1,143.90 "," $1,168.50 "," $1,180.80 "," $1,006.39 "," $1,107.00 "," $1,045.50 ", $971.70 , N/A , $995.44 , $995.44 ," $1,168.50 "," $1,055.46 ", $175.10 ," $1,180.80 "
Rpr Aa Hernia 1st 3-10 Cm Ncrc8/Strangulated,CPT® 49594,N/A,N/A,N/A," $6,346.00 "," $4,124.90 ", N/A , $681.55 , $531.94 , N/A , N/A ," $5,901.78 "," $5,711.40 "," $5,711.40 "," $5,076.80 "," $5,076.80 ", $531.94 ," $5,859.26 "," $6,028.70 "," $5,711.40 "," $5,711.40 "," $5,711.40 "," $5,901.78 "," $6,092.16 ", N/A ," $5,394.10 "," $3,953.70 ", N/A , N/A ," $2,934.14 "," $2,934.14 "," $6,028.70 "," $3,071.79 ", $531.94 ," $6,092.16 "
Biopsy of Ovary(S),CPT® 58900,N/A,N/A,N/A," $2,709.00 "," $1,760.85 "," $2,076.90 ", $420.32 , $677.98 ," $1,680.72 "," $1,709.00 "," $2,519.37 "," $2,438.10 "," $2,438.10 "," $2,167.20 "," $2,167.20 ", $677.98 ," $2,501.22 "," $2,573.55 "," $2,438.10 "," $2,438.10 "," $2,438.10 "," $2,519.37 "," $2,600.64 "," $2,152.02 "," $2,302.65 "," $2,267.55 "," $1,687.21 ", N/A ," $1,713.50 "," $1,713.50 "," $2,573.55 "," $2,055.24 ", $420.32 ," $2,600.64 "
Open Biopsy of Hip Joint,27052,N/A,N/A,N/A," $3,802.00 "," $2,471.30 "," $3,526.84 ", $554.49 , $893.47 ," $2,793.39 "," $2,790.13 "," $3,535.86 "," $3,421.80 "," $3,421.80 "," $3,041.60 "," $3,041.60 ", $893.47 ," $3,510.39 "," $3,611.90 "," $3,421.80 "," $3,421.80 "," $3,421.80 "," $3,535.86 "," $3,649.92 "," $3,277.81 "," $3,231.70 "," $3,077.51 "," $3,294.82 ", N/A ," $2,847.89 "," $2,847.89 "," $3,611.90 "," $3,347.29 ", $554.49 ," $3,649.92 "
 Fac Bcr/Abl1 Major Breakpnt Qualitative/Quantitative ,CPT® 81206,0310 - PATHOLOGY LAB,N/A,N/A," $1,514.00 ", $984.10 ," $1,271.76 ", $167.24 , $167.24 ," $1,223.31 "," $1,362.60 "," $1,281.75 "," $1,362.60 "," $1,362.60 "," $1,362.60 "," $1,286.90 ", $163.96 ," $1,397.88 "," $1,438.30 "," $1,286.90 "," $1,408.02 "," $1,408.02 "," $1,438.30 "," $1,453.44 "," $1,238.75 "," $1,362.60 "," $1,286.90 "," $1,196.06 ", N/A ," $1,225.28 "," $1,225.28 "," $1,438.30 "," $1,299.16 ", $163.96 ," $1,453.44 "
 PANCRELIPASE (LIP-PROT-AMYL) 24000-76000 UNITS PO CPEP ,HCPCS RXC637,0250 - PHARMACY,00032-1224-01,1 capsule, $48.34 , $31.42 , $40.61 , N/A , N/A , $39.06 , $43.51 , $40.92 , $43.51 , $43.51 , $43.51 , $41.09 , N/A , $44.63 , $45.92 , $41.09 , $44.96 , $44.96 , $45.92 , $46.41 , $39.55 , $43.51 , $41.09 , $38.19 , N/A , $39.12 , $39.12 , $45.92 , $41.48 , $38.19 , $46.41 
"Create Eardrum Opening,Gen Anesth",69436,N/A,N/A,N/A, $650.00 , $422.50 , $758.20 , $155.15 , $218.54 , $769.66 , $796.94 , $604.50 , $585.00 , $585.00 , $520.00 , $520.00 , $218.54 , $600.15 , $617.50 , $585.00 , $585.00 , $585.00 , $604.50 , $624.00 , $818.29 , $552.50 , $868.84 , $772.85 , N/A , $784.68 , $784.68 , $617.50 , $895.96 , $155.15 , $895.96 
"Echo,Scrotum & Contents",CPT® 76870,N/A,N/A,N/A," $1,046.00 ", $679.90 , $575.77 , $99.83 , $95.93 , $321.21 , $658.06 , $972.78 , $941.40 , $941.40 , $836.80 , $836.80 , $95.93 , $965.77 , $993.70 , $941.40 , $941.40 , $941.40 , $972.78 ," $1,004.16 ", $581.12 , $889.10 , $718.41 , $380.72 , N/A , $327.48 , $327.48 , $993.70 , $379.04 , $95.93 ," $1,004.16 "
"Excision Branc Clft Cyst,Deep",CPT® 42815,N/A,N/A,N/A," $4,122.00 "," $2,679.30 "," $3,342.24 ", $523.04 , $490.64 ," $2,697.95 "," $2,785.73 "," $3,833.46 "," $3,709.80 "," $3,709.80 "," $3,297.60 "," $3,297.60 ", $490.64 ," $3,805.84 "," $3,915.90 "," $3,709.80 "," $3,709.80 "," $3,709.80 "," $3,833.46 "," $3,957.12 "," $2,397.56 "," $3,503.70 "," $3,041.83 "," $3,156.95 ", N/A ," $2,750.59 "," $2,750.59 "," $3,915.90 "," $2,876.83 ", $490.64 ," $3,957.12 "
 Fac Assay of Oxalate ,CPT® 83945,0301 - LAB/CHEMISTRY,N/A,N/A, $128.00 , $83.20 , $107.52 , $14.74 , $14.74 , $103.42 , $115.20 , $108.36 , $115.20 , $115.20 , $115.20 , $108.80 , $14.45 , $118.18 , $121.60 , $108.80 , $119.04 , $119.04 , $121.60 , $122.88 , $104.73 , $115.20 , $108.80 , $101.12 , N/A , $103.59 , $103.59 , $121.60 , $109.84 , $14.45 , $122.88 
"Removal Colon/Ileostomy,Continent",CPT® 44151,N/A,N/A,N/A," $13,474.00 "," $8,758.10 "," $12,786.67 "," $1,972.17 "," $1,682.05 "," $10,106.60 "," $10,206.74 "," $12,530.82 "," $12,126.60 "," $12,126.60 "," $10,779.20 "," $10,779.20 "," $1,682.05 "," $12,440.54 "," $12,800.30 "," $12,126.60 "," $12,126.60 "," $12,126.60 "," $12,530.82 "," $12,935.04 "," $9,202.92 "," $11,452.90 "," $11,357.35 "," $11,964.46 ", N/A ," $10,303.80 "," $10,303.80 "," $12,800.30 "," $10,776.68 "," $1,682.05 "," $12,935.04 "
"Full Rout Obste Care,Cesarean Deliv",CPT® 59510,N/A,N/A,N/A," $8,241.00 "," $5,356.65 "," $6,196.40 "," $2,418.17 "," $1,172.31 "," $5,357.97 "," $5,659.86 "," $7,664.13 "," $7,416.90 "," $7,416.90 "," $6,592.80 "," $6,592.80 "," $1,172.31 "," $7,608.92 "," $7,828.95 "," $7,416.90 "," $7,416.90 "," $7,416.90 "," $7,664.13 "," $7,911.36 "," $7,224.11 "," $7,004.85 "," $12,465.26 "," $5,357.14 ", N/A ," $5,462.52 "," $5,462.52 "," $7,828.95 "," $6,315.19 "," $1,172.31 "," $12,465.26 "
 Pro Removal of Sperm Duct(S) ,CPT® 55250,0982 - PRO FEE/OUTPT,N/A,N/A," $1,946.00 "," $1,264.90 "," $1,016.33 ", $220.32 , $303.02 , $727.92 , $743.50 ," $1,809.78 "," $1,751.40 "," $1,751.40 "," $1,556.80 "," $1,556.80 ", $303.02 ," $1,796.74 "," $1,848.70 "," $1,751.40 "," $1,751.40 "," $1,751.40 "," $1,809.78 "," $1,868.16 ", $951.50 ," $1,654.10 "," $1,182.83 "," $1,104.13 ", N/A , $742.12 , $742.12 ," $1,848.70 ", $889.48 , $220.32 ," $1,868.16 "
 OB Each Add Gest Less Than 14wks ,CPT® 76802,0402 - ULTRASOUND,N/A,N/A, $392.00 , $254.80 , $329.28 , $60.65 , $69.63 , $316.74 , $352.80 , $331.87 , $352.80 , $352.80 , $352.80 , $333.20 , $68.26 , $361.93 , $372.40 , $333.20 , $364.56 , $364.56 , $372.40 , $376.32 , $320.73 , $352.80 , $333.20 , $309.68 , N/A , $317.25 , $317.25 , $372.40 , $336.38 , $60.65 , $376.32 
" Epstein-Barr Virus, Antibody to Viral Capsid Antigen - Igg Beaker1 ",CPT® 86665,0302 - LAB/IMMUNOLOGY,N/A,N/A, $159.00 , $103.35 , $133.56 , $18.50 , $18.50 , $128.47 , $143.10 , $134.61 , $143.10 , $143.10 , $143.10 , $135.15 , $18.14 , $146.80 , $151.05 , $135.15 , $147.87 , $147.87 , $151.05 , $152.64 , $130.09 , $143.10 , $135.15 , $125.61 , N/A , $128.68 , $128.68 , $151.05 , $136.44 , $18.14 , $152.64 
 Nonspecific Cerebrovascular Disorders With McC ,MS DRG V40 (FY2023) 070,N/A,N/A,N/A," $39,228.53 "," $25,498.54 "," $32,951.97 ", N/A , N/A ," $31,696.65 "," $35,305.68 "," $33,210.87 "," $35,305.68 "," $35,305.68 "," $35,305.68 "," $33,344.25 ", N/A ," $36,219.70 "," $37,267.10 "," $33,344.25 "," $36,482.53 "," $36,482.53 "," $37,267.10 "," $37,659.39 "," $32,096.78 "," $35,305.68 "," $33,344.25 "," $30,990.54 ", N/A ," $31,747.65 "," $31,747.65 "," $37,267.10 "," $33,662.00 "," $30,990.54 "," $37,659.39 "
 Fac Chromosome Karyotype Study ,CPT® 88280,0310 - PATHOLOGY LAB,N/A,N/A, $240.00 , $156.00 , $201.60 , $34.14 , $34.14 , $193.92 , $216.00 , $203.18 , $216.00 , $216.00 , $216.00 , $204.00 , $33.47 , $221.59 , $228.00 , $204.00 , $223.20 , $223.20 , $228.00 , $230.40 , $196.37 , $216.00 , $204.00 , $189.60 , N/A , $194.23 , $194.23 , $228.00 , $205.94 , $33.47 , $230.40 
" Fac Antistreptolysin O, Titer ",CPT® 86060,0302 - LAB/IMMUNOLOGY,N/A,N/A, $122.00 , $79.30 , $102.48 , $7.45 , $7.45 , $98.58 , $109.80 , $103.29 , $109.80 , $109.80 , $109.80 , $103.70 , $7.30 , $112.64 , $115.90 , $103.70 , $113.46 , $113.46 , $115.90 , $117.12 , $99.82 , $109.80 , $103.70 , $96.38 , N/A , $98.73 , $98.73 , $115.90 , $104.69 , $7.30 , $117.12 
 Fac Assay of Ferritin ,CPT® 82728,0301 - LAB/CHEMISTRY,N/A,N/A, $135.00 , $87.75 , $113.40 , $13.90 , $13.90 , $109.08 , $121.50 , $114.29 , $121.50 , $121.50 , $121.50 , $114.75 , $13.63 , $124.65 , $128.25 , $114.75 , $125.55 , $125.55 , $128.25 , $129.60 , $110.46 , $121.50 , $114.75 , $106.65 , N/A , $109.26 , $109.26 , $128.25 , $115.84 , $13.63 , $129.60 
Part Remv Phalanx of Toe,28124,N/A,N/A,N/A," $3,174.00 "," $2,063.10 "," $2,071.49 ", $325.03 , $230.52 ," $1,630.93 "," $1,622.56 "," $2,951.82 "," $2,856.60 "," $2,856.60 "," $2,539.20 "," $2,539.20 ", $230.52 ," $2,930.55 "," $3,015.30 "," $2,856.60 "," $2,856.60 "," $2,856.60 "," $2,951.82 "," $3,047.04 "," $1,921.13 "," $2,697.90 "," $1,751.95 "," $1,945.21 ", N/A ," $1,662.75 "," $1,662.75 "," $3,015.30 "," $1,954.34 ", $230.52 ," $3,047.04 "
" Fac Extrnl Counterpulse, per Tx ",HCPCS G0166,0940 - OTHER RX SVS,N/A,N/A," $2,388.00 "," $1,552.20 "," $2,005.92 ", $101.57 , $147.38 ," $1,929.50 "," $2,149.20 "," $2,021.68 "," $2,149.20 "," $2,149.20 "," $2,149.20 "," $2,029.80 ", $144.49 ," $2,204.84 "," $2,268.60 "," $2,029.80 "," $2,220.84 "," $2,220.84 "," $2,268.60 "," $2,292.48 "," $1,953.86 "," $2,149.20 "," $2,029.80 "," $1,886.52 ", N/A ," $1,932.61 "," $1,932.61 "," $2,268.60 "," $2,049.14 ", $101.57 ," $2,292.48 "
 Fac Rpr Cplx F/C/C/M/N/Ax/G/H/F Ea 5 Cm/< ,CPT® 13133,0761 - TREATMENT ROOM,N/A,N/A, $761.00 , $494.65 , $639.24 , $119.01 , $130.42 , $614.89 , $684.90 , $644.26 , $684.90 , $684.90 , $684.90 , $646.85 , $127.86 , $702.63 , $722.95 , $646.85 , $707.73 , $707.73 , $722.95 , $730.56 , $622.65 , $684.90 , $646.85 , $601.19 , N/A , $615.88 , $615.88 , $722.95 , $653.01 , $119.01 , $730.56 
 Fac Inc Thrombosed Hemorrhoid Xtrnl ,CPT® 46083,0361 - OR/MINOR,N/A,N/A, $938.00 , $609.70 , $787.92 , $104.60 , $84.21 , $757.90 , $844.20 , $794.11 , $844.20 , $844.20 , $844.20 , $797.30 , $82.56 , $866.06 , $891.10 , $797.30 , $872.34 , $872.34 , $891.10 , $900.48 , $767.47 , $844.20 , $797.30 , $741.02 , N/A , $759.12 , $759.12 , $891.10 , $804.90 , $82.56 , $900.48 
Specimen collect covid-19,HCPCS G2023,N/A,N/A,N/A, $32.00 , $20.80 , N/A , $23.93 , N/A , N/A , N/A , $29.76 , $28.80 , $28.80 , $25.60 , $25.60 , N/A , $29.55 , $30.40 , $28.80 , $28.80 , $28.80 , $29.76 , $30.72 , $15.36 , $27.20 , $4.52 , $68.90 , N/A , $99.43 , $99.43 , $30.40 , $108.66 , $4.52 , $108.66 
 LORAZEPAM 2 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6009-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Metacarpohalangeal Disloc,26700,N/A,N/A,N/A, $912.00 , $592.80 ," $1,924.98 ", $306.67 , $96.29 ," $1,453.63 "," $1,482.73 ", $848.16 , $820.80 , $820.80 , $729.60 , $729.60 , $96.29 , $842.05 , $866.40 , $820.80 , $820.80 , $820.80 , $848.16 , $875.52 ," $1,764.46 ", $775.20 ," $1,627.07 "," $1,738.39 ", N/A ," $1,481.99 "," $1,481.99 ", $866.40 ," $1,741.85 ", $96.29 ," $1,924.98 "
 Fac Ear and Throat Examination ,CPT® 92502,0761 - TREATMENT ROOM,N/A,N/A, $699.00 , $454.35 , $587.16 , $92.69 , $124.66 , $564.79 , $629.10 , $591.77 , $629.10 , $629.10 , $629.10 , $594.15 , $122.22 , $645.39 , $664.05 , $594.15 , $650.07 , $650.07 , $664.05 , $671.04 , $571.92 , $629.10 , $594.15 , $552.21 , N/A , $565.70 , $565.70 , $664.05 , $599.81 , $92.69 , $671.04 
 Fac Residential Treatment Center Room Charge ,HCPCS H0010,1002 - BH R&B RES/CHEM,N/A,N/A, $458.00 , $297.70 , $384.72 , N/A , N/A , $370.06 , $412.20 , $387.74 , $412.20 , $412.20 , $412.20 , $389.30 , N/A , $422.87 , $435.10 , $389.30 , $425.94 , $425.94 , $435.10 , $439.68 , $374.74 , $412.20 , $389.30 , $361.82 , N/A , $370.66 , $370.66 , $435.10 , $393.01 , $361.82 , $439.68 
 DEXTROSE-NACL 5-0.9 % IV SOLN ,HCPCS RXA258,0258 - IV SOLUTIONS,00990-7941-09,"1,000 mL", $79.82 , $51.88 , $67.05 , N/A , N/A , $64.49 , $71.84 , $67.58 , $71.84 , $71.84 , $71.84 , $67.85 , N/A , $73.70 , $75.83 , $67.85 , $74.23 , $74.23 , $75.83 , $76.63 , $65.31 , $71.84 , $67.85 , $63.06 , N/A , $64.60 , $64.60 , $75.83 , $68.49 , $63.06 , $76.63 
 Pro Drainage of Skin Abscess ,CPT® 10061,0982 - PRO FEE/OUTPT,N/A,N/A, $834.00 , $542.10 , $590.92 , $177.26 , $93.30 , $490.97 , $481.05 , $775.62 , $750.60 , $750.60 , $667.20 , $667.20 , $93.30 , $770.03 , $792.30 , $750.60 , $750.60 , $750.60 , $775.62 , $800.64 , $644.00 , $708.90 , $950.91 , $632.67 , N/A , $500.54 , $500.54 , $792.30 , $580.46 , $93.30 , $950.91 
 Pro Injection Aa&/Strd Nerves Nrvtg Si Joint W/Img ,CPT® 64451,0982 - PRO FEE/OUTPT,N/A,N/A, $815.00 , $529.75 , $404.72 , $78.68 , $166.49 , $436.58 , N/A , $757.95 , $733.50 , $733.50 , $652.00 , $652.00 , $166.49 , $752.49 , $774.25 , $733.50 , $733.50 , $733.50 , $757.95 , $782.40 , $421.43 , $692.75 , $428.24 , $480.34 , N/A , $445.09 , $445.09 , $774.25 , $477.46 , $78.68 , $782.40 
 Pro Lyr Clsr S/a/T/E 20.1 Cm-30.0 Cm ,CPT® 12036,0982 - PRO FEE/OUTPT,N/A,N/A," $1,842.00 "," $1,197.30 ", $887.81 , $264.02 , $215.14 , $754.97 , $740.93 ," $1,713.06 "," $1,657.80 "," $1,657.80 "," $1,473.60 "," $1,473.60 ", $215.14 ," $1,700.72 "," $1,749.90 "," $1,657.80 "," $1,657.80 "," $1,657.80 "," $1,713.06 "," $1,768.32 ", $974.81 ," $1,565.70 "," $1,489.69 ", $970.85 , N/A , $769.70 , $769.70 ," $1,749.90 ", $892.60 , $215.14 ," $1,768.32 "
 Fac Grafix Stravix Prime Pl Sqcm ,HCPCS Q4133,0636 - DRUGS REQUIRING DETAILED CODIN,N/A,N/A, $413.00 , $268.45 , $346.92 , $140.12 , $173.97 , $333.70 , $371.70 , $349.65 , $371.70 , $371.70 , $371.70 , $351.05 , $170.56 , $381.32 , $392.35 , $351.05 , $384.09 , $384.09 , $392.35 , $396.48 , $337.92 , $371.70 , $351.05 , $326.27 , N/A , $334.24 , $334.24 , $392.35 , $354.40 , $140.12 , $396.48 
Pfizer Admin Biv Booster 6 Months to 4 Yrs,CPT® 0173A,N/A,N/A,N/A, $70.00 , $45.50 , N/A , N/A , $38.92 , N/A , N/A , $65.10 , $63.00 , $63.00 , $56.00 , $56.00 , $38.92 , $64.63 , $66.50 , $63.00 , $63.00 , $63.00 , $65.10 , $67.20 , N/A , $59.50 , $56.00 , N/A , N/A , N/A , N/A , $66.50 , N/A , $38.92 , $67.20 
" Pro Destruct Premalg Les, 2-14 ",CPT® 17003,0982 - PRO FEE/OUTPT,N/A,N/A, $74.00 , $48.10 , $5.10 , $2.04 , $6.46 , $6.51 , $11.67 , $68.82 , $66.60 , $66.60 , $59.20 , $59.20 , $6.46 , $68.32 , $70.30 , $66.60 , $66.60 , $66.60 , $68.82 , $71.04 , $7.62 , $62.90 , $23.19 , $8.16 , N/A , $6.65 , $6.65 , $70.30 , $7.71 , $2.04 , $71.04 
 LORAZEPAM 1 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6008-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
"Puct/Aspir Breast Cyst,Each Addn",CPT® 19001,N/A,N/A,N/A, $250.00 , $162.50 , $67.80 , $19.88 , $21.34 , $60.51 , $56.79 , $232.50 , $225.00 , $225.00 , $200.00 , $200.00 , $21.34 , $230.83 , $237.50 , $225.00 , $225.00 , $225.00 , $232.50 , $240.00 , $74.75 , $212.50 , $112.40 , $75.81 , N/A , $61.69 , $61.69 , $237.50 , $71.53 , $19.88 , $240.00 
 Critical Care First 30-74 Min -Mh ,CPT® 99291,0450 - EMERGENCY SERVICES,N/A,N/A," $8,479.00 "," $5,511.35 "," $7,122.36 ", $205.74 , $270.56 ," $6,851.03 "," $7,631.10 "," $7,178.32 "," $7,631.10 "," $7,631.10 "," $7,631.10 "," $7,207.15 ", $265.25 ," $7,828.66 "," $8,055.05 "," $7,207.15 "," $7,885.47 "," $7,885.47 "," $8,055.05 "," $8,139.84 "," $6,937.52 "," $7,631.10 "," $7,207.15 "," $6,698.41 ", N/A ," $6,862.05 "," $6,862.05 "," $8,055.05 "," $7,275.83 ", $205.74 ," $8,139.84 "
 Fac Drug Test Def 22+ Classes ,CPT® G0483,0301 - LAB/CHEMISTRY,N/A,N/A, $456.00 , $296.40 , $383.04 , $251.86 , $175.62 , $368.45 , $410.40 , $386.05 , $410.40 , $410.40 , $410.40 , $387.60 , $172.18 , $421.02 , $433.20 , $387.60 , $424.08 , $424.08 , $433.20 , $437.76 , $373.10 , $410.40 , $387.60 , $360.24 , N/A , $369.04 , $369.04 , $433.20 , $391.29 , $172.18 , $437.76 
Part Excis 5th Metatarsal Head,CPT® 28110,N/A,N/A,N/A," $3,087.00 "," $2,006.55 "," $1,803.62 ", $283.52 , $280.42 ," $1,426.96 "," $1,423.28 "," $2,870.91 "," $2,778.30 "," $2,778.30 "," $2,469.60 "," $2,469.60 ", $280.42 ," $2,850.23 "," $2,932.65 "," $2,778.30 "," $2,778.30 "," $2,778.30 "," $2,870.91 "," $2,963.52 "," $1,668.70 "," $2,623.95 "," $1,539.65 "," $1,698.59 ", N/A ," $1,454.80 "," $1,454.80 "," $2,932.65 "," $1,709.91 ", $280.42 ," $2,963.52 "
 CEFPROZIL 250 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,57237-0036-01,1 tablet, $22.50 , $14.63 , $18.90 , N/A , N/A , $18.18 , $20.25 , $19.05 , $20.25 , $20.25 , $20.25 , $19.13 , N/A , $20.77 , $21.38 , $19.13 , $20.93 , $20.93 , $21.38 , $21.60 , $18.41 , $20.25 , $19.13 , $17.78 , N/A , $18.21 , $18.21 , $21.38 , $19.31 , $17.78 , $21.60 
"Fasciotomy,Iliotibial,Open",CPT® 27305,N/A,N/A,N/A," $3,369.00 "," $2,189.85 "," $2,955.16 ", $465.14 , $461.04 ," $2,323.35 "," $2,329.29 "," $3,133.17 "," $3,032.10 "," $3,032.10 "," $2,695.20 "," $2,695.20 ", $461.04 ," $3,110.60 "," $3,200.55 "," $3,032.10 "," $3,032.10 "," $3,032.10 "," $3,133.17 "," $3,234.24 "," $2,737.46 "," $2,863.65 "," $2,569.05 "," $2,729.02 ", N/A ," $2,368.68 "," $2,368.68 "," $3,200.55 "," $2,784.04 ", $461.04 ," $3,234.24 "
 Pro Drainage of Hematoma/Fluid ,CPT® 10140,0981 - PRO FEE/ER,N/A,N/A, $667.00 , $433.55 , $379.44 , $113.59 , $45.35 , $324.24 , $318.38 , $620.31 , $600.30 , $600.30 , $533.60 , $533.60 , $45.35 , $615.84 , $633.65 , $600.30 , $600.30 , $600.30 , $620.31 , $640.32 , $417.24 , $566.95 , $629.77 , $417.61 , N/A , $330.56 , $330.56 , $633.65 , $383.34 , $45.35 , $640.32 
 Pro Tracheotomy Tube Change ,CPT® 31502,0981 - PRO FEE/ER,N/A,N/A, $301.00 , $195.65 , $189.00 , $33.08 , $49.19 , $134.38 , $131.26 , $279.93 , $270.90 , $270.90 , $240.80 , $240.80 , $49.19 , $277.91 , $285.95 , $270.90 , $270.90 , $270.90 , $279.93 , $288.96 , $181.55 , $255.85 , $183.76 , $178.84 , N/A , $137.00 , $137.00 , $285.95 , $161.36 , $33.08 , $288.96 
 Fac Expl Lapt Expl Celiotomy +-Bx Spx ,CPT® 49000,0360 - OR SERVICES,N/A,N/A," $4,814.00 "," $3,129.10 "," $4,043.76 ", $712.07 ," $1,026.83 "," $3,889.71 "," $4,332.60 "," $4,075.53 "," $4,332.60 "," $4,332.60 "," $4,332.60 "," $4,091.90 "," $1,006.70 "," $4,444.77 "," $4,573.30 "," $4,091.90 "," $4,477.02 "," $4,477.02 "," $4,573.30 "," $4,621.44 "," $3,938.81 "," $4,332.60 "," $4,091.90 "," $3,803.06 ", N/A ," $3,895.97 "," $3,895.97 "," $4,573.30 "," $4,130.89 ", $712.07 ," $4,621.44 "
 Fac Assay of Tsi ,CPT® 84445,0301 - LAB/CHEMISTRY,N/A,N/A, $383.00 , $248.95 , $321.72 , $51.88 , $32.28 , $309.46 , $344.70 , $324.25 , $344.70 , $344.70 , $344.70 , $325.55 , $31.65 , $353.62 , $363.85 , $325.55 , $356.19 , $356.19 , $363.85 , $367.68 , $313.37 , $344.70 , $325.55 , $302.57 , N/A , $309.96 , $309.96 , $363.85 , $328.65 , $31.65 , $367.68 
"Bx,Vulva/Perineum,Addl Lesion",CPT® 56606,N/A,N/A,N/A, $290.00 , $188.50 , $135.65 , $27.65 , $36.84 , $120.41 , $118.59 , $269.70 , $261.00 , $261.00 , $232.00 , $232.00 , $36.84 , $267.76 , $275.50 , $261.00 , $261.00 , $261.00 , $269.70 , $278.40 , $142.92 , $246.50 , $155.21 , $121.44 , N/A , $122.75 , $122.75 , $275.50 , $147.23 , $27.65 , $278.40 
 Fac Complete Replacement Picc Rs&I ,CPT® 36584,0761 - TREATMENT ROOM,N/A,N/A," $2,780.00 "," $1,807.00 "," $2,335.20 ", $55.92 , $374.09 ," $2,246.24 "," $2,502.00 "," $2,353.55 "," $2,502.00 "," $2,502.00 "," $2,502.00 "," $2,363.00 ", $366.75 ," $2,566.77 "," $2,641.00 "," $2,363.00 "," $2,585.40 "," $2,585.40 "," $2,641.00 "," $2,668.80 "," $2,274.60 "," $2,502.00 "," $2,363.00 "," $2,196.20 ", N/A ," $2,249.85 "," $2,249.85 "," $2,641.00 "," $2,385.52 ", $55.92 ," $2,668.80 "
 CHARCOAL ACTIVATED PO LIQD ,HCPCS RXA250,0250 - PHARMACY,66689-0201-08,240 mL, $208.36 , $135.43 , $175.02 , N/A , N/A , $168.35 , $187.52 , $176.40 , $187.52 , $187.52 , $187.52 , $177.11 , N/A , $192.38 , $197.94 , $177.11 , $193.77 , $193.77 , $197.94 , $200.03 , $170.48 , $187.52 , $177.11 , $164.60 , N/A , $168.63 , $168.63 , $197.94 , $178.79 , $164.60 , $200.03 
Tcat Mitral Valve Repair Addl Prosthesis,CPT® 33419,N/A,N/A,N/A," $5,364.00 "," $3,486.60 "," $2,474.94 ", $380.55 , $398.54 ," $2,163.68 "," $1,891.30 "," $4,988.52 "," $4,827.60 "," $4,827.60 "," $4,291.20 "," $4,291.20 ", $398.54 ," $4,952.58 "," $5,095.80 "," $4,827.60 "," $4,827.60 "," $4,827.60 "," $4,988.52 "," $5,149.44 "," $2,296.19 "," $4,559.40 "," $2,194.52 "," $2,049.68 ", N/A ," $2,205.89 "," $2,205.89 "," $5,095.80 "," $2,505.90 ", $380.55 ," $5,149.44 "
Iiv4 Vacc Presrv Free 0.5 Ml Dos for Im Use,CPT® 90686,N/A,N/A,N/A, $32.00 , $20.80 , N/A , $21.95 , $37.25 , $38.97 , $39.88 , $29.76 , $28.80 , $28.80 , $25.60 , $25.60 , $37.25 , $29.55 , $30.40 , $28.80 , $28.80 , $28.80 , $29.76 , $30.72 , $25.45 , $27.20 , $63.61 , $31.81 , N/A , $39.73 , $39.73 , $30.40 , $46.32 , $21.95 , $63.61 
Intraoperative Sentinel Lymph Node ID W Dye Injection,CPT® 38900,N/A,N/A,N/A," $1,996.00 "," $1,297.40 ", $623.05 , $124.89 , $96.51 , $477.03 , $483.19 ," $1,856.28 "," $1,796.40 "," $1,796.40 "," $1,596.80 "," $1,596.80 ", $96.51 ," $1,842.91 "," $1,896.20 "," $1,796.40 "," $1,796.40 "," $1,796.40 "," $1,856.28 "," $1,916.16 ", $666.95 ," $1,696.60 ", $718.98 , $654.97 , N/A , $486.34 , $486.34 ," $1,896.20 ", $564.22 , $96.51 ," $1,916.16 "
 CULTURELLE PO CAPS ,HCPCS RXC637,0250 - PHARMACY,49100-0400-07,1 capsule, $10.58 , $6.88 , $8.89 , N/A , N/A , $8.55 , $9.52 , $8.96 , $9.52 , $9.52 , $9.52 , $8.99 , N/A , $9.77 , $10.05 , $8.99 , $9.84 , $9.84 , $10.05 , $10.16 , $8.66 , $9.52 , $8.99 , $8.36 , N/A , $8.56 , $8.56 , $10.05 , $9.08 , $8.36 , $10.16 
Home/Res Visit New Patient Low Mdm 30 Minutes,CPT® 99342,N/A,N/A,N/A, $284.00 , $184.60 , $154.62 , $76.62 , $34.36 , $136.98 , $137.28 , $264.12 , $255.60 , $255.60 , $227.20 , $227.20 , $34.36 , $262.22 , $269.80 , $255.60 , $255.60 , $255.60 , $264.12 , $272.64 , $140.77 , $241.40 , $171.77 , $173.92 , $110.00 , $139.65 , $139.65 , $269.80 , $161.08 , $34.36 , $272.64 
Zoledronic Acid 1mg,HCPCS J3489,N/A,N/A,N/A, $429.00 , $278.85 , N/A , $9.27 , $11.36 , N/A , N/A , $398.97 , $386.10 , $386.10 , $343.20 , $343.20 , $11.36 , $396.10 , $407.55 , $386.10 , $386.10 , $386.10 , $398.97 , $411.84 , $15.78 , $364.65 , $21.32 , $11.73 , N/A , N/A , N/A , $407.55 , N/A , $9.27 , $411.84 
Incis/Drain Forearm Deep Abscess,CPT® 25028,N/A,N/A,N/A," $4,044.00 "," $2,628.60 "," $4,396.41 ", $675.59 , $200.70 ," $2,518.57 "," $2,559.99 "," $3,760.92 "," $3,639.60 "," $3,639.60 "," $3,235.20 "," $3,235.20 ", $200.70 ," $3,733.83 "," $3,841.80 "," $3,639.60 "," $3,639.60 "," $3,639.60 "," $3,760.92 "," $3,882.24 "," $3,823.82 "," $3,437.40 "," $2,809.90 "," $3,010.67 ", N/A ," $2,567.71 "," $2,567.71 "," $3,841.80 "," $3,017.98 ", $200.70 ," $4,396.41 "
Tpmt Gene Analaysis Common Variants,CPT® 81335,N/A,N/A,N/A, $784.00 , $509.60 , N/A , $178.31 , $142.64 , $726.76 , N/A , $729.12 , $705.60 , $705.60 , $627.20 , $627.20 , $142.64 , $723.87 , $744.80 , $705.60 , $705.60 , $705.60 , $729.12 , $752.64 ," $1,167.25 ", $666.40 , $833.53 , $513.42 , N/A , $678.26 , $678.26 , $744.80 , $741.19 , $142.64 ," $1,167.25 "
"Removal Testis,Radical",54530,N/A,N/A,N/A," $2,771.00 "," $1,801.15 "," $2,254.97 ", $486.50 , $504.14 ," $1,621.34 "," $1,643.03 "," $2,577.03 "," $2,493.90 "," $2,493.90 "," $2,216.80 "," $2,216.80 ", $504.14 ," $2,558.46 "," $2,632.45 "," $2,493.90 "," $2,493.90 "," $2,493.90 "," $2,577.03 "," $2,660.16 "," $2,115.11 "," $2,355.35 "," $2,620.79 "," $2,447.04 ", N/A ," $1,652.98 "," $1,652.98 "," $2,632.45 "," $1,981.19 ", $486.50 ," $2,660.16 "
 Fac Mecp2 Gene Analysis Full Sequence ,CPT® 81302,0310 - PATHOLOGY LAB,N/A,N/A, $13.00 , $8.45 , $10.92 , $538.43 , $287.28 , $10.50 , $11.70 , $11.01 , $11.70 , $11.70 , $11.70 , $11.05 , $281.65 , $12.00 , $12.35 , $11.05 , $12.09 , $12.09 , $12.35 , $12.48 , $10.64 , $11.70 , $11.05 , $10.27 , N/A , $10.52 , $10.52 , $12.35 , $11.16 , $10.27 , $538.43 
 Pro Removal of Foot Foreign Body ,CPT® 28190,0982 - PRO FEE/OUTPT,N/A,N/A," $1,705.00 "," $1,108.25 ", $821.41 , $128.35 , $42.71 , $660.87 , $659.35 ," $1,585.65 "," $1,534.50 "," $1,534.50 "," $1,364.00 "," $1,364.00 ", $42.71 ," $1,574.23 "," $1,619.75 "," $1,534.50 "," $1,534.50 "," $1,534.50 "," $1,585.65 "," $1,636.80 ", $767.83 ," $1,449.25 ", $713.63 , $787.33 , N/A , $673.77 , $673.77 ," $1,619.75 ", $791.93 , $42.71 ," $1,636.80 "
" Fac Column Chromotography, Quant ",CPT® 82542,0301 - LAB/CHEMISTRY,N/A,N/A, $292.00 , $189.80 , $245.28 , $24.57 , $24.57 , $235.94 , $262.80 , $247.21 , $262.80 , $262.80 , $262.80 , $248.20 , $24.09 , $269.60 , $277.40 , $248.20 , $271.56 , $271.56 , $277.40 , $280.32 , $238.91 , $262.80 , $248.20 , $230.68 , N/A , $236.32 , $236.32 , $277.40 , $250.57 , $24.09 , $280.32 
 Pro Smpl Rpr Supfc S/N/Ax/G/T 20.1cm-30.0cm ,CPT® 12006,0981 - PRO FEE/ER,N/A,N/A," $1,108.00 ", $720.20 , $362.98 , $107.63 , $188.65 , $328.19 , $317.78 ," $1,030.44 ", $997.20 , $997.20 , $886.40 , $886.40 , $188.65 ," $1,023.02 "," $1,052.60 ", $997.20 , $997.20 , $997.20 ," $1,030.44 "," $1,063.68 ", $399.58 , $941.80 , $638.69 , $403.51 , N/A , $334.60 , $334.60 ," $1,052.60 ", $388.01 , $107.63 ," $1,063.68 "
 Fac Office/Outpatient New Low Mdm 30-44 Minutes ,CPT® 99203,0510 - CLINIC,N/A,N/A, $366.00 , $237.90 , $307.44 , $79.48 , $75.25 , $295.73 , $329.40 , N/A , $329.40 , $329.40 , $329.40 , $311.10 , $73.77 , $337.93 , $347.70 , $311.10 , $340.38 , $340.38 , $347.70 , $351.36 , $299.46 , $329.40 , $311.10 , $289.14 , N/A , $296.20 , $296.20 , $347.70 , $314.06 , $73.77 , $351.36 
 AMOXICILLIN 500 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00781-2613-01,1 capsule, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 FOSFOMYCIN TROMETHAMINE 3 G PO PACK ,HCPCS RXC637,0250 - PHARMACY,70700-0268-94,1 packet, $515.75 , $335.24 , $433.23 , N/A , N/A , $416.73 , $464.18 , $436.63 , $464.18 , $464.18 , $464.18 , $438.39 , N/A , $476.19 , $489.96 , $438.39 , $479.65 , $479.65 , $489.96 , $495.12 , $421.99 , $464.18 , $438.39 , $407.44 , N/A , $417.40 , $417.40 , $489.96 , $442.57 , $407.44 , $495.12 
"X-Ray Fistula,Abscess,Sinus Tract",CPT® 76080,N/A,N/A,N/A, $424.00 , $275.60 , $342.03 , $58.94 , $60.89 , $263.86 , $319.87 , $394.32 , $381.60 , $381.60 , $339.20 , $339.20 , $60.89 , $391.48 , $402.80 , $381.60 , $381.60 , $381.60 , $394.32 , $407.04 , $333.16 , $360.40 , $348.61 , $277.33 , N/A , $269.01 , $269.01 , $402.80 , $311.39 , $58.94 , $407.04 
 NIACIN 500 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-2272-60,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Perc D-E Cor Revasc T Cabg B ,HCPCS C9605,0481 - CARDIAC CATH LAB,N/A,N/A," $15,529.00 "," $10,093.85 "," $13,044.36 ", N/A , N/A ," $12,547.43 "," $13,976.10 "," $13,146.85 "," $13,976.10 "," $13,976.10 "," $13,976.10 "," $13,199.65 ", N/A ," $14,337.93 "," $14,752.55 "," $13,199.65 "," $14,441.97 "," $14,441.97 "," $14,752.55 "," $14,907.84 "," $12,705.83 "," $13,976.10 "," $13,199.65 "," $12,267.91 ", N/A ," $12,567.62 "," $12,567.62 "," $14,752.55 "," $13,325.43 "," $12,267.91 "," $14,907.84 "
"Knee Scope,Part Synovect",CPT® 29875,N/A,N/A,N/A," $2,306.00 "," $1,498.90 "," $3,028.48 ", $475.67 , $427.24 ," $2,393.20 "," $2,393.57 "," $2,144.58 "," $2,075.40 "," $2,075.40 "," $1,844.80 "," $1,844.80 ", $427.24 ," $2,129.13 "," $2,190.70 "," $2,075.40 "," $2,075.40 "," $2,075.40 "," $2,144.58 "," $2,213.76 "," $2,817.13 "," $1,960.10 "," $2,640.41 "," $2,823.34 ", N/A ," $2,439.90 "," $2,439.90 "," $2,190.70 "," $2,867.74 ", $427.24 ," $3,028.48 "
 Fac Evasc Plmt Iliac Art Occlusion Dev ,CPT® 34808,0360 - OR SERVICES,N/A,N/A," $2,191.00 "," $1,424.15 "," $1,840.44 ", $178.99 ," $1,301.09 "," $1,770.33 "," $1,971.90 "," $1,854.90 "," $1,971.90 "," $1,971.90 "," $1,971.90 "," $1,862.35 "," $1,275.58 "," $2,022.95 "," $2,081.45 "," $1,862.35 "," $2,037.63 "," $2,037.63 "," $2,081.45 "," $2,103.36 "," $1,792.68 "," $1,971.90 "," $1,862.35 "," $1,730.89 ", N/A ," $1,773.18 "," $1,773.18 "," $2,081.45 "," $1,880.10 ", $178.99 ," $2,103.36 "
 Fac Iaadiadoo Streptococcus Group A ,CPT® 87880,0306 - LAB/BACT-MICRO,N/A,N/A, $115.00 , $74.75 , $96.60 , $16.86 , $16.65 , $92.92 , $103.50 , $97.36 , $103.50 , $103.50 , $103.50 , $97.75 , $16.32 , $106.18 , $109.25 , $97.75 , $106.95 , $106.95 , $109.25 , $110.40 , $94.09 , $103.50 , $97.75 , $90.85 , N/A , $93.07 , $93.07 , $109.25 , $98.68 , $16.32 , $110.40 
" Fac Neutralization Test, Viral ",CPT® 86382,0302 - LAB/IMMUNOLOGY,N/A,N/A, $137.00 , $89.05 , $115.08 , $17.25 , $17.25 , $110.70 , $123.30 , $115.98 , $123.30 , $123.30 , $123.30 , $116.45 , $16.91 , $126.49 , $130.15 , $116.45 , $127.41 , $127.41 , $130.15 , $131.52 , $112.09 , $123.30 , $116.45 , $108.23 , N/A , $110.87 , $110.87 , $130.15 , $117.56 , $16.91 , $131.52 
 Pro Ligation of Hemorrhoid(S) ,CPT® 46221,0982 - PRO FEE/OUTPT,N/A,N/A," $1,138.00 ", $739.70 ," $1,206.14 ", $185.85 , $46.08 , $914.44 , $947.04 ," $1,058.34 "," $1,024.20 "," $1,024.20 ", $910.40 , $910.40 , $46.08 ," $1,050.72 "," $1,081.10 "," $1,024.20 "," $1,024.20 "," $1,024.20 "," $1,058.34 "," $1,092.48 ", $861.85 , $967.30 ," $1,038.33 "," $1,090.74 ", N/A , $932.28 , $932.28 ," $1,081.10 ", $975.06 , $46.08 ," $1,206.14 "
 Pro Removal of Knee Cyst ,CPT® 27345,0982 - PRO FEE/OUTPT,N/A,N/A," $3,310.00 "," $2,151.50 "," $2,973.82 ", $467.50 , $461.04 ," $2,320.85 "," $2,315.25 "," $3,078.30 "," $2,979.00 "," $2,979.00 "," $2,648.00 "," $2,648.00 ", $461.04 ," $3,056.12 "," $3,144.50 "," $2,979.00 "," $2,979.00 "," $2,979.00 "," $3,078.30 "," $3,177.60 "," $2,753.55 "," $2,813.50 "," $2,554.78 "," $2,733.25 ", N/A ," $2,366.12 "," $2,366.12 "," $3,144.50 "," $2,781.06 ", $461.04 ," $3,177.60 "
 HYDROCORTISONE 5 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00115-1696-06,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 Fac Cardioversion Elective Arrhythmia External ,CPT® 92960,0480 - CARDIOLOGY,N/A,N/A," $1,197.00 ", $778.05 ," $1,005.48 ", $104.47 , $244.76 , $967.18 ," $1,077.30 "," $1,013.38 "," $1,077.30 "," $1,077.30 "," $1,077.30 "," $1,017.45 ", $239.96 ," $1,105.19 "," $1,137.15 "," $1,017.45 "," $1,113.21 "," $1,113.21 "," $1,137.15 "," $1,149.12 ", $979.39 ," $1,077.30 "," $1,017.45 ", $945.63 , N/A , $968.73 , $968.73 ," $1,137.15 "," $1,027.15 ", $104.47 ," $1,149.12 "
 Prolact +10 H2mf per Ml ,Custom 2200000005,0220 - SPECIAL CHARGES,N/A,N/A, $30.00 , $19.50 , $25.20 , N/A , N/A , $24.24 , $27.00 , $25.40 , $27.00 , $27.00 , $27.00 , $25.50 , N/A , $27.70 , $28.50 , $25.50 , $27.90 , $27.90 , $28.50 , $28.80 , $24.55 , $27.00 , $25.50 , $23.70 , N/A , $24.28 , $24.28 , $28.50 , $25.74 , $23.70 , $28.80 
"Lumbar Spine Fusion,Anter Apprch",CPT® 22558,N/A,N/A,N/A," $10,107.00 "," $6,569.55 "," $9,007.51 "," $1,403.90 "," $1,324.58 "," $7,391.14 "," $7,300.82 "," $9,399.51 "," $9,096.30 "," $9,096.30 "," $8,085.60 "," $8,085.60 "," $1,324.58 "," $9,331.79 "," $9,601.65 "," $9,096.30 "," $9,096.30 "," $9,096.30 "," $9,399.51 "," $9,702.72 "," $8,402.03 "," $8,590.95 "," $8,162.09 "," $8,574.83 ", N/A ," $7,535.35 "," $7,535.35 "," $9,601.65 "," $8,856.71 "," $1,324.58 "," $9,702.72 "
Drainage of Gums Cyst,CPT® 41800,N/A,N/A,N/A, $731.00 , $475.15 , $949.52 , $149.06 , $30.71 , $713.43 , $755.10 , $679.83 , $657.90 , $657.90 , $584.80 , $584.80 , $30.71 , $674.93 , $694.45 , $657.90 , $657.90 , $657.90 , $679.83 , $701.76 , $697.11 , $621.35 , $824.24 , $871.64 , N/A , $727.36 , $727.36 , $694.45 , $760.72 , $30.71 , $949.52 
 Antineutrophil Cytoplasmic Antb Screen Ea Antb Pbb ,CPT® 86036,0302 - LAB/IMMUNOLOGY,N/A,N/A, $147.00 , $95.55 , $123.48 , $12.29 , $12.29 , $118.78 , $132.30 , $124.45 , $132.30 , $132.30 , $132.30 , $124.95 , $12.05 , $135.73 , $139.65 , $124.95 , $136.71 , $136.71 , $139.65 , $141.12 , $120.28 , $132.30 , $124.95 , $116.13 , N/A , $118.97 , $118.97 , $139.65 , $126.14 , $12.05 , $141.12 
 MISOPROSTOL 100 MCG PO TABS ,HCPCS RXC637,0250 - PHARMACY,59762-5007-01,1 tablet, $4.24 , $2.76 , $3.56 , N/A , N/A , $3.43 , $3.82 , $3.59 , $3.82 , $3.82 , $3.82 , $3.60 , N/A , $3.91 , $4.03 , $3.60 , $3.94 , $3.94 , $4.03 , $4.07 , $3.47 , $3.82 , $3.60 , $3.35 , N/A , $3.43 , $3.43 , $4.03 , $3.64 , $3.35 , $4.07 
 Pro Est Patient Visit Level 3 ,CPT® 99213,0982 - PRO FEE/OUTPT,N/A,N/A, $197.00 , $128.05 , $134.27 , $64.08 , $41.21 , $87.92 , $87.90 , $183.21 , $177.30 , $177.30 , $157.60 , $157.60 , $41.21 , $181.89 , $187.15 , $177.30 , $177.30 , $177.30 , $183.21 , $189.12 , $122.57 , $167.45 , $109.52 , $112.10 , $64.00 , $89.64 , $89.64 , $187.15 , $103.40 , $41.21 , $189.12 
" Direct Repair, Aneurs/Pseudo/Disease; Common Fem Artery ",CPT® 35141,0360 - OR SERVICES,N/A,N/A," $4,418.00 "," $2,871.70 "," $3,711.12 ", $973.81 ," $1,205.52 "," $3,569.74 "," $3,976.20 "," $3,740.28 "," $3,976.20 "," $3,976.20 "," $3,976.20 "," $3,755.30 "," $1,181.88 "," $4,079.14 "," $4,197.10 "," $3,755.30 "," $4,108.74 "," $4,108.74 "," $4,197.10 "," $4,241.28 "," $3,614.81 "," $3,976.20 "," $3,755.30 "," $3,490.22 ", N/A ," $3,575.49 "," $3,575.49 "," $4,197.10 "," $3,791.09 ", $973.81 ," $4,241.28 "
Drain Lower Leg Deep Absc/Hematoma,27603,N/A,N/A,N/A," $3,458.00 "," $2,247.70 "," $2,394.93 ", $374.21 , $200.19 ," $1,872.04 "," $1,898.94 "," $3,215.94 "," $3,112.20 "," $3,112.20 "," $2,766.40 "," $2,766.40 ", $200.19 ," $3,192.77 "," $3,285.10 "," $3,112.20 "," $3,112.20 "," $3,112.20 "," $3,215.94 "," $3,319.68 "," $2,217.61 "," $2,939.30 "," $2,094.49 "," $2,206.18 ", N/A ," $1,908.57 "," $1,908.57 "," $3,285.10 "," $2,243.27 ", $200.19 ," $3,319.68 "
 FLUORESCEIN SODIUM 10 % IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00065-0092-65,5 mL, $318.08 , $206.75 , $267.19 , N/A , N/A , $257.01 , $286.27 , $269.29 , $286.27 , $286.27 , $286.27 , $270.37 , N/A , $293.68 , $302.18 , $270.37 , $295.81 , $295.81 , $302.18 , $305.36 , $260.25 , $286.27 , $270.37 , $251.28 , N/A , $257.42 , $257.42 , $302.18 , $272.94 , $251.28 , $305.36 
Insert and Remove Bone Pin,CPT® 20650,N/A,N/A,N/A," $1,329.00 ", $863.85 , $988.98 , $157.14 , $101.85 , $759.38 , $755.44 ," $1,235.97 "," $1,196.10 "," $1,196.10 "," $1,063.20 "," $1,063.20 ", $101.85 ," $1,227.07 "," $1,262.55 "," $1,196.10 "," $1,196.10 "," $1,196.10 "," $1,235.97 "," $1,275.84 ", $903.35 ," $1,129.65 ", $822.45 , $915.19 , N/A , $774.20 , $774.20 ," $1,262.55 ", $909.95 , $101.85 ," $1,275.84 "
 Fac Paring/Cutting B9 Hyprkeratotic Les > 4 < ,CPT® 11057,0761 - TREATMENT ROOM,N/A,N/A, $174.00 , $113.10 , $146.16 , $27.83 , $47.37 , $140.59 , $156.60 , $147.31 , $156.60 , $156.60 , $156.60 , $147.90 , $46.44 , $160.65 , $165.30 , $147.90 , $161.82 , $161.82 , $165.30 , $167.04 , $142.37 , $156.60 , $147.90 , $137.46 , N/A , $140.82 , $140.82 , $165.30 , $149.31 , $27.83 , $167.04 
Brnchsc Incl Fluor Gdnce Dx W/Cell Washg Spx,CPT® 31622,N/A,N/A,N/A," $2,066.00 "," $1,342.90 ", $714.84 , $124.42 , $514.19 , $563.05 , $553.42 ," $1,921.38 "," $1,859.40 "," $1,859.40 "," $1,652.80 "," $1,652.80 ", $514.19 ," $1,907.54 "," $1,962.70 "," $1,859.40 "," $1,859.40 "," $1,859.40 "," $1,921.38 "," $1,983.36 ", $691.23 ," $1,756.10 ", $777.85 , $682.23 , N/A , $574.03 , $574.03 ," $1,962.70 ", $676.03 , $124.42 ," $1,983.36 "
Assay Gammaglobulin Igm,CPT® 82784,N/A,N/A,N/A, $114.00 , $74.10 , N/A , $9.49 , $9.49 , $52.59 , $62.92 , $106.02 , $102.60 , $102.60 , $91.20 , $91.20 , $9.49 , $105.26 , $108.30 , $102.60 , $102.60 , $102.60 , $106.02 , $109.44 , $62.10 , $96.90 , $61.63 , $33.72 , N/A , $49.08 , $49.08 , $108.30 , $53.64 , $9.49 , $109.44 
 DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN ,HCPCS J1200,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0664-01,1 mL, $18.56 , $12.06 , $15.59 , $1.08 , $1.18 , $15.00 , $16.70 , $15.71 , $16.70 , $16.70 , $16.70 , $15.78 , $1.16 , $17.14 , $17.63 , $15.78 , $17.26 , $17.26 , $17.63 , $17.82 , $15.19 , $16.70 , $15.78 , $14.66 , N/A , $15.02 , $15.02 , $17.63 , $15.93 , $1.08 , $17.82 
 PHENOBARBITAL 32.4 MG PO TABS ,HCPCS RXC637,0250 - PHARMACY,00904-6575-61,1 tablet, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
 IOHEXOL 180 MG/ML IJ SOLN ,HCPCS Q9965,0255 - DRUGS/RADIOLOGY,00407-1411-10,10 mL, $246.83 , $160.44 , $207.34 , $1.34 , $1.58 , $199.44 , $222.15 , $208.97 , $222.15 , $222.15 , $222.15 , $209.81 , $1.55 , $227.90 , $234.49 , $209.81 , $229.55 , $229.55 , $234.49 , $236.96 , $201.96 , $222.15 , $209.81 , $195.00 , N/A , $199.76 , $199.76 , $234.49 , $211.80 , $1.34 , $236.96 
"Tympanoplas/Antrot,Rebld Ossic Chain",CPT® 69636,N/A,N/A,N/A," $8,068.00 "," $5,244.20 "," $6,823.80 "," $1,377.69 "," $1,844.16 "," $6,645.86 "," $6,876.94 "," $7,503.24 "," $7,261.20 "," $7,261.20 "," $6,454.40 "," $6,454.40 "," $1,844.16 "," $7,449.18 "," $7,664.60 "," $7,261.20 "," $7,261.20 "," $7,261.20 "," $7,503.24 "," $7,745.28 "," $7,430.91 "," $6,857.80 "," $7,491.28 "," $6,675.02 ", N/A ," $6,775.54 "," $6,775.54 "," $7,664.60 "," $7,736.48 "," $1,377.69 "," $7,745.28 "
Lens Sphcy Bifocal 4.25-7/4.,HCPCS V2209,N/A,N/A,N/A, $85.00 , $55.25 , N/A , $82.04 , N/A , N/A , N/A , $79.05 , $76.50 , $76.50 , $68.00 , $68.00 , N/A , $78.48 , $80.75 , $76.50 , $76.50 , $76.50 , $79.05 , $81.60 , N/A , $72.25 , $85.00 , $74.53 , N/A , N/A , N/A , $80.75 , N/A , $68.00 , $85.00 
"Release Flex Foot Tendon,Single",CPT® 28220,N/A,N/A,N/A," $2,996.00 "," $1,947.40 "," $1,892.80 ", $296.78 , $384.19 ," $1,492.31 "," $1,477.51 "," $2,786.28 "," $2,696.40 "," $2,696.40 "," $2,396.80 "," $2,396.80 ", $384.19 ," $2,766.21 "," $2,846.20 "," $2,696.40 "," $2,696.40 "," $2,696.40 "," $2,786.28 "," $2,876.16 "," $1,749.45 "," $2,546.60 "," $1,596.74 "," $1,775.10 ", N/A ," $1,521.43 "," $1,521.43 "," $2,846.20 "," $1,788.22 ", $296.78 ," $2,876.16 "
Office/Outpatient Established Sf Mdm 10-19 Min,99212,N/A,N/A,N/A, $119.00 , $77.35 , $72.24 , $34.37 , $29.87 , $44.01 , $43.22 , $110.67 , $107.10 , $107.10 , $95.20 , $95.20 , $29.87 , $109.87 , $113.05 , $107.10 , $107.10 , $107.10 , $110.67 , $114.24 , $65.53 , $101.15 , $54.01 , $55.40 , $64.00 , $44.87 , $44.87 , $113.05 , $51.74 , $29.87 , $114.24 
 Pro I&D Abscess/Complicated ,CPT® 10061,0982 - PRO FEE/OUTPT,N/A,N/A, $834.00 , $542.10 , $590.92 , $177.26 , $93.30 , $490.97 , $481.05 , $775.62 , $750.60 , $750.60 , $667.20 , $667.20 , $93.30 , $770.03 , $792.30 , $750.60 , $750.60 , $750.60 , $775.62 , $800.64 , $644.00 , $708.90 , $950.91 , $632.67 , N/A , $500.54 , $500.54 , $792.30 , $580.46 , $93.30 , $950.91 
 Fac Drug Test Def 1-7 Classes ,CPT® G0480,0301 - LAB/CHEMISTRY,N/A,N/A, $270.00 , $175.50 , $226.80 , $116.72 , $65.23 , $218.16 , $243.00 , $228.58 , $243.00 , $243.00 , $243.00 , $229.50 , $63.95 , $249.29 , $256.50 , $229.50 , $251.10 , $251.10 , $256.50 , $259.20 , $220.91 , $243.00 , $229.50 , $213.30 , N/A , $218.51 , $218.51 , $256.50 , $231.69 , $63.95 , $259.20 
 Fac Assay of Acth ,CPT® 82024,0301 - LAB/CHEMISTRY,N/A,N/A, $353.00 , $229.45 , $296.52 , $39.39 , $39.39 , $285.22 , $317.70 , $298.85 , $317.70 , $317.70 , $317.70 , $300.05 , $38.62 , $325.92 , $335.35 , $300.05 , $328.29 , $328.29 , $335.35 , $338.88 , $288.82 , $317.70 , $300.05 , $278.87 , N/A , $285.68 , $285.68 , $335.35 , $302.91 , $38.62 , $338.88 
" Pro OB US < 14 Wks, Add'l Fetus ",CPT® 76802,0972 - PRO FEE/RAD/DX,N/A,N/A, $289.00 , $187.85 , $348.58 , $60.65 , $69.63 , $314.19 , $348.27 , $268.77 , $260.10 , $260.10 , $231.20 , $231.20 , $69.63 , $266.83 , $274.55 , $260.10 , $260.10 , $260.10 , $268.77 , $277.44 , $349.15 , $245.65 , $379.43 , $365.35 , N/A , $320.32 , $320.32 , $274.55 , $370.77 , $60.65 , $379.43 
 RHO D IMMUNE GLOBULIN 1500 UNIT/2ML IJ SOSY ,HCPCS J2791,0636 - DRUGS REQUIRING DETAILED CODIN,44206-0300-01,2 mL, $988.65 , $642.62 , $830.47 , $5.00 , $5.08 , $798.83 , $889.79 , $836.99 , $889.79 , $889.79 , $889.79 , $840.35 , $4.98 , $912.82 , $939.22 , $840.35 , $919.44 , $919.44 , $939.22 , $949.10 , $808.91 , $889.79 , $840.35 , $781.03 , N/A , $800.11 , $800.11 , $939.22 , $848.36 , $4.98 , $949.10 
 Fac Drug Screening Buprenorphine ,CPT® 80348,0301 - LAB/CHEMISTRY,N/A,N/A, $357.00 , $232.05 , $299.88 , N/A , N/A , $288.46 , $321.30 , $302.24 , $321.30 , $321.30 , $321.30 , $303.45 , N/A , $329.62 , $339.15 , $303.45 , $332.01 , $332.01 , $339.15 , $342.72 , $292.10 , $321.30 , $303.45 , $282.03 , N/A , $288.92 , $288.92 , $339.15 , $306.34 , $282.03 , $342.72 
Fine Needle Aspiration Bx W/CT Gdn 1st Lesion,CPT® 10009,N/A,N/A,N/A, $440.00 , $286.00 , $358.90 , $104.81 , $371.64 , $293.46 , N/A , $409.20 , $396.00 , $396.00 , $352.00 , $352.00 , $371.64 , $406.25 , $418.00 , $396.00 , $396.00 , $396.00 , $409.20 , $422.40 , $377.75 , $374.00 , $572.18 , $403.58 , N/A , $299.19 , $299.19 , $418.00 , $346.95 , $104.81 , $572.18 
Kit Gene Analysis D816 Variant(S),CPT® 81273,N/A,N/A,N/A, $891.00 , $579.15 , N/A , $127.37 , $75.40 , $384.15 , N/A , $828.63 , $801.90 , $801.90 , $712.80 , $712.80 , $75.40 , $822.66 , $846.45 , $801.90 , $801.90 , $801.90 , $828.63 , $855.36 , $833.78 , $757.35 , $594.46 , $366.74 , N/A , $358.51 , $358.51 , $846.45 , $391.78 , $75.40 , $855.36 
X-Ray Sacrum/Coccyx 2+ Vw,CPT® 72220,N/A,N/A,N/A, $392.00 , $254.80 , $182.82 , $32.04 , $27.66 , $131.98 , $153.94 , $364.56 , $352.80 , $352.80 , $313.60 , $313.60 , $27.66 , $361.93 , $372.40 , $352.80 , $352.80 , $352.80 , $364.56 , $376.32 , $176.44 , $333.20 , $169.49 , $142.36 , N/A , $134.56 , $134.56 , $372.40 , $155.74 , $27.66 , $376.32 
Assay G6pd Enzyme,CPT® 82955,N/A,N/A,N/A, $128.00 , $83.20 , N/A , $9.89 , $9.89 , $54.84 , $65.62 , $119.04 , $115.20 , $115.20 , $102.40 , $102.40 , $9.89 , $118.18 , $121.60 , $115.20 , $115.20 , $115.20 , $119.04 , $122.88 , $64.77 , $108.80 , $63.25 , $35.16 , N/A , $51.18 , $51.18 , $121.60 , $55.93 , $9.89 , $122.88 
 Fac Amputation Finger/Thumb+Flaps ,CPT® 26952,0361 - OR/MINOR,N/A,N/A," $7,167.00 "," $4,658.55 "," $6,020.28 ", $669.14 , $336.65 ," $5,790.94 "," $6,450.30 "," $6,067.58 "," $6,450.30 "," $6,450.30 "," $6,450.30 "," $6,091.95 ", $330.05 ," $6,617.29 "," $6,808.65 "," $6,091.95 "," $6,665.31 "," $6,665.31 "," $6,808.65 "," $6,880.32 "," $5,864.04 "," $6,450.30 "," $6,091.95 "," $5,661.93 ", N/A ," $5,800.25 "," $5,800.25 "," $6,808.65 "," $6,150.00 ", $330.05 ," $6,880.32 "
"Bx/Remv,Lymph Node,Intern Mamm",CPT® 38530,N/A,N/A,N/A," $4,144.00 "," $2,693.60 "," $2,611.85 ", $531.87 , $461.04 ," $1,902.65 "," $1,976.04 "," $3,853.92 "," $3,729.60 "," $3,729.60 "," $3,315.20 "," $3,315.20 ", $461.04 ," $3,826.16 "," $3,936.80 "," $3,729.60 "," $3,729.60 "," $3,729.60 "," $3,853.92 "," $3,978.24 "," $2,804.90 "," $3,522.40 "," $2,927.65 "," $2,703.14 ", N/A ," $1,939.77 "," $1,939.77 "," $3,936.80 "," $2,250.37 ", $461.04 ," $3,978.24 "
"Exc Skin Benig 0.6-1cm Trunk,Arm,Leg",CPT® 11401,N/A,N/A,N/A, $590.00 , $383.50 , $339.42 , $102.35 , $82.94 , $283.30 , $279.16 , $548.70 , $531.00 , $531.00 , $472.00 , $472.00 , $82.94 , $544.75 , $560.50 , $531.00 , $531.00 , $531.00 , $548.70 , $566.40 , $369.90 , $501.50 , $554.84 , $364.24 , N/A , $288.83 , $288.83 , $560.50 , $334.93 , $82.94 , $566.40 
 Fac Mycoplasma ,CPT® 87109,0306 - LAB/BACT-MICRO,N/A,N/A, $204.00 , $132.60 , $171.36 , $15.70 , $13.83 , $164.83 , $183.60 , $172.71 , $183.60 , $183.60 , $183.60 , $173.40 , $13.56 , $188.35 , $193.80 , $173.40 , $189.72 , $189.72 , $193.80 , $195.84 , $166.91 , $183.60 , $173.40 , $161.16 , N/A , $165.10 , $165.10 , $193.80 , $175.05 , $13.56 , $195.84 
Sono Eye B-Scan,76512,N/A,N/A,N/A, $376.00 , $244.40 , $270.51 , $47.48 , $89.10 , $449.52 , $497.27 , $349.68 , $338.40 , $338.40 , $300.80 , $300.80 , $89.10 , $347.16 , $357.20 , $338.40 , $338.40 , $338.40 , $349.68 , $360.96 , $273.28 , $319.60 , $543.14 , $423.34 , N/A , $458.29 , $458.29 , $357.20 , $530.47 , $47.48 , $543.14 
Urine Albumin Quantitative,CPT® 82043,N/A,N/A,N/A, $140.00 , $91.00 , N/A , $5.90 , $5.90 , $32.72 , $39.14 , $130.20 , $126.00 , $126.00 , $112.00 , $112.00 , $5.90 , $129.26 , $133.00 , $126.00 , $126.00 , $126.00 , $130.20 , $134.40 , $38.59 , $119.00 , $37.30 , $20.97 , N/A , $30.54 , $30.54 , $133.00 , $33.37 , $5.90 , $134.40 
 SUGAMMADEX SODIUM 200 MG/2ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00006-5423-12,2 mL, $761.29 , $494.84 , $639.48 , N/A , N/A , $615.12 , $685.16 , $644.51 , $685.16 , $685.16 , $685.16 , $647.10 , N/A , $702.90 , $723.23 , $647.10 , $708.00 , $708.00 , $723.23 , $730.84 , $622.89 , $685.16 , $647.10 , $601.42 , N/A , $616.11 , $616.11 , $723.23 , $653.26 , $601.42 , $730.84 
"Blood, Occult, by Peroxid, Feces, Other Sources",CPT® 82271,N/A,N/A,N/A, $46.00 , $29.90 , N/A , $5.43 , $4.21 , $18.42 , $22.06 , $42.78 , $41.40 , $41.40 , $36.80 , $36.80 , $4.21 , $42.47 , $43.70 , $41.40 , $41.40 , $41.40 , $42.78 , $44.16 , $35.52 , $39.10 , $21.08 , $15.59 , N/A , $17.19 , $17.19 , $43.70 , $18.78 , $4.21 , $44.16 
 Pro Peri-Px Dev Eval Pm/Ldls Pm Phys/Qhp in Person ,CPT® 93286,0982 - PRO FEE/OUTPT,N/A,N/A, $293.00 , $190.45 , $301.93 , $45.39 , $25.87 , $147.31 , $148.68 , $272.49 , $263.70 , $263.70 , $234.40 , $234.40 , $25.87 , $270.53 , $278.35 , $263.70 , $263.70 , $263.70 , $272.49 , $281.28 , $277.59 , $249.05 , $139.16 , $113.37 , N/A , $150.19 , $150.19 , $278.35 , $166.47 , $25.87 , $301.93 
 Pro Chg Radiologic Exam Chest 3 Views ,CPT® 71047,0972 - PRO FEE/RAD/DX,N/A,N/A, $177.00 , $115.05 , $238.79 , $41.73 , $30.77 , $175.36 , $196.37 , $164.61 , $159.30 , $159.30 , $141.60 , $141.60 , $30.77 , $163.42 , $168.15 , $159.30 , $159.30 , $159.30 , $164.61 , $169.92 , $234.09 , $150.45 , $243.63 , $196.88 , N/A , $178.79 , $178.79 , $168.15 , $206.94 , $30.77 , $243.63 
 CEFAZOLIN 330 MG/ML IM WATER SYRINGE ,HCPCS J0690,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9924-90,1.52 mL, $16.68 , $10.84 , $14.01 , $0.89 , $0.79 , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , $0.77 , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $0.77 , $16.01 
 Pro Breast Biopsy Proc W Guidance ,CPT® 19083,0972 - PRO FEE/RAD/DX,N/A,N/A," $2,485.00 "," $1,615.25 ", $500.04 , $147.29 , $125.44 , $453.36 , $453.66 ," $2,311.05 "," $2,236.50 "," $2,236.50 "," $1,988.00 "," $1,988.00 ", $125.44 ," $2,294.40 "," $2,360.75 "," $2,236.50 "," $2,236.50 "," $2,236.50 "," $2,311.05 "," $2,385.60 ", $551.50 ," $2,112.25 ", $804.96 , $560.67 , N/A , $462.20 , $462.20 ," $2,360.75 ", $536.00 , $125.44 ," $2,385.60 "
 Fac Chemical Cauterization of Granulation Tissue ,CPT® 17250,0761 - TREATMENT ROOM,N/A,N/A, $378.00 , $245.70 , $317.52 , $35.56 , $24.75 , $305.42 , $340.20 , $320.01 , $340.20 , $340.20 , $340.20 , $321.30 , $24.26 , $349.01 , $359.10 , $321.30 , $351.54 , $351.54 , $359.10 , $362.88 , $309.28 , $340.20 , $321.30 , $298.62 , N/A , $305.92 , $305.92 , $359.10 , $324.36 , $24.26 , $362.88 
 OCTREOTIDE ACETATE 1000 MCG/ML IJ SOLN ,HCPCS J2354,0636 - DRUGS REQUIRING DETAILED CODIN,63323-0379-05,0.5 mL, $306.30 , $199.10 , $257.29 , $1.34 , $1.45 , $247.49 , $275.67 , $259.31 , $275.67 , $275.67 , $275.67 , $260.36 , $1.42 , $282.81 , $290.99 , $260.36 , $284.86 , $284.86 , $290.99 , $294.05 , $250.61 , $275.67 , $260.36 , $241.98 , N/A , $247.89 , $247.89 , $290.99 , $262.84 , $1.34 , $294.05 
 Pro Injection Aa&/Strd Brachial Plexus W/Img Gdn ,CPT® 64415,0960 - PRO FEE,N/A,N/A," $1,842.00 "," $1,197.30 ", $313.20 , $67.27 , $76.84 , $364.26 , $347.59 ," $1,713.06 "," $1,657.80 "," $1,657.80 "," $1,473.60 "," $1,473.60 ", $76.84 ," $1,700.72 "," $1,749.90 "," $1,657.80 "," $1,657.80 "," $1,657.80 "," $1,713.06 "," $1,768.32 ", $339.93 ," $1,565.70 ", $337.19 , $394.87 , N/A , $371.36 , $371.36 ," $1,749.90 ", $398.39 , $67.27 ," $1,768.32 "
Esophagoscopy Rigid Transoral With Biopsy,CPT® 43193,N/A,N/A,N/A," $1,269.00 ", $824.85 ," $1,031.36 ", $161.53 , $136.33 , $848.82 , $895.52 ," $1,180.17 "," $1,142.10 "," $1,142.10 "," $1,015.20 "," $1,015.20 ", $136.33 ," $1,171.67 "," $1,205.55 "," $1,142.10 "," $1,142.10 "," $1,142.10 "," $1,180.17 "," $1,218.24 ", $734.31 ," $1,078.65 ", $895.58 , $962.13 , N/A , $865.38 , $865.38 ," $1,205.55 ", $905.10 , $136.33 ," $1,218.24 "
 Pro Treat Hip Dislocation ,CPT® 27253,0982 - PRO FEE/OUTPT,N/A,N/A," $6,312.00 "," $4,102.80 "," $5,694.20 ", $890.54 , $922.06 ," $4,538.07 "," $4,507.15 "," $5,870.16 "," $5,680.80 "," $5,680.80 "," $5,049.60 "," $5,049.60 ", $922.06 ," $5,827.87 "," $5,996.40 "," $5,680.80 "," $5,680.80 "," $5,680.80 "," $5,870.16 "," $6,059.52 "," $5,303.79 "," $5,365.20 "," $4,984.67 "," $5,329.82 ", N/A ," $4,626.61 "," $4,626.61 "," $5,996.40 "," $5,437.92 ", $890.54 ," $6,059.52 "
 Pro Biopsy Bone Open Deep ,CPT® 20245,0975 - PRO FEE/OR,N/A,N/A," $4,143.00 "," $2,692.95 "," $2,091.25 ", $323.65 , $284.00 ," $2,980.23 "," $3,005.59 "," $3,852.99 "," $3,728.70 "," $3,728.70 "," $3,314.40 "," $3,314.40 ", $284.00 ," $3,825.23 "," $3,935.85 "," $3,728.70 "," $3,728.70 "," $3,728.70 "," $3,852.99 "," $3,977.28 "," $1,952.95 "," $3,521.55 "," $3,313.01 "," $2,013.43 ", N/A ," $3,038.38 "," $3,038.38 "," $3,935.85 "," $3,571.18 ", $284.00 ," $3,977.28 "
"Office Consultation,Level I",99241,N/A,N/A,N/A, $184.00 , $119.60 , N/A , N/A , N/A , $72.65 , $72.20 , $171.12 , $165.60 , $165.60 , $147.20 , $147.20 , N/A , $169.89 , $174.80 , $165.60 , $165.60 , $165.60 , $171.12 , $176.64 , $90.33 , $156.40 , N/A , $71.43 , $56.50 , N/A , N/A , $174.80 , N/A , $56.50 , $176.64 
" Pro Repair Paravag Defect, Vag ",CPT® 57285,0982 - PRO FEE/OUTPT,N/A,N/A," $4,164.00 "," $2,706.60 "," $3,283.90 ", $663.38 , $478.13 ," $2,742.44 "," $2,730.71 "," $3,872.52 "," $3,747.60 "," $3,747.60 "," $3,331.20 "," $3,331.20 ", $478.13 ," $3,844.62 "," $3,955.80 "," $3,747.60 "," $3,747.60 "," $3,747.60 "," $3,872.52 "," $3,997.44 "," $3,424.48 "," $3,539.40 "," $3,575.26 "," $2,763.61 ", N/A ," $2,795.95 "," $2,795.95 "," $3,955.80 "," $3,353.56 ", $478.13 ," $3,997.44 "
"Assay for Phenytoin, Free",CPT® 80186,N/A,N/A,N/A, $109.00 , $70.85 , N/A , $14.04 , $14.04 , $66.39 , $79.41 , $101.37 , $98.10 , $98.10 , $87.20 , $87.20 , $14.04 , $100.64 , $103.55 , $98.10 , $98.10 , $98.10 , $101.37 , $104.64 , $91.88 , $92.65 , $90.82 , $49.90 , N/A , $61.96 , $61.96 , $103.55 , $67.71 , $14.04 , $104.64 
 ED Arthrocentesis Aspir&/Inj Major Jt/Bursa W/US ,CPT® 20611,0761 - TREATMENT ROOM,N/A,N/A," $2,164.00 "," $1,406.60 "," $1,817.76 ", $56.61 , $71.34 ," $1,748.51 "," $1,947.60 "," $1,832.04 "," $1,947.60 "," $1,947.60 "," $1,947.60 "," $1,839.40 ", $69.94 ," $1,998.02 "," $2,055.80 "," $1,839.40 "," $2,012.52 "," $2,012.52 "," $2,055.80 "," $2,077.44 "," $1,770.58 "," $1,947.60 "," $1,839.40 "," $1,709.56 ", N/A ," $1,751.33 "," $1,751.33 "," $2,055.80 "," $1,856.93 ", $56.61 ," $2,077.44 "
Excision Tumor Soft Tissue Foot/Toe Subq 1.5+Cm,28039,N/A,N/A,N/A," $3,578.00 "," $2,325.70 "," $2,127.19 ", $329.68 , $397.09 ," $1,713.47 "," $1,737.33 "," $3,327.54 "," $3,220.20 "," $3,220.20 "," $2,862.40 "," $2,862.40 ", $397.09 ," $3,303.57 "," $3,399.10 "," $3,220.20 "," $3,220.20 "," $3,220.20 "," $3,327.54 "," $3,434.88 "," $1,977.95 "," $3,041.30 "," $1,882.19 "," $2,022.19 ", N/A ," $1,746.91 "," $1,746.91 "," $3,399.10 "," $2,053.23 ", $329.68 ," $3,434.88 "
" Octreoscan,Dx, Up to 6 Mci ",HCPCS A9572,0343 - DIAGNOSTIC RADIOPHARMACEUTICALS,N/A,N/A," $4,636.00 "," $3,013.40 "," $3,894.24 ", N/A ," $5,263.30 "," $3,745.89 "," $4,172.40 "," $3,924.84 "," $4,172.40 "," $4,172.40 "," $4,172.40 "," $3,940.60 "," $5,160.10 "," $4,280.42 "," $4,404.20 "," $3,940.60 "," $4,311.48 "," $4,311.48 "," $4,404.20 "," $4,450.56 "," $3,793.18 "," $4,172.40 "," $3,940.60 "," $3,662.44 ", N/A ," $3,751.91 "," $3,751.91 "," $4,404.20 "," $3,978.15 "," $3,662.44 "," $5,263.30 "
 Fac Basic Metabolic Panel Calcium Ionized ,CPT® 80047,0301 - LAB/CHEMISTRY,N/A,N/A, $137.00 , $89.05 , $115.08 , $14.00 , $11.74 , $110.70 , $123.30 , $115.98 , $123.30 , $123.30 , $123.30 , $116.45 , $11.51 , $126.49 , $130.15 , $116.45 , $127.41 , $127.41 , $130.15 , $131.52 , $112.09 , $123.30 , $116.45 , $108.23 , N/A , $110.87 , $110.87 , $130.15 , $117.56 , $11.51 , $131.52 
 Fac Mitochondrial Antibody Each ,CPT® 86381,0300 - LABORATORY,N/A,N/A, $136.00 , $88.40 , $114.24 , $25.96 , $17.25 , $109.89 , $122.40 , $115.14 , $122.40 , $122.40 , $122.40 , $115.60 , $16.91 , $125.57 , $129.20 , $115.60 , $126.48 , $126.48 , $129.20 , $130.56 , $111.28 , $122.40 , $115.60 , $107.44 , N/A , $110.06 , $110.06 , $129.20 , $116.70 , $16.91 , $130.56 
 Fac Acetone Assay ,CPT® 82010,0301 - LAB/CHEMISTRY,N/A,N/A, $124.00 , $80.60 , $104.16 , $8.33 , $8.33 , $100.19 , $111.60 , $104.98 , $111.60 , $111.60 , $111.60 , $105.40 , $8.17 , $114.49 , $117.80 , $105.40 , $115.32 , $115.32 , $117.80 , $119.04 , $101.46 , $111.60 , $105.40 , $97.96 , N/A , $100.35 , $100.35 , $117.80 , $106.40 , $8.17 , $119.04 
"Speech Audiometry, Complete",CPT® 92556,N/A,N/A,N/A, $282.00 , $183.30 , $91.78 , $41.48 , $21.98 , $81.53 , $85.87 , $262.26 , $253.80 , $253.80 , $225.60 , $225.60 , $21.98 , $260.37 , $267.90 , $253.80 , $253.80 , $253.80 , $262.26 , $270.72 , $113.99 , $239.70 , $114.55 , $143.08 , N/A , $83.12 , $83.12 , $267.90 , $96.91 , $21.98 , $270.72 
 Fac Ko Single Upright Custom Fit ,HCPCS L1843,0274 - PROSTHETIC DEV,N/A,N/A," $1,179.00 ", $766.35 , $990.36 ," $1,049.58 ", $427.85 , $952.63 ," $1,061.10 ", $998.14 ," $1,061.10 "," $1,061.10 "," $1,061.10 "," $1,002.15 ", $419.46 ," $1,088.57 "," $1,120.05 "," $1,002.15 "," $1,096.47 "," $1,096.47 "," $1,120.05 "," $1,131.84 ", $964.66 ," $1,061.10 "," $1,002.15 ", $931.41 , N/A , $954.16 , $954.16 ," $1,120.05 "," $1,011.70 ", $419.46 ," $1,131.84 "
"Detect Agent Nos, Dna, Quant",CPT® 87799,N/A,N/A,N/A, $422.00 , $274.30 , N/A , $43.70 , $43.70 , $242.34 , $289.89 , $392.46 , $379.80 , $379.80 , $337.60 , $337.60 , $43.70 , $389.63 , $400.90 , $379.80 , $379.80 , $379.80 , $392.46 , $405.12 , $286.05 , $358.70 , $280.58 , $155.31 , N/A , $226.17 , $226.17 , $400.90 , $247.15 , $43.70 , $405.12 
 Fac Perq Vert Agmntj Cavity Crtj Uni/Bi Cannulj Each ,CPT® 22515,0361 - OR/MINOR,N/A,N/A," $28,202.00 "," $18,331.30 "," $23,689.68 ", $201.67 ," $3,485.63 "," $22,787.22 "," $25,381.80 "," $23,875.81 "," $25,381.80 "," $25,381.80 "," $25,381.80 "," $23,971.70 "," $3,417.28 "," $26,038.91 "," $26,791.90 "," $23,971.70 "," $26,227.86 "," $26,227.86 "," $26,791.90 "," $27,073.92 "," $23,074.88 "," $25,381.80 "," $23,971.70 "," $22,279.58 ", N/A ," $22,823.88 "," $22,823.88 "," $26,791.90 "," $24,200.14 ", $201.67 ," $27,073.92 "
 INTRATHECAL PAIN PUMP ,HCPCS 62370,0250 - PHARMACY,00001-1049-01,1 each, $563.81 , $366.48 , $473.60 , $44.01 , $101.93 , $455.56 , $507.43 , $477.32 , $507.43 , $507.43 , $507.43 , $479.24 , $99.93 , $520.57 , $535.62 , $479.24 , $524.34 , $524.34 , $535.62 , $541.26 , $461.31 , $507.43 , $479.24 , $445.41 , N/A , $456.29 , $456.29 , $535.62 , $483.81 , $44.01 , $541.26 
 Fac Hemoglobin Electrophoresis ,CPT® 83020,0301 - LAB/CHEMISTRY,N/A,N/A, $126.00 , $81.90 , $105.84 , $13.13 , $6.32 , $101.81 , $113.40 , $106.67 , $113.40 , $113.40 , $113.40 , $107.10 , $6.20 , $116.34 , $119.70 , $107.10 , $117.18 , $117.18 , $119.70 , $120.96 , $103.09 , $113.40 , $107.10 , $99.54 , N/A , $101.97 , $101.97 , $119.70 , $108.12 , $6.20 , $120.96 
Fragmenting of Kidney Stone,CPT® 50590,N/A,N/A,N/A," $8,214.00 "," $5,339.10 "," $3,096.43 ", $545.56 , $905.84 ," $5,739.50 "," $5,883.70 "," $7,639.02 "," $7,392.60 "," $7,392.60 "," $6,571.20 "," $6,571.20 ", $905.84 ," $7,583.99 "," $7,803.30 "," $7,392.60 "," $7,392.60 "," $7,392.60 "," $7,639.02 "," $7,885.44 "," $7,084.90 "," $6,981.90 "," $2,934.79 "," $3,496.99 ", N/A ," $5,851.49 "," $5,851.49 "," $7,803.30 "," $6,749.12 ", $545.56 ," $7,885.44 "
 CLINDAMYCIN PHOSPHATE 600 MG/4ML IJ SOLN ,HCPCS J0736,0636 - DRUGS REQUIRING DETAILED CODIN,00009-0775-26,4 mL, $18.15 , $11.80 , $15.25 , N/A , N/A , $14.67 , $16.34 , $15.37 , $16.34 , $16.34 , $16.34 , $15.43 , N/A , $16.76 , $17.24 , $15.43 , $16.88 , $16.88 , $17.24 , $17.42 , $14.85 , $16.34 , $15.43 , $14.34 , N/A , $14.69 , $14.69 , $17.24 , $15.57 , $14.34 , $17.42 
Treat Metacarpal Fracture,26605,N/A,N/A,N/A," $1,450.00 ", $942.50 ," $1,855.17 ", $293.60 , $235.17 ," $1,410.06 "," $1,432.50 "," $1,348.50 "," $1,305.00 "," $1,305.00 "," $1,160.00 "," $1,160.00 ", $235.17 ," $1,338.79 "," $1,377.50 "," $1,305.00 "," $1,305.00 "," $1,305.00 "," $1,348.50 "," $1,392.00 "," $1,703.17 "," $1,232.50 "," $1,571.76 "," $1,675.41 ", N/A ," $1,437.57 "," $1,437.57 "," $1,377.50 "," $1,689.69 ", $235.17 ," $1,855.17 "
 OSELTAMIVIR PHOSPHATE 30 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,68180-0675-11,1 capsule, $72.85 , $47.35 , $61.19 , N/A , N/A , $58.86 , $65.57 , $61.67 , $65.57 , $65.57 , $65.57 , $61.92 , N/A , $67.26 , $69.21 , $61.92 , $67.75 , $67.75 , $69.21 , $69.94 , $59.61 , $65.57 , $61.92 , $57.55 , N/A , $58.96 , $58.96 , $69.21 , $62.51 , $57.55 , $69.94 
" Fac Hep B Core Antibody, Total ",CPT® 86704,0302 - LAB/IMMUNOLOGY,N/A,N/A, $126.00 , $81.90 , $105.84 , $12.29 , $12.29 , $101.81 , $113.40 , $106.67 , $113.40 , $113.40 , $113.40 , $107.10 , $12.05 , $116.34 , $119.70 , $107.10 , $117.18 , $117.18 , $119.70 , $120.96 , $103.09 , $113.40 , $107.10 , $99.54 , N/A , $101.97 , $101.97 , $119.70 , $108.12 , $12.05 , $120.96 
Wound Trtmnt W/Packing,12021,N/A,N/A,N/A, $794.00 , $516.10 , $449.31 , $134.92 , $40.65 , $376.90 , $386.02 , $738.42 , $714.60 , $714.60 , $635.20 , $635.20 , $40.65 , $733.10 , $754.30 , $714.60 , $714.60 , $714.60 , $738.42 , $762.24 , $490.29 , $674.90 , $768.93 , $482.58 , N/A , $384.26 , $384.26 , $754.30 , $445.62 , $40.65 , $768.93 
"Exc Parotd Lesn,Later Lobe",CPT® 42410,N/A,N/A,N/A," $4,055.00 "," $2,635.75 "," $3,862.30 ", $605.82 , $412.40 ," $2,977.49 "," $3,052.78 "," $3,771.15 "," $3,649.50 "," $3,649.50 "," $3,244.00 "," $3,244.00 ", $412.40 ," $3,743.98 "," $3,852.25 "," $3,649.50 "," $3,649.50 "," $3,649.50 "," $3,771.15 "," $3,892.80 "," $2,735.47 "," $3,446.75 "," $3,346.90 "," $3,500.11 ", N/A ," $3,035.58 "," $3,035.58 "," $3,852.25 "," $3,174.90 ", $412.40 ," $3,892.80 "
"Evaluation of Fna Smear to Determine Adequacy, Ea Add Eval",CPT® 88177,N/A,N/A,N/A, $162.00 , $105.30 , $103.60 , $29.07 , $20.60 , $121.22 , $135.90 , $150.66 , $145.80 , $145.80 , $129.60 , $129.60 , $20.60 , $149.57 , $153.90 , $145.80 , $145.80 , $145.80 , $150.66 , $155.52 , $188.50 , $137.70 , $141.10 , $107.62 , N/A , $113.13 , $113.13 , $153.90 , $124.32 , $20.60 , $188.50 
"Treat Inter/Subtroch Fx,W/Plate/Screw",CPT® 27244,N/A,N/A,N/A," $8,089.00 "," $5,257.85 "," $7,403.89 "," $1,157.71 "," $1,075.02 "," $5,946.99 "," $5,886.73 "," $7,522.77 "," $7,280.10 "," $7,280.10 "," $6,471.20 "," $6,471.20 "," $1,075.02 "," $7,468.57 "," $7,684.55 "," $7,280.10 "," $7,280.10 "," $7,280.10 "," $7,522.77 "," $7,765.44 "," $6,904.76 "," $6,875.65 "," $6,513.62 "," $6,990.58 ", N/A ," $6,063.03 "," $6,063.03 "," $7,684.55 "," $7,126.20 "," $1,075.02 "," $7,765.44 "
" Lac Repair Trunk, Extrem Simple 7.6-12.5cm - Mh ",CPT® 12004,0761 - TREATMENT ROOM,N/A,N/A, $443.00 , $287.95 , $372.12 , $67.81 , $89.32 , $357.94 , $398.70 , $375.04 , $398.70 , $398.70 , $398.70 , $376.55 , $87.57 , $409.02 , $420.85 , $376.55 , $411.99 , $411.99 , $420.85 , $425.28 , $362.46 , $398.70 , $376.55 , $349.97 , N/A , $358.52 , $358.52 , $420.85 , $380.14 , $67.81 , $425.28 
 Pro Shvg Skin Lesion 1 F/E/E/N/L/M Diam 1.1-2.0 Cm ,CPT® 11312,0982 - PRO FEE/OUTPT,N/A,N/A, $605.00 , $393.25 , $238.03 , $71.74 , $86.30 , $213.59 , $207.56 , $562.65 , $544.50 , $544.50 , $484.00 , $484.00 , $86.30 , $558.60 , $574.75 , $544.50 , $544.50 , $544.50 , $562.65 , $580.80 , $263.31 , $514.25 , $413.90 , $273.21 , N/A , $217.77 , $217.77 , $574.75 , $252.54 , $71.74 , $580.80 
"Excision Brach Clft Cyst,Superficial",CPT® 42810,N/A,N/A,N/A," $2,661.00 "," $1,729.65 "," $1,742.98 ", $274.95 , $285.82 ," $1,398.54 "," $1,459.68 "," $2,474.73 "," $2,394.90 "," $2,394.90 "," $2,128.80 "," $2,128.80 ", $285.82 ," $2,456.90 "," $2,527.95 "," $2,394.90 "," $2,394.90 "," $2,394.90 "," $2,474.73 "," $2,554.56 "," $1,246.02 "," $2,261.85 "," $1,589.60 "," $1,642.10 ", N/A ," $1,425.83 "," $1,425.83 "," $2,527.95 "," $1,491.27 ", $274.95 ," $2,554.56 "
 VENLAFAXINE HCL ER 37.5 MG PO CP24 ,HCPCS RXC637,0250 - PHARMACY,00904-7075-61,1 capsule, $3.36 , $2.18 , $2.82 , N/A , N/A , $2.71 , $3.02 , $2.84 , $3.02 , $3.02 , $3.02 , $2.86 , N/A , $3.10 , $3.19 , $2.86 , $3.12 , $3.12 , $3.19 , $3.23 , $2.75 , $3.02 , $2.86 , $2.65 , N/A , $2.72 , $2.72 , $3.19 , $2.88 , $2.65 , $3.23 
Obtaining Screen Pap Smear,Q0091,N/A,N/A,N/A, $150.00 , $97.50 , $88.90 , $17.93 , N/A , N/A , N/A , $139.50 , $135.00 , $135.00 , $120.00 , $120.00 , N/A , $138.50 , $142.50 , $135.00 , $135.00 , $135.00 , $139.50 , $144.00 , $119.72 , $127.50 , $36.33 , $41.27 , N/A , N/A , N/A , $142.50 , N/A , $17.93 , $144.00 
Insj Perq Vad W/Rs&I L Hrt Arterial Access Only,CPT® 33990,N/A,N/A,N/A," $5,256.00 "," $3,416.40 "," $2,110.36 ", $324.57 , $329.73 ," $1,874.35 "," $1,826.31 "," $4,888.08 "," $4,730.40 "," $4,730.40 "," $4,204.80 "," $4,204.80 ", $329.73 ," $4,852.86 "," $4,993.20 "," $4,730.40 "," $4,730.40 "," $4,730.40 "," $4,888.08 "," $5,045.76 "," $1,955.26 "," $4,467.60 "," $2,306.79 "," $2,046.87 ", N/A ," $1,910.92 "," $1,910.92 "," $4,993.20 "," $2,170.80 ", $324.57 ," $5,045.76 "
 Ribs Unilateral (Includes Pa Chest) ,CPT® 71101,0320 - DX X-RAY,N/A,N/A, $351.00 , $228.15 , $294.84 , $41.73 , $37.57 , $283.61 , $315.90 , $297.16 , $315.90 , $315.90 , $315.90 , $298.35 , $36.83 , $324.08 , $333.45 , $298.35 , $326.43 , $326.43 , $333.45 , $336.96 , $287.19 , $315.90 , $298.35 , $277.29 , N/A , $284.06 , $284.06 , $333.45 , $301.19 , $36.83 , $336.96 
"Intraoperative Cyto Path Consult, Initial Site",CPT® 88333,N/A,N/A,N/A, $660.00 , $429.00 , $335.70 , $92.04 , $75.62 , $436.14 , $480.64 , $613.80 , $594.00 , $594.00 , $528.00 , $528.00 , $75.62 , $609.38 , $627.00 , $594.00 , $594.00 , $594.00 , $613.80 , $633.60 , $617.44 , $561.00 , $501.15 , $314.46 , N/A , $407.03 , $407.03 , $627.00 , $447.31 , $75.62 , $633.60 
 Fac Echo Exam of Heart ,CPT® 93308,0483 - CARDIOLOGY – ECHOCARDIOLOGY,N/A,N/A," $1,147.00 ", $745.55 , $963.48 , $96.57 , $153.86 , $926.78 ," $1,032.30 ", $971.05 ," $1,032.30 "," $1,032.30 "," $1,032.30 ", $974.95 , $150.84 ," $1,059.03 "," $1,089.65 ", $974.95 ," $1,066.71 "," $1,066.71 "," $1,089.65 "," $1,101.12 ", $938.48 ," $1,032.30 ", $974.95 , $906.13 , N/A , $928.27 , $928.27 ," $1,089.65 ", $984.24 , $96.57 ," $1,101.12 "
"Repair Conjunc Lac,Rearrang,No Hosp",CPT® 65272,N/A,N/A,N/A," $4,824.00 "," $3,135.60 "," $2,181.34 ", $341.47 , $167.35 ," $1,986.60 "," $1,822.60 "," $4,486.32 "," $4,341.60 "," $4,341.60 "," $3,859.20 "," $3,859.20 ", $167.35 ," $4,454.00 "," $4,582.80 "," $4,341.60 "," $4,341.60 "," $4,341.60 "," $4,486.32 "," $4,631.04 "," $2,994.74 "," $4,100.40 "," $1,850.07 "," $2,522.60 ", N/A ," $2,025.36 "," $2,025.36 "," $4,582.80 "," $2,235.73 ", $167.35 ," $4,631.04 "
 CT Virtual Colonography-Screening ,CPT® 74263,0350 - CT SCAN,N/A,N/A," $12,361.00 "," $8,034.65 "," $10,383.24 ", $677.30 , $599.52 ," $9,987.69 "," $11,124.90 "," $10,464.82 "," $11,124.90 "," $11,124.90 "," $11,124.90 "," $10,506.85 ", $587.76 ," $11,412.91 "," $11,742.95 "," $10,506.85 "," $11,495.73 "," $11,495.73 "," $11,742.95 "," $11,866.56 "," $10,113.77 "," $11,124.90 "," $10,506.85 "," $9,765.19 ", N/A ," $10,003.76 "," $10,003.76 "," $11,742.95 "," $10,606.97 ", $587.76 ," $11,866.56 "
 Fac Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/O Img Gdn ,CPT® 62326,0360 - OR SERVICES,N/A,N/A," $1,702.00 "," $1,106.30 "," $1,429.68 ", $82.74 , $121.29 ," $1,375.22 "," $1,531.80 "," $1,440.91 "," $1,531.80 "," $1,531.80 "," $1,531.80 "," $1,446.70 ", $118.91 ," $1,571.46 "," $1,616.90 "," $1,446.70 "," $1,582.86 "," $1,582.86 "," $1,616.90 "," $1,633.92 "," $1,392.58 "," $1,531.80 "," $1,446.70 "," $1,344.58 ", N/A ," $1,377.43 "," $1,377.43 "," $1,616.90 "," $1,460.49 ", $82.74 ," $1,633.92 "
 Fac Sgmdsc Flx Rmvl Tum Polyp/Oth Les Snare Tq ,CPT® 45338,0360 - OR SERVICES,N/A,N/A," $1,738.00 "," $1,129.70 "," $1,459.92 ", $113.74 , $150.61 ," $1,404.30 "," $1,564.20 "," $1,471.39 "," $1,564.20 "," $1,564.20 "," $1,564.20 "," $1,477.30 ", $147.66 ," $1,604.70 "," $1,651.10 "," $1,477.30 "," $1,616.34 "," $1,616.34 "," $1,651.10 "," $1,668.48 "," $1,422.03 "," $1,564.20 "," $1,477.30 "," $1,373.02 ", N/A ," $1,406.56 "," $1,406.56 "," $1,651.10 "," $1,491.38 ", $113.74 ," $1,668.48 "
" Fac Virus Inoculation, Tissue ",CPT® 87252,0305 - LAB/HEMATOLOGY,N/A,N/A, $241.00 , $156.65 , $202.44 , $26.59 , $26.59 , $194.73 , $216.90 , $204.03 , $216.90 , $216.90 , $216.90 , $204.85 , $26.07 , $222.52 , $228.95 , $204.85 , $224.13 , $224.13 , $228.95 , $231.36 , $197.19 , $216.90 , $204.85 , $190.39 , N/A , $195.04 , $195.04 , $228.95 , $206.80 , $26.07 , $231.36 
"Repair Both Collat Ankl Ligmt,Primry",CPT® 27696,N/A,N/A,N/A," $7,085.00 "," $4,605.25 "," $3,388.78 ", $530.81 , $922.06 ," $2,690.78 "," $2,726.08 "," $6,589.05 "," $6,376.50 "," $6,376.50 "," $5,668.00 "," $5,668.00 ", $922.06 ," $6,541.58 "," $6,730.75 "," $6,376.50 "," $6,376.50 "," $6,376.50 "," $6,589.05 "," $6,801.60 "," $3,161.09 "," $6,022.25 "," $2,975.82 "," $3,234.70 ", N/A ," $2,743.28 "," $2,743.28 "," $6,730.75 "," $3,224.33 ", $530.81 ," $6,801.60 "
" Fac N Block, Stellate Ganglion ",CPT® 64510,0360 - OR SERVICES,N/A,N/A," $1,027.00 ", $667.55 , $862.68 , $74.23 , $129.25 , $829.82 , $924.30 , $869.46 , $924.30 , $924.30 , $924.30 , $872.95 , $126.72 , $948.23 , $975.65 , $872.95 , $955.11 , $955.11 , $975.65 , $985.92 , $840.29 , $924.30 , $872.95 , $811.33 , N/A , $831.15 , $831.15 , $975.65 , $881.27 , $74.23 , $985.92 
 MINOCYCLINE HCL 100 MG PO CAPS ,HCPCS RXC637,0250 - PHARMACY,00904-6888-06,1 capsule, $7.08 , $4.60 , $5.95 , N/A , N/A , $5.72 , $6.37 , $5.99 , $6.37 , $6.37 , $6.37 , $6.02 , N/A , $6.54 , $6.73 , $6.02 , $6.58 , $6.58 , $6.73 , $6.80 , $5.79 , $6.37 , $6.02 , $5.59 , N/A , $5.73 , $5.73 , $6.73 , $6.08 , $5.59 , $6.80 
 Xr Lumbar Spine Bending Only 2 or 3 Views ,CPT® 72120,0320 - DX X-RAY,N/A,N/A, $435.00 , $282.75 , $365.40 , $40.00 , $47.05 , $351.48 , $391.50 , $368.27 , $391.50 , $391.50 , $391.50 , $369.75 , $46.13 , $401.64 , $413.25 , $369.75 , $404.55 , $404.55 , $413.25 , $417.60 , $355.92 , $391.50 , $369.75 , $343.65 , N/A , $352.05 , $352.05 , $413.25 , $373.27 , $40.00 , $417.60 
"Muscle-Skin Flap,Leg",CPT® 15738,N/A,N/A,N/A," $9,866.00 "," $6,412.90 "," $4,032.98 "," $1,197.74 "," $1,244.28 "," $3,350.56 "," $3,281.48 "," $9,175.38 "," $8,879.40 "," $8,879.40 "," $7,892.80 "," $7,892.80 "," $1,244.28 "," $9,109.28 "," $9,372.70 "," $8,879.40 "," $8,879.40 "," $8,879.40 "," $9,175.38 "," $9,471.36 "," $4,454.34 "," $8,386.10 "," $6,611.74 "," $4,589.21 ", N/A ," $3,415.93 "," $3,415.93 "," $9,372.70 "," $3,961.33 "," $1,197.74 "," $9,471.36 "
Alcohol and/or Drug Interven,HCPCS H0022,N/A,N/A,N/A, $43.00 , $27.95 , N/A , N/A , $19.30 , N/A , N/A , $39.99 , $38.70 , $38.70 , $34.40 , $34.40 , $19.30 , $39.70 , $40.85 , $38.70 , $38.70 , $38.70 , $39.99 , $41.28 , N/A , $36.55 , $34.40 , N/A , N/A , N/A , N/A , $40.85 , N/A , $19.30 , $41.28 
" Other Skin, Subcutaneous Tissue And Breast Procedures With Cc ",MS DRG V40 (FY2023) 580,N/A,N/A,N/A," $168,907.67 "," $109,789.99 "," $141,882.44 ", N/A , N/A ," $136,477.40 "," $152,016.90 "," $142,997.23 "," $152,016.90 "," $152,016.90 "," $152,016.90 "," $143,571.52 ", N/A ," $155,952.45 "," $160,462.29 "," $143,571.52 "," $157,084.13 "," $157,084.13 "," $160,462.29 "," $162,151.36 "," $138,200.26 "," $152,016.90 "," $143,571.52 "," $133,437.06 ", N/A ," $136,696.98 "," $136,696.98 "," $160,462.29 "," $144,939.67 "," $133,437.06 "," $162,151.36 "
 IDARUCIZUMAB 2.5 GM/50ML IV SOLN ,HCPCS RXA250,0250 - PHARMACY,00597-0197-05,50 mL," $6,935.47 "," $4,508.06 "," $5,825.79 ", N/A , N/A ," $5,603.86 "," $6,241.92 "," $5,871.57 "," $6,241.92 "," $6,241.92 "," $6,241.92 "," $5,895.15 ", N/A ," $6,403.52 "," $6,588.70 "," $5,895.15 "," $6,449.99 "," $6,449.99 "," $6,588.70 "," $6,658.05 "," $5,674.60 "," $6,241.92 "," $5,895.15 "," $5,479.02 ", N/A ," $5,612.88 "," $5,612.88 "," $6,588.70 "," $5,951.33 "," $5,479.02 "," $6,658.05 "
 Fac Hfo W/O Joints Pf ,HCPCS L3923,0274 - PROSTHETIC DEV,N/A,N/A, $139.00 , $90.35 , $116.76 , $102.84 , $28.32 , $112.31 , $125.10 , $117.68 , $125.10 , $125.10 , $125.10 , $118.15 , $27.76 , $128.34 , $132.05 , $118.15 , $129.27 , $129.27 , $132.05 , $133.44 , $113.73 , $125.10 , $118.15 , $109.81 , N/A , $112.49 , $112.49 , $132.05 , $119.28 , $27.76 , $133.44 
 Fac Iodine I-123 Ioflupane ,HCPCS A9584,0342 - NUC MED/RX PROCEDURES,N/A,N/A," $4,437.00 "," $2,884.05 "," $3,727.08 ", N/A , N/A ," $3,585.10 "," $3,993.30 "," $3,756.36 "," $3,993.30 "," $3,993.30 "," $3,993.30 "," $3,771.45 ", N/A ," $4,096.68 "," $4,215.15 "," $3,771.45 "," $4,126.41 "," $4,126.41 "," $4,215.15 "," $4,259.52 "," $3,630.35 "," $3,993.30 "," $3,771.45 "," $3,505.23 ", N/A ," $3,590.86 "," $3,590.86 "," $4,215.15 "," $3,807.39 "," $3,505.23 "," $4,259.52 "
"Remove Hemorrhoids/Fissure,Complx",CPT® 46261,N/A,N/A,N/A," $3,636.00 "," $2,363.40 "," $3,244.41 ", $504.85 , $614.70 ," $2,478.49 "," $2,542.49 "," $3,381.48 "," $3,272.40 "," $3,272.40 "," $2,908.80 "," $2,908.80 ", $614.70 ," $3,357.12 "," $3,454.20 "," $3,272.40 "," $3,272.40 "," $3,272.40 "," $3,381.48 "," $3,490.56 "," $2,304.71 "," $3,090.60 "," $2,800.98 "," $2,960.67 ", N/A ," $2,526.85 "," $2,526.85 "," $3,454.20 "," $2,642.81 ", $504.85 ," $3,490.56 "
 Fac Flo Cytometry Interpj 2-8 Markers ,CPT® 88187,0311 - PATHOL/CYTOLOGY,N/A,N/A, $181.00 , $117.65 , $152.04 , $34.55 , $69.65 , $146.25 , $162.90 , $153.23 , $162.90 , $162.90 , $162.90 , $153.85 , $68.28 , $167.12 , $171.95 , $153.85 , $168.33 , $168.33 , $171.95 , $173.76 , $148.09 , $162.90 , $153.85 , $142.99 , N/A , $146.48 , $146.48 , $171.95 , $155.32 , $34.55 , $173.76 
"Chicken Pox Vaccine,Live,Subcut",CPT® 90716,N/A,N/A,N/A, $246.00 , $159.90 , N/A , N/A , $128.50 , $162.92 , $170.10 , $228.78 , $221.40 , $221.40 , $196.80 , $196.80 , $128.50 , $227.13 , $233.70 , $221.40 , $221.40 , $221.40 , $228.78 , $236.16 , N/A , $209.10 , $226.06 , $262.86 , N/A , $166.10 , $166.10 , $233.70 , $193.63 , $128.50 , $262.86 
 RASBURICASE 1.5 MG IV SOLR ,HCPCS J2783,0636 - DRUGS REQUIRING DETAILED CODIN,00024-5150-10,1 mL," $3,128.14 "," $2,033.29 "," $2,627.64 ", $364.51 , $349.73 ," $2,527.54 "," $2,815.33 "," $2,648.28 "," $2,815.33 "," $2,815.33 "," $2,815.33 "," $2,658.92 ", $342.87 ," $2,888.21 "," $2,971.73 "," $2,658.92 "," $2,909.17 "," $2,909.17 "," $2,971.73 "," $3,003.01 "," $2,559.44 "," $2,815.33 "," $2,658.92 "," $2,471.23 ", N/A ," $2,531.60 "," $2,531.60 "," $2,971.73 "," $2,684.26 ", $342.87 ," $3,003.01 "
Pvb Thoracic Cont Catheter Infusion W/Img Gid,CPT® 64463,N/A,N/A,N/A," $1,230.00 ", $799.50 , $410.28 , $79.01 , $131.73 , $481.46 , $476.40 ," $1,143.90 "," $1,107.00 "," $1,107.00 ", $984.00 , $984.00 , $131.73 ," $1,135.66 "," $1,168.50 "," $1,107.00 "," $1,107.00 "," $1,107.00 "," $1,143.90 "," $1,180.80 ", $444.16 ," $1,045.50 ", $430.02 , $522.18 , N/A , $490.86 , $490.86 ," $1,168.50 ", $526.58 , $79.01 ," $1,180.80 "
Debride Assoc Fx/Dislo Skin/Mus/Bone,CPT® 11012,N/A,N/A,N/A," $3,578.00 "," $2,325.70 "," $1,302.44 ", $388.61 , $557.87 ," $1,152.59 "," $1,106.95 "," $3,327.54 "," $3,220.20 "," $3,220.20 "," $2,862.40 "," $2,862.40 ", $557.87 ," $3,303.57 "," $3,399.10 "," $3,220.20 "," $3,220.20 "," $3,220.20 "," $3,327.54 "," $3,434.88 "," $1,434.56 "," $3,041.30 "," $2,228.30 "," $1,465.64 ", N/A ," $1,175.08 "," $1,175.08 "," $3,399.10 "," $1,362.70 ", $388.61 ," $3,434.88 "
 KCL-LACTATED RINGERS-D5W 20 MEQ/L IV SOLN ,HCPCS RXA258,0258 - IV SOLUTIONS,00338-0811-04,"1,000 mL", $172.93 , $112.40 , $145.26 , N/A , N/A , $139.73 , $155.64 , $146.40 , $155.64 , $155.64 , $155.64 , $146.99 , N/A , $159.67 , $164.28 , $146.99 , $160.82 , $160.82 , $164.28 , $166.01 , $141.49 , $155.64 , $146.99 , $136.61 , N/A , $139.95 , $139.95 , $164.28 , $148.39 , $136.61 , $166.01 
"Destruc Flat Warts, Up to 14 Lesions",CPT® 17110,N/A,N/A,N/A, $342.00 , $222.30 , $157.95 , $65.34 , $26.07 , $189.80 , $190.02 , $318.06 , $307.80 , $307.80 , $273.60 , $273.60 , $26.07 , $315.77 , $324.90 , $307.80 , $307.80 , $307.80 , $318.06 , $328.32 , $233.71 , $290.70 , $374.65 , $246.56 , N/A , $193.50 , $193.50 , $324.90 , $224.41 , $26.07 , $374.65 
 Duplex Hemodialysis Access ,CPT® 93990,0921 - PERI VASCUL LAB,N/A,N/A," $1,086.00 ", $705.90 , $912.24 , $125.08 , $140.15 , $877.49 , $977.40 , $919.41 , $977.40 , $977.40 , $977.40 , $923.10 , $137.40 ," $1,002.70 "," $1,031.70 ", $923.10 ," $1,009.98 "," $1,009.98 "," $1,031.70 "," $1,042.56 ", $888.57 , $977.40 , $923.10 , $857.94 , N/A , $878.90 , $878.90 ," $1,031.70 ", $931.90 , $125.08 ," $1,042.56 "
Consultation With Family,CPT® 90887,N/A,N/A,N/A, $347.00 , $225.55 , N/A , $83.44 , $79.59 , $169.41 , $167.72 , $322.71 , $312.30 , $312.30 , $277.60 , $277.60 , $79.59 , $320.39 , $329.65 , $312.30 , $312.30 , $312.30 , $322.71 , $333.12 , $183.73 , $294.95 , N/A , $287.75 , N/A , $172.71 , $172.71 , $329.65 , $201.33 , $79.59 , $333.12 
" Urine Dipstick,Nonautomated (Clini ",CPT® 81003,0307 - LAB/UROLOGY,N/A,N/A, $46.00 , $29.90 , $38.64 , $2.30 , $2.30 , $37.17 , $41.40 , $38.94 , $41.40 , $41.40 , $41.40 , $39.10 , $2.25 , $42.47 , $43.70 , $39.10 , $42.78 , $42.78 , $43.70 , $44.16 , $37.64 , $41.40 , $39.10 , $36.34 , N/A , $37.23 , $37.23 , $43.70 , $39.47 , $2.25 , $44.16 
 Fac Blood Clot Inhibitor Test ,CPT® 85306,0305 - LAB/HEMATOLOGY,N/A,N/A, $284.00 , $184.60 , $238.56 , $15.63 , $15.63 , $229.47 , $255.60 , $240.43 , $255.60 , $255.60 , $255.60 , $241.40 , $15.32 , $262.22 , $269.80 , $241.40 , $264.12 , $264.12 , $269.80 , $272.64 , $232.37 , $255.60 , $241.40 , $224.36 , N/A , $229.84 , $229.84 , $269.80 , $243.70 , $15.32 , $272.64 
Replacement Tissue Expander W/Permanent Implant,CPT® 11970,N/A,N/A,N/A," $5,510.00 "," $3,581.50 "," $1,787.21 ", $536.13 , $836.80 ," $1,655.71 "," $1,629.06 "," $5,124.30 "," $4,959.00 "," $4,959.00 "," $4,408.00 "," $4,408.00 ", $836.80 ," $5,087.38 "," $5,234.50 "," $4,959.00 "," $4,959.00 "," $4,959.00 "," $5,124.30 "," $5,289.60 "," $1,959.84 "," $4,683.50 "," $3,266.62 "," $2,122.45 ", N/A ," $1,688.01 "," $1,688.01 "," $5,234.50 "," $1,957.54 ", $536.13 ," $5,289.60 "
 Pro Cl Tx Inphal Jt Dis/Anes ,CPT® 26775,0982 - PRO FEE/OUTPT,N/A,N/A," $2,366.00 "," $1,537.90 "," $2,190.89 ", $348.94 , $96.07 ," $1,665.79 "," $1,696.44 "," $2,200.38 "," $2,129.40 "," $2,129.40 "," $1,892.80 "," $1,892.80 ", $96.07 ," $2,184.53 "," $2,247.70 "," $2,129.40 "," $2,129.40 "," $2,129.40 "," $2,200.38 "," $2,271.36 "," $2,017.00 "," $2,011.10 "," $1,860.78 "," $1,975.65 ", N/A ," $1,698.29 "," $1,698.29 "," $2,247.70 "," $1,996.10 ", $96.07 ," $2,271.36 "
3d Render W/O Image Postprocess,CPT® 76376,N/A,N/A,N/A, $804.00 , $522.60 , $128.30 , $23.55 , $71.81 , $108.52 , $311.87 , $747.72 , $723.60 , $723.60 , $643.20 , $643.20 , $71.81 , $742.33 , $763.80 , $723.60 , $723.60 , $723.60 , $747.72 , $771.84 , $124.06 , $683.40 , $340.91 , $150.39 , N/A , $110.64 , $110.64 , $763.80 , $128.08 , $23.55 , $771.84 
Drain Pilonidal Cyst Simpl,CPT® 10080,N/A,N/A,N/A, $795.00 , $516.75 , $335.61 , $100.38 , $61.55 , $282.06 , $278.01 , $739.35 , $715.50 , $715.50 , $636.00 , $636.00 , $61.55 , $734.02 , $755.25 , $715.50 , $715.50 , $715.50 , $739.35 , $763.20 , $367.33 , $675.75 , $553.06 , $359.71 , N/A , $287.57 , $287.57 , $755.25 , $333.47 , $61.55 , $763.20 
"Biopsy Nasopharynx,Simple",CPT® 42804,N/A,N/A,N/A," $1,343.00 ", $872.95 , $756.93 , $119.54 , $76.84 , $547.36 , $571.48 ," $1,248.99 "," $1,208.70 "," $1,208.70 "," $1,074.40 "," $1,074.40 ", $76.84 ," $1,239.99 "," $1,275.85 "," $1,208.70 "," $1,208.70 "," $1,208.70 "," $1,248.99 "," $1,289.28 ", $520.09 ," $1,141.55 ", $620.85 , $641.62 , N/A , $558.04 , $558.04 ," $1,275.85 ", $583.66 , $76.84 ," $1,289.28 "
Treat Interphalangeal Jnt,28660,N/A,N/A,N/A, $758.00 , $492.70 , $565.96 , $89.32 , $69.38 , $431.41 , $434.98 , $704.94 , $682.20 , $682.20 , $606.40 , $606.40 , $69.38 , $699.86 , $720.10 , $682.20 , $682.20 , $682.20 , $704.94 , $727.68 , $522.51 , $644.30 , $476.35 , $510.98 , N/A , $439.83 , $439.83 , $720.10 , $516.96 , $69.38 , $727.68 
Esophagoscp Rig Transoral Hypopharynx Crv Esoph,CPT® 43180,N/A,N/A,N/A," $3,525.00 "," $2,291.25 "," $3,350.88 ", $524.13 , $412.02 ," $2,725.32 "," $2,753.63 "," $3,278.25 "," $3,172.50 "," $3,172.50 "," $2,820.00 "," $2,820.00 ", $412.02 ," $3,254.63 "," $3,348.75 "," $3,172.50 "," $3,172.50 "," $3,172.50 "," $3,278.25 "," $3,384.00 "," $2,381.43 "," $2,996.25 "," $2,908.86 "," $3,092.41 ", N/A ," $2,778.50 "," $2,778.50 "," $3,348.75 "," $2,906.02 ", $412.02 ," $3,384.00 "
 AZTREONAM 1 G IJ SOLR ,HCPCS J0457,0636 - DRUGS REQUIRING DETAILED CODIN,00409-0829-01,5 mL, $101.72 , $66.12 , $85.44 , N/A , N/A , $82.19 , $91.55 , $86.12 , $91.55 , $91.55 , $91.55 , $86.46 , N/A , $93.92 , $96.63 , $86.46 , $94.60 , $94.60 , $96.63 , $97.65 , $83.23 , $91.55 , $86.46 , $80.36 , N/A , $82.32 , $82.32 , $96.63 , $87.29 , $80.36 , $97.65 
 Fac Oph US Dx B-Scan +-a-Scan ,CPT® 76512,0402 - ULTRASOUND,N/A,N/A, $562.00 , $365.30 , $472.08 , $47.48 , $89.10 , $454.10 , $505.80 , $475.79 , $505.80 , $505.80 , $505.80 , $477.70 , $87.35 , $518.89 , $533.90 , $477.70 , $522.66 , $522.66 , $533.90 , $539.52 , $459.83 , $505.80 , $477.70 , $443.98 , N/A , $454.83 , $454.83 , $533.90 , $482.25 , $47.48 , $539.52 
Revise Ulnar Nerve at Elbow,CPT® 64718,N/A,N/A,N/A," $3,886.00 "," $2,525.90 "," $2,935.92 ", $578.30 , $486.60 ," $3,246.74 "," $3,188.24 "," $3,613.98 "," $3,497.40 "," $3,497.40 "," $3,108.80 "," $3,108.80 ", $486.60 ," $3,587.94 "," $3,691.70 "," $3,497.40 "," $3,497.40 "," $3,497.40 "," $3,613.98 "," $3,730.56 "," $3,158.37 "," $3,303.10 "," $3,161.36 "," $3,490.52 ", N/A ," $3,310.09 "," $3,310.09 "," $3,691.70 "," $3,550.93 ", $486.60 ," $3,730.56 "
"Resect Small Intest,Singl Resec/Anas",CPT® 44120,N/A,N/A,N/A," $8,302.00 "," $5,396.30 "," $7,256.80 "," $1,122.97 "," $1,490.95 "," $5,745.83 "," $5,788.26 "," $7,720.86 "," $7,471.80 "," $7,471.80 "," $6,641.60 "," $6,641.60 "," $1,490.95 "," $7,665.24 "," $7,886.90 "," $7,471.80 "," $7,471.80 "," $7,471.80 "," $7,720.86 "," $7,969.92 "," $5,203.66 "," $7,056.70 "," $6,442.26 "," $6,782.54 ", N/A ," $5,857.94 "," $5,857.94 "," $7,886.90 "," $6,126.79 "," $1,122.97 "," $7,969.92 "
 DESMOPRESSIN ACETATE PF 4 MCG/ML IJ SOLN ,HCPCS J2597,0636 - DRUGS REQUIRING DETAILED CODIN,69918-0899-10,0.5 mL, $181.21 , $117.79 , $152.22 , $7.42 , $7.48 , $146.42 , $163.09 , $153.41 , $163.09 , $163.09 , $163.09 , $154.03 , $7.33 , $167.31 , $172.15 , $154.03 , $168.53 , $168.53 , $172.15 , $173.96 , $148.27 , $163.09 , $154.03 , $143.16 , N/A , $146.65 , $146.65 , $172.15 , $155.50 , $7.33 , $173.96 
Inj for Sacroiliac Jt Anesth,HCPCS G0260,N/A,N/A,N/A, $332.00 , $215.80 , N/A , N/A , N/A , N/A , N/A , $308.76 , $298.80 , $298.80 , $265.60 , $265.60 , N/A , $306.54 , $315.40 , $298.80 , $298.80 , $298.80 , $308.76 , $318.72 , N/A , $282.20 , $265.60 , N/A , N/A , N/A , N/A , $315.40 , N/A , $265.60 , $318.72 
 MEDIHONEY WOUND/BURN DRESSING EX PSTE ,HCPCS RXC637,0250 - PHARMACY,09958-0033-52,5 mL, $24.56 , $15.96 , $20.63 , N/A , N/A , $19.84 , $22.10 , $20.79 , $22.10 , $22.10 , $22.10 , $20.88 , N/A , $22.68 , $23.33 , $20.88 , $22.84 , $22.84 , $23.33 , $23.58 , $20.09 , $22.10 , $20.88 , $19.40 , N/A , $19.88 , $19.88 , $23.33 , $21.07 , $19.40 , $23.58 
Haloperidol Injection,HCPCS J1630,N/A,N/A,N/A, $8.00 , $5.20 , N/A , $1.41 , $1.17 , N/A , N/A , $7.44 , $7.20 , $7.20 , $6.40 , $6.40 , $1.17 , $7.39 , $7.60 , $7.20 , $7.20 , $7.20 , $7.44 , $7.68 , $2.35 , $6.80 , $3.89 , $2.27 , N/A , N/A , N/A , $7.60 , N/A , $1.17 , $7.68 
 Pro Repair Nail Bed-Lh ,CPT® 11760,0982 - PRO FEE/OUTPT,N/A,N/A, $840.00 , $546.00 , $358.36 , $106.67 , $42.71 , $359.65 , $359.77 , $781.20 , $756.00 , $756.00 , $672.00 , $672.00 , $42.71 , $775.57 , $798.00 , $756.00 , $756.00 , $756.00 , $781.20 , $806.40 , $400.51 , $714.00 , $715.41 , $401.98 , N/A , $366.67 , $366.67 , $798.00 , $425.20 , $42.71 , $806.40 
Sigmoidoscopy Flx Ablation Tumor Polyp/Oth Les,45346,N/A,N/A,N/A," $2,218.00 "," $1,441.70 ", $982.48 , $152.15 , $265.94 , $856.55 , $891.41 ," $2,062.74 "," $1,996.20 "," $1,996.20 "," $1,774.40 "," $1,774.40 ", $265.94 ," $2,047.88 "," $2,107.10 "," $1,996.20 "," $1,996.20 "," $1,996.20 "," $2,062.74 "," $2,129.28 ", $706.64 ," $1,885.30 ", $838.72 , $935.76 , N/A , $873.27 , $873.27 ," $2,107.10 ", $913.34 , $152.15 ," $2,129.28 "
"Inject Anter Chmbr Eye,Medicatn",CPT® 66030,N/A,N/A,N/A," $1,619.00 "," $1,052.35 ", $682.63 , $107.75 , $61.48 , $625.61 , $586.48 ," $1,505.67 "," $1,457.10 "," $1,457.10 "," $1,295.20 "," $1,295.20 ", $61.48 ," $1,494.82 "," $1,538.05 "," $1,457.10 "," $1,457.10 "," $1,457.10 "," $1,505.67 "," $1,554.24 ", $936.36 ," $1,376.15 ", $603.01 , $801.05 , N/A , $637.82 , $637.82 ," $1,538.05 ", $704.06 , $61.48 ," $1,554.24 "
 PANCRELIPASE (LIP-PROT-AMYL) 12000-38000 UNITS PO CPEP ,HCPCS RXC637,0250 - PHARMACY,00032-1212-01,1 capsule, $24.39 , $15.85 , $20.49 , N/A , N/A , $19.71 , $21.95 , $20.65 , $21.95 , $21.95 , $21.95 , $20.73 , N/A , $22.52 , $23.17 , $20.73 , $22.68 , $22.68 , $23.17 , $23.41 , $19.96 , $21.95 , $20.73 , $19.27 , N/A , $19.74 , $19.74 , $23.17 , $20.93 , $19.27 , $23.41 
Lens Sphcyl Trifocal Over 12,HCPCS V2314,N/A,N/A,N/A, $90.00 , $58.50 , N/A , $125.24 , N/A , N/A , N/A , $83.70 , $81.00 , $81.00 , $72.00 , $72.00 , N/A , $83.10 , $85.50 , $81.00 , $81.00 , $81.00 , $83.70 , $86.40 , N/A , $76.50 , $90.00 , $113.79 , N/A , N/A , N/A , $85.50 , N/A , $72.00 , $125.24 
Platelet Antibodies,CPT® 86022,N/A,N/A,N/A, $325.00 , $211.25 , N/A , $18.74 , $18.74 , $103.94 , $124.31 , $302.25 , $292.50 , $292.50 , $260.00 , $260.00 , $18.74 , $300.07 , $308.75 , $292.50 , $292.50 , $292.50 , $302.25 , $312.00 , $122.66 , $276.25 , $120.02 , $66.61 , N/A , $97.00 , $97.00 , $308.75 , $106.00 , $18.74 , $312.00 
Place Needle in Vein,36000,N/A,N/A,N/A, $86.00 , $55.90 , N/A , $29.75 , $34.55 , $40.05 , $40.19 , $79.98 , $77.40 , $77.40 , $68.80 , $68.80 , $34.55 , $79.40 , $81.70 , $77.40 , $77.40 , $77.40 , $79.98 , $82.56 , $51.91 , $73.10 , N/A , $46.82 , N/A , $40.83 , $40.83 , $81.70 , $46.38 , $29.75 , $82.56 
 Pro Inject for Spine Disk X-Ray ,CPT® 62290,0982 - PRO FEE/OUTPT,N/A,N/A," $2,393.00 "," $1,555.45 ", $794.92 , $151.94 , $183.16 , $968.91 , $947.88 ," $2,225.49 "," $2,153.70 "," $2,153.70 "," $1,914.40 "," $1,914.40 ", $183.16 ," $2,209.46 "," $2,273.35 "," $2,153.70 "," $2,153.70 "," $2,153.70 "," $2,225.49 "," $2,297.28 ", $879.36 ," $2,034.05 ", $924.15 ," $1,027.28 ", N/A , $987.81 , $987.81 ," $2,273.35 "," $1,059.71 ", $151.94 ," $2,297.28 "
 Inj Proc for Sialogram ,CPT® 42550,0761 - TREATMENT ROOM,N/A,N/A, $735.00 , $477.75 , $617.40 , $59.51 , $24.75 , $593.88 , $661.50 , $622.25 , $661.50 , $661.50 , $661.50 , $624.75 , $24.26 , $678.63 , $698.25 , $624.75 , $683.55 , $683.55 , $698.25 , $705.60 , $601.38 , $661.50 , $624.75 , $580.65 , N/A , $594.84 , $594.84 , $698.25 , $630.70 , $24.26 , $705.60 
 Pro Arthrd Subtalar ,CPT® 28725,0975 - PRO FEE/OR,N/A,N/A," $7,522.00 "," $4,889.30 "," $4,754.69 ", $745.14 , $768.38 ," $3,781.83 "," $3,762.66 "," $6,995.46 "," $6,769.80 "," $6,769.80 "," $6,017.60 "," $6,017.60 ", $768.38 ," $6,945.06 "," $7,145.90 "," $6,769.80 "," $6,769.80 "," $6,769.80 "," $6,995.46 "," $7,221.12 "," $4,420.81 "," $6,393.70 "," $4,122.97 "," $4,473.55 ", N/A ," $3,855.61 "," $3,855.61 "," $7,145.90 "," $4,531.72 ", $745.14 ," $7,221.12 "
Bx Breast W Device 1st Lesion Stereotactic Guide,CPT® 19081,N/A,N/A,N/A," $2,555.00 "," $1,660.75 ", $530.50 , $156.49 , $133.59 , $468.96 , $483.12 ," $2,376.15 "," $2,299.50 "," $2,299.50 "," $2,044.00 "," $2,044.00 ", $133.59 ," $2,359.03 "," $2,427.25 "," $2,299.50 "," $2,299.50 "," $2,299.50 "," $2,376.15 "," $2,452.80 ", $584.71 ," $2,171.75 ", $856.49 , $595.58 , N/A , $478.11 , $478.11 ," $2,427.25 ", $554.44 , $133.59 ," $2,452.80 "
 AQUAPHOR EX OINT ,HCPCS RXC637,0250 - PHARMACY,72140-0032-63,99 gram, $67.13 , $43.63 , $56.39 , N/A , N/A , $54.24 , $60.42 , $56.83 , $60.42 , $60.42 , $60.42 , $57.06 , N/A , $61.98 , $63.77 , $57.06 , $62.43 , $62.43 , $63.77 , $64.44 , $54.93 , $60.42 , $57.06 , $53.03 , N/A , $54.33 , $54.33 , $63.77 , $57.60 , $53.03 , $64.44 
Physiologic Exercise Study & Hemodynamic Measu,CPT® 93464,N/A,N/A,N/A," $3,559.00 "," $2,313.35 "," $1,419.41 ", $215.22 , $183.53 ," $1,484.93 "," $1,608.46 "," $3,309.87 "," $3,203.10 "," $3,203.10 "," $2,847.20 "," $2,847.20 ", $183.53 ," $3,286.02 "," $3,381.05 "," $3,203.10 "," $3,203.10 "," $3,203.10 "," $3,309.87 "," $3,416.64 "," $1,471.60 "," $3,025.15 "," $1,527.16 "," $1,534.43 ", N/A ," $1,513.91 "," $1,513.91 "," $3,381.05 "," $1,678.18 ", $183.53 ," $3,416.64 "
 DARBEPOETIN ALFA 300 MCG/0.6ML IJ SOSY ,HCPCS J0882,0636 - DRUGS REQUIRING DETAILED CODIN,55513-0111-01,0.6 mL," $6,827.41 "," $4,437.82 "," $5,735.02 ", $3.00 , N/A ," $5,516.55 "," $6,144.67 "," $5,780.09 "," $6,144.67 "," $6,144.67 "," $6,144.67 "," $5,803.30 ", N/A ," $6,303.75 "," $6,486.04 "," $5,803.30 "," $6,349.49 "," $6,349.49 "," $6,486.04 "," $6,554.31 "," $5,586.19 "," $6,144.67 "," $5,803.30 "," $5,393.65 ", N/A ," $5,525.42 "," $5,525.42 "," $6,486.04 "," $5,858.60 ", $3.00 ," $6,554.31 "
Whfo W/O Joints Pre Ots,HCPCS L3809,N/A,N/A,N/A, $149.00 , $96.85 , N/A , $266.19 , $55.62 , N/A , N/A , $138.57 , $134.10 , $134.10 , $119.20 , $119.20 , $55.62 , $137.57 , $141.55 , $134.10 , $134.10 , $134.10 , $138.57 , $143.04 , N/A , $126.65 , $444.56 , $223.95 , N/A , N/A , N/A , $141.55 , N/A , $55.62 , $444.56 
" Pro Fix Lid Ptosis,Levatr Resec,Extern ",CPT® 67904,0982 - PRO FEE/OUTPT,N/A,N/A," $6,743.00 "," $4,382.95 "," $3,656.90 ", $573.90 , $588.32 ," $3,377.56 "," $3,189.07 "," $6,270.99 "," $6,068.70 "," $6,068.70 "," $5,394.40 "," $5,394.40 ", $588.32 ," $6,225.81 "," $6,405.85 "," $6,068.70 "," $6,068.70 "," $6,068.70 "," $6,270.99 "," $6,473.28 "," $5,024.21 "," $5,731.55 "," $3,309.44 "," $4,291.25 ", N/A ," $3,443.46 "," $3,443.46 "," $6,405.85 "," $3,801.12 ", $573.90 ," $6,473.28 "
Control Nasal Hemorrhage,CPT® 30903,N/A,N/A,N/A," $1,382.00 ", $898.30 , $411.13 , $72.80 , $61.84 , $302.11 , $295.94 ," $1,285.26 "," $1,243.80 "," $1,243.80 "," $1,105.60 "," $1,105.60 ", $61.84 ," $1,276.00 "," $1,312.90 "," $1,243.80 "," $1,243.80 "," $1,243.80 "," $1,285.26 "," $1,326.72 ", $397.68 ," $1,174.70 ", $419.26 , $398.37 , N/A , $308.01 , $308.01 ," $1,312.90 ", $362.73 , $61.84 ," $1,326.72 "
Remove Thor Lymph Nodes Rad Regnl,CPT® 38746,N/A,N/A,N/A," $3,171.00 "," $2,061.15 ", $958.65 , $191.35 , $340.29 , $748.91 , $763.06 ," $2,949.03 "," $2,853.90 "," $2,853.90 "," $2,536.80 "," $2,536.80 ", $340.29 ," $2,927.78 "," $3,012.45 "," $2,853.90 "," $2,853.90 "," $2,853.90 "," $2,949.03 "," $3,044.16 "," $1,032.58 "," $2,695.35 "," $1,145.37 "," $1,022.25 ", N/A , $763.53 , $763.53 ," $3,012.45 ", $885.77 , $191.35 ," $3,044.16 "
 Direct Immunofluorescence Additional Antibody Bill ,CPT® 88350,0310 - PATHOLOGY LAB,N/A,N/A, $292.00 , $189.80 , $245.28 , $114.53 , $57.02 , $235.94 , $262.80 , $247.21 , $262.80 , $262.80 , $262.80 , $248.20 , $55.90 , $269.60 , $277.40 , $248.20 , $271.56 , $271.56 , $277.40 , $280.32 , $238.91 , $262.80 , $248.20 , $230.68 , N/A , $236.32 , $236.32 , $277.40 , $250.57 , $55.90 , $280.32 
Injection Hip Arthrogram,CPT® 27093,N/A,N/A,N/A," $1,469.00 ", $954.85 , $419.06 , $65.17 , $67.21 , $346.03 , $338.76 ," $1,366.17 "," $1,322.10 "," $1,322.10 "," $1,175.20 "," $1,175.20 ", $67.21 ," $1,356.33 "," $1,395.55 "," $1,322.10 "," $1,322.10 "," $1,322.10 "," $1,366.17 "," $1,410.24 ", $394.94 ," $1,248.65 ", $367.52 , $408.32 , N/A , $352.79 , $352.79 ," $1,395.55 ", $414.65 , $65.17 ," $1,410.24 "
 LIDOCAINE 100 MG/5 ML INJECTION (INPT) ,HCPCS J2001,0636 - DRUGS REQUIRING DETAILED CODIN,76329-3390-01,5 mL, $45.75 , $29.74 , $38.43 , $0.03 , $0.03 , $36.97 , $41.18 , $38.73 , $41.18 , $41.18 , $41.18 , $38.89 , $0.03 , $42.24 , $43.46 , $38.89 , $42.55 , $42.55 , $43.46 , $43.92 , $37.43 , $41.18 , $38.89 , $36.14 , N/A , $37.03 , $37.03 , $43.46 , $39.26 , $0.03 , $43.92 
 Fac Athletic Training Re-Eval Est Plan Care ,CPT® 97172,0951 - OTHER THERAPEUTIC SERVICES - ATHLETIC TRAINING,N/A,N/A, $81.00 , $52.65 , $68.04 , N/A , N/A , $65.45 , $72.90 , $68.57 , $72.90 , $72.90 , $72.90 , $68.85 , N/A , $74.79 , $76.95 , $68.85 , $75.33 , $75.33 , $76.95 , $77.76 , $66.27 , $72.90 , $68.85 , $63.99 , N/A , $65.55 , $65.55 , $76.95 , $69.51 , $63.99 , $77.76 
 Fac Njx Cholangio Prq W/Img Gid Rs&I Existing Access ,CPT® 47531,0361 - OR/MINOR,N/A,N/A," $1,901.00 "," $1,235.65 "," $1,596.84 ", $66.92 , $442.90 ," $1,536.01 "," $1,710.90 "," $1,609.39 "," $1,710.90 "," $1,710.90 "," $1,710.90 "," $1,615.85 ", $434.22 ," $1,755.19 "," $1,805.95 "," $1,615.85 "," $1,767.93 "," $1,767.93 "," $1,805.95 "," $1,824.96 "," $1,555.40 "," $1,710.90 "," $1,615.85 "," $1,501.79 ", N/A ," $1,538.48 "," $1,538.48 "," $1,805.95 "," $1,631.25 ", $66.92 ," $1,824.96 "
 Pro Trim Skin Lesion ,CPT® 11055,0982 - PRO FEE/OUTPT,N/A,N/A, $206.00 , $133.90 , $51.44 , $15.16 , $26.33 , $45.02 , $42.27 , $191.58 , $185.40 , $185.40 , $164.80 , $164.80 , $26.33 , $190.20 , $195.70 , $185.40 , $185.40 , $185.40 , $191.58 , $197.76 , $56.75 , $175.10 , $82.07 , $57.83 , N/A , $45.91 , $45.91 , $195.70 , $53.23 , $15.16 , $197.76 
 ARTICAINE-EPINEPHRINE 4 %-1:100000 IJ SOCT ,HCPCS RXA250,0250 - PHARMACY,45146-0110-02,1.8 mL, $16.68 , $10.84 , $14.01 , N/A , N/A , $13.48 , $15.01 , $14.12 , $15.01 , $15.01 , $15.01 , $14.18 , N/A , $15.40 , $15.85 , $14.18 , $15.51 , $15.51 , $15.85 , $16.01 , $13.65 , $15.01 , $14.18 , $13.18 , N/A , $13.50 , $13.50 , $15.85 , $14.31 , $13.18 , $16.01 
 Pro Rad Exc Bursa Synva Wrst/F/Arm Tdn Shths Xtnsrs ,CPT® 25116,0982 - PRO FEE/OUTPT,N/A,N/A," $1,471.00 ", $956.15 ," $3,698.70 ", $582.98 , $691.53 ," $2,887.82 "," $2,896.69 "," $1,368.03 "," $1,323.90 "," $1,323.90 "," $1,176.80 "," $1,176.80 ", $691.53 ," $1,358.17 "," $1,397.45 "," $1,323.90 "," $1,323.90 "," $1,323.90 "," $1,368.03 "," $1,412.16 "," $3,435.69 "," $1,250.35 "," $3,180.99 "," $3,437.40 ", N/A ," $2,944.17 "," $2,944.17 "," $1,397.45 "," $3,460.43 ", $582.98 ," $3,698.70 "
Tissue Culture-Lymphocyte,CPT® 88230,N/A,N/A,N/A," $1,046.00 ", $679.90 , N/A , $118.82 , $69.14 , $278.89 , $991.14 , $972.78 , $941.40 , $941.40 , $836.80 , $836.80 , $69.14 , $965.77 , $993.70 , $941.40 , $941.40 , $941.40 , $972.78 ," $1,004.16 ", $777.83 , $889.10 , $763.89 , $509.12 , N/A , $260.28 , $260.28 , $993.70 , $286.03 , $69.14 ," $1,004.16 "
 `Tavr; Transcath Aortic Valve Replace W/Cardio Bypass; Perc; Add on Code ,CPT® 33367,0360 - OR SERVICES,N/A,N/A," $11,080.00 "," $7,202.00 "," $9,307.20 ", $546.77 , $468.01 ," $8,952.64 "," $9,972.00 "," $9,380.33 "," $9,972.00 "," $9,972.00 "," $9,972.00 "," $9,418.00 ", $458.83 ," $10,230.16 "," $10,526.00 "," $9,418.00 "," $10,304.40 "," $10,304.40 "," $10,526.00 "," $10,636.80 "," $9,065.66 "," $9,972.00 "," $9,418.00 "," $8,753.20 ", N/A ," $8,967.04 "," $8,967.04 "," $10,526.00 "," $9,507.75 ", $458.83 ," $10,636.80 "
Reconstruct Injured Chest,CPT® 32820,N/A,N/A,N/A," $7,200.00 "," $4,680.00 "," $6,914.95 "," $1,209.36 "," $1,673.60 "," $5,303.58 "," $5,219.84 "," $6,696.00 "," $6,480.00 "," $6,480.00 "," $5,760.00 "," $5,760.00 "," $1,673.60 "," $6,647.76 "," $6,840.00 "," $6,480.00 "," $6,480.00 "," $6,480.00 "," $6,696.00 "," $6,912.00 "," $6,689.56 "," $6,120.00 "," $7,526.97 "," $6,598.72 ", N/A ," $5,407.06 "," $5,407.06 "," $6,840.00 "," $6,367.94 "," $1,209.36 "," $7,526.97 "
 Fac Mod Sed Other Phys/Qhp Each Addl 15 Mins ,CPT® 99157,0370 - ANESTHESIA,N/A,N/A, $120.00 , $78.00 , $100.80 , $59.83 , $45.63 , $96.96 , $108.00 , $101.59 , $108.00 , $108.00 , $108.00 , $102.00 , $44.74 , $110.80 , $114.00 , $102.00 , $111.60 , $111.60 , $114.00 , $115.20 , $98.18 , $108.00 , $102.00 , $94.80 , N/A , $97.12 , $97.12 , $114.00 , $102.97 , $44.74 , $115.20 
"Preparation, Sperm Duct X-Ray",CPT® 55300,N/A,N/A,N/A," $1,028.00 ", $668.20 , $818.83 , $176.10 , $230.52 , $602.40 , $605.58 , $956.04 , $925.20 , $925.20 , $822.40 , $822.40 , $230.52 , $949.15 , $976.60 , $925.20 , $925.20 , $925.20 , $956.04 , $986.88 , $772.38 , $873.80 , $965.18 , $907.18 , N/A , $614.15 , $614.15 , $976.60 , $736.09 , $176.10 , $986.88 
"Closed Rx Dist Fibula Fx,Manip",27788,N/A,N/A,N/A," $2,221.00 "," $1,443.65 "," $2,379.26 ", $375.59 , $230.52 ," $1,854.24 "," $1,880.56 "," $2,065.53 "," $1,998.90 "," $1,998.90 "," $1,776.80 "," $1,776.80 ", $230.52 ," $2,050.65 "," $2,109.95 "," $1,998.90 "," $1,998.90 "," $1,998.90 "," $2,065.53 "," $2,132.16 "," $2,201.70 "," $1,887.85 "," $2,065.95 "," $2,192.00 ", N/A ," $1,890.42 "," $1,890.42 "," $2,109.95 "," $2,221.92 ", $230.52 ," $2,379.26 "
 Sc Puncture Add Cyst ,CPT® 19001,0761 - TREATMENT ROOM,N/A,N/A, $243.00 , $157.95 , $204.12 , $19.88 , $21.34 , $196.34 , $218.70 , $205.72 , $218.70 , $218.70 , $218.70 , $206.55 , $20.92 , $224.36 , $230.85 , $206.55 , $225.99 , $225.99 , $230.85 , $233.28 , $198.82 , $218.70 , $206.55 , $191.97 , N/A , $196.66 , $196.66 , $230.85 , $208.52 , $19.88 , $233.28 
"Compatibility Test, Electronic",CPT® 86923,N/A,N/A,N/A, $136.00 , $88.40 , N/A , N/A , $34.63 , $79.60 , $91.66 , $126.48 , $122.40 , $122.40 , $108.80 , $108.80 , $34.63 , $125.57 , $129.20 , $122.40 , $122.40 , $122.40 , $126.48 , $130.56 , N/A , $115.60 , $92.45 , $82.97 , N/A , $74.29 , $74.29 , $129.20 , $81.18 , $34.63 , $130.56 
Natriuretic Peptide,CPT® 83880,N/A,N/A,N/A, $302.00 , $196.30 , N/A , $40.05 , $40.05 , $192.04 , $229.73 , $280.86 , $271.80 , $271.80 , $241.60 , $241.60 , $40.05 , $278.84 , $286.90 , $271.80 , $271.80 , $271.80 , $280.86 , $289.92 , $262.15 , $256.70 , $222.19 , $123.06 , N/A , $179.22 , $179.22 , $286.90 , $195.85 , $40.05 , $289.92 
"Visual Field Exam,Extended",CPT® 92083,N/A,N/A,N/A, $232.00 , $150.80 , $136.22 , $61.50 , $30.53 , $112.81 , $112.62 , $215.76 , $208.80 , $208.80 , $185.60 , $185.60 , $30.53 , $214.21 , $220.40 , $208.80 , $208.80 , $208.80 , $215.76 , $222.72 , $192.94 , $197.20 , $198.69 , $135.34 , N/A , $115.01 , $115.01 , $220.40 , $136.81 , $30.53 , $222.72 
 Fac Appl Cst Sho Hand Long Arm ,CPT® 29065,0761 - TREATMENT ROOM,N/A,N/A, $229.00 , $148.85 , $192.36 , $64.54 , $78.67 , $185.03 , $206.10 , $193.87 , $206.10 , $206.10 , $206.10 , $194.65 , $77.13 , $211.44 , $217.55 , $194.65 , $212.97 , $212.97 , $217.55 , $219.84 , $187.37 , $206.10 , $194.65 , $180.91 , N/A , $185.33 , $185.33 , $217.55 , $196.50 , $64.54 , $219.84 
"Injection, Mepolizumab, 1mg",HCPCS J2182,N/A,N/A,N/A, $61.00 , $39.65 , N/A , $30.35 , $30.24 , N/A , N/A , $56.73 , $54.90 , $54.90 , $48.80 , $48.80 , $30.24 , $56.32 , $57.95 , $54.90 , $54.90 , $54.90 , $56.73 , $58.56 , $37.36 , $51.85 , $56.22 , $41.06 , N/A , N/A , N/A , $57.95 , N/A , $30.24 , $58.56 
Removal Superficial Implant,20670,N/A,N/A,N/A, $816.00 , $530.40 , $884.65 , $139.34 , $54.21 , $713.22 , $723.32 , $758.88 , $734.40 , $734.40 , $652.80 , $652.80 , $54.21 , $753.41 , $775.20 , $734.40 , $734.40 , $734.40 , $758.88 , $783.36 , $826.94 , $693.60 , $792.12 , $845.36 , N/A , $727.14 , $727.14 , $775.20 , $854.63 , $54.21 , $884.65 
"Surg Rx Missed Abortn,1st Tri",59820,N/A,N/A,N/A," $1,724.00 "," $1,120.60 "," $1,061.25 ", $359.92 , $331.58 , $826.59 , $879.40 ," $1,603.32 "," $1,551.60 "," $1,551.60 "," $1,379.20 "," $1,379.20 ", $331.58 ," $1,591.77 "," $1,637.80 "," $1,551.60 "," $1,551.60 "," $1,551.60 "," $1,603.32 "," $1,655.04 "," $1,058.99 "," $1,465.40 "," $1,926.79 "," $1,545.07 ", N/A , $842.72 , $842.72 ," $1,637.80 ", $974.26 , $331.58 ," $1,926.79 "
Apply Long Leg Splint,CPT® 29505,N/A,N/A,N/A, $570.00 , $370.50 , $310.83 , $49.45 , $46.08 , $241.34 , $244.33 , $530.10 , $513.00 , $513.00 , $456.00 , $456.00 , $46.08 , $526.28 , $541.50 , $513.00 , $513.00 , $513.00 , $530.10 , $547.20 , $289.85 , $484.50 , $267.61 , $292.25 , N/A , $246.04 , $246.04 , $541.50 , $289.17 , $46.08 , $547.20 
Tet/Dip 7+ Preserv Free,CPT® 90714,N/A,N/A,N/A, $56.00 , $36.40 , N/A , $31.67 , $36.78 , $46.77 , $61.03 , $52.08 , $50.40 , $50.40 , $44.80 , $44.80 , $36.78 , $51.70 , $53.20 , $50.40 , $50.40 , $50.40 , $52.08 , $53.76 , $36.06 , $47.60 , $59.81 , $56.42 , N/A , $47.68 , $47.68 , $53.20 , $55.59 , $31.67 , $61.03 
 NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN ,HCPCS J2916,0636 - DRUGS REQUIRING DETAILED CODIN,00143-9570-10,10 mL, $392.05 , $254.83 , $329.32 , $2.16 , $2.24 , $316.78 , $352.85 , $331.91 , $352.85 , $352.85 , $352.85 , $333.24 , $2.20 , $361.98 , $372.45 , $333.24 , $364.61 , $364.61 , $372.45 , $376.37 , $320.78 , $352.85 , $333.24 , $309.72 , N/A , $317.29 , $317.29 , $372.45 , $336.42 , $2.16 , $376.37 
 Fac Dilation Esophagus Guide Wire ,CPT® 43453,0360 - OR SERVICES,N/A,N/A," $1,334.00 ", $867.10 ," $1,120.56 ", $82.00 , $153.67 ," $1,077.87 "," $1,200.60 "," $1,129.36 "," $1,200.60 "," $1,200.60 "," $1,200.60 "," $1,133.90 ", $150.66 ," $1,231.68 "," $1,267.30 "," $1,133.90 "," $1,240.62 "," $1,240.62 "," $1,267.30 "," $1,280.64 "," $1,091.48 "," $1,200.60 "," $1,133.90 "," $1,053.86 ", N/A ," $1,079.61 "," $1,079.61 "," $1,267.30 "," $1,144.71 ", $82.00 ," $1,280.64 "
" Fac Bone Imaging, Multiple Areas ",CPT® 78305,0340 - NUCLEAR MEDICINE,N/A,N/A," $2,586.00 "," $1,680.90 "," $2,172.24 ", $253.17 , $194.90 ," $2,089.49 "," $2,327.40 "," $2,189.31 "," $2,327.40 "," $2,327.40 "," $2,327.40 "," $2,198.10 ", $191.08 ," $2,387.65 "," $2,456.70 "," $2,198.10 "," $2,404.98 "," $2,404.98 "," $2,456.70 "," $2,482.56 "," $2,115.87 "," $2,327.40 "," $2,198.10 "," $2,042.94 ", N/A ," $2,092.85 "," $2,092.85 "," $2,456.70 "," $2,219.05 ", $191.08 ," $2,482.56 "
 Fac Hgb Plsm ,CPT® 83051,0301 - LAB/CHEMISTRY,N/A,N/A, $96.00 , $62.40 , $80.64 , $7.46 , $4.83 , $77.57 , $86.40 , $81.27 , $86.40 , $86.40 , $86.40 , $81.60 , $4.74 , $88.64 , $91.20 , $81.60 , $89.28 , $89.28 , $91.20 , $92.16 , $78.55 , $86.40 , $81.60 , $75.84 , N/A , $77.69 , $77.69 , $91.20 , $82.38 , $4.74 , $92.16 
 Fac Chg Allergen Spec Ige Recombinant/Purified Compnt Ea ,CPT® 86008,0302 - LAB/IMMUNOLOGY,N/A,N/A, $359.00 , $233.35 , $301.56 , $18.29 , $18.06 , $290.07 , $323.10 , $303.93 , $323.10 , $323.10 , $323.10 , $305.15 , $17.71 , $331.46 , $341.05 , $305.15 , $333.87 , $333.87 , $341.05 , $344.64 , $293.73 , $323.10 , $305.15 , $283.61 , N/A , $290.54 , $290.54 , $341.05 , $308.06 , $17.71 , $344.64 
"Exc Skin Malig 1.1-2cm Trunk,Arm,Leg",CPT® 11602,N/A,N/A,N/A," $1,048.00 ", $681.20 , $518.53 , $155.71 , $188.41 , $446.50 , $437.08 , $974.64 , $943.20 , $943.20 , $838.40 , $838.40 , $188.41 , $967.62 , $995.60 , $943.20 , $943.20 , $943.20 , $974.64 ," $1,006.08 ", $568.24 , $890.80 , $870.62 , $574.73 , N/A , $455.21 , $455.21 , $995.60 , $527.89 , $155.71 ," $1,006.08 "
 Fac Allergen Spec Ige Qual Multiallergen Screen ,CPT® 86005,0302 - LAB/IMMUNOLOGY,N/A,N/A, $72.00 , $46.80 , $60.48 , $8.13 , $8.13 , $58.18 , $64.80 , $60.96 , $64.80 , $64.80 , $64.80 , $61.20 , $7.97 , $66.48 , $68.40 , $61.20 , $66.96 , $66.96 , $68.40 , $69.12 , $58.91 , $64.80 , $61.20 , $56.88 , N/A , $58.27 , $58.27 , $68.40 , $61.78 , $7.97 , $69.12 
Prolonged Outpatient E/M Service Each 15 Minutes,CPT® 99417,N/A,N/A,N/A, $140.00 , $91.00 , N/A , $30.39 , N/A , N/A , N/A , $130.20 , $126.00 , $126.00 , $112.00 , $112.00 , N/A , $129.26 , $133.00 , $126.00 , $126.00 , $126.00 , $130.20 , $134.40 , $58.33 , $119.00 , $66.49 , $71.61 , N/A , $53.82 , $53.82 , $133.00 , $60.59 , $30.39 , $134.40 
 OLANZAPINE 10 MG PO TBDP ,HCPCS RXC637,0250 - PHARMACY,49884-0321-55,1 tablet, $107.74 , $70.03 , $90.50 , N/A , N/A , $87.05 , $96.97 , $91.21 , $96.97 , $96.97 , $96.97 , $91.58 , N/A , $99.48 , $102.35 , $91.58 , $100.20 , $100.20 , $102.35 , $103.43 , $88.15 , $96.97 , $91.58 , $85.11 , N/A , $87.19 , $87.19 , $102.35 , $92.45 , $85.11 , $103.43 
 Fac Vngrph Rnl Uni Slctv Rs&I ,CPT® 75831,0320 - DX X-RAY,N/A,N/A," $1,156.00 ", $751.40 , $971.04 , $117.87 , $223.62 , $934.05 ," $1,040.40 ", $978.67 ," $1,040.40 "," $1,040.40 "," $1,040.40 ", $982.60 , $219.24 ," $1,067.33 "," $1,098.20 ", $982.60 ," $1,075.08 "," $1,075.08 "," $1,098.20 "," $1,109.76 ", $945.84 ," $1,040.40 ", $982.60 , $913.24 , N/A , $935.55 , $935.55 ," $1,098.20 ", $991.96 , $117.87 ," $1,109.76 "
MD Certification Hha Patient,HCPCS G0180,N/A,N/A,N/A, $209.00 , $135.85 , $253.80 , $51.17 , N/A , $98.31 , N/A , $194.37 , $188.10 , $188.10 , $167.20 , $167.20 , N/A , $192.97 , $198.55 , $188.10 , $188.10 , $188.10 , $194.37 , $200.64 , $96.05 , $177.65 , $101.21 , $202.34 , N/A , $100.22 , $100.22 , $198.55 , $125.29 , $51.17 , $253.80 
 AMPHOTERICIN B LIPOSOME 50 MG IV SUSR ,HCPCS J0289,0636 - DRUGS REQUIRING DETAILED CODIN,00469-3051-30,12.5 mL," $1,849.54 "," $1,202.20 "," $1,553.61 ", $28.43 , $27.39 ," $1,494.43 "," $1,664.59 "," $1,565.82 "," $1,664.59 "," $1,664.59 "," $1,664.59 "," $1,572.11 ", $26.85 ," $1,707.68 "," $1,757.06 "," $1,572.11 "," $1,720.07 "," $1,720.07 "," $1,757.06 "," $1,775.56 "," $1,513.29 "," $1,664.59 "," $1,572.11 "," $1,461.14 ", N/A ," $1,496.83 "," $1,496.83 "," $1,757.06 "," $1,587.09 ", $26.85 ," $1,775.56 "
"Partial Removal, Clavicle",CPT® 23120,N/A,N/A,N/A," $3,847.00 "," $2,500.55 "," $3,590.15 ", $564.07 , $537.90 ," $2,815.43 "," $2,826.91 "," $3,577.71 "," $3,462.30 "," $3,462.30 "," $3,077.60 "," $3,077.60 ", $537.90 ," $3,551.94 "," $3,654.65 "," $3,462.30 "," $3,462.30 "," $3,462.30 "," $3,577.71 "," $3,693.12 "," $3,332.28 "," $3,269.95 "," $3,116.76 "," $3,327.06 ", N/A ," $2,870.37 "," $2,870.37 "," $3,654.65 "," $3,373.70 ", $537.90 ," $3,693.12 "
 Fac Brncdilat Rspse Spmtry Pre&Post-Brncdilat Admn ,CPT® 94060,0460 - PULMONARY FUNC,N/A,N/A, $666.00 , $432.90 , $559.44 , $37.70 , $53.79 , $538.13 , $599.40 , $563.84 , $599.40 , $599.40 , $599.40 , $566.10 , $52.74 , $614.92 , $632.70 , $566.10 , $619.38 , $619.38 , $632.70 , $639.36 , $544.92 , $599.40 , $566.10 , $526.14 , N/A , $538.99 , $538.99 , $632.70 , $571.49 , $37.70 , $639.36 
"Surg Rx Missed Abortn,2nd Tri",CPT® 59821,N/A,N/A,N/A," $1,796.00 "," $1,167.40 "," $1,032.27 ", $349.83 , $333.97 , $827.19 , $878.22 ," $1,670.28 "," $1,616.40 "," $1,616.40 "," $1,436.80 "," $1,436.80 ", $333.97 ," $1,658.25 "," $1,706.20 "," $1,616.40 "," $1,616.40 "," $1,616.40 "," $1,670.28 "," $1,724.16 "," $1,035.11 "," $1,526.60 "," $1,928.57 "," $1,545.11 ", N/A , $843.34 , $843.34 ," $1,706.20 ", $974.98 , $333.97 ," $1,928.57 "
 T Spine CT Without Contrast ,CPT® 72128,0350 - CT SCAN,N/A,N/A," $2,654.00 "," $1,725.10 "," $2,229.36 ", $132.63 , $250.57 ," $2,144.43 "," $2,388.60 "," $2,246.88 "," $2,388.60 "," $2,388.60 "," $2,388.60 "," $2,255.90 ", $245.66 ," $2,450.44 "," $2,521.30 "," $2,255.90 "," $2,468.22 "," $2,468.22 "," $2,521.30 "," $2,547.84 "," $2,171.50 "," $2,388.60 "," $2,255.90 "," $2,096.66 ", N/A ," $2,147.88 "," $2,147.88 "," $2,521.30 "," $2,277.40 ", $132.63 ," $2,547.84 "
"Culture Typing, Serologic",CPT® 87147,N/A,N/A,N/A, $62.00 , $40.30 , N/A , $5.28 , $5.28 , $29.27 , $35.00 , $57.66 , $55.80 , $55.80 , $49.60 , $49.60 , $5.28 , $57.24 , $58.90 , $55.80 , $55.80 , $55.80 , $57.66 , $59.52 , $34.59 , $52.70 , $34.06 , $18.77 , N/A , $27.32 , $27.32 , $58.90 , $29.85 , $5.28 , $59.52 
X-Ray Toe(S),CPT® 73660,N/A,N/A,N/A, $215.00 , $139.75 , $163.39 , $28.68 , $23.98 , $131.67 , $162.41 , $199.95 , $193.50 , $193.50 , $172.00 , $172.00 , $23.98 , $198.51 , $204.25 , $193.50 , $193.50 , $193.50 , $199.95 , $206.40 , $159.02 , $182.75 , $179.12 , $141.99 , N/A , $134.23 , $134.23 , $204.25 , $155.38 , $23.98 , $206.40 
Neuropsychological Tst Eval Phys/Qhp 1st Hour,CPT® 96132,N/A,N/A,N/A, $895.00 , $581.75 , $248.18 , $105.01 , $152.42 , $226.18 , N/A , $832.35 , $805.50 , $805.50 , $716.00 , $716.00 , $152.42 , $826.35 , $850.25 , $805.50 , $805.50 , $805.50 , $832.35 , $859.20 , $459.49 , $760.75 , $316.03 , $412.80 , $183.90 , $230.60 , $230.60 , $850.25 , $268.83 , $105.01 , $859.20 
 US Abdominal Paracentesis Inc Imaging ,CPT® 49083,0761 - TREATMENT ROOM,N/A,N/A," $1,747.00 "," $1,135.55 "," $1,467.48 ", $101.73 , $362.06 ," $1,411.58 "," $1,572.30 "," $1,479.01 "," $1,572.30 "," $1,572.30 "," $1,572.30 "," $1,484.95 ", $354.96 ," $1,613.01 "," $1,659.65 "," $1,484.95 "," $1,624.71 "," $1,624.71 "," $1,659.65 "," $1,677.12 "," $1,429.40 "," $1,572.30 "," $1,484.95 "," $1,380.13 ", N/A ," $1,413.85 "," $1,413.85 "," $1,659.65 "," $1,499.10 ", $101.73 ," $1,677.12 "
 Fac Blood Clot Factor VIII Test ,CPT® 85240,0305 - LAB/HEMATOLOGY,N/A,N/A, $284.00 , $184.60 , $238.56 , $18.26 , $9.71 , $229.47 , $255.60 , $240.43 , $255.60 , $255.60 , $255.60 , $241.40 , $9.52 , $262.22 , $269.80 , $241.40 , $264.12 , $264.12 , $269.80 , $272.64 , $232.37 , $255.60 , $241.40 , $224.36 , N/A , $229.84 , $229.84 , $269.80 , $243.70 , $9.52 , $272.64 
"Inject Trigger Points, > 3",20553,N/A,N/A,N/A, $465.00 , $302.25 , $108.92 , $40.47 , $26.41 , $210.81 , $207.99 , $432.45 , $418.50 , $418.50 , $372.00 , $372.00 , $26.41 , $429.33 , $441.75 , $418.50 , $418.50 , $418.50 , $432.45 , $446.40 , $244.53 , $395.25 , $224.79 , $250.96 , N/A , $214.93 , $214.93 , $441.75 , $252.63 , $26.41 , $446.40 
 PALIPERIDONE ER 3 MG PO TB24 ,HCPCS RXC637,0250 - PHARMACY,65162-0281-03,1 tablet, $157.17 , $102.16 , $132.02 , N/A , N/A , $126.99 , $141.45 , $133.06 , $141.45 , $141.45 , $141.45 , $133.59 , N/A , $145.12 , $149.31 , $133.59 , $146.17 , $146.17 , $149.31 , $150.88 , $128.60 , $141.45 , $133.59 , $124.16 , N/A , $127.20 , $127.20 , $149.31 , $134.87 , $124.16 , $150.88 
 Fac Assay for Phencyclidine ,CPT® 83992,0301 - LAB/CHEMISTRY,N/A,N/A, $155.00 , $100.75 , $130.20 , N/A , $20.40 , $125.24 , $139.50 , $131.22 , $139.50 , $139.50 , $139.50 , $131.75 , $20.00 , $143.11 , $147.25 , $131.75 , $144.15 , $144.15 , $147.25 , $148.80 , $126.82 , $139.50 , $131.75 , $122.45 , N/A , $125.44 , $125.44 , $147.25 , $133.01 , $20.00 , $148.80 
 LMX 4 PLUS 4 % EX KIT ,HCPCS RXA250,0250 - PHARMACY,00496-0882-07,5 tube, $246.93 , $160.50 , $207.42 , N/A , N/A , $199.52 , $222.24 , $209.05 , $222.24 , $222.24 , $222.24 , $209.89 , N/A , $227.99 , $234.58 , $209.89 , $229.64 , $229.64 , $234.58 , $237.05 , $202.04 , $222.24 , $209.89 , $195.07 , N/A , $199.84 , $199.84 , $234.58 , $211.89 , $195.07 , $237.05 
 Fac Colonoscopy Flexible With Decompression ,CPT® 45393,0750 - GASTR-INST SVS,N/A,N/A," $3,062.00 "," $1,990.30 "," $2,572.08 ", $237.46 , $265.41 ," $2,474.10 "," $2,755.80 "," $2,592.29 "," $2,755.80 "," $2,755.80 "," $2,755.80 "," $2,602.70 ", $260.21 ," $2,827.14 "," $2,908.90 "," $2,602.70 "," $2,847.66 "," $2,847.66 "," $2,908.90 "," $2,939.52 "," $2,505.33 "," $2,755.80 "," $2,602.70 "," $2,418.98 ", N/A ," $2,478.08 "," $2,478.08 "," $2,908.90 "," $2,627.50 ", $237.46 ," $2,939.52 "
 Pro Removal of Anal Tag ,CPT® 46220,0975 - PRO FEE/OR,N/A,N/A, $896.00 , $582.40 , $739.57 , $115.93 , $177.84 , $563.82 , $580.24 , $833.28 , $806.40 , $806.40 , $716.80 , $716.80 , $177.84 , $827.28 , $851.20 , $806.40 , $806.40 , $806.40 , $833.28 , $860.16 , $526.83 , $761.60 , $638.69 , $670.94 , N/A , $574.82 , $574.82 , $851.20 , $601.19 , $115.93 , $860.16 
"Closed Rx Post Hip Fix Disloc,Anesth",27266,N/A,N/A,N/A," $2,568.00 "," $1,669.20 "," $3,570.13 ", $559.59 , $549.47 ," $2,800.32 "," $2,792.35 "," $2,388.24 "," $2,311.20 "," $2,311.20 "," $2,054.40 "," $2,054.40 ", $549.47 ," $2,371.03 "," $2,439.60 "," $2,311.20 "," $2,311.20 "," $2,311.20 "," $2,388.24 "," $2,465.28 "," $3,311.68 "," $2,182.80 "," $3,082.86 "," $3,299.05 ", N/A ," $2,854.97 "," $2,854.97 "," $2,439.60 "," $3,355.60 ", $549.47 ," $3,570.13 "
"Incis/Drain Shldr Absc/Hema,Deep",CPT® 23030,N/A,N/A,N/A," $2,906.00 "," $1,888.90 "," $1,548.95 ", $242.03 , $254.06 ," $1,232.05 "," $1,230.75 "," $2,702.58 "," $2,615.40 "," $2,615.40 "," $2,324.80 "," $2,324.80 ", $254.06 ," $2,683.11 "," $2,760.70 "," $2,615.40 "," $2,615.40 "," $2,615.40 "," $2,702.58 "," $2,789.76 "," $1,434.11 "," $2,470.10 "," $1,359.46 "," $1,460.20 ", N/A ," $1,256.09 "," $1,256.09 "," $2,760.70 "," $1,476.36 ", $242.03 ," $2,789.76 "
 Fac Xers Tst Brncspsm Pre&Post Spmtry&Pls Ox W/Ecg ,CPT® 94617,0460 - PULMONARY FUNC,N/A,N/A, $816.00 , $530.40 , $685.44 , $85.92 , $75.54 , $659.33 , $734.40 , $690.83 , $734.40 , $734.40 , $734.40 , $693.60 , $74.06 , $753.41 , $775.20 , $693.60 , $758.88 , $758.88 , $775.20 , $783.36 , $667.65 , $734.40 , $693.60 , $644.64 , N/A , $660.39 , $660.39 , $775.20 , $700.21 , $74.06 , $783.36 
Layer Closure 2.5cm or Le,CPT® 12031,N/A,N/A,N/A, $981.00 , $637.65 , $484.53 , $146.05 , $60.48 , $418.18 , $412.35 , $912.33 , $882.90 , $882.90 , $784.80 , $784.80 , $60.48 , $905.76 , $931.95 , $882.90 , $882.90 , $882.90 , $912.33 , $941.76 , $531.98 , $833.85 , $820.67 , $538.15 , N/A , $426.34 , $426.34 , $931.95 , $494.42 , $60.48 , $941.76 
Treat Phalangeal Shft Frc,CPT® 26720,N/A,N/A,N/A," $1,300.00 ", $845.00 ," $1,172.86 ", $187.01 , $74.22 , $886.14 , $907.35 ," $1,209.00 "," $1,170.00 "," $1,170.00 "," $1,040.00 "," $1,040.00 ", $74.22 ," $1,200.29 "," $1,235.00 "," $1,170.00 "," $1,170.00 "," $1,170.00 "," $1,209.00 "," $1,248.00 "," $1,075.93 "," $1,105.00 ", $995.51 ," $1,060.64 ", N/A , $903.43 , $903.43 ," $1,235.00 "," $1,061.84 ", $74.22 ," $1,248.00 "
 R/L Hrt Cath Chd Img Cath Trgt Zon Abnl Nt Connj ,CPT® 93597,0480 - CARDIOLOGY,N/A,N/A," $17,644.00 "," $11,468.60 "," $14,820.96 ", N/A ," $2,378.00 "," $14,256.35 "," $15,879.60 "," $14,937.41 "," $15,879.60 "," $15,879.60 "," $15,879.60 "," $14,997.40 "," $2,331.37 "," $16,290.71 "," $16,761.80 "," $14,997.40 "," $16,408.92 "," $16,408.92 "," $16,761.80 "," $16,938.24 "," $14,436.32 "," $15,879.60 "," $14,997.40 "," $13,938.76 ", N/A ," $14,279.29 "," $14,279.29 "," $16,761.80 "," $15,140.32 "," $2,331.37 "," $16,938.24 "
Hdr Rdncl Ntrstl/Intrcav Brachytx 1 Channel,CPT® 77770,N/A,N/A,N/A," $4,442.00 "," $2,887.30 "," $2,327.78 ", $340.26 , $253.88 ," $1,538.86 "," $1,623.34 "," $4,131.06 "," $3,997.80 "," $3,997.80 "," $3,553.60 "," $3,553.60 ", $253.88 ," $4,101.30 "," $4,219.90 "," $3,997.80 "," $3,997.80 "," $3,997.80 "," $4,131.06 "," $4,264.32 "," $1,942.54 "," $3,775.70 "," $1,983.58 "," $1,812.63 ", N/A ," $1,568.88 "," $1,568.88 "," $4,219.90 "," $1,816.00 ", $253.88 ," $4,264.32 "