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

INDIANHEAD MEDICAL CTR

Shell Lake, WI · CCN 521342 · Rates published

Your selected procedure

You selected 93306 (HCPCS)

ECHOCARDIOGRAM RESTING

This hospital’s price: $615 across 5 payers · range $609-$1,295

Source: https://indianheadmedicalcenter.com/wp-content/uploads/2026/04/521651949_indianhead-medical-center-shell-lake-inc._standardcharges.csv · observed 2026-07-15

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

328 distinct procedures filed
12 distinct payers
6,076 rate rows
2026-07-15 last MRF observed
Data quality

1,073 of 6,076 rate rows are consumer-grade (17.7%)

5,003 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 5,003
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://indianheadmedicalcenter.com/wp-content/uploads/2026/04/521651949_indianhead-medical-center-shell-lake-inc._standardcharges.csv
Found on page https://indianheadmedicalcenter.com/price-transparency/
Discovered viaCMS hospital list
Last fetch not_modified · 2026-07-15
Content fingerprint ca95bbb39cd7e9ad… · 2,809,461 bytes · first seen 2026-05-13

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
73723
HCPCS 		MRI Lower Joint Left/right With Without Contrast 1 $3,463.20 $3,463.20 $3,463.20 nat. median
$1,199
outlier · 2.9×
74178
HCPCS 		CT Renal/bladder 4 $1,137.11 $5,489.00 $2,586.23 nat. median
$1,027
outlier · 2.5×
95810
HCPCS 		Baseline Sleep Study 2 $2,400.94 $2,719.61 $2,560.28 nat. median
$1,827
1.4× median
72141
HCPCS 		CT Mri/c-spine 2 $1,886.92 $2,956.30 $2,421.61 nat. median
$785
outlier · 3.1×
74177
HCPCS 		CT Abdomen/pelvis W Contrast 4 $1,137.11 $4,093.56 $2,343.99 nat. median
$976
outlier · 2.4×
72148
HCPCS 		MRI L Spine Without Contrast 4 $1,884.75 $3,595.50 $1,948.15 nat. median
$807
outlier · 2.4×
95811
HCPCS 		Sleep Study With Pap Titration 1 $1,883.50 $1,883.50 $1,883.50 nat. median
$1,894
1.0× median
74176
HCPCS 		CT Abdomen/pelvis Wo Contrast 3 $1,877.65 $3,995.00 $1,879.25 nat. median
$694
outlier · 2.7×
72146
HCPCS 		MRI T Spine Without 1 $1,818.43 $1,818.43 $1,818.43 nat. median
$800
outlier · 2.3×
70492
HCPCS 		CT Neck Soft Tissue Combined 1 $1,790.33 $1,790.33 $1,790.33 nat. median
$650
outlier · 2.8×
70551
HCPCS 		MRI Brain Wo Contrast 3 $850.01 $1,512.28 $1,511.42 nat. median
$787
1.9× median
71250
HCPCS 		CT Chest Wo Contrast 2 $1,081.92 $1,702.00 $1,391.96 nat. median
$469
outlier · 3.0×
72125
HCPCS 		CT C-spine 1 Level CT 6 $377.47 $2,520.00 $1,316.56 nat. median
$480
outlier · 2.7×
70450
HCPCS 		CT Head Wo Contrast 7 $1,137.11 $2,295.00 $1,199.52 nat. median
$454
outlier · 2.6×
72131
HCPCS 		CT L-spine 1 Level CT 3 $377.47 $2,401.00 $1,152.48 nat. median
$460
outlier · 2.5×
93351
HCPCS 		Echocardiogram Stress 1 $1,128.00 $1,128.00 $1,128.00 nat. median
$814
1.4× median
72192
HCPCS 		CT Si Joint 2 $723.00 $1,506.26 $1,114.63 nat. median
$463
outlier · 2.4×
71260
HCPCS 		CT Chest W Contrast 3 $1,109.20 $1,137.11 $1,110.14 nat. median
$651
1.7× median
70486
HCPCS 		CT Maxillofacial Wo Contrast 4 $377.47 $1,710.00 $894.67 nat. median
$481
1.9× median
70491
HCPCS 		CT Neck Soft Tissue W Contrast 1 $852.22 $852.22 $852.22 nat. median
$632
1.3× median
73721
HCPCS 		MRI Lower Joint Left/right Without Contrast 1 $849.82 $849.82 $849.82 nat. median
$856
1.0× median
99285
HCPCS 		E.r. Clinic - Level 5 5 $131.98 $1,570.50 $818.80 nat. median
$1,187
0.7× median
74150
HCPCS 		CT Abdomen Wo Contrast 1 $635.58 $635.58 $635.58 nat. median
$448
1.4× median
93306
HCPCS 		Echocardiogram Resting 5 $608.65 $1,294.70 $615.12 nat. median
$993
0.6× median
43239
HCPCS 		Egd Transoral Biopsy Single/multiple 1 $614.90 $614.90 $614.90 nat. median
$1,379
outlier · 0.4×
76856
HCPCS 		US Pelvic Misc GYN 6 $425.50 $1,035.00 $585.72 nat. median
$272
outlier · 2.2×
93970
HCPCS 		US Venous Complete Bilateral 2 $577.00 $577.20 $577.10 nat. median
$565
1.0× median
76775
HCPCS 		US Aorta Complete 2 $564.00 $566.48 $565.24 nat. median
$233
outlier · 2.4×
99284
HCPCS 		Emergency Visit High/urgent Severity 8 $41.07 $1,178.60 $564.48 nat. median
$754
0.7× median
76700
HCPCS 		US Comp Abdomen 4 $467.60 $732.60 $526.63 nat. median
$313
1.7× median
76641
HCPCS 		US Breasts Left/right Complete 1 $518.00 $518.00 $518.00 nat. median
$235
outlier · 2.2×
76830
HCPCS 		US Transvaginal 6 $386.61 $1,170.00 $507.19 nat. median
$250
outlier · 2.0×
93925
HCPCS 		US Lower Ext Artery Or Graft Bilateral 1 $472.30 $472.30 $472.30 nat. median
$524
0.9× median
76642
HCPCS 		US Breasts Left/right Limited 1 $462.50 $462.50 $462.50 nat. median
$204
outlier · 2.3×
76870
HCPCS 		US Testicle Ultrasound 2 $305.50 $585.00 $445.25 nat. median
$253
1.8× median
99281
HCPCS 		Emergency Visit Limited/minor 4 $216.00 $737.00 $427.98 nat. median
$166
outlier · 2.6×
45378
HCPCS 		Colonoscopy Flx Dx W/collj Spec When Pfr 2 $162.16 $679.14 $420.65 nat. median
$1,339
outlier · 0.3×
71101
HCPCS 		Xr Ribs Unilateral Right With Chest 1 $407.00 $407.00 $407.00 nat. median
$171
outlier · 2.4×
93880
HCPCS 		US Carotid Bilateral 3 $401.74 $585.79 $401.84 nat. median
$531
0.8× median
76705
HCPCS 		US Abd Fol Up 76705 5 $206.98 $403.37 $380.13 nat. median
$277
1.4× median
72128
HCPCS 		CT T-spine 1 Level CT 1 $377.47 $377.47 $377.47 nat. median
$462
0.8× median
0250
RC 		7 $2.82 $28,350.00 $369.90 nat. median
$40
outlier · 9.2×
99283
HCPCS 		Emergency Visit Moderate Severity 8 $24.26 $909.19 $361.90 nat. median
$460
0.8× median
0320
RC 		1 $357.28 $357.28 $357.28 nat. median
$394
0.9× median
73523
HCPCS 		Xr Bilateral Hip & Pelvis 5 View 3 $351.33 $553.15 $353.06 nat. median
$190
1.9× median
73502
HCPCS 		Xr Hip Unilateral With Pelvis 2-3 Views 3 $351.09 $552.78 $351.39 nat. median
$152
outlier · 2.3×
0521
RC 		1 $342.43 $342.43 $342.43 nat. median
$159
outlier · 2.2×
72110
HCPCS 		Xr Spine Lumbar With Obl 2 $265.78 $418.10 $341.94 nat. median
$198
1.7× median
76881
HCPCS 		US Knee Left/right 1 $333.00 $333.00 $333.00 nat. median
$230
1.4× median
73630
HCPCS 		Xr Foot 3 Views Left/right 1 $333.00 $333.00 $333.00 nat. median
$155
outlier · 2.2×

Other procedures at this hospital

Browse this hospital's 328 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
             
73723 HCPCS MRI Lower Joint Left/right With Without Contrast 1 1 $4,680.00 $3,744.00 20% off $3,463.20 $3,463.20 $3,463.20 2026-07-15
74178 HCPCS CT Renal/bladder 6 4 $5,489.00 $4,391.20 20% off $1,137.11 $5,489.00 $2,586.23 2026-07-15
95810 HCPCS Baseline Sleep Study 2 2 $5,100.00 $4,080.00 20% off $2,400.94 $2,719.61 $2,560.28 2026-07-15
72141 HCPCS CT Mri/c-spine 2 2 $1,983.00 $1,586.40 $1,886.92 $2,956.30 $2,421.61 2026-07-15
74177 HCPCS CT Abdomen/pelvis W Contrast 6 4 $5,450.00 $4,360.00 20% off $1,137.11 $4,093.56 $2,343.99 2026-07-15
72148 HCPCS MRI L Spine Without Contrast 5 4 $4,145.00 $3,316.00 20% off $1,884.75 $3,595.50 $1,948.15 2026-07-15
95811 HCPCS Sleep Study With Pap Titration 1 1 $4,000.00 $3,200.00 20% off $1,883.50 $1,883.50 $1,883.50 2026-07-15
74176 HCPCS CT Abdomen/pelvis Wo Contrast 3 3 $3,995.00 $3,196.00 20% off $1,877.65 $3,995.00 $1,879.25 2026-07-15
72146 HCPCS MRI T Spine Without 1 1 $3,850.00 $3,080.00 20% off $1,818.43 $1,818.43 $1,818.43 2026-07-15
70492 HCPCS CT Neck Soft Tissue Combined 1 1 $1,989.25 $1,591.40 $1,790.33 $1,790.33 $1,790.33 2026-07-15
70551 HCPCS MRI Brain Wo Contrast 3 3 $3,200.00 $2,560.00 20% off $850.01 $1,512.28 $1,511.42 2026-07-15
71250 HCPCS CT Chest Wo Contrast 2 2 $2,300.00 $1,840.00 20% off $1,081.92 $1,702.00 $1,391.96 2026-07-15
72125 HCPCS CT C-spine 1 Level CT 6 6 $432.20 $345.76 20% off $377.47 $2,520.00 $1,316.56 2026-07-15
70450 HCPCS CT Head Wo Contrast 9 7 $2,550.00 $2,040.00 20% off $1,137.11 $2,295.00 $1,199.52 2026-07-15
72131 HCPCS CT L-spine 1 Level CT 3 3 $432.20 $345.76 20% off $377.47 $2,401.00 $1,152.48 2026-07-15
93351 HCPCS Echocardiogram Stress 1 1 $2,400.00 $1,920.00 20% off $1,128.00 $1,128.00 $1,128.00 2026-07-15
72192 HCPCS CT Si Joint 2 2 $489.15 $391.32 20% off $723.00 $1,506.26 $1,114.63 2026-07-15
71260 HCPCS CT Chest W Contrast 3 3 $2,360.00 $1,888.00 20% off $1,109.20 $1,137.11 $1,110.14 2026-07-15
70486 HCPCS CT Maxillofacial Wo Contrast 4 4 $2,500.00 $2,000.00 20% off $377.47 $1,710.00 $894.67 2026-07-15
70491 HCPCS CT Neck Soft Tissue W Contrast 1 1 $1,800.00 $1,440.00 20% off $852.22 $852.22 $852.22 2026-07-15
73721 HCPCS MRI Lower Joint Left/right Without Contrast 1 1 $4,650.00 $3,720.00 20% off $849.82 $849.82 $849.82 2026-07-15
99285 HCPCS E.r. Clinic - Level 5 8 5 $209.30 $167.44 20% off $131.98 $1,570.50 $818.80 2026-07-15
74150 HCPCS CT Abdomen Wo Contrast 1 1 $1,341.59 $1,073.27 20% off $635.58 $635.58 $635.58 2026-07-15
93306 HCPCS Echocardiogram Resting 6 5 $1,295.00 $1,036.00 20% off $608.65 $1,294.70 $615.12 2026-07-15
43239 HCPCS Egd Transoral Biopsy Single/multiple 1 1 $2,450.00 $1,960.00 20% off $614.90 $614.90 $614.90 2026-07-15
76856 HCPCS US Pelvic Misc GYN 6 6 $1,150.00 $920.00 20% off $425.50 $1,035.00 $585.72 2026-07-15
93970 HCPCS US Venous Complete Bilateral 2 2 $780.00 $624.00 20% off $577.00 $577.20 $577.10 2026-07-15
76775 HCPCS US Aorta Complete 2 2 $1,200.00 $960.00 20% off $564.00 $566.48 $565.24 2026-07-15
99284 HCPCS Emergency Visit High/urgent Severity 20 8 $1,260.00 $1,008.00 20% off $41.07 $1,178.60 $564.48 2026-07-15
76700 HCPCS US Comp Abdomen 4 4 $990.00 $792.00 20% off $467.60 $732.60 $526.63 2026-07-15
76641 HCPCS US Breasts Left/right Complete 1 1 $700.00 $560.00 20% off $518.00 $518.00 $518.00 2026-07-15
76830 HCPCS US Transvaginal 6 6 $1,300.00 $1,040.00 20% off $386.61 $1,170.00 $507.19 2026-07-15
93925 HCPCS US Lower Ext Artery Or Graft Bilateral 1 1 $1,000.00 $800.00 20% off $472.30 $472.30 $472.30 2026-07-15
76642 HCPCS US Breasts Left/right Limited 1 1 $625.00 $500.00 20% off $462.50 $462.50 $462.50 2026-07-15
76870 HCPCS US Testicle Ultrasound 2 2 $650.00 $520.00 20% off $305.50 $585.00 $445.25 2026-07-15
99281 HCPCS Emergency Visit Limited/minor 4 4 $300.00 $240.00 20% off $216.00 $737.00 $427.98 2026-07-15
45378 HCPCS Colonoscopy Flx Dx W/collj Spec When Pfr 2 2 $3,250.00 $2,600.00 20% off $162.16 $679.14 $420.65 2026-07-15
71101 HCPCS Xr Ribs Unilateral Right With Chest 1 1 $550.00 $440.00 20% off $407.00 $407.00 $407.00 2026-07-15
93880 HCPCS US Carotid Bilateral 3 3 $850.00 $680.00 20% off $401.74 $585.79 $401.84 2026-07-15
76705 HCPCS US Abd Fol Up 76705 6 5 $940.00 $752.00 20% off $206.98 $403.37 $380.13 2026-07-15
72128 HCPCS CT T-spine 1 Level CT 1 1 $432.20 $345.76 20% off $377.47 $377.47 $377.47 2026-07-15
0250 RC — 511 7 $6.00 $4.80 20% off $2.82 $28,350.00 $369.90 2026-07-15
99283 HCPCS Emergency Visit Moderate Severity 21 8 $770.00 $616.00 20% off $24.26 $909.19 $361.90 2026-07-15
0320 RC — 1 1 $159.10 $127.28 $357.28 $357.28 $357.28 2026-07-15
73523 HCPCS Xr Bilateral Hip & Pelvis 5 View 3 3 $747.50 $598.00 20% off $351.33 $553.15 $353.06 2026-07-15
73502 HCPCS Xr Hip Unilateral With Pelvis 2-3 Views 4 3 $747.00 $597.60 20% off $351.09 $552.78 $351.39 2026-07-15
0521 RC — 1 1 $179.40 $143.52 $342.43 $342.43 $342.43 2026-07-15
72110 HCPCS Xr Spine Lumbar With Obl 2 2 $588.00 $470.40 20% off $265.78 $418.10 $341.94 2026-07-15
76881 HCPCS US Knee Left/right 1 1 $118.00 $94.40 $333.00 $333.00 $333.00 2026-07-15
73630 HCPCS Xr Foot 3 Views Left/right 1 1 $450.00 $360.00 20% off $333.00 $333.00 $333.00 2026-07-15
99282 HCPCS Emergency Visit Low/moderate Severity 14 7 $548.00 $438.40 20% off $22.91 $562.80 $331.65 2026-07-15
93971 HCPCS US Ext Venous Duplex Imaging Right 3 3 $700.00 $560.00 20% off $126.00 $331.18 $329.48 2026-07-15
77080 HCPCS Bone Density-dexa Scan 4 3 $626.00 $500.80 20% off $294.22 $463.24 $294.47 2026-07-15
99202 HCPCS Office Outpatient New 20 Minutes 1 1 $312.00 $249.60 20% off $285.00 $285.00 $285.00 2026-07-15
99213 HCPCS Office Outpatient Visit 15 Mins 1 1 $340.00 $272.00 20% off $268.20 $268.20 $268.20 2026-07-15
76770 HCPCS US Renal 1 1 $630.00 $504.00 20% off $264.60 $264.60 $264.60 2026-07-15
72040 HCPCS Xr Spine Cervical Ap/lat/od 3view 4 3 $550.00 $440.00 20% off $197.13 $366.30 $232.75 2026-07-15
73501 HCPCS Xr Hip Unilateral Rt W Pelvis 1 View 2 2 $333.27 $266.62 $205.56 $246.62 $226.09 2026-07-15
77067 HCPCS Ma Mam Screening Bilateral Digital 6 5 $460.00 $368.00 20% off $116.84 $340.40 $216.38 2026-07-15
71047 HCPCS Xr Chest 2v With Apical Lordotic 2 1 $350.00 $280.00 20% off $166.84 $259.00 $212.92 2026-07-15
86666 HCPCS Ehrlichia Antibody 6 5 $180.00 $144.00 20% off $8.17 $397.80 $207.92 2026-07-15
72100 HCPCS Xr Spine Lumbar 2 View 6 5 $398.00 $318.40 20% off $187.06 $325.60 $202.50 2026-07-15
71046 HCPCS Xr Chest 2 Views 7 5 $420.00 $336.00 20% off $197.13 $378.00 $197.57 2026-07-15
72220 HCPCS Xr Sacrum/coccyx 4 Films 1 1 $598.92 $479.14 $197.18 $197.18 $197.18 2026-07-15
74019 HCPCS Xr Abdomen 2 View 4 3 $415.00 $332.00 20% off $195.05 $341.13 $197.00 2026-07-15
76536 HCPCS US Parotid Ultrasound 3 2 $412.70 $330.16 $193.97 $725.20 $196.34 2026-07-15
99215 HCPCS Office Outpatient Visit 40 Minutes 1 1 $620.00 $496.00 20% off $195.22 $195.22 $195.22 2026-07-15
72170 HCPCS Xr Pelvis 1/2 Views 1 1 $386.40 $309.12 $182.50 $182.50 $182.50 2026-07-15
80307 HCPCS Drug Of Abuse-urine 8 7 $395.00 $316.00 20% off $63.39 $342.00 $178.68 2026-07-15
71045 HCPCS Xr Chest 1 View 5 4 $336.00 $268.80 $157.92 $302.40 $158.05 2026-07-15
72070 HCPCS Xr Spine Thoracic 2 Views 2 2 $397.33 $317.86 20% off $98.57 $187.67 $143.12 2026-07-15
0301 RC — 2 2 $69.45 $55.56 20% off $132.18 $145.43 $138.81 2026-07-15
0258 RC — 139 7 $57.00 $45.60 20% off $7.05 $20,071.45 $127.42 2026-07-15
87635 HCPCS Covid 19 Quest 2 2 $270.00 $216.00 20% off $126.90 $127.01 $126.96 2026-07-15
43235 HCPCS Egd Transoral Diagnostic 1 1 $1,901.00 $1,520.80 20% off $124.82 $124.82 $124.82 2026-07-15
86617 HCPCS Lyme Igm-immunoblot 1 1 $159.60 $127.68 $118.10 $118.10 $118.10 2026-07-15
80048 HCPCS Basic Metabolic Panel-chem 8 10 8 $170.00 $136.00 20% off $8.74 $166.60 $102.88 2026-07-15
84443 HCPCS Tsh - Sensitive 9 7 $215.00 $172.00 20% off $17.36 $193.50 $101.14 2026-07-15
85025 HCPCS Cbc With Auto Diff 8 6 $175.00 $140.00 20% off $8.03 $156.80 $96.83 2026-07-15
80061 HCPCS Lipid Profile 9 7 $198.00 $158.40 20% off $13.83 $189.91 $93.14 2026-07-15
93005 HCPCS EKG 7 5 $145.00 $116.00 20% off $68.15 $130.50 $92.18 2026-07-15
77063 HCPCS Ma Screening 3d Biltateral 5 4 $235.00 $188.00 20% off $47.86 $144.30 $91.73 2026-07-15
86618 HCPCS Lyme - Abs (eia) 6 5 $180.00 $144.00 20% off $17.60 $162.00 $84.67 2026-07-15
84153 HCPCS Psa Diagnostic Charge 5 5 $116.30 $93.04 $48.85 $115.21 $83.73 2026-07-15
G0103 HCPCS Psa-screen Charge 2 2 $168.00 $134.40 $19.65 $115.22 $67.44 2026-07-15
83036 HCPCS A1c Glycosylated Hgb 10 8 $109.20 $87.36 20% off $10.03 $107.02 $66.09 2026-07-15
84702 HCPCS Hcg Serum Quant 2 2 $150.00 $120.00 20% off $15.55 $111.00 $63.28 2026-07-15
83880 HCPCS B-type Na Peptide-bnp 6 5 $122.00 $97.60 20% off $40.57 $119.56 $57.39 2026-07-15
85027 HCPCS Cbc-no Diff 4 4 $84.38 $67.50 20% off $39.66 $75.94 $51.07 2026-07-15
90471 HCPCS Sl Administration Influenza Vaccine 1 1 $25.00 $20.00 20% off $49.58 $49.58 $49.58 2026-07-15
80069 HCPCS Renal Function Panel 1 1 $93.80 $75.04 $44.09 $44.09 $44.09 2026-07-15
82728 HCPCS Ferritin 4 4 $90.00 $72.00 20% off $14.08 $66.60 $42.41 2026-07-15
81003 HCPCS Urnls Dip Stick/tab Regnt Auto Without Micrs 8 7 $41.00 $32.80 20% off $2.32 $66.22 $36.69 2026-07-15
87491 HCPCS Chlamydia Pcr 3 3 $129.00 $103.20 20% off $36.26 $292.30 $36.26 2026-07-15
85610 HCPCS Protime/inr 7 6 $75.00 $60.00 20% off $4.43 $67.50 $35.28 2026-07-15
80076 HCPCS Hepatic Function Panel 3 3 $70.40 $56.32 20% off $8.44 $52.10 $33.09 2026-07-15
G0378 HCPCS Observaton-initial 1st Hour 3 2 $230.00 $184.00 20% off $32.93 $33.06 $32.93 2026-07-15
88175 HCPCS Pap Thinprep W Reflex Age 21-29 Quest 3 3 $240.00 $192.00 20% off $27.50 $255.30 $27.50 2026-07-15
81001 HCPCS Urinalysis With Microscopy 8 6 $51.00 $40.80 20% off $3.28 $49.98 $23.98 2026-07-15
85651 HCPCS Sed Rate 6 5 $50.00 $40.00 20% off $4.01 $45.00 $23.52 2026-07-15
86696 HCPCS Herpes Simplex 2 1 1 $22.06 $17.65 $19.99 $19.99 $19.99 2026-07-15
87880 HCPCS Strep Rapid-group A 1 1 $86.55 $69.24 20% off $16.86 $16.86 $16.86 2026-07-15
87210 HCPCS Wet Prep 1 1 $35.05 $28.04 $16.48 $16.48 $16.48 2026-07-15
G0008 HCPCS Administration Influenza Vaccine 6 5 $19.00 $15.20 20% off $8.94 $31.49 $16.36 2026-07-15
84550 HCPCS Uric Acid 7 6 $31.60 $25.28 20% off $3.14 $28.44 $14.87 2026-07-15
85014 HCPCS Hematocrit 2 2 $30.00 $24.00 20% off $14.10 $14.11 $14.11 2026-07-15
82565 HCPCS Creatinine 4 3 $25.50 $20.40 20% off $10.71 $18.87 $12.00 2026-07-15
85018 HCPCS Hemoglobin 3 3 $22.00 $17.60 $2.45 $18.08 $10.35 2026-07-15
81025 HCPCS Hcg Urine 5 5 $160.00 $128.00 20% off $8.90 $119.19 $8.90 2026-07-15
74181 HCPCS MRI Abdomen Without Contrast 0 0 $2,970.00 $2,376.00 20% off — — — 2026-07-15
74182 HCPCS MRI Abdomen With Contrast 0 0 $3,300.00 $2,640.00 20% off — — — 2026-07-15
74183 HCPCS MRI Abdomen W/wo Contrast 0 0 $3,800.00 $3,040.00 20% off — — — 2026-07-15
74220 HCPCS Xr Esophagus Barium Xray 0 0 $635.15 $508.12 — — — 2026-07-15
74240 HCPCS Xr Stomach Xray 0 0 $501.17 $400.94 — — — 2026-07-15
74245 HCPCS Xr Stomach & S M 0 0 $782.30 $625.84 — — — 2026-07-15
74250 HCPCS Xr Small Bowel Xray 0 0 $551.30 $441.04 — — — 2026-07-15
74740 HCPCS Xr Salpingogram 0 0 $470.00 $376.00 20% off — — — 2026-07-15
76100 HCPCS Xr Temporamandibular (plano) 0 0 $429.00 $343.20 20% off — — — 2026-07-15
76499 HCPCS Xr Wrists Hand One Arm/leg Right 0 0 $553.00 $442.40 20% off — — — 2026-07-15
76604 HCPCS US Chest Mediastinum 0 0 $484.30 $387.44 20% off — — — 2026-07-15
76706 HCPCS US Aorta Screening 0 0 $702.35 $561.88 20% off — — — 2026-07-15
76857 HCPCS US Pelvis Ltd 0 0 $825.00 $660.00 20% off — — — 2026-07-15
76930 HCPCS US Peri 76930 0 0 $193.70 $154.96 — — — 2026-07-15
76946 HCPCS US Amnio Ultrasound Guidance 0 0 $412.70 $330.16 — — — 2026-07-15
76970 HCPCS US Follow-up Or Limited 0 0 $429.21 $343.37 — — — 2026-07-15
76999 HCPCS US Arteriovenous Fistula Exam 0 0 $412.70 $330.16 — — — 2026-07-15
77012 HCPCS CT Needle Placement 0 0 $1,727.90 $1,382.32 20% off — — — 2026-07-15
78300 HCPCS Nm Bone Scan 78300 0 0 $633.40 $506.72 — — — 2026-07-15
78305 HCPCS Nm Bone Scan Multiple 0 0 $795.60 $636.48 20% off — — — 2026-07-15
78306 HCPCS Nm Bone Scan Total 0 0 $889.20 $711.36 20% off — — — 2026-07-15
78315 HCPCS Nm Bone Scan 3 Phase 0 0 $964.10 $771.28 20% off — — — 2026-07-15
78320 HCPCS Nm Bone Scan Spect 0 0 $1,658.80 $1,327.04 20% off — — — 2026-07-15
78452 HCPCS Nm Thallium Heart 0 0 $919.75 $735.80 20% off — — — 2026-07-15
78700 HCPCS Nm Kidney Scan 0 0 $465.90 $372.72 — — — 2026-07-15
78708 HCPCS Nm Renogram W/lasix 0 0 $765.40 $612.32 — — — 2026-07-15
78761 HCPCS Nm Testicle Scan 0 0 $362.60 $290.08 20% off — — — 2026-07-15
80050 HCPCS General Health Panel 0 0 $331.00 $264.80 — — — 2026-07-15
80055 HCPCS Profile Prenatal 0 0 $67.95 $54.36 20% off — — — 2026-07-15
82247 HCPCS Bilirubin Total 0 0 $34.70 $27.76 20% off — — — 2026-07-15
82248 HCPCS Bilirubin Direct 0 0 $34.70 $27.76 20% off — — — 2026-07-15
82270 HCPCS Hemocult 0 0 $16.70 $13.36 20% off — — — 2026-07-15
86677 HCPCS H-pylori Antibody 0 0 $88.70 $70.96 20% off — — — 2026-07-15
86735 HCPCS Mumps Antibody Immune Status 0 0 $90.80 $72.64 — — — 2026-07-15
86762 HCPCS Rubella Immune Status 0 0 $50.00 $40.00 20% off — — — 2026-07-15
86765 HCPCS Rubeola Antibody 0 0 $37.00 $29.60 — — — 2026-07-15
87338 HCPCS H-pylori Stool, Antigen 0 0 $175.00 $140.00 20% off — — — 2026-07-15
87798 HCPCS Ehrlichia-pcr 0 0 $573.00 $458.40 20% off — — — 2026-07-15
88142 HCPCS Sl Pap Smear-thin Prep Screen 0 0 $102.00 $81.60 20% off — — — 2026-07-15
90649 HCPCS 4vhpv Vaccine 3 Dose Schedule IM Use 0 0 $298.00 $238.40 20% off — — — 2026-07-15
90650 HCPCS 2vhpv Vaccine 3 Dose Schedule IM Use 0 0 $229.00 $183.20 20% off — — — 2026-07-15
90651 HCPCS 9vhpv Vaccine 3 Dose Schedule IM Use 0 0 $360.00 $288.00 20% off — — — 2026-07-15
90658 HCPCS Influenza Vaccine 0 0 $30.60 $24.48 20% off — — — 2026-07-15
90670 HCPCS Pcv13 Vaccine For Intramuscular Use 0 0 $275.00 $220.00 20% off — — — 2026-07-15
90675 HCPCS Rabies Vaccine (imovax) 2.5u Inj 0 0 $2,500.00 $2,000.00 20% off — — — 2026-07-15
90696 HCPCS Dtap Ipv Vaccine Child 4-6 Yrs For IM US 0 0 $200.00 $160.00 20% off — — — 2026-07-15
90732 HCPCS Pneumovax 0 0 $226.00 $180.80 — — — 2026-07-15
93000 HCPCS ECG Routine With Least 12 Lds W/lr 0 0 $198.00 $158.40 20% off — — — 2026-07-15
93015 HCPCS Treadmill Exercise Test 0 0 $457.00 $365.60 — — — 2026-07-15
93017 HCPCS Tread M Exer Tst Cardiac 0 0 $659.00 $527.20 — — — 2026-07-15
93018 HCPCS Stress Test - Rhc 0 0 $153.05 $122.44 20% off — — — 2026-07-15
93350 HCPCS Stress Echocardiogram(do Not Use) 0 0 $289.45 $231.56 — — — 2026-07-15
93922 HCPCS US Digital Pressure Api Abi 0 0 $525.00 $420.00 20% off — — — 2026-07-15
93923 HCPCS US Digital Pressure Exam- 3 Levels 0 0 $580.00 $464.00 20% off — — — 2026-07-15
93926 HCPCS US Femoral Right 0 0 $614.30 $491.44 — — — 2026-07-15
93931 HCPCS Upper Ext Arterial Unilat Duplex Left 0 0 $525.00 $420.00 20% off — — — 2026-07-15
93976 HCPCS US Abdomen Doppler Limited 0 0 $419.00 $335.20 20% off — — — 2026-07-15
95816 HCPCS EEG 0 0 $505.00 $404.00 20% off — — — 2026-07-15
98966 HCPCS Nonphys Telephone Assessment 5-10 Min 0 0 $60.00 $48.00 20% off — — — 2026-07-15
98967 HCPCS Nonphys Telephone Assessment 11-20 Min 0 0 $96.00 $76.80 20% off — — — 2026-07-15
98968 HCPCS Nonphys Telephone Assessment 21-30 Min 0 0 $171.00 $136.80 — — — 2026-07-15
99201 HCPCS Office Outpatient New 10 Minutes 0 0 $160.00 $128.00 20% off — — — 2026-07-15
99203 HCPCS Office Outpatient New 30 Minutes 0 0 $430.00 $344.00 20% off — — — 2026-07-15
99204 HCPCS Office Outpatient New 45 Min 0 0 $740.00 $592.00 20% off — — — 2026-07-15
99205 HCPCS Office Outpatient New 60 Minutes 0 0 $830.00 $664.00 20% off — — — 2026-07-15
99212 HCPCS Office Outpatient Visit 10 Minutes 0 0 $225.00 $180.00 20% off — — — 2026-07-15
99214 HCPCS Office Outpatient Visit 25 Minutes 0 0 $438.00 $350.40 20% off — — — 2026-07-15
99218 HCPCS Observation Care/day Hour 0 0 $70.00 $56.00 20% off — — — 2026-07-15
99224 HCPCS Sbsq Observation Care Per Day 0 0 $150.00 $120.00 20% off — — — 2026-07-15
99225 HCPCS Sbsq Observation Care Per Day 0 0 $190.00 $152.00 20% off — — — 2026-07-15
99226 HCPCS Sbsq Observation Care Per Day 0 0 $269.00 $215.20 20% off — — — 2026-07-15
99234 HCPCS 0-4 Hrs Observation Unit 0 0 $266.20 $212.96 — — — 2026-07-15
99235 HCPCS Observation Unit 0 0 $423.30 $338.64 20% off — — — 2026-07-15
99236 HCPCS 25-36 Hr Observation Unit 0 0 $786.20 $628.96 20% off — — — 2026-07-15
99241 HCPCS Office Consult New/estab 15 Mins 0 0 $230.00 $184.00 20% off — — — 2026-07-15
99242 HCPCS Office Consult New/estab 30 Mins 0 0 $295.00 $236.00 20% off — — — 2026-07-15
99243 HCPCS Office Consult New/estab 40 Min 0 0 $415.00 $332.00 20% off — — — 2026-07-15
99244 HCPCS Office Consult New/estab 60 Min 0 0 $486.00 $388.80 20% off — — — 2026-07-15
99245 HCPCS Office Consult New/estab 80 Min 0 0 $615.00 $492.00 20% off — — — 2026-07-15
99251 HCPCS Inital Inpatient Consult New/est Pt 20mn 0 0 $242.00 $193.60 20% off — — — 2026-07-15
99252 HCPCS Inital Inpatient Consult New/est Pt 40mn 0 0 $445.00 $356.00 20% off — — — 2026-07-15
99253 HCPCS Inital Inpatient Consult New/est Pt 55mn 0 0 $453.00 $362.40 20% off — — — 2026-07-15
99254 HCPCS Inital Inpatient Consult New/est Pt 80mn 0 0 $566.00 $452.80 20% off — — — 2026-07-15
99255 HCPCS Inital Inpatient Consult New/est 110min 0 0 $713.00 $570.40 20% off — — — 2026-07-15
99354 HCPCS Office/prolonged Physician Contact 0 0 $325.00 $260.00 20% off — — — 2026-07-15
99355 HCPCS Office/prolonged Phy Add 30 Mins 0 0 $300.00 $240.00 20% off — — — 2026-07-15
99381 HCPCS Intial Preventive Med Np <1year 0 0 $285.00 $228.00 20% off — — — 2026-07-15
99382 HCPCS Initial Preventive Med Np/1-4 0 0 $349.00 $279.20 20% off — — — 2026-07-15
99383 HCPCS Initial Prev Med New Pt 5-11yrs 0 0 $410.00 $328.00 20% off — — — 2026-07-15
99384 HCPCS Intial Preventive Medicine Np/12-17yr 0 0 $417.00 $333.60 — — — 2026-07-15
99385 HCPCS Initial Preventive Med Np 18-39yrs 0 0 $365.00 $292.00 20% off — — — 2026-07-15
99386 HCPCS Initial Preventive Medicine New Patient 0 0 $502.00 $401.60 — — — 2026-07-15
99387 HCPCS Initial Preventive Medicine New Ptn 65&> 0 0 $419.00 $335.20 20% off — — — 2026-07-15
99391 HCPCS Pdic Compre Prev Med Ree/m Est Pt/inft 0 0 $410.00 $328.00 20% off — — — 2026-07-15
99392 HCPCS Pdic Comp Prev Med Est Pt/1-4 0 0 $420.00 $336.00 20% off — — — 2026-07-15
99393 HCPCS Pdic Comp Prev Med Ree/m /5-11 0 0 $425.00 $340.00 20% off — — — 2026-07-15
99394 HCPCS Pdic Compre Prev Med Ree/m Est Pt/12-17 0 0 $430.00 $344.00 20% off — — — 2026-07-15
99395 HCPCS Pdic Compre Prev Med Ree/m Est Pt/18-39 0 0 $435.00 $348.00 20% off — — — 2026-07-15
99396 HCPCS Pdic Preventive Med Est Pt/40-64 0 0 $440.00 $352.00 20% off — — — 2026-07-15
99397 HCPCS Pdic Comp Prev Med Est Pt/65+ 0 0 $500.00 $400.00 20% off — — — 2026-07-15
99441 HCPCS Phys/qhp Telephone Evaluation 5-10 Min 0 0 $50.00 $40.00 20% off — — — 2026-07-15
99442 HCPCS Phys/qhp Telephone Evaluation 11-20 Min 0 0 $65.00 $52.00 20% off — — — 2026-07-15
99443 HCPCS Phys/qhp Telephone Evaluation 21-30 Min 0 0 $105.00 $84.00 20% off — — — 2026-07-15
G0009 HCPCS Administration Pneumonia Vaccine 0 0 $18.00 $14.40 20% off — — — 2026-07-15
G0402 HCPCS Intial Prev Physcl Exam Medicare 0 0 $345.00 $276.00 20% off — — — 2026-07-15
G0438 HCPCS Annual Wellness Visit Initial 0 0 $303.00 $242.40 20% off — — — 2026-07-15
0360 RC — 0 0 $1,020.25 $816.20 — — — 2026-07-15
0450 RC — 0 0 $30.20 $24.16 20% off — — — 2026-07-15
0731 RC — 0 0 $251.80 $201.44 20% off — — — 2026-07-15
28292 HCPCS Surg Bunionectomy 0 0 $9,105.00 $7,284.00 20% off — — — 2026-07-15
1288 OTHER Room Charge 2nd Floor 0 0 — — — — — 2026-07-15
43255 HCPCS Egd Transoral Control Bleeding 0 0 $3,168.00 $2,534.40 20% off — — — 2026-07-15
44970 HCPCS Laparoscopic Appendectomy 0 0 $3,949.00 $3,159.20 20% off — — — 2026-07-15
45380 HCPCS Colonoscopy W/biopsy Single/multiple 0 0 $2,998.00 $2,398.40 20% off — — — 2026-07-15
45398 HCPCS Surg Colonoscopy W/banding 0 0 $4,189.00 $3,351.20 20% off — — — 2026-07-15
47562 HCPCS Njx Cholangio Prq W/img Gid Rs&i 0 0 $2,839.00 $2,271.20 20% off — — — 2026-07-15
49505 HCPCS Rpr 1st Ingun Hrna Age 5 Yrs/>reducible 0 0 $2,931.00 $2,344.80 — — — 2026-07-15
58301 HCPCS Removal Intrauterine Device IUD 0 0 $292.00 $233.60 20% off — — — 2026-07-15
69200 HCPCS Removal Fb Auditory Canal 0 0 $410.00 $328.00 20% off — — — 2026-07-15
69209 HCPCS Removal Impacted Cerumen Irrig/lvg Uni 0 0 $150.00 $120.00 20% off — — — 2026-07-15
69210 HCPCS Removal Impacted Cerum Unilat 0 0 $165.00 $132.00 20% off — — — 2026-07-15
70210 HCPCS Xr Sinuses Less Than 3 Views 0 0 $415.00 $332.00 20% off — — — 2026-07-15
70220 HCPCS Xr Sinuses Min 3 Views * 0 0 $381.20 $304.96 20% off — — — 2026-07-15
70240 HCPCS Xr Sella Turcica 0 0 $175.40 $140.32 20% off — — — 2026-07-15
70250 HCPCS Xr Skull 4/> Views 0 0 $345.50 $276.40 20% off — — — 2026-07-15
70260 HCPCS Xr Skull 5 Views 0 0 $454.27 $363.42 — — — 2026-07-15
70328 HCPCS Xr Temporomandibular Joints Unilat Left Or Right 0 0 $330.80 $264.64 20% off — — — 2026-07-15
70330 HCPCS Xr Temporomandibular Joint Bilateral 0 0 $556.72 $445.38 — — — 2026-07-15
70336 HCPCS MRI Tmj Unilateral 0 0 $2,975.00 $2,380.00 20% off — — — 2026-07-15
70460 HCPCS CT Head W Contrast 0 0 $3,600.00 $2,880.00 20% off — — — 2026-07-15
70470 HCPCS CT Head W/wo Contrast 0 0 $3,050.00 $2,440.00 20% off — — — 2026-07-15
70480 HCPCS CT Orbit,sell,po,foss Wo Contrast 0 0 $899.00 $719.20 — — — 2026-07-15
70481 HCPCS CT Orbit,sell,po,foss W Contrast 0 0 $1,300.00 $1,040.00 20% off — — — 2026-07-15
70482 HCPCS CT Orbit,sell,po,foss Combined 0 0 $1,600.00 $1,280.00 20% off — — — 2026-07-15
70487 HCPCS CT Maxillofacial W Contrast 0 0 $1,200.00 $960.00 20% off — — — 2026-07-15
70488 HCPCS CT Maxillofacial Combined 0 0 $1,610.00 $1,288.00 20% off — — — 2026-07-15
70490 HCPCS CT Neck Soft Tissue Wo Contrast 0 0 $1,800.00 $1,440.00 20% off — — — 2026-07-15
70540 HCPCS MRI Face,neck,orbits Without Cont 0 0 $2,940.00 $2,352.00 20% off — — — 2026-07-15
70542 HCPCS MRI Face,neck,orbits W Cont 0 0 $3,255.00 $2,604.00 20% off — — — 2026-07-15
70543 HCPCS MRI Face Neck Orbits W & Without Cont 0 0 $4,725.00 $3,780.00 20% off — — — 2026-07-15
70544 HCPCS MRA Brain Angiography 0 0 $4,393.00 $3,514.40 20% off — — — 2026-07-15
70549 HCPCS MRA Cervical Spine 0 0 $6,835.00 $5,468.00 20% off — — — 2026-07-15
70552 HCPCS MRI Brain W Contrast 0 0 $3,150.00 $2,520.00 20% off — — — 2026-07-15
70553 HCPCS MRI Brain W/wo Contrast 0 0 $6,300.00 $5,040.00 20% off — — — 2026-07-15
71034 HCPCS Xr Cardiac Fluoro Wo Film 0 0 $230.00 $184.00 20% off — — — 2026-07-15
71040 HCPCS Xr Bronchogram Unilat Left Or Right 0 0 $703.00 $562.40 20% off — — — 2026-07-15
71048 HCPCS Xr Chest 4 Views 0 0 $520.80 $416.64 — — — 2026-07-15
71060 HCPCS Xr Bronchogram Bilat 0 0 $1,003.00 $802.40 20% off — — — 2026-07-15
71100 HCPCS Xr Ribs Unilateral Right 0 0 $530.00 $424.00 20% off — — — 2026-07-15
71110 HCPCS Xr Ribs Bilateral 0 0 $580.70 $464.56 20% off — — — 2026-07-15
71111 HCPCS Xr Ribs Bilateral With Chest 0 0 $860.00 $688.00 20% off — — — 2026-07-15
71120 HCPCS Xr Sternum Min 2 Views 0 0 $289.80 $231.84 20% off — — — 2026-07-15
71270 HCPCS CT Chest Combined 0 0 $2,250.00 $1,800.00 20% off — — — 2026-07-15
72020 HCPCS Xr Spine Lumbar 1 View 0 0 $245.00 $196.00 20% off — — — 2026-07-15
72050 HCPCS Xr Spine Cervical Min 5 Views 0 0 $1,100.00 $880.00 20% off — — — 2026-07-15
72072 HCPCS Xr Spine Thoracic 3 Views 0 0 $615.00 $492.00 20% off — — — 2026-07-15
72081 HCPCS Xr Scoliosis Lumbar 2 Views Or Series 0 0 $345.50 $276.40 20% off — — — 2026-07-15
72126 HCPCS CT Spine Cervical W Contrast 0 0 $1,900.00 $1,520.00 20% off — — — 2026-07-15
72129 HCPCS CT Spine Thoracic W Contrast 0 0 $1,587.00 $1,269.60 20% off — — — 2026-07-15
72132 HCPCS CT Spine Lumbar W Contrast 0 0 $1,900.00 $1,520.00 20% off — — — 2026-07-15
72142 HCPCS MRI Spine Cervical W Cont 0 0 $3,150.00 $2,520.00 20% off — — — 2026-07-15
72147 HCPCS MRI T Spine W Contrast 0 0 $3,400.00 $2,720.00 20% off — — — 2026-07-15
72149 HCPCS MRI L Spine Wth Contrast 0 0 $3,276.00 $2,620.80 — — — 2026-07-15
72156 HCPCS MRI Spine Cervical W-without Cont 0 0 $4,725.00 $3,780.00 20% off — — — 2026-07-15
72157 HCPCS MRI T Spine W- Without Contrast 0 0 $4,500.00 $3,600.00 20% off — — — 2026-07-15
72158 HCPCS MRI L Spine W Without Contrast 0 0 $4,875.00 $3,900.00 20% off — — — 2026-07-15
72159 HCPCS MRA L Spine Wth Without Contrast 0 0 $4,725.00 $3,780.00 20% off — — — 2026-07-15
72190 HCPCS Xr Pelvis With Obl 0 0 $436.80 $349.44 20% off — — — 2026-07-15
72193 HCPCS CT Pelvis W Contrast 0 0 $2,360.00 $1,888.00 20% off — — — 2026-07-15
72194 HCPCS CT Pelvis Combined 0 0 $1,900.00 $1,520.00 20% off — — — 2026-07-15
72195 HCPCS MRI Pelvis Without Contrast 0 0 $3,300.00 $2,640.00 20% off — — — 2026-07-15
72196 HCPCS MRI Pelvis W Contrast 0 0 $3,000.00 $2,400.00 20% off — — — 2026-07-15
72197 HCPCS MRI Pelvis W-without Contrast 0 0 $4,750.00 $3,800.00 20% off — — — 2026-07-15
72198 HCPCS MRA Pelvis W Or Without Contrast 0 0 $2,992.50 $2,394.00 20% off — — — 2026-07-15
72202 HCPCS Xr Sacro Iliac Joints 3 Views 0 0 $383.08 $306.46 20% off — — — 2026-07-15
73000 HCPCS Xr Clavicle 2 Views Left 0 0 $415.00 $332.00 20% off — — — 2026-07-15
73010 HCPCS Xr Scapula 2 Views Left Or Right 0 0 $325.00 $260.00 20% off — — — 2026-07-15
73020 HCPCS Xr Shoulder 1 View Left 0 0 $236.67 $189.34 — — — 2026-07-15
73030 HCPCS Xr Shoulder 2 Views Right 0 0 $415.00 $332.00 20% off — — — 2026-07-15
73040 HCPCS Xr Arthrogram Shoulder Left Or Right 0 0 $981.00 $784.80 20% off — — — 2026-07-15
73060 HCPCS Xr Humerus 2 Views Left/right 0 0 $325.00 $260.00 20% off — — — 2026-07-15
73070 HCPCS Xr Elbow 2 Views Right/left 0 0 $415.00 $332.00 20% off — — — 2026-07-15
73080 HCPCS Xr Elbow Comp Min 3 Views Left/right 0 0 $440.00 $352.00 20% off — — — 2026-07-15
73090 HCPCS Xr Forearm 2 Views Right/left 0 0 $445.00 $356.00 20% off — — — 2026-07-15
73100 HCPCS Xr Wrist 2 Views Left/right 0 0 $415.00 $332.00 20% off — — — 2026-07-15
73110 HCPCS Xr Wrist Min 3 Views Left/right 0 0 $460.00 $368.00 20% off — — — 2026-07-15
73130 HCPCS Xr Hand 3 Views Left/right 0 0 $450.00 $360.00 20% off — — — 2026-07-15
73140 HCPCS Xr Thumb-finger Min 2v Left/right 0 0 $415.00 $332.00 20% off — — — 2026-07-15
73200 HCPCS CT Upper Ext Wo Contrast Right/left 0 0 $1,800.00 $1,440.00 20% off — — — 2026-07-15
73201 HCPCS CT Upper Ext W Contrast Right/left 0 0 $1,000.00 $800.00 20% off — — — 2026-07-15
73202 HCPCS CT Upper Ext Combined Right 0 0 $1,200.00 $960.00 20% off — — — 2026-07-15
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