Price Transparencybeta Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

THOMAS H BOYD MEMORIAL HOSPITAL

Carrollton, IL · CCN 141300 · Rates published

11,887 distinct procedures filed
30 distinct payers
282,150 rate rows
2026-07-07 last MRF observed
Data quality

264,078 of 282,150 rate rows are consumer-grade (93.6%)

18,072 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
template filing: same amount across many unrelated codes — excluded 16,285
percent-of-charges filed in the dollar field — excluded from medians 625
per-diem day rate — not a per-procedure price 525
exceeds 10× this hospital's gross charge — excluded from medians 419
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 166
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 52
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbTHBCCARROLLTONIL&type=CDMWithoutLabel
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-08-18
Content fingerprint 5faf29dfc2c95573… · 53,974,518 bytes · first seen 2026-07-17

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
04504533
CDM 		Tremfya 100 Mg/ml Syringe 19 $2,000.00 $55,465.41 $40,410.51 nat. median
$40,411
1.0× median
04504533_1
CDM 		Tremfya 100 Mg/ml Syringe 9 $18,285.30 $55,465.41 $37,789.62 nat. median
$37,790
1.0× median
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 24 $2,000.00 $28,983.50 $23,052.76 nat. median
$3,475
outlier · 6.6×
04506691_1
CDM 		Abilify Maintena ER 300 Mg Syr 17 $2,000.00 $10,454.99 $8,191.66 nat. median
$8,192
1.0× median
04506691
CDM 		Abilify Maintena ER 300 Mg Syr 19 $2,000.00 $10,454.99 $7,617.21 nat. median
$7,617
1.0× median
04506888
CDM 		Abilify Maintena ER 300 Mg Syr 19 $2,000.00 $10,454.99 $7,617.21 nat. median
$7,617
1.0× median
32700002_1
CDM 		Brighter Connection Program 17 $2,000.00 $9,464.00 $7,415.20 nat. median
$7,415
1.0× median
04506888_1
CDM 		Abilify Maintena ER 300 Mg Syr 9 $3,446.70 $10,454.99 $7,123.18 nat. median
$7,123
1.0× median
J0897
HCPCS 		Injection, Denosumab, 1 Mg 24 $2,000.00 $14,161.42 $6,359.68 nat. median
$1,965
outlier · 3.2×
04507064
CDM 		Prolia 60 Mg/ml Syringe 19 $2,000.00 $8,064.42 $5,875.51 nat. median
$5,876
1.0× median
J1306
HCPCS 		Injection, Inclisiran, 1 Mg 20 $2,000.00 $7,580.30 $5,731.04 nat. median
$43
outlier · 132.9×
04507064_1
CDM 		Prolia 60 Mg/ml Syringe 9 $2,658.60 $8,064.42 $5,494.44 nat. median
$5,494
1.0× median
04504884_1
CDM 		Prolia 60 Mg/ml Syringe 17 $2,000.00 $6,655.74 $5,214.88 nat. median
$5,215
1.0× median
04503293_1
CDM 		Nystatin 500 Million Unit Pwd 17 $2,000.00 $6,573.84 $5,150.71 nat. median
$5,151
1.0× median
J0139
HCPCS 		Injection, Adalimumab, 1 Mg 20 $2,000.00 $6,674.85 $5,046.48 nat. median
$3,072
1.6× median
04507241
CDM 		Botox 200 Unit Vial 19 $2,000.00 $6,923.28 $5,044.10 nat. median
$5,044
1.0× median
04507240
CDM 		Botox 200 Unit Vial 19 $2,000.00 $6,923.28 $5,044.10 nat. median
$5,044
1.0× median
J3111
HCPCS 		Injection, Romosozumab-aqqg, 1 Mg 21 $2,000.00 $6,279.00 $5,029.10 nat. median
$657
outlier · 7.7×
J9217
HCPCS 		Leuprolide Acetate (for Depot Suspension), 7.5 Mg 24 $1,657.32 $8,520.33 $4,870.63 nat. median
$1,518
outlier · 3.2×
04504884
CDM 		Prolia 60 Mg/ml Syringe 19 $2,000.00 $6,655.74 $4,849.18 nat. median
$4,849
1.0× median
04503071_1
CDM 		Prolia 60 Mg/ml Syringe 17 $2,000.00 $6,118.84 $4,794.21 nat. median
$4,794
1.0× median
04503293
CDM 		Nystatin 500 Million Unit Pwd 19 $2,000.00 $6,573.84 $4,789.51 nat. median
$4,790
1.0× median
04507240_1
CDM 		Botox 200 Unit Vial 9 $2,282.40 $6,923.28 $4,716.96 nat. median
$4,717
1.0× median
04507241_1
CDM 		Botox 200 Unit Vial 9 $2,282.40 $6,923.28 $4,716.96 nat. median
$4,717
1.0× median
04502412_1
CDM 		Prolia 60 Mg/ml Syringe 17 $2,000.00 $5,951.40 $4,663.02 nat. median
$4,663
1.0× median
04503071
CDM 		Prolia 60 Mg/ml Syringe 19 $2,000.00 $6,118.84 $4,458.01 nat. median
$4,458
1.0× median
04505334
CDM 		Xolair 75 Mg/0.5 Ml Syringe 19 $2,000.00 $6,040.58 $4,400.99 nat. median
$4,401
1.0× median
04505126
CDM 		Xolair 75 Mg/0.5 Ml Syringe 19 $2,000.00 $6,040.58 $4,400.99 nat. median
$4,401
1.0× median
04502412
CDM 		Prolia 60 Mg/ml Syringe 19 $2,000.00 $5,951.40 $4,336.02 nat. median
$4,336
1.0× median
04506287
CDM 		Risperdal Consta 50 Mg Vial 19 $2,000.00 $5,819.45 $4,239.89 nat. median
$4,240
1.0× median
81211
HCPCS 		Brca1&2 Seq & Com Dup/del 25 $88.00 $7,738.50 $4,172.15 nat. median
$1,691
outlier · 2.5×
04505126_1
CDM 		Xolair 75 Mg/0.5 Ml Syringe 9 $1,991.40 $6,040.58 $4,115.56 nat. median
$4,116
1.0× median
04505334_1
CDM 		Xolair 75 Mg/0.5 Ml Syringe 9 $1,991.40 $6,040.58 $4,115.56 nat. median
$4,116
1.0× median
04506593
CDM 		Nf-nexplanon SubQ Implant 68mg 19 $2,000.00 $5,626.53 $4,099.33 nat. median
$4,099
1.0× median
04504316_1
CDM 		Inflectra 100 Mg Vial 17 $2,000.00 $5,166.07 $4,047.70 nat. median
$4,048
1.0× median
04504301_1
CDM 		Inflectra 100 Mg Vial 17 $2,000.00 $5,166.07 $4,047.70 nat. median
$4,048
1.0× median
04506287_1
CDM 		Risperdal Consta 50 Mg Vial 9 $1,918.50 $5,819.45 $3,964.90 nat. median
$3,965
1.0× median
04506593_1
CDM 		Nf-nexplanon SubQ Implant 68mg 9 $1,854.90 $5,626.53 $3,833.46 nat. median
$3,833
1.0× median
04504316
CDM 		Inflectra 100 Mg Vial 19 $2,000.00 $5,166.07 $3,763.85 nat. median
$3,764
1.0× median
04504301
CDM 		Inflectra 100 Mg Vial 19 $2,000.00 $5,166.07 $3,763.85 nat. median
$3,764
1.0× median
72158
HCPCS 		MRI Scan Of Lower Spinal Canal Before And After Contrast 24 $1,041.00 $5,210.66 $3,574.23 nat. median
$1,103
outlier · 3.2×
04504797_1
CDM 		Pomalyst 2 Mg Capsule 17 $2,000.00 $4,473.56 $3,505.11 nat. median
$3,505
1.0× median
76094
HCPCS 		MRI Breast W/implants Bilat 20 $1,041.00 $4,542.72 $3,434.50 nat. median
$595
outlier · 5.8×
04504546_1
CDM 		Pomalyst 2 Mg Capsule 17 $2,000.00 $4,321.59 $3,386.04 nat. median
$3,386
1.0× median
04500636_1
CDM 		Imogam Rabies-ht 150 Unit/ml 17 $2,000.00 $4,252.43 $3,331.85 nat. median
$3,332
1.0× median
04504797
CDM 		Pomalyst 2 Mg Capsule 19 $2,000.00 $4,473.56 $3,259.31 nat. median
$3,259
1.0× median
04504792
CDM 		Pomalyst 2 Mg Capsule 19 $2,000.00 $4,473.56 $3,259.31 nat. median
$3,259
1.0× median
04505291
CDM 		Active-pac Kit 19 $2,000.00 $4,436.25 $3,232.13 nat. median
$3,232
1.0× median
04504546
CDM 		Pomalyst 2 Mg Capsule 19 $2,000.00 $4,321.59 $3,148.59 nat. median
$3,149
1.0× median
04500636
CDM 		Imogam Rabies-ht 150 Unit/ml 19 $2,000.00 $4,252.43 $3,098.20 nat. median
$3,098
1.0× median

Other procedures at this hospital

Browse this hospital's 11,887 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
04504533 CDM Tremfya 100 Mg/ml Syringe 19 19 $60,951.00 $48,760.80 $2,000.00 $55,465.41 $40,410.51 2026-04-24
04504533_1 CDM Tremfya 100 Mg/ml Syringe 9 9 $60,951.00 $48,760.80 $18,285.30 $55,465.41 $37,789.62 2026-07-07
J3101 HCPCS Injection, Tenecteplase, 1 Mg 44 24 $31,850.00 $25,480.00 20% off $2,000.00 $28,983.50 $23,052.76 2026-07-07
04506691_1 CDM Abilify Maintena ER 300 Mg Syr 17 17 $11,489.00 $9,191.20 $2,000.00 $10,454.99 $8,191.66 2026-07-07
04506888 CDM Abilify Maintena ER 300 Mg Syr 19 19 $11,489.00 $9,191.20 $2,000.00 $10,454.99 $7,617.21 2026-04-24
04506691 CDM Abilify Maintena ER 300 Mg Syr 19 19 $11,489.00 $9,191.20 $2,000.00 $10,454.99 $7,617.21 2026-04-24
32700002_1 CDM Brighter Connection Program 17 17 $10,400.00 $8,320.00 20% off $2,000.00 $9,464.00 $7,415.20 2026-07-07
04506888_1 CDM Abilify Maintena ER 300 Mg Syr 9 9 $11,489.00 $9,191.20 $3,446.70 $10,454.99 $7,123.18 2026-07-07
J0897 HCPCS Injection, Denosumab, 1 Mg 78 24 $8,368.00 $6,694.40 20% off $2,000.00 $14,161.42 $6,359.68 2026-07-07
04507064 CDM Prolia 60 Mg/ml Syringe 19 19 $8,862.00 $7,089.60 $2,000.00 $8,064.42 $5,875.51 2026-04-24
J1306 HCPCS Injection, Inclisiran, 1 Mg 36 20 $8,330.00 $6,664.00 20% off $2,000.00 $7,580.30 $5,731.04 2026-07-07
04507064_1 CDM Prolia 60 Mg/ml Syringe 9 9 $8,862.00 $7,089.60 $2,658.60 $8,064.42 $5,494.44 2026-07-07
04504884_1 CDM Prolia 60 Mg/ml Syringe 17 17 $7,314.00 $5,851.20 20% off $2,000.00 $6,655.74 $5,214.88 2026-07-07
04503293_1 CDM Nystatin 500 Million Unit Pwd 17 17 $7,224.00 $5,779.20 20% off $2,000.00 $6,573.84 $5,150.71 2026-07-07
J0139 HCPCS Injection, Adalimumab, 1 Mg 36 20 $7,335.00 $5,868.00 20% off $2,000.00 $6,674.85 $5,046.48 2026-07-07
04507241 CDM Botox 200 Unit Vial 19 19 $7,608.00 $6,086.40 20% off $2,000.00 $6,923.28 $5,044.10 2026-04-24
04507240 CDM Botox 200 Unit Vial 19 19 $7,608.00 $6,086.40 20% off $2,000.00 $6,923.28 $5,044.10 2026-04-24
J3111 HCPCS Injection, Romosozumab-aqqg, 1 Mg 21 21 $6,900.00 $5,520.00 20% off $2,000.00 $6,279.00 $5,029.10 2026-07-07
J9217 HCPCS Leuprolide Acetate (for Depot Suspension), 7.5 Mg 44 24 $9,363.00 $7,490.40 20% off $1,657.32 $8,520.33 $4,870.63 2026-07-07
04504884 CDM Prolia 60 Mg/ml Syringe 19 19 $7,314.00 $5,851.20 20% off $2,000.00 $6,655.74 $4,849.18 2026-04-24
04503071_1 CDM Prolia 60 Mg/ml Syringe 17 17 $6,724.00 $5,379.20 20% off $2,000.00 $6,118.84 $4,794.21 2026-07-07
04503293 CDM Nystatin 500 Million Unit Pwd 19 19 $7,224.00 $5,779.20 20% off $2,000.00 $6,573.84 $4,789.51 2026-04-24
04507240_1 CDM Botox 200 Unit Vial 9 9 $7,608.00 $6,086.40 20% off $2,282.40 $6,923.28 $4,716.96 2026-07-07
04507241_1 CDM Botox 200 Unit Vial 9 9 $7,608.00 $6,086.40 20% off $2,282.40 $6,923.28 $4,716.96 2026-07-07
04502412_1 CDM Prolia 60 Mg/ml Syringe 17 17 $6,540.00 $5,232.00 20% off $2,000.00 $5,951.40 $4,663.02 2026-07-07
04503071 CDM Prolia 60 Mg/ml Syringe 19 19 $6,724.00 $5,379.20 20% off $2,000.00 $6,118.84 $4,458.01 2026-04-24
04505126 CDM Xolair 75 Mg/0.5 Ml Syringe 19 19 $6,638.00 $5,310.40 20% off $2,000.00 $6,040.58 $4,400.99 2026-04-24
04505334 CDM Xolair 75 Mg/0.5 Ml Syringe 19 19 $6,638.00 $5,310.40 20% off $2,000.00 $6,040.58 $4,400.99 2026-04-24
04502412 CDM Prolia 60 Mg/ml Syringe 19 19 $6,540.00 $5,232.00 20% off $2,000.00 $5,951.40 $4,336.02 2026-04-24
04506287 CDM Risperdal Consta 50 Mg Vial 19 19 $6,395.00 $5,116.00 20% off $2,000.00 $5,819.45 $4,239.89 2026-04-24
81211 HCPCS Brca1&2 Seq & Com Dup/del 46 25 $7,370.00 $5,896.00 20% off $88.00 $7,738.50 $4,172.15 2026-07-07
04505126_1 CDM Xolair 75 Mg/0.5 Ml Syringe 9 9 $6,638.00 $5,310.40 20% off $1,991.40 $6,040.58 $4,115.56 2026-07-07
04505334_1 CDM Xolair 75 Mg/0.5 Ml Syringe 9 9 $6,638.00 $5,310.40 20% off $1,991.40 $6,040.58 $4,115.56 2026-07-07
04506593 CDM Nf-nexplanon SubQ Implant 68mg 19 19 $6,183.00 $4,946.40 20% off $2,000.00 $5,626.53 $4,099.33 2026-04-24
04504301_1 CDM Inflectra 100 Mg Vial 17 17 $5,677.00 $4,541.60 $2,000.00 $5,166.07 $4,047.70 2026-07-07
04504316_1 CDM Inflectra 100 Mg Vial 17 17 $5,677.00 $4,541.60 $2,000.00 $5,166.07 $4,047.70 2026-07-07
04506287_1 CDM Risperdal Consta 50 Mg Vial 9 9 $6,395.00 $5,116.00 20% off $1,918.50 $5,819.45 $3,964.90 2026-07-07
04506593_1 CDM Nf-nexplanon SubQ Implant 68mg 9 9 $6,183.00 $4,946.40 20% off $1,854.90 $5,626.53 $3,833.46 2026-07-07
04504301 CDM Inflectra 100 Mg Vial 19 19 $5,677.00 $4,541.60 $2,000.00 $5,166.07 $3,763.85 2026-04-24
04504316 CDM Inflectra 100 Mg Vial 19 19 $5,677.00 $4,541.60 $2,000.00 $5,166.07 $3,763.85 2026-04-24
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 78 24 $5,391.00 $4,312.80 $1,041.00 $5,210.66 $3,574.23 2026-07-07
04504797_1 CDM Pomalyst 2 Mg Capsule 17 17 $4,916.00 $3,932.80 $2,000.00 $4,473.56 $3,505.11 2026-07-07
76094 HCPCS MRI Breast W/implants Bilat 36 20 $4,992.00 $3,993.60 20% off $1,041.00 $4,542.72 $3,434.50 2026-07-07
04504546_1 CDM Pomalyst 2 Mg Capsule 17 17 $4,749.00 $3,799.20 20% off $2,000.00 $4,321.59 $3,386.04 2026-07-07
04500636_1 CDM Imogam Rabies-ht 150 Unit/ml 17 17 $4,673.00 $3,738.40 20% off $2,000.00 $4,252.43 $3,331.85 2026-07-07
04504797 CDM Pomalyst 2 Mg Capsule 19 19 $4,916.00 $3,932.80 $2,000.00 $4,473.56 $3,259.31 2026-04-24
04504792 CDM Pomalyst 2 Mg Capsule 19 19 $4,916.00 $3,932.80 $2,000.00 $4,473.56 $3,259.31 2026-04-24
04505291 CDM Active-pac Kit 19 19 $4,875.00 $3,900.00 20% off $2,000.00 $4,436.25 $3,232.13 2026-04-24
04504546 CDM Pomalyst 2 Mg Capsule 19 19 $4,749.00 $3,799.20 20% off $2,000.00 $4,321.59 $3,148.59 2026-04-24
04500636 CDM Imogam Rabies-ht 150 Unit/ml 19 19 $4,673.00 $3,738.40 20% off $2,000.00 $4,252.43 $3,098.20 2026-04-24
04504792_1 CDM Pomalyst 2 Mg Capsule 9 9 $4,916.00 $3,932.80 $1,474.80 $4,473.56 $3,047.92 2026-07-07
04505291_1 CDM Active-pac Kit 9 9 $4,875.00 $3,900.00 20% off $1,462.50 $4,436.25 $3,022.50 2026-07-07
04507233_1 CDM Aimovig 140 Mg/ml Autoinjector 17 17 $4,180.00 $3,344.00 20% off $2,000.00 $3,803.80 $2,980.34 2026-07-07
04500407_1 CDM Forteo 560 Mcg/2.24 Ml Pen Inj 17 17 $4,155.00 $3,324.00 20% off $2,000.00 $3,781.05 $2,962.52 2026-07-07
80000249_1 CDM Invokana 100 Mg Tablet 17 17 $3,891.00 $3,112.80 $1,984.41 $3,540.81 $2,774.28 2026-07-07
04507233 CDM Aimovig 140 Mg/ml Autoinjector 19 19 $4,180.00 $3,344.00 20% off $2,000.00 $3,803.80 $2,771.34 2026-04-24
70553 HCPCS MRI Scan Of Brain Before And After Contrast 118 25 $5,380.00 $4,304.00 20% off $105.36 $5,409.95 $2,757.52 2026-07-07
04500407 CDM Forteo 560 Mcg/2.24 Ml Pen Inj 19 19 $4,155.00 $3,324.00 20% off $2,000.00 $3,781.05 $2,754.77 2026-04-24
81229 HCPCS Genome-wide Microarray Analysis For Copy Number And Single Nucleotide Polymorphi… 43 24 $3,716.00 $2,972.80 $88.00 $9,824.81 $2,712.68 2026-07-07
76093 HCPCS MRI Breast Unilateral 36 20 $3,801.00 $3,040.80 $1,041.00 $3,458.91 $2,615.09 2026-07-07
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 118 25 $4,085.00 $3,268.00 20% off $28.70 $4,650.10 $2,556.94 2026-07-07
76400 HCPCS MRI Bone Marrow Blood Supply 36 20 $3,625.00 $2,900.00 20% off $1,041.00 $3,298.75 $2,494.01 2026-07-07
04505302_1 CDM Aimovig 140 Mg/ml Autoinjector 17 17 $3,450.00 $2,760.00 20% off $1,759.50 $3,139.50 $2,459.85 2026-07-07
75556 HCPCS MRI Cardiac Velocity Flow 36 20 $3,371.00 $2,696.80 $1,041.00 $3,067.61 $2,319.24 2026-07-07
04505302 CDM Aimovig 140 Mg/ml Autoinjector 19 19 $3,450.00 $2,760.00 20% off $1,759.50 $3,139.50 $2,287.35 2026-04-24
04505301 CDM Aimovig 140 Mg/ml Autoinjector 19 19 $3,450.00 $2,760.00 20% off $1,759.50 $3,139.50 $2,287.35 2026-04-24
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 118 25 $4,325.00 $3,460.00 20% off $54.27 $4,098.64 $2,216.78 2026-07-07
04504934_1 CDM Nf-ozempic 0.25mg Or 0.5mg Doses 2mg/1.5 17 17 $3,089.00 $2,471.20 20% off $1,575.39 $2,810.99 $2,202.46 2026-07-07
75553 HCPCS MRI Cardiac Morphology W Contrast 36 20 $3,127.00 $2,501.60 20% off $1,041.00 $2,845.57 $2,151.38 2026-07-07
75554 HCPCS MRI Cardiac Function Complete 36 20 $3,127.00 $2,501.60 20% off $1,041.00 $2,845.57 $2,151.38 2026-07-07
75552 HCPCS MRI Cardiac Without Contrast 36 20 $3,127.00 $2,501.60 20% off $1,041.00 $2,845.57 $2,151.38 2026-07-07
04505301_1 CDM Aimovig 140 Mg/ml Autoinjector 9 9 $3,450.00 $2,760.00 20% off $1,035.00 $3,139.50 $2,139.00 2026-07-07
74182 HCPCS MRI Scan Of Abdomen With Contrast 44 24 $3,768.00 $3,014.40 20% off $1,041.00 $3,428.88 $2,117.03 2026-07-07
71551 HCPCS MRI Scan Of Chest With Contrast 44 24 $3,810.00 $3,048.00 20% off $1,041.00 $3,467.10 $2,117.03 2026-07-07
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 142 25 $4,220.00 $3,376.00 20% off $70.72 $3,934.84 $2,117.03 2026-07-07
73719 HCPCS MRI Scan Of Leg With Contrast 118 25 $2,989.00 $2,391.20 20% off $74.03 $4,321.59 $2,117.03 2026-07-07
72196 HCPCS MRI Scan Of Pelvis With Contrast 44 24 $3,111.00 $2,488.80 $1,041.00 $2,831.01 $2,117.03 2026-07-07
73722 HCPCS MRI Scan Of Leg Joint With Contrast 118 25 $3,991.00 $3,192.80 $62.68 $4,204.20 $2,117.03 2026-07-07
04507242 CDM Injection, Onabotulinumtoxina, 1 Unit 19 19 $3,122.00 $2,497.60 20% off $1,592.22 $2,841.02 $2,069.89 2026-04-24
04504934 CDM Ozempic 0.25-0.5 Mg/dose Pen 19 19 $3,089.00 $2,471.20 20% off $1,575.39 $2,810.99 $2,048.01 2026-04-24
J0248 HCPCS Injection, Remdesivir, 1 Mg 36 20 $2,858.00 $2,286.40 $1,457.58 $2,600.78 $2,018.88 2026-07-07
70552 HCPCS MRI Scan Of Brain With Contrast 142 25 $3,840.00 $3,072.00 20% off $81.72 $4,008.55 $1,958.40 2026-07-07
36482 HCPCS Chemical Destruction Of First Incompetent Vein Of Arm Or Leg Using Imaging Guida… 86 25 $3,828.00 $3,062.40 20% off $171.04 $14,144.00 $1,952.28 2026-07-07
04507365_1 CDM Trulicity 1.5 Mg/0.5 Ml Pen 17 17 $2,659.00 $2,127.20 20% off $1,356.09 $2,419.69 $1,941.07 2026-07-07
04506707_1 CDM Trulicity 0.75 Mg/0.5 Ml Pen 17 17 $2,659.00 $2,127.20 20% off $1,356.09 $2,419.69 $1,941.07 2026-07-07
04506952_1 CDM Trulicity 1.5 Mg/0.5 Ml Pen 17 17 $2,659.00 $2,127.20 20% off $1,356.09 $2,419.69 $1,941.07 2026-07-07
04507186_1 CDM Trulicity 0.75 Mg/0.5 Ml Pen 17 17 $2,659.00 $2,127.20 20% off $1,356.09 $2,419.69 $1,941.07 2026-07-07
04507242_1 CDM Nf-botox Powder For Inj 100u 9 9 $3,122.00 $2,497.60 20% off $936.60 $2,841.02 $1,935.64 2026-07-07
04500924_1 CDM Zoledronic Acid 4 Mg/5 Ml Vial 17 17 $2,628.00 $2,102.40 $1,340.28 $2,391.48 $1,918.44 2026-07-07
04506952 CDM Trulicity 1.5 Mg/0.5 Ml Pen 19 19 $2,659.00 $2,127.20 20% off $1,356.09 $2,419.69 $1,895.87 2026-04-24
04507186 CDM Trulicity 0.75 Mg/0.5 Ml Pen 19 19 $2,659.00 $2,127.20 20% off $1,356.09 $2,419.69 $1,895.87 2026-04-24
04506707 CDM Trulicity 0.75 Mg/0.5 Ml Pen 19 19 $2,659.00 $2,127.20 20% off $1,356.09 $2,419.69 $1,895.87 2026-04-24
04507365 CDM Trulicity 1.5 Mg/0.5 Ml Pen 19 19 $2,659.00 $2,127.20 20% off $1,356.09 $2,419.69 $1,895.87 2026-04-24
04506706 CDM Trulicity 0.75 Mg/0.5 Ml Pen 19 19 $2,659.00 $2,127.20 20% off $1,356.09 $2,419.69 $1,895.87 2026-04-24
04500924 CDM Zoledronic Acid 4 Mg/5 Ml Vial 19 19 $2,628.00 $2,102.40 $1,340.28 $2,391.48 $1,873.76 2026-04-24
04506511_1 CDM Trulicity 0.75 Mg/0.5 Ml Pen 17 17 $2,533.00 $2,026.40 $1,291.83 $2,305.03 $1,849.09 2026-07-07
04505945_1 CDM Trulicity 1.5 Mg/0.5 Ml Pen 17 17 $2,533.00 $2,026.40 $1,291.83 $2,305.03 $1,849.09 2026-07-07
04505951_1 CDM Trulicity 0.75 Mg/0.5 Ml Pen 17 17 $2,533.00 $2,026.40 $1,291.83 $2,305.03 $1,849.09 2026-07-07
04505949 CDM Trulicity 0.75 Mg/0.5 Ml Pen 19 19 $2,533.00 $2,026.40 $1,291.83 $2,305.03 $1,806.03 2026-04-24
04505945 CDM Trulicity 1.5 Mg/0.5 Ml Pen 19 19 $2,533.00 $2,026.40 $1,291.83 $2,305.03 $1,806.03 2026-04-24
04506511 CDM Trulicity 0.75 Mg/0.5 Ml Pen 19 19 $2,533.00 $2,026.40 $1,291.83 $2,305.03 $1,806.03 2026-04-24
04505951 CDM Trulicity 0.75 Mg/0.5 Ml Pen 19 19 $2,533.00 $2,026.40 $1,291.83 $2,305.03 $1,806.03 2026-04-24
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 118 25 $3,469.00 $2,775.20 20% off $60.98 $3,461.64 $1,778.04 2026-07-07
73219 HCPCS MRI Scan Of Arm With Contrast 44 24 $2,426.00 $1,940.80 20% off $1,041.00 $2,207.66 $1,770.98 2026-07-07
293 MS_DRG Heart Failure And Shock Without Cc/mcc 6 3 $2,474.00 $1,979.20 20% off $4.20 $2,251.34 $1,763.96 2026-07-07
310 MS_DRG Cardiac Arrhythmia And Conduction Disorders Without Cc/mcc 4 2 $2,135.00 $1,708.00 20% off $1,522.26 $1,942.85 $1,732.55 2026-07-07
J1439 HCPCS Injection, Ferric Carboxymaltose, 1 Mg 44 24 $2,325.00 $1,860.00 20% off $1,185.75 $2,362.75 $1,720.50 2026-07-07
04500819_1 CDM Spiriva Handihaler 18 Mcg Cap 17 17 $2,334.00 $1,867.20 20% off $1,190.34 $2,123.94 $1,703.82 2026-07-07
04500209_1 CDM Byetta 10 Mcg Dose Pen Inj 17 17 $2,319.00 $1,855.20 20% off $1,182.69 $2,110.29 $1,692.87 2026-07-07
04500210_1 CDM Byetta 5mcg 250mcg/ml 1.2ml Pen 17 17 $2,319.00 $1,855.20 20% off $1,182.69 $2,110.29 $1,692.87 2026-07-07
04500819 CDM Spiriva Handihaler 18 Mcg Cap 19 19 $2,334.00 $1,867.20 20% off $1,190.34 $2,123.94 $1,664.14 2026-04-24
04505075_1 CDM Trulicity 1.5 Mg/0.5 Ml Pen 17 17 $2,278.00 $1,822.40 $1,161.78 $2,072.98 $1,662.94 2026-07-07
04500210 CDM Byetta 5mcg 250mcg/ml 1.2ml Pen 19 19 $2,319.00 $1,855.20 20% off $1,182.69 $2,110.29 $1,653.45 2026-04-24
04500209 CDM Byetta 10 Mcg Dose Pen Inj 19 19 $2,319.00 $1,855.20 20% off $1,182.69 $2,110.29 $1,653.45 2026-04-24
04506706_1 CDM Trulicity 0.75 Mg/0.5 Ml Pen 9 9 $2,659.00 $2,127.20 20% off $797.70 $2,419.69 $1,648.58 2026-07-07
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 84 25 $4,381.00 $3,504.80 $82.39 $3,986.71 $1,637.65 2026-07-07
04505083 CDM Trulicity 1.5 Mg/0.5 Ml Pen 19 19 $2,278.00 $1,822.40 $1,161.78 $2,072.98 $1,624.21 2026-04-24
04505075 CDM Trulicity 1.5 Mg/0.5 Ml Pen 19 19 $2,278.00 $1,822.40 $1,161.78 $2,072.98 $1,624.21 2026-04-24
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 91 25 $3,138.00 $2,510.40 20% off $30.09 $2,855.58 $1,600.38 2026-07-07
36466 HCPCS Injection Of Chemical Agent Into Multiple Incompetent Veins Of Same Leg Using Ul… 84 25 $3,105.00 $2,484.00 20% off $67.13 $3,302.32 $1,583.55 2026-07-07
04500289_1 CDM Combivent Respimat 20-100 Mcg 17 17 $2,166.00 $1,732.80 20% off $1,104.66 $1,971.06 $1,581.18 2026-07-07
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 84 25 $4,174.00 $3,339.20 20% off $28.39 $3,798.34 $1,579.02 2026-07-07
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 84 25 $5,675.00 $4,540.00 20% off $72.03 $5,164.25 $1,579.02 2026-07-07
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 84 25 $6,279.00 $5,023.20 20% off $85.66 $5,713.89 $1,579.02 2026-07-07
73720 HCPCS MRI Scan Of Leg Before And After Contrast 84 25 $5,321.00 $4,256.80 $21.50 $4,842.11 $1,579.02 2026-07-07
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 84 25 $4,756.00 $3,804.80 $37.88 $4,327.96 $1,579.02 2026-07-07
72142 HCPCS MRI Scan Of Upper Spinal Canal With Contrast 84 25 $4,270.00 $3,416.00 20% off $21.50 $3,885.70 $1,579.02 2026-07-07
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 84 25 $4,756.00 $3,804.80 $66.86 $4,327.96 $1,579.02 2026-07-07
70545 HCPCS MRI Scan Of Blood Vessels Of Head With Contrast 84 25 $4,147.00 $3,317.60 20% off $21.73 $3,773.77 $1,577.98 2026-07-07
70548 HCPCS MRI Scan Of Blood Vessels Of Neck With Contrast 84 25 $4,147.00 $3,317.60 20% off $68.80 $3,773.77 $1,577.98 2026-07-07
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 88 25 $3,087.00 $2,469.60 20% off $83.77 $2,809.17 $1,574.37 2026-07-07
70487 HCPCS CT Scan Of Face With Contrast 118 25 $2,205.00 $1,764.00 20% off $52.29 $2,845.57 $1,572.17 2026-07-07
04505949_1 CDM Trulicity 0.75 Mg/0.5 Ml Pen 9 9 $2,533.00 $2,026.40 $759.90 $2,305.03 $1,570.46 2026-07-07
866 MS_DRG Viral Illness Without Mcc 6 3 $2,193.00 $1,754.40 $4.90 $1,995.63 $1,563.61 2026-07-07
04503536_1 CDM Byetta 5 Mcg Dose Pen Inj 17 17 $2,135.00 $1,708.00 20% off $1,088.85 $1,942.85 $1,558.55 2026-07-07
72149 HCPCS MRI Scan Of Lower Spinal Canal With Contrast 84 25 $4,067.00 $3,253.60 20% off $82.03 $3,700.97 $1,557.59 2026-07-07
73220 HCPCS MRI Scan Of Arm Before And After Contrast 84 25 $4,046.00 $3,236.80 $43.00 $3,681.86 $1,552.23 2026-07-07
04500289 CDM Combivent Respimat 20-100 Mcg 19 19 $2,166.00 $1,732.80 20% off $1,104.66 $1,971.06 $1,544.36 2026-04-24
TI_1 CDM Room & Board - Private (one Bed) - General Classification 2 2 $1,876.00 $1,500.80 20% off $1,337.59 $1,707.16 $1,522.38 2026-07-07
TI CDM Room & Board - Private (one Bed) - General Classification 2 2 $1,876.00 $1,500.80 20% off $1,337.59 $1,707.16 $1,522.38 2026-04-24
04503536 CDM Byetta 5 Mcg Dose Pen Inj 19 19 $2,135.00 $1,708.00 20% off $1,088.85 $1,942.85 $1,522.26 2026-04-24
44602 HCPCS Suture Of Tear Of Hole In Small Bowel 88 25 $2,913.50 $2,330.80 $453.30 $19,849.03 $1,513.69 2026-07-07
36465 HCPCS Injection Of Chemical Agent Into Single Incompetent Vein Of Leg Using Ultrasound… 84 25 $2,958.00 $2,366.40 $74.38 $3,302.32 $1,508.58 2026-07-07
73701 HCPCS CT Scan Of Leg With Contrast Material 118 25 $2,669.00 $2,135.20 20% off $53.60 $2,689.05 $1,507.05 2026-07-07
71555 HCPCS MRI Scan Of Blood Vessels Of Chest 84 25 $3,810.00 $3,048.00 20% off $82.39 $3,467.10 $1,492.05 2026-07-07
70482 HCPCS CT Scan Of Cranial Cavity Before And After Contrast 118 25 $2,379.00 $1,903.20 20% off $58.18 $2,609.88 $1,462.68 2026-07-07
04500123_1 CDM Advair Hfa 115-21 Mcg Inhaler 17 17 $2,000.00 $1,600.00 20% off $1,020.00 $1,820.00 $1,460.00 2026-07-07
Q5101 HCPCS Injection, Filgrastim-sndz, Biosimilar, (zarxio), 1 Microgram 44 24 $2,286.00 $1,828.80 20% off $602.36 $2,080.26 $1,457.32 2026-07-07
71552 HCPCS MRI Scan Of Chest Before And After Contrast 84 25 $3,637.00 $2,909.60 20% off $89.06 $3,309.67 $1,447.93 2026-07-07
04500123 CDM Advair Hfa 115-21 Mcg Inhaler 19 19 $2,000.00 $1,600.00 20% off $1,020.00 $1,820.00 $1,426.00 2026-04-24
69646 HCPCS Extensive Repair And Reconstruction Of Eardrum And Ear Canal With Removal Of Mid… 21 21 $2,476.00 $1,980.80 20% off $362.11 $2,815.23 $1,418.03 2026-07-07
04505083_1 CDM Trulicity 1.5 Mg/0.5 Ml Pen 9 9 $2,278.00 $1,822.40 $683.40 $2,072.98 $1,412.36 2026-07-07
73225 HCPCS MRI Scan Of Blood Vessels Of Arm 84 25 $3,469.00 $2,775.20 20% off $22.09 $3,156.79 $1,405.10 2026-07-07
04503748_1 CDM Cyanocobalamin Powder 17 17 $1,915.00 $1,532.00 20% off $976.65 $1,742.65 $1,397.95 2026-07-07
04503499_1 CDM Cyanocobalamin Powder 17 17 $1,915.00 $1,532.00 20% off $976.65 $1,742.65 $1,397.95 2026-07-07
04500750_1 CDM Premarin 25 Mg Vial 17 17 $1,913.00 $1,530.40 $975.63 $1,740.83 $1,396.49 2026-07-07
72147 HCPCS MRI Scan Of Middle Spinal Canal With Contrast 84 25 $3,377.00 $2,701.60 20% off $70.00 $3,073.07 $1,381.63 2026-07-07
74185 HCPCS MRI Scan Of Blood Vessels Of Abdomen 84 25 $3,371.00 $2,696.80 $82.83 $3,067.61 $1,380.11 2026-07-07
75635 HCPCS CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 84 25 $3,906.00 $3,124.80 $78.45 $3,554.46 $1,366.22 2026-07-07
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 84 25 $4,299.00 $3,439.20 20% off $101.16 $3,912.09 $1,366.22 2026-07-07
04503499 CDM Cyanocobalamin Powder 19 19 $1,915.00 $1,532.00 20% off $976.65 $1,742.65 $1,365.40 2026-04-24
04503748 CDM Cyanocobalamin Powder 19 19 $1,915.00 $1,532.00 20% off $976.65 $1,742.65 $1,365.40 2026-04-24
04500750 CDM Premarin 25 Mg Vial 19 19 $1,913.00 $1,530.40 $975.63 $1,740.83 $1,363.97 2026-04-24
04505651_1 CDM All Inclusive Rate - All-inclusive Room And Board Plus Ancillary 2 2 $1,678.00 $1,342.40 $1,196.41 $1,526.98 $1,361.70 2026-07-07
04505651 CDM All Inclusive Rate - All-inclusive Room And Board Plus Ancillary 2 2 $1,678.00 $1,342.40 $1,196.41 $1,526.98 $1,361.70 2026-04-24
IS_1 CDM Room & Board - Private (one Bed) - General Classification 2 2 $1,665.00 $1,332.00 20% off $1,187.15 $1,515.15 $1,351.15 2026-07-07
IS CDM Room & Board - Private (one Bed) - General Classification 2 2 $1,665.00 $1,332.00 20% off $1,187.15 $1,515.15 $1,351.15 2026-04-24
80000250_1 CDM Brovana 15 Mcg/2 Ml Solution 17 17 $1,849.00 $1,479.20 20% off $942.99 $1,682.59 $1,349.77 2026-07-07
TE_1 CDM Room & Board - Semi-private (two Beds) - General Classification 2 2 $1,658.00 $1,326.40 $1,182.15 $1,508.78 $1,345.47 2026-07-07
TE CDM Room & Board - Semi-private (two Beds) - General Classification 2 2 $1,658.00 $1,326.40 $1,182.15 $1,508.78 $1,345.47 2026-04-24
74175 HCPCS CT Scan Of Blood Vessels Of Abdomen With Contrast 84 25 $3,658.00 $2,926.40 20% off $83.46 $3,328.78 $1,333.29 2026-07-07
72198 HCPCS MRI Scan Of Blood Vessels Of Pelvis 84 25 $3,187.00 $2,549.60 20% off $40.80 $2,900.17 $1,333.18 2026-07-07
J1569 HCPCS Injection, Immune Globulin, (gammagard Liquid), Non-lyophilized, (e.g., Liquid),… 44 24 $1,788.00 $1,430.40 $911.88 $9,311.33 $1,323.12 2026-07-07
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 84 25 $3,123.00 $2,498.40 20% off $37.04 $2,841.93 $1,316.87 2026-07-07
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 84 25 $3,101.00 $2,480.80 $55.24 $2,821.91 $1,311.26 2026-07-07
04502728_1 CDM Trulicity 0.75 Mg/0.5 Ml Pen 17 17 $1,793.00 $1,434.40 $914.43 $1,631.63 $1,308.89 2026-07-07
04500118_1 CDM Zovirax 5% Cream 17 17 $1,793.00 $1,434.40 $914.43 $1,631.63 $1,308.89 2026-07-07
04501371_1 CDM Zoledronic Acid 5 Mg/100 Ml 17 17 $1,780.00 $1,424.00 20% off $907.80 $1,619.80 $1,299.40 2026-07-07
04506601_1 CDM Inlyta 5 Mg Tablet 17 17 $1,777.00 $1,421.60 20% off $906.27 $1,617.07 $1,297.21 2026-07-07
73222 HCPCS MRI Scan Of Arm Joint With Contrast 84 25 $2,989.00 $2,391.20 20% off $74.94 $2,719.99 $1,282.70 2026-07-07
04500118 CDM Zovirax 5% Cream 19 19 $1,793.00 $1,434.40 $914.43 $1,631.63 $1,278.41 2026-04-24
04502728 CDM Trulicity 0.75 Mg/0.5 Ml Pen 19 19 $1,793.00 $1,434.40 $914.43 $1,631.63 $1,278.41 2026-04-24
04501371 CDM Zoledronic Acid 5 Mg/100 Ml 19 19 $1,780.00 $1,424.00 20% off $907.80 $1,619.80 $1,269.14 2026-04-24
70540 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast 118 25 $2,472.00 $1,977.60 20% off $47.30 $2,393.30 $1,267.03 2026-07-07
04506601 CDM Inlyta 5 Mg Tablet 19 19 $1,777.00 $1,421.60 20% off $906.27 $1,617.07 $1,267.00 2026-04-24
74181 HCPCS MRI Scan Of Abdomen Without Contrast 142 25 $2,472.00 $1,977.60 20% off $25.46 $2,651.74 $1,254.76 2026-07-07
70551 HCPCS MRI Scan Of Brain Without Contrast 143 25 $3,111.00 $2,488.80 $67.83 $3,345.16 $1,254.76 2026-07-07
73718 HCPCS MRI Scan Of Leg Without Contrast 142 25 $3,130.00 $2,504.00 20% off $62.08 $3,631.81 $1,254.76 2026-07-07
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 118 25 $2,426.00 $1,940.80 20% off $62.99 $2,939.30 $1,254.76 2026-07-07
04506205_1 CDM Ambrisentan 5 Mg Tablet 17 17 $1,702.00 $1,361.60 20% off $868.02 $1,548.82 $1,242.46 2026-07-07
73725 HCPCS MRI Scan Of Blood Vessels Of Leg 84 25 $2,814.00 $2,251.20 20% off $79.68 $2,560.74 $1,238.07 2026-07-07
04507239 CDM Botox 100 Unit Vial 19 19 $1,718.00 $1,374.40 $876.18 $1,563.38 $1,224.93 2026-04-24
59409 HCPCS Vaginal Delivery 88 25 $3,015.00 $2,412.00 20% off $280.01 $11,199.81 $1,214.92 2026-07-07
04506205 CDM Ambrisentan 5 Mg Tablet 19 19 $1,702.00 $1,361.60 20% off $868.02 $1,548.82 $1,213.53 2026-04-24
70481 HCPCS CT Scan Of Cranial Cavity With Contrast 118 25 $2,191.00 $1,752.80 20% off $52.29 $2,164.89 $1,213.29 2026-07-07
04506194_1 CDM Inlyta 5 Mg Tablet 17 17 $1,662.00 $1,329.60 20% off $847.62 $1,512.42 $1,213.26 2026-07-07
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 84 25 $3,130.00 $2,504.00 20% off $29.48 $2,848.30 $1,198.65 2026-07-07
04500753_1 CDM Premarin Vaginal Cream-appl 17 17 $1,640.00 $1,312.00 20% off $836.40 $1,492.40 $1,197.20 2026-07-07
70488 HCPCS CT Scan Of Face Before And After Contrast 84 25 $3,724.00 $2,979.20 20% off $58.49 $3,388.84 $1,190.88 2026-07-07
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 84 25 $3,516.00 $2,812.80 $64.05 $3,199.56 $1,190.88 2026-07-07
73202 HCPCS CT Scan Of Arm Before And After Contrast 84 25 $3,660.00 $2,928.00 20% off $33.40 $3,330.60 $1,190.88 2026-07-07
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 84 25 $3,877.00 $3,101.60 20% off $79.78 $3,528.07 $1,190.88 2026-07-07
70492 HCPCS CT Scan Of Soft Tissue Of Neck Before And After Contrast 84 25 $3,313.00 $2,650.40 20% off $73.72 $3,014.83 $1,190.88 2026-07-07
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 84 25 $4,268.00 $3,414.40 20% off $84.07 $3,883.88 $1,190.88 2026-07-07
71270 HCPCS CT Scan Of Chest Before And After Contrast 84 25 $3,282.00 $2,625.60 20% off $39.39 $2,986.62 $1,190.88 2026-07-07
74160 HCPCS CT Scan Of Abdomen With Contrast 84 25 $3,142.00 $2,513.60 20% off $58.49 $2,859.22 $1,190.88 2026-07-07
04506194 CDM Inlyta 5 Mg Tablet 19 19 $1,662.00 $1,329.60 20% off $847.62 $1,512.42 $1,185.01 2026-04-24
70470 HCPCS CT Scan Of Head Or Brain Before And After Contrast 84 25 $3,054.00 $2,443.20 20% off $58.49 $2,779.14 $1,179.27 2026-07-07
72194 HCPCS CT Scan Of Pelvis Before And After Contrast 84 25 $3,050.00 $2,440.00 20% off $19.60 $2,775.50 $1,178.25 2026-07-07
SP CDM Room & Board - Semi-private (two Beds) - General Classification 2 2 $1,448.00 $1,158.40 $1,032.42 $1,317.68 $1,175.05 2026-04-24
SP_1 CDM Room & Board - Semi-private (two Beds) - General Classification 2 2 $1,448.00 $1,158.40 $1,032.42 $1,317.68 $1,175.05 2026-07-07
04500753 CDM Premarin Vaginal Cream-appl 19 19 $1,640.00 $1,312.00 20% off $836.40 $1,492.40 $1,169.32 2026-04-24
73702 HCPCS CT Scan Of Leg Before And After Contrast 84 25 $3,006.00 $2,404.80 $55.90 $2,735.46 $1,167.03 2026-07-07
71260 HCPCS CT Scan Of Chest With Contrast 84 25 $3,005.00 $2,404.00 20% off $37.90 $2,734.55 $1,166.78 2026-07-07
70336 HCPCS MRI Scan Of Jaw Joint 84 25 $4,041.00 $3,232.80 $66.69 $3,677.31 $1,147.88 2026-07-07
71550 HCPCS MRI Scan Of Chest Without Contrast 84 25 $4,171.00 $3,336.80 $66.33 $3,795.61 $1,147.88 2026-07-07
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 84 25 $2,936.00 $2,348.80 $68.13 $2,671.76 $1,147.88 2026-07-07
72195 HCPCS MRI Scan Of Pelvis Without Contrast 84 25 $2,580.00 $2,064.00 20% off $21.50 $2,347.80 $1,147.88 2026-07-07
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 84 25 $3,748.00 $2,998.40 20% off $25.35 $3,410.68 $1,147.88 2026-07-07
73218 HCPCS MRI Scan Of Arm Without Contrast 84 25 $2,426.00 $1,940.80 20% off $62.69 $2,207.66 $1,139.13 2026-07-07
72193 HCPCS CT Scan Of Pelvis With Contrast 84 25 $2,833.00 $2,266.40 $42.04 $2,578.03 $1,122.91 2026-07-07
70491 HCPCS CT Scan Of Soft Tissue Of Neck With Contrast 84 25 $2,811.00 $2,248.80 $63.38 $2,558.01 $1,117.30 2026-07-07
72132 HCPCS CT Scan Of Lower Spine With Contrast 84 25 $2,808.00 $2,246.40 $56.21 $2,555.28 $1,116.54 2026-07-07
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 84 25 $2,798.00 $2,238.40 $80.11 $2,546.18 $1,113.99 2026-07-07
04503137_1 CDM Nf-beclomethasone Diprop Micro Pwd 17 17 $1,521.00 $1,216.80 20% off $775.71 $1,384.11 $1,110.33 2026-07-07
04500305_1 CDM Denavir 1% Cream 5gm (penciclovir) 17 17 $1,507.00 $1,205.60 20% off $768.57 $1,371.37 $1,100.11 2026-07-07
313 MS_DRG Chest Pain 2 2 $1,346.00 $1,076.80 20% off $959.70 $1,224.86 $1,092.28 2026-07-07
04503137 CDM Nf-beclomethasone Diprop Micro Pwd 19 19 $1,521.00 $1,216.80 20% off $775.71 $1,384.11 $1,084.47 2026-04-24
04500305 CDM Denavir 1% Cream 5gm (penciclovir) 19 19 $1,507.00 $1,205.60 20% off $768.57 $1,371.37 $1,074.49 2026-04-24
80000253_1 CDM Nf-pradaxa Oral Capsule 75mg 17 17 $1,471.00 $1,176.80 20% off $750.21 $1,338.61 $1,073.83 2026-07-07
04504669_1 CDM Nf-aubagio Oral Tablet 14mg 17 17 $1,460.00 $1,168.00 20% off $744.60 $1,328.60 $1,065.80 2026-07-07
04504634_1 CDM Nf-aubagio Oral Tablet 14mg 17 17 $1,460.00 $1,168.00 20% off $744.60 $1,328.60 $1,065.80 2026-07-07
04507239_1 CDM Botox 100 Unit Vial 9 9 $1,718.00 $1,374.40 $515.40 $1,563.38 $1,065.16 2026-07-07
A0434 HCPCS Specialty Care Transport (sct) 36 20 $1,470.00 $1,176.00 20% off $749.70 $1,337.70 $1,060.61 2026-07-07
A0433 HCPCS Advanced Life Support, Level 2 (als 2) 36 20 $1,468.00 $1,174.40 $748.68 $1,335.88 $1,059.16 2026-07-07
88120 HCPCS Cell Examination Of Urine, Manual 46 25 $1,864.00 $1,491.20 20% off $88.00 $1,957.20 $1,055.21 2026-07-07
80000197_1 CDM Nf-lovastatin Tablet 40mg 17 17 $1,435.00 $1,148.00 20% off $731.85 $1,305.85 $1,047.55 2026-07-07
04504669 CDM Nf-aubagio Oral Tablet 14mg 19 19 $1,460.00 $1,168.00 20% off $744.60 $1,328.60 $1,040.98 2026-04-24
04504634 CDM Nf-aubagio Oral Tablet 14mg 19 19 $1,460.00 $1,168.00 20% off $744.60 $1,328.60 $1,040.98 2026-04-24
04505275 CDM Cholecalciferol Crystals 19 19 $1,448.00 $1,158.40 $738.48 $1,317.68 $1,032.42 2026-04-24
27752 HCPCS Closed Treatment Of Middle Part Of Broken Shin Bone With Manipulation 88 25 $1,809.00 $1,447.20 20% off $503.97 $2,391.88 $1,027.17 2026-07-07
04504161_1 CDM Nf-aubagio Oral Tablet 14mg 17 17 $1,399.04 $1,119.23 20% off $713.51 $1,273.13 $1,021.30 2026-07-07
04504174_1 CDM Nf-aubagio Oral Tablet 14mg 17 17 $1,399.00 $1,119.20 $713.49 $1,273.09 $1,021.27 2026-07-07
04504153_1 CDM Nf-aubagio Oral Tablet 14mg 17 17 $1,399.00 $1,119.20 $713.49 $1,273.09 $1,021.27 2026-07-07
78582 HCPCS Nuclear Medicine Study Of Lung Ventilation And Circulation 46 25 $1,398.00 $1,118.40 $712.98 $4,576.87 $1,020.54 2026-07-07
69310 HCPCS Reconstruction Of Ear Canal 21 21 $1,749.00 $1,399.20 20% off $736.06 $1,988.60 $1,013.35 2026-07-07
04504161 CDM Nf-aubagio Oral Tablet 14mg 19 19 $1,399.04 $1,119.23 20% off $713.51 $1,273.13 $997.52 2026-04-24
04504174 CDM Nf-aubagio Oral Tablet 14mg 19 19 $1,399.00 $1,119.20 $713.49 $1,273.09 $997.49 2026-04-24
04504153 CDM Nf-aubagio Oral Tablet 14mg 19 19 $1,399.00 $1,119.20 $713.49 $1,273.09 $997.49 2026-04-24
73201 HCPCS CT Scan Of Arm With Contrast 84 25 $2,337.00 $1,869.60 20% off $53.60 $2,126.67 $996.43 2026-07-07
J1670 HCPCS Injection, Tetanus Immune Globulin, Human, Up To 250 Units 44 24 $1,525.00 $1,220.00 20% off $777.75 $1,387.75 $994.93 2026-07-07
36475 HCPCS Destruction Of First Incompetent Vein Of Arm Or Leg Using Radiofrequency And Ima… 42 22 $1,567.50 $1,254.00 20% off $249.40 $14,144.00 $994.34 2026-07-07
J1442 HCPCS Injection, Filgrastim (g-csf), Excludes Biosimilars, 1 Microgram 80 24 $1,361.00 $1,088.80 20% off $694.11 $1,554.28 $993.53 2026-07-07
Q0138 HCPCS Injection, Ferumoxytol, For Treatment Of Iron Deficiency Anemia, 1 Mg (non-esrd … 44 24 $1,471.00 $1,176.80 20% off $750.21 $1,338.61 $978.78 2026-07-07
70460 HCPCS CT Scan Head Or Brain With Contrast 84 25 $2,267.00 $1,813.60 20% off $52.29 $2,062.97 $978.59 2026-07-07
90675 HCPCS Rabies Vaccine For Injection Into Muscle 44 24 $1,526.00 $1,220.80 20% off $585.18 $1,388.66 $972.83 2026-07-07
15260 HCPCS Full Thickness Skin Graft To Nose, Ears, Eyelids, Or Lips, 20.0 Sq Cm Or Less 21 21 $1,834.00 $1,467.20 20% off $627.64 $2,112.09 $972.15 2026-07-07
69632 HCPCS Repair Of Eardrum, Ear Canal, And Bones 21 21 $1,741.00 $1,392.80 20% off $166.83 $1,946.16 $963.16 2026-07-07
204 MS_DRG Respiratory Signs And Symptoms 2 2 $1,184.30 $947.44 $844.41 $1,077.71 $961.06 2026-04-24
J1610 HCPCS Injection, Glucagon Hydrochloride, Per 1 Mg 44 24 $1,496.00 $1,196.80 20% off $602.36 $1,361.36 $953.70 2026-07-07
04500796_1 CDM Santyl Ointment 17 17 $1,303.00 $1,042.40 $664.53 $1,185.73 $951.19 2026-07-07
69633 HCPCS Repair Of Eardrum, Ear Canal, And Bones With Insertion Of Prosthesis 21 21 $2,164.00 $1,731.20 20% off $918.15 $1,969.24 $936.43 2026-07-07
70450 HCPCS CT Scan Head Or Brain Without Contrast 84 25 $2,096.00 $1,676.80 20% off $39.48 $1,907.36 $934.98 2026-07-07
04500796 CDM Santyl Ointment 19 19 $1,303.00 $1,042.40 $664.53 $1,185.73 $929.04 2026-04-24
04500122 CDM Advair 500-50 Diskus 19 19 $1,288.00 $1,030.40 $656.88 $1,172.08 $918.34 2026-04-24
36430 HCPCS Transfusion Of Blood Or Blood Products 116 24 $1,237.00 $989.60 20% off $381.99 $2,099.85 $915.38 2026-07-07
04501757_1 CDM Inlyta 5 Mg Tablet 17 17 $1,241.00 $992.80 20% off $632.91 $1,129.31 $905.93 2026-07-07
05000002_1 CDM ........bb Blood Processing I Unit-inpat 17 17 $1,240.00 $992.00 20% off $632.40 $1,128.40 $905.20 2026-07-07
G0410 HCPCS Group Psychotherapy Other Than Of A Multiple-family Group, In A Partial Hospital… 44 24 $1,222.00 $977.60 20% off $623.22 $1,224.88 $904.28 2026-07-07
90853 HCPCS Group Psychotherapy 44 24 $1,222.00 $977.60 20% off $623.22 $1,224.88 $904.28 2026-07-07
04505275_1 CDM Cholecalciferol Crystals 9 9 $1,448.00 $1,158.40 $434.40 $1,317.68 $897.76 2026-07-07
552 MS_DRG Medical Back Problems Without Mcc 4 2 $1,092.75 $874.20 $779.13 $994.40 $886.76 2026-07-07
04501757 CDM Inlyta 5 Mg Tablet 19 19 $1,241.00 $992.80 20% off $632.91 $1,129.31 $884.83 2026-04-24
05000002 CDM ........bb Blood Processing I Unit-inpat 19 19 $1,240.00 $992.00 20% off $632.40 $1,128.40 $884.12 2026-04-24
C7903 HCPCS Group Psychotherapy Service For Diagnosis, Evaluation, Or Treatment Of A Mental … 36 20 $1,222.00 $977.60 20% off $623.22 $1,112.02 $881.67 2026-07-07
93975 HCPCS Complete Ultrasound Of Abdomen And Pelvis Artery And Vein Blood Flow 84 25 $1,912.00 $1,529.60 20% off $36.14 $1,739.92 $875.71 2026-07-07
93970 HCPCS Ultrasound Study Of Arm Or Leg Veins With Compression And Maneuvers 84 25 $1,734.00 $1,387.20 20% off $7.60 $1,577.94 $875.71 2026-07-07
93880 HCPCS Ultrasound Of Both Sides Of Head And Neck Blood Flow 84 25 $1,962.00 $1,569.60 20% off $36.42 $1,785.42 $875.71 2026-07-07
04500834_1 CDM Symbicort 160-4.5 Mcg Inhaler 17 17 $1,195.00 $956.00 20% off $609.45 $1,087.45 $872.35 2026-07-07
04502580_1 CDM Nf-boniva Oral Tablet 150mg 17 17 $1,192.00 $953.60 20% off $607.92 $1,084.72 $870.16 2026-07-07
80000251_1 CDM Nf-hiprex Tablet 1gm 17 17 $1,190.00 $952.00 20% off $606.90 $1,082.90 $868.70 2026-07-07
21335 HCPCS Treatment Of Broken Nose Bone And Tissue Separating Nose Airways 21 21 $1,558.00 $1,246.40 $646.94 $1,552.80 $861.50 2026-07-07
69440 HCPCS Exploration Of Middle Ear 21 21 $1,464.00 $1,171.20 $613.44 $1,332.24 $859.85 2026-07-07
04500869_1 CDM Travoprost 0.004% Eye Drop 17 17 $1,170.00 $936.00 20% off $596.70 $1,064.70 $854.10 2026-07-07
04500834 CDM Symbicort 160-4.5 Mcg Inhaler 19 19 $1,195.00 $956.00 20% off $609.45 $1,087.45 $852.04 2026-04-24
04502580 CDM Nf-boniva Oral Tablet 150mg 19 19 $1,192.00 $953.60 20% off $607.92 $1,084.72 $849.90 2026-04-24
81206 HCPCS Translocation Analysis (bcr/abl1) Major Breakpoint 46 25 $1,330.00 $1,064.00 20% off $88.00 $2,180.67 $847.88 2026-07-07
04500163_1 CDM Atrovent 17 Mcg Hfa Inhaler 17 17 $1,158.00 $926.40 20% off $590.58 $1,053.78 $845.34 2026-07-07
90847 HCPCS Family Psychotherapy With Patient, 50 Minutes 44 24 $1,139.00 $911.20 $580.89 $1,036.49 $842.86 2026-07-07
04500485_1 CDM Infed 100 Mg/2 Ml Vial 17 17 $1,152.00 $921.60 20% off $587.52 $1,048.32 $840.96 2026-07-07
32551 HCPCS Removal Of Fluid From Between Lung And Chest Cavity 88 25 $1,244.00 $995.20 20% off $151.06 $5,180.72 $838.95 2026-07-07
04500869 CDM Travoprost 0.004% Eye Drop 19 19 $1,170.00 $936.00 20% off $596.70 $1,064.70 $834.21 2026-04-24
04508691_1 CDM Atovaquone 750 Mg/5 Ml Susp 17 17 $1,139.00 $911.20 $580.89 $1,036.49 $831.47 2026-07-07
04500163 CDM Atrovent 17 Mcg Hfa Inhaler 19 19 $1,158.00 $926.40 20% off $590.58 $1,053.78 $825.65 2026-04-24
04500346_1 CDM Dulera 200 Mcg-5 Mcg Inhaler 17 17 $1,126.00 $900.80 20% off $574.26 $1,024.66 $821.98 2026-07-07
04500485 CDM Infed 100 Mg/2 Ml Vial 19 19 $1,152.00 $921.60 20% off $587.52 $1,048.32 $821.38 2026-04-24
04508691 CDM Atovaquone 750 Mg/5 Ml Susp 19 19 $1,139.00 $911.20 $580.89 $1,036.49 $812.11 2026-04-24
90837 HCPCS Psychotherapy, 1 Hour 44 24 $1,222.00 $977.60 20% off $623.22 $1,112.02 $806.91 2026-07-07
04504447_1 CDM Dificid 200 Mg Tablet 17 17 $1,104.00 $883.20 $563.04 $1,004.64 $805.92 2026-07-07
27818 HCPCS Closed Treatment Of 3 Broken Lower Leg Bones At Ankle With Manipulation 88 25 $1,288.00 $1,030.40 $464.91 $2,391.88 $804.27 2026-07-07
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