Hospital

MASON DISTRICT HOSPITAL

Havana, IL · CCN 141313 · Rates published

2,503 distinct procedures filed

7 distinct payers

62,686 rate rows

2026-08-01 last MRF observed

Data quality

62,678 of 62,686 rate rows are consumer-grade (100.0%)

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

Excluded — reason	Rows
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	8

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

Source MRF file	https://www.masondistricthospital.org/wp-content/uploads/2026/02/ACA-Price-Hospital-Transparency-100125.xls
Discovered via	Discovered by HANK (automated)
Last fetch	not_modified · 2026-08-03

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
J2350 HCPCS	Ocrelizumab (ocrevus) Inj : 300 Mg	7	$10,839.20	$54,196.00	$43,356.80	nat. median $331 outlier · 131.1×
J3245 HCPCS	Ilumya Subcutaneous Solution 100mg/1ml	7	$9,432.40	$47,162.00	$37,729.60	nat. median $256 outlier · 147.3×
J3380 HCPCS	Vedolizumab (entyvio) Inj: 300 Mg	7	$4,682.60	$23,413.00	$18,730.40	nat. median $150 outlier · 125.1×
J3101 HCPCS	Tenecteplase (TNKase) Inj : 50 Mg	7	$4,408.40	$22,042.00	$17,633.60	nat. median $3,475 outlier · 5.1×
J1162 HCPCS	Digibind (digoxin Immune Fab) : 40 Mg	7	$2,932.99	$14,664.95	$11,731.96	nat. median $7,100 1.7× median
74174TC OTHER	CTA Abd/pelvis	7	$2,313.40	$11,567.00	$9,253.60	nat. median $704 outlier · 13.1×
15273 CPT	Skin Sub Graft T/arm/lg Child 20-29min	7	$1,838.60	$9,533.00	$7,455.20	nat. median $3,152 outlier · 2.4×
74178TC OTHER	CT Abd/pelvis W/wo	7	$1,703.70	$8,682.00	$6,880.20	nat. median $671 outlier · 10.3×
74177TC OTHER	CT Abd/pelvis With IV	7	$1,586.70	$8,657.00	$6,605.13	nat. median $592 outlier · 11.2×
70543TC OTHER	MRI Orbit/face/st Neck Without W Contrast	7	$1,637.60	$8,188.00	$6,550.40	nat. median $657 outlier · 10.0×
74176TC OTHER	CT Abd/pelvis Without Cont	7	$1,499.20	$8,227.50	$6,371.60	nat. median $310 outlier · 20.5×
78816TC OTHER	PET Skull Vertex To Toes	7	$1,530.60	$7,653.00	$6,122.40	nat. median $2,134 outlier · 2.9×
58563 CPT	Hysterosocpy Ablation	7	$1,517.10	$7,585.50	$6,068.40	nat. median $5,175 1.2× median
63650 CPT	O/r Implant Neuroelectrodes	7	$1,504.20	$7,521.00	$6,016.80	nat. median $7,255 0.8× median
6365059 OTHER	O/r Implant Neuroelectrodes	7	$1,504.20	$7,521.00	$6,016.80	nat. median $6,017 1.0× median
63650XS OTHER	O/r Implant Neuroelectrodes	7	$1,504.20	$7,521.00	$6,016.80	nat. median $6,017 1.0× median
72198TC OTHER	MRA Pelvis	7	$1,490.30	$7,451.50	$5,961.20	nat. median $391 outlier · 15.2×
71550TC OTHER	MRI Chest Without	7	$1,476.10	$7,380.50	$5,904.40	nat. median $428 outlier · 13.8×
72158TC OTHER	MRI L-spine Without W/contrast	7	$1,461.60	$7,308.00	$5,846.40	nat. median $625 outlier · 9.4×
72156TC OTHER	MRI C-spine Without W/contrast	7	$1,461.60	$7,308.00	$5,846.40	nat. median $686 outlier · 8.5×
72157TC OTHER	MRI T-spine Without W/contrast	7	$1,461.60	$7,308.00	$5,846.40	nat. median $670 outlier · 8.7×
70546 CPT	MRA Head W Without Contrast Angio	7	$1,412.40	$7,062.00	$5,649.60	nat. median $1,051 outlier · 5.4×
71555TC OTHER	MRA Chest	7	$1,348.50	$7,451.50	$5,648.70	nat. median $428 outlier · 13.2×
73723TC OTHER	MRI Joint Lower Ext Without And W	7	$1,352.70	$6,763.50	$5,410.80	nat. median $442 outlier · 12.2×
72196TC OTHER	MRI Pelvis With Contrast	7	$1,350.90	$6,754.50	$5,403.60	nat. median $398 outlier · 13.6×
74182TC OTHER	MRI Abdomen W Contrast	7	$1,350.90	$6,754.50	$5,403.60	nat. median $428 outlier · 12.6×
74183TC OTHER	MRI Abdomen Without W Contrast	7	$1,350.90	$6,754.50	$5,403.60	nat. median $766 outlier · 7.1×
72197TC OTHER	MRI Sacrum Without W Contrast	7	$1,350.90	$6,754.50	$5,403.60	nat. median $671 outlier · 8.0×
74181TC OTHER	MRI Abdomen Without Contrast	7	$1,350.90	$6,754.50	$5,403.60	nat. median $341 outlier · 15.8×
72142TC OTHER	MRI C-spine W/contrast	7	$1,348.50	$6,742.50	$5,394.00	nat. median $327 outlier · 16.5×
72149TC OTHER	MRI L-spine W/contrast	7	$1,348.50	$6,742.50	$5,394.00	nat. median $366 outlier · 14.7×
71552TC OTHER	MRI Chest Without W Contr	7	$1,348.50	$6,742.50	$5,394.00	nat. median $620 outlier · 8.7×
72147TC OTHER	MRI T-spine W/contrast	7	$1,348.50	$6,742.50	$5,394.00	nat. median $337 outlier · 16.0×
72141TC OTHER	MRI C-spine Without Contrast	7	$1,348.50	$6,742.50	$5,394.00	nat. median $398 outlier · 13.5×
72146TC OTHER	MRI T-spine Without (routine)	7	$1,348.50	$6,742.50	$5,394.00	nat. median $412 outlier · 13.1×
71551TC OTHER	MRI Chest W/contrast	7	$1,348.50	$6,742.50	$5,394.00	nat. median $453 outlier · 11.9×
70552TC OTHER	MRI Head/brain W/contrast	7	$1,348.50	$6,742.50	$5,394.00	nat. median $428 outlier · 12.6×
72148TC OTHER	MRI L-spine Without Cont (rout)	7	$1,348.50	$6,742.50	$5,394.00	nat. median $408 outlier · 13.2×
70553TC OTHER	MRI Head/brain Without W/contrast	7	$1,345.50	$6,727.50	$5,382.00	nat. median $722 outlier · 7.5×
72195TC OTHER	MRI Pelvis Wo Cont	7	$1,308.90	$6,754.50	$5,319.60	nat. median $429 outlier · 12.4×
95811 CPT	Cpap/bipap Titration	7	$1,302.40	$6,512.00	$5,209.60	nat. median $1,923 outlier · 2.7×
73720TC OTHER	Do Not Use	7	$1,290.90	$6,455.50	$5,164.00	nat. median $403 outlier · 12.8×
70552 CPT	MRI Brain W/contrast	7	$1,278.80	$6,394.00	$5,115.20	nat. median $970 outlier · 5.3×
70336TC OTHER	MRI Temporomandibular Joint	7	$1,278.80	$6,394.00	$5,115.20	nat. median $331 outlier · 15.5×
70482TC OTHER	MRI Orbit Face Wo W Cont	7	$1,278.80	$6,394.00	$5,115.20	nat. median $269 outlier · 19.0×
70540TC OTHER	MRI Orbit/face/st Neck Without Contrast	7	$1,278.80	$6,394.00	$5,115.20	nat. median $334 outlier · 15.3×
70551TC OTHER	MRI Brain Without Contrast	7	$1,278.80	$6,394.00	$5,115.20	nat. median $429 outlier · 11.9×
73223TC OTHER	MRA Upper Extremity Without And With	7	$1,274.50	$6,372.50	$5,098.00	nat. median $444 outlier · 11.5×
73719TC OTHER	MRI Lower Extremity With	7	$1,274.50	$6,372.50	$5,098.00	nat. median $300 outlier · 17.0×
73221TC OTHER	MRI Upper Extremity Joint Without	7	$1,274.50	$6,372.50	$5,098.00	nat. median $244 outlier · 20.9×

Other procedures at this hospital

Browse this hospital's 2,503 published procedures. Use the slice to choose what to show, then sort or filter any column.

Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code	Type	Description	Rate rows	Payers	Gross	Cash	Min $	Max $	Avg median	Last observed

00100QZ	OTHER	Ans Integ Head	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
00120QZ	OTHER	Ans. Ear Procedure	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
00140QZ	OTHER	Ans. Eye Procedure	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
00160QZ	OTHER	Ans For Nose	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
00170QZ	OTHER	Ans Intraoral Proced	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
00300QZ	OTHER	Ans Integ Neck	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
00320QZ	OTHER	Ans:eso/thry/lar/tra	13	7	$1,868.50	$1,494.80 20% off	$373.70	$1,868.50	$1,494.80	2026-08-01
00352QZ	OTHER	Ans:simp Lig. Vessel	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
00404QZ	OTHER	Ans Rad/mod.radical	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
00450QZ	OTHER	Ans Clavical/scapula	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
00520QZ	OTHER	Ans Cls.chest+oscopy	13	7	$1,868.50	$1,494.80 20% off	$373.70	$1,868.50	$1,494.80	2026-08-01
00528QZ	OTHER	Ans: Mediastinoscopy	13	7	$2,491.00	$1,992.80 20% off	$498.20	$2,491.00	$1,992.80	2026-08-01
00540QZ	OTHER	Ans Thoracotomy	13	7	$4,036.50	$3,229.20 20% off	$807.30	$4,036.50	$3,229.20	2026-08-01
00730QZ	OTHER	Ans Up.post.abd.wall	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
00740QZ	OTHER	Ans Upr.gi Endoscopy	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
00752QZ	OTHER	Ans Up Vent Hernia	13	7	$1,868.50	$1,494.80 20% off	$373.70	$1,868.50	$1,494.80	2026-08-01
00756QZ	OTHER	Ans Diaphrag. Hernia	13	7	$2,180.00	$1,744.00 20% off	$436.00	$2,180.00	$1,744.00	2026-08-01
00790QZ	OTHER	Ans Laparoscopy	26	7	$2,024.25	$1,619.40	$373.70	$2,180.00	$1,608.35	2026-08-01
00794QZ	OTHER	Ans Pancreatectomy	13	7	$2,491.00	$1,992.80 20% off	$498.20	$2,491.00	$1,992.80	2026-08-01
00820QZ	OTHER	Ans Low Post Abd. Wall	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
00832QZ	OTHER	Ans Low Vent Hernia	13	7	$1,868.50	$1,494.80 20% off	$373.70	$1,868.50	$1,494.80	2026-08-01
00840QZ	OTHER	Ans Low Intra-abdomn	13	7	$1,868.50	$1,494.80 20% off	$373.70	$1,868.50	$1,494.80	2026-08-01
00846QZ	OTHER	Ans Rad Hysterectomy	13	7	$2,491.00	$1,992.80 20% off	$498.20	$2,491.00	$1,992.80	2026-08-01
00860QZ	OTHER	Ans Extraperitoneal	13	7	$1,868.50	$1,494.80 20% off	$373.70	$1,868.50	$1,494.80	2026-08-01
00862QZ	OTHER	Ans Renal + 1/3 Ureter	13	7	$2,180.00	$1,744.00 20% off	$436.00	$2,180.00	$1,744.00	2026-08-01
00870QZ	OTHER	Ans Cystolithotomy	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
00873QZ	OTHER	Ans Lithotripsy	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
00912QZ	OTHER	Ans Tur-bladder Tum	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
00914QZ	OTHER	Ans Tur-prostate	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
00916QZ	OTHER	Ans Post-tur Bleeding	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
00944QZ	OTHER	Ans Vag Hysterectomy	13	7	$1,868.50	$1,494.80 20% off	$373.70	$1,868.50	$1,494.80	2026-08-01
01112QZ	OTHER	Ans Bone Marrow Bx	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
01173QZ	OTHER	Ans Integ Post Pelvis	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
01210QZ	OTHER	Ans Open Hip Proced	13	7	$1,868.50	$1,494.80 20% off	$373.70	$1,868.50	$1,494.80	2026-08-01
01230QZ	OTHER	Ans Open Up2/3 Femur	13	7	$1,868.50	$1,494.80 20% off	$373.70	$1,868.50	$1,494.80	2026-08-01
01232QZ	OTHER	Ans Amputation Ak	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
01360QZ	OTHER	Ans Opn. Low. 1/3 Femur	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
01610QZ	OTHER	Ans Nmtfb Shoulder & Axilla	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
01930QZ	OTHER	Ans Transven. Unbrela	26	7	$2,527.50	$2,022.00 20% off	$312.30	$3,493.50	$1,366.32	2026-08-01
15271	CPT	Skin Sub Graft Trnk/arm/leg 20-29min	39	7	$5,256.00	$4,204.80	$1,026.00	$5,470.00	$4,204.80	2026-08-01
15273	CPT	Skin Sub Graft T/arm/lg Child 20-29min	39	7	$9,319.00	$7,455.20 20% off	$1,838.60	$9,533.00	$7,455.20	2026-08-01
15275	CPT	Skin Sub Graft Face/nk/hg/g 20-29min	39	7	$5,256.00	$4,204.80	$1,026.00	$5,470.00	$4,204.80	2026-08-01
15839	CPT	Labial Reduction	13	7	$3,151.00	$2,520.80	$630.20	$3,151.00	$2,520.80	2026-08-01
24071	CPT	ER Dr Exc Tumor Sft Tissue Upper Arm/elb	13	7	$2,030.00	$1,624.00 20% off	$406.00	$2,030.00	$1,624.00	2026-08-01
24605	CPT	ER Dr Tx Elbow Disclo W/anes	13	7	$2,566.50	$2,053.20 20% off	$513.30	$2,566.50	$2,053.20	2026-08-01
24650	CPT	ER Dr S Reduc Distal Rad	13	7	$1,732.50	$1,386.00 20% off	$346.50	$1,732.50	$1,386.00	2026-08-01
25505	CPT	ER Dr C Reduc Radius	26	7	$1,928.50	$1,542.80 20% off	$346.50	$2,124.50	$1,515.94	2026-08-01
25535	CPT	ER Dr C Reduc Ulna	13	7	$1,732.50	$1,386.00 20% off	$346.50	$1,732.50	$1,386.00	2026-08-01
25565	CPT	ER Dr C Reduc Rad/ulna	26	7	$3,167.25	$2,533.80	$511.00	$3,779.50	$2,235.62	2026-08-01
25605	CPT	ER Dr S Reduc Colles W/manipulation	13	7	$1,732.50	$1,386.00 20% off	$346.50	$1,732.50	$1,386.00	2026-08-01
25624	CPT	ER Dr S Reduc Scaphoid	13	7	$1,732.50	$1,386.00 20% off	$346.50	$1,732.50	$1,386.00	2026-08-01
25650	CPT	ER Dr S Reduc Distalulna	13	7	$1,732.50	$1,386.00 20% off	$346.50	$1,732.50	$1,386.00	2026-08-01
26775	CPT	ER Dr Reduc Inter Phala W/block	13	7	$1,998.00	$1,598.40	$399.60	$1,998.00	$1,598.40	2026-08-01
27240	CPT	ER Dr C Reduc Femoral	13	7	$2,124.50	$1,699.60 20% off	$424.90	$2,124.50	$1,699.60	2026-08-01
27252	CPT	ER Dr C Reduc Hip W/anes	13	7	$2,273.00	$1,818.40	$454.60	$2,273.00	$1,818.40	2026-08-01
27265	CPT	ER Dr C Reduc Post Hip	13	7	$2,035.50	$1,628.40	$407.10	$2,035.50	$1,628.40	2026-08-01
27520	CPT	ER Dr Cl Tx Patellar Fx Without Manipulation	13	7	$1,634.50	$1,307.60 20% off	$326.90	$1,634.50	$1,307.60	2026-08-01
27550	CPT	ER Dr Tx Knee Dislocation	13	7	$2,333.00	$1,866.40	$466.60	$2,333.00	$1,866.40	2026-08-01
27552	CPT	ER Dr Clsd Tx Knee Dislocation W/anes	13	7	$3,102.00	$2,481.60 20% off	$620.40	$3,102.00	$2,481.60	2026-08-01
27562	CPT	ER Dr Tx Dislocation Kneecap	13	7	$1,909.00	$1,527.20 20% off	$381.80	$1,909.00	$1,527.20	2026-08-01
27786	CPT	ER Dr S Reduc Distal Fibular Ankle	13	7	$2,161.00	$1,728.80 20% off	$432.20	$2,161.00	$1,728.80	2026-08-01
27810	CPT	ER Dr S Reduc Bimalleolar Ankle	13	7	$2,161.00	$1,728.80 20% off	$432.20	$2,161.00	$1,728.80	2026-08-01
27818	CPT	ER Dr S Reduc Trimalleolar Ankle	13	7	$2,302.50	$1,842.00 20% off	$460.50	$2,302.50	$1,842.00	2026-08-01
28192	CPT	ER Dr Removal Foreign Body Foot Deep	13	7	$1,915.00	$1,532.00 20% off	$383.00	$1,915.00	$1,532.00	2026-08-01
31500QZ	OTHER	Ans Intubation Oral	13	7	$1,868.50	$1,494.80 20% off	$373.70	$1,868.50	$1,494.80	2026-08-01
31605	CPT	ER Dr Trach-cricothyroid	13	7	$1,501.50	$1,201.20 20% off	$300.30	$1,501.50	$1,201.20	2026-08-01
37618	CPT	ER Dr Angioaccess Arteriovenous Ext	13	7	$2,309.00	$1,847.20 20% off	$461.80	$2,309.00	$1,847.20	2026-08-01
40650	CPT	ER Dr Repair Lip Vermilion Only	13	7	$2,333.00	$1,866.40	$466.60	$2,333.00	$1,866.40	2026-08-01
46040	CPT	ER Dr I&d Perirectal Abscess	13	7	$1,695.50	$1,356.40	$339.10	$1,695.50	$1,356.40	2026-08-01
56620	CPT	Vulvectomy	13	7	$2,077.50	$1,662.00 20% off	$415.50	$2,077.50	$1,662.00	2026-08-01
58260	CPT	Vaginal Hysterectomy	13	7	$2,967.00	$2,373.60 20% off	$593.40	$2,967.00	$2,373.60	2026-08-01
58563	CPT	Hysterosocpy Ablation	13	7	$7,585.50	$6,068.40 20% off	$1,517.10	$7,585.50	$6,068.40	2026-08-01
58661	CPT	Laparoscopic Tubal Ligation	13	7	$2,303.00	$1,842.40	$460.60	$2,303.00	$1,842.40	2026-08-01
59409	CPT	ER Dr Vag Delivery	13	7	$1,732.50	$1,386.00 20% off	$346.50	$1,732.50	$1,386.00	2026-08-01
62270QZ	OTHER	Ans Dx Lumbar Puncture	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
62318QZ	OTHER	Ans Cont Spinal Cath Insertion	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
62319QZ	OTHER	Ans Epidural Cath Insertion	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
63650	CPT	O/r Implant Neuroelectrodes	13	7	$7,521.00	$6,016.80 20% off	$1,504.20	$7,521.00	$6,016.80	2026-08-01
6365059	OTHER	O/r Implant Neuroelectrodes	13	7	$7,521.00	$6,016.80 20% off	$1,504.20	$7,521.00	$6,016.80	2026-08-01
63650XS	OTHER	O/r Implant Neuroelectrodes	13	7	$7,521.00	$6,016.80 20% off	$1,504.20	$7,521.00	$6,016.80	2026-08-01
63661	CPT	O/r Remove Spine Eltrd Perq Aray	13	7	$2,270.50	$1,816.40	$454.10	$2,270.50	$1,816.40	2026-08-01
63662	CPT	O/r Remove Spine Eltrd Plate	13	7	$2,861.50	$2,289.20 20% off	$572.30	$2,861.50	$2,289.20	2026-08-01
63663	CPT	O/r Revise Spine Eltrd Perq Aray	13	7	$2,989.50	$2,391.60 20% off	$597.90	$2,989.50	$2,391.60	2026-08-01
63663XS	OTHER	O/r Revise Spine Eltrd Perq Aray	13	7	$2,989.50	$2,391.60 20% off	$597.90	$2,989.50	$2,391.60	2026-08-01
64625RT	OTHER	O/r Rf Abltj Nrv Nrvtg Si Jt	13	7	$1,562.50	$1,250.00 20% off	$312.50	$1,562.50	$1,250.00	2026-08-01
6463550	OTHER	O/r Destroy Lumb/sac Facet Jnt	13	7	$1,460.50	$1,168.40	$292.10	$1,460.50	$1,168.40	2026-08-01
64635LT	OTHER	O/r Destroy Lumb/sac Facet Jnt	13	7	$1,460.50	$1,168.40	$292.10	$1,460.50	$1,168.40	2026-08-01
64635RT	OTHER	O/r Destroy Lumb/sac Facet Jnt	13	7	$1,460.50	$1,168.40	$292.10	$1,460.50	$1,168.40	2026-08-01
70336TC	OTHER	MRI Temporomandibular Joint	13	7	$6,394.00	$5,115.20 20% off	$1,278.80	$6,394.00	$5,115.20	2026-08-01
70450TC	OTHER	CT Head Without Contrast	13	7	$3,817.50	$3,054.00 20% off	$763.50	$3,817.50	$3,054.00	2026-08-01
70460TC	OTHER	CT Head W IV Cont	13	7	$4,242.00	$3,393.60 20% off	$848.40	$4,242.00	$3,393.60	2026-08-01
70470TC	OTHER	CT Head Without And W Cont	13	7	$5,269.50	$4,215.60	$1,053.90	$5,269.50	$4,215.60	2026-08-01
70480TC	OTHER	CT Temporal, Inner Ear, Mastoid Without IV	13	7	$4,261.00	$3,408.80	$852.20	$4,261.00	$3,408.80	2026-08-01
70481TC	OTHER	CT Inner Ear/mastoids W/iv Cont	13	7	$4,286.50	$3,429.20 20% off	$857.30	$4,286.50	$3,429.20	2026-08-01
70482	CPT	CT Inner Ear/mastoids W/0 & W IV Cont	13	7	$6,315.50	$5,052.40 20% off	$1,263.10	$6,315.50	$5,052.40	2026-08-01
70482TC	OTHER	MRI Orbit Face Wo W Cont	13	7	$6,394.00	$5,115.20 20% off	$1,278.80	$6,394.00	$5,115.20	2026-08-01
70486TC	OTHER	CT Facial Bones Without	26	7	$3,473.50	$2,778.80	$657.00	$3,662.00	$2,763.88	2026-08-01
70487TC	OTHER	CT Facial Bones W/contrast	13	7	$3,977.00	$3,181.60 20% off	$795.40	$3,977.00	$3,181.60	2026-08-01
70488TC	OTHER	CT Facial Bones/sinus Without & W	13	7	$3,314.50	$2,651.60 20% off	$662.90	$3,314.50	$2,651.60	2026-08-01
70490TC	OTHER	CT Neck Soft Tissue Without Cont	13	7	$5,117.50	$4,094.00 20% off	$1,023.50	$5,117.50	$4,094.00	2026-08-01
70491TC	OTHER	CT Neck Soft Tissue W/iv Cont (rout)	13	7	$5,428.00	$4,342.40 20% off	$1,085.60	$5,428.00	$4,342.40	2026-08-01
70492TC	OTHER	CT Neck Soft Tissue Without W/iv Cont (rout)	26	7	$6,178.25	$4,942.60	$1,122.00	$6,746.50	$4,904.07	2026-08-01
70496TC	OTHER	CTA Head	13	7	$5,383.00	$4,306.40 20% off	$1,076.60	$5,383.00	$4,306.40	2026-08-01
70498TC	OTHER	CTA Neck	13	7	$5,994.00	$4,795.20 20% off	$1,198.80	$5,994.00	$4,795.20	2026-08-01
70540TC	OTHER	MRI Orbit/face/st Neck Without Contrast	13	7	$6,394.00	$5,115.20 20% off	$1,278.80	$6,394.00	$5,115.20	2026-08-01
70542TC	OTHER	MRI Orbit/face/st Neck W/contrast	13	7	$5,416.00	$4,332.80	$1,083.20	$5,416.00	$4,332.80	2026-08-01
70543TC	OTHER	MRI Orbit/face/st Neck Without W Contrast	13	7	$8,188.00	$6,550.40 20% off	$1,637.60	$8,188.00	$6,550.40	2026-08-01
70544TC	OTHER	MRA Angiography Head Without Contrast	13	7	$3,325.00	$2,660.00 20% off	$665.00	$3,325.00	$2,660.00	2026-08-01
70545TC	OTHER	MRA Angiography Head W/contrast	13	7	$3,325.00	$2,660.00 20% off	$665.00	$3,325.00	$2,660.00	2026-08-01
70546	CPT	MRA Head W Without Contrast Angio	13	7	$7,062.00	$5,649.60	$1,412.40	$7,062.00	$5,649.60	2026-08-01
70546TC	OTHER	MRA Angio Head Without W Contrast	13	7	$3,325.00	$2,660.00 20% off	$665.00	$3,325.00	$2,660.00	2026-08-01
70547TC	OTHER	MRA Neck/carotids Without Contrast	13	7	$3,325.00	$2,660.00 20% off	$665.00	$3,325.00	$2,660.00	2026-08-01
70548TC	OTHER	MRA Neck/carotids W Contrast	13	7	$3,325.00	$2,660.00 20% off	$665.00	$3,325.00	$2,660.00	2026-08-01
70549TC	OTHER	MRA Neck/carotids Without W Contrast	13	7	$3,325.00	$2,660.00 20% off	$665.00	$3,325.00	$2,660.00	2026-08-01
70551TC	OTHER	MRI Brain Without Contrast	13	7	$6,394.00	$5,115.20 20% off	$1,278.80	$6,394.00	$5,115.20	2026-08-01
70552	CPT	MRI Brain W/contrast	13	7	$6,394.00	$5,115.20 20% off	$1,278.80	$6,394.00	$5,115.20	2026-08-01
70552TC	OTHER	MRI Head/brain W/contrast	13	7	$6,742.50	$5,394.00 20% off	$1,348.50	$6,742.50	$5,394.00	2026-08-01
70553TC	OTHER	MRI Head/brain Without W/contrast	13	7	$6,727.50	$5,382.00 20% off	$1,345.50	$6,727.50	$5,382.00	2026-08-01
71250TC	OTHER	CT Chest/thorax Without	13	7	$4,261.00	$3,408.80	$852.20	$4,261.00	$3,408.80	2026-08-01
71260TC	OTHER	CT Chest W IV Cont	13	7	$5,086.50	$4,069.20 20% off	$1,017.30	$5,086.50	$4,069.20	2026-08-01
71270TC	OTHER	CT Chest W/wo IV Cont*	13	7	$4,717.00	$3,773.60 20% off	$943.40	$4,717.00	$3,773.60	2026-08-01
71275TC	OTHER	CT Pe Study	26	7	$5,014.25	$4,011.40 20% off	$959.70	$5,230.00	$3,992.77	2026-08-01
71550TC	OTHER	MRI Chest Without	13	7	$7,380.50	$5,904.40 20% off	$1,476.10	$7,380.50	$5,904.40	2026-08-01
71551TC	OTHER	MRI Chest W/contrast	13	7	$6,742.50	$5,394.00 20% off	$1,348.50	$6,742.50	$5,394.00	2026-08-01
71552TC	OTHER	MRI Chest Without W Contr	13	7	$6,742.50	$5,394.00 20% off	$1,348.50	$6,742.50	$5,394.00	2026-08-01
71555TC	OTHER	MRA Chest	26	7	$7,097.00	$5,677.60	$1,348.50	$7,451.50	$5,648.70	2026-08-01
72125TC	OTHER	CT Cerv Spine Without	13	7	$5,061.00	$4,048.80	$1,012.20	$5,061.00	$4,048.80	2026-08-01
72126TC	OTHER	CT Cerv Spine With	13	7	$5,313.00	$4,250.40 20% off	$1,062.60	$5,313.00	$4,250.40	2026-08-01
72128TC	OTHER	CT Thoracic Spine Without	13	7	$4,666.50	$3,733.20 20% off	$933.30	$4,666.50	$3,733.20	2026-08-01
72129TC	OTHER	CT Thoracic Spine With	13	7	$4,773.50	$3,818.80	$954.70	$4,773.50	$3,818.80	2026-08-01
72130TC	OTHER	CT Thoracic Spine W/wo	13	7	$4,934.00	$3,947.20 20% off	$986.80	$4,934.00	$3,947.20	2026-08-01
72131TC	OTHER	CT Ls Spine Without	13	7	$4,666.50	$3,733.20 20% off	$933.30	$4,666.50	$3,733.20	2026-08-01
72132TC	OTHER	CT Ls Spine With Contrast	13	7	$4,851.00	$3,880.80	$970.20	$4,851.00	$3,880.80	2026-08-01
72133TC	OTHER	CT Ls Spine W/wo Contrast	13	7	$4,992.50	$3,994.00 20% off	$998.50	$4,992.50	$3,994.00	2026-08-01
72141TC	OTHER	MRI C-spine Without Contrast	13	7	$6,742.50	$5,394.00 20% off	$1,348.50	$6,742.50	$5,394.00	2026-08-01
72142TC	OTHER	MRI C-spine W/contrast	13	7	$6,742.50	$5,394.00 20% off	$1,348.50	$6,742.50	$5,394.00	2026-08-01
72146TC	OTHER	MRI T-spine Without (routine)	13	7	$6,742.50	$5,394.00 20% off	$1,348.50	$6,742.50	$5,394.00	2026-08-01
72147TC	OTHER	MRI T-spine W/contrast	13	7	$6,742.50	$5,394.00 20% off	$1,348.50	$6,742.50	$5,394.00	2026-08-01
72148TC	OTHER	MRI L-spine Without Cont (rout)	13	7	$6,742.50	$5,394.00 20% off	$1,348.50	$6,742.50	$5,394.00	2026-08-01
72149TC	OTHER	MRI L-spine W/contrast	13	7	$6,742.50	$5,394.00 20% off	$1,348.50	$6,742.50	$5,394.00	2026-08-01
72156TC	OTHER	MRI C-spine Without W/contrast	13	7	$7,308.00	$5,846.40 20% off	$1,461.60	$7,308.00	$5,846.40	2026-08-01
72157TC	OTHER	MRI T-spine Without W/contrast	13	7	$7,308.00	$5,846.40 20% off	$1,461.60	$7,308.00	$5,846.40	2026-08-01
72158TC	OTHER	MRI L-spine Without W/contrast	13	7	$7,308.00	$5,846.40 20% off	$1,461.60	$7,308.00	$5,846.40	2026-08-01
72191TC	OTHER	CTA Pelvis	13	7	$4,536.00	$3,628.80	$907.20	$4,536.00	$3,628.80	2026-08-01
72192TC	OTHER	CT Pelvis Without IV Contrast	13	7	$4,060.50	$3,248.40 20% off	$812.10	$4,060.50	$3,248.40	2026-08-01
72193TC	OTHER	CT Pelvis W/iv (routine)	13	7	$4,691.50	$3,753.20 20% off	$938.30	$4,691.50	$3,753.20	2026-08-01
72194TC	OTHER	CT Pelvis Wo/w IV Contrast*	13	7	$5,684.50	$4,547.60	$1,136.90	$5,684.50	$4,547.60	2026-08-01
72195TC	OTHER	MRI Pelvis Wo Cont	26	7	$6,649.50	$5,319.60	$1,308.90	$6,754.50	$5,319.60	2026-08-01
72196TC	OTHER	MRI Pelvis With Contrast	13	7	$6,754.50	$5,403.60	$1,350.90	$6,754.50	$5,403.60	2026-08-01
72197TC	OTHER	MRI Sacrum Without W Contrast	13	7	$6,754.50	$5,403.60	$1,350.90	$6,754.50	$5,403.60	2026-08-01
72198TC	OTHER	MRA Pelvis	13	7	$7,451.50	$5,961.20 20% off	$1,490.30	$7,451.50	$5,961.20	2026-08-01
731	OTHER	Ans Upr.gi Endoscopy	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
73200TC	OTHER	CT Upper Extrem Without	13	7	$4,261.00	$3,408.80	$852.20	$4,261.00	$3,408.80	2026-08-01
73201TC	OTHER	CT Upper Extrem With	13	7	$4,432.00	$3,545.60 20% off	$886.40	$4,432.00	$3,545.60	2026-08-01
73202TC	OTHER	CT Upper Extrem Wo/with	13	7	$4,725.00	$3,780.00 20% off	$945.00	$4,725.00	$3,780.00	2026-08-01
73206TC	OTHER	CTA Upper Extrem	13	7	$4,393.50	$3,514.80	$878.70	$4,393.50	$3,514.80	2026-08-01
73218TC	OTHER	MRI Upper Extremity Without	13	7	$6,372.50	$5,098.00 20% off	$1,274.50	$6,372.50	$5,098.00	2026-08-01
73221TC	OTHER	MRI Upper Extremity Joint Without	13	7	$6,372.50	$5,098.00 20% off	$1,274.50	$6,372.50	$5,098.00	2026-08-01
73222TC	OTHER	MRI Upper Extremity Joint With	26	7	$5,046.75	$4,037.40 20% off	$987.30	$5,157.00	$4,037.40	2026-08-01
73223TC	OTHER	MRA Upper Extremity Without And With	13	7	$6,372.50	$5,098.00 20% off	$1,274.50	$6,372.50	$5,098.00	2026-08-01
73521TC	OTHER	X Hip Bilat W Ap Pelvis	13	7	$1,584.50	$1,267.60 20% off	$316.90	$1,584.50	$1,267.60	2026-08-01
73700TC	OTHER	CT Lower Extrem Wo	13	7	$3,662.00	$2,929.60 20% off	$732.40	$3,662.00	$2,929.60	2026-08-01
73701TC	OTHER	CT Lower Extrem With Contrast	13	7	$3,819.50	$3,055.60 20% off	$763.90	$3,819.50	$3,055.60	2026-08-01
73706TC	OTHER	CTA Iliac Femorals Without Runoff	13	7	$3,794.50	$3,035.60 20% off	$758.90	$3,794.50	$3,035.60	2026-08-01
73718TC	OTHER	MRI Lower Extremity Without	13	7	$6,372.50	$5,098.00 20% off	$1,274.50	$6,372.50	$5,098.00	2026-08-01
73719TC	OTHER	MRI Lower Extremity With	13	7	$6,372.50	$5,098.00 20% off	$1,274.50	$6,372.50	$5,098.00	2026-08-01
73720TC	OTHER	Do Not Use	26	7	$6,455.00	$5,164.00 20% off	$1,290.90	$6,455.50	$5,164.00	2026-08-01
73721TC	OTHER	MRI Joint Lower Extremity Without	13	7	$6,372.50	$5,098.00 20% off	$1,274.50	$6,372.50	$5,098.00	2026-08-01
73723TC	OTHER	MRI Joint Lower Ext Without And W	13	7	$6,763.50	$5,410.80 20% off	$1,352.70	$6,763.50	$5,410.80	2026-08-01
73725TC	OTHER	MRA Leg Run Offs	13	7	$3,325.00	$2,660.00 20% off	$665.00	$3,325.00	$2,660.00	2026-08-01
74150TC	OTHER	CT Abdomen Without Cont	26	7	$4,273.75	$3,419.00 20% off	$852.20	$4,286.50	$3,419.00	2026-08-01
74160TC	OTHER	CT Abdomen With/iv And Oral	13	7	$4,691.50	$3,753.20 20% off	$938.30	$4,691.50	$3,753.20	2026-08-01
74170TC	OTHER	CT Abdomen W/wo	13	7	$5,912.50	$4,730.00 20% off	$1,182.50	$5,912.50	$4,730.00	2026-08-01
74174TC	OTHER	CTA Abd/pelvis	13	7	$11,567.00	$9,253.60	$2,313.40	$11,567.00	$9,253.60	2026-08-01
74175TC	OTHER	CTA Abd	13	7	$4,536.00	$3,628.80	$907.20	$4,536.00	$3,628.80	2026-08-01
74176TC	OTHER	CT Abd/pelvis Without Cont	39	7	$8,063.50	$6,450.80 20% off	$1,499.20	$8,227.50	$6,371.60	2026-08-01
74177TC	OTHER	CT Abd/pelvis With IV	26	7	$8,295.25	$6,636.20	$1,586.70	$8,657.00	$6,605.13	2026-08-01
74178TC	OTHER	CT Abd/pelvis W/wo	26	7	$8,600.25	$6,880.20	$1,703.70	$8,682.00	$6,880.20	2026-08-01
74181TC	OTHER	MRI Abdomen Without Contrast	13	7	$6,754.50	$5,403.60	$1,350.90	$6,754.50	$5,403.60	2026-08-01
74182TC	OTHER	MRI Abdomen W Contrast	13	7	$6,754.50	$5,403.60	$1,350.90	$6,754.50	$5,403.60	2026-08-01
74183TC	OTHER	MRI Abdomen Without W Contrast	13	7	$6,754.50	$5,403.60	$1,350.90	$6,754.50	$5,403.60	2026-08-01
74185TC	OTHER	MRA Renal	13	7	$3,325.00	$2,660.00 20% off	$665.00	$3,325.00	$2,660.00	2026-08-01
75635TC	OTHER	CTA Aorto-iliofemoral Run Off	13	7	$5,994.00	$4,795.20 20% off	$1,198.80	$5,994.00	$4,795.20	2026-08-01
75820TC	OTHER	X Venogram	13	7	$1,676.00	$1,340.80 20% off	$335.20	$1,676.00	$1,340.80	2026-08-01
75822TC	OTHER	X Venogram Bilateral	13	7	$1,611.50	$1,289.20 20% off	$322.30	$1,611.50	$1,289.20	2026-08-01
76360TC	OTHER	CT Needle Biopsy	13	7	$4,009.00	$3,207.20 20% off	$801.80	$4,009.00	$3,207.20	2026-08-01
76706TC	OTHER	U Abdomen Aorta Screening	13	7	$1,593.50	$1,274.80 20% off	$318.70	$1,593.50	$1,274.80	2026-08-01
76770TC	OTHER	U Abdomen Aorta Complete	39	7	$1,656.00	$1,324.80 20% off	$318.70	$2,273.00	$1,354.48	2026-08-01
76775TC	OTHER	U Abd For Ascites	13	7	$1,638.00	$1,310.40	$327.60	$1,638.00	$1,310.40	2026-08-01
76811TC	OTHER	U OB Comp With Detail	13	7	$1,836.50	$1,469.20 20% off	$367.30	$1,836.50	$1,469.20	2026-08-01
76856TC	OTHER	U Pelvic Transabdominal Only	26	7	$2,040.00	$1,632.00 20% off	$340.90	$2,375.50	$1,491.44	2026-08-01
76872TC	OTHER	U Prostate Sono	13	7	$1,792.00	$1,433.60 20% off	$358.40	$1,792.00	$1,433.60	2026-08-01
76881TC	OTHER	U Extremity Sono	13	7	$1,966.00	$1,572.80 20% off	$393.20	$1,966.00	$1,572.80	2026-08-01
77075TC	OTHER	X Bone Survey Complete	13	7	$2,429.00	$1,943.20 20% off	$485.80	$2,429.00	$1,943.20	2026-08-01
78070TC	OTHER	N Parathyroid Imaging	13	7	$2,206.00	$1,764.80 20% off	$441.20	$2,206.00	$1,764.80	2026-08-01
78215TC	OTHER	N Liver/spleen Scan	13	7	$2,926.00	$2,340.80	$585.20	$2,926.00	$2,340.80	2026-08-01
78226TC	OTHER	N Hepatobiliary Scan Without Cck	13	7	$2,926.00	$2,340.80	$585.20	$2,926.00	$2,340.80	2026-08-01
78227TC	OTHER	N Hepatobiliary Scan With Cck	13	7	$2,926.00	$2,340.80	$585.20	$2,926.00	$2,340.80	2026-08-01
78290TC	OTHER	N Meckels Scan	13	7	$1,783.00	$1,426.40	$356.60	$1,783.00	$1,426.40	2026-08-01
78306TC	OTHER	N Bone Scan Whole Body	13	7	$3,110.00	$2,488.00 20% off	$622.00	$3,110.00	$2,488.00	2026-08-01
78315TC	OTHER	N Bone Scan 3 Phase	13	7	$2,776.00	$2,220.80	$555.20	$2,776.00	$2,220.80	2026-08-01
78452TC	OTHER	N *dont Use Thallium Scan Stress & Rest	26	7	$5,853.50	$4,682.80	$203.80	$10,688.00	$1,578.30	2026-08-01
78456TC	OTHER	N Dvt Scan	13	7	$4,429.50	$3,543.60 20% off	$885.90	$4,429.50	$3,543.60	2026-08-01
78461	CPT	N Cardiac Scan (planar)	13	7	$1,458.00	$1,166.40	$291.60	$1,458.00	$1,166.40	2026-08-01
78464TC	OTHER	N Cardiac Spect Stress Or Rest	13	7	$1,729.00	$1,383.20 20% off	$345.80	$1,729.00	$1,383.20	2026-08-01
78465TC	OTHER	N Spect Thallium Study	13	7	$2,542.50	$2,034.00 20% off	$508.50	$2,542.50	$2,034.00	2026-08-01
78472TC	OTHER	N Cardiac First Pass Stress	26	7	$2,197.50	$1,758.00 20% off	$305.70	$2,866.50	$1,337.44	2026-08-01
78473TC	OTHER	N Cardiac Muga Stress	13	7	$1,458.00	$1,166.40	$291.60	$1,458.00	$1,166.40	2026-08-01
78481TC	OTHER	N Cardiac First Pass Rest	13	7	$1,458.00	$1,166.40	$291.60	$1,458.00	$1,166.40	2026-08-01
78582TC	OTHER	N V/q Scan	13	7	$4,285.50	$3,428.40 20% off	$857.10	$4,285.50	$3,428.40	2026-08-01
78701TC	OTHER	N Renal Scan	13	7	$2,763.50	$2,210.80	$552.70	$2,763.50	$2,210.80	2026-08-01
78709TC	OTHER	N Captopril Renal Study	13	7	$3,604.50	$2,883.60 20% off	$720.90	$3,604.50	$2,883.60	2026-08-01
78740TC	OTHER	N Nuclear Voiding Cystogram	13	7	$1,988.00	$1,590.40	$397.60	$1,988.00	$1,590.40	2026-08-01
78761TC	OTHER	N Testicular Scan	13	7	$1,756.50	$1,405.20 20% off	$351.30	$1,756.50	$1,405.20	2026-08-01
78802TC	OTHER	N Gallium Scan	13	7	$3,298.00	$2,638.40 20% off	$659.60	$3,298.00	$2,638.40	2026-08-01
78806TC	OTHER	N In-111 Leukocyte Scan	13	7	$1,881.50	$1,505.20 20% off	$376.30	$1,881.50	$1,505.20	2026-08-01
78815TC	OTHER	PET Skull Base To Mid-thigh	13	7	$6,280.00	$5,024.00 20% off	$1,256.00	$6,280.00	$5,024.00	2026-08-01
78816TC	OTHER	PET Skull Vertex To Toes	13	7	$7,653.00	$6,122.40 20% off	$1,530.60	$7,653.00	$6,122.40	2026-08-01
810	OTHER	Ans Intes. Endoscopy	13	7	$1,868.50	$1,494.80 20% off	$373.70	$1,868.50	$1,494.80	2026-08-01
81162TC	OTHER	.brca1 And Brca2	13	7	$6,025.50	$4,820.40 20% off	$1,205.10	$6,025.50	$4,820.40	2026-08-01
81201TC	OTHER	.familial Adenomatous Polyposis	13	7	$1,522.00	$1,217.60 20% off	$304.40	$1,522.00	$1,217.60	2026-08-01
81206TC	OTHER	.bcr/abl Quant B2a2	26	7	$1,681.75	$1,345.40	$300.40	$1,861.50	$1,314.25	2026-08-01
81210TC	OTHER	81210 Braf, Gene Analysis	13	7	$1,566.00	$1,252.80 20% off	$313.20	$1,566.00	$1,252.80	2026-08-01
81229TC	OTHER	Chromosome (genomic) Microarry	13	7	$1,957.50	$1,566.00 20% off	$391.50	$1,957.50	$1,566.00	2026-08-01
81256TC	OTHER	Hemochromatosis Gene Mutate	13	7	$1,502.00	$1,201.60 20% off	$300.40	$1,502.00	$1,201.60	2026-08-01
813	OTHER	Ans Egd/colonoscopy Combo	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
81301	CPT	81301 Mis Analysis Of Marhers	13	7	$1,566.00	$1,252.80 20% off	$313.20	$1,566.00	$1,252.80	2026-08-01
81383TC	OTHER	.celiac Disease Hla Screen	13	7	$1,809.00	$1,447.20 20% off	$361.80	$1,809.00	$1,447.20	2026-08-01
81407TC	OTHER	.cacna1a (mol 033)	13	7	$1,522.00	$1,217.60 20% off	$304.40	$1,522.00	$1,217.60	2026-08-01
81408TC	OTHER	.aml Ngs 4 Marker Panel	13	7	$1,894.50	$1,515.60 20% off	$378.90	$1,894.50	$1,515.60	2026-08-01
81479TC	OTHER	.familial Hypercholesterolemia Snager Se	13	7	$3,511.00	$2,808.80	$702.20	$3,511.00	$2,808.80	2026-08-01
86651TC	OTHER	Meningoencephalitis Panel	13	7	$1,484.50	$1,187.60 20% off	$296.90	$1,484.50	$1,187.60	2026-08-01
86711TC	OTHER	Stratify Jcv Ab With Index/reflex	13	7	$2,284.00	$1,827.20 20% off	$456.80	$2,284.00	$1,827.20	2026-08-01
87902TC	OTHER	Hepatitis C Genotype	13	7	$1,600.50	$1,280.40	$320.10	$1,600.50	$1,280.40	2026-08-01
87903TC	OTHER	HIV Phenotype Comprehensive	13	7	$1,957.50	$1,566.00 20% off	$391.50	$1,957.50	$1,566.00	2026-08-01
88261	CPT	88261 Chrom Analys 5 Cell	13	7	$1,566.00	$1,252.80 20% off	$313.20	$1,566.00	$1,252.80	2026-08-01
88348TC	OTHER	88348 Surg. Path	13	7	$1,979.50	$1,583.60 20% off	$395.90	$1,979.50	$1,583.60	2026-08-01
88368TC	OTHER	Fish Panel Mm 88368	13	7	$1,894.50	$1,515.60 20% off	$378.90	$1,894.50	$1,515.60	2026-08-01
88377TC	OTHER	Fish Panel Mm 88377	13	7	$1,894.50	$1,515.60 20% off	$378.90	$1,894.50	$1,515.60	2026-08-01
93303TC	OTHER	E Echocardiogram Limited	13	7	$2,068.00	$1,654.40	$413.60	$2,068.00	$1,654.40	2026-08-01
93306TC	OTHER	E Echocardiogram-osf	13	7	$2,558.50	$2,046.80 20% off	$511.70	$2,558.50	$2,046.80	2026-08-01
93307	CPT	E Echocardiogram Outside Reading	13	7	$2,042.00	$1,633.60 20% off	$408.40	$2,042.00	$1,633.60	2026-08-01
93356TC	OTHER	E Echocardiogram With Strain	26	7	$2,479.75	$1,983.80 20% off	$480.20	$2,558.50	$1,980.82	2026-08-01
93880TC	OTHER	U Carotid Doppler	13	7	$2,561.00	$2,048.80	$512.20	$2,561.00	$2,048.80	2026-08-01
93922TC	OTHER	U Lower Arterial Doppler Bilat Limited	39	7	$1,839.50	$1,471.60 20% off	$318.70	$1,974.00	$1,434.15	2026-08-01
93923TC	OTHER	U Lower Arterial Doppler Bilat Comp	26	7	$2,193.00	$1,754.40	$367.90	$2,546.50	$1,609.57	2026-08-01
93924TC	OTHER	U Lower Arterial Exercise/reactive	13	7	$2,927.00	$2,341.60 20% off	$585.40	$2,927.00	$2,341.60	2026-08-01
93925TC	OTHER	U Lower Arterial Duplex	13	7	$1,973.50	$1,578.80 20% off	$394.70	$1,973.50	$1,578.80	2026-08-01
93930TC	OTHER	U Upper Arterial Duplex	13	7	$1,593.50	$1,274.80 20% off	$318.70	$1,593.50	$1,274.80	2026-08-01
93970TC	OTHER	U Follow Up Vascular Studies	26	7	$2,164.75	$1,731.80	$318.70	$2,736.00	$1,394.32	2026-08-01
93975TC	OTHER	U Renal Artery	26	7	$12,097.00	$9,677.60 20% off	$336.40	$22,512.00	$3,092.20	2026-08-01
93990	CPT	U Arterial Doppler/hemodialysis Access	13	7	$1,839.50	$1,471.60 20% off	$367.90	$1,839.50	$1,471.60	2026-08-01
95165	CPT	Antigen Therapy X150 Units	39	7	$3,240.00	$2,592.00 20% off	$480.00	$4,000.00	$2,160.00	2026-08-01
95808TC	OTHER	Psg Only	13	7	$5,743.50	$4,594.80	$1,148.70	$5,743.50	$4,594.80	2026-08-01
95810	CPT	Psg/split Night	13	7	$5,890.50	$4,712.40 20% off	$1,178.10	$5,890.50	$4,712.40	2026-08-01
95811	CPT	Cpap/bipap Titration	13	7	$6,512.00	$5,209.60	$1,302.40	$6,512.00	$5,209.60	2026-08-01
95816	CPT	EEG	13	7	$1,560.50	$1,248.40	$312.10	$1,560.50	$1,248.40	2026-08-01
96374QZ	OTHER	Ans I.v. Regional Blk	13	7	$1,561.50	$1,249.20 20% off	$312.30	$1,561.50	$1,249.20	2026-08-01
99223	CPT	M/s Hospitalist Level 3 I/p	13	7	$2,049.00	$1,639.20 20% off	$409.80	$2,049.00	$1,639.20	2026-08-01
9928525	OTHER	ER Room High Level Medical Decisiono Mak	13	7	$1,530.50	$1,224.40	$306.10	$1,530.50	$1,224.40	2026-08-01
9929125	OTHER	ER Room Critical Care	13	7	$1,937.50	$1,550.00 20% off	$387.50	$1,937.50	$1,550.00	2026-08-01
A0427	HCPCS	Als1 Emergency	13	7	$2,083.00	$1,666.40	$416.60	$2,083.00	$1,666.40	2026-08-01
A0428QN	OTHER	Bls Non-emergency	13	7	$1,475.50	$1,180.40	$295.10	$1,475.50	$1,180.40	2026-08-01
A0429QN	OTHER	Bls Emergency	26	7	$1,984.75	$1,587.80 20% off	$385.40	$2,042.50	$1,587.80	2026-08-01
A0432QN	OTHER	Paramedic/als Intercept	13	7	$1,701.00	$1,360.80 20% off	$340.20	$1,701.00	$1,360.80	2026-08-01
A0433QN	OTHER	Als2 Emergency	26	7	$2,330.50	$1,864.40	$452.60	$2,398.00	$1,864.40	2026-08-01
A0434QN	OTHER	Special Care Transport	26	7	$2,285.25	$1,828.20 20% off	$452.60	$2,307.50	$1,828.20	2026-08-01
A9504	HCPCS	Tc-99m Accutect	13	7	$2,262.00	$1,809.60 20% off	$452.40	$2,262.00	$1,809.60	2026-08-01
J0129	HCPCS	Abatacept (orencia) Inj: 250 Mg	13	7	$3,926.45	$3,141.16 20% off	$785.29	$3,926.45	$3,141.16	2026-08-01
J0248	HCPCS	Remdesivir Inj: 100 Mg	13	7	$1,917.05	$1,533.64	$383.41	$1,917.05	$1,533.64	2026-08-01
J0585	HCPCS	Botox Therapeutic 100 Units	13	7	$2,216.50	$1,773.20 20% off	$443.30	$2,216.50	$1,773.20	2026-08-01
J0630	HCPCS	Calcitonin Inj: 400 Unit/ 2 Ml	13	7	$3,643.95	$2,915.16 20% off	$728.79	$3,643.95	$2,915.16	2026-08-01
J0875	HCPCS	Dalbavancin (dalvance) Inj : 500 Mg - Nf	13	7	$5,614.00	$4,491.20 20% off	$1,122.80	$5,614.00	$4,491.20	2026-08-01
J0897	HCPCS	Denosumab (prolia) Inj: 60 Mg	13	7	$4,936.00	$3,948.80	$987.20	$4,936.00	$3,948.80	2026-08-01
J1162	HCPCS	Digibind (digoxin Immune Fab) : 40 Mg	13	7	$14,664.95	$11,731.96 20% off	$2,932.99	$14,664.95	$11,731.96	2026-08-01
J1438	HCPCS	Nf-etanercept (enbrel) Inj 50mg/1ml	13	7	$1,821.25	$1,457.00 20% off	$364.25	$1,821.25	$1,457.00	2026-08-01
J1451	HCPCS	Fomepizole (antizol) Inj: 1.5 Gram/1.5ml	13	7	$1,806.05	$1,444.84 20% off	$361.21	$1,806.05	$1,444.84	2026-08-01
J1459	HCPCS	Immune Globulin : 10 Gram Vial/100 Ml	39	7	$2,922.00	$2,337.60 20% off	$157.46	$11,648.00	$2,329.60	2026-08-01
J1573	HCPCS	Hepatitis B Immune Globulin 5 Ml Vial	13	7	$2,108.50	$1,686.80 20% off	$421.70	$2,108.50	$1,686.80	2026-08-01
J1602	HCPCS	Golimumab (simponi Aria) Inj: 50mg/4ml	13	7	$5,318.00	$4,254.40 20% off	$1,063.60	$5,318.00	$4,254.40	2026-08-01
J1950	HCPCS	Lupron 3.75 Mg Injection	39	7	$4,808.00	$3,846.40 20% off	$392.40	$10,594.00	$2,118.80	2026-08-01
J2350	HCPCS	Ocrelizumab (ocrevus) Inj : 300 Mg	13	7	$54,196.00	$43,356.80	$10,839.20	$54,196.00	$43,356.80	2026-08-01
J2357	HCPCS	Omalizumab (xolair) Inj: 150 Mg	13	7	$2,671.00	$2,136.80	$534.20	$2,671.00	$2,136.80	2026-08-01
J2997	HCPCS	Tpa Injection : 100 Mg	39	7	$11,651.00	$9,320.80 20% off	$120.50	$22,014.00	$4,402.80	2026-08-01
J3101	HCPCS	Tenecteplase (TNKase) Inj : 50 Mg	13	7	$22,042.00	$17,633.60 20% off	$4,408.40	$22,042.00	$17,633.60	2026-08-01
J3245	HCPCS	Ilumya Subcutaneous Solution 100mg/1ml	13	7	$47,162.00	$37,729.60 20% off	$9,432.40	$47,162.00	$37,729.60	2026-08-01
J3380	HCPCS	Vedolizumab (entyvio) Inj: 300 Mg	13	7	$23,413.00	$18,730.40	$4,682.60	$23,413.00	$18,730.40	2026-08-01
J3424	HCPCS	Hydroxocobalamin (cyanokit) Inj: 5 Gram	13	7	$3,156.20	$2,524.96	$631.24	$3,156.20	$2,524.96	2026-08-01
J7168	HCPCS	Kcentra 1000 Unit Inj	26	7	$3,837.50	$3,070.00 20% off	$512.50	$5,112.50	$2,242.19	2026-08-01
J7296	HCPCS	Levonorgestrel (kyleena) Iud: 19.5 Mg-nf	13	7	$3,482.90	$2,786.32 20% off	$696.58	$3,482.90	$2,786.32	2026-08-01
J9171	HCPCS	Docetaxel (taxotere) Inj: 80mg/2ml	13	7	$3,187.00	$2,549.60 20% off	$637.40	$3,187.00	$2,549.60	2026-08-01
J9217	HCPCS	Eligard (leuprolide) Inj:45 Mg (6month)	13	7	$1,856.00	$1,484.80 20% off	$371.20	$1,856.00	$1,484.80	2026-08-01
J9293	HCPCS	Mitoxantrone (novantrone) Inj: 20 Mg	13	7	$3,107.00	$2,485.60 20% off	$621.40	$3,107.00	$2,485.60	2026-08-01
J9305	HCPCS	Pemetrexed (alimta)inj: 500 Mg Vial	13	7	$5,260.00	$4,208.00 20% off	$1,052.00	$5,260.00	$4,208.00	2026-08-01
J9312	HCPCS	Rituximab (ruxience) Inj: 100 Mg	26	7	$4,409.62	$3,527.70	$205.85	$7,790.00	$1,293.62	2026-08-01
J9351	HCPCS	Topotecan (hycamtin) Inj : 4 Mg	13	7	$1,507.70	$1,206.16 20% off	$301.54	$1,507.70	$1,206.16	2026-08-01
J9395	HCPCS	Fulvestrant (faslodex) Inj: 250mg/5ml	13	7	$1,644.45	$1,315.56 20% off	$328.89	$1,644.45	$1,315.56	2026-08-01
P9035TC	OTHER	Bb Platelets Pheresed, Leukodepleted	13	7	$1,742.00	$1,393.60 20% off	$348.40	$1,742.00	$1,393.60	2026-08-01
Q4235	HCPCS	Aminorepair 2x3cm	52	7	$3,315.50	$2,652.40 20% off	$267.80	$3,910.00	$1,278.74	2026-08-01
Q5108	HCPCS	Pegfilgrastim (fulphila) Inj: 6 Mg/0.6ml	13	7	$4,738.00	$3,790.40 20% off	$947.60	$4,738.00	$3,790.40	2026-08-01

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